Impact of food security on glycemic control among low-income primarily Hispanic/Latino children in Los Angeles, California: A cross-sectional study.

Studies examining the impact of food insecurity on metabolic markers are limited, specifically in Hispanic youth. This study was a cross-sectional analysis of 218 3rd-5th grade students (83% Hispanic and 49% male). Anthropometrics, blood glucose, insulin, and lipids via fasting blood draw, dietary intake via Block screener, and a 5-item food security scale were collected. HOMA-Insulin Resistance was calculated. Multivariate analyses of covariance were used to examine differences in glucose and insulin indices, adiposity, metabolic and dietary intake variables between categories of food security. Food secure children had greater glycemic control and decreased insulin resistance compared to food insecure children.

Passive smoking and Parkinson's disease in California Teachers.

INTRODUCTION: Tobacco smoking is consistently inversely associated with Parkinson's disease (PD) in men and women; recently this has been related to reverse causation, prompting questions as to whether similar patterns exist for passive smoke exposure. We used baseline and follow-up data from the California Teachers Study, a prospective cohort of women, to investigate whether timing, location and cumulative measures of intensity and duration of passive smoke exposure are associated with PD risk. METHODS: Using a nested case-control approach, we included 224 diagnostically validated cases (158 with no history of personal smoking) and selected 3230 age- and race-matched controls (1973 with no history of personal smoking). We estimated odds ratios(ORs) and 95% confidence intervals(CI) by fitting adjusted multivariable unconditional logistic regression models. RESULTS: Among lifelong non-smokers, passive smoke exposure combined across all settings and accumulated over a lifetime was not associated with PD risk (OR = 1.18, 95% CI 0.60, 2.30). Workplace exposure was also not associated with risk. Household exposure during adulthood but not childhood was inversely associated with PD (OR = 0.59, 95% CI 0.40, 0.87). Exposure to passive smoke in other social settings was positively associated with PD (OR = 1.62, 95% CI 1.11, 2.36). These contradictory results may be attributable to chance due to multiple comparisons in subgroup analyses. No pattern emerged to suggest that increasing years of passive smoke exposure, smokiness of the setting, or combined smokiness by exposure years was associated with lower PD risk. CONCLUSION: Results do not convincingly support a protective effect of passive smoking in PD.

LA sprouts randomized controlled nutrition, cooking and gardening programme reduces obesity and metabolic risk in Hispanic/Latino youth.

BACKGROUND: Many programmes for children that involve gardening and nutrition components exist; however, none include experimental designs allowing more rigorous evaluation of their impact on obesity. OBJECTIVES: The objective of this study is to explore the effects of a novel 12-week gardening, nutrition and cooking intervention {'LA Sprouts'} on dietary intake, obesity parameters and metabolic disease risk among low-income, primarily Hispanic/Latino youth in Los Angeles.. METHODS: This study used a randomized control trial involving four elementary schools [two randomized to intervention {172, 3rd-5th grade students}; two randomized to control {147, 3rd-5th grade students}]. Classes were taught in 90-min sessions once per week for 12 weeks. Data collected at pre-intervention and post-intervention included dietary intake via food frequency questionnaire, anthropometric measures {body mass index, waist circumference}, body fat, and fasting blood samples. RESULTS: LA Sprouts participants compared with controls had significantly greater reductions in body mass index z-scores {-0.1 vs. -0.04, respectively; p = 0.01} and waist circumference {-1.2 vs. 0.1 cm; p < 0.001}. Fewer LA Sprouts participants had the metabolic syndrome after the intervention than before, while controls with metabolic syndrome increased. LA Sprouts participants compared with controls increased dietary fiber intake {+3.4% vs. -16.5%; p = 0.04}. All participants decreased vegetable intake, but decreases were less in LA Sprouts than controls {-3.7% vs. -26.1%; p = 0.04}. Change in fruit intake did not differ between LA Sprouts and controls. CONCLUSIONS: LA Sprouts was effective in reducing obesity and metabolic risk; however, additional larger and longer-term studies are warranted.

Lifetime exposure to estrogens and Parkinson's disease in California teachers.

INTRODUCTION: Parkinson's disease (PD) is consistently observed to occur less frequently in women than men, prompting investigation into whether estrogen protects against neurodegeneration of dopaminergic neurons. METHODS: We used baseline data in the California Teachers Study, a prospective cohort of women, to investigate whether reproductive factors indicating higher long-term estrogen levels are associated with PD using a nested case-control approach. We identified 228 PD cases and 3349 unaffected controls frequency matched by age and race. RESULTS: Women who reported using combined estrogen/progesterone therapy or progesterone only formulations had a 57% increase in PD risk (OR = 1.57, 95% CI = 1.06, 2.34) compared to never having used HT. Compared to women with menopause at 50-52 years, menopause at younger (<35-46 years: OR = 0.59, 95% CI = 0.37, 0.94) and older ages (≥53 years: OR = 0.54, 95% CI = 0.36, 0.83) had lower PD risk. A derived composite estrogen summary score for women's exposure to both endogenous and exogenous estrogens throughout life indicated that women with presumed higher cumulative lifetime levels of estrogen (a score of 3-5) had a significantly reduced PD risk [(OR = 0.57, 95% CI = 0.35, 0.91) relative to those with lower lifetime estrogen exposure or a composite estrogen summary score of 0-1]. CONCLUSIONS: These results provide some support for the hypothesis that lifelong high estrogen is protective in PD, suggesting that the level and persistence of exposure over the long term may be important in PD risk reduction.

Hospitalizations due to hepatitis C in Los Angeles County, 2007-2009: case characteristics and factors associated with mortality.

Morbidity and mortality due to hepatitis C (HCV) infection are rising in the United States as the highest risk cohort (those born between 1945 and 1965) ages. It is important for governments and healthcare providers to have timely, readily obtainable data to estimate the burden of HCV locally. Demographic factors, hospital charges and comorbid conditions were summarized for Los Angeles County (LAC) residents who had at least one hospitalization in California during 2007-2009 with HCV as a primary or secondary diagnosis using statewide hospital discharge data. Logistic regression was used to estimate odds ratios for factors associated with dying during hospitalization. A total of 19 907 unique patients were hospitalized with HCV during the 3-year study period; 63.0% were aged 45-65 years; 1874 (9.4%) died. Hospitalizations for HCV doubled during this time period. Total charges for hospitalizations for which HCV was coded as the principal diagnosis increased from $18 million to $58 million, with over 70% charged to government sources. After adjusting for demographic factors, human immunodeficiency virus (HIV) and hepatitis B (HBV), current alcohol abuse and kidney disease were associated with dying during hospitalization. Based on statewide hospital discharge data, morbidity and mortality from HCV infections increased in LAC from 2007-2009, and pose an economic burden to government. To lower mortality risk, HCV patients should be referred for follow-up. The expected increase in HCV hospitalizations as infected patients' age poses an increasing burden to healthcare systems.

Occurrence of depression and anxiety prior to Parkinson's disease.

OBJECTIVE: To assess the relationship between depression and anxiety and Parkinson's disease (PD). BACKGROUND: Many people with PD suffer from depression and anxiety prior to the onset of motor symptoms. Studies suggest these psychiatric conditions may be risk factors for PD or prodromal non-motor symptoms. METHODS: Using a population-based approach in three California counties, we recruited 371 incident PD cases, 402 population and 115 sibling controls. We recorded self-reports of lifetime depression/anxiety diagnoses and use of psychotropic medications. We adjusted for age, race, sex, pack-years of smoking, and education, and also conducted analyses after excluding (lagging) both diagnoses and medication use first occurring within 2, 5, 10, and 20 years of the index/diagnosis date. RESULTS: Cases were more likely to have received a diagnosis of depression or anxiety at any time prior to index date (OR 1.42, 95% CI 1.01, 2.00), but were not more likely to have been both diagnosed and treated (OR 1.11, 95% CI 0.77, 1.60). Male PD patients received diagnoses combined with treatment more often than population controls within 5 years of PD diagnosis (OR 2.21, 95% CI 1.21, 4.04; 2 year lag: OR 2.44, 95% CI 1.29, 4.61; 5 year lag: OR 1.67, 95% CI 0.80, 3.49). We did not see any differences for females. Results for cases compared to sibling controls were similar to those for population controls. CONCLUSION: These results suggest that depression and anxiety may be early symptoms during the prodromal phase of PD.

Lung lesions in SCID-bo and SCID-bg mice after intratracheal inoculation with wild-type or leucotoxin-deficient mutant strains of Mannheimia haemolytica serotype 1.

The purpose of this study was to investigate SCID-bg mice engrafted with bovine haematolymphoid tissues (SCID-bo) as a model for studying bovine Mannheimia haemolytica serotype 1- induced pneumonia, in which leucotoxin (LKT) plays a major role. In experiment A, SCID-bo and SCID-bg mice were inoculated intratracheally with either (1) phosphate-buffered saline (PBS), (2) M. haemolytica wild-type strain 89010807N ("LKT(+)WT"), (3) a M. haemolytica leucotoxin-deficient mutant of strain 89010807N ("LKT(-)mutant"), or (4) the M. haemolytica wild-type Oklahoma strain. Mice were killed for examination at intervals between 20 and 44h after inoculation. Lung lesions consisted of thickened alveolar septa and neutrophil and macrophage infiltrates in the bronchioles and alveoli. Lung lesion scores in the SCID-bo mice inoculated with LKT(+)WT or LKT(-) mutant were significantly (P<0.05) greater than those of the PBS control group, but the two bacterial strains produced results that did not differ significantly. M. haemolytica was isolated from lung, liver and spleen after inoculation but less frequently as time progressed. In experiment B, SCID-bg mice were inoculated intratracheally with live LKT(+)WT or formalin-killed LKT(+)WT and killed 24, 48 or 96 h later. Lung lesions were histologically similar to those observed in experiment A; however, there were no significant differences in the lung lesion scores between groups. It was concluded that the lesions seen in this study were probably not due to LKT, and that the SCID-bo mouse does not provide a good rodent model for bovine pneumonia.

Tumorigenicity assessments of Per.C6 cells and of an Ad5-vectored HIV-1 vaccine produced on this continuous cell line.

PER.C6, a cell line derived from human embryonic retinal cells transformed with the Adenovirus Type 5 (Ad5) E1A and E1B genes, is used to produce E1-deleted Ad5 vectors such as the MRKAd5 HIV-1 gag vaccine. While whole, live PER.C6 cells are capable of growing as tumours when transplanted subcutaneously into immunodeficient nude mice at a high dosage, the process for vaccine production includes filtration steps and other methods which effectively preclude contamination by intact viable substrate cells. However, because of the neoplastic nature of this cell line, we carried out a series of investigations to assess the tumorigenic risk posed by residuals from the cell substrate in a vaccine. To address concerns about transmission of oncogenic DNA, we demonstrated that purified PER.C6 cellular DNA does not induce tumours in newborn hamsters or nude mice. To address concerns about other potential residuals, including hypothetical adventitious tumour viruses, we demonstrated that a PER.C6 cell lysate and a MRKAd5 HIV-1 gag vaccine produced on PER.C6 cells do not induce tumours in newborn hamsters or newborn rats. These results, in conjunction with the wide panel of viral safety tests performed on these cells, support the safety of the PER.C6 as a cell substrate for vaccine production.

Characterization of, and immune responses of mice to, the purified OmpA-equivalent outer membrane protein of Pasteurella multocida serotype A:3 (Omp28).

Pasteurella multocida A:3 is a major cause of bovine pneumonia. A major antigenic heat-modifiable 28kDa outer membrane protein (Omp28) was previously identified. The purpose of this study was to purify and characterize Omp28 immunologically and structurally. Omp28 was extracted from N-lauroylsarcosine-insoluble protein preparations by a combination of detergent fractionation with Zwittergent 3-14 and chromatography. Partial N-terminal amino acid sequence confirmed Omp28 as a member of the OmpA-porin family. However, porin activity could not be demonstrated in a lipid-bilayer assay. Heat modifiability of purified Omp28 was demonstrated, and Omp28 was found in outer membrane fraction of P. multocida. Surface exposure of Omp28 was demonstrated by partial protease digestion of intact bacteria, by binding of anti-Omp28 polyclonal ascites fluid to the bacterial surface, and by partial inhibition of anti-outer membrane antiserum binding by previous incubation of the bacteria with anti-Omp28 serum. CD-1 mice vaccinated with purified Omp28 developed a significant antibody titer (P<0.05) compared to the control treatment group but were not protected from a homologous intraperitoneal bacterial challenge. By contrast, treatment groups vaccinated with P. multocida outer membrane, formalin-killed P. multocida or a commercial vaccine were significantly protected from challenge. In vitro complement-mediated killing of P. multocida was observed in post-vaccination sera of outer membrane, formalin-killed P. multocida, and commercial vaccine-treatment groups, but not with sera from the Omp28-treatment group. In conclusion, although Omp28 is surface exposed and antigenic, it may not be a desirable immunogen for stimulating immunity to P. multocida.

Linkage of the MHC to familial multiple sclerosis suggests genetic heterogeneity. The Multiple Sclerosis Genetics Group.

Multiple sclerosis (MS) is a demyelinating autoimmune disease of the central nervous system. While its etiology is not well understood, genetic factors are clearly involved. Until recently, most genetic studies in MS have been association studies using the case-control design testing specific candidate genes and studying only sporadic cases. The only consistently replicated finding has been an association with the HLA-DR2 allele within the major histocompatibility complex (MHC) on chromosome 6. Using the genetic linkage design, however, evidence for and against linkage of the MHC to MS has been found, fostering suggestions that sporadic and familial MS have different etiologies. Most recently, two of four genomic screens demonstrated linkage to the MHC, although specific allelic associations were not tested. Here, a dataset of 98 multiplex families was studied to test for an association to the HLA-DR2 allele in familial MS and to determine if genetic linkage to the MHC was due solely to such an association. Three highly polymorphic markers (HLA-DR, D6S273 and TNFbeta) in the MHC demonstrated strong genetic linkage (parametric lod scores of 4.60, 2.20 and 1.24, respectively) and a specific association with the HLA-DR2 allele was confirmed (TDT; P < 0.001). Stratifying the results by HLA-DR2 status showed that the linkage results were limited to families segregating HLA-DR2 alleles. These results demonstrate that genetic linkage to the MHC can be explained by the HLA-DR2 allelic association. They also indicate that sporadic and familial MS share a common genetic susceptibility. In addition, preliminary calculations suggest that the MHC explains between 17 and 62% of the genetic etiology of MS. This heterogeneity is also supported by the minority of families showing no linkage or association with loci within the MHC.

Malicious paraquat poisoning in Oklahoma dogs.

Paraquat is a restricted use herbicide which is extremely toxic to companion animals when ingested. This report details one incident of malicious poisoning involving 6 dogs. All dogs were from the same geographic area, and 5 had pulmonary and renal lesions consistent with paraquat toxicosis. Diagnosis was initiated by a modified dithionite spot test on vomitus from 1 dog. Subsequent tissue paraquat levels ranged from non-detectable to 1 ppm.

Identification of Beck Depression Inventory items related to multiple sclerosis.

The percentage contribution of each item on the Beck Depression Inventory (BDI) to the total BDI score was compared across patients with multiple sclerosis (MS), patients diagnosed with major depressive disorder, and normal college students. We considered an item to be confounded by MS-related symptoms if its percentage contribution to the total BDI score was significantly greater in the MS group than the major depression and control groups. Items measuring work difficulty, fatigue, and concerns about health met this criterion. These items accounted for 34, 17, and 19% of the total BDI score in the MS, major depression, and control groups, respectively. Using the 18-item BDI (BDI-18) which resulted from excluding the 3 confounded items, MS patients found to be were more depressed than controls but less depressed than the major depression group. The identification of signs of depression not confounded with MS which could be substituted for confounded signs was also discussed.

Depression, coping and level of neurological impairment in multiple sclerosis.

This study examined the relationship between coping and depression in multiple sclerosis patients, and how that relationship varies at different levels of physical impairment. One-hundred and one patients with clinically definite MS were assessed using the Kurtzke Expanded Disability Status Scale (EDSS), the Ways of Coping Inventory (WCI) with three sub-scales developed by Wineman et al, and the Beck Depression Inventory (BDI). Depression was significantly higher at more advanced levels of neurologic impairment than at lower levels. Escape-Avoidance and Emotional Respite were positively related to level of depression. Planful Problem-Solving and Cognitive Reframing were negatively related to depression. An interaction between coping, depression, and level of neurologic impairment was observed in which Planful Problem-Solving and Cognitive Reframing were more strongly related to depression at higher levels of impairment. The interaction effect for Escape-Avoidance and Emotional Respite with depression and level of impairment did not reach significance. It was concluded that there is a significant interaction between level of neurologic impairment, coping behaviors, and depression in patients with MS.

Canine hepatozoonosis in Oklahoma.

Recognition of hepatozoonosis in four dogs that lived in Oklahoma their entire lifetimes documents expansion of the previously recognized endemic area of the disease. Salient clinical features are fever, marked neutrophilic leukocytosis, periosteal new bone proliferation, myalgia, weakness, muscle and generalized wasting, and lack of response to treatment. Transient, large-bowel diarrhea may be observed. Each of the four cases had signs compatible with chronic, persistent inflammatory disease that were poorly and ultimately nonresponsive to antimicrobial treatment. Diagnosis was confirmed in one case by recognition of Hepatozoon gamonts in peripheral blood leukocytes. Encysted forms of the organism were present in skeletal muscle and other tissues of each case.

Treatment of depression improves adherence to interferon beta-1b therapy for multiple sclerosis.

OBJECTIVES: To examine the relationship between patient-reported depression and adherence to therapy with interferon beta-1b (IFN beta-1b) and to test the hypothesis that treatment of depression is associated with improved adherence. DESIGN: Patients with multiple sclerosis were followed up 6 months after initiating therapy with IFN beta-1b. SETTING: A university outpatient multiple sclerosis center, an academic group practice, and a health maintenance organization. PATIENTS: Eighty-five patients with clinically evident multiple sclerosis taking IFN beta-1b. MAIN OUTCOME MEASURE: Follow-up questionnaire. RESULTS: Thirty-five (41%) of the 85 patients reported new or increased depression within 6 months of initiating therapy with IFN beta-1b. Patients experiencing symptoms of depression were more likely to discontinue therapy. Among the patients reporting new or increased depression, 86% who received psychotherapy or antidepressant medication and 38% of the patients who received no therapy for depression continued the IFN beta-1b therapy (P = .003). Although psychotherapy was used as a treatment option more frequently in university and academic group practice-based multiple sclerosis clinics than in the health maintenance organization (P = .02), the treatment adherence patterns were similar across sites. CONCLUSIONS: These findings support previous findings that patients report increased depression after initiating therapy with IFN beta-1b. Although the source of this depression is unclear, these findings suggest that treating patient-reported depression increases adherence to treatment.

Therapeutic expectations of patients with multiple sclerosis upon initiating interferon beta-1b: relationship to adherence to treatment.

This study, conducted in three separate outpatient health care delivery settings, examined the therapeutic expectations of patients with multiple sclerosis (MS) before they initiated interferon beta-1b therapy, the results of current educational procedures to correct unrealistic expectations, and the relationship between post-education expectations and discontinuing therapy. Ninety-nine consecutive patients were seen in a university based outpatient MS clinic, an academic group practice outpatient MS clinic, or a health maintenance organization outpatient neurology clinic. Before the educational sessions, 57% of the patients expressed unrealistically optimistic expectations regarding reduction in attack rate and 34% expressed unrealistically optimistic expectations regarding improvement in functional status. Educational procedures significantly altered unrealistic expectations but the results were sub-optimal since 33% of the patients maintained overly optimistic expectations regarding reduction in attack rate. Post-education unrealistic expectations of improvement in functional status were significantly related to discontinuing therapy within 6 months. Three adverse effects of therapy also were related independently to adherence to treatment: depression and flu-like symptoms were related to discontinuing therapy while soreness at injection site was related to continuing therapy.