Reduced Odds of Mpox-Associated Hospitalization Among Persons Who Received JYNNEOS Vaccine - California, May 2022-May 2023.

The effectiveness of 1 dose of JYNNEOS vaccine (modified vaccinia Ankara vaccine, Bavarian Nordic) against hospitalization for mpox (caused by Monkeypox virus), has been demonstrated; however, the impact of 2 doses on hospitalization risk, especially among persons infected with HIV, who are at higher risk for severe disease, is an important factor in evaluating vaccine effectiveness against mpox disease severity and Monkeypox virus infection. Surveillance data collected by the California Department of Public Health were used to evaluate whether receipt of 2 doses of JYNNEOS vaccine reduced the odds of hospitalization among persons with mpox. The odds of hospitalization among persons with mpox who had received 1 or 2 JYNNEOS doses were 0.27 (95% CI = 0.08-0.65) and 0.20 (95% CI = 0.01-0.90), respectively, compared with unvaccinated mpox patients. In mpox patients with HIV infection, the odds of hospitalization among those who had received 1 JYNNEOS vaccine dose was 0.28 (95% CI = 0.05-0.91) times that of those who were unvaccinated. No mpox-associated hospitalizations were identified among persons infected with HIV who had received 2 JYNNEOS vaccine doses. To optimize durable immunity, all eligible persons at risk for mpox, especially those infected with HIV, should complete the 2-dose JYNNEOS series.

The health profile of newly-arrived refugee women and girls and the role of region of origin: using a population-based dataset in California between 2013 and 2017.

BACKGROUND: There has been an increasing number of refugee women globally; yet, there is little recent data describing the health profile of refugee women by region of origin in the United States. It is important to monitor the health status of women by region of origin to provide needed targeted interventions. METHODS: We analyzed the Refugee Health Electronic Information System (RHEIS), a population-based dataset that included 14,060 female refugees who entered California between October 3, 2013 and February 15, 2017. We assessed differences in health status by region of origin. RESULTS: Almost one out of three women experienced a traumatic event. Women from Africa and Latin America and the Caribbean experienced higher levels of trauma compared to other regions, including sexual assault, physical, and weapon assault. More than half of women and girls (56.6%) reported experiences of persecution, with Southeast Asians reporting the highest levels. Among women of reproductive age, 7.0% of women were currently pregnant at the time of arrival to the US, 19.0% ever had a spontaneous abortion, and 8.6% reported ever having an abortion. One in three women from Africa reported female genital cutting. Moreover, 80.0% of women reported needing language assistance at the time of their health assessment. CONCLUSIONS: Refugee women and girls experience high levels of trauma and persecution, suggesting the need for trauma-informed care. Those working with refugee women, such as resettlement agencies and health providers, should be equipped with information about antenatal care, nutrition, and pregnancy to newly arrived women. Lastly, differences in health status by region of origin indicate a need for tailored interventions and linguistically appropriate health information.

Effects of dynamic exercise on plasma arachidonic acid epoxides and diols in human volunteers.

Metabolites of the cytochrome P450 (CYP) pathway may contribute to vasodilation of the vasculature. However, it is not known whether exercise affects their circulating concentrations. The authors determined effects of exercise intensity and duration on plasma concentrations of epoxy and dihydroxy metabolites of arachidonic acid. Their goal was to delineate the threshold workload, optimal workload, and duration required to produce increases in plasma concentrations of these vasoactive substances. Healthy volunteers (N = 14) performed maximal exercise testing on a bicycle ergometer during Visit 1. On separate days, subjects cycled for 20 min at 30%, 60%, and 80% of their maximal exercise intensity. The last day consisted of 40 min of exercise at 60% of maximal exercise intensity. Venous blood was obtained before, during, and after exercise for analysis. Compared with rest, increases were observed during the 80% workload at 20 min postexercise -14,15-DHET (0.77 ± 0.21 vs. 0.93 ± 0.27 nM) - and at 2 min postexercise: 11,12-DHET (0.64 ± 0.22 vs. 0.71 ± 0.24 nM; p < .05). Also compared with rest, 40-min values during the 60% workload were 14,15-DHET 0.79 ± 0.22 vs. 0.91 ± 0.31 nM and at 2 min post 14,15 EET 0.12 ± 0.06 vs. 0.21 ± 0.16 nM (p < .05). Results suggest the CYP metabolites (i.e., DHETs) are released during short-term high-intensity and long-term moderate-intensity exercise.

Knowledge, behavior and ethical responsibility of health professionals with regard to smoking.

OBJECTIVE: This is the first study after the implementation of a more restrictive Tobacco Law in Portugal, carried out in collaboration with the Program for Prevention and Treatment of Smoking of the Northern Region Health Authority. The aim of the study was to characterize the attitudes and practices of health professionals with regard to tobacco consumption, given their importance in smoking reduction. The high prevalence of risk factors associated with circulatory diseases, particularly smoking, highlights the need for preventive measures. METHODS: This was a cross-sectional study assessing knowledge of the harmful effects of tobacco consumption and exposure to environmental tobacco smoke, ethical and professional behavior, and agreement with tobacco control measures. Participants were 101 physicians and 524 nurses from the primary health centers (PHCs) and Hospital S. João in the city of Porto. RESULTS: Smoking rates of 23.1% and 13.0% were found among nurses and physicians, respectively. There was a lower proportion of smokers in PHCs (14.5% vs. 23.9%, p = 0.014). Most participants agreed with prohibition of smoking inside and outside the building (70.7% vs. 53.3%), but smokers were more skeptical regarding the benefits, especially nurses. Knowledge of the consequences of tobacco consumption and environmental tobacco smoke was reasonable, but 40.0% of physicians and only 26.5% of nurses did not agree that ventilation systems can eliminate tobacco smoke (p = 0.009). Most participants acknowledged the inappropriateness of smoking in the presence of patients. In PHCs there was a higher percentage of health professionals who saw themselves as role models (80.6% vs. 66.7%, p = 0.001), and of nurses who agreed with the inappropriateness of smoking in the presence of the public (61.9% vs. 42.3%, p = 0.001). Health care professionals supported tobacco control programs, although smokers were less supportive. In PHCs there was a higher percentage of professionals who received training on tobacco, and this appears to have had some impact on nurses' belief that they are seen as role models (OR = 2.431, p = 0.024). DISCUSSION AND CONCLUSIONS: These findings support the need for new campaigns to reduce smoking among health care professionals. The reasons for their skepticism concerning their ethical responsibility must be clarified. Greater investment is required in training on tobacco for pre- and post-graduate health professionals, in order to increase their awareness of the importance of their role in reducing tobacco consumption in society.

Progress in the use of immunotherapy to treat uterine cervical cancer.

Cervical intraepithelial neoplasia has a high incidence in many of the world's populations, and it has been hypothesized to be a precursor of uterine cervical cancer. Cervical intraepithelial neoplasia also shares similar pathological traits with human papillomavirus infections. Various surgical treatments have been proposed over the years for the treatment of cervical intraepithelial neoplasia, including conization, hysterectomy and, more recently, a loop electrosurgical excisional procedure. However, a higher recurrence rate of the disease has been observed after these procedures. Therefore, immunotherapy has been proposed as a potential treatment to be used in conjunction with surgery, or independently, as treatment for cervical intraepithelial neoplasia. Currently, immunotherapy includes the application of recombinant viral proteins, vaccines, or antibody- and dendritic cell-based therapies. In this review, we summarize the development and testing of these immunotherapy approaches, particularly in regard to their application for the treatment of cervical intraepithelial neoplasia.

Evaluation of Hepatitis B Virus Screening, Vaccination, and Linkage to Care Among Newly Arrived Refugees in Four States, 2009-2011.

Many U.S.-bound refugees originate from countries with intermediate or high hepatitis B virus (HBV) infection prevalence and have risk for severe liver disease. We evaluated HBV screening and vaccination of newly arrived refugees in four states to identify program improvement opportunities. Data on HBV testing at domestic health assessments (1/1/2009-12/31/2011) were abstracted from state refugee health surveillance systems. Logistic regression identified correlates of infection. Over 95% of adults aged ≥19 years (N = 24,647) and 50% of children (N = 12,249) were tested. Among 32,107 refugees with valid results, the overall infection prevalence was 2.9% (0.76-9.25%); HBV prevalence reflected the burden in birth countries. Birth in the Western Pacific region carried the greatest infection risk (adjusted prevalence ratio = 4.8, CI 2.9, 7.9). Care linkage for infection was unconfirmed. Of 7409 susceptible persons, 38% received 3 doses of hepatitis B vaccine. Testing children, documenting care linkage, and completing 3-dose vaccine series were opportunities for improvement.

Low folate status is associated with impaired cognitive function and dementia in the Sacramento Area Latino Study on Aging.

BACKGROUND: Low folate status is associated with poor cognitive function and dementia in the elderly. Since 1998, grain products in the United States have been fortified with folic acid, which has reduced the prevalence of folate deficiency and hyperhomocysteinemia. OBJECTIVE: We investigated whether folate status is associated with cognitive function and dementia in a cohort of elderly Latinos (aged >or= 60 y; n = 1789) exposed to folic acid fortification. DESIGN: Global cognitive function was assessed by the Modified Mini-Mental State Examination (3MSE) and specific cognitive functions by cross-culturally validated neuropsychological tests. Dementia was diagnosed according to the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 3rd edition revised, and California Alzheimer Disease Diagnostic and Treatment criteria. Red blood cell (RBC) folate was measured by automated chemiluminescence and total plasma homocysteine by HPLC. RESULTS: The prevalence of folate deficiency (RBC folate

Acute myeloid leukemia with inv(3)(q21q26.2) or t(3;3)(q21;q26.2): Clinical and biological features and comparison with other acute myeloid leukemias with cytogenetic aberrations involving long arm of chromosome 3.

OBJECTIVES: To compare, from a biological and clinical perspective, a significant group of patients with AML with inv(3)(q21q26.2) or t(3;3)(q21;q26.2) with another group of AML carrying different abnormalities of 3q at q21 or q26, the latter named as the AML abn(3q) group. METHODS: We developed a national survey with the participation of 13 Spanish hospitals, and retrospectively reviewed (from 1990 to 2010) these subtypes of AML. Fifty-five patients were collected: 35 with AML inv(3)/t(3;3) and 20 with AML abn(3q). A data collecting page that included main features at diagnosis, therapeutic approach and response, and survival variables, was distributed and completed. RESULTS: We did not find significant differences in sex, age, history of myelodysplastic syndrome or chemo-/radiotherapy, clinical presentation, WBC and platelet counts, hemoglobin level, blasts immunophenotype, serum lactatedehydrogenase, peripheral blood and bone marrow cellular dysplasia, and bone marrow biopsy findings. Although the association with monosomy 7 was significantly more frequent in AML inv(3)/t(3;3), this did not seem to influence outcome. The lack of response to the different modalities of treatment and the aggressive course of the disease were the standard in both cohorts of patients. DISCUSSION: Although not yet recognized by the World Health Organization classification, our results are in agreement with the findings of other authors, who include both subsets of AML together in the same group of adverse prognosis. CONCLUSION: In an attempt to simplify and bound entities with similar genetic background and clinical behavior, it would be desirable to bring together both subgroups of AML in a single section.

Plasma folate concentrations are associated with depressive symptoms in elderly Latina women despite folic acid fortification.

BACKGROUND: A relation between low folate status and depression has been recognized since the 1960s. Since 1998, flour in the United States has been fortified with folic acid, and the prevalence of folate deficiency has decreased dramatically. OBJECTIVE: We investigated whether, in this era of folic acid fortification, low folate status is a determinant of depressive symptoms in a cohort of elderly Latinos (aged >/=60 y) participating in the Sacramento Area Latino Study on Aging (SALSA). DESIGN: In a cross-sectional logistic regression analysis of data from SALSA (n = 627 M, 883 F), odds ratios (ORs) were ascertained for elevated depressive symptoms [Center for Epidemiologic Studies Depression Scale (CES-D) score >/=16] among tertiles of plasma folate. Depressive symptoms were assessed by using the CES-D. Plasma folate concentrations were determined by radioassay. RESULTS: The prevalence of folate deficiency (plasma folate

Homocysteine and cognitive function in the Sacramento Area Latino Study on Aging.

BACKGROUND: Elevated plasma homocysteine (hyperhomocysteinemia), an independent risk factor for vascular disease, has been reported to be inversely correlated with objective measures of cognitive function in patients with Alzheimer disease and in community-dwelling older adults. OBJECTIVE: We evaluated the cross-sectional relation between total plasma homocysteine concentration and cognitive function in elderly Latinos (aged > or = 60 y; n = 1789) participating in the Sacramento Area Latino Study on Aging. DESIGN: Global cognitive function was assessed by using the Modified Mini-Mental State Examination, and specific cognitive functions were assessed by using 6 instruments developed for cross-cultural and multilingual neuropsychological evaluation of older persons. Associations between the cognitive function scores and total plasma homocysteine concentrations were then measured by multiple regression analysis with control for potential confounding by nutrient status (red blood cell folate, plasma vitamin B-12), kidney function (serum creatinine), demographic variables (age, sex, education, acculturation), and depressive symptoms. RESULTS: Modest inverse associations were found between homocysteine concentrations and several indexes of cognitive function, including the global Modified Mini-Mental State Examination assessment and the picture-association, verbal attention-span, and pattern-recognition tests (P < or = 0.05). Demographic variables, particularly age and education, were more strongly associated with cognitive function scores than was homocysteine. CONCLUSIONS: Homocysteine is a modest independent predictor of cognitive function in community-dwelling elderly Latinos. Reducing plasma homocysteine concentrations by administering B-vitamin supplements may provide some protection against cognitive decline in this and other elderly populations, but the effect may be limited.

Evaluation of breathing exercise in hormonal and immunological responses in patients undergoing abdominal surgery.

PURPOSE: To evaluate the effects of sustained deep inspiration in the prevention of postoperative pulmonary complications, the hormonal and immunological responses in patients submitted to abdominal surgery. METHODS: This randomized clinical trial study included 75 patients submitted to abdominal surgery, of which 36 were randomly allocated in the experimental group and underwent sustained deep inspiration during five seconds, in three sets of ten repetitions per day. The others 39 patients were allocated in the control group and were not submitted to any breathing exercise. The following parameters were measured preoperatively, 24h and 48h postoperatively: chest x-ray, serum ACTH, cortisol, IL-4, IL-10, TNF-α, forced expiratory volume in first second (FEV1), forced expiratory flow 25-75% (FEF 25-75), forced vital capacity (FVC), paO2 and paCO2. RESULTS: Mean serum cortisol in patients of the experimental and control groups before surgery were 12.8 mcg/dl (4.6-50) and 10.48 mcg/dl (1-29.1), respectively (p=0.414). The experimental group had significantly increase in serum cortisol levels, 23.6 mcg/dl (9.3-45.8), especially 24h postoperatively (p=0.049). CONCLUSION: Sustained deep inspiration in patients submitted to abdominal surgery determined important changes in serum cortisol, however, without significantly influence the postoperative pulmonary complications and the endocrine and immune responses.

Preoperative ambulatory inspiratory muscle training in patients undergoing esophagectomy. A pilot study.

A major decline in pulmonary function is observed on the first day after upper abdominal surgery. This decline can reduce vital and inspiratory capacity and can culminate in restrictive lung diseases that cause atelectasis, reduced diaphragm movement, and respiratory insufficiency. The objective of this study was to evaluate the efficacy of preoperative ambulatory respiratory muscle training in patients undergoing esophagectomy. The sample consisted of 20 adult patients (14 men [70%] and 6 women [30%]) with a diagnosis of advanced chagasic megaesophagus. A significant increase in maximum inspiratory pressure was observed after inspiratory muscle training when compared with baseline values (from -55.059 ± 18.359 to -76.286 ± 16.786). Preoperative ambulatory inspiratory muscle training was effective in increasing respiratory muscle strength in patients undergoing esophagectomy and contributed to the prevention of postoperative complications.

Contribuições do esporte adaptado: Reflexões da terapia ocupacional para a área da saúde / Adapted sport's contributions: Reflections of occupational therapy for health area / Las contribuciones de los deportes adaptados: Reflexiones de la terapia ocupacional para el área de la salud

A Terapia Ocupacional utiliza atividades como recursos terapêuticos, tais como as Atividades de Lazer, podendo o esporte ser uma delas. Esta pesquisa teve como objetivos caracterizar, pela percepção dos paratletas de handebol, os benefícios e as limitações na prática esportiva, e discutir as ações do terapeuta ocupacional nesse âmbito. O instrumento metodológico utilizado foi a entrevista estruturada, audiogravada e posteriormente transcrita. Sete paratletas de Handebol adaptado foram entrevistados, sendo todos homens, com idades entre 32 e 51 anos. Os sujeitos destacaram, dentre os benefícios da prática esportiva, a melhoria de aspectos sociais, controle emocional e controle motor, além de compreenderem a atividade como promotora de benefícios para a saúde. As dificuldades foram menos relatadas, se comparadas aos benefícios, porém foram mencionadas as questões financeiras e as limitações motoras. Em relação aos profissionais da saúde, os entrevistados destacaram os fisioterapeutas e ortopedistas, porém identificaram que o terapeuta ocupacional também pode atuar no campo esportivo. Discute-se que o terapeuta ocupacional pode contribuir para o reconhecimento da funcionalidade, dos facilitadores e barreiras na realização da atividade esportiva e que essas, entendidas enquanto lazer, podem ser ampliadas e incentivadas pelos profissionais que atuam na atenção básica, ampliando o acesso e promovendo a participação na comunidade, como previsto nas estratégias da Reabilitação Baseada na Comunidade. Assim, o terapeuta ocupacional, ao atuar no campo do esporte adaptado, pode contribuir para o desenvolvimento da atividade, considerando seu conhecimento sobre as ações humanas e sua contribuição para a autonomia e a qualidade de vida.

Occupational Therapy uses activities as therapeutic resources, such as Leisure Activities, including sports. This research aimed to characterize the perception of handball parathletes about benefits and limitations in sports practice, and discuss the actions of the occupational therapist in this field. The methodological instrument used was a structured interview, audio recorded and later transcribed. Seven Handball parathletes were interviewed, all men aged between 32 and 51 years. Among the benefits, the subjects included improvement on social, emotional and motor control, besides the understanding of sports activity as promoter of health benefits. The difficulties were less frequent, but subjects identified financial and motor issues. Regarding rehabilitation professionals, physical therapists and orthopedists were highlighted. Participants recognized that occupational therapist could potentially act in sports and leisure area. It is discussed that occupational therapist may collaborate on identification of functionality, facilitators and barriers factors related to sports activities. These activities understood as leisure activities should be promoted by health professionals to improve the participation on community, as recommended by Community Based Rehabilitation strategies. When acting with adapted sports, occupational therapist may contribute for the development of the activity, considering his knowledge about human actions and its contribution for autonomy and quality of life.

La Terapia Ocupacional utiliza las actividades como recursos terapéuticos, tales como actividades de ocio, y el deporte puede ser uno de ellos. Este estudio tuvo como objetivo caracterizar la percepción de los atletas discapacitados de balonmano acerca de los beneficios y las limitaciones de su practica, y discutir las acciones del terapeuta ocupacional en esta área. El instrumento metodológico utilizado fue la entrevista estructurada, audiogravada y posteriormente transcrita. Siete atletas discapacitados de balonmano fueron entrevistados, todos son hombres, de edades comprendidas entre los 32 y 51 años. Los sujetos destacaron, entre los beneficios del deporte, la promocion de la salud, la mejora del control social, emocional y motor. Las dificultades se reportaron menos, pero se mencionaron problemas financieros y limitaciones motoras. En relación a los profesionales de salud, destacaron los fisioterapeutas y ortopedistas, pero se encontró que el terapeuta ocupacional también puede trabajar en el campo de deportes. Se argumenta que el terapeuta ocupacional puede contribuir al reconocimiento de la funcionalidad, de los facilitadores y las barreras en la realización de la actividad deportiva, ampliando el acceso y la promoción de la participación de personas discapacitadas en la comunidad, como se prevé en las estrategias de rehabilitación basada en la comunidad. Por lo tanto, el terapeuta ocupacional puede contribuir al desarrollo de la actividad, teniendo en cuenta su conocimiento de las acciones humanas y su contribución a la autonomía y la calidad de vida.

Evaluation of breathing exercise in hormonal and immunological responses in patients undergoing abdominal surgery

PURPOSE: To evaluate the effects of sustained deep inspiration in the prevention of postoperative pulmonary complications, the hormonal and immunological responses in patients submitted to abdominal surgery. METHODS: This randomized clinical trial study included 75 patients submitted to abdominal surgery, of which 36 were randomly allocated in the experimental group and underwent sustained deep inspiration during five seconds, in three sets of ten repetitions per day. The others 39 patients were allocated in the control group and were not submitted to any breathing exercise. The following parameters were measured preoperatively, 24h and 48h postoperatively: chest x-ray, serum ACTH, cortisol, IL-4, IL-10, TNF-α, forced expiratory volume in first second (FEV1), forced expiratory flow 25-75% (FEF 25-75), forced vital capacity (FVC), paO2 and paCO2. RESULTS: Mean serum cortisol in patients of the experimental and control groups before surgery were 12.8 mcg/dl (4.6-50) and 10.48 mcg/dl (1-29.1), respectively (p=0.414). The experimental group had significantly increase in serum cortisol levels, 23.6 mcg/dl (9.3-45.8), especially 24h postoperatively (p=0.049). CONCLUSION: Sustained deep inspiration in patients submitted to abdominal surgery determined important changes in serum cortisol, however, without significantly influence the postoperative pulmonary complications and the endocrine and immune responses.

Tabagismo não limita o incremento da força muscular respiratória em pacientes submetidos ao treinamento muscular inspiratório pré-esofagectomia / Smoking doesn't limit the increase in respiratory muscle strength in patients undergoing pre-inspiratory muscle training esophagectomy

Um programa de treinamento muscular respiratório (TMR) para pacientes tabagistas no pré-operatório ambulatorial pode melhorar a força muscular e a capacidade funcional respiratória, evitando complicações que aumentem a permanência do paciente no hospital. O objetivo deste trabalho foi avaliar a eficácia do treinamento muscular inspiratório (TMI) em pacientes tabagistas e não tabagistas que seriam submetidos à cirurgia do megaesôfago. Foram estudados 17 pessoas, divididas em dois grupos: o tabagista (GT), composto por 10 pacientes (58,82%), e o não tabagista (GNT), com 7 pacientes (41,18%). A análise dos dados relacionando os dois foi expressa da seguinte forma: os valores de idade e as medidas antropométricas foram comparadas pelo teste t de Student e os valores da pressão inspiratória máxima (PImáx) e da pressão expiratória máxima (PEmáx) pelo teste t de Student pareado. Os dados foram expressos em média±desvio-padrão quando verificada a normalidade. Consideraram-se diferenças estatisticamente significativas se p<0,05. Na análise comparativa, observou-se aumento significativo da PImáx após as 4 semanas do TMI, como se segue: PImáx no GT de -57,20±18,76 para -79,00±15,38 e no GNT de -52,00±18,76 para -72,66±19,33. A fisioterapia profilática no pré-operatório ambulatorial proporcionou aumento significativo na força dos músculos inspiratórios em ambos os grupos, evidenciada pelo acréscimo na PImáx com consequente melhora da capacidade ventilatória.

A program of muscular respiratory training to smoker patients in pre-operatory ambulatory can improve the muscle strength and the functional respiratory capacity, avoiding complications which increase the hospitalization period of the patient. The aim of this work was to evaluate the effectiveness of the inspiratory muscle training in smoker and non-smoker patients who would be submitted to a megaesophagus surgery. Seventeen patients were studied, divided into two groups: smoker (GT), composed of 10 patients (58.82%), and the non-smoker (GNT), with 7 patients (41.18%). Data analysis comparing the two groups was expressed as follows: the values of age and anthropometric measurements were compared by Student's t-test and the values of Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP) were compared by the paired Student's t-test. Data were expressed as mean±standard deviation when checked to normal. Differences were considered statistically significant if p<0.05. Level of significance adopted was p=0.05. Considering the comparative analysis, it was observed a significant increase of Maximal Inspiratory Pressure MIP after the 4 weeks of inspiratory muscle training (IMT), as follows: MIP in GT from -57.20±18.76 to -79.00±15.38 and in GNT from -52.00±18.76 to -72.66±19.33. The prophylactic therapy in the preoperative outpatient provides a significant increase in inspiratory muscle strength in both groups, as evidenced by the increase in MIP with consequent improvement in ventilatory capacity.

Transcobalamin II 775G>C polymorphism and indices of vitamin B12 status in healthy older adults.

A common polymorphism (775G>C) in the vitamin B12 transport protein, transcobalamin II (TCII), has been identified in which proline replaces arginine at codon 259. We determined the influence of TCII genotype on indices of B12 status, including total serum B12, the amount of B12 bound to TCII (holoTCII), methylmalonic acid, and homocysteine, in 128 healthy older adults (ages 40-88 years). Mean total B12 and homocysteine concentrations were not significantly different among the 3 genotypes. Mean holoTCII concentration was significantly higher in those subjects homozygous for the proline form of TCII (PP) compared with those homozygous for the arginine form (RR) and heterozygotes (PR) (P