Jennifer Massa

Preclinical Serum 25-Hydroxyvitamin D Levels and Risk of Type 1 Diabetes in a Cohort of US Military Personnel

To determine whether serum levels of 25-hydroxyvitamin D (25(OH)D) in young adults are associated with risk of type 1 diabetes mellitus (T1D), we conducted a prospective, nested case-control study among US active-duty military personnel with serum in the US Department of Defense Serum Repository, identifying 310 T1D cases diagnosed between 1997 and 2009 with at least 2 serum samples collected before disease onset and 613 controls matched to cases on age, sex, race/ethnicity, branch of military service, and dates of serum collection. Conditional logistic regression was used to estimate rate ratios and 95% confidence intervals. Among non-Hispanic whites, those with average 25(OH)D levels of ≥ 100 nmol/L had a 44% lower risk of developing T1D than those with average 25(OH)D levels < 75 nmol/L (rate ratio = 0.56, 95% confidence interval: 0.35, 0.90, P for trend = 0.03) over an average follow-up of 5.4 years. In quintile analyses, T1D risk was highest among individuals whose 25(OH)D levels were in the lowest 20% of those measured. There was no association between 25(OH)D levels and risk of T1D among non-Hispanic blacks or Hispanics. Low 25(OH)D levels may predispose healthy, young, non-Hispanic white adults to the development of T1D.

Caffeine and alcohol intakes have no association with risk of multiple sclerosis

Background: The association between alcohol and caffeine intakes and risk of multiple sclerosis (MS) is unclear; no prospective studies have examined this relationship. Objective: We examined intakes of alcohol and caffeine in relation to risk of multiple sclerosis. Methods: Intakes of alcohol and caffeine were examined in relation to the risk of MS in two large cohorts of women, the Nurses’ Health Study (NHS; 92,275 women followed from 1980 to 2004) and Nurses’ Health Study II (NHS II; 95,051 women followed from 1991 to 2005). Their diet was assessed at baseline and every four years thereafter. During the follow-up, 282 cases of MS were confirmed with onset of symptoms after baseline. Twenty-four cases were missing information on alcohol intake, leaving a total of 258 cases for the alcohol analyses. Results: Neither total alcohol consumption, nor consumption of beer, wine, or liquor was related to MS risk. The multivariable-adjusted pooled relative risk (RR) found by comparing categories of alcohol intake to 0 gm/day was 1.07 (95% CI: 0.32–1.99) for 0.1–4.9 gm/day, 1.01 (0.32–1.99) for 5.0–14.9 gm/day, 1.21 (0.69–2.15) for 15.0–29.9 gm/day, and 0.80 (0.32–1.99) for 30+ gm/day; (p for trend=0.89). Caffeine intake was also not significantly associated with MS risk. The multivariable adjusted pooled RR comparing highest to lowest quintile of caffeine intake was 1.14; 95% CI: 0.79–1.66; p for trend=0.71. Consideration of caffeinated and decaffeinated coffee separately also yielded null results. Conclusion: These results do not support an association between alcohol and caffeine intakes and MS risk.

Posttraumatic Stress Disorder and Other Psychological Sequelae Among World Trade Center Clean Up and Recovery Workers

Abstract:  We assessed the health of workers exposed to the World Trade Center (WTC) site and of a comparison group of unexposed workers, by means of a mail survey. Exposed workers reported higher frequency of symptoms consistent with posttraumatic stress disorder (PTSD), depression, anxiety, and other psychological problems, approximately 20 months after the disaster. PTSD was positively associated with traumatic on‐site experiences and with respiratory problems. These findings may have important clinical and public health implications.

Vitamin D and actigraphic sleep outcomes in older community-dwelling men: the MrOS sleep study.

STUDY OBJECTIVES Maintaining adequate serum levels of vitamin D may be important for sleep duration and quality; however, these associations are not well understood. We examined whether levels of serum 25(OH)D are associated with objective measures of sleep in older men. SETTING AND PARTICIPANTS Cross-sectional study within a large cohort of community-dwelling older men, the MrOS study. INTERVENTIONS Among 3,048 men age 68 years or older, we measured total serum vitamin D. Objective estimates of nightly total sleep time, sleep efficiency, and wake time after sleep onset (WASO) were obtained using wrist actigraphy worn for an average of 5 consecutive 24-h periods. RESULTS 16.4% of this study population had low levels of vitamin D (< 20.3 ng/mL 25(OH)D). Lower serum vitamin D levels were associated with a higher odds of short (< 5 h) sleep duration, (odds ratio [OR] for the highest (≥ 40.06 ng/mL) versus lowest (< 20.3 ng/mL) quartile of 25(OH)D, 2.15; 95 % confidence interval (CI), 1.21-3.79; Ptrend = 0.004) as well as increased odds of actigraphy-measured sleep efficiency of less than 70% (OR, 1.45; 95% CI, 0.97-2.18; Ptrend = 0.004), after controlling for age, clinic, season, comorbidities, body mass index, and physical and cognitive function. Lower vitamin D levels were also associated with increased WASO in age-adjusted, but not multivariable adjusted models. CONCLUSIONS Among older men, low levels of total serum 25(OH)D are associated with poorer sleep including short sleep duration and lower sleep efficiency. These findings, if confirmed by others, suggest a potential role for vitamin D in maintaining healthy sleep.

Rethinking first response: Effects of the clean up and recovery effort on workers at the World Trade Center disaster site

Objective: We sought to describe the physical and mental health effects of the cleanup and recovery effort on workers at the World Trade Center disaster site. Methods: A mailed survey was sent to truck drivers, heavy equipment operators, laborers, and carpenters. It assessed work-related exposures and somatic and mental health symptoms. In one open-ended question, respondents shared any aspect of their experiences they wished; these 332 narrative responses were analyzed using qualitative techniques. Results: Respondents reported suffering debilitating consequences of their work, including depression, drug use, and posttraumatic stress disorder. They felt poorly prepared to work in a disaster, lacked protective equipment and training, and felt overwhelmed by the devastation they faced. Conclusions: These workers’ experiences were qualitatively similar to the experiences of the first responders. To protect workers in the future, the focus on preparing “first” responders should be reconsidered more broadly.

Long-term use of multivitamins and risk of colorectal adenoma in women

Background:Use of multivitamins may reduce the risk of colorectal adenoma, but the duration of use needed is unclear.Methods:We prospectively examined years of multivitamin use and risk of colorectal adenoma among 43 641 women who had a first endoscopy between 1991 and 2007 in the Nurses’ Health Study II. Use of multivitamins was assessed through biennial questionnaires since 1989.Results:We documented 2277 colorectal adenoma cases. Reporting multivitamin use at any time during the study period compared with never reporting its use was associated with a reduced risk of adenoma (multivariable relative risk (RR)=0.86, 95% confidence interval (CI): 0.76–0.97). There was no clear trend with duration of multivitamin use: years of use compared with never use, ⩽4 years (RR=0.84, 95% CI: 0.74–0.96), 5–9 years (RR=0.89, 95% CI: 0.77, 1.02), 10–14 years (RR=0.86, 95% CI: 0.74, 1.01), 15–19 years (RR=0.85, 95% CI: 0.70, 1.02), and 20–26 years (RR=0.80, 95% CI: 0.64, 1.01); (P trend=0.87). The strongest associations (years of use vs never user) were for size of adenoma: large (⩾1 cm) <4 years (RR=0.75, 95% CI: 0.58–0.96) and in alcohol users (⩾1.4 g per day) 20–26 years (RR=0.67, 95% CI: 0.49–0.91).Conclusion:Our findings suggest that use of multivitamins is associated with lower risk of colorectal adenoma, even with relatively short duration of use.

Plasma Titers of Antibodies against Epstein-Barr Virus BZLF1 and Risk of Multiple Sclerosis

Background/Aims: Results of recently conducted prospective studies have demonstrated that the presence of high titers of anti-EBNA-1 or anti-EBNA complex IgG antibodies in healthy individuals is a strong risk factor for multiple sclerosis (MS). Antibodies to BZLF1, the product of the homonymous early lytic gene, have been found to be related to risk of nasopharyngeal carcinoma, but have not been previously measured in MS studies. Methods: We examined whether high levels of anti-BZLF1 IgG antibodies also predict MS risk in a nested case-control study among women in the Nurses Health Study and Nurses Health Study II cohorts. Results: Results of this prospective study suggest that antibody titers to EBNAs are the strongest predictor of MS risk. Conclusion: Little further contribution may be provided by measuring anti-BZLF1 antibodies in regard to MS risk.

Serum titers of IgG antibodies against tetanus and diphtheria toxoids and risk of multiple sclerosis

We conducted a prospective nested case-control study among military service members to investigate whether antibodies against tetanus or diphtheria predict multiple sclerosis (MS) risk. Paired T-tests were used to compare means of anti-tetanus and diphtheria toxoids among 56 MS cases and 112 matched controls. Conditional logistic regression was used to estimate odds ratios (OR). There were no differences between the mean serum IgG antibodies against tetanus (p-value 0.28) or diphtheria (p-value 0.45) in the baseline samples. The OR of MS associated with 1 standard deviation difference in antibody titers was 0.76 (95% CI: 0.48-1.21) for tetanus (SD=4.71) and 1.03 (0.73-1.45) for diphtheria (SD=0.87). Results of this study suggest serum IgG antibodies against tetanus or diphtheria are not predictors of MS risk.

Feasibility Pilot Study of a Teaching Kitchen and Self-Care Curriculum in a Workplace Setting:

Objective. To examine the feasibility of a prototype Teaching Kitchen (TK) self-care intervention that offers the combination of culinary, nutrition, exercise, and mindfulness instruction with health coaching; and to describe research methods whereby the impact of TK models can be scientifically assessed. Design. Feasibility pilot study. Subjects were recruited, screened, and consented to participate in 14- or 16-week programs. Feasibility was assessed through ease of recruitment and attendance. One-sample t tests and generalized estimating equation models were used to compare differences in groups. Setting. Workplace. Subjects. Two cohorts of 20 employees and their partners. Results. All 40 participants completed the program with high attendance (89%) and response rates on repeated assessments. Multiple changes were observed in biomarkers and self-reported behaviors from baseline to postprogram including significant ( P < .05) decreases from baseline to postprogram in body weight (−2.8 kg), waist circumference (−2.2 in.), systolic and diastolic blood pressure (−7.7 and −6.3 mm Hg, respectively), and total cholesterol (−7.5 mg/dL). While changes in all of the aforementioned biomarkers persisted over the 12-month follow-up (n = 32), only changes in waist circumference and diastolic blood pressure remained statistically different at 12 months. Conclusions. These study findings suggest that a TK curriculum is feasible within a workplace setting and that its impact on relevant behavioral and clinical outcomes can be scientifically assessed.

The organizational structure of an intensive care unit influences treatment of hypotension among critically ill patients: A retrospective cohort study.

PURPOSE Prior studies report that weekend admission to an intensive care unit is associated with increased mortality, potentially attributed to the organizational structure of the unit. This study aims to determine whether treatment of hypotension, a risk factor for mortality, differs according to level of staffing. METHODS Using the Multiparameter Intelligent Monitoring in Intensive Care database, we conducted a retrospective study of patients admitted to an intensive care unit at Beth Israel Deaconess Medical Center who experienced one or more episodes of hypotension. Episodes were categorized according to the staffing level, defined as high during weekday daytime (7 am-7 pm) and low during weekends or nighttime (7 pm-7 am). RESULTS Patients with a hypotensive event on a weekend were less likely to be treated compared with those that occurred during the weekday daytime (P = .02). No association between weekday daytime vs weekday nighttime staffing levels and treatment of hypotension was found (risk ratio, 1.02; 95% confidence interval, 0.98-1.07). CONCLUSION Patients with a hypotensive event on a weekend were less likely to be treated than patients with an event during high-staffing periods. No association between weekday nighttime staffing and hypotension treatment was observed. We conclude that treatment of a hypotensive episode relies on more than solely staffing levels.