Intussusception and oral poliovirus vaccination: is there an association?

Oral rotavirus vaccine was voluntarily withdrawn from the market after studies observed an increased risk of intussusception within 2 weeks after immunization. Concern has been raised that other orally administered vaccines, such as oral poliovirus vaccine (OPV), may also be associated with intussusception. In this 1990-1998 case-control study, the authors examined the association between OPV and intussusception in the Washington State Medicaid population, evaluating receipt of OPV during the month prior to intussusception among 119 cases and 589 controls matched by date of birth. Analysis was conducted via matched conditional logistic regression, controlling for sex. Between 1990 and 1998, 119 children younger than age 2 years had a therapeutic enema, surgical reduction, or hospitalization for intussusception and had been enrolled in Medicaid for at least 1 month prior to their intussusception date. There was no significantly elevated risk of intussusception associated with receipt of OPV; 9.2% (11/119) of cases and 8.5% (50/589) of controls were given OPV 0-28 days prior to the case's intussusception date (odds ratio=1.1, 95% confidence interval: 0.5, 2.2). However, to address the hypothesis that risk of intussusception is related to receipt of a particular dose of OPV, a larger study would be required.     

Psychological workload and body weight: is there an association? A review of the literature

BACKGROUND: According to Karasek's Demand/Control Model, workload can be conceptualized as job strain, a combination of psychological job demands and control in the job. High job strain may result from high job demands combined with low job control. Aim To give an overview of the literature on the association between obesity and psychological workload. METHOD: We carried out a review of the associations between psychological workload and body weight in men and women. In total, 10 cross-sectional studies were identified. RESULTS: The review showed little evidence of a general association between psychological workload and body mass index. Only weak positive associations were found, and only between elements of psychological workload and overall body weight. For body fat distribution, two out of three studies showed a positive association in men, but the associations became insignificant after adjustment for education. For women, there was no evidence of a consistent association. CONCLUSION: The reviewed articles were not supportive of any associations between psychological workload and either general or abdominal obesity. Future epidemiological studies in this field should be prospective or experimental, and should examine how chronic work stress affects eating and to what extent initial body weight is a predictor for individual differences in perceived psychological workload.     

Within prisons,is there an association between the quantity of prenatal care and infant birthweight?

There is still controversy surrounding the effectiveness of prenatal care in reducing low birthweight. In addition, very few studies have assessed the relationship between prenatal care and infant birthweight among pregnant women within the prison system. We sought to ascertain whether there is an association between the quantity of prenatal care and infant birthweight among pregnant women within such a setting. We examined the prison medical records of 147 infants born to women delivering at term (37-41 weeks of gestation) between 1 January 2002 and 31 December 2004 who were incarcerated during pregnancy in Texas state prisons. Linear regression was used to evaluate the association between the number of prison prenatal care visits and infant birthweight while adjusting for potential confounders (age, gravidity, maternal education, maternal race, history of substance use, history of alcohol use, history of tobacco use and the presence of any chronic disease). We also adjusted for the interaction between the gestational age at admission to prison and the number of prison prenatal care visits. There was a statistically significant 120.5 g increase in adjusted mean birthweight with each additional prison prenatal care visit (P = 0.001) among study infants whose mothers entered prison during the first trimester. This trend was not observed among women who came in after the first trimester. There appears to be a positive association between the amount of prison prenatal care and infant birthweight among incarcerated pregnant women delivering at term, but this association appears to be limited to women entering prison during the first trimester of pregnancy.     

Families with a perinatal death: is there an association between the loss and the birthweight of surviving siblings?

Our objective was to study birthweight among surviving siblings in families with and without a perinatal loss, and to evaluate whether different causes of death were associated with the results. Data were for 1967-98 from the Norwegian Medical Birth Registry. Births were organised with the mother as the observation unit through the personal identification number, providing sibship files. We analysed 550 930 sibships with at least two singletons, 208 586 sibships with at least three singletons and 45 675 sibships with at least four singleton births. We compared mean birthweight and gestational age between infants in sibships with and without a perinatal loss, total losses and the different causes of death. Surviving siblings in families with a perinatal loss had significantly lower mean birthweights than their counterparts in unaffected families, after adjusting for gestational age, interpregnancy interval, time period and marital status. An exception was found when cause of death was a birth defect, when growth retardation among surviving siblings was not found on average. We conclude that families who have lost an infant because of a birth defect do not appear to have an increased risk of adverse birth outcome associated with growth restriction.     

Alcohol volume, drinking pattern, and cardiovascular disease morbidity and mortality: is there a U-shaped function?

The health effects of a binge pattern of alcohol consumption have not been widely investigated. The objective of this study was to evaluate the cardiovascular consequences of binge drinking (consumption of eight or more drinks at one sitting) and usual (nonbinge) drinking in a longitudinal, population-based study. Data obtained from 1,154 men and women aged 18-64 years interviewed in Winnipeg, Manitoba, Canada, in 1990 and 1991 were linked to health care utilization and mortality records. Using an 8-year follow-up period, the authors performed separate Cox proportional hazards regression analyses for men and women on time to first event for physician visits, hospitalizations, and deaths due to coronary heart disease, hypertension, and other cardiovascular disease. Binge drinking increased the risk of coronary heart disease in both men (hazard ratio (HR) = 2.26, 95% confidence interval (CI): 1.22, 4.20) and women (HR = 1.10, 95% CI: 1.02, 1.18). It increased the risk of hypertension in men (HR = 1.57, 95% CI: 1.04, 2.35) but not in women. Binge drinking had no effect on the risk of other cardiovascular disease. In contrast, usual drinking had significant cardioprotective effects in both men and women. Thus, the harmful effects of binge drinking on cardiovascular disease morbidity and mortality can be disaggregated from the protective effects of usual drinking at various levels of consumption.     

Post-treatment Lyme disease syndrome symptomatology and the impact on life functioning: is there something here?

Purpose

A subset of patients treated for Lyme disease report persistent or recurrent symptoms of unknown etiology named post-treatment Lyme disease syndrome (PTLDS). This study aims to describe a cohort of participants with early, untreated Lyme disease, and characterize post-treatment symptomatology and functional impact of PTLDS over time.

Methods

Sixty-three participants with erythema migrans and systemic symptoms were enrolled in a prospective cohort study. Participants underwent physical exams and clinical assessments, and completed the SF-36 (daily life functioning) and the Beck Depression Inventory, Second Edition (BDI-II) (depression), at each of five visits over a period of 6 months.

Results

Signs of Lyme disease disappeared post-treatment; however, new-onset patient-reported symptoms increased or plateaued over time. At 6 months, 36% of patients reported new-onset fatigue, 20% widespread pain, and 45% neurocognitive difficulties. However, less than 10% reported greater than “minimal” depression across the entire period. Those with PTLDS (36%) did not differ significantly from those without with respect to demographics, pre-treatment SF-36, and BDI-II scores. Statistically significant differences were found over time on the Role Physical, Vitality, Social Functioning, Role Emotional, and Mental Health subscales (with a trend toward significance for the remaining three subscales of Physical Functioning, Bodily Pain, and General Health) of the SF-36 between those with an eventual PTLDS diagnosis and those without when measured at 6 months.

Conclusions

Unlike clinical signs of Lyme disease, new-onset symptoms are reported by a subset of participants without evidence of depressive symptomatology. Patients who developed PTLDS had significantly lower life functioning compared to those without PTLDS. We propose future avenues for researching infection-triggered symptoms resulting from multiple mechanisms.     

Impact of high temperatures on mortality: is there an added heat wave effect?

BACKGROUND: Mortality during sustained periods of hot weather is generally regarded as being in excess of what would be predicted from smooth temperature-mortality gradients estimated using standard time-series regression models. However, the evidence for an effect of continuous days of exceptional heat ("heat wave effect") is indirect. In addition, because some interventions may be triggered only during forecasted heat waves, it would be helpful to know what fraction of all heat-related deaths falls during these specific periods and what fraction occurs throughout the remainder of the summer. METHODS: Extended time-series data sets of daily mortality counts in 3 major European cities (London, 28 years of data; Budapest, 31 years; Milan, 18 years) were examined in relation to hot weather using a generalized estimating equations approach. We modeled temperature and specific heat wave terms using a variety of specifications. RESULTS: With a linear effect of same-day temperature above an identified threshold, an additional "heat wave" effect of 5.5% was observed in London (95% confidence interval = 2.2 to 8.9), 9.3% in Budapest (5.8 to 13.0), and 15.2% in Milan (5.7 to 22.5). Heat wave effects were reduced slightly when we relaxed the linear assumption and these effects were reduced substantially when temperature was modeled as an average value of lags 0 to 2 days. In London, fewer than half of all heat-related deaths could be attributed to identified heat wave periods. In Milan and Budapest, the fraction was less than one fifth. CONCLUSIONS: Heat wave effects were apparent in simple time-series models but were reduced in multilag nonlinear models and small when compared with the overall summertime mortality burden of heat. Reduction of the overall heat burden requires preventive measures in addition to those that target warnings and responses uniquely to heat waves.     

Seatbelt usage: is there an association with obesity?

Wearing a seatbelt can prevent motor vehicle crash deaths. While primary seatbelt laws are designed to encourage vehicle passengers to wear seatbelts by allowing law enforcement officers to issue tickets when passengers do not wear seatbelts, discomfort may discourage obese individuals from wearing a seatbelt. The objective of this study is to assess the association between state-level obesity and seatbelt usage rates in the US, and to examine the possible role played by seatbelt laws in these associations. The strength of the association between obesity rates, seatbelt usage, and primary seatbelt laws at the state level is investigated using data from 2006 to 2011. Linear regression analysis is employed. This model estimates that increasing the obesity rate by 1% in a state where a primary seatbelt law (by which law enforcement officers can issue a ticket when seatbelts are not worn) is in effect is associated with a 0.06% decrease in seatbelt usage. However the same percentage of increase in the obesity rate in a state where no primary seatbelt law is in effect is associated with a 0.55% decrease in seatbelt usage. The magnitude of the statistical association between state obesity rates and state-level seatbelt usage is related to the existence of a primary seatbelt law, such that obesity has less impact on seatbelt usage in states where primary seatbelt laws are in effect.     

Alcohol Use Among Arab Americans: What is the Prevalence?

Information is limited on alcohol use among Arab Americans. The purpose of this study was to describe and analyze the alcohol use pattern among Arab Americans by reviewing existing surveys using an acculturation model. Secondary data analysis. Nationally, English-speaking immigrant Arab Americans reported lower rates of lifetime alcohol use (50.8%), past month use (26.4%) and binge drinking (10%) than the White majority group. In a state survey, self-identified English-speaking Arab Americans were less likely to report past month use (45.6%) than the White majority group but reported similar rate of binge drinking (17.0%). Locally, lifetime drinking was reported by 46.2% of the immigrants but only 13.4% of refugees fleeing war. Few databases are available to estimate alcohol use pattern among Arab Americans; the limited data suggest a drinking pattern consistent with acculturation. However, the potential influence of other factors is unknown and needs to be investigated.