Few Associations Found between Mold and Other Allergen Concentrations in the Home versus Skin Sensitivity from Children with Asthma after Hurricane Katrina in the Head-Off Environmental Asthma in Louisiana Study.

Mold and other allergen exposures exacerbate asthma symptoms in sensitized individuals. We evaluated allergen concentrations, skin test sensitivities, and asthma morbidity for 182 children, aged 4-12 years, with moderate to severe asthma, enrolled 18 months after Katrina, from the city of New Orleans and the surrounding parishes that were impacted by the storm, into the Head-off Environmental Asthma in Louisiana (HEAL) observational study. Dust (indoor) and air (indoor and outdoor) samples were collected at baseline of 6 and 12 months. Dust samples were evaluated for dust mite, cockroach, mouse, and Alternaria by immunoassay. Air samples were evaluated for airborne mold spore concentrations. Overall, 89% of the children tested positive to ≥1 indoor allergen, with allergen-specific sensitivities ranging from 18% to 67%. Allergen concentration was associated with skin sensitivity for 1 of 10 environmental triggers analyzed (cat). Asthma symptom days did not differ with skin test sensitivity, and surprisingly, increased symptoms were observed in children whose baseline indoor airborne mold concentrations were below median levels. This association was not observed in follow-up assessments. The lack of relationship among allergen levels (including mold), sensitivities, and asthma symptoms points to the complexity of attempting to assess these associations during rapidly changing social and environmental conditions.

Is knowledge about signs and symptoms of preterm labor related to low birth weight?

The intent of this study was to explore the relationship of patient knowledge about the signs and symptoms of preterm labor and low birth weight. To this end, 538 women were interviewed in the postpartum period. Five aspects of preterm labor knowledge (abdominal tightness, vaginal discharge, cramping, diarrhea, and bleeding) were sought, along with standard demographic information. Data were analyzed as dichotomous variables and compared using odds ratios. Logistic regression was chosen to calculate adjusted odds ratios, including only those factors found to be associated with low birth weight. Patient knowledge of each varied from 46 to 87% for the five items. Only one third knew all five areas. Knowledge of the importance of abdominal tightness, vaginal discharge, and cramping were associated with a reduction in low birth weight, as was knowledge of all five aspects. However, regression analysis failed to support a significant association with any of the five areas alone or when considered as a group. The low sensitivity of the relationship between patient knowledge and low birth weight and the lack of correlation after regression suggest that programs focusing on enhanced patient education may have limited benefits.

Is knowledge of health behavior associated with low birth weight?

OBJECTIVE: To examine the relationship of patient knowledge concerning seven health behaviors identified by the U.S. Public Health Service Expert Panel and low birth weight. METHODS: Interviews of 538 women delivering at an inner-city hospital in New Orleans were conducted. Information concerning patient characteristics, health behavior knowledge, and birth weight was collected. Data were analyzed as dichotomous and compared using odds ratios. Logistic regression was chosen to calculate adjusted odds ratios, including only factors found to be associated with the tested end point, low birth weight. RESULTS: A majority of women knew all seven health behavior items. Individual items were known by > or =80% of respondents. Knowledge associated with low birth weight included avoidance of alcohol and drugs, taking of prenatal vitamins, and following a proper diet. Information on all seven was not associated with a reduction in low birth weight. Other factors found to be associated with low birth weight included inadequate prenatal care, absence of health insurance (primarily Medicaid), and a prior low birth weight infant. Logistic regression confirmed both the importance of the last three factors, and the lack of association with health knowledge about all seven items. CONCLUSIONS: Knowledge concerning health advice behavior recommended by the U.S. Public Health Service was more widely known than previously thought. While individual components were associated with a reduction in low birth weight, overall knowledge was not.

Relationship of phencyclidine and pregnancy outcome.

OBJECTIVE: To analyze the relationship of phencyclidine (PCP) and pregnancy outcome, as judged by low birth weight (< 2,500 g). STUDY DESIGN: A retrospective, case-control study of PCP use was conducted among pregnant women who delivered at a large hospital in New Orleans. PCP use was ascertained by urine screening at the time of obstetric admission. Three control patients were selected for each case, matched for age, parity and month of delivery. The study intended to address the prevalence of low birth weight. RESULTS: Between January 1990 and June 1996, 13,653 patients delivered. Of these, 23 were identified as PCP users. PCP users had smaller infants (2,698 vs. 3,011 g, P < .05); that may have been accounted for by a reduction in gestational age (37.3 vs. 38.3 weeks, P = NS). The users were more likely to give histories of using tobacco, alcohol or marijuana but not cocaine. Syphilis and diabetes mellitus were found more often in the study group. Multisubstance use was also common in the study group. The prevalence of low birth weight was not statistically different for the study and control groups. CONCLUSION: PCP use was not associated with an increase in low birth weight. When identified, patients using PCP require comprehensive evaluation.

A comparative evaluation of collaborative prenatal care.

OBJECTIVE: To evaluate the effectiveness of an advanced-practice nurse-obstetrician collaborative prenatal practice. METHODS: A group of 194 consecutively enrolled medically low-risk obstetric patients was identified between January 1, 1994 and December 31, 1994 at Neighborhood Pregnancy Care, a collaborative-practice site. An equal number of medically low-risk patients attending the Louisiana State University obstetric clinic at the Medical Center of Louisiana at New Orleans was selected randomly from among those registering the same month. The two groups were compared on the primary outcome variable, low birth weight. Data were analyzed by chi2, Fisher exact test, t test, and regression models. RESULTS: We compared 179 collaborative-care and 181 university patients with retrievable information. By univariate analysis, collaborative-care patients more often were teenagers and black, and less likely to be married or employed. Collaborative-care patients had more prenatal visits and were more likely to participate in Medicaid, but less likely to deliver at the Medical Center of Louisiana at New Orleans. Birth weight and gestational age at delivery were greater. Both delivery before 37 weeks (7.3% versus 17.7%, P < .001) and birth weight less than 2500 g (8.9% versus 19.3%, P < .001) were less common. When differences identified at the initial obstetric visit were considered, multivariate weighted logistic regression confirmed the importance of prenatal care at the collaborative-practice program for low birth weight (odds ratio [OR] 0.37; 95% confidence interval [CI] 0.19, 0.71) and preterm delivery (OR 0.36; 95% CI 0.16, 0.78). When all differences were entered, low birth weight remained a significantly less likely occurrence at the collaborative-practice site (OR 0.46; 95% CI 0.23, 0.92). CONCLUSION: An advanced-practice nurse-obstetrician collaborative practice may be implemented successfully and lead to acceptable perinatal outcomes, as judged by low birth weight and prematurity.

The impact of the manual vacuum aspiration (MVA) technique on health care services at Queen Elizabeth Central Teaching Hospital, Blantyre, Malawi.

OBJECTIVES: To assess the impact of the manual vacuum aspiration (MVA) technique on health care services and its acceptability to patients and staff. DESIGN: Prospective descriptive survey. SETTING: The university teaching hospital, Blantyre, Malawi. PARTICIPANTS: All 456 patients who had MVA for treatment or investigation between 10 January and 9 April 1994, the nurses and doctors working in the unit and hospital administrators. MAIN OUTCOMES: Proportion of incomplete abortion patients who had MVA, the need for pain relief, patients' reactions, staff opinion, and reduction in ward occupancy rates and duration of hospitalisation. RESULTS: Of the total, 97.4% had MVA for treatment of incomplete abortion; these comprised 81.2% of all incomplete abortion patients treated during the study period. The mean volume of uterine contents was 33.4 ml. There was no relationship between the volume and either the gestational age or uterine size (P > 0.05). Only 10.7% of patients required pain relief. The bed occupancy rates in the gynaecological ward dropped from an average of 150% before to 130% after the introduction of MVA, and the mean hospital stay was reduced from 3 days, with 78.4% staying for more than 2 days, to 2 days, with 52% staying for less than 24 hours (P < 0.05). Most patients expressed general satisfaction with the method, while the staff were happler because their work had been made easier. There were no major complications associated with the procedure. CONCLUSION: The findings show that MVA is a safe, reliable, effective and acceptable method of treating incomplete abortion, and can conserve hospital resources.

Do human papillomaviruses have a role in the pathogenesis of bladder carcinoma?

PURPOSE: Since little is known of the associations between bladder carcinoma and human papillomaviruses (HPVs), data on the role of HPV in bladder carcinogenesis are controversial. We attempted to clarify whether HPVs are present in bladder carcinomas. MATERIALS AND METHODS: We examined 36 specimens of bladder carcinoma for HPV positivity by the polymerase chain reaction method. RESULTS: HPV-16 deoxyribonucleic acid was detected in 1 specimen (3%) of a transitional cell carcinoma from a 37-year-old woman who had concomitant squamous cell carcinoma of the uterine cervix with positive para-aortic lymph node metastasis. The cervical tumor, bladder tumor and para-aortic lymph node metastasis were all positive for the same type of HPV. CONCLUSIONS: On the basis of this low rate of HPV detection (3%), HPVs are not likely to have a prominent role in carcinogenesis of the bladder.

Effects of single and combined application of anti-cancer drugs on cervical adenocarcinoma. I. Antitumor activity in vitro.

BACKGROUND: Establishment of effective combination chemotherapy regimen for patients with an adenocarcinoma of the uterine cervix has been long-awaited because there has been no documentation concerning chemosensitivity of this tumor against conventional antitumor agents. METHODS: To search for an effective combination regimen, 15 conventional antitumor drugs were tested for growth inhibitory effects on five different cervical adenocarcinoma cell lines. RESULTS: Etoposide, mitomycin C, adriamycin, epirubicin, and vinblastine, were singularly effective. Effects of combination chemotherapy were also tested using the above five antitumor agents plus interferon-gamma. Etoposide, mitomycin C, and interferon-gamma were the most effective when given in combination. CONCLUSIONS: Combined treatment with the above three drugs seems worthy of consideration for clinical application.

Detection of human papillomavirus types 16 and 18 in primary and in metastatic lesions of cervical carcinomas.

Human papillomavirus (HPV) types 16 and 18 are most prevalent in cervical carcinomas and are also present in metastatic sites. Thirty-six patients with lymph node metastases were examined for the possible presence of HPV 16 and 18 DNA sequences in the primary tumors as well as in metastatic lymph nodes. Polymerase chain reaction (PCR) analysis revealed the presence of the genome of HPV type 16 (HPV 16) in 17 tumors (47%) and that of HPV type 18 (HPV 18) in 2 tumors (6%), while 17 tumors (47%) were negative for both types. Of the 17 HPV 16-positive patients, 15 metastatic lymph nodes were also positive and 2 were negative. In 2 patients positive for HPV 18, the metastatic sites were negative. All the 17 patients negative for HPV in the primary tumors were also negative for HPV 16 and HPV 18 in the metastatic lymph nodes. These data confirmed the positive correlation of HPV DNA status between primary and metastatic tumors. However, the discrepancy in 11% of cases was attributed to presence of heterogeneous clones in the primary tumor.

Polymerase chain reaction analysis of human papillomavirus in adenocarcinoma and adenosquamous carcinoma of the uterine cervix.

Thirty-two cervical adenocarcinomas and adenosquamous carcinomas were examined to search for human papillomaviruses (HPVs) using the polymerase chain reaction system. Human papillomavirus type 16 (HPV16) and type 18 (HPV18) deoxyribonucleic acid was detected in 22% and 16% of these carcinomas, respectively. HPV16 was the most common type in both adenocarcinoma and adenosquamous carcinoma, and the mean age of the HPV negative patients was significantly higher than that of HPV positive patients. There may be an association between HPVs and the development of certain adenocarcinomas and adenosquamous carcinomas of the cervix.

Safety and immunogenicity of bacille Calmette-Guérin, diphtheria-tetanus-pertussis, and oral polio vaccines in newborn children in Zaire infected with human immunodeficiency virus type 1.

OBJECTIVE: To determine the safety and immunogenicity of childhood vaccines in children with perinatally acquired human immunodeficiency virus type 1 (HIV-1) infection. DESIGN: Nonrandomized, prospective cohort study; 12-month follow-up period. SETTING: Obstetric wards and outpatient pediatric clinics at two large hospitals in Kinshasa, Zaire. PATIENTS: A total of 8108 pregnant women were screened for HIV-1 antibodies. The 474 children born to 466 seropositive women identified during screening and the 616 children born to 606 seronegative, age- and parity-matched women were vaccinated. INTERVENTION: The following vaccines were administered at the stated ages: bacille Calmette-Guérin (BCG) vaccine (2 days); trivalent oral Sabin poliomyelitis vaccine (2 days and 6, 10, and 14 weeks); and adsorbed diphtheria-tetanus-pertussis (DTP) vaccine (6, 10, and 14 weeks). MEASUREMENTS AND MAIN RESULTS: Protective antibody titers to tetanus and poliovirus types 1, 2, and 3 were achieved in 95% of all children. Among children with HIV-1 infection, 70.8% had protective antibody titers to diphtheria compared with 98.5% of uninfected children (p < 0.05). Geometric mean antibody titers to diphtheria and poliovirus types 1, 2, and 3 were significantly lower in children with HIV-1 infection than in uninfected children. Vaccine-associated side effects were similarly low in all children. CONCLUSIONS: The low incidence of side effects and the high proportion of children with HIV-1 infection who achieved protective postimmunization antibody titers support the continuing use of BCG, DTP, and oral polio vaccines in childhood immunization programs in HIV-1 endemic areas.