The Center for Epidemiologic Studies Depression Scale (CES-D) is a widely used self-report measure of depression symptomatology. This study evaluated the reliability, validity, and measurement invariance of the CES-D 10 in a diverse cohort of Hispanics/Latinos from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). The sample consisted of 16,415 Hispanic/Latino adults recruited from four field centers (Miami, FL; San Diego, CA; Bronx, NY; Chicago, IL). Participants completed interview administered measures in English or Spanish. The CES-D 10 was examined for internal consistency, test-retest reliability, convergent validity, and measurement invariance. The total score for the CES-D 10 displayed acceptable internal consistencies (Cronbach α’s = .80 – .86) and test-retest reliability (r’s = .41 – .70) across the total sample, language group and ethnic background group. The total CES-D 10 scores correlated in a theoretically consistent manner with the Spielberger State-Trait Anxiety Inventory (r = .72, p < .001), the Patient Health Questionnaire-9 depression measure (r = .80, p < .001) the Short Form-12’s Mental Component Summary (r = −.65, p < .001) and Physical Component Summary score (r = −.25, p < .001). A confirmatory factor analysis showed that a one-factor model fit the CES-D 10 data well (CFI = .986, RMSEA = .047) after correlating one pair of item residual variances. Multiple group analyses showed the one-factor structure to be invariant across English and Spanish speaking responders and partially invariant across Hispanic/Latino background groups. The total score of the CES-D 10 can be recommended for use with Hispanics/Latinos in English and Spanish.
Colonization of the vaginal mucosa with uropathogens from fecal flora is an important step in ascending urinary tract infections (UTIs) in women. Colonization is influenced by interactions between uropathogens, vaginal fluid, and epithelial cells. In this study, vaginal fluid from 21 women was assessed for effects on adherence of type 1 piliated Escherichia coli to the A431 cell line. Adherence to cells was enhanced by all fluid specimens when tested at low fluid protein concentrations in an in vitro assay. At higher concentrations, certain specimens maintained enhanced binding whereas others resulted in diminished binding. Increases in adherence were associated with increased binding of E. coli to vaginal fluid in vitro and with higher vaginal fluid pH. These results demonstrate that vaginal fluid significantly alters the adherence of type 1 piliated E. coli to epithelial cells in vitro and, therefore, should be studied as a potential modifier in bacterial colonization and UTIs in vivo.
To better understand the interactions involved in bacterial adherence and the role of mucus in the pathogenesis of urinary tract infections, we developed a system to study the binding of a recombinant Escherichia coli strain, HB101/pWRS1-17, expressing type 1 pili, to vaginal mucus collected from 28 women. Bacteria bound to differing extents to all specimens examined, and preincubation of bacteria with mannose inhibited binding by 50 to 89%. Additionally, all mucus samples showed reactivity with anti-mannose antibody, and the levels of reactivity correlated with the levels of bacterial binding, suggesting that the mannose-terminal saccharides present on these glycoproteins are the receptors for the binding of type 1-piliated bacteria. Mucus specimens collected over periods of 5 days and 12 weeks exhibited significant variation in bacterial binding, indicating temporal differences in the ability of vaginal mucus to act as a receptor for type 1-piliated E. coli. The results show that vaginal mucus can bind bacteria and may thus influence the initial attachment and subsequent colonization of the vaginal and urinary tract epithelium by E. coli.
Blood group antigens on epithelial cells may influence bacterial adherence to mucosal surfaces. In the urinary tract the presence of these genetically determined carbohydrate structures may affect bacterial colonization of the vaginal mucosa and subsequent urinary tract infection. In previous studies the detection of ABH and Lewis antigen expression and distribution in tissues have made use of semiquantitative immunohistochemical staining techniques. To determine the pattern and intensity of blood group antigens on epithelial cells and in the mucus overlying them, we developed quantitative immunoassays that use monoclonal antibodies to detect changes in the expression and intensity of ABH and Lewis antigens on cells and in mucus. Vaginal and buccal cell specimens from 23 healthy women (15 secretors and 8 nonsecretors) with no history of urinary tract infections and known blood group types were analyzed for the expression of these antigenic determinants. The profile of ABH antigen expression was generally consistent with the ABO phenotype of the individual and appeared to be influenced by the secretor status; the levels of A, B and H determinants were higher for secretors than nonsecretors. Lewis antigens were detected on vaginal and buccal cells, and mucus. Le(a) and Le(x) antigen expression was greater on cells and mucus from nonsecretors, whereas the expression of Le(b) and Le(y) was greater on cells and mucus from secretors. Variability in antigen expression was observed among individuals with the same blood type and secretor status. The patterns of antigen expression were similar for the vaginal and buccal cell, and mucus samples of an individual but the amount of antigen generally differed for the various samples. These findings document the variation of blood group antigen expression on vaginal epithelial cells and mucus, which may have a significant role in susceptibility to urinary tract infections in women.
The expression of blood group antigens on the surface of urothelial cells and in mucus is controlled partly by the blood type and secretor status of the individual. To our knowledge, the possibility that the levels of these antigens vary with time has not been previously assessed. We determine if the pattern and/or intensity of blood group antigen expression on vaginal epithelial cells and mucus changed with time. Cell and mucus specimens were collected weekly for 3 months from 10 women: 5 (2 secretors and 3 nonsecretors) with and 5 (3 secretors and 2 nonsecretors) without a history of urinary tract infections. In addition, samples were collected on 5 consecutive days from 5 of these individuals. The cell and mucus samples were assayed for ABH and Lewis blood group antigens using monoclonal antibodies in cell concentration immunofluorescence and enzyme-linked fluorogenic assays, respectively. Although the pattern of antigen expression in the vaginal cell and mucus samples was consistent with the blood type and secretor status of an individual, in all women the level of antigen expression changed significantly and rapidly during the 3-month and 5-day periods. The results show a previously unrecognized phenomenon and demonstrate that the expression of blood group antigens on vaginal cells and in mucus is a dynamic process.
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