Jan Dyer

Cigarette smoking has been linked to the diagnosis of bacterial vaginosis (BV) and other genital infections including herpes simplex virus type 2, Chlamydia trachomatis, and oral and genital human papillomavirus (HPV).  Nicotine’s major metabolite, cotinine, has been found to concentrate in cervical mucus.

In 2014, researchers from Montana State University confirmed that the composition of the vaginal microbiota is “strongly associated with smoking.” They reported that women whose vaginal microbiota lacked significant numbers of Lactobacillus spp were 25-fold more likely to report current smoking than those with microbiota dominated by Lactobacillus crispatus (L crispatus). The researchers note that most Lactobacillus spp are thought to provide broad-spectrum protection to pathogenic infections by reducing vaginal pH.

But what is the mechanistic link between smoking and its effects on the vaginal microenvironment? The researchers conducted further study to assess the metabolome, a set of small molecule chemicals that includes host and microbial-produced and modified biomolecules as well as exogenous chemicals. The metabolome is an important characteristic of the vaginal microenvironment; the researchers say; differences in some metabolites are associated with functional variations of the vaginal microbiota. 

The analysis revealed samples clustered into 3 community state types (CSTs): CST-I (L crispatus dominated), CST-III (L iners dominated) and CST-IV (low Lactobacillus). Overall, smoking did not affect the vaginal metabolome after controlling for CSTs, but the researchers identified “an extensive and diverse range” of vaginal metabolites for which profiles were affected by both the microbiology and smoking status. They found 607 compounds in 36 women, including 12 metabolites that differed significantly between smokers and nonsmokers. Bacterial composition was the most pronounced driver of the vaginal metabolome, they say, associated with changes in 57% of all metabolites. As expected, nicotine, cotinine, and hydroxycotinine were markedly elevated in smokers’ vaginas.

Another “key finding,” the researchers say, was a significant increase in the abundance of various biogenic amines among smokers, far more pronounced in women with a low level of Lactobacillus. Biogenic amines are essential, they note, to mammalian and bacterial physiology. (Several are implicated in the “fishy” odor of BV.)

Their study serves as a pilot study, the researchers say, for future examinations of the connections between smoking and poor gynecologic and reproductive health outcomes.

Cigarette smoking has been linked to the diagnosis of bacterial vaginosis (BV) and other genital infections including herpes simplex virus type 2, Chlamydia trachomatis, and oral and genital human papillomavirus (HPV).  Nicotine’s major metabolite, cotinine, has been found to concentrate in cervical mucus.

In 2014, researchers from Montana State University confirmed that the composition of the vaginal microbiota is “strongly associated with smoking.” They reported that women whose vaginal microbiota lacked significant numbers of Lactobacillus spp were 25-fold more likely to report current smoking than those with microbiota dominated by Lactobacillus crispatus (L crispatus). The researchers note that most Lactobacillus spp are thought to provide broad-spectrum protection to pathogenic infections by reducing vaginal pH.

But what is the mechanistic link between smoking and its effects on the vaginal microenvironment? The researchers conducted further study to assess the metabolome, a set of small molecule chemicals that includes host and microbial-produced and modified biomolecules as well as exogenous chemicals. The metabolome is an important characteristic of the vaginal microenvironment; the researchers say; differences in some metabolites are associated with functional variations of the vaginal microbiota. 

The analysis revealed samples clustered into 3 community state types (CSTs): CST-I (L crispatus dominated), CST-III (L iners dominated) and CST-IV (low Lactobacillus). Overall, smoking did not affect the vaginal metabolome after controlling for CSTs, but the researchers identified “an extensive and diverse range” of vaginal metabolites for which profiles were affected by both the microbiology and smoking status. They found 607 compounds in 36 women, including 12 metabolites that differed significantly between smokers and nonsmokers. Bacterial composition was the most pronounced driver of the vaginal metabolome, they say, associated with changes in 57% of all metabolites. As expected, nicotine, cotinine, and hydroxycotinine were markedly elevated in smokers’ vaginas.

Another “key finding,” the researchers say, was a significant increase in the abundance of various biogenic amines among smokers, far more pronounced in women with a low level of Lactobacillus. Biogenic amines are essential, they note, to mammalian and bacterial physiology. (Several are implicated in the “fishy” odor of BV.)

Their study serves as a pilot study, the researchers say, for future examinations of the connections between smoking and poor gynecologic and reproductive health outcomes.

Cigarette smoking has been linked to the diagnosis of bacterial vaginosis (BV) and other genital infections including herpes simplex virus type 2, Chlamydia trachomatis, and oral and genital human papillomavirus (HPV).  Nicotine’s major metabolite, cotinine, has been found to concentrate in cervical mucus.

In 2014, researchers from Montana State University confirmed that the composition of the vaginal microbiota is “strongly associated with smoking.” They reported that women whose vaginal microbiota lacked significant numbers of Lactobacillus spp were 25-fold more likely to report current smoking than those with microbiota dominated by Lactobacillus crispatus (L crispatus). The researchers note that most Lactobacillus spp are thought to provide broad-spectrum protection to pathogenic infections by reducing vaginal pH.

But what is the mechanistic link between smoking and its effects on the vaginal microenvironment? The researchers conducted further study to assess the metabolome, a set of small molecule chemicals that includes host and microbial-produced and modified biomolecules as well as exogenous chemicals. The metabolome is an important characteristic of the vaginal microenvironment; the researchers say; differences in some metabolites are associated with functional variations of the vaginal microbiota. 

The analysis revealed samples clustered into 3 community state types (CSTs): CST-I (L crispatus dominated), CST-III (L iners dominated) and CST-IV (low Lactobacillus). Overall, smoking did not affect the vaginal metabolome after controlling for CSTs, but the researchers identified “an extensive and diverse range” of vaginal metabolites for which profiles were affected by both the microbiology and smoking status. They found 607 compounds in 36 women, including 12 metabolites that differed significantly between smokers and nonsmokers. Bacterial composition was the most pronounced driver of the vaginal metabolome, they say, associated with changes in 57% of all metabolites. As expected, nicotine, cotinine, and hydroxycotinine were markedly elevated in smokers’ vaginas.

Another “key finding,” the researchers say, was a significant increase in the abundance of various biogenic amines among smokers, far more pronounced in women with a low level of Lactobacillus. Biogenic amines are essential, they note, to mammalian and bacterial physiology. (Several are implicated in the “fishy” odor of BV.)

Their study serves as a pilot study, the researchers say, for future examinations of the connections between smoking and poor gynecologic and reproductive health outcomes.

Public health organizations have learned that when it comes to sharing important information, it pays to capitalize on social media. Platforms like Facebook can not only reach multitudes, but also spread a message far more widely than conventional media can. But what is the best way to leverage social media for public health messages? Researchers from University of Sydney in Australia analyzed 20 Facebook pages on skin cancer, smoking, and other public health issues to find out the most effective strategies for getting users to engage.

The researchers coded 360 days of posts for each page, ending up with 5,356 posts. They categorized the communication techniques as informative, call-to-action, instructive, positive emotive appeal, fear appeal, testimonial, and humor. They also looked at marketing elements, such as whether the page used branding, celebrities or persons of authority, mascots, competitions or giveaways, sponsorships, or vouchers and other offers.

Almost all pages were administered by a nongovernment organization. Mental health and cancer prevention were the most common public health issues. Most posts were photos; the next most common were links (but only 1% of users actually clicked on the links). The most common communication techniques were positive emotional appeal and testimonial. Fear appeal was the least common.

Video posts engaged the most users, getting the most likes and shares, the researchers say. Videos received nearly 4 times as many shares as photo posts; links and text received 30% and 69% fewer shares, respectively. Video and text-only posts received more comments than photo posts. However, the researchers add, this could reflect the Facebook algorithm, which may favor videos over other post types. They also note that only 3% of all posts they coded were videos, “suggesting that public health organizations are trailing behind conventional marketers.”

Posts with positive emotional appeal drew 18% more likes than call-to-action posts, but 27% fewer shares. Informative posts received more than twice as many shares. Fear appeal and humorous posts received more comments than call-to-action posts (perhaps because they are more controversial, the researchers suggest), and instructive posts received fewer.

Conventional marketing, such as using sponsorships or “persons of authority,” generally did not have much engagement. Celebrities and sports figures, though, got 62% more likes, more than double the shares, and 64% more comments than posts without celebrities and sportspeople.

Still, regardless of the post type, communication technique, or marketing element, the researchers say, only 2% to 6% of potential customers engaged with it in some way.

Public health organizations have learned that when it comes to sharing important information, it pays to capitalize on social media. Platforms like Facebook can not only reach multitudes, but also spread a message far more widely than conventional media can. But what is the best way to leverage social media for public health messages? Researchers from University of Sydney in Australia analyzed 20 Facebook pages on skin cancer, smoking, and other public health issues to find out the most effective strategies for getting users to engage.

The researchers coded 360 days of posts for each page, ending up with 5,356 posts. They categorized the communication techniques as informative, call-to-action, instructive, positive emotive appeal, fear appeal, testimonial, and humor. They also looked at marketing elements, such as whether the page used branding, celebrities or persons of authority, mascots, competitions or giveaways, sponsorships, or vouchers and other offers.

Almost all pages were administered by a nongovernment organization. Mental health and cancer prevention were the most common public health issues. Most posts were photos; the next most common were links (but only 1% of users actually clicked on the links). The most common communication techniques were positive emotional appeal and testimonial. Fear appeal was the least common.

Video posts engaged the most users, getting the most likes and shares, the researchers say. Videos received nearly 4 times as many shares as photo posts; links and text received 30% and 69% fewer shares, respectively. Video and text-only posts received more comments than photo posts. However, the researchers add, this could reflect the Facebook algorithm, which may favor videos over other post types. They also note that only 3% of all posts they coded were videos, “suggesting that public health organizations are trailing behind conventional marketers.”

Posts with positive emotional appeal drew 18% more likes than call-to-action posts, but 27% fewer shares. Informative posts received more than twice as many shares. Fear appeal and humorous posts received more comments than call-to-action posts (perhaps because they are more controversial, the researchers suggest), and instructive posts received fewer.

Conventional marketing, such as using sponsorships or “persons of authority,” generally did not have much engagement. Celebrities and sports figures, though, got 62% more likes, more than double the shares, and 64% more comments than posts without celebrities and sportspeople.

Still, regardless of the post type, communication technique, or marketing element, the researchers say, only 2% to 6% of potential customers engaged with it in some way.

Public health organizations have learned that when it comes to sharing important information, it pays to capitalize on social media. Platforms like Facebook can not only reach multitudes, but also spread a message far more widely than conventional media can. But what is the best way to leverage social media for public health messages? Researchers from University of Sydney in Australia analyzed 20 Facebook pages on skin cancer, smoking, and other public health issues to find out the most effective strategies for getting users to engage.

The researchers coded 360 days of posts for each page, ending up with 5,356 posts. They categorized the communication techniques as informative, call-to-action, instructive, positive emotive appeal, fear appeal, testimonial, and humor. They also looked at marketing elements, such as whether the page used branding, celebrities or persons of authority, mascots, competitions or giveaways, sponsorships, or vouchers and other offers.

Almost all pages were administered by a nongovernment organization. Mental health and cancer prevention were the most common public health issues. Most posts were photos; the next most common were links (but only 1% of users actually clicked on the links). The most common communication techniques were positive emotional appeal and testimonial. Fear appeal was the least common.

Video posts engaged the most users, getting the most likes and shares, the researchers say. Videos received nearly 4 times as many shares as photo posts; links and text received 30% and 69% fewer shares, respectively. Video and text-only posts received more comments than photo posts. However, the researchers add, this could reflect the Facebook algorithm, which may favor videos over other post types. They also note that only 3% of all posts they coded were videos, “suggesting that public health organizations are trailing behind conventional marketers.”

Posts with positive emotional appeal drew 18% more likes than call-to-action posts, but 27% fewer shares. Informative posts received more than twice as many shares. Fear appeal and humorous posts received more comments than call-to-action posts (perhaps because they are more controversial, the researchers suggest), and instructive posts received fewer.

Conventional marketing, such as using sponsorships or “persons of authority,” generally did not have much engagement. Celebrities and sports figures, though, got 62% more likes, more than double the shares, and 64% more comments than posts without celebrities and sportspeople.

Still, regardless of the post type, communication technique, or marketing element, the researchers say, only 2% to 6% of potential customers engaged with it in some way.

Researchers from Erasmus University, The Netherlands, and Monash University, Australia, say theirs is the first study to determine the independent association of various measures of subjective health with mortality. Previously, few studies had showed an effect of physical functioning independent of other subjective measures.

The researchers evaluated data on 5,538 adults who took part in the Rotterdam Study and who were followed for a mean of 12 years. One-third had cardiovascular disease; 8% had chronic obstructive pulmonary disease, and 38% had joint problems.

The researchers investigated 6 different measures of subjective health and how they related to all-cause mortality. They conceptualized subjective health—often associated with health and well-being—as a continuum with physical functioning at one end and mental health at the other. Physical functioning included basic activities of daily living (BADL), such as eating and grooming. Instrumental activities of daily living (IADL) included the cognitive attributes of performing self-reliant daily tasks, such as meal preparation and shopping. The researchers assessed mental health with scales measuring positive and negative effects as well as somatic symptoms (the physical manifestations of dysthymia) and quality of life.

“Importantly,” the researchers say, any of those indicators is affected strongly by both physical and mental aspects of health. For example, physical and functional decline are related to higher scores on dysthymia questionnaires.  

During 48,534 person-years of follow-up, 2,021 people died. Only impairment in physical functioning assessed by either self-report of BADL or IADL was related to mortality. Quality of life, positive affect, somatic symptoms, and negative affect did not predict mortality once self-rated physical functioning was accounted for.

Clinically speaking, the researchers say, it might be good to focus interventions aimed at improving survival on subjective indicators of physical well-being: in other words, activities of daily living and what it takes to perform them.

Researchers from Erasmus University, The Netherlands, and Monash University, Australia, say theirs is the first study to determine the independent association of various measures of subjective health with mortality. Previously, few studies had showed an effect of physical functioning independent of other subjective measures.

The researchers evaluated data on 5,538 adults who took part in the Rotterdam Study and who were followed for a mean of 12 years. One-third had cardiovascular disease; 8% had chronic obstructive pulmonary disease, and 38% had joint problems.

The researchers investigated 6 different measures of subjective health and how they related to all-cause mortality. They conceptualized subjective health—often associated with health and well-being—as a continuum with physical functioning at one end and mental health at the other. Physical functioning included basic activities of daily living (BADL), such as eating and grooming. Instrumental activities of daily living (IADL) included the cognitive attributes of performing self-reliant daily tasks, such as meal preparation and shopping. The researchers assessed mental health with scales measuring positive and negative effects as well as somatic symptoms (the physical manifestations of dysthymia) and quality of life.

“Importantly,” the researchers say, any of those indicators is affected strongly by both physical and mental aspects of health. For example, physical and functional decline are related to higher scores on dysthymia questionnaires.  

During 48,534 person-years of follow-up, 2,021 people died. Only impairment in physical functioning assessed by either self-report of BADL or IADL was related to mortality. Quality of life, positive affect, somatic symptoms, and negative affect did not predict mortality once self-rated physical functioning was accounted for.

Clinically speaking, the researchers say, it might be good to focus interventions aimed at improving survival on subjective indicators of physical well-being: in other words, activities of daily living and what it takes to perform them.

Researchers from Erasmus University, The Netherlands, and Monash University, Australia, say theirs is the first study to determine the independent association of various measures of subjective health with mortality. Previously, few studies had showed an effect of physical functioning independent of other subjective measures.

The researchers evaluated data on 5,538 adults who took part in the Rotterdam Study and who were followed for a mean of 12 years. One-third had cardiovascular disease; 8% had chronic obstructive pulmonary disease, and 38% had joint problems.

The researchers investigated 6 different measures of subjective health and how they related to all-cause mortality. They conceptualized subjective health—often associated with health and well-being—as a continuum with physical functioning at one end and mental health at the other. Physical functioning included basic activities of daily living (BADL), such as eating and grooming. Instrumental activities of daily living (IADL) included the cognitive attributes of performing self-reliant daily tasks, such as meal preparation and shopping. The researchers assessed mental health with scales measuring positive and negative effects as well as somatic symptoms (the physical manifestations of dysthymia) and quality of life.

“Importantly,” the researchers say, any of those indicators is affected strongly by both physical and mental aspects of health. For example, physical and functional decline are related to higher scores on dysthymia questionnaires.  

During 48,534 person-years of follow-up, 2,021 people died. Only impairment in physical functioning assessed by either self-report of BADL or IADL was related to mortality. Quality of life, positive affect, somatic symptoms, and negative affect did not predict mortality once self-rated physical functioning was accounted for.

Clinically speaking, the researchers say, it might be good to focus interventions aimed at improving survival on subjective indicators of physical well-being: in other words, activities of daily living and what it takes to perform them.

Mood disorders and cardiovascular disease (CVD) are often linked—1 mechanism may be common underlying low-grade inflammation. Specifically, studies have found a consistent association between circulating levels of pro-inflammatory cytokines with both mood disorders and CVD, say researchers from Lausanne University Hospital and Bern University Hospital, in Switzerland and National Institute of Mental Health in Maryland. They suggest that influence may be oneway: Mood disorders may lead to inflammation, but inflammation may not be a risk factor for the onset of mood disorders.

Noting that much of the research on inflammatory markers and CVD has focused on dysthymia, the researchers decided to conduct a study to investigate any association between atypical subtype of dysthymia and increased levels of inflammatory markers. They analyzed data from 3,118 participants who underwent comprehensive somatic and psychiatric evaluations at baseline and a mean of 5.5 years later. Current and remitted mood disorders included bipolar and major depressive disorders (MDD); subtypes included atypical, melancholic, and combinations of those.

After adjusting for confounders, they found current combined MDD was associated with increased high sensitivity C-reactive protein (hsCRP) levels and decreased IL-6 levels. Current atypical MDD was associated with increased hsCRP levels at follow-up. Moreover, remitted melancholic MDD was associated with decreased IL-6 levels at follow-up.

The major finding, the researchers say, was the association between the current atypical subtype of MDD at baseline with increased levels of hsCRP at follow-up. By contrast, inflammatory levels at baseline were not associated with subsequent atypical MDD at follow-up. What this suggests is that the disorder is causally related to increased inflammation, rather than inflammation increasing the mood disorder.

The finding of unidirectional association seems to be specific to the atypical subtype of MDD, the researchers add, which is characterized by somatic symptoms, including sleep, energy, and eating behavior.

Mood disorders and cardiovascular disease (CVD) are often linked—1 mechanism may be common underlying low-grade inflammation. Specifically, studies have found a consistent association between circulating levels of pro-inflammatory cytokines with both mood disorders and CVD, say researchers from Lausanne University Hospital and Bern University Hospital, in Switzerland and National Institute of Mental Health in Maryland. They suggest that influence may be oneway: Mood disorders may lead to inflammation, but inflammation may not be a risk factor for the onset of mood disorders.

Noting that much of the research on inflammatory markers and CVD has focused on dysthymia, the researchers decided to conduct a study to investigate any association between atypical subtype of dysthymia and increased levels of inflammatory markers. They analyzed data from 3,118 participants who underwent comprehensive somatic and psychiatric evaluations at baseline and a mean of 5.5 years later. Current and remitted mood disorders included bipolar and major depressive disorders (MDD); subtypes included atypical, melancholic, and combinations of those.

After adjusting for confounders, they found current combined MDD was associated with increased high sensitivity C-reactive protein (hsCRP) levels and decreased IL-6 levels. Current atypical MDD was associated with increased hsCRP levels at follow-up. Moreover, remitted melancholic MDD was associated with decreased IL-6 levels at follow-up.

The major finding, the researchers say, was the association between the current atypical subtype of MDD at baseline with increased levels of hsCRP at follow-up. By contrast, inflammatory levels at baseline were not associated with subsequent atypical MDD at follow-up. What this suggests is that the disorder is causally related to increased inflammation, rather than inflammation increasing the mood disorder.

The finding of unidirectional association seems to be specific to the atypical subtype of MDD, the researchers add, which is characterized by somatic symptoms, including sleep, energy, and eating behavior.

Mood disorders and cardiovascular disease (CVD) are often linked—1 mechanism may be common underlying low-grade inflammation. Specifically, studies have found a consistent association between circulating levels of pro-inflammatory cytokines with both mood disorders and CVD, say researchers from Lausanne University Hospital and Bern University Hospital, in Switzerland and National Institute of Mental Health in Maryland. They suggest that influence may be oneway: Mood disorders may lead to inflammation, but inflammation may not be a risk factor for the onset of mood disorders.

Noting that much of the research on inflammatory markers and CVD has focused on dysthymia, the researchers decided to conduct a study to investigate any association between atypical subtype of dysthymia and increased levels of inflammatory markers. They analyzed data from 3,118 participants who underwent comprehensive somatic and psychiatric evaluations at baseline and a mean of 5.5 years later. Current and remitted mood disorders included bipolar and major depressive disorders (MDD); subtypes included atypical, melancholic, and combinations of those.

After adjusting for confounders, they found current combined MDD was associated with increased high sensitivity C-reactive protein (hsCRP) levels and decreased IL-6 levels. Current atypical MDD was associated with increased hsCRP levels at follow-up. Moreover, remitted melancholic MDD was associated with decreased IL-6 levels at follow-up.

The major finding, the researchers say, was the association between the current atypical subtype of MDD at baseline with increased levels of hsCRP at follow-up. By contrast, inflammatory levels at baseline were not associated with subsequent atypical MDD at follow-up. What this suggests is that the disorder is causally related to increased inflammation, rather than inflammation increasing the mood disorder.

The finding of unidirectional association seems to be specific to the atypical subtype of MDD, the researchers add, which is characterized by somatic symptoms, including sleep, energy, and eating behavior.

Nearly 10 million people use indoor tanning (IT) even though it increases the risk of skin cancer. Young white women are particularly at risk—almost 1 in 3 reports using indoor tanning in the past year, and nearly 1 in 5 reports regular use (that is, > 10 times in the past year), according to researchers from Rutgers University in New Brunswick, New Jersey.

Research has already shown that most people use IT to enhance their appearance. But a tan is not only seen as attractive: It “plays an important part of youth culture,” the researchers note, especially when it comes to special events, like high school proms. Still, some IT users might remain “special event” users, not regular clients. What makes the difference? To find out, the researchers conducted 6 interviews with a salon employee who also used tanning beds. Their purpose was not to produce “generalizable knowledge of the experiences of many users” but to provide insights into the behavior and to propose working hypotheses for future examination.

The researchers found that the incentive to use IT mostly comes down to—as many health-related decisions do—how it is advertised. The first encounter is likely to be the most important one. That is when the sell begins, designed to “guide” the patron into coming back, and back again. For instance, the salon employee may be trained to establish rapport, to personalize the interaction, and to ask about “tan goals,” setting the stage for a process, rather than a 1-time purchase. The employee describes the steps of creating a “base tan,” maintaining the tan, deepening the tan. Framing tanning as a process sends the message that frequent visits are needed. The researchers cite self-regulation theories that posit for a habit to take hold, the individual must develop a mental model or plans for how to use the habitual behavior to achieve desired goals.

The US Federal Trade Commission and other agencies have enacted restrictions on IT industry advertisements, the researchers say. But the policy efforts have not addressed greater regulation at the point-of-purchase, other than requiring the provision of standardized risk warnings. The interview findings suggest ways to help reduce IT use. Pricing controls, for instance: If patrons had to buy single sessions—instead of in bulk—they might feel less pressured to “get their money’s worth.” Restrictions on advertisement might require salon employees also to provide information on unnecessary exposure. The researchers contrast the salon employee to a convenience store clerk who “simply serves as a cashier for purchasing cigarettes or unhealthy food options.”

The researchers suggest that their findings be followed up in larger, more representational samples.

Nearly 10 million people use indoor tanning (IT) even though it increases the risk of skin cancer. Young white women are particularly at risk—almost 1 in 3 reports using indoor tanning in the past year, and nearly 1 in 5 reports regular use (that is, > 10 times in the past year), according to researchers from Rutgers University in New Brunswick, New Jersey.

Research has already shown that most people use IT to enhance their appearance. But a tan is not only seen as attractive: It “plays an important part of youth culture,” the researchers note, especially when it comes to special events, like high school proms. Still, some IT users might remain “special event” users, not regular clients. What makes the difference? To find out, the researchers conducted 6 interviews with a salon employee who also used tanning beds. Their purpose was not to produce “generalizable knowledge of the experiences of many users” but to provide insights into the behavior and to propose working hypotheses for future examination.

The researchers found that the incentive to use IT mostly comes down to—as many health-related decisions do—how it is advertised. The first encounter is likely to be the most important one. That is when the sell begins, designed to “guide” the patron into coming back, and back again. For instance, the salon employee may be trained to establish rapport, to personalize the interaction, and to ask about “tan goals,” setting the stage for a process, rather than a 1-time purchase. The employee describes the steps of creating a “base tan,” maintaining the tan, deepening the tan. Framing tanning as a process sends the message that frequent visits are needed. The researchers cite self-regulation theories that posit for a habit to take hold, the individual must develop a mental model or plans for how to use the habitual behavior to achieve desired goals.

The US Federal Trade Commission and other agencies have enacted restrictions on IT industry advertisements, the researchers say. But the policy efforts have not addressed greater regulation at the point-of-purchase, other than requiring the provision of standardized risk warnings. The interview findings suggest ways to help reduce IT use. Pricing controls, for instance: If patrons had to buy single sessions—instead of in bulk—they might feel less pressured to “get their money’s worth.” Restrictions on advertisement might require salon employees also to provide information on unnecessary exposure. The researchers contrast the salon employee to a convenience store clerk who “simply serves as a cashier for purchasing cigarettes or unhealthy food options.”

The researchers suggest that their findings be followed up in larger, more representational samples.

Nearly 10 million people use indoor tanning (IT) even though it increases the risk of skin cancer. Young white women are particularly at risk—almost 1 in 3 reports using indoor tanning in the past year, and nearly 1 in 5 reports regular use (that is, > 10 times in the past year), according to researchers from Rutgers University in New Brunswick, New Jersey.

Research has already shown that most people use IT to enhance their appearance. But a tan is not only seen as attractive: It “plays an important part of youth culture,” the researchers note, especially when it comes to special events, like high school proms. Still, some IT users might remain “special event” users, not regular clients. What makes the difference? To find out, the researchers conducted 6 interviews with a salon employee who also used tanning beds. Their purpose was not to produce “generalizable knowledge of the experiences of many users” but to provide insights into the behavior and to propose working hypotheses for future examination.

The researchers found that the incentive to use IT mostly comes down to—as many health-related decisions do—how it is advertised. The first encounter is likely to be the most important one. That is when the sell begins, designed to “guide” the patron into coming back, and back again. For instance, the salon employee may be trained to establish rapport, to personalize the interaction, and to ask about “tan goals,” setting the stage for a process, rather than a 1-time purchase. The employee describes the steps of creating a “base tan,” maintaining the tan, deepening the tan. Framing tanning as a process sends the message that frequent visits are needed. The researchers cite self-regulation theories that posit for a habit to take hold, the individual must develop a mental model or plans for how to use the habitual behavior to achieve desired goals.

The US Federal Trade Commission and other agencies have enacted restrictions on IT industry advertisements, the researchers say. But the policy efforts have not addressed greater regulation at the point-of-purchase, other than requiring the provision of standardized risk warnings. The interview findings suggest ways to help reduce IT use. Pricing controls, for instance: If patrons had to buy single sessions—instead of in bulk—they might feel less pressured to “get their money’s worth.” Restrictions on advertisement might require salon employees also to provide information on unnecessary exposure. The researchers contrast the salon employee to a convenience store clerk who “simply serves as a cashier for purchasing cigarettes or unhealthy food options.”

The researchers suggest that their findings be followed up in larger, more representational samples.

Employee wellness programs (EWPs) have a good track record, with plenty of affirmative research showing benefits: lowered stress levels, fewer sick days, reduced absenteeism, health care savings. Studies have found that for every dollar spent on an EWP, medical costs fall by $3 to $6. Moreover, studies have found that organizations that invest in EWPs have higher rates of employee satisfaction, morale, and retention.

But does one size of EWP fit all needs? Not according to researchers from Northern Arizona University. They studied factors that go in to successful EWPs and suggest that geography should play a big part in decision making: from whether to have an EWP to what it should offer. Take Houston, Texas, for instance, where influenza lasts longer than in most other places. Geographic and climatologic variables, the researchers say, like those necessitate “tailored wellness responses,” such as spending more money on outreach and educational programs to make sure people are prepared for seasonal outbreaks.

The researchers endorse the idea of “individualism in city preferences”—that is, that cities maximize their wellness offerings by taking advantage of the characteristics of the spaces, cultures, and lifestyles unique to them. The researchers note that cities with high incidence of obesity, such as Memphis, Tennessee, and Louisville, Kentucky, tend to put more money into weight-loss programs. Cities with more elderly workers, like Phoenix, Arizona, and Jacksonville, Florida, have “robust programs” for managing chronic diseases associated with age. Stress management may be a priority in impoverished areas. Similarly, EWPs need to factor in geography to make sure the programs meet local needs. Some cities have more and longer days with sunshine: How much of the year can people be active outside? Some have farmland nearby: EWPs can encourage eating healthy locally sourced foods. It is significant, the researchers say, that EWPs in “lower obesity” regions have a proportionately higher intake of activities associated with the outdoors.

Geography is only one consideration among many, the researchers emphasize. City leadership and commitment and incentive structures lead to recreational investments and investments in healthy-living infrastructures, which in turn, lead to higher livability rankings and quality-of-life indexes, workforce productivity, and attracting new business. Those lead to more community involvement, cohesion, and reduced reliance on public health care facilities. And ultimately, the researchers say, the components of a successful EWP all lead to a positive impact on health and longevity.

Employee wellness programs (EWPs) have a good track record, with plenty of affirmative research showing benefits: lowered stress levels, fewer sick days, reduced absenteeism, health care savings. Studies have found that for every dollar spent on an EWP, medical costs fall by $3 to $6. Moreover, studies have found that organizations that invest in EWPs have higher rates of employee satisfaction, morale, and retention.

But does one size of EWP fit all needs? Not according to researchers from Northern Arizona University. They studied factors that go in to successful EWPs and suggest that geography should play a big part in decision making: from whether to have an EWP to what it should offer. Take Houston, Texas, for instance, where influenza lasts longer than in most other places. Geographic and climatologic variables, the researchers say, like those necessitate “tailored wellness responses,” such as spending more money on outreach and educational programs to make sure people are prepared for seasonal outbreaks.

The researchers endorse the idea of “individualism in city preferences”—that is, that cities maximize their wellness offerings by taking advantage of the characteristics of the spaces, cultures, and lifestyles unique to them. The researchers note that cities with high incidence of obesity, such as Memphis, Tennessee, and Louisville, Kentucky, tend to put more money into weight-loss programs. Cities with more elderly workers, like Phoenix, Arizona, and Jacksonville, Florida, have “robust programs” for managing chronic diseases associated with age. Stress management may be a priority in impoverished areas. Similarly, EWPs need to factor in geography to make sure the programs meet local needs. Some cities have more and longer days with sunshine: How much of the year can people be active outside? Some have farmland nearby: EWPs can encourage eating healthy locally sourced foods. It is significant, the researchers say, that EWPs in “lower obesity” regions have a proportionately higher intake of activities associated with the outdoors.

Geography is only one consideration among many, the researchers emphasize. City leadership and commitment and incentive structures lead to recreational investments and investments in healthy-living infrastructures, which in turn, lead to higher livability rankings and quality-of-life indexes, workforce productivity, and attracting new business. Those lead to more community involvement, cohesion, and reduced reliance on public health care facilities. And ultimately, the researchers say, the components of a successful EWP all lead to a positive impact on health and longevity.

Employee wellness programs (EWPs) have a good track record, with plenty of affirmative research showing benefits: lowered stress levels, fewer sick days, reduced absenteeism, health care savings. Studies have found that for every dollar spent on an EWP, medical costs fall by $3 to $6. Moreover, studies have found that organizations that invest in EWPs have higher rates of employee satisfaction, morale, and retention.

But does one size of EWP fit all needs? Not according to researchers from Northern Arizona University. They studied factors that go in to successful EWPs and suggest that geography should play a big part in decision making: from whether to have an EWP to what it should offer. Take Houston, Texas, for instance, where influenza lasts longer than in most other places. Geographic and climatologic variables, the researchers say, like those necessitate “tailored wellness responses,” such as spending more money on outreach and educational programs to make sure people are prepared for seasonal outbreaks.

The researchers endorse the idea of “individualism in city preferences”—that is, that cities maximize their wellness offerings by taking advantage of the characteristics of the spaces, cultures, and lifestyles unique to them. The researchers note that cities with high incidence of obesity, such as Memphis, Tennessee, and Louisville, Kentucky, tend to put more money into weight-loss programs. Cities with more elderly workers, like Phoenix, Arizona, and Jacksonville, Florida, have “robust programs” for managing chronic diseases associated with age. Stress management may be a priority in impoverished areas. Similarly, EWPs need to factor in geography to make sure the programs meet local needs. Some cities have more and longer days with sunshine: How much of the year can people be active outside? Some have farmland nearby: EWPs can encourage eating healthy locally sourced foods. It is significant, the researchers say, that EWPs in “lower obesity” regions have a proportionately higher intake of activities associated with the outdoors.

Geography is only one consideration among many, the researchers emphasize. City leadership and commitment and incentive structures lead to recreational investments and investments in healthy-living infrastructures, which in turn, lead to higher livability rankings and quality-of-life indexes, workforce productivity, and attracting new business. Those lead to more community involvement, cohesion, and reduced reliance on public health care facilities. And ultimately, the researchers say, the components of a successful EWP all lead to a positive impact on health and longevity.

The severity of traumatic brain injury (TBI) is typically defined at the time of the initial injury, but a diagnosis may not come for months or even years later. Given the complexities of diagnosing what might be a slowly revealed condition, with signs and symptoms that may manifest over time; the need for self-report of symptoms; and the time that might have elapsed since the original injury, a diagnostician needs not only to have experience with TBI but to stay abreast of the state of the science.

As of now, only health care professionals in 4 specialties—neurologist, neurosurgeon, physiatrist, or psychiatrist—are allowed to diagnose TBI in the VA’s disability compensation process. A new congressionally mandated report by the National Academies of Sciences, Engineering, and Medicine, though, is advising that it’s training and experience that count, not necessarily the specialty.

In Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans, a committee of experts in emergency medicine, neurology, neurosurgery, psychiatry, psychology, physical medicine and rehabilitation, and epidemiology and biostatistics review the process and current literature on TBI. The committee advises that any health care professional with “pertinent and ongoing brain injury training and experience” and up-to-date knowledge about TBI should be included in the diagnostic process.

The disability compensation is a tax-free benefit paid to veterans with disabilities resulting from disease or injury incurred or aggravated during active military service. The amount is determined in a 6-step process beginning when the veteran (or a proxy) files a claim. An approved clinician typically must diagnose and evaluate the degree of impairment, functional limitation, and disability.

Between 2000 and 2018, an estimated 384,000 incidents of TBI occurred in the military. That increasing prevalence means more medical specialties now include TBI training in their curriculum. The committee notes that at least 18 brain injury programs are accredited by the Accreditation Council for Graduate Medical Education to train physicians in many specialties to diagnose, treat, and rehabilitate patients with brain injury. 

Among other recommendations, the committee advised that the VA take specific actions to increase transparency at both individual and systemwide levels, such as providing veterans full access to the details of their examinations, allowing veterans to rate the quality of their evaluations, and providing public access to detailed systemwide data on the outcomes of evaluations and outcome quality. Those changes will represent a “fundamental enhancement” in the quality of disability evaluations, the committee says, which added that shifting from a focus on the consistency of the process and practitioner qualifications to a focus on the accuracy of the outcome of the evaluation will help identify steps or components in the process that warrant improvement.

It also suggested regularly updating the Veteran Affairs Schedule for Rating Disabilities and the Disability Benefits Questionnaires (DBQs) for residuals of TBI to “better reflect the current state of medical knowledge.” The committee found that 3 important residuals of TBI are not adequately covered by any of the existing DBQs: insomnia, vestibular dysfunction, and near-vision dysfunction. Although 4 DBQs (mental disorder, chronic fatigue syndrome, PTSD, and sleep apnea) contain isolated questions related to insomnia and sleep disruption, no single DBQ, the committee says, combines them all “in a way that captures the full extent of disability associated with post-TBI sleep disruption.” Similarly, no single DBQ captures the full extent of disability associated with post-TBI vestibular dysfunction or the disability associated with near-vision dysfunction.

The committee sums up: “[B]y adopting an explicit learning structure in which the reliability and validity of disability determinations are directly assessed, the VA will be able to devote its resources to those modifications and enhancements … that will have the greatest impact in improving the service provided to injured veterans.”

The severity of traumatic brain injury (TBI) is typically defined at the time of the initial injury, but a diagnosis may not come for months or even years later. Given the complexities of diagnosing what might be a slowly revealed condition, with signs and symptoms that may manifest over time; the need for self-report of symptoms; and the time that might have elapsed since the original injury, a diagnostician needs not only to have experience with TBI but to stay abreast of the state of the science.

As of now, only health care professionals in 4 specialties—neurologist, neurosurgeon, physiatrist, or psychiatrist—are allowed to diagnose TBI in the VA’s disability compensation process. A new congressionally mandated report by the National Academies of Sciences, Engineering, and Medicine, though, is advising that it’s training and experience that count, not necessarily the specialty.

In Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans, a committee of experts in emergency medicine, neurology, neurosurgery, psychiatry, psychology, physical medicine and rehabilitation, and epidemiology and biostatistics review the process and current literature on TBI. The committee advises that any health care professional with “pertinent and ongoing brain injury training and experience” and up-to-date knowledge about TBI should be included in the diagnostic process.

The disability compensation is a tax-free benefit paid to veterans with disabilities resulting from disease or injury incurred or aggravated during active military service. The amount is determined in a 6-step process beginning when the veteran (or a proxy) files a claim. An approved clinician typically must diagnose and evaluate the degree of impairment, functional limitation, and disability.

Between 2000 and 2018, an estimated 384,000 incidents of TBI occurred in the military. That increasing prevalence means more medical specialties now include TBI training in their curriculum. The committee notes that at least 18 brain injury programs are accredited by the Accreditation Council for Graduate Medical Education to train physicians in many specialties to diagnose, treat, and rehabilitate patients with brain injury. 

Among other recommendations, the committee advised that the VA take specific actions to increase transparency at both individual and systemwide levels, such as providing veterans full access to the details of their examinations, allowing veterans to rate the quality of their evaluations, and providing public access to detailed systemwide data on the outcomes of evaluations and outcome quality. Those changes will represent a “fundamental enhancement” in the quality of disability evaluations, the committee says, which added that shifting from a focus on the consistency of the process and practitioner qualifications to a focus on the accuracy of the outcome of the evaluation will help identify steps or components in the process that warrant improvement.

It also suggested regularly updating the Veteran Affairs Schedule for Rating Disabilities and the Disability Benefits Questionnaires (DBQs) for residuals of TBI to “better reflect the current state of medical knowledge.” The committee found that 3 important residuals of TBI are not adequately covered by any of the existing DBQs: insomnia, vestibular dysfunction, and near-vision dysfunction. Although 4 DBQs (mental disorder, chronic fatigue syndrome, PTSD, and sleep apnea) contain isolated questions related to insomnia and sleep disruption, no single DBQ, the committee says, combines them all “in a way that captures the full extent of disability associated with post-TBI sleep disruption.” Similarly, no single DBQ captures the full extent of disability associated with post-TBI vestibular dysfunction or the disability associated with near-vision dysfunction.

The committee sums up: “[B]y adopting an explicit learning structure in which the reliability and validity of disability determinations are directly assessed, the VA will be able to devote its resources to those modifications and enhancements … that will have the greatest impact in improving the service provided to injured veterans.”

The severity of traumatic brain injury (TBI) is typically defined at the time of the initial injury, but a diagnosis may not come for months or even years later. Given the complexities of diagnosing what might be a slowly revealed condition, with signs and symptoms that may manifest over time; the need for self-report of symptoms; and the time that might have elapsed since the original injury, a diagnostician needs not only to have experience with TBI but to stay abreast of the state of the science.

As of now, only health care professionals in 4 specialties—neurologist, neurosurgeon, physiatrist, or psychiatrist—are allowed to diagnose TBI in the VA’s disability compensation process. A new congressionally mandated report by the National Academies of Sciences, Engineering, and Medicine, though, is advising that it’s training and experience that count, not necessarily the specialty.

In Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans, a committee of experts in emergency medicine, neurology, neurosurgery, psychiatry, psychology, physical medicine and rehabilitation, and epidemiology and biostatistics review the process and current literature on TBI. The committee advises that any health care professional with “pertinent and ongoing brain injury training and experience” and up-to-date knowledge about TBI should be included in the diagnostic process.

The disability compensation is a tax-free benefit paid to veterans with disabilities resulting from disease or injury incurred or aggravated during active military service. The amount is determined in a 6-step process beginning when the veteran (or a proxy) files a claim. An approved clinician typically must diagnose and evaluate the degree of impairment, functional limitation, and disability.

Between 2000 and 2018, an estimated 384,000 incidents of TBI occurred in the military. That increasing prevalence means more medical specialties now include TBI training in their curriculum. The committee notes that at least 18 brain injury programs are accredited by the Accreditation Council for Graduate Medical Education to train physicians in many specialties to diagnose, treat, and rehabilitate patients with brain injury. 

Among other recommendations, the committee advised that the VA take specific actions to increase transparency at both individual and systemwide levels, such as providing veterans full access to the details of their examinations, allowing veterans to rate the quality of their evaluations, and providing public access to detailed systemwide data on the outcomes of evaluations and outcome quality. Those changes will represent a “fundamental enhancement” in the quality of disability evaluations, the committee says, which added that shifting from a focus on the consistency of the process and practitioner qualifications to a focus on the accuracy of the outcome of the evaluation will help identify steps or components in the process that warrant improvement.

It also suggested regularly updating the Veteran Affairs Schedule for Rating Disabilities and the Disability Benefits Questionnaires (DBQs) for residuals of TBI to “better reflect the current state of medical knowledge.” The committee found that 3 important residuals of TBI are not adequately covered by any of the existing DBQs: insomnia, vestibular dysfunction, and near-vision dysfunction. Although 4 DBQs (mental disorder, chronic fatigue syndrome, PTSD, and sleep apnea) contain isolated questions related to insomnia and sleep disruption, no single DBQ, the committee says, combines them all “in a way that captures the full extent of disability associated with post-TBI sleep disruption.” Similarly, no single DBQ captures the full extent of disability associated with post-TBI vestibular dysfunction or the disability associated with near-vision dysfunction.

The committee sums up: “[B]y adopting an explicit learning structure in which the reliability and validity of disability determinations are directly assessed, the VA will be able to devote its resources to those modifications and enhancements … that will have the greatest impact in improving the service provided to injured veterans.”

Studies that look at the relationship between environment and childhood leukemia usually consider exposure at only a single residential address, such as the child’s home at birth or at time of diagnosis, say researchers from University of California and University of Southern California. But residential mobility, they contend, can have an impact on a number of relevant factors.

For instance, mobility can affect selection through the availability of data; cases are usually required to reside and be diagnosed in the same geographic area. It can affect exposure to electromagnetic fields and overhead power lines.  Residential mobility can also function as a marker for other risk factors for childhood leukemia, such as maternal place of birth and younger maternal age at birth, as well as increased exposure to viruses or other infections potentially linked to higher leukemia risk. Finally, the type of dwelling can affect not only exposure but exposure assessment. Mobile homes and apartments, for instance, are more likely to lead to poor geographic information system (GIS) matching of the residential address.

The researchers hoped with their study to “disentangle the effect of mobility.” Using the California Power Lines Study, they analyzed data from 4,879 childhood leukemia patients born in California and diagnosed between 1988 and 2008.

Many childhood leukemia cases were mobile, the researchers found: 2,982 (61%) children changed residence between birth and diagnosis. Of those who moved, 618 stayed within 2 km of their birth home; 1,992 moved outside of their birth neighborhood. Children who moved tended to be older, lived in housing other than single-family homes, had younger mothers and fewer siblings, and were of lower socioeconomic status.

However, the effects of distance to power lines and magnetic field exposure on childhood leukemia were similar for a subset of residentially stable cases, and overall results were unchanged when the researchers controlled for proxies of mobility (except for dwelling). They found an OR for childhood leukemia of 1.44 for those whose birth residence was within 50 m of a 200+ kV line, and an OR of 1.50 for the highest exposure of calculated fields, compared with 1.62 and 1.71, respectively, among children who stayed in place.

While they believe their findings on mobility are relevant to other environmental exposures and other childhood outcome studies, the researchers conclude that confounding by mobility is an unlikely explanation for the associations observed between power lines exposure and childhood leukemia.

Studies that look at the relationship between environment and childhood leukemia usually consider exposure at only a single residential address, such as the child’s home at birth or at time of diagnosis, say researchers from University of California and University of Southern California. But residential mobility, they contend, can have an impact on a number of relevant factors.

For instance, mobility can affect selection through the availability of data; cases are usually required to reside and be diagnosed in the same geographic area. It can affect exposure to electromagnetic fields and overhead power lines.  Residential mobility can also function as a marker for other risk factors for childhood leukemia, such as maternal place of birth and younger maternal age at birth, as well as increased exposure to viruses or other infections potentially linked to higher leukemia risk. Finally, the type of dwelling can affect not only exposure but exposure assessment. Mobile homes and apartments, for instance, are more likely to lead to poor geographic information system (GIS) matching of the residential address.

The researchers hoped with their study to “disentangle the effect of mobility.” Using the California Power Lines Study, they analyzed data from 4,879 childhood leukemia patients born in California and diagnosed between 1988 and 2008.

Many childhood leukemia cases were mobile, the researchers found: 2,982 (61%) children changed residence between birth and diagnosis. Of those who moved, 618 stayed within 2 km of their birth home; 1,992 moved outside of their birth neighborhood. Children who moved tended to be older, lived in housing other than single-family homes, had younger mothers and fewer siblings, and were of lower socioeconomic status.

However, the effects of distance to power lines and magnetic field exposure on childhood leukemia were similar for a subset of residentially stable cases, and overall results were unchanged when the researchers controlled for proxies of mobility (except for dwelling). They found an OR for childhood leukemia of 1.44 for those whose birth residence was within 50 m of a 200+ kV line, and an OR of 1.50 for the highest exposure of calculated fields, compared with 1.62 and 1.71, respectively, among children who stayed in place.

While they believe their findings on mobility are relevant to other environmental exposures and other childhood outcome studies, the researchers conclude that confounding by mobility is an unlikely explanation for the associations observed between power lines exposure and childhood leukemia.

Studies that look at the relationship between environment and childhood leukemia usually consider exposure at only a single residential address, such as the child’s home at birth or at time of diagnosis, say researchers from University of California and University of Southern California. But residential mobility, they contend, can have an impact on a number of relevant factors.

For instance, mobility can affect selection through the availability of data; cases are usually required to reside and be diagnosed in the same geographic area. It can affect exposure to electromagnetic fields and overhead power lines.  Residential mobility can also function as a marker for other risk factors for childhood leukemia, such as maternal place of birth and younger maternal age at birth, as well as increased exposure to viruses or other infections potentially linked to higher leukemia risk. Finally, the type of dwelling can affect not only exposure but exposure assessment. Mobile homes and apartments, for instance, are more likely to lead to poor geographic information system (GIS) matching of the residential address.

The researchers hoped with their study to “disentangle the effect of mobility.” Using the California Power Lines Study, they analyzed data from 4,879 childhood leukemia patients born in California and diagnosed between 1988 and 2008.

Many childhood leukemia cases were mobile, the researchers found: 2,982 (61%) children changed residence between birth and diagnosis. Of those who moved, 618 stayed within 2 km of their birth home; 1,992 moved outside of their birth neighborhood. Children who moved tended to be older, lived in housing other than single-family homes, had younger mothers and fewer siblings, and were of lower socioeconomic status.

However, the effects of distance to power lines and magnetic field exposure on childhood leukemia were similar for a subset of residentially stable cases, and overall results were unchanged when the researchers controlled for proxies of mobility (except for dwelling). They found an OR for childhood leukemia of 1.44 for those whose birth residence was within 50 m of a 200+ kV line, and an OR of 1.50 for the highest exposure of calculated fields, compared with 1.62 and 1.71, respectively, among children who stayed in place.

While they believe their findings on mobility are relevant to other environmental exposures and other childhood outcome studies, the researchers conclude that confounding by mobility is an unlikely explanation for the associations observed between power lines exposure and childhood leukemia.

Fingolimod, a sphingosine-1-phosphate receptor modulator, has been used to treat > 55,000 patients in the US, according to the manufacturer (Gilenya/Novartis). It is believed to work by keeping lymphocytes from migrating into the CNS, sequestering them in the lymph nodes.

Although it has been found effective in randomized controlled trials, fingolimod is also known to have a wide range of adverse effects (AEs), including some that are serious and even life-threatening, such as bradycardia and atrioventricular block. The drug is contraindicated for patients who have had myocardial infarction, unstable angina, or heart failure, among other conditions. Ventricular tachycardia has been reported only once, but clinicians from Hurley Medical Center in Flint, Michigan, suggest that it may actually be an underrecognized cause of sudden death.

They describe the case of their patient, a 63-year-old woman with relapsing-remitting multiple sclerosis and hypertension who was about to start fingolomod. She underwent a basal ECG to be cleared before starting treatment. She received her first dose of fingolimod at the cardiology office, was monitored for 6 hours, and went home with a surface-mounted Holter monitor.

Two weeks later, she was in the emergency department because the monitor had captured ventricular tachycardia, and she was reporting palpitations.

Lab work was normal; the echocardiogram was normal. Cardiac monitoring showed no other evidence of cardiac arrhythmias. Her only other medication was amlodipine. The fingolimod was held back. She was observed for4 days then discharged in a stable condition. Her clinicians followed her for 2 months but the arrhythmia did not return.

Although this patient had no further arrhythmias, the authors warn that serious outcomes are possible. They urge health care practitioners to let patients know of this potential AE and advise them to report symptoms such as palpitations immediately.

Fingolimod, a sphingosine-1-phosphate receptor modulator, has been used to treat > 55,000 patients in the US, according to the manufacturer (Gilenya/Novartis). It is believed to work by keeping lymphocytes from migrating into the CNS, sequestering them in the lymph nodes.

Although it has been found effective in randomized controlled trials, fingolimod is also known to have a wide range of adverse effects (AEs), including some that are serious and even life-threatening, such as bradycardia and atrioventricular block. The drug is contraindicated for patients who have had myocardial infarction, unstable angina, or heart failure, among other conditions. Ventricular tachycardia has been reported only once, but clinicians from Hurley Medical Center in Flint, Michigan, suggest that it may actually be an underrecognized cause of sudden death.

They describe the case of their patient, a 63-year-old woman with relapsing-remitting multiple sclerosis and hypertension who was about to start fingolomod. She underwent a basal ECG to be cleared before starting treatment. She received her first dose of fingolimod at the cardiology office, was monitored for 6 hours, and went home with a surface-mounted Holter monitor.

Two weeks later, she was in the emergency department because the monitor had captured ventricular tachycardia, and she was reporting palpitations.

Lab work was normal; the echocardiogram was normal. Cardiac monitoring showed no other evidence of cardiac arrhythmias. Her only other medication was amlodipine. The fingolimod was held back. She was observed for4 days then discharged in a stable condition. Her clinicians followed her for 2 months but the arrhythmia did not return.

Although this patient had no further arrhythmias, the authors warn that serious outcomes are possible. They urge health care practitioners to let patients know of this potential AE and advise them to report symptoms such as palpitations immediately.

Fingolimod, a sphingosine-1-phosphate receptor modulator, has been used to treat > 55,000 patients in the US, according to the manufacturer (Gilenya/Novartis). It is believed to work by keeping lymphocytes from migrating into the CNS, sequestering them in the lymph nodes.

Although it has been found effective in randomized controlled trials, fingolimod is also known to have a wide range of adverse effects (AEs), including some that are serious and even life-threatening, such as bradycardia and atrioventricular block. The drug is contraindicated for patients who have had myocardial infarction, unstable angina, or heart failure, among other conditions. Ventricular tachycardia has been reported only once, but clinicians from Hurley Medical Center in Flint, Michigan, suggest that it may actually be an underrecognized cause of sudden death.

They describe the case of their patient, a 63-year-old woman with relapsing-remitting multiple sclerosis and hypertension who was about to start fingolomod. She underwent a basal ECG to be cleared before starting treatment. She received her first dose of fingolimod at the cardiology office, was monitored for 6 hours, and went home with a surface-mounted Holter monitor.

Two weeks later, she was in the emergency department because the monitor had captured ventricular tachycardia, and she was reporting palpitations.

Lab work was normal; the echocardiogram was normal. Cardiac monitoring showed no other evidence of cardiac arrhythmias. Her only other medication was amlodipine. The fingolimod was held back. She was observed for4 days then discharged in a stable condition. Her clinicians followed her for 2 months but the arrhythmia did not return.

Although this patient had no further arrhythmias, the authors warn that serious outcomes are possible. They urge health care practitioners to let patients know of this potential AE and advise them to report symptoms such as palpitations immediately.

A study of > 450,000 adults has “confirmed the long-held notion” that flu and heart failure are connected. The Atherosclerosis Risk in Communities study (ARIC), led by a VA researcher, found influenza significantly increased the risk of hospitalization for heart failure.

Every flu season about 36,000 people die, and > 200,000 are hospitalized due to flu, which is known to be associated with a higher risk of cardiovascular events. Several mechanisms likely contribute: Some form of immunocompromise is thought to be a key link. But few studies, the researchers note, have explored the temporal association between influenza activity and hospitalizations, particularly those caused by heart failure.

In ARIC, the researchers analyzed hospitalization data for adults aged 35 to 84 years between 2010 and 2014 in geographically diverse communities in Mississippi, Minnesota, North Carolina, and Maryland. They correlated those data with reports of influenza activity from the CDC Surveillance Network.

A 5% monthly increase in influenza activity was associated with a 24% relative increase in heart failure hospitalization rates. Myocardial infarction hospitalizations did not rise significantly. The most pneumonia and influenza-associated deaths were during the 2012-2013 season, when influenza-like illness (ILI) activity was highest, and the fewest deaths occurred during 2011-2012, when ILI activity was lowest. The model suggests that in a month with high influenza activity, about 19% of hospitalizations could be attributable to influenza, the researchers say.

“The study’s findings support VA’s aggressive effort every year to provide veterans with influenza vaccine,” said VA Secretary Robert Wilkie. Although the flu season is winding down, he added, it is not too late for veterans—and others—to get vaccinated.

A study of > 450,000 adults has “confirmed the long-held notion” that flu and heart failure are connected. The Atherosclerosis Risk in Communities study (ARIC), led by a VA researcher, found influenza significantly increased the risk of hospitalization for heart failure.

Every flu season about 36,000 people die, and > 200,000 are hospitalized due to flu, which is known to be associated with a higher risk of cardiovascular events. Several mechanisms likely contribute: Some form of immunocompromise is thought to be a key link. But few studies, the researchers note, have explored the temporal association between influenza activity and hospitalizations, particularly those caused by heart failure.

In ARIC, the researchers analyzed hospitalization data for adults aged 35 to 84 years between 2010 and 2014 in geographically diverse communities in Mississippi, Minnesota, North Carolina, and Maryland. They correlated those data with reports of influenza activity from the CDC Surveillance Network.

A 5% monthly increase in influenza activity was associated with a 24% relative increase in heart failure hospitalization rates. Myocardial infarction hospitalizations did not rise significantly. The most pneumonia and influenza-associated deaths were during the 2012-2013 season, when influenza-like illness (ILI) activity was highest, and the fewest deaths occurred during 2011-2012, when ILI activity was lowest. The model suggests that in a month with high influenza activity, about 19% of hospitalizations could be attributable to influenza, the researchers say.

“The study’s findings support VA’s aggressive effort every year to provide veterans with influenza vaccine,” said VA Secretary Robert Wilkie. Although the flu season is winding down, he added, it is not too late for veterans—and others—to get vaccinated.

A study of > 450,000 adults has “confirmed the long-held notion” that flu and heart failure are connected. The Atherosclerosis Risk in Communities study (ARIC), led by a VA researcher, found influenza significantly increased the risk of hospitalization for heart failure.

Every flu season about 36,000 people die, and > 200,000 are hospitalized due to flu, which is known to be associated with a higher risk of cardiovascular events. Several mechanisms likely contribute: Some form of immunocompromise is thought to be a key link. But few studies, the researchers note, have explored the temporal association between influenza activity and hospitalizations, particularly those caused by heart failure.

In ARIC, the researchers analyzed hospitalization data for adults aged 35 to 84 years between 2010 and 2014 in geographically diverse communities in Mississippi, Minnesota, North Carolina, and Maryland. They correlated those data with reports of influenza activity from the CDC Surveillance Network.

A 5% monthly increase in influenza activity was associated with a 24% relative increase in heart failure hospitalization rates. Myocardial infarction hospitalizations did not rise significantly. The most pneumonia and influenza-associated deaths were during the 2012-2013 season, when influenza-like illness (ILI) activity was highest, and the fewest deaths occurred during 2011-2012, when ILI activity was lowest. The model suggests that in a month with high influenza activity, about 19% of hospitalizations could be attributable to influenza, the researchers say.

“The study’s findings support VA’s aggressive effort every year to provide veterans with influenza vaccine,” said VA Secretary Robert Wilkie. Although the flu season is winding down, he added, it is not too late for veterans—and others—to get vaccinated.