The Association Between Smoking and Back Pain

February 19, 2010 | by
ResearchBlogging.org

A new study published in The American Journal of Medicine highlights another reason not to light up that cigarette — smokers (current and former) are more likely to suffer from low back pain than people who have never smoked [1]. Although the association is moderate, it is strongest for chronic back pain and for adolescents.

Low back pain

By now, the vast majority of us know that smoking is bad for you. A number of health risks are associated with smoking. Indeed, many women are not aware that smoking is a risk factor for breast cancer [2]. However, there are other conditions associated with smoking besides the key conditions of cancer and heart disease. Previous research has looked at the link between the experience of low back pain and the potential risk factor of smoking [3-6]. The experience of back pain is widespread [7]. “Chronic” back pain is often of particular interest as it is associated with days lost from work and healthcare costs, in addition to the impact on the patient’s quality of life. In the UK, “persistent” back pain is that which has lasted more than 6 weeks [8]. In the US, “chronic” back pain is pain lasting more than 3 months [9]. The causes of back pain are often complex and unclear. In the present study, the association between back pain and smoking was assessed.

Alzheimer’s Disease May Protect Against Cancer and Vice Versa

February 10, 2010 | by
ResearchBlogging.org

As we get older, and care for our parents as they get older, the most feared age-related conditions we face are arguably Alzheimer’s disease and cancer. But researchers at Washington University have just shown that at least we don’t have to fear both of them at the same time; they recently published a paper in the medical journal of the American Academy of Neurology demonstrating that people with Alzheimer’s disease have a significantly reduced risk of being hospitalized for cancer [1].

Feared age-related conditions

This potential link between these two diseases had been noted for some time, but in this study researchers devoted considerable effort to overcoming the limitations in their previous work. Firstly, they used a population-based sample of 3,020 people older than 65, so their results were not limited to a particular geographic area or socio-economic segment of society. Secondly, they used hospital records rather than informant reports to quantify cancer diagnoses. This controlled for the risk that people with Alzheimer’s disease may be less likely to report their cancers than those without. And lastly, to ensure that they were not seeing less cancer in Alzheimer’s patients because physicians were less likely to look for cancer in people with dementia, or because people with dementia simply die earlier than those without it and thereby avoid cancer, they also looked at cancer risk among people with vascular dementia. Vascular dementia is not neurodegenerative in origin; rather, it results from brain damage due to vascular pathology.

Refusing Immunizations Increases Risk of Chickenpox in Children

January 20, 2010 | by
ResearchBlogging.org

According to a new study published in the journal Archives of Pediatrics & Adolescent Medicine, children of parents who refuse vaccines are over eight times more likely to get chickenpox compared to fully immunized children [1]. The study, funded by the National Institute of Allergy and Infectious Diseases (NIAID), it is the first to assess the relationship between parental vaccine refusal and the risk of chickenpox in children.

Varicella zoster virus (VZV) is a virus of the herpes family that causes chickenpox in children. In adults, the virus can cause both shingles, a painful skin rash characterized by a band of blisters that wrap around the torso from the middle of the back to the chest, and postherpetic neuralgia, persistent nerve pain that occurs after skin rash and blisters heal. VZV or chickenpox is a classic childhood disease and is one of the most commonly refused childhood vaccines due to perceptions by parents and healthcare providers that it is the least severe of all vaccine-preventable diseases. More than 90% of cases occur in children less that 15 years of age, with the highest age-specific incidence occurring during the preschool and kindergarten years (ages 3 – 6) [2]. The varicella vaccine, introduced in the U.S. in 1995, has reduced the incidence of disease and hospitalizations due to chickenpox by 90% [3].

chickenpox-immunization

To establish the relationship between refusing vaccination and the risk of VZV infection, researchers used electronic health records of more than 86,000 children who were members of Kaiser Permanente, an integrated managed care organization, in Colorado between 1998 and 2008 to examine data on both vaccination and disease status.

They identified 343 patients with an ICD-9 (International Classification of Diseases, 9th Revision) diagnostic code of varicella infection. Patients were excluded if they met any of the following criteria:

  • a history of varicella illness rather than acute infection
  • diagnosis within 14 days of varicella vaccination
  • diagnosis by telephone only
  • reason for lack of vaccination not documented in the medical records
  • medical contraindications to varicella vaccination

Thus, 133 of the 343 patients were clinically diagnosed with varicella vaccination and evaluated further. Each case was matched by age, sex and length of healthcare enrollment to 4 randomly selected controls; 39 children were excluded from this control population because they did not have immunization records. Thus, the final control population consisted of 493 children.

Among the 133 cases, seven patients (5%) had parents who refused all varicella immunizations compared to 3 (0.6%) among the controls. Parental refusal of varicella vaccination was strongly associated with medical record-verified varicella illness, resulting in an increased risk of chickenpox requiring medical care (odds ratio, 8.6) compared with children who were vaccinated. This means that children whose parents refuse varicella vaccination were 8.6 times more likely to get chickenpox compared to fully immunized children.

The percentage of attributable risk in patients whose parents refused the vaccine was 99.4%. This is the portion of cases attributable and avoidable to VZV infection, suggesting that all seven of the unvaccinated varicella cases in the study were due to vaccine refusal. According to Jason Glanz, Ph.D., an epidemiologist at Kaiser Permanente’s Institute for Health Research and lead author on the study [4]:

Varicella isn’t necessarily a mild illness, and it’s important for parents to know that choosing not to vaccinate their children not only places their child at risk for infection requiring medical care, but also places members of the community at risk. This study adds to the body of information showing that the benefits greatly outweigh the risks of this safe vaccine.

The study has several limitations: the study population was taken from a single managed healthcare plan and geographical area, which may limit the generalizability of the findings; there may be a diagnostic bias, as physicians are more likely to make a diagnosis of chickenpox in children who are unvaccinated; there was not enough statistical power to evaluate the association between vaccine refusal and varicella infection on a yearly basis; and mild cases of varicella that did not come to medical attention would have been overlooked, over- or under-estimating the effect of vaccine refusal on the risk of varicella infection.

Vaccine recommendations

The best way to prevent chickenpox is through vaccination. Universal varicella immunization has reduced annual morbidity, mortality and hospitalizations attributable to chickenpox by more than 80% [5], and reduced healthcare costs by 97% [6].

The CDC recommends the following chickenpox (varicella) vaccination schedules:

  • All healthy children 12 months through 12 years of age should have two doses of chickenpox vaccine, with the first dose administered at age 12 — 15 months and the second dose at age 4 –6 years (preferably before entering pre-kindergarten, kindergarten or first grade).
  • Adolescents and adults 13 years of age and older who have never had chickenpox or the vaccine should receive two doses of the varicella vaccine, administered 4 — 8 weeks apart.

The CDC recommends the shingles (varicella-zoster) vaccine (Zostavax) for all adults 60 years of age and older who have healthy immune systems. Note that Zostavax is not approved for people younger than age 60.

References

  1. Glanz et al. Parental refusal of varicella vaccination and the associated risk of varicella infection in children. Arch Pediatr Adolesc Med. 2010 Jan;164(1):66-70. DOI: 10.1001/archpediatrics.2009.244
    View abstract
  2. Finger et al. Age-specific incidence of chickenpox. Public Health Rep. 1994 Nov-Dec;109(6):750-5.
    View abstract
  3. Guris et al. Changing varicella epidemiology in active surveillance sites–United States, 1995-2005. J Infect Dis. 2008 Mar 1;197 Suppl 2:S71-5.
    View abstract
  4. Refusing Immunizations Increases the Risk of Varicella Illness in Children, Kaiser Permanente Study Finds. Kaiser Permanente press release. 2010 Jan 4.
  5. Roush SW, Murphy TV, Vaccine-Preventable Disease Table Working Group. Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States. JAMA. 2007;298(18):2155-2163.
    View abstract
  6. Zhou et al. An economic analysis of the universal varicella vaccination program in the United States. J Infect Dis. 2008 Mar 1;197 Suppl 2:S156-64.
    View abstract

Details of Critically Ill Patients with H1N1 in Mexico and Canada

October 22, 2009 | by

Two studies, which are available online as early release articles and will be published in the November edition of the Journal of the American Medical Association (JAMA), detail the characteristics, treatment and outcomes of critically ill patients with H1N1 in Mexico and Canada [1-2].

respiratory-ventilation

Although the death rate in each of the studies is quite different, it nonetheless is as high or higher than that of seasonal flu. Furthermore, although seasonal flu typically affects people of older age — the average annual rate of influenza-associated hospitalizations over the last 20 years for people age 65 and older is 70% [3] — these studies show that H1N1 is striking many who are much younger. In both studies, the majority of critically ill patients with influenza A H1N1 had rapidly progressive respiratory failure and required mechanical ventilation.

Rehabilitation at Home Just as Good as Day Hospital Care

September 18, 2009 | by
ResearchBlogging.org

As you or perhaps your parents get older, would you want to be at home when recovering from an illness? Would the choice between home rehabilitation or visits to a day hospital make a difference to your recovery and health? Which is cheaper for the healthcare services? A recent study published in the journal Health Technology Assessment (HTA) shows that home-based care in the United Kingdom is no worse than attendance at a day hospital for older adults [1].