Risk of complications in patients who are obese following upper limb arthroplasty: A systematic review and meta-analysis

PurposeA systematic review was performed to investigate the impact of obesity on complications following total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA) and total elbow arthroplasty (TEA).MethodsElectronic databases and grey literature were searched for studies that evaluated the influence of obesity (Body Mass Index[BMI] ≥30 kg m²) on upper limb arthroplasty outcomes. Fifteen studies were identified, however only twelve reported predetermined outcomes. Unadjusted data was pooled in statistical meta-analysis where appropriate. Effect sizes were expressed as odds ratios (OR) for categorical data and weighted mean differences for continuous data.ResultsOdds of infection increased with increasing BMI, from 2.37 (95%CI [1.653.41]) times in patients who were obese, to greater than five times (OR = 5.04; 95%CI [4.705.39]) in patients who were morbidly obese. Furthermore, patients who were obese or morbidly obese had 3.92 (95%CI [3.594.28]) to 5.46 (95%CI [4.916.07]) times greater odds of venous thromboembolism (VTE) compared to their non-obese counterparts, respectively. Conversely, obesity had no influence on the odds of urinary tract infection (OR = 0.88; 95%CI [0.481.61], or mortality (OR = 1.79; 95%CI [0.794.03]). TSA/RTSA patients who were obese experienced operations 10.00 minutes longer (95%CI [6.3113.69]) than patients with a BMI in the normal range, which increased to 12.48 min utes (95%CI [8.4016.55]) in patients with a BMI ≥ 35.0. Evidence examining the influence of obesity on blood transfusion was inconclusive, while minimal evidence was available on pneumonia.ConclusionSurgeons should consider advising patients who are obese of the greater risk of VTE and infection when considering elective upper limb arthroplasty. However, noteworthy limitations surrounded the lack of information regarding prophylaxis regimes and BMI measurement tools used in included studies.     

Influenza during pregnancy: Incidence,vaccination coverage and attitudes toward vaccination in the French web-based cohort G-GrippeNet

IntroductionPregnancy is a risk factor for severe influenza. However, data on influenza incidence during pregnancy are scarce. Likewise, no data are available on influenza vaccine coverage in France since national recommendation in 2012. We aimed to assess these points using a novel nationwide web-based surveillance system, G-GrippeNet.MethodsDuring the 2014/2015 influenza season, pregnant women living in metropolitan France were enrolled through a web platform (https://www.grippenet.fr/). Throughout the season, participants were asked to report, on a weekly basis, if they had experienced symptoms of influenza-like-illness (ILI). ILI episodes reported were used to calculate incidence density rates based on period of participation from each participant. Vaccination coverage was estimated after weighing on age and education level from national data on pregnant women. Factors associated with higher vaccination coverage were obtained through a logistic regression with Odds Ratio (OR) corrected with the Zhang and Yu method.ResultsA total of 153 women were enrolled. ILI incidence density rate was 1.8 per 100 person-week (95%CI, 1.5–2.1). This rate was higher in women older than 40 years (RR = 3.0, 95%CI [1.1–8.3], p = 0.03) and during first/second trimesters compared to third trimester (RR = 4.0, 95%CI [1.4–12.0], p = 0.01). Crude vaccination coverage was 39% (95%CI, 31–47) and weighted vaccination coverage was estimated at 26% (95%CI, 20–34). Health care provider recommendation for vaccination (corrected OR = 7.8; 95%CI [3.0–17.1]) and non-smoking status (cOR = 2.1; 95%CI [1.2–6.9]) were associated with higher vaccine uptake.ConclusionThis original web based longitudinal surveillance study design proved feasible in pregnant women population. First results are of interest and underline that public health policies should emphasize the vaccination promotion through health care providers.     

Efficacy of 23-valent pneumococcal polysaccharide vaccine in preventing community-acquired pneumonia among immunocompetent adults: A systematic review and meta-analysis of randomized trials

BackgroundData on the efficacy of the 23-valent pneumococcal polysaccharide vaccine (PPV-23) in preventing adult community-acquired pneumonia (CAP) among the target population of individuals aged over 65 years and high-risk individuals aged 19–64 years are conflicting. As the Advisory Committee on Immunization Practices (ACIP) has recently demonstrated PPV-23 is likely beneficial to immunocompromised adults by the Grading, Assessment, Development, and Evaluation (GRADE) framework, we conducted meta-analysis to examine its efficacy in an immunocompetent population.MethodsWe searched the PUBMED, EMBASE, and Cochrane Library databases for randomized trials. Overall relative risks (RRs) with 95% confidential intervals (CIs) were calculated, and the Cochrane Q test (p, I²) was performed. Outcomes were assessed by the GRADE framework.ResultsSeven randomized trials involving 156,010 participants were included in this meta-analysis. High-quality evidence revealed that PPV-23 was weakly associated with the prevention of all-cause pneumonia ([RR] 0.87, [95%CI] 0.76–0.98, p = 0.11, I² = 43%), especially among the target population ([RR] 0.72, [95%CI] 0.69–0.94, p = 0.58 I² = 0%), the elderly group aged over 40 years ([RR] 0.80, [95%CI] 0.69–0.94) and the Japanese population ([RR] 0.72, [95%CI] 0.59–0.88, p = 0.24, I² = 30%). The target population included adults aged over 65 years and patients at high risk of pneumonia due to chronic lung disease, chronic obstructive pulmonary disease or living in a nursing home. Protective trends of PPV-23 in the outcomes of pneumococcal pneumonia ([RR] 0.54, [95%CI] 0.18–1.65, p = 0.01, I² = 77%) and mortality due to pneumonia ([RR] 0.67, [95%CI] 0.43–1.04, p = 0.67, I² = 0%) were observed, although the results were statistically insignificant, possibly due to the small number of trials included. PPV-23 did not prevent all-cause mortality ([RR] 1.04, [95%CI] 0.87–1.24, p = 0.95, I² = 0%).ConclusionsPPV-23 provided weak protection against all-cause pneumonia in an immunocompetent population, especially among the target population. The additional benefit of PPV-23 in preventing CAP further supports its application in the target population.     

Public health impact of Rotarix vaccination among commercially insured children in the United States

BackgroundThis study (NCT01915888) assessed public health impact of Rotarix, GSK [RV1] vaccination.MethodsChildren born between 2007–2011 were identified from Truven Commercial Claims and Encounters Databases and observed until earlier of plan disenrollment or five years old. Children receiving one or two doses of RV1 during the vaccination window were assigned to incomplete and complete vaccination cohorts, respectively. Children without rotavirus (RV) vaccination (RV1 OR RotaTeq, Merck & Co., Inc. [RV5]) were assigned to the unvaccinated cohort. Claims with International Classification of Disease 9th edition (ICD-9) codes for diarrhea and RV infections were identified. First RV episode incidence, RV-related and diarrhea-related healthcare resource utilization were compared. Multivariate Poisson regression with generalized estimating equations was used to generate 95% confidence intervals (CIs) around incidence rate ratios (IRR) between cohorts while adjusting for gender, age and calendar year. Mean costs for first RV and diarrhea episodes were calculated with adjustment for gender and birth year; bootstrapping was used to determine statistically significant differences between cohorts.ResultsIncidence of first RV episodes was significantly reduced in complete and incomplete vaccination cohorts compared to the unvaccinated cohort (IRR = 0.17 [95%CI: 0.09–0.30] and IRR = 0.19 [95%CI: 0.06–0.58], respectively). RV-related inpatient, outpatient and emergency room (ER) visits were significantly lower for complete vaccination versus unvaccinated cohort. Diarrhea-related inpatient and ER visit rates were significantly lower for complete vaccination versus unvaccinated cohorts; outpatient rates were similar. RV-related and diarrhea-related resource utilization rates were significantly lower or no different for incomplete vaccination versus unvaccinated cohort. Compared with unvaccinated children, adjusted mean cost for first RV episode and first diarrhea episode per 1000 persons was $11,511 (95%CI: $9855-$12,024) and $46,772 (95%CI: $26,268-$66,604) lower, respectively, for completely vaccinated children.ConclusionsRV1 vaccination confers benefits in reduction of RV incidence, RV- and diarrhea-related healthcare resource utilization, and RV- and diarrhea-related healthcare costs.     

Carriage of Haemophilus influenzae is associated with pneumococcal vaccination in Italian children

BackgroundThe pneumococcal population changes observed after the implementation of children immunization with pneumococcal conjugative vaccines (PCV) might have affected the composition of the microbial flora inhabiting the same ecological niche of Streptococcus pneumoniae. The aim of this study was to investigate the effect of PCV immunization, (PCV7 or PCV13), on S. pneumoniae and Haemophilus influenzae colonization in young children in Italy.MethodsNasopharyngeal swabs were obtained from 301 children under 6 years of age (vaccinated or unvaccinated with PCV) during the period January–April 2012. Presence of S. pneumoniae and H. influenzae was investigated using conventional cultural methods. S. pneumoniae isolates were serotyped by the Quellung reaction; capsular type of H. influenzae isolates was determined by PCR. The pattern of associations between the two species and potential risk factors were investigated by a Structural Equation Modelling (SEM) analysis.ResultsThe prevalence of carriage was 31.56% and 43.18% for S. pneumoniae and H. influenzae, respectively. The majority of S. pneumoniae isolates belonged to non vaccine serotypes (non PCV13-types 81.1%) while H. influenzae isolates were all non-typeable. SEM analysis revealed a synergistic association between S. pneumoniae and H. influenzae colonization (rho: 0.27; 95%CI: 0.09–0.46; p = 0.004). In addition, children vaccinated with PCV, either with PCV7 (coef 0.43; 95%CI: 0.07–0.79; p = 0.021) or with PCV13 (coef: 0.45; 95%CI: 0.08–0.82; p = 0.018), were more likely to be colonized by H. influenzae.ConclusionsPneumococcal vaccination increased H. influenzae nasopharyngeal carriage in children. This result highlights that an indirect effect of PCV vaccination can be perturbation of the nasopharyngeal flora. In the era of higher-valent pneumococcal vaccines, surveillance of carriage is crucial to monitor alterations in the bacterial ecosystem, thus preventing possible clinical problems.     

Active school transport and fast food intake: Are there racial and ethnic differences?

ObjectivesTo investigate whether active school transport was associated with fast food consumption, and to examine differences across racial/ethnic groups.MethodsAdolescent data (n = 3194) from the 2009 California Health Interview Survey were analyzed with logistic regression models to examine the association between active school transport (AST) and fast food intake across racial/ethnic groups.ResultsIn the overall sample, AST during 1–2 days in the past week was associated with greater likelihood of fast food intake (OR: 1.58; 95% CI: 1.03–2.43), compared with zero days of AST, controlling for demographic and other factors. The association between AST and fast food intake differed significantly by race/ethnicity (p < 0.01). Among Latino adolescents, greater frequency of AST was significantly associated with greater likelihood of fast food intake (1–2 days OR, 2.37, 95%CI: 1.05–5.35; 3–4 days OR, 2.78, 95% CI: 1.04–7.43; 5 days OR, 2.20, 95%CI: 1.23–3.93). Among White and Asian adolescents, there was a curvilinear pattern: relative to adolescents who reported zero days of AST, those who did AST 1–2 days/week had greater likelihood of fast food intake, but AST of 3–4 days and 5 days/week was associated respectively, with higher and lower likelihood of fast food intake among both groups.ConclusionsAST appears to be a risk factor for fast food intake, and may expose some ethnic groups more than others to increased opportunity to purchase and consume fast food. Programs and policies to promote AST among adolescents should incorporate efforts to encourage healthy eating and discourage concentration of fast food outlets near schools.     

Early impact of sequential introduction of 7-valent and 13-valent pneumococcal conjugate vaccine on IPD in Israeli children <5 years: An active prospective nationwide surveillance

BackgroundThe 7-valent pneumococcal conjugated vaccine (PCV7) was introduced to the Israeli national immunization plan (NIP) in July 2009 (administered at age 2, 4 and 12 months), with a fast reduction of invasive pneumococcal disease (IPD) caused by PCV7 serotypes. Starting in November 2010, PCV13 gradually replaced PCV7.AimTo report the impact of PCV7/PCV13 sequential introduction on IPD in Israeli children <5 years.MethodsAn ongoing nationwide, prospective, population-based, active surveillance. All IPD episodes (Streptococcus pneumoniae isolated from blood and/or cerebrospinal fluid) from July 2004 through June 2013 were included.ResultsOverall, 2670 IPD episodes were recorded. Incidence of IPD caused by PCV7 + 6A serotypes during the PCV13 period vs. pre-PCV period decreased by 95% (Incidence Rate Ratio [IRR] = 0.05; 95% CI = 0.03–0.09). This reduction was observed in a two-step manner: 90% in the PCV7-period and further 5% in the PCV13-period. The rates of IPD caused by the 5 additional PCV13-serotypes (1, 3, 5, 7F, 19A; 5VT) increased initially by 47%, but subsequently decreased by 79%, resulting in an overall 70% reduction during the entire study period (IRR = 0.30; 0.21–0.44). A two-fold increase in non-PCV13 serotypes IPD was observed (IRR = 2.43; 1.73–3.66). In total, a 63% reduction of all-serotype IPD episodes was observed in children <5 years (69% and 48% in children <2 and 2–4 years old, respectively).ConclusionsAfter initiation of PCV NIP, a rapid and substantial 2-step IPD reduction was observed in children <5 years. The serotype-specific rate reduction reflected the sequential introduction of PCV7/PCV13.     

Decreased accuracy in interpretation of community-based screening mammography for women with multiple clinical risk factors

ObjectiveTo assess the impact of women's breast cancer risk factors (use of hormone therapy, family history of breast cancer, previous breast biopsy) on radiologists' mammographic interpretive performance and whether the influence of risk factors varies according to radiologist characteristics.Study Design and SettingScreening mammograms (n = 638,947) performed from 1996 to 2005 by 134 radiologists from three Breast Cancer Surveillance Consortium registries was linked to cancer outcomes, radiologist surveys, and patient questionnaires. Interpretive performance measures were modeled using marginal and conditional logistic regression.ResultsHaving one or more clinical risk factors was associated with higher recall rates (1 vs. 0 risk factors: odds ratio [OR] = 1.17, 95% confidence interval [CI] = 1.15–1.19; ≥2 vs. 0: OR = 1.43, 95% CI = 1.40–1.47) and lower specificity (1 vs. 0: OR = 0.86 [95% CI = 0.84–0.88]; ≥2 vs. 0: OR = 0.70 [95% CI = 0.68–0.72]) without a corresponding improvement in sensitivity and only a small increase in positive predictive value (1 vs. 0: OR = 1.08 [95% CI = 0.99–1.19]; ≥2 vs. 0: OR = 1.12 [95% CI = 0.99–1.26]). There was no indication that influence of risk factors varied by radiologist characteristics.ConclusionWomen with clinical risk factors who undergo screening mammography are more likely recalled for false-positive evaluation without an associated increase in cancer detection. Radiologists and patients with risk factors should be aware of this increased risk of adverse screening events.     

Connaissance et couverture vaccinale contre l’hépatite virale B (HVB) : étude transversale parmi les étudiants de l’université de Cocody,Côte d’Ivoire

BackgroundTo evaluate knowledge about hepatitis B and vaccination coverage among students at Cocody's University, Ivory Coast.Materials and methodsA cross-sectional study was conducted during the academic year 2005–2006 (2557 students). Parameters were collected by interview using a survey chart. Factors influencing knowledge and vaccination against hepatitis B were analyzed by logistic regression.ResultsThe majority of students (n = 1174, 69.4% [95% CI 68–71]) knew about hepatitis B. Only 17.5% and 26.1% of students respectively were aware of sexual and blood transmission. None of the students were aware of maternal-fetal transmission. Factors associated with knowledge of hepatitis B were enrollment in health sciences (Odds Ratio = 24.19 [95% CI 8.65–76.63]) and having a scholarship (Odds Ratio = 2.34 [95% CI 1.54–3.56]). Vaccination coverage against hepatitis B was low (Odds Ratio = 3.7% [95% CI 3–4]). Factors associated with vaccination were: knowledge of hepatitis B (Odds Ratio = 6.83 [95% CI 4.57–10.27]), enrollment in health sciences (Odds Ratio = 3.59 [95% CI 2.60–4.96]), marriage (Odds Ratio = 2.04 [95% CI 1.13–3.64]) and having a scholarship (Odds Ratio = 1.60 [95% CI 1.09–2.35]).ConclusionKnowledge and vaccination coverage against hepatitis B among students at Cocody's University is low. Students should be given information about hepatitis B and access to free vaccination. Students enrolled in health sciences should be vaccinated before admission because of specific risks of contamination, for themselves and for their patients.     

Risk factors for tuberculosis among health care workers in South India: a nested case–control study

ObjectiveThe epidemiology of tuberculosis (TB) among health care workers (HCWs) in India remains under-researched. This study is a nested case–control design assessing the risk factors for acquiring TB among HCWs in India.Study Design and SettingsIt is a nested case–control study conducted at a tertiary teaching hospital in India. Cases (n = 101) were HCWs with active TB. Controls (n = 101) were HCWs who did not have TB, randomly selected from the 6,003 subjects employed at the facility. Cases and controls were compared with respect to clinical and demographic variables.ResultsThe cases and controls were of similar age. Logistic regression analysis showed that body mass index (BMI) <19 kg/m² (odds ratio [OR]: 2.96, 95% confidence interval [CI]: 1.49–5.87), having frequent contact with patients (OR: 2.83, 95% CI: 1.47–5.45) and being employed in medical wards (OR: 12.37, 95% CI: 1.38–110.17) or microbiology laboratories (OR: 5.65, 95% CI: 1.74–18.36) were independently associated with increased risk of acquiring TB.ConclusionHCWs with frequent patient contact and those with BMI <19 kg/m² were at high risk of acquiring active TB. Nosocomial transmission of TB was pronounced in locations, such as medical wards and microbiology laboratories. Surveillance of high-risk HCWs and appropriate infrastructure modifications may be important to prevent interpersonal TB transmission in health care facilities.     

Violencia de pareja y depresión en mujeres que trabajan en una institución de salud de México

ObjectiveTo assess the effect of intimate partner violence on the risk of depression and depressive symptoms among adult women.MethodWe analyzed data from the Mexican Health Workers’ Cohort study (n = 470). Type and severity of intimate partner violence was ascertained between 2004 and 2011. Self-reported medical diagnosis of depression (2011) was the main outcome; depressive symptoms ascertained with the Centre for Epidemiologic Studies-Depression (CES-D) scale was the secondary outcome. Random-effects regressions were run to model the risk of depression (logistic) and depressive symptoms (linear) in relation to intimate partner violence.Results41.9% women experienced intimate partner violence at baseline. The incidence of depression was 7.2%. The risk of depression increased with any type of IPV (adjusted odds ratio [aOR] = 2.9; 95% confidence interval [95%CI]: 1.4–6.2) and with physical (aOR = 4.3; 95%CI: 1.8–10.1), psychological (aOR = 3.1; 95%CI: 1.4–6.6) and sexual (aOR = 3.1; 95%CI: 1.2–8.2) violence. Depressive symptoms (CES-D) increased slightly with physical and sexual intimate partner violence.ConclusionsIntimate partner violence was associated with a higher risk of depression in this sample of women working in a Mexican health facility. Our results indicate the need to develop infrastructure, to implement strategies of attention and counselling, and to provide a safe environment in the workplace for women who experience intimate partner violence.     

The impact of 10-valent and 13-valent pneumococcal conjugate vaccines on hospitalization for pneumonia in children: A systematic review and meta-analysis

BackgroundThis systematic review and meta-analysis aimed at summarizing available data on the impact of PCV10 and PCV13 in reducing the incidence of CAP hospitalizations in children aged <5 years.MethodsA systematic search of the literature was conducted. We included time-series analyses and before-after studies, reporting the incidence of hospitalization for pneumonia in the periods before and after the introduction of PCV10 or PCV13 into the immunization program. Pooled estimates of Incidence Rate Ratio (IRR) were calculated by using a random-effects meta-analytic model. Results were stratified according to age-groups (<24 months and 24–59 months) and case definitions of pneumonia (clinically and radiologically confirmed pneumonia).ResultsA total of 1533 potentially relevant articles were identified. Of these, 12 articles were included in the analysis. In children aged <24 months, the meta-analysis showed a reduction of 17% (95%CI: 11–22%, p-value < 0.001) an of 31% (95%CI: 26–35%, p-value < 0.001) in the hospitalization rates respectively for clinically and radiologically confirmed pneumonia, respectively, after the introduction of the novel PCVs.In children aged 24–59 months, the meta-analysis showed a reduction of 9% (95%CI: 5–14%, p-value < 0.001) and of 24% (95%CI: 12–33%, p-value < 0.001) in the hospitalization rates for clinically and radiologically confirmed pneumonia, respectively, after the introduction of the novel PCVs.High heterogeneity was detected among studies evaluating the hospitalization rate for clinically and radiologically confirmed pneumonia.ConclusionsThe results of this study revealed a significant impact of PCV10 and PCV13 in reducing the hospitalizations for pneumonia, particularly in children aged <24 months and for radiologically confirmed disease. Further appropriately designed studies, comparing the impact of PCV10 and PCV13, are needed in order to obtain solid data on which to establish future immunization strategies.     

Influence of socio-demographic,labour and professional factors on nursing perception concerning practice environment in Primary Health Care

AimTo analyze the perception of nursing professionals of the Madrid Primary Health Care environment in which they practice, as well as its relationship with socio-demographic, work-related and professional factors.DesignCross-sectional, analytical, observational study.Participants and contextQuestionnaire sent to a total of 475 nurses in Primary Health Care in Madrid (former Health Care Areas 6 and 9), in 2010.Main measurementsPerception of the practice environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI) questionnaire, as well as; age; sex; years of professional experience; professional category; Health Care Area; employment status and education level.ResultsThere was a response rate of 69.7% (331). The raw score for the PES-NWI was: 81.04 [95%CI: 79.18–82.91]. The factor with the highest score was “Support from Managers” (2.9 [95%CI: 2.8–3]) and the lowest “Workforce adequacy” (2.3 [95%CI: 2.2–2.4]). In the regression model (dependent variable: raw score in PES-NWI), adjusted by age, sex, employment status, professional category (coefficient B = 6.586), and years worked at the centre (coefficient B = 2.139, for a time of 0–2 years; coefficient B = 7.482, for 3–10 years; coefficient B = 7.867, for over 20 years) remained at p ≤ 0.05.ConclusionsThe support provided by nurse managers is the most highly valued factor in this practice environment, while workforce adequacy is perceived as the lowest. Nurses in posts of responsibility and those possessing a higher degree of training perceive their practice environment more favourably. Knowledge of the factors in the practice environment is a key element for health care organizations to optimize provision of care and to improve health care results.     

Barriers to timely administration of birth dose vaccines in The Gambia,West Africa

ObjectiveAlthough vaccine coverage in infants in sub-Saharan Africa is high, this is estimated at the age of 6–12 months. There is little information on the timely administration of birth dose vaccines. The objective of this study was to assess the timing of birth dose vaccines (hepatitis B, BCG and oral polio) and reasons for delayed administration in The Gambia.MethodsWe used vaccination data from the Farafenni Health and Demographic Surveillance System (FHDSS) between 2004 and 2014. Coverage was calculated at birth (0–1 day), day 7, day 28, 6 months and 1 year of age. Logistic regression models were used to identify demographic and socio-economic variables associated with vaccination by day 7 in children born between 2011 and 2014.ResultsMost of the 10,851 children had received the first dose of hepatitis B virus (HBV) vaccine by the age of 6 months (93.1%). Nevertheless, only 1.1% of them were vaccinated at birth, 5.4% by day 7, and 58.4% by day 28. Vaccination by day 7 was associated with living in urban areas (West rural: adjusted OR (AOR) = 6.13, 95%CI: 3.20–11.75, east rural: AOR = 6.72, 95%CI: 3.66–12.33) and maternal education (senior-educations: AOR = 2.43, 95%CI: 1.17–5.06); and inversely associated with distance to vaccination delivery points (≧2 km: AOR = 0.41, 95%CI: 0.24–0.70), and Fula ethnicity (AOR = 0.60, 95%CI: 0.40–0.91).ConclusionVaccine coverage in The Gambia is high but infants are usually vaccinated after the neonatal period. Interventions to ensure the implementation of national vaccination policies are urgently needed.     

Santé et instabilité professionnelle : résultats issus des centres d’examens de santé de l’assurance-maladie

BackgroundJob insecurity has increased over the last 30 years. Socioeconomic changes have led to various insecure employment categories, including fixed term employment, part time employment and government sponsored jobs. This study was aimed at investigating relationships between employment status and health.MethodsThe study population was composed of 767 184 people, aged 26 to 59 years, examined between 2003 and 2005 in the Health Examination Centers of the French General Health Insurance. Employment status was defined using insecure employment (combining permanent/fixed-term contracts and part-time/full time), government sponsored jobs and duration of unemployment (from < 6 months to ≥ 3 years). Health indicators were poor perceived health, smoking, lack of gynecological follow-up, obesity, untreated caries and high blood pressure. Data were analysed by logistic regression (odds ratios [OR]) adjusted on age, occupational social class and education level, the reference category being permanent full time contracts (OR = 1).ResultsSignificant level-dependent relations with health were observed between non permanent versus permanent employments, part time versus full time. Most OR of unemployed people were higher than those of having employment and increased with duration of unemployment. For example, for poor perceived health in men, OR ranged between 1.00 and 1.68 (95%CI 1.57–1.78) according to job insecurity categories, and between 1.75 (95%CI 1.67–1.83) and 2.80 (95%CI 2.72–2.89) according to duration of unemployment. For obesity in women, OR increased from 1.00 to 1.48 (95%CI 1.37–1.60) in active women and from 1.35 (95%CI 1.27–1.44) to 1.77 (95%CI 1.70–1.84) in unemployed.ConclusionsThis study showed quantitative relationships between job insecurity, unemployment and health. In particular, workers having government-sponsored jobs and long-time unemployed people were at high risk of health problems.     

Association between habitual school travel and muscular fitness in youth

ObjectiveTo determine whether active school travel is associated with muscular fitness, which is an emerging marker of youth health.MethodsHandgrip strength, vertical jump and vertical jump peak power were measured in n = 6829 English schoolchildren (53% males, age 12.9 ± 1.2 years) between 2007 and 2011. Participants were grouped according to self-reported habitual school travel modality.ResultsCyclists had greater handgrip strength than passive travelers. Vertical jump height was greater in walkers and cyclists compared with passive travelers. Jump peak power was also higher in walkers than in the passive travel group. Compared with passive travelers, cyclists had a higher (age, sex and BMI-adjusted) likelihood of good handgrip strength (OR 1.42, 95%CI;1.14–1.76) and walkers were more likely to have good measures for vertical jump peak power (OR 1.14, 95%CI;1.00–1.29). Cyclists' likelihood of having good handgrip strength remained significantly higher when adjusted for physical activity (OR 1.29, 95%CI;1.08–1.46).ConclusionMuscular fitness differs according to school travel habits. Cycling is independently associated with better handgrip strength perhaps due to the physical demands of the activity. Better muscular fitness may provide another health-related reason to encourage active school travel.     

Sevrage des nourrissons avant six mois à Marrakech : facteurs associés et prévalence

BackgroundIn Morocco breastfeeding has become a declining practice. The objectives of this study were to estimate the prevalence of weaning before the age of 6 months and to identify associated factors.MethodsA cross-sectional survey was conducted among 400 mothers of infants aged 0 to 24 months. Participants were recruited from patients attending 40 randomly selected general practices in Marrakech. A trained interviewer administered a questionnaire to collect data on breastfeeding practice and factors associated with it. Early weaning was defined as a cessation of breastfeeding before the age of 6 months and was studied in mother–child couples whose infants were aged 6 months and older. Three binary logistic regression models were used to model the probability that an infant aged 6 months or more is weaned early.ResultsBreastfeeding was initiated by the majority of respondents (97.5%). Early weaning was observed in 75 infants (28% of registered weaning). Factors associated with early weaning were: mother having an occupational activity (Odds Ratio [OR] = 2.09; 95% confidence interval [CI]: [1.07–4.06]), caesarean delivery (OR = 4.15; 95% CI: [1.74–9.88]) and the fact that the pregnancy was desired (OR = 0.19; 95% CI: [0.05–0.68]).ConclusionWeaning before 6 months of age is a common practice in our context. Identifying factors associated with early weaning is critical to promote breastfeeding.     

Where can they play? Outdoor spaces and physical activity among adolescents in U.S. urbanized areas

ObjectiveTo estimate behavior-specific effects of several objectively measured outdoor spaces on different types of moderate to vigorous physical activity (MVPA) in a large, diverse sample of U.S. adolescents.MethodsUsing data from Wave I (1994–1995) of the National Longitudinal Study of Adolescent Health (U.S., n = 10,359) and a linked geographic information system, we calculated percent greenspace coverage and distance to the nearest neighborhood and major parks. Using sex-stratified multivariable logistic regression, we modeled reported participation in wheel-based activities, active sports, exercise, and ≥ 5 MVPA bouts/week as a function of each outdoor space variable, controlling for individual- and neighborhood-level sociodemographics.ResultsAvailability of major or neighborhood parks was associated with higher participation in active sports and, in females, wheel-based activity and reporting ≥ 5 MVPA bouts/week [OR (95% CI): up to 1.71 (1.29, 2.27)]. Greater greenspace coverage was associated with reporting ≥ 5 MVPA bouts/week in males and females [OR (95% CI): up to 1.62 (1.10, 2.39) for 10.1 to 20% versus ≤ 10% greenspace] and exercise participation in females [OR (95% CI): up to 1.73 (1.21, 2.49)].ConclusionsProvision of outdoor spaces may promote different types of physical activities, with potentially greater benefits in female adolescents, who have particularly low physical activity levels.     

Factors associated with treatment failure after advice from infectious disease specialists

ObjectiveRisk factors associated with treatment failure after the infectious disease specialist's (IDS) advice remain unknown. We aimed to identify these risk factors.MethodsWe included patients hospitalized in our tertiary care center who consulted an infectious disease specialist between January 2013 and April 2015. Treatment failure was defined by a composite criterion: signs of sepsis beyond Day 3, ICU admission, or death. Treatment success was defined by the patient's sustained clinical improvement.ResultsA total of 240 IDS recommendations were made. Diagnosis was changed for 64 patients (26.7%) and 50 patients experienced treatment failure after the IDS advice. In multivariate analysis, compliance with the IDS advice was associated with a higher rate of success (OR = 0.09, 95%CI [0.01–0.67]). Variables associated with treatment failure in the multivariate analysis were Charlson comorbidity score at admission (OR = 1.24, 95%CI [1.03–1.50]), a history of infection or colonization with multidrug-resistant bacteria (OR = 8.27, 95%CI [1.37–49.80]), and deterioration of the patient's status three days after the IDS advice (OR = 12.50, 95%CI [3.16–49.46]).ConclusionReassessing IDS recommendations could be interesting for specific patients to further adapt and improve them.