Factors associated with favorable drinking outcome 12 months after hospitalization in a prospective cohort study of inpatients with unhealthy alcohol use.

BACKGROUND: Prevalence of unhealthy alcohol use among medical inpatients is high. OBJECTIVE: To characterize the course and outcomes of unhealthy alcohol use, and factors associated with these outcomes. DESIGN: Prospective cohort study. PARTICIPANTS: A total of 287 medical inpatients with unhealthy alcohol use. MAIN MEASURES: At baseline and 12 months later, consumption and alcohol-related consequences were assessed. The outcome of interest was a favorable drinking outcome at 12 months (abstinence or drinking "moderate" amounts without consequences). The independent variables evaluated included demographics, physical/sexual abuse, drug use, depressive symptoms, alcohol dependence, commitment to change (Taking Action), spending time with heavy-drinking friends and receipt of alcohol treatment (after hospitalization). Adjusted regression models were used to evaluate factors associated with a favorable outcome. KEY RESULTS: Thirty-three percent had a favorable drinking outcome 1 year later. Not spending time with heavy-drinking friends [adjusted odds ratio (AOR) 2.14, 95% CI: 1.14-4.00] and receipt of alcohol treatment [AOR (95% CI): 2.16(1.20-3.87)] were associated with a favorable outcome. Compared to the first quartile (lowest level) of Taking Action, subjects in the second, third and highest quartiles had higher odds of a favorable outcome [AOR (95% CI): 3.65 (1.47, 9.02), 3.39 (1.38, 8.31) and 6.76 (2.74, 16.67)]. CONCLUSIONS: Although most medical inpatients with unhealthy alcohol use continue drinking at-risk amounts and/or have alcohol-related consequences, one third are abstinent or drink "moderate" amounts without consequences 1 year later. Not spending time with heavy-drinking friends, receipt of alcohol treatment and commitment to change are associated with this favorable outcome. This can inform efforts to address unhealthy alcohol use among patients who often do not seek specialty treatment.

Factors Supporting Cysteine Tolerance and Sulfite Production in Candida albicans.

The amino acid cysteine has long been known to be toxic at elevated levels for bacteria, fungi, and humans. However, mechanisms of cysteine tolerance in microbes remain largely obscure. Here we show that the human pathogenic yeast Candida albicans excretes sulfite when confronted with increasing cysteine concentrations. Mutant construction and phenotypic analysis revealed that sulfite formation from cysteine in C. albicans relies on cysteine dioxygenase Cdg1, an enzyme with similar functions in humans. Environmental cysteine induced not only the expression of the CDG1 gene in C. albicans, but also the expression of SSU1, encoding a putative sulfite efflux pump. Accordingly, the deletion of SSU1 resulted in enhanced sensitivity of the fungal cells to both cysteine and sulfite. To study the regulation of sulfite/cysteine tolerance in more detail, we screened a C. albicans library of transcription factor mutants in the presence of sulfite. This approach and subsequent independent mutant analysis identified the zinc cluster transcription factor Zcf2 to govern sulfite/cysteine tolerance, as well as cysteine-inducible SSU1 and CDG1 gene expression. cdg1Δ and ssu1Δ mutants displayed reduced hypha formation in the presence of cysteine, indicating a possible role of the newly proposed mechanisms of cysteine tolerance and sulfite secretion in the pathogenicity of C. albicans. Moreover, cdg1Δ mutants induced delayed mortality in a mouse model of disseminated infection. Since sulfite is toxic and a potent reducing agent, its production by C. albicans suggests diverse roles during host adaptation and pathogenicity.

Primary spinal epidural lymphoma: patients' profile, outcome, and prognostic factors: a multicenter Rare Cancer Network study

RESUME Objectif : Les lymphomes épiduraux primaires représentent moins de 10% des tumeurs épidurales et de 0,1 à 3,3% de tous les lymphomes. Le but de cette étude a été d'évaluer le profil clinique de cette maladie rare, son traitement, ses résultats ainsi que ses facteurs de pronostic. Matériel et méthode : Entre 1982 et 2002, 52 patients présentant un lymphome épidural primaire ont été traités dans neuf institutions membres du Rare Cancer Network. Les critères d'inclusion comprenaient : une biopsie confirmant le lymphome non-hodgkinien, un stade IE et IIE selon la classification de Ann Arbor, un traitement à visée curative de radiothérapie combinée ou non à une chimiothérapie et un suivi d'au moins six mois. Selon la Working Formulation, 12 patients (23%) présentaient un lymphome de bas grade, 28 (54%) un grade intermédiaire et 12 (23%) un haut grade. Les hommes étaient atteints 1.9 fois plus fréquemment que les femmes. L'âge moyen était de 61 ans (intervalle : 21 à 96). Le bilan incluait un Ct-scan spinal (98%), une IRM (52%), un CT-scan thoraco-abdominal (77%) et une aspiration ou biopsie de moelle osseuse (96%). Les symptômes les plus fréquents comprenaient des douleurs dorsales (79% des patients), une faiblesse musculaire (92%) et des déficits sensoriels (71 %). Quarante-huit patients ont subi une laminectomie de décompression avec résection partielle ou complète (42% et 13% des cas respectivement), tous ont reçu une radiothérapie seule (20 patients) ou en combinaison avec une chimiothérapie (32 patients). La dose médiane totale était de 36 Gy (intervalle 6-50 Gy) avec une moyenne de 20 Gy par fraction (intervalle : 1-25). Le suivi moyen était de 71 mois (intervalle : 22-165 mois). Résultats : Suite au traitement, une progression locale a été observée chez 6 patients après un temps de latence moyen de 6 mois. Le taux de rechute systémique a été de 42% (22 patients) le plus souvent dans les ganglions lymphatiques (n=9) après un intervalle de temps moyen de 20 mois. Lors du dernier contrôle, 28 patients étaient vivants et 24 patients étaient décédés. Le taux de survie à 5 ans, le taux de survie sans maladie et le contrôle local étaient de 69%, 57% et 88% respectivement. En analyse univariée, les facteurs pronostics favorables statistiquement significatifs concernant la survie sans maladie étaient un âge inférieur à 63 ans, ainsi qu'une réponse neurologique complète. Pour la survie à 5 ans, les facteurs favorables étaient un âge inférieur à 63 ans. En analyse multivariée, les facteurs pronostics favorables pour la survie globale à 5 ans étaient une réponse neurologique complète, un traitement combiné, un volume de radiothérapie plus que focal, une dose totale de radiothérapie supérieure à 36 Gy et une résection partielle ou complète de la tumeur. En ce qui concerne la survie sans maladie, les facteurs pronostics favorables étáient un âge inférieur à 63 ans et un traitement combiné. Conclusion : Ce qui ressort de cette analyse est que le bilan diagnostic devrait inclure une IRM ou un CT-scan, un échantillon de tissu pour poser le diagnostic pathologique définitif de la lésion, une histoire médicale et un examen physique complet, une chimie sanguine, un CTscan thoraco-abdominal et une biopsie de la moelle osseuse, un PET-scan devrait également faire partie du bilan. Le traitement devrait consister, dans la phase aiguë, en une chirurgie de décompression avec ou sans résection, suivie d'une radiothérapie d'au moins 36Gy en 2 Gy par fraction et d'une chimiothérapie. Tous les patients présentant un lymphome de haut grade ou de grade intermédiaire devraient pouvoir bénéficier d'un traitement combiné.

Risk factors of latent tuberculosis infection among asylum-seekers recently arrived in Switzerland : A pilot study in Vaud county

Background: Asylum seekers may have a higher rate of latenttuberculosis infection (LTBI) than resident populations in Westerncountries. LTBI can be detected by an Interferon Gamma ReleaseAssay (IGRA). Screening asylum seekers at highest risk for LTBI orfuture tuberculosis by IGRA could be considered. The aims of this pilotstudy were to assess the prevalence and the risk factors of LTBI amonga group of asylum seekers recently arrived in Switzerland.Methods: A prospective cross-sectional study was performed amongadult asylum seekers, staying in two migrant centers of the Vaud county,Switzerland, after a first screening for active tuberculosis at the border.The participants were offered IGRA screening using T-SPOT.TB andwere questioned about risk factors associated with LTBI. Migrants with apositive test had a chest radiograph and a medical examination. Thosewith active tuberculosis were excluded and were treated. The migrantswith LTBI received a preventive treatment, if indicated. The risk factorswere analyzed by univariate and multivariate logistical regression.Results: Among 788 migrants recently arrived, 639 were adults, 393agreed to be screened (61.50%) and 98 of them had a positive T-SPOT.TB (24.93%) of which 5 (5.1%) had an active tuberculosis (previouslynot detected at the border), and 2 had already been treated for activetuberculosis. In univariate analysis, the major risk factors associatedwith LTBI were country of origin and travel conditions. Compared withmigrants from Balkanic countries, migrants from Africa had an OR forLTBI of 3.68, migrants from Asia an OR of 4.3 and migrants fromFormer Soviet Union an OR of 4.5. Migrants who crossed severalborders before arriving in Switzerland had an OR of LTBI of 2.49compared with migrants who came directly from the home country.Age, cough and prior exposure to tuberculosis had a non-significantinfluence on the rate of test positivity. In multivariate analysis, thecombination of country of origin, travel conditions, age, cough andexposure to tuberculosis resulted in a score with optimal predictivevalue (Roc = 81%).Conclusions: Asylum seekers recently arrived in Vaud county had ahigh prevalence of LTBI and active tuberculosis. The major risk factorswere country of origin and travel conditions. Selecting for screening byIGRA the asylum seekers with the highest risk factors seems possible.

Men having sex with men serosorting with casual partners: who, how much, and what risk factors in Switzerland, 2007-2009.

BACKGROUND: Serosorting is practiced by men who have sex with men (MSM) to reduce human immunodeficiency virus (HIV) transmission. This study evaluates the prevalence of serosorting with casual partners, and analyses the characteristics and estimated numbers of serosorters in Switzerland 2007-2009. METHODS: Data were extracted from cross-sectional surveys conducted in 2007 and 2009 among self-selected MSM recruited online, through gay newspapers, and through gay organizations. Nested models were fitted to ascertain the appropriateness of pooling the datasets. Multiple logistic regression analysis was performed on pooled data to determine the association between serosorting and demographic, lifestyle-related, and health-related factors. Extrapolations were performed by applying proportions of various types of serosorters to Swiss population data collected in 2007. RESULTS: A significant and stable number of MSM (approximately 39% in 2007 and 2009) intentionally engage in serosorting with casual partners in Switzerland. Variables significantly associated with serosorting were: gay organization membership (aOR = 1.67), frequent internet use for sexual encounters (aOR = 1.71), having had a sexually transmitted infection (STI) at any time in the past 12 months (aOR = 1.70), HIV-positive status (aOR = 0.52), regularly frequenting sex-on-premises venues (aOR = 0.42), and unprotected anal intercourse (UAI) with partners of different or unknown HIV status in the past 12 months (aOR = 0.22). Approximately one-fifth of serosorters declared HIV negativity without being tested in the past 12 months; 15.8% reported not knowing their own HIV status. CONCLUSION: The particular risk profile of serosorters having UAI with casual partners (multiple partners, STI history, and inadequate testing frequency) requires specific preventive interventions tailored to HIV status.

The loss of circadian PAR bZip transcription factors results in epilepsy.

DBP (albumin D-site-binding protein), HLF (hepatic leukemia factor), and TEF (thyrotroph embryonic factor) are the three members of the PAR bZip (proline and acidic amino acid-rich basic leucine zipper) transcription factor family. All three of these transcriptional regulatory proteins accumulate with robust circadian rhythms in tissues with high amplitudes of clock gene expression, such as the suprachiasmatic nucleus (SCN) and the liver. However, they are expressed at nearly invariable levels in most brain regions, in which clock gene expression only cycles with low amplitude. Here we show that mice deficient for all three PAR bZip proteins are highly susceptible to generalized spontaneous and audiogenic epilepsies that frequently are lethal. Transcriptome profiling revealed pyridoxal kinase (Pdxk) as a target gene of PAR bZip proteins in both liver and brain. Pyridoxal kinase converts vitamin B6 derivatives into pyridoxal phosphate (PLP), the coenzyme of many enzymes involved in amino acid and neurotransmitter metabolism. PAR bZip-deficient mice show decreased brain levels of PLP, serotonin, and dopamine, and such changes have previously been reported to cause epilepsies in other systems. Hence, the expression of some clock-controlled genes, such as Pdxk, may have to remain within narrow limits in the brain. This could explain why the circadian oscillator has evolved to generate only low-amplitude cycles in most brain regions.

Population dynamics of intermediate snail hosts of Fasciola hepatica and some environmental factors in San Juan y Martinez municipality, Cuba

The variation of abundances of intermediate snail hosts of Fasciola hepatica in Cuba (Fossaria cubensis and Pseudosuccinea columella) was studied during one year under natural conditions at five sampling sites in San Juan y Martinez municipality, Pinar del Rio province, Cuba. The effect of some environmental variables on the lymnaeid abundances was also studied. A canonical correspondence analysis showed that both species do not generally occur together in the same habitat and that most factors affect them in an opposite fashion, although both of them correlate positively through time to the diversity of the habitats. F. cubensis prefers the sites that are in or closer to the city whereas P. columella is more abundant in rural sites. Lymnaeid abundances are mainly affected by nitrite and nitrate concentrations as well as by the abundance of the thiarid Tarebia granifera. F. cubensis is more abundant in polluted habitats with low densities (or absence) of T. granifera whereas P. columella prefers cleaner habitats and can coexist with the thiarid, even at its higher densities. The implications of divergent preferences of the two lymnaeids for the control of fasciolosis are discussed.

Personality factors and alcohol use: a mediator analysis of drinking motives.

Current evidence on the association between personality factors, drinking motives, and alcohol use comes exclusively from North America. The present study, however, is based on a sample of 2090 Swiss college students (mean age 23.5, SD = 2,9) and investigates by means of structural equation modeling whether drinking motives mediate the association between personality factors and alcohol use. The results revealed that extraversion was positively related to drinking for enhancement motives; conscientiousness was negatively related to both enhancement and coping motives; and neuroticism was positively related to drinking for coping motives. The association between extraversion and alcohol use was mediated by enhancement motives, while the negative association between conscientiousness and alcohol use was partially mediated by both enhancement and coping motives. This concurs with the findings of North American studies. However, in contrast to these findings, our study finds that coping motives attenuate the "protective" effect of neuroticism with regard to alcohol use. Taken together, the study indicates that alcohol use serves specific purposes depending on particular personality traits. The finding that personality-related effects are partially mediated by motives increases the likelihood that motive-based preventive efforts will help reduce alcohol use among young adults who display particular personality traits.

Systematic review and meta-analysis of risk factors for survival after lung metastasectomy in colorectal cancer patients

Objective: Resection of lung metastases (LM) from colorectal cancer (CRC)¦is increasingly performed with a curative intent.Most series report small groups¦of patients, and it is currently not possible to identify those CRC patients who¦may benefit the most of surgical management. It is clinically relevant to assess¦risk factors for prolonged survival after this type of procedures.¦Methods: A meta analysis of 24 series published between 2000 and 2011¦which focused on surgical management of LM from CRC and included more¦than 40 patients each, with or without prior resection of in transit liver¦metastases. Random effects were calculated for five variables considered as¦potential prognostic factors.¦Results: A total of 2815 patients who underwent surgery with a curative¦intent were considered in this analysis. Four parameters were associated with¦a decreased survival: 1) a short disease-free interval between primary tumor¦resection and development of LM (HR = 1·59, 95% CI 1·27-1·98); 2) multiple¦LM (HR = 2·04, 95%CI 1·72-2·41); 3) positive hilar/mediastinal lymph nodes¦(HR = 1·65, 95% CI 1·35-2·02); and 4) a high prethoracotomy CEA value (HR¦=1·91, 95% CI 1·57-2·32). By comparison, a history of resected liver metastases¦(HR = 1·36, 95% CI 0·92-2·03) did not achieve statistical significance.¦Conclusion: Risk factors for poor clinical outcome after surgery for lung¦metastases in CRC patients include: 1) synchronous lung metastases; 2) high¦pre-thoracotomy CEA; 3) hilar nodes involvement; and 4) multiple pulmonary¦lesions.

Evaluation of adherence, hemagglutination, and presence of genes codifying for virulence factors of Acinetobacter baumannii causing urinary tract infection

Acinetobacter baumannii is a strictly aerobic bacterium which causes severe infections, however its pathogenic characteristics are not well defined. Thirteen A. baumannii strains isolated from urine of hospitalized and nonhospitalized patients with different ages were investigated for the presence of virulence factors. The isolates belonged to biotypes 2, 6, and 9 and were sensitive to imipenem. The majority of them showed resistance to amikacin, ceftazidime, ceftriaxone, ciprofloxacin, gentamicin, norfloxacin, and trimethoprim-sulfamethoxazole. None of A. baumannii strains presented genes codifying for 17 different virulence factors previously described in uropathogenic Escherichia coli, when tested by polymerase chain reaction (PCR). Nine isolates agglutinated human group AB erythrocytes, in presence of mannose, but none of them agglutinated group O erythrocytes. Adherence to polystyrene was observed in 7 isolates, and this result did not correlate with that obtained in hemagglutination assay. All the isolates were able to grow in iron-limiting conditions, showing that A. baumannii produces some type of siderophore. However, the genes iutA and fyuA, from iron uptake system of E. coli and Yersinia sp., respectively, were not present in the isolates, suggesting the presence of a different type of siderophore. The fimbriae of A. baumannii strains that mediates the adherence are possibly mannose-resistant, eventhough the mechanism of adherence to human epithelial cells still remains to be elucidated.

The Impact of CAROtid plaque Screening on Smoking (CAROSS) cessation and control of other cardiovascular risk factors: rationale and design of a randomized controlled trial

BACKGROUND: Screening tests for subclinical cardiovascular disease, such as markers of atherosclerosis, are increasingly used in clinical prevention to identify individuals at high cardiovascular risk. Being aware of these test results might also enhance patient motivation to change unhealthy behaviors but the effectiveness of such a screening strategy has been poorly studied. METHODS: The CAROtid plaque Screening trial on Smoking cessation (CAROSS) is a randomized controlled trial in 530 regular smokers aged 40-70 years to test the hypothesis that carotid plaque screening will influence smokers' behavior with an increased rate of smoking cessation (primary outcome) and an improved control of other cardiovascular risk factors (secondary outcomes) after 1-year follow-up. All smokers will receive a brief advice for smoking cessation,and will subsequently be randomly assigned to either the intervention group (with plaques screening) or the control group (without plaque screening). Carotid ultrasound will be conducted with a standard protocol. Smokers with at least one carotid plaque will receive pictures of their own plaques with a structured explanation on the general significance of plaques. To ensure equal contact conditions, smokers not undergoing ultrasound and those without plaque will receive a relevant explanation on the risks associated with tobacco smoking. Study outcomes will be compared between smokers randomized to plaque screening and smokers not submitted to plaque screening. SUMMARY: This will be the first trial to assess the impact of carotid plaque screening on 1-year smoking cessation rates and levels of control of other cardiovascular risk factors.

Mental health services for homeless: patient profile and factors associated with suicide and homicide.

This study aimed to establish a profile of users of the mental health service for homeless in Cork, comparing this group with those attending a General Adult Service. The homeless group were significantly more likely to be male (89% v 46%), unemployed (96% v 68%), unmarried (98% v 75%) and under 65 (94% v 83%). Diagnostically, there was a significantly higher prevalence of schizophrenia (50% v 34%); personality disorder (37% v 11%) and substance dependence (74% v 19%) in the homeless service users. They were more likely to have a history of deliberate self harm (54% v 21%) and violence (48% v 10%). Severe mental illness has a high prevalence in the homeless population, with particularly high levels of factors associated with suicide and homicide. Poor compliance and complexity of illness lead to a requirement for significant input from multidisciplinary mental health teams members.This resource was contributed by The National Documentation Centre on Drug Use.

Factors associated with schistosomiasis mansoni in a population from the municipality of Jaboticatubas, State of Minas Gerais, Brazil

Jaboticatubas is a municipality in the metropolitan region of Belo Horizonte which has been a target of a wide media release as "the capital of schistosomiasis" since the 1960's. In order to give support to a work based on an integrated control, we sought to identify the disease determinants at the site. A transversal study was carried out aimed at identifying prevalence rates of the disease and factors associated with the infection in the district of São José de Almeida, and two close localities, Cipó Velho and São José da Serra, all of them located in the municipality of Jaboticatubas. A parasitological survey was performed, applying the Kato-Katz method with two slides per sample in 1186 schoolchildren which represents 77% of all registered pupils in four public schools in 2001. Among these schoolchildren a number of 101 (8.6%) prooved positive for Schistosoma mansoni eggs in their stool samples. A total of 64 families, whose schoolchildren had shown to be positive for schistosomiasis, also undertook examinations. As negative control, a random sample was collected from the 206 families, whose children had proven negative for schistosomiasis. The prevalence among 270 families (1304 people) was 12%. To assess those who continued to have contact with possibly contaminated water, 1061 (81.4%) people of the 270 families were interviewed. A multivariate analysis identified the following factors associated with the infection: time of residence in the area (short period), garbage disposal (use of deserted areas), gender (male), age (from 10 to 29 years), and water contact (daily and weekly). Further analysis of these factors revealed a close correlation between water contact and the disease, with a positive significant frequency concerning almost all those items. Depending on gender and age significant variations of water contact patterns associated with leisure and professional activities were found. A malacological survey on water collections in the area identified snails of the species Biomphalaria straminea and B. glabrata. The latter showed 17 (0.6%) specimens positive for S. mansoni. Qualitative studies have complemented such evidences, which allowed us to design a reference picture and specific indicators of the disease for the local population. Those data provided the essential information to continue the development of an already ongoing educative process, as well as projects on environmental improvements.

Obesity and central obesity as risk factors for incident dementia and its subtypes: a systematic review and meta-analysis

While dementia affects 6-10% of persons 65 years or older, industrialized countries have witnessed an alarming rise in obesity. However, obesity's influence on dementia remains poorly understood. The conducted a systematic review and meta-analysis. PUBMED search (1995-2007) resulted in 10 relevant prospective cohort studies of older adults (40-80 years at baseline) with end points being dementia and predictors including adiposity measures, such as body mass index (BMI) and waist circumference (WC). There was a significant U-shaped association between BMI and dementia (P= 0.034), with dementia risk increased for obesity and underweight. Pooled odds ratios (OR) and 95% confidence intervals (CI) for underweight, overweight and obesity compared with normal weight in relation to incident dementia were: 1.36 (1.07, 1.73), 0.88 (0.60, 1.27) and 1.42 (0.93, 2.18) respectively. Pooled ORs and 95% CI for obesity and incident Alzheimer's disease (AD) and vascular dementia were 1.80 (1.00, 3.29) vs. 1.73 (0.47, 6.31) and were stronger in studies with long follow-up (>10 years) and young baseline age (