Surveillance of autoimmune conditions following routine use of quadrivalent human papillomavirus vaccine.

OBJECTIVE: An observational safety study of the quadrivalent human papillomavirus vaccine (HPV4) in women was conducted. This report presents findings from autoimmune surveillance. Design. Subjects were followed for 180days after each HPV4 dose for new diagnoses of 16 prespecified autoimmune conditions. SETTING: Two managed care organizations in California. Subjects. Number of 189,629 women who received ≥1 dose of HPV4 between 08/2006 and 03/2008. OUTCOME: Potential new-onset autoimmune condition cases amongst HPV4 recipients were identified by electronic medical records. Medical records of those with ≥12-month health plan membership prior to vaccination were reviewed by clinicians to confirm the diagnosis and determine the date of disease onset. The incidence of each autoimmune condition was estimated for unvaccinated women at one study site using multiple imputations and compared with that observed in vaccinated women. Incidence rate ratios (IRR) were calculated. Findings were reviewed by an independent Safety Review Committee (SRC). RESULTS: Overall, 1014 potential new-onset cases were electronically identified; 719 were eligible for case review; 31-40% were confirmed as new onset. Of these, no cluster of disease onset in relation to vaccination timing, dose sequence or age was found for any autoimmune condition. None of the estimated IRR was significantly elevated except Hashimoto's disease [IRR=1.29, 95% confidence interval: 1.08-1.56]. Further investigation of temporal relationship and biological plausibility revealed no consistent evidence for a safety signal for autoimmune thyroid conditions. The SRC and the investigators identified no autoimmune safety concerns in this study. CONCLUSIONS: No autoimmune safety signal was found in women vaccinated with HPV4.

A prospective study of human papillomavirus (HPV) type 16 DNA detection by polymerase chain reaction and its association with acquisition and persistence of other HPV types.

Human papillomavirus (HPV)-16 causes about half the cases of cervical cancer worldwide and is the focus of HPV vaccine development efforts. Systematic data are lacking as to whether the prevention of HPV-16 could affect the equilibrium of infection with other HPV types and thus alter the predicted impact of vaccination on the occurrence of cervical neoplasia. Therefore, the associations of HPV-16 detection with subsequent acquisition of other HPV types and with the persistence of concomitantly detected HPV types were examined prospectively among 1124 initially cytologically normal women. Preexisting HPV-16 was generally associated with an increased risk for subsequent acquisition of other types. HPV-16 did not affect the persistence of concomitant infections, regardless of type. These findings suggest that the prevention or removal of HPV-16 is not likely to promote the risk of infection with other types, a theoretical concern with current vaccination efforts.

Cervical HPV DNA detection as a predictor of a recurrent SIL diagnosis among untreated women.

OBJECTIVES: This study was conducted to test whether patient history of untreated cervical intraepithelial neoplasia (CIN) 1 or low-grade squamous intraepithelial lesions (LGSIL) modifies the interpretation of a positive HPV DNA result with regards to subsequent squamous intraepithelial lesions (SIL). METHODS: Seventy-three women with recurrent SIL were compared to 105 controls who remain cytologically normal during follow up. Cervical samples collected at enrollment were assayed for HPV DNA in the subject and control groups. RESULTS: Women with and without a history of LGSIL who tested positive for HPV DNA were at a similarly increased risk of having (recurrent) LGSIL as compared to controls. However, in women with a history of LGSIL, HPV DNA appeared to be less predictive for high-grade squamous intraepithelial lesions (HGSIL) than in women without a history of disease. CONCLUSIONS: Past history of untreated CIN1 or LGSIL does not modify the predictive value of a positive HPV DNA test for subsequent LGSIL. The observed difference of the predictive value of a positive HPV DNA test for the risk of recurrent HSIL compared to incident HSIL should be pursued.

Detection of human papillomavirus DNA in cytologically normal women and subsequent cervical squamous intraepithelial lesions.

BACKGROUND: Human papillomavirus (HPV) infection has been strongly associated with cervical carcinoma and its cytologic precursors, squamous intraepithelial lesions (SIL). We investigated the risk of SIL prospectively following polymerase chain reaction (PCR)-based DNA testing for a wide range of genital HPV types in a cohort of initially cytologically normal women, to clarify the role of HPV in the etiology of SIL. METHODS: Starting in April 1989, 17,654 women who were receiving routine cytologic screening at Kaiser Permanente (Portland, OR) were followed for the development of incident SIL. During follow-up, 380 incident case patients and 1037 matched control subjects were eligible for this nested case-control study. Cervical lavages collected at enrollment and, later, at the time of case diagnosis (or the corresponding time for selection of control subjects) were tested for HPV DNA using a PCR-based method. The data were analyzed as contingency tables with two-sided P values or, for multivariable analyses, using odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: In comparison with initially HPV-negative women, women who tested positive for HPV DNA at enrollment were 3.8 times (95% CI = 2.6-5.5) more likely to have low-grade SIL subsequently diagnosed for the first time during follow-up and 12.7 times more likely (95% CI = 6.2-25.9) to develop high-grade SIL. At the time of diagnosis, the cross-sectional association of HPV DNA and SIL was extremely strong (OR = 44.4 and 95% CI = 24.2-81.5 for low-grade SIL and OR = 67.1 and 95% CI = 19.3-233.7 for high-grade SIL). HPV16 was the virus type most predictive of SIL, even low-grade SIL. CONCLUSIONS: These findings are consistent with the hypothesis that HPV infection is the primary cause of cervical neoplasia. Furthermore, they support HPV vaccine research to prevent cervical cancer and efforts to develop HPV DNA diagnostic tests.

South-North immigrants' settlement and opportunity structures in the U.S.

"This article makes the case that the new immigration [to the U.S. from developing Latin American and Asian countries], motivated by kinship ties and family reunification provisions of U.S. immigration law, leads to a clustering of new immigrants into areas that are no longer attracting large numbers of native-born Americans. It is argued that the concentration of these groups into ¿high immigration regions' will limit their access to employment and education opportunities that would facilitate their spatial assimilation and upward mobility."

Impacts of low-skilled immigration on the internal migration of the U.S.-born low-skilled Americans in the United States: an assessment in a multivariate context.

"This paper assesses the impacts of low-skilled immigration on the interstate migration of...U.S.-born low-skilled Americans, based on the disaggregated data of the 1990 Census. Our results reveal that the push effects of...immigration on the departure process [were] much stronger than its discouraging and complementary effects on the destination choice process; and that the push effects of low-skilled immigration are (1) stronger on whites than on non-whites, (2) much stronger on the poor than on the non-poor, (3) weaker on the 15-24 age group than on older age groups, and (4) the strongest on poor whites."

Comparison of the hybrid capture tube test and PCR for detection of human papillomavirus DNA in cervical specimens.

The strong association of human papillomavirus (HPV) and cervical cancer makes it important to study HPV detection methods that may play a role in cervical cancer screening. We compared two DNA methods that are commonly used for HPV research in the United States: the MY09/MY11 L1 consensus primer PCR-based test and the first-generation Hybrid Capture tube method (HCT). Laboratory assays by each method were performed with 596 cervicovaginal specimens collected from participants in a large cohort study conducted in Portland, Oreg. Included were 499 specimens from women whose cytology was normal and 97 specimens from women with squamous intraepithelial lesions (SILs). The overall HPV DNA positivity for known types was 22.5% by PCR compared to 13.6% by HCT. When the analysis was restricted to the 14 HPV types detectable by both methods, the sensitivity of HCT, with PCR used as the standard for HPV status, was higher for specimens from women with concurrent SILs (81.0%) than for specimens from women with normal cytology (46.7%). Among specimens testing positive by both methods, 97.2% of the time the two methods agreed on whether specimens were positive for cancer-associated HPV types. Both of these HPV test methods provide information that supplements the information provided by the Pap smear. The PCR method has higher analytic sensitivity than HCT in detecting HPV, but HCT may be helpful in identifying women with concurrent SILs.

Risk of Hodgkin's disease subsequent to tonsillectomy: a population-based cohort study in Sweden.

Although some studies have linked excess of Hodgkin's disease (HD) to tonsillectomy, the findings have not been consistent. In particular, risk of HD by age at tonsillectomy has not been fully evaluated, despite the notable change in immunologic function of the tonsils between childhood and adulthood. To evaluate the risk of HD and other lymphomas, associated with tonsillectomy according to age at surgery, a population-based cohort study was conducted. Using nationwide Swedish hospitalization records, 55,169 patients undergoing tonsillectomy with/without adenoidectomy (T/A) were identified during the period 1964-1983. By linkage with the nationwide Total Population, Migration, Cancer and Causes-of-Death registries, these patients were followed up for as long as 25 years. After exclusion of the first post-operative year, a total of 533 first primary-cancer cases was identified between 1965 and 1989. Small excess risk was observed for HD (20 cases, SIR = 1.4, 95% CI 0.9-2.2). HD risk was more pronounced among patients tonsillectomized before age 12 (7 observed vs. 1.7 expected, SIR = 4.1, 95% CI 1.6-8.4), but declined significantly with older ages at T/A. While our data suggest a small increase in HD among all patients undergoing T/A and a significant excess for those under age 12 at surgery, we cannot exclude the possibility that the excess may be due to factors underlying the disorders that led to surgery.

Rural/urban migrations in Zimbabwe in 1982-92: selectivity by gender, place of birth, and educational attainment.

PIP: "This paper studies the selectivity of the 1982-92 rural/urban migrations of the Africans in Zimbabwe, based on the data from a multidimensional tabulation of all the individual records in the 1992 Population Census. The focus is on the selectivity with respect to gender, place of birth, and educational attainment. The selectivity is interpreted in the context of the country's colonial legacy, cultural norms, and current socioeconomic conditions." (EXCERPT)^ieng

Migration in the urban-rural hierarchy of China: insights from the microdata of the 1987 National Survey.

Microdata from the 1987 National Population Survey are used to analyze internal migration in China in the 1980s. The focus is on the impact of migration policies on rural-urban migration. "There are two main findings. First, although the migration policy resulted in a very low migration level and systematic distortions in migration schedules, its encouragement of downward migrations was very ineffective, whereas its control on rural-to-urban migrations was partially weakened by the strong upward aspirations of rural families awakened by recent economic reform. Consequently, net in-migration contributed substantially to the growth both of city and of town populations. Second, although the level of education had a strong positive effect on the migration propensities both of males and of females in general, it had a strong negative effect on the migration propensities of females at the time of marriage, a finding which suggests that the families at subsistence income level tended to marry their daughters to grooms in other communities in order to reduce the risk of familial income shortfalls."

Possible relation between hypertension and cancers of the renal pelvis and ureter.

To evaluate the relationship of selected medical conditions and medications with cancers of the renal pelvis and ureter, we interviewed 308 subjects with renal pelvis cancer, 194 subjects with ureter cancer and 496 control subjects in 3 areas of the United States. After controlling for the effects of smoking, age, gender and geographic residence, a history of hypertension (reported to have been diagnosed more than 5 years before interview) was associated with a small but significantly increased risk (odds ratio [OR] = 1.3; 95% confidence interval [CI], 1.0-1.8), whereas no relationship was observed with a variety of other medical conditions or medications. Stratified analysis showed that the risk associated with hypertension was twice as high among users of diuretics or other antihypertensive drugs (OR = 2.4; 95% CI, 1.1-4.9) as it was among those who never used these medications (OR = 1.2; 95% CI, 0.8-1.7). Our findings suggest that the association previously reported between hypertension and renal cell cancer may extend to cancers of the renal pelvis and ureter.

Explaining hierarchical and interprovincial migrations of Chinese young adults by personal factors and place attributes: a nested logit analysis.

"This paper uses a two-level nested logit model to explain the inter-stratum (city, town and rural county) and interprovincial migration behaviors of the young adults (aged 17-29) in China during a three-year period (1985-87), based on the micro data of the 1987 National Population Survey. The migration propensity of each person is represented by a departure probability and a destination choice probability. These probabilities are then expressed as functions of personal factors and place attributes. The main findings are that personal factors are of paramount importance in explaining the departure behaviors, and that both departure and destination behaviors responded to market forces in a sensible way, despite government control on territorial movements."

Factors on polygamy in sub-Saharan Africa: findings based on the Demographic and Health Surveys.

PIP: This study presents a brief review of the historical and cultural context of polygamy in sub-Saharan Africa and examines the sociodemographic factors that influence polygamous union formation. Data were obtained from the Demographic and Health Surveys in Ghana (1988), Senegal (1986), Kenya (1989), and Zimbabwe (1988-89). The sample was restricted to currently married or cohabitating women. The proportion of women in a polygamous union was 48% in Senegal, 31% in Ghana, 23% in Kenya, and 16% in Zimbabwe. The authors state that rates may have been higher in Senegal and Ghana due to the higher involvement of women in the cultivation of root crops and trading at local markets. Rate differences indicated a greater proportion of men and women with no education and Muslim affiliation in the high polygamy countries of Senegal and Ghana in West Africa compared to Kenya and Zimbabwe. Single factor analysis was performed for the effects of women's formal education, men's formal education, religion, urbanization, current age, age at first marriage, and ethnicity. Multivariate analysis by country indicated the importance of rising husbands' education and the lack of significance of women's education. As husband's education rose to the secondary level, polygamy declined. Other significant factors were religion, ethnicity, and current age, which was the most important factor. In Ghana, the effect of husbands' education overwhelmed the effect of women's education. Current age was the most important explanatory factor, followed by religion. In Kenya, both women's and men's education, ethnicity, urbanization, and age were significant factors. Ethnicity was the most important factor. In Zimbabwe, every factor was significant. Women's education was the most important factor. Findings reveal different prevalence of polygamy and different effects of sociodemographic factors.^ieng

Human papillomavirus and cervical neoplasia: a case-control study in Taiwan.

As part of a large-scale, community-based cervical neoplasia screening project in rural Taiwan, a case-control study was undertaken to evaluate the etiologic role of human papillomavirus (HPV) infection in this mainly monogamous (2% reported having multiple sexual partners) female population. A total of 88 biopsy-confirmed cases and 261 cytologically normal controls were selected for the study. The case group included 40 cases of cervical intraepithelial neoplasia (CIN) 1, 9 of CIN 2, 36 of CIN 3 and 3 cases of invasive cancer. Cervical swabs collected at screening from study subjects were tested for HPV DNA by an LI consensus primer polymerase chain reaction (PCR)-based technique. HPV DNA was found in 92% of high-grade cases (CIN 2-3 and invasive cancer); 54% of low-grade cases (CIN 1); and 9% of controls. HPV was significantly associated with both high-grade and low-grade cervical neoplasia. As reported in Western countries, HPV 16 was the predominant type among HPV-positive high-grade cases. However, HPVs 52 and/or 58 combined were the most common types among HPV-positive low-grade cases and controls. Among women without any high-risk HPV infection (types 16, 18, 31 or 45), those with multiple-type HPV infection had a higher risk for high-grade cervical neoplasia than those with single-type infection. Overall, 91% of high-grade cases and 50% of low-grade cases could be attributed to HPV infection. Our results show that, even in this monogamous population, HPV is the major risk factor for high-grade cervical neoplasia.

Sensitivity analysis of discrete-time interregional population systems.

This paper shows analytically how (a) the long-run growth rate and (b) the long-run proportional distribution of an interregional population system with a time-homogeneous structural matrix are affected by small changes or errors in (a) the natural growth rates of individual regions and (b) the interregional migration rates. Furthermore, the analytic results are applied to an eight-region Canadian population system. Finally, it is claimed that the method introduced here can be easily applied to sensitivity analysis of both the intrinsic growth rate and the "stable" age-composition of the Leslie model with respect to changes in age-specific birth and survival rates.