Low birth weight as a predictor of adverse health outcomes during adulthood in twins: a systematic review and meta-analysis

BACKGROUND

Low birth weight might affect adverse health outcomes during a lifetime. Our study analyzes the association between low birth weight and negative health outcomes during adulthood in twin populations.

METHODS

Searches were conducted using databases inclusive of MEDLINE, CINAHL, Web of Science, and EBSCO. Observational studies on twins with low birth weight and adverse health outcomes during adulthood were included. Two reviewers independently screened the papers, and a third reviewer resolved the conflicts between the two reviewers. Following abstract and title screening, full-texts were screened to obtain eligibility. Eligible full-text articles were then assessed for quality using a modified Downs and Black checklist. Studies with a score within one standard deviation of the mean were included in the analysis. A fixed-effect model was used for analysis.

RESULTS

3987 studies were screened describing low birth weight as a risk factor for adverse health outcomes during adulthood for all twelve-body systems (circulatory, digestive, endocrine, lymphatic, muscular, nervous, reproductive, respiratory, skeletal, urinary, and integumentary systems). One hundred fourteen articles made it through full-text screening, and 14 of those articles were assessed for quality. Five papers were selected to perform two meta-analyses for two outcomes: asthma and cerebral palsy. For asthma, the meta-analyses of three studies suggested a higher odds of low birth weight twins developing asthma (OR 1.33, 95% CI 1.24-1.44, I2 = 77%). Meta-analysis for cerebral palsy included two studies and suggested a 4.88 times higher odds of low birth weight twins developing cerebral palsy compared to normal birth weight twins (OR 4.88, 95% CI 2.34-10.19, I2 = 79%). We could not find enough studies for other adverse health outcomes to pool data for a Forest plot.

CONCLUSIONS

The odds of low birth weight were found to be high in both asthma and cerebral palsy. There are not enough studies of similar nature (study types, similar body systems) to ensure a meaningful meta-analysis. We recommend that future research considers following up on twins to obtain data about adverse health outcomes during their adult lives.

African born black nurses' perception of their U.S. work environment: Race matters

BACKGROUND

Healthy work environment is essential to patients' safety, staff recruitment, retention, and organization's financial viability. It is imperative to examine, understand and mitigate any and all factors that may contribute to unhealthy work environment.

PURPOSE

This study aimed to describe how African-born Black nurses felt their race affected their experience of the work environment and whether these experiences contributed to perceptions of unhealthy work environments.

METHOD

Thematic analysis was performed on data obtained from unstructured interviews of 17 African born Black nurses in this qualitative descriptive study.

FINDINGS

Seven themes emerged from the study: disregard for personhood, poor communication, democratic disqualification, lack of recognition, missing authentic leadership, attrition, and finding control.

DISCUSSION

The finding suggests African born Black nurses' experiences are uniquely and qualitatively different from that of their American born counterparts. Creating healthy work environment require authentic nurse leaders who can influence and support others in its achievement.

Recurrent Ebolavirus disease in the Democratic Republic of Congo: update and challenges

The current Ebolavirus disease (EVD) outbreak in the provinces of North Kivu and Ituri is the tenth outbreak affecting the Democratic Republic of Congo (DRC); the first outbreak occurring in a war context, and the second most deadly Ebolavirus outbreak on record following the 2014 outbreak in West Africa. The DRC government's response consisted of applying a package of interventions including detection and rapid isolation of cases, contact tracing, population mapping, and identification of high-risk areas to inform a coordinated effort. The coordinated effort was to screen, ring vaccinate, and conduct laboratory diagnoses using GeneXpert (Cepheid) polymerase chain reaction. The effort also included ensuring safe and dignified burials and promoting risk communication, community engagement, and social mobilization. Following the adoption of the “Monitored Emergency Use of Unregistered Products Protocol,” a randomized controlled trial of four investigational treatments (mAb114, ZMapp, and REGN-EB3 and Remdesivir) was carried out with all consenting patients with laboratory-confirmed EVD. REGN-EB3 and mAb114 showed promise as treatments for EVD. In addition, one investigational vaccine (rVSV-ZEBOV-GP) was used first, followed by a second prophylactic vaccine (Ad26.ZEBOV/MVA-BN-Filo) to reinforce the prevention. Although the provision of clinical supportive care remains the cornerstone of EVD outbreak management, the DRC response faced daunting challenges including general insecurity, violence and community resistance, appalling poverty, and entrenched distrust of authority. Ebolavirus remains a public health threat. A fully curative treatment is unlikely to be a game-changer given the settings of transmission, zoonotic nature, limits of effectiveness of any therapeutic intervention, and timing of presentation.

HIV Testing among Adolescents and Youth in the United States: Update from the 2009 Behavioral Risk Factor Surveillance System

OBJECTIVES

We examined the prevalence of HIV testing in a representative sample of US adolescents and youth, assessed the location and method of testing used during their last HIV testing, and compare the characteristics of those who had and had not been tested for HIV.

METHODS AND PRINCIPAL FINDINGS

Data on adolescents and youth who participated in the 2009 Behavioral Risk Factor Surveillance System (BRFSS) survey were analyzed. Of the 6,628 adolescents and youth who participated in the 2009 BRFSS, 54.4% were male, 59.1% were white, 37.4% graduated from high school, 29.6% live in the western states in the United States. Their mean age was 20.9 years (± 2.07 SD). Of these participants, 31.8% had been tested for HIV. The majority of adolescents had been tested for HIV either at private physician offices (38%) or public clinics (31.7%) compared to HIV counseling and testing sites (3.1%). Only 30.5% of adolescents were tested using a rapid HIV antibody test. Being female, African-American, Asian or multiracial, divorced/widowed, and living in the Western and NorthEastern states in the United States were associated with a high probability of testing for HIV.

CONCLUSIONS

The low prevalence of adolescents who tested for HIV and the low proportion of those offered rapid HIV testing after the 2006 CDC's new guidelines about HIV testing raise serious concerns about the effectiveness of HIV prevention efforts particularly among adolescents. More innovative strategies are needed to increase the number of adolescents and youth who become aware of their HIV serostatus.

The case for regulatory reform in the business and healthcare environments

Government regulations affect corporations and consumers on a daily basis. For example, environmental and safety regulations in the workplace are administrated by the Occupational Safety and Health Administration (OSHA) under the Department of Labor. OSHA sets and enforces standards in work environment to ensure the safety and health of workers. Other regulatory agencies, such as the National Highway and Transportation Agency (NHTSA), oversee the transportation and the safety of the automobile and truck industry. The U.S. Food and Drug Administration (FDA) plays a major role in approving new drugs on the market and in monitoring drug safety, and it has the power to remove drugs from the market if they are proved to be safety and health problems to the public. However, the mere existence of these regulations often causes impediments to businesses, and the extent of their ultimate usefulness is examined and analyzed in this paper

HIV knowledge, attitudes and practices among college students in the United States

BACKGROUND

Students enrolled at a Midwestern university in the United States were surveyed between February and April 2008 about their HIV knowledge, sources of information, attitude toward people living with HIV/AIDS, and their sexual behaviors.

METHODS

An anonymous questionnaire was sent to 1,000 students via Survey Monkey.

RESULTS

Of the 650 respondents (65%) who provided complete information, 91.2% were white, 70.6% were female, 76.3% were seniors at the university and 94.7% were heterosexuals. Their average age was 22.5 years (SD +/- 4) with a range of 18 to 30 years. Although the majority of students (77.3%) reported to be very familiar with HIV/AIDS including its mode of transmission, important misconceptions still exist regarding HIV/AIDS. Several students either thought that mosquitoes transmit HIV/AIDS (14.2%) or did not know one way or the other (19.9%). About 43.1% were unsure about the existence of drugs that can prevent maternal to child transmission of HIV and 12% actually believed that these drugs do not exist. Moreover, despite the high prevalence of risky sexual behaviors among students, the majority of participants (86.8%) did not perceive themselves to be at risk for contracting HIV. As a result only 29.4% had ever been tested for HIV.

CONCLUSION

Coexistence among college students of both misconceptions about the mode of HIV/AIDS transmission and denial about their vulnerability to contract this disease underscores the need for a proactive approach to address these challenges facing our youths.

Understanding the scourge of HIV/AIDS in sub-Saharan Africa

Sub-Saharan Africa is the part of the world that has been hit hardest by the HIV epidemic. To fight the spread of HIV in the continent, it is necessary to know and effectively address the factors that drive the spread of HIV. The purpose of this article is to review the factors associated with the spread of the HIV epidemic in sub-Saharan Africa and to propose 6 essential activities, which we refer to by the acronym "ESCAPER," to help curb the spread of HIV/AIDS in Africa.

Male circumcision and the risk of HIV infection

Epidemiologic data have suggested that male circumcision is a major protective factor against male heterosexual HIV transmission and may explain the significant geographic differences in the prevalence of HIV observed within sub-Saharan Africa. To assess the evidence of the protective effect of male circumcision, African studies on its association with HIV infection were reviewed. These studies' systematic lack of control of important confounding factors makes the assessment of the association between male circumcision and HIV transmission very difficult and raises doubt about the validity of the current findings. Randomized trials are needed to determine the true strength of the association. Until then, a decision to recommend mass male circumcision to prevent HIV transmission in sub-Saharan Africa is premature and risky.

Challenges facing health professionals caring for HIV-infected drug users

Although injection drug use accounts for only 5% to 10% of cumulative HIV infections globally, it is a more efficient way of spreading HIV than sexual intercourse. HIV epidemics among injection drug users (IDUs) have a potential for rapid spread of the virus within the IDU community and outward into the general population. Effective interventions addressing this mode of HIV transmission are needed because part of a comprehensive strategy to curb the spread of HIV infection. IDUs, often marginalized, pose serious health challenges that can no longer be overlooked. Health care providers need to familiarize themselves with these challenges in order to meet the needs of this disenfranchised population. Providers need to have a clear understanding of targeted behavior and their patients' environmental context. Efforts must be made to foster healthy behavior among IDUs to assist them in managing their infection effectively and become productive members of society. This paper reviews these challenges and outlines selected models that may assist health care providers in fostering behavior changes among HIV-positive injection drug users.

AIDS-related primary brain lymphoma in Michigan, January 1990 to December 2000

To examine the effect of highly active antiretroviral therapy (HAART) on the occurrence of primary brain lymphoma (PBL), determine the risk factors for PBL, and assess the difference in survival between individuals who did and did not develop PBL, data were analyzed from the Michigan Adult/Adolescent Spectrum of HIV Disease project (ASD). Among 4,026 HIV-infected individuals enrolled in ASD between January 1990 and December 2000, 64 (1.6%) were diagnosed with PBL. The incidence rate of PBL declined from 5.6 cases per 1000 person-year in the pre-HAART era to 2.1 cases per 1000 person-year in post-HAART era. In the multivariate analysis, individuals whose CD4 count at entry in ASD was either <50 cells/microL (OR: 5.0) or 50-200 cells/microL (OR: 2.3) were significantly more likely to develop PBL than those with a CD4 count >/= 200 cells/microL. PBL was a terminal condition in these patients. The median survival time was consistently shorter among individuals who developed PBL than those who did not, regardless of their CD4 count at entry into ASD.