A Pilot Study: examining the effects and tolerability of structured dance intervention for individuals with multiple sclerosis.

PURPOSE: The aims of this pilot were to examine dance as a feasible intervention for persons with multiple sclerosis (MS), specifically to examine issues of tolerability and its longitudinal effects on participants. Dance is an enjoyable physical activity that has been investigated in other neurodegenerative populations but has yet to be studied in MS. METHOD: A 4-week, two 60-min classes per week, pilot salsa dance intervention was administered to eight individuals with MS. The outcomes measured were effects on gait, balance, self-efficacy, motivation, physical activity and MS symptoms. They were administered at baseline, immediately post-intervention and at 3- and 6-month follow-ups. RESULTS: Statistically significant pre-post intervention gains were found for the Timed Up and Go Test (TUG), Dynamic Gait Index (DGI), Activities-specific Balance Confidence Scale and Godin Leisure Time Questionnaire. Significant improvements were also found for the TUG, DGI and MS Walking Scale between baseline and 3-month follow-up assessments. Participants did not report any problems with fatigue or intolerability with the 60-min suggestions, further supporting the feasibility for the concept of a dance intervention. CONCLUSIONS: This study suggests that dance for persons with MS may have promise for improving physical activity, gait and balance. IMPLICATIONS FOR REHABILITATION: Although structured dance has reported benefits in elderly populations and in individuals with cardiovascular and neurological impairments, there is virtually nothing known regarding dance in the MS population. This pilot salsa dance study shows that structured dance demonstrates promise of being well-tolerated, safe and effective at promoting physical activity in people with MS without increased fatigue. A 12-week study has been initiated to test the robustness of initial observations and further examine factors influencing participants' physical activity adherence and behavioral change.

Folic acid supplementation in early pregnancy and the risk of preeclampsia, small for gestational age offspring and preterm delivery.

OBJECTIVE: To assess whether folic acid intake during the first trimester of pregnancy is related to pregnancy outcomes preeclampsia, low birth weight or preterm birth. STUDY DESIGN: Prospective cohort study of 3647 women who were followed from the first trimester of pregnancy. Detailed information on quantity of folic acid intake before and during the first three months of pregnancy was recorded. Pregnancy outcome data were abstracted from obstetric records. RESULTS: Lean mothers who used folic acid supplementation the month before pregnancy had a 40% reduced risk of developing preeclampsia. The adjusted odds ratio (OR) with 95% confidence intervals (95%CI) for preeclampsia in lean mothers (BMI<25) who used folic acid supplements the month before pregnancy was 0.6 (95% CI 0.4-1.0). Obese mothers who used folic acid supplementation in the first trimester had an increased, but not statistically significant risk for preterm birth (adjusted OR 1.9 with 95% CI 0.9-4.0). There were no significant associations between folic acid supplementation and low birth weight. CONCLUSION: Our study supports a possible protective effect of folate intake in early pregnancy on preeclampsia in lean mothers. There was no support for any beneficial effect of folic acid use on preterm birth or low birth weight, and we found no evidence of any harmful effects of folate use for the outcomes included in our study.

Long-term alcohol and caffeine intake and risk of sudden cardiac death in women.

BACKGROUND: Alcohol and caffeine intakes may play a role in the development of sudden cardiac death (SCD) because of their effects on cholesterol, blood pressure, heart rate variability, and inflammation. OBJECTIVE: Our objective was to examine the association between long-term alcohol and caffeine intakes and risk of SCD in women. DESIGN: We examined 93,676 postmenopausal women who participated in the Women's Health Initiative Observational Study. Women were enrolled between 1993 and 1998 and were followed until August 2009. Women completed a food-frequency questionnaire at baseline and again at year 3. We modeled exposure to alcohol 3 ways: by using baseline intake only, a cumulative average of baseline and year 3 intake, and the most recent reported intake (a simple time-varying analysis). RESULTS: Intake of 5-15 g alcohol/d (about one drink) was associated with a nonsignificantly reduced risk of SCD compared with 0.1-5 g/d of baseline intake (HR: 0.64; 95% CI: 0.40, 1.02), of cumulative average intake (HR: 0.69; 95% CI: 0.43, 1.11), and of most recent intake (HR: 0.58; 95% CI: 0.35, 0.96), with adjustment for age, race, income, smoking, body mass index, physical activity, hormone use, and total energy. No association was found between SCD and total caffeine intake (mg/d) or cups of caffeinated coffee, decaffeinated coffee, and caffeinated tea. CONCLUSIONS: Our results suggest that about one drink per day (or 5.1-15 g/d) may be associated with a reduced risk of SCD in this population; however, this association was only statistically significant for a model using the most recent alcohol intake. Total caffeine, regular coffee, decaffeinated coffee, and regular tea intake were not associated with the risk of SCD. This trial was registered at clinicaltrials.gov as NCT00000611.

Effects of ambient pollen concentrations on frequency and severity of asthma symptoms among asthmatic children.

BACKGROUND: Previous studies on the associations between ambient pollen exposures and daily respiratory symptoms have produced inconsistent results. We investigated these relationships in a cohort of asthmatic children using pollen exposure models to estimate individual ambient exposures. METHODS: Daily symptoms of wheeze, night symptoms, shortness of breath, chest tightness, persistent cough, and rescue medication use were recorded in a cohort of 430 children with asthma (age 4-12 years) in Connecticut, Massachusetts, and New York. Daily ambient exposures to tree, grass, weed, and total pollen were estimated using mixed-effects models. We stratified analyses by use of asthma maintenance medication and sensitization to grass or weed pollens. Separate logistic regression analyses using generalized estimating equations were performed for each symptom outcome and pollen type. We adjusted analyses for maximum daily temperature, maximum 8-hour average ozone, fine particles (PM2.5), season, and antibiotic use. RESULTS: Associations were observed among children sensitized to specific pollens; these associations varied by use of asthma maintenance medication. Exposures to even relatively low levels of weed pollen (6-9 grains/m(3)) were associated with increased shortness of breath, chest tightness, rescue medication use, wheeze, and persistent cough, compared with lower exposure among sensitized children on maintenance medication. Grass pollen exposures ≥ 2 grains/m(3) were associated with wheeze, night symptoms, shortness of breath, and persistent cough compared with lower exposure among sensitized children who did not take maintenance medication. CONCLUSION: Even low-level pollen exposure was associated with daily asthmatic symptoms.

Spatial and temporal modeling of daily pollen concentrations.

Accurate assessments of pollen counts are valuable to allergy sufferers, the medical industry, and health researchers; however, monitoring stations do not exist in most areas. In addition, the degree of spatial reliability provided by the limited number of monitoring stations is poorly understood. We developed and compared spatial models to estimate pollen concentrations in locations without monitoring stations. Daily Acer, Quercus, and overall tree, grass, and weed pollen counts, in grains/m(3), were obtained from 14 aeroallergen monitoring stations located in the northeastern and mid-Atlantic region of the United States from 2003 to 2006. Pollen counts were spatially interpolated using ordinary kriging. Mixed effects and generalized estimating equations incorporating daily and seasonal weather characteristics, pollen season characteristics and land-cover information were also developed to estimate daily pollen concentrations. We then compared observed values from a monitoring station to model estimates for that location. Observed counts and kriging estimates for tree pollen differed (p = 0.04), but not when peak periods were removed (p = 0.29). No differences between observed and kriging estimates of Acer (p = 0.46), Quercus (p = 0.24), grass (p = 0.31) or weed pollen (p = 0.29) were found. Estimates from longitudinal models also demonstrated good agreement with observed counts, except for the extremes of pollen distributions. Our results demonstrate that spatial interpolation techniques as well as regression methods incorporating both weather and land-cover characteristics can provide reliable estimates of daily pollen concentrations in areas where monitors do not exist for all but periods of extremely high pollen.

Heterogeneity in assessing self-reports of caffeine exposure: implications for studies of health effects.

BACKGROUND: Coffee and its metabolite caffeine are widely studied for their health effects but with inconclusive results. Caffeine is particularly difficult to assess, and therefore we explore heterogeneity of caffeine exposure. METHODS: We categorized caffeine exposure among 2,478 pregnant women in southern New England during 1996-2000 by the traditional laboratory-based methods of M. Bunker and M. McWilliams. A subsample was examined to ascertain caffeine levels of brewed or purchased beverages actually consumed. RESULTS: More than half (56.6%) of women drank coffee since becoming pregnant. Serving sizes ranged from 2 to 32 oz and are considerably larger than laboratory standards, which are typically 8-10 oz, as compared with the standard of 5 to 6 oz. Conversely, caffeine content per serving of coffee was one-third the laboratory standard, eg, 100 mg caffeine compared with 300 mg for a 10-oz cup. Tea brewed more than 3 minutes contained 42 mg caffeine as compared with the standard of 94 mg. When the amount of caffeine actually consumed was measured, one-quarter (24.8%) of subjects traditionally classified as consuming 300+ gm caffeine daily were reclassified as consuming 150-299 mg. CONCLUSION: Misclassification of caffeine consumption increases difficulty in identifying health effects from caffeine. Some combination of more precise consumption data and a biomarker such as paraxanthine may more precisely estimate exposure.