Bartonella henselae-mediated disease in solid organ transplant recipients: two pediatric cases and a literature review.

Bartonella henselae, the etiologic agent of cat-scratch disease, causes a well-defined, self-limited syndrome of fever and regional lymphadenopathy in immunocompetent hosts. In immunocompromised hosts, however, B. henselae can cause severe disseminated disease and pathologic vasoproliferation known as bacillary angiomatosis (BA) or bacillary peliosis. BA was first recognized in patients infected with human immunodeficiency virus. It has become more frequently recognized in solid organ transplant (SOT) recipients, but reports of pediatric cases remain rare. Our review of the literature revealed only one previously reported case of BA in a pediatric SOT recipient. We herein present 2 pediatric cases, one of which is the first reported case of BA in a pediatric cardiac transplant recipient, to our knowledge. In addition, we review and summarize the literature pertaining to all cases of B. henselae-mediated disease in SOT recipients.

Cloning, mapping and association studies of the ovine ABCG2 gene with facial eczema disease in sheep.

Facial eczema (FE) is a hepatogenous mycotoxicosis in sheep caused by the fungal toxin sporidesmin. Resistance to FE is a multigenic trait. To identify QTL associated with this trait, a scan of ovine chromosomes was implemented. In addition, ABCG2 was investigated as a possible positional candidate gene because of its sequence homology to the yeast PDR5 protein and its functional role as a xenobiotic transporter. The sequence of ovine ABCG2 cDNA was obtained from liver mRNA by RT-PCR and 5' and 3' RACE. The predicted protein sequence shares >80% identity with other mammalian ABCG2 proteins. SNPs were identified within exon 6, exon 9 and intron 4. The intron 4 SNP was used to map ABCG2 to ovine chromosome 6 (OAR6), about 2 cM distal to microsatellite marker OarAE101. Interestingly, this chromosomal region contains weak evidence for a FE QTL detected in a previous genome-scan experiment. To further investigate the association of ABCG2 with FE, allele frequencies for the three SNPs plus three neighbouring microsatellite markers were tested for differences in sheep selected for and against FE. Significant differences were detected in the allele frequencies of the intronic SNP marker among the resistant, susceptible and control lines. No difference in the levels of ABCG2 expression between the resistant and susceptible animals was detected by Northern hybridisation of liver RNA samples. However, significantly higher expression was observed in sporidesmin-dosed sheep compared with naïve animals. Our inference is that the ABCG2 gene may play a minor role in FE sensitivity in sheep, at least within these selection lines.

Autocrine lymphotoxin production in Epstein-Barr virus-immortalized B cells: induction via NF-kappaB activation mediated by EBV-derived latent membrane protein 1.

Epstein-Barr virus (EBV)-immortalized lymphoblastoid cells express high levels of lymphotoxin and use this molecule as an autocrine growth factor. We hypothesized that the EBV-derived latent membrane protein 1 (LMP1) mediates lymphotoxin production by inducing NF-kappaB binding to the lymphotoxin promoter. We assessed lymphotoxin production, LMP1 expression, and NF-kappaB activation in Z-43 (EBV-positive lymphoblastoid cells), Daudi (EBV-positive Burkitt's cells), and 3A4 (EBV-negative Burkitt's cells containing a stably transfected tetracycline-inducible LMP1 construct). Z-43 cells expressed high levels of LMP1 (immunoblot) and lymphotoxin (ELISA); the EBV-positive Burkitt's lymphoma line Daudi expressed neither LMP1 nor lymphotoxin. Similarly, induction of LMP1 in the 3A4 cells (exposed to tetracycline) was accompanied by a 13-fold increase in lymphotoxin levels (ELISA) as compared to uninduced (LMP1-negative) cells. EMSAs demonstrated high levels of NF-kappaB activation in Z-43 and tetracycline-induced 3A4 cells, but much lower levels in the uninduced 3A4 cells. Exposure of these cells to Bay 11-7082 (an inhibitor of IkappaB phosphorylation and, therefore, NF-kappaB activation) abrogated NF-kappaB binding and lymphotoxin production in a dose-dependent manner in both Z-43 and 3A4 cells. Therefore, in our model system, autocrine lymphotoxin production is largely driven by NF-kappaB activation, which is in turn mediated by EBV-derived LMP1 signaling.

Surveillance for homicide among intimate partners--United States, 1981-1998.

PROBLEM/CONDITION: A substantial percentage of all homicides in the United States are committed by intimate partners of the victims. Among females, approximately 1 in 3 homicides are intimate partner homicides (IPHs). Intimate partner homicides cannot be tracked by using death certificates because death certificates do not record the victim's relationship to the perpetrator. REPORTING PERIOD COVERED: This report summarizes information regarding IPHs that occurred in the United States during 1981-1998. DESCRIPTION OF THE SYSTEM: This report is based on Supplemental Homicide Reports (SHRs) collected by the Federal Bureau of Investigation (FBI) as part of their Uniform Crime Reporting System. SHRs are filed voluntarily by police departments for homicides occurring within their jurisdiction. SHRs include demographic variables regarding victims and perpetrators, their relationship, and weapon(s) used. Data from the SHR file were weighted by comparison with homicide data from death certificates to compensate for underreporting. IPHs were restricted to victims aged > or = 10 years. RESULTS: The risk for death from IPH among males was 0.62 times the risk among females. However, the rate among black males was 1.16 times the rate among black females. Among racial groups, rates among blacks were highest, and the rates among Asian or Pacific Islanders were lowest. Rates were highest among females aged 20-49 years and among males aged 30-59 years. During the study period, rates among white females decreased 23%, and rates among white males decreased 61.9%. Rates among black females decreased 47.6%, and rates among black males decreased 76.4%. Highest rates occurred in the southern and western states among both white and black females. A graded increase in IPH risk occurred with community population size. Approximately 50% of IPHs were committed by legal spouses and 33% by boyfriends or girlfriends for both male and female victims. IPH rates were less than expected during the months of January, October, and November. INTERPRETATION: Although total homicide rates have fluctuated during 1981-1998, IPH rates have decreased steadily during this period, and among certain subpopulations, the decrease has been substantial. Decreases are temporally associated with the introduction of social programs and legal measures to curb intimate partner violence, but a causal relationship has not been established. Likewise, no confirmed explanation exists for the greater decrease in rates among males compared with rates among females. The differences in IPH rates by race indicate that economic, social, and cultural factors are involved. The analysis by community population size and state demonstrates that regional sociocultural differences might be involved also. Access to firearms might be a key factor in both male and female IPHs. PUBLIC HEALTH ACTIONS: The descriptive epidemiology of IPH is changing rapidly and should continue to be monitored. Understanding the reasons forthe recent decreases in IPHs might help identify methods for primary and secondary prevention and further reduce IPH rates.

Attitudinal acceptance of intimate partner violence among U.S. adults.

Attitudinal acceptance of intimate partner violence (IPV) is an important correlate of violent behavior. This study examined acceptance of IPV using data collected from a nationally representative telephone survey of 5,238 adults. Multivariable logistic regression analyses were used to test for associations between sociodemographic characteristics, exposure to violence, question order, and acceptance of hitting a spouse or boyfriend/girlfriend under specific circumstances. Depending on the circumstance examined, acceptance of IPV was significantly higher among participants who were male and younger than 35; were non-White; were divorced, separated, or had never married; had not completed high school; had a low household income; or were victims of violence within the past 12 months. Participants were more accepting of women hitting men; they also were consistently more likely to report tolerance of IPV if they were asked first about women hitting men rather than men hitting women. Reports of IPV tolerance need to be interpreted within the context of the survey. Efforts to change IPV attitudes can be tailored to specific IPV circumstances and subgroups, and these efforts should emphasize that the use of physical violence is unacceptable to both genders.

Dietary fatty acids Up-regulate the expression of UCP2 in 3T3-L1 preadipocytes.

States characterised by elevated plasma fatty acid levels are accompanied by increased UCP2 expression but the physiological regulation of UCP2 expression in white adipose tissue is not fully understood. We used 3T3-L1 preadipocytes to determine whether various dietary fatty acids (20:5, 18:3, 18:2, 18:1, 18:0) directly regulate UCP2 expression. Physiological concentrations of each class of polyunsaturated fatty acid and the monounsaturated fatty acid dramatically up-regulated UCP2 mRNA levels 5- to 8-fold, but the saturated fatty acid was not so effective (1.5-fold). The up-regulation occurred in a time- and dose-dependent manner, was evident by 4 h and maximum between 18 and 24 h, and was prevented by actinomycin D. Synthetic ligands selective for each PPAR isoform did not induce UCP2 expression, which suggests that fatty acids might not be acting solely via PPAR transcription factors. In conclusion, dietary unsaturated fatty acids may be physiological signals to alter energy balance by direct induction of UCP2.

Partner violence, social support, and distress among inner-city African American women.

This study examined the role of social support in the partner violence-psychological distress relation in a sample of African American women seeking medical care at a large, urban hospital (n = 138). Results from bivariate correlational analyses revealed that partner violence was related to lower perceived social support and greater psychological distress, and lower social support was related to more distress. Furthermore, findings based on path analysis indicated that low levels of social support helped account for battered women's increased distress. Findings point to the need for service providers to screen for partner violence in nontraditional sites, such as hospital emergency rooms, and to address the role of social support resources in preventive interventions with African American battered women.

Ratings of family functioning of suicidal and nonsuicidal African American women.

This study compared ratings of family functioning between female African American suicide attempters (n = 126) and nonattempters (n = 112). Attempters reported poorer family-of-creation (physical and nonphysical partner abuse, family strengths, and marital adjustment) and family-of-origin (physical, sexual, and emotional abuse and emotional neglect) functioning than did controls. In a multivariate logistic regression, only marital discord and childhood sexual abuse were risk factors for suicide attempts. A cumulative risk model was also tested and indicated that the presence of 4 or more of the risk factors increased a woman's likelihood of making a nonfatal suicide attempt more than threefold. This study offers one of the first investigations of the families of suicidal African American women and highlights the importance of focusing on family concerns when working with this population.

Expanding the National Electronic Injury Surveillance System to monitor all nonfatal injuries treated in US hospital emergency departments.

STUDY OBJECTIVE: Injury is a major cause of morbidity and mortality in the United States. Although the National Vital Statistics System provides data on injury-related deaths, a national surveillance system is needed for timely identification of emerging nonfatal injury problems and continuous monitoring of severe nonfatal injuries. This work assesses the feasibility of expanding the National Electronic Injury Surveillance System (NEISS) to monitor all types and causes of nonfatal injuries treated in US hospital emergency departments and reports national estimates generated by a pilot study of this system. METHODS: At a stratified sample of US hospital EDs, persons receiving first-time treatment for an injury were monitored from May 1 through July 31, 1997. National estimates of the annual number and rate of ED-treated injuries overall, by patient characteristics, injury diagnosis, and external cause of injury were generated, and the sensitivity of the system for detecting ED-treated injuries was assessed. RESULTS: An estimated 29. 1 million injuries were treated in US EDs in 1997 (rate of 108.6/1, 000 population). The leading causes of injury were falls, being struck by or striking against an object or person, cutting or piercing, and motor vehicle traffic. Of 593 cases of injury detected by investigators from the Centers for Disease Control and Prevention during visits to 6 of the 21 NEISS hospitals in the study, 490 were also detected by NEISS coders for an overall sensitivity of 82.6%. CONCLUSION: Expanding the NEISS is a feasible means of timely and continuous monitoring of all types and causes of nonfatal injuries treated in US hospital EDs.

Risk factors for suicide attempts among low-income women with a history of alcohol problems.

This study used bivariate and multivariate analyses to examine nine risk factors for suicide attempts among 80 women (51 attempters, 29 controls) with a history of alcohol problems who were recruited from a large, inner-city hospital. Prior studies established that each of the examined factors increased the risk for suicidal behavioral, but these studies have varied according to whether or not they consisted exclusively of persons with alcohol problems. Whereas eight of the nine factors were bivariately associated with suicide attempt status in this study, only three factors (hopelessness, recent interpersonal loss, childhood trauma) remained significant in the multivariate analysis. These findings illuminate the importance of using multivariate analyses when aiming to identify factors that uniquely increase the risk for suicidal behavior among persons with alcohol problems.

Attributions for the development of substance addiction among participants in a 12-step oriented treatment program.

Attributions for the development of substance addiction problems were collected at admission (Time 1) and two months later (Time 2) for 103 participants in a residential treatment program. These attributions were grouped into personal, parental, and societal causation measures. At both Times 1 and 2, participants perceived personal causes as being more responsible for their substance addictions than were parental and social causes. Additionally, personal causes were perceived as being more responsible, and societal causes were perceived as being less responsible, at Time 2 relative to Time 1. Moreover, after controlling for the Time 1 measures, societal causation at Time 2 was positively related to depression and negatively related to treatment completion. Thus, participants accepted more responsibility as they progressed through treatment, which in turn was associated with higher levels of psychological functioning and treatment completion. These findings have meaningful implications, especially if replicated in other treatment settings with research that employs an experimental design.

Epidemiology of injuries among women after physical assaults: the role of self-protective behaviors.

Physical assaults against women result in more than 5,000 deaths and 1 million nonfatal injuries per year in the United States. Data from the National Crime Victimization Survey, 1992-1995, were used to test the association between injury risk and self-protective behaviors, while controlling for victim, offender, and crime-related characteristics. Unlike in prior studies, a self-protective behavior measure that accounted for the temporal sequencing of the occurrence of injuries and self-protective behaviors was used. The study also examined whether the effect of self-protective behaviors varied as a function of victim-offender relationship status. The sample included 3,206 incidents in which females were physically assaulted by a lone male offender within the previous 6 months. Multivariate results revealed that women who used self-protective measures were less likely to be injured than were women who did not use self-protective measures or who did so only after being injured. The effect of self-protective behaviors on risk of injury did not vary as a function of the victim-offender relationship. The inverse association found between self-protective behaviors and injury risk differs from those of previous studies. Owing to inconsistent findings across studies, caution should be used when making recommendations to women regarding whether or not they should use self-protective behaviors during a physical assault.

The effect of thyroid hormone on size of fat depots accounts for most of the changes in leptin mRNA and serum levels in the rat.

The physiological consequences and mechanism(s) for thyroid hormone-induced alterations in serum leptin are not known. To address this, leptin expression in rats was evaluated in relationship to food intake, fat mass, and body temperature in rats with pharmacologically altered thyroid status. Total body weight, food intake, and temperature were decreased in hypothyroid rats. Fat weight was decreased in both chronically hypothyroid and hyperthyroid rats (n = 6/group). Serum leptin was linearly correlated with fat weight, epididymal and retroperitoneal fat leptin mRNA concentration, but not total body weight. Serum leptin was decreased in the chronically hyperthyroid rats. When fat weight was used as a covariant, serum leptin was not different between the three groups. Epididymal fat leptin mRNA was higher in euthyroid (n = 7) than in hypothyroid and hyperthyroid rats. Retroperitoneal fat leptin mRNA was not affected by thyroid status. A positive linear relationship between food intake and free triiodothyronine (FT3) index was observed, but not between food intake and serum leptin alone. In a time course study, serum leptin, epididymal fat leptin mRNA content, and fat weight did not change within 24 hours of high-dose triiodothyronine (T3) (n = 6/group), but both temperature and epididymal fat S14 mRNA content rapidly increased. These findings demonstrate that thyroid state influences circulating leptin levels, but primarily does so indirectly through the regulation of fat mass. Leptin does not influence core body temperature across thyroidal state. Finally, thyroid state is more important to regulate food intake, through an as yet undefined mechanism, than are thyroid state-associated changes in serum leptin.

Partner abuse and posttraumatic stress disorder as risk factors for suicide attempts in a sample of low-income, inner-city women.

This study examined partner abuse and posttraumatic stress disorder (PTSD) as risk factors for suicidal behavior among women, and whether or not PTSD mediated the partner abuse-suicidal behavior association. Attempters (n = 119) were approximately three times more likely to be above clinical cut-points for physical partner abuse, nonphysical abuse, and PTSD than nonattempters (n = 85). Physical partner abuse, but not nonphysical partner abuse, was associated with an increased risk for PTSD. Further, PTSD mediated the link between physical partner abuse and suicidality, such that when PTSD was statistically controlled, the association between physical partner abuse and suicide attempt status was reduced to nonsignificance. Implications of findings for interventions for female victims of partner abuse, and women who make nonfatal suicide attempts are discussed.

Psychological symptomatology following parental death in a predominantly minority sample of children and adolescents.

Examined the psychological correlates related to experiencing the death of a parent, the main and interactive effects of sex, race, and age on youth distress and the degree of cross-informant correspondence on the outcome measures. The predominately minority sample included 80 bereaved youth and 45 nonbereaved youth. Youth and their legal guardians completed a battery of questionnaires, including measures assessing the youth's psychological symptomatology. Results revealed that bereaved youth manifested greater psychological and behavior problems than their nonbereaved counterparts on guardian-reported measures (Child Behavior Checklist [CBCL]). The clinical significance of parental death experienced during childhood is indicated by the magnitude of distress exhibited by the bereaved sample; almost one quarter of bereaved youth scored in the clinical distress range (T score > or = 63) on the CBCL Externalizing and Internalizing Distress scales. The effect of parental death on guardian-reported externalizing distress was moderated by race, such that distress levels did not significantly differ between bereaved and nonbereaved minority youth but did differ significantly among bereaved and nonbereaved nonminority youth. Finally, the degree of cross-informant agreement was relatively low but consistent with prior studies. Study implications for interventions with bereaved youth and directions for future research are discussed.

Role of secondary stressors in the parental death-child distress relation.

This study examined the psychological consequences and secondary stressors associated with death of a parent. The sample (N = 116) consisted of 26 youths who had lost a parent to homicide, 45 youths who had lost a parent to natural death, and 45 nonbereaved youths. Youngsters completed face-to-face interviews, while their guardians completed measures assessing the children's functioning. Results based on both child and guardian reports indicated that parental death was associated with an increase in secondary stressors, regardless of the mode of death. Findings based on guardian reports also revealed that parental death was related to increased internalizing distress, and that parental death due to homicide was related to increased externalizing distress. Furthermore, secondary stressors mediated the parental death-child distress relation such that parental death led to an increase in stressors, which in turn led to increased child distress. Implications for secondary and tertiary preventive interventions are discussed.

Expression of obese mRNA in genetically lean and fat selection lines of sheep.

Genetically separate lines of Coopworth sheep have been bred by selecting for (fat genotype) or against (lean genotype) backfat depth. Typically, the total fat content, adjusted for carcass weight, is 21.2 and 29.3% for the lean and fat lines, respectively. As a homologue of the obese gene, which shows altered expression in several forms of obesity, is also expressed in sheep, it was decided to determine whether the obese gene was differentially expressed in each line of sheep. The relative level of expression of obese mRNA was approximately twofold higher in the fat line compared with the lean line in back, omental and perirenal fat depots of ram lambs fed ad libitum or fasted for 48 h. This elevation in the fat line is most likely a secondary consequence of obesity rather than a cause. Fasting for 48 h decreased obese mRNA levels by 8.9-, 8.5-, and 4.2-fold in back, omental and perirenal fat, respectively, in the lean line, and by 8.3-, 5.7-, and 3.5-fold in back, omental and perirenal fat, respectively, in the fat line. The lean and fat lines of sheep, therefore, responded in a similar way to fasting.

Applying the criteria for empirically supported treatments to studies of psychosocial interventions for child and adolescent depression.

Reviews the psychosocial treatment outcome studies for depressed children and adolescents and concludes that psychosocial interventions are effective at posttreatment and follow-up in reducing depressive symptoms/disorders in clinical and nonclinical samples of youth, regardless of treatment modality or extent of parental involvement. The article then examines the extent to which each study conforms to the guidelines set forth by the Task Force on Promotion and Dissemination of Psychological Procedures (1996) for well-established and probably efficacious interventions. Results of this analysis indicate only 2 series of studies that meet criteria for probably efficacious interventions and no studies that meet criteria for well-established treatments. Finally, the advantages and disadvantages of applying criteria for empirically supported treatments to identify good treatments for depressed youth are discussed, the importance of devising developmentally and culturally sensitive interventions targeted to the unique needs of each child is highlighted, and recommendations for future research that is informed by clinical practice and empirical findings are offered.

Factors that mediate and moderate the link between partner abuse and suicidal behavior in African American women.

Findings from a study comparing partner abuse in African American women suicide attempters (n = 148) and nonattempters (n = 137) revealed higher rates of physical and nonphysical partner abuse among attempters than their demographically similar nonsuicidal counterparts. The partner abuse--suicidal behavior link was mediated by psychological distress, hopelessness, and drug use and moderated by social support. Results also revealed that nonphysical partner abuse accounted for unique variance in the prediction of suicide attempt status beyond that attributable to childhood maltreatment. Implications of the findings for assessing both suicidal and abused women are discussed, and recommendations for preventive interventions for women at risk for suicidal behavior are provided.