Analysis of the gap in PCR monitoring availability for patients with chronic myeloid leukemia in 60 low- and middle-income countries.

PURPOSE: To estimate the resource gap in the polymerase chain reaction (PCR) monitoring for patients with chronic myeloid leukemia (CML) in low- and middle-income countries (LMICs). METHODS: We developed a model of demand and supply of PCR monitoring of CML patients in 60 LMICs. PCR testing was assumed to use Cepheid's GeneXpert® IV system. We included costs of GeneXpert® instruments, uninterrupted power supplies, warranties, calibration kits, test cartridges, and shipping. We calculated the country-specific monetary gap in PCR monitoring, stratified by country priority defined as the availability of tyrosine kinase inhibitors (TKIs) through The Max Foundation initiatives. RESULTS: The 5-year gap in PCR monitoring was $29.1 million across all countries, 22% ($6.4 million) in countries with all five TKIs available, 20% ($5.7 million) in countries with four TKIs available, 50% ($14.5 million) in countries with three TKIs available, 8% ($2.2 million) in countries with two TKIs available, and 1% ($0.3 million) in countries with one TKI available. The gap was highest in South Asia (52%; $15.1 million) and lowest in Latin America (6%; $1.9 million). Excluding labor costs, the bulk of the resource needs (86%; $25.2 million) were for procurement of BCR-ABL cartridges. CONCLUSION: Removing the 5-year gap in PCR monitoring capacity for CML in LMICs will require the mobilization of significant resources and will likely lead to better treatment outcomes and reduced treatment costs through optimization of treatment, discontinuation of therapy in appropriate patients, and facilitation of clinical research. Development of streamlined monitoring guidelines for resource-limited countries should be considered.

Understanding Trends in Pertussis Incidence: An Agent-Based Model Approach.

OBJECTIVES: We examined the impact of undetected infections, adult immunity, and waning vaccine-acquired immunity on recent age-related trends in pertussis incidence. METHODS: We developed an agent-based model of pertussis transmission in Dakota County, Minnesota using case data from the Minnesota Department of Health. For outbreaks in 2004, 2008, and 2012, we fit our model to incidence in 3 children's age groups relative to adult incidence. We estimated parameters through model calibration. RESULTS: The duration of vaccine-acquired immunity after completion of the 5-dose vaccination series decreased from 6.6 years in the 2004 model to approximately 3.0 years in the 2008 and 2012 models. Tdap waned after 2.1 years in the 2012 model. A greater percentage of adults were immune in the 2008 model than in the 2004 and 2012 models. On average, only 1 in 10 adult infections was detected, whereas 8 in 10 child infections were detected. CONCLUSIONS: The observed trends in relative pertussis incidence in Dakota County can be attributed in part to fluctuations in adult immunity and waning vaccine-acquired immunity. No single factor accounts for current pertussis trends.

Risks of preterm birth and growth restriction in second births after a first-born male infant.

PURPOSE: A first-born male infant may lead to an exaggerated immune response in the mother in subsequent pregnancies, increasing the risk of preterm birth (PTB) and growth restriction. This study investigated whether risks of PTB and growth restriction are greater among infants preceded by a first-born male infant and evaluated if the associations differ by paternity change or the second-born's sex. METHODS: We conducted a population-based cohort study using 2003-2014 Washington State birth certificate data and included mothers and birth year frequency-matched second live-born infants preceded by a first-born male (n = 58,704) or by a first-born female infant (n = 58,704). Using stratified analyses, we estimated adjusted relative risks (RRs) of PTB, low birthweight (LBW), and small for gestational age (SGA). RESULTS: Second-born infants preceded by a first-born male had greater risks of PTB (RR = 1.14; 95% CI: 1.09-1.19), LBW (RR = 1.17; 1.10-1.24), and SGA (RR = 1.13; 1.08-1.18). The RR was elevated for indicated PTB (RR = 1.19; 1.10-1.29), preterm premature rupture of membranes (RR = 1.15; 1.01-1.32), and spontaneous PTB (RR = 1.12; 1.05-1.20). Associations did not differ by second-born infant's sex or paternity change. CONCLUSION: Having a first-born male infant was associated with a greater risk of PTB, LBW, and SGA in the second-born infant.

Residence change during the first trimester of pregnancy and adverse birth outcomes.

BACKGROUND: There are few published studies evaluating the impact of perinatal residence change on infant outcomes and whether these associations differ by socioeconomic status. METHODS: We conducted a population-based cohort study using Washington State birth certificate data from 2007 to 2014 to assess whether women who moved during the first trimester of pregnancy (n=28 011) had a higher risk of low birth weight, preterm birth and small for gestational age than women who did not move during the first trimester (n=112 367). 'Non-first-trimester movers' were frequency matched 4:1 to movers by year. We used generalised linear models to calculate risk ratios and risk differences adjusted for maternal age, race, marital status, parity, education, smoking, income and insurance payer for the birth. We also stratified analyses by variables related to socioeconomic status to see whether associations differed across socioeconomic strata. RESULTS: Moving in the first trimester was associated with an increased risk of low birth weight (6.4% vs 4.5%, adjusted risk ratio 1.37 (95% CI 1.29 to 1.45)) and preterm birth (9.1% vs 6.4%, adjusted risk ratio 1.42 (95% CI 1.36 to 1.49)) and a slight increased risk of small for gestational age (9.8% vs 8.7%, adjusted risk ratio 1.09 (95% CI 1.00 to 1.09)). Residence change was associated with low birth weight and preterm birth in all socioeconomic strata. CONCLUSION: Moving during the first trimester of pregnancy may be a risk factor for adverse birth outcomes in US women. Healthcare providers may want to consider screening for plans to move and offering support.

Predictors of a successful external cephalic version: A population-based study of Washington state births.

BACKGROUND: Breech presentation affects approximately 3% of women with singleton pregnancies. External cephalic version is a manual procedure that reorients a foetus to cephalic position in preparation for birth, reducing indications for caesarean birth. However, unsuccessful attempts are associated with some adverse health outcomes. Versions are successful in 17-86% of attempts. Temporal trends in version success and association between maternal height or prenatal care and version success are unknown. Few population-based studies and no recent investigations in the United States have evaluated predictive factors for version success. OBJECTIVES: This study aimed to estimate the proportion of successful version procedures in the United States and to evaluate factors associated with version success. METHODS: We used birth certificate and hospital administrative data. The study included all women who had a singleton birth in Washington State between 2003-2014 following a version procedure (total n=4981). Prevalence ratios and 95% confidence intervals were calculated using Poisson regression. FINDINGS: 57.2% of version attempts were successful. Primiparity (Prevalence Ratio:1.43; 95% Confidence Interval:1.29-1.60) and multiparity (Prevalence Ratio:1.68; 95% Confidence Interval:1.50-1.88) were associated with procedure success. Oligohydramnios was associated with lower version success (Prevalence Ratio:0.75; 95% Confidence Interval:0.57-1.00). Maternal height, pre-pregnancy weight, polyhydramnios, frequency of prenatal care, smoking, infant sex, and year of birth were not significantly associated with version outcome. CONCLUSION: We found that most version procedures are successful. This reinforces that procedures may be able to reduce the frequency of caesarean birth. These contemporary results can help women and clinicians make decisions with realistic estimates of success.

What's Being Served for Dinner? An Exploratory Investigation of the Associations between the Healthfulness of Family Meals and Child Dietary Intake.

BACKGROUND: Little is known about the healthfulness of foods offered at family meals or the relationship between the food's healthfulness and child overall dietary intake. OBJECTIVE: This exploratory study uses a newly developed Healthfulness of Meal Index to examine the association between the healthfulness of foods served at family dinners and child dietary intake. DESIGN: Direct observational, cross-sectional study. PARTICIPANTS/SETTING: Primarily low-income, minority families (n=120) video recorded 8 days of family dinners and completed a corresponding meal screener. Dietary recalls were completed on the target child (6 to 12 years old). The Healthfulness of Meal Index was used to measure meal healthfulness and included component scores for whole fruit, 100% juice, vegetables, dark green vegetables, dairy, protein, added sugars, and high-sodium foods. MAIN OUTCOME MEASURES: Child dietary intake measured by three 24-hour dietary recalls. STATISTICAL ANALYSES PERFORMED: Linear regression models estimated the association between the healthfulness of foods served at dinner meals and overall child HEI. RESULTS: The majority of coded meals included foods from protein and high-sodium components; more than half included foods from dairy and vegetable components. Nearly half of the meals had an added-sugar component food (eg, soda or dessert). Few meals served foods from fruit, 100% juice, or dark green vegetable components. Many components served at family dinner meals were significantly associated with child daily intake of those same foods (ie, dark green vegetable, non-dark green vegetables, dairy, and added sugars). The Healthfulness of Meal Index total score was significantly associated with child HEI score. CONCLUSIONS: This study represents the first report of a new methodology to collect data of foods served at family dinners. Results indicated a significant association between the majority of components served at family dinner meals and child overall dietary intake. Validation of the Healthfulness of Meal Index and video-recorded family meal methodology is needed to strengthen these research methods for use in future studies.

Childhood obesity and interpersonal dynamics during family meals.

BACKGROUND: Family meals have been found to be associated with a number of health benefits for children; however, associations with obesity have been less consistent, which raises questions about the specific characteristics of family meals that may be protective against childhood obesity. The current study examined associations between interpersonal and food-related family dynamics at family meals and childhood obesity status. METHODS: The current mixed-methods, cross-sectional study included 120 children (47% girls; mean age: 9 years) and parents (92% women; mean age: 35 years) from low-income and minority communities. Families participated in an 8-day direct observational study in which family meals were video-recorded in their homes. Family meal characteristics (eg, length of the meal, types of foods served) were described and associations between dyadic (eg, parent-child, child-sibling) and family-level interpersonal and food-related dynamics (eg, communication, affect management, parental food control) during family meals and child weight status were examined. RESULTS: Significant associations were found between positive family- and parent-level interpersonal dynamics (ie, warmth, group enjoyment, parental positive reinforcement) at family meals and reduced risk of childhood overweight. In addition, significant associations were found between positive family- and parent-level food-related dynamics (ie, food warmth, food communication, parental food positive reinforcement) and reduced risk of childhood obesity. CONCLUSIONS: Results extend previous findings on family meals by providing a better understanding of interpersonal and food-related family dynamics at family meals by childhood weight status. Findings suggest the importance of working with families to improve the dyadic and family-level interpersonal and food-related dynamics at family meals.