Estimated Risk for Altered Fetal Growth Resulting from Exposure to Fine Particles during Pregnancy: An Epidemiologic Prospective Cohort Study in Poland

The purpose of this study was to estimate exposure of pregnant women in Poland to fine particulate matter [≤2.5 μm in diameter (PM(2.5))] and to assess its effect on the birth outcomes. The cohort consisted of 362 pregnant women who gave birth between 34 and 43 weeks of gestation. The enrollment included only nonsmoking women with singleton pregnancies, 18–35 years of age, who were free from chronic diseases such as diabetes and hypertension. PM(2.5) was measured by personal air monitoring over 48 hr during the second trimester of pregnancy. All assessed birth effects were adjusted in multiple linear regression models for potential confounding factors such as the size of mother (maternal height, prepregnancy weight), parity, sex of child, gestational age, season of birth, and self-reported environmental tobacco smoke (ETS). The regression model explained 35% of the variability in birth weight (β = −200.8, p = 0.03), and both regression coefficients for PM(2.5) and birth length (β = −1.44, p = 0.01) and head circumference (HC; β = −0.73, p = 0.02) were significant as well. In all regression models, the effect of ETS was insignificant. Predicted reduction in birth weight at an increase of exposure from 10 to 50 μg/m(3) was 140.3 g. The corresponding predicted reduction of birth length would be 1.0 cm, and of HC, 0.5 cm. The study provides new and convincing epidemiologic evidence that high personal exposure to fine particles is associated with adverse effects on the developing fetus. These results indicate the need to reduce ambient fine particulate concentrations. However, further research should establish possible biologic mechanisms explaining the observed relationship

The Long Island Breast Cancer Study Project: description of a multi-institutional collaboration to identify environmental risk factors for breast cancer

The Long Island Breast Cancer Study Project is a federally mandated, population-based case-control study to determine whether breast cancer risk among women in the counties of Nassau and Suffolk, NY, is associated with selected environmental exposures, assessed by blood samples, self-reports, and environmental home samples. This report describes the collaborative project’s background, rationale, methods, participation rates, and distributions of known risk factors for breast cancer by case-control status, by blood donation, and by availability of environmental home samples. Interview response rates among eligible cases and controls were 82.1% (n=1,508) and 62.8% (n=1,556), respectively. Among case and control respondents who completed the interviewer-administered questionnaire, 98.2 and 97.6% self-completed the food frequency questionnaire; 73.0 and 73.3% donated a blood sample; and 93.0 and 83.3% donated a urine sample. Among a random sample of case and control respondents who are long-term residents, samples of dust (83.6 and 83.0%); soil (93.5 and 89.7%); and water (94.3 and 93.9%) were collected. Established risk factors for breast cancer that were found to increase risk among Long Island women include lower parity, late age at first birth, little or no breast feeding, and family history of breast cancer. Factors that were found to be associated with a decreased likelihood that a respondent would donate blood include increasing age and past smoking; factors associated with an increased probability include white or other race, alcohol use, ever breastfed, ever use of hormone replacement therapy, ever use of oral contraceptives, and ever had a mammogram. Long-term residents (defined as 15+ years in the interview home) with environmental home samples did not differ from other long-term residents, although there were a number of differences in risk factor distributions between long-term residents and other participants, as anticipated

Combined analgesics in (headache) pain therapy: shotgun approach or precise multi-target therapeutics?

<p>Abstract</p> <p>Background</p> <p>Pain in general and headache in particular are characterized by a change in activity in brain areas involved in pain processing. The therapeutic challenge is to identify drugs with molecular targets that restore the healthy state, resulting in meaningful pain relief or even freedom from pain. Different aspects of pain perception, i.e. sensory and affective components, also explain why there is not just one single target structure for therapeutic approaches to pain. A network of brain areas ("pain matrix") are involved in pain perception and pain control. This diversification of the pain system explains why a wide range of molecularly different substances can be used in the treatment of different pain states and why in recent years more and more studies have described a superior efficacy of a precise multi-target combination therapy compared to therapy with monotherapeutics.</p> <p>Discussion</p> <p>In this article, we discuss the available literature on the effects of several fixed-dose combinations in the treatment of headaches and discuss the evidence in support of the role of combination therapy in the pharmacotherapy of pain, particularly of headaches. The scientific rationale behind multi-target combinations is the therapeutic benefit that could not be achieved by the individual constituents and that the single substances of the combinations act together additively or even multiplicatively and cooperate to achieve a completeness of the desired therapeutic effect.</p> <p>As an example the fixesd-dose combination of acetylsalicylic acid (ASA), paracetamol (acetaminophen) and caffeine is reviewed in detail. The major advantage of using such a fixed combination is that the active ingredients act on different but distinct molecular targets and thus are able to act on more signalling cascades involved in pain than most single analgesics without adding more side effects to the therapy.</p> <p>Summary</p> <p>Multitarget therapeutics like combined analgesics broaden the array of therapeutic options, enable the completeness of the therapeutic effect, and allow doctors (and, in self-medication with OTC medications, the patients themselves) to customize treatment to the patient's specific needs. There is substantial clinical evidence that such a multi-component therapy is more effective than mono-component therapies.</p

The Effect of Patient-selected or Preselected Music on Anxiety During Cesarean Delivery: A Randomized Controlled Trial

Background: Women undergoing cesarean delivery may have significant anxiety prior to surgery. Nonpharmacological approaches to anxiety reduction are favored in this patient population.Objective: The aim of this study was to determine the effects of patient-selected or preselected music on anxiety in parturients undergoing scheduled cesarean delivery.Materials and methods: This is a prospective, randomized controlled trial (IRB protocol #2015P002043; ClinicalTrials.gov, NCT02732964), of 150 parturients undergoing elective cesarean delivery. Parturients were randomized to patient-selected music (Pandora(®)), preselected music (Mozart), or no music (control). The primary outcome was anxiety after music exposure (versus no music) in the preoperative holding room. Secondary outcomes included postoperative anxiety, postoperative pain, and patient satisfaction.Results: Baseline anxiety and anxiety following preoperative exposure did not differ in the Pandora versus control group (3.8?±?2.4 versus 4.6?±?2.6, mean difference -0.8 [95% CI -1.8 to 0.2], p?=?.12), but was lower in the Mozart group versus control group (3.5?±?2.5 versus 4.6?±?2.5, mean difference -1.1 [95% CI -2.2 to -0.1], p?=?.03). Postoperative anxiety did not differ in the Pandora versus control group (1.0?±?1.4 versus 1.3?±?2.0, mean difference -0.3 [95% CI -1.0 to 0.4], p?=?.43), or in the Mozart versus control group (0.8?±?1.3 versus 1.3?±?2.0, mean difference -0.5 [95% CI -1.2 to 0.2], p?=?.15). Postoperative pain was not different in the Pandora group versus control group (0.8?±?1.5 versus 1.4?±?1.9, mean difference -0.6 [95% CI -1.3 to 0.1], p?=?.10), but was lower in the Mozart versus control group (0.6?±?1.3 versus 1.4?±?1.9, mean difference -0.8 [95% CI -1.4 to -0.1], p?=?.03). Total patient satisfaction scores were not different among the control, Pandora, and Mozart groups.Conclusion: While preselected Mozart music results in lower anxiety prior to cesarean delivery, patient-selected Pandora music does not. Further investigation to determine how music affects patients, clinicians, and the operating room environment during cesarean delivery is warranted.Clinical trial registration: NCT02732964