Introduction
Cardiomyopathy is a common cause of morbidity and death in patients with Duchenne muscular dystrophy (DMD).
Methods
A cross-sectional analysis of clinical data from a multi-institutional, international CINRG DMD Natural History Study of 340 DMD patients aged 2 to 28 years. Cardiomyopathy was defined as shortening fraction (SF) <28% or ejection fraction (EF) <55%.
Results
231 participants reported a prior clinical echocardiogram study, and 174 had data for SF or EF. The prevalence of cardiomyopathy was 27% (47/174), and it was significantly associated with age and clinical stage. The association of cardiomyopathy with age and clinical stage was not changed by glucocorticoid use as a covariate (P>0.68). In patients with cardiomyopathy, 57 % (27/47) reported not taking any cardiac medications. Cardiac medications were used in 12% (15/127) of patients without cardiomyopathy.
Discussion
Echocardiograms were underutilized, and cardiomyopathy was undertreated in this DMD natural history cohort.
We evaluated the feasibility and acceptability of self-sampling for human papillomavirus (HPV) testing and calculated the prevalence of and risk factors for high-risk (hr) HPV infections in a community-based sample of American Indian women. To this end, we recruited 329 Hopi women aged 21-65 years to self-collect vaginal samples for hrHPV testing. Samples were tested by polymerase chain reaction for 14 hrHPV genotypes. We used chi-square tests to identify correlates of preference for clinician Pap testing versus HPV self-sampling, and age-adjusted Poisson regression to evaluate correlates of hrHPV prevalence. We found that satisfaction with HPV self-sampling was high, with 96% of women reporting that the sample was easy to collect and 87% reporting no discomfort. The majority (62%) indicated that they preferred HPV self-sampling to receiving a Pap test from a clinician. Preference for Pap testing over HPV self-sampling was positively associated with adherence to Pap screening and employment outside the home. All samples evaluated were satisfactory for HPV testing, and 22% were positive for hrHPV. HrHPV prevalence peaked in the late 20s and declined with increasing age. HrHPV positivity was inversely associated with having children living the household. In conclusion, HPV self-sampling is feasible and acceptable to Hopi women, and could be effective in increasing rates of cervical cancer screening in Hopi communities. HrHPV prevalence was similar to estimates in the general United States population.
We evaluated whether delivering educational presentations on human papillomavirus (HPV) to American Indian mothers affected HPV vaccination rates in their adolescent daughters. In March-April 2012, we recruited Hopi mothers or female guardians with daughters aged 9–12 years for a cluster-randomized intervention study on the Hopi Reservation. Participants attended mother-daughter dinners featuring educational presentations for mothers on either HPV (intervention) or juvenile diabetes (control) and completed baseline surveys. Eleven months later, we surveyed mothers on their daughters’ HPV vaccine uptake. We also reviewed aggregated immunization reports from the Indian Health Service to assess community-level HPV vaccination coverage from 2007–2013. Ninety-seven mother-daughter dyads participated; nine mothers reported that their daughters completed the three-dose HPV vaccination series before recruitment. Among the remaining mothers, 63% completed the follow-up survey. Adjusting for household income, the proportion of daughters completing vaccination within 11 months post-intervention was similar in the intervention and control groups (32% vs. 28%, adjusted RR=1.2,95%CI:0.6–2.3). Among unvaccinated daughters, those whose mothers received HPV education were more likely to initiate vaccination (50% vs. 27%, adjusted RR=2.6,95%CI:1.4–4.9) and complete three doses (adjusted RR=4.0,95%CI:1.2-13.1) than girls whose mothers received diabetes education. Community-level data showed that 80% of girls aged 13–17 years and 20% of girls aged 11–12 completed the vaccination series by 2013. HPV vaccine uptake in Hopi girls aged 13–17 years is significantly higher than the U.S. national average. Brief educational presentations on HPV delivered to American Indian mothers might increase HPV vaccination rates in daughters aged 9–12 years.
Background. High-risk human papillomavirus (hrHPV) causes cervical cancer. In the United States, approximately 40% of women aged 14-59 years from all racial and ethnic groups are infected with HPV, and prevalence typically declines with age. However, American Indian (AI) women are insufficiently sampled to permit a population-specific estimate of hrHPV prevalence.Methods. Vaginal swabs were self-collected by 698 AI women aged 21-65 years from a tribal community in the Great Plains. We estimated the population prevalence of hrHPV and identified predominant genotypes.
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