The public health exposome and pregnancy-related mortality in the United States: a high-dimensional computational analysis.

BACKGROUND: Racial inequities in maternal mortality in the U.S. continue to be stark. METHODS: The 2015-2018, 4-year total population, county-level, pregnancy-related mortality ratio (PRM; deaths per 100,000 live births; National Center for Health Statistics (NCHS), restricted use mortality file) was linked with the Public Health Exposome (PHE). Using data reduction techniques, 1591 variables were extracted from over 62,000 variables for use in this analysis, providing information on the relationships between PRM and the social, health and health care, natural, and built environments. Graph theoretical algorithms and Bayesian analysis were applied to PHE/PRM linked data to identify latent networks. RESULTS: PHE variables most strongly correlated with total population PRM were years of potential life lost and overall life expectancy. Population-level indicators of PRM were overall poverty, smoking, lack of exercise, heat, and lack of adequate access to food. CONCLUSIONS: In this high-dimensional analysis, overall life expectancy, poverty indicators, and health behaviors were found to be the strongest predictors of pregnancy-related mortality. This provides strong evidence that maternal death is part of a broader constellation of both similar and unique health behaviors, social determinants and environmental exposures as other causes of death.

Sertoli-Leydig cell tumor of the ovary: a rare cause of amenorrhea.

A 15-year-old girl presented to a primary care clinic with secondary amenorrhea, masculinization, and rapidly increasing abdominal girth. Evaluation revealed a large pelvic mass, which was found at laparotomy to be a bilateral Sertoli-Leydig cell tumor producing androgens and high levels of alpha-fetoprotein (AFP). The patient underwent bilateral salpingo-oophorectomy. Other pelvic structures were uninvolved. The postoperative course was unremarkable, with testosterone and AFP levels in the normal range. A thorough literature search revealed no cases in which bilateral Sertoli-Leydig cell tumors were associated with high AFP levels. This case was unusual in its pathology, dramatic in its presentation, and valuable in its implications regarding the work-up of amenorrhea in young women.

Remodelling of angular deformity after femoral shaft fractures in children.

We reviewed 28 children with unilateral middle-third fractures of the femoral shaft who had an angular deformity after union of 10 degrees to 26 degrees. At an average follow-up of 45 months (20 to 66), we measured remodelling of the proximal physis, the distal physis and the femoral shaft. The average correction was 85% of the initial deformity. We found that 74% of correction occurred at the physes and only 26% at the fracture site. Neither the direction nor the magnitude of the angulation much influenced the degree of remodelling. Younger children remodelled only a little better than older children. We conclude that in children under 13 years of age, malunion of as much as 25 degrees in any plane will remodel enough to give normal alignment of the joint surfaces.

Caffeine dependence in schoolchildren?

Schoolchildren (N = 289) kept a log and calculated their habitual caffeine consumption (principally in soft drinks). On 2 successive days, they completed a 20-item checklist adapted from the Profile of Moods Scale. On Day 2, they abstained from caffeine. Complete data were obtained for 175 children. A low-consumption group (10 mg or less daily) was compared with a high-consumption group (50 mg or more daily). The high-consumption group reported more stimulation than did the low-consumption group on Day 1 and more dysphoric symptoms during abstinence on Day 2. The results of this open-label pilot trial suggest that a large-scale double-blind placebo-controlled trial would be worthwhile.

Women at high risk of HIV infection from drug use.

The purpose of this project was to study women at high risk for contracting AIDS from intravenous drug use or from sexual contact with addicts. Characteristics of the population, differences between HIV+ and HIV- women, substance abuse in primary caretakers of this high risk population, and changes in drug use when learning of HIV status were investigated. Subjects were mothers at high risk for contracting HIV, whose children were referred to a pediatric AIDS clinic of a large urban hospital because of AIDS risk factors. HIV testing revealed that 27 women were HIV+ and 13 were HIV-. The most common source of infection reported by the HIV+ women was sexual contact (17 subjects), with the remainder reporting that they were unsure of the source or reported intravenous drug use as their source of infection. There were significant differences between HIV+ and HIV- mothers with regard to the presence and impact of substance abuse in their own primary caretakers before age 16. Substance abuse in the parents of subjects was apparently reflected in behaviors reflecting health risk in subsequent generations. Subjects did not report changes in AIDS risk behavior when informed of their own HIV status or that of their children.

Effects of stress due to deprivation and transport in different genotypes of house mouse.

The importance of various stress factors involved in boxing and transit of wild and laboratory mice on a 28 hour journey was studied. Transference from laboratory cage to transit box alone caused weight loss; under the best conditions the laboratory mice lost 5% of their initial weight and wild ones 8%. Deprivation of food resulted in absolute loss of weight; from this death ensued when 20% of initial weight was lost: the smaller wild mice died sooner than the larger laboratory ones. Water deprivation resulted in retarding recovery of weight lost; wild mice took longer to recover than laboratory ones. It also caused weight loss and, in conjunction with deprivation of food, poor condition and death. Transit itself affected percentage weight loss and wheat consumption; wild mice were affected differently from laboratory mice in both respects. Genotype is seen to be important not only in controlling initial weight and activity level, but also--and independently of weight--the total food requirement. In the light of these findings current literature giving guidance on shipment of small mammals is shown to be inadequate, and certain recommendations are given.

Canine epilepsy: a genetic counselling programme for keeshonds.

The predisposition of keeshonds (Dutch barge dogs) to an idiopathic epilepsy appears to be determined by a single autosomal recessive gene. The pedigrees of 15 litters which included animals diagnosed as epileptic ('fitters') were compared with those of 34 contemporary, normal animals. The pedigrees of all the fitters traced back, on both the paternal and maternal sides, to a common ancestor. Subsequently, further pedigrees and details of litters were gathered. If both parents of a fitter were heterozygous ('carriers'), the progeny (120 in number) of all known carrier x carrier matings would be expected to have a ratio of three phenotypically normal animals to one fitter, that is, 90:30. The ratio observed (91:29) was not significantly different. The Keeshond Club has published a list from which the identities of carriers can be inferred, with the intention that known carriers should be excluded from breeding. A genetic counselling programme has been in operation since 1989, which is based on advising breeders on the probability that the offspring of proposed matings would be fitters or carriers; advice has been given on 77 proposed matings. The mean probability that the proposed matings would result in carriers has declined significantly, and this is consistent with a decline in the frequency of the gene for this form of epilepsy in the breed.

Recognition of 'trembler', a hypomyelinating condition in the Bernese mountain dog.

An account is given of a hypomyelinating condition, 'trembler', in the Bernese mountain dog. The condition is manifested clinically as a tremor of the limbs and head which becomes more intense with excitement or stress and which disappears with sleep. The tremor, which is first noticeable between two and eight weeks old, may persist throughout life but decline with age. Examination of plastic embedded tissue obtained post mortem from two, nine-week-old animals showed hypomyelination of the spinal cord. Preliminary examination of breeding data suggests that the condition may be inherited as an autosomal recessive.

The cemented custom femoral stem--a 10 year review.

We report a series of 706 patients (759 hip implants) with an average follow up of 10.5 years (range, 10-11 years) following total hip replacement (THR) using a cemented custom-made femoral stem and a cemented HDP acetabular component. The fate of every implant is known. One hundred and seventy-four patients (23%) were deceased at the time of their 10-year review all died with a functioning THR in situ. Four hundred and sixty-two patients (61%) were subsequently reviewed. One hundred and twenty three patients (16%) were assessed by telephone review, as they were too ill or unwilling to attend. Kaplan-Meier survival analysis (all components) demonstrated a median survival at 10 years of 96.05% or 95% Confidence Intervals (CI) for median survival of (94.41% to 97.22%). Revision surgery occurred in 30 cases (3.9%). Seventeen had full revisions (2.2%) and 13 (1.7%) socket revisions only. Twenty-one out of 30 revisions were for infection or dislocation. There were 2 cases (0.3%) of revision for aseptic loosening of the stem. The 10-year results of the custom femoral titanium stem are encouraging and compare well with other cemented systems.

Hexavalent chromium exposures and exposure-control technologies in American enterprise: results of a NIOSH field research study.

The National Institute for Occupational Safety and Health (NIOSH) conducted 21 field surveys in selected industries to characterize workers' exposures to hexavalent chromium-containing airborne particulate and to evaluate existing technologies for controlling these exposures. Hexavalent chromium Cr(VI) is a respiratory irritant and chronic inhalation may cause lung cancer. Primary evaluation methods included collection of full work shift, personal breathing-zone (PBZ) air samples for Cr(VI), measurement of ventilation system parameters, and documentation of processes and work practices. This study emphasized evaluation of engineering exposure control measures, so PBZ exposures were measured on the outside of personal protective equipment, for example, respirators. Field surveys were conducted in two chromium electroplating facilities, including one where full-shift PBZ exposures to Cr(VI) ranged from 3.0 to 16 times the 1 micro g/m(3)NIOSH recommended exposure limit (REL) despite several engineering controls on the plating tanks. At a painting and coating facility that used Cr(VI)-containing products, full-shift exposures of painters and helpers (2.4 to 55 micro g/m(3)) exceeded the REL, but LEV effectiveness was limited. Other operations evaluated included welding in construction; metal cutting operations on chromium-containing materials in ship breaking; chromate-paint removal with abrasive blasting; atomized alloy-spray coating; foundry operations; printing; and the manufacture of refractory brick, colored glass, prefabricated concrete products, and treated wood products. NIOSH researchers concluded that, in many of the evaluated processes, Cr(VI) exposures at or below the current NIOSH REL are achievable. However, for some processes, it is unclear whether controlling exposures to this range is consistently achievable without respirator use. Some operations involving the application of coatings and finishes may be among those most difficult to control to this range. Most operations judged to be moderately difficult to control to this range involve joining and cutting metals with relatively high chromium content. Nonetheless, exposures in a wide variety of other processes were judged more easily controllable to the current REL or below, or were found to be minimal, including some operations meeting the general descriptions named above but with different specific operating parameters producing lower Cr(VI) exposures.

An inherited agent of mutation with chromosome damage in wild mice.

A population of wild mice in Peru was sampled three times over a period of 20 years. Inbreeding from each sample has shown the population to carry an unusually high frequency of visible mutants and nestling lethals. Preliminary evidence of chromosomal damage suggests an inherited tendency to some form of genetic instability.

Hydronephrosis in the mouse: the effects of the short-ear gene, sex and ureteral vascular system.

The short-ear gene in the mouse, se, affects a number of soft tissues; skeletal effects result in reduced body cavities. A high incidence of hydronephrosis in short-ear genotypes has been ascribed to pressure on the lower ureter resulting from crowding of organs in the body cavity. This study concerns the ureteral vascular system as observed in 861 autopsies of mice of varying age, of the three short-ear genotypes, drawn from ten stocks. Incidence and expression of hydronephrosis is greater in short-ear males than in females, and the ratio between the two varies from one stock to another. This study seeks an explanation. Short-ear genotypes have an abnormally high incidence of unusual ureteral veins, hydronephrosis being strongly associated with the more posterior ones. Ureteraonadal and iliac veins. The spermatic vein's more posterior position, compared with the ovarian, is strongly correlated with the sex difference in posterior ureteral venation and thus with the sex difference in incidence of hydronephrosis. Stocks are compared according to the amount of selection for fitness of short-ear genotypes; there is a reduced incidence of hydronephrosis with selection, accompanied by fewer posterior ureteral veins. Age also affects hydronephrosis; its expression increases slightly with age, and the male sese progeny of young mothers appear to be particularly prone to hydronephrosis. Three skeletal mutants segregate; of these fidget, fi, causes a type of hydronephrosis differing somewhat from that caused by se.

Analysis of genetic control of chylous ascites in ragged mice.

Chylous ascites is a disorder visible as a white fluid in the peritoneal cavity of suckling mice. It is due to inadequate lymphatic drainage from the small intestine. An initial genetic study showed it to be a pleiotropic effect of ragged, Ra. There were four main studies. These involved seven major mutants segregating with ragged. Four of the mutants had no effect on chylous ascites, but two mutants linked with ragged, and one unlinked, showed a complex situation involving enhancement, inhibition, epistacy and other interactions. The overall phenotypic effects which these mutants are known to have do not explain how they produce their interaction with ragged in terms of chylous ascites. The studies also indicate the existence of a single major modifier controlling penetrance and expression, and there is evidence for cumulatively acting minor modifiers. In neonates the male sex is more liable to chylous ascites, and in adults this condition affects fertility and fecundity.

Continued high incidence of mutants in a Peruvian population of mice.

A second trapping of wild mice from two sites in a Peruvian river valley confirms the unprecedented high mutant incidence established by a previous trapping. It also shows that the population may be localized. The new mutants are different from those found in the first trapping, and thus indicate a continued source of mutagenic activity either external or within the gene pool of the population. A third study is underway.