RESUMO
BACKGROUND: Recent evidence has indicated a potential role of vitamin D3 in a range of neuropsychiatric outcomes, as well as on cognitive function, but conflicting data have left that role uncertain. Understanding potential associations of vitamin D status with psychiatric illness will allow clinicians to better assess therapeutic options. Few studies have examined vitamin D status among a racially diverse group of psychiatric patients who have been hospitalized, and none has done so in the southern US where socioeconomic inequality is high. METHODS: In this retrospective study, medical records from 113 patients hospitalized for psychiatric illness were retrieved and analyzed. Vitamin D status in this population was estimated, along with any patterns of association between deficiency and risk factors. RESULTS: The vast majority of patients hospitalized for psychiatric illness in this biracial, low-income sample had either insufficient or deficient vitamin D levels. African-American patients had lower levels of vitamin D than Caucasian patients. DISCUSSION: Our findings demonstrate that hospitalized psychiatric patients are at increased risk for vitamin D deficiency and in particular low-income, African-American populations. These results suggest that vitamin D should be assessed and therapy considered at the initiation of psychiatric hospitalizations.
RESUMO
BACKGROUND: Exclusive breastfeeding for infants up to 6 months is widely recommended, yet breastfeeding rates are relatively low in the US. The most common reason women stop breastfeeding early is a perceived insufficiency of milk. Galactagogues are herbal and pharmaceutical products that can help increase milk supply; however, data on their efficacy and safety is limited. Lactation consultants, obstetricians, and other health providers are an important point of contact for breastfeeding women experiencing challenges with lactation. This study explored providers' perceptions, experiences, and practices in relation to galactagogue recommendation. METHOD: A cross-sectional survey was conducted among a convenience sample of English-speaking health providers in the US who counsel breastfeeding women and their infants. RESULTS: More than 70% of respondents reported to recommend galactagogues. The most frequently recommended galactagogue was fenugreek with respondents indicating that they recommend it either 'always' (8.5%) or 'most of the time' (14.9%) and 'sometimes' (46.8%). More than 80% of the respondents indicated that galactagogues were useful for their clients and only one-third reported side effects. Reasons for refraining from recommending galactagogues were insufficient evidence of its efficacy and safety. Respondents reported a wide variety of sources of information used for their own education about galactagogues. DISCUSSION: Despite little evidence regarding safety and efficacy, some galactagogues are widely recommended and often perceived to be useful. However, concerns about their efficacy and safety remain. In order to assure both providers and users about safety and efficacy, more robust studies as well as better pharmacovigilance systems are needed.
RESUMO
BACKGROUND: During March 2004, a large outbreak of legionnaires disease and Pontiac fever occurred among hotel guests in Oklahoma. An investigation was conducted to identify the source and evaluate the utility of the Legionella urine antigen assay and serologic testing for the identification of Pontiac fever. METHODS: A retrospective cohort investigation of hotel guests and employees and an environmental evaluation were performed. Participants were interviewed, and clinical specimens were collected from consenting individuals. RESULTS: Six cases of legionnaires disease and 101 cases of Pontiac fever were identified. Exposure to the indoor pool and hot tub area was associated with legionellosis (relative risk, 4.4; 95% confidence interval, 2.8-6.9). Specimens from the pool and hot tub tested positive for Legionella pneumophila serogroup 1 by polymerase chain reaction. For Pontiac fever, the sensitivity and positive predictive value were 35.7% and 100%, respectively, for the urine antigen assay, and 46.4% and 90%, respectively, for serologic testing. The specificity and negative predictive value were 100% and 47.8%, respectively, for the urine antigen assay, and 89.3% and 45.5%, respectively, for serologic testing. CONCLUSIONS: Urine antigen testing, with or without serologic testing, can be used to confirm outbreak-associated cases of Pontiac fever caused by L. pneumophila serogroup 1.
