Young US Research Articles

Validity of predictive equations for 24-h urinary sodium excretion in adults aged 18–39 y

Collecting a 24-h urine sample is recommended for monitoring the mean population sodium intake, but implementation can be difficult. The objective was to assess the validity of published equations by using spot urinary sodium concentrations to predict 24-h sodium excretion. This was a cross-sectional study, conducted from June to August 2011 in metropolitan Washington, DC, of 407 adults aged 18-39 y, 48% black, who collected each urine void in a separate container for 24 h. Four timed voids (morning, afternoon, evening, and overnight) were selected from each 24-h collection. Published equations were used to predict 24-h sodium excretion with spot urine by specimen timing and race-sex subgroups. We examined mean differences with measured 24-h sodium excretion (bias) and individual differences with the use of Bland-Altman plots. Across equations and specimens, mean bias in predicting 24-h sodium excretion for all participants ranged from -267 to 1300 mg (Kawasaki equation). Bias was least with International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT) equations with morning (-165 mg; 95% CI: -295, 36 mg), afternoon (-90 mg; -208, 28 mg), and evening (-120 mg; -230, -11 mg) specimens. With overnight specimens, mean bias was least when the Tanaka (-23 mg; 95% CI: -141, 95 mg) or Mage (-145 mg; -314, 25 mg) equations were used but was statistically significant when using the Tanaka equations among females (216 to 243 mg) and the Mage equations among races other than black (-554 to -372 mg). Significant over- and underprediction occurred across individual sodium excretion concentrations. Using a single spot urine, INTERSALT equations may provide the least biased information about population mean sodium intakes among young US adults. None of the equations evaluated provided unbiased estimates of individual 24-h sodium excretion.

Incidence of Obesity Among Young US Children Living in Low-Income Families, 2008-2011

Incidence of Obesity Among Young US Children Living in Low-Income Families, 2008-2011

Assessing the need for and acceptability of a free-of-charge postpartum HPV vaccination program

Human papillomavirus (HPV) vaccine uptake rate among young adult US women was only 23% in 2010. One way to improve this low rate is to administer the vaccine postpartum. We examined whether this population requires vaccination and whether they would be agreeable to receiving it free of charge after delivery. Women 26 years of age or younger seeking prenatal care in publicly funded clinics in southeast Texas were interviewed in 2012 regarding their HPV vaccination status, barriers to vaccination, and whether they would be willing to receive this vaccine postpartum if offered free of charge. Medical charts were reviewed to extract additional information. Overall, 13.0% (65 of 500) stated they had initiated and 7.6% (38 of 500) completed the 3-dose vaccine series. Ethnic differences were noted with 21.0% of non-Hispanic whites, 14.6% of blacks, and 9.3% of Hispanics (P = .002) initiating the vaccine and 13.5%, 7.8%, and 5.2% (P = .006) competing all 3 doses, respectively. Lowest initiation (4.2%) and completion (1.4%) rates were observed among recently immigrated Hispanic women. Those who had not graduated from high school and older women were less likely to have been vaccinated. Almost 83% of those who had not received any HPV doses or completed the series were willing to receive the injection free of charge in the hospital after their delivery. HPV vaccine uptake rates are very low among women receiving prenatal care in southeast Texas. Offering this vaccine free of charge to postpartum women could be an effective strategy in this population because 5 of 6 women favored receiving it in this setting.

Pediatrics Digest

Pediatrics Digest Summary| October 01 2013 Pediatrics Digest Pediatrics (2013) 132 (4): D1–D5. https://doi.org/10.1542/peds.digest1324 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Pediatrics Digest. Pediatrics October 2013; 132 (4): D1–D5. 10.1542/peds.digest1324 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP Grand RoundsAAP NewsAll AAP Sites Search Advanced Search Topics: cerebral palsy, emergency service, hospital, infant, premature, newborn, trend, encephalopathy, ischemic-hypoxic, hydroxyurea, pertussis, bronchiolitis, methicillin-resistant staphylococcus aureus infections The prevalence of overweight and obesity in US adolescents has increased over the last century. However, recent evidence indicates a potential change in this trend. Parallel trends in adolescent behaviors that drive this epidemic have not been well studied. Analyses of recent data indicate the prevalence of overweight and obesity may be stabilizing. Over the same period, adolescent physical activity, breakfast eating, and fruit and vegetable consumption increased and television viewing and consumption of sweets and sweetened beverages decreased. Studies of psychotropic use in very young US children in the last decade have been limited by the regions, insurance types, or medication classes examined. There is a paucity of recent, nationally representative investigations of US preschool psychotropic use. In a national sample of 2 to 5 year olds, the likelihood of psychotropic prescription peaked in the mid-2000s, then stabilized in the late 2000s. Increased psychotropic use in boys, white children,... You do not currently have access to this content.

Luxury perceptions: luxury brand vs counterfeit for young US female consumers

PurposeThe purpose of this study is twofold: expand the body of empirical knowledge of consumer luxury brand perceptions by using the Brand Luxury Index (BLI) scale to compare and contrast young female consumers’ luxury perceptions for a luxury brand and counterfeits of that brand, and use the data from the research to investigate the psychometric properties of the BLI scale.Design/methodology/approachA convenience sample of 215 female students across multiple programmes of study completed separate, modified BLI scales for the luxury brand and the counterfeits of that brand. The BLI scale taps five dimensions or factors of brand luxury using non‐personal‐oriented perceptions and personal‐oriented perceptions.FindingsThis study used a modified version of the original BLI scale. Results show that all rated perceptions of the luxury brand were significantly higher than those for the counterfeits of that brand. Between‐subjects effects revealed that luxury perceptions of those whose last handbag acquisition was a luxury brand significantly differed from the luxury perceptions of those whose last handbag acquisition was a counterfeit brand. SEM results produced inadequate fit values for the luxury brand; but suggested adequate fit for the counterfeit of the luxury brand.Research limitations/implicationsAs more luxury brand producers and retailers seek to expand their presence on the world arena, brand equity may be compromised by making luxury brands so ubiquitous in the market place. Reported perceptions in this research suggest the market may be saturated with luxury brands and that luxury brands may be “overexposed”. Results from this study may only be applicable to young female college consumers. Also, since a particular luxury brand was used, results may not be generalized to other luxury brands. Additional research is needed that looks at other populations’ perception of luxury brands.Originality/valueNo research has been found that compared young consumer luxury perceptions for both luxury brands and their counterfeits. An investigation of this area would provide additional insight on consumer perceptions for luxury and counterfeit brands.

The Link Between Substance Use and Reproductive Health Service Utilization Among Young US Women

ABSTRACT. Background: The authors sought to investigate associations between young women's use of alcohol and other substances and their sexual and reproductive health (SRH) service utilization. Methods: The authors used data from 4421 young women aged 15–24 years in the nationally representative study, National Survey of Family Growth, 2002–2008. The authors examined associations between frequency of tobacco, alcohol, marijuana, and illicit drug use and SRH service use in the past year using logistic regression. Results: Over half (59%) of the young women used SRH services, including contraception (48%), gynecological examination (47%), and sexually transmitted infection (STI) testing/treatment (17%) services. Proportions of SRH service use increased with higher frequencies of substance use (all P values <.001); service use was particularly common among daily substance users (range: 72% of daily marijuana users to 83% of daily binge drinkers). In multivariable analyses, associations between substance and SRH service use varied by substance and service type: weekly marijuana (odds ratio [OR] = 2.5, 95% confidence interval [95% CI] = 1.4, 4.3, P = .002) and alcohol (OR = 1.7, 95% CI = 1.1, 2.4, P = .01) use were positively associated with gynecological service use. All substances were positively associated with STI service use. However, daily smoking was negatively associated with contraceptive service use (OR = 0.6, 95% CI = 0.4, 0.8, P = .001). Conclusion: SRH service use was common among women reporting frequent substance use. SRH settings provide an opportunity to deliver substance use screening and preventive care to young women.

Analysing conjoint data with OLS and PLS regression: a case study with wine

This paper presents a case study with wine where two statistical methods for the analysis of rating-based conjoint analysis data were applied. Traditionally, ordinary least squares (OLS) regression is used to estimate the relative importance of the experimental factors and the part-worth utilities of factor levels. Partial least squares (PLS) regression, which is a popular tool in sensory and consumer science, can also be used for the analysis of interval-level conjoint data. Using conjoint analysis, purchase intentions for Californian red and white wine were obtained from a convenience sample of young US adults (n ≈ 250). OLS and PLS regression uncovered the same systematic patterns in the data: negative utility associated with more expensive wine, and positive utility associated with famous wine regions. While OLS regression provided more accessible top-line results, an advantage of PLS regression was the graphical format of results. This provided easy insight to individual differences in the importance attached to the factors driving purchase intention. OLS and PLS regression can complement each other in the analysis of interval-level conjoint data. Dual analysis can help to ensure that the right insights are drawn from the study and communicated to internal/external clients. It may also facilitate communication within project teams.

Increasing Colorectal Cancer Burden Among Young US Hispanics: Is It Time to Change Current Screening Guidelines?

The disease burden for colorectal cancer (CRC) varies considerably according to race and ethnicity. A variety of factors, including adherence to CRC screening, are thought to contribute to the racial/ethnic differences in CRC incidence and mortality [1]. In the US, African Americans (A–A) have the highest incidence CRC and the lowest survival rates compared with other racial groups; Hispanics are diagnosed at a later stage and have worse survival compared to with non-Hispanic whites (NHW) [2, 3]. Since Hispanics, compared with NHW and A–A have lower CRC screening rates, they are less likely to be diagnosed at early stages, reducing survival rates [4]. Moreover, since CRC is ranked as one of the top-three causes of cancer-related deaths in US Hispanics, it is a major cause of mortality in this population [5]. Recent epidemiological studies have reported an increase in the incidence of sporadic early onset (\50 years old) CRC despite a decrease in the incidence of CRC in older individuals, probably due to routine screening [6, 7]. Tumors from early onset CRC patients are characteristically microsatellite stable, are located in the distal colon, and have advanced histological features and more advanced staging compared to late-onset tumors, contributing to a higher mortality rate [8–10]. Furthermore, early onset CRC is more often complicated by metastasis either at presentation or during the disease course compared with CRC patients[50 years old [10]. The population aged\50 thus presents an epidemiologic challenge since they are not covered by current screening guidelines, which currently target individuals C50 years old, with the exception of the A–A population (C45 years old) or those individuals with family history of CRC [11].

Abstract MP78: Validity of Predictive Equations for 24-Hour Urine Sodium Excretion in Young Black and Other Adults

Introduction: Reducing mean population sodium intake by ~1200 mg is projected to reduce thousands of deaths from heart disease and stroke and save billions of health care dollars annually. Twenty-four hour urine collection is recommended for assessing changes in mean population sodium intake, but can be difficult to implement. Predicting 24-hour urine sodium excretion using spot urines is not recommended due to diurnal variations in excretion. Further, sodium excretion patterns differ between black and white persons. We assessed the validity of previously published prediction equations for 24-hour sodium excretion in black and other young adults by timing of spot urine collection. Design: Of 481 adult volunteers aged 18-39 years (50% Blacks) asked to participate in a 2011 study in the Metropolitan DC area, 407 collected each urine void in a separate container for 24 hours. Four timed voids from the 24-h urine collection were selected (morning, afternoon, evening, and overnight) to use with previously published predictive equations. Predictive equations were based on one of two approaches; 1) an indirect approach using spot urine sodium-to-creatinine concentrations and predicted 24-hour creatinine excretion ( Tanaka, Kawasaki, Mage ), and 2) a direct approach using spot urine sodium, potassium, and creatinine concentrations, and age, and body mass index with separate equations by sex ( Brown ). We assessed mean differences between predicted and measured 24-hour sodium excretion (bias) and individual differences across levels of sodium excretion using Bland-Altman plots. Results: Among participants, mean measured 24-hour sodium excretion was ~3300 mg (SD ~1400 mg). Of the equations evaluated, mean bias in predicted 24-hour sodium excretion was least from Brown equations when using morning (-165 mg, 95% confidence interval [CI], -295, -36 mg), afternoon (-90 mg, 95% CI, -208, 28 mg) or evening ( -120 mg, 95% CI -230, -11 mg) spot urines. When using overnight spot urines, mean bias from Brown equations was greatest and statistically significant (-247 mg, 95% CI, -348, -151 mg). When using overnight spot urines, mean bias from Tanaka (-23 mg) or Mage (-145 mg) equations was not significant, however, when stratified by sex, mean biases were significant and in opposite directions. Among Blacks, mean biases from Brown were not significant (-167 to 122 mg) except using overnight specimens among Black females (-267 mg, 95% CI, -525, -47 mg). Across equations and time periods, Bland-Altman plots indicated significant bias at the individual level. Conclusions: Of the evaluated equations, predicted 24-hour urine sodium excretion using the Brown equations with morning, afternoon, or evening specimens may provide the least biased estimates of group mean sodium intake among young US adults. None of the equations adequately predicted individual 24-hour sodium excretion measured on the same day.

Characteristics Associated With Awareness, Perceptions, and Use of Electronic Nicotine Delivery Systems Among Young US Midwestern Adults

We assessed the characteristics associated with the awareness, perceptions, and use of electronic nicotine delivery systems (e-cigarettes) among young adults. We collected data in 2010-2011 from a cohort of 2624 US Midwestern adults aged 20 to 28 years. We assessed awareness and use of e-cigarettes, perceptions of them as a smoking cessation aid, and beliefs about their harmfulness and addictiveness relative to cigarettes and estimated their associations with demographic characteristics, smoking status, and peer smoking. Overall, 69.9% of respondents were aware of e-cigarettes, 7.0% had ever used e-cigarettes, and 1.2% had used e-cigarettes in the past 30 days. Men, current and former smokers, and participants who had at least 1 close friend who smoked were more likely to be aware of and to have used e-cigarettes. Among those who were aware of e-cigarettes, 44.5% agreed e-cigarettes can help people quit smoking, 52.8% agreed e-cigarettes are less harmful than cigarettes, and 26.3% agreed e-cigarettes are less addictive than cigarettes. Health communication interventions to provide correct information about e-cigarettes and regulation of e-cigarette marketing may be effective in reducing young adults' experimentation with e-cigarettes.

Cannabinoid Receptor Genotype Moderation of the Effects of Childhood Physical Abuse on Anhedonia and Depression

The endocannabinoid system has been implicated in stress adaptation and the regulation of mood in rodent studies, but few human association studies have examined these links and replications are limited. To examine whether a synonymous polymorphism, rs1049353, in exon 4 of the gene encoding the human endocannabinoid receptor (CNR1) moderates the effect of self-reported childhood physical abuse on lifetime anhedonia and depression and to replicate this interaction in an independent sample. Genetic association study in 1041 young US women with replication in an independent Australian sample of 1428 heroin-dependent individuals as cases and 506 participants as neighborhood controls. Self-reported anhedonia and depression (with anhedonia). In both samples, individuals who experienced childhood physical abuse were considerably more likely to report lifetime anhedonia. However, in those with 1 or more copies of the minor allele of rs1049353, this pathogenic effect of childhood physical abuse was attenuated. Thus, in participants reporting childhood physical abuse, although 57.1% of those homozygous for the major allele reported anhedonia, only 28.6% of those who were carriers of the minor allele reported it (P=.01). The rs1049353 polymorphism also buffered the effects of childhood physical abuse on major depressive disorder; however, this influence was largely attributable to anhedonic depression. These effects were also noted in an independent sample, in which minor allele carriers were at decreased risk for anhedonia even when exposed to physical abuse. Consistent with preclinical findings, a synonymous CNR1 polymorphism, rs1049353, is linked to the effects of stress attributable to childhood physical abuse on anhedonia and anhedonic depression. This polymorphism reportedly resides in the neighborhood of an exon splice enhancer; hence, future studies should carefully examine its effect on expression and conformational variation in CNR1, particularly in relation to stress adaptation.

Decreasing Prevalence of Obesity Among Young Children in Massachusetts From 2004 to 2008

To examine whether the obesity prevalence is increasing, level, or decreasing among young US children (aged <6 years) in the past decade; and to compare regional data to those of 2 national databases. We analyzed data from 108 762 well-child visits (36 827 children) at a multisite pediatric practice in eastern Massachusetts during 1999-2008. By using the Centers for Disease Control and Prevention 2000 gender-specific growth charts, we defined obesity as weight-for-length ≥95th percentile for children aged <24 months and BMI ≥95th percentile for children aged 24 to <72 months. By using multivariable logistic regression, we estimated gender-specific obesity trends in 2 separate periods, 1999-2003 and 2004-2008, adjusting for age group, race/ethnicity, health insurance, and practice site. From 1999 to 2003, the obesity prevalence was fairly stable among both boys and girls. From 2004 to 2008, the obesity prevalence substantially decreased among both boys and girls. The decline in obesity prevalence during 2004-2008 was more pronounced among children insured by non-Medicaid health plans than among those insured by Medicaid. Among children aged <6 years at this multisite pediatric practice, obesity prevalence decreased during 2004-2008, which is in line with national data showing no increase in prevalence during this time period. The smaller decrease among Medicaid-insured children may portend widening of socioeconomic disparities in childhood obesity.

Abstract P302: Baseline Measures of Adiponectin, Systolic Blood Pressure and Drinking Alcohol are Associated with More Aortic Stiffness Progression among Men: The ERA JUMP Study

Objective: Aortic stiffness, a significant marker of vascular aging, is independently associated with CVD and all-cause mortality. Limited data are available about risk factors for the progression of aortic stiffness in healthy population. We examined several baseline risk factors as possible independent predictors of aortic stiffness progression among US men. Design: Participants were a population-based sample of black and white men aged 40–49 from the Pittsburgh site of the ERA JUMP Study, who were free of CVD at baseline. Aortic stiffness was measured as carotid-femoral pulse wave velocity (cfPWV) using an automated waveform analyzer at baseline and after 4.6±0.21(mean±SD) years of follow-up. Progression of cfPWV was evaluated as: 1) occurrence of progression (defined as ≥ 75th percentile of the change in cfPWV since baseline (≥ 118.5 cm/s increase); and 2) severity of progression as the difference between the natural-log cfPWV at follow-up and the natural-log cfPWV at baseline. Systolic BP (SBP), BMI, visceral adiposity, lipids, glucose, insulin, adiponectin, PAI-1, fibrinogen, CRP, alcohol drinking, and smoking status at baseline were evaluated as possible risk factors for occurrence and severity of cfPWV progression. Stepwise logistic and linear regression models were utilized as appropriate. In univariate analysis, risk factors found to be associated with cfPWV progression at a P value ≤ 0.25 were eligible for stepwise regression analysis. Variables were dropped from models at a P value &gt; 0.1. Age at baseline, follow-up time, race, heart rate, and medication use were forced in all models. Results: A total of 240 men (White:82.5%, Black:17.5%) who were 45.0±2.9 years old at baseline, were included in this analysis. During follow-up, cfPWV progressed in 125 participants (52.0%) with a median increase of 113.5 cm/s (Q1=46.0, Q3=204.5). Final models revealed that independent predictors of the occurrence of cfPWV progression were lower levels of adiponectin (OR: 0.46, 95%CI: 0.23, 0.95, P=0.04), higher levels of SBP (OR: 1.03, 95%CI: 1.002, 1.06, P=0.04) and drinking alcohol ≥ 2 times/week (OR: 1.92, 95%CI: 1.01, 3.64, P=0.046) at baseline. Similarly, adiponectin (β=−0.097(SE=0.04), P=0.02) and drinking alcohol ≥ 2times/week (β=0.084(SE=0.04), P=0.02) were also independent predictors of severity of cfPWV progression. No significant interactions were found between these predictors and race. Conclusions: Independent of age at baseline, follow-up time, race, heart rate and medication use, lower levels of adiponectin, higher levels of SBP and drinking alcohol ≥2 times/week at baseline are associated with greater progression in aortic stiffness among relatively young middle-aged US men.

Young Child Homicide and Accidental Death Rates in the United States, 1940-2005: Classification Issues in Mutually Exclusive Events

Events that are mutually exclusive, collectively exhaustive, and have a constant sum must be negatively correlated. This study examined whether non-motor vehicle accidental deaths and homicides in young US children displayed a period of time when this rule governing mutually exclusive events was applicable. Homicide and non-motor vehicle accident mortality rates in boys and girls, aged 1 to 4 years old, in the United States from 1940 to 2005 were analyzed. Homicide mortality rates increased sharply in young boys when the accident mortality rate dropped to about 25/100,000; and in young girls, when the accident mortality dropped to about 18/100,000. This increase in child homicide mortality rates corresponded to a time period when the sum of homicide rates and non-motor vehicle accident rates in these children were relatively constant, making these rates of unnatural deaths mutually exclusive, collectively exhaustive, and having a nearly constant sum. Homicide rates in young US children were relatively stable both before and after this critical constant sum time period. These findings suggest that the increase in homicide rates in young US children appear to have reflected the necessary negative correlation between mutually exclusive, collectively exhaustive, and constant sum events, rather than an actual increase in societal violence directed against young children.

Baseline estimates of diarrhea-associated mortality among United States children before rotavirus vaccine introduction.

Deaths due to diarrhea among US children declined substantially from the 1960s through the 1980s, but have not been recently assessed. We examined diarrhea-associated mortality among young US children from 1992 to 2006 to establish baseline estimates through which the effect of rotavirus vaccines, introduced in 2006, can be assessed. National Center for Health Statistics multiple cause-of-death mortality data were used to examine diarrhea-associated deaths and death rates among US children 1 to 59 months of age during 1992-2006. The winter residual method was used to indirectly estimate the annual number of diarrhea-associated deaths attributable to rotavirus. An average of 369 diarrhea-associated deaths/year (3320 total deaths) occurred among US children 1 to 59 months of age during 1992-1998 and 2005-2006. The diarrhea-associated death rate increased 40% between the first 3 and last 2 years of the study period, from an average of 1.6 deaths per 100,000 to 2.3 deaths per 100,000. Black children died at almost 4 times the rate of white children. Diarrhea-associated deaths showed a winter seasonal pattern similar to that of rotavirus, particularly among children 4 to 23 months of age. Using indirect methods, we estimated 25 yearly rotavirus-associated deaths during the study period. Rotavirus vaccination could potentially prevent 21 of these deaths annually. Diarrhea-associated mortality among US children stabilized but appears to be increasing in recent years. Rotavirus was associated with a small but significant number of preventable deaths. The national multiple cause-of-death data should prove useful for assessing mortality impact of rotavirus vaccination in the United States.

Professional work and the timing of family formation among young lawyers in US and German cities

There is little cross-national empirical research on which to develop our understanding of the relationship between family formation among lawyers and the organization of work in the legal profession. This study compares young German lawyers practicing in Frankfurt and Berlin with young US lawyers practicing in New York and Washington, DC at similar career stages when they are most likely to marry and have children. The sampled lawyers are about 10 years into practice. We examine the effects of work on women lawyers' childbearing in German and American cities. We find that although the onset and timing of childbearing is much the same in Frankfurt and Berlin, and also in New York and Washington, DC, there are major differences in the onset and timing of fertility between these German and American cities. A discrete-time event history analysis suggests that the more traditional legal culture of Germany offers women greater autonomy for parenting but also reduced economic rewards, while the mega-law culture of America offers women less autonomy for parenting but enhanced prospects for economic rewards. The findings underscore that there is much to be learned from the cross-national study of legal professionals.

William Gorgas

In 1891, Carlos Finlay and Walter Reed made the landmark discovery that yellow fever was transmitted by mosquitoes.1 Unfortunately, this discovery did not immediately lead to the eradication of the disease—not only because the virus was extremely widespread in tropical communities, but also because sanitary officials were reluctant to recognize the importance of mosquitoes as the disease vector. The task of putting this knowledge to effective use fell to a young US Army captain by the name of William C. Gorgas. Yellow fever had been a presence in Gorgas' life from early adulthood, when he had acquired immunity through a mild case of the disease.2 In 1898, soon after the end of the Spanish-American War, Gorgas was detailed to Havana, where yellow fever had been endemic for centuries. Gorgas directed a control strategy to identify and destroy mosquito breeding places, and after only a few months of a strict mosquito control program, yellow fever was eradicated from Havana. When Gorgas learned of the US government's decision to build the Panama Canal, he requested assignment to Panama. There he again tackled the eradication of yellow fever through mosquito control—despite vigorous opposition by US officials who believed yellow fever was caused by environmental filth, and who made efforts to discredit his work.3 President Theodore Roosevelt supported Gorgas′ efforts, and the Canal Zone was free of yellow fever by 1906, followed by eradication of malaria a few years later. Gorgas' enlightened leadership in public health did not go unrecognized. He was elected as the president of the American Medical Association in 1908, and in 1914 he was appointed by President Woodrow Wilson as the Surgeon General of the Army. Even so, public health measures that he promulgated during the First World War were often opposed by his superiors, who objected to their cost. After the First World War, Gorgas continued to agitate for more effective control of infectious diseases, consulting with a number of foreign governments. He was on his way to Africa in 1920 when, at the age of 66, he suffered a stroke. He was knighted by King George V on his deathbed in London, and lay in state in St. Paul's Cathedral before being returned to the US for burial.Figure: William Gorgas

Depression and History of Attempted Suicide as Risk Factors for Heart Disease Mortality in Young Individuals

Although depression is associated with increased cardiovascular morbidity and mortality, there is virtually no information on whether it also increases the risk in young populations. We sought to determine the association of unipolar and bipolar depression and a history of attempted suicide with mortality due to ischemic heart disease (IHD) and cardiovascular disease (CVD) in young US adults and to examine potential sex differences. Longitudinal epidemiologic study. Nationally representative sample of US adults. A total of 7641 US adults aged 17 to 39 years from the 1988-1994 Third National Health and Nutrition Examination Survey. Cardiovascular disease and IHD mortality. Unipolar/bipolar depression and a history of attempted suicide were assessed via the Diagnostic Interview Schedule. After a median follow-up of 14.9 years, a total of 51 subjects (0.67%) died of CVD causes and 28 (0.37%) died of IHD. Depression (538 individuals [7.04%]) and history of attempted suicide (419 [5.48%]) were each associated with an increased risk of IHD death, with adjusted hazard ratios of 3.70 (95% CI, 1.32-10.35) for depression and 7.12 (2.67-18.98) for a history of attempted suicide. Women with depression or a history of attempted suicide had a 3-fold adjusted risk of CVD (adjusted hazard ratio, 3.20 [95% CI, 1.12-9.17]) and a 14-fold adjusted risk of IHD (14.57 [2.65-80.10]). Corresponding figures for men were 2.37 (0.85-6.58) and 3.52 (1.05-11.76). In adults younger than 40 years, depression and history of attempted suicide are significant independent predictors of premature CVD and IHD mortality in both sexes.

Young adults and US healthcare reform: views and marketing strategy

The Patient Protection and Affordable Care Act (PPACA) was created to provide affordable health care to all Americans. Though this legislation became law in 2010, there remains much interest, uncertainty and controversy among Americans in regards to the bill’s provisions. Younger Americans are likely to face higher insurance premiums once the PPACA is fully implemented in 2014, but they may also benefit from a provision which allows young people to remain on their parents insurance to age 26. Yet, no research to date has explored the perceptions of college students regarding their views of the PPACA. This exploratory study will examine college students’ awareness of the PPACA and perceptions regarding the main provisions of the PPACA, and investigate how college students search for healthcare information.

Human Rhinovirus Species Associated With Hospitalizations for Acute Respiratory Illness in Young US Children

The contribution of human rhinovirus (HRV) to severe acute respiratory illness (ARI) is unclear. To assess the association between HRV species detection and ARI hospitalizations. Children <5 years old hospitalized for ARI were prospectively enrolled between December 2003 and April 2005 in 3 US counties. Asymptomatic controls were enrolled between December 2003 and March 2004 and between October 2004 and April 2005 in clinics. Nasal and throat swab samples were tested for HRV and other viruses (ie, respiratory syncytial virus, human metapneumovirus, parainfluenza virus, and influenza virus) by reverse-transcription-polymerase chain reaction, and genetic sequencing identified HRV species and types. HRV species detection was compared between controls and patients hospitalized during months in which controls were enrolled. A total of 1867 children with 1947 ARI hospitalizations and 784 controls with 790 clinic visits were enrolled and tested for HRV. The HRV-A detection rate among participants ≥24 months old was 8.1% in the hospitalized group and 2.2% in the control group (P = .009), and the HRV-C detection rates among those ≥6 months old were 8.2% and 3.9%, respectively (P = .002); among younger children, the detection rates for both species were similar between groups. The HRV-B detection rate was ≤1%. A broad diversity of HRV types was observed in both groups. Clinical presentations were similar among HRV species. Compared with children infected with other viruses, children with HRV detected were similar for severe hospital outcomes and more commonly had histories or diagnoses of asthma or wheezing. HRV-A and HRV-C were associated with ARI hospitalization and serious illness outcomes.