Joshua R. Mann

Meaning in life, anxiety, depression, and general health among smoking cessation patients.

OBJECTIVE Psychosocial factors play a widely recognized role in health and health care utilization. The present study investigated relations among meaning in life, depression, anxiety, and social support with self-reported general health. METHOD Ninety-nine smoking cessation group patients were recruited to complete questionnaires during their third week of treatment. RESULTS Depression was the strongest predictor of perceived general health. However, the interaction of peoples experience of meaning in life and their propensity to seek deeper meaning in their lives predicted variance in perceived health above and beyond depression. Furthermore, propensity to seek meaning in life was the only psychosocial correlate of peoples perceived social benefits of health care utilization. CONCLUSION Psychosocial factors, particularly depression and the two primary dimensions of meaning in life (experiencing and seeking), were related to perceived health. Meaning in life thus emerges as a variable worth further scrutiny in the health of clinical populations.

Healthy Behavior Change of Adults With Mental Retardation: Attendance in a Health Promotion Program

Participation in a health promotion program for 192 overweight and obese adults with mental retardation was associated with behavior change resulting in reduction of body mass index-BMI (weight in kg, divided by height in meters, squared) by the end of the program. We analyzed the mediating and intermediate factors contributing to weight reduction and found knowledge and exercise to be the primary contributing factors. The curriculum emphasized exercise, nutritional choices, and stress reduction. Participation in the program was associated with a reduction of 0.8 BMI or approximately 2.3 kg for 26% of the participants. Increased knowledge about healthy diet and exercise was the most significant mediator of program impact on BMI.

Condom effectiveness: Factors that influence risk reduction

This paper summarizes the proceedings of a workshop convened in June 2000 by four federal agencies to evaluate the published evidence establishing the effectiveness of latex male condoms in preventing HIV/AIDS and other sexually transmitted diseases. It reviews a discussion of other factors that influence condom effectiveness.

Azithromycin and Levofloxacin Use and Increased Risk of Cardiac Arrhythmia and Death

PURPOSE Azithromycin use has been associated with increased risk of death among patients at high baseline risk, but not for younger and middle-aged adults. The Food and Drug Administration issued a public warning on azithromycin, including a statement that the risks were similar for levofloxacin. We conducted a retrospective cohort study among US veterans to test the hypothesis that taking azithromycin or levofloxacin would increase the risk of cardiovascular death and cardiac arrhythmia compared with persons taking amoxicillin. METHODS We studied a cohort of US veterans (mean age, 56.8 years) who received an exclusive outpatient dispensation of either amoxicillin (n = 979,380), azithromycin (n = 594,792), or levofloxacin (n = 201,798) at the Department of Veterans Affairs between September 1999 and April 2012. Azithromycin was dispensed mostly for 5 days, whereas amoxicillin and levofloxacin were dispensed mostly for at least 10 days. RESULTS During treatment days 1 to 5, patients receiving azithromycin had significantly increased risk of death (hazard ratio [HR] = 1.48; 95% CI, 1.05–2.09) and serious arrhythmia (HR = 1.77; 95% CI, 1.20–2.62) compared with patients receiving amoxicillin. On treatment days 6 to 10, risks were not statistically different. Compared with patients receiving amoxicillin, patients receiving levofloxacin for days 1 to 5 had a greater risk of death (HR = 2.49, 95% CI, 1.7–3.64) and serious cardiac arrhythmia (HR = 2.43, 95% CI, 1.56–3.79); this risk remained significantly different for days 6 to 10 for both death (HR = 1.95, 95% CI, 1.32–2.88) and arrhythmia (HR = 1.75; 95% CI, 1.09–2.82). CONCLUSIONS Compared with amoxicillin, azithromycin resulted in a statistically significant increase in mortality and arrhythmia risks on days 1 to 5, but not 6 to 10. Levofloxacin, which was predominantly dispensed for a minimum of 10 days, resulted in an increased risk throughout the 10-day period.

Are maternal genitourinary infection and pre-eclampsia associated with ADHD in school-aged children?

Objective: To investigate the hypothesis that maternal genitourinary infection (GU) infection is associated with increased risk of ADHD. Method: The authors obtained linked Medicaid billing data for pregnant women and their children in South Carolina, with births from 1996 through 2002 and follow-up data through 2008. Maternal GU infections and pre-eclampsia were identified on the basis of diagnoses made during pregnancy, and cases of ADHD were identified on the basis of diagnoses made in the child’s Medicaid file. Results: There were 84,721 children in the data set used for analyses. Maternal genitourinary infection was associated with significantly increased odds of ADHD (OR = 1.29, 95% CI = 1.23-1.35). Pre-eclampsia was also associated with increased risk (OR = 1.19, 95% CI = 1.07-1.32). Children whose mothers had both GU infection and pre-eclampsia were 53% more likely to have ADHD, compared to those with neither exposure. When we examined specific infection diagnoses, chlamydia/nongonococcal urethritis, trichomoniasis, urinary tract infection, and candidiasis were associated with increased risk of ADHD, whereas gonorrhea was not. Discussion: Maternal GU infection appeared to be associated with increased risk of ADHD, and based on the findings it was concluded that further research is needed to describe the mechanism(s) underlying the association.

The role of disease-specific infectivity and number of disease exposures on long-term effectiveness of the latex Condom

Background Condom use is a primary prevention strategy for sexually transmitted infections (STIs). Consistent condom use substantially reduces the risk of HIV infection. Similar levels of effectiveness for reducing the risk of other STIs have not been established. Differences in disease-specific infectivity and the number of exposures to an infected partner may explain differences in condom effectiveness. Goal The goal was to examine the impact of differing infectivities and increasing numbers of exposures on theoretical condom effectiveness. Study Design Mathematical modeling using estimated disease-specific infectivities and condom failure rates. Results Condom effectiveness decreases as disease-specific infectivity and the number of exposures to infection risk increase. Conclusions Condom effectiveness for decreasing STI risk is influenced by disease infectivity and the number of exposures. Generalizations from studies of relatively uninfectious STIs to highly infectious STIs or from short-term studies to longer-term situations will overestimate condom effectiveness.

Do antenatal religious and spiritual factors impact the risk of postpartum depressive symptoms

OBJECTIVES Previous research has identified an inverse relationship between religiosity/spirituality and depressive symptoms. However, prospective studies are needed. This study investigates the association between antenatal religiosity/spirituality and postpartum depression, controlling for antenatal depressive symptoms, social support, and other potential confounders. METHODS This is a prospective cohort study. Women receiving prenatal care were enrolled from three obstetrics practices. Follow-up assessment was conducted at the 6-week postpartum clinic visit. Four measures of religiosity and two measures of spirituality were assessed at baseline. A measure of overall religiosity/spirituality was also created using principal component factor analysis. Depressive symptoms were measured at baseline and again at follow-up using the Edinburgh Postnatal Depression Scale (EPDS). A cutoff score of >or=13 was used to identify women with significant depressive symptoms. RESULTS Four hundred four women were enrolled, and 374 completed follow-up. Thirty women experienced pregnancy loss, leaving 344 with postpartum assessment; 307 women had complete data and were used for analyses. Thirty-six women (11.7%) scored above the EPDS screening cutoff. Controlling for significant covariates (baseline EPDS score and social support), women who participated in organized religious activities at least a few times a month were markedly less likely (OR = 0.18, 95% CI) to exhibit high depressive symptom scores. No other religiosity/spirituality measure was statistically significant. CONCLUSIONS Organized religious participation appears to be protective from postpartum depressive symptoms. Because this association is independent of antenatal depressive symptoms, we hypothesize that religious participation assists in coping with the stress of early motherhood.

An efficacy trial of 'Steps to Your Health', a health promotion programme for adults with intellectual disability

Objective: Although there are evaluation and effectiveness studies of health promotion interventions for adults with intellectual disabilities (ID), randomized efficacy trials of such interventions are lacking. Design: A randomized active control intervention trial. Setting: The participants attended the health promotion classes in local disability agency service facilities. Method: We enrolled 443 individuals and randomly assigned them to one of two eight-week participatory classes. The ‘Steps to Your Health’ (STYH) classes emphasized moderate to vigorous physical activity (MVPA), healthy eating and body mass index (BMI) reduction. The control intervention focused on hygiene and safety. Results: We did not find a statistically significant difference in mean MVPA or BMI change between completers of the STYH group compared to the control group one year after the intervention was completed. We did find that participation in STYH classes had a non-significant association with odds of reduction in BMI (odds ratio [OR] 2.87, 95% confidence interval [CI] 0.91–9.11) and completers who lived in group homes were more likely than their counterparts who lived with families or in apartments to decrease their BMI (OR 4.61; 95% CI 1.14–18.64). Conclusions: This trial did not demonstrate a significant effect of STYH participation on change in mean minutes of MVPA or mean BMI 12 months after classes ended, although there was a non-significant association with odds of reduction of BMI (p = 0.07). This study has implications for design of intervention studies in people with intellectual disability (ID).

Obesity and mortality in persons with obstructive lung disease using data from the NHANES III.

Objectives: The objective of this study was to determine the relationship between obesity and all-cause mortality among participants with obstructive lung disease in the National Health and Nutrition Examination Survey (NHANES III). Methods: Public data from a retrospective cohort of the 33,994 participants in NHANES III was analyzed to determine the relationship between obesity and all-cause mortality among participants with obstructive lung disease. Results were analyzed using proportional hazard models and controlled for age, sex, race, smoking status, current oral corticosteroid use, and severity of airway obstruction. Secondary analysis considered time until death from respiratory disease or time until death from chronic lower respiratory disease (excluding asthma). Results: The subset used in the analysis consisted of 2439 persons with 844 documented deaths. Extreme obesity (body mass index [BMI] >40) was significantly associated with increased respiratory disease mortality (hazard ratio [HR] 5.78; 95% confidence interval {CI} [1.09 to 30.61]) and chronic lower respiratory disease mortality (HR 13.69; 95% CI [1.45 to 129.29]). In addition, underweight status (BMI <18.5) was significantly associated with increased all-cause mortality (HR 2.42; 95% CI [1.31 to 4.46]), respiratory disease mortality (HR 7.10; 95% CI [1.94 to 26.00]) and chronic lower respiratory disease mortality (HR 14.80; 95% CI [2.24 to 97.99]). Conclusion: Underweight adults had increased risk of death from all causes and respiratory conditions, compared to class I obese adults. Extreme obesity was associated with increased risk of death from respiratory conditions, but not all-cause mortality. Additional research is needed to explain the complex relationship between BMI and specific causes of mortality in the context of pulmonary disease.

Predicting depressive symptoms and grief after pregnancy loss

Women who experience pregnancy loss are at high risk for depression and grief. We conducted a prospective cohort study to identify antenatal predictors of depressive symptoms and grief following pregnancy loss. Particular emphasis was given to the potential role of religiosity and spirituality. In multivariable linear regression models, depressive symptoms were significantly positively associated with baseline depression score and a history of mental illness. Depression scores were significantly inversely associated with age. Increasing age was also protective against post-pregnancy loss grief, as was participation in organized religious activities. Clinicians should be particularly alert to signs of depression following pregnancy loss in younger women and in women with a history of mental illness during or before pregnancy. The inverse association between religious attendance and grief following pregnancy loss merits further study.