Kawasaki disease (KD) may result in coronary aneurysm formation, but there is incomplete knowledge regarding its long-term effects. Our objective was to quantify the longer-term rates of adverse ...cardiac events in a modern North American KD cohort.
Using the Kaiser Permanente Northern California population, we performed a retrospective cohort study in patients with a history of KD versus matched patients without KD. Chart review was used to confirm the diagnosis of KD and all outcomes of interest, including acute coronary syndrome, coronary revascularization, heart failure, ventricular arrhythmia, valve disease, aortic aneurysm, and all-cause mortality. All outcomes occurring at age ≥15 years were included in the primary analysis. Outcome rates were compared between the 2 groups by using Cox proportional hazards analysis.
The study included 546 KD patients and 2218 matched patients without KD. Seventy-nine percent of the KD patients received intravenous immunoglobulin and 5% had persistent coronary aneurysm. The average follow-up time was 14.9 years. Only 2 KD patients experienced outcomes after age 15 (0.246 events per 1000 person-years) compared with 7 events in the non-KD group (0.217 events per 1000 person-years), a nonsignificant difference (hazard ratio: 0.81; 95% confidence interval: 0.16-4.0). Within the KD subgroup, persistent coronary aneurysm predicted the occurrence of adverse events (P = .007).
This is the largest US study of longer-term cardiac outcomes after KD and reveals a low rate of adverse cardiovascular events through age 21. Additional validation studies, including studies with longer-term follow-up, should be performed.
The COVID-19 pandemic has affected clinical services globally, including colorectal cancer (CRC) screening and diagnostic testing. We investigated the pandemic’s impact on fecal immunochemical test ...(FIT) screening, colonoscopy utilization, and colorectal neoplasia detection across 21 medical centers in a large integrated health care organization.
We performed a retrospective cohort study in Kaiser Permanente Northern California patients ages 18 to 89 years in 2019 and 2020 and measured changes in the numbers of mailed, completed, and positive FITs; colonoscopies; and cases of colorectal neoplasia detected by colonoscopy in 2020 vs 2019.
FIT kit mailings ceased in mid-March through April 2020 but then rebounded and there was an 8.7% increase in kits mailed compared with 2019. With the later mailing of FIT kits, there were 9.0% fewer FITs completed and 10.1% fewer positive tests in 2020 vs 2019. Colonoscopy volumes declined 79.4% in April 2020 compared with April 2019 but recovered to near pre-pandemic volumes in September through December, resulting in a 26.9% decline in total colonoscopies performed in 2020. The number of patients diagnosed by colonoscopy with CRC and advanced adenoma declined by 8.7% and 26.9%, respectively, in 2020 vs 2019.
The pandemic led to fewer FIT screenings and colonoscopies in 2020 vs 2019; however, after the lifting of shelter-in-place orders, FIT screenings exceeded, and colonoscopy volumes nearly reached numbers from those same months in 2019. Overall, there was an 8.7% reduction in CRC cases diagnosed by colonoscopy in 2020. These data may help inform the development of strategies for CRC screening and diagnostic testing during future national emergencies.
The COVID-19 pandemic led to declines in colonoscopy volumes and the number of colorectal cancer and advanced adenoma cases detected in 2020 compared with 2019.
The fecal immunochemical test (FIT) is a common method for colorectal cancer (CRC) screening, yet its acceptability and performance over several rounds of annual testing are largely unknown.
To ...assess FIT performance characteristics over 4 rounds of annual screening.
Retrospective cohort study.
Kaiser Permanente Northern and Southern California.
323 349 health plan members aged 50 to 70 years on their FIT mailing date in 2007 or 2008 who completed the first round of FIT and were followed for up to 4 screening rounds.
Screening participation, FIT positivity (≥20 µg of hemoglobin/g), positive predictive values for adenoma and CRC, and FIT sensitivity for detecting CRC obtained from Kaiser Permanente electronic databases and cancer registries.
Of the patients invited for screening, 48.2% participated in round 1. Of those who remained eligible, 75.3% to 86.1% participated in subsequent rounds. Median follow-up was 4.0 years, and 32% of round 1 participants crossed over to endoscopy over 4 screening rounds-7.0% due to a positive FIT result. The FIT positivity rate (5.0%) and positive predictive values (adenoma, 51.5%; CRC, 3.4%) were highest in round 1. Overall, programmatic FIT screening detected 80.4% of patients with CRC diagnosed within 1 year of testing, including 84.5% in round 1 and 73.4% to 78.0% in subsequent rounds.
Screening detection, rather than long-term cancer prevention, was evaluated.
Annual FIT screening was associated with high sensitivity for CRC, with high adherence to annual follow-up screening among initial participants. The findings indicate that annual programmatic FIT screening is feasible and effective for population-level CRC screening.
National Institutes of Health.
Abstract Background Reports on associations between azole antifungal medications and acute liver injury are inconsistent and have not been based on liver-related laboratory tests. We evaluated ...incidence rates of acute liver injury associated with oral azole antifungals. Methods We conducted a cohort study among Kaiser Permanente Northern California members who initiated an oral azole antifungal in an outpatient setting during 2004-2010. We determined development of: (1) liver aminotransferases >200 U/L, (2) severe acute liver injury (coagulopathy with hyperbilirubinemia), and (3) acute liver failure. We calculated incidence rates of endpoints. Cox regression was used to determine whether chronic liver disease was a risk factor for outcomes. Results Among 195,334 azole initiators (178,879 fluconazole; 14,296 ketoconazole; 1653 itraconazole; 478 voriconazole; 28 posaconazole), incidence rates (events/1000 person-years 95% confidence intervals (CIs)) of liver aminotransferases >200 U/L were similarly low with fluconazole (13.0 11.4-14.6), ketoconazole (19.3 13.8-26.3), and itraconazole (24.5 10.6-48.2). Rates were higher with voriconazole (181.9 112.6-278.0) and posaconazole (191.1 23.1-690.4), but comparable. Severe acute liver injury was uncommon with fluconazole (2.0 1.4-2.7), ketoconazole (2.9 1.1-6.3), and itraconazole (0.0 0.0-11.2), but more frequent with voriconazole (16.7 2.0-60.2) and posaconazole (93.4 2.4-520.6). One patient developed acute liver failure due to ketoconazole. Pre-existing chronic liver disease increased risks of aminotransferases >200 U/L (hazard ratio 4.68 95% CI, 3.68-5.94) and severe acute liver injury (hazard ratio 5.62 95% CI, 2.56-12.35). Conclusions Rates of acute liver injury were similarly low for fluconazole, ketoconazole, and itraconazole. Events were more common among voriconazole and posaconazole users but were comparable. Pre-existing chronic liver disease increased risk of azole-induced liver injury.
Organophosphate (OP) pesticides are widely used in agriculture and homes. Animal studies suggest that even moderate doses are neurodevelopmental toxicants, but there are few studies in humans.
We ...investigated the relationship of prenatal and child OP urinary metabolite levels with children's neurodevelopment.
Participating children were from a longitudinal birth cohort of primarily Latino farm-worker families in California. We measured six nonspecific dialkylphosphate (DAP) metabolites in maternal and child urine as well as metabolites specific to malathion (MDA) and chlorpyrifos (TCPy) in maternal urine. We examined their association with children's performance at 6 (n = 396), 12 (n = 395), and 24 (n = 372) months of age on the Bayley Scales of Infant Development Mental Development (MDI) and Psychomotor Development (PDI) Indices and mother's report on the Child Behavior Checklist (CBCL) (n = 356).
Generally, pregnancy DAP levels were negatively associated with MDI, but child measures were positively associated. At 24 months of age, these associations reached statistical significance per 10-fold increase in prenatal DAPs: beta = -3.5 points; 95% confidence interval (CI), -6.6 to -0.5; child DAPs: beta = 2.4 points; 95% CI, 0.5 to 4.2. Neither prenatal nor child DAPs were associated with PDI or CBCL attention problems, but both prenatal and postnatal DAPs were associated with risk of pervasive developmental disorder per 10-fold increase in prenatal DAPs: odds ratio (OR) = 2.3, p = 0.05; child DAPs OR = 1.7, p = 0.04. MDA and TCPy were not associated with any outcome.
We report adverse associations of prenatal DAPs with mental development and pervasive developmental problems at 24 months of age. Results should be interpreted with caution given the observed positive relationship with postnatal DAPs.
Most HIV prevention for sexual minority men and men who have sex with men targets risk behaviors (e.g., condom use) and helps <50% of participants. Bolstering resilience might increase HIV ...prevention’s effectiveness. This systematic review identified resilience resources (protective factors) in high-risk, HIV-negative, sexual minority men. We reviewed PsycINFO, PsycARTICLES, MEDLINE, references, and Listservs for studies including sexual minority men with 1+ HIV risk factor (syndemics): childhood sexual abuse, partner abuse, substance abuse, or mental health symptoms. From 1356 articles screened, 20 articles met inclusion criteria. Across the articles, we identified and codified 31 resilience resources: socioeconomic (e.g., employment), behavioral coping strategies (e.g., mental health treatment), cognitions/emotions (e.g., acceptance), and relationships. Resilience resources were generally associated with lower HIV risk; there were 18 low-risk associations, 4 high-risk associations, 8 non-significant associations). We generated a set of empirically based resilience variables and a hypothesis to be evaluated further to improve HIV prevention.
Transitions Suárez-Orozco, Carola; Abo-Zena, Mona M; Marks, Amy K
10/2015
eBook
Immigration to the United States has reached historic numbers- 25 percent of children under the age of 18 have an immigrant parent, and this number is projected to grow to one in three by 2050. These ...children have become a significant part of our national tapestry, and how they fare is deeply intertwined with the future of our nation. Immigrant children and the children of immigrants face unique developmental challenges. Navigating two distinct cultures at once, immigrant-origin children have no expert guides to lead them through the process. Instead, they find themselves acting as guides for their parents.
How are immigrant children like all other children, and how are they unique? What challenges as well as what opportunities do their circumstances present for their development? What characteristics are they likely to share because they have immigrant parents, and what characteristics are unique to specific groups of origin? How are children of first-generation immigrants different from those of second-generation immigrants?Transitionsoffers comprehensive coverage of the field's best scholarship on the development of immigrant children, providing an overview of what the field needs to know-or at least systematically begin to ask-about the immigrant child and adolescent from a developmental perspective.
This book takes an interdisciplinary perspective to consider how personal, social, and structural factors interact to determine a variety of trajectories of development. The editors have curated contributions from experts across a carefully selected variety of topics covering ecologies, processes, and outcomes of development pertinent to immigrant origin children.
Nonmedical use of prescription drugs (NMUPD) among U.S. adolescents is a burgeoning public health problem. Previous studies have observed differences in rates of NMUPD among ethnic/racial groups. ...However, less is known on the social and cultural processes and mechanisms, which may influence adolescents’ prescription drug beliefs and practices. We conducted semi-structured interviews with 20 diverse 13- to 17-year-olds in an adolescent psychiatric inpatient unit to elicit in-depth, context-sensitive information about social factors relevant to NMUPD. Data analysis was completed using grounded theory and interpreted with a social ecological approach. Results highlighted the myriad of important contextual influences on adolescent NMUPD. Responses reflected factors within microsystem, exosystem, and macrosystem contexts as well as important intrapersonal factors. Furthermore, adolescents who identified as an ethnic minority also described cultural values (e.g., religion) and culturally based beliefs (e.g., mental health stigma), which influenced their prescription drug beliefs. Narratives revealed the interplay between intrapersonal factors and socialization agents, such as parents, peers, and the media, influencing prescription drug behavior. Our findings present ecologically framed insights as a first step in understanding this health risk behavior among U.S. adolescents. Implications as well as important next steps for future research and interdisciplinary prevention and intervention program development are discussed.
Background: Pollution may play a role in population trends of declining semen quality and regional differences in time to pregnancy (TTP) in industrialized societies. Dioxins including ...2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) have been suspected. In 1976, an explosion near Seveso, Italy resulted in the highest TCDD exposure known in residential populations. Twenty years later, we conducted a retrospective cohort study, the Seveso Women's Health Study. Methods: Of 981 participants, 472 women attempted pregnancy after the explosion, and 278 delivered a livebirth not associated with contraceptive failure. Individual serum TCDD levels were measured from samples collected soon after the explosion and extrapolated to the conception attempt. We examined the relation of TCDD levels to time to pregnancy (parameterized as the monthly probability of conception within the first 12 months of trying) and to infertility (defined as conception after at least 12 months of trying). We modeled fecundability with discrete-time Cox proportional hazards regression, and we modeled fertility with logistic regression. We tested the sensitivity of the conclusions to differing definitions of eligibility and outcome. Results: Median TCDD level was 50 parts per trillion, median time to pregnancy was 2 months, and 17% reported taking 12 or more months to conceive. For every 10-fold increase in serum TCDD, we observed a 25% increase in time to pregnancy (adjusted-fecundability odds ratio = 0.75 95% confidence interval (CI) = 0.60–0.95) and about a doubling in odds of infertility (adjusted odds ratio = 1.9 95% CI = 1.1–3.2). Results were similar for extrapolated TCDD and sensitivity analyses. Conclusions: We found dose-related increases in TTP and infertility associated with individual serum TCDD levels in the women from Seveso, Italy. These findings may have implications for fertility in industrialized areas.
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