Recent Publications by CFE Educators

More than one percent of adults in the Dominican Republic are HIV-infected and most infections are acquired sexually. We studied sexual risk behaviours in a group of HIV-positive patients treated in Santiago, Dominican Republic. Interviews were conducted with 129 participants seen in May 2006 at one of the country's largest public hospital HIV clinics. Questions included demographics, sexual history, condom use and focused on patients' last sexual encounter. Most patients (72.4%) had been sexually active since their HIV diagnosis. Following their diagnosis, 72.8% of sexually active patients used condoms more frequently, 21.7% used condoms with the same frequency and 5.4% used condoms less often. The most common reason cited for not using a condom after HIV diagnosis differed by gender; men cited decreased sexual pleasure (70.0%) and women reported that their partner had refused to use a condom (71.8%). Sexually active patients who believed that their partner did not have HIV were much more likely to report using a condom at their last sexual encounter than those who did not know their partner's HIV status (OR=16.9). HIV-positive patients reported using condoms more frequently following their HIV diagnosis and were more likely to use a condom if they believed their partner did not have HIV. Increased HIV testing may lead to reduced sexual risk behaviour in the Dominican Republic.

The reeler gene encodes Reelin, a secreted glycoprotein that binds to the very-low-density lipoprotein receptor (Vldlr) and apolipoprotein E receptor 2 (Apoer 2), and induces Src- and Fyn-mediated tyrosine phosphorylation of the intracellular adaptor protein Disabled-1 (Dab1). This Reelin-Dab1 signaling pathway regulates neuronal positioning during development. A second Reelin pathway acts through Apoer 2-exon 19 to modulate synaptic plasticity in adult mice. We recently reported positioning errors in reeler dorsal horn laminae I-II and V, and the lateral spinal nucleus. Behavioral correlates of these positioning errors include a decreased mechanical and increased thermal sensitivity in reeler mice. Here we examined mice with deletions or modifications of both the Reelin-Dab1 signaling pathway and the Reelin-Apoer 2-exon 19 pathway on a Vldlr-deficient background. We detected reeler-like dorsal horn positioning errors only in Dab1 mutant and Apoer 2/Vldlr double mutant mice. Although Dab1 mutants, like reeler, showed decreased mechanical and increased thermal sensitivity, neither the single Vldlr or Apoer 2 knockouts, nor the Apoer 2-exon 19 mutants differed in their acute pain sensitivity from controls. However, despite the dramatic alterations in acute 'pain' processing in reeler and Dab1 mutants, the exacerbation of pain processing after tissue injury (hindpaw carrageenan injection) was preserved. Finally, we recapitulated the reeler dorsal horn positioning errors by inhibiting Dab1 phosphorylation in organotypic cultures. We conclude that the Reelin-Dab1 pathway differentially contributes to acute and persistent pain, and that the plasticity associated with the Reelin-Apoer 2-exon 19 pathway is distinct from that which contributes to injury-induced enhancement of 'pain' processing.

BACKGROUND

There is a paucity of data on the adequacy of the resources and tools used by the Centers for Medicaid and Medicare Services (CMS) in making national coverage determinations about services for beneficiaries. The objective of this study was to determine the extent to which clinical trials relied on by the CMS are applicable to Medicare beneficiaries.

METHODS

We performed a meta-analysis of data on 40 009 individuals from all 141 trials included in the technology assessments for the 6 cardiovascular disease meetings of the CMS advisory panel and compared them with the demographics of the Medicare population.

RESULTS

Medicare beneficiaries differ significantly from the cardiovascular clinical trial participants used to inform Medicare coverage decisions. Clinical trial participants, compared with beneficiaries, are more likely to be younger (60.1 vs 74.7 years), male (75.4% vs 41.8%), and non-US residents (60% vs 0%). The clinical trials, moreover, rarely included outcome stratification by age, sex, and race.

CONCLUSIONS

Participants in cardiovascular studies relied on by the CMS for coverage determinations differ substantially from the Medicare population. Data frequently are not available on relevant subgroup populations. Suggestions are made that address the need for data more relevant to Medicare beneficiaries by increasing enrollment of, and reporting on, women and elderly individuals in clinical trials and use of relevant data for coverage decisions.

OBJECTIVE

To assess whether lower adiponectin concentrations in South Asian Indians may be responsible for their greater degree of insulin resistance.

RESEARCH DESIGN AND METHODS

Insulin-mediated glucose uptake and plasma total and high molecular weight (HMW) adiponectin concentrations were quantified in 52 women of South Asian (SA) and Caucasian (CAU) ancestry and compared.

RESULTS

Mean +/- SD total (2,965 +/- 1,278 vs. 4,235 +/- 160 ng/ml) and HMW (1,001 +/- 352 vs. 1,591 +/- 854 ng/ml) adiponectin were lower in SAs than CAUs (P 0.005). Insulin-resistant CAUs (CAU-IR) had lower total (2,665 +/- 1,040 vs. 5,133 +/- 1,086 ng/ml) and HMW (987 +/- 479 vs. 1,935 +/- 838 ng/ml) adiponectin than insulin-sensitive CAUs (CAU-IS) (P 0.01), but there were no significant differences between insulin-resistant (SA-IR) and insulin-sensitive (SA-IS) SAs. HMW adiponectin did not differ between SA-IR and CAU-IR, but SA-IS had significantly lower adiponectin concentrations than CAU-IS.

CONCLUSIONS

Insulin resistance status is not associated with significantly lower levels of adiponectin in these SA women, in contrast to the CAU women.

INTRODUCTION

Little is known about the personal sexual lives of medical students.

AIM

To assess sexual habits and determine the presence of sexual dysfunction among medical students.

MAIN OUTCOME MEASURES

Demographic and sexual experience data and domain scores on validated sexuality surveys. Instruments selected included the International Index of Erectile Function, the Index of Premature Ejaculation, and the Self Esteem and Relationship Quality Survey for male medical students and the Female Sexual Function Index (FSFI), and the Index of Sex Life for female medical students.

METHODS

Medical students at our institution were invited to complete a demographic questionnaire and gender- appropriate sexuality surveys. Results were compared with established normative data and validated cut-off scores when available. Linear regression and Pearson coefficient were used to assess relationships between variables.

RESULTS

There were 132 responses (78 female mean age 24 years, 54 male, mean age 25 years). Condoms and oral contraceptives were the most popular form of contraception. Among men, 81.5%, 37%, and 93% were in a relationship, married, and heterosexual, respectively. Among women, 64%, 18%, and 95% were in a relationship, married, and heterosexual. Erectile dysfunction was reported by 30% of men. Proxy measures of other sexual problems in men revealed a 28% prevalence of dissatisfaction with sex life, a 28% prevalence of problems controlling ejaculation, an 11% prevalence of orgasmic dysfunction, and a 6% prevalence of low sexual desire. Based on validated FSFI scoring, 63% of women were at high risk of sexual dysfunction. Proxy measures of other problems in women indicated disorders of pain, orgasms, desire, sex satisfaction, lubrication, and arousal in 39%, 37%, 32%, 28%, 26%, and 24% of female respondents, respectively.

CONCLUSIONS

These data provide insight into the sexual lives of medical students. Rates of sexual dysfunction are higher than expected based on normative data. Further research is required.

OBJECTIVE

This literature review describes evaluation and treatment of minority youth with ADHD.

METHOD

A search of databases for reports of ADHD in minority children was conducted.

RESULTS

Interpretation of behavior varies among parents, as does their trust in health care providers and school personnel. Parents desire to avoid stigmatization of their children from diagnostic labels and medications. They may not understand the sequelae of inadequate treatment or fear side effects of treatment. Children respond to stimulant medication but fare better when it is combined with regularly scheduled psychosocial treatment, including education and support for parents. Financial struggles affect access, evaluation, and treatment. Community support is desperately needed to gain parental trust. Creative planning allows health care providers and neighborhood leaders to join in, benefiting the children.

CONCLUSION

Quality evaluation by a competent provider, careful choice of assessment tools, clear communication with parents, and close follow-up of progress are all needed.

OBJECTIVE

To delineate factors that may contribute to maxillary hypoplasia requiring maxillary advancement surgery in individuals with nonsyndromic unilateral cleft lip and palate (UCLP).

METHODS

This retrospective, longitudinal study used lateral cephalometric radiographs and chart reviews of 16 nonsyndromic UCLP individuals who underwent Le Fort I maxillary advancement and 16 controls matched for cleft type, age, and gender. Cephalometric measurements were made at three time points (T1, T2, and T3): mean ages of 10.7, 13.3, and 15.8 years for the Le Fort group and 10.11, 12.9, and 15.7 years, respectively, for the control group. Information regarding team care, timing and number of surgical procedures, and number of congenitally missing teeth were determined from clinical records.

RESULTS

The Le Fort group had significant maxillary hypoplasia at all time points compared to the UCLP controls, indicated by midface length measurements, ANB and Wit's analysis (p .001). The Le Fort group had twice the number of palatal surgical procedures and number of missing teeth in the maxillary arch as compared with the cleft controls. Most of the control group had consistent team care, while most of the surgical group did not.

CONCLUSIONS

Maxillary hypoplasia that will require a Le Fort I advancement can be determined as early as age 10. Multiple missing maxillary teeth, secondary palate procedures including pharyngeal flaps, and inconsistent team care with delayed orthodontic intervention are contributing factors to maxillary underdevelopment.