Publications

The purpose of this study was to identify Andean youth's beliefs regarding ceremonial tobacco use and to discuss potential applications of findings in tobacco control interventions. The study was conducted in the Province of Jujuy, Argentina among 202 boys and girls, 10 to 20 years of age, living in rural and urban areas. The world of beliefs and meanings became accessible by asking youth to focus on tangible experiences regarding the Pachamama ceremony, a ritual honoring Mother Earth. Concepts such as reciprocity, the unity of material and spiritual realms, and the complementary nature of opposite forces were linked to beliefs about ceremonial tobacco use. Three domains for understanding smoking behaviour beliefs and norms were identified including mechanisms of production, conceptual tenants and behavioural expressions. These findings suggest that tobacco control interventions based on solidarity, reciprocity, and non-rational ways of learning are more culturally appropriate for native populations in the Andes than the current individual behaviour change models and have the potential applications with other indigenous populations. The research methods also have the potential for generalized application in cross-cultural studies of health behaviours in understudied populations in middle and low-income countries.

BACKGROUND

The aim of the present study is to explore factors affecting or modifying self-reported neck/shoulder pain in sewing machine operators.

METHODS

We investigated self-report neck/shoulder pain in 247 workers who participated in a 4-month prospective intervention study for musculoskeletal disorders. All participants were immigrants. We examine the influence of individual and work-related factors on changes in neck/shoulder pain during follow-up employing linear mixed models with time-spline functions.

RESULTS

We observed a dramatic decline (72%) in self-reported pain intensity in the first month of follow-up, followed by a small increase from the first to fourth month (4% per month). Workers who perceived and reported their physical workload as high or worked overtime experienced less overall pain reduction. Higher baseline pain intensity, being of Hispanic ethnicity (vs. Asian), and taking cumulative daily rest time during work of 35 min or more allowing for muscles to rest were associated with a larger pain reduction in the first month, but not thereafter.

CONCLUSION

Our findings indicate that some work-related factors may be of clinical relevance for reducing neck/shoulder pain. Having lower physical workloads and less overtime work should be considered when treating patients or planning workplace interventions for managing work-related musculoskeletal disorders in this underserved immigrant population.

The human superorganism is a conglomerate of mammalian and microbial cells, with the latter estimated to outnumber the former by ten to one and the microbial genetic repertoire (microbiome) to be approximately 100-times greater than that of the human host. Given the ability of the immune response to rapidly counter infectious agents, it is striking that such a large density of microbes can exist in a state of synergy within the human host. This is particularly true of the distal gastrointestinal (GI) tract, which houses up to 1000 distinct bacterial species and an estimated excess of 1 x 10(14) microorganisms. An ever-increasing body of evidence implicates the GI microbiota in defining states of health and disease. Here, we review the literature in adult and pediatric GI microbiome studies, the emerging links between microbial community structure, function, infection and disease, and the approaches to manipulate this crucial ecosystem to improve host health.

OBJECTIVES

Although osteoporosis treatment can dramatically reduce fracture risk, rates of treatment after hip fracture remain low. In-hospital initiation of recommended medications has improved outcomes in heart disease; hospitalization for hip fracture may represent a similar opportunity for improvement. The objective of this study was to examine rates of in-hospital treatment with a combination of calcium and vitamin D (Cal+D) and antiresorptive or bone-forming medications in patients hospitalized for hip fractures

DESIGN

Observational cohort.

SETTING

Three hundred eighteen hospitals in the United States.

PARTICIPANTS

Fifty-one thousand three hundred forty-six patients aged 65 and older hospitalized for osteoporotic hip fracture.

MEASUREMENTS

In-hospital administration of Cal+D and antiresorptive or bone-forming medications.

RESULTS

Three thousand four hundred five patients (6.6%) received Cal+D anytime after a procedure to correct femoral fracture; 3,763 patients (7.3%) received antiresorptive or bone-forming medications. Only 1,023 patients (2.0%) were prescribed ideal therapy, receiving Cal+D and an antiresorptive or bone-forming medication. Treatment rates remained low across virtually all patient-, provider-, and hospital-level characteristics. The strongest predictor of treatment with Cal+D was the receipt of an antiresorptive or bone-forming medication (adjusted odds ratio=5.50, 95% confidence interval=4.84-6.25), but only 27.2% of patients who received these medications also received Cal+D.

CONCLUSION

Rates of in-hospital initiation of osteoporosis treatment for patients with hip fracture are low and may represent an opportunity to improve care.

Undifferentiated connective tissue disease (UCTD) is a distinct clinical entity that may be accompanied by interstitial lung disease (ILD). The natural history of UCTD-ILD is unknown. We hypothesized that patients with UCTD-ILD would be more likely to have improvement in lung function than those with idiopathic pulmonary fibrosis (IPF) during longitudinal follow-up. We identified subjects enrolled in the UCSF ILD cohort study with a diagnosis of IPF or UCTD. The primary outcome compared the presence or absence of a > or = 5% increase in percent predicted forced vital capacity (FVC) in IPF and UCTD. Regression models were used to account for potential confounding variables. Ninety subjects were identified; 59 subjects (30 IPF, 29 UCTD) had longitudinal pulmonary function data for inclusion in the analysis. After accounting for baseline pulmonary function tests, treatment, and duration between studies, UCTD was associated with substantial improvement in FVC (odds ratio = 8.23, 95% confidence interval, 1.27-53.2; p = 0.03) during follow-up (median, 8 months) compared with IPF. Patients with UCTD-ILD are more likely to have improved pulmonary function during follow-up than those with IPF. These findings demonstrate the clinical importance of identifying UCTD in patients presenting with an "idiopathic" interstitial pneumonia.