An examination of the relationship between maternal and neighborhood-level characteristics and intrauterine growth retardation in Harris County, Texas, 1999--2001

The persistence of low birth weight and intrauterine growth retardation (IUGR) in the United States has puzzled researchers for decades. Much of the work that has been conducted on adverse birth outcomes has focused on low birth weight in general and not on IUGR. Studies that have examined IUGR specifically thus far have focused primarily on individual-level maternal risk factors. These risk factors have only been able to explain a small portion of the variance in IUGR. Therefore, recent work has begun to focus on community-level risk factors in addition to the individual-level maternal characteristics. This study uses Social Ecology to examine the relationship of individual and community-level risk factors and IUGR. Logistic regression was used to establish an individual-level model based on 155, 856 births recorded in Harris County, TX during 1999-2001. IUGR was characterized using a fetal growth ratio method with race/ethnic and sex specific mean birth weights calculated from national vital records. The spatial distributions of 114,460 birth records spatially located within the City of Houston were examined using choropleth, probability and density maps. Census tracts with higher than expected rates of IUGR and high levels of neighborhood disadvantage were highlighted. Neighborhood disadvantage was constructed using socioeconomic variables from the 2000 U.S. Census. Factor analysis was used to create a unified single measure. Lastly, a random coefficients model was used to examine the relationship between varying levels of community disadvantage, given the set of individual-level risk factors for 152,997 birth records spatially located within Harris County, TX. Neighborhood disadvantage was measured using three different indices adapted from previous work. The findings show that pregnancy-induced hypertension, previous preterm infant, tobacco use and insufficient weight gain have the highest association with IUGR. Neighborhood disadvantage only slightly further increases the risk of IUGR (OR 1.12 to 1.23). Although community level disadvantage only helped to explain a small proportion of the variance of IUGR, it did have a significant impact. This finding suggests that community level risk factors should be included in future work with IUGR and that more work needs to be conducted. ^

Club drug use and unprotected anal intercourse among HIV-seronegative men who have sex with men seeking HIV/STD testing at a local STD clinic in Houston

Objective. To explore (1) the association between "club drug" use and unprotected anal intercourse (UAI) and (2) the association between binge drug use and UAI among HIV seronegative men who have sex with men (MSM) seeking HIV/STD testing at a local clinic in Houston. ^ Study design. A sub-sample of 297 HIV seronegative MSM from a cross-sectional study of drug and sexual behavior in Houston was conducted in 2006. Patients who were seeking HIV/STD testing at a local MSM-identified STD clinic were recruited for an anonymous computer-assisted interview. Analysis of identified secondary data consisted of self-reported information about demographic characteristics, use of drugs, and sexual behaviors. ^ Results. With new and casual sex partners, there was a strong and statistically significant association between use of "club drugs" and UAI. No association between binge drug use and UAI was evident. Men aware of HIV seropositivity or unaware of the HIV serostatus of their primary partner were less likely to report UAI. ^ Conclusion. These data suggest that in the Houston area, HIV-negative MSM club drug users, particularly multiple drug users, are at higher risk of UAI than comparable MSMs who do not use club drugs. Episode-level data regarding binge use of these and other drugs, and UAI should be collected in future studies to explore their relationship. The 'new partner' category should be added to sex partner types to measure sex and drug use behaviors in future studies.^ Keywords. HIV-negative MSM; club drugs; unprotected anal intercourse; binge drug use. ^

Sex, drugs, and STIs: Syphilis infection and hepatitis B vaccine compliance among illicit drug users in Houston

Although the association between syphilis infection status and compliance with the hepatitis B virus vaccine has been the focus of investigation, there is a lack of data regarding the association between syphilis infection and HBV vaccine compliance. The author investigated the association between the exposure of syphilis infection and the outcome of HBV vaccine completion, defined as degree of constancy and accuracy with which a patient follows a prescribed regimen. A cohort design was employed using interview and serological data from the Drugs, AIDS, STDs, Hepatitis (DASH) Research Project; analysis was restricted to HIV and HBV seronegative (at baseline), illicit drug users residing in Harris County. Syphilis negative and syphilis positive infection status was determined from the serological data while covariates and outcome information were determined from the DASH Project Questionnaire; enrolled subjects (n=1160) were selected from the data. Association between exposure and outcome was assessed with logistic regression adjusted for data-based confounders. ^ A prevalence of 7% and 71% was found for syphilis and HBV vaccine compliance, respectively. When measuring the actual association between syphilis infection status and HBV vaccine compliance, an odds ratio of 1.49 (95% CI: 0.86, 2.72) was obtained. There was a non-significant association between these two variables. 78% of the study population was syphilis positive and completed the vaccine series compared to 70% of the population that was syphilis negative and received all three doses. This finding confirms that there is a difference between syphilis positive and negative drug users with respect to HBV vaccine compliance. The fact that differences were found in these drug users with respect to vaccine schedule supports the idea that sub-group differences may exist and thus merits further investigation. If these differences are confirmed, it is recommended that STI interventions identify community characteristics of their samples and target populations based on practices specific to that community. ^

THE EFFECTS OF COST-SHARING ON USE OF SERVICES AND CONSUMER CHARACTERISTICS IN A STATE'S CRIPPLED CHILDREN'S DIVISION

The present study analyzed some of the effects of imposing a cost-sharing requirement on users of a state's health service program. The study population consisted of people who were in diagnosed medical need and included, but was not limited to, people in financial need.^ The purpose of the study was to determine if the cost-sharing requirement had any detrimental effects on the service population. Changes in the characteristics of service consumers and in utilization patterns were analyzed using time-series techniques and pre-post policy comparisons.^ The study hypotheses stated that the distribution of service provided, diagnoses serviced, and consumer income levels would change following the cost-sharing policy.^ Analysis of data revealed that neither the characteristics of service users (income, race, sex, etc.) nor services provided by the program changed significantly following the policy. The results were explainable in part by the fact that all of the program participants were in diagnosed medical need. Therefore, their use of "discretionary" or "less necessary" services was limited.^ The study's findings supported the work of Joseph Newhouse, Charles Phelps, and others who have contended that necessary service use would not be detrimentally affected by reasonable cost-sharing provisions. These contentions raise the prospect of incorporating cost-sharing into programs such as Medicaid, which, at this writing, do not demand any consumer payment for services.^ The study concluded with a discussion of the cost-containment problem in health services. The efficacy of cost-sharing was considered relative to other financing and reimbursement strategies such as HMO's, self-funding, and reimbursement for less costly services and places of service. ^

Childhood cancer survivor satisfaction with characteristics of clinical care

This study investigated the characteristics of a clinic that affect how satisfied survivors of childhood cancer are with their medical care. Questionnaire and interview data from the Passport for Care: Texas Implementation project collected between January 2011 to April 2012 were analyzed. Eleven clinics in Texas participated. Questionnaire respondents were childhood cancer survivor patients who had been off therapy for at least 2 years, or their parents. Interview respondents were clinical providers or research staff at the participating clinics. The outcomes evaluated were answers to a single question on satisfaction with care and a composite Percent Satisfaction Score created from seven other questionnaire items that were correlated (Spearman Rho >0.3) with the question on satisfaction. The following characteristics were also evaluated: sex, age, race, education, and type of cancer. The following clinic indicators were evaluated: type of clinic (general vs. dedicated cancer survivor clinics), number of providers, number of survivors, ratio of survivors/providers, distribution of handouts, distribution of treatment summaries, and use of Children's Oncology Group (COG) guidelines. ^ The only demographic characteristic that affected satisfaction was race. A Kruskal-Wallis test showed a statistically significant difference (Chi-square 6.129, 2 d.f., p = 0.0467). To analyze this further, Wilcoxon Rank Sum test of pairings of the three groups were performed. A Bonferroni correction for multiple testing was applied, with p = 0.017 indicating significance at alpha = 0.05. There was no significant difference between the White and Hispanic groups or between the Hispanic and "Other" groups. For the White and "Other" groups there was a significant difference for the satisfaction item (p = 0.0123) but not for the Percent Satisfaction Score (p = 0.0289). These results suggest that race may influence satisfaction and should be evaluated further in future studies. ^ None of the clinic indicators affected the Percent Satisfaction Score. Going to a clinic that distributed patient information handouts (Wilcoxon Rank Sum p = 0.048) and going to a clinic with >=100 survivors (Wilcoxon Rank Sum p = 0.021) were associated with increased satisfaction. The population of childhood cancer survivors is a growing group of individuals with special health needs. In the future survivors will likely seek medical care in a variety of clinical settings, so it is important to investigate features to improve patient satisfaction with clinical care.^

Characteristics, home ranges and population estimates of narwhals (Monodon monoceros) around Baffin Island

Twenty-one narwhals tagged in 2003 and 2004 in Admiralty Inlet showed a different summer distributional pattern than previous narwhal-tracking studies from Somerset Island, Eclipse Sound and Melville Bay. The migration of the narwhals tracked from Admiralty Inlet moved out through Lancaster Sound 15 days earlier (P <0.0001) than the narwhals summering around Eclipse Sound, whereas the Admiralty Inlet narwhals reached the mouths of Eclipse Sound 18 days later (P <0.0001) than the Eclipse Sound summering population. The winter range of the Admiralty Inlet narwhals overlapped with the winter range of narwhals from Melville Bay and Eclipse Sound in central southern Baffin Bay and Northern Davis Strait, but not with the winter range of narwhals from Somerset Island that wintered further north. Distribution size of range, and population size did not appear to be related. An example of considerable year to year variation between area of summer and winter distribution in the 2 years was believed to be related to the sample size and number of pods of whales tagged, rather than to differences in sex or age classes.

Characteristics of eggs and female adults of Calanus finmarchicus, C. glacialis and C. hyperboreus from Disko Bay, western Greenland

This is the first high temporal-resolution study in Disko Bay covering population dynamics, grazing, reproduction, and biochemical composition of 3 dominating copepod species (Calanus finmarchicus, C. glacialis and C. hyperboreus) from late winter to midsummer in 2008. C. finmarchicus and C. glacialis ascended to the surface layer at the onset of the spring phytoplankton bloom, followed by C. hyperboreus 2 wk later. C. finmarchicus spawning occurred during the bloom and postbloom period, partially fueled by wax esters. C. glacialis commenced spawning before the bloom, yet it was greatly stimulated when food became available. However, feeding and reproduction was terminated after the main bloom despite the presence of food. In terms of feeding, this was also the strategy for C. hyperboreus. Between pre-bloom and post-bloom, C. finmarchicus showed an increase in carbon, nitrogen, and phospholipid content but a decrease in total lipid content. This was likely the result of protein synthesis, oocyte maturation, and spawning fueled by wax esters and by feeding. C. glacialis showed a similar pattern, although with an increasing total lipid content from pre-bloom to post-bloom, and an increasing wax ester and decreasing phospholipid content after reproduction was terminated. C. hyperboreus showed greatly increased content of carbon, nitrogen, and all lipid classes between the pre- and post-bloom periods. Hence, C. finmarchicus commenced feeding and spawning at the onset of the bloom and continued throughout the remaining study period. Both C. glacialis and C. hyperboreus females refueled their storage lipids (wax esters) during the bloom and post-bloom period, suggesting that they may spawn in an additional year.

Characteristics and stomach contents of Greenland sharks (Somniosus microcephalus) caught in Svalbard during June 2008-2009

Harbour seals in Svalbard have short longevity, despite being protected from human hunting and having limited terrestrial predation at their haulout sites, low contaminant burdens and no fishery by-catch issues. This led us to explore the diet of Greenland sharks (Somniosus microcephalus) in this region as a potential seal predator. We examined gastrointestinal tracts (GITs) from 45 Greenland sharks in this study. These sharks ranged from 229 to 381 cm in fork length and 136-700 kg in body mass; all were sexually immature. Seal and whale tissues were found in 36.4 and 18.2%, respectively, of the GITs that had contents (n = 33). Based on genetic analyses, the dominant seal prey species was the ringed seal (Pusa hispida); bearded seal (Erignathus barbatus) and hooded seal (Cystophora cristata) tissues were each found in a single shark. The sharks had eaten ringed seal pups and adults based on the presence of lanugo-covered prey (pups) and age determinations based on growth rings on claws (<1 year and adults). All of the whale tissue was from minke whale (Balenoptera acutorostrata) offal, from animals that had been harvested in the whale fishery near Svalbard. Fish dominated the sharks' diet, with Atlantic cod (Gadus morhua), Atlantic wolffish (Anarhichas lupus) and haddock (Melanogrammus aeglefinus) being the most important fish species. Circumstantial evidence suggests that these sharks actively prey on seals and fishes, in addition to eating carrion such as the whale tissue. Our study suggests that Greenland sharks may play a significant predatory role in Arctic food webs.

Body sizes and dive characteristics of narwhals (Monodon monoceros) from Kakiak Point and Melville Bay (2005-2007)

We report on wintertime data collected from Baffin Bay and northern Davis Strait, a major gateway linking the Arctic with the subpolar North Atlantic, using narwhals (Monodon monoceros) as an oceanographic sampling platform. Fourteen narwhals were instrumented with satellite-linked time-depth-temperature recorders between 2005 and 2007. Transmitters collected and transmitted water column temperature profiles from each dive between December and April, where >90% of maximum daily dive depths reached the bottom. Temperature measurements were combined with 15 helicopter-based conductivity-temperature-depth (CTD) casts taken in April 2007 across central Baffin Bay and compared with hydrographic climatology values used for the region in Arctic climate models. Winter temperature maxima for whale and CTD data were in good agreement, ranging between 4.0°C and 4.6°C in inshore and offshore Baffin Bay and in Davis Strait. The warm Irminger Water was identified between 57°W and 59°W (at 68°N) between 200 and 400 m depths. Whale data correlated well with climatological temperature maxima; however, they were on average 0.9°C warmer ±0.6°C (P < 0.001). Furthermore, climatology data overestimated the winter surface isothermal layer thickness by 50-80 m. Our results suggest the previously documented warming in Baffin Bay has continued through 2007 and is associated with a warmer West Greenland Current in both of its constituent water masses. This research demonstrates the feasibility of using narwhals as ocean observation platforms in inaccessible Arctic areas where dense sea ice prevents regular oceanographic measurements and where innate site fidelity, affinity for winter pack ice, and multiple daily dives to >1700 m offer a useful opportunity to sample the area.

Lesion, and haematologic and serum characteristics of Weddell seals (Leptonychotes weddellii) sampled in McMurdo Sound, Antarctica

We examined and collected biomedical samples from Weddell seals (Leptonychotes weddellii) during studies of post-breeding-season foraging behaviour of adults and movements of weaned pups as a complement to ongoing studies on the ecology and population dynamics of the McMurdo seals (Stewart et al. 2000, 2003). Here we report on Weddell seal health assessments conducted during the 1996/97, 1997/98 and 1998/99 breeding seasons at the Delbridge Islands (77.68°S, 166.50°E), McMurdo Sound, Antarctica. Our objectives were to compile baseline biomedical data for Weddell seals in McMurdo Sound, and to identify infectious and non-infectious diseases affecting the population. Development of such a database, including information on normal background morbidity and mortality, is an important first step in evaluating natural versus anthropogenic impacts on population health (Geraci et al. 1999; Reddy et al. 2001). These data will be integral to international studies of southern ocean pinnipeds that seek to evaluate the influence of biotic and abiotic factors on the ecology of these apex predators.

Income disparity among persons with disabilities assessed by education and sex : findings from a field survey conducted in Metro Manila, the Philippines

How do persons with disabilities (PWDs) earn a living? From the view point of poverty reduction, this question is quite critical in developing countries. This paper presents an investigation of economic activities of PWDs in the Philippines where, among developing countries, disability-related legislation is relatively progressive. In 2008, a field survey was conducted in cooperation with Disability People’s Organizations (DPOs) using a tailor-made questionnaire in four representative cities of Metro Manila. The level and determinants of income of PWDs were examined with Mincer regression. Conclusions are as follows: (1) The incidence and depth of poverty are greater among sample PWDs than that of the total population in Metro Manila. (2) There is remarkable income disparity among PWDs which is associated with education and sex. (3) After controlling individual, parental, and environmental characteristics, it was found that female PWDs are likely to earn less than male PWDs due to fewer opportunities to participate in economic activities. It is suggested that female PWDs are doubly handicapped in earning income.

Naturally variant autosomal and sex-linked loci determine the severity of iron overload in β2-microglobulin-deficient mice

Hereditary hemochromatosis (HH) is a common chronic human genetic disorder whose hallmark is systemic iron overload. Homozygosity for a mutation in the MHC class I heavy chain paralogue gene HFE has been found to be a primary cause of HH. However, many individuals homozygous for the defective allele of HFE do not develop iron overload, raising the possibility that genetic variation in modifier loci contributes to the HH phenotype. Mice deficient in the product of the β2-microglobulin (β2M) class I light chain fail to express HFE and other MHC class I family proteins, and they have been found to manifest many characteristics of the HH phenotype. To determine whether natural genetic variation plays a role in controlling iron overload, we performed classical genetic analysis of the iron-loading phenotype in β2M-deficient mice in the context of different genetic backgrounds. Strain background was found to be a major determinant in iron loading. Sex played a role that was less than that of strain background but still significant. Resistance and susceptibility to iron overload segregated as complex genetic traits in F1 and back-cross progeny. These results suggest the existence of naturally variant autosomal and Y chromosome-linked modifier loci that, in the context of mice genetically predisposed by virtue of a β2M deficiency, can profoundly influence the severity of iron loading. These results thus provide a genetic explanation for some of the variability of the HH phenotype.