Risk of acute myocardial infarction among new users of bisphosphonates: a nested case-control study.

OBJECTIVE: To test the hypothesis that bisphosphonates reduce AMI risk among new users and to assess whether the effect depends on the duration of treatment. METHODS: Case-control study nested in a primary cohort composed of patients aged 40 to 99 years, with at least 1-year registry in the BIFAP database throughout the study period 2002-2015. Out of this cohort, incident AMI cases were identified and five controls per case were randomly selected, matched by exact age, sex, and index date. The association of AMI with current, recent and past use of bisphosphonates was assessed by computing adjusted odds ratios (AOR) and their corresponding 95% confidence interval (CI) through an unconditional logistic regression. Only initiators of bisphosphonates were considered. RESULTS: A total of 23,590 cases of AMI and 117,612 controls were included. The mean age was 66.8 (SD 13.4) years, and 72.52% was male, in both groups. About 276 (1.17%) cases and 1458 (1.24%) controls were current users of bisphosphonates yielding an AOR of 0.98 (95% CI 0.854-1.14). Recent and past use were not associated with a reduced risk, either, nor was it found a reduction with treatment duration (AOR less than 1 year = 0.92; 95% CI 0.73-1.15; AOR more than 1 year = 1.03; 95% CI 0.86-1.23). Stratified analysis by age, sex and background cardiovascular risk did not show an effect modification by these variables. CONCLUSION: The results do not support a cardioprotective effect of bisphosphonates regardless of the duration of treatment, age, sex or background cardiovascular risk. However, a small protective effect could have been masked if patients with osteoporosis have had a background higher risk of AMI.

'Supporting a first-time mother': Assessment of success of a breastfeeding promotion programme.

BACKGROUND: The aim of this study was to measure the effectiveness on breast feeding rates by the program 'Supporting a First-time Mother', a web-based platform of interactionbetween first-time mothers and breastfeeding-experienced women who act as peer-supporters. METHODS: A randomized study with a control and intervention group was conducted between April and October 2016. Participants were recruited from Hospital Universitario de Canarias (Spain). Inclusive criteria were singleton pregnancy, healthy term baby, vaginal or assisted delivery. Participants were randomly assigned to either an intervention or control group. Type of feeding (exclusive, partial or artificial) was noted at 3 and 6 months. The study also gathered information from the peer-supporters. RESULTS: Data showed higher rates of exclusive breastfeeding in the intervention group,at both 3 and 6 months post delivery (76% vs 56%, p = 0.020; 47% vs 35%, p = 0.049). Taking part in the study also increased the overall success of breastfeeding 2.65 times (IC95%, 1.21-5.78, p = 0.014) at 3 months and 3.30 times (IC95% 1.52-7.17, p = 0.003) at 6 months. CONCLUSIONS: A limitation of the study is mainly related to participation in the intervention. In spite of this limitation, this support programme increased breastfeeding rates 3 fold.

El dolor crónico de hombro en las actividades instrumentales de la vida diaria / Chronic shoulder pain in advanced activities of daily living

Introducción. El dolor crónico de hombro afecta entre el 7% y 34% de la población, siendo la tercera causa de enfermedad musculoesquelética. El objetivo fue analizar la influencia del hombro doloroso en las actividades cotidianas y su repercusión en el sueño en un grupo con esta enfermedad comparado con uno asintomático. Métodos. Mediante un estudio transversal se evaluó la amplitud articular del hombro y se administraron la Escala visual analógica graduada del dolor, la Disabilities of the Arm Shoulder and Hand, y el Índice de calidad del sueño de Pittsburgh a un grupo de personas con hombro doloroso del Hospital Universitario de Burgos y a uno de personas asintomáticas, emparejadas por edad y sexo. El análisis de datos se hizo desde una vertiente descriptiva y otra cuantitativa donde se utilizaron pruebas de contraste y de correlación. Resultados. Se evaluaron 40 sujetos con una edad media de 49,3±12,51 años. Se detectó menor amplitud articular del hombro en el grupo con dolor. Las diferencias entre ambos grupos fueron significativas para la flexión (t(38)=9,52; p=0,024), la abducción (t(38)=8,78; p=0,004), la rotación medial (t(38)=9,05; p=0,002) y lateral (Z=-3,43; p=0,001). Igualmente en la calidad del sueño (t(38)=10.60; p<0,0001) y el dolor (Z=5,69; p<0,0001). Se estableció asociación entre el dolor y la discapacidad en las actividades cotidianas (ρ=0,849; p<0,0001). Conclusión. La presencia de hombro doloroso disminuye el rango articular en 4 de 6 movimientos, interfiere en gran parte de las actividades instrumentales de la vida diaria y altera la calidad del sueño (AU)

Introduction. Chronic shoulder pain affects between 7 and 34% of the population and is the third most frequent cause of musculoskeletal disorders. The aim of this study was to analyse the influence of shoulder pain on activities of daily living and its effect on sleep in a group with this disorder compared with an asymptomatic group. Methods. A cross-sectional study was conducted. Range of movement of the shoulder was assessed, and the Disabilities of the Arm, Shoulder and Hand scale, the Visual Analogue Graded Pain Scale, and the Pittsburgh Sleep Quality Index were administered in a group with shoulder pain and a matched-control group, by age and gender. Descriptive and quantitative analyses of the data were performed and correlation and contrast tests were applied. Results. A total of 40 participants with a mean age of 49.3±12.51 years were assessed. Lower shoulder range of motion was detected in the pain group. Significant differences were found between groups in shoulder flexion (t(38)=9.52; P=.024), abduction (t(38)=8.78; P=.004), medial rotation (t(38)=9.05; p=.002) and lateral rotation (Z=-3.43; P=.001), as well as in sleep (t(38)=10.60; P<0.0001) and pain (Z=5.69; P<.0001). An association between pain and disability in advanced activities of daily living was identified (ρ=0.849; P<.0001). Conclusion. Chronic shoulder pain decreases the range of movement in 4 of the 6 joint movements, interferes with many activities of daily living and causes sleep alteration (AU)