Antibiotics are the most commonly prescribed drugs in children and, yet, their long-term effects on this population are relatively unknown. In this retrospective study of patients born between 2001 and 2011 at 35 or more weeks of gestation that had at least 1 visit within the first 14 days of life and at least two more within the first year of life, investigators studied the relationship between antibiotic exposures as an infant and childhood weight gain in 38,522 singleton children and 92 twins across pediatric primary care practices in the Northeast. The children were followed from their first visit until age 7. Exposure was considered any systemic antibiotic use and was compared to weight measurements taken at preventive care visits. The results showed that antibiotics were not significantly related to the rate of weight change in singleton children, showing only 0.05 kg of added weight gain between ages 2 and 5 (95% CI, -0.004 to 0.11; P=0.07). The results also showed that antibiotic exposure was not related to the rate of weight change in twins, as the study demonstrated added weight change of -0.09 kg between ages 2 and 5 (95% CI, -0.26 to 0.08; P=0.30). Therefore, it was concluded that antibiotics during infancy do not need to be limited for the sake of preventing an increased weight gain during the patient’s childhood.
Exercise has a well-documented positive impact on all-cause mortality, as well as several common morbidities. However, more than 50% of adults in the United States don’t perform the recommended amount of physical activity. In this single-center randomized control trial, three systems of financial incentives to encourage adults to exercise were investigated on 281 adult employees for 13 weeks. The first group was a gain-incentive group, where participants received a set sum of money ($1.40) if they met the daily step goal (7000 steps). In the second loss-incentive group, participants would be docked $1.40 cents off of a monthly incentive of $42 for each day they didn’t meet the step goal. Finally, there was a lottery-incentive group that had a 1% chance of winning $50 and an 18% chance of winning $5 if they had completed their step goal the day before. There was also a control group that did not have any financial incentive. The mean proportion of participant-days where the step goal was met was measured for each system. In proportion of participant-days meeting the step goal, the control group had a proportion of 0.30 (95% CI, 0.22 to 0.37), the gain-incentive system showed a proportion of 0.35 (95% CI, 0.28 to 0.41), the lottery-incentive yielded a proportion of 0.36 (95% CI, 0.29 to 0.43), and the loss-incentive had the highest proportion with 0.45 (95% CI, 0.38 to 0.52). Only the loss-incentive group had a significant difference in participant-days from the control group (P=0.001). However, differences in mean daily steps were not different (P=0.056). Overall, this study helped the investigators to conclude that loss-incentives were the best system for achieving physical activity goals in employees. The investigators also called for more research to be done in this area.
Higher levels of circulating triglycerides have been associated with an increased risk of ischemic cardiovascular disease. Lipoprotein lipase is an enzyme that helps utilize triglycerides by hydrolyzing them to release free fatty acids and, thus, lowering serum levels. Angiopoietin-like 4 (ANGPTL4) is a secreted protein that inhibits lipoprotein lipase. This study utilized the DiscovEHR genetics study to sequence the ANGPTL4 exons for 42,930 participants and correlated genomic data with clinical lipid levels in those who had inactivating mutations like the missense E40K variant. Next, they looked at 10,552 patients with coronary artery disease and 29,233 controls to see if there was an association with the E40K variant. Finally, they tested monoclonal antibodies against ANGPTL4 in mice and monkeys. The results showed that those who were either heterozygous for the E40K mutation (1661 patients) or homozygous for it (17 patients), as well as the 75 other patients who had 13 other inactivating mutations, had 7% higher high-density lipoprotein and 7% lower triglycerides. Additionally, those with the E40K mutations had a lower risk for coronary artery disease with an odds ratio of 0.81 (95% CI, 0.70 to 0.92). Homozygotes for the inactivation had more pronounced increases in high-density lipoprotein and decreases in tryglyceride levels. Similarly, those with unspecified inactivating mutations also were found to have lower risk of coronary artery disease with an odds ratio of 0.56 (95% CI, 0.32 to 1.00). Finally, the monoclonal antibodies that acted on ANGPTL4 showed efficacy in reducing circulating triglyceride levels in rhesus monkeys, reducing 4 out of 5 obese monkeys by 60%. As a result of this studies, it was concluded that inactivating mutations of the ANGPTL4 protein result in lower risk for coronary artery disease.
In the United States, back pain is one of the major causes of disability. As a result, efficacious treatments with the potential for pervasive implementation are needed. This study sought to compare mindful-based stress reduction (MSBR) versus cognitive behavior therapy (CBT) or usual care for adults with chronic low back pain. 342 adults, with ages ranging from 20 to 70, who had been diagnosed with chronic low back pain were assigned to cognitive behavior therapy (113 patients), mindful-based stress reduction (116 patients), or normal care (113 patients). Both the MSBR and CBT interventions were 2 hours a week for 8 weeks with similar numbers of participants per group. Those in the usual care group were free to seek their own treatment, if desired. MSBR was adapted from the 2009 MSBR instructor’s manual. An MSBR instructor conducted sessions that involved practicing mindfulness through activities like yoga, as well as didactic content. The CBT intervention was focused on teaching participants about their pain, trying to change their thoughts about it, and meeting behavioral goals. Improvement was measured by the Roland Disability Questionnaire at 26 weeks and showed that a higher percentage of those undergoing MSBR (60.5%) and CBT (57.7%) had clinically meaningful improvement, whereas usual care showed this type of improvement in 44.1% of the group. This yields a relative risk of 1.37 for MSBR compared to usual care (95%CI, 1.06 to 1.77), a relative risk of 0.95 when MSBR is compared to CBT (95% CI, 0.77 to 1.18), and a relative risk of 1.31 (95% CI, 1.01 to 1.69) when CBT was compared to usual care. CBT and MSBR also showed improvement over usual care in pain bothersomeness (P=0.01). Therefore, it was concluded that MSBR and CBT showed more improvement in patients with chronic low back pain than usual care at 26 weeks. However, there were no significant differences between the two. As a result, MSBR should be considered as a treatment for chronic low back pain.
Many adolescents rely on the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine to protect them against pertussis, as DTaP (diphtheria, tetanus, and acellular pertussis) vaccines efficacy wanes significantly in school-aged children. However, there have been large outbreaks of pertussis even in locations where vaccine coverage with Tdap has been extensive. This study compares the risk for adolescents older than 10 with Tdap vaccines for contracting pertussis as compared to unvaccinated counterparts. Adjusting for factors like age, race, healthcare facility, gender, and time, the investigators were able estimate vaccine effectiveness (1-hazard ratio). The study showed the vaccine effectiveness was 68.8 after year 1 (95% CI, 59.7 to 75.9), 56.9 after year 2 (95% CI, 41.3 to 68.4), 25.2 after year 3 (95% CI, -4.3 to 46.4) and, finally, 8.9 at least 4 years out from the vaccination (95% CI, -30.6 to 36.4). It was also directly shown that as more time passed from the administration of the vaccine, the adolescent was more likely to contract pertussis, with a hazard ratio of 1.35 per year (95% CI, 1.22 to 1.50). Additionally, California had outbreaks in 2010 and 2014 that were not prevented by routine use of the Tdap vaccine. As a result, the efficacy of a single dose of Tdap given to every 11 or 12 year old is called into question. Due to its short-term efficacy with significant drop off over time, the investigators proposed that it should be given in anticipation of an outbreak as opposed to routinely.
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