Hepatitis C virus (HCV) infection is the most common blood-borne infection in the United States (U.S.). The largest increases of incidence for HCV infection are reported in the Appalachian region. This study aimed to 1) examine the prevalence and trends of HCV infection in the U.S. from 1999 to 2012; 2) investigate barriers to HCV infection treatment in Northeast Tennessee and the U.S.; and 3) study characteristics and risk factors for HIV-infection and HCV-infection in Northeast Tennessee. In the U.S., data were obtained from the National Health and Nutrition Examination Survey (NHANES) 1999-2012 to study the prevalence of HCV infection and barriers to treatment. In Northeast Tennessee, hepatitis C and HIV/AIDS data were obtained from National Electronic Disease Surveillance System (NEDSS) and enhanced HIV/AIDS Reporting System (eHARS). Descriptive statistics and multiple logistic regression models were used for analysis. Odds ratios (OR) and 95% confidence intervals (CI) were reported. There was an estimated 3.8 million people having HCV antibody in the U.S. in 2012. No significant change was found in the prevalence of HCV infection during 1999 – 2012. The leading barrier to the treatment was cost issues in the U.S. (50.0%) and Northeast Tennessee (25.0%), respectively. HCV patients without symptoms in Northeast Tennessee were more likely to be untreated (OR: 3.08, 95% CI: 1.10-8.60) and patients without health insurance in the U.S. were more likely to be untreated than their counterparts (OR: 3.38, 95% CI: 1.14-10.05). The incidence of acute hepatitis C peaked in 2012-2013 in Northeast Tennessee, while the incidence of HIV/AIDS increased by 100% from 2013 to 2015. More injection drug users (IDUs) and less men who have sex with men (MSM) were observed in patients with HCV infection than in those with HIV infection (IDUs: 50.63% vs.16.38% p

Orientador: José Paes de Oliveira Filho / Resumo: O Labrador Retriever (LR) é uma das principais raças caninas com maior predisposição à obesidade. Vários fatores, especialmente as inter-relações entre a alimentação, exercício e fatores sociais, influenciam a probabilidade de um cão se tornar obeso. Além disso, fatores genéticos são também responsáveis pela obesidade em cães, e no LR a mutação P187fs no gene pró-opiomelanocortina (POMC) está fortemente associada à obesidade. Não existem estudos prévios de prevalência da desta em LR no Brasil. Portanto, o objetivo deste estudo foi investigar esta mutação em cães da raça LR no Brasil. Dos 108 LR avaliados neste estudo, 59 eram de um estudo retrospectivo (composto por animais atendido no hospital veterinário e sem linhagem conhecida) e 49 eram de um estudo prospectivo (composto por 19 cães pet e 30 cães de assistência/resgate). Um questionário de risco de obesidade modificado foi aplicado nos tutores dos animais usados no estudo prospectivo. Fragmentos de DNA, contendo a região mutada, foram amplificados por PCR e submetidos ao sequenciamento gênico direto. A frequência alélica da mutação (21,3%) estava fora do equilíbrio de Hardy-Weinberg (P < 0,05). Usando somente os dados dos animais de linhagem conhecida, o alelo mutado foi mais frequente no grupo de assistência/resgate que no grupo de pets (P < 0,01). Embora a mutação tenha aumentado a motivação pelo alimento em LR do grupo de assistência/resgate, outras variáveis, especialmente o frequente exercício, favoreceu a manutençã... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The Labrador retriever (LR) is among the main breeds with the greatest predisposition to obesity. Several factors; especially the interrelationships between food management, exercise and social factors; influence the likelihood of a dog becoming obese. Furthermore, genetic factors are also responsible for obesity in dogs, and in LR, the mutation P187fs in pro-opiomelanocortin (POMC) gene is strongly associated with obesity. There is no knowledge of studies that have previously evaluated the prevalence of this mutation in Brazilian LR. Therefore, the objective of this study was to investigate this mutation in LR in Brazil. Of the 108 LR that were assessed in this study, 59 were from a previous study, composed by animals assisted in a veterinary hospital with unknown lineage, and 49 were from a prospective study, composed of 19 pet and 30 assistance/rescue LR dogs. The obesity risk and appetite questionnaire were applied, with some modifications, to tutors of the animals used in the prospective study. Fragments of the DNA, containing the mutated region, were amplified by PCR and submitted to direct gene sequencing. The mutated allele frequency (21.3%) was out of Hardy-Weinberg Equilibrium (HWE) (P < 0.05). Using only the data of animals with known lineage, the presence of the mutated allele was higher in the assistance/rescue dogs than pets (P < 0.01). Although the mutation has increased the food-motivation in the assistance/rescue dogs, other variables, especially frequent exe... (Complete abstract click electronic access below) / Mestre

Choanal atresia is a well-defined congenital malformation; however, little is known about its prevalence and risk factors. Data from the Iowa Registry for Congenital and Inherited Disorders were used to examine prevalence, infant, and maternal characteristics of choanal artesia. Data from the National Birth Defects Prevention Study (NBDPS) were used to examine selected risk factors for choanal atresia. Overall prevalence was estimated as number of choanal atresia cases per 10,000 live births with 95% confidence intervals (CI)s. Crude and adjusted odds ratios (OR)s and 95% CIs were estimated to investigate selected risk factors. The overall prevalence of choanal atresia among live born deliveries in Iowa from January, 1998 through December, 2005 was 0.46 (95% CI=0.27, 0.78) per 10,000 live births. Using data from the NBDPS, choanal atresia cases were compared to unaffected control infants for births from October 1997 through December 2005. Overall, case infants compared to control infants were more likely to be female, preterm, and a multiple birth. For all choanal atresia cases combined, odds of high maternal zinc (OR=2.1; 95% CI=1.2, 3.9) and vitamin B-12 (OR=2.4; 95% CI=1.4, 4.3) intake in the year prior to pregnancy, and maternal periconceptional (one month before through three months after conception) exposure to anti-infective urinary tract medications (OR=3.3; 95% CI=1.3, 8.4) were significantly elevated among case compared to control mothers. For isolated choanal atresia cases (those with no additional major malformations), odds of maternal periconceptional exposure to passive cigarette smoke (OR=2.3; 95% CI=1.0, 5.3) as well as maternal intake of 3 or more cups of coffee per day one-year prior to pregnancy were increased (OR=2.9; 95% CI=1.3, 6.4) for case compared to control mothers. The reverse was found for low maternal intake of pantothenic acid (OR=0.4; 95% CI=0.2,0.9) and vitamin A (OR=0.3; 95% CI=0.1, 0.8) one-year prior to pregnancy. The current study provided support for potential associations between maternal health behaviors before and during pregnancy and choanal atresia; however, the findings were based on a modest number of cases. The study needs to be replicated in a larger case sample, also examining the role of genetics in choanal atresia.

Background: Antiretroviral drug resistance is steadily growing in populations of HIV treatment-naive individuals due to person-to-person transmission. However, Iowa-specific data for transmitted antiretroviral drug resistance-associated mutations prevalence has not been previously reported. We postulate that the prevalence of drug resistance in Iowa does not differ significantly between HIV risk groups. Methods: Data were collected from electronic medical records and an HIV Program database between 2006 and 2011. Information included age, gender, risk exposure group, viral load, CD4 count, CD4%, and other HIV risk factors and behaviors. Results: Transmitted drug resistance mutations (TDRM) were not associated with many risk factors, but rapid plasma reagin (RPR) screening for syphilis was significant (p=0.02) and used as a proxy for highest level of sexual risk behavior. RPR was used with minor NRTI and NNRTI along with intravenous drug use in logistic regression to model the likelihood of acquiring TDRM. Conclusion: Some question the practicality of implementing genotypic ARV resistance testing guidelines because of uncertainty about the prevalence of ARV drug resistance among treatment-naïve patients but harboring resistance mutations puts patients at high risk of failing effective, first-line therapies. Hence, genotypic resistance testing at HIV diagnoses can not only improve disease management but also assist in surveillance.

The purpose of this study was to investigate the prevalence rates and effects of child sexual abuse in both deaf and hearing individuals living in Utah. A total of 104 deaf and 69 hearing individuals responded to the survey. The survey inquired about participants' experiences with sexual abuse and their mental health status. The difference in rates of abuse between the two groups was not statistically significant. However, deaf individuals tended to be abused more often than hearing individuals. Deaf victims also experienced more severe forms of abuse and were abused more frequently than hearing victims. However, hearing victims experienced the use of force during abuse more often than deaf victims. The difference in mental health status between the deaf and hearing groups was not statistically significantly different. However, the difference between the total deaf group and the total hearing group was statistically significant, the deaf group reporting more problems than the hearing group.

Influenza virus is a RNA virus that exists as different types and subtypes. Influenza A virus strains are known to cause disease in several bird and mammalian species. Wild birds are believed to constitute the natural reservoir for influenza A virus. In humans, influenza A virus causes yearly seasonal influenza epidemics of respiratory disease resulting in high morbidity and severe economic consequences. Due to the virus’ ability to change its antigenic properties by mutation, yearly vaccination is required for protection from the disease. There are many different subtypes of influenza virus which are characterized according to two surface structures - the hemagglutinin and neuraminidase proteins - , for example; H5N1. These subtypes have the ability to recombine, and thereby creating new variant combinations. If a subtype that the living population of humans has not encountered before starts to spread among humans, it can result in a pandemic. Pandemic outbreaks have occurred at irregular intervals throughout history and have had a devastating impact on mankind. For example the Spanish influenza pandemic of 1918 is thought to have killed more than 50 million people. Influenza A virus is also an important cause of disease in poultry where virus strains of some subtypes may change into forms that are highly pathogenic. These virus strains may transmit directly to man and multiple other species. This has been the case in the ongoing outbreak that started in South East Asia in 2003. All known subtypes of influenza A virus have been isolated from wild birds living in aquatic environments, mainly dabbling ducks. These species are considered to be the reservoir for influenza A virus. The virus causes sub clinical gastrointestinal infection in ducks. High amounts of virus are excreted in the feces and spread via the fecal-oral route through water where it can persist for a prolonged time. There are still many unknowns about the ecology of influenza virus in the wild bird reservoir. This thesis includes five articles where data are presented that add new knowledge on this subject. We add proof that wild ducks are indeed the host for most influenza A virus subtypes by presenting data from a meta-analysis on all published screening data from wild birds and by presenting data from a four year screening of migratory ducks that were caught and sampled at Ottenby Bird Observatory. Our investigations have shown that the prevalence of influenza virus in the wild duck population of western Eurasia shows temporal differences in comparison to the results found in studies in North America. The prevalence in western Eurasian ducks is high during the period August to December and also rises in the spring. These findings are of importance for the understanding of how influenza virus is perpetuated in nature. During the course of the study only low pathogenic subtypes were isolated. Of concern is the high frequency of isolation of virus strains of the H5 and H7 subtypes that are prone to change into highly pathogenic variants in poultry. Many of the strains isolated in our study are similar to the ones that have caused influenza outbreaks in poultry in Europe during the last seven years. This indicates that wild bird surveillance for influenza A virus can be of major value as a sentinel system to prevent outbreaks in domestic poultry. Studies on Black-headed Gulls (Larus ridibundus) revealed a previously unknown subtype, H16. This finding widened the spectra of known influenza A virus subtypes in nature. Influenza A virus was also isolated in samples from Guillemots (Uria aalge) in the Baltic Sea. This was the first time influenza A virus was isolated from this species in Europe. The isolated virus strains contained a mix of genes, some of which must have been derived from influenza A virus strains present in the North American bird population. This finding proves that limited exchanges between the virus strains present on the American and the Eurasian continents exist, which is of concern for evaluating the risk of spread of highly pathogenic virus strains by wild birds to the Americas. / Influensavirus är RNA virus och indelas i olika typer och subtyper. Influensa A virus orsakar sjukdom hos ett flertal fågel- och däggdjursarter. Vilda fåglar anses utgöra den viktigaste reservoaren för influensa A virus. Hos människa orsakar influensa A virus årliga epidemier av luftvägssjukdom med hög sjuklighet och stora ekonomiska konsekvenser för samhället. Eftersom frekventa mutationer orsakar ändringar i virusets ytstrukturer krävs årlig vaccination med nytt anpassat vaccin för att ge skydd mot sjukdom. Det finns många olika subtyper av influensa A virus. Dessa karaktäriseras med två av virusets ytstrukturer; hemagglutinin och neuraminidas, vilket till exempel skrivs H5N1. Virus av olika subtyper kan rekombinera och på så sätt skapa nya varianter. Om en subtyp som tidigare ej cirkulerat bland världens befolkning orsakar ett utbrott kan detta leda till en världsomfattande epidemi, en så kallad pandemi. Pandemier har drabbat mänskligheten med viss regelbundenhet genom historien och haft förödande konsekvenser. Till exempel orsakade pandemin ”Spanska sjukan” under åren 1918-1920 mer än 50 miljoner dödsfall. Influensa A virus orsakar också förödande utbrott i fjäderfäbesättningar. Virus av vissa subtyper kan mutera till högpatogena varianter och orsaka så kallad högpatogen aviär influensa. Dessa högpatogena varianter kan även överföras till och orsaka sjukdom hos människa och andra djur vilket varit fallet under det pågående utbrott av H5N1 som startade i sydöstra Asien 2003. Alla kända subtyper av influensa A virus har isolerats i material från vilda fåglar vilka lever i vattenmiljö, framförallt från änder. Dessa arter anses därför utgöra influensavirusets reservoar i naturen. Hos änder orsakar viruset framförallt en subklinisk infektion i gastrointestinalkanalen och sprids genom faekal-oral överföring via vatten i vilket viruset kan förbli aktivt en längre tid. Det finns fortfarande många obesvarade frågor angående influensa A virus ekologi bland vilda fåglar. I denna avhandling presenteras fem artiklar som tillför ny kunskap inom detta område. I avhandlingen styrks bevisen för att vilda änder utgör virusets reservoar i naturen dels genom en metaanalys av samtliga publicerade data rörande fynd av influensa A virus hos vilda fåglar, dels med hjälp av data från fyra års provtagning från flyttande vilda änder vid Ottenby fågelstation. Resultaten påvisar temporala skillnader i influensvirusets prevalens i den västeuroasiatiska andpopulationen jämfört med den nordamerikanska. Prevalensen i den västeuroasiatiska andpopulationen är hög under perioden augusti till december och i viss mån även under våren. Dessa fynd talar för att influensavirus kontinuerligt cirkulerar i andpopulationen. Under studien av förekomsten av influensa A virus hos änder isolerades enbart olika lågpatogena subtyper. Subtyperna H5 och H7 var vanligt förekommande. Dessa subtyper är benägna att utvecklas till högpatogena varianter om de sprids till fjäderfäbesättningar med svåra konsekvenser som följd. Genom studier av virus släktskap visas att de virus vi isolerat från vilda änder är snarlika de som orsakat utbrott bland fjäderfä i Europa under de senaste sju åren. Detta styrker värdet av att övervaka förekomsten av influensavirus hos vilda fåglar för att på så sätt förhindra utbrott av sjukdom bland fjäderfä. Undersökning av prover från skrattmås (Larus ridibundus) ledde fram till upptäckten av en helt ny subtyp av influensavirus; H16. Därmed utvidgades spektret av kända subtyper i naturen. Influensa A virus isolerades från sillgrisslor (Uria aalge) i Östersjön vilket inte tidigare gjorts hos denna art i Europa. Dessa virus innehöll gener från både nordamerikanska och euroasiatiska fågelpopulationers virus. Det visar att det finns ett utbyte av virus mellan fågelpopulationerna på de skilda kontinenterna. / On the day of the defence data the status on article IV was Submitted and the title was "Multi-year surveillance of influenza virus type A in migratory waterfowl in northern Europe".

Effective antiretroviral therapy (ART) is essential for viral suppression (VS) in HIV-infected patients. However, there is a lack of nationally representative data on types of ART regimens used and their impact on VS. This thesis used self-reported interview and abstracted medical record from 2009 Medical Monitoring Project (MMP) to study ART regimen type and related health outcomes. Results showed that 88.6% of HIV-infected adults in care was prescribed ART, and about half took regimens designated as ‘preferred’ according to U.S ART guidelines. Among MMP participants prescribed ART, 62.7% achieved durable VS, 77.8% achieved recent VS, 83.5% were 100% dose-adherent, and 17.1% reported side effects. Multivariate regression analyses revealed that although ART was critical for VS, there were minor differences in health outcomes among the major ART classes in the U.S. ART guidelines or six most-commonly used regimens. This study could be potentially useful for future strategic planning of HIV care.

Background In the past half-century, the prevalence of asthma among children and adolescents has risen and asthma has become an important public health challenge in Sweden as well as in many other countries, necessitating further studies on this complex disease and its risk factor pattern. The studies included in this thesis aimed to investigate the clinical expression of childhood asthma over time, to describe the determinants of new-onset and remission of asthma, and to evaluate possible environmental risk factors in northern Sweden. Methods As the result of a repeated questionnaire survey among primary school children aged 7-8 years in three municipalities in the north of Sweden, two pediatric cohorts were formed, one in 1996 (n=3430) and one in 2006 (n=2585). The cohort created in 1996 was followed annually until the age of 19 years. Skin prick testing was performed on children in both cohorts. Lung function and bronchial hyperreactivity testing were carried out in children with asthma in the first cohort. The study participation and retention rates were very high in both cohorts. Among children in the second cohort living in Luleå, the home addresses were assigned to coordinates in a geographical information system (GIS) to evaluate the impact on respiratory health of living near roads with much traffic, which was measured as the number of vehicles daily. We used a validated reported diagnosis of asthma and International Study of Asthma and Allergies in Childhood (ISAAC) questions were incorporated into the questionnaire. A cross-sectional study of children of the same age ten years apart, longitudinal studies on asthma incidence and remission as well as a cross-sectional study on vehicle traffic were performed. Results While children aged 7-8 years in 2006 more often had a physician-diagnosed asthma compared to children of the same age in 1996 (7.4% vs 5.7%, p&lt;0.001), they had less asthma symptoms, especially severe symptoms. In parallel, a more beneficial environment and a more intense treatment with inhaled corticosteroids (ICS) were observed. The explanation for this change in clinical expression probably includes also an increased awareness and diagnosing of asthma. From age 12 years to age 19 years, the cumulative incidence of physician-diagnosed asthma was 7.2% and of current wheeze 22.0%. The risk of new-onset asthma in adolescence was increased among girls, sensitized and those with heredity for asthma. Smoking and home dampness increased the risk for incident wheeze. The risk for both incident asthma and wheeze was inversely related to number of siblings. Among children with current asthma at age 7-8 years, 21% were in remission, 38% had periodic asthma and 41% had persistent asthma at a follow-up at age 19 years. Subjects in remission and with periodic asthma had significantly less airway obstruction and showed less bronchial hyperreactivity compared to subjects with persistent asthma. The probability of asthma remission from childhood to early adulthood was significantly increased by absence of allergic sensitization, male gender and a low asthma severity scoring at age 7-8 years. Sensitization to furred animals was more important as a determinant of both incidence and remission than sensitization to pollen. Living close to roads with high traffic flows, especially with heavy vehicles, was associated with an increased risk for current wheeze. Stratified analyses showed that the effect of traffic on asthma and wheeze was restricted to non-sensitized subjects. Conclusion Asthma onset in adolescence was more common among girls and remission was more common among boys. Children sensitized to furred animals and children with a more severe asthma were risk groups for persistence of asthma. Environmental factors such as smoking and dampness were associated to onset of asthma symptoms during adolescence, and vehicle traffic was associated with asthma symptoms among children also in a small city with relatively low traffic flows. Preventive measures like smoking reduction programs, improvement of damp housing conditions and separation of areas where many children live from heavily trafficked roads could prove to be beneficial. / OLIN-studierna

<i>Escherichia coli</i> O157 is a food borne pathogen of increasing public health concern worldwide. Cattle have been implicated as the primary reservoir of <i>E. coli</i> O157. The fact that the livestock industry has rapidly expanded in Saskatchewan makes it imperative to have a clear scientific understanding of the prevalence of <i>E. coli</i> O157 in this province as well as its survival in soil under ambient conditions.<p>Longitudinal and point studies were employed to determine the prevalence of <i>E. coli</i> O157 among Saskatchewans cattle. During a 2-year period, 23 feedlot and cattle operations were examined and an overall prevalence of 15.6% was reported. The most important finding was that the prevalence rates were highly dependent on cattle density. All <i>E. coli</i> O157 isolates obtained from this study were characterized by using multiplex PCR, RAPD fingerprinting, a Vero cell cytotoxicity assay and antibiotic susceptibility tests. This characterization revealed a surprisingly highly virulent and heterogenous population of <i>E. coli</i> O157 isolates. <p>Subsequently, the survival characteristics of <i>E. coli</i> O157:H7 ATCC 43894 in sterile soil and manure-amended soil microcosms, as well as in situ under ambient environmental conditions were examined. Findings from this work indicated that desiccation had the most lethal effect on cell viability, whereas nutritionally-rich soils significantly increased survival times of the pathogen population. <p>A final study was designed to examine the survival strategy of hyper- and hypothermally adapted <i>E. coli</i> O157 cells exposed to high and low temperatures, with specific focus on the role of RpoS. Using wild type and its rpoS null allele <i>E. coli</i> O157 strains, in combination with 2D PAGE, It was found that both heat and cold post-acclimation stimulons consisted of two large sub-groups: (i) stress proteins, and (ii) housekeeping proteins. Comparative proteomic analyses revealed that the GroEL/S chaperonin complex and Pnp ribonuclease played a crucial role in growth resumption during high and low temperatures, respectively. Notably, RpoS had no control over key stress proteins in either stress stimulon. RpoS, however, showed a significantly more pronounced role during cold temperatures, where it was seen to regulate key proteins involved in homoeoviscous adaptation as well as various housekeeping proteins of both stress stimulons.

Purpose: Little is known about the use of complementary and alternative medicine (CAM), including traditional Chinese medicine (TCM) in ethnic populations with cancer living in Canada. The purpose of this study was to assess the prevalence and predictors of TCM/CAM use in newly diagnosed Chinese cancer patients who were starting cancer treatments. <p>Patients and Methods: A consecutive sample of newly diagnosed Chinese cancer patients treated at the British Columbia Cancer Agency over a four month period was surveyed. During admission, the study questionnaire was distributed along with other registration forms and anonymously returned in well-labeled boxes. A bilingual Chinese interpreter was available to answer any questions potential participants might have had. The 15-item questionnaire focused on TCM/CAM use, socio-demographics, and medical and cultural factors. <p>Results: Ninety-one patients completed the questionnaire. The majority of respondents (90%) were born outside of Canada and 64% completed the questionnaire in Chinese. TCM/CAM was used by 44% of respondents. Herbal remedies, vitamins/minerals, and prayer were the most commonly used therapies. In the bivariate analysis, factors predicting TCM/CAM use were prior TCM/CAM use (p < 0.001), having received chemo/radiotherapy (p = 0.021), female sex (p = 0.015), immigrant status (p = 0.040), and reporting a non-official language most frequently used at home (p = 0.018). Following multivariate analysis, it was found that prior CAM use (p < 0.001), lower income (p = 0.043), and immigrant status (p = 0.030) were associated with TCM/CAM use. <p>Conclusion: TCM/CAM use in newly diagnosed Chinese cancer patients is very common and results are comparable to previous studies in other populations. Healthcare practitioners must become aware of the widespread use of CAM and engage discussions about CAM use with their patients, especially those of a specific ethno-cultural group who may be less acculturated to Western society.