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Stress fractures are common in military personnel and endurance athletes, and nonsteroidal anti‐inflammatory drug (NSAID) use is widespread in these populations. NSAIDs inhibit prostaglandin synthesis, which blunts the anabolic response of bone to physical activity and could therefore increase risk of stress fracture. The objective of this study was to determine whether prescribed NSAIDs were associated with stress fracture diagnoses among US Army soldiers. We also aimed to establish whether acetaminophen, an analgesic alternative to NSAIDs, was associated with stress fracture risk. A nested case‐control study was conducted using data from the Total Army Injury and Health Outcomes Database from 2002 to 2011 (n = 1,260,168). We identified soldiers with a diagnosis of stress fracture (n = 24,146) and selected 4 controls per case matched on length of military service (n = 96,584). We identified NSAID and acetaminophen prescriptions 180 to 30 days before injury (or match date). We also identified soldiers who participated in basic combat training (BCT), a 10‐week period of heightened physical activity at the onset of Army service. Among these individuals, we identified 9088 cases and 36,878 matched controls. Conditional logistic regression was used to calculate incident rate ratios (RR) for stress fracture with adjustment for sex. NSAID prescription was associated with a 2.9‐fold increase (RR = 2.9, 95% confidence interval [CI] 2.8–2.9) and acetaminophen prescription with a 2.1‐fold increase (RR = 2.1, 95% CI 2.0–2.2) in stress fracture risk within the total Army population. The risk was more than 5‐fold greater in soldiers prescribed NSAIDs (RR = 5.3, 95% CI 4.9–5.7) and more than 4‐fold greater in soldiers prescribed acetaminophen (RR = 4.4, 95% CI 3.9–4.9) during BCT. Our results reveal an association between NSAID and acetaminophen prescriptions and stress fracture risk, particularly during periods of heightened physical activity. Prospective observational studies and randomized controlled trials are needed to support these findings before clinical recommendations can be made. © 2018 American Society for Bone and Mineral Research. [ABSTRACT FROM AUTHOR]

Objective The US Army recruits new soldiers from an increasingly obese civilian population. The change in weight status at entry into the Army between 1989 and 2012 and the demographic characteristics associated with overweight/obesity at entry were examined. Methods 1,741,070 unique individuals with complete sex, age, and anthropometric information contributed data to linear and logistic regressions examining time trends and associations between demographic characteristics and overweight/obesity. Results The prevalence of overweight (body mass index 25-<30 kg/m2) generally increased, from 25.8% (1989) to 37.2% (2012), peaking at 37.9% (2011). The prevalence of obesity (body mass index ≥30 kg/m2) also increased from 5.6% (1989) to 8.0% (2012), peaking at 12.3% (2009); 2005-2009 annual prevalence exceeded 10%. The most consistent demographic characteristics predicting overweight/obesity were male sex, older age, Hispanic or Asian/Pacific Island race/ethnicity, and being married. There were no distinct geographic trends. Conclusions The US Army is not immune to the US obesity epidemic. Demographic characteristics associated with being overweight or obese should be considered when developing military-sponsored weight management programs for new soldiers. [ABSTRACT FROM AUTHOR]

Background: Ivacaftor approval was extended to people with cystic fibrosis (CF) with ≥1 of 28 additional ivacaftor-responsive mutations in the USA in 2017 based on preclinical in vitro data. This retrospective, observational study assessed real-world clinical response to ivacaftor in people with CF with ≥1 of these mutations, using data from the US Cystic Fibrosis Foundation Patient Registry., Methods: Participants aged ≥2 years with ≥1 of 28 eligible mutations initiating ivacaftor between May 2017 and December 2018 were included. Clinical outcomes data were evaluated for ≤1 year before and ≤2 years after ivacaftor initiation. Participants initiating ivacaftor between May and December 2017 (2017 cohort) were used for the primary analysis because up to 2 years of post-ivacaftor-initiation data were available. Analyses were descriptive; key outcomes included percent predicted forced expiratory volume in 1 s (ppFEV 1 ), body mass index (BMI) and BMI z-score, pulmonary exacerbations (PEx) and hospitalisations., Results: The study included 1004 eligible participants. In the 2017 cohort (n=613), mean absolute change in ppFEV 1 from pre-ivacaftor initiation was 1.9 (95% CI 1.4, 2.4) and 1.8 (95% CI 1.0, 2.7) percentage points in years 1 and 2 post-ivacaftor initiation, respectively; mean absolute change in BMI was 0.6 (95% CI 0.5, 0.7) and 1.0 (95% CI 0.8, 1.2) kg/m 2 in years 1 and 2, respectively; BMI z-score was unchanged. Annualised event rates of PEx and hospitalisations per patient-year were lower with ivacaftor (0.24 (95% CI 0.21, 0.26) and 0.28 (95% CI 0.25, 0.31), respectively) compared with pre-ivacaftor initiation (0.41 (95% CI 0.37, 0.46) and 0.45 (95% CI 0.41, 0.49), respectively)., Conclusions: These real-world observational study findings support the effectiveness of ivacaftor in people with CF aged ≥2 years with selected CFTR mutations., Competing Interests: Competing interests: CM, TT, AC and MH are employees of Vertex Pharmaceuticals and may own stock or stock options in that company., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The role of occupational stress on male fertility is understudied. We examined associations between male occupational stress and fecundability. We used data from Pregnancy Study Online (PRESTO), a North American preconception cohort study. At baseline (2013-2019), male participants aged ≥ 21 years completed a baseline questionnaire on employment status, hours worked per week, time of day worked (daytime, evening, nights, and changing or rotating shifts), and job title. We used the O*NET occupational database to rate independence by job title. Female partners were followed via bimonthly follow-up questionnaires for 12 months or until pregnancy. We restricted analyses to 1,818 couples attempting conception for ≤ 6 cycles at enrollment. We used proportional probabilities regression to estimate fecundability ratios (FRs) and 95% confidence intervals (CIs). The FR comparing unemployed with employed men was0.84 (95% CI: 0.62-1.14). Among employed men, FRs and 95% CIs for evening shift work, night shift work, and rotating shift work were 0.89 (95% CI: 0.68-1.17), 0.94 (95% CI: 0.66-1.33), and 0.91 (95% CI: 0.75-1.11) relative to daytime shift work. The FR for any nondaytime shift work was 0.91 (95% CI: 0.78-1.07). Total work hours (long or short) and job independence scores were not appreciably associated with fecundability. In conclusion, working nondaytime shifts and being unemployed were associated with slightly decreased fecundability. However, the variability in these estimates was substantial and the results were reasonably consistent with chance. Little association was observed for other occupation measures. (PsycInfo Database Record (c) 2022 APA, all rights reserved).