Gender disparity in a large nonreferral-based cohort of hypertrophic cardiomyopathy patients.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a genetic disease of the heart muscle that affects 1 in 500 people. HCM is highly heterogeneous in its clinical presentation and severity. HCM research has typically been carried out using hospital-based and referral populations. The Hypertrophic Cardiomyopathy Association (HCMA) is a patient support group founded in 1996. The HCMA membership and related database represent a large, heterogeneous, and diverse nonhospital and nonreferral-based HCM patient population. METHODS: To examine gender disparities in self-reported symptom and medication patterns among HCM patients participating in the HCMA database, HCMA patient information was entered into an Access database. Patients were added to the HCMA database when they joined or requested information from the HCMA. Consenting patients were interviewed by phone or mailed an intake survey. RESULTS: Information was available for 1228 HCM patients from 49 states and 32 countries (549 females, 679 males). Females were significantly more likely to report a family history of HCM to experience chest pain, fatigue, lightheadedness, and palpitations and to be taking non-HCM-related medications. In terms of symptom clustering, 44.9% of females had four or five symptoms vs. 31.4% of the males. CONCLUSIONS: The HCMA patient database represents a nonhospital-based patient cohort useful in scientific investigations of HCM. Observed gender-related disparities in HCM symptom profiles are significant but are subject to the design and self-report-based limitations of the HCM database.

Fetal alcohol syndrome disorder pilot media intervention in New Jersey.

BACKGROUND: The New Jersey Fetal Alcohol Spectrum Disorders Task Force launched the âBe in the kNOwâ multimedia public education campaign in July 2006. The campaign continued until December 2006. OBJECTIVE: To report on the pilot media intervention campaign in Essex and Atlantic Counties, New Jersey, with the goal of identifying strategies to help prevent Fetal Alcohol Syndrome Disorder (FASD). METHODS: The campaign used various media outlets from July 2006 to December 2006, including billboard posters along New Jersey transit routes serving Atlantic City and Newark, local newspapers and radio public service announcements. Messages were distributed in English and Spanish and were primarily aimed at Essex and Atlantic counties. Printed material was distributed throughout the community. All media materials included an 800 number for the New Jersey Family Health Line. Data was collected from individual callers. RESULTS: A total of 49 Fetal Alcohol Syndrome (FAS) related telephone calls were received through the Family Health Line over the six-month period. An increase from the 5-6 FAS calls typically received in a six-month period. Callers were located throughout New Jersey with 24.5% from Essex County, 12.2% from Mercer County, and 12.2% from Bergen County. 69% of callers identified themselves as white, 25% black, and 6% other. 76% of callers were female. Ages ranged from 8 to 50. CONCLUSION: The media intervention reached a wide geographic audience, provoking interest beyond the initial target area and expected age ranges. The results, however, point to the difficulty of raising awareness of FASD.

Fetal alcohol syndrome related knowledge assessment and comparison in New Jersey health professional groups.

BACKGROUND There is a need to educate health professionals in regard to Fetal Alcohol Syndrome and Fetal Alcohol Spectrum Disorders across many health and allied health fields. OBJECTIVE Conduct evaluations of educational programs designed to assess knowledge, attitudes and beliefs in relation to Fetal Alcohol Spectrum Disorders (FASD) among health and allied health professionals in the northeastern United States. METHODS FASD related educational efforts were carried out and evaluated in New Jersey for various health-related professional groups over a four-month period using a common set of materials. Pre and post-test evaluation comprised 20 questions on FASD recognition, diagnosis, treatment, and prevention. Groups surveyed included nurses, social workers, counselors, therapists, clinicians and allied health professionals comprising physician assistants, dieticians, physical therapists, occupational therapists. RESULTS Results showed that a majority of health care professionals in New Jersey possess basic knowledge related to FASD and the effects of alcohol on a child in utero. They also had significant awareness of the importance of early diagnosis and the importance of reducing secondary disabilities. The study did however reveal areas for improvement in some professional groups. CONCLUSIONS FASD is the most important preventable cause of mental retardation. Health professionals attending workshops typically had a good basic understanding of FASD, though with some weaknesses specific to their discipline. Educational efforts in regard to FASD should be sensitive to the various health professionals engaged in preventing, diagnosing and treating FASD.

Antibiotic resistance and single-nucleotide polymorphism cluster grouping type in a multinational sample of resistant Mycobacterium tuberculosis isolates.

A single-nucleotide polymorphism-based cluster grouping (SCG) classification system for Mycobacterium tuberculosis was used to examine antibiotic resistance type and resistance mutations in relationship to specific evolutionary lineages. Drug resistance and resistance mutations were seen across all SCGs. SCG-2 had higher proportions of katG codon 315 mutations and resistance to four drugs.

Prenatal and birth complications in autism.

OBJECTIVES: Prenatal and birth history as potential sources of risk factors in relation to the onset of autism were examined. METHODS: A cohort of 164 families of autistic children referred to The Autism Center at New Jersey Medical School-UMDNJ, Newark, New Jersey, over a two-year period was studied. Intake prenatal and birth history information was obtained from each family and reviewed by a clinician. RESULTS: Prevalence rates in this cohort for vaginal bleeding, prolonged labor and prematurity were higher than comparable rates reported nationally and in New Jersey. Clustering of multiple prenatal risk factors was observed. This clustering was associated with the age of the mother, but uncorrelated with birth order. CONCLUSIONS: These findings support the general hypothesis that systemic problems at the prenatal stage may form a distinct dimension of risk associated with autism.

Increased excretion of a lipid peroxidation biomarker in autism.

It is thought that autism could result from an interaction between genetic and environmental factors with oxidative stress as a potential mechanism linking the two. One genetic factor may be altered oxidative-reductive capacity. This study tested the hypothesis that children with autism have increased oxidative stress. We evaluated children with autism for the presence of two oxidative stress biomarkers. Urinary excretion of 8-hydroxy-2-deoxyguanosine (8-OHdG) and 8-isoprostane-F2alpha (8-iso-PGF2alpha) were determined in 33 children with autism and 29 healthy controls. 8-iso-PGF2alpha levels were significantly higher in children with autism. The isoprostane levels in autistic subjects were variable with a bimodal distribution. The majority of autistic subjects showed a moderate increase in isoprostane levels while a smaller group of autistic children showed dramatic increases in their isoprostane levels. There was a trend of an increase in 8-OHdG levels in children with autism but it did not reach statistical significance. There was no significant correlation between the levels of the biomarkers and vitamin intake, dietary supplements, medicine, medical disorders, or history of regression. These results suggest that the lipid peroxidation biomarker is increased in this cohort of autistic children, especially in the subgroup of autistic children.

Stakeholder evaluation of a high-risk prenatal nutrition intervention program in Prince Edward Island.

Since 1971, a Prince Edward Island prenatal program has provided nutrition support to pregnant women at high risk for poor birth outcomes. Provincial changes in the delivery of health care services since 1986 have caused concern that the program is becoming less effective. The current research was designed to evaluate stakeholders satisfaction with the program; it was part of a larger study conducted in 1998 and 1999 to evaluate overall program effectiveness. Nutritionists (n=9), referring health professionals (n=57), and clients (n=50) completed a survey. The results indicated that program satisfaction was high for all stakeholders. Perceived program strengths included the counselling approach, program quality, food and income supplements, and accessibility. Perceived program weaknesses included inadequate staff/time, administrative requirements, limited communication/awareness, the counselling approach, and difficulty contacting clients. Recommendations for improvement fall into four key areas: staff services, program delivery, the counselling approach, and communication. The findings suggest that the components of prenatal education considered important vary among clients and staff, and that the relationship developed between staff and clients during counselling is an important contributor to program success.

Cytologic and biochemical changes associated with inoculation of amniotic fluid and meconium into lungs of neonatal rats.

OBJECTIVE: To evaluate the effect of homologous amniotic fluid and meconium inoculated intratracheally into the lungs of neonatal rats. ANIMALS: 153 male 7-day-old Fischer-344 rats. PROCEDURE: Amniotic fluid was obtained by cesarean section from the uterus of pregnant rats and meconium was collected at the time of birth from the gastrointestinal tract of neonatal rats. Neonatal rats were randomly allocated into 5 treatment groups. Two groups received 0.05 ml of saline (0.9% NaCl) solution; the third and fourth groups received 0.05 ml of 50% or 100% amniotic fluid, respectively; the fifth group was inoculated with 0.05 ml of a 20% suspension of meconium. Six or 7 rat pups/group were euthanatized by exsanguination under halothane anesthesia at postinoculation days 1, 3, 7, and 14. The magnitude of injury and inflammatory response was determined by biochemical and cytologic analyses of bronchoalveolar lavage fluid. RESULTS: Inoculation with saline solution and amniotic fluid did not induce pulmonary injury or inflammatory response. Inoculation with meconium induced significant (P < 0.01) injury and inflammatory response, characterized by the release of cytosolic enzymes and recruitment of neutrophils in the lung. CONCLUSIONS: Saline solution is an innocuous vehicle that can be safely used in intratracheal inoculations in neonatal rats. Homologous amniotic fluid, despite containing keratin and epidermal cells, does not cause acute injury or inflammation in the lung. In contrast, meconium acts as a toxic substance injuring respiratory cells and causing a vigorous but transient leukocytic inflammatory reaction in the lungs.

Thoracic radiographic appearance in the normal llama.

The goal of this study was to collect quantitative and qualitative radiographic information of the normal adult llama thorax. Standing right-left lateral radiographs of the thorax of 16 normal llamas were made. Normal ratios of cardiac height, width, and height plus width to thoracic vertebrae 3-5 and thoracic height were calculated. Normal values determined for tracheal angle of divergence from the thoracic spine, cardiophrenic and cardiosternal contact are additional potential indicators of cardiac enlargement. Ratios of normal pulmonary artery and vein, caudal vena cava and trachea to the height of the fourth thoracic vertebra should allow identification of pathology of these structures. Observations regarding pulmonary vessels and airways, thoracic spine, sternebrae and portions of the gastrointestinal tract observed on thoracic radiographs are also included. It is proposed that these normal values and observations can be used to better evaluate diseases of the cardiovascular and respiratory systems of adult llamas.

What determines health? To where should we shift resources? Attitudes towards the determinants of health among multiple stakeholder groups in Prince Edward Island, Canada.

The population health perspective has become significant in academic and policy discourse. The purpose of this paper is to assess its significance among health care practitioners and administrators as well as the general public. Respondents in Prince Edward Island, Canada were asked to rank the broad determinants of health and comment on to where resources should be shifted to improve the health of the population. Important variations are noted between the groups with family physicians and front-line staff being similar in perceptions to the general public on most determinants than other groups. The paper concludes with discussion on the relevance of the findings for population health research and health policy.

Changes in serum thyroxine and thyroid-stimulating hormone concentrations in epileptic dogs receiving phenobarbital for one year.

A multicentric prospective study was conducted to monitor the effect of phenobarbital on serum total thyroxine (T4) and thyroid-stimulating hormone (TSH) concentrations in epileptic dogs. Serum T4 concentrations were determined for 22 epileptic dogs prior to initiation of phenobarbital therapy (time 0), and 3 weeks, 6 months, and 12 months after the start of phenobarbital. Median T4 concentration was significantly lower at 3 weeks and 6 months compared to time 0. Thirty-two percent of dogs had T4 concentrations below the reference range at 6 and 12 months. Nineteen of the 22 dogs had serum TSH concentrations determined at all sampling times. A significant upward trend in median TSH concentration was found. No associations were found between T4 concentration, dose of phenobarbital, or serum phenobarbital concentration. No signs of overt hypothyroidism were evident in dogs with low T4, with one exception. TSH stimulation tests were performed on six of seven dogs with low T4 concentrations at 12 months, and all but one had normal responses. In conclusion, phenobarbital therapy decreased serum T4 concentration but did not appear to cause clinical signs of hypothyroidism. Serum TSH concentrations and TSH stimulation tests suggest that the hypothalamic-pituitary-thyroid axis is functioning appropriately.

Effects of phenobarbital treatment on serum thyroxine and thyroid-stimulating hormone concentrations in epileptic dogs.

OBJECTIVE: To determine whether phenobarbital treatment of epileptic dogs alters serum thyroxine (T4) and thyroid-stimulating hormone (TSH) concentrations. DESIGN: Cross-sectional study. ANIMALS: 78 epileptic dogs receiving phenobarbital (group 1) and 48 untreated epileptic dogs (group 2). PROCEDURE: Serum biochemical analyses, including T4 and TSH concentrations, were performed for all dogs. Additional in vitro analyses were performed on serum from healthy dogs to determine whether phenobarbital in serum interferes with T4 assays or alters free T4 (fT4) concentrations. RESULTS: Mean serum T4 concentration was significantly lower, and mean serum TSH concentration significantly higher, in dogs in group 1, compared with those in group 2. Thirty-one (40%) dogs in group 1 had serum T4 concentrations less than the reference range, compared with 4 (8%) dogs in group 2. All dogs in group 2 with low serum T4 concentrations had recently had seizure activity. Five (7%) dogs in group 1, but none of the dogs in group 2, had serum TSH concentrations greater than the reference range. Associations were not detected between serum T4 concentration and TSH concentration, age, phenobarbital dosage, duration of treatment, serum phenobarbital concentration, or degree of seizure control. Signs of overt hypothyroidism were not evident in dogs with low T4 concentrations. Addition of phenobarbital in vitro to serum did not affect determination of T4 concentration and only minimally affected fT4 concentration. CONCLUSIONS AND CLINICAL RELEVANCE: Clinicians should be aware of the potential for phenobarbital treatment to decrease serum T4 and increase TSH concentrations and should use caution when interpreting results of thyroid tests in dogs receiving phenobarbital.

Effects of environmental management on seasonal decrease in milk production in dairy cattle.

OBJECTIVE: To describe effects of season on milk production in Holstein dairy cows and to determine the location and effectiveness of fans and sprinklers in the management of stress attributable to season. DESIGN: Longitudinal observational study. ANIMALS: 141 dairy herds for which owners used the Dairy Herd Improvement Association's database for production and reproduction record keeping. PROCEDURE: Owners were interviewed to identify location of fans, shade structures, and sprinklers. Production and reproduction data were retrieved from the database, and a mixed model ANOVA was used to estimate effects of season, parity, and use of sprinklers, and fans on milk production. RESULTS: Daily peak milk production decreased for all parity groups in the summer, but the effect decreased with increasing days in lactation. Use of sprinklers increased peak milk production in parity-1 and -3 or higher cows, but use of fans did not significantly alter effects of season. After calving in the summer, 305-day milk production decreased in parity-2 and -3 cows. This decrease was not significantly modified by the presence of sprinklers or fans. CLINICAL IMPLICATIONS: Use of sprinklers may increase peak milk production in high-producing cows and could be recommended for reducing heat and total stress during this time. Production-oriented veterinarians should be cautious when recommending use of sprinklers and fans to increase production because of the wide confidence intervals describing their effectiveness. Management of parity-2 or higher cows so that they calve from October to June could increase 305-day milk production.

Results of bone scintigraphy in horses used for show jumping, hunting, or eventing: 141 cases (1988-1994).

OBJECTIVE: To determine anatomic patterns and clinical importance of increased radiopharmaceutical uptake in bones of horses used for show jumping, hunting, and eventing. DESIGN: Retrospective study. ANIMALS: 141 horses evaluated because of lameness. PROCEDURE: Medical records were reviewed, and information on results of physical examination, radiography, and scintigraphy were obtained. Scintigrams were evaluated to identify areas of increased radio-pharmaceutical uptake. RESULTS: 834 areas of increased radiopharmaceutical uptake were identified. Scintigraphy of the vertebral column was performed in 78 horses, and 50 had areas of increased radiopharmaceutical uptake involving the spinous processes. Scintigraphy of the proximal phalanx of the forelimb was performed in 88 horses. Similarly, scintigraphy of the proximal phalanx of the hind limb was performed in 99 horses, and scintigrams of 374 proximal phalanges were available for review. One hundred fifty-five scintigrams had areas of increased radiopharmaceutical uptake. Scintigraphy of the tarsal joint was performed in 99 horses, and scintigrams of 198 joints were available for review. Eighty-five had areas of increased radiopharmaceutical uptake. Overall, 214 of 834 areas of increased radiopharmaceutical uptake were definitively associated with lameness. CLINICAL IMPLICATIONS: Results of this study suggest that jumping creates unique stresses on the bones of horses. The distinctive patterns of increased radiopharmaceutical uptake identified in this study suggest that horses used for jumping may have a predilection to develop orthopedic disease at specific sites distinct from those in racehorses.