Serological differences in folate/vitamin B12 in pregnancies affected by neural tube defects.

BACKGROUND: Laboratory evidence is presented of significant associations between reduced maternal serum folate and vitamin B12 levels and neural tube birth defects (NTD) compared to referents. METHODS: This was an incident case-control study. Cases of neural tube defects (including anencephaly and open spina bifida) diagnosed in residents within 100 miles of the US-Mexico border from January 1993 to October 2000 were eligible. Most cases were diagnosed in utero upon visits to clinics, obstetrical or genetic expert offices. Cases identified upon hospital admission or at delivery were also eligible. Cases identified after discharge were not. Controls were matched on geographic region, maternal age, race/ethnicity, gestational age, and type of health insurance (including none). RESULTS: Three hundred eighty-two border area residents (107 cases and 275 individually matched controls) provided biological specimens. Median folate concentrations for case mothers were 36% lower than controls (9.8 ng/mL vs. 15 ng/mL). Maternal serum folate concentrations in quartiles above 9.5 ng/mL indicated significantly reduced risk (OR = 0.4, OR = 0.3, and OR = 0.2). Likewise, the risk for NTD decreased (OR = 0.4, OR = 0.3, and OR = 0.2) in quartiles of sera B12 concentrations above 246 pg/mL. CONCLUSIONS: Physician attention is invited to significantly lower concentrations of serum folate and vitamin B12 in women with NTD-affected pregnancies. This study assayed sera samples from women while still pregnant or immediately after delivery. The confounding effect of reduced folate and B12 levels with other biological and chemical exposures will be addressed in subsequent communications.

Factors contributing to elevated indoor radon in the Paso Del Norte region of the Texas-Mexico border: information for physicians.

BACKGROUND: We collected sample data on radon concentrations concurrently in the air, water, and soil in the northern part of the Texas-Mexico border (both sides) popularly known as Paso Del Norte. METHODS: These field data were used to statistically correlate relative contributions of yard soil, tap water, location, and house features to concentrations of radon indoors. RESULTS: Indoor air radon concentrations in some homes were up to nine-fold the limit recommended by the US Environmental Protection Agency (USEPA). Concentrations of radon in tap water were up to nearly three-fold the recommended limit. Apartments and manufactured homes had generally greater concentrations of indoor radon. Statistically significant associations were indicated between indoor radon air levels and radon in the soil (P < 0.001); radon in the water and radium in water (P = 0.016); radon air levels and apartment living (P = 0.010); and mobile homes vs. wood, brick, and stucco construction (P = 0.016). CONCLUSION: Radon soil gas, apartment living, and the aluminum plank wall environment of mobile homes were associated with elevated indoor radon in the homes studied. Physician's attention is invited to the potential nontrivial risk from radon, as it becomes trapped inside enclosed structures. This article is intended to serve as a resource for primary care physicians who want to better understand the distribution and contributing factors for indoor radon. The Surgeon General recommends every US home be tested for radon as of January 13, 2005.

Recent change in the annual pattern of sexually transmitted diseases in the United States.

This study analyzed the 1999 to 2003 database of the Center for Disease Control and Prevention (CDC) for seasonal and longer-term time trends in the sexually transmitted diseases (STDs) of chlamydia, gonorrhea, and syphilis in the United States. Linear regression was used to ascertain time trends, and a linear mixed auto-regression model was applied to determine the statistical significance of the major peaks relative to the annualized time series mean. A statistically significant increasing trend during the 5 yr span was documented only in the incidence of chlamydia. No clear annual periodicity was detected in any of the STDs; instead, significant three-month cycles were documented in all the STDs, with prominent peaks evident in March, May, August, and November. The March and May peaks could be associated with the sexual activities of young adults during spring break, which for different colleges and universities, commences as early as mid- to late-February and concludes as late as early- to mid-April, when huge numbers of sexually active youth congregate at beach resort settings. We propose the August peak is representative of summer sexual activity, in particular, of youths during school recess when adult supervision is poor. Finally, the autumn peak seems to be an expression of an endogenous annual rhythm in human reproductive biology, exemplified by elevated levels of testosterone in young males and sexual activity at this time of the year.

Association of spirituality and sobriety during a behavioral spirituality intervention for Twelve Step (TS) recovery.

Twelve-Step (TS) recovery utilizes spirituality to promote sobriety, yet there are no proven programs designed to facilitate spiritual involvement. We developed a seven-week behavioral spirituality intervention titled "Knowing Your Higher Power" for implementation along with usual TS care. Twenty-six participants from a recovery center enrolled. We assessed behavior at baseline, 7-week, and 12-week follow-up. The sample showed significant increase in spiritual involvement and beliefs over the 12-week measurement period and a significantly greater spirituality score in those maintaining total sobriety compared to those that relapsed. These findings encourage a controlled trial to determine if this work has efficacy for practitioners in substance abuse treatment.

Spatial distribution of orofacial cleft defect births in Harris County, Texas, 1990 to 1994, and historical evidence for the presence of low-level radioactivity in tap water.

BACKGROUND: While both ionizing and nonionizing radiation are known to impair human reproductive capacity, the role of low-level domestic radiation continues to be an unsettled issue. OBJECTIVES: We examined the geostatistical distribution (residential longitude and latitude) of orofacial cleft birth cases adjusted for the underlying population distribution. Furthermore, we examined the cleft birth rates enumerated by zip codes for possible associations with levels of radium and radon in drinking water. METHODS: Cleft births and unaffected live births in Harris County, Texas, from 1990 to 1994, were geocoded by residential addresses and tested for spatial clusters using the space-time clustering program SaTScan. Historical sample data on local variations in water quality facilitated the assessment of the association of orofacial cleft defect births with low-level radiation exposure. RESULTS: A cluster of significantly greater than expected numbers of cleft defect births was identified in northwest Harris County, (relative risk = 3.0, P = 0.043), where the presence of elevated levels of radium (> 3 pCi/L) and radon (> 300 pCi/L) in the tap water has been known since the 1980s. CONCLUSIONS: Despite the ecological design of the study, lacking individual exposure measurements for cleft birth residences, there was strong suggestive evidence of an association between elevated radiation levels in tap water and elevated cleft birth prevalence rates by zip codes. Attention of physicians is invited to environmental causes as potential risk factors for orofacial cleft. This would aid in genetic counseling and the development of future preventive measures.

Seasonality of primarily childhood and young adult infectious diseases in the United States.

The Center for Disease Control (CDC) in the United States collects and maintains records of communicable (so-called notifiable) infectious diseases that cause significant morbidity and mortality and impact the national economy. This investigation focused on seasonal patterns in the primarily childhood and young adult infectious diseases of meningococcal meningitis, mumps, pertussis, typhoid fever, streptococcal toxic shock syndrome (1990 to 2003 CDC database), and varicella (1993 to 2003 CDC database). Linear regression was performed to ascertain the trend in the incidence of each disease, and multi-component cosinor analysis was applied to determine and describe periodicities. Significant decreasing trends in incidence were detected in meningococcal meningitis, mumps, typhoid fever, and streptococcal toxic shock syndrome, and increasing trends were found in pertussis and varicella. Significant annual patterns were documented in meningococcal meningitis (January peak), mumps (April peak), pertussis (August peak), varicella (April peak), typhoid fever (August peak), and in the hospital-acquired streptococcal toxic shock syndrome (February peak). Such seasonal patterns and long-term trends in infectious diseases are of practical public health significance in indicating which can benefit from timely prevention interventions.

Lead and copper in drinking water fountains--information for physicians.

BACKGROUND: Lead and copper are potentially toxic metals. The objective of our work was to test the water from the drinking fountains of a large public access office complex in southwest Houston, Texas, for the presence of lead, copper, and microbiologic contamination. The data for the water fountains were compared with what we found in the local municipal drinking water supplies. METHODS: Samples were collected as the first draw at the beginning of the work week. These samples were acidified to prevent the precipitation of heavy metals and analyzed using United States Environmental Protection Agency (USEPA) approved procedures and quality control. RESULTS: Traces of lead were detected in 37.5% and copper in 100% of the tested water fountains. In two buildings, concentrations in some fountains exceeded the USEPA action level for lead (by up to 12-fold) and for copper (by up to 3.9 fold). One sample was positive for total coliform and Escherichia coli bacteria. Comparison with samples from the local municipal drinking water supplies indicated that both metals and bacteria were the result of secondary contamination at the water fountain sites. CONCLUSIONS: This study showed that drinking water fountains can be an unexpected and unappreciated source of intake of metal and bacterial contaminants.

Association of type 2 diabetes mellitus and seroprevalence for cytomegalovirus.

BACKGROUND: Infection is known to play a role in type 1 diabetes, but there is a paucity of information on its role in diabetes mellitus type 2. We examined the seroprevalence of selected viruses in a group of predominantly Hispanic patients with type 2 diabetes and control subjects without diabetes. METHODS: One hundred thirteen patients, 83 with type 2 diabetes and 30 control subjects, all undergoing hemodialysis at the same facility in San Antonio, Texas, were tested for antibodies against coxsackie B viruses, cytomegalovirus (CMV), and parvovirus. Sixty-six of these patients and 25 control subjects were tested bimonthly for 6 months. RESULTS: We observed a greater seroprevalence of anti-CMV IgG antibodies among patients with diabetes (97.6%), compared with control subjects (86.7%), and the difference was statistically significant [OR = 6.2, 95% CI: 1.1 to 36.0, P < 0.05]. Three draws on a subset of 91 patients produced still greater odds [OR = 12.4, 95% CI: 1.3 to 117, P < 0.05]. There were significantly more (P < or = 0.001) vascular complications among patients with diabetes. There was a colinearity of trends between diabetes, seropositivity to CMV, and age. CONCLUSIONS: Our findings indicated an up to 12 times greater odds of having type 2 diabetes for persons previously exposed to CMV. Since accelerated atherosclerosis is also associated with diabetes and CMV, past CMV infection may be a common factor that links atherosclerosis and diabetes. No other viruses tested in this study, either coxsackie B viruses or parvovirus, showed a significant association with type 2 diabetes.

Annual pattern of human conception in the State of Texas.

A total of 2,828,068 State of Texas singleton conceptions, estimated from the date of the first day of the last menstrual period, were assessed for annual periodicity by multiple-component (1-yr fundamental plus the 6- and 3-month harmonics) Cosinor analysis. An annual pattern (p < 0.001) of conception was detected with a December peak, end of July-beginning of August trough and modest amplitude (total peak-to-trough variation) equal to 13.3% of the yearly mean. Annual patterns (p < 0.005) of generally comparable peak and trough times were also documented for conceptions categorized by maternal marital status, age, ethnicity, years of education, birthplace, and county (Texas-Mexico border vs. non-border) of residence. The amplitude, a measure of the prominence of the annual pattern, varied by race (two-fold greater for non-Hispanic Blacks and Hispanics than non-Hispanic Whites), age (50-60% greater for the 19-year-old and younger group than the 20-29 and 30-44-year-old groups) and maternal education (two-fold greater for those with 0-8 than 13 or more years of schooling). Annual patterns (p < 0.001) in conceptions, generally with December peak and end of July-beginning of August trough, were also detected for neonatal variables categorized by birth weight, birth order, gestational age, and gender. The amplitude of the annual pattern in conceptions varied directly with gestational age and inversely with birth weight class.

Bacterial Indicators and Environmental Factors as Related to Contamination of Oysters by Enteroviruses.

Enteric viruses previously have been reported in marine waters and shellfish which met acceptable bacteriological standards for recreational use and shellfish harvesting. Unfortunately, previous data on occurrence of enteric viruses are limited and usually not quantitative. In this report, results of studies conducted along the upper Texas Gulf coast, where a substantial amount of quantitative virological data was collected, are compared to bacteriological indicators and other environmental factors on a statistical basis. A product-moment correlation matrix showed that there was a moderate correlation between viruses in water and total coliforms in water, total coliforms in oysters and fecal coliforms in oysters. However, presence of viruses in water was not found to be correlated with presence of viruses in oysters. The only significant regression coefficient found for the model relating the concentration of viruses in water to bacterial indicators and other environmental variables was concentration of coliforms in oysters. Multiple regression analysis showed that approximately 25% of the variance in the number of viruses detected in water was statistically accounted for by the linear correlation with the total coliforms in oysters. The amount of variation in the number of viruses explained by this indicator, however, was not large enough to make the concentration of coliforms in oysters a good predictor of the concentration of viruses in water. Furthermore, none of the bacterial or other environmental variables was found to be a good predictor of the concentration of viruses detected in oysters. Our failure to find a strong predictive relationship between viruses in marine water and in oysters, and the occurrence of viruses in high frequency in waters which met current bacteriological standards, indicate that these standards do not reflect the occurrence of enteroviruses in marine waters.