Early life adversity and depressive symptoms predict cortisol in pregnancy

Archives of Women's Mental Health - Evidence suggests that exposure to early life adversity (ELA) programs the hypothalamic-pituitary-adrenal (HPA) axis to influence responses to later...     

Porcine reproductive and respiratory syndrome (PRRS): an immune dysregulatory pandemic

Porcine reproductive and respiratory disease syndrome (PRRS) is a viral pandemic that especially affects neonates within the “critical window” of immunological development. PRRS was recognized in 1987 and within a few years became pandemic causing an estimated yearly $600,000 economic loss in the USA with comparative losses in most other countries. The causative agent is a single-stranded, positive-sense enveloped arterivirus (PRRSV) that infects macrophages and plasmacytoid dendritic cells. Despite the discovery of PRRSV in 1991 and the publication of >2,000 articles, the control of PRRS is problematic. Despite the large volume of literature on this disease, the cellular and molecular mechanisms describing how PRRSV dysregulates the host immune system are poorly understood. We know that PRRSV suppresses innate immunity and causes abnormal B cell proliferation and repertoire development, often lymphopenia and thymic atrophy. The PRRSV genome is highly diverse, rapidly evolving but amenable to the generation of many mutants and chimeric viruses for experimental studies. PRRSV only replicates in swine which adds to the experimental difficulty since no inbred well-defined animal models are available. In this article, we summarize current knowledge and apply it toward developing a series of provocative and testable hypotheses to explain how PRRSV immunomodulates the porcine immune system with the goal of adding new perspectives on this disease.     

Use of Single-Item Self-Rated Health Measure to Identify Frailty and Geriatric Assessment-Identified Impairments Among Older Adults with Cancer

BackgroundPoor self-rated health (SRH) is a known predictor of frailty and mortality in the general population; however, its role among older adults with cancer is unknown. We evaluated the role of SRH as a potential screening tool to identify frailty and geriatric assessment (GA)-identified impairments.Materials and MethodsAdults ≥60 years diagnosed with cancer in the UAB Cancer & Aging Resilience Evaluation (CARE) registry underwent a GA at the time of initial consultation. We measured SRH using a single-item from the Patient-Reported Outcomes Measurement Information System global health scale and dichotomized responses as poor (poor, fair) and good (good, very good, and excellent). We evaluated the diagnostic performance of SRH in measuring frailty, and GA impairment (≥2 deficits among a set of seven GA domains). We examined the impact of SRH with survival using a Cox model adjusting for confounders, exploring the mediating role of frailty.ResultsSix hundred and three older adults with cancer were included, with a median age of 69 years. Overall, 45% (n = 274) reported poor SRH. Poor SRH demonstrated high sensitivity and specificity for identifying frailty (85% and 78%, respectively) and GA impairment (75% and 78%, respectively). In a Cox regression model, poor SRH was associated with inferior survival (HR = 2.26; 95% CI 1.60-3.18) after adjusting for confounders; frailty mediated 69% of this observed relationship.ConclusionSelf-rated health may be used as a screening tool to identify older adults with cancer with frailty and GA impairments. Poor SRH is associated with inferior survival, which is mediated by frailty.     

School health promotion in South‐East Asia by Japan and partners

School health promotion in South‐East Asia has developed rapidly in recent years, and Japan has been one of the significant contributors to the reinforcement of school health promotion in the region. Starting from the Hashimoto Initiative on global parasite control, Japan advocated for international partnerships with several agencies for the development of school health programs in South‐East Asia. Through a strengthened collaboration with international organizations, countries such as the Lao PDR, Cambodia, the Philippines, and Thailand have created and implemented school health programs on nutrition, sanitation, and deworming, among others. In addition to school health program formulation and implementation, the expanded network in South‐East Asia led to more capable school health personnel, with many workers in the education and health sectors benefitting from the training programs jointly held by collaborating organizations.     

Lessons Learned: Recruiting Research Participants from an Underrepresented Patient Population at a Safety Net Hospital

BackgroundRecruiting participants to clinical research studies is challenging, especially when conducted in safety net settings. We sought to compare the efficacy of different recruitment strategies in an NIH-funded study assessing treatment burden in patients with multiple chronic conditions (MCCs).MethodsTargeted mailing, in-person table-based recruitment (“tabling”) in the waiting room, and telephone calling were used to enroll subjects into one of two studies of treatment burden: a survey study to validate a brief measure of treatment burden for quality assessment (study 1) or a qualitative study to develop a treatment burden clinical communication tool (study 2).ResultsOver 50% of subjects in each study were African American or African immigrants. In study 1, the enrollment goal of 200 was reached within 4 months. Tabling enrolled 78.5% of patients, while the remainder (21.5%) were enrolled from phone calls to eligible patients identified through the electronic medical record (EMR). In study 2, 340 eligible patients were identified through the EMR, and 7 (2.1%) were successfully enrolled via mailed invitations and responses. Retention rates (66% in study 1 and 71% in study 2) were reasonable in all groups.ConclusionsStudy recruiting goals in our safety net population were rapidly reached using the tabling method, which had substantively higher enrollment rates than mailings or telephone calls based on EMR reports. Future trials could compare recruitment strategies across settings and clinical populations.     

Sterility of Sustained-release Buprenorphine

Sustained-release formulations of controlled substances are commonly used to provide analgesia in research animals. These formulations represent refinements that offer the advantage of prolonged, multiday pain relief with a single injection, thereby decreasing handling stress in animals and saving time for scientists. Compounding pharmacies produce sustained-release buprenorphine for veterinary use (i.e., buprenorphine SR-LAB); one of these pharmacies has shortened the original 6-mo shelf-life to 28 d to comply with United States Pharmacopeia standards for ensuring sterility. This limitation risks increasing the waste of controlled substances, which require an expensive destruction process that is legally enforced in our state. To assess whether the sterility of buprenorphine SR-LAB is preserved for at least 6 mo in a general laboratory setting, we tested 5 bottles for the presence of endotoxin and bacterial and fungal contamination monthly for 6 mo. Overall, results of the study showed that the bottles remained sterile over the 6-mo duration as no endotoxin was detected and the bottles did not become contaminated with bacteria or fungi. In conclusion, when stored securely and used with aseptic handling techniques, buprenorphine SR-LAB can be maintained in a sterile state for 6 mo in a general laboratory setting.Abbreviation: buprenorphine SR-LAB, sustained-release buprenorphine for veterinary use

Sustained-release formulations of buprenorphine for analgesic use in animals (i.e., buprenorphine SR-LAB) are produced for the veterinary market by compounding pharmacies. The extended release properties of these formulations serve as a refinement that benefits animals and their caregivers by providing multiday pain relief after a single injection.^{4,8,9,11,14,15} Compared with the administration of traditional analgesic medications, sustained-release analgesics provide continuous pain relief—typically for multiple days—and lessen the time, cost, stress, and hazards associated with handling an easily stressed and potentially painful animal daily (or more often).^2-4,14,15 Compounding pharmacies provide crucial services in human and veterinary medicine and must comply with United States Pharmacopeia standards as enforced by state pharmacy regulators.⁵ For example, as a consequence of inspection by a state pharmacy board, a veterinary compounding pharmacy preparing buprenorphine SR-LAB was required to label and limit the use of buprenorphine SR-LAB to 28 d after first puncture of the vial to best ensure sterility, although the formulation was labeled with a 6-mo expiration date (shelf-life). The majority of use of buprenorphine SR-LAB at our institution is for rodents, and the 28-d use rule is problematic due to considerable amounts of remaining drug at this time point. For example, a 5 mL-vial of buprenorphine SR-LAB with a concentration of 0.5 mg/mL contains enough drug to treat 100 mice each weighing 25 g at the dose of 1 mg/kg. If the buprenorphine SR-LAB is considered to be expired after 28 d, any remaining drug is wasted, poses a potential for abuse, requires strict secure storage, and involves considerable expense for its legal destruction. These hurdles increase the likelihood that researchers will abandon attempts to use this formulation in animals, violate state-mandated standards, and engage in drug conserving and sharing schemes that are not compliant with federal law. As such, the change in shelf life complicates the use of buprenorphine SR-LAB in rodents, which in turn discourages the use of an effective analgesic that improves animal welfare. Although sterility studies for analgesic drugs such as carprofen, buprenorphine, and meloxicam have been conducted,^7,10,13,16 the long-term sterility of sustained-release buprenorphine currently is unknown. Therefore, this study was conducted to test the sterility of buprenorphine SR-LAB over the stated 6-mo shelf-life.