Impact of socio-economic position on health and quality of care in adults with Type 2 diabetes in France: the Entred 2007 study.

PubMed

Fosse-Edorh, S; Fagot-Campagna, A; Detournay, B; Bihan, H; Eschwege, E; Gautier, A; Druet, C

2015-11-01

To describe the association between socio-economic position, health status and quality of diabetes care in people with Type 2 diabetes in France, where people may receive full healthcare coverage for chronic disease. Data from a national cross-sectional survey performed in people pharmacologically treated for diabetes were used. They combined data from medical claims, hospital discharge, questionnaires for patients (n = 3894 with Type 2 diabetes) and their physicians (n = 2485). Socio-economic position was assessed using educational level (low, intermediate, high) and ability to make ends meet (financial difficulties vs. financially comfortable). People with diabetes reporting financial difficulties were more likely to be smokers (adjusted odds ratio 1.4; 95% CI 1.1-1.6) and obese (adjusted odds ratio 1.3; 95% CI 1.2-1.6) and to have poorer glycaemic control (HbA1c > 64 mmol/mol (8%); adjusted odds ratio 1.4; 95% CI 1.1-1.8), than those who were financially comfortable. They were more likely to have their diabetes diagnosed because of complications (adjusted odds ratio 1.6; 95% CI 1.3-2.0). They were also more likely to have coronary and podiatric complications (adjusted odds ratios 1.3; 95% CI 1.1-1.6 and 1.7; 95% CI 1.4-2.2, respectively). They benefited more often from full coverage (adjusted odds ratio 1.3; 95% CI 1.1-1.6), visited general practitioners more often (ratio of estimated marginal means 1.2; 95% CI 1.1-1.2) but specialists less often (adjusted odds ratio 0.7; 95% CI 0.6-0.8 for a visit to private ophthalmologist). They also felt less well informed about their condition. Despite frequent access to full healthcare coverage, socio-economic position has an impact on the diagnosis of diabetes, health status and quality of diabetes care in France. © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK.

Excessive work and risk of haemorrhagic stroke: a nationwide case-control study.

PubMed

Kim, Beom Joon; Lee, Seung-Hoon; Ryu, Wi-Sun; Kim, Chi Kyung; Chung, Jong-Won; Kim, Dohoung; Park, Hong-Kyun; Bae, Hee-Joon; Park, Byung-Joo; Yoon, Byung-Woo

2013-10-01

Adverse effect of excessive work on health has been suggested previously, but it was not documented in cerebrovascular diseases. The authors investigated whether excessive working conditions would associate with increased risk of haemorrhagic stroke. A nationwide matched case-control study database, which contains 940 cases of incident haemorrhagic stroke (498 intracerebral haemorrhages and 442 sub-arachnoid haemorrhages) with 1880 gender- and age- (± 5-year) matched controls, was analysed. Work-related information based on the regular job situation, including type of occupation, regular working time, duration of strenuous activity during regular work and shift work, was gathered through face-to-face interviews. Conditional logistic regression analyses were used for the multivariable analyses. Compared with white-collar workers, blue-collar workers had a higher risk for haemorrhagic stroke (odds ratio, 1.33 [95% confidence interval, 1.06-1.66]). Longer regular working time was associated with increased risk of haemorrhagic stroke [odds ratio, 1.38 (95% confidence interval, 1.05-1.81) for 8-12 h/day; odds ratio, 1.95 (95% confidence interval, 1.33-2.86) for ≥ 13 h/day; compared with ≤ 4 h/day]. Exposure to ≥ 8 h/week of strenuous activity also associated haemorrhagic stroke risk [odds ratio, 1.61 (95% confidence interval, 1.26-2.05); compared with no strenuous activity]. Shift work was not associated with haemorrhagic stroke (P = 0.98). Positive associations between working condition indices and haemorrhagic stroke risk were consistent regardless of haemorrhagic stroke sub-types and current employment status. Blue-collar occupation, longer regular working time and extended duration of strenuous activity during work may relate to an increased risk of haemorrhagic stroke. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

Practical Guidance for Conducting Mediation Analysis With Multiple Mediators Using Inverse Odds Ratio Weighting

PubMed Central

Nguyen, Quynh C.; Osypuk, Theresa L.; Schmidt, Nicole M.; Glymour, M. Maria; Tchetgen Tchetgen, Eric J.

2015-01-01

Despite the recent flourishing of mediation analysis techniques, many modern approaches are difficult to implement or applicable to only a restricted range of regression models. This report provides practical guidance for implementing a new technique utilizing inverse odds ratio weighting (IORW) to estimate natural direct and indirect effects for mediation analyses. IORW takes advantage of the odds ratio's invariance property and condenses information on the odds ratio for the relationship between the exposure (treatment) and multiple mediators, conditional on covariates, by regressing exposure on mediators and covariates. The inverse of the covariate-adjusted exposure-mediator odds ratio association is used to weight the primary analytical regression of the outcome on treatment. The treatment coefficient in such a weighted regression estimates the natural direct effect of treatment on the outcome, and indirect effects are identified by subtracting direct effects from total effects. Weighting renders treatment and mediators independent, thereby deactivating indirect pathways of the mediators. This new mediation technique accommodates multiple discrete or continuous mediators. IORW is easily implemented and is appropriate for any standard regression model, including quantile regression and survival analysis. An empirical example is given using data from the Moving to Opportunity (1994–2002) experiment, testing whether neighborhood context mediated the effects of a housing voucher program on obesity. Relevant Stata code (StataCorp LP, College Station, Texas) is provided. PMID:25693776

The effect of anesthetic technique on postoperative outcomes in hip fracture repair.

PubMed

O'Hara, D A; Duff, A; Berlin, J A; Poses, R M; Lawrence, V A; Huber, E C; Noveck, H; Strom, B L; Carson, J L

2000-04-01

The impact of anesthetic choice on postoperative mortality and morbidity has not been determined with certainty. The authors evaluated the effect of type of anesthesia on postoperative mortality and morbidity in a retrospective cohort study of consecutive hip fracture patients, aged 60 yr or older, who underwent surgical repair at 20 US hospitals between 1983 and 1993. The primary outcome was defined as death within 30 days of the operative procedure. The secondary outcomes were postoperative 7-day mortality, postoperative myocardial infarction, postoperative pneumonia, postoperative congestive heart failure, and postoperative change in mental status. Numerous comorbid conditions were controlled for individually and by several comorbidity indices using logistic regression. General anesthesia was used in 6,206 patients (65.8%) and regional anesthesia in 3,219 patients (3,078 spinal anesthesia and 141 epidural anesthesia). The 30-day mortality rate in the general anesthesia group was 4.4%, compared with 5.4% in the regional anesthesia group (unadjusted odds ratio = 0.80; 95% confidence interval = 0.66-0.97). However, the adjusted odds ratio for general anesthesia increased to 1.08 (0.84-1.38). The adjusted odds ratios for general anesthesia versus regional anesthesia for the 7-day mortality was 0.90 (0.59-1.39) and for postoperative morbidity outcomes were as follows: myocardial infarction: adjusted odds ratio = 1.17 (0.80-1.70); congestive heart failure: adjusted odds ratio = 1.04 (0.80-1.36); pneumonia: adjusted odds ratio = 1.21 (0.87-1.68); postoperative change in mental status: adjusted odds ratio = 1.08 (0.95-1.22). The authors were unable to demonstrate that regional anesthesia was associated with better outcome than was general anesthesia in this large observational study of elderly patients with hip fracture. These results suggest that the type of anesthesia used should depend on factors other than any associated risks of mortality or morbidity.

Prescription of Zolpidem and the Risk of Fatal Motor Vehicle Collisions: A Population-Based, Case-Crossover Study from South Korea.

PubMed

Yang, Bo Ram; Kim, Ye-Jee; Kim, Mi-Sook; Jung, Sun-Young; Choi, Nam-Kyong; Hwang, Byungkwan; Park, Byung-Joo; Lee, Joongyub

2018-05-23

Zolpidem is one of the most frequently used hypnotics worldwide, but associations with serious adverse effects such as motor vehicle collisions have been reported. The objective of this study was to evaluate the association of fatal motor vehicle collisions with a prescription for zolpidem, considering the context of the motor vehicle collisions. We conducted a case-crossover study, where each case served as its own control, by linking data about fatal motor vehicle collisions from the Korean Road Traffic Authority between 2010 and 2014 with national health insurance data. The case period was defined as 1 day before the fatal motor vehicle collisions, and was matched to four control periods at 90-day intervals. Conditional logistic regression was performed to calculate the odds ratio for fatal motor vehicle collisions associated with zolpidem exposure, and odds ratios were adjusted for time-varying exposure to confounding medications. A stratified analysis was performed by age group (younger than 65 years or not), the Charlson Comorbidity Index, and whether patients were new zolpidem users. Among the 714 subjects, the adjusted odds ratio for a fatal motor vehicle collision associated with a prescription for zolpidem the previous day was 1.48 (95% confidence interval 1.06-2.07). After stratification, a significantly increased risk was observed in subjects with a high Charlson Comorbidity Index (odds ratio 1.81; 95% confidence interval 1.16-2.84), the younger age group (odds ratio: 1.62; 95% confidence interval 1.03-2.56), and new zolpidem users (odds ratio 2.37; 95% confidence interval 1.40-4.00). A prescription for zolpidem on the previous day was significantly related to an increased risk of fatal motor vehicle collisions in this population-based case-crossover study.

The Association Between Maternal Age and Cerebral Palsy Risk Factors.

PubMed

Schneider, Rilla E; Ng, Pamela; Zhang, Xun; Andersen, John; Buckley, David; Fehlings, Darcy; Kirton, Adam; Wood, Ellen; van Rensburg, Esias; Shevell, Michael I; Oskoui, Maryam

2018-05-01

Advanced maternal age is associated with higher frequencies of antenatal and perinatal conditions, as well as a higher risk of cerebral palsy in offspring. We explore the association between maternal age and specific cerebral palsy risk factors. Data were extracted from the Canadian Cerebral Palsy Registry. Maternal age was categorized as ≥35 years of age and less than 20 years of age at the time of birth. Chi-square and multivariate logistic regressions were performed to calculate odds ratios and their 95% confidence intervals. The final sample consisted of 1391 children with cerebral palsy, with 19% of children having mothers aged 35 or older and 4% of children having mothers below the age of 20. Univariate analyses showed that mothers aged 35 or older were more likely to have gestational diabetes (odds ratio 1.9, 95% confidence interval 1.3 to 2.8), to have a history of miscarriage (odds ratio 1.8, 95% confidence interval 1.3 to 2.4), to have undergone fertility treatments (odds ratio 2.4, 95% confidence interval 1.5 to 3.9), and to have delivered by Caesarean section (odds ratio 1.6, 95% confidence interval 1.2 to 2.2). These findings were supported by multivariate analyses. Children with mothers below the age of 20 were more likely to have a congenital malformation (odds ratio 2.4, 95% confidence interval 1.4 to 4.2), which is also supported by multivariate analysis. The risk factor profiles of children with cerebral palsy vary by maternal age. Future studies are warranted to further our understanding of the compound causal pathways leading to cerebral palsy and the observed greater prevalence of cerebral palsy with increasing maternal age. Copyright © 2018 Elsevier Inc. All rights reserved.

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

Associations among Obesity, Eating Speed, and Oral Health

PubMed Central

Sonoda, Chikanobu; Fukuda, Hideki; Kitamura, Masayasu; Hayashida, Hideaki; Kawashita, Yumiko; Furugen, Reiko; Koyama, Zenya; Saito, Toshiyuki

2018-01-01

Objective This study was conducted to understand how eating speed and oral health condition are associated with obesity in Japanese working men. Methods We studied a total of 863 men attending an annual medical checkup of the Japanese Maritime Self Defense Force in Sasebo City, Japan. Participants answered a questionnaire about their eating speed, and we examined their anthropometric status in terms of BMI, waist circumference, and oral health condition, especially periodontal disease and number of functional teeth. Multivariate logistic regression analyses adjusting for potential confounding variables were performed. Results The multivariate-adjusted odds ratio for waist circumference greater than 90 cm of the ‘very fast’ group compared to the ‘slow, very slow’ group was 5.22 (95% confidence interval 1.81–15.06) after adjusting for potential confounding factors. Individuals were more likely to have waist circumference greater than 90 cm if they had a larger ‘number of missing functional teeth’ (odds ratio 1.14; 95% confidence interval 1.01–1.28) and severe periodontal disease (odds ratio 2.74; 95% confidence interval, 1.46–5.13). Conclusion Eating speed, the number of missing functional teeth, and severe periodontal disease are associated independently with larger waist circumference. PMID:29669358

Relationship of activities outside work to sleep and depression/anxiety disorders in Korean workers: the 4th Korean working condition survey.

PubMed

Lee, Kyung-Jae; Jung, Sung Won; Lee, Hee Sung; Kim, Guang Hwi; Lee, Jae Gwang; Lee, June-Hee; Kim, Joo Ja

2017-01-01

Sleep disorders and depression/anxiety disorders are long-standing and significant problem for mental health. Also there are already known so many negative health effect of these disorders. But there were few studies to examine the association between activities outside work and forementioned disorders. So this study aimed the association of those things by using the Republic of Korean data. Data from 32,232 wage workers were used in the 4th Korean Working Condition Survey. General and occupational characteristics, sleep disorders, depression/anxiety disorders and activities outside work are included in questionnaire. To find the relationship between activities outside work and sleep, depression/anxiety disorders, multivariate logistic regression analysis was used after adjusting for general and occupational characteristics. We observed that volunteer activities increased the odds ratio of both sleep disorders and depression/anxiety disorders(Odds ratio[OR] = 1.35, 95% confidence interval[CI]: 1.03-1.78 and OR = 1.54, 95% CI: 1.29-1.84, respectively). And self-development activities increase the odds ratio of sleep disorders(OR = 1.35, 95% CI: 1.17-1.57). Gardening activities lowered the odds ratio of depression/anxiety disorders(OR = 0.74, 95% CI: 0.59-0.94). Some of activities outside work were related to sleep disorders and depression/anxiety disorders among Korean wage workers. Our results showed negative health effect of some kinds of activities outside work such as volunteering and self-devlopment compared to other studies that emphasized positive effect of those activities for health.

Factors Associated With Mortality in Low-Risk Pediatric Critical Care Patients in The Netherlands.

PubMed

Verlaat, Carin W; Visser, Idse H; Wubben, Nina; Hazelzet, Jan A; Lemson, Joris; van Waardenburg, Dick; van der Heide, Douwe; van Dam, Nicolette A; Jansen, Nicolaas J; van Heerde, Mark; van der Starre, Cynthia; van Asperen, Roelie; Kneyber, Martin; van Woensel, Job B; van den Boogaard, Mark; van der Hoeven, Johannes

2017-04-01

To determine differences between survivors and nonsurvivors and factors associated with mortality in pediatric intensive care patients with low risk of mortality. Retrospective cohort study. Patients were selected from a national database including all admissions to the PICUs in The Netherlands between 2006 and 2012. Patients less than 18 years old admitted to the PICU with a predicted mortality risk lower than 1% according to either the recalibrated Pediatric Risk of Mortality or the Pediatric Index of Mortality 2 were included. None. In total, 16,874 low-risk admissions were included of which 86 patients (0.5%) died. Nonsurvivors had more unplanned admissions (74.4% vs 38.5%; p < 0.001), had more complex chronic conditions (76.7% vs 58.8%; p = 0.001), were more often mechanically ventilated (88.1% vs 34.9%; p < 0.001), and had a longer length of stay (median, 11 [interquartile range, 5-32] d vs median, 3 [interquartile range, 2-5] d; p < 0.001) when compared with survivors. Factors significantly associated with mortality were complex chronic conditions (odds ratio, 3.29; 95% CI, 1.97-5.50), unplanned admissions (odds ratio, 5.78; 95% CI, 3.40-9.81), and admissions in spring/summer (odds ratio, 1.67; 95% CI, 1.08-2.58). Nonsurvivors in the PICU with a low predicted mortality risk have recognizable risk factors including complex chronic condition and unplanned admissions.

Lifestyle Cardiovascular Risk Score, Genetic Risk Score, and Myocardial Infarction in Hispanic/Latino Adults Living in Costa Rica.

PubMed

Sotos-Prieto, Mercedes; Baylin, Ana; Campos, Hannia; Qi, Lu; Mattei, Josiemer

2016-12-20

A lifestyle cardiovascular risk score (LCRS) and a genetic risk score (GRS) have been independently associated with myocardial infarction (MI) in Hispanics/Latinos. Interaction or joint association between these scores has not been examined. Thus, our aim was to assess interactive and joint associations between LCRS and GRS, and each individual lifestyle risk factor, on likelihood of MI. Data included 1534 Costa Rican adults with nonfatal acute MI and 1534 matched controls. The LCRS used estimated coefficients as weights for each factor: unhealthy diet, physical inactivity, smoking, elevated waist:hip ratio, low/high alcohol intake, low socioeconomic status. The GRS included 14 MI-associated risk alleles. Conditional logistic regressions were used to calculate adjusted odds ratios. The odds ratios for MI were 2.72 (2.33, 3.17) per LCRS unit and 1.13 (95% CI 1.06, 1.21) per GRS unit. A significant joint association for highest GRS tertile and highest LCRS tertile and odds of MI was detected (odds ratio=5.43 [3.71, 7.94]; P<1.00×10 -7 ), compared to both lowest tertiles. The odds ratios were 1.74 (1.22, 2.49) under optimal lifestyle and unfavorable genetic profile, and 5.02 (3.46, 7.29) under unhealthy lifestyle but advantageous genetic profile. Significant joint associations were observed for the highest GRS tertile and the highest of each lifestyle component risk category. The interaction term was nonsignificant (P=0.33). Lifestyle risk factors and genetics are jointly associated with higher odds of MI among Hispanics/Latinos. Individual and combined lifestyle risk factors showed stronger associations. Efforts to improve lifestyle behaviors could help prevent MI regardless of genetic susceptibility. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Practical guidance for conducting mediation analysis with multiple mediators using inverse odds ratio weighting.

PubMed

Nguyen, Quynh C; Osypuk, Theresa L; Schmidt, Nicole M; Glymour, M Maria; Tchetgen Tchetgen, Eric J

2015-03-01

Despite the recent flourishing of mediation analysis techniques, many modern approaches are difficult to implement or applicable to only a restricted range of regression models. This report provides practical guidance for implementing a new technique utilizing inverse odds ratio weighting (IORW) to estimate natural direct and indirect effects for mediation analyses. IORW takes advantage of the odds ratio's invariance property and condenses information on the odds ratio for the relationship between the exposure (treatment) and multiple mediators, conditional on covariates, by regressing exposure on mediators and covariates. The inverse of the covariate-adjusted exposure-mediator odds ratio association is used to weight the primary analytical regression of the outcome on treatment. The treatment coefficient in such a weighted regression estimates the natural direct effect of treatment on the outcome, and indirect effects are identified by subtracting direct effects from total effects. Weighting renders treatment and mediators independent, thereby deactivating indirect pathways of the mediators. This new mediation technique accommodates multiple discrete or continuous mediators. IORW is easily implemented and is appropriate for any standard regression model, including quantile regression and survival analysis. An empirical example is given using data from the Moving to Opportunity (1994-2002) experiment, testing whether neighborhood context mediated the effects of a housing voucher program on obesity. Relevant Stata code (StataCorp LP, College Station, Texas) is provided. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Obesity and disability: relation among older adults living in Latin America and the Caribbean.

PubMed

Al Snih, Soham; Graham, James E; Kuo, Yong-Fang; Goodwin, James S; Markides, Kyriakos S; Ottenbacher, Kenneth J

2010-06-15

The prevalence and incidence of both obesity and disability are projected to increase in the coming decades. The authors examined the relation between obesity and disability in older adults from 6 Latin American cities participating in the Health, Well-Being and Aging in Latin America and the Caribbean (SABE) Study (1999-2000). The sample included 6,166 participants aged 65 years or more. Data on sociodemographic factors, smoking status, medical conditions, body mass index (BMI; weight (kg)/height (m)(2)), and self-reported activities of daily living (ADL) were obtained. The prevalence of obesity (BMI > or = 30) ranged from 13.3% in Havana, Cuba, to 37.6% in Montevideo, Uruguay. Using a BMI of 18.5-<25 as the reference category and controlling for all covariates, the lowest odds ratio for ADL limitation was for a BMI of 25-<30 (odds ratio = 1.10, 95% confidence interval: 0.93, 1.30), and the highest odds ratio for ADL limitation was for a BMI of 35 or higher (odds ratio = 1.63, 95% confidence interval: 1.26, 2.11). The results indicated that obesity is an independent factor contributing to ADL disability in these populations and should be included in future planning to reduce the impact of disability on global health.

How does sex affect the care dependency risk one year after stroke? A study based on claims data from a German health insurance fund.

PubMed

Schnitzer, Susanne; Deutschbein, Johannes; Nolte, Christian H; Kohler, Martin; Kuhlmey, Adelheid; Schenk, Liane

2017-09-01

The study explores the association between sex and care dependency risk one year after stroke. The study uses claims data from a German statutory health insurance fund. Patients were included if they received a diagnosis of ischemic or hemorrhagic stroke between 1 January and 31 December 2007 and if they survived for one year after stroke and were not dependent on care before the event (n = 1851). Data were collected over a one-year period. Care dependency was defined as needing substantial assistance in activities of daily living for a period of at least six months. Geriatric conditions covered ICD-10 symptom complexes that characterize geriatric patients (e.g. urinary incontinence, cognitive deficits, depression). Multivariate regression analyses were performed. One year after the stroke event, women required nursing care significantly more often than men (31.2% vs. 21.3%; odds ratio for need of assistance: 1.67; 95% CI: 1.36-2.07). Adjusted for age, the odds ratio decreased by 65.7% to 1.23 (n.s.). Adjusted for geriatric conditions, the odds ratio decreased further and did not remain significant (adjusted OR: 1.18 (CI: 0.90-1.53). It may be assumed that women have a higher risk of becoming care-dependent after stroke than men because they are older and suffer more often from geriatric conditions such as urinary incontinence at onset of stroke. Preventive strategies should therefore focus on geriatric conditions in order to reduce the post-stroke care dependency risk for women.

Advertising for Demand Creation for Voluntary Medical Male Circumcision.

PubMed

Wilson, Nicholas; Frade, Sasha; Rech, Dino; Friedman, Willa

2016-08-15

To measure the effects of information, a challenge, and a conditional cash transfer on take-up of voluntary medical male circumcision (VMMC). A randomized, controlled experiment with 4000 postcard recipients in Soweto (Johannesburg), South Africa. We examined differences in take-up of several decisions in the VMMC cascade between the control arm and each of several intervention arms using logistic regression. Logistic regression analysis indicated that the group offered US $10 as compensation and the group challenged with "Are you tough enough?" had significantly higher take-up of the VMMC procedure than did the control group [odds ratios, respectively, 5.30 (CI: 2.20 to 12.76) and 2.70 (CI: 1.05 to 6.91)]. Similarly, the compensation group had significantly higher take-up of the VMMC counseling session than did the control group [odds ratio 3.76 (CI: 1.79 to 7.89)]. The analysis did not reveal significantly different take-up of either the VMMC counseling session or the procedure in the partner preference information group compared with the control group [odds ratios, respectively, 1.23 (CI: 0.51 to 2.97) and 1.67 (CI: 0.61 to 4.62)]. The analysis did not reveal significantly higher take-up of the VMMC nurse hotline in any intervention group compared with the control group [odds ratios for US $10, information, and challenge, respectively, 1.17 (CI: 0.67 to 2.07), 0.69 (CI: 0.36 to 1.32), and 0.60 (0.31 to 1.18)]. Among adult males in Soweto, South Africa, compensation of US $10 provided conditional on completing the VMMC counseling session compared with no compensation offer and a postcard with a challenge, "Are you tough enough?" compared with no challenge, resulted in moderate increases in take-up of circumcision.

Interpreting the concordance statistic of a logistic regression model: relation to the variance and odds ratio of a continuous explanatory variable.

PubMed

Austin, Peter C; Steyerberg, Ewout W

2012-06-20

When outcomes are binary, the c-statistic (equivalent to the area under the Receiver Operating Characteristic curve) is a standard measure of the predictive accuracy of a logistic regression model. An analytical expression was derived under the assumption that a continuous explanatory variable follows a normal distribution in those with and without the condition. We then conducted an extensive set of Monte Carlo simulations to examine whether the expressions derived under the assumption of binormality allowed for accurate prediction of the empirical c-statistic when the explanatory variable followed a normal distribution in the combined sample of those with and without the condition. We also examine the accuracy of the predicted c-statistic when the explanatory variable followed a gamma, log-normal or uniform distribution in combined sample of those with and without the condition. Under the assumption of binormality with equality of variances, the c-statistic follows a standard normal cumulative distribution function with dependence on the product of the standard deviation of the normal components (reflecting more heterogeneity) and the log-odds ratio (reflecting larger effects). Under the assumption of binormality with unequal variances, the c-statistic follows a standard normal cumulative distribution function with dependence on the standardized difference of the explanatory variable in those with and without the condition. In our Monte Carlo simulations, we found that these expressions allowed for reasonably accurate prediction of the empirical c-statistic when the distribution of the explanatory variable was normal, gamma, log-normal, and uniform in the entire sample of those with and without the condition. The discriminative ability of a continuous explanatory variable cannot be judged by its odds ratio alone, but always needs to be considered in relation to the heterogeneity of the population.

The impact of coagulopathy on traumatic splenic injuries.

PubMed

Smalls, Norma; Obirieze, Augustine; Ehanire, Imudia

2015-10-01

Patients with pre-injury coagulopathy have worse outcomes than those without coagulopathy. This article investigated the risk-adjusted effect of pre-injury coagulopathy on outcomes after splenic injuries. Review of the National Trauma Data Bank from 2007 to 2010 comparing mortality and complications between splenic injury patients with and without a pre-injury bleeding disorder. Of 58,896 patients, 2% had a bleeding disorder. Coagulopathic patients had higher odds of mortality (odds ratio, 1.3), sepsis (odds ratio, 2.0), acute respiratory distress syndrome (odds ratio, 2.6), acute renal failure (odds ratio, 1.5), cardiac arrest (odds ratio, 1.5), and overall complications (odds ratio, 2.4). The higher odds of myocardial infarction did not achieve statistical significance (odds ratio, 1.6). Pre-injury coagulopathy in patients with splenic injury has a negative impact on cardiac arrest, sepsis, acute respiratory distress syndrome, acute renal failure, and mortality. The higher likelihood of myocardial infarction did not reach statistical significance. Copyright © 2015 Elsevier Inc. All rights reserved.

Atmospheric conditions, lunar phases, and childbirth: a multivariate analysis

NASA Astrophysics Data System (ADS)

Ochiai, Angela Megumi; Gonçalves, Fabio Luiz Teixeira; Ambrizzi, Tercio; Florentino, Lucia Cristina; Wei, Chang Yi; Soares, Alda Valeria Neves; De Araujo, Natalucia Matos; Gualda, Dulce Maria Rosa

2012-07-01

Our objective was to assess extrinsic influences upon childbirth. In a cohort of 1,826 days containing 17,417 childbirths among them 13,252 spontaneous labor admissions, we studied the influence of environment upon the high incidence of labor (defined by 75th percentile or higher), analyzed by logistic regression. The predictors of high labor admission included increases in outdoor temperature (odds ratio: 1.742, P = 0.045, 95%CI: 1.011 to 3.001), and decreases in atmospheric pressure (odds ratio: 1.269, P = 0.029, 95%CI: 1.055 to 1.483). In contrast, increases in tidal range were associated with a lower probability of high admission (odds ratio: 0.762, P = 0.030, 95%CI: 0.515 to 0.999). Lunar phase was not a predictor of high labor admission ( P = 0.339). Using multivariate analysis, increases in temperature and decreases in atmospheric pressure predicted high labor admission, and increases of tidal range, as a measurement of the lunar gravitational force, predicted a lower probability of high admission.

Back disorders and health problems among subway train operators exposed to whole-body vibration.

PubMed

Johanning, E

1991-12-01

Back disease associated with whole-body vibration has not been evaluated for subway train operators. A recent study demonstrated that this group is exposed to whole-body vibration at levels above the international standard. To investigate this risk further, a self-administered questionnaire survey was conducted among subway train operators (N = 492) and a similar reference group (N = 92). The operators had a higher prevalence than the referents in all aspects of back problems, particularly for cervical and lower back pain. In a multiple logistic regression model, the odds ratio for sciatic pain among subway train operators was 3.9 (95% CI 1.7-8.6); the operators also had a higher risk of hearing-related problems (odds ratio 3.2, 95% CI 0.6-17.4) and of gastrointestinal problems (odds ratio 1.6, 95% CI 1.1-2.5). Although a cumulative dose-response relationship could not be statistically demonstrated, the findings appear to be related to exposure to whole-body vibration and inadequate ergonomic conditions.

Marital status, social capital, material conditions and self-rated health: a population-based study.

PubMed

Lindström, Martin

2009-12-01

Associations between marital status and self-rated health were investigated, adjusting for material conditions and trust (social capital). The 2004 public-health survey in Skåne is a cross-sectional study. A total of 27,757 persons aged 18-80 years answered a postal questionnaire, which represents 59% of the random sample. A logistic regression model was used to investigate associations between marital status and self-rated health, adjusting for economic problems and trust. The prevalence of poor self-rated health was 28.7% among men and 33.2% among women. Older respondents, respondents born abroad, with medium/low education, low emotional support, low instrumental support, economic problems, low trust, never married and divorced had significantly higher odds ratios of poor self-rated health than their respective reference group. Low trust was significantly higher among the divorced and unmarried compared to the married/cohabitating. Adjustment for economic problems but not for trust reduced the odds ratios of poor self-rated health among the divorced, which became not significant among men. Never married and the divorced have significantly higher age-adjusted odds ratios of poor self-rated health than the married/cohabitating group. Economic problems but not trust seem to affect the association between marital status and poor self-rated health.

Analyzing disparity trends for health care insurance coverage among non-elderly adults in the US: evidence from the Behavioral Risk Factor Surveillance System, 1993-2009.

PubMed

Assaf, Shireen; Campostrini, Stefano; Di Novi, Cinzia; Xu, Fang; Gotway Crawford, Carol

2017-04-01

To explore the changing disparities in access to health care insurance in the United States using time-varying coefficient models. Secondary data from the Behavioral Risk Factor Surveillance System (BRFSS) from 1993 to 2009 was used. A time-varying coefficient model was constructed using a binary outcome of no enrollment in health insurance plan versus enrolled. The independent variables included age, sex, education, income, work status, race, and number of health conditions. Smooth functions of odds ratios and time were used to produce odds ratio plots. Significant time-varying coefficients were found for all the independent variables with the odds ratio plots showing changing trends except for a constant line for the categories of male, student, and having three health conditions. Some categories showed decreasing disparities, such as the income categories. However, some categories had increasing disparities in health insurance enrollment such as the education and race categories. As the Affordable Care Act is being gradually implemented, studies are needed to provide baseline information about disparities in access to health insurance, in order to gauge any changes in health insurance access. The use of time-varying coefficient models with BRFSS data can be useful in accomplishing this task.

[Four numbers and a bit more basic knowledge of mathematics].

PubMed

Günther, Judith; Briel, Matthias; Suter, Katja

2015-02-01

In addition to relative risk, relative risk reduction and absolute risk reduction there circulates another effect size for binary endpoints in the scientific medical literature: the odds ratio. Relative risk and odds ratio are alternative ways of reflecting study results. Both, relative risk (RR) and odds ratio (OR), can easily be calculated from the "2 x 2-table". Advantage of OR: odds ratios can be calculated in every type of controlled study design, including retrospective studies. Furthermore, odds ratios--the biostatisticians are swarming--offer beautiful mathematical properties and therefore are often used in meta-analysis as an effect size for calculating a pooled estimate of the results of different studies with the same clinical question. Disadvantage of OR: In clinical studies the presentation of the results as "odds ratios" may result in an overestimation of the intervention effect. This article shows the difference between "chance" and "risk" and how odds ratio and relative risk are associated.

Risk factors for new-onset late postpartum preeclampsia in women without a history of preeclampsia.

PubMed

Bigelow, Catherine A; Pereira, Guilherme A; Warmsley, Amber; Cohen, Jennifer; Getrajdman, Chloe; Moshier, Erin; Paris, Julia; Bianco, Angela; Factor, Stephanie H; Stone, Joanne

2014-04-01

Risk factors for the development of new-onset late postpartum preeclampsia (LPP) in women without any history of preeclampsia are not known. Because identification of women who are at risk may lead to an earlier diagnosis of disease and improved maternal outcomes, this study identified risk factors (associated patient characteristics) for new-onset LPP. A case-control study of 34 women with new-onset LPP and 68 women without new-onset LPP after normal delivery, who were matched on date of delivery, was conducted at Mount Sinai Hospital, New York, NY. Data were collected by chart review. Exact conditional logistic regression identified patient characteristics that were associated with new-onset LPP. New-onset LPP was associated with age ≥40 years (adjusted odds ratio, 24.83; 95% confidence interval [CI], 1.43-infinity; P = .03), black race (adjusted odds ratio, 78.35; 95% CI, 7.25-infinity; P < .001), Latino ethnicity (adjusted odds ratio, 19.08; 95% CI, 2.73-infinity; P = .001), final pregnancy body mass index of ≥30 kg/m(2) (adjusted odds ratio, 13.38; 95% CI, 1.87-infinity; P = .01), and gestational diabetes mellitus (adjusted odds ratio, 72.91; 95% CI, 5.52-infinity; P < .001). As predictive tests for new-onset LPP, the sensitivity and specificity of having ≥1 of these characteristics was 100% and 59%, respectively, and the sensitivity and specificity of having ≥2 was 56% and 93%, respectively. Older age, black race, Latino ethnicity, obesity, and a pregnancy complicated by gestational diabetes mellitus all are associated positively with the development of new-onset LPP. Closer observation may be warranted in these populations. Copyright © 2014 Mosby, Inc. All rights reserved.

Association of Urinary Biomarkers of Inflammation, Injury, and Fibrosis with Renal Function Decline: The ACCORD Trial

PubMed Central

Nadkarni, Girish N.; Rao, Veena; Ismail-Beigi, Faramarz; Fonseca, Vivian A.; Shah, Sudhir V.; Simonson, Michael S.; Cantley, Lloyd; Devarajan, Prasad; Parikh, Chirag R.

2016-01-01

Background and objectives Current measures for predicting renal functional decline in patients with type 2 diabetes with preserved renal function are unsatisfactory, and multiple markers assessing various biologic axes may improve prediction. We examined the association of four biomarker-to-creatinine ratio levels (monocyte chemotactic protein-1, IL-18, kidney injury molecule-1, and YKL-40) with renal outcome. Design, setting, participants, & measurements We used a nested case-control design in the Action to Control Cardiovascular Disease Trial by matching 190 participants with ≥40% sustained eGFR decline over the 5-year follow-up period to 190 participants with ≤10% eGFR decline in a 1:1 fashion on key characteristics (age within 5 years, sex, race, baseline albumin-to-creatinine ratio within 20 μg/mg, and baseline eGFR within 10 ml/min per 1.73 m2), with ≤10% decline. We used a Mesoscale Multiplex Platform and measured biomarkers in baseline and 24-month specimens, and we examined biomarker associations with outcome using conditional logistic regression. Results Baseline and 24-month levels of monocyte chemotactic protein-1-to-creatinine ratio levels were higher for cases versus controls. The highest quartile of baseline monocyte chemotactic protein-1-to-creatinine ratio had fivefold greater odds, and each log increment had 2.27-fold higher odds for outcome (odds ratio, 5.27; 95% confidence interval, 2.19 to 12.71 and odds ratio, 2.27; 95% confidence interval, 1.44 to 3.58, respectively). IL-18-to-creatinine ratio, kidney injury molecule-1-to-creatinine ratio, and YKL-40-to-creatinine ratio were not consistently associated with outcome. C statistic for traditional predictors of eGFR decline was 0.70, which improved significantly to 0.74 with monocyte chemotactic protein-1-to-creatinine ratio. Conclusions Urinary monocyte chemotactic protein-1-to-creatinine ratio concentrations were strongly associated with sustained renal decline in patients with type 2 diabetes with preserved renal function. PMID:27189318

Association of Urinary Biomarkers of Inflammation, Injury, and Fibrosis with Renal Function Decline: The ACCORD Trial.

PubMed

Nadkarni, Girish N; Rao, Veena; Ismail-Beigi, Faramarz; Fonseca, Vivian A; Shah, Sudhir V; Simonson, Michael S; Cantley, Lloyd; Devarajan, Prasad; Parikh, Chirag R; Coca, Steven G

2016-08-08

Current measures for predicting renal functional decline in patients with type 2 diabetes with preserved renal function are unsatisfactory, and multiple markers assessing various biologic axes may improve prediction. We examined the association of four biomarker-to-creatinine ratio levels (monocyte chemotactic protein-1, IL-18, kidney injury molecule-1, and YKL-40) with renal outcome. We used a nested case-control design in the Action to Control Cardiovascular Disease Trial by matching 190 participants with ≥40% sustained eGFR decline over the 5-year follow-up period to 190 participants with ≤10% eGFR decline in a 1:1 fashion on key characteristics (age within 5 years, sex, race, baseline albumin-to-creatinine ratio within 20 μg/mg, and baseline eGFR within 10 ml/min per 1.73 m(2)), with ≤10% decline. We used a Mesoscale Multiplex Platform and measured biomarkers in baseline and 24-month specimens, and we examined biomarker associations with outcome using conditional logistic regression. Baseline and 24-month levels of monocyte chemotactic protein-1-to-creatinine ratio levels were higher for cases versus controls. The highest quartile of baseline monocyte chemotactic protein-1-to-creatinine ratio had fivefold greater odds, and each log increment had 2.27-fold higher odds for outcome (odds ratio, 5.27; 95% confidence interval, 2.19 to 12.71 and odds ratio, 2.27; 95% confidence interval, 1.44 to 3.58, respectively). IL-18-to-creatinine ratio, kidney injury molecule-1-to-creatinine ratio, and YKL-40-to-creatinine ratio were not consistently associated with outcome. C statistic for traditional predictors of eGFR decline was 0.70, which improved significantly to 0.74 with monocyte chemotactic protein-1-to-creatinine ratio. Urinary monocyte chemotactic protein-1-to-creatinine ratio concentrations were strongly associated with sustained renal decline in patients with type 2 diabetes with preserved renal function. Copyright © 2016 by the American Society of Nephrology.

Low caregiver health literacy is associated with higher pediatric emergency department use and nonurgent visits.

PubMed

Morrison, Andrea K; Schapira, Marilyn M; Gorelick, Marc H; Hoffmann, Raymond G; Brousseau, David C

2014-01-01

We sought to determine the association between low caregiver health literacy and child emergency department (ED) use, both the number and urgency of ED visits. This year long cross-sectional study utilized the Newest Vital Sign questionnaire to measure the health literacy of caregivers accompanying children to a pediatric ED. Prior ED visits were extracted from a regional database. ED visit urgency was classified by resources utilized during the index ED visit. Regression analyses were used to model 2 outcomes-prior ED visits and ED visit urgency-stratified by chronic illness. Analyses were weighted by triage level. Overall, 503 caregivers completed the study; 55% demonstrated low health literacy. Children of caregivers with low health literacy had more prior ED visits (adjusted incidence rate ratio 1.5; 95% confidence interval 1.2, 1.8) and increased odds of a nonurgent index ED visit (adjusted odds ratio 2.4; 95% confidence interval 1.3, 4.4). Among children without chronic illness, low caregiver health literacy was associated with an increased proportion of nonurgent index ED visits (48% vs. 22%; adjusted odds ratio 3.2; 1.8, 5.7). Over half of caregivers presenting with their children to the ED have low health literacy. Low caregiver health literacy is an independent predictor of higher ED use and use of the ED for nonurgent conditions. In children without a chronic illness, low health literate caregivers had more than 3 times greater odds of presenting for a nonurgent condition than those with adequate health literacy. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

An Analytical Evaluation of Two Common-Odds Ratios as Population Indicators of DIF.

ERIC Educational Resources Information Center

Pommerich, Mary; And Others

The Mantel-Haenszel (MH) statistic for identifying differential item functioning (DIF) commonly conditions on the observed test score as a surrogate for conditioning on latent ability. When the comparison group distributions are not completely overlapping (i.e., are incongruent), the observed score represents different levels of latent ability…

Explaining Racial Disparities in Obesity Among Men: Does Place Matter?

PubMed

Thorpe, Roland J; Kelley, Elizabeth; Bowie, Janice V; Griffith, Derek M; Bruce, Marino; LaVeist, Thomas

2015-11-01

National data indicate that Black men have higher rates of obesity than White men. Black men also experience earlier onset of many chronic conditions and premature mortality linked to obesity. Explanations for these disparities have been underexplored, and existing national-level studies may be limited in their ability to explicate these long-standing patterns. National data generally do not account for race differences in risk exposures resulting from racial segregation or the confounding between race and socioeconomic status. Therefore, these differences in obesity may be a function of social environment rather than race. This study examined disparities in obesity among Black and White men living in the same social and environmental conditions, who have similar education levels and incomes using data from the Exploring Health Disparities in Integrated Communities-SWB (EHDIC-SWB) study. The findings were compared with the 2003 National Health Interview Survey (NHIS). Logistic regression was used to examine the association between race and obesity adjusting for demographics, socioeconomic status, and health conditions. In the NHIS, Black men had a higher odds of obesity (odds ratio=1.29, 95% confidence interval=1.12-1.49) than White men. However in the EHDIC-SWB, which accounts for social and environmental conditions of where these men live, Black men had similar odds of obesity (odds ratio=1.06, 95% confidence interval=0.70-1.62) compared with White men. These data highlight the importance of the role that setting plays in understanding race disparities in obesity among men. Social environment may be a key determinant of health when seeking to understand race disparities in obesity among Black and White men. © The Author(s) 2014.

Reproductive history and progression of lower urinary tract symptoms in women: results from a population-based cohort study.

PubMed

Maserejian, Nancy N; Curto, Teresa; Hall, Susan A; Wittert, Gary; McKinlay, John B

2014-04-01

To examine whether reproductive history and related conditions are associated with the development and persistence of lower urinary tract symptoms (LUTS) other than urinary incontinence in a racially and/or ethnically diverse population-based sample of women. The Boston Area Community Health Survey enrolled 3201 women aged 30-79 years of black, Hispanic, or white race and/or ethnicity. Baseline and 5-year follow-up interviews were completed by 2534 women (conditional response rate, 83.4%). The association between reproductive history factors and population-weighted estimates of LUTS progression and persistence was tested using multivariable logistic regression models. Between baseline and 5-year follow-up, 23.9% women had LUTS progression. In age-adjusted models, women who had delivered ≥2 childbirths had higher odds of LUTS progression, but the association was completely accounted for by vaginal child delivery (eg, 2 vaginal childbirths vs none, multivariable-adjusted odds ratio = 2.21; 95% CI, 1.46-3.35; P <.001). No increased odds of LUTS progression were found for women with only 1 vaginal delivery or who only had cesarean section(s). Uterine prolapse was associated with higher odds of LUTS progression (multivariable-adjusted odds ratio = 3.05; 95% CI, 1.43-6.50; P = .004). Gestational diabetes was associated with approximately twice the odds of LUTS progression, but only among younger women (interaction P = .003). In this cohort study, ≥2 vaginal child deliveries, uterine prolapse, and among younger women, gestational diabetes were robust predictors of LUTS progression. Clinicians should assess the presence of bothersome urinary frequency, urgency, and voiding symptoms among women who have had multiple vaginal childbirths or gestational diabetes. Copyright © 2014 Elsevier Inc. All rights reserved.

Agreement between Myocardial Infarction Patients and Their Spouses on Reporting of Data on 82 Cardiovascular Risk Exposures.

PubMed

Quintana, Hedley Knewjen; Vikström, Max; Andersson, Tomas; Hallqvist, Johan; Leander, Karin

2015-01-01

The validity of exposure data collected from proxy respondents of myocardial infarction patients has scarcely been studied. We assessed the level of disagreement between myocardial infarction patients and their spouses with respect to the reporting of the patient´s cardiovascular risk exposures. Within the frame of the Stockholm Heart Epidemiology Program (SHEEP), a case-control study of risk factors of myocardial infarction performed in Stockholm county 1992-1994, a subset of 327 first time myocardial infarction cases aged 45-70 who survived >28 days after the event and who co-habited with a spouse or common-law spouse (proxy) were identified between 1993-04-05 and 1993-12-31. Among these, 243 cases participated along with their respective proxy in the present study. Control individuals, matched to cases by age, sex and residential area were also included (n = 243). Data were collected using questionnaires. Using conditional logistic regression we calculated for each of 82 exposures the odds ratio based on information collected from 1) myocardial infarction cases and controls [odds ratio A] and 2) proxies and the same set of controls [odds ratio B]. Disagreement was measured by calculating the ratio between odds ratio B and odds ratio A with 95% confidence intervals (CI) calculated using resampling bootstrap. For the vast majority of the exposures considered including diet, smoking, education, work-related stress, and family history of CVD, there was no statistically significant disagreement between myocardial infarction patients and proxies (n = 243 pairs). However, leisure time physical inactivity (proxy bias = 1.59, 95% CI 1.05-3.57) was overestimated by spouses compared to myocardial infarction patients. A few other exposures including some sleep-related problems and work-related issues also showed disagreement. Myocardial infarction patients and their spouses similarly reported data on a wide range of exposures including the majority of the traditional cardiovascular risk factors, leisure time physical inactivity being an exception.

Prevalence and clinical correlates of sarcopenia in community-dwelling older people: application of the EWGSOP definition and diagnostic algorithm.

PubMed

Volpato, Stefano; Bianchi, Lara; Cherubini, Antonio; Landi, Francesco; Maggio, Marcello; Savino, Elisabetta; Bandinelli, Stefania; Ceda, Gian Paolo; Guralnik, Jack M; Zuliani, Giovanni; Ferrucci, Luigi

2014-04-01

Muscle impairment is a common condition in older people and a powerful risk factor for disability and mortality. The aim of this study was to apply the European Working Group on Sarcopenia in Older People criteria to estimate the prevalence and investigate the clinical correlates of sarcopenia, in a sample of Italian community-dwelling older people. Cross-sectional analysis of 730 participants (74% aged 65 years and older) enrolled in the InCHIANTI study. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People criteria using bioimpedance analysis for muscle mass assessment. Logistic regression analysis was used to identify the factors independently associated with sarcopenia. Sarcopenia defined by the European Working Group on Sarcopenia in Older People criteria increased steeply with age (p < .001), with 31.6% of women and 17.4% of men aged 80 years or older being affected by this condition. Higher education (odds ratio: 0.85; 95% CI: 0.74-0.98), lower insulin-like growth factor I (lowest vs highest tertile, odds ratio: 3.89; 95% CI: 1.03-14.1), and low bioavailable testosterone (odds ratio: 2.67; 95% CI: 1.31-5.44) were independently associated with the likelihood of being sarcopenic. Nutritional intake, physical activity, and level of comorbidity were not associated with sarcopenia. Sarcopenia identified by the European Working Group on Sarcopenia in Older People criteria is a relatively common condition in Italian octogenarians, and its prevalence increases with aging. Correlates of sarcopenia identified in this study might suggest new approaches for prevention and treatment of sarcopenia.

Driver Mortality in Paired Side Impact Collisions Due to Incompatible Vehicle Types

PubMed Central

Crandall, C.S.

2003-01-01

Using a matched case control design, this study measured the mortality associated with paired passenger car-sport utility vehicle side impact (‘T-bone’) collisions using FARS data. Survival versus fatal outcome within the matched crash pairs was measured with matched pair odds ratios. Conditional logistic regression adjusted for multiple effects. Overall, passenger car drivers experienced greater mortality than did SUV drivers, regardless if they were in the struck or striking vehicle (odds ratio: 10.0; 95% confidence interval: 7.9, 12.5). Differential mortality persisted after adjustment for confounders. Efforts should be sought to improve passenger car side impact crashworthiness and to reduce SUV aggressivity. PMID:12941243

To be involved or not to be involved: a survey of public preferences for self-involvement in decision-making involving mental capacity (competency) within Europe.

PubMed

Daveson, Barbara A; Bausewein, Claudia; Murtagh, Fliss E M; Calanzani, Natalia; Higginson, Irene J; Harding, Richard; Cohen, Joachim; Simon, Steffen T; Deliens, Luc; Bechinger-English, Dorothee; Hall, Sue; Koffman, Jonathan; Ferreira, Pedro Lopes; Toscani, Franco; Gysels, Marjolein; Ceulemans, Lucas; Haugen, Dagny F; Gomes, Barbara

2013-05-01

The Council of Europe has recommended that member states of European Union encourage their citizens to make decisions about their healthcare before they lose capacity to do so. However, it is unclear whether the public wants to make such decisions beforehand. To examine public preferences for self-involvement in end-of-life care decision-making and identify associated factors. A population-based survey with 9344 adults in England, Belgium, Germany, Italy, the Netherlands, Portugal and Spain. Across countries, 74% preferred self-involvement when capable; 44% preferred self-involvement when incapable through, for example, a living will. Four factors were associated with a preference for self-involvement across capacity and incapacity scenarios, respectively: higher educational attainment ((odds ratio = 1.93-2.77), (odds ratio = 1.33-1.80)); female gender ((odds ratio = 1.27, 95% confidence interval = 1.14-1.41), (odds ratio = 1.30, 95% confidence interval = 1.20-1.42)); younger-middle age ((30-59 years: odds ratio = 1.24-1.40), (50-59 years: odds ratio = 1.23, 95% confidence interval = 1.04-1.46)) and valuing quality over quantity of life or valuing both equally ((odds ratio = 1.49-1.58), (odds ratio = 1.35-1.53)). Those with increased financial hardship (odds ratio = 0.64-0.83) and a preference to die in hospital (not a palliative care unit) (odds ratio = 0.73, 95% confidence interval = 0.60-0.88), a nursing home or residential care (odds ratio = 0.73, 95% confidence interval = 0.54-0.99) were less likely to prefer self-involvement when capable. For the incapacity scenario, single people were more likely to prefer self-involvement (odds ratio = 1.34, 95% confidence interval = 1.18-1.53). Self-involvement in decision-making is important to the European public. However, a large proportion of the public prefer to not make decisions about their care in advance of incapacity. Financial hardship, educational attainment, age, and preferences regarding quality and quantity of life require further examination; these factors should be considered in relation to policy.

Secretaries, depression and absenteeism.

PubMed

Garrison, R; Eaton, W W

1992-01-01

This study examines the prevalence of Major Depressive Disorder; missed work; and mental health services use among secretaries and other women employed full-time. In a random sample of 3,484 women employed full-time, women employed as secretaries were significantly more likely to be depressed than other women even after controlling for socio-demographic characteristics (odds ratio = 1.69, 95% confidence interval = 1.05, 2.73). Secretaries were significantly more likely to report missing work in the last three months (odds ratio = 1.77, confidence interval = 1.01, 3.11); a finding not attributable to depression. Secretaries were also more likely to seek mental health services, but this finding was not significant (odds ratio = 1.78, confidence interval = 0.55, 5.78). It is possible that these findings are attributable to a selection effect whereby depressed women, and women who are likely to miss work, become secretaries. A second possibility is that women employed as secretaries have more "nonwork role stress" than other employed women. Alternatively, job conditions which result in dissatisfaction and stress may lead to depression and absenteeism. We believe our findings warrant further investigation into the work environment of secretaries.

The interaction between maternal race/ethnicity and chronic hypertension on preterm birth.

PubMed

Premkumar, Ashish; Henry, Dana E; Moghadassi, Michelle; Nakagawa, Sanae; Norton, Mary E

2016-12-01

In both the biomedical and public health literature, the risk for preterm birth has been linked to maternal racial/ethnic background, in particular African-American heritage. Despite this well-documented health disparity, the relationship of comorbid conditions, such as chronic hypertension, to maternal race/ethnicity and preterm birth has received relatively limited attention in the literature. The objective of the study was to evaluate the interaction between chronic hypertension and maternal racial/ethnic background on preterm birth. This is a retrospective cohort study of singleton pregnancies among women who delivered between 2002 and 2015 at the University of California, San Francisco. The associations of chronic hypertension with both spontaneous and medically indicated preterm birth were examined by univariate and multivariate logistical regression, adjusting for confounders including for maternal age, history of preterm birth, maternal body mass index, insurance type (public vs private), smoking, substance abuse, history of pregestational diabetes mellitus, and use of assisted reproductive technologies. The interaction effect of chronic hypertension and racial/ethnicity was also evaluated. All values are reported as odds ratios, with 95% confidence intervals and significance set at P = .05. In this cohort of 23,425 singleton pregnancies, 8.8% had preterm deliveries (3% were medically indicated preterm birth, whereas 5.5% were spontaneous preterm births), and 3.8% of women carried the diagnosis of chronic hypertension. Chronic hypertension was significantly associated with preterm birth in general (adjusted odds ratio, 2.74, P < .001) and medically indicated preterm birth specifically (adjusted odds ratio, 5.25, P < .001). When evaluating the effect of chronic hypertension within racial/ethnic groups, there was an increased odds of a preterm birth among hypertensive, African-American women (adjusted odds ratio, 3.91, P < .001) and hypertensive, Asian-American/Pacific Islander women (adjusted odds ratio, 3.51, P < .001) when compared with their nonhypertensive counterparts within the same racial/ethnic group. These significant effects were also noted with regard to medically indicated preterm birth for hypertensive African-American women (adjusted odds ratio, 6.85, P < .001) and Asian-American/Pacific Islander women (adjusted odds ratio, 9.87, P < .001). There was no significant association of chronic hypertension with spontaneous preterm birth (adjusted odds ratio, 0.87, P = .4). The effect of chronic hypertension on overall preterm birth and medically indicated preterm birth differs by racial/ethnic group. The larger effect of chronic hypertension among African-American and Asian/Pacific Islander women on medically indicated and total preterm birth rates raises the possibility of an independent variable that is not captured in the data analysis, although data regarding the indication for medically indicated preterm delivery was limited in this data set. Further investigation into both social-structural and biological predispositions to preterm birth should accompany research focusing on the effect of chronic hypertension on birth outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Chronic periodontitis among diabetics and nondiabetics aged 35-65 years, in a rural block in Vellore, Tamil Nadu: A cross-sectional study.

PubMed

Nand, Khushboo Yamima; Oommen, Anu Mary; Chacko, Rabin Kurudamannil; Abraham, Vinod Joseph

2017-01-01

Chronic periodontitis is a common cause of poor oral health globally. Those at higher risk of this preventable and easily treatable condition need to be identified so that efforts can be taken to decrease disease burden and subsequent consequences. The aims of the study were (1) To compare the prevalence of chronic periodontitis among individuals with and without type 2 diabetes, aged 35-65 years from a rural block in Vellore, Tamil Nadu and (2) to assess risk factors for chronic periodontitis among individuals with diabetes. A cross-sectional study was done in nine villages of Kaniyambadi block, Vellore, between October 2015 and July 2016 among participants aged 35-65 years of a previous cross-sectional survey which had identified individuals with and without type 2 diabetes. Chronic periodontitis was assessed using the Community Periodontal Index and Treatment Needs index. Oral hygiene was assessed clinically using the Simplified Oral Hygiene Index. Diabetes was defined as on medication for type 2 diabetes or detected to have fasting blood glucose ≥126 mg/dl (in a previous survey). Chi-square test and odds ratios (adjusted using logistic regression) were used to study risk factors for periodontitis among those with diabetes. Prevalence of chronic periodontitis was 45.9% (95% confidence interval [CI]: 40.88%-50.9%) among 98 individuals with diabetes and 35.6% (95% CI: 30.91-40.29%) among 104 individuals without diabetes. Poor oral hygiene (odds ratio: 8.33, 95% CI: 3.33-25.00), low socioeconomic status (odds ratio: 3.19, 95% CI: 1.00-10.12), and smoking (odds ratio: 3.51, 95% CI: 1.17-10.51) were associated with periodontitis among diabetics. Individuals with type 2 diabetes have a higher prevalence of periodontitis. As poor oral hygiene is a strong risk factor for periodontitis, there is a need for targeted education regarding dental hygiene to reduce this preventable condition.

Individual, school-related and family characteristics distinguish co-occurrence of drinking and depressive symptoms in very young adolescents.

PubMed

Salom, Caroline L; Kelly, Adrian B; Alati, Rosa; Williams, Gail M; Patton, George C; Williams, Joanne W

2016-07-01

Alcohol misuse and depressed mood are common during early adolescence, and comorbidity of these conditions in adulthood is associated with poorer health and social outcomes, yet little research has examined the co-occurrence of these problems at early adolescence. This study assessed risky and protective characteristics of pre-teens with concurrent depressed mood/early alcohol use in a large school-based sample. School children aged 10-14 years (n = 7289) from late primary and early secondary school classes in government, Catholic and independent sectors participated with parental consent in the cross-sectional Healthy Neighbourhoods Study. Key measures included depressed mood, recent alcohol use, school mobility, family relationship quality, school engagement and coping style. Multinomial logistic regression analyses were used to identify school and family-related factors that distinguished those with co-occurring drinking and depressive symptoms from those with either single condition. Gender and school-level interactions for each factor were evaluated. Co-occurring conditions were reported by 5.7% of students [confidence interval (CI)95 5.19, 6.19]. Recent drinkers were more likely than non-drinkers to have symptoms consistent with depression (odds ratio 1.80; CI95 1.58, 2.03). Low school commitment was associated with co-occurring drinking/depressive symptoms (odds ratio 2.86; CI95 2.25, 3.65 compared with null condition). This association appeared to be weaker in the presence of adaptive stress-coping skills (odds ratio 0.18; CI95 0.14, 0.23). We have identified factors that distinguish pre-teens with very early co-occurrence of drinking and depressed mood, and protective factors with potential utility for school-based prevention programmes targeting these conditions. [Salom CL, Kelly AB, Alati R, Williams GM, Patton GC, Williams JW. Individual, school-related and family characteristics distinguish co-occurrence of drinking and depressive symptoms in very young adolescents. Drug Alcohol Rev 2016;35:387-396]. © 2015 Australasian Professional Society on Alcohol and other Drugs.

Interpreting the concordance statistic of a logistic regression model: relation to the variance and odds ratio of a continuous explanatory variable

PubMed Central

2012-01-01

Background When outcomes are binary, the c-statistic (equivalent to the area under the Receiver Operating Characteristic curve) is a standard measure of the predictive accuracy of a logistic regression model. Methods An analytical expression was derived under the assumption that a continuous explanatory variable follows a normal distribution in those with and without the condition. We then conducted an extensive set of Monte Carlo simulations to examine whether the expressions derived under the assumption of binormality allowed for accurate prediction of the empirical c-statistic when the explanatory variable followed a normal distribution in the combined sample of those with and without the condition. We also examine the accuracy of the predicted c-statistic when the explanatory variable followed a gamma, log-normal or uniform distribution in combined sample of those with and without the condition. Results Under the assumption of binormality with equality of variances, the c-statistic follows a standard normal cumulative distribution function with dependence on the product of the standard deviation of the normal components (reflecting more heterogeneity) and the log-odds ratio (reflecting larger effects). Under the assumption of binormality with unequal variances, the c-statistic follows a standard normal cumulative distribution function with dependence on the standardized difference of the explanatory variable in those with and without the condition. In our Monte Carlo simulations, we found that these expressions allowed for reasonably accurate prediction of the empirical c-statistic when the distribution of the explanatory variable was normal, gamma, log-normal, and uniform in the entire sample of those with and without the condition. Conclusions The discriminative ability of a continuous explanatory variable cannot be judged by its odds ratio alone, but always needs to be considered in relation to the heterogeneity of the population. PMID:22716998

A Nationally Representative Study of Calcific Uremic Arteriolopathy Risk Factors

PubMed Central

Zhao, Sophia; Wenger, Julia; Hymes, Jeffrey L.; Maddux, Franklin W.; Thadhani, Ravi I.; Chan, Kevin E.

2016-01-01

Accurate identification of risk factors for calcific uremic arteriolopathy (CUA) is necessary to develop preventive strategies for this morbid disease. We investigated whether baseline factors recorded at hemodialysis initiation would identify patients at risk for future CUA in a matched case-control study using data from a large dialysis organization. Hemodialysis patients with newly diagnosed CUA (n=1030) between January 1, 2010, and December 31, 2014, were matched by age, sex, and race in a 1:2 ratio to hemodialysis patients without CUA (n=2060). Mean ages for patients and controls were 54 and 55 years, respectively; 67% of participants were women and 49% were white. Median duration between hemodialysis initiation and subsequent CUA development was 925 days (interquartile range, 273–2185 days). In multivariable conditional logistic regression analyses, diabetes mellitus; higher body mass index; higher levels of serum calcium, phosphorous, and parathyroid hormone; and nutritional vitamin D, cinacalcet, and warfarin treatments were associated with increased odds of subsequent CUA development. Compared with patients with diabetes receiving no insulin injections, those receiving insulin injections had a dose-response increase in the odds of CUA involving lower abdomen and/or upper thigh areas (odds ratio, 1.49; 95% confidence interval, 1.03 to 2.51 for one or two injections per day; odds ratio, 1.88; 95% confidence interval, 1.30 to 3.43 for 3 injections per day; odds ratio, 3.74; 95% confidence interval, 2.28 to 6.25 for more than three injections per day), suggesting a dose-effect relationship between recurrent skin trauma and CUA risk. The presence of risk factors months to years before CUA development observed in this study will direct the design of preventive strategies and inform CUA pathobiology. PMID:27080977

Impact of four training conditions on physician use of a web-based clinical decision support system.

PubMed

Kealey, Edith; Leckman-Westin, Emily; Finnerty, Molly T

2013-09-01

Training has been identified as an important barrier to implementation of clinical decision support systems (CDSSs), but little is known about the effectiveness of different training approaches. Using an observational retrospective cohort design, we examined the impact of four training conditions on physician use of a CDSS: (1) computer lab training with individualized follow-up (CL-FU) (n=40), (2) computer lab training without follow-up (CL) (n=177), (3) lecture demonstration (LD) (n=16), or (4) no training (NT) (n=134). Odds ratios of any use and ongoing use under training conditions were compared to no training over a 2-year follow-up period. CL-FU was associated with the highest percent of active users and odds for any use (90.0%, odds ratio (OR)=10.2, 95% confidence interval (CI): 3.2-32.9) and ongoing use (60.0%, OR=6.1 95% CI: 2.6-13.7), followed by CL (any use=81.4%, OR=5.3, CI: 2.9-9.6; ongoing use=28.8%, OR=1.7, 95% CI: 1.0-3.0). LD was not superior to no training (any use=47%, ongoing use=22.4%). Training format may have differential effects on initial and long-term follow-up of CDSSs use by physicians. Copyright © 2013 Elsevier B.V. All rights reserved.

Efficacy and Safety of Oral and Transdermal Opioid Analgesics for Musculoskeletal Pain in Older Adults: A Systematic Review of Randomized, Placebo-Controlled Trials.

PubMed

Megale, Rodrigo Z; Deveza, Leticia A; Blyth, Fiona M; Naganathan, Vasi; Ferreira, Paulo H; McLachlan, Andrew J; Ferreira, Manuela L

2018-05-01

This systematic review with meta-analysis was performed to evaluate the efficacy and safety of using opioid analgesics in older adults with musculoskeletal pain. We searched Cochrane Library, MEDLINE, EMBASE, Web of Science, AMED, CINAHL, and LILACS for randomized controlled trials with mean population age of 60 years or older, comparing the efficacy and safety of opioid analgesics with placebo for musculoskeletal pain conditions. Reviewers extracted data, assessed risk of bias, and evaluated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. Random effects models were used to calculate standardized mean differences (when different scales were used across trials), mean differences and odds ratios with respective 95% confidence intervals (CIs). Meta-regressions were carried out to assess the influence of opioid analgesic daily dose and treatment duration on our main outcomes. We included 23 randomized placebo-controlled trials in the meta-analysis. Opioid analgesics had a small effect on decreasing pain intensity (standardized mean difference = -.27; 95% CI = -.33 to -.20) and improving function (standardized mean difference = -.27, 95% CI = -.36 to -.18), which was not associated with daily dose or treatment duration. The odds of adverse events were 3 times higher (odds ratio = 2.94; 95% CI = 2.33-3.72) and the odds of treatment discontinuation due to adverse events 4 times higher (odds ratio = 4.04; 95% CI = 3.10-5.25) in patients treated with opioid analgesics. The results show that in older adults suffering from musculoskeletal pain, using opioid analgesics had only a small effect on pain and function at the cost of a higher odds of adverse events and treatment discontinuation. For this specific population, the opioid-related risks may outweigh the benefits. The systematic review shows that, in older adults suffering from musculoskeletal conditions, opioid analgesics have only a small effect on pain and disability. Conversely, this population is at higher risk of adverse events. The results may reflect age-related physiological changes in pain processing, pharmacokinetics, and pharmacodynamics. Copyright © 2017 The American Pain Society. Published by Elsevier Inc. All rights reserved.

Time does not heal all wounds: older adults who experienced childhood adversities have higher odds of mood, anxiety, and personality disorders.

PubMed

Raposo, Sarah M; Mackenzie, Corey S; Henriksen, Christine A; Afifi, Tracie O

2014-11-01

We aimed to examine the prevalence of several types of childhood adversity across adult cohorts, whether age moderates the effect of childhood adversity on mental health, the relationship between childhood adversity and psychopathology among older adults, the dose-response relationship between number of types of childhood adversities and mental disorders in later life, and whether lifetime mental health treatment reduces the odds of psychopathology among older survivors of childhood adversity. In a population-based, cross-sectional study on a nationally representative U.S. sample, we studied 34,653 community-dwelling Americans 20 years and older, including 7,080 adults 65 years and older from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Trained lay interviewers assessed past-year mood and anxiety disorders and lifetime personality disorders. Participants self-reported childhood adversity based on questions from the Adverse Childhood Experiences Study. Childhood adversity was prevalent across five age cohorts. In our adjusted models, age did not moderate the effect of childhood adversity on mental disorders. Older adults who experienced childhood adversity had higher odds of having mood (odds ratio: 1.73; 95% confidence interval: 1.32-2.28), anxiety (odds ratio: 1.48; 95% confidence interval: 1.20-1.83), and personality disorders (odds ratio: 2.11; 95% confidence interval: 1.75-2.54) after adjusting for covariates. An increasing number of types of childhood adversities was associated with higher odds of personality disorders and somewhat higher odds of anxiety disorders. Treatment-seeking was associated with a reduced likelihood of anxiety and, especially, mood disorders in older adult childhood adversity survivors. These results emphasize the importance of preventing childhood adversity and intervening once it occurs to avoid the negative mental health effects that can last into old age. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Impact of donor mismatches at individual HLA-A, -B, -C, -DR, and -DQ loci on the development of HLA-specific antibodies in patients listed for repeat renal transplantation.

PubMed

Kosmoliaptsis, Vasilios; Gjorgjimajkoska, Olivera; Sharples, Linda D; Chaudhry, Afzal N; Chatzizacharias, Nikolaos; Peacock, Sarah; Torpey, Nicholas; Bolton, Eleanor M; Taylor, Craig J; Bradley, J Andrew

2014-11-01

We have analyzed the relationship between donor mismatches at each HLA locus and development of HLA locus-specific antibodies in patients listed for repeat transplantation. HLA antibody screening was undertaken using single-antigen beads in 131 kidney transplant recipients returning to the transplant waiting list following first graft failure. The number of HLA mismatches and the calculated reaction frequency of antibody reactivity against 10,000 consecutive deceased organ donors were determined for each HLA locus. Two-thirds of patients awaiting repeat transplantation were sensitized (calculated reaction frequency over 15%) and half were highly sensitized (calculated reaction frequency of 85% and greater). Antibody levels peaked after re-listing for repeat transplantation, were independent of graft nephrectomy and were associated with length of time on the waiting list (odds ratio 8.4) and with maintenance on dual immunosuppression (odds ratio 0.2). Sensitization was independently associated with increasing number of donor HLA mismatches (odds ratio 1.4). All mismatched HLA loci contributed to the development of HLA locus-specific antibodies (HLA-A: odds ratio 3.2, HLA-B: odds ratio 3.4, HLA-C: odds ratio 2.5, HLA-DRB1: odds ratio 3.5, HLA-DRB3/4/5: odds ratio 3.9, and HLA-DQ: odds ratio 3.0 (all significant)). Thus, the risk of allosensitization following failure of a first renal transplant increases incrementally with the number of mismatches at all HLA loci assessed. Maintenance of re-listed patients on dual immunosuppression was associated with a reduced risk of sensitization.

Clinicians' Perception and Experience of Organ Donation From Brain-Dead Patients.

PubMed

Kentish-Barnes, Nancy; Duranteau, Jacques; Montlahuc, Claire; Charpentier, Julien; Martin-Lefevre, Laurent; Joseph, Liliane; Lefrant, Jean-Yves; Fieux, Fabienne; Renault, Anne; Thuong, Marie; Chevret, Sylvie; Azoulay, Elie

2017-09-01

ICU clinicians are primarily involved in organ donation after brain death of ICU patients. Their perceptions of organ donation may affect outcomes. Our objective was to describe ICU clinician's perceptions and experience of organ donation. Cross-sectional study among physicians and nurses (90 ICUs in France). We used factorial correspondence analysis to describe categories of clinicians regarding their perceptions and experience of organ donation. Factors associated with a positive (motivating) or negative (stressful) experiences were studied using multivariate logistic regression. Physicians and nurses. Three thousand three hundred twenty-five clinicians working in 77 ICUs returned questionnaires. Professionals who experienced organ donation as motivating were younger (odds ratio, 0.41; 95% CI, 0.32-0.53; p < 0.001), more often potential organ donors (odds ratio, 1.92; 95% CI, 1.56-2.35; p < 0.001), less likely to describe inconsistency (odds ratio, 0.43; 95% CI, 0.23-0.8) or complexity (odds ratio, 0.55; 95% CI, 0.45-0.67) of their feelings versus their professional activity, less likely to report that organ donation was not a priority in their ICU (odds ratio, 0.68; 95% CI, 0.55-0.84), and more likely to have participated in meetings of transplant coordinators with relatives (odds ratio, 1.71; 95% CI, 1.37-2.14; p < 0.001). Professionals who felt organ donation was stressful were older (odds ratio, 1.84; 95% CI, 1.34-2.54; p < 0.001), less often physicians (odds ratio, 0.58; 95% CI, 0.44-0.77; p < 0.001), more likely to describe shift from curative care to organ donation as emotionally complex (odds ratio, 1.83; 95% CI, 1.52-2.21; p < 0.001), care of relatives of brain-dead patients as complex (odds ratio, 1.59; 95% CI, 1.32-1.93; p < 0.001), and inconsistency and complexity of personal feelings about organ donation versus professional activity (odds ratio, 3.25; 95% CI, 1.92-5.53; p < 0.001), and more likely to have little experience with caring for potential organ donors (odds ratio, 1.49; 95% CI, 1.09-2.04). Significant differences exist among ICU clinician's perceptions of organ donation. Whether these differences affect family experience and consent rates deserves investigation.

Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation.

PubMed

Fang, Margaret C; Chang, Yuchiao; Hylek, Elaine M; Rosand, Jonathan; Greenberg, Steven M; Go, Alan S; Singer, Daniel E

2004-11-16

The risk for atrial fibrillation-associated stroke increases at low anticoagulation intensities. However, higher intensities increase hemorrhage risk. Optimal use of warfarin for atrial fibrillation requires precise information on the risk for intracranial hemorrhage as a function of patient age and anticoagulation intensity. To examine the relationship of age, anticoagulation intensity, and risk for intracranial hemorrhage. Case-control study. Academic medical center. 170 case-patients who developed intracranial hemorrhage during warfarin therapy and 1020 matched controls who did not; both case-patients and controls were taking warfarin for atrial fibrillation. The authors performed multivariable conditional logistic regression to determine the odds of intracranial hemorrhage with regard to age and international normalized ratio (INR), controlling for comorbid conditions and aspirin use. Case-patients were older than controls (median age, 78 years vs. 75 years; P < 0.001) and had higher median INRs (2.7 vs. 2.3; P < 0.001). The risk for intracranial hemorrhage increased at 85 years of age or older (adjusted odds ratio, 2.5 [95% CI, 1.3 to 4.7]; referent age, 70 to 74 years) and at an INR range of 3.5 to 3.9 (adjusted odds ratio, 4.6 [CI, 2.3 to 9.4]; referent INR, 2.0 to 3.0). The risk for intracranial hemorrhage at INRs less than 2.0 did not differ statistically from the risk at INRs of 2.0 to 3.0 (adjusted odds ratio, 1.3 [CI, 0.8 to 2.2]). Although duration of anticoagulation has been associated with hemorrhage in other studies, the current study could not control for this potential confounder. The risk for intracranial hemorrhage increases at age 85 years. International normalized ratios less than 2.0 were not associated with lower risk for intracranial hemorrhage compared with INRs between 2.0 and 3.0. Therefore, anticoagulation management should focus on maintaining INRs in the 2.0 to 3.0 range, even in elderly patients with atrial fibrillation, rather than targeting INRs less than 2.0. Similarly, INRs of 3.5 or greater should be avoided.

Commentary: Air-conditioning as a risk for increased use of healthservices

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

Mendell, Mark J.

2004-06-01

In this issue of the journal, Preziosi et al. [2004] report the first study to assess differences in the utilization of health care related to the presence of air-conditioning in office workplaces. Although the study was simple and cross-sectional, the data variables from questionnaires, and the findings subject to a variety of questions, the findings are striking enough to deserve clarification. The study used a large random national sample of French women assembled for another purpose (to study antioxidant nutrients and prevention of cancer and cardiovascular disease). Participants reported health services and health events in monthly questionnaires over 1 year,more » and in one questionnaire in the middle of that period also reported whether air-conditioning was in use at their workplace. Fifteen percent of participants reported air-conditioning at work. Analyses adjusting for age and smoking status of participants found increases in most outcomes assessed: use of specific kinds of physicians, sickness absence, and hospital stays. While the increases in odds ratios (OR) and 95% confidence intervals (CI) were statistically significant for only otorhinolaryngology [OR (95% CI) = 2.33 (1.35-4.04)] and sickness absence [1.70 (1.13-2.58)], other increases were notable--dermatology [1.6 (0.98-2.65)]; hospital stay [1.51 (0.92-2.45)], and pneumonology [2.10 (0.65-6.82)]. The least elevated outcomes were for general practice medicine [0.99 (0.65-1.48)] and global medical visits [1.18 (0.67-2.07)]. [Preziosi et al., 2004 ,(Table 2)] Odds ratios for relatively common health outcomes often lie farther from the null than the risk ratios most useful for quantifying the increase in risk. Risk ratios, or prevalence ratios (PRs, the equivalent measure of effect for cross-sectional data), have seldom been used because of the convenience and availability of logistic regression models that estimate odds ratios. With baseline prevalences ranging up to 85.7% in the data from Preziosi et al. [2004], PRs allow a more appropriate estimate of the increase in each outcome associated with the risk factor of air-conditioning. The increase in prevalence was roughly estimated as [100* (crude PR * adjusted OR/crude OR)-100] %. Based on the data in Table 2 of Preziosi et al. [ 2004], estimates for the increased prevalence associated with air-conditioned offices include increases of 120% in otorhinolaryngology visits, and 40% in sickness absence. If these associated increases represented valid causal relationships, it would indicate enormous costs for employers and for society associated with air-conditioning systems, from increased health care and for reduced workplace productivity from sickness absence, in addition to a large burden of disease on workers.« less

Prevalence and Clinical Correlates of Sarcopenia in Community-Dwelling Older People: Application of the EWGSOP Definition and Diagnostic Algorithm

PubMed Central

2014-01-01

Background. Muscle impairment is a common condition in older people and a powerful risk factor for disability and mortality. The aim of this study was to apply the European Working Group on Sarcopenia in Older People criteria to estimate the prevalence and investigate the clinical correlates of sarcopenia, in a sample of Italian community-dwelling older people. Methods. Cross-sectional analysis of 730 participants (74% aged 65 years and older) enrolled in the InCHIANTI study. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People criteria using bioimpedance analysis for muscle mass assessment. Logistic regression analysis was used to identify the factors independently associated with sarcopenia. Results. Sarcopenia defined by the European Working Group on Sarcopenia in Older People criteria increased steeply with age (p < .001), with 31.6% of women and 17.4% of men aged 80 years or older being affected by this condition. Higher education (odds ratio: 0.85; 95% CI: 0.74–0.98), lower insulin-like growth factor I (lowest vs highest tertile, odds ratio: 3.89; 95% CI: 1.03–14.1), and low bioavailable testosterone (odds ratio: 2.67; 95% CI: 1.31–5.44) were independently associated with the likelihood of being sarcopenic. Nutritional intake, physical activity, and level of comorbidity were not associated with sarcopenia. Conclusions. Sarcopenia identified by the European Working Group on Sarcopenia in Older People criteria is a relatively common condition in Italian octogenarians, and its prevalence increases with aging. Correlates of sarcopenia identified in this study might suggest new approaches for prevention and treatment of sarcopenia. PMID:24085400

Participation and retention of youth with perinatal HIV infection in mental health research studies: the IMPAACT P1055 psychiatric comorbidity study.

PubMed

Williams, Paige L; Chernoff, Miriam; Angelidou, Konstantia; Brouwers, Pim; Kacanek, Deborah; Deygoo, Nagamah S; Nachman, Sharon; Gadow, Kenneth D

2013-07-01

Obtaining accurate estimates of mental health problems among youth perinatally infected with HIV (PHIV) helps clinicians develop targeted interventions but requires enrollment and retention of representative youth into research studies. The study design for IMPAACT P1055, a US-based, multisite prospective study of psychiatric symptoms among PHIV youth and uninfected controls aged 6 to 17 years old, is described. Participants were compared with nonparticipants by demographic characteristics and reasons were summarized for study refusal. Adjusted logistic regression models were used to evaluate the association of psychiatric symptoms and other factors with loss to follow-up (LTFU). Among 2281 youth screened between 2005 and 2006 at 29 IMPAACT research sites, 580 (25%) refused to participate, primarily because of time constraints. Among 1162 eligible youth approached, 582 (50%) enrolled (323 PHIV and 259 Control), with higher participation rates for Hispanic youth. Retention at 2 years was significantly higher for PHIV than Controls (84% vs 77%, P = 0.03). In logistic regression models adjusting for sociodemographic characteristics and HIV status, youth with any self-assessed psychiatric condition had higher odds of LTFU compared with those with no disorder (adjusted odds ratio = 1.56, 95% confidence interval: 1.00 to 2.43). Among PHIV youth, those with any psychiatric condition had 3-fold higher odds of LTFU (adjusted odds ratio = 3.11, 95% confidence interval: 1.61 to 6.01). Enrollment and retention of PHIV youth into mental health research studies is challenging for those with psychiatric conditions and may lead to underestimated risks for mental health problems. Creative approaches for engaging HIV-infected youth and their families are required for ensuring representative study populations.

Peritonitis in Rwanda: Epidemiology and risk factors for morbidity and mortality.

PubMed

Ndayizeye, Leonard; Ngarambe, Christian; Smart, Blair; Riviello, Robert; Majyambere, Jean Paul; Rickard, Jennifer

2016-12-01

Few studies discuss causes and outcomes of peritonitis in low-income settings. This study describes epidemiology of patients with peritonitis at a Rwandan referral hospital. Identification of risk factors associated with mortality and unplanned reoperation could improve management of peritonitis. Data were collected on demographics, clinical presentation, operative findings, and outcomes for all patients with peritonitis. Multivariate regression analysis identified factors associated with in-hospital mortality and unplanned reoperation. A total of 280 patients presented with peritonitis over a 6-month period. Causes of peritonitis were complications of intestinal obstruction (39%) and appendicitis (17%). Thirty-six (13%) patients required unplanned reoperation, and in-hospital mortality was 17%. Factors associated with increased odds of in-hospital mortality were unplanned reoperation (adjusted odds ratio 34.12), vasopressor use (adjusted odds ratio 24.91), abnormal white blood cell count (adjusted odds ratio 12.6), intensive care unit admission (adjusted odds ratio 9.06), and American Society of Anesthesiologist score ≥3 (adjusted odds ratio 7.80). Factors associated with increased odds of unplanned reoperation included typhoid perforation (adjusted odds ratio 5.92) and hypoxia on admission (adjusted odds ratio 3.82). Peritonitis in Rwanda presents with high morbidity and mortality. Minimizing delays in care is important, as many patients with intestinal obstruction present with features of peritonitis. A better understanding of patient care and management prior to arrival at the referral hospital is needed to identify areas for improvement at the health center and district hospital. Copyright © 2016 Elsevier Inc. All rights reserved.

Impact of previous vascular burden on in-hospital and long-term mortality in patients with ST-segment elevation myocardial infarction.

PubMed

Consuegra-Sánchez, Luciano; Melgarejo-Moreno, Antonio; Galcerá-Tomás, José; Alonso-Fernández, Nuria; Díaz-Pastor, Angela; Escudero-García, Germán; Jaulent-Huertas, Leticia; Vicente-Gilabert, Marta

2014-06-01

Patients with a current acute coronary syndrome and previous ischemic heart disease, peripheral arterial disease, and/or cerebrovascular disease are reported to have a poorer outcome than those without these previous conditions. It is uncertain whether this association with outcome is observed at long-term follow-up. Prospective observational study, including 4247 patients with ST-segment elevation myocardial infarction. Detailed clinical data and information on previous ischemic heart disease, peripheral arterial disease, and cerebrovascular disease ("vascular burden") were recorded. Multivariate models were performed for in-hospital and long-term (median, 7.2 years) all-cause mortality. One vascular territory was affected in 1131 (26.6%) patients and ≥ 2 territories in 221 (5.2%). The total in-hospital mortality rate was 12.3% and the long-term incidence density was 3.5 deaths per 100 patient-years. A background of previous ischemic heart disease (odds ratio = 0.83; P = .35), peripheral arterial disease (odds ratio = 1.30; P = .34), or cerebrovascular disease (stroke) (odds ratio = 1.15; P = .59) was not independently predictive of in-hospital death. In an adjusted model, previous cerebrovascular disease and previous peripheral arterial disease were both predictors of mortality at long-term follow-up (hazard ratio = 1.57; P < .001; and hazard ratio = 1.34; P = .001; respectively). Patients with ≥ 2 diseased vascular territories showed higher long-term mortality (hazard ratio = 2.35; P < .001), but not higher in-hospital mortality (odds ratio = 1.07; P = .844). In patients with a diagnosis of ST-segment elevation acute myocardial infarction, the previous vascular burden determines greater long-term mortality. Considered individually, previous cerebrovascular disease and peripheral arterial disease were predictors of mortality at long-term after hospital discharge. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

Population levels of wellbeing and the association with social capital.

PubMed

Taylor, A W; Kelly, G; Dal Grande, E; Kelly, D; Marin, T; Hey, N; Burke, K J; Licinio, J

2017-07-03

This research investigates wellbeing at the population level across demographic, social and health indicators and assesses the association between wellbeing and social capital. Data from a South Australian monthly chronic disease/risk factor surveillance system of randomly selected adults (mean age 48.7 years; range 16-99) from 2014/5 (n = 5551) were used. Univariable analyses compared wellbeing/social capital indicators, socio-demographic, risk factors and chronic conditions. Multi-nominal logistic regression modelling, adjusting for multiple covariates was used to simultaneously estimate odds ratios for good wellbeing (reference category) versus neither good nor poor, and good wellbeing versus poor wellbeing. 48.6% were male, mean age 48.7 (sd 18.3), 54.3% scored well on all four of the wellbeing indicators, and positive social capital indicators ranged from 93.1% for safety to 50.8% for control over decisions. The higher level of social capital corresponded with the good wellbeing category. Modeling showed higher odds ratios for all social capital variables for the lowest level of wellbeing. These higher odds ratios remained after adjusting for confounders. The relationship between wellbeing, resilience and social capital highlights areas for increased policy focus.

Increased incidence of peptic ulcer disease in central serous chorioretinopathy patients: a population-based retrospective cohort study.

PubMed

Chen, San-Ni; Lian, Iebin; Chen, Yi-Chiao; Ho, Jau-Der

2015-02-01

To investigate peptic ulcer disease and other possible risk factors in patients with central serous chorioretinopathy (CSR) using a population-based database. In this population-based retrospective cohort study, longitudinal data from the Taiwan National Health Insurance Research Database were analyzed. The study cohort comprised 835 patients with CSR and the control cohort comprised 4175 patients without CSR from January 2000 to December 2009. Conditional logistic regression was applied to examine the association of peptic ulcer disease and other possible risk factors for CSR, and stratified Cox regression models were applied to examine whether patients with CSR have an increased chance of peptic ulcer disease and hypertension development. The identifiable risk factors for CSR included peptic ulcer disease (adjusted odd ratio: 1.39, P = 0.001) and higher monthly income (adjusted odd ratio: 1.30, P = 0.006). Patients with CSR also had a significantly higher chance of developing peptic ulcer disease after the diagnosis of CSR (adjusted odd ratio: 1.43, P = 0.009). Peptic ulcer disease and higher monthly income are independent risk factors for CSR. Whereas, patients with CSR also had increased risk for peptic ulcer development.

Adverse events associated with meropenem versus imipenem/cilastatin therapy in a large retrospective cohort of hospitalized infants.

PubMed

Hornik, Christoph P; Herring, Amy H; Benjamin, Daniel K; Capparelli, Edmund V; Kearns, Gregory L; van den Anker, John; Cohen-Wolkowiez, Michael; Clark, Reese H; Smith, P Brian

2013-07-01

Carbapenems are commonly used in hospitalized infants despite a lack of complete safety data and associations with seizures in older children. We compared the incidence of adverse events in hospitalized infants receiving meropenem versus imipenem/cilastatin. We conducted a retrospective cohort study of 5566 infants treated with meropenem or imipenem/cilastatin in neonatal intensive care units managed by the Pediatrix Medical Group between 1997 and 2010. Multivariable conditional logistic regression was performed to evaluate the association between carbapenem therapy and adverse events, controlling for infant factors and severity of illness. Adverse events were more common with use of meropenem compared with imipenem/cilastatin (62.8/1000 infant days versus 40.7/1000 infant days, P < 0.001). There was no difference in seizures with meropenem versus imipenem/cilastatin (adjusted odds ratio 0.96; 95% confidence interval: 0.68, 1.32). The incidence of death, as well as the combined outcome of death or seizure, was lower with meropenem use-odds ratio 0.68 (0.50, 0.88) and odds ratio 0.77 (0.62, 0.95), respectively. In this cohort of infants, meropenem was associated with more frequent but less severe adverse events when compared with imipenem/cilastatin.

Physical Activity and Incident Depression: A Meta-Analysis of Prospective Cohort Studies.

PubMed

Schuch, Felipe B; Vancampfort, Davy; Firth, Joseph; Rosenbaum, Simon; Ward, Philip B; Silva, Edson S; Hallgren, Mats; Ponce De Leon, Antonio; Dunn, Andrea L; Deslandes, Andrea C; Fleck, Marcelo P; Carvalho, Andre F; Stubbs, Brendon

2018-04-25

The authors examined the prospective relationship between physical activity and incident depression and explored potential moderators. Prospective cohort studies evaluating incident depression were searched from database inception through Oct. 18, 2017, on PubMed, PsycINFO, Embase, and SPORTDiscus. Demographic and clinical data, data on physical activity and depression assessments, and odds ratios, relative risks, and hazard ratios with 95% confidence intervals were extracted. Random-effects meta-analyses were conducted, and the potential sources of heterogeneity were explored. Methodological quality was assessed using the Newcastle-Ottawa Scale. A total of 49 unique prospective studies (N=266,939; median proportion of males across studies, 47%) were followed up for 1,837,794 person-years. Compared with people with low levels of physical activity, those with high levels had lower odds of developing depression (adjusted odds ratio=0.83, 95% CI=0.79, 0.88; I 2 =0.00). Furthermore, physical activity had a protective effect against the emergence of depression in youths (adjusted odds ratio=0.90, 95% CI=0.83, 0.98), in adults (adjusted odds ratio=0.78, 95% CI=0.70, 0.87), and in elderly persons (adjusted odds ratio=0.79, 95% CI=0.72, 0.86). Protective effects against depression were found across geographical regions, with adjusted odds ratios ranging from 0.65 to 0.84 in Asia, Europe, North America, and Oceania, and against increased incidence of positive screen for depressive symptoms (adjusted odds ratio=0.84, 95% CI=0.79, 0.89) or major depression diagnosis (adjusted odds ratio=0.86, 95% CI=0.75, 0.98). No moderators were identified. Results were consistent for unadjusted odds ratios and for adjusted and unadjusted relative risks/hazard ratios. Overall study quality was moderate to high (Newcastle-Ottawa Scale score, 6.3). Although significant publication bias was found, adjusting for this did not change the magnitude of the associations. Available evidence supports the notion that physical activity can confer protection against the emergence of depression regardless of age and geographical region.

Factors associated with undiagnosed obstructive sleep apnoea among hypertensive patients: A multisite cross-sectional survey study in Taiwan.

PubMed

Hsu, Hsiu-Chin; Chen, Ning-Hung; Ho, Wan Jing; Lin, Mei-Hsiang

2018-05-01

To investigate the distribution and risk factors associated with undiagnosed obstructive sleep apnoea among hypertensive patients. Obstructive sleep Apnoea has been deemed a cardinal risk factor affecting cardiovascular event, and the condition is still frequently overlooked clinically. The lack of advanced diagnosis often causes hypertensive patients with obstructive sleep apnoea to miss opportunities for preventing chronic diseases. A cross-sectional design. A total of 215 hypertensive participants were recruited from the cardiovascular outpatients of medical centre in northern and middle Taiwan. The Chinese version of Pittsburgh Sleep Quality Index, the Chinese version of the Epworth Sleep Scale and a portable sleep monitoring device were used for data collection. Logistic regression analysis was conducted to identify the factors affecting hypertensive patients with obstructive sleep apnoea, and a multinomial logistic regression analysis was used to examine the major influence factors for each obstructive sleep apnoea severity level. 81.9% of the hypertensive participants were found having obstructive sleep apnoea. Concerning to the obstructive sleep apnoea severity, 50.0% of participants had mild obstructive sleep apnoea. After controlling the confounding variables, the supine position (odds ratio, 1.04; 95% CI, 1.01-1.07), SO 2 (odds ratio, 0.58; 95% CI, 0.38-0.89) and oxygen desaturation index (odds ratio, 2.70; 95% CI, 1.18-6.18) were significantly associated with obstructive sleep apnoea. Furthermore, severe obstructive sleep apnoea was significantly correlated with gender (odds ratio, 0.04; 95% CI, 0.00-0.66), excessive daytime sleepiness (odds ratio, 20.27; 95% CI, 1.58-26.97) and oxygen desaturation index (odds ratio, 4.05; 95% CI, 1.86-8.81). Nearly 82% of the hypertensive participants were found having undiagnosed obstructive sleep apnoea, and 80% of them were mild or moderate severity. Oxygen desaturation index, SO 2 and the supine position were found to be major predictors for obstructive sleep apnoea. Remarkably, oxygen desaturation index was the most significant predictor for mild, moderate and severe obstructive sleep apnoea. Healthcare providers should enhance their sensitivities to hypertensive patients at a high risk for obstructive sleep apnoea by actively assessing common obstructive sleep apnoea symptoms and providing strategies to alleviate obstructive sleep apnoea symptoms. © 2018 John Wiley & Sons Ltd.

Spatiotemporal Analysis of Cryptosporidium Species/Genotypes and Relationships with Other Zoonotic Pathogens in Surface Water from Mixed-Use Watersheds

PubMed Central

Wilkes, Graham; Ruecker, Norma J.; Neumann, Norman F.; Gannon, Victor P. J.; Jokinen, Cassandra; Sunohara, Mark; Topp, Edward; Pintar, Katarina D. M.; Edge, Thomas A.

2013-01-01

Nearly 690 raw surface water samples were collected during a 6-year period from multiple watersheds in the South Nation River basin, Ontario, Canada. Cryptosporidium oocysts in water samples were enumerated, sequenced, and genotyped by detailed phylogenetic analysis. The resulting species and genotypes were assigned to broad, known host and human infection risk classes. Wildlife/unknown, livestock, avian, and human host classes occurred in 21, 13, 3, and <1% of sampled surface waters, respectively. Cryptosporidium andersoni was the most commonly detected livestock species, while muskrat I and II genotypes were the most dominant wildlife genotypes. The presence of Giardia spp., Salmonella spp., Campylobacter spp., and Escherichia coli O157:H7 was evaluated in all water samples. The greatest significant odds ratios (odds of pathogen presence when host class is present/odds of pathogen presence when host class is absent) for Giardia spp., Campylobacter spp., and Salmonella spp. in water were associated, respectively, with livestock (odds ratio of 3.1), avian (4.3), and livestock (9.3) host classes. Classification and regression tree analyses (CART) were used to group generalized host and human infection risk classes on the basis of a broad range of environmental and land use variables while tracking cooccurrence of zoonotic pathogens in these groupings. The occurrence of livestock-associated Cryptosporidium was most strongly related to agricultural water pollution in the fall (conditions also associated with elevated odds ratios of other zoonotic pathogens occurring in water in relation to all sampling conditions), whereas wildlife/unknown sources of Cryptosporidium were geospatially associated with smaller watercourses where urban/rural development was relatively lower. Conditions that support wildlife may not necessarily increase overall human infection risks associated with Cryptosporidium since most Cryptosporidium genotypes classed as wildlife in this study (e.g., muskrat I and II genotype) do not pose significant infection risks to humans. Consequently, from a human health perspective, land use practices in agricultural watersheds that create opportunities for wildlife to flourish should not be rejected solely on the basis of their potential to increase relative proportions of wildlife fecal contamination in surface water. The present study suggests that mitigating livestock fecal pollution in surface water in this region would likely reduce human infection risks associated with Cryptosporidium and other zoonotic pathogens. PMID:23124241

Return to Function, Complication, and Reoperation Rates Following Primary Pectoralis Major Tendon Repair in Military Service Members.

PubMed

Nute, Drew W; Kusnezov, Nicholas; Dunn, John C; Waterman, Brian R

2017-01-04

Pectoralis major tendon ruptures have become increasingly common injuries among young, active individuals over the past 30 years; however, there is presently a paucity of reported outcome data. We investigated the ability to return to full preoperative level of function, complications, reoperation rates, and risk factors for failure following surgical repair of the pectoralis major tendon in a cohort of young, highly active individuals. All U.S. active-duty military patients undergoing pectoralis major tendon repair between 2008 and 2013 were identified from the Military Health System using the Management Analysis and Reporting Tool (M2). Demographic characteristics, injury characteristics, and trends in preoperative and postoperative self-reported pain scale (0 to 10) and strength were extracted. The ability to return to the full preoperative level of function and rates of rerupture and reoperation were the primary outcome measures. Univariate analysis followed by multivariate analysis identified significant variables. A total of 257 patients with pectoralis major tendon repair were identified with a mean follow-up (and standard deviation) of 47.8 ± 17 months (range, 24 to 90 months). At the time of the latest follow-up, 242 patients (94%) were able to return to the full preoperative level of military function. Fifteen patients (5.8%) were unable to return to duty because of persistent upper-extremity disability. A total of 15 reruptures occurred in 14 patients (5.4%). Increasing body mass index and active psychiatric conditions were significant predictors of inability to return to function (odds ratio, 1.56 [p = 0.0001] for increasing body mass index; and odds ratio, 6.59 [p = 0.00165] for active psychiatric conditions) and total failure (odds ratio, 1.26 [p = 0.0012] for increasing body mass index; and odds ratio, 2.73 [p = 0.0486] for active psychiatric conditions). We demonstrate that 94% of patients were able to return to the full preoperative level of function within active military duty following surgical repair of pectoralis major tendon rupture and 5.4% of patients experienced rerupture after primary repair. Increasing body mass index and active psychiatric diagnoses are significant risk factors for an inability to return to function and postoperative failures. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Impact of Undetected Comorbidity on Treatment and Outcomes of Breast Cancer

PubMed Central

Griffiths, Robert I.; Gleeson, Michelle L.; Valderas, José M.; Danese, Mark D.

2014-01-01

Preexisting comorbidity adversely impacts breast cancer treatment and outcomes. We examined the incremental impact of comorbidity undetected until cancer. We followed breast cancer patients in SEER-Medicare from 12 months before to 84 months after diagnosis. Two comorbidity indices were constructed: the National Cancer Institute index, using 12 months of claims before cancer, and a second index for previously undetected conditions, using three months after cancer. Conditions present in the first were excluded from the second. Overall, 6,184 (10.1%) had ≥1 undetected comorbidity. Chronic obstructive pulmonary disease (38%) was the most common undetected condition. In multivariable analyses that adjusted for comorbidity detected before cancer, older age, later stage, higher grade, and poor performance status all were associated with higher odds of ≥1 undetected comorbidity. In stage I–III cancer, undetected comorbidity was associated with lower adjusted odds of receiving adjuvant chemotherapy (Odds Ratio (OR) = 0.81, 95% Confidence Interval (CI) 0.73–0.90, P < 0.0001; OR = 0.38, 95% CI 0.30–0.49, P < 0.0001; index score 1 or ≥2, respectively), and with increased mortality (Hazard Ratio (HR) = 1.45, 95% CI 1.38–1.53, P < 0.0001; HR = 2.38, 95% CI 2.18–2.60, P < 0.0001; index score 1 or ≥2). Undetected comorbidity is associated with less aggressive treatment and higher mortality in breast cancer. PMID:24688795

Association of Preoperative Urinary Uromodulin with AKI after Cardiac Surgery.

PubMed

Garimella, Pranav S; Jaber, Bertrand L; Tighiouart, Hocine; Liangos, Orfeas; Bennett, Michael R; Devarajan, Prasad; El-Achkar, Tarek M; Sarnak, Mark J

2017-01-06

AKI is a serious complication after cardiac surgery. Although high urinary concentrations of the tubular protein uromodulin, a marker of tubular health, are associated with less AKI in animal models, its relationship in humans is unknown. A post hoc analysis of a prospective cohort study of 218 adults undergoing on-pump cardiac surgery between 2004 and 2011 was conducted. Multivariable logistic and linear regression analyses were used to evaluate the associations of preoperative urinary uromodulin-to-creatinine ratio with postoperative AKI (defined as a rise in serum creatinine of >0.3 mg/dl or >1.5 times baseline); severe AKI (doubling of creatinine or need for dialysis) and peak postoperative serum creatinine over the first 72 hours. Mean age was 68 years, 27% were women, 95% were white, and the median uromodulin-to-creatinine ratio was 10.0 μg/g. AKI developed in 64 (29%) patients. Lower urinary uromodulin-to-creatinine ratio was associated with higher odds for AKI (odds ratio, 1.49 per 1-SD lower uromodulin; 95% confidence interval, 1.04 to 2.13), which was marginally attenuated after multivariable adjustment (odds ratio, 1.43; 95% confidence interval, 0.99 to 2.07). The lowest uromodulin-to-creatinine ratio quartile was also associated with higher odds for AKI relative to the highest quartile (odds ratio, 2.94; 95% confidence interval, 1.19 to 7.26), which was slightly attenuated after multivariable adjustment (odds ratio, 2.43; 95% confidence interval, 0.91 to 6.48). A uromodulin-to-creatinine ratio below the median was associated with higher adjusted odds for severe AKI, although this did not reach statistical significance (odds ratio, 4.03; 95% confidence interval, 0.87 to 18.70). Each 1-SD lower uromodulin-to-creatinine ratio was associated with a higher adjusted mean peak serum creatinine (0.07 mg/dl per SD; 95% confidence interval, 0.02 to 0.13). Lower uromodulin-to-creatinine ratio is associated with higher odds of AKI and higher peak serum creatinine after cardiac surgery. Additional studies are needed to confirm these preliminary results. Copyright © 2016 by the American Society of Nephrology.

Association of Preoperative Urinary Uromodulin with AKI after Cardiac Surgery

PubMed Central

Garimella, Pranav S.; Jaber, Bertrand L.; Tighiouart, Hocine; Liangos, Orfeas; Bennett, Michael R.; Devarajan, Prasad; El-Achkar, Tarek M.

2017-01-01

Background and objectives AKI is a serious complication after cardiac surgery. Although high urinary concentrations of the tubular protein uromodulin, a marker of tubular health, are associated with less AKI in animal models, its relationship in humans is unknown. Design, setting, participants, & measurements A post hoc analysis of a prospective cohort study of 218 adults undergoing on–pump cardiac surgery between 2004 and 2011 was conducted. Multivariable logistic and linear regression analyses were used to evaluate the associations of preoperative urinary uromodulin-to-creatinine ratio with postoperative AKI (defined as a rise in serum creatinine of >0.3 mg/dl or >1.5 times baseline); severe AKI (doubling of creatinine or need for dialysis) and peak postoperative serum creatinine over the first 72 hours. Results Mean age was 68 years, 27% were women, 95% were white, and the median uromodulin-to-creatinine ratio was 10.0 μg/g. AKI developed in 64 (29%) patients. Lower urinary uromodulin-to-creatinine ratio was associated with higher odds for AKI (odds ratio, 1.49 per 1-SD lower uromodulin; 95% confidence interval, 1.04 to 2.13), which was marginally attenuated after multivariable adjustment (odds ratio, 1.43; 95% confidence interval, 0.99 to 2.07). The lowest uromodulin-to-creatinine ratio quartile was also associated with higher odds for AKI relative to the highest quartile (odds ratio, 2.94; 95% confidence interval, 1.19 to 7.26), which was slightly attenuated after multivariable adjustment (odds ratio, 2.43; 95% confidence interval, 0.91 to 6.48). A uromodulin-to-creatinine ratio below the median was associated with higher adjusted odds for severe AKI, although this did not reach statistical significance (odds ratio, 4.03; 95% confidence interval, 0.87 to 18.70). Each 1-SD lower uromodulin-to-creatinine ratio was associated with a higher adjusted mean peak serum creatinine (0.07 mg/dl per SD; 95% confidence interval, 0.02 to 0.13). Conclusions Lower uromodulin-to-creatinine ratio is associated with higher odds of AKI and higher peak serum creatinine after cardiac surgery. Additional studies are needed to confirm these preliminary results. PMID:27797887

Race, Ethnicity, Language, Social Class, and Health Communication Inequalities: A Nationally-Representative Cross-Sectional Study

PubMed Central

Viswanath, Kasisomayajula; Ackerson, Leland K.

2011-01-01

Background While mass media communications can be an important source of health information, there are substantial social disparities in health knowledge that may be related to media use. The purpose of this study is to investigate how the use of cancer-related health communications is patterned by race, ethnicity, language, and social class. Methodology/Principal Findings In a nationally-representative cross-sectional telephone survey, 5,187 U.S. adults provided information about demographic characteristics, cancer information seeking, and attention to and trust in health information from television, radio, newspaper, magazines, and the Internet. Cancer information seeking was lowest among Spanish-speaking Hispanics (odds ratio: 0.42; 95% confidence interval: 0.28–0.63) compared to non-Hispanic whites. Spanish-speaking Hispanics were more likely than non-Hispanic whites to pay attention to (odds ratio: 3.10; 95% confidence interval: 2.07–4.66) and trust (odds ratio: 2.61; 95% confidence interval: 1.53–4.47) health messages from the radio. Non-Hispanic blacks were more likely than non-Hispanic whites to pay attention to (odds ratio: 2.39; 95% confidence interval: 1.88–3.04) and trust (odds ratio: 2.16; 95% confidence interval: 1.61–2.90) health messages on television. Those who were college graduates tended to pay more attention to health information from newspapers (odds ratio: 1.98; 95% confidence interval: 1.42–2.75), magazines (odds ratio: 1.86; 95% confidence interval: 1.32–2.60), and the Internet (odds ratio: 4.74; 95% confidence interval: 2.70–8.31) and had less trust in cancer-related health information from television (odds ratio: 0.44; 95% confidence interval: 0.32–0.62) and radio (odds ratio: 0.54; 95% confidence interval: 0.34–0.86) compared to those who were not high school graduates. Conclusions/Significance Health media use is patterned by race, ethnicity, language and social class. Providing greater access to and enhancing the quality of health media by taking into account factors associated with social determinants may contribute to addressing social disparities in health. PMID:21267450

Pregnancy outcome in joint hypermobility syndrome and Ehlers-Danlos syndrome.

PubMed

Sundelin, Heléne E K; Stephansson, Olof; Johansson, Kari; Ludvigsson, Jonas F

2017-01-01

An increased risk of preterm birth in women with joint hypermobility syndrome or Ehlers-Danlos syndrome is suspected. In this nationwide cohort study from 1997 through 2011, women with either joint hypermobility syndrome or Ehlers-Danlos syndrome or both disorders were identified through the Swedish Patient Register, and linked to the Medical Birth Register. Thereby, 314 singleton births to women with joint hypermobility syndrome/Ehlers-Danlos syndrome before delivery were identified. These births were compared with 1 247 864 singleton births to women without a diagnosis of joint hypermobility syndrome/Ehlers-Danlos syndrome. We used logistic regression, adjusted for maternal age, smoking, parity, and year of birth, to calculate adjusted odds ratios for adverse pregnancy outcomes. Maternal joint hypermobility syndrome/Ehlers-Danlos syndrome was not associated with any of our outcomes: preterm birth (adjusted odds ratio = 0.6, 95% confidence interval 0.3-1.2), preterm premature rupture of membranes (adjusted odds ratio = 0.8; 95% confidence interval 0.3-2.2), cesarean section (adjusted odds ratio = 0.9, 95% confidence interval 0.7-1.2), stillbirth (adjusted odds ratio = 1.1, 95% confidence interval 0.2-7.9), low Apgar score (adjusted odds ratio = 1.6, 95% confidence interval 0.7-3.6), small for gestational age (adjusted odds ratio = 0.9, 95% confidence interval 0.4-1.8) or large for gestational age (adjusted odds ratio = 1.2, 95% confidence interval 0.6-2.1). Examining only women with Ehlers-Danlos syndrome (n = 62), we found a higher risk of induction of labor (adjusted odds ratio = 2.6; 95% confidence interval 1.4-4.6) and amniotomy (adjusted odds ratio = 3.8; 95% confidence interval 2.0-7.1). No excess risks for adverse pregnancy outcome were seen in joint hypermobility syndrome. Women with joint hypermobility syndrome/Ehlers-Danlos syndrome do not seem to be at increased risk of adverse pregnancy outcome. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

Upper extremity deep venous thrombosis after port insertion: What are the risk factors?

PubMed

Tabatabaie, Omidreza; Kasumova, Gyulnara G; Kent, Tara S; Eskander, Mariam F; Fadayomi, Ayotunde B; Ng, Sing Chau; Critchlow, Jonathan F; Tawa, Nicholas E; Tseng, Jennifer F

2017-08-01

Totally implantable venous access devices (ports) are widely used, especially for cancer chemotherapy. Although their use has been associated with upper extremity deep venous thrombosis, the risk factors of upper extremity deep venous thrombosis in patients with a port are not studied adequately. The Healthcare Cost and Utilization Project's Florida State Ambulatory Surgery and Services Database was queried between 2007 and 2011 for patients who underwent outpatient port insertion, identified by Current Procedural Terminology code. Patients were followed in the State Ambulatory Surgery and Services Database, State Inpatient Database, and State Emergency Department Database for upper extremity deep venous thrombosis occurrence. The cohort was divided into a test cohort and a validation cohort based on the year of port placement. A multivariable logistic regression model was developed to identify risk factors for upper extremity deep venous thrombosis in patients with a port. The model then was tested on the validation cohort. Of the 51,049 patients in the derivation cohort, 926 (1.81%) developed an upper extremity deep venous thrombosis. On multivariate analysis, independently significant predictors of upper extremity deep venous thrombosis included age <65 years (odds ratio = 1.22), Elixhauser score of 1 to 2 compared with zero (odds ratio = 1.17), end-stage renal disease (versus no kidney disease; odds ratio = 2.63), history of any deep venous thrombosis (odds ratio = 1.77), all-cause 30-day revisit (odds ratio = 2.36), African American race (versus white; odds ratio = 1.86), and other nonwhite races (odds ratio = 1.35). Additionally, compared with genitourinary malignancies, patients with gastrointestinal (odds ratio = 1.55), metastatic (odds ratio = 1.76), and lung cancers (odds ratio = 1.68) had greater risks of developing an upper extremity deep venous thrombosis. This study identified major risk factors of upper extremity deep venous thrombosis. Further studies are needed to evaluate the appropriateness of thromboprophylaxis in patients at greater risk of upper extremity deep venous thrombosis. Copyright © 2017 Elsevier Inc. All rights reserved.

All part of the job? The contribution of the psychosocial and physical work environment to health inequalities in Europe and the European health divide.

PubMed

Toch, Marlen; Bambra, Clare; Lunau, Thorsten; van der Wel, Kjetil A; Witvliet, Margot I; Dragano, Nico; Eikemo, Terje A

2014-01-01

This study is the first to examine the contribution of both psychosocial and physical risk factors to occupational inequalities in self-assessed health in Europe. Data from 27 countries were obtained from the 2010 European Working Conditions Survey for men and women aged 16 to 60 (n = 21,803). Multilevel logistic regression analyses (random intercept) were applied, estimating odds ratios of reporting less than good health. Analyses indicate that physical working conditions account for a substantial proportion of occupational inequalities in health in both Central/Eastern and Western Europe. Physical, rather than psychosocial, working conditions seem to have the largest effect on self-assessed health in manual classes. For example, controlling for physical working conditions reduced the inequalities in the prevalence of"less than good health" between the lowest (semi- and unskilled manual workers) and highest (higher controllers) occupational groups in Europe by almost 50 percent (Odds Ratio 1.87, 95% Confidence Interval 1.62-2.16 to 1.42, 1.23-1.65). Physical working conditions contribute substantially to health inequalities across "post-industrial" Europe, with women in manual occupations being particularly vulnerable, especially those living in Central/Eastern Europe. An increased political and academic focus on physical working conditions is needed to explain and potentially reduce occupational inequalities in health.

The Impact of Weather on Mobility and Participation in Older US Adults

PubMed Central

Yan, Ting; Keusch, Florian; Gallagher, Nancy Ambrose

2015-01-01

Objectives. We examined the impact of weather on the daily lives of US adults to understand which populations are most vulnerable to various weather conditions. Methods. Data came from a 2013 supplement to the University of Michigan–Thomson Reuters Surveys of Consumers, a nationally representative telephone survey of 502 adults in the contiguous United States. We used logistic regressions to assess the odds of mobility difficulty and participation restriction during different weather conditions, as well as age group differences. Results. Ice was most likely to change the way respondents got around (reported by 47%). In icy conditions, participants had difficulty leaving home (40%) and driving (35%). Facing ice, older adults (≥ 65 years) had twice the odds of having great difficulty leaving home (odds ratio [OR] = 2.22; 95% confidence interval [CI] = 1.12, 4.42) and curtailing work or volunteer activities (OR = 2.01; 95% CI = 1.01, 4.06), and 3 times the odds of difficulty driving (OR = 3.33; 95% CI = 1.62, 6.86) as younger respondents. We also found significant differences in mobility and participation by gender and region of residence. Conclusions. Weather can affect social isolation, health, well-being, and mortality among older US adults. PMID:25973825

Relationship Between Chronic Conditions and Disability in African American Men and Women

PubMed Central

Thorpe, Roland J.; Wynn, Anastasia J.; Walker, Janiece L.; Smolen, Jenny R.; Cary, Michael P.; Szanton, Sarah L.; Whitfield, Keith E.

2018-01-01

Background Race differences in chronic conditions and disability are well established; however, little is known about the association between specific chronic conditions and disability in African Americans. This is important because African Americans have higher rates and earlier onset of both chronic conditions and disability than white Americans. Methods We examined the relationship between chronic conditions and disability in 602 African Americans aged 50 years and older in the Baltimore Study of Black Aging. Disability was measured using self-report of difficulty in activities of daily living (ADL). Medical conditions included diagnosed self-reports of asthma, depressive symptoms, arthritis, cancer, diabetes, cardiovascular disease (CVD), stroke, and hypertension. Results After adjusting for age, high school graduation, income, and marital status, African Americans who reported arthritis (women: odds ratio (OR)=4.87; 95% confidence interval(CI): 2.92–8.12; men: OR=2.93; 95% CI: 1.36–6.30) had higher odds of disability compared to those who did not report having arthritis. Women who reported major depressive symptoms (OR=2.59; 95% CI: 1.43–4.69) or diabetes (OR=1.83; 95% CI: 1.14–2.95) had higher odds of disability than women who did not report having these conditions. Men who reported having CVD (OR=2.77; 95% CI: 1.03–7.41) had higher odds of disability than men who did not report having CVD. Conclusions These findings demonstrate the importance of chronic conditions in understanding disability in African Americans and how it varies by gender. Also, these findings underscore the importance of developing health promoting strategies focused on chronic disease prevention and management to delay or postpone disability in African Americans. Publication Indices Pubmed, Pubmed Central, Web of Science database PMID:26928493

Depressive symptoms in nonresident african american fathers and involvement with their sons.

PubMed

Davis, R Neal; Caldwell, Cleopatra Howard; Clark, Sarah J; Davis, Matthew M

2009-12-01

Our objective was to determine whether paternal depressive symptoms were associated with less father involvement among African American fathers not living with their children (ie, nonresident fathers). We analyzed survey data for 345 fathers enrolled in a program for nonresident African American fathers and their preteen sons. Father involvement included measures of contact, closeness, monitoring, communication, and conflict. We used bivariate analyses and multivariate logistic regression analysis to examine associations between father involvement and depressive symptoms. Thirty-six percent of fathers reported moderate depressive symptoms, and 11% reported severe depressive symptoms. In bivariate analyses, depressive symptoms were associated with less contact, less closeness, low monitoring, and increased conflict. In multivariate analyses controlling for basic demographic features, fathers with moderate depressive symptoms were more likely to have less contact (adjusted odds ratio: 1.7 [95% confidence interval: 1.1-2.8]), less closeness (adjusted odds ratio: 2.1 [95% confidence interval: 1.3-3.5]), low monitoring (adjusted odds ratio: 2.7 [95% confidence interval: 1.4-5.2]), and high conflict (adjusted odds ratio: 2.1 [95% confidence interval: 1.2-3.6]). Fathers with severe depressive symptoms also were more likely to have less contact (adjusted odds ratio: 3.1 [95% confidence interval: 1.4-7.2]), less closeness (adjusted odds ratio: 2.6 [95% confidence interval: 1.2-5.7]), low monitoring (adjusted odds ratio: 2.8 [95% confidence interval: 1.1-7.1]), and high conflict (adjusted odds ratio: 2.6 [95% confidence interval: 1.1-5.9]). Paternal depressive symptoms may be an important, but modifiable, barrier for nonresident African American fathers willing to be more involved with their children.

Risk factors of childhood asthma in children attending Lyari General Hospital.

PubMed

Kamran, Amber; Hanif, Shahina; Murtaza, Ghulam

2015-06-01

To determine the factors associated with asthma in children. The case-control study was conducted in the paediatrics clinic of Lyari General Hospital, Karachi, from May to October 2010. Children 1-15 years of age attending the clinic represented the cases, while the control group had children who were closely related (sibling or cousin) to the cases but did not have the symptoms of disease at the time. Data was collected through a proforma and analysed using SPSS 10. Of the total 346 subjects, 173(50%) each comprised the two groups. According to univariable analysis the risk factors were presence of at least one smoker (odds ratio: 3.6; 95% confidence interval: 2.3-5.8), resident of kacha house (odds ratio: 16.2; 95% confidence interval: 3.8-69.5),living in room without windows (odds ratio: 9.3; 95% confidence interval: 2.1-40.9) and living in houses without adequate sunlight (odds ratio: 1.6; 95% confidence interval: 1.2-2.4).Using multivariable modelling, family history of asthma (odds ratio: 5.9; 95% confidence interval: 3.1-11.6), presence of at least one smoker at home (odds ratio: 4.1; 95% confidence interval: 2.3-7.2), people living in a room without a window (odds ratio: 5.5; 95% confidence interval: 1.15-26.3) and people living in an area without adequate sunlight (odds ratio: 2.2; 95% confidence interval: 1.13-4.31) were found to be independent risk factors of asthma in children adjusting for age, gender and history of weaning. Family history of asthma, children living with at least one smoker at home, room without windows and people living in an area without sunlight were major risk factors of childhood asthma.

Adverse childhood experiences and disability in U.S. adults.

PubMed

Schüssler-Fiorenza Rose, Sophia Miryam; Xie, Dawei; Stineman, Margaret

2014-08-01

To assess relationships between adverse childhood experiences and self-reported disabilities in adult life. Cross-sectional, random-digit-dialed, state-population-based survey (Behavioral Risk Factor Surveillance System). Fourteen states and the District of Columbia. Noninstitutionalized adults ages ≥18 years surveyed in 2009 and/or in 2010 (n = 81,184). The Behavioral Risk Factor Surveillance System Adverse Childhood Experience (ACE) Module asks about abuse (physical, sexual, emotional), family dysfunction (exposures to domestic violence, living with mentally ill, substance abusing, or incarcerated family member(s), and/or parental separation and/or divorce) that occurred before age 18 years. The ACE score sums affirmed ACE categories (range, 0-8). We controlled for demographic characteristics (age, race, education, income, and marital status) and self-reported physical health conditions (stroke, myocardial infarction, diabetes, coronary heart disease, asthma). Five states asked participants about mental health conditions (anxiety, depression). A subset analysis of participants in these states evaluated the effect of adjusting for these conditions. The primary outcome was disability (self-reported activity limitation and/or assistive device use). More than half of participants (57%) reported at least 1 adverse childhood experience category, and 23.2% reported disability. The odds ratio (95% confidence interval) of disability increased in a graded fashion from odds ratio 1.3 (95% confidence interval, 1.2-1.4) among those who experienced 1 adverse experience to odds ratio 5.8 (95% confidence interval, 4.6-7.5) among those with 7-8 adverse experiences compared with those with no such experiences when adjusting for demographic factors. The relationship between adverse experiences and disability remained strong after adjusting for physical and mental health conditions. There is a strong graded relationship between childhood exposure to abuse and household dysfunction and self-reported disability in adulthood, even after adjusting for potentially mediating health conditions. Greater clinician, researcher, and policymaker awareness of the impact of childhood adversity on disability is crucial to help those affected by childhood adversity lead more functional lives. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Risk factors for bronchiectasis in children with cystic fibrosis.

PubMed

Sly, Peter D; Gangell, Catherine L; Chen, Linping; Ware, Robert S; Ranganathan, Sarath; Mott, Lauren S; Murray, Conor P; Stick, Stephen M

2013-05-23

Bronchiectasis develops early in the course of cystic fibrosis, being detectable in infants as young as 10 weeks of age, and is persistent and progressive. We sought to determine risk factors for the onset of bronchiectasis, using data collected by the Australian Respiratory Early Surveillance Team for Cystic Fibrosis (AREST CF) intensive surveillance program. We examined data from 127 consecutive infants who received a diagnosis of cystic fibrosis after newborn screening. Chest computed tomography (CT) and bronchoalveolar lavage (BAL) were performed, while the children were in stable clinical condition, at 3 months and 1, 2, and 3 years of age. Longitudinal data were used to determine risk factors associated with the detection of bronchiectasis from 3 months to 3 years of age. The point prevalence of bronchiectasis at each visit increased from 29.3% at 3 months of age to 61.5% at 3 years of age. In multivariate analyses, risk factors for bronchiectasis were presentation with meconium ileus (odds ratio, 3.17; 95% confidence interval [CI], 1.51 to 6.66; P=0.002), respiratory symptoms at the time of CT and BAL (odds ratio, 2.27; 95% CI, 1.24 to 4.14; P=0.008), free neutrophil elastase activity in BAL fluid (odds ratio, 3.02; 95% CI, 1.70 to 5.35; P<0.001), and gas trapping on expiratory CT (odds ratio, 2.05; 95% CI, 1.17 to 3.59; P=0.01). Free neutrophil elastase activity in BAL fluid at 3 months of age was associated with persistent bronchiectasis (present on two or more sequential scans), with the odds seven times as high at 12 months of age and four times as high at 3 years of age. Neutrophil elastase activity in BAL fluid in early life was associated with early bronchiectasis in children with cystic fibrosis. (Funded by the National Health and Medical Research Council of Australia and Cystic Fibrosis Foundation Therapeutics.)

Bendectin (Debendox) as a risk factor for pyloric stenosis.

PubMed

Eskenazi, B; Bracken, M B

1982-12-15

The maternal use of Bendectin (Debendox) in the first trimester of pregnancy was examined in a case-control (n = 1,427 and 3,001, respectively) study of malformed infants whose mothers were interviewed between 1974 and 1976. Mothers of infants with congenital malformation showed an increased likelihood (odds ratio = 1.40) of having used Bendectin, with a stronger association of Bendectin with birth defects for mothers who also smoked (odds ratio = 2.91). A significant association was observed between the occurrence of pyloric stenosis in the infant and exposure to Bendectin in utero (odds ratio = 4.33). When maternal sociodemographic factors, including smoking, and smoking alone, were controlled, the association between Bendectin and pyloric stenosis was further increased (odds ratio = 4.63 and 5.24, respectively). Except for a possible association of Bendectin with heart valve anomalies (odds ratio = 2.99), we were unable to document other significantly increased risks for congenital malformations.

Social capital, economic conditions, marital status and daily smoking: a population-based study.

PubMed

Lindström, Martin

2010-02-01

To investigate the association between marital status and daily smoking, adjusting for economic conditions and trust. Cross-sectional study. In total, 27,757 individuals aged 18-80 years answered a postal questionnaire, which represents 59% of the random sample. A logistic regression model was used to investigate the association between marital status and daily smoking, adjusting for economic (material) conditions and trust. A multivariate analysis was performed to investigate the importance of possible confounders concerning the differences in daily smoking according to marital status. Smoking prevalence was 14.9% among men and 18.1% among women. The odds ratios of daily smoking for middle-aged respondents, born abroad, medium/low education, problems paying bills, low trust, and unmarried and (particularly) divorced respondents were significantly higher than those for their reference groups. Low trust was significantly higher among divorced and unmarried respondents compared with married/cohabitating respondents. Adjustment for economic conditions reduced the odds ratios of daily smoking among divorced subjects; this was not seen following adjustment for trust. Never-married subjects and (particularly) divorced subjects showed a significantly higher prevalence of daily smoking than married/cohabitating respondents. Economic conditions have a significant effect on the association between marital status and daily smoking, but this was not seen for trust. Copyright 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Prevalence of Tanning Addiction and Behavioral Health Conditions among Ethnically and Racially Diverse Adolescents.

PubMed

Miller, Kimberly A; Piombo, Sarah E; Cho, Junhan; Higgins, Shauna; Wysong, Ashley; Sussman, Steve; Cockburn, Myles G; Leventhal, Adam M

2018-02-23

Evidence indicates that tanning may be addictive and is associated with other behavioral health conditions. Few studies have examined tanning addiction among adolescents. We performed a cross-sectional study to explore the relationship between tanning addiction, substance use, and psychological conditions among a racially and ethnically diverse adolescent population. Tanning addiction was assessed using the modified CAGE measure among 11th grade students in Los Angeles (N = 2,637; response rate 78%). Overall, 7.02% of the sample met tanning addiction criteria. Tanning addiction was significantly associated with past 30-day smoking and marijuana use, problem substance use, depression, panic disorder, obsessive-compulsive disorder, and bipolar disorder in regression models. After controlling for all significant substance use and psychological variables, we found that problem marijuana use and obsessive-compulsive disorder remained significantly associated with tanning addiction (odds ratio = 2.06 [95% confidence interval = 1.03-4.09] and odds ratio = 2.54 [95% confidence interval = 1.73-3.72], respectively.) Tanning addiction was also significantly associated with multiple problem substance use and behavioral health conditions. Our findings indicate an appreciable prevalence of tanning addiction among ethnically and racially diverse adolescents and suggest the importance of addressing tanning addiction in the context of comorbid behavioral conditions to reduce this high-risk behavior among diverse youth. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Risk factors for postpartum ovarian cysts and their spontaneous recovery or persistence in lactating dairy cows.

PubMed

López-Gatius, F; Santolaria, P; Yániz, J; Fenech, M; López-Béjar, M

2002-11-01

Cystic ovarian disease is a major cause of reproductive failure and economic loss for the dairy industry. Many cysts that develop during the early postpartum period regress spontaneously. However, it is difficult to decide at what point it would be more cost effective to treat ovarian cysts than to wait for spontaneous recovery. The objective of this study was to analyze risk factors for the development of the ovarian cystic condition during early and late postpartum, and for its persistence or recovery during the pre-service period in lactating dairy cows. Using multiple logistic regression, we analyzed data derived from 873 lactating dairy cows from a single herd. An ovarian cyst was diagnosed if it was possible to observe a single follicular structure with an antrum diameter > or = 25 mm in the absence of a corpus luteum in three sonograms performed at 7-day intervals. The cystic condition was denoted as early if the cyst was diagnosed 43-49 days postpartum, and late if detected 57-63-day postpartum. Spontaneous cyst regression before 60-day postpartum was regarded as early cystic recovery. For the early cystic group, there were no significant effects of lactation number, body condition score on prepartum Day 60, at parturition or on postpartum Day 30, or of body condition loss from parturition to 30-day postpartum. Cows calving in summer were 2.6 times more likely to develop ovarian cysts than those giving birth in winter. The risk of having a cyst was 1.9 times higher in cows with an abnormal puerperium. A 1-kg increase in milk yield raised the risk of cysts by a factor of 1.05. A 1-unit increase in body condition score (scale from 1 to 5) from prepartum Day 60 to parturition increased the risk of cyst development 8.4 times. Milk production and lactation number were negatively correlated with spontaneous early cyst recovery. A 1-kg decrease in milk production increased the probability of cyst recovery by a factor of 1.06, and a 1-unit drop in lactation number was associated with a 1.4-fold increased probability of cyst recovery. For the late cystic group, there were no significant effects of abnormal puerperium and body score data, except for a prepartum change in body score. Calving season (Odds ratio: 2.3), lactation number (Odds ratio: 1.36), increased milk production (Odds ratio: 1.05) and increased body condition score during the prepartum period (Odds ratio: 4.3) were all related to an increased risk of ovarian cysts. The probability of having a late cyst was 36.6 times greater in cows with early cysts. These findings suggest that it would be profitable to treat multiparous cows having cysts very early in the postpartum period, while treatment of primiparous cows should be delayed, at least until the end of the pre-service period, to provide the opportunity for spontaneous recovery.

The influence of prehospital systemic corticosteroid use on development of acute respiratory distress syndrome and hospital outcomes.

PubMed

Karnatovskaia, Lioudmila V; Lee, Augustine S; Gajic, Ognjen; Festic, Emir

2013-07-01

The role of systemic corticosteroids in pathophysiology and treatment of acute respiratory distress syndrome is controversial. Use of prehospital systemic corticosteroid therapy may prevent the development of acute respiratory distress syndrome and improve hospital outcomes. This is a preplanned retrospective subgroup analysis of the prospectively identified cohort from a trial by the U.S. Critical Illness and Injury Trials Group designed to validate the Lung Injury Prediction Score. Twenty-two acute care hospitals. : Five thousand eighty-nine patients with at least one risk factor for acute respiratory distress syndrome at the time of hospitalization. Propensity-based analysis of previously recorded data. Three hundred sixty-four patients were on systemic corticosteroids. Prevalence of acute respiratory distress syndrome was 7.7% and 6.9% (odds ratio, 1.1 [95% CI, 0.8-1.7]; p = 0.54) for patients on systemic corticosteroid and not on systemic corticosteroids, respectively. A propensity for being on systemic corticosteroids was derived through logistic regression by using all available covariates. Subsequently, 354 patients (97%) on systemic corticosteroids were matched to 1,093 not on systemic corticosteroids by their propensity score for a total of 1,447 patients in the matched set. Adjusted risk for acute respiratory distress syndrome (odds ratio, 0.96 [95% CI, 0.54-1.38]), invasive ventilation (odds ratio, 0.84 [95% CI, 0.62-1.12]), and in-hospital mortality (odds ratio, 0.97 [95% CI, 0.63-1.49]) was then calculated from the propensity-matched sample using conditional logistic regression model. No significant associations were present. Prehospital use of systemic corticosteroids neither decreased the development of acute respiratory distress syndrome among patients hospitalized with at one least risk factor, nor affected the need for mechanical ventilation or hospital mortality.

Clinical decision-making: predictors of patient participation in nursing care.

PubMed

Florin, Jan; Ehrenberg, Anna; Ehnfors, Margareta

2008-11-01

To investigate predictors of patients' preferences for participation in clinical decision-making in inpatient nursing care. Patient participation in decision-making in nursing care is regarded as a prerequisite for good clinical practice regarding the person's autonomy and integrity. A cross-sectional survey of 428 persons, newly discharged from inpatient care. The survey was conducted using the Control Preference Scale. Multiple logistic regression analysis was used for testing the association of patient characteristics with preferences for participation. Patients, in general, preferred adopting a passive role. However, predictors for adopting an active participatory role were the patient's gender (odds ratio = 1.8), education (odds ratio = 2.2), living condition (odds ratio = 1.8) and occupational status (odds ratio = 2.0). A probability of 53% was estimated, which female senior citizens with at least a high school degree and who lived alone would prefer an active role in clinical decision-making. At the same time, a working cohabiting male with less than a high school degree had a probability of 8% for active participation in clinical decision making in nursing care. Patient preferences for participation differed considerably and are best elicited by assessment of the individual patient. Relevance to clinical practice. The nurses have a professional responsibility to act in such a way that patients can participate and make decisions according to their own values from an informed position. Access to knowledge of patients'basic assumptions and preferences for participation is of great value for nurses in the care process. There is a need for nurses to use structured methods and tools for eliciting individual patient preferences regarding participation in clinical decision-making.

Risk factors for Cryptosporidium infection in low and middle income countries: A systematic review and meta-analysis.

PubMed

Bouzid, Maha; Kintz, Erica; Hunter, Paul R

2018-06-07

Cryptosporidium infection causes gastrointestinal disease and has a worldwide distribution. The highest burden is in developing countries. We sought to conduct a systematic review and meta-analysis to identify Cryptosporidium risk factors in Low and Middle Income countries (LMICs). Medline Ovid and Scopus databases were searched with no restriction on year or language of publication. All references were screened independently in duplicate and were included if they presented data on at least 3 risk factors. Meta-analyses using random effects models were used to calculate overall estimates for each exposure. The most frequently reported risk factors in the 15 included studies were overcrowding, household diarrhoea, poor quality drinking water, animal contact, open defecation/ lack of toilet and breastfeeding. The combined odds ratio for animal contact was 1.98 (95%CI: 1.11-3.54) based on 11 studies and for diarrhoea in the household 1.98 (95%CI: 1.13-3.49) based on 4 studies. Open defecation was associated with a pooled odds ratio of 1.82 (95%CI: 1.19-2.8) based on 5 studies. Poor drinking water quality was not associated with a significant Cryptosporidium risk, odds ratio 1.06 (95%CI: 0.77-1.47). Breastfeeding was protective with pooled odds ratio 0.4 (95%CI: 0.13-1.22), which was not statistically significant. Based on the included studies, crowded living conditions, animal contact and open defecation are responsible for the majority of Cryptosporidium cases in LMICs. Future studies investigating Cryptosporidium risk factors should have a good study design and duration, include appropriate number of cases, select suitable controls, investigate multiple relevant risk factors, fully report data and perform multivariate analysis.

Risk of Psoriasis Following Terbinafine or Itraconazole Treatment for Onychomycosis: A Population-Based Case-Control Comparative Study.

PubMed

Chiu, Hsien-Yi; Chang, Wei-Lun; Tsai, Tsen-Fang; Tsai, Yi-Wen; Shiu, Ming-Neng

2018-03-01

Several case studies have reported an association between antifungal drug use and psoriasis risk. The objective of this study was to investigate the association between terbinafine/itraconazole exposure and psoriasis incidence. Among patients with onychomycosis in the Taiwan National Health Insurance Research Database, 3831 incident psoriasis cases were identified during 2004-2010 and compared with 3831 age- and sex-matched controls with the same look-back period. Multivariate conditional logistic regression was used for the analysis. The psoriasis cases were significantly more likely than matched controls to have used terbinafine or itraconazole (59.85 vs. 42.70%, respectively; p < 0.0001). After adjusting for potential confounders and cumulative duration of antifungal drug prescription, terbinafine/itraconazole use was associated with an increased psoriasis risk (adjusted odds ratio 1.33, 95% confidence interval 1.15-1.54). The association was stronger for more recent drug exposure (adjusted odds ratio 2.96, 95% confidence interval 2.25-3.90 for ≤ 90 days before the sampling date; adjusted odds ratio 1.04, 95% confidence interval 0.89-1.22 for > 360 days). In a comparison of patients receiving terbinafine or itraconazole only, psoriasis risk was higher for itraconazole (adjusted odds ratio 1.21, 95% confidence interval 1.05-1.40). This large population-based case-control analysis showed that exposure to terbinafine or itraconazole is associated with an increased risk of incident psoriasis. The finding of an increased psoriasis risk for antifungal drug users, particularly for itraconazole, deserves attention in clinical practice although further prospective studies are necessary to confirm our findings and clarify the biological mechanisms that underlie these associations.

Effects of advanced life support on patients who suffered cardiac arrest outside of hospital and were defibrillated.

PubMed

Hagihara, Akihito; Onozuka, Daisuke; Nagata, Takashi; Hasegawa, Manabu

2018-01-01

The effects and relative benefits of advanced airway management and epinephrine on patients with out-of-hospital cardiac arrest (OHCA) who were defibrillated are not well understood. This was a prospective observational study. Using data of all out-of-hospital cardiac arrest cases occurring between 2005 and 2013 in Japan, hierarchical logistic regression and conditional logistic regression along with time-dependent propensity matching were performed. Outcome measures were survival and minimal neurological impairment [cerebral performance category (CPC) 1 or 2] at 1month after the event. We analyzed 37,873 cases that met the inclusion criteria. Among propensity-matched patients, advanced airway management and/or prehospital epinephrine use was related to decreased rates of 1-month survival (adjusted odds ratio 0.88, 95% confidence interval 0.80 to 0.97) and CPC (1, 2) (adjusted odds ratio 0.56, 95% confidence interval 0.48 to 0.66). Advanced airway management was related to decreased rates of 1-month survival (adjusted odds ratio 0.89, 95% confidence interval 0.81to 0.98) and CPC (1, 2) (adjusted odds ratio 0.54, 95% confidence interval 0.46 to 0.64) in patients who did not receive epinephrine, whereas epinephrine use was not related to the outcome measures. In defibrillated patients with OHCA, advanced airway management and/or epinephrine are related to reduced long-term survival, and advanced airway management is less beneficial than epinephrine. However, the proportion of patients with OHCA who responded to an initial shock was very low in the study subjects, and the external validity of our findings might be limited. Copyright © 2017 Elsevier Inc. All rights reserved.

Patient, surgeon, and hospital disparities associated with benign hysterectomy approach and perioperative complications.

PubMed

Mehta, Ambar; Xu, Tim; Hutfless, Susan; Makary, Martin A; Sinno, Abdulrahman K; Tanner, Edward J; Stone, Rebecca L; Wang, Karen; Fader, Amanda N

2017-05-01

Hysterectomy is among the most common major surgical procedures performed in women. Approximately 450,000 hysterectomy procedures are performed each year in the United States for benign indications. However, little is known regarding contemporary US hysterectomy trends for women with benign disease with respect to operative technique and perioperative complications, and the association between these 2 factors with patient, surgeon, and hospital characteristics. We sought to describe contemporary hysterectomy trends and explore associations between patient, surgeon, and hospital characteristics with surgical approach and perioperative complications. Hysterectomies performed for benign indications by general gynecologists from July 2012 through September 2014 were analyzed in the all-payer Maryland Health Services Cost Review Commission database. We excluded hysterectomies performed by gynecologic oncologists, reproductive endocrinologists, and female pelvic medicine and reconstructive surgeons. We included both open hysterectomies and those performed by minimally invasive surgery, which included vaginal hysterectomies. Perioperative complications were defined using the Agency for Healthcare Research and Quality patient safety indicators. Surgeon hysterectomy volume during the 2-year study period was analyzed (0-5 cases annually = very low, 6-10 = low, 11-20 = medium, and ≥21 = high). We utilized logistic regression and negative binomial regression to identify patient, surgeon, and hospital characteristics associated with minimally invasive surgery utilization and perioperative complications, respectively. A total of 5660 hospitalizations were identified during the study period. Most patients (61.5%) had an open hysterectomy; 38.5% underwent a minimally invasive surgery procedure (25.1% robotic, 46.6% laparoscopic, 28.3% vaginal). Most surgeons (68.2%) were very low- or low-volume surgeons. Factors associated with a lower likelihood of undergoing minimally invasive surgery included older patient age (reference 45-64 years; 20-44 years: adjusted odds ratio, 1.16; 95% confidence interval, 1.05-1.28), black race (reference white; adjusted odds ratio, 0.70; 95% confidence interval, 0.63-0.78), Hispanic ethnicity (adjusted odds ratio, 0.62; 95% confidence interval, 0.48-0.80), smaller hospital (reference large; small: adjusted odds ratio, 0.26; 95% confidence interval, 0.15-0.45; medium: adjusted odds ratio, 0.87; 95% confidence interval, 0.79-0.96), medium hospital hysterectomy volume (reference ≥200 hysterectomies; 100-200: adjusted odds ratio, 0.78; 95% confidence interval, 0.71-0.87), and medium vs high surgeon volume (reference high; medium: adjusted odds ratio, 0.87; 95% confidence interval, 0.78-0.97). Complications occurred in 25.8% of open and 8.2% of minimally invasive hysterectomies (P < .0001). Minimally invasive hysterectomy (adjusted odds ratio, 0.22; 95% confidence interval, 0.17-0.27) and large hysterectomy volume hospitals (reference ≥200 hysterectomies; 1-100: adjusted odds ratio, 2.26; 95% confidence interval, 1.60-3.20; 101-200: adjusted odds ratio, 1.63; 95% confidence interval, 1.23-2.16) were associated with fewer complications, while patient payer, including Medicare (reference private; adjusted odds ratio, 1.86; 95% confidence interval, 1.33-2.61), Medicaid (adjusted odds ratio, 1.63; 95% confidence interval, 1.30-2.04), and self-pay status (adjusted odds ratio, 2.41; 95% confidence interval, 1.40-4.12), and very-low and low surgeon hysterectomy volume (reference ≥21 cases; 1-5 cases: adjusted odds ratio, 1.73; 95% confidence interval, 1.22-2.47; 6-10 cases: adjusted odds ratio, 1.60; 95% confidence interval, 1.11-2.23) were associated with perioperative complications. Use of minimally invasive hysterectomy for benign indications remains variable, with most patients undergoing open, more morbid procedures. Older and black patients and smaller hospitals are associated with open hysterectomy. Patient race and payer status, hysterectomy approach, and surgeon volume were associated with perioperative complications. Hysterectomies performed for benign indications by high-volume surgeons or by minimally invasive techniques may represent an opportunity to reduce preventable harm. Copyright © 2017 Elsevier Inc. All rights reserved.

Socioeconomic inequalities in risk of hospitalization for community-acquired bacteremia: a Danish population-based case-control study.

PubMed

Koch, Kristoffer; Søgaard, Mette; Nørgaard, Mette; Thomsen, Reimar Wernich; Schønheyder, Henrik Carl

2014-05-01

In a Danish population-based case-control study, we examined the association between socioeconomic status (SES) and risk of community-acquired bacteremia, as well as the contribution of chronic diseases and substance abuse to differences in bacteremia risk. Analyses were based on 4,117 patients aged 30-65 years who were hospitalized with first-time community-acquired bacteremia during 2000-2008 and 41,170 population controls matched by sex, age, and region of residence. Individual-level information on SES (education and income), chronic diseases, and substance abuse was retrieved from public and medical registries. Conditional logistic regression was used to compute odds ratios for bacteremia. Persons of low SES had a substantially higher risk of bacteremia than those of high SES (for short duration of education vs. long duration, odds ratio = 2.30 (95% confidence interval: 2.10, 2.52); for low income vs. high income, odds ratio = 2.77 (95% confidence interval: 2.54, 3.02)). A higher prevalence of chronic diseases and substance abuse in low-SES individuals versus high-SES individuals explained 43%-48% of the socioeconomic differences in bacteremia risk. In a country with a universal welfare system, differences in the burden of chronic diseases and substance abuse seem to have major importance in explaining inequalities in bacteremia risk.

Aging reduces the association between sleepiness and sleep-disordered breathing

PubMed Central

Morrell, Mary; Finn, Laurel; McMillian, Alison; Peppard, Paul E.

2013-01-01

Aim To investigate age-related changes in sleepiness symptoms associated with sleep disordered breathing (SDB). Methods Wisconsin Sleep Cohort participants were assessed with polysomnography, Epworth Sleepiness Scale (ESS) and Multiple Sleep Latency Test (MSLT). SDB was defined as an apnea/hypopnea index≥15 events/hour, sleepiness as ESS≥10 and MSLT≤5 minutes. Odds ratios were calculated using generalized estimating equations associating sleepiness with SDB, and conditional logistic regression examining changes in longitudinal sleepiness status (ESS only). Models were, a priori, stratified by gender. Results ESS was measured in 1281 participants and MSLT in 998, at multiple time points (ESS n=3695; MSLT n=1846). Significant interactions were found between SDB and age in men, but not women. The odds ratios (OR) modeled for sleepiness in a 40 year old male with SDB were significant, compared to a male without SDB (OR: ESS 2.1; MSLT 2.9); however, these associations were not significant at 60 years. The within-subject odds ratio for sleepiness was also significant at 40 years (OR: 3.4), but not at 60 years. Conclusion The age-related reductions in the association between sleepiness and SDB may have clinical implications for the diagnosis and treatment of SDB in older people since sleepiness is often used as a therapeutic marker. PMID:22241742

A case-control study evaluating relative risk factors for decompression sickness: a research report.

PubMed

Suzuki, Naoko; Yagishita, Kazuyosi; Togawa, Seiichiro; Okazaki, Fumihiro; Shibayama, Masaharu; Yamamoto, Kazuo; Mano, Yoshihiro

2014-01-01

Factors contributing to the pathogenesis of decompression sickness (DCS) in divers have been described in many studies. However, relative importance of these factors has not been reported. In this case-control study, we compared the diving profiles of divers experiencing DCS with those of a control group. The DCS group comprised 35 recreational scuba divers who were diagnosed by physicians as having DCS. The control group consisted of 324 apparently healthy recreational divers. All divers conducted their dives from 2009 to 2011. The questionnaire consisted of 33 items about an individual's diving profile, physical condition and activities before, during and just after the dive. To simplify dive parameters, the dive site was limited to Izu Osezaki. Odds ratios and multiple logistic regression were used for the analysis. Odds ratios revealed several items as dive and health factors associated with DCS. The major items were as follows: shortness of breath after heavy exercise during the dive (OR = 12.12), dehydration (OR = 10.63), and maximum dive depth > 30 msw (OR = 7.18). Results of logistic regression were similar to those by odds ratio analysis. We assessed the relative weights of the surveyed dive and health factors associated with DCS. Because results of several factors conflict with previous studies, future studies are needed.

Characteristics of users of online personalized genomic risk assessments: implications for physician-patient interactions.

PubMed

McBride, Colleen M; Alford, Sharon Hensley; Reid, Robert J; Larson, Eric B; Baxevanis, Andreas D; Brody, Lawrence C

2009-08-01

To evaluate what psychological and behavioral factors predict who is likely to seek SNP-based genetic tests for multiple common health conditions where feedback can be used to motivate primary prevention. Adults aged 25-40 years who were enrolled in a large managed care organization were surveyed. Those eligible could log on to a secure study Web site to review information about the risks and benefits of a SNP-based genetic test and request free testing. Two primary outcomes are addressed: accessing the Web (yes or no) and deciding to be tested (completed a blood draw at the clinic) Those considering genetic susceptibility testing did not hold genetically deterministic beliefs (0.42 on scale of 0 [behavior] to 1 [genetic]) but believed genetic information to be valuable and were confident they could understand such information. Individuals who believed it important to learn about genetics (odds ratio = 1.28), were confident they could understand genetics (odds ratio = 1.26), and reported the most health habits to change (odds ratio = 1.39) were most likely to get tested. Individuals who present to health care providers with online genetics information may be among the most motivated to take steps toward healthier lifestyles. These motives might be leveraged by health care providers to promote positive health outcomes.

Elevated blood pressure and its predictors among secondary school students in Sarawak: a cross-sectional study.

PubMed

Grace Kho, Woei Feng; Cheah, Whye Lian; Hazmi, Helmy

2018-03-01

Hypertension is a health issue affecting adolescents. Accumulating evidence affirms that elevated blood pressure begins in childhood and tracks into adulthood. This cross-sectional study was conducted to determine the prevalence of elevated blood pressure and its predictors among secondary school students in Sarawak, Malaysia. A total of 2,461 secondary school students aged 12-17 years from 19 schools in Sarawak participated in the study. Questionnaire was used to obtain socio-demographic data, parental history of hypertension, and self-reported physical activity. Anthropometric and blood pressure measurements were taken. Data was entered and analysed using SPSS version 23.0. The prevalence of adolescents with elevated blood pressure, overweight, central obesity, and overfat were 30.1%, 24.3%, 13.5%, and 6.7%, respectively. Multivariate logistic regression demonstrated the predictors significantly associated with elevated blood pressure among respondents: overweight (adjusted odds ratio=3.144), being male (adjusted odds ratio=3.073), being Chinese (adjusted odds ratio=2.321) or Iban (adjusted odds ratio=1.578), central obesity (adjusted odds ratio=2.145), being overfat (adjusted odds ratio=1.885), and being an older adolescent (adjusted odds ratio=1.109). Parental history of hypertension, locality, and physical activity showed no significant associations. The obesity epidemic must be tackled at community and school levels by health education and regulation of school canteen foods. Copyright© by the National Institute of Public Health, Prague 2018.

Occupational heat exposure among municipal workers.

PubMed

Uejio, Christopher K; Morano, Laurel Harduar; Jung, Jihoon; Kintziger, Kristina; Jagger, Meredith; Chalmers, Juanita; Holmes, Tisha

2018-06-05

Outdoor workers face elevated and prolonged heat exposures and have limited access to air-conditioned spaces. This study's overarching research aim is to increase knowledge of municipal worker heat exposure and adaptation practices. The study's sub-objectives are: (1) quantifying exposure misclassification from estimating personal heat exposure from the official weather station; (2) surveying worker's knowledge and practices to adapt to extreme heat; and (3) relating heat exposure and adaptation practices to self-reported thermal comfort. Participants wore a personal heat exposure sensor over 7 days from June 1st to July 3rd, 2015 in Tallahassee, Florida US. Next, participants confirmed the days that they wore the sensor and reported their daily thermal comfort and heat adaptations. Finally, participants completed an extreme heat knowledge, attitudes, and practices survey. Some participants (37%) experienced hotter and more humid conditions (heat index > 2) than the weather station. The most common heat adaptations were staying hydrated (85%), wearing a hat (46%), and seeking shade (40%). During work hours, higher temperatures increased the odds (odds ratio: 1.21, 95% confidence interval: 1.03-1.41, p = 0.016) of a participant feeling too hot. Shifting work duty indoors made workers to feel more comfortable (odds ratio: 0.28, 95% confidence interval: 0.11-0.70, p = 0.005). In hot and humid climates, everyday, heat exposures continuously challenge the health of outdoor workers.

Suicide and self-injury among children and youth with chronic health conditions.

PubMed

Barnes, Andrew J; Eisenberg, Marla E; Resnick, Michael D

2010-05-01

Chronic conditions may be associated with suicide risk. This study aimed to specify the extent to which youth chronic conditions are at risk for suicidality and self-harm. Logistic regression was used to estimate odds of self-harm, suicidal ideation, and suicide attempts in 10- to 19-year-olds with and without chronic physical and/or mental health conditions. Independent of race, socioeconomic status, absent parent, special education status, substance use, and emotional distress, youth with co-occurring chronic physical and mental conditions (n = 4099) had significantly higher odds of self-harm (odds ratio [OR]: 2.5 [99% confidence interval (CI): 2.3-2.8), suicidal ideation (OR: 2.5 [99% CI: 2.3-2.8), and suicide attempts (OR: 3.5 [99% CI: 3.1-3.9]) than healthy peers (n = 106,967), as did those with chronic mental conditions alone (n = 8752). Youth with chronic physical conditions alone (n = 12,554) were at slightly elevated risk for all 3 outcomes. Findings were similar among male and female youth, with a risk gradient by grade. Chronic physical conditions are associated with a slightly elevated risk for self-harm, suicidal thinking, and attempted suicide; chronic mental conditions are associated with an increased risk for all 3 outcomes. Co-occurring chronic physical and mental conditions are associated with an increased risk for self-harm and suicidal ideation that is similar to the risk in chronic mental conditions and with an attempted suicide risk in excess of that predicted by the chronic mental health conditions alone. Preventive interventions for these youth should be developed and evaluated.

Health Care Use, Health Behaviors, and Medical Conditions Among Individuals in Same-Sex and Opposite-Sex Partnerships: A Cross-Sectional Observational Analysis of the Medical Expenditures Panel Survey (MEPS), 2003-2011.

PubMed

Blosnich, John R; Hanmer, Janel; Yu, Lan; Matthews, Derrick D; Kavalieratos, Dio

2016-06-01

Prior research documents disparities between sexual minority and nonsexual minority individuals regarding health behaviors and health services utilization. However, little is known regarding differences in the prevalence of medical conditions. To examine associations between sexual minority status and medical conditions. We conducted multiple logistic regression analyses of the Medical Expenditure Panel Survey (2003-2011). We identified individuals who reported being partnered with an individual of the same sex, and constructed a matched cohort of individuals in opposite-sex partnerships. A total of 494 individuals in same-sex partnerships and 494 individuals in opposite-sex partnerships. Measures of health risk (eg, smoking status), health services utilization (eg, physician office visits), and presence of 15 medical conditions (eg, cancer, diabetes, arthritis, HIV, alcohol disorders). Same-sex partnered men had nearly 4 times the odds of reporting a mood disorder than did opposite-sex partnered men [adjusted odds ratio (aOR)=3.96; 95% confidence interval (CI), 1.85-8.48]. Compared with opposite-sex partnered women, same-sex partnered women had greater odds of heart disease (aOR=2.59; 95% CI, 1.19-5.62), diabetes (aOR=2.75; 95% CI, 1.10-6.90), obesity (aOR=1.92; 95% CI, 1.26-2.94), high cholesterol (aOR=1.89; 95% CI, 1.03-3.50), and asthma (aOR=1.90; 95% CI, 1.02-1.19). Even after adjusting for sociodemographics, health risk behaviors, and health conditions, individuals in same-sex partnerships had 67% increased odds of past-year emergency department utilization and 51% greater odds of ≥3 physician visits in the last year compared with opposite-sex partnered individuals. A combination of individual-level, provider-level, and system-level approaches are needed to reduce disparities in medical conditions and health care utilization among sexual minority individuals.

Coping With Staff Burnout and Work-Related Posttraumatic Stress in Intensive Care.

PubMed

Colville, Gillian A; Smith, Jared G; Brierley, Joe; Citron, Kim; Nguru, Noreen M; Shaunak, Priyanka D; Tam, Olivia; Perkins-Porras, Linda

2017-07-01

To examine the associations with symptoms of 1) burnout and 2) work-related posttraumatic stress, in adult and pediatric intensive care staff, focusing on the particular contributions of resilience and coping strategies. Point prevalence cross-sectional study. Three adult ICUs and four PICUs. Three hundred seventy-seven ICU staff. None. Brief Resilience Scale, abbreviated Maslach Burnout Inventory, Trauma Screening Questionnaire, and Hospital Anxiety and Depression Scale. Prevalence of burnout (defined as high emotional exhaustion or high depersonalization) was 37%. Prevalence of clinically significant posttraumatic stress symptoms was 13%. There was a degree of overlap between burnout and other measures of distress, most notably for anxiety (odds ratio, 10.56; 95% CI, 4.12-27.02; p < 0.001). Hierarchical logistic regression demonstrated that self-reported resilience was strongly associated with decreased likelihood of meeting criteria for both forms of work-related distress (burnout: odds ratio, 0.52; 95% CI, 0.36-0.74; p < 0.001 and posttraumatic stress: odds ratio, 0.28; 95% CI, 0.16-0.46; p < 0.001) and that physicians were twice as likely as nurses to be at risk of reporting burnout (odds ratio, 2.11; 95% CI, 1.18-3.78; p = 0.012). After controlling for resilience, profession, and setting, the following coping strategies were independently associated with outcomes: attending debriefing reduced risk of burnout (odds ratio, 0.45; 95% CI, 0.21-0.95; p = 0.036), whereas the odds of posttraumatic stress were less if staff used talking to seniors (odds ratio, 0.43; 95% CI, 0.20-0.92; p = 0.029) or hobbies (odds ratio, 0.46; 95% CI, 0.23-0.93; p = 0.030) to cope with stress at work. Venting emotion (odds ratio, 1.92; 95% CI, 1.12-3.31; p = 0.018) and using alcohol (odds ratio, 2.30; 95% CI, 1.26-4.20; p = 0.006) were associated with a doubling in risk of reporting burnout. The use of particular coping strategies was systematically associated with symptoms of burnout and work-related posttraumatic stress in this group of intensive care staff, even after controlling for resilience and other factors. More research on how best to promote adaptive coping is needed in these challenging settings.

For better or worse: An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy.

PubMed

Rozental, Alexander; Magnusson, Kristoffer; Boettcher, Johanna; Andersson, Gerhard; Carlbring, Per

2017-02-01

Psychological treatments can relieve mental distress and improve well-being, and the dissemination of evidence-based methods can help patients gain access to the right type of aid. Meanwhile, Internet-based cognitive-behavioral therapy (ICBT) has shown promising results for many psychiatric disorders. However, research on the potential for negative effects of psychological treatments has been lacking. An individual patient data meta-analysis of 29 clinical trials of ICBT (N = 2,866) was performed using the Reliable Change Index for each primary outcome measures to distinguish deterioration rates among patients in treatment and control conditions. Statistical analyses of predictors were conducted using generalized linear mixed models. Missing data was handled by multiple imputation. Deterioration rates were 122 (5.8%) in treatment and 130 (17.4%) in control conditions. Relative to receiving treatment, patients in a control condition had higher odds of deteriorating, odds ratios (ORs) = 3.10, 95% confidence interval (CI) [2.21, 4.34]. Clinical severity at pretreatment was related to lower odds, OR = 0.62, 95% CI [0.50, 0.77], and OR = 0.51, 95% CI [0.51, 0.80], for treatment and control conditions. In terms of sociodemographic variables, being in a relationship, OR = 0.58, 95% CI [0.35, 0.95], having at least a university degree, OR = 0.54, 95% CI [0.33, 0.88], and being older, OR = 0.78, 95% CI, [0.62, 0.98], were also associated with lower odds of deterioration, but only for patients assigned to a treatment condition. Deterioration among patients receiving ICBT or being in a control condition can occur and should be monitored by researchers to reverse and prevent a negative treatment trend. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Business travel and self-rated health, obesity, and cardiovascular disease risk factors.

PubMed

Richards, Catherine A; Rundle, Andrew G

2011-04-01

To assess associations between extent of travel for business and health. Associations between business travel and cardiovascular disease risk factors were assessed using medical record data from 13,057 patients provided by EHE International, Inc. Compared with light travelers (1 to 6 nights per month), nontravelers were more likely to report poor/fair health (odds ratio = 1.58; 95% confidence interval [CI]: 1.33 to 1.87) and the odds ratios increased with increasing travel, reaching 2.61 (95% CI: 1.57 to 4.33) among extensive travelers (>20 nights per month). Compared with light travelers, the odds ratios for obesity were highest among nontravelers (odds ratio = 1.33; 95% CI: 1.18 to 1.50) and extensive travelers (odds ratio = 1.92; 95% CI: 1.25 to 2.94). Although the differences were small, nontravelers and extensive travelers had the highest diastolic blood pressure and lowest high-density lipoprotein cholesterol levels. Poor self-rated health and obesity are associated with extensive business travel.

Analysis of factors associated with seatbelt wearing among rear passengers in Malaysia.

PubMed

Mohamed, Norlen; Mohd Yusoff, Muhammad Fadhli; Isah, Noradrenalina; Othman, Ihamah; Syed Rahim, Sharifah-Allyana; Paiman, Noorfaradilla

2011-03-01

A cross-sectional survey using a self-administered questionnaire was conducted among 793 rear passengers in Malaysia. Logistic regression was performed to analyse the association of rear seatbelt wearing with 12 independent variables. Seven factors were significantly associated with rear seatbelt wearing. Experience of being stopped by an enforcement officer for not wearing rear seatbelt yielded the highest odds ratio 2.3 (p = 0.002) followed by self-consciousness (odds ratio 1.7; p = 0.004), attitude (odds ratio 1.5, p = 0.001), and knowledge (odds ratio 1.4, p = 0.004). Age of participants and their perception of being caught by an enforcement officer were also significantly associated with rear seatbelt wearing, odds ratios were 1.03 (p = 0.004) and 1.1 (p = 0.004), respectively. In contrast, level of education was negatively associated with rear seatbelt wearing (odds ratio 0.59, p = 0.003). It was concluded that enforcement activities, knowledge and attitude on seatbelt wearing play a very important role in improving the rate of rear seatbelt wearing. Thus, efforts to increase these factors should be the special focus in designing education and social marketing activities to advocate rear seatbelt wearing.

Risk factors for the breakdown of perineal laceration repair after vaginal delivery.

PubMed

Williams, Meredith K; Chames, Mark C

2006-09-01

The purpose of this study was to identify risk factors that are associated with the breakdown of perineal laceration repair in the postpartum period. We conducted a retrospective, case-control study to review perineal laceration repair breakdown in patients who were delivered between September 1995 and February 2005 at the University of Michigan. Bivariate analysis with chi-square test and t-test and stepwise logistic regression analysis were performed. Fifty-nine cases and 118 control deliveries were identified from a total of 14,124 vaginal deliveries. Risk factors were longer second stage of labor (142 vs 87 minutes; P = .001), operative vaginal delivery (odds ratio, 3.6; 95% CI, 1.8-7.3), mediolateral episiotomy (odds ratio, 6.9; 95% CI, 2.6-18.7), third- or fourth-degree laceration (odds ratio, 3.1; 95% CI, 1.5-6.4), and meconium-stained amniotic fluid (odds ratio, 3.0; 95% CI, 1.1-7.9). Previous vaginal delivery was protective (odds ratio, 0.38; 95% CI, 0.18-0.84). Logistic regression showed the most significant factor to be an interaction between operative vaginal delivery and mediolateral episiotomy (odd ratio, 6.36; 95% CI, 2.18-18.57). The most significant events were mediolateral episiotomy, especially in conjunction with operative vaginal delivery, third- and fourth-degree lacerations, and meconium.

Elder Self-neglect and Suicidal Ideation in an U.S. Chinese Aging Population: Findings From the PINE Study.

PubMed

Dong, XinQi; Xu, Ying; Ding, Ding

2017-07-01

Self-neglect and suicidal ideations are important public health issues among the aging population. This study aims to examine the association between self-neglect, its phenotypes, and suicidal ideation among U.S. Chinese older adults. Guided by a community-based participatory research approach, the Population Study of Chinese Elderly in Chicago (PINE) study is a population-based epidemiological study conducted from 2011 to 2013 among 3,159 Chinese older adults aged 60 years and older in the Greater Chicago area. Self-neglect was assessed by a 27-item instrument, describing five phenotypes with hoarding, poor personal hygiene, unsanitary condition, lack of utilities, and need of home repair. Suicidal ideation was assessed by the ninth item of the Patient Health Questionnaire-9 (PHQ-9) and the Geriatric Mental State Examination-Version A (GMS-A). Logistic regression is utilized to analyze the association. Higher level of self-neglect was found significantly associated with increased risk of self-reported suicidal ideation within 2 weeks (odds ratio 2.97 [1.54-5.72]); 12 months (odds ratio 2.82 [1.77-4.51]); and lifetime (odds ratio 2.74 [1.89-3.95]). For phenotypes, the study found that poorer personal hygiene and severer level of unsanitary conditions were associated with increased risk of suicidal ideation at all three time periods. This study suggests that self-neglect and its phenotypes are significantly associated with suicidal ideation among Chinese older adults. Longitudinal studies are needed to explore the mechanisms through which self-neglect links with suicidal ideation. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension.

PubMed

Pedrosa, Rodrigo P; Drager, Luciano F; Gonzaga, Carolina C; Sousa, Marcio G; de Paula, Lílian K G; Amaro, Aline C S; Amodeo, Celso; Bortolotto, Luiz A; Krieger, Eduardo M; Bradley, T Douglas; Lorenzi-Filho, Geraldo

2011-11-01

Recognition and treatment of secondary causes of hypertension among patients with resistant hypertension may help to control blood pressure and reduce cardiovascular risk. However, there are no studies systematically evaluating secondary causes of hypertension according to the Seventh Joint National Committee. Consecutive patients with resistant hypertension were investigated for known causes of hypertension irrespective of symptoms and signs, including aortic coarctation, Cushing syndrome, obstructive sleep apnea, drugs, pheochromocytoma, primary aldosteronism, renal parenchymal disease, renovascular hypertension, and thyroid disorders. Among 125 patients (age: 52±1 years, 43% males, systolic and diastolic blood pressure: 176±31 and 107±19 mm Hg, respectively), obstructive sleep apnea (apnea-hypopnea index: >15 events per hour) was the most common condition associated with resistant hypertension (64.0%), followed by primary aldosteronism (5.6%), renal artery stenosis (2.4%), renal parenchymal disease (1.6%), oral contraceptives (1.6%), and thyroid disorders (0.8%). In 34.4%, no secondary cause of hypertension was identified (primary hypertension). Two concomitant secondary causes of hypertension were found in 6.4% of patients. Age >50 years (odds ratio: 5.2 [95% CI: 1.9-14.2]; P<0.01), neck circumference ≥41 cm for women and ≥43 cm for men (odds ratio: 4.7 [95% CI: 1.3-16.9]; P=0.02), and presence of snoring (odds ratio: 3.7 [95% CI: 1.3-11]; P=0.02) were predictors of obstructive sleep apnea. In conclusion, obstructive sleep apnea appears to be the most common condition associated with resistant hypertension. Age >50 years, large neck circumference measurement, and snoring are good predictors of obstructive sleep apnea in this population.

Polygenic Overlap Between C-Reactive Protein, Plasma Lipids, and Alzheimer Disease.

PubMed

Desikan, Rahul S; Schork, Andrew J; Wang, Yunpeng; Thompson, Wesley K; Dehghan, Abbas; Ridker, Paul M; Chasman, Daniel I; McEvoy, Linda K; Holland, Dominic; Chen, Chi-Hua; Karow, David S; Brewer, James B; Hess, Christopher P; Williams, Julie; Sims, Rebecca; O'Donovan, Michael C; Choi, Seung Hoan; Bis, Joshua C; Ikram, M Arfan; Gudnason, Vilmundur; DeStefano, Anita L; van der Lee, Sven J; Psaty, Bruce M; van Duijn, Cornelia M; Launer, Lenore; Seshadri, Sudha; Pericak-Vance, Margaret A; Mayeux, Richard; Haines, Jonathan L; Farrer, Lindsay A; Hardy, John; Ulstein, Ingun Dina; Aarsland, Dag; Fladby, Tormod; White, Linda R; Sando, Sigrid B; Rongve, Arvid; Witoelar, Aree; Djurovic, Srdjan; Hyman, Bradley T; Snaedal, Jon; Steinberg, Stacy; Stefansson, Hreinn; Stefansson, Kari; Schellenberg, Gerard D; Andreassen, Ole A; Dale, Anders M

2015-06-09

Epidemiological findings suggest a relationship between Alzheimer disease (AD), inflammation, and dyslipidemia, although the nature of this relationship is not well understood. We investigated whether this phenotypic association arises from a shared genetic basis. Using summary statistics (P values and odds ratios) from genome-wide association studies of >200 000 individuals, we investigated overlap in single-nucleotide polymorphisms associated with clinically diagnosed AD and C-reactive protein (CRP), triglycerides, and high- and low-density lipoprotein levels. We found up to 50-fold enrichment of AD single-nucleotide polymorphisms for different levels of association with C-reactive protein, low-density lipoprotein, high-density lipoprotein, and triglyceride single-nucleotide polymorphisms using a false discovery rate threshold <0.05. By conditioning on polymorphisms associated with the 4 phenotypes, we identified 55 loci associated with increased AD risk. We then conducted a meta-analysis of these 55 variants across 4 independent AD cohorts (total: n=29 054 AD cases and 114 824 healthy controls) and discovered 2 genome-wide significant variants on chromosome 4 (rs13113697; closest gene, HS3ST1; odds ratio=1.07; 95% confidence interval=1.05-1.11; P=2.86×10(-8)) and chromosome 10 (rs7920721; closest gene, ECHDC3; odds ratio=1.07; 95% confidence interval=1.04-1.11; P=3.38×10(-8)). We also found that gene expression of HS3ST1 and ECHDC3 was altered in AD brains compared with control brains. We demonstrate genetic overlap between AD, C-reactive protein, and plasma lipids. By conditioning on the genetic association with the cardiovascular phenotypes, we identify novel AD susceptibility loci, including 2 genome-wide significant variants conferring increased risk for AD. © 2015 American Heart Association, Inc.

Chronic pulmonary disease is associated with pain spreading and restless legs syndrome in middle-aged women-a population-based study.

PubMed

Ding, Zou; Stehlik, Romana; Hedner, Jan; Ulfberg, Jan; Grote, Ludger

2018-06-04

Recent studies suggest an increased prevalence of chronic pain conditions and restless legs syndrome (RLS) in patients with chronic pulmonary disease (CPD). We analyzed the prevalence and risk factors for pain and RLS in a population-based sample of females with comorbid CPD. Questionnaire-based data from 2745 women aged 18-64 years were analyzed regarding comorbid CPD status (severe bronchitis, emphysema, asthma). Pain status was assessed according to symptoms reflecting severity (Visual Analogue Scale, VAS rating 0-10) and duration and spreading (limited spread or widespread) of pain. A diagnosis of RLS was defined by four validated diagnostic criteria. Anthropometrics and co-morbidities were assessed as covariates in univariate and multivariate analyses. Widespread pain was overrepresented in women with CPD (44.6 vs. 24.6%, p < 0.001). The odds ratio for widespread pain in women with CPD was 1.6 (95% confidence interval (CI) 1.2-2.2, p < 0.001) in the fully adjusted model. Severe pain (VAS rating ≥ 7) was more prevalent in females with known CPD (28.8 vs. 15.4%, p < 0.001, odd ratio 1.4 (95% CI 1.0-1.9, p = 0.029)). The prevalence of RLS was 37.4 and 23.8% in subjects with or without CPD, respectively (p < 0.001). In multivariate analysis, CPD was associated with a 30% risk increase for RLS (odds ratio 1.3 (95% CI 1.0-1.7, p = 0.04)). This population-based study identified CPD as an independent risk factor for severe and widespread pain as well as for RLS. Further research addressing pathophysiological mechanisms linking CPD and chronic pain conditions/RLS is warranted.

Lack of association between migraine headache and patent foramen ovale: results of a case-control study.

PubMed

Garg, Pallav; Servoss, Stephen J; Wu, Justina C; Bajwa, Zahid H; Selim, Magdy H; Dineen, Alexis; Kuntz, Richard E; Cook, E Francis; Mauri, Laura

2010-03-30

Clinical observations of migraine headache symptoms in patients with a patent foramen ovale (PFO), both of which conditions are highly prevalent, have raised the question of a possible pathophysiological relationship. We sought to evaluate the assumption of an association between migraine headaches and the presence of PFO by use of a large case-control study. We conducted a case-control study to assess the prevalence of PFO in subjects with and without migraine. Case subjects were those with a history of migraine (diagnosed by neurologists at a specialty academic headache clinic). Control subjects were healthy volunteers without migraine 1:1 matched on the basis of age and sex with case subjects. Presence of PFO was determined by transthoracic echocardiogram with second harmonic imaging and transcranial Doppler ultrasonography during a standardized procedure of infused agitated saline contrast with or without Valsalva maneuver and a review of the results by experts blinded to case-control status. PFO was considered present if both studies were positive. Odds ratios were calculated with conditional logistic regression in the matched cohort (n=288). In the matched analysis, the prevalence of PFO was similar in case and control subjects (26.4% versus 25.7%; odds ratio 1.04, 95% confidence interval 0.62 to 1.74, P=0.90). There was no difference in PFO prevalence in those with migraine with aura and those without (26.8% versus 26.1%; odds ratio 1.03, 95% confidence interval 0.48 to 2.21, P=0.93). We found no association between migraine headaches and the presence of PFO in this large case-control study.

Primary repair of penetrating colon injuries: a systematic review.

PubMed

Singer, Marc A; Nelson, Richard L

2002-12-01

Primary repair of penetrating colon injuries is an appealing management option; however, uncertainty about its safety persists. This study was conducted to compare the morbidity and mortality of primary repair with fecal diversion in the management of penetrating colon injuries by use of a meta-analysis of randomized, prospective trials. We searched for prospective, randomized trials in MEDLINE (1966 to November 2001), the Cochrane Library, and EMBase using the terms colon, penetrating, injury, colostomy, prospective, and randomized. Studies were included if they were randomized, controlled trials that compared the outcomes of primary repair with fecal diversion in the management of penetrating colon injuries. Five studies were included. Reviewers performed data extraction independently. Outcomes evaluated from each trial included mortality, total complications, infectious complications, intra-abdominal infections, wound complications, penetrating abdominal trauma index, and length of stay. Peto odds ratios for combined effect were calculated with a 95 percent confidence interval for each outcome. Heterogeneity was also assessed for each outcome. The penetrating abdominal trauma index of included subjects did not differ significantly between studies. Mortality was not significantly different between groups (odds ratio, 1.70; 95 percent confidence interval, 0.51-5.66). However, total complications (odds ratio, 0.28; 95 percent confidence interval, 0.18-0.42), total infectious complications (odds ratio, 0.41; 95 percent confidence interval, 0.27-0.63), abdominal infections including dehiscence (odds ratio, 0.59; 95 percent confidence interval, 0.38-0.94), abdominal infections excluding dehiscence (odds ratio, 0.52; 95 percent confidence interval, 0.31-0.86), wound complications including dehiscence (odds ratio, 0.55; 95 percent confidence interval, 0.34-0.89), and wound complications excluding dehiscence (odds ratio, 0.43; 95 percent confidence interval, 0.25-0.76) all significantly favored primary repair. Meta-analysis of currently published randomized, controlled trials favors primary repair over fecal diversion for penetrating colon injuries.

Imaging Findings Associated with Space-Occupying Edema in Patients with Large Middle Cerebral Artery Infarcts.

PubMed

Horsch, A D; Dankbaar, J W; Stemerdink, T A; Bennink, E; van Seeters, T; Kappelle, L J; Hofmeijer, J; de Jong, H W; van der Graaf, Y; Velthuis, B K

2016-05-01

Prominent space-occupying cerebral edema is a devastating complication occurring in some but not all patients with large MCA infarcts. It is unclear why differences in the extent of edema exist. Better knowledge of factors related to prominent edema formation could aid treatment strategies. This study aimed to identify variables associated with the development of prominent edema in patients with large MCA infarcts. From the Dutch Acute Stroke Study (DUST), 137 patients were selected with large MCA infarcts on follow-up NCCT (3 ± 2 days after stroke onset), defined as ASPECTS ≤4. Prominent edema was defined as a midline shift of ≥5 mm on follow-up. Admission patient and treatment characteristics were collected. Admission CT parameters used were ASPECTS on NCCT and CBV and MTT maps, and occlusion site, clot burden, and collaterals on CTA. Permeability on admission CTP, and day 3 recanalization and reperfusion statuses were obtained if available. Unadjusted and adjusted (age and NIHSS) odds ratios were calculated for all variables in relation to prominent edema. Prominent edema developed in 51 patients (37%). Adjusted odds ratios for prominent edema were higher with lower ASPECTS on NCCT (adjusted odds ratio, 1.32; 95% CI, 1.13-1.55) and CBV (adjusted odds ratio, 1.26; 95% CI, 1.07-1.49), higher permeability (adjusted odds ratio, 2.35; 95% CI, 1.30-4.24), more proximal thrombus location (adjusted odds ratio, 3.40; 95% CI, 1.57-7.37), higher clot burden (adjusted odds ratio, 2.88; 95% CI, 1.11-7.45), and poor collaterals (adjusted odds ratio, 3.93; 95% CI, 1.78-8.69). Extensive proximal occlusion, poor collaterals, and larger ischemic deficits with higher permeability play a role in the development of prominent edema in large MCA infarcts. © 2016 by American Journal of Neuroradiology.

Severe anemia in Malawian children.

PubMed

Calis, Job Cj; Phiri, Kamija S; Faragher, E Brian; Brabin, Bernard J; Bates, Imelda; Cuevas, Luis E; de Haan, Rob J; Phiri, Ajib I; Malange, Pelani; Khoka, Mirriam; Hulshof, Paul Jm; van Lieshout, Lisette; Beld, Marcel Ghm; Teo, Yik Y; Rockett, Kirk A; Richardson, Anna; Kwiatkowski, Dominic P; Molyneux, Malcolm E; van Hensbroek, Michaël Boele

2016-09-01

Severe anemia is a major cause of sickness and death in African children, yet the causes of anemia in this population have been inadequately studied. We conducted a case-control study of 381 preschool children with severe anemia (hemoglobin concentration, <5.0 g per deciliter) and 757 preschool children without severe anemia in urban and rural settings in Malawi. Causal factors previously associated with severe anemia were studied. The data were examined by multivariate analysis and structural equation modeling. Bacteremia (adjusted odds ratio, 5.3; 95% confidence interval [CI], 2.6 to 10.9), malaria (adjusted odds ratio, 2.3; 95% CI, 1.6 to 3.3), hookworm (adjusted odds ratio, 4.8; 95% CI, 2.0 to 11.8), human immunodeficiency virus infection (adjusted odds ratio, 2.0; 95% CI, 1.0 to 3.8), the G6PD -202/-376 genetic disorder (adjusted odds ratio, 2.4; 95% CI, 1.3 to 4.4), vitamin A deficiency (adjusted odds ratio, 2.8; 95% CI, 1.3 to 5.8), and vitamin B 12 deficiency (adjusted odds ratio, 2.2; 95% CI, 1.4 to 3.6) were associated with severe anemia. Folate deficiency, sickle cell disease, and laboratory signs of an abnormal inflammatory response were uncommon. Iron deficiency was not prevalent in case patients (adjusted odds ratio, 0.37; 95% CI, 0.22 to 0.60) and was negatively associated with bacteremia. Malaria was associated with severe anemia in the urban site (with seasonal transmission) but not in the rural site (where malaria was holoendemic). Seventy-six percent of hookworm infections were found in children under 2 years of age. There are multiple causes of severe anemia in Malawian preschool children, but folate and iron deficiencies are not prominent among them. Even in the presence of malaria parasites, additional or alternative causes of severe anemia should be considered.

Extracorporeal cardiopulmonary resuscitation outcomes in term and premature neonates*.

PubMed

McMullan, David Michael; Thiagarajan, Ravi R; Smith, Kendra M; Rycus, Peter T; Brogan, Thomas V

2014-01-01

Extracorporeal cardiopulmonary resuscitation appears to improve survival in patients with acute refractory cardiopulmonary failure. This analysis was performed to determine survival outcomes and predictors of in-hospital mortality for term and preterm neonates who received extracorporeal cardiopulmonary resuscitation. Retrospective review of data from the Extracorporeal Life Support Organization international registry. Pediatric and neonatal ICUs. Infants less than or equal to 30 days. Extracorporeal cardiopulmonary resuscitation. Demographic, clinical, and survival data from patients who received extracorporeal cardiopulmonary resuscitation between 1998 and 2010 were analyzed to determine factors that affect in-hospital mortality. Overall survival to hospital discharge for the 641 neonates who received extracorporeal cardiopulmonary resuscitation was 39%. In univariate analysis, gestational age correlated inversely with stroke (odds ratio, 0.84 [95% CI, 0.75-0.95]; p = 0.006) and death (odds ratio, 0.87 [95% CI, 0.78-0.96]; p = 0.005) as did corrected gestational age (odds ratio, 0.89 [95% CI, 0.81-0.97]; p = 0.006) and birth weight (odds ratio, 0.53 [95% CI, 0.38-0.74]; p < 0.001). Dysrhythmia as the primary diagnosis had significantly lower odds of death than single-ventricle cardiac disease (odds ratio, 0.24 [95% CI, 0.06-0.95]; p = 0.04). Higher pre-extracorporeal cardiopulmonary resuscitation oxygenation decreased the odds of death (odds ratio, 0.996 [95% CI, 0.994-0.999]; p = 0.01), whereas complications occurring on extracorporeal life support increased the odds of death. In the multivariate analysis, lower birth weight and pre-extracorporeal cardiopulmonary resuscitation oxygenation, as well as complications including CNS hemorrhage, pulmonary hemorrhage, acidosis, renal replacement therapy, and mechanical complications, increased the odds of death. Overall survival for neonates receiving extracorporeal cardiopulmonary resuscitation is similar to older pediatric patients but decreases with lower gestational age and weight. Despite this, many low-birth weight neonates survive to hospital discharge.

Factors affecting nutritional status in female adults in Dhaka slums, Bangladesh.

PubMed

Pryer, Jane A; Rogers, Stephen; Rahman, Ataur

2003-01-01

This study looks at women from the slums in Mohammadpur, Dhaka, Bangladesh, where 54 percent of women's BMI was less than 18.5. Fifty percent of the Dhaka slum population lived below the poverty line. Logistic regression showed that women with income above 1,500 taka per capita were 1.78 times more likely to have a higher BMI (odds ratio 1.7863; CI = 0.671-3.639). Women with their own savings were 1.89 times more likely to have higher BMI (odds ratio 1.879; CI = 0.01163-1.6431). Women were 4.5 times more likely to have a higher BMI when food expenditure per capita above 559 taka per month (odds ratio 4.55; CI = 1.0302-8.0799). Women were 1.82 times more likely to have higher BMI when there was a break even situation in financial status (odds ratio 1.8212; CI = -015709-3.6285). Female headed households were 3.3 times more likely to have a higher BMI compared to women living in male headed households (odds ratio 3.2966; CI = 0.33711-6.25620). Women who work 15-23 days per month were 2.3 times more likely to have a higher BMI (odds ratio 2.33; CI = 0.1133-4.5600). Women who are the budget manager are 1.12 times more likely to have a higher BMI (odds ratio 1.125; CI = 0.29296-2.0966). Where as a husband who beats his wife is 1.83 more likely to have a poorer BMI (odds ratio 1.8312; CI = -3.72596-0.17508). Women who have no marriage documents and women who take days off due to illness less than 11 days per month were more likely to have a poorer BMI (odds ratio 0.5567; CI = -0.049339-2.8379; odds ratio 0.7569; CI = 0.183167-2.0002). Women's nutritional status and well being can influence their ability to provide for themselves and their families and the demonstration of a relationship between measures of women's autonomy and control in the household and women's nutritional status is an important indication of the importance of these sociological constructs. Women's participation in work outside the home may be a factor increasing their autonomy. The identification of relationships between women's autonomy and control and their physical well being should provide further leverage for policy change that will enable women to escape some traditional roles and to contribute as more equal partners with men in the future of Bangladeshi society.

Statistical analyses of the relative risk.

PubMed Central

Gart, J J

1979-01-01

Let P1 be the probability of a disease in one population and P2 be the probability of a disease in a second population. The ratio of these quantities, R = P1/P2, is termed the relative risk. We consider first the analyses of the relative risk from retrospective studies. The relation between the relative risk and the odds ratio (or cross-product ratio) is developed. The odds ratio can be considered a parameter of an exponential model possessing sufficient statistics. This permits the development of exact significance tests and confidence intervals in the conditional space. Unconditional tests and intervals are also considered briefly. The consequences of misclassification errors and ignoring matching or stratifying are also considered. The various methods are extended to combination of results over the strata. Examples of case-control studies testing the association between HL-A frequencies and cancer illustrate the techniques. The parallel analyses of prospective studies are given. If P1 and P2 are small with large samples sizes the appropriate model is a Poisson distribution. This yields a exponential model with sufficient statistics. Exact conditional tests and confidence intervals can then be developed. Here we consider the case where two populations are compared adjusting for sex differences as well as for the strata (or covariate) differences such as age. The methods are applied to two examples: (1) testing in the two sexes the ratio of relative risks of skin cancer in people living in different latitudes, and (2) testing over time the ratio of the relative risks of cancer in two cities, one of which fluoridated its drinking water and one which did not. PMID:540589

Morphological Features in Children with Autism Spectrum Disorders: A Matched Case-Control Study

ERIC Educational Resources Information Center

Ozgen, Heval; Hellemann, Gerhard S.; Stellato, Rebecca K.; Lahuis, Bertine; van Daalen, Emma; Staal, Wouter G.; Rozendal, Marije; Hennekam, Raoul C.; Beemer, Frits A.; van Engeland, Herman

2011-01-01

This study was designed to examine morphological features in a large group of children with autism spectrum disorder versus normal controls. Amongst 421 patients and 1,007 controls, 224 matched pairs were created. Prevalence rates and odds ratios were analyzed by conditional regression analysis, McNemar test or paired t-test matched pairs.…

Changes in erythrocytic deformability and plasma viscosity in neonatal ictericia.

PubMed

Bonillo-Perales, A; Muñoz-Hoyos, A; Martínez-Morales, A; Molina-Carballo, A; Uberos-Fernández, J; Puertas-Prieto, A

1999-01-01

We studied 45 full-term newborns divided into 3 groups. Group 1: 17 newborns with bilirubin <10 mg/dL; Group 2: 18 newborns with hemolytic ictericia (bilirubin 11-20 mg/dL) and Group 3: 10 newborns with moderate hemolytic ictericia needing exchange transfusion. The following were studied: erythrocytic deformability, plasma viscosity, plasmatic osmolarity, seric bilirubin, bilirubin/albumin ratio, free fatty acids and corpuscular volume of the erythrocytes. In full-term newborns, the following are risk factors for increased erythrocytic rigidity: neonatal hemolytic illness (p = 0.004, odds ratio: 7.02), increases in total bilirubin (p = 0.02, odds ratio: 4.3) and increases in the bilirubin/albumin ratio (p = 0.025, odds ratio: 4.25). Furthermore, the most important risk factor for high plasma viscosity is also neonatal hemolytic illness (p = 0.01, odds ratio: 2.30). The role of total bilirubin is also important (p = 0.09, odds ratio: 2.10), while that of the bilirubin/albumin ratio (p = 0.012, NS) is less so. The greater the hemolysis, the greater the erythrocytic rigidity and plasma viscosity (p < 0.01). In full-term newborns with moderate ictericia, hemolytic illness and increases in the bilirubin/albumin ratio are accompanied by rheological alterations that could affect cerebral microcirculation and cause a neurological deficit not exclusively related to the levels of bilirubin in plasma.

Health conditions in methamphetamine-dependent adults 3 years after treatment.

PubMed

Mooney, Larissa J; Glasner-Edwards, Suzette; Marinelli-Casey, Patricia; Hillhouse, Maureen; Ang, Alfonso; Hunter, Jeremy; Haning, William; Colescott, Paula; Ling, Walter; Rawson, Richard

2009-09-01

: Medical conditions in methamphetamine (MA) users have not been well characterized. Using both self-report and physical examination data, the aims of this study were to (1) describe the frequency of medical conditions in a sample of MA users 3 years posttreatment; (2) evaluate the association between medical conditions and MA use frequency; and (3) examine the relationship of route of administration with medical outcomes. : MA-dependent adults (N = 301) who participated in the Methamphetamine Treatment Project were interviewed and examined 3 years after treatment. Medical, demographic, and substance use characteristics were assessed using the Addiction Severity Index and Life Experiences Timeline. Current and lifetime medical conditions, electrocardiogram characteristics, and physical examination abnormalities were assessed. : Among the most frequently reported lifetime conditions were wounds and burns (40.5%, N = 122) and severe dental problems (33%, N = 99), and a significant proportion of the sample evidenced prolonged corrected QT interval (19.6%, N = 43). Although health conditions were not associated with MA use frequency during follow-up, intravenous MA use was significantly associated with missing teeth (odds ratio = 2.4; 95% confidence interval, 1.2-4.7) and hepatitis C antibodies (odds ratio = 13.1; confidence interval, 5.6-30.1). : In this sample of MA users, dental problems and corrected QT prolongation were observed at elevated rates. Although posttreatment MA use frequency was not associated with a majority of medical outcomes, intravenous MA use exacerbated risk for dental pathology and hepatitis C. Longer term follow-up research is needed to elucidate health trajectories of MA users.

Firefighter heart presumption retirements in Massachusetts 1997-2004.

PubMed

Holder, Jonathan D; Stallings, Leonard A; Peeples, Lynne; Burress, John W; Kales, Stefanos N

2006-10-01

"Heart Presumption" legislation is common throughout North America. We sought to study Massachusetts firefighters retiring with heart disability awards. The authors conducted a retrospective review of Massachusetts firefighters: 362 receiving Heart Presumption pensions (1997-2004) and a comparison group of 310 professionally active firefighters. Of retirements, 77% were due to coronary heart disease and 23% for other cardiovascular conditions. Only 42% of the retirements were related to discrete on-duty events. Fire suppression (odds ratio = 51, 95% confidence interval = 12-223) and alarm response (odds ratio = 6.4, 95% confidence interval = 2.5-17) were associated with markedly higher risks of duty-related heart retirement events than nonemergency activities. Cardiovascular risk factor prevalence was high among all retiree subgroups and significantly greater than among control firefighters in almost all cases. Our study supports calls for improved cardiovascular prevention and risk reduction strategies among firefighters.

[Effect of different anesthetic methods on postoperative outcomes in elderly patients undergoing hip fracture surgery].

PubMed

Wei, B; Zhang, H; Xu, M; Li, M; Wang, J; Zhang, L P; Guo, X Y; Zhao, Y M; Zhou, F

2017-12-18

To investigate the effect of general or regional anesthesia on postoperative cardiopulmonary complications and inpatient mortality after hip fracture surgery in elderly patients. A retrospective analysis was conducted according to the medical records of 572 elderly patients with hip fractures admitted to our hospital from January 1, 2005 to December 31, 2014. The age, gender, preoperative comorbidities, length of preoperative bedridden time, mechanism of injury, surgical types, anesthetic methods, major postoperative complications and inpatient mortality were recorded. Multivariate Logistic regression analysis was applied to analyze the impact of different anesthetic methods on inpatient mortality in these patients. Of the 572 patients, 392 (68.5%) received regional anesthesia. Inpatient death occurred in 8 (8/572, mortality: 1.4%), including 5 cases of RA group (5/392, mortality: 1.3%) and 3 cases of GA group (3/180, mortality: 1.7%). There was no statistically significant difference between the two groups in inpatient mortality (P>0.05). Multiple Logistic regression analysis showed that gender (odds ratio: 0.18, 95% CI: 0.03-1.05, P=0.057), age (odds ratio: 1.22, 95% CI: 1.07-1.38, P=0.002), preoperative pulmonary comorbidities (odds ratio: 12.09, 95% CI: 2.28-64.12, P=0.003) and surgical types (odds ratio: 9.36, 95% CI: 1.34-64.26, P=0.024) were risk factors for inpatient mortality. Postoperative cardiovascular complications occurred in 36 patients (36/572, morbidity: 6.3%), with 19 patients in RA group (19/392, morbidity: 4.8%),and 17 patients in GA group (17/180, morbidity: 9.4%). Multiple Logistic regression analysis showed that age (odds ratio: 1.13, 95% CI: 1.07-1.19, P<0.001), hypertension (odds ratio: 2.72, 95% CI: 1.24-5.96, P=0.012) and preoperative cerebral comorbidities (odds ratio: 2.11, 95% CI: 0.99-4.52, P=0.054) were risk factors for postoperative cardiovascular complications. Postoperative pulmonary complications occurred in 56 patients (56/572, morbidity: 9.8%), with 19 patients in RA group (19/392, morbidity: 4.8%), and 37 patients in GA group (37/180, morbidity: 20.6%). Multiple Logistic regression analysis showed that age (odds ratio: 1.13, 95% CI: 1.07-1.19, P<0.001), preoperative pulmonary comorbidities (odds ratio: 2.89, 95% CI: 1.28-7.05, P=0.020), length of preoperative bedridden time (odds ratio: 1.11, 95% CI: 1.04-1.18, P=0.003) and anesthetic methods (odds ratio: 5.86, 95% CI: 2.98-11.53, P<0.001) were risk factors for postoperative pulmonary complications. General anesthesia may not affect the inpatient mortality after hip fracture surgery in elderly patients. Regional anesthesia is associated with a lower risk of pulmonary complications after surgical procedure compared with general anesthesia.

Associations of Sedentary Behavior, Physical Activity, Cardiorespiratory Fitness, and Body Fat Content With Pain Conditions in Children: The Physical Activity and Nutrition in Children Study.

PubMed

Vierola, Anu; Suominen, Anna Liisa; Lindi, Virpi; Viitasalo, Anna; Ikävalko, Tiina; Lintu, Niina; Väistö, Juuso; Kellokoski, Jari; Närhi, Matti; Lakka, Timo A

2016-07-01

We investigated the cross-sectional associations of sedentary behavior, physical activity, cardiorespiratory fitness, and body fat content with pain conditions in prepubertal children. The participants were a population sample of 439 children aged 6 to 8 years. Sedentary behavior, physical activity, and pain conditions were assessed using questionnaires, cardiorespiratory fitness using maximal cycle ergometer test, and body fat percentage using dual-energy X-ray absorptiometry. The associations of sedentary behavior, physical activity, cardiorespiratory fitness, and body fat percentage with the risk of pain conditions were analyzed using multivariate logistic regression. Children in the highest sex-specific third of sedentary behavior had 1.95 (95% confidence interval [CI], 1.20-3.17; P = .007 for trend across thirds) times higher odds of any pain than children in the lowest third. Children in the highest sex-specific third of cardiorespiratory fitness had 46% (odds ratio [OR] = .54; 95% CI, .32-.91; P = .019) lower odds of any pain and 50% (OR = .50; 95% CI, .28-.87; P = .015) lower odds of headache than children in the lowest third. Children in the highest sex-specific third of body fat percentage had 44% (OR = .56; 95% CI, .34-.93; P = .023) lower odds of any pain, 49% (OR = .51; 95% CI, .30-.86; P = .011) lower risk of multiple pain, and 48% (OR = .52; 95% CI, .31-.86; P = .010) lower odds of lower limb pain than children in the lowest third. Physical activity was not associated with pain conditions. These findings suggest that prepubertal children with high levels of sedentary behavior, low levels of cardiorespiratory fitness, and low body fat content have increased likelihood of various pain conditions. This information could be used to develop strategies to prevent chronic pain in childhood. Our findings suggest that low cardiorespiratory fitness, high levels of sedentary behavior, and low body fat content are associated with increased likelihood of various pain conditions among prepubertal children. This information could be used to develop strategies to prevent chronic pain in childhood. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

Sexual dysfunction among Chinese married men aged 30-60 years: a population-based study in Hong Kong.

PubMed

Zhang, Huiping; Yip, Andrew W C; Fan, Susan; Yip, Paul S F

2013-02-01

To estimate the prevalence of, and risk factors associated with, sexual dysfunction among Hong Kong Chinese married men aged 30-60 years. The present study was a part of the Ninth Knowledge, Attitude, and Practice survey conducted in 2007 by the Family Planning Association of Hong Kong. The data set consisted of 728 face-to-face interviews with Hong Kong Chinese married men aged 30-60 years living in the community. The classification of sexual dysfunction in the "Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition" was used to measure male sexual dysfunction (MSD). Regarding MSD prevalence, approximately 15% of men reported ≥ 1 form of MSD, with a lack of sexual interest, erectile dysfunction, and premature ejaculation present in 11.1%, 4.3%, and 4.7%, respectively. Multivariate analysis showed that age (odds ratio 2.39), employment status (odds ratio 3.62), having a wife who sought medical help for sexual problems (odds ratio 4.47), liberal attitudes toward female sexual initiation (odds ratio 2.07), and marital dissatisfaction (odds ratio 2.35) were all statistically significant risk factors for MSD and its specific components among the sample. However, having traditional attitudes toward female sexual refusal was a protective factor for MSD (odds ratio 0.51) and lack of sexual interest (odds ratio 0.51). The prevalence of MSD was low among young and middle-age married men in Hong Kong. Factors contributing to the risk of MSD spanned the domains of socioeconomic status, attitudes toward sex, and relationship factors. These findings suggest future directions for public health policies and the delivery of services that address the prevention and treatment of MSD. Copyright © 2013 Elsevier Inc. All rights reserved.

Breast-feeding and infant illness: a dose-response relationship?

PubMed Central

Raisler, J; Alexander, C; O'Campo, P

1999-01-01

OBJECTIVES: The purpose of this study was to determine whether breast-feeding has a dose-related protective effect against illness and whether it confers special health benefits to poor infants. METHODS: The association between breast-feeding dose and illnesses in the first 6 months of life was analyzed with generalized estimating equations regression for 7092 infants from the National Maternal and Infant Health Survey. Breast-feeding dose (ratio of breast-feedings to other feedings) was categorized as full, most, equal, less, or no breast-feeding. RESULTS: Compared with no breast-feeding, full breast-feeding infants had lower odds ratios of diarrhea, cough or wheeze, and vomiting and lower mean ratios of illness months and sick baby medical visits. Most breast-feeding infants had lower odds ratios of diarrhea and cough or wheeze, and equal breast-feeding infants had lower odds ratios of cough or wheeze. Full, most, and equal breast-feeding infants without siblings had lower odds ratios of ear infections and certain other illnesses, but those with siblings did not. Less breast-feeding infants had no reduced odds ratios of illness. Findings did not vary by income. CONCLUSIONS: Full breast-feeding was associated with the lowest illness rates. Minimal (less) breast-feeding was not protective. Breast-feeding conferred similar health benefits in all economic groups. PMID:9987460

Age-specific fluoride exposure in drinking water and osteosarcoma (United States).

PubMed

Bassin, Elise B; Wypij, David; Davis, Roger B; Mittleman, Murray A

2006-05-01

We explored age-specific and gender-specific effects of fluoride level in drinking water and the incidence of osteosarcoma. We used data from a matched case-control study conducted through 11 hospitals in the United States that included a complete residential history for each patient and type of drinking water (public, private well, bottled) used at each address. Our analysis was limited to cases less than 20 years old. We standardized fluoride exposure estimates based on CDC-recommended target levels that take climate into account. We categorized exposure into three groups (<30%, 30-99%, >99% of target) and used conditional logistic regression to estimate odds ratios. Analysis is based on 103 cases under the age of 20 and 215 matched controls. For males, the unadjusted odds ratios for higher exposures were greater than 1.0 at each exposure age, reaching a peak of 4.07 (95% CI 1.43, 11.56) at age 7 years for the highest exposure. Adjusting for potential confounders produced similar results with an adjusted odds ratio for males of 5.46 (95% CI 1.50, 19.90) at age 7 years. This association was not apparent among females. Our exploratory analysis found an association between fluoride exposure in drinking water during childhood and the incidence of osteosarcoma among males but not consistently among females. Further research is required to confirm or refute this observation.

Marital status, social capital and health locus of control: a population-based study.

PubMed

Lindström, M; Rosvall, M

2012-09-01

To investigate the association between marital status and lack of internal health locus of control (HLC), taking economic stress and trust into account. Cross-sectional study. The public health survey Skåne 2008 is a postal questionnaire study (55% participation rate). A random sample was invited to participate, and 28,198 individuals aged 18-80 years agreed. Logistic regression models were used to discern associations between marital status and lack of internal HLC. The multiple regression analyses included age, country of birth, education, economic stress and 'horizontal' trust. In total, 33.7% of the men and 31.8% of the women lacked internal HLC. After age-adjustments, the unmarried and divorced men and the widowed women displayed significantly higher odds ratios of lack of internal HLC. The significantly higher odds ratios only remained for unmarried men throughout the multiple analyses. In contrast, divorced women had significantly lower odds ratios of lack of internal HLC than married women after adjustments for economic stress. Health promotion regarding HLC and related behaviours should consider men and women who are not cohabiting. Health promotion should particularly consider unmarried men due to their higher propensity to lack internal HLC. The economic conditions and exposure to economic stress among widowed and divorced women should also be highlighted. Copyright © 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Impact of prestroke selective serotonin reuptake inhibitor treatment on stroke severity and mortality.

PubMed

Mortensen, Janne Kaergaard; Larsson, Heidi; Johnsen, Søren Paaske; Andersen, Grethe

2014-07-01

Selective serotonin reuptake inhibitors (SSRIs) have been associated with an increased risk of bleeding but also a possible neuroprotective effect in stroke. We aimed to examine the implications of prestroke SSRI use in hemorrhagic and ischemic stroke. We conducted a registry-based propensity score-matched follow-up study among first-ever patients with hemorrhage and ischemic stroke in Denmark (2003-2012). Multiple conditional logistic regression was used to compute adjusted odds ratios of severe stroke and death within 30 days. Among 1252 hemorrhagic strokes (626 prestroke SSRI users and 626 propensity score-matched nonusers), prestroke SSRI use was associated with an increased risk of the strokes being severe (adjusted propensity score-matched odds ratios, 1.41; confidence interval, 1.08-1.84) and an increased risk of death within 30 days (adjusted propensity score-matched odds ratios, 1.60; confidence interval, 1.17-2.18). Among 8956 patients with ischemic stroke (4478 prestroke SSRI users and 4478 propensity score-matched nonusers), prestroke SSRI use was not associated with the risk of severe stroke or death within 30 days. Prestroke SSRI use is associated with increased stroke severity and mortality in patients with hemorrhagic stroke. Although prestroke depression in itself may increase stroke severity and mortality, this was not found in SSRI users with ischemic stroke. © 2014 American Heart Association, Inc.

Internal Medicine residents use heuristics to estimate disease probability.

PubMed

Phang, Sen Han; Ravani, Pietro; Schaefer, Jeffrey; Wright, Bruce; McLaughlin, Kevin

2015-01-01

Training in Bayesian reasoning may have limited impact on accuracy of probability estimates. In this study, our goal was to explore whether residents previously exposed to Bayesian reasoning use heuristics rather than Bayesian reasoning to estimate disease probabilities. We predicted that if residents use heuristics then post-test probability estimates would be increased by non-discriminating clinical features or a high anchor for a target condition. We randomized 55 Internal Medicine residents to different versions of four clinical vignettes and asked them to estimate probabilities of target conditions. We manipulated the clinical data for each vignette to be consistent with either 1) using a representative heuristic, by adding non-discriminating prototypical clinical features of the target condition, or 2) using anchoring with adjustment heuristic, by providing a high or low anchor for the target condition. When presented with additional non-discriminating data the odds of diagnosing the target condition were increased (odds ratio (OR) 2.83, 95% confidence interval [1.30, 6.15], p = 0.009). Similarly, the odds of diagnosing the target condition were increased when a high anchor preceded the vignette (OR 2.04, [1.09, 3.81], p = 0.025). Our findings suggest that despite previous exposure to the use of Bayesian reasoning, residents use heuristics, such as the representative heuristic and anchoring with adjustment, to estimate probabilities. Potential reasons for attribute substitution include the relative cognitive ease of heuristics vs. Bayesian reasoning or perhaps residents in their clinical practice use gist traces rather than precise probability estimates when diagnosing.

Maternal and neonatal outcomes of antenatal anemia in a Scottish population: a retrospective cohort study.

PubMed

Rukuni, Ruramayi; Bhattacharya, Sohinee; Murphy, Michael F; Roberts, David; Stanworth, Simon J; Knight, Marian

2016-05-01

Antenatal anemia is a major public health problem in the UK, yet there is limited high quality evidence for associated poor clinical outcomes. The objectives of this study were to estimate the incidence and clinical outcomes of antenatal anemia in a Scottish population. A retrospective cohort study of 80 422 singleton pregnancies was conducted using data from the Aberdeen Maternal and Neonatal Databank between 1995 and 2012. Antenatal anemia was defined as haemoglobin ≤ 10 g/dl during pregnancy. Incidence was calculated with 95% confidence intervals and compared over time using a chi-squared test for trend. Multivariable logistic regression was used to adjust for confounding variables. Results are presented as adjusted odds ratios with 95% confidence interval. The overall incidence of antenatal anemia was 9.3 cases/100 singleton pregnancies (95% confidence interval 9.1-9.5), decreasing from 16.9/100 to 4.1/100 singleton pregnancies between 1995 and 2012 (p < 0.001). Maternal anemia was associated with antepartum hemorrhage (adjusted odds ratio 1.26, 95% confidence interval 1.17-1.36), postpartum infection (adjusted odds ratio 1.89, 95% confidence interval 1.39-2.57), transfusion (adjusted odds ratio 1.87, 95% confidence interval 1.65-2.13) and stillbirth (adjusted odds ratio 1.42, 95% confidence interval 1.04-1.94), reduced odds of postpartum hemorrhage (adjusted odds ratio 0.92, 95% confidence interval 0.86-0.98) and low birthweight (adjusted odds ratio 0.77, 95% confidence interval 0.69-0.86). No other outcomes were statistically significant. This study shows the incidence of antenatal anemia is decreasing steadily within this Scottish population. However, given that anemia is a readily correctable risk factor for major causes of morbidity and mortality in the UK, further work is required to investigate appropriate preventive measures. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

Statin Exposure Is Associated with Decreased Asthma-related Emergency Department Visits and Oral Corticosteroid Use

PubMed Central

Li, Lingling; Butler, Melissa G.; Fung, Vicki; Kharbanda, Elyse O.; Larkin, Emma K.; Vollmer, William M.; Miroshnik, Irina; Rusinak, Donna; Weiss, Scott T.; Lieu, Tracy; Wu, Ann Chen

2013-01-01

Rationale: Statins, or HMG-CoA reductase inhibitors, may aid in the treatment of asthma through their pleiotropic antiinflammatory effects. Objectives: To examine the effect of statin therapy on asthma-related exacerbations using a large population-based cohort. Methods: Statin users aged 31 years or greater with asthma were identified from the Population-Based Effectiveness in Asthma and Lung population, which includes data from five health plans. Statin exposure and asthma exacerbations were assessed over a 24-month observation period. Statin users with a statin medication possession ratio greater than or equal to 80% were matched to non–statin users by age, baseline asthma therapy, site of enrollment, season at baseline, and propensity score, which was calculated based on patient demographics and Deyo-Charlson conditions. Asthma exacerbations were defined as two or more oral corticosteroid dispensings, asthma-related emergency department visits, or asthma-related hospitalizations. The association between statin exposure and each of the three outcome measures was assessed using conditional logistic regression. Measurements and Main Results: Of the 14,566 statin users, 8,349 statin users were matched to a nonuser. After adjusting for Deyo-Charlson conditions that remained unbalanced after matching, among statin users, statin exposure was associated with decreased odds of having asthma-related emergency department visits (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.53–0.77; P < 0.0001) and two or more oral corticosteroid dispensings (OR, 0.90; 95% CI, 0.81–0.99; P = 0.04). There were no differences in asthma-related hospitalizations (OR, 0.91; 95% CI, 0.66–1.24; P = 0.52). Conclusions: Among statin users with asthma, statin exposure was associated with decreased odds of asthma-related emergency department visits and oral corticosteroid dispensings. PMID:24093599

Factors affecting mortality in older trauma patients-A systematic review and meta-analysis.

PubMed

Sammy, Ian; Lecky, Fiona; Sutton, Anthea; Leaviss, Joanna; O'Cathain, Alicia

2016-06-01

Major trauma in older people is a significant health burden in the developed world. The aging of the population has resulted in larger numbers of older patients suffering serious injury. Older trauma patients are at greater risk of death from major trauma, but the reasons for this are less well understood. The aim of this review was to identify the factors affecting mortality in older patients suffering major injury. A systematic review of Medline, Cinhal and the Cochrane database, supplemented by a manual search of relevant papers was undertaken, with meta-analysis. Multi-centre cohort studies of existing trauma registries that reported risk-adjusted mortality (adjusted odds ratios, AOR) in their outcomes and which analysed patients aged 65 and older as a separate cohort were included in the review. 3609 papers were identified from the electronic databases, and 28 from manual searches. Of these, 15 papers fulfilled the inclusion criteria. Demographic variables (age and gender), pre-existing conditions (comorbidities and medication), and injury-related factors (injury severity, pattern and mechanism) were found to affect mortality. The 'oldest old', aged 75 and older, had higher mortality rates than younger patients, aged 65-74 years. Older men had a significantly higher mortality rate than women (cumulative odds ratio 1.51, 95% CI 1.37-1.66). Three papers reported a higher risk of death in patients with pre-existing conditions. Two studies reported increased mortality in patients on warfarin (cumulative odds ratio 1.32, 95% CI 1.05-1.66). Higher mortality was seen in patients with lower Glasgow coma scores and systolic blood pressures. Mortality increased with increased injury severity and number of injuries sustained. Low level falls were associated with higher mortality than motor vehicle collisions (cumulative odds ratio 2.88, 95% CI 1.26-6.60). Multiple factors contribute to mortality risk in older trauma patients. The relation between these factors and mortality is complex, and a fuller understanding of the contribution of each factor is needed to develop a better predictive model for trauma outcomes in older people. More research is required to identify patient and process factors affecting mortality in older patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

Acute Maternal Infection and Risk of Pre-Eclampsia: A Population-Based Case-Control Study

PubMed Central

Minassian, Caroline; Thomas, Sara L.; Williams, David J.; Campbell, Oona; Smeeth, Liam

2013-01-01

Background Infection in pregnancy may be involved in the aetiology of pre-eclampsia. However, a clear association between acute maternal infection and pre-eclampsia has not been established. We assessed whether acute urinary tract infection, respiratory tract infection, and antibiotic drug prescriptions in pregnancy (a likely proxy for maternal infection) are associated with an increased risk of pre-eclampsia. Methods and Findings We used a matched nested case-control design and data from the UK General Practice Research Database to examine the association between maternal infection and pre-eclampsia. Primiparous women aged at least 13 years and registered with a participating practice between January 1987 and October 2007 were eligible for inclusion. We selected all cases of pre-eclampsia and a random sample of primiparous women without pre-eclampsia (controls). Cases (n = 1533) were individually matched with up to ten controls (n = 14236) on practice and year of delivery. We calculated odds ratios and 95% confidence intervals for pre-eclampsia comparing women exposed and unexposed to infection using multivariable conditional logistic regression. After adjusting for maternal age, pre-gestational hypertension, diabetes, renal disease and multifetal gestation, the odds of pre-eclampsia were increased in women prescribed antibiotic drugs (adjusted odds ratio 1.28;1.14–1.44) and in women with urinary tract infection (adjusted odds ratio 1.22;1.03–1.45). We found no association with maternal respiratory tract infection (adjusted odds ratio 0.91;0.72–1.16). Further adjustment for maternal smoking and pre-pregnancy body mass index made no difference to our findings. Conclusions Women who acquire a urinary infection during pregnancy, but not those who have a respiratory infection, are at an increased risk of pre-eclampsia. Maternal antibiotic prescriptions are also associated with an increased risk. Further research is required to elucidate the underlying mechanism of this association and to determine whether, among women who acquire infections in pregnancy, prompt treatment or prophylaxis against infection might reduce the risk of pre-eclampsia. PMID:24019891

Expression of Proteins Involved in Epithelial-Mesenchymal Transition as Predictors of Metastasis and Survival in Breast Cancer Patients

DTIC Science & Technology

2013-11-01

Ptrend 0.78 0.62 0.75 Unconditional logistic regression was used to estimate odds ratios (OR) and 95 % confidence intervals (CI) for risk of node...Ptrend 0.71 0.67 Unconditional logistic regression was used to estimate odds ratios (OR) and 95 % confidence intervals (CI) for risk of high-grade tumors... logistic regression was used to estimate odds ratios (OR) and 95 % confidence intervals (CI) for the associations between each of the seven SNPs and

Effect of aspirin in pregnant women is dependent on increase in bleeding time.

PubMed

Dumont, A; Flahault, A; Beaufils, M; Verdy, E; Uzan, S

1999-01-01

Randomized trials with low-dose aspirin to prevent preeclampsia and intrauterine growth restriction have yielded conflicting results. In particular, 3 recent large trials were not conclusive. Study designs, however, varied greatly regarding selection of patients, dose of aspirin, and timing of treatment, all of which can be determinants of the results. Retrospectively analyzing the conditions associated with failure or success of aspirin may therefore help to draw up new hypotheses and prepare for more specific randomized trials. We studied a historical cohort of 187 pregnant women who were considered at high risk for preeclampsia, intrauterine growth restriction, or both and were therefore treated with low-dose aspirin between 1989 and 1994. Various epidemiologic, clinical, and laboratory data were extracted from the files. Univariate and multivariate analyses were performed to search for independent parameters associated with the outcome of pregnancy. Age, parity, weight, height, and race had no influence on the outcome. The success rate was higher when treatment was given because of previous poor pregnancy outcomes than when it was given for other indications, and the patients with successful therapy had started aspirin earlier than had those with therapy failure (17.7 vs 20.0 weeks' gestation, P =.04). After multivariate analysis an increase in Ivy bleeding time after 10 days of treatment by >2 minutes was an independent predictor of a better outcome (odds ratio 0.22, 95% confidence interval 0.09-0.51). Borderline statistical significance was observed for aspirin initiation before 17 weeks' gestation (odds ratio 0.44, 95% confidence interval 0.18-1. 08). Abnormal uterine artery Doppler velocimetric scan at 20-24 weeks' gestation (odds ratio 3.31, 95% confidence interval 1.41-7.7), abnormal umbilical artery Doppler velocimetric scan after 26 weeks' gestation (odds ratio 37.6, 95% confidence interval 3.96-357), and use of antihypertensive therapy (odds ratio 6.06, 95% confidence interval 2.45-15) were independent predictors of poor outcome. Efficacy of aspirin seems optimal when bleeding time increases >/=2 minutes with treatment, indicating a more powerful antiplatelet effect. This suggests that the dose of aspirin should be adjusted according to a biologic marker of the antiplatelet effect. A prospective trial is warranted to test this hypothesis.

Assessing neural activity related to decision-making through flexible odds ratio curves and their derivatives.

PubMed

Roca-Pardiñas, Javier; Cadarso-Suárez, Carmen; Pardo-Vazquez, Jose L; Leboran, Victor; Molenberghs, Geert; Faes, Christel; Acuña, Carlos

2011-06-30

It is well established that neural activity is stochastically modulated over time. Therefore, direct comparisons across experimental conditions and determination of change points or maximum firing rates are not straightforward. This study sought to compare temporal firing probability curves that may vary across groups defined by different experimental conditions. Odds-ratio (OR) curves were used as a measure of comparison, and the main goal was to provide a global test to detect significant differences of such curves through the study of their derivatives. An algorithm is proposed that enables ORs based on generalized additive models, including factor-by-curve-type interactions to be flexibly estimated. Bootstrap methods were used to draw inferences from the derivatives curves, and binning techniques were applied to speed up computation in the estimation and testing processes. A simulation study was conducted to assess the validity of these bootstrap-based tests. This methodology was applied to study premotor ventral cortex neural activity associated with decision-making. The proposed statistical procedures proved very useful in revealing the neural activity correlates of decision-making in a visual discrimination task. Copyright © 2011 John Wiley & Sons, Ltd.

Emergency department imaging: are weather and calendar factors associated with imaging volume?

PubMed

Burns, K; Chernyak, V; Scheinfeld, M H

2016-12-01

To identify weather and calendar factors that would enable prediction of daily emergency department (ED) imaging volume to aid appropriate scheduling of imaging resources for efficient ED function. Daily ED triage and imaging volumes for radiography, computed tomography (CT), and ultrasound were obtained from hospital databases for the period between January 2011 and December 2013 at a large tertiary urban hospital with a Level II trauma centre. These data were tabulated alongside daily weather conditions (temperature, wind and precipitation), day of week, season, and holidays. Multivariate analysis was performed. Pearson correlations were used to measure the association between number of imaging studies performed and ED triage volume. For every additional 50 triaged patients, the odds of having high (imaging volume ≥90th percentile) radiography, CT, and ultrasound volume increased by 4.3 times (p<0.001), 1.5 times (p=0.02), and 1.4 times (p=0.02), respectively. Tuesday was an independent predictor of high radiography volume (odds ratio=2.8) and Monday was an independent predictor of high CT volume (odds ratio=3.0). Weekday status was an independent factor increasing the odds of a high US volume compared to Saturday (odds ratios ranging from 5.6-9.8). Weather factors and other calendar variables were not independent predictors of high imaging volume. Using Pearson correlations, ED triage volume correlated with number of radiographs, CT, and ultrasound examinations with r=0.73, 0.37, and 0.41, respectively (p<0.0001). As ED triage volume was found to be the only factor associated with imaging volume for all techniques, analysis of predictors of ED triage volumes at a particular healthcare facility would be useful to determine imaging needs. Although calendar and weather factors were found to be minor or non-significant independent predictors of ED imaging utilisation, these may be important in influencing the actual number of ED triages. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Geriatric emergency general surgery: Survival and outcomes in a low-middle income country.

PubMed

Shah, Adil A; Haider, Adil H; Riviello, Robert; Zogg, Cheryl K; Zafar, Syed Nabeel; Latif, Asad; Rios Diaz, Arturo J; Rehman, Zia; Zafar, Hasnain

2015-08-01

Geriatric patients remain largely unstudied in low-middle income health care settings. The purpose of this study was to compare the epidemiology and outcomes of older versus younger adults with emergency general surgical conditions in South Asia. Discharge data from March 2009 to April 2014 were obtained for all adult patients (≥16 years) with an International Classification of Diseases, 9th revision, Clinical Modification diagnosis codes consistent with an emergency general surgery condition as defined by the American Association for the Surgery of Trauma. Multivariable regression analyses compared patients >65 years of age with patients ≤65 years for differences in all-cause mortality, major complications, and duration of hospital stay. Models were adjusted for potential confounding owing to patient demographic and clinical case-mix data with propensity scores. We included 13,893 patients; patients >65 years constituted 15% (n = 2,123) of the cohort. Relative to younger patients, older adults were more likely to present with a number of emergency general surgery conditions, including gastrointestinal bleeding (odds ratio OR [95% CI], 2.63[1.99-3.46]), resuscitation (2.17 [1.67-2.80]), and peptic ulcer disease (2.09 [1.40-3.10]). They had an 89% greater risk-adjusted odds (1.89 [1.55-2.29]) of complications and a 63% greater odds (1.63 [1.21-2.20]) of mortality. Restricted to patients undergoing operative interventions, older adults had 95% greater odds (1.95 [1.29-2.94]) of complications and 117% greater odds (2.17 [1.62-2.91]) of mortality. Understanding unique needs of geriatric patients is critical to enhancing the management and prioritization of appropriate care in developing settings. Copyright © 2015 Elsevier Inc. All rights reserved.

Ratio of muscle mass to fat mass assessed by bioelectrical impedance analysis is significantly correlated with liver fat accumulation in patients with type 2 diabetes mellitus.

PubMed

Kurinami, Noboru; Sugiyama, Seigo; Morita, Ayami; Yoshida, Akira; Hieshima, Kunio; Miyamoto, Fumio; Kajiwara, Keizo; Jinnouch, Katsunori; Jinnouchi, Tomio; Jinnouchi, Hideaki

2018-05-01

Obesity and ectopic fat accumulation are important conditions of type 2 diabetes mellitus (T2DM). Our aim was to determine whether bioelectrical impedance body composition analysis combined with blood test results could estimate liver ectopic fat accumulation in patients with treatment-naïve T2DM. Subjects were 119 untreated T2DM patients. Computed tomography scans were performed to calculate the liver to spleen attenuation ratio (L/S ratio) as a measure of liver fat accumulation, with excess liver fat accumulation defined as an L/S ratio <1.0. Elementary body composition was measured by bioelectrical impedance analysis using InBody770. The Nagelkerke R 2 test showed that the muscle mass/fat mass ratio (muscle/fat ratio) was the most suitable variable among anthropometric factors and body component indexes for estimating liver fat accumulation. The muscle/fat ratio was significantly correlated with the L/S ratio (ρ = 0.4386, P < 0.0001). Multivariable logistic regression analysis showed that the muscle/fat ratio (odds ratio 0.40, 95% confidence interval 0.22-0.73, P < 0.01) and alanine aminotransferase (odds ratio 1.06, 95% confidence interval 1.02-1.10, P < 0.01) were independently and significantly associated with liver fat accumulation. In receiver operating characteristic curve analysis, the cutoff value of the muscle/fat ratio for excess liver fat accumulation was 2.34. In patients with treatment-naïve T2DM, the muscle/fat ratio and ALT are useful for estimating the presence of excess liver fat accumulation in daily clinical practice. Copyright © 2018. Published by Elsevier B.V.

Obesity, Physical Activity and Sedentary Behaviors in Children with an Autism Spectrum Disorder.

PubMed

Corvey, Kathryn; Menear, Kristi S; Preskitt, Julie; Goldfarb, Samantha; Menachemi, Nir

2016-02-01

Previous literature using small sample sizes and limited geographic areas report that overweight/obesity and physical inactivity occur at higher rates among children with autism spectrum disorder (ASD) compared to typically developing peers. The purpose of this study was to examine obesity, overweight, physical activity, and sedentary behavior among children and youth with and without ASD using nationally representative data and controlling for secondary conditions, including intellectual and learning disabilities, ADHD, developmental delay, and other mental, physical, and medical conditions, as well as medication use. Data were collected from the 2011-2012 National Survey of Children's Health, a cross-sectional survey of 65,680 (weighted N = 49,586,134) children aged 6-17 (1385 with ASD, weighted N = 986,352). Logistic regression was used to estimate odds ratios, adjusting for demographics and possible secondary conditions. Having a diagnosis of ASD was associated with higher odds of obesity (OR 1.76, CI 1.27-2.43; p = <0.001). However, after additional adjustment for possible secondary conditions, ASD diagnosis was no longer associated with obesity. Those with moderate ASD (OR 0.58, CI 0.36-0.93; p = <0.05) reported lower odds of sedentary behavior, but this association failed to achieve significance after adjustment for secondary conditions and medication use. No significant associations between ASD and overweight or physical activity were found. These findings suggest that ASD diagnosis is not significantly associated with obesity status after adjustment for possible secondary conditions and medication use. Decision makers, clinicians, and researchers developing interventions for children with ASDs should consider how secondary conditions may impact obesity and related activities.

Medical Comorbidity of Attention-Deficit/Hyperactivity Disorder in US Adolescents.

PubMed

Jameson, Nicole D; Sheppard, Brooke K; Lateef, Tarannum M; Vande Voort, Jennifer L; He, Jian-Ping; Merikangas, Kathleen Ries

2016-10-01

Understanding patterns of medical comorbidity in attention-deficit/hyperactivity disorder (ADHD) may lead to better treatment of affected individuals as well as aid in etiologic study of disease. This article provides the first systematic evaluation on the medical comorbidity of ADHD in a nationally representative sample (National Comorbidity Replication Survey-Adolescent Supplement; N = 6483) using formal diagnostic criteria. Survey-weighted odds ratios adjusted for demographics, additional medical, and mental disorders were calculated for associations between ADHD and medical conditions. Models adjusted for demographics revealed significantly increased odds of allergy, asthma, enuresis, headache/migraine, and serious stomach or bowel problems. After adjusting for comorbidity, across the medical conditions, enuresis and serious stomach problems were the strongest correlates of ADHD. These findings confirm the pervasive medical comorbidity of ADHD reported in previous clinical and community-based studies. The intriguing salience of enuresis and serious stomach or bowel conditions may also provide an important clue to multisystem involvement in ADHD. © The Author(s) 2016.

Is delayed surgical revascularization in acute myocardial infarction useful or dangerous? New insights into an old problem.

PubMed

Grieshaber, Philippe; Roth, Peter; Oster, Lukas; Schneider, Tobias M; Görlach, Gerold; Nieman, Bernd; Böning, Andreas

2017-11-01

Haemodynamically stable patients admitted for coronary artery bypass grafting in acute myocardial infarction often undergo delayed surgery in order to avoid the risks of emergency surgery. However, initially stable patients undergoing delayed surgery may develop low cardiac output syndrome (LCOS) during the waiting period, which might be a major drawback of this strategy. We aim to define risk factors and clinical consequences of LCOS during the waiting period. A total of 530 consecutive patients with acute myocardial infarction (33% non-ST-segment elevation myocardial infarction and 67% ST-segment-elevation myocardial infarction) underwent isolated coronary artery bypass grafting between 2008 and 2013. Outcomes after either immediate (<48 h after onset of symptoms) or delayed (>48 h after onset of symptoms) therapy were compared. Predictors of preoperative development of LCOS were identified using multivariate regression analysis. Of the 327 patients undergoing delayed therapy, 39 (12%) developed preoperative LCOS, resulting in increased mortality compared with patients who remained stable (21 vs 7.6%, P < 0.001). Immediate therapy resulted in similar mortality compared with delayed therapy (6.4 vs 7.6%; P = 0.68) and better 7-year survival (70 vs 55%; P < 0.001). Predictors of developing LCOS were reduced left ventricular function (odds ratio 4.4), renal impairment (odds ratio 3.0), acute pulmonary infection (odds ratio 3.4) and the extent of troponin elevation at admission (odds ratio 1.01 per increase by 1 µg/l). In patients with acute myocardial infarction undergoing delayed coronary artery bypass grafting, preoperative LCOS is a relevant and dangerous condition that can be avoided by operating immediately or by carefully selecting patients to be delayed according to the risk parameters identified preoperatively. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Associations between body-mass index and surgery for rotator cuff tendinitis.

PubMed

Wendelboe, Aaron M; Hegmann, Kurt T; Gren, Lisa H; Alder, Stephen C; White, George L; Lyon, Joseph L

2004-04-01

Rotator cuff tendinopathy is a common entity. We hypothesized that obesity, because of biomechanical and systemic risk factors, increases the risks of rotator cuff tendinitis, tears, and related surgical procedures. A frequency-matched case-control study was conducted. Three hundred and eleven patients who were fifty-three to seventy-seven years old and who underwent rotator cuff repair, arthroscopy, and/or other repair of the shoulder in a large hospital from 1992 to 2000 were included in the study. These surgical procedures were used as proxies for the risk of rotator cuff tendinitis. These patients were age and frequency-matched to 933 controls, who were randomly drawn from a pool of 10,943 potential controls consisting of Utah state residents who were enrolled in a large cancer-screening trial. Age-adjusted odds ratios were calculated with use of the International Classification of Diseases, Ninth Revision procedural codes and body-mass-index groups. The data were stratified according to gender and age. Multiple linear regression analyses also were performed. There was an association between increasing body-mass index and shoulder repair surgery. The highest odds ratios for both men (odds ratio = 3.13; 95% confidence interval = 1.29 to 7.61) and women (odds ratio = 3.51; 95% confidence interval = 1.80 to 6.85) were for individuals with a body-mass index of > or =35.0 kg/m(2). Tests for trend also were highly significant for both men (p = 0.002) and women (p < or = 0.001). Multiple linear regression analysis also indicated a significant association between increasing body-mass index and shoulder surgery (beta = 1.57; 95% confidence interval = 0.97 to 2.17; p < or = 0.001). There is an association between obesity and shoulder repair surgery in men and women who are fifty-three to seventy-seven years of age. The results of the present study suggest that increasing body-mass index is a risk factor for rotator cuff tendinitis and related conditions.

Enhanced Detection of Chromosomal Abnormalities in Chronic Lymphocytic Leukemia by Conventional Cytogenetics Using CpG Oligonucleotide in Combination with Pokeweed Mitogen and Phorbol Myristate Acetate

PubMed Central

Muthusamy, Natarajan; Breidenbach, Heather; Andritsos, Leslie; Flynn, Joseph; Jones, Jeffrey; Ramanunni, Asha; Mo, Xiaokui; Jarjoura, David; Byrd, John C.; Heerema, Nyla A.

2011-01-01

Reproducible cytogenetic analysis in CLL has been limited by the inability to obtain reliable metaphase cells for analysis. CpG oligonucleotide and cytokine stimulation have been shown to improve metaphase analysis of CLL cytogenetic abnormalities, but is limited by variability in the cytokine receptor levels, stability and biological activity of the cytokine in culture conditions and high costs associated with these reagents. We report here use of a novel, stable CpG, GNKG168 along with pokeweed mitogen (PWM) and phorbol 12-myristate 13-acetate (PMA) for conventional cytogenetic assessment in CLL. We demonstrate that the combined use of GNKG168+PWM/PMA increased the sensitivity of detection of chromosomal abnormalities compared to PWM/PMA (n=207, odds ratio=2.2, p=0.0002) and GNKG168 (n=219, odds ratio=1.5, p=0.0452). Further, a significant increase in sensitivity to detect complexity ≥3 with GNKG168+PWM/PMA compared to GNKG168 alone (odds ratio 8.0, p=0.0022) or PWM/PMA alone (odds ratio 9.6, p=0.0007) was observed. The trend toward detection of higher complexity was significantly greater with GNKG168+PWM/PMA compared to GNKG168 alone (p=0.0412). The increased sensitivity was mainly attributed to the addition of PWM/PMA with GNKG168 because GNKG168 alone showed no difference in sensitivity for detection of complex abnormalities (p=0.17). Comparison of fluorescence in situ hybridization (FISH) results with karyotypic results showed a high degree of consistency, although some complex karyotypes were present in cases with no adverse FISH abnormality. These studies provide evidence for potential use of GNKG168 in combination with PWM and PMA in karyotypic analysis of CLL patient samples to better identify chromosomal abnormalities for risk stratification. PMID:21494579

Cardiac Arrest in Patients Managed for Convulsive Status Epilepticus: Characteristics, Predictors, and Outcome.

PubMed

Legriel, Stephane; Bresson, Edouard; Deye, Nicolas; Grimaldi, David; Sauneuf, Bertrand; Lesieur, Olivier; Lascarrou, Jean-Baptiste; Argaud, Laurent; Chelly, Jonathan; Beuret, Pascal; Schnell, David; Chateauneuf, Anne-Laure; Holleville, Mathilde; Perier, François; Lemiale, Virginie; Bruel, Cedric; Cronier, Pierrick; Pichon, Nicolas; Mongardon, Nicolas; de-Prost, Nicolas; Dumas, Florence; Cariou, Alain

2018-05-08

Cardiac arrest is a catastrophic event that may arise during the management of convulsive status epilepticus. We aimed to report the clinical characteristics, outcomes, and early predictors of convulsive status epilepticus-related cardiac arrest. Retrospective multicenter study. Seventeen university or university affiliated participating ICUs in France and Belgium. Consecutive patients admitted to the participating ICUs for management of successfully resuscitated out-of-hospital cardiac arrest complicating the initial management of convulsive status epilepticus between 2000 and 2015. Patients were compared with controls without cardiac arrest identified in a single-center registry of convulsive status epilepticus patients, regarding characteristics, management, and outcome. None. We included 49 cases with convulsive status epilepticus-cardiac arrest and 235 controls. In the cases, median time from medical team arrival to cardiac arrest was 25 minutes (interquartile range, 5-85 min). First recorded rhythm was asystole in 25 patients (51%) and pulseless electrical activity in 13 patients (27%). A significantly larger proportion of patients had a favorable 1-year outcome (Glasgow Outcome Scale score of 5) among controls (90/235; 38%) than among cases (10/49; 21%; p = 0.02). By multivariate analysis, independent predictors of cardiac arrest were pulse oximetry less than 97% on scene (odds ratio, 2.66; 95% CI, 1.03-7.26; p = 0.04), drug poisoning as the cause of convulsive status epilepticus (odds ratio, 4.13; 95% CI, 1.27-13.53; p = 0.02), and complications during early management (odds ratio, 11.98; 95% CI, 4.67-34.69; p < 0.0001). Having at least one comorbidity among cardiac, respiratory, and neurologic (other than epilepsy) conditions predicted absence of cardiac arrest (odds ratio, 0.28; 95% CI, 0.10-0.80; p = 0.02). In patients managed for convulsive status epilepticus, relative hypoxemia, on-scene management complications, and drug poisoning as the cause of convulsive status epilepticus were strong early predictors of cardiac arrest, suggesting areas for improvement.

Associations of dioxins, furans and dioxin-like PCBs with diabetes and pre-diabetes: is the toxic equivalency approach useful?

PubMed

Everett, Charles J; Thompson, Olivia M

2012-10-01

Toxic equivalency factors for dioxins and dioxin-like compounds have been established by the World Health Organization. Toxic equivalency (TEQ) was derived using 6 chlorinated dibenzo-p-dioxins, 9 chlorinated dibenzofurans and 8 polychlorinated biphenyls, in blood, from the 1999-2004 National Health and Nutrition Examination Survey. Relationships of 8 individual chemicals, the number of compounds elevated, and TEQ with pre-diabetes and total diabetes (diagnosed and undiagnosed) were investigated using logistic regressions. For the 8 chemicals analyzed separately, values above the 75th percentile were considered elevated, whereas for the other 15 compounds, values above the maximum limit of detection were considered elevated. Pre-diabetes with glycohemoglobin (A1c) 5.9-6.4% was associated with PCB 126, PCB 118 and having one or more compounds elevated (odds ratio 2.47, 95% CI 1.51-4.06). Pre-diabetes with A1c 5.7-5.8% was not associated with any individual chemical or the number of compounds elevated. Total diabetes was associated with 6 of the 8 individual compounds tested, and was associated with having 4 or more compounds elevated. Toxic equivalency ≥81.58 TEQ fg/g was associated with total diabetes (odds ratio 3.08, 95% CI 1.20-7.90), but was not associated with A1c 5.9-6.4%. Having multiple compounds elevated appeared to be important for total diabetes, whereas for pre-diabetes with A1c 5.9-6.4%, having a single compound elevated appeared most important. Diabetes plus A1c ≥5.9% was associated with 34.16-81.57 TEQ fg/g (odds ratio 2.00, 95% CI 1.06-3.77) and with ≥81.58 TEQ fg/g (odds ratio 2.48, 95% CI 1.21-5.11), indicating that half the population has elevated risk for this combination of conditions. Copyright © 2012 Elsevier Inc. All rights reserved.

Fluconazole use and birth defects in the National Birth Defects Prevention Study.

PubMed

Howley, Meredith M; Carter, Tonia C; Browne, Marilyn L; Romitti, Paul A; Cunniff, Christopher M; Druschel, Charlotte M

2016-05-01

Low-dose fluconazole is used commonly to treat vulvovaginal candidiasis, a condition occurring frequently during pregnancy. Conflicting information exists on the association between low-dose fluconazole use among pregnant women and the risk of major birth defects. We used data from the National Birth Defects Prevention Study to examine this association. The National Birth Defects Prevention Study is a multisite, population-based, case-control study that includes pregnancies with estimated delivery dates from 1997 to 2011. Information on fluconazole use in early pregnancy was collected by self-report from 31,645 mothers of birth defect cases and 11,612 mothers of unaffected controls. Adjusted odds ratios and 95% confidence intervals were estimated for birth defects with 5 or more exposed cases; crude odds ratios and exact 95% confidence intervals were estimated for birth defects with 3-4 exposed cases. Of the 43,257 mothers analyzed, 44 case mothers and 6 control mothers reported using fluconazole. Six exposed infants had cleft lip with cleft palate, 4 had an atrial septal defect, and each of the following defects had 3 exposed cases: hypospadias, tetralogy of Fallot, d-transposition of the great arteries, and pulmonary valve stenosis. Fluconazole use was associated with cleft lip with cleft palate (odds ratio = 5.53; confidence interval = 1.68-18.24) and d-transposition of the great arteries (odds ratio = 7.56; confidence interval = 1.22-35.45). The associations between fluconazole and both cleft lip with cleft palate and d-transposition of the great arteries are consistent with earlier published case reports but not recent epidemiologic studies. Despite the larger sample size of the National Birth Defects Prevention Study, fluconazole use was rare. Further investigation is needed in large studies, with particular emphasis on oral clefts and conotruncal heart defects. Copyright © 2016 Elsevier Inc. All rights reserved.

The influence of age at onset and duration of illness on long-term outcome in patients with obsessive-compulsive disorder: a report from the International College of Obsessive Compulsive Spectrum Disorders (ICOCS).

PubMed

Dell'Osso, Bernardo; Benatti, Beatrice; Buoli, Massimiliano; Altamura, A Carlo; Marazziti, Donatella; Hollander, Eric; Fineberg, Naomi; Stein, Dan J; Pallanti, Stefano; Nicolini, Humberto; Van Ameringen, Michael; Lochner, Christine; Hranov, Georgi; Karamustafalioglu, Oguz; Hranov, Luchezar; Menchon, Jose M; Zohar, Joseph

2013-08-01

Several studies reported a negative effect of early onset and long duration of illness on long-term outcome in psychiatric disorders, including Obsessive-Compulsive Disorder (OCD). OCD is a prevalent, comorbid and disabling condition, associated with reduced quality of life and overall well-being for affected patients and related caregivers. The present multicenter naturalistic study sought to assess the influence of early onset and duration of illness on long-term outcome in a sample of 376 OCD out-patients worldwide, as part of the "International College of Obsessive-Compulsive Spectrum Disorders" (ICOCS) network. Binary logistic regressions were performed with age at the onset and duration of illness, as continuous independent variables, on a series of different outcome dependent variables, including lifetime number of hospitalizations and suicide attempts, poly-therapy and psychiatric comorbidity. Correlations in terms of disability (SDS) were analyzed as well. Results showed that a longer duration of illness (but not earlier age of onset) was associated with hospitalization (odds ratio=1.03, p=0.01), earlier age at onset with CBT (odds ratio=0.94, p<0.001) and both a later age at onset (odds ratio=1.05, p=0.02) and a shorter duration of illness (odds ratio=0.93, p=0.02) with panic disorder comorbidity. In addition, earlier age at onset inversely correlated with higher social disability (r=-0.12, p=0.048) and longer duration of illness directly correlated with higher disability in work, social and family life (r=0.14, p=0.017; r=0.13, p=0.035; r=0.14, p=0.02). The findings from the present large, multicenter study indicate early onset and long duration of illness as overall negative predictors of long-term outcome in OCD. Copyright © 2013 Elsevier B.V. and ECNP. All rights reserved.

The Effect of Work Characteristics on Dermatologic Symptoms in Hairdressers

PubMed Central

2014-01-01

Objectives Hairdressers in Korea perform various tasks and are exposed to health risk factors such as chemical substances or prolonged duration of wet work. The objective of this study is to provide descriptive statistics on the demographics and work characteristics of hairdressers in Korea and to identify work-related risk factors for dermatologic symptoms in hairdressers. Methods 1,054 hairdressers were selected and analyzed for this study. Independent variables were exposure to chemical substances, the training status of the hairdressers, and the main tasks required of them, and the dependent variable was the incidence of dermatologic symptoms. The relationships between work characteristics and dermatologic symptoms were evaluated by estimating odds ratios using multiple logistic regression analysis. Results Among the 1,054 study subjects, 212 hairdressers (20.1%) complained of dermatologic symptoms, and the symptoms were more prevalent in younger, unmarried or highly educated hairdressers. The main tasks that comprise the majority of the wet work were strictly determined by training status, since 96.5% of staff hairdressers identified washing as their main task, while only 1.5% and 2.0% of master and designer hairdressers, respectively, identified this as their main task. Multiple logistic regressions was performed to estimate odds ratios. While exposure to hairdressing chemicals showed no significant effect on the odds ratio for the incidence of dermatologic symptoms, higher odds ratios of dermatologic symptoms were shown in staff hairdressers (2.70, 95% CI: 1.32 - 5.51) and in hairdressers who perform washing as their main task (2.03, 95% CI: 1.22 - 3.37), after adjusting for general and work characteristics. Conclusions This study showed that the training status and main tasks of hairdressers are closely related to each other and that the training status and main tasks of hairdressers are related to the incidence of dermatologic symptoms. This suggests that in the future, regulations on working conditions and health management guidelines for hairdressers should be established. PMID:25028609

Circulating 25-hydroxyvitamin D3 in relation to renal cell carcinoma incidence and survival in the EPIC cohort.

PubMed

Muller, David C; Fanidi, Anouar; Midttun, Øivind; Steffen, Annika; Dossus, Laure; Boutron-Ruault, Marie-Christine; Severi, Gianluca; Kühn, Tilman; Katzke, Verena; de la Torre, Ramón Alonso; González, Carlos A; Sánchez, María-José; Dorronsoro, Miren; Santiuste, Carmen; Barricarte, Aurelio; Khaw, Kay-Tee; Wareham, Nick; Travis, Ruth C; Trichopoulou, Antonia; Giotaki, Maria; Trichopoulos, Dimitrios; Palli, Domenico; Krogh, Vittorio; Tumino, Rosario; Vineis, Paolo; Panico, Salvatore; Tjønneland, Anne; Olsen, Anja; Bueno-de-Mesquita, H Bas; Peeters, Petra H; Ljungberg, Börje; Wennberg, Maria; Weiderpass, Elisabete; Murphy, Neil; Riboli, Elio; Ueland, Per Magne; Boeing, Heiner; Brennan, Paul; Johansson, Mattias

2014-10-15

Normal renal function is essential for vitamin D metabolism, but it is unclear whether circulating vitamin D is associated with risk of renal cell carcinoma (RCC). We assessed whether 25-hydroxyvitamin D3 (25(OH)D3) was associated with risk of RCC and death after RCC diagnosis in the European Prospective Investigation into Cancer and Nutrition (EPIC). EPIC recruited 385,747 participants with blood samples between 1992 and 2000. The current study included 560 RCC cases, 557 individually matched controls, and 553 additional controls. Circulating 25(OH)D3 was assessed by mass spectrometry. Conditional and unconditional logistic regression models were used to calculate odds ratios and 95% confidence intervals. Death after RCC diagnosis was assessed using Cox proportional hazards models and flexible parametric survival models. A doubling of 25(OH)D3 was associated with 28% lower odds of RCC after adjustment for season of and age at blood collection, sex, and country of recruitment (odds ratio = 0.72, 95% confidence interval: 0.60, 0.86; P = 0.0004). This estimate was attenuated somewhat after additional adjustment for smoking status at baseline, circulating cotinine, body mass index (weight (kg)/height (m)(2)), and alcohol intake (odds ratio = 0.82, 95% confidence interval: 0.68, 0.99; P = 0.038). There was also some indication that both low and high 25(OH)D3 levels were associated with higher risk of death from any cause among RCC cases. © The Author 2014. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Anxiety disorders are independently associated with suicide ideation and attempts: propensity score matching in two epidemiological samples.

PubMed

Thibodeau, Michel A; Welch, Patrick G; Sareen, Jitender; Asmundson, Gordon J G

2013-10-01

Research suggests that suicidal behavior in individuals with anxiety disorders is attributable to co-occurring risk factors, such as depression. We argue that these conclusions are founded primarily in statistical adjustments that may obscure independent associations. We explored independent associations between specific anxiety disorders and suicide attempts and ideation by means of propensity score matching, a process that simulates a case-control study by creating matched groups that differ in group status (e.g., diagnosis of a specific anxiety disorder) but that are statistically equivalent on observed covariates. We made use of the National Comorbidity Survey Replication (NCS-R) and the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), which include a total of 43,935 adults. Diagnoses included agoraphobia without panic disorder, generalized anxiety disorder, panic disorder with or without agoraphobia, posttraumatic stress disorder, social anxiety disorder, and specific phobia. Each anxiety disorder was (95% confidence intervals) associated with increased odds of lifetime suicide attempts (odds ratios 3.57-6.64 [NCS-R], 3.03-7.00 [NESARC]) and suicidal ideation (odds ratios 2.62-4.87 [NCS-R], 3.34-10.57 [NESARC]). Odds ratios for each disorder remained statistically significant after matching on diagnostic status of dysthymia, major depressive disorder, alcohol abuse/dependence, substance abuse/dependence, bipolar disorder I, bipolar disorder II, all other anxiety disorders, and on sociodemographic variables. This is the first report to present evidence that each anxiety disorder is associated with suicide ideation and suicide attempts beyond the effects of co-occurring mental disorders. These findings warrant consideration in assessment, intervention, and related policies. © 2013 Wiley Periodicals, Inc.

Causes of corneal graft failure in India.

PubMed

Dandona, L; Naduvilath, T J; Janarthanan, M; Rao, G N

1998-09-01

The success of corneal grafting in visual rehabilitation of the corneal blind in India depends on survival of the grafts. Understanding the causes of graft failure may help reduce the risk of failure. We studied these causes in a series of 638 graft failures at our institution. Multivariate logistic regression analysis was used to evaluate the association of particular causes of graft failure with indications for grafting, socioeconomic status, age, sex, host corneal vascularization, donor corneal quality, and experience of surgeon. The major causes of graft failure were allograft rejection (29.2%), increased intraocular pressure (16.9%), infection excluding endophthalmitis (15.4%), and surface problems (12.7%). The odds of infection causing graft failure were significantly higher in patients of lower socioeconomic status (odds ratio 2.45, 95% CI 1.45-4.15). Surface problems as a cause of graft failure was significantly associated with grafts done for corneal scarring or for regrafts (odds ratio 3.36, 95% CI 1.80-6.30). Increased intraocular pressure as a cause of graft failure had significant association with grafts done for aphakic or pseudophakic bullous keratopathy, congenital conditions or glaucoma, or regrafts (odds ratio 2.19, 95% CI 1.25-3.84). Corneal dystrophy was the indication for grafting in 12 of the 13 cases of graft failure due to recurrence of host disease. Surface problems, increased intraocular pressure, and infection are modifiable risk factors that are more likely to cause graft failure in certain categories of patients in India. Knowledge about these associations can be helpful in looking for and aggressively treating these modifiable risk factors in the at-risk categories of corneal graft patients. This can possibly reduce the chance of graft failure.

Impact of Drinking Water Fluoride on Human Thyroid Hormones: A Case- Control Study.

PubMed

Kheradpisheh, Zohreh; Mirzaei, Masoud; Mahvi, Amir Hossein; Mokhtari, Mehdi; Azizi, Reyhane; Fallahzadeh, Hossein; Ehrampoush, Mohammad Hassan

2018-02-08

The elevated fluoride from drinking water impacts on T 3 , T 4 and TSH hormones. The aim was study impacts of drinking water fluoride on T 3 , T 4 and TSH hormones inYGA (Yazd Greater Area). In this case- control study 198 cases and 213 controls were selected. Fluoride was determined by the SPADNS Colorimetric Method. T 3 , T 4 and TSH hormones tested in the Yazd central laboratory by RIA (Radio Immuno Assay) method. The average amount of TSH and T 3 hormones based on the levels of fluoride in two concentration levels 0-0.29 and 0.3-0.5 (mg/L) was statistically significant (P = 0.001 for controls and P = 0.001 for cases). In multivariate regression logistic analysis, independent variable associated with Hypothyroidism were: gender (odds ratio: 2.5, CI 95%: 1.6-3.9), family history of thyroid disease (odds ratio: 2.7, CI 95%: 1.6-4.6), exercise (odds ratio: 5.34, CI 95%: 3.2-9), Diabetes (odds ratio: 3.7, CI 95%: 1.7-8), Hypertension (odds ratio: 3.2, CI 95%: 1.3-8.2), water consumption (odds ratio: 4, CI 95%: 1.2-14). It was found that fluoride has impacts on TSH, T 3 hormones even in the standard concentration of less than 0.5 mg/L. Application of standard household water purification devices was recommended for hypothyroidism.

Maternal Genitourinary Infections and the Risk of Gastroschisis

PubMed Central

Yazdy, Mahsa M.; Mitchell, Allen A.; Werler, Martha M.

2014-01-01

Genitourinary infections (GUIs) have been associated with increased risk of gastroschisis in 2 studies. Using data collected in the Slone Epidemiology Center Birth Defects Study, we examined the association between GUI and gastroschisis. From 1998 to 2010, mothers of 249 gastroschisis cases and 7,104 controls were interviewed within 6 months of delivery about pregnancy events, including vaginal infections, genital herpes, urinary tract infections (UTIs), and other sexually transmitted diseases (STDs). Women were considered exposed if they reported at least 1 instance of a GUI in the first trimester. Logistic regression models were used to calculate odds ratios and 95% confidence intervals. Women who reported having any GUI had an adjusted odds ratio of 1.8 (95% confidence interval (CI): 1.3, 2.4). The highest risk was seen among women who reported a UTI only (adjusted odds ratio = 2.3, 95% CI: 1.5, 3.5), while the odds ratio for an STD only was slightly elevated (adjusted odds ratio = 1.2, 95% CI: 1.0, 1.5). Among women under 25 years of age, the odds ratio for UTI only was 2.6 (95% CI: 1.7, 4.0), and among older women it was 1.8 (95% CI: 0.6, 5.9). When we considered the joint association of UTIs and young maternal age, a synergistic effect was observed. The results of this study add further evidence that UTIs may increase the risk of gastroschisis. PMID:25073472

Allergies and risk of pancreatic cancer: a pooled analysis from the Pancreatic Cancer Case-Control Consortium.

PubMed

Olson, Sara H; Hsu, Meier; Satagopan, Jaya M; Maisonneuve, Patrick; Silverman, Debra T; Lucenteforte, Ersilia; Anderson, Kristin E; Borgida, Ayelet; Bracci, Paige M; Bueno-de-Mesquita, H Bas; Cotterchio, Michelle; Dai, Qi; Duell, Eric J; Fontham, Elizabeth H; Gallinger, Steven; Holly, Elizabeth A; Ji, Bu-Tian; Kurtz, Robert C; La Vecchia, Carlo; Lowenfels, Albert B; Luckett, Brian; Ludwig, Emmy; Petersen, Gloria M; Polesel, Jerry; Seminara, Daniela; Strayer, Lori; Talamini, Renato

2013-09-01

In order to quantify the risk of pancreatic cancer associated with history of any allergy and specific allergies, to investigate differences in the association with risk according to age, gender, smoking status, or body mass index, and to study the influence of age at onset, we pooled data from 10 case-control studies. In total, there were 3,567 cases and 9,145 controls. Study-specific odds ratios and 95% confidence intervals were calculated by using unconditional logistic regression adjusted for age, gender, smoking status, and body mass index. Between-study heterogeneity was assessed by using the Cochran Q statistic. Study-specific odds ratios were pooled by using a random-effects model. The odds ratio for any allergy was 0.79 (95% confidence interval (CI): 0.62, 1.00) with heterogeneity among studies (P < 0.001). Heterogeneity was attributable to one study; with that study excluded, the pooled odds ratio was 0.73 (95% CI: 0.64, 0.84) (Pheterogeneity = 0.23). Hay fever (odds ratio = 0.74, 95% CI: 0.56, 0.96) and allergy to animals (odds ratio = 0.62, 95% CI: 0.41, 0.94) were related to lower risk, while there was no statistically significant association with other allergies or asthma. There were no major differences among subgroups defined by age, gender, smoking status, or body mass index. Older age at onset of allergies was slightly more protective than earlier age.

Allergies and Risk of Pancreatic Cancer: A Pooled Analysis From the Pancreatic Cancer Case-Control Consortium

PubMed Central

Olson, Sara H.; Hsu, Meier; Satagopan, Jaya M.; Maisonneuve, Patrick; Silverman, Debra T.; Lucenteforte, Ersilia; Anderson, Kristin E.; Borgida, Ayelet; Bracci, Paige M.; Bueno-de-Mesquita, H. Bas; Cotterchio, Michelle; Dai, Qi; Duell, Eric J.; Fontham, Elizabeth H.; Gallinger, Steven; Holly, Elizabeth A.; Ji, Bu-Tian; Kurtz, Robert C.; La Vecchia, Carlo; Lowenfels, Albert B.; Luckett, Brian; Ludwig, Emmy; Petersen, Gloria M.; Polesel, Jerry; Seminara, Daniela; Strayer, Lori; Talamini, Renato

2013-01-01

In order to quantify the risk of pancreatic cancer associated with history of any allergy and specific allergies, to investigate differences in the association with risk according to age, gender, smoking status, or body mass index, and to study the influence of age at onset, we pooled data from 10 case-control studies. In total, there were 3,567 cases and 9,145 controls. Study-specific odds ratios and 95% confidence intervals were calculated by using unconditional logistic regression adjusted for age, gender, smoking status, and body mass index. Between-study heterogeneity was assessed by using the Cochran Q statistic. Study-specific odds ratios were pooled by using a random-effects model. The odds ratio for any allergy was 0.79 (95% confidence interval (CI): 0.62, 1.00) with heterogeneity among studies (P < 0.001). Heterogeneity was attributable to one study; with that study excluded, the pooled odds ratio was 0.73 (95% CI: 0.64, 0.84) (Pheterogeneity = 0.23). Hay fever (odds ratio = 0.74, 95% CI: 0.56, 0.96) and allergy to animals (odds ratio = 0.62, 95% CI: 0.41, 0.94) were related to lower risk, while there was no statistically significant association with other allergies or asthma. There were no major differences among subgroups defined by age, gender, smoking status, or body mass index. Older age at onset of allergies was slightly more protective than earlier age. PMID:23820785

A cross-sectional study of reproductive performance of smallholder dairy cows in coastal Tanzania.

PubMed

Swai, E S; Bryant, M J; Karimuribo, E D; French, N P; Ogden, N H; Fitzpatrick, J L; Kambarage, D M

2005-08-01

A retrospective cross-sectional study was conducted on 200 randomly selected smallholder farms from a mixed dairy farming system in Tanga, Tanzania, between January and April 1999. We estimated the frequency and determinants of long calving interval (LCI), retention of fetal membrane (RFM), dystocia, and abortion in smallholder crossbred cattle and explored birth trends. The mean calving interval was 500 days and birth rate was 65 per 100 cow-years. Dystocia was reported to affect 58% of calvings, and 17.2% of animals suffered RFM. Using mixed effect models, the variables associated with LCI, RFM and dystocia were breed, level of exotic blood and condition score. Zebu breeding was associated with LCI (odds ratio (OR) = 2.3, p = 0.041) and Friesian breeding with lower odds for RF (OR = 0.26, p = 0.020). Animals with higher levels of exotic blood had lower odds for evidence of dystocia (OR = 0.45, p = 0.021). Evidence of dystocia was significantly associated with poor condition score (p = -1.10, p = 0.001). Our observations suggest that LCIs are common in smallholder dairy farms in this region and a likely source of economic loss. Dystocia, RFM, poor condition score and mineral deficiency were common problems and were possibly linked to LCI.

Intelligence in youth and health at age 50

PubMed Central

Wraw, Christina; Deary, Ian J.; Gale, Catharine R.; Der, Geoff

2015-01-01

Background The link between intelligence in youth and all-cause mortality in later-life is well established. To better understand this relationship, the current study examines the links between pre-morbid intelligence and a number of specific health outcomes at age 50 using the NLSY-1979 cohort. Methods Participants were the 5793 participants in the NLSY-79 who responded to questions about health outcomes at age 50. Sixteen health outcomes were examined: two were summary measures (physical health and functional limitation), 9 were diagnosed illness conditions, 4 were self-reported conditions, and one was a measure of general health status. Linear and logistic regressions were used, as appropriate, to examine the relationship between intelligence in youth and the health outcomes. Age, sex and both childhood and adult SES, and its sub-components – income, education, & occupational prestige – are all adjusted for separately. Results & conclusion Higher pre-morbid intelligence is linked with better physical health at age 50, and a lower risk for a number of chronic health conditions. For example, a 1 SD higher score in IQ was significantly associated with increased odds of having good, very good, or excellent health, with an odds ratio of 1.70 (C.I. 1.55–1.86). Thirteen of the illness outcomes were significantly and negatively associated with IQ in youth; the odds ratios ranged from 0.85 for diabetes/high blood sugar to 0.65 for stroke, per one standard deviation higher score in IQ. Adjustment for childhood SES led to little attenuation but adult SES partially mediated the relationship for a number of conditions. Mediation by adult SES was not consistently explained by any one of its components—income, education, and occupation status. The current findings contribute to our understanding of lower intelligence as a risk factor for poor health and how this may contribute to health inequalities. PMID:26766880

Evidence-Based Imaging Guidelines and Medicare Payment Policy

PubMed Central

Sistrom, Christopher L; McKay, Niccie L

2008-01-01

Objective This study examines the relationship between evidence-based appropriateness criteria for neurologic imaging procedures and Medicare payment determinations. The primary research question is whether Medicare is more likely to pay for imaging procedures as the level of appropriateness increases. Data Sources The American College of Radiology Appropriateness Criteria (ACRAC) for neurological imaging, ICD-9-CM codes, CPT codes, and payment determinations by the Medicare Part B carrier for Florida and Connecticut. Study Design Cross-sectional study of appropriateness criteria and Medicare Part B payment policy for neurological imaging. In addition to descriptive and bivariate statistics, multivariate logistic regression on payment determination (yes or no) was performed. Data Collection Methods The American College of Radiology Appropriateness Criteria (ACRAC) documents specific to neurological imaging, ICD-9-CM codes, and CPT codes were used to create 2,510 medical condition/imaging procedure combinations, with associated appropriateness scores (coded as low/middle/high). Principal Findings As the level of appropriateness increased, more medical condition/imaging procedure combinations were payable (low = 61 percent, middle = 70 percent, and high = 74 percent). Logistic regression indicated that the odds of a medical condition/imaging procedure combination with a middle level of appropriateness being payable was 48 percent higher than for an otherwise similar combination with a low appropriateness score (95 percent CI on odds ratio=1.19–1.84). The odds ratio for being payable between high and low levels of appropriateness was 2.25 (95 percent CI: 1.66–3.04). Conclusions Medicare could improve its payment determinations by taking advantage of existing clinical guidelines, appropriateness criteria, and other authoritative resources for evidence-based practice. Such an approach would give providers a financial incentive that is aligned with best-practice medicine. In particular, Medicare should review and update its payment policies to reflect current information on the appropriateness of alternative imaging procedures for the same medical condition. PMID:18454778

Increased Risk of Cerebrovascular Disease Among Patients With Neurofibromatosis Type 1: Population-Based Approach.

PubMed

Terry, Anna R; Jordan, Justin T; Schwamm, Lee; Plotkin, Scott R

2016-01-01

Although neurofibromatosis type 1 (NF1) may be associated with an incompletely understood vasculopathy, relative odds of stroke in this population is not known. Using the 1998 to 2009 US Nationwide Inpatient Sample, we performed a case-control study matching cases of NF1 to controls without such a diagnosis. We then compared the odds of stroke between the 2 groups. We used multivariable logistic regression to adjust for known or suspected confounders. NF1 was associated with younger mean age at the time of stroke (41 versus 48) and a lower prevalence of stroke risk factors among adult patients. Pediatric patients with NF1, however, were more likely to have hypertension. Patients with NF1 were significantly more likely to be diagnosed with any stroke (odds ratio, 1.2; P<0.0001) than the general population. The odds of intracerebral hemorrhage were greatest among hemorrhagic stroke types analyzed (odds ratio, 1.9; P<0.0001). In the pediatric NF1 population, the odds of intracerebral hemorrhage were more dramatically elevated (odds ratio, 8.1; P<0.0001). The odds of ischemic stroke were also increased with NF1 in the pediatric (odds ratio, 3.4; P<0.0001) but not in the adult population. When compared with the general population, the odds of any type of stroke are significantly increased for patients with NF1, both adult and pediatric. This risk is most notable for hemorrhagic strokes although it is also increased for ischemic strokes in children. Physicians should be aware of the increased risk of stroke in this population, and consider stroke as a potential cause of new neurological symptoms. © 2015 American Heart Association, Inc.

Some risk factors for non-Hodgkin's lymphoma.

PubMed

Persson, B; Fredrikson, M

1999-01-01

Non-Hodgkin's lymphoma (NHL) has been subject to several epidemiological studies and various occupational and non-occupational exposures have been identified as determinants. The present study is a pooled analysis of two earlier methodologically similar case-referent studies encompassing 199 cases of NHL and 479 referents, all alive. Exposure information, mainly on occupational agents, was obtained by mailed questionnaires to the subjects. Exposure to white spirits, thinner, and aviation gasoline as well as work as a painter was connected with increased odds ratios, whereas no increased risk was noted for benzene. Farming was associated with a decreased odds ratio and exposure to phenoxy herbicides, wood preservatives, and work as a lumberjack showed increased odds ratios. Moreover, exposure to plastic and rubber chemicals and also contact with some kinds of pets appeared with increased odds ratios. Office employment and housework showed decreased odds ratios. This study indicates the importance of investigating exposures not occurring very frequently in the general population. Solvents were studied as a group of compounds but were also separated into various specific compounds. The present findings suggest that the carcinogenic property of solvents is not only related to the aromatic ones or to the occurrence of benzene contamination, but also to other types of compounds.

An assessment of the relationship of physical activity, obesity, and chronic diseases/conditions between active/obese and sedentary/ normal weight American women in a national sample.

PubMed

Pharr, J R; Coughenour, C A; Bungum, T J

2018-03-01

Obesity and physical inactivity are associated with increased rates of chronic diseases and conditions. However, the 'fit but fat' theory posits that cardiopulmonary fitness (or physical activity) can mitigate risks to health associated with obesity. The purpose of this study was to compare chronic diseases and conditions of highly active/obese women with inactive/normal weight women. This was a cross-sectional study of the 2015 Behavioral Risk Factor Surveillance System data. Weighted descriptive statistics were performed to describe the demographic characteristics of the two groups. We calculated odds ratios and adjusted odds ratios for chronic diseases and conditions comparing highly active/obese women with inactive/normal weight women. Highly active/obese women were more likely to report risk factors (hypertension, high cholesterol, and diabetes) for coronary heart disease (CHD) and cardiovascular disease (CVD) than inactive/normal weight women; however, they did not have increased rates of CVD, CHD, or heart attack and had decreased risk for stroke. Highly active/obese women had increased risk for asthma, arthritis, and depression, but not for cancer, kidney disease, or chronic obstructive pulmonary disease. Highly active/obese women appear to be staving off the actual development of CHD and CVD; however, further research is needed to understand the long-term health benefits of physical activity among obese women. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Psychosocial work conditions, unemployment, and leisure-time physical activity: a population-based study.

PubMed

Ali, Sadiq Mohammad; Lindström, Martin

2006-01-01

To investigate the association between psychosocial work conditions and unemployment, and low leisure-time physical activity. The 2000 public health survey in Scania is a cross-sectional postal questionnaire study with a 59% participation rate. A total of 5,180 persons aged 18-64 years who belonged to the workforce and the unemployed were included in this study. Logistic regression models were used to investigate the associations between psychosocial factors at work and unemployment, and low leisure-time physical activity. Psychosocial conditions at work were defined according to the Karasek-Theorell demand-control/decision latitudes into relaxed, active, passive, and job strain categories. The multivariate analyses included age, country of birth, education, economic stress, and social participation. In total, 16.1% of men and 14.8% of women had low leisure-time physical activity. The job strain (high demands/low control) and unemployed categories had significantly higher odds ratios of low leisure-time physical activity among both men and women compared with the relaxed (low demands/high control) reference category. However, the significant differences between the job strain, the unemployed, and the relaxed categories disappeared in the multivariate models. Respondents with job strain or unemployment have significantly higher odds ratios of low leisure-time physical activity than the relaxed category. However, after adjustments for education in particular the differences disappear. Nevertheless, the results suggest that the association between psychosocial work conditions, which are often dependent on education, and leisure-time physical activity may be interesting to study in more detail.

Access to health programs at the workplace and the reduction of work presenteeism: a population-based cross-sectional study.

PubMed

Bustillos, Arnaldo Sanchez; Trigoso, Oswaldo Ortiz

2013-11-01

To examine access to health programs at workplace as a determinant of presenteeism among adults. Data source was a subsample of the 2009-2010 Canadian Community Health Survey. The outcome was self-reported reduced activities at work (presenteeism). The explanatory variable was self-reported access to a health program at workplace. Logistic regression was used to measure the association between outcome and explanatory variables adjusting for potential confounders. Adjusting for sex, age, education, income, work stress, and chronic conditions, presenteeism was not associated with having access to a health program at workplace (adjusted odds ratio, 1.23; 95% confidence interval, 0.91 to 1.65). The odds of presenteeism were higher in workers who reported high work stress and those with chronic medical conditions. This study found that access to health programs at workplace is not significantly associated with a decline in presenteeism.

Association between levels of physical activity and poor self-rated health in Korean adults: The Third Korea National Health and Nutrition Examination Survey (KNHANES), 2005.

PubMed

Han, M A; Kim, K S; Park, J; Kang, M G; Ryu, S Y

2009-10-01

To investigate the association between level of physical activity and poor self-rated health in Korean adults. A cross-sectional study was conducted on 7,800 adults aged > or =19 years who completed the Health Interview and the Health Behavior Surveys, issued during the Third National Health and Nutrition Examination Survey (2005). The association between self-rated health and physical activity was tested using Chi-squared test. Multiple logistic regression analysis was used to calculate the odds ratios of poor self-rated health for different levels of physical activity after adjusting for physical and chronic medical conditions. The prevalence of poor self-rated health was significantly lower as the level of physical activity increased, and odds ratios for poor self-rated health were significantly lower for higher levels of physical activity after adjusting for age, marital status, educational status, smoking, alcohol consumption, and the number of physical impairments and chronic medical conditions. The association was similar in different age groups and among healthy respondents and respondents with physical impairments or chronic medical conditions. Physical activity was positively associated with self-rated health in Koreans. The independent association between a lower level of physical activity and poor self-rated health supports public health programmes that encourage regular physical activity.

Maternal and neonatal outcomes after bariatric surgery; a systematic review and meta-analysis: do the benefits outweigh the risks?

PubMed

Kwong, Wilson; Tomlinson, George; Feig, Denice S

2018-02-15

Obesity during pregnancy is associated with a number of adverse obstetric outcomes that include gestational diabetes mellitus, macrosomia, and preeclampsia. Increasing evidence shows that bariatric surgery may decrease the risk of these outcomes. Our aim was to evaluate the benefits and risks of bariatric surgery in obese women according to obstetric outcomes. We performed a systematic literature search using MEDLINE, Embase, Cochrane, Web of Science, and PubMed from inception up to December 12, 2016. Studies were included if they evaluated patients who underwent bariatric surgery, reported subsequent pregnancy outcomes, and compared these outcomes with a control group. Two reviewers extracted study outcomes independently, and risk of bias was assessed with the use of the Newcastle-Ottawa Quality Assessment Scale. Pooled odds ratios for each outcome were estimated with the Dersimonian and Laird random effects model. After a review of 2616 abstracts, 20 cohort studies and approximately 2.8 million subjects (8364 of whom had bariatric surgery) were included in the metaanalysis. In our primary analysis, patients who underwent bariatric surgery showed reduced rates of gestational diabetes mellitus (odds ratio, 0.20; 95% confidence interval, 0.11-0.37, number needed to benefit, 5), large-for-gestational-age infants (odds ratio, 0.31; 95% confidence interval, 0.17-0.59; number needed to benefit, 6), gestational hypertension (odds ratio, 0.38; 95% confidence interval, 0.19-0.76; number needed to benefit, 11), all hypertensive disorders (odds ratio, 0.38; 95% confidence interval, 0.27-0.53; number needed to benefit, 8), postpartum hemorrhage (odds ratio, 0.32; 95% confidence interval, 0.08-1.37; number needed to benefit, 21), and caesarean delivery rates (odds ratio, 0.50; 95% confidence interval, 0.38-0.67; number needed to benefit, 9); however, group of patients showed an increase in small-for-gestational-age infants (odds ratio, 2.16; 95% confidence interval, 1.34-3.48; number needed to harm, 21), intrauterine growth restriction (odds ratio, 2.16; 95% confidence interval, 1.34-3.48; number needed to harm, 66), and preterm deliveries (odds ratio, 1.35; 95% confidence interval, 1.02-1.79; number needed to harm, 35) when compared with control subjects who were matched for presurgery body mass index. There were no differences in rates of preeclampsia, neonatal intensive care unit admissions, stillbirths, malformations, and neonatal death. Malabsorptive surgeries resulted in a greater increase in small-for-gestational-age infants (P=.0466) and a greater decrease in large-for-gestational-age infants (P=<.0001) compared with restrictive surgeries. There were no differences in outcomes when we used administrative databases vs clinical charts. Although bariatric surgery is associated with a reduction in the risk of several adverse obstetric outcomes, there is a potential for an increased risk of other important outcomes that should be considered when bariatric surgery is discussed with reproductive-age women. Copyright © 2018 Elsevier Inc. All rights reserved.

Antecedents and neuroimaging patterns in cerebral palsy with epilepsy and cognitive impairment: a population-based study in children born at term.

PubMed

Ahlin, Kristina; Jacobsson, Bo; Nilsson, Staffan; Himmelmann, Kate

2017-07-01

Antecedents of accompanying impairments in cerebral palsy and their relation to neuroimaging patterns need to be explored. A population-based study of 309 children with cerebral palsy born at term between 1983 and 1994. Prepartum, intrapartum, and postpartum variables previously studied as antecedents of cerebral palsy type and motor severity were analyzed in children with cerebral palsy and cognitive impairment and/or epilepsy, and in children with cerebral palsy without these accompanying impairments. Neuroimaging patterns and their relation to identified antecedents were analyzed. Data were retrieved from the cerebral palsy register of western Sweden, and from obstetric and neonatal records. Children with cerebral palsy and accompanying impairments more often had low birthweight (kg) (odds ratio 0.5, 95% confidence interval 0.3-0.8), brain maldevelopment known at birth (p = 0.007, odds ratio ∞) and neonatal infection (odds ratio 5.4, 95% confidence interval 1.04-28.4). Moreover, neuroimaging patterns of maldevelopment (odds ratio 7.2, 95% confidence interval 2.9-17.2), cortical/subcortical lesions (odds ratio 5.3, 95% confidence interval 2.3-12.2) and basal ganglia lesions (odds ratio 7.6, 95% confidence interval 1.4-41.3) were more common, wheras white matter injury was found significantly less often (odds ratio 0.2, 95% confidence interval 0.1-0.5). In most children with maldevelopment, the intrapartum and postpartum periods were uneventful (p < 0.05). Cerebral maldevelopment was associated with prepartum antecedents, whereas subcortical/cortical and basal ganglia lesions were associated with intrapartum and postpartum antecedents. No additional factor other than those related to motor impairment was associated with epilepsy and cognitive impairment in cerebral palsy. Timing of antecedents deemed important for the development of cerebral palsy with accompanying impairments were supported by neuroimaging patterns. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

Prevalence odds ratio versus prevalence ratio: choice comes with consequences.

PubMed

Tamhane, Ashutosh R; Westfall, Andrew O; Burkholder, Greer A; Cutter, Gary R

2016-12-30

Odds ratio, risk ratio, and prevalence ratio are some of the measures of association which are often reported in research studies quantifying the relationship between an independent variable and the outcome of interest. There has been much debate on the issue of which measure is appropriate to report depending on the study design. However, the literature on selecting a particular category of the outcome to be modeled and/or change in reference group for categorical independent variables and the effect on statistical significance, although known, is scantly discussed nor published with examples. In this article, we provide an example of a cross-sectional study wherein prevalence ratio was chosen over (Prevalence) odds ratio and demonstrate the analytic implications of the choice of category to be modeled and choice of reference level for independent variables. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Internal Medicine residents use heuristics to estimate disease probability

PubMed Central

Phang, Sen Han; Ravani, Pietro; Schaefer, Jeffrey; Wright, Bruce; McLaughlin, Kevin

2015-01-01

Background Training in Bayesian reasoning may have limited impact on accuracy of probability estimates. In this study, our goal was to explore whether residents previously exposed to Bayesian reasoning use heuristics rather than Bayesian reasoning to estimate disease probabilities. We predicted that if residents use heuristics then post-test probability estimates would be increased by non-discriminating clinical features or a high anchor for a target condition. Method We randomized 55 Internal Medicine residents to different versions of four clinical vignettes and asked them to estimate probabilities of target conditions. We manipulated the clinical data for each vignette to be consistent with either 1) using a representative heuristic, by adding non-discriminating prototypical clinical features of the target condition, or 2) using anchoring with adjustment heuristic, by providing a high or low anchor for the target condition. Results When presented with additional non-discriminating data the odds of diagnosing the target condition were increased (odds ratio (OR) 2.83, 95% confidence interval [1.30, 6.15], p = 0.009). Similarly, the odds of diagnosing the target condition were increased when a high anchor preceded the vignette (OR 2.04, [1.09, 3.81], p = 0.025). Conclusions Our findings suggest that despite previous exposure to the use of Bayesian reasoning, residents use heuristics, such as the representative heuristic and anchoring with adjustment, to estimate probabilities. Potential reasons for attribute substitution include the relative cognitive ease of heuristics vs. Bayesian reasoning or perhaps residents in their clinical practice use gist traces rather than precise probability estimates when diagnosing. PMID:27004080

The effects of time of disease occurrence, milk yield, and body condition on fertility of dairy cows.

PubMed

Loeffler, S H; de Vries, M J; Schukken, Y H

1999-12-01

The associations between occurrence of diseases, milk yield, and body condition score on conception risk after first artificial insemination (AI) were analyzed in an observational study on a convenience sample of 43 farms participating in a herd health program. Data were taken from 9369 lactations, from 4382 cows inseminated between 20 and 180 d in milk from 1990 to 1996. Two logistic regression models, one containing data from all lactations and a subset containing data from 1762 lactations with body condition scoring, were used to determine pregnancy risk at first AI. The effects of herd deviation in test-day milk yield, body condition score loss, and milk fat to protein ratio changes in early lactation were significant predictors of pregnancy risk, independent of disease; days in milk; farm; and seasonal factors. Three different methods of disease parameterization (incidence rates, binomial classes dependent on the interval in days since last occurrence with respect to AI, and a linear variable weighted for this interval) produced similar results. Metritis, cystic ovarian disease, lameness, and mastitis gave odds ratios for pregnancy risk ranging from 0.35 to 1.15, largely dependent on the interval in days from final disease occurrence to first AI. Displaced abomasum, milk fever, and retained fetal membranes resulted in odds ratios for pregnancy risk of 0.25, 0.85, and 0.55, respectively. These diseases showed little relationship between fertility and the number of days since last occurrence. Results of this study confirm the negative effects of milk yield, body score condition loss, and disease on dairy cow fertility. The effects of some diseases on first service conception were strongly dependent on the interval since last disease occurrence. This was especially valid for clinical mastitis, which has an extremely weak effect on conception if occurring prior to AI and is associated with > 50% reduction in pregnancy risk if occurring in the 3 wk directly after AI.

Effect of rearing factors on the prevalence of floor eggs, cloacal cannibalism and feather pecking in commercial flocks of loose housed laying hens.

PubMed

Gunnarsson, S; Keeling, L J; Svedberg, J

1999-03-01

1. Effects of rearing conditions on behavioural problems were investigated in a cohort study of commercial flocks of laying hens housed in 2 different loose housing systems. The sample population was 120 385 laying hens from 59 flocks of various hybrids at 21 different farms. 2. Logistic regression modelling was used to test the effects of selected factors on floor eggs, cloacal cannibalism and feather pecking. In addition to early access to perches or litter, models included hybrid, stocking density, group size, housing system, age at delivery, identical housing system at the rearing farm and at the production farm and, in models for floor eggs and cloacal cannibalism, nest area per hen. Odds ratios were calculated from the results of the models to allow risk assessment. 3. No significant correlations were found between the prevalence of floor eggs, cloacal cannibalism and feather pecking. 4. Access to perches from not later than the 4th week of age decreased the prevalence of floor eggs during the period from start-of-lay until 35 weeks of age, odds ratio 0-30 (P<0-001). Furthermore, early access to perches decreased the prevalence of cloacal cannibalism during the production period, odds ratio 0-46 (P=0.03). 5. No other factor had a significant effect in these models. Although it was not significant, early access to litter had a non-significant tendency to reduce the prevalence of feather pecking.

Urinary calculi increase the risk for adverse pregnancy outcomes: a nationwide study.

PubMed

Chung, Shiu-Dong; Chen, Yi-Hua; Keller, Jospeh J; Lin, Ching-Chun; Lin, Herng-Ching

2013-01-01

Using two large-scale nationwide population-based data sets, this study aimed to assess the risk of adverse pregnancy outcomes between mothers with and without urinary calculi. Cross-sectional study. Taiwan. This study included 3694 women who had live singleton births and received a diagnosis of urinary calculi (UC) in the year prior to their delivery, as well as 18 470 matched women without UC, who were used as a comparison group. Conditional logistic regression analyses were performed. Low birthweight, preterm birth, small for gestational age, cesarean section, lower Apgar score and pre-eclampsia/eclampsia. Women with UC had a higher prevalence of low-birthweight neonates (7.4 vs. 6.0%, p = 0.003), preterm births (9.5 vs. 7.3%, p < 0.001) and cesarean sections (43.1 vs. 35.4%, p < 0.001) than women without UC. After adjusting for potential confounding factors, women with UC were more likely than women without UC to have low-birthweight neonates (odds ratio 1.21, 95% confidence interval 1.05-1.39), preterm birth (odds ratio 1.28, 95% confidence interval 1.13-1.43) and cesarean sections (odds ratio 1.37, 95% confidence interval 1.28-1.48). There were increased risks for having low-birthweight, preterm infants and for experiencing cesarean section among women with UC in comparison to women without UC. © 2012 The Authors © 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

Pregnancy and birth outcomes in couples with infertility with and without assisted reproductive technology: with an emphasis on US population-based studies.

PubMed

Luke, Barbara

2017-09-01

Infertility, defined as the inability to conceive within 1 year of unprotected intercourse, affects an estimated 80 million individuals worldwide, or 10-15% of couples of reproductive age. Assisted reproductive technology includes all infertility treatments to achieve conception; in vitro fertilization is the process by which an oocyte is fertilized by semen outside the body; non-in vitro fertilization assisted reproductive technology treatments include ovulation induction, artificial insemination, and intrauterine insemination. Use of assisted reproductive technology has risen steadily in the United States during the past 2 decades due to several reasons, including childbearing at older maternal ages and increasing insurance coverage. The number of in vitro fertilization cycles in the United States has nearly doubled from 2000 through 2013 and currently 1.7% of all live births in the United States are the result of this technology. Since the birth of the first child from in vitro fertilization >35 years ago, >5 million babies have been born from in vitro fertilization, half within the past 6 years. It is estimated that 1% of singletons, 19% of twins, and 25% of triplet or higher multiples are due to in vitro fertilization, and 4%, 21%, and 52%, respectively, are due to non-in vitro fertilization assisted reproductive technology. Higher plurality at birth results in a >10-fold increase in the risks for prematurity and low birthweight in twins vs singletons (adjusted odds ratio, 11.84; 95% confidence interval, 10.56-13.27 and adjusted odds ratio, 10.68; 95% confidence interval, 9.45-12.08, respectively). The use of donor oocytes is associated with increased risks for pregnancy-induced hypertension (adjusted odds ratio, 1.43; 95% confidence interval, 1.14-1.78) and prematurity (adjusted odds ratio, 1.43; 95% confidence interval, 1.11-1.83). The use of thawed embryos is associated with higher risks for pregnancy-induced hypertension (adjusted odds ratio, 1.30; 95% confidence interval, 1.08-1.57) and large-for-gestation birthweight (adjusted odds ratio, 1.74; 95% confidence interval, 1.45-2.08). Among singletons, in vitro fertilization is associated with increased risk of severe maternal morbidity compared with fertile deliveries (vaginal: adjusted odds ratio, 2.27; 95% confidence interval, 1.78-2.88; cesarean: adjusted odds ratio, 1.67; 95% confidence interval, 1.40-1.98, respectively) and subfertile deliveries (vaginal: adjusted odds ratio, 1.97; 95% confidence interval, 1.30-3.00; cesarean: adjusted odds ratio, 1.75; 95% confidence interval, 1.30-2.35, respectively). Among twins, cesarean in vitro fertilization deliveries have significantly greater severe maternal morbidity compared to cesarean fertile deliveries (adjusted odds ratio, 1.48; 95% confidence interval, 1.14-1.93). Subfertility, with or without in vitro fertilization or non-in vitro fertilization infertility treatments to achieve a pregnancy, is associated with increased risks of adverse maternal and perinatal outcomes. The major risk from in vitro fertilization treatments of multiple births (and the associated excess of perinatal morbidity) has been reduced over time, with fewer and better-quality embryos being transferred. Copyright © 2017. Published by Elsevier Inc.

Associations between maternal periconceptional exposure to secondhand tobacco smoke and major birth defects.

PubMed

Hoyt, Adrienne T; Canfield, Mark A; Romitti, Paul A; Botto, Lorenzo D; Anderka, Marlene T; Krikov, Sergey V; Tarpey, Morgan K; Feldkamp, Marcia L

2016-11-01

While associations between secondhand smoke and a few birth defects (namely, oral clefts and neural tube defects) have been noted in the scientific literature, to our knowledge, there is no single or comprehensive source of population-based information on its associations with a range of birth defects among nonsmoking mothers. We utilized data from the National Birth Defects Prevention Study, a large population-based multisite case-control study, to examine associations between maternal reports of periconceptional exposure to secondhand smoke in the household or workplace/school and major birth defects. The multisite National Birth Defects Prevention Study is the largest case-control study of birth defects to date in the United States. We selected cases from birth defect groups having >100 total cases, as well as all nonmalformed controls (10,200), from delivery years 1997 through 2009; 44 birth defects were examined. After excluding cases and controls from multiple births and whose mothers reported active smoking or pregestational diabetes, we analyzed data on periconceptional secondhand smoke exposure-encompassing the period 1 month prior to conception through the first trimester. For the birth defect craniosynostosis, we additionally examined the effect of exposure in the second and third trimesters as well due to the potential sensitivity to teratogens for this defect throughout pregnancy. Covariates included in all final models of birth defects with ≥5 exposed mothers were study site, previous live births, time between estimated date of delivery and interview date, maternal age at estimated date of delivery, race/ethnicity, education, body mass index, nativity, household income divided by number of people supported by this income, periconceptional alcohol consumption, and folic acid supplementation. For each birth defect examined, we used logistic regression analyses to estimate both crude and adjusted odds ratios and 95% confidence intervals for both isolated and total case groups for various sources of exposure (household only; workplace/school only; household and workplace/school; household or workplace/school). The prevalence of secondhand smoke exposure only across all sources ranged from 12.9-27.8% for cases and 14.5-15.8% for controls. The adjusted odds ratios for any vs no secondhand smoke exposure in the household or workplace/school and isolated birth defects were significantly elevated for neural tube defects (anencephaly: adjusted odds ratio, 1.66; 95% confidence interval, 1.22-2.25; and spina bifida: adjusted odds ratio, 1.49; 95% confidence interval, 1.20-1.86); orofacial clefts (cleft lip without cleft palate: adjusted odds ratio, 1.41; 95% confidence interval, 1.10-1.81; cleft lip with or without cleft palate: adjusted odds ratio, 1.24; 95% confidence interval, 1.05-1.46; cleft palate alone: adjusted odds ratio, 1.31; 95% confidence interval, 1.06-1.63); bilateral renal agenesis (adjusted odds ratio, 1.99; 95% confidence interval, 1.05-3.75); amniotic band syndrome-limb body wall complex (adjusted odds ratio, 1.66; 95% confidence interval, 1.10-2.51); and atrial septal defects, secundum (adjusted odds ratio, 1.37; 95% confidence interval, 1.09-1.72). There were no significant inverse associations observed. Additional studies replicating the findings are needed to better understand the moderate positive associations observed between periconceptional secondhand smoke and several birth defects in this analysis. Increased odds ratios resulting from chance (eg, multiple comparisons) or recall bias cannot be ruled out. Copyright © 2016 Elsevier Inc. All rights reserved.

Meta-analysis of Odds Ratios: Current Good Practices

PubMed Central

Chang, Bei-Hung; Hoaglin, David C.

2016-01-01

Background Many systematic reviews of randomized clinical trials lead to meta-analyses of odds ratios. The customary methods of estimating an overall odds ratio involve weighted averages of the individual trials’ estimates of the logarithm of the odds ratio. That approach, however, has several shortcomings, arising from assumptions and approximations, that render the results unreliable. Although the problems have been documented in the literature for many years, the conventional methods persist in software and applications. A well-developed alternative approach avoids the approximations by working directly with the numbers of subjects and events in the arms of the individual trials. Objective We aim to raise awareness of methods that avoid the conventional approximations, can be applied with widely available software, and produce more-reliable results. Methods We summarize the fixed-effect and random-effects approaches to meta-analysis; describe conventional, approximate methods and alternative methods; apply the methods in a meta-analysis of 19 randomized trials of endoscopic sclerotherapy in patients with cirrhosis and esophagogastric varices; and compare the results. We demonstrate the use of SAS, Stata, and R software for the analysis. Results In the example, point estimates and confidence intervals for the overall log-odds-ratio differ between the conventional and alternative methods, in ways that can affect inferences. Programming is straightforward in the three software packages; an appendix gives the details. Conclusions The modest additional programming required should not be an obstacle to adoption of the alternative methods. Because their results are unreliable, use of the conventional methods for meta-analysis of odds ratios should be discontinued. PMID:28169977

[Factors associated with prehospital delay in men and women with acute coronary syndrome].

PubMed

Daponte-Codina, A; Bolívar-Muñoz, J; Sánchez-Cantalejo, E; Mateo-Rodríguez, I; Babio, G; Romo-Avilés, N; Rosell-Ortiz, F

2016-04-30

To identify factors associated with prehospital delay in people who have had an acute coronary syndrome. Using a survey we studied patients admitted due to acute coronary syndrome in the 33 Andalusian public hospitals, obtaining information about different types of variables: socio-demographic, contextual,clinical, perception, action, and transportation.Multivariate logistic regression models were applied to calculate the odds ratios for the delay. Of the 1,416 patients studied, more than half had a delay of more than an hour. This is associated to distance to the hospital and means of transport: when the event occurs in the same city,using the patient's own means of transport increases the delay, odds ratio = 1.51 (1.02 to 2.23); if the distance is 1 to 25 kilometers from the hospital,there is no difference between the patient's own means of transport and an ambulance, odds ratio =1.41 and odds ratio =1.43 respectively; and when the distance exceeds 25 kilometers transport by ambulance means more delay, odds ratio = 3.13 and odds ratio = 2.20 respectively. Also, typical symptoms reduce delay amongst men but increase amongst women. Also, not caring and waiting for the resolution of symptoms, seeking health care other than a hospital or emergency services, previous clinical history, being away from home, and having an income under 1,500 euros, all increase delay. Respiratory symptoms reduce delay. Prehospital delay times do not meet health recommendations. The physical and social environment,in addition to clinical, perceptual and attitudinal factors, are associated with this delay.

Environmental factors associated with physician's engagement in communication activities.

PubMed

Mazurenko, Olena; Hearld, Larry R

2015-01-01

Communication between patients and providers is a crucial component of effective care coordination and is associated with a number of desired patient and provider outcomes. Despite these benefits, physician-patient and physician-physician communication occurs infrequently. The purpose of this study was to examine the relationship between a medical practice's external environment and physician engagement in communication activities. This was a cross-sectional examination of 4,299 U.S. physicians' self-reported engagement in communication activities. Communication was operationalized as physician's time spent on communication with patients and other providers during a typical work day. The explanatory variables were measures of environmental complexity, dynamism, and munificence. Data sources were the Health Tracking Physician Survey, the Area Resource File database, and the Dartmouth Atlas. Binary logistic regression was used to estimate the association between the environmental factors and physician engagement in communication activities. Several environmental factors, including per capita income (odds ratio range, 1.17-1.38), urban location (odds ratio range, 1.08-1.45), fluctuations in Health Maintenance Organization penetration (odds ratio range, 3.47-13.22), poverty (odds ratio range, 0.80-0.97) and population rates (odds ratio range, 1.01-1.02), and the presence of a malpractice crisis (odds ratio range, 0.22-0.43), were significantly associated with communication. Certain aspects of a physician's external environment are associated with different modes of communication with different recipients (patients and providers). This knowledge can be used by health care managers and policy makers who strive to improve communication between different stakeholders within the health care system (e.g., patient and providers).

Prevalence of Untreated Surgical Conditions in Rural Rwanda: A Population-Based Cross-sectional Study in Burera District.

PubMed

Maine, Rebecca G; Linden, Allison F; Riviello, Robert; Kamanzi, Emmanuel; Mody, Gita N; Ntakiyiruta, Georges; Kansayisa, Grace; Ntaganda, Edmond; Niyonkuru, Francine; Mubiligi, Joel M; Mpunga, Tharcisse; Meara, John G; Hedt-Gauthier, Bethany L

2017-12-20

In low- and middle-income countries, community-level surgical epidemiology is largely undefined. Accurate community-level surgical epidemiology is necessary for surgical health systems planning. To determine the prevalence of surgical conditions in Burera District, Northern Province, Rwanda. A cross-sectional study with a 2-stage cluster sample design (at village and household level) was carried out in Burera District in March and May 2012. A team of surgeons randomly sampled 30 villages with probability proportionate to village population size, then sampled 23 households within each village. All available household members were examined. The presence of 10 index surgical conditions (injuries/wounds, hernias/hydroceles, breast masses, neck masses, obstetric fistulas, undescended testes, hypospadias, hydrocephalus, cleft lip/palate, and clubfoot) was determined by physical examination. Prevalence was estimated overall and for each condition. Multivariable logistic regression was performed to identify factors associated with surgical conditions, accounting for the complex survey design. Of the 2165 examined individuals, 1215 (56.2%) were female. The prevalence of any surgical condition among all examined individuals was 12% (95% CI, 9.2-14.9%). Half of conditions were hernias/hydroceles (49.6%), and 44% were injuries/wounds. In multivariable analysis, children 5 years or younger had twice the odds of having a surgical condition compared with married individuals 21 to 35 years of age (reference group) (odds ratio [OR], 2.2; 95% CI, 1.26-4.04; P = .01). The oldest group, people older than 50 years, also had twice the odds of having a surgical condition compared with the reference group (married, aged >50 years: OR, 2.3; 95% CI, 1.28-4.23; P = .01; unmarried, aged >50 years: OR, 2.38; 95% CI, 1.02-5.52; P = .06). Unmarried individuals 21 to 35 years of age and unmarried individuals aged 36 to 50 years had higher odds of a surgical condition compared with the reference group (aged 21-35 years: OR, 1.68; 95% CI, 0.74-3.82; P = .22; aged 36-50 years: OR, 3.35; 95% CI, 1.29-9.11; P = .02). There was no statistical difference in odds by sex, wealth, education, or travel time to the nearest hospital. The prevalence of surgically treatable conditions in northern Rwanda was considerably higher than previously estimated modeling and surveys in comparable low- and middle-income countries. This surgical backlog must be addressed in health system plans to increase surgical infrastructure and workforce in rural Africa.

Previous treatment, sputum-smear nonconversion, and suburban living: The risk factors of multidrug-resistant tuberculosis among Malaysians.

PubMed

Mohd Shariff, Noorsuzana; Shah, Shamsul Azhar; Kamaludin, Fadzilah

2016-03-01

The number of multidrug-resistant tuberculosis patients is increasing each year in many countries all around the globe. Malaysia has no exception in facing this burdensome health problem. We aimed to investigate the factors that contribute to the occurrence of multidrug-resistant tuberculosis among Malaysian tuberculosis patients. An unmatched case-control study was conducted among tuberculosis patients who received antituberculosis treatments from April 2013 until April 2014. Cases are those diagnosed as pulmonary tuberculosis patients clinically, radiologically, and/or bacteriologically, and who were confirmed to be resistant to both isoniazid and rifampicin through drug-sensitivity testing. On the other hand, pulmonary tuberculosis patients who were sensitive to all first-line antituberculosis drugs and were treated during the same time period served as controls. A total of 150 tuberculosis patients were studied, of which the susceptible cases were 120. Factors found to be significantly associated with the occurrence of multidrug-resistant tuberculosis are being Indian or Chinese (odds ratio 3.17, 95% confidence interval 1.04-9.68; and odds ratio 6.23, 95% confidence interval 2.24-17.35, respectively), unmarried (odds ratio 2.58, 95% confidence interval 1.09-6.09), living in suburban areas (odds ratio 2.58, 95% confidence interval 1.08-6.19), are noncompliant (odds ratio 4.50, 95% confidence interval 1.71-11.82), were treated previously (odds ratio 8.91, 95% confidence interval 3.66-21.67), and showed positive sputum smears at the 2nd (odds ratio 7.00, 95% confidence interval 2.46-19.89) and 6th months of treatment (odds ratio 17.96, 95% confidence interval 3.51-91.99). Living in suburban areas, positive sputum smears in the 2nd month of treatment, and was treated previously are factors that independently contribute to the occurrence of multidrug-resistant tuberculosis. Those with positive smears in the second month of treatment, have a history of previous treatment, and live in suburban areas are found to have a higher probability of becoming multidrug resistant. The results presented here may facilitate improvements in the screening and detection process of drug-resistant patients in Malaysia in the future. Copyright © 2015 Asian-African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.

Statin therapy in lower limb peripheral arterial disease: Systematic review and meta-analysis.

PubMed

Antoniou, George A; Fisher, Robert K; Georgiadis, George S; Antoniou, Stavros A; Torella, Francesco

2014-11-01

To investigate and analyse the existing evidence supporting statin therapy in patients with lower limb atherosclerotic arterial disease. A systematic search of electronic information sources was undertaken to identify studies comparing cardiovascular outcomes in patients with lower limb peripheral arterial disease treated with a statin and those not receiving a statin. Estimates were combined applying fixed- or random-effects models. Twelve observational cohort studies and two randomised trials reporting 19,368 patients were selected. Statin therapy was associated with reduced all-cause mortality (odds ratio 0.60, 95% confidence interval 0.46-0.78) and incidence of stroke (odds ratio 0.77, 95% confidence interval 0.67-0.89). A trend towards improved cardiovascular mortality (odds ratio 0.62, 95% confidence interval 0.35-1.11), myocardial infarction (odds ratio 0.62, 95% confidence interval 0.38-1.01), and the composite of death/myocardial infarction/stroke (odds ratio 0.91, 95% confidence interval 0.81-1.03), was identified. Meta-analyses of studies performing adjustments showed decreased all-cause mortality in statin users (hazard ratio 0.77, 95% confidence interval 0.68-0.86). Evidence supporting statins' protective role in patients with lower limb peripheral arterial disease is insufficient. Statin therapy seems to be effective in reducing all-cause mortality and the incidence cerebrovascular events in patients diagnosed with peripheral arterial disease. Copyright © 2014 Elsevier Inc. All rights reserved.

Association of cardiac disease and alcohol use with the development of severe ciguatera.

PubMed

Radke, Elizabeth G; Grattan, Lynn M; Morris, John Glenn

2013-12-01

Ciguatera is a foodborne illness that causes severe gastrointestinal and neurologic symptoms, but the risk factors for illness are not well established. In St Thomas, US Virgin Islands, we performed a case-control study for ciguatera, enrolling 47 patients primarily through the emergency department and 141 age- and sex-matched controls identified through an island-wide survey. We used conditional logistic regression to assess health-related risk factors for ciguatera, including comorbidities and alcohol and tobacco use. Cases were more likely than controls to report alcohol consumption at least weekly (odds ratio 5.7, 95% confidence interval 2.7-24.8). Cases also more frequently had a history of heart disease (odds ratio 6.3, 95% confidence interval 1.2-32.7). Previous ciguatera episodes, lower levels of education, and frequent fish consumption also were associated with illness. This study provides preliminary evidence that preexisting health status influences an individual's risk of developing severe ciguatera. There may be a benefit to educating high-risk individuals about preventing ciguatera.

Case-crossover design and its implementation in R

PubMed Central

2016-01-01

Case-crossover design is a variation of case-control design that it employs persons’ history periods as controls. Case-crossover design can be viewed as the hybrid of case-control study and crossover design. Characteristic confounding that is constant within one person can be well controlled with this method. The relative risk and odds ratio, as well as their 95% confidence intervals (CIs), can be estimated using Cochran-Mantel-Haenszel method. R codes for the calculation are provided in the main text. Readers may adapt these codes to their own task. Conditional logistic regression model is another way to estimate odds ratio of the exposure. Furthermore, it allows for incorporation of other time-varying covariates that are not constant within subjects. The model fitting per se is not technically difficult because there is well developed statistical package. However, it is challenging to convert original dataset obtained from case report form to that suitable to be passed to clogit() function. R code for this task is provided and explained in the text. PMID:27761445

Prevalence of Salmonella on retail broiler chicken meat carcasses in Colombia.

PubMed

Donado-Godoy, Pilar; Clavijo, Viviana; León, Maribel; Tafur, Mc Allister; Gonzales, Sebastian; Hume, Michael; Alali, Walid; Walls, Isabel; Lo Fo Wong, Danilo M A; Doyle, M P

2012-06-01

A cross-sectional study was performed to estimate the prevalence of Salmonella on retail market chicken carcasses in Colombia. A total of 1,003 broiler chicken carcasses from 23 departments (one city per department) were collected via a stratified sampling method. Carcass rinses were tested for the presence of Salmonella by conventional culture methods. Salmonella strains were isolated from 27 % of the carcasses sampled. Logistic regression analysis was used to determine potential risk factors for Salmonella contamination associated with the chicken production system (conventional versus free-range), storage condition (chilled versus frozen), retail store type (supermarket, independent, and wet market), poultry company (integrated company versus nonintegrated company), and socioeconomic stratum. Chickens from a nonintegrated poultry company were associated with a significantly (P < 0.05) greater risk of Salmonella contamination (odds ratio, 2.0) than were chickens from an integrated company. Chilled chickens had a significantly (P < 0.05) higher risk of Salmonella contamination (odds ratio, 4.3) than did frozen chicken carcasses.

Diesel exhaust, solvents, and other occupational exposures as risk factors for wheeze among farmers.

PubMed

Hoppin, Jane A; Umbach, David M; London, Stephanie J; Alavanja, Michael C R; Sandler, Dale P

2004-06-15

Farmers engage in activities that result in exposure to diesel exhaust, solvents, welding fumes, and other respiratory irritants. Using the Agricultural Health Study, a cohort of pesticide applicators in Iowa and North Carolina, we evaluated the odds of wheeze associated with nonpesticide occupational exposures. We used logistic regression models controlling for age, state, smoking, and history of asthma or atopy to evaluate odds of wheeze in the past year among the 20898 farmers who provided complete information on all covariates. Driving diesel tractors was associated with elevated odds of wheeze (odds ratio = 1.31; 95% confidence interval = 1.13, 1.52); the odds ratio for driving gasoline tractors was 1.11 (95% confidence interval = 1.02, 1.21). A duration-response relationship was observed for driving diesel tractors but not for driving gasoline tractors. Activities involving solvent exposure, including painting and use of solvents for cleaning, were associated with an increased odds of wheeze in a duration-dependent fashion. The highest odds of wheeze for farm activities were for daily painting (odds ratio = 1.82; 95% confidence interval = 0.89, 3.73), an indication of daily solvent exposure. These results add to the growing body of evidence of adverse respiratory effects of diesel exposure on the lung and suggest exposure to solvents may contribute as well.

Association Between Mental Health Burden and Coronary Artery Disease in U.S. Women Veterans Over 45: A National Cross-Sectional Study.

PubMed

Gerber, Megan R; King, Matthew W; Iverson, Katherine M; Pineles, Suzanne L; Haskell, Sally G

2018-03-01

The women Veteran population accessing Veterans Health Administration (VA) care has grown rapidly. Women Veterans exhibit high rates of mental health conditions that increase coronary artery disease (CAD) risk; however, the relationship between specific conditions and increasing mental health burden to CAD in this population is unknown. Using VA National Patient Care Data for 2009, we identified women Veterans over 45 (N = 157,195). Logistic regression models examined different mental health diagnoses and increasing mental health burden (number of diagnostic clusters) as predictors of CAD. CAD prevalence was 4.16%, and 36% of women Veterans were current smokers. Depression exhibited the strongest association with CAD (odds ratio [OR] 1.60, 95% confidence interval [CI] [1.50-1.71]), similar to that of current smoking (OR 1.68 [1.58-1.78]). Controlling for demographic variables, smoking, diabetes, and obesity, each additional mental health diagnosis increased the odds of CAD by 44%. Women Veterans over age 45 accessing VA care exhibited a high degree of mental health burden, which is associated with elevated odds of CAD; those with depression alone had 60% higher odds of CAD. For women Veterans using VA, mental health diagnoses may act as CAD risk factors that are potentially modifiable. Novel interventions in primary care and mental health are needed to address heart disease in this growing and aging population.

Religious hospital policies on reproductive care: what do patients want to know?

PubMed

Freedman, Lori R; Hebert, Luciana E; Battistelli, Molly F; Stulberg, Debra B

2018-02-01

Religious hospitals are a large and growing part of the American healthcare system. Patients who receive obstetric and other reproductive care in religious hospitals may face religiously-based restrictions on the treatment their doctor can provide. Little is known about patients' knowledge or preferences regarding religiously restricted reproductive healthcare. We aimed to assess women's preferences for knowing a hospital's religion and religiously based restrictions before deciding where to seek care and the acceptability of a hospital denying miscarriage treatment options for religious reasons, with and without informing the patient that other options may be available. We conducted a national survey of women aged 18-45 years. The sample was recruited from AmeriSpeak, a probability-based research panel of civilian noninstitutionalized adults. Of 2857 women invited to participate, 1430 completed surveys online or over the phone, for a survey response rate of 50.1%. All analyses adjusted for the complex sampling design and were weighted to generate estimates representative of the population of US adult reproductive-age women. We used χ 2 tests and multivariable logistic regression to evaluate associations. One third of women aged 18-45 years (34.5%) believe it is somewhat or very important to know a hospital's religion when deciding where to get care, but 80.7% feel it is somewhat or very important to know about a hospital's religious restrictions on care. Being Catholic or attending religious services more frequently does not make one more or less likely to want this information. Compared with Protestant women who do not identify as born-again, women of other religious backgrounds are more likely to consider it important to know a hospital's religious affiliation. These include religious minority women (adjusted odds ratio, 2.17; 95% confidence interval, 1.11-4.27), those who reported no religion/atheist/agnostic (adjusted odds ratio, 2.27; 95% confidence interval, 1.19-4.34), and born-again Protestants (adjusted odds ratio, 2.38; 95% confidence interval, 1.32-4.28). Religious minority women (adjusted odds ratio, 2.36; 95% confidence interval, 1.01-5.51) and those who reported no religion/atheist/agnostic (adjusted odds ratio, 3.16; 95% confidence interval, 1.42-7.04) were more likely to want to know a hospital's restrictions on care. More than two thirds of women find it unacceptable for the hospital to restrict information and treatment options during miscarriage based on religion. Women who attended weekly religious services were significantly more likely to accept such restrictions (adjusted odds ratio, 3.13; 95% confidence interval, 1.70-5.76) and to consider transfer to another site an acceptable solution (adjusted odds ratio, 3.22; 95% confidence interval, 1.69-6.12). The question, "When should a religious hospital be allowed to restrict care based on religion?" was asked, and 52.3% responded never; 16.6%, always; and 31.1%,"under some conditions. The vast majority of adult American women of reproductive age want information about a hospital's religious restrictions on care when deciding where to go for obstetrics/gynecology care. Growth in the US Catholic health care sector suggests an increasing need for transparency about these restrictions so that women can make informed decisions and, when needed, seek alternative providers. Copyright © 2017 Elsevier Inc. All rights reserved.

Crash Rates of Quebec Drivers with Medical Conditions

PubMed Central

Dow, Jamie; Gaudet, Michel; Turmel, Émilie

2013-01-01

Using a databank that combines comprehensive medical data with the driving records of 96% of the drivers in Quebec, odds ratios were calculated for crash risk involving death or serious injury according to the diagnosis of medical conditions traditionally associated with increased crash risk. Results were controlled for age, sex, residence (rural/urban), possession of a professional licence (classes 1 – 4), previous involvement in a crash with injury or death and for the presence of other medical conditions. In addition, crash risk was calculated for drivers with multiple conditions. There was a slight to moderate increase in crash risk for most of the conditions and an incremental increase in crash risk as the number of conditions increased. PMID:24406946

Educational differences in leisure-time physical inactivity: a descriptive and explanatory study.

PubMed

Droomers, M; Schrijvers, C T; van de Mheen, H; Mackenbach, J P

1998-12-01

In this study we aim to explain educational differences in leisure-time physical inactivity in terms of psychosocial and material factors. Cross-sectional data were obtained from the baseline of the Dutch GLOBE study in 1991, including 2598 men and women, aged 15-74 years. Physical inactivity during leisure time was defined as not participating in any activity, such as sports, gardening, walking or cycling. Psychosocial factors included in the study were coping resources, personality, and stressors. Material factors were financial situation, employment status, and living conditions. Logistic regression models were used to calculate educational differences in physical inactivity. Physical inactivity was more prevalent in lower educational groups. Psychosocial factors related to physical inactivity were locus of control, parochialism, neuroticism, emotional social support, active problem focussing, optimistic and palliative coping styles. Material factors associated with physical inactivity were income, employment status and financial problems. All correlates of physical inactivity were unequally distributed over educational groups, except optimistic and palliative coping. Personality and coping style were the main contributors to the observed educational differences in physical inactivity. That is to say, parochialism, locus of control, neuroticism and active problem focussing explained about half of elevated odds ratios of physical inactivity in the lower educational groups. The material factors, equivalent income and employment status explained about 40% of the elevated odds ratios. Psychosocial and material correlates together reduced the odds ratios of lower educational groups by on average 75%. These results have practical consequences for the design of more effective interventions to promote physical activity. In particular, personality and coping style of risk groups, such as lower educational groups, should be taken into consideration at the future development of these interventions, as well as inequalities in material restrictions related to engaging in physical activity. Supplementary interventions focussing on childhood conditions which, partly, influence both personality and physical inactivity may also contribute to a reduction of socio-economic differences in physical inactivity.

Association Between Media Use in Adolescence and Depression in Young Adulthood

PubMed Central

Primack, Brian A.; Swanier, Brandi; Georgiopoulos, Anna M.; Land, Stephanie R.; Fine, Michael J.

2010-01-01

Context Although certain media exposures have been linked to the presence of psychiatric conditions, few studies have investigated the association between media exposure and depression. Objective To assess the longitudinal association between media exposure in adolescence and depression in young adulthood in a nationally representative sample. Design Longitudinal cohort study. Setting and Participants We used the National Longitudinal Survey of Adolescent Health (Add Health) to investigate the relationship between electronic media exposure in 4142 adolescents who were not depressed at baseline and subsequent development of depression after 7 years of follow-up. Main Outcome Measure Depression at follow-up assessed using the 9-item Center for Epidemiologic Studies–Depression Scale. Results Of the 4142 participants (47.5% female and 67.0% white) who were not depressed at baseline and who underwent follow-up assessment, 308 (7.4%) reported symptoms consistent with depression at follow-up. Controlling for all covariates including baseline Center for Epidemiologic Studies–Depression Scale score, those reporting more television use had significantly greater odds of developing depression (odds ratio [95% confidence interval], 1.08 [1.01-1.16]) for each additional hour of daily television use. In addition, those reporting more total media exposure had significantly greater odds of developing depression (1.05 [1.0004-1.10]) for each additional hour of daily use. We did not find a consistent relationship between development of depressive symptoms and exposure to videocassettes, computer games, or radio. Compared with young men, young women were less likely to develop depression given the same total media exposure (odds ratio for interaction term, 0.93 [0.88-0.99]). Conclusion Television exposure and total media exposure in adolescence are associated with increased odds of depressive symptoms in young adulthood, especially in young men. PMID:19188540

Association between media use in adolescence and depression in young adulthood: a longitudinal study.

PubMed

Primack, Brian A; Swanier, Brandi; Georgiopoulos, Anna M; Land, Stephanie R; Fine, Michael J

2009-02-01

Although certain media exposures have been linked to the presence of psychiatric conditions, few studies have investigated the association between media exposure and depression. To assess the longitudinal association between media exposure in adolescence and depression in young adulthood in a nationally representative sample. Longitudinal cohort study. We used the National Longitudinal Survey of Adolescent Health (Add Health) to investigate the relationship between electronic media exposure in 4142 adolescents who were not depressed at baseline and subsequent development of depression after 7 years of follow-up. Main Outcome Measure Depression at follow-up assessed using the 9-item Center for Epidemiologic Studies-Depression Scale. Of the 4142 participants (47.5% female and 67.0% white) who were not depressed at baseline and who underwent follow-up assessment, 308 (7.4%) reported symptoms consistent with depression at follow-up. Controlling for all covariates including baseline Center for Epidemiologic Studies-Depression Scale score, those reporting more television use had significantly greater odds of developing depression (odds ratio [95% confidence interval], 1.08 [1.01-1.16]) for each additional hour of daily television use. In addition, those reporting more total media exposure had significantly greater odds of developing depression (1.05 [1.0004-1.10]) for each additional hour of daily use. We did not find a consistent relationship between development of depressive symptoms and exposure to videocassettes, computer games, or radio. Compared with young men, young women were less likely to develop depression given the same total media exposure (odds ratio for interaction term, 0.93 [0.88-0.99]). Television exposure and total media exposure in adolescence are associated with increased odds of depressive symptoms in young adulthood, especially in young men.

Does menopausal hormone therapy reduce myocardial infarction risk if initiated early after menopause? A population-based case-control study.

PubMed

Carrasquilla, Germán D; Berglund, Anita; Gigante, Bruna; Landgren, Britt-Marie; de Faire, Ulf; Hallqvist, Johan; Leander, Karin

2015-06-01

This study aims to assess whether the timing of menopausal hormone therapy initiation in relation to onset of menopause and hormone therapy duration is associated with myocardial infarction risk. This study was based on the Stockholm Heart Epidemiology Program, a population-based case-control study including 347 postmenopausal women who had experienced a nonfatal myocardial infarction and 499 female control individuals matched for age and residential area. Odds ratios (with 95% CIs) for myocardial infarction were calculated using logistic regression. Early initiation of hormone therapy (within 10 y of onset of menopause or before age 60 y), compared with never use, was associated with an odds ratio of 0.87 (95% CI, 0.58-1.30) after adjustments for lifestyle factors, body mass index, and socioeconomic status. For late initiation of hormone therapy, the corresponding odds ratio was 0.97 (95% CI, 0.53-1.76). For hormone therapy duration of 5 years or more, compared with never use, the adjusted odds ratio was 0.64 (95% CI, 0.35-1.18). For hormone therapy duration of less than 5 years, the odds ratio was 0.97 (95% CI, 0.63-1.48). Neither the timing of hormone therapy initiation nor the duration of therapy is significantly associated with myocardial infarction risk.

Relationship between Hay Fever and Mineral Concentration in the Hair, Lifestyle or Aging.

PubMed

Yamashiro, Kaito; Ogata, Fumihiko; Kawasaki, Naohito

2017-01-01

It is important to ingest just proportions of minerals to prevent disease, but these minerals are also secreted into the hair. Meanwhile, the number of hay fever patients in Japan is increasing, causing an increase in national medical expenses. In this study, we investigated the relationship between hay fever and mineral concentrations in hair to obtain findings on the risk of developing pollen allergies. A questionnaire survey was conducted for 275 men and 977 women on their lifestyle habits and ten kinds of mineral concentrations present in their hair were measured with subsequent analysis using nominal logistic regression analysis. The results indicated that half the patients in each age group had hay fever, with no significant difference between hay fever and aging, exercise habits, sleep and dietary rhythms. On the other hand, there was a significant difference between hay fever and mineral concentrations in the hair, and in men with hay fever, iron (odds ratio: 0.55, p<0.05) was low, while in women calcium (odds ratio: 0.67, p<0.05), chromium (odds ratio: 0.46, p<0.001), cadmium (odds ratio: 0.68, p<0.01) were low and selenium (odds ratio: 1.78, p<0.01) was high. These results, suggest that measurements mineral concentrations in hair are indicators of hay fever risk.

A Genome-wide Association Study of Myasthenia Gravis

PubMed Central

Renton, Alan E.; Pliner, Hannah A.; Provenzano, Carlo; Evoli, Amelia; Ricciardi, Roberta; Nalls, Michael A.; Marangi, Giuseppe; Abramzon, Yevgeniya; Arepalli, Sampath; Chong, Sean; Hernandez, Dena G.; Johnson, Janel O.; Bartoccioni, Emanuela; Scuderi, Flavia; Maestri, Michelangelo; Raphael Gibbs, J.; Errichiello, Edoardo; Chiò, Adriano; Restagno, Gabriella; Sabatelli, Mario; Macek, Mark; Scholz, Sonja W.; Corse, Andrea; Chaudhry, Vinay; Benatar, Michael; Barohn, Richard J.; McVey, April; Pasnoor, Mamatha; Dimachkie, Mazen M.; Rowin, Julie; Kissel, John; Freimer, Miriam; Kaminski, Henry J.; Sanders, Donald B.; Lipscomb, Bernadette; Massey, Janice M.; Chopra, Manisha; Howard, James F.; Koopman, Wilma J.; Nicolle, Michael W.; Pascuzzi, Robert M.; Pestronk, Alan; Wulf, Charlie; Florence, Julaine; Blackmore, Derrick; Soloway, Aimee; Siddiqi, Zaeem; Muppidi, Srikanth; Wolfe, Gil; Richman, David; Mezei, Michelle M.; Jiwa, Theresa; Oger, Joel; Drachman, Daniel B.; Traynor, Bryan J.

2016-01-01

IMPORTANCE Myasthenia gravis is a chronic, autoimmune, neuromuscular disease characterized by fluctuating weakness of voluntary muscle groups. Although genetic factors are known to play a role in this neuroimmunological condition, the genetic etiology underlying myasthenia gravis is not well understood. OBJECTIVE To identify genetic variants that alter susceptibility to myasthenia gravis, we performed a genome-wide association study. DESIGN, SETTING, AND PARTICIPANTS DNA was obtained from 1032 white individuals from North America diagnosed as having acetylcholine receptor antibody–positive myasthenia gravis and 1998 race/ethnicity-matched control individuals from January 2010 to January 2011. These samples were genotyped on Illumina OmniExpress single-nucleotide polymorphism arrays. An independent cohort of 423 Italian cases and 467 Italian control individuals were used for replication. MAIN OUTCOMES AND MEASURES We calculated P values for association between 8114394 genotyped and imputed variants across the genome and risk for developing myasthenia gravis using logistic regression modeling. A threshold P value of 5.0 × 10−8 was set for genome-wide significance after Bonferroni correction for multiple testing. RESULTS In the over all case-control cohort, we identified association signals at CTLA4 (rs231770; P = 3.98 × 10−8; odds ratio, 1.37; 95% CI, 1.25–1.49), HLA-DQA1 (rs9271871; P = 1.08 × 10−8; odds ratio, 2.31; 95% CI, 2.02 – 2.60), and TNFRSF11A (rs4263037; P = 1.60 × 10−9; odds ratio, 1.41; 95% CI, 1.29–1.53). These findings replicated for CTLA4 and HLA-DQA1 in an independent cohort of Italian cases and control individuals. Further analysis revealed distinct, but overlapping, disease-associated loci for early- and late-onset forms of myasthenia gravis. In the late-onset cases, we identified 2 association peaks: one was located in TNFRSF11A (rs4263037; P = 1.32 × 10−12; odds ratio, 1.56; 95% CI, 1.44–1.68) and the other was detected in the major histocompatibility complex on chromosome 6p21 (HLA-DQA1; rs9271871; P = 7.02 × 10−18; odds ratio, 4.27; 95% CI, 3.92–4.62). Association within the major histocompatibility complex region was also observed in early-onset cases (HLA-DQA1; rs601006; P = 2.52 × 10−11; odds ratio, 4.0; 95% CI, 3.57–4.43), although the set of single-nucleotide polymorphisms was different from that implicated among late-onset cases. CONCLUSIONS AND RELEVANCE Our genetic data provide insights into aberrant cellular mechanisms responsible for this prototypical autoimmune disorder. They also suggest that clinical trials of immunomodulatory drugs related to CTLA4 and that are already Food and Drug Administration approved as therapies for other autoimmune diseases could be considered for patients with refractory disease. PMID:25643325

Child Physical Abuse and Adult Mental Health: A National Study

PubMed Central

Sugaya, Luisa; Hasin, Deborah S.; Olfson, Mark; Lin, Keng-Han; Grant, Bridget F.; Blanco, Carlos

2013-01-01

This study characterizes adults who report being physically abused during childhood, and examines associations of reported type and frequency of abuse with adult mental health. Data were derived from the 2000–2001 and 2004–2005 National Epidemiologic Survey on Alcohol and Related Conditions, a large cross-sectional survey of a representative sample (N = 43,093) of the U.S. population. Weighted means, frequencies, and odds ratios of sociodemographic correlates and prevalence of psychiatric disorders were computed. Logistic regression models were used to examine the strength of associations between child physical abuse and adult psychiatric disorders adjusted for sociodemographic characteristics, other childhood adversities, and comorbid psychiatric disorders. Child physical abuse was reported by 8% of the sample and was frequently accompanied by other childhood adversities. Child physical abuse was associated with significantly increased adjusted odds ratios (AORs) of a broad range of DSM-IV psychiatric disorders (AOR = 1.16–2.28), especially attention-deficit hyperactivity disorder, posttraumatic stress disorder, and bipolar disorder. A dose-response relationship was observed between frequency of abuse and several adult psychiatric disorder groups; higher frequencies of assault were significantly associated with increasing adjusted odds. The long-lasting deleterious effects of child physical abuse underscore the urgency of developing public health policies aimed at early recognition and prevention. PMID:22806701

Child physical abuse and adult mental health: a national study.

PubMed

Sugaya, Luisa; Hasin, Deborah S; Olfson, Mark; Lin, Keng-Han; Grant, Bridget F; Blanco, Carlos

2012-08-01

This study characterizes adults who report being physically abused during childhood, and examines associations of reported type and frequency of abuse with adult mental health. Data were derived from the 2000-2001 and 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions, a large cross-sectional survey of a representative sample (N = 43,093) of the U.S. population. Weighted means, frequencies, and odds ratios of sociodemographic correlates and prevalence of psychiatric disorders were computed. Logistic regression models were used to examine the strength of associations between child physical abuse and adult psychiatric disorders adjusted for sociodemographic characteristics, other childhood adversities, and comorbid psychiatric disorders. Child physical abuse was reported by 8% of the sample and was frequently accompanied by other childhood adversities. Child physical abuse was associated with significantly increased adjusted odds ratios (AORs) of a broad range of DSM-IV psychiatric disorders (AOR = 1.16-2.28), especially attention-deficit hyperactivity disorder, posttraumatic stress disorder, and bipolar disorder. A dose-response relationship was observed between frequency of abuse and several adult psychiatric disorder groups; higher frequencies of assault were significantly associated with increasing adjusted odds. The long-lasting deleterious effects of child physical abuse underscore the urgency of developing public health policies aimed at early recognition and prevention. Copyright © 2012 International Society for Traumatic Stress Studies.

Evaluation of a water, sanitation, and hygiene education intervention on diarrhoea in northern Pakistan.

PubMed Central

Nanan, D.; White, F.; Azam, I.; Afsar, H.; Hozhabri, S.

2003-01-01

OBJECTIVE: Inadequate water and sanitation services adversely affect the health and socioeconomic development of communities. The Water and Sanitation Extension Programme (WASEP) project, undertaken in selected villages in northern Pakistan between 1997 and 2001, was designed to deliver an integrated package of activities to improve potable water supply at village and household levels, sanitation facilities and their use, and awareness and practices about hygiene behaviour. METHODS: A case-control study was conducted during July-September 2001 to evaluate whether, after selected confounders were controlled for, children aged <6 years with diarrhoea were more or less likely to reside in villages that participated in the project than in villages that did not participate. Descriptive and logistic regression analyses were performed. FINDINGS: Children not living in WASEP villages had a 33% higher adjusted odds ratio for having diarrhoea than children living in WASEP villages (adjusted odds ratio, 1.331; P<0.049). Boys had 25% lower odds of having diarrhoea than girls (adjusted odds ratio, 0.748; P<0.049). A 2.6% decrease was found in the odds of diarrhoea for every yearly increase in the mother's age (adjusted odds ratio, 0.974; P<0.044) and a 1.4% decrease for every monthly increase in the child's age (adjusted odds ratio, 0.986; P<0.001). CONCLUSIONS: The findings in this study may help refine the approach to future water, sanitation, and hygiene initiatives in northern Pakistan. The integrated approach taken by WASEP, which incorporates engineering solutions with appropriate education to maximize facility usage and improve hygiene practices, is a useful example of how desired health benefits can be obtained from projects of this type. PMID:12764511

Insomnia and incident depression: role of objective sleep duration and natural history.

PubMed

Fernandez-Mendoza, Julio; Shea, Sarah; Vgontzas, Alexandros N; Calhoun, Susan L; Liao, Duanping; Bixler, Edward O

2015-08-01

Longitudinal studies that have examined the association of insomnia with incident depression using objective sleep measures are very limited. The aim of this study was to examine the predictive role of the severity of insomnia for incident depression in a general population sample using psychometric and polysomnographic data. From a random, general population sample of 1741 individuals of the Penn State Adult Cohort, 1137 adults without depression were followed up with a structured telephone interview after 7.5 years. All subjects completed a full medical evaluation, 1-night polysomnogram and Multiphasic Minnesota Personality Inventory at baseline. The incidence of depression was 15%. Poor sleep (odds ratio = 1.5, P = 0.001) and insomnia (odds ratio = 1.9, P = 0.031) were significantly associated with incident depression. The odds of incident depression were highest (odds ratio = 2.2, P = 0.019) in insomnia with objective short sleep duration and independent of Multiphasic Minnesota Personality Inventory Ego Strength scores, an index of poor coping resources. The persistence of insomnia and worsening of poor sleep into insomnia significantly increased the odds of incident depression (odds ratios ranged from 1.8 to 6.3), whereas their full remission did not (odds ratio ranged from 1.2 to 1.8). Insomnia with short sleep duration is associated with incident depression independent of poor coping resources, whereas the association of insomnia with normal sleep duration with incident depression was mediated by poor coping resources. Persistence and worsening of poor sleep or insomnia, but not their full remission, are significant predictors of incident depression. These data suggest that there is a significant relationship between the severity of insomnia and incident depression. © 2015 European Sleep Research Society.

Association between gestational weight gain and perinatal outcomes in women with chronic hypertension.

PubMed

Yee, Lynn M; Caughey, Aaron B; Cheng, Yvonne W

2017-09-01

Gestational weight gain above or below the 2009 National Academy of Medicine guidelines has been associated with adverse maternal and neonatal outcomes. Although it has been well established that excess gestational weight gain is associated with the development of gestational hypertension and preeclampsia, the relationship between gestational weight gain and adverse perinatal outcomes among women with pregestational (chronic) hypertension is less clear. The objective of this study was to examine the relationship between gestational weight gain above and below National Academy of Medicine guidelines and perinatal outcomes in a large, population-based cohort of women with chronic hypertension. This is a population-based retrospective cohort study of women with chronic hypertension who had term, singleton, vertex births in the United States from 2012 through 2014. Prepregnancy body mass index was calculated using self-reported prepregnancy weight and height. Women were categorized into 4 groups based on gestational weight gain and prepregnancy body mass index: (1) weight gain less than, (2) weight gain within, (3) weight gain 1-19 lb in excess of, and (4) weight gain ≥20 lb in excess of the National Academy of Medicine guidelines. The χ 2 tests and multivariable logistic regression analysis were used for statistical comparisons. Stratified analyses by body mass index category were additionally performed. In this large birth cohort, 101,259 women met criteria for inclusion. Compared to hypertensive women who had gestational weight gain within guidelines, hypertensive women with weight gain ≥20 lb over National Academy of Medicine guidelines were more likely to have eclampsia (adjusted odds ratio, 1.93; 95% confidence interval, 1.54-2.42) and cesarean delivery (adjusted odds ratio, 1.60; 95% confidence interval, 1.50-1.70). Excess weight gain ≥20 lb over National Academy of Medicine guidelines was also associated with increased odds of 5-minute Apgar <7 (adjusted odds ratio, 1.29; 95% confidence interval, 1.13-1.47), neonatal intensive care unit admission (adjusted odds ratio, 1.23; 95% confidence interval, 1.14-1.33), and large-for-gestational-age neonates (adjusted odds ratio, 2.41; 95% confidence interval, 2.27-2.56) as well as decreased odds of small-for-gestational-age status (adjusted odds ratio, 0.52; 95% confidence interval, 0.46-0.58). Weight gain 1-19 lb over guidelines was associated with similar fetal growth outcomes although with a smaller effect size. In contrast, weight gain less than National Academy of Medicine guidelines was not associated with adverse maternal outcomes but was associated with increased odds of small for gestational age (adjusted odds ratio, 1.31; 95% confidence interval, 1.21-1.52) and decreased odds of large-for-gestational-age status (adjusted odds ratio, 0.86; 95% confidence interval, 0.81-0.92). Analysis of maternal and neonatal outcomes stratified by body mass index demonstrated similar findings. Women with chronic hypertension who gain less weight than National Academy of Medicine guidelines experience increased odds of small-for-gestational-age neonates, whereas excess weight gain ≥20 lb over National Academy of Medicine guidelines is associated with cesarean delivery, eclampsia, 5-minute Apgar <7, neonatal intensive care unit admission, and large-for-gestational-age neonates. Copyright © 2017 Elsevier Inc. All rights reserved.

Breast cancer biology varies by method of detection and may contribute to overdiagnosis.

PubMed

Hayse, Brandon; Hooley, Regina J; Killelea, Brigid K; Horowitz, Nina R; Chagpar, Anees B; Lannin, Donald R

2016-08-01

Recently, it has been suggested that screening mammography may result in some degree of overdiagnosis (ie, detection of breast cancers that would never become clinically important within the lifespan of the patient). The extent and biology of these overdiagnosed cancers, however, is not well understood, and the effect of newer screening modalities on overdiagnosis is unknown. We performed a retrospective review of a prospectively collected database of breast cancers diagnosed at the Yale Breast Center from 2004-2014. The mode of initial presentation was categorized into 5 groups: screening mammogram, screening magnetic resonance imaging, screening ultrasonography, self-detected masses, and physician-detected masses. Compared with cancers presenting with masses, cancers detected by image-based screening were more likely to present with ductal carcinoma-in-situ or T1 cancers (P < .001). In addition to a simple stage shift, however, cancers detected by image-based screening were also more likely to be luminal and low-grade cancers; symptomatic cancers were more likely high-grade and triple-negative (P < .001, respectively). On a multivariate analysis, adjusting for age, race, and tumor size, cancers detected by mammogram, US, and magnetic resonance imaging had greater odds of being luminal (odds ratio 1.8, 95% confidence interval, 1.5-2.3; odds ratio 2.2, 95% confidence interval, 1.1-4.7; and odds ratio 4.7, 95% confidence interval, 2.1-10.6, respectively), and low-grade (odds ratio 2.2, 95% confidence interval, 1.6-2.9; odds ratio 4.9, 95% confidence interval, 2.7-8.9; and odds ratio 4.6, 95% confidence interval, 2.6-8.1, respectively) compared with cancers presenting with self-detected masses. Screening detects cancers with more indolent biology, potentially contributing to the observed rate of overdiagnosis. With magnetic resonance imaging and US being used more commonly for screening, the rate of overdiagnosis may increase further. Copyright © 2016. Published by Elsevier Inc.

Excess Risk of Temporomandibular Disorder Associated with Cigarette Smoking in Young Adults

PubMed Central

Sanders, Anne E.; Slade, Gary D.; Maixner, William; Nackley, Andrea G.; Diatchenko, Luda; By, Kunthel; Miller, Vanessa E.

2011-01-01

Evidence suggests that the effect of cigarette smoking on chronic pain is stronger in younger than older adults. This case control study investigated whether age modified an effect of smoking on temporomandibular disorder (TMD) in 299 females aged 18–60 years. It also investigated the extent to which this relationship was explained by psychological profile, inflammatory response and allergy. Cases were defined using the Research Diagnostic Criteria for Temporomandibular Disorders based on clinical examination. Psychological profile was evaluated using standardized instruments. Inflammatory response was evaluated with 11 cytokines isolated in plasma. History of allergy conditions was self-reported. Odds ratios (OR) for the effect of smoking were calculated using binary logistic regression. Stratified analyses and the likelihood ratio test examined effect modification by smoking. Compared to non-smokers, ever smokers aged <30 years had higher odds of TMD (OR =4.14, 95% CI: 1.57, 11.35) than older adults (OR =1.23, 95% CI: 0.55, 2.78) (P (effect modification) =0.038). Adjustment for psychological profile, cytokines and history of allergy-like conditions attenuated the effect by 45% to statistical non-significance. The main finding was reproduced with secondary analyses of two nationally-representative surveys of adults conducted in the U.S. and Australia. PMID:22036516

Remission of depression in patients with schizophrenia and comorbid major depressive disorder: results from the FACE-SZ cohort.

PubMed

Fond, Guillaume; Boyer, Laurent; Berna, Fabrice; Godin, Ophélia; Bulzacka, Ewa; Andrianarisoa, Méja; Brunel, Lore; Aouizerate, Bruno; Capdevielle, Delphine; Chereau, Isabelle; Coulon, Nathalie; D'Amato, Thierry; Dubertret, Caroline; Dubreucq, Julien; Faget, Catherine; Leignier, Sylvain; Lançon, Christophe; Mallet, Jasmina; Misdrahi, David; Passerieux, Christine; Rey, Romain; Schandrin, Aurélie; Urbach, Mathieu; Vidailhet, Pierre; Leboyer, Marion; Schürhoff, Franck; Llorca, Pierre-Michel

2018-06-06

Major depressive disorder (MDD) is underdiagnosed and undertreated in schizophrenia, and has been strongly associated with impaired quality of life.AimsTo determine the prevalence and associated factors of MDD and unremitted MDD in schizophrenia, to compare treated and non-treated MDD. Participants were included in the FondaMental Expert Centers for Schizophrenia and received a thorough clinical assessment. MDD was defined by a Calgary score ≥6. Non-remitted MDD was defined by current antidepressant treatment (unchanged for >8 weeks) and current Calgary score ≥6. 613 patients were included and 175 (28.5%) were identified with current MDD. MDD has been significantly associated with respectively paranoid delusion (odds ratio 1.8; P = 0.01), avolition (odds ratio 1.8; P = 0.02), blunted affect (odds ratio 1.7; P = 0.04) and benzodiazepine consumption (odds ratio 1.8; P = 0.02). Antidepressants were associated with lower depressive symptoms score (5.4 v. 9.5; P < 0.0001); however, 44.1% of treated patients remained in non-remittance MDD. Nonremitters were found to have more paranoid delusion (odds ratio 2.3; P = 0.009) and more current alcohol misuse disorder (odds ratio 4.8; P = 0.04). No antidepressant class or specific antipsychotic were associated with higher or lower response to antidepressant treatment. MDD was associated with Metabolic syndrome (31.4 v. 20.2%; P = 0.006) but not with increased C-reactive protein. Antidepressant administration is associated with lower depressive symptom level in patients with schizophrenia and MDD. Paranoid delusions and alcohol misuse disorder should be specifically explored and treated in cases of non-remission under treatment. MetS may play a role in MDD onset and/or maintenance in patients with schizophrenia.Declaration of interestNone.

Surgical resident supervision in the operating room and outcomes of care in Veterans Affairs hospitals.

PubMed

Itani, Kamal M F; DePalma, Ralph G; Schifftner, Tracy; Sanders, Karen M; Chang, Barbara K; Henderson, William G; Khuri, Shukri F

2005-11-01

There has been concern that a reduced level of surgical resident supervision in the operating room (OR) is correlated with worse patient outcomes. Until September 2004, Veterans' Affairs (VA) hospitals entered in the surgical record level 3 supervision on every surgical case when the attending physician was available but not physically present in the OR or the OR suite. In this study, we assessed the impact of level 3 on risk-adjusted morbidity and mortality in the VA system. Surgical cases entered into the National Surgical Quality Improvement Program database between 1998 and 2004, from 99 VA teaching facilities, were included in a logistic regression analysis for each year. Level 3 versus all other levels of supervision were forced into the model, and patient characteristics then were selected stepwise to arrive at a final model. Confidence limits for the odds ratios were calculated by profile likelihood. A total of 610,660 cases were available for analysis. Thirty-day mortality and morbidity rates were reported in 14,441 (2.36%) and 63,079 (10.33%) cases, respectively. Level 3 supervision decreased from 8.72% in 1998 to 2.69% in 2004. In the logistic regression analysis, the odds ratios for mortality for level 3 ranged from .72 to 1.03. Only in the year 2000 were the odds ratio for mortality statistically significant at the .05 level (odds ratio, .72; 95% confidence interval, .594-.858). For morbidity, the odds ratios for level 3 supervision ranged from .66 to 1.01, and all odds ratios except for the year 2004 were statistically significant. Between 1998 and 2004, the level of resident supervision in the OR did not affect clinical outcomes adversely for surgical patients in the VA teaching hospitals.

Prevalence and Risk Factors for Depressive Reaction among Resident Survivors after the Tsunami following the Great East Japan Earthquake, March 11, 2011

PubMed Central

Matsubara, Chieko; Murakami, Hitoshi; Imai, Koubun; Mizoue, Tetsuya; Akashi, Hidechika; Miyoshi, Chiaki; Nakasa, Tamotsu

2014-01-01

Objectives The Great East Japan Earthquake caused a gigantic tsunami which devastated coastal areas of northern Japan on 11 March 2011. Despite the large number of ‘resident survivors’ who continued to reside in their damaged houses on the second or upper floors, research on the mental health of these individuals has been limited. This study explored the prevalence of depressive reaction and risk factors for depressive reaction among these resident survivors. Methods A cross-sectional household health support needs screening was conducted for resident survivors in Higashi-Matsushima city, Miyagi prefecture, two to four months after the tsunami. The health interview that was conducted including mental status, assessed by the Patient Health Questionnaire-2 (PHQ-2). Results Of 5,454 respondents, 8.1% had depressive reaction. After adjustment by the number of weeks from the tsunami and the mortality rate at each respondent's place of residence, depressive reaction was significantly associated with house flooding below or above the ground floor (odds ratios of 1.92, 2.36, respectively), the unavailability of gas supply (odds ratio, 1.67), being female (odds ratio, 1.47), middle aged or elderly (odds ratios of 2.41, 2.42, respectively), regular intake of psychotropic medicine(s) since before the tsunami (odds ratio, 2.53) and the presence of one to five or more than six cohabiters (odds ratios of 0.61, 0.52, respectively). Conclusions The results suggest a considerable psychological burden (depressive reaction) following the tsunami among resident survivors. Special supports for families with psychiatric problems need to be considered among resident survivors. Restoration of lifeline utilities and the strengthening of social ties of persons living alone may help prevent depressive reaction among resident survivors after a tsunami. PMID:25279563

Prevalence and risk factors for depressive reaction among resident survivors after the tsunami following the Great East Japan Earthquake, March 11, 2011.

PubMed

Matsubara, Chieko; Murakami, Hitoshi; Imai, Koubun; Mizoue, Tetsuya; Akashi, Hidechika; Miyoshi, Chiaki; Nakasa, Tamotsu

2014-01-01

The Great East Japan Earthquake caused a gigantic tsunami which devastated coastal areas of northern Japan on 11 March 2011. Despite the large number of 'resident survivors' who continued to reside in their damaged houses on the second or upper floors, research on the mental health of these individuals has been limited. This study explored the prevalence of depressive reaction and risk factors for depressive reaction among these resident survivors. A cross-sectional household health support needs screening was conducted for resident survivors in Higashi-Matsushima city, Miyagi prefecture, two to four months after the tsunami. The health interview that was conducted including mental status, assessed by the Patient Health Questionnaire-2 (PHQ-2). Of 5,454 respondents, 8.1% had depressive reaction. After adjustment by the number of weeks from the tsunami and the mortality rate at each respondent's place of residence, depressive reaction was significantly associated with house flooding below or above the ground floor (odds ratios of 1.92, 2.36, respectively), the unavailability of gas supply (odds ratio, 1.67), being female (odds ratio, 1.47), middle aged or elderly (odds ratios of 2.41, 2.42, respectively), regular intake of psychotropic medicine(s) since before the tsunami (odds ratio, 2.53) and the presence of one to five or more than six cohabiters (odds ratios of 0.61, 0.52, respectively). The results suggest a considerable psychological burden (depressive reaction) following the tsunami among resident survivors. Special supports for families with psychiatric problems need to be considered among resident survivors. Restoration of lifeline utilities and the strengthening of social ties of persons living alone may help prevent depressive reaction among resident survivors after a tsunami.

Antibiotic treatment of bacterial vaginosis in pregnancy: a meta-analysis.

PubMed

Leitich, Harald; Brunbauer, Mathias; Bodner-Adler, Barbara; Kaider, Alexandra; Egarter, Christian; Husslein, Peter

2003-03-01

The purpose of this study was to evaluate the effectiveness of antibiotic treatment of bacterial vaginosis in pregnancy to reduce preterm delivery. We performed a meta-analysis of published, English-language, randomized, placebo-controlled clinical trials of antibiotic treatment of bacterial vaginosis in pregnant women with intact amniotic membranes at <37 weeks of gestation. Primary outcomes included preterm delivery, perinatal or neonatal death, and neonatal morbidity. Ten studies with results for 3969 patients were included. In patients without preterm labor, antibiotic treatment did not significantly decrease preterm delivery at <37 weeks of gestation, in all patients combined (odds ratio, 0.83; 95% CI, 0.57-1.21) nor in high-risk patients with a previous preterm delivery (odds ratio, 0.50; 95% CI, 0.22-1.12). In both groups, significant statistical heterogeneity was observed. A significant reduction in preterm delivery and no statistical heterogeneity were observed in 338 high-risk patients who received oral regimens with treatment durations of > or =7 days (odds ratio, 0.42; 95% CI, 0.27-0.67). Nonsignificant effects and no statistical heterogeneity were observed in low-risk patients (odds ratio, 0.94; 95% CI, 0.71-1.25) and with vaginal regimens (odds ratio, 1.25; 95% CI: 0.86-1.81). In one study antibiotic treatment in patients with preterm labor led to a nonsignificant decrease in the rate of preterm deliveries (odds ratio, 0.31; 95% CI, 0.03-3.24). The screening of pregnant women who have bacterial vaginosis and who have had a previous preterm delivery and treatment with an oral regimen of longer duration can be justified on the basis of current evidence. More studies are needed to confirm the effectiveness of this strategy, both in high-risk patients without preterm labor and in patients with preterm labor.

Patient-reported immunosuppression nonadherence 6 to 24 months after liver transplant: association with pretransplant psychosocial factors and perceptions of health status change

PubMed Central

Rodrigue, James R.; Nelson, David R.; Hanto, Douglas W.; Reed, Alan I.; Curry, Michael P.

2014-01-01

Context Knowing the prevalence and risk factors of immunosuppression nonadherence after liver transplant may help guide intervention development. Objective To examine whether sociodemographic and psychosocial variables before liver transplant are predictive of nonadherence after liver transplant. Design Structured telephone interviews were used to collect self-report immunosuppression adherence and health status information. Medical record reviews were then completed to retrospectively examine the relationship between immunosuppression adherence and pretransplant variables, including sociodemographic and medical characteristics and the presence or absence of 6 hypothesized psychosocial risk factors. Setting and Participants A nonprobability sample of 236 adults 6 to 24 months after liver transplant at 2 centers completed structured telephone interviews. Main Outcome Measure Immunosuppressant medication nonadherence, categorized as missed-dose and altered-dose “adherent” or “nonadherent” during the past 6 months; immunosuppression medication holidays. Results Eighty-two patients (35%) were missed-dose nonadherent and 34 patients (14%) were altered-dose nonadherent. Seventy-one patients (30%) reported 1 or more 24-hour immunosuppression holidays in the past 6 months. Missed-dose nonadherence was predicted by male sex (odds ratio, 2.46; P = .01), longer time since liver transplant (odds ratio, 1.08; P = .01), pretransplant mood disorder (odds ratio, 2.52; P = .004), and pretransplant social support instability (odds ratio, 2.25; P = .03). Altered-dose nonadherence was predicted by pretransplant mood disorder (odds ratio, 2.15; P = .04) and pretransplant social support instability (odds ratio, 1.89; P = .03). Conclusion Rates of immunosuppressant nonadherence and drug holidays in the first 2 years after liver transplant are unacceptably high. Pretransplant mood disorder and social support instability increase the risk of nonadherence, and interventions should target these modifiable risk factors. PMID:24311395

Is case-chaos methodology an appropriate alternative to conventional case-control studies for investigating outbreaks?

PubMed

Edelstein, Michael; Wallensten, Anders; Kühlmann-Berenzon, Sharon

2014-08-15

Case-chaos methodology is a proposed alternative to case-control studies that simulates controls by randomly reshuffling the exposures of cases. We evaluated the method using data on outbreaks in Sweden. We identified 5 case-control studies from foodborne illness outbreaks that occurred between 2005 and 2012. Using case-chaos methodology, we calculated odds ratios 1,000 times for each exposure. We used the median as the point estimate and the 2.5th and 97.5th percentiles as the confidence interval. We compared case-chaos matched odds ratios with their respective case-control odds ratios in terms of statistical significance. Using Spearman's correlation, we estimated the correlation between matched odds ratios and the proportion of cases exposed to each exposure and quantified the relationship between the 2 using a normal linear mixed model. Each case-control study identified an outbreak vehicle (odds ratios = 4.9-45). Case-chaos methodology identified the outbreak vehicle 3 out of 5 times. It identified significant associations in 22 of 113 exposures that were not associated with outcome and 5 of 18 exposures that were significantly associated with outcome. Log matched odds ratios correlated with their respective proportion of cases exposed (Spearman ρ = 0.91) and increased significantly with the proportion of cases exposed (b = 0.054). Case-chaos methodology missed the outbreak source 2 of 5 times and identified spurious associations between a number of exposures and outcome. Measures of association correlated with the proportion of cases exposed. We recommended against using case-chaos analysis during outbreak investigations. © The Author 2014. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Lower hospital mortality and complications after pediatric hematopoietic stem cell transplantation.

PubMed

Bratton, Susan L; Van Duker, Heather; Statler, Kimberly D; Pulsipher, Michael A; McArthur, Jennifer; Keenan, Heather T

2008-03-01

To assess protective and risk factors for mortality among pediatric patients during initial care after hematopoietic stem cell transplantation (HSCT) and to evaluate changes in hospital mortality. Retrospective cohort using the 1997, 2000, and 2003 Kids Inpatient Database, a probabilistic sample of children hospitalized in the United States with a procedure code for HSCT. Hospitalized patients in the United States submitted to the database. Age, <19 yrs. None. Hospital mortality significantly decreased from 12% in 1997 to 6% in 2003. Source of stem cells changed with increased use of cord blood. Rates of sepsis, graft versus host disease, and mechanical ventilation significantly decreased. Compared with autologous HSCT, patients who received an allogenic HSCT without T-cell depletion were more likely to die (adjusted odds ratio, 2.4; 95% confidence interval, 1.5, 3.9), while children who received cord blood HSCT were at the greatest risk of hospital death (adjusted odds ratio, 4.8; 95% confidence interval, 2.6, 9.1). Mechanical ventilation (adjusted odds ratio, 26.32; 95% confidence interval, 16.3-42.2), dialysis (adjusted odds ratio, 12.9; 95% confidence interval, 4.7-35.4), and sepsis (adjusted odds ratio, 3.9; 95% confidence interval, 2.5-6.1) were all independently associated with death, while care in 2003 was associated with decreased risk (adjusted odds ratio, 0.4; 95% confidence interval, 0.2-0.7) of death. Hospital mortality after HSCT in children decreased over time as did complications including need for mechanical ventilation, graft versus host disease, and sepsis. Prevention of complications is essential as the need for invasive support continues to be associated with high mortality risk.

Salmonella typhimurium infections associated with peanut products.

PubMed

Cavallaro, Elizabeth; Date, Kashmira; Medus, Carlota; Meyer, Stephanie; Miller, Benjamin; Kim, Clara; Nowicki, Scott; Cosgrove, Shaun; Sweat, David; Phan, Quyen; Flint, James; Daly, Elizabeth R; Adams, Jennifer; Hyytia-Trees, Eija; Gerner-Smidt, Peter; Hoekstra, Robert M; Schwensohn, Colin; Langer, Adam; Sodha, Samir V; Rogers, Michael C; Angulo, Frederick J; Tauxe, Robert V; Williams, Ian T; Behravesh, Casey Barton

2011-08-18

Contaminated food ingredients can affect multiple products, each distributed through various channels and consumed in multiple settings. Beginning in November 2008, we investigated a nationwide outbreak of salmonella infections. A case was defined as laboratory-confirmed infection with the outbreak strain of Salmonella Typhimurium occurring between September 1, 2008, and April 20, 2009. We conducted two case-control studies, product "trace-back," and environmental investigations. Among 714 case patients identified in 46 states, 166 (23%) were hospitalized and 9 (1%) died. In study 1, illness was associated with eating any peanut butter (matched odds ratio, 2.5; 95% confidence interval [CI], 1.3 to 5.3), peanut butter-containing products (matched odds ratio, 2.2; 95% CI, 1.1 to 4.7), and frozen chicken products (matched odds ratio, 4.6; 95% CI, 1.7 to 14.7). Investigations of focal clusters and single cases associated with nine institutions identified a single institutional brand of peanut butter (here called brand X) distributed to all facilities. In study 2, illness was associated with eating peanut butter outside the home (matched odds ratio, 3.9; 95% CI, 1.6 to 10.0) and two brands of peanut butter crackers (brand A: matched odds ratio, 17.2; 95% CI, 6.9 to 51.5; brand B: matched odds ratio, 3.6; 95% CI, 1.3 to 9.8). Both cracker brands were made from brand X peanut paste. The outbreak strain was isolated from brand X peanut butter, brand A crackers, and 15 other products. A total of 3918 peanut butter-containing products were recalled between January 10 and April 29, 2009. Contaminated peanut butter and peanut products caused a nationwide salmonellosis outbreak. Ingredient-driven outbreaks are challenging to detect and may lead to widespread contamination of numerous food products.

Poor self-reported sleep quality and health-related quality of life in patients with chronic fatigue syndrome/myalgic encephalomyelitis.

PubMed

Castro-Marrero, Jesús; Zaragozá, Maria C; González-Garcia, Sergio; Aliste, Luisa; Sáez-Francàs, Naia; Romero, Odile; Ferré, Alex; Fernández de Sevilla, Tomás; Alegre, José

2018-05-16

Non-restorative sleep is a hallmark symptom of chronic fatigue syndrome/myalgic encephalomyelitis. However, little is known about self-reported sleep disturbances in these subjects. This study aimed to assess the self-reported sleep quality and its impact on quality of life in a Spanish community-based chronic fatigue syndrome/myalgic encephalomyelitis cohort. A prospective cross-sectional cohort study was conducted in 1,455 Spanish chronic fatigue syndrome/myalgic encephalomyelitis patients. Sleep quality, fatigue, pain, functional capacity impairment, psychopathological status, anxiety/depression and health-related quality of life were assessed using validated subjective measures. The frequencies of muscular, cognitive, neurological, autonomic and immunological symptom clusters were above 80%. High scores were recorded for pain, fatigue, psychopathological status, anxiety/depression, and low scores for functional capacity and quality of life, all of which correlated significantly (all p < 0.01) with quality of sleep as measured by the Pittsburgh Sleep Quality Index. Multivariate regression analysis showed that after adjusting for age and gender, the pain intensity (odds ratio, 1.11; p <0.05), psychopathological status (odds ratio, 1.85; p < 0.001), fibromyalgia (odds ratio, 1.39; p < 0.05), severe autonomic dysfunction (odds ratio, 1.72; p < 0.05), poor functional capacity (odds ratio, 0.98; p < 0.05) and quality of life (odds ratio, 0.96; both p < 0.001) were significantly associated with poor sleep quality. These findings suggest that this large chronic fatigue syndrome/myalgic encephalomyelitis sample presents poor sleep quality, as assessed by the Pittsburgh Sleep Quality Index, and that this poor sleep quality is associated with many aspects of quality of life. © 2018 European Sleep Research Society.

Celiac Disease and Anorexia Nervosa: A Nationwide Study.

PubMed

Mårild, Karl; Størdal, Ketil; Bulik, Cynthia M; Rewers, Marian; Ekbom, Anders; Liu, Edwin; Ludvigsson, Jonas F

2017-05-01

Previous research suggests an association of celiac disease (CD) with anorexia nervosa (AN), but data are mostly limited to case reports. We aimed to determine whether CD is associated with the diagnosis of AN. Register-based cohort and case-control study including women with CD ( n = 17 959) and sex- and age-matched population-based controls ( n = 89 379). CD (villous atrophy) was identified through the histopathology records of Sweden's 28 pathology departments. Inpatient and hospital-based outpatient records were used to identify AN. Hazard ratios for incident AN diagnosis were estimated by using stratified Cox regression with CD diagnosis as a time-dependent exposure variable. In the secondary analyses, we used conditional logistic regression to estimate odds ratios for being diagnosed with AN before CD. Median age of CD diagnosis was 28 years. During 1 174 401 person-years of follow-up, 54 patients with CD were diagnosed with AN (27/100 000 person-years) compared with 180 matched controls (18/100 000 person-years). The hazard ratio for later AN was 1.46 (95% confidence interval [CI], 1.08-1.98) and 1.31 beyond the first year after CD diagnosis (95% CI, 0.95-1.81). A previous AN diagnosis was also associated with CD (odds ratio, 2.18; 95% CI, 1.45-3.29). Estimates remained largely unchanged when adjusted for socioeconomic characteristics and type 1 diabetes. The bidirectional association between AN diagnosis and CD warrants attention in the initial assessment and follow-up of these conditions because underdiagnosis and misdiagnosis of these disorders likely cause protracted and unnecessary morbidity. Copyright © 2017 by the American Academy of Pediatrics.

Maternal Metabolic Conditions and Risk for Autism and Other Neurodevelopmental Disorders

PubMed Central

Walker, Cheryl K.; Bremer, Andrew A.; Baker, Alice S.; Ozonoff, Sally; Hansen, Robin L.; Hertz-Picciotto, Irva

2012-01-01

OBJECTIVE: We examined whether metabolic conditions (MCs) during pregnancy (diabetes, hypertension, and obesity) are associated with autism spectrum disorder (ASD), developmental delays (DD), or impairments in specific domains of development in the offspring. METHODS: Children aged 2 to 5 years (517 ASD, 172 DD, and 315 controls) were enrolled in the CHARGE (Childhood Autism Risks from Genetics and the Environment) study, a population-based, case-control investigation between January 2003 and June 2010. Eligible children were born in California, had parents who spoke English or Spanish, and were living with a biological parent in selected regions of California. Children’s diagnoses were confirmed by using standardized assessments. Information regarding maternal conditions was ascertained from medical records or structured interview with the mother. RESULTS: All MCs were more prevalent among case mothers compared with controls. Collectively, these conditions were associated with a higher likelihood of ASD and DD relative to controls (odds ratio: 1.61 [95% confidence interval: 1.10–2.37; odds ratio: 2.35 [95% confidence interval: 1.43–3.88], respectively). Among ASD cases, children of women with diabetes had Mullen Scales of Early Learning (MSEL) expressive language scores 0.4 SD lower than children of mothers without MCs (P < .01). Among children without ASD, those exposed to any MC scored lower on all MSEL and Vineland Adaptive Behavior Scales (VABS) subscales and composites by at least 0.4 SD (P < .01 for each subscale/composite). CONCLUSIONS: Maternal MCs may be broadly associated with neurodevelopmental problems in children. With obesity rising steadily, these results appear to raise serious public health concerns. PMID:22492772

Character Apps for Children's Snacks: Effects of Character Awareness on Snack Selection and Consumption Patterns

PubMed Central

Cotto, Caroline E.; Calvert, Sandra L.

2018-01-01

Abstract Objective: Media characters are used to market snacks that are typically of poor nutritional value, which has been linked to childhood obesity. This study examines whether children's snack selections and consumption patterns are influenced by an app depicting a popular children's media character, as well as the role that children's awareness of the character plays. The results can increase our understanding of how to encourage healthier snack selection and consumption in newer game-based marketing venues, such as apps. Materials and Methods: Four- and 5-year-old children (N = 132) played a bowling game on an iPad with no character or with a character holding either healthier or unhealthy snacks. After app-play, children selected and consumed healthier or unhealthy snacks. Children's awareness of the character was measured by children's verbalizations of the character's name during or after app-play. Results: An ordered logistic regression found no significant effect of treatment conditions compared with the control group. Within treatment conditions, awareness of the character led to selection and consumption of more healthy snacks in the healthier condition (odds ratio β = 10.340, P = 0.008), and of unhealthy snacks in the unhealthy condition (odds ratio β = 0.228, P = 0.033), but children were unaware that the character influenced their decisions. Conclusions: Results suggest that young children will choose and consume healthier, not just unhealthy, products when they are aware that a popular character in an app is associated with the snack, potentially leading to healthier eating patterns. PMID:29297713

Character Apps for Children's Snacks: Effects of Character Awareness on Snack Selection and Consumption Patterns.

PubMed

Putnam, Marisa M; Cotto, Caroline E; Calvert, Sandra L

2018-04-01

Media characters are used to market snacks that are typically of poor nutritional value, which has been linked to childhood obesity. This study examines whether children's snack selections and consumption patterns are influenced by an app depicting a popular children's media character, as well as the role that children's awareness of the character plays. The results can increase our understanding of how to encourage healthier snack selection and consumption in newer game-based marketing venues, such as apps. Four- and 5-year-old children (N = 132) played a bowling game on an iPad with no character or with a character holding either healthier or unhealthy snacks. After app-play, children selected and consumed healthier or unhealthy snacks. Children's awareness of the character was measured by children's verbalizations of the character's name during or after app-play. An ordered logistic regression found no significant effect of treatment conditions compared with the control group. Within treatment conditions, awareness of the character led to selection and consumption of more healthy snacks in the healthier condition (odds ratio β = 10.340, P = 0.008), and of unhealthy snacks in the unhealthy condition (odds ratio β = 0.228, P = 0.033), but children were unaware that the character influenced their decisions. Results suggest that young children will choose and consume healthier, not just unhealthy, products when they are aware that a popular character in an app is associated with the snack, potentially leading to healthier eating patterns.

Illness representation on H1N1 influenza and preventive behaviors in the Hong Kong general population.

PubMed

Mo, Phoenix K H; Lau, Joseph T F

2015-12-01

This study examined illness representations of new influenza Human Swine Influenza A (H1N1) and association with H1N1 preventive behaviors among 300 Chinese adults using a population-based randomized telephone survey. Results showed that relatively few participants thought H1N1 would have serious consequences (12%-15.7%) and few showed negative emotional responses toward H1N1 (9%-24.7%). The majority of the participants thought H1N1 could be controlled by treatment (70.4%-72.7%). Multiple logistic regression analyses showed that treatment control (odds ratio = 1.78) and psychological attribution (odds ratio = .75) were associated with intention to take up influenza vaccination. Emotional representations were associated with lower likelihood of wearing face mask (odds ratio = .77) and hand washing (odds ratio = .67). Results confirm that illness representation variables are associated with H1N1 preventive behaviors. © The Author(s) 2014.

Increased calcium supplementation is associated with morbidity and mortality in the infant postoperative cardiac patient.

PubMed

Dyke, Peter C; Yates, Andrew R; Cua, Clifford L; Hoffman, Timothy M; Hayes, John; Feltes, Timothy F; Springer, Michelle A; Taeed, Roozbeh

2007-05-01

The purpose of this study was to assess the association of calcium replacement therapy with morbidity and mortality in infants after cardiac surgery involving cardiopulmonary bypass. Retrospective chart review. The cardiac intensive care unit at a tertiary care children's hospital. Infants undergoing cardiac surgery involving cardiopulmonary bypass between October 2002 and August 2004. None. Total calcium replacement (mg/kg calcium chloride given) for the first 72 postoperative hours was measured. Morbidity and mortality data were collected. The total volume of blood products given during the first 72 hrs was recorded. Infants with confirmed chromosomal deletions at the 22q11 locus were noted. Correlation and logistic regression analyses were used to generate odds ratios and 95% confidence intervals, with p < .05 being significant. One hundred seventy-one infants met inclusion criteria. Age was 4 +/- 3 months and weight was 4.9 +/- 1.7 kg at surgery. Six infants had deletions of chromosome 22q11. Infants who weighed less required more calcium replacement (r = -.28, p < .001). Greater calcium replacement correlated with a longer intensive care unit length of stay (r = .27, p < .001) and a longer total hospital length of stay (r = .23, p = .002). Greater calcium replacement was significantly associated with morbidity (liver dysfunction [odds ratio, 3.9; confidence interval, 2.1-7.3; p < .001], central nervous system complication [odds ratio, 1.8; confidence interval, 1.1-3.0; p = .02], infection [odds ratio, 1.5; confidence interval, 1.0-2.2; p < .04], extracorporeal membrane oxygenation [odds ratio, 5.0; confidence interval, 2.3-10.6; p < .001]) and mortality (odds ratio, 5.8; confidence interval, 5.8-5.9; p < .001). Greater calcium replacement was not associated with renal insufficiency (odds ratio, 1.5; confidence interval, 0.9-2.3; p = .07). Infants with >1 sd above the mean of total calcium replacement received on average fewer blood products than the total study population. Greater calcium replacement is associated with increasing morbidity and mortality. Further investigation of the etiology and therapy of hypocalcemia in this population is warranted.

Exclusive breastfeeding practices in working women of Pakistan: A cross sectional study.

PubMed

Sabin, Aroona; Manzur, Farida; Adil, Saleem

2017-01-01

To determine the prevalence of exclusive breast feeding in working women and to identify the factors effecting exclusive breast feeding in working women. This cross-sectional survey was conducted in Faisalabad city within a period of six months from June 2016 to December 2016. Working women of age 18 to 45 years, working as doctors, teachers, nurses and bankers in public (government) setup were included. The data was collected using interview method by pre-structured questionnaire. Multi-variable logistic regression model was developed considering EBF practice as dependent and the significant independent variables. Results were reported as Crude Odds Ratio (COR) or Adjusted Odds Ratio (AOR) with 95% Confidence Intervals (CIs). Prevalence of exclusive breast feeding (EBF) was 166 (41.5%). EFB practice was significantly less in doctors and bankers as compared to nurses and teachers (p-value <0.001). Women working as nurses and teachers, having one or two children and short working hours had higher prevalence of exclusive breast feeding. Women having prior knowledge about EBF, training of EBF and women who had previously heard about EBF had five time higher rate of breast feeding. Women having knowledge of colostrum had three times higher EBF practice [odds ratio: 3.02 (1.86-4.91)]. Women having knowledge about hazards of bottle feeding had 12.7 times higher prevalence of EBF [odds ratio: 12.72 (5.70-28.38)]. Those who knew about expression of breast milk had three times higher prevalence of EBF [odds ratio: 3.0 (1.98-4.55)]. Mothers working in organizations that support EBF had 4.1 times higher prevalence of EBF [odds ratio: 4.1 (2.67-6.21)]. And proper training of mothers about correct expression technique of breast milk had 12 time [odds ratio: 12.06 (4.97-29.23)] higher prevalence of EBF. Long working hours, banking profession, family income and lack of proper knowledge about exclusive breast feeding are responsible for non-EBF practice in working women. Proper Knowledge and awareness about exclusive breastfeeding and provision of facilities for exclusive breastfeeding (EBF) by the organizations can play a significant role in promoting it.

The Protective Effect of Pregnancy on Risk for Drug Abuse: A Population, Co-Relative, Co-Spouse, and Within-Individual Analysis.

PubMed

Kendler, Kenneth S; Ohlsson, Henrik; Svikis, Dace S; Sundquist, Kristina; Sundquist, Jan

2017-10-01

The authors sought to determine whether pregnancy is an intrinsic motivator for cessation of drug abuse. The authors conducted prospective cohort, co-relative, co-spouse, and within-person analyses of registration for drug abuse during pregnancy among Swedish women born between 1980 and 1990 who gave birth between ages 20 and 35 (N=149,512). Drug abuse was assessed from medical, criminal, and pharmacy registries. In the population, rates of drug abuse were lower during pregnancy (unadjusted odds ratio=0.67, 95% CI=0.60, 0.74). Compared with population results, the negative association between pregnancy and drug abuse was moderately stronger in cousins (odds ratio=0.49, 95% CI=0.39, 0.62) and substantially stronger in siblings (odds ratio=0.35, 95% CI=0.24, 0.51) discordant for pregnancy. The estimated odds ratio for drug abuse in pregnancy-discordant monozygotic twins was even stronger, at 0.17 (95% CI=0.10, 0.31). Within individuals, the odds ratio for drug abuse while pregnant compared with an equivalent prepregnancy interval was similar to that seen in pregnancy-discordant monozygotic twins, at 0.22 (95% CI=0.19, 0.26). Compared with cohabiting fathers, mothers had a greater reduction in risk for drug abuse during pregnancy (odds ratio=0.40, 95% CI=0.34, 0.47). Pregnancy was more protective in women with low parental education and without a cohabiting, actively drug-abusing father. Compared with prepregnancy baseline, within-individual analyses indicate that risk for drug abuse is also substantially reduced in the postpartum period, for example, the odds ratio for postpartum days 0-242 was 0.13 (95% CI=0.11, 0.16). Risk for drug abuse in women is substantially reduced during pregnancy. Multiple analyses suggest that this association is largely causal, suggesting that pregnancy is indeed a strong intrinsic motivator for drug abuse cessation. Similar strong protective effects may be present in the immediate postpartum period. Our results have implications for our etiologic models of drug abuse and especially for contingency management programs seeking to reduce drug abuse risk.

Distracted Driving and Risk of Road Crashes among Novice and Experienced Drivers

PubMed Central

Klauer, Sheila G.; Guo, Feng; Simons-Morton, Bruce G.; Ouimet, Marie Claude; Lee, Suzanne E.; Dingus, Thomas A.

2014-01-01

BACKGROUND Distracted driving attributable to the performance of secondary tasks is a major cause of motor vehicle crashes both among teenagers who are novice drivers and among adults who are experienced drivers. METHODS We conducted two studies on the relationship between the performance of secondary tasks, including cell-phone use, and the risk of crashes and near-crashes. To facilitate objective assessment, accelerometers, cameras, global positioning systems, and other sensors were installed in the vehicles of 42 newly licensed drivers (16.3 to 17.0 years of age) and 109 adults with more driving experience. RESULTS During the study periods, 167 crashes and near-crashes among novice drivers and 518 crashes and near-crashes among experienced drivers were identified. The risk of a crash or near-crash among novice drivers increased significantly if they were dialing a cell phone (odds ratio, 8.32; 95% confidence interval [CI], 2.83 to 24.42), reaching for a cell phone (odds ratio, 7.05; 95% CI, 2.64 to 18.83), sending or receiving text messages (odds ratio, 3.87; 95% CI, 1.62 to 9.25), reaching for an object other than a cell phone (odds ratio, 8.00; 95% CI, 3.67 to 17.50), looking at a roadside object (odds ratio, 3.90; 95% CI, 1.72 to 8.81), or eating (odds ratio, 2.99; 95% CI, 1.30 to 6.91). Among experienced drivers, dialing a cell phone was associated with a significantly increased risk of a crash or near-crash (odds ratio, 2.49; 95% CI, 1.38 to 4.54); the risk associated with texting or accessing the Internet was not assessed in this population. The prevalence of high-risk attention to secondary tasks increased over time among novice drivers but not among experienced drivers. CONCLUSIONS The risk of a crash or near-crash among novice drivers increased with the performance of many secondary tasks, including texting and dialing cell phones. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Highway Traffic Safety Administration.) PMID:24382065

A risk score for predicting coronary artery disease in women with angina pectoris and abnormal stress test finding.

PubMed

Lo, Monica Y; Bonthala, Nirupama; Holper, Elizabeth M; Banks, Kamakki; Murphy, Sabina A; McGuire, Darren K; de Lemos, James A; Khera, Amit

2013-03-15

Women with angina pectoris and abnormal stress test findings commonly have no epicardial coronary artery disease (CAD) at catheterization. The aim of the present study was to develop a risk score to predict obstructive CAD in such patients. Data were analyzed from 337 consecutive women with angina pectoris and abnormal stress test findings who underwent cardiac catheterization at our center from 2003 to 2007. Forward selection multivariate logistic regression analysis was used to identify the independent predictors of CAD, defined by ≥50% diameter stenosis in ≥1 epicardial coronary artery. The independent predictors included age ≥55 years (odds ratio 2.3, 95% confidence interval 1.3 to 4.0), body mass index <30 kg/m(2) (odds ratio 1.9, 95% confidence interval 1.1 to 3.1), smoking (odds ratio 2.6, 95% confidence interval 1.4 to 4.8), low high-density lipoprotein cholesterol (odds ratio 2.9, 95% confidence interval 1.5 to 5.5), family history of premature CAD (odds ratio 2.4, 95% confidence interval 1.0 to 5.7), lateral abnormality on stress imaging (odds ratio 2.8, 95% confidence interval 1.5 to 5.5), and exercise capacity <5 metabolic equivalents (odds ratio 2.4, 95% confidence interval 1.1 to 5.6). Assigning each variable 1 point summed to constitute a risk score, a graded association between the score and prevalent CAD (ptrend <0.001). The risk score demonstrated good discrimination with a cross-validated c-statistic of 0.745 (95% confidence interval 0.70 to 0.79), and an optimized cutpoint of a score of ≤2 included 62% of the subjects and had a negative predictive value of 80%. In conclusion, a simple clinical risk score of 7 characteristics can help differentiate those more or less likely to have CAD among women with angina pectoris and abnormal stress test findings. This tool, if validated, could help to guide testing strategies in women with angina pectoris. Copyright © 2013 Elsevier Inc. All rights reserved.

Distracted driving and risk of road crashes among novice and experienced drivers.

PubMed

Klauer, Sheila G; Guo, Feng; Simons-Morton, Bruce G; Ouimet, Marie Claude; Lee, Suzanne E; Dingus, Thomas A

2014-01-02

Distracted driving attributable to the performance of secondary tasks is a major cause of motor vehicle crashes both among teenagers who are novice drivers and among adults who are experienced drivers. We conducted two studies on the relationship between the performance of secondary tasks, including cell-phone use, and the risk of crashes and near-crashes. To facilitate objective assessment, accelerometers, cameras, global positioning systems, and other sensors were installed in the vehicles of 42 newly licensed drivers (16.3 to 17.0 years of age) and 109 adults with more driving experience. During the study periods, 167 crashes and near-crashes among novice drivers and 518 crashes and near-crashes among experienced drivers were identified. The risk of a crash or near-crash among novice drivers increased significantly if they were dialing a cell phone (odds ratio, 8.32; 95% confidence interval [CI], 2.83 to 24.42), reaching for a cell phone (odds ratio, 7.05; 95% CI, 2.64 to 18.83), sending or receiving text messages (odds ratio, 3.87; 95% CI, 1.62 to 9.25), reaching for an object other than a cell phone (odds ratio, 8.00; 95% CI, 3.67 to 17.50), looking at a roadside object (odds ratio, 3.90; 95% CI, 1.72 to 8.81), or eating (odds ratio, 2.99; 95% CI, 1.30 to 6.91). Among experienced drivers, dialing a cell phone was associated with a significantly increased risk of a crash or near-crash (odds ratio, 2.49; 95% CI, 1.38 to 4.54); the risk associated with texting or accessing the Internet was not assessed in this population. The prevalence of high-risk attention to secondary tasks increased over time among novice drivers but not among experienced drivers. The risk of a crash or near-crash among novice drivers increased with the performance of many secondary tasks, including texting and dialing cell phones. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Highway Traffic Safety Administration.).

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.

Individual and System Contributions to Race and Sex Disparities in Thrombolysis Use for Stroke Patients in the United States.

PubMed

Faigle, Roland; Urrutia, Victor C; Cooper, Lisa A; Gottesman, Rebecca F

2017-04-01

Intravenous thrombolysis (IVT) is underutilized in ethnic minorities and women. To disentangle individual and system-based factors determining disparities in IVT use, we investigated race/sex differences in IVT utilization among hospitals serving varying proportions of minority patients. Ischemic stroke admissions were identified from the Nationwide Inpatient Sample between 2007 and 2011. Hospitals were categorized based on the percentage of minority patients admitted with stroke (<25% minority patients [white hospitals], 25% to 50% minority patients [mixed hospitals], or >50% minority patients [minority hospitals]). Logistic regression was used to evaluate the association between race/sex and IVT use within and between the different hospital strata. Among 337 201 stroke admissions, white men had the highest odds of IVT among all race/sex groups in any hospital strata, and the odds of IVT for white men did not differ by hospital strata. For white women and minority men, the odds of IVT were significantly lower in minority hospitals compared with white hospitals (odds ratio, 0.83; 95% confidence interval, 0.71-0.97, for white women; and odds ratio, 0.82; 95% confidence interval, 0.69-0.99, for minority men). Race disparities in IVT use among women were observed in white hospitals (odds ratio, 0.88; 95% confidence interval, 0.78-0.99, in minority compared with white women), but not in minority hospitals (odds ratio, 0.94, 95% confidence interval, 0.82-1.09). Sex disparities in IVT use were observed among whites but not among minorities. Minority men and white women have significantly lower odds of IVT in minority hospitals compared with white hospitals. IVT use in white men does not differ by hospital strata. © 2017 American Heart Association, Inc.

ADHD Medication and Substance-Related Problems.

PubMed

Quinn, Patrick D; Chang, Zheng; Hur, Kwan; Gibbons, Robert D; Lahey, Benjamin B; Rickert, Martin E; Sjölander, Arvid; Lichtenstein, Paul; Larsson, Henrik; D'Onofrio, Brian M

2017-09-01

Substance use disorders are major contributors to excess mortality among individuals with attention deficit hyperactivity disorder (ADHD), yet associations between pharmacological ADHD treatment and substance-related problems remain unclear. This study investigated concurrent and long-term associations between ADHD medication treatment and substance-related events. The authors analyzed 2005-2014 commercial health care claims from 2,993,887 (47.2% female) adolescent and adult ADHD patients. Within-individual analyses compared the risk of substance-related events (i.e., emergency department visits related to substance use disorders) during months in which patients received prescribed stimulant medication or atomoxetine relative to the risk during months in which they did not. In adjusted within-individual comparisons, relative to periods in which patients did not receive ADHD medication, male patients had 35% lower odds of concurrent substance-related events when receiving medication (odds ratio=0.65, 95% CI=0.64-0.67), and female patients had 31% lower odds of concurrent substance-related events (odds ratio=0.69, 95% CI=0.67-0.71). Moreover, male patients had 19% lower odds of substance-related events 2 years after medication periods (odds ratio=0.81, 95% CI=0.78-0.85), and female patients had 14% lower odds of substance-related events 2 years after medication periods (odds ratio=0.86, 95% CI= 0.82-0.91). Sensitivity analyses supported most findings but were less consistent for long-term associations among women. These results provide evidence that receiving ADHD medication is unlikely to be associated with greater risk of substance-related problems in adolescence or adulthood. Rather, medication was associated with lower concurrent risk of substance-related events and, at least among men, lower long-term risk of future substance-related events.

Effect of gender and sports on the risk of full-thickness articular cartilage lesions in anterior cruciate ligament-injured knees: a nationwide cohort study from Sweden and Norway of 15 783 patients.

PubMed

Røtterud, Jan Harald; Sivertsen, Einar A; Forssblad, Magnus; Engebretsen, Lars; Årøen, Asbjørn

2011-07-01

The presence of an articular cartilage lesion in anterior cruciate ligament-injured knees is considered a predictor of osteoarthritis. This study was undertaken to evaluate risk factors for full-thickness articular cartilage lesions in anterior cruciate ligament-injured knees, in particular the role of gender and the sport causing the initial injury. Cohort study (prognosis); Level of evidence, 2. Primary unilateral anterior cruciate ligament reconstructions prospectively registered in the Swedish and the Norwegian National Knee Ligament Registry during 2005 through 2008 were included (N = 15 783). Logistic regression analyses were used to evaluate risk factors for cartilage lesions. A total of 1012 patients (6.4%) had full-thickness cartilage lesions. The median time from injury to surgery was 9 months (range, 0 days-521 months). Male patients had an increased odds of full-thickness cartilage lesions compared with females (odds ratio = 1.22; 95% confidence interval, 1.04-1.42). In males, team handball had an increase in the odds of full-thickness cartilage lesions compared with soccer (odds ratio = 2.36; 95% confidence interval, 1.33-4.19). Among female patients, no sport investigated showed a significant decrease or increase in the odds of full-thickness cartilage lesions. The odds of a full-thickness cartilage lesion increased by 1.006 (95% confidence interval, 1.005-1.008) for each month elapsed from time of injury until anterior cruciate ligament reconstruction when all patients were considered, while time from injury to surgery did not affect the odds significantly in those patients reconstructed within 1 year of injury (odds ratio = 0.98; 95% confidence interval, 0.95-1.02). Previous surgery increased the odds of having a full-thickness cartilage lesion (odds ratio = 1.40; 95% confidence interval, 1.21-1.63). One year of increasing patient age also increased the odds (odds ratio = 1.05; 95% confidence interval, 1.05-1.06). Male gender is associated with an increased risk of full-thickness articular cartilage lesions in anterior cruciate ligament-injured knees. Male team handball players had an increased risk of full-thickness lesions. No other sports investigated were found to have significant effect on the risk in either gender. Furthermore, age, previous surgery, and time from injury to surgery exceeding 12 months are risk factors for full-thickness cartilage lesions.

Image Quality of Cardiac Magnetic Resonance Imaging in Patients With an Implantable Cardioverter Defibrillator System Designed for the Magnetic Resonance Imaging Environment.

PubMed

Schwitter, Juerg; Gold, Michael R; Al Fagih, Ahmed; Lee, Sung; Peterson, Michael; Ciuffo, Allen; Zhang, Yan; Kristiansen, Nina; Kanal, Emanuel; Sommer, Torsten

2016-05-01

Recently, magnetic resonance (MR)-conditional implantable cardioverter defibrillator (ICD) systems have become available. However, associated cardiac MR image (MRI) quality is unknown. The goal was to evaluate the image quality performance of various cardiac MR sequences in a multicenter trial of patients implanted with an MR-conditional ICD system. The Evera-MRI trial enrolled 275 patients in 42 centers worldwide. There were 263 patients implanted with an Evera-MRI single- or dual-chamber ICD and randomized to controls (n=88) and MRI (n=175), 156 of whom underwent a protocol-required MRI (9-12 weeks post implant). Steady-state-free-precession (SSFP) and fast-gradient-echo (FGE) sequences were acquired in short-axis and horizontal long-axis orientations. Qualitative and quantitative assessment of image quality was performed by using a 7-point scale (grades 1-3: good quality, grades 6-7: nondiagnostic) and measuring ICD- and lead-related artifact size. Good to moderate image quality (grades 1-5) was obtained in 53% and 74% of SSFP and FGE acquisitions, respectively, covering the left ventricle, and in 69% and 84%, respectively, covering the right ventricle. Odds for better image quality were greater for right ventricle versus left ventricle (odds ratio, 1.8; 95% confidence interval, 1.5-2.2; P<0.0001) and greater for FGE versus SSFP (odds ratio, 3.5; 95% confidence interval, 2.5-4.8; P<0.0001). Compared with SSFP, ICD-related artifacts on FGE were smaller (141±65 versus 75±57 mm, respectively; P<0.0001). Lead artifacts were much smaller than ICD artifacts (P<0.0001). FGE yields good to moderate quality in 74% of left ventricle and 84% of right ventricle acquisitions and performs better than SSFP in patients with an MRI-conditional ICD system. In these patients, cardiac MRI can offer diagnostic information in most cases. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02117414. © 2016 American Heart Association, Inc.

Welding and Lung Cancer in a Pooled Analysis of Case-Control Studies

PubMed Central

Kendzia, Benjamin; Behrens, Thomas; Jöckel, Karl-Heinz; Siemiatycki, Jack; Kromhout, Hans; Vermeulen, Roel; Peters, Susan; Van Gelder, Rainer; Olsson, Ann; Brüske, Irene; Wichmann, H.-Erich; Stücker, Isabelle; Guida, Florence; Tardón, Adonina; Merletti, Franco; Mirabelli, Dario; Richiardi, Lorenzo; Pohlabeln, Hermann; Ahrens, Wolfgang; Landi, Maria Teresa; Caporaso, Neil; Consonni, Dario; Zaridze, David; Szeszenia-Dabrowska, Neonila; Lissowska, Jolanta; Gustavsson, Per; Marcus, Michael; Fabianova, Eleonora; ‘t Mannetje, Andrea; Pearce, Neil; Tse, Lap Ah; Yu, Ignatius Tak-sun; Rudnai, Peter; Bencko, Vladimir; Janout, Vladimir; Mates, Dana; Foretova, Lenka; Forastiere, Francesco; McLaughlin, John; Demers, Paul; Bueno-de-Mesquita, Bas; Boffetta, Paolo; Schüz, Joachim; Straif, Kurt; Pesch, Beate; Brüning, Thomas

2013-01-01

Several epidemiologic studies have indicated an increased risk of lung cancer among welders. We used the SYNERGY project database to assess welding as a risk factor for developing lung cancer. The database includes data on 15,483 male lung cancer cases and 18,388 male controls from 16 studies in Europe, Canada, China, and New Zealand conducted between 1985 and 2010. Odds ratios and 95% confidence intervals between regular or occasional welding and lung cancer were estimated, with adjustment for smoking, age, study center, and employment in other occupations associated with lung cancer risk. Overall, 568 cases and 427 controls had ever worked as welders and had an odds ratio of developing lung cancer of 1.44 (95% confidence interval: 1.25, 1.67) with the odds ratio increasing for longer duration of welding. In never and light smokers, the odds ratio was 1.96 (95% confidence interval: 1.37, 2.79). The odds ratios were somewhat higher for squamous and small cell lung cancers than for adenocarcinoma. Another 1,994 cases and 1,930 controls had ever worked in occupations with occasional welding. Work in any of these occupations was associated with some elevation of risk, though not as much as observed in regular welders. Our findings lend further support to the hypothesis that welding is associated with an increased risk of lung cancer. PMID:24052544

Welding and lung cancer in a pooled analysis of case-control studies.

PubMed

Kendzia, Benjamin; Behrens, Thomas; Jöckel, Karl-Heinz; Siemiatycki, Jack; Kromhout, Hans; Vermeulen, Roel; Peters, Susan; Van Gelder, Rainer; Olsson, Ann; Brüske, Irene; Wichmann, H-Erich; Stücker, Isabelle; Guida, Florence; Tardón, Adonina; Merletti, Franco; Mirabelli, Dario; Richiardi, Lorenzo; Pohlabeln, Hermann; Ahrens, Wolfgang; Landi, Maria Teresa; Caporaso, Neil; Consonni, Dario; Zaridze, David; Szeszenia-Dabrowska, Neonila; Lissowska, Jolanta; Gustavsson, Per; Marcus, Michael; Fabianova, Eleonora; 't Mannetje, Andrea; Pearce, Neil; Tse, Lap Ah; Yu, Ignatius Tak-Sun; Rudnai, Peter; Bencko, Vladimir; Janout, Vladimir; Mates, Dana; Foretova, Lenka; Forastiere, Francesco; McLaughlin, John; Demers, Paul; Bueno-de-Mesquita, Bas; Boffetta, Paolo; Schüz, Joachim; Straif, Kurt; Pesch, Beate; Brüning, Thomas

2013-11-15

Several epidemiologic studies have indicated an increased risk of lung cancer among welders. We used the SYNERGY project database to assess welding as a risk factor for developing lung cancer. The database includes data on 15,483 male lung cancer cases and 18,388 male controls from 16 studies in Europe, Canada, China, and New Zealand conducted between 1985 and 2010. Odds ratios and 95% confidence intervals between regular or occasional welding and lung cancer were estimated, with adjustment for smoking, age, study center, and employment in other occupations associated with lung cancer risk. Overall, 568 cases and 427 controls had ever worked as welders and had an odds ratio of developing lung cancer of 1.44 (95% confidence interval: 1.25, 1.67) with the odds ratio increasing for longer duration of welding. In never and light smokers, the odds ratio was 1.96 (95% confidence interval: 1.37, 2.79). The odds ratios were somewhat higher for squamous and small cell lung cancers than for adenocarcinoma. Another 1,994 cases and 1,930 controls had ever worked in occupations with occasional welding. Work in any of these occupations was associated with some elevation of risk, though not as much as observed in regular welders. Our findings lend further support to the hypothesis that welding is associated with an increased risk of lung cancer.

[Funding of the management of severe malaria in children by Kinshasa households (Democratic Republic of Congo)].

PubMed

Ilunga-Ilunga, Félicien; Levêque, Alain; Dramaix, Michèle

2015-01-01

The objective of this study was to determine the source of health care funding for heads of households related to the management of severe malaria in children admitted to a Kinshasa reference hospital. This cross-sectional study was conducted on 1,350 hospitalised children under the age of 15 years treated for severe malaria in Kinshasa reference hospitals from January to November 2011 and the heads of households of these children. Only 46% of heads of households reported having sufficient funds directly available in the household budget. The remaining 54% had to call upon external sources of funding (sale of assets, loans, pawning goods). The use of a loan tended to increase significantly mainly for households with a low (adjusted odds ratio = 6.2), and intermediate socioeconomic status (adjusted odds ratio = 3.8) and for households working in the informal sector (adjusted odds ratio = 2.5). Similarly, the sale of assets was more frequently reported for households working in the informal sector (adjusted odds ratio = 2.4) and for female heads of households (adjusted odds ratio = 3.9). The management of severe malaria is a burden on household income. The majority of heads of households concerned needs to use external funding sources. A State subsidy for this management would help to reduce the risk of debt and sale of assets, especially for the poorest households.

Evaluation of goal kicking performance in international rugby union matches.

PubMed

Quarrie, Kenneth L; Hopkins, Will G

2015-03-01

Goal kicking is an important element in rugby but has been the subject of minimal research. To develop and apply a method to describe the on-field pattern of goal-kicking and rank the goal kicking performance of players in international rugby union matches. Longitudinal observational study. A generalized linear mixed model was used to analyze goal-kicking performance in a sample of 582 international rugby matches played from 2002 to 2011. The model adjusted for kick distance, kick angle, a rating of the importance of each kick, and venue-related conditions. Overall, 72% of the 6769 kick attempts were successful. Forty-five percent of points scored during the matches resulted from goal kicks, and in 5.7% of the matches the result of the match hinged on the outcome of a kick attempt. There was an extremely large decrease in success with increasing distance (odds ratio for two SD distance 0.06, 90% confidence interval 0.05-0.07) and a small decrease with increasingly acute angle away from the mid-line of the goal posts (odds ratio for 2 SD angle, 0.44, 0.39-0.49). Differences between players were typically small (odds ratio for 2 between-player SD 0.53, 0.45-0.65). The generalized linear mixed model with its random-effect solutions provides a tool for ranking the performance of goal kickers in rugby. This modelling approach could be applied to other performance indicators in rugby and in other sports in which discrete outcomes are measured repeatedly on players or teams. Copyright © 2015. Published by Elsevier Ltd.

The Influence of Health and Lifestyle Characteristics on the Relation of Serum 25-Hydroxyvitamin D With Risk of Colorectal and Breast Cancer in Postmenopausal Women

PubMed Central

Neuhouser, Marian L.; Manson, JoAnn E.; Millen, Amy; Pettinger, Mary; Margolis, Karen; Jacobs, Elizabeth T.; Shikany, James M.; Vitolins, Mara; Adams-Campbell, Lucile; Liu, Simin; LeBlanc, Erin; Johnson, Karen C.; Wactawski-Wende, Jean

2012-01-01

The authors’ objective was to discern whether lifestyle or health-related factors were confounders, effect modifiers, or irrelevant with regard to understanding observational associations of serum 25-hydroxyvitamin D (25(OH)D) with colorectal and breast cancer. The authors conducted nested case-control studies of colorectal cancer (310 cases, 310 controls) and breast cancer (1,080 cases, 1,080 controls) in the Women’s Health Initiative Calcium and Vitamin D Clinical Trial (1994–2005). Case-control matching factors included age, latitude, race/ethnicity, and blood collection date. Serum 25(OH)D was assayed in baseline fasting blood. Conditional logistic regression was used to estimate odds ratios for each cancer by serum 25(OH)D concentration, comparing the relative effects of successively adding body mass index, physical activity, and other health and lifestyle characteristics particular to each cancer. In models with matching factors only, low (vs. high) serum 25(OH)D was associated with a colorectal cancer odds ratio of 2.72 (95% confidence interval (CI): 1.55, 4.77) and a breast cancer odds ratio of 1.33 (95% CI: 1.02, 1.72). In multivariate-adjusted models for colorectal cancer, the association strengthened (OR = 4.45, 95% CI: 1.96, 10.10). However, in multivariate-adjusted breast cancer models, associations were no longer significant (OR = 1.06, 95% CI: 0.78, 1.43). Adjusting for health and lifestyle characteristics has differential effects depending on the cancer site; when modeling such relations, investigators should take these factors into account. PMID:22362582

Allergic rhinitis, rhinoconjunctivitis, and eczema: prevalence and associated factors in children.

PubMed

Singh, Sheetu; Sharma, Bharat Bhushan; Salvi, Sundeep; Chhatwal, Jugesh; Jain, Kailash Chandra; Kumar, Lata; Joshi, Mohan Keshav; Pandramajal, Suresh Babu; Awasthi, Shally; Bhave, Sheila; Rego, Sylvan; Sukumaran, Thevaruparambil Unny; Khatav, Vasant A; Singh, Virendra; Sharma, Surendra Kumar; Sabir, Mohammed

2018-02-01

We aim to describe the data collected from India during phase 3 of the International study of asthma and allergy in childhood (ISAAC) study. Prevalence, severity, and population characteristics associated with rhinitis, rhinoconjunctivitis, and eczema were assessed. Children from two age groups (6-7 and 13-14 years) were included in the study as per the ISAAC protocol. The symptoms of allergy and associated features were assessed using a questionnaire. The prevalence of allergic rhinitis among the 6-7 years age group was 11.3%, while it was 24.4% in the 13-14 years age group. The prevalence of allergic rhinoconjunctivitis was 3.9% in the 6-7 years age group and 10.9% in the 13-14 years age group. The prevalence of eczema was 2.8% in the 6-7 years age group and 3.7% in the 13-14 years age group. The passage of trucks near home, parental smoking, use of paracetamol, use of antibiotics, cooking with firewood, and television watching were associated with allergic rhinitis, rhinoconjunctivitis, and eczema. Maternal smoking was the strongest of all the associated features for allergic rhinitis, rhinoconjunctivitis, and eczema, especially in the 6-7 years age group (odds ratio: 1.9, 95% CI: 1.5-2.4; odds ratio: 2.9, 95% CI, 2.2-3.9; and odds ratio: 3.5, 95% CI: 2.6-4.8, respectively). Allergic conditions like allergic rhinitis, rhinoconjunctivitis, and eczema are prevalent among Indian children and are associated with environmental tobacco smoke, paracetamol use, antibiotic use, television watching, and outdoor and indoor air pollution. © 2016 John Wiley & Sons Ltd.

RBC Distribution Width: Biomarker for Red Cell Dysfunction and Critical Illness Outcome?

PubMed

Said, Ahmed S; Spinella, Philip C; Hartman, Mary E; Steffen, Katherine M; Jackups, Ronald; Holubkov, Richard; Wallendorf, Mike; Doctor, Allan

2017-02-01

RBC distribution width is reported to be an independent predictor of outcome in adults with a variety of conditions. We sought to determine if RBC distribution width is associated with morbidity or mortality in critically ill children. Retrospective observational study. Tertiary PICU. All admissions to St. Louis Children's Hospital PICU between January 1, 2005, and December 31, 2012. We collected demographics, laboratory values, hospitalization characteristics, and outcomes. We calculated the relative change in RBC distribution width from admission RBC distribution width to the highest RBC distribution width during the first 7 days of hospitalization. Our primary outcome was ICU mortality or use of extracorporeal membrane oxygenation as a composite. Secondary outcomes were ICU- and ventilator-free days. We identified 3,913 eligible subjects with an estimated mortality (by Pediatric Index of Mortality 2) of 2.94% ± 9.25% and an actual ICU mortality of 2.91%. For the study cohort, admission RBC distribution width was 14.12% ± 1.89% and relative change in RBC distribution width was 2.63% ± 6.23%. On univariate analysis, both admission RBC distribution width and relative change in RBC distribution width correlated with mortality or the use of extracorporeal membrane oxygenation (odds ratio, 1.19 [95% CI, 1.12-1.27] and odds ratio, 1.06 [95% CI, 1.04-1.08], respectively; p < 0.001). After adjusting for confounding variables, including severity of illness, both admission RBC distribution width (odds ratio, 1.13; 95% CI, 1.03-1.24) and relative change in RBC distribution width (odds ratio, 1.04; 95% CI, 1.01-1.07) remained independently associated with ICU mortality or the use of extracorporeal membrane oxygenation. Admission RBC distribution width and relative change in RBC distribution width both weakly correlated with fewer ICU- (r = 0.038) and ventilator-free days (r = 0.05) (p < 0.001). Independent of illness severity in critically ill children, admission RBC distribution width is associated with ICU mortality and morbidity. These data suggest that RBC distribution width may be a biomarker for RBC injury that is of sufficient magnitude to influence critical illness outcome, possibly via oxygen delivery impairment.

Trimethoprim-sulfamethoxazole induced hyperkalaemia in elderly patients receiving spironolactone: nested case-control study

PubMed Central

Gomes, Tara; Mamdani, Muhammad M; Yao, Zhan; Hellings, Chelsea; Garg, Amit X; Weir, Matthew A; Juurlink, David N

2011-01-01

Objectives To characterise the risk of admission to hospital for hyperkalaemia in elderly patients treated with trimethoprim-sulfamethoxazole in combination with spironolactone. Design Population based nested case-control study. Setting Ontario, Canada, from 1 April 1992 to 1 March 2010. Participants Cases were residents of Ontario aged 66 years or above receiving chronic treatment with spironolactone and admitted to hospital with hyperkalaemia within 14 days of receiving a prescription for either trimethoprim-sulfamethoxazole, amoxicillin, norfloxacin, or nitrofurantoin. Up to four controls for each case were identified from the same cohort, matched on age, sex, and presence or absence of chronic kidney disease and diabetes, and required to have received one of the study antibiotics within 14 days before the case’s index date. Main outcome measures Odds ratio for association between admission to hospital with hyperkalaemia and receipt of a study antibiotic in the preceding 14 days, adjusted for conditions and drugs that may influence risk of hyperkalaemia. Results During the 18 year study period, 6903 admissions for hyperkalaemia were identified, 306 of which occurred within 14 days of antibiotic use. Of these, 248 (81%) cases were matched to 783 controls. 10.8% (17 859/165 754) of spironolactone users received at least one prescription for trimethoprim-sulfamethoxazole. Compared with amoxicillin, prescription of trimethoprim-sulfamethoxazole was associated with a marked increase in the risk of admission to hospital for hyperkalaemia (adjusted odds ratio 12.4, 95% confidence interval 7.1 to 21.6). The population attributable fraction was 59.7%, suggesting that approximately 60% of all cases of hyperkalaemia in older patients taking spironolactone and treated with an antibiotic for a urinary tract infection could be avoided if trimethoprim-sulfamethoxazole was not prescribed. Treatment with nitrofurantoin was also associated with an increase in the risk of hyperkalaemia (adjusted odds ratio 2.4, 1.3 to 4.6), but no such risk was found with norfloxacin (adjusted odds ratio 1.6, 0.8 to 3.4) Conclusions Among older patients receiving spironolactone, treatment with trimethoprim-sulfamethoxazole was associated with a major increase in the risk of admission to hospital for hyperkalaemia. This drug combination should be avoided when possible. PMID:21911446

Trimethoprim-sulfamethoxazole induced hyperkalaemia in elderly patients receiving spironolactone: nested case-control study.

PubMed

Antoniou, Tony; Gomes, Tara; Mamdani, Muhammad M; Yao, Zhan; Hellings, Chelsea; Garg, Amit X; Weir, Matthew A; Juurlink, David N

2011-09-12

To characterise the risk of admission to hospital for hyperkalaemia in elderly patients treated with trimethoprim-sulfamethoxazole in combination with spironolactone. Population based nested case-control study. Ontario, Canada, from 1 April 1992 to 1 March 2010. Cases were residents of Ontario aged 66 years or above receiving chronic treatment with spironolactone and admitted to hospital with hyperkalaemia within 14 days of receiving a prescription for either trimethoprim-sulfamethoxazole, amoxicillin, norfloxacin, or nitrofurantoin. Up to four controls for each case were identified from the same cohort, matched on age, sex, and presence or absence of chronic kidney disease and diabetes, and required to have received one of the study antibiotics within 14 days before the case's index date. Odds ratio for association between admission to hospital with hyperkalaemia and receipt of a study antibiotic in the preceding 14 days, adjusted for conditions and drugs that may influence risk of hyperkalaemia. During the 18 year study period, 6903 admissions for hyperkalaemia were identified, 306 of which occurred within 14 days of antibiotic use. Of these, 248 (81%) cases were matched to 783 controls. 10.8% (17,859/165,754) of spironolactone users received at least one prescription for trimethoprim-sulfamethoxazole. Compared with amoxicillin, prescription of trimethoprim-sulfamethoxazole was associated with a marked increase in the risk of admission to hospital for hyperkalaemia (adjusted odds ratio 12.4, 95% confidence interval 7.1 to 21.6). The population attributable fraction was 59.7%, suggesting that approximately 60% of all cases of hyperkalaemia in older patients taking spironolactone and treated with an antibiotic for a urinary tract infection could be avoided if trimethoprim-sulfamethoxazole was not prescribed. Treatment with nitrofurantoin was also associated with an increase in the risk of hyperkalaemia (adjusted odds ratio 2.4, 1.3 to 4.6), but no such risk was found with norfloxacin (adjusted odds ratio 1.6, 0.8 to 3.4) Among older patients receiving spironolactone, treatment with trimethoprim-sulfamethoxazole was associated with a major increase in the risk of admission to hospital for hyperkalaemia. This drug combination should be avoided when possible.

Exploring Rural Disparities in Medical Diagnoses Among Veterans With Transgender-related Diagnoses Utilizing Veterans Health Administration Care.

PubMed

Bukowski, Leigh A; Blosnich, John; Shipherd, Jillian C; Kauth, Michael R; Brown, George R; Gordon, Adam J

2017-09-01

Research shows transgender individuals experience pronounced health disparities compared with their nontransgender peers. Yet, there remains insufficient research about health differences within transgender populations. This study seeks to fill this gap by exploring how current urban/rural status is associated with lifetime diagnosis of mood disorder, alcohol dependence disorder, illicit drug abuse disorder, tobacco use, posttraumatic stress disorder, human immunodeficiency virus, and suicidal ideation or attempt among veterans with transgender-related diagnoses. This study used a retrospective review of The Department of Veterans Affairs (VA) administrative data for transgender patients who received VA care from 1997 through 2014. Transgender patients were defined as individuals that had a lifetime diagnosis of any of 4 International Classification of Diseases-9 diagnosis codes associated with transgender status. Independent multivariable logistic regression models were used to explore associations of rural status with medical conditions. Veterans with transgender-related diagnoses residing in small/isolated rural towns had increased odds of tobacco use disorder (adjusted odds ratio=1.39; 95% confidence intervals, 1.09-1.78) and posttraumatic stress disorder (adjusted odds ratio=1.33; 95% confidence intervals, 1.03-1.71) compared with their urban transgender peers. Urban/rural status was not significantly associated with other medical conditions of interest. This study contributes the first empirical investigations of how place of residence is associated with medical diagnoses among veterans with transgender-related diagnoses. The importance of place as a determinant of health is increasingly clear, but for veterans with transgender-related diagnoses this line of research is currently limited. The addition of self-reported sex identity data within VA electronic health records is one way to advance this line of research.

WASP (Write a Scientific Paper) using Excel - 12: Odds ratio and relative risk.

PubMed

Grech, Victor

2018-07-01

The calculation of odds ratios and relative risks may be required as part of a data analysis exercise. This paper explains how to set up these calculations in Microsoft Excel from a two by two contingency table. Copyright © 2018 Elsevier B.V. All rights reserved.

Analysis on Reactor Criticality Condition and Fuel Conversion Capability Based on Different Loaded Plutonium Composition in FBR Core

NASA Astrophysics Data System (ADS)

Permana, Sidik; Saputra, Geby; Suzuki, Mitsutoshi; Saito, Masaki

2017-01-01

Reactor criticality condition and fuel conversion capability are depending on the fuel arrangement schemes, reactor core geometry and fuel burnup process as well as the effect of different fuel cycle and fuel composition. Criticality condition of reactor core and breeding ratio capability have been investigated in this present study based on fast breeder reactor (FBR) type for different loaded fuel compositions of plutonium in the fuel core regions. Loaded fuel of Plutonium compositions are based on spent nuclear fuel (SNF) of light water reactor (LWR) for different fuel burnup process and cooling time conditions of the reactors. Obtained results show that different initial fuels of plutonium gives a significant chance in criticality conditions and fuel conversion capability. Loaded plutonium based on higher burnup process gives a reduction value of criticality condition or less excess reactivity. It also obtains more fuel breeding ratio capability or more breeding gain. Some loaded plutonium based on longer cooling time of LWR gives less excess reactivity and in the same time, it gives higher breeding ratio capability of the reactors. More composition of even mass plutonium isotopes gives more absorption neutron which affects to decresing criticality or less excess reactivity in the core. Similar condition that more absorption neutron by fertile material or even mass plutonium will produce more fissile material or odd mass plutonium isotopes to increase the breeding gain of the reactor.

Preconception maternal polychlorinated biphenyl concentrations and the secondary sex ratio

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

Taylor, Kira C.; Department of Epidemiology, 1518 Clifton Road, NE Atlanta, GA 30322; Jackson, Leila W.

2007-01-15

The secondary sex ratio is the ratio of male to female live births and historically has ranged from 102 to 106 males to 100 females. Temporal declines have been reported in many countries prompting authors to hypothesize an environmental etiology. Blood specimens were obtained from 99 women aged 24-34 prior to attempting pregnancy and quantified for 76 polychlorinated biphenyl (PCB) congeners using dual column gas chromatography with electron capture detection. Women were prospectively followed until pregnancy or 12 cycles of trying. The odds of a male birth for three PCB groupings (total, estrogenic, anti-estrogenic) controlling for maternal characteristics were estimatedmore » using logistic regression. Among the 50 women with live births and PCB data, 26 female and 24 male infants were born (ratio 0.92). After adjusting for age and body mass index, odds of a male birth were elevated among women in the second (OR=1.29) and third (OR=1.48) tertiles of estrogenic PCBs; odds (OR=0.70) were reduced among women in the highest tertile of anti-estrogenic PCBs. All confidence intervals included one. The direction of the odds ratios in this preliminary study varied by PCB groupings, supporting the need to study specific PCB patterns when assessing environmental influences on the secondary sex ratio.« less

Meaningful Use of Electronic Health Records by Outpatient Physicians and Readmissions of Medicare Fee-for-Service Beneficiaries.

PubMed

Unruh, Mark A; Jung, Hye-Young; Vest, Joshua R; Casalino, Lawrence P; Kaushal, Rainu

2017-05-01

Nearly one-fifth of hospitalized Medicare fee-for-service beneficiaries are readmitted within 30 days. Participation in the Meaningful Use initiative among outpatient physicians may reduce readmissions. To evaluate the impact of outpatient physicians' participation in Meaningful Use on readmissions. The study population included 90,774 Medicare fee-for-service beneficiaries from New York State (2010-2012). We compared changes in the adjusted odds of readmission for patients of physicians who participated in Meaningful Use-stage 1, before and after attestation as meaningful users, with concurrent patients of matched control physicians who used paper records or electronic health records without Meaningful Use participation. Three secondary analyses were conducted: (1) limited to patients with 3+ Elixhauser comorbidities; (2) limited to patients with conditions used by Medicare to penalize hospitals with high readmission rates (acute myocardial infarction, congestive heart failure, and pneumonia); and (3) using only patients of physicians with electronic health records who were not meaningful users as the controls. Thirty-day readmission. Patients of Meaningful Use physicians had 6% lower odds of readmission compared with patients of physicians who were not meaningful users, but the estimate was not statistically significant (odds ratio: 0.94, 95% confidence interval, 0.88-1.01). Estimated odds ratios from secondary analyses were broadly consistent with our primary analysis. Physician participation in Meaningful Use was not associated with reduced readmissions. Additional studies are warranted to see if readmissions decline in future stages of Meaningful Use where more emphasis is placed on health information exchange and outcomes.

Yo Puedo--a conditional cash transfer and life skills intervention to promote adolescent sexual health: results of a randomized feasibility study in san francisco.

PubMed

Minnis, Alexandra M; vanDommelen-Gonzalez, Evan; Luecke, Ellen; Dow, William; Bautista-Arredondo, Sergio; Padian, Nancy S

2014-07-01

We designed and evaluated for feasibility an intervention-Yo Puedo-that addresses social network influences and socioeconomic opportunities in a neighborhood with substantial gang exposure and early childbearing. Yo Puedo combined conditional cash transfers for completion of educational and reproductive health wellness goals with life skills sessions, and targeted youth 16-21 years of age and same-aged members of their social network. We conducted a two-arm study with social networks randomized to the intervention or a standard services control arm. We evaluated intervention uptake, adherence, and safety; and assessed evidence of effects on behavioral outcomes associated with unintended pregnancy and sexually transmitted infection risk. A total of 72 social networks composed of 162 youth enrolled, with 92% retention over 6 months. Seventy-two percent of youth randomized to the intervention participated in intervention activities: 53% received at least one conditional cash transfer payment and 66% came to at least one life skills session. We found no evidence that cash payments financed illicit or high-risk behavior. At 6 months, compared with controls, intervention participants had a lower odds of hanging out on the street frequently (odds ratio [OR], .54; p = .10) and a lower odds of reporting that their close friends had been incarcerated (OR, .6; p = .12). They reported less regular alcohol use (OR, .54; p = .04) and a lower odds of having sex (OR, .50; p = .04). The feasibility evaluation of Yo Puedo demonstrated its promise; a larger evaluation of effects on pregnancy and sustained behavioral changes is warranted. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Preconception B-vitamin and homocysteine status, conception, and early pregnancy loss.

PubMed

Ronnenberg, Alayne G; Venners, Scott A; Xu, Xiping; Chen, Changzhong; Wang, Lihua; Guang, Wenwei; Huang, Aiqun; Wang, Xiaobin

2007-08-01

Maternal vitamin status contributes to clinical spontaneous abortion, but the role of B-vitamin and homocysteine status in subclinical early pregnancy loss is unknown. Three-hundred sixty-four textile workers from Anqing, China, who conceived at least once during prospective observation (1996-1998), provided daily urine specimens for up to 1 year, and urinary human chorionic gonadotropin was assayed to detect conception and early pregnancy loss. Homocysteine, folate, and vitamins B6 and B12 were measured in preconception plasma. Relative to women in the lowest quartile of vitamin B6, those in the third and fourth quartiles had higher adjusted proportional hazard ratios of conception (hazard ratio (HR)=2.2, 95% confidence interval (CI): 1.3, 3.4; HR=1.6, 95% CI: 1.1, 2.3, respectively), and the adjusted odds ratio for early pregnancy loss in conceptive cycles was lower in the fourth quartile (odds ratio=0.5, 95% CI: 0.3, 1.0). Women with sufficient vitamin B6 had a higher adjusted hazard ratio of conception (HR=1.4, 95% CI: 1.1, 1.9) and a lower adjusted odds ratio of early pregnancy loss in conceptive cycles (odds ratio=0.7, 95% CI: 0.4, 1.1) than did women with vitamin B6 deficiency. Poor vitamin B6 status appears to decrease the probability of conception and to contribute to the risk of early pregnancy loss in this population.

Severity of pulmonary emphysema and lung cancer: analysis using quantitative lobar emphysema scoring.

PubMed

Bae, Kyungsoo; Jeon, Kyung Nyeo; Lee, Seung Jun; Kim, Ho Cheol; Ha, Ji Young; Park, Sung Eun; Baek, Hye Jin; Choi, Bo Hwa; Cho, Soo Buem; Moon, Jin Il

2016-11-01

The aim of this study was to determine the relationship between lobar severity of emphysema and lung cancer using automated lobe segmentation and emphysema quantification methods.This study included 78 patients (74 males and 4 females; mean age of 72 years) with the following conditions: pathologically proven lung cancer, available chest computed tomographic (CT) scans for lobe segmentation, and quantitative scoring of emphysema. The relationship between emphysema and lung cancer was analyzed using quantitative emphysema scoring of each pulmonary lobe.The most common location of cancer was the left upper lobe (LUL) (n = 28), followed by the right upper lobe (RUL) (n = 27), left lower lobe (LLL) (n = 13), right lower lobe (RLL) (n = 9), and right middle lobe (RML) (n = 1). Emphysema ratio was the highest in LUL, followed by that in RUL, LLL, RML, and RLL. Multivariate logistic regression analysis revealed that upper lobes (odds ratio: 1.77; 95% confidence interval: 1.01-3.11, P = 0.048) and lobes with emphysema ratio ranked the 1st or the 2nd (odds ratio: 2.48; 95% confidence interval: 1.48-4.15, P < 0.001) were significantly and independently associated with lung cancer development.In emphysema patients, lung cancer has a tendency to develop in lobes with more severe emphysema.

Severity of pulmonary emphysema and lung cancer: analysis using quantitative lobar emphysema scoring

PubMed Central

Bae, Kyungsoo; Jeon, Kyung Nyeo; Lee, Seung Jun; Kim, Ho Cheol; Ha, Ji Young; Park, Sung Eun; Baek, Hye Jin; Choi, Bo Hwa; Cho, Soo Buem; Moon, Jin Il

2016-01-01

Abstract The aim of this study was to determine the relationship between lobar severity of emphysema and lung cancer using automated lobe segmentation and emphysema quantification methods. This study included 78 patients (74 males and 4 females; mean age of 72 years) with the following conditions: pathologically proven lung cancer, available chest computed tomographic (CT) scans for lobe segmentation, and quantitative scoring of emphysema. The relationship between emphysema and lung cancer was analyzed using quantitative emphysema scoring of each pulmonary lobe. The most common location of cancer was the left upper lobe (LUL) (n = 28), followed by the right upper lobe (RUL) (n = 27), left lower lobe (LLL) (n = 13), right lower lobe (RLL) (n = 9), and right middle lobe (RML) (n = 1). Emphysema ratio was the highest in LUL, followed by that in RUL, LLL, RML, and RLL. Multivariate logistic regression analysis revealed that upper lobes (odds ratio: 1.77; 95% confidence interval: 1.01–3.11, P = 0.048) and lobes with emphysema ratio ranked the 1st or the 2nd (odds ratio: 2.48; 95% confidence interval: 1.48–4.15, P < 0.001) were significantly and independently associated with lung cancer development. In emphysema patients, lung cancer has a tendency to develop in lobes with more severe emphysema. PMID:27902611

Nitrous Oxide and Serious Long-term Morbidity and Mortality in the Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA)-II Trial.

PubMed

Leslie, Kate; Myles, Paul S; Kasza, Jessica; Forbes, Andrew; Peyton, Philip J; Chan, Matthew T V; Paech, Michael J; Sessler, Daniel I; Beattie, W Scott; Devereaux, P J; Wallace, Sophie

2015-12-01

The Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA)-II trial randomly assigned 7,112 noncardiac surgery patients at risk of perioperative cardiovascular events to 70% N2O or 70% N2 groups. The aim of this follow-up study was to determine the effect of nitrous oxide on a composite primary outcome of death and major cardiovascular events at 1 yr after surgery. One-year follow-up was conducted via a medical record review and telephone interview. Disability was defined as a Katz index of independence in activities of daily living score less than 8. Adjusted odds ratios and hazard ratios were calculated as appropriate for primary and secondary outcomes. Among 5,844 patients evaluated at 1 yr, 435 (7.4%) had died, 206 (3.5%) had disability, 514 (8.8%) had a fatal or nonfatal myocardial infarction, and 111 (1.9%) had a fatal or nonfatal stroke during the 1-yr follow-up period. Exposure to nitrous oxide did not increase the risk of the primary outcome (odds ratio, 1.08; 95% CI, 0.94 to 1.25; P = 0.27), disability or death (odds ratio, 1.07; 95% CI, 0.90 to 1.27; P = 0.44), death (hazard ratio, 1.17; 95% CI, 0.97 to 1.43; P = 0.10), myocardial infarction (odds ratio, 0.97; 95% CI, 0.81 to 1.17; P = 0.78), or stroke (odds ratio, 1.08; 95% CI, 0.74 to 1.58; P = 0.70). These results support the long-term safety of nitrous oxide administration in noncardiac surgical patients with known or suspected cardiovascular disease.

Past-Year Treatment Utilization Among Individuals Meeting DSM-5 PTSD Criteria: Results From a Nationally Representative Sample.

PubMed

Hale, Andrew C; Sripada, Rebecca K; Bohnert, Kipling M

2018-03-01

Little is known regarding treatment utilization among individuals meeting DSM-5 criteria for posttraumatic stress disorder (PTSD). Data were analyzed from the third wave of the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample using DSM-5 criteria. Factors related to increased odds of PTSD treatment utilization for individuals meeting lifetime criteria included some college education versus less than a high school degree (odds ratio [OR]=3.17), having health insurance versus no insurance (OR=2.86), having a comorbid phobia disorder versus not having a phobia disorder (OR=1.36), and greater PTSD symptom count (OR=1.11). Older age (OR=.40), identifying as black or Asian versus white non-Hispanic (OR=.70 and OR=.28, respectively), and greater social functioning (OR=.98) were associated with decreased odds of PTSD treatment utilization. Results highlight factors that may be useful in identifying population subgroups with PTSD that are at risk for underutilization of services.

Influence of landscape characteristics on migration strategies of white-tailed deer

USGS Publications Warehouse

Grovenburg, T.W.; Jacques, C.N.; Klaver, R.W.; Deperno, C.S.; Brinkman, T.J.; Swanson, C.C.; Jenks, J.A.

2011-01-01

A trade-off exists for migrating animals as to whether to migrate or remain residents. Few studies have documented relationships between landscape variables and deer migration strategies. From 2000 to 2007 we captured 267 adult female white-tailed deer (Odocoileus virginianus) at 7 study sites in Minnesota and South Dakota and monitored 149 individuals through ≥3 seasonal migration periods (585 deer-migration seasons). All deer classified as obligate migrators with ≥3 migrations (range 3–9 migration seasons) maintained their obligate status for the duration of the study. Multinomial logistic odds ratios from generalized estimating equations indicated that the odds of being a resident increased by 1.4 and 1.3 per 1-unit increase in forest patch density and mean area, respectively, compared to migrating deer. Odds of being an obligate migrator increased by 0.7 and 0.8 per 1-unit decrease in forest patch density and mean area, respectively, compared to resident or conditional migrating deer. Areas inhabited by resident deer were characterized by greater number of forest patches per 100 ha and larger mean forest patch area than conditional and obligate migrant areas. Odds of migrating increased by 1.1 per 1-unit increase in deer winter severity index. Migration behavior of white-tailed deer varied among regions, and land-cover and landscape characteristics provided predictive indicators of migration strategies for deer that could have important implications for conservation, metapopulation dynamics, and species management.

Examination of the association between announced inspections and inspection scores.

PubMed

Waters, A Blake; VanDerslice, James; Porucznik, Christina A; Kim, Jaewhan; DeLegge, Royal; Durrant, Lynne

2013-09-01

In 2010 the Salt Lake Valley Health Department conducted a pilot of an announced inspection program utilizing a randomized assignment of restaurants to an intervention group with announced inspections and a control group that remained on the usual schedule of unannounced inspections. After adjusting for food type, visible kitchen, outside quality assurance, season, and standardized inspector, significant reductions were found in the odds ratios of personal hygiene (adjusted odds ratios [aOR] = 0.11, p = .00) and equipment cleanliness (aOR = 0.19, p = .00) violations. In the models for the control group, none of the odds ratios were statistically different from one, indicating no change in the postintervention time period as compared to the preintervention period.

Calf and replacement heifer mortality from birth until weaning in pasture-based dairy herds in New Zealand.

PubMed

Cuttance, E L; Mason, W A; McDermott, J; Laven, R A; McDougall, S; Phyn, C V C

2017-10-01

The aims of this study were to (1) estimate the perinatal (birth to 24 h) and postnatal (∼24 h to the mean weaning age of 13 wk) mortality risk in pasture-based dairy calves until weaning, and (2) identify associated risk factors in the 2015 calving season. A prospective survey of 32 seasonal calving dairy farms was undertaken. Farmers recorded (daily) the number and sex of the calves alive or dead in the paddocks where cows calved. All daily animal movements in and out of the calf rearing facilities, including death and euthanasia, and the identification of the animals (if applicable) were recorded, and a survey of the farm management practices was undertaken. Individual and farm-level risk factors for perinatal mortality were modeled separately using generalized logistic mixed models with a random effect fitted for herd. Postnatal mortality incidence risk was calculated using time at risk for each calf from 24 h of age, collapsed into weeks, and multiplying the incidence risk by the mean weaning age of the study population. Farm-level risk factors contributing to postnatal mortality in the first week of life were assessed using a multivariable logistic mixed regression model. The mean perinatal mortality risk was 5.7% (95% confidence interval 5.4 to 6.1%) with a range from 2.2 to 8.6% (18,437 calves, 30 farms). Perinatal calf mortality was greater for male relative to female calves (odds ratio 1.39; 95% confidence interval 1.22 to 1.59), calves born in the first week of the calving period in comparison to wk 2 to 11 (odds ratio 0.32 to 0.66), and those born on days with greater rainfall (odds ratio 1.01 per 1 mm increase; 95% confidence interval 1.00 to 1.02). At the farm level, perinatal mortality increased for every extra week of calving period length (odds ratio 1.12; 95% confidence interval 1.06 to 1.17). The mean postnatal mortality risk was 4.1% (95% confidence interval 3.6 to 4.6%) with a range of 0 to 11% between farms. Farm-level risk factors contributing to mortality in the first week of life included farmer-reported disease problems in calves (odds ratio 2.2; 95% confidence interval 1.62 to 2.96), or calves hand-fed colostrum in the first 12 h of life (odds ratio 1.66; 95% confidence interval 1.26 to 2.19), which was assumed to be associated with poor colostrum quality and bacterial contamination. Regional differences were also observed in both perinatal and postnatal mortality risks, indicating that weather conditions, herd size, and management variations contribute to mortality incidence. In summary, the mortality risk of perinatal calves and postnatal calves until weaning on pasture-based farms is comparable with data published from other dairying systems despite the notable management differences. Several risk factors were identified that could be managed to reduce mortality incidence of dairy calves. Copyright © 2017 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Visual impairment is associated with physical and mental comorbidities in older adults: a cross-sectional study.

PubMed

Court, Helen; McLean, Gary; Guthrie, Bruce; Mercer, Stewart W; Smith, Daniel J

2014-10-17

Visual impairment is common in older people and the presence of additional health conditions can compromise health and rehabilitation outcomes. A small number of studies have suggested that comorbities are common in visual impairment; however, those studies have relied on self-report and have assessed a relatively limited number of comorbid conditions. We conducted a cross-sectional analysis of a dataset of 291,169 registered patients (65-years-old and over) within 314 primary care practices in Scotland, UK. Visual impairment was identified using Read Code ever recorded for blindness and/or low vision (within electronic medical records). Prevalence, odds ratios (from prevalence rates standardised by stratifying individuals by age groups (65 to 69 years; 70 to 74; 75 to 79; 80 to 84; and 85 and over), gender and deprivation quintiles) and 95% confidence intervals (95% CI) of 37 individual chronic physical/mental health conditions and total number of conditions were calculated and compared for those with visual impairment to those without. Twenty seven of the 29 physical health conditions and all eight mental health conditions were significantly more likely to be recorded for individuals with visual impairment compared to individuals without visual impairment, after standardising for age, gender and social deprivation. Individuals with visual impairment were also significantly more likely to have more comorbidities (for example, five or more conditions (odds ratio (OR) 2.05 95% CI 1.94 to 2.18)). Patients aged 65 years and older with visual impairment have a broad range of physical and mental health comorbidities compared to those of the same age without visual impairment, and are more likely to have multiple comorbidities. This has important implications for clinical practice and for the future design of integrated services to meet the complex needs of patients with visual impairment, for example, embedding depression and hearing screening within eye care services.

Maternal geographic residence, local health service supply and birth outcomes.

PubMed

Haraldsdottir, Sigridur; Gudmundsson, Sigurdur; Bjarnadottir, Ragnheidur I; Lund, Sigrun H; Valdimarsdottir, Unnur A

2015-02-01

To describe pregnancy complications, mode of delivery and neonatal outcomes by mother's residence. Register-based cohort study. Geographical regions of Iceland. Live singleton births from 1 January 2000 to 31 December 2009 (n = 40 982) and stillbirths ≥22 weeks or weighing ≥500 g (n = 145). Logistic regression was used to explore differences in outcomes by area of residence while controlling for potential confounders. Maternal residence was classified according to distance from Capital Area and availability of local health services. Preterm birth, low birthweight, perinatal death, gestational diabetes and hypertension. Of the 40 982 infants of the study population 26 255 (64.1%) were born to mothers residing in the Capital Area and 14 727 (35.9%) to mothers living outside the Capital Area. Infants outside the Capital Area were more likely to have been delivered by cesarean section (adjusted odds ratio 1.28; 95% CI 1.21-1.36). A lower prevalence of gestational diabetes (adjusted odds ratio 0.68; 95% CI 0.59-0.78), hypertension (adjusted odds ratio 0.82; 95% CI 0.71-0.94) as well as congenital malformations (adjusted odds ratio 0.55; 95% CI 0.48-0.63) was observed outside the Capital Area. We observed neither differences in mean birthweight, gestation length nor rate of preterm birth or low birthweight across Capital Area and non-Capital Area. The odds of perinatal deaths were significantly higher (adjusted odds ratio 1.87; 95% CI 1.18-2.95) outside the Capital Area in the second half of the study period. Lower prevalence of gestational diabetes and hypertension outside the Capital Area may be an indication of underreporting and/or lower diagnostic activity. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.

Reported health, lifestyle and clinical manifestations associated with HIV status in people from rural and urban communities in the Free State Province, South Africa.

PubMed

Pienaar, Michélle; van Rooyen, Francois C; Walsh, Corinna M

2017-01-01

HIV infection impacts heavily on the infected individual's overall health status. To determine significant health, lifestyle (smoking and alcohol use) and independent clinical manifestations associated with HIV status in rural and urban communities. Adults aged between 25 and 64 years completed a questionnaire in a structured interview with each participant. Blood specimens were analysed in an accredited laboratory using standard techniques and controls. Anthropometric measurements were determined using standardised methods. Of the 567 rural participants, 97 (17.1%) were HIV-infected, and 172 (40.6%) of the 424 urban participants. More than half of HIV-infected rural participants used alcohol and more than 40% smoked. Median body mass index (BMI) of HIV-infected participants was lower than that of uninfected participants. Significantly more HIV-infected participants reported experiencing cough (rural), skin rash (urban), diarrhoea (rural and urban), vomiting (rural), loss of appetite (urban) and involuntary weight loss (rural). Significantly more HIV-uninfected participants reported diabetes mellitus (urban) and high blood pressure (rural and urban). In rural areas, HIV infection was positively associated with losing weight involuntarily (odds ratio 1.86), ever being diagnosed with tuberculosis (TB) (odds ratio 2.50) and being on TB treatment (odds ratio 3.29). In the urban sample, HIV infection was positively associated with having diarrhoea (odds ratio 2.04) and ever being diagnosed with TB (odds ratio 2.49). Involuntary weight loss and diarrhoea were most likely to predict the presence of HIV. In addition, present or past diagnosis of TB increased the odds of being HIV-infected. Information related to diarrhoea, weight loss and TB is easy to obtain from patients and should prompt healthcare workers to screen for HIV.

Job strain as a risk factor for leisure-time physical inactivity: an individual-participant meta-analysis of up to 170,000 men and women: the IPD-Work Consortium.

PubMed

Fransson, Eleonor I; Heikkilä, Katriina; Nyberg, Solja T; Zins, Marie; Westerlund, Hugo; Westerholm, Peter; Väänänen, Ari; Virtanen, Marianna; Vahtera, Jussi; Theorell, Töres; Suominen, Sakari; Singh-Manoux, Archana; Siegrist, Johannes; Sabia, Séverine; Rugulies, Reiner; Pentti, Jaana; Oksanen, Tuula; Nordin, Maria; Nielsen, Martin L; Marmot, Michael G; Magnusson Hanson, Linda L; Madsen, Ida E H; Lunau, Thorsten; Leineweber, Constanze; Kumari, Meena; Kouvonen, Anne; Koskinen, Aki; Koskenvuo, Markku; Knutsson, Anders; Kittel, France; Jöckel, Karl-Heinz; Joensuu, Matti; Houtman, Irene L; Hooftman, Wendela E; Goldberg, Marcel; Geuskens, Goedele A; Ferrie, Jane E; Erbel, Raimund; Dragano, Nico; De Bacquer, Dirk; Clays, Els; Casini, Annalisa; Burr, Hermann; Borritz, Marianne; Bonenfant, Sébastien; Bjorner, Jakob B; Alfredsson, Lars; Hamer, Mark; Batty, G David; Kivimäki, Mika

2012-12-15

Unfavorable work characteristics, such as low job control and too high or too low job demands, have been suggested to increase the likelihood of physical inactivity during leisure time, but this has not been verified in large-scale studies. The authors combined individual-level data from 14 European cohort studies (baseline years from 1985-1988 to 2006-2008) to examine the association between unfavorable work characteristics and leisure-time physical inactivity in a total of 170,162 employees (50% women; mean age, 43.5 years). Of these employees, 56,735 were reexamined after 2-9 years. In cross-sectional analyses, the odds for physical inactivity were 26% higher (odds ratio = 1.26, 95% confidence interval: 1.15, 1.38) for employees with high-strain jobs (low control/high demands) and 21% higher (odds ratio = 1.21, 95% confidence interval: 1.11, 1.31) for those with passive jobs (low control/low demands) compared with employees in low-strain jobs (high control/low demands). In prospective analyses restricted to physically active participants, the odds of becoming physically inactive during follow-up were 21% and 20% higher for those with high-strain (odds ratio = 1.21, 95% confidence interval: 1.11, 1.32) and passive (odds ratio = 1.20, 95% confidence interval: 1.11, 1.30) jobs at baseline. These data suggest that unfavorable work characteristics may have a spillover effect on leisure-time physical activity.

Job Strain as a Risk Factor for Leisure-Time Physical Inactivity: An Individual-Participant Meta-Analysis of Up to 170,000 Men and Women

PubMed Central

Fransson, Eleonor I.; Heikkilä, Katriina; Nyberg, Solja T.; Zins, Marie; Westerlund, Hugo; Westerholm, Peter; Väänänen, Ari; Virtanen, Marianna; Vahtera, Jussi; Theorell, Töres; Suominen, Sakari; Singh-Manoux, Archana; Siegrist, Johannes; Sabia, Séverine; Rugulies, Reiner; Pentti, Jaana; Oksanen, Tuula; Nordin, Maria; Nielsen, Martin L.; Marmot, Michael G.; Magnusson Hanson, Linda L.; Madsen, Ida E. H.; Lunau, Thorsten; Leineweber, Constanze; Kumari, Meena; Kouvonen, Anne; Koskinen, Aki; Koskenvuo, Markku; Knutsson, Anders; Kittel, France; Jöckel, Karl-Heinz; Joensuu, Matti; Houtman, Irene L.; Hooftman, Wendela E.; Goldberg, Marcel; Geuskens, Goedele A.; Ferrie, Jane E.; Erbel, Raimund; Dragano, Nico; De Bacquer, Dirk; Clays, Els; Casini, Annalisa; Burr, Hermann; Borritz, Marianne; Bonenfant, Sébastien; Bjorner, Jakob B.; Alfredsson, Lars; Hamer, Mark; Batty, G. David; Kivimäki, Mika

2012-01-01

Unfavorable work characteristics, such as low job control and too high or too low job demands, have been suggested to increase the likelihood of physical inactivity during leisure time, but this has not been verified in large-scale studies. The authors combined individual-level data from 14 European cohort studies (baseline years from 1985–1988 to 2006–2008) to examine the association between unfavorable work characteristics and leisure-time physical inactivity in a total of 170,162 employees (50% women; mean age, 43.5 years). Of these employees, 56,735 were reexamined after 2–9 years. In cross-sectional analyses, the odds for physical inactivity were 26% higher (odds ratio = 1.26, 95% confidence interval: 1.15, 1.38) for employees with high-strain jobs (low control/high demands) and 21% higher (odds ratio = 1.21, 95% confidence interval: 1.11, 1.31) for those with passive jobs (low control/low demands) compared with employees in low-strain jobs (high control/low demands). In prospective analyses restricted to physically active participants, the odds of becoming physically inactive during follow-up were 21% and 20% higher for those with high-strain (odds ratio = 1.21, 95% confidence interval: 1.11, 1.32) and passive (odds ratio = 1.20, 95% confidence interval: 1.11, 1.30) jobs at baseline. These data suggest that unfavorable work characteristics may have a spillover effect on leisure-time physical activity. PMID:23144364

Effect of sibling number in the household and birth order on prevalence of Helicobacter pylori: a cross-sectional study.

PubMed

Ford, Alexander C; Forman, David; Bailey, Alastair G; Goodman, Karen J; Axon, Anthony T R; Moayyedi, Paul

2007-12-01

Infection with Helicobacter pylori (H. pylori) is acquired mainly in childhood, with studies demonstrating this is related to living conditions. Effects of sibling number and birth order on prevalence of infection have not been extensively studied. The authors performed a cross-sectional survey of adults, aged between 50 and 59 years, previously involved in a community-screening programme for H. pylori in Leeds and Bradford, UK. Prevalence of H. pylori was assessed at baseline with urea breath test. All individuals who were alive, and could be traced, were contacted by postal questionnaire in 2003 obtaining information on number of siblings and birth order. Data concerning childhood socioeconomic conditions were stored on file from the original study. 3928 (47%) of 8407 original participants provided data. Prevalence of infection increased according to sibling number (20% in those with none vs 63% with eight or more). Controlling for childhood socioeconomic conditions and birth order using multivariate logistic regression, infection odds were substantially increased with three siblings compared with none [odds ratio (OR) 1.51; 95% confidence interval (CI) 1.06-2.15], and a gradient of effect continued up to eight or more siblings (OR 5.70; 95% CI 2.92-11.14). Odds of infection also increased substantially with birth order, but the positive gradient disappeared on adjustment for sibling number and childhood socioeconomic conditions. : In this cross section of UK adults, aged 50-59 years, sibling number in the household, but not birth order, was independently associated with prevalence of H. pylori infection.

Participation of pregnant women in a community-based nutrition program in Mumbai's informal settlements: Effect on exclusive breastfeeding practices

PubMed Central

Waingankar, Anagha; Shah More, Neena; Pantvaidya, Shanti; Fernandez, Armida; Jayaraman, Anuja

2018-01-01

Background In urban Maharashtra, India, approximately half of mothers exclusively breastfeed. For children residing in informal settlements of Mumbai, this study examines factors associated with exclusive breastfeeding, and whether exclusive breastfeeding, in a community-based nutrition program to prevent and treat wasting among children under age three, is associated with enrolment during the mother’s pregnancy. Methods The nutrition program conducted a cross-sectional endline survey (October-December 2015) of caregivers in intervention areas. Factors associated with exclusive breastfeeding for infants under six months of age were explored using multi-level logistic regressions. Additionally, program surveillance data collected during home-based counselling visits documented breastfeeding practices for children under six months of age. Using the surveillance data (January 2014-March 2016), exclusive breastfeeding status was regressed adjusting for child, maternal and socioeconomic characteristics, and whether the child was enrolled in the program in utero or after birth. Results The community-based endline survey included 888 mothers of infants. Mothers who received the nutrition program home visits or attended group counselling sessions were more likely to exclusively breastfeed (adjusted odds ratio 1.67, 95% CI 1.16, 2.41). Having a normal weight-for-height z-score (adjusted odds ratio 1.57, 95% CI 1.00, 2.45) was associated positively with exclusive breastfeeding. As expected, being an older infant aged three to five months (adjusted odds ratio 0.34, 95% CI 0.25, 0.48) and receiving a prelacteal feed after birth (adjusted odds ratio 0.57, 95% CI 0.41, 0.80) were associated with lower odds of exclusively breastfeeding. Surveillance data (N = 3420) indicate that infants enrolled in utero have significantly higher odds of being exclusively breastfed (adjusted odds ratio 1.55, 95% CI 1.30, 1.84) than infants enrolled after birth. Conclusions Prenatal enrolment in community-based programs working on child nutrition in urban informal settlements of India can improve exclusive breastfeeding practices. PMID:29621355

Participation of pregnant women in a community-based nutrition program in Mumbai's informal settlements: Effect on exclusive breastfeeding practices.

PubMed

Chanani, Sheila; Waingankar, Anagha; Shah More, Neena; Pantvaidya, Shanti; Fernandez, Armida; Jayaraman, Anuja

2018-01-01

In urban Maharashtra, India, approximately half of mothers exclusively breastfeed. For children residing in informal settlements of Mumbai, this study examines factors associated with exclusive breastfeeding, and whether exclusive breastfeeding, in a community-based nutrition program to prevent and treat wasting among children under age three, is associated with enrolment during the mother's pregnancy. The nutrition program conducted a cross-sectional endline survey (October-December 2015) of caregivers in intervention areas. Factors associated with exclusive breastfeeding for infants under six months of age were explored using multi-level logistic regressions. Additionally, program surveillance data collected during home-based counselling visits documented breastfeeding practices for children under six months of age. Using the surveillance data (January 2014-March 2016), exclusive breastfeeding status was regressed adjusting for child, maternal and socioeconomic characteristics, and whether the child was enrolled in the program in utero or after birth. The community-based endline survey included 888 mothers of infants. Mothers who received the nutrition program home visits or attended group counselling sessions were more likely to exclusively breastfeed (adjusted odds ratio 1.67, 95% CI 1.16, 2.41). Having a normal weight-for-height z-score (adjusted odds ratio 1.57, 95% CI 1.00, 2.45) was associated positively with exclusive breastfeeding. As expected, being an older infant aged three to five months (adjusted odds ratio 0.34, 95% CI 0.25, 0.48) and receiving a prelacteal feed after birth (adjusted odds ratio 0.57, 95% CI 0.41, 0.80) were associated with lower odds of exclusively breastfeeding. Surveillance data (N = 3420) indicate that infants enrolled in utero have significantly higher odds of being exclusively breastfed (adjusted odds ratio 1.55, 95% CI 1.30, 1.84) than infants enrolled after birth. Prenatal enrolment in community-based programs working on child nutrition in urban informal settlements of India can improve exclusive breastfeeding practices.

The Association Between the Levels of Thyroid Hormones and Peripheral Nerve Conduction in Patients with Type 2 Diabetes Mellitus.

PubMed

Zhu, Fan-Fan; Yang, Li-Zhen

2018-06-26

Type 2 diabetes has an underlying pathology with thyroid dysfunction. However, few studies have investigated the association between thyroid hormones and diabetic peripheral neuropathy. Our aim was to evaluate the relationship between thyroid hormones and electrophysiological properties of peripheral nerves in type 2 diabetes. The medical records of 308 patients with type 2 diabetes were enrolled in this study. Subjects stratified by sex were divided into subgroups based on the diagnosis of nerve conduction study. The nerve conduction parameters were separately described with the spectrum of thyroid hormones. Multivariate regression models to analyze the potential links between thyroid hormones and nerve conduction parameters. The serum free triiodine thyronine levels between normal and abnormal nerve conduction groups were statistically different in total (4.55±0.65 vs 4.37±0.63, P<0.05) and female diabetic patients (4.46±0.50 vs 4.14±0.57, P<0.01). Moreover, the summed amplitude and velocity Z score of female and male increased with free triiodine thyronine levels (P<0.05). Sex-specific binary logistic regression models showed that free triiodine thyronine levels were associated with decreased odds of abnormal nerve conduction diagnosis (odds ratio [95%CI]=0.151[0.047-0.186]) and low tertile of summed amplitude Z score (odds ratio [95%CI]=0.283[0.099-0.809]) in female. In total patients, free triiodine thyronine level was negatively associated with odds of abnormal nerve conduction (odds ratio [95%CI]=0.436 [0.226-0.842]), low tertile of summed velocity (odds ratio [95%CI]=0.44[0.226-0.858]) and amplitude (odds ratio [95%CI]=0.436[0.227-0.838) Z score. Serum free triiodine thyronine level is associated with nerve conduction in diabetes. Low free triiodine thyronine may be a potential risk for diabetic peripheral neuropathy. © Georg Thieme Verlag KG Stuttgart · New York.

Associations between gender-based violence and personality disorders in U.S. women.

PubMed

Walsh, Kate; Hasin, Deborah; Keyes, Katherine M; Koenen, Karestan C

2016-04-01

Gender-based violence (GBV) is prevalent and associated with deleterious outcomes including posttraumatic stress disorder, depression, and substance use disorders. Despite substantial comorbidity between these conditions and personality disorders (PDs), few, if any, studies have examined associations between lifetime exposure to GBV and risk for a range of PDs in nationally representative U.S. The current study addressed this gap in the literature by examining adjusted odds ratios (aORs) and population attributable fractions (PAFs) of 10 PDs by lifetime GBV exposure. Participants were 20,089 women who participated in wave 2 (2004-2005) of the National Epidemiologic Survey of Alcohol and Related Conditions. Lifetime GBV and PD were reported by 25% and 20% of women, respectively. Logistic regressions indicated that women with GBV had 3.5 times the odds of lifetime PD; aORs ranged from 2.3 to 6.3 for Schizoid and Borderline PD, respectively. GBV was associated with 38% of all PD cases, and women who had experienced all 3 GBV types had 8.5 times the odds of PD compared to nonvictims. Preventing GBV, particularly multitype GBV, may be critical to reducing the burden of PDs. Clinicians working with GBV victims should consider assessing PDs and providing treatment targeting multiple outcomes. (c) 2016 APA, all rights reserved).

Magnetic resonance imaging findings in Ménière's disease.

PubMed

Patel, V A; Oberman, B S; Zacharia, T T; Isildak, H

2017-07-01

To identify and evaluate cranial magnetic resonance imaging findings associated with Ménière's disease. Seventy-eight patients with a documented diagnosis of Ménière's disease and 35 controls underwent 1.5 T or 3 T magnetic resonance imaging of the brain. Patients also underwent otological, vestibular and audiometric examinations. Lack of visualisation of the left and right vestibular aqueducts was identified as statistically significant amongst Ménière's disease patients (left, p = 0.0001, odds ratio = 0.02; right, p = 0.0004, odds ratio = 0.03). Both vestibular aqueducts were of abnormal size in the Ménière's disease group, albeit with left-sided significance (left, p = 0.008, odds ratio = 10.91; right, p = 0.49, odds ratio = 2.47). Lack of vestibular aqueduct visualisation on magnetic resonance imaging was statistically significant in Ménière's disease patients compared to the general population. The study findings suggest that magnetic resonance imaging can be useful to rule out retrocochlear pathology and provide radiological data to support the clinical diagnosis of Ménière's disease.

Attention deficit/hyperactivity disorder and risk of injuries: A systematic review and meta-analysis

PubMed Central

Amiri, Shahrokh; Sadeghi-Bazargani, Homayoun; Nazari, Soulmaz; Ranjbar, Fatemeh; Abdi, Salman

2017-01-01

Abstract: Background: This study systematically reviewed the literature in order to determine the effect of Attention-Deficit Hyperactivity Disorder (ADHD) on injuries and assessed the magnitude of the potential association. Methods: A systematic review of the studies examining the association of ADHD and injuries was carried out across multiple databases. Odds ratios and standardized mean differences were pooled. Results: A total of 35 studies were selected for quantitative analysis. The association of ADHD and injuries was confirmed over the meta-analysis of eligible studies. The odds ratio pooled over all comparative studies was 1.96(95% CI: 1.6-2.4) using random effects model. Pooled odds ratio of 2.1 and 2.17 were calculated respectively when cohort and case-control studies or just cohort studies were included. The pooled odds ratio reduced to 1.8(CI:1.45-2.3) when studies on specific injuries were removed. For studies comparing scores of rating scales, the pooled standardized mean difference was 0.61(95% CI: 0.03-1.2). Conclusions: Those with ADHD are nearly two times more likely to be injured. PMID:28554188

Testing equality and interval estimation of the generalized odds ratio in ordinal data under a three-period crossover design.

PubMed

Lui, Kung-Jong; Chang, Kuang-Chao; Lin, Chii-Dean

2017-06-01

The crossover design can be of use to save the number of patients or improve power of a parallel groups design in studying treatments to noncurable chronic diseases. We propose using the generalized odds ratio for paired sample data to measure the relative effects in ordinal data between treatments and between periods. We show that one can apply the commonly used asymptotic and exact test procedures for stratified analysis in epidemiology to test non-equality of treatments in ordinal data, as well as obtain asymptotic and exact interval estimators for the generalized odds ratio under a three-period crossover design. We further show that one can apply procedures for testing the homogeneity of the odds ratio under stratified sampling to examine whether there are treatment-by-period interactions. We use the data taken from a three-period crossover trial studying the effects of low and high doses of an analgesic versus a placebo for the relief of pain in primary dysmenorrhea to illustrate the use of these test procedures and estimators proposed here.

Selective serotonin reuptake inhibitors and adverse pregnancy outcomes.

PubMed

Wen, Shi Wu; Yang, Qiuying; Garner, Peter; Fraser, William; Olatunbosun, Olufemi; Nimrod, Carl; Walker, Mark

2006-04-01

The purpose of this study was to assess the safety of the use of selective serotonin reuptake inhibitors in pregnancy. We carried out a retrospective cohort study of 972 pregnant women who had been given at least 1 selective serotonin reuptake inhibitor prescription in the year before delivery and 3878 pregnant women who did not receive selective serotonin reuptake inhibitors and who were matched by the year of the infant's birth, the type of institute at birth, and the mother's postal code from 1990 to 2000 in the Canadian province of Saskatchewan. The risks of low birth weight (adjusted odds ratio, 1.58; 95% CI, 1.19, 2.11), preterm birth (adjusted odds ratio, 1.57; 95% CI, 1.28, 1.92), fetal death (adjusted odds ratio, 2.23; 95% CI, 1.01, 4.93), and seizures (adjusted odds ratio, 3.87; 95% CI, 1.00, 14.99) were increased in infants who were born to mothers who had received selective serotonin reuptake inhibitor therapy. The use of selective serotonin reuptake inhibitors in pregnancy may increase the risks of low birth weight, preterm birth, fetal death, and seizures.

Statistical aspects of genetic association testing in small samples, based on selective DNA pooling data in the arctic fox.

PubMed

Szyda, Joanna; Liu, Zengting; Zatoń-Dobrowolska, Magdalena; Wierzbicki, Heliodor; Rzasa, Anna

2008-01-01

We analysed data from a selective DNA pooling experiment with 130 individuals of the arctic fox (Alopex lagopus), which originated from 2 different types regarding body size. The association between alleles of 6 selected unlinked molecular markers and body size was tested by using univariate and multinomial logistic regression models, applying odds ratio and test statistics from the power divergence family. Due to the small sample size and the resulting sparseness of the data table, in hypothesis testing we could not rely on the asymptotic distributions of the tests. Instead, we tried to account for data sparseness by (i) modifying confidence intervals of odds ratio; (ii) using a normal approximation of the asymptotic distribution of the power divergence tests with different approaches for calculating moments of the statistics; and (iii) assessing P values empirically, based on bootstrap samples. As a result, a significant association was observed for 3 markers. Furthermore, we used simulations to assess the validity of the normal approximation of the asymptotic distribution of the test statistics under the conditions of small and sparse samples.

Maternal Occupation and Term Low Birth Weight in a Predominantly Latina Population in Los Angeles, California

PubMed Central

von Ehrenstein, Ondine S.; Wilhelm, Michelle; Ritz, Beate

2014-01-01

Objectives Focussing on Latinas, we investigated whether maternal occupations during pregnancy increase term low birth weight (TLBW) (<2,500 gram, ≥37 weeks). Methods In a case-control study (n=1,498) nested within the 2003 birth-cohort (n=58,316) in Los Angeles county, California, (65% Latina) we assessed the influence of maternal occupation on TLBW using U.S. Census-Occupational Categories. Results Odds ratios for TLBW were increased among women working during pregnancy in “Transportation and Material Moving Operations” (adjusted odds ratio (aOR)=3.28; 95% confidence interval (CI)=1.00, 10.73), “Food Preparation and Serving Occupations” (aOR=3.03; 95%CI=1.21, 7.62), or in “Production Occupations” (aOR=2.63; 95%CI=1.01, 6.82) compared with “Office Occupations”; 73%–93% of women working in these higher risk jobs were immigrant Latinas. Conclusions Working conditions in various jobs held mainly by first-generation-immigrant Latinas increase risks for TLBW, and need to be addressed to develop strategies to reduce TLBW. PMID:23969503

Treatment of infertility does not increase the risk of ovarian cancer among women with a BRCA1 or BRCA2 mutation.

PubMed

Gronwald, Jacek; Glass, Karen; Rosen, Barry; Karlan, Beth; Tung, Nadine; Neuhausen, Susan L; Moller, Pal; Ainsworth, Peter; Sun, Ping; Narod, Steven A; Lubinski, Jan; Kotsopoulos, Joanne

2016-03-01

To evaluate the relationship between use of fertility medication (i.e., selective estrogen receptor [ER] modulator, gonadotropin, or other) or infertility treatment (i.e., IVF or IUI) and the risk of ovarian cancer among women with a BRCA1 or BRCA2 mutation. A matched case-control study of 941 pairs of BRCA1 or BRCA2 mutation carriers with and without a diagnosis of ovarian cancer. Genetic clinics. Detailed information regarding treatment of infertility was collected from a routinely administered questionnaire. None. Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals associated with fertility treatment. There was no significant relationship between the use of any fertility medication or IVF treatment (odds ratio, 0.66; 95% confidence interval 0.18-2.33) and the subsequent risk of ovarian cancer. Our findings suggest that treatment for infertility does not significantly increase the risk of ovarian cancer among women with a BRCA mutation. Copyright © 2016 American Society for Reproductive Medicine. All rights reserved.

N-acetyltransferase 2 gene polymorphism as a biomarker for susceptibility to bladder cancer in Bangladeshi population.

PubMed

Hosen, Md Bayejid; Islam, Jahidul; Salam, Md Abdus; Islam, Md Fakhrul; Hawlader, M Zakir Hossain; Kabir, Yearul

2015-03-01

To investigate the association between the three most common single nucleotide polymorphisms of the N-acetyltransferase 2 gene together with cigarette smoking and the risk of developing bladder cancer and its aggressiveness. A case-control study on 102 bladder cancer patients and 140 control subjects was conducted. The genomic DNA was extracted from peripheral white blood cells and N-acetyltransferase 2 alleles were differentiated by polymerase chain reaction-based restriction fragment length polymorphism methods. Bladder cancer risk was estimated as odds ratio and 95% confidence interval using binary logistic regression models adjusting for age and gender. Overall, N-acetyltransferase 2 slow genotypes were associated with bladder cancer risk (odds ratio=4.45; 95% confidence interval=2.26-8.77). The cigarette smokers with slow genotypes were found to have a sixfold increased risk to develop bladder cancer (odds ratio=6.05; 95% confidence interval=2.23-15.82). Patients with slow acetylating genotypes were more prone to develop high-grade (odds ratio=6.63; 95% confidence interval=1.15-38.13; P<0.05) and invasive (odds ratio=10.6; 95% confidence interval=1.00-111.5; P=0.05) tumor. N-acetyltransferase 2 slow genotype together with tobacco smoking increases bladder cancer risk. Patients with N-acetyltransferase 2 slow genotypes were more likely to develop a high-grade and invasive tumor. N-acetyltransferase 2 slow genotype is an important genetic determinant for bladder cancer in Bangladesh population. © 2014 Wiley Publishing Asia Pty Ltd.

Assessment of occupational stress and associated factors among bank employees in Vitoria, State of Espírito Santo, Brazil.

PubMed

Petarli, Glenda Blaser; Zandonade, Eliana; Salaroli, Luciane Bresciani; Bissoli, Nazaré Souza

2015-12-01

Occupational stress has become a major cause of illness and a major risk to the psychological and social well-being of workers. In this context, the aim of this study was to estimate the prevalence of occupational stress in employees of a banking network in the municipal region of Vitória, state of Espírito Santo, and its association with sociodemographic variables and work characteristics. This cross-sectional study involved 525 bank employees. Occupational stress was evaluated using the short version of the Job Stress Scale. A multivariate analysis was conducted to evaluate the association between the Karasek quadrants and the independent variables. It was found that most bank employees belonged to the "passive jobs" quadrant (34.4%, n = 179) and were considered to have an intermediate risk of occupational stress. Considering the "low demand jobs" category as the standard, the increased risk of stress was associated with low education levels (odds ratio, 3.69, 95% CI, 1.64-8.28), working in bank agencies (odds ratio, 2.55, 95% CI, 1.36-4.77), a length of employment at the bank of more than five years (odds ratio, 3.32, 95% CI, 1.89-5.81), a daily work period of six hours (odds ratio, 2.72, 95% CI, 1.27-5.81), and, mainly, low social support (odds ratio, 2.57, 95% CI 1.45- 4.56).

Hopelessness among adults with congenital heart disease: Cause for despair or hope?

PubMed

Eslami, Bahareh; Kovacs, Adrienne H; Moons, Philip; Abbasi, Kyomars; Jackson, Jamie L

2017-03-01

Adults with congenital heart disease (CHD) face unique life courses and challenges that may negatively influence their psychological functioning. The aims of this study were to (1) examine the level of hopelessness among adults with CHD in comparison with non-CHD participants and (2) identify correlates of elevated hopelessness among adults with CHD. We enrolled 347 patients with CHD (18-64years, 52.2% female) and 353 matched (by sex/age) non-CHD persons in this cross-sectional study. Hopelessness was assessed by Beck Hopelessness Scale. Hierarchical multiple logistic regression analyses were performed to explore correlates of elevated hopelessness. The mean total hopelessness score did not significantly differ between the CHD and non-CHD groups. Twenty-eight percent of CHD patients had elevated hopelessness scores. Within the CHD patient sample, regression analyses revealed that being male (odds ratio=2.62), not having children (odds ratio=3.57), being unemployed (odds ratio=2.27), and elevated depressive symptoms (odds ratio=1.21) were significantly associated with hopelessness. Regular physical activity (odds ratio=0.36) emerged as a protective factor and all CHD disease parameters were unrelated to hopelessness. The final model explained 43% of the variance in hopelessness. Adult CHD teams are encouraged to continue to explore strategies to support patients to live as rich and full as lives as possible by pursuing relationships, employment and physical activity, as well as managing depression and hopelessness. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Prevalence of orofacial clefts and risks for nonsyndromic cleft lip with or without cleft palate in newborns at a university hospital from West Mexico.

PubMed

Corona-Rivera, Jorge Román; Bobadilla-Morales, Lucina; Corona-Rivera, Alfredo; Peña-Padilla, Christian; Olvera-Molina, Sandra; Orozco-Martín, Miriam A; García-Cruz, Diana; Ríos-Flores, Izabel M; Gómez-Rodríguez, Brian Gabriel; Rivas-Soto, Gemma; Pérez-Molina, J Jesús

2018-02-19

We determined the overall prevalence of typical orofacial clefts and the potential risks for nonsyndromic cleft lip with or without cleft palate in a university hospital from West México. For the prevalence, 227 liveborn infants with typical orofacial clefts were included from a total of 81,193 births occurred during the period 2009-2016 at the "Dr. Juan I. Menchaca" Civil Hospital of Guadalajara (Guadalajara, Jalisco, Mexico). To evaluate potential risks, a case-control study was conducted among 420 newborns, including only those 105 patients with nonsyndromic cleft lip with or without cleft palate (cases), and 315 infants without birth defects (controls). Data were analyzed using multivariable logistic regression analysis expressed as adjusted odds ratio with 95% confidence intervals . The overall prevalence for typical orofacial clefts was 28 per 10,000 (95% confidence interval: 24.3-31.6), or 1 per 358 live births. The mean values for the prepregnancy weight, antepartum weight, and pre-pregnancy body mass index were statistically higher among the mothers of cases. Infants with nonsyndromic cleft lip with or without cleft palate had a significantly higher risk for previous history of any type of congenital anomaly (adjusted odds ratio: 2.7; 95% confidence interval: 1.4-5.1), history of a relative with cleft lip with or without cleft palate (adjusted odds ratio: 19.6; 95% confidence interval: 8.2-47.1), and first-trimester exposures to progestogens (adjusted odds ratio: 6.8; 95% CI 1.8-25.3), hyperthermia (adjusted odds ratio: 3.4; 95% confidence interval: 1.1-10.6), and common cold (adjusted odds ratio: 3.6; 95% confidence interval: 1.1-11.9). These risks could have contributed to explain the high prevalence of orofacial clefts in our region of Mexico, emphasizing that except for history of relatives with cleft lip with or without cleft palate, most are susceptible of modification. © 2018 Japanese Teratology Society.

Prevalence of abnormal plasma liver enzymes in older people with Type 2 diabetes.

PubMed

Morling, J R; Strachan, M W J; Hayes, P C; Butcher, I; Frier, B M; Reynolds, R M; Price, J F

2012-04-01

To determine the prevalence and distribution of abnormal plasma liver enzymes in a representative sample of older adults with Type 2 diabetes. Plasma concentrations of alanine aminotransferase, aspartate aminotransferase and γ-glutamyltransferase were measured in a randomly selected, population-based cohort of 1066 men and women aged 60-75 years with Type 2 diabetes (the Edinburgh Type 2 Diabetes Study). Overall, 29.1% (95% CI 26.1-31.8) of patients had one or more plasma liver enzymes above the upper limit of the normal reference range. Only 10.1% of these patients had a prior history of liver disease and a further 12.4% reported alcohol intake above recommended limits. Alanine aminotransferase was the most commonly raised liver enzyme (23.1% of patients). The prevalence of abnormal liver enzymes was significantly higher in men (odds ratio 1.40, 95% CI 1.07-1.83), in the youngest 5-year age band (odds ratio 2.02, 95% CI 1.44-2.84), in patients with diabetes duration < 5 years (odds ratio 1.38, 95% CI 1.01-1.90), plasma HbA(1c) ≥ 58 mmol/mol (7.5%) (odds ratio 1.43, 95% CI 1.09-1.88), obese BMI (odds ratio 2.84, 95% CI 1.59-3.06) and secondary care management for their diabetes (odds ratio 1.40, 95% CI 1.05-1.87). However, all these factors combined accounted for only 7.6% of the variation in liver enzyme abnormality. The prevalence of elevated liver enzymes in people with Type 2 diabetes is high, with only modest variation between clinically defined patient groups. Further research is required to determine the prognostic value of raised, routinely measured liver enzymes to inform decisions on appropriate follow-up investigations. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

Neonatal Infection in Children With Cerebral Palsy: A Registry-Based Cohort Study.

PubMed

Smilga, Anne-Sophie; Garfinkle, Jarred; Ng, Pamela; Andersen, John; Buckley, David; Fehlings, Darcy; Kirton, Adam; Wood, Ellen; van Rensburg, Esias; Shevell, Michael; Oskoui, Maryam

2018-03-01

The goal of this study was to explore the association between neonatal infection and outcomes in children with cerebral palsy. We conducted a retrospective cohort study using the Canadian CP Registry. Neonatal infection was defined as meeting one of the following criteria: (1) septicemia, (2) septic shock, or (3) administration of antibiotics for ≥10 days. Phenotypic profiles of children with cerebral palsy with and without an antecedent neonatal infection were compared. Subgroup analysis was performed, stratified by gestational age (term versus preterm). Of the 1229 registry participants, 505 (41.1%) were preterm, and 192 (15.6%) met the criteria for neonatal infection with 29% of preterm children having a neonatal infection compared with 6.5% in term-born children. Children with prior neonatal infection were more likely to have a white matter injury (odds ratio 2.2, 95% confidence interval 1.5 to 3.2), spastic diplegic neurological subtype (odds ratio 1.6, 95% confidence interval 1.1 to 2.3), and sensorineural auditory impairment (odds ratio 2.1, 95% confidence interval 1.4 to 3.3). Among preterm children, neonatal infection was not associated with a difference in phenotypic profile. Term-born children with neonatal infection were more likely to have spastic triplegia or quadriplegia (odds ratio 2.4, 95% confidence interval 1.3 to 4.3), concomitant white matter and cortical injury (odds ratio 4.1, 95% confidence interval 1.6 to 10.3), and more severe gross motor ability (Gross Motor Function Classification System IV to V) (odds ratio 2.6, 95% confidence interval 1.4 to 4.8) compared with preterm children. Findings suggest a role of systemic infection on the developing brain in term-born infants, and the possibility to develop targeted therapeutic and preventive strategies to reduce cerebral palsy morbidity. Copyright © 2017. Published by Elsevier Inc.

Effect of knowledge of community health workers on essential newborn health care: a study from rural India

PubMed Central

Agrawal, Praween K; Agrawal, Sutapa; Ahmed, Saifuddin; Darmstadt, Gary L; Williams, Emma K; Rosen, Heather E; Kumar, Vishwajeet; Kiran, Usha; Ahuja, Ramesh C; Srivastava, Vinod K; Santosham, Mathuram; Black, Robert E; Baqui, Abdullah H

2012-01-01

Background This study explored the relationship between the knowledge of community health workers (CHWs)—anganwadi workers (AWWs) and auxiliary nurse midwives (ANMs)—and their antenatal home visit coverage and effectiveness of the visits, in terms of essential newborn health care practices at the household level in rural India. Methods We used data from 302 AWWs and 86 ANMs and data from recently delivered women (RDW) (n = 13 023) who were residents of the CHW catchment areas and gave birth to a singleton live baby during 2004–05. Using principal component analysis, knowledge scores for preventive care and danger signs were computed separately for AWWs and ANMs and merged with RDW data. A multivariate logistic regression model was used to estimate the adjusted effect of knowledge level. A generalized estimating equation (GEE) was used to account for clustering. Results Coverage of antenatal home visits and newborn care practices were positively correlated with the knowledge level of AWWs and ANMs. Initiation of breastfeeding in the first hour of life (odds ratio 1.97; 95% confidence interval (CI): 1.55–2.49 for AWW, and odds ratio 1.62; 95% CI: 1.25–2.09 for ANM), clean cord care (odds ratio 2.03; 95% CI: 1.64–2.52 for AWW, and odds ratio 1.43; 95% CI: 1.17–1.75 for ANM) and thermal care (odds ratio 2.16; 95% CI: 1.64–2.85 for AWW and odds ratio 1.88; 95% CI: 1.43–2.48 for ANM) were significantly higher among women visited by AWWs or ANMs who had better knowledge compared with those with poor knowledge. Conclusion CHWs’ knowledge is one of the crucial aspects of health systems to improve the coverage of community-based newborn health care programmes as well as adherence to essential newborn care practices at the household level. PMID:21385799

Growth hormone-Insulin-like growth factor 1 axis hyperactivity on bone fibrous dysplasia in McCune-Albright Syndrome.

PubMed

Tessaris, Daniele; Boyce, Alison M; Zacharin, Margaret; Matarazzo, Patrizia; Lala, Roberto; De Sanctis, Luisa; Collins, Michael T

2018-04-19

In fibrous dysplasia (BFD), normal bone and bone marrow are replaced by fibro-osseous tissue, leading to fracture, deformity and pain. BFD may be isolated, or in association with cutaneous hyperpigmentation and/or hyperfunctioning endocrinopathies, termed McCune-Albright syndrome (MAS). GH hypersecretion has been described in 10%-20% of MAS-BFD patients. Aim of the study was to determine the impact of GH-insulin like growth factor 1 (IGF1) axis hyperactivity on MAS-BFD morbidities and the efficacy of GH excess therapy. A multicentric cross-sectional analysis was conducted on three different MAS cohorts. From 195 MAS patients, 37 subjects (19%) with GH excess were identified and compared with 34 MAS controls without GH hypersecretion. Mean head circumference SDS was significantly higher in GH excess: 4.025 SDS vs 0.683 SDS (P < .0001). The risk of optic neuropathy (Odds ratio 4.231; P = .039), hearing deficit (Odds ratio 2.961; P = .0481), facial asymmetry (Odds ratio 6.563; P = .0192), malignancies (Odds ratio 15.24; P = .0173) were higher in GH excess group. Overall, pharmacotherapy (octreotide alone 10-30 mg/mo or with pegvisomant 10-20 mg/d) was effective in IGF1 normalization (IGF1 Z-score between -2 and +2 SDS) in 21/29 patients (72.4%) with good compliance to the regimen. Late diagnosis and GH excess treatment after 16 years old of age was associated with an increased risk of optic neuropathy (Odds ratio 4.500; P = .0491) and growth of pituitary adenomas (Odds ratio 7.846; P = .050). GH-IGF1 hyperactivity increases risk of morbidities in MAS. Medical therapy is effective in normalizing IGF1 in most patients, and early treatment during paediatric age is associated with a decreased risk of optic neuropathy and GH-secreting adenomas growth. © 2018 John Wiley & Sons Ltd.

Age-Specific Sex Differences in Magnetic Resonance Imaging-Depicted Carotid Intraplaque Hemorrhage.

PubMed

Singh, Navneet; Moody, Alan R; Zhang, Bowen; Kaminski, Isabella; Kapur, Kush; Chiu, Stephanie; Tyrrell, Pascal N

2017-08-01

Stroke rates are higher in men compared with women in the fourth through seventh decades of life, and higher rates may result from differences in carotid intraplaque hemorrhage (IPH), an unstable atherosclerotic plaque component. We report age-specific sex differences in the presence of magnetic resonance imaging-depicted carotid IPH. Patients (n=1115) underwent magnetic resonance imaging for carotid IPH between 2005 and 2014. Low-grade carotid stenosis patients (n=906) without prior endarterectomy were eligible for this cross-sectional study. Of the 906 patients included (mean age±SD in years, 66.98±15.15), 63 (6.95%) had carotid IPH. In men and women, carotid IPH was present in 11.43% (48 of 420) and 3.09% (15 of 486), respectively ( P <0.0001). Multivariable logistic regression analysis confirmed greater odds of carotid IPH in men for all ages: 45 to 54 (odds ratio=45.45; 95% confidence interval, 3.43-500), 55 to 64 years (odds ratio=21.74; 95% confidence interval, 3.21-142.86), 65 to 74 years (odds ratio=10.42; 95% confidence interval, 2.91-37.04), and ≥75 years (odds ratio=5.00; 95% confidence interval, 2.31-10.75). Male sex modified the effect of age on the presence of carotid IPH (β=0.074; SE=0.036; P =0.0411). Men have greater age-specific odds of magnetic resonance imaging-depicted carotid IPH compared with women. With increasing age post-menopause, the odds of carotid IPH in women becomes closer to that of men. Delayed onset of carotid IPH in women, an unstable plaque component, may partly explain differential stroke rates between sexes, and further studies are warranted. © 2017 American Heart Association, Inc.

Cardiac rehabilitation after percutaneous coronary intervention: Results from a nationwide survey.

PubMed

Olsen, Siv Js; Schirmer, Henrik; Bønaa, Kaare H; Hanssen, Tove A

2018-03-01

The purpose of this study was to estimate the proportion of Norwegian coronary heart disease patients participating in cardiac rehabilitation programmes after percutaneous coronary intervention, and to determine predictors of cardiac rehabilitation participation. Participants were patients enrolled in the Norwegian Coronary Stent Trial. We assessed cardiac rehabilitation participation in 9013 of these patients who had undergone their first percutaneous coronary intervention during 2008-2011. Of these, 7068 patients (82%) completed a self-administered questionnaire on cardiac rehabilitation participation within three years after their percutaneous coronary intervention. Twenty-eight per cent of the participants reported engaging in cardiac rehabilitation. Participation rate differed among the four regional health authorities in Norway, varying from 20%-31%. Patients undergoing percutaneous coronary intervention for an acute coronary syndrome were more likely to participate in cardiac rehabilitation than patients with stable angina (odds ratio 3.2; 95% confidence interval 2.74-3.76). A multivariate statistical model revealed that men had a 28% lower probability ( p<0.001) of participating in cardiac rehabilitation, and the odds of attending cardiac rehabilitation decreased with increasing age ( p<0.001). Contributors to higher odds of cardiac rehabilitation participation were educational level >12 years (odds ratio 1.50; 95% confidence interval 1.32-1.71) and body mass index>25 (odds ratio 1.19; 95% confidence interval 1.05-1.36). Prior coronary artery bypass graft was associated with lower odds of cardiac rehabilitation participation (odds ratio 0.47; 95% confidence interval 0.32-0.70) Conclusion: The estimated cardiac rehabilitation participation rate among patients undergoing first-time percutaneous coronary intervention is low in Norway. The typical participant is young, overweight, well-educated, and had an acute coronary event. These results varied by geographical region.

Sleep quality and the risk of work injury: a Swiss case-control study.

PubMed

Uehli, Katrin; Miedinger, David; Bingisser, Roland; Dürr, Selina; Holsboer-Trachsler, Edith; Maier, Sabrina; Mehta, Amar J; Müller, Roland; Schindler, Christian; Zogg, Stefanie; Künzli, Nino; Leuppi, Jörg D

2014-10-01

Sleep problems are a well-known risk factor for work injuries, but less is known about which vulnerable populations are most at risk. The aims of this study were to investigate the association between sleep quality and the risk of work injury and to identify factors that may modify the association. A case-control study including 180 cases and 551 controls was conducted at the University Hospital in Basel, Switzerland, from 1 December 2009 to 30 June 2011. Data on work injuries and sleep quality were collected. Adjusted odds ratios and 95% confidence intervals of the association between sleep quality and work injury were estimated in multivariable logistic regression analyses and were stratified by hypothesized effect modifiers (age, gender, job risk, shift work, sleep duration and working hours). Poor sleep quality was associated significantly with work injury of any type (P < 0.05) and with being caught in particular (P < 0.05). The association between poor sleep quality and work injury was significantly higher for workers older than 30 years (odds ratio>30 1.30 versus odds ratio≤30 0.91, P < 0.01), sleeping 7 h or less per night (odds ratio≤7 1.17 versus odds ratio>7 0.79, P < 0.05) and working 50 h or more per week (odds ratio≥50 1.79 versus odd ratio<50 1.10, P < 0.01). Work injury risk increased with increasing severity of sleep problems (P < 0.05). Prior work injury frequency increased with decreasing sleep quality (P < 0.05). Older age, short sleep duration and long working hours may enhance the risk of work injuries associated with sleep quality. © 2014 European Sleep Research Society.

Hypocalcemia in dairy cows: meta-analysis and dietary cation anion difference theory revisited.

PubMed

Lean, I J; DeGaris, P J; McNeil, D M; Block, E

2006-02-01

Data from 137 published trials involving 2,545 calvings were analyzed using random effects normal logistic regression models to identify risk factors for clinical hypocalcemia in dairy cows. The aim of the study was to examine which form, if any, of the dietary cation anion difference (DCAD) equation provided the best estimate of milk fever risk and to clarify roles of calcium, magnesium, and phosphorus concentrations of prepartum diets in the pathogenesis of milk fever. Two statistically equivalent and biologically plausible models were developed that predict incidence of milk fever. These models were validated using data from 37 trials excluded from the original data used to generate the models; missing variables were replaced with mean values from the analyzed data. The preferred models differed slightly; Model 1 included prepartum DCAD, and Model 2 included prepartum dietary concentrations of potassium and sulfur alone, but not sodium and chloride. Other factors, included in both models were prepartum dietary concentrations of calcium, magnesium, phosphorus; days exposed to the prepartum diet; and breed. Jersey cows were at 2.25 times higher risk of milk fever than Holstein cows in Model 1. The results support the DCAD theory of greater risk of milk fever with higher prepartum dietary DCAD (odds ratio = 1.015). The only DCAD equation supported in statistical analyses was (Na(+) + K(+)) - (Cl(-) + S(2-)). This finding highlights the difference between developing equations to predict DCAD and those to predict milk fever. The results support a hypothesis of a quadratic role for Ca in the pathogenesis of milk fever (model 1, odds ratio = 0.131; Model 2, odds ratio = 0.115). Milk fever risk was highest with a prepartum dietary concentration of 1.35% calcium. Increasing prepartum dietary magnesium concentrations had the largest effect on decreasing incidence of milk fever in both Model 1 (odds ratio = 0.006) and Model 2 (odds ratio = 0.001). Increasing dietary phosphorus concentrations prepartum increased the risk of milk fever (Model 1, odds ratio = 6.376; Model 2, odds ratio = 9.872). The models presented provide the basis for the formulation of diets to reduce the risk of milk fever and strongly support the need to evaluate macro mineral nutrition apart from DCAD of the diet.

Toxoplasma gondii exposure and epilepsy: A matched case-control study in a public hospital in northern Mexico.

PubMed

Alvarado-Esquivel, Cosme; Rico-Almochantaf, Yazmin Del Rosario; Hernández-Tinoco, Jesús; Quiñones-Canales, Gerardo; Sánchez-Anguiano, Luis Francisco; Torres-González, Jorge; Ramírez-Valles, Eda Guadalupe; Minjarez-Veloz, Andrea

2018-01-01

This study aimed to determine the association between infection with Toxoplasma gondii and epilepsy in patients attended to in a public hospital in the northern Mexican city of Durango. We performed an age- and gender-matched case-control study of 99 patients suffering from epilepsy and 99 without epilepsy. Sera of participants were analyzed for anti- T. gondii IgG and IgM antibodies using commercially available enzyme-linked immunoassays. Seropositive samples to T. gondii were further analyzed for detection of T. gondii DNA by polymerase chain reaction. Anti- T. gondii IgG antibodies were found in 10 (10.1%) of the 99 cases and in 6 (6.1%) of the 99 controls (odds ratio = 1.74; 95% confidence interval: 0.60-4.99; p = 0.43). High (> 150 IU/mL) levels of anti- T. gondii IgG antibodies were found in 6 of the 99 cases and in 4 of the 99 controls (odds ratio = 1.53; 95% confidence interval: 0.41-5.60; p = 0.74). Anti- T. gondii IgM antibodies were found in 2 of the 10 IgG seropositive cases, and in 2 of the 6 IgG seropositive controls (odds ratio = 0.50; 95% confidence interval: 0.05-4.97; p = 0.60). T. gondii DNA was not found in any of the 10 anti- T. gondii IgG positive patients. Bivariate analysis of IgG seropositivity to T. gondii and International Statistical Classification of Diseases and related Health Problems, 10th Edition codes of epilepsy showed an association between seropositivity and G40.1 code (odds ratio = 22.0; 95% confidence interval: 2.59-186.5; p = 0.008). Logistic regression analysis showed an association between T. gondii infection and consumption of goat meat (odds ratio = 6.5; 95% confidence interval: 1.22-34.64; p = 0.02), unwashed raw vegetables (odds ratio = 26.3; 95% confidence interval: 2.61-265.23; p = 0.006), and tobacco use (odds ratio = 6.2; 95% confidence interval: 1.06-36.66; p = 0.04). Results suggest that T. gondii infection does not increase the risk of epilepsy in our setting; however, infection might be linked to specific types of epilepsy. Factors associated with T. gondii infection found in this study may aid in the design of preventive measures against toxoplasmosis.

Impact of mobile intensive care unit use on total ischemic time and clinical outcomes in ST-elevation myocardial infarction patients - real-world data from the Acute Coronary Syndrome Israeli Survey.

PubMed

Koifman, Edward; Beigel, Roy; Iakobishvili, Zaza; Shlomo, Nir; Biton, Yitschak; Sabbag, Avi; Asher, Elad; Atar, Shaul; Gottlieb, Shmuel; Alcalai, Ronny; Zahger, Doron; Segev, Amit; Goldenberg, Ilan; Strugo, Rafael; Matetzky, Shlomi

2017-01-01

Ischemic time has prognostic importance in ST-elevation myocardial infarction patients. Mobile intensive care unit use can reduce components of total ischemic time by appropriate triage of ST-elevation myocardial infarction patients. Data from the Acute Coronary Survey in Israel registry 2000-2010 were analyzed to evaluate factors associated with mobile intensive care unit use and its impact on total ischemic time and patient outcomes. The study comprised 5474 ST-elevation myocardial infarction patients enrolled in the Acute Coronary Survey in Israel registry, of whom 46% ( n=2538) arrived via mobile intensive care units. There was a significant increase in rates of mobile intensive care unit utilization from 36% in 2000 to over 50% in 2010 ( p<0.001). Independent predictors of mobile intensive care unit use were Killip>1 (odds ratio=1.32, p<0.001), the presence of cardiac arrest (odds ratio=1.44, p=0.02), and a systolic blood pressure <100 mm Hg (odds ratio=2.01, p<0.001) at presentation. Patients arriving via mobile intensive care units benefitted from increased rates of primary reperfusion therapy (odds ratio=1.58, p<0.001). Among ST-elevation myocardial infarction patients undergoing primary reperfusion, those arriving by mobile intensive care unit benefitted from shorter median total ischemic time compared with non-mobile intensive care unit patients (175 (interquartile range 120-262) vs 195 (interquartile range 130-333) min, respectively ( p<0.001)). Upon a multivariate analysis, mobile intensive care unit use was the most important predictor in achieving door-to-balloon time <90 min (odds ratio=2.56, p<0.001) and door-to-needle time <30 min (odds ratio=2.96, p<0.001). One-year mortality rates were 10.7% in both groups (log-rank p-value=0.98), however inverse propensity weight model, adjusted for significant differences between both groups, revealed a significant reduction in one-year mortality in favor of the mobile intensive care unit group (odds ratio=0.79, 95% confidence interval (0.66-0.94), p=0.01). Among patients with ST-elevation myocardial infarction, the utilization of mobile intensive care units is associated with increased rates of primary reperfusion, a reduction in the time interval to reperfusion, and a reduction in one-year adjusted mortality.

Factors influencing repeated teenage pregnancy: a review and meta-analysis.

PubMed

Maravilla, Joemer C; Betts, Kim S; Couto E Cruz, Camila; Alati, Rosa

2017-11-01

Existing evidence of predictors of repeated teenage pregnancy has not been assessed rigorously. This systematic review provides a comprehensive evaluation of protective and risk factors that are associated with repeated teenage pregnancy through a metaanalytical consensus. We used PubMed, EMBASE, CINAHL, ProQuest, PsychINFO, ScienceDirect, Scopus, and Web of Science databases from 1997-2015 and the reference list of other relevant research papers and related reviews. Eligibility criteria included (1) epidemiologic studies that analyzed factors associated with repeated pregnancy or birth among adolescents <20 years of age who were nulliparous or experienced at least 1 pregnancy, and (2) experimental studies with an observational component that was adjusted for the intervention. We performed narrative synthesis of study characteristics, participant characteristics, study results, and quality assessment. We also conducted random-effects and quality-effects metaanalyses with meta-regression to obtain pooled odds ratios of identified factors and to determine sources of between-study heterogeneity. Twenty-six eligible epidemiologic studies, most from the United States (n=24), showed >47 factors with no evidence of publication bias for each metaanalysis. Use of contraception (pooled odds ratio, 0.60; 95% confidence interval, 0.35-1.02), particularly long-acting reversible contraceptives (pooled odds ratio, 0.19; 95% confidence interval, 0.08-0.45), considerably reduced repeated teenage pregnancy risk. Among studies about contraception, the number of follow-up visits (adjusted coefficient, 0.72; P=.102) and country of study (unadjusted coefficient, 2.57; permuted P=.071) explained between-study heterogeneity. Education-related factors, which included higher level of education (pooled odds ratio, 0.74; 95% confidence interval, 0.60-0.91) and school continuation (pooled odds ratio, 0.53; 95% confidence interval, 0.33-0.84), were found to be protective. Conversely, depression (pooled odds ratio, 1.46; 95% confidence interval, 1.14-1.87), history of abortion (pooled odds ratio, 1.66; 95% confidence interval, 1.08-2.54), and relationship factors, such as partner support, increased the repeated teenage pregnancy risk. Contraceptive use, educational factors, depression, and a history of abortion are the highly influential predictors of repeated teenage pregnancy. However, there is a lack of epidemiologic studies in low- and middle-income countries to measure the extent and characteristics of repeated teenage pregnancy across more varied settings. Copyright © 2017 Elsevier Inc. All rights reserved.

Association of protein tyrosine phosphatase, non-receptor type 22 +1858C→T polymorphism and susceptibility to vitiligo: Systematic review and meta-analysis.

PubMed

Agarwal, Silky; Changotra, Harish

2017-01-01

Protein tyrosine phosphatase, non-receptor type 22 gene, which translates to lymphoid tyrosine phosphatase, is considered to be a susceptibility gene marker associated with several autoimmune diseases. Several studies have demonstrated the association of protein tyrosine phosphatase, non-receptor type 22 +1858C→T polymorphism with vitiligo. However, these studies showed conflicting results. Meta-analysis of the same was conducted earlier that included fewer number of publications in their study. We performed a meta-analysis of a total of seven studies consisting of 2094 cases and 3613 controls to evaluate the possible association of protein tyrosine phosphatase, non-receptor type 22 +1858C>T polymorphism with vitiligo susceptibility. We conducted a literature search in PubMed, Google Scholar and Dogpile for all published paper on protein tyrosine phosphatase, non-receptor type 22 +1858C→T polymorphism and vitiligo risk till June 2016. Data analysis was performed by RevMan 5.3 and comprehensive meta-analysis v3.0 software. Meta-analysis showed an overall significant association of protein tyrosine phosphatase, non- receptor type 22 +1858C→T polymorphism with vitiligo in all models (allelic model [T vs. C]: odds ratio = 1.50, 95% confidence interval [1.32-1.71], P< 0.001; dominant model [TT + CT vs. CC]: odds ratio = 1.61, 95% confidence interval [1.16-2.24], P = 0.004; recessive model [TT vs. CT + CC]: odds ratio = 4.82, 95% confidence interval [1.11-20.92], P = 0.04; homozygous model [TT vs. CC]: odds ratio = 5.34, 95% confidence interval [1.23-23.24], P = 0.03; co-dominant model [CT vs. CC]: odds ratio = 1.52, 95% confidence interval [1.09-2.13], P = 0.01). No publication bias was detected in the funnel plot study. Limited ethnic-based studies, unable to satisfy data by gender or vitiligo-type are some limitations of the present meta-analysis. Stratifying data by ethnicity showed an association of protein tyrosine phosphatase, non-receptor type 22 +1858C→T with vitiligo in European population (odds ratio = 1.53, 95% confidence interval [1.34-1.75], P< 0.001) but not in Asian population (odds ratio = 0.59, 95% confidence interval [0.26-1.32], P = 0.2). In conclusion, protein tyrosine phosphatase, non-receptor type 22 +1858 T allele predisposes European individuals to vitiligo.

An epidemiological study of intestinal parasites of dogs from Yucatan, Mexico, and their risk to public health.

PubMed

Rodríguez-Vivas, Roger Ivan; Gutierrez-Ruiz, Edwin; Bolio-González, Manuel Emilio; Ruiz-Piña, Hugo; Ortega-Pacheco, Antonio; Reyes-Novelo, Enrique; Manrique-Saide, Pablo; Aranda-Cirerol, Francisco; Lugo-Perez, J A

2011-08-01

The prevalence of intestinal parasites in dogs and factors associated were studied in a rural community of Yucatan (southern Mexico), with special attention to those gastrointestinal parasites potentially transmitted to man. One hundred thirty dogs from 91 households were studied. Fecal samples were processed by the centrifugation-flotation and the McMaster techniques. To determine factors associated with zoonotic parasites in dogs, univariate analysis was performed, using sex, age, and body condition as independent variables. Variables with p < 0.2 were analyzed by a logistic regression. Of 130 dogs, 104 were positive for the presence of intestinal parasites, representing a prevalence of 80%. Eggs of four species of helminths (Ancylostoma caninum, Thichuris vulpis, Toxocara canis, and Dipylidium caninum) and coccidian oocysts were detected. A. caninum was the most prevalent parasite (73.8%), followed by T. vulpis (25.4%), T. canis (6.2%), D. caninum (2.3%), and coccidian oocysts (2.3%). The majority of dogs were infected by only one species of parasite (70/130, 53.8%). Mixed infection caused by two or three zoonotic parasites were discovered in 21.3% (30/130) and 3.1% (4/130), respectively. A. caninum showed the highest egg output (42.3% of dogs had ≥ 500 eggs per gram). Factors associated with zoonotic parasites were age (<2 years old; odds ratio = 5.30, p = 0.029) and body condition (poor body condition; odds ratio = 6.69, p = 0.026). In conclusion, young dogs from rural Yucatan, Mexico, with poor body condition had a higher prevalence of intestinal zoonotic parasites as these factors were associated with a higher risk of becoming infected.

Solar Exposure and Residential Geographic History in Relation to Exfoliation Syndrome in the United States and Israel

PubMed Central

Pasquale, Louis R.; Jiwani, Aliya Z.; Zehavi-Dorin, Tzukit; Majd, Arow; Rhee, Douglas J.; Chen, Teresa; Turalba, Angela; Shen, Lucy; Brauner, Stacey; Grosskreutz, Cynthia; Gardiner, Matthew; Chen, Sherleen; Borboli-Gerogiannis, Sheila; Greenstein, Scott H.; Chang, Kenneth; Ritch, Robert; Loomis, Stephanie; Kang, Jae H.; Wiggs, Janey L.; Levkovitch-Verbin, Hani

2014-01-01

Importance Residential (geographic) history and extent of solar exposure may be important risk factors for exfoliation syndrome, but detailed lifetime solar exposure has not been previously evaluated in exfoliation syndrome. Objective To assess the relation between residential history, solar exposure and exfoliation syndrome. Design Clinic-based, case control studies. Setting A clinical center in the United States and in Israel. Participants Exfoliation syndrome cases and controls (all 60+ years old Caucasians) enrolled from 2010 to 2012 (United States: 118 cases and 106 controls; Israel: 67 cases and 72 controls). Main Outcomes and Measures Weighted lifetime average latitude of residence and average number of hours per week spent outdoors as determined by validated questionnaires. Results In multivariable analyses, each degree of weighted lifetime average residential latitude away from the equator was associated with an 11% increased odds of exfoliation syndrome (pooled odds ratio = 1.11; 95% CI: 1.05-1.17; p < .001). Furthermore, every hour per week spent outdoors during the summer, averaged over a lifetime, was associated with a 4% increased odds of exfoliation syndrome (pooled odds ratio = 1.04; 95% CI: 1.00-1.07; p = .03). For every 1% of average lifetime summer time between 10 a.m. and 4 p.m. that sunglasses were worn, the odds of exfoliation syndrome decreased by 2% (odds ratio = 0.98; 95% CI: 0.97-0.99; p < .001) in the United States, but not in Israel (odds ratio = 1.00; 95% CI: 0.99-1.01; p = .92; p for heterogeneity = .005). In the United States, after controlling for important environmental covariates, history of work over water or snow was associated with increased odds of exfoliation syndrome (odds ratio = 3.86; 95% CI: 1.36-10.9); in Israel, there were too few people with such history for analysis. We did not identify an association between brimmed hat wear and exfoliation syndrome (p>.57). Conclusion and Relevance Lifetime outdoor activities may contribute to exfoliation syndrome. The association with work over snow or water and the lack of association with brimmed hat wear suggests that ocular exposure to light from reflective surfaces may be an important type of exposure in exfoliation syndrome etiology. PMID:25188364

The relationship of race to women's use of health information resources.

PubMed

Nicholson, Wanda K; Grason, Holly A; Powe, Neil R

2003-02-01

The purpose of this study was to examine, among the general public, the independent effect of race on women's use of health information resources. A population-based random-digit dialing survey of adult women, aged 18 to 64 years, was conducted between October 1999 and January 2000. Subjects included 509 women (341 white women, 135 black women, and 33 women of other races). The response rate was 66%. The main outcome variable was the use of health information resources (print health or news media, broadcast media, computer resources [Internet], health organizations, organized health events). Logistic regression was used to determine the independent effect of race/ethnicity on the use of different information resources, with an adjustment for age, income, education, and marital status. After the adjustment for socioeconomic factors, black women had <50% odds of using print news media (odds ratio, 0.5; 95% CI, 0.4-0.8), <60% odds of using computer-based resources (odds ratio, 0.4; 95% CI, 0.2-0.6), and <70% odds of using health policy organizations (odds ratio, 0.3; 95% CI, 0.2-0.7), compared with white women. There is a large racial disparity in women's use of health information resources. Traditional sources that are used to provide patient information may not be effective in certain populations.

Socioeconomic inequality and peripheral artery disease prevalence in US adults.

PubMed

Pande, Reena L; Creager, Mark A

2014-07-01

Lower socioeconomic status is associated with cardiovascular disease. We sought to determine whether there is a higher prevalence of peripheral artery disease (PAD) in individuals with lower socioeconomic status. We analyzed data from the National Health and Nutrition Examination Survey 1999 to 2004. PAD was defined based on an ankle.brachial index .0.90. Measures of socioeconomic status included poverty.income ratio,a ratio of self-reported income relative to the poverty line, and attained education level. Of 6791 eligible participants,overall weighted prevalence of PAD was 5.8% (SE, 0.3). PAD prevalence was significantly higher in individuals with low income and lower education. Individuals in the lowest of the 6 poverty.income ratio categories had more than a2-fold increased odds of PAD compared with those in the highest poverty-income ratio category (odds ratio, 2.69; 95%confidence interval, 1.80.4.03; P<0.0001). This association remained significant even after multivariable adjustment(odds ratio, 1.64; 95% confidence interval, 1.04.2.6; P=0.034). Lower attained education level also associated with higher PAD prevalence (odds ratio, 2.8; 95% confidence interval, 1.96.4.0; P<0.0001) but was no longer significant after multivariable adjustment. Low income and lower attained education level are associated with PAD in US adults. These data suggest that individuals of lower socioeconomic status remain at high risk and highlight the need for education and advocacy efforts focused on these at-risk populations.

Ethnic Differences in Incidence and Outcomes of Childhood Nephrotic Syndrome.

PubMed

Banh, Tonny H M; Hussain-Shamsy, Neesha; Patel, Viral; Vasilevska-Ristovska, Jovanka; Borges, Karlota; Sibbald, Cathryn; Lipszyc, Deborah; Brooke, Josefina; Geary, Denis; Langlois, Valerie; Reddon, Michele; Pearl, Rachel; Levin, Leo; Piekut, Monica; Licht, Christoph P B; Radhakrishnan, Seetha; Aitken-Menezes, Kimberly; Harvey, Elizabeth; Hebert, Diane; Piscione, Tino D; Parekh, Rulan S

2016-10-07

Ethnic differences in outcomes among children with nephrotic syndrome are unknown. We conducted a longitudinal study at a single regional pediatric center comparing ethnic differences in incidence from 2001 to 2011 census data and longitudinal outcomes, including relapse rates, time to first relapse, frequently relapsing disease, and use of cyclophosphamide. Among 711 children, 24% were European, 33% were South Asian, 10% were East/Southeast Asian, and 33% were of other origins. Over 10 years, the overall incidence increased from 1.99/100,000 to 4.71/100,000 among children ages 1-18 years old. In 2011, South Asians had a higher incidence rate ratio of 6.61 (95% confidence interval, 3.16 to 15.1) compared with Europeans. East/Southeast Asians had a similar incidence rate ratio (0.76; 95% confidence interval, 0.13 to 2.94) to Europeans. We determined outcomes in 455 children from the three largest ethnic groups with steroid-sensitive disease over a median of 4 years. South Asian and East/Southeast Asian children had significantly lower odds of frequently relapsing disease at 12 months (South Asian: adjusted odds ratio; 0.55; 95% confidence interval, 0.39 to 0.77; East/Southeast Asian: adjusted odds ratio; 0.42; 95% confidence interval, 0.34 to 0.51), fewer subsequent relapses (South Asian: adjusted odds ratio; 0.64; 95% confidence interval, 0.50 to 0.81; East/Southeast Asian: adjusted odds ratio; 0.47; 95% confidence interval, 0.24 to 0.91), lower risk of a first relapse (South Asian: adjusted hazard ratio, 0.74; 95% confidence interval, 0.67 to 0.83; East/Southeast Asian: adjusted hazard ratio, 0.65; 95% CI, 0.63 to 0.68), and lower use of cyclophosphamide (South Asian: adjusted hazard ratio, 0.82; 95% confidence interval, 0.53 to 1.28; East/Southeast Asian: adjusted hazard ratio, 0.54; 95% confidence interval, 0.41 to 0.71) compared with European children. Despite the higher incidence among South Asians, South and East/Southeast Asian children have significantly less complicated clinical outcomes compared with Europeans. Copyright © 2016 by the American Society of Nephrology.

Oriented acidification of wasted activated sludge (WAS) focused on odd-carbon volatile fatty acid (VFA): Regulation strategy and microbial community dynamics.

PubMed

Huang, Long; Chen, Zhiqiang; Xiong, Dandan; Wen, Qinxue; Ji, Ye

2018-06-01

As the main intermediate metabolite in anaerobic digestion of wasted activated sludge (WAS), volatile fatty acids (VFAs) are proper substrate for mixed culture (MC) polyhydroxyalkanoate (PHA) synthesis. To further optimize the performance of MC PHA production process, VFA _odd (i.e., VFA with odd carbon atoms) oriented acidification process was proposed and conducted in this study. Three regulation factors including reaction pH, fraction of added β-cyclodextrin (β-CD) and glycerol were selected and response surface methodology (RSM) was used to enhance and effectively regulate the VFA _odd production while maintaining enough acidification degree in the WAS acidification. High percentage of VFA _odd (larger than 60% and dominated by propionic acid) can be obtained in the operating condition area with glycerol addition ratio (quantified by C/N) ranging from 15 to 20 and reaction pH ranging from 8.0 to 9.5 when β-CD addition was held at zero level (0.2 g/gTSS) according to the RSM. Semi-continuous acidification and MC PHA production assays further verified the reliability and effectiveness of the VFA _odd oriented acidification strategy. Microbial function group related to propionic acid production (G prop ) was defined based on the relationships between system function and microbial community structure, and 13 frequent species were found being involved in the G prop . Roles of the group members in the oriented acidification were analyzed to understand the mechanisms of the regulation of VFA _odd production at microbial ecological level. A synergistic effect of WAS and glycerol on the VFA _odd production in the acidification process was revealed based on the ecological analysis. Copyright © 2018 Elsevier Ltd. All rights reserved.

An Odds Ratio Approach for Detecting DDF under the Nested Logit Modeling Framework

ERIC Educational Resources Information Center

Terzi, Ragip; Suh, Youngsuk

2015-01-01

An odds ratio approach (ORA) under the framework of a nested logit model was proposed for evaluating differential distractor functioning (DDF) in multiple-choice items and was compared with an existing ORA developed under the nominal response model. The performances of the two ORAs for detecting DDF were investigated through an extensive…

Intraoperative factors associated with delayed recovery of liver function after hepatectomy: analysis of 1969 living donors.

PubMed

Choi, S-S; Cho, S-S; Ha, T-Y; Hwang, S; Lee, S-G; Kim, Y-K

2016-02-01

The safety of healthy living donors who are undergoing hepatic resection is a primary concern. We aimed to identify intraoperative anaesthetic and surgical factors associated with delayed recovery of liver function after hepatectomy in living donors. We retrospectively analysed 1969 living donors who underwent hepatectomy for living donor liver transplantation. Delayed recovery of hepatic function was defined by increases in international normalised ratio of prothrombin time and concomitant hyperbilirubinaemia on or after post-operative day 5. Univariate and multivariate logistic regression analyses were performed to determine the factors associated with delayed recovery of hepatic function after living donor hepatectomy. Delayed recovery of liver function after donor hepatectomy was observed in 213 (10.8%) donors. Univariate logistic regression analysis showed that sevoflurane anaesthesia, synthetic colloid, donor age, body mass index, fatty change and remnant liver volume were significant factors for prediction of delayed recovery of hepatic function. Multivariate logistic regression analysis showed that independent factors significantly associated with delayed recovery of liver function after donor hepatectomy were sevoflurane anaesthesia (odds ratio = 3.514, P < 0.001), synthetic colloid (odds ratio = 1.045, P = 0.033), donor age (odds ratio = 0.970, P = 0.003), female gender (odds ratio = 1.512, P = 0.014) and remnant liver volume (odds ratio = 0.963, P < 0.001). Anaesthesia with sevoflurane was an independent factor in predicting delayed recovery of hepatic function after donor hepatectomy. Although synthetic colloid may be associated with delayed recovery of hepatic function after donor hepatectomy, further study is required. These results can provide useful information on perioperative management of living liver donors. © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Nutritional Status Based on Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU.

PubMed

Bechard, Lori J; Duggan, Christopher; Touger-Decker, Riva; Parrott, J Scott; Rothpletz-Puglia, Pamela; Byham-Gray, Laura; Heyland, Daren; Mehta, Nilesh M

2016-08-01

To determine the influence of admission anthropometry on clinical outcomes in mechanically ventilated children in the PICU. Data from two multicenter cohort studies were compiled to examine the unique contribution of nutritional status, defined by body mass index z score, to 60-day mortality, hospital-acquired infections, length of hospital stay, and ventilator-free days, using multivariate analysis. Ninety PICUs from 16 countries with eight or more beds. Children aged 1 month to 18 years, admitted to each participating PICU and requiring mechanical ventilation for more than 48 hours. Data from 1,622 eligible patients, 54.8% men and mean (SD) age 4.5 years (5.1), were analyzed. Subjects were classified as underweight (17.9%), normal weight (54.2%), overweight (14.5%), and obese (13.4%) based on body mass index z score at admission. After adjusting for severity of illness and site, the odds of 60-day mortality were higher in underweight (odds ratio, 1.53; p < 0.001) children. The odds of hospital-acquired infections were higher in underweight (odds ratio, 1.88; p = 0.008) and obese (odds ratio, 1.64; p < 0.001) children. Hazard ratios for hospital discharge were lower among underweight (hazard ratio, 0.71; p < 0.001) and obese (hazard ratio, 0.82; p = 0.04) children. Underweight was associated with 1.3 (p = 0.001) and 1.6 (p < 0.001) fewer ventilator-free days than normal weight and overweight, respectively. Malnutrition is prevalent in mechanically ventilated children on admission to PICUs worldwide. Classification as underweight or obese was associated with higher risk of hospital-acquired infections and lower likelihood of hospital discharge. Underweight children had a higher risk of mortality and fewer ventilator-free days.

The relationship between microalbuminuria, cardiovascular risk factors and disease management in type 2 diabetes.

PubMed

Udenze, I C; Azinge, E C; Ebuehi, O A T; Awolola, N A; Adekola, O O; Menkiti, I; Irurhe, N K

2012-01-01

In patients with type 2 diabetes, microalbuminuria is an early clinical sign suggestive of vascular damage to the glomerulus. Microalbuminuria has also been currently reported as an important risk factor for cardiovascular disease and becomes relevant in the management of type 2 diabetes. This study is to determine the prevalence of microalbuminuria, identify the risk factors associated with microalbuminuria in type 2 diabetes, and to asses the achievement of treatment goals for cardiovascular risk reduction in type 2 diabetics. Seventy- two subjects with microalbuminuria were recruited from three hundred consecutively screened type 2 diabetics attending the Diabetic Clinic at the Lagos University Teaching Hospital. Clinical data were obtained by interviewing the participants. Anthropometric measurements were made and blood specimens were collected for analysis. The prevalence of microalbuminuria was twenty-four percent (24%) in type 2 diabetes. Multiple logistic regression identified duration of diabetes (odds ratio 1.3 (95% CI; 0.03-1.58), hypertension(odds ratio 5.2 (95% Cl; 1.24-18.62), Body mass index (BMI) (odds ratio 1.27 (95% CI; 1.0-1.6), waist/hip ratio (WHR) (odds ratio 1.9 (95% Cl; 1.3-3.5), andHbA,c (odds ratio 6.6 (95% Cl; 1.02-27) as independent risk factors associated with microalbuminuria in type 2 diabetics. Optimum blood pressure, glycemic and weight control were achieved in eighty five percent (85%), fifty eight percent (58%) and nineteen percent (19%) of the type 2 diabetes respectively. This study showed that microalbuminuria is common among patients with type 2 diabetes. It also showed improvement in glycemic control and modifiable cardiovascular risk factor control when compared with previous studies.

Comparative evaluation of two asthma care quality measures among Medicaid beneficiaries.

PubMed

Samnaliev, Mihail; Baxter, Jeffrey D; Clark, Robin E

2009-05-01

The relative performance of asthma care quality measures has not been evaluated in Medicaid populations. Using complete claims and pharmaceutical data for 19,076 patients with persistent asthma (based on Health Effectiveness and Data Information Set criteria) in five Medicaid populations, we compared the following two measures of asthma care quality: filling prescriptions for controller asthma medications within 1 year and the ratio of controller medication to the total number of asthma medication prescriptions filled within 1 year. We calculated whether meeting each quality measure was associated with decreased odds of emergency department (ED) treatment episodes. We then compared the odds ratios, receiver operating characteristic (ROC) curves, and deviances between models, using each measure to predict ED utilization in Medicaid populations. Although meeting each measure was associated with lower odds of ED utilization, this decrease was larger if the controller asthma medication measure was met rather than the ratio measure. Additionally, models using the controller medication measure had greater areas under the ROC curve and smaller deviances than models using the ratio measure. Both administrative measures of asthma care quality were associated with lower odds of ED utilization. The controller medication measure of asthma care quality may be better than the ratio measure in relation to emergency asthma care utilization by Medicaid beneficiaries.

Small bowel lymphangiectasia and angiodysplasia: a positive association; novel clinical marker or shared pathophysiology?

PubMed

Macdonald, Jonathan; Porter, Victoria; Scott, Neil W; McNamara, Deirdre

2010-10-01

Small bowel angiodysplasia accounts for 30 to 40% of cases of obscure gastrointestinal bleeding and is associated with significant morbidity and mortality. Identifying lesions can be difficult. Small bowel capsule endoscopy (SBCE) is a significant advance on earlier diagnostic techniques. The cause of angiodysplasia is unknown and the natural history poorly understood. Many lesions are thought to arise from a degenerative process associated with ageing, local vascular anomalies, and tissue hypoxia. Nonpathologic lymphangiectasias are commonly seen throughout the small bowel and are considered a normal finding. To determine whether there is an association between lymphangiectasias, angiodysplasia, and atherosclerosis related conditions. Relevant information was collected from a dedicated SBCE database. Logistic regression analysis was used to examine associations between angiodysplasia, lymphangiectasia, patient demographics, and comorbidity. In all, 180 patients underwent SBCE during the study period, 46 (25%) had angiodysplasia and 47 (26%) lymphangiectasia. Lymphangiectasia were seen in 24 (52%) of 46 with angiodysplasia, in 16 (19%) of 84 with obscure gastrointestinal bleeding without angiodysplasia and in 7 (14%) of 50 without gastrointestinal bleeding. Logistic regression analysis confirmed a strong positive association between angiodysplasia and lymphangiectasia; odds ratio 4.42, P<0.003. Angiodysplasias were also associated with increasing age; odds ratio 1.1. There was no correlation with any other patient characteristic. Lymphangiectasia are strongly associated with the presence of small intestinal angiodysplasia and may represent a useful clinical marker for this condition. Angiodysplasia are also associated with increasing age. Conditions associated with systemic atherosclerosis did not increase the risk of angiodysplasia.

Patient perceptions of physical and emotional discomfort related to urodynamic testing: a questionnaire-based study in men and women with and without neurologic conditions.

PubMed

Suskind, Anne M; Clemens, J Quentin; Kaufman, Samuel R; Stoffel, John T; Oldendorf, Ann; Malaeb, Bahaa S; Jandron, Teresa; Cameron, Anne P

2015-03-01

To determine predictors of physical and emotional discomfort associated with urodynamic testing in men and women both with and without neurologic conditions. An anonymous questionnaire-based study was completed by patients immediately after undergoing fluoroscopic urodynamic testing. Participants were asked questions pertaining to their perceptions of physical and emotional discomfort related to the study, their urologic and general health history, and demographics. Logistic regression was performed to determine predictors of physical and emotional discomfort. A total of 314 patients completed the questionnaire representing a response rate of 60%. Half of the respondents (50.7%) felt that the examination was neither physically nor emotionally uncomfortable, whereas 29.0% and 12.4% of respondents felt that the physical and emotional components of the examination were most uncomfortable, respectively. Placement of the urethral catheter was the most commonly reported component of physical discomfort (42.9%), whereas anxiety (27.7%) was the most commonly reported component of emotional discomfort. Presence of a neurologic problem (odds ratio, 0.273; 95% confidence interval, 0.121-0.617) and older age (odds ratio, 0.585; 95% confidence interval, 0.405-0.847) were factors associated with less physical discomfort. There were no significant predictors of emotional discomfort based on our model. Urodynamic studies were well tolerated regardless of gender. Presence of a neurologic condition and older age were predictors of less physical discomfort. These findings are useful in counseling patients regarding what to expect when having urodynamic procedures. Copyright © 2015 Elsevier Inc. All rights reserved.

Psychosocial work environment and the risk of coronary heart disease.

PubMed

Peter, R; Siegrist, J

2000-06-01

Remarkable changes in the working situation have led to the increasing importance of psychomentally and socio-emotionally demanding conditions at work. With the help of theoretical models, those highly prevalent psychosocial work environments were conceptualized which influence the risk of coronary heart disease by enhanced activation of the autonomic nervous system. One of the most prominent theoretical approaches, the job strain model, and a more recent approach, the effort-reward imbalance model, are discussed in the paper. Findings from prospective and cross-sectional studies indicate that job strain and effort-reward imbalance at work define specific conditions of chronic work stress that are associated with an elevated risk of coronary heart disease (CHD). Respective multivariate odds-ratios range from 1.2 to 5.0 with respect to job strain, and from 1.5 to 6.1 with respect to effort-reward imbalance. These associations are explained neither by established behavioral or biomedical risk factors nor by physical and chemical hazards at work, rather they define independent, new work-related risk conditions. There is additional evidence that effort-reward imbalance may mediate the association of some traditional occupational exposures, such as shift work, with cardiovascular risk: in a cross-sectional study, prevalence odds ratios of hypertension and atherogenic lipids attributable to effort-reward imbalance were relatively highest among shiftworkers as compared to daytime workers. Preliminary results from intervention programs based on the theoretical models document favorable effects on health. Information derived from theoretical models on psychosocial work environment may help to better identify populations at risk and to develop and apply specific, theory-guided preventive activities in the future.

Unexplained Variation for Hospitals' Use of Inpatient Rehabilitation and Skilled Nursing Facilities After an Acute Ischemic Stroke.

PubMed

Xian, Ying; Thomas, Laine; Liang, Li; Federspiel, Jerome J; Webb, Laura E; Bushnell, Cheryl D; Duncan, Pamela W; Schwamm, Lee H; Stein, Joel; Fonarow, Gregg C; Hoenig, Helen; Montalvo, Cris; George, Mary G; Lutz, Barbara J; Peterson, Eric D; Bettger, Janet Prvu

2017-10-01

Rehabilitation is recommended after a stroke to enhance recovery and improve outcomes, but hospital's use of inpatient rehabilitation facilities (IRFs) or skilled nursing facility (SNF) and the factors associated with referral are unknown. We analyzed clinical registry and claims data for 31 775 Medicare beneficiaries presenting with acute ischemic stroke from 918 Get With The Guidelines-Stroke hospitals who were discharged to either IRF or SNF between 2006 and 2008. Using a multilevel logistic regression model, we evaluated patient and hospital characteristics, as well as geographic availability, in relation to discharge to either IRF or SNF. After accounting for observed factors, the median odds ratio was reported to quantify hospital-level variation in the use of IRF versus SNF. Of 31 775 patients, 17 662 (55.6%) were discharged to IRF and 14 113 (44.4%) were discharged to SNF. Compared with SNF patients, IRF patients were younger, more were men, had less health-service use 6 months prestroke, and had fewer comorbid conditions and in-hospital complications. Use of IRF or SNF varied significantly across hospitals (median IRF use, 55.8%; interquartile range, 34.8%-75.0%; unadjusted median odds ratio, 2.59; 95% confidence interval, 2.44-2.77). Hospital-level variation in discharge rates to IRF or SNF persisted after adjustment for patient, clinical, and geographic variables (adjusted median odds ratio, 2.87; 95% confidence interval, 2.68-3.11). There is marked unexplained variation among hospitals in their use of IRF versus SNF poststroke even after accounting for clinical characteristics and geographic availability. URL: https://clinicaltrials.gov. Unique identifier: NCT02284165. © 2017 American Heart Association, Inc.

Work-related stress, education and work ability among hospital nurses.

PubMed

Golubic, Rajna; Milosevic, Milan; Knezevic, Bojana; Mustajbegovic, Jadranka

2009-10-01

This paper is a report of a study conducted to determine which occupational stressors are present in nurses' working environment; to describe and compare occupational stress between two educational groups of nurses; to estimate which stressors and to what extent predict nurses' work ability; and to determine if educational level predicts nurses' work ability. Nurses' occupational stress adversely affects their health and nursing quality. Higher educational level has been shown to have positive effects on the preservation of good work ability. A cross-sectional study was conducted in 2006-2007. Questionnaires were distributed to a convenience sample of 1392 (59%) nurses employed at four university hospitals in Croatia (n = 2364). The response rate was 78% (n = 1086). Data were collected using the Occupational Stress Assessment Questionnaire and Work Ability Index Questionnaire. We identified six major groups of occupational stressors: 'Organization of work and financial issues', 'public criticism', 'hazards at workplace', 'interpersonal conflicts at workplace', 'shift work' and 'professional and intellectual demands'. Nurses with secondary school qualifications perceived Hazards at workplace and Shift work as statistically significantly more stressful than nurses a with college degree. Predictors statistically significantly related with low work ability were: Organization of work and financial issues (odds ratio = 1.69, 95% confidence interval 122-236), lower educational level (odds ratio = 1.69, 95% confidence interval 122-236) and older age (odds ratio = 1.07, 95% confidence interval 1.05-1.09). Hospital managers should develop strategies to address and improve the quality of working conditions for nurses in Croatian hospitals. Providing educational and career prospects can contribute to decreasing nurses' occupational stress levels, thus maintaining their work ability.

Habitual Consumption of Soy Products and Risk of Nasopharyngeal Carcinoma in Chinese Adults: A Case-Control Study

PubMed Central

Liu, Yuan-ting; Fan, Yu-ying; Xu, Chun-hua; Lin, Xiao-ling; Lu, Yun-kai; Zhang, Xing-lan; Zhang, Cai-xia; Chen, Yu-ming

2013-01-01

Background and Objectives Many studies have shown a negative association between the consumption of soy products and the risk of some cancers, but little is known about the effect of soy consumption on nasopharyngeal carcinoma. We assessed the association between the consumption of soy products on nasopharyngeal carcinoma risk in Chinese individuals. Methods This case-control study included 600 (448 males and 152 females) incident cases of nasopharyngeal carcinoma, and an equal number of controls, matched according to gender, age (± 3 y) and household type to the nasopharyngeal carcinoma cases. All subjects were recruited from hospitals in Guangzhou, China. A face-to-face interview was conducted with each study individual to collect general information and habitual dietary intake using a 78-item quantitative food-frequency questionnaire. Odds ratios and their 95% confidence intervals were estimated using conditional logistic regression analyses. Results The median intakes of soy foods (in protein) were 0.5/0.5, 1.4/1.7, 2.7/3.3 and 6.1/7.7 (male/female) g/d in the quartiles 1 to 4. Both univariate and multivariate analyses showed no significant association between the consumption of soy proteins or soy isoflavones and the risk of nasopharyngeal carcinoma. The adjusted odds ratios (95% confidence intervals) between extreme quartiles were 0.97 (0.66-1.45) for soy proteins and 0.97 (0.66-1.42) for total isoflavones. Null associations were also observed between intake of the individual isoflavones daidzein, genistein and glycitein and NPC risk, with adjusted odds ratios for the extreme quartiles ranging between 0.73 and 1.23. Conclusion Habitual consumption of soy products had no significant effect on the risk of nasopharyngeal carcinoma in Chinese adults with a relatively low intake. PMID:24155974

Thyroid gland invasion in advanced squamous cell carcinoma of the larynx and hypopharynx.

PubMed

Mangussi-Gomes, João; Danelon-Leonhardt, Fernando; Moussalem, Guilherme Figner; Ahumada, Nicolas Galat; Oliveira, Cleydson Lucena; Hojaij, Flávio Carneiro

Squamous cell carcinoma of the larynx and hypopharynx has the potential to invade the thyroid gland. Despite this risk, the proposition of either partial or total thyroidectomy as part of the surgical treatment of all such cases remains controversial. To evaluate the frequency of invasion of the thyroid gland in patients with advanced laryngeal or hypopharyngeal squamous cell carcinoma submitted to total laryngectomy or pharyngolaryngectomy and thyroidectomy; to determine whether clinic-pathological characteristics can predict glandular involvement. A retrospective case series with chart review, from January 1998 to July 2013, was undertaken in a tertiary care university medical center. An inception cohort of 83 patients with larynx/hypopharynx squamous cell carcinoma was considered. All patients had advanced stage disease (clinically T3-T4) and underwent total laryngectomy or total pharyngolaryngectomy in association with thyroidectomy. Adjuvant therapy was indicated when tumor or neck conditions required. Frequency of thyroid cartilage invasion was calculated; univariate and multivariate analysis of demographic, clinical and pathological characteristics associated with cartilage invasion were performed. The overall frequency of invasion of the thyroid gland was 18.1%. Glandular involvement was associated with invasion of the following structures: anterior commissure (odds ratio=5.13; 95% confidence interval 1.07-24.5), subglottis (odds ratio=12.44; 95% confidence interval 1.55-100.00) and cricoid cartilage (odds ratio=15.95; 95% confidence interval 4.23-60.11). Invasion of the thyroid gland is uncommon in the context of laryngopharyngeal squamous cell carcinoma. Clinical and pathological features such as invasion of the anterior commissure, subglottis and cricoid cartilage are more associated with glandular invasion. Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Relationship of ZNF423 and CTSO with breast cancer risk in two randomised tamoxifen prevention trials.

PubMed

Brentnall, Adam R; Cuzick, Jack; Byers, Helen; Segal, Corrinne; Reuter, Caroline; Detre, Simone; Sestak, Ivana; Howell, Anthony; Powles, Trevor J; Newman, William G; Dowsett, Mitchell

2016-08-01

A case-control study from two randomised breast cancer prevention trials of tamoxifen and raloxifene (P-1 and P-2) identified single-nucleotide polymorphisms (SNPs) in or near genes ZNF423 and CTSO as factors which predict which women will derive most anti-cancer benefit from selective oestrogen receptor modulator (SERM) therapy. In this article, we further examine this question using blood samples from two randomised tamoxifen prevention trials: the International Breast Cancer Intervention Study I (IBIS-I) and the Royal Marsden trial (Marsden). A nested case-control study was designed with 2:1 matching in IBIS-I and 1:1 matching in Marsden. The OncoArray was used for genotyping and included two SNPs previously identified (rs8060157 in ZNF423 and rs10030044 near CTSO), and 102 further SNPs within the same regions. Overall, there were 369 cases and 662 controls, with 148 cases and 268 controls from the tamoxifen arms. Odds ratios were estimated by conditional logistic regression, with Wald 95 % confidence intervals. In the tamoxifen arms, the per-allele odds ratio for rs8060157 was 0.99 (95 %CI 0.73-1.34) and 1.00 (95 %CI 0.76-1.33) for rs10030044. In the placebo arm, the odds ratio was 1.10 (95 %CI 0.87-1.40) for rs8060157 and 1.01 (95 %CI 0.79-1.29) for rs10030044. There was no evidence to suggest that other SNPs in the surrounding regions of these SNPs might predict response to tamoxifen. Results from these two prevention trials do not support the earlier findings. rs8060157 in ZNF423 and rs10030044 near CTSO do not appear to predict response to tamoxifen.

Unemployment and disability pension--an 18-year follow-up study of a 40-year-old population in a Norwegian county.

PubMed

Støver, Morten; Pape, Kristine; Johnsen, Roar; Fleten, Nils; Sund, Erik R; Claussen, Bjørgulf; Bjørngaard, Johan H

2012-02-28

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. 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. 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%. 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.

Incidence and risk factors associated with pressure ulcers among patients with HIV infection.

PubMed

Nicastri, Emanuele; Viale, Pierluigi; Lyder, Courtney H; Cristini, Francesco; Martini, Lorena; Preziosi, Gianni; Dodi, Ferdinando; Irato, Laura; Pan, Angelo; Petrosillo, Nicola

2004-06-01

To assess the incidence of and risk factors for pressure ulcers among patients with advanced human immunodeficiency virus type 1 (HIV-1) infection. Multicenter trial that included 1258 consecutive patients infected with HIV-1 who had 1815 admissions to 16 acute care infectious disease units in Italy. Data were collected for demographic, clinical, immunologic, and virologic parameters. The chi-square test was used to compare categorical variables, and the Student t test was used for continuous variables. Univariate analysis was performed to examine possible risk factors for pressure ulcers by computing odds ratios; a multiple logistic regression model was used to obtain adjusted estimates of odds ratios while accounting for all possible risk factors. The incidence of pressure ulcers was 2.31 per 100 admissions, 3.33 per 100 patients, and 1.06 per 1000 patient days. All stages of pressure ulcers were represented in the sample: 7 Stage I (15.9%), 24 Stage II (54.5%), 8 Stage III (18.2%), and 5 Stage IV (11.4%). Multivariate analyses showed that being female, length of hospitalization, and clinical markers of HIV infection were independently associated with pressure ulcers. Mortality rates were 50% among patients with pressure ulcers and 7.2% among patients without pressure ulcers (P <.0001), with an attributable mortality rate of 42.8% and an odds ratio of 12.96 (95% confidence interval 6.99-24.22). A higher incidence of pressure ulcers was found in patients infected with HIV-1 when compared with noninfected patients. Because a longer hospitalization may increase the risk of developing a pressure ulcer, practitioners should be aware of the clinical conditions that may prolong a patient's hospital stay. Aggressive preventive strategies should be implemented to decrease the complications associated with pressure ulcers among patients infected with HIV-1.

Statin use is associated with reduced risk of histologic subtypes of esophageal cancer: a nested case-control analysis.

PubMed

Alexandre, Leo; Clark, Allan B; Bhutta, Hina Y; Holt, Sean; Lewis, Michael P N; Hart, Andrew R

2014-03-01

Most patients with esophageal adenocarcinoma (EAC) or squamous cell cancer (ESCC) present with advanced, incurable disease. Statins have reported anti-carcinogenic effects and may be chemoprotective. We investigated the association between regular use of statins and the main histologic subtypes of esophageal malignancy (EAC, esophagogastric junctional adenocarcinoma, and ESCC) in the UK general population. We identified all individuals in the UK General Practice Research Database diagnosed with esophageal cancer from 2000 through 2009. Patients were linked to the National Cancer Registry to confirm histologic subtypes. Each patient was matched with up to 4 controls for age, sex, and practice. We performed a nested case-control analysis using conditional logistic regression to estimate the risk of each subtype with regular statin use, adjusted for body mass index, smoking, alcohol intake, and concomitant use of medications. In total, 581 participants with EAC, 213 with esophagogastric junctional adenocarcinoma, and 332 with ESCC were matched to 2167, 783, and 1242 controls, respectively. Regular statin use was inversely associated with development of EAC (odds ratio = 0.58; 95% confidence interval: 0.39-0.87) (with significant dose and duration responses) and esophagogastric junctional adenocarcinoma (odds ratio = 0.29; 95% confidence interval: 0.09-0.92) (with high-dose use only). Statin use for 1-4 years was inversely associated with ESCC (odds ratio = 0.51; 95% confidence interval: 0.27-0.98). In a nested case-control analysis of a UK population-based cohort, statin use was inversely associated with histologic subtypes of esophageal cancer. Randomized controlled trials are warranted to determine whether statins have chemopreventive effects in high-risk groups. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

Depression and risk of type 2 diabetes: the potential role of metabolic factors.

PubMed

Schmitz, N; Deschênes, S S; Burns, R J; Smith, K J; Lesage, A; Strychar, I; Rabasa-Lhoret, R; Freitas, C; Graham, E; Awadalla, P; Wang, J L

2016-12-01

The aim of the present study was to evaluate the interaction between depressive symptoms and metabolic dysregulations as risk factors for type 2 diabetes. The sample comprised of 2525 adults who participated in a baseline and a follow-up assessment over a 4.5-year period in the Emotional Health and Wellbeing Study (EMHS) in Quebec, Canada. A two-way stratified sampling design was used, on the basis of the presence of depressive symptoms and metabolic dysregulation (obesity, elevated blood sugar, high blood pressure, high levels of triglycerides and decreased high-density lipoprotein). A total of 87 (3.5%) individuals developed diabetes. Participants with both depressive symptoms and metabolic dysregulation had the highest risk of diabetes (adjusted odds ratio=6.61, 95% confidence interval (CI): 4.86-9.01), compared with those without depressive symptoms and metabolic dysregulation (reference group). The risk of diabetes in individuals with depressive symptoms and without metabolic dysregulation did not differ from the reference group (adjusted odds ratio=1.28, 95% CI: 0.81-2.03), whereas the adjusted odds ratio for those with metabolic dysregulation and without depressive symptoms was 4.40 (95% CI: 3.42-5.67). The Synergy Index (SI=1.52; 95% CI: 1.07-2.17) suggested that the combined effect of depressive symptoms and metabolic dysregulation was greater than the sum of individual effects. An interaction between depression and metabolic dysregulation was also suggested by a structural equation model. Our study highlights the interaction between depressive symptoms and metabolic dysregulation as a risk factor for type 2 diabetes. Early identification, monitoring and a comprehensive management approach of both conditions might be an important diabetes prevention strategy.

Better Nurse Staffing and Nurse Work Environments Associated With Increased Survival of In-Hospital Cardiac Arrest Patients

PubMed Central

McHugh, Matthew D.; Rochman, Monica F.; Sloane, Douglas M.; Berg, Robert A.; Mancini, Mary E.; Nadkarni, Vinay M.; Merchant, Raina M.; Aiken, Linda H.

2015-01-01

Background Although nurses are the most likely first responders to witness an in-hospital cardiac arrest (IHCA) and provide treatment, little research has been undertaken to determine what features of nursing are related to cardiac arrest outcomes. Objectives To determine the association between nurse staffing, nurse work environments, and IHCA survival. Research Design Cross-sectional study of data from: (1) the American Heart Association’s Get With The Guidelines-Resuscitation database; (2) the University of Pennsylvania Multi-State Nursing Care and and Patient Safety; and (3) the American Hospital Association annual survey. Logistic regression models were used to determine the association of the features of nursing and IHCA survival to discharge after adjusting for hospital and patient characteristics. Subjects A total of 11,160 adult patients aged 18 and older between 2005 and 2007 in 75 hospitals in 4 states (Pennsylvania, Florida, California, and New Jersey). Results Each additional patient per nurse on medical-surgical units was associated with a 5% lower likelihood of surviving IHCA to discharge (odds ratio = 0.95; 95% confidence interval, 0.91–0.99). Further, patients cared for in hospitals with poor work environments had a 16% lower likelihood of IHCA survival (odds ratio = 0.84; 95% confidence interval, 0.71–0.99) than patients cared for in hospitals with better work environments. Conclusions Better work environments and decreased patient-to-nurse ratios on medical-surgical units are associated with higher odds of patient survival after an IHCA. These results add to a large body of literature suggesting that outcomes are better when nurses have a more reasonable workload and work in good hospital work environments. Improving nurse working conditions holds promise for improving survival following IHCA. PMID:26783858

A Bayesian goodness of fit test and semiparametric generalization of logistic regression with measurement data.

PubMed

Schörgendorfer, Angela; Branscum, Adam J; Hanson, Timothy E

2013-06-01

Logistic regression is a popular tool for risk analysis in medical and population health science. With continuous response data, it is common to create a dichotomous outcome for logistic regression analysis by specifying a threshold for positivity. Fitting a linear regression to the nondichotomized response variable assuming a logistic sampling model for the data has been empirically shown to yield more efficient estimates of odds ratios than ordinary logistic regression of the dichotomized endpoint. We illustrate that risk inference is not robust to departures from the parametric logistic distribution. Moreover, the model assumption of proportional odds is generally not satisfied when the condition of a logistic distribution for the data is violated, leading to biased inference from a parametric logistic analysis. We develop novel Bayesian semiparametric methodology for testing goodness of fit of parametric logistic regression with continuous measurement data. The testing procedures hold for any cutoff threshold and our approach simultaneously provides the ability to perform semiparametric risk estimation. Bayes factors are calculated using the Savage-Dickey ratio for testing the null hypothesis of logistic regression versus a semiparametric generalization. We propose a fully Bayesian and a computationally efficient empirical Bayesian approach to testing, and we present methods for semiparametric estimation of risks, relative risks, and odds ratios when parametric logistic regression fails. Theoretical results establish the consistency of the empirical Bayes test. Results from simulated data show that the proposed approach provides accurate inference irrespective of whether parametric assumptions hold or not. Evaluation of risk factors for obesity shows that different inferences are derived from an analysis of a real data set when deviations from a logistic distribution are permissible in a flexible semiparametric framework. © 2013, The International Biometric Society.

Factors associated with Salmonella prevalence on pork carcasses in very small abattoirs in Wisconsin.

PubMed

Algino, R J; Badtram, G A; Ingham, B H; Ingham, S C

2009-04-01

The U.S. Department of Agriculture has expressed concern over Salmonella prevalence on pork carcasses. Our objectives were to survey the prevalence of Salmonella on pork carcasses in very small Wisconsin abattoirs, and identify processing conditions and indicator bacteria levels associated with reduced Salmonella prevalence. During April to July 2007, sponge samples were obtained from 181 pork carcasses at 10 Wisconsin abattoirs before carcass washing (carcass half A), and after washing and chilling and before fabrication (carcass half B). Each sample was categorized by whether the carcass was skinned, by wash-water temperature (7 to 43 degrees C), and the duration (1 or 2 days), temperature, and percent relative humidity of chilling. Sponge samples were analyzed qualitatively for Salmonella and quantitatively for Escherichia coli, coliforms, Enterobacteriaceae, and aerobic plate count (APC). Salmonella prevalences on skinned and unskinned prewash carcasses were 11.7 and 8.3%, respectively. Corresponding values for chilled carcasses were 32.0 and 19.5% for 1-day chilled carcasses, and 11.4 and 14.7% for 2-day chilled carcasses. Lower Salmonella prevalence on prewash carcasses was significantly related to lower prewash carcass APC levels (odds ratio = 7.8 per change of 1.0 log CFU/cm2), while lower Salmonella prevalence on chilled carcasses was significantly related to 2-day chilling (odds ratio = 5.2), and chilled-carcass levels of coliforms, Enterobacteriaceae, and APC (odds ratio = 1.5 to 1.9 per change of 1.0 log CFU/cm2). Salmonella prevalence on chilled pork carcasses in very small Wisconsin plants could be reduced by chilling carcasses 2 days before fabrication and improving carcass-handling hygiene.

Prevalence of hypothyroidism in patients with frozen shoulder.

PubMed

Schiefer, Marcio; Teixeira, Patricia F Santos; Fontenelle, Cesar; Carminatti, Tiago; Santos, Daniel A; Righi, Lucas D; Conceição, Flavia Lucia

2017-01-01

Hypothyroidism and frozen shoulder (FS) have been associated, although this relationship remains uncertain. The main objective of this study was to determine the prevalence of hypothyroidism in patients with FS. A case-control study was performed to compare FS patients (cases) with patients who visited an orthopedic service for other clinical conditions (controls). FS was diagnosed according to specific criteria based on anamnesis, physical examination, and shoulder radiographs. A specific questionnaire was applied, and measurements of serum thyroid-stimulating hormone (TSH) and free tetraiodothyronine were performed in all subjects. We evaluated 401 shoulders from 93 FS patients and 151 controls. The prevalence of hypothyroidism diagnosis was significantly higher in the FS group (27.2% vs. 10.7%; P = .001). There was also a tendency for higher prevalence of bilateral FS among patients with elevated TSH levels (P = .09). Mean serum TSH levels were higher in patients with bilateral FS compared with those with unilateral compromise (3.39 vs. 2.28; P = .05) and were higher in patients with severe FS compared with those with mild and moderate FS together (3.15 vs. 2.21; P = .03). Multivariate analysis showed that FS was independently related to a diagnosis of hypothyroidism (odds ratio, 3.1 [1.5-6.4]; P = .002). There was a trend toward independent association between high serum TSH levels and both severe (odds ratio, 3.5 [0.8-14.9]; P = .09) and bilateral (odds ratio, 11.7 [0.9-144.8]; P = .05) compromise. The prevalence of hypothyroidism was significantly higher in FS patients than in controls. The results suggest that higher serum TSH levels are associated with bilateral and severe cases of FS. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

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

Risk factors of neonatal mortality and child mortality in Bangladesh

PubMed Central

Maniruzzaman, Md; Suri, Harman S; Kumar, Nishith; Abedin, Md Menhazul; Rahman, Md Jahanur; El-Baz, Ayman; Bhoot, Makrand; Teji, Jagjit S; Suri, Jasjit S

2018-01-01

Background Child and neonatal mortality is a serious problem in Bangladesh. The main objective of this study was to determine the most significant socio-economic factors (covariates) between the years 2011 and 2014 that influences on neonatal and child mortality and to further suggest the plausible policy proposals. Methods We modeled the neonatal and child mortality as categorical dependent variable (alive vs death of the child) while 16 covariates are used as independent variables using χ2 statistic and multiple logistic regression (MLR) based on maximum likelihood estimate. Findings Using the MLR, for neonatal mortality, diarrhea showed the highest positive coefficient (β = 1.130; P < 0.010) leading to most significant covariate for both 2011 and 2014. The corresponding odds ratios were: 0.323 for both the years. The second most significant covariate in 2011 was birth order between 2-6 years (β = 0.744; P < 0.001), while father’s education was negative correlation (β = -0.910; P < 0.050). In general, 10 covariates in 2011 and 5 covariates in 2014 were significant, so there was an improvement in socio-economic conditions for neonatal mortality. For child mortality, birth order between 2-6 years and 7 and above years showed the highest positive coefficients (β = 1.042; P < 0.010) and (β = 1.285; P < 0.050) for 2011. The corresponding odds ratios were: 2.835 and 3.614, respectively. Father's education showed the highest coefficient (β = 0.770; P < 0.050) indicating the significant covariate for 2014 and the corresponding odds ratio was 2.160. In general, 6 covariates in 2011 and 4 covariates in 2014 were also significant, so there was also an improvement in socio-economic conditions for child mortality. This study allows policy makers to make appropriate decisions to reduce neonatal and child mortality in Bangladesh. Conclusions In 2014, mother’s age and father’s education were also still significant covariates for child mortality. This study allows policy makers to make appropriate decisions to reduce neonatal and child mortality in Bangladesh. PMID:29740501

Risk factors of neonatal mortality and child mortality in Bangladesh.

PubMed

Maniruzzaman, Md; Suri, Harman S; Kumar, Nishith; Abedin, Md Menhazul; Rahman, Md Jahanur; El-Baz, Ayman; Bhoot, Makrand; Teji, Jagjit S; Suri, Jasjit S

2018-06-01

Child and neonatal mortality is a serious problem in Bangladesh. The main objective of this study was to determine the most significant socio-economic factors (covariates) between the years 2011 and 2014 that influences on neonatal and child mortality and to further suggest the plausible policy proposals. We modeled the neonatal and child mortality as categorical dependent variable (alive vs death of the child) while 16 covariates are used as independent variables using χ 2 statistic and multiple logistic regression (MLR) based on maximum likelihood estimate. Using the MLR, for neonatal mortality, diarrhea showed the highest positive coefficient (β = 1.130; P  < 0.010) leading to most significant covariate for both 2011 and 2014. The corresponding odds ratios were: 0.323 for both the years. The second most significant covariate in 2011 was birth order between 2-6 years (β = 0.744; P  < 0.001), while father's education was negative correlation (β = -0.910; P  < 0.050). In general, 10 covariates in 2011 and 5 covariates in 2014 were significant, so there was an improvement in socio-economic conditions for neonatal mortality. For child mortality, birth order between 2-6 years and 7 and above years showed the highest positive coefficients (β = 1.042; P  < 0.010) and (β = 1.285; P  < 0.050) for 2011. The corresponding odds ratios were: 2.835 and 3.614, respectively. Father's education showed the highest coefficient (β = 0.770; P  < 0.050) indicating the significant covariate for 2014 and the corresponding odds ratio was 2.160. In general, 6 covariates in 2011 and 4 covariates in 2014 were also significant, so there was also an improvement in socio-economic conditions for child mortality. This study allows policy makers to make appropriate decisions to reduce neonatal and child mortality in Bangladesh. In 2014, mother's age and father's education were also still significant covariates for child mortality. This study allows policy makers to make appropriate decisions to reduce neonatal and child mortality in Bangladesh.

Androgens, Irregular Menses, and Risk of Diabetes and Coronary Artery Calcification in the Diabetes Prevention Program.

PubMed

Kim, Catherine; Aroda, Vanita R; Goldberg, Ronald B; Younes, Naji; Edelstein, Sharon L; Carrion-Petersen, MaryLou; Ehrmann, David A

2018-02-01

It is unclear whether relative elevations in androgens or irregular menses (IM) are associated with greater cardiometabolic risk among women who are already overweight and glucose intolerant. We conducted a secondary analysis of the Diabetes Prevention Program (DPP) and the Diabetes Prevention Program Outcomes Study (DPPOS). Participants included women with sex hormone measurements who did not use exogenous estrogen (n = 1422). We examined whether free androgen index (FAI) or IM was associated with diabetes risk during the DPP/DPPOS or with coronary artery calcification (CAC) at DPPOS year 10. Models were adjusted for menopausal status, age, race or ethnicity, randomization arm, body mass index (BMI), and hemoglobin A1c. Women had an average age of 48.2 ± 9.9 years. Elevations in FAI and IM were associated with greater BMI, waist circumference, and blood pressure and lower adiponectin. FAI was not associated with diabetes risk during the DPP/DPPOS [hazard ratio (HR) 0.97; 95% confidence interval (CI), 0.93 to 1.02] or increased odds of CAC [odds ratio (OR) 1.06; 95% CI, 0.92 to 1.23]. IM was also not associated with diabetes risk during the DPP/DPPOS (HR 1.07; 95% CI, 0.87 to 1.31) or increased odds of CAC (OR 0.89; 95% CI, 0.53 to 1.49). Women who had both relative elevations in FAI and IM had similar diabetes risk and odds of CAC as women without these conditions. Differences by treatment arm and menopausal status were not observed. Among midlife women who were already glucose intolerant and overweight, androgen concentrations and IM did not additionally contribute to increased risk for diabetes or CAC. Copyright © 2017 Endocrine Society

Polysomnographic Measurement of Sleep Duration and Bodily Pain Perception in the Sleep Heart Health Study.

PubMed

Weingarten, Jeremy A; Dubrovsky, Boris; Basner, Robert C; Redline, Susan; George, Liziamma; Lederer, David J

2016-08-01

To determine whether total sleep time (TST) and specific sleep stage duration are associated with bodily pain perception and whether sex, age, or subjective sleepiness modifies this relationship. Data from adults ages 39-90 y (n = 5,199) who took part in the Sleep Heart Health Study Exam 1 were analyzed. TST, rapid eye movement (REM) sleep time, and slow wave sleep (SWS) time were measured by unattended, in-home nocturnal polysomnography. Bodily pain perception was measured via the Short Form-36 questionnaire bodily pain component. We used logistic regression to examine associations between total and individual sleep stage durations and bodily pain perception controlling for age, sex, race, body mass index, apnea-hypopnea index, antidepressant use, and important cardiovascular conditions (smoking [pack-years], history of diabetes, and history of percutaneous coronary intervention and/or coronary artery bypass graft). In the fully adjusted model, REM sleep time and SWS time were not associated with "moderate to severe pain," whereas TST was: Each 1-h decrement in TST was associated with a 7% increased odds of "moderate to severe pain" (odds ratio 1.07, 95% confidence interval 1.002, 1.14). Due to modification of the association between SWS time and "moderate to severe pain" by sex (P for interaction = 0.01), we performed analyses stratified by sex: Each 1-h decrement in SWS time was associated with a 20% higher odds of "moderate to severe pain" among men (odds ratio 1.20, 95% confidence interval 1.03-1.42) whereas an association was not observed among women. Shorter TST among all subjects and shorter SWS time in men was associated with "moderate to severe pain." REM sleep time was not associated with bodily pain perception in this cohort. © 2016 Associated Professional Sleep Societies, LLC.

Childhood Abuse and Suicidal Ideation in a Cohort of Pregnant Peruvian Women

PubMed Central

ZHONG, Qiu-Yue; WELLS, Anne; RONDON, Marta B.; WILLIAMS, Michelle A.; BARRIOS, Yasmin V.; SANCHEZ, Sixto E.; GELAYE, Bizu

2016-01-01

Background Childhood abuse is a major global and public health problem associated with a myriad of adverse outcomes across the life course. Suicide is one of the leading causes of mortality during the perinatal period. However, few studies have assessed the relationship between experiences of childhood abuse and suicidal ideation in pregnancy. Objective To examine the association between exposure to childhood abuse and suicidal ideation among pregnant women. Study Design A cross-sectional study was conducted among 2,964 pregnant women attending prenatal clinics, in Lima, Peru. Childhood abuse was assessed using the Childhood Physical and Sexual Abuse Questionnaire. Depression and suicidal ideation were assessed using the Patient Health Questionnaire-9 scale. Logistic regression procedures were performed to estimate adjusted odds ratios and 95% confidence intervals adjusted for potential confounders. Results Overall, the prevalence of childhood abuse in this cohort was 71.8% and antepartum suicidal ideation was 15.8%. The prevalence of antepartum suicidal ideation was higher among women who reported experiencing any childhood abuse compared to those reporting none (89.3% vs. 10.7%, P<0.0001). After adjusting for potential confounders, including antepartum depression and lifetime intimate partner violence, those with history of any childhood abuse had a 2.9-fold (adjusted odds ratios; 95% confidence intervals: 2.12-3.97) increased odds of reporting suicidal ideation. Women who experienced both physical and sexual childhood abuse had much higher odds of suicidal ideation (adjusted odds ratios =4.04; 95% confidence intervals: 2.88-5.68). Women who experienced any childhood abuse and reported depression had 3.44-fold (adjusted odds ratios; 95% confidence intervals: 1.84-6.43) increased odds of suicidal ideation compared with depressed women with no history of childhood abuse. Finally, the odds of suicidal ideation increased with increased number of childhood abuse events experienced (P-value for trend<0.001). Conclusion Maternal history of childhood abuse was associated with increased odds of antepartum suicidal ideation. It is important for clinicians to be aware of the potential increased risk of suicidal behaviors among pregnant women with a history of childhood physical and sexual abuse. PMID:27173085

Childhood abuse and suicidal ideation in a cohort of pregnant Peruvian women.

PubMed

Zhong, Qiu-Yue; Wells, Anne; Rondon, Marta B; Williams, Michelle A; Barrios, Yasmin V; Sanchez, Sixto E; Gelaye, Bizu

2016-10-01

Childhood abuse is a major global and public health problem associated with a myriad of adverse outcomes across the life course. Suicide is one of the leading causes of mortality during the perinatal period. However, few studies have assessed the relationship between experiences of childhood abuse and suicidal ideation in pregnancy. We sought to examine the association between exposure to childhood abuse and suicidal ideation among pregnant women. A cross-sectional study was conducted among 2964 pregnant women attending prenatal clinics in Lima, Peru. Childhood abuse was assessed using the Childhood Physical and Sexual Abuse Questionnaire. Depression and suicidal ideation were assessed using the Patient Health Questionnaire-9 scale. Logistic regression procedures were performed to estimate adjusted odds ratios and 95% confidence intervals adjusted for potential confounders. Overall, the prevalence of childhood abuse in this cohort was 71.8% and antepartum suicidal ideation was 15.8%. The prevalence of antepartum suicidal ideation was higher among women who reported experiencing any childhood abuse compared to those reporting none (89.3% vs 10.7%, P < .0001). After adjusting for potential confounders, including antepartum depression and lifetime intimate partner violence, those with history of any childhood abuse had a 2.9-fold (2.90, adjusted odds ratio; 95% confidence interval, 2.12-3.97) increased odds of reporting suicidal ideation. Women who experienced both physical and sexual childhood abuse had much higher odds of suicidal ideation (adjusted odds ratio, 4.04; 95% confidence interval, 2.88-5.68). Women who experienced any childhood abuse and reported depression had 3.44-fold (3.44, adjusted odds ratio; 95% confidence interval, 1.84-6.43) increased odds of suicidal ideation compared with depressed women with no history of childhood abuse. Finally, the odds of suicidal ideation increased with increased number of childhood abuse events experienced (P value for linear trend < .001). Maternal history of childhood abuse was associated with increased odds of antepartum suicidal ideation. It is important for clinicians to be aware of the potential increased risk of suicidal behaviors among pregnant women with a history of childhood physical and sexual abuse. Copyright © 2016 Elsevier Inc. All rights reserved.

Physical and Organizational Job Stressors in Pregnancy and Associations With Primary Cesarean Deliveries.

PubMed

Guendelman, Sylvia; Gemmill, Alison; Hosang, Nap; MacDonald, Leslie A

2017-06-01

The aim of this study was to assess the relationship between exposure to physical and organizational job stressors during pregnancy and cesarean delivery. We sampled 580 employed women in California who participated in a nested population-based case-control study of birth outcomes. Adjusted multivariate regression analyses estimated associations between heavy lifting, frequent bending, high noise, extreme temperature, prolonged standing and organizational stressors (shift work, inflexible schedules, effort-reward ratio), and primary cesarean (vs vaginal) delivery, controlling for covariates. Women occupationally exposed had higher odds of cesarean. Those exposed to daily manual lifting more than 15 pounds [adjusted odds ratio = 2.54; 95% confidence interval (95% CI) 1.21 to 5.32] and at least four physical job stressors (adjusted odds ratio = 3.49; 95% CI 1.21 to 10.09) had significantly elevated odds of cesarean delivery. Exposed morbid women experienced greater risk; risk was lower among those with schedule flexibility. Associations were found between modifiable exposure to physical job stressors during pregnancy and cesarean delivery.

Cigarette Smoking, Desire to Quit, and Tobacco-Related Counseling Among Patients at Adult Health Centers

PubMed Central

Lebrun-Harris, Lydie A.; Fiore, Michael C.; Tomoyasu, Naomi; Ngo-Metzger, Quyen

2015-01-01

Objectives. We determined cigarette smoking prevalence, desire to quit, and tobacco-related counseling among a national sample of patients at health centers. Methods. Data came from the 2009 Health Center Patient Survey and the 2009 National Health Interview Survey. The analytic sample included 3949 adult patients at health centers and 27 731 US adults. Results. Thirty-one percent of health center patients were current smokers, compared with 21% of US adults in general. Among currently smoking health center patients, 83% desired to quit and 68% received tobacco counseling. In multivariable models, patients had higher adjusted odds of wanting to quit if they had indications of severe mental illness (adjusted odds ratio [AOR] = 3.26; 95% confidence interval [CI] = 1.19, 8.97) and lower odds if they had health insurance (AOR = 0.43; 95% CI = 0.22, 0.86). Patients had higher odds of receiving counseling if they had 2 or more chronic conditions (AOR = 2.05; 95% CI = 1.11, 3.78) and lower odds if they were Hispanic (AOR = 0.57; 95% CI = 0.34, 0.96). Conclusions. Cigarette smoking prevalence is substantially higher among patients at health centers than US adults in general. However, most smokers at health centers desire to quit. Continued efforts are warranted to reduce tobacco use in this vulnerable group. PMID:24625147

Cigarette Smoking, Desire to Quit, and Tobacco-Related Counseling Among Patients at Adult Health Centers.

PubMed

Lebrun-Harris, Lydie A; Fiore, Michael C; Tomoyasu, Naomi; Ngo-Metzger, Quyen

2015-01-01

Objectives. We determined cigarette smoking prevalence, desire to quit, and tobacco-related counseling among a national sample of patients at health centers. Methods. Data came from the 2009 Health Center Patient Survey and the 2009 National Health Interview Survey. The analytic sample included 3949 adult patients at health centers and 27 731 US adults. Results. Thirty-one percent of health center patients were current smokers, compared with 21% of US adults in general. Among currently smoking health center patients, 83% desired to quit and 68% received tobacco counseling. In multivariable models, patients had higher adjusted odds of wanting to quit if they had indications of severe mental illness (adjusted odds ratio [AOR] = 3.26; 95% confidence interval [CI] = 1.19, 8.97) and lower odds if they had health insurance (AOR = 0.43; 95% CI = 0.22, 0.86). Patients had higher odds of receiving counseling if they had 2 or more chronic conditions (AOR = 2.05; 95% CI = 1.11, 3.78) and lower odds if they were Hispanic (AOR = 0.57; 95% CI = 0.34, 0.96). Conclusions. Cigarette smoking prevalence is substantially higher among patients at health centers than US adults in general. However, most smokers at health centers desire to quit. Continued efforts are warranted to reduce tobacco use in this vulnerable group.

Frequency of depression in type 2 diabetes mellitus and an analysis of predictive factors.

PubMed

Arshad, Abdul Rehman; Alvi, Kamran Yousaf

2016-04-01

To determine frequency of depression in patients with diabetes mellitus type 2 and to identify predictive factors. The observational study was carried out at 1 Mountain Medical Battalion, Bagh, Azad Kashmir, Pakistan, from June 2013 to May 2014, and comprised type 2 diabetic patients who were not using anti-depressants and did not have history of other psychiatric illnesses. Demographic data, duration of diabetes, presence of hypertension and type of treatment were recorded and body mass index was calculated. Patient Health Questionnaire-9, translated into Urdu, was administered during face-to-face interviews. Scores >5 indicated depression, which was classified into different grades of severity using standard cut-off values. Of the 133 patients, 51(38.35%) were depressed. Depression was mild in 34(26%), moderate in 12(9.6%), moderately severe in 4(2.9%) and severe in 1(0.7%) patient. On univariate binary logistic regression, female gender (odds ratio=3.07; 95% confidence interval = 1.43, 6.59), lesser education (odds ratio = 0.90; 95% confidence interval 0.84, 0.97) shorter duration of diabetes (odds ratio=0.87; 95% confidence interval = 0.80, 0.96) and higher body mass index (odds ratio=1.41; 95% confidence interval = 1.05, 1.25) were significantly associated with depression. Only shorter duration of diabetes (odds ratio=0.90; 95% confidence interval = 0.82, 0.99) remained significant after adjustment for confounders. Age, level of education, glycaemic control and type of treatment did not predict depression. A significant proportion of type 2 diabetics were depressed. Shorter duration of diabetes reliably predicted depression in these patients.

Hospital Differences Drive Antibiotic Delays for Black Patients Compared With White Patients With Suspected Septic Shock.

PubMed

Taylor, Stephanie Parks; Karvetski, Colleen H; Templin, Megan A; Taylor, Brice T

2018-02-01

Evaluate racial disparities in sepsis processes of care. Observational cohort study. Nine hospitals in the Southeastern United States between 2014 and 2016. Two thousand two hundred twenty-one white and 707 black patients treated in the emergency department through "code sepsis" pathway for suspected septic shock. Black patients were less likely to receive timely antibiotics than were white patients using multiple definitions (1 hr from code sepsis activation [odds ratio, 0.57; 95% CI, [0.44-0.74]; 85.6% vs. 91.2%; p < 0.0001]; 1 hr from triage [odds ratio, 0.83; 95% CI, [0.69-1.00]; 28.0% vs. 31.8%; p = 0.06]; 3 hr from triage [odds ratio, 0.71; 95% CI, [0.57-0.88]; 80.1% vs. 85.0%; p = 0.002]). Focusing on antibiotic administration within 1 hour of triage, these differences were enhanced after adjusting for patient-level factors (adjusted odds ratio, 0.80; 95% CI, [0.66-0.96]; p = 0.02), but attenuated after adjusting for hospital-level differences (adjusted odds ratio, 0.90; 95% CI, [0.81-1.01]; p = 0.07). Black and white patients did not differ on other sepsis quality indicators or adjusted mortality. Black patients appear to be less likely than white patients to receive timely antibiotic therapy for sepsis. These differences were largely explained by variation in care among hospitals, such that hospitals that disproportionately treat black patients were less likely to provide timely antibiotic therapy overall. There were no differences between races in other sepsis quality measures or adjusted mortality.

Systematic review and meta-analysis estimating association of cysticercosis and neurocysticercosis with epilepsy.

PubMed

Debacq, Gabrielle; Moyano, Luz M; Garcia, Héctor H; Boumediene, Farid; Marin, Benoit; Ngoungou, Edgard B; Preux, Pierre-Marie

2017-03-01

We reviewed studies that analyzed cysticercosis (CC), neurocysticercosis (NCC) and epilepsy across Latin America, Asia and Sub-Saharan Africa, to estimate the odds ratio and etiologic fraction of epilepsy due to CC in tropical regions. We conducted a systematic review of the literature on cysticercosis and epilepsy in the tropics, collecting data from case-control and cross-sectional studies. Exposure criteria for CC included one or more of the following: serum ELISA or EITB positivity, presence of subcutaneous cysts (both not verified and unverified by histology), histology consistent with calcified cysts, and brain CT scan consistent with NCC. A common odds-ratio was then estimated using meta-analysis. 37 studies from 23 countries were included (n = 24,646 subjects, 14,934 with epilepsy and 9,712 without epilepsy). Of these, 29 were case-control (14 matched). The association between CC and epilepsy was significant in 19 scientific articles. Odds ratios ranged from 0.2 to 25.4 (a posteriori power 4.5-100%) and the common odds ratio was 2.7 (95% CI 2.1-3.6, p <0.001). Three subgroup analyses performed gave odds ratios as: 2.2 (EITB-based studies), 3.2 (CT-based studies), 1.9 (neurologist-confirmed epilepsy; door-to-door survey and at least one matched control per case). Etiologic fraction was estimated to be 63% in the exposed group among the population. Despite differences in findings, this meta-analysis suggests that cysticercosis is a significant contributor to late-onset epilepsy in tropical regions around the world, and its impact may vary depending on transmission intensity.

Adverse pregnancy outcomes around incinerators and crematoriums in Cumbria, north west England, 1956–93

PubMed Central

Dummer, T; Dickinson, H; Parker, L

2003-01-01

Study objective: To investigate the risk of stillbirth, neonatal death, and lethal congenital anomaly among babies of mothers living close to incinerators and crematoriums in Cumbria, north west England, 1956–93. Design: Retrospective cohort study. Logistic regression was used to investigate the risk of each outcome in relation to proximity at birth to incinerators and crematoriums, adjusting for social class, year of birth, birth order, and multiple births. Continuous odds ratios for trend with proximity to sites were estimated. Setting: All 3234 stillbirths, 2663 neonatal deaths, and 1569 lethal congenital anomalies among the 244 758 births to mothers living in Cumbria, 1956–1993. Main results: After adjustment for social class, year of birth, birth order, and multiple births, there was an increased risk of lethal congenital anomaly, in particular spina bifida (odds ratio 1.17, 95% CI: 1.07 to 1.28) and heart defects (odds ratio 1.12, 95% CI: 1.03 to 1.22) around incinerators and an increased risk of stillbirth (odds ratio 1.04, 95% CI: 1.01 to 1.07) and anencephalus (odds ratio 1.05, 95% CI: 1.00 to 1.10) around crematoriums. Conclusions: The authors cannot infer a causal effect from the statistical associations reported in this study. However, as there are few published studies with which to compare our results, the risk of spina bifida, heart defects, stillbirth, and anencephalus in relation to proximity to incinerators and crematoriums should be investigated further, in particular because of the increased use of incineration as a method of waste disposal. PMID:12775795

Lung Cancer Risk Among Hairdressers: A Pooled Analysis of Case-Control Studies Conducted Between 1985 and 2010

PubMed Central

Olsson, Ann C.; Xu, Yiwen; Schüz, Joachim; Vlaanderen, Jelle; Kromhout, Hans; Vermeulen, Roel; Peters, Susan; Stücker, Isabelle; Guida, Florence; Brüske, Irene; Wichmann, Heinz-Erich; Consonni, Dario; Landi, Maria Teresa; Caporaso, Neil; Tse, Lap Ah; Yu, Ignatius Tak-sun; Siemiatycki, Jack; Richardson, Lesley; Mirabelli, Dario; Richiardi, Lorenzo; Simonato, Lorenzo; Gustavsson, Per; Plato, Nils; Jöckel, Karl-Heinz; Ahrens, Wolfgang; Pohlabeln, Hermann; Tardón, Adonina; Zaridze, David; Marcus, Michael W.; ‘t Mannetje, Andrea; Pearce, Neil; McLaughlin, John; Demers, Paul; Szeszenia-Dabrowska, Neonila; Lissowska, Jolanta; Rudnai, Peter; Fabianova, Eleonora; Dumitru, Rodica Stanescu; Bencko, Vladimir; Foretova, Lenka; Janout, Vladimir; Boffetta, Paolo; Fortes, Cristina; Bueno-de-Mesquita, Bas; Kendzia, Benjamin; Behrens, Thomas; Pesch, Beate; Brüning, Thomas; Straif, Kurt

2013-01-01

Increased lung cancer risks among hairdressers were observed in large registry-based cohort studies from Scandinavia, but these studies could not adjust for smoking. Our objective was to evaluate the lung cancer risk among hairdressers while adjusting for smoking and other confounders in a pooled database of 16 case-control studies conducted in Europe, Canada, China, and New Zealand between 1985 and 2010 (the Pooled Analysis of Case-Control Studies on the Joint Effects of Occupational Carcinogens in the Development of Lung Cancer). Lifetime occupational and smoking information was collected through interviews with 19,369 cases of lung cancer and 23,674 matched population or hospital controls. Overall, 170 cases and 167 controls had ever worked as hairdresser or barber. The odds ratios for lung cancer in women were 1.65 (95% confidence interval (CI): 1.16, 2.35) without adjustment for smoking and 1.12 (95% CI: 0.75, 1.68) with adjustment for smoking; however, women employed before 1954 also experienced an increased lung cancer risk after adjustment for smoking (odds ratio = 2.66, 95% CI: 1.09, 6.47). The odds ratios in male hairdressers/barbers were generally not elevated, except for an increased odds ratio for adenocarcinoma in long-term barbers (odds ratio = 2.20, 95% CI: 1.02, 4.77). Our results suggest that the increased lung cancer risks among hairdressers are due to their smoking behavior; single elevated risk estimates should be interpreted with caution and need replication in other studies. PMID:24068200

The impact of parental history of type 2 diabetes on hyperinsulinemia and insulin resistance in subjects from central Mexico.

PubMed

Acevedo-Negrete, Ana Paula; Porchia, Leonardo M; Gonzalez-Mejia, M Elba; Torres-Rasgado, Enrique; Solis-Cano, Dania G; Ruiz-Vivanco, Guadalupe; Pérez-Fuentes, Ricardo

2017-12-01

Hyperinsulinemia and insulin resistance are both associated with the development of Type 2 Diabetes and other pathologies; however, the influence of parental history of Type 2 diabetes (PH-T2D) has yet to be investigated. Therefore, this study was conducted to determine the effect of PH-T2D has on the risk of developing hyperinsulinemia and IR. 1092 subjects (703 non-pregnant females and 389 males) were enrolled for a cross-sectional study. Clinical and biochemical parameters were collected. Subjects were allocated according to their PH-T2D: no parents, one parent, or both parents. Insulin resistance was calculated using the HOMA1 equation (HOMA1-IR). Logistic regression was used to determine the association (odds ratio) between PH-T2D and hyperinsulinemia or insulin resistance. Increasing degrees of PH-T2D were associated with significant increases in fasting plasma glucose, insulin, and HOMA1-IR (p <0.05). Subjects having one or both parents were associated with an increase risk of developing hyperinsulinemia (odds ratio=1.53, 95%CI: 1.12-2.09, and odds ratio=1.92, 95%CI: 1.21-3.06, respectively) and insulin resistance (odds ratio=1.47, 95%CI: 1.08-2.00 and odds ratio=1.77, 95%CI: 1.09-2.87, respectively), when adjusting for age, sex, BMI, fasting plasma glucose, and triglycerides. The presences of PH-T2D significantly increased the risk of developing hyperinsulinemia and insulin resistance. Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Risk factors for gametocyte carriage in uncomplicated falciparum malaria in children before and after artemisinin-based combination treatments.

PubMed

Sowunmi, Akintunde; Okuboyejo, Titilope M; Gbotosho, Grace O; Happi, Christian T

2011-01-01

Artemisinin-based combination treatments (ACTs) are the recommended first-line antimalarials globally, but their influence on the risk factors associated with gametocyte carriage has had little evaluation in endemic areas. The risk factors associated with gametocytaemia at presentation and after ACTs were evaluated in 835 children assigned to artesunate, artesunate-amodiaquine, artesunate-mefloquine or artemether-lumefantrine. Gametocyte carriage at enrolment was 8.4%. During follow-up, 24 patients (2.8%) developed gametocytaemia, which in 83% (20 patients) had developed by day 7 following treatment. In a multiple regression model, 2 factors were independent risk factors for the presence of gametocytaemia at enrolment, namely age <3 years (adjusted odds ratio 2.03, 95% confidence interval 1.01-4.05; p = 0.04) and enrolment before 2009 (adjusted odds ratio 4.2, 95% confidence interval 2.09-8.44; p < 0.001). Haematocrit <25% and parasitaemia <50,000/μl blood were associated with an increased risk of gametocytaemia. Following treatment, 3 factors were independent risk factors for gametocytaemia, namely gametocytaemia at enrolment (adjusted odds ratio 46.39, 95% confidence interval 22.3-96.46; p < 0.0001) and treatment with artesunate (adjusted odds ratio 6.74, 95% confidence interval 1.79-25.27; p = 0.005) or artesunate-mefloquine (adjusted odds ratio 9.66, 95% confidence interval 2.87-32.46; p < 0.0.0001) relative to other ACTs. ACTs modified the risk factors associated with gametocyte carriage after use. Copyright © 2012 S. Karger AG, Basel.

Risk factors for postoperative intraretinal cystoid changes after peeling of idiopathic epiretinal membranes among patients randomized for balanced salt solution and air-tamponade.

PubMed

Leisser, Christoph; Hirnschall, Nino; Hackl, Christoph; Döller, Birgit; Varsits, Ralph; Ullrich, Marlies; Kefer, Katharina; Karl, Rigal; Findl, Oliver

2018-02-20

Epiretinal membranes (ERM) are macular disorders leading to loss of vision and metamorphopsia. Vitrectomy with membrane peeling displays the gold standard of care. Aim of this study was to assess risk factors for postoperative intraretinal cystoid changes in a study population randomized for balanced salt solution and air-tamponade at the end of surgery. A prospective randomized study, including 69 eyes with idiopathic ERM. Standard 23-gauge three-port pars plana vitrectomy with membrane peeling, using intraoperative optical coherence tomography (OCT), was performed. Randomization for BSS and air-tamponade was performed prior to surgery. Best-corrected visual acuity improved from 32.9 letters to 45.1 letters 3 months after surgery. Presence of preoperative intraretinal cystoid changes was found to be the only risk factor for presence of postoperative intraretinal cystoid changes 3 months after surgery (p = 0.01; odds ratio: 8.0). Other possible risk factors such as combined phacoemulsification with 23G-ppv and membrane peeling (p = 0.16; odds ratio: 2.4), intraoperative subfoveal hyporeflective zones (p = 0.23; odds ratio: 2.6), age over 70 years (p = 0.29; odds ratio: 0.5) and air-tamponade (p = 0.59; odds ratio: 1.5) were not found to be significant. There is strong evidence that preoperative intraretinal cystoid changes lead to smaller benefit from surgery. © 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Risks of high-dose stimulants in the treatment of disorders of excessive somnolence: a case-control study.

PubMed

Auger, R Robert; Goodman, Scott H; Silber, Michael H; Krahn, Lois E; Pankratz, V Shane; Slocumb, Nancy L

2005-06-01

To ascertain complications associated with high-dose stimulant therapy in patients with narcolepsy or idiopathic hypersomnia. Case-control, retrospective chart review. Sleep center in an academic hospital. 116 patients with narcolepsy or idiopathic hypersomnia were individually matched by sex, diagnosis, age of onset, and duration of follow-up from both onset and diagnosis. Members of the high-dose group (n = 58) had received at least 1 stimulant at a dosage > or = 120% of the maximum recommended by the American Academy of Sleep Medicine Standards of Practice Committee. The standard-dose control group (n = 58) had received stimulants at a dosage < or = 100% of the American Academy of Sleep Medicine guidelines. N/A. The prevalence of psychosis (odds ratio = 12.0 [1.6-92.0]), alcohol or polysubstance misuse (odds ratio = 4.3 [1.2-15.2]), and psychiatric hospitalization (odds ratio = 3.2 [1.1-10.0]) was significantly increased in the high-dose group. More high-dose patients also experienced tachyarrhythmias (odds ratio = 3.3 [0.92-12.1] and anorexia or weight loss (odds ratio = 11.0 [1.4-85.2]). The frequency of physician-diagnosed depression, drug-seeking and suicide-related behaviors, hypertension, and cardiovascular disease did not differ significantly between the groups. This study demonstrated a significantly higher occurrence of psychosis, substance misuse, and psychiatric hospitalizations in patients using high-dose stimulants compared to those using standard doses. Tachyarrhythmias and anorexia or weight loss were also more common in this group as compared with controls. Clinicians should be very cautious in prescribing dosages that exceed maximum guidelines.

Association between glutathione S-transferase pi genetic polymorphisms and oral cancer risk.

PubMed

Park, J Y; Schantz, S P; Stern, J C; Kaur, T; Lazarus, P

1999-08-01

Polymorphisms in the gene encoding the glutathione S-transferase (GST) pi metabolizing enzyme have previously been associated with susceptibility to various cancers. In this study, the importance of GSTP1 genotypes as determinants of risk for oral cancer was assessed by examining the prevalence of GSTP1 alleles in 157 incident oral cancer cases and 260 non-cancer control individuals frequency-matched by race, sex, and age at diagnosis (+/- 5 years). The GSTP1*A, GSTP1*B, GSTP1*C, and GSTP1*D alleles were elucidated by polymerase chain reaction-restriction fragment length polymorphism analysis of polymorphisms present in codons 105 (isoleucine:valine) and 114 (alanine:valine) of the GSTP1 gene. Increased risk for oral cancer was observed in individuals who were homozygous for any combination of GSTP1 polymorphic alleles (i.e. *B, *C, and/or *D alleles; odds ratio = 2.4, 95% confidence interval = 1.2-4.8). Similar risk was observed in both Caucasians (odds ratio = 2.6, 95% confidence interval = 1.1-6.2) and African-Americans (odds ratio = 2.3, 95% CI = 0.68-7.5). A greater risk was observed in individuals with the GSTP1 (Var/Var) genotype who were exposed to low levels of smoking (i.e. < or = 20 pack-years [py], odds ratio = 3.4, 95% confidence interval = 1.1-11) than among heavier smokers (i.e. > 20 pack-years [py], odds ratio = 1.4, 95% confidence interval = 0.48-4.0). These results suggest that GSTP1 genotype may play a role in risk for oral cancer particularly among lighter smokers.

Non-alcoholic fatty liver disease is associated with high prevalence of gastro-oesophageal reflux symptoms.

PubMed

Miele, Luca; Cammarota, Giovanni; Vero, Vittoria; Racco, Simona; Cefalo, Consuelo; Marrone, Giuseppe; Pompili, Maurizio; Rapaccini, Gianlodovico; Bianco, Alessandro; Landolfi, Raffaele; Gasbarrini, Antonio; Grieco, Antonio

2012-12-01

Gastro-oesophageal reflux symptoms are usually reported by patients with obesity and metabolic syndrome. Aim of this study was to assess the prevalence and clinical characteristics of gastro-oesophageal reflux symptoms in subjects with non-alcoholic fatty liver disease. Cross-sectional, case-control study of 185 consecutive patients with non-alcoholic fatty liver disease and an age- and sex-matched control group of 112 healthy volunteers. Participants were interviewed with the aid of a previously validated questionnaire to assess lifestyle and reflux symptoms in the 3 months preceding enrolment. Odds ratios were determined before and after adjustment for body mass index, increased waist circumference, physical activity, metabolic syndrome and proton pump inhibitors and/or antiacid medication. The prevalence of heartburn and/or regurgitation and of at least one of gastro-oesophageal reflux symptoms was significantly higher in the non-alcoholic fatty liver disease group. Non-alcoholic fatty liver disease subjects were associated to higher prevalence of heartburn (adjusted odds ratios: 2.17, 95% confidence intervals: 1.16-4.04), regurgitation (adjusted odds ratios: 2.61, 95% confidence intervals: 1.24-5.48) and belching (adjusted odds ratios: 2.01, 95% confidence intervals: 1.12-3.59) and had higher prevalence of at least one GER symptom (adjusted odds ratios: 3.34, 95% confidence intervals: 1.76-6.36). Non-alcoholic fatty liver disease is associated with a higher prevalence of gastro-oesophageal reflux symptoms. Copyright © 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Age trends in 30 day hospital readmissions: US national retrospective analysis

PubMed Central

Berry, Jay G; Gay, James C; Joynt Maddox, Karen; Coleman, Eric A; Bucholz, Emily M; O’Neill, Margaret R; Blaine, Kevin; Hall, Matthew

2018-01-01

Abstract Objective To assess trends in and risk factors for readmission to hospital across the age continuum. Design Retrospective analysis. Setting and participants 31 729 762 index hospital admissions for all conditions in 2013 from the US Agency for Healthcare Research and Quality Nationwide Readmissions Database. Main outcome measure 30 day, all cause, unplanned hospital readmissions. Odds of readmission were compared by patients’ age in one year epochs with logistic regression, accounting for sex, payer, length of stay, discharge disposition, number of chronic conditions, reason for and severity of admission, and data clustering by hospital. The middle (45 years) of the age range (0-90+ years) was selected as the age reference group. Results The 30 day unplanned readmission rate following all US index admissions was 11.6% (n=3 678 018). Referenced by patients aged 45 years, the adjusted odds ratio for readmission increased between ages 16 and 20 years (from 0.70 (95% confidence interval 0.68 to 0.71) to 1.04 (1.02 to 1.06)), remained elevated between ages 21 and 44 years (range 1.02 (1.00 to 1.03) to 1.12 (1.10 to 1.14)), steadily decreased between ages 46 and 64 years (range 1.02 (1.00 to 1.04) to 0.91 (0.90 to 0.93)), and decreased abruptly at age 65 years (0.78 (0.77 to 0.79)), after which the odds remained relatively constant with advancing age. Across all ages, multiple chronic conditions were associated with the highest adjusted odds of readmission (for example, 3.67 (3.64 to 3.69) for six or more versus no chronic conditions). Among children, young adults, and middle aged adults, mental health was one of the most common reasons for index admissions that had high adjusted readmission rates (≥75th centile). Conclusions The likelihood of readmission was elevated for children transitioning to adulthood, children and younger adults with mental health disorders, and patients of all ages with multiple chronic conditions. Further attention to the measurement and causes of readmission and opportunities for its reduction in these groups is warranted. PMID:29487063

Repeated Cross-Sectional Assessment of Commercial Truck Driver Health.

PubMed

Thiese, Matthew S; Moffitt, Gary; Hanowski, Richard J; Kales, Stefanos N; Porter, Richard J; Hegmann, Kurt T

2015-09-01

To assess relationships and trends over time in individual conditions and multiple conditions among a large sample of independent, nonoverlapping truck drivers using a repeated cross-sectional study design. Commercial driver medical examinations were conducted on 95,567 commercial drivers between January 1, 2005, and October 31, 2012. Specific medical conditions that have been identified by the Federal Motor Carrier Safety Administration's Medical Review Board as possibly increasing crash risk were examined. Prevalence and trends over time were analyzed. A total of 8 of the 13 conditions significantly increased from 2005 to 2012. Prevalence of multiple concomitant conditions also increased, with prevalence odds ratios as high as 7.39 (95% confidence interval, 3.92 to 13.98) for four or more conditions in 2012 as compared with 2005. Individual and multiple conditions thought to be associated with increased crash risk significantly increased between 2005 and 2012.

Asthma and food allergy management in Chicago Public Schools.

PubMed

Gupta, Ruchi S; Rivkina, Victoria; DeSantiago-Cardenas, Lilliana; Smith, Bridget; Harvey-Gintoft, Blair; Whyte, Stephanie A

2014-10-01

This study aimed to characterize asthma and food allergy reporting and management in Chicago Public Schools. Demographic and health data for students who have asthma and food allergy were extracted from the Chicago Public Schools database. Demographic and geographic variability and the existence of school health management plans were analyzed, and multiple logistic regression models were computed. Home addresses were geocoded to create maps of case counts per community area. Approximately 18,000 asthmatic and 4000 food allergic students were identified. Of asthmatic students, 9.3% had a food allergy; of food allergic students, 40.1% had asthma. Asthma odds were significantly higher among black and Hispanic students (odds ratio [OR] = 2.3 and 1.3, respectively), whereas food allergy odds were significantly higher among black students (OR = 1.1; 95% confidence interval [CI], 1.0-1.3) and significantly lower among Hispanic students (OR = 0.8; 95% CI, 0.7-0.9). Only 24.3% of students who had asthma and 50.9% of students who had food allergy had a school health management plan on file. Odds of having a school health management plan were significantly higher among students with both conditions, but the likelihood of having a plan on file was significantly lower among racial/ethnic minority and low-income students, regardless of medical condition. Only 1 in 4 students who have asthma and half of food allergic students have health management plans in schools, with lower numbers among minority and low-income students. Improving chronic disease reporting and access to school health management plans is critical. Copyright © 2014 by the American Academy of Pediatrics.

Work disability and depressive disorders: impact on the European population.

PubMed

Veronese, Antonio; Ayuso-Mateos, José Luis; Cabello, Maria; Chatterji, Somnath; Nuevo, Roberto

2012-02-01

Our aim was to study the impact of depressive disorders on work disability to discover the determinants of depression for work disability in the European countries. The sample was composed of 31,126 individuals from 29 countries included in the 2002 World Health Survey of the World Health Organization. National representative samples of countries from all regions of Europe and with different levels of economic development and health coverage were selected. Estimates of people not working because of ill health did not differ among European countries in relation to levels of economic development or health coverage. Significant determinants of people with diagnosis of depression not working because of ill health (reference category) versus working were age (odds ratio = 0.97), female sex (odds ratio = 1.71), education (odds ratio = 1.11), marital status (being unmarried indicating less probability), lowest income level, and comorbidity with angina pectoris (odds ratio = 0.51). Moreover, according to previous studies, we found some determinants (comorbidity with other diseases, young age, and unemployment) impacting on health status. Depression is a substantial cause of work disability and it is a complex phenomenon that involves many variables. Investigation into this relationship should improve, focusing on the role of determinants.

Health effects of people living close to a petrochemical industrial estate in Thailand.

PubMed

Kongtip, Pornpimol; Singkaew, Panawadee; Yoosook, Witaya; Chantanakul, Suttinun; Sujiratat, Dusit

2013-12-01

An acute health effect of people living near the petrochemical industrial estate in Thailand was assessed using a panel study design. The populations in communities near the petrochemical industrial estates were recruited. The daily air pollutant concentrations, daily percentage of respiratory and other health symptoms reported were collected for 63 days. The effect of air pollutants to reported symptoms of people were estimated by adjusted odds ratios and 95% confidence interval using binary logistic regression. The significant associations were found with the adjusted odds ratios of 38.01 for wheezing, 18.63 for shortness of breath, 4.30 for eye irritation and 3.58 for dizziness for total volatile organic compounds (Total VOCs). The adjusted odds ratio for carbon monoxide (CO2) was 7.71 for cough, 4.55 for eye irritation and 3.53 for weakness and the adjusted odds ratio for ozone (O3) was 1.02 for nose congestion, sore throat and 1.05 for phlegm. The results showed that the people living near petrochemical industrial estate had acute adverse health effects, shortness of breath, eye irritation, dizziness, cough, nose congestion, sore throat, phlegm and weakness from exposure to industrial air pollutants.

Identification of risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis in a high volume center.

PubMed

Phillip, Veit; Schwab, Miriam; Haf, David; Algül, Hana

2017-01-01

Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Several patients´ or procedure related risk factors for post-ERCP pancreatitis (PEP) have been suggested. The aim of this study was to validate the risk factors for PEP in a high-volume center. All patients undergoing first time ERCP at a tertiary referral center between December 2010 and October 2013 were retrospectively included. PEP was defined according to the Atlanta Classification. 344 patients were included in the final analysis. The risk to develop PEP was increased in patients with chronic pancreatitis (odds ratio 3.7) and after inadvertent cannulation of the pancreatic duct (odds ratio 2.2), which occurred in 26.5% of the patients. Inadvertent cannulation occurred significantly more frequently in patients with difficult cannulation of the papilla duodeni major (odds ratio 12.7; p<0.001). ERCP on call was associated with an increased risk for difficult cannulation (odds ratio 3.0). Inadvertent cannulation of the pancreatic duct is a procedure related risk factor for PEP. Measurements on preventing inadvertent cannulation of the pancreatic duct should be established and studies on prophylactic measurements should focus particularly on patients with inadvertent cannulation of the pancreatic duct.

Bendectin and human congenital malformations.

PubMed

Shiono, P H; Klebanoff, M A

1989-08-01

The relationship between Bendectin exposure during the first trimester of pregnancy and the occurrence of congenital malformations was prospectively studied in 31,564 newborns registered in the Northern California Kaiser Permanente Birth Defects Study. The odds ratio for any major malformation and Bendectin use was 1.0 (95% confidence interval 0.8-1.4). There were 58 categories of congenital malformations; three of them were statistically associated with Bendectin exposure (microcephaly--odds ratio = 5.3, 95% confidence interval = 1.8-15.6; congenital cataract--odds ratio = 5.3, 95% confidence interval = 1.2-24.3; lung malformations (ICD-8 codes 484.4-484.8)--odds ratio = 4.6, 95% confidence interval = 1.9-10.9). This is exactly the number of associations that would be expected by chance. An independent study (the Collaborative Perinatal Project) was used to determine whether vomiting during pregnancy in the absence of Bendectin use was associated with these three malformations. Two of the three (microcephaly and cataract) had strong positive associations with vomiting in the absence of Bendectin use. We conclude that there is no increase in the overall rate of major malformations after exposure to Bendectin and that the three associations found between Bendectin and individual malformations are unlikely to be causal.

Alcohol-to-acid ratio and substrate concentration affect product structure in chain elongation reactions initiated by unacclimatized inoculum.

PubMed

Liu, Yuhao; Lü, Fan; Shao, Liming; He, Pinjing

2016-10-01

The objective of the study was to investigate whether the ratio of ethanol to acetate affects yield and product structure in chain elongation initiated by unacclimatized mixed cultures. The effect of varying the substrate concentration, while maintaining the same ratio of alcohol to acid, was also investigated. With a high substrate concentration, an alcohol to acid ratio >2:1 provided sufficient electron donor capacity for the chain elongation reaction. With an ethanol to acetate ratio of 3:1 (300mM total carbon), the highest n-caproate concentration (3033±98mg/L) was achieved during the stable phase of the reaction. A lower substrate concentration (150mM total carbon) gave a lower yield of products and led to reduced carbon transformation efficiency compared with other reaction conditions. The use of unacclimatized inoculum in chain elongation can produce significant amounts of odd-carbon-number carboxylates as a result of protein hydrolysis. Copyright © 2016 Elsevier Ltd. All rights reserved.

Homogamy and Intermarriage of Japanese and Japanese Americans With Whites Surrounding World War II.

PubMed

Ono, Hiromi; Berg, Justin

2010-10-01

Although some sociologists have suggested that Japanese Americans quickly assimilated into mainstream America, scholars of Japanese America have highlighted the heightened exclusion that the group experienced. This study tracked historical shifts in the exclusion level of Japanese and Japanese Americans in the United States surrounding World War II with homogamy and intermarriage with Whites for the prewar (1930-1940) and resettlement (1946-1966) marriage cohorts. The authors applied log-linear models to census microsamples (N = 1,590,416) to estimate the odds ratios of homogamy versus intermarriage. The unadjusted odds ratios of Japanese Americans declined between cohorts and appeared to be consistent with the assimilation hypothesis. Once compositional influences and educational pairing patterns were adjusted, however, the odds ratios increased and supported the heightened exclusion hypothesis.

Brief Report: Sexual Attraction and Relationships in Adolescents with Autism.

PubMed

May, Tamara; Pang, Ken C; Williams, Katrina

2017-06-01

Past research suggests more variation in sexual attraction in Autism Spectrum Disorder (ASD) using clinical samples. This study utilised a population representative group of 14/15 year olds from the Longitudinal Study of Australian Children. Ninety-four adolescents (73 males, 21 females) with ASD and 3454 (1685 males, 1675 females) without self-reported on sexual attraction and past sexual relationships. Females with ASD reported lower rates of heterosexual preference (adjusted odds ratio: 0.14, p < .001), higher rates of bisexuality (adjusted odds ratio: 6.05, p < .001) and uncertainty in attraction (adjusted odds ratio: 10.44, p < .001) compared with non-ASD females. ASD males reported fewer prior boyfriends/girlfriends. Findings confirm female adolescents with ASD have differences in sexual attraction compared with non-ASD females.

Geochemical characteristics of organic matter in the Andaman Sea sediments: Implications for source, paleovegetation and paleoclimate changes

NASA Astrophysics Data System (ADS)

Hossain, H. M. Z.; Sampei, Y.; Kawahata, H.

2016-12-01

The distribution, source, and redox variation of sedimentary organic matter in the Andaman Sea is significant for understanding its biogeochemical cycle, which we determined the total organic carbon (TOC), total nitrogen (TN), and n-alkanes contents. TOC and TN concentrations varied from 0.61 to 1.18 wt.% (average 0.87 wt.%) and 0.07 to 0.17 wt.% (average 0.13 wt.%), respectively with high TOC in the clay-rich sediments indicate hydrodynamic sorting readily controlled TOC abundances. Bulk C/N ratio (5.51 to 11.92, average 7.89) is attributed to the high inputs of organic matter from planktonic sources and an appreciable amounts of terrestrial derived organic matter. n-Alkane distributions from the Andaman Sea sediment cores are characterized mainly by C17 to C35, with odd-over-even predominance suggest a diverse origin of organic matter. High relative abundances of mid-chain n-alkanes of C23 and C25 recorded in the samples that are characteristically derived from submerges/floating aquatic macrophytes. However, odd long-chain n-alkanes from C27 to C33 with high peaks at C29 and C31 were detected in the samples reflecting a terrigenous origin of organic matter. The average chain length (ACL), carbon preference index (CPI), Paq and Pwax ratio values further suggested that major influence of organic matter from non-emergent aquatic macrophytes together significant proportions of grasses and herbs. Low Pr/Ph and Tm/Ts ratios in most section implying a more reducing to suboxic conditions prevailed during organic matter preservation in the oceanic event. However, high ACL values and low Paq values in the down-core variation could suggest initially cold and dry climates and gradually shifted to warm and humid conditions.

Association between Soluble Klotho and Change in Kidney Function: The Health Aging and Body Composition Study.

PubMed

Drew, David A; Katz, Ronit; Kritchevsky, Stephen; Ix, Joachim; Shlipak, Michael; Gutiérrez, Orlando M; Newman, Anne; Hoofnagle, Andy; Fried, Linda; Semba, Richard D; Sarnak, Mark

2017-06-01

CKD appears to be a condition of soluble klotho deficiency. Despite known associations between low soluble klotho levels and conditions that promote kidney damage, such as oxidative stress and fibrosis, little information exists regarding the longitudinal association between soluble klotho levels and change in kidney function. We assayed serum soluble α -klotho in 2496 participants within the Health Aging and Body Composition study, a cohort of older adults. The associations between soluble klotho levels and decline in kidney function (relative decline: eGFR decline ≥30%; absolute decline: eGFR decline >3 ml/min per year) and incident CKD (incident eGFR <60 ml/min per 1.73 m 2 and >1 ml/min per year decline) were evaluated. We adjusted models for demographics, baseline eGFR, urine albumin-to-creatinine ratio, comorbidity, and measures of mineral metabolism. Among participants, the mean (SD) age was 75 (3) years, 52% were women, and 38% were black. Median (25th, 75th percentiles) klotho level was 630 (477, 817) pg/ml. In fully adjusted models, each two-fold higher level of klotho associated with lower odds of decline in kidney function (odds ratio, 0.78 [95% confidence interval, 0.66 to 0.93] for 30% decline in eGFR, and 0.85 [95% confidence interval, 0.73 to 0.98] for >3 ml/min per year decline in eGFR), but not of incident CKD (incident rate ratio, 0.90 [95% confidence interval, 0.78 to 1.04]). Overall, a higher soluble klotho level independently associated with a lower risk of decline in kidney function. Future studies should attempt to replicate these results in other cohorts and evaluate the underlying mechanism. Copyright © 2017 by the American Society of Nephrology.

Defining risk of prescription opioid overdose: pharmacy shopping and overlapping prescriptions among long-term opioid users in medicaid.

PubMed

Yang, Zhuo; Wilsey, Barth; Bohm, Michele; Weyrich, Meghan; Roy, Kakoli; Ritley, Dominique; Jones, Christopher; Melnikow, Joy

2015-05-01

Use of multiple pharmacies concurrently (pharmacy shopping) and overlapping prescriptions may be indicators of potential misuse or abuse of prescription opioid medications. To evaluate strategies for identifying patients at high risk, we first compared different definitions of pharmacy shopping and then added the indicator of overlapping opioid prescriptions. We identified a cohort of 90,010 Medicaid enrollees who used ≥ 3 opioid prescriptions for ≥ 90 days during 2008 to 2010 from a multistate Medicaid claims database. We compared the diagnostic odds ratios for opioid overdose events of 9 pharmacy shopping definitions. Within a 90-day interval, a threshold of 4 pharmacies had the highest diagnostic odds ratio and was used to define pharmacy shopping. The overdose rate was higher in the subgroup with overlapping prescriptions (18.5 per 1,000 person-years [PYs]) than in the subgroup with pharmacy shopping as the sole indicator (10.7 per 1,000 PYs). Among the subgroup with both conditions, the overdose rate was 26.3 per 1,000 PYs, compared with 4.3 per 1,000 PYs for those with neither condition. Overlapping opioid prescriptions and pharmacy shopping measures had adjusted hazard ratios of 3.0 and 1.8, respectively, for opioid overdose. Using these measures will improve accurate identification of patients at highest risk of opioid overdose, the first step in implementing targeted prevention policies. Long-term prescription opioid use may lead to adverse events, including overdose. Both pharmacy shopping and overlapping opioid prescriptions are associated with adverse outcomes. This study demonstrates that using both indicators will better identify those at high risk of overdose. Published by Elsevier Inc.

Abdominal aortic atherosclerosis at MR imaging is associated with cardiovascular events: the Dallas heart study.

PubMed

Maroules, Christopher D; Rosero, Eric; Ayers, Colby; Peshock, Ronald M; Khera, Amit

2013-10-01

To determine the value of two abdominal aortic atherosclerosis measurements at magnetic resonance (MR) imaging for predicting future cardiovascular events. This study was approved by the institutional review board and complied with HIPAA regulations. The study consisted of 2122 participants from the multiethnic, population-based Dallas Heart Study who underwent abdominal aortic MR imaging at 1.5 T. Aortic atherosclerosis was measured by quantifying mean aortic wall thickness (MAWT) and aortic plaque burden. Participants were monitored for cardiovascular death, nonfatal cardiac events, and nonfatal extracardiac vascular events over a mean period of 7.8 years ± 1.5 (standard deviation [SD]). Cox proportional hazards regression was used to assess independent associations of aortic atherosclerosis and cardiovascular events. Increasing MAWT was positively associated with male sex (odds ratio, 3.66; P < .0001), current smoking (odds ratio, 2.53; P < .0001), 10-year increase in age (odds ratio, 2.24; P < .0001), and hypertension (odds ratio, 1.66; P = .0001). A total of 143 participants (6.7%) experienced a cardiovascular event. MAWT conferred an increased risk for composite events (hazard ratio, 1.28 per 1 SD; P = .001). Aortic plaque was not associated with increased risk for composite events. Increasing MAWT and aortic plaque burden both conferred an increased risk for nonfatal extracardiac events (hazard ratio of 1.52 per 1 SD [P < .001] and hazard ratio of 1.46 per 1 SD [P = .03], respectively). MR imaging measures of aortic atherosclerosis are predictive of future adverse cardiovascular events. © RSNA, 2013.

RCGP Research and Surveillance Centre Annual Report 2014–2015: disparities in presentations to primary care

PubMed Central

de Lusignan, Simon; Correa, Ana; Pathirannehelage, Sameera; Byford, Rachel; Yonova, Ivelina; Elliot, Alex J; Lamagni, Theresa; Amirthalingam, Gayatri; Pebody, Richard; Smith, Gillian; Jones, Simon; Rafi, Imran

2017-01-01

Background The Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) comprises over 100 general practices in England, with a population of around 1 million, providing a public health surveillance system for England and data for research. Aim To demonstrate the scope of data with the RCGP Annual Report 2014–2015 (May 2014 to April 2015) by describing disparities in the presentation of six common conditions included in the report. Design and setting This is a report of respiratory and communicable disease incidence from a primary care sentinel network in England. Method Incidence rates and demographic profiles are described for common cold, acute otitis media, pneumonia, influenza-like illness, herpes zoster, and scarlet fever. The impact of age, sex, ethnicity, and deprivation on the diagnosis of each condition is explored using a multivariate logistic regression. Results With the exception of herpes zoster, all conditions followed a seasonal pattern. Apart from pneumonia and scarlet fever, the odds of presenting with any of the selected conditions were greater for females (P<0.001). Older people had a greater probability of a pneumonia diagnosis (≥75 years, odds ratio [OR] 6.37; P<0.001). Common cold and influenza-like illness were more likely in people from ethnic minorities than white people, while the converse was true for acute otitis media and herpes zoster. There were higher odds of acute otitis media and herpes zoster diagnosis among the less deprived (least deprived quintile, OR 1.32 and 1.48, respectively; P<0.001). Conclusion The RCGP RSC database provides insight into the content and range of GP workload and provides insight into current public health concerns. Further research is needed to explore these disparities in presentation to primary care. PMID:27993900

Factors associated with success in the oral part of the European Diploma in Intensive Care

PubMed Central

Waldauf, Petr; Rubulotta, Francesca; Sitzwohl, Christian; Elbers, Paul; Girbes, Armand; Saha, Rajnish; Marsh, Brian; Kumar, Ravindra; Maggiorini, Marco

2017-01-01

Introduction The oral part of European Diploma in Intensive Care diploma examinations changed in 2013 into an objective structured clinical examination-type exam. This step was undertaken to provide a fair and reproducible clinical exam. All candidates face identical questions with predefined correct answers simultaneously in seven high throughput exam centres on the same day. We describe the factors that are associated with success in part 2 European Diploma in Intensive Care exam. Methods We prospectively collected self-reported data from all candidates sitting European Diploma in Intensive Care part 2 in 2015, namely demographics, professional background and attendance to a European Diploma in Intensive Care part 2 or generic objective structured clinical examination preparatory courses. After testing association with success (with cutoff at p < 0.10) and co-linearity of these factors as independent variables, we performed a multivariate logistical analysis, with binary exam outcome (pass/fail) as the dependent variable. Structural equation modelling was used to gain further insight into relations among determinants of success in the oral part of the European Diploma in Intensive Care. Results Out of 427 candidates sitting the exam, completed data from 341 (80%) were available for analysis. The following candidates' factors were associated with increased chance of success: English as native language (odds ratio 4.3 (95% CI 1.7–10.7)), use of Patient-centred Acute Care Training e-learning programme module (odds ratios 2.0 (1.2–3.3)), working in an EU country (odds ratios 2.5 (1.5–4.3)), and better results in the written part of the European Diploma in Intensive Care (for each additional SD of 6.1 points odds ratios 1.9 (1.4–2.4)). Chance of success in the European Diploma in Intensive Care 2 decreased with increased candidates ‘age (for each additional SD of 5.5 years odds ratios 0.67 (0.51–0.87)). Exam centres (7 in total) could be clustered into 3 groups with similar success rates. There were significant differences in exam outcomes among these 3 groups of exam centres even after adjustment to known candidates' factors (G1 vs G2 odds ratios 2.4 (1.4–4.1); G1 vs G3 odds ratios 9.7 (4.0–23.1) and G2 vs G3 odds ratios 3.9 (1.7–9.2)). A short data collection period (only one year) and 20% of missing candidates' data are the main limitations of this study. Conclusions Younger age, English as native language, better results in written part of the exam, working at a European country and the use of PACT for preparation, were factors associated with success in the oral part of the European Diploma in Intensive Care exam. Despite the limitations of this study, the differences in outcome among the exam centres will need further investigation. PMID:29123559

Factors associated with success in the oral part of the European Diploma in Intensive Care.

PubMed

Waldauf, Petr; Rubulotta, Francesca; Sitzwohl, Christian; Elbers, Paul; Girbes, Armand; Saha, Rajnish; Marsh, Brian; Kumar, Ravindra; Maggiorini, Marco; Duška, František

2017-11-01

The oral part of European Diploma in Intensive Care diploma examinations changed in 2013 into an objective structured clinical examination-type exam. This step was undertaken to provide a fair and reproducible clinical exam. All candidates face identical questions with predefined correct answers simultaneously in seven high throughput exam centres on the same day. We describe the factors that are associated with success in part 2 European Diploma in Intensive Care exam. We prospectively collected self-reported data from all candidates sitting European Diploma in Intensive Care part 2 in 2015, namely demographics, professional background and attendance to a European Diploma in Intensive Care part 2 or generic objective structured clinical examination preparatory courses. After testing association with success (with cutoff at p < 0.10) and co-linearity of these factors as independent variables, we performed a multivariate logistical analysis, with binary exam outcome (pass/fail) as the dependent variable. Structural equation modelling was used to gain further insight into relations among determinants of success in the oral part of the European Diploma in Intensive Care. Out of 427 candidates sitting the exam, completed data from 341 (80%) were available for analysis. The following candidates' factors were associated with increased chance of success: English as native language (odds ratio 4.3 (95% CI 1.7-10.7)), use of Patient-centred Acute Care Training e-learning programme module (odds ratios 2.0 (1.2-3.3)), working in an EU country (odds ratios 2.5 (1.5-4.3)), and better results in the written part of the European Diploma in Intensive Care (for each additional SD of 6.1 points odds ratios 1.9 (1.4-2.4)). Chance of success in the European Diploma in Intensive Care 2 decreased with increased candidates 'age (for each additional SD of 5.5 years odds ratios 0.67 (0.51-0.87)). Exam centres (7 in total) could be clustered into 3 groups with similar success rates. There were significant differences in exam outcomes among these 3 groups of exam centres even after adjustment to known candidates' factors (G1 vs G2 odds ratios 2.4 (1.4-4.1); G1 vs G3 odds ratios 9.7 (4.0-23.1) and G2 vs G3 odds ratios 3.9 (1.7-9.2)). A short data collection period (only one year) and 20% of missing candidates' data are the main limitations of this study. Younger age, English as native language, better results in written part of the exam, working at a European country and the use of PACT for preparation, were factors associated with success in the oral part of the European Diploma in Intensive Care exam. Despite the limitations of this study, the differences in outcome among the exam centres will need further investigation.

Heterogeneity in Early Responses in ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial).

PubMed

Dhruva, Sanket S; Huang, Chenxi; Spatz, Erica S; Coppi, Andreas C; Warner, Frederick; Li, Shu-Xia; Lin, Haiqun; Xu, Xiao; Furberg, Curt D; Davis, Barry R; Pressel, Sara L; Coifman, Ronald R; Krumholz, Harlan M

2017-07-01

Randomized trials of hypertension have seldom examined heterogeneity in response to treatments over time and the implications for cardiovascular outcomes. Understanding this heterogeneity, however, is a necessary step toward personalizing antihypertensive therapy. We applied trajectory-based modeling to data on 39 763 study participants of the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) to identify distinct patterns of systolic blood pressure (SBP) response to randomized medications during the first 6 months of the trial. Two trajectory patterns were identified: immediate responders (85.5%), on average, had a decreasing SBP, whereas nonimmediate responders (14.5%), on average, had an initially increasing SBP followed by a decrease. Compared with those randomized to chlorthalidone, participants randomized to amlodipine (odds ratio, 1.20; 95% confidence interval [CI], 1.10-1.31), lisinopril (odds ratio, 1.88; 95% CI, 1.73-2.03), and doxazosin (odds ratio, 1.65; 95% CI, 1.52-1.78) had higher adjusted odds ratios associated with being a nonimmediate responder (versus immediate responder). After multivariable adjustment, nonimmediate responders had a higher hazard ratio of stroke (hazard ratio, 1.49; 95% CI, 1.21-1.84), combined cardiovascular disease (hazard ratio, 1.21; 95% CI, 1.11-1.31), and heart failure (hazard ratio, 1.48; 95% CI, 1.24-1.78) during follow-up between 6 months and 2 years. The SBP response trajectories provided superior discrimination for predicting downstream adverse cardiovascular events than classification based on difference in SBP between the first 2 measurements, SBP at 6 months, and average SBP during the first 6 months. Our findings demonstrate heterogeneity in response to antihypertensive therapies and show that chlorthalidone is associated with more favorable initial response than the other medications. © 2017 American Heart Association, Inc.

The Effect of Dexamethasone on Symptoms of Posttraumatic Stress Disorder and Depression After Cardiac Surgery and Intensive Care Admission: Longitudinal Follow-Up of a Randomized Controlled Trial.

PubMed

Kok, Lotte; Hillegers, Manon H; Veldhuijzen, Dieuwke S; Cornelisse, Sandra; Nierich, Arno P; van der Maaten, Joost M; Rosseel, Peter M; Hofland, Jan; Sep, Milou S; Dieleman, Jan M; Vinkers, Christiaan H; Peelen, Linda M; Joëls, Marian; van Dijk, Diederik

2016-03-01

Cardiac surgery and postoperative admission to the ICU may lead to posttraumatic stress disorder and depression. Perioperatively administered corticosteroids potentially alter the risk of development of these psychiatric conditions, by affecting the hypothalamic-pituitary-adrenal axis. However, findings of previous studies are inconsistent. We aimed to assess the effect of a single dose of dexamethasone compared with placebo on symptoms of posttraumatic stress disorder and depression and health-related quality of life after cardiac surgery and ICU admission. Follow-up study of a randomized clinical trial. Five Dutch heart centers. Cardiac surgery patients (n = 1,244) who participated in the Dexamethasone for Cardiac Surgery trial. A single intraoperative IV dose of dexamethasone or placebo was administered in a randomized, double-blind way. Symptoms of posttraumatic stress disorder, depression, and health-related quality of life were assessed with validated questionnaires 1.5 years after randomization. Data were available for 1,125 patients (90.4%); of which 561 patients received dexamethasone and 564 patients received placebo. Overall, the prevalence of psychopathology was not influenced by dexamethasone. Posttraumatic stress disorder and depression were present in, respectively, 52 patients (9.3%) and 69 patients (12.3%) who received dexamethasone and in 66 patients (11.7%) and 78 patients (13.8%) who received placebo (posttraumatic stress disorder: odds ratio, 0.82; 95% CI, 0.55-1.20; p = 0.30; depression: odds ratio, 0.92; 95% CI, 0.64-1.31; p = 0.63). Subgroup analysis revealed a lower prevalence of posttraumatic stress disorder (odds ratio, 0.23; 95% CI, 0.07-0.72; p < 0.01) and depression (odds ratio, 0.29; 95% CI, 0.11-0.77; p < 0.01) in female patients after dexamethasone administration. Health-related quality of life did not differ between groups and was not associated with psychopathology. Overall, our findings suggest that exogenous administration of the glucocorticoid receptor agonist dexamethasone-compared with placebo-during cardiac surgery does not positively or negatively affect the prevalence of posttraumatic stress disorder and depression. However, in female patients, beneficial effects on the occurrence of posttraumatic stress disorder and depression may be present.

The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy.

PubMed

Melles, Ronald B; Marmor, Michael F

2014-12-01

Hydroxychloroquine sulfate is widely used for the long-term treatment of autoimmune conditions but can cause irreversible toxic retinopathy. Prior estimations of risk were low but were based largely on short-term users or severe retinal toxicity (bull's eye maculopathy). The risk may be much higher because retinopathy can be detected earlier when using more sensitive screening techniques. To reassess the prevalence of and risk factors for hydroxychloroquine retinal toxicity and to determine dosage levels that facilitate safe use of the drug. Retrospective case-control study in an integrated health organization of approximately 3.4 million members among 2361 patients who had used hydroxychloroquine continuously for at least 5 years according to pharmacy records and who were evaluated with visual field testing or spectral-domain optical coherence tomography. Hydroxychloroquine use for at least 5 years. Retinal toxicity as determined by characteristic visual field loss or retinal thinning and photoreceptor damage, as well as statistical measures of risk factors and prevalence. Real body weight predicted risk better than ideal body weight and was used for all calculations. The overall prevalence of hydroxychloroquine retinopathy was 7.5% but varied with daily consumption (odds ratio, 5.67; 95% CI, 4.14-7.79 for >5.0 mg/kg) and with duration of use (odds ratio, 3.22; 95% CI, 2.20-4.70 for >10 years). For daily consumption of 4.0 to 5.0 mg/kg, the prevalence of retinal toxicity remained less than 2% within the first 10 years of use but rose to almost 20% after 20 years of use. Other major risk factors include kidney disease (odds ratio, 2.08; 95% CI, 1.44-3.01) and concurrent tamoxifen citrate therapy (odds ratio, 4.59; 95% CI, 2.05-10.27). These data suggest that hydroxychloroquine retinopathy is more common than previously recognized, especially at high dosages and long duration of use. While no completely safe dosage is identified from this study, daily consumption of 5.0 mg/kg of real body weight or less is associated with a low risk for up to 10 years. Knowledge of these data and risk factors should help physicians prescribe hydroxychloroquine in a manner that will minimize the likelihood of vision loss.

Long working hours and emotional well-being in korean manufacturing industry employees.

PubMed

Lee, Kyoung-Hye; Kim, Jong-Eun; Kim, Young-Ki; Kang, Dong-Mug; Yun, Myeong-Ja; Park, Shin-Goo; Song, Jae-Seok; Lee, Sang-Gil

2013-12-05

Korea is well known for its long work hours amongst employees. Because workers of the manufacturing industry are constantly exposed to extended work hours, this study was based on how long work hours affect their emotional well-being. The analysis was done using the secondary Korean Working Condition Survey (KWCS). Long work hours were defined to be more than 48 hours, and they were subcategorized into units of 52 hours and 60 hours. Based on the WHO (five) well-being index, emotional state was subdivided into three groups - reference group, low-mood group, and possible depression group- where 28 points and 50 points were division points, and two groups were compared at a time. Association between long work hours and emotional state was analyzed using binary and multinomial logistic regression analysis. Working for extended working hours in the manufacturing industry showed a statistically significant increase (t test p < 0.001) in trend among the possible depression group when compared to the reference group and the low-mood group. When demographical characteristics, health behaviors, socioeconomic state, and work-related characteristics were fixed as controlled variables, as work hours increased the odds ratio of the possible depression group increased compared to the reference group, and especially the odds ratio was 2.73 times increased for work hours between 48-52 and 4.09 times increased for 60 hours or more and both were statistically significant. In comparing the low-mood group and possible depression group, as work hours increased the odds ratio increased to 1.73, 2.39, and 4.16 times, and all work hours from working 48-52 hours, 53-60 hours, and 60 hours or more were statistically significant. Multinomial logistic regression analysis also showed that among the reference group and possible group, the possible depression group was statistically significant as odds ratio increased to 2.94 times in working 53-60 hours, and 4.35 times in 60 hours or more. Long work hours have an adverse effect on emotional well-being. A more diversified research towards variables that affect long work hours and emotional well-being and how they interact with each other and their relationship to overall health is imperative.

Pre-B-cell colony-enhancing factor gene polymorphisms and risk of acute respiratory distress syndrome.

PubMed

Bajwa, Ednan K; Yu, Chu-Ling; Gong, Michelle N; Thompson, B Taylor; Christiani, David C

2007-05-01

Pre-B-cell colony-enhancing factor (PBEF) levels are elevated in bronchoalveolar lavage fluid and serum of patients with acute lung injury. There are several suspected functional polymorphisms of the corresponding PBEF gene. We hypothesized that variations in PBEF gene polymorphisms alter the risk of developing acute respiratory distress syndrome (ARDS). Nested case-control study. Tertiary academic medical center. We studied 375 patients with ARDS and 787 at-risk controls genotyped for the PBEF T-1001G and C-1543T polymorphisms. None. Patients with the -1001G (variant) allele had significantly greater odds of developing ARDS than wild-type homozygotes (odds ratio, 1.35; 95% confidence interval, 1.02-1.78). Patients with the -1543T (variant) allele did not have significantly different odds of developing ARDS than wild-type homozygotes (odds ratio, 0.86; 95% confidence interval, 0.65-1.13). When analysis was stratified by ARDS risk factor, -1543T was associated with decreased odds of developing ARDS in septic shock patients (odds ratio, 0.66; 95% confidence interval, 0.45-0.97). Also, -1001G was associated with increased hazard of intensive care unit mortality, whereas -1543T was associated with decreased hazard of 28-day and 60-day ARDS mortality, as well as shorter duration of mechanical ventilation. Similar results were found in analyses of the related GC (-1001G:-1543C) and TT (-1001T:-1543T) haplotypes. The PBEFT-1001G variant allele and related haplotype are associated with increased odds of developing ARDS and increased hazard of intensive care unit mortality among at-risk patients, whereas the C-1543T variant allele and related haplotype are associated with decreased odds of ARDS among patients with septic shock and better outcomes among patients with ARDS.

Psychiatric symptoms and antiretroviral nonadherence in US youth with perinatal HIV: a longitudinal study.

PubMed

Kacanek, Deborah; Angelidou, Konstantia; Williams, Paige L; Chernoff, Miriam; Gadow, Kenneth D; Nachman, Sharon

2015-06-19

The relationship of specific psychiatric conditions to adherence has not been examined in longitudinal studies of youth with perinatal HIV infection (PHIV). We examined associations between psychiatric conditions and antiretroviral nonadherence over 2 years. Longitudinal study in 294 PHIV youth, 6-17 years old, in the United States and Puerto Rico. We annually assessed three nonadherence outcomes: missed above 5% of doses in the past 3 days, missed a dose within the past month, and unsuppressed viral load (>400 copies/ml). We fit multivariable logistic models for nonadherence using Generalized Estimating Equations, and evaluated associations of psychiatric conditions (attention deficit hyperactivity disorder, disruptive behavior, depression, anxiety) at entry with incident nonadherence using multivariable logistic regression. Nonadherence prevalence at study entry was 14% (3-day recall), 32% (past month nonadherence), and 38% (unsuppressed viral load), remaining similar over time. At entry, 38% met symptom cut-off criteria for at least one psychiatric condition. Greater odds of 3-day recall nonadherence were observed at week 96 for those with depression [adjusted odds ratio (aOR) 4.14, 95% confidence interval (CI) 1.11-15.42] or disruptive behavior (aOR 3.36, 95% CI 1.02-11.10], but not at entry. Those with vs. without attention deficit hyperactivity disorder had elevated odds of unsuppressed viral load at weeks 48 (aOR 2.46, 95% CI 1.27-4.78) and 96 (aOR 2.35, 95% CI 1.01-5.45), but not at entry. Among 232 youth adherent at entry, 16% reported incident 3-day recall nonadherence. Disruptive behavior conditions at entry were associated with incident 3-day recall nonadherence (aOR 3.01, 95% CI 1.24-7.31). In PHIV youth, comprehensive adherence interventions that address psychiatric conditions throughout the transition to adult care are needed.

Prevalence and Factors Associated to Hypertension Among Older Adults in Bogotá, Colombia.

PubMed

Cano-Gutierrez, Carlos; Reyes-Ortiz, Carlos A; Samper-Ternent, Rafael; Gélvez-Rueda, Juan Sebastián; Borda, Miguel German

2015-09-01

To characterize older adults in Bogotá with high blood pressure and identify factors associated to this condition within this population. Using data from the Salud, Bienestar y Envejecimiento (SABE) (Health, Well-being and Aging) Bogotá Study, we analyzed community-dwelling adults 60 years and older with hypertension. We estimated the prevalence and used logistic regression models to identify factors associated to hypertension. The overall prevalence for hypertension was 56.9%. Older age (odds ratio [OR] = 1.46, 95% confidence interval [CI] = [1.07, 1.97]), having health insurance (OR = 4.15, CI = [1.95, 8.85]), cardiovascular diseases (ORs between 1.70 and 3.65), and poor self-rated health (OR = 1.57, CI = [1.20,2.06]) significantly increased the odds of hypertension. Most individuals received pharmacologic treatment (93.5%); however, 28.4% of individuals had uncontrolled hypertension. We found a high prevalence of hypertension in our cohort and found that comorbidities and poor self-rated health increase the odds of hypertension. Future studies need to tailor interventions for hypertension management in old age. © The Author(s) 2015.

Socioeconomic inequality in the provision of specific preventive dental interventions among children in the UK: Children's Dental Health Survey 2003.

PubMed

Shaban, R; Kassim, S; Sabbah, W

2017-06-09

Aim To assess socioeconomic inequality regarding specific preventive interventions (fissure sealants or any treatment to prevent caries) and dental visits among UK children.Method Data were from the Children's Dental Health Survey 2003, which included participants from England, Wales, Scotland, and Northern Ireland. The number of children in the analysis was 2,286. Variables were sex, age, area of residency (for example, England), mother's education, family social class, and deprivation level. Descriptive and regression analyses were performed.Results There were no significant socioeconomic differences in the use of preventive services. Deprivation and family social class (for example, intermediate and manual) were significantly associated with less regular dental visits (odd ratio 0.41, 95% CI [0.28, 0.63]; odd ratio 0.53, 95% CI [0.31, 0.89]; odd ratio 0.37, 95% CI [0.24, 0.58], respectively). Regular dental visits were associated with reporting preventive care for caries (odds ratio 2.25, 95% CI [1.45, 3.49]) and with the number of sealed tooth surfaces (rate ratio 1.73, 95% CI [1.16, 2.60]).Conclusion Despite apparent socioeconomic inequalities in regular dental visits, there was no significant inequality in using specific preventive interventions by children in the UK. This finding should be interpreted with caution considering the relatively small subsample included in this analysis.

Meta-analysis on shift work and risks of specific obesity types.

PubMed

Sun, M; Feng, W; Wang, F; Li, P; Li, Z; Li, M; Tse, G; Vlaanderen, J; Vermeulen, R; Tse, L A

2018-01-01

This systematic review and meta-analysis evaluated the associations between shift work patterns and risks of specific types of obesity. PubMed was searched until March 2017 for observational studies that examined the relationships between shift work patterns and obesity. Odds ratio for obesity was extracted using a fixed-effects or random-effects model. Subgroup meta-analyses were carried out for study design, specific obesity types and characteristics of shift work pattern. A total of 28 studies were included in this meta-analysis. The overall odds ratio of night shift work was 1.23 (95% confidence interval = 1.17-1.29) for risk of obesity/overweight. Cross-sectional studies showed a higher risk of 1.26 than those with the cohort design (risk ratio = 1.10). Shift workers had a higher frequency of developing abdominal obesity (odds ratio = 1.35) than other obesity types. Permanent night workers demonstrated a 29% higher risk than rotating shift workers (odds ratio 1.43 vs. 1.14). This meta-analysis confirmed the risks of night shift work for the development of overweight and obesity with a potential gradient association suggested, especially for abdominal obesity. Modification of working schedules is recommended, particularly for prolonged permanent night work. More accurate and detailed measurements on shift work patterns should be conducted in future research. © 2017 World Obesity Federation.

The Overall Odds Ratio as an Intuitive Effect Size Index for Multiple Logistic Regression: Examination of Further Refinements

ERIC Educational Resources Information Center

Le, Huy; Marcus, Justin

2012-01-01

This study used Monte Carlo simulation to examine the properties of the overall odds ratio (OOR), which was recently introduced as an index for overall effect size in multiple logistic regression. It was found that the OOR was relatively independent of study base rate and performed better than most commonly used R-square analogs in indexing model…

Obesity and Associated Health Disparities Among Understudied Multiracial, Pacific Islander, and American Indian Adults.

PubMed

Subica, Andrew M; Agarwal, Neha; Sullivan, J Greer; Link, Bruce G

2017-12-01

This study examined the state of obesity, diabetes, and associated health disparities among understudied multiracial, Native Hawaiian and Other Pacific Islander (NHOPI), and American Indian and Alaskan Native (AIAN) adults. Aggregated data for 184,617 adults from the California Health Interview Survey (2005 to 2011) were analyzed to determine obesity, diabetes, poor/fair health, and physical disability prevalence by racial group. Logistic regressions controlling for age, gender, and key social determinants (education, marital status, poverty, health insurance) generated multiracial, NHOPI, and AIAN adults' odds ratios (ORs) for our targeted health conditions versus non-Hispanic white adults. Obesity, diabetes, and other targeted health conditions were highly prevalent among multiracial, NHOPI, and AIAN adults, who displayed significantly greater adjusted odds than non-Hispanic white adults for obesity (ORs = 1.2-1.9), diabetes (ORs = 1.6-2.4), poor/fair health (ORs = 1.4-1.7), and, with the exception of NHOPI adults, physical disability (ORs = 1.5-1.6). Multiracial and AIAN adults with obesity also had significantly higher adjusted odds of diabetes (OR = 1.5-2.6) than non-Hispanic white adults with obesity. Multiracial, NHOPI, and AIAN adults experience striking obesity-related disparities versus non-Hispanic white adults, urging further disparities research with these vulnerable minority populations. © 2017 The Obesity Society.

Psychotic experiences and religiosity: data from the WHO World Mental Health Surveys.

PubMed

Kovess-Masfety, V; Saha, S; Lim, C C W; Aguilar-Gaxiola, S; Al-Hamzawi, A; Alonso, J; Borges, G; de Girolamo, G; de Jonge, P; Demyttenaere, K; Florescu, S; Haro, J M; Hu, C; Karam, E G; Kawakami, N; Lee, S; Lepine, J P; Navarro-Mateu, F; Stagnaro, J C; Ten Have, M; Viana, M C; Kessler, R C; McGrath, J J

2018-04-01

Religiosity is often associated with better health outcomes. The aim of the study was to examine associations between psychotic experiences (PEs) and religiosity in a large, cross-national sample. A total of 25 542 adult respondents across 18 countries from the WHO World Mental Health Surveys were assessed for PEs, religious affiliation and indices of religiosity, DSM-IV mental disorders and general medical conditions. Logistic regression models were used to estimate the association between PEs and religiosity with various adjustments. Of 25 542 included respondents, 85.6% (SE = 0.3) (n = 21 860) respondents reported having a religious affiliation. Overall, there was no association between religious affiliation status and PEs. Within the subgroup having a religious affiliation, four of five indices of religiosity were significantly associated with increased odds of PEs (odds ratios ranged from 1.3 to 1.9). The findings persisted after adjustments for mental disorders and/or general medical conditions, as well as religious denomination type. There was a significant association between increased religiosity and reporting more types of PEs. Among individuals with religious affiliations, those who reported more religiosity on four of five indices had increased odds of PEs. Focussed and more qualitative research will be required to unravel the interrelationship between religiosity and PEs. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Acute Kidney Injury and Subsequent Frailty Status in Survivors of Critical Illness: A Secondary Analysis.

PubMed

Abdel-Kader, Khaled; Girard, Timothy D; Brummel, Nathan E; Saunders, Christina T; Blume, Jeffrey D; Clark, Amanda J; Vincz, Andrew J; Ely, E Wesley; Jackson, James C; Bell, Susan P; Archer, Kristin R; Ikizler, T Alp; Pandharipande, Pratik P; Siew, Edward D

2018-05-01

Acute kidney injury frequently complicates critical illness and is associated with high morbidity and mortality. Frailty is common in critical illness survivors, but little is known about the impact of acute kidney injury. We examined the association of acute kidney injury and frailty within a year of hospital discharge in survivors of critical illness. Secondary analysis of a prospective cohort study. Medical/surgical ICU of a U.S. tertiary care medical center. Three hundred seventeen participants with respiratory failure and/or shock. None. Acute kidney injury was determined using Kidney Disease Improving Global Outcomes stages. Clinical frailty status was determined using the Clinical Frailty Scale at 3 and 12 months following discharge. Covariates included mean ICU Sequential Organ Failure Assessment score and Acute Physiology and Chronic Health Evaluation II score as well as baseline comorbidity (i.e., Charlson Comorbidity Index), kidney function, and Clinical Frailty Scale score. Of 317 patients, 243 (77%) had acute kidney injury and one in four patients with acute kidney injury was frail at baseline. In adjusted models, acute kidney injury stages 1, 2, and 3 were associated with higher frailty scores at 3 months (odds ratio, 1.92; 95% CI, 1.14-3.24; odds ratio, 2.40; 95% CI, 1.31-4.42; and odds ratio, 4.41; 95% CI, 2.20-8.82, respectively). At 12 months, a similar association of acute kidney injury stages 1, 2, and 3 and higher Clinical Frailty Scale score was noted (odds ratio, 1.87; 95% CI, 1.11-3.14; odds ratio, 1.81; 95% CI, 0.94-3.48; and odds ratio, 2.76; 95% CI, 1.34-5.66, respectively). In supplemental and sensitivity analyses, analogous patterns of association were observed. Acute kidney injury in survivors of critical illness predicted worse frailty status 3 and 12 months postdischarge. These findings have important implications on clinical decision making among acute kidney injury survivors and underscore the need to understand the drivers of frailty to improve patient-centered outcomes.

Site fidelity, territory fidelity, and natal philopatry in Willow Flycatchers (Empidonax traillii)

USGS Publications Warehouse

Sedgwick, James A.

2004-01-01

I investigated the causes and consequences of adult breeding-site fidelity, territory fidelity, and natal philopatry in Willow Flycatchers (Empidonax traillii) in southeastern Oregon over a 10-year period, testing the general hypothesis that fidelity and dispersal distances are influenced by previous breeding performance. Willow Flycatchers adhered to the generally observed tendencies of passerine birds for low natal philopatry and high breedingsite fidelity. Site fidelity (return to the study area) of adult males (52.0%) and females (51.3%), and median dispersal distances between seasons (16 m vs. 19 m) were similar. Previous breeding performance and residency (age-experience), but not study-site quality, explained site fidelity in females. Site fidelity of females rearing 4–5 young (64.4%) exceeded that of unsuccessful females (40.0%), breeding dispersal was less (successful: 15 m; unsuccessful: 33 m), and novice residents were more site-faithful than former residents. Probability of site fidelity was higher for previously successful females (odds ratio = 4.76), those with greater seasonal fecundity (odds ratio = 1.58), novice residents (odds ratio = 1.41), and unparasitized females (odds ratio = 2.76). Male site fidelity was not related to residency, site quality, or previous breeding performance. Territory fidelity (return to the previous territory) in females was best explained by previous breeding performance, but not by site quality or residency. Previously successful females were more likely to return to their territory of the previous season than either unsuccessful (odds ratio = 14.35) or parasitized birds (odds ratio = 6.38). Male territory fidelity was not related to residency, site quality, or previous breeding performance. Natal philopatry was low (7.8%) and similar for males and females. Site quality appeared to influence philopatry, given that no birds reared at a low-quality study site returned there to breed, and birds reared there dispersed farther than birds reared at two other study sites. My results partially support the hypothesis that site fidelity is an adaptive response: (1) previously successful females that switched territories underperformed those that did not switch (P = 0.01); and (2) previously unsuccessful females that switched territories outperformed those that did not switch, but not significantly (P = 0.22).

Factors affecting poor nutritional status after small bowel resection in patients with Crohn disease.

PubMed

Jang, Ki Ung; Yu, Chang Sik; Lim, Seok-Byung; Park, In Ja; Yoon, Yong Sik; Kim, Chan Wook; Lee, Jong Lyul; Yang, Suk-Kyun; Ye, Byong Duk; Kim, Jin Cheon

2016-07-01

In Crohn disease, bowel-preserving surgery is necessary to prevent short bowel syndrome due to repeated operations. This study aimed to determine the remnant small bowel length cut-off and to evaluate the clinical factors related to nutritional status after small bowel resection in Crohn disease.We included 394 patients (69.3% male) who underwent small bowel resection for Crohn disease between 1991 and 2012. Patients who were classified as underweight (body mass index < 17.5) or at high risk of nutrition-related problems (modified nutritional risk index < 83.5) were regarded as having a poor nutritional status. Preliminary remnant small bowel length cut-offs were determined using receiver operating characteristic curves. Variables associated with poor nutritional status were assessed retrospectively using Student t tests, chi-squared tests, Fisher exact tests, and logistic regression analyses.The mean follow-up period was 52.9 months and the mean patient ages at the time of the last bowel surgery and last follow-up were 31.2 and 35.7 years, respectively. The mean remnant small bowel length was 331.8 cm. Forty-three patients (10.9%) underwent ileostomy, 309 (78.4%) underwent combined small bowel and colon resection, 111 (28.2%) had currently active disease, and 105 (26.6%) underwent at least 2 operations for recurrent disease. The mean body mass index and modified nutritional risk index were 20.6 and 100.8, respectively. The independent factors affecting underweight status were remnant small bowel length ≤240 cm (odds ratio: 4.84, P < 0.001), ileostomy (odds ratio: 4.70, P < 0.001), and currently active disease (odds ratio: 4.16, P < 0.001). The independent factors affecting high nutritional risk were remnant small bowel length ≤230 cm (odds ratio: 2.84, P = 0.012), presence of ileostomy (odds ratio: 3.36, P = 0.025), and currently active disease (odds ratio: 4.90, P < 0.001).Currently active disease, ileostomy, and remnant small bowel length ≤230 cm are risk factors affecting the poor nutritional status of patients with Crohn disease after small bowel resection.

Predicting the occurrence of embolic events: an analysis of 1456 episodes of infective endocarditis from the Italian Study on Endocarditis (SEI).

PubMed

Rizzi, Marco; Ravasio, Veronica; Carobbio, Alessandra; Mattucci, Irene; Crapis, Massimo; Stellini, Roberto; Pasticci, Maria Bruna; Chinello, Pierangelo; Falcone, Marco; Grossi, Paolo; Barbaro, Francesco; Pan, Angelo; Viale, Pierluigi; Durante-Mangoni, Emanuele

2014-04-29

Embolic events are a major cause of morbidity and mortality in patients with infective endocarditis. We analyzed the database of the prospective cohort study SEI in order to identify factors associated with the occurrence of embolic events and to develop a scoring system for the assessment of the risk of embolism. We retrospectively analyzed 1456 episodes of infective endocarditis from the multicenter study SEI. Predictors of embolism were identified. Risk factors identified at multivariate analysis as predictive of embolism in left-sided endocarditis, were used for the development of a risk score: 1 point was assigned to each risk factor (total risk score range: minimum 0 points; maximum 2 points). Three categories were defined by the score: low (0 points), intermediate (1 point), or high risk (2 points); the probability of embolic events per risk category was calculated for each day on treatment (day 0 through day 30). There were 499 episodes of infective endocarditis (34%) that were complicated by ≥ 1 embolic event. Most embolic events occurred early in the clinical course (first week of therapy: 15.5 episodes per 1000 patient days; second week: 3.7 episodes per 1000 patient days). In the total cohort, the factors associated with the occurrence of embolism at multivariate analysis were prosthetic valve localization (odds ratio, 1.84), right-sided endocarditis (odds ratio, 3.93), Staphylococcus aureus etiology (odds ratio, 2.23) and vegetation size ≥ 13 mm (odds ratio, 1.86). In left-sided endocarditis, Staphylococcus aureus etiology (odds ratio, 2.1) and vegetation size ≥ 13 mm (odds ratio, 2.1) were independently associated with embolic events; the 30-day cumulative incidence of embolism varied with risk score category (low risk, 12%; intermediate risk, 25%; high risk, 38%; p < 0.001). Staphylococcus aureus etiology and vegetation size are associated with an increased risk of embolism. In left-sided endocarditis, a simple scoring system, which combines etiology and vegetation size with time on antimicrobials, might contribute to a better assessment of the risk of embolism, and to a more individualized analysis of indications and contraindications for early surgery.

Clinical impact and predictors of complete ST segment resolution after primary percutaneous coronary intervention: A subanalysis of the ATLANTIC Trial.

PubMed

Fabris, Enrico; van 't Hof, Arnoud; Hamm, Christian W; Lapostolle, Frédéric; Lassen, Jens F; Goodman, Shaun G; Ten Berg, Jurriën M; Bolognese, Leonardo; Cequier, Angel; Chettibi, Mohamed; Hammett, Christopher J; Huber, Kurt; Janzon, Magnus; Merkely, Béla; Storey, Robert F; Zeymer, Uwe; Cantor, Warren J; Tsatsaris, Anne; Kerneis, Mathieu; Diallo, Abdourahmane; Vicaut, Eric; Montalescot, Gilles

2017-08-01

In the ATLANTIC (Administration of Ticagrelor in the catheterization laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery) trial the early use of aspirin, anticoagulation, and ticagrelor coupled with very short medical contact-to-balloon times represent good indicators of optimal treatment of ST-elevation myocardial infarction and an ideal setting to explore which factors may influence coronary reperfusion beyond a well-established pre-hospital system. This study sought to evaluate predictors of complete ST-segment resolution after percutaneous coronary intervention in ST-elevation myocardial infarction patients enrolled in the ATLANTIC trial. ST-segment analysis was performed on electrocardiograms recorded at the time of inclusion (pre-hospital electrocardiogram), and one hour after percutaneous coronary intervention (post-percutaneous coronary intervention electrocardiogram) by an independent core laboratory. Complete ST-segment resolution was defined as ≥70% ST-segment resolution. Complete ST-segment resolution occurred post-percutaneous coronary intervention in 54.9% ( n=800/1456) of patients and predicted lower 30-day composite major adverse cardiovascular and cerebrovascular events (odds ratio 0.35, 95% confidence interval 0.19-0.65; p<0.01), definite stent thrombosis (odds ratio 0.18, 95% confidence interval 0.02-0.88; p=0.03), and total mortality (odds ratio 0.43, 95% confidence interval 0.19-0.97; p=0.04). In multivariate analysis, independent negative predictors of complete ST-segment resolution were the time from symptoms to pre-hospital electrocardiogram (odds ratio 0.91, 95% confidence interval 0.85-0.98; p<0.01) and diabetes mellitus (odds ratio 0.6, 95% confidence interval 0.44-0.83; p<0.01); pre-hospital ticagrelor treatment showed a favorable trend for complete ST-segment resolution (odds ratio 1.22, 95% confidence interval 0.99-1.51; p=0.06). This study confirmed that post-percutaneous coronary intervention complete ST-segment resolution is a valid surrogate marker for cardiovascular clinical outcomes. In the current era of ST-elevation myocardial infarction reperfusion, patients' delay and diabetes mellitus are independent predictors of poor reperfusion and need specific attention in the future.

Association of CKD with Outcomes Among Patients Undergoing Transcatheter Aortic Valve Implantation

PubMed Central

Kaier, Klaus; Kaleschke, Gerrit; Gebauer, Katrin; Meyborg, Matthias; Malyar, Nasser M.; Freisinger, Eva; Baumgartner, Helmut; Reinecke, Holger; Reinöhl, Jochen

2017-01-01

Background and objectives Despitethe multiple depicted associations of CKD with reduced cardiovascular and overall prognoses, the association of CKD with outcome of patients undergoing transcatheter aortic valve implantation has still not been well described. Design, setting, participants, & measurements Data from all hospitalized patients who underwent transcatheter aortic valve implantation procedures between January 1, 2010 and December 31, 2013 in Germany were evaluated regarding influence of CKD, even in the earlier stages, on morbidity, in-hospital outcomes, and costs. Results A total of 28,716 patients were treated with transcatheter aortic valve implantation. A total of 11,189 (39.0%) suffered from CKD. Patients with CKD were predominantly women; had higher rates of comorbidities, such as coronary artery disease, heart failure at New York Heart Association 3/4, peripheral artery disease, and diabetes; and had a 1.3-fold higher estimated logistic European System for Cardiac Operative Risk Evaluation value. In-hospital mortality was independently associated with CKD stage ≥3 (up to odds ratio, 1.71; 95% confidence interval, 1.35 to 2.17; P<0.05), bleeding was independently associated with CKD stage ≥4 (up to odds ratio, 1.82; 95% confidence interval, 1.47 to 2.24; P<0.001), and AKI was independently associated with CKD stages 3 (odds ratio, 1.83; 95% confidence interval, 1.62 to 2.06) and 4 (odds ratio, 2.33; 95% confidence interval, 1.92 to 2.83 both P<0.001). The stroke risk, in contrast, was lower for patients with CKD stages 4 (odds ratio, 0.23; 95% confidence interval, 0.16 to 0.33) and 5 (odds ratio, 0.24; 95% confidence interval, 0.15 to 0.39; both P<0.001). Lengths of hospital stay were, on average, 1.2-fold longer, whereas reimbursements were, on average, only 1.03-fold higher in patients who suffered from CKD. Conclusions This analysis illustrates for the first time on a nationwide basis the association of CKD with adverse outcomes in patients who underwent transcatheter aortic valve implantation. Thus, classification of CKD stages before transcatheter aortic valve implantation is important for appropriate risk stratification. PMID:28289067

Association of CKD with Outcomes Among Patients Undergoing Transcatheter Aortic Valve Implantation.

PubMed

Lüders, Florian; Kaier, Klaus; Kaleschke, Gerrit; Gebauer, Katrin; Meyborg, Matthias; Malyar, Nasser M; Freisinger, Eva; Baumgartner, Helmut; Reinecke, Holger; Reinöhl, Jochen

2017-05-08

Despitethe multiple depicted associations of CKD with reduced cardiovascular and overall prognoses, the association of CKD with outcome of patients undergoing transcatheter aortic valve implantation has still not been well described. Data from all hospitalized patients who underwent transcatheter aortic valve implantation procedures between January 1, 2010 and December 31, 2013 in Germany were evaluated regarding influence of CKD, even in the earlier stages, on morbidity, in-hospital outcomes, and costs. A total of 28,716 patients were treated with transcatheter aortic valve implantation. A total of 11,189 (39.0%) suffered from CKD. Patients with CKD were predominantly women; had higher rates of comorbidities, such as coronary artery disease, heart failure at New York Heart Association 3/4, peripheral artery disease, and diabetes; and had a 1.3-fold higher estimated logistic European System for Cardiac Operative Risk Evaluation value. In-hospital mortality was independently associated with CKD stage ≥3 (up to odds ratio, 1.71; 95% confidence interval, 1.35 to 2.17; P <0.05), bleeding was independently associated with CKD stage ≥4 (up to odds ratio, 1.82; 95% confidence interval, 1.47 to 2.24; P <0.001), and AKI was independently associated with CKD stages 3 (odds ratio, 1.83; 95% confidence interval, 1.62 to 2.06) and 4 (odds ratio, 2.33; 95% confidence interval, 1.92 to 2.83 both P <0.001). The stroke risk, in contrast, was lower for patients with CKD stages 4 (odds ratio, 0.23; 95% confidence interval, 0.16 to 0.33) and 5 (odds ratio, 0.24; 95% confidence interval, 0.15 to 0.39; both P <0.001). Lengths of hospital stay were, on average, 1.2-fold longer, whereas reimbursements were, on average, only 1.03-fold higher in patients who suffered from CKD. This analysis illustrates for the first time on a nationwide basis the association of CKD with adverse outcomes in patients who underwent transcatheter aortic valve implantation. Thus, classification of CKD stages before transcatheter aortic valve implantation is important for appropriate risk stratification. Copyright © 2017 by the American Society of Nephrology.

Combined metformin-clomiphene in clomiphene-resistant polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials.

PubMed

Abu Hashim, Hatem; Foda, Osama; Ghayaty, Essam

2015-09-01

Our objective was to compare the effectiveness of metformin plus clomiphene citrate vs. gonadotrophins, laparoscopic ovarian diathermy, aromatase inhibitors, N-acetyl-cysteine and other insulin sensitizers+clomiphene for improving fertility outcomes in women with clomiphene-resistant polycystic ovary syndrome. PubMed, SCOPUS and CENTRAL databases were searched until April 2014 with the key words: PCOS, polycystic ovary syndrome, metformin, clomiphene citrate, ovulation induction and pregnancy. The search was limited to articles conducted with humans and published in English. The PRISMA statement was followed. Twelve randomized controlled trials (n = 1411 women) were included. Ovulation and clinical pregnancy rates per woman randomized. Compared with gonadotrophins, the metformin+clomiphene combination resulted in significantly fewer ovulations (odds ratio 0.25; 95% confidence interval 0.15-0.41; p < 0.00001, 3 trials, I(2) = 85%, n = 323) and pregnancies (odds ratio 0.45; 95% confidence interval 0.27-0.75; p = 0.002, 3 trials, I(2) = 0%, n = 323). No significant differences were found when metformin+clomiphene was compared with laparoscopic ovarian diathermy (odds ratio 0.88; 95% confidence interval 0.53-1.47; p = 0.62, 1 trial, n = 282; odds ratio 0.96; 95% confidence interval 0.60-1.54; p = 0.88, 2 trials, I(2) = 0%, n = 332, for ovulation and pregnancy rates, respectively). Likewise, no differences were observed in comparison with aromatase inhibitors (odds ratio 0.88; 95% confidence interval 0.58-1.34; p = 0.55, 3 trials, I(2) = 3%, n = 409; odds ratio 0.85; 95% confidence interval 0.53-1.36; p = 0.50, 2 trials, n = 309, for ovulation and pregnancy rates, respectively). There is evidence for the superiority of gonadotrophins, but the metformin+clomiphene combination is mainly relevant for clomiphene-resistant polycystic ovary syndrome patients and, if not effective, a next step could be gonadotrophins. More attempts with metformin+clomiphene are only relevant if there is limited access to gonadotrophins. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

Gastric dilation-volvulus in dogs attending UK emergency-care veterinary practices: prevalence, risk factors and survival.

PubMed

O'Neill, D G; Case, J; Boag, A K; Church, D B; McGreevy, P D; Thomson, P C; Brodbelt, D C

2017-11-01

To report prevalence, risk factors and clinical outcomes for presumptive gastric dilation-volvulus diagnosed among an emergency-care population of UK dogs. The study used a cross-sectional design using emergency-care veterinary clinical records from the VetCompass Programme spanning September 1, 2012 to February 28, 2014 and risk factor analysis using multivariable logistic regression modelling. The study population comprised 77,088 dogs attending 50 Vets Now clinics. Overall, 492 dogs had presumptive gastric dilation-volvulus diagnoses, giving a prevalence of 0·64% (95% Confidence interval: 0·58 to 0·70%). Compared with cross-bred dogs, breeds with the highest odds ratios for the diagnosis of presumptive gastric dilation-volvulus were the great Dane (odds ratio: 114·3, 95% Confidence interval 55·1 to 237·1, P<0·001), akita (odds ratio: 84·4, 95% Confidence interval 33·6 to 211·9, P<0·001) and dogue de Bordeaux (odds ratio: 82·9, 95% Confidence interval 39·0 to 176·3, P<0·001). Odds increased as dogs aged up to 12 years and neutered male dogs had 1·3 (95% Confidence interval 1·0 to 1·8, P=0·041) times the odds compared with entire females. Of the cases that were presented alive, 49·7% survived to discharge overall, but 79·3% of surgical cases survived to discharge. Approximately 80% of surgically managed cases survived to discharge. Certain large breeds were highly predisposed. © 2017 British Small Animal Veterinary Association.

Functional Status Is Associated With 30-Day Potentially Preventable Hospital Readmissions After Inpatient Rehabilitation Among Aged Medicare Fee-for-Service Beneficiaries.

PubMed

Middleton, Addie; Graham, James E; Ottenbacher, Kenneth J

2018-06-01

To determine the association between patients' functional status at discharge from inpatient rehabilitation and 30-day potentially preventable hospital readmissions. A secondary objective was to examine the conditions resulting in these potentially preventable readmissions. Retrospective cohort study. Inpatient rehabilitation facilities submitting claims to Medicare. National cohort (N=371,846) of inpatient rehabilitation discharges among aged Medicare fee-for-service beneficiaries in 2013 to 2014. The average age was 79.1±7.6 years. Most were women (59.7%) and white (84.5%). Not applicable. (1) Observed rates and adjusted odds of 30-day potentially preventable hospital readmissions after inpatient rehabilitation and (2) primary diagnoses for readmissions. The overall rate of any 30-day hospital readmission after inpatient rehabilitation was 12.4% (n=46,265), and the overall rate of potentially preventable readmissions was 5.0% (n=18,477). Functional independence was associated with lower observed rates and adjusted odds ratios for potentially preventable readmissions. Observed rates for the highest versus lowest quartiles within each functional domain were as follows: self-care: 3.4% (95% confidence interval [CI], 3.3-3.5) versus 6.9% (95% CI, 6.7-7.1), mobility: 3.3% (95% CI, 3.2-3.4) versus 7.2% (95% CI, 7.0-7.4), and cognition: 3.5% (95% CI, 3.4-3.6) versus 6.2% (95% CI, 6.0-6.4), respectively. Similarly, adjusted odds ratios were as follows: self-care: .70 (95% CI, .67-.74), mobility: .64 (95% CI, .61-.68), and cognition: .84 (95% CI, .80-.89). Infection-related conditions (44.1%) were the most common readmission diagnoses followed by inadequate management of chronic conditions (31.2%) and inadequate management of other unplanned events (24.7%). Functional status at discharge from inpatient rehabilitation was associated with 30-day potentially preventable readmissions in our sample of aged Medicare beneficiaries. This information may help identify at-risk patients. Future research is needed to determine whether follow-up programs focused on improving functional independence will reduce readmission rates. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Fraternal Birth Order, Family Size, and Male Homosexuality: Meta-Analysis of Studies Spanning 25 Years.

PubMed

Blanchard, Ray

2018-01-01

The fraternal birth order effect is the tendency for older brothers to increase the odds of homosexuality in later-born males. This study compared the strength of the effect in subjects from small versus large families and in homosexual subjects with masculine versus feminine gender identities. Meta-analyses were conducted on 30 homosexual and 30 heterosexual groups from 26 studies, totaling 7140 homosexual and 12,837 heterosexual males. The magnitude of the fraternal birth order effect was measured with a novel variable, the Older Brothers Odds Ratio, computed as (homosexuals' older brothers ÷ homosexuals' other siblings) ÷ (heterosexuals' older brothers ÷ heterosexuals' other siblings), where other siblings = older sisters + younger brothers + younger sisters. An Older Brothers Odds Ratio of 1.00 represents no effect of sexual orientation; values over 1.00 are positive evidence for the fraternal birth order effect. Evidence for the reliability of the effect was consistent. The Older Brothers Odds Ratio was significantly >1.00 in 20 instances, >1.00 although not significantly in nine instances, and nonsignificantly <1.00 in 1 instance. The pooled Older Brothers Odds Ratio for all samples was 1.47, p < .00001. Subgroups analyses showed that the magnitude of the effect was significantly greater in the 12 feminine or transgender homosexual groups than in the other 18 homosexual groups. There was no evidence that the magnitude of the effect differs according to family size.

Influence of gender role attitudes on smoking and drinking among girls from Jujuy, Argentina.

PubMed

Mejia, Raul; Kaplan, Celia P; Alderete, Ethel; Gregorich, Steven E; Pérez-Stable, Eliseo J

2013-09-01

Evaluate effect of gender role attitudes on tobacco and alcohol use among Argentinean girls. Cross-sectional survey of 10th grade students attending 27 randomly selected schools in Jujuy, Argentina. Questions about tobacco and alcohol use were adapted from global youth surveys. Five items with 5-point response options of agreement-disagreement assessed attitude towards egalitarian (higher score) gender roles. 2133 girls, aged 13-18 years, 71% Indigenous, 22% mixed Indigenous/European, and 7% European responded. Of these, 60% had ever smoked, 32% were current smokers, 58% ever drinkers, 27% drank in previous month, and 13% had ≥5 drinks on one occasion. Mean response to the gender role scale was 3.49 (95% Confidence Intervals = 3.41-3.57) out of 5 tending toward egalitarian attitudes. Logistic regression models using the gender role scale score as the main predictor and adjusting for demographic and social confounders showed that egalitarian gender role was associated with ever smoking (Odds Ratio = 1.25; 95% Confidence Intervals 1.09-1.44), ever drinking (Odds Ratio = 1.24; 95% Confidence Intervals 1.10-1.40), drinking in prior month (Odds Ratio = 1.21; 95% Confidence Intervals 1.07-1.37) and ≥5 drinks on one occasion (Odds Ratio = 1.15; 95% Confidence Intervals 1.00-1.33), but was not significant for current smoking. Girls in Jujuy who reported more egalitarian gender role attitudes had higher odds of smoking or drinking. Copyright © 2013 Elsevier Inc. All rights reserved.

Physical Activity and Anger or Emotional Upset as Triggers of Acute Myocardial Infarction: The INTERHEART Study.

PubMed

Smyth, Andrew; O'Donnell, Martin; Lamelas, Pablo; Teo, Koon; Rangarajan, Sumathy; Yusuf, Salim

2016-10-11

Physical exertion, anger, and emotional upset are reported to trigger acute myocardial infarction (AMI). In the INTERHEART study, we explored the triggering association of acute physical activity and anger or emotional upset with AMI to quantify the importance of these potential triggers in a large, international population. INTERHEART was a case-control study of first AMI in 52 countries. In this analysis, we included only cases of AMI and used a case-crossover approach to estimate odds ratios for AMI occurring within 1 hour of triggers. Of 12 461 cases of AMI 13.6% (n=1650) engaged in physical activity and 14.4% (n=1752) were angry or emotionally upset in the case period (1 hour before symptom onset). Physical activity in the case period was associated with increased odds of AMI (odds ratio, 2.31; 99% confidence interval [CI], 1.96-2.72) with a population-attributable risk of 7.7% (99% CI, 6.3-8.8). Anger or emotional upset in the case period was associated with an increased odds of AMI (odds ratio, 2.44; 99% CI, 2.06-2.89) with a population-attributable risk of 8.5% (99% CI, 7.0-9.6). There was no effect modification by geographical region, prior cardiovascular disease, cardiovascular risk factor burden, cardiovascular prevention medications, or time of day or day of onset of AMI. Both physical activity and anger or emotional upset in the case period were associated with a further increase in the odds of AMI (odds ratio, 3.05; 99% CI, 2.29-4.07; P for interaction <0.001). Physical exertion and anger or emotional upset are triggers associated with first AMI in all regions of the world, in men and women, and in all age groups, with no significant effect modifiers. © 2016 American Heart Association, Inc.

REVERSALS OF GNEVYSHEV-OHL RULE

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

Tlatov, Andrey G., E-mail: tlatov@mail.ru

2013-08-01

We perform an analysis of the number of sunspot groups in activity cycles from 1610 through the present. Here we use the G{sub n} index, which is defined as the average daily number of sunspot groups in cycle n. There is a high positive correlation between the parameter G{sub n} in the current cycle and an analogous parameter in the following cycle G{sub n{sub +1}} both for pairs of even-odd cycles and odd-even activity cycles. In cycle Nos. 10-21 for pairs of even-odd cycles, the ratio of parameter G{sub n} corresponds to the GO rule G{sub n{sub +1}{sup odd}}/G{sub n}{supmore » even}>1. However, during the period {approx}1745-1850, odd cycles were less than the preceding even cycles G{sub n{sub +1}{sup odd}}/G{sub n}{sup even}<1. The ratio of the parameter G{sub n{sub +1}{sup odd}}/G{sub n}{sup even} has a long-term variation within the range 0.5-1.5 with a period of about 21 activity cycles, and it proves the reversal of the GO rule.« less

The psychological impact of terrorism: an epidemiologic study of posttraumatic stress disorder and associated factors in victims of the 1995-1996 bombings in France.

PubMed

Verger, Pierre; Dab, William; Lamping, Donna L; Loze, Jean-Yves; Deschaseaux-Voinet, Céline; Abenhaim, Lucien; Rouillon, Frédéric

2004-08-01

A wave of bombings struck France in 1995 and 1996, killing 12 people and injuring more than 200. The authors conducted follow-up evaluations with the victims in 1998 to determine the prevalence of and factors associated with posttraumatic stress disorder (PTSD). Victims directly exposed to the bombings (N=228) were recruited into a retrospective, cross-sectional study. Computer-assisted telephone interviews were conducted to evaluate PTSD, per DSM-IV criteria, and to assess health status before the attack, initial injury severity and perceived threat at the time of attack, and psychological symptoms, cosmetic impairment, hearing problems, and health service use at the time of the follow-up evaluation. Factors associated with PTSD were investigated with univariate logistic regression followed by multiple logistic regression analyses. A total of 196 respondents (86%) participated in the study. Of these, 19% had severe initial physical injuries (hospitalization exceeding 1 week). Problems reported at the follow-up evaluation included attack-related hearing problems (51%), cosmetic impairment (33%), and PTSD (31%) (95% confidence interval=24.5%-37.5%). Results of logistic regression analyses indicated that the risk of PTSD was significantly higher among women (odds ratio=2.54), participants age 35-54 (odds ratio=2.83), and those who had severe initial injuries (odds ratio=2.79) or cosmetic impairment (odds ratio=2.74) or who perceived substantial threat during the attack (odds ratio=3.99). The high prevalence of PTSD 2.6 years on average after a terrorist attack emphasizes the need for improved health services to address the intermediate and long-term consequences of terrorism.

Systematic review and meta-analysis estimating association of cysticercosis and neurocysticercosis with epilepsy

PubMed Central

Debacq, Gabrielle; Garcia, Héctor H.; Boumediene, Farid; Marin, Benoit; Ngoungou, Edgard B.; Preux, Pierre-Marie

2017-01-01

Background We reviewed studies that analyzed cysticercosis (CC), neurocysticercosis (NCC) and epilepsy across Latin America, Asia and Sub-Saharan Africa, to estimate the odds ratio and etiologic fraction of epilepsy due to CC in tropical regions. Methodology We conducted a systematic review of the literature on cysticercosis and epilepsy in the tropics, collecting data from case-control and cross-sectional studies. Exposure criteria for CC included one or more of the following: serum ELISA or EITB positivity, presence of subcutaneous cysts (both not verified and unverified by histology), histology consistent with calcified cysts, and brain CT scan consistent with NCC. A common odds-ratio was then estimated using meta-analysis. Principal findings 37 studies from 23 countries were included (n = 24,646 subjects, 14,934 with epilepsy and 9,712 without epilepsy). Of these, 29 were case-control (14 matched). The association between CC and epilepsy was significant in 19 scientific articles. Odds ratios ranged from 0.2 to 25.4 (a posteriori power 4.5–100%) and the common odds ratio was 2.7 (95% CI 2.1–3.6, p <0.001). Three subgroup analyses performed gave odds ratios as: 2.2 (EITB-based studies), 3.2 (CT-based studies), 1.9 (neurologist-confirmed epilepsy; door-to-door survey and at least one matched control per case). Etiologic fraction was estimated to be 63% in the exposed group among the population. Significance Despite differences in findings, this meta-analysis suggests that cysticercosis is a significant contributor to late-onset epilepsy in tropical regions around the world, and its impact may vary depending on transmission intensity. PMID:28267746

Intrauterine fetal death and risk of shoulder dystocia at delivery.

PubMed

Larsen, Sandra; Dobbin, Joanna; McCallion, Oliver; Eskild, Anne

2016-12-01

Vaginal delivery is recommended after intrauterine fetal death. However, little is known about the risk of shoulder dystocia in these deliveries. We studied whether intrauterine fetal death increases the risk of shoulder dystocia at delivery. In this population-based register study using the Medical Birth Registry of Norway, we included all singleton pregnancies with vaginal delivery of offspring in cephalic presentation in Norway during the period 1967-2012 (n = 2 266 118). Risk of shoulder dystocia was estimated as absolute risk (%) and odds ratio with 95% confidence interval. Adjustment was made for offspring birthweight (in grams). We performed sub-analyses within categories of birthweight (<4000 and ≥4000 g) and in pregnancies with maternal diabetes. Shoulder dystocia occurred in 1.1% of pregnancies with intrauterine fetal death and in 0.8% of pregnancies without intrauterine fetal death (p < 0.0001) (crude odds ratio 1.5, 95% confidence interval 1.2-4.9). After adjustment for birthweight, the odds ratio was 5.9 (95% confidence interval 4.7-7.4). In pregnancies with birthweight ≥4000 g, shoulder dystocia occurred in 14.6% of pregnancies with intrauterine fetal death and in 2.8% of pregnancies without intrauterine fetal death (p < 0.001) (crude odds ratio 5.9, 95% confidence interval 4.5-7.9). In pregnancies with birthweight ≥4000 g and concurrent maternal diabetes, shoulder dystocia occurred in 57.1% of pregnancies with intrauterine fetal death and 9.6% of pregnancies without intrauterine fetal death (p < 0.001) (crude odds ratio 12.6, 95% confidence interval 5.9-26.9). Intrauterine fetal death increased the risk of shoulder dystocia at delivery, and the absolute risk of shoulder dystocia was particularly high if offspring birthweight was high and the mother had diabetes. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

Responsibility Study: Main Illicit Psychoactive Substances Among Car Drivers Involved in Fatal Road Crashes

PubMed Central

Gadegbeku, Blandine; Amoros, Emmanuelle; Laumon, Bernard

2011-01-01

In 1999, in France, before considering modifications in drug legislation, the government requested a study of the effect of illicit drugs on the risk of road crashes. It implemented a systematic screening of illicit drugs for all drivers involved in fatal crashes between October 2001 and September 2003. Within the European DRUID project, the study was restricted to car drivers. The project reported here is a responsibility analysis and, as such, it belongs to the framework of case-control studies; the outcome of interest is “being responsible for a fatal crash”. It was assessed with a method adapted from Robertson and Drummer. Cases are the 4,946 car drivers who are responsible for the crash; controls are the 1,986 car drivers selected from the non-responsible car drivers, in a way that makes the control group similar to the general driving population. The effect of cannabis on fatal crash responsibility is significant after adjustment for age, sex and alcohol: adjusted odds ratio is 1.89 [1.43–2.51]. The dose-response effect is significant (p=0.0001). For alcohol (≥0.1 g/l), the adjusted odds ratio for responsibility is 8.39 [6.95–10.11]. No interaction was found between alcohol and cannabis. For amphetamine, cocaine and opiates, adjusted odds ratios were not significantly different from 1. However the statistical power is low. The study finds similar odds ratios for alcohol as previously published. For cannabis, the significant odds ratio together with the significant dose-response effect indicates a causal relationship between cannabis and road crashes. A multiplicative effect between cannabis and alcohol was noted. PMID:22105404

Prediction of posttraumatic stress disorder symptomatology after childbirth - A Croatian longitudinal study.

PubMed

Srkalović Imširagić, Azijada; Begić, Dražen; Šimičević, Livija; Bajić, Žarko

2017-02-01

Following childbirth, a vast number of women experience some degree of mood swings, while some experience symptoms of postpartum posttraumatic stress disorder. Using a biopsychosocial model, the primary aim of this study was to identify predictors of posttraumatic stress disorder and its symptomatology following childbirth. This observational, longitudinal study included 372 postpartum women. In order to explore biopsychosocial predictors, participants completed several questionnaires 3-5 days after childbirth: the Impact of Events Scale Revised, the Big Five Inventory, The Edinburgh Postnatal Depression Scale, breastfeeding practice and social and demographic factors. Six to nine weeks after childbirth, participants re-completed the questionnaires regarding psychiatric symptomatology and breastfeeding practice. Using a multivariate level of analysis, the predictors that increased the likelihood of postpartum posttraumatic stress disorder symptomatology at the first study phase were: emergency caesarean section (odds ratio 2.48; confidence interval 1.13-5.43) and neuroticism personality trait (odds ratio 1.12; confidence interval 1.05-1.20). The predictor that increased the likelihood of posttraumatic stress disorder symptomatology at the second study phase was the baseline Impact of Events Scale Revised score (odds ratio 12.55; confidence interval 4.06-38.81). Predictors that decreased the likelihood of symptomatology at the second study phase were life in a nuclear family (odds ratio 0.27; confidence interval 0.09-0.77) and life in a city (odds ratio 0.29; confidence interval 0.09-0.94). Biopsychosocial theory is applicable to postpartum psychiatric disorders. In addition to screening for depression amongst postpartum women, there is a need to include other postpartum psychiatric symptomatology screenings in routine practice. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Determinants of Long-Term Neurological Recovery Patterns Relative to Hospital Discharge Among Cardiac Arrest Survivors.

PubMed

Agarwal, Sachin; Presciutti, Alex; Roth, William; Matthews, Elizabeth; Rodriguez, Ashley; Roh, David J; Park, Soojin; Claassen, Jan; Lazar, Ronald M

2018-02-01

To explore factors associated with neurological recovery at 1 year relative to hospital discharge after cardiac arrest. Observational, retrospective review of a prospectively collected cohort. Medical or surgical ICUs in a single tertiary care center. Older than 18 years, resuscitated following either in-hospital or out-of-hospital cardiac arrest and considered for targeted temperature management between 2007 and 2013. None. Logistic regressions to determine factors associated with a poor recovery pattern after 1 year, defined as persistent Cerebral Performance Category Score 3-4 or any worsening of Cerebral Performance Category Score relative to discharge status. In total, 30% (117/385) of patients survived to hospital discharge; among those discharged with Cerebral Performance Category Score 1, 2, 3, and 4, good recovery pattern was seen in 54.5%, 48.4%, 39.5%, and 0%, respectively. Significant variables showing trends in associations with a poor recovery pattern (62.5%) in a multivariate model were age more than 70 years (odds ratio, 4; 95% CIs, 1.1-15; p = 0.04), Hispanic ethnicity (odds ratio, 4; CI, 1.2-13; p = 0.02), and discharge disposition (home needing out-patient services (odds ratio, 1), home requiring no additional services (odds ratio, 0.15; CI, 0.03-0.8; p = 0.02), acute rehabilitation (odds ratio, 0.23; CI, 0.06-0.9; p = 0.04). Patients discharged with mild or moderate cerebral dysfunction sustained their risk of neurological worsening within 1 year of cardiac arrest. Old age, Hispanic ethnicity, and discharge disposition of home with out-patient services may be associated with a poor 1 year neurological recovery pattern after hospital discharge from cardiac arrest.

Gastrointestinal symptoms in spinal cord injury: relationships with level of injury and psychologic factors.

PubMed

Ng, Clinton; Prott, Gillian; Rutkowski, Susan; Li, Yueming; Hansen, Ross; Kellow, John; Malcolm, Allison

2005-08-01

Previous surveys of gastrointestinal symptoms after spinal cord injury have not used validated questionnaires and have not focused on the full spectrum of such symptoms and their relationship to factors, such as level of spinal cord injury and psychologic dysfunction. This study was designed to detail the spectrum and prevalence of gastrointestinal symptoms in spinal cord injury and to determine clinical and psychologic factors associated with such symptoms. Established spinal cord injury patients (>12 months) randomly selected from a spinal cord injury database completed the following three questionnaires: 1) Rome II Integrative Questionnaire, 2) Hospital Anxiety and Depression Scale, and 3) Burwood Bowel Dysfunction after spinal cord injury. A total of 110 patients participated. The prevalence of abdominal bloating and constipation were 22 and 46 percent, respectively. Bloating was associated with cervical (odds ratio = 9.5) and lumbar (odds ratio = 12.1) level but not with thoracic level of injury. Constipation was associated with a higher level of injury (cervical odds ratio = 5.6 vs. lumbar) but not with psychologic factors. In contrast, abdominal pain (33 percent) and fecal incontinence (41 percent) were associated with higher levels of anxiety (odds ratio = 6.8, and odds ratio = 2.4) but not with the level of injury. There is a high prevalence and wide spectrum of gastrointestinal symptoms in spinal cord injury. Abdominal bloating and constipation are primarily related to specific spinal cord levels of injury, whereas abdominal pain and fecal incontinence are primarily associated with higher levels of anxiety. Based on our findings, further physiologic and psychologic research studies in spinal cord injury patients should lead to more rational management strategies for the common gastrointestinal symptoms in spinal cord injury.

High definition versus standard definition white light endoscopy for detecting dysplasia in patients with Barrett's esophagus.

PubMed

Sami, S S; Subramanian, V; Butt, W M; Bejkar, G; Coleman, J; Mannath, J; Ragunath, K

2015-01-01

High-definition endoscopy systems provide superior image resolution. The aim of this study was to assess the utility of high definition compared with standard definition endoscopy system for detecting dysplastic lesions in patients with Barrett's esophagus. A retrospective cohort study of patients with non-dysplastic Barrett's esophagus undergoing routine surveillance was performed. Data were retrieved from the central hospital electronic database. Procedures performed for non-surveillance indications, Barrett's esophagus Prague C0M1 classification with no specialized intestinal metaplasia on histology, patients diagnosed with any dysplasia or cancer on index endoscopy, and procedures using advanced imaging techniques were excluded. Logistic regression models were constructed to estimate adjusted odds ratios and 95% confidence intervals comparing outcomes with standard definition and high-definition systems. The high definition was superior to standard definition system in targeted detection of all dysplastic lesions (odds ratio 3.27, 95% confidence interval 1.27-8.40) as well as overall dysplasia detected on both random and target biopsies (odds ratio 2.36, 95% confidence interval 1.50-3.72). More non-dysplastic lesions were detected with the high-definition system (odds ratio 1.16, 95% confidence interval 1.01-1.33). There was no difference between high definition and standard definition endoscopy in the overall (random and target) high-grade dysplasia or cancers detected (odds ratio 0.93, 95% confidence interval 0.83-1.04). Trainee endoscopists, number of biopsies taken, and male sex were all significantly associated with a higher yield for dysplastic lesions. The use of the high-definition endoscopy system is associated with better targeted detection of any dysplasia during routine Barrett's esophagus surveillance. However, high-definition endoscopy cannot replace random biopsies at present time. © 2014 International Society for Diseases of the Esophagus.

An outcomes analysis of patients undergoing body contouring surgery after massive weight loss.

PubMed

Shermak, Michele A; Chang, David; Magnuson, Thomas H; Schweitzer, Michael A

2006-09-15

Although published reports about technical management of massive weight loss patients are beginning to appear, risk factors for complications following body contouring operations are not known. A retrospective analysis of massive weight loss patients who had body contouring operations between March of 1998 and October of 2004 was performed. Demographic and surgical factors were analyzed. Outcome measures included seroma, wound dehiscence, thromboembolic complications, blood transfusion after surgery, and extended lengths of stay (>2 days). A total of 139 patients were analyzed; 82.7 percent of them were female; mean age was 41 years. On multiple logistic regression, male gender was associated with significant risks for wound dehiscence (odds ratio, 6.4; p = 0.01). There were also trends toward increased risk for wound dehiscence with hypothyroidism (odds ratio, 4.3; p = 0.06) and Ehlers-Danlos syndrome (odds ratio, 18.7; p = 0.05). In terms of risk of blood transfusion, asthma and having three or more procedures were the two variables that emerged with significant association (odds ratio, 16.8 and 13.7, respectively; both p < 0.01). Increased length of stay to greater than 2 days was also significantly associated with having three or more procedures (odds ratio, 4.72; p < 0.01). Male gender, hypothyroidism, and Ehlers-Danlos syndrome may be risk factors for wound dehiscence following body contour operations for massive weight loss. Asthma may be a marker of poor general health status, and asthmatic patients are at increased risk for requiring blood transfusions. Having three or more procedures is associated with an increased risk of blood transfusion and increased length of stay.

Do doctors vote?

PubMed

Grande, David; Asch, David A; Armstrong, Katrina

2007-05-01

Organizational leaders and scholars have issued calls for the medical profession to refocus its efforts on fulfilling the core tenets of professionalism. A key element of professionalism is participation in community affairs. To measure physician voting rates as an indicator of civic participation. Cross-sectional survey of a subgroup of physicians from a nationally representative household survey of civilian, noninstitutionalized adult citizens. A total of 350,870 participants in the Current Population Survey (CPS) November Voter Supplement from 1996-2002, including 1,274 physicians and 1,886 lawyers; 414,989 participants in the CPS survey from 1976-1982, including 2,033 health professionals. Multivariate logistic regression models were used to compare adjusted physician voting rates in the 1996-2002 congressional and presidential elections with those of lawyers and the general population and to compare voting rates of health professionals in 1996-2002 with those in 1976-1992. After multivariate adjustment for characteristics known to be associated with voting rates, physicians were less likely to vote than the general population in 1998 (odds ratio 0.76; 95% confidence interval [CI] 0.59-0.99), 2000 (odds ratio 0.64; 95% CI 0.44-0.93), and 2002 (odds ratio 0.62; 95% CI 0.48-0.80) but not 1996 (odds ratio 0.83; 95% CI 0.59-1.17). Lawyers voted at higher rates than the general population and doctors in all four elections (P < .001). The pooled adjusted odds ratio for physician voting across the four elections was 0.70 (CI 0.61-0.81). No substantial changes in voting rates for health professionals were observed between 1976-1982 and 1996-2002. Physicians have lower adjusted voting rates than lawyers and the general population, suggesting reduced civic participation.

Smoking, obesity and risk of sarcoidosis: A population-based nested case-control study.

PubMed

Ungprasert, Patompong; Crowson, Cynthia S; Matteson, Eric L

2016-11-01

Smoking and obesity might alter the risk of sarcoidosis. However, the data remained inconclusive. A cohort of Olmsted County, Minnesota residents diagnosed with sarcoidosis between January 1, 1976 and December 31, 2013 was identified based on individual medical record review. For each sarcoidosis subject, one sex and aged-matched control without sarcoidosis was randomly selected from the same underlying population. Medical records of cases and controls were reviewed for smoking status at index date and body mass index (BMI) within 1 year before to 3 months after index date. 345 incident cases of sarcoidosis and 345 controls were identified. The odds ratio of sarcoidosis comparing current smokers with never smokers adjusted for age and sex was 0.34 (95% confidence interval (CI), 0.23-0.50). The odds ratio of sarcoidosis comparing current smokers with never smokers and former smokers adjusted for age and sex was 0.38 (95% CI, 0.26-0.56). The odds ratio of sarcoidosis comparing overweight subjects (BMI ≥ 25 kg/m 2 but < 30 kg/m 2 ) with subjects with normal/low BMI was 1.12 (95% CI, 0.72-1.75). The odds ratio of sarcoidosis comparing obese subjects (BMI ≥ 30 kg/m 2 ) with subjects with normal/low BMI was 2.54 (95% CI, 1.58-4.06). The odds ratio of sarcoidosis comparing obese subjects with non-obese subjects was 2.38 (95% CI, 1.60-3.56). In this population, current smokers have a lower risk of developing sarcoidosis while subjects with obesity have a higher risk of developing sarcoidosis. Copyright © 2016 Elsevier Ltd. All rights reserved.

Inverse relationship between moderate alcohol intake and rectal cancer: analysis of the North Carolina Colon Cancer Study.

PubMed

Crockett, Seth D; Long, Millie D; Dellon, Evan S; Martin, Christopher F; Galanko, Joseph A; Sandler, Robert S

2011-07-01

The relationship between alcohol intake and rectal cancer is uncertain. We sought to evaluate whether alcohol consumption is associated with distal colorectal cancer and rectal cancer specifically. Data on alcohol intake were examined from the North Carolina Colon Cancer Study, a population-based case-control study of distal colorectal cancer. This study encompassed 33 counties in the central and eastern part of North Carolina. Cases had adenocarcinoma of the rectum, rectosigmoid, and sigmoid colon. Controls were frequency-matched on age, race, and sex. Demographic and dietary intake data were collected with use of a validated questionnaire. Logistic regression was used to estimate odds ratios for the relationship between alcohol consumption and distal colorectal cancer. Included in the study were 1033 cases and 1011 controls. The odds ratio for rectal cancer comparing any vs no alcohol intake was 0.73 (95% CI 0.60, 0.90), adjusted for age, sex, race, smoking status, obesity, education, red meat intake, use of nonsteroidal anti-inflammatory medications, and family history of colorectal cancer. The odds ratio for moderate alcohol (≤14 g/day) was 0.66 (95% CI 0.53, 0.82), whereas the odds ratio for heavy alcohol (>14 g/day) was 0.93 (95% CI 0.70, 1.23). Moderate beer and wine intakes were also inversely associated with distal colorectal cancer: odds ratios 0.76 (95% CI 0.60, 0.96) and 0.69 (95% CI 0.56, 0.86). This was a retrospective, observational study. Residual confounding is possible. In this study, moderate alcohol intake (especially wine) was inversely associated with distal colorectal cancer.

Predictive value of the fibrosis scores in patients with chronic hepatitis C associated with liver fibrosis and metabolic syndrome.

PubMed

Miyaaki, Hisamitsu; Ichikawa, Tatsuki; Taura, Naota; Miuma, Satoshi; Shibata, Hidetaka; Isomoto, Hajime; Takeshima, Fuminao; Nakao, Kazuhiko

2011-01-01

We evaluated patients with chronic hepatitis C (CHC) and compared the clinical and pathological features of steatosis and metabolic syndrome to identify the risk factors for CHC with severe fibrosis. One hundred seventy-one patients with biopsy-confirmed CHC were included in the study: 90 males and 81 females, age 56.2 ± 12.8 years; 46 with obesity (BMI≥25 kg/m(2)); 51 with hypertension; 36 with type 2 diabetes mellitus; and 20 with hypertriglyceridemia. Steatosis was detected in 79 patients (46%); 92 patients (54%) showed no steatosis. Seventy-four patients (43%) showed mild fibrosis and 97 patients (56%) showed severe fibrosis. The variables that were significantly associated with steatosis were obesity [odds ratio 2.160 (1.010-4.727), p=0.046] and type 2 diabetes [odds ratio 3.667 (1.559-8.430), p=0.027]. The variables that were significantly associated with severe fibrosis were older age [odds ratio 2.675 (1.309-5.464), p=0.007], obesity [odds ratio 2.156 (1.006-4.619), p=0.048] and type 2 diabetes [odds ratio 8.739 (2.845-26.846), p=0.0002]. Nagasaki (N) score (the total number of specific risk factors, namely an older age, obesity, and type 2 diabetes) was higher in the severe fibrosis group than in the mild fibrosis group (mild fibrosis: severe fibrosis=1.48 ± 1.14 vs.2.66 ± 94, p<0.001). Metabolic syndrome factors, including obesity and diabetes, play a critical role in the pathogenesis of fibrosis in CHC. The N score was therefore found to be a significant predictor of severe fibrosis in CHC.

The association of lifetime physical inactivity with bladder and renal cancer risk: A hospital-based case-control analysis.

PubMed

Cannioto, Rikki; Etter, John Lewis; Guterman, Lauren Beryl; Joseph, Janine M; Gulati, Nicholas R; Schmitt, Kristina L; LaMonte, Michael J; Nagy, Ryan; Minlikeeva, Albina; Szender, James Brian; Moysich, Kirsten B

2017-08-01

Recreational physical inactivity has been gaining recognition as an independent epidemiological exposure of interest in relation to cancer endpoints due to evidence suggesting that it may associate with cancer independent of obesity. In the current analyses, we examined the associations of lifetime recreational physical inactivity with renal and bladder cancer risk. In this hospital-based case-control study, we identified N=160 renal cancer patients, N=208 bladder cancer patients, and N=766 age frequency-matched controls without cancer. Participants self-reporting never participating in any regular/weekly recreational physical activity throughout their lifetime were classified as physically inactive. Utilizing unconditional multivariable logistic regression analyses, we estimated odds ratios and 95% confidence intervals to represent the associations between lifetime physical inactivity and renal and bladder cancer risk. In multivariable logistic regression models, we observed significant positive associations between lifetime recreational physical inactivity and renal cancer and bladder cancer risk: odds ratio=1.77 (95% CI: 1.10-2.85) and odds ratio=1.73 (95% CI: 1.13-2.63), respectively. Similar associations also persisted among individuals who were not obese for both renal and bladder cancer: odds ratio=1.75 (95% CI: 1.03-2.98) and odds ratio=1.70 (95% CI: 1.08-2.69), respectively. In this case-control study, we observed evidence of a positive association between renal and bladder cancer with lifetime recreational physical inactivity. These data add to the growing body of evidence suggesting that physical inactivity may be an important independent risk factor for cancer. However, additional studies using a larger sample and prospectively collected data are needed to substantiate the current findings. Copyright © 2017 Elsevier Ltd. All rights reserved.

Factors Associated with Physical Inactivity among Adult Urban Population of Puducherry, India: A Population Based Cross-sectional Study.

PubMed

Newtonraj, Ariarathinam; Murugan, Natesan; Singh, Zile; Chauhan, Ramesh Chand; Velavan, Anandan; Mani, Manikandan

2017-05-01

Physical inactivity is the fourth leading cause of death worldwide. Increase in physical activity decreases the incidence of cardiovascular diseases, Type 2 diabetes, stroke, and improves psychological wellbeing. To study the level of physical inactivity among the adult population in an urban area of Puducherry in India and its associated risk factors. This cross-sectional study was conducted among 569 adult participants from an urban area of Pondicherry. The level of physical inactivity was measured by using WHO standard Global Physical Activity Questionnaire (GPAQ). Overall prevalence of physical inactivity in our study was 49.7% (CI: 45.6-53.8). Among the physically active people, contribution of physical activity by work was 77.4%, leisure time activities were 11.6% and transport time was 11%. Both men and women were equally inactive {Physically inactive among women was 50% (CI:44.1-55.9)} and {Physically inactive among men was 49.5% (CI:43.8-55.2)}. Prevalence of physical inactivity was increasing with increasing age. Non tobacco users were two times more active than tobacco users {Adjusted Odds Ratio: 2.183 (1.175- 4.057)}. Employed were more active as compared to retired {Adjusted Odds Ratio: 0.412 (0.171-0.991)}, students {Adjusted Odds Ratio: 0.456 (0.196-1.060)}, house wives {Adjusted Odds Ratio: 0.757 (0.509-1.127)} and unemployed {Adjusted Odds Ratio: 0.538 (0.271-1.068)}. Non alcoholics were only 0.34 times as active as alcoholics. Level of physical activity was found to be insufficient among adult urban population of Puducherry. Working adult population found to be active, that too due to their work pattern. There is a need to promote leisure time and travelling time physical activity.

Breast-feeding, dietary intakes and their associations with subclinical vitamin A deficiency in children in Anhui Province, China.

PubMed

Zhang, Yewu; Tao, Fangbiao; Yin, Huiping; Zhu, Xiaoming; Ji, Guoping; Kong, Shenghua; Song, Qinhua; Chen, Jianhua; Chu, Chengzhi; Li, Zhu

2007-07-01

This study aimed to explore the associations between breast-feeding, dietary intakes and other related factors and subclinical vitamin A deficiency (SVAD) in children aged 0-5 years in an area in China where mild vitamin A deficiency (VAD) is found. Data were from a population-based cross-sectional study with 1052 children aged 0-5 years. SVAD cases were identified by the indicator of serum retinol

Use of autologous and microsurgical breast reconstruction by U.S. plastic surgeons.

PubMed

Kulkarni, Anita R; Sears, Erika Davis; Atisha, Dunya M; Alderman, Amy K

2013-09-01

Concern exists that plastic surgeons are performing fewer autologous and microsurgical breast reconstructions, despite superior long-term outcomes. The authors describe the proportion of U.S. plastic surgeons performing these procedures and evaluate motivating factors and perceived barriers. A random national sample of American Society of Plastic Surgeons members was surveyed (n = 325; response rate, 76 percent). Surgeon and practice characteristics were assessed, and two multiple logistic regression models were created to evaluate factors associated with (1) high-volume autologous providers and (2) microsurgical providers. Qualitative assessments of motivating factors and barriers to microsurgery were also performed. Fewer than one-fifth of plastic surgeons perform autologous procedures for more than 50 percent of their breast cancer patients, and only one-quarter perform any microsurgical breast reconstruction. Independent predictors of a high-volume autologous practice include involvement with resident education (odds ratio, 2.57; 95 percent CI, 1.26 to 5.24) and a microsurgical fellowship (odds ratio, 2.09; 95 percent CI, 1.04 to 4.27). Predictors of microsurgical breast reconstruction include involvement with resident education (odds ratio, 6.8; 95 percent CI, 3.32 to 13.91), microsurgical fellowship (odds ratio, 2.4; 95 percent CI, 1.16 to 4.95), and high breast reconstruction volume (odds ratio, 6.68; 95 percent CI, 1.76 to 25.27). The primary motivator for microsurgery is superior outcomes, and the primary deterrents are time and reimbursement. The proportion of U.S. plastic surgeons with a high-volume autologous or microsurgical breast reconstruction practice is low. Involvement with resident education appears to facilitate both, whereas time constraints and reimbursement are primary deterrents. Future efforts should focus on improving the feasibility and accessibility of all types of breast reconstruction.

Parental use of sun protection for their children-does skin color matter?

PubMed

Tan, Marcus G; Nag, Shudeshna; Weinstein, Miriam

2018-03-01

Excessive sun exposure during childhood is a risk factor for skin cancer. This study aimed to compare the frequency of ideal sun protection use between parents with lighter- and darker-skinned children and explore their attitudes and beliefs on sun safety and their choice of sun protection. Parents of children aged 6 months to 6 years completed self-administered questionnaires about sun protection practices for their children. Parents assessed their child's Fitzpatrick phototype and were divided into lighter- (Fitzpatrick phototype I-III) and darker-skinned (Fitzpatrick phototype IV-VI) groups. Sun safety guidelines from the Canadian Dermatology Association were used to qualify ideal sun protection. A total of 183 parents were included. Overall, 31 parents (17%) used ideal sun protection for their children. As their children grew older, parents were less likely to use ideal sun protection (odds ratio = 0.69, 95% confidence interval = 0.53-0.90). Parents in the lighter-skinned group were more likely to use ideal sun protection for their children (odds ratio = 7.4, 95% confidence interval = 2.7-20.1), believe that sun exposure was harmful (odds ratio = 17.2, 95% confidence interval = 4.0-74.9), and perceive value in sun protection (odds ratio = 11.4, 95% confidence interval = 3.3-39.0); the darker-skinned group believed that darker skin tones provided more sun protection (odds ratio = 12.4, 95% confidence interval = 6.1-25.4). Ideal parental sun protection efforts are overall low, particularly in parents of darker-skinned children. The identified attitudes toward and beliefs about sun safety may aid in delivery of future sun protection interventions, especially in multiracial populations. © 2018 Wiley Periodicals, Inc.

Meta-analysis of residential exposure to radon gas and lung cancer.

PubMed Central

Pavia, Maria; Bianco, Aida; Pileggi, Claudia; Angelillo, Italo F.

2003-01-01

OBJECTIVES: To investigate the relation between residential exposure to radon and lung cancer. METHODS: A literature search was performed using Medline and other sources. The quality of studies was assessed. Adjusted odds ratios with 95% confidence intervals (CI) for the risk of lung cancer among categories of levels of exposure to radon were extracted. For each study, a weighted log-linear regression analysis of the adjusted odds ratios was performed according to radon concentration. The random effect model was used to combine values from single studies. Separate meta-analyses were performed on results from studies grouped with similar characteristics or with quality scores above or equal to the median. FINDINGS: Seventeen case-control studies were included in the meta-analysis. Quality scoring for individual studies ranged from 0.45 to 0.77 (median, 0.64). Meta-analysis based on exposure at 150 Bq/m3 gave a pooled odds ratio estimate of 1.24 (95% CI, 1.11-1.38), which indicated a potential effect of residential exposure to radon on the risk of lung cancer. Pooled estimates of fitted odds ratios at several levels of randon exposure were all significantly different from unity--ranging from 1.07 at 50 Bq/m3 to 1.43 at 250 Bq/m3. No remarkable differences from the baseline analysis were found for odds ratios from sensitivity analyses of studies in which > 75% of eligible cases were recruited (1.12, 1.00-1.25) and studies that included only women (1.29, 1.04-1.60). CONCLUSION: Although no definitive conclusions may be drawn, our results suggest a dose-response relation between residential exposure to radon and the risk of lung cancer. They support the need to develop strategies to reduce human exposure to radon. PMID:14758433

Dietary Pattern and Risk of Hodgkin Lymphoma in a Population-Based Case-Control Study

PubMed Central

Epstein, Mara M.; Chang, Ellen T.; Zhang, Yawei; Fung, Teresa T.; Batista, Julie L.; Ambinder, Richard F.; Zheng, Tongzhang; Mueller, Nancy E.; Birmann, Brenda M.

2015-01-01

Classic Hodgkin lymphoma (cHL) has few known modifiable risk factors, and the relationship between diet and cHL risk is unclear. We performed the first investigation of an association between dietary pattern and cHL risk in 435 cHL cases and 563 population-based controls from Massachusetts and Connecticut (1997–2000) who completed baseline diet questionnaires. We identified 4 major dietary patterns (“vegetable,” “high meat,” “fruit/low-fat dairy,” “desserts/sweets”) using principal components analysis. We computed multivariable odds ratios and 95% confidence intervals for associations of dietary pattern score (quartiles) with younger-adult (age <50 years), older-adult (age ≥50 years), and overall cHL risk. Secondary analyses examined associations by histological subtype and tumor Epstein-Barr virus (EBV) status. A diet high in desserts/sweets was associated with younger-adult (odds ratio(quartile 4 vs. quartile 1) = 1.60, 95% confidence interval: 1.05, 2.45; Ptrend = 0.008) and EBV-negative, younger-adult (odds ratio = 2.11, 95% confidence interval: 1.31, 3.41; Ptrend = 0.007) cHL risk. A high meat diet was associated with older-adult (odds ratio = 3.34, 95% confidence interval: 1.02, 10.91; Ptrend = 0.04) and EBV-negative, older-adult (odds ratio = 4.64, 95% confidence interval: 1.03, 20.86; Ptrend = 0.04) cHL risk. Other dietary patterns were not clearly associated with cHL. We report the first evidence for a role of dietary pattern in cHL etiology. Diets featuring high intake of meat or desserts and sweets may increase cHL risk. PMID:26182945

Dietary pattern and risk of hodgkin lymphoma in a population-based case-control study.

PubMed

Epstein, Mara M; Chang, Ellen T; Zhang, Yawei; Fung, Teresa T; Batista, Julie L; Ambinder, Richard F; Zheng, Tongzhang; Mueller, Nancy E; Birmann, Brenda M

2015-09-01

Classic Hodgkin lymphoma (cHL) has few known modifiable risk factors, and the relationship between diet and cHL risk is unclear. We performed the first investigation of an association between dietary pattern and cHL risk in 435 cHL cases and 563 population-based controls from Massachusetts and Connecticut (1997-2000) who completed baseline diet questionnaires. We identified 4 major dietary patterns ("vegetable," "high meat," "fruit/low-fat dairy," "desserts/sweets") using principal components analysis. We computed multivariable odds ratios and 95% confidence intervals for associations of dietary pattern score (quartiles) with younger-adult (age <50 years), older-adult (age ≥50 years), and overall cHL risk. Secondary analyses examined associations by histological subtype and tumor Epstein-Barr virus (EBV) status. A diet high in desserts/sweets was associated with younger-adult (odds ratio(quartile 4 vs. quartile 1) = 1.60, 95% confidence interval: 1.05, 2.45; Ptrend = 0.008) and EBV-negative, younger-adult (odds ratio = 2.11, 95% confidence interval: 1.31, 3.41; Ptrend = 0.007) cHL risk. A high meat diet was associated with older-adult (odds ratio = 3.34, 95% confidence interval: 1.02, 10.91; Ptrend = 0.04) and EBV-negative, older-adult (odds ratio = 4.64, 95% confidence interval: 1.03, 20.86; Ptrend = 0.04) cHL risk. Other dietary patterns were not clearly associated with cHL. We report the first evidence for a role of dietary pattern in cHL etiology. Diets featuring high intake of meat or desserts and sweets may increase cHL risk. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Relationship between estimated glomerular filtration rate, albuminuria, and oxidant status in the Japanese population

PubMed Central

2013-01-01

Background In the general population, reported levels of oxidative stress and antioxidant potential seem to vary. The aim of this study was to investigate the levels of oxidant status markers in relation to estimated glomerular filtration rate (eGFR) and albuminuria in Japanese population. Methods Data were analyzed from 8335 individuals who underwent a general health screening test. For the estimation of albuminuria, urinary albumin-to-creatinine ratio (UAER) was calculated. Oxidant status was determined by assessing derivatives of reactive oxygen metabolites (d-ROMs) and biological antioxidant potential (BAP). Results After adjusting for age, high blood pressure, depressor agent use, CRP, smoking status, multivariate logistic regression analysis showed that the lowest eGFR quartile was associated negatively with the top d-ROM quartile in men (odds ratio 0.78 [95% CI 0.62-0.98, P = 0.034]) and the highest UAER was associated with the top d-ROM in men (odds ratio 1.68) [95% CI 1.35-2.10, P < 0.001]. In addition, both the first eGFR quartile and the fourth UAER quartile showed significant positive association with low BAP levels in men, but not in women. Conclusions Among men who underwent general health screening, lower eGFR and increased albuminuria was negatively and positively, respectively, associated with higher oxidative stress levels, whereas both conditions were positively associated with lower antioxidant potential levels. PMID:24016221

Preoperative Serum Thyrotropin to Thyroglobulin Ratio Is Effective for Thyroid Nodule Evaluation in Euthyroid Patients.

PubMed

Wang, Lina; Li, Hao; Yang, Zhongyuan; Guo, Zhuming; Zhang, Quan

2015-07-01

This study was designed to assess the efficiency of the serum thyrotropin to thyroglobulin ratio for thyroid nodule evaluation in euthyroid patients. Cross-sectional study. Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China. Retrospective analysis was performed for 400 previously untreated cases presenting with thyroid nodules. Thyroid function was tested with commercially available radioimmunoassays. The receiver operating characteristic curves were constructed to determine cutoff values. The efficacy of the thyrotropin:thyroglobulin ratio and thyroid-stimulating hormone for thyroid nodule evaluation was evaluated in terms of sensitivity, specificity, positive predictive value, positive likelihood ratio, negative likelihood ratio, and odds ratio. In receiver operating characteristic curve analysis, the area under the curve was 0.746 for the thyrotropin:thyroglobulin ratio and 0.659 for thyroid-stimulating hormone. With a cutoff point value of 24.97 IU/g for the thyrotropin:thyroglobulin ratio, the sensitivity, specificity, positive predictive value, positive likelihood ratio, and negative likelihood ratio were 78.9%, 60.8%, 75.5%, 2.01, and 0.35, respectively. The odds ratio for the thyrotropin:thyroglobulin ratio indicating malignancy was 5.80. With a cutoff point value of 1.525 µIU/mL for thyroid-stimulating hormone, the sensitivity, specificity, positive predictive value, positive likelihood ratio, and negative likelihood ratio were 74.0%, 53.2%, 70.8%, 1.58, and 0.49, respectively. The odds ratio indicating malignancy for thyroid-stimulating hormone was 3.23. Increasing preoperative serum thyrotropin:thyroglobulin ratio is a risk factor for thyroid carcinoma, and the correlation of the thyrotropin:thyroglobulin ratio to malignancy is higher than that for serum thyroid-stimulating hormone. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

"Dealing" with Incidence, Prevalence, and Odds Concepts in Undergraduate Epidemiology

ERIC Educational Resources Information Center

Senchina, David S.; Laurson, Kelly R.

2009-01-01

Concepts and associated statistical formulae of incidence, prevalence, and odds/odds ratios are core knowledge in epidemiology yet can be confusing for students. The purpose of this project was to develop, validate, and share one possible pedagogical technique using playing cards that could be employed to improve undergraduate understanding of…

Trends in contraceptive use according to HIV status among privately insured women in the United States.

PubMed

Haddad, Lisa B; Monsour, Michael; Tepper, Naomi K; Whiteman, Maura K; Kourtis, Athena P; Jamieson, Denise J

2017-12-01

There is limited information on the patterns and trends of contraceptive use among women living with HIV, compared with noninfected women in the United States. Further, little is known about whether antiretroviral therapy correlates with contraceptive use. Such information is needed to help identify potential gaps in care and to enhance unintended pregnancy prevention efforts. We sought to compare contraceptive method use among HIV-infected and noninfected privately insured women in the United States, and to evaluate the association between antiretroviral therapy use and contraceptive method use. We used a large US nationwide health care claims database to identify girls and women ages 15-44 years with prescription drug coverage. We used diagnosis, procedure, and National Drug Codes to assess female sterilization and reversible prescription contraception use in 2008 and 2014 among women continuously enrolled in the database during 2003 through 2008 or 2009 through 2014, respectively. Women with no codes were classified as using no method; these may have included women using nonprescription methods, such as condoms. We calculated prevalence of contraceptive use by HIV infection status, and by use of antiretroviral therapy among those with HIV. We used multivariable polytomous logistic regression to calculate unadjusted and adjusted odds ratios and 95% confidence intervals for female sterilization, long-acting reversible contraception, and short-acting hormonal contraception compared to no method. While contraceptive use increased among HIV-infected and noninfected women from 2008 through 2014, in both years, a lower proportion of HIV-infected women used prescription contraceptive methods (2008: 17.5%; 2014: 28.9%, compared with noninfected women (2008: 28.8%; 2014: 39.8%, P < .001 for both). Controlling for demographics, chronic medical conditions, pregnancy history, and cohort year, HIV-infected women compared to HIV-noninfected women had lower odds of using long-acting reversible contraception (adjusted odds ratio, 0.67; 95% confidence interval, 0.52-0.86 compared to no method) or short-acting hormonal contraception method (adjusted odds ratio, 0.59; 95% confidence interval, 0.50-0.70 compared to no method). In 2014, HIV-infected women using antiretroviral therapy were significantly more likely to use no method (76.8% vs 64.1%), and significantly less likely to use short-acting hormonal contraception (11.0% vs 22.7%) compared to HIV-infected women not using antiretroviral therapy. Those receiving antiretroviral therapy had lower odds of using short-acting hormonal contraception compared to no method (adjusted odds ratio, 0.45; 95% confidence interval, 0.32-0.63). There was no significant difference in female sterilization by HIV status or antiretroviral therapy use. Despite the safety of reversible contraceptives for women with HIV, use of prescription contraception continues to be lower among privately insured HIV-infected women compared to noninfected women, particularly among those receiving antiretroviral therapy. Copyright © 2017 Elsevier Inc. All rights reserved.

Modelling increased landslide susceptibility near highways in the Andes of southern Ecuador

NASA Astrophysics Data System (ADS)

Brenning, Alexander; Muenchow, Jannes

2016-04-01

Modelling increased landslide susceptibility near highways in the Andes of southern Ecuador A. Brenning (1), J. Muenchow (1) (1) Department of Geography, Friedrich Schiller University Jena, Loebdergraben 32, 07743 Jena, Germany Mountain roads are affected by and also affect themselves landslide suceptibility. Especially in developing countries, inadequate drainage systems and mechanical destabilization of hillslopes by undercutting and overloading are known processes through which road construction and maintenance can enhance landslide activity within the immediate surroundings of road infrastructure. In the Andes of southern Ecuador, strong precipitation gradients as well as lithological differences provide an excellent study site in which the relationship between highways and landslide susceptibility and its regional differentiation can be studied. This study uses Generalized Additive Models (GAM) to investigate patterns of landslide susceptibility along two paved interurban highways in the tropical Andes of southern Ecuador. The relationship of landslides to distance from road is modeled while accounting for topographic, climatic and lithological predictors as possible confounders and modifiers, focusing on the odds ratio of landslide occurrence at 25 m versus 200 m distance from the highway. Spatial attention is given to uncertainties in estimated odds ratios of landslide occurrence using spatial block bootstrap techniques. The GAM is able to represent nonlinear additive terms as well as bivariate smooth interaction terms, providing a good tradeoff between model complexity and interpretability. The estimated odds of landslide occurrence were 18-21 times higher near the highway than at 200 m distance, based on different analyses, with lower 95% confidence limits always >13. (Semi-) parametric estimates confirmed this general range of values but suggests slightly higher odds ratios (95% confidence interval: 15.5-25.3). Highway-related effects were observed to fade at about 150 m distance from the highway. The results suggest that there may be local modifications of landslide susceptibility based on geological conditions, with increased occurrences in Holocene gravels and Laramide andesite/basalt. Overall, landslide susceptibility near paved interurban highways was more than one order of magnitude higher than in areas distant from the highways.

Homogamy and Intermarriage of Japanese and Japanese Americans With Whites Surrounding World War II

PubMed Central

Ono, Hiromi; Berg, Justin

2010-01-01

Although some sociologists have suggested that Japanese Americans quickly assimilated into mainstream America, scholars of Japanese America have highlighted the heightened exclusion that the group experienced. This study tracked historical shifts in the exclusion level of Japanese and Japanese Americans in the United States surrounding World War II with homogamy and intermarriage with Whites for the prewar (1930–1940) and resettlement (1946–1966) marriage cohorts. The authors applied log-linear models to census microsamples (N = 1,590,416) to estimate the odds ratios of homogamy versus intermarriage. The unadjusted odds ratios of Japanese Americans declined between cohorts and appeared to be consistent with the assimilation hypothesis. Once compositional influences and educational pairing patterns were adjusted, however, the odds ratios increased and supported the heightened exclusion hypothesis. PMID:21116449

Systematics of α-decay fine structure in odd-mass nuclei based on a finite-range nucleon-nucleon interaction

NASA Astrophysics Data System (ADS)

Adel, A.; Alharbi, T.

2018-07-01

A systematic study on α-decay fine structure is presented for odd-mass nuclei in the range 83 ≤ Z ≤ 92. The α-decay partial half-lives and branching ratios to the ground and excited states of daughter nuclei are calculated in the framework of the Wentzel-Kramers-Brillouin (WKB) approximation with the implementation of the Bohr-Sommerfeld quantization condition. The microscopic α-daughter potential is obtained using the double-folding model with a realistic M3Y-Paris nucleon-nucleon (NN) interaction. The exchange potential, which accounts for the knock-on exchange of nucleons between the interacting nuclei, is calculated using the finite-range exchange NN interaction which is essentially a much better approximation as compared to the zero-range pseudo-potential adopted in the usual double-folding calculations. Our calculations of α-decay fine structure have been improved by considering the preformation factor extracted from the recently proposed cluster formation model on basis of the binding energy difference. The computed partial half-lives and branching ratios are compared with the recent experimental data and they are in good agreement.

Clinically observed chickenpox and the risk of childhood-onset multiple sclerosis.

PubMed

Mikaeloff, Yann; Caridade, Guillaume; Suissa, Samy; Tardieu, Marc

2009-05-15

The authors conducted a population-based case-control study to investigate whether clinically observed chickenpox, linked with a level of intensity for clinical expression, increases the risk of multiple sclerosis (MS) in childhood. The cases were MS patients whose disease onset occurred between 1994 and 2003, before age 16 years, in France. Each case was matched for age, sex, and geographic origin with as many as 12 controls randomly selected from the general population. Information about clinically observed chickenpox in cases and controls before the index date regarding onset of MS was collected with a standardized questionnaire and was checked against health certificates. Conditional logistic regression was used to estimate the odds ratio for an association between MS and chickenpox. The 137 MS cases were matched with 1,061 controls. Clinically observed chickenpox had occurred in 76.6% of the cases and 84.9% of their matched controls. The adjusted odds ratio of MS onset associated with chickenpox occurrence was 0.58 (95% confidence interval: 0.36, 0.92). The authors concluded that clinically observed chickenpox was associated with a lower risk of childhood-onset MS in a French population.

Association of smokeless tobacco use and smoking in adolescents in the US: Youth Risk Behavior Survey, 2011

PubMed Central

Wiener, R. Constance

2014-01-01

Background Using smokeless tobacco and smoking are risk behaviors for oral cancer, soft tissue lesions, caries, periodontal disease and other oral conditions. The purpose of this study was to examine adolescent smokeless tobacco use and smoking. Methods The study was a cross-sectional analysis of participants with complete data on smoking, smokeless tobacco use, and other variables of interest in the 2011 Youth Risk Behavior Survey (n=9655). Descriptive analysis and multivariable logistic regression analyses were performed. Results The unadjusted odds ratio for smokeless tobacco use and smoking was 9.68 (95% CI: 7.72, 12.13, p<.0001); the adjusted odds ratio was 3.92 (95%CI: 2.89, 5.31, p<.0001). Adolescents using smokeless tobacco were more likely to be male, to smoke, and to have engaged in binge drinking. Conclusions Adolescents who are using smokeless tobacco are more likely to also be engaging in concomitant smoking and are participating in other risk-taking behaviors. Practice implications Dentists are involved in helping patients in tobacco cessation. The strong association of smoking with smokeless tobacco needs to be considered in designing cessation programs for adolescents. PMID:23904581

Role of survivor bias in pancreatic cancer case-control studies.

PubMed

Hu, Zhen-Huan; Connett, John E; Yuan, Jian-Min; Anderson, Kristin E

2016-01-01

The purpose of this study was to evaluate the impact of survivor bias on pancreatic cancer case-control studies. The authors constructed five case-loss scenarios based on the Iowa Women's Health Study cohort to reflect how case recruitment in population-based studies varies by case survival time. Risk factors for disease incidence included smoking, body mass index (BMI), waist circumference, diabetes, and alcohol consumption. Odds ratios (ORs) were estimated by conditional logistic regression and quantitatively compared by the interactions between risk factors and 3-month survival time. Additionally, Kaplan-Meier estimates for overall survival were compared within the subset cohort of pancreatic cancer cases. BMI and waist circumference showed a significant inverse relationship with survival time. Decreasing trends in ORs for BMI and waist circumference were observed with increasing case survival time. The interaction between BMI and survival time based on a cutpoint of 3 months was significant (P < .01) as was the interaction between waist circumference and survival time (P < .01). The findings suggested that case losses could result in survivor bias causing underestimated odds ratios for both BMI and waist circumference, whereas other risk factors were not significantly affected by case losses. Copyright © 2016 Elsevier Inc. All rights reserved.

Medical training in Greece: A crisis in progress.

PubMed

Makris, Gregory C; Trigkidis, Kyriakos K; Apiranthiti, Katerina; Malietzis, George; Alexiou, Vangelis G; Falagas, Matthew E

2015-08-01

We sought to evaluate the opinions of medical students and graduates regarding the quality of medical education in Greece. Two online questionnaires concerning the undergraduate medical education and specialty training respectively were distributed. Regarding the quality of undergraduate medical education, 52.1% of participants replied favorably while clinical training was found satisfactory by 45.1. Dissatisfaction rates with research opportunities and support from tutors reached 88.4 and 83.3%, respectively. The majority (75.3%) supported the introduction of examinations for commencing specialty training. 52.3% of physicians were satisfied with the quality of specialty training. The most common complaint was the absence of a formal educational program. 67.2% of participants were dissatisfied with working conditions during their specialty training, with 70.1% working >60 h per week. Physicians practicing medical specialties were more satisfied with the quality of specialty training than those practicing surgical specialties (odds ratio: 1.43; 95% confidence limits: 1.09-1.87) and were less likely to work for >60 h per week (odds ratio: 0.66; 95% confidence limits: 0.48-0.9). Opinions expressed in this survey highlight the need for reforming medical education in Greece.

Breast feeding and the sudden infant death syndrome in Scandinavia, 1992–95

PubMed Central

Alm, B; Wennergren, G; Norvenius, S; Skjaerven, R; Lagercrantz, H; Helweg-Larsen, K; Irgens, L

2002-01-01

Aims: To assess the effects of breast feeding habits on sudden infant death syndrome (SIDS). Methods: The analyses are based on data from the Nordic Epidemiological SIDS Study, a case–control study in which parents of SIDS victims in the Scandinavian countries between 1 September 1992 and 31 August 1995 were invited to participate, each with parents of four matched controls. The odds ratios presented were computed by conditional logistic regression analysis. Results: After adjustment for smoking during pregnancy, paternal employment, sleeping position, and age of the infant, the adjusted odds ratio (95% CI) was 5.1 (2.3 to 11.2) if the infant was exclusively breast fed for less than four weeks, 3.7 (1.6 to 8.4) for 4–7 weeks, 1.6 (0.7 to 3.6) for 8–11 weeks, and 2.8 (1.2 to 6.8) for 12–15 weeks, with exclusive breast feeding over 16 weeks as the reference. Mixed feeding in the first week post partum did not increase the risk. Conclusions: The study is supportive of a weak relation between breast feeding and SIDS reduction. PMID:12023166

Technical factors that affect anastomotic integrity following esophagectomy: systematic review and meta-analysis.

PubMed

Markar, Sheraz R; Arya, Shobhit; Karthikesalingam, Alan; Hanna, George B

2013-12-01

Due to the significant contribution of anastomotic leak, with its disastrous consequences to patient morbidity and mortality, multiple parameters have been proposed and individually meta-analyzed for the formation of the ideal esophagogastric anastomosis following cancer resection. The purpose of this pooled analysis was to examine the main technical parameters that impact on anastomotic integrity. Medline, Embase, trial registries, and conference proceedings were searched. Technical factors evaluated included hand-sewn versus stapled esophagogastric anastomosis (EGA), cervical versus thoracic EGA, minimally invasive versus open esophagectomy, anterior versus posterior route of reconstruction and ischemic conditioning of the gastric conduit. The outcome of interest was the incidence of anastomotic leak, for which pooled odds ratios were calculated for each technical factor. No significant difference in the incidence of anastomotic leak was demonstrated for the following technical factors: hand-sewn versus stapled EGA, minimally invasive versus open esophagectomy, anterior versus posterior route of reconstruction and ischemic conditioning of the gastric conduit. Four randomized, controlled trials comprising 298 patients were included that compared cervical and thoracic EGA. Anastomotic leak was seen more commonly in the cervical group (13.64 %) than in the thoracic group (2.96 %). Pooled analysis demonstrated a significantly increased incidence of anastomotic leak in the cervical group (pooled odds ratio = 4.73; 95 % CI 1.61-13.9; P = 0.005). A tailored surgical approach to the patient's physiology and esophageal cancer stage is the most important factor that influences anastomotic integrity after esophagectomy.

Dose-response effects for depression and Schizophrenia management on hospital utilization in Illinois Medicaid: a multivariate regression analysis.

PubMed

Berg, Gregory D; Donnelly, Shawn; Warnick, Kathleen; Medina, Wendie; Miller, Mary

2014-07-03

The prevalence of schizophrenia and depression in the United States is far higher among Medicaid recipients than in the general population. Individuals suffering from mental illness, including schizophrenia and depression, also have higher rates of emergency department utilization, which is costly and may not generate the positive health outcomes desired. Disease management programs strive to help individuals suffering from chronic illnesses better manage their condition(s) and seek health care in the appropriate settings. The objective of this manuscript is to estimate a dose-response impact on hospital inpatient and emergency room utilizations for any reason by Medicaid recipients with depression or schizophrenia who received disease management contacts. Multivariate regression analysis of panel data taken from administrative claims was conducted to test the hypothesis that increased contacts lower the likelihood of all-cause inpatient admissions and emergency room visits. Subjects included 6,274 members of Illinois' non-institutionalized Medicaid-only aged, blind or disabled population diagnosed with depression or schizophrenia. The statistical measure is the odds ratio. The odds ratio association is between the monthly utilization indicators and the number of contacts (doses) a member had for each particular disease management intervention. Higher numbers of intervention contacts for Medicaid recipients diagnosed with depression or schizophrenia were associated with statistically significant reductions in all-cause inpatient admissions and emergency room utilizations. There is a high correlation between depression and schizophrenia disease management contacts and lowered all-cause hospital inpatient and emergency room utilizations.

Common Immune-Related Exposures/Conditions and Risk of Non-Hodgkin Lymphoma: A Case-Control Study of Disease-Discordant Twin Pairs

PubMed Central

Wang, Jun; Mack, Thomas M.; Hamilton, Ann S.; Hwang, Amie E.; Nathwani, Bharat N.; Masood, Kamil; Buchanan, Laura H.; Bernstein, Leslie; Deapen, Dennis M.; Martínez-Maza, Otoniel; Cozen, Wendy

2015-01-01

We evaluated the association between common immune system–altering experiences and non-Hodgkin lymphoma (NHL) risk using a case-control study of 162 like-sex twin pairs discordant for NHL, identified from the International Twin Study. Information on medical history and evidence of childhood exposure to microbes was obtained by questionnaire from 1998 to 2002. Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals. Intra-twin-pair agreement between twins on individual exposures was high (76%–97%). A negative association between NHL and seasonal hay fever (odds ratio (OR) = 0.28, 95% confidence interval (CI): 0.10, 0.75) and certain allergies (OR = 0.29, 95% CI: 0.13, 0.68) was observed. The number of atopic diseases was negatively associated with NHL (P for trend = 0.0003). A history of infectious mononucleosis was negatively associated with NHL risk (OR = 0.35, 95% CI: 0.14, 0.90). NHL risk was associated with more frequent childhood exposure to microbes during early life (P for trend = 0.04). No differences in association by NHL subtype were observed, although statistical power for these comparisons was low. These observations support the hypothesis that immune-related exposures, especially atopy, are associated with decreased NHL risk. Use of the within-twin-pair study design mitigates confounding by genome, family structure, and unmeasured characteristics of early childhood factors. PMID:26271116

School wellbeing among children in grades 1-10.

PubMed

Løhre, Audhild; Lydersen, Stian; Vatten, Lars J

2010-09-01

Determinants of children's school wellbeing have not been extensively studied. In this cross-sectional study of school children we assessed how factors assumed to promote wellbeing and factors assumed to adversely influence wellbeing were associated with self-reported wellbeing in school. Children from five schools, 230 boys and 189 girls in grades 1-10, responded to the same set of questions. We used proportional odds logistic regression to assess the associations of promoting and restraining factors with school wellbeing. In a multivariable analysis, degree of school wellbeing in boys was strongly and positively related to enjoying school work (odds ratio, 3.84, 95% CI 2.38 to 6.22) and receiving necessary help (odds ratio, 3.55, 95% CI 2.17 to 5.80) from teachers. In girls, being bothered during lessons was strongly and negatively associated with school wellbeing (odds ratio, 0.43, 95% CI 0.22 to 0.85). Different factors may determine school wellbeing in boys and girls, but for both genders, factors relevant for lessons may be more important than factors related to recess. Especially in boys, the student-teacher relationship may be of particular importance.

Artistic creativity and risk for schizophrenia, bipolar disorder and unipolar depression: a Swedish population-based case-control study and sib-pair analysis.

PubMed

MacCabe, J H; Sariaslan, A; Almqvist, C; Lichtenstein, P; Larsson, H; Kyaga, S

2018-06-01

Many studies have addressed the question of whether mental disorder is associated with creativity, but high-quality epidemiological evidence has been lacking.AimsTo test for an association between studying a creative subject at high school or university and later mental disorder. In a case-control study using linked population-based registries in Sweden (N = 4 454 763), we tested for associations between tertiary education in an artistic field and hospital admission with schizophrenia (N = 20 333), bipolar disorder (N = 28 293) or unipolar depression (N = 148 365). Compared with the general population, individuals with an artistic education had increased odds of developing schizophrenia (odds ratio = 1.90, 95% CI = [1.69; 2.12]) bipolar disorder (odds ratio = 1.62 [1.50; 1.75]) and unipolar depression (odds ratio = 1.39 [1.34; 1.44]. The results remained after adjustment for IQ and other potential confounders. Students of artistic subjects at university are at increased risk of developing schizophrenia, bipolar disorder and unipolar depression in adulthood.Declaration of interestNone.

POLYCYCLIC AROMATIC HYDROCARBONS WITH STRAIGHT EDGES AND THE 7.6/6.2 AND 8.6/6.2 INTENSITY RATIOS IN REFLECTION NEBULAE.

PubMed

Ricca, Alessandra; Bauschlicher, Charles W; Roser, Joseph E; Peeters, Els

2018-01-01

We have investigated the mid-infrared spectral characteristics of a series of polycyclic aromatic hydrocarbons (PAHs) with straight edges and containing an even or odd number of carbons using density functional theory (DFT). For several even and odd-carbon PAHs, the 8.6/6.2 and 7.6/6.2 intensity ratios computed in emission after the absorption of a 8 eV photon match the observed ratios obtained for three reflection nebulae (RNe), namely NGC 1333, NGC 7023, and NGC 2023. Odd-carbon PAHs are favored, particularly for NGC 1333. Both cations and anions are present with the cations being predominant. Relevant PAHs span sizes ranging from 46 to 103-113 carbons for NGC 7023 and NGC 2023 and from 38 to 127 carbons for NGC 1333 and have symmetries ranging from D 2 h to C s . Our work suggests that even and odd-carbon PAHs with straight edges are viable candidates for the PAH emission seen towards irradiated Photo-Dissociation Regions (PDRs).

Polycyclic Aromatic Hydrocarbons with Straight Edges and the 7.6/6.2 and 8.6/6.2 Intensity Ratios in Reflection Nebulae

NASA Astrophysics Data System (ADS)

Ricca, Alessandra; Bauschlicher, Charles W., Jr.; Roser, Joseph E.; Peeters, Els

2018-02-01

Using density functional theory, we have investigated the mid-infrared spectral characteristics of a series of polycyclic aromatic hydrocarbons (PAHs) that have straight edges and that contain an even or odd number of carbons. For several even and odd-carbon PAHs, the 8.6/6.2 and 7.6/6.2 intensity ratios computed in emission after the absorption of a 8 eV photon match the observed ratios obtained for three reflection nebulae (RNe), namely NGC 1333, NGC 7023, and NGC 2023. Odd-carbon PAHs are favored, particularly for NGC 1333. Both cations and anions are present, with the cations being predominant. Relevant PAHs span sizes ranging from 46 to 113 carbons for NGC 7023 and NGC 2023 and from 38 to 127 carbons for NGC 1333, and have symmetries ranging from D2h to C s . Our work suggests that even- and odd-carbon PAHs with straight edges are viable candidates for the PAH emission seen toward irradiated photodissociation regions.

The Effects of Small Sample Size on Identifying Polytomous DIF Using the Liu-Agresti Estimator of the Cumulative Common Odds Ratio

ERIC Educational Resources Information Center

Carvajal, Jorge; Skorupski, William P.

2010-01-01

This study is an evaluation of the behavior of the Liu-Agresti estimator of the cumulative common odds ratio when identifying differential item functioning (DIF) with polytomously scored test items using small samples. The Liu-Agresti estimator has been proposed by Penfield and Algina as a promising approach for the study of polytomous DIF but no…

Effects of vehicle-ride exposure on cervical pathology: a meta-analysis

PubMed Central

KOLLOCK, Roger; GAMES, Kenneth; WILSON, Alan E.; SEFTON, JoEllen M.

2015-01-01

Research to date on the effect vehicle-ride exposure has on the development of cervical pathologies in mounted Warfighters is conflicting. The purpose of this study was to determine if the literature suggests a definite effect of vehicle-ride exposure on cervical pathology. Databases were searched using multiple combinations of select terms. Twelve studies meeting the inclusion criteria were included in the meta-analysis. The results of the meta-analysis revealed that overall vehicle-ride exposure was likely to increase cervical pathology (p=0.01, odds ratio=1.59, 95% CI=1.16−2.17). Using vehicle type as a moderator it was found that vehicle-ride exposure in ground-based vehicles (p=0.01, odds ratio=2.33, 95% CI=1.41−3.85) and fixed-wing aircraft (p=0.01, odds ratio =1.59, 95% CI=1.13−2.23) were likely to increase cervical pathology. Using operator/other personnel moderator it was found that in the populations tested, fighter pilots or fighter jet weapons systems operators were more likely to develop a cervical pathology (p<0.001, odds ratio=1.78, 95% CI=1.26−2.50). The available studies indicate an increase in cervical pathology for personnel exposed to ground-based vehicles and fixed-wing aircraft. PMID:25739897

Outcomes After Direct Thrombectomy or Combined Intravenous and Endovascular Treatment Are Not Different.

PubMed

Abilleira, Sònia; Ribera, Aida; Cardona, Pedro; Rubiera, Marta; López-Cancio, Elena; Amaro, Sergi; Rodríguez-Campello, Ana; Camps-Renom, Pol; Cánovas, David; de Miquel, Maria Angels; Tomasello, Alejandro; Remollo, Sebastian; López-Rueda, Antonio; Vivas, Elio; Perendreu, Joan; Gallofré, Miquel

2017-02-01

Whether intravenous thrombolysis adds a further benefit when given before endovascular thrombectomy (EVT) is unknown. Furthermore, intravenous thrombolysis delays time to groin puncture, mainly among drip and ship patients. Using region-wide registry data, we selected cases that received direct EVT or combined intravenous thrombolysis+EVT for anterior circulation strokes between January 2011 and October 2015. Treatment effect was estimated by stratification on a propensity score. The average odds ratios for the association of treatment with good outcome and death at 3 months and symptomatic bleedings at 24 hours were calculated with the Mantel-Haenszel test statistic. We included 599 direct EVT patients and 567 patients with combined treatment. Stratification through propensity score achieved balance of baseline characteristics across treatment groups. There was no association between treatment modality and good outcome (odds ratio, 0.97; 95% confidence interval, 0.74-1.27), death (odds ratio, 1.07; 95% confidence interval, 0.74-1.54), or symptomatic bleedings (odds ratio, 0.56; 95% confidence interval, 0.25-1.27). This observational study suggests that outcomes after direct EVT or combined intravenous thrombolysis+EVT are not different. If confirmed by a randomized controlled trial, it may have a significant impact on organization of stroke systems of care. © 2017 American Heart Association, Inc.

Combining matched and unmatched control groups in case-control studies.

PubMed

le Cessie, Saskia; Nagelkerke, Nico; Rosendaal, Frits R; van Stralen, Karlijn J; Pomp, Elisabeth R; van Houwelingen, Hans C

2008-11-15

Multiple control groups in case-control studies are used to control for different sources of confounding. For example, cases can be contrasted with matched controls to adjust for multiple genetic or unknown lifestyle factors and simultaneously contrasted with an unmatched population-based control group. Inclusion of different control groups for a single exposure analysis yields several estimates of the odds ratio, all using only part of the data. Here the authors introduce an easy way to combine odds ratios from several case-control analyses with the same cases. The approach is based upon methods used for meta-analysis but takes into account the fact that the same cases are used and that the estimated odds ratios are therefore correlated. Two ways of estimating this correlation are discussed: sandwich methodology and the bootstrap. Confidence intervals for the pooled estimates and a test for checking whether the odds ratios in the separate case-control studies differ significantly are derived. The performance of the method is studied by simulation and by applying the methods to a large study on risk factors for thrombosis, the MEGA Study (1999-2004), wherein cases with first venous thrombosis were included with a matched control group of partners and an unmatched population-based control group.

[Health promotion for long-term unemployed. Effects on motivation for a healthy lifestyle].

PubMed

Horns, K; Seeger, K; Heinmüller, M; Limm, H; Waldhoff, H-P; Salman, R; Gündel, H; Angerer, P

2012-05-01

Among the long-term unemployed ill health is often a hindrance to successful reintegration in the job market. In a quasi-experimental controlled study we examined the effects of a health promotion intervention program tailored to the specific needs of the long-term unemployed combining individual sessions based on motivational interviewing and participatory group sessions including physical activity. Over a period of 3 months the participants of the intervention group (n = 179) showed more improvement compared to the control group (n = 108) in terms of motivation for lifestyle changes towards more physical activity and healthier nutrition. Participants of the intervention group developed an intention to act significantly more often (active lifestyle: odds ratio 4.44; 95% CI: 2.00-9.83; healthy nutrition: odds ratio 3.94; 95% CI: 1.55-10.00) and actually implemented a behavior change significantly more often (active lifestyle: odds ratio 2.77; 95% CI: 1.35-5.71; healthy nutrition: odds ratio 4.34; 95% CI: 1.92-9.78). In terms of smoking and alcohol consumption no significant intervention effects were detected. The results of the study show the effectiveness of the described health promotion program regarding a lifestyle change towards more healthy nutrition and more physical activity.

Sex differences in injury patterns among workers in heavy manufacturing.

PubMed

Taiwo, Oyebode A; Cantley, Linda F; Slade, Martin D; Pollack, Keshia M; Vegso, Sally; Fiellin, Martha G; Cullen, Mark R

2009-01-15

The objective of the study was to determine if female workers in a heavy manufacturing environment have a higher risk of injury compared with males when performing the same job and to evaluate sex differences in type or severity of injury. By use of human resources and incident surveillance data for the hourly population at 6 US aluminum smelters, injuries that occurred from January 1, 1996, through December 21, 2005, were analyzed. Multivariate logistic regression, adjusted for job, tenure, and age category, was used to calculate odds ratios and 95% confidence intervals for female versus male injury risk for all injuries, recordable injuries, and lost work time injuries. The analysis was repeated for acute injuries and musculoskeletal disorder-related injuries separately. Female workers in this industry have a greater risk for sustaining all forms of injury after adjustment for age, tenure, and standardized job category (odds ratio = 1.365, 95% confidence interval: 1.290, 1.445). This excess risk for female workers persisted when injuries were dichotomized into acute injuries (odds ratio = 1.2) and musculoskeletal disorder-related injuries (odds ratio = 1.1). This study provides evidence of a sex disparity in occupational injury with female workers at higher risk compared with their male counterparts in a heavy manufacturing environment.

Individual participant data meta-analyses should not ignore clustering

PubMed Central

Abo-Zaid, Ghada; Guo, Boliang; Deeks, Jonathan J.; Debray, Thomas P.A.; Steyerberg, Ewout W.; Moons, Karel G.M.; Riley, Richard David

2013-01-01

Objectives Individual participant data (IPD) meta-analyses often analyze their IPD as if coming from a single study. We compare this approach with analyses that rather account for clustering of patients within studies. Study Design and Setting Comparison of effect estimates from logistic regression models in real and simulated examples. Results The estimated prognostic effect of age in patients with traumatic brain injury is similar, regardless of whether clustering is accounted for. However, a family history of thrombophilia is found to be a diagnostic marker of deep vein thrombosis [odds ratio, 1.30; 95% confidence interval (CI): 1.00, 1.70; P = 0.05] when clustering is accounted for but not when it is ignored (odds ratio, 1.06; 95% CI: 0.83, 1.37; P = 0.64). Similarly, the treatment effect of nicotine gum on smoking cessation is severely attenuated when clustering is ignored (odds ratio, 1.40; 95% CI: 1.02, 1.92) rather than accounted for (odds ratio, 1.80; 95% CI: 1.29, 2.52). Simulations show models accounting for clustering perform consistently well, but downwardly biased effect estimates and low coverage can occur when ignoring clustering. Conclusion Researchers must routinely account for clustering in IPD meta-analyses; otherwise, misleading effect estimates and conclusions may arise. PMID:23651765

Incidence of endometrial spotting or bleeding during continuous-combined estrogen-progestin therapy in postmenopausal women with and without hypertension.

PubMed

Sriprasert, Intira; Beydoun, Hind; Barnabei, Vanessa; Nassir, Rami; LaCroix, Andrea Z; Archer, David F

2015-10-01

Endometrial spotting or bleeding is a common adverse effect among women taking continuous-combined estrogen-progestin therapy. The renin-angiotensin-aldosterone system plays a major role in hypertension and is present in the endometrium. We hypothesized that postmenopausal women with hypertension would have a higher incidence of bleeding compared with postmenopausal women without hypertension. A multivariate mixed-effects logistic model estimated the odds ratios for the relationship of hypertension status or use of antihypertensive drugs with endometrial bleeding using the Women's Health Initiative database. The incidence of spotting or bleeding in the first 12 months of estrogen-progestin use was 42% in women aged 50 to 79 years. Women with hypertension were more likely to experience bleeding than women without hypertension (odds ratio, 1.07; 95% CI, 1.02-1.13). Overall antihypertensive medication use increased bleeding with an odds ratio of 1.24, whereas angiotensin II receptor antagonists had a reduced odds ratio (0.53). Postmenopausal women with hypertension are more likely to bleed than postmenopausal women without hypertension when taking continuous estrogen-progestin, with less bleeding in women using angiotensin II receptor antagonists. This finding is novel and supports our hypothesis that the endometrial renin-angiotensin-aldosterone system may contribute to endometrial bleeding.

Statin and NSAID Use and Prostate Cancer Risk

PubMed Central

Coogan, Patricia F.; Kelly, Judith Parsells; Strom, Brian L.; Rosenberg, Lynn

2010-01-01

Purpose Some studies have reported reduced risks of advanced, but not early, prostate cancer among statin users, and one study found a reduced risk only among statin users who had also used nonsteroidal anti-inflammatory drugs (NSAIDs). We have previously reported no association between statin use and prostate cancer in our hospital-based Case Control Surveillance Study. The purpose of the present analyses was to update the findings by cancer stage and to evaluate the joint use of statins and NSAIDs. Methods Cases were 1367 men with prostate cancer and controls were 2007 men with diagnoses unrelated to statin or NSAID use. We used multivariable logistic regression analyses to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for statin use compared with no use, and joint use of statin and NSAIDs compared with use of neither. Results The odds ratio among regular statin users was 1.1 (95% CI 0.9–1.5), and odds ratios were similar among early and late stage cancers. The odds ratio among joint statin and NSAID users was 1.1 (95% CI 0.7–1.6). Conclusion The present results do not support a protective effect of statin use, or statin and NSAID use, on the risk of advanced prostate cancer. PMID:20582910

The role of initial radiologic and clinical manifestations in predicting the prognosis for pneumonia caused by H1N1 influenza virus.

PubMed

Göya, Cemil; Yavuz, Alpaslan; Hamidi, Cihad; Cetinçakmak, Mehmet Güli; Teke, Memik; Hattapoğlu, Salih; Duşak, Abdurrahim

2014-06-01

The aim of this study is to investigate the prognostic values of initial radiologic findings and preexisting medical conditions in pneumonia caused by H1N1 influenza virus that were obtained during the novel swine-origin influenza A (H1N1) virus (S-OIV) pandemic spread. Thirty-nine patients hospitalized due to H1N1 infection between September and December 2009 were retrospectively evaluated regarding the radiologic and clinical aspects. The thoracic computed tomography (CT) findings of all patients were assessed and accompanying conditions that may raise the morbidity were stated. The patients were divided into two groups as those who needed the intensive care unit administration and those treated with brief hospitalization; initial radiologic findings and preexisting medical situations of patients were compared among both groups respectively in terms of their prognostic value. In 39 patients with H1N1 infection (21 males and 18 females; mean age of 53.9±14 in range between 19 and 99 years); the necessity of intensive care was significantly higher in patients with solely chronic obstructive pulmonary disease (COPD) (P=0.008, Odds ratio: 27) or co-existence of COPD and malignity (Odds ratio: 13); however, no statistically significant difference between two groups was observed regarding the radiologic facts or other combinations of accompanying medical conditions in terms of any effects to the prognosis. In the H1N1 (S-OIV) pandemic, we observed that merely the contribution to the diagnostic process; the radiologic features have no significance as being prognostic indicator. Additionally; the superposition of H1N1 infection in patients with either COPD or COPD by malignity was stated to be a potential risk factor in terms of increased morbidity.

A Case-Crossover Study of Heat Exposure and Injury Risk in Outdoor Agricultural Workers.

PubMed

Spector, June T; Bonauto, David K; Sheppard, Lianne; Busch-Isaksen, Tania; Calkins, Miriam; Adams, Darrin; Lieblich, Max; Fenske, Richard A

2016-01-01

Recent research suggests that heat exposure may increase the risk of traumatic injuries. Published heat-related epidemiological studies have relied upon exposure data from individual weather stations. To evaluate the association between heat exposure and traumatic injuries in outdoor agricultural workers exposed to ambient heat and internal heat generated by physical activity using modeled ambient exposure data. A case-crossover study using time-stratified referent selection among 12,213 outdoor agricultural workers with new Washington State Fund workers' compensation traumatic injury claims between 2000 and 2012 was conducted. Maximum daily Humidex exposures, derived from modeled meteorological data, were assigned to latitudes and longitudes of injury locations on injury and referent dates. Conditional logistic regression was used to estimate odds ratios of injury for a priori daily maximum Humidex categories. The mean of within-stratum (injury day and corresponding referent days) standard deviations of daily maximum Humidex was 4.8. The traumatic injury odds ratio was 1.14 (95% confidence interval 1.06, 1.22), 1.15 (95% confidence interval 1.06, 1.25), and 1.10 (95% confidence interval 1.01, 1.20) for daily maximum Humidex of 25-29, 30-33, and ≥34, respectively, compared to < 25, adjusted for self-reported duration of employment. Stronger associations were observed during cherry harvest duties in the June and July time period, compared to all duties over the entire study period. Agricultural workers laboring in warm conditions are at risk for heat-related traumatic injuries. Combined heat-related illness and injury prevention efforts should be considered in high-risk populations exposed to warm ambient conditions in the setting of physical exertion.

Racial/Ethnic Disparities in the Mental Health Care Utilization of Fifth Grade Children

PubMed Central

Coker, Tumaini R.; Elliott, Marc N.; Kataoka, Sheryl; Schwebel, David C.; Mrug, Sylvie; Grunbaum, Jo Anne; Cuccaro, Paula; Peskin, Melissa F.; Schuster, Mark A.

2015-01-01

Objective The aim of this study was to examine racial/ethnic differences in fifth grade children’s mental health care utilization. Methods We analyzed cross-sectional data from a study of 5147 fifth graders and their parents in 3 US metropolitan areas from 2004–06. Multivariate logistic regression was used to examine racial/ethnic differences in mental health care utilization. Results Nine percent of parents reported that their child had ever used mental health care services; fewer black (6%) and Hispanic (8%) children had used services than white children (14%). Fewer black and Hispanic children with recent symptoms of attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder, and fewer black children with symptoms of depression had ever utilized services compared with white children. In multivariate analyses controlling for demographic factors, parental mental health, social support, and symptoms of the 4 mental health conditions, we found that black children were less likely than white children to have ever used services (Odds ratio [OR] 0.3, 95% confidence interval [95% CI], 0.2–0.4, P <.001). The odds ratio for black children remained virtually unchanged when the analysis was restricted to children with symptoms of ≥1 mental health condition, and when the analysis was stratified by mental health condition. The difference in utilization for Hispanic compared with white children was fully explained by sociodemographics in all multivariate models. Conclusions Disparities exist in mental health care utilization for black and Hispanic children; the disparity for black children is independent of sociodemographics and child mental health need. Efforts to reduce this disparity may benefit from addressing not only access and diagnosis issues, but also parents’ help-seeking preferences for mental health care for their children. PMID:19329099

Housing conditions and Plasmodium falciparum infection: protective effect of iron-sheet roofed houses.

PubMed

Yé, Yazoumé; Hoshen, Moshe; Louis, Valérie; Séraphin, Simboro; Traoré, Issouf; Sauerborn, Rainer

2006-02-01

Identification and better understanding of potential risk factors for malaria are important for targeted and cost-effective health interventions. Housing conditions have been suggested as one of the potential risk factors. This study aims to further investigate this risk factor, and is focused on the effect of the type of roof on Plasmodium falciparum infection among children below five years in the North West of Burkina Faso. In a cross-sectional study design, 661 children aged six to 60 months were randomly selected from three rural and one semi-urban site at the end of the rainy season (November 2003). The children were screened for fever and tested for Plasmodium falciparum infection. In addition, data on bed net use and house characteristics was collected from the household were each child lived. Using adjusted odds ratios, children living in house roofed with iron-sheet were compared with those in house with mud or grass roof. Overall P. falciparum infection prevalence was 22.8 % with a significant variation between (Chi-square, p < 0.0001). The prevalence in Cissé (33.3 %) and Goni (30.6 %) were twice times more than in Nouna (15.2 %) and Kodougou (13.2 %). After adjusting for age, sex, use of bed net and housing conditions, children living in houses with mud roofs had significantly higher risk of getting P. falciparum infection compared to those living in iron-sheet roofed houses (Odds Ratio 2.6; 95% Confidence Interval, 1.4-4.7). These results suggest that house characteristics should be taken into consideration when designing health intervention against P. falciparum infection and particular attention should be paid to children living in houses with mud roofs.

Suicide in Tourette's and Chronic Tic Disorders.

PubMed

Fernández de la Cruz, Lorena; Rydell, Mina; Runeson, Bo; Brander, Gustaf; Rück, Christian; D'Onofrio, Brian M; Larsson, Henrik; Lichtenstein, Paul; Mataix-Cols, David

2017-07-15

Persons with neuropsychiatric disorders are at increased risk of suicide, but there is little data concerning Tourette's and chronic tic disorders (TD/CTD). We aimed to quantify the risk of suicidal behavior in a large nationwide cohort of patients with TD/CTD, establish the contribution of psychiatric comorbidity to this risk, and identify predictors of suicide. Using a validated algorithm, we identified 7736 TD/CTD cases in the Swedish National Patient Register during a 44-year period (1969-2013). Using a matched case-cohort design, patients were compared with general population control subjects (1:10 ratio). Risk of suicidal behavior was estimated using conditional logistic regressions. Predictors of suicidal behavior in the TD/CTD cohort were studied using Cox regression models. In unadjusted models, TD/CTD patients, compared with control subjects, had an increased risk of both dying by suicide (odds ratio: 4.39; 95% confidence interval [CI]: 2.89-6.67) and attempting suicide (odds ratio: 3.86; 95% CI: 3.50-4.26). After adjusting for psychiatric comorbidities, the risk was reduced but remained substantial. Persistence of tics beyond young adulthood and a previous suicide attempt were the strongest predictors of death by suicide in TD/CTD patients (hazard ratio: 11.39; 95% CI: 3.71-35.02, and hazard ratio: 5.65; 95% CI: 2.21-14.42, respectively). TD/CTD are associated with substantial risk of suicide. Suicidal behavior should be monitored in these patients, particularly in those with persistent tics, history of suicide attempts, and psychiatric comorbidities. Preventive and intervention strategies aimed to reduce the suicidal risk in this group are warranted. Copyright © 2016 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

The Effect of Birth Order on Neonatal Morbidity and Mortality in Very Preterm Twins.

PubMed

Mei-Dan, Elad; Shah, Jyotsna; Lee, Shoo; Shah, Prakesh S; Murphy, Kellie E

2017-07-01

Objective  This retrospective cohort study examined the effect of birth order on neonatal morbidity and mortality in very preterm twins. Study Design  Using 2005 to 2012 data from the Canadian Neonatal Network, very preterm twins born between 24 0/7 and 32 6/7 weeks of gestation were included. Odds of morbidity and mortality of second-born cotwins compared with first-born cotwins were examined by matched-pair analysis. Outcomes were neonatal death, severe brain injury (intraventricular hemorrhage grade 3 or 4 or persistent periventricular echogenicity), bronchopulmonary dysplasia, severe retinopathy of prematurity (ROP) (> stage 2), necrotizing enterocolitis (≥ stage 2), and respiratory distress syndrome (RDS). Multivariable analysis was performed adjusting for confounders. Result  There were 6,636 twins (3,318 pairs) included with a mean gestational age (GA) of 28.9 weeks. A higher rate of small for GA occurred in second-born twins (10 vs. 6%). Mortality was significantly lower for second-born twins (4.3 vs. 5.3%; adjusted odds ratio: 0.75; 95% confidence interval [CI]: 0.59-0.95). RDS (66 vs. 60%; adjusted odds ratio: 1.40; 95% CI: 1.29-1.52) and severe retinopathy (9 vs. 7%; adjusted odds ratio: 1.46; 95% CI: 1.07-2.01) were significantly higher in second-born twins. Conclusion  Thus, while second-born twins had reduced odds of mortality, they also had increased odds of RDS and ROP. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Wheelchair services and use outcomes: A cross-sectional survey in Kenya and the Philippines

PubMed Central

Himelfarb Hurwitz, Elizabeth J.; Onguti, Brenda N.; Noon, Jamie H.; Xavier, Cheryl A.; Gabbow, Mohammed; Musakhi, Peter

2017-01-01

Background The World Health Organisation recommends that services accompany wheelchair distribution. This study examined the relationship of wheelchair service provision in Kenya and the Philippines and wheelchair-use–related outcomes. Method We surveyed 852 adult basic manual wheelchair users. Participants who had received services and those who had not were sought in equal numbers from wheelchair-distribution entities. Outcomes assessed were daily wheelchair use, falls, unassisted outdoor use and performance of activities of daily living (ADL). Descriptive, bivariate and multivariable regression model results are presented. Results Conditions that led to the need for a basic wheelchair were mainly spinal cord injury, polio/post-polio, and congenital conditions. Most Kenyans reported high daily wheelchair use (60%) and ADL performance (80%), while these practices were less frequent in the Philippine sample (42% and 74%, respectively). Having the wheelchair fit assessed while the user propelled the wheelchair was associated with greater odds of high ADL performance in Kenya (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.6, 5.1) and the Philippines (OR 2.8, 95% CI 1.8, 4.5). Wheelchair-related training was associated with high ADL performance in Kenya (OR 3.2, 95% CI 1.3, 8.4). In the Philippines, training was associated with greater odds of high versus no daily wheelchair use but also odds of serious versus no falls (OR 2.5, 95% CI 1.4, 4.5). Conclusion Select services that were associated with some better wheelchair use outcomes and should be emphasised in service delivery. Service providers should be aware that increased mobility may lead to serious falls. PMID:29134178

Low control beliefs in relation to school dropout and poor health: findings from the SIODO case-control study.

PubMed

Bosma, Hans; Theunissen, Marie-José; Verdonk, Petra; Feron, Frans

2014-11-28

There is cumulating evidence that health is compromised through adverse socioeconomic conditions negatively affecting how people think, feel, and behave. Low control beliefs might be a key mechanism. The reversed possibility that low control beliefs might set people on a pathway towards adverse socioeconomic and health-related outcomes is much less examined. A case-control design was used, consisting of 330 cases who dropped out of school in the 2010-2011 school year and 330 controls who still attended school at the end of that year. The respondents, aged between 18 and 23, came from Eindhoven and surrounding areas in the south-east of The Netherlands. A questionnaire asked for current health status, recalled socioeconomic and social background, and recalled control beliefs (mastery and general self-efficacy). Logistic regression analyses were used. Recalls of low mastery and low self-efficacy were strongly related to both dropout and less than good health. Low socioeconomic background was also associated to odds of dropout, but did not confound or moderate the associations of low control beliefs with dropout and health. Odds ratios of dropout and less than good health indicated at least twice the odds of a poor outcome with recalls of low control beliefs. Independent of the socioeconomic background, low control beliefs are related to heightened odds of both poor health and school dropout. Individual differences in control beliefs might thus be as fundamental as socioeconomic conditions in generating life-course socioeconomic and health-related pathways. Although the findings should first be cross-validated in prospective studies, public health professionals working with youth might already start considering early interventions in youth with all too fatalistic and powerless mind-sets.

Incidence of Lower Respiratory Tract Infections and Atopic Conditions in Boys and Young Male Adults: Royal College of General Practitioners Research and Surveillance Centre Annual Report 2015-2016

PubMed Central

Correa, Ana; Pebody, Richard; Yonova, Ivelina; Smith, Gillian; Byford, Rachel; Pathirannehelage, Sameera Rankiri; McGee, Christopher; Elliot, Alex J; Hriskova, Mariya; Ferreira, Filipa IM; Rafi, Imran; Jones, Simon

2018-01-01

Background The Royal College of General Practitioners Research and Surveillance Centre comprises more than 150 general practices, with a combined population of more than 1.5 million, contributing to UK and European public health surveillance and research. Objective The aim of this paper was to report gender differences in the presentation of infectious and respiratory conditions in children and young adults. Methods Disease incidence data were used to test the hypothesis that boys up to puberty present more with lower respiratory tract infection (LRTI) and asthma. Incidence rates were reported for infectious conditions in children and young adults by gender. We controlled for ethnicity, deprivation, and consultation rates. We report odds ratios (OR) with 95% CI, P values, and probability of presenting. Results Boys presented more with LRTI, largely due to acute bronchitis. The OR of males consulting was greater across the youngest 3 age bands (OR 1.59, 95% CI 1.35-1.87; OR 1.13, 95% CI 1.05-1.21; OR 1.20, 95% CI 1.09-1.32). Allergic rhinitis and asthma had a higher OR of presenting in boys aged 5 to 14 years (OR 1.52, 95% CI 1.37-1.68; OR 1.31, 95% CI 1.17-1.48). Upper respiratory tract infection (URTI) and urinary tract infection (UTI) had lower odds of presenting in boys, especially those older than 15 years. The probability of presenting showed different patterns for LRTI, URTI, and atopic conditions. Conclusions Boys younger than 15 years have greater odds of presenting with LRTI and atopic conditions, whereas girls may present more with URTI and UTI. These differences may provide insights into disease mechanisms and for health service planning. PMID:29712621

Maternal, fetal, and placental conditions associated with medically indicated late preterm and early term delivery: a retrospective study.

PubMed

Brown, H K; Speechley, K N; Macnab, J; Natale, R; Campbell, M K

2016-04-01

Our objectives were: (1) to examine the association between maternal, fetal, and placental phenotypes of preterm delivery and medically indicated early delivery of singletons during the late preterm and early term periods; and (2) to identify the specific maternal, fetal, and placental conditions associated with these early deliveries. Retrospective study. City of London and Middlesex County, Ontario, Canada. Singleton live deliveries, at 34-41 weeks of gestation to women in London and Middlesex. We obtained data from a city-wide perinatal database (2002-2011; n = 25 699). We used multinomial logistic regression for multivariable analyses. The outcome was the occurrence of medically indicated late preterm (34-36 weeks of gestation) and early term (37-38 weeks of gestation) delivery, versus delivery at full term (39-41 weeks of gestation). After controlling for confounding factors, all phenotypes were associated with increased odds of medically indicated late preterm and early term delivery. Within the maternal phenotype, chronic maternal medical conditions were associated with increased odds of medically indicated early term delivery (e.g. for gastrointestinal disease, adjusted odds ratio, aOR 1.72, 95% CI 1.47-2.00; for anaemia, aOR 1.40, 95% CI 1.20-1.63), but not late preterm delivery. The aetiology of medically indicated early delivery close to full term is heterogeneous. Patterns of associations suggest slightly different conditions underlying the late preterm and early term phenotypes, with chronic maternal medical conditions being associated with early term delivery but not with late preterm delivery. These results have implications for the prevention of early delivery as well as the identification of high-risk groups among those born early. The aetiology of medically indicated late preterm and early term delivery is heterogeneous. © 2015 Royal College of Obstetricians and Gynaecologists.

Quality of Vitamin K Antagonist Anticoagulation in Spain: Prevalence of Poor Control and Associated Factors.

PubMed

Anguita Sánchez, Manuel; Bertomeu Martínez, Vicente; Cequier Fillat, Ángel

2015-09-01

To study the prevalence of poorly controlled vitamin K antagonist anticoagulation in Spain in patients with nonvalvular atrial fibrillation, and to identify associated factors. We studied 1056 consecutive patients seen at 120 cardiology clinics in Spain between November 2013 and March 2014. We analyzed the international normalized ratio from the 6 months prior to the patient's visit, calculating the prevalence of poorly controlled anticoagulation, defined as < 65% time in therapeutic range using the Rosendaal method. Mean age was 73.6 years (standard deviation, 9.8 years); women accounted for 42% of patients. The prevalence of poorly controlled anticoagulation was 47.3%. Mean time in therapeutic range was 63.8% (25.9%). The following factors were independently associated with poorly controlled anticoagulation: kidney disease (odds ratio = 1.53; 95% confidence interval, 1.08-2.18; P = .018), routine nonsteroidal anti-inflammatory drugs (odds ratio = 1.79; 95% confidence interval, 1.20-2.79; P = .004), antiplatelet therapy (odds ratio = 2.16; 95% confidence interval, 1.49-3.12; P < .0001) and absence of angiotensin receptor blockers (odds ratio = 1.39; 95% confidence interval, 1.08-1.79; P = .011). There is a high prevalence of poorly controlled vitamin K antagonist anticoagulation in Spain. Factors associated with poor control are kidney disease, routine nonsteroidal anti-inflammatory drugs, antiplatelet use, and absence of angiotensin receptor blockers. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Occupation and male lung cancer: a case-control study in northern Sweden.

PubMed Central

Damber, L A; Larsson, L G

1987-01-01

Using a case-control study comprising about 600 men with lung cancer in northern Sweden the potential risk of different occupations and groups of occupations was studied. Longitudinal data concerning occupation, employment, and smoking habits were obtained by questionnaires. Some occupational groups (underground miners, copper smelter workers, electricians, and plumbers) exposed to previously known lung carcinogenic agents such as radon daughters, arsenic, and asbestos, had considerably increased odds ratios, which persisted after adjustment for smoking. A slightly raised odds ratio was observed in a group of blue collar workers potentially exposed to lung carcinogenic agents; this rise in the group as a whole mainly disappeared after adjustment for smoking. Farmers and foresters had strikingly low odds ratios, which could only partly be explained by their more moderate smoking habits. The population aetiological fraction attributable to occupation was estimated as 9%. PMID:3620367

Factors associated with obstructive sleep apnea among commercial motor vehicle drivers.

PubMed

Xie, Wen; Chakrabarty, Sangita; Levine, Robert; Johnson, Roy; Talmage, James B

2011-02-01

Identify factors associated with obstructive sleep apnea (OSA) risk during commercial driver medical examinations. A case-control study was conducted at an occupational health clinic by reviewing the commercial driver medical examinations medical records performed from January 2007 to December 2008. The magnitude of association with OSA was estimated with logistic regression. Among 1890 commercial motor vehicle drivers, 51 were confirmed positive for OSA by polysomnography after initial screening by Joint Task Force guidelines, yielding estimated positive predictive values of 78.5% for the screening criteria. Multivariable logistic regression showed that body mass index ≥ 30 (odds ratio: 26.86), hypertension (odds ratio: 2.57), and diabetes (odds ratio: 2.03) were independently associated with OSA. Medical examiners' use of objectively measurable risk factors, such as obesity, history of hypertension, and/or diabetes, rather than symptoms, may be more effective in identifying undiagnosed OSA in commercial drivers during the commercial driver medical examinations.

Topiramate-induced paresthesia is more frequently reported by migraine than epileptic patients.

PubMed

Sedighi, Behnaz; Shafiei, Kaveh; Azizpour, Iman

2016-04-01

Topiramate is an approved and effective drug in migraine prophylaxis. Paresthesia is the most commonly reported side effect. The primary objective of this study was to compare the frequency of topiramate-induced paresthesia in migraine headache to epileptic patients. Patients with migraine without aura and epilepsy were enrolled in this observational study. All cases were interviewed by telephone about their history of paresthesia. Confounding factors were controlled through logistic regression. The odds ratio of developing topiramate-induced paresthesia in migraine compared to epilepsy patients was 3.4. Three factors were independent contributors to developing topiramate-induced paresthesia: female sex (odds ratio 2.1), topiramate dosage (odds ratio 0.3) and duration of therapy. Our findings indicate an independent association between migraine and development of paresthesia. Migraineurs were more likely than epileptic patients to report paresthesia as topiramate adverse effects. Female sex, treatment duration and topiramate dosage contribute significantly to subsequent development of paresthesia.

Predictors of successful closure of patent ductus arteriosus with indomethacin.

PubMed

Ahamed, M F; Verma, P; Lee, S; Vega, M; Wang, D; Kim, M; Fuloria, M

2015-09-01

To determine whether platelet counts can predict the likelihood of successful closure of patent ductus arteriosus (PDA) with indomethacin. This was a retrospective cohort study of infants <32 weeks' gestational age (GA) and birth weight <1500 g with PDA. Clinical characteristics between infants who achieved ductal closure with indomethacin and those who failed were compared. Multivariable logistic regression was used to identify predictors of successful ductal closure. In infants with hemodynamically significant PDA, older GA (odds ratio=1.54; 95% confidence interval: 1.12 to 2.13), male gender (odds ratio=3.02; 95% confidence interval: 1.08 to 8.49) and higher platelet count (odds ratio=1.5; 95% confidence interval: 1.04 to 2.17) prior to indomethacin treatment were associated with successful ductal closure with indomethacin. Older GA, male gender and higher platelet count at time of treatment of hemodynamically significant PDA are predictors of successful ductal closure with indomethacin.

Induction of labor before 40 weeks is associated with lower rate of cesarean delivery in women with gestational diabetes mellitus.

PubMed

Melamed, Nir; Ray, Joel G; Geary, Michael; Bedard, Daniel; Yang, Cathy; Sprague, Ann; Murray-Davis, Beth; Barrett, Jon; Berger, Howard

2016-03-01

In women with gestational diabetes mellitus, it is not clear whether routine induction of labor at <40 weeks of gestation is beneficial to mother and newborn infant. The purpose of this study was to compare outcomes among women with gestational diabetes mellitus who had induction of labor at either 38 or 39 weeks with those whose pregnancy was managed expectantly. We included all women in Ontario, Canada, with diagnosed gestational diabetes mellitus who had a singleton hospital birth at ≥38 + 0 weeks of gestation between April 2012 and March 2014. Data were obtained from the Better Outcomes Registry & Network Ontario, which is a province-wide registry of all births in Ontario, Canada. Women who underwent induction of labor at 38 + 0 to 38 + 6 weeks of gestation (38-IOL; n = 1188) were compared with those who remained undelivered until 39 + 0 weeks of gestation (38-Expectant; n = 5229). Separately, those women who underwent induction of labor at 39 + 0 to 39 + 6 weeks of gestation (39-IOL; n = 1036) were compared with women who remained undelivered until 40 + 0 weeks of gestation (39-Expectant; n = 2162). Odds ratios and 95% confidence intervals were adjusted for maternal age, parity, insulin treatment, and prepregnancy body mass index. Of 281,480 women who gave birth during the study period, 14,600 women (5.2%) had gestational diabetes mellitus; of these, 8392 women (57.5%) met all inclusion criteria. Compared with the 38-Expectant group, those women in the 38-IOL group had lower odds for cesarean delivery (adjusted odds ratio, 0.73; 95% confidence interval, 0.52-0.90), higher odds for neonatal intensive care unit admission (adjusted odds ratio, 1.36; 95% confidence interval, 1.09-1.69), and no difference in other maternal-newborn infant outcomes. Compared with the 39-Expectant group, women in the 39-IOL group likewise had lower odds for cesarean delivery (adjusted odds ratio, 0.73; 95% confidence interval, 0.58-0.93) but no difference in neonatal intensive care unit admission (adjusted odds ratio, 0.83; 95% confidence interval, 0.61-1.11). In women with gestational diabetes mellitus, the routine induction of labor at 38 or 39 weeks is associated with a lower risk of cesarean delivery compared with expectant management but may increase the risk of neonatal intensive care unit admission when done at <39 weeks of gestation. Copyright © 2016 Elsevier Inc. All rights reserved.

A prospective study of the natural history of urinary incontinence in women.

PubMed

Hagan, Kaitlin A; Erekson, Elisabeth; Austin, Andrea; Minassian, Vatche A; Townsend, Mary K; Bynum, Julie P W; Grodstein, Francine

2018-05-01

Symptoms of urinary incontinence are commonly perceived to vary over time; yet, there is limited quantitative evidence regarding the natural history of urinary incontinence, especially over the long term. We sought to delineate the course of urinary incontinence symptoms over time, using 2 large cohorts of middle-aged and older women, with data collected over 10 years. We studied 9376 women from the Nurses' Health Study, age 56-81 years at baseline, and 7491 women from the Nurses' Health Study II, age 39-56 years, with incident urinary incontinence in 2002 through 2003. Urinary incontinence severity was measured by the Sandvik severity index. We tracked persistence, progression, remission, and improvement of symptoms over 10 years. We also examined risk factors for urinary incontinence progression using logistic regression models. Among women age 39-56 years, 39% had slight, 45% had moderate, and 17% had severe urinary incontinence at onset. Among women age 56-81 years, 34% had slight, 45% had moderate, and 21% had severe urinary incontinence at onset. Across ages, most women reported persistence or progression of symptoms over follow-up; few (3-11%) reported remission. However, younger women and women with less severe urinary incontinence at onset were more likely to report remission or improvement of symptoms. We found that increasing age was associated with higher odds of progression only among older women (age 75-81 vs 56-60 years; odds ratio, 1.84; 95% confidence interval, 1.51-2.25). Among all women, higher body mass index was strongly associated with progression (younger women: odds ratio, 2.37; 95% confidence interval, 2.00-2.81; body mass index ≥30 vs <25 kg/m 2 ; older women: odds ratio, 1.93; 95% confidence interval, 1.62-2.22). Additionally, greater physical activity was associated with lower odds of progression to severe urinary incontinence (younger women: odds ratio, 0.86; 95% confidence interval, 0.71-1.03; highest vs lowest quartile of activity; older women: odds ratio, 0.68; 95% confidence interval, 0.59-0.80). Most women with incident urinary incontinence continued to experience symptoms over 10 years; few had complete remission. Identification of risk factors for urinary incontinence progression, such as body mass index and physical activity, could be important for reducing symptoms over time. Copyright © 2018 Elsevier Inc. All rights reserved.

Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data

PubMed Central

Holmes, Michael V; Dale, Caroline E; Zuccolo, Luisa; Silverwood, Richard J; Guo, Yiran; Ye, Zheng; Prieto-Merino, David; Dehghan, Abbas; Trompet, Stella; Wong, Andrew; Cavadino, Alana; Drogan, Dagmar; Padmanabhan, Sandosh; Yesupriya, Ajay; Leusink, Maarten; Sundstrom, Johan; Hubacek, Jaroslav A; Pikhart, Hynek; Swerdlow, Daniel I; Panayiotou, Andrie G; Borinskaya, Svetlana A; Finan, Chris; Shah, Sonia; Kuchenbaecker, Karoline B; Shah, Tina; Engmann, Jorgen; Folkersen, Lasse; Eriksson, Per; Ricceri, Fulvio; Melander, Olle; Sacerdote, Carlotta; Gamble, Dale M; Rayaprolu, Sruti; Ross, Owen A; McLachlan, Stela; Vikhireva, Olga; Sluijs, Ivonne; Scott, Robert A; Adamkova, Vera; Flicker, Leon; van Bockxmeer, Frank M; Power, Christine; Marques-Vidal, Pedro; Meade, Tom; Marmot, Michael G; Ferro, Jose M; Paulos-Pinheiro, Sofia; Humphries, Steve E; Talmud, Philippa J; Leach, Irene Mateo; Verweij, Niek; Linneberg, Allan; Skaaby, Tea; Doevendans, Pieter A; Cramer, Maarten J; van der Harst, Pim; Klungel, Olaf H; Dowling, Nicole F; Dominiczak, Anna F; Kumari, Meena; Nicolaides, Andrew N; Weikert, Cornelia; Boeing, Heiner; Ebrahim, Shah; Gaunt, Tom R; Price, Jackie F; Lannfelt, Lars; Peasey, Anne; Kubinova, Ruzena; Pajak, Andrzej; Malyutina, Sofia; Voevoda, Mikhail I; Tamosiunas, Abdonas; Maitland-van der Zee, Anke H; Norman, Paul E; Hankey, Graeme J; Bergmann, Manuela M; Hofman, Albert; Franco, Oscar H; Cooper, Jackie; Palmen, Jutta; Spiering, Wilko; de Jong, Pim A; Kuh, Diana; Hardy, Rebecca; Uitterlinden, Andre G; Ikram, M Arfan; Ford, Ian; Hyppönen, Elina; Almeida, Osvaldo P; Wareham, Nicholas J; Khaw, Kay-Tee; Hamsten, Anders; Husemoen, Lise Lotte N; Tjønneland, Anne; Tolstrup, Janne S; Rimm, Eric; Beulens, Joline W J; Verschuren, W M Monique; Onland-Moret, N Charlotte; Hofker, Marten H; Wannamethee, S Goya; Whincup, Peter H; Morris, Richard; Vicente, Astrid M; Watkins, Hugh; Farrall, Martin; Jukema, J Wouter; Meschia, James; Cupples, L Adrienne; Sharp, Stephen J; Fornage, Myriam; Kooperberg, Charles; LaCroix, Andrea Z; Dai, James Y; Lanktree, Matthew B; Siscovick, David S; Jorgenson, Eric; Spring, Bonnie; Coresh, Josef; Buxbaum, Sarah G; Schreiner, Pamela J; Ellison, R Curtis; Tsai, Michael Y; Patel, Sanjay R; Redline, Susan; Johnson, Andrew D; Hoogeveen, Ron C; Hakonarson, Hakon; Rotter, Jerome I; Boerwinkle, Eric; de Bakker, Paul I W; Kivimaki, Mika; Asselbergs, Folkert W; Sattar, Naveed; Lawlor, Debbie A; Whittaker, John; Davey Smith, George; Mukamal, Kenneth; Psaty, Bruce M; Wilson, James G; Lange, Leslie A; Hamidovic, Ajna; Hingorani, Aroon D; Nordestgaard, Børge G; Bobak, Martin; Leon, David A; Langenberg, Claudia; Palmer, Tom M; Reiner, Alex P; Keating, Brendan J; Dudbridge, Frank

2014-01-01

Objective To use the rs1229984 variant in the alcohol dehydrogenase 1B gene (ADH1B) as an instrument to investigate the causal role of alcohol in cardiovascular disease. Design Mendelian randomisation meta-analysis of 56 epidemiological studies. Participants 261 991 individuals of European descent, including 20 259 coronary heart disease cases and 10 164 stroke events. Data were available on ADH1B rs1229984 variant, alcohol phenotypes, and cardiovascular biomarkers. Main outcome measures Odds ratio for coronary heart disease and stroke associated with the ADH1B variant in all individuals and by categories of alcohol consumption. Results Carriers of the A-allele of ADH1B rs1229984 consumed 17.2% fewer units of alcohol per week (95% confidence interval 15.6% to 18.9%), had a lower prevalence of binge drinking (odds ratio 0.78 (95% CI 0.73 to 0.84)), and had higher abstention (odds ratio 1.27 (1.21 to 1.34)) than non-carriers. Rs1229984 A-allele carriers had lower systolic blood pressure (−0.88 (−1.19 to −0.56) mm Hg), interleukin-6 levels (−5.2% (−7.8 to −2.4%)), waist circumference (−0.3 (−0.6 to −0.1) cm), and body mass index (−0.17 (−0.24 to −0.10) kg/m2). Rs1229984 A-allele carriers had lower odds of coronary heart disease (odds ratio 0.90 (0.84 to 0.96)). The protective association of the ADH1B rs1229984 A-allele variant remained the same across all categories of alcohol consumption (P=0.83 for heterogeneity). Although no association of rs1229984 was identified with the combined subtypes of stroke, carriers of the A-allele had lower odds of ischaemic stroke (odds ratio 0.83 (0.72 to 0.95)). Conclusions Individuals with a genetic variant associated with non-drinking and lower alcohol consumption had a more favourable cardiovascular profile and a reduced risk of coronary heart disease than those without the genetic variant. This suggests that reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health. PMID:25011450

RELATIONSHIP FORMATION AND STABILITY IN EMERGING ADULTHOOD: DO SEX RATIOS MATTER?

PubMed Central

Warner, Tara D.; Manning, Wendy D.; Giordano, Peggy C.; Longmore, Monica A.

2013-01-01

Research links sex ratios with the likelihood of marriage and divorce. However, whether sex ratios similarly influence precursors to marriage—transitions in and out of dating or cohabiting relationships—is unknown. Utilizing data from the Toledo Adolescent Relationships Study (TARS) and the 2000 census, this study assesses whether sex ratios influence the formation and stability of emerging adults’ romantic relationships. Findings show that relationship formation is unaffected by partner availability, yet the presence of partners increases women’s odds of cohabiting, decreases men’s odds of cohabiting, and increases number of dating partners and cheating among men. It appears that sex ratios influence not only transitions in and out of marriage, but also the process through which individuals search for and evaluate partners prior to marriage. PMID:24265510

Dieting and smoking initiation in early adolescent girls and boys: a prospective study.

PubMed Central

Austin, S B; Gortmaker, S L

2001-01-01

OBJECTIVES: This analysis tested the relation between dieting frequency and risk of smoking initiation in a longitudinal sample of adolescents. METHODS: From 1995 to 1997, 1295 middle school girls and boys participated in a nutrition and physical activity intervention study. The prospective association between dieting frequency at baseline and smoking initiation 2 years later was tested. RESULTS: Compared with girls who reported no dieting at baseline, girls who dieted up to once per week had 2 times the adjusted odds of becoming smokers (odds ratio = 2.0; 95% confidence interval = 1.1, 3.5), and girls who dieted more often had 4 times the adjusted odds of becoming smokers (odds ratio = 3.9; 95% confidence interval = 1.5, 10.4). CONCLUSIONS: Dieting among girls may exacerbate risk of initiating smoking, with increasing risk with greater dieting frequency. PMID:11236412

Pattern of comorbidity among anxious and odd personality disorders: the case of obsessive-compulsive personality disorder.

PubMed

Rossi, A; Marinangeli, M G; Butti, G; Kalyvoka, A; Petruzzi, C

2000-09-01

The aim of this study was to examine the pattern of comorbidity among obsessive-compulsive personality disorder (OCPD) and other personality disorders (PDs) in a sample of 400 psychiatric inpatients. PDs were assessed using the Semistructured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Odds ratios (ORs) were calculated to determine significant comorbidity among OCPD and other axis II disorders. The most elevated odds ratios were found for the cooccurrence of OCPD with cluster A PDs (the "odd" PDs, or paranoid and schizoid PDs). These results are consistent with those of previous studies showing a higher cooccurrence of OCPD with cluster A than with cluster C ("anxious") PDs. In light of these observations, issues associated with the nosologic status of OCPD within the Diagnostic and Statistical Manual of Mental Disorders clustering system remain unsettled.

Self-reported chemicals exposure, beliefs about disease causation, and risk of breast cancer in the Cape Cod Breast Cancer and Environment Study: a case-control study

PubMed Central

2010-01-01

Background Household cleaning and pesticide products may contribute to breast cancer because many contain endocrine disrupting chemicals or mammary gland carcinogens. This population-based case-control study investigated whether use of household cleaners and pesticides increases breast cancer risk. Methods Participants were 787 Cape Cod, Massachusetts, women diagnosed with breast cancer between 1988 and 1995 and 721 controls. Telephone interviews asked about product use, beliefs about breast cancer etiology, and established and suspected breast cancer risk factors. To evaluate potential recall bias, we stratified product-use odds ratios by beliefs about whether chemicals and pollutants contribute to breast cancer; we compared these results with odds ratios for family history (which are less subject to recall bias) stratified by beliefs about heredity. Results Breast cancer risk increased two-fold in the highest compared with lowest quartile of self-reported combined cleaning product use (Adjusted OR = 2.1, 95% CI: 1.4, 3.3) and combined air freshener use (Adjusted OR = 1.9, 95% CI: 1.2, 3.0). Little association was observed with pesticide use. In stratified analyses, cleaning products odds ratios were more elevated among participants who believed pollutants contribute "a lot" to breast cancer and moved towards the null among the other participants. In comparison, the odds ratio for breast cancer and family history was markedly higher among women who believed that heredity contributes "a lot" (OR = 2.6, 95% CI: 1.9, 3.6) and not elevated among others (OR = 0.7, 95% CI: 0.5, 1.1). Conclusions Results of this study suggest that cleaning product use contributes to increased breast cancer risk. However, results also highlight the difficulty of distinguishing in retrospective self-report studies between valid associations and the influence of recall bias. Recall bias may influence higher odds ratios for product use among participants who believed that chemicals and pollutants contribute to breast cancer. Alternatively, the influence of experience on beliefs is another explanation, illustrated by the protective odds ratio for family history among women who do not believe heredity contributes "a lot." Because exposure to chemicals from household cleaning products is a biologically plausible cause of breast cancer and avoidable, associations reported here should be further examined prospectively. PMID:20646273

Predicting the occurrence of embolic events: an analysis of 1456 episodes of infective endocarditis from the Italian Study on Endocarditis (SEI)

PubMed Central

2014-01-01

Background Embolic events are a major cause of morbidity and mortality in patients with infective endocarditis. We analyzed the database of the prospective cohort study SEI in order to identify factors associated with the occurrence of embolic events and to develop a scoring system for the assessment of the risk of embolism. Methods We retrospectively analyzed 1456 episodes of infective endocarditis from the multicenter study SEI. Predictors of embolism were identified. Risk factors identified at multivariate analysis as predictive of embolism in left-sided endocarditis, were used for the development of a risk score: 1 point was assigned to each risk factor (total risk score range: minimum 0 points; maximum 2 points). Three categories were defined by the score: low (0 points), intermediate (1 point), or high risk (2 points); the probability of embolic events per risk category was calculated for each day on treatment (day 0 through day 30). Results There were 499 episodes of infective endocarditis (34%) that were complicated by ≥ 1 embolic event. Most embolic events occurred early in the clinical course (first week of therapy: 15.5 episodes per 1000 patient days; second week: 3.7 episodes per 1000 patient days). In the total cohort, the factors associated with the occurrence of embolism at multivariate analysis were prosthetic valve localization (odds ratio, 1.84), right-sided endocarditis (odds ratio, 3.93), Staphylococcus aureus etiology (odds ratio, 2.23) and vegetation size ≥ 13 mm (odds ratio, 1.86). In left-sided endocarditis, Staphylococcus aureus etiology (odds ratio, 2.1) and vegetation size ≥ 13 mm (odds ratio, 2.1) were independently associated with embolic events; the 30-day cumulative incidence of embolism varied with risk score category (low risk, 12%; intermediate risk, 25%; high risk, 38%; p < 0.001). Conclusions Staphylococcus aureus etiology and vegetation size are associated with an increased risk of embolism. In left-sided endocarditis, a simple scoring system, which combines etiology and vegetation size with time on antimicrobials, might contribute to a better assessment of the risk of embolism, and to a more individualized analysis of indications and contraindications for early surgery. PMID:24779617

A Randomized Study of How Physicians Interpret Research Funding Disclosures

PubMed Central

Kesselheim, Aaron S.; Robertson, Christopher T.; Myers, Jessica A.; Rose, Susannah L.; Gillet, Victoria; Ross, Kathryn M.; Glynn, Robert J.; Joffe, Steven; Avorn, Jerry

2012-01-01

BACKGROUND The effects of clinical-trial funding on the interpretation of trial results are poorly understood. We examined how such support affects physicians’ reactions to trials with a high, medium, or low level of methodologic rigor. METHODS We presented 503 board-certified internists with abstracts that we designed describing clinical trials of three hypothetical drugs. The trials had high, medium, or low methodologic rigor, and each report included one of three support disclosures: funding from a pharmaceutical company, NIH funding, or none. For both factors studied (rigor and funding), one of the three possible variations was randomly selected for inclusion in the abstracts. Follow-up questions assessed the physicians’ impressions of the trials’ rigor, their confidence in the results, and their willingness to prescribe the drugs. RESULTS The 269 respondents (53.5% response rate) perceived the level of study rigor accurately. Physicians reported that they would be less willing to prescribe drugs tested in low-rigor trials than those tested in medium-rigor trials (odds ratio, 0.64; 95% confidence interval [CI], 0.46 to 0.89; P = 0.008) and would be more willing to prescribe drugs tested in high-rigor trials than those tested in medium-rigor trials (odds ratio, 3.07; 95% CI, 2.18 to 4.32; P<0.001). Disclosure of industry funding, as compared with no disclosure of funding, led physicians to downgrade the rigor of a trial (odds ratio, 0.63; 95% CI, 0.46 to 0.87; P = 0.006), their confidence in the results (odds ratio, 0.71; 95% CI, 0.51 to 0.98; P = 0.04), and their willingness to prescribe the hypothetical drugs (odds ratio, 0.68; 95% CI, 0.49 to 0.94; P = 0.02). Physicians were half as willing to prescribe drugs studied in industry-funded trials as they were to prescribe drugs studied in NIH-funded trials (odds ratio, 0.52; 95% CI, 0.37 to 0.71; P<0.001). These effects were consistent across all levels of methodologic rigor. CONCLUSIONS Physicians discriminate among trials of varying degrees of rigor, but industry sponsorship negatively influences their perception of methodologic quality and reduces their willingness to believe and act on trial findings, independently of the trial’s quality. These effects may influence the translation of clinical research into practice. PMID:22992075

High Frequency of Neuroimaging Abnormalities Among Pediatric Patients With Sepsis Who Undergo Neuroimaging.

PubMed

Sandquist, Mary K; Clee, Mark S; Patel, Smruti K; Howard, Kelli A; Yunger, Toni; Nagaraj, Usha D; Jones, Blaise V; Fei, Lin; Vadivelu, Sudhakar; Wong, Hector R

2017-07-01

This study was intended to describe and correlate the neuroimaging findings in pediatric patients after sepsis. Retrospective chart review. Single tertiary care PICU. Patients admitted to Cincinnati Children's Hospital Medical Center with a discharge diagnosis of sepsis or septic shock between 2004 and 2013 were crossmatched with patients who underwent neuroimaging during the same time period. All neuroimaging studies that occurred during or subsequent to a septic event were reviewed, and all new imaging findings were recorded and classified. As many patients experienced multiple septic events and/or had multiple neuroimaging studies after sepsis, our statistical analysis utilized the most recent or "final" imaging study available for each patient so that only brain imaging findings that persisted were included. A total of 389 children with sepsis and 1,705 concurrent or subsequent neuroimaging studies were included in the study. Median age at first septic event was 3.4 years (interquartile range, 0.7-11.5). Median time from first sepsis event to final neuroimaging was 157 days (interquartile range, 10-1,054). The most common indications for final imaging were follow-up (21%), altered mental status (18%), and fever/concern for infection (15%). Sixty-three percentage (n = 243) of final imaging studies demonstrated abnormal findings, the most common of which were volume loss (39%) and MRI signal and/or CT attenuation abnormalities (21%). On multivariable logistic regression, highest Pediatric Risk of Mortality score and presence of oncologic diagnosis/organ transplantation were independently associated with any abnormal final neuroimaging study findings (odds ratio, 1.032; p = 0.048 and odds ratio, 1.632; p = 0.041), although early timing of neuroimaging demonstrated a negative association (odds ratio, 0.606; p = 0.039). The most common abnormal finding of volume loss was independently associated with highest Pediatric Risk of Mortality score (odds ratio, 1.037; p = 0.016) and oncologic diagnosis/organ transplantation (odds ratio, 2.207; p = 0.001) and was negatively associated with early timing of neuroimaging (odds ratio, 0.575; p = 0.037). The majority of pediatric patients with sepsis and concurrent or subsequent neuroimaging have abnormal neuroimaging findings. The implications of this high incidence for long-term neurologic outcomes and follow-up require further exploration.

The impact of water on health and ill-health in a sub-Saharan African wetland: Exploring both sides of the coin.

PubMed

Anthonj, Carmen; Githinji, Sophie; Kistemann, Thomas

2018-05-15

Wetlands are a source of water out of which humans derive their livelihoods in Sub-Saharan Africa. They are often over-utilized and expose humans to disease-causing infectious agents. This calls for an evaluation of the role of water, sanitation and hygiene (WASH) and their effects in disease prevention and transmission in wetlands. A health risk assessment based on syndromic surveillance of self-reported abdominal complaints and fever gathered from a rural wetland in semiarid Kenya is presented with symptoms serving as proxies for real health threats in wetlands. The incidence of abdominal complaints was significantly higher for those using unimproved water sources compared to improved water users (odds ratio 7.5; 95% CI 2.59-26.9; p=0.001). Drainage of stagnant water near the house (odds ratio 0.2; 95% CI 0.08-0.54; p=0.002) and sanitary hygiene (odds ratio 0.4; 95% CI 0.71-0.97; p=0.056) were associated with reduced risk of abdominal complaints. Drainage of water was also associated with reduced risk of fever (odds ratio 0.3; 95% CI 0.02-0.59; p=0.002) and so was the use of mosquito nets (odds ratio 0.6; 95% CI 0.39-0.02; p=0.063). Usage of wetlands in the afternoon, e.g. for irrigated agriculture, increased the incidence of fever (odds ratio 1.5; 95% CI 0.91-2.33; p=0.040). Overall, there appears a greater likelihood of reducing pathogen exposure in the domestic than in the occupational domain or in the proximity to the wetland. We show that WASH, environmental hygiene and human behaviour are risk factors associated with the contraction of diseases characterized by abdominal complaints (e.g. diarrhoea) and fever (e.g. malaria) in wetlands. The same factors also have the potential to promote human health in the context of wetlands. We demonstrate the applicability of syndromic approaches in surveillance-scarce areas and emphasize the importance of adopting an integrated health-based wetland management that considers WASH and incorporates strategies based on grassroots level risk assessments. Copyright © 2017 Elsevier B.V. All rights reserved.

Assessment of best single sample for finding chlamydia in women with and without symptoms: a diagnostic test study.

PubMed

Schoeman, Sarah A; Stewart, Catherine M W; Booth, Russell A; Smith, Susan D; Wilcox, Mark H; Wilson, Janet D

2012-12-12

To compare vulvovaginal swabs with endocervical swabs as optimal diagnostic sample for detection of Chlamydia trachomatis infection. A diagnostic test study. An urban sexual health centre. 3973 women aged ≥ 16 years requesting testing for sexually transmitted infections. Participants took a vulvovaginal swab before routine examination, and clinicians took an endocervical swab during examination. Diagnosis of chlamydia infection with samples analysed using the Aptima Combo-2 assay; positive results confirmed with the Aptima CT assay. Of the 3973 participants, 410 (10.3%) were infected with C trachomatis. Infected women were significantly younger (22 v 25 years, P<0.0001) and more likely to have symptoms suggestive of a bacterial sexually transmitted infection (53% v 41%, odds ratio 1.63 (95% CI 1.30 to 2.04)), be a contact of someone with a sexually transmitted infection (25% v 5%, odds ratio 6.18 (4.61 to 8.30)), clinically diagnosed with cervicitis (17% v 4%, odds ratio 4.92 (3.50 to 6.91)), and have pelvic inflammatory disease (9% v 3%, odds ratio 2.85 (1.87 to 4.33)). When women co-infected with gonorrhoea were included in the analysis, there was an association with mixed ethnicity (10% v 7%, odds ratio 1.53 (1.07 to 2.17)); but when those with gonorrhoea were removed, women of white ethnicity were significantly more likely to have chlamydia (85% v 80%, odds ratio 1.40 (1.03 to 1.91)). On analysis of complete paired results, vulvovaginal swabs were significantly more sensitive than endocervical swabs (97% (95% CI 95% to 98%) v 88% (85% to 91%), P<0.00001); corresponding specificities were 99.9% and 100%. In women with symptoms suggestive of a bacterial sexually transmitted infection, vulvovaginal swabs were significantly more sensitive than endocervical swabs (97% (93% to 98%) v 88% (83% to 92%), P=0.0008), as they were in women without symptoms (97% (94% to 99%) v 89% (84% to 93%), P=0.002). Vulvovaginal swabs are significantly better than endocervical swabs at detecting chlamydia in women with and without symptoms suggestive of sexually transmitted infections. In those with symptoms, using endocervical samples rather than vulvovaginal swabs would have missed 9% of infections, or 1 in every 11 cases of chlamydia. ISRCTN42867448.

The Association of Peripheral Blood Regulatory T-Cell Concentrations With Epithelial Ovarian Cancer: A Brief Report.

PubMed

Cannioto, Rikki A; Sucheston-Campbell, Lara E; Hampras, Shalaka; Goode, Ellen L; Knutson, Keith; Ness, Roberta; Modugno, Francesmary; Wallace, Paul; Szender, J Brian; Mayor, Paul; Hong, Chi-Chen; Joseph, Janine M; Friel, Grace; Davis, Warren; Nesline, Mary; Eng, Kevin H; Edwards, Robert P; Kruszka, Bridget; Schmitt, Kristina; Odunsi, Kunle; Moysich, Kirsten B

2017-01-01

There is a mounting body of evidence demonstrating higher percentages of regulatory T (Treg) cells in the peripheral blood of patients with cancer in comparison to healthy controls, but there is a paucity of epidemiological literature characterizing circulating Treg cells among patients with epithelial ovarian cancer (EOC). To investigate the role of peripheral Treg cells in ovarian neoplasms, we conducted a case-control study to characterize circulating concentrations of Treg cells among patients with EOC, women with benign ovarian conditions, and healthy controls without a history of cancer. Participants were identified for inclusion due to their participation in the Data Bank and BioRepository program at Roswell Park Cancer Institute in Buffalo, NY. Patients included 71 women with a primary diagnosis of EOC and 195 women with a diagnosis of benign ovarian conditions. Controls included 101 age- and race-matched women without a history of cancer. Nonfasting, pretreatment peripheral blood levels of CD3+CD4+CD25+FOXP3+ Treg cells were measured using flow cytometric analyses and expressed as a percentage of total CD3+ cells and as a percentage of total CD3+CD4+ cells. Compared to healthy controls and women with benign ovarian conditions, patients with EOC had significantly higher frequency of Treg cells (P < 0.04). In multivariable logistic regression analyses using Treg frequency expressed as a percentage of CD+3 cells, we observed a significant positive association between Treg cell percentage and EOC risk, with each 1% increase associated with a 37% increased risk of EOC (odds ratio, 1.37; 95% confidence interval, 1.04-1.80). We observed a similar trend when Treg frequency was expressed as a percentage of CD3+CD+4 cells (odds ratio, 1.22; 95% confidence interval, 0.99-1.49). The current study provides support that peripheral Treg cell frequency is elevated in patients with EOC in comparison to women with benign ovarian conditions and healthy controls.

Obesity and rhinitis in a nationwide study of children and adults in the United States.

PubMed

Han, Yueh-Ying; Forno, Erick; Gogna, Mudita; Celedón, Juan C

2016-05-01

Obesity has been associated with higher risk of asthma and asthma severity both in children and adults. However, studies evaluating the relation between obesity and rhinitis have yielded conflicting results. We performed a cross-sectional study of obesity indicators and rhinitis using data from 8165 participants in the 2005-2006 National Health and Nutrition Examination Survey. Allergic rhinitis was defined as physician-diagnosed hay fever or allergy, the presence of symptoms in the past 12 months, and at least 1 positive allergen-specific IgE level. Nonallergic rhinitis was defined as a physician's diagnosis and symptoms but no positive allergen-specific IgE levels. Multivariate regression was used to assess the relationship between obesity and rhinitis in children and adults. In adults, overweight or obesity was associated with increased odds of nonallergic rhinitis (adjusted odds ratio, 1.43; 95% CI, 1.06-1.93; P = .02). Similarly, central obesity was associated with increased odds of nonallergic rhinitis in adults (adjusted odds ratio, 1.61; 95% CI, 1.20-2.16; P < .01). In an analysis stratified by sex, the observed associations were attenuated and became nonstatistically significant in female adults but remained significant in male adults. Overweight, obesity, or central obesity were not associated with allergic rhinitis in adults. In children, central obesity was associated with reduced odds of allergic rhinitis (adjusted odds ratio, 0.35; 95% CI, 0.19-0.64; P < .01). After stratification by sex, this association was similar in female and male children. In adults, obesity is associated with increased odds of nonallergic rhinitis, particularly in male subjects. In children, central obesity is associated with reduced odds of allergic rhinitis, regardless of sex. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Predicting Long-Term Outcomes in Pleural Infections. RAPID Score for Risk Stratification.

PubMed

White, Heath D; Henry, Christopher; Stock, Eileen M; Arroliga, Alejandro C; Ghamande, Shekhar

2015-09-01

Pleural infections are associated with significant morbidity and mortality. The recently developed RAPID (renal, age, purulence, infection source, and dietary factors) score consists of five clinical factors that can identify patients at risk for increased mortality. The objective of this study was to further validate the RAPID score in a diverse cohort, identify factors associated with mortality, and provide long-term outcomes. We evaluated a single-center retrospective cohort of 187 patients with culture-positive pleural infections. Patients were classified by RAPID scores into low-risk (0-2), medium-risk (3-4), and high-risk (5-7) groups. The Social Security Death Index was used to determine date of death. All-cause mortality was assessed at 3 months, 1 year, 3 years, and 5 years. Clinical factors and comorbid conditions were evaluated for association. Three-month mortality for low-, medium-, and high-risk groups was 1.5, 17.8, and 47.8%, respectively. Increased odds were observed among medium-risk (odds ratio, 14.3; 95% confidence interval, 1.8-112.6; P = 0.01) and high-risk groups (odds ratio, 53.3; 95% confidence interval, 6.8-416.8; P < 0.01). This trend continued at 1, 3, and 5 years. Factors associated with high-risk scores include gram-negative rod infections, heart disease, diabetes, cancer, lung disease, and increased length of stay. When applied to a diverse patient cohort, the RAPID score predicts outcomes in patients up to 5 years and may aid in long-term risk stratification on presentation.

The association of ambient air pollution and traffic exposures with selected congenital anomalies in the San Joaquin Valley of California.

PubMed

Padula, Amy M; Tager, Ira B; Carmichael, Suzan L; Hammond, S Katharine; Lurmann, Frederick; Shaw, Gary M

2013-05-15

Congenital anomalies are a leading cause of infant mortality and are important contributors to subsequent morbidity. Studies suggest associations between environmental contaminants and some anomalies, although evidence is limited. We aimed to investigate whether ambient air pollutant and traffic exposures in early gestation contribute to the risk of selected congenital anomalies in the San Joaquin Valley of California, 1997-2006. Seven exposures and 5 outcomes were included for a total of 35 investigated associations. We observed increased odds of neural tube defects when comparing the highest with the lowest quartile of exposure for several pollutants after adjusting for maternal race/ethnicity, education, and multivitamin use. The adjusted odds ratio for neural tube defects among those with the highest carbon monoxide exposure was 1.9 (95% confidence interval: 1.1, 3.2) compared with those with the lowest exposure, and there was a monotonic exposure-response across quartiles. The highest quartile of nitrogen oxide exposure was associated with neural tube defects (adjusted odds ratio = 1.8, 95% confidence interval: 1.1, 2.8). The adjusted odds ratio for the highest quartile of nitrogen dioxide exposure was 1.7 (95% confidence interval: 1.1, 2.7). Ozone was associated with decreased odds of neural tube defects. Our results extend the limited body of evidence regarding air pollution exposure and adverse birth outcomes.

The Association of Ambient Air Pollution and Traffic Exposures With Selected Congenital Anomalies in the San Joaquin Valley of California

PubMed Central

Padula, Amy M.; Tager, Ira B.; Carmichael, Suzan L.; Hammond, S. Katharine; Lurmann, Frederick; Shaw, Gary M.

2013-01-01

Congenital anomalies are a leading cause of infant mortality and are important contributors to subsequent morbidity. Studies suggest associations between environmental contaminants and some anomalies, although evidence is limited. We aimed to investigate whether ambient air pollutant and traffic exposures in early gestation contribute to the risk of selected congenital anomalies in the San Joaquin Valley of California, 1997–2006. Seven exposures and 5 outcomes were included for a total of 35 investigated associations. We observed increased odds of neural tube defects when comparing the highest with the lowest quartile of exposure for several pollutants after adjusting for maternal race/ethnicity, education, and multivitamin use. The adjusted odds ratio for neural tube defects among those with the highest carbon monoxide exposure was 1.9 (95% confidence interval: 1.1, 3.2) compared with those with the lowest exposure, and there was a monotonic exposure-response across quartiles. The highest quartile of nitrogen oxide exposure was associated with neural tube defects (adjusted odds ratio = 1.8, 95% confidence interval: 1.1, 2.8). The adjusted odds ratio for the highest quartile of nitrogen dioxide exposure was 1.7 (95% confidence interval: 1.1, 2.7). Ozone was associated with decreased odds of neural tube defects. Our results extend the limited body of evidence regarding air pollution exposure and adverse birth outcomes. PMID:23538941

Hourly differences in air pollution and risk of respiratory disease in the elderly: a time-stratified case-crossover study.

PubMed

Yorifuji, Takashi; Suzuki, Etsuji; Kashima, Saori

2014-08-13

Epidemiological studies have shown adverse effects of short-term exposure to air pollution on respiratory disease outcomes; however, few studies examined this association on an hourly time scale. We evaluated the associations between hourly changes in air pollution and the risk of respiratory disease in the elderly, using the time of the emergency call as the disease onset for each case. We used a time-stratified case-crossover design. Study participants were 6,925 residents of the city of Okayama, Japan, aged 65 or above who were taken to hospital emergency rooms between January 2006 and December 2010 for onset of respiratory disease. We calculated city-representative hourly average concentrations of air pollutants from several monitoring stations. By using conditional logistic regression models, we estimated odds ratios per interquartile-range increase in each pollutant by exposure period prior to emergency call, adjusting for hourly ambient temperature, hourly relative humidity, and weekly numbers of reported influenza cases aged ≥60. Suspended particulate matter (SPM) exposure 24 to <72 hours prior to the onset and ozone exposure 48 to <96 hours prior to the onset were associated with the increased risk of respiratory disease. For example, following one interquartile-range increase, odds ratios were 1.05 (95% confidence interval: 1.01, 1.09) for SPM exposure 24 to <48 hours prior to the onset and 1.13 (95% confidence interval: 1.04, 1.23) for ozone exposure 72 to <96 hours prior to the onset. Sulfur dioxide (SO2) exposure 0 to <24 hours prior to onset was associated with the increased risk of pneumonia and influenza: odds ratio was 1.07 per one interquartile-range increase (95% confidence interval: 1.00, 1.14). Elevated risk for pneumonia and influenza of SO2 was observed at shorter lags (i.e., 8-18 hours) than the elevated risks for respiratory disease of SPM or ozone. Overall, the effect estimates for chronic obstructive pulmonary disease and allied conditions were equivocal. This study provides further evidence that hourly changes in air pollution exposure increase the risks of respiratory disease, and that SO2 may be related with more immediate onset of the disease than other pollutants.

Identification of EGFLAM, SPATC1L and RNASE13 as novel susceptibility loci for aortic aneurysm in Japanese individuals by exome-wide association studies

PubMed Central

Yamada, Yoshiji; Sakuma, Jun; Takeuchi, Ichiro; Yasukochi, Yoshiki; Kato, Kimihiko; Oguri, Mitsutoshi; Fujimaki, Tetsuo; Horibe, Hideki; Muramatsu, Masaaki; Sawabe, Motoji; Fujiwara, Yoshinori; Taniguchi, Yu; Obuchi, Shuichi; Kawai, Hisashi; Shinkai, Shoji; Mori, Seijiro; Arai, Tomio; Tanaka, Masashi

2017-01-01

We performed an exome-wide association study (EWAS) to identify genetic variants - in particular, low-frequency or rare variants with a moderate to large effect size - that confer susceptibility to aortic aneurysm with 8,782 Japanese subjects (456 patients with aortic aneurysm, 8,326 control individuals) and with the use of Illumina HumanExome-12 DNA Analysis BeadChip or Infinium Exome-24 BeadChip arrays. The correlation of allele frequencies for 41,432 single nucleotide polymorphisms (SNPs) that passed quality control to aortic aneurysm was examined with Fisher's exact test. Based on Bonferroni's correction, a P-value of <1.21×10−6 was considered statistically significant. The EWAS revealed 59 SNPs that were significantly associated with aortic aneurysm. None of these SNPs was significantly (P<2.12×10−4) associated with aortic aneurysm by multivariable logistic regression analysis with adjustment for age, gender and hypertension, although 8 SNPs were related (P<0.05) to this condition. Examination of the correlation of these latter 8 SNPs to true or dissecting aortic aneurysm separately showed that rs1465567 [T/C (W229R)] of the EGF-like, fibronectin type III, and laminin G domains gene (EGFLAM) (dominant model; P=0.0014; odds ratio, 1.63) was significantly (P<0.0016) associated with true aortic aneurysm. We next performed EWASs for true or dissecting aortic aneurysm separately and found that 45 and 19 SNPs were significantly associated with these conditions, respectively. Multivariable logistic regression analysis with adjustment for covariates revealed that rs113710653 [C/T (E231K)] of the spermatogenesis- and centriole associated 1-like gene (SPATC1L) (dominant model; P=0.0002; odds ratio, 5.32) and rs143881017 [C/T (R140H)] of the ribonuclease A family member 13 gene (RNASE13) (dominant model; P=0.0006; odds ratio, 5.77) were significantly (P<2.78×10−4 or P<6.58×10−4, respectively) associated with true or dissecting aortic aneurysm, respectively. EGFLAM and SPATC1L may thus be susceptibility loci for true aortic aneurysm and RNASE13 may be such a locus for dissecting aneurysm in Japanese individuals. PMID:28339009

Relationship Between Body Mass Index and Outcomes Among Hospitalized Patients With Community-Acquired Pneumonia.

PubMed

Bramley, Anna M; Reed, Carrie; Finelli, Lyn; Self, Wesley H; Ampofo, Krow; Arnold, Sandra R; Williams, Derek J; Grijalva, Carlos G; Anderson, Evan J; Stockmann, Chris; Trabue, Christopher; Fakhran, Sherene; Balk, Robert; McCullers, Jonathan A; Pavia, Andrew T; Edwards, Kathryn M; Wunderink, Richard G; Jain, Seema

2017-06-15

The effect of body mass index (BMI) on community-acquired pneumonia (CAP) severity is unclear. We investigated the relationship between BMI and CAP outcomes (hospital length of stay [LOS], intensive care unit [ICU] admission, and invasive mechanical ventilation) in hospitalized CAP patients from the Centers for Disease Control and Prevention Etiology of Pneumonia in the Community (EPIC) study, adjusting for age, demographics, underlying conditions, and smoking status (adults only). Compared with normal-weight children, odds of ICU admission were higher in children who were overweight (adjusted odds ratio [aOR], 1.7; 95% confidence interval [CI], 1.1-2.8) or obese (aOR, 2.1; 95% CI, 1.4-3.2), and odds of mechanical ventilation were higher in children with obesity (aOR, 2.7; 95% CI, 1.3-5.6). When stratified by asthma (presence/absence), these findings remained significant only in children with asthma. Compared with normal-weight adults, odds of LOS >3 days were higher in adults who were underweight (aOR, 1.6; 95% CI, 1.1-2.4), and odds of mechanical ventilation were lowest in adults who were overweight (aOR, 0.5; 95% CI, .3-.9). Children who were overweight or obese, particularly those with asthma, had higher odds of ICU admission or mechanical ventilation. In contrast, adults who were underweight had longer LOS. These results underscore the complex relationship between BMI and CAP outcomes. Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

District Policies and Practices Vary in Their Association With Adolescents' Consumption of Milk and 100% Fruit Juice.

PubMed

Sliwa, Sarah A; Miller, Gabrielle F; Brener, Nancy D; Park, Sohyun; Merlo, Caitlin L

2017-05-01

Researchers previously examined the relationship between school beverage policies and sugar-sweetened beverage (SSB) consumption. This study addressed a research gap by examining cross-sectional associations between district-level policies and practices and U.S. high school students' consumption of milk and 100% fruit juice. Data from the 2012 School Health Policies and Practices Study and 2013 Youth Risk Behavior Surveillance System were linked for 12 large urban school districts. Outcome variables were daily milk consumption (≥1 glass/day) and 100% fruit juice consumption (≥1 time/day). Exposure variables were five district policies (i.e., restrict SSB sales, maintain closed campuses, offer/sell healthful alternatives, restrict promotional products, and require nutrition education). Logistic regression models estimated the odds of consuming milk or 100% fruit juice daily, conditional on the policies and adjusting for sex, race/ethnicity, grade level, weight status, and district free/reduced-price lunch eligibility (n = 23,173). Students in districts that required/recommended restricting the times of SSB sales had 55% higher (adjusted odds ratio [AOR], 1.55; 95% confidence interval [CI], 1.28-1.87) odds of consuming ≥1 glass/day of milk than students in districts without this policy. Closed campus policies were associated with lower odds of consuming milk (AOR, .72; 95% CI, .63-.82) and higher odds of consuming juice (AOR, 1.27; 95% CI, 1.07-1.50). Policies requiring/recommending that districts offer/sell healthful alternatives were associated with lower odds of consuming 100% fruit juice daily. Results suggest that restricting SSB sales may support adolescents' milk consumption. Future studies should assess whether the implementation of federal standards that further restrict SSB sales in school leads to increased milk consumption. Published by Elsevier Inc.

The Association Between Atopy and Childhood/Adolescent Leukemia: A Meta-Analysis

PubMed Central

Linabery, Amy M.; Jurek, Anne M.; Duval, Sue; Ross, Julie A.

2010-01-01

Atopic disease is hypothesized to be protective against several malignancies, including childhood/adolescent leukemia. To summarize the available epidemiologic evidence, the authors performed a meta-analysis of associations between atopy/allergies, asthma, eczema, hay fever, and hives and childhood/adolescent leukemia, acute lymphoblastic leukemia (ALL), and acute myeloid leukemia (AML). They searched MEDLINE literature (1952–March 2009) and queried international experts to identify eligible studies. Ten case-control studies were included. Summary odds ratios and 95% confidence intervals were computed via random-effects models. Odds ratios for atopy/allergies were 1.42 (95% confidence interval (CI): 0.60, 3.35) for 3 studies of leukemia overall, 0.69 (95% CI: 0.54, 0.89) for 6 studies of ALL, and 0.87 (95% CI: 0.62, 1.22) for 2 studies of AML, with high levels of heterogeneity detected for leukemia overall and ALL. Inverse associations were observed for ALL and asthma (odds ratio (OR) = 0.79, 95% CI: 0.61, 1.02), eczema (OR = 0.74, 95% CI: 0.58, 0.96), and hay fever (OR = 0.55, 95% CI: 0.46, 0.66) examined separately. Odds ratios for ALL differed by study design, exposure data source, and latency period, indicating that these factors affect study results. These results should be interpreted cautiously given the modest number of studies, substantial heterogeneity, and potential exposure misclassification but are useful in designing future research. PMID:20228139

Does peripartum infection increase the incidence of cerebral palsy in extremely low birthweight infants?

PubMed

Costantine, Maged M; How, Helen Y; Coppage, Kristin; Maxwell, Rose A; Sibai, Baha M

2007-05-01

This study was undertaken to determine the perinatal predictors of cerebral palsy in extremely low birthweight infants (<1000 g). A case control study of infants with birthweight of less than 1000 g (19 with cerebral palsy and 38 controls) who survived beyond 18-22 months of corrected age was performed. Outcome variables included maternal demographics, obstetric complications, and neonatal outcome (gestational age at delivery, birthweight, Apgar scores, intrauterine growth restriction, respiratory distress syndrome, intraventricular hemorrhage, and neonatal sepsis). Data analysis consisted of t tests, chi2, and analysis of variance when appropriate. There were no significant differences between cerebral palsy and control groups with regard to mode of delivery, Apgar scores, preeclampsia, antenatal vaginal bleeding, or the use of magnesium sulfate. However, male gender (odds ratio 3.70; 95% CI 1.05-12.5), primigravid status (odds ratio 5.52; 95% CI 1.67-18.3), early neonatal sepsis (odds ratio 12.9; 95% CI 2.94-57.2) and chorioamnionitis, both clinical and histologic (odds ratio 3.71; 95% CI 1.16-11.9) were significantly associated with the development of cerebral palsy. The strong association between cerebral palsy and chorioamnionitis, as well as early neonatal sepsis, remain significant after adjustment for primigravid status and male gender. In extremely low birthweight infants, cerebral palsy was strongly associated with chorioamnionitis, early neonatal sepsis, male gender, and primigravid status.

Medication Use in Pregnancy in Relation to the Risk of Isolated Clubfoot in Offspring

PubMed Central

Werler, Martha M.; Yazdy, Mahsa M.; Kasser, James R.; Mahan, Susan T.; Meyer, Robert E.; Anderka, Marlene; Druschel, Charlotte M.; Mitchell, Allen A.

2014-01-01

Clubfoot, a common major structural malformation, develops early in gestation. Epidemiologic studies have identified higher risks among boys, first-born children, and babies with a family history of clubfoot, but studies of risks associated with maternal exposures are lacking. We conducted the first large-scale, population-based, case-control study of clubfoot with detailed information on maternal medication use in pregnancy. Study subjects were ascertained from birth defect registries in Massachusetts, New York, and North Carolina during 2007–2011. Cases were 646 mothers of children with clubfoot without other major structural malformations (i.e., isolated clubfoot); controls were mothers of 2,037 children born without major malformations. Mothers were interviewed within 12 months of delivery about medication use, including product, timing, and frequency. Odds ratios were estimated for exposure to 27 medications in pregnancy months 2–4 after adjustment for study site, infant sex, first-born status, body mass index (weight (kg)/height (m)2), and smoking. Odds ratios were less than 1.20 for 14 of the medications; of the remainder, most odds ratios were only slightly elevated (range, 1.21–1.66), with wide confidence intervals. The use of antiviral drugs was more common in clubfoot cases than in controls (odds ratio = 4.22, 95% confidence interval: 1.52, 11.73). Most of these results are new findings and require confirmation in other studies. PMID:24824985

Childhood Acute Lymphoblastic Leukemia and Indicators of Early Immune Stimulation: A Childhood Leukemia International Consortium Study

PubMed Central

Rudant, Jérémie; Lightfoot, Tracy; Urayama, Kevin Y.; Petridou, Eleni; Dockerty, John D.; Magnani, Corrado; Milne, Elizabeth; Spector, Logan G.; Ashton, Lesley J.; Dessypris, Nikolaos; Kang, Alice Y.; Miller, Margaret; Rondelli, Roberto; Simpson, Jill; Stiakaki, Eftichia; Orsi, Laurent; Roman, Eve; Metayer, Catherine; Infante-Rivard, Claire; Clavel, Jacqueline

2015-01-01

The associations between childhood acute lymphoblastic leukemia (ALL) and several proxies of early stimulation of the immune system, that is, day-care center attendance, birth order, maternally reported common infections in infancy, and breastfeeding, were investigated by using data from 11 case-control studies participating in the Childhood Leukemia International Consortium (enrollment period: 1980–2010). The sample included 7,399 ALL cases and 11,181 controls aged 2–14 years. The data were collected by questionnaires administered to the parents. Pooled odds ratios and 95% confidence intervals were estimated by unconditional logistic regression adjusted for age, sex, study, maternal education, and maternal age. Day-care center attendance in the first year of life was associated with a reduced risk of ALL (odds ratio = 0.77, 95% confidence interval: 0.71, 0.84), with a marked inverse trend with earlier age at start (P < 0.0001). An inverse association was also observed with breastfeeding duration of 6 months or more (odds ratio = 0.86, 95% confidence interval: 0.79, 0.94). No significant relationship with a history of common infections in infancy was observed even though the odds ratio was less than 1 for more than 3 infections. The findings of this large pooled analysis reinforce the hypothesis that day-care center attendance in infancy and prolonged breastfeeding are associated with a decreased risk of ALL. PMID:25731888

Disordered eating in entry-level military personnel.

PubMed

Warner, Christopher; Warner, Carolynn; Matuszak, Theresa; Rachal, James; Flynn, Julianne; Grieger, Thomas A

2007-02-01

The goal was to determine the prevalence of and risk factors for disordered eating in an entry-level U.S. Army population. A cross-sectional survey of advanced individual training U.S. Army soldiers at Aberdeen Proving Ground, Maryland, was performed with an anonymous self-report survey containing demographic factors, history (including abuse and psychiatric treatment), and Eating Attitudes Test-26. Of 1,184 advanced individual training soldiers approached, 1090 participated. The response rate was 91.2% (955 men and 135 women). Forty percent were overweight (body mass index of > or =25), 11% reported a psychiatric history, 26% reported a history of abuse, and 9.8% endorsed disordered eating (male, 7.0%; female, 29.6%), as defined by Eating Attitudes Test-26. Factors that placed soldiers at higher risk for disordered eating were female gender (odds ratio, 5.63; 95% confidence interval, 3.32-9.57; p < 0.00005), overweight (odds ratio, 3.06; 95% confidence interval, 1.92-4.89; p < 0.00005), previous psychiatric treatment (odds ratio, 1.87; 95% confidence interval, 1.04-3.36; p = 0.035), and history of verbal abuse (odds ratio, 2.02; 95% confidence interval, 1.16-3.51; p = 0.014). Our study shows a higher than expected rate of disordered eating in advanced individual training soldiers with identifiable risk factors. This indicates an important need for further study, effective screening, preventive counseling, and early intervention for treatment.

Occupational risk factors for Wilms' tumor

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

Bunin, G.; Kramer, S.; Nass, C.

A matched case-control study of Wilms' tumor investigated parental occupational risk factors. Cases diagnosed in 1970-1983 were identified through a population-based tumor registry and hospital registries in the Greater Philadelphia area. Controls were selected by random digit dialing and were matched to cases on race, birth date (+/- 3 years), and the area code and exchange of the case's telephone number at diagnosis. Parents of 100 matched pairs were interviewed by telephone. Parents of patients and controls were generally similar in demographic characteristics, except that mothers differed in religion. Published schemes were used to group jobs into clusters of similarmore » exposures and to determine exposures from industry and job title. Analyses were done for preconception, pregnancy, and postnatal time periods. More case than control fathers had jobs in a cluster that includes machinists and welders (odds ratios (ORs) = 4.0-5.7, p less than or equal to 0.04). Paternal exposures to lead, silver, tin, and iron (some exposures of this cluster) were associated with Wilms' tumor in some analyses, with moderate odds ratios (ORs = 1.5-3.4). In general, the highest odds ratios were found for the preconception period among the genetic (prezygotic) cases. No maternal job clusters or exposures gave significantly elevated odds ratios. These results support a previous finding that lead is a risk factor, but not radiation, hydrocarbon, or boron exposures.« less

Radiographic sarcopenia predicts postoperative infectious complications in patients undergoing pancreaticoduodenectomy.

PubMed

Takagi, Kosei; Yoshida, Ryuichi; Yagi, Takahito; Umeda, Yuzo; Nobuoka, Daisuke; Kuise, Takashi; Fujiwara, Toshiyoshi

2017-05-26

Recently, skeletal muscle depletion (sarcopenia) has been reported to influence postoperative outcomes after certain procedures. This study investigated the impact of sarcopenia on postoperative outcomes following pancreaticoduodenectomy (PD). We performed a retrospective study of consecutive patients (n = 219) who underwent PD at our institution between January 2007 and May 2013. Sarcopenia was evaluated using preoperative computed tomography. We evaluated postoperative outcomes and the influence of sarcopenia on short-term outcomes, especially infectious complications. Subsequently, multivariate analysis was used to assess the impact of prognostic factors (including sarcopenia) on postoperative infections. The mortality, major complication, and infectious complication rates for all patients were 1.4%, 16.4%, and 47.0%, respectively. Fifty-five patients met the criteria for sarcopenia. Sarcopenia was significantly associated with a higher incidence of in-hospital mortality (P = 0.004) and infectious complications (P < 0.001). In multivariate analyses, sarcopenia (odds ratio = 3.43; P < 0.001), preoperative biliary drainage (odds ratio = 2.20; P = 0.014), blood loss (odds ratio = 1.92; P = 0.048), and soft pancreatic texture (odds ratio = 3.71; P < 0.001) were independent predictors of postoperative infections. Sarcopenia is an independent preoperative predictor of infectious complications after PD. Clinical assessment combined with sarcopenia may be helpful for understanding the risk of postoperative outcomes and determining perioperative management strategies.

In utero exposure to pets is associated with asthma and wheezing in Mexican American children.

PubMed

Eldeirawi, Kamal; Kunzweiler, Colin; Combs, Angela M T; Persky, Victoria W

2016-01-01

To examine the associations of in utero and early life exposure to cats/dogs and birds with the risk of lifetime doctor-diagnosed asthma and other respiratory conditions in a sample of Mexican American (MA) children 4-18 years of age. This study is a population-based cross-sectional investigation of 1816 MA children. We conducted multiple logistic models examining the relationship of asthma and wheezing with exposures to cats/dogs and birds in utero, infancy and at the time of the survey adjusted for country of birth, family history of asthma/allergies, antibiotics use in infancy and other covariates. In adjusted analyses, in utero exposure to cats/dogs and birds jointly was associated with increased odds of asthma (adjusted odds ratio (aOR): 2.89; 95% confidence interval (CI): 1.34-6.23), ever wheezing (aOR: 1.96; 95% CI: 1.11-3.46) and current exercise-induced wheezing (aOR: 3.16; 95% CI: 1.27-7.85) compared to children not exposed to these pets in utero. Children who were exposed to both cats/dogs and birds in utero had an elevated, albeit statistically non-significant, odds of current wheezing. Exposures in infancy and at the time of the survey to cats/dogs and birds were not associated with asthma or wheezing. In utero exposure to pets might be associated with an increased risk of asthma and respiratory conditions in a sample of non-affluent MA children.

Preventing PTSD and Depression and Reducing Health Care Costs in the Military: A Call for Building Resilience Among Service Members.

PubMed

Vyas, Kartavya J; Fesperman, Susan F; Nebeker, Bonnie J; Gerard, Steven K; Boyd, Nicholas D; Delaney, Eileen M; Webb-Murphy, Jennifer A; Johnston, Scott L

2016-10-01

The present study investigates the role of psychological resilience in protecting against the development of post-traumatic stress disorder (PTSD), depression, and comorbid PTSD and depression; and estimates the percent reductions in incidence of, and associated treatment cost savings for, each condition as a function of increasing resilience. A retrospective cohort of mental health care-seeking service members (n = 2,171) completed patient-reported outcome measures approximately every 10 weeks as part of the Psychological Health Pathways program. Patients with low resilience were at significantly greater odds for developing physical, behavioral, and mental health conditions, particularly sleep disorder (adjusted odds ratio [AOR] = 2.60, 95% confidence interval [CI] = 1.81-3.73), perceived stress (AOR = 2.86, 95% CI = 1.05-7.75), and depression (AOR = 2.89, 95% CI = 2.34-3.57) compared to patients with moderate/high resilience. Increasing resilience across services by 20% is estimated to reduce the odds of developing PTSD, depression, and comorbid PTSD and depression by 73%, 54%, and 93%, respectively; the incidence by 32%, 19%, and 61%, respectively; and save approximately $196, $288, and $597 million in annual treatment costs, respectively, or approximately $1.1 billion total (a 35% reduction in costs). Using resilience as a preventive model may reduce health care utilization and costs in an already overtaxed health care system. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Maternal depressive symptoms and healthcare expenditures for publicly insured children with chronic health conditions.

PubMed

Brooks, Jada L; Beil, Heather; Beeber, Linda S

2015-04-01

This study estimated the prevalence of maternal depressive symptoms and tested associations between maternal depressive symptoms and healthcare utilization and expenditures among United States publicly insured children with chronic health conditions (CCHC). A total of 6,060 publicly insured CCHC from the 2004-2009 Medical Expenditure Panel Surveys were analyzed using negative binomial models to compare healthcare utilization for CCHC of mothers with and without depressive symptoms. Annual healthcare expenditures for both groups were compared using a two-part model with a logistic regression and generalized linear model. The prevalence of depressive symptoms among mothers with CCHC was 19 %. There were no differences in annual healthcare utilization for CCHC of mothers with and without depressive symptoms. Maternal depressive symptoms were associated with greater odds of ED expenditures [odds ratio (OR) 1.26; 95 % CI 1.03-1.54] and lesser odds of dental expenditures (OR 0.81; 95 % CI 0.66-0.98) and total expenditures (OR 0.71; 95 % CI 0.51-0.98). Children of symptomatic mothers had lower predicted outpatient expenditures and higher predicted expenditures for total health, prescription medications, dental care; and office based, inpatient and ED visits. Mothers with CCHC were more likely to report depressive symptoms than were mothers with children without chronic health conditions. There were few differences in annual healthcare utilization and expenditures between CCHC of mothers with and without depressive symptoms. However, having a mother with depressive symptoms was associated with higher ED expenditures and higher predicted healthcare expenditures in a population of children who comprise over three-fourths of the top decile of Medicaid spending.

Rapid Eye Movement Sleep in Relation to Overweight in Children and Adolescents

PubMed Central

Liu, Xianchen; Forbes, Erika E.; Ryan, Neal D.; Rofey, Dana; Hannon, Tamara S.; Dahl, Ronald E.

2009-01-01

Context Short sleep duration is associated with obesity, but few studies have examined the relationship between obesity and specific physiological stages of sleep. Objective To examine specific sleep stages, including rapid eye movement (REM) sleep and stages 1 through 4 of non-REM sleep, in relation to overweight in children and adolescents. Design, Setting, and Participants A total of 335 children and adolescents (55.2% male; aged 7-17 years) underwent 3 consecutive nights of standard polysomnography and weight and height assessments as part of a study on the development of internalizing disorders (depression and anxiety). Main Outcome Measures Body mass index (calculated as weight in kilograms divided by height in meters squared) z score and weight status (normal, at risk for overweight, overweight) according to the body mass index percentile for age and sex. Results The body mass index z score was significantly related to total sleep time (β=-0.174), sleep efficiency (β=-0.027), and REM density (β=-0.256). Compared with normal-weight children, overweight children slept about 22 minutes less and had lower sleep efficiency, shorter REM sleep, lower REM activity and density, and longer latency to the first REM period. After adjustment for demographics, pubertal status, and psychiatric diagnosis, 1 hour less of total sleep was associated with approximately 2-fold increased odds of overweight (odds ratio=1.85), 1 hour less of REM sleep was associated with about 3-fold increased odds (odds ratio=2.91), and REM density and activity below the median increased the odds of overweight by 2-fold (odds ratio=2.18) and 3-fold (odds ratio=3.32), respectively. Conclusions Our results confirm previous epidemiological observations that short sleep time is associated with overweight in children and adolescents. A core aspect of the association between short sleep duration and overweight may be attributed to reduced REM sleep. Further studies are needed to investigate possible mechanisms underpinning the association between diminished REM sleep and endocrine and metabolic changes that may contribute to obesity. PMID:18678797

Perinatal outcome in relation to fetal sex in offspring to mothers with pre-gestational and gestational diabetes--a population-based study.

PubMed

Persson, M; Fadl, H

2014-09-01

The objective of the present study was to investigate if perinatal outcome differs with fetal sex in pregnancies with maternal Type 1 diabetes, Type 2 diabetes or gestational diabetes. This was a population-based cohort study, with data from the Medical Birth Registry in Sweden throughout the period 1998-2007. Singleton pregnancies with maternal Type 1 diabetes (n = 4092), Type 2 diabetes (n = 412) and gestational diabetes (n = 8602) were identified based on the International Classification of Diseases, 10th edition code. For comparison, 905 565 pregnancies without diabetes were included. The primary outcome was a composite outcome, consisting of any of the following diagnoses: perinatal mortality rate, major malformation, preterm delivery, acute respiratory disorders and neonatal hypoglycaemia. Logistic regression was used to obtain odds ratios for adverse outcomes in male offspring within the diabetic and reference cohorts, respectively. In pregnancies with diabetes, maternal characteristics did not differ with fetal sex, except for a higher rate of Caesarean delivery in male offspring of women with Type 1 diabetes. Male infants to mothers with Type 1 diabetes and gestational diabetes had significantly increased odds of respiratory disorders [adjusted odds ratio (confidence interval) Type 1 diabetes: 1.50 (1.12-2.02); gestational diabetes: 1.81 (1.27-2.57)]. Male infants to mothers with gestational diabetes also had significantly increased odds of major malformations [adjusted odds ratio: 1.44 (1.07-1.93)]. In offspring of mothers with Type 2 diabetes, odds ratios of most outcomes were higher in male infants; however, not significantly different from female infants. In pregnancies without diabetes, male infants had significantly higher odds of all adverse outcomes, except perinatal mortality rate. The risk of adverse perinatal outcome in offspring of mothers with Type 1 diabetes and gestational diabetes did not differ by sex, except for a higher risk in male infants for respiratory disorders. The risk of major malformations was also significantly increased in male offspring to mothers with gestational diabetes. In offspring of mothers with Type 2 diabetes, no significant differences between sexes were found. © 2014 The Authors. Diabetic Medicine © 2014 Diabetes UK.

Transient Elastography vs. Aspartate Aminotransferase to Platelet Ratio Index in Hepatitis C: A Meta-Analysis.

PubMed

Mattos, A Z; Mattos, A A

Many different non-invasive methods have been studied with the purpose of staging liver fibrosis. The objective of this study was verifying if transient elastography is superior to aspartate aminotransferase to platelet ratio index for staging fibrosis in patients with chronic hepatitis C. A systematic review with meta-analysis of studies which evaluated both non-invasive tests and used biopsy as the reference standard was performed. A random-effects model was used, anticipating heterogeneity among studies. Diagnostic odds ratio was the main effect measure, and summary receiver operating characteristic curves were created. A sensitivity analysis was planned, in which the meta-analysis would be repeated excluding each study at a time. Eight studies were included in the meta-analysis. Regarding the prediction of significant fibrosis, transient elastography and aspartate aminotransferase to platelet ratio index had diagnostic odds ratios of 11.70 (95% confidence interval = 7.13-19.21) and 8.56 (95% confidence interval = 4.90-14.94) respectively. Concerning the prediction of cirrhosis, transient elastography and aspartate aminotransferase to platelet ratio index had diagnostic odds ratios of 66.49 (95% confidence interval = 23.71-186.48) and 7.47 (95% confidence interval = 4.88-11.43) respectively. In conclusion, there was no evidence of significant superiority of transient elastography over aspartate aminotransferase to platelet ratio index regarding the prediction of significant fibrosis, but the former proved to be better than the latter concerning prediction of cirrhosis.

Extension and Density of Root Fillings and Post-operative Apical Radiolucencies in the Veterans Affairs Dental Longitudinal Study

PubMed Central

Zhong, Yan; Chasen, Joel; Yamanaka, Ryan; Garcia, Raul; Kaye, Elizabeth Krall; Kaufman, Jay S; Cai, Jianwen; Wilcosky, Tim; Trope, Martin; Caplan, Daniel J

2008-01-01

We evaluated the association between radiographically-assessed extension and density of root canal fillings and post-operative apical radiolucencies (AR) using data from 288 participants in the Veterans Affairs Dental Longitudinal Study. Study subjects were not VA patients; all received their medical and dental care in the private sector. Generalized Estimating Equations were used to account for multiple teeth within subjects and to control for covariates of interest. Defective root filling density was associated with increased odds of post-operative AR among teeth with no pre-operative AR (Odds Ratio=3.0, 95%CI=1.3–7.1), though pre-operative AR was the strongest risk factor for post-operative AR (Odds Ratio=29.2, 95%CI=13.6–63.0 among teeth with ideal density). Compared to well-extended root fillings, neither over- nor under-extended root fillings separately were related to post-operative AR, but when those two categories were collapsed into one “poorly-extended” category, poor extension was related to post-operative AR (Odds Ratio=1.8, 95%CI=1.1–3.2). PMID:18570982

Mode Selection Rules for a Two-Delay System with Positive and Negative Feedback Loops

NASA Astrophysics Data System (ADS)

Takahashi, Kin'ya; Kobayashi, Taizo

2018-04-01

The mode selection rules for a two-delay system, which has negative feedback with a short delay time t1 and positive feedback with a long delay time t2, are studied numerically and theoretically. We find two types of mode selection rules depending on the strength of the negative feedback. When the strength of the negative feedback |α1| (α1 < 0) is sufficiently small compared with that of the positive feedback α2 (> 0), 2m + 1-th harmonic oscillation is well sustained in a neighborhood of t1/t2 = even/odd, i.e., relevant condition. In a neighborhood of the irrelevant condition given by t1/t2 = odd/even or t1/t2 = odd/odd, higher harmonic oscillations are observed. However, if |α1| is slightly less than α2, a different mode selection rule works, where the condition t1/t2 = odd/even is relevant and the conditions t1/t2 = odd/odd and t1/t2 = even/odd are irrelevant. These mode selection rules are different from the mode selection rule of the normal two-delay system with two positive feedback loops, where t1/t2 = odd/odd is relevant and the others are irrelevant. The two types of mode selection rules are induced by individually different mechanisms controlling the Hopf bifurcation, i.e., the Hopf bifurcation controlled by the "boosted bifurcation process" and by the "anomalous bifurcation process", which occur for |α1| below and above the threshold value αth, respectively.

Relationships among ketosis, serum metabolites, body condition, and reproductive outcomes in dairy cows.

PubMed

Shin, Eun-Kyung; Jeong, Jae-Kwan; Choi, In-Soo; Kang, Hyun-Gu; Hur, Tai-Young; Jung, Young-Hun; Kim, Ill-Hwa

2015-07-15

We determined the relationships among ketosis, serum metabolites, body condition, and reproductive disorders and performance in dairy cows. Blood samples from 213 dairy cows were collected at 4 and 2 weeks prepartum, just after calving, and at 1, 2, 4, 6, and 8 weeks postpartum to measure serum β-hydroxybutyrate, nonesterified fatty acids (NEFAs), glucose, total cholesterol, urea nitrogen, aspartate aminotransferase, γ-glutamyltransferase, and progesterone concentrations. Cows were grouped on the basis of the β-hydroxybutyrate concentration at 1 and/or 2 weeks postpartum into two groups: the ketotic group (≥1200 μmol/L, n = 59) and the nonketotic group (<1200 μmol/L, n = 154). The body condition score (BCS) was assessed simultaneously with blood collection. Clinical endometritis was diagnosed by observation of vaginal discharges (>50% pus), and subclinical endometritis was diagnosed by evaluation of uterine cytology (>18% neutrophils) at 4 weeks postpartum. Ovarian cysts were diagnosed by ultrasonography, and resumption of postpartum cyclicity was evaluated by progesterone concentrations (≥1 ng/mL) at 4, 6, and 8 weeks postpartum. In the ketotic group, NEFA levels were higher (P ≤ 0.0005), whereas glucose (P < 0.05-0.0005) and urea nitrogen levels (P < 0.05-0.01) were lower than those in the nonketotic group during the postpartum period. Aspartate aminotransferase levels were higher (P < 0.01) in the ketotic group than those in the nonketotic group at 2 weeks postpartum. The BCS of the ketotic group was higher than the nonketotic group during the prepartum (P < 0.001) and postpartum (P < 0.05-0.001) periods. The probabilities of clinical endometritis (odds ratio = 2.55) and ovarian cysts (odds ratio = 2.80) were higher (P < 0.05) in the ketotic group than those in the nonketotic group. The hazards of resumption of postpartum cyclicity by 8 weeks postpartum (hazard ratio = 0.67) and pregnancy by 360 days postpartum (hazard ratio = 0.68) were lower (P < 0.05) in the ketotic group. In conclusion, a higher BCS during prepartum and postpartum period and increased NEFA and aspartate aminotransferase levels, along with decreased glucose and urea nitrogen levels during postpartum, were associated with ketosis, increased reproductive disorders, and decreased reproductive performance in dairy cows. Copyright © 2015 Elsevier Inc. All rights reserved.

Minding the Gap: Factors Associated With Primary Care Coordination of Adults in 11 Countries.

PubMed

Penm, Jonathan; MacKinnon, Neil J; Strakowski, Stephen M; Ying, Jun; Doty, Michelle M

2017-03-01

Care coordination has been identified as a key strategy in improving the effectiveness, safety, and efficiency of the US health care system. Our objective was to determine whether population or health care system issues are associated with primary care coordination gaps in the United States and other high-income countries. We analyzed data from the 2013 Commonwealth Fund International Health Policy (IHP) survey with multivariate logistic regression analysis. Respondents were adult primary care patients from 11 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom, and the United States. Poor primary care coordination was defined as participants reporting at least 3 gaps in the coordination of care out of a maximum of 5. Analyses were based on 13,958 respondents. The rate of poor primary care coordination was 5.2% (724/13,958 respondents) overall and highest in the United States, at 9.8% (137/1,395 respondents). Multivariate regression analysis among all respondents found that they were less likely to experience poor primary care coordination if their primary care physician often or always knew their medical history, spent sufficient time, involved them, and explained things well (odds ratio = 0.6 for each). Poor primary care coordination was more likely to occur among patients with chronic conditions (odds ratios = 1.4-2.1 depending on number) and patients younger than 65 years (odds ratios = 1.6-2.3 depending on age-group). Among US respondents, insurance status, health status, household income, and sex were not associated with poor primary care coordination. The United States had the highest rate of poor primary care coordination among the 11 high-income countries evaluated. An established relationship with a primary care physician was significantly associated with better care coordination, whereas being chronically ill or younger was associated with poorer care coordination. © 2017 Annals of Family Medicine, Inc.

Minding the Gap: Factors Associated With Primary Care Coordination of Adults in 11 Countries

PubMed Central

Penm, Jonathan; MacKinnon, Neil J.; Strakowski, Stephen M.; Ying, Jun; Doty, Michelle M.

2017-01-01

PURPOSE Care coordination has been identified as a key strategy in improving the effectiveness, safety, and efficiency of the US health care system. Our objective was to determine whether population or health care system issues are associated with primary care coordination gaps in the United States and other high-income countries. METHODS We analyzed data from the 2013 Commonwealth Fund International Health Policy (IHP) survey with multivariate logistic regression analysis. Respondents were adult primary care patients from 11 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom, and the United States. Poor primary care coordination was defined as participants reporting at least 3 gaps in the coordination of care out of a maximum of 5. RESULTS Analyses were based on 13,958 respondents. The rate of poor primary care coordination was 5.2% (724/13,958 respondents) overall and highest in the United States, at 9.8% (137/1,395 respondents). Multivariate regression analysis among all respondents found that they were less likely to experience poor primary care coordination if their primary care physician often or always knew their medical history, spent sufficient time, involved them, and explained things well (odds ratio = 0.6 for each). Poor primary care coordination was more likely to occur among patients with chronic conditions (odds ratios = 1.4–2.1 depending on number) and patients younger than 65 years (odds ratios = 1.6–2.3 depending on age-group). Among US respondents, insurance status, health status, household income, and sex were not associated with poor primary care coordination. CONCLUSIONS The United States had the highest rate of poor primary care coordination among the 11 high-income countries evaluated. An established relationship with a primary care physician was significantly associated with better care coordination, whereas being chronically ill or younger was associated with poorer care coordination. PMID:28289109

Personality Disorders and the 3-Year Course of Alcohol, Drug, and Nicotine Use Disorders

PubMed Central

Hasin, Deborah; Fenton, Miriam C.; Skodol, Andrew; Krueger, Robert; Keyes, Katherine; Geier, Timothy; Greenstein, Eliana; Blanco, Carlos; Grant, Bridget

2012-01-01

Context Little is known about the role of a broad range of personality disorders in the course of substance use disorder (SUD), and whether these differ by substance. The existing literature focuses mostly on antisocial personality disorder and does not come to clear conclusions. Objective To determine the association between the ten DSM-IV personality disorders and the persistence of common SUDs in a 3-year prospective study of a national sample. Design Data were drawn from participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who had alcohol dependence (N=1,172), cannabis use disorder (N=454) or nicotine dependence (N=4,017) at baseline and who were re-interviewed three years later. Control variables included demographic characteristics, family history of substance disorders, baseline Axis I disorders and treatment status, and prior SUD duration. Main outcome measure Persistent SUD, defined as meeting full criteria for the relevant SUD throughout the 3-year follow-up period. Results Persistent SUD was found among 30.1% of participants with alcohol dependence, 30.8% with cannabis use disorder, and 56.6% with nicotine dependence at baseline. Axis I disorders did not have strong or consistent associations with persistent SUD. In contrast, antisocial personality disorder was significantly associated with persistent alcohol, cannabis and nicotine use disorders (adjusted odds ratios: 2.46-3.51), as was borderline personality disorder (adjusted odds ratios: 2.04-2.78) and schizotypal personality disorder (adjusted odds ratios: 1.65-5.90). Narcissistic, schizoid, and obsessive-compulsive personality disorders were less consistently associated with SUD persistence. Conclusions The consistent findings on the association of antisocial, borderline and schizotypal personality disorders with persistent SUD indicates the importance of these personality disorders in understanding the course of SUD. Future studies should examine dimensional representations of personality disorders and the role of specific components of these disorders, biological and environmental contributors to these relationships, and potential applications of these findings to treatment development. PMID:22065531

PTEN loss and chromosome 8 alterations in Gleason grade 3 prostate cancer cores predicts the presence of un-sampled grade 4 tumor: implications for active surveillance.

PubMed

Trock, Bruce J; Fedor, Helen; Gurel, Bora; Jenkins, Robert B; Knudsen, B S; Fine, Samson W; Said, Jonathan W; Carter, H Ballentine; Lotan, Tamara L; De Marzo, Angelo M

2016-07-01

Men who enter active surveillance because their biopsy exhibits only Gleason grade 3 (G3) frequently have higher grade tumor missed by biopsy. Thus, biomarkers are needed that, when measured on G3 tissue, can predict the presence of higher grade tumor in the whole prostate. We evaluated whether PTEN loss, chromosome 8q gain (MYC) and/or 8p loss (LPL) measured only on G3 cores is associated with un-sampled G4 tumor. A tissue microarray was constructed of prostatectomy tissue from patients whose prostates exhibited only Gleason score 3+3, only 3+4 or only 4+3 tumor (n=50 per group). Cores sampled only from areas of G3 were evaluated for PTEN loss by immunohistochemistry, and PTEN deletion, LPL/8p loss and MYC/8q gain by fluorescence in situ hybridization. Biomarker results were compared between Gleason score 6 vs 7 tumors using conditional logistic regression. PTEN protein loss, odds ratio=4.99, P=0.033; MYC/8q gain, odds ratio=5.36, P=0.010; and LPL/8p loss, odds ratio=3.96, P=0.003 were significantly more common in G3 cores derived from Gleason 7 vs Gleason 6 tumors. PTEN gene deletion was not statistically significant. Associations were stronger comparing Gleason 4+3 vs 6 than for Gleason 3+4 vs 6. MYC/8q gain, LPL/8p loss and PTEN protein loss measured in G3 tissue microarray cores strongly differentiate whether the core comes from a Gleason 6 or Gleason 7 tumor. If validated to predict upgrading from G3 biopsy to prostatectomy these biomarkers could reduce the likelihood of enrolling high-risk men and facilitate safe patient selection for active surveillance.

Postoperative Delirium in Severely Burned Patients Undergoing Early Escharotomy: Incidence, Risk Factors, and Outcomes.

PubMed

Guo, Zhenggang; Liu, Jiabin; Li, Jia; Wang, Xiaoyan; Guo, Hui; Ma, Panpan; Su, Xiaojun; Li, Ping

The aim of this study is to investigate the incidence, related risk factors, and outcomes of postoperative delirium (POD) in severely burned patients undergoing early escharotomy. This study included 385 severely burned patients (injured <1 week; TBSA, 31-50% or 11-20%; American Society of Anesthesiologists physical status, II-IV) aged 18 to 65 years, who underwent early escharotomy between October 2014 and December 2015, and were selected by cluster sampling. The authors excluded patients with preoperative delirium or diagnosed dementia, depression, or cognitive dysfunction. Preoperative, perioperative, intraoperative, and postoperative information, such as demographic characteristics, vital signs, and health history were collected. The Confusion Assessment Method was used once daily for 5 days after surgery to identify POD. Stepwise binary logistic regression analysis was used to identify the risk factors for POD, t-tests, and χ tests were performed to compare the outcomes of patients with and without the condition. Fifty-six (14.55%) of the patients in the sample were diagnosed with POD. Stepwise binary logistic regression showed that the significant risk factors for POD in severely burned patients undergoing early escharotomy were advanced age (>50 years old), a history of alcohol consumption (>3/week), high American Society of Anesthesiologists classification (III or IV), time between injury and surgery (>2 days), number of previous escharotomies (>2), combined intravenous and inhalation anesthesia, no bispectral index applied, long duration surgery (>180 min), and intraoperative hypotension (mean arterial pressure < 55 mm Hg). On the basis of the different odds ratios, the authors established a weighted model. When the score of a patient's weighted odds ratios is more than 6, the incidence of POD increased significantly (P < .05). When the score of a patient's weighted odds ratios is more than 6, the incidence of POD increased significantly (P < .05). Further, POD was associated with more postoperative complications, including hepatic and renal function impairment and hypernatremia, as well as prolonged hospitalization, increased medical costs, and higher mortality.

Prognostic Importance of Low Admission Serum Creatinine Concentration for Mortality in Hospitalized Patients.

PubMed

Thongprayoon, Charat; Cheungpasitporn, Wisit; Kittanamongkolchai, Wonngarm; Harrison, Andrew M; Kashani, Kianoush

2017-05-01

The study objective was to assess the association between low serum creatinine value at admission and in-hospital mortality in hospitalized patients. This was a retrospective single-center cohort study conducted at a tertiary referral hospital. All hospitalized adult patients between 2011 and 2013 who had an admission creatinine value available were identified for inclusion in this study. Admission creatinine value was categorized into 7 groups: ≤0.4, 0.5 to 0.6, 0.7 to 0.8, 0.9 to 1.0, 1.1 to 1.2, 1.3 to 1.4, and ≥1.5 mg/dL. The primary outcome was in-hospital mortality. Logistic regression analysis was performed to obtain the odds ratio of in-hospital mortality for the various admission creatinine levels, using a creatinine value of 0.7 to 0.8 mg/dL as the reference group in the analysis of all patients and female patients and of 0.9 to 1.0 mg/dL in the analysis of male patients because it was associated with the lowest in-hospital mortality. Of 73,994 included patients, 973 (1.3%) died in the hospital. The association between different categories of admission creatinine value and in-hospital mortality assumed a U-shaped distribution, with both low and high creatinine values associated with higher in-hospital mortality. After adjustment for age, sex, ethnicity, principal diagnosis, and comorbid conditions, very low creatinine value (≤0.4 mg/dL) was significantly associated with increased mortality (odds ratio, 3.29; 95% confidence interval, 2.08-5.00), exceeding the risk related to a markedly increased creatinine value of ≥1.5 mg/dL (odds ratio, 2.56; 95% confidence interval, 2.07-3.17). The association remained significant in the subgroup analysis of male and female patients. Low creatinine value at admission is independently associated with increased in-hospital mortality in hospitalized patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Counseling African Americans to Control Hypertension: cluster-randomized clinical trial main effects.

PubMed

Ogedegbe, Gbenga; Tobin, Jonathan N; Fernandez, Senaida; Cassells, Andrea; Diaz-Gloster, Marleny; Khalida, Chamanara; Pickering, Thomas; Schwartz, Joseph E

2014-05-20

Data are limited on the implementation of evidence-based multilevel interventions targeted at blood pressure (BP) control in hypertensive blacks who receive care in low-resource primary care practices. Counseling African Americans to Control Hypertension is a cluster-randomized clinical trial in which 30 community health centers were randomly assigned to the intervention condition (IC) or usual care (UC). Patients at the IC sites received patient education, home BP monitoring, and monthly lifestyle counseling, whereas physicians attended monthly hypertension case rounds and received feedback on their patients' home BP readings and chart audits. Patients and physicians at the UC sites received printed patient education material and hypertension treatment guidelines, respectively. The primary outcome was BP control, and secondary outcomes were mean changes in systolic and diastolic BPs at 12 months, assessed with an automated BP device. A total of 1059 patients (mean age, 56 years; 28% men, 59% obese, and 36% with diabetes mellitus) were enrolled. The BP control rate was similar in both groups (IC=49.3% versus UC=44.5%; odds ratio, 1.21 [95% confidence interval, 0.90-1.63]; P=0.21). In prespecified subgroup analyses, the intervention was associated with greater BP control in patients without diabetes mellitus (IC=54.0% versus UC=44.7%; odds ratio, 1.45 [confidence interval, 1.02-2.06]); and small-sized community health centers (IC=51.1% versus UC=39.6%; odds ratio, 1.45 [confidence interval, 1.04-2.45]). A practice-based, multicomponent intervention was no better than UC in improving BP control among hypertensive blacks. Future research on the implementation of behavioral modification strategies for hypertension control in low-resource settings should focus on the development of more efficient and tailored interventions in this high-risk population. http://www.clinicaltrials.gov. Unique identifier: NCT00233220. © 2014 American Heart Association, Inc.

Effectiveness of Pentavalent Rotavirus Vaccine Under Conditions of Routine Use in Rwanda.

PubMed

Tate, Jacqueline E; Ngabo, Fidele; Donnen, Philippe; Gatera, Maurice; Uwimana, Jeannine; Rugambwa, Celse; Mwenda, Jason M; Parashar, Umesh D

2016-05-01

Rotavirus vaccine efficacy is lower in low-income countries than in high-income countries. Rwanda was one of the first low-income countries in sub-Saharan Africa to introduce rotavirus vaccine into its national immunization program. We sought to evaluate rotavirus vaccine effectiveness (VE) in this setting. VE was assessed using a case-control design. Cases and test-negative controls were children who presented with a diarrheal illness to 1 of 8 sentinel district hospitals and 10 associated health centers and had a stool specimen that tested positive (cases) or negative (controls) for rotavirus by enzyme immunoassay. Due to high vaccine coverage almost immediately after vaccine introduction, the analysis was restricted to children 7-18 weeks of age at time of rotavirus vaccine introduction. VE was calculated as (1 - odds ratio) × 100, where the odds ratio was the adjusted odds ratio for the rotavirus vaccination rate among case-patients compared with controls. Forty-eight rotavirus-positive and 152 rotavirus-negative children were enrolled. Rotavirus-positive children were significantly less likely to have received rotavirus vaccine (33/44 [73%] unvaccinated) compared with rotavirus-negative children (81/136 [59%] unvaccinated) (P= .002). A full 3-dose series was 75% (95% confidence interval [CI], 31%-91%) effective against rotavirus gastroenteritis requiring hospitalization or a health center visit and was 65% (95% CI, -80% to 93%) in children 6-11 months of age and 81% (95% CI, 25%-95%) in children ≥12 months of age. Rotavirus vaccine is effective in preventing rotavirus disease in Rwandan children who began their rotavirus vaccine series from 7 to 18 weeks of age. Protection from vaccination was sustained after the first year of life. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Personality disorders and the 3-year course of alcohol, drug, and nicotine use disorders.

PubMed

Hasin, Deborah; Fenton, Miriam C; Skodol, Andrew; Krueger, Robert; Keyes, Katherine; Geier, Timothy; Greenstein, Eliana; Blanco, Carlos; Grant, Bridget

2011-11-01

Little is known about the role of a broad range of personality disorders in the course of substance use disorder (SUD) and whether these differ by substance. The existing literature focuses mostly on antisocial personality disorder and does not come to clear conclusions. To determine the association between the 10 DSM-IV personality disorders and the persistence of common SUDs in a 3-year prospective study of a national sample. Data were drawn from participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who had alcohol dependence (n = 1172), cannabis use disorder (n = 454), or nicotine dependence (n = 4017) at baseline and who were reinterviewed 3 years later. Control variables included demographic characteristics, family history of substance disorders, baseline Axis I disorders and treatment status, and prior SUD duration. Main Outcome Measure  Persistent SUD, defined as meeting full criteria for the relevant SUD throughout the 3-year follow-up period. Persistent SUD was found among 30.1% of participants with alcohol dependence, 30.8% with cannabis use disorder, and 56.6% with nicotine dependence at baseline. Axis I disorders did not have strong or consistent associations with persistent SUD. In contrast, antisocial personality disorder was significantly associated with persistent alcohol, cannabis, and nicotine use disorders (adjusted odds ratios, 2.46-3.51), as was borderline personality disorder (adjusted odds ratios, 2.04-2.78) and schizotypal personality disorder (adjusted odds ratios, 1.65-5.90). Narcissistic, schizoid, and obsessive-compulsive personality disorders were less consistently associated with SUD persistence. The consistent findings on the association of antisocial, borderline, and schizotypal personality disorders with persistent SUD indicates the importance of these personality disorders in understanding the course of SUD. Future studies should examine dimensional representations of personality disorders and the role of specific components of these disorders, biological and environmental contributors to these relationships, and potential applications of these findings to treatment development.

Effect of fenfluramine-derivative diet pills on cardiac valves: a meta-analysis of observational studies.

PubMed

Sachdev, Molly; Miller, William C; Ryan, Thomas; Jollis, James G

2002-12-01

Fenfluramine-derivative diet pills were withdrawn from the market in 1997 because of an association with valvular regurgitation, but subsequent estimates of the prevalence of this condition have varied widely. We systematically reviewed evidence regarding the prevalence of valvular disease after fenfluramine exposure. We searched multiple databases with multiple search terms. Conference proceedings from 1997 onward were searched by index. Authors of eligible studies were contacted to identify unpublished works. Selection criteria were liberally determined. Ten of the identified 11 articles met these criteria. Reviewers assessed the studies' methodologic quality by use of a standard form to evaluate selection, attrition, performance, and detection bias. The studies were analyzed in 2 groups on the basis of length of exposure (<90 days or >90 days). The Mantel-Haenszel method was used to summarize data. Quantitative and qualitative tests for heterogeneity were performed. Tests for publication bias were also done. Tests for heterogeneity were nonsignificant after removing 1 outlier trial. The pooled prevalence of valvular regurgitation meeting Food and Drug Administration criteria (at least mild aortic regurgitation or at least moderate mitral regurgitation) among patients treated for >90 days was 12.0% compared with 5.9% for the unexposed group (prevalence odds ratio 2.2, 95% CI 1.7-2.7). The combined analyses also identified a small but statistically significant increase in mitral regurgitation not previously identified by individual studies (exposed 3.5%, unexposed 1.8%, prevalence odds ratio 1.6, 95% CI 1.05-2.3). Among patients exposed for <90 days, a trend toward more regurgitation was not statistically significant by either combined Food and Drug Administration criteria (exposed 6.8%, unexposed 5.8%, prevalence odds ratio 1.4, 95% CI 0.8-2.4) or by individual valve. These data indicate that fenfluramine-associated valvular regurgitation is less common than initially reported, but still present in 1 of 8 patients treated for >90 days.

Primary percutaneous coronary intervention for acute myocardial infarction in the elderly aged ≥75 years.

PubMed

Sakai, Koyu; Nagayama, Shinya; Ihara, Kasumi; Ando, Kenji; Shirai, Shinichi; Kondo, Katsuhiro; Yokoi, Hiroyoshi; Iwabuchi, Masashi; Nosaka, Hideyuki; Nobuyoshi, Masakiyo

2012-01-01

We aimed to see whether primary percutaneous coronary intervention (PCI) benefits for ST-segment elevation myocardial infarction (STEMI) in the aged could be validated. Primary PCI benefits in elderly patients with STEMI remain uncertain. We reviewed 947 consecutive patients treated with primary PCI for STEMI: 331 were aged ≥75 years (older) and 616 <75 years (younger). The older group had higher percentage of renal insufficiency (7.9% vs. 3.1%, P = 0.0010), prior stroke (9.4% vs. 3.9%, P = 0.0006), 30-day mortality rate (7.6% vs. 3.9%, P = 0.015), and cardiac mortality rate (6.6% vs. 3.7%, P = 0.045). Successful reperfusion rates were similarly high in both groups (90.0% and 92.7%, P = 0.16), despite the higher proportion of patients with door-to-balloon time >90 min (15% vs. 8.4%, P = 0.0016) in older patients. Successful compared with unsuccessful PCI significantly decreased 30-day mortality rates in the older group (6.0% vs. 21%, P = 0.0018) and in the younger group (2.8% vs. 18%, P < 0.0001). When reperfusion was successful, cardiac mortality rate in older patients was not significantly greater than in younger patients (5.4% vs. 2.8%, P = 0.057). By multivariate analysis, unsuccessful reperfusion independently predicted 30-day mortality (odds ratio, 4.04; 95% confidence interval, 1.79-9.12; P = 0.0008), whereas age ≥75 years (odds ratio, 1.00; 95% confidence interval, 0.41-2.41; P = 0.99) and door-to-balloon time >90 min (odds ratio, 1.78; 95% confidence interval, 0.76-4.20; P = 0.19) did not. Pre-existing comorbidities characterize older patients developing STEMI. Aggressive PCI in older patients improves prognosis, and short door-to-balloon time is an important parameter conditioning the prognosis. Copyright © 2011 Wiley Periodicals, Inc.

US-guided percutaneous cholecystostomy: features predicting culture-positive bile and clinical outcome.

PubMed

Sosna, Jacob; Kruskal, Jonathan B; Copel, Laurian; Goldberg, S Nahum; Kane, Robert A

2004-03-01

To assess sonographic and clinical features that might be used to predict infected bile and/or patient outcome from ultrasonography (US)-guided percutaneous cholecystostomy. Between February 1997 and August 2002 at one institution, 112 patients underwent US-guided percutaneous cholecystostomy (59 men, 53 women; average age, 69.3 years). All US images were scored on a defined semiquantitative scale according to preset parameters: (a) gallbladder distention, (b) sludge and/or stones, (c) wall appearance, (d) pericholecystic fluid, and (e) common bile duct size and/or choledocholithiasis. Separate and total scores were generated. Retrospective evaluation of (a) the bacteriologic growth of aspirated bile and its color and (b) clinical indices (fever, white blood cell count, bilirubin level, liver function test results) was conducted by reviewing medical records. For each patient, the clinical manifestation was classified into four groups: (a) localized right upper quadrant symptoms, (b) generalized abdominal symptoms, (c) unexplained sepsis, or (d) sepsis with other known infection. Logistic regression models, exact Wilcoxon-Mann-Whitney test, and the Kruskal-Wallis test were used. Forty-seven (44%) of 107 patients had infected bile. A logistic regression model showed that wall appearance, distention, bile color, and pericholecystic fluid were not individually significant predictors for culture-positive bile, leaving sludge and/or stones (P =.003, odds ratio = 1.647), common bile duct status (P =.02, odds ratio = 2.214), and total score (P =.007, odds ratio = 1.267). No US covariates or clinical indices predicted clinical outcome. Clinical manifestation was predictive of clinical outcome (P =.001) and aspirating culture-positive bile (P =.008); specifically, 30 (86%) of 35 patients with right upper quadrant symptoms had their condition improve, compared with one (7%) of 15 asymptomatic patients with other known causes of infection. US variables can be used to predict culture-positive bile but not patient outcome. Clinical manifestation is important because patients with right upper quadrant symptoms have the best clinical outcome. Copyright RSNA, 2004

Proton Pump Inhibitor and Histamine-2 Receptor Antagonist Use and Iron Deficiency.

PubMed

Lam, Jameson R; Schneider, Jennifer L; Quesenberry, Charles P; Corley, Douglas A

2017-03-01

Proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) suppress gastric acid production, which can inhibit iron absorption. However, few data exist regarding whether these medications increase the risk of clinical iron deficiency. A community-based case-control study evaluated the association between acid-suppressing medication use and the subsequent risk of iron deficiency. It contrasted 77,046 patients with new iron deficiency diagnoses (January 1999-December 2013), with 389,314 controls. Medication exposures, outcomes, and potential confounders used electronic databases. We excluded patients with pre-existing risk factors for iron deficiency. Associations were estimated using conditional logistic regression. Among cases, 2343 (3.0%) received a prior ≥2-year supply of PPIs and 1063 (1.4%) received H2RAs (without PPI use). Among controls, 3354 (0.9%) received a prior ≥2-year supply of PPIs and 2247 (0.6%) H2RAs. Both ≥2 years of PPIs (adjusted odds ratio, 2.49; 95% confidence interval, 2.35-2.64) and ≥2 years of H2RAs (odds ratio, 1.58; 95% CI, 1.46-1.71) were associated with an increased subsequent risk for iron deficiency. Among PPI users, the associations were stronger for higher daily doses (>1.5 vs <0.75 PPI pills/d; P value interaction = .004) and decreased after medication discontinuation (P-trend < .001). Some of the strongest associations were among persons taking >1.5 pills per day for at least 10 years (odds ratio, 4.27; 95% CI, 2.53-7.21). No similar strong associations were found for other commonly used prescription medications. Among patients without known risk factors for iron deficiency, gastric acid inhibitor use for ≥2 years was associated with an increased subsequent risk of iron deficiency. The risk increased with increasing potency of acid inhibition and decreased after medication discontinuation. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

The association between suicidal ideation and sleep quality in elderly individuals: A cross-sectional study in Shandong, China.

PubMed

Qian, Yangyang; Sun, Long; Zhou, Chengchao; Ge, Dandan; Zhang, Li

2017-10-01

Previous studies have identified global associations between sleep quality and suicidal ideation. However, little is known regarding the relationship between sleep quality and suicidal ideation among Chinese older adults. We examined the relationship between sleep quality and suicidal ideation in older adults in China. A cross-sectional study was conducted in 3313 seniors in Shandong, China. Suicidal ideation was assessed using the interviewees' answers to the question "Have you ever seriously considered wanting to die?". Sleep quality was assessed using the Pittsburgh Sleep Quality Index. Logistic regression was performed to estimate odds ratios and 95% confidence intervals adjusted for confounders. When controlling for sex, age, living condition, economic status, marital status, education, past occupation, relationship with children, non-communicable diseases, and mental health, the odds of suicidal ideation increased in association with an increase in the total score for sleep quality and its components (subjective sleep quality, sleep duration, habitual sleep efficiency, and daytime dysfunction). Poor sleep quality was associated with increased odds of suicidal ideation in Chinese older adults. Sleep-based interventions should be developed to prevent suicide in older adults in China. Copyright © 2017 Elsevier B.V. All rights reserved.

The Association between a Mediterranean-Style Diet and Kidney Function in the Northern Manhattan Study Cohort

PubMed Central

Moon, Yeseon P.; Scarmeas, Nikolaos; Gu, Yian; Gardener, Hannah; Cheung, Ken; Wright, Clinton B.; Sacco, Ralph L.; Nickolas, Thomas L.; Elkind, Mitchell S.V.

2014-01-01

Background and objectives Various dietary strategies have been investigated to slow kidney function decline. However, it is unknown whether a Mediterranean diet, which has been associated with improved cardiovascular risk, is associated with change in kidney function. Design, setting, participants, & measurements This study used the Northern Manhattan Study, a prospective, multiethnic, observational cohort of participants who were stroke free at baseline. Data were collected between 1993 and 2008. Serum creatinine measurements were taken a mean 6.9 years apart. A baseline dietary questionnaire was extrapolated into a previously used 9-point scoring system (MeDi). The primary outcome was incident eGFR<60 ml/min per 1.73 m2using the Modification of Diet in Renal Disease formula. A secondary outcome was the upper quartile of annualized eGFR decline (≥2.5 ml/min per 1.73 m2 per year). Conditional logistic regression models adjusted for demographics and baseline vascular risk factors. Results Mean baseline age was 64 years, with 59% women and 65% Hispanics (N=900); mean baseline eGFR was 83.1 ml/min per 1.73 m2. Incident eGFR<60 ml/min per 1.73 m2 developed in 14% . In adjusted models, every 1-point increase in the MeDi score, indicating increasing adherence to a Mediterranean diet, was associated with decreased odds of incident eGFR<60 ml/min per 1.73 m2 (odds ratio, 0.83; 95% confidence interval, 0.71 to 0.96) and decreased odds of being in the upper quartile of eGFR decline (odds ratio, 0.88; 95% confidence interval, 0.79 to 0.98). Conclusions A Mediterranean diet was associated with a reduced incidence of eGFR<60 ml/min per 1.73 m2 and upper quartile of eGFR decline in a multiethnic cohort. PMID:25359387

The association between a Mediterranean-style diet and kidney function in the Northern Manhattan Study cohort.

PubMed

Khatri, Minesh; Moon, Yeseon P; Scarmeas, Nikolaos; Gu, Yian; Gardener, Hannah; Cheung, Ken; Wright, Clinton B; Sacco, Ralph L; Nickolas, Thomas L; Elkind, Mitchell S V

2014-11-07

Various dietary strategies have been investigated to slow kidney function decline. However, it is unknown whether a Mediterranean diet, which has been associated with improved cardiovascular risk, is associated with change in kidney function. This study used the Northern Manhattan Study, a prospective, multiethnic, observational cohort of participants who were stroke free at baseline. Data were collected between 1993 and 2008. Serum creatinine measurements were taken a mean 6.9 years apart. A baseline dietary questionnaire was extrapolated into a previously used 9-point scoring system (MeDi). The primary outcome was incident eGFR<60 ml/min per 1.73 m(2)using the Modification of Diet in Renal Disease formula. A secondary outcome was the upper quartile of annualized eGFR decline (≥ 2.5 ml/min per 1.73 m(2) per year). Conditional logistic regression models adjusted for demographics and baseline vascular risk factors. Mean baseline age was 64 years, with 59% women and 65% Hispanics (N=900); mean baseline eGFR was 83.1 ml/min per 1.73 m(2). Incident eGFR<60 ml/min per 1.73 m(2) developed in 14% . In adjusted models, every 1-point increase in the MeDi score, indicating increasing adherence to a Mediterranean diet, was associated with decreased odds of incident eGFR<60 ml/min per 1.73 m(2) (odds ratio, 0.83; 95% confidence interval, 0.71 to 0.96) and decreased odds of being in the upper quartile of eGFR decline (odds ratio, 0.88; 95% confidence interval, 0.79 to 0.98). A Mediterranean diet was associated with a reduced incidence of eGFR<60 ml/min per 1.73 m(2) and upper quartile of eGFR decline in a multiethnic cohort. Copyright © 2014 by the American Society of Nephrology.

Lack of blinding of outcome assessors in animal model experiments implies risk of observer bias.

PubMed

Bello, Segun; Krogsbøll, Lasse T; Gruber, Jan; Zhao, Zhizhuang J; Fischer, Doris; Hróbjartsson, Asbjørn

2014-09-01

To examine the impact of not blinding outcome assessors on estimates of intervention effects in animal experiments modeling human clinical conditions. We searched PubMed, Biosis, Google Scholar, and HighWire Press and included animal model experiments with both blinded and nonblinded outcome assessors. For each experiment, we calculated the ratio of odds ratios (ROR), that is, the odds ratio (OR) from nonblinded assessments relative to the corresponding OR from blinded assessments. We standardized the ORs according to the experimental hypothesis, such that an ROR <1 indicates that nonblinded assessor exaggerated intervention effect, that is, exaggerated benefit in experiments investigating possible benefit or exaggerated harm in experiments investigating possible harm. We pooled RORs with inverse variance random-effects meta-analysis. We included 10 (2,450 animals) experiments in the main meta-analysis. Outcomes were subjective in most experiments. The pooled ROR was 0.41 (95% confidence interval [CI], 0.20, 0.82; I(2) = 75%; P < 0.001), indicating an average exaggeration of the nonblinded ORs by 59%. The heterogeneity was quantitative and caused by three pesticides experiments with very large observer bias, pooled ROR was 0.20 (95% CI, 0.07, 0.59) in contrast to the pooled ROR in the other seven experiments, 0.82 (95% CI, 0.57, 1.17). Lack of blinding of outcome assessors in animal model experiments with subjective outcomes implies a considerable risk of observer bias. Copyright © 2014 Elsevier Inc. All rights reserved.

Association between maternal, fetal and paternal MTHFR gene C677T and A1298C polymorphisms and risk of recurrent pregnancy loss: a comprehensive evaluation.

PubMed

Yang, Yi; Luo, Yunyao; Yuan, Jing; Tang, Yidan; Xiong, Lang; Xu, MangMang; Rao, XuDong; Liu, Hao

2016-06-01

Numerous studies have investigated the associations between methylenetetrahydrofolate reductase (MTHFR) gene C677T and A1298C polymorphisms and risk of recurrent pregnancy loss (RPL); however, the results remain controversial. The aim of this study is to drive a more precise estimation of association between MTHFR gene polymorphisms and risk of RPL. We searched PubMed, EMBASE, Cochrane library, Web of Science and China Knowledge Resource Integrated Database for papers on MTHFR gene C677T and A1298C polymorphisms and RPL risk. The pooled odds ratios (ORs) with 95 % confidence intervals (CIs) were used to assess the strength of association in the homozygous model, heterozygous model, dominant model, recessive model and an additive model. The software STATA (Version 13.0) was used for statistical analysis. Overall, 57 articles were included in the final meta-analysis. In maternal group the MTHFR C677T polymorphism showed pooled odds ratios for the homozygous comparison [OR = 2.285, 95 % CI (1.702, 3.067)] and the MTHFR A1298C polymorphism showed pooled odds ratios for recessive model [OR = 1.594, 95 % CI (1.136, 2.238)]. In fetal group the MTHFR C677T polymorphism showed pooled odds ratios for dominant model [OR = 1.037, 95 % CI (0.567, 1.894)] and the MTHFR A1298C polymorphism showed pooled odds ratios for dominant model [OR = 1.495, 95 % CI (1.102, 2.026)]. In summary, the results of our meta-analysis indicate that maternal and paternal MTHFR gene C677T and A1298C polymorphisms are associated with RPL. We also observed a significant association between fetal MTHFR A1298C polymorphism and RPL but not C677T.

Longitudinal study of changing psychological outcomes following the Victorian Black Saturday bushfires.

PubMed

Bryant, Richard A; Gibbs, Lisa; Gallagher, Hugh Colin; Pattison, Phillipa; Lusher, Dean; MacDougall, Colin; Harms, Louise; Block, Karen; Sinnott, Vikki; Ireton, Greg; Richardson, John; Forbes, David

2017-06-01

To map the changing prevalence and predictors of psychological outcomes in affected communities 5 years following the Black Saturday bushfires in Victoria. Follow-up assessment of longitudinal cohort study in high, medium and non-affected communities in Victoria, Australia. Participants included 1017 respondents (Wave 1) interviewed via telephone and web-based survey between December 2011 and January 2013, and 735 (76.1%) eligible participants were retested between July and November 2014 (Wave 2). The survey included measures of fire-related and subsequent stressful events, probable posttraumatic stress disorder, major depressive episode, alcohol use and severe distress. There were reduced rates of fire-related posttraumatic stress disorder (8.7% vs 12.1%), general posttraumatic stress disorder (14.7% vs 18.2%), major depressive episode (9.0% vs 10.9%) and serious mental illness (5.4% vs 7.8%). Rates of resilience increased over time (81.8% vs 77.1%), and problem alcohol use remained high across Wave 1 (22.1%) and Wave 2 (21.4%). The most robust predictor of later development of fire-related posttraumatic stress disorder (odds ratio: 2.11; 95% confidence interval: [1.22, 3.65]), general posttraumatic stress disorder (odds ratio: 3.15; 95% confidence interval: [1.98, 5.02]), major depressive episode (odds ratio: 2.86; 95% confidence interval: [1.74, 4.70]), serious mental illness (odds ratio: 2.67; 95% confidence interval: [0.57, 1.72]) or diminished resilience (odds ratio: 2.01; 95% confidence interval: [1.32, 3.05]) was extent of recent life stressors. Although rates of mental health problems diminished over time, they remained higher than national levels. Findings suggest that policy-makers need to recognize that the mental health consequences of disasters can persist for many years after the event and need to allocate resources towards those who are most at risk as a result of substantive losses and ongoing life stressors.