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INTRODUCTION: Kaposi’s sarcoma (KS) is a multifocal low-grade vascular neoplasm that can affect the skin, mucus membranes, visceral organs, and lymph nodes. KS can also affect the ocular surface and adnexa and can masquerade as other entities, delaying prompt diagnosis. AREAS COVERED: In this review, the manifestations of ocular KS are discussed along with theories for pathogenesis, common risk factors, and management options. EXPERT OPINION: KS is caused by the oncogenic human herpesvirus 8 (HHV8). Immunosuppression in patients with HIV and AIDS contributes to the development of KS but conjunctival and ocular adnexal KS lesions are now uncommon in the era of anti-retroviral therapy. A high index of suspicion is required to diagnose ocular KS as these lesions can be mistaken for alternative entities. Prompt diagnosis can reduce significant morbidity and mortality by prompting a multidisciplinary systemic evaluation, particularly in immunosuppressed individuals. While surgical excision, cryotherapy, intralesional or systemic chemotherapy, and radiation are all viable treatment options, ongoing research to identify novel therapies and molecular treatment targets will help expand the armamentarium of therapeutics available for this disease.

Background/aimAn objective marker is needed to detect when corneal nerve abnormalities underlie neuropathic corneal pain (NCP), as symptoms often overlap with those of dry eye (DE). This study evaluated microneuroma (MN) frequency in various populations and investigated relationships between MN presence and DE clinical features in individuals with DE symptoms but without a history of refractive surgery, in order to eliminate refractive surgery as a potential confounder of nerve abnormalities.MethodsThis was a retrospective study that included individuals with and without DE symptoms who underwent a clinical evaluation for DE (symptom surveys and ocular surface evaluation) and in vivo confocal microscopy imaging. DE clinical features (including those suggestive of neuropathic pain) were compared based on MN presence using t-tests, χ2 analyses and Pearson’s correlation coefficients with 0.05 alpha level.ResultsMN frequencies did not significantly differ between individuals with DE symptoms (Dry Eye Questionnaire 5 score ≥6) and a history of refractive surgery (n=1/16, 6%), individuals with DE symptoms without a history of refractive surgery (n=26/119, 22%) and individuals without DE symptoms (n=2/18, 11%, p=0.22). Among individuals with DE symptoms without a history of refractive surgery, DE clinical features, including those indicative of NCP (burning sensation and sensitivity to light, wind and extreme temperatures), did not significantly differ based on MN presence (p>0.05).ConclusionMN frequencies did not significantly differ between individuals with and without DE symptoms. Their presence alone could not distinguish between DE subtypes, including features of NCP in our study population.

Maternal mortality remains a large concern in the United States (US), although other Western countries are making progress. In this scoping review, we identify four problems that may contribute to the maternal mortality burden in the US: inadequately investing in women's health, poor quality of care, increasing disparities, and poor data collection and monitoring of maternal health issues. Because maternal mortality is decreasing in California, we identify strategies implemented there that could improve maternal health outcomes nationwide: funding programs to address social determinants of maternal health; supporting health care strategies to improve maternal health (including national standards and goals for health care systems); and investing in maternal health monitoring and surveillance (including use of technology). We encourage researchers, practitioners, and policymakers to work together to develop evidence-based policies and practices to improve maternal health and reduce maternal. We conclude with recommendations for the United States and globally.

Ocular surface pain is a frequent cause of visits to an eye care provider and has a substantial impact on healthcare cost, yet a complete understanding of its causative factors and tools for diagnostic workup are notably missing in many eye clinics. The cornea has the densest sensory innervation in the human body and has the potential to be a powerful producer of pain. Pain can manifest as a result of a noxious stimulus or disruption in the ocular surface anatomy (nociceptive pain), or it can result from abnormalities in the ocular surface neurosensory apparatus itself (neuropathic pain). Novel advances in neurobiology have sought to differentiate the two entities, particularly to identify when chronic dry eye symptomatology is driven by neuropathic ocular pain. In this review, we seek to provide an overview of the prevalence, physiologic factors, and management of ocular surface pain complaints.

The purpose of this Association Report is to recognize the significant progress of the leadership of women in dental education and to document the importance of increasing opportunities for women in global health, education, and research. Five American Dental Education Association International Women’s Leadership Conferences have provided opportunities for women leaders in dentistry around the world to exchange experiences and strategies that support their increasing value in the global landscape. Dental disease is now considered one of the top targets for disease eradication by the World Health Organization, and women are seen as critical to the achievement of global health objectives worldwide.

Purpose To study how young adult college students are managing their health behaviors and risks related to spreading COVID-19. Methods We created a national cohort of full-time college students in late April 2020 (n = 707), and conducted a follow-up survey with participants in July 2020 (n = 543). Participants reported COVID-19-related health risk behaviors and COVID-19 symptoms, and also responded to an open-ended prompt about how the COVID-19 pandemic has affected their lives. Quantitative data were analyzed in Stata and we conducted content analysis to identify themes in the qualitative data. Results For most health protective behaviors (e.g., frequent handwashing, social distancing), participants were less compliant in summer 2020 than spring 2020, with the exception of face mask use, which increased. In each month of the first half of 2020, only approximately half of participants with any symptoms that could indicate COVID-19 stayed home exclusively while symptomatic (there was no meaningful change from pre-pandemic or over the course of the pandemic). In qualitative data, the participants who had gone to bars or clubs at least twice within a 4-week period this summer reported being bored and/or isolated, stressed, and/or taking pandemic safety measures seriously. Conclusions These findings suggest multiple areas for intervention, including harm reduction and risk management education approaches for the students who are going to bars and clubs, and creating policies and programs to better incentivize young people with symptoms to stay home exclusively while symptomatic.

Purpose This is one of the first surveys of a USA-wide sample of full-time college students about their COVID-19–related experiences in spring 2020. Methods We surveyed 725 full-time college students aged 18–22 years recruited via Instagram promotions on April 25–30, 2020. We inquired about their COVID-19–related experiences and perspectives, documented opportunities for transmission, and assessed COVID-19's perceived impacts to date. Results Thirty-five percent of participants experienced any COVID-19–related symptoms from February to April 2020, but less than 5% of them got tested, and only 46% stayed home exclusively while experiencing symptoms. Almost all (95%) had sheltered in place/stayed primarily at home by late April 2020; 53% started sheltering in place before any state had an official stay-at-home order, and more than one-third started sheltering before any metropolitan area had an order. Participants were more stressed about COVID-19's health implications for their family and for American society than for themselves. Participants were open to continuing the restrictions in place in late April 2020 for an extended period of time to reduce pandemic spread. Conclusions There is substantial opportunity for improved public health responses to COVID-19 among college students, including for testing and contact tracing. In addition, because most participants restricted their behaviors before official stay-at-home orders went into effect, they may continue to restrict movement after stay-at-home orders are lifted, including when colleges reopen for in-person activities, if they decide it is not yet prudent to circulate freely. The public health, economic, and educational implications of COVID-19 are continuing to unfold; future studies must continue to monitor college student experiences and perspectives.

Background: Atrial fibrillation (AF) adversely impacts health-related quality of life (hrQoL). While some patients demonstrate improvements in hrQoL, the factors associated with large improvements in hrQoL are not well described. Methods: We assessed factors associated with a 1-year increase in the Atrial Fibrillation Effect on Quality-of-Life score of 1 SD (≥18 points; 3× clinically important difference), among outpatients in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation I registry. Results: Overall, 28% (181/636) of patients had such a hrQoL improvement. Compared with patients not showing large hrQoL improvement, they were of similar age (median 73 versus 74, P =0.3), equally likely to be female (44% versus 48%, P =0.3), but more likely to have newly diagnosed AF at baseline (18% versus 8%; P =0.0004), prior antiarrhythmic drug use (52% versus 40%, P =0.005), baseline antiarrhythmic drug use (34.8% versus 26.8%, P =0.045), and more likely to undergo AF-related procedures during follow-up (AF ablation: 6.6% versus 2.0%, P =0.003; cardioversion: 12.2% versus 5.9%, P =0.008). In multivariable analysis, a history of alcohol abuse (adjusted OR, 2.41; P =0.01) and increased baseline diastolic blood pressure (adjusted OR, 1.23 per 10-point increase and >65 mm Hg; P =0.04) were associated with large improvements in hrQoL at 1 year, whereas patients with prior stroke/transient ischemic attack, chronic obstructive pulmonary disease, and peripheral arterial disease were less likely to improve ( P Conclusions: In this national registry of patients with AF, potentially treatable AF risk factors are associated with large hrQoL improvement, whereas less reversible conditions appeared negatively associated with hrQoL improvement. Understanding which patients are most likely to have large hrQoL improvement may facilitate targeting interventions for high-value care that optimizes patient-reported outcomes in AF. Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01165710.

OBJECTIVE To evaluate the efficacy and safety associated with use of a 589-nm solid-state laser for treatment of facial erythema. METHODS A prospective, IRB-approved study was conducted. Participants who were interested in treatment for facial erythema were recruited. They received four monthly treatments with the 589-nm laser. Erythema of the right and left face was graded on a scale of 0-4, 4 being most severe, by both investigators and participants prior to each treatment and at follow-up. Safety was assessed by any reported side effects. RESULTS Twenty-four participants enrolled in the study, 16 women (67%) and 8 men (33%), with an average age of 51.1 years. Investigator grades showed a statistically significant improvement in erythema of 31% for both the right and left face. Participant grades showed a statistically significant improvement in erythema of 23.2% for the right face and 22.8% for the left face. Side effects were limited to transient erythema posttreatment. CONCLUSION A 589-nm solid-state laser achieved a modest improvement in facial erythema when evaluating results 1 month after four monthly treatments. No major safety issues were reported.

We surveyed 75 staff and administrators involved in Oakland (CA)’s Second Chance Initiative from diverse agencies (e.g., probation, behavioral health, public health/medical, education, community-based service providers) to assess the local juvenile reentry system. Sharing and using data across partner agencies, mutual trust, opportunities for interagency collaboration, system-level youth and family engagement, shared governance, and limited resources repeatedly arose as areas for improvement. Many defined reentry success using positive youth developmental outcomes. Government and community perspectives around barriers and effectiveness often differed with some similarities.

To mark the 25th anniversary of the journal, each issue in 2020 will include an interview with a health care thought leader. The August issue features a conversation with Mandy K. Cohen, MD, MPH, secretary of the North Carolina Department of Health and Human Services.

Summary Self-reported maternal weight is error-prone, and the context of pregnancy may impact error distributions. This systematic review summarizes error in self-reported weight across pregnancy and assesses implications for bias in associations between pregnancy-related weight and birth outcomes. We searched PubMed and Google Scholar through November 2015 for peer-reviewed articles reporting accuracy of self-reported, pregnancy-related weight at four time points: prepregnancy, delivery, over gestation and postpartum. Included studies compared maternal self-report to anthropometric measurement or medical report of weights. Sixty-two studies met inclusion criteria. We extracted data on magnitude of error and misclassification. We assessed impact of reporting error on bias in associations between pregnancy-related weight and birth outcomes. Women underreported prepregnancy (PPW: −2.94 to −0.29 kg) and delivery weight (DW: −1.28 to 0.07 kg), and over-reported gestational weight gain (GWG: 0.33 to 3 kg). Magnitude of error was small, ranged widely, and varied by prepregnancy weight class and race/ethnicity. Misclassification was moderate (PPW: 0–48.3%; DW: 39.0–49.0%; GWG: 16.7–59.1%), and overestimated some estimates of population prevalence. However, reporting error did not largely bias associations between pregnancy-related weight and birth outcomes. Although measured weight is preferable, self-report is a cost-effective and practical measurement approach. Future researchers should develop bias correction techniques for self-reported pregnancy-related weight.

The Marseille, France, metropolitan area is home to a heavily concentrated industrial region directly adjacent to residential communities. These towns have been subjected to a wide variety of social science and public health studies, but residents continue to have many questions about health concerns for which they currently have primarily anecdotal evidence. Reflecting on our in-progress research in two of these towns, we argue that community-based participatory research that draws from both social science and public health science can be successfully adapted to the French political and cultural context and is key for developing environmental health research that is relevant for community residents and local leaders. Understanding and working within the customs of the local values and practices culture is critical for community-based participatory research regardless of location but is particularly paramount when working in non-United States contexts, since local values and practices will shape the particular techniques used within the community-based participatory research framework.

Solid organ transplants are rarely performed in both adult and pediatric patients with primary mitochondrial disease. Poor outcomes have been described in case reports and small case series. It is unclear whether the underlying genetic disease has a significant impact on post-transplant morbidity and mortality. Data were obtained for 35 patients from 17 Mitochondrial Disease Centers across North America, the United Kingdom and Australia. Patient outcomes were noted after liver, kidney or heart transplantation. Excluding patients with POLG-related disease, post-transplant survival approached or met outcomes seen in non-mitochondrial disease transplant patients. The majority of mitochondrial disease patients did not have worsening of their mitochondrial disease within 90-days post-transplant. Post-transplant complications, including organ rejection, were not a common occurrence and were generally treatable. Many patients did not have a mitochondrial disease considered or diagnosed prior to transplantation. In conclusion, patients with mitochondrial disease in this cohort generally tolerated solid-organ transplantation. Such patients may not need to be excluded from transplant solely for their mitochondrial diagnosis; additional caution may be needed for patients with POLG-related disease. Transplant teams should be aware of mitochondrial disease as an etiology for organ-failure and consider appropriate consultation in patients without a known cause of their symptoms.

Mohs micrographic surgery (MMS) is a frequently used technique that provides total margin visualization for treatment of skin neoplasms.To provide a comprehensive review of MMS literature, focusing on its origins, evidence behind present-day uses of MMS, and future directions.A literature search was conducted using PubMed to identify articles pertaining to MMS.The fresh frozen technique led to widespread use of MMS in the 1970s. One randomized controlled trial and several large prospective studies have demonstrated low recurrence rates for treatment of nonmelanoma skin cancer (NMSC). MMS, when compared with surgical excision, also achieved a statistically significant higher cure rate for treatment of recurrent NMSC. Studies have demonstrated low recurrence for the treatment of melanoma and melanoma in situ with MMS. MMS has also been shown to effectively treat several rare cutaneous neoplasms. The future of MMS is likely to include the adoption of noninvasive imaging, immunostaining, and digital technology.Mohs micrographic surgery is an effective treatment modality for numerous cutaneous neoplasms. It has achieved statistically significant superiority to surgical excision for the treatment of recurrent and high-risk NMSC. The future is likely to see increased use of noninvasive imaging, immunostaining, and digital technology.

BACKGROUND: There is a direct relationship between bodyweight and risk of diabetes. Lorcaserin, a selective serotonin 2C receptor agonist that suppresses appetite, has been shown to facilitate sustained weight loss in obese or overweight patients. We aimed to evaluate the long-term effects of lorcaserin on diabetes prevention and remission. METHODS: In this randomised, double-blind, placebo-controlled trial done in eight countries, we recruited overweight or obese patients (body-mass index ≥27 kg/m2) with or at high risk for atherosclerotic vascular disease. Eligible patients were aged 40 years or older; patients at high risk for atherosclerotic vascular disease had to be aged 50 years or older with diabetes and at least one other risk factor. Patients were randomly assigned to receive either lorcaserin (10 mg twice daily) or matching placebo. Additionally, all patients had access to a standardised weight management programme based on lifestyle modification. The prespecified primary metabolic efficacy endpoint of time to incident diabetes was assessed in patients with prediabetes at baseline. The prespecified secondary outcomes for efficacy were incident diabetes in all patients without diabetes, achievement of normoglycaemia in patients with prediabetes, and change in glycated haemoglobin (HbA1c) in patients with diabetes. Hypoglycaemia was a prespecified safety outcome. Analysis was by intention to treat, using Cox proportional hazard models for time-to-event analyses. This trial is registered with ClinicalTrials.gov, number NCT02019264. FINDINGS: Between Feb 7, 2014, and Nov 20, 2015, 12 000 patients were randomly assigned to lorcaserin or placebo (6000 patients in each group) and followed up for a median of 3·3 years (IQR 3·0-3·5). At baseline, 6816 patients (56·8%) had diabetes, 3991 (33·3%) prediabetes, and 1193 (9·9%) normoglycaemia. At 1 year, patients treated with lorcaserin had a net weight loss beyond placebo of 2·6 kg (95% CI 2·3-2·9) for those with diabetes, 2·8 kg (2·5-3·2) for those with prediabetes, and 3·3 kg (2·6-4·0) for those with normoglycaemia (p

OBJECTIVES: The current study examined how prepregnancy body mass index (BMI), gestational weight gain, and birth weight cluster between births within women and between women who are sisters. METHODS: Using data from the National Longitudinal Survey of Youth 1979 cohort, we utilized nested, multivariable hierarchical linear models to examine the correlation of these three outcomes between births (n = 6006) to women (n = 3605) and sisters (n = 3170) so that we can quantify the clustering by sibship and by woman for these three pregnancy-related outcomes. RESULTS: After controlling for confounding covariates, prepregnancy BMI (intraclass correlation (ICC) 0.24, 95% CI 0.16, 0.32), gestational weight gain (ICC 0.23, 95% CI 0.16, 0.31), and infant’s birthweight (ICC 0.07, 95% CI 0.003, 0.13) were correlated between sisters. Additionally, all three outcomes were significantly correlated between births for each sister, suggesting that prepregnancy BMI (ICC 0.82, 95% CI 0.81, 0.83), gestational weight gain (ICC 0.45, 95% CI 0.42, 0.49), and birth weight (ICC 0.31, 95% CI 0.28, 0.35) track between pregnancies in the same woman. CONCLUSIONS FOR PRACTICE: The observed clustering both within women and between sisters suggests that shared genetic and environmental factors among sisters play a role in pregnancy outcomes above and beyond that of women’s own genetic and environmental factors. Findings suggest that asking a woman about her sisters’ pregnancy outcomes could provide insight into the possible outcomes for her current pregnancy. Future research should test if collecting such a family history and providing tailored clinical recommendations accordingly would be useful.

Objectives. To model the hypothetical impact of preventing excessive gestational weight gain on midlife obesity and compare the estimated reduction with the US Healthy People 2020 goal of a 10% reduction of obesity prevalence in adults. Methods. We analyzed 3917 women with 1 to 3 pregnancies in the prospective US National Longitudinal Survey of Youth, from 1979 to 2012. We compared the estimated obesity prevalence between 2 scenarios: gestational weight gain as reported and under the scenario of a hypothetical intervention that all women with excessive gestational weight gain instead gained as recommended by the Institute of Medicine (2009). Results. A hypothetical intervention was associated with a significantly reduced estimated prevalence of obesity for first (3.3 percentage points; 95% confidence interval [CI] = 1.0, 5.6) and second (3.0 percentage points; 95% CI = 0.7, 5.2) births, and twice as high in Black as in White mothers, but not significant in Hispanics. The population attributable fraction was 10.7% (95% CI = 3.3%, 18.1%) in first and 9.3% (95% CI = 2.2%, 16.5%) in second births. Conclusions. Development of effective weight-management interventions for childbearing women could lead to meaningful reductions in long-term obesity.

Low back pain is the leading cause of years lost to disability with approximately 15%-25% of the chronic back pain population suffering from lumbar facet arthropathy. No large-scale study has sought to systematically identify inciting events for lumbar facet arthropathy. The aim of this study is to quantify the proportion of individuals with lumbar facetogenic pain who report a specific precipitating event(s) and to determine if there is a correlation between these events and treatment outcome.Institutional electronic medical records were searched based on the current procedural terminology (CPT) codes representing lumbar facet joint radiofrequency ablation for procedures performed between January 2007 and December 2015. All patients had obtained ≥50% pain relief based on 6-hour pain diaries after 1 or more diagnostic facet blocks. A positive outcome was defined as ≥50% pain relief sustained for longer than 3-month after procedure, without additional procedural interventions.One thousand sixty-nine people were included in analysis. In the 52% of individuals who described an inciting event, the most commonly reported causes were falls (11%), motor vehicle collisions (11%), sports-related injuries (11%, of which weightlifting accounted for 62%), nonspine postsurgical injuries (2%), and "other" (17%). Six hundred seventeen (57.7%) individuals experienced ≥50% pain relief sustained for3 months. Patients whose pain was preceded by an inciting event were more likely to have a positive outcome than those who could not recall a specific precipitating factor (odds ratio, 1.5; confidence interval, 1.02-2.1, P = .01). Another factor associated with outcome was shorter duration of pain (8.1 ± 9.2 vs 9.7 ± 10.1 years, P = .02), with an observed modifier effect of age on outcomes. For a 1-year increase in age, there was a 10% increase in the odds of a positive response.Inciting events are common in patients diagnosed with lumbar facetogenic pain and may be associated with a positive outcome.

Mucosal melanomas are aggressive cancers of mucosal surfaces with clinical and pathologic characteristics distinct from cutaneous melanomas, warranting different staging systems and treatment approaches. Surgical resection is performed frequently for the primary tumor, although the utility of lymph node surgery and radiation therapy is not established. Therapies targeted against C-KIT activating mutations, identified in many mucosal melanomas, are emerging as promising treatments.

Meaningfully engaging and supporting youth in their communities can promote their sense of efficacy and potentially their health and wellbeing. The objective of this study was to test whether a school-based youth civic empowerment program, Generation Citizen (GC), was associated with self-reported mental and physical health among participants, and whether these associations differed by two potential modifiers: civic self-efficacy and a sense of meaningful contributions to one's community. Participants were middle and high school students (N = 364) who participated in GC in the fall semester of 2014 and completed surveys at the beginning and end of the semester. Analyses revealed a small but statistically significant increase in self-reported physical health after GC and no statistically significant change in self-reported mental health. There was evidence of effect measure modification by civic self-efficacy such that the difference in physical health as civic self-efficacy increased was smaller post-intervention compared to pre-intervention. This could suggest that GC participation is particularly beneficial for those with lower civic self-efficacy. While our findings suggest that public health interventions may benefit from centering empowerment opportunities for youth, future research is warranted to better understand the particular role of civic self-efficacy in that process., Highlights • Associations between participation in a school-based civic empowerment program and self-reported health were tested. • Participation was not associated with changes in self-reported mental health. • Participation was associated with an increase in self-reported physical health. • Program participation was particularly beneficial for those with lower civic self-efficacy.

Objective While several studies have found an association between excessive gestational weight gain and obesity later in life, to the best of our knowledge, no studies have explored the role of gestational weight gain events across the life course. Design and Methods We describe how the prevalence of mid-life obesity (BMI≥30 at age 40 or 41) among women varies by life course patterns of gestational weight gain (using 2009 IOM guidelines) in the USA’s National Longitudinal Survey of Youth 1979 cohort. Results Among women who reported 1–3 births before age 40, the prevalence of mid-life obesity increased with a rising number of excessive gestational weight gain events: from none (23.4%, n=875), to one (37.6%, n=707), to two (46.8%, n=427), and to three (54.6%, n=108), p

Although previous systematic reviews considered the relationship between socioeconomic status and obesity, almost 200 peer-reviewed articles have been published since the last review on that topic, and this paper focuses specifically on education, which has different implications. The authors systematically review the peer-reviewed literature from around the world considering the association between educational attainment and obesity. Databases from public health and medicine, education, psychology, economics, and other social sciences were searched, and articles published in English, French, Portuguese and Spanish were included. This paper includes 289 articles that report on 410 populations in 91 countries. The relationship between educational attainment and obesity was modified by both gender and the country's economic development level: an inverse association was more common in studies of higher-income countries and a positive association was more common in lower-income countries, with stronger social patterning among women. Relatively few studies reported on lower-income countries, controlled for a comprehensive set of potential confounding variables and/or attempted to assess causality through the use of quasi-experimental designs. Future research should address these gaps to understand if the relationship between educational attainment and obesity may be causal, thus supporting education policy as a tool for obesity prevention.

Resume Introduction Le but de notre etude a ete d’evaluer la pratique lilloise dans la prise en charge du kyste de l’ovaire pendant la grossesse et de comparer nos resultats aux donnees de la litterature. Patientes et methodes L’etude est une cohorte retrospective du CHRU de Lille entre le 1er janvier 2007 et le 31 decembre 2010. L’inclusion residait sur le diagnostic en echographie d’un kyste ovarien superieur ou egal a 30 mm au cours de la grossesse. Les donnees obstetricales, neonatales, les techniques operatoires et les indications ont ete analysees. Resultats Soixante et onze patientes ont eu un diagnostic de kyste ovarien pendant la grossesse soit 0,35 % des grossesses suivies au CHRU de Lille sur la periode d’etude. Le diagnostic a eu lieu au 1er trimestre dans la majorite des cas, a 12,30 ± 6,99 SA. Le plus souvent le kyste ovarien est surveille pendant la grossesse ce qui a ete strictement le cas dans 63,38 % des kystes (45 patientes). Quatorze patientes ont du etre operees pendant la grossesse (19,72 %) en dehors des cesariennes. Il y a eu 7 interventions en urgence et 7 interventions programmees en per-partum. Cinq cœlioscopies per-partum ont ete realisees a un terme moyen de 14,75 ± 2,63 SA, et 9 laparotomies a un terme moyen de 18,88 ± 4,57 SA. Douze chirurgies de la masse ovarienne ont ete realisees per cesarienne. Les kystes operes sont le plus souvent des kystes organiques (74,39 %). Aucun cas de malignite n’a ete observe, et 3 cas de tumeurs borderline ont ete diagnostiques. Il n’y a pas eu de complications obstetricales ou neonatales. Conclusion Une surveillance simple est possible si le kyste est benin, moins de 6 cm et n’evolue pas. La chirurgie est de mise en cas d’urgence ou de signes suspects de complication ou de malignite. La cœlioscopie peut etre utilisee largement jusqu’au 2nd trimestre. L’attitude lilloise respecte les recommandations et est en accord avec la litterature.

Background and Objectives Gestational weight gain (GWG) is associated with both long- and short-term maternal and child health outcomes, particularly obesity. Targeting maternal nutrition through policies is a potentially powerful pathway to influence these outcomes. Yet prior research has often failed to evaluate national policies and guidelines that address maternal and child health. In 1990, the U.S. Institute of Medicine (IOM) released guidelines recommending different GWG thresholds based on women’s pre-pregnancy body mass index (BMI), with the goal of improving infant birth weight. In this study, we employ quasi-experimental methods to examine whether the release of the IOM guidelines led to changes in GWG among a diverse and nationally representative sample of women. Methods Our sample included female participants of the National Longitudinal Survey of Youth who self-reported GWG for pregnancies during 1979–2000 (N = 7,442 pregnancies to 4,173 women). We compared GWG before and after the guidelines were released using difference-in-differences (DID) and regression discontinuity (RD) analyses. Results In DID analyses we found no reduction in GWG among overweight/obese women relative to normal/underweight women. Meanwhile, RD analyses demonstrated no changes in GWG by pre-pregnancy BMI for either overweight/obese or normal/underweight women. Results were similar for women regardless of educational attainment, race, or parity. Conclusions The findings suggest that national guidelines had no effect on weight gain among pregnant women. These results have implications for the implementation of policies targeting maternal and child health via dietary behaviors.

Introduction Patients presenting with ST elevation myocardial infarction (STEMI) derive significant benefit from timely percutaneous coronary intervention (PCI). Electrocardiogram (ECG) scoring systems can complement history to estimate the infarction age and inform clinical decision-making. Case A 76 year old man presented with eight days of dyspnea on exertion and chest pain. Triage ECG showed ST elevation and Q waves in the anterior leads. The patient was taken for coronary angiography and found to have a 100% occlusion of the left anterior descending artery. Discussion Determining timing of acute coronary syndromes is challenging. ECG indices aid clinical history by quantifying infarction acuity.

Introduction Little is known about trends in national rates of injection-related skin and soft tissue infections (SSTI) and their relationship to the structural risk environment for heroin users. Use of Mexican-sourced “Black Tar” heroin, predominant in western US states, may have greater risk for SSTI compared with eastern US powder heroin (Colombian-sourced) due to its association with non-intravenous injection or from possible contamination. Methods Using nationally representative hospital admissions data from the Nationwide Inpatient Sample and heroin price and purity data from the Drug Enforcement Administration, we looked at rates of hospital admissions for opiate-related SSTI (O-SSTI) between 1993 and 2010. Regression analyses examined associations between O-SSTI and heroin source, form and price. Results Hospitalization rates of O-SSTI doubled from 4 to 9 per 100,000 nationally between 1993 and 2010; the increase concentrated among individuals aged 20–40. Heroin market features were strongly associated with changes in the rate of SSTI. Each $100 increase in yearly heroin price-per–gram-pure was associated with a 3% decrease in the rate of heroin-related SSTI admissions. Mexican-sourced-heroin-dominant cities had twice the rate of O-SSTI compared to Colombian-sourced-heroin-dominant cities. Discussion Heroin-related SSTI are increasing and structural factors, including heroin price and source-form, are associated with higher rates of SSTI hospital admissions. Clinical and harm reduction efforts should educate heroin users on local risk factors, e.g., heroin type, promote vein health strategies and provide culturally sensitive treatment services for persons suffering with SSTI.

Inequities in education, the urban environment, and health co-exist and mutually reinforce each other. Educators, planners, and public health practitioners share commitments to place-based, participatory, youth-focused, and equitable work. They also have shared goals of building community resilience, social capital, and civic engagement. Interdisciplinary programs that embody these shared values and work towards these shared goals are emerging, including school-based health centers, full-service community schools, community health centers, Promise Neighborhoods, and Choice Neighborhoods. The intersection of these three fields represents an opportunity to intervene on social determinants of health. More collaborative research and practice across public health, education, and planning should build from the shared values identified to continue to address these common goals.

Objectives: The sense of urgency concerning the inadequacies of the current U.S. oral health care system in better preventing oral diseases, eliminating oral health disparities, and ensuring access to basic oral health services has increased in recent years. This paper sought to articulate the attributes that an ideal oral health care system would possess, which would be consistent with the principles of the leading authorities on the public's health. Methods: The authors reviewed policy statements and position papers of the World Health Organization, The Institute of Medicine, The American Public Health Association, Healthy People 2010 Objectives for the Nation, and the American Association of Public Health Dentistry. Results: Consistent with leading public health authorities, an ideal oral health care system would be have the following attributes: integration with the rest of the health care system; emphasis on health promotion and disease prevention; monitoring of population oral health status and needs; evidence-based; effective; cost-effective; sustainable; equitable; universal; comprehensive; ethical; includes continuous quality assessment and assurance; culturally competent; and empowers communities and individuals to create conditions conducive to health. Conclusions: Although there are some attributes of an ideal oral health care system on which the United States has made initial strides, it falls far short in many areas. The development of an oral health care delivery system that meets the characteristics described above is possible but would require tremendous commitment and political will on the part of the American public and its elected officials to bring it to fruition.

Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b OBJECTIVE To evaluate whether Raman molecular imaging (RMI, which combines digital imaging and analytical spectroscopy to evaluate the biochemical composition of interrogated material) can be used to identify biochemical differences in patients with Gleason 7 prostate cancer who progress to metastatic disease and die from prostate cancer. PATIENTS AND METHODS We identified 38 patients who had a radical prostatectomy for Gleason 7 adenocarcinoma of the prostate. Half progressed to metastatic disease and half had no evidence of disease after treatment. Patients were matched for preoperative prostate-specific antigen level, surgical margin status, pathological stage, tumour volume, age at surgery, year of surgery and DNA ploidy. Sequential 5 µm sections were obtained from paraffin-embedded tissue and one genitourinary pathologist selected areas of tumour for study. Principal component analysis was used to investigate the correlation between spectral response and clinical outcome. RESULTS The analysis was able to distinguish between those with progressive disease and those with no evidence of disease, most notably within the Gleason 3 regions when evaluating the epithelium and stroma as separate histological elements. A two-sample t-test gave P < 0.01 for both the Gleason 3 and 4 epithelium and stroma classes. CONCLUSIONS RMI is a novel technique that shows promise for identifying patients at risk of progression by visualizing molecular information not seen using other current methods. In Gleason 7 disease, RMI shows distinctive chemical differences in patients who progress to metastatic disease in both Gleason pattern 3 and 4 regions. This preliminary work lays the foundation for the further study of RMI for evaluating prostate tissue.

Proteus mirabilis (PM) as well as other members of the Enterobacteriaceae family are a leading cause of infectious diseases in both the community and acute care settings. The prevalence of multi-drug resistant (MDR) bacterial isolates have increased in the last few years, affecting the prognosis and survival of hospitalized patients. The aim of our study was to determine the risk factors and clinical outcomes of urinary tract infections (UTIs) caused by MDR PM in patients hospitalized in our institution.This was a retrospective matched case-control study. Records of patients with PM-positive urine culture were reviewed, and data were included for analysis.Univariate analysis revealed that the variables significantly associated with acquisition of MDR PM vs non-MDR PM UTI were younger age ([in years] median 77.5, range 20-94 vs median 78, range 40-94, p = 0.04), other concomitant infectious diseases (57.1 vs 35.7%, p = 0.037),number of prior infectious diseases (mean 0.95 +/- 0.99 vs 0.57 +/- 0.85, p = 0.035), diagnosis of infection at hospital admission (67.9 vs 42.9%, p = 0.008), and prior therapy with antipseudomonal penicillin (17.9 vs 1.8%, p = 0.004),respectively. Mean length of hospitalization was 29.95 days for the MDR group and 30.04 days for the non-MDR group(p = non-significant [NS]). The crude mortality rate following hospital admission was 19/56 (33.9%) vs 14 (25%)in the MDR PM and non-MDR PM groups, respectively(p = 0.300, odds ratio [OR] 1.54, 95% confidence interval[CI] 0.63-3.82). The production of extended-spectrum beta lactamases(ESBL) was found in 100% of MDR-PM vs 31.5%of non-MDR-PM urine isolates (p0.001). All variables found to be significantly associated with MDR-PM UTI were included in a logistic regression model. Independent risk factors for MDR-PM UTI were empiric cephalosporin therapy(OR 4.694, 95% CI 1.76-12.516, p = 0.002) and prior antipseudomonal penicillin (piperacillin/tazobactam) therapy during the last year (OR 11.175, 95% CI 1.09-114.2,p = 0.04).Prior piperacillin/tazobactam and empiric cephalosporin use were the independent risk factors of MDR-PM strains. All MDR-PM urinary isolates at our institution were ESBL producers. Therefore, carbapenem use remains the only available treatment option for MDR-PM isolates in our institution.

The Massachusetts General Hospital-Swallow Screening Tool (MGH-SST) is a two-part dysphagia screening tool for use by trained staff working with acute neuroscience patients. It was developed in 2004 for use on our neuroscience inpatient units using factors sensitive to aspiration risk. The MGH-SST provides early detection of those at risk for aspiration, guides the decision whether a patient can safely eat or drink, and acts as a trigger for appropriate speech--language pathology (SLP) consult for a comprehensive swallow evaluation. A staff education module was developed including a training video with clinical examples to simulate disordered clinical features, as well as a competency assessment. The MGH-SST was validated using trained nurses with patients with a broad range of neurological and neurosurgical injuries, comparing the MGH-SST results to an instrumental dysphagia assessment, fiberoptic endoscopic evaluation of swallowing (FEES). It was found to be a valid and effective screening to identify patients at risk for dysphagia. Elements critical to the success of a dysphagia screening program include multi-disciplinary collaboration, administrative support, comprehensive training to ensure reliable and consistent administration, and continuous performance measurements.

OBJECTIVE To gather a pooled database from six tertiary-care referral centres using salvage cryotherapy (SC) for locally recurrent prostate cancer, and develop a pretreatment nomogram allowing a prediction of the probability of biochemical failure after SC, based on pretreatment clinical variables. PATIENTS AND METHODS We retrospectively analysed 797 men treated at six tertiary-care referral centres with SC for locally recurrent disease after primary radiotherapy with curative intent. The median duration of follow-up from the time of SC to the date of last contact was 3.4 years. The primary study endpoint was biochemical failure, defined as a serum prostate-specific antigen (PSA) level after SC of >0.5 ng/mL. RESULTS Overall, the rate of biochemical failure was 66% with a median of 3.4 years of follow-up. A logistic regression model was used to predict biochemical failure. Covariates included serum PSA level at diagnosis, initial clinical T stage, and initial biopsy Gleason score. On the basis of these results, a pretreatment nomogram was developed which can be used to help select patients best suited for SC. Our pretreatment nomogram was internally validated using 500 bootstrap samples, with the concordance index of the model being 0.70. CONCLUSION A pretreatment nomogram based on several diagnostic variables (serum PSA level at diagnosis, biopsy Gleason grade, and initial clinical T stage) was developed and might allow the selection of ideal candidates for SC.

Background Education is an important social determinant of many health outcomes, but the relationship between educational attainment and the amount of weight gained over the course of a woman's pregnancy (gestational weight gain [GWG]) has not been established clearly. Methods We used data from 1979 through 2010 for women in the National Longitudinal Survey of Youth (1979) cohort (n = 6,344 pregnancies from 2,769 women). We used generalized estimating equations to estimate the association between educational attainment and GWG adequacy (as defined by 2009 Institute of Medicine guidelines), controlling for diverse social factors from across the life course (e.g., income, wealth, educational aspirations and expectations) and considering effect measure modification by race/ethnicity and prepregnancy overweight status. Results In most cases, women with more education had increased odds of gaining a recommended amount of gestational weight, independent of educational aspirations and educational expectations and relatively robust to sensitivity analyses. This trend manifested itself in a few different ways. Those with less education had higher odds of inadequate GWG than those with more education. Among those who were not overweight before pregnancy, those with less education had higher odds of excessive GWG than college graduates. Among women who were White, those with less than a high school degree had higher odds of excessive GWG than those with more education. Conclusion The relationship between educational attainment and GWG is nuanced and nonlinear.

Although poor clinic attendance is associated with increased morbidity and mortality among HIV-infected individuals, less is known about predictors of retention and the acceptability of targeted interventions to increase regular clinic attendance. To better understand which patients are at risk for irregular clinic attendance and to explore interventions to aid in retention to care, we surveyed patients attending two outpatient HIV clinics affiliated with the University of California, San Francisco. A total of 606 participants were surveyed, and the analysis was restricted to the 523 male respondents. Of this group, 45% (N = 299) reported missing at least one visit a year. Missing a clinic visit was associated with being African American (aOR = 1.99; 95%CI 1.12-3.52), being a man who has sex with both men and women (aOR=2.72; 95%CI 1.16-6.37), and reporting at least weekly methamphetamine use (aOR=5.79; 95%CI 2.47-13.57). Participants who reported a monthly income greater than $2000 were less likely to miss an appointment (aOR = 0.56; 95%CI 0.34-0.93). Regarding possible retention interventions, most patients preferred phone calls over other forms of support. These findings support the need for ongoing engagement support with particular attention to at-risk sub-groups.

Diffuse normolipemic plane xanthoma (DNPX) was first described by Altman and Winkelmann in 1962. It is a rare and non-inherited form of xanthomatosis. Clinically, the dermatosis is characterized by the presence of symmetric yellowish-orange plaques that favor the neck, upper trunk, flexural folds and periorbital region. It has been recognized to be associated with hematological diseases, especially with multiple myeloma and monoclonal gammopathy. We present a patient with diffuse plane xanthoma, normal lipid level, and monoclonal gammopathy.

Background Lower childhood socioeconomic position is associated with greater risk of adult obesity among women, but not men. Pregnancy-related weight changes may contribute to this gender difference. The objectives of this study were to determine the associations between: 1. childhood socioeconomic disadvantage and midlife obesity; 2. excessive gestational weight gain (GWG) and midlife obesity; and 3. childhood socioeconomic disadvantage and excessive GWG, among a representative sample of childbearing women. Methods We constructed marginal structural models for seven measures of childhood socioeconomic position for 4780 parous women in the United States, using National Longitudinal Survey of Youth (1979–2010) data. Institute of Medicine definitions were used for excessive GWG; body mass index ≥30 at age 40 defined midlife obesity. Analyses were separated by race/ethnicity. Additionally, we estimated controlled direct effects of childhood socioeconomic disadvantage on midlife obesity under a condition of never gaining excessively in pregnancy. Results Low parental education, but not other measures of childhood disadvantage, was associated with greater midlife obesity among non-black non-Hispanic women. Among black and Hispanic mothers, childhood socioeconomic disadvantage was not consistently associated with midlife obesity. Excessive GWG was associated with greater midlife obesity in all racial/ethnic groups. Childhood socioeconomic disadvantage was not statistically significantly associated with excessive GWG in any group. Controlled direct effects were not consistently weaker than total effects. Conclusions Childhood socioeconomic disadvantage was associated with adult obesity, but not with excessive gestational weight gain, and only for certain disadvantage measures among non-black non-Hispanic mothers. Prevention of excessive GWG may benefit all groups through reducing obesity, but excessive GWG does not appear to serve as a mediator between childhood socioeconomic position and adult obesity in women.

SummaryThis study determined microdamage associated with external fixation pin insertion and short-term cyclical loading, using an ex vivo ovine tibial model. Orthofix tapered blunt-tipped 3.5/4.5 mm fixation pins and Apex® self-drilling self-tapping fixation pins, 4 mm in diameter, were used. After insertion, the constructs were either loaded in cantilever bending or not loaded. Constructs were then bulk-stained in basic fuchsin, and calcified sections were made. The sections were reviewed qualitatively and the microcrack surface density (Cr.S.Dn, μm/mm2) was quantified at the pin-bone interface. The pattern and quantity of microdamage induced was significantly influenced by fixation pin design and cortical region within the cisor transcortex, but not short-term cyclical loading. Overall, Cr.S.Dn was significantly increased with use of the Orthofix fixation pin (P < 0.01). Cr.S.Dn was also increased in the medial cis-cortex, compared with the lateral transcortex (P < 0.05). Diffuse damage within the medial cis-cortex was higher with the Orthofix pin. In contrast, the Howmedica Apex® fixation pin caused fracture of the periosteal region of the lateral transcortex, but relatively little microdamage within the medial cis-cortex. In this model as a consequence of pin insertion, fixation pin design had significant specific damage effects on both the medial cis-cortex and the lateral trans-cortex

The literature on social capital and civic engagement as they relate to health and health services outcomes is nuanced and sometimes conflicting, and has been a topic of much investigation in the pages of Social Science and Medicine. Ko etal. (2014) add to this research by considering two health services outcomes: the closure and privatization of public hospitals. We draw from education research on the role of community/civic engagement in public school closures to identify areas for future research to better understand these nuances. Qualitative research on school closures suggest that there are both well-managed and poorly managed closure decisions, and there are diverse community groups with interests in the decision who can interact with each other in nuanced ways. Furthermore, across stakeholder groups, there is not always agreement as to if closure would help or harm their students' education. We encourage health and health services researchers to glean insights from education research and other disciplines disparate but related and relevant to public health when developing research questions and considering alternative methodologies. © 2014 Elsevier Ltd.

Background: Neural cell transplantation is a promising therapy for stroke, but rejection of human cells in animal models is an obstacle to furthering this research. Many antirejection strategies have been reported, but few comparison data are available. We asked if human neural cell grafts would have different survival or differentiation with injected or oral cyclosporine regimens. Methods: Rats received intracerebral grafts of human embryonic stem cell-derived neural progenitors, and 6 rats each were randomized to 4 cyclosporine regimens: 1) daily injections, 2) initial injections followed by oral drug in the drinking water, 3) oral drug only, or 4) no cyclosporine. Histology was performed 14 days after grafting for quantification of markers of human cells, neural cell types, and immune cells. Results: More rats in the injection (6/6) and injection+oral (5/6) groups had surviving graft cells than in the oral (1/6) and control (3/6) groups (p

ObjectivesHigh maternal weight before and during pregnancy contributes to child obesity. To assess the additional role of weight change after delivery, we examined associations between pre- and post-pregnancy weight changes and preschooler overweight.MethodsSample4359 children from the Children and Young Adults of the 1979 National Longitudinal Survey of Youth (NLSY) born to 2816 NLSY mothers between 1979 and 2006 and followed to age 4-5years old.Exposuresgestational weight gain (GWG) and post-delivery maternal weight change (PDWC).Outcomechild overweight (body mass index (BMI) ≥85th percentile).ResultsAdjusted models suggested that both increased GWG (OR: 1.08 per 5kg GWG, 95% CI: 1.01, 1.16) and excessive GWG (OR: 1.29 versus adequate GWG, 95% CI: 1.06, 1.56) were associated with preschooler overweight. Maternal weight change after delivery was also independently associated with child overweight (OR: 1.12 per 5kg PDWC, 95% CI: 1.04, 1.21). Associations were stronger among children with overweight or obese mothers.ConclusionsIncreased maternal weight gain both during and after pregnancy predicted overweight in preschool children. Our results suggest that healthy post-pregnancy weight may join normal pre-pregnancy BMI and adequate GWG as a potentially modifiable risk factor for child overweight.

We report on the fine-needle aspiration (FNA) findings of a low-grade fibromyxoid sarcoma arising from the renal capsule in a 70-yr-old male. Cytologic examination revealed a spindle-cell and myxoid lesion characterized by microtissue fragments of delicate spindle-shaped cells and thin-walled capillary-type channels enmeshed in metachromatically staining myxoid material, best appreciated in Diff-Quik-stained smears. The spindle cells had slightly elongated, bland, oval to tapered nuclei. Based on the FNA diagnosis, the renal mass was resected, which revealed a hypocellular to moderately cellular, spindle-shaped neoplasm showing alternating hypercellular fibrous foci with hypocellular myxoid areas arranged in a swirling growth pattern, characteristic of low-grade fibromyxoid sarcoma. We believe that this is the first report of a low-grade fibromyxoid sarcoma arising in the renal capsule (capsuloma), as well as the first capsuloma diagnosed by FNA biopsy. Differential diagnoses of other sarcomas arising from the kidney and nearby retroperitoneal region are discussed, as well as other entities that might enter into the differential diagnosis of this low-grade sarcoma.

Background.The initial cleavage of collagen by collagenase represents the rate-limiting step in the degradation of this central extracellular matrix protein. Chronic nonhealing ulcers, especially pressure ulcers, typically contain elevated levels of collagenolytic activity. However, there have been no detailed attempts to identify the source of these collagenases and their activity either in normal healing wounds or in chronic nonhealing ulcers. Materials and Methods.Levels of the matrix metalloproteinases, MMP-1 and MMP-8, and the tissue inhibitor of matrix metalloproteinases, TIMP-1, were measured in fluids and tissues of healing human wounds and nonhealing ulcers by ELISA. Relative MMP-1 and MMP-8 levels were also analyzed by substrate preference in a functional assay. Results.The patterns of the collagenases MMP-1 and MMP-8 in healing wounds were distinct, with MMP-8 appearing in significantly greater amounts than MMP-1. Chronic nonhealing ulcers were characterized by significantly higher levels of MMP-1 and MMP-8, and lower levels of TIMP-1, than in healing wounds. Levels of both MMP-1 and MMP-8 varied greatly in chronic ulcers, although MMP-8 was always the predominant collagenase present in these wounds. Interestingly, these collagenases were present almost exclusively in their inactive forms in healing wounds, whereas nonhealing ulcers possessed significant levels of the active forms of these enzymes. Conclusions.These results clearly demonstrate that the neutrophil-derived MMP-8 is the predominant collagenase present in normal healing wounds and suggest that overexpression and activation of this collagenase may be involved in the pathogenesis of nonhealing chronic ulcers. In addition, excessive collagenolytic activity in chronic ulcers is made possible, partly because of the reduced levels of the inhibitor, TIMP-1.