Blunted cardiovascular reactions are a predictor of negative health outcomes: A prospective cohort study

The study examined whether cardiovascular responses to psychological stress tests predict future anxiety and depression scores 40‐months later. Hemodynamic measures were obtained from 102 healthy adults before, during and after mental arithmetic, a speech task, and a cold pressor task. The 14‐item Hospital Anxiety and Depression Scale was administered at initial testing and at 40‐months follow‐up. At initial testing analyses revealed that high anxiety symptoms were characterized by blunted cardiovascular reactions to acute mental stress, particularly mental arithmetic. Furthermore, after adjustment for baseline blood pressure (BP ), baseline anxiety levels and traditional risk factors, attenuated systolic BP responses to mental arithmetic were associated with future anxiety levels (ΔR ² = .055). These findings suggest that blunted cardiovascular reactions to stress may be an independent risk factor for future anxiety levels.     

Profound barriers to basic cancer care most notably experienced by uninsured women: Historical note on the present policy considerations

America is considering the replacement of Obamacare with Trumpcare. This historical cohort revisited pre-Obamacare colon cancer care among people living in poverty in California (N = 5,776). It affirmed a gender by health insurance hypothesis on nonreceipt of surgery such that uninsured women were at greater risk than uninsured men. Uninsured women were three times as likely as insured women to be denied access to such basic care. Similar men were two times as likely. America is bound to repeat such profound health care inequities if Obamacare is repealed. Instead, Obamacare ought to be retained and strengthened in all states, red and blue.     

Phenotypes of sleep-disordered breathing symptoms to two years of age based on age of onset and duration of symptoms

ObjectiveChildhood sleep-disordered breathing (SDB) symptoms may comprise multiple phenotypes depending on craniofacial anatomy, tonsil and adenoid growth, body habitus, and rhinitis symptoms. The primary objective of this study is to identify and characterize the different SDB phenotypes to two years of age.MethodsData from 770 infants in the Edmonton sub-cohort of the Canadian Healthy Infant Longitudinal Study (CHILD) were analyzed to identify SDB phenotypes based on age of onset and duration of symptoms. Parents completed the 22-item sleep-related breathing disorder (SRBD) scale. Children with a SRBD ratio greater than 0.33 were considered positive for SDB at each quarterly assessment between three months and two years. The STATA Proc trajectory extension identified SDB phenotypes based on their age of onset and duration of symptoms and attributed the percentage chance of a participant being assigned to each phenotype. Multivariate linear regression identified factors associated with increased risk of being assigned to each SDB phenotype.ResultsTrajectory analysis identified four phenotypes: no SDB (65.7%), early-onset SDB (15.7%) with peak symptoms at nine months, late-onset SDB (14.2%) with peak symptoms at 18 months, and persistent SDB (5.3%) with symptoms from 3 to 24 months. Rhinitis was associated with all three SDB symptom trajectories (p < 0.05). Children with gastroesophageal reflux disease presented with early (p = 0.03) and late SDB (p < 0.001). Maternal obstructive sleep apnea syndrome (OSAS) was associated with persistent (p = 0.01) and late SDB (p < 0.001). Atopy (positive skin prick test at one year) was associated with persistent SDB (p = 0.04). Infants born prior to 36.5 weeks gestational age were more likely to present with late SDB (p = 0.03).ConclusionChildhood SDB symptoms, rather than being a homogenous disorder, may comprise multiple overlapping phenotypes each with unique risk factors.     

Phthalate metabolites and bisphenol A in urines from German school-aged children: Results of the Duisburg Birth Cohort and Bochum Cohort Studies

Some phthalates and also bisphenol A (BPA) interfere with the human endocrine system and are labelled as reproductive toxicants. Children's exposure to these contaminants is suspected to be associated with developmental disorders and other health impairments.We provide biomonitoring data on 21 urinary phthalate metabolite and BPA levels in first morning urine of 8–10 year old children. Participants were children born between 1999 and 2002 of the Duisburg birth cohort (8–9 years, N = 113) and of the Bochum cohort study (8–10 years, N = 352). Additionally, for the Duisburg birth cohort we compare current data of children from Duisburg (8–9 years) with data from 2 years earlier when the children were 6–7 years old. We analyzed influences of important covariates on exposure levels by multiple regression analysis and those from two sampling time points by generalized equation estimation models adjusted for important covariates. Compared to recently published studies the phthalate metabolite and BPA concentrations were within the range of background levels. There were no significant differences between children from Bochum and Duisburg. Comparison between the two Duisburg birth cohort data sets (2007–2008 and 2009–2010) showed significant correlations for most of the phthalate metabolites (r_Spearman between 0.25 and 0.51; p ≤ 0.05) but not for BPA (r_Spearman= 0.162; p = 0.143). Most of the phthalate metabolites in the groups of the 6–7 and 8–9 years old Duisburg children were negatively associated with higher age, except for BPA concentrations with nearly constant levels. Exposure levels may be influenced by changes in child specific exposure patterns with age but also by the rapidly changing phthalate market.