Spiritual Well-Being and Dyadic Adjustment: Mediator Effects for Family Strengths

PubMed Central

Ghaffari, Majid

2016-01-01

Objectives The aim of the present study was to test a structural model of hypothesized relationships between spiritual well-being, intervening variables of personal worth of self and others, commitment to relationship stability, commitment to relationship growth, positive interaction/appreciation, communication/conflict resolution, time spent together, and, the dependent variable, dyadic adjustment. Materials and Methods Two hundred and sixty eight (171 females and 97 males) married parent subjects were selected by convenience sampling from three universities in Mazandaran, Iran, to take part in this study. They were all volunteers and were not paid and their age range was 23 to 47 (31.07 ± 4.37 years). All participants were asked to complete the spiritual well-being scale (SWBS), family strengths scale (FSS) and revised dyadic adjustment scale (RDAS). Results The results from structural equation modeling confirmed a hierarchy for the development of family strengths, and indicated that spiritual well-being and strength in most characteristics affected dyadic adjustment, positively (P <0.05). Conclusions Couples’ level of dyadic adjustment is increased when they have higher spiritual well-being, value each other, have commitment to each other, communicate well, enjoy being with each other, and spend time together. PMID:27822273

A Matter of Classes: Stratifying Health Care Populations to Produce Better Estimates of Inpatient Costs

PubMed Central

Rein, David B

2005-01-01

Objective To stratify traditional risk-adjustment models by health severity classes in a way that is empirically based, is accessible to policy makers, and improves predictions of inpatient costs. Data Sources Secondary data created from the administrative claims from all 829,356 children aged 21 years and under enrolled in Georgia Medicaid in 1999. Study Design A finite mixture model was used to assign child Medicaid patients to health severity classes. These class assignments were then used to stratify both portions of a traditional two-part risk-adjustment model predicting inpatient Medicaid expenditures. Traditional model results were compared with the stratified model using actuarial statistics. Principal Findings The finite mixture model identified four classes of children: a majority healthy class and three illness classes with increasing levels of severity. Stratifying the traditional two-part risk-adjustment model by health severity classes improved its R2 from 0.17 to 0.25. The majority of additional predictive power resulted from stratifying the second part of the two-part model. Further, the preference for the stratified model was unaffected by months of patient enrollment time. Conclusions Stratifying health care populations based on measures of health severity is a powerful method to achieve more accurate cost predictions. Insurers who ignore the predictive advances of sample stratification in setting risk-adjusted premiums may create strong financial incentives for adverse selection. Finite mixture models provide an empirically based, replicable methodology for stratification that should be accessible to most health care financial managers. PMID:16033501

A Review on Methods of Risk Adjustment and their Use in Integrated Healthcare Systems

PubMed Central

Juhnke, Christin; Bethge, Susanne

2016-01-01

Introduction: Effective risk adjustment is an aspect that is more and more given weight on the background of competitive health insurance systems and vital healthcare systems. The objective of this review was to obtain an overview of existing models of risk adjustment as well as on crucial weights in risk adjustment. Moreover, the predictive performance of selected methods in international healthcare systems should be analysed. Theory and methods: A comprehensive, systematic literature review on methods of risk adjustment was conducted in terms of an encompassing, interdisciplinary examination of the related disciplines. Results: In general, several distinctions can be made: in terms of risk horizons, in terms of risk factors or in terms of the combination of indicators included. Within these, another differentiation by three levels seems reasonable: methods based on mortality risks, methods based on morbidity risks as well as those based on information on (self-reported) health status. Conclusions and discussion: After the final examination of different methods of risk adjustment it was shown that the methodology used to adjust risks varies. The models differ greatly in terms of their included morbidity indicators. The findings of this review can be used in the evaluation of integrated healthcare delivery systems and can be integrated into quality- and patient-oriented reimbursement of care providers in the design of healthcare contracts. PMID:28316544

A risk-model for hospital mortality among patients with severe sepsis or septic shock based on German national administrative claims data

PubMed Central

Fleischmann-Struzek, Carolin; Rüddel, Hendrik; Reinhart, Konrad; Thomas-Rüddel, Daniel O.

2018-01-01

Background Sepsis is a major cause of preventable deaths in hospitals. Feasible and valid methods for comparing quality of sepsis care between hospitals are needed. The aim of this study was to develop a risk-adjustment model suitable for comparing sepsis-related mortality between German hospitals. Methods We developed a risk-model using national German claims data. Since these data are available with a time-lag of 1.5 years only, the stability of the model across time was investigated. The model was derived from inpatient cases with severe sepsis or septic shock treated in 2013 using logistic regression with backward selection and generalized estimating equations to correct for clustering. It was validated among cases treated in 2015. Finally, the model development was repeated in 2015. To investigate secular changes, the risk-adjusted trajectory of mortality across the years 2010–2015 was analyzed. Results The 2013 deviation sample consisted of 113,750 cases; the 2015 validation sample consisted of 134,851 cases. The model developed in 2013 showed good validity regarding discrimination (AUC = 0.74), calibration (observed mortality in 1st and 10th risk-decile: 11%-78%), and fit (R2 = 0.16). Validity remained stable when the model was applied to 2015 (AUC = 0.74, 1st and 10th risk-decile: 10%-77%, R2 = 0.17). There was no indication of overfitting of the model. The final model developed in year 2015 contained 40 risk-factors. Between 2010 and 2015 hospital mortality in sepsis decreased from 48% to 42%. Adjusted for risk-factors the trajectory of decrease was still significant. Conclusions The risk-model shows good predictive validity and stability across time. The model is suitable to be used as an external algorithm for comparing risk-adjusted sepsis mortality among German hospitals or regions based on administrative claims data, but secular changes need to be taken into account when interpreting risk-adjusted mortality. PMID:29558486

Suitability of a three-dimensional model to measure empathy and its relationship with social and normative adjustment in Spanish adolescents: a cross-sectional study

PubMed Central

Gómez-Ortiz, Olga; Ortega-Ruiz, Rosario; Jolliffe, Darrick; Romera, Eva M.

2017-01-01

Objectives (1) To examine the psychometric properties of the Basic Empathy Scale (BES) with Spanish adolescents, comparing a two and a three-dimensional structure;(2) To analyse the relationship between the three-dimensional empathy and social and normative adjustment in school. Design Transversal and ex post facto retrospective study. Confirmatory factorial analysis, multifactorial invariance analysis and structural equations models were used. Participants 747 students (51.3% girls) from Cordoba, Spain, aged 12–17 years (M=13.8; SD=1.21). Results The original two-dimensional structure was confirmed (cognitive empathy, affective empathy), but a three-dimensional structure showed better psychometric properties, highlighting the good fit found in confirmatory factorial analysis and adequate internal consistent valued, measured with Cronbach’s alpha and McDonald’s omega. Composite reliability and average variance extracted showed better indices for a three-factor model. The research also showed evidence of measurement invariance across gender. All the factors of the final three-dimensional BES model were direct and significantly associated with social and normative adjustment, being most strongly related to cognitive empathy. Conclusions This research supports the advances in neuroscience, developmental psychology and psychopathology through a three-dimensional version of the BES, which represents an improvement in the original two-factorial model. The organisation of empathy in three factors benefits the understanding of social and normative adjustment in adolescents, in which emotional disengagement favours adjusted peer relationships. Psychoeducational interventions aimed at improving the quality of social life in schools should target these components of empathy. PMID:28951400

Birth outcomes in a disaster recovery environment: New Orleans women after Katrina

PubMed Central

Harville, Emily W.; Giarratano, Gloria; Savage, Jane; de Mendoza, Veronica Barcelona; Zotkiewicz, TrezMarie

2015-01-01

Objectives To examine how the recovery following Hurricane Katrina affected pregnancy outcomes. Methods 308 New Orleans area pregnant women were interviewed 5-7 years after Hurricane Katrina about their exposure to the disaster (danger, damage, and injury); current disruption; and perceptions of recovery. Birthweight, gestational age, birth length, and head circumference were examined in linear models, and low birthweight (<2500 g) and preterm birth (<37 weeks) in logistic models, with adjustment for confounders. Results Associations were found between experiencing damage during Katrina and birthweight (adjusted beta for high exposure = −158 g) and between injury and gestational age (adjusted beta= −0.5 days). Of the indicators of recovery experience, most consistently associated with worsened birth outcomes was worry that another hurricane would hit the region (adjusted beta for birthweight: −112 g, p=0.08; gestational age: −3.2 days, p=0.02; birth length: −0.65 cm, p=0.06) Conclusions Natural disaster may have long-term effects on pregnancy outcomes. Alternately, women who are most vulnerable to disaster may be also vulnerable to poor pregnancy outcome. PMID:26122255

Influence of adult attachment insecurities on parenting self-esteem: the mediating role of dyadic adjustment

PubMed Central

Calvo, Vincenzo; Bianco, Francesca

2015-01-01

Background: Parenting self-esteem includes two global components, parents’ self-efficacy and satisfaction with their parental role, and has a crucial role in parent–child interactions. The purpose of this study was to develop an integrative model linking adult attachment insecurities, dyadic adjustment, and parenting self-esteem. Methods: The study involved 118 pairs (236 subjects) of heterosexual parents of a firstborn child aged 0–6 years. They were administered the Experiences in Close Relationships-Revised (ECR-R) questionnaire, the Dyadic Adjustment Scale, and the Parenting Sense of Competence Scale. Results: Path analysis was used to design and test a theoretical integrative model, achieving a good fit with the data. Findings showed that dyadic adjustment mediates the negative influence on parenting self-efficacy of both attachment anxiety and attachment avoidance. Parenting satisfaction is positively influenced by parenting self-efficacy and negatively affected by child’s age. Attachment anxiety negatively influences parenting satisfaction. Conclusion: Our findings are in line with the theoretical expectations and have promising implications for future research and intervention programs designed to improve parenting self-esteem. PMID:26441811

Adjustment for reporting bias in network meta-analysis of antidepressant trials

PubMed Central

2012-01-01

Background Network meta-analysis (NMA), a generalization of conventional MA, allows for assessing the relative effectiveness of multiple interventions. Reporting bias is a major threat to the validity of MA and NMA. Numerous methods are available to assess the robustness of MA results to reporting bias. We aimed to extend such methods to NMA. Methods We introduced 2 adjustment models for Bayesian NMA. First, we extended a meta-regression model that allows the effect size to depend on its standard error. Second, we used a selection model that estimates the propensity of trial results being published and in which trials with lower propensity are weighted up in the NMA model. Both models rely on the assumption that biases are exchangeable across the network. We applied the models to 2 networks of placebo-controlled trials of 12 antidepressants, with 74 trials in the US Food and Drug Administration (FDA) database but only 51 with published results. NMA and adjustment models were used to estimate the effects of the 12 drugs relative to placebo, the 66 effect sizes for all possible pair-wise comparisons between drugs, probabilities of being the best drug and ranking of drugs. We compared the results from the 2 adjustment models applied to published data and NMAs of published data and NMAs of FDA data, considered as representing the totality of the data. Results Both adjustment models showed reduced estimated effects for the 12 drugs relative to the placebo as compared with NMA of published data. Pair-wise effect sizes between drugs, probabilities of being the best drug and ranking of drugs were modified. Estimated drug effects relative to the placebo from both adjustment models were corrected (i.e., similar to those from NMA of FDA data) for some drugs but not others, which resulted in differences in pair-wise effect sizes between drugs and ranking. Conclusions In this case study, adjustment models showed that NMA of published data was not robust to reporting bias and provided estimates closer to that of NMA of FDA data, although not optimal. The validity of such methods depends on the number of trials in the network and the assumption that conventional MAs in the network share a common mean bias mechanism. PMID:23016799

Issues in Proposing a General Model of the Effects of Divorce on Children.

ERIC Educational Resources Information Center

Kurdek, Lawrence A.

1993-01-01

Responds to previous article by Amato on children's adjustment to divorce. Focuses on two aspects of Amato's review: the mechanics of the review (perspectives advanced, criteria used to evaluate generated hypotheses, and accuracy of conclusions) and critical comments raised about the existing literature and in particular the proposed general model…

MO-C-17A-04: Forecasting Longitudinal Changes in Oropharyngeal Tumor Morphology Throughout the Course of Head and Neck Radiation Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yock, A; UT Graduate School of Biomedical Sciences, Houston, TX; Rao, A

2014-06-15

Purpose: To generate, evaluate, and compare models that predict longitudinal changes in tumor morphology throughout the course of radiation therapy. Methods: Two morphology feature vectors were used to describe the size, shape, and position of 35 oropharyngeal GTVs at each treatment fraction during intensity-modulated radiation therapy. The feature vectors comprised the coordinates of the GTV centroids and one of two shape descriptors. One shape descriptor was based on radial distances between the GTV centroid and 614 GTV surface landmarks. The other was based on a spherical harmonic decomposition of these distances. Feature vectors over the course of therapy were describedmore » using static, linear, and mean models. The error of these models in forecasting GTV morphology was evaluated with leave-one-out cross-validation, and their accuracy was compared using Wilcoxon signed-rank tests. The effect of adjusting model parameters at 1, 2, 3, or 5 time points (adjustment points) was also evaluated. Results: The addition of a single adjustment point to the static model decreased the median error in forecasting the position of GTV surface landmarks by 1.2 mm (p<0.001). Additional adjustment points further decreased forecast error by about 0.4 mm each. The linear model decreased forecast error compared to the static model for feature vectors based on both shape descriptors (0.2 mm), while the mean model did so only for those based on the inter-landmark distances (0.2 mm). The decrease in forecast error due to adding adjustment points was greater than that due to model selection. Both effects diminished with subsequent adjustment points. Conclusion: Models of tumor morphology that include information from prior patients and/or prior treatment fractions are able to predict the tumor surface at each treatment fraction during radiation therapy. The predicted tumor morphology can be compared with patient anatomy or dose distributions, opening the possibility of anticipatory re-planning. American Legion Auxiliary Fellowship; The University of Texas Graduate School of Biomedical Sciences at Houston.« less

Light-adjustable lens.

PubMed Central

Schwartz, Daniel M

2003-01-01

PURPOSE: First, to determine whether a silicone light-adjustable intraocular lens (IOL) can be fabricated and adjusted precisely with a light delivery device (LDD). Second, to determine the biocompatibility of an adjustable IOL and whether the lens can be adjusted precisely in vivo. METHODS: After fabrication of a light-adjustable silicone formulation, IOLs were made and tested in vitro for cytotoxicity, leaching, precision of adjustment, optical quality after adjustment, and mechanical properties. Light-adjustable IOLs were then tested in vivo for biocompatibility and precision of adjustment in a rabbit model. In collaboration with Zeiss-Meditec, a digital LDD was developed and tested to correct for higher-order aberrations in light-adjustable IOLs. RESULTS: The results establish that a biocompatible silicone IOL can be fabricated and adjusted using safe levels of light. There was no evidence of cytotoxicity or leaching. Testing of mechanical properties revealed no significant differences from commercial controls. Implantation of light-adjustable lenses in rabbits demonstrated- excellent biocompatibility after 6 months, comparable to a commercially available IOL. In vivo spherical (hyperopic and myopic) adjustment in rabbits was achieved using an analog light delivery system. The digital light delivery system was tested and achieved correction of higher-order aberrations. CONCLUSION: A silicone light-adjustable IOL and LDD have been developed to enable postoperative, noninvasive adjustment of lens power. The ability to correct higher-order aberrations in these materials has broad potential applicability for optimization of vision in patients undergoing cataract and refractive surgery. PMID:14971588

Case-Mix Adjusting Performance Measures in a Veteran Population: Pharmacy- and Diagnosis-Based Approaches

PubMed Central

Liu, Chuan-Fen; Sales, Anne E; Sharp, Nancy D; Fishman, Paul; Sloan, Kevin L; Todd-Stenberg, Jeff; Nichol, W Paul; Rosen, Amy K; Loveland, Susan

2003-01-01

Objective To compare the rankings for health care utilization performance measures at the facility level in a Veterans Health Administration (VHA) health care delivery network using pharmacy- and diagnosis-based case-mix adjustment measures. Data Sources/Study Setting The study included veterans who used inpatient or outpatient services in Veterans Integrated Service Network (VISN) 20 during fiscal year 1998 (October 1997 to September 1998; N=126,076). Utilization and pharmacy data were extracted from VHA national databases and the VISN 20 data warehouse. Study Design We estimated concurrent regression models using pharmacy or diagnosis information in the base year (FY1998) to predict health service utilization in the same year. Utilization measures included bed days of care for inpatient care and provider visits for outpatient care. Principal Findings Rankings of predicted utilization measures across facilities vary by case-mix adjustment measure. There is greater consistency within the diagnosis-based models than between the diagnosis- and pharmacy-based models. The eight facilities were ranked differently by the diagnosis- and pharmacy-based models. Conclusions Choice of case-mix adjustment measure affects rankings of facilities on performance measures, raising concerns about the validity of profiling practices. Differences in rankings may reflect differences in comparability of data capture across facilities between pharmacy and diagnosis data sources, and unstable estimates due to small numbers of patients in a facility. PMID:14596393

Modeled Urea Distribution Volume and Mortality in the HEMO Study

PubMed Central

Greene, Tom; Depner, Thomas A.; Levin, Nathan W.; Chertow, Glenn M.

2011-01-01

Summary Background and objectives In the Hemodialysis (HEMO) Study, observed small decreases in achieved equilibrated Kt/Vurea were noncausally associated with markedly increased mortality. Here we examine the association of mortality with modeled volume (Vm), the denominator of equilibrated Kt/Vurea. Design, setting, participants, & measurements Parameters derived from modeled urea kinetics (including Vm) and blood pressure (BP) were obtained monthly in 1846 patients. Case mix–adjusted time-dependent Cox regressions were used to relate the relative mortality hazard at each time point to Vm and to the change in Vm over the preceding 6 months. Mixed effects models were used to relate Vm to changes in intradialytic systolic BP and to other factors at each follow-up visit. Results Mortality was associated with Vm and change in Vm over the preceding 6 months. The association between change in Vm and mortality was independent of vascular access complications. In contrast, mortality was inversely associated with V calculated from anthropometric measurements (Vant). In case mix–adjusted analysis using Vm as a time-dependent covariate, the association of mortality with Vm strengthened after statistical adjustment for Vant. After adjustment for Vant, higher Vm was associated with slightly smaller reductions in intradialytic systolic BP and with risk factors for mortality including recent hospitalization and reductions in serum albumin concentration and body weight. Conclusions An increase in Vm is a marker for illness and mortality risk in hemodialysis patients. PMID:21511841

A comparison of administrative and physiologic predictive models in determining risk adjusted mortality rates in critically ill patients.

PubMed

Enfield, Kyle B; Schafer, Katherine; Zlupko, Mike; Herasevich, Vitaly; Novicoff, Wendy M; Gajic, Ognjen; Hoke, Tracey R; Truwit, Jonathon D

2012-01-01

Hospitals are increasingly compared based on clinical outcomes adjusted for severity of illness. Multiple methods exist to adjust for differences between patients. The challenge for consumers of this information, both the public and healthcare providers, is interpreting differences in risk adjustment models particularly when models differ in their use of administrative and physiologic data. We set to examine how administrative and physiologic models compare to each when applied to critically ill patients. We prospectively abstracted variables for a physiologic and administrative model of mortality from two intensive care units in the United States. Predicted mortality was compared through the Pearsons Product coefficient and Bland-Altman analysis. A subgroup of patients admitted directly from the emergency department was analyzed to remove potential confounding changes in condition prior to ICU admission. We included 556 patients from two academic medical centers in this analysis. The administrative model and physiologic models predicted mortalities for the combined cohort were 15.3% (95% CI 13.7%, 16.8%) and 24.6% (95% CI 22.7%, 26.5%) (t-test p-value<0.001). The r(2) for these models was 0.297. The Bland-Atlman plot suggests that at low predicted mortality there was good agreement; however, as mortality increased the models diverged. Similar results were found when analyzing a subgroup of patients admitted directly from the emergency department. When comparing the two hospitals, there was a statistical difference when using the administrative model but not the physiologic model. Unexplained mortality, defined as those patients who died who had a predicted mortality less than 10%, was a rare event by either model. In conclusion, while it has been shown that administrative models provide estimates of mortality that are similar to physiologic models in non-critically ill patients with pneumonia, our results suggest this finding can not be applied globally to patients admitted to intensive care units. As patients and providers increasingly use publicly reported information in making health care decisions and referrals, it is critical that the provided information be understood. Our results suggest that severity of illness may influence the mortality index in administrative models. We suggest that when interpreting "report cards" or metrics, health care providers determine how the risk adjustment was made and compares to other risk adjustment models.

A concordance-based study to assess doctors’ and nurses’ mental models in Internal Medicine

PubMed Central

Chan, K. C. Gary; Muller-Juge, Virginie; Cullati, Stéphane; Hudelson, Patricia; Maître, Fabienne; Vu, Nu V.; Savoldelli, Georges L.; Nendaz, Mathieu R.

2017-01-01

Interprofessional collaboration between doctors and nurses is based on team mental models, in particular for each professional’s roles. Our objective was to identify factors influencing concordance on the expectations of doctors’ and nurses’ roles and responsibilities in an Internal Medicine ward. Using a dataset of 196 doctor-nurse pairs (14x14 = 196), we analyzed choices and prioritized management actions of 14 doctors and 14 nurses in six clinical nurse role scenarios, and in five doctor role scenarios (6 options per scenario). In logistic regression models with a non-nested correlation structure, we evaluated concordance among doctors and nurses, and adjusted for potential confounders (including prior experience in Internal Medicine, acuteness of case and gender). Concordance was associated with number of female professionals (adjusted OR 1.32, 95% CI 1.02 to 1.73), for acute situations (adjusted OR 2.02, 95% CI 1.13 to 3.62), and in doctor role scenarios (adjusted OR 2.19, 95% CI 1.32 to 3.65). Prior experience and country of training were not significant predictors of concordance. In conclusion, our concordance-based approach helped us identify areas of lower concordance in expected doctor-nurse roles and responsibilities, particularly in non-acute situations, which can be targeted by future interprofessional, educational interventions. PMID:28792524

Formulation of Efficient Finite Element Prediction Models.

DTIC Science & Technology

1980-01-01

vorticity-divergence FEM formulation. This paper will compare these FEM formulations by considering the Vgeostrophic adjustment process with the linearized...by Fourier transforming the terms that are independent of t in (2.12)-(2.14) or (2.19)-(2.21). However, in this paper the final state will be...filtering in a baroclinic primitive equation model. 17 L . , 5. Conclusions The objective of this paper is to determine the response of various finite

Benchmarking antibiotic use in Finnish acute care hospitals using patient case-mix adjustment.

PubMed

Kanerva, Mari; Ollgren, Jukka; Lyytikäinen, Outi

2011-11-01

It is difficult to draw conclusions about the prudence of antibiotic use in different hospitals by directly comparing usage figures. We present a patient case-mix adjustment model of antibiotic use to rank hospitals while taking patient characteristics into account. Data on antibiotic use were collected during the national healthcare-associated infection (HAI) prevalence survey in 2005 in Finland in all 5 tertiary care, all 15 secondary care and 10 (25% of 40) other acute care hospitals. The use of antibiotics was measured using use-days/100 patient-days during a 7day period and the prevalence of patients receiving at least two antimicrobials during the study day. Case-mix-adjusted antibiotic use was calculated by using multivariate models and an indirect standardization method. Parameters in the model included age, sex, severity of underlying diseases, intensive care, haematology, preceding surgery, respirator, central venous and urinary catheters, community-associated infection, HAI and contact isolation due to methicillin-resistant Staphylococcus aureus. The ranking order changed one position in 12 (40%) hospitals and more than two positions in 13 (43%) hospitals when the case-mix-adjusted figures were compared with those observed. In 24 hospitals (80%), the antibiotic use density observed was lower than expected by the case-mix-adjusted use density. The patient case-mix adjustment of antibiotic use ranked the hospitals differently from the ranking according to observed use, and may be a useful tool for benchmarking hospital antibiotic use. However, the best set of easily and widely available parameters that would describe both patient material and hospital activities remains to be determined.

Magnesium intake, plasma C-peptide, and colorectal cancer incidence in US women: a 28-year follow-up study

PubMed Central

Zhang, X; Giovannucci, E L; Wu, K; Smith-Warner, S A; Fuchs, C S; Pollak, M; Willett, W C; Ma, J

2012-01-01

Background: Laboratory studies suggest a possible role of magnesium intake in colorectal carcinogenesis but epidemiological evidence is inconclusive. Method: We tested magnesium–colorectal cancer hypothesis in the Nurses' Health Study, in which 85 924 women free of cancer in 1980 were followed until June 2008. Cox proportional hazards regression models were used to estimate multivariable relative risks (MV RRs, 95% confidence intervals). Results: In the age-adjusted model, magnesium intake was significantly inversely associated with colorectal cancer risk; the RRs from lowest to highest decile of total magnesium intake were 1.0 (ref), 0.93, 0.81, 0.72, 0.74, 0.77, 0.72, 0.75, 0.80, and 0.67 (Ptrend<0.001). However, in the MV model adjusted for known dietary and non-dietary risk factors for colorectal cancer, the association was significantly attenuated; the MV RRs were 1.0 (ref), 0.96, 0.85, 0.78, 0.82, 0.86, 0.84, 0.91, 1.02, and 0.93 (Ptrend=0.77). Similarly, magnesium intakes were significantly inversely associated with concentrations of plasma C-peptide in age-adjusted model (Ptrend=0.002) but not in multivariate-adjusted model (Ptrend=0.61). Results did not differ by subsite or modified by calcium intakes or body mass index. Conclusion: These prospective results do not support an independent association of magnesium intake with either colorectal cancer risk or plasma C-peptide levels in women. PMID:22415230

An Innovate Robotic Endoscope Guidance System for Transnasal Sinus and Skull Base Surgery: Proof of Concept.

PubMed

Friedrich, D T; Sommer, F; Scheithauer, M O; Greve, J; Hoffmann, T K; Schuler, P J

2017-12-01

Objective  Advanced transnasal sinus and skull base surgery remains a challenging discipline for head and neck surgeons. Restricted access and space for instrumentation can impede advanced interventions. Thus, we present the combination of an innovative robotic endoscope guidance system and a specific endoscope with adjustable viewing angle to facilitate transnasal surgery in a human cadaver model. Materials and Methods  The applicability of the robotic endoscope guidance system with custom foot pedal controller was tested for advanced transnasal surgery on a fresh frozen human cadaver head. Visualization was enabled using a commercially available endoscope with adjustable viewing angle (15-90 degrees). Results  Visualization and instrumentation of all paranasal sinuses, including the anterior and middle skull base, were feasible with the presented setup. Controlling the robotic endoscope guidance system was effectively precise, and the adjustable endoscope lens extended the view in the surgical field without the common change of fixed viewing angle endoscopes. Conclusion  The combination of a robotic endoscope guidance system and an advanced endoscope with adjustable viewing angle enables bimanual surgery in transnasal interventions of the paranasal sinuses and the anterior skull base in a human cadaver model. The adjustable lens allows for the abandonment of fixed-angle endoscopes, saving time and resources, without reducing the quality of imaging.

Cognitive ability and risk of post-traumatic stress disorder after military deployment: an observational cohort study

PubMed Central

Karstoft, Karen-Inge; Vedtofte, Mia S.; Nielsen, Anni B.S.; Osler, Merete; Mortensen, Erik L.; Christensen, Gunhild T.; Andersen, Søren B.

2017-01-01

Background Studies of the association between pre-deployment cognitive ability and post-deployment post-traumatic stress disorder (PTSD) have shown mixed results. Aims To study the influence of pre-deployment cognitive ability on PTSD symptoms 6–8 months post-deployment in a large population while controlling for pre-deployment education and deployment-related variables. Method Study linking prospective pre-deployment conscription board data with post-deployment self-reported data in 9695 Danish Army personnel deployed to different war zones in 1997–2013. The association between pre-deployment cognitive ability and post-deployment PTSD was investigated using repeated-measure logistic regression models. Two models with cognitive ability score as the main exposure variable were created (model 1 and model 2). Model 1 was only adjusted for pre-deployment variables, while model 2 was adjusted for both pre-deployment and deployment-related variables. Results When including only variables recorded pre-deployment (cognitive ability score and educational level) and gender (model 1), all variables predicted post-deployment PTSD. When deployment-related variables were added (model 2), this was no longer the case for cognitive ability score. However, when educational level was removed from the model adjusted for deployment-related variables, the association between cognitive ability and post-deployment PTSD became significant. Conclusions Pre-deployment lower cognitive ability did not predict post-deployment PTSD independently of educational level after adjustment for deployment-related variables. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license. PMID:29163983

An international age- and gender-controlled model for the Spinal Cord Injury Ability Realization Measurement Index (SCI-ARMI).

PubMed

Scivoletto, Giorgio; Glass, Clive; Anderson, Kim D; Galili, Tal; Benjamin, Yoav; Front, Lilach; Aidinoff, Elena; Bluvshtein, Vadim; Itzkovich, Malka; Aito, Sergio; Baroncini, Ilaria; Benito-Penalva, Jesùs; Castellano, Simona; Osman, Aheed; Silva, Pedro; Catz, Amiram

2015-01-01

Background. A quadratic formula of the Spinal Cord Injury Ability Realization Measurement Index (SCI-ARMI) has previously been published. This formula was based on a model of Spinal Cord Independence Measure (SCIM95), the 95th percentile of the SCIM III values, which correspond with the American Spinal Injury Association Motor Scores (AMS) of SCI patients. Objective. To further develop the original formula. Setting. Spinal cord injury centers from 6 countries and the Statistical Laboratory, Tel-Aviv University, Israel. Methods. SCIM95 of 661 SCI patients was modeled, using a quantile regression with or without adjustment for age and gender, to calculate SCI-ARMI values. SCI-ARMI gain during rehabilitation and its correlations were examined. Results. A new quadratic SCIM95 model was created. This resembled the previously published model, which yielded similar SCIM95 values in all the countries, after adjustment for age and gender. Without this adjustment, however, only 86% of the non-Israeli SCIM III observations were lower than those SCIM95 values (P < .0001). Adding the variables age and gender to the new model affected the SCIM95 value significantly (P < .04). Adding country information did not add a significant effect (P > .1). SCI-ARMI gain was positive (38.8 ± 22 points, P < .0001) and correlated weakly with admission age and AMS. Conclusions. The original quadratic SCI-ARMI formula is valid for an international population after adjustment for age and gender. The new formula considers more factors that affect functional ability following SCI. © The Author(s) 2014.

Quality Reporting of Multivariable Regression Models in Observational Studies: Review of a Representative Sample of Articles Published in Biomedical Journals.

PubMed

Real, Jordi; Forné, Carles; Roso-Llorach, Albert; Martínez-Sánchez, Jose M

2016-05-01

Controlling for confounders is a crucial step in analytical observational studies, and multivariable models are widely used as statistical adjustment techniques. However, the validation of the assumptions of the multivariable regression models (MRMs) should be made clear in scientific reporting. The objective of this study is to review the quality of statistical reporting of the most commonly used MRMs (logistic, linear, and Cox regression) that were applied in analytical observational studies published between 2003 and 2014 by journals indexed in MEDLINE.Review of a representative sample of articles indexed in MEDLINE (n = 428) with observational design and use of MRMs (logistic, linear, and Cox regression). We assessed the quality of reporting about: model assumptions and goodness-of-fit, interactions, sensitivity analysis, crude and adjusted effect estimate, and specification of more than 1 adjusted model.The tests of underlying assumptions or goodness-of-fit of the MRMs used were described in 26.2% (95% CI: 22.0-30.3) of the articles and 18.5% (95% CI: 14.8-22.1) reported the interaction analysis. Reporting of all items assessed was higher in articles published in journals with a higher impact factor.A low percentage of articles indexed in MEDLINE that used multivariable techniques provided information demonstrating rigorous application of the model selected as an adjustment method. Given the importance of these methods to the final results and conclusions of observational studies, greater rigor is required in reporting the use of MRMs in the scientific literature.

Parental bonding in males with adjustment disorder and hyperventilation syndrome

PubMed Central

2012-01-01

Background The purpose of the study was to identify the style of parental bonding and the personality characteristics that might increase the risk of hyperventilation and adjustment disorder. Methods A total of 917 males were recruited, 156 with adjustment disorder and hyperventilation syndrome (AD + HY), 273 with adjustment disorder without hyperventilation syndrome (AD–HY), and 488 healthy controls. All participants completed the Parental Bonding Instrument, Eysenck Personality Questionnaire, and Chinese Health Questionnaire. Results Analysis using structural equation models identified a pathway relationship in which parental bonding affected personality characteristics, personality characteristics affected mental health condition, and mental health condition affected the development of hyperventilation or adjustment disorder. Males with AD–HY perceived less paternal care, and those with AD + HY perceived more maternal protection than those with adjustment disorder and those in the control group. Participants with AD–HY were more neurotic and less extroverted than those with AD + HY. Both groups showed poorer mental health than the controls. Conclusions Although some patients with hyperventilation syndrome demonstrated symptoms of adjustment disorder, there were different predisposing factors between the two groups in terms of parental bonding and personality characteristics. This finding is important for the early intervention and prevention of hyperventilation and adjustment disorder. PMID:22672223

Through the Lens of Culture: Quality of Life Among Latina Breast Cancer Survivors

PubMed Central

Graves, Kristi D.; Jensen, Roxanne E.; Cañar, Janet; Perret-Gentil, Monique; Leventhal, Kara-Grace; Gonzalez, Florencia; Caicedo, Larisa; Jandorf, Lina; Kelly, Scott; Mandelblatt, Jeanne

2012-01-01

BACKGROUND Latinas have lower quality of life than Caucasian cancer survivors but we know little about factors associated with quality of life in this growing population. METHODS Bilingual staff conducted interviews with a national cross-sectional sample of 264 Latina breast cancer survivors. Quality of life was measured using the Functional Assessment of Cancer Therapy-Breast (FACT-B). Regression models evaluated associations between culture, social and medical context and overall quality of life and its subdomains. RESULTS Latina survivors were 1-5 years post-diagnosis and reported a lower mean quality of life score compared to other published reports of non-Latina survivors (M=105; SD=19.4 on the FACT-B). Culturally-based feelings of breast cancer-related stigma and shame were consistently related to lower overall quality of life and lower well-being in each quality of life domain. Social and medical contextual factors were independently related to quality of life; together cultural, social and medical context factors uniquely accounted for 62% of the explained model variance of overall quality of life (Adjusted R2=0.53, P<.001). Similar relationships were seen for quality of life subdomains in which cultural, social and medical contextual variables independently contributed to the overall variance of each final model: physical well-being (Adjusted R2=0.23, P <.001), social well-being (Adjusted R2=0.51, P<.001), emotional well-being (Adjusted R2=0.28, P<.001), functional well-being (Adjusted R2=0.41, P<.001) and additional breast concerns (Adjusted R2=0.40, P<.001). CONCLUSIONS Efforts to improve Latinas’ survivorship experiences should consider cultural, social and medical contextual factors to close existing quality of life gaps between Latinas and other survivors. PMID:23085764

Household Debt and Relation to Intimate Partner Violence and Husbands' Attitudes Toward Gender Norms: A Study Among Young Married Couples in Rural Maharashtra, India

PubMed Central

Donta, Balaiah; Dasgupta, Anindita; Ghule, Mohan; Battala, Madhusudana; Nair, Saritha; Silverman, Jay G.; Jadhav, Arun; Palaye, Prajakta; Saggurti, Niranjan; Raj, Anita

2015-01-01

Objective Evidence has linked economic hardship with increased intimate partner violence (IPV) perpetration among males. However, less is known about how economic debt or gender norms related to men's roles in relationships or the household, which often underlie IPV perpetration, intersect in or may explain these associations. We assessed the intersection of economic debt, attitudes toward gender norms, and IPV perpetration among married men in India. Methods Data were from the evaluation of a family planning intervention among young married couples (n=1,081) in rural Maharashtra, India. Crude and adjusted logistic regression models for dichotomous outcome variables and linear regression models for continuous outcomes were used to examine debt in relation to husbands' attitudes toward gender-based norms (i.e., beliefs supporting IPV and beliefs regarding male dominance in relationships and the household), as well as sexual and physical IPV perpetration. Results Twenty percent of husbands reported debt. In adjusted linear regression models, debt was associated with husbands' attitudes supportive of IPV (b=0.015, p=0.004) and norms supporting male dominance in relationships and the household (b=0.006, p=0.003). In logistic regression models adjusted for relevant demographics, debt was associated with perpetration of physical IPV (adjusted odds ratio [AOR] = 1.4, 95% confidence interval [CI] 1.1, 1.9) and sexual IPV (AOR=1.6, 95% CI 1.1, 2.1) from husbands. These findings related to debt and relation to IPV were slightly attenuated when further adjusted for men's attitudes toward gender norms. Conclusion Findings suggest the need for combined gender equity and economic promotion interventions to address high levels of debt and related IPV reported among married couples in rural India. PMID:26556938

Living Near Major Traffic Roads and Risk of Deep Vein Thrombosis

PubMed Central

Baccarelli, Andrea; Martinelli, Ida; Pegoraro, Valeria; Melly, Steven; Grillo, Paolo; Zanobetti, Antonella; Hou, Lifang; Bertazzi, Pier Alberto; Mannucci, Pier Mannuccio; Schwartz, Joel

2010-01-01

Background Particulate air pollution has been consistently linked to increased risk of arterial cardiovascular disease. Few data on air pollution exposure and risk of venous thrombosis are available. We investigated whether living near major traffic roads increases the risk of deep vein thrombosis (DVT), using distance from roads as a proxy for traffic exposure. Methods and Results Between 1995-2005, we examined 663 patients with DVT of the lower limbs and 859 age-matched controls from cities with population>15,000 inhabitants in Lombardia Region, Italy. We assessed distance from residential addresses to the nearest major traffic road using geographic information system methodology. The risk of DVT was estimated from logistic regression models adjusting for multiple clinical and environmental covariates. The risk of DVT was increased (Odds Ratio [OR]=1.33; 95% CI 1.03-1.71; p=0.03 in age-adjusted models; OR=1.47; 95%CI 1.10-1.96; p=0.008 in models adjusted for multiple covariates) for subjects living near a major traffic road (3 meters, 10th centile of the distance distribution) compared to those living farther away (reference distance of 245 meters, 90th centile). The increase in DVT risk was approximately linear over the observed distance range (from 718 to 0 meters), and was not modified after adjusting for background levels of particulate matter (OR=1.47; 95%CI 1.11-1.96; p=0.008 for 10th vs. 90th distance centile in models adjusting for area levels of particulate matter <10 μm in aerodynamic diameter [PM10] in the year before diagnosis). Conclusions Living near major traffic roads is associated with increased risk of DVT. PMID:19506111

Analysis of Observational Studies in the Presence of Treatment Selection Bias: Effects of Invasive Cardiac Management on AMI Survival Using Propensity Score and Instrumental Variable Methods

PubMed Central

Stukel, Thérèse A.; Fisher, Elliott S; Wennberg, David E.; Alter, David A.; Gottlieb, Daniel J.; Vermeulen, Marian J.

2007-01-01

Context Comparisons of outcomes between patients treated and untreated in observational studies may be biased due to differences in patient prognosis between groups, often because of unobserved treatment selection biases. Objective To compare 4 analytic methods for removing the effects of selection bias in observational studies: multivariable model risk adjustment, propensity score risk adjustment, propensity-based matching, and instrumental variable analysis. Design, Setting, and Patients A national cohort of 122 124 patients who were elderly (aged 65–84 years), receiving Medicare, and hospitalized with acute myocardial infarction (AMI) in 1994–1995, and who were eligible for cardiac catheterization. Baseline chart reviews were taken from the Cooperative Cardiovascular Project and linked to Medicare health administrative data to provide a rich set of prognostic variables. Patients were followed up for 7 years through December 31, 2001, to assess the association between long-term survival and cardiac catheterization within 30 days of hospital admission. Main Outcome Measure Risk-adjusted relative mortality rate using each of the analytic methods. Results Patients who received cardiac catheterization (n=73 238) were younger and had lower AMI severity than those who did not. After adjustment for prognostic factors by using standard statistical risk-adjustment methods, cardiac catheterization was associated with a 50% relative decrease in mortality (for multivariable model risk adjustment: adjusted relative risk [RR], 0.51; 95% confidence interval [CI], 0.50–0.52; for propensity score risk adjustment: adjusted RR, 0.54; 95% CI, 0.53–0.55; and for propensity-based matching: adjusted RR, 0.54; 95% CI, 0.52–0.56). Using regional catheterization rate as an instrument, instrumental variable analysis showed a 16% relative decrease in mortality (adjusted RR, 0.84; 95% CI, 0.79–0.90). The survival benefits of routine invasive care from randomized clinical trials are between 8% and 21 %. Conclusions Estimates of the observational association of cardiac catheterization with long-term AMI mortality are highly sensitive to analytic method. All standard risk-adjustment methods have the same limitations regarding removal of unmeasured treatment selection biases. Compared with standard modeling, instrumental variable analysis may produce less biased estimates of treatment effects, but is more suited to answering policy questions than specific clinical questions. PMID:17227979

An Analysis of the Effects of RFID Tags on Narrowband Navigation and Communication Receivers

NASA Technical Reports Server (NTRS)

LaBerge, E. F. Charles

2007-01-01

The simulated effects of the Radio Frequency Identification (RFID) tag emissions on ILS Localizer and ILS Glide Slope functions match the analytical models developed in support of DO-294B provided that the measured peak power levels are adjusted for 1) peak-to-average power ratio, 2) effective duty cycle, and 3) spectrum analyzer measurement bandwidth. When these adjustments are made, simulated and theoretical results are in extraordinarily good agreement. The relationships hold over a large range of potential interference-to-desired signal power ratios, provided that the adjusted interference power is significantly higher than the sum of the receiver noise floor and the noise-like contributions of all other interference sources. When the duty-factor adjusted power spectral densities are applied in the evaluation process described in Section 6 of DO-294B, most narrowband guidance and communications radios performance parameters are unaffected by moderate levels of RFID interference. Specific conclusions and recommendations are provided.

Worldwide impact of economic cycles on suicide trends over 3 decades: differences according to level of development. A mixed effect model study

PubMed Central

Perez-Rodriguez, M Mercedes; Garcia-Nieto, Rebeca; Fernandez-Navarro, Pablo; Galfalvy, Hanga; de Leon, Jose; Baca-Garcia, Enrique

2012-01-01

Objectives To investigate the trends and correlations of gross domestic product (GDP) adjusted for purchasing power parity (PPP) per capita on suicide rates in 10 WHO regions during the past 30 years. Design Analyses of databases of PPP-adjusted GDP per capita and suicide rates. Countries were grouped according to the Global Burden of Disease regional classification system. Data sources World Bank's official website and WHO's mortality database. Statistical analyses After graphically displaying PPP-adjusted GDP per capita and suicide rates, mixed effect models were used for representing and analysing clustered data. Results Three different groups of countries, based on the correlation between the PPP-adjusted GDP per capita and suicide rates, are reported: (1) positive correlation: developing (lower middle and upper middle income) Latin-American and Caribbean countries, developing countries in the South East Asian Region including India, some countries in the Western Pacific Region (such as China and South Korea) and high-income Asian countries, including Japan; (2) negative correlation: high-income and developing European countries, Canada, Australia and New Zealand and (3) no correlation was found in an African country. Conclusions PPP-adjusted GDP per capita may offer a simple measure for designing the type of preventive interventions aimed at lowering suicide rates that can be used across countries. Public health interventions might be more suitable for developing countries. In high-income countries, however, preventive measures based on the medical model might prove more useful. PMID:22586285

Adjustment Disorders as a Stress-Related Disorder: A Longitudinal Study of the Associations among Stress, Resources, and Mental Health

PubMed Central

Kocalevent, Rüya-Daniela; Mierke, Annett; Danzer, Gerhard; Klapp, Burghard F.

2014-01-01

Objective Adjustment disorders are re-conceptualized in the DSM-5 as a stress-related disorder; however, besides the impact of an identifiable stressor, the specification of a stress concept, remains unclear. This study is the first to examine an existing stress-model from the general population, in patients diagnosed with adjustment disorders, using a longitudinal design. Methods The study sample consisted of 108 patients consecutively admitted for adjustment disorders. Associations of stress perception, emotional distress, resources, and mental health were measured at three time points: the outpatients’ presentation, admission for inpatient treatment, and discharge from the hospital. To evaluate a longitudinal stress model of ADs, we examined whether stress at admission predicted mental health at each of the three time points using multiple linear regressions and structural equation modeling. A series of repeated-measures one-way analyses of variance (rANOVAs) was performed to assess change over time. Results Significant within-participant changes from baseline were observed between hospital admission and discharge with regard to mental health, stress perception, and emotional distress (p<0.001). Stress perception explained nearly half of the total variance (44%) of mental health at baseline; the adjusted R2 increased (0.48), taking emotional distress (i.e., depressive symptoms) into account. The best predictor of mental health at discharge was the level of emotional distress (i.e., anxiety level) at baseline (β = −0.23, R2 corr = 0.56, p<0.001). With a CFI of 0.86 and an NFI of 0.86, the fit indices did not allow for acceptance of the stress-model (Cmin/df = 15.26; RMSEA = 0.21). Conclusions Stress perception is an important predictor in adjustment disorders, and mental health-related treatment goals are dependent on and significantly impacted by stress perception and emotional distress. PMID:24825165

Health risk factors as predictors of workers' compensation claim occurrence and cost

PubMed Central

Schwatka, Natalie V; Atherly, Adam; Dally, Miranda J; Fang, Hai; vS Brockbank, Claire; Tenney, Liliana; Goetzel, Ron Z; Jinnett, Kimberly; Witter, Roxana; Reynolds, Stephen; McMillen, James; Newman, Lee S

2017-01-01

Objective The objective of this study was to examine the predictive relationships between employee health risk factors (HRFs) and workers' compensation (WC) claim occurrence and costs. Methods Logistic regression and generalised linear models were used to estimate the predictive association between HRFs and claim occurrence and cost among a cohort of 16 926 employees from 314 large, medium and small businesses across multiple industries. First, unadjusted (HRFs only) models were estimated, and second, adjusted (HRFs plus demographic and work organisation variables) were estimated. Results Unadjusted models demonstrated that several HRFs were predictive of WC claim occurrence and cost. After adjusting for demographic and work organisation differences between employees, many of the relationships previously established did not achieve statistical significance. Stress was the only HRF to display a consistent relationship with claim occurrence, though the type of stress mattered. Stress at work was marginally predictive of a higher odds of incurring a WC claim (p<0.10). Stress at home and stress over finances were predictive of higher and lower costs of claims, respectively (p<0.05). Conclusions The unadjusted model results indicate that HRFs are predictive of future WC claims. However, the disparate findings between unadjusted and adjusted models indicate that future research is needed to examine the multilevel relationship between employee demographics, organisational factors, HRFs and WC claims. PMID:27530688

Understanding the Low Level of Cervical Cancer Screening in Masaka Uganda Using the ASE Model: A Community-Based Survey.

PubMed

Twinomujuni, Cyprian; Nuwaha, Fred; Babirye, Juliet Ndimwibo

2015-01-01

Cervical cancer is one of the leading causes of cancer deaths among women globally and its impact is mostly felt in developing countries like Uganda where its prevalence is higher and utilization of cancer screening services is low. This study aimed to identify factors associated with intention to screen for cervical cancer among women of reproductive age in Masaka Uganda using the attitude, social influence and self efficacy (ASE) model. A descriptive community based survey was conducted among 416 women. A semi-structured interviewer administered questionnaire was used to collect data. Unadjusted and adjusted prevalence ratios (PR) were computed using a generalized linear model with Poisson family and a log link using STATA 12. Only 7% (29/416) of our study respondents had ever screened for cervical cancer although a higher proportion (63%, 262/416) reported intention to screen for cervical cancer. The intention to screen for cervical cancer was higher among those who said they were at risk of developing cervical cancer (Adjusted prevalence ratio [PR] 2.0, 95% CI 1.60-2.58), those who said they would refer other women for screening (Adjusted PR 1.4, 95% CI 1.06-1.88) and higher among those who were unafraid of being diagnosed with cervical cancer (Adjusted PR 1.6, 95% CI 1.36-1.93). Those who reported discussions on cervical cancer with health care providers (Adjusted PR 1.2, 95% CI 1.05-1.44), those living with a sexual partner (Adjusted PR 1.4, 95% CI 1.11-1.68), and those who were formally employed (Adjusted PR 1.2, 95% CI 1.03-1.35) more frequently reported intention to screen for cervical cancer. In conclusion, health education to increase risk perception, improve women's attitudes towards screening for cervical cancer and address the fears held by the women would increase intention to screen for cervical cancer. Interventions should also target increased discussions with health workers.

Parental Psychological Control and Adolescent Adjustment: The Role of Adolescent Emotion Regulation

PubMed Central

Cui, Lixian; Morris, Amanda Sheffield; Criss, Michael M.; Houltberg, Benjamin J.; Silk, Jennifer S.

2014-01-01

SYNOPSIS Objective This study investigated associations between parental psychological control and aggressive behavior and depressive symptoms among adolescents from predominantly disadvantaged backgrounds. The indirect effects of psychological control on adolescent adjustment through adolescent emotion regulation (anger and sadness regulation) were examined as well as the moderating effects of adolescent emotion regulation. Design 206 adolescents (ages 10–18) reported on parental psychological control and their own depressive symptoms, and parents and adolescents reported on adolescent emotion regulation and aggressive behavior. Indirect effect models were tested using structural equation modeling; moderating effects were tested using hierarchical multiple regression. Results The associations between parental psychological control and adolescent aggressive behavior and depressive symptoms were indirect through adolescents’ anger regulation. Moderation analyses indicated that the association between parental psychological control and adolescent depressive symptoms was stronger among adolescents with poor sadness regulation and the association between psychological control and aggressive behavior was stronger among older adolescents with poor anger regulation. Conclusions Psychological control is negatively associated with adolescent adjustment, particularly among adolescents who have difficulty regulating emotions. Emotion regulation is one mechanism through which psychological control is linked to adolescent adjustment, particularly anger dysregulation, and this pattern holds for both younger and older adolescents and for both boys and girls. PMID:25057264

Associations between different components of fitness and fatness with academic performance in Chilean youths

PubMed Central

2016-01-01

Objectives To analyze the associations between different components of fitness and fatness with academic performance, adjusting the analysis by sex, age, socio-economic status, region and school type in a Chilean sample. Methods Data of fitness, fatness and academic performance was obtained from the Chilean System for the Assessment of Educational Quality test for eighth grade in 2011 and includes a sample of 18,746 subjects (49% females). Partial correlations adjusted by confounders were done to explore association between fitness and fatness components, and between the academic scores. Three unadjusted and adjusted linear regression models were done in order to analyze the associations of variables. Results Fatness has a negative association with academic performance when Body Mass Index (BMI) and Waist to Height Ratio (WHR) are assessed independently. When BMI and WHR are assessed jointly and adjusted by cofounders, WHR is more associated with academic performance than BMI, and only the association of WHR is positive. For fitness components, strength was the variable most associated with the academic performance. Cardiorespiratory capacity was not associated with academic performance if fatness and other fitness components are included in the model. Conclusions Fitness and fatness are associated with academic performance. WHR and strength are more related with academic performance than BMI and cardiorespiratory capacity. PMID:27761345

Association between adolescent marriage and marital violence among young adult women in India

PubMed Central

Raj, Anita; Saggurti, Niranjan; Lawrence, Danielle; Balaiah, Donta; Silverman, Jay G.

2010-01-01

Objective To assess whether a history of adolescent marriage (<18 years) places women in young adulthood in India at increased risk of physical or sexual marital violence. Methods Cross-sectional analysis was performed on data from a nationally representative household study of 124 385 Indian women aged 15–49 years collected in 2005–2006. The analyses were restricted to married women aged 20–24 years who participated in the marital violence (MV) survey module (n=10 514). Simple regression models and models adjusted for participant demographics were constructed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between adolescent marriage and MV. Results Over half (58%) of the participants were married before 18 years of age; 35% of the women had experienced physical or sexual violence in their marriage; and 27% reported such abuse in the last year. Adjusted regression analyses revealed that women married as minors were significantly more likely than those married as adults to report ever experiencing MV (adjusted OR 1.77; 95% CI, 1.61–1.95) and in the last 12 months (adjusted OR 1.51; 95% CI, 1.36–1.67). Conclusions Women who were married as adolescents remain at increased risk of MV into young adulthood. PMID:20347089

Influenza vaccines in low and middle income countries

PubMed Central

Ott, Jördis J.; Klein Breteler, Janna; Tam, John S.; Hutubessy, Raymond C.W.; Jit, Mark; de Boer, Michiel R.

2013-01-01

Objectives: Economic evaluations on influenza vaccination from low resource settings are scarce and have not been evaluated using a systematic approach. Our objective was to conduct a systematic review on the value for money of influenza vaccination in low- and middle-income countries. Methods: PubMed and EMBASE were searched for economic evaluations published in any language between 1960 and 2011. Main outcome measures were costs per influenza outcome averted, costs per quality-adjusted life years gained or disability-adjusted life years averted, costs per benefit in monetary units or cost-benefit ratios. Results: Nine economic evaluations on seasonal influenza vaccine met the inclusion criteria. These were model- or randomized-controlled-trial (RCT)-based economic evaluations from middle-income countries. Influenza vaccination provided value for money for elderly, infants, adults and children with high-risk conditions. Vaccination was cost-effective and cost-saving for chronic obstructive pulmonary disease patients and in elderly above 65 y from model-based evaluations, but conclusions from RCTs on elderly varied. Conclusion: Economic evaluations from middle income regions differed in population studied, outcomes and definitions used. Most findings are in line with evidence from high-income countries highlighting that influenza vaccine is likely to provide value for money. However, serious methodological limitations do not allow drawing conclusions on cost-effectiveness of influenza vaccination in middle income countries. Evidence on cost-effectiveness from low-income countries is lacking altogether, and more information is needed from full economic evaluations that are conducted in a standardized manner. PMID:23732900

Objectively-Measured Physical Activity and Cognitive Functioning in Breast Cancer Survivors

PubMed Central

Marinac, Catherine R.; Godbole, Suneeta; Kerr, Jacqueline; Natarajan, Loki; Patterson, Ruth E.; Hartman, Sheri J.

2015-01-01

Purpose To explore the relationship between objectively measured physical activity and cognitive functioning in breast cancer survivors. Methods Participants were 136 postmenopausal breast cancer survivors. Cognitive functioning was assessed using a comprehensive computerized neuropsychological test. 7-day physical activity was assessed using hip-worn accelerometers. Linear regression models examined associations of minutes per day of physical activity at various intensities on individual cognitive functioning domains. The partially adjusted model controlled for primary confounders (model 1), and subsequent adjustments were made for chemotherapy history (model 2), and BMI (model 3). Interaction and stratified models examined BMI as an effect modifier. Results Moderate-to-vigorous physical activity (MVPA) was associated with Information Processing Speed. Specifically, ten minutes of MVPA was associated with a 1.35-point higher score (out of 100) on the Information Processing Speed domain in the partially adjusted model, and a 1.29-point higher score when chemotherapy was added to the model (both p<.05). There was a significant BMI x MVPA interaction (p=.051). In models stratified by BMI (<25 vs. ≥25 kg/m2), the favorable association between MVPA and Information Processing Speed was stronger in the subsample of overweight and obese women (p<.05), but not statistically significant in the leaner subsample. Light-intensity physical activity was not significantly associated with any of the measured domains of cognitive function. Conclusions MVPA may have favorable effects on Information Processing Speed in breast cancer survivors, particularly among overweight or obese women. Implications for Cancer Survivors Interventions targeting increased physical activity may enhance aspects of cognitive function among breast cancer survivors. PMID:25304986

Psychosocial Working Conditions and Cognitive Complaints among Swedish Employees

PubMed Central

Stenfors, Cecilia U. D.; Magnusson Hanson, Linda; Oxenstierna, Gabriel; Theorell, Töres; Nilsson, Lars-Göran

2013-01-01

Background Cognitive complaints involving problems with concentration, memory, decision-making and thinking are relatively common in the work force. The sensitivity of both subjective and objective cognitive functioning to common psychiatric conditions, stress levels and to cognitive load makes it plausible that psychosocial working conditions play a role in cognitive complaints. Thus, this study aimed to test the associations between psychosocial work factors and cognitive complaints in nationally representative samples of the Swedish work force. Cross-sectional (n = 9751) and prospective (n = 3644; two time points two years apart) sequential multiple regression analyses were run, adjusting for general confounders, depressive- and sleeping problems. Additional prospective analyses were run adjusting for baseline cognitive complaints. Cross-sectional results High quantitative demands, information and communication technology (ICT) demands, underqualification and conflicts were positively associated with cognitive complaints, while social support, good resources at work and overqualification were negatively associated with cognitive complaints in all models. Skill discretion and decision authority were weakly associated with cognitive complaints. Conflicts were more strongly associated with cognitive complaints in women than in men, after adjustment for general confounders. Prospective results Quantitative job demands, ICT demands and underqualification were positively associated with future cognitive complaints in all models, including when adjusted for baseline cognitive complaints. Decision authority was weakly positively associated with future cognitive complaints, only after adjustment for depressive- and sleeping problems respectively. Social support was negatively associated with future cognitive complaints after adjustment for general confounders and baseline cognitive complaints. Skill discretion and resources were negatively associated with future cognitive complaints after adjustment for general confounders. The associations between quantitative demands and future cognitive complaints were stronger in women. Discussion/Conclusions The findings indicate that psychosocial working conditions should be taken into account when considering cognitive complaints among employees. PMID:23560101

Emotional insecurity about the community: A dynamic, within-person mediator of child adjustment in contexts of political violence.

PubMed

Cummings, E Mark; Merrilees, Christine; Taylor, Laura K; Goeke-Morey, Marcie; Shirlow, Peter

2017-02-01

Over 1 billion children worldwide are exposed to political violence and armed conflict. The current conclusions are qualified by limited longitudinal research testing sophisticated process-oriented explanatory models for child adjustment outcomes. In this study, consistent with a developmental psychopathology perspective emphasizing the value of process-oriented longitudinal study of child adjustment in developmental and social-ecological contexts, we tested emotional insecurity about the community as a dynamic, within-person mediating process for relations between sectarian community violence and child adjustment. Specifically, this study explored children's emotional insecurity at a person-oriented level of analysis assessed over 5 consecutive years, with child gender examined as a moderator of indirect effects between sectarian community violence and child adjustment. In the context of a five-wave longitudinal research design, participants included 928 mother-child dyads in Belfast (453 boys, 475 girls) drawn from socially deprived, ethnically homogenous areas that had experienced political violence. Youth ranged in age from 10 to 20 years and were 13.24 (SD = 1.83) years old on average at the initial time point. Greater insecurity about the community measured over multiple time points mediated relations between sectarian community violence and youth's total adjustment problems. The pathway from sectarian community violence to emotional insecurity about the community was moderated by child gender, with relations to emotional insecurity about the community stronger for girls than for boys. The results suggest that ameliorating children's insecurity about community in contexts of political violence is an important goal toward improving adolescents' well-being and adjustment. These results are discussed in terms of their translational research implications, consistent with a developmental psychopathology model for the interface between basic and intervention research.

Age of first arrest varies by gambling status in a cohort of young adults

PubMed Central

Martins, Silvia S.; Lee, Grace P.; Santaella, Julian; Liu, Weiwei; Ialongo, Nicholas S.; Storr, Carla L.

2015-01-01

Background and objectives To describe the association between social and problem gambling and first criminal arrest by age 23 in a cohort of urban, mainly African-American youth. Methods: Data for this study was derived from several annual interviews being completed on a community sample of 617 participants during late adolescence until age 23. Information on gambling status, engagement in deviant behaviors, illegal drug use, and arrest history were collected through yearly interviews. Analysis was carried out using Nelson-Aalen cumulative hazard models and simple and adjusted Cox proportional hazards models. Results More problem gamblers had been arrested before age 23 than social gamblers and non-gamblers, i.e. 65% of problem gamblers were arrested before age 23, compared to 38% of social gamblers and 24% non-gamblers. Social gambling was only significantly associated with the hazard of first arrest by age 23 in the unadjusted model (HR: 1.6, p<.001), but not after adjustment for covariates (HR: 1.1, p=0.47). Problem gambling was significantly associated with the hazard of first arrest by age 23 years in the unadjusted (HR: 3.6,p<.001) and adjusted models (HR:1.6, p=0.05). Conclusions and Scientific Significance Problem gambling was significantly associated with earlier age of being arrested. Dilution effects after adjustment for several deviant behaviors and illegal drug use by age 17 suggest that youth exposed to certain common factors may result in engagement in multiple risky behaviors, including problem gambling. Studies are needed to investigate the developmental pathways that lead to these combined behaviors among youth. PMID:24628694

Parent’s Socioeconomic Status, Adolescents’ Disposable Income, and Adolescents’ Smoking Status in Massachusetts

PubMed Central

Soteriades, Elpidoforos S.; DiFranza, Joseph R.

2003-01-01

Objectives. This study examined the association between parental socioeconomic status (SES) and adolescent smoking. Methods. We conducted telephone interviews with a probability sample of 1308 Massachusetts adolescents aged 12 to 17 years. We used multiple-variable-adjusted logistic regression models. Results. The risk of adolescent smoking increased by 28% with each step down in parental education and increased by 30% for each step down in parental household income. These associations persisted after adjustment for age, sex, race/ethnicity, and adolescent disposable income. Parental smoking status was a mediator of these associations. Conclusions. Parental SES is inversely associated with adolescent smoking. Parental smoking is a mediator but does not fully explain the association. PMID:12835202

Access disparities to Magnet hospitals for patients undergoing neurosurgical operations

PubMed Central

Missios, Symeon; Bekelis, Kimon

2017-01-01

Background Centers of excellence focusing on quality improvement have demonstrated superior outcomes for a variety of surgical interventions. We investigated the presence of access disparities to hospitals recognized by the Magnet Recognition Program of the American Nurses Credentialing Center (ANCC) for patients undergoing neurosurgical operations. Methods We performed a cohort study of all neurosurgery patients who were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database from 2009–2013. We examined the association of African-American race and lack of insurance with Magnet status hospitalization for neurosurgical procedures. A mixed effects propensity adjusted multivariable regression analysis was used to control for confounding. Results During the study period, 190,535 neurosurgical patients met the inclusion criteria. Using a multivariable logistic regression, we demonstrate that African-Americans had lower admission rates to Magnet institutions (OR 0.62; 95% CI, 0.58–0.67). This persisted in a mixed effects logistic regression model (OR 0.77; 95% CI, 0.70–0.83) to adjust for clustering at the patient county level, and a propensity score adjusted logistic regression model (OR 0.75; 95% CI, 0.69–0.82). Additionally, lack of insurance was associated with lower admission rates to Magnet institutions (OR 0.71; 95% CI, 0.68–0.73), in a multivariable logistic regression model. This persisted in a mixed effects logistic regression model (OR 0.72; 95% CI, 0.69–0.74), and a propensity score adjusted logistic regression model (OR 0.72; 95% CI, 0.69–0.75). Conclusions Using a comprehensive all-payer cohort of neurosurgery patients in New York State we identified an association of African-American race and lack of insurance with lower rates of admission to Magnet hospitals. PMID:28684152

Distribution of physical activity facilities in Scotland by small area measures of deprivation and urbanicity

PubMed Central

2010-01-01

Background The aim of this study was to examine the distribution of physical activity facilities by area-level deprivation in Scotland, adjusting for differences in urbanicity, and exploring differences between and within the four largest Scottish cities. Methods We obtained a list of all recreational physical activity facilities in Scotland. These were mapped and assigned to datazones. Poisson and negative binomial regression models were used to investigate associations between the number of physical activity facilities relative to population size and quintile of area-level deprivation. Results The results showed that prior to adjustment for urbanicity, the density of all facilities lessened with increasing deprivation from quintiles 2 to 5. After adjustment for urbanicity and local authority, the effect of deprivation remained significant but the pattern altered, with datazones in quintile 3 having the highest estimated mean density of facilities. Within-city associations were identified between the number of physical activity facilities and area-level deprivation in Aberdeen and Dundee, but not in Edinburgh or Glasgow. Conclusions In conclusion, area-level deprivation appears to have a significant association with the density of physical activity facilities and although overall no clear pattern was observed, affluent areas had fewer publicly owned facilities than more deprived areas but a greater number of privately owned facilities. PMID:20955548

The association of parental education with childhood undernutrition in low- and middle-income countries: comparing the role of paternal and maternal education

PubMed Central

Vollmer, Sebastian; Bommer, Christian; Krishna, Aditi; Harttgen, Kenneth; Subramanian, SV

2017-01-01

Abstract Background: Most existing research on the association of parental education with childhood undernutrition focuses on maternal education and often ignores paternal education. We systematically investigate differences in maternal and paternal education and their association with childhood undernutrition. Methods: One hundred and eighty Demographic and Health Surveys from 62 countries performed between 1990 and 2014 were analysed. We used linear-probability models to predict childhood undernutrition prevalences, measured as stunting, underweight and wasting, for all combinations of maternal and paternal attainment in school. Models were adjusted for demographic and socio-economic covariates for the child, mother and household, country-level fixed effects and clustering. Additional specifications adjust for local area characteristics instead of country fixed effects. Results: Both higher maternal and paternal education levels are associated with lower childhood undernutrition. In regressions adjusted for child age and sex as well as country-level fixed effects, the association is stronger for maternal education than for paternal education when their combined level of education is held constant. In the fully adjusted models, the observed differences in predicted undernutrition prevalences are strongly attenuated, suggesting a similar importance of maternal and paternal education. These findings are confirmed by the analysis of composite schooling indicators. Conclusions: We find that paternal education is similarly important for reducing childhood undernutrition as maternal education and should therefore receive increased attention in the literature. PMID:27501820

Combined expectancies: electrophysiological evidence for the adjustment of expectancy effects

PubMed Central

Mattler, Uwe; van der Lugt, Arie; Münte, Thomas F

2006-01-01

Background When subjects use cues to prepare for a likely stimulus or a likely response, reaction times are facilitated by valid cues but prolonged by invalid cues. In studies on combined expectancy effects, two cues can independently give information regarding two dimensions of the forthcoming task. In certain situations, cueing effects on one dimension are reduced when the cue on the other dimension is invalid. According to the Adjusted Expectancy Model, cues affect different processing levels and a mechanism is presumed which is sensitive to the validity of early level cues and leads to online adjustment of expectancy effects at later levels. To examine the predictions of this model cueing of stimulus modality was combined with response cueing. Results Behavioral measures showed the interaction of cueing effects. Electrophysiological measures of the lateralized readiness potential (LRP) and the N200 amplitude confirmed the predictions of the model. The LRP showed larger effects of response cues on response activation when modality cues were valid rather than invalid. N200 amplitude was largest with valid modality cues and invalid response cues, medium with invalid modality cues, and smallest with two valid cues. Conclusion Findings support the view that the validity of early level expectancies modulates the effects of late level expectancies, which included response activation and response conflict in the present study. PMID:16674805

Association between maternal health literacy and child vaccination in India: a cross-sectional study

PubMed Central

Johri, Mira; Subramanian, S V; Sylvestre, Marie-Pierre; Dudeja, Sakshi; Chandra, Dinesh; Koné, Georges K; Sharma, Jitendar K; Pahwa, Smriti

2015-01-01

Background Education of mothers may improve child health. We investigated whether maternal health literacy, a rapidly modifiable factor related to mother's education, was associated with children's receipt of vaccines in two underserved Indian communities. Methods Cross-sectional surveys in an urban and a rural site. We assessed health literacy using Indian child health promotion materials. The outcome was receipt of three doses of diphtheria-tetanus-pertussis (DTP3) vaccine. We used multivariate logistic regression to investigate the relationship between maternal health literacy and vaccination status independently in each site. For both sites, adjusted models considered maternal age, maternal and paternal education, child sex, birth order, household religion and wealth quintile. Rural analyses used multilevel models adjusted for service delivery characteristics. Urban analyses represented cluster characteristics through fixed effects. Results The rural analysis included 1170 women from 60 villages. The urban analysis included 670 women from nine slum clusters. In each site, crude and adjusted models revealed a positive association between maternal health literacy and DTP3. In the rural site, the adjusted OR was 1.57 (95% CI 1.11 to 2.21, p=0.010) for those with medium health literacy, and OR=1.30 (95% CI 0.89 to 1.91, p=0.172) for those with high health literacy. In the urban site, the adjusted OR was 1.10 (95% CI 0.65 to 1.88, p=0.705) for those with medium health literacy, and OR=2.06 (95% CI 1.06 to 3.99, p=0.032) for those with high health literacy. Conclusions In these study settings, maternal health literacy is independently associated with child vaccination. Initiatives targeting health literacy could improve vaccination coverage. PMID:25827469

Dialysate Sodium Concentration and the Association with Interdialytic Weight Gain, Hospitalization, and Mortality

PubMed Central

Hecking, Manfred; Karaboyas, Angelo; Saran, Rajiv; Sen, Ananda; Inaba, Masaaki; Rayner, Hugh; Hörl, Walter H.; Pisoni, Ronald L.; Robinson, Bruce M.; Sunder-Plassmann, Gere; Port, Friedrich K.

2012-01-01

Summary Background and objectives Recommendations to decrease the dialysate sodium (DNa) prescription demand analyses of patient outcomes. We analyzed morbidity and mortality at various levels of DNa, simultaneously accounting for interdialytic weight gain (IDWG) and for the mortality risk associated with lower predialysis serum sodium (SNa) levels. Design, setting, participants, & measurements We used multiply-adjusted linear mixed models to evaluate the magnitude of IDWG and Cox proportional hazards models to assess hospitalizations and deaths in 29,593 patients from the Dialysis Outcomes and Practice Patterns Study with baseline DNa and SNa as predictors, categorized according to lowest to highest levels. Results IDWG increased with higher DNa across all SNa categories, by 0.17% of body weight per 2 mEq/L higher DNa; however, higher DNa was not associated with higher mortality in a fully adjusted model (also adjusted for SNa; hazard ratio [HR]=0.98 per 2 mEq/L higher DNa, 95% confidence interval [CI] 0.95–1.02). Instead, higher DNa was associated with lower hospitalization risk (HR=0.97 per 2 mEq/L higher DNa, 95% CI 0.95–1.00, P=0.04). Additional adjustments for IDWG did not change these results. In sensitivity analyses restricted to study facilities, in which 90%–100% of patients have the same DNa (56%), the adjusted HR for mortality was 0.88 per 2 mEq/L higher DNa (95% CI 0.83–0.94). These analyses represented a pseudo-randomized experiment in which the association between DNa and mortality is unlikely to have been confounded by indication. Conclusions In the absence of randomized prospective studies, the benefit of reducing IDWG by decreasing DNa prescriptions should be carefully weighed against an increased risk for adverse outcomes. PMID:22052942

Reproductive Factors and Incidence of Heart Failure Hospitalization in the Women’s Health Initiative

PubMed Central

Hall, Philip S.; Nah, Gregory; Howard, Barbara V.; Lewis, Cora E.; Allison, Matthew A.; Sarto, Gloria E.; Waring, Molly E.; Jacobson, Lisette T.; Manson, JoAnn E.; Klein, Liviu; Parikh, Nisha I.

2017-01-01

BACKGROUND Reproductive factors reflective of endogenous sex hormone exposure might have an effect on cardiac remodeling and the development of heart failure (HF). OBJECTIVES This study examined the association between key reproductive factors and the incidence of HF. METHODS Women from a cohort of the Women’s Health Initiative were systematically evaluated for the incidence of HF hospitalization from study enrollment through 2014. Reproductive factors (number of live births, age at first pregnancy, and total reproductive duration [time from menarche to menopause]) were self-reported at study baseline in 1993 to 1998. We employed Cox proportional hazards regression analysis in age- and multivariable-adjusted models. RESULTS Among 28,516 women, with an average age of 62.7 ± 7.1 years at baseline, 1,494 (5.2%) had an adjudicated incident HF hospitalization during an average follow-up of 13.1 years. After adjusting for covariates, total reproductive duration in years was inversely associated with incident HF: hazard ratios (HRs) of 0.99 per year (95% confidence interval [CI]: 0.98 to 0.99 per year) and 0.95 per 5 years (95% CI: 0.91 to 0.99 per 5 years). Conversely, early age at first pregnancy and nulliparity were significantly associated with incident HF in age-adjusted models, but not after multivariable adjustment. Notably, nulliparity was associated with incident HF with preserved ejection fraction in the fully adjusted model (HR: 2.75; 95% CI: 1.16 to 6.52). CONCLUSIONS In postmenopausal women, shorter total reproductive duration was associated with higher risk of incident HF, and nulliparity was associated with higher risk for incident HF with preserved ejection fraction. Whether exposure to endogenous sex hormones underlies this relationship should be investigated in future studies. PMID:28521890

A field intervention examining the impact of an office ergonomics training and a highly adjustable chair on visual symptoms in a public sector organization

PubMed Central

Amick, Benjamin C.; Menéndez, Cammie Chaumont; Bazzani, Lianna; Robertson, Michelle; DeRango, Kelly; Rooney, Ted; Moore, Anne

2016-01-01

Objective Examine the effect of a multi-component office ergonomics intervention on visual symptom reductions. Methods Office workers were assigned to either a group receiving a highly adjustable chair with office ergonomics training (CWT), a training-only group (TO) or a control group (C). A work environment and health questionnaire was administered 2 and 1 month(s) pre-intervention and 3, 6, and 12 months post-intervention. Multi-level statistical models tested hypotheses. Results The CWT intervention lowered daily visual symptoms (p < 0.01) post-intervention. The TO group did not significantly differ from the control group. The CWT group differed significantly from the TO group (p = 0.01) post-intervention. Conclusion Workers who received a highly adjustable chair and office ergonomics training had reduced visual symptoms and the effect was maintained through twelve months post-intervention. The lack of a training-only group effect supports implementing training in conjunction with the highly adjustable chair to reduce visual symptoms. PMID:21963250

The effect of accuracy motivation on anchoring and adjustment: do people adjust from provided anchors?

PubMed

Simmons, Joseph P; LeBoeuf, Robyn A; Nelson, Leif D

2010-12-01

Increasing accuracy motivation (e.g., by providing monetary incentives for accuracy) often fails to increase adjustment away from provided anchors, a result that has led researchers to conclude that people do not effortfully adjust away from such anchors. We challenge this conclusion. First, we show that people are typically uncertain about which way to adjust from provided anchors and that this uncertainty often causes people to believe that they have initially adjusted too far away from such anchors (Studies 1a and 1b). Then, we show that although accuracy motivation fails to increase the gap between anchors and final estimates when people are uncertain about the direction of adjustment, accuracy motivation does increase anchor-estimate gaps when people are certain about the direction of adjustment, and that this is true regardless of whether the anchors are provided or self-generated (Studies 2, 3a, 3b, and 5). These results suggest that people do effortfully adjust away from provided anchors but that uncertainty about the direction of adjustment makes that adjustment harder to detect than previously assumed. This conclusion has important theoretical implications, suggesting that currently emphasized distinctions between anchor types (self-generated vs. provided) are not fundamental and that ostensibly competing theories of anchoring (selective accessibility and anchoring-and-adjustment) are complementary. PsycINFO Database Record (c) 2010 APA, all rights reserved.

SHBG, Sex Hormones, and Inflammatory Markers in Older Women

PubMed Central

Ceda, Gian Paolo; Lauretani, Fulvio; Bandinelli, Stefania; Corsi, Anna Maria; Giallauria, Francesco; Guralnik, Jack M.; Zuliani, Giovanni; Cattabiani, Chiara; Parrino, Stefano; Ablondi, Fabrizio; Dall'Aglio, Elisabetta; Ceresini, Graziano; Basaria, Shehzad; Ferrucci, Luigi

2011-01-01

Context: In premenopausal and older women, high testosterone and estradiol (E2) and low SHBG levels are associated with insulin resistance and diabetes, conditions characterized by low-grade inflammation. Objective: The aim of the study was to examine the relationship between SHBG, total testosterone, total E2, and inflammatory markers in older women. Design and Patients: We conducted a retrospective cross-sectional study of 433 women at least 65 yr old from the InCHIANTI Study, Italy, who were not on hormone replacement therapy or recently hospitalized and who had complete data on SHBG, testosterone, E2, C-reactive protein (CRP), IL-6, soluble IL-6 receptor (sIL-6r), and TNF-α. Relationships between sex hormones and inflammatory markers were examined by multivariate linear regression analyses adjusted for age, body mass index, smoking, insulin, physical activity, and chronic disease. Results: In fully adjusted analyses, SHBG was negatively associated with CRP (P = 0.007), IL-6 (P = 0.008), and sIL-6r (P = 0.02). In addition, testosterone was positively associated with CRP (P = 0.006), IL-6 (P = 0.001), and TNF-α (P = 0.0002). The negative relationship between testosterone and sIL-6r in an age-adjusted model (P = 0.02) was no longer significant in a fully adjusted model (P = 0.12). E2 was positively associated with CRP (P = 0.002) but not with IL-6 in fully adjusted models. In a final model including E2, testosterone, and SHBG, and all the confounders previously considered, SHBG (0.23 ± 0.08; P = 0.006) and E2 (0.21 ± 0.08; P = 0.007), but not testosterone (P = 0.21), were still significantly associated with CRP. Conclusion: In late postmenopausal women not on hormone replacement therapy, SHBG and E2 are, respectively, negative and positive, independent and significant correlates of a proinflammatory state. PMID:21239514

Single-nucleotide polymorphisms of MMP2 in MMP/TIMP pathways associated with the risk of alcohol-induced osteonecrosis of the femoral head in Chinese males: A case-control study.

PubMed

Yu, Yan; Xie, Zhilan; Wang, Jihan; Chen, Chu; Du, Shuli; Chen, Peng; Li, Bin; Jin, Tianbo; Zhao, Heping

2016-12-01

The proportion of alcohol-induced osteonecrosis of the femoral head (ONFH) in all ONFH patients was 30.7%, with males prevailing among the ONFH patients in mainland China (70.1%). Matrix metalloproteinase 2 (MMP2), a member of the MMP gene family, encodes the enzyme MMP2, which can promote osteoclast migration, attachment, and bone matrix degradation. In this case-control study, we aimed to investigate the association between MMP2 and the alcohol-induced ONFH in Chinese males.In total, 299 patients with alcohol-induced ONFH and 396 healthy controls were recruited for a case-control association study. Five single-nucleotide polymorphisms within the MMP2 locus were genotyped and examined for their correlation with the risk of alcohol-induced ONFH and treatment response using Pearson χ test and unconditional logistic regression analysis. We identified 3 risk alleles for carriers: the allele "T" of rs243849 increased the risk of alcohol-induced ONFH in the allele model, the log-additive model without adjustment, and the log-additive model with adjustment for age. Conversely, the genotypes "CC" in rs7201 and "CC" in rs243832 decreased the risk of alcohol-induced ONFH, as revealed by the recessive model. After the Bonferroni multiple adjustment, no significant association was found. Furthermore, the haplotype analysis showed that the "TT" haplotype of MMP2 was more frequent among patients with alcohol-induced ONFH by unconditional logistic regression analysis adjusted for age.In conclusion, there may be an association between MMP2 and the risk of alcohol-induced ONFH in North-Chinese males. However, studies on larger populations are needed to confirm this hypothesis; these data may provide a theoretical foundation for future studies.

Parental Psychological Control and Autonomy Granting: Distinctions and Associations with Child and Family Functioning.

PubMed

Kunz, Jennifer Hauser; Grych, John H

2013-04-01

OBJECTIVE: This study utilized an observational coding scheme to identify parenting behavior reflecting psychological control and autonomy granting and examined relations between these parenting dimensions and indices of child and family functioning. DESIGN: A community sample of 90 preadolescents (aged 10.5 to 12 years) and both of their parents engaged in a triadic interaction that was coded for parental psychological control and autonomy granting. Participants also completed measures of child adjustment, interparental conflict, and triangulation. RESULTS: Factor analyses indicated that a two-factor model better fit the data than a one-factor model, suggesting that psychological control and autonomy granting are best conceptualized as independent but related constructs. Parental psychological control and autonomy granting exhibited some shared and some unique correlates with indices of child and family functioning. Hierarchical regressions revealed significant interactions between these dimensions, suggesting that the strength of some associations between parents' use of psychological control and youth adjustment problems depends on the level of autonomy granting exhibited by the parent. CONCLUSIONS: By examining psychological control and autonomy granting simultaneously as unique constructs, this study identifies patterns of psychological control and autonomy granting that undermine youth adjustment. Findings inform targeted intervention efforts for families of preadolescent youth.

Relationships between cognitive performance, neuroimaging, and vascular disease: the DHS-Mind Study

PubMed Central

Hsu, Fang-Chi; Raffield, Laura M.; Hugenschmidt, Christina E.; Cox, Amanda; Xu, Jianzhao; Carr, J. Jeffery; Freedman, Barry I.; Maldjian, Joseph A.; Williamson, Jeff D.; Bowden, Donald W.

2015-01-01

Background Type 2 diabetes mellitus increases risk for cognitive decline and dementia; elevated burdens of vascular disease are hypothesized to contribute to this risk. These relationships were examined in the Diabetes Heart Study-Mind using a battery of cognitive tests, neuroimaging measures, and subclinical cardiovascular disease (CVD) burden assessed by coronary artery calcified plaque (CAC). We hypothesized that CAC would attenuate the association between neuroimaging measures and cognition performance. Methods Associations were examined using marginal models in this family-based cohort of 572 European Americans from 263 families. All models were adjusted for age, gender, education, type 2 diabetes, and hypertension, with some neuroimaging measures additionally adjusted for intracranial volume. Results Higher total brain volume (TBV) was associated with better performance on the Digit Symbol Substitution Task (DSST) and Semantic Fluency (both p≤7.0 x 10−4). Higher gray matter volume (GMV) was associated with better performance on the Modified Mini-Mental State Examination and Semantic Fluency (both p≤9.0 x 10−4). Adjusting for CAC caused minimal changes to the results. Conclusions Relationships exist between neuroimaging measures and cognitive performance in a type 2 diabetes-enriched European American cohort. Associations were minimally attenuated after adjusting for subclinical CVD. Additional work is needed to understand how subclinical CVD burden interacts with other factors and impacts relationships between neuroimaging and cognitive testing measures. PMID:26185004

Consciousness Level and Off‐Hour Admission Affect Discharge Outcome of Acute Stroke Patients: A J‐ASPECT Study

PubMed Central

Kamitani, Satoru; Nishimura, Kunihiro; Nakamura, Fumiaki; Kada, Akiko; Nakagawara, Jyoji; Toyoda, Kazunori; Ogasawara, Kuniaki; Ono, Junichi; Shiokawa, Yoshiaki; Aruga, Toru; Miyachi, Shigeru; Nagata, Izumi; Matsuda, Shinya; Miyamoto, Yoshihiro; Iwata, Michiaki; Suzuki, Akifumi; Ishikawa, Koichi B.; Kataoka, Hiroharu; Morita, Kenichi; Kobayashi, Yasuki; Iihara, Koji

2014-01-01

Background Poor outcomes have been reported for stroke patients admitted outside of regular working hours. However, few studies have adjusted for case severity. In this nationwide assessment, we examined relationships between hospital admission time and disabilities at discharge while considering case severity. Methods and Results We analyzed 35 685 acute stroke patients admitted to 262 hospitals between April 2010 and May 2011 for ischemic stroke (IS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). The proportion of disabilities/death at discharge as measured by the modified Rankin Scale (mRS) was quantified. We constructed 2 hierarchical logistic regression models to estimate the effect of admission time, one adjusted for age, sex, comorbidities, and number of beds; and the second adjusted for the effect of consciousness levels and the above variables at admission. The percentage of severe disabilities/death at discharge increased for patients admitted outside of regular hours (22.8%, 27.2%, and 28.2% for working‐hour, off‐hour, and nighttime; P<0.001). These tendencies were significant in the bivariate and multivariable models without adjusting for consciousness level. However, the effects of off‐hour or nighttime admissions were negated when adjusted for consciousness levels at admission (adjusted OR, 1.00 and 0.99; 95% CI, 1.00 to 1.13 and 0.89 to 1.10; P=0.067 and 0.851 for off‐hour and nighttime, respectively, versus working‐hour). The same trend was observed when each stroke subtype was stratified. Conclusions The well‐known off‐hour effect might be attributed to the severely ill patient population. Thus, sustained stroke care that is sufficient to treat severely ill patients during off‐hours is important. PMID:25336463

Relationship between Carotenoids, Retinol, and Estradiol Levels in Older Women

PubMed Central

Maggio, Marcello; de Vita, Francesca; Lauretani, Fulvio; Bandinelli, Stefania; Semba, Richard D.; Bartali, Benedetta; Cherubini, Antonio; Cappola, Anne R.; Ceda, Gian Paolo; Ferrucci, Luigi

2015-01-01

Background. In vitro evidence suggests anti-estrogenic properties for retinol and carotenoids, supporting a chemo-preventive role of these phytochemicals in estrogen-dependent cancers. During aging there are significant reductions in retinol and carotenoid concentrations, whereas estradiol levels decline during menopause and progressively increase from the age of 65. We aimed to investigate the hypothesis of a potential relationship between circulating levels of retinol, carotenoids, and estradiol (E2) in a cohort of late post-menopausal women. Methods. We examined 512 women ≥ 65 years from the InCHIANTI study. Retinol, α-caroten, β-caroten, β-criptoxantin, lutein, zeaxanthin, and lycopene levels were assayed at enrollment (1998–2000) by High-Performance Liquid Chromatography. Estradiol and testosterone (T) levels were assessed by Radioimmunometry (RIA) and testosterone-to-estradiol ratio (T/E2), as a proxy of aromatase activity, was also calculated. General linear models adjusted for age (Model 1) and further adjusted for other confounders including Body Mass Index (BMI) BMI, smoking, intake of energy, lipids, and vitamin A; C-Reactive Protein, insulin, total cholesterol, liver function, and testosterone (Model 2) were used to investigate the relationship between retinol, carotenoids, and E2 levels. To address the independent relationship between carotenoids and E2 levels, factors significantly associated with E2 in Model 2 were also included in a fully adjusted Model 3. Results. After adjustment for age, α-carotene (β ± SE = −0.01 ± 0.004, p = 0.02) and β-carotene (β ± SE = −0.07 ± 0.02, p = 0.0007) were significantly and inversely associated with E2 levels. α-Carotene was also significantly and positively associated with T/E2 ratio (β ± SE = 0.07 ± 0.03, p = 0.01). After adjustment for other confounders (Model 2), the inverse relationship between α-carotene (β ± SE = −1.59 ± 0.61, p = 0.01), β-carotene (β ± SE = −0.29 ± 0.08, p = 0.0009), and E2 persisted whereas the relationship between α-carotene and T/E2 ratio was attenuated (β ± SE = 0.22 ± 0.12, p = 0.07). In a fully adjusted model (Model 3), only β-carotene (β ± SE = −0.05 ± 0.02, p = 0.03) was significantly and inversely associated with E2 levels independent of α-carotene. No association was found between retinol, total non-pro-vitamin A carotenoids, lutein, zeaxanthin, and lycopene, and E2 levels. Conclusions: In older women, β-carotene levels are independently and inversely associated with E2. PMID:26251919

Modelling the cost-effectiveness of public awareness campaigns for the early detection of non-small-cell lung cancer

PubMed Central

Hinde, S; McKenna, C; Whyte, S; Peake, M D; Callister, M E J; Rogers, T; Sculpher, M

2015-01-01

Background: Survival rates in lung cancer in England are significantly lower than in many similar countries. A range of Be Clear on Cancer (BCOC) campaigns have been conducted targeting lung cancer and found to improve the proportion of diagnoses at the early stage of disease. This paper considers the cost-effectiveness of such campaigns, evaluating the effect of both the regional and national BCOC campaigns on the stage distribution of non-small-cell lung cancer (NSCLC) at diagnosis. Methods: A natural history model of NSCLC was developed using incidence data, data elicited from clinical experts and model calibration techniques. This structure is used to consider the lifetime cost and quality-adjusted survival implications of the early awareness campaigns. Incremental cost-effectiveness ratios (ICERs) in terms of additional costs per quality-adjusted life-years (QALYs) gained are presented. Two scenario analyses were conducted to investigate the role of changes in the ‘worried-well' population and the route of diagnosis that might occur as a result of the campaigns. Results: The base-case theoretical model found the regional and national early awareness campaigns to be associated with QALY gains of 289 and 178 QALYs and ICERs of £13 660 and £18 173 per QALY gained, respectively. The scenarios found that increases in the ‘worried-well' population may impact the cost-effectiveness conclusions. Conclusions: Subject to the available evidence, the analysis suggests that early awareness campaigns in lung cancer have the potential to be cost-effective. However, significant additional research is required to address many of the limitations of this study. In addition, the estimated natural history model presents previously unavailable estimates of the prevalence and rate of disease progression in the undiagnosed population. PMID:26010412

Exposure to traffic noise and air pollution and risk for febrile seizure: a cohort study.

PubMed

Hjortebjerg, Dorrit; Nybo Andersen, Anne-Marie; Ketzel, Matthias; Raaschou-Nielsen, Ole; Sørensen, Mette

2018-03-25

Objectives Exposure to traffic noise and air pollution is suspected to increase susceptibility to viral infections - the main triggering factor for febrile seizures. No studies have examined these two exposures in relation to febrile seizures. We aimed to investigate whether exposure to road traffic noise and air pollution are associated with risk of febrile seizures in childhood. Methods From our study base of 51 465 singletons from a national birth cohort, we identified 2175 cases with febrile seizures using a nationwide registry. Residential address history from conception to six years of age were found in national registers, and road traffic noise (L den ) and air pollution (NO 2 ) were modeled for all addresses. Analyses were done using Cox proportional hazard model with adjustment for potential confounders, including mutual exposure adjustment. Results An interquartile range (IQR) increase in childhood exposure to road traffic noise and air pollution was associated with an 11% [incidence rate ratio (IRR) 1.11, 95% confidence interval (CI) 1.04-1.19) and 5% (IRR 1.05, 95% CI 1.02-1.07) higher risk for febrile seizures, respectively, after adjustment for potential confounders. Weaker tendencies were seen for pregnancy exposure. In models with mutual exposure adjustment, the estimates were slightly lower, with IRR of 1.08 (95% CI 1.00-1.16) and 1.03 (95% CI 0.99-1.06) per IQR increase in childhood exposure to road traffic noise and air pollution, respectively. Conclusions This study suggests that residential exposure to road traffic noise and air pollution is associated with higher risk for febrile seizures.

Comparison of Survival Models for Analyzing Prognostic Factors in Gastric Cancer Patients

PubMed

Habibi, Danial; Rafiei, Mohammad; Chehrei, Ali; Shayan, Zahra; Tafaqodi, Soheil

2018-03-27

Objective: There are a number of models for determining risk factors for survival of patients with gastric cancer. This study was conducted to select the model showing the best fit with available data. Methods: Cox regression and parametric models (Exponential, Weibull, Gompertz, Log normal, Log logistic and Generalized Gamma) were utilized in unadjusted and adjusted forms to detect factors influencing mortality of patients. Comparisons were made with Akaike Information Criterion (AIC) by using STATA 13 and R 3.1.3 softwares. Results: The results of this study indicated that all parametric models outperform the Cox regression model. The Log normal, Log logistic and Generalized Gamma provided the best performance in terms of AIC values (179.2, 179.4 and 181.1, respectively). On unadjusted analysis, the results of the Cox regression and parametric models indicated stage, grade, largest diameter of metastatic nest, largest diameter of LM, number of involved lymph nodes and the largest ratio of metastatic nests to lymph nodes, to be variables influencing the survival of patients with gastric cancer. On adjusted analysis, according to the best model (log normal), grade was found as the significant variable. Conclusion: The results suggested that all parametric models outperform the Cox model. The log normal model provides the best fit and is a good substitute for Cox regression. Creative Commons Attribution License

Can statistic adjustment of OR minimize the potential confounding bias for meta-analysis of case-control study? A secondary data analysis.

PubMed

Liu, Tianyi; Nie, Xiaolu; Wu, Zehao; Zhang, Ying; Feng, Guoshuang; Cai, Siyu; Lv, Yaqi; Peng, Xiaoxia

2017-12-29

Different confounder adjustment strategies were used to estimate odds ratios (ORs) in case-control study, i.e. how many confounders original studies adjusted and what the variables are. This secondary data analysis is aimed to detect whether there are potential biases caused by difference of confounding factor adjustment strategies in case-control study, and whether such bias would impact the summary effect size of meta-analysis. We included all meta-analyses that focused on the association between breast cancer and passive smoking among non-smoking women, as well as each original case-control studies included in these meta-analyses. The relative deviations (RDs) of each original study were calculated to detect how magnitude the adjustment would impact the estimation of ORs, compared with crude ORs. At the same time, a scatter diagram was sketched to describe the distribution of adjusted ORs with different number of adjusted confounders. Substantial inconsistency existed in meta-analysis of case-control studies, which would influence the precision of the summary effect size. First, mixed unadjusted and adjusted ORs were used to combine individual OR in majority of meta-analysis. Second, original studies with different adjustment strategies of confounders were combined, i.e. the number of adjusted confounders and different factors being adjusted in each original study. Third, adjustment did not make the effect size of original studies trend to constringency, which suggested that model fitting might have failed to correct the systematic error caused by confounding. The heterogeneity of confounder adjustment strategies in case-control studies may lead to further bias for summary effect size in meta-analyses, especially for weak or medium associations so that the direction of causal inference would be even reversed. Therefore, further methodological researches are needed, referring to the assessment of confounder adjustment strategies, as well as how to take this kind of bias into consideration when drawing conclusion based on summary estimation of meta-analyses.

Perceived discrimination and mental health disorders: The South African Stress and Health study

PubMed Central

Moomal, Hashim; Jackson, Pamela B; Stein, Dan J; Herman, Allen; Myer, Landon; Seedat, Soraya; Madela-Mntla, Edith; Williams, David R

2011-01-01

Objectives To describe the demographic correlates of perceived discrimination and explore the association between perceived discrimination and psychiatric disorders. Design A national household survey was conducted between 2002 and 2004 using the World Health Organization Composite International Diagnostic Interview (CIDI) to generate diagnoses of psychiatric disorders. Additional instruments provided data on perceived discrimination and related variables. Setting A nationally representative sample of adults in South Africa. Subjects 4 351 individuals aged 18 years and older. Outcomes 12-month and lifetime mood, anxiety and substance use disorders. Results In the multivariate analyses, acute and chronic racial discrimination were associated with an elevated risk of any 12-month DSM-IV disorder when adjusted for socio-demographic factors, but this association was no longer statistically significant when adjusted for other sources of social stress. In fully adjusted models, acute racial discrimination was associated with an elevated risk of lifetime substance use disorders. Acute and chronic non-racial discrimination were associated with an elevated risk of 12-month and lifetime rates of any disorder, even after adjustment for other stressors and potentially confounding psychological factors. The association of chronic non-racial discrimination and 12-month and lifetime disorder was evident across mood, anxiety, and substance use disorders in the fully adjusted models. Conclusion The risk of psychiatric disorders is elevated among persons who report experiences of discrimination. These associations are more robust for chronic than for acute discrimination and for non-racial than for racial discrimination. Perceived discrimination constitutes an important stressor that should be taken into account in the aetiology of psychiatric disorders. PMID:19588802

New Utility for an Old Tool

PubMed Central

Odonkor, Charles A.; Schonberger, Robert B.; Dai, Feng; Shelley, Kirk H.; Silverman, David G.; Barash, Paul G.

2013-01-01

Objective The primary aim of this study was to design prediction models based on a functional marker (preoperative gait-speed) to predict readiness for home discharge time of ≤ 90 minutes, and to identify those at risk for unplanned admissions, after elective ambulatory surgery. Design This prospective observational cohort study evaluated all patients scheduled for elective ambulatory surgery. Home discharge readiness and unplanned admissions were the primary outcomes. Independent variables included preoperative gait speed, heart rate, and total anesthesia time. The relationship between all predictors and each primary outcome was determined in separate multivariable logistic regression models. Results After adjustment for covariates, gait speed with adjusted odds ratio = 3.71 (95% CI: 1.21-11.26), p=0.02; was independently associated with early home discharge readiness ≤90 minutes. Importantly, gait speed dichotomized as greater or less than 1 m/s predicted unplanned admissions with odds ratio = 0.35 (95% CI: 0.16 to 0.76, p=0.008) for those with speeds ≥ 1 m/s in comparison to those with speed < 1 m/s. In a separate model, prior history of cardiac surgery with adjusted odds ratio =7.5 (95% CI: 2.34-24.41)(p=0.001) was independently associated with unplanned admissions after elective ambulatory surgery, when other covariates were held constant. Conclusions This study demonstrates use of novel prediction models based on gait speed testing to predict early home discharge and to identify those patients at risk for unplanned admissions, after elective ambulatory surgery. PMID:24051992

Estimating changes in mean body temperature for humans during exercise using core and skin temperatures is inaccurate even with a correction factor.

PubMed

Jay, Ollie; Reardon, Francis D; Webb, Paul; Ducharme, Michel B; Ramsay, Tim; Nettlefold, Lindsay; Kenny, Glen P

2007-08-01

Changes in mean body temperature (DeltaT(b)) estimated by the traditional two-compartment model of "core" and "shell" temperatures and an adjusted two-compartment model incorporating a correction factor were compared with values derived by whole body calorimetry. Sixty participants (31 men, 29 women) cycled at 40% of peak O(2) consumption for 60 or 90 min in the Snellen calorimeter at 24 or 30 degrees C. The core compartment was represented by esophageal, rectal (T(re)), and aural canal temperature, and the shell compartment was represented by a 12-point mean skin temperature (T(sk)). Using T(re) and conventional core-to-shell weightings (X) of 0.66, 0.79, and 0.90, mean DeltaT(b) estimation error (with 95% confidence interval limits in parentheses) for the traditional model was -95.2% (-83.0, -107.3) to -76.6% (-72.8, -80.5) after 10 min and -47.2% (-40.9, -53.5) to -22.6% (-14.5, -30.7) after 90 min. Using T(re), X = 0.80, and a correction factor (X(0)) of 0.40, mean DeltaT(b) estimation error for the adjusted model was +9.5% (+16.9, +2.1) to -0.3% (+11.9, -12.5) after 10 min and +15.0% (+27.2, +2.8) to -13.7% (-4.2, -23.3) after 90 min. Quadratic analyses of calorimetry DeltaT(b) data was subsequently used to derive best-fitting values of X for both models and X(0) for the adjusted model for each measure of core temperature. The most accurate model at any time point or condition only accounted for 20% of the variation observed in DeltaT(b) for the traditional model and 56% for the adjusted model. In conclusion, throughout exercise the estimation of DeltaT(b) using any measure of core temperature together with mean skin temperature irrespective of weighting is inaccurate even with a correction factor customized for the specific conditions.

[Association between physical fitness parameters and health related quality of life in Chilean community-dwelling older adults].

PubMed

Guede Rojas, Francisco; Chirosa Ríos, Luis Javier; Fuentealba Urra, Sergio; Vergara Ríos, César; Ulloa Díaz, David; Campos Jara, Christian; Barbosa González, Paola; Cuevas Aburto, Jesualdo

2017-01-01

There is no conclusive evidence about the association between physical fitness (PF) and health related quality of life (HRQOL) in older adults. To seek for an association between PF and HRQOL in non-disabled community-dwelling Chilean older adults. One hundred and sixteen subjects participated in the study. PF was assessed using the Senior Fitness Test (SFT) and hand grip strength (HGS). HRQOL was assessed using eight dimensions provided by the SF-12v2 questionnaire. Binary multivariate logistic regression models were carried out considering the potential influence of confounder variables. Non-adjusted models, indicated that subjects with better performance in arm curl test (ACT) were more likely to score higher on vitality dimension (OR > 1) and those with higher HGS were more likely to score higher on physical functioning, bodily pain, vitality and mental health (OR > 1). The adjusted models consistently showed that ACT and HGS predicted a favorable perception of vitality and mental health dimensions respectively (OR > 1). HGS and ACT have a predictive value for certain dimensions of HRQOL.

Quantification of Treatment Effect Modification on Both an Additive and Multiplicative Scale

PubMed Central

Girerd, Nicolas; Rabilloud, Muriel; Pibarot, Philippe; Mathieu, Patrick; Roy, Pascal

2016-01-01

Background In both observational and randomized studies, associations with overall survival are by and large assessed on a multiplicative scale using the Cox model. However, clinicians and clinical researchers have an ardent interest in assessing absolute benefit associated with treatments. In older patients, some studies have reported lower relative treatment effect, which might translate into similar or even greater absolute treatment effect given their high baseline hazard for clinical events. Methods The effect of treatment and the effect modification of treatment were respectively assessed using a multiplicative and an additive hazard model in an analysis adjusted for propensity score in the context of coronary surgery. Results The multiplicative model yielded a lower relative hazard reduction with bilateral internal thoracic artery grafting in older patients (Hazard ratio for interaction/year = 1.03, 95%CI: 1.00 to 1.06, p = 0.05) whereas the additive model reported a similar absolute hazard reduction with increasing age (Delta for interaction/year = 0.10, 95%CI: -0.27 to 0.46, p = 0.61). The number needed to treat derived from the propensity score-adjusted multiplicative model was remarkably similar at the end of the follow-up in patients aged < = 60 and in patients >70. Conclusions The present example demonstrates that a lower treatment effect in older patients on a relative scale can conversely translate into a similar treatment effect on an additive scale due to large baseline hazard differences. Importantly, absolute risk reduction, either crude or adjusted, can be calculated from multiplicative survival models. We advocate for a wider use of the absolute scale, especially using additive hazard models, to assess treatment effect and treatment effect modification. PMID:27045168

Antibody Levels to Persistent Pathogens and Incident Stroke in Mexican Americans

PubMed Central

Sealy-Jefferson, Shawnita; Gillespie, Brenda W.; Aiello, Allison E.; Haan, Mary N.; Morgenstern, Lewis B.; Lisabeth, Lynda D.

2013-01-01

Background Persistent pathogens have been proposed as risk factors for stroke; however, the evidence remains inconclusive. Mexican Americans have an increased risk of stroke especially at younger ages, as well as a higher prevalence of infections caused by several persistent pathogens. Methodology/Principal Findings Using data from the Sacramento Area Latino Study on Aging (n = 1621), the authors used discrete-time regression to examine associations between stroke risk and (1) immunoglobulin G antibody levels to Helicobacter pylori (H. pylori), Cytomegalovirus, Varicella Zoster Virus, Toxoplasma gondii and Herpes simplex virus 1, and (2) concurrent exposure to several pathogens (pathogen burden), defined as: (a) summed sero-positivity, (b) number of pathogens eliciting high antibody levels, and (c) average antibody level. Models were adjusted for socio-demographics and stroke risk factors. Antibody levels to H. pylori predicted incident stroke in fully adjusted models (Odds Ratio: 1.58; 95% Confidence Interval: 1.09, 2.28). No significant associations were found between stroke risk and antibody levels to the other four pathogens. No associations were found for pathogen burden and incident stroke in fully adjusted models. Conclusions/Significance Our results suggest that exposure to H. pylori may be a stroke risk factor in Mexican Americans and may contribute to ethnic differences in stroke risk given the increased prevalence of exposure to H. pylori in this population. Future studies are needed to confirm this association. PMID:23799066

Advanced statistical methods to study the effects of gastric tube and non-invasive ventilation on functional decline and survival in amyotrophic lateral sclerosis.

PubMed

Atassi, Nazem; Cudkowicz, Merit E; Schoenfeld, David A

2011-07-01

A few studies suggest that non-invasive ventilation (1) and gastric tube (G-tube) may have a positive impact on survival but the effect on functional decline is unclear. Confounding by indication may have produced biased estimates of the benefit seen in some of these retrospective studies. The objective of this study was to evaluate the effects of G-tube and NIV on survival and functional decline using advanced statistical models that adjust for confounding by indications. A database of 331 subjects enrolled in previous clinical trials in ALS was available for analysis. Marginal structural models (MSM) were used to compare the mortality hazards and ALSFRS-R slopes between treatment and non-treatment groups, after adjusting for confounding by indication. Results showed that the placement of a G-tube was associated with an additional 1.42 units/month decline in the ALSFRS-R slope (p < 0.0001) and increased mortality hazard of 0.28 (p = 0.02). The use of NIV had no significant effect on ALSFRS-R decline or mortality. In conclusion, marginal structural models can be used to adjust for confounding by indication in retrospective ALS studies. G-tube placement could be followed by a faster rate of functional decline and increased mortality. Our results may suffer from some of the limitations of retrospective analyses.

Sleep Duration and Quality in Relation to Autonomic Nervous System Measures: The Multi-Ethnic Study of Atherosclerosis (MESA)

PubMed Central

Castro-Diehl, Cecilia; Diez Roux, Ana V.; Redline, Susan; Seeman, Teresa; McKinley, Paula; Sloan, Richard; Shea, Steven

2016-01-01

Study Objectives: Short sleep duration and poor sleep quality are associated with adverse cardiovascular outcomes. Potential pathophysiological mechanisms include sleep-associated alterations in the autonomic nervous system. The objective of this study was to examine the associations of shorter sleep duration and poorer sleep quality with markers of autonomic tone: heart rate (HR), high-frequency HR variability (HF-HRV) and salivary amylase. Methods: Cross-sectional analysis of data from actigraphy-based measures of sleep duration and efficiency and responses to a challenge protocol obtained from 527 adult participants in the Multi-Ethnic Study of Atherosclerosis. Results: Participants who slept fewer than 6 h per night (compared to those who slept 7 h or more per night) had higher baseline HR (fully adjusted model 0.05 log beats/min, 95% confidence interval [CI] 0.01, 0.09) and greater HR orthostatic reactivity (fully adjusted model 0.02 log beats/min, 95% CI 0.002, 0.023). Participants who slept 6 to less than 7 h/night (compared to those who slept 7 h or more per night) had lower baseline HF-HRV (fully adjusted model −0.31 log msec2, 95% CI −0.60, −0.14). Participants with low sleep efficiency had lower baseline HF-HRV than those with higher sleep efficiency (fully adjusted model −0.59 log msec2, 95% CI −1.03, −0.15). Participants with low sleep efficiency had higher baseline levels of amylase than those with higher sleep efficiency (fully adjusted model 0.45 log U/mL, 95% CI 0.04, 0.86). Conclusions: Short sleep duration, low sleep efficiency, and insomnia combined with short sleep duration were associated with markers of autonomic tone that indicate lower levels of cardiac parasympathetic (vagal) tone and/or higher levels of sympathetic tone. Citation: Castro-Diehl C, Roux AV, Redline S, Seeman T, McKinley P, Sloan R, Shea S. Sleep duration and quality in relation to autonomic nervous system measures: the Multi-Ethnic Study of Atherosclerosis (MESA). SLEEP 2016;39(11):1927–1940. PMID:27568797

Identifying unusual performance in Australian and New Zealand intensive care units from 2000 to 2010

PubMed Central

2014-01-01

Background The Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database (APD) collects voluntary data on patient admissions to Australian and New Zealand intensive care units (ICUs). This paper presents an in-depth statistical analysis of risk-adjusted mortality of ICU admissions from 2000 to 2010 for the purpose of identifying ICUs with unusual performance. Methods A cohort of 523,462 patients from 144 ICUs was analysed. For each ICU, the natural logarithm of the standardised mortality ratio (log-SMR) was estimated from a risk-adjusted, three-level hierarchical model. This is the first time a three-level model has been fitted to such a large ICU database anywhere. The analysis was conducted in three stages which included the estimation of a null distribution to describe usual ICU performance. Log-SMRs with appropriate estimates of standard errors are presented in a funnel plot using 5% false discovery rate thresholds. False coverage-statement rate confidence intervals are also presented. The observed numbers of deaths for ICUs identified as unusual are compared to the predicted true worst numbers of deaths under the model for usual ICU performance. Results Seven ICUs were identified as performing unusually over the period 2000 to 2010, in particular, demonstrating high risk-adjusted mortality compared to the majority of ICUs. Four of the seven were ICUs in private hospitals. Our three-stage approach to the analysis detected outlying ICUs which were not identified in a conventional (single) risk-adjusted model for mortality using SMRs to compare ICUs. We also observed a significant linear decline in mortality over the decade. Distinct yearly and weekly respiratory seasonal effects were observed across regions of Australia and New Zealand for the first time. Conclusions The statistical approach proposed in this paper is intended to be used for the review of observed ICU and hospital mortality. Two important messages from our study are firstly, that comprehensive risk-adjustment is essential in modelling patient mortality for comparing performance, and secondly, that the appropriate statistical analysis is complicated. PMID:24755369

A replicated field intervention study evaluating the impact of a highly adjustable chair and office ergonomics training on visual symptoms☆

PubMed Central

Menéndez, Cammie Chaumont; Amick, Benjamin C.; Robertson, Michelle; Bazzani, Lianna; DeRango, Kelly; Rooney, Ted; Moore, Anne

2016-01-01

Objective Examine the effects of two office ergonomics interventions in reducing visual symptoms at a private sector worksite. Methods A quasi-experimental study design evaluated the effects of a highly adjustable chair with office ergonomics training intervention (CWT group) and the training only (TO group) compared with no intervention (CO group). Data collection occurred 2 and 1 month(s) pre-intervention and 2, 6 and 12 months post-intervention. During each data collection period, a work environment and health questionnaire (covariates) and daily health diary (outcomes) were completed. Multilevel statistical models tested hypotheses. Results Both the training only intervention (p < 0.001) and the chair with training intervention (p = 0.01) reduced visual symptoms after 12 months. Conclusion The office ergonomics training alone and coupled with a highly adjustable chair reduced visual symptoms. In replicating results from a public sector worksite at a private sector worksite the external validity of the interventions is strengthened, thus broadening its generalizability. PMID:22030069

Adjustment factors to per capita health-care indicators in countries with expatriate male-majority populations.

PubMed

Hussin, A H

2014-12-17

From 2000 to 2010, the population in the Gulf Cooperation Council (GCC) countries underwent an increase of 53%, compared with an average global increase of 13%. The rates varied by country, ranging from 23% in Oman to 198% in Qatar. The main driving force for this sharp increase in population was the high demand for immigrant labour. The aim of this study was to adjust the population in the GCC countries in order to ensure that the comparisons of health-care key performance indicators with other countries account for the composition of the populations. The conclusion of the study was that adjusting the population in the GCC is instrumental for determining health spending and health outcomes, and that inaccurate forecasting would result in serious overestimation of the need for GCC countries to invest in the health-care sector. Policy-makers can utilize the population models in this study to accurately plan for health-care delivery.

Estradiol and Inflammatory Markers in Older Men

PubMed Central

Maggio, Marcello; Ceda, Gian Paolo; Lauretani, Fulvio; Bandinelli, Stefania; Metter, E. Jeffrey; Artoni, Andrea; Gatti, Elisa; Ruggiero, Carmelinda; Guralnik, Jack M.; Valenti, Giorgio; Ling, Shari M.; Basaria, Shehzad; Ferrucci, Luigi

2009-01-01

Background: Aging is characterized by a mild proinflammatory state. In older men, low testosterone levels have been associated with increasing levels of proinflammatory cytokines. It is still unclear whether estradiol (E2), which generally has biological activities complementary to testosterone, affects inflammation. Methods: We analyzed data obtained from 399 men aged 65–95 yr enrolled in the Invecchiare in Chianti study with complete data on body mass index (BMI), serum E2, testosterone, IL-6, soluble IL-6 receptor, TNF-α, IL-1 receptor antagonist, and C-reactive protein. The relationship between E2 and inflammatory markers was examined using multivariate linear models adjusted for age, BMI, smoking, physical activity, chronic disease, and total testosterone. Results: In age-adjusted analysis, log (E2) was positively associated with log (IL-6) (r = 0.19; P = 0.047), and the relationship was statistically significant (P = 0.032) after adjustments for age, BMI, smoking, physical activity, chronic disease, and serum testosterone levels. Log (E2) was not significantly associated with log (C-reactive protein), log (soluble IL-6 receptor), or log (TNF-α) in both age-adjusted and fully adjusted analyses. Conclusions: In older men, E2 is weakly positively associated with IL-6, independent of testosterone and other confounders including BMI. PMID:19050054

Identification of Hospital Outliers in Bleeding Complications After Percutaneous Coronary Intervention

PubMed Central

Hess, Connie N.; Rao, Sunil V.; McCoy, Lisa A.; Neely, Megan L.; Singh, Mandeep; Spertus, John A.; Krone, Ronald J.; Weaver, W. Douglas; Peterson, Eric D.

2014-01-01

Background Post-percutaneous coronary intervention (PCI) bleeding complications are an important quality metric. We sought to characterize site-level variation in post-PCI bleeding and explore the influence of patient and procedural factors on hospital bleeding performance. Methods and Results Hospital-level bleeding performance was compared pre- and post-adjustment using the newly-revised CathPCI Registry® bleeding risk model (c-index 0.77) among 1,292 NCDR® hospitals performing >50 PCIs from 7/2009–9/2012 (n=1,984,998 procedures). Using random effects models, outlier sites were identified based on 95% confidence intervals around the hospital’s random intercept. Bleeding 72 hours post-PCI was defined as: arterial access site, retroperitoneal, gastrointestinal, or genitourinary bleeding; intracranial hemorrhage; cardiac tamponade; non-bypass surgery-related blood transfusion with pre-procedure hemoglobin ≥8 g/dl; or absolute decrease in hemoglobin value ≥3g/dl with pre-procedure hemoglobin ≤16 g/dl. Overall, the median unadjusted post-PCI bleeding rate was 5.2% and varied among hospitals from 2.6%–10.4% (5th, 95th percentiles). Center-level bleeding variation persisted after case-mix adjustment (2.8%–9.5%; 5th, 95th percentiles). While hospitals’ observed and risk-adjusted bleeding ranks were correlated (Spearman’s rho 0.88), individual rankings shifted after risk-adjustment (median Δ rank order ± 91.5; IQR 37.0, 185.5). Outlier classification changed post-adjustment for 29.3%, 16.1%, and 26.5% of low-, non-, and high-outlier sites, respectively. Hospital use of bleeding avoidance strategies (bivalirudin, radial access, or vascular closure device) was associated with risk-adjusted bleeding rates. Conclusions Despite adjustment for patient case-mix, there is wide variation in rates of hospital PCI-related bleeding in the United States. Opportunities may exist for best performers to share practices with other sites. PMID:25424242

Determinants of Captan Air and Dermal Exposures among Orchard Pesticide Applicators in the Agricultural Health Study

PubMed Central

Hines, Cynthia J.; Deddens, James A.; Coble, Joseph; Kamel, Freya; Alavanja, Michael C. R.

2011-01-01

Objectives: To identify and quantify determinants of captan exposure among 74 private orchard pesticide applicators in the Agricultural Health Study (AHS). To adjust an algorithm used for estimating pesticide exposure intensity in the AHS based on these determinants and to compare the correlation of the adjusted and unadjusted algorithms with urinary captan metabolite levels. Methods: External exposure metrics included personal air, hand rinse, and dermal patch samples collected from each applicator on 2 days in 2002–2003. A 24-h urine sample was also collected. Exposure determinants were identified for each external metric using multiple linear regression models via the NLMIXED procedure in SAS. The AHS algorithm was adjusted, consistent with the identified determinants. Mixed-effect models were used to evaluate the correlation between the adjusted and unadjusted algorithm and urinary captan metabolite levels. Results: Consistent determinants of captan exposure were a measure of application size (kilogram of captan sprayed or application method), wearing chemical-resistant (CR) gloves and/or a coverall/suit, repairing spray equipment, and product formulation. Application by airblast was associated with a 4- to 5-fold increase in exposure as compared to hand spray. Exposure reduction to the hands, right thigh, and left forearm from wearing CR gloves averaged ∼80%, to the right and left thighs and right forearm from wearing a coverall/suit by ∼70%. Applicators using wettable powder formulations had significantly higher air, thigh, and forearm exposures than those using liquid formulations. Application method weights in the AHS algorithm were adjusted to nine for airblast and two for hand spray; protective equipment reduction factors were adjusted to 0.2 (CR gloves), 0.3 (coverall/suit), and 0.1 (both). Conclusions: Adjustment of application method, CR glove, and coverall weights in the AHS algorithm based on our exposure determinant findings substantially improved the correlation between the AHS algorithm and urinary metabolite levels. PMID:21427168

Sunlight exposure and cardiovascular risk factors in the REGARDS study: a cross-sectional split-sample analysis

PubMed Central

2014-01-01

Background Previous research has suggested that vitamin D and sunlight are related to cardiovascular outcomes, but associations between sunlight and risk factors have not been investigated. We examined whether increased sunlight exposure was related to improved cardiovascular risk factor status. Methods Residential histories merged with satellite, ground monitor, and model reanalysis data were used to determine previous-year sunlight radiation exposure for 17,773 black and white participants aged 45+ from the US. Exploratory and confirmatory analyses were performed by randomly dividing the sample into halves. Logistic regression models were used to examine relationships with cardiovascular risk factors. Results The lowest, compared to the highest quartile of insolation exposure was associated with lower high-density lipoprotein levels in adjusted exploratory (−2.7 mg/dL [95% confidence interval: −4.2, −1.2]) and confirmatory (−1.5 mg/dL [95% confidence interval: −3.0, −0.1]) models. The lowest, compared to the highest quartile of insolation exposure was associated with higher systolic blood pressure levels in unadjusted exploratory and confirmatory, as well as the adjusted exploratory model (2.3 mmHg [95% confidence interval: 0.8, 3.8]), but not the adjusted confirmatory model (1.6 mg/dL [95% confidence interval: −0.5, 3.7]). Conclusions The results of this study suggest that lower long-term sunlight exposure has an association with lower high-density lipoprotein levels. However, all associations were weak, thus it is not known if insolation may affect cardiovascular outcomes through these risk factors. PMID:24946776

Comparison of Surgical Outcomes Between Teaching and Nonteaching Hospitals in the Department of Veterans Affairs

PubMed Central

Khuri, Shukri F.; Najjar, Samer F.; Daley, Jennifer; Krasnicka, Barbara; Hossain, Monir; Henderson, William G.; Aust, J. Bradley; Bass, Barbara; Bishop, Michael J.; Demakis, John; DePalma, Ralph; Fabri, Peter J.; Fink, Aaron; Gibbs, James; Grover, Frederick; Hammermeister, Karl; McDonald, Gerald; Neumayer, Leigh; Roswell, Robert H.; Spencer, Jeannette; Turnage, Richard H.

2001-01-01

Objective To determine whether the investment in postgraduate education and training places patients at risk for worse outcomes and higher costs than if medical and surgical care was delivered in nonteaching settings. Summary Background Data The Veterans Health Administration (VA) plays a major role in the training of medical students, residents, and fellows. Methods The database of the VA National Surgical Quality Improvement Program was analyzed for all major noncardiac operations performed during fiscal years 1997, 1998, and 1999. Teaching status of a hospital was determined on the basis of a background and structure questionnaire that was independently verified by a research fellow. Stepwise logistic regression was used to construct separate models predictive of 30-day mortality and morbidity for each of seven surgical specialties and eight operations. Based on these models, a severity index for each patient was calculated. Hierarchical logistic regression models were then created to examine the relationship between teaching versus nonteaching hospitals and 30-day postoperative mortality and morbidity, after adjusting for patient severity. Results Teaching hospitals performed 81% of the total surgical workload and 90% of the major surgery workload. In most specialties in teaching hospitals, the residents were the primary surgeons in more than 90% of the operations. Compared with nonteaching hospitals, the patient populations in teaching hospitals had a higher prevalence of risk factors, underwent more complex operations, and had longer operation times. Risk-adjusted mortality rates were not different between the teaching and nonteaching hospitals in the specialties and operations studied. The unadjusted complication rate was higher in teaching hospitals in six of seven specialties and four of eight operations. Risk adjustment did not eliminate completely these differences, probably reflecting the relatively poor predictive validity of some of the risk adjustment models for morbidity. Length of stay after major operations was not consistently different between teaching and nonteaching hospitals. Conclusion Compared with nonteaching hospitals, teaching hospitals in the VA perform the majority of complex and high-risk major procedures, with comparable risk-adjusted 30-day mortality rates. Risk-adjusted 30-day morbidity rates in teaching hospitals are higher in some specialties and operations than in nonteaching hospitals. Although this may reflect the weak predictive validity of some of the risk adjustment models for morbidity, it may also represent suboptimal processes and structures of care that are unique to teaching hospitals. Despite good quality of care in teaching hospitals, as evidenced by the 30-day mortality data, efforts should be made to examine further the structures and processes of surgical care prevailing in these hospitals. PMID:11524590

Posttraumatic Stress Symptoms Among National Guard Soldiers Deployed to Iraq: Associations with Parenting Behaviors and Couple Adjustment

PubMed Central

Gewirtz, Abigail H.; Polusny, Melissa A.; DeGarmo, David S.; Khaylis, Anna; Erbes, Christopher R.

2011-01-01

Objective This article reports findings from a one-year longitudinal study examining the impact of change in PTSD symptoms following combat deployment on National Guard soldiers’ perceived parenting, and couple adjustment one year following return from Iraq. Method Participants were 468 Army National Guard fathers from a Brigade Combat Team (mean age 36 years; median deployment length 16 months; 89% European American, 5% African American, 6% Hispanic American). Participants completed an in-theater survey one month before returning home from OIF deployment (Time 1), and again, one year post-deployment (Time 2). The PTSD Checklist-Military Version (PCL-M; Weathers, Litz, Herman, Huska, & Keane, 1993) was gathered at both times, and two items assessing social support were gathered at baseline only. At Time 2, participants also completed self-report measures of parenting (Alabama Parenting Questionnaire—Short Form; Elgar, Waschbusch, Dadds, & Sigvaldason, 2007), couple adjustment (Dyadic Adjustment Scale-7; Sharpley & Rogers, 1984; Spanier, 1976), parent-child relationship quality (4 items from the Social Adjustment Scale-Self Report; Weissman & Bothwell, 1976), alcohol use (Alcohol Use Disorders Identification Test; Babor, Higgins-Biddle, Saunders, & Monteiro, 2001), and items assessing injuries sustained while deployed. Results Structural equation modeling analyses showed that increases in PTSD symptoms were associated with poorer couple adjustment and greater perceived parenting challenges at Time 2 (both at p<.001). Furthermore, PTSD symptoms predicted parenting challenges independent of their impact on couple adjustment. Conclusions Findings highlight the importance of investigating and intervening to support parenting and couple adjustment among combat-affected National Guard families. PMID:20873896

Testing for Clinical Inertia in Medication Treatment of Bipolar Disorder

PubMed Central

Hodgkin, Dominic; Merrick, Elizabeth L.; O'Brien, Peggy L.; McGuire, Thomas G.; Lee, Sue; Deckersbach, Thilo; Nierenberg, Andrew A.

2016-01-01

Background Clinical inertia has been defined as lack of change in medication treatment at visits where a medication adjustment appears to be indicated. This paper seeks to identify the extent of clinical inertia in medication treatment of bipolar disorder. A second goal is to identify patient characteristics that predict this treatment pattern. Method Data describe 23,406 visits made by 1,815 patients treated for bipolar disorder during the STEP-BD practical clinical trial. Visits were classified in terms of whether a medication adjustment appears to be indicated, and also whether or not one occurred. Multivariable regression analyses were conducted to find which patient characteristics were predictive of whether adjustment occurred. Results 36% of visits showed at least 1 indication for adjustment. The most common indications were non-response to medication, side effects, and start of a new illness episode. Among visits with an indication for adjustment, no adjustment occurred 19% of the time, which may be suggestive of clinical inertia. In multivariable models, presence of any indication for medication adjustment was a predictor of receiving one (OR=1.125, 95% CI = 1.015, 1.246), although not as strong as clinical status measures. Limitations The associations observed are not necessarily causal, given the study design. The data also lack information about physician-patient communication. Conclusions Many patients remained on the same medication regimen despite indications of side effects or non-response to treatment. Although lack of adjustment does not necessarily reflect clinical inertia in all cases, the reasons for this treatment pattern merit further examination. PMID:27391267

Accounting for individual differences and timing of events: estimating the effect of treatment on criminal convictions in heroin users

PubMed Central

2014-01-01

Background The reduction of crime is an important outcome of opioid maintenance treatment (OMT). Criminal intensity and treatment regimes vary among OMT patients, but this is rarely adjusted for in statistical analyses, which tend to focus on cohort incidence rates and rate ratios. The purpose of this work was to estimate the relationship between treatment and criminal convictions among OMT patients, adjusting for individual covariate information and timing of events, fitting time-to-event regression models of increasing complexity. Methods National criminal records were cross linked with treatment data on 3221 patients starting OMT in Norway 1997–2003. In addition to calculating cohort incidence rates, criminal convictions was modelled as a recurrent event dependent variable, and treatment a time-dependent covariate, in Cox proportional hazards, Aalen’s additive hazards, and semi-parametric additive hazards regression models. Both fixed and dynamic covariates were included. Results During OMT, the number of days with criminal convictions for the cohort as a whole was 61% lower than when not in treatment. OMT was associated with reduced number of days with criminal convictions in all time-to-event regression models, but the hazard ratio (95% CI) was strongly attenuated when adjusting for covariates; from 0.40 (0.35, 0.45) in a univariate model to 0.79 (0.72, 0.87) in a fully adjusted model. The hazard was lower for females and decreasing with older age, while increasing with high numbers of criminal convictions prior to application to OMT (all p < 0.001). The strongest predictors were level of criminal activity prior to entering into OMT, and having a recent criminal conviction (both p < 0.001). The effect of several predictors was significantly time-varying with their effects diminishing over time. Conclusions Analyzing complex observational data regarding to fixed factors only overlooks important temporal information, and naïve cohort level incidence rates might result in biased estimates of the effect of interventions. Applying time-to-event regression models, properly adjusting for individual covariate information and timing of various events, allows for more precise and reliable effect estimates, as well as painting a more nuanced picture that can aid health care professionals and policy makers. PMID:24886472

A system dynamics model of China's electric power structure adjustment with constraints of PM10 emission reduction.

PubMed

Guo, Xiaopeng; Ren, Dongfang; Guo, Xiaodan

2018-06-01

Recently, Chinese state environmental protection administration has brought out several PM10 reduction policies to control the coal consumption strictly and promote the adjustment of power structure. Under this new policy environment, a suitable analysis method is required to simulate the upcoming major shift of China's electric power structure. Firstly, a complete system dynamics model is built to simulate China's evolution path of power structure with constraints of PM10 reduction considering both technical and economical factors. Secondly, scenario analyses are conducted under different clean-power capacity growth rates to seek applicable policy guidance for PM10 reduction. The results suggest the following conclusions. (1) The proportion of thermal power installed capacity will decrease to 67% in 2018 with a dropping speed, and there will be an accelerated decline in 2023-2032. (2) The system dynamics model can effectively simulate the implementation of the policy, for example, the proportion of coal consumption in the forecast model is 63.3% (the accuracy rate is 95.2%), below policy target 65% in 2017. (3) China should promote clean power generation such as nuclear power to meet PM10 reduction target.

Intimate partner violence and anxiety disorders in pregnancy: the importance of vocational training of the nursing staff in facing them1

PubMed Central

Fonseca-Machado, Mariana de Oliveira; Monteiro, Juliana Cristina dos Santos; Haas, Vanderlei José; Abrão, Ana Cristina Freitas de Vilhena; Gomes-Sponholz, Flávia

2015-01-01

Objective: to identify the relationship between posttraumatic stress disorder, trait and state anxiety, and intimate partner violence during pregnancy. Method: observational, cross-sectional study developed with 358 pregnant women. The Posttraumatic Stress Disorder Checklist - Civilian Version was used, as well as the State-Trait Anxiety Inventory and an adapted version of the instrument used in the World Health Organization Multi-country Study on Women's Health and Domestic Violence. Results: after adjusting to the multiple logistic regression model, intimate partner violence, occurred during pregnancy, was associated with the indication of posttraumatic stress disorder. The adjusted multiple linear regression models showed that the victims of violence, in the current pregnancy, had higher symptom scores of trait and state anxiety than non-victims. Conclusion: recognizing the intimate partner violence as a clinically relevant and identifiable risk factor for the occurrence of anxiety disorders during pregnancy can be a first step in the prevention thereof. PMID:26487135

Obese women less likely to have low serum ferritin, Nicaragua

PubMed Central

Wendt, Amanda S; Jefferds, Maria E; Perrine, Cria G; Halleslevens, Patricia; Sullivan, Kevin M

2015-01-01

Objective To examine the association between overweight and obesity and serum ferritin among women of reproductive age (15–49 years) in Nicaragua, considering the effect of α1-acid glycoprotein (AGP), a marker of inflammation. Design We analysed data from the 2004–05 Nicaraguan Integrated Surveillance System for Nutrition Interventions. Three logistic regression models were analysed with low serum ferritin (<15 μg/l) as the dependent variable: (i) overweight or obese status and covariates; (ii) model 1 plus AGP; and (iii) model 1 restricted to only women with normal AGP levels (≤1·0 g/l). Setting Nicaragua. Subjects Included in this analysis were 832 non-pregnant mother/caregivers (15–49 years) surveyed in 2004–2005. Results In the sample, prevalence of overweight and obesity was 31·8 % and 19·2 %, respectively, and 27·6 % had low serum ferritin. In model 1, the adjusted OR of low serum ferritin was 0·74 (95 % CI 0·52, 1·05) for overweight women and 0·42 (95 % CI 0·26, 0·65) for obese women. In model 2, AGP was significantly independently associated with low serum ferritin (adjusted OR=0·56, 95 % CI 0·34, 0·92) while the adjusted OR for overweight and obesity were largely unchanged. Excluding women with elevated AGP did not appreciably affect the relationship between overweight or obesity and low serum ferritin (model 3). Conclusions Overall, in this population of reproductive-age women, obese women were less likely to have low serum ferritin levels, and this was independent of inflammation as measured by AGP. PMID:24848519

Rapid Adjustments Cause Weak Surface Temperature Response to Increased Black Carbon Concentrations

NASA Astrophysics Data System (ADS)

Stjern, Camilla Weum; Samset, Bjørn Hallvard; Myhre, Gunnar; Forster, Piers M.; Hodnebrog, Øivind; Andrews, Timothy; Boucher, Olivier; Faluvegi, Gregory; Iversen, Trond; Kasoar, Matthew; Kharin, Viatcheslav; Kirkevâg, Alf; Lamarque, Jean-François; Olivié, Dirk; Richardson, Thomas; Shawki, Dilshad; Shindell, Drew; Smith, Christopher J.; Takemura, Toshihiko; Voulgarakis, Apostolos

2017-11-01

We investigate the climate response to increased concentrations of black carbon (BC), as part of the Precipitation Driver Response Model Intercomparison Project (PDRMIP). A tenfold increase in BC is simulated by nine global coupled-climate models, producing a model median effective radiative forcing of 0.82 (ranging from 0.41 to 2.91) W m-2, and a warming of 0.67 (0.16 to 1.66) K globally and 1.24 (0.26 to 4.31) K in the Arctic. A strong positive instantaneous radiative forcing (median of 2.10 W m-2 based on five of the models) is countered by negative rapid adjustments (-0.64 W m-2 for the same five models), which dampen the total surface temperature signal. Unlike other drivers of climate change, the response of temperature and cloud profiles to the BC forcing is dominated by rapid adjustments. Low-level cloud amounts increase for all models, while higher-level clouds are diminished. The rapid temperature response is particularly strong above 400 hPa, where increased atmospheric stabilization and reduced cloud cover contrast the response pattern of the other drivers. In conclusion, we find that this substantial increase in BC concentrations does have considerable impacts on important aspects of the climate system. However, some of these effects tend to offset one another, leaving a relatively small median global warming of 0.47 K per W m-2—about 20% lower than the response to a doubling of CO2. Translating the tenfold increase in BC to the present-day impact of anthropogenic BC (given the emissions used in this work) would leave a warming of merely 0.07 K.

Girls’ childhood trajectories of disruptive behavior predict adjustment problems in early adolescence

PubMed Central

van der Molen, Elsa; Blokland, Arjan A. J.; Hipwell, Alison E.; Vermeiren, Robert R.J.M.; Doreleijers, Theo A.H.; Loeber, Rolf

2014-01-01

Background It is widely recognized that early onset of disruptive behavior is linked to a variety of detrimental outcomes in males later in life. In contrast, little is known about the association between girls’ childhood trajectories of disruptive behavior and adjustment problems in early adolescence. Methods The current study used 9 waves of data from the ongoing Pittsburgh Girls Study. A semi-parametric group based model was used to identify trajectories of disruptive behavior in 1,513 girls from age 6 to 12 years. Adjustment problems were characterized by depression, self-harm, PTSD, substance use, interpersonal aggression, sexual behavior, affiliation with delinquent peers, and academic achievement at ages 13 and 14. Results Three trajectories of childhood disruptive behavior were identified: low, medium, and high. Girls in the high group were at increased risk for depression, self-harm, PTSD, illegal substance use, interpersonal aggression, early and risky sexual behavior, and lower academic achievement. The likelihood of multiple adjustment problems increased with trajectories reflecting higher levels of disruptive behavior. Conclusion Girls following the high childhood trajectory of disruptive behavior require early intervention programs to prevent multiple, adverse outcomes in adolescence and further escalation in adulthood. PMID:25302849

A four-culture study of self-enhancement and adjustment using the social relations model: do alternative conceptualizations and indices make a difference?

PubMed

Church, A Timothy; Katigbak, Marcia S; Mazuera Arias, Rina; Rincon, Brigida Carolina; Vargas-Flores, José de Jesús; Ibáñez-Reyes, Joselina; Wang, Lei; Alvarez, Juan M; Wang, Congcong; Ortiz, Fernando A

2014-06-01

In the self-enhancement literature, 2 major controversies remain--whether self-enhancement is a cultural universal and whether it is healthy or maladaptive. Use of the social relations model (SRM; Kenny, 1994) might facilitate resolution of these controversies. We applied the SRM with a round-robin design in both friend and family contexts in 4 diverse cultures: the United States (n = 399), Mexico (n = 413), Venezuela (n = 290), and China (n = 222). Results obtained with social comparison, self-insight, and SRM conceptualizations and indices of self-enhancement were compared for both agentic traits (i.e., egoistic bias) and communal traits (i.e., moralistic bias). Conclusions regarding cultural differences in the prevalence of self-enhancement vs. self-effacement tendencies, and the relationship between self-enhancement and adjustment, varied depending on the index of self-enhancement used. For example, consistent with cultural psychology perspectives, Chinese showed a greater tendency to self-efface than self-enhance using social comparison and self-insight indices, particularly on communal traits in the friend context. However, no cultural differences were observed when perceiver and target effects were controlled using the SRM indices. In all cultures, self-enhancement indices were moderately consistent across friend and family contexts, suggesting traitlike tendencies. To a similar extent in all 4 cultures, self-enhancement tendencies, as measured by the SRM indices, were moderately related to self-rated adjustment, but unrelated, or less so, to observer-rated adjustment.

Combining QMRA and Epidemiology to Estimate Campylobacteriosis Incidence.

PubMed

Evers, Eric G; Bouwknegt, Martijn

2016-10-01

The disease burden of pathogens as estimated by QMRA (quantitative microbial risk assessment) and EA (epidemiological analysis) often differs considerably. This is an unsatisfactory situation for policymakers and scientists. We explored methods to obtain a unified estimate using campylobacteriosis in the Netherlands as an example, where previous work resulted in estimates of 4.9 million (QMRA) and 90,600 (EA) cases per year. Using the maximum likelihood approach and considering EA the gold standard, the QMRA model could produce the original EA estimate by adjusting mainly the dose-infection relationship. Considering QMRA the gold standard, the EA model could produce the original QMRA estimate by adjusting mainly the probability that a gastroenteritis case is caused by Campylobacter. A joint analysis of QMRA and EA data and models assuming identical outcomes, using a frequentist or Bayesian approach (using vague priors), resulted in estimates of 102,000 or 123,000 campylobacteriosis cases per year, respectively. These were close to the original EA estimate, and this will be related to the dissimilarity in data availability. The Bayesian approach further showed that attenuating the condition of equal outcomes immediately resulted in very different estimates of the number of campylobacteriosis cases per year and that using more informative priors had little effect on the results. In conclusion, EA was dominant in estimating the burden of campylobacteriosis in the Netherlands. However, it must be noted that only statistical uncertainties were taken into account here. Taking all, usually difficult to quantify, uncertainties into account might lead to a different conclusion. © 2016 Society for Risk Analysis.

Poor asthma control and exposure to traffic pollutants and obesity in older adults

PubMed Central

Epstein, Tolly G.; Ryan, Patrick H.; LeMasters, Grace K.; Bernstein, Cheryl K.; Levin, Linda S.; Bernstein, Jonathan A.; Villareal, Manuel S.; Bernstein, David I.

2015-01-01

Background Environmental and host predictors of asthma control in older asthmatic patients (>65 years old) are poorly understood. Objective To examine the effects of residential exposure to traffic exhaust and other environmental and host predictors on asthma control in older adults. Methods One hundred four asthmatic patients 65 years of age or older from allergy and pulmonary clinics in greater Cincinnati, Ohio, completed the validated Asthma Control Questionnaire (ACQ), pulmonary function testing, and skin prick testing to 10 common aeroallergens. Patients had a physician’s diagnosis of asthma, had significant reversibility in forced expiratory volume in 1 second or a positive methacholine challenge test result, and did not have chronic obstructive pulmonary disease. The mean daily residential exposure to elemental carbon attributable to traffic (ECAT) was estimated using a land-use regression model. Regression models were used to evaluate associations among independent variables, ACQ scores, and the number of asthma exacerbations, defined as acute worsening of asthma symptoms requiring prednisone use, in the past year. Results In the adjusted model, mean daily residential exposure to ECAT greater than 0.39 µg/m3 was significantly associated with poorer asthma control based on ACQ scores (adjusted β = 2.85; 95% confidence interval [CI], 0.58–5.12; P = .02). High ECAT levels were also significantly associated with increased risk of asthma exacerbations (adjusted odds ratio, 3.24; 95% CI, 1.01–10.37; P = .05). A significant association was found between higher body mass index and worse ACQ scores (adjusted β = 1.15; 95% CI, 0.53–1.76; P < .001). Atopic patients (skin prick test positive) had significantly better ACQ scores than nonatopic patients (adjusted β = −0.39; 95% CI, −0.67 to −0.11; P < .01). Conclusion Higher mean daily residential exposure to traffic exhaust, obesity, and nonatopic status are associated with poorer asthma control among older asthmatic patients. PMID:22626595

Workplace policies and prevalence of knee osteoarthritis: the Johnston County Osteoarthritis Project

PubMed Central

Chen, J-C; Linnan, L; Callahan, L F; Yelin, E H; Renner, J B

2007-01-01

Objective Previous studies on work and knee osteoarthritis (KOA) have been primarily focused on physical demands; very little is known about work-related organisational policies and KOA risks and outcomes. We examined the associations between workplace policies and KOA in a community-based population in the USA. Methods The associations between employment offering accommodations (switch to physically less demanding jobs; part-time work for people needing reduced time) and benefits policies (paid sick leave; disability payment) with KOA outcomes (knee symptoms; symptomatic KOA [sKOA]; asymptomatic radiographic KOA [rKOA]) were analysed in participants (n = 1639) aged <65 years old and with completed employment histories and knee radiographs at baseline examination of the Johnston County Osteoarthritis Project. Multiple logistic regression models were used to estimate the prevalence odds ratios (ORs) of KOA associated with each workplace policy, adjusting for sociodemographic features, lifestyle factors, knee injuries, body mass index and other workplace characteristics. We used propensity score models to evaluate the differential selection in employment offering favourable policies and adjust for this potential bias accordingly. Results Individuals employed in workplaces offering better policies had significantly less knee symptoms. Lower sKOA prevalence was noted in workplaces offering job-switch accommodation (8% vs. 13%), paid sick leave (9% vs. 16%) and disability payment (8% vs. 16%) than their counterparts. In multivariable models, the difference in sKOA prevalence was statistically significant for paid sick leave (adjusted OR 0.58, 95% CI 0.37 to 0.91) and disability payment policies (adjusted OR 0.54, 95% CI 0.35 to 0.85). Even among those without overt knee-related symptoms, a similar pattern of negative association between workplace policies and rKOA was present and remained robust after propensity score adjustment. Conclusion The negative associations between KOA and workplace policies raise concerns about possible employment discrimination or beneficial effects of workplace policies. Longitudinal studies are needed to clarify the dynamic complexities of KOA risks and outcomes in relation to workplace policies. PMID:17567725

Native American Ancestry, Lung Function, and COPD in Costa Ricans

PubMed Central

Chen, Wei; Brehm, John M.; Boutaoui, Nadia; Soto-Quiros, Manuel; Avila, Lydiana; Celli, Bartolome R.; Bruse, Shannon; Tesfaigzi, Yohannes

2014-01-01

Background: Whether Native American ancestry (NAA) is associated with COPD or lung function in a racially admixed Hispanic population is unknown. Methods: We recruited 578 Costa Ricans with and without COPD into a hybrid case-control/family-based cohort, including 316 members of families of index case subjects. All participants completed questionnaires and spirometry and gave a blood sample for DNA extraction. Genome-wide genotyping was conducted with the Illumina Human610-Quad and HumanOmniExpress BeadChip kits (Illumina Inc), and individual ancestral proportions were estimated from these genotypic data and reference panels. For unrelated individuals, linear or logistic regression was used for the analysis of NAA and COPD (GOLD [Global Initiative for Chronic Obstructive Lung Disease] stage II or greater) or lung function. For extended families, linear mixed models and generalized estimating equations were used for the analysis. All models were adjusted for age, sex, educational level, and smoking behavior; models for FEV1 were also adjusted for height. Results: The average proportion of European, Native American, and African ancestry among participants was 62%, 35%, and 3%, respectively. After adjustment for current smoking and other covariates, NAA was inversely associated with COPD (OR per 10% increment, 0.55; 95% CI, 0.41-0.75) but positively associated with FEV1, FVC, and FEV1/FVC. After additional adjustment for pack-years of smoking, the association between NAA and COPD or lung function measures was slightly attenuated. We found that about 31% of the estimated effect of NAA on COPD is mediated by pack-years of smoking. Conclusions: NAA is inversely associated with COPD but positively associated with FEV1 or FVC in Costa Ricans. Ancestral effects on smoking behavior partly explain the findings for COPD but not for FEV1 or FVC. PMID:24306962

Associations of sedentary time patterns and TV viewing time with inflammatory and endothelial function biomarkers in children

PubMed Central

Gabel, L.; Ridgers, N. D.; Della Gatta, P. A.; Arundell, L.; Cerin, E.; Robinson, S.; Daly, R. M.; Dunstan, D. W.

2015-01-01

Summary Objective Investigate associations of TV viewing time and accelerometry‐derived sedentary time with inflammatory and endothelial function biomarkers in children. Methods Cross‐sectional analysis of 164 7–10‐year‐old children. TV viewing time was assessed by parental proxy report and total and patterns of sedentary time accumulation (e.g. prolonged bouts) were assessed by accelerometry. C‐reactive protein (CRP), homeostasis model assessment of insulin resistance, interleukin‐2, ‐6, ‐8, ‐10, tumour necrosis factor alpha, adiponectin, resistin, brain‐derived neurotrophic factor, soluble intercellular and vascular adhesion molecule 1, plasminogen activator inhibitor 1 and soluble E‐selectin were assessed. Generalised linear models assessed the associations of TV viewing and sedentary time with biomarkers, adjusting for sex, waist circumference, moderate‐ to vigorous‐intensity physical activity and diet density. Results Each additional h week−1 of TV viewing was associated with 4.4% (95% CI: 2.1, 6.7) greater CRP and 0.6% (0.2, 1.0) greater sVCAM‐1 in the fully adjusted model. The association between frequency and duration of 5–10 min bouts of sedentary time and CRP was positive after adjustment for sex and waist circumference but attenuated after adjustment for diet density. Conclusions This study suggests that TV viewing was unfavourably associated with several markers of inflammation and endothelial dysfunction. The detrimental association between 5 and 10 min bouts of sedentary time and CRP approached significance, suggesting that further research with a stronger study design (longitudinal and/or experimental) is needed to better understand how the accumulation of sedentary time early in life may influence short and longer term health. PMID:26097139

Parental Psychological Control and Autonomy Granting: Distinctions and Associations with Child and Family Functioning

PubMed Central

Kunz, Jennifer Hauser; Grych, John H.

2012-01-01

Objective This study utilized an observational coding scheme to identify parenting behavior reflecting psychological control and autonomy granting and examined relations between these parenting dimensions and indices of child and family functioning. Design A community sample of 90 preadolescents (aged 10.5 to 12 years) and both of their parents engaged in a triadic interaction that was coded for parental psychological control and autonomy granting. Participants also completed measures of child adjustment, interparental conflict, and triangulation. Results Factor analyses indicated that a two-factor model better fit the data than a one-factor model, suggesting that psychological control and autonomy granting are best conceptualized as independent but related constructs. Parental psychological control and autonomy granting exhibited some shared and some unique correlates with indices of child and family functioning. Hierarchical regressions revealed significant interactions between these dimensions, suggesting that the strength of some associations between parents’ use of psychological control and youth adjustment problems depends on the level of autonomy granting exhibited by the parent. Conclusions By examining psychological control and autonomy granting simultaneously as unique constructs, this study identifies patterns of psychological control and autonomy granting that undermine youth adjustment. Findings inform targeted intervention efforts for families of preadolescent youth. PMID:23418403

Aspects of Piaget's cognitive developmental psychology and neurobiology of psychotic disorders - an integrative model.

PubMed

Gebhardt, Stefan; Grant, Phillip; von Georgi, Richard; Huber, Martin T

2008-09-01

Psychological, neurobiological and neurodevelopmental approaches have frequently been used to provide pathogenic concepts on psychotic disorders. However, aspects of cognitive developmental psychology have hardly been considered in current models. Using a hypothesis-generating approach an integration of these concepts was conducted. According to Piaget (1896-1980), assimilation and accommodation as forms of maintenance and modification of cognitive schemata represent fundamental processes of the brain. In general, based on the perceived input stimuli, cognitive schemata are developed resulting in a conception of the world, the realistic validity and the actuality of which is still being controlled and modified by cognitive adjustment processes. In psychotic disorders, however, a disproportion of environmental demands and the ability to activate required neuronal adaptation processes occurs. We therefore hypothesize a failure of the adjustment of real and requested output patterns. As a consequence autonomous cognitive schemata are generated, which fail to adjust with reality resulting in psychotic symptomatology. Neurobiological, especially neuromodulatory and neuroplastic processes play a central role in these perceptive and cognitive processes. In conclusion, integration of cognitive developmental psychology into the existing pathogenic concepts of psychotic disorders leads to interesting insights into basic disease mechanisms and also guides future research in the cognitive neuroscience of such disorders.

Validation of the Dutch version of the Swallowing Quality-of-Life Questionnaire (DSWAL-QoL) and the adjusted DSWAL-QoL (aDSWAL-QoL) using item analysis with the Rasch model: a pilot study.

PubMed

Simpelaere, Ingeborg S; Van Nuffelen, Gwen; De Bodt, Marc; Vanderwegen, Jan; Hansen, Tina

2017-04-07

The Swallowing Quality-of-Life Questionnaire (SWAL-QoL) is considered the gold standard for assessing health-related QoL in oropharyngeal dysphagia. The Dutch translation (DSWAL-QoL) and its adjusted version (aDSWAL-QoL) have been validated using classical test theory (CTT). However, these scales have not been tested against the Rasch measurement model, which is required to establish the structural validity and objectivity of the total scale and subscale scores. Thus, the purpose of this study was to examine the psychometric properties of these scales using item analysis according to the Rasch model. Item analysis with the Rasch model was performed using RUMM2030 software with previously collected data from a validation study of 108 patients. The assessment included evaluations of overall model fit, reliability, unidimensionality, threshold ordering, individual item and person fits, differential item functioning (DIF), local item dependency (LID) and targeting. The analysis could not establish the psychometric properties of either of the scales or their subscales because they did not fit the Rasch model, and multidimensionality, disordered thresholds, DIF, and/or LID were found. The reliability and power of fit were high for the total scales (PSI = 0.93) but low for most of the subscales (PSI < 0.70). The targeting of persons and items was suboptimal. The main source of misfit was disordered thresholds for both the total scales and subscales. Based on the results of the analysis, adjustments to improve the scales were implemented as follows: disordered thresholds were rescaled, misfit items were removed and items were split for DIF. However, the multidimensionality and LID could not be resolved. The reliability and power of fit remained low for most of the subscales. This study represents the first analyses of the DSWAL-QoL and aDSWAL-QoL with the Rasch model. Relying on the DSWAL-QoL and aDSWAL-QoL total and subscale scores to make conclusions regarding dysphagia-related HRQoL should be treated with caution before the structural validity and objectivity of both scales have been established. A larger and well-targeted sample is recommended to derive definitive conclusions about the items and scales. Solutions for the psychometric weaknesses suggested by the model and practical implications are discussed.

Understanding New Jersey's School Funding Formula: The Role of Adjustment Aid

ERIC Educational Resources Information Center

Farrie, Danielle; Luhm, Theresa; Johnson, Monete

2015-01-01

The objective of this policy brief is to explain the purpose of adjustment aid in New Jersey's school funding formula and to correct several misconceptions about the level of aid and how it is distributed. The main conclusions include: (1) The amount of adjustment aid in the funding formula is currently overstated in the "informational"…

New Model for Estimating Glomerular Filtration Rate in Patients With Cancer

PubMed Central

Janowitz, Tobias; Williams, Edward H.; Marshall, Andrea; Ainsworth, Nicola; Thomas, Peter B.; Sammut, Stephen J.; Shepherd, Scott; White, Jeff; Mark, Patrick B.; Lynch, Andy G.; Jodrell, Duncan I.; Tavaré, Simon; Earl, Helena

2017-01-01

Purpose The glomerular filtration rate (GFR) is essential for carboplatin chemotherapy dosing; however, the best method to estimate GFR in patients with cancer is unknown. We identify the most accurate and least biased method. Methods We obtained data on age, sex, height, weight, serum creatinine concentrations, and results for GFR from chromium-51 (51Cr) EDTA excretion measurements (51Cr-EDTA GFR) from white patients ≥ 18 years of age with histologically confirmed cancer diagnoses at the Cambridge University Hospital NHS Trust, United Kingdom. We developed a new multivariable linear model for GFR using statistical regression analysis. 51Cr-EDTA GFR was compared with the estimated GFR (eGFR) from seven published models and our new model, using the statistics root-mean-squared-error (RMSE) and median residual and on an internal and external validation data set. We performed a comparison of carboplatin dosing accuracy on the basis of an absolute percentage error > 20%. Results Between August 2006 and January 2013, data from 2,471 patients were obtained. The new model improved the eGFR accuracy (RMSE, 15.00 mL/min; 95% CI, 14.12 to 16.00 mL/min) compared with all published models. Body surface area (BSA)–adjusted chronic kidney disease epidemiology (CKD-EPI) was the most accurate published model for eGFR (RMSE, 16.30 mL/min; 95% CI, 15.34 to 17.38 mL/min) for the internal validation set. Importantly, the new model reduced the fraction of patients with a carboplatin dose absolute percentage error > 20% to 14.17% in contrast to 18.62% for the BSA-adjusted CKD-EPI and 25.51% for the Cockcroft-Gault formula. The results were externally validated. Conclusion In a large data set from patients with cancer, BSA-adjusted CKD-EPI is the most accurate published model to predict GFR. The new model improves this estimation and may present a new standard of care. PMID:28686534

New Model for Estimating Glomerular Filtration Rate in Patients With Cancer.

PubMed

Janowitz, Tobias; Williams, Edward H; Marshall, Andrea; Ainsworth, Nicola; Thomas, Peter B; Sammut, Stephen J; Shepherd, Scott; White, Jeff; Mark, Patrick B; Lynch, Andy G; Jodrell, Duncan I; Tavaré, Simon; Earl, Helena

2017-08-20

Purpose The glomerular filtration rate (GFR) is essential for carboplatin chemotherapy dosing; however, the best method to estimate GFR in patients with cancer is unknown. We identify the most accurate and least biased method. Methods We obtained data on age, sex, height, weight, serum creatinine concentrations, and results for GFR from chromium-51 ( 51 Cr) EDTA excretion measurements ( 51 Cr-EDTA GFR) from white patients ≥ 18 years of age with histologically confirmed cancer diagnoses at the Cambridge University Hospital NHS Trust, United Kingdom. We developed a new multivariable linear model for GFR using statistical regression analysis. 51 Cr-EDTA GFR was compared with the estimated GFR (eGFR) from seven published models and our new model, using the statistics root-mean-squared-error (RMSE) and median residual and on an internal and external validation data set. We performed a comparison of carboplatin dosing accuracy on the basis of an absolute percentage error > 20%. Results Between August 2006 and January 2013, data from 2,471 patients were obtained. The new model improved the eGFR accuracy (RMSE, 15.00 mL/min; 95% CI, 14.12 to 16.00 mL/min) compared with all published models. Body surface area (BSA)-adjusted chronic kidney disease epidemiology (CKD-EPI) was the most accurate published model for eGFR (RMSE, 16.30 mL/min; 95% CI, 15.34 to 17.38 mL/min) for the internal validation set. Importantly, the new model reduced the fraction of patients with a carboplatin dose absolute percentage error > 20% to 14.17% in contrast to 18.62% for the BSA-adjusted CKD-EPI and 25.51% for the Cockcroft-Gault formula. The results were externally validated. Conclusion In a large data set from patients with cancer, BSA-adjusted CKD-EPI is the most accurate published model to predict GFR. The new model improves this estimation and may present a new standard of care.

Angiogenic and inflammatory biomarkers in mid-pregnancy and small-for-gestational age outcomes in Tanzania

PubMed Central

DARLING, Anne Marie; MCDONALD, Chloe R.; CONROY, Andrea L.; HAYFORD, Kyla T.; RAJWANS, Nimerta; WANG, Molin; ABOUD, Said; URASSA, Willy S.; KAIN, Kevin C.; FAWZI, Wafaie W.

2014-01-01

OBJECTIVE To investigate the relationship between a panel of angiogenic and inflammatory biomarkers measured in mid-pregnancy and small-for-gestational age (SGA) outcomes in sub-Saharan Africa. STUDY DESIGN Concentrations of 18 angiogenic and inflammatory biomarkers were determined in 432 pregnant women in Dar es Salaam, Tanzania who participated in a trial examining the effect of multivitamins on pregnancy outcomes. Infants falling below the 10th percentile of birth weight for gestational age relative to the applied growth standards were considered SGA. Multivariate binomial regression models with the log link function were used to determine the relative risk of SGA associated with increasing quartiles of each biomarker. Stepwise cubic restricted splines were used to test for non-linearity of these associations. Receiver operating curves obtained from multivariate logistic regression models were used to assess the discriminatory capability of selected biomarkers. RESULTS A total of 60 participants (13.9%) gave birth to SGA infants. Compared to those in the first quartile, the risk of SGA was reduced among those in the fourth quartiles of VEGF-A (adjusted risk ratio (RR) 0.38, 95% Confidence Interval (CI), 0.19-0.74), PGF (adjusted RR 0.28, 95% CI, 0.12-0.61), sFlt-1 (adjusted RR 0.48, 95% CI, 0.23-1.01), MCP-1 (adjusted RR 0.48, 95% CI, 0.25-0.92), and Leptin (adjusted RR 0.46, 95% CI, 0.22-0.96) CONCLUSION Our findings provide evidence of altered angiogenic and inflammatory mediators, at mid-pregnancy, in women who went on to deliver small for gestational age infants. PMID:24881826

Sedentary Screen Time and Left Ventricular Structure and Function: the CARDIA Study

PubMed Central

Gibbs, Bethany Barone; Reis, Jared P.; Schelbert, Erik B.; Craft, Lynette L.; Sidney, Steve; Lima, Joao; Lewis, Cora E.

2013-01-01

Sedentary screen time (watching TV or using a computer) predicts cardiovascular outcomes independently from moderate and vigorous physical activity and could impact left ventricular structure and function through the adverse consequences of sedentary behavior. Purpose To determine whether sedentary screen time is associated with measures of left ventricular structure and function. Methods The Coronary Artery Risk Development in Young Adults (CARDIA) Study measured screen time by questionnaire and left ventricular structure and function by echocardiography in 2,854 black and white participants, aged 43–55 years, in 2010–2011. Generalized linear models evaluated cross-sectional trends for echocardiography measures across higher categories of screen time and adjusting for demographics, smoking, alcohol, and physical activity. Further models adjusted for potential intermediate factors (blood pressure, antihypertensive medication use, diabetes, and body mass index (BMI). Results The relationship between screen time and left ventricular mass(LVM) differed in blacks vs. whites. Among whites, higher screen time was associated with larger LVM (P<0.001), after adjustment for height, demographics, and lifestyle variables. Associations between screen time and LVM persisted when adjusting for blood pressure, antihypertensive medication use, and diabetes (P=0.008) but not with additional adjustment for BMI (P=0.503). Similar relationships were observed for screen time with LVM indexed to height2.7, relative wall thickness, and mass-to-volume ratio. Screen time was not associated with left ventricular structure among blacks or left ventricular function in either race group. Conclusions Sedentary screen time is associated with greater LVM in white adults and this relationship was largely explained by higher overall adiposity. The lack of association in blacks supports a potential qualitative difference in the cardiovascular consequences of sedentary screen-based behavior. PMID:23863618

Prevalence and determinants of asthma in adult male leather tannery workers in Karachi, Pakistan: A cross sectional study

PubMed Central

Shahzad, Khurram; Akhtar, Saeed; Mahmud, Sadia

2006-01-01

Background This study aimed to estimate the prevalence and to identify some risk factors of adult asthma in male leather tannery workers in Karachi, Pakistan. Methods A cross sectional study was conducted from August 2003 to March 2004 on leather tannery workers of Karachi, Pakistan. Data were collected from 641 workers engaged in 95 different tanneries in Korangi industrial area selected as sample of convenience. Face to face interviews were performed using a structured pre-tested questionnaire by trained data collectors. Results Prevalence of adult asthma was 10.8% (69/641) in this study population. The prevalence of perceived work-related asthma was 5.3% (34/641). Multivariable logistic regression model showed that after taking into account the age effect, the leather tannery worker were more likely to be asthmatic, if they were illiterate (adjusted OR = 2.13, 95% CI: 1.17–3.88), of Pathan ethnicity (adjusted OR = 2.69; 95% CI: 1.35–5.36), ever-smoked (adjusted OR = 2.22, 95% CI: 1.16–4.26), reportedly never used gloves during different tanning tasks (OR = 3.28; 95% CI : 1.72–6.26). Also, the final model showed a significant interaction between perceived allergy and duration of work. Those who perceived to have allergy were more likely to have asthma if their duration of work was 8 years (adjusted OR = 2.26; 95% CI: 1.19 – 4.29) and this relationship was even stronger if duration was 13 years (adjusted OR = 3.67; 95% CI: 1.98–6.79). Conclusion Prevalence of asthma in leather tannery workers appears to be high and is associated with educational status, ethnicity, smoking, glove use, perceived to have allergy and duration of work. PMID:17144930

Severity-Adjusted Mortality in Trauma Patients Transported by Police

PubMed Central

Band, Roger A.; Salhi, Rama A.; Holena, Daniel N.; Powell, Elizabeth; Branas, Charles C.; Carr, Brendan G.

2018-01-01

Study objective Two decades ago, Philadelphia began allowing police transport of patients with penetrating trauma. We conduct a large, multiyear, citywide analysis of this policy. We examine the association between mode of out-of-hospital transport (police department versus emergency medical services [EMS]) and mortality among patients with penetrating trauma in Philadelphia. Methods This is a retrospective cohort study of trauma registry data. Patients who sustained any proximal penetrating trauma and presented to any Level I or II trauma center in Philadelphia between January 1, 2003, and December 31, 2007, were included. Analyses were conducted with logistic regression models and were adjusted for injury severity with the Trauma and Injury Severity Score and for case mix with a modified Charlson index. Results Four thousand one hundred twenty-two subjects were identified. Overall mortality was 27.4%. In unadjusted analyses, patients transported by police were more likely to die than patients transported by ambulance (29.8% versus 26.5%; OR 1.18; 95% confidence interval [CI] 1.00 to 1.39). In adjusted models, no significant difference was observed in overall mortality between the police department and EMS groups (odds ratio [OR] 0.78; 95% CI 0.61 to 1.01). In subgroup analysis, patients with severe injury (Injury Severity Score >15) (OR 0.73; 95% CI 0.59 to 0.90), patients with gunshot wounds (OR 0.70; 95% CI 0.53 to 0.94), and patients with stab wounds (OR 0.19; 95% CI 0.08 to 0.45) were more likely to survive if transported by police. Conclusion We found no significant overall difference in adjusted mortality between patients transported by the police department compared with EMS but found increased adjusted survival among 3 key subgroups of patients transported by police. This practice may augment traditional care. PMID:24387925

Carotid arterial wall characteristics are associated with incident ischemic stroke but not coronary heart disease in the ARIC Study

PubMed Central

Yang, Eric Y.; Chambless, Lloyd; Sharrett, A. Richey; Virani, Salim S.; Liu, Xiaoxi; Tang, Zhengzheng; Boerwinkle, Eric; Ballantyne, Christie M.; Nambi, Vijay

2011-01-01

Background and Purpose Ultrasound measurements of arterial stiffness are associated with atherosclerosis risk factors, but limited data exist on their association with incident cardiovascular events. We evaluated the association of carotid ultrasound derived arterial stiffness measures with incident coronary heart disease (CHD) and ischemic stroke in the ARIC study. Methods Carotid arterial strain (CAS) and compliance (AC), distensibility (AD) and stiffness indices (SI), pressure-strain (Ep) and Young’s elastic moduli (YEM) were measured in 10,407 individuals using ultrasound. Hazard ratios for incident CHD (myocardial infarction [MI], fatal CHD, coronary revascularization) and stroke in minimally adjusted (age, sex, center, race) and fully adjusted models (minimally adjusted model + diabetes, height, weight, total cholesterol, high-density lipoprotein cholesterol, tobacco use, systolic blood pressure, antihypertensive medication use, and carotid intima-media thickness (CIMT) were calculated. Results The mean age was 55.3 years. Over a mean follow up of 13.8 years, 1,267 incident CHD and 383 ischemic stroke events occurred. After full adjustment for risk factors and CIMT, all arterial stiffness parameters [CAS HR (95% confidence interval [CI]) =1.14 (1.02, 1.28); AD HR=1.19 (1.02, 1.39); SI HR=1.14 (1.04, 1.25); Ep HR=1.17 (1.06, 1.28); YEM HR=1.13 (1.03, 1.24)], except arterial compliance HR=1.02 (0.90, 1.16), were significantly associated with incident stroke but not with CHD. Conclusions After adjusting for cardiovascular risk factors, ultrasound measures of carotid arterial stiffness are associated with incident ischemic stroke but not incident CHD events, despite that the 2 outcomes sharing similar risk factors. PMID:22033999

Adjusting for multiple prognostic factors in the analysis of randomised trials

PubMed Central

2013-01-01

Background When multiple prognostic factors are adjusted for in the analysis of a randomised trial, it is unclear (1) whether it is necessary to account for each of the strata, formed by all combinations of the prognostic factors (stratified analysis), when randomisation has been balanced within each stratum (stratified randomisation), or whether adjusting for the main effects alone will suffice, and (2) the best method of adjustment in terms of type I error rate and power, irrespective of the randomisation method. Methods We used simulation to (1) determine if a stratified analysis is necessary after stratified randomisation, and (2) to compare different methods of adjustment in terms of power and type I error rate. We considered the following methods of analysis: adjusting for covariates in a regression model, adjusting for each stratum using either fixed or random effects, and Mantel-Haenszel or a stratified Cox model depending on outcome. Results Stratified analysis is required after stratified randomisation to maintain correct type I error rates when (a) there are strong interactions between prognostic factors, and (b) there are approximately equal number of patients in each stratum. However, simulations based on real trial data found that type I error rates were unaffected by the method of analysis (stratified vs unstratified), indicating these conditions were not met in real datasets. Comparison of different analysis methods found that with small sample sizes and a binary or time-to-event outcome, most analysis methods lead to either inflated type I error rates or a reduction in power; the lone exception was a stratified analysis using random effects for strata, which gave nominal type I error rates and adequate power. Conclusions It is unlikely that a stratified analysis is necessary after stratified randomisation except in extreme scenarios. Therefore, the method of analysis (accounting for the strata, or adjusting only for the covariates) will not generally need to depend on the method of randomisation used. Most methods of analysis work well with large sample sizes, however treating strata as random effects should be the analysis method of choice with binary or time-to-event outcomes and a small sample size. PMID:23898993

Burden of Disease Measured by Disability-Adjusted Life Years and a Disease Forecasting Time Series Model of Scrub Typhus in Laiwu, China

PubMed Central

Yang, Li-Ping; Liang, Si-Yuan; Wang, Xian-Jun; Li, Xiu-Jun; Wu, Yan-Ling; Ma, Wei

2015-01-01

Background Laiwu District is recognized as a hyper-endemic region for scrub typhus in Shandong Province, but the seriousness of this problem has been neglected in public health circles. Methodology/Principal Findings A disability-adjusted life years (DALYs) approach was adopted to measure the burden of scrub typhus in Laiwu, China during the period 2006 to 2012. A multiple seasonal autoregressive integrated moving average model (SARIMA) was used to identify the most suitable forecasting model for scrub typhus in Laiwu. Results showed that the disease burden of scrub typhus is increasing yearly in Laiwu, and which is higher in females than males. For both females and males, DALY rates were highest for the 60–69 age group. Of all the SARIMA models tested, the SARIMA(2,1,0)(0,1,0)12 model was the best fit for scrub typhus cases in Laiwu. Human infections occurred mainly in autumn with peaks in October. Conclusions/Significance Females, especially those of 60 to 69 years of age, were at highest risk of developing scrub typhus in Laiwu, China. The SARIMA (2,1,0)(0,1,0)12 model was the best fit forecasting model for scrub typhus in Laiwu, China. These data are useful for developing public health education and intervention programs to reduce disease. PMID:25569248

Should measures of patient experience in primary care be adjusted for case mix? Evidence from the English General Practice Patient Survey

PubMed Central

Paddison, Charlotte; Elliott, Marc; Parker, Richard; Staetsky, Laura; Lyratzopoulos, Georgios; Campbell, John L

2012-01-01

Objectives Uncertainties exist about when and how best to adjust performance measures for case mix. Our aims are to quantify the impact of case-mix adjustment on practice-level scores in a national survey of patient experience, to identify why and when it may be useful to adjust for case mix, and to discuss unresolved policy issues regarding the use of case-mix adjustment in performance measurement in health care. Design/setting Secondary analysis of the 2009 English General Practice Patient Survey. Responses from 2 163 456 patients registered with 8267 primary care practices. Linear mixed effects models were used with practice included as a random effect and five case-mix variables (gender, age, race/ethnicity, deprivation, and self-reported health) as fixed effects. Main outcome measures Primary outcome was the impact of case-mix adjustment on practice-level means (adjusted minus unadjusted) and changes in practice percentile ranks for questions measuring patient experience in three domains of primary care: access; interpersonal care; anticipatory care planning, and overall satisfaction with primary care services. Results Depending on the survey measure selected, case-mix adjustment changed the rank of between 0.4% and 29.8% of practices by more than 10 percentile points. Adjusting for case-mix resulted in large increases in score for a small number of practices and small decreases in score for a larger number of practices. Practices with younger patients, more ethnic minority patients and patients living in more socio-economically deprived areas were more likely to gain from case-mix adjustment. Age and race/ethnicity were the most influential adjustors. Conclusions While its effect is modest for most practices, case-mix adjustment corrects significant underestimation of scores for a small proportion of practices serving vulnerable patients and may reduce the risk that providers would ‘cream-skim’ by not enrolling patients from vulnerable socio-demographic groups. PMID:22626735

Are Comparisons of Patient Experiences Across Hospitals Fair? A Study in Veterans Health Administration Hospitals

PubMed Central

Cleary, Paul D.; Meterko, Mark; Wright, Steven M.; Zaslavsky, Alan M.

2015-01-01

Background Surveys are increasingly used to assess patient experiences with health care. Comparisons of hospital scores based on patient experience surveys should be adjusted for patient characteristics that might affect survey results. Such characteristics are commonly drawn from patient surveys that collect little, if any, clinical information. Consequently some hospitals, especially those treating particularly complex patients, have been concerned that standard adjustment methods do not adequately reflect the challenges of treating their patients. Objectives To compare scores for different types of hospitals after making adjustments using only survey-reported patient characteristics and using more complete clinical and hospital information. Research Design We used clinical and survey data from a national sample of 1858 veterans hospitalized for an initial acute myocardial infarction (AMI) in a Department of Veterans Affairs (VA) medical center during fiscal years 2003 and 2004. We used VA administrative data to characterize hospitals. The survey asked patients about their experiences with hospital care. The clinical data included 14 measures abstracted from medical records that are predictive of survival after an AMI. Results Comparisons of scores across hospitals adjusted only for patient-reported health status and sociodemographic characteristics were similar to those that also adjusted for patient clinical characteristics; the Spearman rank-order correlations between the 2 sets of adjusted scores were >0.97 across 9 dimensions of inpatient experience. Conclusions This study did not support concerns that measures of patient care experiences are unfair because commonly used models do not adjust adequately for potentially confounding patient clinical characteristics. PMID:24926709

Relationship of Pain and Ancestry in African American Women

PubMed Central

Robbins, John A.; Qi, Lihong; Garcia, Lorena; Younger, Jarred W.; Seldin, Michael F.

2015-01-01

Background African Americans are reported to be more sensitive to pain than European Americans. Pain sensitivity has been shown to be genetically linked in animal models and is likely to be in humans. Methods 11,239 self-identified African American post menopausal women enrolled in the Women’s Health Initiative had percentage African ancestry determined by ancestry informative markers, “Pain Construct” measurements and covariate information. They answered 5 questions about specific types and location of pain, such as joint, neck, low back, headache, and urinary. They also answered 2 questions which were used to derive a “Pain Construct”, a measure of general pain scored on a scale of 1 to 100. Associations were tested in linear regression models adjusting for age, self-reported medical conditions, neighborhood socio-economic status, education, and depression. Results In the unadjusted model of the 5 specific types of pain measures, greater pain perception was associated with a higher proportion of African ancestry. However, some of the specific types of pain measures were no longer associated with African ancestry after adjustment for other study covariates. The Pain Construct was statistically significantly associated with African ancestry in both the unadjusted [Beta = −0.132, 95% confidence interval (C I) = −099 – −0.164; r = −0.075, 95% CI −0.056 – −0.093] and the adjusted models (Beta = −0.069 95% CI = −0.04 – 0.10). Conclusions Greater African ancestry was associated with higher levels of self-reported pain although this accounted for only a minor fraction of the overall variation in the Pain Construct. PMID:25752262

Synthesis and evaluation of chondroitin sulfate based hydrogels of loxoprofen with adjustable properties as controlled release carriers.

PubMed

Khalid, Ikrima; Ahmad, Mahmood; Usman Minhas, Muhammad; Barkat, Kashif

2018-02-01

Mixtures of polymer (chondroitin sulfate) and monomer (AMPS) in the presence of co-monomer (MBA) were employed for the production of hydrogels, with adjustable properties, following free radical copolymerization. The hydrogel's structural properties were assessed by FTIR, DSC, TGA, SEM and XRD which confirmed the development and stability of synthesized structure. The results from FTIR analysis showed that CS react with the AMPS monomer during the polymerization process and confirmed the grafting of AMPS chains onto CS backbone. The surface morphology of CS-co-poly(AMPS) hydrogels, as evident by SEM, corresponds to their improved swelling ability due to high porosity. Thermal analysis showed that crosslinking formed a stable hydrogel network which is thermally more stable than its basic ingredients. The effects of pH revealed an increasing trend in swelling with increasing concentration of either CS or AMPS. In addition, different modalities for drug loading were studied with respect to drug homogeneous distribution; loxoprofen sodium was employed as model drug and was loaded by swelling-diffusion method. In vitro drug release profiles and kinetics were assessed to confirm their reproducibility and reliability. Higuchi model is the best fit model to explain drug release from formed gels indicating diffusion-controlled release. Similarly, Korsmeyer-Peppas model yields remarkably good adjustments where release kinetics involves a combination of diffusion in hydrated matrix and polymer relaxation. Conclusively, CS-co-poly(AMPS) hydrogels could be a potential alternate to conventional dosage forms for controlled delivery of loxoprofen sodium for extended period of time. Copyright © 2017. Published by Elsevier Ltd.

Exposure to Advertisements and Marijuana Use Among US Adolescents

PubMed Central

2017-01-01

Introduction This study examined whether exposure to marijuana advertisements was associated with current marijuana use and frequency of use among US adolescents in grades 8, 10, and 12. Methods Weighted estimates of exposure to marijuana advertisements and marijuana use from the 2014 and 2015 Monitoring the Future studies were investigated. Factors associated with the prevalence and frequency of marijuana use were analyzed by using logistic regression and linear regression models, respectively. Results Of all respondents (n = 12,988), 13.8% reported marijuana use in the past 30 days. Exposure to marijuana advertisements was prevalent among adolescents, with 52.8% reporting exposure from internet advertisements, 32.1% from television advertisements, 24.1% from magazine or newspaper advertisements, 19.7% from radio advertisements, 19.0% from advertisements on storefronts, and 16.6% from billboards. In the multivariable analysis, current use of marijuana among adolescents was associated with exposure to marijuana advertisements on storefronts (adjusted odds ratio [OR] = 1.4, P < .001), magazines or newspapers (adjusted OR = 1.6, P < .001), billboards (adjusted OR = 1.4, P = .002), internet (adjusted OR = 1.8, P < .001), television (adjusted OR = 1.4, P < .001) and radio (adjusted OR = 1.7, P < .001). Exposure to marijuana advertisements from the internet was associated with increased use of marijuana (β = 0.3, P = .04). Conclusion Exposure to marijuana advertisements was associated with higher odds of current marijuana use among adolescents. Regulations that limit marijuana advertisements to adolescents and educational campaigns on harmfulness of illicit marijuana use are needed. PMID:29191259

Instructional Model and Thinking Skill in Chemistry Class

NASA Astrophysics Data System (ADS)

Langkudi, H. H.

2018-02-01

Chemistry course are considered a difficult lesson for students as evidenced by low learning outcomes on daily tests, mid-semester tests as well as final semester tests. This research intended to investigate the effect of instructional model, thinking skill and the interaction of these variables on students’ achievement in chemistry. Experimental method was applying used 2 x 2 factorial design. The results showed that the use of instructional model with thinking skill influences student’s learning outcomes, so that the chemistry teacher is recommended to pay attention to the learning model, and adjusted to the student’s skill thinking on the chemistry material being taught. The conclusion of this research is that discovery model is suitable for students who have formal thinking skill and conventional model is fit for the students that have concrete thinking skill.

Environmental Chemicals in Urine and Blood: Improving Methods for Creatinine and Lipid Adjustment

PubMed Central

O’Brien, Katie M.; Upson, Kristen; Cook, Nancy R.; Weinberg, Clarice R.

2015-01-01

Background Investigators measuring exposure biomarkers in urine typically adjust for creatinine to account for dilution-dependent sample variation in urine concentrations. Similarly, it is standard to adjust for serum lipids when measuring lipophilic chemicals in serum. However, there is controversy regarding the best approach, and existing methods may not effectively correct for measurement error. Objectives We compared adjustment methods, including novel approaches, using simulated case–control data. Methods Using a directed acyclic graph framework, we defined six causal scenarios for epidemiologic studies of environmental chemicals measured in urine or serum. The scenarios include variables known to influence creatinine (e.g., age and hydration) or serum lipid levels (e.g., body mass index and recent fat intake). Over a range of true effect sizes, we analyzed each scenario using seven adjustment approaches and estimated the corresponding bias and confidence interval coverage across 1,000 simulated studies. Results For urinary biomarker measurements, our novel method, which incorporates both covariate-adjusted standardization and the inclusion of creatinine as a covariate in the regression model, had low bias and possessed 95% confidence interval coverage of nearly 95% for most simulated scenarios. For serum biomarker measurements, a similar approach involving standardization plus serum lipid level adjustment generally performed well. Conclusions To control measurement error bias caused by variations in serum lipids or by urinary diluteness, we recommend improved methods for standardizing exposure concentrations across individuals. Citation O’Brien KM, Upson K, Cook NR, Weinberg CR. 2016. Environmental chemicals in urine and blood: improving methods for creatinine and lipid adjustment. Environ Health Perspect 124:220–227; http://dx.doi.org/10.1289/ehp.1509693 PMID:26219104

Concentration Addition, Independent Action and Generalized Concentration Addition Models for Mixture Effect Prediction of Sex Hormone Synthesis In Vitro

PubMed Central

Hadrup, Niels; Taxvig, Camilla; Pedersen, Mikael; Nellemann, Christine; Hass, Ulla; Vinggaard, Anne Marie

2013-01-01

Humans are concomitantly exposed to numerous chemicals. An infinite number of combinations and doses thereof can be imagined. For toxicological risk assessment the mathematical prediction of mixture effects, using knowledge on single chemicals, is therefore desirable. We investigated pros and cons of the concentration addition (CA), independent action (IA) and generalized concentration addition (GCA) models. First we measured effects of single chemicals and mixtures thereof on steroid synthesis in H295R cells. Then single chemical data were applied to the models; predictions of mixture effects were calculated and compared to the experimental mixture data. Mixture 1 contained environmental chemicals adjusted in ratio according to human exposure levels. Mixture 2 was a potency adjusted mixture containing five pesticides. Prediction of testosterone effects coincided with the experimental Mixture 1 data. In contrast, antagonism was observed for effects of Mixture 2 on this hormone. The mixtures contained chemicals exerting only limited maximal effects. This hampered prediction by the CA and IA models, whereas the GCA model could be used to predict a full dose response curve. Regarding effects on progesterone and estradiol, some chemicals were having stimulatory effects whereas others had inhibitory effects. The three models were not applicable in this situation and no predictions could be performed. Finally, the expected contributions of single chemicals to the mixture effects were calculated. Prochloraz was the predominant but not sole driver of the mixtures, suggesting that one chemical alone was not responsible for the mixture effects. In conclusion, the GCA model seemed to be superior to the CA and IA models for the prediction of testosterone effects. A situation with chemicals exerting opposing effects, for which the models could not be applied, was identified. In addition, the data indicate that in non-potency adjusted mixtures the effects cannot always be accounted for by single chemicals. PMID:23990906

Association of Fitness With Incident Dyslipidemias Over 25 Years in the Coronary Artery Risk Development in Young Adults Study

PubMed Central

Sarzynski, Mark A.; Schuna, John M.; Carnethon, Mercedes R.; Jacobs, David R.; Lewis, Cora E.; Quesenberry, Charles P.; Sidney, Stephen; Schreiner, Pamela J.; Sternfeld, Barbara

2015-01-01

Introduction Few studies have examined the longitudinal associations of fitness or changes in fitness on the risk of developing dyslipidemias. This study examined the associations of: (1) baseline fitness with 25-year dyslipidemia incidence; and (2) 20-year fitness change on dyslipidemia development in middle age in the Coronary Artery Risk Development in young Adults (CARDIA) study. Methods Multivariable Cox proportional hazards regression models were used to test the association of baseline fitness (1985–1986) with dyslipidemia incidence over 25 years (2010–2011) in CARDIA (N=4,898). Modified Poisson regression models were used to examine the association of 20-year change in fitness with dyslipidemia incidence between Years 20 and 25 (n=2,487). Data were analyzed in June 2014 and February 2015. Results In adjusted models, the risk of incident low high-density lipoprotein cholesterol (HDL-C), high triglycerides, and high low-density lipoprotein cholesterol (LDL-C) was significantly lower, by 9%, 16%, and 14%, respectively, for each 2.0-minute increase in baseline treadmill endurance. After additional adjustment for baseline trait level, the associations remained significant for incident high triglycerides and high LDL-C in the total population and for incident high triglycerides in both men and women. In race-stratified models, these associations appeared to be limited to whites. In adjusted models, change in fitness did not predict 5-year incidence of dyslipidemias, whereas baseline fitness significantly predicted 5-year incidence of high triglycerides. Conclusions Our findings demonstrate the importance of cardiorespiratory fitness in young adulthood as a risk factor for developing dyslipidemias, particularly high triglycerides, during the transition to middle age. PMID:26165197

THE IMPACT OF MEASURES OF SOCIOECONOMIC STATUS ON HOSPITAL PROFILING IN NEW YORK CITY

PubMed Central

Blum, Alexander B.; Egorova, Natalia N.; Sosunov, Eugene A.; Gelijns, Annetine C.; DuPree, Erin; Moskowitz, Alan J.; Federman, Alex D.; Ascheim, Deborah D.; Keyhani, Salomeh

2014-01-01

Background Current 30-day readmission models used by the Center for Medicare and Medicaid Services for the purpose of hospital-level comparisons lack measures of socioeconomic status (SES). We examined whether the inclusion of a SES measure in 30-day congestive heart failure (CHF) readmission models changed hospital risk standardized readmission rates (RSRR) in New York City (NYC) hospitals. Methods and Results Using a Centers for Medicare & Medicaid Services (CMS)-like model we estimated 30-day hospital-level RSRR by adjusting for age, gender and comorbid conditions. Next, we examined how hospital RSRRs changed relative to the New York City mean with inclusion of the Agency for Healthcare Research and Quality (AHRQ) validated SES index score. In a secondary analysis, we examined whether inclusion of the AHRQ SES Index score in 30-day readmission models disproportionately impacted the RSRR of minority-serving hospitals. Higher AHRQ SES scores, indicators of higher socioeconomic status, were associated with lower odds, 0.99, of 30-day readmission (p< 0.019). The addition of the AHRQ SES index did not change the model’s C statistic (0.63). After adjustment for the AHRQ SES index, one hospital changed status from “worse than the NYC average” to “no different than the NYC average”. After adjustment for the AHRQ SES index, one NYC minority-serving hospital was re-classified from “worse” to “no different than average”. Conclusions While patients with higher SES were less likely to be admitted, the impact of SES on readmission was very small. In NYC, inclusion of the AHRQ SES score in a CMS based model did not impact hospital-level profiling based on 30-day readmission. PMID:24823956

THE RELATIONSHIP BETWEEN SEX HORMONES, SEX HORMONE BINDING GLOBULIN AND PERIPHERAL ARTERY DISEASE IN OLDER PERSONS

PubMed Central

Maggio, M; Cattabiani, C; Lauretani, F; Artoni, A; Bandinelli, S; Schiavi, G; Vignali, A; Volpi, R; Ceresini, G; Lippi, G; Aloe, R; De Vita, F; Giallauria, F; McDermott, MM; Ferrucci, L; Ceda, GP

2014-01-01

Objective The prevalence of peripheral artery disease (PAD) increases with aging and is higher in persons with metabolic syndrome and diabetes. PAD is associated with adverse outcomes, including frailty and disability. The protective effect of testosterone and sex hormone binding globulin (SHBG) for diabetes in men suggests that the biological activity of sex hormones may affect PAD, especially in older populations. Methods Nine hundred and twenty-one elderly subjects with data on SHBG, testosterone (T), estradiol (E2) were selected from InCHIANTI study. PAD was defined as an Ankle-Brachial Index (ABI) <0.90. Logistic regression models adjusted for age (Model 1), age, BMI, insulin, interleukin-6, physical activity, smoking, chronic diseases including metabolic syndrome (Model 2), and a final model including also sex hormones (Model 3) were performed to test the relationship between SHBG, sex hormones and PAD. Results The mean age (± SD) of the 419 men and 502 women was 75.0 ± 6.8 years (Sixty two participants (41 men, 21 women) had ABI<0.90. Men with PAD had SHBG levels lower than men without PAD (p=0.03). SHBG was negatively and independently associated with PAD in men (p=0.028). but not in women. The relationship was however attenuated after adjusting for sex hormones (p=0.07). The E2 was not significantly associated with PAD in both men and women. In women, but not in men, T was positively associated with PAD, even after adjusting for multiple confounders, including E2 (p=0.01). Conclusions Low SHBG and high T levels are significantly and independently associated with the presence of PAD in older men and women, respectively. PMID:23102785

Stereotactic Body Radiotherapy Versus Surgery for Medically Operable Stage I Non-Small-Cell Lung Cancer: A Markov Model-Based Decision Analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Louie, Alexander V.; Rodrigues, George, E-mail: george.rodrigues@lhsc.on.ca; Department of Epidemiology/Biostatistics, University of Western Ontario, London, ON

Purpose: To compare the quality-adjusted life expectancy and overall survival in patients with Stage I non-small-cell lung cancer (NSCLC) treated with either stereotactic body radiation therapy (SBRT) or surgery. Methods and Materials: We constructed a Markov model to describe health states after either SBRT or lobectomy for Stage I NSCLC for a 5-year time frame. We report various treatment strategy survival outcomes stratified by age, sex, and pack-year history of smoking, and compared these with an external outcome prediction tool (Adjuvant{exclamation_point} Online). Results: Overall survival, cancer-specific survival, and other causes of death as predicted by our model correlated closely withmore » those predicted by the external prediction tool. Overall survival at 5 years as predicted by baseline analysis of our model is in favor of surgery, with a benefit ranging from 2.2% to 3.0% for all cohorts. Mean quality-adjusted life expectancy ranged from 3.28 to 3.78 years after surgery and from 3.35 to 3.87 years for SBRT. The utility threshold for preferring SBRT over surgery was 0.90. Outcomes were sensitive to quality of life, the proportion of local and regional recurrences treated with standard vs. palliative treatments, and the surgery- and SBRT-related mortalities. Conclusions: The role of SBRT in the medically operable patient is yet to be defined. Our model indicates that SBRT may offer comparable overall survival and quality-adjusted life expectancy as compared with surgical resection. Well-powered prospective studies comparing surgery vs. SBRT in early-stage lung cancer are warranted to further investigate the relative survival, quality of life, and cost characteristics of both treatment paradigms.« less

Comparing Self-Reported Health Status and Diagnosis-Based Risk Adjustment to Predict 1- and 2 to 5-Year Mortality

PubMed Central

Pietz, Kenneth; Petersen, Laura A

2007-01-01

Objectives To compare the ability of two diagnosis-based risk adjustment systems and health self-report to predict short- and long-term mortality. Data Sources/Study Setting Data were obtained from the Department of Veterans Affairs (VA) administrative databases. The study population was 78,164 VA beneficiaries at eight medical centers during fiscal year (FY) 1998, 35,337 of whom completed an 36-Item Short Form Health Survey for veterans (SF-36V) survey. Study Design We tested the ability of Diagnostic Cost Groups (DCGs), Adjusted Clinical Groups (ACGs), SF-36V Physical Component score (PCS) and Mental Component Score (MCS), and eight SF-36V scales to predict 1- and 2–5 year all-cause mortality. The additional predictive value of adding PCS and MCS to ACGs and DCGs was also evaluated. Logistic regression models were compared using Akaike's information criterion, the c-statistic, and the Hosmer–Lemeshow test. Principal Findings The c-statistics for the eight scales combined with age and gender were 0.766 for 1-year mortality and 0.771 for 2–5-year mortality. For DCGs with age and gender the c-statistics for 1- and 2–5-year mortality were 0.778 and 0.771, respectively. Adding PCS and MCS to the DCG model increased the c-statistics to 0.798 for 1-year and 0.784 for 2–5-year mortality. Conclusions The DCG model showed slightly better performance than the eight-scale model in predicting 1-year mortality, but the two models showed similar performance for 2–5-year mortality. Health self-report may add health risk information in addition to age, gender, and diagnosis for predicting longer-term mortality. PMID:17362210

Self-Reported Sleep Duration in Relation to Incident Stroke Symptoms: Nuances by Body Mass and Race from the REGARDS Study

PubMed Central

Ruiter Petrov, Megan E.; Letter, Abraham J.; Howard, Virginia J.; Kleindorfer, Dawn

2013-01-01

Objectives Determine, amongst employed persons with low risk for obstructive sleep apnea (OSA), if sleep duration is associated with incident stroke symptoms, independent of body mass index (BMI), and if sleep duration mediates racial differences in stroke symptoms. Methods In 2008, 5,666 employed participants (US blacks and whites, ≥45years) from the longitudinal and nationally-representative REasons for Geographic And Racial Differences in Stroke (REGARDS) study, self-reported their average sleep duration. Participants had no history of stroke, transient ischemic attack, or stroke symptoms, and were low risk for OSA. After the sleep assessment, self-reported stroke symptoms were collected at six-month intervals, up to 3 years (M=751 days). Interval-censored, parametric survival models were conducted to estimate hazard ratios predicting time from sleep duration measurement (<6, 6-6.9, 7-7.9(reference), 8-8.9, ≥9 hours) to first stroke symptom. Adjusted models included demographics, stroke risk factors, psychological symptoms, health behaviors, and diet. Results During follow-up, 224 participants reported ≥1 stroke symptom. In the unadjusted model, short sleep (<6hrs) significantly predicted increased risk of stroke symptoms, but not in adjusted models. Stratification by BMI revealed a significant association between short sleep duration and stroke symptoms only for normal BMI persons in unadjusted (HR: 2.93, 95%CI: 1.38-6.22) and fully adjusted models (HR: 4.19, 95%CI: 1.62-10.84). The mediating effect of sleep duration on the relationship between race and stroke symptoms was borderline significant in normal weight participants. Conclusions Among middle-aged to older employed individuals of normal weight and low risk of OSA, self-reported short sleep duration is prospectively associated with increased risk of stroke symptoms. PMID:24119626

A Cost-Utility Model of Care for Peristomal Skin Complications

PubMed Central

Inglese, Gary; Manson, Andrea; Townshend, Arden

2016-01-01

PURPOSE: The aim of this study was to evaluate the economic and humanistic implications of using ostomy components to prevent subsequent peristomal skin complications (PSCs) in individuals who experience an initial, leakage-related PSC event. DESIGN: Cost-utility analysis. METHODS: We developed a simple decision model to consider, from a payer's perspective, PSCs managed with and without the use of ostomy components over 1 year. The model evaluated the extent to which outcomes associated with the use of ostomy components (PSC events avoided; quality-adjusted life days gained) offset the costs associated with their use. RESULTS: Our base case analysis of 1000 hypothetical individuals over 1 year assumes that using ostomy components following a first PSC reduces recurrent events versus PSC management without components. In this analysis, component acquisition costs were largely offset by lower resource use for ostomy supplies (barriers; pouches) and lower clinical utilization to manage PSCs. The overall annual average resource use for individuals using components was about 6.3% ($139) higher versus individuals not using components. Each PSC event avoided yielded, on average, 8 additional quality-adjusted life days over 1 year. CONCLUSIONS: In our analysis, (1) acquisition costs for ostomy components were offset in whole or in part by the use of fewer ostomy supplies to manage PSCs and (2) use of ostomy components to prevent PSCs produced better outcomes (fewer repeat PSC events; more health-related quality-adjusted life days) over 1 year compared to not using components. PMID:26633166

Preoperative anemia and postoperative outcomes after hepatectomy

PubMed Central

Tohme, Samer; Varley, Patrick R.; Landsittel, Douglas P.; Chidi, Alexis P.; Tsung, Allan

2015-01-01

Background Preoperative anaemia is associated with adverse outcomes after surgery but outcomes after liver surgery specifically are not well established. We aimed to analyze the incidence of and effects of preoperative anemia on morbidity and mortality in patients undergoing liver resection. Methods All elective hepatectomies performed for the period 2005–2012 recorded in the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database were evaluated. We obtained anonymized data for 30-day mortality and major morbidity (one or more major complication), demographics, and preoperative and perioperative risk factors. We used multivariable logistic regression models to assess the adjusted effect of anemia, which was defined as (hematocrit <39% in men, <36% in women), on postoperative outcomes. Results We obtained data for 12,987 patients, of whom 4260 (32.8%) had preoperative anemia. Patients with preoperative anemia experienced higher postoperative major morbidity and mortality rates compared to those without anemia. After adjustment for predefined variables, preoperative anemia was an independent risk factor for postoperative major morbidity (adjusted OR 1.21, 1.09–1.33). After adjustment, there was no significant difference in postoperative mortality for patients with or without preoperative anemia (adjusted OR 0.88, 0.66–1.16). Conclusion Preoperative anemia is independently associated with an increased risk of major morbidity in patients undergoing hepatectomy. Therefore, it is crucial to readdress preoperative blood management in anemic patients prior to hepatectomy. PMID:27017165

Relationship between mobility, violence and HIV/STI among female sex workers in Andhra Pradesh, India

PubMed Central

2012-01-01

Background Violence and mobility have been identified as critical factors contributing to the spread of HIV worldwide. This study aimed to assess the independent and combined associations of mobility and violence with sexual risk behaviors and HIV, STI prevalence among female sex workers (FSWs) in India. Methods Data were drawn from a cross-sectional, bio-behavioral survey conducted among 2042 FSWs across five districts of southern India in 2005–06. Regression models were used to estimate odds ratios and 95% confidence intervals (CIs) for sexual risk behaviors and HIV infection based on experience of violence and mobility after adjusting for socio-demographic and sex work related characteristics. Results One-fifth of FSWs (19%) reported experiencing violence; 68% reported travelling outside their current place of residence at least once in the past year and practicing sex work during their visit. Mobile FSWs were more likely to report violence compared to their counterparts (23% vs. 10%, p < 0.001). Approximately 1 in 5 tested positive for HIV. In adjusted models, FSWs reporting both mobility and violence as compared to their counterparts were more likely to be infected with HIV (Adjusted odds ratio (adjusted OR): 2.07, 95% CI: 1.42–3.03) and to report unprotected sex with occasional (adjusted OR: 2.86, 95% CI: 1.76–4.65) and regular clients (adjusted OR: 2.07, 95% CI: 1.40–3.06). Conclusions The findings indicate that mobility and violence were independently associated with HIV infection. Notably, the combined effect of mobility and violence posed greater HIV risk than their independent effect. These results point to the need for the provision of an enabling environment and safe spaces for FSWs who are mobile, to augment existing efforts to reduce the spread of HIV/AIDS. PMID:22967276

Is the maturity of hospitals' quality improvement systems associated with measures of quality and patient safety?

PubMed Central

2011-01-01

Background Previous research addressed the development of a classification scheme for quality improvement systems in European hospitals. In this study we explore associations between the 'maturity' of the hospitals' quality improvement system and clinical outcomes. Methods The maturity classification scheme was developed based on survey results from 389 hospitals in eight European countries. We matched the hospitals from the Spanish sample (113 hospitals) with those hospitals participating in a nation-wide, voluntary hospital performance initiative. We then compared sample distributions and explored associations between the 'maturity' of the hospitals' quality improvement system and a range of composite outcomes measures, such as adjusted hospital-wide mortality, -readmission, -complication and -length of stay indices. Statistical analysis includes bivariate correlations for parametrically and non-parametrically distributed data, multiple robust regression models and bootstrapping techniques to obtain confidence-intervals for the correlation and regression estimates. Results Overall, 43 hospitals were included. Compared to the original sample of 113, this sample was characterized by a higher representation of university hospitals. Maturity of the quality improvement system was similar, although the matched sample showed less variability. Analysis of associations between the quality improvement system and hospital-wide outcomes suggests significant correlations for the indicator adjusted hospital complications, borderline significance for adjusted hospital readmissions and non-significance for the adjusted hospital mortality and length of stay indicators. These results are confirmed by the bootstrap estimates of the robust regression model after adjusting for hospital characteristics. Conclusions We assessed associations between hospitals' quality improvement systems and clinical outcomes. From this data it seems that having a more developed quality improvement system is associated with lower rates of adjusted hospital complications. A number of methodological and logistic hurdles remain to link hospital quality improvement systems to outcomes. Further research should aim at identifying the latent dimensions of quality improvement systems that predict quality and safety outcomes. Such research would add pertinent knowledge regarding the implementation of organizational strategies related with quality of care outcomes. PMID:22185479

Cycling Empirical Antibiotic Therapy in Hospitals: Meta-Analysis and Models

PubMed Central

Abel, Sören; Viechtbauer, Wolfgang; Bonhoeffer, Sebastian

2014-01-01

The rise of resistance together with the shortage of new broad-spectrum antibiotics underlines the urgency of optimizing the use of available drugs to minimize disease burden. Theoretical studies suggest that coordinating empirical usage of antibiotics in a hospital ward can contain the spread of resistance. However, theoretical and clinical studies came to different conclusions regarding the usefulness of rotating first-line therapy (cycling). Here, we performed a quantitative pathogen-specific meta-analysis of clinical studies comparing cycling to standard practice. We searched PubMed and Google Scholar and identified 46 clinical studies addressing the effect of cycling on nosocomial infections, of which 11 met our selection criteria. We employed a method for multivariate meta-analysis using incidence rates as endpoints and find that cycling reduced the incidence rate/1000 patient days of both total infections by 4.95 [9.43–0.48] and resistant infections by 7.2 [14.00–0.44]. This positive effect was observed in most pathogens despite a large variance between individual species. Our findings remain robust in uni- and multivariate metaregressions. We used theoretical models that reflect various infections and hospital settings to compare cycling to random assignment to different drugs (mixing). We make the realistic assumption that therapy is changed when first line treatment is ineffective, which we call “adjustable cycling/mixing”. In concordance with earlier theoretical studies, we find that in strict regimens, cycling is detrimental. However, in adjustable regimens single resistance is suppressed and cycling is successful in most settings. Both a meta-regression and our theoretical model indicate that “adjustable cycling” is especially useful to suppress emergence of multiple resistance. While our model predicts that cycling periods of one month perform well, we expect that too long cycling periods are detrimental. Our results suggest that “adjustable cycling” suppresses multiple resistance and warrants further investigations that allow comparing various diseases and hospital settings. PMID:24968123

Higher Serum Direct Bilirubin Levels Were Associated with a Lower Risk of Incident Chronic Kidney Disease in Middle Aged Korean Men

PubMed Central

Ryu, Seungho; Chang, Yoosoo; Zhang, Yiyi; Woo, Hee-Yeon; Kwon, Min-Jung; Park, Hyosoon; Lee, Kyu-Beck; Son, Hee Jung; Cho, Juhee; Guallar, Eliseo

2014-01-01

Background The association between serum bilirubin levels and incident chronic kidney disease (CKD) in the general population is unknown. We aimed to examine the association between serum bilirubin concentration (total, direct, and indirect) and the risk of incident CKD. Methods and Findings Longitudinal cohort study of 12,823 Korean male workers 30 to 59 years old without CKD or proteinuria at baseline participating in medical health checkup program in a large worksite. Study participants were followed for incident CKD from 2002 through 2011. Estimated glomerular filtration rate (eGFR) was estimated by using the CKD-EPI equation. CKD was defined as eGFR <60 mL/min per 1.73 m2. Parametric Cox models and pooled logistic regression models were used to estimate adjusted hazard ratios for incident CKD. We observed 238 incident cases of CKD during 70,515.8 person-years of follow-up. In age-adjusted models, the hazard ratios for CKD comparing quartiles 2–4 vs. quartile 1 of serum direct bilirubin were 0.93 (95% CI 0.67–1.28), 0.88 (0.60–1.27) and 0.60 (0.42–0.88), respectively. In multivariable models, the adjusted hazard ratio for CKD comparing the highest to the lowest quartile of serum direct bilirubin levels was 0.60 (95% CI 0.41–0.87; P trend = 0.01). Neither serum total nor indirect bilirubin levels were significantly associated with the incidence of CKD. Conclusions Higher serum direct bilirubin levels were significantly associated with a lower risk of developing CKD, even adjusting for a variety of cardiometabolic parameters. Further research is needed to elucidate the mechanisms underlying this association and to establish the role of serum direct bilirubin as a marker for CKD risk. PMID:24586219

An evaluation of gender equity in different models of primary care practices in Ontario

PubMed Central

2010-01-01

Background The World Health Organization calls for more work evaluating the effect of health care reforms on gender equity in developed countries. We performed this evaluation in Ontario, Canada where primary care models resulting from reforms co-exist. Methods This cross sectional study of primary care practices uses data collected in 2005-2006. Healthcare service models included in the study consist of fee for service (FFS) based, salaried, and capitation based. We compared the quality of care delivered to women and men in practices of each model. We performed multi-level, multivariate regressions adjusting for patient socio-demographic and economic factors to evaluate vertical equity, and adjusting for these and health factors in evaluating horizontal equity. We measured seven dimensions of health service delivery (e.g. accessibility and continuity) and three dimensions of quality of care using patient surveys (n = 5,361) and chart abstractions (n = 4,108). Results Health service delivery measures were comparable in women and men, with differences ≤ 2.2% in all seven dimensions and in all models. Significant gender differences in the health promotion subjects addressed were observed. Female specific preventive manoeuvres were more likely to be performed than other preventive care. Men attending FFS practices were more likely to receive influenza immunization than women (Adjusted odds ratio: 1.75, 95% confidence intervals (CI) 1.05, 2.92). There was no difference in the other three prevention indicators. FFS practices were also more likely to provide recommended care for chronic diseases to men than women (Adjusted difference of -11.2%, CI -21.7, -0.8). A similar trend was observed in Community Health Centers (CHC). Conclusions The observed differences in the type of health promotion subjects discussed are likely an appropriate response to the differential healthcare needs between genders. Chronic disease care is non equitable in FFS but not in capitation based models. We recommend that efforts to monitor and address gender based differences in the delivery of chronic disease management in primary care be pursued. PMID:20331861

[Consumption of fruits and its association with nutritional status in chilean university students career of physical education].

PubMed

Durán-Agüero, Samuel; Valdes-Badilla, Pablo; Godoy Cumillaf, Andrés; Herrera-Valenzuela, Tomás

2015-05-01

Chile is a country that reaches the highest levels of overweight and obesity worldwide (66.7% of the Chilean population), with a group of college students tending to swell these numbers considered nutritionally vulnerable group. To associate the consumption of fruits with nutritional status of Chilean university students in physical education. The study population consisted of all students of the School of Pedagogy in Physical Education from the Autonomous University of Chile, Temuco based (n = 420). The sample included 239 students (56.9%), men (76.5%) with a mean age of 21.5 ± 2.1 years. Each student nutritional status was determined and applied a validated survey eating habits. An association between fruit consumption (≥2 servings / day) in the model crude OR = 0.528 (from 0.288 to 0.965), Model 1 adjusted OR = 0.496 (0.268 to 0.916) and Model 2 adjusted OR = 0.495 is observed (0.265 to 0.924) CONCLUSION: Consumption ≥ 2 servings a day of fruits is a protective factor for a good BMI Chilean university students in physical education. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

GENETIC VARIANTS, IMMUNE FUNCTION AND RISK OF PRE-ECLAMPSIA AMONG AMERICAN INDIANS

PubMed Central

Best, Lyle G.; Nadeau, Melanie; Davis, Kylie; Lamb, Felicia; Bercier, Shellee; Anderson, Cindy M.

2011-01-01

Objective To determine the prevalence in an American Indian population of genetic variants with putative effects on immune function and determine if they are associated with pre-eclampsia. Methods In a study of 66 cases and 130 matched controls, six single nucleotide polymorphisms (SNP) with either previously demonstrated or postulated modulating effects on the immune system were genotyped. Allele frequencies and various genetic models were evaluated by conditional logistic regression in both univariate and multiply adjusted models. Results Although most genetic variants lacked evidence of association with pre-eclampsia, the minor allele of the CRP related, rs1205 SNP in a dominant model with adjustment for age at delivery, nulliparity and body mass index, exhibited an odds ratio of 0.259 (95% CI of 0.08 – 0.81, p=0.020) in relation to severe pre-eclampsia (48 cases). The allelic prevalence of this variant was 46.1% in this population. Conclusion Of the six SNPs related to immune function in this study, a functional variant in the 3'UTR of the CRP gene was shown to be associated with severe pre-eclampsia in an American Indian population. PMID:22004660

Influenza vaccines in low and middle income countries: a systematic review of economic evaluations.

PubMed

Ott, Jördis J; Klein Breteler, Janna; Tam, John S; Hutubessy, Raymond C W; Jit, Mark; de Boer, Michiel R

2013-07-01

Economic evaluations on influenza vaccination from low resource settings are scarce and have not been evaluated using a systematic approach. Our objective was to conduct a systematic review on the value for money of influenza vaccination in low- and middle-income countries. PubMed and EMBASE were searched for economic evaluations published in any language between 1960 and 2011. Main outcome measures were costs per influenza outcome averted, costs per quality-adjusted life years gained or disability-adjusted life years averted, costs per benefit in monetary units or cost-benefit ratios. Nine economic evaluations on seasonal influenza vaccine met the inclusion criteria. These were model- or randomized-controlled-trial (RCT)-based economic evaluations from middle-income countries. Influenza vaccination provided value for money for elderly, infants, adults and children with high-risk conditions. Vaccination was cost-effective and cost-saving for chronic obstructive pulmonary disease patients and in elderly above 65 y from model-based evaluations, but conclusions from RCTs on elderly varied. Economic evaluations from middle income regions differed in population studied, outcomes and definitions used. Most findings are in line with evidence from high-income countries highlighting that influenza vaccine is likely to provide value for money. However, serious methodological limitations do not allow drawing conclusions on cost-effectiveness of influenza vaccination in middle income countries. Evidence on cost-effectiveness from low-income countries is lacking altogether, and more information is needed from full economic evaluations that are conducted in a standardized manner.

Exploring rationality in schizophrenia

PubMed Central

Mortensen, Erik Lykke; Owen, Gareth; Nordgaard, Julie; Jansson, Lennart; Sæbye, Ditte; Flensborg-Madsen, Trine; Parnas, Josef

2015-01-01

Background Empirical studies of rationality (syllogisms) in patients with schizophrenia have obtained different results. One study found that patients reason more logically if the syllogism is presented through an unusual content. Aims To explore syllogism-based rationality in schizophrenia. Method Thirty-eight first-admitted patients with schizophrenia and 38 healthy controls solved 29 syllogisms that varied in presentation content (ordinary v. unusual) and validity (valid v. invalid). Statistical tests were made of unadjusted and adjusted group differences in models adjusting for intelligence and neuropsychological test performance. Results Controls outperformed patients on all syllogism types, but the difference between the two groups was only significant for valid syllogisms presented with unusual content. However, when adjusting for intelligence and neuropsychological test performance, all group differences became non-significant. Conclusions When taking intelligence and neuropsychological performance into account, patients with schizophrenia and controls perform similarly on syllogism tests of rationality. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence. PMID:27703730

Fluid flow characteristics during polymer flooding

NASA Astrophysics Data System (ADS)

Yao, S. L.; Dou, H. E.; Wu, M.; Zhang, H. J.

2018-05-01

At present the main problems of polymer flooding is the high injection pressure which could not guarantee the later injection. In this paper the analyses of polymer’s physical properties and its solution’s variable movement characteristics in porous media reveal the inevitable trend of decrease in injection capacity and liquid production due to the increase of fluid viscosity and flow rate with more flow resistance. The injection rate makes the primary contribution to the active viscosity of the polymer solution in porous media. The higher injection rate, the greater shearing degradation and the more the viscosity loss. Besides the quantitative variation, the rate also changes qualitatively as that the injection rate demonstrates composite change of injection intensity and density. Due to the different adjustment function of the polymer solution on its injection profile, there should be different adjustment model of rates in such stages. Here in combination of the on-site recognitions, several conclusions and recommendations are made based on the study of the injection pattern adjustment during polymer flooding to improve the pressure distribution system, which would be a meaningful reference for extensive polymer flooding in the petroleum industry.

Marginal Structural Cox Models for Estimating the Association Between β-Interferon Exposure and Disease Progression in a Multiple Sclerosis Cohort

PubMed Central

Karim, Mohammad Ehsanul; Gustafson, Paul; Petkau, John; Zhao, Yinshan; Shirani, Afsaneh; Kingwell, Elaine; Evans, Charity; van der Kop, Mia; Oger, Joel; Tremlett, Helen

2014-01-01

Longitudinal observational data are required to assess the association between exposure to β-interferon medications and disease progression among relapsing-remitting multiple sclerosis (MS) patients in the “real-world” clinical practice setting. Marginal structural Cox models (MSCMs) can provide distinct advantages over traditional approaches by allowing adjustment for time-varying confounders such as MS relapses, as well as baseline characteristics, through the use of inverse probability weighting. We assessed the suitability of MSCMs to analyze data from a large cohort of 1,697 relapsing-remitting MS patients in British Columbia, Canada (1995–2008). In the context of this observational study, which spanned more than a decade and involved patients with a chronic yet fluctuating disease, the recently proposed “normalized stabilized” weights were found to be the most appropriate choice of weights. Using this model, no association between β-interferon exposure and the hazard of disability progression was found (hazard ratio = 1.36, 95% confidence interval: 0.95, 1.94). For sensitivity analyses, truncated normalized unstabilized weights were used in additional MSCMs and to construct inverse probability weight-adjusted survival curves; the findings did not change. Additionally, qualitatively similar conclusions from approximation approaches to the weighted Cox model (i.e., MSCM) extend confidence in the findings. PMID:24939980

Impact of Neighborhood Socioeconomic Conditions on the Risk of Stroke in Japan

PubMed Central

Honjo, Kaori; Iso, Hiroyasu; Nakaya, Tomoki; Hanibuchi, Tomoya; Ikeda, Ai; Inoue, Manami; Sawada, Norie; Tsugane, Shoichiro

2015-01-01

Background Neighborhood deprivation has been shown in many studies to be an influential factor in cardiovascular disease risk. However, no previous studies have examined the effect of neighborhood socioeconomic conditions on the risk of stroke in Asian countries. Methods This study investigated whether neighborhood deprivation was associated with the risk of stroke and stroke death using data from the Japan Public Health Center-based Prospective Study. We calculated the adjusted hazard ratios of stroke mortality (mean follow-up, 16.4 years) and stroke incidence (mean follow-up, 15.4 years) according to the area deprivation index (ADI) among 90 843 Japanese men and women aged 40–69 years. A Cox proportional-hazard regression model using a shared frailty model was applied. Results The adjusted hazard ratios of stroke incidence, in order of increasing deprivation with reference to the least deprived area, were 1.16 (95% CI, 1.04–1.29), 1.12 (95% CI, 1.00–1.26), 1.18 (95% CI, 1.02–1.35), and 1.19 (95% CI, 1.01–1.41), after adjustment for individual socioeconomic conditions. Behavioral and psychosocial factors attenuated the association, but the association remained significant. The associations were explained by adjusting for biological cardiovascular risk factors. No significant association with stroke mortality was identified. Conclusions Our results indicate that the neighborhood deprivation level influences stroke incidence in Japan, suggesting that area socioeconomic conditions could be a potential target for public health intervention to reduce the risk of stroke. PMID:25757802

The HHS-HCC Risk Adjustment Model for Individual and Small Group Markets under the Affordable Care Act

PubMed Central

Kautter, John; Pope, Gregory C; Ingber, Melvin; Freeman, Sara; Patterson, Lindsey; Cohen, Michael; Keenan, Patricia

2014-01-01

Beginning in 2014, individuals and small businesses are able to purchase private health insurance through competitive Marketplaces. The Affordable Care Act (ACA) provides for a program of risk adjustment in the individual and small group markets in 2014 as Marketplaces are implemented and new market reforms take effect. The purpose of risk adjustment is to lessen or eliminate the influence of risk selection on the premiums that plans charge. The risk adjustment methodology includes the risk adjustment model and the risk transfer formula. This article is the second of three in this issue of the Review that describe the Department of Health and Human Services (HHS) risk adjustment methodology and focuses on the risk adjustment model. In our first companion article, we discuss the key issues and choices in developing the methodology. In this article, we present the risk adjustment model, which is named the HHS-Hierarchical Condition Categories (HHS-HCC) risk adjustment model. We first summarize the HHS-HCC diagnostic classification, which is the key element of the risk adjustment model. Then the data and methods, results, and evaluation of the risk adjustment model are presented. Fifteen separate models are developed. For each age group (adult, child, and infant), a model is developed for each cost sharing level (platinum, gold, silver, and bronze metal levels, as well as catastrophic plans). Evaluation of the risk adjustment models shows good predictive accuracy, both for individuals and for groups. Lastly, this article provides examples of how the model output is used to calculate risk scores, which are an input into the risk transfer formula. Our third companion paper describes the risk transfer formula. PMID:25360387

77 FR 17219 - Patient Protection and Affordable Care Act; Standards Related to Reinsurance, Risk Corridors and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-23

... parts of the risk adjustment process--the risk adjustment model, the calculation of plan average... risk adjustment process. The risk adjustment model calculates individual risk scores. The calculation...'' to mean all data that are used in a risk adjustment model, the calculation of plan average actuarial...

Hospital Standardized Mortality Ratios: Sensitivity Analyses on the Impact of Coding

PubMed Central

Bottle, Alex; Jarman, Brian; Aylin, Paul

2011-01-01

Introduction Hospital standardized mortality ratios (HSMRs) are derived from administrative databases and cover 80 percent of in-hospital deaths with adjustment for available case mix variables. They have been criticized for being sensitive to issues such as clinical coding but on the basis of limited quantitative evidence. Methods In a set of sensitivity analyses, we compared regular HSMRs with HSMRs resulting from a variety of changes, such as a patient-based measure, not adjusting for comorbidity, not adjusting for palliative care, excluding unplanned zero-day stays ending in live discharge, and using more or fewer diagnoses. Results Overall, regular and variant HSMRs were highly correlated (ρ > 0.8), but differences of up to 10 points were common. Two hospitals were particularly affected when palliative care was excluded from the risk models. Excluding unplanned stays ending in same-day live discharge had the least impact despite their high frequency. The largest impacts were seen when capturing postdischarge deaths and using just five high-mortality diagnosis groups. Conclusions HSMRs in most hospitals changed by only small amounts from the various adjustment methods tried here, though small-to-medium changes were not uncommon. However, the position relative to funnel plot control limits could move in a significant minority even with modest changes in the HSMR. PMID:21790587

Prostate Cancer Radiation Therapy and Risk of Thromboembolic Events

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bosco, Cecilia, E-mail: Cecilia.t.bosco@kcl.ac.uk; Garmo, Hans; Regional Cancer Centre, Uppsala, Akademiska Sjukhuset, Uppsala

Purpose: To investigate the risk of thromboembolic disease (TED) after radiation therapy (RT) with curative intent for prostate cancer (PCa). Patients and Methods: We identified all men who received RT as curative treatment (n=9410) and grouped according to external beam RT (EBRT) or brachytherapy (BT). By comparing with an age- and county-matched comparison cohort of PCa-free men (n=46,826), we investigated risk of TED after RT using Cox proportional hazard regression models. The model was adjusted for tumor characteristics, demographics, comorbidities, PCa treatments, and known risk factors of TED, such as recent surgery and disease progression. Results: Between 2006 and 2013, 6232more » men with PCa received EBRT, and 3178 underwent BT. A statistically significant association was found between EBRT and BT and risk of pulmonary embolism in the crude analysis. However, upon adjusting for known TED risk factors these associations disappeared. No significant associations were found between BT or EBRT and deep venous thrombosis. Conclusion: Curative RT for prostate cancer using contemporary methodologies was not associated with an increased risk of TED.« less

Modeling Employer Self-Insurance Decisions after the Affordable Care Act

PubMed Central

Cordova, Amado; Eibner, Christine; Vardavas, Raffaele; Broyles, James; Girosi, Federico

2013-01-01

Objective To present a microsimulation model that addresses the methodological challenge of estimating the firm decision to self-insure. Methodology The model considers the risk that the firm bears when self-insuring and the opportunity to mitigate that risk by purchasing stop-loss insurance. The model makes use of a structural, utility maximization framework to account for numerous aspects of the firm decision, and a multinomial probit to reproduce the elasticity of the firm's demand for health insurance. Findings and Conclusions Our simulations provide three important conclusions. First, they project significant increases in self-insurance rates among small firms--presumably induced by the desire to avoid ACA's rate-banding and risk adjustment regulations—only if generous stop-loss policies become widely available. Second, they show that this increase would be due to this hypothetical adoption of widespread, generous reinsurance by the market and not by passage of the ACA. Third, even with a substantial increase of self-insurance rates among small firms, they project negligible adverse selection in the exchanges, as indicated by our finding that the increase in exchange premium is less than 0.5% when assuming very generous stop-loss policies after implementation of the ACA. PMID:23346976

Space Station Freedom restructure impacts on technology experiment accommodation

NASA Technical Reports Server (NTRS)

Avery, Don E.; Collier, Lisa D.; Degrace, David M.; Thomas, Carolyn C.

1992-01-01

This is a follow up to NASA Technical Memorandum (TM) 102766; it provides an overview of the Office of Aeronautics and Space Technology (OAST) Space Station Freedom (SSF) Technology Development Payload Program, reviews the OAST SSF resource requirements, and contrasts the requirements with the resources that are available to OAST since the restructure of SSF. A discussion of the issues as well as conclusions and recommendations, is provided. It is concluded that, even after adjustments to the OAST traffic model to reflect restructure, some resources will be inadequate even at the 20 percent allocation level. It is also concluded that bartering resources among U.S. users and international partners, and increasing the level of automation may be viable solutions to the resource constraint problem. The final conclusion is that, to facilitate the performance of technology experiments on SSF, OAST should fund SSF experiments and update its traffic model as soon as possible, and should provide technical and programmatic assistance to technology experiment developers.

Vigorous Physical Activity, Mental Health, Perceived Stress, and Socializing Among College Students

PubMed Central

VanKim, Nicole A.; Nelson, Toben F.

2013-01-01

Purpose To examine cross-sectional associations between vigorous physical activity, mental health, perceived stress, and socializing among 4-year college students. Design A national cross-sectional sample of 4-year colleges in the United States. Setting Ninety-four 4-year colleges in the United States. Subjects A total of 14,804 undergraduate students. Measures Self-report vigorous physical activity, perceived stress (measured using the Cohen Perceived Stress Scale), mental health (measured using the SF-36), and socializing (assessed using self-report number of friends and hours spent socializing). Analysis Logistic regression models accounting for clustering within schools were estimated to examine the association between vigorous physical activity, mental health, perceived stress, and socializing. Adjusted models included high school vigorous physical activity and sociodemographic characteristics. Results Students who met vigorous physical activity recommendations were less likely to report poor mental health (adjusted odds ratio [OR]: .79; 95% confidence interval [CI]: .69, .90) and perceived stress (adjusted OR: .75; 95% CI: .67, .83) than students who did not meet recommendations. In addition, socializing partially mediated the relationship between vigorous physical activity, mental health, and perceived stress; however, race and sex did not moderate the relationship. Conclusion Interventions aiming to improve mental well-being of college students should also consider promoting physical activity. At least some of the positive benefits of physical activity may arise from social interactions. PMID:23470187

Organisational justice and smoking: the Finnish public sector study

PubMed Central

Kouvonen, Anne; Vahtera, Jussi; Elovainio, Marko; Cox, Sara J; Cox, Tom; Linna, Anne; Virtanen, Marianna; Kivimäki, Mika

2007-01-01

Objective To examine the extent to which the justice of decision‐making procedures and interpersonal relationships is associated with smoking. Setting 10 municipalities and 21 hospitals in Finland. Design and participants Cross‐sectional data derived from the Finnish Public Sector Study were analysed with logistic regression analysis models with generalised estimating equations. Analyses of smoking status were based on data provided by 34 021 employees. Separate models for heavy smoking (⩾20 cigarettes/day) were calculated for 6295 current smokers. Results After adjustment for age, education, socioeconomic position, marital status, job contract and negative affectivity, smokers who reported low procedural justice were about 1.4 times more likely to smoke ⩾20 cigarettes/day compared with their counterparts who reported high levels of justice. In a similar way, after adjustments, low levels of justice in interpersonal treatment was significantly associated with an increased prevalence of heavy smoking (OR 1.35, 95% CI 1.03 to 1.77 for men and OR 1.41, 95% CI 1.09 to 1.83 for women). Further adjustment for job strain and effort–reward imbalance had little effect on these results. No associations were observed between justice components and smoking status or ex‐smoking. Conclusions The extent to which employees are treated with justice in the workplace seems to be associated with smoking intensity independently of established stressors at work. PMID:17435210

Identification of SNPs associated with variola virus virulence

PubMed Central

2013-01-01

Background Decades after the eradication of smallpox, its etiological agent, variola virus (VARV), remains a threat as a potential bioweapon. Outbreaks of smallpox around the time of the global eradication effort exhibited variable case fatality rates (CFRs), likely attributable in part to complex viral genetic determinants of smallpox virulence. We aimed to identify genome-wide single nucleotide polymorphisms associated with CFR. We evaluated unadjusted and outbreak geographic location-adjusted models of single SNPs and two- and three-way interactions between SNPs. Findings Using the data mining approach multifactor dimensionality reduction (MDR), we identified five VARV SNPs in models significantly associated with CFR. The top performing unadjusted model and adjusted models both revealed the same two-way gene-gene interaction. We discuss the biological plausibility of the influence of the SNPs identified these and other significant models on the strain-specific virulence of VARV. Conclusions We have identified genetic loci in the VARV genome that are statistically associated with VARV virulence as measured by CFR. While our ability to infer a causal relationship between the specific SNPs identified in our analysis and VARV virulence is limited, our results suggest that smallpox severity is in part associated with VARV strain variation and that VARV virulence may be determined by multiple genetic loci. This study represents the first application of MDR to the identification of pathogen gene-gene interactions for predicting infectious disease outbreak severity. PMID:23410064

Acculturation, Psychological Adjustment, and Parenting Styles of Chinese Immigrant Mothers in the U.S.

PubMed Central

Yu, Jing; Cheah, Charissa S. L.; Calvin, Grace

2016-01-01

Objectives This study examined whether acculturation to American culture, maintenance of Chinese culture, and their interaction predicted Chinese immigrant parents’ psychological adjustment and parenting styles. We hypothesized that American orientation would be associated with more positive psychological well-being and fewer depressive symptoms in immigrant mothers, which in turn would be associated with more authoritative parenting and less authoritarian parenting. The examination of the roles of Chinese orientation and the interaction of the two cultural orientations in relation to psychological adjustment and parenting were exploratory. Methods Participants were 164 first-generation Chinese immigrant mothers in the U.S. (Mage = 37.80). Structural equation modeling was used to examine the direct and indirect effects of acculturation on psychological adjustment and parenting. Bootstrapping technique was used to explore the conditional indirect effects of acculturation on parenting as appropriate. Results American orientation was strongly associated with positive psychological well-being, which was in turn related to more authoritative parenting and less authoritarian parenting. Moreover, American and Chinese orientations interacted to predict depressive symptoms, which were in turn associated with more authoritarian parenting. Specifically, American orientation was negatively associated with depressive symptoms only at mean or high levels of Chinese orientation. Conclusions Results suggest acculturation as a distal contextual factor and psychological adjustment as one critical mechanism that transmits the effects of acculturation to parenting. Promoting immigrant parents’ ability and comfort in the new culture independently or in conjunction with encouraging biculturalism through policy intervention efforts appear crucial for the positive adjustment of Chinese immigrant parents and children. PMID:27077796

Evidence of a major locus for lipoprotein lipase (LPL) activity in addition to a pleiotropic locus for both LPL and fasting insulin: results from the HERITAGE Family Study.

PubMed

Hong, Y; Rice, T; Després, J P; Gagnon, J; Nadeau, A; Bergeron, J; Pérusse, L; Bouchard, C; Leon, A S; Skinner, J S; Wilmore, J H; Rao, D C

1999-06-01

A major gene hypothesis for heparin releasable plasma lipoprotein lipase (PH-LPL) activity was assessed using segregation analyses of data on 495 members in 98 normolipidemic sedentary families of Caucasian descent who participated in the HERITAGE Family Study. Segregation analyses were performed on PH-LPL adjusted for age, and on PH-LPL activity adjusted for age and fasting insulin. Prior to adjustment for insulin, neither a major gene effect nor a multifactorial component could be rejected, and support for a major gene was equivocal i.e. neither the Mendelian transmission nor the no transmission (equal tau s) models were rejected. However, after adjusting for the effects of insulin, a major gene effect on PH-LPL activity was unambiguous. The putative locus accounted for 60% of the total phenotypic variance, and the homozygous recessive form affected 10% (q2) of the sample (i.e. gene frequency (q) = 0.31), and led to a low PH-LPL value. The lack of a significant multifactorial effect suggested that the familial etiology of PH-LPL activity adjusted for insulin was likely to be primarily a function of the major locus. In conclusion, the present study is the first to report segregation analyses on PH-LPL activity prior to and after adjusting for insulin, and suggests that there is an indication of a pleiotropic genetic effect on PH-LPL activity and insulin, in addition to a major gene effect on PH-LPL activity alone.

A spatially explicit approach to the study of socio-demographic inequality in the spatial distribution of trees across Boston neighborhoods.

PubMed

Duncan, Dustin T; Kawachi, Ichiro; Kum, Susan; Aldstadt, Jared; Piras, Gianfranco; Matthews, Stephen A; Arbia, Giuseppe; Castro, Marcia C; White, Kellee; Williams, David R

2014-04-01

The racial/ethnic and income composition of neighborhoods often influences local amenities, including the potential spatial distribution of trees, which are important for population health and community wellbeing, particularly in urban areas. This ecological study used spatial analytical methods to assess the relationship between neighborhood socio-demographic characteristics (i.e. minority racial/ethnic composition and poverty) and tree density at the census tact level in Boston, Massachusetts (US). We examined spatial autocorrelation with the Global Moran's I for all study variables and in the ordinary least squares (OLS) regression residuals as well as computed Spearman correlations non-adjusted and adjusted for spatial autocorrelation between socio-demographic characteristics and tree density. Next, we fit traditional regressions (i.e. OLS regression models) and spatial regressions (i.e. spatial simultaneous autoregressive models), as appropriate. We found significant positive spatial autocorrelation for all neighborhood socio-demographic characteristics (Global Moran's I range from 0.24 to 0.86, all P =0.001), for tree density (Global Moran's I =0.452, P =0.001), and in the OLS regression residuals (Global Moran's I range from 0.32 to 0.38, all P <0.001). Therefore, we fit the spatial simultaneous autoregressive models. There was a negative correlation between neighborhood percent non-Hispanic Black and tree density (r S =-0.19; conventional P -value=0.016; spatially adjusted P -value=0.299) as well as a negative correlation between predominantly non-Hispanic Black (over 60% Black) neighborhoods and tree density (r S =-0.18; conventional P -value=0.019; spatially adjusted P -value=0.180). While the conventional OLS regression model found a marginally significant inverse relationship between Black neighborhoods and tree density, we found no statistically significant relationship between neighborhood socio-demographic composition and tree density in the spatial regression models. Methodologically, our study suggests the need to take into account spatial autocorrelation as findings/conclusions can change when the spatial autocorrelation is ignored. Substantively, our findings suggest no need for policy intervention vis-à-vis trees in Boston, though we hasten to add that replication studies, and more nuanced data on tree quality, age and diversity are needed.

Attributable Cost of Clostridium difficile Infection in Pediatric Patients.

PubMed

Mehrotra, Preeti; Jang, Jisun; Gidengil, Courtney; Sandora, Thomas J

2017-12-01

OBJECTIVES The attributable cost of Clostridium difficile infection (CDI) in children is unknown. We sought to determine a national estimate of attributable cost and length of stay (LOS) of CDI occurring during hospitalization in children. DESIGN AND METHODS We analyzed discharge records of patients between 2 and 18 years of age from the Agency for Healthcare Research and Quality (AHRQ) Kids' Inpatient Database. We created a logistic regression model to predict CDI during hospitalization based on demographic and clinical characteristics. Predicted probabilities from the logistic regression model were then used as propensity scores to match 1:2 CDI to non-CDI cases. Charges were converted to costs and compared between patients with CDI and propensity-score-matched controls. In a sensitivity analysis, we adjusted for LOS as a confounder by including it in both the propensity score and a generalized linear model predicting cost. RESULTS We identified 8,527 pediatric hospitalizations (0.53%) with a diagnosis of CDI and 1,597,513 discharges without CDI. In our matched cohorts, the attributable cost of CDI occurring during a hospitalization ranged from $1,917 to $8,317, depending on whether model was adjusted for LOS. When not adjusting for LOS, CDI-associated hospitalizations cost 1.6 times more than non-CDI associated hospitalizations. Attributable LOS of CDI was approximately 4 days. CONCLUSIONS Clostridium difficile infection in hospitalized children is associated with an economic burden similar to adult estimates. This finding supports a continued focus on preventing CDI in children as a priority. Pediatric CDI cost analyses should account for LOS as an important confounder of cost. Infect Control Hosp Epidemiol 2017;38:1472-1477.

Coffee consumption modifies risk of estrogen-receptor negative breast cancer

PubMed Central

2011-01-01

Introduction Breast cancer is a complex disease and may be sub-divided into hormone-responsive (estrogen receptor (ER) positive) and non-hormone-responsive subtypes (ER-negative). Some evidence suggests that heterogeneity exists in the associations between coffee consumption and breast cancer risk, according to different estrogen receptor subtypes. We assessed the association between coffee consumption and postmenopausal breast cancer risk in a large population-based study (2,818 cases and 3,111 controls), overall, and stratified by ER tumour subtypes. Methods Odds ratios (OR) and corresponding 95% confidence intervals (CI) were estimated using the multivariate logistic regression models fitted to examine breast cancer risk in a stratified case-control analysis. Heterogeneity among ER subtypes was evaluated in a case-only analysis, by fitting binary logistic regression models, treating ER status as a dependent variable, with coffee consumption included as a covariate. Results In the Swedish study, coffee consumption was associated with a modest decrease in overall breast cancer risk in the age-adjusted model (OR> 5 cups/day compared to OR≤ 1 cup/day: 0.80, 95% CI: 0.64, 0.99, P trend = 0.028). In the stratified case-control analyses, a significant reduction in the risk of ER-negative breast cancer was observed in heavy coffee drinkers (OR> 5 cups/day compared to OR≤ 1 cup/day : 0.43, 95% CI: 0.25, 0.72, P trend = 0.0003) in a multivariate-adjusted model. The breast cancer risk reduction associated with higher coffee consumption was significantly higher for ER-negative compared to ER-positive tumours (P heterogeneity (age-adjusted) = 0.004). Conclusions A high daily intake of coffee was found to be associated with a statistically significant decrease in ER-negative breast cancer among postmenopausal women. PMID:21569535

Uric acid and endothelial function in elderly community-dwelling subjects.

PubMed

Ticinesi, Andrea; Lauretani, Fulvio; Ceda, Gian Paolo; Ruggiero, Carmelinda; Ferrucci, Luigi; Aloe, Rosalia; Larsson, Anders; Cederholm, Tommy; Lind, Lars; Meschi, Tiziana; Maggio, Marcello

2017-03-01

The role of serum uric acid (SUA), an inflammatory agent and potential mediator of cardiovascular diseases, in endothelial function (EF) has been tested only in middle-aged subjects affected by specific diseases. Our aim was to assess the relationship between SUA and measures of EF in a cohort of elderly community-dwellers. This study involved 424 males and 426 females aged 70years from the Prospective Study of the Vasculature in Uppsala Seniors (PIVUS), having complete data on SUA and EF assessed by flow-mediated vasodilation (FMD) and by intra-arterial infusion of acetylcholine (endothelium-dependent vasodilation, EDV) and sodium nitroprusside (endothelium-independent vasodilation, EIDV). Univariate and multivariate regression models obtained by backward selection from initial fully-adjusted models were built to assess the relationship between SUA and measures of EF in both genders. Cardiovascular risk factors, serum hormonal and metabolic mediators, and body composition were considered as potential confounders. In the univariate model, SUA was inversely associated in both genders with log(EDV) (β±SE males -0.39±0.17, p=0.03; females -0.57±0.19, p=0.003) and log(EIDV) (males -0.23±0.12, p=0.05; females -0.49±0.15, p=0.002), but not with log(FMD). After adjustment for BMI, only the association between SUA and log(EIDV) in females persisted, though attenuated (-0.32±0.16, p=0.049), and was no longer significant in the fully-adjusted multivariate model including waist/hip ratio. In conclusion, in older subjects, especially women, SUA is associated with EF not independently of a list of confounders including BMI and trunk fat mass, suggesting a role as surrogate metabolic marker rather than an active player in EF. Copyright © 2017 Elsevier Inc. All rights reserved.

Uric acid and endothelial function in elderly community-dwelling subjects

PubMed Central

Ticinesi, Andrea; Lauretani, Fulvio; Ceda, Gian Paolo; Ruggiero, Carmelinda; Ferrucci, Luigi; Aloe, Rosalia; Larsson, Anders; Cederholm, Tommy; Lind, Lars; Meschi, Tiziana; Maggio, Marcello

2017-01-01

The role of serum uric acid (SUA), an inflammatory agent and potential mediator of cardiovascular diseases, in endothelial function (EF) has been tested only in middle-aged subjects affected by specific diseases. Our aim was to assess the relationship between SUA and measures of EF in a cohort of elderly community-dwellers. This study involved 424 males and 426 females aged 70 years from the Prospective Study of the Vasculature in Uppsala Seniors (PIVUS), having complete data on SUA and EF assessed by flow-mediated vasodilation (FMD) and by intra-arterial infusion of acetylcholine (endothelium-dependent vasodilation, EDV) and sodium nitroprusside (endothelium-independent vasodilation, EIDV). Univariate and multivariate regression models obtained by backward selection from initial fully-adjusted models were built to assess the relationship between SUA and measures of EF in both genders. Cardiovascular risk factors, serum hormonal and metabolic mediators, and body composition were considered as potential confounders. In the univariate model, SUA was inversely associated in both genders with log(EDV) (β ± SE males −0.39 ± 0.17, p = 0.03; females −0.57 ± 0.19, p = 0.003) and log(EIDV) (males −0.23 ± 0.12, p = 0.05; females −0.49 ± 0.15, p = 0.002), but not with log(FMD). After adjustment for BMI, only the association between SUA and log(EIDV) in females persisted, though attenuated (−0.32 ± 0.16, p = 0.049), and was no longer significant in the fully-adjusted multivariate model including waist/hip ratio. In conclusion, in older subjects, especially women, SUA is associated with EF not independently of a list of confounders including BMI and trunk fat mass, suggesting a role as surrogate metabolic marker rather than an active player in EF. PMID:28057563

A multilevel study on the association of observer-assessed working conditions with depressive symptoms among female eldercare workers from 56 work units in 10 care homes in Denmark

PubMed Central

Jakobsen, Louise M; Jorgensen, Anette F B; Thomsen, Birthe L; Greiner, Birgit A; Rugulies, Reiner

2015-01-01

Objectives Eldercare workers in Denmark have a higher prevalence of poor psychological health than other occupational groups. We examined the association between working conditions assessed by trained observers and depressive symptoms assessed by self-report in a study of female Danish eldercare workers. Methods Working conditions were observed based on action regulation theory and defined as (1) regulation requirements, a workplace resource providing opportunity for decision-making and skill development and (2) barriers for task completion. We examined the associations of individual and work unit averaged working conditions with depressive symptoms in a sample of 95 individually observed eldercare workers. Further, we examined the association of work unit averaged working conditions with depressive symptoms in a sample of 205 care workers, including both observed and non-observed individuals. We used regression models that allowed for correlations within work units and care homes and adjusted these models for demographics, job characteristics and stressful life events. Results Higher levels of regulation requirements were associated with lower depressive symptoms at the individual level (p=0.04), but not at the workplace level. Barriers were not associated with depressive symptoms at the individual level. At the workplace level, a higher number of qualitatively different barriers (p=0.04) and a higher number of barriers for equipment use (p=0.03) were associated with lower levels of depressive symptoms in the age and cohabitation adjusted model, however statistical significance was lost in the fully adjusted model. Conclusions Low level of regulation requirements was associated with a high level of depressive symptoms. The study highlights the importance of examining both individual and workplace levels of working conditions. PMID:26560058

Resting Heart Rate as Predictor for Left Ventricular Dysfunction and Heart Failure: The Multi-Ethnic Study of Atherosclerosis

PubMed Central

Opdahl, Anders; Venkatesh, Bharath Ambale; Fernandes, Veronica R. S.; Wu, Colin O.; Nasir, Khurram; Choi, Eui-Young; Almeida, Andre L. C.; Rosen, Boaz; Carvalho, Benilton; Edvardsen, Thor; Bluemke, David A.; Lima, Joao A. C.

2014-01-01

OBJECTIVE To investigate the relationship between baseline resting heart rate and incidence of heart failure (HF) and global and regional left ventricular (LV) dysfunction. BACKGROUND The association of resting heart rate to HF and LV function is not well described in an asymptomatic multi-ethnic population. METHODS Participants in the Multi-Ethnic Study of Atherosclerosis had resting heart rate measured at inclusion. Incident HF was registered (n=176) during follow-up (median 7 years) in those who underwent cardiac MRI (n=5000). Changes in ejection fraction (ΔEF) and peak circumferential strain (Δεcc) were measured as markers of developing global and regional LV dysfunction in 1056 participants imaged at baseline and 5 years later. Time to HF (Cox model) and Δεcc and ΔEF (multiple linear regression models) were adjusted for demographics, traditional cardiovascular risk factors, calcium score, LV end-diastolic volume and mass in addition to resting heart rate. RESULTS Cox analysis demonstrated that for 1 bpm increase in resting heart rate there was a 4% greater adjusted relative risk for incident HF (Hazard Ratio: 1.04 (1.02, 1.06 (95% CI); P<0.001). Adjusted multiple regression models demonstrated that resting heart rate was positively associated with deteriorating εcc and decrease in EF, even in analyses when all coronary heart disease events were excluded from the model. CONCLUSION Elevated resting heart rate is associated with increased risk for incident HF in asymptomatic participants in MESA. Higher heart rate is related to development of regional and global LV dysfunction independent of subclinical atherosclerosis and coronary heart disease. PMID:24412444

Access to Obstetric Care and Children's Health, Growth and Cognitive Development in Vietnam: Evidence from Young Lives.

PubMed

Lavin, Tina; Preen, David B; Newnham, Elizabeth A

2017-06-01

Background The impact of birth with poor access to skilled obstetric care such as home birth on children's long term development is unknown. This study explores the health, growth and cognitive development of children surviving homebirth in the Vietnam Young Lives sample during early childhood. Methods The Young Lives longitudinal cohort study was conducted in Vietnam with 1812 children born in 2001/2 with follow-up at 1, 5, and 8 years. Data were collected on height/weight, health and cognitive development (Peabody Picture Vocabulary test). Statistical models adjusted for sociodemographic and pregnancy-related factors. Results Children surviving homebirth did not have significantly poorer long-term health, greater stunting after adjusting for sociodemographic/pregnancy-related factors. Rural location, lack of household education, ethnic minority status and lower wealth predicted greater stunting and poorer scores on Peabody Vocabulary test. Conclusions Social disadvantage rather than homebirth influenced children's health, growth and development.

Does Occupation Explain Gender and Other Differences in Work-Related Eye Injury Hospitalization Rates?

PubMed Central

Smith, Gordon S.; Lincoln, Andrew E.; Wong, Tien Y.; Bell, Nicole S.; Vinger, Paul F.; Amoroso, Paul J.; Lombardi, David A.

2007-01-01

Objective We sought to determine whether demographic differences in eye injury rates persist after adjusting for occupational exposure. Methods On-duty eye injury hospitalizations were linked to occupation among active-duty US Army personnel. Results Eye injury rates were higher for white solidiers, men, and for younger soldiers, even after adjusting for occupational group and specific job titles using multivariate models. Conclusions This finding contrasts with studies of other injuries, suggesting that occupation does not fully account for variations in eye injury risk. Because protective eyewear can prevent most serious eye injuries, we hypothesize that differences in protective eyewear use between men and women may contribute to differences in eye injury rates, although follow-up studies are needed to confirm this. Prevention efforts should consider targeting high-risk demographic groups in addition to high-risk occupations. PMID:15951724

Current State of Modeling the Photochemistry of Titan's Mutually Dependent Atmosphere and Ionosphere

NASA Technical Reports Server (NTRS)

Wilson, Eric H.; Atreya, S. K.

2004-01-01

In the context of recent observations, microphysical models, and laboratory data, a photochemical model of Titan's atmosphere, including updated chemistry focusing on rate coefficients and cross sections measured under appropriate conditions, has been developed to increase understanding of these processes and improve upon previous Titan photochemical models. The model employs a two-stream discrete ordinates method to characterize the transfer of solar radiation, and the effects of electron-impact, cosmic-ray deposition, and aerosol opacities from fractal and Mie particles are analyzed. Sensitivity studies demonstrate that an eddy diffusion profile with a homopause level of 850 km and a methane stratospheric mole fraction of 2.2% provides the best fit of stratospheric and upper atmosphere observations and an improved fit over previous Titan photochemical models. Lack of fits for C3H8, HC3N, and possibly C2H3CN can be resolved with adjustments in aerosol opacity. The model presents a benzene profile consistent with its detection in Titan's stratosphere [Coustenis et al., 2003], which may play an important role in the formation of Titan hazes. An electron peak concentration of 4200 cm(exp -3) is calculated, which exceeds observations by 20%, considerably lower than previous ionosphere models. With adjustments in aerosol opacities and surface fluxes the model illustrates that reasonable fits to existing observations are possible with a single eddy diffusion profile, contrary to the conclusions of previous Titan models. These results will aid in the receipt and interpretation of data from Cassini-Huygens, which will arrive at Titan in 2004 and deploy a probe into Titan's atmosphere in January 2005.

Lifetime comorbidities between phobic disorders and major depression in Japan: Results from the World Mental Health Japan 2002-2004 Survey

PubMed Central

Tsuchiya, Masao; Kawakami, Norito; Ono, Yutaka; Nakane, Yoshibumi; Nakamura, Yosikazu; Tachimori, Hisateru; Iwata, Noboru; Uda, Hidenori; Nakane, Hideyuki; Watanabe, Makoto; Naganuma, Yoichi; Furukawa, Toshiaki A.; Hata, Yukihiro; Kobayashi, Masayo; Miyake, Yuko; Takeshima, Tadashi; Kikkawa, Takehiko; Kessler, Ronald C.

2013-01-01

Background Although often considered of minor significance in themselves, evidence exists that early-onset phobic disorders might be predictors of later more serious disorders, such as major depressive disorder (MDD). The purpose of this study was to investigate the association of phobic disorders with the onset of MDD in the community in Japan. Methods Data from the World Mental Health Japan 2002-2004 Survey were analyzed. A total of 2,436 community residents aged 20 and older were interviewed using the WHO Composite International Diagnostic Interview 3.0 (response rate, 58.4%). A Cox proportional hazards model was used to predict the onset of MDD as a function of prior history of DSM-IV specific phobia, agoraphobia, or social phobia, adjusting for gender, birth cohort, other anxiety disorders, education, and marital status at survey. Results Social phobia was strongly associated with the subsequent onset of MDD (hazard ratio [HR] = 4.1 [95%CI: 2.0-8.7]) after adjusting for sex, birth cohort, and the number of other anxiety disorders. The association between agoraphobia or specific phobia and MDD was not statistically significant after adjusting for these variables. Conclusions Social phobia is a powerful predictor of the subsequent first onset of MDD in Japan. While this finding argues against a simple neurobiological model and in favor of a model in which the cultural meanings of phobia play a part in promoting MDD, an elucidation of causal pathways will require more fine-grained comparative research. PMID:19195005

Derivation of a needs based capitation formula for allocating prescribing budgets to health authorities and primary care groups in England: regression analysis

PubMed Central

Rice, Nigel; Dixon, Paul; Lloyd, David C E F; Roberts, David

2000-01-01

Objective To develop a weighted capitation formula for setting target allocations for prescribing expenditures for health authorities and primary care groups in England. Design Regression analysis relating prescribing costs to the demographic, morbidity, and mortality composition of practice lists. Setting 8500 general practices in England. Subjects Data from the 1991 census were attributed to practice lists on the basis of the place of residence of the practice population. Main outcome measures Variation in age, sex, and temporary resident originated prescribing units (ASTRO(97)-PUs) adjusted net ingredient cost of general practices in England for 1997-8 modelled for the impact of health and social needs after controlling for differences in supply. Results A needs gradient based on the four variables: permanent sickness, percentage of dependants in no carer households, percentage of students, and percentage of births on practice lists. These, together with supply characteristics, explained 41% of variation in prescribing costs per ASTRO(97)-PU adjusted capita across practices. The latter alone explained about 35% of variation in total costs per head across practices. Conclusions The model has good statistical specification and contains intuitively plausible needs drivers of prescribing expenditure. Together with adjustments made for differences in ASTRO(97)-PUs the model is capable of explaining 62% (35%+0.65% (41%)) of variation in prescribing expenditure at practice level. The results of the study have formed the basis for setting target budgets for 1999-2000 allocations for prescribing expenditure for health authorities and primary care groups. PMID:10650026

Comparison of Bruch's Membrane Opening-Minimum Rim Width among Those with Normal Ocular Health by Race

PubMed Central

Rhodes, Lindsay A.; Huisingh, Carrie E.; Quinn, Adam E.; McGwin, Gerald; LaRussa, Frank; Box, Daniel; Owsley, Cynthia; Girkin, Christopher A.

2016-01-01

Purpose To examine if racial differences in Bruch's membrane opening-minimum rim width (BMO-MRW) in spectral domain optical coherence tomography (SDOCT) exist, specifically between people of African descent (AD) and European descent (ED) in normal ocular health. Design Cross-sectional study Methods Patients presenting for a comprehensive eye exam at retail-based primary eye clinics were enrolled based on ≥1 of the following at-risk criteria for glaucoma: AD aged ≥ 40 years, ED aged ≥50 years, diabetes, family history of glaucoma, and/or preexisting diagnosis of glaucoma. Participants with normal optic nerves on exam received SDOCT of the optic nerve head (24 radial scans). Global and regional (temporal, superotemporal, inferotemporal, nasal, superonasal, and inferonasal) BMO-MRW were measured and compared by race using generalized estimating equations. Models were adjusted for age, gender, and BMO area. Results SDOCT scans from 269 eyes (148 participants) were included in the analysis. Mean global BMO-MRW declined as age increased. After adjusting for age, gender, and BMO area, there was not a statistically significant difference in mean global BMO-MRW by race (P = 0.60). Regionally, the mean BMO-MRW was lower in the crude model among AD eyes in the temporal, superotemporal, and nasal regions and higher in the inferotemporal, superonasal, and inferonasal regions. However, in the adjusted model, these differences were not statistically significant. Conclusions BMO-MRW was not statistically different between those of AD and ED. Race-specific normative data may not be necessary for the deployment of BMO-MRW in AD patients. PMID:27825982

Cost-Effectiveness of Radiofrequency Catheter Ablation Compared with Antiarrhythmic Drug Therapy for Paroxysmal Atrial Fibrillation

PubMed Central

Reynolds, Matthew R.; Zimetbaum, Peter; Josephson, Mark E.; Ellis, Ethan; Danilov, Tatyana; Cohen, David J.

2009-01-01

Background Radiofrequency catheter ablation (RFA) has emerged as an important treatment strategy for AF. The potential cost-effectiveness of RFA for AF, relative to antiarrhythmic drug (AAD) therapy, has not been fully explored from a U.S. perspective. Methods and Results We constructed a Markov disease simulation model for a hypothetical cohort of drug- refractory paroxysmal AF patients managed either with RFA ± AAD or AAD alone. Costs and quality-adjusted life years (QALYs) were projected over 5 years. Model inputs were drawn from published clinical trial and registry data, from new registry and trial data analysis, and from data prospectively collected from AF patients managed with RFA at our institution. We assumed no benefit form ablation on stroke, heart failure or death, but did estimate changes in quality-adjusted life expectancy using data from several AF cohorts. In the base case scenario, cumulative costs with the RFA and AAD strategies were $26,584 and $19,898, respectively. Over 5 years, quality adjusted life expectancy was 3.51 QALYs with RFA, versus 3.38 for the AAD group. The incremental cost-effectiveness ratio for RFA vs. AAD was thus $51,431/QALY. Model results were most sensitive to time horizon, the relative utility weights of successful ablation vs. unsuccessful drug therapy, and to the cost of an ablation procedure. Conclusions RFA ± AAD for symptomatic, drug-refractory paroxysmal AF appears to be reasonably cost-effective compared with AAD therapy alone from the perspective of the US health care system, based on improved quality of life and avoidance of future health care costs. PMID:19808491

Cranioplasty prosthesis manufacturing based on reverse engineering technology

PubMed Central

Chrzan, Robert; Urbanik, Andrzej; Karbowski, Krzysztof; Moskała, Marek; Polak, Jarosław; Pyrich, Marek

2012-01-01

Summary Background Most patients with large focal skull bone loss after craniectomy are referred for cranioplasty. Reverse engineering is a technology which creates a computer-aided design (CAD) model of a real structure. Rapid prototyping is a technology which produces physical objects from virtual CAD models. The aim of this study was to assess the clinical usefulness of these technologies in cranioplasty prosthesis manufacturing. Material/Methods CT was performed on 19 patients with focal skull bone loss after craniectomy, using a dedicated protocol. A material model of skull deficit was produced using computer numerical control (CNC) milling, and individually pre-operatively adjusted polypropylene-polyester prosthesis was prepared. In a control group of 20 patients a prosthesis was manually adjusted to each patient by a neurosurgeon during surgery, without using CT-based reverse engineering/rapid prototyping. In each case, the prosthesis was implanted into the patient. The mean operating times in both groups were compared. Results In the group of patients with reverse engineering/rapid prototyping-based cranioplasty, the mean operating time was shorter (120.3 min) compared to that in the control group (136.5 min). The neurosurgeons found the new technology particularly useful in more complicated bone deficits with different curvatures in various planes. Conclusions Reverse engineering and rapid prototyping may reduce the time needed for cranioplasty neurosurgery and improve the prosthesis fitting. Such technologies may utilize data obtained by commonly used spiral CT scanners. The manufacturing of individually adjusted prostheses should be commonly used in patients planned for cranioplasty with synthetic material. PMID:22207125

Family history of diabetes modifies the effect of blood pressure for incident diabetes in Middle Eastern women: Tehran Lipid and Glucose Study.

PubMed

Hatami, M; Hadaegh, F; Khalili, D; Sheikholeslami, F; Azizi, F

2012-02-01

Elevated blood pressure (BP) may lead to incident diabetes. However, data about the effect of different BP components on incident diabetes in Middle Eastern women is lacking. We evaluated systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP) and mean arterial pressure (MAP) as independent predictors of diabetes in Iranian women. We performed a population-based prospective study among 3028 non-diabetic women, aged ≥20 years. Odds ratios (ORs) of diabetes were calculated for every 1 s.d. increase in SBP, DBP, PP and MAP. During ≈6 years of follow-up, 220 women developed diabetes. There were significant interactions between family history of diabetes and SBP, PP and MAP (P≤0.01) in predicting incident diabetes. In women without a family history of diabetes, all BP components were significantly associated with diabetes in the age-adjusted model; the risk factor-adjusted ORs were significant (P<0.05) for SBP, PP and MAP (1.30, 1.34 and 1.27, respectively) with similar predictive ability (area under the receiver operating characteristic curve ≈83%). In women with family history of diabetes, in the age-adjusted model, SBP, DBP and MAP were associated with diabetes; in multivariable model, they were not independent predictors of diabetes. In conclusion, in women without family history of diabetes, SBP, PP and MAP, were independent predictors of diabetes with almost similar predictive ability; hence, in the evaluation of the risk of BP components for prediction of diabetes, the presence of family history of diabetes should be considered.

Relation of Anxiety and Depressive Symptoms to Coronary Artery Calcium (from the ELSA-Brasil Baseline Data).

PubMed

Santos, Itamar S; Bittencourt, Marcio S; Rocco, Priscila T; Pereira, Alexandre C; Barreto, Sandhi M; Brunoni, André R; Goulart, Alessandra C; Blaha, Michael J; Lotufo, Paulo A; Bensenor, Isabela M

2016-07-15

Previous studies of the association between symptoms of anxiety or depression and coronary artery calcium (CAC) have produced heterogeneous results. Our aim was to investigate whether psychopathological symptoms were associated with CAC in a cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline. We analyzed data from 4,279 ELSA-Brasil subjects (aged 35 to 74 years) from the São Paulo site without previous cardiovascular disease who underwent CAC score assessment at baseline. Prevalent CAC was defined as a CAC score >0. Anxiety and depressive symptoms were assessed using the Clinical Interview Schedule-Revised (CIS-R). We built binary logistic regression models to determine whether CIS-R scores, anxiety, or depression were associated with prevalent CAC. Prevalent CAC was found in 1,211 subjects (28.3%). After adjustment for age and gender, a direct association between CIS-R scores and prevalent CAC was revealed (odds ratio for 1-SD increase: 1.12; 95% confidence interval [CI] 1.04 to 1.22). This association persisted after multivariate adjustment (odds ratio for 1-SD increase 1.11; 95% CI 1.02 to 1.20). No independent associations were found for specific diagnoses of anxiety or depression and prevalent CAC. In post hoc models, a significant interaction term (p = 0.019) suggested a stronger association in older subjects. In conclusion, psychopathological symptoms were directly associated with coronary atherosclerosis in the ELSA-Brasil baseline in adjusted models, and this association seems to be stronger in older subjects. Copyright © 2016 Elsevier Inc. All rights reserved.

Association Of Church-Sponsored Activity Participation And Prevalence Of Overweight And Obesity In African American Protestants, National Survey Of American Life, 2001–2003

PubMed Central

Taylor, Jerome; Belay, Brook; Park, Sohyun; Onufrak, Stephen; Dietz, William

2015-01-01

Objective This study examines the relationships between participation in the African American church and overweight/obesity (body mass index (BMI) ≥25 kg/m2). Design: This cross-sectional analysis was based on the National Survey of American Life 2001–2003 and included 2,689 African American Protestant (AAP) adults. Multivariate logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for overweight/obesity. Two practices were examined – frequency of participation in church activities (excluding services) and frequency of church service attendance. Each practice was analyzed in separate models. Each model included the following covariates: age, marital status, education, poverty, smoking, and region of country. We also adjusted models for sex. Results After adjustment, African American Protestant men (AAPM) who participated in church activities at least weekly were more likely to be overweight/obese (aOR=2.17; 95% CI=1.25, 3.77) compared to AAPM who did not participate in church activities. There was no statistically significant association between overweight/obesity and participation in church activities for AAPW. There was no association between overweight/obesity and attendance of church services for AAP men and women combined. Conclusions For AAPM, participation in church activities was significantly associated with overweight/obesity. Further studies are required to determine why this association occurs in AAPM but not AAPW. Studies looking at the wider application of the several successful health initiatives targeting the AAP community should also be considered. PMID:23914418

Influence of Gestational Age and Body Weight on the Pharmacokinetics of Labetalol in Pregnancy

PubMed Central

Fischer, James H.; Sarto, Gloria E.; Hardman, Jennifer; Endres, Loraine; Jenkins, Thomas M.; Kilpatrick, Sarah J.; Jeong, Hyunyoung; Geller, Stacie; Deyo, Kelly; Fischer, Patricia A.; Rodvold, Keith A.

2015-01-01

Background and Objectives Labetalol is frequently prescribed for treatment of hypertension during pregnancy. However, the influence of pregnancy on labetalol pharmacokinetics is uncertain, with inconsistent findings reported by previous studies. This study examined the population pharmacokinetics of oral labetalol during and after pregnancy in women receiving labetalol for hypertension. Methods Data were collected from 57 women receiving the drug for hypertension from the 12th week of pregnancy through 12 weeks postpartum using a prospective, longitudinal design. A sparse sampling strategy guided collection of plasma samples. Samples were assayed for labetalol by high performance liquid chromatography. Estimation of population pharmacokinetic parameters and covariate effects was performed by nonlinear mixed effects modeling using NONMEM. Final population model was validated by bootstrap analysis and visual predictive check. Simulations were performed with the final model to evaluate the appropriate body weight to guide labetalol dosing. Results Lean body weight (LBW) and gestational age, i.e., weeks of pregnancy, were identified as significantly influencing oral clearance (CL/F) of labetalol, with CL/F ranging from 1.4-fold greater than postpartum values at 12 weeks gestational age to 1.6-fold greater at 40 weeks. Doses adjusted for LBW provide more consistent drug exposure than doses adjusted for total body weight. The apparent volumes of distribution for the central compartment and at steady-state were 1.9-fold higher during pregnancy. Conclusions Gestational age and LBW impact the pharmacokinetics of labetalol during pregnancy and have clinical implications for adjusting labetalol doses in these women. PMID:24297680

Predictors of Chikungunya rheumatism: a prognostic survey ancillary to the TELECHIK cohort study

PubMed Central

2013-01-01

Introduction Long-lasting relapsing or lingering rheumatic musculoskeletal pain (RMSP) is the hallmark of Chikungunya virus (CHIKV) rheumatism (CHIK-R). Little is known on their prognostic factors. The aim of this prognostic study was to search the determinants of lingering or relapsing RMSP indicative of CHIK-R. Methods Three hundred and forty-six infected adults (age ≥ 15 years) having declared RMSP at disease onset were extracted from the TELECHIK cohort study, Reunion island, and analyzed using a multinomial logistic regression model. We also searched for the predictors of CHIKV-specific IgG titres, assessed at the time of a serosurvey, using multiple linear regression analysis. Results Of these, 111 (32.1%) reported relapsing RMSP, 150 (43.3%) lingering RMSP, and 85 (24.6%) had fully recovered (reference group) on average two years after acute infection. In the final model controlling for gender, the determinants of relapsing RMSP were the age 45-59 years (adjusted OR: 2.9, 95% CI: 1.0, 8.6) or greater or equal than 60 years (adjusted OR: 10.4, 95% CI: 3.5, 31.1), severe rheumatic involvement (fever, at least six joints plus four other symptoms) at presentation (adjusted OR: 3.6, 95% CI: 1.5, 8.2), and CHIKV-specific IgG titres (adjusted OR: 3.2, 95% CI: 1.8, 5.5, per one unit increase). Prognostic factors for lingering RMSP were age 45-59 years (adjusted OR: 6.4, 95% CI: 1.8, 22.1) or greater or equal than 60 years (adjusted OR: 22.3, 95% CI: 6.3, 78.1), severe initial rheumatic involvement (adjusted OR: 5.5, 95% CI: 2.2, 13.8) and CHIKV-specific IgG titres (adjusted OR: 6.2, 95% CI: 2.8, 13.2, per one unit increase). CHIKV specific IgG titres were positively correlated with age, female gender and the severity of initial rheumatic symptoms. Conclusions Our data support the roles of age, severity at presentation and CHIKV specific IgG titres for predicting CHIK-R. By identifying the prognostic value of the humoral immune response of the host, this work also suggest a significant contribution of the adaptive immune response to the physiopathology of CHIK-R and should help to reconsider the paradigm of this chronic infection primarily shifted towards the involvement of the innate immune response. PMID:23302155

Albuminuria and Rapid Loss of GFR and Risk of New Hip and Pelvic Fractures

PubMed Central

Gao, Peggy; Clase, Catherine M.; Mente, Andrew; Mann, Johannes F.E.; Sleight, Peter; Yusuf, Salim; Teo, Koon K.

2013-01-01

Summary Background and objectives The microvascular circulation plays an important role in bone health. This study examines whether albuminuria, a marker of renal microvascular disease, is associated with incident hip and pelvic fractures. Design, setting, participants, & measurements This study reanalyzed data from the Ongoing Telmisartan Alone and in combination with Ramipril Global End Point Trial/Telmisartan Randomized Assessment Study in Angiotensin-Converting Enzyme Intolerant Subjects with Cardiovascular Disease trials, which examined the impact of renin angiotensin system blockade on cardiovascular outcomes (n=28,601). Albuminuria was defined as an albumin-to-creatinine ratio≥30 mg/g (n=4597). Cox proportional hazards models were used to determine the association of albuminuria with fracture risk adjusted for known risk factors for fractures, estimated GFR, and rapid decline in estimated GFR (≥5%/yr). Results There were 276 hip and pelvic fractures during a mean of 4.6 years of follow-up. Participants with baseline albuminuria had a significantly increased risk of fracture compared with participants without albuminuria (unadjusted hazard ratio=1.62 [1.22, 2.15], P<0.001; adjusted hazard ratio=1.36 [1.01, 1.84], P=0.05). A dose-dependent relationship was observed, with macroalbuminuria having a large fracture risk (unadjusted hazard ratio=2.01 [1.21, 3.35], P=0.007; adjusted hazard ratio=1.71 [1.007, 2.91], P=0.05) and microalbuminuria associating with borderline or no statistical significance (unadjusted hazard ratio=1.52 [1.10, 2.09], P=0.01; adjusted hazard ratio=1.28 [0.92, 1.78], P=0.15). Estimated GFR was not a predictor of fracture in any model, but rapid loss of estimated GFR over the first 2 years of follow-up predicted subsequent fracture (adjusted hazard ratio=1.47 [1.05, 2.04], P=0.02). Conclusions Albuminuria, especially macroalbuminuria, and rapid decline of estimated GFR predict hip and pelvic fractures. These findings support a theoretical model of a relationship between underlying causes of microalbuminuria and bone disease. PMID:23184565

Age adjustment in ecological studies: using a study on arsenic ingestion and bladder cancer as an example.

PubMed

Guo, How-Ran

2011-10-20

Despite its limitations, ecological study design is widely applied in epidemiology. In most cases, adjustment for age is necessary, but different methods may lead to different conclusions. To compare three methods of age adjustment, a study on the associations between arsenic in drinking water and incidence of bladder cancer in 243 townships in Taiwan was used as an example. A total of 3068 cases of bladder cancer, including 2276 men and 792 women, were identified during a ten-year study period in the study townships. Three methods were applied to analyze the same data set on the ten-year study period. The first (Direct Method) applied direct standardization to obtain standardized incidence rate and then used it as the dependent variable in the regression analysis. The second (Indirect Method) applied indirect standardization to obtain standardized incidence ratio and then used it as the dependent variable in the regression analysis instead. The third (Variable Method) used proportions of residents in different age groups as a part of the independent variables in the multiple regression models. All three methods showed a statistically significant positive association between arsenic exposure above 0.64 mg/L and incidence of bladder cancer in men and women, but different results were observed for the other exposure categories. In addition, the risk estimates obtained by different methods for the same exposure category were all different. Using an empirical example, the current study confirmed the argument made by other researchers previously that whereas the three different methods of age adjustment may lead to different conclusions, only the third approach can obtain unbiased estimates of the risks. The third method can also generate estimates of the risk associated with each age group, but the other two are unable to evaluate the effects of age directly.

Evaluation of markers and risk prediction models: Overview of relationships between NRI and decision-analytic measures

PubMed Central

Calster, Ben Van; Vickers, Andrew J; Pencina, Michael J; Baker, Stuart G; Timmerman, Dirk; Steyerberg, Ewout W

2014-01-01

BACKGROUND For the evaluation and comparison of markers and risk prediction models, various novel measures have recently been introduced as alternatives to the commonly used difference in the area under the ROC curve (ΔAUC). The Net Reclassification Improvement (NRI) is increasingly popular to compare predictions with one or more risk thresholds, but decision-analytic approaches have also been proposed. OBJECTIVE We aimed to identify the mathematical relationships between novel performance measures for the situation that a single risk threshold T is used to classify patients as having the outcome or not. METHODS We considered the NRI and three utility-based measures that take misclassification costs into account: difference in Net Benefit (ΔNB), difference in Relative Utility (ΔRU), and weighted NRI (wNRI). We illustrate the behavior of these measures in 1938 women suspect of ovarian cancer (prevalence 28%). RESULTS The three utility-based measures appear transformations of each other, and hence always lead to consistent conclusions. On the other hand, conclusions may differ when using the standard NRI, depending on the adopted risk threshold T, prevalence P and the obtained differences in sensitivity and specificity of the two models that are compared. In the case study, adding the CA-125 tumor marker to a baseline set of covariates yielded a negative NRI yet a positive value for the utility-based measures. CONCLUSIONS The decision-analytic measures are each appropriate to indicate the clinical usefulness of an added marker or compare prediction models, since these measures each reflect misclassification costs. This is of practical importance as these measures may thus adjust conclusions based on purely statistical measures. A range of risk thresholds should be considered in applying these measures. PMID:23313931

A Developmental Sequence Model to University Adjustment of International Undergraduate Students

ERIC Educational Resources Information Center

Chavoshi, Saeid; Wintre, Maxine Gallander; Dentakos, Stella; Wright, Lorna

2017-01-01

The current study proposes a Developmental Sequence Model to University Adjustment and uses a multifaceted measure, including academic, social and psychological adjustment, to examine factors predictive of undergraduate international student adjustment. A hierarchic regression model is carried out on the Student Adaptation to College Questionnaire…

Adjustment to Spinal Cord Injury: A Comprehensive Follow-Up Study.

ERIC Educational Resources Information Center

Cook, Daniel; And Others

This document reports a comprehensive followup study to describe postservice life status of former vocational rehabilitation clients and to develop an empirical index of postservice adjustment to spinal cord injury. Significant findings, conclusions, and implications are found at the beginning. The introduction section summarizes followup studies…

Antidepressant Medication Use and its Association with Cardiovascular Disease and All-Cause Mortality in the Reasons for Geographic and Ethnic Differences in Stroke (REGARDS) Study

PubMed Central

Hansen, Richard A.; Khodneva, Yulia; Glasser, Stephen P.; Qian, Jingjing; Redmond, Nicole; Safford, Monika M.

2018-01-01

Background Mixed evidence suggests second-generation antidepressants may increase risk of cardiovascular and cerebrovascular events. Objective Assess whether antidepressant use is associated with acute coronary heart disease, stroke, cardiovascular disease death, and all-cause mortality. Methods Secondary analyses of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) longitudinal cohort study were conducted. Use of selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, bupropion, nefazodone, and trazodone was measured during the baseline (2003-2007) in-home visit. Outcomes of coronary heart disease, stroke, cardiovascular disease death, and all-cause mortality were assessed every 6 months and adjudicated by medical record review. Cox proportional hazards time-to-event analysis followed patients until their first event on or before December 31, 2011, iteratively adjusting for covariates. Results Among 29,616 participants, 3,458 (11.7%) used an antidepressant of interest. Intermediate models adjusting for everything but physical and mental health found an increased risk of acute coronary heart disease (Hazard Ratio=1.21; 95% CI 1.04-1.41), stroke (Hazard Ratio=1.28; 95% CI 1.02-1.60), cardiovascular disease death (Hazard Ratio =1.29; 95% CI 1.09-1.53), and all-cause mortality (Hazard Ratio=1.27; 95% CI 1.15-1.41) for antidepressant users. Risk estimates trended in this direction for all outcomes in the fully adjusted model, but only remained statistically associated with increased risk of all-cause mortality (Hazard Ratio=1.12; 95% CI 1.01-1.24). This risk was attenuated in sensitivity analyses censoring follow-up time at 2-years (Hazard Ratio=1.37; 95% CI 1.11-1.68). Conclusions In fully adjusted models antidepressant use was associated with a small increase in all-cause mortality. PMID:26783360

Persistent opioid use following Cesarean delivery: patterns and predictors among opioid naïve women

PubMed Central

Bateman, Brian T.; Franklin, Jessica M.; Bykov, Katsiaryna; Avorn, Jerry; Shrank, William H.; Brennan, Troyen A.; Landon, Joan E.; Rathmell, James P.; Huybrechts, Krista F.; Fischer, Michael A.; Choudhry, Niteesh K.

2016-01-01

Background The incidence of opioid-related death in women has increased five-fold over the past decade. For many women, their initial opioid exposure will occur in the setting of routine medical care. Approximately 1 in 3 deliveries in the U.S. is by Cesarean and opioids are commonly prescribed for post-surgical pain management. Objective The objective of this study was to determine the risk that opioid naïve women prescribed opioids after Cesarean delivery will subsequently become consistent prescription opioid users in the year following delivery, and to identify predictors for this behavior. Study Design We identified women in a database of commercial insurance beneficiaries who underwent Cesarean delivery and who were opioid-naïve in the year prior to delivery. To identify persistent users of opioids, we used trajectory models, which group together patients with similar patterns of medication filling during follow-up, based on patterns of opioid dispensing in the year following Cesarean delivery. We then constructed a multivariable logistic regression model to identify independent risk factors for membership in the persistent user group. Results 285 of 80,127 (0.36%, 95% confidence interval 0.32 to 0.40), opioid-naïve women became persistent opioid users (identified using trajectory models based on monthly patterns of opioid dispensing) following Cesarean delivery. Demographics and baseline comorbidity predicted such use with moderate discrimination (c statistic = 0.73). Significant predictors included a history of cocaine abuse (risk 7.41%; adjusted odds ratio 6.11, 95% confidence interval 1.03 to 36.31) and other illicit substance abuse (2.36%; adjusted odds ratio 2.78, 95% confidence interval 1.12 to 6.91), tobacco use (1.45%; adjusted odds ratio 3.04, 95% confidence interval 2.03 to 4.55), back pain (0.69%; adjusted odds ratio 1.74, 95% confidence interval 1.33 to 2.29), migraines (0.91%; adjusted odds ratio 2.14, 95% confidence interval 1.58 to 2.90), antidepressant use (1.34%; adjusted odds ratio 3.19, 95% confidence interval 2.41 to 4.23) and benzodiazepine use (1.99%; adjusted odds ratio 3.72, 95% confidence interval 2.64 to 5.26) in the year prior to Cesarean delivery. Conclusions A very small proportion of opioid-naïve women (approximately 1 in 300) become persistent prescription opioid users following Cesarean delivery. Pre-existing psychiatric comorbidity, certain pain conditions, and substance use/abuse conditions identifiable at the time of initial opioid prescribing were predictors of persistent use. PMID:26996986

Are food and beverage purchases in households with preschoolers changing? A longitudinal analysis from 2000–2011

PubMed Central

Ford, Christopher N.; Ng, Shu Wen; Popkin, Barry M.

2014-01-01

Background US dietary studies from 2003–2010 show decreases in children’s caloric intake. We examine purchases of consumer-packaged foods/beverages in the US between 2000- and 2011 among households with children ages 2–5y. Objectives Describe changes in consumer-packaged goods purchases between 2000 and 2011 after adjusting for economic indicators, and explore differences by race, education, and household income level. Methods Consumer-packaged goods purchases data were obtained for 42,753 US households with ≥1 child aged 2–5y using the Nielsen Homescan Panel. Top sources of calories purchased were grouped, and random effects regression was used to model the relationship between calories purchased from each food/beverage group and race, female head of household education, and household income. Models adjusted for household composition, market-level unemployment rate, prices, and quarter. Bonferroni correction was used to adjust for multiple comparisons (α=0.05). Results Between 2000 and 2011, adjusted total calories purchased from foods (−182 kcal/d) and beverages (−100 kcal/d) declined significantly. Decreases in purchases of milk (−40 kcal), soft drinks (−27 kcal/d), juice and juice drinks (−24 kcal/d), grain-based desserts (−24 kcal/d), savory snacks (−17 kcal/d), and sweet snacks and candy (−13 kcal/d) were among the major changes observed. There were significant differences by race, female head of household education, and household income for changes in consumer-packaged food and beverage purchases between 2000 and 2011. Conclusions Trends in consumer-packaged goods purchases suggest that solid fats and added sugars are decreasing in the food ply of US preschool children. Yet, pronounced differences by race, education, and household income persist. PMID:25049217

Effect of health promotion and fluoride varnish on dental caries among Australian Aboriginal children: results from a community-randomized controlled trial*

PubMed Central

Slade, Gary D; Bailie, Ross S; Roberts-Thomson, Kaye; Leach, Amanda J; Raye, Iris; Endean, Colin; Simmons, Bruce; Morris, Peter

2011-01-01

Objectives We tested a dental health program in remote Aboriginal communities of Australia's Northern Territory, hypothesizing that it would reduce dental caries in preschool children. Methods In this 2-year, prospective, cluster-randomized, concurrent controlled, open trial of the dental health program compared to no such program, 30 communities were allocated at random to intervention and control groups. All residents aged 18–47 months were invited to participate. Twice per year for 2 years in the 15 intervention communities, fluoride varnish was applied to children's teeth, water consumption and daily tooth cleaning with toothpaste were advocated, dental health was promoted in community settings, and primary health care workers were trained in preventive dental care. Data from dental examinations at baseline and after 2 years were used to compute net dental caries increment per child (d3mfs). A multi-level statistical model compared d3mfs between intervention and control groups with adjustment for the clustered randomization design; four other models used additional variables for adjustment. Results At baseline, 666 children were examined; 543 of them (82%) were re-examined 2 years later. The adjusted d3mfs increment was significantly lower in the intervention group compared to the control group by an average of 3.0 surfaces per child (95% CI = 1.2, 4.9), a prevented fraction of 31%. Adjustment for additional variables yielded caries reductions ranging from 2.3 to 3.5 surfaces per child and prevented fractions of 24–36%. Conclusions These results corroborate findings from other studies where fluoride varnish was efficacious in preventing dental caries in young children. PMID:20707872

Effects of child long-term illness on maternal employment: longitudinal findings from the UK Millennium Cohort Study

PubMed Central

Pearce, Anna; Whitehead, Margaret; Law, Catherine

2017-01-01

Background: Maternal employment has increased in European countries, but levels of employment are lower among mothers whose children have a limiting long-term illness or disability. However, we do not know whether having a child with a limiting illness prevents take-up or maintenance of paid employment or whether ‘common causes’, such as lack of qualifications or maternal disability lead to both maternal unemployment and childhood illness. Longitudinal data have the potential to distinguish between these. Methods: We analyzed four waves (3, 5, 7 and 11 years) of the Millennium Cohort Study (MCS) to examine the relationship between childhood limiting illness and maternal employment, unadjusted and adjusted for covariates. Multinomial regression models were used to test the association between child illness and trajectories of maternal employment. Fixed effects models assessed whether a new report of a child illness increased the odds of a mother exiting employment. Results: At every wave, maternal employment was more likely if the child did not have a limiting illness. After adjustment for covariates, childhood illness was associated with risks of continuous non-employment (adjusted Relative Risk Ratio = 1.46 [Confidence Interval: 1.21, 1.76]) or disrupted employment (aRRR = 1.26 [CI: 1.06, 1.49]), compared with entering or maintaining employment. If a child developed a limiting long-term illness, the likelihood of their mother exiting employment increased (adjusted Odds Ratio = 1.27 [CI: 1.05, 1.54]). Conclusions: ‘Common causes’ did not fully account for the association between child illness and maternal employment. Having a child with a limiting illness potentially reduces maternal employment opportunities. PMID:28177497

A zero-augmented generalized gamma regression calibration to adjust for covariate measurement error: A case of an episodically consumed dietary intake

PubMed Central

Agogo, George O.

2017-01-01

Measurement error in exposure variables is a serious impediment in epidemiological studies that relate exposures to health outcomes. In nutritional studies, interest could be in the association between long-term dietary intake and disease occurrence. Long-term intake is usually assessed with food frequency questionnaire (FFQ), which is prone to recall bias. Measurement error in FFQ-reported intakes leads to bias in parameter estimate that quantifies the association. To adjust for bias in the association, a calibration study is required to obtain unbiased intake measurements using a short-term instrument such as 24-hour recall (24HR). The 24HR intakes are used as response in regression calibration to adjust for bias in the association. For foods not consumed daily, 24HR-reported intakes are usually characterized by excess zeroes, right skewness, and heteroscedasticity posing serious challenge in regression calibration modeling. We proposed a zero-augmented calibration model to adjust for measurement error in reported intake, while handling excess zeroes, skewness, and heteroscedasticity simultaneously without transforming 24HR intake values. We compared the proposed calibration method with the standard method and with methods that ignore measurement error by estimating long-term intake with 24HR and FFQ-reported intakes. The comparison was done in real and simulated datasets. With the 24HR, the mean increase in mercury level per ounce fish intake was about 0.4; with the FFQ intake, the increase was about 1.2. With both calibration methods, the mean increase was about 2.0. Similar trend was observed in the simulation study. In conclusion, the proposed calibration method performs at least as good as the standard method. PMID:27704599

The volume-mortality relation for radical cystectomy in England: retrospective analysis of hospital episode statistics

PubMed Central

Bottle, Alex; Darzi, Ara W; Athanasiou, Thanos; Vale, Justin A

2010-01-01

Objectives To investigate the relation between volume and mortality after adjustment for case mix for radical cystectomy in the English healthcare setting using improved statistical methodology, taking into account the institutional and surgeon volume effects and institutional structural and process of care factors. Design Retrospective analysis of hospital episode statistics using multilevel modelling. Setting English hospitals carrying out radical cystectomy in the seven financial years 2000/1 to 2006/7. Participants Patients with a primary diagnosis of cancer undergoing an inpatient elective cystectomy. Main outcome measure Mortality within 30 days of cystectomy. Results Compared with low volume institutions, medium volume ones had a significantly higher odds of in-hospital and total mortality: odds ratio 1.72 (95% confidence interval 1.00 to 2.98, P=0.05) and 1.82 (1.08 to 3.06, P=0.02). This was only seen in the final model, which included adjustment for structural and processes of care factors. The surgeon volume-mortality relation showed weak evidence of reduced odds of in-hospital mortality (by 35%) for the high volume surgeons, although this did not reach statistical significance at the 5% level. Conclusions The relation between case volume and mortality after radical cystectomy for bladder cancer became evident only after adjustment for structural and process of care factors, including staffing levels of nurses and junior doctors, in addition to case mix. At least for this relatively uncommon procedure, adjusting for these confounders when examining the volume-outcome relation is critical before considering centralisation of care to a few specialist institutions. Outcomes other than mortality, such as functional morbidity and disease recurrence may ultimately influence towards centralising care. PMID:20305302

Cost-effectiveness of apixaban vs warfarin for secondary stroke prevention in atrial fibrillation

PubMed Central

Easton, J. Donald; Johnston, S. Claiborne; Kim, Anthony S.

2012-01-01

Objective: To compare the cost-effectiveness of apixaban vs warfarin for secondary stroke prevention in patients with atrial fibrillation (AF). Methods: Using standard methods, we created a Markov decision model based on the estimated cost of apixaban and data from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial and other trials of warfarin therapy for AF. We quantified the cost and quality-adjusted life expectancy resulting from apixaban 5 mg twice daily compared with those from warfarin therapy targeted to an international normalized ratio of 2–3. Our base case population was a cohort of 70-year-old patients with no contraindication to anticoagulation and a history of stroke or TIA from nonvalvular AF. Results: Warfarin therapy resulted in a quality-adjusted life expectancy of 3.91 years at a cost of $378,500. In comparison, treatment with apixaban led to a quality-adjusted life expectancy of 4.19 years at a cost of $381,700. Therefore, apixaban provided a gain of 0.28 quality-adjusted life-years (QALYs) at an additional cost of $3,200, resulting in an incremental cost-effectiveness ratio of $11,400 per QALY. Our findings were robust in univariate sensitivity analyses varying model inputs across plausible ranges. In Monte Carlo analysis, apixaban was cost-effective in 62% of simulations using a threshold of $50,000 per QALY and 81% of simulations using a threshold of $100,000 per QALY. Conclusions: Apixaban appears to be cost-effective relative to warfarin for secondary stroke prevention in patients with AF, assuming that it is introduced at a price similar to that of dabigatran. PMID:22993279

Relations of Insulin Resistance and Glycemic Abnormalities to Cardiovascular Magnetic Resonance Measures of Cardiac Structure and Function: the Framingham Heart Study

PubMed Central

Velagaleti, Raghava S.; Gona, Philimon; Chuang, Michael L.; Salton, Carol J.; Fox, Caroline S.; Blease, Susan J.; Yeon, Susan B.; Manning, Warren J.; O’Donnell, Christopher J.

2011-01-01

Background Data regarding the relationships of diabetes, insulin resistance and sub-clinical hyperinsulinemia/hyperglycemia with cardiac structure and function are conflicting. We sought to apply volumetric cardiovascular magnetic resonance (CMR) in a free-living cohort to potentially clarify these associations. Methods and Results A total of 1603 Framingham Heart Study Offspring participants (age 64±9 years; 55% women) underwent CMR to determine left ventricular mass (LVM), LVM to end-diastolic volume ratio (LVM/LVEDV), relative wall thickness (RWT), ejection fraction (EF), cardiac output (CO) and left atrial size (LAD). Data regarding insulin resistance (homeostasis model, HOMA-IR) and glycemia categories (normal, impaired insulinemia or glycemia, pre-diabetes and diabetes) were determined. In a subgroup (253 men, 290 women) that underwent oral glucose tolerance testing, we related 2-hr insulin and glucose with CMR measures. In both men and women, all age-adjusted CMR measures increased across HOMA-IR quartiles, but multivariable-adjusted trends were significant only for LVM/ht2.7 and LVM/LVEDV. LVM/LVEDV and RWT were higher in participants with pre-diabetes and diabetes (in both sexes) in age-adjusted models, but these associations remained significant after multivariable-adjustment only in men. LVM/LVEDV was significantly associated with 2-hr insulin in men only, and RWT was significantly associated with 2-hr glucose in women only. In multivariable stepwise selection analyses, the inclusion of BMI led to a loss in statistical significance. Conclusions While insulin and glucose indices are associated with abnormalities in cardiac structure, insulin resistance and worsening glycemia are consistently and independently associated with LVM/LVEDV. These data implicate hyperglycemia and insulin resistance in concentric LV remodeling. PMID:20208015

Intelligence and socioeconomic position in childhood in relation to frailty and cumulative allostatic load in later life: the Lothian Birth Cohort 1936

PubMed Central

Gale, Catharine R; Booth, Tom; Starr, John M; Deary, Ian J

2016-01-01

Background Information on childhood determinants of frailty or allostatic load in later life is sparse. We investigated whether lower intelligence and greater socioeconomic disadvantage in childhood increased the risk of frailty and higher allostatic load, and explored the mediating roles of adult socioeconomic position, educational attainment and health behaviours. Methods Participants were 876 members of the Lothian Birth Cohort 1936 whose intelligence was assessed at age 11. At age 70, frailty was assessed using the Fried criteria. Measurements were made of fibrinogen, triglyceride, total and high-density lipoprotein cholesterol, albumin, glycated haemoglobin, C reactive protein, body mass index and blood pressure, from which an allostatic load score was calculated. Results In sex-adjusted analyses, lower intelligence and lower social class in childhood were associated with an increased risk of frailty: relative risks (95% CIs) were 1.57 (1.21 to 2.03) for a SD decrease in intelligence and 1.48 (1.12 to 1.96) for a category decrease in social class. In the fully adjusted model, both associations ceased to be significant: relative risks were 1.13 (0.83 to 1.54) and 1.19 (0.86 to 1.61), respectively. Educational attainment had a significant mediating effect. Lower childhood intelligence in childhood, but not social class, was associated with higher allostatic load. The sex-adjusted coefficient for allostatic load for a SD decrease in intelligence was 0.10 (0.07 to 0.14). In the fully adjusted model, this association was attenuated but remained significant (0.05 (0.01 to 0.09)). Conclusions Further research will need to investigate the mechanisms whereby lower childhood intelligence is linked to higher allostatic load in later life. PMID:26700299

Follicle-stimulating hormone is independently associated with lean mass but not BMD in younger postmenopausal women

PubMed Central

Gourlay, Margaret L.; Specker, Bonny L.; Li, Chenxi; Hammett-Stabler, Catherine A.; Renner, Jordan B.; Rubin, Janet E.

2011-01-01

Purpose Increased follicle-stimulating hormone (FSH) has been associated with lower bone mineral density (BMD) in animal models and longitudinal studies of women, but a direct effect has not been demonstrated. Methods We tested associations between FSH, non-bone body composition measures and BMD in 94 younger (aged 50 to 64 years) postmenopausal women without current use of hormone therapy, adjusting for sex hormone concentrations and clinical risk factors for osteoporosis. Lean mass, fat mass and areal BMD (aBMD) at the spine, femoral neck and total hip were measured using dual energy X-ray absorptiometry (DXA). Volumetric BMD (vBMD) was measured at the distal radius using peripheral quantitative computed tomography (pQCT). Results: FSH was inversely correlated with lean and fat mass, bioavailable estradiol, spine and hip aBMD, and vBMD at the ultradistal radius. In the multivariable analysis, FSH was independently associated with lean mass (β= −0.099, p=0.005) after adjustment for age, race, years since menopause, bioavailable estradiol, bioavailable testosterone, LH, PTH, SHBG and urine N-telopeptide. FSH showed no statistically significant association with aBMD at any site or pQCT measures at the distal radius in adjusted models. Race was independently associated with aBMD, and race and urine N-telopeptide were independently associated with bone area and vBMD. Conclusions After adjustment for hormonal measures and osteoporosis risk factors, higher concentrations of FSH were independently associated with lower lean mass, but not with BMD. Previously reported correlations between FSH and BMD might have been due to indirect associations via lean mass or weight. PMID:22086136

Psychosocial Factors Are Associated With Blood Pressure Progression Among African Americans in the Jackson Heart Study

PubMed Central

Sims, Mario; Higginbotham, John C.; Crowther, Martha R.; Wyatt, Sharon B.; Musani, Solomon K.; Payne, Thomas J.; Fox, Ervin R.; Parton, Jason M.

2016-01-01

BACKGROUND Research that examines the associations of psychosocial factors with incident hypertension among African Americans (AA) is limited. Using Jackson Heart Study (JHS) data, we examined associations of negative affect and stress with incident hypertension and blood pressure (BP) progression among AA. METHODS Our sample consisted of 1,656 normotensive participants at baseline (2000–2004) (mean age 47±12; 61% women). We investigated associations of negative affect (cynical distrust, anger-in, anger-out, and depressive symptoms) and stress (perceived stress, weekly stress inventory (WSI)-event, WSI-impact, and major life events) with BP progression (an increase by one BP stage as defined by JNC VII) and incident hypertension by examination 2 (2005–2008). Poisson regression analysis was utilized to examine the prevalence ratios (PRs; 95% confidence interval (CI)) of BP tracking and incident hypertension with psychosocial factors, adjusting for baseline age, sex, socioeconomic status (SES), and hypertension risk factors. RESULTS Fifty-six percentage of the sample (922 cases) had BP progression from 2005 to 2008. After adjustment for age, sex, and SES, a high anger-out score was associated with a 20% increased risk of BP progression compared to a low anger-out score (PR 1.20; 95% CI 1.05–1.36). High depressive symptoms score was associated with BP progression in the age, sex, and SES-adjusted model (PR 1.14; 95% CI 1.00–1.30). High WSI-event scores were associated with BP progression in the fully adjusted model (PR 1.21; 95% CI 1.04–1.40). We did not observe significant associations with any of the psychosocial measures and incident hypertension. CONCLUSIONS Psychosocial factors were associated with BP progression, with the strongest evidence for number of stressful events that occurred. PMID:26964661

Hormone replacement therapy is associated with gastro-oesophageal reflux disease: a retrospective cohort study

PubMed Central

2012-01-01

Background Oestrogen and progestogen have the potential to influence gastro-intestinal motility; both are key components of hormone replacement therapy (HRT). Results of observational studies in women taking HRT rely on self-reporting of gastro-oesophageal symptoms and the aetiology of gastro-oesophageal reflux disease (GORD) remains unclear. This study investigated the association between HRT and GORD in menopausal women using validated general practice records. Methods 51,182 menopausal women were identified using the UK General Practice Research Database between 1995–2004. Of these, 8,831 were matched with and without hormone use. Odds ratios (ORs) were calculated for GORD and proton-pump inhibitor (PPI) use in hormone and non-hormone users, adjusting for age, co-morbidities, and co-pharmacy. Results In unadjusted analysis, all forms of hormone use (oestrogen-only, tibolone, combined HRT and progestogen) were statistically significantly associated with GORD. In adjusted models, this association remained statistically significant for oestrogen-only treatment (OR 1.49; 1.18–1.89). Unadjusted analysis showed a statistically significant association between PPI use and oestrogen-only and combined HRT treatment. When adjusted for covariates, oestrogen-only treatment was significant (OR 1.34; 95% CI 1.03–1.74). Findings from the adjusted model demonstrated the greater use of PPI by progestogen users (OR 1.50; 1.01–2.22). Conclusions This first large cohort study of the association between GORD and HRT found a statistically significant association between oestrogen-only hormone and GORD and PPI use. This should be further investigated using prospective follow-up to validate the strength of association and describe its clinical significance. PMID:22642788

Using a conformal water bolus to adjust heating patterns of microwave waveguide applicators

NASA Astrophysics Data System (ADS)

Stauffer, Paul R.; Rodrigues, Dario B.; Sinahon, Randolf; Sbarro, Lyndsey; Beckhoff, Valeria; Hurwitz, Mark D.

2017-02-01

Background: Hyperthermia, i.e., raising tissue temperature to 40-45°C for 60 min, has been demonstrated to increase the effectiveness of radiation and chemotherapy for cancer. Although multi-element conformal heat applicators are under development to provide more adjustable heating of contoured anatomy, to date the most often used applicator to heat superficial disease is the simple microwave waveguide. With only a single power input, the operator must be resourceful to adjust heat treatment to accommodate variable size and shape tumors spreading across contoured anatomy. Methods: We used multiphysics simulation software that couples electromagnetic, thermal and fluid dynamics physics to simulate heating patterns in superficial tumors from commercially available microwave waveguide applicators. Temperature distributions were calculated inside homogenous muscle and layered skin-fat-muscle-tumor-bone tissue loads for a typical range of applicator coupling configurations and size of waterbolus. Variable thickness waterbolus was simulated as necessary to accommodate contoured anatomy. Physical models of several treatment configurations were constructed for comparison of simulation results with experimental specific absorption rate (SAR) measurements in homogenous muscle phantom. Results: Accuracy of the simulation model was confirmed with experimental SAR measurements of three unique applicator setups. Simulations demonstrated the ability to generate a wide range of power deposition patterns with commercially available waveguide antennas by controllably varying size and thickness of the waterbolus layer. Conclusion: Heating characteristics of 915 MHz waveguide antennas can be varied over a wide range by controlled adjustment of microwave power, coupling configuration, and waterbolus lateral size and thickness. The uniformity of thermal dose delivered to superficial tumors can be improved by cyclic switching of waterbolus thickness during treatment to proactively shift heat peaks and nulls around under the aperture, thereby reducing patient pain while increasing minimum thermal dose by end of treatment.

Macro- and Microstructural Magnetic Resonance Imaging Indices Associated With Diabetes Among Community-Dwelling Older Adults

PubMed Central

Falvey, Cherie M.; Rosano, Caterina; Simonsick, Eleanor M.; Harris, Tamara; Strotmeyer, Elsa S.; Satterfield, Suzanne; Yaffe, Kristine

2013-01-01

OBJECTIVE To better understand the association between diabetes and cognitive impairment, we evaluated macro- and microstructural brain MRI measures for the total brain and regions of interest (ROIs) in a group of community-dwelling elders with and without diabetes. RESEARCH DESIGN AND METHODS MRI measures were obtained on 308 elders (mean age 83.3 years; n = 85 with diabetes) from the Health ABC Healthy Brain Substudy. We performed a series of linear regressions and used standardized β values to estimate the cross-sectional association between diabetes and macrostructural (gray matter volume [GMV] and white matter hyperintensities [WMHs]) and microstructural (mean diffusivity [MD] and fractional anisotropy [FA]) measures for the total brain and ROIs. Models were adjusted for age, race, and sex; GMV values for ROIs were also adjusted for total brain volume (TBV). RESULTS In multivariate-adjusted models, diabetes was associated with lower total GMV (P = 0.0006), GMV in the putamen (P = 0.02 for left and right), and TBV (P = 0.04) and greater cerebral atrophy (P = 0.02). There was no association with WMHs. On microstructural measures, diabetes was associated with reduced FA for total white matter (P = 0.006) and greater MD for the hippocampus (P = 0.006 left; P = 0.01 right), dorsolateral prefrontal cortex (P = 0.0007, left; P = 0.002, right), left posterior cingulate (P = 0.02), and right putamen (P = 0.02). Further adjustment for stroke, hypertension, and myocardial infarction produced similar results. CONCLUSIONS In this cross-sectional study, elders with diabetes compared with those without had greater brain atrophy and early signs of neurodegeneration. Further studies are needed to determine whether these structural changes associated with diabetes predict risk of cognitive decline. PMID:23160721

Inflammation as a Mediator of the Association Between Race and Atrial Fibrillation: Results from the Health, Aging, and Body Composition Study

PubMed Central

Dewland, Thomas A.; Vittinghoff, Eric; Harris, Tamara B.; Magnani, Jared W.; Liu, Yongmei; Hsu, Fang-Chi; Satterfield, Suzanne; Wassel, Christina; Marcus, Gregory M.

2015-01-01

Background Despite a lower prevalence of established atrial fibrillation (AF) risk factors, Whites exhibit substantially higher rates of this arrhythmia compared to Blacks. The mechanism underlying this observation is not known. Both inflammation and obesity are risk factors for AF, and adipose tissue is a known contributor to systemic inflammation. Objectives We sought to determine the degree to which racial differences in AF risk are explained by differences in inflammation and adiposity. Methods Baseline serum inflammatory biomarker concentrations and abdominal adiposity (assessed by computed tomography) were quantified in a subset of Black and White participants without prevalent AF in the Health, Aging, and Body Composition (Health ABC) Study. Participants were prospectively followed for the diagnosis of AF using study ECGs and Medicare claims data. Cox proportional hazards models were used to determine the adjusted relative hazard of incident AF between races before and after biomarker adjustment. Results Among 2,768 participants (43% Black), 721 developed incident AF over a median follow up of 10.9 years. White race was associated with a heightened adjusted risk of incident AF (HR 1.55, 95% CI 1.30 to 1.84, p < 0.001). Abdominal adiposity was not associated with AF when added to the adjusted model. Among the studied biomarkers, adiponectin, TNF-α, TNF-α SR I, and TNF-α SR II concentrations were each higher among Whites and independently associated with a greater risk of incident AF. Together, these inflammatory cytokines mediated 42% (95% CI 15 to 119%, p = 0.004) of the adjusted race-AF association. Conclusions Systemic inflammatory pathways significantly mediate the heightened risk of AF among Whites. The higher level of systemic inflammation and concomitant increased AF risk in Whites is not explained by racial differences in abdominal adiposity or the presence of other pro-inflammatory cardiovascular comorbidities. PMID:26501131

Model-Based Economic Evaluation of Treatments for Depression: A Systematic Literature Review.

PubMed

Kolovos, Spyros; Bosmans, Judith E; Riper, Heleen; Chevreul, Karine; Coupé, Veerle M H; van Tulder, Maurits W

2017-09-01

An increasing number of model-based studies that evaluate the cost effectiveness of treatments for depression are being published. These studies have different characteristics and use different simulation methods. We aimed to systematically review model-based studies evaluating the cost effectiveness of treatments for depression and examine which modelling technique is most appropriate for simulating the natural course of depression. The literature search was conducted in the databases PubMed, EMBASE and PsycInfo between 1 January 2002 and 1 October 2016. Studies were eligible if they used a health economic model with quality-adjusted life-years or disability-adjusted life-years as an outcome measure. Data related to various methodological characteristics were extracted from the included studies. The available modelling techniques were evaluated based on 11 predefined criteria. This methodological review included 41 model-based studies, of which 21 used decision trees (DTs), 15 used cohort-based state-transition Markov models (CMMs), two used individual-based state-transition models (ISMs), and three used discrete-event simulation (DES) models. Just over half of the studies (54%) evaluated antidepressants compared with a control condition. The data sources, time horizons, cycle lengths, perspectives adopted and number of health states/events all varied widely between the included studies. DTs scored positively in four of the 11 criteria, CMMs in five, ISMs in six, and DES models in seven. There were substantial methodological differences between the studies. Since the individual history of each patient is important for the prognosis of depression, DES and ISM simulation methods may be more appropriate than the others for a pragmatic representation of the course of depression. However, direct comparisons between the available modelling techniques are necessary to yield firm conclusions.

Medicare capitation model, functional status, and multiple comorbidities: model accuracy

PubMed Central

Noyes, Katia; Liu, Hangsheng; Temkin-Greener, Helena

2012-01-01

Objective This study examined financial implications of CMS-Hierarchical Condition Categories (HCC) risk-adjustment model on Medicare payments for individuals with comorbid chronic conditions. Study Design The study used 1992-2000 data from the Medicare Current Beneficiary Survey and corresponding Medicare claims. The pairs of comorbidities were formed based on the prior evidence about possible synergy between these conditions and activities of daily living (ADL) deficiencies and included heart disease and cancer, lung disease and cancer, stroke and hypertension, stroke and arthritis, congestive heart failure (CHF) and osteoporosis, diabetes and coronary artery disease, CHF and dementia. Methods For each beneficiary, we calculated the actual Medicare cost ratio as the ratio of the individual’s annualized costs to the mean annual Medicare cost of all people in the study. The actual Medicare cost ratios, by ADLs, were compared to the HCC ratios under the CMS-HCC payment model. Using multivariate regression models, we tested whether having the identified pairs of comorbidities affects the accuracy of CMS-HCC model predictions. Results The CMS-HCC model underpredicted Medicare capitation payments for patients with hypertension, lung disease, congestive heart failure and dementia. The difference between the actual costs and predicted payments was partially explained by beneficiary functional status and less than optimal adjustment for these chronic conditions. Conclusions Information about beneficiary functional status should be incorporated in reimbursement models since underpaying providers for caring for population with multiple comorbidities may provide severe disincentives for managed care plans to enroll such individuals and to appropriately manage their complex and costly conditions. PMID:18837646

Diagnostics Cost Groups and Concurrent Utilization among Patients

PubMed Central

Rosen, Amy K; Loveland, Susan A; Anderson, Jennifer J; Hankin, Cheryl S; Breckenridge, James N; Berlowitz, Dan R

2002-01-01

Objective To assess the performance of Diagnostic Cost Groups (DCGs) in explaining variation in concurrent utilization for a defined subgroup, patients with substance abuse (SA) disorders, within the Department of Veterans Affairs (VA). Data Sources A 60 percent random sample of veterans who used health care services during Fiscal Year (FY) 1997 was obtained from VA administrative databases. Patients with SA disorders (13.3 percent) were identified from primary and secondary ICD-9-CM diagnosis codes. Study Design Concurrent risk adjustment models were fitted and tested using the DCG/HCC model. Three outcome measures were defined: (1) “service days” (the sum of a patient's inpatient and outpatient visit days), (2) mental health/substance abuse (MH/SA) service days, and (3) ambulatory provider encounters. To improve model performance, we ran three DCG/HCC models with additional indicators for patients with SA disorders. Data Collection To create a single file of veterans who used health care services in FY 1997, we merged records from all VA inpatient and outpatient files. Principal Findings Adding indicators for patients with mild/moderate SA disorders did not appreciably improve the R-squares for any of the outcome measures. When indicators were added for patients with severe SA who were in the most costly category, the explanatory ability of the models was modestly improved for all three outcomes. Conclusions Modifying the DCG/HCC model with additional markers for SA modestly improved homogeneity and model prediction. Because considerable variation still remained after modeling, we conclude that health care systems should evaluate “off-the-shelf” risk adjustment systems before applying them to their own populations. PMID:12236385

Simulation of Changes in Diffusion Related to Different Pathologies at Cellular Level After Traumatic Brain Injury

PubMed Central

Lin, Mu; He, Hongjian; Schifitto, Giovanni; Zhong, Jianhui

2016-01-01

Purpose The goal of the current study was to investigate tissue pathology at the cellular level in traumatic brain injury (TBI) as revealed by Monte Carlo simulation of diffusion tensor imaging (DTI)-derived parameters and elucidate the possible sources of conflicting findings of DTI abnormalities as reported in the TBI literature. Methods A model with three compartments separated by permeable membranes was employed to represent the diffusion environment of water molecules in brain white matter. The dynamic diffusion process was simulated with a Monte Carlo method using adjustable parameters of intra-axonal diffusivity, axon separation, glial cell volume fraction, and myelin sheath permeability. The effects of tissue pathology on DTI parameters were investigated by adjusting the parameters of the model corresponding to different stages of brain injury. Results The results suggest that the model is appropriate and the DTI-derived parameters simulate the predominant cellular pathology after TBI. Our results further indicate that when edema is not prevalent, axial and radial diffusivity have better sensitivity to axonal injury and demyelination than other DTI parameters. Conclusion DTI is a promising biomarker to detect and stage tissue injury after TBI. The observed inconsistencies among previous studies are likely due to scanning at different stages of tissue injury after TBI. PMID:26256558

Cost-Utility Analysis of Bariatric Surgery in Italy: Results of Decision-Analytic Modelling

PubMed Central

Lucchese, Marcello; Borisenko, Oleg; Mantovani, Lorenzo Giovanni; Cortesi, Paolo Angelo; Cesana, Giancarlo; Adam, Daniel; Burdukova, Elisabeth; Lukyanov, Vasily; Di Lorenzo, Nicola

2017-01-01

Objective To evaluate the cost-effectiveness of bariatric surgery in Italy from a third-party payer perspective over a medium-term (10 years) and a long-term (lifetime) horizon. Methods A state-transition Markov model was developed, in which patients may experience surgery, post-surgery complications, diabetes mellitus type 2, cardiovascular diseases or die. Transition probabilities, costs, and utilities were obtained from the Italian and international literature. Three types of surgeries were considered: gastric bypass, sleeve gastrectomy, and adjustable gastric banding. A base-case analysis was performed for the population, the characteristics of which were obtained from surgery candidates in Italy. Results In the base-case analysis, over 10 years, bariatric surgery led to cost increment of EUR 2,661 and generated additional 1.1 quality-adjusted life years (QALYs). Over a lifetime, surgery led to savings of EUR 8,649, additional 0.5 life years and 3.2 QALYs. Bariatric surgery was cost-effective at 10 years with an incremental cost-effectiveness ratio of EUR 2,412/QALY and dominant over conservative management over a lifetime. Conclusion In a comprehensive decision analytic model, a current mix of surgical methods for bariatric surgery was cost-effective at 10 years and cost-saving over the lifetime of the Italian patient cohort considered in this analysis. PMID:28601866

Comprehensive Search for Alzheimer Disease Susceptibility Loci in the APOE Region

PubMed Central

Jun, Gyungah; Vardarajan, Badri N.; Buros, Jacqueline; Yu, Chang-En; Hawk, Michele V.; Dombroski, Beth A.; Crane, Paul K.; Larson, Eric B.; Mayeux, Richard; Haines, Jonathan L.; Lunetta, Kathryn L.; Pericak-Vance, Margaret A.; Schellenberg, Gerard D.; Farrer, Lindsay A.

2013-01-01

Objective To evaluate the association of risk and age at onset (AAO) of Alzheimer disease (AD) with single-nucleotide polymorphisms (SNPs) in the chromosome 19 region including apolipoprotein E (APOE) and a repeat-length polymorphism in TOMM40 (poly-T, rs10524523). Design Conditional logistic regression models and survival analysis. Setting Fifteen genome-wide association study data sets assembled by the Alzheimer's Disease Genetics Consortium. Participants Eleven thousand eight hundred forty AD cases and 10 931 cognitively normal elderly controls. Main Outcome Measures Association of AD risk and AAO with genotyped and imputed SNPs located in an 800-Mb region including APOE in the entire Alzheimer's Disease Genetics Consortium data set and with the TOMM40 poly-T marker genotyped in a subset of 1256 cases and 1605 controls. Results In models adjusting for APOE ε4, no SNPs in the entire region were significantly associated with AAO at P<.001. Rs10524523 was not significantly associated with AD or AAO in models adjusting for APOE genotype or within the subset of ε3/ε3 subjects. Conclusions APOE alleles ε2, ε3, and ε4 account for essentially all the inherited risk of AD associated with this region. Other variants including a poly-T track in TOMM40 are not independent risk or AAO loci. PMID:22869155

Accuracy of Cycling Power Meters against a Mathematical Model of Treadmill Cycling.

PubMed

Maier, Thomas; Schmid, Lucas; Müller, Beat; Steiner, Thomas; Wehrlin, Jon Peter

2017-06-01

The aim of this study was to compare the accuracy among a high number of current mobile cycling power meters used by elite and recreational cyclists against a first principle-based mathematical model of treadmill cycling. 54 power meters from 9 manufacturers used by 32 cyclists were calibrated. While the cyclist coasted downhill on a motorised treadmill, a back-pulling system was adjusted to counter the downhill force. The system was then loaded 3 times with 4 different masses while the cyclist pedalled to keep his position. The mean deviation (trueness) to the model and coefficient of variation (precision) were analysed. The mean deviations of the power meters were -0.9±3.2% (mean±SD) with 6 power meters deviating by more than±5%. The coefficients of variation of the power meters were 1.2±0.9% (mean±SD), with Stages varying more than SRM (p<0.001) and PowerTap (p<0.001). In conclusion, current power meters used by elite and recreational cyclists vary considerably in their trueness; precision is generally high but differs between manufacturers. Calibrating and adjusting the trueness of every power meter against a first principle-based reference is advised for accurate measurements. © Georg Thieme Verlag KG Stuttgart · New York.

42 CFR § 512.300 - Determination of episode quality-adjusted target prices and actual episode payments.

Code of Federal Regulations, 2010 CFR

2017-10-01

... PROGRAMS EPISODE PAYMENT MODEL Pricing and Payment § 512.300 Determination of episode quality-adjusted... historical episode payments. (iii) For the AMI model, quality-adjusted target prices for anchor MS-DRGs 246... 100 percent regional historical episode payments. (iv) For the CABG model, quality-adjusted target...

Relevance of the c-statistic when evaluating risk-adjustment models in surgery.

PubMed

Merkow, Ryan P; Hall, Bruce L; Cohen, Mark E; Dimick, Justin B; Wang, Edward; Chow, Warren B; Ko, Clifford Y; Bilimoria, Karl Y

2012-05-01

The measurement of hospital quality based on outcomes requires risk adjustment. The c-statistic is a popular tool used to judge model performance, but can be limited, particularly when evaluating specific operations in focused populations. Our objectives were to examine the interpretation and relevance of the c-statistic when used in models with increasingly similar case mix and to consider an alternative perspective on model calibration based on a graphical depiction of model fit. From the American College of Surgeons National Surgical Quality Improvement Program (2008-2009), patients were identified who underwent a general surgery procedure, and procedure groups were increasingly restricted: colorectal-all, colorectal-elective cases only, and colorectal-elective cancer cases only. Mortality and serious morbidity outcomes were evaluated using logistic regression-based risk adjustment, and model c-statistics and calibration curves were used to compare model performance. During the study period, 323,427 general, 47,605 colorectal-all, 39,860 colorectal-elective, and 21,680 colorectal cancer patients were studied. Mortality ranged from 1.0% in general surgery to 4.1% in the colorectal-all group, and serious morbidity ranged from 3.9% in general surgery to 12.4% in the colorectal-all procedural group. As case mix was restricted, c-statistics progressively declined from the general to the colorectal cancer surgery cohorts for both mortality and serious morbidity (mortality: 0.949 to 0.866; serious morbidity: 0.861 to 0.668). Calibration was evaluated graphically by examining predicted vs observed number of events over risk deciles. For both mortality and serious morbidity, there was no qualitative difference in calibration identified between the procedure groups. In the present study, we demonstrate how the c-statistic can become less informative and, in certain circumstances, can lead to incorrect model-based conclusions, as case mix is restricted and patients become more homogenous. Although it remains an important tool, caution is advised when the c-statistic is advanced as the sole measure of a model performance. Copyright © 2012 American College of Surgeons. All rights reserved.

Using Claims Data to Examine Mortality Trends Following Hospitalization for Heart Attack in Medicare

PubMed Central

Ash, Arlene S; Posner, Michael A; Speckman, Jeanne; Franco, Shakira; Yacht, Andrew C; Bramwell, Lindsey

2003-01-01

Objective To see if changes in the demographics and illness burden of Medicare patients hospitalized for acute myocardial infarction (AMI) from 1995 through 1999 can explain an observed rise (from 32 percent to 34 percent) in one-year mortality over that period. Data Sources Utilization data from the Centers for Medicare and Medicaid Services (CMS) fee-for-service claims (MedPAR, Outpatient, and Carrier Standard Analytic Files); patient demographics and date of death from CMS Denominator and Vital Status files. For over 1.5 million AMI discharges in 1995–1999 we retain diagnoses from one year prior, and during, the case-defining admission. Study Design We fit logistic regression models to predict one-year mortality for the 1995 cases and apply them to 1996–1999 files. The CORE model uses age, sex, and original reason for Medicare entitlement to predict mortality. Three other models use the CORE variables plus morbidity indicators from well-known morbidity classification methods (Charlson, DCG, and AHRQ's CCS). Regressions were used as is—without pruning to eliminate clinical or statistical anomalies. Each model references the same diagnoses—those recorded during the pre- and index admission periods. We compare each model's ability to predict mortality and use each to calculate risk-adjusted mortality in 1996–1999. Principal Findings The comprehensive morbidity classifications (DCG and CCS) led to more accurate predictions than the Charlson, which dominated the CORE model (validated C-statistics: 0.81, 0.82, 0.74, and 0.66, respectively). Using the CORE model for risk adjustment reduced, but did not eliminate, the mortality increase. In contrast, adjustment using any of the morbidity models produced essentially flat graphs. Conclusions Prediction models based on claims-derived demographics and morbidity profiles can be extremely accurate. While one-year post-AMI mortality in Medicare may not be worsening, outcomes appear not to have continued to improve as they had in the prior decade. Rich morbidity information is available in claims data, especially when longitudinally tracked across multiple settings of care, and is important in setting performance targets and evaluating trends. PMID:14596389

Determinants of Perceived Stress in Individuals with Obesity: Exploring the Relationship of Potentially Obesity-Related Factors and Perceived Stress

PubMed Central

Junne, Florian; Ziser, Katrin; Giel, Katrin Elisabeth; Schag, Kathrin; Skoda, Eva; Mack, Isabelle; Niess, Andreas; Zipfel, Stephan; Teufel, Martin

2017-01-01

Objective Associations of specific types of stress with increased food intake and subsequent weight gain have been demonstrated in animal models as well as in experimental and epidemiological studies on humans. This study explores the research question of to what extent potentially obesity-related factors determine perceived stress in individuals with obesity. Methods N = 547 individuals with obesity participated in a cross-sectional study assessing perceived stress as the outcome variable and potential determinants of stress related to obesity. Based on the available evidence, a five factorial model of ‘obesity-related obesogenic stressors’ was hypothesized, including the dimensions, ‘drive for thinness’, ‘impulse regulation’, ‘ineffectiveness’, ‘social insecurity’, and ‘body dissatisfaction’. The model was tested using multiple linear regression analyses. Results The five factorial model of ‘potentially obesity-related stressors’ resulted in a total variance explanation of adjusted R² = 0.616 for males and adjusted R² = 0.595 for females for perceived stress. The relative variance contribution of the five included factors differed substantially for the two sexes. Conclusion The findings of this cross-sectional study support the hypothesized, potentially obesity-related factors: ‘drive for thinness’, ‘impulse regulation’, ‘ineffectiveness’, ‘social insecurity’, and ‘body dissatisfaction’ as relevant determinants of perceived stress in individuals with obesity. PMID:28433993

Influenza epidemics, seasonality, and the effects of cold weather on cardiac mortality

PubMed Central

2012-01-01

Background More people die in the winter from cardiac disease, and there are competing hypotheses to explain this. The authors conducted a study in 48 US cities to determine how much of the seasonal pattern in cardiac deaths could be explained by influenza epidemics, whether that allowed a more parsimonious control for season than traditional spline models, and whether such control changed the short term association with temperature. Methods The authors obtained counts of daily cardiac deaths and of emergency hospital admissions of the elderly for influenza during 1992–2000. Quasi-Poisson regression models were conducted estimating the association between daily cardiac mortality, and temperature. Results Controlling for influenza admissions provided a more parsimonious model with better Generalized Cross-Validation, lower residual serial correlation, and better captured Winter peaks. The temperature-response function was not greatly affected by adjusting for influenza. The pooled estimated increase in risk for a temperature decrease from 0 to −5°C was 1.6% (95% confidence interval (CI) 1.1-2.1%). Influenza accounted for 2.3% of cardiac deaths over this period. Conclusions The results suggest that including epidemic data explained most of the irregular seasonal pattern (about 18% of the total seasonal variation), allowing more parsimonious models than when adjusting for seasonality only with smooth functions of time. The effect of cold temperature is not confounded by epidemics. PMID:23025494

The association between obesity, depression, and educational attainment in women: The mediating role of body image dissatisfaction

PubMed Central

Gavin, Amelia R.; Simon, Greg E.; Ludman, Evette J.

2011-01-01

Objective We examine the mediating role of body image dissatisfaction (BID) on the association between obesity and depression and the variation of this association as a function of years of education among a population-based sample of women aged 40–65 years. Methods A series of sample-weighted logistic regression models were used to estimate the associations between obesity, BID, and depression, stratified by educational attainment. Data were obtained from a structured telephone interview of 4543 female health plan enrollees, including self-reported height and weight, the Patient Health Questionnaire assessment of depression, and a single-item measure of BID. Results Among those with <16 years of education, in both the unadjusted and adjusted models, obesity and BID were significantly associated with depression. Similarly, among those with ≥16 years of education, obesity and BID were significantly associated with depression in the unadjusted models. However, in the adjusted model, only BID was associated with depression. A formal test for mediation suggests that the association between obesity and depression was mediated by BID regardless of level of education. Conclusions Our data suggest that BID-mediated the obesity-depression association. In addition, obesity and BID may be salient risk factors for depression among middle-aged women as a function of the level of education. PMID:21109045

Polygenic risk scores in familial Alzheimer disease

PubMed Central

Tosto, Giuseppe; Bird, Thomas D.; Tsuang, Debby; Bennett, David A.; Boeve, Bradley F.; Cruchaga, Carlos; Faber, Kelley; Foroud, Tatiana M.; Farlow, Martin; Goate, Alison M.; Bertlesen, Sarah; Graff-Radford, Neill R.; Medrano, Martin; Lantigua, Rafael; Manly, Jennifer; Ottman, Ruth; Rosenberg, Roger; Schaid, Daniel J.; Schupf, Nicole; Stern, Yaakov; Sweet, Robert A.

2017-01-01

Objective: To investigate the association between a genetic risk score (GRS) and familial late-onset Alzheimer disease (LOAD) and its predictive value in families multiply affected by the disease. Methods: Using data from the National Institute on Aging Genetics Initiative for Late-Onset Alzheimer Disease (National Institute on Aging–Late-Onset Alzheimer's Disease Family Study), mixed regression models tested the association of familial LOAD with a GRS based on single nucleotide polymorphisms (SNPs) previously associated with LOAD. We modeled associations using unweighted and weighted scores with estimates derived from the literature. In secondary models, we adjusted subsequent models for presence of the APOE ε4 allele and further tested the interaction between APOE ε4 and the GRS. We constructed a similar GRS in a cohort of Caribbean Hispanic families multiply affected by LOAD by selecting the SNP with the strongest p value within the same regions. Results: In the NIA-LOAD families, the GRS was significantly associated with LOAD (odds ratio [OR] 1.29; 95% confidence interval 1.21–1.37). The results did not change after adjusting for APOE ε4. In Caribbean Hispanic families, the GRS also significantly predicted LOAD (OR 1.73; 1.57–1.93). Higher scores were associated with lower age at onset in both cohorts. Conclusions: High GRS increases the risk of familial LOAD and lowers the age at onset, regardless of ethnic group. PMID:28213371

Forcings and feedbacks in the GeoMIP ensemble for a reduction in solar irradiance and increase in CO2

NASA Astrophysics Data System (ADS)

Huneeus, Nicolas; Boucher, Olivier; Alterskjær, Kari; Cole, Jason N. S.; Curry, Charles L.; Ji, Duoying; Jones, Andy; Kravitz, Ben; Kristjánsson, Jón Egill; Moore, John C.; Muri, Helene; Niemeier, Ulrike; Rasch, Phil; Robock, Alan; Singh, Balwinder; Schmidt, Hauke; Schulz, Michael; Tilmes, Simone; Watanabe, Shingo; Yoon, Jin-Ho

2014-05-01

The effective radiative forcings (including rapid adjustments) and feedbacks associated with an instantaneous quadrupling of the preindustrial CO2 concentration and a counterbalancing reduction of the solar constant are investigated in the context of the Geoengineering Model Intercomparison Project (GeoMIP). The forcing and feedback parameters of the net energy flux, as well as its different components at the top-of-atmosphere (TOA) and surface, were examined in 10 Earth System Models to better understand the impact of solar radiation management on the energy budget. In spite of their very different nature, the feedback parameter and its components at the TOA and surface are almost identical for the two forcing mechanisms, not only in the global mean but also in their geographical distributions. This conclusion holds for each of the individual models despite intermodel differences in how feedbacks affect the energy budget. This indicates that the climate sensitivity parameter is independent of the forcing (when measured as an effective radiative forcing). We also show the existence of a large contribution of the cloudy-sky component to the shortwave effective radiative forcing at the TOA suggesting rapid cloud adjustments to a change in solar irradiance. In addition, the models present significant diversity in the spatial distribution of the shortwave feedback parameter in cloudy regions, indicating persistent uncertainties in cloud feedback mechanisms.

Knowledge, Perceptions, and Self-reported Performance of Hand Hygiene Among Registered Nurses at Community-based Hospitals in the Republic of Korea: A Cross-sectional Multi-center Study

PubMed Central

2018-01-01

Objectives To assess the nurses’ hand hygiene (HH) knowledge, perception, attitude, and self-reported performance in small- and medium-sized hospitals after Middle East Respiratory Syndrome outbreak. Methods The structured questionnaire was adapted from the World Health Organization’s survey. Data were collected between June 26 and July 14, 2017. Results Nurses showed scores on knowledge (17.6±2.5), perception (69.3±0.8), self-reported HH performance of non-self (86.0±11.0), self-reported performance of self (88.2±11.0), and attitude (50.5±5.5). HH performance rate of non-self was Y1=36.678+ 0.555X1 (HH performance rate of self) (adjusted R2=0.280, p<0.001). The regression model for performance was Y4=18.302+0.247X41 (peception)+0.232X42 (attitude)+0.875X42 (role model); coefficients were significant statistically except attitude, and this model significant statistically (adjusted R2=0.191, p<0.001). Conclusions Advanced HH education program would be developed and operated continuously. Perception, attitude, role model was found to be a significant predictors of HH performance of self. So these findings could be used in future HH promotion strategies for nurses. PMID:29886707

The influence of pelvic adjustment on vertical jump height in female university students with functional leg length inequality.

PubMed

Gong, Wontae

2015-01-01

[Purpose] This study aimed to investigate the effect of pelvic adjustment on vertical jump height (VJH) in female university students with functional leg length inequality (FLLI). [Subjects] Thirty female university students with FLLI were divided into a pelvic adjustment group (n = 15) and a stretching (control) group (n = 15). [Methods] VJH was measured using an OptoGait. [Results] After the intervention, jump height improved significantly compared with the pre-intervention height only in the pelvic adjustment group, while FLLI showed statistically significant improvement in both groups. [Conclusion] Pelvic adjustment as per the Gonstead method can be applied as a method of reducing FLLI and increasing VJH.

Usefulness of the admission electrocardiogram to predict long-term outcomes after non-ST-elevation acute coronary syndrome (from the FRISC II, ICTUS, and RITA-3 [FIR] Trials).

PubMed

Damman, Peter; Holmvang, Lene; Tijssen, Jan G P; Lagerqvist, Bo; Clayton, Tim C; Pocock, Stuart J; Windhausen, Fons; Hirsch, Alexander; Fox, Keith A A; Wallentin, Lars; de Winter, Robbert J

2012-01-01

The aim of this study was to evaluate the independent prognostic value of qualitative and quantitative admission electrocardiographic (ECG) analysis regarding long-term outcomes after non-ST-segment elevation acute coronary syndromes (NSTE-ACS). From the Fragmin and Fast Revascularization During Instability in Coronary Artery Disease (FRISC II), Invasive Versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS), and Randomized Intervention Trial of Unstable Angina 3 (RITA-3) patient-pooled database, 5,420 patients with NSTE-ACS with qualitative ECG data, of whom 2,901 had quantitative data, were included in this analysis. The main outcome was 5-year cardiovascular death or myocardial infarction. Hazard ratios (HRs) were calculated with Cox regression models, and adjustments were made for established outcome predictors. The additional discriminative value was assessed with the category-less net reclassification improvement and integrated discrimination improvement indexes. In the 5,420 patients, the presence of ST-segment depression (≥1 mm; adjusted HR 1.43, 95% confidence interval [CI] 1.25 to 1.63) and left bundle branch block (adjusted HR 1.64, 95% CI 1.18 to 2.28) were independently associated with long-term cardiovascular death or myocardial infarction. Risk increases were short and long term. On quantitative ECG analysis, cumulative ST-segment depression (≥5 mm; adjusted HR 1.34, 95% CI 1.05 to 1.70), the presence of left bundle branch block (adjusted HR 2.15, 95% CI 1.36 to 3.40) or ≥6 leads with inverse T waves (adjusted HR 1.22, 95% CI 0.97 to 1.55) was independently associated with long-term outcomes. No interaction was observed with treatment strategy. No improvements in net reclassification improvement and integrated discrimination improvement were observed after the addition of quantitative characteristics to a model including qualitative characteristics. In conclusion, in the FRISC II, ICTUS, and RITA-3 NSTE-ACS patient-pooled data set, admission ECG characteristics provided long-term prognostic value for cardiovascular death or myocardial infarction. Quantitative ECG characteristics provided no incremental discrimination compared to qualitative data. Copyright © 2012 Elsevier Inc. All rights reserved.

The Influence of Family Income Trajectories From Birth to Adulthood on Adult Oral Health: Findings From the 1982 Pelotas Birth Cohort

PubMed Central

Peres, Karen G.; Thomson, W. Murray; Broadbent, Jonathan M.; Gigante, Denise P.; Horta, Bernardo L.

2011-01-01

Objectives. We assessed whether 3 models of life course socioeconomic status (critical period, accumulation of risk, and social mobility) predicted unsound teeth in adulthood among a Brazilian cohort. Methods. Life course data were collected on the 5914 live-born infants in the 1982 Pelotas Birth Cohort study. Participants' oral health was assessed at 15 (n = 888) and 24 (n = 720) years of age. We assessed family income trajectories and number of episodes of poverty in the life course through Poisson regressions, yielding unadjusted and adjusted prevalence ratios for number of unsound teeth at age 24 years. Results. The adjusted prevalence ratio for participants born into poverty was 30% higher than for those who were not. Participants who were always poor had the highest prevalence of unsound teeth; those who were downwardly or upwardly mobile also had more unsound teeth than did other participants, after adjustment for confounders. More episodes of poverty were associated with greater prevalence of unsound teeth in adulthood. Conclusions. Poverty at birth and during the life course was correlated with the number of unsound teeth at 24 years of age. PMID:20558788

Symptoms of depression and all-cause mortality in farmers, a cohort study: the HUNT study, Norway

PubMed Central

Letnes, Jon Magne; Hilt, Bjørn; Bjørngaard, Johan Håkon; Krokstad, Steinar

2016-01-01

Objectives To explore all-cause mortality and the association between symptoms of depression and all-cause mortality in farmers compared with other occupational groups, using a prospective cohort design. Methods We included adult participants with a known occupation from the second wave of the Nord-Trøndelag Health Study (Helseundersøkelsen i Nord-Trøndelag 2 (HUNT2) 1995–1997), Norway. Complete information on emigration and death from all causes was obtained from the National Registries. We used the depression subscale of the Hospital Anxiety and Depression Scale (HADS) to measure symptoms of depression. We compared farmers to 4 other occupational groups. Our baseline study population comprised 32 618 participants. Statistical analyses were performed using the Cox proportional hazards models. Results The estimated mortality risk in farmers was lower than in all other occupations combined, with a sex and age-adjusted HR (0.91, 95% CI 0.82 to 1.00). However, farmers had an 11% increased age-adjusted and sex-adjusted mortality risk compared with the highest ranked socioeconomic group (HR 1.11, 95% CI 0.98 to 1.25). In farmers, symptoms of depression were associated with a 13% increase in sex-adjusted and age-adjusted mortality risk (HR 1.13, 95% CI 0.88 to 1.45). Compared with other occupations this was the lowest HR, also after adjusting for education, marital status, long-lasting limiting somatic illness and lifestyle factors (HR 1.08, 95% CI 0.84 to 1.39). Conclusions Farmers had lower all-cause mortality compared with the other occupational groups combined. Symptoms of depression were associated with an increased mortality risk in farmers, but the risk increase was smaller compared with the other occupational groups. PMID:27188811

Effects of autistic traits on social and school adjustment in children and adolescents: the moderating roles of age and gender.

PubMed

Hsiao, Mei-Ni; Tseng, Wan-Ling; Huang, Hui-Yi; Gau, Susan Shur-Fen

2013-01-01

This study examined the associations between children's and adolescents' autistic-like social deficits and school and social adjustment as well as the moderating roles of age and gender in these associations. The sample consisted of 1321 students (48.7% boys) in Grade 1 to Grade 8 from northern Taiwan. Children's and adolescents' autistic-like social deficits were assessed using the Social Responsiveness Scale (SRS), and their school and social adjustment (i.e., academic performance, negative attitudes toward schoolwork/teachers/classmates, behavioral problems at schools, negative peer relationships, and problems with peers) were assessed using the Social Adjustment Inventory for Children and Adolescents (SAICA). Both measures were completed by the mothers of the participants. Results from the linear mixed models demonstrated that autistic-like social deficits were associated with poor academic performance, negative attitudes toward schoolwork, teachers, and classmates, behavioral problems at schools, negative peer relationships, and problematic peer interactions. Moreover, gender and/or age moderated the associations between autistic-like social deficits and school and social adjustment problems. For example, autistic-like social deficits were more strongly related to negative school attitude, school social problems, and negative peer relationships in boys than in girls. Further, autistic-like social deficits were more strongly related to problems with peers in older girls than in older boys or younger children (regardless of gender). In conclusion, the present study suggests that autistic-like social deficits may place children and adolescents at increased risk for social and school maladjustment and that the extent of maladjustment may vary with the child's age and gender and the domains of adjustment under discussion. Copyright © 2012 Elsevier Ltd. All rights reserved.

Common Breast Cancer Susceptibility Variants in LSP1 and RAD51L1 Are Associated with Mammographic Density Measures that Predict Breast Cancer Risk

PubMed Central

Vachon, Celine M.; Scott, Christopher G.; Fasching, Peter A.; Hall, Per; Tamimi, Rulla M.; Li, Jingmei; Stone, Jennifer; Apicella, Carmel; Odefrey, Fabrice; Gierach, Gretchen L.; Jud, Sebastian M.; Heusinger, Katharina; Beckmann, Matthias W.; Pollan, Marina; Fernández-Navarro, Pablo; González-Neira, Anna; Benítez, Javier; van Gils, Carla H.; Lokate, Mariëtte; Onland-Moret, N. Charlotte; Peeters, Petra H.M.; Brown, Judith; Leyland, Jean; Varghese, Jajini S.; Easton, Douglas F.; Thompson, Deborah J.; Luben, Robert N.; Warren, Ruth ML; Wareham, Nicholas J.; Loos, Ruth JF; Khaw, Kay-Tee; Ursin, Giske; Lee, Eunjung; Gayther, Simon A.; Ramus, Susan J.; Eeles, Rosalind A.; Leach, Martin O.; Kwan-Lim, Gek; Couch, Fergus J.; Giles, Graham G.; Baglietto, Laura; Krishnan, Kavitha; Southey, Melissa C.; Le Marchand, Loic; Kolonel, Laurence N.; Woolcott, Christy; Maskarinec, Gertraud; Haiman, Christopher A; Walker, Kate; Johnson, Nichola; McCormack, Valerie A.; Biong, Margarethe; Alnæs, Grethe I.G.; Gram, Inger Torhild; Kristensen, Vessela N.; Børresen-Dale, Anne-Lise; Lindström, Sara; Hankinson, Susan E.; Hunter, David J.; Andrulis, Irene L.; Knight, Julia A.; Boyd, Norman F.; Figueroa, Jonine D.; Lissowska, Jolanta; Wesolowska, Ewa; Peplonska, Beata; Bukowska, Agnieszka; Reszka, Edyta; Liu, JianJun; Eriksson, Louise; Czene, Kamila; Audley, Tina; Wu, Anna H.; Pankratz, V. Shane; Hopper, John L.; dos-Santos-Silva, Isabel

2013-01-01

Background Mammographic density adjusted for age and body mass index (BMI) is a heritable marker of breast cancer susceptibility. Little is known about the biological mechanisms underlying the association between mammographic density and breast cancer risk. We examined whether common low-penetrance breast cancer susceptibility variants contribute to inter-individual differences in mammographic density measures. Methods We established an international consortium (DENSNP) of 19 studies from 10 countries, comprising 16,895 Caucasian women, to conduct a pooled cross-sectional analysis of common breast cancer susceptibility variants in 14 independent loci and mammographic density measures. Dense and non-dense areas, and percent density, were measured using interactive-thresholding techniques. Mixed linear models were used to assess the association between genetic variants and the square roots of mammographic density measures adjusted for study, age, case status, body mass index (BMI) and menopausal status. Results Consistent with their breast cancer associations, the C-allele of rs3817198 in LSP1 was positively associated with both adjusted dense area (p=0.00005) and adjusted percent density (p=0.001) whereas the A-allele of rs10483813 in RAD51L1 was inversely associated with adjusted percent density (p=0.003), but not with adjusted dense area (p=0.07). Conclusion We identified two common breast cancer susceptibility variants associated with mammographic measures of radio-dense tissue in the breast gland. Impact We examined the association of 14 established breast cancer susceptibility loci with mammographic density phenotypes within a large genetic consortium and identified two breast cancer susceptibility variants, LSP1-rs3817198 and RAD51L1-rs10483813, associated with mammographic measures and in the same direction as the breast cancer association. PMID:22454379

Trends in Hospitalization Rates and Outcomes of Endocarditis among Medicare Beneficiaries

PubMed Central

Bikdeli, Behnood; Wang, Yun; Kim, Nancy; Desai, Mayur M.; Quagliarello, Vincent; Krumholz, Harlan M.

2015-01-01

Objectives To determine the hospitalization rates and outcomes of endocarditis among older adults. Background Endocarditis is the most serious cardiovascular infection and is especially common among older adults. Little is known about recent trends for endocarditis hospitalizations and outcomes. Methods Using Medicare inpatient Standard Analytic Files, we identified all Fee-For-Service beneficiaries aged ≥65 years with a principal or secondary diagnosis of endocarditis from 1999-2010. We used Medicare Denominator Files to report hospitalizations per 100,000 person-years. Rates of 30-day and 1-year mortality were calculated using Vital Status Files. We used mixed-effects models to calculate adjusted rates of hospitalization and mortality and to compare the results before and after 2007, when the American Heart Association revised recommendations for endocarditis prophylaxis. Results Overall, 262,658 beneficiaries were hospitalized with endocarditis. The adjusted hospitalization rate increased from 1999-2005, reaching 83.5 per 100,000 person-years in 2005, and declined during 2006-2007. After 2007, the decline continued, reaching 70.6 per 100,000 person-years in 2010. Adjusted 30-day and 1-year mortality rates ranged from 14.2% to 16.5% and from 32.6% to 36.2%, respectively. There were no consistent changes in adjusted rates of 30-day and 1-year mortality after 2007. Trends in rates of hospitalization and outcomes were consistent across demographic subgroups. Adjusted rates of hospitalization and mortality declined consistently in the subgroup with principal diagnosis of endocarditis. Conclusions Our study highlights the high burden of endocarditis among older adults. We did not observe an increase in adjusted rates of hospitalization or mortality associated with endocarditis after publication of the 2007 guidelines. PMID:23994421

The Mediterranean Diet and Cognitive Function among Healthy Older Adults in a 6-Month Randomised Controlled Trial: The MedLey Study.

PubMed

Knight, Alissa; Bryan, Janet; Wilson, Carlene; Hodgson, Jonathan M; Davis, Courtney R; Murphy, Karen J

2016-09-20

Evidence from a limited number of randomised controlled intervention trials (RCTs) have shown that a Mediterranean dietary pattern may reduce the risk of cognitive decline and enhance cognitive function among healthy older adults. However, there are currently no data in non-Mediterranean older adult populations. The present study aimed to address this gap by examining the effect of a Mediterranean dietary pattern (MedDiet) for six months on aspects of cognitive function in a randomised controlled intervention trial (the MedLey study) that extended for a duration of 18 months. In the final analysed cohort, a total of 137 men and women (mean age of 72.1 ± 5.0 years) randomly assigned to either a MedDiet or control diet (HabDiet) (i.e., habitual dietary intake), were assessed on a comprehensive neuropsychological test battery, including 11 individual tests. In multivariable-adjusted models, the MedDiet group did not perform significantly better than the HabDiet control group for executive functioning (adjusted mean differences: +2.53, 95% CI -2.59 to 7.65, p = 0.33); speed of processing (adjusted mean differences: +3.24, 95% CI -1.21 to 7.70, p = 0.15); memory (adjusted mean differences: +2.00, 95% CI -3.88 to 7.88, p = 0.50); visual-spatial ability (adjusted mean differences: +0.21, 95% CI -0.38 to 0.81, 0.48); and overall age-related cognitive performance (adjusted mean differences: +7.99, 95% CI -4.00 to 19.9, p = 0.19). In conclusion, this study did not find evidence of a beneficial effect of a MedDiet intervention on cognitive function among healthy older adults.

Compensation in Academic Medicine: Progress Toward Gender Equity

PubMed Central

Ryan, Kenneth; St. Germain, Patricia; Schwindt, Leslie; Sager, Rebecca; Reed, Kathryn L.

2007-01-01

Background Studies have documented substantial salary disparities between women and men in academic medicine. While various strategies have been proposed to increase equity, to our knowledge, no interventions have been evaluated. Objective This paper aims to assess the effect of an identity-conscious intervention on salary equity. Design This study shows comparison of adjusted annual salaries for women and men before and after an intervention. Participants/Setting We studied full time faculty employed in FY00 (n = 393) and FY04 (n = 462) in one College of Medicine. Intervention Compensation data were obtained from personnel databases for women and men, and adjusted for predictors. After verification of data accuracy by departments, comparable individuals within the same department who had different salaries were identified. The Dean discussed apparent disparities with department heads, and salaries were adjusted. Measurements Total adjusted annualized salaries were compared for men and women for the year the project began and the year after the intervention using multivariate models. Female faculty members’ salaries were also considered as a percent of male faculty members’ salaries. Results Twenty-one potential salary disparities were identified. Eight women received equity adjustments to their salaries, with the average increase being $17,323. Adjusted salaries for women as a percent of salary for men increased from 89.4% before the intervention to 93.5% after the intervention. Disparities in compensation were no longer significant in FY2004 in basic science departments, where women were paid 97.6% of what men were paid. Conclusions This study shows that gender disparities in compensation can be reduced through careful documentation, identification of comparable individuals paid different salaries, and commitment from leadership to hold the appropriate person accountable. PMID:17694417

Ground-level falls: 9-year cumulative experience in a regionalized trauma system

PubMed Central

Cade, Angela; King, Brad; Berne, John; Fernandez, Luis; Norwood, Scott

2012-01-01

Ground-level falls (GLFs) are the leading cause of nonfatal hospitalized injuries in the US. We hypothesized that risk-adjusted mortality would not vary between levels of trauma center verification if regional triage functioned appropriately. Data were collected from our regional trauma registry for the years 2001 through 2009. A multilevel mixed-effects logistic regression model was developed to compare risk-adjusted mortality rates by trauma center level and by year. GLF patients numbered 8202 over 9 years with 2.1% mortality. Mean age was 74.5 years and mean probability of death was 0.021 (95% confidence interval [CI], 0.020–0.021). The level I center–treated patients had the highest probability of death (0.033) compared to levels II and III/IV patients (0.023 and 0.018, respectively; P < 0.001), with the highest mortality (6.0%, 3.1%, and 1.1% for levels I, II, and III/IV; P < 0.001). The adjusted odds ratio of mortality was lowest at the level I center (0.71; 95% CI, 0.56–0.91), while no difference existed between level II (1.17; 95% CI, 0.90–1.51) and level III/IV centers (1.22; 95% CI, 0.90–1.66). The 95% CIs for risk-adjusted mortality by year overlapped the 1.0 reference line for each year from 2002 to 2009. In conclusion, regional risk-adjusted mortality for GLF has varied little since 2002. More study is warranted to understand the lower risk-adjusted GLF mortality at the level I center for this growing patient population. PMID:22275774

Real time monitoring of risk-adjusted paediatric cardiac surgery outcomes using variable life-adjusted display: implementation in three UK centres

PubMed Central

Pagel, Christina; Utley, Martin; Crowe, Sonya; Witter, Thomas; Anderson, David; Samson, Ray; McLean, Andrew; Banks, Victoria; Tsang, Victor; Brown, Katherine

2013-01-01

Objective To implement routine in-house monitoring of risk-adjusted 30-day mortality following paediatric cardiac surgery. Design Collaborative monitoring software development and implementation in three specialist centres. Patients and methods Analyses incorporated 2 years of data routinely audited by the National Institute of Cardiac Outcomes Research (NICOR). Exclusion criteria were patients over 16 or undergoing non-cardiac or only catheter procedures. We applied the partial risk adjustment in surgery (PRAiS) risk model for death within 30 days following surgery and generated variable life-adjusted display (VLAD) charts for each centre. These were shared with each clinical team and feedback was sought. Results Participating centres were Great Ormond Street Hospital, Evelina Children's Hospital and The Royal Hospital for Sick Children in Glasgow. Data captured all procedures performed between 1 January 2010 and 31 December 2011. This incorporated 2490 30-day episodes of care, 66 of which were associated with a death within 30 days.The VLAD charts generated for each centre displayed trends in outcomes benchmarked to recent national outcomes. All centres ended the 2-year period within four deaths from what would be expected. The VLAD charts were shared in multidisciplinary meetings and clinical teams reported that they were a useful addition to existing quality assurance initiatives. Each centre is continuing to use the prototype software to monitor their in-house surgical outcomes. Conclusions Timely and routine monitoring of risk-adjusted mortality following paediatric cardiac surgery is feasible. Close liaison with hospital data managers as well as clinicians was crucial to the success of the project. PMID:23564473

Waist Circumference Adjusted for Body Mass Index and Intra-Abdominal Fat Mass

PubMed Central

Berentzen, Tina Landsvig; Ängquist, Lars; Kotronen, Anna; Borra, Ronald; Yki-Järvinen, Hannele; Iozzo, Patricia; Parkkola, Riitta; Nuutila, Pirjo; Ross, Robert; Allison, David B.; Heymsfield, Steven B.; Overvad, Kim; Sørensen, Thorkild I. A.; Jakobsen, Marianne Uhre

2012-01-01

Background The association between waist circumference (WC) and mortality is particularly strong and direct when adjusted for body mass index (BMI). One conceivable explanation for this association is that WC adjusted for BMI is a better predictor of the presumably most harmful intra-abdominal fat mass (IAFM) than WC alone. We studied the prediction of abdominal subcutaneous fat mass (ASFM) and IAFM by WC alone and by addition of BMI as an explanatory factor. Methodology/Principal Findings WC, BMI and magnetic resonance imaging data from 742 men and women who participated in clinical studies in Canada and Finland were pooled. Total adjusted squared multiple correlation coefficients (R2) of ASFM and IAFM were calculated from multiple linear regression models with WC and BMI as explanatory variables. Mean BMI and WC of the participants in the pooled sample were 30 kg/m2 and 102 cm, respectively. WC explained 29% of the variance in ASFM and 51% of the variance in IAFM. Addition of BMI to WC added 28% to the variance explained in ASFM, but only 1% to the variance explained in IAFM. Results in subgroups stratified by study center, sex, age, obesity level and type 2 diabetes status were not systematically different. Conclusion/Significance The prediction of IAFM by WC is not improved by addition of BMI. PMID:22384179

Lipid Adjustment for Chemical Exposures: Accounting for Concomitant Variables

PubMed Central

Li, Daniel; Longnecker, Matthew P.; Dunson, David B.

2013-01-01

Background Some environmental chemical exposures are lipophilic and need to be adjusted by serum lipid levels before data analyses. There are currently various strategies that attempt to account for this problem, but all have their drawbacks. To address such concerns, we propose a new method that uses Box-Cox transformations and a simple Bayesian hierarchical model to adjust for lipophilic chemical exposures. Methods We compared our Box-Cox method to existing methods. We ran simulation studies in which increasing levels of lipid-adjusted chemical exposure did and did not increase the odds of having a disease, and we looked at both single-exposure and multiple-exposures cases. We also analyzed an epidemiology dataset that examined the effects of various chemical exposures on the risk of birth defects. Results Compared with existing methods, our Box-Cox method produced unbiased estimates, good coverage, similar power, and lower type-I error rates. This was the case in both single- and multiple-exposure simulation studies. Results from analysis of the birth-defect data differed from results using existing methods. Conclusion Our Box-Cox method is a novel and intuitive way to account for the lipophilic nature of certain chemical exposures. It addresses some of the problems with existing methods, is easily extendable to multiple exposures, and can be used in any analyses that involve concomitant variables. PMID:24051893

Hope in the Context of Lung Cancer: Relationships of Hope to Symptoms and Psychological Distress

PubMed Central

Berendes, David; Keefe, Francis J.; Somers, Tamara J.; Kothadia, Sejal M.; Porter, Laura S.; Cheavens, Jennifer S.

2010-01-01

Context Hope may be important in explaining the variability in how patients adjust to lung cancer. Objectives The aim of this study was to examine how hope, as conceptualized by Snyder and colleagues, is associated with multiple indices of adjustment to lung cancer. This theoretical model of hope suggests that people with high levels of hope are able to think about the pathways to goals (pathways) and feel confident that they can pursue those pathways to reach their goals (agency). Methods We hypothesized that higher levels of hope, as measured by Snyder et al.’s hope scale, would be related to lower levels of pain and other lung cancer symptoms (i.e., fatigue, cough) and lower psychological distress (i.e., depression). Participants in this study included patients with a diagnosis of lung cancer (n = 51). All participants provided demographic and medical information and completed measures of hope, lung cancer symptoms, and psychological distress. Results Data analyses found that hope was inversely associated with major symptoms of cancer (i.e., pain, fatigue, cough) and psychological distress (i.e., depression), even after accounting for important demographic and medical variables (i.e., age, cancer stage). Conclusion The findings of this cross-sectional study highlight the potential importance of hope in understanding adjustment to lung cancer. Future longitudinal research could help reveal how hope and adjustment interact over the course of cancer survivorship. PMID:20579840

Husbands’ perceptions of their wives’ breast cancer coping efficacy: testing congruence models of adjustment

PubMed Central

Martinez Sanchez, MaryAnn

2018-01-01

Introduction Recent reviews have reinforced the notion that having a supportive spouse can help with the process of coping with and adjusting to cancer. Congruence between spouses’ perspectives has been proposed as one mechanism in that process, yet alternative models of congruence have not been examined closely. This study assessed alternative models of congruence in perceptions of coping and their mediating effects on adjustment to breast cancer. Methods Seventy-two women in treatment for breast cancer and their husbands completed measures of marital adjustment, self-efficacy for coping, and adjustment to cancer. Karnofsky Performance Status was obtained from medical records. Wives completed a measure of self-efficacy for coping (wives’ ratings of self-efficacy for coping [WSEC]) and husbands completed a measure of self-efficacy for coping (husbands’ ratings of wives’ self-efficacy for coping [HSEC]) based on their perceptions of their wives’ coping efficacy. Results Interestingly, the correlation between WSEC and HSEC was only 0.207; thus, they are relatively independent perspectives. The following three models were tested to determine the nature of the relationship between WSEC and HSEC: discrepancy model (WSEC − HSEC), additive model (WSEC + HSEC), and multiplicative model (WSEC × HSEC). The discrepancy model was not related to wives’ adjustment; however, the additive (B=0.205, P<0.001) and multiplicative (B=0.001, P<0.001) models were significantly related to wives’ adjustment. Also, the additive model mediated the relationship between performance status and adjustment. Discussion Husbands’ perception of their wives’ coping efficacy contributed marginally to their wives’ adjustment, and the combination of WSEC and HSEC mediated the relationship between functional status and wives’ adjustment, thus positively impacting wives’ adjustment to cancer. Future research is needed to determine the quality of the differences between HSEC and WSEC in order to develop interventions to optimize the impact of these two relatively independent perspectives on cancer outcomes. PMID:29491720

Husbands' perceptions of their wives' breast cancer coping efficacy: testing congruence models of adjustment.

PubMed

Merluzzi, Thomas V; Martinez Sanchez, MaryAnn

2018-01-01

Recent reviews have reinforced the notion that having a supportive spouse can help with the process of coping with and adjusting to cancer. Congruence between spouses' perspectives has been proposed as one mechanism in that process, yet alternative models of congruence have not been examined closely. This study assessed alternative models of congruence in perceptions of coping and their mediating effects on adjustment to breast cancer. Seventy-two women in treatment for breast cancer and their husbands completed measures of marital adjustment, self-efficacy for coping, and adjustment to cancer. Karnofsky Performance Status was obtained from medical records. Wives completed a measure of self-efficacy for coping (wives' ratings of self-efficacy for coping [WSEC]) and husbands completed a measure of self-efficacy for coping (husbands' ratings of wives' self-efficacy for coping [HSEC]) based on their perceptions of their wives' coping efficacy. Interestingly, the correlation between WSEC and HSEC was only 0.207; thus, they are relatively independent perspectives. The following three models were tested to determine the nature of the relationship between WSEC and HSEC: discrepancy model (WSEC - HSEC), additive model (WSEC + HSEC), and multiplicative model (WSEC × HSEC). The discrepancy model was not related to wives' adjustment; however, the additive ( B =0.205, P <0.001) and multiplicative ( B =0.001, P <0.001) models were significantly related to wives' adjustment. Also, the additive model mediated the relationship between performance status and adjustment. Husbands' perception of their wives' coping efficacy contributed marginally to their wives' adjustment, and the combination of WSEC and HSEC mediated the relationship between functional status and wives' adjustment, thus positively impacting wives' adjustment to cancer. Future research is needed to determine the quality of the differences between HSEC and WSEC in order to develop interventions to optimize the impact of these two relatively independent perspectives on cancer outcomes.

Disaster Hits Home: A Model of Displaced Family Adjustment after Hurricane Katrina

ERIC Educational Resources Information Center

Peek, Lori; Morrissey, Bridget; Marlatt, Holly

2011-01-01

The authors explored individual and family adjustment processes among parents (n = 30) and children (n = 55) who were displaced to Colorado after Hurricane Katrina. Drawing on in-depth interviews with 23 families, this article offers an inductive model of displaced family adjustment. Four stages of family adjustment are presented in the model: (a)…

Posttreatment Motivation and Alcohol Treatment Outcome 9 Months Later: Findings From Structural Equation Modeling

PubMed Central

2014-01-01

Objective: To investigate the association between posttreatment motivation to change as measured by the Readiness to Change Questionnaire Treatment Version and drinking outcomes 9 months after the conclusion of treatment for alcohol problems. Method: Data from 392 participants in the United Kingdom Alcohol Treatment Trial were used to fit structural equation models investigating relationships between motivation to change pre- and posttreatment and 5 outcomes 9 months later. The models included pathways through changes in drinking behavior during treatment and adjustment for sociodemographic information. Results: Greater posttreatment motivation (being in action vs. preaction) was associated with 3 times higher odds of the most stringent definition of positive outcome (being abstinent or entirely a nonproblem drinker) 9 months later (odds ratio = 3.10, 95% confidence interval [1.83, 5.25]). A smaller indirect effect of pretreatment motivation on this outcome was seen from pathways through drinking behavior during treatment and posttreatment motivation (probit coefficient = 0.08, 95% confidence interval [0.03, 0.14]). A similar pattern of results was seen for other outcomes evaluated. Conclusion: Posttreatment motivation to change has hitherto been little studied and is identified here as a clearly important predictor of longer term treatment outcome. PMID:25244390

Aspirin for Primary Prevention of Cardiovascular Events

PubMed Central

Augustovski, Federico A.; Cantor, Scott B.; Thach, Chau T.; Spann, Stephen J.

1998-01-01

OBJECTIVE The use of aspirin for primary prevention of cardiovascular events in the general population is controversial. The purpose of this study was to create a versatile model to evaluate the effects of aspirin in the primary prevention of cardiovascular events in patients with different risk profiles. DESIGN A Markov decision-analytic model evaluated the expected length and quality of life for the cohort's next 10 years as measured by quality-adjusted survival for the options of taking or not taking aspirin. SETTING Hypothetical model of patients in a primary care setting. PATIENTS Several cohorts of patients with a range of risk profiles typically seen in a primary care setting were considered. Risk factors considered included gender, age, cholesterol levels, systolic blood pressure, smoking status, diabetes, and presence of left ventricular hypertrophy. The cohorts were followed for 10 years. Outcomes were myocardial infarction, stroke, gastrointestinal bleed, ulcer, and death. MAIN RESULTS For the cases considered, the effects of aspirin varied according to the cohort's risk profile. By taking aspirin, the lowest-risk cohort would be the most harmed with a loss of 1.8 quality-adjusted life days by taking aspirin; the highest risk cohort would achieve the most benefit with a gain of 11.3 quality-adjusted life days. Results without quality adjustment favored taking aspirin in all the cohorts, with a gain of 0.73 to 8.04 days. The decision was extremely sensitive to variations in the utility of taking aspirin and to aspirin's effects on cardiovascular mortality. The model was robust to other probability and utility changes within reasonable parameters. CONCLUSIONS The decision of whether to take aspirin as primary prevention for cardiovascular events depends on patient risk. It is a harmful intervention for patients with no risk factors, and it is beneficial in moderate and high-risk patients. The benefits of aspirin in this population are comparable to those of other widely accepted preventive strategies. It is especially dependent on the patient's risk profile, patient preferences for the adverse effects of aspirin, and on the level of beneficial effects of aspirin on cardiovascular-related mortality. PMID:9844080

A novel heuristic for optimization aggregate production problem: Evidence from flat panel display in Malaysia

NASA Astrophysics Data System (ADS)

Al-Kuhali, K.; Hussain M., I.; Zain Z., M.; Mullenix, P.

2015-05-01

Aim: This paper contribute to the flat panel display industry it terms of aggregate production planning. Methodology: For the minimization cost of total production of LCD manufacturing, a linear programming was applied. The decision variables are general production costs, additional cost incurred for overtime production, additional cost incurred for subcontracting, inventory carrying cost, backorder costs and adjustments for changes incurred within labour levels. Model has been developed considering a manufacturer having several product types, which the maximum types are N, along a total time period of T. Results: Industrial case study based on Malaysia is presented to test and to validate the developed linear programming model for aggregate production planning. Conclusion: The model development is fit under stable environment conditions. Overall it can be recommended to adapt the proven linear programming model to production planning of Malaysian flat panel display industry.

A diffusion modelling approach to understanding contextual cueing effects in children with ADHD

PubMed Central

Weigard, Alexander; Huang-Pollock, Cynthia

2014-01-01

Background Strong theoretical models suggest implicit learning deficits may exist among children with Attention Deficit Hyperactivity Disorder (ADHD). Method We examine implicit contextual cueing (CC) effects among children with ADHD (n=72) and non-ADHD Controls (n=36). Results Using Ratcliff’s drift diffusion model, we found that among Controls, the CC effect is due to improvements in attentional guidance and to reductions in response threshold. Children with ADHD did not show a CC effect; although they were able to use implicitly acquired information to deploy attentional focus, they had more difficulty adjusting their response thresholds. Conclusions Improvements in attentional guidance and reductions in response threshold together underlie the CC effect. Results are consistent with neurocognitive models of ADHD that posit sub-cortical dysfunction but intact spatial attention, and encourage the use of alternative data analytic methods when dealing with reaction time data. PMID:24798140

Exploring the Impact of Work Satisfaction and Involvement on Marital Interaction When Both Partners are Employed

ERIC Educational Resources Information Center

Ridley, Carl A.

1973-01-01

The two major conclusions of this study were: (1) teachers and their husbands follow different patterns concerning the job satisfaction-marital adjustment relationship, and (2) teachers and their husbands were more than moderately successful at preventing their job involvement from interfering with their marital adjustment. (Author)

Long-Term Ozone Exposure and Mortality in a Large Prospective Study

PubMed Central

Jerrett, Michael; Pope, C. Arden; Krewski, Daniel; Gapstur, Susan M.; Diver, W. Ryan; Beckerman, Bernardo S.; Marshall, Julian D.; Su, Jason; Crouse, Daniel L.; Burnett, Richard T.

2016-01-01

Rationale: Tropospheric ozone (O3) is potentially associated with cardiovascular disease risk and premature death. Results from long-term epidemiological studies on O3 are scarce and inconclusive. Objectives: In this study, we examined associations between chronic ambient O3 exposure and all-cause and cause-specific mortality in a large cohort of U.S. adults. Methods: Cancer Prevention Study II participants were enrolled in 1982. A total of 669,046 participants were analyzed, among whom 237,201 deaths occurred through 2004. We obtained estimates of O3 concentrations at the participant’s residence from a hierarchical Bayesian space–time model. Estimates of fine particulate matter (particulate matter with an aerodynamic diameter of up to 2.5 μm [PM2.5]) and NO2 concentrations were obtained from land use regression. Cox proportional hazards regression models were used to examine mortality associations adjusted for individual- and ecological-level covariates. Measurements and Main Results: In single-pollutant models, we observed significant positive associations between O3, PM2.5, and NO2 concentrations and all-cause and cause-specific mortality. In two-pollutant models adjusted for PM2.5, significant positive associations remained between O3 and all-cause (hazard ratio [HR] per 10 ppb, 1.02; 95% confidence interval [CI], 1.01–1.04), circulatory (HR, 1.03; 95% CI, 1.01–1.05), and respiratory mortality (HR, 1.12; 95% CI, 1.08–1.16) that were unchanged with further adjustment for NO2. We also observed positive mortality associations with both PM2.5 (both near source and regional) and NO2 in multipollutant models. Conclusions: Findings derived from this large-scale prospective study suggest that long-term ambient O3 contributes to risk of respiratory and circulatory mortality. Substantial health and environmental benefits may be achieved by implementing further measures aimed at controlling O3 concentrations. PMID:26680605

Ambient Air Pollution and Cancer Mortality in the Cancer Prevention Study II

PubMed Central

Krewski, Daniel; Diver, W. Ryan; Pope, C. Arden; Burnett, Richard T.; Jerrett, Michael; Marshall, Julian D.; Gapstur, Susan M.

2017-01-01

Background: The International Agency for Research on Cancer classified both outdoor air pollution and airborne particulate matter as carcinogenic to humans (Group 1) for lung cancer. There may be associations with cancer at other sites; however, the epidemiological evidence is limited. Objective: The aim of this study was to clarify whether ambient air pollution is associated with specific types of cancer other than lung cancer by examining associations of ambient air pollution with nonlung cancer death in the Cancer Prevention Study II (CPS-II). Methods: Analysis included 623,048 CPS-II participants who were followed for 22 y (1982–2004). Modeled estimates of particulate matter with aerodynamic diameter <2.5µm (PM2.5) (1999–2004), nitrogen dioxide (NO2) (2006), and ozone (O3) (2002–2004) concentrations were linked to the participant residence at enrollment. Cox proportional hazards models were used to estimate associations per each fifth percentile–mean increment with cancer mortality at 29 anatomic sites, adjusted for individual and ecological covariates. Results: We observed 43,320 nonlung cancer deaths. PM2.5 was significantly positively associated with death from cancers of the kidney {adjusted hazard ratio (HR) per 4.4 μg/m3=1.14 [95% confidence interval (CI): 1.03, 1.27]} and bladder [HR=1.13 (95% CI: 1.03, 1.23)]. NO2 was positively associated with colorectal cancer mortality [HR per 6.5 ppb=1.06 (95% CI: 1.02, 1.10). The results were similar in two-pollutant models including PM2.5 and NO2 and in three-pollutant models with O3. We observed no statistically significant positive associations with death from other types of cancer based on results from adjusted models. Conclusions: The results from this large prospective study suggest that ambient air pollution was not associated with death from most nonlung cancers, but associations with kidney, bladder, and colorectal cancer death warrant further investigation. https://doi.org/10.1289/EHP1249 PMID:28886601

Ensemble-based methods for forecasting census in hospital units

PubMed Central

2013-01-01

Background The ability to accurately forecast census counts in hospital departments has considerable implications for hospital resource allocation. In recent years several different methods have been proposed forecasting census counts, however many of these approaches do not use available patient-specific information. Methods In this paper we present an ensemble-based methodology for forecasting the census under a framework that simultaneously incorporates both (i) arrival trends over time and (ii) patient-specific baseline and time-varying information. The proposed model for predicting census has three components, namely: current census count, number of daily arrivals and number of daily departures. To model the number of daily arrivals, we use a seasonality adjusted Poisson Autoregressive (PAR) model where the parameter estimates are obtained via conditional maximum likelihood. The number of daily departures is predicted by modeling the probability of departure from the census using logistic regression models that are adjusted for the amount of time spent in the census and incorporate both patient-specific baseline and time varying patient-specific covariate information. We illustrate our approach using neonatal intensive care unit (NICU) data collected at Women & Infants Hospital, Providence RI, which consists of 1001 consecutive NICU admissions between April 1st 2008 and March 31st 2009. Results Our results demonstrate statistically significant improved prediction accuracy for 3, 5, and 7 day census forecasts and increased precision of our forecasting model compared to a forecasting approach that ignores patient-specific information. Conclusions Forecasting models that utilize patient-specific baseline and time-varying information make the most of data typically available and have the capacity to substantially improve census forecasts. PMID:23721123

SU-E-T-561: Monte Carlo-Based Organ Dose Reconstruction Using Pre-Contoured Human Model for Hodgkins Lymphoma Patients Treated by Cobalt-60 External Beam Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jung, J; Pelletier, C; Lee, C

Purpose: Organ doses for the Hodgkin’s lymphoma patients treated with cobalt-60 radiation were estimated using an anthropomorphic model and Monte Carlo modeling. Methods: A cobalt-60 treatment unit modeled in the BEAMnrc Monte Carlo code was used to produce phase space data. The Monte Carlo simulation was verified with percent depth dose measurement in water at various field sizes. Radiation transport through the lung blocks were modeled by adjusting the weights of phase space data. We imported a precontoured adult female hybrid model and generated a treatment plan. The adjusted phase space data and the human model were imported to themore » XVMC Monte Carlo code for dose calculation. The organ mean doses were estimated and dose volume histograms were plotted. Results: The percent depth dose agreement between measurement and calculation in water phantom was within 2% for all field sizes. The mean organ doses of heart, left breast, right breast, and spleen for the selected case were 44.3, 24.1, 14.6 and 3.4 Gy, respectively with the midline prescription dose of 40.0 Gy. Conclusion: Organ doses were estimated for the patient group whose threedimensional images are not available. This development may open the door to more accurate dose reconstruction and estimates of uncertainties in secondary cancer risk for Hodgkin’s lymphoma patients. This work was partially supported by the intramural research program of the National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics.« less

Perceived Neighborhood Social Cohesion and Myocardial Infarction

PubMed Central

Kim, Eric S.; Hawes, Armani M.; Smith, Jacqui

2015-01-01

Background The main strategy for alleviating heart disease has been to target individuals and encourage them to change their health behaviors. Though important, emphasis on individuals has diverted focus and responsibility away from neighborhood characteristics, which also strongly influence people’s behaviors. Although a growing body of research has repeatedly demonstrated strong associations between neighborhood characteristics and cardiovascular health, it has typically focused on negative neighborhood characteristics. Only a few studies have examined the potential health enhancing effects of positive neighborhood characteristics, such as perceived neighborhood social cohesion. Methods Using multiple logistic regression models, we tested whether higher perceived neighborhood social cohesion was associated with lower incidence of myocardial infarction. Prospective data from the Health and Retirement Study—a nationally representative panel study of American adults over the age of 50—were used to analyze 5,276 participants with no history of heart disease. Respondents were tracked for four years and analyses adjusted for relevant sociodemographic, behavioral, biological, and psychosocial factors. Results In a model that adjusted for age, gender, race, marital status, education, and total wealth, each standard deviation increase in perceived neighborhood social cohesion was associated with a 22% reduced odds of myocardial infarction (OR = 0.78, 95% CI, 0.63–0.94. The association between perceived neighborhood social cohesion and myocardial infarction remained even after adjusting for behavioral, biological, and psychosocial covariates. Conclusions Higher perceived neighborhood social cohesion may have a protective effect against myocardial infarction. PMID:25135074

Depressive symptoms are associated with incident coronary heart disease or revascularization among Blacks but not among Whites in the Reasons for Geographical and Racial Differences in Stroke (REGARDS) Study

PubMed Central

Sims, Mario; Redmond, Nicole; Khodneva, Yulia; Durant, Raegan W.; Halanych, Jewell; Safford, Monika M.

2015-01-01

Purpose To examine the association of depressive symptoms with coronary heart disease (CHD) endpoints by race and income. Methods Study participants were Blacks and Whites (n=24,443) without CHD at baseline from the national REasons for Geographical and Racial Differences in Stroke (REGARDS) cohort. Outcomes included acute CHD and CHD or revascularization. We estimated race-stratified multivariable Cox proportional hazards models of incident CHD and incident CHD or revascularization with the 4-item Center for Epidemiological Studies-Depression scale, adjusting for risk factors. Results Mean follow-up was 4.2+1.5 years, CHD incidence was 8.3 events per 1000 person years (n=366) among Blacks and 8.8 events per 1000 person years (n=613) among Whites. After adjustment for age, sex, marital status, region, and socioeconomic status, depressive symptoms were significantly associated with incident CHD among Blacks [HR 1.39 (95%CI 1.00-1.91)], but not among Whites [HR 1.10 (95%CI 0.74-1.64)]. In the fully-adjusted model, compared to Blacks who reported no depressive symptoms, those reporting depressive symptoms had greater risk for the composite endpoint of CHD or revascularization [HR 1.36 (95%CI 1.01-1.81)]. Depressive symptoms were not associated with incident CHD endpoints among Whites. Conclusions High depressive symptoms were associated with higher risk of CHD or revascularization for Blacks but not Whites. PMID:25891100

Relation of aortic valve calcium to chronic kidney disease (from the Chronic Renal Insufficiency Cohort Study).

PubMed

Guerraty, Marie A; Chai, Boyang; Hsu, Jesse Y; Ojo, Akinlolu O; Gao, Yanlin; Yang, Wei; Keane, Martin G; Budoff, Matthew J; Mohler, Emile R

2015-05-01

Although subjects with chronic kidney disease (CKD) are at markedly increased risk for cardiovascular mortality, the relation between CKD and aortic valve calcification has not been fully elucidated. Also, few data are available on the relation of aortic valve calcification and earlier stages of CKD. We sought to assess the relation of aortic valve calcium (AVC) with estimated glomerular filtration rate (eGFR), traditional and novel cardiovascular risk factors, and markers of bone metabolism in the Chronic Renal Insufficiency Cohort (CRIC) Study. All patients who underwent aortic valve scanning in the CRIC study were included. The relation between AVC and eGFR, traditional and novel cardiovascular risk factors, and markers of calcium metabolism were analyzed using both unadjusted and adjusted regression models. A total of 1,964 CRIC participants underwent computed tomography for AVC quantification. Decreased renal function was independently associated with increased levels of AVC (eGFR 47.11, 44.17, and 39 ml/min/1.73 m2, respectively, p<0.001). This association persisted after adjusting for traditional, but not novel, AVC risk factors. Adjusted regression models identified several traditional and novel risk factors for AVC in patients with CKD. There was a difference in AVC risk factors between black and nonblack patients. In conclusion, our study shows that eGFR is associated in a dose-dependent manner with AVC in patients with CKD, and this association is independent of traditional cardiovascular risk factors. Copyright © 2015 Elsevier Inc. All rights reserved.

Fatigue in employees with diabetes: its relation with work characteristics and diabetes related burden

PubMed Central

Weijman, I; Ros, W; Rutten, G; Schaufeli, W; Schabracq, M; Winnubst, J

2003-01-01

Aims: To examine the relations between work characteristics as defined by the Job Demand-Control-Support model (JDCS) (that is, job demands, decision latitude, and social support), diabetes related burden (symptoms, seriousness of disease, self care activities, and disease duration), and fatigue in employees with diabetes mellitus. Methods: Employees (n = 292) aged 30–60 years, with insulin treated diabetes, filled in self administered questionnaires that assess the above mentioned components of the JDCS model and diabetes related burdens. Results: Both work and diabetes related factors are related to fatigue in employees with diabetes. Regression analyses revealed that work characteristics explain 19.1% of the variance in fatigue; lack of support, and the interaction of job demands and job control contribute significantly. Diabetes related factors explain another 29.0% of the variance, with the focus on diabetes related symptoms and the burden of adjusting insulin dosage to circumstances. Fatigue is more severe in case of lack of social support at work, high job demands in combination with a lack of decision latitude, more burden of adjusting insulin dosage to circumstances, and more diabetic symptoms. Furthermore, regression analysis revealed that diabetic symptoms and the burden of adjusting the insulin dosage to circumstances are especially relevant in combination with high job demands. Conclusions: Both diabetes and work should be taken into consideration—by (occupational) physicians as well as supervisors—in the communication with people with diabetes. PMID:12782754

Television viewing duration during childhood and long- association with adolescent neuropsychological outcomes.

PubMed

O'Connor, Giselle; Piñero Casas, Maria; Basagaña, Xavier; Vicente, Mònica López; Davand, Payam; Torrent, Maties; Martínez-Murciano, David; García-Esteban, Raquel; Marinelli, Marcella; Sunyer, Jordi; Julvez, Jordi

2016-12-01

This study is aiming to evaluate the association between television viewing during childhood and long-term adolescent neuropsychological outcomes and the potential explanatory pathways. This is a longitudinal study based on 278 children participating in the INMA birth cohort (1998) in Menorca Island, Spain. The exposure is parent-reported duration of child television viewing (hours per week) at 6 and 9 years of age. Neuropsychological outcomes were assessed at 14 years of age using the N-back test. Behavioral outcomes at 14 years of age were assessed using the Strengths and Difficulties Questionnaire (SDQ) and school performance was assessed by the global school score. Regression models were developed to quantify the associations between duration of television viewing and neuropsychological outcomes adjusted for child and parents' characteristics. The average of weekly TV viewing from 6 to 9 years was 9.2 h (SD: 4.1). Only N-back test outcomes exhibited statistically significant differences in crude models. Children viewing > 14 h per week tended to show larger latencies in working memory reaction time (HRT in ms), beta (CI) = 53 (0-107). After adjusting for potential social confounders, the association weakened and became non-significant but adverse trends were slightly preserved. Early life TV viewing was not associated with adolescent neuropsychological outcomes after adjustment for potential confounders. Further research including larger and exhaustive population-based cohort studies is required in order to verify our conclusions.

A comparison of three methods for estimating the requirements for medical specialists: the case of otolaryngologists.

PubMed Central

Anderson, G F; Han, K C; Miller, R H; Johns, M E

1997-01-01

OBJECTIVE: To compare three methods of computing the national requirements for otolaryngologists in 1994 and 2010. DATA SOURCES: Three large HMOs, a Delphi panel, the Bureau of Health Professions (BHPr), and published sources. STUDY DESIGN: Three established methods of computing requirements for otolaryngologists were compared: managed care, demand-utilization, and adjusted needs assessment. Under the managed care model, a published method based on reviewing staffing patterns in HMOs was modified to estimate the number of otolaryngologists. We obtained from BHPr estimates of work force projections from their demand model. To estimate the adjusted needs model, we convened a Delphi panel of otolaryngologists using the methodology developed by the Graduate Medical Education National Advisory Committee (GMENAC). DATA COLLECTION/EXTRACTION METHODS: Not applicable. PRINCIPAL FINDINGS: Wide variation in the estimated number of otolaryngologists required occurred across the three methods. Within each model it was possible to alter the requirements for otolaryngologists significantly by changing one or more of the key assumptions. The managed care model has a potential to obtain the most reliable estimates because it reflects actual staffing patterns in institutions that are attempting to use physicians efficiently. CONCLUSIONS: Estimates of work force requirements can vary considerably if one or more assumptions are changed. In order for the managed care approach to be useful for actual decision making concerning the appropriate number of otolaryngologists required, additional research on the methodology used to extrapolate the results to the general population is necessary. PMID:9180613

Spatio-temporal models to determine association between Campylobacter cases and environment

PubMed Central

Sanderson, Roy A; Maas, James A; Blain, Alasdair P; Gorton, Russell; Ward, Jessica; O’Brien, Sarah J; Hunter, Paul R; Rushton, Stephen P

2018-01-01

Abstract Background Campylobacteriosis is a major cause of gastroenteritis in the UK, and although 70% of cases are associated with food sources, the remainder are probably associated with wider environmental exposure. Methods In order to investigate wider environmental transmission, we conducted a spatio-temporal analysis of the association of human cases of Campylobacter in the Tyne catchment with weather, climate, hydrology and land use. A hydrological model was used to predict surface-water flow in the Tyne catchment over 5 years. We analysed associations between population-adjusted Campylobacter case rate and environmental factors hypothesized to be important in disease using a two-stage modelling framework. First, we investigated associations between temporal variation in case rate in relation to surface-water flow, temperature, evapotranspiration and rainfall, using linear mixed-effects models. Second, we used the random effects for the first model to quantify how spatial variation in static landscape features of soil and land use impacted on the likely differences between subcatchment associations of case rate with the temporal variables. Results Population-adjusted Campylobacter case rates were associated with periods of high predicted surface-water flow, and during above average temperatures. Subcatchments with cattle on stagnogley soils, and to a lesser extent sheep plus cattle grazing, had higher Campylobacter case rates. Conclusions Areas of stagnogley soils with mixed livestock grazing may be more vulnerable to both Campylobacter spread and exposure during periods of high rainfall, with resultant increased risk of human cases of the disease. PMID:29069406

Effectiveness on Early Childhood Caries of an Oral Health Promotion Program for Medical Providers

PubMed Central

Widmer-Racich, Katina; Sevick, Carter; Starzyk, Erin J.; Mauritson, Katya; Hambidge, Simon J.

2017-01-01

Objectives. To assess an oral health promotion (OHP) intervention for medical providers’ impact on early childhood caries (ECC). Methods. We implemented a quasiexperimental OHP intervention in 8 federally qualified health centers that trained medical providers on ECC risk assessment, oral examination and instruction, dental referral, and fluoride varnish applications (FVAs). We measured OHP delivery by FVA count at medical visits. We measured the intervention’s impact on ECC in 3 unique cohorts of children aged 3 to 4 years in 2009 (preintervention; n = 202), 2011 (midintervention; n = 420), and 2015 (≥ 4 FVAs; n = 153). We compared numbers of decayed, missing, and filled tooth surfaces using adjusted zero-inflated negative binomial models. Results. Across 3 unique cohorts, the FVA mean (range) count was 0.0 (0), 1.1 (0–7), and 4.5 (4–7) in 2009, 2011, and 2015, respectively. In adjusted zero-inflated negative binomial models analyses, children in the 2015 cohort had significantly fewer decayed, missing, and filled tooth surfaces than did children in previous cohorts. Conclusions. An OHP intervention targeting medical providers reduced ECC when children received 4 or more FVAs at a medical visit by age 3 years. PMID:28661802

Social and Environmental Factors Related to Smoking Cessation among Mothers: Findings from the Geographic Research on Welling (Grow) Study

PubMed Central

Castro, Yessenia; Heck, Katherine; Forster, Jean L.; Widome, Rachel; Cubbin, Catherine

2015-01-01

Objectives The current study examined associations between race/ethnicity and psychosocial/environmental factors with current smoking status, and whether psychosocial/environmental factors accounted for racial differences in smoking status in a population-based sample of mothers in California. Methods Cross-sectional data from 542 women with a history of smoking were used. Analyses adjusted for age, partner status, and educational attainment. Results In models adjusted for sociodemographics, black women had significantly lower odds, and Latina immigrants had significantly higher odds of being a former smoker compared to white women. Persons smoking in the home, having a majority of friends who smoke, having perceptions of their neighborhood as being somewhat or very unsafe, and experiencing food insecurity were associated with decreased odds of being a former smoker. When these variables were entered into a single model, only being a Latina immigrant and having a majority of friends who smoke were significantly associated with smoking status. Conclusions Black women demonstrated a notable disparity compared with white women in smoking status, accounted for by psychosocial/environmental factors. Immigrant Latinas demonstrated notable success in ever quitting smoking. Social networks may be important barriers to smoking cessation among women. PMID:26450549

Periodontal disease associates with higher brain amyloid load in normal elderly

PubMed Central

Kamer, Angela R.; Pirraglia, Elizabeth; Tsui, Wai; Rusinek, Henry; Vallabhajosula, Shankar; Mosconi, Lisa; Yi, Li; McHugh, Pauline; Craig, Ronald G.; Svetcov, Spencer; Linker, Ross; Shi, Chen; Glodzik, Lidia; Williams, Schantel; Corby, Patricia; Saxena, Deepak; de Leon, Mony J.

2015-01-01

Background The accumulation of amyloid β plaques (Aβ) is a central feature of Alzheimer’s disease (AD). First reported in animal models, it remains uncertain if peripheral inflammatory/infectious conditions in humans can promote Aβ brain accumulation. Periodontal disease, a common chronic infection, has been previously reported to be associated with AD. Methods Thirty-eight cognitively normal, healthy, community residing elderly (mean age 61; 68% female) were examined in an Alzheimer’s Disease research center and a University-based Dental School. Linear regression models (adjusted for age, ApoE and smoking) were used to test the hypothesis that periodontal disease assessed by clinical attachment loss was associated with brain Aβ load using 11C-PIB PET imaging. Results After adjusting for confounders, clinical attachment loss (≥ 3mm), representing a history of periodontal inflammatory/infectious burden, was associated with increased 11C-PIB uptake in Aβ vulnerable brain regions (p=0.002). Conclusion We show for the first time in humans an association between periodontal disease and brain Aβ load. These data are consistent with prior animal studies showing that peripheral inflammation/infections are sufficient to produce brain Aβ accumulations. PMID:25491073

Impaired Fertility Associated with Subclinical Hypothyroidism and Thyroid Autoimmunity: The Danish General Suburban Population Study

PubMed Central

Pedersen, Palle L.; Larsen, Jacob

2015-01-01

Introduction. The aim of this study was to estimate the significance of TSH, thyroid peroxidase antibody (TPOAb), and mild (subclinical) hypothyroidism in women from The Danish General Suburban Population Study (GESUS) on the number of children born, the number of pregnancies, and the number of spontaneous abortions. Methods. Retrospective cross sectional study of 11254 women participating in GESUS. Data included biochemical measurements and a self-administrated questionnaire. Results. 6.7% had mild (subclinical) hypothyroidism and 9.4% prevalent hypothyroidism. In women with mild hypothyroidism TPOAb was significantly elevated and age at first child was older compared to controls. TSH and TPOAb were negatively linearly associated with the number of children born and the number of pregnancies in the full cohort in age-adjusted and multiadjusted models. TSH or TPOAb was not associated with spontaneous abortions. Mild (subclinical) hypothyroidism was associated with a risk of not having children and a risk of not getting pregnant in age-adjusted and multiadjusted models. Prevalent hypothyroidism was not associated with the number of children born, the number of pregnancies, or spontaneous abortions. Conclusion. Impaired fertility is associated with TSH, TPOAb, and mild (subclinical) hypothyroidism in a Danish population of women. PMID:26351582

An item response theory analysis of the Olweus Bullying scale.

PubMed

Breivik, Kyrre; Olweus, Dan

2014-12-02

In the present article, we used IRT (graded response) modeling as a useful technology for a detailed and refined study of the psychometric properties of the various items of the Olweus Bullying scale and the scale itself. The sample consisted of a very large number of Norwegian 4th-10th grade students (n = 48 926). The IRT analyses revealed that the scale was essentially unidimensional and had excellent reliability in the upper ranges of the latent bullying tendency trait, as intended and desired. Gender DIF effects were identified with regard to girls' use of indirect bullying by social exclusion and boys' use of physical bullying by hitting and kicking but these effects were small and worked in opposite directions, having negligible effects at the scale level. Also scale scores adjusted for DIF effects differed very little from non-adjusted scores. In conclusion, the empirical data were well characterized by the chosen IRT model and the Olweus Bullying scale was considered well suited for the conduct of fair and reliable comparisons involving different gender-age groups. Information Aggr. Behav. 9999:XX-XX, 2014. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.

An item response theory analysis of the Olweus Bullying scale.

PubMed

Breivik, Kyrre; Olweus, Dan

2015-01-01

In the present article, we used IRT (graded response) modeling as a useful technology for a detailed and refined study of the psychometric properties of the various items of the Olweus Bullying scale and the scale itself. The sample consisted of a very large number of Norwegian 4th-10th grade students (n = 48 926). The IRT analyses revealed that the scale was essentially unidimensional and had excellent reliability in the upper ranges of the latent bullying tendency trait, as intended and desired. Gender DIF effects were identified with regard to girls' use of indirect bullying by social exclusion and boys' use of physical bullying by hitting and kicking but these effects were small and worked in opposite directions, having negligible effects at the scale level. Also scale scores adjusted for DIF effects differed very little from non-adjusted scores. In conclusion, the empirical data were well characterized by the chosen IRT model and the Olweus Bullying scale was considered well suited for the conduct of fair and reliable comparisons involving different gender-age groups. Information Aggr. Behav. 41:1-13, 2015. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.

Kuk's Model Adjusted for Protection and Efficiency

ERIC Educational Resources Information Center

Su, Shu-Ching; Sedory, Stephen A.; Singh, Sarjinder

2015-01-01

In this article, we adjust the Kuk randomized response model for collecting information on a sensitive characteristic for increased protection and efficiency by making use of forced "yes" and forced "no" responses. We first describe Kuk's model and then the proposed adjustment to Kuk's model. Next, by means of a simulation…

Identifying best-fitting inputs in health-economic model calibration: a Pareto frontier approach.

PubMed

Enns, Eva A; Cipriano, Lauren E; Simons, Cyrena T; Kong, Chung Yin

2015-02-01

To identify best-fitting input sets using model calibration, individual calibration target fits are often combined into a single goodness-of-fit (GOF) measure using a set of weights. Decisions in the calibration process, such as which weights to use, influence which sets of model inputs are identified as best-fitting, potentially leading to different health economic conclusions. We present an alternative approach to identifying best-fitting input sets based on the concept of Pareto-optimality. A set of model inputs is on the Pareto frontier if no other input set simultaneously fits all calibration targets as well or better. We demonstrate the Pareto frontier approach in the calibration of 2 models: a simple, illustrative Markov model and a previously published cost-effectiveness model of transcatheter aortic valve replacement (TAVR). For each model, we compare the input sets on the Pareto frontier to an equal number of best-fitting input sets according to 2 possible weighted-sum GOF scoring systems, and we compare the health economic conclusions arising from these different definitions of best-fitting. For the simple model, outcomes evaluated over the best-fitting input sets according to the 2 weighted-sum GOF schemes were virtually nonoverlapping on the cost-effectiveness plane and resulted in very different incremental cost-effectiveness ratios ($79,300 [95% CI 72,500-87,600] v. $139,700 [95% CI 79,900-182,800] per quality-adjusted life-year [QALY] gained). Input sets on the Pareto frontier spanned both regions ($79,000 [95% CI 64,900-156,200] per QALY gained). The TAVR model yielded similar results. Choices in generating a summary GOF score may result in different health economic conclusions. The Pareto frontier approach eliminates the need to make these choices by using an intuitive and transparent notion of optimality as the basis for identifying best-fitting input sets. © The Author(s) 2014.

Effect of Adding McKenzie Syndrome, Centralization, Directional Preference, and Psychosocial Classification Variables to a Risk-Adjusted Model Predicting Functional Status Outcomes for Patients With Lumbar Impairments.

PubMed

Werneke, Mark W; Edmond, Susan; Deutscher, Daniel; Ward, Jason; Grigsby, David; Young, Michelle; McGill, Troy; McClenahan, Brian; Weinberg, Jon; Davidow, Amy L

2016-09-01

Study Design Retrospective cohort. Background Patient-classification subgroupings may be important prognostic factors explaining outcomes. Objectives To determine effects of adding classification variables (McKenzie syndrome and pain patterns, including centralization and directional preference; Symptom Checklist Back Pain Prediction Model [SCL BPPM]; and the Fear-Avoidance Beliefs Questionnaire subscales of work and physical activity) to a baseline risk-adjusted model predicting functional status (FS) outcomes. Methods Consecutive patients completed a battery of questionnaires that gathered information on 11 risk-adjustment variables. Physical therapists trained in Mechanical Diagnosis and Therapy methods classified each patient by McKenzie syndromes and pain pattern. Functional status was assessed at discharge by patient-reported outcomes. Only patients with complete data were included. Risk of selection bias was assessed. Prediction of discharge FS was assessed using linear stepwise regression models, allowing 13 variables to enter the model. Significant variables were retained in subsequent models. Model power (R(2)) and beta coefficients for model variables were estimated. Results Two thousand sixty-six patients with lumbar impairments were evaluated. Of those, 994 (48%), 10 (<1%), and 601 (29%) were excluded due to incomplete psychosocial data, McKenzie classification data, and missing FS at discharge, respectively. The final sample for analyses was 723 (35%). Overall R(2) for the baseline prediction FS model was 0.40. Adding classification variables to the baseline model did not result in significant increases in R(2). McKenzie syndrome or pain pattern explained 2.8% and 3.0% of the variance, respectively. When pain pattern and SCL BPPM were added simultaneously, overall model R(2) increased to 0.44. Although none of these increases in R(2) were significant, some classification variables were stronger predictors compared with some other variables included in the baseline model. Conclusion The small added prognostic capabilities identified when combining McKenzie or pain-pattern classifications with the SCL BPPM classification did not significantly improve prediction of FS outcomes in this study. Additional research is warranted to investigate the importance of classification variables compared with those used in the baseline model to maximize predictive power. Level of Evidence Prognosis, level 4. J Orthop Sports Phys Ther 2016;46(9):726-741. Epub 31 Jul 2016. doi:10.2519/jospt.2016.6266.

Long-Term Coarse Particulate Matter Exposure and Heart Rate Variability in the Multi-Ethnic Study of Atherosclerosis (MESA)

PubMed Central

Adhikari, Richa; D’Souza, Jennifer; Solimon, Elsayed Z.; Burke, Gregory L.; Daviglus, Martha; Jacobs, David R.; Park, Sung Kyun; Sheppard, Lianne; Thorne, Peter S.; Kaufman, Joel D.; Larson, Timothy V.; Adar, Sara D.

2017-01-01

Background Reduced heart rate variability, a marker of impaired cardiac autonomic function, has been linked to short-term exposure to airborne particles. This research adds to the literature by examining associations with long-term exposures to coarse particles (PM10-2.5). Methods Using electrocardiogram recordings from 2,780 participants (45-84 years) from three Multi-Ethnic Study of Atherosclerosis sites, we assessed the standard deviation of normal-to-normal intervals (SDNN) and root-mean square differences of successive normal-to-normal intervals (rMSSD) at a baseline (2000-2002) and follow-up (2010-2012) examination (mean visits/person=1.5). Annual average concentrations of PM10-2.5 mass, copper, zinc, phosphorus, silicon, and endotoxin were estimated using site-specific spatial prediction models. We assessed associations for baseline heart rate variability and rate of change in heart rate variability over time using multivariable mixed models adjusted for time, sociodemographic, lifestyle, health, and neighborhood confounders, including co-pollutants. Results In our primary models adjusted for demographic and lifestyle factors and site, PM10-2.5 mass was associated with 1.0% (95% CI: -4.1, 2.1%) lower SDNN levels per interquartile range of 2 μg/m3. Stronger associations, however, were observed prior to site adjustment and with increasing residential stablity. Similar patterns were found for rMSSD. We found little evidence for associations with other chemical species and with with the rate of change in heart rate variability, though endotoxin was associated with increasing heart rate variability over time. Conclusion We found only weak evidence that long-term PM10-2.5 exposures are associated with lowered heart rate variability. Stronger associations among residentially stable individuals suggest that confirmatory studies are needed. PMID:27035690

Protein Biomarkers of New-Onset Cardiovascular Disease: A Prospective Study from the Systems Approach to Biomarker Research in Cardiovascular Disease (SABRe CVD) Initiative

PubMed Central

Yin, Xiaoyan; Subramanian, Subha; Hwang, Shih-Jen; O’Donnell, Christopher J.; Fox, Caroline S.; Courchesne, Paul; Muntendam, Pieter; Adourian, Aram; Juhasz, Peter; Larson, Martin G.; Levy, Daniel

2014-01-01

Objective Incorporation of novel plasma protein biomarkers may improve current models for prediction of atherosclerotic cardiovascular disease (ASCVD) risk. Approach and Results We utilized discovery mass spectrometry (MS) to determine plasma concentrations of 861 proteins in 135 myocardial infarction (MI) cases and 135 matched controls. We then measured 59markers by targeted MS in 336 ASCVD case-control pairs. Associations with MI or ASCVD were tested in single marker and multimarker analyses adjusted for established ASCVD risk factors. Twelve single markers from discovery MS were associated with MI incidence (at p<0.01) adjusting for clinical risk factors. Seven proteins in aggregate (cyclophilin A, CD5 antigen-like, cell surface glycoprotein MUC18, collagen-alpha 1 [XVIII] chain, salivary alpha-amylase 1, C-reactive protein, and multimerin-2) were highly associated with MI (p<0.0001) and significantly improved its prediction compared to a model with clinical risk factors alone (C-statistic of 0.71 vs. 0.84). Through targeted MS, twelve single proteins were predictors of ASCVD (at p<0.05) after adjusting for established risk factors. In multimarker analyses, four proteins in combination (alpha-1-acid glycoprotein 1, paraoxonase 1, tetranectin, and CD5 antigen-like, predicted incident ASCVD (p<0.0001) and moderately improved the C-statistic from the model with clinical covariates alone (C-statistic of 0.69 vs. 0.73). Conclusions Proteomics profiling identified single and multimarker protein panels that are associated with new onset ASCVD and may lead to a better understanding of underlying disease mechanisms. Our findings include many novel protein biomarkers that, if externally validated, may improve risk assessment for MI and ASCVD. PMID:24526693

Age-related impairments of mobility associated with cobalt and other heavy metals: Data from NHANES 1999-2004

PubMed Central

Lang, Iain A; Scarlett, Alan; Guralnik, Jack; Depledge, Michael H; Melzer, David; Galloway, Tamara S

2012-01-01

Introduction Exposure to heavy metals can promote oxidative stress and damage to cellular components, and may accelerate age-related disease and disability.. Physical mobility is a validated biomarker of age-related disability and is predictive of hospitalization and mortality. Aim To examine associations between selected heavy metals and impaired lower limb mobility in a representative older human population. Methods Data for 1615 adults aged ≥60 years from the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004 were used to identify associations between urinary concentrations of 10 metals with self-reported and measured walking impairments (at p<0.01). Models were adjusted for confounding factors, including smoking. Results In models adjusted for age, sex and ethnicity, elevated levels of cadmium, cobalt and uranium were associated with impairment of the ability to walk a quarter mile. In fully adjusted models, cobalt was the only metal that remained associated: the odds ratio for reporting walking problems with a 1-unit increase in logged cobalt concentration (μg L-1) was 1.43 (95% CI 1.12 to 1.84). Cobalt was also the only metal associated with an increased measured time to walk a 20 foot course (p=0.008). In analyses of disease categories to explain the mobility finding, cobalt was associated with physician diagnosed arthritis (1-unit increase OR=1.22 (95% CI 1.00 to 1.49, p=0.045). Conclusions Low level cobalt exposure, assessed through urinary concentrations of this essential heavy metal may be a risk factor for age-related physical impairments. Independent replication is needed to confirm this association. PMID:19199147

Cefepime vs Other Antibacterial Agents for the Treatment of Enterobacter Species Bacteremia

PubMed Central

Siedner, Mark J.; Galar, Alicia; Guzmán-Suarez, Belisa B.; Kubiak, David W.; Baghdady, Nour; Ferraro, Mary Jane; Hooper, David C.; O'Brien, Thomas F.; Marty, Francisco M.

2014-01-01

Background. Carbapenems are recommended for treatment of Enterobacter infections with AmpC phenotypes. Although isolates are typically susceptible to cefepime in vitro, there are few data supporting its clinical efficacy. Methods. We reviewed all cases of Enterobacter species bacteremia at 2 academic hospitals from 2005 to 2011. Outcomes of interest were (1) persistent bacteremia ≥1 calendar day and (2) in-hospital mortality. We fit logistic regression models, adjusting for clinical risk factors and Pitt bacteremia score and performed propensity score analyses to compare the efficacy of cefepime and carbapenems. Results. Three hundred sixty-eight patients experienced Enterobacter species bacteremia and received at least 1 antimicrobial agent, of whom 52 (14%) died during hospitalization. Median age was 59 years; 19% were neutropenic, and 22% were in an intensive care unit on the day of bacteremia. Twenty-nine (11%) patients had persistent bacteremia for ≥1 day after antibacterial initiation. None of the 36 patients who received single-agent cefepime (0%) had persistent bacteremia, as opposed to 4 of 16 (25%) of those who received single-agent carbapenem (P < .01). In multivariable models, there was no association between carbapenem use and persistent bacteremia (adjusted odds ratio [aOR], 1.52; 95% CI, .58–3.98; P = .39), and a nonsignificant lower odds ratio with cefepime use (aOR, 0.52; 95% CI, .19–1.40; P = .19). In-hospital mortality was similar for use of cefepime and carbapenems in adjusted regression models and propensity-score matched analyses. Conclusions. Cefepime has a similar efficacy as carbapenems for the treatment of Enterobacter species bacteremia. Its use should be further explored as a carbapenem-sparing agent in this clinical scenario. PMID:24647022

Chronic Condition Combinations and Health Care Expenditures and Out-of-Pocket Spending Burden Among Adults, Medical Expenditure Panel Survey, 2009 and 2011

PubMed Central

Raval, Amit D.; Sambamoorthi, Usha

2015-01-01

Introduction Little is known about how combinations of chronic conditions in adults affect total health care expenditures. Our objective was to estimate the annual average total expenditures and out-of-pocket spending burden among US adults by combinations of conditions. Methods We conducted a cross-sectional study using 2009 and 2011 data from the Medical Expenditure Panel Survey. The sample consisted of 9,296 adults aged 21 years or older with at least 2 of the following 4 highly prevalent chronic conditions: arthritis, diabetes mellitus, heart disease, and hypertension. Unadjusted and adjusted regression techniques were used to examine the association between chronic condition combinations and log-transformed total expenditures. Logistic regressions were used to analyze the relationship between chronic condition combinations and high out-of-pocket spending burden. Results Among adults with chronic conditions, adults with all 4 conditions had the highest average total expenditures ($20,016), whereas adults with diabetes/hypertension had the lowest annual total expenditures ($7,116). In adjusted models, adults with diabetes/hypertension and hypertension/arthritis had lower health care expenditures than adults with diabetes/heart disease (P < .001). In adjusted models, adults with all 4 conditions had higher expenditures compared with those with diabetes and heart disease. However, the difference was only marginally significant (P = .04). Conclusion Among adults with arthritis, diabetes, heart disease, and hypertension, total health care expenditures differed by type of chronic condition combinations. For individuals with multiple chronic conditions, such as heart disease and diabetes, new models of care management are needed to reduce the cost burden on the payers. PMID:25633487

Health Spending Among Working-Age Immigrants With Disabilities Compared To Those Born In The US

PubMed Central

Tarraf, Wassim; Mahmoudi, Elham; Dillaway, Heather E; Gonzalez, Hector M.

2016-01-01

Background Immigrants have disparate access to healthcare. Disabilities can amplify their healthcare burdens. Objective/Hypothesis Examine how US- and foreign-born working-age adults with disabilities differ in their healthcare spending patterns. Methods Medical Expenditures Panel Survey yearly-consolidated files (2000-2010) on working-age adults (18-64 years) with disabilities. We used three operational definitions of disability: physical, cognitive, and sensory. We examined annual total, outpatient/office-based, prescription medication, inpatient, and emergency department (ED) health expenditures. We tested bivariate logistic and linear regression models to, respectively, assess unadjusted group differences in the propensity to spend and average expenditures. Second, we used multivariable two-part models to estimate and test per-capita expenditures adjusted for predisposing, enabling, health need and behavior indicators. Results Adjusted for age and sex differences, US-born respondents with physical, cognitive, sensory spent on average $2,977, $3,312, and $2,355 more in total compared to their foreign-born counterparts (P<0.01). US-born spending was also higher across the four types of healthcare expenditures considered. Adjusting for the behavioral model factors, especially predisposing and enabling indicators, substantially reduced nativity differences in overall, outpatient/office-based and medication spending but not in inpatient and ED expenditures. Conclusions Working-age immigrants with disabilities have lower levels of healthcare use and expenditures compared to their US-born counterparts. Affordable Care Act provisions aimed at increasing access to insurance and primary care can potentially align the consumption patterns of US- and foreign-born disabled working-age adults. More work is needed to understand the pathways leading to differences in hospital and prescription medication care. PMID:26917103

Area-Level Deprivation and Overall and Cause-Specific Mortality: 12 Years’ Observation on British Women and Systematic Review of Prospective Studies

PubMed Central

Sánchez-Santos, Maria T.; Mesa-Frias, Marco; Choi, Minkyoung; Nüesch, Eveline; Asunsolo-Del Barco, Angel; Amuzu, Antoinette; Smith, George Davey; Ebrahim, Shah; Prieto-Merino, David; Casas, Juan P.

2013-01-01

Background Prospective studies have suggested a negative impact of area deprivation on overall mortality, but its effect on cause-specific mortality and the mechanisms that account for this association remain unclear. We investigate the association of area deprivation, using Index of Multiple deprivation (IMD), with overall and cause-specific mortality, contextualising findings within a systematic review. Methods And Findings We used data from 4,286 women from the British Women’s Heart Health Study (BWHHS) recruited at 1999-2001 to examine the association of IMD with overall and cause-specific mortality using Cox regression models. One standard deviation (SD) increase in the IMD score had a hazard ratio (HR) of 1.21 (95% CI: 1.13-1.30) for overall mortality after adjustment for age and lifecourse individual deprivation, which was attenuated to 1.15 (95% CI: 1.04-1.26) after further inclusion of mediators (health behaviours, biological factors and use of statins and blood pressure-lowering medications). A more pronounced association was observed for respiratory disease and vascular deaths. The meta-analysis, based on 20 published studies plus the BWHHS (n=21), yielded a summary relative risk (RR) of 1.15 (95% CI: 1.11-1.19) for area deprivation (top [least deprived; reference] vs. bottom tertile) with overall mortality in an age and sex adjusted model, which reduced to 1.06 (95% CI: 1.04-1.08) in a fully adjusted model. Conclusions Health behaviours mediate the association between area deprivation and cause-specific mortality. Efforts to modify health behaviours may be more successful if they are combined with measures that tackle area deprivation. PMID:24086262

Readmissions After Colon Cancer Surgery: Does It Matter Where Patients Are Readmitted?

PubMed Central

Hussain, Tanvir; Chang, Hsien-Yen; Pfoh, Elizabeth; Pollack, Craig Evan

2016-01-01

Purpose: Readmissions to a different hospital may place patients at increased risk for poor outcomes and may increase their overall costs of care. We evaluated whether mortality and costs differ for patients with colon cancer on the basis of whether patients are readmitted to the index hospital or to a different hospital within 30 days of discharge. Methods: We conducted a retrospective analysis using SEER-Medicare linked claims data for patients with stage I to III colon cancer diagnosed between 2000 and2009 who were readmitted within 30 days (N = 3,399). Our primary outcome was all-cause mortality, which was modeled by using Cox proportional hazards. Secondary outcomes included colon cancer–specific mortality, 90-day mortality, and costs of care. We used subhazard ratios for colon cancer– specific mortality and generalized linear models for costs. For each model, we used a propensity score–weighted doubly robust approach to adjust for patient, physician, and hospital characteristics. Results: Approximately 23% (n = 769) of readmitted patients were readmitted to a different hospital than where they were initially discharged. After adjustment, there was no difference in all-cause mortality, colon cancer–specific mortality, or cost of care for patients readmitted to a different hospital. Patient readmitted to a different hospital did have a higher risk of short-term mortality (90-day all-cause mortality; adjusted hazard ratio, 1.18; 95% CI, 1.02 to 1.38). Conclusion: Readmission to a different hospital after colon cancer surgery is associated with short-term mortality but not with long-term mortality nor with post-discharge costs of care. Additional investigation is needed to determine how to improve short-term mortality among patients readmitted to different hospitals. PMID:27048614

Nicotine Metabolism in Young Adult Daily Menthol and Nonmenthol Smokers

PubMed Central

Pokhrel, Pallav; Herzog, Thaddeus A.; Pagano, Ian S.; Franke, Adrian A.; Clanton, Mark S.; Alexander, Linda A.; Trinidad, Dennis R.; Sakuma, Kari-Lyn K.; Johnson, Carl A.; Moolchan, Eric T.

2016-01-01

Introduction: Menthol cigarette smoking may increase the risk for tobacco smoke exposure and inhibit nicotine metabolism in the liver. Nicotine metabolism is primarily mediated by the enzyme CYP2A6 and the nicotine metabolite ratio (NMR = trans 3′ hydroxycotinine/cotinine) is a phenotypic proxy for CYP2A6 activity. No studies have examined differences in this biomarker among young adult daily menthol and nonmenthol smokers. This study compares biomarkers of tobacco smoke exposure among young adult daily menthol and nonmenthol smokers. Methods: Saliva cotinine and carbon monoxide were measured in a multiethnic sample of daily smokers aged 18–35 (n = 186). Nicotine, cotinine, the cotinine/cigarette per day ratio, trans 3′ hydroxycotinine, the NMR, and expired carbon monoxide were compared. Results: The geometric means for nicotine, cotinine, and the cotinine/cigarette per day ratio did not significantly differ between menthol and nonmenthol smokers. The NMR was significantly lower among menthol compared with nonmenthol smokers after adjusting for race/ethnicity, gender, body mass index, and cigarette smoked per day (0.19 vs. 0.24, P = .03). White menthol smokers had significantly higher cotinine/cigarettes per day ratio than white nonmenthol smokers in the adjusted model. White menthol smokers had a lower NMR in the unadjusted model (0.24 vs. 0.31, P = .05) and the differences remained marginally significant in the adjusted model (0.28 vs. 0.34, P = .06). We did not observe these differences in Native Hawaiians and Filipinos. Conclusions: Young adult daily menthol smokers have slower rates of nicotine metabolism than nonmenthol smokers. Studies are needed to determine the utility of this biomarker for smoking cessation treatment assignments. PMID:25995160

End-of-Life Care Interventions: An Economic Analysis

PubMed Central

Pham, B; Krahn, M

2014-01-01

Background The annual cost of providing care for patients in their last year of life is estimated to account for approximately 9% of the Ontario health care budget. Access to integrated, comprehensive support and pain/symptom management appears to be inadequate and inequitable. Objective To evaluate the cost-effectiveness of end-of-life (EoL) care interventions included in the EoL care mega-analysis. Data Sources Multiple sources were used, including systematic reviews, linked health administration databases, survey data, planning documents, expert input, and additional literature searches. Review Methods We conducted a literature review of cost-effectiveness studies to inform the primary economic analysis. We conducted the primary economic analysis and budget impact analysis for an Ontario cohort of decedents and their families and included interventions pertaining to team-based models of care, patient care planning discussions, educational interventions for patients and caregivers, and supportive interventions for informal caregivers. The time horizon was the last year of life. Costs were in 2013 Canadian dollars. Effectiveness measures included days at home, percentage dying at home, and quality-adjusted life-days. We developed a Markov model; model inputs were obtained from a cohort of Ontario decedents assembled from Institute for Clinical Evaluative Sciences databases and published literature. Results In-home palliative team care was cost-effective; it increased the chance of dying at home by 10%, increased the average number of days at home (6 days) and quality-adjusted life-days (0.5 days), and it reduced costs by approximately $4,400 per patient. Expanding in-home palliative team care to those currently not receiving such services (approximately 45,000 per year, at an annual cost of $76–108 million) is likely to improve quality of life, reduce the use of acute care resources, and save $191–$385 million in health care costs. Results for the other interventions were uncertain. Limitations The cost-effectiveness analysis was based in part on the notion that resources allocated to EoL care interventions were designed to maximize quality-adjusted life-years (QALY) for patients and their family, but improving QALYs may not be the intended aim of EoL interventions. Conclusions In-home palliative team care was cost-effective, but firm conclusions about the cost-effectiveness of other interventions were not possible. PMID:26339303

How Noisy Does a Noisy Miner Have to Be? Amplitude Adjustments of Alarm Calls in an Avian Urban ‘Adapter’

PubMed Central

Lowry, Hélène; Lill, Alan; Wong, Bob B. M.

2012-01-01

Background Urban environments generate constant loud noise, which creates a formidable challenge for many animals relying on acoustic communication. Some birds make vocal adjustments that reduce auditory masking by altering, for example, the frequency (kHz) or timing of vocalizations. Another adjustment, well documented for birds under laboratory and natural field conditions, is a noise level-dependent change in sound signal amplitude (the ‘Lombard effect’). To date, however, field research on amplitude adjustments in urban environments has focused exclusively on bird song. Methods We investigated amplitude regulation of alarm calls using, as our model, a successful urban ‘adapter’ species, the Noisy miner, Manorina melanocephala. We compared several different alarm calls under contrasting noise conditions. Results Individuals at noisier locations (arterial roads) alarm called significantly more loudly than those at quieter locations (residential streets). Other mechanisms known to improve sound signal transmission in ‘noise’, namely use of higher perches and in-flight calling, did not differ between site types. Intriguingly, the observed preferential use of different alarm calls by Noisy miners inhabiting arterial roads and residential streets was unlikely to have constituted a vocal modification made in response to sound-masking in the urban environment because the calls involved fell within the main frequency range of background anthropogenic noise. Conclusions The results of our study suggest that a species, which has the ability to adjust the amplitude of its signals, might have a ‘natural’ advantage in noisy urban environments. PMID:22238684

A Missed Opportunity for U.S. Perinatal Human Immunodeficiency Virus Elimination

PubMed Central

Fruhauf, Timothee; Coleman, Jenell S.

2018-01-01

OBJECTIVE To estimate the proportion of women at increased risk of sexual human immunodeficiency virus (HIV) acquisition during pregnancy in a high HIV incidence urban setting to identify those who may be eligible for pre-exposure prophylaxis. METHODS We conducted a retrospective cohort study of women who received prenatal care at a large academic center in 2012. Univariable analyses and multiple logistic regression models were built to identify correlates for pre-exposure prophylaxis eligibility. RESULTS Among 1,637 pregnant women, mean age was 27.6 years (SD 6.3), 59.7% were African American, and 56.0% were single. Based on the Centers for Disease Control and Prevention’s guidelines, more than 10% of women were at increased risk for HIV acquisition during pregnancy and eligible for pre-exposure prophylaxis. Younger [adjusted odds ratio (OR) 0.9/1-year increase, 95% CI 0.8–0.9], single (adjusted OR 2.4, 95% CI 1.2–4.8), African American women (adjusted OR 3.3, 95% CI 1.6–6.7) with higher parity (adjusted OR 1.3/one-child increase, 95% CI 1.1–1.5), and who smoked regularly during pregnancy (adjusted OR 1.8, 95% CI 1.0–3.0) had greater odds of being eligible for pre-exposure prophylaxis at any time during pregnancy. CONCLUSIONS Pregnancy is a vulnerable period during which some heterosexual women in urban settings have a high risk for HIV acquisition and stand to benefit from pre-exposure prophylaxis. PMID:28885420

Declines in Outpatient Antimicrobial Use in Canada (1995–2010)

PubMed Central

Finley, Rita; Glass-Kaastra, Shiona K.; Hutchinson, Jim; Patrick, David M.; Weiss, Karl; Conly, John

2013-01-01

Background With rising reports of antimicrobial resistance in outpatient communities, surveillance of antimicrobial use is imperative for supporting stewardship programs. The primary objective of this article is to assess the levels of antimicrobial use in Canada over time. Methods Canadian antimicrobial use data from 1995 to 2010 were acquired and assessed by four metrics: population-adjusted prescriptions, Defined Daily Doses, spending on antimicrobials (inflation-adjusted), and average Defined Daily Doses per prescription. Linear mixed models were built to assess significant differences among years and antimicrobial groups, and to account for repeated measurements over time. Measures were also compared to published reports from European countries. Results Temporal trends in antimicrobial use in Canada vary by metric and antimicrobial grouping. Overall reductions were seen for inflation-adjusted spending, population-adjusted prescription rates and Defined Daily Doses, and increases were observed for the average number of Defined Daily Doses per prescription. The population-adjusted prescription and Defined Daily Doses values for 2009 were comparable to those reported by many European countries, while the average Defined Daily Dose per prescription for Canada ranked high. A significant reduction in the use of broad spectrum penicillins occurred between 1995 and 2004, coupled with increases in macrolide and quinolone use, suggesting that replacement of antimicrobial drugs may occur as new products arrive on the market. Conclusions There have been modest decreases of antimicrobial use in Canada over the past 15 years. However, continued surveillance of antimicrobial use coupled with data detailing antimicrobial resistance within bacterial pathogens affecting human populations is critical for targeting interventions and maintaining the effectiveness of these products for future generations. PMID:24146863

Model for the evaluation of drug-dispensing services in primary health care

PubMed Central

Sartor, Vanessa de Bona; de Freitas, Sergio Fernando Torres

2014-01-01

OBJECTIVE To develop a model for evaluating the efficacy of drug-dispensing service in primary health care. METHODS An efficacy criterion was adopted to determine the level of achievement of the service objectives. The evaluation model was developed on the basis of a literature search and discussions with experts. The applicability test of the model was conducted in 15 primary health care units in the city of Florianópolis, state of Santa Catarina, in 2010, and data were recorded in structured and pretested questionnaires. RESULTS The model developed was evaluated using five dimensions of analysis for analysis. The model was suitable for evaluating service efficacy and helped to identify the critical points of each service dimension. CONCLUSIONS Adaptations to the data collection technique may be required to adjust for the reality and needs of each situation. The evaluation of the drug-dispensing service should promote adequate access to medications supplied through the public health system. PMID:25372174

Lower extremity EMG-driven modeling of walking with automated adjustment of musculoskeletal geometry

PubMed Central

Meyer, Andrew J.; Patten, Carolynn

2017-01-01

Neuromusculoskeletal disorders affecting walking ability are often difficult to manage, in part due to limited understanding of how a patient’s lower extremity muscle excitations contribute to the patient’s lower extremity joint moments. To assist in the study of these disorders, researchers have developed electromyography (EMG) driven neuromusculoskeletal models utilizing scaled generic musculoskeletal geometry. While these models can predict individual muscle contributions to lower extremity joint moments during walking, the accuracy of the predictions can be hindered by errors in the scaled geometry. This study presents a novel EMG-driven modeling method that automatically adjusts surrogate representations of the patient’s musculoskeletal geometry to improve prediction of lower extremity joint moments during walking. In addition to commonly adjusted neuromusculoskeletal model parameters, the proposed method adjusts model parameters defining muscle-tendon lengths, velocities, and moment arms. We evaluated our EMG-driven modeling method using data collected from a high-functioning hemiparetic subject walking on an instrumented treadmill at speeds ranging from 0.4 to 0.8 m/s. EMG-driven model parameter values were calibrated to match inverse dynamic moments for five degrees of freedom in each leg while keeping musculoskeletal geometry close to that of an initial scaled musculoskeletal model. We found that our EMG-driven modeling method incorporating automated adjustment of musculoskeletal geometry predicted net joint moments during walking more accurately than did the same method without geometric adjustments. Geometric adjustments improved moment prediction errors by 25% on average and up to 52%, with the largest improvements occurring at the hip. Predicted adjustments to musculoskeletal geometry were comparable to errors reported in the literature between scaled generic geometric models and measurements made from imaging data. Our results demonstrate that with appropriate experimental data, joint moment predictions for walking generated by an EMG-driven model can be improved significantly when automated adjustment of musculoskeletal geometry is included in the model calibration process. PMID:28700708

Modeling wind adjustment factor and midflame wind speed for Rothermel's surface fire spread model

Treesearch

Patricia L. Andrews

2012-01-01

Rothermel's surface fire spread model was developed to use a value for the wind speed that affects surface fire, called midflame wind speed. Models have been developed to adjust 20-ft wind speed to midflame wind speed for sheltered and unsheltered surface fuel. In this report, Wind Adjustment Factor (WAF) model equations are given, and the BehavePlus fire modeling...

The efficacy of ticagrelor is maintained in women with acute coronary syndromes participating in the prospective, randomized, PLATelet inhibition and patient Outcomes (PLATO) trial

PubMed Central

Husted, Steen; James, Stefan K.; Bach, Richard G.; Becker, Richard C.; Budaj, Andrzej; Heras, Magda; Himmelmann, Anders; Horrow, Jay; Katus, Hugo A.; Lassila, Riita; Morais, Joao; Nicolau, José C.; Steg, Ph. Gabriel; Storey, Robert F.; Wojdyla, Daniel; Wallentin, Lars

2014-01-01

Aims The aim of this study was to assess the relationship between sex and clinical outcomes and treatment-related complications in patients with ST-elevation or non-ST-elevation acute coronary syndromes (ACS) randomized to treatment with ticagrelor or clopidogrel in the PLATelet inhibition and patient Outcomes (PLATO) trial. Methods The associations between sex subgroup and the primary composite outcomes, secondary outcomes, and major bleeding endpoints as well as interaction of sex subgroup with treatment effects were analysed using Cox proportional-hazards models. Results Sex was not significantly associated with the probability of the primary composite endpoint [adjusted hazard ratio (HR): 1.02 (0.91−1.16)], or other adverse cardiovascular endpoints. Ticagrelor was similarly more effective than clopidogrel in reducing rates of the primary endpoint in women 11.2 vs. 13.2% [adjusted HR: 0.88 (0.74−1.06)] and men 9.4 vs. 11.1% [adjusted HR: 0.86 (0.76−0.97)] (interaction P-value 0.78), all-cause death in women 5.8 vs. 6.8% [adjusted HR: 0.90 (0.69−1.16)] and men 4.0 vs. 5.7% [adjusted HR: 0.80 (0.67−0.96)] (interaction P-value 0.49), and definite stent thrombosis in women 1.2 vs. 1.4% [adjusted HR: 0.71 (0.36−1.38)] and men 1.4 vs. 2.1% [adjusted HR: 0.63 (0.45−0.89)] (interaction P-value 0.78). The treatments did not differ for PLATO-defined overall major bleeding complications in women [adjusted HR: 1.01 (0.83−1.23)] or men [adjusted HR: 1.10 (0.98−1.24)]. Sex had no significant association with these outcomes (interactions P = 0.43−0.88). Conclusion Female sex is not an independent risk factor for adverse clinical outcomes in moderate-to-high risk ACS patients. Ticagrelor has a similar efficacy and safety profile in men and women. PMID:24682844

Body mass index adjustments to increase the validity of body fatness assessment in UK Black African and South Asian children

PubMed Central

Hudda, M T; Nightingale, C M; Donin, A S; Fewtrell, M S; Haroun, D; Lum, S; Williams, J E; Owen, C G; Rudnicka, A R; Wells, J C K; Cook, D G; Whincup, P H

2017-01-01

Background/Objectives: Body mass index (BMI) (weight per height2) is the most widely used marker of childhood obesity and total body fatness (BF). However, its validity is limited, especially in children of South Asian and Black African origins. We aimed to quantify BMI adjustments needed for UK children of Black African and South Asian origins so that adjusted BMI related to BF in the same way as for White European children. Methods: We used data from four recent UK studies that made deuterium dilution BF measurements in UK children of White European, South Asian and Black African origins. A height-standardized fat mass index (FMI) was derived to represent BF. Linear regression models were then fitted, separately for boys and girls, to quantify ethnic differences in BMI–FMI relationships and to provide ethnic-specific BMI adjustments. Results: We restricted analyses to 4–12 year olds, to whom a single consistent FMI (fat mass per height5) could be applied. BMI consistently underestimated BF in South Asians, requiring positive BMI adjustments of +1.12 kg m−2 (95% confidence interval (CI): 0.83, 1.41 kg m−2; P<0.0001) for boys and +1.07 kg m−2 (95% CI: 0.74, 1.39 kg m−2; P<0.0001) for girls of all age groups and FMI levels. BMI overestimated BF in Black Africans, requiring negative BMI adjustments for Black African children. However, these were complex because there were statistically significant interactions between Black African ethnicity and FMI (P=0.004 boys; P=0.003 girls) and also between FMI and age group (P<0.0001 for boys and girls). BMI adjustments therefore varied by age group and FMI level (and indirectly BMI); the largest adjustments were in younger children with higher unadjusted BMI and the smallest in older children with lower unadjusted BMI. Conclusions: BMI underestimated BF in South Asians and overestimated BF in Black Africans. Ethnic-specific adjustments, increasing BMI in South Asians and reducing BMI in Black Africans, can improve the accuracy of BF assessment in these children. PMID:28325931

Sex Differences in Functional Stress Test Versus CT Angiography in Symptomatic Patients With Suspected CAD: Insights From PROMISE

PubMed Central

Pagidipati, Neha J.; Hemal, Kshipra; Coles, Adrian; Mark, Daniel B.; Dolor, Rowena J.; Pellikka, Patricia A.; Hoffmann, Udo; Litwin, Sheldon E.; Udelson, James; Daubert, Melissa A.; Shah, Svati H.; Martinez, Beth; Lee, Kerry L.; Douglas, Pamela S.

2016-01-01

Background Risk stratification is an important goal of cardiac noninvasive tests (NITs), yet little contemporary data exist on the prognostic value of different NITs by patient sex. Objectives To compare the results and prognostic information derived from anatomic versus stress testing in stable men and women with suspected coronary artery disease. Methods In 8966 PROMISE trial patients tested as randomized (4500 computed tomographic angiography [CTA], 52% female; 4466 stress testing, 53% female), we assessed the relationship between sex and NIT results using logistic regression, and the relationship between sex and a composite of death, myocardial infarction, and unstable angina hospitalization using Cox proportional hazards models. Results In women, a positive CTA (≥70% stenosis) was less likely than a positive stress test (8% vs. 12%, adjusted OR 0.67 [95% CI 0.55-0.82]). Compared with negative tests, a positive CTA was more strongly associated with subsequent clinical events than a positive stress test (CTA adjusted HR 5.86 [95% CI 3.32-10.35]; stress adjusted HR 2.27 [95% CI 1.21-4.25]; adjusted p=0.028). Men were more likely to have a positive CTA than stress test (16% vs. 14%, adjusted OR 1.23 [95% CI 1.04-1.47]). Compared with negative tests, a positive CTA was less strongly associated with subsequent clinical events than a positive stress test in men, although this difference was not statistically significant (CTA adjusted HR 2.80 [95% CI 1.76-4.45]; stress adjusted HR 4.42 [95% CI 2.77-7.07]; adjusted p=0.168). Negative CTA and stress tests were equally likely to predict an event in both sexes (adjusted p-values=NS). A significant interaction between sex, NIT type, and test result (p=0.01) suggests that sex and NIT type jointly influence the relationship between test result and clinical events. Conclusions The prognostic value of an NIT result varies by test type and patient sex. Women appear to derive more prognostic information from a CTA, while men tend to derive similar prognostic value from both test types. PMID:27058908

Political Violence and Child Adjustment: Longitudinal Tests of Sectarian Antisocial Behavior, Family Conflict, and Insecurity as Explanatory Pathways

ERIC Educational Resources Information Center

Cummings, Edward M.; Merrilees, Christine E.; Schermerhorn, Alice C.; Goeke-Morey, Marcie C.; Shirlow, Peter; Cairns, Ed

2012-01-01

Understanding the impact of political violence on child maladjustment is a matter of international concern. Recent research has advanced a social ecological explanation for relations between political violence and child adjustment. However, conclusions are qualified by the lack of longitudinal tests. Toward examining pathways longitudinally,…

Two Models of Caregiver Strain and Bereavement Adjustment: A Comparison of Husband and Daughter Caregivers of Breast Cancer Hospice Patients

ERIC Educational Resources Information Center

Bernard, Lori L.; Guarnaccia, Charles A.

2003-01-01

Purpose: Caregiver bereavement adjustment literature suggests opposite models of impact of role strain on bereavement adjustment after care-recipient death--a Complicated Grief Model and a Relief Model. This study tests these competing models for husband and adult-daughter caregivers of breast cancer hospice patients. Design and Methods: This…

Concurrent validity of the College Adjustment scales using comparison with the MMPI College Maladjustment Scale.

PubMed

Campbell, Michael H; Palmieri, Michael; Lasch, Brandi

2006-12-01

The concurrent validity of the College Adjustment Scales was assessed using comparison to the College Maladjustment Scale of the Minnesota Multiphasic Inventory-2. Undergraduate students (N=56, 40 women, M age = 21.3 yr., 87.5% white, non-Hispanic) completed both tests. Analysis indicated scores on 8 of 9 College Adjustment Scales correlated significantly in the predicted direction with those on the College Maladjustment Scale, thereby providing some additional support for convergent validity. While the conclusions are limited significantly by the small sample, this report provides an incremental contribution to the validity of the College Adjustment Scales.

Using latent class analysis to model prescription medications in the measurement of falling among a community elderly population

PubMed Central

2013-01-01

Background Falls among the elderly are a major public health concern. Therefore, the possibility of a modeling technique which could better estimate fall probability is both timely and needed. Using biomedical, pharmacological and demographic variables as predictors, latent class analysis (LCA) is demonstrated as a tool for the prediction of falls among community dwelling elderly. Methods Using a retrospective data-set a two-step LCA modeling approach was employed. First, we looked for the optimal number of latent classes for the seven medical indicators, along with the patients’ prescription medication and three covariates (age, gender, and number of medications). Second, the appropriate latent class structure, with the covariates, were modeled on the distal outcome (fall/no fall). The default estimator was maximum likelihood with robust standard errors. The Pearson chi-square, likelihood ratio chi-square, BIC, Lo-Mendell-Rubin Adjusted Likelihood Ratio test and the bootstrap likelihood ratio test were used for model comparisons. Results A review of the model fit indices with covariates shows that a six-class solution was preferred. The predictive probability for latent classes ranged from 84% to 97%. Entropy, a measure of classification accuracy, was good at 90%. Specific prescription medications were found to strongly influence group membership. Conclusions In conclusion the LCA method was effective at finding relevant subgroups within a heterogenous at-risk population for falling. This study demonstrated that LCA offers researchers a valuable tool to model medical data. PMID:23705639

A spatially explicit approach to the study of socio-demographic inequality in the spatial distribution of trees across Boston neighborhoods

PubMed Central

Duncan, Dustin T.; Kawachi, Ichiro; Kum, Susan; Aldstadt, Jared; Piras, Gianfranco; Matthews, Stephen A.; Arbia, Giuseppe; Castro, Marcia C.; White, Kellee; Williams, David R.

2017-01-01

The racial/ethnic and income composition of neighborhoods often influences local amenities, including the potential spatial distribution of trees, which are important for population health and community wellbeing, particularly in urban areas. This ecological study used spatial analytical methods to assess the relationship between neighborhood socio-demographic characteristics (i.e. minority racial/ethnic composition and poverty) and tree density at the census tact level in Boston, Massachusetts (US). We examined spatial autocorrelation with the Global Moran’s I for all study variables and in the ordinary least squares (OLS) regression residuals as well as computed Spearman correlations non-adjusted and adjusted for spatial autocorrelation between socio-demographic characteristics and tree density. Next, we fit traditional regressions (i.e. OLS regression models) and spatial regressions (i.e. spatial simultaneous autoregressive models), as appropriate. We found significant positive spatial autocorrelation for all neighborhood socio-demographic characteristics (Global Moran’s I range from 0.24 to 0.86, all P=0.001), for tree density (Global Moran’s I=0.452, P=0.001), and in the OLS regression residuals (Global Moran’s I range from 0.32 to 0.38, all P<0.001). Therefore, we fit the spatial simultaneous autoregressive models. There was a negative correlation between neighborhood percent non-Hispanic Black and tree density (rS=−0.19; conventional P-value=0.016; spatially adjusted P-value=0.299) as well as a negative correlation between predominantly non-Hispanic Black (over 60% Black) neighborhoods and tree density (rS=−0.18; conventional P-value=0.019; spatially adjusted P-value=0.180). While the conventional OLS regression model found a marginally significant inverse relationship between Black neighborhoods and tree density, we found no statistically significant relationship between neighborhood socio-demographic composition and tree density in the spatial regression models. Methodologically, our study suggests the need to take into account spatial autocorrelation as findings/conclusions can change when the spatial autocorrelation is ignored. Substantively, our findings suggest no need for policy intervention vis-à-vis trees in Boston, though we hasten to add that replication studies, and more nuanced data on tree quality, age and diversity are needed. PMID:29354668

Protein structure prediction with local adjust tabu search algorithm

PubMed Central

2014-01-01

Background Protein folding structure prediction is one of the most challenging problems in the bioinformatics domain. Because of the complexity of the realistic protein structure, the simplified structure model and the computational method should be adopted in the research. The AB off-lattice model is one of the simplification models, which only considers two classes of amino acids, hydrophobic (A) residues and hydrophilic (B) residues. Results The main work of this paper is to discuss how to optimize the lowest energy configurations in 2D off-lattice model and 3D off-lattice model by using Fibonacci sequences and real protein sequences. In order to avoid falling into local minimum and faster convergence to the global minimum, we introduce a novel method (SATS) to the protein structure problem, which combines simulated annealing algorithm and tabu search algorithm. Various strategies, such as the new encoding strategy, the adaptive neighborhood generation strategy and the local adjustment strategy, are adopted successfully for high-speed searching the optimal conformation corresponds to the lowest energy of the protein sequences. Experimental results show that some of the results obtained by the improved SATS are better than those reported in previous literatures, and we can sure that the lowest energy folding state for short Fibonacci sequences have been found. Conclusions Although the off-lattice models is not very realistic, they can reflect some important characteristics of the realistic protein. It can be found that 3D off-lattice model is more like native folding structure of the realistic protein than 2D off-lattice model. In addition, compared with some previous researches, the proposed hybrid algorithm can more effectively and more quickly search the spatial folding structure of a protein chain. PMID:25474708

Evidence for distinct modes of solar activity

NASA Astrophysics Data System (ADS)

Usoskin, I. G.; Hulot, G.; Gallet, Y.; Roth, R.; Licht, A.; Joos, F.; Kovaltsov, G. A.; Thébault, E.; Khokhlov, A.

2014-02-01

Aims: The Sun shows strong variability in its magnetic activity, from Grand minima to Grand maxima, but the nature of the variability is not fully understood, mostly because of the insufficient length of the directly observed solar activity records and of uncertainties related to long-term reconstructions. Here we present a new adjustment-free reconstruction of solar activity over three millennia and study its different modes. Methods: We present a new adjustment-free, physical reconstruction of solar activity over the past three millennia, using the latest verified carbon cycle, 14C production, and archeomagnetic field models. This great improvement allowed us to study different modes of solar activity at an unprecedented level of details. Results: The distribution of solar activity is clearly bi-modal, implying the existence of distinct modes of activity. The main regular activity mode corresponds to moderate activity that varies in a relatively narrow band between sunspot numbers 20 and 67. The existence of a separate Grand minimum mode with reduced solar activity, which cannot be explained by random fluctuations of the regular mode, is confirmed at a high confidence level. The possible existence of a separate Grand maximum mode is also suggested, but the statistics is too low to reach a confident conclusion. Conclusions: The Sun is shown to operate in distinct modes - a main general mode, a Grand minimum mode corresponding to an inactive Sun, and a possible Grand maximum mode corresponding to an unusually active Sun. These results provide important constraints for both dynamo models of Sun-like stars and investigations of possible solar influence on Earth's climate. Data are only available at the CDS via anonymous ftp to http://cdsarc.u-strasbg.fr (ftp://130.79.128.5) or via http://cdsarc.u-strasbg.fr/viz-bin/qcat?J/A+A/562/L10

The frontotemporal syndrome of ALS is associated with poor survival.

PubMed

Govaarts, Rosanne; Beeldman, Emma; Kampelmacher, Mike J; van Tol, Marie-Jose; van den Berg, Leonard H; van der Kooi, Anneke J; Wijkstra, Peter J; Zijnen-Suyker, Marianne; Cobben, Nicolle A M; Schmand, Ben A; de Haan, Rob J; de Visser, Marianne; Raaphorst, Joost

2016-12-01

Thirty percent of ALS patients have a frontotemporal syndrome (FS), defined as behavioral changes or cognitive impairment. Despite previous studies, there are no firm conclusions on the effect of the FS on survival and the use of non-invasive ventilation (NIV) in ALS. We examined the effect of the FS on survival and the start and duration of NIV in ALS. Behavioral changes were defined as >22 points on the ALS-Frontotemporal-Dementia-Questionnaire or ≥3 points on ≥2 items of the Neuropsychiatric Inventory. Cognitive impairment was defined as below the fifth percentile on ≥2 tests of executive function, memory or language. Classic ALS was defined as ALS without the frontotemporal syndrome. We performed survival analyses from symptom onset and time from NIV initiation, respectively, to death. The impact of the explanatory variables on survival and NIV initiation were examined using Cox proportional hazards models. We included 110 ALS patients (76 men) with a mean age of 62 years. Median survival time was 4.3 years (95 % CI 3.53-5.13). Forty-seven patients (43 %) had an FS. Factors associated with shorter survival were FS, bulbar onset, older age at onset, short time to diagnosis and a C9orf72 repeat expansion. The adjusted hazard ratio (HR) for the FS was 2.29 (95 % CI 1.44-3.65, p < 0.001) in a multivariate model. Patients with an FS had a shorter survival after NIV initiation (adjusted HR 2.70, 95 % CI 1.04-4.67, p = 0.04). In conclusion, there is an association between the frontotemporal syndrome and poor survival in ALS, which remains present after initiation of NIV.

Comparative evaluation of test methods to simulate acoustic response of shroud-enclosed spacecraft structures

NASA Technical Reports Server (NTRS)

On, F. J.

1975-01-01

Test methods were evaluated to ascertain whether a spacecraft, properly tested within its shroud, could be vibroacoustic tested without the shroud, with adjustments made in the acoustic input spectra to simulate the acoustic response of the missing shroud. The evaluation was based on vibroacoustic test results obtained from a baseline model composed (1) of a spacecraft with adapter, lower support structure, and shroud; (2) of the spacecraft, adapter, and lower structure, but without the shroud; and (3) of the spacecraft and adapter only. Emphasis was placed on the magnitude of the acoustic input changes required to substitute for the shroud and the difficulty of making such input changes, and the degree of missimulation which can result from the performance of a particular, less-than optimum test. Conclusions are drawn on the advantages and disadvantages derived from the use of input spectra adjustment methods and lower support structure simulations. Test guidelines were also developed for planning and performing a launch acoustic-environmental test.

Beverages Sales in Mexico before and after Implementation of a Sugar Sweetened Beverage Tax

PubMed Central

Colchero, M. A; Guerrero-López, Carlos Manuel; Molina, Mariana; Rivera, Juan Angel

2016-01-01

Objective To estimate changes in sales of sugar sweetened beverages (SSB) and plain water after a 1 peso per liter excise SSB tax was implemented in Mexico in January 2014. Material and Methods We used sales data from the Monthly Surveys of the Manufacturing Industry from January 2007 to December 2015. We estimated Ordinary Least Squares models to assess changes in per capita sales of SSB and plain water adjusting for seasonality and the global indicator of economic activity. Results We found a decrease of 7.3% in per capita sales of SSB and an increase of 5.2% of per capita sales of plain water in 2014–2015 compared to the pre-tax period (2007–2013). Conclusions Adjusting for variables that change over time and that are associated with the demand for SSB, we found the tax was associated with a reduction in per capita sales of SSB. The effectiveness of the tax should be evaluated in the medium and long term. PMID:27668875

Outcomes of Surgeries Performed in Physician Offices Compared With Ambulatory Surgery Centers and Hospital Outpatient Departments in Florida

PubMed Central

Ohsfeldt, Robert L; Li, Pengxiang; Schneider, John E; Stojanovic, Ivana; Scheibling, Cara M

2017-01-01

Background: The proportion of outpatient surgeries performed in physician offices has been increasing over time, raising concern about the impact on outcomes. Objective: To use a private insurance claims database to compare 7-day and 30-day hospitalization rates following relatively complex outpatient surgical procedures across physician offices, freestanding ambulatory surgery centers (ASCs), and hospital outpatient departments (HOPDs). Methods: A multivariable logistic regression model was used to compare the risk-adjusted probability of hospitalization among patients after any of the 88 study outpatient procedures at physician offices, ASCs, and HOPDs over 2008-2012 in Florida. Results: Risk-adjusted hospitalization rates were higher following procedures performed in physician offices compared with ASCs for all procedures grouped together, for most procedures grouped by type, and for many individual procedures. Conclusions: Hospitalizations following surgery were more likely for procedures performed in physician offices compared with ASCs, which highlights the need for ongoing research on the safety and efficacy of office-based surgery. PMID:28469457

Risk factors for UK Plasmodium falciparum cases

PubMed Central

2014-01-01

Background An increasing proportion of malaria cases diagnosed in UK residents with a history of travel to malaria endemic areas are due to Plasmodium falciparum. Methods In order to identify travellers at most risk of acquiring malaria a proportional hazards model was used to estimate the risk of acquiring malaria stratified by purpose of travel and age whilst adjusting for entomological inoculation rate (EIR) and duration of stay in endemic countries. Results Travellers visiting friends and relatives and business travellers were found to have significantly higher hazard of acquiring malaria (adjusted hazard ratio (HR) relative to that of holiday makers 7.4, 95% CI 6.4–8.5, p < 0. 0001 and HR 3.4, 95% CI 2.9-3.8, p < 0. 0001, respectively). All age-groups were at lower risk than children aged 0–15 years. Conclusions These estimates of the increased risk for business travellers and those visiting friends and relatives should be used to inform programmes to improve awareness of the risks of malaria when travelling. PMID:25091803

Sweetened beverages intake, hyperuricemia and metabolic syndrome: the Mexico City Diabetes Study.

PubMed

López-Molina, Rubén; Parra-Cabrera, Socorro; López-Ridaura, Ruy; González-Villalpando, María E; Ferrannini, Ele; González-Villalpando, Clicerio

2013-12-01

OBJECTIVE. To determine prevalence of hyperuricemia and its relation with intake of sweetened beverages (SB) and metabolic syndrome (MS) in low income urban Mexican population. MATERIALS AND METHODS. A cross-sectional analysis of The Mexico City Diabetes Study, a prospective population-based investigation (1 173 participants) was performed. We used logistic regression, adjusted by pertinent variables. We determined prevalence of hyperuricemia and explored associations of uric acid levels with MS and intake of SB. RESULTS. Prevalence of hyperuricemia was 26.5 and 19.8% in males and females respectively. In an adjusted multivariate model, body mass index, waist circumference, and triglyceride were higher as uric acid quartiles increased (p<0.005-0.001). The odds ratio for MS was 1.48 for 3rd uric acid quartile and 2.03 for 4th quartile. Higher consumption of SB was associated with higher uric acid levels (p<0.001). CONCLUSION. Prevalence of hyperuricemia is high. Potential association with intake of SB, resulting in metabolic alterations should be considered.

Localized Scleroderma, Systemic Sclerosis and Cardiovascular Risk: A Danish Nationwide Cohort Study.

PubMed

Hesselvig, Jeanette Halskou; Kofoed, Kristian; Wu, Jashin J; Dreyer, Lene; Gislason, Gunnar; Ahlehoff, Ole

2018-03-13

Recent findings indicate that patients with systemic sclerosis have an increased risk of cardiovascular disease. To determine whether patients with systemic sclerosis or localized scleroderma are at increased risk of cardiovascular disease, a cohort study of the entire Danish population aged ≥ 18 and ≤ 100 years was conducted, followed from 1997 to 2011 by individual-level linkage of nationwide registries. Multivariable adjusted Cox regression models were used to estimate the hazard ratios (HRs) for a composite cardiovascular disease endpoint. A total of 697 patients with localized scleroderma and 1,962 patients with systemic sclerosis were identified and compared with 5,428,380 people in the reference population. In systemic sclerosis, the adjusted HR was 2.22 (95% confidence interval 1.99-2.48). No association was seen between patients with localized scleroderma and cardiovascular disease. In conclusion, systemic sclerosis is a significant cardiovascular disease risk factor, while patients with localized scleroderma are not at increased risk of cardiovascular disease.

An evaluation of bias in propensity score-adjusted non-linear regression models.

PubMed

Wan, Fei; Mitra, Nandita

2018-03-01

Propensity score methods are commonly used to adjust for observed confounding when estimating the conditional treatment effect in observational studies. One popular method, covariate adjustment of the propensity score in a regression model, has been empirically shown to be biased in non-linear models. However, no compelling underlying theoretical reason has been presented. We propose a new framework to investigate bias and consistency of propensity score-adjusted treatment effects in non-linear models that uses a simple geometric approach to forge a link between the consistency of the propensity score estimator and the collapsibility of non-linear models. Under this framework, we demonstrate that adjustment of the propensity score in an outcome model results in the decomposition of observed covariates into the propensity score and a remainder term. Omission of this remainder term from a non-collapsible regression model leads to biased estimates of the conditional odds ratio and conditional hazard ratio, but not for the conditional rate ratio. We further show, via simulation studies, that the bias in these propensity score-adjusted estimators increases with larger treatment effect size, larger covariate effects, and increasing dissimilarity between the coefficients of the covariates in the treatment model versus the outcome model.

Reducing Periconceptional Methylmercury Exposure: Cost–Utility Analysis for a Proposed Screening Program for Women Planning a Pregnancy in Ontario, Canada

PubMed Central

Rennie, Colin; Coyle, Doug

2015-01-01

Background The assessment of neurodevelopmental effects in children associated with prenatal methylmercury exposure, from contaminated fish and seafood in the maternal diet, has recently been strengthened by adjustment for the negative confounding resulting from co-exposure to beneficial polyunsaturated fatty acids (PUFAs). Objectives We aimed to determine the cost-effectiveness of a periconceptional screening program of blood mercury concentration for women planning to become pregnant in Ontario, Canada. Fish intake recommendations would be provided for those found to have blood mercury levels above the intervention threshold. Methods Analysis was conducted using a combined decision tree/Markov model to compare the proposed screening intervention with standard care from a societal perspective over a lifetime horizon. We used the national blood mercury distributions of women 20–49 years of age reported in the Canadian Health Measures Survey from 2009 through 2011 to determine the cognitive deficits associated with prenatal methylmercury exposure for successful planned pregnancies. Outcomes modeled included the loss in quality of life and the remedial education costs. Value of information analysis was conducted to assess the underlying uncertainty around the model results and to identify which parameters contribute most to this uncertainty. Results The incremental cost per quality-adjusted life year (QALY) gained for the proposed screening intervention was estimated to be Can$18,051, and the expected value for a willingness to pay of Can$50,000/QALY to be Can$0.61. Conclusions Our findings suggest that the proposed periconceptional blood mercury screening program for women planning a pregnancy would be highly cost-effective from a societal perspective. The results of a value of information analysis confirm the robustness of the study’s conclusions. Citation Gaskin J, Rennie C, Coyle D. 2015. Reducing periconceptional methylmercury exposure: cost–utility analysis for a proposed screening program for women planning a pregnancy in Ontario, Canada. Environ Health Perspect 123:1337–1344; http://dx.doi.org/10.1289/ehp.1409034 PMID:26024213

Warm Dark Matter and Cosmic Reionization

DOE PAGES

Villanueva-Domingo, Pablo; Gnedin, Nickolay Y.; Mena, Olga

2018-01-10

In models with dark matter made of particles with keV masses, such as a sterile neutrino, small-scale density perturbations are suppressed, delaying the period at which the lowest mass galaxies are formed and therefore shifting the reionization processes to later epochs. In this study, focusing on Warm Dark Matter (WDM) with masses close to its present lower bound, i.e., around the 3 keV region, we derive constraints from galaxy luminosity functions, the ionization history and the Gunn–Peterson effect. We show that even if star formation efficiency in the simulations is adjusted to match the observed UV galaxy luminosity functions in bothmore » CDM and WDM models, the full distribution of Gunn–Peterson optical depth retains the strong signature of delayed reionization in the WDM model. Furthermore, until the star formation and stellar feedback model used in modern galaxy formation simulations is constrained better, any conclusions on the nature of dark matter derived from reionization observables remain model-dependent.« less

Warm Dark Matter and Cosmic Reionization

NASA Astrophysics Data System (ADS)

Villanueva-Domingo, Pablo; Gnedin, Nickolay Y.; Mena, Olga

2018-01-01

In models with dark matter made of particles with keV masses, such as a sterile neutrino, small-scale density perturbations are suppressed, delaying the period at which the lowest mass galaxies are formed and therefore shifting the reionization processes to later epochs. In this study, focusing on Warm Dark Matter (WDM) with masses close to its present lower bound, i.e., around the 3 keV region, we derive constraints from galaxy luminosity functions, the ionization history and the Gunn–Peterson effect. We show that even if star formation efficiency in the simulations is adjusted to match the observed UV galaxy luminosity functions in both CDM and WDM models, the full distribution of Gunn–Peterson optical depth retains the strong signature of delayed reionization in the WDM model. However, until the star formation and stellar feedback model used in modern galaxy formation simulations is constrained better, any conclusions on the nature of dark matter derived from reionization observables remain model-dependent.

Warm Dark Matter and Cosmic Reionization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Villanueva-Domingo, Pablo; Gnedin, Nickolay Y.; Mena, Olga

In models with dark matter made of particles with keV masses, such as a sterile neutrino, small-scale density perturbations are suppressed, delaying the period at which the lowest mass galaxies are formed and therefore shifting the reionization processes to later epochs. In this study, focusing on Warm Dark Matter (WDM) with masses close to its present lower bound, i.e., around the 3 keV region, we derive constraints from galaxy luminosity functions, the ionization history and the Gunn–Peterson effect. We show that even if star formation efficiency in the simulations is adjusted to match the observed UV galaxy luminosity functions in bothmore » CDM and WDM models, the full distribution of Gunn–Peterson optical depth retains the strong signature of delayed reionization in the WDM model. Furthermore, until the star formation and stellar feedback model used in modern galaxy formation simulations is constrained better, any conclusions on the nature of dark matter derived from reionization observables remain model-dependent.« less

Association between dietary protein intake and grip strength among adults aged 51 years and over: What We Eat in America, National Health and Nutrition Examination Survey 2011-2014

PubMed Central

Goldman, Joseph D.; Sahyoun, Nadine R.; Moshfegh, Alanna J.

2018-01-01

Introduction Distributing daily protein intake evenly across meals (∼25–30g/meal) has been suggested to improve muscle mass. The aim of this research is to examine the association between grip strength, total protein intake and its distribution across day’s meals in older adults. Methods Nationally representative dietary intake data of adults aged 51 years and older (n = 4,123) who participated in What We Eat in America, NHANES 2011–2014 were analyzed. Protein intake per day and per eating occasion (breakfast, lunch, dinner, and snack) were determined. Combined grip strength was calculated and expressed in kilograms. Grip strength of individuals consuming ≥25g protein at 1 eating occasion was compared with those consuming same level of protein at 2 and 3 or more eating occasions. Grip strength of individuals in quartile 1 of daily protein intake was compared to those in the other quartiles. All associations were examined without and with adjustment for age, race/ethnicity, physical activity, health status, and smoking status. The comparison involving eating occasions and protein intake quartiles were further adjusted for daily protein intake and energy intake, respectively. Results Only 33% of men and 19% of women had protein intake of ≥25g at 2 or more eating occasions. These individuals also had higher grip strength and daily protein intake. Grip strength was positively associated with consumption of ≥25g protein at 2 eating occasions as compared to consumption of same level of protein at 1 eating occasion (p<0.05) in unadjusted model, but not when adjusted. Grip strength was positively associated with daily protein intake among women in quartiles 3 and 4 (p<0.05) of protein intake in both unadjusted and adjusted models compared to lowest protein intake. Among men, grip strength was associated with daily protein intake in quartiles 3 and 4 (p<0.05) in the unadjusted model, but not when adjusted. Conclusion In a nationally representative sample of older adults, consuming ≥25g protein at 2 or more eating occasions was not associated with grip strength. However, higher daily protein intake was positively associated with grip strength in women. PMID:29364939

Urinary and Dietary Analysis of 18,470 Bangladeshis Reveal a Correlation of Rice Consumption with Arsenic Exposure and Toxicity

PubMed Central

Melkonian, Stephanie; Argos, Maria; Hall, Megan N.; Chen, Yu; Parvez, Faruque; Pierce, Brandon; Cao, Hongyuan; Aschebrook-Kilfoy, Briseis; Ahmed, Alauddin; Islam, Tariqul; Slavcovich, Vesna; Gamble, Mary; Haris, Parvez I.; Graziano, Joseph H.; Ahsan, Habibul

2013-01-01

Background We utilized data from the Health Effects of Arsenic Longitudinal Study (HEALS) in Araihazar, Bangladesh, to evaluate the association of steamed rice consumption with urinary total arsenic concentration and arsenical skin lesions in the overall study cohort (N=18,470) and in a subset with available urinary arsenic metabolite data (N=4,517). Methods General linear models with standardized beta coefficients were used to estimate associations between steamed rice consumption and urinary total arsenic concentration and urinary arsenic metabolites. Logistic regression models were used to estimate prevalence odds ratios (ORs) and their 95% confidence intervals (CIs) for the associations between rice intake and prevalent skin lesions at baseline. Discrete time hazard models were used to estimate discrete time (HRs) ratios and their 95% CIs for the associations between rice intake and incident skin lesions. Results Steamed rice consumption was positively associated with creatinine-adjusted urinary total arsenic (β=0.041, 95% CI: 0.032-0.051) and urinary total arsenic with statistical adjustment for creatinine in the model (β=0.043, 95% CI: 0.032-0.053). Additionally, we observed a significant trend in skin lesion prevalence (P-trend=0.007) and a moderate trend in skin lesion incidence (P-trend=0.07) associated with increased intake of steamed rice. Conclusions This study suggests that rice intake may be a source of arsenic exposure beyond drinking water. PMID:24260455

Urinary Tract Stones and Osteoporosis: Findings From the Women’s Health Initiative

PubMed Central

Carbone, Laura D; Hovey, Kathleen M; Andrews, Christopher A; Thomas, Fridtjof; Sorensen, Mathew D; Crandall, Carolyn J; Watts, Nelson B; Bethel, Monique; Johnson, Karen C

2017-01-01

Kidney and bladder stones (urinary tract stones) and osteoporosis are prevalent, serious conditions for postmenopausal women. Men with kidney stones are at increased risk of osteoporosis; however, the relationship of urinary tract stones to osteoporosis in postmenopausal women has not been established. The purpose of this study was to determine whether urinary tract stones are an independent risk factor for changes in bone mineral density (BMD) and incident fractures in women in the Women’s Health Initiative (WHI). Data were obtained from 150,689 women in the Observational Study and Clinical Trials of the WHI with information on urinary tract stones status: 9856 of these women reported urinary tract stones at baseline and/or incident urinary tract stones during follow-up. Cox regression models were used to determine the association of urinary tract stones with incident fractures and linear mixed models were used to investigate the relationship of urinary tract stones with changes in BMD that occurred during WHI. Follow-up was over an average of 8 years. Models were adjusted for demographic and clinical factors, medication use, and dietary histories. In unadjusted models there was a significant association of urinary tract stones with incident total fractures (HR 1.10; 95% CI, 1.04 to 1.17). However, in covariate adjusted analyses, urinary tract stones were not significantly related to changes in BMD at any skeletal site or to incident fractures. In conclusion, urinary tract stones in postmenopausal women are not an independent risk factor for osteoporosis. PMID:25990099

Motivational Climate Sport Youth Scale: Measurement Invariance Across Gender and Five Different Sports.

PubMed

Monteiro, Diogo; Borrego, Carla Chicau; Silva, Carlos; Moutão, João; Marinho, Daniel Almeida; Cid, Luís

2018-03-01

The aim of this study was to analyze the psychometric properties of the Portuguese version of the Motivational Climate Sport Youth Scale (MCSYSp) and invariance across gender and different sports (swimming, soccer, handball, basketball, futsal). A total of 4,569 athletes (3,053 males, 1,516 females) from soccer (1,098), swimming (1,049), basketball (1,754), futsal (340), and handball (328) participated in this study, with ages between 10 and 20 years (M = 15.13; SD = 1.95). The results show that the original model (two factors/12 items) did not adjust to the data in a satisfactory way; therefore, it was necessary to change the model by removing four items (two from each factor). Subsequently, the model adjusted to the data in a satisfactory way (χ 2 = 499.84; df = 19; χ 2 /df = 26.30; p < .001; SRMR = .037; TLI = .923; CFI = .948; RMSEA = .074; IC90% .069-.080) and was invariant by gender and team sports (soccer, handball, basketball, futsal) (ΔCFK≤.01); however, it was not invariant between swimming and team sports (soccer, handball, basketball, futsal) (ΔCFI ≥ .01). In conclusion, the MCSYSp (two factors/eight items) is a valid and reliable choice that is transversal not only to gender, but also to the different studied team sports to measure the perception of the motivational climate in athletes. Future studies can research more deeply the invariance analysis between individual sports to better understand the invariance of the model between individual and team sports.

On the Hydrologic Adjustment of Climate-Model Projections: The Potential Pitfall of Potential Evapotranspiration

USGS Publications Warehouse

Milly, Paul C.D.; Dunne, Krista A.

2011-01-01

Hydrologic models often are applied to adjust projections of hydroclimatic change that come from climate models. Such adjustment includes climate-bias correction, spatial refinement ("downscaling"), and consideration of the roles of hydrologic processes that were neglected in the climate model. Described herein is a quantitative analysis of the effects of hydrologic adjustment on the projections of runoff change associated with projected twenty-first-century climate change. In a case study including three climate models and 10 river basins in the contiguous United States, the authors find that relative (i.e., fractional or percentage) runoff change computed with hydrologic adjustment more often than not was less positive (or, equivalently, more negative) than what was projected by the climate models. The dominant contributor to this decrease in runoff was a ubiquitous change in runoff (median -11%) caused by the hydrologic model’s apparent amplification of the climate-model-implied growth in potential evapotranspiration. Analysis suggests that the hydrologic model, on the basis of the empirical, temperature-based modified Jensen–Haise formula, calculates a change in potential evapotranspiration that is typically 3 times the change implied by the climate models, which explicitly track surface energy budgets. In comparison with the amplification of potential evapotranspiration, central tendencies of other contributions from hydrologic adjustment (spatial refinement, climate-bias adjustment, and process refinement) were relatively small. The authors’ findings highlight the need for caution when projecting changes in potential evapotranspiration for use in hydrologic models or drought indices to evaluate climate-change impacts on water.

Decision analytic modeling for the economic analysis of proton radiotherapy for non-small cell lung cancer

PubMed Central

Richard, Patrick J.; Zeng, Jing; Apisarnthanarax, Smith; Rengan, Ramesh; Phillips, Mark H.

2018-01-01

Background Although proton radiation treatments are more costly than photon/X-ray therapy, they may lower overall treatment costs through reducing rates of severe toxicities and the costly management of those toxicities. To study this issue, we created a decision-model comparing proton vs. X-ray radiotherapy for locally advanced non-small cell lung cancer patients. Methods An influence diagram was created to model for radiation delivery, associated 6-month pneumonitis/esophagitis rates, and overall costs (radiation plus toxicity costs). Pneumonitis (age, chemo type, V20, MLD) and esophagitis (V60) predictors were modeled to impact toxicity rates. We performed toxicity-adjusted, rate-adjusted, risk group-adjusted, and radiosensitivity analyses. Results Upfront proton treatment costs exceeded that of photons [$16,730.37 (3DCRT), $23,893.83 (IMRT), $41,061.80 (protons)]. Based upon expected population pneumonitis and esophagitis rates for each modality, protons would be expected to recover $1,065.62 and $1,139.63 of the cost difference compared to 3DCRT or IMRT. For patients treated with IMRT experiencing grade 4 pneumonitis or grade 4 esophagitis, costs exceeded patients treated with protons without this toxicity. 3DCRT patients with grade 4 esophagitis had higher costs than proton patients without this toxicity. For the risk group analysis, high risk patients (age >65, carboplatin/paclitaxel) benefited more from proton therapy. A biomarker may allow patient selection for proton therapy, although the AUC alone is not sufficient to determine if the biomarker is clinically useful. Conclusions The comparison between proton and photon/X-ray radiation therapy for NSCLC needs to consider both the up-front cost of treatment and the possible long term cost of complications. In our analysis, current costs favor X-ray therapy. However, relatively small reductions in the cost of proton therapy may result in a shift to the preference for proton therapy.

Active and uncontrolled asthma among children exposed to air stack emissions of sulphur dioxide from petroleum refineries in Montreal, Quebec: A cross-sectional study

PubMed Central

Deger, Leylâ; Plante, Céline; Jacques, Louis; Goudreau, Sophie; Perron, Stéphane; Hicks, John; Kosatsky, Tom; Smargiassi, Audrey

2012-01-01

BACKGROUND: Little attention has been devoted to the effects on children’s respiratory health of exposure to sulphur dioxide (SO2) in ambient air from local industrial emissions. Most studies on the effects of SO2 have assessed its impact as part of the regional ambient air pollutant mix. OBJECTIVE: To examine the association between exposure to stack emissions of SO2 from petroleum refineries located in Montreal’s (Quebec) east-end industrial complex and the prevalence of active asthma and poor asthma control among children living nearby. METHODS: The present cross-sectional study used data from a respiratory health survey of Montreal children six months to 12 years of age conducted in 2006. Of 7964 eligible households that completed the survey, 842 children between six months and 12 years of age lived in an area impacted by refinery emissions. Ambient SO2 exposure levels were estimated using dispersion modelling. Log-binomial regression models were used to estimate crude and adjusted prevalence ratios (PRs) and 95% CIs for the association between yearly school and residential SO2 exposure estimates and asthma outcomes. Adjustments were made for child’s age, sex, parental history of atopy and tobacco smoke exposure at home. RESULTS: The adjusted PR for the association between active asthma and SO2 levels was 1.14 (95% CI 0.94 to 1.39) per interquartile range increase in modelled annual SO2. The effect on poor asthma control was greater (PR=1.39 per interquartile range increase in modelled SO2 [95% CI 1.00 to 1.94]). CONCLUSIONS: Results of the present study suggest a relationship between exposure to refinery stack emissions of SO2 and the prevalence of active and poor asthma control in children who live and attend school in proximity to refineries. PMID:22536578

Simultaneous Prediction of New Morbidity, Mortality, and Survival without New Morbidity from Pediatric Intensive Care: A New Paradigm for Outcomes Assessment

PubMed Central

Pollack, Murray M.; Holubkov, Richard; Funai, Tomohiko; Berger, John T.; Clark, Amy E.; Meert, Kathleen; Berg, Robert A.; Carcillo, Joseph; Wessel, David L.; Moler, Frank; Dalton, Heidi; Newth, Christopher J. L.; Shanley, Thomas; Harrison, Rick E.; Doctor, Allan; Jenkins, Tammara L.; Tamburro, Robert; Dean, J. Michael

2015-01-01

Objective Assessments of care including quality assessments adjusted for physiological status should include the development of new morbidities as well as mortalities. We hypothesized that morbidity, like mortality, is associated with physiological dysfunction and could be predicted simultaneously with mortality. Design Prospective cohort study from December 4, 2011 to April 7, 2013. Setting and Patients General and cardiac/cardiovascular pediatric intensive care units at 7 sites. Measurements and Main Results Among 10,078 admissions, the unadjusted morbidity rates (measured with the Functional Status Scale (FSS), and defined as an increase of ≥ 3 from pre-illness to hospital discharge) were 4.6% (site range 2.6% to 7.7%) and unadjusted mortality rates were 2.7% (site range 1.3% – 5.0%). Morbidity and mortality were significantly (p<0.001) associated with physiological instability (measured with the PRISM III score) in dichotomous (survival, death) and trichotomous (survival without new morbidity, survival with new morbidity, death) models without covariate adjustments. Morbidity risk increased with increasing PRISM III scores and then decreased at the highest PRISM III values as potential morbidities became mortalities. The trichotomous model with covariate adjustments included age, admission source, diagnostic factors, baseline FSS and the PRISM III score. The three-level goodness of fit test indicated satisfactory performance for the derivation and validation sets (p>0.20). Predictive ability assessed with the volume under the surface (VUS) was 0.50 ± 0.019 (derivation) and 0.50 ± 0.034 (validation) (versus chance performance = 0.17). Site-level standardized morbidity ratios were more variable than standardized mortality ratios. Conclusions New morbidities were associated with physiological status and can be modeled simultaneously with mortality. Trichotomous outcome models including both morbidity and mortality based on physiological status are suitable for research studies, and quality and other outcome assessments. This approach may be applicable to other assessments presently based only on mortality. PMID:25985385

New experimental model for single liver lobe hyperthermia in small animals using non-directional microwaves

PubMed Central

Iliescu, Radu; Dimofte, Gabriel M.

2017-01-01

Purpose Our aim was to develop a new experimental model for in vivo hyperthermia using non-directional microwaves, applicable to small experimental animals. We present an affordable approach for targeted microwave heat delivery to an isolated liver lobe in rat, which allows rapid, precise and stable tissue temperature control. Materials and methods A new experimental model is proposed. We used a commercial available magnetron generating 2450 MHz, with 4.4V and 14A in the filament and 4500V anodic voltage. Modifications were required in order to adjust tissue heating such as to prevent overheating and to allow for fine adjustments according to real-time target temperature. The heating is controlled using a virtual instrument application implemented in LabView® and responds to 0.1° C variations in the target. Ten healthy adult male Wistar rats, weighing 250–270 g were used in this study. The middle liver lobe was the target for controlled heating, while the rest of the living animal was protected. Results In vivo microwave delivery using our experimental setting is safe for the animals. Target tissue temperature rises from 30°C to 40°C with 3.375°C / second (R2 = 0.9551), while the increment is lower it the next two intervals (40–42°C and 42–44°C) with 0.291°C/ s (R2 = 0.9337) and 0.136°C/ s (R2 = 0.7894) respectively, when testing in sequences. After reaching the desired temperature, controlled microwave delivery insures a very stable temperature during the experiments. Conclusions We have developed an inexpensive and easy to manufacture system for targeted hyperthermia using non-directional microwave radiation. This system allows for fine and stable temperature adjustments within the target tissue and is ideal for experimental models testing below or above threshold hyperthermia PMID:28934251

Periconceptional Over-the-Counter Nonsteroidal Anti-inflammatory Drug Exposure and Risk for Spontaneous Abortion

PubMed Central

Velez Edwards, Digna R.; Aldridge, Tiara; Baird, Donna D.; Funk, Michele Jonsson; Savitz, David A.; Hartmann, Katherine E.

2012-01-01

Objective To estimate the association between over-the-counter nonsteroidal anti-inflammatory drug (NSAID) exposure during the early first-trimester and risk for spontaneous abortion (gestation prior to 20 weeks) in a prospective cohort. Methods Women were enrolled in the Right from the Start study (2004–2010). Exposure data regarding over-the-counter NSAID use from the last menstrual period through the 6th week of pregnancy were obtained from intake and first-trimester interviews. Pregnancy outcomes were self-reported and verified by medical records. Gestational age was determined from last menstrual period. Stage of development prior to loss was determined from study ultrasound. Cox proportional hazards regression models were used to estimate the association between NSAID exposure and pregnancy outcome, taking into account candidate confounders. Results Among 2,780 pregnancies, 367 women (13%) experienced an spontaneous abortion. NSAID exposure was reported by 1,185 (43%) women. NSAID exposure was not associated with spontaneous abortion risk in unadjusted models (hazard ratio [HR] = 1.01, 95% confidence interval [CI] 0.82, 1.24) or models adjusted for maternal age (adjusted [aHR] = 1.00, 95% CI 0.81, 1.23). Conclusions Our findings suggest that use of non-prescription over-the-counter NSAIDs in early pregnancy does not put women at increased risk of spontaneous abortion. PMID:22914399

Racial and ethnic disparities in the financial burden of prescription drugs among older Americans.

PubMed

Xu, K Tom; Borders, Tyrone F

2007-01-01

This study examines racial and ethnic disparities in the financial burden of prescription drugs among older Americans using a market and an egalitarian model. A nationally representative data set, the Medical Expenditure Panel Survey 2002, was used. The financial burden of prescription drugs was measured by the out-of-pocket expenditure and proportion. In the market model (utilization adjustment)., utilization was measured at the annual aggregate level by the total number of prescription drugs, the average refills and the average quantity per prescription drug. In the egalitarian model (need adjustment)., health was measured by 15 chronic and costly diseases and the SF-12. Individuals 65 years or older were included. Nationally representative estimates were calculated. Raw racial and ethnic disparities were observed in the bivariate analyses between non-Hispanic whites and Hispanics in the out-of-pocket expenditure and proportion, and between non-Hispanic whites and non-Hispanic blacks in the out-of-pocket proportion. However, these disparities disappeared after controlling for utilization or health needs. Insurance status contributed the most to the disparities in the financial burden of prescription drugs. In conclusion, The disparities in the financial burden of prescription drugs between non-Hispanic elderly whites and Hispanics may be attributable to differences in utilization patterns. However, whether health disparities contribute to disparities in the financial burden of prescription drugs requires studies of specific diseases.

Exposure to air pollution and tobacco smoking and their combined effects on depression in six low- and middle-income countries.

PubMed

Lin, Hualiang; Guo, Yanfei; Kowal, Paul; Airhihenbuwa, Collins O; Di, Qian; Zheng, Yang; Zhao, Xing; Vaughn, Michael G; Howard, Steven; Schootman, Mario; Salinas-Rodriguez, Aaron; Yawson, Alfred E; Arokiasamy, Perianayagam; Manrique-Espinoza, Betty Soledad; Biritwum, Richard B; Rule, Stephen P; Minicuci, Nadia; Naidoo, Nirmala; Chatterji, Somnath; Qian, Zhengmin Min; Ma, Wenjun; Wu, Fan

2017-09-01

Background Little is known about the joint mental health effects of air pollution and tobacco smoking in low- and middle-income countries. Aims To investigate the effects of exposure to ambient fine particulate matter pollution (PM 2.5 ) and smoking and their combined (interactive) effects on depression. Method Multilevel logistic regression analysis of baseline data of a prospective cohort study ( n = 41 785). The 3-year average concentrations of PM 2.5 were estimated using US National Aeronautics and Space Administration satellite data, and depression was diagnosed using a standardised questionnaire. Three-level logistic regression models were applied to examine the associations with depression. Results The odds ratio (OR) for depression was 1.09 (95% C11.01-1.17) per 10 μg/m 3 increase in ambient PM 2.5 , and the association remained after adjusting for potential confounding factors (adjusted OR = 1.10, 95% CI 1.02-1.19). Tobacco smoking (smoking status, frequency, duration and amount) was also significantly associated with depression. There appeared to be a synergistic interaction between ambient PM 2.5 and smoking on depression in the additive model, but the interaction was not statistically significant in the multiplicative model. Conclusions Our study suggests that exposure to ambient PM 2.5 may increase the risk of depression, and smoking may enhance this effect. © The Royal College of Psychiatrists 2017.

Role of Educational Exposure in the Association between Myopia and Birth Order

PubMed Central

Guggenheim, Jeremy A.; Williams, Cathy

2015-01-01

Importance Visual impairment due to myopia is an important public health issue. Recent analysis of population-based cohorts aged 15-22 years-old recruited from the UK and Israel, suggested myopia and high myopia were ~10% more common in first-born compared to later-born children. Objectives To examine whether myopia was associated with birth order in an earlier generation than studied previously, and if so, whether the association was attenuated after adjusting for education exposure, as predicted by the hypothesis that the education of children with later birth orders is less intense. Design, setting, and participants Cross-sectional study of UK Biobank participants recruited from 2006 to 2010. Analysis was restricted to participants 40-69 years-old who had a vision assessment, self-reported ethnicity ‘White’, and no history of eye disorders (N=89,120). Myopia and high myopia were defined as autorefraction <= −0.75D and <= −6.00D, respectively. Exposures Birth order and information on potential confounders including highest educational qualification ascertained using a structured questionnaire. Main Outcome Measures Odds ratio (OR) for myopia and high myopia by birth order, using logistic regression adjusting for age and sex (Model 1), or age, sex, and highest educational qualification (Model 2). Results Model 1 (no adjustment for education): Birth order was associated with both myopia and high myopia, e.g. comparing first versus second born individuals, OR = 1.12 (95% CI 1.08 to 1.16, P=1.4E-11) and OR = 1.21 (95% CI 1.11 to 1.30, P=3.6E-6) for myopia and high myopia, respectively. The risk of myopia became progressively lower for later-birth orders suggesting a dose-response. Model 2 (after adjusting for education): The effect sizes were attenuated by approximately 25%: OR = 1.09 (95% CI 1.05 to 1.12, P=1.3E-6) and OR = 1.15 (95% CI 1.06 to 1.25, P=4.6E-4) for myopia and high myopia, respectively, and the apparent dose-response was abolished. Conclusions and Relevance These data suggest that the association between birth order and myopia is not due to a new environmental pressure in the last 30-40 years. The attenuated effect size after adjusting for educational exposure supports a role for reduced parental investment in education of children with later birth orders in their relative protection from myopia. PMID:26448589

Modeling and Simulation of Hydropower Station Diversion System's characteristic line method by introducing water head to flow feedback

NASA Astrophysics Data System (ADS)

Guangwen, Xu; Xi, Li; Ze, Yao

2018-06-01

To solve the damping problem of water hammer wave in the modeling method of water diversion system of hydropower station, this paper introduces the feedback regulation technology from head to flow, that is: A fixed water head is taken out for flow feedback, and the following conclusions are obtained through modeling and simulation. Adjusting the feedback coefficient F of the water head to the flow rate can change the damping characteristic of the system, which can simulate the attenuation process of the water shock wave in the true water diversion pipeline. Even if a small feedback coefficient is introduced, the damping effect of the system is very obvious, but it has little effect on the amplitude of the first water shock wave after the transition process. Therefore, it is feasible and reasonable to introduce water head to flow rate feedback coefficient F in hydraulic turbine diversion system.

Persistent HIV-related stigma in rural Uganda during a period of increasing HIV incidence despite treatment expansion

PubMed Central

Chan, Brian T.; Weiser, Sheri D.; Boum, Yap; Siedner, Mark J.; Mocello, A. Rain; Haberer, Jessica E.; Hunt, Peter W.; Martin, Jeffrey N.; Mayer, Kenneth H.; Bangsberg, David R.; Tsai, Alexander C.

2014-01-01

Objective Program implementers have argued that the increasing availability of anti-retroviral therapy (ART) will reduce the stigma of HIV. We analyzed data from Uganda to assess how HIV-related stigma has changed during a period of ART expansion. Design Serial cross-sectional surveys. Methods We analyzed data from the Uganda AIDS Rural Treatment Outcomes (UARTO) study during 2007-2012 to estimate trends in internalized stigma among people living with HIV (PLHIV) at the time of treatment initiation. We analyzed data from the Uganda Demographic and Health Surveys (DHS) from 2006 and 2011 to estimate trends in stigmatizing attitudes and anticipated stigma in the general population. We fitted regression models adjusted for socio-demographic characteristics, with year of data collection as the primary explanatory variable. Results We estimated an upward trend in internalized stigma among PLHIV presenting for treatment initiation (adjusted b=0.18; 95% CI, 0.06 to 0.30). In the general population, the odds of reporting anticipated stigma were greater in 2011 compared to 2006 (adjusted OR=1.80; 95% CI, 1.51 to 2.13), despite an apparent decline in stigmatizing attitudes (adjusted OR=0.62; 95% CI, 0.52 to 0.74). Conclusions Internalized stigma has increased over time among PLHIV in the setting of worsening anticipated stigma in the general population. Further study is needed to better understand the reasons for increasing HIV-related stigma in Uganda and its impact on HIV prevention efforts. PMID:25268886

Impact of Preoperative Anaemia and Blood Transfusion on Postoperative Outcomes in Gynaecological Surgery

PubMed Central

Richards, Toby; Musallam, Khaled M.; Nassif, Joseph; Ghazeeri, Ghina; Seoud, Muhieddine; Gurusamy, Kurinchi S.; Jamali, Faek R.

2015-01-01

Objective To evaluate the effect of preoperative anaemia and blood transfusion on 30-day postoperative morbidity and mortality in patients undergoing gynecological surgery. Study Design Data were analyzed from 12,836 women undergoing operation in the American College of Surgeons National Surgical Quality Improvement Program. Outcomes measured were; 30-day postoperative mortality, composite and specific morbidities (cardiac, respiratory, central nervous system, renal, wound, sepsis, venous thrombosis, or major bleeding). Multivariate logistic regression models were performed using adjusted odds ratios (ORadj) to assess the independent effects of preoperative anaemia (hematocrit <36.0%) on outcomes, effect estimates were performed before and after adjustment for perioperative transfusion requirement. Results The prevalence of preoperative anaemia was 23.9% (95%CI: 23.2–24.7). Adjusted for confounders by multivariate logistic regression; preoperative anaemia was independently and significantly associated with increased odds of 30-day mortality (OR: 2.40, 95%CI: 1.06–5.44) and composite morbidity (OR: 1.80, 95%CI: 1.45–2.24). This was reflected by significantly higher adjusted odds of almost all specific morbidities including; respiratory, central nervous system, renal, wound, sepsis, and venous thrombosis. Blood Transfusion increased the effect of preoperative anaemia on outcomes (61% of the effect on mortality and 16% of the composite morbidity). Conclusions Preoperative anaemia is associated with adverse post-operative outcomes in women undergoing gynecological surgery. This risk associated with preoperative anaemia did not appear to be corrected by use of perioperative transfusion. PMID:26147954

Mobility and muscle strength in male former elite endurance and power athletes aged 66-91 years.

PubMed

Manderoos, S; Wasenius, N; Laine, M K; Kujala, U M; Mälkiä, E; Kaprio, J; Sarna, S; Bäckmand, H M; Kettunen, J A; Heinonen, O J; Jula, A M; Aunola, S; Eriksson, J G

2017-11-01

The aim of this cross-sectional study was to compare mobility and muscle strength in male former elite endurance and power athletes aged 66-91 years (n = 150; 50 men in both former elite athlete groups and in their control group). Agility, dynamic balance, walking speed, chair stand, self-rated balance confidence (ABC-scale), jumping height, and handgrip strength were assessed. Former elite power athletes had better agility performance time than the controls (age- and body mass index, BMI-adjusted mean difference -3.6 s; 95% CI -6.3, -0.8). Adjustment for current leisure time physical activity (LTPA) and prevalence of diseases made this difference non-significant (P = 0.214). The subjects in the power sports group jumped higher than the men in the control group (age- and BMI-adjusted mean differences for vertical squat jump, VSJ 4.4 cm; 95% CI 2.0, 6.8; for countermovement jump, CMJ 4.0 cm; 95% CI 1.7, 6.4). Taking current LTPA and chronic diseases for adjusting process did not improve explorative power of the model. No significant differences between the groups were found in the performances evaluating dynamic balance, walking speed, chair stand, ABC-scale, or handgrip strength. In conclusion, power athletes among the aged former elite sportsmen had greater explosive force production in their lower extremities than the men in the control group. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Low Bone Mineral Content and Challenges in Interpretation of Dual-Energy X-Ray Absorptiometry in Children With Mucopolysaccharidosis Types I, II, and VI

PubMed Central

Polgreen, Lynda E.; Thomas, William; Fung, Ellen; Viskochil, David; Stevenson, David A.; Steinberger, Julia; Orchard, Paul; Whitley, Chester B.; Ensrud, Kristine E.

2013-01-01

Osteoporosis has been described in animal models of mucopolysaccharidosis (MPS). Whether clinically significant osteoporosis is common among children with MPS is unknown. Therefore, cross-sectional data from whole body (WB; excluding head) and lumbar spine (LS) bone mineral density (BMD) compared with sex-, chronologic age–, and ethnicity-matched healthy individuals (Zage), height-for-age (HAZ) Z-score (ZHAZ) and bone mineral content (BMC) measured by dual-energy X-ray absorptiometry (DXA) in 40 children with MPS were analyzed. A subset of these children (n = 24) was matched 1:3 by age and sex to a group of healthy children (n = 72) for comparison of BMC adjusted for Tanner stage, race, lean body mass, height, and bone area. Low BMD Z-score was defined as Z-score of −2 or less. In children with MPS, 15% had low WB Zage and 48% had low LS Zage; 0% and 6% had low WB ZHAZ and low LS ZHAZ, respectively. Adjusted WB BMC was lower in MPS participants (p = 0.009). In conclusion, children with MPS had deficits in WB BMC after adjustments for stature and bone area. HAZ adjustment underestimated bone deficits (i.e., overestimated WB BMD Z-scores) in children with MPS likely owing to their abnormal bone shape. The influence of severe short stature and bone geometry on DXA measurements must be considered in children with MPS to avoid unnecessary exposure to antiresorptive treatments. PMID:23562131

What factors contribute to hospital variation in obstetric transfusion rates?

PubMed Central

Patterson, J A; Roberts, C L; Isbister, J P; Irving, D O; Nicholl, M C; Morris, J M; Ford, J B

2015-01-01

Background and Objectives To explore variation in red blood cell transfusion rates between hospitals, and the extent to which this can be explained. A secondary objective was to assess whether hospital transfusion rates are associated with maternal morbidity. Materials and Methods Linked hospital discharge and birth data were used to identify births (n = 279 145) in hospitals with at least 10 deliveries per annum between 2008 and 2010 in New South Wales, Australia. To investigate transfusion rates, a series of random-effects multilevel logistic regression models were fitted, progressively adjusting for maternal, obstetric and hospital factors. Correlations between hospital transfusion and maternal, neonatal morbidity and readmission rates were assessed. Results Overall, the transfusion rate was 1·4% (hospital range 0·6–2·9) across 89 hospitals. Adjusting for maternal casemix reduced the variation between hospitals by 26%. Adjustment for obstetric interventions further reduced variation by 8% and a further 39% after adjustment for hospital type (range 1·1–2·0%). At a hospital level, high transfusion rates were moderately correlated with maternal morbidity (0·59, P = 0·01), but not with low Apgar scores (0·39, P = 0·08), or readmission rates (0·18, P = 0·29). Conclusion Both casemix and practice differences contributed to the variation in transfusion rates between hospitals. The relationship between outcomes and transfusion rates was variable; however, low transfusion rates were not associated with worse outcomes. PMID:25092527

An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan.

PubMed

Chang, Hsien-Yen; Weiner, Jonathan P

2010-01-18

Diagnosis-based risk adjustment is becoming an important issue globally as a result of its implications for payment, high-risk predictive modelling and provider performance assessment. The Taiwanese National Health Insurance (NHI) programme provides universal coverage and maintains a single national computerized claims database, which enables the application of diagnosis-based risk adjustment. However, research regarding risk adjustment is limited. This study aims to examine the performance of the Adjusted Clinical Group (ACG) case-mix system using claims-based diagnosis information from the Taiwanese NHI programme. A random sample of NHI enrollees was selected. Those continuously enrolled in 2002 were included for concurrent analyses (n = 173,234), while those in both 2002 and 2003 were included for prospective analyses (n = 164,562). Health status measures derived from 2002 diagnoses were used to explain the 2002 and 2003 health expenditure. A multivariate linear regression model was adopted after comparing the performance of seven different statistical models. Split-validation was performed in order to avoid overfitting. The performance measures were adjusted R2 and mean absolute prediction error of five types of expenditure at individual level, and predictive ratio of total expenditure at group level. The more comprehensive models performed better when used for explaining resource utilization. Adjusted R2 of total expenditure in concurrent/prospective analyses were 4.2%/4.4% in the demographic model, 15%/10% in the ACGs or ADGs (Aggregated Diagnosis Group) model, and 40%/22% in the models containing EDCs (Expanded Diagnosis Cluster). When predicting expenditure for groups based on expenditure quintiles, all models underpredicted the highest expenditure group and overpredicted the four other groups. For groups based on morbidity burden, the ACGs model had the best performance overall. Given the widespread availability of claims data and the superior explanatory power of claims-based risk adjustment models over demographics-only models, Taiwan's government should consider using claims-based models for policy-relevant applications. The performance of the ACG case-mix system in Taiwan was comparable to that found in other countries. This suggested that the ACG system could be applied to Taiwan's NHI even though it was originally developed in the USA. Many of the findings in this paper are likely to be relevant to other diagnosis-based risk adjustment methodologies.

Hydrological simulation of Sperchios River basin in Central Greece using the MIKE SHE model and geographic information systems

NASA Astrophysics Data System (ADS)

Paparrizos, Spyridon; Maris, Fotios

2017-05-01

The MIKE SHE model is able to simulate the entire stream flow which includes direct and basic flow. Many models either do not simulate or use simplistic methods to determine the basic flow. The MIKE SHE model takes into account many hydrological data. Since this study was directed towards the simulation of surface runoff and infiltration into saturated and unsaturated zone, the MIKE SHE is an appropriate model for reliable conclusions. In the current research, the MIKE SHE model was used to simulate runoff in the area of Sperchios River basin. Meteorological data from eight rainfall stations within the Sperchios River basin were used as inputs. Vegetation as well as geological data was used to perform the calibration and validation of the physical processes of the model. Additionally, ArcGIS program was used. The results indicated that the model was able to simulate the surface runoff satisfactorily, representing all the hydrological data adequately. Some minor differentiations appeared which can be eliminated with the appropriate adjustments that can be decided by the researcher's experience.

A Severe Sepsis Mortality Prediction Model and Score for Use with Administrative Data

PubMed Central

Ford, Dee W.; Goodwin, Andrew J.; Simpson, Annie N.; Johnson, Emily; Nadig, Nandita; Simpson, Kit N.

2016-01-01

Objective Administrative data is used for research, quality improvement, and health policy in severe sepsis. However, there is not a sepsis-specific tool applicable to administrative data with which to adjust for illness severity. Our objective was to develop, internally validate, and externally validate a severe sepsis mortality prediction model and associated mortality prediction score. Design Retrospective cohort study using 2012 administrative data from five US states. Three cohorts of patients with severe sepsis were created: 1) ICD-9-CM codes for severe sepsis/septic shock, 2) ‘Martin’ approach, and 3) ‘Angus’ approach. The model was developed and internally validated in ICD-9-CM cohort and externally validated in other cohorts. Integer point values for each predictor variable were generated to create a sepsis severity score. Setting Acute care, non-federal hospitals in NY, MD, FL, MI, and WA Subjects Patients in one of three severe sepsis cohorts: 1) explicitly coded (n=108,448), 2) Martin cohort (n=139,094), and 3) Angus cohort (n=523,637) Interventions None Measurements and Main Results Maximum likelihood estimation logistic regression to develop a predictive model for in-hospital mortality. Model calibration and discrimination assessed via Hosmer-Lemeshow goodness-of-fit (GOF) and C-statistics respectively. Primary cohort subset into risk deciles and observed versus predicted mortality plotted. GOF demonstrated p>0.05 for each cohort demonstrating sound calibration. C-statistic ranged from low of 0.709 (sepsis severity score) to high of 0.838 (Angus cohort) suggesting good to excellent model discrimination. Comparison of observed versus expected mortality was robust although accuracy decreased in highest risk decile. Conclusions Our sepsis severity model and score is a tool that provides reliable risk adjustment for administrative data. PMID:26496452

The Dutch Hospital Standardised Mortality Ratio (HSMR) method and cardiac surgery: benchmarking in a national cohort using hospital administration data versus a clinical database

PubMed Central

Siregar, S; Pouw, M E; Moons, K G M; Versteegh, M I M; Bots, M L; van der Graaf, Y; Kalkman, C J; van Herwerden, L A; Groenwold, R H H

2014-01-01

Objective To compare the accuracy of data from hospital administration databases and a national clinical cardiac surgery database and to compare the performance of the Dutch hospital standardised mortality ratio (HSMR) method and the logistic European System for Cardiac Operative Risk Evaluation, for the purpose of benchmarking of mortality across hospitals. Methods Information on all patients undergoing cardiac surgery between 1 January 2007 and 31 December 2010 in 10 centres was extracted from The Netherlands Association for Cardio-Thoracic Surgery database and the Hospital Discharge Registry. The number of cardiac surgery interventions was compared between both databases. The European System for Cardiac Operative Risk Evaluation and hospital standardised mortality ratio models were updated in the study population and compared using the C-statistic, calibration plots and the Brier-score. Results The number of cardiac surgery interventions performed could not be assessed using the administrative database as the intervention code was incorrect in 1.4–26.3%, depending on the type of intervention. In 7.3% no intervention code was registered. The updated administrative model was inferior to the updated clinical model with respect to discrimination (c-statistic of 0.77 vs 0.85, p<0.001) and calibration (Brier Score of 2.8% vs 2.6%, p<0.001, maximum score 3.0%). Two average performing hospitals according to the clinical model became outliers when benchmarking was performed using the administrative model. Conclusions In cardiac surgery, administrative data are less suitable than clinical data for the purpose of benchmarking. The use of either administrative or clinical risk-adjustment models can affect the outlier status of hospitals. Risk-adjustment models including procedure-specific clinical risk factors are recommended. PMID:24334377

Reproductive Risk Factors and Coronary Heart Disease in the Women’s Health Initiative Observational Study

PubMed Central

Parikh, Nisha I.; Jeppson, Rebecca P.; Berger, Jeffrey S.; Eaton, Charles B.; Kroenke, Candyce H.; LeBlanc, Erin S.; Lewis, Cora E.; Loucks, Eric B.; Parker, Donna R.; Rillamas-Sun, Eileen; Ryckman, Kelli K; Waring, Molly E.; Schenken, Robert S.; Johnson, Karen C; Edstedt-Bonamy, Anna-Karin; Allison, Matthew A.; Howard, Barbara V.

2016-01-01

Background Reproductive factors provide an early window into a woman’s coronary heart disease (CHD) risk, however their contribution to CHD risk stratification is uncertain. Methods and Results In the Women’s Health Initiative Observational Study, we constructed Cox proportional hazards models for CHD including age, pregnancy status, number of live births, age at menarche, menstrual irregularity, age at first birth, stillbirths, miscarriages, infertility ≥ 1 year, infertility cause, and breastfeeding. We next added each candidate reproductive factor to an established CHD risk factor model. A final model was then constructed with significant reproductive factors added to established CHD risk factors. Improvement in C-statistic, net reclassification index (or NRI with risk categories of <5%, 5–<10%, and ≥10% 10-year risk of CHD) and integrated discriminatory index (IDI) were assessed. Among 72,982 women [n=4607 CHD events, median follow-up=12.0 (IQR=8.3–13.7) years, mean (SD) age 63.2 (7.2) years], an age-adjusted reproductive risk factor model had a C-statistic of 0.675 for CHD. In a model adjusted for established CHD risk factors, younger age at first birth, number of still births, number of miscarriages and lack of breastfeeding were positively associated with CHD. Reproductive factors modestly improved model discrimination (C-statistic increased from 0.726 to 0.730; IDI=0.0013, p-value < 0.0001). Net reclassification for women with events was not improved (NRI events=0.007, p-value=0.18); and for women without events was marginally improved (NRI non-events=0.002, p-value=0.04) Conclusions Key reproductive factors are associated with CHD independently of established CHD risk factors, very modestly improve model discrimination and do not materially improve net reclassification. PMID:27143682

Improving the Process of Adjusting the Parameters of Finite Element Models of Healthy Human Intervertebral Discs by the Multi-Response Surface Method.

PubMed

Gómez, Fátima Somovilla; Lorza, Rubén Lostado; Bobadilla, Marina Corral; García, Rubén Escribano

2017-09-21

The kinematic behavior of models that are based on the finite element method (FEM) for modeling the human body depends greatly on an accurate estimate of the parameters that define such models. This task is complex, and any small difference between the actual biomaterial model and the simulation model based on FEM can be amplified enormously in the presence of nonlinearities. The current paper attempts to demonstrate how a combination of the FEM and the MRS methods with desirability functions can be used to obtain the material parameters that are most appropriate for use in defining the behavior of Finite Element (FE) models of the healthy human lumbar intervertebral disc (IVD). The FE model parameters were adjusted on the basis of experimental data from selected standard tests (compression, flexion, extension, shear, lateral bending, and torsion) and were developed as follows: First, three-dimensional parameterized FE models were generated on the basis of the mentioned standard tests. Then, 11 parameters were selected to define the proposed parameterized FE models. For each of the standard tests, regression models were generated using MRS to model the six stiffness and nine bulges of the healthy IVD models that were created by changing the parameters of the FE models. The optimal combination of the 11 parameters was based on three different adjustment criteria. The latter, in turn, were based on the combination of stiffness and bulges that were obtained from the standard test FE simulations. The first adjustment criteria considered stiffness and bulges to be equally important in the adjustment of FE model parameters. The second adjustment criteria considered stiffness as most important, whereas the third considered the bulges to be most important. The proposed adjustment methods were applied to a medium-sized human IVD that corresponded to the L3-L4 lumbar level with standard dimensions of width = 50 mm, depth = 35 mm, and height = 10 mm. Agreement between the kinematic behavior that was obtained with the optimized parameters and that obtained from the literature demonstrated that the proposed method is a powerful tool with which to adjust healthy IVD FE models when there are many parameters, stiffnesses, and bulges to which the models must adjust.

Improving the Process of Adjusting the Parameters of Finite Element Models of Healthy Human Intervertebral Discs by the Multi-Response Surface Method

PubMed Central

Somovilla Gómez, Fátima

2017-01-01

The kinematic behavior of models that are based on the finite element method (FEM) for modeling the human body depends greatly on an accurate estimate of the parameters that define such models. This task is complex, and any small difference between the actual biomaterial model and the simulation model based on FEM can be amplified enormously in the presence of nonlinearities. The current paper attempts to demonstrate how a combination of the FEM and the MRS methods with desirability functions can be used to obtain the material parameters that are most appropriate for use in defining the behavior of Finite Element (FE) models of the healthy human lumbar intervertebral disc (IVD). The FE model parameters were adjusted on the basis of experimental data from selected standard tests (compression, flexion, extension, shear, lateral bending, and torsion) and were developed as follows: First, three-dimensional parameterized FE models were generated on the basis of the mentioned standard tests. Then, 11 parameters were selected to define the proposed parameterized FE models. For each of the standard tests, regression models were generated using MRS to model the six stiffness and nine bulges of the healthy IVD models that were created by changing the parameters of the FE models. The optimal combination of the 11 parameters was based on three different adjustment criteria. The latter, in turn, were based on the combination of stiffness and bulges that were obtained from the standard test FE simulations. The first adjustment criteria considered stiffness and bulges to be equally important in the adjustment of FE model parameters. The second adjustment criteria considered stiffness as most important, whereas the third considered the bulges to be most important. The proposed adjustment methods were applied to a medium-sized human IVD that corresponded to the L3–L4 lumbar level with standard dimensions of width = 50 mm, depth = 35 mm, and height = 10 mm. Agreement between the kinematic behavior that was obtained with the optimized parameters and that obtained from the literature demonstrated that the proposed method is a powerful tool with which to adjust healthy IVD FE models when there are many parameters, stiffnesses, and bulges to which the models must adjust. PMID:28934161

On the hydrologic adjustment of climate-model projections: The potential pitfall of potential evapotranspiration

USGS Publications Warehouse

Milly, P.C.D.; Dunne, K.A.

2011-01-01

Hydrologic models often are applied to adjust projections of hydroclimatic change that come from climate models. Such adjustment includes climate-bias correction, spatial refinement ("downscaling"), and consideration of the roles of hydrologic processes that were neglected in the climate model. Described herein is a quantitative analysis of the effects of hydrologic adjustment on the projections of runoff change associated with projected twenty-first-century climate change. In a case study including three climate models and 10 river basins in the contiguous United States, the authors find that relative (i.e., fractional or percentage) runoff change computed with hydrologic adjustment more often than not was less positive (or, equivalently, more negative) than what was projected by the climate models. The dominant contributor to this decrease in runoff was a ubiquitous change in runoff (median 211%) caused by the hydrologic model's apparent amplification of the climate-model-implied growth in potential evapotranspiration. Analysis suggests that the hydrologic model, on the basis of the empirical, temperature-based modified Jensen-Haise formula, calculates a change in potential evapotranspiration that is typically 3 times the change implied by the climate models, which explicitly track surface energy budgets. In comparison with the amplification of potential evapotranspiration, central tendencies of other contributions from hydrologic adjustment (spatial refinement, climate-bias adjustment, and process refinement) were relatively small. The authors' findings highlight the need for caution when projecting changes in potential evapotranspiration for use in hydrologic models or drought indices to evaluate climatechange impacts on water. Copyright ?? 2011, Paper 15-001; 35,952 words, 3 Figures, 0 Animations, 1 Tables.

The Effect of State Regulatory Stringency on Nursing Home Quality

PubMed Central

Mukamel, Dana B; Weimer, David L; Harrington, Charlene; Spector, William D; Ladd, Heather; Li, Yue

2012-01-01

Objective To test the hypothesis that more stringent quality regulations contribute to better quality nursing home care and to assess their cost-effectiveness. Data Sources/Setting Primary and secondary data from all states and U.S. nursing homes between 2005 and 2006. Study Design We estimated seven models, regressing quality measures on the Harrington Regulation Stringency Index and control variables. To account for endogeneity between regulation and quality, we used instrumental variables techniques. Quality was measured by staffing hours by type per case-mix adjusted day, hotel expenditures, and risk-adjusted decline in activities of daily living, high-risk pressure sores, and urinary incontinence. Data Collection All states' licensing and certification offices were surveyed to obtain data about deficiencies. Secondary data included the Minimum Data Set, Medicare Cost Reports, and the Economic Freedom Index. Principal Findings Regulatory stringency was significantly associated with better quality for four of the seven measures studied. The cost-effectiveness for the activities-of-daily-living measure was estimated at about 72,000 in 2011/ Quality Adjusted Life Year. Conclusions Quality regulations lead to better quality in nursing homes along some dimensions, but not all. Our estimates of cost-effectiveness suggest that increased regulatory stringency is in the ballpark of other acceptable cost-effective practices. PMID:22946859

Effects of Residential Indoor Air Quality and Household Ventilation on Preterm Birth and Term Low Birth Weight in Los Angeles County, California

PubMed Central

Wilhelm, Michelle; Ritz, Beate

2013-01-01

Objectives. The purpose of our study was to examine the effects of indoor residential air quality on preterm birth and term low birth weight (LBW). Methods. We evaluated 1761 nonsmoking women from a case-control survey of mothers who delivered a baby in 2003 in Los Angeles County, California. In multinomial logistic regression models adjusted for maternal age, education, race/ethnicity, parity and birthplace, we evaluated the effects of living with smokers or using personal or household products that may contain volatile organic compounds and examined the influence of household ventilation. Results. Compared with unexposed mothers, women exposed to secondhand smoke (SHS) at home had increased odds of term LBW (adjusted odds ratio [OR] = 1.36; 95% confidence interval [CI] =  0.85, 2.18) and preterm birth (adjusted OR = 1.27; 95% CI = 0.95, 1.70), although 95% CIs included the null. No increase in risk was observed for SHS-exposed mothers reporting moderate or high window ventilation. Associations were also observed for product usage, but only for women reporting low or no window ventilation. Conclusions. Residential window ventilation may mitigate the effects of indoor air pollution among pregnant women in Los Angeles County, California. PMID:23409879

Previous Violent Events and Mental Health Outcomes in Guatemala

PubMed Central

Puac-Polanco, Victor D.; Lopez-Soto, Victor A.; Kohn, Robert; Xie, Dawei; Richmond, Therese S.

2015-01-01

Objectives. We analyzed a probability sample of Guatemalans to determine if a relationship exists between previous violent events and development of mental health outcomes in various sociodemographic groups, as well as during and after the Guatemalan Civil War. Methods. We used regression modeling, an interaction test, and complex survey design adjustments to estimate prevalences and test potential relationships between previous violent events and mental health. Results. Many (20.6%) participants experienced at least 1 previous serious violent event. Witnessing someone severely injured or killed was the most common event. Depression was experienced by 4.2% of participants, with 6.5% experiencing anxiety, 6.4% an alcohol-related disorder, and 1.9% posttraumatic stress disorder (PTSD). Persons who experienced violence during the war had 4.3 times the adjusted odds of alcohol-related disorders (P < .05) and 4.0 times the adjusted odds of PTSD (P < .05) compared with the postwar period. Women, indigenous Maya, and urban dwellers had greater odds of experiencing postviolence mental health outcomes. Conclusions. Violence that began during the civil war and continues today has had a significant effect on the mental health of Guatemalans. However, mental health outcomes resulting from violent events decreased in the postwar period, suggesting a nation in recovery. PMID:25713973

Dogmatism and Happiness

PubMed Central

MALMIR, Maryam; KHANAHMADI, Mohammad; FARHUD, Dariush

2017-01-01

Background: Happiness is a drive and constructive force of life. A person feels wellbeing under different effective factors. Religious dogmatism that has an influence on the entire world is one of the depreciatory factors of happiness or wellbeing. The current study decided to analyze the relation between dogmatism and wellbeing, and according to a model, answer the following question: how does religious dogmatism decrease wellbeing? Methods: This study is a correlation research. Population of study includes all people with 30–50 yr old who live in Tehran, Iran, in 2015. Among all, 180 subjects were selected as in access sample. The Oxford happiness questionnaire and Rokeach dogmatism scale were used. Data were analyzed by Pearson correlation test. Results: There is a significant negative correlation between dogmatism and happiness (α=0.05). Conclusion: Dogmatism is one of the factors that have a negative effect on wellbeing. Religious dogmatism is the most dangerous factor against wellbeing. Dogmatic individuals have an inflexible cognitive system that emerges as a stable personality trait and decreases their adjustment with environment. Affective well-being and cognitive wellbeing are affected by individual adjustment. Therefore, in dogmatic individuals with low adjustment, the decrease of affective well-being and cognitive wellbeing is inevitable. This process will result in decrease of happiness and increase of aggression. PMID:28435818

Consumption of Soft Drinks and Hyperactivity, Mental Distress, and Conduct Problems Among Adolescents in Oslo, Norway

PubMed Central

Lien, Lars; Lien, Nanna; Heyerdahl, Sonja; Thoresen, Magne; Bjertness, Espen

2006-01-01

Objectives. We examined whether high levels of consumption of sugar-containing soft drinks were associated with mental distress, hyperactivity, and conduct problems among adolescents. Methods. A cross-sectional population-based survey was conducted with 10th-grade students in Oslo, Norway (n = 5498). We used the Hopkins Symptom Checklist and the Strengths and Difficulties Questionnaire to assess mental health outcomes. Results. There was a J-shaped dose–response relationship between soft drink consumption and mental distress, conduct problems, and total mental health difficulties score; that is, adolescents who did not consume soft drinks had higher scores (indicating worse symptoms) than those who consumed soft drinks at moderate levels but lower scores than those with high consumption levels. The relationship was linear for hyperactivity. In a logistic regression model, the association between soft drink consumption and mental health problems remained significant after adjustment for behavioral, social, and food-related variables. The highest adjusted odds ratios were observed for conduct problems among boys and girls who consumed 4 or more glasses of sugar-containing soft drinks per day. Conclusions. High consumption levels of sugar-containing soft drinks were associated with mental health problems among adolescents even after adjustment for possible confounders. PMID:17008578

Effects of Age at First Childbirth and Other Factors on Central Obesity in Postmenopausal Women: The 2013–2015 Korean National Health and Nutrition Examination Survey

PubMed Central

Lee, Wang Jin; Lee, Joo Ha; Kwag, Byoung Gyu; Chang, Shin Hae; Choi, Yu Jin

2018-01-01

Background Waist circumference is one of the key components of metabolic syndrome. Recent studies demonstrated that the reproductive profile was associated with metabolic syndrome in postmenopausal women. This study focused on the association between central obesity and age at first childbirth. It also considered other factors associated with central obesity in postmenopausal women. Methods This study was based on the 2013–2015 Korean National Health and Nutrition Examination Survey and involved 3,143 naturally postmenopausal women. These women were divided into three groups according to their age at first childbirth: 19 years or younger (n=252), 20–29 years (n=2,695), and 30 years or older (n=196). Multivariate analysis using logistic regression was performed to evaluate the effects of various reproductive factors, including other confounding factors. Results During adjustment for confounding factors, in the early age at first childbirth group, odds ratios (95% confidence intervals) for central obesity decreased. In the final model, younger age at first childbirth was not significantly related to central obesity (waist circumference more than 85 cm) in naturally postmenopausal women after adjusting for other confounding factors. Conclusion Younger age at first childbirth was not significantly associated with central obesity after adjustment for confounding factors. PMID:29788703

Drugs to Treat Systemic Lupus Erythematosus: Relationship between Current Use and Cardiovascular Risk Factors

PubMed Central

Rho, Young Hee; Oeser, Annette; Chung, Cecilia P; Morrow, Jason D; Stein, C Michael

2008-01-01

Objectives Cardiovascular risk is increased in patients with systemic lupus erythematosus (SLE). Drugs used to treat SLE can modify traditional cardiovascular risk factors. We examined the effect of selected drugs used in the treatment of SLE on cardiovascular risk factors. Methods We compared systolic and diastolic blood pressure, serum lipid concentrations, glucose, homocysteine, and urinary F2-isoprostane concentrations in 99 patients with lupus who were either current users or non-users of systemic corticosteroids, antimalarials, non-steroidal anti-inflammatory drugs (NSAIDs), COX-2 selective NSAIDs, azathioprine, and methotrexate. Multivariable adjustment was done with linear regression modeling using sex, age and disease activity (SLEDAI) as controlling variables. Results Serum triglyceride concentrations were higher (135.1 ± 61.4 vs. 95.3 ± 47.5 mg/dL, adjusted P = 0.003) in patients receiving corticosteroids. Homocysteine concentrations were marginally higher in patients receiving methotrexate (adjusted P = 0.08). Current use of either NSAIDs or COX-2 inhibitors was not associated with increased cardiovascular risk factors. Current hydroxychloroquine use was not associated with significant alterations in lipid profiles. Conclusions In a non-random sample of patients with SLE, current corticosteroid use was associated with increased triglyceride concentrations, but other drugs had little effect on traditional cardiovascular risk factors. PMID:20157365

Longitudinal impacts of pubertal timing and weight status on adolescent Internet use: Analysis from a cohort study of Taiwanese youths

PubMed Central

Strong, Carol; Chen, Wan-Ting; Lee, Chih-Ting; Lin, Chung-Ying

2018-01-01

Aim To investigate the longitudinal impacts of pubertal timing and weight status on Internet use in adolescents. Methods Three waves of data on a longitudinal cohort of 7th grade students (N = 2430) were retrieved from the Taiwan Youth Project. Univariate and multivariate regression models were applied using crude and adjusted odds ratios (OR) with 95% confidence intervals (CI) to examine the concomitant impacts of pubertal timing and weight status on adolescent Internet use. Results The dataset identified 210 (8.7%) students using the Internet for more than 20 hours/week, and 81 (3.3%) were viewing pornographic material online. Early maturing and thin-weight adolescents were at 35% and 46% increased risks of spending long hours on Internet use, respectively. While early puberty was associated with online pornography viewing among males (adjusted OR 1.84, 95% CI 1.04–3.28), early puberty was contrarily a protective factor against online gaming in females (adjusted OR 0.59, 95% CI 0.36–0.96). Conclusion Early puberty was found to be positively related to adolescent Internet use. Appropriate health education and guidance regarding Internet use should be provided to those with different developing needs. PMID:29795649

Interleukin-6 is associated with cognitive function: the Northern Manhattan Study

PubMed Central

Wright, C.B.; Sacco, R.L.; Rundek, T.R.; Delman, J.B.; Rabbani, L.E.; Elkind, M.S.V.

2006-01-01

Background and purpose Inflammation has been linked to cognitive decline and dementia but the mechanism is not clear and few studies have included Hispanic and black subjects that may be at increased risk of these disorders. Methods We performed a cross-sectional analysis of the association between inflammatory marker levels and cognition in the stroke-free population-based cohort of the Northern Manhattan Study. Mini Mental State Exam (MMSE) scores were the continuous outcome and we adjusted for sociodemographic and vascular risk factors as well as subclinical atherosclerosis. Results Of the inflammatory markers, only interleukin (IL)-6 levels were associated with the MMSE. In univariate analysis age, hypertension, diabetes, smoking, moderate alcohol use, total homocysteine, carotid intima media thickness, and body mass index were positively associated with IL-6 levels. Hispanics compared to whites, those with less than a high school education, hypertension, cardiac disease, and total homocysteine were associated with lower MMSE scores. In a multivariate linear regression model, IL-6 was negatively associated with MMSE score adjusting for sociodemographic and vascular risk factors. Conclusions IL-6 levels were negatively associated with performance on the MMSE in this multiethnic cohort. Adjusting for vascular disease and subclinical atherosclerosis did not attenuate the association, suggesting a direct effect on the brain. PMID:16501663

Children's longing for everydayness: life following traumatic brain injury in the USA

PubMed Central

Roscigno, Cecelia I.; Swanson, Kristen M.; Vavilala, Monica S.; Solchany, JoAnne

2012-01-01

Primary Objective Little is known about life after traumatic brain injury (TBI) from the child's perspective. Research Design This descriptive phenomenological investigation explored themes of children's experiences following moderate to severe TBI. Methods and Procedures Inclusion criteria: 1) 6 – 18 years of age at injury; 2) moderate to severe TBI; 3) ≤ 3 years since injury; and 4) English speaking and could participate in an interview. Children participated (N = 39) in two interviews at least one year apart. A preliminary model was developed and shared for participants' input. Main Outcomes and Results Six themes emerged: 1) it is like waking up in a bad dream; 2) I thought going home would get me back to my old life, but it did not; 3) everything is such hard work; 4) you feel like you will never be like the person you were before; 5) it is not all bad; and 6) some people get it, but many people do not. Conclusions Social support was important to how children adjusted to changes or losses. Most children did adjust to functional changes by second interviews. Children had a more difficult time adjusting to how others defined them and limited their possibilities for a meaningful life. PMID:21631183

Multilevel latent class casemix modelling: a novel approach to accommodate patient casemix

PubMed Central

2011-01-01

Background Using routinely collected patient data we explore the utility of multilevel latent class (MLLC) models to adjust for patient casemix and rank Trust performance. We contrast this with ranks derived from Trust standardised mortality ratios (SMRs). Methods Patients with colorectal cancer diagnosed between 1998 and 2004 and resident in Northern and Yorkshire regions were identified from the cancer registry database (n = 24,640). Patient age, sex, stage-at-diagnosis (Dukes), and Trust of diagnosis/treatment were extracted. Socioeconomic background was derived using the Townsend Index. Outcome was survival at 3 years after diagnosis. MLLC-modelled and SMR-generated Trust ranks were compared. Results Patients were assigned to two classes of similar size: one with reasonable prognosis (63.0% died within 3 years), and one with better prognosis (39.3% died within 3 years). In patient class one, all patients diagnosed at stage B or C died within 3 years; in patient class two, all patients diagnosed at stage A, B or C survived. Trusts were assigned two classes with 51.3% and 53.2% of patients respectively dying within 3 years. Differences in the ranked Trust performance between the MLLC model and SMRs were all within estimated 95% CIs. Conclusions A novel approach to casemix adjustment is illustrated, ranking Trust performance whilst facilitating the evaluation of factors associated with the patient journey (e.g. treatments) and factors associated with the processes of healthcare delivery (e.g. delays). Further research can demonstrate the value of modelling patient pathways and evaluating healthcare processes across provider institutions. PMID:21362172

Mediators of the Association of Major Depressive Syndrome and Anxiety Syndrome with Postpartum Smoking Relapse

PubMed Central

Correa-Fernández, Virmarie; Ji, Lingyun; Castro, Yessenia; Heppner, Whitney L.; Vidrine, Jennifer Irvin; Costello, Tracy J.; Mullen, Patricia Dolan; Cofta-Woerpel, Ludmila; Velasquez, Mary M.; Greisinger, Anthony; Cinciripini, Paul M.; Wetter, David W.

2012-01-01

Objective Based on conceptual models of addiction and affect regulation, this study examined the mechanisms linking current major depressive syndrome (MDS) and anxiety syndrome (AS) to postpartum smoking relapse. Method Data were collected in a randomized clinical trial from 251 women who quit smoking during pregnancy. Simple and multiple mediation models of the relations of MDS and AS with postpartum relapse were examined using linear regression, continuation ratio logit models, and a Bootstrapping procedure to test the indirect effects. Results Both MDS and AS significantly predicted postpartum smoking relapse. After adjusting for MDS, AS significantly predicted relapse. However, after adjusting for AS, MDS no longer predicted relapse. Situationally-based self-efficacy, expectancies of controlling negative affect by means other than smoking, and various dimensions of primary and secondary tobacco dependence individually mediated the effect of both MDS and AS on relapse. In multiple mediation models, self-efficacy in negative/affective situations significantly mediated the effect of MDS and AS on relapse. Conclusion The findings underscore the negative impact of depression and anxiety on postpartum smoking relapse, and suggest that the effects of MDS on postpartum relapse may be largely explained by comorbid AS. The current investigation provided mixed support for affect regulation models of addiction. Cognitive and tobacco dependence-related aspects of negative and positive reinforcement significantly mediated the relationship of depression and anxiety with relapse, while affect and stress did not. The findings emphasize the unique role of low agency with respect to abstaining from smoking in negative affective situations as a key predictor of postpartum smoking relapse. PMID:22390410

Predicting cost of care using self-reported health status data.

PubMed

Boscardin, Christy K; Gonzales, Ralph; Bradley, Kent L; Raven, Maria C

2015-09-23

We examined whether self-reported employee health status data can improve the performance of administrative data-based models for predicting future high health costs, and develop a predictive model for predicting new high cost individuals. This retrospective cohort study used data from 8,917 Safeway employees self-insured by Safeway during 2008 and 2009. We created models using step-wise multivariable logistic regression starting with health services use data, then socio-demographic data, and finally adding the self-reported health status data to the model. Adding self-reported health data to the baseline model that included only administrative data (health services use and demographic variables; c-statistic = 0.63) increased the model" predictive power (c-statistic = 0.70). Risk factors associated with being a new high cost individual in 2009 were: 1) had one or more ED visits in 2008 (adjusted OR: 1.87, 95 % CI: 1.52, 2.30), 2) had one or more hospitalizations in 2008 (adjusted OR: 1.95, 95 % CI: 1.38, 2.77), 3) being female (adjusted OR: 1.34, 95 % CI: 1.16, 1.55), 4) increasing age (compared with age 18-35, adjusted OR for 36-49 years: 1.28; 95 % CI: 1.03, 1.60; adjusted OR for 50-64 years: 1.92, 95 % CI: 1.55, 2.39; adjusted OR for 65+ years: 3.75, 95 % CI: 2.67, 2.23), 5) the presence of self-reported depression (adjusted OR: 1.53, 95 % CI: 1.29, 1.81), 6) chronic pain (adjusted OR: 2.22, 95 % CI: 1.81, 2.72), 7) diabetes (adjusted OR: 1.73, 95 % CI: 1.35, 2.23), 8) high blood pressure (adjusted OR: 1.42, 95 % CI: 1.21, 1.67), and 9) above average BMI (adjusted OR: 1.20, 95 % CI: 1.04, 1.38). The comparison of the models between the full sample and the sample without theprevious high cost members indicated significant differences in the predictors. This has importantimplications for models using only the health service use (administrative data) given that the past high costis significantly correlated with future high cost and often drive the predictive models. Self-reported health data improved the ability of our model to identify individuals at risk for being high cost beyond what was possible with administrative data alone.

Effect of Tubal Sterilization Technique on Risk of Serous Ovarian and Primary Peritoneal Carcinoma

PubMed Central

LESSARD-ANDERSON, Collette R.; HANDLOGTEN, Kathryn S.; MOLITOR, Rochelle J.; DOWDY, Sean C.; CLIBY, William A.; WEAVER, Amy L.; SAUVER, Jennifer ST.; BAKKUM-GAMEZ, Jamie N.

2014-01-01

Objective To determine the effect of excisional tubal sterilization on subsequent development of serous epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC). Methods We performed a population-based, nested case-control study using the Rochester Epidemiology Project. We identified all patients with a diagnosis of serous EOC or PPC from 1966 through 2009. Each case was age-matched to 2 controls without either diagnosis. Odds ratios (ORs) and corresponding 95% CIs were estimated from conditional logistic regression models. Models were adjusted for prior hysterectomy, prior salpingo-oophorectomy, oral contraceptive use, endometriosis, infertility, gravidity, and parity. Results In total, we identified 194 cases of serous EOC and PPC during the study period and matched them with 388 controls (mean [SD] age, 61.4 [15.2] years). Fourteen cases (7.2%) and 46 controls (11.9%) had undergone tubal sterilization. Adjusted risk of serous EOC or PPC was slightly lower after any tubal sterilization (OR, 0.59 [95% CI, 0.29–1.17]; P=.13). The rate of excisional tubal sterilization was lower in cases than controls (2.6% vs 6.4%). Adjusted risk of serous EOC and PPC was decreased by 64% after excisional tubal sterilization (OR, 0.36 [95% CI, 0.13–1.02]; P=.054) compared with those without sterilization or with nonexcisional tubal sterilization. Conclusions We present a population-based investigation of the effects of excisional tubal sterilization on the risk of serous EOC and PPC. Excisional methods may confer greater risk reduction than other sterilization methods. PMID:25316178

A Cluster Randomized Trial of Tailored Breastfeeding Support for Women with Gestational Diabetes

PubMed Central

Bonuck, Karen; Adatorwovor, Reuben; Schwartz, Todd A.; Berry, Diane C.

2016-01-01

Abstract Background: Women with gestational diabetes mellitus (GDM) and their infants are at increased risk of developing metabolic disease; however, longer breastfeeding is associated with a reduction in these risks. We tested an intervention to increase breastfeeding duration among women with GDM. Materials and Methods: We conducted a cluster randomized trial to determine the efficacy of a breastfeeding education and support program for women with GDM. Women were enrolled between 22 and 36 weeks of pregnancy and cluster randomized to an experimental lifestyle intervention or wait-list control group. Breastfeeding duration and intensity were prespecified secondary outcomes of the trial. Duration of exclusive and any breastfeeding was assessed at 6 weeks and at 4, 7, and 10 months postpartum. We quantified differences in breastfeeding rates using Kaplan–Meier estimates, log-rank tests, and Cox regression models. Results: We enrolled 100 women, of whom 52% were African American, 31% non-Hispanic white, 11% Hispanic, 9% American Indian or Alaskan Native, 2% Asian, 2% other, and 4% more than one race. In models accounting for within-cluster correlation and adjusted for study site, breastfeeding intention, and African American race, women allocated to the intervention group were less likely to stop breastfeeding (adjusted hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.21–0.74) or to introduce formula (adjusted HR 0.50, 95% CI 0.34–0.72). Conclusion: Our results suggest that targeted breastfeeding education for women with GDM is feasible and efficacious. Clinical Trials Registration: http://clinicaltrials.gov/ct2/show/NCT01809431 PMID:27782758

Combination Antiretroviral Use and Preterm Birth

PubMed Central

Watts, D. Heather; Williams, Paige L.; Kacanek, Deborah; Griner, Raymond; Rich, Kenneth; Hazra, Rohan; Mofenson, Lynne M.; Mendez, Hermann A.

2013-01-01

Background. Use of antiretroviral drugs (ARVs) during pregnancy has been associated with higher risk of preterm birth. Methods. The Pediatric HIV/AIDS Cohort Study network's Surveillance Monitoring for ART Toxicities study is a US-based cohort of human immunodeficiency virus (HIV)–exposed uninfected children. We evaluated maternal ARV use during pregnancy and the risk of any type of preterm birth (ie, birth before 37 completed weeks of gestation), the risk of spontaneous preterm birth (ie, preterm birth that occurred after preterm labor or membrane rupture, without other complications), and the risk of small for gestational age (SGA; ie, a birth weight of <10th percentile for gestational age). Multivariable logistic regression models were used to evaluate the association of ARVs and timing of exposure, while adjusting for maternal characteristics. Results. Among 1869 singleton births, 18.6% were preterm, 10.2% were spontaneous preterm, and 7.3% were SGA. A total of 89% used 3-drug combination ARV regimens during pregnancy. In adjusted models, the odds of preterm birth and spontaneous preterm birth were significantly greater among mothers who used protease inhibitors during the first trimester (adjusted odds ratios, 1.55 and 1.59, respectively) but not among mothers who used nonnucleoside reverse-transcriptase inhibitor or triple-nucleoside regimens during the first trimester. Combination ARV exposure starting later in pregnancy was not associated with increased risk. No associations were observed between SGA and exposure to combination ARV regimens. Conclusions. Protease inhibitor use early in pregnancy may be associated with increased risk for prematurity. PMID:23204173

Menopause and risk of diabetes in the Diabetes Prevention Program

PubMed Central

Kim, Catherine; Edelstein, Sharon L.; Crandall, Jill P.; Dabelea, Dana; Kitabchi, Abbas E.; Hamman, Richard F.; Montez, Maria G.; Perreault, Leigh; Foulkes, Mary A.; Barrett-Connor, Elizabeth

2012-01-01

Objective The study objective was to examine the association between menopause status and diabetes risk among women with glucose intolerance and to determine if menopausal status modifies response to diabetes prevention interventions. Methods The study population included women in premenopause (n=708), natural postmenopause (n=328), and bilateral oophorectomy (n=201) in the Diabetes Prevention Program (DPP), a randomized placebo-controlled trial of lifestyle intervention and metformin among glucose intolerant adults. Associations between menopause and diabetes risk were evaluated using Cox proportional hazard models that adjusted for demographic variables (age, race/ethnicity, family history of diabetes, history of gestational diabetes mellitus), waist circumference, insulin resistance and corrected insulin response. Similar models were constructed after stratification by menopause type and hormone therapy (HT) use. Results After adjustment for age, there was no association between natural menopause or bilateral oophorectomy and diabetes risk. Differences by study arm were observed in women who reported bilateral oophorectomy. In the lifestyle arm, women with bilateral oophorectomy had a lower adjusted hazard for diabetes (HR 0.19, 95% CI 0.04, 0.94), although observations were too few to determine if this was independent of HT use. No significant differences were seen in the metformin (HR 1.29, 95% CI 0.63, 2.64) or placebo arms (HR 1.37, 95% CI 0.74, 2.55). Conclusions Among women at high-risk for diabetes, natural menopause was not associated with diabetes risk and did not affect response to diabetes prevention interventions. In the lifestyle intervention, bilateral oophorectomy was associated with decreased diabetes risk. PMID:21709591

After Mexico Implemented a Tax, Purchases of Sugar-Sweetened Beverages Decreased and Water Increased: Difference by Place of Residence, Household Composition, and Income Level.

PubMed

Colchero, M Arantxa; Molina, Mariana; Guerrero-López, Carlos M

2017-08-01

Background: In January 2014, Mexico implemented a tax on sugar-sweetened beverage (SSB) purchases of 1 peso/L. Objective: We examined the heterogeneity of changes in nonalcoholic beverage (SSB and bottled water) purchases after the tax was implemented by household income, urban and rural strata, and household composition. Methods: We used 4 rounds of the National Income and Expenditure Surveys: 2008, 2010, 2012, and 2014. Changes in purchases in per capita liters per week were estimated with the use of 2-part models to adjust for nonpurchases. We compared absolute and relative differences between adjusted changes in observed purchases in 2014 with expected purchases in 2014 based on prior trends (2008-2012). The models were adjusted for sociodemographic characteristics of the households, place of residence, and lagged gross domestic product per capita. Results: We found a 6.3% reduction in the observed purchases of SSBs in 2014 compared with the expected purchases in that same year based on trends from 2008 to 2012. These reductions were higher among lower-income households, residents living in urban areas, and households with children. We also found a 16.2% increase in water purchases that was higher in low- and middle-income households, in urban areas, and among households with adults only. Conclusions: SSB purchases decreased and water purchases increased after an SSB tax was imposed in Mexico. The magnitude of these changes was greater in lower-income and urban households. © 2017 American Society for Nutrition.

Unchained Melody: Revisiting the Estimation of SF-6D Values

PubMed Central

Craig, Benjamin M.

2015-01-01

Purpose In the original SF-6D valuation study, the analytical design inherited conventions that detrimentally affected its ability to predict values on a quality-adjusted life year (QALY) scale. Our objective is to estimate UK values for SF-6D states using the original data and multi-attribute utility (MAU) regression after addressing its limitations and to compare the revised SF-6D and EQ-5D value predictions. Methods Using the unaltered data (611 respondents, 3503 SG responses), the parameters of the original MAU model were re-estimated under 3 alternative error specifications, known as the instant, episodic, and angular random utility models. Value predictions on a QALY scale were compared to EQ-5D3L predictions using the 1996 Health Survey for England. Results Contrary to the original results, the revised SF-6D value predictions range below 0 QALYs (i.e., worse than death) and agree largely with EQ-5D predictions after adjusting for scale. Although a QALY is defined as a year in optimal health, the SF-6D sets a higher standard for optimal health than the EQ-5D-3L; therefore, it has larger units on a QALY scale by construction (20.9% more). Conclusions Much of the debate in health valuation has focused on differences between preference elicitation tasks, sampling, and instruments. After correcting errant econometric practices and adjusting for differences in QALY scale between the EQ-5D and SF-6D values, the revised predictions demonstrate convergent validity, making them more suitable for UK economic evaluations compared to original estimates. PMID:26359242

Relation of Aortic Valve Calcium to Chronic Kidney Disease (from the Chronic Renal Insufficiency Cohort [CRIC] Study)

PubMed Central

Guerraty, Marie A.; Chai, Boyang; Hsu, Jesse Yenchih; Ojo, Akinlolu O.; Gao, Yanlin; Yang, Wei; Keane, Martin G.; Budoff, Matthew J.; Mohler, Emile R.

2015-01-01

Although subjects with chronic kidney disease (CKD) are at markedly increased risk for cardiovascular mortality, the relationship between CKD and aortic valve calcification has not been fully elucidated. Also, few data are available on the relationship of aortic valve calcification and earlier stages of CKD. We sought to assess the relationship of aortic valve calcium (AVC) with estimated glomerular filtration rate (eGFR), traditional and novel cardiovascular risk factors, and markers of bone metabolism in the Chronic Renal Insufficiency Cohort (CRIC) Study. All patients who underwent aortic valve scanning in the CRIC study were included. The relationship between AVC and eGFR, traditional and novel cardiovascular risk factors, and markers of calcium metabolism were analyzed using both unadjusted and adjusted regression models. A total of 1964 CRIC participants underwent computed tomography for AVC quantification. Decreased renal function was independently associated with increased levels of AVC (eGFR 47.11 ml/min/1.73m2, 44.17 ml/min/1.73m2, and 39 ml/min/1.73m2, respectively, p< 0.001). This association persisted after adjusting for traditional, but not novel, AVC risk factors. Adjusted regression models identified several traditional and novel risk factors for AVC in patients with CKD. There was a difference in AVC risk factors between black and non-black patients. In conclusion, our study shows that eGFR is associated in a dose-dependent manner with AVC in patients with CKD, and this association is independent of traditional cardiovascular risk factors. PMID:25791240

Trimethoprim prescription and subsequent resistance in childhood urinary infection: multilevel modelling analysis

PubMed Central

Duffy, Mary A; Hernandez-Santiago, Virginia; Orange, Gillian; Davey, Peter G; Guthrie, Bruce

2013-01-01

Background Antibiotic resistance is a growing concern and antibiotic usage the main contributing factor, but there are few studies examining antibiotic use and resistance in children. Aim To investigate the association between previous trimethoprim prescribing and resistance in urinary Escherichia coli (E. coli) isolates in children. Design and setting Retrospective, population cohort study in Tayside, Scotland. Method Multilevel modelling of linked microbiology and dispensed prescribing data for 1373 ≤16-year-olds with E. coli urinary isolates in 2004–2009, examining the association between prior trimethoprim prescription and subsequent trimethoprim resistance in people with urinary E. coli isolates. Results Trimethoprim resistance was common (26.6%, 95% confidence interval [CI] = 24.6 to 28.6). Previous trimethoprim prescription was associated with subsequent culture of trimethoprim-resistant E. coli, with more recent prescription being more strongly associated with resistance. After adjusting for the number of previous E. coli isolates and sample year, trimethoprim prescribing in the previous 84 days remained significantly associated with culturing trimethoprim-resistant E. coli (adjusted OR 4.71, 95% CI = 1.83 to 12.16 for the previous 15–28 days versus never prescribed; adjusted OR 3.16, 95% CI = 1.63 to 6.13 for the previous 29–84 days); however, associations were not statistically significant for longer periods since prior exposure. Conclusion Trimethoprim prescription has implications for future resistance in individual children, as well as at population level. Clinicians must ensure appropriateness of treatment choice and duration, and alternative antibiotics should be considered for childhood urinary tract infections if trimethoprim has been prescribed in the preceding 3 months. PMID:23540479

Early Childhood Precursors and Adolescent Sequelae of Gradeschool Peer Rejection and Victimization

PubMed Central

Bierman, Karen L.; Kalvin, Carla B.; Heinrichs, Brenda S.

2014-01-01

Objective This study examined the early childhood precursors and adolescent outcomes associated with gradeschool peer rejection and victimization among children oversampled for aggressive-disruptive behaviors. A central goal was to better understand the common and unique developmental correlates associated with these two types of peer adversity. Method 754 participants (46% African American, 50% European American, 4% other; 58% male; average age 5.65 at kindergarten entry) were followed into seventh grade. Six waves of data were included in structural models focused on three developmental periods. Parents and teachers rated aggressive behavior, emotion dysregulation, and internalizing problems in kindergarten and grade 1 (waves 1–2); peer sociometric nominations tracked “least liked” and victimization in grades 2, 3, and 4 (waves 3–5); and youth reported on social problems, depressed mood, school adjustment difficulties, and delinquent activities in early adolescence (grade 7, wave 6). Results Structural models revealed that early aggression and emotion dysregulation (but not internalizing behavior) made unique contributions to gradeschool peer rejection; only emotion dysregulation made unique contributions to gradeschool victimization. Early internalizing problems and gradeschool victimization uniquely predicted adolescent social problems and depressed mood. Early aggression and gradeschool peer rejection uniquely predicted adolescent school adjustment difficulties and delinquent activities. Conclusions Aggression and emotion dysregulation at school entry increased risk for peer rejection and victimization, and these two types of peer adversity had distinct, as well as shared risk and adjustment correlates. Results suggest that the emotional functioning and peer experiences of aggressive-disruptive children deserve further attention in developmental and clinical research. PMID:24527989

Women's Work Conditions and Marital Adjustment in Two-Earner Couples: A Structural Model.

ERIC Educational Resources Information Center

Sears, Heather A.; Galambos, Nancy L.

1992-01-01

Evaluated structural model of women's work conditions, women's stress, and marital adjustment using path analysis. Findings from 86 2-earner couples with adolescents indicated support for spillover model in which women's work stress and global stress mediated link between their work conditions and their perceptions of marital adjustment.…

Association between DNA Methylation in Whole Blood and Measures of Glucose Metabolism: KORA F4 Study

PubMed Central

Wahl, Simone; Kunze, Sonja; Molnos, Sophie; Volkova, Nadezda; Schramm, Katharina; Carstensen-Kirberg, Maren; Waldenberger, Melanie; Gieger, Christian; Peters, Annette; Illig, Thomas; Prokisch, Holger; Roden, Michael; Grallert, Harald

2016-01-01

Epigenetic regulation has been postulated to affect glucose metabolism, insulin sensitivity and the risk of type 2 diabetes. Therefore, we performed an epigenome-wide association study for measures of glucose metabolism in whole blood samples of the population-based Cooperative Health Research in the Region of Augsburg F4 study using the Illumina HumanMethylation 450 BeadChip. We identified a total of 31 CpG sites where methylation level was associated with measures of glucose metabolism after adjustment for age, sex, smoking, and estimated white blood cell proportions and correction for multiple testing using the Benjamini-Hochberg (B-H) method (four for fasting glucose, seven for fasting insulin, 25 for homeostasis model assessment-insulin resistance [HOMA-IR]; B-H-adjusted p-values between 9.2x10-5 and 0.047). In addition, DNA methylation at cg06500161 (annotated to ABCG1) was associated with all the aforementioned phenotypes and 2-hour glucose (B-H-adjusted p-values between 9.2x10-5 and 3.0x10-3). Methylation status of additional three CpG sites showed an association with fasting insulin only after additional adjustment for body mass index (BMI) (B-H-adjusted p-values = 0.047). Overall, effect strengths were reduced by around 30% after additional adjustment for BMI, suggesting that this variable has an influence on the investigated phenotypes. Furthermore, we found significant associations between methylation status of 21 of the aforementioned CpG sites and 2-hour insulin in a subset of samples with seven significant associations persisting after additional adjustment for BMI. In a subset of 533 participants, methylation of the CpG site cg06500161 (ABCG1) was inversely associated with ABCG1 gene expression (B-H-adjusted p-value = 1.5x10-9). Additionally, we observed an enrichment of the top 1,000 CpG sites for diabetes-related canonical pathways using Ingenuity Pathway Analysis. In conclusion, our study indicates that DNA methylation and diabetes-related traits are associated and that these associations are partially BMI-dependent. Furthermore, the interaction of ABCG1 with glucose metabolism is modulated by epigenetic processes. PMID:27019061

Challenging the myths about parents' adjustment after the sudden, violent death of a child.

PubMed

Murphy, Shirley A; Johnson, L Clark; Lohan, Janet

2003-01-01

To examine three commonly held myths: (a) a child's death by suicide results in the worst parental outcomes compared with other causes of violent death, (b) divorce is not only more common among bereaved than nonbereaved married couples, it might be inevitable, and (c) "letting go and moving on" is an essential bereavement task needed for a satisfactory adjustment following the violent death of a child. Review of empirical evidence and critical reviews, review of Internet resources available to the general public, and the inclusion of original data obtained from a longitudinal, prospective study conducted by the authors. Conclusive evidence was found to dispel two of the three myths, but sufficient evidence was not found to draw conclusions about the third myth regarding parents' adjustment to a child's suicidal death. Myths in regard to parental bereavement are resistant to disconfirming evidence and they appear to persist among professional practitioners and the general public despite contrary empirical evidence.

Association of Various Components of Media Literacy and Adolescent Smoking

PubMed Central

Primack, Brian A.; Hobbs, Renee

2010-01-01

Objective To determine which specific aspects of media literacy were most strongly associated with smoking outcomes. Methods Students at a public high school responded to cross-sectional survey items measuring smoking outcomes, components of media literacy, and other variables. Results Of the 1211 participants, 19% were current smokers (N = 216) and 40% of the nonsmokers (N = 342) were susceptible to smoking. In the adjusted models, current smoking was most strongly related to representation-reality domain items, but susceptibility to smoking was associated with each of the media literacy domains. Conclusion Varied relationships exist between individual facets of media literacy and smoking outcomes. PMID:18844513

Evaluation of Rapid Adjustments to Radiative Forcing for Five Climate Forcing Agents in the Precipitation Driver Response Model Intercomparison Project (PDRMIP)

NASA Astrophysics Data System (ADS)

Smith, C. J.; Forster, P.; Richardson, T.; Myhre, G.

2016-12-01

Effective radiative forcing (ERF), rather than "traditional" radiative forcing (RF), has become an increasingly popular metric in recent years, as it more closely links the difference in the earth's top-of-atmosphere (TOA) energy budget to equilibrium near-surface temperature rise. One method to diagnose ERF is to take the difference of TOA radiative fluxes from two climate model runs (a perturbation and a control) with prescribed sea-surface temperatures and sea-ice coverage. ERF can be thought of as the sum of a direct forcing, which is the pure radiative effect of a forcing agent, plus rapid adjustments, which are changes in climate state triggered by the forcing agent that themselves affect the TOA energy budget and are unrelated to surface temperature changes.In addition to the classic experiment of doubling of CO2 (2xCO2), we analyse rapid adjustments to a tripling of methane (3xCH4), a quintupling of sulphate aerosol (5xSul), a ten times increase in black carbon (10xBC) and a 2% increase in the solar constant (2%Sol). We use CMIP-style climate model diagnostics from six participating models of the Precipitation Driver Response Model Intercomparison Project (PDRMIP).Assuming approximately linear contributions to the TOA flux differences, the rapid adjustments from changes in atmospheric temperature, surface temperature, surface albedo and water vapour can be cleanly and simply separated from the direct forcing by radiative kernels. The rapid adjustments are in turn decomposed into stratospheric and tropospheric components. We introduce kernels based on the HadGEM2 climate model and find similar results to those based on other models. Cloud adjustments are evaluated as a residual of the TOA radiative fluxes between all-sky and clear-sky runs once direct forcing and rapid adjustments have been subtracted. The cloud adjustments are also calculated online within the HadGEM2 model using the ISCCP simulator. For aerosol forcing experiments, rapid adjustments vary substantially between models. Much of the contribution to this model spread is in the cloud adjustments. We also notice a spread in the model calculations of direct forcing for greenhouse gases, which suggest differences in the radiative transfer parameterisations used by each model.

Accounting for energy and protein reserve changes in predicting diet-allowable milk production in cattle.

PubMed

Tedeschi, L O; Seo, S; Fox, D G; Ruiz, R

2006-12-01

Current ration formulation systems used to formulate diets on farms and to evaluate experimental data estimate metabolizable energy (ME)-allowable and metabolizable protein (MP)-allowable milk production from the intake above animal requirements for maintenance, pregnancy, and growth. The changes in body reserves, measured via the body condition score (BCS), are not accounted for in predicting ME and MP balances. This paper presents 2 empirical models developed to adjust predicted diet-allowable milk production based on changes in BCS. Empirical reserves model 1 was based on the reserves model described by the 2001 National Research Council (NRC) Nutrient Requirements of Dairy Cattle, whereas empirical reserves model 2 was developed based on published data of body weight and composition changes in lactating dairy cows. A database containing 134 individually fed lactating dairy cows from 3 trials was used to evaluate these adjustments in milk prediction based on predicted first-limiting ME or MP by the 2001 Dairy NRC and Cornell Net Carbohydrate and Protein System models. The analysis of first-limiting ME or MP milk production without adjustments for BCS changes indicated that the predictions of both models were consistent (r(2) of the regression between observed and model-predicted values of 0.90 and 0.85), had mean biases different from zero (12.3 and 5.34%), and had moderate but different roots of mean square errors of prediction (5.42 and 4.77 kg/d) for the 2001 NRC model and the Cornell Net Carbohydrate and Protein System model, respectively. The adjustment of first-limiting ME- or MP-allowable milk to BCS changes improved the precision and accuracy of both models. We further investigated 2 methods of adjustment; the first method used only the first and last BCS values, whereas the second method used the mean of weekly BCS values to adjust ME- and MP-allowable milk production. The adjustment to BCS changes based on first and last BCS values was more accurate than the adjustment to BCS based on the mean of all BCS values, suggesting that adjusting milk production for mean weekly variations in BCS added more variability to model-predicted milk production. We concluded that both models adequately predicted the first-limiting ME- or MP-allowable milk after adjusting for changes in BCS.

Predictors of adjustment and growth in women with recurrent ovarian cancer.

PubMed

Ponto, Julie Ann; Ellington, Lee; Mellon, Suzanne; Beck, Susan L

2010-05-01

To analyze predictors of adjustment and growth in women who had experienced recurrent ovarian cancer using components of the Resiliency Model of Family Stress, Adjustment, and Adaptation as a conceptual framework. Cross-sectional. Participants were recruited from national cancer advocacy groups. 60 married or partnered women with recurrent ovarian cancer. Participants completed an online or paper survey. Independent variables included demographic and illness variables and meaning of illness. Outcome variables were psychological adjustment and post-traumatic growth. A model of five predictor variables (younger age, fewer years in the relationship, poorer performance status, greater symptom distress, and more negative meaning) accounted for 64% of the variance in adjustment but did not predict post-traumatic growth. This study supports the use of a model of adjustment that includes demographic, illness, and appraisal variables for women with recurrent ovarian cancer. Symptom distress and poorer performance status were the most significant predictors of adjustment. Younger age and fewer years in the relationship also predicted poorer adjustment. Nurses have the knowledge and skills to influence the predictors of adjustment to recurrent ovarian cancer, particularly symptom distress and poor performance status. Nurses who recognize the predictors of poorer adjustment can anticipate problems and intervene to improve adjustment for women.

Work-family conflicts and subsequent sleep medication among women and men: a longitudinal registry linkage study.

PubMed

Lallukka, T; Arber, S; Laaksonen, M; Lahelma, E; Partonen, T; Rahkonen, O

2013-02-01

Work and family are two key domains of life among working populations. Conflicts between paid work and family life can be detrimental to sleep and other health-related outcomes. This study examined longitudinally the influence of work-family conflicts on subsequent sleep medication. Questionnaire data were derived from the Helsinki Health Study mail surveys in 2001-2002 (2929 women, 793 men) of employees aged 40-60 years. Data concerning sleep medication were derived from the Finnish Social Insurance Institution's registers covering all prescribed medication from 1995 to 2007. Four items measured whether job responsibilities interfered with family life (work to family conflicts), and four items measured whether family responsibilities interfered with work (family to work conflicts). Cox proportional hazard models were fitted, adjusting for age, sleep medication five years before baseline, as well as various family- and work-related covariates. During a five-year follow-up, 17% of women and 10% of men had at least one purchase of prescribed sleep medication. Among women, family to work conflicts were associated with sleep medication over the following 5 years after adjustment for age and prior medication. The association remained largely unaffected after adjusting for family-related and work-related covariates. Work to family conflicts were also associated with subsequent sleep medication after adjustment for age and prior medication. The association attenuated after adjustment for work-related factors. No associations could be confirmed among men. Thus reasons for men's sleep medication likely emerge outside their work and family lives. Concerning individual items, strain-based ones showed stronger associations with sleep medication than more concrete time-based items. In conclusion, in particular family to work conflicts, but also work to family conflicts, are clear determinants of women's sleep medication. Copyright © 2012 Elsevier Ltd. All rights reserved.

Impact of disasters on child stunting in Nepal

PubMed Central

Gaire, Surya; Delbiso, Tefera Darge; Pandey, Srijana; Guha-Sapir, Debarati

2016-01-01

Background Stunting is a major public health problem that results from inadequate nutritional intake over a long period of time. Disasters have major implications in poor and vulnerable children. The aim of this study was, therefore, to assess the impact of disasters on child stunting in Nepal. Method A sample consisting of 2,111 children aged 6–59 months was obtained from the 2011 Nepal Demographic and Health Survey. We used bivariate and multivariate analyses to examine moderate and severe stunting against disaster, controlling for all possible confounders. Result Out of the total study sample, 43% were stunted (17.1% severely and 25.9% moderately). The final model, after adjusting for confounders, showed that epidemics have no impact on child stunting (adjusted odds ratio [OR] =1.14, 95% confidence interval [CI]: 0.66, 1.97 and adjusted OR =1.04, 95% CI: 0.66, 1.65 for severe and moderate stunting, respectively). Floods have impact on child stunting (adjusted OR =0.57, 95% CI: 0.31, 0.96 and adjusted OR =0.66, 95% CI: 0.41, 0.94 for severe and moderate stunting, respectively). However, children aged 6–11 months, nonvaccinated children, children of working women, children who live in mountainous areas, and children from the poorest households were more likely to be moderately stunted. Similarly, children aged 36–47 months, Dalit and other ethnic groups, children from rural settings, and children from the poorest households were more likely to be severely stunted. Conclusion This article illustrates the need to rethink about child stunting in Nepal. This study suggests need for further research, integration of disaster data in the Nepal Demography Health Survey, educational interventions, public awareness, promotion of vaccination, and equity in health service delivery. PMID:27354834

Neighborhood-Level Racial/Ethnic Residential Segregation and Incident Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis

PubMed Central

Kershaw, Kiarri N.; Osypuk, Theresa L.; Do, D. Phuong; De Chavez, Peter J.; Roux, Ana V. Diez

2014-01-01

Background Previous research suggests neighborhood-level racial/ethnic residential segregation is linked to health, but it has not been studied prospectively in relation to cardiovascular disease (CVD). Methods and Results Participants were 1,595 non-Hispanic Black, 2,345 non-Hispanic White, and 1,289 Hispanic adults from the Multi-Ethnic Study of Atherosclerosis free of CVD at baseline (ages 45-84). Own-group racial/ethnic residential segregation was assessed using the Gi∗ statistic, a measure of how the neighborhood racial/ethnic composition deviates from surrounding counties’ racial/ethnic composition. Multivariable Cox proportional hazards modeling was used to estimate hazard ratios (HR) for incident CVD (first definite angina, probable angina followed by revascularization, myocardial infarction, resuscitated cardiac arrest, CHD death, stroke, or stroke death) over 10.2 median years of follow-up. Among Blacks, each standard deviation increase in Black segregation was associated with a 12% higher hazard of developing CVD after adjusting for demographics (95% Confidence Interval (CI): 1.02, 1.22). This association persisted after adjustment for neighborhood-level characteristics, individual socioeconomic position, and CVD risk factors (HR: 1.12; 95% CI: 1.02, 1.23). For Whites, higher White segregation was associated with lower CVD risk after adjusting for demographics (HR: 0.88; 95% CI: 0.81, 0.96), but not after further adjustment for neighborhood characteristics. Segregation was not associated with CVD risk among Hispanics. Similar results were obtained after adjusting for time-varying segregation and covariates. Conclusions The association of residential segregation with cardiovascular risk varies according to race/ethnicity. Further work is needed to better characterize the individual- and neighborhood-level pathways linking segregation to CVD risk. PMID:25447044

SENSE OF CONTROL AND SELF-REPORTED HEALTH IN A POPULATION-BASED SAMPLE OF OLDER AMERICANS: ASSESSMENT OF POTENTIAL CONFOUNDING BY AFFECT, PERSONALITY, AND SOCIAL SUPPORT

PubMed Central

Ward, Michael M.

2012-01-01

Background Sense of control has been linked to improved health outcomes, but it is unclear if this association is independent of other psychosocial factors. Purpose To test the strength of association between sense of control and self-reported health after adjustment for positive and negative affect, “Big 5” personality factors, and social support. Method Data on sense of control (measured by personal mastery, perceived constraints, and a health-specific rating of control), affect, personality, social support, and two measures of self-reported health (global rating of fair or poor health, and presence of functional limitations) were obtained on 6891 participants in the Health and Retirement Study, a population-based survey of older Americans. The cross-sectional association between sense of control measures and each measure of self-reported health was tested in hierarchical logistic regression models, before and after adjustment for affect, personality, and social support. Results Participants with higher personal mastery were less likely to report fair/poor health (odds ratio 0.76 per 1-point increase) while those with higher perceived constraints were more likely to report fair/poor health (odds ratio 1.37 per 1-point increase). Associations remained after adjustment for affect, but adjustment for affect attenuated the association of personal mastery by 37% and of perceived constraints by 67%. Further adjustment for personality and social support did not alter the strength of association. Findings were similar for the health-specific rating of control, and for associations with functional limitations. Conclusions Sense of control is associated with self-reported health in older Americans, but this association is partly confounded by affect. PMID:22282403

The relationship between foot and ankle symptoms and risk of developing knee osteoarthritis: data from the osteoarthritis initiative

PubMed Central

Paterson, Kade L; Kasza, Jessica; Hunter, David J; Hinman, Rana S; Menz, Hylton B; Peat, George; Bennell, Kim L

2016-01-01

Objective To investigate whether foot and/or ankle symptoms increase the risk of developing (i) knee symptoms and (ii) symptomatic radiographic knee osteoarthritis (OA). Design 1020 Osteoarthritis Initiative participants who were at-risk of knee OA, but were without knee symptoms or radiographic knee OA, were investigated. Participants indicated the presence and laterality of foot/ankle symptoms at baseline. The main outcome was development of knee symptoms (pain, aching or stiffness in and around the knee on most days of the month for at least one month in the past year). A secondary outcome was development of symptomatic radiographic knee OA (symptoms plus Kellgren and Lawrence [KL] grade ≥2), over the subsequent four years. Associations between foot/ankle symptoms and study outcomes were assessed by logistic regression models. Results Foot/ankle symptoms in either or both feet significantly increased the odds of developing knee symptoms (adjusted odds ratio (OR) 1.55, 95% confidence interval (CI) 1.10 to 2.19), and developing symptomatic radiographic knee OA (adjusted OR 3.28, 95% CI 1.69 to 6.37). Based on laterality, contralateral foot/ankle symptoms were associated with developing both knee symptoms (adjusted OR 1.68, 95% CI 1.05 to 2.68) and symptomatic radiographic knee OA (adjusted OR 3.08, 95% CI 1.06 to 8.98), whilst bilateral foot/ankle symptoms were associated with developing symptomatic radiographic knee OA (adjusted OR 4.02, 95% CI 1.76 to 9.17). Conclusion In individuals at-risk of knee OA, the presence of contralateral foot/ankle symptoms in particular increases risk of developing both knee symptoms and symptomatic radiographic knee OA. PMID:27939621

Social participation and coronary heart disease risk in a large prospective study of UK women

PubMed Central

Balkwill, Angela; Canoy, Dexter; Reeves, Gillian K; Green, Jane; Beral, Valerie; Cairns, Benjamin J

2015-01-01

Background Participation in social activities is thought to prevent heart disease, but evidence is inconclusive. Design We assessed whether participating in social activities reduces the risk of coronary heart disease (CHD) in a large prospective study of 735,159 middle-aged UK women. Methods Women reported their participation in eight social activities (religious group, voluntary work, adult education, art/craft/music, dancing, sports club, yoga, bingo) and were followed for first CHD event (hospital admission or death) over the next 8.6 years. Cox regression models were used to estimate relative risks for CHD incidence by participation in each and in any of the social activities. Results After adjustment for age and region only, every activity except bingo was associated with a reduced risk of CHD (n = 30,756 cases in total). However, after additional adjustment for 11 factors (deprivation, education, smoking, physical activity, body mass index, alcohol, marital status, self-rated health, happiness, hypertension, diabetes), every relative risk estimate moved close to 1.0. For example, for participation in any of the activities compared with none, the relative risk adjusted for age and region only was 0.83 (99% confidence interval 0.81–0.86), but changed to 1.06 (99% confidence interval 1.02–1.09) after additional adjustment. Adjustment for education, self-rated health, smoking and physical activity attenuated the associations most strongly. Residual confounding and other unmeasured factors may well account for any small remaining associations. Conclusions Associations between participation in various social activities and CHD risk appear to be largely or wholly due to confounding by personal characteristics of the participants. PMID:26416995

The relationship between the number of cardiologists and clinical practice patterns in acute heart failure: a cross-sectional observational study

PubMed Central

Sasaki, Noriko; Kunisawa, Susumu; Otsubo, Tetsuya; Ikai, Hiroshi; Fushimi, Kiyohide; Yasumura, Yoshio; Kimura, Takeshi; Imanaka, Yuichi

2014-01-01

Objectives Despite the increasing burden of acute heart failure (AHF) on healthcare systems, the association between centralised cardiovascular specialist care and the quality of AHF care remains unknown. We examine the relationship between the number of cardiologists per hospital and hospital practice variations. Design, setting and participants In a retrospective observational study, we analysed 38 668 patients with AHF admitted to 546 Japanese acute care hospitals between 2010 and 2011 using the Diagnosis Procedure Combination administrative claims database. Sample hospitals were categorised into four groups according to the number of cardiologists per facility (none, 1–4, 5–9 and ≥10). To confirm the capability of administrative data to identify patients with AHF, the ≥10 cardiologists group was compared with two recent clinical registries in Japan. Main outcome measures Using multivariable logistic regression models, patient risk-adjusted in-hospital mortality rates and age-sex-adjusted ORs of various AHF therapies were calculated and compared among four hospital groups. Results The ≥10 cardiologists group of hospitals from the administrative database had similar major underlying disease incidence and therapeutic practices to those of the clinical registry hospitals. Age-adjusted and sex-adjusted ORs of various AHF therapies in the four hospital groups revealed wide practice variations associated with the number of cardiologists. Adjusted in-hospital mortality demonstrated a negative association with the number of cardiologists. In addition, the different hospital-level distribution patterns of specific therapeutic practices illustrated the diffusion process of therapies across facilities. Conclusions Wide practice variations in AHF care were associated with the number of cardiologists per facility, indicating a possible relationship between the quality of AHF care and manpower resources. The provision of recommended therapies increased together with the number of cardiologists. PMID:25550294

Coffee consumption and incidence of lung cancer in the NIH-AARP Diet and Health Study

PubMed Central

Guertin, Kristin A; Freedman, Neal D; Loftfield, Erikka; Graubard, Barry I; Caporaso, Neil E; Sinha, Rashmi

2016-01-01

Background: Coffee drinkers had a higher risk of lung cancer in some previous studies, but as heavy coffee drinkers tend to also be cigarette smokers, such findings could be confounded. Therefore, we examined this association in the nearly half a million participants of the US NIH-AARP Diet and Health Study. Methods: Typical coffee intake and smoking history were queried at baseline. During 4 155 256 person-years of follow-up, more than 9000 incident lung cancer cases occurred. We used Cox proportional hazards regression to estimate hazard ratios (HRs)and 95% confidence intervals for coffee intake and subsequent incidence of lung cancer. We also comprehensively adjusted for tobacco smoking and examined associations by detailed strata of tobacco use. Results: Coffee drinkers were far more likely to smoke than non-drinkers. Although coffee drinking was associated with lung cancer in age- and sex- adjusted models (HR for ≥ 6 cups/day compared with none: 4.56, 4.08-5.10), this association was substantially attenuated after adjusting for smoking (HR: 1.27, 1.14-1.42). Similar findings were observed for each different histological type of lung cancer, and for participants drinking predominantly caffeinated or decaffeinated coffee. Little evidence for an association was observed in our stratified analyses, either within never smokers or in most categories of tobacco use. Conclusions: Coffee drinking was positively associated with lung cancer in our study, although the association was substantially attenuated after adjustment for tobacco smoking. As our adjustment for lifetime tobacco use was imperfect, it is likely that the remaining association is due to residual confounding by smoking, although other explanations are possible. PMID:26082405

Relationship between Exposure to Household Humidifier Disinfectants and Risk of Lung Injury: A Family-Based Study

PubMed Central

Park, Dong-Uk; Choi, Ye-Yong; Ahn, Jong-Ju; Lim, Heung-Kyu; Kim, Sun-Kyung; Roh, Hyun-Suk; Cheong, Hae-Kwan; Leem, Jong-Han; Koh, Dong-Hee; Jung, Hye-Jung; Lee, Kyoung-Mu; Lee, Jong-Hyeon; Kim, Yong-Hwa; Lim, Sin-Ye; Paek, Do-Myung; Lim, Chae-Man; Hong, Soo-Jong

2015-01-01

Background In South Korea, a cluster of acute lung disease patients included lung injury disease suspected of being caused by the use of humidifier disinfectants. We examined the relationship between humidifier disinfectant exposure and clinically diagnosed humidifier disinfectant-associated lung injury (HDLI) in a family-based study. Methods This case-control study included 169 clinically confirmed HDLI cases and 303 family controls who lived with the HDLI patients. A range of information on exposure to humidifier disinfectants was obtained using a structured questionnaire and field investigations. Odds ratios (ORs) and confidence intervals (CIs) were estimated using unconditional logistic regression models that were adjusted for age, sex, presence of a factory within 1 km of residence, and the number of household chemical products used. Results HDLI risk increased approximately two-fold or more among the highest quartile compared with the lowest quartile in terms of the hours sleeping in a room with an operating humidifier treated with disinfectant (adjusted OR = 2.0, 95 % CI = 1.1-3.7), average hours of disinfectant-treated humidifier use per day (adjusted OR = 2.1, 95 % CI = 1.0-4.5), airborne disinfectant intensity (adjusted OR = 2.6, 95% CI = 1.2-5.3), and cumulative disinfectant inhalation level (adjusted OR = 2.0, 95% CI = 1.0-4.1). HDLI risk increased as the distance of the bed from humidifier gets shorter; compared with longer distance (> 1 m), the odds ratio was 2.7 for 0.5 to 1 m (95 % CI = 1.5-5.1) and 13.2 for <0.5 m (95 % CI = 2.4-73.0). Conclusions The use of household humidifier disinfectants was associated with HDLI risk in a dose-response manner. PMID:25978522

Exposure to Smoking Imagery in Popular Films and Adolescent Smoking in Mexico

PubMed Central

Thrasher, James F.; Jackson, Christine; Arillo-Santillán, Edna; Sargent, James D.

2008-01-01

Background Exposure to smoking imagery in films is consistently associated with smoking behavior and its psychological antecedents among adolescents in high-income countries, but its association with adolescent smoking in middle-income countries is unknown. Methods In 2006, a cross-sectional sample of 3876 Mexican adolescents in secondary school was surveyed on smoking behavior, smoking risk factors, and exposure to 42 popular films that contained smoking. Participants were classified into quartiles of exposure to smoking imagery across all films they reported having seen. Models were estimated to determine associations among quartiles of film-smoking exposure, smoking behavior, and the psychological antecedents of smoking, adjusting for age, gender, sensation seeking, self-esteem, parental smoking, sibling smoking, best-friend smoking, having a bedroom TV, and private versus public school attendance. Analyses were conducted in 2007. Results Adolescents were exposed to an average of 51.7 (SE=1.3) minutes of smoking in the films they viewed. Crude and adjusted ORs indicated positive associations between quartiles of film-smoking exposure and both current smoking (AOR4v1=3.13; p<0.0001) and having ever smoked (AOR4v1=2.42; p<0.0001). Data from never-smokers (n=2098) were analyzed to determine associations between film-smoking exposure and psychological antecedents of smoking uptake. Crude and adjusted coefficients indicated significant, positive associations between exposure and susceptibility to smoking (AOR4v1=1.66; p<0.05); favorable attitudes toward smoking (Adjusted B4v1=0.44; p<0.0001); and perceived peer prevalence of smoking (Adjusted B4v1=0.26; p<0.0001). Conclusions Exposure to smoking in films appears associated with smoking among Mexican adolescents. Policies could aim to decrease youth exposure to smoking in nationally and internationally distributed films. PMID:18617078

Nuclear Cataract Shows Significant Familial Aggregation in an Older Population after Adjustment for Possible Shared Environmental Factors

PubMed Central

Congdon, Nathan; Broman, Karl W.; Lai, Hong; Munoz, Beatriz; Bowie, Heidi; Gilber, Donna; Wojciechowski, Robert; Alston, Christine; West, Sheila K.

2011-01-01

Purpose To quantify the association between siblings in age-related nuclear cataract, after adjusting for known environmental and personal risk factors. Methods All participants (probands) in the Salisbury Eye Evaluation (SEE) project and their locally resident siblings underwent digital slit lamp photography and were administered a questionnaire to assess risk factors for cataract including: age, gender, lifetime sun exposure, smoking and diabetes history, and use of alcohol and medications such as estrogens and steroids. In addition, blood pressure, body mass index, and serum antioxidants were measured in all participants. Lens photographs were graded by trained observers masked to the subjects' identity, using the Wilmer Cataract Grading System. The odds ratio for siblings for affectedness with nuclear cataract and the sibling correlation of nuclear cataract grade, after adjusting for covariates, were estimated with generalized estimating equations. Results Among 307 probands (mean age, 77.6 ± 4.5 years) and 434 full siblings (mean age, 72.4 ± 7.4 years), the average sibship size was 2.7 per family. After adjustment for covariates, the probability of development of nuclear cataract was significantly increased (odds ratio [OR] = 2.07, 95% confidence interval [CI], 1.30–3.30) among individuals with a sibling with nuclear cataract (nuclear grade ≥ 3.0). The final fitted model indicated a magnitude of heritability for nuclear cataract of 35.6% (95% CI: 21.0%–50.3%) after adjustment for the covariates. Conclusions Findings in this study are consistent with a genetic effect for age-related nuclear cataract, a common and clinically significant form of lens opacity. PMID:15223793

The association between disease activity and NT-proBNP in 238 patients with rheumatoid arthritis: a 10-year longitudinal study

PubMed Central

Provan, Sella A; Angel, Kristin; Ødegård, Sigrid; Mowinckel, Petter; Atar, Dan; Kvien, Tore K

2008-01-01

Introduction Disease activity in patients with rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity and mortality, of which N-terminal pro-brain natriuretic peptide (NT-proBNP) is a predictor. Our objective was to examine the cross-sectional and longitudinal associations between markers of inflammation, measures of RA disease activity, medication used in the treatment of RA, and NT-proBNP levels (dependent variable). Methods Two hundred thirty-eight patients with RA of less than 4 years in duration were followed longitudinally with three comprehensive assessments of clinical and radiographic data over a 10-year period. Serum samples were frozen and later batch-analyzed for NT-proBNP levels and other biomarkers. Bivariate, multivariate, and repeated analyses were performed. Results C-reactive protein (CRP) levels at baseline were cross-sectionally associated with NT-proBNP levels after adjustment for age and gender (r2 adjusted = 0.23; P < 0.05). At the 10-year follow-up, risk factors for cardiovascular disease were recorded. Duration of RA and CRP levels were independently associated with NT-proBNP in the final model that was adjusted for gender, age, and creatinine levels (r2 adjusted = 0.38; P < 0.001). In the longitudinal analyses, which adjusted for age, gender, and time of follow-up, we found that repeated measures of CRP predicted NT-proBNP levels (P < 0.001). Conclusion CRP levels are linearly associated with levels of NT-proBNP in cross-sectional and longitudinal analyses of patients with RA. The independent associations of NT-proBNP levels and markers of disease activity with clinical cardiovascular endpoints need to be further investigated. PMID:18573197

Unemployment and disability pension-an 18-year follow-up study of a 40-year-old population in a Norwegian county

PubMed Central

2012-01-01

Background This study explored the association of unemployment and an increased risk of receiving disability pension, and the possibility that this risk is attributed to municipality-specific characteristics. Methods A cohort of 7,985 40-42 year olds was followed for 18 years in national registers, identifying new episodes of unemployment and cases of disability pension. The association between an unemployment period and disability pension in the subsequent year was estimated using discrete time multilevel logistic regressions and clustering individuals by municipality. The association between unemployment and disability pension was adjusted for age in the follow up-period, sex, baseline health status, health behaviour and education level. A conditional intra-class correlation coefficient (ICC) was estimated as a measure of inter-municipality variance. Results In the follow-up period, 2784 (35%) of the participants were granted disability pension. The crude odds ratio for receiving disability pension after unemployment (adjusted for age in follow-up period and sex only) was 1.42 (95% CI 1.1-1.8). Adjusting for baseline health indicators reduced the odds ratio of unemployment to 1.33 (CI 1.1-1.7). A fully adjusted model, including education level, further reduced the odds ratio of unemployment to 1.25 (CI 1.00-1.6). The ICC of the municipality level was approximately 2%. Conclusions Becoming unemployed increased the risk of receiving subsequent disability pension. However, adjusting for baseline health status, health behaviour and education attenuated this impact considerably. The multilevel analysis indicated that a minor, yet statistically significant, proportion of the risk of disability pension can be attributed to the municipality of residence. PMID:22369630

Cost-effectiveness of biological treatment sequences for fistulising Crohn’s disease across Europe

PubMed Central

Baji, Petra; Gulácsi, László; Brodszky, Valentin; Végh, Zsuzsanna; Danese, Silvio; Irving, Peter M; Peyrin-Biroulet, Laurent; Schreiber, Stefan; Rencz, Fanni; Lakatos, Péter L; Péntek, Márta

2017-01-01

Background In clinical practice, treatment sequences of biologicals are applied for active fistulising Crohn’s disease, however underlying health economic analyses are lacking. Objective The purpose of this study was to analyse the cost-effectiveness of different biological sequences including infliximab, biosimilar-infliximab, adalimumab and vedolizumab in nine European countries. Methods A Markov model was developed to compare treatment sequences of one, two and three biologicals from the payer’s perspective on a five-year time horizon. Data on effectiveness and health state utilities were obtained from the literature. Country-specific costs were considered. Calculations were performed with both official list prices and estimated real prices of biologicals. Results Biosimilar-infliximab is the most cost-effective treatment against standard care across the countries (with list prices: €34684–€72551/quality adjusted life year; with estimated real prices: €24364–€56086/quality adjusted life year). The most cost-effective two-agent sequence, except for Germany, is the biosimilar-infliximab–adalimumab therapy compared with single biosimilar-infliximab (with list prices: €58533–€133831/quality adjusted life year; with estimated prices: €45513–€105875/quality adjusted life year). The cost-effectiveness of the biosimilar-infliximab–adalimumab–vedolizumab three-agent sequence compared wit biosimilar-infliximab –adalimumab is €87214–€152901/quality adjusted life year. Conclusions The suggested first-choice biological treatment is biosimilar-infliximab. In case of treatment failure, switching to adalimumab then to vedolizumab provides meaningful additional health gains but at increased costs. Inter-country differences in cost-effectiveness are remarkable due to significant differences in costs. PMID:29511561

The association between social relationships and self-harm: a case–control study in Taiwan

PubMed Central

2013-01-01

Background Although suicide has been postulated as a result of social breakdown, relatively little attention has been paid to the association between social relationships and non-fatal self-harm. We sought to investigate the extent to which social factors correlate with self-harm in this case–control study. Methods The primary outcome was self-harm with hospital presentation. Cases of self-harm from the Emergency Department in a general hospital in Northern Taiwan were recruited, and individually age-and-gender-matched control participants were recruited from non-psychiatric outpatient clinics at the same hospital. The Close Persons Questionnaire was administered and its social support and social network subscales were used to measure social relationships in the 12 months prior to the interview. Other covariates, comprising sociodemographic factors, major life events, physical and mental health, were adjusted in conditional logistic regression models. Results A total of 124 case–control pairs were recruited. The mean (standard deviation) age of the case group was 34.7 (12.8) years and 80.6% were female. Higher social isolation score remained significantly associated with self-harm after adjustment (adjusted odds ratio per standard deviation increase 2.92, 95% confidence interval 1.44-5.95) and household size was negatively associated with the outcome (adjusted odds ratio per unit increase 0.54, 95% CI 0.32-0.94). Conclusions More limited social networks were associated with self-harm after adjustment for potential confounders. Enhancing social structure and effective networking of people with self-harm to community resources may be important for self-harm management in Asian societies and elsewhere. PMID:23531045

Interpretations and pitfalls in modelling vector-transmitted infections.

PubMed

Amaku, M; Azevedo, F; Burattini, M N; Coutinho, F A B; Lopez, L F; Massad, E

2015-07-01

In this paper we propose a debate on the role of mathematical models in evaluating control strategies for vector-borne infections. Mathematical models must have their complexity adjusted to their goals, and we have basically two classes of models. At one extreme we have models that are intended to check if our intuition about why a certain phenomenon occurs is correct. At the other extreme, we have models whose goals are to predict future outcomes. These models are necessarily very complex. There are models in between these classes. Here we examine two models, one of each class and study the possible pitfalls that may be incurred. We begin by showing how to simplify the description of a complicated model for a vector-borne infection. Next, we examine one example found in a recent paper that illustrates the dangers of basing control strategies on models without considering their limitations. The model in this paper is of the second class. Following this, we review an interesting paper (a model of the first class) that contains some biological assumptions that are inappropriate for dengue but may apply to other vector-borne infections. In conclusion, we list some misgivings about modelling presented in this paper for debate.

International Workshop on Educational Infrastructure: Conclusions (Summary of Proceedings, Guadalajara, Jalisco, Mexico, February 24-27, 2002).

ERIC Educational Resources Information Center

Organisation for Economic Cooperation and Development, Paris (France). Programme on Educational Building.

This document summarizes themes developed and conclusions from the International Workshop on Educational Infrastructure. The opening topic was "Delivering Education and Training in the Knowledge Society." It was clear to participants that educational infrastructure must go hand-in-hand with reengineering processes to adjust to the needs…

Dynamic gauge adjustment of high-resolution X-band radar data for convective rain storms: Model-based evaluation against measured combined sewer overflow

NASA Astrophysics Data System (ADS)

Borup, Morten; Grum, Morten; Linde, Jens Jørgen; Mikkelsen, Peter Steen

2016-08-01

Numerous studies have shown that radar rainfall estimates need to be adjusted against rain gauge measurements in order to be useful for hydrological modelling. In the current study we investigate if adjustment can improve radar rainfall estimates to the point where they can be used for modelling overflows from urban drainage systems, and we furthermore investigate the importance of the aggregation period of the adjustment scheme. This is done by continuously adjusting X-band radar data based on the previous 5-30 min of rain data recorded by multiple rain gauges and propagating the rainfall estimates through a hydraulic urban drainage model. The model is built entirely from physical data, without any calibration, to avoid bias towards any specific type of rainfall estimate. The performance is assessed by comparing measured and modelled water levels at a weir downstream of a highly impermeable, well defined, 64 ha urban catchment, for nine overflow generating rain events. The dynamically adjusted radar data perform best when the aggregation period is as small as 10-20 min, in which case it performs much better than static adjusted radar data and data from rain gauges situated 2-3 km away.

High-sensitivity C-reactive protein predicts mortality but not stroke

PubMed Central

Elkind, M S.V.; Luna, J M.; Moon, Y P.; Liu, K M.; Spitalnik, S L.; Paik, M C.; Sacco, R L.

2009-01-01

Objective: To determine whether high-sensitivity C-reactive protein (hsCRP) and serum amyloid A (SAA) predict stroke, vascular events, and mortality in a prospective cohort study. Background: Markers of inflammation have been associated with risk of myocardial infarction (MI). Their association with stroke is controversial. Methods: The Northern Manhattan Study includes a stroke-free community-based cohort study in participants aged ≥40 years (median follow-up 7.9 years). hsCRP and SAA were measured using nephelometry. Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the association of markers with risk of ischemic stroke and other outcomes after adjusting for demographics and risk factors. Results: hsCRP measurements were available in 2,240 participants (mean age 68.9 ± 10.1 years; 64.2% women; 18.8% white, 23.5% black, and 55.1% Hispanic). The median hsCRP was 2.5 mg/L. Compared with those with hsCRP <1 mg/L, those with hsCRP >3 mg/L were at increased risk of ischemic stroke in a model adjusted for demographics (HR = 1.60, 95% CI 1.06–2.41), but the effect was attenuated after adjusting for other risk factors (adjusted HR = 1.20, 95% CI 0.78–1.86). hsCRP >3 mg/L was associated with risk of MI (adjusted HR = 1.70, 95% CI 1.04–2.77) and death (adjusted HR = 1.55, 95% CI 1.23–1.96). SAA was not associated with stroke risk. Conclusion: In this multiethnic cohort, high-sensitivity C-reactive protein (hsCRP) was not associated with ischemic stroke, but was modestly associated with myocardial infarction and mortality. The value of hsCRP and serum amyloid A may depend on population characteristics such as age and other risk factors. GLOSSARY AHA = American Heart Association; BP = blood pressure; CDC = Centers for Disease Control and Prevention; CI = confidence interval; CRP = C-reactive protein; CUMC = Columbia University Medical Center; HR = hazard ratio; hsCRP = high-sensitivity C-reactive protein; IQR = interquartile range; JUPITER = Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin; MI = myocardial infarction; NOMAS = Northern Manhattan Study; SAA = serum amyloid A. PMID:19841382

Stress and Personal Resource as Predictors of the Adjustment of Parents to Autistic Children: A Multivariate Model

ERIC Educational Resources Information Center

Siman-Tov, Ayelet; Kaniel, Shlomo

2011-01-01

The research validates a multivariate model that predicts parental adjustment to coping successfully with an autistic child. The model comprises four elements: parental stress, parental resources, parental adjustment and the child's autism symptoms. 176 parents of children aged between 6 to 16 diagnosed with PDD answered several questionnaires…

Comparison of LiST measles mortality model and WHO/IVB measles model

PubMed Central

2011-01-01

Background The Lives Saved Tool (LiST) has been developed to estimate the impact of health interventions and can consider multiple interventions simultaneously. Given its increasing usage by donor organizations and national program planner, we compare the LiST measles model to the widely used World Health Organization's Department of Immunization, Vaccines and Biologicals (WHO/IVB) measles model which is used to produce estimates serving as a major indicator of monitoring country measles epidemics and the progress of measles control. Methods We analyzed the WHO/IVB models and the LiST measles model and identified components and assumptions held in each model. We contrasted the important components, and compared results from the two models by applying historical measles containing vaccine (MCV) coverages and the default values of all parameters set in the models. We also conducted analyses following a hypothetical scenario to understand how both models performed when the proportion of population protected by MCV declined to zero percent in short time period. Results The WHO/IVB measles model and the LiST measles model structures differ: the former is a mixed model which applies surveillance data adjusted for reporting completeness for countries with good disease surveillance system and applies a natural history model for countries with poorer disease control program and surveillance system, and the latter is a cohort model incorporating country-specific cause-of-death (CoD) profiles among children under-five. The trends of estimates of the two models are similar, but the estimates of the first year are different in most of the countries included in the analysis. The two models are comparable if we adjust the measles CoD in the LiST to produce the same baseline estimates. In addition, we used the models to estimate the potential impact of stopping using measles vaccine over a 7-year period. The WHO/IVB model produced similar estimates to the LiST model with adjusted CoD. But the LiST model produced low estimates for countries with very low or eliminated measles infection that may be inappropriate. Conclusions The study presents methodological and quantitative comparisons between the WHO/IVB and the LiST measles models that highlights differences in model structures and may help users to better interpret and contrast estimates of the measles death from the two models. The major differences are resulted from the usage of case-fatality rate (CFR) in the WHO/IVB model and the CoD profile in the LiST. Both models have their own advantages and limitations. Users should be aware of the issue and apply as update country parameters as possible. Advanced models are expected to validate the policy-planning tools in the future. PMID:21501452

Adjustment in Mothers of Children with Asperger Syndrome: An Application of the Double ABCX Model of Family Adjustment

ERIC Educational Resources Information Center

Pakenham, Kenneth I.; Samios, Christina; Sofronoff, Kate

2005-01-01

The present study examined the applicability of the double ABCX model of family adjustment in explaining maternal adjustment to caring for a child diagnosed with Asperger syndrome. Forty-seven mothers completed questionnaires at a university clinic while their children were participating in an anxiety intervention. The children were aged between…

Long-term Survival Outcomes by Smoking Status in Surgical and Nonsurgical Patients With Non-small Cell Lung Cancer

PubMed Central

Meguid, Robert A.; Hooker, Craig M.; Harris, James; Xu, Li; Westra, William H.; Sherwood, J. Timothy; Sussman, Marc; Cattaneo, Stephen M.; Shin, James; Cox, Solange; Christensen, Joani; Prints, Yelena; Yuan, Nance; Zhang, Jennifer; Yang, Stephen C.

2010-01-01

Background: Survival outcomes of never smokers with non-small cell lung cancer (NSCLC) who undergo surgery are poorly characterized. This investigation compared surgical outcomes of never and current smokers with NSCLC. Methods: This investigation was a single-institution retrospective study of never and current smokers with NSCLC from 1975 to 2004. From an analytic cohort of 4,546 patients with NSCLC, we identified 724 never smokers and 3,822 current smokers. Overall, 1,142 patients underwent surgery with curative intent. For survival analysis by smoking status, hazard ratios (HRs) were estimated using Cox proportional hazard modeling and then further adjusted by other covariates. Results: Never smokers were significantly more likely than current smokers to be women (P < .01), older (P < .01), and to have adenocarcinoma (P < .01) and bronchioloalveolar carcinoma (P < .01). No statistically significant differences existed in stage distribution at presentation for the analytic cohort (P = .35) or for the subgroup undergoing surgery (P = .24). The strongest risk factors of mortality among patients with NSCLC who underwent surgery were advanced stage (adjusted hazard ratio, 3.43; 95% CI, 2.32-5.07; P < .01) and elevated American Society of Anesthesiologists classification (adjusted hazard ratio, 2.18; 95% CI, 1.40-3.40; P < .01). The minor trend toward an elevated risk of death on univariate analysis for current vs never smokers in the surgically treated group (hazard ratio, 1.20; 95% CI, 0.98-1.46; P = .07) was completely eliminated when the model was adjusted for covariates (P = .97). Conclusions: Our findings suggest that smoking status at time of lung cancer diagnosis has little impact on the long-term survival of patients with NSCLC, especially after curative surgery. Despite different etiologies between lung cancer in never and current smokers the prognosis is equally dismal. PMID:20507946

Fat mass and obesity-associated gene rs11642015 polymorphism is significantly associated with prediabetes and type 2 diabetes subsequent to adjustment for body mass index.

PubMed

Han, Liyuan; Tang, Linlin; Wang, Changyi; Chen, Zhongwei; Zhang, Tao; Chen, Sihan; Liu, Shengyuan; Peng, Xiaolin; Mai, Yifeng; Duan, Shiwei

2014-09-01

The association of the fat mass and obesity-associated gene ( FTO ) rs11642015 polymorphism with prediabetes, type 2 diabetes and obesity in certain populations has not been previously reported. A population-based study was conducted that included 490 type 2 diabetic, 471 prediabetic and 575 normal subjects. The main outcomes of the study were prediabetes, type 2 diabetes and obesity. Binary logistic regression was performed to estimate the association of FTO rs11642015 with the risk of prediabetes, type 2 diabetes and obesity following adjustment for the corresponding confounders. A meta-analysis was also conducted to evaluate the association between FTO rs11642015 and obesity. FTO rs11642015 was significantly associated with prediabetes in the whole sample under the additive model [odds ratio (OR), 1.50; 95% confidence interval (CI), 1.17-1.93; P=0.002], particularly in females. The polymorphism remained consistently significant following adjustment for age and body mass index (BMI), showing an increased prediabetes risk with an additive effect (OR, 1.55; 95% CI, 1.19-2.01; P=0.001). In addition, a significant association was found for rs11642015 with prediabetes and type 2 diabetes under the dominant model. However, under the stringent Bonferroni's correction there was no evidence of positive associations for FTO rs11642015 with obesity in the whole sample, females or males. Findings of the meta-analysis showed that FTO rs11642015 was not predisposed to obesity. In conclusion, the T allele of FTO rs11642015 is positively associated with an increased risk of prediabetes, even after adjustment for age and BMI, particularly in females. Subjects carrying the CT + TT genotype are predisposed to prediabetes and type 2 diabetes. Therefore, results of the population-based study and follow-up meta-analysis suggested that FTO rs11642015 is not significantly associated with susceptibility to obesity.

CD4/CD8 ratio, age, and risk of serious non-communicable diseases in HIV-infected adults on antiretroviral therapy

PubMed Central

CASTILHO, Jessica L.; SHEPHERD, Bryan E.; KOETHE, John; TURNER, Megan; BEBAWY, Sally; LOGAN, James; ROGERS, William B.; RAFFANTI, Stephen; STERLING, Timothy R.

2015-01-01

Objective In virologically suppressed HIV-infected adults, non-communicable diseases (NCDs) have been associated with immune senescence and low CD4/CD8 lymphocyte ratio. Age differences in the relationship between CD4/CD8 ratio and NCDs have not been described. Design Observational cohort study. Methods We assessed CD4/CD8 ratio and incident NCDs (cardiovascular, cancer, liver, and renal diseases) in HIV-infected adults started on antiretroviral therapy between 1998–2012. Study inclusion began once patients maintained virologic suppression for 12 months (defined as baseline). We examined age and baseline CD4/CD8 ratio and used Cox proportional hazard models to assess baseline CD4/CD8 ratio and NCDs. Results This study included 2,006 patients. Low baseline CD4/CD8 ratio was associated with older age, male sex, and low CD4 lymphocyte counts. In models adjusting for CD4 lymphocyte count, CD4/CD8 ratio was inversely associated with age (p <0.01). Among all patients, 182 had incident NCDs, including 46 with coronary artery disease (CAD) events. CD4/CD8 ratio was inversely associated with risk of CAD events (adjusted HR per 0.1 increase in CD4/CD8 ratio = 0.87, 95% CI: 0.76–0.99, p=0.03). This association was driven by those under age 50 years (adjusted HR 0.83 [0.70–0.97], p = 0.02) versus those over age 50 years (adjusted HR = 0.96 [0.79–1.18], p = 0.71). CD4/CD8 ratio was not significantly associated with incident non-cardiac NCDs. Conclusions Higher CD4/CD8 ratio after one year of HIV virologic suppression was independently predictive of decreased CAD risk, particularly among younger adults. Advanced immune senescence may contribute to CAD events in younger HIV patients on antiretroviral therapy. PMID:26959354

Prevalence of obesity, diabetes and other cardiovascular risk factors in Andalusia (southern Spain). Comparison with national prevalence data. The Di@bet.es study.

PubMed

Valdés, Sergio; García-Torres, Francisca; Maldonado-Araque, Cristina; Goday, Albert; Calle-Pascual, Alfonso; Soriguer, Federico; Castaño, Luis; Catalá, Miguel; Gomis, Ramon; Rojo-Martínez, Gemma

2014-06-01

The aim of this study was to compare the prevalences of obesity, diabetes and other cardiovascular risk factors in the region of Andalusia with those in the rest of Spain. The Di@bet.es study is a national, cross-sectional, population-based survey of cardiometabolic risk factors and their association with lifestyle. The sample consisted of 5103 participants ≥ 18 years. The variables analyzed were clinical, demographic and lifestyle survey, physical examination, and oral glucose tolerance test. The prevalence of cardiovascular risk factors in Andalusia (n=1517) was compared with that for the rest of Spain (n=3586). In data adjusted to the Spanish population, the prevalence of diabetes (World Health Organization, 1999), hypertension (blood pressure ≥ 140/90 mmHg), high-sensitivity CRP levels (≥ 3 mg/L) and obesity (body mass index ≥ 30 kg/m(2)) were 16.3%, 43.9%, 32.0%, and 37.0% in Andalusia compared with 12.5%, 39.9%, 28.3%, and 26.6% in the rest of Spain (P<.001 for differences except P=.01 for the difference in high-sensitivity CRP levels). The corresponding figures for the Andalusia data adjusted to the Andalusian population were 15.3%, 42.3%, 31.4%, and 34.0%, respectively. Differences in diabetes, hypertension and high-sensitivity CRP were not significant in models adjusted for age, sex, and adiposity measurements. Differences in obesity were not significant in models adjusted for age, sex, educational level, marital status, work status, and physical activity (P=.086) CONCLUSIONS: This study contributes information from a national study perspective and shows a higher prevalence of cardiovascular risk factors in southern Spain, in close relation to obesity, a sedentary lifestyle, and markers of socioeconomic disadvantage. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

Cost-Effectiveness of Providing Full Drug Coverage to Increase Medication Adherence in Post–Myocardial Infarction Medicare Beneficiaries

PubMed Central

Choudhry, Niteesh K.; Patrick, Amanda R.; Antman, Elliott M.; Avorn, Jerry; Shrank, William H.

2009-01-01

Background Effective therapies for the secondary prevention of coronary heart disease–related events are significantly underused, and attempts to improve adherence have often yielded disappointing results. Elimination of patient out-of-pocket costs may be an effective strategy to enhance medication use. We sought to estimate the incremental cost-effectiveness of providing full coverage for aspirin, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins (combination pharmacotherapy) to individuals enrolled in the Medicare drug benefit program after acute myocardial infarction. Methods and Results We created a Markov cost-effectiveness model to estimate the incremental cost-effectiveness of providing Medicare beneficiaries with full coverage for combination pharmacotherapy compared with current coverage under the Medicare Part D program. Our analysis was conducted from the societal perspective and considered a lifetime time horizon. In a sensitivity analysis, we repeated our analysis from the perspective of Medicare. In the model, post–myocardial infarction Medicare beneficiaries who received usual prescription drug coverage under the Part D program lived an average of 8.21 quality-adjusted life-years after their initial event, incurring coronary heart disease–related medical costs of $114 000. Those who received prescription drug coverage without deductibles or copayments lived an average of 8.56 quality-adjusted life-years and incurred $111 600 in coronary heart disease–related costs. Compared with current prescription drug coverage, full coverage for post–myocardial infarction secondary prevention therapies would result in greater functional life expectancy (0.35 quality-adjusted life-year) and less resource use ($2500). From the perspective of Medicare, full drug coverage was highly cost-effective ($7182/quality-adjusted life-year) but not cost saving. Conclusions Our analysis suggests that providing full coverage for combination therapy to post–myocardial infarction Medicare beneficiaries would save both lives and money from the societal perspective. PMID:18285564

Scaling up integrated prevention campaigns for global health: costs and cost-effectiveness in 70 countries

PubMed Central

Marseille, Elliot; Jiwani, Aliya; Raut, Abhishek; Verguet, Stéphane; Walson, Judd; Kahn, James G

2014-01-01

Objective This study estimated the health impact, cost and cost-effectiveness of an integrated prevention campaign (IPC) focused on diarrhoea, malaria and HIV in 70 countries ranked by per capita disability-adjusted life-year (DALY) burden for the three diseases. Methods We constructed a deterministic cost-effectiveness model portraying an IPC combining counselling and testing, cotrimoxazole prophylaxis, referral to treatment and condom distribution for HIV prevention; bed nets for malaria prevention; and provision of household water filters for diarrhoea prevention. We developed a mix of empirical and modelled cost and health impact estimates applied to all 70 countries. One-way, multiway and scenario sensitivity analyses were conducted to document the strength of our findings. We used a healthcare payer's perspective, discounted costs and DALYs at 3% per year and denominated cost in 2012 US dollars. Primary and secondary outcomes The primary outcome was cost-effectiveness expressed as net cost per DALY averted. Other outcomes included cost of the IPC; net IPC costs adjusted for averted and additional medical costs and DALYs averted. Results Implementation of the IPC in the 10 most cost-effective countries at 15% population coverage would cost US$583 million over 3 years (adjusted costs of US$398 million), averting 8.0 million DALYs. Extending IPC programmes to all 70 of the identified high-burden countries at 15% coverage would cost an adjusted US$51.3 billion and avert 78.7 million DALYs. Incremental cost-effectiveness ranged from US$49 per DALY averted for the 10 countries with the most favourable cost-effectiveness to US$119, US$181, US$335, US$1692 and US$8340 per DALY averted as each successive group of 10 countries is added ordered by decreasing cost-effectiveness. Conclusions IPC appears cost-effective in many settings, and has the potential to substantially reduce the burden of disease in resource-poor countries. This study increases confidence that IPC can be an important new approach for enhancing global health. PMID:24969782

Normalized Shape and Location of Perturbed Craniofacial Structures in the Xenopus Tadpole Reveal an Innate Ability to Achieve Correct Morphology

PubMed Central

Vandenberg, Laura N.; Adams, Dany S.; Levin, Michael

2012-01-01

Background Embryonic development can often adjust its morphogenetic processes to counteract external perturbation. The existence of self-monitoring responses during pattern formation is of considerable importance to the biomedicine of birth defects, but has not been quantitatively addressed. To understand the computational capabilities of biological tissues in a molecularly-tractable model system, we induced craniofacial defects in Xenopus embryos, then tracked tadpoles with craniofacial deformities and used geometric morphometric techniques to characterize changes in the shape and position of the craniofacial structures. Results Canonical variate analysis revealed that the shapes and relative positions of perturbed jaws and branchial arches were corrected during the first few months of tadpole development. Analysis of the relative movements of the anterior-most structures indicates that misplaced structures move along the anterior-posterior and left-right axes in ways that are significantly different from their normal movements. Conclusions Our data suggest a model in which craniofacial structures utilize a measuring mechanism to assess and adjust their location relative to other local organs. Understanding the correction mechanisms at work in this system could lead to the better understanding of the adaptive decision-making capabilities of living tissues and suggest new approaches to correct birth defects in humans. PMID:22411736

Association Between Neighborhood-Level Smoking and Individual Smoking Risk: Maternal Smoking Among Latina Women in Pennsylvania

PubMed Central

French, Benjamin; Weibe, Douglas; Camenga, Deepa R.; Yun, Katherine

2015-01-01

Objective We examined whether or not high maternal smoking rates at the neighborhood level increase the likelihood of individual smoking by Latina women in the three months prior to and during pregnancy, independent of other individual and neighborhood factors. Methods This study was observational in nature, using linked vital statistics records for 24,443 Latina women in Pennsylvania (2009–2010) and U.S. Census data for 2,398 census tracts. We used multilevel logistic regression models to determine the individual odds of self-reported maternal smoking given different census tract-level rates of maternal smoking in the previous three years (2006–2008), adjusting for maternal and census-tract characteristics, including ethnic density, population density, and poverty. Results Higher levels of maternal smoking at the census-tract level were associated with increased individual odds of smoking among Latina mothers. In the fully adjusted model, a 10% increase in the neighborhood smoking rate was associated with a 1.28 (95% confidence interval 1.22, 1.34) increase in the individual odds of smoking. Conclusion Latina women living in census tracts where more women have smoked during or immediately prior to pregnancy are themselves at higher risk of smoking during this period. PMID:26556939

Correlates of Suicidality: Investigation of a Representative Sample of Manitoba First Nations Adolescents

PubMed Central

Mota, Natalie; Elias, Brenda; Tefft, Bruce; Medved, Maria; Munro, Garry

2012-01-01

Objectives. We examined individual, friend or family, and community or tribe correlates of suicidality in a representative on-reserve sample of First Nations adolescents. Methods. Data came from the 2002–2003 Manitoba First Nations Regional Longitudinal Health Survey of Youth. Interviews were conducted with adolescents aged 12 to 17 years (n = 1125) from 23 First Nations communities in Manitoba. We used bivariate logistic regression analyses to examine the relationships between a range of factors and lifetime suicidality. We conducted sex-by-correlate interactions for each significant correlate at the bivariate level. A multivariate logistic regression analysis identified those correlates most strongly related to suicidality. Results. We found several variables to be associated with an increased likelihood of suicidality in the multivariate model, including being female, depressed mood, abuse or fear of abuse, a hospital stay, and substance use (adjusted odds ratio range = 2.43–11.73). Perceived community caring was protective against suicidality (adjusted odds ratio = 0.93; 95% confidence interval = 0.88, 0.97) in the same model. Conclusions. Results of this study may be important in informing First Nations and government policy related to the implementation of suicide prevention strategies in First Nations communities. PMID:22676500

Environmental arsenic exposure and serum matrix metalloproteinase-9.

PubMed

Burgess, Jefferey L; Kurzius-Spencer, Margaret; O'Rourke, Mary Kay; Littau, Sally R; Roberge, Jason; Meza-Montenegro, Maria Mercedes; Gutiérrez-Millán, Luis Enrique; Harris, Robin B

2013-03-01

The objective of this study was to evaluate the relationship between environmental arsenic exposure and serum matrix metalloproteinase (MMP)-9, a biomarker associated with cardiovascular disease and cancer. In a cross-sectional study of residents of Arizona, USA (n=215) and Sonora, Mexico (n=163), drinking water was assayed for total arsenic, and daily drinking water arsenic intake was estimated. Urine was speciated for arsenic, and concentrations were adjusted for specific gravity. Serum was analyzed for MMP-9 using ELISA. Mixed model linear regression was used to assess the relation among drinking water arsenic concentration, drinking water arsenic intake, urinary arsenic sum of species (the sum of arsenite, arsenate, monomethylarsonic acid and dimethylarsinic acid), and MMP-9, controlling for autocorrelation within households. Drinking water arsenic concentration and intake were positively associated with MMP-9, both in crude analysis and after adjustment for gender, country/ethnicity, age, body mass index, current smoking, and diabetes. Urinary arsenic sum of species was positively associated with MMP-9 in multivariable analysis only. Using Akaike's Information Criterion, arsenic concentration in drinking water provided a better fitting model of MMP-9 than either urinary arsenic or drinking water arsenic intake. In conclusion, arsenic exposure evaluated using all three exposure metrics was positively associated with MMP-9.

Environmental arsenic exposure and serum matrix metalloproteinase-9

PubMed Central

Burgess, Jefferey L.; Kurzius-Spencer, Margaret; O’Rourke, Mary Kay; Littau, Sally R.; Roberge, Jason; Meza-Montenegro, Maria Mercedes; Gutiérrez-Millán, Luis Enrique; Harris, Robin B.

2014-01-01

The objective of this study was to evaluate the relationship between environmental arsenic exposure and serum matrix metalloproteinase (MMP)-9, a biomarker associated with cardiovascular disease and cancer. In a cross-sectional study of residents of Arizona, USA (n=215) and Sonora, Mexico (n=163), drinking water was assayed for total arsenic, and daily drinking water arsenic intake estimated. Urine was speciated for arsenic and concentrations were adjusted for specific gravity. Serum was analyzed for MMP-9 using ELISA. Mixed model linear regression was used to assess the relation among drinking water arsenic concentration, drinking water arsenic intake, urinary arsenic sum of species (the sum of arsenite, arsenate, monomethylarsonic acid and dimethylarsinic acid), and MMP-9, controlling for autocorrelation within households. Drinking water arsenic concentration and intake were positively associated with MMP-9, both in crude analysis and after adjustment for gender, country/ethnicity, age, body mass index, current smoking and diabetes. Urinary arsenic sum of species was positively associated with MMP-9 in multivariable analysis only. Using Akaike’s Information Criterion, arsenic concentration in drinking water provided a better fitting model of MMP-9, than either urinary arsenic or drinking water arsenic intake. In conclusion, arsenic exposure was positively associated with MMP-9 using all three exposure metrics evaluated. PMID:23232971

Vitamin D levels and menopause-related symptoms

PubMed Central

LeBlanc, Erin S.; Desai, Manisha; Perrin, Nancy; Wactawski-Wende, Jean; Manson, JoAnn E.; Cauley, Jane A.; Michael, Yvonne L.; Tang, Jean; Womack, Catherine; Song, Yiqing; Johnson, Karen C.; O’Sullivan, Mary J.; Woods, Nancy; Stefanick, Marcia L.

2015-01-01

Objective To determine whether vitamin D levels are associated with menopause-related symptoms in older women. Methods A randomly selected subset of 1,407 women, among 26,104 potentially eligible participants of the Women’s Health Initiative Calcium and Vitamin D (CaD) trial of postmenopausal women aged 51-80 years, had 25-hydroxyvitamin D [25(OH)D] levels measured at the CaD trial baseline visit. Information about menopause-related symptoms at baseline was obtained by questionnaire and included overall number of symptoms and composite measures of sleep disturbance, emotional well-being, and energy/fatigue, as well as individual symptoms. After exclusions for missing data, 530 women [mean age 66.2 years (SD 6.8)] were included in these analyses. Results There were borderline significant associations between 25(OH)D levels and total number of menopausal symptoms (p values ranging from 0.05 to 0.06 for fully adjusted models); however, the effect was clinically insignificant and disappeared with correction for multiple testing. There were no associations between 25(OH)D levels and composite measures of sleep disturbance, emotional well-being, or energy/fatigue (p’s > 0.10 for fully adjusted models). Conclusions There was no evidence of a clinically important association between serum 25(OH)D levels and menopause-related symptoms in postmenopausal women. PMID:24736200

No association of smoke-free ordinances with profits from bingo and charitable games in Massachusetts

PubMed Central

Glantz, S; Wilson-Loots, R

2003-01-01

Background: Because it is widely played, claims that smoking restrictions will adversely affect bingo games is used as an argument against these policies. We used publicly available data from Massachusetts to assess the impact of 100% smoke-free ordinances on profits from bingo and other gambling sponsored by charitable organisations between 1985 and 2001. Methods: We conducted two analyses: (1) a general linear model implementation of a time series analysis with net profits (adjusted to 2001 dollars) as the dependent variable, and community (as a fixed effect), year, lagged net profits, and the length of time the ordinance had been in force as the independent variables; (2) multiple linear regression of total state profits against time, lagged profits, and the percentage of the entire state population in communities that allow charitable gaming but prohibit smoking. Results: The general linear model analysis of data from individual communities showed that, while adjusted profits fell over time, this effect was not related to the presence of an ordinance. The analysis in terms of the fraction of the population living in communities with ordinances yielded the same result. Conclusion: Policymakers can implement smoke-free policies without concern that these policies will affect charitable gaming. PMID:14660778

Advertising Receptivity and Youth Initiation of Smokeless Tobacco.

PubMed

Timberlake, David S

2016-07-28

Cross-sectional data suggests that adolescents' receptivity to the advertising of smokeless tobacco is correlated with use of chewing tobacco or snuff. Lack of longitudinal data has precluded determination of whether advertising receptivity precedes or follows initiation of smokeless tobacco. The objective of this study was to test for the association between advertising receptivity and subsequent initiation of smokeless tobacco among adolescent males. Adolescent males from the 1993-1999 Teen Longitudinal California Tobacco Survey were selected at the baseline survey for never having used smokeless tobacco. Separate longitudinal analyses corresponded to two dependent variables, ever use of smokeless tobacco (1993-1996; N = 1,388) and use on 20 or more occasions (1993-1999; N = 1,014). Models were adjusted for demographic variables, risk factors for smokeless tobacco use, and exposure to users of smokeless tobacco. Advertising receptivity at baseline was predictive of ever use by late adolescence (RR(95% CI) = 2.0 (1.5, 2.8)) and regular use by young adulthood (RR(95% CI) = 3.7 (2.1, 6.7)) in models that were adjusted for covariates. Conclusions/ Importance: The findings challenge the tobacco industry's assertion that tobacco marketing does not impact youth initiation. This is particularly relevant to tobacco control in the United States because the 2009 Tobacco Control Act places fewer restrictions on smokeless tobacco products compared to cigarettes.

Multigenerational effects of parental prenatal exposure to famine on adult offspring cognitive function

PubMed Central

Li, Jie; Na, Lixin; Ma, Hao; Zhang, Zhe; Li, Tianjiao; Lin, Liqun; Li, Qiang; Sun, Changhao; Li, Ying

2015-01-01

The effects of prenatal nutrition on adult cognitive function have been reported for one generation. However, human evidence for multigenerational effects is lacking. We examined whether prenatal exposure to the Chinese famine of 1959–61 affects adult cognitive function in two consecutive generations. In this retrospective family cohort study, we investigated 1062 families consisting of 2124 parents and 1215 offspring. We assessed parental and offspring cognitive performance by means of a comprehensive test battery. Generalized linear regression model analysis in the parental generation showed that prenatal exposure to famine was associated with a 8.1 (95% CI 5.8 to 10.4) second increase in trail making test part A, a 7.0 (1.5 to 12.5) second increase in trail making test part B, and a 5.5 (−7.3 to −3.7) score decrease in the Stroop color-word test in adulthood, after adjustment for potential confounders. In the offspring generation, linear mixed model analysis found no significant association between parental prenatal exposure to famine and offspring cognitive function in adulthood after adjustment for potential confounders. In conclusion, prenatal exposure to severe malnutrition is negatively associated with visual- motor skill, mental flexibility, and selective attention in adulthood. However, these associations are limited to only one generation. PMID:26333696

Maternal pre-pregnancy obesity and neuropsychological development in pre-school children: a prospective cohort study.

PubMed

Casas, Maribel; Forns, Joan; Martínez, David; Guxens, Mònica; Fernandez-Somoano, Ana; Ibarluzea, Jesus; Lertxundi, Nerea; Murcia, Mario; Rebagliato, Marisa; Tardon, Adonina; Sunyer, Jordi; Vrijheid, Martine

2017-10-01

BackgroundMaternal pre-pregnancy obesity may impair infant neuropsychological development, but it is unclear whether intrauterine or confounding factors drive this association.MethodsWe assessed whether maternal pre-pregnancy obesity was associated with neuropsychological development in 1,827 Spanish children. At 5 years, cognitive and psychomotor development was assessed using McCarthy Scales of Children's Abilities, attention deficit hyperactivity disorder (ADHD) symptoms using the Criteria of Diagnostic and Statistical Manual of Mental Disorders, and autism spectrum disorder symptoms using the Childhood Asperger Syndrome Test. Models were adjusted for sociodemographic factors and maternal intelligence quotient. We used paternal obesity as negative control exposure as it involves the same source of confounding than maternal obesity.ResultsThe percentage of obese mothers and fathers was 8% and 12%, respectively. In unadjusted models, children of obese mothers had lower scores than children of normal weight mothers in all McCarthy subscales. After adjustment, only the verbal subscale remained statistically significantly reduced (β: -2.8; 95% confidence interval: -5.3, -0.2). No associations were observed among obese fathers. Maternal and paternal obesity were associated with an increase in ADHD-related symptoms. Parental obesity was not associated with autism symptoms.ConclusionMaternal pre-pregnancy obesity was associated with a reduction in offspring verbal scores at pre-school age.

Method of Individual Adjustment for 3D CT Analysis: Linear Measurement.

PubMed

Kim, Dong Kyu; Choi, Dong Hun; Lee, Jeong Woo; Yang, Jung Dug; Chung, Ho Yun; Cho, Byung Chae; Choi, Kang Young

2016-01-01

Introduction . We aim to regularize measurement values in three-dimensional (3D) computed tomography (CT) reconstructed images for higher-precision 3D analysis, focusing on length-based 3D cephalometric examinations. Methods . We measure the linear distances between points on different skull models using Vernier calipers (real values). We use 10 differently tilted CT scans for 3D CT reconstruction of the models and measure the same linear distances from the picture archiving and communication system (PACS). In both cases, each measurement is performed three times by three doctors, yielding nine measurements. The real values are compared with the PACS values. Each PACS measurement is revised based on the display field of view (DFOV) values and compared with the real values. Results . The real values and the PACS measurement changes according to tilt value have no significant correlations ( p > 0.05). However, significant correlations appear between the real values and DFOV-adjusted PACS measurements ( p < 0.001). Hence, we obtain a correlation expression that can yield real physical values from PACS measurements. The DFOV value intervals for various age groups are also verified. Conclusion . Precise confirmation of individual preoperative length and precise analysis of postoperative improvements through 3D analysis is possible, which is helpful for facial-bone-surgery symmetry correction.

Socioeconomic Status and Longitudinal Lung Function of Healthy Mexican Children

PubMed Central

Martínez-Briseño, David; Fernández-Plata, Rosario; Gochicoa-Rangel, Laura; Torre-Bouscoulet, Luis; Rojas-Martínez, Rosalba; Mendoza-Alvarado, Laura; García-Sancho, Cecilia; Pérez-Padilla, Rogelio

2015-01-01

Introduction Our aim was to estimate the longitudinal effect of Socioeconomic status (SES) on lung function growth of Mexican children and adolescents. Materials and Methods A cohort of Mexican children in third grade of primary school was followed with spirometry twice a year for 6 years through secondary school. Multilevel mixed-effects lineal models were fitted for the spirometric variables of 2,641 respiratory-healthy Mexican children. Monthly family income (in 2002 U.S. dollars [USD]) and parents’ years completed at school were used as proxies of SES. Results Individuals with higher SES tended to have greater height for age, and smaller sitting height/standing height and crude lung function. For each 1-year increase of parents’ schooling, Forced expiratory volume in 1 sec (FEV1) and Forced vital capacity (FVC) increased 8.5 (0.4%) and 10.6 mL (0.4%), respectively (p <0.05) when models were adjusted for gender. Impact of education on lung function was reduced drastically or abolished on adjusting by anthropometric variables and ozone. Conclusions Higher parental schooling and higher monthly family income were associated with higher lung function in healthy Mexican children, with the majority of the effect likely due to the increase in height-for-age. PMID:26379144

The association between psychotic experiences and disability: results from the WHO World Mental Health Surveys

PubMed Central

Navarro-Mateu, Fernando; Alonso, Jordi; Lim, Carmen C. W.; Saha, Sukanta; Aguilar-Gaxiola, Sergio; Al-Hamzawi, Ali; Andrade, Laura H.; Bromet, Evelyn J.; Bruffaerts, Ronny; Chatterji, Somnath; Degenhardt, Louisa; de Girolamo, Giovanni; de Jonge, Peter; Fayyad, John; Florescu, Silvia; Gureje, Oye; Haro, Josep M.; Hu, Chiyi; Karam, Elie G.; Kovess-Masfety, Viviane; Lee, Sing; Medina-Mora, Maria E.; Ojagbemi, Akin; Pennell, Beth-Ellen; Posada-Villa, Jose; Scott, Kate M.; Stagnaro, Juan Carlos; Kendler, Kenneth S.; Kessler, Ronald C.; McGrath, John J.

2017-01-01

Objective While psychotic experiences (PEs) are known to be associated with a range of mental and general medical disorders, little is known about the association between PEs and measures of disability. We aimed to investigate this question using the World Mental Health surveys. Method Lifetime occurrences of 6 types of PEs were assessed along with 21 mental disorders and 14 general medical conditions. Disability was assessed with a modified version of the WHO Disability Assessment Schedule. Descriptive statistics and logistic regression models were used to investigate the association between PEs and high disability scores (top quartile) with various adjustments. Results Respondents with PEs were more likely to have top quartile scores on global disability than respondents without PEs (19.1% vs. 7.5%; χ2 = 190.1, p<.001) as well as greater likelihood of cognitive, social, and role impairment. Relationships persisted in each adjusted model. A significant dose-response relationship was also found for the PE type measures with most of these outcomes. Conclusions Psychotic experiences are associated with disability measures with a dose response relationship. These results are consistent with the view that PEs are associated with disability regardless of the presence of comorbid mental or general medical disorders. PMID:28542726

The Association between Bone Quality and Atherosclerosis: Results from Two Large Population-Based Studies

PubMed Central

Lange, V.; Dörr, M.; Schminke, U.; Völzke, H.; Nauck, M.; Wallaschofski, H.

2017-01-01

Objective It is highly debated whether associations between osteoporosis and atherosclerosis are independent of cardiovascular risk factors. We aimed to explore the associations between quantitative ultrasound (QUS) parameters at the heel with the carotid artery intima-media thickness (IMT), the presence of carotid artery plaques, and the ankle-brachial index (ABI). Methods The study population comprised 5680 men and women aged 20–93 years from two population-based cohort studies: Study of Health in Pomerania (SHIP) and SHIP-Trend. QUS measurements were performed at the heel. The extracranial carotid arteries were examined with B-mode ultrasonography. ABI was measured in a subgroup of 3853 participants. Analyses of variance and linear and logistic regression models were calculated and adjusted for major cardiovascular risk factors. Results Men but not women had significantly increased odds for carotid artery plaques with decreasing QUS parameters independent of diabetes mellitus, dyslipidemia, and hypertension. Beyond this, the QUS parameters were not significantly associated with IMT or ABI in fully adjusted models. Conclusions Our data argue against an independent role of bone metabolism in atherosclerotic changes in women. Yet, in men, associations with advanced atherosclerosis, exist. Thus, men presenting with clinical signs of osteoporosis may be at increased risk for atherosclerotic disease. PMID:28852407

Individual and contextual factors influencing dental health care utilization by preschool children: a multilevel analysis

PubMed

Piovesan, Chaiana; Ardenghi, Thiago Machado; Mendes, Fausto Medeiros; Agostini, Bernardo Antonio; Michel-Crosato, Edgard

2017-03-30

The effect of contextual factors on dental care utilization was evaluated after adjustment for individual characteristics of Brazilian preschool children. This cross-sectional study assessed 639 preschool children aged 1 to 5 years from Santa Maria, a town in Rio Grande do Sul State, located in southern Brazil. Participants were randomly selected from children attending the National Children's Vaccination Day and 15 health centers were selected for this research. Visual examinations followed the ICDAS criteria. Parents answered a questionnaire about demographic and socioeconomic characteristics. Contextual influences on children's dental care utilization were obtained from two community-related variables: presence of dentists and presence of workers' associations in the neighborhood. Unadjusted and adjusted multilevel logistic regression models were used to describe the association between outcome and predictor variables. A prevalence of 21.6% was found for regular use of dental services. The unadjusted assessment of the associations of dental health care utilization with individual and contextual factors included children's ages, family income, parents' schooling, mothers' participation in their children's school activities, dental caries, and presence of workers' associations in the neighborhood as the main outcome covariates. Individual variables remained associated with the outcome after adding contextual variables in the model. In conclusion, individual and contextual variables were associated with dental health care utilization by preschool children.

Suicidal ideation in Veterans misusing alcohol: Relationships with insomnia symptoms and sleep duration

PubMed Central

Chakravorty, Subhajit; Grandner, Michael A.; Mavandadi, Shahrzad; Perlis, Michael L.; Sturgis, Elliott B.; Oslin, David W.

2015-01-01

Objective The aim of this investigation was to assess the relationships between suicidal ideation and insomnia symptoms in Veterans misusing alcohol. Method Data were extracted in this retrospective chart review of Veterans referred from primary care for a behavioral health evaluation (N = 161) based on evidence of heavy drinking, drug use or another behavioral problem. Suicidal ideation (SI) was assessed using the Paykel questionnaire. Insomnia symptoms were assessed with standard diary questions in an interview format and pertained to sleep latency (SL), wake after sleep onset time (WASO), sleep quality (SQ), and habitual sleep duration (HSD). The relations between suicidal ideation and insomnia symptoms were assessed using ordinal regression analyses adjusted for socio-demographic, psychiatric and addiction-related variables. Results Suicidal ideation was reported in 62 (39%) of the Veterans interviewed. In a multivariable model, only inadequate SQ was associated with suicidal ideation. Short sleepers were more likely to endorse suicidal ideation and have attempted suicide in the past year. In addition, older age, inadequate financial status, and the presence of a psychiatric disorder were also significantly associated with suicidal ideation in most of the adjusted models. Conclusion Given their association with suicidal ideation, insomnia symptoms in Veterans misusing alcohol should prompt an assessment of underlying psychiatric and social factors. PMID:24169371

Sleep Duration and Insomnia Symptoms as Risk Factors for Suicidal Ideation in a Nationally Representative Sample

PubMed Central

Chakravorty, Subhajit; Siu, H.Y. Katy; Lalley-Chareczko, Linden; Brown, Gregory K.; Findley, James C.; Perlis, Michael L.; Grandner, Michael A.

2015-01-01

Objective: Suicidal behavior (suicidal ideation, suicide attempts, and suicide completion) has been increasingly linked with difficulty initiating sleep, maintaining sleep, and early morning awakenings. However, the relationship between suicidal behavior and sleep duration abnormalities is unclear, especially at the population level. The present study used a nationally representative sample to examine the association of suicidal ideation with extreme sleep durations and insomnia symptoms. Method: Cross-sectional data from adult respondents (≥ 18 years of age, N = 6,228) were extracted from the 2007–2008 wave of the National Health and Nutritional Examination Survey. Ordinal logistic regression analyses were used to evaluate the relationship of suicidal ideation with sleep duration, global insomnia, and individual insomnia symptoms in models adjusted for sociodemographic, socioeconomic, and health-related covariates. Results: Suicidal ideation was associated with abnormalities of sleep duration. This relationship ceased to exist once the model was adjusted for depressive symptoms. As expected, an increased level of suicidal ideation was consistently associated with insomnia. Of the insomnia symptoms, difficulty maintaining sleep was found to be the most predictive of suicidal ideation, followed by difficulty initiating sleep (P< .05). Conclusions: Abnormalities of sleep duration and continuity should prompt a clinical assessment for suicide risk. PMID:27057399

Metabolic syndrome and mammographic density: The Study of Women’s Health Across the Nation (SWAN)

PubMed Central

Conroy, Shannon M.; Butler, Lesley M.; Harvey, Danielle; Gold, Ellen B.; Sternfeld, Barbara; Greendale, Gail A.; Habel, Laurel A.

2013-01-01

The metabolic syndrome (MetS) is associated with an increase in breast cancer risk. In this study, we evaluated whether the MetS was associated with an increase in percent mammographic density (MD), a breast cancer risk factor. We used linear regression and mixed models to examine the cross-sectional and longitudinal associations of the MetS and components of the MetS to percent MD in 790 pre- and early perimenopausal women enrolled in the Study of Women’s Health Across the Nation (SWAN). In cross-sectional analyses adjusted for body mass index (BMI), modest inverse associations were observed between percent MD and the MetS (β = −2.5, SE = 1.9, p = 0.19), abdominal adiposity (β = −4.8, SE = 1.9, p = 0.01) and raised glucose (β = −3.7, SE = 2.4, p = 0.12). In longitudinal models adjusted for covariates including age and BMI, abdominal adiposity (β = 0.34, SE = 0.17, p = 0.05) was significantly positively associated with slower annual decline in percent MD with time. In conclusion, our results do not support the hypothesis that the MetS increases breast cancer risk via a mechanism reflected by an increase in percent MD. PMID:21105041

Ice loading model for Glacial Isostatic Adjustment in the Barents Sea constrained by GRACE gravity observations

NASA Astrophysics Data System (ADS)

Root, Bart; Tarasov, Lev; van der Wal, Wouter

2014-05-01

The global ice budget is still under discussion because the observed 120-130 m eustatic sea level equivalent since the Last Glacial Maximum (LGM) can not be explained by the current knowledge of land-ice melt after the LGM. One possible location for the missing ice is the Barents Sea Region, which was completely covered with ice during the LGM. This is deduced from relative sea level observations on Svalbard, Novaya Zemlya and the North coast of Scandinavia. However, there are no observations in the middle of the Barents Sea that capture the post-glacial uplift. With increased precision and longer time series of monthly gravity observations of the GRACE satellite mission it is possible to constrain Glacial Isostatic Adjustment in the center of the Barents Sea. This study investigates the extra constraint provided by GRACE data for modeling the past ice geometry in the Barents Sea. We use CSR release 5 data from February 2003 to July 2013. The GRACE data is corrected for the past 10 years of secular decline of glacier ice on Svalbard, Novaya Zemlya and Frans Joseph Land. With numerical GIA models for a radially symmetric Earth, we model the expected gravity changes and compare these with the GRACE observations after smoothing with a 250 km Gaussian filter. The comparisons show that for the viscosity profile VM5a, ICE-5G has too strong a gravity signal compared to GRACE. The regional calibrated ice sheet model (GLAC) of Tarasov appears to fit the amplitude of the GRACE signal. However, the GRACE data are very sensitive to the ice-melt correction, especially for Novaya Zemlya. Furthermore, the ice mass should be more concentrated to the middle of the Barents Sea. Alternative viscosity models confirm these conclusions.

Cost utility, budget impact, and scenario analysis of racecadotril in addition to oral rehydration for acute diarrhea in children in Malaysia

PubMed Central

Rautenberg, Tamlyn Anne; Zerwes, Ute; Lee, Way Seah

2018-01-01

Objective To perform cost utility (CU) and budget impact (BI) analyses augmented by scenario analyses of critical model structure components to evaluate racecadotril as adjuvant to oral rehydration solution (ORS) for children under 5 years with acute diarrhea in Malaysia. Methods A CU model was adapted to evaluate racecadotril plus ORS vs ORS alone for acute diarrhea in children younger than 5 years from a Malaysian public payer’s perspective. A bespoke BI analysis was undertaken in addition to detailed scenario analyses with respect to critical model structure components. Results According to the CU model, the intervention is less costly and more effective than comparator for the base case with a dominant incremental cost-effectiveness ratio of −RM 1,272,833/quality-adjusted life year (USD −312,726/quality-adjusted life year) in favor of the intervention. According to the BI analysis (assuming an increase of 5% market share per year for racecadotril+ORS for 5 years), the total cumulative incremental percentage reduction in health care expenditure for diarrhea in children is 0.136578%, resulting in a total potential cumulative cost savings of −RM 73,193,603 (USD −17,983,595) over a 5-year period. Results hold true across a range of plausible scenarios focused on critical model components. Conclusion Adjuvant racecadotril vs ORS alone is potentially cost-effective from a Malaysian public payer perspective subject to the assumptions and limitations of the model. BI analysis shows that this translates into potential cost savings for the Malaysian public health care system. Results hold true at evidence-based base case values and over a range of alternate scenarios. PMID:29588606

Direct risk standardisation: a new method for comparing casemix adjusted event rates using complex models

PubMed Central

2013-01-01

Background Comparison of outcomes between populations or centres may be confounded by any casemix differences and standardisation is carried out to avoid this. However, when the casemix adjustment models are large and complex, direct standardisation has been described as “practically impossible”, and indirect standardisation may lead to unfair comparisons. We propose a new method of directly standardising for risk rather than standardising for casemix which overcomes these problems. Methods Using a casemix model which is the same model as would be used in indirect standardisation, the risk in individuals is estimated. Risk categories are defined, and event rates in each category for each centre to be compared are calculated. A weighted sum of the risk category specific event rates is then calculated. We have illustrated this method using data on 6 million admissions to 146 hospitals in England in 2007/8 and an existing model with over 5000 casemix combinations, and a second dataset of 18,668 adult emergency admissions to 9 centres in the UK and overseas and a published model with over 20,000 casemix combinations and a continuous covariate. Results Substantial differences between conventional directly casemix standardised rates and rates from direct risk standardisation (DRS) were found. Results based on DRS were very similar to Standardised Mortality Ratios (SMRs) obtained from indirect standardisation, with similar standard errors. Conclusions Direct risk standardisation using our proposed method is as straightforward as using conventional direct or indirect standardisation, always enables fair comparisons of performance to be made, can use continuous casemix covariates, and was found in our examples to have similar standard errors to the SMR. It should be preferred when there is a risk that conventional direct or indirect standardisation will lead to unfair comparisons. PMID:24168424

Associations of anthropometric, behavioral, and social factors on level of body esteem in peripubertal girls

PubMed Central

Szamreta, Elizabeth A.; Qin, Bo; Ohman-Strickland, Pamela A.; Devine, Katie A.; Stapleton, Jerod L.; Ferrante, Jeanne M.; Bandera, Elisa V.

2016-01-01

Objective Lower body esteem may decrease self-esteem and lead to adverse health effects in children. This study explored the role of anthropometric, behavioral, and social factors on body esteem in peripubertal girls. Method We evaluated associations of body esteem (measured by the Revised Body Esteem Scale) with body mass index (BMI), mother’s BMI, puberty, physical activity, role models for appearance, and screen time among girls (ages 9 and 10) participating in the Jersey Girl Study (n=120). Linear models were used to evaluate differences in body esteem scores. Results Overweight/obese girls had a significantly lower mean body esteem score compared to underweight/healthy weight girls [14.09 (95% CI 12.53–15.27) vs. 17.17 (95% CI 16.87–17.43)]. Girls who were physically active for at least 7 hours per week had a significantly higher body esteem score than those who were less active, after adjusting for BMI [17.00 (95% CI 16.62–17.32) vs. 16.39 (95% CI 15.82–16.86)]. Girls whose mothers were overweight/obese, who had entered puberty, and who cited girls at school or females in the media as role models had lower body esteem scores, but differences disappeared after adjusting for girl’s BMI. A trend of higher body esteem scores was found for girls whose mothers were role models. Conclusion Lower BMI and higher levels of physical activity are independently associated with higher body esteem score. Having classmates or girls/women in the media as role models may detrimentally affect girls’ body esteem, but having mothers as role models may have a positive effect. PMID:27902543

Playing Active Video Games may not develop movement skills: An intervention trial

PubMed Central

Barnett, Lisa M.; Ridgers, Nicola D.; Reynolds, John; Hanna, Lisa; Salmon, Jo

2015-01-01

Background: To investigate the impact of playing sports Active Video Games on children's actual and perceived object control skills. Methods: Intervention children played Active Video Games for 6 weeks (1 h/week) in 2012. The Test of Gross Motor Development-2 assessed object control skill. The Pictorial Scale of Perceived Movement Skill Competence assessed perceived object control skill. Repeated measurements of object control and perceived object control were analysed for the whole sample, using linear mixed models, which included fixed effects for group (intervention or control) and time (pre and post) and their interaction. The first model adjusted for sex only and the second model also adjusted for age, and prior ball sports experience (yes/no). Seven mixed-gender focus discussions were conducted with intervention children after programme completion. Results: Ninety-five Australian children (55% girls; 43% intervention group) aged 4 to 8 years (M 6.2, SD 0.95) participated. Object control skill improved over time (p = 0.006) but there was no significant difference (p = 0.913) between groups in improvement (predicted means: control 31.80 to 33.53, SED = 0.748; intervention 30.33 to 31.83, SED = 0.835). A similar result held for the second model. Similarly the intervention did not change perceived object control in Model 1 (predicted means: control: 19.08 to 18.68, SED = 0.362; intervention 18.67 to 18.88, SED = 0.406) or Model 2. Children found the intervention enjoyable, but most did not perceive direct equivalence between Active Video Games and ‘real life’ activities. Conclusions: Whilst Active Video Game play may help introduce children to sport, this amount of time playing is unlikely to build skill. PMID:26844136

Translation and cultural adaptation for Brazil of the Developing Nurses' Thinking model1

PubMed Central

Jensen, Rodrigo; da Cruz, Diná de Almeida Lopes Monteiro; Tesoro, Mary Gay; Lopes, Maria Helena Baena de Moraes

2014-01-01

Objectives to translate and culturally adapt to Brazilian Portuguese the Developing Nurses' Thinking model, used as a strategy for teaching clinical reasoning. Method the translation and cultural adaptation were undertaken through initial translation, synthesis of the translations, back-translation, evaluation by a committee of specialists and a pre-test with 33 undergraduate nursing students. Results the stages of initial translation, synthesis of the translations and back-translation were undertaken satisfactorily, small adjustments being needed. In the evaluation of the translated version by the committee of specialists, all the items obtained agreement over 80% in the first round of evaluation and in the pre-test with the students, so the model was shown to be fit for purpose. Conclusion the use of the model as a complementary strategy in the teaching of diagnostic reasoning is recommended, with a view to the training of nurses who are more aware regarding the diagnostic task and the importance of patient safety. PMID:26107825

Models of traumatic experiences and children's psychological adjustment: the roles of perceived parenting and the children's own resources and activity.

PubMed

Punamäki, R L; Qouta, S; el Sarraj, E

1997-08-01

The relations between traumatic events, perceived parenting styles, children's resources, political activity, and psychological adjustment were examined among 108 Palestinian boys and girls of 11-12 years of age. The results showed that exposure to traumatic events increased psychological adjustment problems directly and via 2 mediating paths. First, the more traumatic events children had experienced, the more negative parenting they experienced. And, the poorer they perceived parenting, the more they suffered from high neuroticism and low self-esteem. Second, the more traumatic events children had experienced, the more political activity they showed, and the more active they were, the more they suffered from psychological adjustment problems. Good perceived parenting protected children's psychological adjustment by making them less vulnerable in two ways. First, traumatic events decreased their intellectual, creative, and cognitive resources, and a lack of resources predicted many psychological adjustment problems in a model excluding perceived parenting. Second, political activity increased psychological adjustment problems in the same model, but not in the model including good parenting.

Stromal-epithelial dynamics in response to fractionated radiotherapy

NASA Astrophysics Data System (ADS)

Rong, Panying

The speech of individuals with velopharyngeal incompetency (VPI) is characterized by hypernasality, a speech quality related to excessive emission of acoustic energy through the nose, as caused by failure of velopharyngeal closure. As an attempt to reduce hypernasality and, in turn, improve the quality of VPI-related hypernasal speech, this study is dedicated to developing an approach that uses speech-dependent articulatory adjustments to reduce hypernasality caused by excessive velopharyngeal opening. A preliminary study has been done to derive such articulatory adjustments for hypernasal /i/ vowels based on the simulation of an articulatorymodel (Speech Processing and Synthesis Toolboxes, Childers (2000)). Both nasal /i/ vowels with and without articulatory adjustments were synthesized by the model. Spectral analysis found that nasal acoustic features were attenuated and oral formant structures were restored after articulatory adjustments. In addition, comparisons of perceptual ratings of nasality between the two types of nasal vowels showed the articulatory adjustments generated by the model significantly reduced the perception of nasality for nasal /i/ vowels. Such articulatory adjustments for nasal /i/ have two patterns: 1) a consistent adjustment pattern, which corresponds an expansion at the velopharynx, and 2) some speech-dependent fine-tuning adjustment patterns, including adjustments in the lip area and the upper pharynx. The long-term goal of this study is to apply this approach of articulatory adjustment as a therapeutic tool in clinical speech treatment to detect and correct the maladaptive articulatory behaviors developed spontaneously by speakers with VPI on individual bases. This study constructed a speaker-adaptive articulatory model on the basis of the framework of Childers's vocal tract model to simulate articulatory adjustments aiming at compensating for the acoustic outcome caused by velopharyngeal opening and reducing nasality. To construct such a speaker-adaptive articulatory model, (1) an articulatory-acoustic-aerodynamic database was recorded using the articulography and aerodynamic instruments to provide point-wise articulatory data to be fitted into the framework of Childers's standard vocal tract model; (2) the length and transverse dimension of the vocal tract were adjusted to fit individual speaker by minimizing the acoustic discrepancy between the model simulation and the target derived from acoustic signal in the database using the simulated annealing algorithm; (3) the articulatory space of the model was adjusted to fit individual articulatory features by adapting the movement ranges of all articulators. With the speaker-adaptive articulatory model, the articulatory configurations of the oral and nasal vowels in the database were simulated and synthesized. Given the acoustic targets derived from the oral vowels in the database, speech-dependent articulatory adjustments were simulated to compensate for the acoustic outcome caused by VPO. The resultant articulatory configurations corresponds to nasal vowels with articulatory adjustment, which were synthesized to serve as the perceptual stimuli for a listening task of nasality rating. The oral and nasal vowels synthesized based on the oral and nasal vowel targets in the database also served as the perceptual stimuli. The results suggest both acoustic and perceptual effects of the mode-generated articulatory adjustment on the nasal vowels /a/, /i/ and /u/. In terms of acoustics, the articulatory adjustment (1) restores the altered formant structures due to nasal coupling, including shifted formant frequency, attenuated formant intensity and expanded formant bandwidth and (2) attenuates the peaks and zeros caused by nasal resonances. Perceptually, the articulatory adjustment generated by the speaker-adaptive model significantly reduces the perceived nasality for all three vowels (/a/, /i/, /u/). The acoustic and perceptual effects of articulatory adjustment suggest achievement of the acoustic goal of compensating for the acoustic discrepancy caused by VPO and the auditory goal of reducing the perception of nasality. Such a finding is consistent with motor equivalence (Hughes and Abbs, 1976; Maeda, 1990), which enables inter-articulator coordination to compensate for the deviation from the acoustic/auditory goal caused by the shifted position of an articulator. The articulatory adjustment responsible for the acoustic and perceptual effects as described above was decomposed into a set of empirical orthogonal modes (Story and Titze, 1998). Both gross articulatory patterns and fine-tuning adjustments were found in the principal orthogonal modes, which lead to the acoustic compensation and reduction of nasality. For /a/ and /i/, a direct relationship was found among the acoustic features, nasality, and articulatory adjustment patterns. Specifically, the articulatory adjustments indicated by the principal orthogonal modes of the adjusted nasal /a/ and /i/ were directly correlated with the attenuation of the acoustic cues of nasality (i.e., shifting of F1 and F2 frequencies) and the reduction of nasality rating. For /u/, such a direct relationship among the acoustic features, nasality and articulatory adjustment was not as prominent, suggesting the possibility of additional acoustic correlates of nasality other than F1 and F2. The findings of this study demonstrate the possibility of using articulatory adjustment to reduce the perception of nasality through model simulation. A speaker-adaptive articulatory model is able to simulate individual-based articulatory adjustment strategies that can be applied in clinical settings to serve as the articulatory targets for correction of the maladaptive articulatory behaviors developed spontaneously by speakers with hypernasal speech. Such a speaker-adaptive articulatory model provides an intuitive way of articulatory learning and self-training for speakers with VPI to learn appropriate articulatory strategies through model-speaker interaction.

Association of sexual maturation with excess body weight and height in children and adolescents

PubMed Central

2014-01-01

Background Studies addressing the influence of early sexual maturation on the excess of body weight and height of children and adolescents are scarce. The aim of the study was to analyze the association of sexual maturation with excess body weight and height in children and adolescents. Methods This was a cross-sectional study performed in Florianópolis city, Brazil, in 2007, with 2339 school children, aged 8–14 years (1107 males). Selection was based on a probabilistic, cluster-stratified sampling technique. School children were classified according to the presence of excess body weight, using sex- and age-specific body mass index (BMI) cutoff points. Z-scores were calculated from height and BMI data. Sexual maturation was self-assessed according to Tanner stages of development. Subjects were ranked based on tertiles of sexual maturation (early, normal and late) for each stage of development. Poisson and linear regression models were used. Results Compared to the reference group (normal sexual maturation), early maturing females had higher prevalence of excess weight (adjusted prevalence ratio: 1.70; 95% CI: 1.24 to 2.33) and increased height-for-age (adjusted β: 0.37; 95% CI: 0.14 to 0.59), while late maturing females had lower prevalence of excess weight (adjusted prevalence ratio: 0.57; 95% CI: 0.37 to 0.87) and decreased height-for-age (adjusted β: −0.38; 95% CI: −0.56 to −0.20). In males, early and late sexual maturation were associated with increased (adjusted β: 0.37; 95% CI: 0.14 to 0.59) and decreased (adjusted β: −0.38; 95% CI: −0.56 to −0.20) height-for-age, respectively. Conclusion Early sexual maturation is associated with excess body weight in females and with greater height-for-age in both sexes. PMID:24625111

Effectiveness of Booster Seats Compared With No Restraint or Seat Belt Alone for Crash Injury Prevention

PubMed Central

Ma, Xiaoguang; Griffin, Russell; McGwin, Gerald; Allison, David B.; Heymsfield, Steven B.; He, Wei; Zhu, Shankuan

2013-01-01

Objectives The objective was to evaluate the effectiveness of belt-positioning booster seats, compared with no restraint use and with seat belt use only, during motor vehicle crashes among U.S. children. Methods This was a retrospective matched cohort study with data from the 1998 through 2009 National Automotive Sampling System (NASS) Crashworthiness Data System (CDS). The study sample consisted of children aged 0 to 10 years who were not seated in the front seat of the vehicle. We used Cox proportional hazards models to estimate the risk of overall, fatal, and regional body injury. Results Children using seat belts in belt-positioning booster seats experienced less overall injury (Injury Severity Score [ISS] > 0, adjusted risk ratio [RR] = 0.73, 95% confidence interval [CI] = 0.55 to 0.96; Abbreviated Injury Scale [AIS] score of 2 or higher, adjusted RR = 0.30, 95% CI = 0.16 to 0.58; ISS > 8, adjusted RR = 0.19, 95% CI = 0.06 to 0.56), and less injury in most body regions except the neck (adjusted RR = 4.79, 95% CI = 1.43 to 16.00) than did children with no restraint use. Children using seat belts in belt-positioning booster seats had an equal risk of injury but higher risks of neck (adjusted RR = 1.86, 95% CI = 1.02 to 3.40) and thorax (adjusted RR = 2.86, 95% CI = 1.33 to 6.15) injury than did children restrained by seat belts only. Conclusions Children using belt-positioning booster seats appear to experience a higher risk of AIS > 0 injury to the neck and thorax than do children using seat belts only. Future research should examine whether the observed increase in neck and thorax injuries can be attributed to improper use of booster seats. PMID:24050794

Demand for Colonoscopy in Colorectal Cancer Screening Using a Quantitative Fecal Immunochemical Test and Age/Sex-Specific Thresholds for Test Positivity.

PubMed

Chen, Sam Li-Sheng; Hsu, Chen-Yang; Yen, Amy Ming-Fang; Young, Graeme P; Chiu, Sherry Yueh-Hsia; Fann, Jean Ching-Yuan; Lee, Yi-Chia; Chiu, Han-Mo; Chiou, Shu-Ti; Chen, Hsiu-Hsi

2018-06-01

Background: Despite age and sex differences in fecal hemoglobin (f-Hb) concentrations, most fecal immunochemical test (FIT) screening programs use population-average cut-points for test positivity. The impact of age/sex-specific threshold on FIT accuracy and colonoscopy demand for colorectal cancer screening are unknown. Methods: Using data from 723,113 participants enrolled in a Taiwanese population-based colorectal cancer screening with single FIT between 2004 and 2009, sensitivity and specificity were estimated for various f-Hb thresholds for test positivity. This included estimates based on a "universal" threshold, receiver-operating-characteristic curve-derived threshold, targeted sensitivity, targeted false-positive rate, and a colonoscopy-capacity-adjusted method integrating colonoscopy workload with and without age/sex adjustments. Results: Optimal age/sex-specific thresholds were found to be equal to or lower than the universal 20 μg Hb/g threshold. For older males, a higher threshold (24 μg Hb/g) was identified using a 5% false-positive rate. Importantly, a nonlinear relationship was observed between sensitivity and colonoscopy workload with workload rising disproportionately to sensitivity at 16 μg Hb/g. At this "colonoscopy-capacity-adjusted" threshold, the test positivity (colonoscopy workload) was 4.67% and sensitivity was 79.5%, compared with a lower 4.0% workload and a lower 78.7% sensitivity using 20 μg Hb/g. When constrained on capacity, age/sex-adjusted estimates were generally lower. However, optimizing age/-sex-adjusted thresholds increased colonoscopy demand across models by 17% or greater compared with a universal threshold. Conclusions: Age/sex-specific thresholds improve FIT accuracy with modest increases in colonoscopy demand. Impact: Colonoscopy-capacity-adjusted and age/sex-specific f-Hb thresholds may be useful in optimizing individual screening programs based on detection accuracy, population characteristics, and clinical capacity. Cancer Epidemiol Biomarkers Prev; 27(6); 704-9. ©2018 AACR . ©2018 American Association for Cancer Research.

A new universal dynamic model to describe eating rate and cumulative intake curves123

PubMed Central

Paynter, Jonathan; Peterson, Courtney M; Heymsfield, Steven B

2017-01-01

Background: Attempts to model cumulative intake curves with quadratic functions have not simultaneously taken gustatory stimulation, satiation, and maximal food intake into account. Objective: Our aim was to develop a dynamic model for cumulative intake curves that captures gustatory stimulation, satiation, and maximal food intake. Design: We developed a first-principles model describing cumulative intake that universally describes gustatory stimulation, satiation, and maximal food intake using 3 key parameters: 1) the initial eating rate, 2) the effective duration of eating, and 3) the maximal food intake. These model parameters were estimated in a study (n = 49) where eating rates were deliberately changed. Baseline data was used to determine the quality of model's fit to data compared with the quadratic model. The 3 parameters were also calculated in a second study consisting of restrained and unrestrained eaters. Finally, we calculated when the gustatory stimulation phase is short or absent. Results: The mean sum squared error for the first-principles model was 337.1 ± 240.4 compared with 581.6 ± 563.5 for the quadratic model, or a 43% improvement in fit. Individual comparison demonstrated lower errors for 94% of the subjects. Both sex (P = 0.002) and eating duration (P = 0.002) were associated with the initial eating rate (adjusted R2 = 0.23). Sex was also associated (P = 0.03 and P = 0.012) with the effective eating duration and maximum food intake (adjusted R2 = 0.06 and 0.11). In participants directed to eat as much as they could compared with as much as they felt comfortable with, the maximal intake parameter was approximately double the amount. The model found that certain parameter regions resulted in both stimulation and satiation phases, whereas others only produced a satiation phase. Conclusions: The first-principles model better quantifies interindividual differences in food intake, shows how aspects of food intake differ across subpopulations, and can be applied to determine how eating behavior factors influence total food intake. PMID:28077377

Computational comparison of quantum-mechanical models for multistep direct reactions

NASA Astrophysics Data System (ADS)

Koning, A. J.; Akkermans, J. M.

1993-02-01

We have carried out a computational comparison of all existing quantum-mechanical models for multistep direct (MSD) reactions. The various MSD models, including the so-called Feshbach-Kerman-Koonin, Tamura-Udagawa-Lenske and Nishioka-Yoshida-Weidenmüller models, have been implemented in a single computer system. All model calculations thus use the same set of parameters and the same numerical techniques; only one adjustable parameter is employed. The computational results have been compared with experimental energy spectra and angular distributions for several nuclear reactions, namely, 90Zr(p,p') at 80 MeV, 209Bi(p,p') at 62 MeV, and 93Nb(n,n') at 25.7 MeV. In addition, the results have been compared with the Kalbach systematics and with semiclassical exciton model calculations. All quantum MSD models provide a good fit to the experimental data. In addition, they reproduce the systematics very well and are clearly better than semiclassical model calculations. We furthermore show that the calculated predictions do not differ very strongly between the various quantum MSD models, leading to the conclusion that the simplest MSD model (the Feshbach-Kerman-Koonin model) is adequate for the analysis of experimental data.

Diagnosis-Based Risk Adjustment for Medicare Capitation Payments

PubMed Central

Ellis, Randall P.; Pope, Gregory C.; Iezzoni, Lisa I.; Ayanian, John Z.; Bates, David W.; Burstin, Helen; Ash, Arlene S.

1996-01-01

Using 1991-92 data for a 5-percent Medicare sample, we develop, estimate, and evaluate risk-adjustment models that utilize diagnostic information from both inpatient and ambulatory claims to adjust payments for aged and disabled Medicare enrollees. Hierarchical coexisting conditions (HCC) models achieve greater explanatory power than diagnostic cost group (DCG) models by taking account of multiple coexisting medical conditions. Prospective models predict average costs of individuals with chronic conditions nearly as well as concurrent models. All models predict medical costs far more accurately than the current health maintenance organization (HMO) payment formula. PMID:10172666

Public and private pregnancy care in Reggio Emilia Province: an observational study on appropriateness of care and delivery outcomes

PubMed Central

2014-01-01

Background In industrialized countries, improvements have been made in both maternal and newborn health. While attention to antenatal care is increasing, excessive medicalization is also becoming more common. The aim of this study is to compare caesarean section (CS) frequency and ultrasound scan utilization in a public model of care involving both midwives and obstetricians with a private model in which care is provided by obstetricians only. Methods Design: Observational population-based study. Setting: Reggio Emilia Province. Population: 5957 women resident in the province who delivered between October 2010 and November 2011. Main outcome measures: CS frequency and ultrasound scan utilization, stillbirths, and other negative perinatal outcomes. Women in the study were searched in the public family and reproductive health clinic medical records to identify those cared for in the public system. Outcomes of the two antenatal care models were compared through multivariate logistic regression adjusting for maternal characteristics and, for CS only, by stratifying by Robson’s Group. Results Compared to women cared for in private services (N = 3,043), those in public service (N = 2,369) were younger, less educated, more frequently non-Italian, and multiparous. The probability of CS was slightly higher for women cared for by private obstetricians than for those cared for in the public system (31.8% vs. 27.1%; adjusted odds ratio: 1.10; 95% CI: 0.93–1.29): The probability of having more than 3 ultrasound scans was higher in private care (89.6% vs. 49.8%; adjusted odds ratio: 5.11; 95% CI: 4.30–6.08). CS frequency was higher in private care for all Robson’s classes except women who underwent CS during spontaneous labour. Among negative perinatal outcomes only a higher risk of pre-term birth was observed for pregnancies cared for in private services. Conclusions The public model provides less medicalized and more guidelines-oriented care than does the private model, with no increase in negative perinatal outcomes. PMID:24533853

Utility of Urinary Biomarkers in Predicting Loss of Residual Renal Function: The balANZ Trial

PubMed Central

Cho, Yeoungjee; Johnson, David W.; Vesey, David A.; Hawley, Carmel M.; Clarke, Margaret; Topley, Nicholas

2015-01-01

♦ Background: The ability of urinary biomarkers to predict residual renal function (RRF) decline in peritoneal dialysis (PD) patients has not been defined. The present study aimed to explore the utility of established biomarkers from kidney injury models for predicting loss of RRF in incident PD patients, and to evaluate the impact on RRF of using neutral-pH PD solution low in glucose degradation products. ♦ Methods: The study included 50 randomly selected participants from the balANZ trial who had completed 24 months of follow-up. A change in glomerular filtration rate (GFR) was used as the primary clinical outcome measure. In a mixed-effects general linear model, baseline measurements of 18 novel urinary biomarkers and albumin were used to predict GFR change. The model was further used to evaluate the impact of biocompatible PD solution on RRF, adjusted for each biomarker. ♦ Results: Baseline albuminuria was not a useful predictor of change in RRF in PD patients (p = 0.84). Only clusterin was a significant predictor of GFR decline in the whole population (p = 0.04, adjusted for baseline GFR and albuminuria). However, the relationship was no longer apparent when albuminuria was removed from the model (p = 0.31). When the effect of the administered PD solutions was examined using a model adjusted for PD solution type, baseline albuminuria, and GFR, higher baseline urinary concentrations of trefoil factor 3 (TFF3, p = 0.02), kidney injury molecule 1 (KIM-1, p = 0.04), and interferon γ-induced protein 10 (IP-10, p = 0.03) were associated with more rapid decline of RRF in patients receiving conventional PD solution compared with biocompatible PD solution. ♦ Conclusions: Higher urinary levels of kidney injury biomarkers (TFF3, KIM-1, IP-10) at baseline predicted significantly slower RRF decline in patients receiving biocompatible PD solutions. Findings from the present investigation should help to guide future studies to validate the utility of urinary biomarkers as tools to predict RRF decline in PD patients. PMID:24711637

SU-G-IeP4-03: Cone Beam X-Ray Luminescence Computed Tomography Based On Generalized Gaussian Markov Random Field

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, G; Xing, L

2016-06-15

Purpose: Cone beam X-ray luminescence computed tomography (CB-XLCT), which aims to achieve molecular and functional imaging by X-rays, has recently been proposed as a new imaging modality. However, the inverse problem of CB-XLCT is seriously ill-conditioned, hindering us to achieve good image quality. In this work, a novel reconstruction method based on Bayesian theory is proposed to tackle this problem Methods: Bayesian theory provides a natural framework for utilizing various kinds of available prior information to improve the reconstruction image quality. A generalized Gaussian Markov random field (GGMRF) model is proposed here to construct the prior model of the Bayesianmore » theory. The most important feature of GGMRF model is the adjustable shape parameter p, which can be continuously adjusted from 1 to 2. The reconstruction image tends to have more edge-preserving property when p is slide to 1, while having more noise tolerance property when p is slide to 2, just like the behavior of L1 and L2 regularization methods, respectively. The proposed method provides a flexible regularization framework to adapt to a wide range of applications. Results: Numerical simulations were implemented to test the performance of the proposed method. The Digimouse atlas were employed to construct a three-dimensional mouse model, and two small cylinders were placed inside to serve as the targets. Reconstruction results show that the proposed method tends to obtain better spatial resolution with a smaller shape parameter, while better signal-to-noise image with a larger shape parameter. Quantitative indexes, contrast-to-noise ratio (CNR) and full-width at half-maximum (FWHM), were used to assess the performance of the proposed method, and confirmed its effectiveness in CB-XLCT reconstruction. Conclusion: A novel reconstruction method for CB-XLCT is proposed based on GGMRF model, which enables an adjustable performance tradeoff between L1 and L2 regularization methods. Numerical simulations were conducted to demonstrate its performance.« less

Factoring socioeconomic status into cardiac performance profiling for hospitals: does it matter?

PubMed

Alter, David A; Austin, Peter C; Naylor, C David; Tu, Jack V

2002-01-01

Critics of "scorecard medicine" often highlight the incompleteness of risk-adjustment methods used when accounting for baseline patient differences. Although socioeconomic status is a highly important determinant of adverse outcome for patients admitted to the hospital with acute myocardial infarction, it has not been used in most risk-adjustment models for cardiovascular report cards. To determine the incremental impact of socioeconomic status adjustments on age, sex, and illness severity for hospital-specific 30-day mortality rates after acute myocardial infarction. The authors compared the absolute and relative hospital-specific 30-day acute myocardial infarction mortality rates in 169 hospitals throughout Ontario between April 1, 1994 and March 31, 1997. Patient socioeconomic status was characterized by median neighborhood income using postal codes and 1996 Canadian census data. They examined two risk-adjustment models: the first adjusted for age, sex, and illness severity (standard), whereas the second adjusted for age, sex, illness severity, and median neighborhood income level (socioeconomic status). There was an extremely strong correlation between 'standard' and 'socioeconomic status' risk-adjusted mortality rates (r = 0.99). Absolute differences in 30-day risk-adjusted mortality rates between the socioeconomic status and standard risk-adjustment models were small (median, 0.1%; 25th-75th percentile, 0.1-0.2). The agreement in the quintile rankings of hospitals between the socioeconomic status and standard risk-adjustment models was high (weighted kappa = 0.93). Despite its importance as a determinant of patient outcomes, the effect of socioeconomic status on hospital-specific mortality rates over and above standard risk-adjustment methods for acute myocardial infarction hospital profiling in Ontario was negligible.

Cancer incidence and specific occupational exposures in the Swedish leather tanning industry: a cohort based case-control study.

PubMed Central

Mikoczy, Z; Schütz, A; Strömberg, U; Hagmar, L

1996-01-01

OBJECTIVE--To study the effect on the incidence of cancer of exposure to chemicals handled in the leather tanning industry. MATERIALS AND METHODS--A case-control study was performed within a cohort of 2487 workers employed for at least six months during the period 1900-89 in three Swedish leather tanneries. 68 cancer cases (lung, stomach, bladder, kidney, nasal, and pancreatic cancers and soft tissue sarcomas) and 178 matched controls were studied. Effects of chemical exposures on cancer incidence, adjusted for age at risk, sex, and plant were estimated with a conditional logistic regression model. RESULTS--A significant association was found between exposure to leather dust and pancreatic cancer (odds ratio (OR) 7.19, 95% confidence interval (95% CI) 1.44 to 35-89). An association was indicated between leather dust from vegetable tanning and lung cancer. After adjustment for smoking habits a tentative association between organic solvents and lung cancer lost its significance. No association was found between exposure to chlorophenols and soft tissue sarcomas. CONCLUSIONS--The significant association between leather tanning and soft tissue sarcomas that was found in our previous cohort analysis could not be explained by exposure to chlorophenols. On the other hand a significant association was found between exposure to leather dust and pancreatic cancer, and exposure to leather dust from vegetable tanning was often present in cases with lung cancer. Due to the small numbers of cases, the results can, however, only lead to tentative conclusions. PMID:8704870

Impact and Cost-Effectiveness of Haemophilus influenzae Type b Conjugate Vaccination in India

PubMed Central

Clark, Andrew D.; Griffiths, Ulla K.; Abbas, Syed Shahid; Rao, Krishna D.; Privor-Dumm, Lois; Hajjeh, Rana; Johnson, Hope; Sanderson, Colin; Santosham, Mathuram

2017-01-01

Objective To estimate the potential health impact and cost-effectiveness of nationwide Haemophilus influenzae type b (Hib) vaccination in India. Study design A decision support model was used, bringing together estimates of demography, epidemiology, Hib vaccine effectiveness, Hib vaccine costs, and health care costs. Scenarios favorable and unfavorable to the vaccine were evaluated. State-level analyses indicate where the vaccine might have the greatest impact and value. Results Between 2012 and 2031, Hib conjugate vaccination is estimated to prevent over 200 000 child deaths (~1% of deaths in children <5 years of age) in India at an incremental cost of US$127 million per year. From a government perspective, state-level cost-effectiveness ranged from US$192 to US$1033 per discounted disability adjusted life years averted. With the inclusion of household health care costs, cost-effectiveness ranged from US$155-US$939 per discounted disability adjusted life year averted. These values are below the World Health Organization thresholds for cost effectiveness of public health interventions. Conclusions Hib conjugate vaccination is a cost-effective intervention in all States of India. This conclusion does not alter with plausible changes in key parameters. Although investment in Hib conjugate vaccination would significantly increase the cost of the Universal Immunization Program, about 15% of the incremental cost would be offset by health care cost savings. Efforts should be made to expedite the nationwide introduction of Hib conjugate vaccination in India. PMID:23773596

Custodial grandmothers' psychological distress, dysfunctional parenting, and grandchildren's adjustment.

PubMed

Smith, Gregory C; Palmieri, Patrick A; Hancock, Gregory R; Richardson, Rhonda A

2008-01-01

An adaptation of the Family Stress Model (FSM) with hypothesized linkages between family contextual factors, custodial grandmothers' psychological distress, parenting practices, and grandchildren's adjustment was tested with structural equation modeling. Interview data from 733 custodial grandmothers of grandchildren between ages 4-17 revealed that the effect of grandmothers' distress on grandchildren's adjustment was mediated by dysfunctional parenting, especially regarding externalizing problems. The effects of contextual factors on grandchildren's adjustment were also indirect. The model's measurement and structural components were largely invariant across grandmothers' race and age, as well as grandchildren's gender and age. Group differences were more prevalent regarding the magnitude of latent means for model constructs. We conclude that parenting models like the FSM are useful for investigating custodial grandfamilies.

Custodial Grandmothers' Psychological Distress, Dysfunctional Parenting, and Grandchildren's Adjustment*ł

PubMed Central

Smith, Gregory C.; Palmieri, Patrick A.; Hancock, Gregory R.; Richardson, Rhonda A.

2009-01-01

An adaptation of the Family Stress Model (FSM) with hypothesized linkages between family contextual factors, custodial grandmothers' psychological distress, parenting practices, and grandchildren's adjustment was tested with structural equation modeling. Interview data from 733 custodial grandmothers of grandchildren between ages 4-17 revealed that the effect of grandmothers' distress on grandchildren's adjustment was mediated by dysfunctional parenting, especially regarding externalizing problems. The effects of contextual factors on grandchildren's adjustment were also indirect. The model's measurement and structural components were largely invariant across grandmothers' race and age, as well as grandchildren's gender and age. Group differences were more prevalent regarding the magnitude of latent means for model constructs. We conclude that parenting models like the FSM are useful for investigating custodial grandfamilies. PMID:19266869

Contact angle adjustment in equation-of-state-based pseudopotential model.

PubMed

Hu, Anjie; Li, Longjian; Uddin, Rizwan; Liu, Dong

2016-05-01

The single component pseudopotential lattice Boltzmann model has been widely applied in multiphase simulation due to its simplicity and stability. In many studies, it has been claimed that this model can be stable for density ratios larger than 1000. However, the application of the model is still limited to small density ratios when the contact angle is considered. The reason is that the original contact angle adjustment method influences the stability of the model. Moreover, simulation results in the present work show that, by applying the original contact angle adjustment method, the density distribution near the wall is artificially changed, and the contact angle is dependent on the surface tension. Hence, it is very inconvenient to apply this method with a fixed contact angle, and the accuracy of the model cannot be guaranteed. To solve these problems, a contact angle adjustment method based on the geometry analysis is proposed and numerically compared with the original method. Simulation results show that, with our contact angle adjustment method, the stability of the model is highly improved when the density ratio is relatively large, and it is independent of the surface tension.

Contact angle adjustment in equation-of-state-based pseudopotential model

NASA Astrophysics Data System (ADS)

Hu, Anjie; Li, Longjian; Uddin, Rizwan; Liu, Dong

2016-05-01

The single component pseudopotential lattice Boltzmann model has been widely applied in multiphase simulation due to its simplicity and stability. In many studies, it has been claimed that this model can be stable for density ratios larger than 1000. However, the application of the model is still limited to small density ratios when the contact angle is considered. The reason is that the original contact angle adjustment method influences the stability of the model. Moreover, simulation results in the present work show that, by applying the original contact angle adjustment method, the density distribution near the wall is artificially changed, and the contact angle is dependent on the surface tension. Hence, it is very inconvenient to apply this method with a fixed contact angle, and the accuracy of the model cannot be guaranteed. To solve these problems, a contact angle adjustment method based on the geometry analysis is proposed and numerically compared with the original method. Simulation results show that, with our contact angle adjustment method, the stability of the model is highly improved when the density ratio is relatively large, and it is independent of the surface tension.

Trajectories of premorbid childhood and adolescent functioning in schizophrenia-spectrum psychoses: A first-episode study.

PubMed

Horton, Leslie E; Tarbox, Sarah I; Olino, Thomas M; Haas, Gretchen L

2015-06-30

Evidence of social and behavioral problems preceding the onset of schizophrenia-spectrum psychoses is consistent with a neurodevelopmental model of these disorders. Here we predict that individuals with a first episode of schizophrenia-spectrum psychoses will evidence one of three patterns of premorbid adjustment: an early deficit, a deteriorating pattern, or adequate or good social adjustment. Participants were 164 (38% female; 31% black) individuals ages 15-50 with a first episode of schizophrenia-spectrum psychoses. Premorbid adjustment was assessed using the Cannon-Spoor Premorbid Adjustment Scale. We compared the fit of a series of growth mixture models to examine premorbid adjustment trajectories, and found the following 3-class model provided the best fit with: a "stable-poor" adjustment class (54%), a "stable-good" adjustment class (39%), and a "deteriorating" adjustment class (7%). Relative to the "stable-good" class, the "stable-poor" class experienced worse negative symptoms at 1-year follow-up, particularly in the social amotivation domain. This represents the first known growth mixture modeling study to examine premorbid functioning patterns in first-episode schizophrenia-spectrum psychoses. Given that the stable-poor adjustment pattern was most prevalent, detection of social and academic maladjustment as early as childhood may help identify people at increased risk for schizophrenia-spectrum psychoses, potentially increasing feasibility of early interventions. Published by Elsevier Ireland Ltd.

Peer Victimization and Rejection: Investigation of an Integrative Model of Effects on Emotional, Behavioral, and Academic Adjustment in Early Adolescence

ERIC Educational Resources Information Center

Lopez, Cristy; DuBois, David L.

2005-01-01

This study investigated an integrative model of the effects of peer victimization (PV) and peer rejection (PR) on youth adjustment using data from 508 middle-school students. In the proposed model, PV and PR each contribute independently to problems in emotional, behavioral, and academic adjustment. The adverse consequences of PV and PR are each…

Antidepressant sales and regional variations of suicide mortality in Germany.

PubMed

Blüml, Victor; Helbich, Marco; Mayr, Michael; Turnwald, Roland; Vyssoki, Benjamin; Lewitzka, Ute; Hartung, Sebastian; Plener, Paul L; Fegert, Jörg M; Kapusta, Nestor D

2017-04-01

Suicides account for over one million deaths per year worldwide with depression among the most important risk factors. Epidemiological research into the relationship between antidepressant utilization and suicide mortality has shown heterogeneous and contradictory results. Different methodological approaches and limitations could at least partially explain varying results. This is the first study assessing the association of suicide mortality and antidepressant sales across Germany using complex statistical approaches in order to control for possible confounding factors including spatial dependency of data. German suicide counts were analyzed on a district level (n = 402) utilizing ecological Poisson regressions within a hierarchical Bayesian framework. Due to significant spatial effects between adjacent districts spatial models were calculated in addition to a baseline non-spatial model. Models were adjusted for several confounders including socioeconomic variables, quality of psychosocial care, and depression prevalence. Separate analyses were performed for Eastern and Western Germany and for different classes of antidepressants (SSRIs and TCAs). Overall antidepressant sales were significantly negatively associated with suicide mortality in the non-spatial baseline model, while after adjusting for spatially structured and unstructured effects the association turned out to be insignificant. In sub-analyses, analogue results were found for SSRIs and TCAs separately. Suicide risk shows a distinct heterogeneous pattern with a pronounced relative risk in Southeast Germany. In conclusion, the results reflect the heterogeneous findings of previous studies on the association between suicide mortality and antidepressant sales and point to the complexity of this hypothesized link. Furthermore, the findings support tailored suicide preventive efforts within high risk areas. Copyright © 2016 Elsevier Ltd. All rights reserved.

Foot Type Biomechanics Part 2: Are structure and anthropometrics related to function?

PubMed Central

Mootanah, Rajshree; Song, Jinsup; Lenhoff, Mark W.; Hafer, Jocelyn F.; Backus, Sherry I.; Gagnon, David; Deland, Jonathan T.; Hillstrom, Howard J.

2013-01-01

Background Many foot pathologies are associated with specific foot types. If foot structure and function are related, measurement of either could assist with differential diagnosis of pedal pathologies. Hypothesis Biomechanical measures of foot structure and function are related in asymptomatic healthy individuals. Methods Sixty-one healthy subjects' left feet were stratified into cavus (n = 12), rectus (n = 27) and planus (n = 22) foot types. Foot structure was assessed by malleolar valgus index, arch height index, and arch height flexibility. Anthropometrics (height and weight), age, and walking speed were measured. Foot function was assessed by center of pressure excursion index, peak plantar pressure, maximum force, and gait pattern parameters. Foot structure and anthropometric variables were entered into stepwise linear regression models to identify predictors of function. Results Measures of foot structure and anthropometrics explained 10–37% of the model variance (adjusted R2) for gait pattern parameters. When walking speed was included, the adjusted R2 increased to 45–77% but foot structure was no longer a factor. Foot structure and anthropometrics predicted 7–47% of the model variance for plantar pressure and 16–64% for maximum force parameters. All multivariate models were significant (p < 0.05), supporting acceptance of the hypothesis. Discussion and conclusion Foot structure and function are related in asymptomatic healthy individuals. The structural parameters employed are basic measurements that do not require ionizing radiation and could be used in a clinical setting. Further research is needed to identify additional predictive parameters (plantar soft tissue characteristics, skeletal alignment, and neuromuscular control) and to include individuals with pathology. PMID:23107624

Urinary Tract Stones and Osteoporosis: Findings From the Women's Health Initiative.

PubMed

Carbone, Laura D; Hovey, Kathleen M; Andrews, Christopher A; Thomas, Fridtjof; Sorensen, Mathew D; Crandall, Carolyn J; Watts, Nelson B; Bethel, Monique; Johnson, Karen C

2015-11-01

Kidney and bladder stones (urinary tract stones) and osteoporosis are prevalent, serious conditions for postmenopausal women. Men with kidney stones are at increased risk of osteoporosis; however, the relationship of urinary tract stones to osteoporosis in postmenopausal women has not been established. The purpose of this study was to determine whether urinary tract stones are an independent risk factor for changes in bone mineral density (BMD) and incident fractures in women in the Women's Health Initiative (WHI). Data were obtained from 150,689 women in the Observational Study and Clinical Trials of the WHI with information on urinary tract stones status: 9856 of these women reported urinary tract stones at baseline and/or incident urinary tract stones during follow-up. Cox regression models were used to determine the association of urinary tract stones with incident fractures and linear mixed models were used to investigate the relationship of urinary tract stones with changes in BMD that occurred during WHI. Follow-up was over an average of 8 years. Models were adjusted for demographic and clinical factors, medication use, and dietary histories. In unadjusted models there was a significant association of urinary tract stones with incident total fractures (HR 1.10; 95% CI, 1.04 to 1.17). However, in covariate adjusted analyses, urinary tract stones were not significantly related to changes in BMD at any skeletal site or to incident fractures. In conclusion, urinary tract stones in postmenopausal women are not an independent risk factor for osteoporosis. © 2015 American Society for Bone and Mineral Research.

Genome-Wide Association Study of the Modified Stumvoll Insulin Sensitivity Index Identifies BCL2 and FAM19A2 as Novel Insulin Sensitivity Loci

PubMed Central

Gustafsson, Stefan; Rybin, Denis; Stančáková, Alena; Chen, Han; Liu, Ching-Ti; Hong, Jaeyoung; Jensen, Richard A.; Rice, Ken; Morris, Andrew P.; Mägi, Reedik; Tönjes, Anke; Prokopenko, Inga; Kleber, Marcus E.; Delgado, Graciela; Silbernagel, Günther; Jackson, Anne U.; Appel, Emil V.; Grarup, Niels; Lewis, Joshua P.; Montasser, May E.; Landenvall, Claes; Staiger, Harald; Luan, Jian’an; Frayling, Timothy M.; Weedon, Michael N.; Xie, Weijia; Morcillo, Sonsoles; Martínez-Larrad, María Teresa; Biggs, Mary L.; Chen, Yii-Der Ida; Corbaton-Anchuelo, Arturo; Færch, Kristine; Gómez-Zumaquero, Juan Miguel; Goodarzi, Mark O.; Kizer, Jorge R.; Koistinen, Heikki A.; Leong, Aaron; Lind, Lars; Lindgren, Cecilia; Machicao, Fausto; Manning, Alisa K.; Martín-Núñez, Gracia María; Rojo-Martínez, Gemma; Rotter, Jerome I.; Siscovick, David S.; Zmuda, Joseph M.; Zhang, Zhongyang; Serrano-Rios, Manuel; Smith, Ulf; Soriguer, Federico; Hansen, Torben; Jørgensen, Torben J.; Linnenberg, Allan; Pedersen, Oluf; Walker, Mark; Langenberg, Claudia; Scott, Robert A.; Wareham, Nicholas J.; Fritsche, Andreas; Häring, Hans-Ulrich; Stefan, Norbert; Groop, Leif; O’Connell, Jeff R.; Boehnke, Michael; Bergman, Richard N.; Collins, Francis S.; Mohlke, Karen L.; Tuomilehto, Jaakko; März, Winfried; Kovacs, Peter; Stumvoll, Michael; Psaty, Bruce M.; Kuusisto, Johanna; Laakso, Markku; Meigs, James B.; Dupuis, Josée; Ingelsson, Erik; Florez, Jose C.

2016-01-01

Genome-wide association studies (GWAS) have found few common variants that influence fasting measures of insulin sensitivity. We hypothesized that a GWAS of an integrated assessment of fasting and dynamic measures of insulin sensitivity would detect novel common variants. We performed a GWAS of the modified Stumvoll Insulin Sensitivity Index (ISI) within the Meta-Analyses of Glucose and Insulin-Related Traits Consortium. Discovery for genetic association was performed in 16,753 individuals, and replication was attempted for the 23 most significant novel loci in 13,354 independent individuals. Association with ISI was tested in models adjusted for age, sex, and BMI and in a model analyzing the combined influence of the genotype effect adjusted for BMI and the interaction effect between the genotype and BMI on ISI (model 3). In model 3, three variants reached genome-wide significance: rs13422522 (NYAP2; P = 8.87 × 10−11), rs12454712 (BCL2; P = 2.7 × 10−8), and rs10506418 (FAM19A2; P = 1.9 × 10−8). The association at NYAP2 was eliminated by conditioning on the known IRS1 insulin sensitivity locus; the BCL2 and FAM19A2 associations were independent of known cardiometabolic loci. In conclusion, we identified two novel loci and replicated known variants associated with insulin sensitivity. Further studies are needed to clarify the causal variant and function at the BCL2 and FAM19A2 loci. PMID:27416945

Implementing the Institute of Medicine Definition of Disparities: An Application to Mental Health Care

PubMed Central

McGuire, Thomas G; Alegria, Margarita; Cook, Benjamin L; Wells, Kenneth B; Zaslavsky, Alan M

2006-01-01

Objective In a recent report, the Institute of Medicine (IOM) defines a health service disparity between population groups to be the difference in treatment or access not justified by the differences in health status or preferences of the groups. This paper proposes an implementation of this definition, and applies it to disparities in outpatient mental health care. Data Sources Health Care for Communities (HCC) reinterviewed 9,585 respondents from the Community Tracking Study in 1997–1998, oversampling individuals with psychological distress, alcohol abuse, drug abuse, or mental health treatment. The HCC is designed to make national estimates of service use. Study Design Expenditures are modeled using generalized linear models with a log link for quantity and a probit model for any utilization. We adjust for group differences in health status by transforming the entire distribution of health status for minority populations to approximate the white distribution. We compare disparities according to the IOM definition to other methods commonly used to assess health services disparities. Principal Findings Our method finds significant service disparities between whites and both blacks and Latinos. Estimated disparities from this method exceed those for competing approaches, because of the inclusion of effects of mediating factors (such as income) in the IOM approach. Conclusions A rigorous definition of disparities is needed to monitor progress against disparities and to compare their magnitude across studies. With such a definition, disparities can be estimated by adjusting for group differences in models for expenditures and access to mental health services. PMID:16987312

Including information about comorbidity in estimates of disease burden: Results from the WHO World Mental Health Surveys

PubMed Central

Alonso, Jordi; Vilagut, Gemma; Chatterji, Somnath; Heeringa, Steven; Schoenbaum, Michael; Üstün, T. Bedirhan; Rojas-Farreras, Sonia; Angermeyer, Matthias; Bromet, Evelyn; Bruffaerts, Ronny; de Girolamo, Giovanni; Gureje, Oye; Haro, Josep Maria; Karam, Aimee N.; Kovess, Viviane; Levinson, Daphna; Liu, Zhaorui; Mora, Maria Elena Medina; Ormel, J.; Posada-Villa, Jose; Uda, Hidenori; Kessler, Ronald C.

2010-01-01

Background The methodology commonly used to estimate disease burden, featuring ratings of severity of individual conditions, has been criticized for ignoring comorbidity. A methodology that addresses this problem is proposed and illustrated here with data from the WHO World Mental Health Surveys. Although the analysis is based on self-reports about one’s own conditions in a community survey, the logic applies equally well to analysis of hypothetical vignettes describing comorbid condition profiles. Methods Face-to-face interviews in 13 countries (six developing, nine developed; n = 31,067; response rate = 69.6%) assessed 10 classes of chronic physical and 9 of mental conditions. A visual analog scale (VAS) was used to assess overall perceived health. Multiple regression analysis with interactions for comorbidity was used to estimate associations of conditions with VAS. Simulation was used to estimate condition-specific effects. Results The best-fitting model included condition main effects and interactions of types by numbers of conditions. Neurological conditions, insomnia, and major depression were rated most severe. Adjustment for comorbidity reduced condition-specific estimates with substantial between-condition variation (.24–.70 ratios of condition-specific estimates with and without adjustment for comorbidity). The societal-level burden rankings were quite different from the individual-level rankings, with the highest societal-level rankings associated with conditions having high prevalence rather than high individual-level severity. Conclusions Plausible estimates of disorder-specific effects on VAS can be obtained using methods that adjust for comorbidity. These adjustments substantially influence condition-specific ratings. PMID:20553636

Comorbidities of COPD Have a Major Impact on Clinical Outcomes, Particularly in African Americans

PubMed Central

Putcha, Nirupama; Han, Meilan K.; Martinez, Carlos H.; Foreman, Marilyn G.; Anzueto, Antonio R.; Casaburi, Richard; Cho, Michael H.; Hanania, Nicola A.; Hersh, Craig P.; Kinney, Gregory L.; Make, Barry J.; Steiner, Robert M.; Lutz, Sharon M.; Thomashow, Byron M.; Williams, Andre A.; Bhatt, Surya P.; Beaty, Terri H.; Bowler, Russell P.; Ramsdell, Joe W.; Curtis, Jeffrey L.; Everett, Douglas; Hokanson, John E.; Lynch, David A.; Sutherland, E. Rand; Silverman, Edwin K.; Crapo, James D.; Wise, Robert A.; Regan, Elizabeth A.; Hansel, Nadia N.

2014-01-01

Background: COPD patients have a great burden of comorbidity. However, it is not well established whether this is due to shared risk factors such as smoking, if the comorbidities impact patients’ exercise capacity and quality of life, or whether there are racial disparities in their impact on COPD. Methods: We analyzed data from 10,192 current and ex-smokers with (cases) and without COPD (controls) from the Genetic Epidemiology of COPD (COPDGene®) study cohort to establish risk for COPD comorbidities adjusted for pertinent covariates. In adjusted models, we examined comorbidity prevalence and impact in African-Americans (AA) and non-Hispanic whites (NHW). Results: Comorbidities are more common in individuals with COPD compared to those with normal spirometry (controls), and the risk persists after adjustments for covariates including pack-years smoked. After adjustment for confounders, 8 conditions were independently associated with worse exercise capacity, quality of life and dyspnea. There were racial disparities in the impact of comorbidities on exercise capacity, dyspnea and quality of life, with the presence of osteoarthritis and gastroesophageal reflux disease having a greater negative impact on all three outcomes in AAs than NHWs (p<0.05 for all interaction terms). Conclusions: Individuals with COPD have a higher risk for comorbidities than controls, an important finding shown for the first time comprehensively after accounting for confounders. Individual comorbidities are associated with worse exercise capacity, quality of life, and dyspnea, in AAs compared with NHWs. Note: The abstract of a previous version of this work was presented at the American Thoracic Society Conference in Philadelphia, PA on May 21, 2013. PMID:25695106

Validating a benchmarking tool for audit of early outcomes after operations for head and neck cancer.

PubMed

Tighe, D; Sassoon, I; McGurk, M

2017-04-01

INTRODUCTION In 2013 all UK surgical specialties, with the exception of head and neck surgery, published outcome data adjusted for case mix for indicator operations. This paper reports a pilot study to validate a previously published risk adjustment score on patients from separate UK cancer centres. METHODS A case note audit was performed of 1,075 patients undergoing 1,218 operations for head and neck squamous cell carcinoma under general anaesthesia in 4 surgical centres. A logistic regression equation predicting for all complications, previously validated internally at sites A-C, was tested on a fourth external validation sample (site D, 172 operations) using receiver operating characteristic curves, Hosmer-Lemeshow goodness of fit analysis and Brier scores. RESULTS Thirty-day complication rates varied widely (34-51%) between the centres. The predictive score allowed imperfect risk adjustment (area under the curve: 0.70), with Hosmer-Lemeshow analysis suggesting good calibration. The Brier score changed from 0.19 for sites A-C to 0.23 when site D was also included, suggesting poor accuracy overall. CONCLUSIONS Marked differences in operative risk and patient case mix captured by the risk adjustment score do not explain all the differences in observed outcomes. Further investigation with different methods is recommended to improve modelling of risk. Morbidity is common, and usually has a major impact on patient recovery, ward occupancy, hospital finances and patient perception of quality of care. We hope comparative audit will highlight good performance and challenge underperformance where it exists.

Dyadic Coping in Metastatic Breast Cancer

PubMed Central

Badr, Hoda; Carmack, Cindy L.; Kashy, Deborah A.; Cristofanilli, Massimo; Revenson, Tracey A.

2011-01-01

Objective Couples facing metastatic breast cancer (MBC) must learn to cope with stressors that can affect both partners' quality of life as well as the quality of their relationship. Common dyadic coping involves taking a “we” approach, whereby partners work together to maintain their relationship while jointly managing their shared stress. This study prospectively evaluated whether common dyadic coping was associated with less cancer-related distress and greater dyadic adjustment for female MBC patients and their male partners. Design Couples (N = 191) completed surveys at the start of treatment for MBC (baseline), and 3 and 6 months later. Main Outcome Measures Cancer-related distress was assessed with the Impact of Events Scale; dyadic adjustment was assessed using the short-form of the Dyadic Adjustment Scale. Results Multilevel models using the couple as the unit of analysis showed that the effects of common positive dyadic coping on cancer-related distress significantly differed for patients and their partners. Whereas partners experienced slightly lower levels of distress, patients experienced slightly higher levels of distress. Although patients and partners who used more common negative dyadic coping experienced significantly greater distress at all times, the association was stronger for patients. Finally, using more common positive dyadic coping and less common negative dyadic coping was mutually beneficial for patients and partners in terms of greater dyadic adjustment. Conclusion Our findings underscore the importance of couples working together to manage the stress associated with MBC. Future research may benefit from greater focus on the interactions between patients and their partners to address ways that couples can adaptively cope together. PMID:20230090

Economic Hardship in Childhood: A Neglected Issue in ACE Studies?

PubMed

Braveman, Paula; Heck, Katherine; Egerter, Susan; Rinki, Christine; Marchi, Kristen; Curtis, Mike

2018-03-01

Objectives Adverse childhood experiences (ACEs) have been linked with ill-health in adulthood, but ACE literature has focused on family disruption or dysfunction (e.g., child abuse, parental separation), with less attention to economic adversity. We examined whether a mother's economic hardship in childhood (EHC) was associated with women's hardships and health-risk behaviors during/just before pregnancy. Methods We analyzed population-based survey data on 27,102 postpartum California women. EHC included respondents' reports that during childhood they/their families experienced hunger because of inability to afford food or moved because of problems paying rent/mortgage and the frequency of difficulty paying for basic needs. We examined six maternal hardships/behaviors during/just before pregnancy, including four hardships (poverty, food insecurity, homelessness/no regular place to sleep, intimate partner violence) and two behaviors (smoking, binge drinking). Prevalence ratios (PRs) were calculated from sequential logistic regression models estimating associations between EHC (categorized by level of hardship) and each maternal hardship/behavior, first without adjustment, then adjusting for other childhood and current maternal factors, and finally adding family disruption/dysfunction. Results Before adjustment for family disruption/dysfunction, the highest and intermediate EHC levels were associated with each maternal hardship/behavior; after full adjustment, those associations persisted except with smoking. Higher EHC levels generally appeared associated with larger PRs, although confidence intervals overlapped. Conclusions for Policy/Practice These findings link childhood economic hardship with women's hardships, binge drinking, and possibly smoking around the time of pregnancy. Without establishing causality, they support previous research indicating that childhood economic adversity should be considered an ACE.

Trends in Health Care Expenditure in U.S. Adults With Diabetes: 2002–2011

PubMed Central

Ozieh, Mukoso N.; Bishu, Kinfe G.; Dismuke, Clara E.

2015-01-01

OBJECTIVE Direct medical cost of diabetes in the U.S. has been estimated to be 2.3 times higher relative to individuals without diabetes. This study examines trends in health care expenditures by expenditure category in U.S. adults with diabetes between 2002 and 2011. RESEARCH DESIGN AND METHODS We analyzed 10 years of data representing a weighted population of 189,013,514 U.S. adults aged ≥18 years from the Medical Expenditure Panel Survey. We used a novel two-part model to estimate adjusted mean and incremental medical expenditures by diabetes status, while adjusting for demographics, comorbidities, and time. RESULTS Relative to individuals without diabetes ($5,058 [95% CI 4,949–5,166]), individuals with diabetes ($12,180 [11,775–12,586]) had more than double the unadjusted mean direct expenditures over the 10-year period. After adjustment for confounders, individuals with diabetes had $2,558 (2,266–2,849) significantly higher direct incremental expenditures compared with those without diabetes. For individuals with diabetes, inpatient expenditures rose initially from $4,014 in 2002/2003 to $4,183 in 2004/2005 and then decreased continuously to $3,443 in 2010/2011, while rising steadily for individuals without diabetes. The estimated unadjusted total direct expenditures for individuals with diabetes were $218.6 billion/year and adjusted total incremental expenditures were approximately $46 billion/year. CONCLUSIONS Our findings show that compared with individuals without diabetes, individuals with diabetes had significantly higher health expenditures from 2002 to 2011 and the bulk of the expenditures came from hospital inpatient and prescription expenditures. PMID:26203060

Medication Use in Early-HD Participants in Track-HD: an Investigation of its Effects on Clinical Performance.

PubMed

Keogh, Ruth; Frost, Chris; Owen, Gail; Daniel, Rhian M; Langbehn, Doug R; Leavitt, Blair; Durr, Alexandra; Roos, Raymund A C; Landwehrmeyer, G Bernhard; Reilmann, Ralf; Borowsky, Beth; Stout, Julie; Craufurd, David; Tabrizi, Sarah J

2016-01-11

 Insufficient evidence exists to guide the long-term pharmacological management of Huntington's disease (HD) although most current interventions rely on symptomatic management. The effect of many frontline treatments on potential endpoints for HD clinical trials remains unknown. Our objective was to investigate how therapies widely used to manage HD affect the symptom for which they are prescribed and other endpoints using data from TRACK-HD. We used longitudinal models to estimate effects of medication use on performance on tests of motor, cognitive and neuropsychiatric function using data from 123 TRACK-HD stage 1/2 participants across four study visits. Adjustment for confounding by prior medication use, prior clinical performance, concomitant use of other medications, and baseline variables (sex, disease group, age, CAG, study site, education) enabled a closer-to-causal interpretation of the associations. Adjusting for baseline variables only, medication use was typically associated with worse clinical performance, reflecting greater medication use in more advanced patients. After additional adjustment for longitudinal confounders such "inverse" associations were generally eliminated and in the expected directions: participants taking neuroleptics tended to have better motor performance, improved affect and poorer cognitive performance, and those taking SSRI/SNRIs had less apathy, less affect and better total behaviour scores. However, we uncovered few statistically significant associations. Limitations include sample size and unmeasured confounding. In conclusion, adjustment for confounding by prior measurements largely eliminated associations between medication use and poorer clinical performance from simple analyses. However, there was little convincing evidence of causal effects of medication on clinical performance and larger cohorts or trials are needed.

Economic evaluation of an implementation strategy for the management of low back pain in general practice.

PubMed

Jensen, Cathrine Elgaard; Riis, Allan; Petersen, Karin Dam; Jensen, Martin Bach; Pedersen, Kjeld Møller

2017-05-01

In connection with the publication of a clinical practice guideline on the management of low back pain (LBP) in general practice in Denmark, a cluster randomised controlled trial was conducted. In this trial, a multifaceted guideline implementation strategy to improve general practitioners' treatment of patients with LBP was compared with a usual implementation strategy. The aim was to determine whether the multifaceted strategy was cost effective, as compared with the usual implementation strategy. The economic evaluation was conducted as a cost-utility analysis where cost collected from a societal perspective and quality-adjusted life years were used as outcome measures. The analysis was conducted as a within-trial analysis with a 12-month time horizon consistent with the follow-up period of the clinical trial. To adjust for a priori selected covariates, generalised linear models with a gamma family were used to estimate incremental costs and quality-adjusted life years. Furthermore, both deterministic and probabilistic sensitivity analyses were conducted. Results showed that costs associated with primary health care were higher, whereas secondary health care costs were lower for the intervention group when compared with the control group. When adjusting for covariates, the intervention was less costly, and there was no significant difference in effect between the 2 groups. Sensitivity analyses showed that results were sensitive to uncertainty. In conclusion, the multifaceted implementation strategy was cost saving when compared with the usual strategy for implementing LBP clinical practice guidelines in general practice. Furthermore, there was no significant difference in effect, and the estimate was sensitive to uncertainty.

Validating a benchmarking tool for audit of early outcomes after operations for head and neck cancer

PubMed Central

Sassoon, I; McGurk, M

2017-01-01

INTRODUCTION In 2013 all UK surgical specialties, with the exception of head and neck surgery, published outcome data adjusted for case mix for indicator operations. This paper reports a pilot study to validate a previously published risk adjustment score on patients from separate UK cancer centres. METHODS A case note audit was performed of 1,075 patients undergoing 1,218 operations for head and neck squamous cell carcinoma under general anaesthesia in 4 surgical centres. A logistic regression equation predicting for all complications, previously validated internally at sites A–C, was tested on a fourth external validation sample (site D, 172 operations) using receiver operating characteristic curves, Hosmer–Lemeshow goodness of fit analysis and Brier scores. RESULTS Thirty-day complication rates varied widely (34–51%) between the centres. The predictive score allowed imperfect risk adjustment (area under the curve: 0.70), with Hosmer–Lemeshow analysis suggesting good calibration. The Brier score changed from 0.19 for sites A–C to 0.23 when site D was also included, suggesting poor accuracy overall. CONCLUSIONS Marked differences in operative risk and patient case mix captured by the risk adjustment score do not explain all the differences in observed outcomes. Further investigation with different methods is recommended to improve modelling of risk. Morbidity is common, and usually has a major impact on patient recovery, ward occupancy, hospital finances and patient perception of quality of care. We hope comparative audit will highlight good performance and challenge underperformance where it exists. PMID:27917662

[Application of ARIMA model to predict number of malaria cases in China].

PubMed

Hui-Yu, H; Hua-Qin, S; Shun-Xian, Z; Lin, A I; Yan, L U; Yu-Chun, C; Shi-Zhu, L I; Xue-Jiao, T; Chun-Li, Y; Wei, H U; Jia-Xu, C

2017-08-15

Objective To study the application of autoregressive integrated moving average (ARIMA) model to predict the monthly reported malaria cases in China, so as to provide a reference for prevention and control of malaria. Methods SPSS 24.0 software was used to construct the ARIMA models based on the monthly reported malaria cases of the time series of 20062015 and 2011-2015, respectively. The data of malaria cases from January to December, 2016 were used as validation data to compare the accuracy of the two ARIMA models. Results The models of the monthly reported cases of malaria in China were ARIMA (2, 1, 1) (1, 1, 0) 12 and ARIMA (1, 0, 0) (1, 1, 0) 12 respectively. The comparison between the predictions of the two models and actual situation of malaria cases showed that the ARIMA model based on the data of 2011-2015 had a higher accuracy of forecasting than the model based on the data of 2006-2015 had. Conclusion The establishment and prediction of ARIMA model is a dynamic process, which needs to be adjusted unceasingly according to the accumulated data, and in addition, the major changes of epidemic characteristics of infectious diseases must be considered.

Respiratory health effects and exposure to superabsorbent polymer and paper dust - an epidemiological study

PubMed Central

2011-01-01

Background The primary aim of the present study was to investigate if exposure to dust from absorbent hygiene products containing superabsorbent polymer is related to symptoms from the airways and from the eyes. The secondary aim was to estimate the current exposure to superabsorbent polymer among production and maintenance workers in a plant producing hygiene products. Methods The cohort comprised 1043 workers of whom 689 were exposed to super absorbent polymer and 804 were exposed to paper dust (overlapping groups). There was 186 workers not exposed to either superabsorbent polymer or to paper dust They were investigated with a comprehensive questionnaire about exposure, asthma, rhinitis and symptoms from eyes and airways. The results were analyzed with logistic regression models adjusting for sex, age, atopy and smoking habits. An aerosol sampler equipped with a polytetrafluoroethylene filter with 1 μm pore size was used for personal samplings in order to measure inhalable dust and superabsorbent polymer. Results The prevalence of nasal crusts (OR 1.4, 95% CI 1.01-2.0) and nose-bleeding (OR 1.7, 95% CI 1.2-2.4) was increased among the paper dust exposed workers (adjusted for superabsorbent polymer exposure). There were no significant effects associated with exposure to superabsorbent polymer (adjusted for paper dust exposure). The average exposure to inhalable levels of total dust (paper dust) varied between 0.40 and 1.37 mg/m3. For superabsorbent polymer dust the average exposure varied between 0.02 and 0.81 mg/m3. Conclusions In conclusion, our study shows that workers manufacturing diapers in the hygiene industry have an increased prevalence of symptoms from the nose, especially nose-bleeding. There was no relation between exposure to superabsorbent polymer and symptoms from eyes, nose or respiratory tract, but exposure to paper dust was associated with nose-bleeding and nasal crusts. This group of workers had also a considerable exposure to superabsorbent polymer dust. PMID:21752269

Early Urinary Markers of Diabetic Kidney Disease: A Nested Case-Control Study From the Diabetes Control and Complications Trial (DCCT)

PubMed Central

Kern, Elizabeth O; Erhard, Penny; Sun, Wanjie; Genuth, Saul; Weiss, Miriam F

2010-01-01

Background Urinary markers were tested as predictors of macroalbuminuria or microalbuminuria in type 1 diabetes. Study Design Nested case:control of participants in the Diabetes Control and Complications Trial (DCCT) Setting & Participants Eighty-seven cases of microalbuminuria were matched to 174 controls in a 1:2 ratio, while 4 cases were matched to 4 controls in a 1:1 ratio, resulting in 91 cases and 178 controls for microalbuminuria. Fifty-five cases of macroalbuminuria were matched to 110 controls in a 1:2 ratio. Controls were free of micro/macroalbuminuria when their matching case first developed micro/macroalbuminuria. Predictors Urinary N-acetyl-β-D-glucosaminidase, pentosidine, AGE fluorescence, albumin excretion rate (AER) Outcomes Incident microalbuminuria (two consecutive annual AER > 40 but <= 300 mg/day), or macroalbuminuria (AER > 300 mg/day) Measurements Stored urine samples from DCCT entry, and 1–9 years later when macroalbuminuria or microalbuminuria occurred, were measured for the lysosomal enzyme, N-acetyl-β-D-glucosaminidase, and the advanced glycosylation end-products (AGEs) pentosidine and AGE-fluorescence. AER and adjustor variables were obtained from the DCCT. Results Sub-microalbuminuric levels of AER at baseline independently predicted microalbuminuria (adjusted OR 1.83; p<.001) and macroalbuminuria (adjusted OR 1.82; p<.001). Baseline N-acetyl-β-D-glucosaminidase independently predicted macroalbuminuria (adjusted OR 2.26; p<.001), and microalbuminuria (adjusted OR 1.86; p<.001). Baseline pentosidine predicted macroalbuminuria (adjusted OR 6.89; p=.002). Baseline AGE fluorescence predicted microalbuminuria (adjusted OR 1.68; p=.02). However, adjusted for N-acetyl-β-D-glucosaminidase, pentosidine and AGE-fluorescence lost predictive association with macroalbuminuria and microalbuminuria, respectively. Limitations Use of angiotensin converting-enzyme inhibitors was not directly ascertained, although their use was proscribed during the DCCT. Conclusions Early in type 1 diabetes, repeated measurements of AER and urinary NAG may identify individuals susceptible to future diabetic nephropathy. Combining the two markers may yield a better predictive model than either one alone. Renal tubule stress may be more severe, reflecting abnormal renal tubule processing of AGE-modified proteins, among individuals susceptible to diabetic nephropathy. PMID:20138413

Phobic Anxiety and Plasma Levels of Global Oxidative Stress in Women

PubMed Central

Hagan, Kaitlin A.; Wu, Tianying; Rimm, Eric B.; Eliassen, A. Heather; Okereke, Olivia I.

2015-01-01

Background and Objectives Psychological distress has been hypothesized to be associated with adverse biologic states such as higher oxidative stress and inflammation. Yet, little is known about associations between a common form of distress – phobic anxiety – and global oxidative stress. Thus, we related phobic anxiety to plasma fluorescent oxidation products (FlOPs), a global oxidative stress marker. Methods We conducted a cross-sectional analysis among 1,325 women (aged 43-70 years) from the Nurses’ Health Study. Phobic anxiety was measured using the Crown-Crisp Index (CCI). Adjusted least-squares mean log-transformed FlOPs were calculated across phobic categories. Logistic regression models were used to calculate odds ratios (OR) comparing the highest CCI category (≥6 points) vs. lower scores, across FlOPs quartiles. Results No association was found between phobic anxiety categories and mean FlOP levels in multivariable adjusted linear models. Similarly, in multivariable logistic regression models there were no associations between FlOPs quartiles and likelihood of being in the highest phobic category. Comparing women in the highest vs. lowest FlOPs quartiles: FlOP_360: OR=0.68 (95% CI: 0.40-1.15); FlOP_320: OR=0.99 (95% CI: 0.61-1.61); FlOP_400: OR=0.92 (95% CI: 0.52, 1.63). Conclusions No cross-sectional association was found between phobic anxiety and a plasma measure of global oxidative stress in this sample of middle-aged and older women. PMID:26635425

Genetic variation in Tanis was associated with elevating plasma triglyceride level in Chinese nondiabetic subjects

PubMed Central

2013-01-01

Background The association of genetic polymorphisms of Tanis with triglyceride concentration in human has not been thoroughly examined. We aimed to investigate the relationship between triglyceride concentrations and Tanis genetic polymorphisms. Methods All participants (n=1497) selected from subjects participating in the Cardiovascular Risk Survey (CRS) study were divided into two groups according to ethnicity (Han: n=1059; Uygur: n= 438). Four tagging SNPs (rs12910524, rs1384565, rs2101171, rs4965814) of Tanis gene were genotyped using TaqMan® assays from Applied Biosystems following the manufacturer’s suggestions and analyzed in an ABI 7900HT Fast Real-Time PCR System. Results We found that the SNP rs12910524 was associated with triglyceride levels by analyses of a dominant model (P<0.001), recessive model (P <0.001) and additive model (P < 0.001) not only in Han ethnic but also in Uygur ethnic group, and the difference remained significant after the adjustment of sex, age, alcohol intake, smoking, BMI and plasma glucose (GLU) level (All P < 0.001). However, this relationship was not observed in rs1384565, rs2101171, and rs4965814 before and after multivariate adjustment (All P > 0.05). Furthermore, there were significant interactions between rs12910524 and GLU on TG both in Han (P=0.001) and Uygur population (P=2.60×10-4). Conclusion Our results indicated that the rs12910524 in the Tanis gene was associated with triglyceride concentrations in subjects without diabetes in China. PMID:23829426

A Frailty Index from Next-of-Kin Data: A Cross-Sectional Analysis from the Mexican Health and Aging Study.

PubMed

Pérez-Zepeda, Mario Ulises; Cesari, Matteo; Carrillo-Vega, María Fernanda; Salinas-Escudero, Guillermo; Tella-Vega, Pamela; García-Peña, Carmen

2017-01-01

Objectives. To construct a frailty index from next-of-kin information of the last year of life of community-dwelling 50 years old or older adults and test its association with health services utilization. Methods. Cross-sectional analysis from next-of-kin data available from the last wave of the Mexican Health and Aging Study (MHAS). Measurements. Along with descriptive statistics, the frailty index (FI) was tested in regression models to assess its association with adverse outcomes previous to death: number of hospitalized days in the previous year and number of visits to a physician in the previous year, in unadjusted and adjusted models. Results. From a total of 2,649 individuals the mean of age was 74.8 (±11.4) and 56.3% ( n = 1,183) were women. The mean of the FI was of 0.279 (±SD 0.131, R = 0.0-0.738) and distribution was biased to the right. There was a significant association ( p < 0.001) between the FI and number of hospitalized days ( β = 45.7, 95% CI 36.1-55.4, p < 0.001) and for the number of visits to a physician ( β = 25.93, 95% CI 19.27-32.6, p < 0.001) both models adjusted for age and sex. Conclusion. The FI constructed with next-of-kin data showed similar characteristics to similar indexes of older adults. It was independently associated with health care use.

The alarming problems of confounding equivalence using logistic regression models in the perspective of causal diagrams.

PubMed

Yu, Yuanyuan; Li, Hongkai; Sun, Xiaoru; Su, Ping; Wang, Tingting; Liu, Yi; Yuan, Zhongshang; Liu, Yanxun; Xue, Fuzhong

2017-12-28

Confounders can produce spurious associations between exposure and outcome in observational studies. For majority of epidemiologists, adjusting for confounders using logistic regression model is their habitual method, though it has some problems in accuracy and precision. It is, therefore, important to highlight the problems of logistic regression and search the alternative method. Four causal diagram models were defined to summarize confounding equivalence. Both theoretical proofs and simulation studies were performed to verify whether conditioning on different confounding equivalence sets had the same bias-reducing potential and then to select the optimum adjusting strategy, in which logistic regression model and inverse probability weighting based marginal structural model (IPW-based-MSM) were compared. The "do-calculus" was used to calculate the true causal effect of exposure on outcome, then the bias and standard error were used to evaluate the performances of different strategies. Adjusting for different sets of confounding equivalence, as judged by identical Markov boundaries, produced different bias-reducing potential in the logistic regression model. For the sets satisfied G-admissibility, adjusting for the set including all the confounders reduced the equivalent bias to the one containing the parent nodes of the outcome, while the bias after adjusting for the parent nodes of exposure was not equivalent to them. In addition, all causal effect estimations through logistic regression were biased, although the estimation after adjusting for the parent nodes of exposure was nearest to the true causal effect. However, conditioning on different confounding equivalence sets had the same bias-reducing potential under IPW-based-MSM. Compared with logistic regression, the IPW-based-MSM could obtain unbiased causal effect estimation when the adjusted confounders satisfied G-admissibility and the optimal strategy was to adjust for the parent nodes of outcome, which obtained the highest precision. All adjustment strategies through logistic regression were biased for causal effect estimation, while IPW-based-MSM could always obtain unbiased estimation when the adjusted set satisfied G-admissibility. Thus, IPW-based-MSM was recommended to adjust for confounders set.

Biological and Behavioral Risks for Incident Chlamydia trachomatis Infection in a Prospective Cohort

PubMed Central

Hwang, Loris Y.; Ma, Yifei; Moscicki, Anna-Barbara

2014-01-01

Objective To identify biological and behavioral risks for incident Chlamydia trachomatis among a prospective cohort of young women followed frequently. Methods Our cohort of 629 women from two outpatient sites was seen every 4 months (October 2000 through April 2012) for behavioral interviews and infection testing. C trachomatis was tested annually, and anytime patients reported symptoms or possible exposure using commercial nucleic acid amplification tests. Analyses excluded baseline prevalent C trachomatis infections. Risk factors for incident C trachomatis were assessed using Cox proportional hazards models. Significant risks (p<0.10) from bivariate models were entered in a multivariate model, adjusted for four covariates chosen a priori (age, race or ethnicity, condom use, study site). Backwards step-wise elimination produced a final parsimonious model retaining significant variables (p<0.05) and the four adjustment variables. Results The 629 women attended 9,594 total visits. Median follow-up time was 6.9 years (interquartile range 3.2-9.8), during which 97 (15%) women had incident C trachomatis . In the final multivariate model, incident C trachomatis was independently associated with HPV at the preceding visit (p<0.01), smoking (p=0.02), and weekly use of substances besides alcohol and marijuana (p<0.01) since prior visit. Among 207 women with available colpophotographs (1,742 visits), cervical ectopy was not a significant risk factor (p range=0.16-0.39 for ectopy as continuous and ordinal variables). Conclusion Novel risks for C trachomatis include preceding HPV, smoking, and substance use, which may reflect both biological and behavioral mechanisms of risk, such as immune modulation, higher-risk sexual networks, or both. Improved understanding of the biological bases for C trachomatis risk would inform our strategies for C trachomatis control. PMID:25437724

Pragmatic pharmacology: population pharmacokinetic analysis of fentanyl using remnant samples from children after cardiac surgery

PubMed Central

Van Driest, Sara L.; Marshall, Matthew D.; Hachey, Brian; Beck, Cole; Crum, Kim; Owen, Jill; Smith, Andrew H.; Kannankeril, Prince J.; Woodworth, Alison; Caprioli, Richard M.

2016-01-01

Aims One barrier contributing to the lack of pharmacokinetic (PK) data in paediatric populations is the need for serial sampling. Analysis of clinically obtained specimens and data may overcome this barrier. To add evidence for the feasibility of this approach, we sought to determine PK parameters for fentanyl in children after cardiac surgery using specimens and data generated in the course of clinical care, without collecting additional blood samples. Methods We measured fentanyl concentrations in plasma from leftover clinically‐obtained specimens in 130 paediatric cardiac surgery patients and successfully generated a PK dataset using drug dosing data extracted from electronic medical records. Using a population PK approach, we estimated PK parameters for this population, assessed model goodness‐of‐fit and internal model validation, and performed subset data analyses. Through simulation studies, we compared predicted fentanyl concentrations using model‐driven weight‐adjusted per kg vs. fixed per kg fentanyl dosing. Results Fentanyl clearance for a 6.4 kg child, the median weight in our cohort, is 5.7 l h–1 (2.2–9.2 l h–1), similar to values found in prior formal PK studies. Model assessment and subset analyses indicated the model adequately fit the data. Of the covariates studied, only weight significantly impacted fentanyl kinetics, but substantial inter‐individual variability remained. In simulation studies, model‐driven weight‐adjusted per kg fentanyl dosing led to more consistent therapeutic fentanyl concentrations than fixed per kg dosing. Conclusions We show here that population PK modelling using sparse remnant samples and electronic medical records data provides a powerful tool for assessment of drug kinetics and generation of individualized dosing regimens. PMID:26861166

Dual energy X-ray absorptiometry spine scans to determine abdominal fat in post-menopausal women

PubMed Central

Bea, J. W.; Blew, R. M.; Going, S. B.; Hsu, C-H; Lee, M. C.; Lee, V. R.; Caan, B.J.; Kwan, M.L.; Lohman, T. G.

2016-01-01

Body composition may be a better predictor of chronic disease risk than body mass index (BMI) in older populations. Objectives We sought to validate spine fat fraction (%) from dual energy X-ray absorptiometry (DXA) spine scans as a proxy for total abdominal fat. Methods Total body DXA scan abdominal fat regions of interest (ROI) that have been previously validated by magnetic resonance imaging were assessed among healthy, postmenopausal women who also had antero-posterior spine scans (n=103). ROIs were 1) lumbar vertebrae L2-L4 and 2) L2-Iliac Crest (L2-IC), manually selected by two independent raters, and 3) trunk, auto-selected by DXA software. Intra-class correlation coefficients evaluated intra and inter-rater reliability on a random subset (N=25). Linear regression models, validated by bootstrapping, assessed the relationship between spine fat fraction (%) and total abdominal fat (%) ROIs. Results Mean age, BMI and total body fat were: 66.1 ± 4.8y, 25.8 ± 3.8kg/m2 and 40.0 ± 6.6%, respectively. There were no significant differences within or between raters. Linear regression models adjusted for several participant and scan characteristics were equivalent to using only BMI and spine fat fraction. The model predicted L2-L4 (Adj. R2: 0.83) and L2-IC (Adj.R2:0.84) abdominal fat (%) well; the adjusted R2 for trunk fat (%) was 0.78. Model validation demonstrated minimal over-fitting (Adj. R2: 0.82, 0.83, and 0.77 for L2-L4, L2-IC, and trunk fat respectively). Conclusions The strong correlation between spine fat fraction and DXA abdominal fat measures make it suitable for further development in post-menopausal chronic disease risk prediction models. PMID:27416964

Modelling the cost-effectiveness of public awareness campaigns for the early detection of non-small-cell lung cancer.

PubMed

Hinde, S; McKenna, C; Whyte, S; Peake, M D; Callister, M E J; Rogers, T; Sculpher, M

2015-06-30

Survival rates in lung cancer in England are significantly lower than in many similar countries. A range of Be Clear on Cancer (BCOC) campaigns have been conducted targeting lung cancer and found to improve the proportion of diagnoses at the early stage of disease. This paper considers the cost-effectiveness of such campaigns, evaluating the effect of both the regional and national BCOC campaigns on the stage distribution of non-small-cell lung cancer (NSCLC) at diagnosis. A natural history model of NSCLC was developed using incidence data, data elicited from clinical experts and model calibration techniques. This structure is used to consider the lifetime cost and quality-adjusted survival implications of the early awareness campaigns. Incremental cost-effectiveness ratios (ICERs) in terms of additional costs per quality-adjusted life-years (QALYs) gained are presented. Two scenario analyses were conducted to investigate the role of changes in the 'worried-well' population and the route of diagnosis that might occur as a result of the campaigns. The base-case theoretical model found the regional and national early awareness campaigns to be associated with QALY gains of 289 and 178 QALYs and ICERs of £13 660 and £18 173 per QALY gained, respectively. The scenarios found that increases in the 'worried-well' population may impact the cost-effectiveness conclusions. Subject to the available evidence, the analysis suggests that early awareness campaigns in lung cancer have the potential to be cost-effective. However, significant additional research is required to address many of the limitations of this study. In addition, the estimated natural history model presents previously unavailable estimates of the prevalence and rate of disease progression in the undiagnosed population.

Physician-owned Surgical Hospitals Outperform Other Hospitals in the Medicare Value-based Purchasing Program

PubMed Central

Ramirez, Adriana G; Tracci, Margaret C; Stukenborg, George J; Turrentine, Florence E; Kozower, Benjamin D; Jones, R Scott

2016-01-01

Background The Hospital Value-Based Purchasing Program measures value of care provided by participating Medicare hospitals while creating financial incentives for quality improvement and fostering increased transparency. Limited information is available comparing hospital performance across healthcare business models. Study Design 2015 hospital Value-Based Purchasing Program results were used to examine hospital performance by business model. General linear modeling assessed differences in mean total performance score, hospital case mix index, and differences after adjustment for differences in hospital case mix index. Results Of 3089 hospitals with Total Performance Scores (TPS), categories of representative healthcare business models included 104 Physician-owned Surgical Hospitals (POSH), 111 University HealthSystem Consortium (UHC), 14 US News & World Report Honor Roll (USNWR) Hospitals, 33 Kaiser Permanente, and 124 Pioneer Accountable Care Organization affiliated hospitals. Estimated mean TPS for POSH (64.4, 95% CI 61.83, 66.38) and Kaiser (60.79, 95% CI 56.56, 65.03) were significantly higher compared to all remaining hospitals while UHC members (36.8, 95% CI 34.51, 39.17) performed below the mean (p < 0.0001). Significant differences in mean hospital case mix index included POSH (mean 2.32, p<0.0001), USNWR honorees (mean 2.24, p 0.0140) and UHC members (mean =1.99, p<0.0001) while Kaiser Permanente hospitals had lower case mix value (mean =1.54, p<0.0001). Re-estimation of TPS did not change the original results after adjustment for differences in hospital case mix index. Conclusions The Hospital Value-Based Purchasing Program revealed superior hospital performance associated with business model. Closer inspection of high-value hospitals may guide value improvement and policy-making decisions for all Medicare Value-Based Purchasing Program Hospitals. PMID:27502368

Coding Response to a Case-Mix Measurement System Based on Multiple Diagnoses

PubMed Central

Preyra, Colin

2004-01-01

Objective To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Data Sources Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Study Design Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Principal Findings Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Conclusions Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post. PMID:15230940

Dosimetric Analysis of Radiation-induced Gastric Bleeding

DOE Office of Scientific and Technical Information (OSTI.GOV)

Feng, Mary, E-mail: maryfeng@umich.edu; Normolle, Daniel; Pan, Charlie C.

2012-09-01

Purpose: Radiation-induced gastric bleeding has been poorly understood. In this study, we described dosimetric predictors for gastric bleeding after fractionated radiation therapy. Methods and Materials: The records of 139 sequential patients treated with 3-dimensional conformal radiation therapy (3D-CRT) for intrahepatic malignancies were reviewed. Median follow-up was 7.4 months. The parameters of a Lyman normal tissue complication probability (NTCP) model for the occurrence of {>=}grade 3 gastric bleed, adjusted for cirrhosis, were fitted to the data. The principle of maximum likelihood was used to estimate parameters for NTCP models. Results: Sixteen of 116 evaluable patients (14%) developed gastric bleeds at amore » median time of 4.0 months (mean, 6.5 months; range, 2.1-28.3 months) following completion of RT. The median and mean maximum doses to the stomach were 61 and 63 Gy (range, 46-86 Gy), respectively, after biocorrection of each part of the 3D dose distributions to equivalent 2-Gy daily fractions. The Lyman NTCP model with parameters adjusted for cirrhosis predicted gastric bleed. Best-fit Lyman NTCP model parameters were n=0.10 and m=0.21 and with TD{sub 50} (normal) = 56 Gy and TD{sub 50} (cirrhosis) = 22 Gy. The low n value is consistent with the importance of maximum dose; a lower TD{sub 50} value for the cirrhosis patients points out their greater sensitivity. Conclusions: This study demonstrates that the Lyman NTCP model has utility for predicting gastric bleeding and that the presence of cirrhosis greatly increases this risk. These findings should facilitate the design of future clinical trials involving high-dose upper abdominal radiation.« less

Flow adjustment inside homogeneous canopies after a leading edge – An analytical approach backed by LES

DOE PAGES

Kroniger, Konstantin; Banerjee, Tirtha; De Roo, Frederik; ...

2017-10-06

A two-dimensional analytical model for describing the mean flow behavior inside a vegetation canopy after a leading edge in neutral conditions was developed and tested by means of large eddy simulations (LES) employing the LES code PALM. The analytical model is developed for the region directly after the canopy edge, the adjustment region, where one-dimensional canopy models fail due to the sharp change in roughness. The derivation of this adjustment region model is based on an analytic solution of the two-dimensional Reynolds averaged Navier–Stokes equation in neutral conditions for a canopy with constant plant area density (PAD). The main assumptionsmore » for solving the governing equations are separability of the velocity components concerning the spatial variables and the neglection of the Reynolds stress gradients. These two assumptions are verified by means of LES. To determine the emerging model parameters, a simultaneous fitting scheme was applied to the velocity and pressure data of a reference LES simulation. Furthermore a sensitivity analysis of the adjustment region model, equipped with the previously calculated parameters, was performed varying the three relevant length, the canopy height ( h), the canopy length and the adjustment length ( Lc), in additional LES. Even if the model parameters are, in general, functions of h/ Lc, it was found out that the model is capable of predicting the flow quantities in various cases, when using constant parameters. Subsequently the adjustment region model is combined with the one-dimensional model of Massman, which is applicable for the interior of the canopy, to attain an analytical model capable of describing the mean flow for the full canopy domain. As a result, the model is tested against an analytical model based on a linearization approach.« less

Flow adjustment inside homogeneous canopies after a leading edge – An analytical approach backed by LES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kroniger, Konstantin; Banerjee, Tirtha; De Roo, Frederik

A two-dimensional analytical model for describing the mean flow behavior inside a vegetation canopy after a leading edge in neutral conditions was developed and tested by means of large eddy simulations (LES) employing the LES code PALM. The analytical model is developed for the region directly after the canopy edge, the adjustment region, where one-dimensional canopy models fail due to the sharp change in roughness. The derivation of this adjustment region model is based on an analytic solution of the two-dimensional Reynolds averaged Navier–Stokes equation in neutral conditions for a canopy with constant plant area density (PAD). The main assumptionsmore » for solving the governing equations are separability of the velocity components concerning the spatial variables and the neglection of the Reynolds stress gradients. These two assumptions are verified by means of LES. To determine the emerging model parameters, a simultaneous fitting scheme was applied to the velocity and pressure data of a reference LES simulation. Furthermore a sensitivity analysis of the adjustment region model, equipped with the previously calculated parameters, was performed varying the three relevant length, the canopy height ( h), the canopy length and the adjustment length ( Lc), in additional LES. Even if the model parameters are, in general, functions of h/ Lc, it was found out that the model is capable of predicting the flow quantities in various cases, when using constant parameters. Subsequently the adjustment region model is combined with the one-dimensional model of Massman, which is applicable for the interior of the canopy, to attain an analytical model capable of describing the mean flow for the full canopy domain. As a result, the model is tested against an analytical model based on a linearization approach.« less

Employment outcome for people with schizophrenia in rural v. urban China: population-based study

PubMed Central

Yang, Lawrence H.; Phillips, Michael R.; Li, Xianyun; Yu, Gary; Zhang, Jingxuan; Shi, Qichang; Song, Zhiqiang; Ding, Zhijie; Pang, Shutao; Susser, Ezra

2013-01-01

Background Although outcomes among people with schizophrenia differ by social context, this has rarely been examined across rural v. urban settings. For individuals with schizophrenia, employment is widely recognised as a critical ingredient of social integration. Aims To compare employment for people with schizophrenia in rural v. urban settings in China. Method In a large community-based study in four provinces representing 12% of China’s population, we identified 393 people with schizophrenia (112 never treated). We used adjusted Poisson regression models to compare employment for those living in rural (n = 297) v. urban (n = 96) settings. Results Although rural and urban residents had similar impairments due to symptoms, rural residents were three times more likely to be employed (adjusted relative risk 3.27, 95% CI 2.11–5.07, P<0.001). Conclusions People with schizophrenia have greater opportunities to use their capacities for productive work in rural than urban settings in China. Contextual mechanisms that may explain this result offer a useful focus for future research. PMID:23258768

Sleep duration, cognitive decline, and dementia risk in older women

PubMed Central

Chen, Jiu-Chiuan; Espeland, Mark A.; Brunner, Robert L.; Lovato, Laura C.; Wallace, Robert B.; Leng, Xiaoyan; Phillips, Lawrence S.; Robinson, Jennifer G.; Kotchen, Jane M.; Johnson, Karen C.; Manson, JoAnn E.; Stefanick, Marcia L.; Sarto, Gloria E.; Mysiw, W. Jerry

2015-01-01

Background Consistent evidence linking habitual sleep duration with risks of mild cognitive impairment (MCI) and dementia is lacking. Methods We conducted a prospective study on 7444 community-dwelling women (aged 65–80) with self-reported sleep duration, within the Women’s Health Initiative Memory Study in 1995–2008. Incident MCI/dementia cases were ascertained by validated protocols. Cox models were used to adjust for multiple sociodemographic and lifestyle factors, depression, cardiovascular disease (CVD), and other clinical characteristics. Results We found a statistically significant (p=0.03) V-shaped association, with a higher MCI/dementia risk in women with either short (≤6 hours/night) or long (≥8 hours/night) sleep duration (vs.7 hours/night). The multicovariate-adjusted hazard for MCI/dementia was increased by 36% in short sleepers irrespective of CVD, and by 35% in long sleepers without CVD. A similar V-shaped association was found with cognitive decline. Conclusion In older women, habitual sleep duration predicts the future risk for cognitive impairments including dementia, independent of vascular risk factors. PMID:26086180

Adolescent mental health and subsequent parenting: a longitudinal birth cohort study

PubMed Central

Byford, M; Abbott, R A; Maughan, B; Richards, M; Kuh, D

2014-01-01

Background Adolescent mental health problems are associated with a range of adverse outcomes in adulthood but little is known about the effects on adult parenting practices. This study aimed to examine prospective associations between adolescent conduct and emotional problems and subsequent parenting behaviours in adulthood. Methods The study sample comprised 1110 members from the MRC National Survey of Health and Development. Prospective data were collected from teacher reports of conduct and emotional problems at age 13 and 15 years and adult outcome measures of parenting included intellectual environment, cognitive stimulation, coercive discipline, parental interest and parental aspiration. Results In regression models adjusted for the confounding effects of social background, cognition and education, adolescent conduct problems predicted coercive parenting behaviours in adulthood. The effects of adolescent emotional problems on the development of coercive discipline practices were explained by covariates. Likewise, the inability of parents who displayed conduct problems in adolescence to provide an intellectually stimulating home environment was fully explained by the adjustment for education. Conclusions Adolescents who exhibit conduct problems are more likely to develop coercive styles of parenting. PMID:24357583

Prognostic Utility of Novel Biomarkers of Cardiovascular Stress: The Framingham Heart Study

PubMed Central

Wang, Thomas J.; Wollert, Kai C.; Larson, Martin G.; Coglianese, Erin; McCabe, Elizabeth L.; Cheng, Susan; Ho, Jennifer E.; Fradley, Michael G.; Ghorbani, Anahita; Xanthakis, Vanessa; Kempf, Tibor; Benjamin, Emelia J.; Levy, Daniel; Vasan, Ramachandran S.; Januzzi, James L.

2013-01-01

Background Biomarkers for predicting cardiovascular events in community-based populations have not consistently added information to standard risk factors. A limitation of many previously studied biomarkers is their lack of cardiovascular specificity. Methods and Results To determine the prognostic value of 3 novel biomarkers induced by cardiovascular stress, we measured soluble ST2, growth differentiation factor-15, and high-sensitivity troponin I in 3,428 participants (mean age 59, 53% women) in the Framingham Heart Study. We performed multivariable-adjusted proportional hazards models to assess the individual and combined ability of the biomarkers to predict adverse outcomes. We also constructed a “multimarker” score composed of the 3 biomarkers, in addition to B-type natriuretic peptide and high-sensitivity C-reactive protein. During a mean follow-up of 11.3 years, there were 488 deaths, 336 major cardiovascular events, 162 heart failure events, and 142 coronary events. In multivariable-adjusted models, the 3 new biomarkers were associated with each endpoint (p<0.001) except for coronary events. Individuals with multimarker scores in the highest quartile had a 3-fold risk of death (adjusted hazard ratio, 3.2, 95% CI, 2.2–4.7; p<0.001), 6-fold risk of heart failure (6.2, 95% CI, 2.6–14.8; p<0.001), and 2-fold risk of cardiovascular events (1.9, 95% CI, 1.3–2.7; p=0.001). Addition of the multimarker score to clinical variables led to significant increases in the c-statistic (p=0.007 or lower) and net reclassification improvement (p=0.001 or lower). Conclusions Multiple biomarkers of cardiovascular stress are detectable in ambulatory individuals, and add prognostic value to standard risk factors for predicting death, overall cardiovascular events, and heart failure. PMID:22907935

Muscle mass, BMI, and mortality among adults in the United States: A population-based cohort study

PubMed Central

Hall, Charles B.; Amodu, Afolarin; Sharma, Deep; Androga, Lagu; Hawkins, Meredith

2018-01-01

Background The level of body-mass index (BMI) associated with the lowest risk of death remains unclear. Although differences in muscle mass limit the utility of BMI as a measure of adiposity, no study has directly examined the effect of muscle mass on the BMI-mortality relationship. Methods Body composition was measured by dual-energy x-ray absorptiometry in 11,687 participants of the National Health and Nutrition Examination Survey 1999–2004. Low muscle mass was defined using sex-specific thresholds of the appendicular skeletal muscle mass index (ASMI). Proportional hazards models were created to model associations with all-cause mortality. Results At any level of BMI ≥22, participants with low muscle mass had higher body fat percentage (%TBF), an increased likelihood of diabetes, and higher adjusted mortality than other participants. Increases in %TBF manifested as 30–40% smaller changes in BMI than were observed in participants with preserved muscle mass. Excluding participants with low muscle mass or adjustment for ASMI attenuated the risk associated with low BMI, magnified the risk associated with high BMI, and shifted downward the level of BMI associated with the lowest risk of death. Higher ASMI was independently associated with lower mortality. Effects were similar in never-smokers and ever-smokers. Additional adjustment for waist circumference eliminated the risk associated with higher BMI. Results were unchanged after excluding unintentional weight loss, chronic illness, early mortality, and participants performing muscle-strengthening exercises or recommended levels of physical activity. Conclusions Muscle mass mediates associations of BMI with adiposity and mortality and is inversely associated with the risk of death. After accounting for muscle mass, the BMI associated with the greatest survival shifts downward toward the normal range. These results provide a concrete explanation for the obesity paradox. PMID:29641540

The effect of maternal child marriage on morbidity and mortality of children under 5 in India: cross sectional study of a nationally representative sample

PubMed Central

Saggurti, Niranjan; Winter, Michael; Labonte, Alan; Decker, Michele R; Balaiah, Donta; Silverman, Jay G

2010-01-01

Objective To assess associations between maternal child marriage (marriage before age 18) and morbidity and mortality of infants and children under 5 in India. Design Cross-sectional analyses of nationally representative household sample. Generalised estimating equation models constructed to assess associations. Adjusted models included maternal and child demographics and maternal body mass index as covariates. Setting India. Population Women aged 15-49 years (n=124 385); data collected in 2005-6 through National Family Health Survey-3. Data about child morbidity and mortality reported by participants. Analyses restricted to births in past five years reported by ever married women aged 15-24 years (n=19 302 births to 13 396 mothers). Main outcome measures In under 5s: mortality related infectious diseases in the past two weeks (acute respiratory infection, diarrhoea); malnutrition (stunting, wasting, underweight); infant (age <1 year) and child (1-5 years) mortality; low birth weight (<2500 kg). Results The majority of births (73%; 13 042/19 302) were to mothers married as minors. Although bivariate analyses showed significant associations between maternal child marriage and infant and child diarrhoea, malnutrition (stunted, wasted, underweight), low birth weight, and mortality, only stunting (adjusted odds ratio 1.22, 95% CI 1.12 to 1.33) and underweight (1.24, 1.14 to 1.36) remained significant in adjusted analyses. We noted no effect of maternal child marriage on health of boys versus girls. Conclusions The risk of malnutrition is higher in young children born to mothers married as minors than in those born to women married at a majority age. Further research should examine how early marriage affects food distribution and access for children in India. PMID:20093277

Using Bayesian Models to Assess the Effects of Under-reporting of Cannabis Use on the Association with Birth Defects, National Birth Defects Prevention Study, 1997–2005

PubMed Central

van Gelder, Marleen M. H. J.; Rogier, A.; Donders, T.; Devine, Owen; Roeleveld, Nel; Reefhuis, Jennita

2015-01-01

Background Studies on associations between periconceptional cannabis exposure and birth defects have mainly relied on self-reported exposure. Therefore, the results may be biased due to underreporting of the exposure. The aim of this study was to quantify the potential effects of this form of exposure misclassification. Methods Using multivariable logistic regression, we re-analyzed associations between periconceptional cannabis use and 20 specific birth defects using data from the National Birth Defects Prevention Study from 1997–2005 for 13 859 case infants and 6556 control infants. For seven birth defects, we implemented four Bayesian models based on various assumptions concerning the sensitivity of self-reported cannabis use to estimate odds ratios (ORs), adjusted for confounding and underreporting of the exposure. We used information on sensitivity of self-reported cannabis use from the literature for prior assumptions. Results The results unadjusted for underreporting of the exposure showed an association between cannabis use and anencephaly (posterior OR 1.9 [95% credible interval (CRI) 1.1, 3.2]) which persisted after adjustment for potential exposure misclassification. Initially, no statistically significant associations were observed between cannabis use and the other birth defect categories studied. Although adjustment for underreporting did not notably change these effect estimates, cannabis use was associated with esophageal atresia (posterior OR 1.7 [95% CRI 1.0, 2.9]), diaphragmatic hernia (posterior OR 1.8 [95% CRI 1.1, 3.0]) and gastroschisis (posterior OR 1.7 [95% CRI 1.2, 2.3]) after correction for exposure misclassification. Conclusions Underreporting of the exposure may have obscured some cannabis-birth defect associations in previous studies. However, the resulting bias is likely to be limited. PMID:25155701

Consumption of monosodium glutamate in relation to incidence of overweight in Chinese adults: China Health and Nutrition Survey (CHNS)123

PubMed Central

Du, Shufa; Xun, Pengcheng; Sharma, Sangita; Wang, Huijun; Zhai, Fengying; Popkin, Barry

2011-01-01

Background: It has been hypothesized that monosodium glutamate (MSG), a flavor enhancer, is positively associated with weight gain, which influences energy balance through the disruption of the hypothalamic signaling cascade of leptin action. Objective: The objective was to examine the longitudinal association between MSG consumption and incidence of overweight. Design: Data were collected from the China Health and Nutrition Survey (CHNS), a prospective open-cohort, ongoing nationwide health and nutrition survey, consisting of 10,095 apparently healthy Chinese adults aged 18–65 y at entry from 1991 to 2006. Diet, including MSG and other condiments, was assessed with a weighed food inventory in combination with three 24-h recalls. Incident overweight was defined as a body mass index (BMI; in kg/m2) ≥ 25 or ≥23 based on World Health Organization recommendations for Asian populations. Multilevel mixed-effects models were constructed to estimate change in BMI, and Cox regression models with gamma shared frailty were used to determine the incidence of overweight. Results: The mean follow-up was 5.5 y. The cumulative mean (±SD) MSG intake of 2.2 ± 1.6 g/d was positively associated with BMI after adjustment for potential confounders and cluster effects at different levels (individual, household, and community). The adjusted hazard ratio of overweight was 1.33 (95% CI: 1.01, 1.75; P for trend < 0.01) for participants in the highest quintile of MSG intake compared with those in the lowest quintile after adjustment for age, physical activity, total energy intake, and other major lifestyle factors. Conclusions: MSG consumption was positively, longitudinally associated with overweight development among apparently healthy Chinese adults. Additional studies are needed to elucidate mechanisms of action and to establish causal inference. PMID:21471280

Wealth, mother's education and physical access as determinants of retail sector net use in rural Kenya

PubMed Central

2006-01-01

Background Insecticide-treated bed nets (ITN) provide real hope for the reduction of the malaria burden across Africa. Understanding factors that determine access to ITN is crucial to debates surrounding the optimal delivery systems. The influence of homestead wealth on use of nets purchased from the retail sector is well documented, however, the competing influence of mother's education and physical access to net providers is less well understood. Methods Between December 2004 and January 2005, a random sample of 72 rural communities was selected across four Kenyan districts. Demographic, assets, education and net use data were collected at homestead, mother and child (aged < 5 years) levels. An assets-based wealth index was developed using principal components analysis, travel time to net sources was modelled using geographic information systems, and factors influencing the use of retail sector nets explored using a multivariable logistic regression model. Results Homestead heads and guardians of 3,755 children < 5 years of age were interviewed. Approximately 15% (562) of children slept under a net the night before the interview; 58% (327) of the nets used were purchased from the retail sector. Homestead wealth (adjusted OR = 10.17, 95% CI = 5.45–18.98), travel time to nearest market centres (adjusted OR = 0.51, 95% CI = 0.37–0.72) and mother's education (adjusted OR = 2.92, 95% CI = 1.93–4.41) were significantly associated with use of retail sector nets by children aged less than 5 years. Conclusion Approaches to promoting access to nets through the retail sector disadvantage poor and remote communities where mothers are less well educated. PMID:16436216

Neuropsychological performance in LRRK2 G2019S carriers with Parkinson’s disease

PubMed Central

Alcalay, Roy N.; Mejia-Santana, Helen; Mirelman, Anat; Saunders-Pullman, Rachel; Raymond, Deborah; Palmese, Christina; Caccappolo, Elise; Ozelius, Laurie; Orr-Urtreger, Avi; Clark, Lorraine; Giladi, Nir; Bressman, Susan; Marder, Karen

2014-01-01

Background Ashkenazi Jewish (AJ) LRRK2 carriers are more likely to manifest the postural instability gait difficulty (PIGD) motor phenotype than non-carriers but perform similarly to non-carriers on cognitive screening tests. Objective To compare the cognitive profiles of AJ with Parkinson’s disease (PD) with and without LRRK2 G2019S mutations using a comprehensive neuropsychological battery. Methods We administered a neuropsychological battery to PD participants in the Michael J. Fox Foundation AJ consortium. Participants (n=236) from Beth Israel Medical Center, NY, Columbia University Medical Center, NY and Tel Aviv Medical Center, Israel included 116 LRRK2 G2019S carriers and 120 non-carriers. Glucocerbrosidase mutation carriers were excluded. We compared performance on each neuropsychological test between carriers and non-carriers. Participants in New York (n=112) were evaluated with the entire battery. Tel Aviv participants (n=124) were evaluated on attention, executive function and psychomotor speed tasks. The association between G2019S mutation status (predictor) and each neuropsychological test (outcome) was assessed using linear regression models adjusted for PIGD motor phenotype, site, sex, age, disease duration, education, Unified Parkinson’s Disease Rating Scale (UPDRS) Part III, levodopa equivalent dose, and Geriatric Depression Score (GDS). Results Carriers had longer disease duration (p<0.001) and were more likely to manifest the PIGD phenotype (p=0.024). In adjusted regression models, carriers performed better than non-carriers in Stroop Word Reading (p<0.001), Stroop Interference (p=0.011) and Category Fluency (p=0.026). Conclusion In AJ-PD, G2019S mutation status is associated with better attention (Stroop Word Reading), executive function (Stroop Interference) and language (Category Fluency) after adjustment for PIGD motor phenotype. PMID:25434972

Understanding the High Prevalence of Diabetes in U.S. South Asians Compared With Four Racial/Ethnic Groups: The MASALA and MESA Studies

PubMed Central

Kanaya, Alka M.; Herrington, David; Vittinghoff, Eric; Ewing, Susan K.; Liu, Kiang; Blaha, Michael J.; Dave, Swapna S.; Qureshi, Fareeha; Kandula, Namratha R.

2014-01-01

OBJECTIVE We compared South Asians with four other racial/ethnic groups in the U.S. to determine whether sociodemographic, lifestyle, or metabolic factors could explain the higher diabetes prevalence and whether insulin resistance and β-cell dysfunction occurred at younger ages and/or lower adiposity levels compared with other groups. RESEARCH DESIGN AND METHODS We performed a cross-sectional analysis of two community-based cohorts, the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study and the Multi-Ethnic Study of Atherosclerosis (MESA); all participants had no known cardiovascular disease and were between 44 and 84 years of age. We compared 799 South Asians with 2,611 whites, 1,879 African Americans, 1,493 Latinos, and 801 Chinese Americans. Type 2 diabetes was classified by fasting plasma glucose ≥126 mg/dL or use of a diabetes medication. Insulin resistance was estimated by the homeostasis model assessment (HOMA) and β-cell function was measured by the HOMA-β model. RESULTS South Asians had significantly higher age-adjusted prevalence of diabetes (23%) than the MESA ethnic groups (6% in whites, 18% in African Americans, 17% in Latinos, and 13% in Chinese Americans). This difference increased further after adjustment for potential confounders. HOMA of insulin resistance (HOMA-IR) levels were significantly higher and HOMA-β levels were lower among South Asians compared with all other racial/ethnic groups after adjustment for age and adiposity. CONCLUSIONS The higher prevalence of diabetes in South Asians is not explained by traditionally measured risk factors. South Asians may have lower β-cell function and an inability to compensate adequately for higher glucose levels from insulin resistance. PMID:24705613

Risk factors for death from pandemic influenza in 1918–1919: a case–control study

PubMed Central

Summers, Jennifer A; Stanley, James; Baker, Michael G; Wilson, Nick

2014-01-01

Background Despite the persisting threat from future influenza pandemics, much is still unknown about the risk factors for death from such events, and especially for the 1918–1919 influenza pandemic. Methods A case–control study was performed to explore possible risk factors for death from pandemic influenza among New Zealand military personnel in the Northern Hemisphere in 1918–1919 (n = 218 cases, n = 221 controls). Data were compiled from a Roll-of-Honour dataset, a dataset of nearly all military personnel involved in the war and archived individual records. Results In the fully adjusted multivariable model, the following were significantly associated with increased risk of death from pandemic influenza: age (25–29 years), pre-pandemic hospitalisations for a chronic condition (e.g. tuberculosis), relatively early year of military deployment, a relatively short time from enlistment to foreign service, and having a larger chest size (e.g. adjusted odds ratio for 90–99 cm versus <90 cm was 2·45; 95% CI=1·47–4·10). There were no significant associations in the fully adjusted model with military rank, occupational class at enlistment, and rurality at enlistment. Conclusions This is one of the first published case–control studies of mortality risk factors for the 1918–1919 influenza pandemic. Some of the findings are consistent with previous research on risk factors (such as chronic conditions and age groups), but others appear more novel (e.g., larger chest size). As all such historical analyses have limitations, there is a need for additional studies in other settings as archival World War One records become digitalised. PMID:24490663

Long-term prediction of prostate cancer diagnosis and death using PSA and obesity related anthropometrics at early middle age: data from the malmö preventive project

PubMed Central

Assel, Melissa J.; Gerdtsson, Axel; Thorek, Daniel L.J.; Carlsson, Sigrid V.; Malm, Johan; Scardino, Peter T.; Vickers, Andrew; Lilja, Hans; Ulmert, David

2018-01-01

Objectives To evaluate whether anthropometric parameters add to PSA measurements in middle-aged men for risk assessment of prostate cancer (PCa) diagnosis and death. Results After adjusting for PSA, both BMI and weight were significantly associated with an increased risk of PCa death with the odds of a death corresponding to a 10 kg/m2 or 10 kg increase being 1.58 (95% CI 1.10, 2.28; p = 0.013) and 1.14 (95% CI 1.02, 1.26; p = 0.016) times greater, respectively. AUCs did not meaningfully increase with the addition of weight or BMI to prediction models including PSA. Materials and Methods In 1974 to 1986, 22,444 Swedish men aged 44 to 50 enrolled in Malmö Preventive Project, Sweden, and provided blood samples and anthropometric data. Rates of PSA screening in the cohort were very low. Documentation of PCa diagnosis and disease-specific death up to 2014 was retrieved through national registries. Among men with anthropometric measurements available at baseline, a total of 1692 men diagnosed with PCa were matched to 4190 controls, and 464 men who died of disease were matched to 1390 controls. Multivariable conditional logistic regression was used to determine whether diagnosis or death from PCa were associated with weight and body mass index (BMI) at adulthood after adjusting for PSA. Conclusions Men with higher BMI and weight at early middle age have an increased risk of PCa diagnosis and death after adjusting for PSA. However, in a multi-variable numerical statistical model, BMI and weight do not importantly improve the predictive accuracy of PSA. Risk-stratification of screening should be based on PSA without reference to anthropometrics. PMID:29464033

Safety of Tenofovir Use During Pregnancy: Early Growth Outcomes in HIV-Exposed Uninfected Infants

PubMed Central

SIBERRY, George K.; WILLIAMS, Paige L.; MENDEZ, Hermann; SEAGE, George R.; JACOBSON, Denise L.; HAZRA, Rohan; RICH, Kenneth C.; GRINER, Raymond; TASSIOPOULOS, Katherine; KACANEK, Deborah; MOFENSON, Lynne M.; MILLER, Tracie; DiMEGLIO, Linda A.; WATTS, D. Heather

2012-01-01

Objective To evaluate the association of tenofovir disoproxil fumarate (TDF) use during pregnancy with early growth parameters in HIV-exposed, uninfected (HEU) infants. Design US-based prospective cohort study of HEU children to examine potential adverse effects of prenatal TDF exposure. Methods We evaluated the association of maternal TDF use during pregnancy with small for gestational age (SGA); low birth weight (LBW, <2.5kg); weight-for-age z-scores (WAZ), length-forage z-scores (LAZ) and head circumference-for-age (HCAZ) z-scores at newborn visit; and LAZ, HCAZ, and WAZ at age one year. Logistic regression models for LBW and SGA were fit, adjusting for maternal and sociodemographic factors. Adjusted linear regression models were used to evaluate LAZ, WAZ and HCAZ by TDF exposure. Results Of 2029 enrolled children with maternal antiretroviral information, TDF was used by 449 (21%) HIV-infected mothers, increasing from 14% in 2003 to 43% in 2010. There was no difference between those exposed to combination regimens with versus without TDF for SGA, LBW, and newborn LAZ and HCAZ. However, at age one year, infants exposed to combination regimens with TDF had significantly lower adjusted mean LAZ and HCAZ than those without TDF (LAZ: −0.17 vs. −0.03, p=0.04; HCAZ: 0.17 vs. 0.42, p=0.02). Conclusions TDF use during pregnancy was not associated with increased risk for LBW or SGA. The slightly lower mean LAZ and HCAZ observed at age one year in TDF-exposed infants are of uncertain significance but underscore the need for additional studies of growth outcomes after TDF use during pregnancy. PMID:22382151

New insights into the correlation structure of DSM-IV depression symptoms in the general population v. subsamples of depressed individuals.

PubMed

Foster, S; Mohler-Kuo, M

2018-06-01

Previous research failed to uncover a replicable dimensional structure underlying the symptoms of depression. We aimed to examine two neglected methodological issues in this research: (a) adjusting symptom correlations for overall depression severity; and (b) analysing general population samples v. subsamples of currently depressed individuals. Using population-based cross-sectional and longitudinal data from two nations (Switzerland, 5883 young men; USA, 2174 young men and 2244 young women) we assessed the dimensions of the nine DSM-IV depression symptoms in young adults. In each general-population sample and each subsample of currently depressed participants, we conducted a standardised process of three analytical steps, based on exploratory and confirmatory factor and bifactor analysis, to reveal any replicable dimensional structure underlying symptom correlations while controlling for overall depression severity. We found no evidence of a replicable dimensional structure across samples when adjusting symptom correlations for overall depression severity. In the general-population samples, symptoms correlated strongly and a single dimension of depression severity was revealed. Among depressed participants, symptom correlations were surprisingly weak and no replicable dimensions were identified, regardless of severity-adjustment. First, caution is warranted when considering studies assessing dimensions of depression because general population-based studies and studies of depressed individuals generate different data that can lead to different conclusions. This problem likely generalises to other models based on the symptoms' inter-relationships such as network models. Second, whereas the overall severity aligns individuals on a continuum of disorder intensity that allows non-affected individuals to be distinguished from affected individuals, the clinical evaluation and treatment of depressed individuals should focus directly on each individual's symptom profile.

Home blood-pressure monitoring among hypertensive patients in an Asian population.

PubMed

Tan, N C; Khin, L W; Pagi, R

2005-07-01

Hypertension is a principal cause of mortality and morbidity in Singapore. The use of home blood-pressure monitoring (HBPM) to assess hypertensive control with digital devices in the local multi-racial population is unknown. The study determined the factors associated with hypertensive patients' use of HBPM in primary care in a multi-racial Asian population. Randomized cross-sectional questionnaire survey of hypertensive patients managed in a district polyclinic. A model predicting use of HBPM was constructed by univariate and multivariate logistic regression. A total of 224 eligible subjects were randomly selected from 1943 patients. Response rate was 78.1% (n = 175). In all, 61.7% of them were aware of HBPM but only 24% used HBPM. Using multivariate analysis by stepwise backward regression, the final fitted model showed that HBPM was associated with higher patients' socioeconomic status: (adjusted OR for middle-income status = 2.85, 95% CI: 1.2-6.78, P = 0.018; adjusted OR for high-income status = 3.46, 95% CI: 1.22-9.87, P = 0.020) and their documented diastolic BP (adjusted OR for diastolic BP > 80 mmHg = 2.26, 95% CI: 1.06-4.82, P = 0.034). Nonusers cited failure to recognize benefits (54.1%), lack of HBPM awareness (29.3%), understanding of device operation (18.8%) and perception of inaccuracy (10.5%) as deterrents. 76.2% of users were satisfied with HBPM but lacked knowledge in maintenance of devices. In conclusion, 61.7% of the study population were aware of HBPM but only 24% used it. Patients' failure to recognize benefits, lack of awareness, cost and perception of inaccuracy were barriers. Higher socioeconomic status and patient's documented diastolic BP correlated with HBPM usage.

Reference intervals for plasma free metanephrines with an age adjustment for normetanephrine for optimized laboratory testing of phaeochromocytoma

PubMed Central

Eisenhofer, Graeme; Lattke, Peter; Herberg, Maria; Siegert, Gabriele; Qin, Nan; Därr, Roland; Hoyer, Jana; Villringer, Arno; Prejbisz, Aleksander; Januszewicz, Andrzej; Remaley, Alan; Martucci, Victoria; Pacak, Karel; Ross, H Alec; Sweep, Fred C G J; Lenders, Jacques W M

2016-01-01

Background Measurements of plasma normetanephrine and metanephrine provide a useful diagnostic test for phaeochromocytoma, but this depends on appropriate reference intervals. Upper cut-offs set too high compromise diagnostic sensitivity, whereas set too low, false-positives are a problem. This study aimed to establish optimal reference intervals for plasma normetanephrine and metanephrine. Methods Blood samples were collected in the supine position from 1226 subjects, aged 5–84 y, including 116 children, 575 normotensive and hypertensive adults and 535 patients in whom phaeochromocytoma was ruled out. Reference intervals were examined according to age and gender. Various models were examined to optimize upper cut-offs according to estimates of diagnostic sensitivity and specificity in a separate validation group of 3888 patients tested for phaeochromocytoma, including 558 with confirmed disease. Results Plasma metanephrine, but not normetanephrine, was higher (P < 0.001) in men than in women, but reference intervals did not differ. Age showed a positive relationship (P < 0.0001) with plasma normetanephrine and a weaker relationship (P = 0.021) with metanephrine. Upper cut-offs of reference intervals for normetanephrine increased from 0.47 nmol/L in children to 1.05 nmol/L in subjects over 60 y. A curvilinear model for age-adjusted compared with fixed upper cut-offs for normetanephrine, together with a higher cut-off for metanephrine (0.45 versus 0.32 nmol/L), resulted in a substantial gain in diagnostic specificity from 88.3% to 96.0% with minimal loss in diagnostic sensitivity from 93.9% to 93.6%. Conclusions These data establish age-adjusted cut-offs of reference intervals for plasma normetanephrine and optimized cut-offs for metanephrine useful for minimizing false-positive results. PMID:23065528

Imaging skills for transthoracic echocardiography in cardiology fellows: The value of motion metrics

PubMed Central

Montealegre-Gallegos, Mario; Mahmood, Feroze; Kim, Han; Bergman, Remco; Mitchell, John D.; Bose, Ruma; Hawthorne, Katie M.; O’Halloran, T. David; Wong, Vanessa; Hess, Philip E.; Matyal, Robina

2016-01-01

Background: Proficiency in transthoracic echocardiography (TTE) requires an integration of cognitive knowledge and psychomotor skills. Whereas cognitive knowledge can be quantified, psychomotor skills are implied after repetitive task performance. We applied motion analyses to evaluate psychomotor skill acquisition during simulator-based TTE training. Methods and Results: During the first month of their fellowship training, 16 cardiology fellows underwent a multimodal TTE training program for 4 weeks (8 sessions). The program consisted of online and live didactics as well as simulator training. Kinematic metrics (path length, time, probe accelerations) were obtained at the start and end of the course for 8 standard TTE views using a simulator. At the end of the course TTE image acquisition skills were tested on human models. After completion of the training program the trainees reported improved self-perceived comfort with TTE imaging. There was also an increase of 8.7% in post-test knowledge scores. There was a reduction in the number of probe accelerations [median decrease 49.5, 95% CI = 29-73, adjusted P < 0.01], total time [median decrease 10.6 s, 95% CI = 6.6-15.5, adjusted P < 0.01] and path length [median decrease 8.8 cm, 95% CI = 2.2-17.7, adjusted P < 0.01] from the start to the end of the course. During evaluation on human models, the trainees were able to obtain all the required TTE views without instructor assistance. Conclusion: Simulator-derived motion analyses can be used to objectively quantify acquisition of psychomotor skills during TTE training. Such an approach could be used to assess readiness for clinical practice of TTE. PMID:27052064

Relationships between social isolation, neighborhood poverty, and cancer mortality in a population-based study of US adults

PubMed Central

Illescas, Alex H.; Hohl, Bernadette C.; Llanos, Adana A. M.

2017-01-01

Background Social isolation is an important determinant of all-cause mortality, with evidence suggesting an association with cancer-specific mortality as well. In this study, we examined the associations between social isolation and neighborhood poverty (independently and jointly) on cancer mortality in a population-based sample of US adults. Methods Using data from the Third National Health and Nutrition Examination Survey (NHANES III; 1988–1994), NHANES III Linked Mortality File (through 2011) and 1990 Census, we estimated the relationship between social isolation and high neighborhood poverty and time-to-cancer death using multivariable-adjusted Cox proportional hazards models. We examined the associations of each factor independently and explored the multiplicative and additive interaction effects on cancer mortality risk and also analyzed these associations by sex. Results Among 16 044 US adults with 17–23 years of follow-up, there were 1133 cancer deaths. Social isolation (HR 1.25, 95% CI: 1.01–1.54) and high neighborhood poverty (HR 1.31, 95% CI: 1.08–1.60) were associated with increased risk of cancer mortality adjusting for age, sex, and race/ethnicity; in sex-specific estimates this increase in risk was evident among females only (HR 1.39, 95% CI: 1.04–1.86). These associations were attenuated upon further adjustment for socioeconomic status. There was no evidence of joint effects of social isolation and high neighborhood poverty on cancer mortality overall or in the sex-stratified models. Conclusions These findings suggest that social isolation and higher neighborhood poverty are independently associated with increased risk of cancer mortality, although there is no evidence to support our a priori hypothesis of a joint effect. PMID:28273125

Antidepressant response in patients with major depression exposed to NSAIDs: a pharmacovigilance study.

PubMed

Gallagher, Patience J; Castro, Victor; Fava, Maurizio; Weilburg, Jeffrey B; Murphy, Shawn N; Gainer, Vivian S; Churchill, Susanne E; Kohane, Isaac S; Iosifescu, Dan V; Smoller, Jordan W; Perlis, Roy H

2012-10-01

OBJECTIVE It has been suggested that there is a mechanism by which nonsteroidal anti-inflammatory drugs (NSAIDs) may interfere with antidepressant response, and poorer outcomes among NSAID-treated patients were reported in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. To attempt to confirm this association in an independent population-based treatment cohort and explore potential confounding variables, the authors examined use of NSAIDs and related medications among 1,528 outpatients in a New England health care system. METHOD Treatment outcomes were classified using a validated machine learning tool applied to electronic medical records. Logistic regression was used to examine the association between medication exposure and treatment outcomes, adjusted for potential confounding variables. To further elucidate confounding and treatment specificity of the observed effects, data from the STAR*D study were reanalyzed. RESULTS NSAID exposure was associated with a greater likelihood of depression classified as treatment resistant compared with depression classified as responsive to selective serotonin reuptake inhibitors (odds ratio=1.55, 95% CI=1.21-2.00). This association was apparent in the NSAIDs-only group but not in those using other agents with NSAID-like mechanisms (cyclooxygenase-2 inhibitors and salicylates). Inclusion of age, sex, ethnicity, and measures of comorbidity and health care utilization in regression models indicated confounding; association with outcome was no longer significant in fully adjusted models. Reanalysis of STAR*D results likewise identified an association in NSAIDs but not NSAID-like drugs, with more modest effects persisting after adjustment for potential confounding variables. CONCLUSIONS These results support an association between NSAID use and poorer antidepressant outcomes in major depressive disorder but indicate that some of the observed effect may be a result of confounding.

The Importance of Abnormal Chloride Homeostasis in Stable Chronic Heart Failure

PubMed Central

Grodin, Justin L.; Verbrugge, Frederik H.; Ellis, Stephen G.; Mullens, Wilfried; Testani, Jeffrey M.; Wilson Tang MD, W. H.

2015-01-01

Background The aim of this analysis was to determine the long-term prognostic value of lower serum chloride in patients with stable chronic heart failure. Electrolyte abnormalities are prevalent in patients with chronic heart failure. Little is known regarding the prognostic implications of lower serum chloride. Methods and Results Serum chloride was measured in 1,673 consecutively consented stable patients with a history of heart failure undergoing elective diagnostic coronary angiography. All patients were followed for 5-year all-cause mortality, and survival models were adjusted for variables that confounded the chloride-risk relationship. The average chloride level was 102±4 mEq/L. Over 6,772 person-years of follow-up, there were 547 deaths. Lower chloride (per standard deviation decrease) was associated with a higher adjusted risk of mortality (HR 1.29, 95%CI 1.12–1.49, P<0.001). Chloride levels net-reclassified risk in 10.4% (P=0.03) when added to a multivariable model (with a resultant C-statistic of 0.70), in which sodium levels were not prognostic (P=0.30). In comparison to those with above first quartile chloride (≥101 mEq/L) and sodium (≥138 meq/L), subjects with first quartile chloride had a higher adjusted mortality risk, whether they had first quartile sodium (HR 1.35, 95%CI 1.08–1.69, P=0.008) or higher (HR 1.43, 95%CI 1.12–1.85, P=0.005). However, subjects with first quartile sodium but above first quartile chloride had no association with mortality (P=0.67). Conclusions Lower serum chloride levels are independently and incrementally associated with increased mortality risk in patients with chronic heart failure. A better understanding of the biological role of serum chloride is warranted. PMID:26721916

Psychological Resources and Glucoregulation in Japanese Adults: Findings from MIDJA

PubMed Central

Boylan, Jennifer Morozink; Tsenkova, Vera K.; Miyamoto, Yuri; Ryff, Carol D.

2017-01-01

Objective To examine associations between glucoregulation and three categories of psychological resources: hedonic well-being (i.e., life satisfaction, positive affect), eudaimonic well-being (i.e., personal growth, purpose in life, ikigai) and interdependent well-being (i.e., gratitude, peaceful disengagement, adjustment) among Japanese adults. The question is important given increases in rates of type 2 diabetes in Japan in recent years, combined with the fact that most prior studies linking psychological resources to better physical health have utilized Western samples. Methods Data came from the Midlife in Japan (MIDJA) Study involving randomly selected participants from the Tokyo metropolitan area, a subsample of whom completed biological data collection (N=382; 56.0% female; M(SD)age = 55.5(14.0) years). Glycosylated hemoglobin (HbA1c) was the outcome. Models adjusted for age, gender, educational attainment, smoking, alcohol, chronic conditions, body mass index, use of anti-diabetic medication, and negative affect. Results Purpose in life (β = −.102, p = .022) was associated with lower HbA1c, and peaceful disengagement (β = .124, p = .004) was associated with higher HbA1c in fully adjusted models. Comparable to the effects of BMI, a one standard deviation change in well-being was associated with a .1% change in HbA1c. Conclusions Associations among psychological resources and glucoregulation were mixed. Healthy glucoregulation was evident among Japanese adults with higher levels of purpose in life and lower levels of peaceful disengagement, thereby extending prior research from the U.S. The results emphasize the need for considering sociocultural contexts in which psychological resources are experienced in order to understand linkages to physical health. PMID:28192004

The impact of depression and antidepressant usage on primary biliary cholangitis clinical outcomes

PubMed Central

Kaplan, Gilaad G.; Almishri, Wagdi; Vallerand, Isabelle; Frolkis, Alexandra D.; Patten, Scott; Swain, Mark G.

2018-01-01

Background Depression is prevalent in primary biliary cholangitis (PBC) patients. Our aims were to examine the effects of depression and antidepressants on hepatic outcomes of PBC patients. Methods We used the UK Health Improvement Network database to identify PBC patients between 1974 and 2007. Our primary outcome was one of three clinical events: decompensated cirrhosis, liver transplantation and death. We assessed depression and each class of antidepressant medication in adjusted multivariate Cox proportional hazards models to identify independent predictors of outcomes. In a sensitivity analysis, the study population was restricted to PBC patients using ursodeoxycholic acid (UDCA). Results We identified 1,177 PBC patients during our study period. In our cohort, 86 patients (7.3%) had a depression diagnosis prior to PBC diagnosis, while 79 patients (6.7%) had a depression diagnosis after PBC diagnosis. Ten-year incidence of mortality, decompensated cirrhosis, and liver transplantation were 13.4%, 6.6%, and 2.0%, respectively. In our adjusted models, depression status was not a predictor of poor outcomes. After studying all classes of antidepressants, using the atypical antidepressant mirtazapine after PBC diagnosis was significantly protective (Adjusted HR 0.23: 95% CI 0.07–0.72) against poor liver outcomes (decompensation, liver transplant, mortality), which remained statistically significant in patients using UCDA (HR 0.21: 95% CI 0.05–0.83). Conclusions In our study, depression was not associated with poor clinical outcomes. However, using the antidepressant mirtazapine was associated with decreased mortality, decompensated cirrhosis and liver transplantation in PBC patients. These findings support further assessment of mirtazapine as a potential treatment for PBC patients. PMID:29617396

The association of nonalcoholic fatty liver disease with central and peripheral blood pressure in adolescence: findings from a cross-sectional study

PubMed Central

Patel, Sumaiya; Lawlor, Debbie A.; Ferreira, Diana L.S.; Hughes, Alun D.; Chaturvedi, Nish; Callaway, Mark; Day, Chris; Sattar, Naveed; Fraser, Abigail

2015-01-01

Objectives: We aimed to determine the association of nonalcoholic fatty liver disease (NAFLD) with central and peripheral blood pressure (BP), in a general adolescent population and to examine whether associations are independent of adiposity. Methods: Using cross-sectional data from a subsample (N = 1904) of a UK birth cohort, we assessed markers of NAFLD including ultrasound scan (USS) determined fatty liver, shear velocity (marker of liver fibrosis), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT) at a mean age of 17.8 years. These were related to BP [central and peripheral SBP and DBP and mean arterial pressure (MAP)]. Results: Fatty liver was positively associated with central and peripheral SBP, DBP and MAP in models adjusting for age, sex, social class, puberty and alcohol intake. These positive associations were attenuated to the null when fat mass was included. For example, in confounder-adjusted models, not including fat mass, mean central SBP was 3.74 mmHg [95% confidence interval (CI) 1.12 to 6.36] higher in adolescents with USS fatty liver than in those without; with additional adjustment for fat mass, the association attenuated to the null value (−0.37 mmHg; 95% CI –3.09 to 2.36). Similar patterns were found for associations of ALT and GGT with central and peripheral BP. There was no consistent evidence of associations of shear velocity or AST with BP measurements. Fatty liver was not consistently associated with central pulse pressure (PP), peripheral PP and Aix@75. Conclusion: NAFLD is not associated with higher central or peripheral BP in adolescents once confounding by adiposity is taken into account. PMID:25426570

Teen pregnancy among sexual minority women: Results from the National Longitudinal Study of Adolescent to Adult Health

PubMed Central

Goldberg, Shoshana K; Reese, Bianka M; Halpern, Carolyn T

2016-01-01

Purpose To explore the association between sexual orientation and teen pregnancy (before age 20) in a U.S. nationally representative cohort of young adult females aged 24–32. Methods 5,972 participants in Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health were included. Self-reported sexual orientation identity was categorized as heterosexual, and three sexual minority [SM] groups: mostly heterosexual; bisexual; and lesbian [combining ‘mostly homosexual’ & ‘100% homosexual’]. Stepwise multivariate logistic regression models were fit to compare odds of teen pregnancy, and timing of teen pregnancy, between heterosexual and sexual minority [SM] groups, adjusting for sociodemographic characteristics, sexual victimization history, and sexual risk behaviors. Results After adjusting for sociodemographics and sexual victimization, bisexual women had significantly higher odds than heterosexual peers of teen pregnancy (OR=1.70; 95% CI=1.05, 2.75); this association was marginally significant after adjusting for sexual risk behaviors. Bisexuals were also more likely to have an early (before age 18) teen pregnancy (OR=2.04; 95% CI=1.17, 3.56). In contrast, lesbian women were significantly less likely to have a teen pregnancy than heterosexual (OR=0.47; 95% CI=0.23, 0.97), mostly heterosexual (OR=0.46; 95% CI=0.21, 0.99), and bisexual (OR=0.29; 95% CI=0.12, 0.71) women in final models. Conclusions Expanding upon extant literature, we found opposing risk patterns for teen pregnancy between bisexual and lesbian women, likely due to distinct patterns of sexual risk taking. Findings suggest that SM-inclusive teen pregnancy prevention efforts tailored to meet the unique needs of SM young women, particularly bisexuals, are needed. PMID:27444867

Simple anthropometric measures correlate with metabolic risk indicators as strongly as magnetic resonance imaging–measured adipose tissue depots in both HIV-infected and control subjects2

PubMed Central

Scherzer, Rebecca; Shen, Wei; Bacchetti, Peter; Kotler, Donald; Lewis, Cora E; Shlipak, Michael G; Heymsfield, Steven B

2008-01-01

Background Studies in persons without HIV infection have compared percentage body fat (%BF) and waist circumference as markers of risk for the complications of excess adiposity, but only limited study has been conducted in HIV-infected subjects. Objective We compared anthropometric and magnetic resonance imaging (MRI)–based adiposity measures as correlates of metabolic complications of adiposity in HIV-infected and control subjects. Design The study was a cross-sectional analysis of 666 HIV-positive and 242 control subjects in the Fat Redistribution and Metabolic Change in HIV Infection (FRAM) study assessing body mass index (BMI), waist (WC) and hip (HC) circumferences, waist-to-hip ratio (WHR), %BF, and MRI-measured regional adipose tissue. Study outcomes were 3 metabolic risk variables [homeostatic model assessment (HOMA), triglycerides, and HDL cholesterol]. Analyses were stratified by sex and HIV status and adjusted for demographic, lifestyle, and HIV-related factors. Results In HIV-infected and control subjects, univariate associations with HOMA, triglycerides, and HDL were strongest for WC, MRI-measured visceral adipose tissue, and WHR; in all cases, differences in correlation between the strongest measures for each outcome were small (r ≤ 0.07). Multivariate adjustment found no significant difference for optimally fitting models between the use of anthropometric and MRI measures, and the magnitudes of differences were small (adjusted R2 ≤ 0.06). For HOMA and HDL, WC appeared to be the best anthropometric correlate of metabolic complications, whereas, for triglycerides, the best was WHR. Conclusion Relations of simple anthropometric measures with HOMA, triglycerides, and HDL cholesterol are approximately as strong as MRI-measured whole-body adipose tissue depots in both HIV-infected and control subjects. PMID:18541572

Survival Advantage in Black Versus White Men With CKD: Effect of Estimated GFR and Case Mix

PubMed Central

Kovesdy, Csaba P.; Quarles, L. Darryl; Lott, Evan H.; Lu, Jun Ling; Ma, Jennie Z.; Molnar, Miklos Z.; Kalantar-Zadeh, Kamyar

2013-01-01

Background Black dialysis patients have significantly lower mortality compared to white patients, in contradistinction to the higher mortality seen in blacks in the general population. It is unclear if a similar paradox exists in non–dialysis-dependent CKD, and if it does, what its underlying reasons are. Study Design Historical cohort. Setting & Participants 518,406 white and 52,402 black male US veterans with non-dialysis dependent CKD stages 3–5. Predictor Black race. Outcomes & Measurements We examined overall and CKD stage-specific all-cause mortality using parametric survival models. The effect of sociodemographic characteristics, comorbidities and laboratory characteristics on the observed differences was explored in multivariable models. Results Over a median follow-up of 4.7 years 172,093 patients died (mortality rate, 71.0 [95% CI, 70.6–71.3] per 1000 patient-years). Black race was associated with significantly lower crude mortality (HR, 0.95; 95% CI, 0.94–0.97; p<0.001). The survival advantage was attenuated after adjustment for age (HR, 1.14; 95% CI, 1.12–1.16), but was even magnified after full multivariable adjustment (HR, 0.72; 95% CI, 0.70–0.73; p<0.001). The unadjusted survival advantage of blacks was more prominent in those with more advanced stages of CKD, but CKD stage-specific differences were attenuated by multivariable adjustment. Limitations Exclusively male patients. Conclusions Black patients with CKD have lower mortality compared to white patients. The survival advantage seen in blacks is accentuated in patients with more advanced stages of CKD, which may be explained by changes in case mix and laboratory characteristics occurring during the course of kidney disease. PMID:23369826

The Association between Peace and Life Expectancy: An Empirical Study of the World Countries

PubMed Central

YAZDI FEYZABADI, Vahid; HAGHDOOST, Aliakbar; MEHROLHASSANI, Mohammad Hossein; AMINIAN, Zahra

2015-01-01

Background: Although theoretically peace affects health, few published evidence for such an association was empirically available. This study aimed to explore the association between peace and life expectancy (LE) among the world countries. Methods: In an ecological study and using random effects regression model, we examined the association between peace and LE among world countries between 2007 and 2012. The LE at birth and global peace index (GPI: a score between 1 and 5, higher score means lower peace) were selected as outcome and main predictor variables, respectively. We adjusted their association for the gross national income (GNI) per capita and education index (EI). Data were obtained from the Institute for Economics and Peace (IEP) and UNDP (United Nations Development Programme (UNDP). Numbers of included countries were 158 based on the available data. Results: GPI had a negative, considerable, and statistically significant effect on LE (standardized coefficient −0.039; 95% CI: −0.058, −0.019). This association was also significant even after the adjustment for EI (−0.019; 95% CI: −0.035, −0.003), GNI (−0.035; 95% CI: −0.055, −0.015), and both EI and GNI (−0.017; 95% CI: −0.033, −0.001). The full model showed that around 0.61 of the variation of LE among countries may be explained by the GPI, EI and GNI per capita. Conclusion: The contribution of peace as a global determinant of LE was empirically considerable even after the adjustment for the economic and education levels of countries. This implies that governments should make efforts to settle peace through implementing good governance based on interactions with both public and other countries. PMID:25905077

Cost comparison of transcatheter and operative closures of ostium secundum atrial septal defects

PubMed Central

O’Byrne, Michael L.; Gillespie, Matthew J.; Shinohara, Russell T.; Dori, Yoav; Rome, Jonathan J.; Glatz, Andrew C.

2015-01-01

Background Clinical outcomes for transcatheter and operative closures of atrial septal defects (ASDs) are similar. Economic cost for each method has not been well described. Methods A single-center retrospective cohort study of children and adults <30 years of age undergoing closure for single secundum ASD from January 1, 2007, to April 1, 2012, was performed to measure differences in inflation-adjusted cost of operative and transcatheter closures of ASD. A propensity score weight-adjusted multivariate regression model was used in an intention-to-treat analysis. Costs for reintervention and crossover admissions were included in primary analysis. Results A total of 244 subjects were included in the study (64% transcatheter and 36% operative), of which 2% (n = 5) were ≥18 years. Crossover rate from transcatheter to operative group was 3%. Risk of reintervention (P = .66) and 30-day mortality (P = .37) were not significantly different. In a multivariate model, adjusted cost of operative closure was 2012 US $60,992 versus 2012 US $55,841 for transcatheter closure (P < .001). Components of total cost favoring transcatheter closure were length of stay, medications, and follow-up radiologic and laboratory testing, overcoming higher costs of procedure and echocardiography. Professional costs did not differ. The rate of 30-day readmission was greater in the operative cohort, further increasing the cost advantage of transcatheter closure. Sensitivity analyses demonstrated that costs of follow-up visits influenced relative cost but that device closure remained favorable over a broad range of crossover and reintervention rates. Conclusion For single secundum ASD, cost comparison analysis favors transcatheter closure over the short term. The cost of follow-up regimens influences the cost advantage of transcatheter closure. PMID:25965721

Serious Infections among Adult Medicaid Beneficiaries with Systemic Lupus Erythematosus and Lupus Nephritis

PubMed Central

Feldman, Candace H.; Hiraki, Linda T.; Winkelmayer, Wolfgang C.; Marty, Francisco M.; Franklin, Jessica M.; Kim, Seoyoung C.; Costenbader, Karen H.

2015-01-01

Objective While serious infections are significant causes of morbidity and mortality in systemic lupus erythematosus (SLE), the epidemiology in a nationwide cohort of SLE and lupus nephritis (LN) patients has not been examined. Methods Using the Medicaid Analytic eXtract (MAX) database, 2000-2006, we identified patients 18-64 years with SLE and a subset with LN. We ascertained hospitalized serious infections using validated algorithms, and 30-day mortality rates. We used Poisson regression to calculate infection incidence rates (IR), and multivariable Cox proportional hazards models to calculate hazard ratios (HR) for first infection, adjusted for sociodemographics, medication use, and a SLE-specific risk adjustment index. Results We identified 33,565 patients with SLE and 7,113 with LN. There were 9,078 serious infections in 5,078 SLE patients and 3,494 infections in 1,825 LN patients. The infection IR per 100 person-years was 10.8 in SLE and 23.9 in LN. In adjusted models, in SLE, we observed increased risks of infection among males compared to females (HR 1.33, 95% CI 1.20-1.47), in Blacks compared to Whites (HR 1.14, 95% CI 1.06-1.21), and glucocorticoid users (HR 1.51, 95% CI 1.43-1.61) and immunosuppressive users (HR 1.11, 95% CI 1.03-1.20) compared with non-users. Hydroxychloroquine users had a reduced risk of infection compared to non-users (HR 0.73, 95% CI 0.68-0.77). The 30-day mortality rate per 1,000 person-years among those hospitalized with infections was 21.4 in SLE and 38.7 in LN. Conclusion In this diverse, nationwide cohort of SLE patients, we observed a substantial burden of serious infections with many subsequent deaths. PMID:25772621

Paternal Urinary Concentrations of Parabens and Other Phenols in Relation to Reproductive Outcomes among Couples from a Fertility Clinic

PubMed Central

Dodge, Laura E.; Williams, Paige L.; Williams, Michelle A.; Missmer, Stacey A.; Toth, Thomas L.; Calafat, Antonia M.

2015-01-01

Background Human exposure to phenols, including bisphenol A and parabens, is widespread. Evidence suggests that paternal exposure to environmental chemicals may adversely affect reproductive outcomes. Objectives We evaluated associations of paternal phenol urinary concentrations with fertilization rate, embryo quality, implantation, and live birth. Methods Male–female couples who underwent in vitro fertilization (IVF) and/or intrauterine insemination (IUI) cycles in a prospective study of environmental determinants of fertility and pregnancy outcomes were included. The geometric mean of males’ specific gravity–adjusted urinary phenol concentrations measured before females’ cycle was quantified. Associations between male urinary phenol concentrations and fertilization rate, embryo quality, implantation, and live birth were investigated using generalized linear mixed models to account for multiple cycles per couple. Results Couples (n = 218) underwent 195 IUI and 211 IVF cycles. Paternal phenol concentrations were not associated with fertilization or live birth following IVF. In adjusted models, compared with the lowest quartile of methyl paraben, paternal concentrations in the second quartile were associated with decreased odds of live birth following IUI (adjusted odds ratio = 0.19; 95% CI: 0.04, 0.82). Conclusions To our knowledge, these are some of the first data on the association of paternal urinary phenol concentrations with reproduction and pregnancy outcomes. Although these results do not preclude possible adverse effects of paternal paraben exposures on such outcomes, given the modest sample size, further understanding could result from confirmation using a larger and more diverse population. Citation Dodge LE, Williams PL, Williams MA, Missmer SA, Toth TL, Calafat AM, Hauser R. 2015. Paternal urinary concentrations of parabens and other phenols in relation to reproductive outcomes among couples from a fertility clinic. Environ Health Perspect 123:665–671; http://dx.doi.org/10.1289/ehp.1408605 PMID:25767892

Left Atrial Enlargement and Stroke Recurrence: The Northern Manhattan Stroke Study

PubMed Central

Yaghi, Shadi; Moon, Yeseon P.; Mora-McLaughlin, Consuelo; Willey, Joshua Z.; Cheung, Ken; Tullio, Marco R. Di; Homma, Shunichi; Kamel, Hooman; Sacco, Ralph L.; Elkind, Mitchell S. V.

2015-01-01

Background and purpose While left atrial enlargement (LAE) increases incident stroke risk, the association with recurrent stroke is less clear. Our aim was to determine the association of LAE with recurrent stroke most likely related to embolism (cryptogenic and cardioembolic), and all ischemic stroke recurrences. Methods We followed 655 first ischemic stroke patients in the Northern Manhattan Stroke Study for up to 5 years. LA size from 2-D echocardiography was categorized as normal (52.7%), mild LAE (31.6%), and moderate-severe LAE (15.7%). We used Cox proportional hazard models to calculate the hazard ratios and 95% confidence intervals (HR, 95%CI) for the association of LA size and LAE with recurrent cryptogenic/cardioembolic and total recurrent ischemic stroke. Results LA size was available in 529 (81%) patients. Mean age at enrollment was 69±13 years; 45.8% were male, 54.0% Hispanic, and 18.5% had atrial fibrillation. Over a median of 4 years there were 65 recurrent ischemic strokes (29 were cardioembolic or cryptogenic). In multivariable models adjusted for confounders including atrial fibrillation and heart failure, moderate-severe LAE compared to normal LA size was associated with greater risk of recurrent cardioembolic/cryptogenic stroke (adjusted HR 2.83, 95% CI 1.03-7.81), but not total ischemic stroke (adjusted HR 1.06, 95% CI, 0.48-2.30). Mild LAE was not associated with recurrent stroke. Conclusion Moderate to severe LAE was an independent marker of recurrent cardioembolic or cryptogenic stroke in a multiethnic cohort of ischemic stroke patients. Further research is needed to determine whether anticoagulant use may reduce risk of recurrence in ischemic stroke patients with moderate to severe LAE. PMID:25908460

Neighborhood Poverty, Urban Residence, Race/ethnicity and Asthma: Rethinking the Inner-city Asthma Epidemic

PubMed Central

Keet, Corinne A.; McCormack, Meredith C.; Pollack, Craig E.; Peng, Roger D.; McGowan, Emily; Matsui, Elizabeth C.

2015-01-01

Background Although it is thought that inner-city areas have a high burden of asthma, the prevalence of asthma in inner-cities across the U.S. is not known. Objective To estimate the prevalence of current asthma in U.S. children living in inner-city and non-inner city areas, and to examine whether urban residence, poverty or race/ethnicity are the main drivers of asthma disparities. Methods The National Health Interview Survey 2009–2011 was linked by census tract to data from the U.S. Census and the National Center for Health Statistics. Multivariate logistic regression models adjusted for sex, age, race/ethnicity, residence in an urban, suburban, medium metro or small metro/rural area, poverty, and birth outside the U.S. with current asthma and asthma morbidity as outcome variables. Inner-city areas were defined as urban areas with ≥20% of households below the poverty line. Results 23,065 children living in 5,853 census tracts were included. The prevalence of current asthma was 12.9% in inner-city and 10.6% in non-inner-city areas, but this difference was not significant after adjusting for race/ethnicity, region, age and sex. In fully adjusted models, Black race, Puerto Rican ethnicity and lower household income, but not residence in poor or urban areas, were independent risk factors for current asthma. Household poverty increased the risk of asthma among non-Hispanics and Puerto Ricans but not among other Hispanics. Associations with asthma morbidity were very similar to prevalent asthma. Conclusions Although the prevalence of asthma is high in some inner-city areas, this is largely explained by demographic factors and not by living in an urban neighborhood. PMID:25617226

Evaluating the cost-effectiveness of afatinib after platinum-based therapy for the treatment of squamous non-small-cell lung cancer in France

PubMed Central

Pignata, Maud; Chouaid, Christos; Le Lay, Katell; Luciani, Laura; McConnachie, Ceilidh; Gordon, James; Roze, Stéphane

2017-01-01

Background and aims Lung cancer has the highest mortality rate of all cancers worldwide. Non-small-cell lung cancer (NSCLC) accounts for 85% of all lung cancers and has an extremely poor prognosis. Afatinib is an irreversible ErbB family blocker designed to suppress cellular signaling and inhibit cellular growth and is approved in Europe after platinum-based therapy for squamous NSCLC. The objective of the present analysis was to evaluate the cost-effectiveness of afatinib after platinum-based therapy for squamous NSCLC in France. Methods The study population was based on the LUX-Lung 8 trial that compared afatinib with erlotinib in patients with squamous NSCLC. The analysis was performed from the perspective of all health care funders and affected patients. A partitioned survival model was developed to evaluate cost-effectiveness based on progression-free survival and overall survival in the trial. Life expectancy, quality-adjusted life expectancy and direct costs were evaluated over a 10-year time horizon. Future costs and clinical benefits were discounted at 4% annually. Deterministic and probabilistic sensitivity analyses were performed. Results Model projections indicated that afatinib was associated with greater life expectancy (0.16 years) and quality-adjusted life expectancy (0.094 quality-adjusted life years [QALYs]) than that projected for erlotinib. The total cost of treatment over a 10-year time horizon was higher for afatinib than erlotinib, EUR12,364 versus EUR9,510, leading to an incremental cost-effectiveness ratio of EUR30,277 per QALY gained for afatinib versus erlotinib. Sensitivity analyses showed that the base case findings were stable under variation of a range of model inputs. Conclusion Based on data from the LUX-Lung 8 trial, afatinib was projected to improve clinical outcomes versus erlotinib, with a 97% probability of being cost-effective assuming a willingness to pay of EUR70,000 per QALY gained, after platinum-based therapy in patients with squamous NSCLC in France. PMID:29123418

Serum pentadecanoic acid (15:0), a short-term marker of dairy food intake, is inversely associated with incident type 2 diabetes and its underlying disorders123

PubMed Central

Santaren, Ingrid D; Watkins, Steven M; Liese, Angela D; Wagenknecht, Lynne E; Rewers, Marian J; Haffner, Steven M; Lorenzo, Carlos

2014-01-01

Background: Growing evidence suggests that dairy consumption is associated with lower type 2 diabetes risk. However, observational studies have reported inconsistent results, and few have examined dairy's association with the underlying disorders of insulin resistance and β-cell dysfunction. Objective: We investigated the association of the dairy fatty acid biomarkers pentadecanoic acid (15:0) and trans-palmitoleic acid (trans 16:1n−7) with type 2 diabetes traits by evaluating 1) prospective associations with incident diabetes after 5 y of follow-up and 2) cross-sectional associations with directly measured insulin resistance and β-cell dysfunction. Design: The study analyzed 659 adults without diabetes at baseline from the triethnic multicenter Insulin Resistance Atherosclerosis Study (IRAS). Diabetes status was assessed by using oral-glucose-tolerance tests. Frequently sampled intravenous-glucose-tolerance tests measured insulin sensitivity (SI) and β-cell function [disposition index (DI)]. Serum fatty acids were quantified by using gas chromatography. Logistic and linear regression models were adjusted for demographic, lifestyle, and dietary variables. Results: Serum 15:0 was a significant biomarker for total dairy intake in the IRAS cohort. It was associated with a decreased incident diabetes risk (OR: 0.73, P = 0.02) and was positively associated with log SI (β: 0.84, P = 0.03) and log DI (β: 2.21, P = 0.02) in fully adjusted models. trans 16:1n−7 was a marker of total partially hydrogenated dietary fat intake and was not associated with outcomes in fully adjusted models. Conclusions: Serum 15:0, a marker of short-term intake of this fatty acid, was inversely associated with diabetes risk in this multiethnic cohort. This study may contribute to future recommendations regarding the benefits of dairy products on type 2 diabetes risk. PMID:25411288

Diet-Quality Scores and Prevalence of Nonalcoholic Fatty Liver Disease: A Population Study Using Proton-Magnetic Resonance Spectroscopy

PubMed Central

Chan, Ruth; Wong, Vincent Wai-Sun; Chu, Winnie Chiu-Wing; Wong, Grace Lai-Hung; Li, Liz Sin; Leung, Jason; Chim, Angel Mei-Ling; Yeung, David Ka-Wai; Sea, Mandy Man-Mei; Woo, Jean; Chan, Francis Ka-Leung; Chan, Henry Lik-Yuen

2015-01-01

Dietary pattern analysis is an alternative approach to examine the association between diet and nonalcoholic fatty liver disease (NAFLD). This study examined the association of two diet-quality scores, namely Diet Quality Index-International (DQI-I) and Mediterranean Diet Score (MDS) with NAFLD prevalence. Apparently healthy Chinese adults (332 male, 465 female) aged 18 years or above were recruited through a population screening between 2008 and 2010 in a cross-sectional population-based study in Hong Kong. DQI-I and MDS, as well as major food group and nutrient intakes were calculated based on dietary data from a food frequency questionnaire. NAFLD was defined as intrahepatic triglyceride content at ≥5% by proton-magnetic resonance spectroscopy. Multivariate logistic regression models were used to examine the association between each diet-quality score or dietary component and prevalent NAFLD with adjustment for potential lifestyle, metabolic and genetic factors. A total of 220 subjects (27.6%) were diagnosed with NAFLD. DQI-I but not MDS was associated with the prevalence of NAFLD. A 10-unit decrease in DQI-I was associated with 24% increase in the likelihood of having NAFLD in the age and sex adjusted model (95% CI: 1.06–1.45, p = 0.009), and the association remained significant when the model was further adjusted for other lifestyle factors, metabolic and genetic factors [OR: 1.26 (95% CI: 1.03–1.54), p = 0.027]. Multivariate regression analyses showed an inverse association of the intake of vegetables and legumes, fruits and dried fruits, as well as vitamin C with the NAFLD prevalence (p<0.05). In conclusion, a better diet quality as characterized by a higher DQI-I and a higher consumption of vegetables, legumes and fruits was associated with a reduced likelihood of having NAFLD in Hong Kong Chinese. PMID:26418083

Alcohol Misuse and Psychological Resilience among U.S. Iraq and Afghanistan Era Veteran Military Personnel

PubMed Central

Green, Kimberly T.; Beckham, Jean C.; Youssef, Nagy; Elbogen, Eric B.

2013-01-01

Objective The present study sought to investigate the longitudinal effects of psychological resilience against alcohol misuse adjusting for socio-demographic factors, trauma-related variables, and self-reported history of alcohol abuse. Methodology Data were from National Post-Deployment Adjustment Study (NPDAS) participants who completed both a baseline and one-year follow-up survey (N=1090). Survey questionnaires measured combat exposure, probable posttraumatic stress disorder (PTSD), psychological resilience, and alcohol misuse, all of which were measured at two discrete time periods (baseline and one-year follow-up). Baseline resilience and change in resilience (increased or decreased) were utilized as independent variables in separate models evaluating alcohol misuse at the one-year follow-up. Results Multiple linear regression analyses controlled for age, gender, level of educational attainment, combat exposure, PTSD symptom severity, and self-reported alcohol abuse. Accounting for these covariates, findings revealed that lower baseline resilience, younger age, male gender, and self-reported alcohol abuse were related to alcohol misuse at the one-year follow-up. A separate regression analysis, adjusting for the same covariates, revealed a relationship between change in resilience (from baseline to the one-year follow-up) and alcohol misuse at the one-year follow-up. The regression model evaluating these variables in a subset of the sample in which all the participants had been deployed to Iraq and/or Afghanistan was consistent with findings involving the overall era sample. Finally, logistic regression analyses of the one-year follow-up data yielded similar results to the baseline and resilience change models. Conclusions These findings suggest that increased psychological resilience is inversely related to alcohol misuse and is protective against alcohol misuse over time. Additionally, it supports the conceptualization of resilience as a process which evolves over time. Moreover, our results underscore the importance of assessing resilience as part of alcohol use screening for preventing alcohol misuse in Iraq and Afghanistan era military veterans. PMID:24090625

Factors associated with improvement in disability-adjusted life years in patients with HIV/AIDS

PubMed Central

Bermudez-Tamayo, Clara; Martin, Jose Jesus Martin; Ruiz-Pérez, Isabel; Lima, Antonio Olry de Labry

2008-01-01

Background The epidemic of HIV/AIDS and treatments that have emerged to alleviate, have brought about a shift in the burden of disease from death to quality of life/disability. The aim was to determine which factors are associated with improvements in the level of health of male and female patients with HIV/AIDS in Andalusia, in terms of disability-adjusted life years. Methods Descriptive study based on a sample group of 8800 people on the Andalusian AIDS register between 1983 and 2004. Dependent variables: Life lost due to premature mortality (YLL), years lost due to disability (YLD) and disability-adjusted life years (DALY). Independent variables: vital state, sex, age at the time of diagnosis, age at the time of death, transmission category, province of residence, AIDS-indicator disease and the period of diagnosis. A bivariate analysis was carried out to find out if the health level variables changed in accordance with the independent variables. Using the independent variables which had a statistically significant link with the level of health variables, a multivariate linear regression model, disaggregated by gender, was constructed. Results Amongst the women, we found a model which explained the level of health of 64.9%: a link was found between a higher level of health (lower DALYs) and not intravenous drug use, the province of residence, being diagnosed during the HAART era and older age at the time of diagnosis. Amongst the men, we found a model which explained the level of health of 64.4%: a link was found between a higher level of health (lower DALYs) and intravenous drug use, the province of residence, being diagnosed during the HAART era and older age at the time of diagnosis. Conclusion A higher level of health (lower DALY) amongst both men and women was found to be linked to not be intravenous drug user, the province of residence, being diagnosed during the HAART era and older age at the time of diagnosis. PMID:18939970

Relation of Heart Rate and its Variability during Sleep with Age, Physical Activity, and Body Composition in Young Children

PubMed Central

Herzig, David; Eser, Prisca; Radtke, Thomas; Wenger, Alina; Rusterholz, Thomas; Wilhelm, Matthias; Achermann, Peter; Arhab, Amar; Jenni, Oskar G.; Kakebeeke, Tanja H.; Leeger-Aschmann, Claudia S.; Messerli-Bürgy, Nadine; Meyer, Andrea H.; Munsch, Simone; Puder, Jardena J.; Schmutz, Einat A.; Stülb, Kerstin; Zysset, Annina E.; Kriemler, Susi

2017-01-01

Background: Recent studies have claimed a positive effect of physical activity and body composition on vagal tone. In pediatric populations, there is a pronounced decrease in heart rate with age. While this decrease is often interpreted as an age-related increase in vagal tone, there is some evidence that it may be related to a decrease in intrinsic heart rate. This factor has not been taken into account in most previous studies. The aim of the present study was to assess the association between physical activity and/or body composition and heart rate variability (HRV) independently of the decline in heart rate in young children. Methods: Anthropometric measurements were taken in 309 children aged 2–6 years. Ambulatory electrocardiograms were collected over 14–18 h comprising a full night and accelerometry over 7 days. HRV was determined of three different night segments: (1) over 5 min during deep sleep identified automatically based on HRV characteristics; (2) during a 20 min segment starting 15 min after sleep onset; (3) over a 4-h segment between midnight and 4 a.m. Linear models were computed for HRV parameters with anthropometric and physical activity variables adjusted for heart rate and other confounding variables (e.g., age for physical activity models). Results: We found a decline in heart rate with increasing physical activity and decreasing skinfold thickness. HRV parameters decreased with increasing age, height, and weight in HR-adjusted regression models. These relationships were only found in segments of deep sleep detected automatically based on HRV or manually 15 min after sleep onset, but not in the 4-h segment with random sleep phases. Conclusions: Contrary to most previous studies, we found no increase of standard HRV parameters with age, however, when adjusted for heart rate, there was a significant decrease of HRV parameters with increasing age. Without knowing intrinsic heart rate correct interpretation of HRV in growing children is impossible. PMID:28286485

Relation of Heart Rate and its Variability during Sleep with Age, Physical Activity, and Body Composition in Young Children.

PubMed

Herzig, David; Eser, Prisca; Radtke, Thomas; Wenger, Alina; Rusterholz, Thomas; Wilhelm, Matthias; Achermann, Peter; Arhab, Amar; Jenni, Oskar G; Kakebeeke, Tanja H; Leeger-Aschmann, Claudia S; Messerli-Bürgy, Nadine; Meyer, Andrea H; Munsch, Simone; Puder, Jardena J; Schmutz, Einat A; Stülb, Kerstin; Zysset, Annina E; Kriemler, Susi

2017-01-01

Background: Recent studies have claimed a positive effect of physical activity and body composition on vagal tone. In pediatric populations, there is a pronounced decrease in heart rate with age. While this decrease is often interpreted as an age-related increase in vagal tone, there is some evidence that it may be related to a decrease in intrinsic heart rate. This factor has not been taken into account in most previous studies. The aim of the present study was to assess the association between physical activity and/or body composition and heart rate variability (HRV) independently of the decline in heart rate in young children. Methods: Anthropometric measurements were taken in 309 children aged 2-6 years. Ambulatory electrocardiograms were collected over 14-18 h comprising a full night and accelerometry over 7 days. HRV was determined of three different night segments: (1) over 5 min during deep sleep identified automatically based on HRV characteristics; (2) during a 20 min segment starting 15 min after sleep onset; (3) over a 4-h segment between midnight and 4 a.m. Linear models were computed for HRV parameters with anthropometric and physical activity variables adjusted for heart rate and other confounding variables (e.g., age for physical activity models). Results: We found a decline in heart rate with increasing physical activity and decreasing skinfold thickness. HRV parameters decreased with increasing age, height, and weight in HR-adjusted regression models. These relationships were only found in segments of deep sleep detected automatically based on HRV or manually 15 min after sleep onset, but not in the 4-h segment with random sleep phases. Conclusions: Contrary to most previous studies, we found no increase of standard HRV parameters with age, however, when adjusted for heart rate, there was a significant decrease of HRV parameters with increasing age. Without knowing intrinsic heart rate correct interpretation of HRV in growing children is impossible.

Competing Risk Analysis of Neurologic versus Nonneurologic Death in Patients Undergoing Radiosurgical Salvage After Whole-Brain Radiation Therapy Failure: Who Actually Dies of Their Brain Metastases?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lucas, John T., E-mail: jolucas@wakehealth.edu; Colmer, Hentry G.; White, Lance

Purpose: To estimate the hazard for neurologic (central nervous system, CNS) and nonneurologic (non-CNS) death associated with patient, treatment, and systemic disease status in patients receiving stereotactic radiosurgery after whole-brain radiation therapy (WBRT) failure, using a competing risk model. Patients and Methods: Of 757 patients, 293 experienced recurrence or new metastasis following WBRT. Univariate Cox proportional hazards regression identified covariates for consideration in the multivariate model. Competing risks multivariable regression was performed to estimate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for both CNS and non-CNS death after adjusting for patient, disease, and treatment factors. The resultantmore » model was converted into an online calculator for ease of clinical use. Results: The cumulative incidence of CNS and non-CNS death at 6 and 12 months was 20.6% and 21.6%, and 34.4% and 35%, respectively. Patients with melanoma histology (relative to breast) (aHR 2.7, 95% CI 1.5-5.0), brainstem location (aHR 2.1, 95% CI 1.3-3.5), and number of metastases (aHR 1.09, 95% CI 1.04-1.2) had increased aHR for CNS death. Progressive systemic disease (aHR 0.55, 95% CI 0.4-0.8) and increasing lowest margin dose (aHR 0.97, 95% CI 0.9-0.99) were protective against CNS death. Patients with lung histology (aHR 1.3, 95% CI 1.1-1.9) and progressive systemic disease (aHR 2.14, 95% CI 1.5-3.0) had increased aHR for non-CNS death. Conclusion: Our nomogram provides individual estimates of neurologic death after salvage stereotactic radiosurgery for patients who have failed prior WBRT, based on histology, neuroanatomical location, age, lowest margin dose, and number of metastases after adjusting for their competing risk of death from other causes.« less

Weight trajectory over 20 years and likelihood of mild cognitive impairment or dementia among older women

PubMed Central

LeBlanc, Erin S.; Rizzo, Joanne H.; Pedula, Kathryn L.; Yaffe, Kristine; Ensrud, Kristine E.; Cauley, Jane; Cawthon, Peggy M.; Cummings, Steven; Hillier, Teresa A.

2017-01-01

Background/Objectives The association between weight change and cognition is controversial. We examined the association between 20-year weight change and cognitive function in late life. Design Cohort study. Setting Study of Osteoporotic Fractures (SOF). Participants 1,289 older, community-dwelling women (mean baseline age 68 [65–81] and 88 [82–102] at cognitive testing). Measurements SOF participants had body weight measured repeatedly over 20 years (mean 8 weights). Adjudicated cognitive status was classified as normal (n=775) or mild cognitive impairment (MCI)/dementia (n=514) at Year 20. Logistic models were used to evaluate whether absolute weight change, rate of weight loss per year, presence of abrupt, unrecovered weight loss, and weight variability were associated with MCI or dementia. Results Women with greater rate of weight loss over 20 years had increased chance of developing MCI or dementia. In age/education/clinic-adjusted “base” models, each 0.5 kg/year decrease resulted in 30% increased odds of MCI/dementia (OR=1.30 [95% CI: 1.14, 1.49]). After adjustment for age, education, clinic, depression, and walking speed, there was 17% (OR=1.17 [95% CI: 1.02, 1.35]) increased odds of MCI/dementia for each 0.5 kg/year decrease in weight. In base models, variability in weight was significant. Each 1% average deviation from each woman’s predicted weight curve was associated with 11% increased odds of MCI/dementia (OR=1.11 [95% CI: 1.04, 1.18]). The estimate was attenuated after full adjustment (OR=1.06 [95% CI: 0.99, 1.14]). The presence of an abrupt weight decline was not associated with MCI/dementia. Conclusions Rate of weight loss over 20 years was associated with development of MCI or dementia in women surviving past 80 years, suggesting that nutritional status, social-environmental factors, and/or adipose tissue function and structure may affect cognitive function with aging. PMID:27991654

Short-term association between sulfur dioxide and daily mortality: the Public Health and Air Pollution in Asia (PAPA) study.

PubMed

Kan, Haidong; Wong, Chit-Ming; Vichit-Vadakan, Nuntavarn; Qian, Zhengmin

2010-04-01

Sulfur dioxide (SO(2)) has been associated with increased mortality and morbidity, but only few studies were conducted in Asian countries. Previous studies suggest that SO(2) may have adverse health effects independent of other pollutants. In the Public Health and Air Pollution in Asia (PAPA) project, the short-term associations between ambient sulfur dioxide (SO(2)) and daily mortality were examined in Bangkok, Thailand, and three Chinese cities: Hong Kong, Shanghai, and Wuhan. Poisson regression models incorporating natural spline smoothing functions were used to adjust for seasonality and other time-varying covariates. Effect estimates were obtained for each city and then for the cities combined. The impact of alternative model specifications, such as lag structure of pollutants and degree of freedom (df) for time trend, on the estimated effects of SO(2) were also examined. In both individual-city and combined analysis, significant effects of SO(2) on total non-accidental and cardiopulmonary mortality were observed. An increase of 10 microg/m(3) of 2-day moving average concentrations of SO(2) corresponded to 1.00% [95% confidence interval (CI), 0.75-1.24], 1.09% (95% CI, 0.71-1.47), and 1.47% (95% CI, 0.85-2.08) increase of total, cardiovascular and respiratory mortality, respectively, in the combined analysis. Sensitivity analyzes suggested that these findings were generally insensitive to alternative model specifications. After adjustment for PM(10) or O(3), the effect of SO(2) remained significant in three Chinese cities. However, adjustment for NO(2) diminished the associations and rendered them statistically insignificant in all four cities. In conclusion, ambient SO(2) concentration was associated with daily mortality in these four Asian cities. These associations may be attributable to SO(2) serving as a surrogate of other substances. Our findings suggest that the role of outdoor exposure to SO(2) should be investigated further in this region. (c) 2010 Elsevier Inc. All rights reserved.