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This article discusses the role of community champions in providing early years support to parents, particularly those from low-income families. The article emphasizes the importance of addressing health inequalities and engaging parents across the socio-economic spectrum. The case study presented focuses on a program called Building Babies Brains, which uses community champions to disseminate evidence-based neuroscience and parenting strategies to parents within the community. The article highlights the core relational elements that led to improved peer-to-peer knowledge exchange, including attending to immediate needs, gauging the right moment, getting alongside the parent, providing praise and validation, and revisiting. The article concludes by emphasizing the importance of building trusting relationships and the need for further research on the impact of these messages on parent behavior. [Extracted from the article]

Background: The impact of wildfire smoke is a growing public health issue, especially for those living with preexisting respiratory conditions. Understanding perceptions and behaviors relevant to the use of individual protective strategies, and how these affect the adoption of these strategies, is critical for the development of future communication and support interventions. This study focused on the use of masks by people living in the Australian community with asthma or chronic obstructive pulmonary disease (COPD). Methods: Semi-structured phone interviews were undertaken with people living in the community aged 18 years and over. Participants lived in a bushfire-prone area and reported having been diagnosed with asthma or COPD. Results: Twenty interviews were undertaken between July and September 2021. We found that, during wildfire episodes, there was an overwhelming reliance on closing windows and staying inside as a means of mitigating exposure to smoke. There was limited use of masks for this purpose. Even among those who had worn a mask, there was little consideration given to the type of mask or respirator used. Reliance on sensory experiences with smoke was a common prompt to adopting an avoidance behavior. Participants lacked confidence in the information available from air-quality apps and websites, however they were receptive to the idea of using masks in the future. Conclusions: Whilst COVID-19 has changed the nature of community mask use over the last couple of years, there is no guarantee that this event will influence an individual’s mask behavior during other events like bushfires. Instead, we must create social support processes for early and appropriate mask use, including the use of air quality monitoring. [ABSTRACT FROM AUTHOR]

Summary: Respirable aerosols (< 5 µm in diameter) present a high risk of SARS‐CoV‐2 transmission. Guidelines recommend using aerosol precautions during aerosol‐generating procedures, and droplet (> 5 µm) precautions at other times. However, emerging evidence indicates respiratory activities may be a more important source of aerosols than clinical procedures such as tracheal intubation. We aimed to measure the size, total number and volume of all human aerosols exhaled during respiratory activities and therapies. We used a novel chamber with an optical particle counter sampling at 100 l.min‐1 to count and size‐fractionate close to all exhaled particles (0.5–25 µm). We compared emissions from ten healthy subjects during six respiratory activities (quiet breathing; talking; shouting; forced expiratory manoeuvres; exercise; and coughing) with three respiratory therapies (high‐flow nasal oxygen and single or dual circuit non‐invasive positive pressure ventilation). Activities were repeated while wearing facemasks. When compared with quiet breathing, exertional respiratory activities increased particle counts 34.6‐fold during talking and 370.8‐fold during coughing (p < 0.001). High‐flow nasal oxygen 60 at l.min‐1 increased particle counts 2.3‐fold (p = 0.031) during quiet breathing. Single and dual circuit non‐invasive respiratory therapy at 25/10 cm.H2O with quiet breathing increased counts by 2.6‐fold and 7.8‐fold, respectively (both p < 0.001). During exertional activities, respiratory therapies and facemasks reduced emissions compared with activities alone. Respiratory activities (including exertional breathing and coughing) which mimic respiratory patterns during illness generate substantially more aerosols than non‐invasive respiratory therapies, which conversely can reduce total emissions. We argue the risk of aerosol exposure is underappreciated and warrants widespread, targeted interventions. [ABSTRACT FROM AUTHOR]

Background: The use of synthetic insecticides is one of the most common strategies for controlling disease vectors such as mosquitos. However, their overuse can result in serious risks to human health, to the environment, as well as to the selection of insecticidal resistant insect strains. The development of efficient and eco-friendly insect control is urgent, and essential oils have been presented as potential alternatives to synthetic insecticides. Moreover, nanoencapsulation techniques can enhance their efficiency by protecting from degradation and providing a controlled release rate. Results: We assessed the potential of chitosan nanoparticles in encapsulating Siparuna guianensis essential oil, and maintaining its efficiency and prolonging its activity for the control of Aedes aegypti larvae. The encapsulation was characterized by scanning electron microscopy (SEM), Fourier-transform infrared spectroscopy (FTIR), and thermogravimetric analysis (TGA), with an encapsulation efficiency ranging from 84.8% to 88.0%. Toxicity studies have demonstrated efficacy against mosquito larvae over 50% for 19 days with 100% mortality during the first week. This persistent action is presumably due to the enhanced contact and slow and maintained release conferred by chitosan nanoparticles. Furthermore, the exposure of aquatic non-target organisms (e.g. embryos and small adult fishes) revealed adequate selectivity of these nanoparticles. Conclusions: The encapsulation of S. guianensis essential oil in chitosan nanoparticles showed promising potential as a larvicide control alternative and should be considered within strategies for fighting Ae. aegypti. [ABSTRACT FROM AUTHOR]

Background Tuberculosis is the leading infectious cause of death. Steep reductions in tuberculosis-related mortality are required to realize the World Health Organization's "End Tuberculosis Strategy." However, accurate mortality estimates are lacking in many countries, particularly following discharge from care. This study aimed to establish the mortality rate among patients with pulmonary tuberculosis in Vietnam and to quantify the excess mortality in this population. Methods We conducted a prospective cohort study among adult patients treated for smear-positive pulmonary tuberculosis in 70 clinics across Vietnam. People living in the same households were recruited as controls. Participants were re-interviewed and their survival was established at least 2 years after their treatment with an 8-month standardized regimen. The presence of relapse was established by linking identifying data on patients and controls to clinic registries. Verbal autopsies were performed. The cumulative mortality among patients was compared to that among a control population, adjusting for age and gender. Results We enrolled 10964 patients and 25707 household controls. Among enrolled tuberculosis patients, 9% of patients died within a median follow-up period of 2.9 years: 342 (3.1%) during treatment and 637 (5.8%) after discharge. The standardized mortality ratio was 4.0 (95% confidence interval 3.7–4.2) among patients with tuberculosis, compared to the control population. Tuberculosis was the likely cause of death for 44.7% of these deceased patients. Conclusions Patients treated for tuberculosis had a markedly elevated risk of death, particularly in the post-treatment period. Interventions to reduce tuberculosis mortality must enhance the early detection of drug-resistance, improve treatment effectiveness, and address non-communicable diseases. [ABSTRACT FROM AUTHOR]

Background Previous studies have reached conflicting conclusions about the role of atopy as a risk factor for COPD. In part, this is attributable to variation in the definitions of airflow limitation and the treatment of people with asthma. Objective To establish whether there is any independent association between atopy and post-bronchodilator airflow limitation in the general population aged 40 years and over. Methods A cross-sectional survey was conducted in a general population sample of 2415 people aged 40 years and over in Australia. A history of ever being diagnosed with asthma was elicited by questionnaire. Atopy was defined as any skin prick test weal to common aeroallergens ≥4 mm. Airflow limitation was defined as post-bronchodilator spirometric (FEV1/FVC) ratio

Background Omalizumab (Xolair) dosing in severe allergic asthma is based on serum IgE and bodyweight. In Australia, patients eligible for omalizumab but exceeding recommended ranges for IgE (30-1500 IU/mL) and bodyweight (30-150 kg) may still receive a ceiling dose of 750 mg/4 weeks. About 62% of patients receiving government-subsidized omalizumab are enrolled in the Australian Xolair Registry ( AXR). Objectives To determine whether AXR participants above the recommended dosing ranges benefit from omalizumab and to compare their response to within-range participants. Methods Data were stratified according to dose range status (above-range or within-range). Further sub-analyses were conducted according to the reason for being above the dosing range (IgE only vs. IgE and weight). Results Data for 179 participants were analysed. About 55 (31%) were above recommended dosing criteria; other characteristics were similar to within-range participants. Above-range participants had higher baseline IgE [812 ( IQR 632, 1747) IU/mL vs. 209 ( IQR 134, 306) IU/mL] and received higher doses of omalizumab [750 ( IQR 650, 750) mg] compared to within-range participants [450 ( IQR, 300, 600) mg]. At 6 months, improvements in Juniper 5-item Asthma Control Questionnaire ( ACQ-5, 3.61 down to 2.01 for above-range, 3.47 down to 1.93 for within-range, P < 0.0001 for both) and Asthma Quality of Life Questionnaire ( AQLQ mean score (3.22 up to 4.41 for above-range, 3.71 up to 4.88 for within-range, P < 0.0001) were observed in both groups. Forced expiratory volume in one second ( FEV1) improved among above-range participants. There was no difference in response between above-range and within-range participants. Above-range participants due to either IgE alone or IgE and weight had similar improvements in ACQ-5, AQLQ and FEV1. Conclusions and Clinical Relevance Patients with severe allergic asthma above recommended dosing criteria for omalizumab have significantly improved symptom control, quality of life and lung function to a similar degree to within-range participants, achieved without dose escalation above 750 mg. [ABSTRACT FROM AUTHOR]

Background: Natural orifice translumenal endoscopic surgery (NOTES) has always made more sense in the colorectal field where the target organ for entry houses the pathology. To address the question whether an adequate total mesorectal excision (TME) for rectal cancer can be performed from a transanal bottoms-up approach, we performed a case-matched study. Methods: Starting in 2009, transanal TME (taTME) surgery was selectively used for rectal cancer after neoadjuvant therapy and prospectively entered into a database. Between March 2012 and February 2014, 17 consecutive taTME rectal cancer patients were identified and case-matched to multiport laparoscopic TME (MP TME) based on age, body mass index, uT stage, radiation dose, level in the rectum, and procedure. Perioperative outcomes, morbidity, mortality, local recurrence, completeness of TME, and radial and distal margins were analyzed. Statistically significant differences were identified using Student's t test. Results: There were 12 transanal abdominal transanal (TATA)/5 abdominoperineal resection procedures in each group. Data regarding overall/taTME/MP TME are as follows: % positive-circumferential margin: 2.9/0/5.9 % ( p = 0.32). Distal margin: 0/0/0 %. Complete or near-complete TME: 97.1/100/94.1 % ( p = 0.32). Incomplete TME 2.9/0/5.9 % ( p = 0.32). Local recurrence: 2.9/5.9/0 % ( p = 0.32). There were no perioperative mortalities. Morbidity in each group: 26.4/23.5/29.4 % ( p = 0.79). There were no differences in perioperative or postoperative outcomes except days to clear liquids (1/2 days, p = 0.03) and largest incision length (1.3/2.6 cm, p = 0.05). Conclusions: We demonstrated no differences in perioperative/postoperative outcomes or pathologic TME outcomes of transanal or bottoms-up TME compared to standard laparoscopic TME. TaTME is a promising progressive approach to NOTES and deserves additional evaluation. [ABSTRACT FROM AUTHOR]

Estimation of the true incidence of tuberculosis (TB) is challenging. The approach proposed by Styblo in 1985 is known to be inaccurate in the modern era where there is widespread availability of treatment for TB. This study re-examines the relationship of incidence to prevalence and other disease indicators that can be derived from surveys. We adapt a simple, previously published model that describes the epidemiology of TB in the presence of treatment to investigate a revised ratio-based approach to estimating incidence. We show that, following changes to treatment programmes for TB, the ratio of incidence to prevalence reaches an equilibrium value rapidly; long before other model indicators have stabilized. We also show that this ratio relies on few parameters but is strongly dependent on, and requires knowledge of, the efficacy and timeliness of treatment. [ABSTRACT FROM AUTHOR]

Background/objectives: Consumption of oily fish more than once per week has been shown to improve cognitive outcomes in children. However, it is unknown whether similar benefits can be achieved by long-term omega-3 fatty acid supplementation. The objective was to investigate the effect of omega-3 fatty acid supplementation during the first 5 years of life on subsequent academic performance in children by conducting a secondary analysis of the CAPS (Childhood Asthma Prevention Study).Subjects/methods: A total of 616 infants with a family history of asthma were randomised to receive tuna fish oil (high in long-chain omega-3 fatty acids, active) or Sunola oil (low in omega-3 fatty acids, control) from the time breastfeeding ceased or at the age of 6 months until the age of 5 years. Academic performance was measured by a nationally standardised assessment of literacy and numeracy (National Assessment Program Literacy and Numeracy (NAPLAN)) in school years 3, 5, 7 and 9. Plasma omega-3 fatty acid levels were measured at regular intervals until 8 years of age. Between-group differences in test scores, adjusted for maternal age, birth weight and maternal education, were estimated using mixed-model regression.Results: Among 239 children, there were no significant differences in NAPLAN scores between active and control groups. However, at 8 years, the proportion of omega-3 fatty acid in plasma was positively associated with the NAPLAN score (0.13 s.d. unit increase in score per 1% absolute increase in plasma omega-3 fatty acid (95% CI 0.03, 0.23)).Conclusions: Our findings do not support the practice of supplementing omega-3 fatty acids in the diet of young children to improve academic outcomes. Further exploration is needed to understand the association between plasma omega-3 fatty acid levels at 8 years and academic performance. [ABSTRACT FROM AUTHOR]

Background/objectives:Consumption of oily fish more than once per week has been shown to improve cognitive outcomes in children. However, it is unknown whether similar benefits can be achieved by long-term omega-3 fatty acid supplementation. The objective was to investigate the effect of omega-3 fatty acid supplementation during the first 5 years of life on subsequent academic performance in children by conducting a secondary analysis of the CAPS (Childhood Asthma Prevention Study).Subjects/methods:A total of 616 infants with a family history of asthma were randomised to receive tuna fish oil (high in long-chain omega-3 fatty acids, active) or Sunola oil (low in omega-3 fatty acids, control) from the time breastfeeding ceased or at the age of 6 months until the age of 5 years. Academic performance was measured by a nationally standardised assessment of literacy and numeracy (National Assessment Program Literacy and Numeracy (NAPLAN)) in school years 3, 5, 7 and 9. Plasma omega-3 fatty acid levels were measured at regular intervals until 8 years of age. Between-group differences in test scores, adjusted for maternal age, birth weight and maternal education, were estimated using mixed-model regression.Results:Among 239 children, there were no significant differences in NAPLAN scores between active and control groups. However, at 8 years, the proportion of omega-3 fatty acid in plasma was positively associated with the NAPLAN score (0.13 s.d. unit increase in score per 1% absolute increase in plasma omega-3 fatty acid (95% CI 0.03, 0.23)).Conclusions:Our findings do not support the practice of supplementing omega-3 fatty acids in the diet of young children to improve academic outcomes. Further exploration is needed to understand the association between plasma omega-3 fatty acid levels at 8 years and academic performance. [ABSTRACT FROM AUTHOR]

Background The debate about whether energy consumed in liquid form is more obesogenic than energy consumed in solid form remains equivocal. We aimed to evaluate the effects of liquid versus solid energy intake and different beverage types on changes in childhood adiposity. Methods Our analyses included 8-year-old Australian children ( n = 158) participating in the Childhood Asthma Prevention Study. Dietary information was collected using three 24-h recalls at age 9 years. Multivariate linear regression was used to evaluate the effects of liquid versus solid energy intake and different beverage types on changes in body mass index ( BMI) Z-score from ages 8 to 11.5 years (△ BMI z8-11.5y) and percentage body fat (%BF) at age 11.5 years (% BF11.5y). Substitution models were used to evaluate the effects of substituting other beverage types for sugar-sweetened beverages ( SSB). Results Liquid energy intake (1 MJ day-1) was more closely associated with both △ BMI z8-11.5y (β = 0.23, P = 0.02) and % BF11.5y (β = 2.31%, P = 0.01) than solid energy intake (△ BMI z8-11.5y: β = 0.12, P = 0.01 and % BF11.5y: β = 0.80%, P = 0.07). SSB consumption (100 g day-1) was directly associated with △ BMI z8-11.5y (β = 0.08, P = 0.02) and % BF11.5y (β = 0.92%, P = 0.004),whereas diet drinks (100 g day-1) were inversely associated with △ BMI z8-11.5y (β = 0.18, P = 0.02). Substitution of 100 g of SSB by 100 g of water or diet drink, but not other beverages, was inversely associated with both △ BMI z8-11.5y and % BF11.5y ( P < 0.01). Conclusions Our findings indicate that liquid energy is more obesogenic than solid energy. In particular, SSB, but not other beverage types, are a significant predictor of childhood adiposity and replacing SSB with water can have long-term beneficial effects on childhood adiposity. [ABSTRACT FROM AUTHOR]

There have been many calls for epidemiological investigations into the potential health impacts of coal mining in the Hunter Valley. Epidemiological studies of air pollution and health are subject to potential confounding by other determinants of health outcomes such as temperature, tobacco smoke exposure and socio-economic status. Furthermore, the effect sizes are generally quite small. Therefore, large and well-designed studies, with careful measurement of air pollution exposures, health outcomes and potential confounders are required to establish whether adverse health effects of the pollutant exposure do exist. Studies conducted in smaller populations are very likely to miss small but important impacts. There is a need, therefore, to integrate understanding of dose response (concentration-response) relationships between particulate exposure and health outcomes from large population based studies with local exposure monitoring data to assess potential public health impacts and to evaluate local sources of pollution. [ABSTRACT FROM AUTHOR]

The study assessed the prevalence of obesity and related conditions among Sudanese adult migrants living in Brisbane, Australia. Data were obtained on 314 Sudanese immigrants aged 18-70 years. Measured body mass index (BMI) and self-reported diabetes and hypertension were obtained. More than half (51 %) of participants were overweight or obese, 6.4 % reported having type 2 diabetes while 12.4 % had hypertension. The full adjusted regression model explained 28.1 % of the variance in BMI. Odds of reporting type 2 diabetes increased with age, BMI and were greater among participants rating health as poor/fair than those rating as good/very good/excellent. Odds of high blood pressure increased with age, BMI, and were higher among participants rating health as poor/fair than those as good/very good/excellent. Health promotion programs to prevent weight gain in this subpopulation will significantly reduce inequalities related to type 2 diabetes and improve cardio-vascular outcomes. [ABSTRACT FROM AUTHOR]

Mycobacterium tuberculosis is primarily a pathogen of humans. Infections have been reported in animal species and it is emerging as a significant disease of elephants in the care of humans. With the close association between humans and animals, transmission can occur. In November 2010, a clinically healthy Asian elephant in an Australian zoo was found to be shedding M. tuberculosis; in September 2011, a sick chimpanzee at the same zoo was diagnosed with tuberculosis caused by an indistinguishable strain of M. tuberculosis. Investigations included staff and animal screening. Four staff had tuberculin skin test conversions associated with spending at least 10 hours within the elephant enclosure; none had disease. Six chimpanzees had suspected infection. A pathway of transmission between the animals could not be confirmed. Tuberculosis in an elephant can be transmissible to people in close contact and to other animals more remotely. The mechanism for transmission from elephants requires further investigation. [ABSTRACT FROM PUBLISHER]

Background Atopy in early life is heterogeneous in timing of onset, remission and persistence and in the nature of specific sensitization to allergens. However, this heterogeneity is not well characterized. Objective Our aim was to define longitudinal phenotypes of atopy between ages 1.5 and 8 years, and to assess the relationship of the atopy phenotypes to the risk of asthma, eczema and rhinitis at 8 years of age. Methods We used latent class analysis (LCA) to define atopy phenotypes using data from skin prick tests that were performed at 1.5, 3, 5 and 8 years in participants in the Childhood Asthma Prevention Study (CAPS). Results Four phenotypes were defined: late mixed inhalant sensitization; mixed food and inhalant sensitization; house dust mite (HDM) monosensitized; and no atopy. All three atopic phenotypes were associated with asthma, eczema and rhinitis, but the strongest association, particularly for asthma, was with the mixed food and inhalant sensitization phenotype. Conclusion & clinical relevance We have used a LCA model to define atopy phenotypes empirically. The finding of a strong association between the mixed food and inhalant sensitization class and the presence of asthma and poor asthma control at age 8 years implies that food sensitization in early life may be of greater significance for subsequent risk of asthma than previously thought. [ABSTRACT FROM AUTHOR]

Understanding the cause of poor inkjet printing can aid in improving the technology. Furthermore, the effects of the structure of nonwoven fabrics on inkjet-printed image quality are largely unknown. Therefore, this study investigates the effect of fiber orientation and needlepunch density of nonwoven substrates on inkjet-printed line quality. The inkjet image quality was evaluated on several web structures: carded, crosslapped, and airlaid, resulting in different fiber orientations, all under varying needlepunch densities ranging from 98.6 to 197.2 penetrations per square centimeter. The resultant line quality on the nonwoven substrates was poor and under all needlepunch densities the effects of fiber orientation was found to be minimal. This indicates that other factors such as surface characteristics and not fiber orientation contribute more likely to the poor image quality. [ABSTRACT FROM AUTHOR]

Background There is conflicting evidence regarding the associations between anthropometric birth measures and asthma and lung function in children, particularly for apparently healthy infants born at term. Objective Our objective was to elucidate these relationships paying particular attention to features of study design and analysis that may threaten the validity of previous studies in this field. Methods We analysed data from a cohort of children with a family history of asthma who were recruited antenatally. Anthropometric birth measures and potential confounders were recorded at birth and within the first year of life. Lung function and asthma outcomes were measured at 8 years of age. Airway hyperresponsiveness ( AHR) was measured by methacholine challenge. The potential for a reversal paradox, due to inclusion of covariates on the causal pathway, was investigated. Results Four hundred and fifty (73% of the initial cohort) children were tested at age 8 years. Birth weight in the lowest tertile was associated with current asthma ( OR 1.95, 95% CI 1.08, 3.54) and recent wheeze ( OR 1.87, 95% CI 1.08, 3.24), but not with AHR ( OR 1.37, 95% CI 0.68, 2.78). Birth weight was positively associated with lung function. Current height modified the relationship between birth length and lung function suggesting that post-natal growth has an effect on this relationship. Conclusions Low birth weight is associated with a greater risk of current asthma and lower lung function at 8 years in children with a family history of asthma. Current height should be treated as an effect modifier when investigating the fetal origins hypothesis. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES:It has been postulated that a higher dairy consumption may affect blood pressure regulation. The aim of this study was to examine the association between dairy consumption and blood pressure in mid-childhood.SUBJECTS/METHODS:Subjects (n=335) were participants of a birth cohort at high risk of asthma with information on diet at 18 months and blood pressure at 8 years. Multivariate analyses were used to assess the association of dairy consumption (serves) and micronutrient intakes (mg). In a subgroup of children (n=201), dietary intake was also measured at approximately 9 years.RESULTS:Children in the highest quintile of dairy consumption at 18 months had lower systolic blood pressure (SBP) and diastolic blood pressure (DBP) at 8 years (2.5 mm Hg, P=0.046 and 1.9 mm Hg, P=0.047, respectively) than those in the lowest quintiles. SBP was lowest among children in the highest quintiles of calcium, magnesium and potassium intakes. Significant negative linear trends were observed between SBP and intakes of dairy serves, calcium, magnesium and potassium. Furthermore, SBP and DBP were lowest in the group of children that consumed at least two dairy serves at both 18 months and the follow-up dietary data collection at 9 years, compared with all other children (SBP 98.7 vs 101.0 mm Hg, P=0.07; and DBP 56.5 vs 59.3 mm Hg, P=0.006, respectively).CONCLUSION:These results are consistent with a protective effect of dairy consumption in childhood on blood pressure at age 8 years. [ABSTRACT FROM AUTHOR]

Background/Objectives:Multiple micronutrient supplementation with Sprinkles powder and crushable Foodlets tablets may be effective means of controlling micronutrient deficiencies in infants. Their efficacy has not been tested in countries like Iran where wheat as the staple food may affect nutrient bioavailability. This study aimed to compare the efficacy of Sprinkles, Foodlets and the current supplement (Drops) for improving micronutrient status and growth among Iranian infants.Subjects/Methods:Infants of 6-18 months of age, living in an urban district of Iran were randomised to receive daily Sprinkles (n=120), Foodlets (n=121) or Drops (n=121) for 4 months. Haemoglobin (Hb), serum ferritin, serum retinol, serum zinc, 25(OH) D concentration and anthropometry were assessed at baseline and at 4 months.Results:Iron status improved with all treatments. Drops showed significantly greater changes in Hb and serum ferritin, though changes in anaemia prevalence were not different across groups. Infants having Foodlets and Sprinkles had significantly greater reductions in proportion of children with zinc deficiency compared with Drops. No significant differences in treatment effects were observed for mean serum 25(OH) D and retinol, or for growth of infants across groups.Conclusion:The study was the first efficacy trial with Sprinkles and Foodlets in the Middle East where wheat or rice is the principal complementary foods. Differences across treatment groups were largely consistent with supplement micronutrient composition for iron and zinc, with no benefit in this population for serum retinol, 25(OH) D, growth or anthropometric status. The trial identified trade-offs in combining multiple micronutrients in a single delivery mechanism. [ABSTRACT FROM AUTHOR]

Background/Objectives:Programs to address obesity are a high priority for public policy especially for young children. Research into dietary determinants of obesity is challenging but important for rational planning of interventions to prevent obesity, given that both diet and energy expenditure influence weight status. We investigated whether early life dietary factors were predictive of weight status at 8 years in a cohort of Australian children.Subjects/Methods:We used data from the Childhood Asthma Prevention Study-a birth cohort at high risk of asthma. Dietary data (3-day weighed food records) were collected at 18 months and height, weight and waist circumference were collected at 8 years. We assessed the relationship between dietary predictor variables and measures of adiposity using linear regression.Results:Intakes of protein, meat and fruit at age 18 months were positively associated with measures of adiposity at age 8 years, namely, body mass index and/or waist circumference. We also showed a significant negative relationship between these measures of adiposity at 8 years and intake at 18 months of dairy foods as a percent of total energy, and intake of energy dense cereal-based foods such as cookies and crackers.Conclusions:This birth cohort study with rigorous design, measures and analyses, has shown a number of associations between early dietary intake and subsequent adiposity that contribute to the growing evidence base in this important field. [ABSTRACT FROM AUTHOR]

Background/Objective:Experimental studies suggest that dietary factors may influence skin cancer risk, but there have been few human studies of diet and basal cell carcinoma (BCC), the most common type of skin cancer. The objective was to prospectively investigate the association between food intake and incidence of BCC skin cancers.Subjects/Methods:At baseline in 1992, 1056 adults in a subtropical Australian community completed a validated food-frequency questionnaire from which we estimated the intake of 15 food groups, selected based on hypothesized associations in the literature. Between 1992 and 2002, incident, histologically confirmed BCCs were recorded in terms of number of persons newly affected by BCC, as well as BCC tumor counts.Results:Intakes of the food groups were not associated with the incidence of persons affected by BCC. However, there was a borderline positive association between intake of eggs and incidence of BCC tumors (highest vs lowest tertile adjusted relative risk (RR) 1.5; 95% confidence interval (CI): 1.0-2.2; P for trend=0.06). A borderline inverse association with potato intake (highest vs lowest tertile RR 0.7; 95% CI: 0.4-1.0, P for trend=0.06) disappeared after exclusion of three subjects with more than 10 BCCs.Conclusion:Despite some suggestive evidence that egg and potato consumption may be associated with BCC tumor incidence, there are no plausible grounds for considering these as truly causal rather than chance associations. This study provides little evidence for a role of food intake in BCC prevention. [ABSTRACT FROM AUTHOR]

Background: This study reports the short- and long-term results for a prospective rectal cancer management program using laparoscopic radical transanal abdominal transanal proctosigmoidectomy with coloanal anastomosis (TATA) after neoadjuvant therapy. Methods: A prospective database included 102 rectal cancer patients treated with laparoscopic TATA from 1998 to 2008. Patients with distant metastasis at presentation, patients with a tumor more than 3 cm from the anorectal ring, and patients not undergoing neoadjuvant therapy were excluded, leaving 79 patients (54 men and 25 women) with a mean age of 59.2 years (range, 22-85 years) for this study. 13 patients completed neoadjuvant therapy before the original evaluation, and they are excluded from the report of initial clinical assessment. Before treatment, 50 patients were staged as T3 and 16 patients as T2. The mean level in the rectum superior to the anorectal ring was 1.2 cm (range, −0.5 to 3 cm). In terms of fixity, 31 of the tumors were mobile, 27 were tethered, and 8 showed early fixation. Ulceration was absent in 8 cases, minimal in 12 cases, superficial in 7 cases, moderate in 22 cases, and deep in 17 cases. The mean pretreatment tumor size tumor was 4.8 cm (range, 1.5-12 cm). The median external beam radiation was 5,400 cGy (range, 3,000-8,040 cGy), and 77 patients underwent chemotherapy. Results: The mean follow-up period was 34.2 months (range, 1.9-113.9 months). There were no perioperative mortalities. The conversion rate was 2.5%, and the mean largest incision length was 4.3 cm (range, 1.2-21 cm). For 84% of the patients, the incision was less than 6.0 cm, and 46% of the patients had no abdominal incision for delivery of the specimen. The mean estimated blood loss was 367 ml (range, 75-2,200 ml). All the patients had a temporary diverting stoma. The major morbidity rate was 11%, and the minor morbidity rate was 19%. The major complications included four full-thickness rectal prolapses with repair, one ischemic neorectum with successful reanastomosis, two bowel obstructions, and two failed anastomoses requiring stoma. The ypT stages included 22 complete responses, 12 cases of ypT1, 22 cases of ypT2, 23 cases of ypT3; 65 cases of ypN0, and 14 cases of ypN + (T3 = 7, T2 = 4, T1 = 3). The local recurrence rate was 2.5% (2/79), and the distant metastases rate was 10.1% (8/79). The KM5YAS rate was 97%. Overall, 90% of the patients lived without a stoma. Neorectal loss was due to positive margins or recurrence and was followed by abdominoperineal resection in three cases and ischemia in two cases. The condition of two patients was not reversed due to comorbidities, and one patient had a stoma secondary to bowel obstruction. Conclusion: The study results indicate excellent local recurrence (2.7%) and 5-year survival rates without the need for permanent colostomy in patients with cancers in the distal one-third of the rectum. Laparoscopic total mesorectal excision (TME) with the TATA approach is safe and can be performed laparoscopically. Multi-institutional studies are required to establish the reproducibility of this promising approach. [ABSTRACT FROM AUTHOR]

Neoadjuvant therapy for rectal cancer has led to improved tumor downstaging and higher complete pathologic response rates. At the same time, the introduction of transanal endoscopic microsurgery (TEM) technique has renewed interest in local excision of rectal cancer. There has been concern that radiation may make the more radical local excision with TEM unsuitable. Our study compared morbidity rates and wound complication rates for patients undergoing TEM and local excision with and without neoadjuvant radiation to determine whether this could be accomplished safely. Data for all patients undergoing TEM are prospectively entered into a database. This database was queried for patients with rectal cancer undergoing TEM from November 1997 to June 2007. Of 64 patients identified, 2 were excluded because of previous radiation to the pelvis. The study enrolled 62 patients with a final pathologic diagnosis of rectal cancer: 43 treated using neoadjuvant therapy with radiation (XRT) and 19 patients treated with TEM alone. The patients in the XRT group were 67 years of age (range, 29–86 years) and included 13 women. The patients in the non-XRT group were 66 years of age (range, 40–89 years) and included 8 women. Neither group had any mortalities. The overall morbidity rate was 33% for the XRT group and 5.3% for the non-XRT group, and this difference was statistically significant ( p < 0.05). The wound complication rates were 25.6% for the XRT group (11 patients) and 0% for the non-XRT group ( p = 0.015). Nine patients in the XRT group (82%) had minor wound separations, and two patients (18%) had major wound separation. Ten patients with wound separations were treated as outpatients and administered long-term oral antibiotics. One patient required additional surgery (diverting stoma). Not unexpectedly, the wound complication rate was higher in the XRT group. However, 82% of those wounds were minor, and 91% were treated without any additional surgery or intervention. Although a significant concern, wound complications do not prohibit TEM treatment after neoadjuvant treatment. [ABSTRACT FROM AUTHOR]

Context: Randomized controlled trials and meta-analyses have demonstrated that male circumcision reduces men's risk of contracting human immunodeficiency virus (HIV) infection during heterosexual intercourse. Less is known about whether male circumcision provides protection against HIV infection among men who have sex with men (MSM).Objectives: To quantitatively summarize the strength of the association between male circumcision and HIV infection and other sexually transmitted infections (STIs) across observational studies of MSM.Data Sources: Comprehensive search of databases, including MEDLINE, EMBASE, ERIC, Sociofile, PsycINFO, Web of Science, and Google Scholar, and correspondence with researchers, to find published articles, conference proceedings, and unpublished reports through February 2008.Study Selection: Of 18 studies that quantitatively examined the association between male circumcision and HIV/STI among MSM, 15 (83%) met the selection criteria for the meta-analysis.Data Extraction: Independent abstraction was conducted by pairs of reviewers using a standardized abstraction form. Study quality was assessed using the Newcastle-Ottawa Scale.Data Synthesis: A total of 53,567 MSM participants (52% circumcised) were included in the meta-analysis. The odds of being HIV-positive were not significantly lower among MSM who were circumcised than uncircumcised (odds ratio, 0.95; 95% confidence interval, 0.81-1.11; number of independent effect sizes [k]=15) [corrected].). Higher study quality was associated with a reduced odds of HIV infection among circumcised MSM (beta, -0.415; P = .01). Among MSM who primarily engaged in insertive anal sex, the association between male circumcision and HIV was protective but not statistically significant (odds ratio, 0.71; 95% confidence interval, 0.22-2.28; k=4) [corrected].Male circumcision had a protective association with HIV in studies of MSM conducted before the introduction of highly active antiretroviral therapy (odds ratio, 0.47; 95% confidence interval, 0.32-0.69; k = 3).Neither the association between male circumcision and other STIs (odds ratio, 1.06; 95% confidence interval, 0.97-1.15; k=8) nor its relationship with study quality was statistically significant (beta, 0.265; P=.47) [corrected].Conclusions: Pooled analyses of available observational studies of MSM revealed insufficient evidence that male circumcision protects against HIV infection or other STIs. However, the comparable protective effect of male circumcision in MSM studies conducted before the era of highly active antiretroviral therapy, as in the recent male circumcision trials of heterosexual African men, supports further investigation of male circumcision for HIV prevention among MSM. [ABSTRACT FROM AUTHOR]

Background: Continuing professional development (CPD) has been long considered an integral component of professional practice across a range of health professions. It is believed to ensure the maintenance of practitioner clinical competence and knowledge of current concepts. This study investigated the participation in and attitudes of Victorian dental personnel to CPD activities. Methods: A self-administered cross-sectional survey of a random sample of registered dental care providers (n = 451) was conducted from March to June 2005 using an anonymous, postal, self-administered questionnaire. Results: The response rate was low (48.1 per cent). Nearly 90 per cent of respondents attended a CPD course in 2004, with the mean hours of attendance ranging from 8.3 to 36.9 hours, depending on registration category. Nearly half of the dentists attended more than 20 hours of CPD courses, while less than 20 per cent of prosthetists attended more than 15 hours of CPD courses. Three-quarters of respondents supported mandatory CPD as a condition of registration. Conclusions: There was a high level of participation in continuing professional development activities by surveyed Victorian dental care providers in 2004, although more than half of the dentists and specialists, and nearly two-thirds of therapists, hygienists and prosthetists would fail to meet the new DPBV mandatory requirements for CPD. [ABSTRACT FROM AUTHOR]

Background: Clinical trials measure exacerbations of chronic obstructive pulmonary disease (COPD) inconsistently. A study was undertaken to determine if different methods for ascertaining and analysing COPD exacerbations lead to biased estimates of treatment effects. Methods: Information on the methods used to count, analyse and report COPD exacerbation rates was abstracted from clinical trials of long-acting bronchodilators or long-acting bronchodilator/inhaled steroid combination products published between 2000 and 2006. Data from the Canadian Optimal Therapy of COPD Trial was used to illustrate how different analytical approaches can affect the estimate of exacerbation rates and their confidence intervals. Results: 22 trials (17 156 patients) met the inclusion criteria and were reviewed. None of the trials adjudicated exacerbations or determined independence of events. 14/22 studies (64%) introduced selection bias by not analysing outcome data for subjects who prematurely stopped study medications. Only 31% of trials used time-weighted analyses to calculate the mean number of exacerbations/patient-year and only 15% accounted for between-subject variation. In the Canadian Optimal Therapy of COPD Trial the rate ratio for exacerbations/patient-year was 0.85 when all data were included in a time-weighted analysis, but was overestimated as 0.79 when data for those who prematurely stopped study medications were excluded and was further overestimated as 0.46 when a time-weighted analysis was not conducted; p values ranged from 0.03 to 0.24 depending on how exacerbations were determined and analysed. Conclusions: Clinical trials have used widely different methods to define and analyse COPD exacerbations and this can lead to biased estimates of treatment effects. Future trials should strive to include blinded adjudication and assessment of the independence of exacerbation events, and trials should report time-weighted intention-to-treat analyses with adjustments for between-subject variation in COPD exacerbations. [ABSTRACT FROM AUTHOR]

Objective:To investigate the association between total alcohol intake and intake of different types of alcoholic beverages in relation to the risk of basal cell (BCC) and squamous cell (SCC) carcinoma of the skin.Design:Prospective cohort study.Setting:Follow-up data from a community-based skin cancer study in Australia.Subjects:Randomly selected sample of 1360 adult residents of the township of Nambour who completed a food frequency questionnaire in 1992 and were monitored for BCC and SCC until 31 December 2002.Results:No significant association was found between overall BCC or SCC risk and total alcohol intake, or intake of beer, white wine, red wine or sherry and port. However, among those with a prior skin cancer history, there was a significant doubling of risk of SCC for above-median consumption of sherry and port (multivariable adjusted relative risk 2.46, 95% confidence interval 1.06–5.72) compared with abstainers.Conclusions:There are no associations between first occurrence of skin cancers and alcoholic beverage consumption. People with a history of skin cancer who consume above-average quantities of sherry or port may be at a raised risk of SCC, although replication of these findings in different study populations is needed to confirm this possible role of specific alcoholic beverages in secondary keratinocytic skin cancer risk.European Journal of Clinical Nutrition (2008) 62, 162–170; doi:10.1038/sj.ejcn.1602717; published online publication, 28 March 2007 [ABSTRACT FROM AUTHOR]

Background: House dust mite (HDM) allergy is closely linked to the expression of asthma and other allergic diseases. Understanding factors influencing variation in allergen may help in controlling allergic disease. The objective of this study was to investigate the effects of seasonal changes in climate, type of bed used in very early childhood and anti-mite interventions on HDM allergen concentration. Methods: Participants were enrolled in a randomized-controlled trial of HDM avoidance. Der p 1 was measured in dust samples from children’s beds on 13 occasions, from birth to age 5 years, between 1997 and 2004. Bed types were categorized as bassinette, cot or bed. The effects of study month, type of bed and intervention group on HDM allergen concentration were estimated by multiple linear regression. The relation between climatic variables and HDM allergen concentration was investigated using a polynomial distributed lag model. Results: House dust mite allergen concentrations were initially low in cots and bassinettes in 1997/1998, peaked in bassinettes and beds between 1999 and 2001 and then slowly declined during the period 2002/2004. Seasonal fluctuations occurred with minima in summer and two- to threefold higher maxima during late autumn. Allergen peaks were correlated with relative humidity peaks 2 months previously. Seasonal changes in allergen were not affected by the HDM avoidance intervention. Conclusions: House dust mite allergen concentrations in Sydney beds fluctuate approximately two- to threefold on an annual cycle, partly determined by relative humidity, with peaks in late autumn and minima in summer. Fluctuations of this magnitude might be sufficient to influence asthma symptoms. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the prevalence of asthma and use of asthma medications in elite athletes compared with an age-matched non-athlete population. Data were collected from the respiratory component of annual medical screening of 424 elite athletes from the Queensland Academy of Sport. Measures included the prevalence of current asthma and ever doctor-diagnosed asthma, and the prevalence of use of treatment for asthma including β-agonists and inhaled corticosteroid medication. The prevalence of current asthma in athletes aged 18–29 years was 14% (95% CI, 9–19%), which did not differ significantly from the prevalence in the non-athlete control population (11%; 95% CI, 9–12%, P=0.3). Of athletes with current asthma, 27% were not taking any medications for asthma, and 25% were treated with short-acting β-agonist medications alone and were not taking inhaled corticosteroids. These data indicate that the overall cumulative and period prevalence of asthma in Queensland athletes is similar to that in the general age-matched population. Athletes use β-agonists with a frequency similar to the general population. [ABSTRACT FROM AUTHOR]

Background Sensitization and symptoms of allergic disease are strongly correlated, but little is known about the early clinical precursors of the development of allergen sensitization in childhood. The aim of this study was to identify these predictors, and to examine separately the effect of early sensitization on subsequent wheeze, asthma, rhinitis and eczema. Methods In the Childhood Asthma Prevention Study, children with a family history of asthma were assessed for allergen sensitization, total serum IgE, wheeze, asthma, eczema and rhinitis at ages 18 months and 5 years. To examine predictors, at 18 months, for subsequent sensitization, children who were non-sensitized at 18 months and had data on sensitization at 5 years were investigated, n=375. To examine the predictors, at age 18 months, of subsequent onset of symptoms, children who did not have wheeze, asthma, eczema or rhinitis at 18 months were followed-up at 5 years, n=177. Results Among children who were non-sensitized at age 18 months, the presence of eczema [adjusted relative risk (aRR), 1.67, 95% confidence interval (CI) 1.20–2.33], but not wheeze, asthma or rhinitis, was an independent predictor of the onset of sensitization by age 5 years. Among children who were asymptomatic at age 18 months, sensitization to any allergen at 18 months was an independent predictor for the presence of wheeze (aRR 2.41, 95% CI 1.28–4.55), asthma (aRR 4.66, 95% CI 1.88–11.54) and rhinitis (aRR 1.77, 95% CI 1.08–2.90), but not for the development of eczema (aRR 0.78, 95% CI 0.23–2.64) at 5 years. Conclusion In non-sensitized children, eczema, but not wheeze, asthma or rhinitis is a predictor for subsequent development of sensitization. This suggests that early childhood eczema, rather than wheeze and rhinitis, may promote subsequent allergen sensitization and raises the possibility that early management of eczema may reduce the prevalence of sensitization in children. [ABSTRACT FROM AUTHOR]

We examine the nature of the immune responses to inhaled skin particles and query whether early exposure could play a role in providing protection against the development of allergic disease. Currently, the main hypothesis used to explain environmental modulation of allergic diseases, the ‘hygiene hypothesis’, is linked exclusively to microbial exposures acting upon the innate immune system. However, many of the exposures sustaining this hypothesis also involve co-exposure to skin flakes from humans or animals. Such skin flakes contain a complex mixture of antigens, glycolipids and small peptides that may induce immune responses. Should these responses prove relevant to the modulation of allergic diseases, it provides new opportunities to better understand the epidemic of allergic disease and to develop new interventions for its prevention. [ABSTRACT FROM AUTHOR]

The present study sought to examine psychological and behavioral variables as predictors of attending an HIV medical care provider among person's recently diagnosed with HIV. The study, carried out between 2001 and 2003, was a two-arm randomized intervention trial with participants recruited from public HIV testing centers, sexually transmitted disease (STD) clinics, hospitals, and community-based organizations in Atlanta, Georgia; Baltimore, Maryland; Miami, Florida; and Los Angeles, California. Eighty-six percent of those enrolled (273) had complete baseline and 12-month follow-up data. Measures of number of months since HIV diagnosis, readiness to enter care (based on stages of change), barriers and facilitators to entering care, drug use, and intervention arm (case managed versus simple referral) were examined as predictors of attending an HIV care provider, defined as being in care at least once in each of two consecutive 6-month follow-up periods. In logistic regression, seeing a care provider was significantly more likely among participants diagnosed with HIV within 6 months of enrollment (odds ratio [OR] = 2.52, 95% confidence interval [CI], 1.25, 5.06), those in the preparation versus precontemplation stages at baseline (OR = 2.87, 95% CI, 1.21, 6.81), those who reported at baseline that someone (friend, family member, social worker, other) was helping them get into care (OR = 2.13, 95% CI, 1.02, 4.44), and those who received a case manager intervention (OR = 2.16, 95% CI, 1.23, 3.78). The findings indicate a need to reach HIV-positive person's soon after diagnosis and assist them in getting into medical care. Knowing a person's stages of readiness to enter care and their support networks can help case managers formulate optimal client plans. [ABSTRACT FROM AUTHOR]

Background Although longer duration of breastfeeding and later introduction of solid foods are both recommended for the prevention of asthma and allergic disease, evidence to support these recommendations is controversial. Objective To examine the relation between infant feeding practices and the risk of asthma and allergic disease at age 5 years. Methods A cohort of children with a family history of asthma in Sydney, Australia, was followed from birth to age 5 years. Data on infant feeding practices and on early manifestations of eczema were collected prospectively. The presence of eczema, asthma and atopy (positive allergen skin prick tests) were determined at age 5 years. Results In 516 children evaluated at age 5 years, there was no significant association between the duration of breastfeeding or timing of introduction of solid foods and protection against asthma or other allergic disease, after adjustment for confounding factors. However, breastfeeding for 6 months or more and introduction of solid foods after 3 months were both associated with an increased risk of atopy at age 5 years ( P=0.02 and 0.01, respectively). There was no significant association between the presence of eczema at 4 weeks and at 3 months and continued breastfeeding beyond those times. Conclusion Longer duration of breastfeeding and later introduction of solid foods did not prevent the onset of asthma, eczema or atopy by age 5 years. [ABSTRACT FROM AUTHOR]

Due to the growing knowledge about the role of specific fatty acids in health and disease, dietary intake measurements of individual fatty acids or classes of fatty acids are becoming increasingly important. The objective of this study was to evaluate the ability of the Nambour FFQ to estimate intakes of specific fatty acids, particularly PUFA. The study population was a sub-sample of adult participants in a randomised controlled trial of ??-carotene and sunscreen in the prevention of skin cancer (n 43). Dietary intake was assessed by a self-administered FFQ and a weighed food record (WFR). Non-fasting blood samples were collected and analysed for plasma phospholipid fatty acids. Median intakes on the FFQ were generally higher than the WFR except for the n-3 PUFA groups, where the FFQ estimated higher intakes. Correlations between the FFQ and WFR were moderate (r 0??32???0??59) except for trans fatty acids (r 0??03). Correlations between each of the dietary assessment methods and the plasma phospholipids were poor for all fatty acids other than the PUFA. Using the methods of triads approach, the FFQ validity coefficients for total n-3 fatty acids, total long chain n-3 fatty acids, EPA, arachidonic acid, docosapentaenoic acid and DHA were 0??50, 0??63, 0??45 and 0??62 and 0??62, respectively. For most fatty acids, the FFQ adequately estimates group mean fatty acid intakes and can adequately rank individuals; however, the ability of this FFQ to estimate trans fatty acids was poor. [ABSTRACT FROM PUBLISHER]

The delay between testing positive for human immunodeficiency virus (HIV) and entering medical care can be better understood by identifying variables associated with use of HIV primary care among persons recently diagnosed with the virus. We report findings from 270 HIV-positive persons enrolled in the Antiretroviral Treatment Access Study (ARTAS). 74% had not seen an HIV care provider before enrolment; 26% had one prior visit only. Based on Andersen's behavioural model of health care utilization, several variables reflecting demographic, healthcare, illness, behavioural, and psychosocial dimensions were assessed and used to predict the likelihood that participants had seen an HIV care provider six months after enrolment. Overall, 69% had seen an HIV care provider by six months. In multivariate analysis, the likelihood of seeing a provider was significantly (p<.05) higher among men, Hispanics (vs. non-Hispanic Blacks), those with higher education, those who did not use injection drugs, those with three or more HIV-related symptoms, those with public health insurance (vs. no insurance), and those who received short-term case management (vs. passive referral). The findings support several conceptual categories of Andersen's behavioural model of health services utilization as applied to the use of HIV medical care among persons recently diagnosed with HIV. [ABSTRACT FROM AUTHOR]

The objective of this study was to estimate frequency and correlates of discussing HIV viral load (VL) with serodiscordant sex partners to guide decisions about sexual activities among men who have sex with men (MSM). We conducted a cross-sectional survey of 573 San Francisco MSM. Among 507 who knew their HIV status, 397 (78%) were familiar with the term 'viral load', and half (n=199) had a serodiscordant partner in the prior year. These 199 respondents (n=130 [65%] HIV-positive; n=69 [35%] HIV-negative) were the focus of this analysis. A majority (n=111, 56%) discussed VL in the prior year with serodiscordant partners specifically to guide decisions about sexual risk behaviour. Discussion was more common among HIV-positive than HIV-negative participants (adjusted odds ratio [AOR], 3.5; 95% confidence interval [CI], 1.6-7.6), and African Americans compared to whites (AOR, 3.7; 95% CI, 1.5-9.5). HIV-negative men who discussed VL were more concerned about becoming infected, but also more willing to engage in risky behaviour with a partner whose VL is undetectable, than men not discussing VL. Some HIV-negative men may be discussing VL to engage in higher risk behaviour upon learning of an HIV-positive partner's undetectable VL. Interventions targeting MSM should explain that while risk of transmission is likely reduced with a low blood plasma VL, it is not necessarily eliminated. [ABSTRACT FROM AUTHOR]

The objective of this study was to estimate frequency and correlates of discussing HIV viral load (VL) with serodiscordant sex partners to guide decisions about sexual activities among men who have sex with men (MSM). We conducted a cross-sectional survey of 573 San Francisco MSM. Among 507 who knew their HIV status, 397 (78%) were familiar with the term ‘viral load’, and half (n=199) had a serodiscordant partner in the prior year. These 199 respondents (n=130 [65%] HIV-positive; n=69 [35%] HIV-negative) were the focus of this analysis. A majority (n=111, 56%) discussed VL in the prior year with serodiscordant partners specifically to guide decisions about sexual risk behaviour. Discussion was more common among HIV-positive than HIV-negative participants (adjusted odds ratio [AOR], 3.5; 95% confidence interval [CI], 1.6–7.6), and African Americans compared to whites (AOR, 3.7; 95% CI, 1.5–9.5). HIV-negative men who discussed VL were more concerned about becoming infected, but also more willing to engage in risky behaviour with a partner whose VL is undetectable, than men not discussing VL. Some HIV-negative men may be discussing VL to engage in higher risk behaviour upon learning of an HIV-positive partner's undetectable VL. Interventions targeting MSM should explain that while risk of transmission is likely reduced with a low blood plasma VL, it is not necessarily eliminated. [ABSTRACT FROM AUTHOR]

Objectives: There is evidence that methamphetamine and sildenafil (Viagra) use are associated with sexual risk behaviour among men who have sex with men (MSM). We investigated the association of methamphetamine, sildenafil, and other substance use with unprotected receptive and insertive anal sex among MSM by conducting an encounter specific analysis. Methods: Data were from a cross sectional, community based survey of MSM in San Francisco regarding behaviour during their most recent anal sex encounter. Mulitvariate regression analysed independent associations of specific substance use and demographic variables with unprotected anal sex behaviours. Results: The sample (n=388) was diverse in race/ethnicity, age, income, education, HIV status, and homosexual/bisexual identification. More than half (53%) reported unprotected anal sex, including insertive (29%) and receptive (37%) during their most recent anal sex encounter; 12% reported unprotected insertive and 17% reported unprotected receptive anal sex with an HIV discordant or unknown partner. Methamphetamine was used by 15% and sildenafil was used by 6% of the men before or during the encounter; 2% used both drugs. In multivariate analysis controlling for demographic factors and other substance use, methamphetamine use was associated with unprotected receptive (odds ratio (OR), 2.03; 95% confidence interval (Cl), 1.09 to 3.76) and sildenafil use was associated with unprotected insertive (OR, 6.51; Cl, 2.46 to 17.24) anal sex. Effects were stronger with HIV discordant or unknown sex partners specifically. Conclusion: Encounter specific associations of methamphetamine and sildenafil use with unprotected receptive and insertive anal sex, respectively, indicate the importance of assessment specificity and tailoring risk reduction efforts to address certain drugs and sexual behavioural roles among MSM. [ABSTRACT FROM AUTHOR]

Background: This article is part of a project to determine the cost-effectiveness of averting the burden of disease. We used population data to investigate the costs and benefits of allocating resources to optimal treatment for asthma in adults, using a burden of disease framework. Methods: We calculated the population burden of asthma in the absence of any treatment as years lived with disability (YLD), ignoring the years of life lost. We then estimated the proportion of burden averted with current interventions, the proportion that could be averted with optimally implemented current evidence-based guidelines and the direct treatment cost-effectiveness ratio in $A per YLD averted for both current and optimal treatment. Results: The direct treatment cost of current treatment of adult asthma in Australia was $A452 million and averted 25% of the burden with a cost-effectiveness ratio of $A14 000/YLD averted. Optimal treatment and optimal compliance would cost $A627 million and avert 69% of the burden with a cost-effectiveness ratio of $A7000/YLD averted. Conclusion: Implementation of optimal treatment for asthma is affordable, will be more cost-effective and will significantly decrease disability. [ABSTRACT FROM AUTHOR]

Background: The impact of asthma has traditionally been measured in terms of the prevalence of the disease, mortality rates, and levels of healthcare utilisation, particularly hospital admissions. However, the impact of asthma extends beyond these outcomes to include effects on lifestyle, well being, and perceived health status. Methods: Information on self-reported current asthma status, arthritis and diabetes as well as measures of life satisfaction, self-assessed health status, psychological distress, and interference with usual activities was obtained for 14 641 respondents aged 18-64 years in the 2001 National Health Survey of the general population in all states and territories in Australia. Log linear models were fitted separately for each of the dichotomised quality of life measures as dependent variables. The estimates of the adjusted rate ratio obtained from each model were used to compute the population attributable fraction (PM) of self-reported asthma, arthritis, and diabetes for each of the health status and quality of life measures. Results: The presence of asthma accounted for 3.18% (95% CI 2.13 to 4.23) of people reporting poor life satisfaction, 8.12% (95% CI 6.57 to 9.67) of people reporting poor health status, 5.90% (95% CI 4.19 to 7.61) of people reporting high psychological distress, and 3.58% (95% CI 2.16 to 5.01) of people reporting any reduced activity days. The proportions of people with these adverse health states attributable to asthma were higher than the proportions attributable to diabetes but lower than the proportions attributable to arthritis. Conclusion: Asthma is an important contributor to the burden of ill health and impaired quality of life in the community. A strategic approach is needed to develop and implement strategies to address the impact of asthma on quality of life. [ABSTRACT FROM AUTHOR]

The measurement of peak nasal inspiratory flow (PNIF) provides a simple, cheap, fast and readily available tool for determining the extent of nasal airway patency. However, there are questions regarding its repeatability when used to assess the degree of nasal obstruction in large populations. Therefore, this study aimed to evaluate the repeatability of PNIF measurements and to assess their association with the signs and symptoms of rhinitis.The PNIF, rhinitis symptoms, judged by Meltzer questionnaire and rhinitis signs, as determined by anterior rhinoscopy, were assessed in 283 adults representative of the general population. One training and two test PNIF measurements were recorded during the same session.The PNIF was highly reproducible (ICC = 0.92; 95% limits of agreement:±36 l/min). The PNIF was strongly correlated with rhinitis signs, measured by anterior rhinoscopy (rs = −0.38,P < 0.0001) but was not correlated with rhinitis symptoms, measured by questionnaire (rs = −0.11,P = 0.057). Differences in PNIF for subjects categorized as asymptomatic, mild or moderate/severe on the basis of rhinitis signs, were highly significant (P < 0.0001), but less significant on the basis of rhinitis symptoms (P = 0.04). A PNIF cut-off of 115 l/min had moderately high specificity (72%) and sensitivity (65%) and a high negative predictive value (90%) for moderate/severe signs of rhinitis.In a large general population-based sample of young adults, PNIF was highly reproducible and closely related to the signs of rhinitis, as determined by clinical examination. The PNIF provides information that is qualitatively different to that provided by symptom scores and may be useful to measure the extent of nasal obstruction. [ABSTRACT FROM AUTHOR]

BACKGROUND:: Reliability or validity studies are important for the evaluation of measurement error in dietary assessment methods. An approach to validation known as the method of triads uses triangulation techniques to calculate the validity coefficient of a food-frequency questionnaire (FFQ). OBJECTIVE:: To assess the validity of an FFQ estimates of carotenoid and vitamin E intake against serum biomarker measurements and weighed food records (WFRs), by applying the method of triads. DESIGN:: The study population was a sub-sample of adult participants in a randomised controlled trial ofß-carotene and sunscreen in the prevention of skin cancer. Dietary intake was assessed by a self-administered FFQ and a WFR. Nonfasting blood samples were collected and plasma analysed for five carotenoids (a-carotene,ß-carotene,ß-cryptoxanthin, lutein, lycopene) and vitamin E. Correlation coefficients were calculated between each of the dietary methods and the validity coefficient was calculated using the method of triads. The 95%confidence intervals for the validity coefficients were estimated using bootstrap sampling. RESULTS:: The validity coefficients of the FFQ were highest fora-carotene (0.85) and lycopene (0.62), followed byß-carotene (0.55) and total carotenoids (0.55), while the lowest validity coefficient was for lutein (0.19). The method of triads could not be used forß-cryptoxanthin and vitamin E, as one of the three underlying correlations was negative. CONCLUSIONS:: Results were similar to other studies of validity using biomarkers and the method of triads. For many dietary factors, the upper limit of the validity coefficients was less than 0.5 and therefore only strong relationships between dietary exposure and disease will be detected. SPONSORSHIP:: National Health and Medical Research Council.European Journal of Clinical Nutrition (2005) 59, 211-218. doi:10.1038/sj.ejcn.1602060 Published online 13 October 2004 [ABSTRACT FROM AUTHOR]