DICER1-mutated rhabdomyosarcoma of the ovary with teratoid features.

DICER1-mutated rhabdomyosarcoma is a rare, emerging entity with a predilection for the gynecologic and genitourinary tracts. We report here a case of DICER1-mutated rhabdomyosarcoma of the ovary in a 14 years old girl which displayed interspersed mature teratoid glands, neuroectodermal rosettes and immature blastematous-like tubes. Morphologically the sarcomatous component predominated, corresponding to a high grade spindle cell rhabdomyosarcoma with botryoid features. Islets of cartilage were present. The sarcomatous proliferation encased the teratoid glands, forming cambium layer-like arrangements. The sarcoma cells were Myogenin and MYOD1 positive, the neuroectodermal rosettes expressed SALL4 along with cytokeratins and EMA and were negative for Inhibin; immature blastematous-like tubes were negative for SALL4 and Inhibin. Whole RNA- and targeted DNA-sequencing revealed two DICER1 mutations in exon 26: c.5113G>A: p.(Glu1705Lys) and exon 12: c.1642C>T: p.(Gln548X). The sarcomatous component harbored a complex genetic profile while the teratoid component was diploid, none of the above displayed abnormality of 12p. DICER1-mutated sarcomas display pathological features similar to embryonal rhabdomyosarcomas, botryoid type. They also display heterogeneous features combining cartilage foci, teratoid mature glands, immature blastematous-like tubes and/or neuroectodermal components. Molecular testing remains necessary to confirm the diagnosis. Further studies need to clarify the nosology of DICER1-mutated sarcomas and devise specific therapeutic strategies.

Pregnancy and infant outcomes by trimester of SARS-CoV-2 infection in pregnancy-SET-NET, 22 jurisdictions, January 25, 2020-December 31, 2020.

OBJECTIVES: We describe clinical characteristics, pregnancy, and infant outcomes in pregnant people with laboratory-confirmed SARS-CoV-2 infection by trimester of infection. STUDY DESIGN: We analyzed data from the Surveillance for Emerging Threats to Mothers and Babies Network and included people with infection in 2020, with known timing of infection and pregnancy outcome. Outcomes are described by trimester of infection. Pregnancy outcomes included live birth and pregnancy loss (<20 weeks and ≥20 weeks gestation). Infant outcomes included preterm birth (<37 weeks gestation), small for gestational age, birth defects, and neonatal intensive care unit admission. Adjusted prevalence ratios (aPR) were calculated for pregnancy and selected infant outcomes by trimester of infection, controlling for demographics. RESULTS: Of 35,200 people included in this analysis, 50.8% of pregnant people had infection in the third trimester, 30.8% in the second, and 18.3% in the first. Third trimester infection was associated with a higher frequency of preterm birth compared to first or second trimester infection combined (17.8% vs. 11.8%; aPR 1.44 95% CI: 1.35-1.54). Prevalence of birth defects was 553.4/10,000 live births, with no difference by trimester of infection. CONCLUSIONS: There were no signals for increased birth defects among infants in this population relative to national baseline estimates, regardless of timing of infection. However, the prevalence of preterm birth in people with SARS-CoV-2 infection in pregnancy in our analysis was higher relative to national baseline data (10.0-10.2%), particularly among people with third trimester infection. Consequences of COVID-19 during pregnancy support recommended COVID-19 prevention strategies, including vaccination.

Demographic and Clinical Characteristics of Mpox in Persons Who Had Previously Received 1 Dose of JYNNEOS Vaccine and in Unvaccinated Persons - 29 U.S. Jurisdictions, May 22-September 3, 2022.

As of November 14, 2022, monkeypox (mpox) cases had been reported from more than 110 countries, including 29,133 cases in the United States.* Among U.S. cases to date, 95% have occurred among males (1). After the first confirmed U.S. mpox case on May 17, 2022, limited supplies of JYNNEOS vaccine (Modified Vaccinia Ankara vaccine, Bavarian Nordic) were made available to jurisdictions for persons exposed to mpox. JYNNEOS vaccine was approved by the Food and Drug Administration (FDA) in 2019 as a 2-dose series (0.5 mL per dose, administered subcutaneously) to prevent smallpox and mpox disease.† On August 9, 2022, FDA issued an emergency use authorization to allow administration of JYNNEOS vaccine by intradermal injection (0.1 mL per dose) (2). A previous report on U.S. mpox cases during July 31-September 3, 2022, suggested that 1 dose of vaccine offers some protection against mpox (3). This report describes demographic and clinical characteristics of cases occurring ≥14 days after receipt of 1 dose of JYNNEOS vaccine and compares them with characteristics of cases among unvaccinated persons with mpox and with the vaccine-eligible vaccinated population in participating jurisdictions. During May 22-September 3, 2022, among 14,504 mpox cases reported from 29 participating U.S. jurisdictions,§ 6,605 (45.5%) had available vaccination information and were included in the analysis. Among included cases, 276 (4.2%) were among persons who had received 1 dose of vaccine ≥14 days before illness onset. Mpox cases that occurred in these vaccinated persons were associated with lower percentage of hospitalization (2.1% versus 7.5%), fever, headache, malaise, myalgia, and chills, compared with cases in unvaccinated persons. Although 1 dose of JYNNEOS vaccine offers some protection from disease, mpox infection can occur after receipt of 1 dose, and the duration of protection conferred by 1 dose is unknown. Providers and public health officials should therefore encourage persons at risk for acquiring mpox to complete the 2-dose vaccination series and provide guidance and education regarding nonvaccine-related prevention strategies (4).

How Different Pre-existing Mental Disorders and Their Co-occurrence Affects COVID-19 Clinical Outcomes? A Real-World Data Study in the Southern United States.

Background: Although a psychiatric history might be an independent risk factor for COVID-19 infection and mortality, no studies have systematically investigated how different clusters of pre-existing mental disorders may affect COVID-19 clinical outcomes or showed how the coexistence of mental disorder clusters is related to COVID-19 clinical outcomes. Methods: Using a retrospective cohort study design, a total of 476,775 adult patients with lab-confirmed and probable COVID-19 between March 06, 2020 and April 14, 2021 in South Carolina, United States were included in the current study. The electronic health record data of COVID-19 patients were linked to all payer-based claims data through the SC Revenue and Fiscal Affairs Office. Pre-existing mental disorder diagnoses from Jan 2, 2019 to Jan 14, 2021 were extracted from the patients' healthcare utilization data via ICD-10 codes. Results: There is an elevated risk of COVID-19-related hospitalization and death among participants with pre-existing mental disorders adjusting for key socio-demographic and comorbidity covariates. Co-occurrence of any two clusters was positively associated with COVID-19-related hospitalization and death. The odds ratio of being hospitalized was 1.26 (95% CI: 1.151, 1.383) for patients with internalizing and externalizing disorders, 1.65 (95% CI: 1.298, 2.092) for internalizing and thought disorders, 1.76 (95% CI: 1.217, 2.542) for externalizing and thought disorders, and 1.64 (95% CI: 1.274, 2.118) for three clusters of mental disorders. Conclusions: Pre-existing internalizing disorders and thought disorders are positively related to COVID-19 hospitalization and death. Co-occurrence of any two clusters of mental disorders have elevated risk of COVID-19-related hospitalization and death compared to those with a single cluster.

How different pre-existing mental disorders and their co-occurrence affects clinical outcomes of COVID-19? A study based on real-world data in the Southern United States

ImportanceA growing body of research focuses on the impact of pre-existing mental disorders on clinical outcomes of COVID-19 illness. Although a psychiatric history might be an independent risk factor for COVID-19 infection and mortality, no studies have systematically investigated how different clusters of pre-existing mental disorders may affect COVID-19 clinical outcomes or showed how the coexistence of mental disorder clusters is related to COVID-19 clinical outcomes. ObjectiveTo explore how different pre-existing mental disorders and their co-occurrence affects COVID-19-related clinical outcomes based on real-world data. Design, Setting, and ParticipantsUsing a retrospective cohort study design, a total of 476,775 adult patients with lab-confirmed and probable COVID-19 between March 06, 2020 and April 14, 2021 in South Carolina, United States were included in the current study. The electronic health record data of COVID-19 patients were linked to all payer-based claims data through the SC Revenue and Fiscal Affairs Office. Main Outcomes and MeasuresKey COVID-19 clinical outcomes included severity, hospitalization, and death. COVID-19 severity was defined as asymptomatic, mild, and moderate/severe. Pre-existing mental disorder diagnoses from Jan 2, 2019 to Jan 14, 2021 were extracted from the patients healthcare utilization data via ICD-10 codes. Mental disorders were categorized into internalizing disorders, externalizing disorders, and thought disorders. ResultsOf the 476,775 COVID-19 patients, 55,300 had pre-existing mental disorders. There is an elevated risk of COVID-19-related hospitalization and death among participants with pre-existing mental disorders adjusting for key socio-demographic covariates (i.e., age, gender, race, ethnicity, residence, smoking). Co-occurrence of any two clusters was positively associated with COVID-19-related hospitalization and death. The odds ratio of being hospitalized was 2.50 (95%CI 2.284, 2.728) for patients with internalizing and externalizing disorders, 3.34 (95%CI 2.637, 4.228) for internalizing and thought disorders, 3.29 (95%CI 2.288, 4.733) for externalizing and thought disorders, and 3.35 (95%CI 2.604, 4.310) for three clusters of mental disorders. Conclusions and RelevancePre-existing internalizing disorders, externalizing disorders, and thought disorders are positively related to COVID-19 hospitalization and death. Co-occurrence of any two clusters of mental disorders have elevated risk of COVID-19-related hospitalization and death compared to those with a single cluster.

Demographic Disparities in Clinical Outcomes of COVID-19: Data From a Statewide Cohort in South Carolina.

BACKGROUND: Current literature examining the clinical characteristics of coronavirus disease 2019 (COVID-19) patients under-represent COVID-19 cases who were either asymptomatic or had mild symptoms. METHODS: We analyzed statewide data from 280 177 COVID-19 cases from various health care facilities during March 4-December 31, 2020. Each COVID-19 case was reported using the standardized Case Report Form (CRF), which collected information on demographic characteristics, symptoms, hospitalization, and death. We used multivariable logistic regression to analyze the associations between sociodemographics and disease severity, hospitalization, and mortality. RESULTS: Among a total of 280 177 COVID-19 cases, 5.2% (14 451) were hospitalized and 1.9% (5308) died. Older adults, males, and Black individuals had higher odds of hospitalization and death from COVID-19 (all P < 0.0001). In particular, individuals residing in rural areas experienced a high risk of death (odds ratio [OR], 1.16; 95% CI, 1.08-1.25). Regarding disease severity, older adults (OR, 1.06; 95% CI, 1.03-1.10) and Hispanic or Latino patients (OR, 2.06; 95% CI, 1.95-2.18) had higher odds of experiencing moderate/severe symptoms, while male and Asian patients, compared with White patients, had lower odds of experiencing moderate/severe symptoms. CONCLUSIONS: As the first statewide population-based study using data from multiple health care systems with a long follow-up period in the United States, we provide a more generalizable picture of COVID-19 symptoms and clinical outcomes. The findings from this study reinforce the fact that rural residence and racial/ethnic social determinants of health, unfortunately, remain predictors of adverse health outcomes for COVID-19 patients.

Tissue cholesterol metabolism and prostate cancer aggressiveness: Ethno-geographic variations.

BACKGROUND: Prostate cancer (PCa) is more frequent and more aggressive in populations of African descent than in Caucasians. Since the fatty acid composition of peri-prostatic adipose tissue (PPAT) has been shown to differ according to the ethno-geographic origin and is involved in PCa aggressiveness, we aimed to analyze the cholesterol content of PPAT from Caucasian and African-Caribbean patients, in correlation with markers of disease aggressiveness and cholesterol metabolism in cancer tissues. METHODS: The quantification of cholesterol in PPAT was analyzed in 52 Caucasian and 52 African-Caribbean PCa patients, with in each group 26 indolent tumors (ISUP Group1 and pT2) and 26 potentially aggressive tumors (ISUP Group 3-5 and/or pT3). The expression of proteins involved in cholesterol metabolism was analyzed by immunohistochemistry on cancer tissue samples included in tissue microarrays. RESULTS: The amount of cholesterol esters was lower in PPAT from African-Caribbean patients compared with Caucasians, without any correlation with markers of disease aggressiveness. In cancer tissues from African-Caribbean patients, the expression of ABCA1 (involved in cholesterol efflux) was decreased, and that of SREBP-2 (involved in cholesterol uptake) was increased. In both groups of patients, SREBP-2 expression was strongly associated with that of Zeb1, a key player in the epithelial-to-mesenchymal transition (EMT) process. CONCLUSION: These results suggest that cholesterol metabolism differs according to the ethno-geographic origin, in both PPAT and cancer tissues. In African-Caribbeans, the orientation towards accumulation of cholesterol in cancer cells is associated with a more frequent state of EMT, which may promote PCa aggressiveness in this population.

Frequent high-risk HPV co-infections excluding types 16 or 18 in cervical neoplasia in Guadeloupe.

BACKGROUND: Cervical cancer is the fourth cancer worldwide. The Human Papilloma Virus is responsible for 99% of the cases but the distribution of its genotypes varies among populations. We aimed to identify HPV genotypes distribution in women with grade 2/3 cervical intraepithelial dysplasia or invasive cervical cancer in Guadeloupe, a French Caribbean territory with a population mainly of African descent. METHODS: We used paraffin-embedded tumors for viral DNA extraction from women diagnosed between 2014 and 2016 and identified by the population-based cancer registry. The HPV Genotyping was performed with the InnoLIPA HPV Genotyping Extra kit®. RESULTS: Overall, 213 samples out of the 321 eligible records were analyzed. The HPV status was positive for 94% of the cases. The five most common oncogenic HPV genotypes were HPV31 (47%), HPV33 (38%), HPV16 (32%), HPV44 (31%) and HPV26 (28%). HPV18 was found in only in 5% of the cases. Among the studied cases, 94% had multiple infections. More than 60% of single infections were HPV16-related, accounting for 35% of HPV16 infections. CONCLUSIONS: These results show a different distribution of oncogenic HPVs in Guadeloupe with "31 >  33 > 16" and a high frequency of multiple infections. Despite a lower coverage, the nine-valent vaccine is nevertheless adequate.

Coronavirus Disease among Workers in Food Processing, Food Manufacturing, and Agriculture Workplaces.

We describe coronavirus disease (COVID-19) among US food manufacturing and agriculture workers and provide updated information on meat and poultry processing workers. Among 742 food and agriculture workplaces in 30 states, 8,978 workers had confirmed COVID-19; 55 workers died. Racial and ethnic minority workers could be disproportionately affected by COVID-19.

Update: COVID-19 Among Workers in Meat and Poultry Processing Facilities - United States, April-May 2020.

Meat and poultry processing facilities face distinctive challenges in the control of infectious diseases, including coronavirus disease 2019 (COVID-19) (1). COVID-19 outbreaks among meat and poultry processing facility workers can rapidly affect large numbers of persons. Assessment of COVID-19 cases among workers in 115 meat and poultry processing facilities through April 27, 2020, documented 4,913 cases and 20 deaths reported by 19 states (1). This report provides updated aggregate data from states regarding the number of meat and poultry processing facilities affected by COVID-19, the number and demographic characteristics of affected workers, and the number of COVID-19-associated deaths among workers, as well as descriptions of interventions and prevention efforts at these facilities. Aggregate data on confirmed COVID-19 cases and deaths among workers identified and reported through May 31, 2020, were obtained from 239 affected facilities (those with a laboratory-confirmed COVID-19 case in one or more workers) in 23 states.* COVID-19 was confirmed in 16,233 workers, including 86 COVID-19-related deaths. Among 14 states reporting the total number of workers in affected meat and poultry processing facilities (112,616), COVID-19 was diagnosed in 9.1% of workers. Among 9,919 (61%) cases in 21 states with reported race/ethnicity, 87% occurred among racial and ethnic minority workers. Commonly reported interventions and prevention efforts at facilities included implementing worker temperature or symptom screening and COVID-19 education, mandating face coverings, adding hand hygiene stations, and adding physical barriers between workers. Targeted workplace interventions and prevention efforts that are appropriately tailored to the groups most affected by COVID-19 are critical to reducing both COVID-19-associated occupational risk and health disparities among vulnerable populations. Implementation of these interventions and prevention efforts† across meat and poultry processing facilities nationally could help protect workers in this critical infrastructure industry.

COVID-19 in Correctional and Detention Facilities - United States, February-April 2020.

An estimated 2.1 million U.S. adults are housed within approximately 5,000 correctional and detention facilities† on any given day (1). Many facilities face significant challenges in controlling the spread of highly infectious pathogens such as SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Such challenges include crowded dormitories, shared lavatories, limited medical and isolation resources, daily entry and exit of staff members and visitors, continual introduction of newly incarcerated or detained persons, and transport of incarcerated or detained persons in multiperson vehicles for court-related, medical, or security reasons (2,3). During April 22-28, 2020, aggregate data on COVID-19 cases were reported to CDC by 37 of 54 state and territorial health department jurisdictions. Thirty-two (86%) jurisdictions reported at least one laboratory-confirmed case from a total of 420 correctional and detention facilities. Among these facilities, COVID-19 was diagnosed in 4,893 incarcerated or detained persons and 2,778 facility staff members, resulting in 88 deaths in incarcerated or detained persons and 15 deaths among staff members. Prompt identification of COVID-19 cases and consistent application of prevention measures, such as symptom screening and quarantine, are critical to protecting incarcerated and detained persons and staff members.

Estimating county-level tobacco use and exposure in South Carolina: a spatial model-based small area estimation approach.

PURPOSE: Local health statistics are increasingly requested for policy-making and programmatic purposes; however, population-based surveys are often inadequate to support direct estimation for small areas. Model-based estimation techniques can be used to create local estimates for public health outcomes. Using the 2014-2015 South Carolina (SC) Adult Tobacco Survey, we examined tobacco-related outcomes at the county level using a spatial multilevel, poststratification approach. METHODS: To create county-level tobacco estimates, we used a two-level model with a spatially intrinsic conditional autoregressive random intercept. Stratum-specific (race, age, and sex) estimates for each county were then created and averaged based on population data obtained from the U.S. Census. RESULTS: The estimated prevalence of current smoking in SC counties among adults ranged from 7.4% to 35.1%, and the percentage reporting ever trying an e-cigarette ranged from 4.2% to 30.2%. Model validation showed considerable agreement between direct and indirect estimates (Pearson and Spearman correlations all >0.75) that varied by the sample size of the outcome, as hypothesized. CONCLUSIONS: Data from the SC Adult Tobacco Survey were used to develop county-level estimates of multiple tobacco-related outcomes using a spatial multilevel, poststratification approach. The results showed heterogeneity in smoking behaviors across the state along with marked spatial correlation.

South Carolina 20 Years of Diabetes--A Public Health Concern.

OBJECTIVE: To assess and enumerate the trends in diabetes prevalence, morbidity and mortality rates in South Carolina (SC) within the past 2 decades. MATERIALS AND METHODS: We analyzed state-level data from vital records, Behavioral Risk Factor Surveillance System, Children's Health Assessment Survey and Administrative Claim Files. RESULTS: Over the past 20 years, there has been an average 2.5% annual increase in diabetes prevalence among adults in SC (P < 0.01). Although a typical reduction in mortality rate of 2.2% has been observed during the same period, the increased number of people living with diabetes (from 5.0% in 1995 to 12.0% in 2014) has brought more need for diabetes care, particularly for severe in-hospital cases and cases with crisis at the emergency department, totaling $404 million in annual costs. CONCLUSIONS: SC has experienced an epidemic of diabetes. Coupled with declining trends in mortality and increased hospitalization and emergency department visits, the state is experiencing historical morbidity and complications due to diabetes. The shift in complexity of the disease onset and management has resulted in more individuals living with cardiovascular disease and other comorbidities. The cost of care for all South Carolinians with diabetes is estimated to exceed 2.8 billion dollars in 2014 and projected to be more than 4 billion dollars by 2020. If the diabetes prevalence trend of increasing rates continues over the next 20 years, the number of individuals living with diabetes and its complications would rise to 1.3 million in SC.

Successful mLearning Pilot in Senegal: Delivering Family Planning Refresher Training Using Interactive Voice Response and SMS.

BACKGROUND: In-service training of health workers plays a pivotal role in improving service quality. However, it is often expensive and requires providers to leave their posts. We developed and assessed a prototype mLearning system that used interactive voice response (IVR) and text messaging on simple mobile phones to provide in-service training without interrupting health services. IVR allows trainees to respond to audio recordings using their telephone keypad. METHODS: In 2013, the CapacityPlus project tested the mobile delivery of an 8-week refresher training course on management of contraceptive side effects and misconceptions to 20 public-sector nurses and midwives working in Mékhé and Tivaouane districts in the Thiès region of Senegal. The course used a spaced-education approach in which questions and detailed explanations are spaced and repeated over time. We assessed the feasibility through the system's administrative data, examined participants' experiences using an endline survey, and employed a pre- and post-test survey to assess changes in provider knowledge. RESULTS: All participants completed the course within 9 weeks. The majority of participant prompts to interact with the mobile course were made outside normal working hours (median time, 5:16 pm); average call duration was about 13 minutes. Participants reported positive experiences: 60% liked the ability to determine the pace of the course and 55% liked the convenience. The largest criticism (35% of participants) was poor network reception, and 30% reported dropped IVR calls. Most (90%) participants thought they learned the same or more compared with a conventional course. Knowledge of contraceptive side effects increased significantly, from an average of 12.6/20 questions correct before training to 16.0/20 after, and remained significantly higher 10 months after the end of training than at baseline, at 14.8/20, without any further reinforcement. CONCLUSIONS: The mLearning system proved appropriate, feasible, and acceptable to trainees, and it was associated with sustained knowledge gains. IVR mLearning has potential to improve quality of care without disrupting routine service delivery. Monitoring and evaluation of larger-scale implementation could provide evidence of system effectiveness at scale.

[Mammary analog secretory carcinoma of the parotid gland]. / Carcinome salivaire sécrétoire, analogue des carcinomes sécrétoires mammaires.

Mammary analog secretory carcinoma (MASC) of the parotid gland is a rare and recently described lesion. We report the case of a 46-year-old man with a tumor of the parotid gland which was carried to the diagnosis of MASC. Diagnostic was confirmed by highlighting the ETV6-NTRK3 gene translocation. However, some morphologic and immunohistochemical features are suggestive of this entity. This carcinoma should be distinguished from its main differential diagnoses: acinic cell carcinoma and low grade cribriform cystadenocarcinoma.

A longitudinal evaluation of religiosity and psychosocial determinants of suicidal behaviors among a population-based sample in the United States.

BACKGROUND: Relationships among religiosity and other psychosocial factors in determining suicidal behaviors in adolescence and in emerging adulthood have been inconclusive. We sought to investigate prospective relationships among religiosity, psychosocial factors and suicidal behaviors using a nationally representative sample of adolescents emerging into adulthood. METHOD: Analysis was based on 9412 respondents from four waves of National Longitudinal Study of Adolescent Health. A Generalized Estimating Equation (GEE) procedure was used to fit a series of models on the response variable (suicidal behaviors) and a set of psychosocial and religiosity predictors taking into account the correlated structure of the datasets. RESULTS: Analyses showed that adolescent suicidality and religious activity participation showed significant declines over time. Using multinomial logistic regression we found that females showed statistically significant risks of suicidal behaviors, but this effect declined in adulthood. In adjusted models, baseline attendance of a church weekly was associated with 42% reduction (95% Confidence Interval: 0.35-0.98) of suicide ideation in Wave III. Across all waves, low support from fathers (compared with mothers) consistently explained variability in suicidal behaviors among genders emerging into adulthood. LIMITATIONS: Accurate measurement of religiosity is psychometrically challenging. CONCLUSIONS: The findings of the study indicate that religious activity participation is associated with reduced suicidal behaviors among adolescents but this effect declines during emerging adulthood. Psychosocial supports particularly from fathers' have an enduring impact on reduced suicidal behaviors among adolescents and emerging adults. Prevention, identification and evaluation of disorders of suicidality need a careful assessment of underlying mental pain (psyache) to reduce the likelihood of aggravated suicide.

Correlates of sexual risk behaviors among high school students in Colorado: analysis and implications for school-based HIV/AIDS programs.

Objectives of this study are to examine correlates of antecedent sexual risk exposures associated with HIV/AIDS infection among adolescents participating in the 2005 Colorado Youth Behavioral Risk Survey (CYBRS), and to determine gender differences associated with these exposures since previous studies have produced mixed findings. Variables assessing these relationships were drawn from CYBRS, 2005. We used χ2 to assess bivariate relationships and multinomial logistic regression to evaluate associations among dependent variables (sexual risk behaviors, age at first sex, and number of sexual partners in the past 3 months) and independent variables (in-school HIV/AIDS education, use of illegal substances, physically forced sex, and alcohol use). We found no significant effect of having received in-school HIV/AIDS education on all outcome measures. Compared with females, males were more likely to initiate sex at a relatively younger age, report unprotected sex with multiple partners, and drink alcohol before sexual intercourse. Among females, using 2 illegal substances increased the odds of early sexual debut by 12 times, while using ≥3 substances increased the same odds to 44-fold. Likewise, binge drinking was also associated with higher odds of having multiple partners. Hispanic ethnicity and physically forced sex variables were consistently associated with high risk sexual behaviors, early sexual initiation, and increased number of sexual partners. Efforts to control the HIV/AIDS epidemic among adolescents may need to focus on targeted interventions aimed at addressing gender- and racial/ethnic-specific risk exposures among this population group, including risk behaviors linked with lifetime physically forced sex. The need to re-examine the role of in-school HIV prevention programs to build adequate competencies among students, parents and community leaders to reduce risk exposures associated with HIV/AIDS infection among youth is emphasized.

Evaluating correlates of adolescent physical activity duration towards National Health Objectives: analysis of the Colorado Youth Risk Behavioral Survey, 2005.

BACKGROUND: While numerous studies have examined the relationships among correlates of physical activity (PA), less attention has been given to identifying the correlates of low PA duration. The main objective of the current study was to examine correlates of low PA duration, team sports participation and smoking behaviors among adolescents. METHODS: Data from the 2005 Colorado Youth Behavioral Risk Survey were analyzed using Cox proportional hazard models. We evaluated associations between two measures of low PA duration, assessed as per Healthy People 2010 (HP2010) objectives and 2008 Physical Activity Guidelines (PAG) for Americans, and smoking behaviors, participation in the physical education (PE) and team sports, controlling for age, gender and other behavioral characteristics. RESULTS: Forty percent and 70%, respectively, of adolescents did not meet the 2008 PAG and HP2010 objectives. After adjustment, smoking remained associated with failure to meet the 2008 PAG. However, no significant relationship was found with low PA duration as per the HP2010 objectives. The risk of low PA was higher among girls for both outcome measures. Likewise, adolescents who reported no participation in team sports presented a 7-fold higher risk of low PA as per the 2008 PAG and 51% higher risk of low PA as per the HP2010 objectives compared with the group with team sports participation. CONCLUSIONS: Regular participation in school PE and team sports may represent an important avenue for increasing PA duration and reducing smoking behaviors among adolescents.

Relationship between presence of a reported medical home and emergency department use among children with asthma.

This study examined data from the 2005-2006 National Survey of Children with Special Health Care Needs to assess the relationship among children with asthma between a reported medical home and emergency department (ED) use. The authors used 21 questions to measure 6 medical home components: personal doctor/nurse, family-centered, compassionate, culturally effective and comprehensive care, and effective care coordination. Weighted zero-inflated Poisson regression analyses assessed the independent effects of having a medical home on annual number of child ED visits while controlling for child and parental characteristics, and the differential likelihood of securing a medical home. Nearly half (49.9%) of asthmatic children had a medical home. Receiving primary care in a medical home was associated with fewer ED visits (incidence rate ratio = 0.93; 95% confidence interval = 0.89-0.97). A medical home in which physicians and parents share responsibility for ensuring that children have access to needed services may improve child and family outcomes for children with asthma.