Quantifying side effects and caregiver burdens of pediatric pulmonary hypertension therapies.

BACKGROUND AND OBJECTIVES: Pulmonary hypertension (PH) is a rare, but serious disease among children. However, PH has been primarily evaluated among adults. Consequently, treatment therapies have not been fully evaluated among pediatric populations and are used in an 'off label' manner. The purpose of this study was to estimate the side effect profiles of the most commonly prescribed pediatric PH therapies and to understand the burdens placed upon families caring for children living with PH. METHODS: Participants were recruited online through the "Families of children with pulmonary hypertension" Facebook group and asked to complete a survey about PH treatments. RESULTS: A total of 139 parents of a child living with PH completed the survey. Almost all children used ≥ 1 medication to treat PH, with 52% using ≥ 3 medications. The highest average number of side effects was reported by users of Treprostinil, Selexipag and type-5 phosphodiesterase (PDE5) inhibitors. The most common side effects were skin flushing, headache, nasal congestion, joint/muscle pain, and nausea. In terms of accessing care, 81% travel ≥ 20 miles and 68% travel for ≥ 60 min to receive care. CONCLUSIONS: We found an array of treatment combinations employed to mitigate symptoms of PH in children, with a wide range of side effects. We also found a large, unseen economic, emotional, and time burden of caring for a child living with PH. Further research is warranted to understand the clinical implications of these side effects to move towards labeled usage of these therapies rather than post-hoc off-label usage.

Preventative practices and effects of the COVID-19 pandemic on caregivers of children with pediatric pulmonary hypertension.

BACKGROUND: Pulmonary hypertension (PH) is a serious and life-threatening disease characterized by elevated mean arterial pressure and pulmonary vascular resistance. COVID-19 may exacerbate PH, as evidenced by higher mortality rates among those with PH. The objective of this study was to understand the unique burdens that the COVID-19 pandemic has placed upon families of children living with PH. METHODS: Participants were recruited online through the "Families of children with pulmonary hypertension" Facebook group and asked to complete a survey about their experiences during the COVID-19 pandemic. RESULTS: A total of 139 parents/caregivers of children living with PH completed the online survey. Almost all (85.6%) of parents/caregivers had received the COVID-19 vaccine, though only 59.7% reported a willingness to vaccinate their child with PH against COVID-19. Over 75% of parents/caregivers felt that they practiced preventative measures (e.g., wearing a facemask, social distancing, and avoiding gatherings) more than those in the community where they live. They also reported several hardships related to caring for their child with PH during the pandemic such as financial duress, loss of work, and affording treatment costs. CONCLUSIONS: These findings indicate that parents/caregivers of children at higher risk for COVID-19 complications may be more willing to act on clinical recommendations themselves as proxy for protecting those at high risk. The economic, emotional and social impacts of COVID-19 are significantly greater for high-risk individuals.

Resonant inelastic X-ray scattering using a miniature dispersive Rowland refocusing spectrometer.

X-ray absorption spectroscopy (XAS) beamlines worldwide are steadily increasing their emphasis on full photon-in/photon-out spectroscopies, such as resonant inelastic X-ray scattering (RIXS), resonant X-ray emission spectroscopy (RXES) and high energy resolution fluorescence detection XAS (HERFD-XAS). In such cases, each beamline must match the choice of emission spectrometer to the scientific mission of its users. Previous work has recently reported a miniature tender X-ray spectrometer using a dispersive Rowland refocusing (DRR) geometry that functions with high energy resolution even with a large X-ray spot size on the sample [Holden et al. (2017). Rev. Sci. Instrum. 88, 073904]. This instrument has been used in the laboratory in multiple studies of non-resonant X-ray emission spectroscopy using a conventional X-ray tube, though only for preliminary measurements at a low-intensity microfocus synchrotron beamline. This paper reports an extensive study of the performance of a miniature DRR spectrometer at an unfocused wiggler beamline, where the incident monochromatic flux allows for resonant studies which are impossible in the laboratory. The results support the broader use of the present design and also suggest that the DRR method with an unfocused beam could have important applications for materials with low radiation damage thresholds and that would not survive analysis on focused beamlines.

Knowledge and perceptions of Zika virus transmission in the community of Puerto Plata, Dominican Republic.

BACKGROUND: Zika virus is associated with increased cases of both microcephaly and Guillain-Barré syndrome. Community knowledge, perceptions and practices to prevent infection with the Zika virus are not well understood, particularly among high risk populations living in resource-poor and Zika-endemic areas. Our objective was to assess knowledge of symptoms, health effects and prevention practices associated with Zika virus in rural communities on the northern coast of the Dominican Republic. METHODS: Study participants were contacted while attending community events such as free medical clinics and invited to be interviewed regarding their knowledge, attitudes, and perceptions of Zika virus using the World Health Organization's Zika survey tool. RESULTS: Of the 75 Dominicans that participated, 33% did not know who could become infected with Zika. In addition, only 40% of respondents were able to identify mosquitoes or sexual transmission as the primary routes of infection though 51% of respondents thought that Zika was an important issue in their community. CONCLUSIONS: This study found that general knowledge regarding the basic risks and transmission of Zika were not well understood among a sample of rural Dominicans. Our findings highlight disparities in knowledge and perception of risk from Zika in rural areas compared to previous studies conducted in the Dominican Republic. Education about the basic risks and transmission of Zika are critically needed in these remote populations to reduce Zika transmission.

Zika knowledge and prevention practices among U.S. travelers: a large cross-sectional survey study.

BACKGROUND: The aim of this study was to investigate what factors predict knowledge about Zika transmission, symptomology, and treatment among U.S. travelers and, additionally, to evaluate how Zika knowledge influences the adoption of personal protective behaviors. METHODS: Data were collected as part of a cross-sectional survey study using a probability-based internet panel of U.S. travelers in June 2017. We ran logistic regression models of factors predicting Zika knowledge (high vs. low) and of knowledge predicting adoption of personal protective measures. RESULTS: We found that traveling to a Zika endemic country and travelers' gender were both significantly predictive of higher Zika knowledge (odds ratio (OR): 1.48, 95% confidence interval (CI): 1.14-1.93 and OR: 1.44, 95% CI: 1.08-1.92), adjusting for age, race, education, income, and trip purpose. Additionally, among travelers to Zika endemic countries, individuals with higher Zika knowledge had significantly higher odds of engaging in preventive behaviors compared to those with lower knowledge. However, few travelers knew about the sexual transmission of Zika and adopted sexual prevention measures. CONCLUSIONS: Our findings suggest that there are gaps in knowledge about the risks and transmission of Zika and travelers with low knowledge are less likely to engage in the appropriate prevention methods. Significantly, few U.S. travelers have knowledge of the sexual transmission of Zika and, accordingly, there is less overall engagement with prevention measures for this transmission mechanism than for vector-borne transmission.

Knowledge of the Sexual Transmission of Zika Virus and Preventive Practices Against Zika Virus Among U.S. Travelers.

Individuals are often at increased risk of acquiring infectious disease while traveling. We sought to understand knowledge, attitudes and practices (KAP) regarding Zika virus among travelers from the United States. A total of 1043 study participants were recruited from a probability-based internet panel. Participants self-reported their knowledge of Zika infection and modes of transmission, and identified actions they had taken to prevent Zika infection and transmission including actions to prevent unintentional pregnancy since becoming aware of the Zika virus. Logistic regression was used to model the odds of taking preventive actions against Zika infection with adjustment for potential confounding factors. Knowledge of the sexual transmissibility of Zika virus significantly increased the odds of taking a preventive action against Zika infection, especially condom use or sexual abstention. Participants reported preferences for receiving information about Zika from private doctors and from the Internet. Discrepancies between where travelers seek information about Zika and how they would like to receive information regarding Zika were also found. These findings suggest that improving targeted messaging through online media may increase awareness of the sexual transmissibility of Zika as well as improve health communications with U.S. travelers. Travelers who are unaware of potential disease risks are less likely to adopt personal protective measures to protect themselves and reduce disease spread. Thus, future work should focus on improving communication and providing education to adopt effective prevention strategies while traveling.

Abstention from Drug Use and Delinquency Increasing among Youth in the United States, 2002-2014.

BACKGROUND: Trends in abstaining from substance use and delinquency among adolescent's ages 12-17 in the United States was examined. METHODS: Data was derived from the National Survey on Drug Use and Health (NSDUH) involving non-Hispanic white, African American, and Hispanic respondents (n = 98,620) and spanning the years 2002-2014. Logistic regression was used to examine significance of trend year and correlates of low-risk and high-risk behavioral groups relative to abstaining. RESULTS: Overall, the prevalence of abstaining was 47.56% between 2002 and 2014. Prevalence increased significantly among all adolescents from 44.85% in 2002 to 53.58% in 2014. Relative to abstainers nonabstaining youth were more likely to be male, and report lower household income, poorer grades, depression, and lower levels of parental affirmation and control. CONCLUSIONS: Findings indicate that there is a corresponding increase in abstaining mirroring the recent decreases found in adolescent drug use found in national surveys.

Ambient PM2.5 and Stroke: Effect Modifiers and Population Attributable Risk in Six Low- and Middle-Income Countries.

BACKGROUND AND PURPOSE: Short-term exposure to ambient fine particulate pollution (PM2.5) has been linked to increased stroke. Few studies, however, have examined the effects of long-term exposure. METHODS: A total of 45 625 participants were interviewed and included in this study, the participants came from the Study on Global Ageing and Adult Health, a prospective cohort in 6 low- and middle-income countries. Ambient PM2.5 levels were estimated for participants' communities using satellite data. A multilevel logistic regression model was used to examine the association between long-term PM2.5 exposure and stroke. Potential effect modification by physical activity and consumption of fruit and vegetables was assessed. RESULTS: The odds of stroke were 1.13 (95% confidence interval, 1.04-1.22) for each 10 µg/m3 increase in PM2.5. This effect remained after adjustment for confounding factors including age, sex, smoking, and indoor air pollution (adjusted odds ratio=1.12; 95% confidence interval, 1.04-1.21). Further stratified analyses suggested that participants with higher levels of physical activity had greater odds of stroke, whereas those with higher consumption of fruit and vegetables had lower odds of stroke. These effects remained robust in sensitivity analyses. We further estimated that 6.55% (95% confidence interval, 1.97%-12.01%) of the stroke cases could be attributable to ambient PM2.5 in the study population. CONCLUSIONS: This study suggests that ambient PM2.5 may increase the risk of stroke and may be responsible for the astounding stroke burden in low- and middle-income countries. In addition, greater physical activity may enhance, whereas greater consumption of fruit and vegetables may mitigate the effect.

The acceptability of self-sampled screening for HPV DNA: a systematic review and meta-analysis.

OBJECTIVE: To examine whether or not self-sampled cervical screening for human papillomavirus (HPV) DNA is acceptable and if women prefer self-sampling to clinician-based sampling. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Thirty-seven primary studies obtained through a comprehensive search of six electronic bibliographic databases from 1986 to 2014 and other sources. Search keywords included HPV, screening, DNA testing, vaginal testing, self-collected specimen, self-collected sample, self-sampling, self-screening, preferences and acceptability. REVIEW METHODS: Studies eligible for analysis included those that had participants perform self-sampling, evaluated participant acceptance of or preference for self-sampled vaginal HPV DNA and reported data to calculate an effect size. There were no exclusion criteria for publication status or geographical location. Meta-analytic methods were used to quantitatively synthesise effect sizes across studies. RESULTS: The 37 studies included 18 516 female participants from 24 countries across five continents. Overall, there was a high level of acceptability of self-sampling among the participants. Participants reported preference for self-sampling over clinician sampling due to attractive characteristics such as ease and privacy. CONCLUSIONS: The overall acceptability of self-sampled cervical screening, coupled with economic and effective care, provides opportunities for expanding screening services. Importantly, this can provide a creative screening alternative for women who do not participate in traditional cytological screening, and may ultimately reduce health disparities and prevent cervical disease.

Potential High-Risk Areas for Zika Virus Transmission in the Contiguous United States.

OBJECTIVES: To understand where transmission of Zika virus has the highest likelihood to occur in the contiguous United States with regard to its transmission both sexually and via Aedes aegypti mosquito bites. METHODS: We evaluated the 2 routes of transmission risk with predictors of sexually transmitted infections (percentage women of childbearing age, birthrate, gonorrhea and chlamydia rates, concentrated disadvantage) as a surrogate for unprotected sexual activity and the demographic distribution of the A. aegypti mosquito across 3108 counties in the contiguous United States. RESULTS: We found that 507 counties had the highest risk of virus exposure via mosquito vector or unprotected sexual activity; these were concentrated in southern states extending northward along the Atlantic coast and southern California, with the highest predicted risk in Mississippi counties. CONCLUSIONS: Identifying areas with higher transmission risk can inform prevention strategies and vector control, and assist in planning for diagnosis and treatment.