Ultrasound-Confirmed, Age-Specific Uterine Leiomyoma Incidence in a Cohort of Black Individuals.

OBJECTIVE: To estimate the age-specific incidence of uterine leiomyomas identified by transvaginal ultrasonography among participants in SELF (Study of Environment, Lifestyle & Fibroids). METHODS: SELF is a longitudinal cohort study of individuals aged 23-35 years who self-identified as Black. Participants were recruited from the Detroit, Michigan, area and underwent up to five transvaginal ultrasonograms over a period of up to 10 years to identify uterine leiomyomas. We randomly imputed incidence dates between the last ultrasonogram date in which no leiomyomas were detected and the date of the ultrasonogram in which leiomyomas were first detected. We used Poisson regression to estimate age-specific incidence rates per 1,000 person-years with 95% CIs. The rates were then compared with those of the BWHS (Black Women's Health Study) and the NHS II (Nurses' Health Study II)-two prospective cohort studies based on self-reported leiomyoma diagnoses. RESULTS: In this cohort, 1,693 participants completed a baseline interview and ultrasonogram. We excluded 385 (22.7%) participants with leiomyomas detected during baseline, seven participants whose ultrasonograms were poor quality, and 60 participants with only a baseline ultrasonogram. Among the remaining 1,241 participants, the overall incidence rate was 53.9 cases per 1,000 person-years (95% CI 48.6-59.6). The age-specific incidence rates (cases/1,000 person-years) were: younger than 30 years: 49.7, 95% CI 40.9-59.9; 30-34 years: 55.2, 95% CI 47.0-64.3; and 35-39 years: 58.2, 95% CI 47.3-70.9. Among participants aged younger than 30 years, the incidence rate in SELF was more than double that of the BWHS or the NHS II. CONCLUSION: The high age-specific leiomyoma incidence rates in this prospective ultrasound-based study indicate that many young Black individuals with leiomyomas go undiagnosed. These data suggest that individuals could benefit from ultrasound screening when they experience symptoms compatible with leiomyomas (eg, heavy menstrual bleeding, anemia, pelvic pain).

Participant-level characteristics differ by recruitment setting when evaluating a behavioral intervention targeting adolescents with asthma.

OBJECTIVE: The recruitment setting plays a key role in the evaluation of behavioral interventions. We evaluated a behavioral intervention for urban adolescents with asthma in three randomized trials conducted separately in three different settings over the course of 8 years. We hypothesized that characteristics of trial participants recruited from the ED and clinic settings would be significantly different from that of youth participating in the school-based trials. The intervention evaluated was Puff City, a web-based program that uses tailoring to improve asthma management behaviors. METHODS: The present analysis includes youth aged 13-19 years who reported a physician diagnosis of asthma and symptoms at trial baseline. In the three trials, all participants were randomized post-baseline to a web-based, tailored intervention (treatment) or generic web-based asthma education (control). RESULTS: Compared to school-based trial participants, ED participants had significantly more acute-care visits for asthma (p < 0.001) and more caregiver depression (p < 0.001). Clinic-based participants were more likely to have computer/ internet access than participants from the school-based trial (p < 0.001). Both ED and clinic participants were more likely to report controller medication (p's < 0.001) and higher teen emotional support (p's < 0.01) when compared to the schools, but were less likely to report Medicaid (p's < 0.014) and exposure to environmental tobacco smoke (p < 0.001). CONCLUSION: Compared to participants in the school-based trials, participants recruited from ED and clinic settings differed significantly in terms of healthcare use, as well as psychosocial and sociodemographic factors. These factors can inform intervention content, and may impact external validity of behavioral interventions for asthma.

Association between cesarean delivery types and obesity in preadolescence.

BACKGROUND/OBJECTIVES: The association between mode of delivery and childhood obesity remains inconclusive. Because few studies have separated C-section types (planned or unplanned C-section), our objective was to assess how these subtypes relate to preadolescent obesity. SUBJECTS/METHODS: The study consisted of 570 maternal-child pairs drawn from the WHEALS birth cohort based in Detroit, Michigan. Children were followed-up at 10 years of age where a variety of anthropometric measurements were collected. Obesity was defined based on BMI percentile (≥95th percentile), as well as through Gaussian finite mixture modeling on the anthropometric measurements. Risk ratios (RRs) and 95% confidence intervals (CIs) for obesity comparing planned and unplanned C-sections to vaginal deliveries were computed, which utilized inverse probability weights to account for loss to follow-up and multiple imputation for covariate missingness. Mediation models were fit to examine the mediation role of breastfeeding. RESULTS: After adjusting for marital status, maternal race, prenatal tobacco smoke exposure, maternal age, maternal BMI, any hypertensive disorders during pregnancy, gestational diabetes, prenatal antibiotic use, child sex, parity, and birthweight z-score, children born via planned C-section had 1.77 times higher risk of obesity (≥95th percentile), relative to those delivered vaginally ((95% CI) = (1.16, 2.72); p = 0.009). No association was found comparing unplanned C-section to vaginal delivery (RR (95% CI) = 0.75 (0.45, 1.23); p = 0.25). The results were similar but slightly stronger when obesity was defined by anthropometric class (RR (95% CI) = 2.78 (1.47, 5.26); p = 0.002). Breastfeeding did not mediate the association between mode of delivery and obesity. CONCLUSIONS: These findings indicate that children delivered via planned C-section-but not unplanned C-section-have a higher risk of preadolescent obesity, suggesting that partial labor or membrane rupture (typically experienced during unplanned C-section delivery) may offer protection. Additional research is needed to understand the biological mechanisms behind this effect, including whether microbiological differences fully or partially account for the association.

Expression quantitative trait locus fine mapping of the 17q12-21 asthma locus in African American children: a genetic association and gene expression study.

BACKGROUND: African ancestry is associated with a higher prevalence and greater severity of asthma than European ancestries, yet genetic studies of the most common locus associated with childhood-onset asthma, 17q12-21, in African Americans have been inconclusive. The aim of this study was to leverage both the phenotyping of the Children's Respiratory and Environmental Workgroup (CREW) birth cohort consortium, and the reduced linkage disequilibrium in African Americans, to fine map the 17q12-21 locus. METHODS: We first did a genetic association study and meta-analysis using 17q12-21 tag single-nucleotide polymorphisms (SNPs) for childhood-onset asthma in 1613 European American and 870 African American children from the CREW consortium. Nine tag SNPs were selected based on linkage disequilibrium patterns at 17q12-21 and their association with asthma, considering the effect allele under an additive model (0, 1, or 2 effect alleles). Results were meta-analysed with publicly available summary data from the EVE consortium (on 4303 European American and 3034 African American individuals) for seven of the nine SNPs of interest. Subsequently, we tested for expression quantitative trait loci (eQTLs) among the SNPs associated with childhood-onset asthma and the expression of 17q12-21 genes in resting peripheral blood mononuclear cells (PBMCs) from 85 African American CREW children and in upper airway epithelial cells from 246 African American CREW children; and in lower airway epithelial cells from 44 European American and 72 African American adults from a case-control study of asthma genetic risk in Chicago (IL, USA). FINDINGS: 17q12-21 SNPs were broadly associated with asthma in European Americans. Only two SNPs (rs2305480 in gasdermin-B [GSDMB] and rs8076131 in ORMDL sphingolipid biosynthesis regulator 3 [ORMDL3]) were associated with asthma in African Americans, at a Bonferroni-corrected threshold of p<0·0055 (for rs2305480_G, odds ratio [OR] 1·36 [95% CI 1·12-1·65], p=0·0014; and for rs8076131_A, OR 1·37 [1·13-1·67], p=0·0010). In upper airway epithelial cells from African American children, genotype at rs2305480 was the most significant eQTL for GSDMB (eQTL effect size [ß] 1·35 [95% CI 1·25-1·46], p<0·0001), and to a lesser extent showed an eQTL effect for post-GPI attachment to proteins phospholipase 3 (ß 1·15 [1·08-1·22], p<0·0001). No SNPs were eQTLs for ORMDL3. By contrast, in PBMCs, the five core SNPs were associated only with expression of GSDMB and ORMDL3. Genotype at rs12936231 (in zona pellucida binding protein 2) showed the strongest associations across both genes (for GSDMB, eQTLß 1·24 [1·15-1·32], p<0·0001; and for ORMDL3 (ß 1·19 [1·12-1·24], p<0·0001). The eQTL effects of rs2305480 on GSDMB expression were replicated in lower airway cells from African American adults (ß 1·29 [1·15-1·44], p<0·0001). INTERPRETATION: Our study suggests that SNPs regulating GSDMB expression in airway epithelial cells have a major role in childhood-onset asthma, whereas SNPs regulating the expression levels of 17q12-21 genes in resting blood cells are not central to asthma risk. Our genetic and gene expression data in African Americans and European Americans indicated GSDMB to be the leading candidate gene at this important asthma locus. FUNDING: National Institutes of Health, Office of the Director.

Serum cholesterol trajectories in the 10 years prior to lymphoma diagnosis.

PURPOSE: Many studies suggest a role for cholesterol in cancer development. Serum cholesterol levels have been observed to be low in newly diagnosed lymphoma cases. The objective of these analyses was to examine the time-varying relationship of cholesterol with lymphomagenesis in the 10 years prior to diagnosis by lymphoma subtype. METHODS: Participants were selected from the combined membership of six National Cancer Institute-funded Cancer Research Network health plans from 1998 to 2008, excluding members with human immunodeficiency virus, cancer (except lymphoma), or organ transplants. Incident lymphoma cases within this population were ascertained and matched with up to five controls. Total serum cholesterol, high-density lipoprotein, and low-density lipoprotein were collected from plan databases. Multilevel, multivariable longitudinal models were fit after choosing the best polynomial order by deviance statistics for selected lymphoma histotypes to examine pre-diagnosis cholesterol trajectories: Hodgkin lymphoma (n = 519) and all non-Hodgkin lymphomas combined (n = 12,635) as well as six subtypes of the latter. RESULTS: For all categories, lymphoma cases had statistically significantly lower estimated total serum cholesterol, high-density lipoprotein, and low-density lipoprotein levels than controls in the years prior to diagnosis/index date. Between-group differences were most pronounced 3-4 years prior to diagnosis, when cases' cholesterol levels declined steeply. CONCLUSIONS: This analysis is the first to examine changes in serum cholesterol for a decade prior to lymphoma diagnosis. A drop in cholesterol levels was evident several years before diagnosis. Our results suggest that cholesterol-related pathways have an important relationship with lymphomagenesis and low cholesterol could be a preclinical lymphoma marker.

Breast Milk Transforming Growth Factor ß Is Associated With Neonatal Gut Microbial Composition.

BACKGROUND AND OBJECTIVES: Breast milk is a complex bioactive fluid that varies across numerous maternal and environmental conditions. Although breast-feeding is known to affect neonatal gut microbiome, the milk components responsible for this effect are not well-characterized. Given the wide range of immunological activity breast milk cytokines engage in, we investigated 3 essential breast milk cytokines and their association with early life gut microbiota. METHODS: A total of 52 maternal-child pairs were drawn from a racially diverse birth cohort based in Detroit, Michigan. Breast milk and neonatal stool specimens were collected at 1-month postpartum. Breast milk transforming growth factor (TGF)ß1, TGFß2, and IL-10 were assayed using enzyme-linked immunosorbent assays, whereas neonatal gut microbiome was profiled using 16S rRNA sequencing. RESULTS: Individually, immunomodulators TGFß1 and TGFß2 were significantly associated with neonatal gut microbial composition (R = 0.024, P = 0.041; R = 0.026, P = 0.012, respectively) and increased richness, evenness, and diversity, but IL-10 was not. The effects of TGFß1 and TGFß2, however, were not independent of one another, and the effect of TGFß2 was stronger than that of TGFß1. Higher levels of TGFß2 were associated with the increased relative abundance of several bacteria, including members of Streptococcaceae and Ruminococcaceae, and lower relative abundance of distinct Staphylococcaceae taxa. CONCLUSIONS: Breast milk TGFß concentration explains a portion of variability in gut bacterial microbiota composition among breast-fed neonates. Whether TGFß acts in isolation or jointly with other bioactive components to alter bacterial composition requires further investigation. These findings contribute to an increased understanding of how breast-feeding affects the gut microbiome-and potentially immune development-in early life.

Joint effects of pregnancy, sociocultural, and environmental factors on early life gut microbiome structure and diversity.

The joint impact of pregnancy, environmental, and sociocultural exposures on early life gut microbiome is not yet well-characterized, especially in racially and socioeconomically diverse populations. Gut microbiota of 298 children from a Detroit-based birth cohort were profiled using 16S rRNA sequencing: 130 neonates (median age = 1.2 months) and 168 infants (median age = 6.6 months). Multiple factors were associated with neonatal gut microbiome composition in both single- and multi-factor models, with independent contributions of maternal race-ethnicity, breastfeeding, mode of delivery, marital status, exposure to environmental tobacco smoke, and indoor pets. These findings were consistent in the infants, and networks demonstrating the shared impact of factors on gut microbial composition also showed notable topological similarity between neonates and infants. Further, latent groups defined by these factors explained additional variation, highlighting the importance of combinatorial effects. Our findings also have implications for studies investigating the impact of the early life gut microbiota on disease.

Association Between Body Mass Index and Patient-Centered Outcomes After Hysterectomy.

OBJECTIVE: To assess whether body mass index (BMI) was associated with self-reported pain, well-being, or procedure satisfaction in the 3 months after hysterectomy. STUDY DESIGN: Prospective cohort study that recruited women undergoing hysterectomy. Data was collected over 1 year for 245 women. RESULTS: BMI was not associated with pain either at baseline or in the 3 months after surgery versus no pain; odds ratio [OR] = 1.0, 95% confidence interval [CI] 0.97-1.03, p = 0.88 for a 1 unit increase in BMI) or being fully satisfied with the procedure (versus not fully satisfied; OR = 1.01, 95% CI 0.97-1.04, p = 0.77 for a 1unit increase in BMI). Similarly, patient's perception of well-being was also not influenced by BMI as reflected in their well-being score (0.98 increase in score, 95% CI 0.95-1.02, p = 0.40, for a 1-unit increase in BMI). CONCLUSION: The data from this prospectively studied cohort of women who had undergone hysterectomy suggest that BMI is not associated with self-report of pain, well-being, -or procedure satisfaction in the 3 month after surgery.

Myomectomy to conserve fertility: seven-year follow-up.

OBJECTIVE: To observe the occurrence of pregnancy in women undergoing minimally invasive and open myomectomy for symptoms attributed to uterine fibroids and who desire future pregnancy. METHODS: We performed a retrospective chart review of women who had undergone myomectomy at least two years previously within the Henry Ford Health System in Detroit, MI. We reviewed the subsequent fertility outcomes according to the fertility goals identified by each woman. RESULTS: During the seven-year observation window, 310 women underwent myomectomy and 124 (40%) of these women desired pregnancy. Forty-nine women desiring pregnancy (40%) conceived, and 30 (61% of those who conceived) delivered a viable infant from their first pregnancy. In addition, two women had a live birth after a miscarriage, and one had a live birth after an ectopic pregnancy. Five women had a second live-born baby. There were no differences in the occurrence of pregnancy or pregnancy outcome according to surgical approach, patient age or race, number of uterine incisions, or whether the endometrial cavity was entered. In addition, five of 186 women who did not have a fertility goal (3%) conceived, and one woman delivered two babies. CONCLUSION: Myomectomy performed to preserve fertility resulted in approximately one in four women having a live birth, independent of surgical technique.

Objectif : Se pencher sur la probabilité d'obtenir une grossesse chez les femmes qui ont subi une myomectomie (ouverte ou à effraction minimale) en raison de symptômes ayant été attribués à la présence de fibromes utérins et qui souhaitent encore connaître une grossesse. Méthodes : Nous avons mené une analyse rétrospective des dossiers des femmes qui avaient subi une myomectomie au moins deux ans au préalable au sein du Henry Ford Health System de Détroit, au Michigan. Nous avons analysé les issues de fertilité subséquentes en fonction des objectifs génésiques identifiés par chacune de ces femmes. Résultats : Au cours de la période d'observation de sept ans, 310 femmes ont subi une myomectomie et 124 (40 %) de ces femmes souhaitaient obtenir une grossesse. Parmi ces dernières, 49 (40 %) y sont parvenues et 30 d'entre elles (soit 61 % des femmes ayant obtenu une grossesse) ont accouché d'un enfant viable dès leur première grossesse. De plus, deux femmes en sont venues à accoucher d'un enfant vivant après avoir d'abord connu une fausse couche et une femme en est venue à accoucher d'un enfant vivant après avoir d'abord connu une grossesse ectopique. Cinq femmes en sont venues à accoucher d'un deuxième enfant vivant. Aucune différence n'a été constatée en ce qui concerne l'obtention d'une grossesse ou en matière d'issue de grossesse en fonction de l'approche chirurgicale, de l'âge ou de l'origine ethnique de la patiente, du nombre d'incisions utérines ou de la pénétration ou non de la cavité endométriale. De surcroît, cinq des 186 femmes qui n'avaient pas d'objectifs génésiques (3 %) en sont venues à connaître une grossesse (une de ces femmes a même accouché de deux enfants). Conclusion : La myomectomie menée dans le but de préserver la fertilité a permis à environ une femme sur quatre d'accoucher d'un enfant vivant, peu importe la technique chirurgicale utilisée.

Cytokine patterns differ seasonally between women with and without uterine leiomyomata.

PROBLEM: Uterine leiomyomata are the most common reproductive tumor in women, and their cause is not known. METHODS OF STUDY: Plasma samples from 155 women (74 with and 81 without ultrasound-confirmed leiomyoma) from a new study of leiomyoma risk factors in the Detroit, Michigan area, were examined for any cross-sectional associations between commonly examined cytokines and leiomyoma presence. RESULTS: Associations varied by season of sample collection defined a priori as winter (December-February) and non-winter seasons. In the winter months, interleukin (IL)13 and IL17 were positively and IP10 was inversely associated with having a leiomyoma. In the non-winter samples, VEGF, G-CSF, and IP10 were positively associated and Monocyte chemotactic protein-1, IL13, and IL17 were inversely associated with having a leiomyoma. Associations were not changed by adjustment for age or BMI. CONCLUSIONS: These data suggest that new insight into leiomyoma formation may be acquired through investigation of the immune system.

Evaluation of a web-based asthma management intervention program for urban teenagers: reaching the hard to reach.

PURPOSE: Asthma interventions targeting urban adolescents are rare, despite a great need. Motivating adolescents to achieve better self-management of asthma is challenging, and the literature suggests that certain subgroups are more resistant than others. We conducted a school-based, randomized controlled trial (RCT) to evaluate Puff City, a Web-based, tailored asthma intervention, which included a referral coordinator, and incorporated theory-based strategies to target urban teens with characteristics previously found to be associated with lack of behavior change. METHODS: To identify eligible teens, we administered questionnaires on asthma diagnoses and symptoms to ninth through 12th graders of participating schools during a scheduled English class. We randomized eligible, consenting students to Puff City (treatment) or generic asthma education (control). RESULTS: We randomized 422 students (98% African-American, mean age = 15.6 years). At 12-month follow-up, adjusted odds ratios (aORs) (95% confidence intervals) indicated intervention benefit for treatment teens for symptom-days and restricted activity days (analyzed as categorical variables) as aOR = .49 (.24-.79), p = .006 and .53 (.32-.86), p = .010, respectively. Among teens meeting baseline criteria for rebelliousness, treatment teens reported fewer symptom-days, symptom-nights, school absences, and restricted activity days: aOR = .30 (.11-.80), .29 (.14-.64), .40 (.20-.78), and .23 (.10-.55); all p < .05. Among teens reporting low perceived emotional support, treatment students reported only fewer symptom-days than controls: aOR = .23 (.06-.88), p = .031. We did not observe statistically significant differences in medical care use. CONCLUSIONS: Results suggest that a theory-based, tailored approach, with a referral coordinator, can improve asthma management in urban teens. Puff City represents a viable strategy for disseminating an effective intervention to high-risk and hard-to-reach populations.

Tobacco smoke exposure and allergic sensitization in children: a propensity score analysis.

BACKGROUND AND OBJECTIVE: There is conflicting evidence of the effect of environmental tobacco smoke (ETS) on the development of allergic diseases in children. Studies have shown that this relationship differs depending on maternal history of the disease. We employed the rigour of propensity score methods to assess this relationship using data from a birth cohort. METHODS: Using n = 662 children from the Wayne County Health, Environment, Allergy and Asthma Longitudinal Study, we assessed the relationship between early-life ETS and subsequent allergic sensitization via a positive skin prick test (SPT+) or at least one specific immunoglobulin E (IgE) ≥ 0.35 (sIgE+) in children aged 2-3 years. Propensity score estimation followed by full and nearest neighbour matching was compared with standard multivariable regression models. RESULTS: Among children without a maternal history of allergic disease, ETS was positively associated with allergic sensitization in children with an adjusted odds ratio (aOR) for SPT+ of 2.32 (95% confidence interval (CI): 1.28-4.22) and the aOR for sIgE+ was 2.53 (95% CI: 1.43-4.48). Contrarily, for children with a positive maternal history, the aOR for SPT+ and sIgE+ was 0.56 (95% CI: 0.24-1.32) and 0.43 (95% CI: 0.20-0.91), respectively. CONCLUSIONS: Using propensity score methods to rigorously control for confounding factors, ETS exposure was found to reduce the risk of allergic sensitization in children with a positive maternal history. There is a strong association between early-life ETS and the development of allergic sensitization for children aged 2-3 years without maternal history.

Studying forced expiratory volume at 1 second over menstrual segments in asthmatic and non-asthmatic women: assessing protocol feasibility.

BACKGROUND: Sex hormones may play an important role in observed gender differences in asthma incidence and severity, as well as in the observed changes in asthma symptoms during times of hormonal fluctuation (i.e.; premenstrual, pregnancy, etc.). This pilot study sought to demonstrate the feasibility of data collection methods to investigate the effects of sex hormones on lung function in women. FINDINGS: A cohort of 13 women (6 with and 7 without prior asthma diagnoses) who were having menstrual periods and were not taking hormones collected urine samples daily for measurement of estrogen (estrone E1C) and progesterone (Pregnanediol-glucuronide PDG) metabolites over the course of a menstrual segment (bleeding episode plus the following bleeding-free interval). Hormones were used to estimate menstrual segment phase (follicular versus luteal) based on a published algorithm. Daily bleeding and FEV1 measurements were recorded and percent predicted FEV1 was calculated. Percent predicted FEV1 decreased over the course of the follicular but not the luteal phase. More specifically, among women without a prior asthma diagnosis, the E1C/PDG ratio and E1C and PDG were individually associated with FEV1 in the follicular phase. No associations were found between hormones and percent predicted FEV1 in the luteal phase or among asthmatic women. E1C was associated with FEV1 in the five days before bleeding onset only among non-asthmatic women. DISCUSSION: A study of contiguous daily hormones and symptoms over menstrual segments from a large group of women with and without asthma is needed to better determine within-woman cyclicity of the observed patterns.

Regulatory T cells vary over bleeding segments in asthmatic and non-asthmatic women.

Sex hormones may play an important role in observed gender differences in asthma incidence and severity. Regulatory T cells (Treg cells) are presumed to be involved in asthma and may vary with hormone levels. To investigate the effects of sex hormones on levels of Treg cells (percentage of CD4+CD25+Foxp3+ lymphocytes that are CD127-), a cohort of 13 women (6 with and 7 without an asthma diagnosis) had blood drawn multiple times over the course of a bleeding segment (bleeding interval plus the following bleeding-free interval) and collected urine samples daily for measurement of estrogen (estrone E1C) and progesterone (pregnanediol-glucuronide PDG) metabolites. The samples from non-asthmatic women indicated no association between bleeding segment day and Treg cells. Asthmatic women showed a 3% increase in Treg cell percentage with each successive day over the bleeding segment. Among non-asthmatic women, Treg cell percentages were not associated with PDG levels on the same day, or 1, 2 or 3 days before Treg cell measurement. E1C was positively correlated with the Treg cell percentage measured only on the same day - a 5% increase in E1C was associated with a 1.4% increase in Treg cell percentage. Among asthmatic women, only E1C was associated with Treg cell percentages after adjusting for PDG on the same day and 1 and 2 days before Treg cell measurement. A 5% increase in E1C was associated with a 2.3% increase in Treg cell percentage. A larger study of contiguous cycles to better determine within-woman cyclicity of the observed patterns is needed.

Within-woman change in regulatory T cells from pregnancy to the postpartum period.

Regulatory T cells (Treg cells) are an important area of investigation in human health and disease. In this study, the trajectory of percentage of Treg cells (defined as CD4+CD25+Foxp3+CD127--lymphocytes) was measured in the blood of 208 women during pregnancy and up to three additional times in the postpartum period (1, 6 and 12 months postpartum). Whether the trajectory was affected by gravidity, parity, neonatal sex, pet exposure, maternal atopic and asthma status, smoking, maternal race or other pregnancy factors was examined. Multilevel models were fit using full maximum likelihood methods and included both random and fixed effects. Overall, percentages of Treg cells increased from the prenatal to the postpartum period. Among women who were not atopic, nulliparous women had lower percentages of Treg cells over time compared with parous women. Atopic women with pets in the home during pregnancy had lower percentages of Treg cells than atopic women who did not have pets. The trajectory was not affected by the other factors investigated. We conclude that within-woman change in percentages of Treg cells may vary by time in relation to delivery, as well as by maternal atopic status and exposure to pets and number of prior births. The data did not indicate an overall decline in Treg cells in the postpartum period. Future work to better identify the role of Treg cells in successful pregnancy would ideally include a set of well characterized women sampled serially starting prior to pregnancy and throughout the postpartum period.

Respiratory medication prescriptions before and after bariatric surgery.

BACKGROUND: Increased body mass index is associated with asthma and frequent respiratory complaints. Bariatric surgery often results in rapid weight loss associated with an improved respiratory status. OBJECTIVE: To assess whether patients undergoing bariatric surgery would have fewer respiratory symptoms after surgery as evidenced by decreases in respiratory prescription drug claims. METHODS: A retrospective cohort of 320 patients continuously enrolled in a large, southeast Michigan health maintenance organization were studied for 1 year before and 1 year after bariatric surgery. The health maintenance organization claims database was used to compare respiratory prescriptions filled before and after surgery. Respiratory medications included bronchodilator inhalers, inhaled corticosteroids, oral corticosteroids, theophylline, and leukotriene antagonists. RESULTS: Of 320 surgical patients, 64 (20%) filled at least 1 respiratory medication prescription for a total of 468 prescriptions during the 2-year observation period. Of the prescriptions filled, 35% were beta-agonists, 38% inhaled corticosteroids, 12% oral corticosteroids, 15% leukotriene antagonists, and less than 1% theophylline. Total respiratory medication prescription fills decreased by 49% (from 314 to 154 prescriptions) in the postsurgical year, with only 43.1% of patients filling prescriptions in the year before surgery also filling a prescription in the postsurgical surveillance period. Analyses restricted to 40 patients with physician-diagnosed asthma revealed mean (SD) presurgical prescription fills of 7.0 (6.9) per year, decreasing to 3.8 (6.1) per year in the postsurgical year (P = .002). CONCLUSION: Respiratory medication use decreases significantly after bariatric surgery. A secondary benefit of bariatric surgery may include a decrease in respiratory symptoms and concomitant medication use.

Racial differences in sarcoidosis granuloma density.

STUDY OBJECTIVES: While sarcoidosis generally inflicts a greater morbidity on African-American compared with Caucasian patients, no studies have examined whether racial differences exist in the intensity of the histologic hallmark of sarcoidosis, noncaseating granulomas. DESIGN AND SETTING: The study was conducted as a retrospective case series in a tertiary referral center. PATIENTS: The study included 187 patients with histopathologic confirmation of sarcoidosis by trans- and/or endobronchial biopsy between July 1991 and December 2001. MEASUREMENTS AND RESULTS: Granuloma density was the average number of granulomas per biopsy piece on the slide with the most intense granulomatous inflammation at fourfold magnification. Overall, African-American patients had a twofold greater median granuloma density than Caucasians (p = 0.005). In a negative binomial multivariate model, radiographic pattern had the strongest association with granuloma density, with Scadding stage II and III patients having adjusted granuloma densities of 60% (p = 0.005) and 105% (p = 0.0001) higher than stage I patients. In the specific-tissue types, radiographic stage-adjusted granuloma densities in African-American patients were 49% greater in bronchial tissue (p = 0.03), but only a 27% greater in alveolar tissue (p = 0.51). CONCLUSIONS: A greater granuloma density in bronchiolar lung tissue of African-American sarcoidosis patients may explain racial differences in diagnostic yield by lung biopsy and disease severity at diagnosis. This association persists even after controlling for Scadding radiographic stage, a measure of disease severity strongly associated with granuloma density.

Effects of baseline comorbidities on cancer screening trial adherence among older African American men.

BACKGROUND: The purpose of this study was to examine the effects of baseline comorbidities on screening adherence in a sample of older African American men (ages >or=55 years) enrolled in a case management intervention in a cancer screening trial. METHODS: Baseline comorbidity data were obtained from 683 African American men who were randomly assigned to a case management intervention group (n = 344) or to a case management control group (n = 339). The effects of comorbidities on the screening adherence rates of each group were then assessed. RESULTS: No statistically significant interactions were found between each health history characteristic and the intervention. Therefore, analyses were not stratified by intervention status. In general, participants with comorbidities were no less likely to adhere to trial screening than participants without comorbidities. Exceptions were current smokers and participants with chronic bronchitis. Current smokers were less likely than others to adhere to the prostate-specific antigen test (P = 0.02) and the digital rectal examination for prostate cancer screening (P = 0.01), to the chest X-ray for lung cancer screening (P < 0.01), and to the flexible sigmoidoscopy for colorectal cancer screening (P = 0.04). Participants with chronic bronchitis had lower rates of adherence to the chest X-ray (P = 0.06). Having a relative with cancer positively influenced adherence to the digital rectal examination (P = 0.05). CONCLUSIONS: Overall, older African American men with comorbidities appear to be very good candidates for participation in longitudinal cancer screening trials. However, smoking had a statistically significant and deleterious effect on adherence to all types of screening.

Risk factors associated with transient wheezing in young children.

Transient wheezing in young children has been reported to be independent of atopy. Although persistence of early wheezing has been associated with factors related to allergy in multiple studies, transient wheezing has not been similarly studied. The Childhood Allergy Study birth cohort was the source of these data. Transient wheezing was defined as history of wheezing in the past 12 months at ages 1, 2, and/or 4 years, but not at 6 years, and evaluated in relationship to aeroallergen-specific circulating IgE and positive skin testing as markers of an atopic profile. Testing for IgE and skin-prick testing to dust mites, dogs, cats, ragweed, and timothy were performed at the age of 6 years. Other variables in logistic regression analyses were sex; breast-feeding; birth order; parental allergy and smoking history; and household pets, daycare, fever, and antibiotic use in the 1st year of life. Of 372 children, 128 (34.4%) experienced transient wheezing and 175 (47.0%) never wheezed. Atopy was not associated with transient wheezing (adjusted odds ratio for a positive allergen-specific IgE test = 1.2, p = 0.66; skin-prick test = 0.8, p = 0.47). Boys were more likely to be transient wheezers (adjusted relative risk [RR] = 1.7; 95% confidence interval [CI], 1.1-2.8; p = 0.018). Transient wheeze was associated with antibiotic treatment in the first 6 months of life (adjusted RR = 1.6; 95% CI, 1.0-2.6; p = 0.048). We confirm previous observations that transient wheezing in young children is not associated with an atopic predisposition.