High Prevalence of Osteopathy in Chronic Pancreatitis: A Cross-sectional Analysis From the PROCEED Study.

BACKGROUND & AIMS: Chronic pancreatitis (CP) is associated with osteopathy (osteoporosis or osteopenia). However, existing literature is mostly limited to retrospective or administrative studies that have not clearly defined the prevalence and risk factors. Our aim was to identify patient- and disease-related associations with osteopathy in a prospective cohort study of CP. METHODS: We studied 282 subjects with definitive CP enrolled in the PROCEED study who had a baseline dual-energy X-ray absorptiometry (DXA) scan. Osteopenia and osteoporosis were defined using the lowest T-scores. Clinical data were collected using standardized case report forms. Comparisons were performed with a multivariate logistic regression model with forward selection to identify risk factors for osteopathy. RESULTS: The majority of subjects had osteopathy on DXA scan (56.0%; 17.0% osteoporosis; 39.0% osteopenia). Subjects with osteopathy had a higher prevalence of traumatic (40.0% vs 26.4%; P = .02) and spontaneous fractures (3.9% vs 0; P = .04). On multivariate analysis, older age (odds ratio [OR], 1.29 per 5 years; 95% confidence interval [CI], 1.15-1.45), female sex (OR, 3.08; 95% CI, 1.75-5.43), white race (OR, 2.68; 95% CI, 1.20-6.01), and underweight body mass index category (OR, 7.40; 95% CI, 1.56-34.99) were associated with higher probability of osteopathy. There were no significant associations between osteopathy and other patient and disease-related features of CP. CONCLUSION: In the largest study of patients with CP who underwent DXA screening, the majority had osteopathy. There are overlapping risk factors with osteopathy in the general population, but the high prevalence in men and younger women supports the need for future investigations into the mechanisms of bone loss in CP. CLINICALTRIALS: gov number, NCT03099850.

Biomarkers of Chronic Pancreatitis: A systematic literature review.

BACKGROUND: Chronic pancreatitis (CP) does not have diagnostic or prognostic biomarkers. CP is the end stage of a progressive inflammatory syndrome that is diagnosed at late stages by morphologic features. To diagnose earlier stages of the disease, a new mechanistic definition was established based on identifying underlying pathogenic processes and biomarker evidence of disease activity and stage. Although multiple risk factors are known, the corresponding biomarkers needed to make a highly accurate diagnosis of earlier disease stages have not been established. The goal of this study is to systematically analyze the literature to identify the most likely candidates for development into biomarkers of CP. METHODS: We conducted a systematic review of candidate analytes from easily accessible biological fluids and identified 67 studies that compared CP to nonpancreatic-disease controls. We then ranked candidate biomarkers for sensitivity and specificity by area under the receiver operator curves (AUROCs). RESULTS: Five biomarkers had a large effect size (an AUROC > 0.96), whereas 30 biomarkers had a moderate effect size (an AUROC between 0.96 and 0.83) for distinguishing CP cases from controls or other diseases. However, the studies reviewed had marked variability in design, enrollment criteria, and biospecimen sample handling and collection. CONCLUSIONS: Several biomarkers have the potential for evaluation in prospective cohort studies and should be correlated with risk factors, clinical features, imaging studies and outcomes. The Consortium for the Study of Chronic Pancreatitis, Diabetes and Pancreas Cancer provides recommendations for avoiding design biases and heterogeneity in sample collection and handling in future studies.

The association between school-to-work programs and school performance.

PURPOSE: The School-to-Work (STW) Opportunities Act was passed to aid students in transitioning from education to employment by offering work-based learning opportunities. In the United States, 72% of high schools offer work-based learning opportunities for credit. This is the first study to describe school performance and school-based behaviors among students enrolled in STW programs and compare them with nonworking and other-working students. METHODS: In 2003, a questionnaire was administered to five school districts and one large urban school in Wisconsin. Between 2008 and 2010, analyses were completed to characterize STW students and compare them with other students. RESULTS: Of the 6,519 students aged 14-18 years included in the analyses, 461 were involved in an STW program (7%), 3,108 were non-working (48%), and 2,950 were other-working students (45%). Compared with other students, STW students were less likely to have a grade point average >2.0, more likely to have three or more unexcused absences from school, and more likely to spend <1 hour in school-sponsored activities. Holding multiple jobs also negatively affected a student's academic performance. CONCLUSIONS: School-to-Work students reported poorer academic performance and more unhealthy school-related behaviors compared with nonworking students and other-working students. Whereas many factors have a role in why students perform poorly in school, more research on students enrolled in STW programs is needed to understand whether participating has a negative impact on students' academic achievement.

Working for mom and dad: are teens more likely to get injured working in family-owned businesses?

Recent controversy regarding the issue of children working in family-owned businesses has come to the forefront, pitting safety and health versus parent's right to teach their children the family trade. While studies have characterized injury among working teens, no studies have assessed work and injury among teens employed in family-owned businesses. This study is the first to examine teenagers working in family-owned businesses and to compare the experiences of teens working in family-businesses to the experiences of other working teens. A questionnaire was distributed to 8,085 teens in high schools throughout the five public health regions of Wisconsin. A total of 6, 810 teens responded (84%). Overall 2,858 high school teens aged 14-17 reported working (42%); of which 963 (34%) worked in a family-business. Teens working in family-businesses were more likely to report that their injury was severe, affecting their activities for more than three days, compared with other working teens (33% vs. 21%, P = 0.05). The percentage of teens working in family-businesses that reported broken bones or crushed body parts was 17% compared to only 5% of other-working teens. Additionally, teens employed in family-businesses were more likely to file for workers' compensation (28% vs. 12%, P = 0.005). Teens working in family-owned businesses may be at a greater risk for more severe injury based on the jobs and tasks they are doing. Teens working in family-owned businesses were more likely to report engaging in dangerous tasks, including some that are illegal under the Hazardous Occupation Orders. More research is needed to assess the dynamics that exist for teens working in family-owned businesses.

School-sponsored work programs: a first look at differences in work and injury outcomes of teens enrolled in school-to-work programs compared to other-working teens.

OBJECTIVES: To evaluate work experiences among teens enrolled in school-sponsored work (SSW) programs and compare the findings to other-working teens. This study, the first to assess work-related safety and health for teens in SSW programs, includes teens working one job and teens working multiple jobs. METHODS: A survey was conducted among 6810 teens in school districts in five public health regions in Wisconsin. Information on demographics, work characteristics, injury and school performance was collected. RESULTS: Of 3411 high school teens (14-18 years old) working during the school year, 461 were enrolled in SSW programs. SSW teens were more likely to hold multiple jobs, work over 40 h per week, and work 2 or more days per week before 8:00 h compared with other-working teens. SSW teens working only one job were no more likely to be injured than other-working teens. However, SSW teens working multiple jobs were significantly more likely to be severely injured compared to other-working teens (AOR 3.49; 95% CI 1.52 to 8.02). CONCLUSIONS: SSW programs were created to prepare youth for transition into the workforce after high school. This first study suggests that students in SSW programs working only one job are no more likely to be injured at work compared with other-working teens. However, being enrolled in SSW programs is not protective against work injury, which would have been expected based on the philosophy of these programs. Furthermore, when students work multiple jobs, those enrolled in SSW programs are more likely to be severely injured. Possible explanations are provided.

Students enrolled in school-sponsored work programs: the effect of multiple jobs on workplace safety and school-based behaviors.

BACKGROUND: Throughout the United States, over 70% of public schools with 12th grade offer school-sponsored work (SSW) programs for credit; 60% offer job-shadowing programs for students. Wisconsin offers a variety of work-based learning programs for students, including, but not limited to, job shadowing, internships, co-op education, and youth apprenticeship programs. No research has compared workplace injury and school-based behaviors in students enrolled in SSW programs who work only 1 job compared with those who work multiple jobs. METHODS: A total of 6810 students in the 5 public health regions in Wisconsin responded to an anonymous questionnaire that was administered in 2003. The questionnaire asked about employment, injury, characteristics of injury, and school-based behaviors and performance. RESULTS: A total of 3411 high school students aged 14 to 18 reported they were employed during the school year. Among the working students, 13.5% were enrolled in a SSW program. Of the SSW students, 44% worked multiple jobs. SSW students who worked multiple jobs were more likely to do hazardous job tasks, to work after 11 PM, to work over 40 hours per week, to have a near-miss incident, to have a coworker injured, and to be injured at work. CONCLUSIONS: SSW students who are working multiple jobs are violating labor laws that put their safety and their school performance at risk. The responsibilities of employers and schools have to be addressed to ensure that SSW students are abiding by labor laws when working multiple jobs.