Viral interference induced by live attenuated virus vaccine (OPV) can prevent otitis media

Background

The goal of this study was to evaluate whether a live attenuated poliovirus vaccine (OPV) has clinically relevant interfering effect with non-polio infections causing otitis media in young children.

Methods

Open trial in which the intervention group (64 children) received OPV at the age of 2, 3, 6 and 12 months. The control group (250 children) received IPV (inactivated polio vaccine) at the age of 6 and 12 months. Clinical symptoms were recorded by a questionnaire at the age of 3, 6, 12, 18 and 24 months.

Results

Otitis media episodes were less frequent in the OPV than in the control group. A significant difference was seen at the age of 6-18 months (IRR = 0.76 [95% CI 0.59-0.94], P = 0.011) and was particularly clear among children, who attended daycare (IRR 0.37 [95% CI 0.19-0.71], P = 0.003).

Conclusions

OPV provides some protection against otitis media. This effect may be mediated by viral interference with non-polio viruses.     

Differential Influence of Diet and Physical Activity on Components of Metabolic Syndrome in a Multiethnic Sample of Children

Background

Treatment of the metabolic syndrome in adults is generally approached with diet and physical activity. The influence of diet and physical activity on cardiometabolic outcomes in children has not been clearly established.

Objective

The main objective of this study was to test the hypothesis that the distribution of energy from fat and carbohydrate in addition to limited time spent engaging in physical activity would contribute to the prevalence of the metabolic syndrome and its components in a multiethnic pediatric population.

Design

Observational, cross-sectional study. Diet was assessed by two 24-hour recalls, physical activity by accelerometry, body composition by dual-energy absorptiometry, and glucose and lipid levels using fasting sera.

Main outcome measures

Presence of metabolic syndrome and its components.

Subjects

202 African-American (n=79), white (n=68), or Hispanic (n=55) healthy children aged 7 to 12 years.

Statistical analysis

The contribution of diet and physical activity to the metabolic syndrome and its components were assessed by logistic regression and multiple linear regression analyses.

Results

Prevalence of the metabolic syndrome in the total sample was 8.4%, with Hispanics more likely than whites and African Americans to meet the criteria. A greater intake of energy from carbohydrate was related to a greater waist circumference and higher concentrations of triglyceride and glucose particularly apparent within the African-American sample (P<0.05). Fat intake was associated with a lower waist circumference (P<0.05) and with lower concentrations of triglyceride (P<0.05) and glucose (P<0.001) in the total sample. Greater moderate/hard physical activity was associated with higher high-density lipoprotein cholesterol concentrations in whites (P<0.05). Increased sedentary behavior was related to greater glucose concentration in whites and Hispanics (P<0.05 for both).

Conclusions

Diet composition was more closely related to the components of the metabolic syndrome than was physical activity, with carbohydrate intake being adversely related to waist circumference, triglyceride levels, and glucose levels. Furthermore, relationships among diet and metabolic syndrome outcomes were stronger among African-American children, suggesting that nutrition interventions in this group may be particularly beneficial.     

Term pregnancy with intraperitoneal levonorgestrel intrauterine system: a case report and review of the literature

Background

The risk of adverse effects of fetal exposure to the levonorgestrel intrauterine system (LNG-IUS) has not been established.

Study Design

In this case report and literature review, we describe a pregnant patient with an intraperitoneal LNG-IUS and the subsequent maternal and neonatal outcomes. A systematic literature search was performed to identify similar clinical reports. The MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, Web of Science and Scopus databases were searched from inception through March 2007.

Results

The pregnancy progressed uneventfully and culminated in the elective cesarean delivery of a full-term healthy boy. Of the 35 pregnancies identified in the literature review (34 pregnancies with intrauterine LNG-IUS and 1 term delivery with intraperitoneal LNG-IUS), congenital anomalies were reported in 2 infants (6%).

Conclusions

Fetal exposure to LNG-IUS is associated with a low frequency of congenital anomalies.     

Lead dustfall from demolition of scattered site family housing: Developing a sampling methodology

Background

Over 3000 older homes containing lead-based paint are demolished in Chicago each year. While previous studies investigating large multifamily housing demolitions have shown high levels of lead in dustfall, dispersed single-family housing demolition have yet to be assessed. Presently, no standards exist to regulate the extent of lead dustfall from housing demolition.

Objectives

We studied ten residences in Chicago undergoing demolition and debris removal and compared dustfall rates to five standing homes from March to October 2006.

Methods

Dustfall was measured using a modification of APHA Method 502; samplers consisted of plastic buckets filled with 1 l of deionized water, elevated to breathing zone height and placed around the demolition site perimeter. Laboratory analysis consisted of filtration, acid digestion and analysis by ICP/MS.

Results

During demolition, the geometric mean lead dustfall (n=43 at 10 locations) was 64.1 μg Pb/m²/h (range: 1.3-3902.5), while the geometric mean lead dustfall for areas with no demolition (n=18 at 6 locations) was 12.9 μg Pb/m²/h (range: 1.8-54.5). This difference was highly statistically significant (p=0.0004). When dust suppression measures were used, dustfall lead levels were lower, although the difference was not statistically significant. The geometric mean lead dustfall with dust suppression (n=25 at five locations) and without (n=22 at six locations) was 48 Pb μg/m²/h and 74.6 μg Pb/m²/h, respectively.

Conclusion

Demolition dustfall lead levels are much higher than background levels of lead during demolition of single-family housing and may constitute a yet uncharacterized but important source of lead exposure to nearby residents. Simple dust suppression methods are likely to reduce the contamination considerably.     

Nutrition Knowledge Is Associated with Greater Weight Loss in Obese and Overweight Low-Income Mothers

Objective

To examine if greater nutrition knowledge vs gains in knowledge promote more successful weight loss in low-income, overweight and obese mothers with young children.

Design

A convenience sample of mothers and their children were measured for height and weight; mothers completed demographic and nutrition knowledge questionnaires pre- and postintervention.

Subjects/setting

Participants (N=141) were recruited from government and public health clinics and elementary schools. Inclusion criteria for mothers were: family income <200% federal poverty level; overweight/obese; and Hispanic, African-American, or white race/ethnicity.

Intervention

Eight weekly weight-loss classes emphasizing diet, physical activity, and behavior modification based on Social Cognitive Theory were administered to mothers.

Main Outcome Measures

Improvements in maternal nutrition knowledge and weight loss.

Statistical Analyses Performed

Paired-samples t tests, repeated measures analysis of variance, analysis of covariance, Pearson correlations, and χ² statistics.

Results

Nutrition knowledge of mothers increased in all areas. Participants with weight loss ≥2.27 kg (responders) had greater knowledge than those who did not; however, the actual net gain was similar for those who lost and did not lose weight. Weight gainers only improved in two areas on the test, whereas weight-loss responders increased knowledge in all six. Responders appeared more cognizant of diet, weight loss, and health information.

Conclusions

Weight-management programs should include a strong component of nutrition education to alleviate knowledge inequalities and promote more effective weight control. In low-income mothers, greater initial knowledge may be more predictive of weight loss than gains in knowledge during an intervention.     

Randomized controlled trials of herbal interventions underreport important details of the intervention

Objective

To examine the quality of reporting and predictors of reporting in randomized clinical trials (RCTs) of herbal medicine interventions.

Study Design and Setting

We searched Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, and Academy of Microscope Enhanced Dentistry up to December 2007 for any English language RCT of 11 commonly used herbal medicine interventions. Two individuals separately and independently assessed all trials using the Consolidated Standards of Reporting Trials (CONSORT) checklist for herbal medicines interventions. We randomly selected 100 of these trials, extracted a set of potential predictor variables identified through a literature search and consultation with experts, and performed a conceptually driven stepwise elimination regression analyses for predictor variables.

Results

The 406 trials reported on average 38% of the information suggested in the checklist. Regression analyses revealed better overall reporting in trials with a participant flow diagram (P = 0.008), those of Panax quinquefolius (P = 0.018), and those published in more recent years (P = 0.02).

Conclusion

Our results indicate that RCTs of herbal medicine interventions frequently do not report important characteristics of the intervention. Trialists should refer to the CONSORT for herbal medicines when reporting their trials.     

Calcium Intake and 10-Year Weight Change in Middle-Aged Adults

Objective

The goal of this study was to examine the purported effects of calcium on modulating body weight.

Design

Retrospective data was used to assess the relationship between calcium intake and weight change over an 8- to 12-year period among middle-aged adults.

Subjects

Participants were 10,591 men and women aged 53 to 57 years recruited during 2000-2002.

Statistical Analysis

Linear regression was used to model associations of 10-year weight change and calcium intake, adjusted for weight at age 45 years, energy intake, physical activity, and other factors.

Results

Calcium intake was associated with 10-year weight change only in women. Women with current calcium supplement dose of >500 mg/day had a 10-year weight gain of 5.1 kg (95% confidence interval 4.7 to 5.5) compared to 6.9 kg (95% confidence interval 6.5 to 7.4) among nonusers (P for trend=0.001). Trends were similar for total calcium intake from diet plus supplements (P for trend=0.001). Dietary calcium alone had no significant effect on 10-year weight change.

Conclusions

Increasing total calcium intake, in the form of calcium supplementation, may be beneficial to weight maintenance, especially in women during midlife.     

Severe catabolic state after an overnight fast in patients with chronic renal failure

Objective

Starvation causes more rapid development of a catabolic state in patients with liver cirrhosis than in normal subjects. Because the kidneys have a gluconeogenic activity similar to that of the liver, we tested whether patients with chronic renal failure develop a catabolic state after an overnight fast.

Methods

The effect of an overnight fast on diurnal changes in respiratory quotient (RQ) was studied in 12 normal subjects and 12 patients with stable chronic renal failure. Changes in RQ in the early morning after an overnight fast were also studied in 27 patients with chronic renal failure not on dialysis. We also examined the effect on RQ of consuming a light snack in the evening before the measurements.

Results

The RQ before breakfast, but not at other times, was significantly lower in patients with renal failure than in normal subjects (0.824 ± 0.051 versus 0.868 ± 0.038, P < 0.05). This indicated that patients with renal failure had higher fat use and developed a catabolic state early in the morning. The RQ before breakfast showed significant inverse correlations with creatinine levels (r = −0.604, P < 0.001). Supplementation with a carbohydrate-rich snack in the evening resulted in a significant increase of 0.07 ± 0.04 (P < 0.05) in mean RQ in the early morning. This suggested that a late evening snack is useful for improving the catabolic state of patients with renal failure.

Conclusion

Starvation involving an overnight fast facilitates catabolism of visceral and muscle proteins in renal failure. This suggests that nutritional management of renal failure should focus not only on the contents of a meal, but also on the timing of the meal.     

Diet Based on the Japanese Food Guide Spinning Top and Subsequent Mortality among Men and Women in a General Japanese Population

Background

The Japanese Food Guide Spinning Top was developed by the Japanese Ministry of Health, Labor, and Welfare and the Ministry of Agriculture, Forestry, and Fishery to promote healthful diets.

Objective

Adherence to the Japanese Food Guide Spinning Top was evaluated in terms of future mortality in a prospective cohort study.

Design

A prospective cohort study among men and women in a general Japanese population.

Subjects/setting

The cohort consisted of 13,355 men and 15,724 women residing in Takayama, Japan, in 1992. At baseline, a food frequency questionnaire was administered, and adherence to the food guide was measured based on consuming the recommended number of servings of grains, vegetables, fish and meat, milk, and fruits, as well as total daily energy intake and energy from snacks and alcoholic beverages. Higher scores indicated better adherence to the recommendations on a scale of 0 to 70. Based on data obtained from the Office of the National Vital Statistics, deaths occurring among members of the cohort were prospectively noted from 1992 to 1999.

Statistical analyses performed

To assess the magnitude of association of adherence scores with subsequent mortality, a Cox proportional hazard model was applied to estimate hazard ratios (HRs) with 95% confidence intervals (CIs).

Results

Among women, the adherence score was significantly associated with a lower risk of mortality from all causes (comparing highest and lowest quartiles of the score, HR 0.78, 95% CI 0.65 to 0.94, P for trend 0.01) in a multivariate analysis; noncardiovascular, noncancer causes (HR 0.69, 95% CI 0.50 to 0.96, P for trend 0.04) and cardiovascular disease (HR 0.76, 95% CI 0.56 to 1.04, P for trend0.05). No statistically significant association was observed between the adherence score and mortality among men.

Conclusions

The results suggest that diets based on the food guide have the benefit of reducing future mortality in women.     

Housing and allergens: A pooled analysis of nine US studies

Background

Housing conditions can contribute to allergen exposures that are linked to asthma, but little is known about which of those conditions are most likely to predict high levels of allergens in settled house dust.

Methods

We pooled allergen, housing condition, occupant behavior, demographic, and other data from nine asthma studies (n=950 homes in 6 US cities). Dust mite (Der f 1 or Der p 1), cockroach (Bla g 1 or Bla g 2), mouse (Mus m 1), cat (Fel d 1) and dog (Can f 1) allergens were measured in settled dust from kitchens or bedrooms, and concentrations were categorized according to previously published asthma symptom thresholds. We calculated odds ratios (OR) using logistic regression to identify those housing conditions and occupant behaviors that were associated with clinically significant allergen levels, after adjusting for numerous confounding variables.

Results

The adjusted results show that high cockroach allergen was associated with cracks or holes in walls (OR=2.1), high dust mite allergen was associated with mold odor (OR=2.5), housing built before 1951 (OR=2.1), and single-family home with slab on grade (OR=1.9); and mouse allergen was associated with rodent control or signs of rodents (OR=3.62) and inversely associated with presence of a cat (OR=0.20). Water leaks and below average housekeeping had unadjusted high odds ratios for high cockroach allergen.

Conclusion

We have identified a number of housing conditions that are consistently associated with increased allergen dust concentrations. This study indicates that screening for housing-based asthma triggers should include presence of cats, dogs, cockroaches, or rodents; water leaks; mold or mold odor; holes or cracks in walls; and below average housekeeping. Single family houses that have basements or crawl spaces or are built before 1951are also important predictors for increased allergens in housing.     

Vitamin C provision improves mood in acutely hospitalized patients

Objective

Hypovitaminosis C and D are highly prevalent in acutely hospitalized patients, but the clinical significance of these biochemical abnormalities is not known. Because deficiencies of vitamin C and D have been linked to psychologic abnormalities, vitamin C or D provision could improve the mood state of acutely hospitalized patients.

Methods

Double-blind clinical trial of the effect of vitamin C (500 mg twice daily) or vitamin D (1000 IU twice daily) on mood, as assessed with a validated instrument, the Profile of Mood States.

Results

Vitamin C therapy increased plasma (P < 0.0001) and mononuclear leukocyte (P = 0.014) vitamin C concentrations and was associated with a 34% reduction in mood disturbance (P = 0.013). Vitamin D therapy increased plasma 25-hydroxyvitamin D concentrations (P = 0.0004), but had no significant effect on mood.

Conclusions

Treatment of hypovitaminosis C improves the mood state of acutely hospitalized patients.     

Validation of an Australian electronic food frequency questionnaire to measure polyunsaturated fatty acid intake

Objective

To develop and validate a simple non-invasive method that estimates the intakes of omega-3 and omega-6 polyunsaturated fatty acids (PUFA) in a healthy adult population.

Methods

A new electronic PUFA food frequency questionnaire (FFQ) was validated by comparison with a 3-d weighed food record and blood biomarkers (erythrocytes and plasma) using the method of triads model and tested for reproducibility. Healthy subjects were recruited from the local Illawarra Region, New South Wales, Australia.

Results

The PUFA FFQ adequately estimated intakes for eicosapentaenoic acid, docosahexaenoic acid, total long chain omega-3 PUFA, linoleic acid, total omega-6 PUFA, and total PUFA, which were comparable with results from the 3-d food record. Eicosapentaenoic acid, docosahexaenoic acid, and total long chain omega-3 showed high validity coefficients for erythrocytes (and plasma) 0.92 (0.87), 0.69 (0.64), and 0.78 (0.73) (P < 0.05), respectively. Spearman’s rank correlation coefficients ranged from 0.48 to 0.76 when the PUFA FFQ was tested for reproducibility (P < 0.05).

Conclusion

The electronic PUFA questionnaire was found to be reproducible and is a valid tool to assess PUFA intakes in a healthy adult population.     

Real-world effectiveness of a German school-based intervention for primary prevention of anorexia nervosa in preadolescent girls

Objective

Anorexia nervosa (‘AN’) is notoriously difficult to treat, has high mortality rates, and has a prevalence peak in 15-year-old girls. We developed a German school-based intervention program (‘PriMa’) for the primary prevention of AN in preadolescent girls and assessed the effects in a sample of Thuringian girls.

Method

Intervention involved nine guided lessons with special posters and group discussions. A parallel controlled trial with pre-post measurements and a three-month follow-up was conducted in 92 Thuringian schools (n = 1553 girls) in 2007 and 2008. Primary outcomes were conspicuous eating behavior, body self esteem, and AN-related knowledge.

Results

After adjusting for the girls' ages and the type of school, we observed significant improvements in the areas of knowledge (d = .24) and body self esteem (d = .29), but not for eating behavior.

Conclusion

The PriMa intervention provides an efficient and practical model to increase AN-related protection factors.     

Change in contraceptive methods following the Yogyakarta earthquake and its association with the prevalence of unplanned pregnancy

Background

This study was conducted to examine access to contraception and change in contraceptive methods before and after the disaster in Bantul area, and to evaluate the prevalence of unplanned pregnancy.

Study Design

In total, 450 married women participated. Questionnaires, which included participants' background, contraceptive methods, difficulties in accessing contraceptive method, and unplanned pregnancy, were completed.

Results

Within 1 year of the disaster, the percentage of participants who used injections and implants tended to decrease, while the percentage of participants who used pills tended to increase. Use of coitus interruptus significantly increased after the disaster. The prevalence of unplanned pregnancy was significantly higher in a group of participants who had difficulty accessing contraceptive methods compared to a group that did not.

Conclusions

Health personnel should not only actively deliver contraceptive methods in a disaster situation but also educate couples to prevent unplanned pregnancy.     

Review of enteric outbreaks in prisons: effective infection control interventions

Objectives

To identify documented outbreaks, worldwide, of enteric illness in correctional facilities over the last 10 years to understand the epidemiology of the outbreaks and explicitly identify effective infection control measures.

Study design

Review of literature and outbreak investigation reports.

Methods

Computer-aided searches of literature databases and systematic searches of government websites were completed to identify relevant outbreak reports. Reference lists were hand-searched to validate the electronic search methodology. Reports identified through personal communications with public health officials were also included.

Results

Of the 72 outbreaks meeting the inclusion criteria, 76% and 21% were associated with bacterial agents and viral agents, respectively. The majority of outbreaks were associated with Salmonella (n = 20), Clostridium perfringens (n = 14), norovirus (n = 14), pathogenic Escherichia coli (n = 10) and Campylobacter spp. (n = 5). Transmission was primarily foodborne (67%). During an outbreak, the most common control measures included limiting movements of ill inmates and staff, and their exclusion from kitchen duty. The most common retrospectively reported preventative recommendations included monitoring food temperatures and effective infection control procedures.

Conclusions

It is essential to monitor food temperatures to prevent enteric outbreaks in prisons. Training in safe food handling should be offered to inmates who work in the kitchen. Enteric outbreaks are best controlled by effective infection control practices, while active surveillance and early diagnosis may prevent further spread of illness.     

Behavioral change with influenza vaccination: factors influencing increased uptake of the pandemic H1N1 versus seasonal influenza vaccine in health care personnel

Background

Many health care personnel (HCP) choose not to get vaccinated against influenza despite recommendations to do so. The pH1N1 epidemic gave a unique opportunity to evaluate the attitudes to influenza vaccination of a group of HCP who routinely choose not to get vaccinated, but accepted the pH1N1 vaccine.

Methods

HCP employed at a tertiary care hospital in Winnipeg, Canada who received the pH1N1 vaccine were invited to participate in an online survey asking about attitudes and experiences regarding seasonal and pH1N1 influenza and vaccination. Those eligible included primarily nurses, other clinical staff, and support staff, as few physicians work as employees.

Results

Of the 684 respondents (29% return rate), 504 reported routinely getting vaccinated (RV) for seasonal influenza and 180 reported routinely not getting vaccinated (NRV). These two groups had different attitude towards the two strains of influenza, with markedly lower level of concern about seasonal influenza than pH1N1 for the NRV group. The contrast was especially notable regarding the NRV's view of the seriousness of the illness, their sense of exposure risk, and their confidence in the vaccine effectiveness (for all, seasonal < pH1N1, p < 0.001). The most common motivators for getting vaccinated for both NRV and RV groups related to concerns about personal or family safety, while the choice to decline seasonal vaccination related primarily to lack concern about the illness and concerns about vaccine effectiveness and safety. Coworkers were influential in the decision to get the pH1N1 vaccine for the NRV group.

Conclusion

For HCP who do not routinely get the seasonal vaccination, perception of risk outweighing side effect concerns appeared to be a major influence in going ahead with the pH1N1 vaccine. Educational campaigns that focus on personal benefit, engage peer champions, and address concerns about the vaccine may improve influenza vaccine uptake among health care personnel.     

Intrauterine device use among women with ovarian cancer: a systematic review

Background

Fertility-sparing treatment may be an option for women with early stage ovarian cancer and certain tumor types. This systematic review evaluated the evidence on the safety of intrauterine device (IUD) use by women with ovarian cancer.

Study Design

We searched the PubMed database for peer-reviewed articles relevant to IUD (copper or levonorgestrel-releasing) use and ovarian cancer published in any language from database inception through August 2009. We sought studies that examined outcomes among women using an IUD at or after ovarian cancer diagnosis.

Results

Of the 250 articles identified by our search strategy, none provided evidence (direct or indirect) regarding the safety of IUD use among women with ovarian cancer.

Conclusions

No evidence on the safety of IUD use among women with ovarian cancer was identified. While there are some theoretical concerns that IUD use might affect monitoring of disease progression of sex cord-stromal tumors, or increase risk of pelvic infection or vaginal bleeding among women undergoing chemotherapy, we did not find any data to suggest that IUD use would lead to worsening of primary ovarian cancer.     

Validity and reliability of a survey to identify vaccine-hesitant parents

Objective

To assess the construct validity and reliability of the Parent Attitudes about Childhood Vaccines survey.

Study Design

Cross-sectional survey of parents of 19-35 month old children in a closed model HMO. We used factor analysis to confirm survey sub-domains and Cronbach's α to determine the internal consistency reliability of sub-domain scales. Construct validity was assessed by linking parental responses to their child's immunization record.

Results

Our response rate was 46% (N = 230). Factor analysis identified 3 factors that explained 70% of the total variance for the 18 survey items. We deleted 3 items that failed to load highly (>.4) on an identified factor, correlated poorly with other items, or had a hesitant response that was not associated with increased under-immunization. Cronbach's α coefficients for the 3 sub-domain scales created by grouping the remaining 15 items were .74, .84, and .74, respectively. Children of parents with survey scores of 50-79 had 14% more days under-immunized from birth to 19 months (95% CI: 8.0, 20.5) than those with parents who scored <50. Scores of ≥80 were associated with 51% more days under-immunized (95% CI: 38.2, 63.4).

Conclusion

The revised survey is a valid and reliable instrument to identify vaccine-hesitant parents.