HEIGHT, OCCUPATION AND BACK PAIN IN A NATIONAL PROSPECTIVE STUDY

Back pain is an important public health problem but there isa paucity of knowledge about risk factors and causal mechanisms.Previous studies have shown that tall men are more at risk ofback pain, although observations in women have been less consistent.This paper presents findings from a national longitudinal studyof 3262 men and women aged 43 yr. Standing height and sittingheight were related to 18-month reported prevalence of ‘sciatica,lumbago or severe backache’ in both men and women. Thepaper investigates explanations for these findings using previouslycollected data on childhood growth and detailed lifetime occupationalhistories. Neither greater susceptibility of tall men to heavylifting, nor the timing of growth, were able to account forthese relationships. To assess further the association betweenheight and back pain, information is needed on the relationshipbetween stature and characteristics of spinal structure. KEY WORDS: Longitudinal, British, Growth, Adults, Lifting, Spine     

Factor IX replacement to cover total knee replacement surgery in haemophilia B: a single‐centre experience, 2000–2010

Summary. Total knee replacement (TKR) is a well recognized treatment for haemophilic arthropathy. Successful haemostasis can be achieved by bolus doses or continuous infusion (CI) using either recombinant (r) or plasma‐derived (pd) factor IX (FIX). We retrospectively analysed our experience of factor replacement to cover TKR in haemophilia B patients and explored factors related to FIX use during surgery. Between 2000 and 2010, 13 primary TKRs were performed in 11 haemophilia B patients. Operations were performed by the same surgeon using standard techniques. Median age was 58 years (42–79). An adjusted CI protocol was used for 5 days followed by bolus doses. FIX:C was maintained at 100 IU dL^?1 in the immediate postoperative period. There was no excess haemorrhage. There was no evidence of thrombosis or infection. All patients received mechanical thromboprophylaxis and only one chemical. CI was used in seven cases. Ten patients received pdFIX. Median hospital stay was 14 days (8–17). Median factor usage was 999 IU kg^?1 (768–1248). During CI, factor consumption was 695 IU kg^?1, 691 IU kg^?1 and 495 IU kg^?1 for Bene Fix ®, Replenine® and Haemonine, respectively. Clearance of both pdFIX and rFIX reduced during CI. All operations were uncomplicated. The decreased clearance in the CI setting reduced the amount of FIX required to maintain a therapeutic level. This reduction was greater with pdFIX and may be related to pharmacokinetic differences between pdFIX and rFIX. Given the excellent safety profile of the pdFIX products, CI of FIX and particularly pdFIX is safe, efficacious and convenient.     

Maternal hypertension and intrapartum fever are associated with increased risk of ischemic stroke during infancy

Aim To examine maternal hypertension, diabetes, and intrapartum fever as potential risk factors for ischemic stroke in infants. Method We conducted a retrospective cohort study of 226 117 children born from January 2000 to December 2007 who were enrolled in the South Carolina Medicaid program. We linked maternal and child Medicaid billing records and birth certificate data. Children with ischemic stroke were identified based on the International Classification of Diseases, Ninth Revision (ICD‐9), code 434 in the child’s billing data. Independent variables and covariates were identified using ICD‐9 codes and birth certificate data. We modeled the odds of ischemic stroke diagnosis in infants, either before 30 days of life or before 365 days. Results Forty‐three children were diagnosed with ischemic stroke before 30 days and 161 before 365 days. Maternal hypertension (odds ratio 2.31 before 30d) and intrapartum fever (odds ratio 3.36 <30d) were significantly associated with odds of ischemic stroke before 30 days and before 365 days; maternal diabetes was not. Interpretation Maternal hypertension and intrapartum fever appear to be risk factors for ischemic stroke in infants. Additional research is needed to determine the mechanism(s) underlying these associations and to develop effective preventive methods for high‐risk infants.     

AGGRESSIVENESS, ONSET OF DEPENDENCE, AND TREATMENT OUTCOME IN SOCIALLY WELL-ADAPTED ALCOHOLICS

Current typologies of alcoholism derive from the whole spectrumof afflicted persons. One type is characterized by variablessuch as early onset of dependence, violence, and aggressiveness.In previous research, this has been shown to be correlated withpoorer prognosis. We tested this association in a fairly homogeneoussubgroup of 258 socially rather well-adjusted male inpatients.Aggressiveness was assessed psychometrically. As a group, patientsdid not differ from general population norms. However, age wasnegatively correlated with aggressiveness. Even after takingpatients' age and duration of dependence into account, aggressivenesswas associated with an early onset of dependence and furtheraspects of drinking history, thus confirming results from previoustypology research. Overall treatment outcome after 6 and 12months was quite good, but was not influenced by aggression.     

TETRAPLOIDY AND BLINDNESS

Cells with tetraploid nuclei have been examined in the striate cortex of patients with visual impairment and compared with age and sex matched controls. The number of these nuclei is reduced in those with visual impairment suggesting that tetraploidy is dependent upon an intact visual pathway and may be related to visual experience and memory.