Janet Rosenbaum

Procalcitonin as a Marker for the Detection of Bacteremia and Sepsis in the Emergency Department

Rapid diagnosis of bloodstream infections (BSIs) in the emergency department (ED) is challenging, with turnaround times exceeding the timeline for rapid diagnosis. We studied the usefulness of procalcitonin as a marker of BSI in 367 adults admitted to our ED with symptoms of systemic infection. Serum samples obtained at the same time as blood cultures were available from 295 patients. Procalcitonin levels were compared with blood culture results and other clinical data obtained during the ED visit. Procalcitonin levels of less than 0.1 ng/mL were considered negative; all other levels were considered positive. In 16 patients, there was evidence of BSI by blood culture, and 12 (75%) of 16 patients had a procalcitonin level of more than 0.1 ng/mL. In 186 (63.1%) of 295 samples, procalcitonin values were less than 0.1 ng/mL, and all were culture negative. With a calculated threshold of 0.1475 ng/mL for procalcitonin, sensitivity and specificity for the procalcitonin assay were 75% and 79%, respectively. The positive predictive value was 17% and the negative predictive value 98% compared with blood cultures. Procalcitonin is a useful marker to rule out sepsis and systemic inflammation in the ED.

True Love Waits: Do Southern Baptists? Premarital Sexual Behavior Among Newly Married Southern Baptist Sunday School Students

This study measures premarital sex prevalence, sources of sex education, and support for secular sex education among 151 newly married young adults surveyed at 9 Texas Southern Baptist churches. More than 70% of respondents reported having had premarital vaginal or oral sex, but more than 80% regretted premarital sex. The proportion of premarital sex exceeded 80% in 6 of 9 churches, among men and women married after age 25 and women married before age 21. School sex education was the only source of information about sexually transmitted infections for 57% of respondents, and 65% supported secular sex education despite church opposition.

Gun utopias? Firearm access and ownership in Israel and Switzerland

The 2011 attempted assassination of a US representative renewed the national gun control debate. Gun advocates claim mass-casualty events are mitigated and deterred with three policies: (a) permissive gun laws, (b) widespread gun ownership, (c) and encouragement of armed civilians who can intercept shooters. They cite Switzerland and Israel as exemplars. We evaluate these claims with analysis of International Crime Victimization Survey (ICVS) data and translation of laws and original source material. Swiss and Israeli laws limit firearm ownership and require permit renewal one to four times annually. ICVS analysis finds the United States has more firearms per capita and per household than either country. Switzerland and Israel curtail off-duty soldiers’ firearm access to prevent firearm deaths. Suicide among soldiers decreased by 40 per cent after the Israeli armys 2006 reforms. Compared with the United States, Switzerland and Israel have lower gun ownership and stricter gun laws, and their policies discourage personal gun ownership.

Telling truth from Ys: an evaluation of whether the accuracy of self-reported semen exposure assessed by a semen Y-chromosome biomarker predicts pregnancy in a longitudinal cohort study of pregnancy

Objectives Adolescents may use condoms inconsistently or incorrectly, or may over-report condom use. This study used a semen exposure biomarker to evaluate the accuracy of female adolescents’ reports of condom use and predict subsequent pregnancy. Methods The sample comprised 715 sexually active African-American female adolescents, ages 15–21 years. At baseline, 6 months and 12 months, participants completed a 40-min interview and were tested for semen Y-chromosome with PCR from a self-administered vaginal swab. We predicted pregnancy from semen exposure under-report using multivariate regression controlling for oral contraception, reported condom use and coital frequency. Results At the 3 surveys, 30%, 20% and 15% of adolescents who reported always using condoms tested positive for semen exposure. At 6 month follow-up, 20.4% and 16.2% of the adolescents who under-reported semen exposure reported pregnancy, a higher pregnancy rate than accurate reporters of semen exposure, even accurate reporters who reported never using condoms (14.2% and 11.8%). Under-reporters of semen exposure were 3.23 (95% CI (1.61, 6.45)) times as likely to become pregnant at 6-month follow-up and 2.21 (0.94, 5.20) times as likely to become pregnant at 12-month follow-up as accurate reporters who reported not using contraception, adjusting for self-reported coital frequency. Conclusions Adolescents who under-report semen exposure may be at uniquely high risk for unplanned pregnancy and STIs, and may also under-report coital frequency. Condom efficacy trials that rely on self-report may yield inaccurate results. Adapted to a clinical setting, the Y-chromosome PCR could alert women to incorrect or inconsistent condom use.

Do Jobs Work? Risk and Protective Behaviors Associated with Employment Among Disadvantaged Female Teens in Urban Atlanta.

Adolescent employment research has focused on middle-class rather than disadvantaged adolescents. We identified risks and benefits of adolescent employment in a 12-month study of 715 low-socioeconomic-status female African American adolescents using nearest-neighbor Mahalanobis matching on baseline factors including substance use and socioeconomic status. Employed adolescents were more likely to graduate high school and less likely to depend on boyfriends for spending money, but they were more likely to use marijuana, alcohol, and have sex while high or drunk. Employment may help female adolescents avoid potentially coercive romantic relationships, but increase access to drugs or alcohol.

Educational and Criminal Justice Outcomes 12 Years After School Suspension

A third of U.S. students are suspended over a K-12 school career. Suspended youth have worse adult outcomes than nonsuspended students, but these outcomes could be due to selection bias: that is, suspended youth may have had worse outcomes even without suspension. This study compares the educational and criminal justice outcomes of 480 youth suspended for the first time with those of 1,193 matched nonsuspended youth from a nationally representative sample. Prior to suspension, the suspended and nonsuspended youth did not differ on 60 pre-suspension variables including students’ self-reported delinquency and risk behaviors, parents’ reports of socioeconomic status, and administrators’ reports of school disciplinary policies. Twelve years after suspension (ages 25-32), suspended youth were less likely than matched nonsuspended youth to have earned bachelor’s degrees or high school diplomas, and were more likely to have been arrested and on probation, suggesting that suspension rather than selection bias explains negative outcomes.

Disabilities and Degrees: Identifying Health Impairments that Predict Lower Chances of College Enrollment and Graduation in a Nationally Representative Sample:

Objective: Colleges have increased postsecondary educational access for youth, including individuals with disabilities, but completion rates remain low. This study tests the hypothesis that health conditions that reduce social integration predict lower educational attainment among college students. Method: The sample from the nationally representative Add Health (National Longitudinal Study of Adolescent and Adult Health) data (1995, 2001, 2008) comprised respondents in 2001 whose highest degree was a high school diploma (n = 9,909), focusing on subsamples of students enrolled in 2-year colleges and 4-year colleges (n = 1,494; n = 2,721). For each of 57 health conditions in 2001, the relative risk of earning certificate, associate’s degree, or bachelor’s degree in 2008 was estimated, controlling for precollege factors, including high school grades, test scores, parents’ household income, and full-time enrollment. Results: Health conditions associated with social stigma predicted lower educational attainment among 2-year college students including stuttering, being overweight, and health that restricts engaging in vigorous sports. A broader range of health conditions predicted lower educational attainment among 4-year college students, including restrictions on climbing one and several flights of stairs and walking one and several blocks. Contributions: Stigmatized health conditions may disproportionately reduce educational attainment by impacting students’ social integration in 2-year colleges. Improved awareness may reduce the impact of unconscious stigma. Until 4-year colleges improve accommodations, students may benefit by earning credentials at 2-year colleges before transferring to 4-year institutions.

Semen says: assessing the accuracy of adolescents' self-reported sexual abstinence using a semen Y-chromosome biomarker

Objective Researchers often assess condom use only among participants who report recent sexual behaviour, excluding participants who report no recent vaginal sex or who did not answer questions about their sexual behaviour, but self-reported sexual behaviour may be inaccurate. This study uses a semen Y-chromosome biomarker to assess semen exposure among participants who reported sexual abstinence or did not report their sexual behaviour. Methods This prospective cohort study uses data from 715 sexually active African–American female adolescents in Atlanta, surveyed at baseline, 6 months and 12 months. Participants completed a 40 min interview and were tested for semen Y-chromosome with PCR from a self-administered vaginal swab. We predicted Y-chromosome test results from self-reported sexual behaviour using within-subject panel regression. Results Among the participants who reported abstinence from vaginal sex in the past 14 days, 9.4% tested positive for semen Y-chromosome. Among item non-respondents, 6.3% tested positive for semen Y-chromosome. Women who reported abstinence and engaged in item non-response regarding their sexual behaviour had respectively 62% and 78% lower odds of testing positive for Y-chromosome (OR 0.38 (0.21 to 0.67), OR 0.22 (0.12 to 0.40)), controlling for smoking, survey wave and non-coital sexual behaviours reported during abstinence. Conclusions Adolescents who report sexual abstinence under-report semen exposure. Research should validate self-reported sexual behaviour with biomarkers. Adolescents who engage in item non-response regarding vaginal sex test positive for semen Y-chromosome at similar rates, which supports the practice of grouping non-respondents with adolescents reporting abstinence in statistical analysis. Trial registration number NCT00633906.

What Educators Should Know about College-for-All Policies.

This study finds that schools are poorly prepared to counsel students about community college certificate or associate degree programs. Instead the mantra of college for all continues to encourage youth to spend time and money on bachelor’s degrees, for which many students are not prepared to do well. Teachers desire more information on college and career options for their low-performing and disengaged students, and the authors show that community colleges offer many college and career opportunities that can serve these students.

P2-S1.18 Accuracy of self-reported condom use assessed by the semen Y-chromosome biomarker for unprotected sex

Background Adolescents may use condoms inconsistently or incorrectly, and may over-report their condom use. Biomarkers offer a potential solution to over-report, allowing interventions to target populations at risk from inconsistent condom use. This study uses a biomarker for unprotected sex to evaluate the accuracy of adolescent womens reports of condom use. Methods The sample comprised 715 African-American female participants in an HIV prevention trial who were ages 15–21, sexually active, and recruited from three urban Atlanta family planning and STI clinics in 2002–2004. At baseline, 6, and 12 months, participants completed a 40 min ACASI interview and were tested for semen Y-chromosome with PCR from a self-administered vaginal swab. Data analysis used non-parametric tests for trend and clustered logistic regression to predict self-reported pregnancy. Results At the three waves respectively 30%, 20% and 15% of participants who reported 100% condom use tested positive for semen Y chromosome. Suspected over-reporters of condom use were more likely to report being pregnant at the following wave than any other category of condom and birth control users: at wave 2, 20.4% of wave 1 suspected over- reporters were pregnant vs 14.2% of wave 1 condom never-users and 9.8% of those reporting no birth control at last sex; at wave 3, 16.2% of wave 2 suspected over-reporters were pregnant vs 11.8% of condom never-users and 10.8% reporting no birth control at last sex. Suspected over-reporters of unprotected sex were more likely to report pregnancy at the following wave, controlling for frequency of sex, condom use, and oral contraception (OR 3.95 (1.63 to 9.58), 2.64 (0.92 to 7.58)) see Abstract P2-S1.18 Table 1. Abstract P2-S1.18 Table 1 Prediction of pregnancy with logistic regression. Analysis was limited to those who participated in all 3 waves of the survey (n=560). Did not report sex past 60 days are those who participated in the wave but did not answer the question how many times they had sex in the past 60 days. Condom use in the past 60 days was imputed from condom use in the past 14 days for these individuals. Predictors of pregnancy are measured in the wave previous to pregnancy Variable OR (95% CI) p Pregnancy at wave 2  Suspected over–report 3.95 (1.63 to 9.58) 0.002  Times sex past 60 days 1.02 (1.00 to 1.05) 0.02  Proportion condom use past 60 days 0.50 (0.21 to 1.18) 0.11  Birth control pill 0.42 (0.12 to 1.40) 0.16  Did not report sex past 60 days 0.57 (0.15 to 2.17) 0.41 Pregnancy at wave 3  Suspected over–report 2.64 (0.92 to 7.58) 0.07  Times sex past 60 days 1.04 (1.02 to 1.06) 0.000  Proportion condom use past 60 days 0.56 (0.24 to 1.31) 0.18  Birth control pill 0.14 (0.02 to 1.08) 0.06  Did not report sex past 60 days 1.52 (0.57 to 4.01) 0.40 Conclusions Respondents who report 100% condom use but test positive for semen Y-chromosome are at higher risk than other women. These women may be over-reporting their condom use and under-reporting their frequency of sex.