Immunogenicity and safety of an adjuvanted inactivated polio vaccine,IPV-Al,following vaccination in children at 2, 4, 6 and at 15–18 months

BackgroundAvailability of affordable inactivated polio vaccines (IPV) is of major importance to meet the increasing global supply needs. The results presented here demonstrate non-inferiority of a reduced-dose, aluminium hydroxide-adjuvanted IPV (IPV-Al) to standard IPV.MethodsA phase 3, observer-blinded, randomised, clinical trial was conducted in Panama in infants who received either IPV-Al (n = 400) or standard IPV (n = 400) at age 2, 4 and 6 months. In the booster trial, subjects received a single dose of IPV-Al at age 15–18 months. The primary endpoint was type-specific seroconversion, defined as an antibody titre ≥4-fold higher than the estimated maternal antibody titre and a titre ≥8, one month after the primary vaccination series. In the booster trial, the primary endpoint was the type-specific booster effects (geometric mean titre (GMT) post-booster (Day 28)/GMT pre-booster (Day 0).ResultsSeroconversion rates following primary vaccination with IPV-Al vs IPV were: 96.1% vs 100% (type 1); 100% vs 100% (type 2); and 99.2% vs 100% (type 3) respectively. IPV-Al was non-inferior to IPV, as the lower 95% confidence limits of the treatment differences were above the pre-defined −10%-point limit: 3.94% (-6.51; −2.01) for type 1; 0.0% (-1.30; −1.37) for type 2; −0.85 (-2.46; 0.40) for type 3. The booster effects for the group primed with IPV-Al versus the group primed with IPV were 25.3 vs 9.2 (type 1), 19.1 vs 6.5 (type 2) and 50.4 vs 12.5 (type 3). IPV-Al had a comparable safety profile to that of IPV.ConclusionsNon-inferiority of IPV-Al to standard IPV with respect to seroconversion after vaccination at 2, 4 and 6 months was confirmed for all three poliovirus serotypes. A robust booster response was demonstrated following vaccination with IPV-Al, regardless of the primary vaccine received. Both vaccines were well tolerated.ClinicalTrials.gov identifiers: NCT03025750 and NCT03671616.Funding: Bill & Melinda Gates Foundation.     

Effort-reward imbalance, “locked in” at work,and long-term sick leave

Objectives  The objective was to study the relationship between a situation characterized as being in a “locked-in” position (LIP) in occupation and/or place of work, Effort-reward imbalance (ERI), and long-term sick leave. Methods  The study population derived from one section of a cross-sectional study SKA (sick-leave, culture and attitudes), and comprised all employees at the Swedish Social Insurance Agency responsible for management and compensation of illness in the working population. The analyses were performed for 2,951 women and 534 men who had complete data. Logistic regression was used to calculate odds ratio (OR) for ERI and sick-leave, the latter only for women. Results  The results showed a strong association between LIP within the place of work and ERI (for women OR = 3.28 95% CI 2.65–4.07, and for men 2.74 1.75–4.30). Also LIP within occupation resulted in high ERI (for women OR = 1.96 1.57–2.41, and for men 1.92 1.22–3.03). In women, ERI (OR = 1.40 1.15–1.70) as well as LIP within place of work (1.88 1.50–2.36) and within occupation (1.48 1.12–1.86) were associated with sick leave. ERI showed a significant mediating effect between LIP and sick leave, within place of work and within occupation (Z value 2.20 and 2.88, respectively). Conclusions  High ERI is associated with a situation characterized by being locked-in within an occupation or/and within a place of work. The results thereby support the theoretical model of Effort-reward imbalance. The results show that high ERI and being locked in are associated with long-term sick leave. ERI is a potential mediator of the association between being locked in and sick leave.     

Triple jeopardy? Mental health at the intersection of gender,race, and class

Structural theories of stratification predict that groups with low positions in social hierarchies experience high rates of mental health problems. Extensions of this approach such as a triple jeopardy hypotheses claim that groups that are subordinate in multiple stratification systems such as gender, race and class are at especially high risk. Multiple minority statuses affect mental health in paradoxical ways, however, that refute triple jeopardy approaches. This paper presents a theoretical perspective based in cultural as well as structural theories that offers an alternative to triple jeopardy. I predict that certain relational schemas are jointly shaped by gender, race, and class and help explain their anomalous effects on mental health. These schemas of self-salience refer to beliefs about the relative importance of the self and others in social relations; they affect mental health by forming subjective alternative hierarchies to larger societal stratification systems. I use secondary analyses of two U.S. data sets to investigate this perspective. Results of regression analysis show that self-salience helps explain the paradoxical patterns of mental health by gender, race, and social class. The findings underscore the importance of using an intersectional approach and integrating cultural and structural factors to understand how stratification shapes mental health.     

Do long workhours impact health, safety, and productivity at a heavy manufacturer?

OBJECTIVES: To test the health, safety, and productivity effects of long workhours. METHODS: Secondary analyses of a longitudinal employee panel (n = 2746). Average hours worked during spring 2001 were assessed relative to health, safety, and productivity outcomes spanning summer 2001 through spring 2002. RESULTS: Employees working overtime were no more likely to incur adverse physical or mental health, presenteeism, or disability outcomes. Those working 60+ hours were more likely to report new injuries and diagnoses, but these effects were overwhelmed by prior health, demographics, and compensation type. CONCLUSIONS: Much previous work has suggested that long workhours generate a wide range of adverse outcomes across the employee continuum. This study found no evidence for pervasive workhour effects. Rather, long workhours--especially weekly schedules at the 60 hour or above mark--can lead to problems in certain areas of health and safety. More research is needed that tests group differences across segmented characteristics (eg, poor versus good health) but keeps workhour impact in perspective.     

Acupuncture Use in the United States: Who,Where, Why,and at What Price?

Despite the increase in acupuncture uses and greater than ever before interest of funding agencies to fund biomedical research in acupuncture, little is known about the profile of acupuncture users. We examined who these individuals are, where they reside, why they use acupuncture, and what price they pay. The increased use and high costs associated with each acupuncture visit poses questions to health care insurers regarding its coverage. Profiling will help conventional providers identify the segment of the population who are more likely to use acupuncture and educate them on the possible risks and benefits of using it with conventional medicine.     

Sunshine and suicide at the tropic of Capricorn, São Paulo, Brazil, 1996-2004

Several studies have confirmed seasonal variation in suicide rates according to hours of sunshine. The suicide pattern was assessed in S?o Paulo, southeastern Brazil, at the tropic of Capricorn from 1996 to 2004. Poisson regression was employed to estimate parameters of seasonality, as well as to verify associations for each day between daylight duration and suicide. During the nine-year study period, there were 3,984 suicides (76.9% in men; median age=38.7 years old). Seasonal averages of suicides were similar, as were monthly averages. Poisson regression did not reveal any association between suicide rates and hours of sunshine (p=0.45) for both sexes. In conclusion, no seasonal pattern was observed for suicides.     

Job strain, effort--reward imbalance, and stress at work: competing or complementary models?

BACKGROUND: The Demand Control Model (DCM) and the Effort Reward Imbalance Model (ERI) offer putative explanations of the relationship between stressful working conditions, job strain, and psychological and physical ill health. AIMS: The aims of this study are to: (a) compare the predictive powers of the two models for explaining perceived job stress and mental distress amongst workers as a whole, (b) identify whether a model which combines dimensions of the DCM and ERI might have more predictive power than either of them separately, and (c) ascertain whether the models make distinct contributions to explaining stress at work in specific occupational settings. METHODS: Statistical analysis was carried out on data collected from a cross-sectional postal survey of a random sample (n = 7,069), of the adult population in an urban area in Southern England. The analysis focused on the 4,135 respondents who were in paid employment. RESULTS: There was little support for combining the models as the combined model was dominated by the predictive power of dimensions from the ERI. However, the results also showed that the models or dimensions of the models made distinct contributions to explaining perceived work stress in different types of occupation. CONCLUSIONS: There is little evidence to support a combined model of work characteristics. The ERI appears to be the stronger of the two models although the DCM has explanatory value for specific occupations.     

Investigation and Control of Anthrax Outbreak at the Human–Animal Interface,Bhutan, 2010

In 2010, we investigated anthrax outbreak in Bhutan. A total of 43 domestic animals died, and cutaneous anthrax developed in 9 persons, and 1 died. All affected persons had contact with the carcasses of infected animals. Comprehensive preparedness and response guidelines are needed to increase public awareness of anthrax in Bhutan.     

Cripples at the medieval hospital of Bátmonostor, Hungary--archeological findings

Cripples from the medieval hospital of Bátmonostor, Hungary. People with disabilities were generally burdened with a painful fate in ancient times, however in the hospitals was no effective therapy. The hospital of Batmonostor was founded at late 13th century, The authors examine by morphological, radiological and histological methods 426 complete skeletons excavated from medieval (14th-15th century) cemetery of Bátmonostor (Hungary). Among them 30 cases (7.1%) of bony ankylosis, (24 cases on lower limb and 6 cases on upper limb) was found. Sacroiliac ankylosis 3 cases, Bechterew's spondylitis ankylopoetica 1 case was seen. Spondylitis tuberculosa and malum Potti 4 cases, and hunchback with other aetiology 2 cases was detected. Beside the cases with ankylosis severe posttraumatic osteomyelitis (7 cases), primary malignant bone tumors (2 cases) and an osteoplastic metastatic tumors (probably prostata carcinoma) was diagnosed. Paleopathologic study of the physically disabled may yield information and insight on the prevalence of crippling disorders. The authors hypothetize, that crippled persons lived in the hospital until their deaths.     

Cholera management and prevention at Hôpital Albert Schweitzer, Haiti

In October 2010, Hopital Albert Schweitzer Haiti treated some of the first patients with cholera in Haiti. Over the following 10 months, a strategic plan was developed and implemented to improve the management of cases at the hospital level and to address the underlying risk factors at the community level.     

Secondary Standard Dosimetry Laboratory at the Ruder Bosković Institute, Zagreb

The Secondary Standard Dosimetry Laboratory at the Ruder Boskovi? Institute (SSDL), Zagreb, Croatia, was set up over the last few years with a strong support by the International Atomic Energy Agency (IAEA) through the Technical Cooperation Project CRO/1/004, Establishing Calibration Services. The SSDL occupies two calibration rooms, each 9.6 m long and 6 m wide and each with proper air conditioning. Their walls are concrete and 1 m thick, and the entrance doors are plated with lead to protect the control rooms and the surroundings against radiation. In the first calibration room in the basement, there are two sealed sources which share the same, 6 m long calibration bench. A 30 TBq 60Co source on one side of the bench is used for calibrating ionising chambers and other high-dose radiation equipment. The irradiation unit on the other side of the bench combines two sealed sources, that is, a 740 MBq 137Cs source and a 185 MBq 60Co source, and is used for radiation protection purposes. It has three attenuators with nominal attenuations of x10, x100, and x1000. The second calibration room, which is just above the first, accommodates an X-ray unit (ISOVOLT 420, 40 kV to 300 kV, 1 mA to 20 mA) with a 5 m long calibration bench, aperture wheel assembly designed to modify the X-ray beam diameter to meet various configuration requirements for calibration instruments, a set of filter assemblies to control beam definition according to ISO 4037-3, and a half-value layer kit.     

Medical humanities: stranger at the gate,or long-lost friend?

“Medical humanities” is a phrase whose currency is wider than its agreed meaning or denotation. What sort of study is it, and what is its relation to the study of philosophy of medicine? This paper briefly reviews the origins of the current flowering of interest and activity in studies that are collectively called “medical humanities” and presents an account of its nature and central enquiries in which philosophical questions are unashamedly central. In the process this paper argues that the field of enquiry is well-conceived as being philosophical in character, and as having philosophy — albeit pursued over a larger canvas — at the core of its contributing humanities disciplines. The paper characterises humanities disciplines as having an important focus on human experience and subjectivity, of which the experiences and subjectivities at stake in health, medicine and illness form an important sub-set, the preoccupation of the medical humanities as a whole. Claims of interdisciplinarity (as distinct from multidisciplinarity) are noted, but such claims need to be recognised for the high and stern ambition that they embody, and should not be made lightly.