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Objective: To assess whether women with a genetic predisposition to medical conditions known to increase pre‐eclampsia risk have an increased risk of pre‐eclampsia in pregnancy. Design: Case–control study. Setting and population: Pre‐eclampsia cases (n = 498) and controls (n = 1864) in women of European ancestry from five US sites genotyped on a cardiovascular gene‐centric array. Methods: Significant single‐nucleotide polymorphisms (SNPs) from 21 traits in seven disease categories (cardiovascular, inflammatory/autoimmune, insulin resistance, liver, obesity, renal and thrombophilia) with published genome‐wide association studies (GWAS) were used to create a genetic instrument for each trait. Multivariable logistic regression was used to test the association of each continuous scaled genetic instrument with pre‐eclampsia. Odds of pre‐eclampsia were compared across quartiles of the genetic instrument and evaluated for significance. Main outcome measures: Genetic predisposition to medical conditions and relationship with pre‐eclampsia. Results: An increasing burden of risk alleles for elevated diastolic blood pressure (DBP) and increased body mass index (BMI) were associated with an increased risk of pre‐eclampsia (DBP, overall OR 1.11, 95% CI 1.01–1.21, P = 0.025; BMI, OR 1.10, 95% CI 1.00–1.20, P = 0.042), whereas alleles associated with elevated alkaline phosphatase (ALP) were protective (OR 0.89, 95% CI 0.82–0.97, P = 0.008), driven primarily by pleiotropic effects of variants in the FADS gene region. The effect of DBP genetic loci was even greater in early‐onset pre‐eclampsia cases (at <34 weeks of gestation, OR 1.30, 95% CI 1.08–1.56, P = 0.005). For other traits, there was no evidence of an association. Conclusions: These results suggest that the underlying genetic architecture of pre‐eclampsia may be shared with other disorders, specifically hypertension and obesity. A genetic predisposition to increased diastolic blood pressure and obesity increases the risk of pre‐eclampsia. A genetic predisposition to increased diastolic blood pressure and obesity increases the risk of pre‐eclampsia. [ABSTRACT FROM AUTHOR]

Carbon fibre couch inserts are widely used in external beam radiotherapy to provide rigid and lightweight patient support. Carbon fibre is often perceived to be essentially radiotranslucent implying that it does not interfere with the radiation beam. However, there is evidence in the literature which suggests that this perception may not be appropriate, particularly at oblique angles of incidence. Furthermore, there is evidence indicating that the use of carbon fibre significantly reduces the skin sparing effect. In this study, the radiation attenuation and surface dose enhancement characteristics of the carbon fibre insert for the Varian ExactTM couch have been investigated. It was found that attenuation increased significantly with increasing angle of incidence, resulting in in-phantom dose reductions of up to 6% at 6 MV and 4% at 15 MV. It has been shown that it is possible to model couch attenuation on a commercial treatment planning system (Elekta CMS XiO) by including the carbon fibre insert in the planning computed tomography (CT) dataset. Finally, the carbon fibre insert was found to significantly increase skin dose to the patient. The skin dose was approximately three times as large when the couch insert was added to 6 and 15 MV photon beams. However, even with this substantial increase it is highly unlikely that the skin tolerance dose will be exceeded. [ABSTRACT FROM PUBLISHER]

OBJECTIVES: We compared 3 methods for classifying methicillin-resistant Staphylococcus aureus (MRSA) infections as health care associated or community associated for use in public health surveillance. METHODS: We analyzed data on MRSA infections reported to the Michigan Department of Community Health from October 1, 2004, to December 31, 2005. Patient demographics, risk factors, infection information, and susceptibility were collected for 2151 cases. We classified each case by the health care risk factor, infection-type, and susceptibility pattern methods and compared the results of the 3 methods. RESULTS: Demographic, clinical, and microbiological variables yielded similar health care-associated and community-associated distributions when classified by risk factor and infection type. When 2 methods yielded the same classifications, the overall distribution was similar to classification by 3 methods. No specific combination of 2 methods was superior. CONCLUSIONS: MRSA categorization by 2 methods is more accurate than it is by a single method. The health care risk factor and infection-type methods yield comparable classification results. Accuracy is increased by using more variables; however, further research is needed to identify the optimal combination. [ABSTRACT FROM AUTHOR]

Objective: In previous studies, we have shown a three to four times higher urban incidence of breast cancer and estrogen receptor-positive breast cancers in the Gharbiah Province of Egypt. We investigated the urban-rural incidence differences of gynaecologic malignancies (uterine, ovarian and cervical cancers) to explore if they show the same trend that we found for breast cancer.Design: Cancer registry-based incidence comparison.Setting: Gharbiah population-based cancer registry (GPCR), Tanta, Egypt.Sample: All patients with uterine, ovarian and cervical cancer in GPCR from 1999 to 2002.Methods: We calculated uterine, ovarian and cervical cancer incidence from 1999 to 2002. For each of the three cancers, we calculated the overall and age-specific rates for the province as a whole, and by urban-rural status, as well as for the eight districts of the province.Results: Incidence of all three cancer sites was higher in urban than in rural areas. Uterine cancer showed the highest urban-rural incidence rate ratio (IRR = 6.07, 95% CI = 4.17, 8.85). Uterine cancer also showed the highest urban incidence in the oldest age group (70+ age category, IRR = 14.39, 95% CI = 4.24, 48.87) and in developed districts (Tanta, IRR = 4.14, 95% CI = 0.41, 42.04). Incidence rates by groups of cancer sites showed an increasing gradient of urban incidence for cancers related to hormonal aetiology, mainly of the breast and uterus (IRR = 4.96, 95% CI = 2.86, 8.61).Conclusions: The higher urban incidence of uterine cancer, coupled with our previous findings of higher incidence of breast cancer and estrogen receptor positive breast cancer in urban areas in this region, may be suggestive of possible higher exposure to environmental estrogenic compounds, such as xenoestrogens, in urban areas. [ABSTRACT FROM AUTHOR]

Objective: To identify risk factors for uncomplicated malaria in highland areas of East Africa at higher risk of malaria epidemics, in order to design appropriate interventions.Methods: Prospective, population-based, case-control study in the Nandi Hills, a highland area of western Kenya, to identify environmental, sociodemographic and behavioural factors associated with clinical malaria. Data were collected using field observation, a structured questionnaire, and a global positioning system device.Results: We interviewed 488 cases of slide-confirmed malaria and 980 age-matched controls. Multivariate analyses associated higher malaria risk with living <250 m of a forest [OR = 3.3 (95% CI 1.5, 7.1)], <250 m of a swamp [2.8 (1.3, 5.9)], <200 m of maize fields [2.0 (1.2, 3.4)], in the absence of trees <200 m [1.6 (1.2, 2.2)], on flat land [1.6 (1.2, 2.2)], in houses without ceilings [1.5 (1.1, 2.2)], in houses with a separate kitchen building [1.8 (1.4, 2.3)] and in households where the female household head had no education [1.9 (1.1, 3.1)]. Travelling out of the study site [2.2 (1.2, 4.1)] was also associated with increased risk. CONCLUSIONS; In this East African highland area, risk of developing uncomplicated malaria was multifactorial with a risk factor profile similar to that in endemic regions. Households within close proximity to forest and swamp borders are at higher risk of malaria and should be included in indoor residual spraying campaigns. [ABSTRACT FROM AUTHOR]

The regular seasonality of influenza in temperate countries is recognized, but regional differences in patterns of influenza-related mortality are poorly understood. Identifying patterns could improve epidemic prediction and prevention. The authors analyzed the monthly percentage of deaths attributable to pneumonia and influenza among people aged 65 or more years in the contiguous United States, 1968-1998. The local Moran's I test for spatial autocorrelation and correlograms assessing space-time synchrony within each influenza season were applied to detect and to characterize mortality patterns. Western US regions experienced epidemics of greater magnitude than did eastern regions. Positive spatial autocorrelation (two-sided p = 0.001) revealed the similarity in influenza mortality of neighboring states, with several western states forming a focus of high mortality. In transmission seasons dominated by virus subtype A(H3N2), mortality was correlated at a high and consistent level across the United States (mean correlation = 0.56, standard deviation = 0.134). However, when subtype A(H1N1) or type B dominated, the average synchrony was lower (mean correlation = 0.23, standard deviation = 0.058). These novel analyses suggest that causes of spatial heterogeneity (e.g., large-scale environmental drivers and population movement) have impacted influenza-associated mortality. [ABSTRACT FROM AUTHOR]