Seasonal transmission dynamics of varicella in Japan: The role of temperature and school holidays.

In Japan, major and minor bimodal seasonal patterns of varicella have been observed. To investigate the underlying mechanisms of seasonality, we evaluated the effects of the school term and temperature on the incidence of varicella in Japan. We analyzed epidemiological, demographic and climate datasets of seven prefectures in Japan. We fitted a generalized linear model to the number of varicella notifications from 2000 to 2009 and quantified the transmission rates as well as the force of infection, by prefecture. To evaluate the effect of annual variation in temperature on the rate of transmission, we assumed a threshold temperature value. In northern Japan, which has large annual temperature variations, a bimodal pattern in the epidemic curve was observed, reflecting the large deviation in average weekly temperature from the threshold value. This bimodal pattern was diminished with southward prefectures, gradually shifting to a unimodal pattern in the epidemic curve, with little temperature deviation from the threshold. The transmission rate and force of infection, considering the school term and temperature deviation from the threshold, exhibited similar seasonal patterns, with a bimodal pattern in the north and a unimodal pattern in the south. Our findings suggest the existence of preferable temperatures for varicella transmission and an interactive effect of the school term and temperature. Investigating the potential impact of temperature elevation that could reshape the epidemic pattern of varicella to become unimodal, even in the northern part of Japan, is required.

Evaluating the "holiday season effect" of hospital care on the risk of mortality from pulmonary embolism: a nationwide analysis in Taiwan.

We aimed to determine whether hospital admissions during an extended holiday period (Chinese New Year) and weekends were associated with increased mortality risk from pulmonary embolism (PE), compared to admissions on weekdays. We conducted a nationwide retrospective cohort study using Taiwan's National Health Insurance Research Database. Data of newly diagnosed PEs during the months of January and February from 2001 to 2017 were obtained from patient records and classified into three admission groups: Chinese New Year (≥ 4 consecutive holiday days), weekends, and weekdays. The adjusted odds ratios (aORs) (95% confidence intervals [CIs]) for 7-day and in-hospital mortality were calculated using multivariable logistic regression models. The 7-day and in-hospital mortality risks were higher for patients admitted during the Chinese New Year holiday (10.6% and 18.7%) compared to those admitted on weekends (8.4% and 16.1%) and weekdays (6.6% and 13.8%). These higher mortality risks for holiday admissions compared to weekday admissions were confirmed by multivariable analysis (7-day mortality: aOR = 1.68, 95% CI 1.15-2.44, P = 0.007; in-hospital mortality: aOR = 1.41, 95% CI 1.05-1.90, P = 0.022), with no subgroup effects by sex or age. Hospital admission for PE over an extended holiday period, namely Chinese New Year, was associated with an increased risk of mortality.

Evaluating the Effects of Holidays on Road Crash Injuries in the United Kingdom.

BACKGROUND: Research suggests that drivers tend to engage in risk-taking behaviours on public holidays. Studies that examined the association between holidays (or other special days) and fatal injuries are inconsistent. This study used UK STATS19 data to investigate the associations of nine public holidays on road crash casualties. METHODS: This retrospective study assessed UK STATS19 crash data for 1990-2017. All casualties from two vehicle crashes were initially considered; subsequently, casualties with missing data were excluded. Multiple logistic regression was estimated to explore the associations of potential risk factors with the likelihood of killed or seriously injured (KSI) casualties and to calculate adjusted odds ratios (AORs). RESULTS: In total, 3,751,998 casualties from traffic accidents in the United Kingdom during 1990-2017 were included in the final data set; among these, 410,299 (10.9%) were KSI casualties, and 3,341,699 (89.1%) were slight injuries. Crashes on public holidays were 16% (AOR = 1.16; 95% confidence interval [CI] = 1.13-1.19) more likely to involve KSI casualties than were crashes on non-holidays. With other factors controlled for, crashes during the Queen's 2002 Golden Jubilee and on New Year's Day were 48% (AOR = 1.48; 95% CI = 1.06-2.07) and 36% (AOR = 1.36; 1.26-1.48) more likely to lead to KSIs, respectively. CONCLUSIONS: The proportion of crashes resulting in KSI casualties on public holidays was higher than that on non-holidays. Furthermore, crashes during the Queen's 2002 Golden Jubilee had the highest risk of KSI casualties followed by New Year's Day.

Do statutory holidays impact the number of opioid-related hospitalizations among Canadian adults? Findings from a national case-crossover study.

OBJECTIVE: In Canada, emergency department visits, hospitalizations, and deaths due to opioid use have risen substantially in recent years. While these events have exhibited seasonal and day of week patterns, there have been no attempts to investigate the extent to which statutory holidays influence these patterns, particularly opioid-related hospitalizations. METHODS: We applied a time-stratified case-crossover study design to investigate whether statutory holidays were predictive of opioid-related hospitalizations using the Canadian Discharge Abstract Database (excluding Quebec) for fiscal years 2011/2012 to 2016/2017. This design controls for day of week effects. We restricted analyses to opioid hospitalizations (ICD-10 codes: F11.x, T40.0-T40.4, and T40.6) among individuals 15 years and older. Conditional logistic regression models were fit to estimate the odds of opioid-related hospitalization on holidays relative to non-holidays. We examined these patterns across different holiday types, namely social gathering holidays (e.g., Canada Day) and family holidays (e.g., Christmas). Stratified analyses were done to identify whether these associations varied by age group and sex. RESULTS: We identified a total of 59,965 opioid-related hospitalizations. Overall, we found a 12% reduced odds in opioid hospitalizations on holidays (odds ratio [OR] = 0.88, 95% CI 0.83, 0.93) relative to non-holidays. Similar reductions were observed for both family (OR = 0.86, 95% CI 0.79, 0.93) and social gathering holidays (OR = 0.90, 95% CI 0.84, 0.96). No substantive differences were noted by age group or sex. CONCLUSIONS: Our findings support the hypothesis that opioid-related hospitalizations occur less frequently on statutory holidays. This knowledge may help inform healthcare resources and health promotion activities to reduce the impacts of opioid use.

RéSUMé: OBJECTIVES: Au Canada, les visites aux urgences, les hospitalisations ou les décès liés aux opioïdes ont augmenté considérablement dans les dernières années. Bien que ces événements présentent des tendances saisonnières et des tendances dépendant du jour de la semaine, aucun essai n'a été fait pour déterminer dans quelle manière les jours de fêtes influencent ces tendances, particulièrement pour les hospitalisations liées aux opioïdes. MéTHODES: Nous avons appliqué une étude cas croisés stratifiée dans le temps pour déterminer si les jours de fêtes étaient prédictifs des hospitalisations liées aux opioïdes enregistrées dans la Base de données canadienne sur les congés des patients (à l'exclusion du Québec) durant les années 2011/2012 à 2016/2017. Ce modèle d'étude contrôle pour les effets du jour de la semaine. Nous avons limité les analyses aux hospitalisations liées aux opioïdes (codes CIM-10 : F11.x, T40.0-T40.4 et T40.6) chez les personnes de 15 ans et plus. Des modèles de régression logistique conditionnelle ont été ajustés pour estimer la probabilité d'une hospitalisation liée aux opioïdes pendant les jours de fêtes par rapport aux jours non-fêtes. Nous avons ensuite examiné ces tendances pour de différents types de fêtes, par exemple les fêtes de rassemblement social (p. ex., la fête du Canada) ou les fêtes familiales (p. ex., Noël). Des analyses stratifiées ont été réalisées pour déterminer si ces associations variaient en fonction de l'âge et du sexe. RéSULTATS: Nous avons identifié un total de 59 965 hospitalisations liées aux opioïdes. Nous avons vu une réduction de 12 % des risques d'hospitalisation pendant les jours de fêtes (OR = 0,88, 95 % CI : 0,83, 0,93) par rapport aux jours non-fêtes. Des réductions similaires ont été observées pour les fêtes familiales (OR = 0,86, CI 95 % : 0,79, 0,93) et les fêtes de rassemblement social (OR = 0,90, CI 95 % : 0,84, 0,96). Aucune différence n'a été observée selon l'âge et le sexe. CONCLUSIONS: Nos résultats confirment l'hypothèse selon laquelle les hospitalisations liées aux opioïdes sont réduites durant les jours de fêtes. Ces connaissances peuvent aider à informer les ressources de soins de santé et les activités de promotion de la santé afin de réduire les impacts de l'utilisation des opioïdes.

Effects of a One-week Vacation with Various Activity Programs on Metabolism and Adipokines.

This study was conducted as part of a larger study of East Tyrolean health tourism, and investigates the effects of an active seven-day vacation on metabolic parameters and adipokines. Fifty-two healthy vacationers participated in two types of vacation activities (golf vs. Nordic walking or e-biking [nw&eb]). In the former group, 30 subjects played golf for a mean duration of 33.5 h per week; in the NW&EB group, 22 persons performed Nordic walking or e-biking for a mean duration of 14.2 h per week. Metabolic parameters and adipokines, such as leptin, adiponectin, GF-21, irisin, omentin-1, betatrophin, and resistin, were measured one day before and one day after the stay. After one week, only the NW&EB group experienced a significant decrease of 1.0 kg in body weight. Significant changes in HDL-C, FGF-21, irisin, and omentin-1 were seen in the golf group; and in triglycerides, HbA1c, leptin and adiponectin in the NW&EB group. No significant changes in betatrophin or resistin were registered in either group. A seven-day vacation with an activity program for several hours per week causes favorable changes in metabolic parameters and adipokines known to be involved in the pathophysiology of the metabolic syndrome. The changes differed in their magnitude and significance, depending on the type of activity.

Risk of preventable injuries associated with Halloween.

OBJECTIVES: The objective of this study was to investigate the potential health risks associated with Halloween festivities. STUDY DESIGN: This was a retrospective, population health study using insurance claims data between 2003-2014 representing more than 150 million unique Americans. METHODS: We analyzed the entire spectrum of external cause of injuries and quantified the relative risk associated with Halloween celebrations by comparing the observed diagnosis rate during Halloween week with its statistical expectation. We further used the closest federal holiday in October, Columbus Day, as a comparison to further corroborate the effects of Halloween. RESULTS: Our results indicate that no significant difference in relative risk for most conditions, like vehicle accidents, accidental poisoning and drowning, and adverse drug effects, during the Halloween season, when compared to the statistical expectation. However, we noticed a significant increase in the relative risk of accidental fall, self-inflicted injury, and injury inflicted by others, notably among young males. CONCLUSION: Halloween is an exciting time of year for kids, families, and the entire community. A more vigilant approach toward celebration, including attempts to prevent fights and brawls, would help everyone have a safe and harmonious Halloween.

A single holiday was the turning point of the COVID-19 policy of Israel.

OBJECTIVES: Despite an initial success, Israel's quarantine-isolation COVID-19 policy has abruptly collapsed. This study's aim is to identify the causes that led to this exponential rise in the accumulation of confirmed cases. METHODS: Epidemiological investigation reports were used to reconstruct chains of transmission as well as assess the net contribution of local infections relative to imported cases, infected travelers arriving from abroad. A mathematical model was implemented in order to describe the efficiency of the quarantine-isolation policy and the inflow of imported cases. The model's simulations included two scenarios for the actual time series of the symptomatic cases, providing insights into the conditions that lead to the abrupt change. RESULTS: The abrupt change followed a Jewish holiday, Purim, in which many public gatherings were held. According to the first scenario, the accumulation of confirmed cases before Purim was driven by imported cases resulting in a controlled regime, with an effective reproduction number, Re, of 0.69. In the second scenario, which followed Purim, a continuous rise of the local to imported cases ratio began, which led to an exponential growth regime characterized by an Re of 4.34. It was found that the change of regime cannot be attributed to super-spreader events, as these consisted of approximately 5% of the primary cases, which resulted in 17% of the secondary cases. CONCLUSIONS: A general lesson for health policymakers should be that even a short lapse in public responsiveness can lead to dire consequences.

Risk of peanut- and tree-nut-induced anaphylaxis during Halloween, Easter and other cultural holidays in Canadian children.

BACKGROUND: It is not established whether the risk of anaphylaxis induced by peanuts or tree nuts in children increases at specific times of the year. We aimed to evaluate the risk of peanut-and tree-nut-induced anaphylaxis during certain cultural holidays in Canadian children. METHODS: We collected data on confirmed pediatric cases of anaphylaxis presenting to emergency departments in 4 Canadian provinces as part of the Cross-Canada Anaphylaxis Registry. We assessed the mean number of cases per day and incidence rate ratio (IRR) of anaphylaxis induced by unknown nuts, peanuts and tree nuts presenting during each of 6 holidays (Halloween, Christmas, Easter, Diwali, Chinese New Year and Eid al-Adha) versus the rest of the year. We estimated IRRs and 95% confidence intervals (CIs) using Poisson regression. RESULTS: Data were collected for 1390 pediatric cases of anaphylaxis between 2011 and 2020. Their median age was 5.4 years, and 864 (62.2%) of the children were boys. During Halloween and Easter, there were higher rates of anaphylaxis to unknown nuts (IRR 1.66, 95% CI 1.13-2.43 and IRR 1.71, 95% CI 1.21-2.42, respectively) and peanuts (IRR 1.86, 95% CI 1.12-3.11 and IRR 1.57, 95% CI 0.94-2.63, respectively) compared to the rest of the year. No increased risk of peanut- or tree-nut-induced anaphylaxis was observed during Christmas, Diwali, Chinese New Year or Eid al-Adha. Anaphylaxis induced by unknown nuts, peanuts and tree nuts was more likely in children aged 6 years or older than in younger children. INTERPRETATION: We found an increased risk of anaphylaxis induced by unknown nuts and peanuts during Halloween and Easter among Canadian children. Educational tools are needed to increase awareness and vigilance in order to decrease the risk of anaphylaxis induced by peanuts and tree nuts in children during these holidays.

Comparisons of summer break effect on anthropometric profile, body composition and somatotype between adolescent swimmers and less active adolescents / Comparación del efecto de las vacaciones de verano en el perfil antropométrico, la composición corporal y el somatotipo entre nadadores adolescentes y adolescentes menos activos

OBJECTIVE: The aim of this study was to compare changes in anthropometric profile, body composition, and somatotype of adolescent swimmers and less active adolescents. METHOD: We selected 16 swimmers and 8 less active adolescents. The swimmers were divided based on the amount of swimming activity performed per week. A longitudinal study with repeated measures was carried out. The anthropometric profile, body composition, and somatotype were assessed before and after the summer break from swimming activity. RESULTS: Both groups of swimmers showed more changes in anthropometric profile, body composition, and somatotype than the less active adolescents. The very active swimmers showed a higher increase in the sum of the two central skinfolds than peripheral ones (p = 0.018). Both groups of swimmers had a great increase of the percent change in the sum of the two central skinfolds (medium active swimmers: p = 0.006, medium effect size = 0.72; very active swimmers: p = 0.001, medium effect size = 0.64). CONCLUSIONS: The fat component seems to be more variable than the muscular and bone component during 55 - 65 days of summer break from swimming activity. The two groups of swimmers showed a preferential accumulation of central fat after the summer break compared to the less active adolescents. The suprailiac and abdominal skinfolds could be used as early predictive measurements to assess changes in body fat

OBJETIVO: El objetivo del estudio fue comparar los cambios en el perfil antropométrico, la composición corporal y el somatotipo entre nadadores adolescentes y adolescentes sedentarios. MÉTODO: Se llevó a cabo un estudio longitudinal con medidas repetidas. Se analizó el perfil antropométrico, la composición corporal y el somatotipo antes y después del verano. Se seleccionaron 24 adolescentes: 16 nadadores y 8 sedentarios. Los nadadores se dividieron en dos grupos según los minutos de entrenamiento realizado por semana: actividad intensa = 960 minutos, actividad media = 480 minutos. RESULTADOS: Los nadadores mostraron mayores cambios en el perfil antropométrico, la composición corporal y el somatotipo respecto a los adolescentes sedentarios tras el verano. Ambos grupos de nadadores tuvieron un aumento en la suma de los dos pliegues centrales (nadadores de actividad media: p = 0.006, tamaño de efecto medio = 0.72; nadadores de actividad intensa: p = 0.001, tamaño de efecto medio = 0.64). Los nadadores de actividad intensa mostraron un aumento en la suma de los dos pliegues centrales frente a los periféricos (p = 0.018). CONCLUSIONES: En nadadores adolescentes, la grasa corporal parece ser más variable frente al componente muscular y óseo después del verano. Ambos grupos de nadadores mostraron una acumulación preferencial de grasa central después del verano frente a los adolescentes sedentarios. Los pliegues centrales podrían usarse como medidas predictivas tempranas para evaluar los cambios en la grasa corporal

Efficacy of a smartphone-based intervention - "Holidaily" - promoting recovery behaviour in workers after a vacation: study protocol for a randomised controlled trial.

BACKGROUND: While work-related rumination increases the risk of acute stressors developing into chronic load reactions and adverse health, mental detachment has been suggested as a way to interrupt this chain. Despite the importance of mentally detaching from work during leisure time, workers seem to struggle to disengage and, instead, experience the constant mental representation of work-related stressors, regardless of their absence. Those who struggle with work-related rumination could benefit from an easy-access intervention that fosters mental detachment by promoting recreational activities. Especially during vacations, workers appear to naturally engage in sufficient recovery activities; however, this beneficial behaviour is not sustained. The smartphone app-based intervention "Holidaily" promotes recovery behaviour and, thus, mental detachment from work with the intension of extending the beneficial effects of workers' vacations into their daily working life. METHODS: This randomised-controlled trial (RCT) evaluates the efficacy of "Holidaily". The Holidaily app is a German stand-alone program for mobile devices with either Android/iOS operating systems. The sample includes workers, who are awaiting to go on vacation and are randomly assigned to either the intervention (IG) or a waitlist-control group (CG). The IG receives two weeks pre-vacation access to Holidaily, while the CG receives access two weeks post-vacation. On a daily basis participants in the IG are provided with three options promoting recreational activities and beneficial recovery experiences. Online questionnaires are distributed to all participants at several timepoints. The primary outcome measure assesses participants' work-related rumination (Irritation Scale). A significant difference two weeks post-vacation is expected, favouring the IG. Secondary outcomes include symptoms of depression, insomnia severity, emotional exhaustion, thinking about work, recovery experiences, vacation specifics, work and personal characteristics. To help explain the intervention's effect, explorative analyses will investigate the mediation properties of the frequency of engaging in recreational activities and the moderation properties of Holidaily users' experiences. DISCUSSION: If successful, workers will maintain their recovery behaviour beyond their vacation into daily working life. Findings could, therefore, provide evidence for low-intensity interventions that could be very valuable from a public-health perspective. App-based interventions have greater reach; hence, more workers might access preventative tools to protect themselves from developing adverse health effects linked to work-related rumination. Further studies will still be needed to investigate whether the vacation phenomenon of "lots of fun quickly gone" can be defied and long-term benefits attained. TRIAL REGISTRATION: German Clinical Trials Registration DRKS00013650 . Registered retrospectively 15.01.2018.

Weekly, seasonal and holiday body weight fluctuation patterns among individuals engaged in a European multi-centre behavioural weight loss maintenance intervention.

BACKGROUND: Technological advances in remote monitoring offer new opportunities to quantify body weight patterns in free-living populations. This paper describes body weight fluctuation patterns in response to weekly, holiday (Christmas) and seasonal time periods in a large group of individuals engaged in a weight loss maintenance intervention. METHODS: Data was collected as part The NoHoW Project which was a pan-European weight loss maintenance trial. Three eligible groups were defined for weekly, holiday and seasonal analyses, resulting in inclusion of 1,421, 1,062 and 1,242 participants, respectively. Relative weight patterns were modelled on a time series following removal of trends and grouped by gender, country, BMI and age. RESULTS: Within-week fluctuations of 0.35% were observed, characterised by weekend weight gain and weekday reduction which differed between all groups. Over the Christmas period, weight increased by a mean 1.35% and was not fully compensated for in following months, with some differences between countries observed. Seasonal patterns were primarily characterised by the effect of Christmas weight gain and generally not different between groups. CONCLUSIONS: This evidence may improve current understanding of regular body weight fluctuation patterns and help target future weight management interventions towards periods, and in groups, where weight gain is anticipated.

The Impact of Control Measures and Holiday Seasons on Incidence and Mortality Rate of COVID-19 in Iran.

BACKGROUND: Preventive measures on the COVID-19 pandemic is an effective way to control its spread. We aimed to investigate the effect of control measures and holiday seasons on the incidence and mortality rate of COVID-19 in Iran. STUDY DESIGN: An observational study. METHODS: The daily data of confirmed new cases and deaths in Iran were taken from the Johns Hopkins University COVID-19 database. We calculated weekly data from 19 Feb to 6 Oct 2020. To estimate the impact of control measures and holiday seasons on the incidence rate of new cases and deaths, an autoregressive hidden Markov model (ARHMM) with two hidden states fitted the data. The hidden states of the fitted model can distinguish the peak period from the non-peak period. RESULTS: The control measures with a delay of one-week and two-week had a decreasing effect on the new cases in the peak and non-peak periods, respectively (P=0.005). The holiday season with a two-week delay increased the total number of new cases in the peak periods (P=0.031). The peak period for the occurrence of COVID-19 was estimated at 3 weeks. In the peak period of mortality, the control measures with a three-week delay decreased the COVID-19 mortality (P=0.010). The expected duration of staying in the peak period of mortality was around 6 weeks. CONCLUSION: When an increasing trend was seen in the country, the control measures could decline the incidence and mortality related to COVID-19. Implementation of official restrictions on holiday seasons could prevent an upward trend of incidence for COVID-19 during the peak period.

The effects of Thanksgiving, Christmas and Valentine's Day on the sex ratio at birth in the United States, 2003-2015.

INTRODUCTION: Males are born slightly in excess of females and many factors have been shown to influence M/F, the sex ratio at birth. Seasonality has also been shown to impinge on M/F. This study was carried out in order to ascertain whether Thanksgiving Day, Christmas Day and Valentine's Day had any influence on M/F in the United States population, nine months later. METHODS: Births by ethnicity, region and sex were obtained from the website of the Centres for Disease Control. Analyses were applied to seasonally adjusted time series and non-seasonally adjusted series. A seasonally adjusted indirect result was calculated for the sex ratio. RESULTS: This paper studied 53,105,069 live births for 2003-2015 (27,178,968 males, 25,926,101 females). M/F rises exceeding 90th and 95th percentiles were strongest for the seasonally adjusted series for all births in regions: South (CENS-R3), West (CENS-R4) and the time series All-regions_All-race. When comparing unadjusted and seasonally adjusted series, a similar pattern was observed in the regions Northeast and Midwest for American Indian or Alaska Native and Asian or Pacific Islander. A similar pattern was observed for the region Midwest for the ethnic group White. DISCUSSION: M/F rose above the 90th percentile in all the series and occasionally above the 95th percentile. Increased periconceptual coital rates increases M/F and this study thus lends further credence to the hypothesis that coital rates around the time of conception causally influences the sex ratio of subsequent births nine months later, possibly due to a hormonal mechanism.

Emergency department visits during the 4/20 cannabis celebration.

BACKGROUND: Annual '4/20' cannabis festivals occur around the world on April 20 and often feature synchronised consumption of cannabis at 4:20 pm. The relationship between these events and demand for emergency medical services has not been systematically studied. METHODS: We conducted a population-based retrospective cohort study in Vancouver, Canada, using 10 consecutive years of data (2009-2018) from six regional hospitals. The number of emergency department (ED) visits between 4:20 pm and 11:59 pm on April 20 were compared with the number of visits during identical time intervals on control days 1 week earlier and 1 week later (ie, April 13 and April 27) using negative binomial regression. RESULTS: A total of 3468 ED visits occurred on April 20 and 6524 ED visits occurred on control days. A non-significant increase in all-cause ED visits was observed on April 20 (adjusted relative risk: 1.06; 95% CI 1.00 to 1.12). April 20 was associated with a significant increase in ED visits among prespecified subgroups including a 5-fold increase in visits for substance misuse and a 10-fold increase in visits for intoxication. The hospital closest to the festival site experienced a clinically and statistically significant 17% (95% CI 5.1% to 29.6%) relative increase in ED visits on April 20 compared with control days. INTERPRETATION: Substance use at annual '4/20' festivals may be associated with an increase in ED visits among key subgroups and at nearby hospitals. These findings may inform harm reduction initiatives and festival medical care service planning.

Homicides during the Barranquilla Carnival, Colombia: A 10 Year Time-Series Analysis.

Homicides are currently the third leading cause of death among young adults, and an increase has been reported during holidays. The aim of the present study was to explore whether an association exists between Carnival in Barranquilla, Colombia, and an increase in homicides in the city. We used mortality records to identify the number of daily homicides of men and women throughout the week of Carnival, and we compared those with records from all of standard days between 1 January 2005 and 31 December 2015. Conditional fixed-effects models were used, stratified by time and adjusted by weather variables. The average number of homicides on Carnival days was found to be higher than on a standard day, with an OR of 2.34 (CI 95%: 1.19-4.58) for the occurrence of at least one male homicide per day during Carnival, and 1.22 (CI 95%: 1.22-7.36) for female homicides, adjusted by weather variables. The occurrence of homicides during Carnival was observed and was similar to findings for other holidays. Given that violence is a multifactorial phenomenon, the identification of the factors involved serves as a basis for evaluating whether current strategies have a positive effect on controlling it.

Health Care Use by Muslim Patients During Ramadan.

PURPOSE: Health care utilization during Ramadan has not been examined in the United States. METHODS: A retrospective review of billing and electronic health record data for Muslims (n = 2,919) and non-Muslims (n = 184,803) in primary care practices in Eastern Massachusetts. RESULTS: Muslim patients were younger, less educated, less often commercially insured, more likely to have Medicare, and less likely to be primary English speakers (p < .0001 for all comparisons). In multivariate models, during Ramadan, Muslims, compared with non-Muslims, had a higher rate of primary care visits (incidence rate ratio [IRR], 1.06; 95% confidence interval [CI], 1.01-1.11), emergency department visits (IRR, 1.60; 95% CI, 1.34-1.91), and hospitalizations (IRR, 1.18; 95% CI, 1.03-1.34). CONCLUSIONS: Important demographic differences exist between Muslim and non-Muslim patients. Muslims, compared with non-Muslims, had higher health care utilization during Ramadan.