These data indicate an emerging US epidemic of HCV infection among young nonurban persons of predominantly white race. Reported incidence was higher in 2012 than 2006 in at least 30 states, with largest increases in nonurban counties east of the Mississippi River. Prescription opioid abuse at an early age was commonly reported and should be a focus for medical and public health intervention.

Abstract-Risk factors for arterial stiffness progression have not been well characterized. We examined the relationship between arterial stiffness progression and body weight and weight gain in a group of healthy young adults. Aortic pulse-wave velocity was assessed at 2 time points approximately 2 years apart in 152 white and black adults aged 20 to 40 years, and was standardized by the time between visits to obtain annualized pulse-wave velocity changes. Blacks had 15.5 cm/s per year larger annual pulse-wave velocity increases compared with whites (Pϭ0.02), even after multivariable adjustment for weight and blood pressure changes. Larger annual pulse-wave velocity increases were also associated with larger baseline body weight (Pϭ0.02), waist girth (Pϭ0.003), and body mass index (PϽ0.001), and greater annual weight gain (Pϭ0.02), after adjustment for baseline pulse-wave velocity. After multivariable adjustment that included blood pressure changes, larger baseline waist girth (Pϭ0.009), baseline body mass index (Pϭ0.001), body mass index increase (Pϭ0.037), and weight gain (Pϭ0.017) remained significantly associated with larger annual pulse-wave velocity progression. Weight change showed a direct relationship with pulse-wave velocity change; mean annual pulse-wave velocity changes were Ϫ29.9 cm/s per year (regression) for those with Ն4.5 kg annual weight loss and 18.2 cm/s per year (progression) for those with Ն4.5 kg annual weight gain. These data show strong associations between weight gain and arterial stiffness progression, as well as between weight loss and arterial stiffness regression. These data greatly underscore the vascular benefit of weight loss. Successful weight loss programs in young adults, particularly blacks, are needed.

Objectives To examine the association of cardiovascular disease (CVD) and its risk factors with age-associated hearing loss, in a cohort of older black and white adults. Study Design Cross-sectional cohort study Setting The Health, Aging, and Body Composition (Health ABC) study; A community-based cohort study of older adults from Pittsburgh, PA and Memphis TN. Participants 2,049 well-functioning adults (mean age: 77.5 years; 37% black) Measurements Pure-tone audiometry and history of clinical CVD were obtained at the 4th annual follow-up visit. Pure-tone averages in decibels reflecting low frequencies (250, 500, and 1000 Hz) middle frequencies (500, 1000, and 2000 Hz) and high frequencies (2000, 4000, and 8000Hz) were calculated for each ear. CVD risk factors, aortic pulse-wave velocity, and ankle-arm index were obtained at the study baseline. Results In gender-stratified models, after adjustment for age, race, study site and occupational noise exposure, risk factors associated with poorer hearing sensitivity among men included higher triglyceride levels, higher resting heart rate and history of smoking. Among women, poorer hearing sensitivity was associated with higher BMI, higher resting heart rate, faster pulse-wave velocity, and low ankle-arm index. Conclusion Modifiable risk factors for CVD may play a role in the development of age-related hearing loss.

BackgroundThe number of cases of gonorrhoea in the USA and worldwide caused by Neisseria gonorrhoeae is increasing (555 608 reported US cases in 2017, and 87 million cases worldwide in 2016). Many countries report declining in vitro susceptibility of azithromycin, which is a concern because azithromycin and ceftriaxone are the recommended dual treatment in many countries. We aimed to identify strain types associated with decreased susceptibility to azithromycin. MethodsWe did a genomic analysis of N gonorrhoeae isolates obtained by the US Gonococcal Isolate Surveillance Project. Isolates were whole-genome sequenced based on decreased susceptibility to azithromycin (minimal inhibitory concentration [MIC] ≥2 µg/mL, using agar dilution antibiotic susceptibility testing) and geographical representation. Bioinformatic analyses established genomic diversity, strain population dynamics, and antimicrobial resistance profiles. Findings 410 isolates were sorted into more than 20 unique phylogenetic clades. One predominant persistent clade (consisting of 97 isolates) included the most isolates with azithromycin MICs of 2 µg/mL or higher (61 of 97 [63%] vs 59 of 311 [19%]; p<0•0001) and carried a mosaic mtr (multiple transferable resistance) locus (68 of 97 [70%] vs two of 313 [1%]; p<0•0001). Of the remaining 313 isolates, 57 (18%) had decreased susceptibility to azithromycin (MIC ≥4 µg/mL), which was attributed to 23S rRNA variants (56 of 57 [98%]) and formed phylogenetically diverse clades, showing various levels of clonal expansion. Interpretation Reduced azithromycin susceptibility was associated with expanding and persistent clades harbouring two well described resistance mechanisms, mosaic mtr locus and 23S rRNA variants. Understanding the role of recombination, particularly within the mtr locus, on the fitness and expansion of strains with decreased susceptibility has important implications for the public health response to minimise gonorrhoea transmission. Funding US Centers for Disease Control and Prevention (CDC), CDC Combating Antibiotic Resistant Bacteria initiative,

There was an increased risk of mortality from IHD associated with cumulative exposure to coal dust, and with coal rank. The effect of coal rank may be due differences in the composition of coal mine dust particulate. The association of risk of IHD mortality with cumulative particulate exposure is consistent with air pollution studies.

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