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Importance Otitis media (OM) is a leading cause of pediatric healthcare visits and the most frequent reason children consume antibiotics or undergo surgery. During recent years, several interventions have been introduced aiming to decrease OM burden. Objective To study the trend in OM-related healthcare utilization in the United States, during the pneumococcal conjugated vaccine (PCV) era (2001-2011). Design and Participants Analysis of an insurance claims database of a large, nationwide managed healthcare plan. Enrolled children ≤6 years with OM visit(s) were identified. Outcome measures Annual OM visit rates, OM-related complications and surgical interventions. Results Overall, 7.82 million unique children (5.51 million child-years) contributed 6.21 million primary OM visits; 52% were boys, and 48% were <2 years. There was a downward trend in OM visit rates from 2004-2011, with a significant drop that coincided with the advent of PCV-13 in 2010. The observed OM visit rates in 2010 (1.00/child-year) and 2011 (0.81) were lower than the projected rates, based on the 2005-2009 trend, had there been no intervention (P<0.001). Recurrent OM (≥3 OM within 6 months look-back) rates decreased at 0.003/ child-year in 2001-2009 (95% CI=0.002-0.004) and at 0.018/child-year in 2010-2011 (0.008-0.028). In the PCV-13 pre-market years, there was stable rate ratio (RR) between OM visit rates in children aged <2 years and of those aged 2-6 years (RRs=1.38; 95% CI: 1.38-1.39); RR decreased significantly (P<0.001), during the transition year 2010 (RR=1.32; 95% CI: 1.31-1.33) and the post-market year 2011 (RR =1.01; 95%; CI: 1.00-1.02). Tympanic membrane (TM) perforation/otorrhea rates gradually increased (from 3,721/100,000 OM child-years in 2001 to 4,542 in 2011; P<0.001); the increase was significant only in the older children group. Mastoiditis rates substantially decreased (from 61/100,000 child-years in 2008 to 37 in 2011; P<0.001). Ventilating tube insertion rate decreased by 19% from 2010 to 2011 (P=0.03). Conclusions There was an overall downward trend in OM-related healthcare utilization from 2001-2011. The significant reduction in OM visit rates in 2010-2011 in children <2 years coincided with the advent of PCV-13. While TM perforation/otorrhea rates steadily increased, mastoiditis and ventilating tube insertion rates decreased in the last years of the study.

The authors interviewed 428 pathologically confirmed cases of colon cancer and controls matched on age, sex, race, and neighborhood in the New York counties containing the cities of Buffalo, Niagara Falls, and Rochester. Risk of colon cancer in both males and females, studied separately, appeared to increase with the amount of total fats and total calories ingested. In addition, we found the risk to increase with increases in the Quetelet index of relative weight (weight (kg)/height (m)2). Dietary fiber was only equivocally associated with risk. Fats and Quetelet index were associated with increased risk in a regression analysis adjusting each factor for the other, as well as for fiber, age, and socioeconomic status. The same was true for calories and Quetelet index. Future efforts to clarify a possible protective role for fiber and to disentangle the effects of fats and calories need to be undertaken. The fact that calories ingested and obesity are each associated with increased risk suggests the importance of studying calorie expenditure.

A number of epidemiological studies have suggested that diet may affect the etiology of prostate cancer, but few have investigated the impact of phytochemical intakes on this cancer. We conducted a case-control study of diet and prostate cancer in western New York involving 433 men with primary, histologically confirmed prostate cancer and 538 population-based controls, frequency matched to cases on age and county of residence. Diet was assessed with a detailed food-frequency questionnaire. We calculated daily intakes of nutrients and the phytochemicals beta-sitosterol, campesterol, stigmasterol, total phytosterols, total lignan precursors, quercetin, and kaempferol based on published food composition data. Odds ratios (ORs) and 95% confidence intervals (CIs) describing the association of prostate cancer risk with selected nutrients, phytochemicals, and food groups were estimated with unconditional logistic regression. Compared with men in the lowest quartile of intake, reduced risks were observed for men in the highest quartile of intake of vitamin C (OR = 0.49; 95% CI = 0.33-0.74), beta-carotene (OR = 0.53; 95% CI = 0.36-0.79), alpha-carotene (OR = 0.67; 95% CI = 0.47-0.97), lutein (OR = 0.55; 95% CI = 0.37-0.81), lycopene (OR = 0.62; 95% CI = 0.42-0.92), total lignan precursors (OR = 0.66; 95% CI = 0.47-0.94), quercetin (OR = 0.64; 95% CI = 0.44-0.92), and total vegetables (OR = 0.53; 95% CI = 0.36-0.79), but weak increased risks were observed for snacks and sweets (OR = 1.46; 95% CI = 0.95-2.23). Estimates associated with nutrients and phytochemicals were attenuated after adjustment for total vegetable intake. Nevertheless, our results support the hypothesis that a phytochemical-rich, plant-based diet is of importance in reducing risks of hormone-related neoplasms.

Users of intravenous bisphosphonates had an increased risk of inflammatory conditions, osteomyelitis, and surgical procedures of the jaw and facial bones. The increased risk may reflect an increased risk for osteonecrosis of the jaw.