Claudia A. Kozinetz

Noroviruses as a Cause of Diarrhea in Immunocompromised Pediatric Hematopoietic Stem Cell and Solid Organ Transplant Recipients.

Case reports describe significant norovirus gastroenteritis morbidity in immunocompromised patients. We evaluated norovirus pathogenesis in prospectively enrolled solid organ (SOT) and hematopoietic stem cell transplant (HSCT) patients with diarrhea who presented to Texas Childrens Hospital and submitted stool for enteric testing. Noroviruses were detected by real‐time reverse transcription polymerase chain reaction. Clinical outcomes of norovirus diarrhea and non‐norovirus diarrhea patients, matched by transplanted organ type, were compared. Norovirus infection was identified in 25 (22%) of 116 patients, more frequently than other enteropathogens. Fifty percent of norovirus patients experienced diarrhea lasting ≥14 days, with median duration of 12.5 days (range 1–324 days); 29% developed diarrhea recurrence. Fifty‐five percent of norovirus patients were hospitalized for diarrhea, with 27% requiring intensive care unit (ICU) admission. One HSCT recipient developed pneumatosis intestinalis. Three HSCT patients expired ≤6 months of norovirus diarrhea onset. Compared to non‐norovirus diarrhea patients, norovirus patients experienced significantly more frequent ICU admission (27% vs. 0%, p = 0.02), greater serum creatinine rise (median 0.3 vs. 0.2 mg/dL, p = 0.01), and more weight loss (median 1.6 vs. 0.6 kg, p < 0.01). Noroviruses are an important cause of diarrhea in pediatric transplant patients and are associated with significant clinical complications.

New sexual partners and readiness to seek screening for chlamydia and gonorrhoea: predictors among minority young women

Objectives: To determine (1) level of readiness and (2) demographic and behavioural predictors of readiness to seek chlamydia (CT) and gonorrhoea (NGC) screening in the absence of symptoms after sex with a “new” partner. Methods: Baseline data, obtained as part of a larger randomised controlled clinical trial in young women, were analysed. Readiness to seek screening for CT and NGC after sex with a “new” partner was assessed using the stages of change framework from the transtheoretical model of change—precontemplation, contemplation, preparation, and action. Ordinal logistic regression, using the proportional odds model, was used to determine predictors of being in action for or having already been screened for CT and NGC after sex with a “new” partner. Results: The sample consisted of 376 predominantly African American (67%) young women (mean age 18.5 (SD 1.4) years). The distribution of readiness to seek CT and NGC screening was 4% precontemplation, 11% contemplation, 28% preparation, and 57% action. The best fitting logistic model that predicted being in action for seeking screening after sex with a “new” partner included high perceived seriousness of acquiring a sexually transmitted infection (OR = 2.02, 95% CI 1.05 to 3.89), and having “other” (not steady) partners in the last 6 months (OR = 0.50, 95% C.I. 0.32 to 0.78) Conclusions: Many young women report that they were not getting screened for CT and NGC after sex with a “new” partner and therefore may be at increased risk of an untreated STI. Enhancing level of perceived seriousness of acquiring an STI from a “new” partner may increase a young woman’s readiness to seek screening after initiating a new sexual relationship.

Youtube and Food Allergy: An Appraisal of the Educational Quality of Information

Food allergy affects an estimated 8% of children and 3% of adults in the United States. Food‐allergic individuals increasingly use the web for medical information. We sought to determine the educational quality of food allergy YouTube videos.

Multilevel Provider-Based Sampling for Recruitment of Pregnant Women and Mother-Newborn Dyads

OBJECTIVE: In 2010, the National Children’s Study launched 3 alternative recruitment methods to test possible improvements in efficiency compared with traditional household-based recruitment and participant enrollment. In 2012, a fourth method, provider-based sampling (PBS), tested a probability-based sampling of prenatal provider locations supplemented by a second cohort of neonates born at a convenience sample of maternity hospitals. METHODS: From a sampling frame of 472 prenatal care provider locations and 59 maternity hospitals, 49 provider and 7 hospital locations within or just outside 3 counties participated in study recruitment. During first prenatal care visits or immediately postdelivery at these locations, face-to-face contact was used to screen and recruit eligible women. RESULTS: Of 1450 screened women, 1270 were eligible. Consent rates at prenatal provider locations (62%–74% by county) were similar to those at birth locations (64%–77% by county). During 6 field months, 3 study centers enrolled a total prenatal cohort of 530 women (the majority in the first trimester) and during 2 months enrolled a birth cohort of an additional 320 mother-newborn dyads. As personnel became experienced in the field, the time required to enroll a woman in the prenatal cohort declined from up to 200 hours to 50 to 100 hours per woman recruited. CONCLUSIONS: We demonstrated that PBS was feasible and operationally efficient in recruiting a representative cohort of newborns from 3 diverse US counties. Our findings suggest that PBS is a practical approach to recruit large pregnancy and birth cohorts across the United States.

Treatment-Naïve HIV-Infected Patients Have Fewer Gut-Homing β7 Memory CD4 T Cells than Healthy Controls

Objectives The integrin &agr;4&bgr;7 is the gut-homing receptor for lymphocytes. It also is an important co-receptor for human immunodeficiency virus (HIV) via glycoprotein (gp)120 binding. Depletion of gut cluster of differentiation (CD)4 T cells is linked to chronic inflammation in patients with HIV; however, measuring CD4 cells in the gut is invasive and not routine. As such, establishing a peripheral marker for CD4 depletion of the gut is needed. We hypothesized that &agr;4&bgr;7 CD4 T cells are depleted in the peripheral blood of treatment-naïve patients with HIV compared with healthy controls. Methods The study groups were treatment-naïve patients with HIV and uninfected controls. Subjects were included if they were 18 years or older with no history of opportunistic infections, active tuberculosis, or cancer. We collected peripheral blood and examined on whole blood using flow cytometry for the following cell surface markers: CD4, CD45RO, chemokine receptor type 5, C-X-C chemokine receptor type 4 (CXCR4), and the integrin &bgr;7. We collected demographic information, including age, sex, and ethnicity, as well as viral load (VL) and CD4 count. Two-sample t tests and Fisher exact tests were used to compare the differences between the two groups. Spearman correlation coefficients were calculated between CD4 count and log10− VL and percentage of CD4+/CD45RO+/&bgr;7+ and log10− VL in patients. Results Twenty-two subjects were enrolled in the study (12 patients with HIV and 10 controls). There were no differences in age or sex between the two groups. There were more Hispanics and fewer Asians in the group comprising patients with HIV compared with the control group (7 vs 2 and 0 vs 4, P = 0.05, respectively). Patients infected with HIV had significantly lower frequencies of CD4+/CD45RO+/&bgr;7+ cells (median 12%, range 5–18 compared with uninfected controls: median 20%, range 11–26, P = 0.0007). There was a statistically significant difference in the percentage of CD4+/CD45RO+/C-X-C chemokine receptor type 4+ cells between patients (72%, range 60%–91%) compared with controls (79%, range 72%–94%, P = 0.04). The percentage of CD4+/CD45RO+/chemokine receptor type 5+ did not differ between the group of patients with HIV and the control groups (22%, range 11%–57% vs 27%, range 14%–31%; P = 0.8, respectively). There was no correlation between percentage of CD4+/CD45RO+/&bgr;+ cells and log10− VL as measured by the Spearman correlation coefficient (r = 0.05, P = 0.88) in patients infected with HIV. Conclusions Memory CD4 &bgr;7+ cells are reduced significantly in the peripheral blood of untreated patients infected with HIV, which could be used as a noninvasive indicator of intestinal CD4 T cell loss and recovery. Further studies are needed to examine whether depletion of these CD4+/CD45RO+/&bgr;7+ cells in the peripheral blood parallels depletion in the gut of treatment-naïve patients with HIV and whether levels return to control levels after treatment.

Pregnant Adolescents As Perpetrators and Victims of Intimate Partner Violence

The role of pregnant adolescents as perpetrators of intimate partner violence (IPV) is not well understood. Socioecological factors associated with IPV (physical assault and injury, and psychological aggression) perpetrated by pregnant adolescents and the association between IPV and attitudes toward the use of physical punishment to discipline children were examined among 246 pregnant adolescents. Pregnant adolescents were more likely to report perpetrating both physical assault (24%) and psychological aggression (52.7%) than being the recipient (12.2% and 38.6%, respectively) and having been physically injured (7%) than inflicting injury (4.1%). Risk factors for perpetrating physical assault included prior assault by partner, being African American, exposure to community violence, being in trouble with the police, and multiple lifetime drug use. IPV perpetrators had more favorable attitudes toward the use of physical punishment. Interventions should address IPV and parenting attitudes in young couples to maximize the health and safety of both mother and unborn child.