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1.  Mental Health Comorbidity in Atopic Dermatitis 
Recent data, primarily from Europe, suggest children with atopic dermatitis may be at increased risk of developing mental health disorders.
We aimed to quantify the mental health burden associated with pediatric atopic dermatitis in the United States.
A cross-sectional study design was used analyzing data from the 2007 National Survey of Children's Health – a survey reporting on the health status of 92,642 non-institutionalized children ages 0-17. The lifetime prevalence of various provider-diagnosed mental health conditions was calculated for those with and without a history of atopic dermatitis.
The odds of having attention-deficit/hyperactivity disorder was significantly increased in children with atopic dermatitis compared to non-atopic dermatitis controls, OR 1.87 (95% CI 1.54, 2.27) even after controlling for known confounders. The adjusted odds ratios for depression, anxiety, conduct disorder, and autism were 1.81 (95% CI 1.33,2.46) , 1.77 (95% CI 1.36, 2.29), 1.87 (1.46, 2.39), and 3.04 (95% CI 2.13, 4.34), respectively, and these estimates were all statistically significant. A clear dose-dependent relationship was observed between the prevalence of a mental health disorder and the reported severity of the skin disease.
Our data reveal a striking association between mental health disorders and atopic dermatitis in the U.S. pediatric population. The severity of the skin disease alters the strength of the association. Prospective cohort studies are needed to verify these associations and to explore underlying mechanisms. Strategies to prevent atopic dermatitis or to aggressively treat early skin inflammation may modify the risk of developing mental health disorders in at-risk children.
PMCID: PMC3565469  PMID: 23245818
Atopic dermatitis; Comorbidities; Attention-deficit/hyperactivity disorder; Anxiety; Depression; Autism; Prevalence
2.  Loss of naïve T-cells and repertoire constriction predict poor response to vaccination in old primates1 
Aging is usually accompanied by diminished immune protection upon infection or vaccination. While aging results in well-characterized changes in the T-cell compartment of long-lived, outbred, and pathogen-exposed organisms, their relevance for primary antigen responses remain unclear. Therefore, it remains unclear whether and to what extent the loss of naïve T-cells, their partial replacement by oligoclonal memory populations, and the consequent constriction of T-cell receptor (TCR) repertoire, limit the antigen responses in aging primates.
PMCID: PMC3504654  PMID: 20483749
3.  Cytomegalovirus-specific T cell immunity is maintained in immunosenescent rhesus macaques 
Although Cytomegalovirus (CMV) infection is largely benign in immunocompetent people, the specific T cell responses associated with control of this persistent virus are enormous and must be maintained for life. These responses may increase with advanced age and have been linked to an “Immune Risk Profile” (IRP) that is associated with poor immune responsiveness and increased mortality in aged individuals. Based on this association, it has been suggested that CMV-specific T cell responses might become dysfunctional with age, and thereby contribute to the development of immune senescence by homeostatic disruption of other T cell populations, diminished control of CMV replication, and/or excess chronic inflammation. Here, we use the rhesus macaque (RM) model of aging to ask whether the quantity and quality of CMV-specific T cell responses differ between healthy adult RM and elderly RM that manifest hallmarks of immune aging. We demonstrate that the size of the CD4+ and CD8+ CMV-specific T cell pools are similar in adult vs. old RM, and show essentially identical phenotypic and functional characteristics, including a dominant effector memory (EM) phenotype, identical patterns of IFN-γ, TNF-α and IL-2 production and cytotoxic degranulation, and comparable functional avidities of optimal epitope-specific CD8+ T cells. Most importantly, the response to and protection against an in vivo CMV challenge were identical in adult and aged RM. These data indicate that CMV-specific T cell immunity is well maintained in old RM, and argue against a primary role for progressive dysfunction of these responses in the development of immune senescence.
PMCID: PMC3151292  PMID: 21765018
4.  Effect of Low Concentrations of Apomorphine on Parkinsonism in a Randomized, Placebo-Controlled, Crossover Study 
Archives of Neurology  2008;65(2):193-198.
To determine whether low concentrations of a dopamine agonist worsen parkinsonism, which would suggest that activation of presynaptic dopamine autoreceptors causes a super-off state.
Randomized, double-blind, placebo-controlled, crossover clinical trial.
Academic movement disorders center.
Patients with Parkinson disease and motor fluctuations.
Fourteen patients with Parkinson disease and motor fluctuations were randomized to receive 1 of 6 possible sequences of placebo, low-dose (sub-threshold) apomorphine hydrochloride, and high-dose (threshold to suprathreshold) apomorphine hydrochloride infusions. Subthreshold doses of apomorphine hydrochloride (12.5 μg/kg/h every 2 hours and 25 μg/kg/h every 2 hours), threshold to suprathreshold doses of apomorphine hydrochloride (50 μg/kg/h every 2 hours and 100 μg/kg/h every 2 hours), and placebo were infused for 4 hours daily for 3 consecutive days.
Main Outcome Measures
Finger and foot tapping rates.
There was no decline in finger or foot tapping rates during the low-dose apomorphine hydrochloride infusions relative to placebo. The high-dose infusions increased foot tapping (P<.001) and trended toward increasing finger tapping compared with placebo infusions.
Subthreshold concentrations of apomorphine did not worsen parkinsonism, suggesting that pre-synaptic dopamine autoreceptors are not important to the motor response in moderate to advanced Parkinson disease.
PMCID: PMC3390309  PMID: 18268187
5.  Eczema prevalence in the United States: Data from the 2003 National Survey of Children’s Health 
Using the 2003 National Survey of Children’s Health (NSCH) sponsored by the federal Maternal and Child Health Bureau, we calculated prevalence estimates of eczema nationally and for each state among a nationally representative sample of 102,353 children 17 years of age and under. Our objective was to determine the national prevalence of eczema/atopic dermatitis in the United States pediatric population and to further examine geographic and demographic associations previously reported in other countries. Overall, 10.7% of children were reported to have a diagnosis of eczema in the last 12 months. Prevalence ranged from 8.7% to 18.1% between states and districts, with the highest prevalence reported in many of the East Coast states, as well as Nevada, Utah, and Idaho. After adjusting for confounders, metropolitan living was found to be a significant factor in predicting a higher disease prevalence with an OR of 1.67 (95% confidence interval of 1.19-2.35, p=0.008). Black race (OR 1.70, p=0.005) and education level in the household greater than high school (OR 1.61, p=0.004) were also significantly associated with a higher prevalence of eczema. The wide range of prevalence suggests social or environmental factors may influence disease expression.
PMCID: PMC3130508  PMID: 20739951
6.  Antiviral Immunity following Smallpox Virus Infection: a Case-Control Study▿  
Journal of Virology  2010;84(24):12754-12760.
Outbreaks of smallpox (i.e., caused by variola virus) resulted in up to 30% mortality, but those who survived smallpox infection were regarded as immune for life. Early studies described the levels of neutralizing antibodies induced after infection, but smallpox was eradicated before contemporary methods for quantifying T-cell memory were developed. To better understand the levels and duration of immunity after smallpox infection, we performed a case-control study comparing antiviral CD4+ and CD8+ T-cell responses and neutralizing antibody levels of 24 smallpox survivors with the antiviral immunity observed in 60 smallpox-vaccinated (i.e., vaccinia virus-immune) control subjects. We found that the duration of immunity following smallpox infection was remarkably similar to that observed after smallpox vaccination, with antiviral T-cell responses that declined slowly over time and antiviral antibody responses that remained stable for decades after recovery from infection. These results indicate that severe, potentially life-threatening disease is not required for the development of sustainable long-term immunity. This study shows that the levels of immunity induced following smallpox vaccination are comparable in magnitude to that achieved through natural variola virus infection, and this may explain the notable success of vaccination in eradicating smallpox, one of the world's most lethal diseases.
PMCID: PMC3004327  PMID: 20926574

Results 1-6 (6)