Partnership with the University of São Paulo Panel of Twins: A Four-City Tour and More / Twin Research Reviews: Twin Research on Binge Eating; Twins' Physical Outcomes Linked to Different Diets; Working Conditions and Sickness Absence in Swedish Twins; Facial Morphology Differences in Monozygotic Twins / Human Interest and Importance: Michigan Family Forced to Adopt Their Own Twins; Ethics of Hiring a Surrogate to Bear Twins; Twin Survivors of the Israel-Hamas War; Twin Pregnancy with Double Uterus; Three Twin Pairs on Same Women's Soccer Team.

This article begins with an overview of twin research in Brazil, initiated by the University of São Paulo Panel of Twins. I met with many new research collaborators and students while on a fall 2023 four-city lecture tour in that country. A meeting with a world-famous surgeon who recently separated craniopagus conjoined twin pairs is also described. This overview is followed by summaries of twin research on binge eating, twins' physical outcomes linked to different diets, working conditions and sickness absence in Swedish Twins and facial morphology differences in monozygotic twins. The final section of this article provides a sampling of human interest stories with important implications. They include a Michigan family forced to adopt their own twins, ethical issues surrounding the hiring of a surrogate to bear twins; twin survivors of the Israel-Hamas war, a twin pregnancy with a double uterus, and three twin pairs on the same women's soccer team.

Knowledge and Attitudes of two Latino Groups about Alzheimer Disease: a Qualitative Study.

Clustering Latinos under a single group in Alzheimer Disease (AD) research, neglects, among other things cultural and environmental differences. To address this, we examine knowledge and attitudes about AD among two Latino groups. We held 5 focus groups and 2 interviews all in Spanish with Mexicans and Puerto Ricans between 40 and 60 years old living in the Grand Rapids area in Michigan. Using content analysis of the discussions, we identified themes related to knowledge, attitudes and concerns about AD and caregiving. A total of 20 Mexicans and 9 Puerto Ricans participated. Improving knowledge and awareness, barriers and home-based family care were important themes in both Latino groups. Puerto Rican groups raised more concerns about the disease, whereas lack of knowledge was a key theme among Mexican participants. The exploratory study is a first step in promoting research that is attentive to the commonalities and differences of Latino groups and in continuing efforts to enhance health literacy among these groups.

Using a Quitline to Deliver Opt-Out Smoking Cessation for Cancer Patients.

PURPOSE: Although smoking by patients with cancer and survivors causes adverse outcomes, many patients with cancer do not receive access to evidence-based tobacco use treatment. The purpose of this article is to report on delivery of tobacco use treatment to patients with cancer using a state-supported Quitline. METHODS: Statewide agencies in Michigan partnered with the Michigan Oncology Quality Consortium to develop and implement a clinical quality improvement initiative with the goal of addressing tobacco use by patients with cancer across Michigan oncology practices. The collaborative designed an opt-out approach for identifying tobacco users and referring them to the Michigan Tobacco Quitline (hereafter known as Quitline) within participating practices. As the initiative progressed, patients with cancer who were not referred through the initiative also became eligible for enrollment in the Quitline program. RESULTS: A total of 4,347 patients with cancer enrolled in the Quitline between 2012 and 2017, and annual referrals from oncology practices increased from 364 (5% of Quitline participants) to 876 (17% of Quitline participants). The 2013-2016 Michigan Behavioral Risk Factor Surveillance System also demonstrated an increase from 60% to 80% of cancer survivors receiving smoking cessation resources. Of 3,892 patients with cancer who had Quitline follow-up data through 2017, 79% completed one or more counseling calls. The 6-month self-reported quit rate for patients with cancer assessed between 2013 and 2016 was 26%. CONCLUSION: Using statewide resources to increase access to evidence-based smoking cessation assistance to patients with cancer is achievable. In an increasingly cost-conscious health care environment, collaborative initiatives that use or enhance existing resources should be considered and refined to deliver effective evidence-based care.

The influence of identity on the prevalence and persistence of disordered eating and weight control behaviors in Mexican American college women.

Disordered eating behaviors are prevalent in Mexican-American college-enrolled women and contribute to compromised physical and psychological health. Although disordered eating behaviors are multi-determined, few studies have examined individual difference factors that contribute to disordered eating behaviors in Mexican women beyond acculturation. Evidence suggests that individual differences in the constellation of identities may be an important factor influencing the disordered eating behaviors. We hypothesized that individual differences in the collection of identities (self-schemas) increases susceptibility to defining oneself as fat (fat self-schema) and contribute to disordered eating behaviors over time in Mexican American college women. A 12-month longitudinal design was used to measure the level of disordered eating behaviors at 5 points over 12 months in 477 Mexican American women. Identity properties (i.e., positive self-schemas, negative self-schemas, fat self-schema) were measured at baseline. Controlling for relevant covariates, latent growth curve models showed that Mexican American women with few positive and many negative self-schemas were more likely to define themselves as fat, which in turn, predicted purging and fasting/restricting behaviors across the year. However, identity properties were not predictive of binge eating and excessive exercise episodes. Interventions focused on development of positive self-schemas that reflect areas of interest and competence and the revision of negative self-schemas may protect against purging and fasting/restricting in Mexican American college-enrolled women.

Polyneuropathy in Severely Obese Women Without Diabetes: Prevalence and Associated Factors.

BACKGROUND: Obesity and its complications are prevalent in women and increase with age. Polyneuropathy (PNP) is a complication of obesity and bariatric surgery (BS). In subjects with severe (grades II and III) obesity and without DM who are candidates for BS, the prevalence of PNP and associated conditions are not well characterized. The aim of this study was to evaluate the prevalence of PNP in severely obese (SO) women without DM or common nutritional deficiencies in order to determine factors associated with the presence of PNP. METHODS: A cross-sectional study was performed on 450 SO women. They were evaluated with the Michigan Neuropathy Screening Instrument, a Sleep Apnea Questionnaire, and the short form of the International Physical Activity Questionnaire. Data on blood pressure, body mass index, waist circumference, serum glucose, glycated hemoglobin, LDL and HDL cholesterol, triglycerides, vitamin B12, and postmenopausal (PM) status were also collected. Patients with DM and other common causes of PNP were excluded. To evaluate which variables were independently associated with PNP (dependent variable), Poisson regression models were used. RESULTS: The prevalence of PNP was 11.6%. In univariate analysis, PNP was associated with age, PM status, and diagnosis of systemic arterial hypertension (p < 0.001, p < 0.001, and p = 0.016, respectively), and there was a trend toward an association with sleep apnea risk (p = 0.101). In multivariate analysis, PM status (PR = 2.836, 95% CI 1.735-4.636, p = 0.001) and age (PR = 1.0511, 95% CI 1.031-1.071, p = 0.001) were independently associated with PNP diagnosis in two different models. CONCLUSION: Even prior to BS, PNP is highly prevalent and is associated with PM status and age in SO women without diabetes.

Blood Lead Levels of Children in Flint, Michigan: 2006-2016.

OBJECTIVE: We evaluated the increases in blood lead levels (BLLs) observed in young children in Flint, Michigan, during their exposure to corrosive Flint River water during the years 2014 and 2015 and compared their BLLs to those of Flint children measured during the years 2006-2013 and 2016. STUDY DESIGN: This was a retrospective study design using BLLs extracted from databases from 2006 to 2016. We analyzed a population sample of 15 817 BLLs from children aged ≤5 years with potential exposure to contaminated Flint River water. Percentages of BLLs ≥5.0 µg/dL and geometric mean (GM) BLLs were analyzed over time. RESULTS: A significant decline in the percentages of BLLs ≥5.0 µg/dL from 11.8% in 2006 to 3.2% in 2016 was observed (P < .001). GM ± SE BLLs decreased from 2.33 ± 0.04 µg/dL in 2006 to 1.15 ± 0.02 µg/dL in 2016 (P < .001). GM BLLs increased twice: from 1.75 ± 0.03 µg/dL to 1.87 ± 0.03 µg/dL (2010-2011) and from 1.19 ± 0.02 µg/dL to 1.30 ± 0.02 µg/dL (2014-2015). Overall, from 2006 to 2016, there was a 72.9% decrease in the percentage of children with BLLs ≥5.0 µg/dL and a 50.6% decrease in GM BLLs. CONCLUSION: These findings suggest that the 11 year trend of annual decreases in BLLs in children in Flint, Michigan, reversed to a degree consistent with random variation from 2010 to 2011, and again during the exposure to Flint River water in 2014-2015. Historically, public health efforts to reduce BLLs of young children in Flint have been effective over the 11-year period studied.

Moms' Empowerment Program participation associated with improved physical health among Latinas experiencing intimate partner violence / La participación en la iniciativa Programa de Empoderamiento de las Mamás, se asocia con mejoría de la salud física de las mujeres latinas objeto de violencia de pareja / Participação no Programa de Empoderamento de Mães associada à melhora da saúde física em mulheres latinas que sofrem violência infligida pelo parceiro íntimo

ABSTRACT Objective To evaluate whether participation in the Moms' Empowerment Program (MEP), a 10-week, 10-session intervention designed to provide support and increase access to available community resources for women experiencing intimate partner violence (IPV), enhanced the physical health of participants who self-identified as Latina. Methods Mothers of children ages 4-12 who self-identified as Latina and had experienced IPV within the past two years were recruited at three intervention sites in Michigan, Ohio, and Texas, via community postings and referrals from agencies serving IPV-exposed families. Selected study participants (n = 93) were assigned to one of two groups: Treatment (immediate enrollment in the MEP) or Control (placement on a waitlist with an invitation to participate in the MEP after the 10-week study period). Data were drawn from two structured interviews, one at the time of recruitment for the study (Time One), and one following the intervention or wait period (Time Two). Results After controlling for age, educational attainment, and partner residence (living with a violent partner at the time of the interview), multilevel modeling revealed that improvement in physical health over time was significantly greater among women who participated in the intervention relative to controls. Conclusions These data suggest that enhancing interpersonal connectedness and access to resources positively affects physical health for Latinas experiencing IPV.

RESUMEN Objetivo Evaluar si la participación en la iniciativa Programa de Empoderamiento de las Mamás (PEM), una intervención de 10 sesiones en 10 semanas concebida para prestar apoyo a mujeres autodefinidas como latinas objeto de violencia de pareja y brindarles un mayor acceso a los recursos comunitarios, mejoró la salud física de las participantes. Métodos Participaron en el estudio madres de niños de 4 a 12 años de edad que se autodefinieron como latinas y habían sido objeto de violencia de pareja en los últimos dos años. El reclutamiento de las participantes se hizo en tres sitios donde se realizaba la intervención, en Michigan, Ohio y Texas, por medio de avisos comunitarios y referencias de organismos que atienden a familias expuestas a la violencia de pareja. Las participantes seleccionadas para el estudio (n = 93) se asignaron a uno de los dos grupos siguientes: grupo de tratamiento (se inscribieron de inmediato en el PEM) o grupo de control (se pusieron en una lista de espera y se invitaron a participar en el PEM una vez que transcurrieran las 10 semanas del estudio). Se extrajeron datos de dos entrevistas estructuradas, una realizada al inscribir a las participantes en el estudio (fecha 1) y otra después de la intervención o el período de espera (fecha 2). Resultados Después de controlar la edad, el nivel de escolaridad y el lugar de residencia de la pareja (vivir con una pareja violenta en el momento de la entrevista), el modelo de varios niveles mostró que el mejoramiento de la salud física con el transcurso del tiempo era significativamente mayor en las mujeres que habían participado en la intervención que en las mujeres del grupo de control. Conclusiones Estos datos indican que mejorar la conexión interpersonal y el acceso a los recursos tiene un efecto positivo en la salud física de las mujeres latinas que son objeto de violencia de pareja.

RESUMO Objetivo Avaliar se a participação no Programa de Empoderamento de Mães (PEM), uma intervenção composta por 10 sessões semanais com o objetivo de prestar apoio e melhorar o acesso aos recursos disponíveis na comunidade para mulheres que sofrem violência infligida pelo parceiro íntimo, promove a melhora da saúde física das participantes que se reconhecem como latinas. Métodos Mães de crianças com idade de 4 a 12 anos que se reconhecem como latinas e sofreram violência infligida pelo parceiro íntimo nos dois anos anteriores foram recrutadas em três centros de intervenção em Michigan, Ohio e Texas, por meio de anúncios na comunidade e o encaminhamento de órgãos que fazem o atendimento de famílias expostas à violência infligida pelo parceiro íntimo. As participantes selecionadas para o estudo (n = 93) foram divididas em dois grupos: grupo de tratamento (inscrição imediata no PEM) ou grupo de controle (inscrição na lista de espera com convite para participar do PEM após o período do estudo de 10 semanas). Os dados foram coletados em duas entrevistas estruturadas, uma ao recrutamento para o estudo (momento 1) e a outra após a intervenção ou o período de espera (momento 2). Resultados Após controlar idade, nível de instrução e residência do parceiro (coabitação com o parceiro violento no momento da entrevista), a análise com o modelo de múltiplos níveis demonstrou que houve uma melhora significativamente maior da saúde física ao longo do tempo nas participantes da intervenção em comparação ao grupo de controle. Conclusões Esses resultados indicam que reforçar o senso de conexão interpessoal e melhorar o acesso aos recursos têm um impacto positivo na saúde física de mulheres latinas que sofrem violência infligida pelo parceiro íntimo.

Severe anemia in cats with urethral obstruction: 17 cases (2002-2011).

OBJECTIVE: To characterize clinical parameters of cats with severe anemia due to suspected urinary bladder hemorrhage associated with urethral obstruction. DESIGN: Retrospective case-control study. SETTING: University teaching hospital. ANIMALS: Seventeen cats with urethral obstruction and severe anemia (group "UO-A") that required transfusion were identified via medical record database search. Thirty cats with urethral obstruction and mild or no anemia (group "UO") were included as controls. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The median PCV of all cases at presentation was 28% (range, 9%-47%). Seven cats had PCV ≤20% at presentation, and all transfused cats had PCV ≤20% at the time of transfusion. Three cats did not receive a transfusion despite PCV ≤18%. Cats in the UO-A group had a significantly longer duration of clinical signs (P = 0.001), and were more likely to have a history of previous urethral obstruction (P = 0.011), have a heart murmur (P = 0.002), have a gallop rhythm (P = 0.005), and have lower blood pressure (P = 0.007) compared to those in the UO group. Additionally, UO-A cats had significantly lower pH, more negative base excess, higher BUN, and higher creatinine compared to UO cats. Duration of urinary catheterization was significantly (P = 0.016) longer in UO-A cats. All UO cats survived to discharge, whereas 4/17 (23.5%) UO-A cats were euthanized (P = 0.013). CONCLUSIONS: A history of previous urethral obstruction and longer duration of clinical signs may be important risk factors for severe anemia in UO cats. Additionally, UO-A cats appeared to be more severely affected, as evidenced by lower blood pressure, more severe metabolic acidosis, higher BUN and creatinine, and worse outcome.

Fontan-associated protein-losing enteropathy and plastic bronchitis.

OBJECTIVE: To characterize the medical history, disease progression, and treatment of current-era patients with the rare diseases Fontan-associated protein-losing enteropathy (PLE) and plastic bronchitis. STUDY DESIGN: A novel survey that queried demographics, medical details, and treatment information was piloted and placed online via a Facebook portal, allowing social media to power the study. Participation regardless of PLE or plastic bronchitis diagnosis was allowed. Case control analyses compared patients with PLE and plastic bronchitis with uncomplicated control patients receiving the Fontan procedure. RESULTS: The survey was completed by 671 subjects, including 76 with PLE, 46 with plastic bronchitis, and 7 with both. Median PLE diagnosis was 2.5 years post-Fontan. Hospitalization for PLE occurred in 71% with 41% hospitalized ≥ 3 times. Therapy varied significantly. Patients with PLE more commonly had hypoplastic left ventricle (62% vs 44% control; OR 2.81, 95% CI 1.43-5.53), chylothorax (66% vs 41%; OR 2.96, CI 1.65-5.31), and cardiothoracic surgery in addition to staged palliation (17% vs 5%; OR 4.27, CI 1.63-11.20). Median plastic bronchitis diagnosis was 2 years post-Fontan. Hospitalization for plastic bronchitis occurred in 91% with 61% hospitalized ≥ 3 times. Therapy was very diverse. Patients with plastic bronchitis more commonly had chylothorax at any surgery (72% vs 51%; OR 2.47, CI 1.20-5.08) and seasonal allergies (52% vs 36%; OR 1.98, CI 1.01-3.89). CONCLUSIONS: Patient-specific factors are associated with diagnoses of PLE or plastic bronchitis. Treatment strategies are diverse without clear patterns. These results provide a foundation upon which to design future therapeutic studies and identify a clear need for forming consensus approaches to treatment.

Cervical cancer screening coverage in a high-incidence region / Cobertura do rastreamento do câncer de colo de útero em região de alta incidência

OBJECTIVE To analyze the coverage of a cervical cancer screening program in a city with a high incidence of the disease in addition to the factors associated with non-adherence to the current preventive program. METHODS A cross-sectional study based on household surveys was conducted. The sample was composed of women between 25 and 59 years of age of the city of Boa Vista, RR, Northern Brazil who were covered by the cervical cancer screening program. The cluster sampling method was used. The dependent variable was participation in a women’s health program, defined as undergoing at least one Pap smear in the 36 months prior to the interview; the explanatory variables were extracted from individual data. A generalized linear model was used. RESULTS 603 women were analyzed, with an mean age of 38.2 years (SD = 10.2). Five hundred and seventeen women underwent the screening test, and the prevalence of adherence in the last three years was up to 85.7% (95%CI 82.5;88.5). A high per capita household income and recent medical consultation were associated with the lower rate of not being tested in multivariate analysis. Disease ignorance, causes, and prevention methods were correlated with chances of non-adherence to the screening system; 20.0% of the women were reported to have undergone opportunistic and non-routine screening. CONCLUSIONS The informed level of coverage is high, exceeding the level recommended for the control of cervical cancer. The preventive program appears to be opportunistic in nature, particularly for the most vulnerable women (with low income and little information on the disease). Studies on the diagnostic quality of cervicovaginal cytology and therapeutic schedules for positive cases are necessary for understanding the barriers to the control of cervical cancer. .

OBJETIVO Analisar a cobertura do programa de rastreamento do câncer do colo uterino em município com alta incidência da doença e os fatores relacionados à não adesão ao programa preventivo vigente. MÉTODOS Foi realizado estudo transversal, com base em inquérito domiciliar. A amostra foi composta por mulheres entre 25 e 59 anos de idade do município de Boa vista, RR, Brasil, com cobertura pelo programa de rastreamento do câncer do colo uterino. Foi utilizado o método de amostragem por conglomerado. A variável dependente foi a adesão ao programa de saúde da mulher, definida como a realização de pelo menos um teste de Papanicolaou nos 36 meses anteriores à data da entrevista; as variáveis explicativas foram extraídas a partir de informações individuais. Foi utilizado modelo linear generalizado. RESULTADOS Foram analisadas 603 mulheres, com idade média de 38,2 anos (DP = 10,2). Quinhentas e dezessete mulheres realizaram o exame, sendo a prevalência de realização, nos últimos três anos, de 85,7% (IC95% 82,5;88,5). Renda familiar per capita elevada e consulta médica recente associaram-se à menor taxa de não realização do exame na análise multivariada. O desconhecimento da doença, das causas e dos meios de prevenção correlacionou-se com a chance de não adesão ao rastreamento. Vinte por cento das mulheres relataram realização do exame em caráter oportunístico, e não rotineiro. CONCLUSÕES A cobertura informada é elevada, acima do recomendado para controle do câncer do colo uterino. O programa preventivo apresenta caráter oportunístico, sobretudo para as mulheres mais vulneráveis (com baixa renda e pouca informação sobre a doença). Estudos sobre a qualidade diagnóstica da citologia cervicovaginal e dos itinerários terapêuticos dos casos positivos são necessários para compreensão das barreiras para o controle do câncer do colo uterino. .

Human papillomavirus (HPV) testing for normal cervical cytology in low-risk women aged 30-65 years by family physicians.

PURPOSE: The purpose of this study was to assess ordering of human papillomavirus (HPV) testing for normal cervical cytology among low-risk women aged 30 to 65 years. METHODS: Audits of 833 cytology request forms for low-risk women completing a Papanicolaou smear, from January 2008 to April 2011, from 5 Michigan family medicine clinics determined HPV orders completed by the clinician performing the Papanicolaou smear. Multivariate logistic regression models examined differences in HPV test ordering by patient age at Papanicolaou test, provider status and sex, and clinic across sites. A Poisson regression model analyzed the annual number of HPV test orders over time. RESULTS: Cytology requests were completed by 622 faculty (75%), 169 residents/fellows (20%), and 42 nurse practitioner/physician assistants (NP/PAs) (5%). HPV testing for any cytology result was ordered on 324 request forms (39%) by residents/fellows (48%), faculty (38%), and NP/PAs (10%). Female providers were twice as likely as men to order HPV testing for any cytology result across all clinics and provider statuses (P < .001). There were significant differences in HPV test ordering among clinics. Between 2008 and 2011 annual cytology requests increased 46%, including HPV testing for any cytology result after adjusting for faculty provider sex. CONCLUSION: HPV test ordering when cytology is collected varied by clinic and provider status and sex. HPV co-testing for any cytology result remains modest, but is increasing over time in these clinics.

Infants with single ventricle physiology in the emergency department: are physicians prepared?

OBJECTIVE: To assess emergency department (ED) utilization and physician preparedness for infants with single ventricle (SV) physiology between stage 1 and stage 2 surgical palliation. STUDY DESIGN: Records of infants with SV physiology discharged after stage I palliation between July 2006 and June 2009 were retrospectively reviewed. Next, a cross-sectional survey of registered ED physicians in Michigan was performed. RESULTS: Thirty-three of 42 patients (79%) required 65 ED visits, most commonly presenting with respiratory distress (35%). Six patients died in the ED; 35 other visits resulted in hospital admission, 4 requiring urgent surgery or catheterization. Median initial hospital stay in those with ED visits was significantly longer (21 days; IQR, 17-45 days) than those without (12 days; IQR, 5.5-24 days) (P = .032). Three hundred seventy-six of 915 surveyed ED physicians responded. Most (72%) were unsure of the acceptable range of arterial oxygen saturation for these infants, and 58% felt "uncomfortable" or "worried" about their treatment. Despite these concerns, 59% deemed education in SV physiology as low priority. CONCLUSIONS: Between stages I and II, infants with SV physiology utilized the ED frequently, often with high disease acuity. Most ED physicians surveyed appeared underprepared for these infants. These findings underscore the need for educational efforts aimed at increasing ED preparedness.

Population-based analysis of survival for hypoplastic left heart syndrome.

OBJECTIVE: To analyze survival patterns among infants with hypoplastic left heart syndrome (HLHS) in the State of Michigan. STUDY DESIGN: Cases of HLHS prevalent at live birth were identified and confirmed within the Michigan Birth Defects Registry from 1992 to 2005 (n=406). Characteristics of infants with HLHS were compared with a 10:1 random control sample. RESULTS: Compared with 4060 control subjects, the 406 cases of HLHS were more frequently male (62.6% vs 51.4%), born prematurely (<37 weeks gestation; 15.3% vs 8.7%), and born at low birth weight (LBW) (<2.5 kg; 16.0% vs 6.6%). HLHS 1-year survival rate improved over the study period (P=.041). Chromosomal abnormalities, LBW, premature birth, and living in a high poverty neighborhood were significantly associated with death. Controlling for neighborhood poverty, term infants versus preterm with HLHS or LBW were 3.2 times (95% CI: 1.9-5.3; P<.001) more likely to survive at least 1 year. Controlling for age and weight, infants from low-poverty versus high-poverty areas were 1.8 times (95% CI: 1.1-2.8; P=.015) more likely to survive at least 1 year. CONCLUSIONS: Among infants with HLHS in Michigan, those who were premature, LBW, had chromosomal abnormalities, or lived in a high-poverty area were at increased risk for early death.

Personal identities and disordered eating behaviors in Mexican American women.

Eating disorder behaviors are prevalent in Latina populations. This study tested Schwartz's (2006) theoretical view that a broad array of personal identities serves as an internal resource during acculturation and prevents internalization of dysfunctional weight related beliefs. Sixty-six Mexican American women completed measures of personal identities, fat self-definition, eating disorder symptoms and acculturation. Results show that few positive and many negative personal identities predict higher eating disorder scores and effects are mediated through the fat self-definition. Characteristics of personal identities may influence internalization of cultural values related to weight. Interventions focused on overall identity may prevent eating disorders in Latinas.

Self care and health-seeking behavior of migrant farmworkers.

There are an estimated three million migrant and seasonal farmworkers (MSFW) in the United States. In addition to the inherent dangers of farm work, numerous factors place MSFW at even greater risk for work-related injuries. Little is known about how MSFW care for work-related injuries, and how the decision to seek professional care is made. A prospective survey using face-to-face structured interviews was used to explore the type and frequency of occupational injuries as well as self-care and health-care seeking practices of MSFW. Musculoskeletal injuries were the most commonly reported injuries, followed by injuries of the skin and chemical exposure. Self care with over-the-counter remedies was the predominant method of dealing with injuries, and, with the exception of chemical exposure, was found to be for the most part, appropriate. The reported use of alternative medicine or herbal remedies was low. Future research efforts should focus on ergonomic modifications and farmworker education to reduce or prevent musculoskeletal injuries. The number of reported chemical exposures and inappropriate treatment draw attention to the need for continued efforts for both primary prevention of exposure and optimal treatment once exposure occurs.

Epidemiology and risk factors for thromboembolic complications of childhood nephrotic syndrome: a Midwest Pediatric Nephrology Consortium (MWPNC) study.

OBJECTIVES: To identify clinical variables predictive of the risk of thromboembolism (TE), and to confirm the incidence of TE in primary and secondary childhood nephrotic syndrome (NS). STUDY DESIGN: A comprehensive chart review identified 326 children with NS from any cause evaluated between 1999 and 2006. These patients had a total of 1472.8 patient-years of follow-up. Comparison statistics, survival analysis, and logistic regression were used to define TE epidemiology and clinical risk factors. RESULTS: We found that 9.2% of our cohort had experienced at least 1 TE. The overall incidence was 20.4 patients with TEs/1000 patient-years. The median time to the first TE was 70.5 days after diagnosis of NS. Deep venous thrombosis was the most common TE (76%) and was frequently associated with the use of a central venous catheter (45%). Significant independent predictors of TE included age > or = 12 years at onset of NS (P < .0001), severity of proteinuria (P < .0001), and history of TE preceding diagnosis of NS (P < .0001). Life- or limb-threatening TEs represented 23.7% of the events. CONCLUSIONS: Children with NS should be carefully followed for TE, particularly those who are age 12 years or older, have severe proteinuria, or have a previous history of TE.

Overweight and obesity among youth participants in American football.

OBJECTIVE: To estimate the prevalence of overweight and obesity among participants in youth American football 9 to 14 years of age. STUDY DESIGN: Cross-sectional, 653 boys, 8.7 to 14.6 years. Height and weight were measured; body mass index (BMI) was calculated. Overweight and obesity were defined by international (International Obesity Task Force [IOTF]) and United States (Centers for Disease Control [CDC]) criteria. Prevalence and 95% confidence interval were calculated. Player age, height, and weight and midparent height were used to predict mature height; current height was expressed as a percentage of predicted mature height as an estimate of maturity status. RESULTS: Overall 45.0% (41.2% to 48.9%) and 42.6% (38.8% to 46.5%) of players were overweight or obese by CDC and IOTF criteria, respectively. Prevalence was highest in early maturing boys. Based on position-activity at time of injury (n = 180), overweight and obesity were more common among offensive and defensive linemen. CONCLUSION: Overweight and obesity were more prevalent in youth football players than in national samples of American boys. Allowing for limitations of the BMI and the relative stability of the BMI from adolescence into adulthood, a relatively large number of football participants may be at risk for later overweight or obesity, and the risk appears to be greater for offensive and defensive line positions.

Interpretation of serum ferritin concentrations as indicators of total-body iron stores in survey populations: the role of biomarkers for the acute phase response.

BACKGROUND: Nutritional surveys use acute phase protein (APP) biomarkers such as C-reactive protein (CRP) and alpha1-acid glycoprotein (AGP) to identify the influence of inflammation on the distribution of iron status biomarkers. Few, however, have examined which biomarker better identifies persons with spurious elevations in iron status markers. OBJECTIVE: We explored the relations of APP biomarkers to iron-status biomarkers in infants and school-age children. DESIGN: In screening surveys, we identified a sample of African American infants (n = 351) and Guatemalan school-age children (n = 375). We used a common set of APP and iron-status biomarkers to examine the association between the 2 sets of markers (laboratory variables). RESULTS: The overall prevalence of either inflammation or iron deficiency was <10% in both samples. The log AGP and CRP values were significantly correlated (r = 0.70), but the unexplained variance still was >50%. Serum ferritin-but not transferrin receptor, transferrin receptor index, or serum iron-was related to APP concentrations, but poor positive predictive value (<72%) and low kappa scores were found. Ferritin concentrations >1 geometric SD above the geometric mean were poorly predicted by either elevated AGP or CRP. Qualitative CRP analysis was not effective in identifying persons who had other indications of mild inflammation. CONCLUSIONS: These analyses show that a low prevalence of inflammation has little influence on the distribution of ferritin, and 2 common indicators of inflammation do not perform equally well in identifying persons who may have elevations in ferritin due to inflammation.

The influence of maternal weight and glucose tolerance on infant birthweight in Latino mother-infant pairs.

OBJECTIVES: We assessed the influence of maternal anthropometric and metabolic variables, including glucose tolerance, on infant birthweight. METHODS: In our prospective, population-based cohort study of 1041 Latino mother-infant pairs, we used standardized interviews, anthropometry, metabolic assays, and medical record reviews. We assessed relationships among maternal sociodemographic, prenatal care, anthropometric, and metabolic characteristics and birthweight with analysis of variance and bivariate and multivariate linear regression analyses. RESULTS: Forty-two percent of women in this study entered pregnancy overweight or obese; at least 36% exceeded weight-gain recommendations. Twenty-seven percent of the women had at least some degree of glucose abnormality, including 6.8% who had gestational diabetes. Maternal multiparity, height, weight, weight gain, and 1-hour screening glucose levels were significant independent predictors of infant birthweight after adjustment for gestational age. CONCLUSION: Studies of birthweight should account for maternal glucose level. Given the increased risk of adverse maternal and infant outcomes associated with excessive maternal weight, weight gain, and glucose intolerance, and the high prevalence of these conditions and type 2 diabetes among Latinas, public health professionals have unique opportunities for prevention through prenatal and postpartum interventions.

Deletion allele of angiotensin-converting enzyme is associated with increased risk and severity of bronchopulmonary dysplasia.

OBJECTIVE: To explore whether the deletion (D) allele of angiotensin-converting enzyme (ACE) is associated with the risk or severity of bronchopulmonary dysplasia (BPD) among very low birth weight (BW) infants. STUDY DESIGN: Infants with a BW < or = 1250 g were prospectively recruited. The D and I (insertion) alleles of ACE were determined using a polymerase chain reaction followed by restriction fragment length polymorphism analysis. RESULTS: Infants with DD/DI genotype of ACE had a (mean +/- SD) birth weight (938 +/- 204 g vs 925 +/- 196 g) and gestational age (28 +/- 3 weeks vs 28 +/- 2 weeks), similar to infants with II genotype of ACE (P > .05). Infants with DD/DI genotype of ACE were more likely to have BPD than infants with II genotype (47% vs 22%, P = .025). Among infants with BPD, ACE DD/DI genotype was more common among infants with moderate or severe BPD compared with infants with mild BPD (74% vs 26%, P = .012). The number of D alleles of ACE correlated directly and positively with the severity of BPD (R = 0.23, P = .045). CONCLUSION: The D allele of ACE is associated with an increased risk and severity of BPD among preterm infants.