Genome-wide association identifies nine common variants associated with fasting proinsulin levels and provides new insights into the pathophysiology of type 2 diabetes.

Objective: Proinsulin is a precursor of mature insulin and C-peptide. Higher circulating proinsulin levels are associated with impaired β-cell function, raised glucose levels, insulin resistance, and type 2 diabetes (T2D). Studies of the insulin processing pathway could provide new insights about T2D pathophysiology.

Access to care for children with autism in the context of state Medicaid reimbursement.

This paper examines the role of state residence and Medicaid reimbursement rates in explaining the relationship between having autism and access to care for children. Three questions are addressed: (1) Is there variation across states in the relationship between having autism and access to care? (2) Does taking account of state residence explain a significant amount of the variation in this relationship? (3) Does accounting for Medicaid reimbursement rates enhance our understanding of this relationship? Data from the 2005 National Survey of Children with Special Health Care Needs were combined with state characteristics to estimate a hierarchical generalized linear model of the association between state residence, Medicaid reimbursement rate and problems accessing care for children with special health care needs with and without autism. Findings indicate there is significant variation between states in the relationship between having autism and problems accessing care, and accounting for state residence explains a significant amount of variation in the model.

Acute glomerulonephritis in a child with multidrug-resistant tuberculosis and multibacillary leprosy.

A 10-year-old boy from Papua New Guinea with multidrug-resistant tuberculosis and multibacillary leprosy developed acute glomerulonephritis while being treated as an inpatient at Thursday Island Hospital in the Torres Strait, Queensland. This is the first such case to be reported in Australia, where these diseases are uncommon and the combination is extremely rare, and it outlines important learning points regarding the aetiology of renal disease among patients with tuberculosis and leprosy.

The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial.

Background: Lowering LDL cholesterol with statin regimens reduces the risk of myocardial infarction, ischaemic stroke, and the need for coronary revascularisation in people without kidney disease, but its effects in people with moderate-to-severe kidney disease are uncertain. The SHARP trial aimed to assess the efficacy and safety of the combination of simvastatin plus ezetimibe in such patients.

Methods: This randomised double-blind trial included 9270 patients with chronic kidney disease (3023 on dialysis and 6247 not) with no known history of myocardial infarction or coronary revascularisation.

The effects of exposure of susceptible alpacas to alpacas persistently infected with bovine viral diarrhea virus.

Reports of bovine viral diarrhea virus (BVDV) infections in alpacas have been increasing in recent years but much is still unknown about the mechanisms of disease in this species. This report characterizes the transmission of BVDV from persistently infected (PI) alpacas to BVDV naïve alpacas, documents shedding patterns, and characterizes the disease effects in both PI and transiently infected alpacas. Two PI alpacas shed BVDV Type 1b virus in most body fluids, and commonly available diagnostic tests verified their status.

No impact of KIF6 genotype on vascular risk and statin response among 18,348 randomized patients in the heart protection study.

Objectives: The aim of this study was to test the effects of the KIF6 Trp719Arg polymorphism (rs20455) on vascular risk and response to statin therapy in 18,348 participants from the Heart Protection Study.

Background: There have been claims that noncarriers of the KIF6 719Arg variant receive little benefit from statin therapy. Screening for this genetic variant is now being used to influence statin use.

HIV, malaria and pneumonia in a Torres Strait Islander male--a case report.

This report presents the case of a middle-aged Torres Strait Islander male with HIV who contracted Plasmodium vivax malaria in Papua New Guinea. His presentation included clinical and radiological features of pneumonia and he required inpatient treatment for 13 days. This study reviews the literature concerning co-infection with HIV and malaria, which is an uncommon combination in Australia, discusses the public health risks posed by patients with malaria in the Torres Strait, given the presence of a known vector, and suggests strategies to reduce the disease burden posed by malaria in this patient and other Torres Strait Islanders travelling to Papua New Guinea under the terms of the Torres Strait Treaty.

Recruitment and consent of women with intellectual disabilities in a randomised control trial of a health promotion intervention.

Background: The need for evidence-based health promotion interventions for women with intellectual and developmental disabilities is critical. However, significant barriers impede them from participating in research, including those related to recruitment and obtaining informed consent.

Methods: This study describes a procedure for the recruitment and consent of women with intellectual disabilities into a community-based, multi-site randomised controlled trial.

Direct immunization of the abomasum or rectum of goats induces local lymph node responses against Haemonchus contortus mucosal antigens.

We investigated several methods to immunize the abomasum (fourth and gastric stomach) of kid goats by direct (abomasal) or distal (rectal or nasal) routes utilizing mucosal antigens isolated from the abomasal parasite, Haemonchus contortus. Direct (ultrasound guided), immunization of the abomasal mucosa together with rectal immunization established lymphocyte proliferation responses in abomasal lymph nodes (ALNs), while distal methods, alone, produced equivocal results. The differential responses (cellular and antibody) induced by alternative immunization methods demonstrated an experimental system that can facilitate advances in mucosal immunization against H.

Lipoprotein(a) genetic variants associated with coronary and peripheral vascular disease but not with stroke risk in the Heart Protection Study.

Background: Genetic studies have identified 2 single-nucleotide polymorphisms (SNPs) at the LPA locus (rs3798220 and rs10455872) that are strongly and independently related to lipoprotein(a) levels and to coronary disease risk, but their relevance for other atherothrombotic disease is uncertain.

Methods And Results: These 2 LPA SNPs were examined together as an LPA genotype score for associations with vascular outcomes among participants in the Heart Protection Study. The LPA score was examined first in 12 236 participants with prevalent vascular disease (9277 coronary disease cases, and 1326 ischemic stroke and 2011 peripheral vascular disease cases with no history of coronary disease) and 3687 vascular disease-free controls and, subsequently, in 3251 participants who had incident major vascular events during follow-up (2106 coronary disease, 507 ischemic stroke, and 707 peripheral vascular disease events).

Financial well-being of US parents caring for co-resident children and adults with developmental disabilities: an age cohort analysis.

Background: Understanding how financial well-being changes through the life course of caregiving parents of children with developmental disabilities is critically important.

Methods: We analyse SIPP (U.S.

Intensive lowering of LDL cholesterol with 80 mg versus 20 mg simvastatin daily in 12,064 survivors of myocardial infarction: a double-blind randomised trial.

Background: Lowering of LDL cholesterol reduces major vascular events, but whether more intensive therapy safely produces extra benefits is uncertain. We aimed to establish efficacy and safety of more intensive statin treatment in patients at high cardiovascular risk.

Methods: We undertook a double-blind randomised trial in 12,064 men and women aged 18-80 years with a history of myocardial infarction.

International Society for Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation.

Introduction: Over the past 20 years our knowledge of premature ejaculation (PE) has significantly advanced. Specifically, we have witnessed substantial progress in understanding the physiology of ejaculation, clarifying the real prevalence of PE in population-based studies, reconceptualizing the definition and diagnostic criterion of the disorder, assessing the psychosocial impact on patients and partners, designing validated diagnostic and outcome measures, proposing new pharmacologic strategies and examining the efficacy, safety and satisfaction of these new and established therapies. Given the abundance of high level research it seemed like an opportune time for the International Society for Sexual Medicine (ISSM) to promulgate an evidenced-based, comprehensive and practical set of clinical guidelines for the diagnosis and treatment of PE.

Education in sexual medicine: proceedings from the international consultation in sexual medicine, 2009.

Introduction: Sexual problems in men and women are common; and physicians endorse many barriers to addressing these issues, including lack of knowledge about the diagnosis and management of sexual problems and inadequate training in sexual health communication and counseling.

Aim: To update the recommendations published in 2004, from the International Consultation on Sexual Medicine (ICSM) relevant to the educational aspects of sexual health in undergraduate, graduate, and postgraducate medical education.

Methods: A third international consultation in collaboration with the major sexual health organizations assembled over 186 multidisciplinary experts from 33 countries into 25 committees.

Healthcare utilization in women diagnosed with hypoactive sexual desire disorder: interim baseline results from the HSDD Registry for Women.

Objective: To investigate treatment seeking and utilization of women diagnosed with hypoactive sexual desire disorder (HSDD) in the clinical setting.

Methods: We used interim baseline data from the ongoing HSDD Registry for Women (n = 724, enrolled at 27 clinical sites across the United States in 2008-2009). The recent diagnosis of generalized, acquired HSDD was confirmed by clinician's administration of the validated diagnostic Decreased Sexual Desire Screener.

Sustained CD28 expression delays multiple features of replicative senescence in human CD8 T lymphocytes.

CD28 costimulatory signal transduction in T lymphocytes is essential for optimal telomerase activity, stabilization of cytokine mRNAs, and glucose metabolism. During aging and chronic infection with HIV-1, there are increased proportions of CD8 T lymphocytes that lack CD28 expression and show additional features of replicative senescence. Moreover, the abundance of these cells correlates with decreased vaccine responsiveness, early mortality in the very old, and accelerated HIV disease progression.

The presentation of hypoactive sexual desire disorder in premenopausal women.

Introduction: Little is known about the clinical presentation of hypoactive sexual desire disorder (HSDD) in premenopausal women or their perceptions of sexual problems.

Aim: Describe characteristics of premenopausal women with clinically diagnosed acquired, generalized HSDD, and investigate factors perceived to contribute to desire problems.

Methods: Cross-sectional analysis of baseline data from premenopausal women with clinically diagnosed and confirmed HSDD enrolled during the first year of the HSDD Registry for Women (N=400).

Effects of homocysteine-lowering with folic acid plus vitamin B12 vs placebo on mortality and major morbidity in myocardial infarction survivors: a randomized trial.

Context: Blood homocysteine levels are positively associated with cardiovascular disease, but it is uncertain whether the association is causal.

Objective: To assess the effects of reducing homocysteine levels with folic acid and vitamin B(12) on vascular and nonvascular outcomes.

Design, Setting, And Patients: Double-blind randomized controlled trial of 12,064 survivors of myocardial infarction in secondary care hospitals in the United Kingdom between 1998 and 2008.

Do children with developmental disabilities and mental health conditions have greater difficulty using health services than children with physical disorders?

The objective of this study is to determine whether achievement of the Maternal and Child Health Bureau core outcome ease of use of health services differs between children with developmental disabilities, mental health conditions and physical disorders. We analyzed data from the 2005 National Survey of Children with Special Health Care Needs. Children with special health care needs were classified into 4 health condition groups: developmental disabilities (DD), mental health conditions (MH), physical disorders (PD) and multiple conditions.

Suppression of racial disparities for children with special health care needs among families receiving Medicaid.

This study examines whether the US public health insurance program Medicaid suppresses racial disparities in parental identification of service needs of their children with special health care needs (CSHCN). We analyze data from the 2001 US National Survey of CSHCN (n = 14,167 children). We examine three outcomes which were parental identification of (a) the child's need for professional care coordination, (b) the child's need for mental health services, and (c) the family's need for mental health services.

Adenosine deaminase modulation of telomerase activity and replicative senescence in human CD8 T lymphocytes.

Increased proportions of CD8 T lymphocytes lacking expression of the CD28 costimulatory receptor have been documented during both aging and chronic infection with HIV-1, and their abundance correlates with numerous deleterious clinical outcomes. CD28-negative cells also arise in cell cultures of CD8(+)CD28(+) following multiple rounds of Ag-driven proliferation, reaching the end stage of replicative senescence. The present study investigates the role of a second T cell costimulatory receptor component, adenosine deaminase (ADA), on the process of replicative senescence.

Financial burden of raising CSHCN: association with state policy choices.

Objective: We examined the association between state Medicaid and State Children's Health Insurance Program (SCHIP) income eligibility and the financial burden reported by low-income families raising children with special health care needs (CSHCN).

Sample And Methods: Data on low-income CSHCN and their families were from the National Survey of Children With Special Health Care Needs (N = 17039), with a representative sample from each state. State Medicaid and SCHIP income-eligibility thresholds were from publicly available sources.

Genetic variants associated with Lp(a) lipoprotein level and coronary disease.

Background: An increased level of Lp(a) lipoprotein has been identified as a risk factor for coronary artery disease that is highly heritable. The genetic determinants of the Lp(a) lipoprotein level and their relevance for the risk of coronary disease are incompletely understood.

Methods: We used a novel gene chip containing 48,742 single-nucleotide polymorphisms (SNPs) in 2100 candidate genes to test for associations in 3145 case subjects with coronary disease and 3352 control subjects.

Challenges in the identification and management of HSDD.

This case illustrates some of the challenges involved in establishing a diagnosis of female sexual dysfunction and, specifically, hypoactive sexual desire disorder (HSDD). Problems with sexual desire and arousal may indicate a primary diagnosis of HSDD or may occur secondary to factors such as poorly controlled depressive symptoms, the manifestations of menopause, or the side effects of antidepressant medications. Moreover, declining estrogen levels beginning during perimenopause may decrease vaginal lubrication and cause atrophy of vaginal tissue, which can result in discomfort during intercourse and can also reduce desire.