Young people's books concerning visual impairment

First of an in-depth, two-part review of literature for young people on the subjects of blindness and visual impairment.

Are US degree-granting institutions associated with better community health determinants and outcomes?

OBJECTIVES

The impact of individual education level on health outcomes is well-established, but the effect of degree-granting institutions on county health rankings (CHRs) is unknown. The objective of this study is to determine if there is an association between the presence of degree-granting institutions and CHRs.

STUDY DESIGN

This is an ecologic study.

METHODS

Data for 3062 counties were derived from the Robert Wood Johnson County Health Rankings and the Integrated Postsecondary Education Data System for year 2016. Ordinal logistic regression was utilized to determine the association between presence of a degree-granting institution and county rankings for health behaviors, health outcomes, clinical care, social and economic factors, and physical environment. All models were adjusted for potential confounding factors including age, sex, race/ethnicity, English language proficiency, and urban/rural location.

RESULTS

The presence of a degree-granting institution was positively associated with CHRs for length of life (odds ratio [OR] = 1.28; 95% confidence interval [CI]: 1.05, 1.58), health behaviors (OR = 1.46; 95% CI: 1.19, 1.79), and clinical care (OR = 1.36; 95% CI: 1.11, 1.67). Counties with the highest rankings in one health category were more likely to score in the highest rankings for other health categories.

CONCLUSIONS

These findings suggest that degree-granting institutions are associated with CHRs. Partnerships between public health agencies and degree-granting institutions are recommended to improve population health.

Engineering a soluble high-affinity receptor domain that neutralizes staphylococcal enterotoxin C in rabbit models of disease

Superantigens (SAgs) are a class of immunostimulatory exotoxins that activate large numbers of T cells, leading to overproduction of cytokines and subsequent inflammatory reactions and systemic toxicity. Staphylococcal enterotoxin C (SEC), a SAg secreted by Staphylococcus aureus, has been implicated in various illnesses including non-menstrual toxic shock syndrome (TSS) and necrotizing pneumonia. SEC has been shown to cause TSS illness in rabbits and the toxin contributes to lethality associated with methicillin-resistant S.aureus (MRSA) in a rabbit model of pneumonia. With the goal of reducing morbidity and mortality associated with SEC, a high-affinity variant of the extracellular variable domain of the T-cell receptor beta-chain for SEC (~14 kDa) was generated by directed evolution using yeast display. This protein was characterized biochemically and shown to cross-react with the homologous (65% identical) SAg staphylococcal enterotoxin B (SEB). The soluble, high-affinity T-cell receptor protein neutralized SEC and SEB in vitro and also significantly reduced the bacterial burden of an SEC-positive strain of MRSA (USA400 MW2) in an infective endocarditis model. The neutralizing agent also prevented lethality due to MW2 in a necrotizing pneumonia rabbit model. These studies characterize a soluble high-affinity neutralizing agent against SEC, which is cross-reactive with SEB, and that has potential to be used intravenously with antibiotics to manage staphylococcal diseases that involve these SAgs.

Effect of surgeon education on lymphadenectomy in colon cancer

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Background: The most important determinant of prognosis for localized colon cancer is metastatic lymph node involvement. The American Joint Commission on Cancer and the College of American Pathologists have recommended examination ≥ 12 lymph nodes to ensure adequate staging. We hypothesized that surgeon education would improve the extent of lymphadenectomy in patients being treated for colon cancer. A large community based metropolitan health care system served as a model for testing this hypothesis.

Methods: 906 patients comprising AJCC stage I (n=265), stage II (n=304), and stage III (n=337) colon cancers were evaluated. Surgical approach was either open (n=567), laparoscopic (n=310), or unknown (n=29). Lymphadenectomy results obtained from post-operative pathology reports were tracked across four separate time periods: era 1 (1/1/02-1/31/04), era 2 (1/1/05-1/31/06), and era 3 (1/1/07-1/31/07). Results were then compared against a study endpoint measurement of 2008, era four.

Results: Upon analysis and comparison of individual era results, a significant improvement in lymphadenectomy (percentage of patients with ≥12 nodes harvested) was noted for all AJCC stages (p-values compare era 4 versus era 1): I (34.2% vs. 59% vs. 65% vs. 69%, P=0.0001), II (62% vs. 76% vs. 90% vs. 91%, P=0.0004), and III (55% vs. 72% vs. 84% vs. 86%, P<0.0001; see table). Surgical approach was not a significant factor. Neither age nor sex was significant.

Conclusions: Through physician education, we were able to increase awareness of optimal staging practice for lymphadenectomy in colon cancer. This resulted in significantly improved patient outcomes within a large metropolitan health care system.

No significant financial relationships to disclose.

Risk factors for syphilis among incarcerated women in Rhode Island

Syphilis remains a significant problem in the United States. The prison environment is an ideal location to identify and treat syphilis. We undertook this study to describe the correlates and risk factors for syphilis among incarcerated women in Rhode Island. The study design was a review of all cases of syphilis identified through routine screening in the state prison and a case control study. Between 1992 and 1998, among 6,249 incarcerated women, 86 were found to have syphilis; of these, 29 were primary and secondary cases representing 49% of infectious cases of syphilis in women in the state. The prison environment offers a unique opportunity for the diagnosis and treatment of syphilis.

Hepatitis B vaccination practices in state and federal prisons

OBJECTIVE

Incarcerated populations are a group at high risk for hepatitis B. About 30% of people experiencing acute hepatitis B virus infection (HBV) have a history of incarceration. Offering routine HBV vaccinations to incarcerated individuals could have a significant effect on public health. The objective of this study is to identify current vaccine practices and the perceived feasibility of routine vaccinations for hepatitis B within correctional settings.

METHOD

The authors surveyed the medical directors of state correctional facilities in all 50 states and the federal prison system regarding current HBV vaccine practices. Surveys were faxed or mailed between July 1 and September 1, 2000.

RESULTS

Thirty-five states and the federal system responded (response rate = 70.6%). These systems account for 77% of all inmates in federal or state prisons and jails. Two states give hepatitis B vaccine routinely, nine states offer no hepatitis B vaccine, and 26 states and the Federal Bureau of Prisons offer hepatitis vaccine to some inmates. Most states do not spend enough money to vaccinate even those prisoners at highest risk. Under the Vaccine for Children program, 19,520 youths could receive vaccine immediately. According to the respondents, if vaccine were available at no-cost, 25 states and the Federal Bureau of Prisons would routinely offer vaccination to all inmates.

CONCLUSIONS

Most correctional systems do not routinely offer vaccine to their incarcerated populations, but would if funds were available. There exists now a unique public health opportunity to prevent a significant proportion of new hepatitis B infections.

Comprehensive medical care among HIV-positive incarcerated women: the Rhode Island experience

Our objective was to characterize the clinical presentation of human immunodeficiency virus (HIV) infection among incarcerated women in a program that provides HIV testing and primary care to all state prisoners in Rhode Island. A retrospective medical chart review on all HIV-seropositive women who were incarcerated between 1989 and 1994 and had at least two medical visits with an HIV medical care provider was used. At the Rhode Island Adult Correctional Institution (ACI), under mandatory testing laws between 1989 and 1994, 28% (172 of 623) of all women were identified with HIV infection. Of the 172 women who tested seropositive in prison, 110 were included in the study. Of the 110 women followed, 84% reported injection drug use (IDU) as their primary risk factor, and 30% reported both IDU and sex work. The median CD4 count was 596/mm3, with 60% having a CD4 count >500 cells/mm3. The most common medical conditions were vaginal candidiasis, oral candidiasis, and bronchitis. Antiretroviral therapy was well accepted and followed community standards. Continuity of medical care after release was facilitated by the same physician caring for the patient in the community setting, with 83% of women following up for HIV care after release. The medical conditions noted reflect that these women are early in the course of their HIV disease when they are initially diagnosed. This comprehensive program in Rhode Island's state prison plays a central role in the diagnosis of HIV-seropositive women and provides counseling, primary medical and gynecological care, and linkage to community resources after release.

Prevalence and incidence of HIV among incarcerated and reincarcerated women in Rhode Island

This study explores recent temporal trends in HIV prevalence among women entering prison and the incidence and associated risk factors among women reincarcerated in Rhode Island. Results from mandatory HIV testing from 1992 to 1996 for all incarcerated women were examined. In addition, a case control study was conducted on all seroconverters from 1989 to 1997. In all, 5836 HIV tests were performed on incarceration in 3146 women, 105 of whom tested positive (prevalence, 3.3%). Between 1992 and 1996, the annual prevalence of HIV among all women known to be HIV-positive was stable (p = .12). Age >25 years, nonwhite race, and prior incarceration were associated with seropositivity. Of 1081 initially seronegative women who were retested on reincarceration, 12 seroconverted during 1885 person-years (PY) of follow-up (incidence, 0.6/100 PY). Self-reported injection drug use (IDU; odds ratio [OR], 3.7; 95% confidence interval [CI], 1.3-10.1) was significantly associated with seroconversion, but sexual risk was not (OR, 1.1; 95% CI, 0.4-3.5). Incarceration serves as an opportunity for initiation of treatment and linkage to community services for a population that is at high risk for HIV infection.

Hepatitis C in state correctional facilities

BACKGROUND

No previous studies have examined the extent to which correctional facilities in the United States screen for and treat hepatitis C (HCV) infection.

METHODS

Medical directors of state correctional facilities responded to a survey assessing the degree to which prisons screen for and treat hepatitis C. To estimate numbers of inmates eligible for interferon treatment and to examine costs associated with HCV management, we constructed a feasibility model that incorporated screening criteria used in California and Rhode Island.

RESULTS

Thirty-six states and Washington, DC, responded, resulting in a survey response rate of 73%, representing 77% of all inmates in state facilities nationwide. Colorado alone reported routine screening. Only California reported conducting a systematic seroprevalence study, which found that 39.4% of male inmates were hepatitis C antibody positive in 1994. Seventy-three percent of the respondents sometimes consider treating with interferon. Four states follow a standard protocol. The feasibility model suggests that treating suitably screened inmates is a reasonable expenditure for correctional systems.

CONCLUSION

Prison may be an appropriate setting for treatment of hepatitis C. If accompanying substance abuse issues are addressed, instituting HCV treatment for certain eligible incarcerated individuals may be a worthy target for public health dollars.

Interpretation of indeterminate HIV serology results in an incarcerated population

The objective of this study was to evaluate the significance of indeterminate HIV test results in the prison setting. No specific information or guidelines are currently available to direct counseling of incarcerated persons with an indeterminate HIV test. A medical chart review was conducted on all incarcerated inmates at the Rhode Island State Prison who received indeterminate HIV test results between the inception of mandatory testing in 1990 and October 1996. Thirty-five inmates had an indeterminate HIV Western blot (WB) result, and 31 had follow-up HIV testing. Twenty-three of 31 (74%) of the prisoners with follow-up HIV tests seroconverted (95% confidence interval, 55%-88%). Drug/alcohol use, including crack cocaine and injection drug use, was strongly associated with seroconversion (p < 0.01, odds ratio [OR] = 11.8, relative risk [RR] = 2.04). Injection drug use was also significantly associated with seroconversion (p = 0.03, OR = 9.3, RR = 1.56). This is the highest rate of seroconversion ever reported for persons with indeterminate WB test results. Indeterminate test results need to be interpreted differently in the prison setting than in the community. Prison inmates with indeterminate HIV serology should be counseled that in all likelihood they are HIV-infected, and confirmatory viral load testing should be conducted immediately.

Fibrin coating of bladder tumor cells (T24) is not protective against LAK cell cytotoxicity

Certain evidence indicates that tumor cells in the circulation may be enshrouded with a coat of fibrin. It has been suggested that this fibrin coat protects tumor cells from attack by the immune system. This study compared the interaction of lymphokine activated killer (LAK) cells with tumor cells alone and with fibrin coating. LAK cell killing of cultured human bladder tumor cells (T24) was measured by a 4-hour chromium release assay. Tumor cells (3 x 10(6] were incubated with Na51CrO4 for 2 hours at 37 degrees C and 5% CO2 in serum-free medium. After washing, one half of the cells were coated with fibrin by exposure to recalcified platelet-poor plasma. Fibrin coating was confirmed by immunofluorescence with anti-human-fibrinogen-fluorescein-conjugated antibodies. LAK cells were prepared from peripheral blood lymphocytes by incubation with interleukin-2 at a concentration of 1000 units of interleukin-2/1 ml serum-free medium/1 million cells for 5 days at 37 degrees C, 5% CO2. Five thousand tumor cells with or without fibrin were incubated with varying concentrations of either LAK or peripheral blood lymphocytes (10,000 to 100,000 cells). After 4 hours the supernatants were harvested and counted in a gamma counter for 1 minute. Over a range of effector-to-target cell ratios of 10:1 to 100:1 (LAK to T24), no difference was seen in percentage of specific lysis for T24 alone versus fibrin-coated T24 cells. At a ratio of 100:1 (LAK to T24), percentage of specific lysis was 83.3% versus 87.7% for uncoated and coated T24 cells, respectively. This suggests that fibrin coating of tumor cells is insufficient to provide protection from LAK cell killing.