Child blood lead concentrations have been associated with measures of immune dysregulation in nationally representative study samples. However, response to vaccination—often considered the gold standard in immunotoxicity testing—has not been examined in relation to typical background lead concentrations common among U.S. children. The present study estimated the association between blood lead concentrations and antigen-specific antibody levels to measles, mumps, and rubella in a nationally representative sample of 7005 U.S. children aged 6–17 years. Data from the 1999–2004 cycles of the National Health and Nutrition Examination Survey (NHANES) were used. In the adjusted models, children with blood lead concentrations between 1 and 5 µg/dL had an 11% lower anti-measles (95% CI: −16, −5) and a 6% lower anti-mumps antibody level (95% CI: −11, −2) compared to children with blood lead concentrations <1 µg/dL. The odds of a seronegative anti-measles antibody level was approximately two-fold greater for children with blood lead concentrations between 1 and 5 µg/dL compared to children with blood lead concentrations <1 µg/dL (OR = 2.0, 95% CI: 1.4, 3.1). The adverse associations observed in the present study provide further evidence of potential immunosuppression at blood lead concentrations <5 µg/dL, the present Centers for Disease Control and Prevention action level.
This study examined perceptions of barriers to care among patients presenting through the emergency department with a suicide attempt. Eighteen patients were surveyed on their perceived access to providers and how they felt 6 distinct barriers limited their access to treatment. Although most (73%) reported having a health care provider they could have contacted before their suicide attempt, the majority (78%) reported at least 1 moderate barrier to care, with the most common barrier being difficulty finding transportation. Of those reporting any experienced barriers, 80% reported more than 1. Knowledge of the most prevalent and serious barriers perceived can subsequently be used to craft tailored follow-up instructions to prevent repeated attempts. (PsycINFO Database Record
model, we assumed that ASA reduced the risk of preterm preeclampsia by 61% but did not reduce the risk of term preeclampsia. Sensitivity analyses that varied these and other assumptions were performed to assess the model's robustness. Threshold analyses were performed to identify the costs and risks of ASA-related complications (e.g., gastrointestinal bleeding and respiratory sensitivity) at which the preferred strategy shifted. The primary outcome was the incremental cost effectiveness ratio (ICER) defined as the cost needed to avert one case of preeclampsia. An ICER less than 100,000 USD was considered cost-effective based on literature describing maternal and neonatal costs associated with preeclampsia. RESULTS: Under baseline estimates, universal ASA use is the dominant strategy (i.e., costs the least and provides the greatest health benefit). For every 100,000 women, universal ASA use would save $19,216,551 and result in 308 fewer cases of preeclampsia compared to ASA use guided by biomarker and ultrasound risk assessment (Table 1). In univariate and multivariate analyses, the model was sensitive only to the probability of ASA administration. When ASA use in the universal strategy was below 55%, following USPSTF guidelines became more cost effective. Threshold analysis revealed that only when the rate of GI bleeding with ASA exceeded 0.94% or the rate of respiratory complications exceeded 38% was universal ASA no longer the dominant strategy. In a Monte Carlo analysis, universal ASA was the most cost-effective strategy in 89% of simulations. CONCLUSION: Universal aspirin administration, as compared to several other strategies for preeclampsia risk assessment and selected ASA use is a dominant strategy across a broad range of relevant probabilities.
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