Air Pollution and Mortality at the Intersection of Race and Social Class.

BACKGROUND: Black Americans are exposed to higher annual levels of air pollution containing fine particulate matter (particles with an aerodynamic diameter of ≤2.5 µm [PM2.5]) than White Americans and may be more susceptible to its health effects. Low-income Americans may also be more susceptible to PM2.5 pollution than high-income Americans. Because information is lacking on exposure-response curves for PM2.5 exposure and mortality among marginalized subpopulations categorized according to both race and socioeconomic position, the Environmental Protection Agency lacks important evidence to inform its regulatory rulemaking for PM2.5 standards. METHODS: We analyzed 623 million person-years of Medicare data from 73 million persons 65 years of age or older from 2000 through 2016 to estimate associations between annual PM2.5 exposure and mortality in subpopulations defined simultaneously by racial identity (Black vs. White) and income level (Medicaid eligible vs. ineligible). RESULTS: Lower PM2.5 exposure was associated with lower mortality in the full population, but marginalized subpopulations appeared to benefit more as PM2.5 levels decreased. For example, the hazard ratio associated with decreasing PM2.5 from 12 µg per cubic meter to 8 µg per cubic meter for the White higher-income subpopulation was 0.963 (95% confidence interval [CI], 0.955 to 0.970), whereas equivalent hazard ratios for marginalized subpopulations were lower: 0.931 (95% CI, 0.909 to 0.953) for the Black higher-income subpopulation, 0.940 (95% CI, 0.931 to 0.948) for the White low-income subpopulation, and 0.939 (95% CI, 0.921 to 0.957) for the Black low-income subpopulation. CONCLUSIONS: Higher-income Black persons, low-income White persons, and low-income Black persons may benefit more from lower PM2.5 levels than higher-income White persons. These findings underscore the importance of considering racial identity and income together when assessing health inequities. (Funded by the National Institutes of Health and the Alfred P. Sloan Foundation.).

Sickle cell disease and COVID-19: Susceptibility and severity.

We surveyed published papers and an international sickle cell disease (SCD) registry to detect susceptibility and clinical course of coronavirus disease 2019 (COVID-19) in SCD patients. COVID-19 presentation was mild in children and moderate in many SCD adults. Regarding increased comorbidities with age, it seems severe COVID-19 to be more common in older SCD patients. Although the overall outcome of COVID-19 was favorable in SCD children, a high rate of pediatric intensive care unit admission should be considered in managing these patients. To explain COVID-19 outcome in SCD patients, the possible benefits of hydroxyurea therapy could be considered. The obtained results should be interpreted, considering low cases from sub-Saharan people, younger age of SCD patients compared to general population, a bias toward registry of the more severe form of disease, the effect of pre-existing comorbidities with multisystem organ damage, and the role of health socio-economic determinants.

New Insights into Malaria Pathogenesis.

Malaria remains a major public health threat in tropical and subtropical regions across the world. Even though less than 1% of malaria infections are fatal, this leads to about 430,000 deaths per year, predominantly in young children in sub-Saharan Africa. Therefore, it is imperative to understand why a subset of infected individuals develop severe syndromes and some of them die and what differentiates these cases from the majority that recovers. Here, we discuss progress made during the past decade in our understanding of malaria pathogenesis, focusing on the major human parasite Plasmodium falciparum.

Ducks Are Susceptible to Infection with a Range of Doses of H5N8 Highly Pathogenic Avian Influenza Virus (2016, Clade 2.3.4.4b) and Are Largely Resistant to Virus-Specific Mortality, but Efficiently Transmit Infection to Contact Turkeys.

Widespread H5N8 highly pathogenic avian influenza virus (HPAIV; clade 2.3.4.4b) infections occurred in wild birds and poultry across Europe during winter 2016-17. Four different doses of H5N8 HPAIV (A/wigeon/Wales/052833/2016 [wg-Wal-16]) were used to infect 23 Pekin ducks divided into four separate pens, with three contact turkeys introduced for cohousing per pen at 1 day postinfection (dpi). All doses resulted in successful duck infection, with four sporadic mortalities recorded among the 23 (17%) infected ducks, which appeared unrelated to the dose. The ducks transmitted wg-Wal-16 efficiently to the contact turkeys; all 12 (100%) turkeys died. Systemic viral dissemination was detected in multiple organs in two duck mortalities, with limited viral dissemination in another duck, which died after resolution of shedding. Systemic viral tropism was observed in two of the turkeys. The study demonstrated the utility of Pekin ducks as surrogates of infected waterfowl to model the wild bird/gallinaceous poultry interface for introduction of H5N8 HPAIV into terrestrial poultry, where contact turkeys served as a susceptible host. Detection of H5N8-specific antibody up to 58 dpi assured the value of serologic surveillance in farmed ducks by hemagglutination inhibition and anti-nucleoprotein ELISAs.

Los patos son susceptibles a la infección con un rango de dosis del virus de la influenza aviar altamente patógena subtipo H5N8 (2016, clado 2.3.4.4b) son muy resistentes a la mortalidad específica por el virus, pero transmiten la infección de manera eficiente a pavos por contacto. La diseminación de la infección por el virus de la influenza aviar altamente patógeno H5N8 (con las siglas en inglés HPAIV); clado 2.3.4.4b ocurrió en aves silvestres y avicultura comercial en toda Europa durante el invierno 2016­17. Se usaron cuatro dosis diferentes del virus de alta patogenicidad H5N8 (A/wigeon/Gales/052833/2016 [wg-Wal-16]) para infectar a 23 patos Pekin divididos en cuatro corrales, cohabitando con tres pavos en el corral para determinar transmisión por contacto al primer día después de la infección (dpi). Todas las dosis dieron como resultado una infección exitosa de los patos, con mortalidad esporádica en cuatro aves (17%) registradas entre los 23 patos infectados, que no parecieron estar relacionadas con la dosis. Los patos transmitieron el virus wg-Wal-16 de manera eficiente a los pavos por contacto; los 12 pavos (100%) murieron. La diseminación viral sistémica se detectó en múltiples órganos en dos patos muertos, con diseminación viral limitada en otro pato que murió después de la resolución de la eliminación viral. Se observó tropismo viral sistémico en dos de los pavos. El estudio demostró la utilidad de los patos Pekin como sustitutos de las aves acuáticas infectadas en un modelo de la interface entre aves silvestres y aves comerciales gallináceas para la introducción del subtipo H5N8 del virus de influenza aviar de alta patogenicidad en las aves comerciales terrestres. Los pavos de contacto sirvieron como hospedadores susceptibles. La detección de anticuerpos específicos contra el subtipo H5N8 hasta 58 días después de la inoculación justificó el valor de la vigilancia serológica en las granjas de patos mediante la inhibición de la hemaglutinación y por estuches de ELISA dirigidos contra la nucleoproteína.

Macroecology of birds potentially susceptible to West Nile virus.

Zoonotic diseases transmitted by wildlife affect biological conservation, public and animal health, and the economy. Current research efforts are aimed at finding wildlife pathogens at a given location. However, a meta-analytical approach may reveal emerging macroecological patterns in the host-pathogen relationship at different temporal and spatial scales. West Nile virus (WNV) is a pathogen with worldwide detrimental impacts on bird populations. To understand macroecological patterns driving WNV infection, we aimed to recognize unknown competent reservoirs using three disease metrics-serological prevalence (SP), molecular prevalence (MP) and mortality (M)-and test if these metrics are correlated with the evolutionary history, geographical origin of bird species, viral strain, time-space and methodology. We performed a quantitative review of field studies on birds sampled for WNV. We obtained 4945 observations of 949 species from 39 countries. Our analysis supported the idea that MP and M are good predictors of reservoir competence, and allowed us to identify potential competent reservoirs. Furthermore, results indicated that the variability of these metrics was attributable to phylogeny, time-space and sample size. A macroecological approach is needed to recognize susceptible species and competent reservoirs, and to identify other factors driving zoonotic diseases originating from wildlife.

Susceptibility of isogeneic ginbuna Carassius auratus langsdorfii Temminck et Schlegel to cyprinid herpesvirus-2 (CyHV-2) as a model species.

Herpesviral haematopoietic necrosis (HVHN), caused by cyprinid herpesvirus-2 (CyHV-2), has affected the commercial production of the goldfish Carassius auratus and gibelio carp Carassius auratus gibelio. High water temperature treatments are reported to reduce the mortality rate of infected goldfish and elicit immunity in the survivors. To define the mechanism by which this intervention induces resistance, clonal ginbuna Carassius auratus langsdorfii, which is closely related to both species and has been used in fish immunology, may represent a promising model species. In this study, we investigated the susceptibility of clonal ginbuna strains to CyHV-2 and the effect of high water temperature treatment on infected ginbuna and goldfish. Experimental intraperitoneal infection with CyHV-2 at 25 °C caused 100% mortality in ginbuna strains, which was accompanied by histopathological changes typical of HVHN. Both infected ginbuna S3n strain and goldfish, exposed to high temperature for 6 days [shifting from 25 °C (permissive) to 34 °C (non-permissive)], showed reduced mortalities after the 1st inoculation, and subsequent 2nd virus challenge to 0%, indicating induction of immunity. It was concluded that ginbuna showed a similar susceptibility and disease development in CyHV-2 infection compared to goldfish, suggesting that ginbuna can be a useful fish model for the study of CyHV-2 infection and immunity.

How the effects of aging and stresses of life are integrated in mortality rates: insights for genetic studies of human health and longevity.

Increasing proportions of elderly individuals in developed countries combined with substantial increases in related medical expenditures make the improvement of the health of the elderly a high priority today. If the process of aging by individuals is a major cause of age related health declines then postponing aging could be an efficient strategy for improving the health of the elderly. Implementing this strategy requires a better understanding of genetic and non-genetic connections among aging, health, and longevity. We review progress and problems in research areas whose development may contribute to analyses of such connections. These include genetic studies of human aging and longevity, the heterogeneity of populations with respect to their susceptibility to disease and death, forces that shape age patterns of human mortality, secular trends in mortality decline, and integrative mortality modeling using longitudinal data. The dynamic involvement of genetic factors in (i) morbidity/mortality risks, (ii) responses to stresses of life, (iii) multi-morbidities of many elderly individuals, (iv) trade-offs for diseases, (v) genetic heterogeneity, and (vi) other relevant aging-related health declines, underscores the need for a comprehensive, integrated approach to analyze the genetic connections for all of the above aspects of aging-related changes. The dynamic relationships among aging, health, and longevity traits would be better understood if one linked several research fields within one conceptual framework that allowed for efficient analyses of available longitudinal data using the wealth of available knowledge about aging, health, and longevity already accumulated in the research field.

Susceptibility of Carrion Crows to Experimental Infection with Lineage 1 and 2 West Nile Viruses.

West Nile virus (WNV) outbreaks in North America have been characterized by substantial die-offs of American crows (Corvus brachyrhynchos). In contrast, a low incidence of bird deaths has been observed during WNV epidemic activity in Europe. To examine the susceptibility of the western European counterpart of American crows, we inoculated carrion crows (Corvus corone) with WNV strains isolated in Greece (Gr-10), Italy (FIN and Ita09), and Hungary (578/10) and with the highly virulent North American genotype strain (NY99). We also inoculated American crows with a selection of these strains to examine the strains' virulence in a highly susceptible bird species. Infection with all strains, except WNV FIN, resulted in high rates of death and high-level viremia in both bird species and virus dissemination to several organs. These results suggest that carrion crows are highly susceptible to WNV and may potentially be useful as part of dead bird surveillance for early warning of WNV activity in Europe.

DRUG-RESISTANT TUBERCULOSIS AMONG URBAN THAI CHILDREN: A 10-YEAR REVIEW.

Drug-resistant tuberculosis (DR-TB) has become an increasing public health concern. We conducted this retrospective chart review to determine the risk factors, susceptibility patterns, and clinical outcomes of children with DR-TB treated at the Queen Sirikit National Institute of Child Health, Bangkok, Thailand. Susceptibility results were available for 78 of the 91 patients (85.7%) with positive cultures for M. tuberculosis. Sensitivity of tuberculin skin testing for overall culture-confirmed tuberculosis with a cut-off point of 10 mm for human immunodeficiency virus (HIV)-uninfected cases was 76.9%. Using a 5-mm induration cut-off-point for tuberculin skin testing for HIV-infected cases, sensitivity was only 14.3%. Resistance to at least one anti-tubercular drug was found in 22 cases (28.2%), with streptomycin resistance being the most common (21.7%), followed by isoniazid (11.5%), rifampicin (5.1%), and ethambutol (5.1%). Multi-drug resistance (MDR) was observed in 3 cases (3.8%). A history of previous TB treatment and bone and joint involvement were associated with a significantly higher percentage of DR-TB: 18.2% vs 1.8% (p = 0.0078) and 22.7 vs 1.8% (p = 0.0018), respectively. Case fatality rates were 1.7% and 4.5% for drug-susceptible and DR-TB, respectively. Due to the high rate of resistance, streptomycin is not recommended as first time treatment of childhood tuberculosis in Thailand.

Influenza vaccination and associated factors among Korean cancer survivors : a cross-sectional analysis of the Fourth & Fifth Korea National Health and Nutrition Examination Surveys.

Influenza vaccination is important for cancer survivors, a population with impaired immunity. This study was designed to assess influenza vaccination patterns among Korean cancer survivors. In this cross-sectional analysis, data were obtained from standardized questionnaires from 943 cancer survivors and 41,233 non-cancer survivors who participated in the Fourth and Fifth Korea National Health and Nutrition Examination Surveys (2007-2011). We identified the adjusted influenza vaccination rates and assessed factors associated with influenza vaccination using multivariate logistic regression. Cancer survivors tended to have a higher adjusted influenza vaccination rate than the general population. The rates for influenza vaccination in specific cancer types such as stomach, hepatic, colon, and lung cancers were significantly higher than non-cancer survivors. Among all cancer survivors, those with chronic diseases, elderly subjects, and rural dwellers were more likely to receive influenza vaccination; those with cervical cancer were less likely to receive influenza vaccination. Cancer survivors were more likely to receive influenza vaccinations than non-cancer survivors, but this was not true for particular groups, especially younger cancer survivors. Cancer survivors represent a sharply growing population; therefore, immunization against influenza among cancer survivors should be concerned as their significant preventative healthcare services.

Influência do tratamento com benzonidazol na resposta imunológica de camundongos infectados com cepas do trypanosoma cruzi de diferentes biodemas / Influence of treatment with benznidazole in the immune response of mice infected with Trypanosoma cruzi strains of different biodemes

A infecção pelo Trypanosoma cruzi determina uma resposta imunológica inata do hospedeiro vertebrado, decorrente da multiplicação parasitaria em macrófagos e a produção de Interferon gama (IFNy) pelas células T ativadas, além de estimulação policlonal de células do baço, com imunossupressão. Por outro lado tem sido demonstrado que o tratamento com quimioterápico Benzonidazol em camundongos infectados, além de determinar uma destruição dos parasitos, tem também uma ação sobre o sistema imunológico em camundongos infectados com cepas do T. cruzi com diferentes graus de suscetibilidade ao Benzonidazol, como a cepa Y (suscetível ao quimioterápico) e a cepa Colombiana (resistente). No presente estudo procura-se investigar a influência do tratamento com o Benzonidazol sobre a resposta imunológica em camundongos infectados com cepa suscetível (Cepa Y) ou resistente (Colombiana). Foram utilizados 320 camundongos, subdivididos em grupos experimentais: Infectados tratados cepa Y (YT) e não tratados (Y-NT); Colombiana tratados (COL-T) e não tratados (COL-NT), Tratados não infectados (TNI) e Controles sem tratamento (CI). O inóculo foi de 1,0 x 104 por via intraperitoneal. O tratamento foi iniciado no pico parasitêmico de cada cepa, sendo no 7º dia após a infecção nos animais infectados pela cepa Y e, nos tratados e não infectados, no 18º dia de infecção na cepa Colombiana. A quimioterapia foi realizada em 60 doses (100mg/kg/dia de Benzonidazol-Benz). Os camundongos sacrificados na fase aguda e na fase crônica em todos os grupos tiveram as secções de coração e músculo esquelético coletadas, fixadas e processadas para o estudo histopatológico em secções coradas pela Hematoxilina & Eosina e Picro-Sirius. Investigou-se a resposta humoral pela sorologia (Imunofluorescência indireta) e pela reação de Elisa. A resposta celular pela proliferação celular do baço, e pela avaliação quantitativa das subpopulações celulares no baço de CD4+, CD8+...

Infection with T. cruzi determines an immunological response in the vertebrate host, wit h parasites multiplication in macrophages, with production of TNFα by these cells an IFNγ, by stimulated T. cells: a polyclonal multiplication of spleen cells is present, with immunossuppression. Treatment of infected mice with BENZ showed that this chemotherapy determines parasitic destruction and also stimulates the immunological system in mice infected either with the Y or the Colombian strain which differs in the susceptibility to chemotherapy with BENZ. In the present study we intend to investigate the influence of treatment with BENZ on the immunological response in mice infected either with the Y strain (susceptible) or the Colombian strain (resistant). This study was performed by comparing the results obtained with the groups of mice not infected and treated, and infected controls, not treated. Material and methods : Number of animals: 320, sub-divided in the experimental groups:Ystrain infected and treated with BENZ(YT) or not-treated (YNT); Colombian treated (COL-T) and not-treated (COL-NT); treated not infected (TNI); Control not treated (COL-NT). Inoculum : 1x104 trypomastigotes, (blood forms) injected intraperitoneally. Treatment was initiated in the peak of parasitemia for each strain:7th day for the Y strain and in the 18th day in the infection with the Colombian strain. Chemotherapy was performed in 60 doses (100mg x kg x day) of BENZ. Mice were killed in the acute and chronic phases post infection; sections of the heart and skeletal muscles were collected, fixed and processed for histopathology, in sections stained with Hematoxylin and Eosin, and with Picro-Sirius staining, for collagen. The humoral response was evaluated by serological reactium of indirect immununofluorescence and ELISA reaction. Celular responses were evaluated by celular proliferation in the spleen of CD4+, CD8+...

Predisposition, insult/infection, response and organ dysfunction (PIRO): a pilot clinical staging system for hospital mortality in patients with infection.

PURPOSE: To develop a clinical staging system based on the PIRO concept (Predisposition, Infection, RESPONSE and Organ dysfunction) for hospitalized patients with infection. METHODS: One year prospective cohort study of all hospitalized patients with infection (n = 1035), admitted into a large tertiary care, university hospital. Variables associated with hospital mortality were selected using logistic regressions. Based on the regression coefficients, a score for each PIRO component was developed and a classification tree was used to stratify patients into four stages of increased risk of hospital mortality. The final clinical staging system was then validated using an independent cohort (n = 186). RESULTS: Factors significantly associated with hospital mortality were • for Predisposition: age, sex, previous antibiotic therapy, chronic hepatic disease, chronic hematologic disease, cancer, atherosclerosis and a Karnofsky index<70; • for Insult/Infection: type of infection • for RESPONSE: abnormal temperature, tachypnea, hyperglycemia and severity of infection and • for Organ dysfunction: hypotension and SOFA score≥1. The area under the ROC curve (CI95%) for the combined PIRO model as a predictor for mortality was 0.85 (0.82-0.88). Based on the scores for each of the PIRO components and on the cut-offs estimated from the classification tree, patients were stratified into four stages of increased mortality rates: stage I: ≤5%, stage II: 6-20%, stage III: 21-50% and stage IV: >50%. Finally, this new clinical staging system was studied in a validation cohort, which provided similar results (0%, 9%, 31% and 67%, in each stage, respectively). CONCLUSIONS: Based on the PIRO concept, a new clinical staging system was developed for hospitalized patients with infection, allowing stratification into four stages of increased mortality, using the different scores obtained in Predisposition, RESPONSE, Infection and Organ dysfunction. The proposed system will likely help to define inclusion criteria in clinical trials as well as tailoring individual management plans for patients with infection.

Risk factors and mortality of patients with nosocomial carbapenem-resistant Acinetobacter baumannii pneumonia.

BACKGROUND: Acinetobacter baumannii is characterized by strictly aerobic, gram-negative, nonmotile, nonlactose-fermenting, oxidase-negative, catalase-positive coccobacilli, and the combination of its environmental resilience and its rapid development of resistance to multiple classes of antimicrobials renders it a successful nosocomial pathogen. OBJECTIVES: The aim of this study was to identify specific risk factors and outcome of nosocomial pneumonia because of carbapenem-resistant Acinetobacter baumannii (CRAB). METHODS: The retrospective study, set in a 1,500-bed referral and tertiary care hospital, was conducted to analyze the clinical and microbiologic data of patients with nosocomial pneumonia because of Acinetobacter baumannii (A baumannii) from January 2006 to December 2011. Comparisons were made between patients with CRAB pneumonia and patients with carbapenem-susceptible A baumannii (CSAB) pneumonia. Only the first isolation of A baumannii was considered. RESULTS: A total of 145 patients with CSAB pneumonia and 97 patients with CRAB pneumonia was included. Among these patients, the independent risk factors for acquiring CRAB pneumonia were Acute Physiology and Chronic Health Evaluation II (APACHE II) score (>20) at admission, systemic illnesses (chronic respiratory disease and cerebrovascular accident), presence of excess noninvasive or invasive devices (mechanical ventilation), and ever used antibiotics within 28 days (carbapenem and cefepime). The patients with CRAB pneumonia had higher mortality rate than CSAB pneumonia. Multivariate analysis showed that, among patients with A baumannii pneumonia, APACHE II score (>20) at pneumonia onset, infections with other microorganisms, and inappropriate therapy were independently associated with 28-day mortality. CONCLUSION: Patients with CRAB pneumonia have a higher mortality rate than those with CSAB pneumonia. The nosocomial occurrence of CRAB pneumonia is strongly related to systemic illnesses, APACHE II score, mechanical ventilation, and ever used antibiotics within 28 days.

Comparative susceptibility among three stocks of yellow perch, Perca flavescens (Mitchill), to viral haemorrhagic septicaemia virus strain IVb from the Great Lakes.

The Great Lakes strain of viral haemorrhagic septicaemia virus IVb (VHSV-IVb) is capable of infecting a wide number of naive species and has been associated with large fish kills in the Midwestern United States since its discovery in 2005. The yellow perch, Perca flavescens (Mitchill), a freshwater species commonly found throughout inland waters of the United States and prized for its high value in sport and commercial fisheries, is a species documented in several fish kills affiliated with VHS. In the present study, differences in survival after infection with VHSV IVb were observed among juvenile fish from three yellow perch broodstocks that were originally derived from distinct wild populations, suggesting innate differences in susceptibility due to genetic variance. While all three stocks were susceptible upon waterborne exposure to VHS virus infection, fish derived from the Midwest (Lake Winnebago, WI) showed significantly lower cumulative % survival compared with two perch stocks derived from the East Coast (Perquimans River, NC and Choptank River, MD) of the United States. However, despite differences in apparent susceptibility, clinical signs did not vary between stocks and included moderate-to-severe haemorrhages at the pelvic and pectoral fin bases and exophthalmia. After the 28-day challenge was complete, VHS virus was analysed in subsets of whole fish that had either survived or succumbed to the infection using both plaque assay and quantitative PCR methodologies. A direct correlation was identified between the two methods, suggesting the potential for both methods to be used to detect virus in a research setting.

Low lipoprotein(a) concentration is associated with cancer and all-cause deaths: a population-based cohort study (the JMS cohort study).

BACKGROUND: Experimental studies support the anti-neoplastic effect of apo(a), but several clinical studies have reported contradictory results. The purpose of this study was to determine whether a low lipoprotein(a) [Lp(a)] concentration is related to mortality from major causes of death, especially cancer. METHODS: The subjects were 10,413 participants (4,005 men and 6,408 women) from a multi-center population-based cohort study in Japan (The Jichi Medical School cohort study). The average age at registration was 55.0 years, and the median observation period was 4,559 days. As the estimated hazard ratio was high for both the low and very high Lp(a) levels, we defined two Lp(a) groups: a low Lp(a) group [Lp(a)<80 mg/L] and an intermediate-to-high Lp(a) group [Lp(a) ≥ 80]. Participants who died from malignant neoplasms (n = 316), cardiovascular disease (202), or other causes (312) during the observation period were examined. RESULTS: Cumulative incidence plots showed higher cumulative death rates for the low Lp(a) group than for the intermediate-to-high Lp(a) group for all-cause, cancer, and miscellaneous-cause deaths (p<0.001, p = 0.03, and p = 0.03, respectively). Cox proportional hazards analyses with the sex and age of the participants, body mass index, and smoking and drinking histories as covariates showed that a low Lp(a) level was a significant risk for all-cause, cancer, and miscellaneous-cause deaths (p<0.001, p = 0.003, and p = 0.01, respectively). The hazard ratio (95% CI) [1.48, 1.15-1.92] of a low Lp(a) level for cancer deaths was almost the same as that for a male sex (1.46, 1.00-2.13). CONCLUSIONS: This is the first report to describe the association between a low Lp(a) level and all-cause or cancer death, supporting the anti-neoplastic effect of Lp(a). Further epidemiological studies are needed to confirm the present results.

Prostate cancer and prostate-specific antigen (PSA) screening in Austria.

The possible effect of prostate-specific antigen (PSA) testing on prostate cancer mortality has remained controversial, despite the test's widespread application. We examined age-specific mortality trends for prostate cancer in Austria before and after the introduction of (opportunistic) PSA testing, to ask whether PSA screening reduces prostate cancer mortality in a uniform cohort of men with equal access to health care. Prostate cancer mortality data covering all 9 federal states of Austria were analysed from 1970 to 2002. PSA testing became widely available in Austria not before 1989. Tyrol, one of the nine federal states of Austria, independently launched a mass prostate cancer prevention project in 1993. We applied join-point regression models to identify changes in the slope of age-specific mortality trends in selected age groups (50-59, 60-69, 70-79, and 80-89 years) and calculated the annual percent change (APC) in mortality between 1970 and 2002 for Tyrol and the rest of Austria separately. After 12 years of follow-up, we were not able to observe a significant reduction in prostate cancer mortality since the introduction of the PSA test in the age groups of 50-59, 60-69, and 80-89 years. A significant decrease was found in the age group of 70-79 (Austria without Tyrol 1989 through 2002: APC, -2.36; 95% CI, -3.38 to -1.34; Tyrol 1991 through 2002: APC, -6.42; 95% CI, -8.92 to -3.86). In this age group the join points 1989 and 1991 cannot be related to PSA testing. PSA screening does not appear to reduce prostate cancer mortality in a uniform cohort of men with equal access to health care. However, given the long lead-time for prostate cancer, even longer follow-up may still be needed to detect any important trends.

Feed deprivation of channel catfish, Ictalurus punctatus (Rafinesque), influences organosomatic indices, chemical composition and susceptibility to Flavobacterium columnare.

Withholding feed has been suggested as a strategy to manage infectious disease of channel catfish, Ictalurus punctatus (Rafinesque). In a previous study, we demonstrated that deprivation of feed for as little as 7 days reduced innate resistance of catfish to Flavobacterium columnare. This study was conducted to evaluate the effect of feeding regimens [no feeding (NF), fed once every other day to satiation (FEOD) and fed once daily to satiation (FD)] on organosomatic indices, physiological changes and susceptibility of channel catfish to F. columnare. Fish that were not fed for 2 and 4 weeks had a significant increase (P < 0.05) in gutted weight:-wet weight ratio and decrease in other organosomatic indices [gut index (GI), mesenteric fat index (MFI) and hepatosomatic index (HSI)]. Haematology was not effected by feeding regimen except at week 4, when a significantly higher haemoglobin level was observed in the NF fish. Serum protein did not differ at week 2, but the level at week 4 of the NF fish (35.91 mg mL(-1)) was significantly lower than that of the FD fish (41.77 mg mL(-1)). Significantly lower (P < 0.05) blood glucose (39.5 and 40.3 mg dL(-1)) and liver glycogen (1.7 and 1.8 mg g(-1)) were seen in the NF fish at weeks 2 and 4, respectively, as compared with blood glucose and liver glycogen levels of FD fish (67.5 and 92.8 mg dL(-1) and 46.5 and 52.6 mg g(-1) at weeks 2 and 4, respectively) and FEOD (82.8 and 85.5 mg dL(-1) and 45.1 and 51.4 mg g(-1) at weeks 2 and 4, respectively). Mortality in the NF fish caused by F. columnare (78%) was significantly higher (P < 0.05) than mortality in the FD and FEOD treatments (0.0 and 1.7%, respectively). Blood glucose and liver glycogen showed the same trend of low values for NF fish following challenge (week 6). Blood glucose, liver glycogen, GI and HSI are sensitive indicators for channel catfish deprived of feed (NF) for 4 weeks. Blood glucose and liver glycogen levels around 40 mg dL(-1) and 2 mg g(-1), respectively, are indicative of starvation in juvenile channel catfish. Moreover, NF fish were susceptible to F. columnare infection. Thus, it is suggested that in the absence of natural food, juvenile channel catfish should be fed at least once every other day to apparent satiation to maintain normal physiological function and improve resistance to F. columnare.

Men with colorectal cancer are predisposed to prostate cancer.

BACKGROUND: The objective of the present study was to investigate the relationship between colorectal and prostate cancer. METHODS: All Victorian men who developed metachronous colorectal and prostate cancer with the first primary diagnosed between 1982 and 1993 were identified retrospectively from the Victorian Cancer Registry and were followed up to the end of 1995. Analyses were stratified by age group and years of follow up. The cause of death in those men who had prostate cancer following colorectal cancer was determined. The stage of colorectal cancer was compared between men with and without second primary prostate cancer and the grade of prostate cancer was compared with men who did not have a prior colorectal cancer. RESULTS: Men who develop colorectal cancer are at increased risk of prostate cancer, with the greatest risk in men under the age of 65 (Relative risk approximately 2). Men with first primary colorectal cancer are more likely to develop prostate cancer than colorectal second primaries, and men who develop second primary prostate cancer are more likely to die of prostate cancer than colorectal cancer. CONCLUSIONS: Younger men diagnosed with colorectal cancer are at increased risk of prostate cancer. However, there is no direct evidence that screening for prostate cancer leads to a reduction in mortality. This should be considered when discussing long-term follow up.

Infant susceptibility of mortality to air pollution in Seoul, South Korea.

OBJECTIVE: Susceptibility of target populations to air pollution is an important issue, because air pollution policies and standards should be based on the susceptibilities of those at particular risk. To evaluate which age group is more susceptible to the adverse health effects of air pollution, we compared the effects of air pollution on mortality among postneonates, those aged 2 to 64 years, and those over 65 years of age. DESIGN: Daily counts of total and respiratory death along with daily levels of meteorological variables and air pollutants were analyzed using generalized additive Poisson regression. The relative risks (RR) of mortality for interquartile changes of the levels of particulate matter <10 micro m (PM(10)) were calculated on the same day. RESULTS: For postneonates, the RR of total mortality for an interquartile change (42.9 micro g/m(3)) in PM(10) (RR: 1.142; 95% confidence interval [CI]: 1.096-1.190) was greatest among age groups. Next were the elderly over 65 years of age (RR: 1.023; 95% CI: 1.022-1.024). Regarding respiratory mortality, RR for an interquartile change of PM(10) in postneonates (RR: 2.018; 95% CI: 1.784-2.283) was also greater than those in the other groups. CONCLUSIONS: These results agree with the hypothesis that infants are most susceptible to PM(10) in terms of mortality, particularly respiratory mortality.