Health care costs in US patients with and without a diagnosis of osteoarthritis

PubMed Central

Le, T Kim; Montejano, Leslie B; Cao, Zhun; Zhao, Yang; Ang, Dennis

2012-01-01

Background Osteoarthritis is a chronic and costly condition affecting 14% of adults in the US, and has a significant impact on patient quality of life. This retrospective cohort study compared direct health care utilization and costs between patients with osteoarthritis and a matched control group without osteoarthritis. Methods MarketScan® databases were used to identify adult patients with an osteoarthritis claim (ICD-9-CM, 715.xx) in 2007, and the date of first diagnosis served as the index. Patients were excluded if they did not have 12 months of continuous health care benefit prior to and following the index date, were aged <18 years, or lacked a second diagnosis code for osteoarthritis between 15 and 365 days pre-index or post-index. Osteoarthritis patients were matched 1:1 to patients without osteoarthritis for age group, gender, geographic region, health plan type, and Medicare eligibility. Multivariate analyses were conducted to assess for differences in utilization and costs, controlling for differences between cohorts. Results The study sample included 258,237 patients with osteoarthritis and 258,237 matched controls without osteoarthritis. Most patients were women and over 55 years of age. Patients with osteoarthritis had significantly higher pre-index rates of comorbidity than controls. Mean total adjusted direct costs for osteoarthritis patients were more than double those for the control group at US$18,435 (95% confidence interval [CI]: US$18,318–US$18,560) versus US$7494 (95% CI: US$7425–US$7557). Osteoarthritis patients incurred significantly higher inpatient costs at US$6668 (95% CI: US$6587–US$6744) versus US$1756 (95% CI: US$1717–US$1794), outpatient costs at US$7840 (95% CI: US$7786–US$7902) versus US$3675 (95% CI: US$3637–US$3711), and prescription drug costs at US$3213 (95% CI: US$3195–US$3233) versus US$2245 (95% CI: US$2229–US$2262) compared with the controls. Conclusion The direct health care costs of osteoarthritis patients were over two times higher than those of similar patients without the condition. The primary drivers of the cost difference were comorbidities and inpatient costs. PMID:22328832

Association and interaction between triglyceride-glucose index and obesity on risk of hypertension in middle-aged and elderly adults.

PubMed

Jian, Song; Su-Mei, Nie; Xue, Chen; Jie, Zhang; Xue-Sen, Wu

2017-01-01

To investigate the association between triglyceride-glucose(TyG) index and the risk of hypertension. A cross-sectional study was conducted in Bengbu, China. The participants received relevant questionnaire survey, anthropometric tests, and laboratory examination. Multivariate logistic regression analysis was performed to estimate the possible association between TyG index and hypertension risk. The additive interaction evaluated by the relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index(SI) was calculated. A total of 1777 participants (748 men and 1029 women) were investigated. There was a significant increase in the risk of hypertension and isolated systolic hypertension (ISH) when comparing the highest TyG index (the fourth quartile) to the lowest TyG index (the first quartile) and corresponding ORs were 2.446 (95% CI: 1.746-3.426) and 2.621(95%CI: 1.627-4.224), respectively. However, no significant relationship was observed between TyG index and isolated diastolic hypertension (IDH). In males, significant interactions between TyG index and WHtR (RERI:1.978, 95%CI: 0.162-3.792; AP: 0.359, 0.113-0.605; SI:1.782, 1.017-3.122), smoking (AP: 0.437, 95%CI: 0.048-0.825), family history of hypertension (AP:0.433, 95%CI: 0.203-0.662; SI:2.248, 95%CI: 1.333-3.791) were observed. As for females, there were also significant interactions between TyG index and WHtR (RERI:1.415, 95%CI: 0.693-2.136; AP: 0.198, 95%CI: 0.104-0.291; SI:1.298, 95%CI:1.101-1.530), family history of hypertension (RERI:1.744, 95%CI: 0.221-3.267; AP:0.405, 95%CI: 0.113-0.697) on risk of hypertension. Increased TyG index was significantly associated with higher risk of hypertension and ISH, but not for IDH in middle-aged and elderly adults. Our results also demonstrated interactions of TyG index and abdominal obesity and family history of hypertension on hypertension risk.

Sleep-disordered Breathing and Cancer Mortality

PubMed Central

Peppard, Paul E.; Young, Terry; Finn, Laurel; Hla, Khin Mae; Farré, Ramon

2012-01-01

Rationale: Sleep-disordered breathing (SDB) has been associated with total and cardiovascular mortality, but an association with cancer mortality has not been studied. Results from in vitro and animal studies suggest that intermittent hypoxia promotes cancer tumor growth. Objectives: The goal of the present study was to examine whether SDB is associated with cancer mortality in a community-based sample. Methods: We used 22-year mortality follow-up data from the Wisconsin Sleep Cohort sample (n = 1,522). SDB was assessed at baseline with full polysomnography. SDB was categorized using the apnea-hypopnea index (AHI) and the hypoxemia index (percent sleep time below 90% oxyhemoglobin saturation). The hazards of cancer mortality across levels of SDB severity were compared using crude and multivariate analyses. Measurements and Main Results: Adjusting for age, sex, body mass index, and smoking, SDB was associated with total and cancer mortality in a dose–response fashion. Compared with normal subjects, the adjusted relative hazards of cancer mortality were 1.1 (95% confidence interval [CI], 0.5–2.7) for mild SDB (AHI, 5–14.9), 2.0 (95% CI, 0.7–5.5) for moderate SDB (AHI, 15–29.9), and 4.8 (95% CI, 1.7–13.2) for severe SDB (AHI ≥ 30) (P-trend = 0.0052). For categories of increasing severity of the hypoxemia index, the corresponding relative hazards were 1.6 (95% CI, 0.6–4.4), 2.9 (95% CI, 0.9–9.8), and 8.6 (95% CI, 2.6–28.7). Conclusions: Our study suggests that baseline SDB is associated with increased cancer mortality in a community-based sample. Future studies that replicate our findings and look at the association between sleep apnea and survival after cancer diagnosis are needed. PMID:22610391

The triglycerides and glucose index is associated with cardiovascular risk factors in normal-weight children and adolescents.

PubMed

Simental-Mendía, Luis E; Hernández-Ronquillo, Gabriela; Gómez-Díaz, Rita; Rodríguez-Morán, Martha; Guerrero-Romero, Fernando

2017-12-01

BackgroundGiven the usefulness of the product of triglycerides and glucose (TyG) to recognize individuals at high risk for developing cardiovascular events, the aim of this study was to determine whether the TyG index is associated with the presence of cardiovascular risk factors in apparently healthy normal-weight children and adolescents.MethodsApparently healthy children and adolescents with normal weight, aged 6-15 years, were enrolled in a population-based cross-sectional study. The children were allocated into groups with and without cardiovascular risk factors. Cardiovascular risk factors were considered as the occurrence of at least one of the following: elevated blood pressure, hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C), or hyperglycemia.ResultsA total of 2,117 children and adolescents were enrolled in the study; of them, 1,078 (50.9%) participants exhibited cardiovascular risk. The adjusted logistic regression analysis showed that elevated TyG index was significantly associated with hypertriglyceridemia (odds ratio (OR)=96.45, 95% confidence interval (CI): 48.44-192.04), low HDL-C (OR=2.07, 95% CI: 1.46-2.92), and hyperglycemia (OR=3.11, 95% CI: 2.05-4.72), but not with elevated blood pressure (OR=1.39, 95% CI: 0.89-2.16).ConclusionThe elevated TyG index is associated with the presence of cardiovascular risk factors in healthy normal-weight children and adolescents.

Assessment of the periodontal health status in patients undergoing orthodontic treatment with fixed appliances and Invisalign system

PubMed Central

Lu, Haili; Tang, Haifang; Zhou, Tian; Kang, Na

2018-01-01

Abstract Background: At present, many scholars have studied the periodontal health status of patients undergoing orthodontic treatment with fixed appliances and invisalign. However, those results are inconsistent. Therefore, we conducted this meta-analysis, and then provide reference for clinical treatment. Methods: Most databases, such as the Cochrane Library, EMBASE, PubMed, Medline, Chinese Biomedical Literature Database, CNKI, and Wan Fang Data were retrieved for related articles from the establishment of the database to October 2017. Meanwhile, we also searched the references of the related literatures manually, in order to increase the included literatures. Two researchers screened the related literatures according to the inclusion criteria and exclusion criteria. Stata 12.0 software was used for data analysis, and results are estimated by odds ratio (OR) and 95% confidence interval (CI). Results: Finally, 7 articles, including 368 patients, were included into our meta-analysis. Meta-analysis results showed that there was no statistically significant difference of gingival index (GI) and sulcus probing depth (SPD) status between the invisalign group and the control group, including at 1, 3, and 6 months (all P > .05). When compared with the control group, the invisalign group presented a lower plaque index (PLI) and sulcus bleeding index (SBI) status at 1 month (OR = −0.53, 95% CI: −0.89 to −0.18; OR = −0.44, 95% CI: −0.70 to −0.19, respectively), 3 months (OR = −0.69, 95% CI: −1.12 to −0.27; OR = −0.49, 95% CI: −0.93 to −0.05, respectively), and 6 months (OR = −0.91, 95% CI: −1.47 to −0.35; OR = −0.40, 95% CI: −0.63 to −0.07, respectively). Subgroup analysis showed that the SPD status was lower in the invisalign group at 6 months when measured the teeth using Ramfjord index (OR = −0.74, 95% CI: −1.35 to −0.12). However, there was no statistically significant difference between the 2 groups when using other measure methods (OR = 0.12, 95% CI: −0.26 to 0.17). Conclusion: Our meta-analysis suggests that comparing with the traditional fixed appliances, patients treated with invisalign have a better periodontal health. However, more studies are needed to confirm this conclusion in the future. PMID:29595680

Preoperative risk factors for in-hospital mortality and validity of the Glasgow aneurysm score and Hardman index in patients with ruptured abdominal aortic aneurysm.

PubMed

Kurc, Erol; Sanioglu, Soner; Ozgen, Ayca; Aka, Serap Aykut; Yekeler, Ibrahim

2012-06-01

The aim of this study is to evaluate the validity of the Glasgow aneurysm score (GAS) and Hardman index in patients operated on because of ruptured abdominal aortic aneurysm (rAAA), and determining preoperative risk factors that affect in-hospital mortality. One hundred one patients operated on to repair a rAAA within the last 10 years were included. The GAS and Hardman index were calculated for each patient separately. The relation between in-hospital mortality and the Hardman index and GAS was analyzed by means of the receiver-operator characteristic (ROC) curve. Univariate and multivariate methods of analyses were used to determine preoperative risk factors. Average age was 69 ± 8, and in-hospital mortality rate was 51.5%. Analysis of the ROC curve showed that the Hardman index had an area under the curve (AUC) = 0.71 (95% confidence interval [CI], 0.593-0.800, P = 0.0002) for predicting in-hospital mortality. The GAS had an AUC = 0.77 (95% CI, 0.680-0.851, P < 0.0001). The results of multivariate analysis revealed the presence of the following preoperative risk factors: age more than 63 years (odds ratio [OR], 4.4; 95% CI, 1.17-16.49, P = 0.028); loss of consciousness (OR, 9.33; 95% CI, 1.94-44.86, P = 0.005); creatinine higher than 1.7 mg/dL (OR, 5.52; 95% CI, 1.92-15.85, P = 0.001); and pH lower than 7.31 (OR, 3.77; 95% CI, 1.18-11.99, P = 0.024). In conclusion, the Hardman index and GAS have a significant correlation with in-hospital mortality rates. Nevertheless, a high score does not necessarily correspond with a definite mortality. This is why scoring systems could not be considered as the sole criterion for choosing patients for this study. Clinical experience was still the leading factor in deciding against or in favor of surgery.

Evaluating the relationship between job stress and job satisfaction among female hospital nurses in Babol: An application of structural equation modeling.

PubMed

Bagheri Hosseinabadi, Majid; Etemadinezhad, Siavash; Khanjani, Narges; Ahmadi, Omran; Gholinia, Hemat; Galeshi, Mina; Samaei, Seyed Ehsan

2018-01-01

Background: This study was designed to investigate job satisfaction and its relation to perceived job stress among hospital nurses in Babol County, Iran. Methods: This cross-sectional study was conducted on 406 female nurses in 6 Babol hospitals. Respondents completed the Minnesota Satisfaction Questionnaire (MSQ), the health and safety executive (HSE) indicator tool and a demographic questionnaire. Descriptive, analytical and structural equation modeling (SEM) analyses were carried out applying SPSS v. 22 and AMOS v. 22. Results: The Normed Fit Index (NFI), Non-normed Fit Index (NNFI), Incremental Fit Index (IFI)and Comparative Fit Index (CFI) were greater than 0.9. Also, goodness of fit index (GFI=0.99)and adjusted goodness of fit index (AGFI) were greater than 0.8, and root mean square error of approximation (RMSEA) were 0.04, The model was found to be with an appropriate fit. The R-squared was 0.42 for job satisfaction, and all its dimensions were related to job stress. The dimensions of job stress explained 42% of changes in the variance of job satisfaction. There was a significant relationship between the dimensions of job stress such as demand (β =0.173,CI =0.095 - 0.365, P≤0.001), control (β =0.135, CI =0.062 - 0.404, P =0.008), relationships(β =-0.208, CI =-0.637- -0.209; P≤0.001) and changes (β =0.247, CI =0.360 - 1.026, P≤0.001)with job satisfaction. Conclusion: One of the important interventions to increase job satisfaction among nurses maybe improvement in the workplace. Reducing the level of workload in order to improve job demand and minimizing role conflict through reducing conflicting demands are recommended.

Evaluating the relationship between job stress and job satisfaction among female hospital nurses in Babol: An application of structural equation modeling

PubMed Central

Bagheri Hosseinabadi, Majid; Etemadinezhad, Siavash; khanjani, Narges; Ahmadi, Omran; Gholinia, Hemat; Galeshi, Mina; Samaei, Seyed Ehsan

2018-01-01

Background: This study was designed to investigate job satisfaction and its relation to perceived job stress among hospital nurses in Babol County, Iran. Methods: This cross-sectional study was conducted on 406 female nurses in 6 Babol hospitals. Respondents completed the Minnesota Satisfaction Questionnaire (MSQ), the health and safety executive (HSE) indicator tool and a demographic questionnaire. Descriptive, analytical and structural equation modeling (SEM) analyses were carried out applying SPSS v. 22 and AMOS v. 22. Results: The Normed Fit Index (NFI), Non-normed Fit Index (NNFI), Incremental Fit Index (IFI)and Comparative Fit Index (CFI) were greater than 0.9. Also, goodness of fit index (GFI=0.99)and adjusted goodness of fit index (AGFI) were greater than 0.8, and root mean square error of approximation (RMSEA) were 0.04, The model was found to be with an appropriate fit. The R-squared was 0.42 for job satisfaction, and all its dimensions were related to job stress. The dimensions of job stress explained 42% of changes in the variance of job satisfaction. There was a significant relationship between the dimensions of job stress such as demand (β =0.173,CI =0.095 - 0.365, P≤0.001), control (β =0.135, CI =0.062 - 0.404, P =0.008), relationships(β =-0.208, CI =-0.637– -0.209; P≤0.001) and changes (β =0.247, CI =0.360 - 1.026, P≤0.001)with job satisfaction. Conclusion: One of the important interventions to increase job satisfaction among nurses maybe improvement in the workplace. Reducing the level of workload in order to improve job demand and minimizing role conflict through reducing conflicting demands are recommended. PMID:29744305

Socioeconomic Inequalities in the Oral Health of People Aged 15-40 Years in Kurdistan, Iran in 2015: A Cross-sectional Study.

PubMed

Moradi, Ghobad; Moinafshar, Ardavan; Adabi, Hemen; Sharafi, Mona; Mostafavi, Farideh; Bolbanabad, Amjad Mohamadi

2017-09-01

The aim of this study was to evaluate socioeconomic inequalities in the prevalence of dental caries among an urban population. This study was conducted among 2000 people 15-40 years of age living in Kurdistan, Iran in 2015. Using a questionnaire, data were collected by 4 trained dental students. The dependent variable was the decayed, missing, and filled teeth (DMF) index. Using principal component analysis, the socioeconomic status (SES) of families was determined based on their household assets. Inequality was measured using the concentration index; in addition, the Oaxaca analytical method was used to determine the contribution of various determinants to the observed inequality. The concentration index for poor scores on the DMF index was -0.32 (95% confidence interval [CI], -0.40 to -0.36); thus, poor DMF indices had a greater concentration in groups with a low SES (p<0.001). Decomposition analysis showed that the mean prevalence of a poor DMF index was 43.7% (95% CI, 40.4 to 46.9%) in the least privileged group and 14.4% (95% CI, 9.5 to 9.2%) in the most privileged group. It was found that 85.8% of the gap observed between these groups was due to differences in sex, parents' education, and the district of residence. A poor DMF index was less prevalent among people with higher SES than among those with lower SES (odds ratio, 0.31; 95% CI, 0.19 to 0.52). An alarming degree of SES inequality in oral health status was found in the studied community. Hence, it is suggested that inequalities in oral health status be reduced via adopting appropriate policies such as the delivery of oral health services to poorer groups and covering such services in insurance programs.

Periodic Limb Movements during Sleep and Cardiac Arrhythmia in Older Men (MrOS Sleep)

PubMed Central

Koo, Brian B.; Mehra, Reena; Blackwell, Terri; Ancoli-Israel, Sonia; Stone, Katie L.; Redline, Susan

2014-01-01

Study Objectives: To determine if periodic limb movements during sleep (PLMS) are associated with nocturnal cardiac arrhythmia. Methods: 2,793 community-dwelling older men underwent polysomnography with measurement of limb movements and EKG. Logistic regression assessed association of periodic limb movement index and periodic limb movement arousal index with arrhythmia including atrial fibrillation and non-sustained ventricular tachycardia detected by polysomnography. Models were adjusted for age, race, cardiovascular risk factors, and clinic site. Secondary analyses were subset to men without calcium channel/β-adrenergic medication usage, and stratified by congestive heart failure or myocardial infarction history. Results: In the overall cohort, periodic limb movement index, and periodic limb movement arousal index were not associated with ventricular or atrial arrhythmia after considering potential confounders. In men not taking calcium channel/β-blocking medication, increased adjusted odds of non-sustained ventricular tachycardia were observed for periodic limb movement index (OR = 1.30 per SD increase; 95% CI 1.00, 1.68) and periodic limb movement arousal index (OR = 1.29 per SD increase; 95% CI 1.03, 1.62). In men with CHF or MI, there was a suggested association of atrial fibrillation with periodic limb movement index (OR = 1.29, 95% CI 0.96, 1.73 per SD increase; p = 0.09) or periodic limb movement arousal index (OR = 1.21, 95% CI 0.94, 1.57 per SD increase; p = 0.14), although results were not statistically significant. Conclusions: There is not an association between PLMS and cardiac arrhythmia in all older men but in subsets of men, particularly those with structural heart disease and not on calcium channel or β-adrenergic medication, cardiac arrhythmia does associate with PLMS. Citation: Koo BB; Mehra R; Blackwell T; Ancoli-Israel S; Stone KL; Redline S; for the Osteoporotic Fractures in Men (MrOS) Study Group. Periodic limb movements during sleep and cardiac arrhythmia in older men (MrOS sleep). J Clin Sleep Med 2014;10(1):7-11. PMID:24426814

Neighborhood contextual characteristics and leisure-time physical activity: Pró-Saúde Study

PubMed Central

Boclin, Karine de Lima Sírio; Faerstein, Eduardo; de Leon, Antônio Carlos Monteiro Ponce

2014-01-01

OBJECTIVE To estimate the association between neighborhood contextual variables and leisure-time physical activity. METHODS Data were analyzed for 2,674 adults from Rio de Janeiro, RJ, Southeastern Brazil, participating in the longitudinal study in 1999. Leisure-time physical activity in the two preceding weeks was assessed dichotomously. Sex, age, income, education and marital status were analyzed as individual variables. Neighborhood contextual characteristics were the social development index, the Theil index and the proportion of the area occupied by parks, squares and gardens, categorized in quintiles. The unadjusted and adjusted odds ratios and 95% confidence intervals were estimated using multilevel logistic regression. RESULTS The prevalence of leisure-time physical activity was higher in residents in neighborhoods with higher indices of social development (between 32.3% and 53.1%) and a greater proportion of parks, squares and gardens (between 35.8% and 53.1%). Regarding the social development index, the adjusted odds ratios for physical activity were 1.22 (95%CI 0.93;1.61), 1.44 (95%CI 1.09;1.89), 1.75 (95%CI 1.31;2.34) and 2.25 (95%CI 1.70;3.00) for residents in neighborhoods in the second, third, fourth and fifth quintiles, respectively, compared with residents in neighborhoods in the first quintile. The odds ratios for the proportion of parks, squares and gardens were 0.90 (95%CI 0.69;1.19), 1.41 (95%CI 1.04;1.90), 1.63 (95%CI 1.24;2.14) and 1.05 (95%CI 0.80;1.38) for residents in neighborhoods in the second, third, fourth and fifth quintiles. After adjusting for the other variables, only the social development index continued to be associated with leisure-time physical activity, with odds ratios of 1.41 (95%CI 1.02;1.95); 1.54 (95%CI 1.12;2.12); 1.65 (95%CI 1.14;2.39) and 2.13 (95%CI 1.40;3.25) for residents in neighborhoods in the second, third, fourth and fifth quintiles. CONCLUSIONS Leisure-time physical activity was more common in residents in neighborhoods with higher social development indices. No association was observed between access to leisure areas and income inequality. PMID:24897046

Association of Body Mass Index with Depression, Anxiety and Suicide—An Instrumental Variable Analysis of the HUNT Study

PubMed Central

Bjørngaard, Johan Håkon; Carslake, David; Lund Nilsen, Tom Ivar; Linthorst, Astrid C. E.; Davey Smith, George; Gunnell, David; Romundstad, Pål Richard

2015-01-01

Objective While high body mass index is associated with an increased risk of depression and anxiety, cumulative evidence indicates that it is a protective factor for suicide. The associations from conventional observational studies of body mass index with mental health outcomes are likely to be influenced by reverse causality or confounding by ill-health. In the present study, we investigated the associations between offspring body mass index and parental anxiety, depression and suicide in order to avoid problems with reverse causality and confounding by ill-health. Methods We used data from 32,457 mother-offspring and 27,753 father-offspring pairs from the Norwegian HUNT-study. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale and suicide death from national registers. Associations between offspring and own body mass index and symptoms of anxiety and depression and suicide mortality were estimated using logistic and Cox regression. Causal effect estimates were estimated with a two sample instrument variable approach using offspring body mass index as an instrument for parental body mass index. Results Both own and offspring body mass index were positively associated with depression, while the results did not indicate any substantial association between body mass index and anxiety. Although precision was low, suicide mortality was inversely associated with own body mass index and the results from the analysis using offspring body mass index supported these results. Adjusted odds ratios per standard deviation body mass index from the instrumental variable analysis were 1.22 (95% CI: 1.05, 1.43) for depression, 1.10 (95% CI: 0.95, 1.27) for anxiety, and the instrumental variable estimated hazard ratios for suicide was 0.69 (95% CI: 0.30, 1.63). Conclusion The present study’s results indicate that suicide mortality is inversely associated with body mass index. We also found support for a positive association between body mass index and depression, but not for anxiety. PMID:26167892

Risk factors for Barrett’s oesophagus and oesophageal adenocarcinoma: Results from the FINBAR study

PubMed Central

Anderson, Lesley A; Watson, RG Peter; Murphy, Seamus J; Johnston, Brian T; Comber, Harry; Mc Guigan, Jim; Reynolds, John V; Murray, Liam J

2007-01-01

AIM: To investigate risk factors associated with Barrett’s oesophagus and oesophageal adenocarcinoma. METHODS: This all-Ireland population-based case-control study recruited 224 Barrett’s oesophagus patients, 227 oesophageal adenocarcinoma patients and 260 controls. All participants underwent a structured interview with information obtained about potential lifestyle and environmental risk factors. RESULTS: Gastro-oesophageal reflux was associated with Barrett’s [OR 12.0 (95% CI 7.64-18.7)] and oesophageal adenocarcinoma [OR 3.48 (95% CI 2.25-5.41)]. Oesophageal adenocarcinoma patients were more likely than controls to be ex- or current smokers [OR 1.72 (95% CI 1.06-2.81) and OR 4.84 (95% CI 2.72-8.61) respectively] and to have a high body mass index [OR 2.69 (95% CI 1.62-4.46)]. No significant associations were observed between these risk factors and Barrett's oesophagus. Fruit but not vegetables were negatively associated with oesophageal adenocarcinoma [OR 0.50 (95% CI 0.30-0.86)]. CONCLUSION: A high body mass index, a diet low in fruit and cigarette smoking may be involved in the progression from Barrett’s oesophagus to oesophageal adenocarcinoma. PMID:17461453

Estimation of Environment-Related Properties of Chemicals for Design of Sustainable Processes: Development of Group-Contribution+ (GC+) Property Models and Uncertainty Analysis

EPA Science Inventory

The aim of this work is to develop group-contribution+ (GC+) method (combined group-contribution (GC) method and atom connectivity index (CI) method) based property models to provide reliable estimations of environment-related properties of organic chemicals together with uncert...

Transesophageal Doppler measurement of renal arterial blood flow velocities and indices in children.

PubMed

Zabala, Luis; Ullah, Sana; Pierce, Carol D'Ann; Gautam, Nischal K; Schmitz, Michael L; Sachdeva, Ritu; Craychee, Judith A; Harrison, Dale; Killebrew, Pamela; Bornemeier, Renee A; Prodhan, Parthak

2012-06-01

Doppler-derived renal blood flow indices have been used to assess renal pathologies. However, transesophageal ultrasonography (TEE) has not been previously used to assess these renal variables in pediatric patients. In this study, we (a) assessed whether TEE allows adequate visualization of the renal parenchyma and renal artery, and (b) evaluated the concordance of TEE Doppler-derived renal blood flow measurements/indices compared with a standard transabdominal renal ultrasound (TAU) in children. This prospective cohort study enrolled 28 healthy children between the ages of 1 and 17 years without known renal dysfunction who were undergoing atrial septal defect device closure in the cardiac catheterization laboratory. TEE was used to obtain Doppler renal artery blood velocities (peak systolic velocity, end-diastolic velocity, mean diastolic velocity, resistive index, and pulsatility index), and these values were compared with measurements obtained by TAU. Concordance correlation coefficient (CCC) was used to determine clinically significant agreement between the 2 methods. The Bland-Altman plots were used to determine whether these 2 methods agree sufficiently to be used interchangeably. Statistical significance was accepted at P ≤ 0.05. Obtaining 2-dimensional images of kidney parenchyma and Doppler-derived measurements using TEE in children is feasible. There was statistically significant agreement between the 2 methods for all measurements. The CCC between the 2 imaging techniques was 0.91 for the pulsatility index and 0.66 for the resistive index. These coefficients were sensitive to outliers. When the highest and lowest data points were removed from the analysis, the CCC between the 2 imaging techniques was 0.62 for the pulsatility index and 0.50 for the resistive index. The 95% confidence interval (CI) for pulsatility index was 0.35 to 0.98 and for resistive index was 0.21 to 0.89. The Bland-Altman plots indicate good agreement between the 2 methods; for the pulsatility index, the limits of agreement were -0.80 to 0.53. The correlation of the size of the measurement and the mean difference in methods (-0.14; 95% CI = -0.28, 0.01) was not statistically significant (r = 0.31, P = 0.17). For the resistive index, the limits of agreement were -0.22 to 0.12. The correlation of the size of the measurement and the mean difference in methods (-0.05; 95% CI = -0.09, -0.01) was not statistically significant (r = 0.10, P = 0.65). This study confirms the feasibility of obtaining 2-dimensional images of kidney parenchyma and Doppler-derived measurements using TEE in children. Angle-independent TEE Doppler-derived indices show significant concordance with those derived by TAU. Further studies are required to assess whether this correlation holds true in the presence of renal pathology. This technique has the potential to help modulate intraoperative interventions based on their impact on renal variables and may prove helpful in the perioperative period for children at risk of acute kidney injury.

A short note on jackknifing the concordance correlation coefficient.

PubMed

Feng, Dai; Baumgartner, Richard; Svetnik, Vladimir

2014-02-10

Lin's concordance correlation coefficient (CCC) is a very popular scaled index of agreement used in applied statistics. To obtain a confidence interval (CI) for the estimate of CCC, jackknifing was proposed and shown to perform well in simulation as well as in applications. However, a theoretical proof of the validity of the jackknife CI for the CCC has not been presented yet. In this note, we establish a sufficient condition for using the jackknife method to construct the CI for the CCC. Copyright © 2013 John Wiley & Sons, Ltd.

Quantitative (13)C MultiCP solid-state NMR as a tool for evaluation of cellulose crystallinity index measured directly inside sugarcane biomass.

PubMed

Bernardinelli, Oigres Daniel; Lima, Marisa Aparecida; Rezende, Camila Alves; Polikarpov, Igor; deAzevedo, Eduardo Ribeiro

2015-01-01

The crystallinity index (CI) is often associated with changes in cellulose structure after biological and physicochemical pretreatments. While some results obtained with lignocellulosic biomass demonstrate a progressive increase in the CI as a function of pretreatments, it is also shown that the CI can significantly vary depending on the choice of the measurement method. Besides, the influence of the CI on the recalcitrance of biomass has been controversial for a long time, but the most recent results tend to point out that the efficiency of pretreatments in reducing the recalcitrance is not clearly correlated with the decrease of the CI. Much of this controversy is somewhat associated with the inability to distinguish between the CI of the cellulose inside the biomass and the CI of the full biomass, which contains other amorphous components such as lignin and hemicellulose. Cross polarization by multiple contact periods (Multi-CP) method was used to obtain quantitative (13)C solid-state nuclear magnetic resonance (ssNMR) spectra of sugarcane bagasse biomass submitted to two-step pretreatments and/or enzymatic hydrolysis. By comparing the dipolar filtered Multi-CP (13)C NMR spectra of untreated bagasse samples with those of samples submitted to acid pretreatment, we show that a 1% H2SO4-assisted pretreatment was very effective in removing practically all the hemicellulose signals. This led us to propose a spectral editing procedure based on the subtraction of MultiCP spectra of acid-treated biomass from that of the extracted lignin, to obtain a virtually pure cellulose spectrum. Based on this idea, we were able to evaluate the CI of the native cellulose inside the sugarcane bagasse biomass. The results show the validity of the proposed method as a tool for evaluating the variations in the CI of the cellulose inside biomasses of similar kinds. Despite a clear increase in the CI of biomass as measured by X-ray diffraction, no significant variations were observed in the CI of the cellulose inside the biomass after a particular 1% H2SO4/0.25-4% NaOH chemical-assisted pretreatments. The CI of cellulose inside the biomass solid fraction that remained after the enzymatic hydrolysis was also evaluated. The results show a slight increase in crystallinity.

Suicide Attempt as a Risk Factor for Completed Suicide: Even More Lethal Than We Knew

PubMed Central

Bostwick, J. Michael; Pabbati, Chaitanya; Geske, Jennifer R.; McKean, Alastair J.

2017-01-01

Objective While suicide attempt history is considered to robustly predict completed suicide, previous studies have limited generalizability from using convenience samples of specific methods/treatment settings, disregarding previous attempts, or overlooking first-attempt deaths. Eliminating these biases should more accurately estimate suicide prevalence in attempters. Method This observational retrospective-prospective cohort study using the Rochester Epidemiology Project identified 1,490 (555 males/935 females) Olmsted County residents making index suicide attempts (first lifetime attempts reaching medical attention) between 01-01-1986 and 12-31-2007. The National Death Index identified suicides between enrollment and 12-31-2010 (follow-up 3-25 years). Medical records were queried for sex, age, method, and follow-up care for index attempt survivors. Coroner records yielded data on index attempt deaths. Results During the study period, 81/1490 enrollees (5.4%) died by suicide. Of the 81, 48 (59.3%) perished on index attempt; 27 of the surviving 33 index attempt survivors (81.8%) killed themselves within a year. Males were disproportionately represented: 62/81 (11.2% of men; 76.5% of suicides) vs 19/81 (2.0% of women, 23.5% of suicides). Of dead index attempters, 72.9% used guns, yielding an odds ratio for gunshot death vs all other methods of 140 [95%CI:60,325]. When adjusted for covariates, survivors given follow-up psychiatric appointments had significantly lower likelihood of subsequent suicide (OR=0.212[95%CI:0.089, 0.507]). Conclusions At 5.4%, completed suicide prevalence in this community cohort of suicide attempters was almost 59% higher than previously reported. An innovative aspect of this study explains the discrepancy: by including index attempt deaths—approximately 60% of total suicides—suicide prevalence more than doubled. We contend that counting both index and subsequent attempts deaths more accurately reflects prevalence. Our findings support suicide attempt as an even more lethal risk factor for completed suicide than previously thought. Research should focus on identifying risk factors for populations vulnerable to making first attempts and target risk reduction in those groups. PMID:27523496

Associations of key diet-quality indexes with mortality in the Multiethnic Cohort: the Dietary Patterns Methods Project.

PubMed

Harmon, Brook E; Boushey, Carol J; Shvetsov, Yurii B; Ettienne, Reynolette; Reedy, Jill; Wilkens, Lynne R; Le Marchand, Loic; Henderson, Brian E; Kolonel, Laurence N

2015-03-01

Healthy dietary patterns have been linked positively with health and longevity. However, prospective studies in diverse populations in the United States addressing dietary patterns and mortality are limited. We assessed the ability of the following 4 diet-quality indexes [the Healthy Eating Index-2010 (HEI-2010), the Alternative HEI-2010 (AHEI-2010), the alternate Mediterranean diet score (aMED), and the Dietary Approaches to Stop Hypertension (DASH)] to predict the reduction in risk of mortality from all causes, cardiovascular disease (CVD), and cancer. White, African American, Native Hawaiian, Japanese American, and Latino adults (n = 215,782) from the Multiethnic Cohort completed a quantitative food-frequency questionnaire. Scores for each dietary index were computed and divided into quintiles for men and women. Mortality was documented over 13-18 y of follow-up. HRs and 95% CIs were computed by using adjusted Cox models. High HEI-2010, AHEI-2010, aMED, and DASH scores were all inversely associated with risk of mortality from all causes, CVD, and cancer in both men and women (P-trend < 0.0001 for all models). For men, the HEI-2010 was consistently associated with a reduction in risk of mortality for all causes (HR: 0.75; 95% CI: 0.71, 0.79), CVD (HR: 0.74; 95% CI: 0.69, 0.81), and cancer (HR: 0.76; 95% CI: 0.70, 0.83) when lowest and highest quintiles were compared. In women, the AHEI and aMED showed large reductions for all-cause mortality (HR: 0.78; 95% CI: 0.74, 0.82), the AHEI showed large reductions for CVD (HR: 0.76; 95% CI: 0.69, 0.83), and the aMED showed large reductions for cancer (HR: 0.84; 95% CI: 0.76, 0. 92). These results, in a US multiethnic population, suggest that consuming a dietary pattern that achieves a high diet-quality index score is associated with lower risk of mortality from all causes, CVD, and cancer in adult men and women. © 2015 American Society for Nutrition.

Assessing Participation in Community-Based Physical Activity Programs in Brazil

PubMed Central

REIS, RODRIGO S.; YAN, YAN; PARRA, DIANA C.; BROWNSON, ROSS C.

2015-01-01

Purpose This study aimed to develop and validate a risk prediction model to examine the characteristics that are associated with participation in community-based physical activity programs in Brazil. Methods We used pooled data from three surveys conducted from 2007 to 2009 in state capitals of Brazil with 6166 adults. A risk prediction model was built considering program participation as an outcome. The predictive accuracy of the model was quantified through discrimination (C statistic) and calibration (Brier score) properties. Bootstrapping methods were used to validate the predictive accuracy of the final model. Results The final model showed sex (women: odds ratio [OR] = 3.18, 95% confidence interval [CI] = 2.14–4.71), having less than high school degree (OR = 1.71, 95% CI = 1.16–2.53), reporting a good health (OR = 1.58, 95% CI = 1.02–2.24) or very good/excellent health (OR = 1.62, 95% CI = 1.05–2.51), having any comorbidity (OR = 1.74, 95% CI = 1.26–2.39), and perceiving the environment as safe to walk at night (OR = 1.59, 95% CI = 1.18–2.15) as predictors of participation in physical activity programs. Accuracy indices were adequate (C index = 0.778, Brier score = 0.031) and similar to those obtained from bootstrapping (C index = 0.792, Brier score = 0.030). Conclusions Sociodemographic and health characteristics as well as perceptions of the environment are strong predictors of participation in community-based programs in selected cities of Brazil. PMID:23846162

Correlations of Apparent Cellulose Crystallinity Determined by XRD, NMR, IR, Raman, and SFG Methods

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

Johnson, David K; Lee, Christopher; Dazen, Kevin

2015-07-04

Although the cellulose crystallinity index (CI) is used widely, its limitations have not been adequately described. In this study, the CI values of a set of reference samples were determined from X-ray diffraction (XRD), nuclear magnetic resonance (NMR), and infrared (IR), Raman, and vibrational sum frequency generation (SFG) spectroscopies. The intensities of certain crystalline peaks in IR, Raman, and SFG spectra positively correlated with the amount of crystalline cellulose in the sample, but the correlation with XRD was nonlinear as a result of fundamental differences in detection sensitivity to crystalline cellulose and improper baseline corrections for amorphous contributions. It ismore » demonstrated that the intensity and shape of the XRD signal is affected by both the amount of crystalline cellulose and crystal size, which makes XRD analysis complicated. It is clear that the methods investigated show the same qualitative trends for samples, but the absolute CI values differ depending on the determination method. This clearly indicates that the CI, as estimated by different methods, is not an absolute value and that for a given set of samples the CI values can be compared only as a qualitative measure.« less

Correlations of Apparent Cellulose Crystallinity Determined by XRD, NMR, IR, Raman, and SFG Methods

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

Lee, Christopher M; Dazen, Kevin; Kafle, Kabindra

2015-01-01

Although the cellulose crystallinity index (CI) is used widely, its limitations have not been adequately described. In this study, the CI values of a set of reference samples were determined from X-ray diffraction (XRD), nuclear magnetic resonance (NMR), and infrared (IR), Raman, and vibrational sum frequency generation (SFG) spectroscopies. The intensities of certain crystalline peaks in IR, Raman, and SFG spectra positively correlated with the amount of crystalline cellulose in the sample, but the correlation with XRD was nonlinear as a result of fundamental differences in detection sensitivity to crystalline cellulose and improper baseline corrections for amorphous contributions. It ismore » demonstrated that the intensity and shape of the XRD signal is affected by both the amount of crystalline cellulose and crystal size, which makes XRD analysis complicated. It is clear that the methods investigated show the same qualitative trends for samples, but the absolute CI values differ depending on the determination method. This clearly indicates that the CI, as estimated by different methods, is not an absolute value and that for a given set of samples the CI values can be compared only as a qualitative measure.« less

The economic and clinical burden of early versus late initiation of celecoxib among patients with osteoarthritis

PubMed Central

Shelbaya, Ahmed; Solem, Caitlyn T; Walker, Chris; Wan, Yin; Johnson, Courtney; Cappelleri, Joseph C

2018-01-01

Objective This study aimed to evaluate the characteristics associated with early versus late initiation of celecoxib treatment after osteoarthritis (OA) diagnosis and whether economic and safety outcomes differ between patients with early versus late initiation of celecoxib. Methods Adults (≥18 years) with a confirmed OA diagnosis (International Classification of Diseases, 9th Edition, Clinical Modifications code: 715.XX), ≥12 months of continuous pre- and post-index enrollment, and ≥1 post-index claim for celecoxib were included from the MarketScan® Commercial Claims and Encounter Database (2009–2013). Index date was defined as initial OA diagnosis. Patients were categorized as initiating celecoxib early (within 6 months of index date) or late (≥6 months after index date). Logistic regressions were used to assess characteristics associated with early versus late celecoxib initiation. Key outcomes included health care resource utilization (HCRU) and costs post-index, and adverse event incidence post-celecoxib initiation. Unadjusted and adjusted comparisons (using generalized linear models with a gamma distribution for costs and Poisson distribution for event and resource utilization) were made between early and late celecoxib initiators. Results Of the 62,434 OA patients identified, 27,402 were early and 35,032 were late initiators. Post-index hospital admissions and length of stay did not differ statistically between early versus late initiators after controlling for pre-index event rates and covariates, but early patients had significantly fewer outpatient (incidence rate ratio [IRR]: 0.96; 95% confidence interval [CI]: 0.95, 0.97) and emergency room visits (IRR: 0.89; 95% CI: 0.84, 0.95). After adjustment for key covariates, early initiators (versus late initiators) had lower all-cause (US$12,909 versus US$13,781, P<0.001) and OA-related (US$4,988 versus US$5,178, P=0.015) costs per person-year. Early initiators had no statistically significant difference in the incidence of post-celecoxib cardiovascular (IRR: 0.92; 95% CI: 0.73, 1.14), gastrointestinal (IRR: 1.25; 95% CI: 0.81, 1.92), or renal (IRR: 1.19; 95% CI: 0.65, 2.18) events, controlling for pre-index event rates and covariates when compared to late initiators. Conclusion In this real-world cohort, patients initiated on celecoxib early (versus late) had significantly lower costs and HCRU; this may warrant consideration when making treatment decisions for OA patients. PMID:29670383

Assessment of the periodontal health status in patients undergoing orthodontic treatment with fixed appliances and Invisalign system: A meta-analysis.

PubMed

Lu, Haili; Tang, Haifang; Zhou, Tian; Kang, Na

2018-03-01

At present, many scholars have studied the periodontal health status of patients undergoing orthodontic treatment with fixed appliances and invisalign. However, those results are inconsistent. Therefore, we conducted this meta-analysis, and then provide reference for clinical treatment. Most databases, such as the Cochrane Library, EMBASE, PubMed, Medline, Chinese Biomedical Literature Database, CNKI, and Wan Fang Data were retrieved for related articles from the establishment of the database to October 2017. Meanwhile, we also searched the references of the related literatures manually, in order to increase the included literatures. Two researchers screened the related literatures according to the inclusion criteria and exclusion criteria. Stata 12.0 software was used for data analysis, and results are estimated by odds ratio (OR) and 95% confidence interval (CI). Finally, 7 articles, including 368 patients, were included into our meta-analysis. Meta-analysis results showed that there was no statistically significant difference of gingival index (GI) and sulcus probing depth (SPD) status between the invisalign group and the control group, including at 1, 3, and 6 months (all P > .05). When compared with the control group, the invisalign group presented a lower plaque index (PLI) and sulcus bleeding index (SBI) status at 1 month (OR = -0.53, 95% CI: -0.89 to -0.18; OR = -0.44, 95% CI: -0.70 to -0.19, respectively), 3 months (OR = -0.69, 95% CI: -1.12 to -0.27; OR = -0.49, 95% CI: -0.93 to -0.05, respectively), and 6 months (OR = -0.91, 95% CI: -1.47 to -0.35; OR = -0.40, 95% CI: -0.63 to -0.07, respectively). Subgroup analysis showed that the SPD status was lower in the invisalign group at 6 months when measured the teeth using Ramfjord index (OR = -0.74, 95% CI: -1.35 to -0.12). However, there was no statistically significant difference between the 2 groups when using other measure methods (OR = 0.12, 95% CI: -0.26 to 0.17). Our meta-analysis suggests that comparing with the traditional fixed appliances, patients treated with invisalign have a better periodontal health. However, more studies are needed to confirm this conclusion in the future.

Impact of Missing Data for Body Mass Index in an Epidemiologic Study.

PubMed

Razzaghi, Hilda; Tinker, Sarah C; Herring, Amy H; Howards, Penelope P; Waller, D Kim; Johnson, Candice Y

2016-07-01

Objective To assess the potential impact of missing data on body mass index (BMI) on the association between prepregnancy obesity and specific birth defects. Methods Data from the National Birth Defects Prevention Study (NBDPS) were analyzed. We assessed the factors associated with missing BMI data among mothers of infants without birth defects. Four analytic methods were then used to assess the impact of missing BMI data on the association between maternal prepregnancy obesity and three birth defects; spina bifida, gastroschisis, and cleft lip with/without cleft palate. The analytic methods were: (1) complete case analysis; (2) assignment of missing values to either obese or normal BMI; (3) multiple imputation; and (4) probabilistic sensitivity analysis. Logistic regression was used to estimate crude and adjusted odds ratios (aOR) and 95 % confidence intervals (CI). Results Of NBDPS control mothers 4.6 % were missing BMI data, and most of the missing values were attributable to missing height (~90 %). Missing BMI data was associated with birth outside of the US (aOR 8.6; 95 % CI 5.5, 13.4), interview in Spanish (aOR 2.4; 95 % CI 1.8, 3.2), Hispanic ethnicity (aOR 2.0; 95 % CI 1.2, 3.4), and <12 years education (aOR 2.3; 95 % CI 1.7, 3.1). Overall the results of the multiple imputation and probabilistic sensitivity analysis were similar to the complete case analysis. Conclusions Although in some scenarios missing BMI data can bias the magnitude of association, it does not appear likely to have impacted conclusions from a traditional complete case analysis of these data.

Evaluation of Biological Activity of Cellulose Pulp by Means of the Static Respiration Index (At4)/ Ocena Aktywności Biologicznej Pulpy Celulozowej Testem Respiracyjnym At4

NASA Astrophysics Data System (ADS)

Myszograj, Sylwia; Kozłowska, Katarzyna; Krochmal, Agata

2014-09-01

In the countries of the European Union, work is presently being conducted on the standardisation of the limit values and test methods for the determination of the biological activity of waste. The aim of conducting the tests is to monitor the effectiveness of waste biodegradation during composting, the evaluate any decrease in the biological activity of the waste before its landfilling and control processes taking place at landfills. The evaluation of the waste's biological activity can be performed, among others, by testing respiration. One such method is AT4 (Static Respiration Index) determination. The results of respirometric tests depict the availability of substrates for microorganisms, that is, the biodegradability. The article describes the tests of the biological activity of the cellulose pulp, the impact of the degree of compost inoculation on the value of this parameter and the dependence on the content of organic mass and total organic carbon in the tested substrate. The measurements of the oxygen demand were made using the OxiTop® Control measuring system. W krajach UE prowadzone są obecnie prace nad ujednoliceniem wartości granicznych oraz metod testowych oznaczania aktywności biologicznej odpadów. Celem prowadzenia testów jest monitoring efektywności biologicznego rozkładu odpadów podczas kompostowania, ocena zmniejszenia aktywności biologicznej odpadów przed ich składowaniem, kontrola procesów zachodzących na składowiskach. Ocenę aktywności biologicznej odpadów można przeprowadzić m.in. poprzez badanie respiracji. Jedną z takich metod jest oznaczenie AT4 (Static Respiration Index). Wyniki badań respirometrycznych obrazują dostępność substratów dla mikroorganizmów, czyli podatność na biodegradację. W artykule opisano badania aktywności biologicznej pulpy celulozowej testem AT4, wpływ stopnia zaczepienia kompostem na wartość tego parametru oraz zależność od zawartości masy organicznej i OWO w badanym substracie. Pomiarów zapotrzebowania na tlen dokonano przy pomocy systemu pomiarowego OxiTop® Control.

Matching-adjusted indirect comparison of efficacy in patients with moderate-to-severe plaque psoriasis treated with ixekizumab vs. secukinumab.

PubMed

Warren, R B; Brnabic, A; Saure, D; Langley, R G; See, K; Wu, J J; Schacht, A; Mallbris, L; Nast, A

2018-05-01

Head-to-head randomized studies comparing ixekizumab and secukinumab in the treatment of psoriasis are not available. To assess efficacy and quality of life using matching-adjusted indirect comparisons for treatment with ixekizumab vs. secukinumab. Psoriasis Area and Severity Index (PASI) improvement of at least 75%, 90% and 100% and Dermatology Life Quality Index (DLQI) 0/1 response rates for approved dosages of ixekizumab (160 mg at Week 0, then 80 mg every two weeks for the first 12 weeks) and secukinumab (300 mg at Weeks 0, 1, 2, 3 and 4, then 300 mg every 4 weeks) treatment were compared using data from active (etanercept and ustekinumab) and placebo-controlled studies. Comparisons were made using the Bucher (BU) method and two modified versions of the Signorovitch (SG) method (SG total and SG separate). Subsequently, results based on active treatment common comparators were combined using generic inverse-variance meta-analysis. In the meta-analysis of studies with active comparators, PASI 90 response rates were 12·7% [95% confidence interval (CI) 5·5-19·8, P = 0·0005], 10·0% (95% CI 2·1-18·0, P = 0·01) and 11·2% (95% CI 3·2-19·1, P = 0·006) higher and PASI 100 response rates were 11·7% (95% CI 5·9-17·5, P < 0·001), 12·7% (95% CI 6·0-19·4, P < 0·001) and 13·1% (95% CI 6·3-19·9, P < 0·001) higher for ixekizumab compared with secukinumab using BU, SG total and SG separate methods. PASI 75 results were comparable when SG methods were used and favoured ixekizumab when the BU method was used. Week 12 DLQI 0/1 response rates did not differ significantly. Ixekizumab had higher PASI 90 and PASI 100 responses at week 12 compared with secukinumab using adjusted indirect comparisons. © 2017 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.

Cameriere's third molar maturity index in assessing age of majority.

PubMed

Galić, Ivan; Lauc, Tomislav; Brkić, Hrvoje; Vodanović, Marin; Galić, Elizabeta; Biazevic, Maria Gabriela Haye; Brakus, Ivan; Badrov, Jozo; Cameriere, Roberto

2015-07-01

Estimation of chronological age of an individual is one of the main challenges in forensic science. Legally to be able to treat a person as a minor or an adult, it is necessary to determine whether their age of majority (if they are older or younger than 18, in most countries). Methods for estimating age are especially important when an individual in question lacks personal documents or other means of identification. As the dental age differs in various populations, the aim of this study was to evaluate applicability of third molar method for assessing age of majority in Croatia. Cameriere's third molar maturity index (I3M) value of 0.08, measured by the open apices of the teeth, was verified in sample of 1336 panoramic images aged between 14 and 23 years. Chronological age gradually decreased as I3M increased in both genders. Males showed statistically significant advanced maturation when I3M was between 0.0 and 0.3 value. The results indicate that the sensitivity of the test for 0.08 value was 84.3% (95%CI 80.6%, 87.5%) for females and 91.2% (95%CI 88.7%, 93.1) for males. Specificity was 95.4% (95%CI 92.5%, 97.5%) and 91.9% (95%CI 88.8%, 94.3%). The proportions of accurately classified males were 88.8% and that of females 91.5%. The estimated post-test probabilities, of individuals, in other word the probability that a Croatian individual with an I3M<0.08 is 18 years or older is 94.5% for females, and 96.5% for males. With high accuracy, the third molar maturity index should be used as a determinant of the age of majority in Croatia. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A systematic review and meta-analysis of randomized controlled trials on the effects of magnesium supplementation on insulin sensitivity and glucose control.

PubMed

Simental-Mendía, Luis E; Sahebkar, Amirhossein; Rodríguez-Morán, Martha; Guerrero-Romero, Fernando

2016-09-01

A systematic review and meta-analysis was conducted to evaluate the effect of oral magnesium supplementation on insulin sensitivity and glucose control in both diabetic and non-diabetic individuals. PubMed-Medline, SCOPUS, Web of Science and Google Scholar databases were searched (from inception to November 25, 2015) to identify RCTs evaluating the effect of magnesium on insulin sensitivity and glucose control. A random-effects model and generic inverse variance method were used to compensate for the heterogeneity of studies. Publication bias, sensitivity analysis, and meta-regression assessments were conducted using standard methods. The impact of magnesium supplementation on plasma concentrations of glucose, glycated hemoglobin (HbA1c), insulin, and HOMA-IR index was assessed in 22, 14, 12 and 10 treatment arms, respectively. A significant effect of magnesium supplementation was observed on HOMA-IR index (WMD: -0.67, 95% CI: -1.20, -0.14, p=0.013) but not on plasma glucose (WMD: -0.20mmol/L, 95% CI: -0.45, 0.05, p=0.119), HbA1c (WMD: 0.018mmol/L, 95% CI: -0.10, 0.13, p=0.756), and insulin (WMD: -2.22mmol/L, 95% CI: -9.62, 5.17, p=0.556). A subgroup analysis comparing magnesium supplementation durations of <4 months versus ≥4 months, exhibited a significant difference for fasting glucose concentrations (p<0.001) and HOMA-IR (p=0.001) in favor of the latter subgroup. Magnesium supplementation for ≥4 months significantly improves the HOMA-IR index and fasting glucose, in both diabetic and non-diabetic subjects. The present findings suggest that magnesium may be a beneficial supplement in glucose metabolic disorders. Copyright © 2016 Elsevier Ltd. All rights reserved.

Women empowerment and use of contraception

PubMed Central

Patrikar, S.R.; Basannar, D.R.; Seema Sharma, Maj

2014-01-01

Background Use of contraception is influenced by many processes most by the women's empowerment. Women's decision making power and their autonomy within the household is the most important factor affecting contraceptive use. This paper aims to analyze the relationship between these two indicators of women's empowerment and the use of contraception. Methods This cross sectional study was conducted by personally interviewing 385 currently married women selected by systematic sampling on a pretested and validated questionnaire. Two indices, women's decision-making power index and women's autonomy index, were constructed and association with contraception use analyzed. Results & Conclusion The study gives the evidence that decision making power is low in the respondents with 48.2% (95% CI 43.34, 53.31) of them having low level of power, while 27.6% (95% CI 23.24, 32.16) have medium level and 3.6% (95% CI 2.08, 5.88) having high level of power. 22.4% (95% CI 18.39, 26.70) of women do not have any autonomy as against 43.9% (95% CI 38.99, 48.89) with low level, 25% (95% CI 20.80, 29.44) with medium autonomy and 8.7% (95% CI 6.29, 11.98) scoring above 7 (high level of autonomy). In the study population it was found that 273 (70.7%, 95% CI 66.2, 75.28) of the respondents were using contraceptives. Women's autonomy, years of marriage and number of children were significant variables. PMID:25378779

Large daily stock variation is associated with cardiovascular mortality in two cities of Guangdong, China.

PubMed

Lin, Hualiang; Zhang, Yonghui; Xu, Yanjun; Liu, Tao; Xiao, Jianpeng; Luo, Yuan; Xu, Xiaojun; He, Yanhui; Ma, Wenjun

2013-01-01

The current study aimed to examine the effects of daily change of the Shenzhen Stock Exchange Index on cardiovascular mortality in Guangzhou and Taishan, China. Daily mortality and stock performance data during 2006-2010 were collected to construct the time series for the two cities. A distributed lag non-linear model was utilized to examine the effect of daily stock index changes on cardiovascular mortality after controlling for potential confounding factors. We observed a delayed non-linear effect of the stock index change on cardiovascular mortality: both rising and declining of the stock index were associated with increased cardiovascular deaths. In Guangzhou, the 15-25 lag days cumulative relative risk of an 800 index drop was 2.08 (95% CI: 1.38-3.14), and 2.38 (95% CI: 1.31-4.31) for an 800 stock index increase on the cardiovascular mortality, respectively. In Taishan, the cumulative relative risk over 15-25 days lag was 1.65 (95% CI: 1.13-2.42) for an 800 index drop and 2.08 (95% CI: 1.26-3.42) for an 800 index rising, respectively. Large ups and downs in daily stock index might be important predictor of cardiovascular mortality.

Socioeconomic status in childhood and obesity in adults: a population-based study.

PubMed

Wagner, Katia Jakovljevic Pudla; Bastos, João Luiz Dornelles; Navarro, Albert; Gonzalez-Chica, David Alejandro; Boing, Antonio Fernando

2018-01-01

OBJECTIVE To test whether there is an association between socioeconomic status in childhood and measures of body mass index, waist circumference and the presence of overall and abdominal obesity in adult life. METHODS A cross-sectional analysis of a population-based cohort study, including a sample of adults (22-63 years old) living in Florianópolis, Southern Brazil. The socioeconomic status in childhood was analyzed through the education level of the participant's parents. Height, weight and waist circumference were measured by previously trained interviewers. Linear and logistic regressions with adjustment for confounding factors and stratification of data according to gender were used. RESULTS Of the 1,222 adults evaluated, 20.4% (95%CI 18.1-22.8) presented overall obesity and 24.8% (95%CI 22.4-27.4), abdominal obesity. The body mass index and waist circumference averages among women were, respectively, 1.2 kg/m2 (95%CI -2.3- -0.04) and 2.8 cm (95%CI -5.3- -0.2) lower among those with higher socioeconomic status in childhood. Among men, waist circumference was 3.9 cm (95%CI 1.0-6.8) higher in individuals with higher socioeconomic status in childhood. Regarding obesity, women of higher socioeconomic status in childhood had lower odds of abdominal obesity (OR = 0.56, 95%CI 0.34-0.90), and no such association was observed among men. CONCLUSIONS The socioeconomic status in childhood influences body mass index, waist circumference and obesity in adults, with a difference in the direction of association according to gender. The higher socioeconomic status among men and the lower socioeconomic status among women were associated with higher adiposity indicators.

Accuracy of the caval index and the expiratory diameter of the inferior vena cava for the diagnosis of dehydration in elderly.

PubMed

Orso, Daniele; Guglielmo, Nicola; Federici, Nicola; Cugini, Francesco; Ban, Alessio; Mearelli, Filippo; Copetti, Roberto

2016-09-01

Dehydration is a very common condition among elderly people. Till date there is not yet a fast and easy method to determine a state of dehydration in the emergency department. In the literature there are some exploratory studies that have tried to establish the relationship between some widely used laboratory values and ultrasound for the purpose of diagnosing dehydration. The primary aim of this study is to verify the correlation between two measures derived by ultrasound (caval index and expiratory diameter of inferior vena cava) and blood urea nitrogen (BUN)/creatinine ratio. The relationship between vital signs and BUN/creatinine ratio has also been explored. An observational cohort study of patients aged 70 years or more, all examined in our ED. The population was divided on the basis of the BUN/creatinine ratio greater or lower than 20. A total of 270 patients have been considered. No vital sign correlated with an increased BUN/creatinine ratio. Both the diameter of the inferior vena cava in expiratory and the percentage of its collapsibility in inspiratory (caval index) have revealed a correlation with a BUN/creatinine ratio greater than 20. Areas under the curve are, respectively, 76 % (95 % CI 70-82) and 80 % (95 % CI 75-86). Sensitivity, specificity, positive predictive value and negative predictive value are, respectively, 85.5 % (95 % CI 79.4-90.4); 100 % (95 % CI 97-100); 100 % (95 % CI 97.5-100); 82.9 % (95 % CI 75.9-88.7) and 99.3 % (95 % CI 96.3-99.9); 100 % (95 % CI 97-100); 100 % (95 % CI 97.5-100); 99.2 % (95 % CI 95.6-99.9). Ultrasound has proved to be useful to diagnose dehydration in elderly people while in the emergency department. Vice versa the vital signs have shown to be unrelated to the hydration state of elderly patients.

[Relationship between dysphagia and malnutritition in patients over 65 years of age].

PubMed

Galán Sánchez-Heredero, María José; Santander Vaquero, Cecilio; Cortázar Sáez, Milagros; de la Morena López, Felipe; Susi García, Rosario; Martínez Rincón, María Del Carmen

2014-01-01

The main objective of this study was to understand the relationship between oropharyngeal dysphagia, nutritional risk factors and functional impairment in the elderly (>65y) admitted to a medical-surgical hospital unit. Secondary objectives were to determine the prevalence of oropharyngeal dysphagia, the nutritional status and their functional capacity. A cross-sectional observational study was performed. It included patients over 65 years of age admitted to the Gastroenterology-Urology Department in La Princesa University Hospital (Madrid, Spain) during the months of February and March. The following variables were recorded: age, sex, body mass index, family support, diagnosis, comorbidity, oropharyngeal dysphagia (EAT-10 and volume-viscosity evaluation method), malnutrition (Mininutritional Assessment) and functional capacity (Barthel index). A total of 167 patients were recruited, with 30.8% and 15.4% prevalence of dysphagia and malnutrition, respectively. Prevalence of malnutrition increased to 75% in patients with oropharyngeal dysphagia. The logistic regression analysis showed how conditions as low score on the Barthel index (OR 0.97 [95% CI, 0.95-0.99]), comorbidity (OR 7.98 [CI 95%, 3.09-20.61]) and dysphagia (OR 4.07 [CI 95%, 1.57-10.52]) were associated with a greater likelihood of suffering malnutrition. Oropharyngeal dysphagia is one of the most underdiagnosed and underestimated conditions among elderly patients and one that has a greater effect on their nutritional status. Accordingly, we suggest using established diagnostic methods with a multidisciplinary team collaboration for its early detection. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Computer-assisted shape descriptors for skull morphology in craniosynostosis.

PubMed

Shim, Kyu Won; Lee, Min Jin; Lee, Myung Chul; Park, Eun Kyung; Kim, Dong Seok; Hong, Helen; Kim, Yong Oock

2016-03-01

Our aim was to develop a novel method for characterizing common skull deformities with high sensitivity and specificity, based on two-dimensional (2D) shape descriptors in computed tomography (CT) images. Between 2003 and 2014, 44 normal subjects and 39 infants with craniosynostosis (sagittal, 29; bicoronal, 10) enrolled for analysis. Mean age overall was 16 months (range, 1-120 months), with a male:female ratio of 56:29. Two reference planes, sagittal (S-plane: through top of lateral ventricle) and coronal (C-plane: at maximum dimension of fourth ventricle), were utilized to formulate three 2D shape descriptors (cranial index [CI], cranial radius index [CR], and cranial extreme spot index [CES]), which were then applied to S- and C-plane target images of both groups. In infants with sagittal craniosynostosis, CI in S-plane (S-CI) usually was <1.0 (mean, 0.78; range, 0.67-0.95), with CR consistently at 3 and a characteristic CES pattern of two discrete hot spots oriented diagonally. In the bicoronal craniosynostosis subset, CI was >1.0 (mean 1.11; range, 1.04-1.25), with CR at -3 and a CES pattern of four discrete diagonally oriented hot spots. Scatter plots underscored the highly intuitive joint performance of CI and CES in distinguishing normal and deformed states. Altogether, these novel 2D shape descriptors enabled effective discrimination of sagittal and bicoronal skull deformities. Newly developed 2D shape descriptors for cranial CT imaging enabled recognition of common skull deformities with statistical significance, perhaps providing impetus for automated CT-based diagnosis of craniosynostosis.

Association of body mass index with amnestic and non-amnestic mild cognitive impairment risk in elderly.

PubMed

Wang, Feng; Zhao, Minghui; Han, Zhaoli; Li, Dai; Zhang, Shishuang; Zhang, Yongqiang; Kong, Xiaodong; Sun, Ning; Zhang, Qiang; Lei, Ping

2017-09-15

Previous studies focused on the relationship between body mass index and cognitive disorder and obtained many conflicting results. This study explored the potential effects of body mass index on the risk of mild cognitive impairment (amnestic and non-amnestic) in the elderly. The study enrolled 240 amnestic mild cognitive impairment patients, 240 non-amnestic mild cognitive impairment patients and 480 normal cognitive function controls. Data on admission and retrospective data at baseline (6 years ago) were collected from their medical records. Cognitive function was evaluated using Mini-Mental State Examination and Montreal Cognitive Assessment. Being underweight, overweight or obese at baseline was associated with an increased risk of amnestic mild cognitive impairment (OR: 2.30, 95%CI: 1.50 ~ 3.52; OR: 1.74, 95%CI: 1.36 ~ 2.20; OR: 1.71, 95%CI: 1.32 ~ 2.22, respectively). Being overweight or obese at baseline was also associated with an increased risk of non-amnestic mild cognitive impairment (OR: 1.51, 95%CI: 1.20 ~ 1.92; OR: 1.52, 95%CI: 1.21 ~ 1.97, respectively). In subjects with normal weights at baseline, an increased or decreased body mass index at follow-up was associated with an elevated risk of amnestic mild cognitive impairment (OR: 1.80, 95%CI: 1.10 ~ 3.05; OR: 3.96, 95%CI: 2.88 ~ 5.49, respectively), but only an increased body mass index was associated with an elevated risk of non-amnestic mild cognitive impairment (OR: 1.71, 95%CI: 1.16 ~ 2.59). Unhealthy body mass index levels at baseline and follow-up might impact the risk of both types of mild cognitive impairment (amnestic and non-amnestic).

Pregnancy Intention and Contraceptive Use among Women by Class of Obesity: Results from the 2006-2010 and 2011-2013 National Survey of Family Growth.

PubMed

Nguyen, Brian T; Elia, Jennifer L; Ha, Cathrine Y; Kaneshiro, Bliss E

Conflicting research findings on the association of obesity and pregnancy intention may be due to their collective definition of obesity at a body mass index of 30 kg/m 2 or greater. However, obese women with a BMI of 40 kg/m 2 or greater may be both behaviorally and clinically different from obese women with a lower BMI. This study reexamines this relationship, stratifying by class of obesity; the study also explores variations in contraceptive use by class of obesity given their potential contribution to the incidence of unintended or unwanted pregnancy. This study combined data from the 2006 through 2010 and 2011 through 2013 US National Survey of Family Growth. Pregnancy intention (intended, mistimed, unwanted) and current contraceptive use (no method, barrier, pill/patch/ring/injection, long-acting reversible contraceptive, sterilization) were compared across body mass index categories: normal (18.5-24.9 kg/m kg/m 2 ), overweight (25.0-29.9), obese class 1 (30.0-34.9 kg/m 2 ), class 2 (35.0-39.9 kg/m 2 ), and class 3 (≥40 kg/m 2 , severe obesity). Weighted multinomial logistic regressions were refined to determine independent associations of body mass index class and pregnancy intention, as well as contraceptive method, controlling for demographic, socioeconomic, and reproductive factors. Body mass index data were available for 9,848 nonpregnant, sexually active women who reported not wanting to become pregnant. Women with class 3 obesity had significantly greater odds of mistimed (adjusted odd ratio [aOR], 1.67; 95% confidence interval [CI], 1.02-2.75) or unwanted (aOR, 1.96; 95% CI, 1.15-3.32) pregnancy compared with normal weight women. Women with class 2 or 3 obesity were more likely to not be using contraception (aOR, 1.53-1.62; 95% CI, 1.04-2.29). Although women with class 2 obesity were more likely to be using long-acting reversible contraceptive methods and sterilization over short-acting hormonal methods (aOR, 1.67; 95% CI, 1.08-2.57; aOR, 2.05; 95% CI,1.44-2.91), this association was not observed among women with class 3 obesity. Women with class 3 obesity are at greater risk of unintended pregnancy and are less likely to be using contraception than normal weight women. Whether these findings are related to patient and/or provider barriers that are not as visible among women with class 1 and class 2 obesity warrants further investigation. Copyright © 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Suicide Attempt as a Risk Factor for Completed Suicide: Even More Lethal Than We Knew.

PubMed

Bostwick, J Michael; Pabbati, Chaitanya; Geske, Jennifer R; McKean, Alastair J

2016-11-01

While suicide attempt history is considered to robustly predict completed suicide, previous studies have limited generalizability because of using convenience samples of specific methods/treatment settings, disregarding previous attempts, or overlooking first-attempt deaths. Eliminating these biases should more accurately estimate suicide prevalence in attempters. This observational retrospective-prospective cohort study using the Rochester Epidemiology Project identified 1,490 (males, N=555; females, N=935) Olmsted County residents making index suicide attempts (first lifetime attempts reaching medical attention) between January 1, 1986, and December 31, 2007. The National Death Index identified suicides between enrollment and December 31, 2010 (follow-up 3-25 years). Medical records were queried for sex, age, method, and follow-up care for index attempt survivors. Coroner records yielded data on index attempt deaths. During the study period, 81/1,490 enrollees (5.4%) died by suicide. Of the 81, 48 (59.3%) perished on index attempt; 27 of the surviving 33 index attempt survivors (81.8%) killed themselves within a year. Males were disproportionately represented: 62/81 (11.2% of men, 76.5% of suicides) compared with 19/81 (2.0% of women, 23.5% of suicides). Of dead index attempters, 72.9% used guns, yielding an odds ratio for gunshot death, compared with all other methods, of 140 (95% CI=60-325). When adjusted for covariates, survivors given follow-up psychiatric appointments had significantly lower likelihood of subsequent suicide (odds ratio=0.212, 95% CI=0.089-0.507). At 5.4%, completed suicide prevalence in this community cohort of suicide attempters was almost 59% higher than previously reported. An innovative aspect of this study explains the discrepancy: by including index attempt deaths-approximately 60% of total suicides-suicide prevalence more than doubled. We contend that counting both index and subsequent attempt deaths more accurately reflects prevalence. Our findings support suicide attempt as an even more lethal risk factor for completed suicide than previously thought. Research should focus on identifying risk factors for populations vulnerable to making first attempts and target risk reduction in those groups.

[Factors associated with the quality of life in patients with chronic obstructive pulmonary disease].

PubMed

Villar Balboa, Iván; Carrillo Muñoz, Ricard; Regí Bosque, Meritxell; Marzo Castillejo, Mercè; Arcusa Villacampa, Núria; Segundo Yagüe, Marta

2014-04-01

To describe the relationship between individual or combined prognostic factors in the multidimensional classifications (BODE and ADO), and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD). Cross-sectional descriptive study. Primary care. Systematic random sample of 102 patients diagnosed with COPD, excluding those patients with acute exacerbation, dementia, terminal illness or those who receive home care. Demographics variables, smoking habits, body mass index and number of exacerbations. Comorbidity. Degree of dyspnea. Respiratory function tests. Exercise capacity. The BODE index and the ADO index. The EuroQol-5D questionnaire (EQ-5D), and visual analogue scale (VAS). EQ-5D: mobility: 43.9%; personal care: 13.3%; daily-life activities: 29.6%; pain/discomfort: 55.1%; anxiety/depression: 37.8%, and 34.7% VAS ≤ 60%. Exacerbations: Mobility, OR: 1.85 (95%CI: 1.08-3.20); personal care, OR: 2.12 (95%CI: 1.3-4.76); daily-life activities, OR: 2.35 (95%CI: 1.17-4.71); VAS, regression coefficient: -3.50 (95%CI: 6.31- -0.70). Dyspnea: mobility, OR: 4.47 (95%CI: 1.39-14.42); daily-life activities, OR: 7.71 (95%CI: 2.03-12.34); VAS, regression coefficient: -7.15 (95%CI: 11.71- -2.59). BODE: mobility, OR: 1.53 (95%CI: 1.15-2.02); personal care, OR: 2.08 (95%CI: 1.40-3.11); daily-life activities, OR: 1.97 (95%CI: 1.38-2.80); VAS, regression coefficient: -3.96 (95%CI: -5.51- -2.42). ADO: mobility, OR: 2.42 (95%CI: 1.39-4.20); personal care, OR: 3.21 (95%CI: 1.67-6.18); daily-life activities, OR: 3.17 (95%CI: 1.69-5.93); VAS, regression coefficient: -3.53 (95%CI: -5.57- -1.49). The BODE index and the ADO index showed a significant association with HRQOL. Exacerbations and dyspnea were the best individual factors related to HRQoL. Copyright © 2013 Elsevier España, S.L. All rights reserved.

The associations of cardiorespiratory fitness, adiposity and sports participation with arterial stiffness in youth with chronic diseases or physical disabilities

PubMed Central

Haapala, Eero A; Lankhorst, Kristel; de Groot, Janke; Zwinkels, Maremka; Verschuren, Olaf; Wittink, Harriet; Backx, Frank JG; Visser-Meily, Anne

2017-01-01

Background The evidence on the associations of cardiorespiratory fitness, body adiposity and sports participation with arterial stiffness in children and adolescents with chronic diseases or physical disabilities is limited. Methods Altogether 140 children and adolescents with chronic diseases or physical disabilities participated in this cross-sectional study. Cardiorespiratory fitness was assessed using maximal exercise test with respiratory gas analyses either using shuttle run, shuttle ride, or cycle ergometer test. Cardiorespiratory fitness was defined as peak oxygen uptake by body weight or fat-free mass. Body adiposity was assessed using waist circumference, body mass index standard deviation score and body fat percentage. Sports participation was assessed by a questionnaire. Aortic pulse wave velocity and augmentation index were assessed by a non-invasive oscillometric tonometry device. Results Peak oxygen uptake/body weight (standardised regression coefficient β −0.222, 95% confidence interval (CI) −0.386 to −0.059, P = 0.002) and peak oxygen uptake/fat-free mass (β −0.173, 95% CI −0.329 to −0.017, P = 0.030) were inversely and waist circumference directly (β 0.245, 95% CI 0.093 to 0.414, P = 0.002) associated with aortic pulse wave velocity. However, the associations of the measures of cardiorespiratory fitness with aortic pulse wave velocity were attenuated after further adjustment for waist circumference. A higher waist circumference (β −0.215, 95% CI −0.381 to −0.049, P = 0.012) and a higher body mass index standard deviation score (β 0.218, 95% CI −0.382 to −0.054, P = 0.010) were related to lower augmentation index. Conclusions Poor cardiorespiratory fitness and higher waist circumference were associated with increased arterial stiffness in children and adolescents with chronic diseases and physical disabilities. The association between cardiorespiratory fitness and arterial stiffness was partly explained by waist circumference. PMID:28374647

The associations of cardiorespiratory fitness, adiposity and sports participation with arterial stiffness in youth with chronic diseases or physical disabilities.

PubMed

Haapala, Eero A; Lankhorst, Kristel; de Groot, Janke; Zwinkels, Maremka; Verschuren, Olaf; Wittink, Harriet; Backx, Frank Jg; Visser-Meily, Anne; Takken, Tim

2017-07-01

Background The evidence on the associations of cardiorespiratory fitness, body adiposity and sports participation with arterial stiffness in children and adolescents with chronic diseases or physical disabilities is limited. Methods Altogether 140 children and adolescents with chronic diseases or physical disabilities participated in this cross-sectional study. Cardiorespiratory fitness was assessed using maximal exercise test with respiratory gas analyses either using shuttle run, shuttle ride, or cycle ergometer test. Cardiorespiratory fitness was defined as peak oxygen uptake by body weight or fat-free mass. Body adiposity was assessed using waist circumference, body mass index standard deviation score and body fat percentage. Sports participation was assessed by a questionnaire. Aortic pulse wave velocity and augmentation index were assessed by a non-invasive oscillometric tonometry device. Results Peak oxygen uptake/body weight (standardised regression coefficient β -0.222, 95% confidence interval (CI) -0.386 to -0.059, P = 0.002) and peak oxygen uptake/fat-free mass (β -0.173, 95% CI -0.329 to -0.017, P = 0.030) were inversely and waist circumference directly (β 0.245, 95% CI 0.093 to 0.414, P = 0.002) associated with aortic pulse wave velocity. However, the associations of the measures of cardiorespiratory fitness with aortic pulse wave velocity were attenuated after further adjustment for waist circumference. A higher waist circumference (β -0.215, 95% CI -0.381 to -0.049, P = 0.012) and a higher body mass index standard deviation score (β 0.218, 95% CI -0.382 to -0.054, P = 0.010) were related to lower augmentation index. Conclusions Poor cardiorespiratory fitness and higher waist circumference were associated with increased arterial stiffness in children and adolescents with chronic diseases and physical disabilities. The association between cardiorespiratory fitness and arterial stiffness was partly explained by waist circumference.

Predictors of Outcome in Modern Surgery for Lung Abscess.

PubMed

Schweigert, Michael; Solymosi, Norbert; Dubecz, Attila; John, Joseph; West, Doug; Boenisch, Paul Leonhard; Karmy-Jones, Riyad; Ospina, Carlos F Giraldo; Almeida, Ana Beatriz; Witzigmann, Helmut; Stein, Hubert J

2017-10-01

Background  Surgery for lung abscess is a challenging task. Timing and indications for surgery are not well established. Identification of predictors of outcome could help to clarify the role of surgery. Methods  Patients who underwent major thoracic surgery for infectious lung abscess were identified at six centers for general thoracic surgery in Germany, Spain, the United Kingdom, and the United States. Study period was 2000 to 2016. Results  There were 91 patients. Pulmonary sepsis (48), pleural empyema (43), persistent air leakage (25), acute renal failure (12), and respiratory failure with mechanical ventilation (25) were already preoperatively present. The mean Charlson index of comorbidity was 3.0 (median: 2.0; interquartile range: 3). Procedures were segmentectomy (18), lobectomy (58), and pneumonectomy (15). The 30-day mortality following surgery was 13/91.Preoperative sepsis (odds ratio [OR]: 13.69; 95% confidence interval [CI]: 1.86-610.53; p  < 0.01), preoperative persistent air leak (OR: 13.46, 95% CI: 3.00-85.37, p  < 0.01), respiratory failure (OR: 5.60; 95% CI: 1.41-24.84; p  < 0.01), acute renal failure (OR: 6.15 ; 95% CI: 1.24-29.56 ; p  = 0.01), and Charlson index of comorbidity ≥ 3 (OR: 7.19 ; 95% CI: 1.43-71.21 ; p  < 0.01) are associated with higher mortality, whereas age > 70 years ( p  = 0.46) and the extent of pulmonary resection (segmentectomy, lobectomy, pneumonectomy) have no significant influence on mortality. Patients with fatal outcome have significantly higher Charlson index of comorbidity ( p  < 0.01). Conclusions  Delayed referral for surgery is common. Significant predictors for fatal outcome are pulmonary sepsis, septic complications (air leak, pleural empyema), septic organ failure (respiratory, acute renal failure), and preexisting comorbidity (Charlson index of comorbidity ≥ 3). The extent of surgical resection shows no significant influence. Georg Thieme Verlag KG Stuttgart · New York.

Are the Poor Dying Younger in Malaysia? An Examination of the Socioeconomic Gradient in Mortality

PubMed Central

2016-01-01

Introduction Socioeconomic inequalities in health represent unfairness in the health distribution of a population. Efforts to produce information on mortality distributions in many low and middle income countries (LMICs) are mostly hampered by lack of data disaggregated by socioeconomic groups. In this paper we describe how mortality statistics obtained from multiple data sources were combined to provide an evaluation of the socioeconomic distribution of mortality in Malaysia, a LMIC located in the Asia Pacific region. Methods This study has an ecological design. As a measure of socioeconomic status, we used principal component analysis to construct a socioeconomic index using census data. Districts were ranked according to the standardised median index of households and assigned to each individual in the 5-year mortality data. The mortality indicators of interest were potential years of life lost (PYLL), standardised mortality ratio (SMR), infant mortality rate (IMR) and under-5 mortality rate (U5MR). Both socioeconomic status and mortality outcomes were used compute the concentration index which provided the summary measure of the magnitude of inequality. Results Socially disadvantaged districts were found to have worse mortality outcomes compared to more advantaged districts. The values of the concentration index for the overall population of the Peninsula are C = -0.1334 (95% CI: -0.1605 to -0.1063) for the PYLL, C = -0.0685 (95% CI: -0.0928 to -0.0441) for the SMR, C = -0.0997 (95% CI: -0.1343 to -0.0652) for the IMR and C = -0.1207 (95% CI: -0.1523 to -0.0891) for the U5MR. Mortality outcomes within ethnic groups were also found to be less favourable among the poor. Conclusion The findings of this study suggest that socioeconomic inequalities disfavouring the poor exist in Malaysia. PMID:27362581

Quantitative analysis of ventricular ectopic beats in short-term RR interval recordings to predict imminent ventricular tachyarrhythmia.

PubMed

Martínez-Alanis, Marisol; Ruiz-Velasco, Silvia; Lerma, Claudia

2016-12-15

Most approaches to predict ventricular tachyarrhythmias which are based on RR intervals consider only sinus beats, excluding premature ventricular complexes (PVCs). The method known as heartprint, which analyses PVCs and their characteristics, has prognostic value for fatal arrhythmias on long recordings of RR intervals (>70,000 beats). To evaluate characteristics of PVCs from short term recordings (around 1000 beats) and their prognostic value for imminent sustained tachyarrhythmia. We analyzed 132 pairs of short term RR interval recordings (one before tachyarrhythmia and one control) obtained from 78 patients. Patients were classified into two groups based on the history of accelerated heart rate (HR) (HR>90bpm) before a tachyarrhythmia episode. Heartprint indexes, such as mean coupling interval (meanCI) and the number of occurrences of the most prevalent form of PVCs (SNIB) were calculated. The predictive value of all the indexes and of the combination of different indexes was calculated. MeanCI shorter than 482ms and the occurrence of more repetitive arrhythmias (sNIB≥2.5), had a significant prognostic value for patients with accelerated heart rate: adjusted odds ratio of 2.63 (1.33-5.17) for meanCI and 2.28 (1.20-4.33) for sNIB. Combining these indexes increases the adjusted odds ratio: 10.94 (3.89-30.80). High prevalence of repeating forms of PVCs and shorter CI are potentially useful risk markers of imminent ventricular tachyarrhythmia. Knowing if a patient has history of VT/VF preceded by accelerated HR, improves the prognostic value of these risk markers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Major adverse events and atrial tachycardia in Ebstein’s anomaly predicted by cardiovascular magnetic resonance

PubMed Central

Rydman, Riikka; Shiina, Yumi; Diller, Gerhard-Paul; Niwa, Koichiro; Li, Wei; Uemura, Hideki; Uebing, Anselm; Barbero, Umberto; Bouzas, Beatriz; Ernst, Sabine; Wong, Tom; Pennell, Dudley J; Gatzoulis, Michael A; Babu-Narayan, Sonya V

2018-01-01

Objectives Patients with Ebstein’s anomaly of the tricuspid valve (EA) are at risk of tachyarrhythmia, congestive heart failure and sudden cardiac death. We sought to determine the value of cardiovascular magnetic resonance (CMR) for predicting these outcomes. Methods Seventy-nine consecutive adult patients (aged 37±15 years) with unrepaired EA underwent CMR and were followed prospectively for a median 3.4 (range 0.4–10.9) years for clinical outcomes, namely major adverse cardiovascular events (MACEs: sustained ventricular tachycardia/heart failure hospital admission/cardiac transplantation/death) and first-onset atrial tachyarrhythmia (AT). Results CMR-derived variables associated with MACE (n=6) were right ventricular (RV) or left ventricular (LV) ejection fraction (EF) (HR 2.06, 95% CI 1.168 to 3.623, p=0.012 and HR 2.35, 95% CI 1.348 to 4.082, p=0.003, respectively), LV stroke volume index (HR 2.82, 95% CI 1.212 to 7.092, p=0.028) and cardiac index (HR 1.71, 95% CI 1.002 to 1.366, p=0.037); all remained significant when tested solely for mortality. History of AT (HR 11.16, 95% CI 1.30 to 95.81, p=0.028) and New York Heart Association class >2 (HR 7.66, 95% CI 1.54 to 38.20, p=0.013) were also associated with MACE; AT preceded all but one MACE, suggesting its potential role as an early marker of adverse outcome (p=0.011). CMR variables associated with first-onset AT (n=17; 21.5%) included RVEF (HR 1.55, 95% CI 1.103 to 2.160, p=0.011), total R/L volume index (HR 1.18, 95% CI 1.06 to 1.32, p=0.002), RV/LV end diastolic volume ratio (HR 1.55, 95% CI 1.14 to 2.10, p=0.005) and apical septal leaflet displacement/total LV septal length (HR 1.03, 95% CI 1.00 to 1.07, p=0.041); the latter two combined enhanced risk prediction (HR 6.12, 95% CI 1.67 to 22.56, p=0.007). Conclusion CMR-derived indices carry prognostic information regarding MACE and first-onset AT among adults with unrepaired EA. CMR may be included in the periodic surveillance of these patients. PMID:28684436

Trends and Inequalities in Use of Maternal Health Care Services in Nepal: Strategy in the Search for Improvements

PubMed Central

Aryal, Krishna Kumar; Lal, Bibek Kumar; Khanal, Mukti Nath; Thomas, Deborah

2017-01-01

Background Nepal has made significant progress against the Millennium Development Goals for maternal and child health over the past two decades. However, disparities in use of maternal health services persist along geographic, economic, and sociocultural lines. Methods Trends and inequalities in the use of maternal health services in Nepal between 1994 and 2011 were examined using four Nepal Demographic and Health Surveys (NDHS), nationally representative cross-sectional surveys conducted by interviewing women who gave birth 3–5 years prior to the survey. Sociodemographic disparities in maternal health service utilization were measured. Rate difference, rate ratios, and concentration index were calculated to measure income inequalities. Findings The percentage of mothers that received four antenatal care (ANC) consultations increased from 9% to 54%, the institutional delivery rate increased from 6% to 47%, and the cesarean section (C-section) rate increased from 1% in 1994 to 6% in 2011. The ratio of the richest and the poorest quintile mothers for use of four ANC, institutional delivery, and C-section delivery were 5.08 (95% CI: 3.82–6.76), 9.00 (95% CI: 6.55–12.37), and 9.37 (95% CI: 4.22–20.83), respectively. However, inequality is reducing over time; for the use of four ANC services, the concentration index fell from 0.60 (95% CI: 0.56–0.64) in 1994–1996 to 0.31 (95% CI: 0.29–0.33) in 2009–2011. For institutional delivery, the concentration index fell from 0.65 (95% CI: 0.62–0.70) to 0.40 (95% CI: 0.38–0.40) between 1994–1996 and 2009–2011. For C-section deliveries, an increase in concentration index was observed, 0.64 (95% CI: 0.51–0.77); 0.76 (95% CI: 0.64–0.88); 0.77 (95% CI: 0.71–0.84); and 0.66 (95% CI: 0.60–0.72) in the periods 1994–1996, 1999–2001, 2004–2006, and 2009–2011, respectively. All sociodemographic variables were significant predictors of use of maternal health services, out of which maternal education was the most powerful. Conclusion To increase equitable use of maternal health services in Nepal there is a need to strengthen the health system to increase access to and utilization of services among poorer women, those with less education, and those living in remote areas. Beyond the health sector stronger efforts are needed to tackle the root causes of health inequality, reduce poverty, increase female education, eradicate caste/ethnicity based social discrimination, and invest in the development of remote areas. PMID:28808658

[Risk factors on the recurrence of ischemic stroke and the establishment of a Cox's regression model].

PubMed

An, Ya-chen; Chen, Yun-xia; Wang, Yu-xun; Zhao, Xiao-jing; Wang, Yan; Zhang, Jiang; Li, Chun-ling; Peng, Yan-bo; Gao, Su-ling; Chang, Li-sha; Zhang, Li; Xue, Xin-hong; Chen, Rui-ying; Wang, Da-li

2011-08-01

To investigate the risk factors and establish the Cox's regression model on the recurrence of ischemic stroke. We retrospectively reviewed consecutive patients with ischemic stroke admitted to the Neurology Department of the Hebei United University Affiliated Hospital between January 1, 2008 and December 31, 2009. Cases had been followed since the onset of ischemic stroke. The follow-up program was finished in June 30, 2010. Kaplan-Meier methods were used to describe the recurrence rate. Monovariant and multivariate Cox's proportional hazard regression model were used to analyze the risk factors associated to the episodes of recurrence. And then, a recurrence model was set up. During the period of follow-up program, 79 cases were relapsed, with the recurrence rates as 12.75% in one year and 18.87% in two years. Monovariant and multivariate Cox's proportional hazard regression model showed that the independent risk factors that were associated with the recurrence appeared to be age (X₁) (RR = 1.025, 95%CI: 1.003 - 1.048), history of hypertension (X₂) (RR = 1.976, 95%CI: 1.014 - 3.851), history of family strokes (X₃) (RR = 2.647, 95%CI: 1.175 - 5.961), total cholesterol amount (X₄) (RR = 1.485, 95%CI: 1.214 - 1.817), ESRS total scores (X₅) (RR = 1.327, 95%CI: 1.057 - 1.666) and progression of the disease (X₆) (RR = 1.889, 95%CI: 1.123 - 3.178). Personal prognosis index (PI) of the recurrence model was as follows: PI = 0.025X₁ + 0.681X₂ + 0.973X₃ + 0.395X₄ + 0.283X₅ + 0.636X₆. The smaller the personal prognosis index was, the lower the recurrence risk appeared, while the bigger the personal prognosis index was, the higher the recurrence risk appeared. Age, history of hypertension, total cholesterol amount, total scores of ESRS, together with the disease progression were the independent risk factors associated with the recurrence episodes of ischemic stroke. Both recurrence model and the personal prognosis index equation were successful constructed.

Association of Changes in Diet Quality with Total and Cause-Specific Mortality

PubMed Central

Sotos-Prieto, Mercedes; Bhupathiraju, Shilpa N.; Mattei, Josiemer; Fung, Teresa T.; Li, Yanping; Pan, An; Willett, Walter C.; Rimm, Eric B.; Hu, Frank B.

2017-01-01

BACKGROUND Few studies have evaluated the relationship between changes in diet quality over time and the risk of death. METHODS We used Cox proportional-hazards models to calculate adjusted hazard ratios for total and cause-specific mortality among 47,994 women in the Nurses’ Health Study and 25,745 men in the Health Professionals Follow-up Study from 1998 through 2010. Changes in diet quality over the preceding 12 years (1986–1998) were assessed with the use of the Alternate Healthy Eating Index–2010 score, the Alternate Mediterranean Diet score, and the Dietary Approaches to Stop Hypertension (DASH) diet score. RESULTS The pooled hazard ratios for all-cause mortality among participants who had the greatest improvement in diet quality (13 to 33% improvement), as compared with those who had a relatively stable diet quality (0 to 3% improvement), in the 12-year period were the following: 0.91 (95% confidence interval [CI], 0.85 to 0.97) according to changes in the Alternate Healthy Eating Index score, 0.84 (95 CI%, 0.78 to 0.91) according to changes in the Alternate Mediterranean Diet score, and 0.89 (95% CI, 0.84 to 0.95) according to changes in the DASH score. A 20-percentile increase in diet scores (indicating an improved quality of diet) was significantly associated with a reduction in total mortality of 8 to 17% with the use of the three diet indexes and a 7 to 15% reduction in the risk of death from cardiovascular disease with the use of the Alternate Healthy Eating Index and Alternate Mediterranean Diet. Among participants who maintained a high-quality diet over a 12-year period, the risk of death from any cause was significantly lower — by 14% (95% CI, 8 to 19) when assessed with the Alternate Healthy Eating Index score, 11% (95% CI, 5 to 18) when assessed with the Alternate Mediterranean Diet score, and 9% (95% CI, 2 to 15) when assessed with the DASH score — than the risk among participants with consistently low diet scores over time. CONCLUSIONS Improved diet quality over 12 years was consistently associated with a decreased risk of death. PMID:28700845

The Statin-Associated Muscle Symptom Clinical Index (SAMS-CI): Revision for Clinical Use, Content Validation, and Inter-rater Reliability.

PubMed

Rosenson, Robert S; Miller, Kate; Bayliss, Martha; Sanchez, Robert J; Baccara-Dinet, Marie T; Chibedi-De-Roche, Daniela; Taylor, Beth; Khan, Irfan; Manvelian, Garen; White, Michelle; Jacobson, Terry A

2017-04-01

The Statin-Associated Muscle Symptom Clinical Index (SAMS-CI) is a method for assessing the likelihood that a patient's muscle symptoms (e.g., myalgia or myopathy) were caused or worsened by statin use. The objectives of this study were to prepare the SAMS-CI for clinical use, estimate its inter-rater reliability, and collect feedback from physicians on its practical application. For content validity, we conducted structured in-depth interviews with its original authors as well as with a panel of independent physicians. Estimation of inter-rater reliability involved an analysis of 30 written clinical cases which were scored by a sample of physicians. A separate group of physicians provided feedback on the clinical use of the SAMS-CI and its potential utility in practice. Qualitative interviews with providers supported the content validity of the SAMS-CI. Feedback on the clinical use of the SAMS-CI included several perceived benefits (such as brevity, clear wording, and simple scoring process) and some possible concerns (workflow issues and applicability in primary care). The inter-rater reliability of the SAMS-CI was estimated to be 0.77 (confidence interval 0.66-0.85), indicating high concordance between raters. With additional provider feedback, a revised SAMS-CI instrument was created suitable for further testing, both in the clinical setting and in prospective validation studies. With standardized questions, vetted language, easily interpreted scores, and demonstrated reliability, the SAMS aims to estimate the likelihood that a patient's muscle symptoms were attributable to statins. The SAMS-CI may support better detection of statin-associated muscle symptoms in clinical practice, optimize treatment for patients experiencing muscle symptoms, and provide a useful tool for further clinical research.

Prognostic validation of the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index in inoperable non-small-cell lung cancer.

PubMed

Denehy, Linda; Hornsby, Whitney E; Herndon, James E; Thomas, Samantha; Ready, Neal E; Granger, Catherine L; Valera, Lauren; Kenjale, Aarti A; Eves, Neil D; Jones, Lee W

2013-12-01

To investigate the prognostic utility of the body mass index, severity of airflow obstruction, measures of exertional dyspnea, and exercise capacity (BODE) index in patients with inoperable non-small-cell lung cancer (NSCLC). One hundred consecutive patients with inoperable NSCLC and performance status 0 to 3 completed pulmonary function testing, the modified Medical Research Council dyspnea scale, a 6-minute walk test, and body mass index-the multidimensional 10-point BODE index. Cox proportional models were used to estimate the risk of all-cause mortality according to the BODE index with or without adjustment for traditional prognostic factors. Median follow-up was 31.5 months; 61 deaths (61%) were reported during this period. There was a significant univariate association between the BODE index score and mortality (adjusted p(trend) = 0.027). Compared with patients with a BODE index of 0, the adjusted hazard ratio for risk of death was 1.37 (95% confidence interval [CI], 0.74-2.55) for a BODE index of 1, 1.22 (95% CI, 0.45-3.25) for a BODE index of 2, and 2.44 (95% CI, 1.19-4.99) for a BODE index more than 2. The BODE index provided incremental prognostic information beyond that provided traditional markers of prognosis (adjusted p(trend) = 0.051). Every one-point increase in the BODE index, the risk of death increased by 25% (hazard ratio = 1.25; 95% CI, 1.27-4.64). The BODE index is a strong independent predictor of survival in inoperable NSCLC beyond traditional risk factors. Use of this multidimensional tool may improve risk stratification and prognostication in NSCLC.

Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors

PubMed Central

Mazur, Katarzyna; Wilczyński, Krzysztof; Szewieczek, Jan

2016-01-01

Background Inpatient geriatric falls are a frequent complication of hospital care that results in significant morbidity and mortality. Objective Evaluate factors associated with falls in geriatric inpatients after implementation of the fall prevention program. Methods Prospective observational study comprised of 788 consecutive patients aged 79.5±7.6 years ( χ¯ ± standard deviation) (66% women and 34% men) admitted to the subacute geriatric ward. Comprehensive geriatric assessment (including Mini-Mental State Examination, Barthel Index of Activities of Daily Living, and modified Get-up and Go Test) was performed. Confusion Assessment Method was used for diagnosis of delirium. Patients were categorized into low, moderate, or high fall risk groups after clinical and functional assessment. Results About 15.9%, 21.1%, and 63.1% of participants were classified into low, moderate, and high fall risk groups, respectively. Twenty-seven falls were recorded in 26 patients. Increased fall probability was associated with age ≥76 years (P<0.001), body mass index (BMI) <23.5 (P=0.007), Mini-Mental State Examination <20 (P=0.004), Barthel Index <65 (P=0.002), hemoglobin <7.69 mmol/L (P=0.017), serum protein <70 g/L (P=0.008), albumin <32 g/L (P=0.001), and calcium level <2.27 mmol/L. Four independent factors associated with fall risk were included in the multivariate logistic regression model: delirium (odds ratio [OR] =7.33; 95% confidence interval [95% CI] =2.76–19.49; P<0.001), history of falls (OR =2.55; 95% CI =1.05–6.19; P=0.039), age (OR =1.14; 95% CI =1.05–1.23; P=0.001), and BMI (OR =0.91; 95% CI =0.83–0.99; P=0.034). Conclusion Delirium, history of falls, and advanced age seem to be the primary risk factors for geriatric falls in the context of a hospital fall prevention program. Higher BMI appears to be associated with protection against inpatient geriatric falls. PMID:27695303

Central obesity is an independent predictor of erectile dysfunction in older men.

PubMed

Riedner, Charles Edison; Rhoden, Ernani Luis; Ribeiro, Eduardo Porto; Fuchs, Sandra Costa

2006-10-01

There is a growing body of evidence in the literature correlating erectile dysfunction to obesity. We investigated the correlation of different anthropometric indexes of central obesity to erectile dysfunction. A cross-sectional study was performed including 256 consecutive men 40 years old or older. All men completed the International Index of Erectile Function, and were evaluated routinely with a clinical history, physical examination and blood analysis for fasting serum glucose, lipid profile and serum testosterone. Anthropometric measures included body mass index, waist circumference, sagittal abdominal diameter, maximal abdominal circumference, and waist-hip, waist-thigh, waist-height, sagittal abdominal diameter-thigh and sagittal abdominal diameter-height indexes. In men 40 to 60 years old the different anthropometric indexes of central obesity were not correlated with the presence of erectile dysfunction (p > 0.05). Men older than 60 years (41%, range 61 to 81) demonstrated an association among erectile dysfunction and waist-hip index (p = 0.04), waist-thigh index (p = 0.02), sagittal abdominal diameter (p = 0.03), sagittal abdominal diameter-height index (p = 0.02) and maximal abdominal circumference (p = 0.04). After logistic regression analysis an independent effect on the presence of erectile dysfunction was observed for waist-hip index (OR 8.56, 95% CI 1.44-50.73), sagittal abdominal diameter (OR 7.87, 95% CI 1.24-49.75), sagittal abdominal diameter-height index (OR 14.21, 95% CI 1.11-182.32), maximum abdominal circumference (OR 11.72, 95% CI 1.73-79.18) and waist circumference (OR 19.37, 95% CI 1.15-326.55). This study suggests that central obesity, assessed by several anthropometric indicators, is associated to the presence of erectile dysfunction in men older than 60 years. Sagittal abdominal diameter, sagittal abdominal diameter-height index, maximum abdominal circumference, waist circumference and waist-hip index were useful indicators to predict the presence of erectile dysfunction.

Multiparametric ultrasonography and ultrasound elastography in the differentiation of parathyroid lesions from ectopic thyroid lesions or lymphadenopathies.

PubMed

Isidori, Andrea M; Cantisani, Vito; Giannetta, Elisa; Diacinti, Daniele; David, Emanuele; Forte, Valerio; Elia, Daniela; De Vito, Corrado; Sbardella, Emilia; Gianfrilli, Daniele; Monteleone, Francesco; Pepe, Jessica; Minisola, Salvatore; Ascenti, Giorgio; D'Andrea, Vito; Catalano, Carlo; D'Ambrosio, Ferdinando

2017-08-01

To evaluate the accuracy of ultrasound elastography with Elastoscan TM Core Index in the differential diagnosis of parathyroid lesions from ectopic thyroid nodules and lymph nodes. Seventy nine patients with repeatedly high levels of circulating intact parathyroid hormone, normal vitamin D and renal function tests, with an ultrasound scan showing a neck lesion, sharply demarcated from the thyroid lobules, were consecutively enrolled. Ultrasound with and without Color Doppler and ultrasound elastography were performed before histological examination. All ultrasound features, vascularization and ultrasound elastography diagnostic performance were assessed using ROC curves. Histological examination confirmed 47 parathyroid lesions, 18 thyroid ectopic nodules and 14 reactive lymph nodes. In distinguishing parathyroid from thyroid nodules, shape had a 100 % sensitivity (95 % CI 92.4-100) and 50 % specificity (95 % CI 37.2-64.7), cleavage had a 85.1 % sensitivity (95 % CI 72.3-92.6) and 77.8 % specificity (95 % CI 65.1-88) while peripheral vascularization had a sensitivity of 91.5 (95 % CI 79.6-97.6) and specificity of 72.2 (95 % CI 46.5-90.3). An Elastoscan TM Core Indexof 1.28 was 46 % sensitive (95 % CI 33.4-58.7) and 77 % specific (95 % CI 66.2-89.1) in discriminating parathyroid lesions from thyroid nodules. An Elastoscan TM Core Index of 1.0 was 78 % sensitive (95 % CI 65.1-88) and 71 % specific (95 % CI 56-81.3) in discriminating parathyroid lesions from lymph nodes (p = 0.045). An Elastoscan TM Core Index greater than 2.58 had a 100 % sensitivity (95 % CI 43.8-100) and 95.4 % specificity (95 % CI 38.3-99.7) in discriminating malignant from benign parathyroid nodules. Elastoscan TM Core Index was significantly higher in thyroid nodules than in reactive lymph nodes (1.18 ± 0.62, p = 0.008). The ultrasound features of cleavage and peripheral vascularization help to differentiate parathyroid from thyroid nodules. Elastoscan TM Core Index can improve ultrasound discrimination of parathyroid lesions from lymph nodes. The Elastoscan TM Core Index is significantly higher in malignant than in benign parathyroid lesions.

Determinants of Short Interbirth Interval among Reproductive Age Mothers in Arba Minch District, Ethiopia

PubMed Central

Hailu, Desta; Gulte, Teklemariam

2016-01-01

Background. One of the key strategies to reduce fertility and promote the health status of mothers and their children is adhering to optimal birth spacing. However, women still have shorter birth intervals and studies addressing their determinants were scarce. The objective of this study, therefore, was to assess determinants of birth interval among women who had at least two consecutive live births. Methods. Case control study was conducted from February to April 2014. Cases were women with short birth intervals (<3 years), whereas controls were women having history of optimal birth intervals (3 to 5 years). Bivariate and multivariable analyses were performed. Result. Having no formal education (AOR = 2.36, 95% CL: [1.23–4.52]), duration of breast feeding for less than 24 months (AOR: 66.03, 95% CI; [34.60–126]), preceding child being female (AOR: 5.73, 95% CI; [3.18–10.310]), modern contraceptive use (AOR: 2.79, 95% CI: [1.58–4.940]), and poor wealth index (AOR: 4.89, 95% CI; [1.81–13.25]) of respondents were independent predictors of short birth interval. Conclusion. In equalities in education, duration of breast feeding, sex of the preceding child, contraceptive method use, and wealth index were markers of unequal distribution of inter birth intervals. Thus, to optimize birth spacing, strategies of providing information, education and communication targeting predictor variables should be improved. PMID:27239553

Risk factors associated with treatment refusal in lung cancer

PubMed Central

Suh, Won Na; Kong, Kyoung Ae; Han, Yeji; Kim, Soo Jung; Lee, Su Hwan; Ryu, Yon Ju; Lee, Jin Hwa; Shim, Sung Shine; Kim, Yookyung

2017-01-01

Background The incidence of lung cancer is increasing with longer life expectancy. Refusal of active treatment for cancer is prone to cause patients to experience more severe symptoms and shorten survival. The purpose of this study was to define the factors related to refusal or abandonment of active therapy in lung cancer. Methods We retrospectively reviewed the data of 617 patients from medical records from 2010 to 2014. Two groups were formed: 149 patients who refused anti‐cancer treatment and allowed only palliative care were classified into the non‐treatment group, while the remaining 468 who received anti‐cancer treatment were classified into the treatment group. Results The groups differed significantly in age, employment, relationship status, number of offspring, educational status, body mass index, presence of chest and systemic symptoms, Charlson Comorbidity Index, Eastern Cooperative Oncology Group score, and tumor node metastasis stage (P < 0.05). In logistic regression analysis, age (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.07–1.13), educational status lower than high school (OR 1.95, 95% CI 1.2–3.2), no history of surgery (OR 2.29, 95% CI 1.4–3.7), body mass index < 18.5 (OR 2.49, 95% CI 1.3–4.7), and a high Eastern Cooperative Oncology Group score of 3 or 4 (OR 5.02, 95% CI 2.3–10.8) were significant factors for refusal of cancer treatment. Conclusion Individual factors, such as old age, low educational status, low weight, and poor performance status can influence refusal of cancer treatment in patients with lung cancer, and should be considered prior to consultation with patients. PMID:28627788

Augmentation index is a better marker for cardiovascular risk in young Malaysian males. A comparison of involvement of pulse wave velocity, augmentation index, and C-reactive protein.

PubMed

Aminuddin, Amilia; Chellappan, Kalaivani; Maskon, Oteh; Zakaria, Zaiton; Karim, Aminuddin A; Ngah, Wan Z; Nordin, Nor Anita M

2014-02-01

To determine the association between carotid femoral pulse wave velocity (PWVCF) and augmentation index (AI) with future cardiovascular disease (CVD) risk, and to assess whether high sensitivity C-reactive protein (hs-CRP) is an important mediator towards these vascular changes, among young men. This cross-sectional study was conducted at Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia from July 2011 to December 2012. Two hundred and eleven young men were recruited. The PWVCF and AI were measured using Vicorder. High sensitivity C-reactive protein was measured by using immunological methods. The future CVD risk was assessed by Framingham risk score (FRS) and age adjusted FRS (A-FRS). Data for analysis was conducted using the Statistical Package for Social Sciences Version 15 (SPSS Inc., Chicago, IL, USA). The mean age of the subjects was 27.09 (95% confidence intervals [CI] 26.39-27.79) years old. Those with ≥2 risk factors had significantly higher AI [10.09 (95% CI: 9.06-11.12) versus 6.56 (95% CI: 5.54-7.57) (p=0.001), but not PWVCF 7.45 (95% CI: 7.29-7.61) m/s versus 7.29 (95% CI: 7.06-7.51) m/s, (p=0.90) when compared to the healthy subjects. High sensitivity C-reactive protein was not an independent determinant for PWVCF and AI. Only AI was significantly associated with FRS and A-FRS (p=0.0001). To assess the impact of risk factors on vascular damage and for future assessment of CVD risk among the young men, AI may be a better marker than PWVCF. The increase in AI among these subjects was not related to hs-CRP.

Meta-analysis shows similar re-bleeding rates among Western and Eastern populations after index video capsule endoscopy.

PubMed

Tziatzios, Georgios; Gkolfakis, Paraskevas; Hassan, Cesare; Toth, Ervin; Zullo, Angelo; Koulaouzidis, Anastasios; Dimitriadis, George D; Triantafyllou, Konstantinos

2018-03-01

Video capsule endoscopy (VCE) is the first-line diagnostic procedure for investigating obscure gastrointestinal bleeding (OGIB). Different re-bleeding rates following index VCE have been reported among Western and Eastern studies. We conducted a comprehensive literature search to identify studies examining re-bleeding rates after VCE for OGIB. Meta-analysis assessed the pooled proportion of re-bleeding events after VCE for OGIB according to study's origin (Western vs. Eastern) and according to the length of follow-up (≥24 months vs. <24 months). We also calculated the re-bleeding odds ratios (OR; 95% CI) after positive vs. negative index VCE, overt vs. occult initial presentation of bleeding and after interventional treatment for positive index cases, according to the study's origin. We included 46 (30 Western and 16 Eastern) studies with 5796 patients. Significant heterogeneity was detected among meta-analyzed studies. Overall, the pooled re-bleeding rate was similar between Western (29%; 95% CI: 23-34) and Eastern (21%; 95% CI: 15-27) populations, irrespective of the length of follow-up. The odds of re-bleeding was significantly higher after positive as compared to negative index VCE in Eastern studies (OR: 1.77; 95% CI: 1.07-2.94). Application of specific treatment after positive index VCE was associated with lower re-bleeding odds in both Western (OR: 0.37; 95% CI: 0.16-0.87) and Eastern (OR: 0.39; 95% CI: 0.21-0.72) populations. Patients undergoing VCE for OGIB have similar re-bleeding rates in the East and the West, regardless of the length of follow-up. However, increased re-bleeding odds after positive index VCE is observed in Eastern studies. Copyright © 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Neurocognitive functioning predicts frailty index in HIV.

PubMed

Oppenheim, Hannah; Paolillo, Emily W; Moore, Raeanne C; Ellis, Ronald J; Letendre, Scott L; Jeste, Dilip V; Grant, Igor; Moore, David J

2018-06-06

To evaluate the association between a frailty index (i.e., scale of accumulated deficits) and neurocognitive functioning among persons living with HIV/AIDS (PLWHA). Observational, cross-sectional data were gathered from the University of California, San Diego, HIV Neurobehavioral Research Program from 2002 to 2016. Eight hundred eleven PLWHA aged 18 to 79 years completed comprehensive physical, neuropsychological, and neuromedical evaluations. The frailty index was composed of 26 general and HIV-specific health maintenance measures, and reflects the proportion of accumulated deficits from 0 (no deficits) to 1 (all 26 deficits). Multiple linear regression was used to examine the association between continuous frailty index scores and neurocognitive functioning. Participants had a mean age of 44.6 years (11.2), and were mostly male (86.9%) and white (60.2%) with a mean frailty index of 0.26 (0.11). Over the study period, prevalence of HIV-related components (e.g., low CD4) decreased, while non-HIV comorbidities (e.g., diabetes) increased. There were no changes in the frailty index by study year. Higher frailty index was associated with worse global neurocognitive functioning, even after adjusting for covariates (age, employment, and premorbid intellectual functioning; b = -0.007; 95% confidence interval [CI] = -0.0112 to -0.003; p < 0.001). The cognitive domains of verbal fluency (b = -0.004; 95% CI = -0.006 to -0.002), executive functioning (b = -0.004; 95% CI = -0.006 to -0.002), processing speed (b = -0.005; 95% CI = -0.007 to -0.003), and motor skills (b = -0.006; 95% CI = -0.007 to -0.005) also significantly predicted worse frailty index score ( p values <0.001). A frailty index can standardize how clinicians identify PLWHA who may be at higher risk of neurocognitive impairment. © 2018 American Academy of Neurology.

Nomogram-based prediction of survival in patients with advanced oesophagogastric adenocarcinoma receiving first-line chemotherapy: a multicenter prospective study in the era of trastuzumab

PubMed Central

Custodio, A; Carmona-Bayonas, A; Jiménez-Fonseca, P; Sánchez, M L; Viudez, A; Hernández, R; Cano, J M; Echavarria, I; Pericay, C; Mangas, M; Visa, L; Buxo, E; García, T; Rodríguez Palomo, A; Álvarez Manceñido, F; Lacalle, A; Macias, I; Azkarate, A; Ramchandani, A; Fernández Montes, A; López, C; Longo, F; Sánchez Bayona, R; Limón, M L; Díaz-Serrano, A; Hurtado, A; Madero, R; Gómez, C; Gallego, J

2017-01-01

Background: To develop and validate a nomogram and web-based calculator to predict overall survival (OS) in Caucasian-advanced oesophagogastric adenocarcinoma (AOA) patients undergoing first-line combination chemotherapy. Methods: Nine hundred twenty-four AOA patients treated at 28 Spanish teaching hospitals from January 2008 to September 2014 were used as derivation cohort. The result of an adjusted-Cox proportional hazards regression was represented as a nomogram and web-based calculator. The model was validated in 502 prospectively recruited patients treated between October 2014 and December 2016. Harrell's c-index was used to evaluate discrimination. Results: The nomogram includes seven predictors associated with OS: HER2-positive tumours treated with trastuzumab, Eastern Cooperative Oncology Group performance status, number of metastatic sites, bone metastases, ascites, histological grade, and neutrophil-to-lymphocyte ratio. Median OS was 5.8 (95% confidence interval (CI), 4.5–6.6), 9.4 (95% CI, 8.5–10.6), and 14 months (95% CI, 11.8–16) for high-, intermediate-, and low-risk groups, respectively (P<0.001), in the derivation set and 4.6 (95% CI, 3.3–8.1), 12.7 (95% CI, 11.3–14.3), and 18.3 months (95% CI, 14.6–24.2) for high-, intermediate-, and low-risk groups, respectively (P<0.001), in the validation set. The nomogram is well-calibrated and reveals acceptable discriminatory capacity, with optimism-corrected c-indices of 0.618 (95% CI, 0.591–0.631) and 0.673 (95% CI, 0.636–0.709) in derivation and validation groups, respectively. The AGAMENON nomogram outperformed the Royal Marsden Hospital (c-index=0.583; P=0.00046) and Japan Clinical Oncology Group prognostic indices (c-index=0.611; P=0.03351). Conclusions: We developed and validated a straightforward model to predict survival in Caucasian AOA patients initiating first-line polychemotherapy. This model can contribute to inform clinical decision-making and optimise clinical trial design. PMID:28463962

Deprivation index and dependency ratio are key determinants of emergency medical admission rates.

PubMed

Conway, Richard; Byrne, Declan; O'Riordan, Deirdre; Cournane, Seán; Coveney, Seamus; Silke, Bernard

2015-11-01

Patients from deprived backgrounds have a higher in-patient mortality following an emergency medical admission; there has been debate as to the extent to which deprivation and population structure influences hospital admission rate. All emergency medical admissions to an Irish hospital over a 12-year period (2002-2013) categorized by quintile of Deprivation Index and Dependency Ratio (proportion of population <15 or ≥ 65 years) from small area population statistics (SAPS), were evaluated against hospital admission rates. Univariate and multivariable risk estimates (Odds Ratios (OR) or Incidence Rate Ratios (IRR)) were calculated, using logistic or zero truncated Poisson regression as appropriate. 66,861 admissions in 36,214 patients occured during the study period. The Deprivation Index quintile independently predicted the admission rate/1000 population, Q1 9.4 (95%CI 9.2 to 9.7), Q2 16.8 (95%CI 16.6 to 17.0), Q3 33.8 (95%CI 33.5 to 34.1), Q4 29.6 (95%CI 29.3 to 29.8) and Q5 45.4 (95%CI 44.5 to 46.2). Similarly the population Dependency Ratio was an independent predictor of the admission rate with adjusted predicted rates of Q1 20.8 (95%CI 20.5 to 21.1), Q2 19.2 (95%CI 19.0 to 19.4), Q3 27.6 (95%CI 27.3 to 27.9), Q4 43.9 (95%CI 43.5 to 44.4) and Q5 34.4 (95%CI 34.1 to 34.7). A high concurrent Deprivation Index and Dependency Ratio were associated with very high admission rates. Deprivation Index and population Dependency Ratio are key determinants of the rate of emergency medical admissions. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Visceral Obesity If Associated with Gallbladder Polyps

PubMed Central

Lee, Jun Kyu; Hahn, Suk Jae; Kang, Hyoun Woo; Jung, Jae Gu; Choi, Han Seok; Lee, Jin Ho; Han, In Woong; Jung, Jin-Hee; Kwon, Jae Hyun

2016-01-01

Background/Aims Gallbladder polyps (GBP) are a common clinical finding and may possess malignant potential. We conducted this study to determine whether visceral obesity is a risk factor for GBP. Methods We retrospectively reviewed records of subjects who received both ultrasonography and computed tomography with measurements of the areas of visceral adipose tissue and total adipose tissue (TAT) on the same day as health checkups. Results Ninety-three of 1,615 subjects (5.8%) had GBP and were compared with 186 age- and sex-matched controls. VAT (odds ratio [OR], 2.941; 95% confidence interval [CI], 1.325 to 6.529; p=0.008 for the highest quartile vs the lowest quartile) and TAT (OR, 3.568; 95% CI, 1.625 to 7.833; p=0.002 for the highest quartile vs the lowest quartile) were independent risk factors together with hypertension (OR, 2.512; 95% CI, 1.381 to 4.569; p=0.003), diabetes mellitus (OR, 2.942; 95% CI, 1.061 to 8.158; p=0.038), hepatitis B virus positivity (OR, 3.548; 95% CI, 1.295 to 9.716; p=0.014), and a higher level of total cholesterol (OR, 2.232; 95% CI, 1.043 to 4.778; p=0.039 for <200 mg/dL vs ≥240 mg/dL). Body mass index and waist circumference were not meaningful variables. Conclusions Visceral obesity measured by VAT and TAT was associated with GBP irrespective of body mass index or waist circumference. PMID:26260756

Prevalence and risk factors of asymptomatic peptic ulcer disease in Taiwan

PubMed Central

Wang, Fu-Wei; Tu, Ming-Shium; Mar, Guang-Yuan; Chuang, Hung-Yi; Yu, Hsien-Chung; Cheng, Lung-Chih; Hsu, Ping-I

2011-01-01

AIM: To investigate the prevalence and risk factors of asymptomatic peptic ulcer disease (PUD) in a general Taiwanese population. METHODS: From January to August 2008, consecutive asymptomatic subjects undergoing a routine health check-up were evaluated by upper gastrointestinal endoscopy. Gastroduodenal mucosal breaks were carefully assessed, and a complete medical history and demographic data were obtained from each patient. Logistic regression analysis was conducted to identify independent risk factors for asymptomatic PUD. RESULTS: Of the 572 asymptomatic subjects, 54 (9.4%) were diagnosed as having PUD. The prevalence of gastric ulcer, duodenal ulcer and both gastric and duodenal ulcers were 4.7%, 3.9%, and 0.9%, respectively. Multivariate analysis revealed that prior history of PUD [odds ratio (OR), 2.0, 95% CI: 1.3-2.9], high body mass index [body mass index (BMI) 25-30: OR, 1.5, 95% CI: 1.0-2.2; BMI > 30 kg/m2: OR, 3.6, 95% CI: 1.5-8.7] and current smoker (OR, 2.6, 95% CI: 1.6-4.4) were independent predictors of asymptomatic PUD. In contrast, high education level was a negative predictor of PUD (years of education 10-12: OR, 0.5, 95% CI: 0.3-0.8; years of education > 12: OR, 0.6, 95% CI: 0.3-0.9). CONCLUSION: The prevalence of PUD in asymptomatic subjects is 9.4% in Taiwan. Prior history of PUD, low education level, a high BMI and current smoker are independent risk factors for developing asymptomatic PUD. PMID:21448426

Assessing participation in community-based physical activity programs in Brazil.

PubMed

Reis, Rodrigo S; Yan, Yan; Parra, Diana C; Brownson, Ross C

2014-01-01

This study aimed to develop and validate a risk prediction model to examine the characteristics that are associated with participation in community-based physical activity programs in Brazil. We used pooled data from three surveys conducted from 2007 to 2009 in state capitals of Brazil with 6166 adults. A risk prediction model was built considering program participation as an outcome. The predictive accuracy of the model was quantified through discrimination (C statistic) and calibration (Brier score) properties. Bootstrapping methods were used to validate the predictive accuracy of the final model. The final model showed sex (women: odds ratio [OR] = 3.18, 95% confidence interval [CI] = 2.14-4.71), having less than high school degree (OR = 1.71, 95% CI = 1.16-2.53), reporting a good health (OR = 1.58, 95% CI = 1.02-2.24) or very good/excellent health (OR = 1.62, 95% CI = 1.05-2.51), having any comorbidity (OR = 1.74, 95% CI = 1.26-2.39), and perceiving the environment as safe to walk at night (OR = 1.59, 95% CI = 1.18-2.15) as predictors of participation in physical activity programs. Accuracy indices were adequate (C index = 0.778, Brier score = 0.031) and similar to those obtained from bootstrapping (C index = 0.792, Brier score = 0.030). Sociodemographic and health characteristics as well as perceptions of the environment are strong predictors of participation in community-based programs in selected cities of Brazil.

Educational Differences in Postmenopausal Breast Cancer – Quantifying Indirect Effects through Health Behaviors, Body Mass Index and Reproductive Patterns

PubMed Central

Hvidtfeldt, Ulla Arthur; Lange, Theis; Andersen, Ingelise; Diderichsen, Finn; Keiding, Niels; Prescott, Eva; Sørensen, Thorkild I. A.; Tjønneland, Anne; Rod, Naja Hulvej

2013-01-01

Studying mechanisms underlying social inequality in postmenopausal breast cancer is important in order to develop prevention strategies. Standard methods for investigating indirect effects, by comparing crude models to adjusted, are often biased. We applied a new method enabling the decomposition of the effect of educational level on breast cancer incidence into indirect effects through reproductive patterns (parity and age at first birth), body mass index and health behavior (alcohol consumption, physical inactivity, and hormone therapy use). The study was based on a pooled cohort of 6 studies from the Copenhagen area including 33,562 women (1,733 breast cancer cases) aged 50–70 years at baseline. The crude absolute rate of breast cancer was 399 cases per 100,000 person-years. A high educational level compared to low was associated with 74 (95% CI 22–125) extra breast cancer cases per 100,000 person-years at risk. Of these, 26% (95% CI 14%–69%) could be attributed to alcohol consumption. Similar effects were observed for age at first birth (32%; 95% CI 10%–257%), parity (19%; 95%CI 10%–45%), and hormone therapy use (10%; 95% CI 6%–18%). Educational level modified the effect of physical activity on breast cancer. In conclusion, this analysis suggests that a substantial number of the excess postmenopausal breast cancer events among women with a high educational level compared to a low can be attributed to differences in alcohol consumption, use of hormone therapy, and reproductive patterns. Women of high educational level may be more vulnerable to physical inactivity compared to women of low educational level. PMID:24205296

Association of Body Mass Index with Timing of Death during Tuberculosis Treatment

PubMed Central

Lai, Yun-Ju; Yen, Yung-Feng

2017-01-01

Background The association between body mass index and mortality in patients with tuberculosis has not been extensively studied, and the existing evidence is inconsistent. This study aimed to investigate the impact of body mass index on timing of death in patients with tuberculosis. Methods All Taiwanese adults with tuberculosis in Taipei, Taiwan, were included in a retrospective cohort study in 2011–2012. Multinomial logistic regression was used to evaluate the association between body mass index and timing of death in patients with tuberculosis. Results Among 1557 eligible patients, 84.1% (1310), 8.2% (128), and 7.6% (119) underwent successful treatment, early death, and late death, respectively. The mean age of the patients with tuberculosis was 64.2 years old, and 67.7% were male. After controlling for potential confounding variables, underweight with body mass index less than 18.5 kg/ m2 was significantly associated with elevated risk of all-cause mortality [Adjusted odds ratio (AOR), 1.64; 95% confidence interval (CI), 1.17–2.30]. Considering timing of death, underweight with body mass index less than 18.5 was significantly associated only with elevated risk of early mortality within the first 8 weeks of treatment onset (AOR, 2.22; 95% CI, 1.45–3.40) Conclusions For patients with tuberculosis infection, underweight with body mass index less than 18.5 kg/ m2 is an independent predictor for early mortality within the first 8 weeks of treatment. PMID:28085951

Lengthening Temporalis Myoplasty: Objective Outcomes and Site-Specific Quality-of-Life Assessment.

PubMed

Panciera, Davide Thomas; Sampieri, Claudio; Deganello, Alberto; Danesi, Giovanni

2017-12-01

Objective Evaluate outcomes of the lengthening temporalis myoplasty in facial reanimations. Study Design Case series with planned data collection. Setting Ospedali Riuniti, Bergamo, and AOUC Careggi, Florence, Italy. Subjects and Methods From 2011 to 2016, 11 patients underwent lengthening temporalis myoplasty; demographic data were collected for each. Pre- and postoperative photographs and videos were recorded and used to measure the smile angle and the excursion of the oral commissure, according to the SMILE system (Scaled Measurements of Improvement in Lip Excursion). All patients were tested with the Facial Disability Index, and they also completed a questionnaire about the adherence to physiotherapy indications. Results All patients demonstrated a significant improvement in functional parameters and in quality of life. On the reanimated side, the mean z-line and a-value, measured when smiling, significantly improved in all patients: from 22.6 mm (95% CI, 20.23-25.05) before surgery to 30.9 mm (95% CI, 27.82-33.99) after surgery ( P < .001) and from 100.5° (95% CI, 93.96°-107.13°) to 111.6° (95% CI, 105.63°-117.64°; P < .001), respectively. The mean postoperative dynamic gain, passing from rest to a full smile at the reanimated side, was 3.1 mm (95% CI, 1.30-4.88) for the z-line and 3.3° (95% CI, 1.26°-5.29°) for the a-value. The Facial Disability Index score increased from a preoperative mean of 33.4 points (95% CI, 28.25-38.66) to 49.9 points (95% CI, 47.21-52.60) postoperatively ( P < .001). Conclusions The lengthening temporalis myoplasty can be successfully used for smile reanimation, with satisfying functional and quality-of-life outcomes.

Evaluation of the brain anaesthesia response monitor during anaesthesia for cardiac surgery: a double-blind, randomised controlled trial using two doses of fentanyl.

PubMed

Shoushtarian, Mehrnaz; McGlade, Desmond P; Delacretaz, Louis J; Liley, David T J

2016-12-01

The brain anaesthesia response (BAR) monitor uses a method of EEG analysis, based on a model of brain electrical activity, to monitor the cerebral response to anaesthetic and sedative agents via two indices, composite cortical state (CCS) and cortical input (CI). It was hypothesised that CCS would respond to the hypnotic component of anaesthesia and CI would differentiate between two groups of patients receiving different doses of fentanyl. Twenty-five patients scheduled to undergo elective first-time coronary artery bypass graft surgery were randomised to receive a total fentanyl dose of either 12 μg/kg (fentanyl low dose, FLD) or 24 μg/kg (fentanyl moderate dose, FMD), both administered in two divided doses. Propofol was used for anaesthesia induction and pancuronium for intraoperative paralysis. Hemodynamic management was protocolised using vasoactive drugs. BIS, CCS and CI were simultaneously recorded. Response of the indices (CI, CCS and BIS) to propofol and their differences between the two groups at specific points from anaesthesia induction through to aortic cannulation were investigated. Following propofol induction, CCS and BIS but not CI showed a significant reduction. Following the first dose of fentanyl, CI, CCS and BIS decreased in both groups. Following the second dose of fentanyl, there was a significant reduction in CI in the FLD group but not the FMD group, with no significant change found for BIS or CCS in either group. The BAR monitor demonstrates the potential to monitor the level of hypnosis following anaesthesia induction with propofol via the CCS index and to facilitate the titration of fentanyl as a component of balanced anaesthesia via the CI index.

Factors associated with work ability index (WAI) among intensive care units' (ICUs') nurses.

PubMed

Rostamabadi, Akbar; Zamanian, Zahra; Sedaghat, Zahra

2017-03-28

Work ability is a crucial occupational health issue in health care settings where a high physical and psychosocial work capacity is required and a high risk of disabling injuries and illnesses is predictable. This study aims to examine the association between the work ability index (WAI) and individual characterizations, workload, fatigue, and diseases among intensive care units' (ICUs') nurses. The study sample included 214 nurses selected by a random sampling method from a target population consisting of 321 registered nurses working in eight ICUs. Multiple linear regression analysis was used to test the association between WAI scores and each of the independent variables. Results of multivariate analysis revealed a strong and negative association between WAI scores and diseases (B=-5.82, 95% CI=-7.16, -4.48, P<0.001). Among the studied individual characterizations, body mass index (BMI) was significantly and inversely associated with WAI scores. A significant and negative association was also found between WAI scores and dimensions of MFI-20, such as general fatigue (B=-0.31, 95% CI=-0.53, -0.09, P=0.005) and physical fatigue (B=-0.44, 95% CI=-0.65, -0.23, P<0.001). From dimensions of workload, frustration (B=-0.04, 95% CI=-0.07, -0.02, P<0.001) and temporary demand (B=-0.04, 95% CI=-0.08, -0.0001, P=0.04) showed a negative and significant association with WAI scores, while performance showed a positive and significant association (B=0.04, 95% CI=0.01, 0.07, P=0.005). Based on the study findings, development of health care programs with the aim of setting up a healthy work environment characterized by a well-structured preventive attitude toward controlling diseases, and a well-designed organizational framework toward increasing the level of performance and motivation, reducing the level of fatigue, as well as reducing the workload, is necessary to promote work ability among ICUs' nurses.

Risk Factors for Obesity in Adult Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

PubMed Central

Green, Daniel M.; Cox, Cheryl L.; Zhu, Liang; Krull, Kevin R.; Srivastava, Deo Kumar; Stovall, Marilyn; Nolan, Vikki G.; Ness, Kirsten K.; Donaldson, Sarah S.; Oeffinger, Kevin C.; Meacham, Lillian R.; Sklar, Charles A.; Armstrong, Gregory T.; Robison, Leslie L.

2012-01-01

Purpose Many Childhood Cancer Survivor Study (CCSS) participants are at increased risk for obesity. The etiology of their obesity is likely multifactorial but not well understood. Patients and Methods We evaluated the potential contribution of demographic, lifestyle, treatment, and intrapersonal factors and self-reported pharmaceutical use to obesity (body mass index ≥ 30 kg/m2) among 9,284 adult (> 18 years of age) CCSS participants. Independent predictors were identified using multivariable regression models. Interrelationships were determined using structural equation modeling (SEM). Results Independent risk factors for obesity included cancer diagnosed at 5 to 9 years of age (relative risk [RR], 1.12; 95% CI, 1.01 to 1.24; P = .03), abnormal Short Form–36 physical function (RR, 1.19; 95% CI, 1.06 to 1.33; P < .001), hypothalamic/pituitary radiation doses of 20 to 30 Gy (RR, 1.17; 95% CI, 1.05 to 1.30; P = .01), and paroxetine use (RR, 1.29; 95% CI, 1.08 to 1.54; P = .01). Meeting US Centers for Disease Control and Prevention guidelines for vigorous physical activity (RR, 0.90; 95% CI, 0.82 to 0.97; P = .01) and a medium amount of anxiety (RR, 0.86; 95% CI, 0.75 to 0.99; P = .04) reduced the risk of obesity. Results of SEM (N = 8,244; comparative fit index = 0.999; Tucker Lewis index = 0.999; root mean square error of approximation = 0.014; weighted root mean square residual = 0.749) described the hierarchical impact of the direct predictors, moderators, and mediators of obesity. Conclusion Treatment, lifestyle, and intrapersonal factors, as well as the use of specific antidepressants, may contribute to obesity among survivors. A multifaceted intervention, including alternative drug and other therapies for depression and anxiety, may be required to reduce risk. PMID:22184380

[Validity of three methods for inmuno-diagnostic of neurocysticercosis: systematic review of the literature with meta-analysis 1960-2014].

PubMed

Cardona-Arias, Jaiberth Antonio; Carrasquilla-Agudelo, Yoneida Elena; Restrepo-Posada, Deisy Cristina

2017-02-01

The screening of neurocysticercosis is complex and immunological methods have varying validity. To evaluate the validity of ELISA for antigen and antibody, and EITB for antibody in the screening of neurocysticercosis. Meta-analysis of diagnostic tests with an ex-ante protocol implemented in five databases with 15 search strategies, ensuring reproducibility in the selection and extraction of information. Sensitivity, specificity, likelihood ratios (LR), diagnostic odds ratio and ROC curve were estimated in MetaDiSc, and predictive values, and Youden index were estimated in Epidat. EITB presented sensitivity of 85.7% (95% CI 83.5-87.7), specificity 93.9% (95% CI = 92.7-95.0), PLR 19.6 (95% CI = 8,6-44.6), NLR 0.16 (95% CI = 0.12-0.21), OR diagnostic 136.2 (95% CI = 54.7-342.6) and area under the curve 0.926. In ELISA for antibody sensitivity was 87.5% (95% CI = 86.1-88.8), specificity 92.2% (95% CI = 91.4-93.0), PLR 11.3 (95% CI = 8.45-15.11), NLR 0.15 (95% CI = 0.13-0.18), diagnostic OR 87.4 (95% CI = 60.1-127.1) and area under the curve 0.950. ELISA for antigen showed low diagnostic validity. No differences were found in these parameters by sample, antigen or antibody type. ELISA for antibodies and EITB have a similar diagnostic value, detection of serum and CSF showed a similar validity.

Metabolically healthy polycystic ovary syndrome (MH-PCOS) and metabolically unhealthy polycystic ovary syndrome (MU-PCOS): a comparative analysis of four simple methods useful for metabolic assessment.

PubMed

Amato, M C; Guarnotta, V; Forti, D; Donatelli, M; Dolcimascolo, S; Giordano, C

2013-07-01

Is it possible to distinguish metabolically healthy polycystic ovary syndrome (MH-PCOS) from metabolically unhealthy PCOS (MU-PCOS) by simple diagnostic tools such as body mass index (BMI), waist/hip ratio (WHR), at-risk category suggested by Androgen Excess Society (AES) and visceral adiposity index (VAI)? VAI could be an easy and useful tool in clinical practice and in population studies for assessment of MU-PCOS. VAI is a good indicator of insulin sensitivity and cardiometabolic risk in oligo-ovulatory women with PCOS. We conducted a cross-sectional study of 232 women with PCOS in a university hospital setting. Anthropometric, hormonal and metabolic parameters were evaluated. An oral glucose tolerance test measured areas under the curve (AUC) for insulin (AUC 2h insulin) and for glucose (AUC 2h glucose). Homeostasis model assessment of insulin resistance (HOMA2-IR), the Matsuda index of insulin sensitivity (ISI), the oral dispositional index (DIo) and VAI were determined. The prevalence of MU-PCOS according to the different criteria was: BMI, 56.0%; WHR, 18.1%; at-risk criteria of AES, 72.0% and VAI, 34.5%. The likelihood that a woman would exhibit MU-PCOS (except when diagnosed by the WHR criterion) showed a significant positive association with high HOMA2-IR [BMI criterion: (odds ratio (OR): 1.86; 95% confidence interval (CI): 1.43-2.41); risk criteria of AES (OR: 1.86; 95% CI: 1.36-2.56); VAI criterion (OR: 1.45; 95% CI: 1.17-1.80)] and a significant negative association with low ISI Matsuda [BMI criterion: (OR: 0.81; 95% CI: 0.72-0.91); risk criteria of AES (OR: 0.78; 95% CI: 0.69-0.89); VAI criterion (OR: 0.82; 95% CI: 0.71-0.94)]. Only MU-PCOS according to the VAI criterion showed a significant association with low DIo (OR: 0.85; 95% CI: 0.75-0.96); these women also showed a significant association with low luteal progesterone levels (OR: 0.97; 95% CI: 0.95-0.99). The analysis is limited by the lack of a gold standard definition of metabolic health that would have allowed the execution of a receiver operator characteristic analysis of the four proposed criteria. The results will facilitate the early recognition of cardiometabolic risk in women with PCOS before they develop overt metabolic syndrome.

Validation of cardiac output using real-time measurement of oxygen consumption during cardiac catheterization in children under 3 years of age.

PubMed

Seckeler, Michael D; Hirsch, Russel; Beekman, Robert H; Goldstein, Bryan H

2014-01-01

To validate a method for determination of cardiac index (CI) using real-time measurement of oxygen consumption (VO2 ) in young children undergoing cardiac catheterization. Retrospective review comparing thermodilution cardiac index (TDCI) to CI calculated by the Fick equation using real-time measured VO2 (RT-VO2 ) and VO2 derived from 2 published predictive equations. Paired t-test and Bland-Altman analysis were used to compare TDCI to Fick CI. A survey to ascertain pediatric cardiac catheterization practices regarding VO2 determination was also conducted. Quaternary care children's hospital cardiac catheterization laboratory. Children <3 years old with structurally normal hearts undergoing cardiac catheterization under general anesthesia with at least one set of contemporaneous TDCI and RT-VO2 measurements. Thirty-six paired measurements of TDCI and RT-VO2 were made in 27 patients over a 2-year period. Indications for catheterization included congenital diaphragmatic hernia postrepair (n = 13), heart disease post-orthotopic heart transplant (n = 13), and suspected cardiomyopathy (n = 1). Mean age was 21.5 ± 8 months; median weight was 9.9 kg (IQR 8.57, 12.2). RT-VO2 was higher than VO2 predicted by the LaFarge equation (190 ± 31 vs. 173.8 ± 12.8 mL/min/m(2), P < .001), but there was no difference between TDCI and Fick CI calculated using VO2 from any method. Bland-Altman analysis showed excellent agreement between TDCI and Fick CI using RT-VO2 and VO2 predicted by the Lundell equation; Fick CI using VO2 predicted by the LaFarge equation showed fair agreement with TDCI. In children <3 years with a structurally normal heart, RT-VO2 generates highly accurate determinations of Fick CI as compared with TDCI. Additionally, in this population, VO2 derived from the LaFarge and Lundell equations generates accurate Fick CI compared with TDCI. Future studies are needed to identify factors associated with inaccurate VO2 generated from these predictive equations. © 2013 Wiley Periodicals, Inc.

The VACS index accurately predicts mortality and treatment response among multi-drug resistant HIV infected patients participating in the options in management with antiretrovirals (OPTIMA) study.

PubMed

Brown, Sheldon T; Tate, Janet P; Kyriakides, Tassos C; Kirkwood, Katherine A; Holodniy, Mark; Goulet, Joseph L; Angus, Brian J; Cameron, D William; Justice, Amy C

2014-01-01

The VACS Index is highly predictive of all-cause mortality among HIV infected individuals within the first few years of combination antiretroviral therapy (cART). However, its accuracy among highly treatment experienced individuals and its responsiveness to treatment interventions have yet to be evaluated. We compared the accuracy and responsiveness of the VACS Index with a Restricted Index of age and traditional HIV biomarkers among patients enrolled in the OPTIMA study. Using data from 324/339 (96%) patients in OPTIMA, we evaluated associations between indices and mortality using Kaplan-Meier estimates, proportional hazards models, Harrel's C-statistic and net reclassification improvement (NRI). We also determined the association between study interventions and risk scores over time, and change in score and mortality. Both the Restricted Index (c = 0.70) and VACS Index (c = 0.74) predicted mortality from baseline, but discrimination was improved with the VACS Index (NRI = 23%). Change in score from baseline to 48 weeks was more strongly associated with survival for the VACS Index than the Restricted Index with respective hazard ratios of 0.26 (95% CI 0.14-0.49) and 0.39(95% CI 0.22-0.70) among the 25% most improved scores, and 2.08 (95% CI 1.27-3.38) and 1.51 (95%CI 0.90-2.53) for the 25% least improved scores. The VACS Index predicts all-cause mortality more accurately among multi-drug resistant, treatment experienced individuals and is more responsive to changes in risk associated with treatment intervention than an index restricted to age and HIV biomarkers. The VACS Index holds promise as an intermediate outcome for intervention research.

Sibling Feeding Behavior: Mothers as Role Models During Mealtimes

PubMed Central

Mosli, Rana H.; Miller, Alison L.; Peterson, Karen E.; Lumeng, Julie C.

2015-01-01

Siblings may act as caregivers and role models during mealtimes, and develop caregiving skills by observing and imitating the behavior of their mothers. The objective of this study was to examine the association between maternal feeding behaviors and encouragements to eat delivered from the sibling to the index child during mealtimes. Index children aged 4-8 years (n = 69) were videotaped while eating a routine evening meal at home with one sibling present. Encouragements to eat delivered from the sibling to the index child were coded from the videotapes. Mothers completed the Child Feeding Questionnaire and the Caregiver's Feeding Styles Questionnaire. Poisson regression was used to examine the association of maternal Pressure to Eat, Restriction, Monitoring, Verbal Direction, and Coercion with number of encouragements to eat delivered from the sibling to the index child. Models were adjusted for index child's age, sex, and race/ethnicity, and maternal education. Results showed that maternal Pressure to Eat (Rate Ratio (RR): 1.39, 95% confidence interval (CI): 1.19, 1.69), Restriction (RR: 1.31, 95% CI: 1.07, 1.60), Verbal Direction (RR: 2.04, 95% CI: 1.68, 2.47), and Coercion (RR: 1.58, 95% CI: 1.29, 1.92) were each positively associated with the number of encouragements to eat delivered from the sibling to the index child. Maternal Monitoring was not associated with the number of encouragements to eat delivered from the sibling to the index child (RR: 0.92, 97% CI: 0.78, 1.09). Findings suggest that maternal behavior during mealtimes may affect the index child indirectly by shaping the behavior of siblings. Since controlling feeding behaviors have been associated with greater child obesity risk, future studies may evaluate the compounded effect of experiencing controlling feeding behaviors from both mothers and siblings. PMID:26585632

FIB-4 index for assessing the prognosis of hepatocellular carcinoma in patients with Child-Pugh class A liver function.

PubMed

Ito, Takanori; Kumada, Takashi; Toyoda, Hidenori; Tada, Toshifumi

2015-07-01

We evaluated the prognosis of hepatocellular carcinoma (HCC) patients with Child-Pugh (C-P) class A based on FIB-4 index, which is a liver fibrosis marker. A total of 915 HCC patients with C-P class A were investigated. We assessed the prognosis using FIB-4 index, and factors associated with survival rates were analyzed in these patients. When patients were categorized according to FIB-4 index as <2.0 (n = 93), ≥ 2.0 and <4.0 (n = 311), and ≥ 4.0 (n = 511), survival rates at 5 years were 70.5% [95% confidence interval (CI) 59.0-79.9], 56.4% (95% CI 50.1-62.5), and 47.1% (95% CI 42.2-52.1), respectively. Patients with FIB-4 index <2.0 had a higher survival rate than the other groups (≥ 4.0 vs ≥ 2.0 and <4.0, p = 0.010; ≥ 2.0 and <4.0 vs <2.0, p = 0.028). We were able to predict prognosis in patients with C-P score 5 by FIB-4 index, but survival rate did not significantly differ in patients with C-P score 6. Multivariate analysis identified C-P score, FIB-4 index [≥ 2.0 and <4.0; hazard ratios (HRs) 1.638 (95% CI 1.084-2.474); p = 0.019/≥ 4.0; HR 1.828 (95% CI 1.217-2.744); p = 0.004], Lens culinaris agglutinin-reactive α-fetoprotein, tumor size, number, vascular invasion, antiviral therapy, and hepatectomy as independent predictive factors for survival. The FIB-4 index is useful for assessing prognosis in HCC patients with C-P class A, especially those with C-P score 5.

Gender disparities in high-quality research revealed by Nature Index journals

PubMed Central

Müller, Ruth; Brueggmann, Doerthe; Groneberg, David A.

2018-01-01

Background The present study aims to elucidate the state of gender equality in high-quality research by analyzing the representation of female authorships in the last decade (from 2008 to 2016). Methods Based on the Gendermetrics platform, 293,557 research articles from 54 journals listed in the Nature Index were considered covering the categories Life Science, Multidisciplinary, Earth & Environmental and Chemistry. The core method was the combined analysis of the proportion of female authorships and the female-to-male odds ratio for first, co- and last authorships. The distribution of prestigious authorships was measured by the Prestige Index. Results 29.8% of all authorships and 33.1% of the first, 31.8% of the co- and 18.1% of the last authorships were held by women. The corresponding female-to-male odds ratio is 1.19 (CI: 1.18–1.20) for first, 1.35 (CI: 1.34–1.36) for co- and 0.47 (CI: 0.46–0.48) for last authorships. Women are underrepresented at prestigious authorships compared to men (Prestige Index = -0.42). The underrepresentation accentuates in highly competitive articles attracting the highest citation rates, namely, articles with many authors and articles that were published in highest-impact journals. More specifically, a large negative correlation between the 5-Year-Impact-Factor of a journal and the female representation at prestigious authorships was revealed (r(52) = -.63, P < .001). Women publish fewer articles compared to men (39.0% female authors are responsible for 29.8% of all authorships) and are underrepresented at productivity levels of more than 2 articles per author. Articles with female key authors are less frequently cited than articles with male key authors. The gender-specific differences in citation rates increase the more authors contribute to an article. Distinct differences at the journal, journal category, continent and country level were revealed. The prognosis for the next decades forecast a very slow harmonization of authorships odds between the two genders. PMID:29293499

Sensitivity and specificity of different methods for cystic fibrosis-related diabetes screening: is the oral glucose tolerance test still the standard?

PubMed

Mainguy, Catherine; Bellon, Gabriel; Delaup, Véronique; Ginoux, Tiphanie; Kassai-Koupai, Behrouz; Mazur, Stéphane; Rabilloud, Muriel; Remontet, Laurent; Reix, Philippe

2017-01-01

Cystic fibrosis-related diabetes (CFRD) is a late cystic fibrosis (CF)-associated comorbidity whose prevalence is increasing sharply lifelong. Guidelines for glucose metabolism (GM) monitoring rely on the oral glucose tolerance test (OGTT). However, this test is neither sensitive nor specific. The aim of this study was to compare sensitivity and specificity of different methods for GM monitoring in children and adolescents with CF. Continuous glucose monitoring system (CGMS), used as the reference method, was compared with the OGTT, intravenous glucose tolerance test (IGTT), homeostasis model assessment index of insulin resistance (HOMA-IR), homeostasis model assessment index of β-cell function (HOMA-%B) and glycated haemoglobin A1C. Patients were classified into three groups according to CGMS: normal glucose tolerance (NGT), impaired glucose tolerance (IGT) and diabetes mellitus (DM). Twenty-nine patients (median age: 13.1 years) were recruited. According to CGMS, 11 had DM, 12 IGT and six NGT, whereas OGTT identified three patients with DM and five with IGT. While 13 of 27 had insulin deficiency according to IGTT, there was 19 of 28 according to HOMA-%B. According to HOMA-IR, 12 of 28 had insulin resistance. HOMA-%B was the most sensitive method for CFRD screening [sensitivity 91% (95% CI), specificity 47% (95% CI) and negative predictive value 89% (95% CI)]. OGTT showed the weak capacity to diagnose DM in CF and should no longer be considered as the reference method for CFRD screening in patients with CF. In our study, HOMA-%B showed promising metrics for CFRD screening. Finally, CGMS revealed that pathological glucose excursions were frequent even early in life.

Pre-Pregnancy Body Mass Index in Relation to Infant Birth Weight and Offspring Overweight/Obesity: A Systematic Review and Meta-Analysis

PubMed Central

Yu, Zhangbin; Han, Shuping; Zhu, Jingai; Sun, Xiaofan; Ji, Chenbo; Guo, Xirong

2013-01-01

Background Overweight/obesity in women of childbearing age is a serious public-health problem. In China, the incidence of maternal overweight/obesity has been increasing. However, there is not a meta-analysis to determine if pre-pregnancy body mass index (BMI) is related to infant birth weight (BW) and offspring overweight/obesity. Methods Three electronic bibliographic databases (MEDLINE, EMBASE and CINAHL) were searched systematically from January 1970 to November 2012. The dichotomous data on pre-pregnancy overweight/obesity and BW or offspring overweight/obesity were extracted. Summary statistics (odds ratios, ORs) were used by Review Manager, version 5.1.7. Results After screening 665 citations from three electronic databases, we included 45 studies (most of high or medium quality). Compared with normal-weight mothers, pre-pregnancy underweight increased the risk of small for gestational age (SGA) (odds ratios [OR], 1.81; 95% confidence interval [CI], 1.76–1.87); low BW (OR, 1.47; 95% CI, 1.27–1.71). Pre-pregnancy overweight/obesity increased the risk of being large for gestational age (LGA) (OR, 1.53; 95% CI, 1.44–1.63; and OR, 2.08; 95% CI; 1.95–2.23), high BW (OR, 1.53; 95% CI, 1.44–1.63; and OR, 2.00; 95% CI; 1.84–2.18), macrosomia (OR, 1.67; 95% CI, 1.42–1.97; and OR, 3.23; 95% CI, 2.39–4.37), and subsequent offspring overweight/obesity (OR, 1.95; 95% CI, 1.77–2.13; and OR, 3.06; 95% CI, 2.68–3.49), respectively. Sensitivity analyses revealed that sample size, study method, quality grade of study, source of pre-pregnancy BMI or BW had a strong impact on the association between pre-pregnancy obesity and LGA. No significant evidence of publication bias was observed. Conclusions Pre-pregnancy underweight increases the risk of SGA and LBW; pre-pregnancy overweight/obesity increases the risk of LGA, HBW, macrosomia, and subsequent offspring overweight/obesity. A potential effect modification by maternal age, ethnicity, gestational weight gain, as well as the role of gestational diseases should be addressed in future studies. PMID:23613888

Wealth index and risk of childhood overweight and obesity: evidence from four prospective cohorts in Peru and Vietnam.

PubMed

Carrillo-Larco, Rodrigo M; Miranda, J Jaime; Bernabé-Ortiz, Antonio

2016-05-01

To estimate the incidence and risk of childhood overweight and obesity according to socioeconomic status in Peruvian and Vietnamese school-aged children. Longitudinal data from the Young Lives study were analyzed. Exposure was wealth index in tertiles. Outcome was overweight and obesity. Cumulative incidence per 100 children-years, relative risks (RR), and 95 % confidence intervals (95 % CI) were calculated. A hierarchical approach, including child- and family-related variables, was followed to construct multivariable models. The cumulative incidence of overweight and obesity was 4.8 (95 % CI 4.1-5.5) and 1.7 (95 % CI 1.3-2.2) in the younger and older Peruvian cohort, respectively; and in Vietnam 1.5 (95 % CI 1.2-1.8) and 0.3 (95 % CI 0.2-0.5), respectively. The incidence of overweight and obesity was higher at the top wealth index tertile in all samples. In the older cohorts, comparing highest versus bottom wealth index tertile, RR of overweight and obesity was four to nine times higher: 4.25 in Peru (95 % CI 2.21-8.18) and 9.11 in Vietnam (95 % CI 1.07-77.42). The results provide important information for childhood obesity prevention in countries moving ahead with economic, epidemiological and nutritional transitions.

Functional Independence, Diagnostic Groups, Hospital Stay, and Modality of Payment in Three Croatian Seaside Inpatient Rehabilitation Centers

PubMed Central

Mrčela, Nada Tomasović; Massari, Dražen; Vlak, Tonko

2010-01-01

Aim To determine patients’ functional independence, diagnostic groups, duration of hospital stay, and modality of payment of rehabilitation in major special hospitals for rheumatology and medical rehabilitation on the Croatian seaside. Methods In a cross-sectional study conducted from October 2006 until January 2009, we surveyed 400 patients treated at 3 special hospitals for medical rehabilitation. Their functional independence was assessed by modified Barthel index and they self-evaluated their health using the first item from the 36-Item Short-Form Health Survey questionnaire. Results On admission, almost half of the patients (46%) were fully functionally independent, 33% were slightly dependent, while 21% were moderately or severely dependent. At the end of the hospitalization, significant predictors for the increase in Barthel index were longer hospital stay (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.06-1.22), diagnosis of post-procedural musculoskeletal disorders (OR, 4.84; 95% CI, 1.90-10.57), diagnosis of conditions following acute ischemic heart disease (OR, 9.71; 95% CI, 3.40-27.75), and lower Barthel index at admission (OR, 0.96; 95% CI, 0.94-0.97). Of the 97 patients with dorsopathy, 73 (75%) were fully functionally independent and 57 (59%) paid for the treatment either themselves or contributed substantially to the total cost. Conclusion Assessment of patients’ functional status is important for the organization of inpatient rehabilitation. Patients with dorsopathy could be targeted as a population for medical tourism in rehabilitation medicine in order to maximize the use of rehabilitation hospitals. PMID:21162166

Decreased Body Mass Index in Schoolchildren After Yearlong Information Sessions With Parents Reinforced With Web and Mobile Phone Resources: Community Trial

PubMed Central

Vilchis-Gil, Jenny; Klünder-Klünder, Miguel; Duque, Ximena

2016-01-01

Background The obesity pandemic has now reached children, and households should change their lifestyles to prevent it. Objective The objective was to assess the effect of a comprehensive intervention on body mass index z-score (BMIZ) in schoolchildren. Methods A yearlong study was conducted at 4 elementary schools in Mexico City. Intervention group (IG) and control group (CG) were split equally between governmental and private schools. Three educational in-person parents and children sessions were held at 2-month intervals to promote healthy eating habits and exercise. To reinforce the information, a website provided extensive discussion on a new topic every 2 weeks, including school snack menus and tools to calculate body mass index in children and adults. Text messages were sent to parents’ mobile phones reinforcing the information provided. The IG contained 226 children and CG 181 children. We measured their weight and height and calculated BMIZ at 0, 6, and 12 months. Results The CG children showed a change of +0.06 (95% CI 0.01, 0.11) and +0.05 (95% CI 0.01, 0.10) in their BMIZ at 6 and 12 months, respectively. The BMIZ of IG children decreased by -0.13 (95% CI -0.19 to -0.06) and -0.10 (95% CI -0.16 to -0.03), respectively, and the effect was greater in children with obesity. Conclusions The comprehensive intervention tested had beneficial effects, preserved the BMIZ of normal weight children, and reduced the BMIZ of children with obesity. PMID:27342650

Modified Creatinine Index and the Risk of Bone Fracture in Patients Undergoing Hemodialysis: The Q-Cohort Study.

PubMed

Yamada, Shunsuke; Taniguchi, Masatomo; Tokumoto, Masanori; Yoshitomi, Ryota; Yoshida, Hisako; Tatsumoto, Narihito; Hirakata, Hideki; Fujimi, Satoru; Kitazono, Takanari; Tsuruya, Kazuhiko

2017-08-01

Hemodialysis patients are at increased risk for bone fracture and sarcopenia. There is close interplay between skeletal muscle and bone. However, it is still unclear whether lower skeletal muscle mass increases the risk for bone fracture. Cross-sectional study and prospective longitudinal cohort study. An independent cohort of 78 hemodialysis patients in the cross-sectional study and 3,030 prevalent patients undergoing maintenance hemodialysis prospectively followed up for 4 years. Skeletal muscle mass measured by bioelectrical impedance analysis (BIA) and modified creatinine index, an estimate of skeletal muscle mass based on age, sex, Kt/V for urea, and serum creatinine level. Bone fracture at any site. In the cross-sectional study, modified creatinine index was significantly correlated with skeletal muscle mass measured by BIA. During a median follow-up of 3.9 years, 140 patients had bone fracture. When patients were divided into sex-specific quartiles based on modified creatinine index, risk for bone fracture estimated by a Fine-Gray proportional subdistribution hazards model with all-cause death as a competing risk was significantly higher in the lower modified creatinine index quartiles (Q1 and Q2) compared to the highest modified creatinine index quartile (Q4) as the reference value in both sexes (multivariable-adjusted HRs for men were 7.81 [95% CI, 2.63-23.26], 5.48 [95% CI, 2.08-14.40], 2.24 [95% CI, 0.72-7.00], and 1.00 [P for trend < 0.001], and for women were 4.44 [95% CI, 1.50-13.11], 2.33 [95% CI, 0.86-6.31], 1.96 [95% CI, 0.82-4.65], and 1.00 [P for trend = 0.007] for Q1, Q2, Q3, and Q4, respectively). One-time assessment of modified creatinine index; no data for residual kidney function and fracture sites and causes. Modified creatinine index was correlated with skeletal muscle mass measured by BIA. Lower modified creatinine index was associated with increased risk for bone fracture in male and female hemodialysis patients. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Diagnostic accuracy of tests to detect Hepatitis C antibody: a meta-analysis and review of the literature.

PubMed

Tang, Weiming; Chen, Wen; Amini, Ali; Boeras, Debi; Falconer, Jane; Kelly, Helen; Peeling, Rosanna; Varsaneux, Olivia; Tucker, Joseph D; Easterbrook, Philippa

2017-11-01

Although direct-acting antivirals can achieve sustained virological response rates greater than 90% in Hepatitis C Virus (HCV) infected persons, at present the majority of HCV-infected individuals remain undiagnosed and therefore untreated. While there are a wide range of HCV serological tests available, there is a lack of formal assessment of their diagnostic performance. We undertook a systematic review and meta-analysis to evaluate he diagnostic accuracy of available rapid diagnostic tests (RDT) and laboratory based EIA assays in detecting antibodies to HCV. We used the PRISMA checklist and Cochrane guidance to develop our search protocol. The search strategy was registered in PROSPERO (CRD42015023567). The search focused on hepatitis C, diagnostic tests, and diagnostic accuracy within eight databases (MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Science Citation Index Expanded, Conference Proceedings Citation Index-Science, SCOPUS, Literatura Latino-Americana e do Caribe em Ciências da Saúde and WHO Global Index Medicus. Studies were included if they evaluated an assay to determine the sensitivity and specificity of HCV antibody (HCV Ab) in humans. Two reviewers independently extracted data and performed a quality assessment of the studies using the QUADAS tool. We pooled test estimates using the DerSimonian-Laird method, by using the software R and RevMan. 5.3. A total of 52 studies were identified that included 52,673 unique test measurements. Based on five studies, the pooled sensitivity and specificity of HCV Ab rapid diagnostic tests (RDTs) were 98% (95% CI 98-100%) and 100% (95% CI 100-100%) compared to an enzyme immunoassay (EIA) reference standard. High HCV Ab RDTs sensitivity and specificity were observed across screening populations (general population, high risk populations, and hospital patients) using different reference standards (EIA, nucleic acid testing, immunoblot). There were insufficient studies to undertake subanalyses based on HIV co-infection. Oral HCV Ab RDTs also had excellent sensitivity and specificity compared to blood reference tests, respectively at 94% (95% CI 93-96%) and 100% (95% CI 100-100%). Among studies that assessed individual oral RDTs, the eight studies revealed that OraQuick ADVANCE® had a slightly higher sensitivity (98%, 95% CI 97-98%) compared to the other oral brands (pooled sensitivity: 88%, 95% CI 84-92%). RDTs, including oral tests, have excellent sensitivity and specificity compared to laboratory-based methods for HCV antibody detection across a wide range of settings. Oral HCV Ab RDTs had good sensitivity and specificity compared to blood reference standards.

Measurement of the ankle brachial index with a non-mercury sphygmomanometer in diabetic patients: a concordance study

PubMed Central

2013-01-01

Background The removal of mercury sphygmomanometers from health centers requires the validation of other instruments to measure blood pressure in the limbs to calculate the ankle-brachial index (ABI). Methods Descriptive cross-sectional study of agreement between two measurement methods in type 2 diabetes patients from three urban primary healthcare centres in the Barcelonès Nord i Maresme area (Catalonia, Spain). ABI was determined with Doppler and mercury sphygmomanometer and Doppler and the “hybrid” sphygmomanometer OMRON HEM-907 model. Agreement was evaluated using the weighted kappa index. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated using the mercury sphygmomanometer as the gold standard. Results 211 patients were included, from these, 421 limbs were available for study. The mean age of the participants was 67 years (SD = 10), 51.7% were women. The index of agreement between ABI measured with a mercury sphygmomanometer and with the OMRON HEM-907 blood pressure monitor was good (weighted kappa index = 0.68; CI 95%: [0.55–0.79]) and improved when the ABI cut-off value was set at ≤0.70 (weighted kappa index = 0.92; CI 95%: [0.81–1.00]). Sensitivity and specificity were 77.5% and 98.2%, respectively. PPV was 83.8% and NPV was 97.3%. With the ABI cut-off value ≤0.70, sensitivity and specificity increased to 85.7% and 100%, respectively, PPV to 100% and NPV to 99.4%. Conclusion The combination of a Doppler device with the hybrid sphygmomanometer is a simple and reliable method to measure ABI showing that hybrid sphygmomanometer is a good alternative to the use of mercury sphygmomanometers. PMID:23497339

Pretreatment of Oil Palm Frond (OPF) with Ionic Liquid

NASA Astrophysics Data System (ADS)

Azmi, I. S.; Azizan, A.; Salleh, R. Mohd

2018-05-01

Pretreatment is the key to unlock the recalcitrance of lignocellulose for cellulosic biofuel production. Increasing attention has been drawn to ionic liquids (ILs) for pretreatment of lignocellulosic biomass because this approach was considered as a green engineering method over other conventional methods. In this work, Oil palm frond (OPF) was pretreated by using the ionic liquid 1-ethyl-3-methylimidazolium acetate [EMIM] Ac at the temperature of 99˚C for 3 hours. The characterization of the untreated and pretreated OPF was conducted by using different techniques which are Fourier Transform Infrared Spectroscopy (FTIR), X-Ray Diffraction (XRD) and Scanning Electron Microscopy (SEM). The pretreatment of OPF with [EMIM] Ac was demonstrated to be effective evidenced by the significant reduction of Lateral Order Index (LOI) from FTIR, reduction of Crystallinity Index (CI) based on XRD and the significant morphology changes indicated by SEM. The CI value for the pretreated OPF decreased from 0.47 (untreated sample) to 0.28 while the LOI value decreased from 1.10 to 0.24 after pretreatment with [EMIM]Ac and the SEM morphology showed that the pretreated OPF becomes distorted and disordered.

Oral Health Status among Children with Cerebral Palsy in Dubai, United Arab Emirates

PubMed Central

Al Hashmi, Haifa; Kowash, Mawlood; Hassan, Amar; Al Halabi, Manal

2017-01-01

Objectives: The purpose of this study was to assess the oral health status of children with cerebral palsy (CP) in Dubai, United Arab Emirates (UAE). Materials and Methods: Eighty-four CP and 125 healthy children were recruited from special needs centers and private/public schools in Dubai. A dental examination for decayed-missing-filled teeth in primary dentition (dmft)/Decayed-Missing-Filled teeth in permanent dentition (DMFT) indices, simplified oral hygiene index, calculus index (CI), and oral debris index was conducted. In addition, assessments of occlusal, dentofacial, soft tissue anomalies and erosion were conducted. Statistical analysis was conducted using SPSS for Windows, version 20.0 (SPSS Inc., Chicago, IL, USA). Results: DMFT/dmft scores were comparable in both groups. CI was significantly higher among children with CP. CP patients had a significantly higher proportion of anterior open bite, anterior spacing, Class II molar Angle malocclusion, trauma, high-arched palate, tongue thrust, lymphadenopathy, angular cheilitis, macroglossia, drooling, and erosion as compared to controls. Conclusions: The study highlighted peculiar characteristics and needs for the CP patients in Dubai, UAE. PMID:29285470

Validation of adipose lipid content as a body condition index for polar bears

USGS Publications Warehouse

McKinney, Melissa A.; Atwood, Todd C.; Dietz, Rune; Sonne, Christian; Iverson, Sara J.; Peacock, Elizabeth

2014-01-01

Body condition is a key indicator of individual and population health. Yet, there is little consensus as to the most appropriate condition index (CI), and most of the currently used CIs have not been thoroughly validated and are logistically challenging. Adipose samples from large datasets of capture biopsied, remote biopsied, and harvested polar bears were used to validate adipose lipid content as a CI via tests of accuracy, precision, sensitivity, biopsy depth, and storage conditions and comparisons to established CIs, to measures of health and to demographic and ecological parameters. The lipid content analyses of even very small biopsy samples were highly accurate and precise, but results were influenced by tissue depth at which the sample was taken. Lipid content of capture biopsies and samples from harvested adult females was correlated with established CIs and/or conformed to expected biological variation and ecological changes. However, lipid content of remote biopsies was lower than capture biopsies and harvested samples, possibly due to lipid loss during dart retrieval. Lipid content CI is a biologically relevant, relatively inexpensive and rapidly assessed CI and can be determined routinely for individuals and populations in order to infer large-scale spatial and long-term temporal trends. As it is possible to collect samples during routine harvesting or remotely using biopsy darts, monitoring and assessment of body condition can be accomplished without capture and handling procedures or noninvasively, which are methods that are preferred by local communities. However, further work is needed to apply the method to remote biopsies.

Validation of adipose lipid content as a body condition index for polar bears

PubMed Central

McKinney, Melissa A; Atwood, Todd; Dietz, Rune; Sonne, Christian; Iverson, Sara J; Peacock, Elizabeth

2014-01-01

Body condition is a key indicator of individual and population health. Yet, there is little consensus as to the most appropriate condition index (CI), and most of the currently used CIs have not been thoroughly validated and are logistically challenging. Adipose samples from large datasets of capture biopsied, remote biopsied, and harvested polar bears were used to validate adipose lipid content as a CI via tests of accuracy, precision, sensitivity, biopsy depth, and storage conditions and comparisons to established CIs, to measures of health and to demographic and ecological parameters. The lipid content analyses of even very small biopsy samples were highly accurate and precise, but results were influenced by tissue depth at which the sample was taken. Lipid content of capture biopsies and samples from harvested adult females was correlated with established CIs and/or conformed to expected biological variation and ecological changes. However, lipid content of remote biopsies was lower than capture biopsies and harvested samples, possibly due to lipid loss during dart retrieval. Lipid content CI is a biologically relevant, relatively inexpensive and rapidly assessed CI and can be determined routinely for individuals and populations in order to infer large-scale spatial and long-term temporal trends. As it is possible to collect samples during routine harvesting or remotely using biopsy darts, monitoring and assessment of body condition can be accomplished without capture and handling procedures or noninvasively, which are methods that are preferred by local communities. However, further work is needed to apply the method to remote biopsies. PMID:24634735

Self-Reported Work Ability Predicts Rehabilitation Measures, Disability Pensions, Other Welfare Benefits, and Work Participation: Longitudinal Findings from a Sample of German Employees.

PubMed

Bethge, Matthias; Spanier, Katja; Peters, Elke; Michel, Elliot; Radoschewski, Michael

2017-09-27

Purpose The study examined the performance of the Work Ability Index in predicting rehabilitation measures and disability pensions, sickness absence and unemployment benefits, and work participation among a sample of workers previously receiving sickness absence benefits. Methods Workers aged 40 to 54 years who received sickness absence benefits in 2012 completed the Work Ability Index in 2013. Outcomes were extracted from administrative data records. Results Data for 2149 participants were included (mean age: 47.8 years; 54.4% women). Mean follow-up was 19 months. Work Ability Index scores were poor (7-27 points) in 21% of the participants, and moderate (28-36 points) in 38.4%. In all, 224 rehabilitation measures and 35 disability pensions were approved. Fully adjusted analyses showed increased risk of rehabilitation measures in workers with poor (HR 4.55; 95% CI 3.14-6.60) and moderate scores (HR 2.08; 95% CI 1.43-3.01) compared to workers with good or excellent scores (37-49 points). The risk of a disability pension increased significantly for workers with poor scores (HR 7.78; 95% CI 2.59-23.35). In addition, poor scores were prospectively associated with a longer duration of sickness absence and employment benefits, and fewer employment days and less income from regular employment. Conclusions The Work Ability Index is a potential tool for following up workers who already have an increased risk of permanent work disability due to previous long-term sickness absence.

Characteristics of Responders to Cardiac Resynchronization Therapy: The Impact of Echocardiographic Left Ventricular Volume

PubMed Central

Park, Mi Young; Altman, Robert K.; Orencole, Mary; Kumar, Prabhat; Parks, Kimberly A.; Heist, Kevin E.; Singh, Jagmeet P.; Picard, Michael H.

2012-01-01

Summary Background One third of patients who receive cardiac resynchronization therapy (CRT) are classified as nonresponders. Characteristics of responders to CRT have been studied in multiple clinical trials. Hypothesis We aimed to examine characteristics of CRT responders in a routine clinical practice. Method One hundred and twenty five patients were examined retrospectively from a multidisciplinary CRT clinic program. Echocardiographic CRT response was defined as a decrease in left ventricular (LV) end systolic volume (ESV) of ≥ 15% and/or absolute increase of 5% in LV ejection fraction (EF) at 6 month visit. Results There were 81 responders and 44 nonresponders. By univariate analyses, female gender, nonischemic cardiomyopathy etiology, baseline QRS duration, the presence of left bundle branch block (LBBB) and left ventricular end-diastolic volume (LVEDV) index predicted CRT response. However, multivariate analysis demonstrated only QRS duration, LBBB and LVEDV index were independent predictors (QRS width: Odd ratio [OR] 1.027, 95% CI 1.004 – 1.050, p = 0.023; LBBB: OR 3.568, 95% CI 1.284 – 9.910, p=0.015; LV EDV index: OR 0.970, 95% CI 0.953 – 0.987, p= 0.001). While female gender and nonischemic etiology were associated with an improved CRT response on univariate analyses, after adjusting for LV volumes, they were not independent predictors. Conclusion QRS width, LBBB and LVEDV index are independent predictors for echocardiographic CRT response. Previously reported differences in CRT response for gender and cardiomyopathy etiology are associated with differences in baseline LV volumes in our clinical practice. PMID:22886700

Slope stability analysis using limit equilibrium method in nonlinear criterion.

PubMed

Lin, Hang; Zhong, Wenwen; Xiong, Wei; Tang, Wenyu

2014-01-01

In slope stability analysis, the limit equilibrium method is usually used to calculate the safety factor of slope based on Mohr-Coulomb criterion. However, Mohr-Coulomb criterion is restricted to the description of rock mass. To overcome its shortcomings, this paper combined Hoek-Brown criterion and limit equilibrium method and proposed an equation for calculating the safety factor of slope with limit equilibrium method in Hoek-Brown criterion through equivalent cohesive strength and the friction angle. Moreover, this paper investigates the impact of Hoek-Brown parameters on the safety factor of slope, which reveals that there is linear relation between equivalent cohesive strength and weakening factor D. However, there are nonlinear relations between equivalent cohesive strength and Geological Strength Index (GSI), the uniaxial compressive strength of intact rock σ ci , and the parameter of intact rock m i . There is nonlinear relation between the friction angle and all Hoek-Brown parameters. With the increase of D, the safety factor of slope F decreases linearly; with the increase of GSI, F increases nonlinearly; when σ ci is relatively small, the relation between F and σ ci is nonlinear, but when σ ci is relatively large, the relation is linear; with the increase of m i , F decreases first and then increases.

Slope Stability Analysis Using Limit Equilibrium Method in Nonlinear Criterion

PubMed Central

Lin, Hang; Zhong, Wenwen; Xiong, Wei; Tang, Wenyu

2014-01-01

In slope stability analysis, the limit equilibrium method is usually used to calculate the safety factor of slope based on Mohr-Coulomb criterion. However, Mohr-Coulomb criterion is restricted to the description of rock mass. To overcome its shortcomings, this paper combined Hoek-Brown criterion and limit equilibrium method and proposed an equation for calculating the safety factor of slope with limit equilibrium method in Hoek-Brown criterion through equivalent cohesive strength and the friction angle. Moreover, this paper investigates the impact of Hoek-Brown parameters on the safety factor of slope, which reveals that there is linear relation between equivalent cohesive strength and weakening factor D. However, there are nonlinear relations between equivalent cohesive strength and Geological Strength Index (GSI), the uniaxial compressive strength of intact rock σ ci, and the parameter of intact rock m i. There is nonlinear relation between the friction angle and all Hoek-Brown parameters. With the increase of D, the safety factor of slope F decreases linearly; with the increase of GSI, F increases nonlinearly; when σ ci is relatively small, the relation between F and σ ci is nonlinear, but when σ ci is relatively large, the relation is linear; with the increase of m i, F decreases first and then increases. PMID:25147838

Study on Entomological Surveillance and its Significance during a Dengue Outbreak in the District of Tirunelveli in Tamil Nadu, India

PubMed Central

Basker, Parasuraman; Kannan, Pichai; Porkaipandian, Rajagopal Thirugnanasambandam; Saravanan, Sivsankaran; Sridharan, Subramaniam; Kadhiresan, Mahaligam

2013-01-01

Objectives To study the significance of entomological surveillance, the house index (HI), container index (CI), and Breteau index (BI) were determined to estimate the degree of a major dengue outbreak in Tirunelveli, Tamil Nadu, India (Latitude: 8°42′N; Longitude: 77°42′E) in May 2012. Methods The HI, CI, and BI were determined in a primary health center (PHC) in the village of Maruthamputhur (Pappakudi taluk, Tirunelveli) by carrying out an antilarval (AL) work that involved door-to-door search for immature stages of Aedes spp. mosquitoes by trained field workers and volunteers. The work of field workers was evaluated by a junior and senior entomologist the following day. Results Before the AL work, the reported numbers of fever cases from Week 1 to 5 in Maruthamputhur were 211, 394, 244, 222, and 144 with two deaths. By contrast, after the AL work, these numbers were considerably reduced and there was no fever-related death (the HI was reduced from 48.2% to 1.6%, the CI from 28.6% to 0.4%, and the BI from 48.2 to 1.6). Conclusion Because no specific medicine and vaccines are available to treat dengue fever and dengue hemorrhagic fever, entomological surveillance and its significance can be used to halt the outbreak of dengue as shown in this study. PMID:24159547

[Identification of adverse events in hospitalised influenza patients].

PubMed

Aranaz-Andrés, J M; Gea-Velázquez de Castro, M T; Jiménez-Pericás, F; Balbuena-Segura, A I; Meyer-García, M C; López-Fresneña, N; Miralles-Bueno, J J; Obón-Azuara, B; Moliner-Lahoz, J; Aibar-Remón, C

2015-01-01

To test the inter-observer agreement in identifying adverse events (AE) in patients hospitalized by flu and undergoing precautionary isolation measures. Historical cohort study, 50 patients undergoing isolation measures due to flu, and 50 patients without any isolation measures. The AE incidence ranges from 10 to 26% depending on the observer (26% [95%CI: 17.4%-34.60%], 10% [95%CI: 4.12%-15.88%], and 23% [95%CI: 14.75%-31.25%]). It was always lower in the cohort undergoing the isolation measures. This difference is statistically significant when the accurate definition of a case is applied. The agreement as regards the screening was good (higher than 76%; Kappa index between 0.29 and 0.81). The agreement as regards the accurate identification of AE related to care was lower (from 50 to 93.3%, Kappa index from 0.20 to 0.70). Before performing an epidemiological study on AE, interobserver concordance must be analyzed to improve the accuracy of the results and the validity of the study. Studies have different levels of reliability. Kappa index shows high levels for the screening guide, but not for the identification of AE. Without a good methodology the results achieved, and thus the decisions made from them, cannot be guaranteed. Researchers have to be sure of the method used, which should be as close as possible to the optimal achievable. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

Quantitative Assessment of Combination Antimicrobial Therapy against Multidrug-Resistant Acinetobacter baumannii▿

PubMed Central

Lim, Tze-Peng; Ledesma, Kimberly R.; Chang, Kai-Tai; Hou, Jing-Guo; Kwa, Andrea L.; Nikolaou, Michael; Quinn, John P.; Prince, Randall A.; Tam, Vincent H.

2008-01-01

Treatment of multidrug-resistant bacterial infections poses a therapeutic challenge to clinicians; combination therapy is often the only viable option for multidrug-resistant infections. A quantitative method was developed to assess the combined killing abilities of antimicrobial agents. Time-kill studies (TKS) were performed using a multidrug-resistant clinical isolate of Acinetobacter baumannii with escalating concentrations of cefepime (0 to 512 mg/liter), amikacin (0 to 256 mg/liter), and levofloxacin (0 to 64 mg/liter). The bacterial burden data in single and combined (two of the three agents with clinically achievable concentrations in serum) TKS at 24 h were mathematically modeled to provide an objective basis for comparing various antimicrobial agent combinations. Synergy and antagonism were defined as interaction indices of <1 and >1, respectively. A hollow-fiber infection model (HFIM) simulating various clinical (fluctuating concentrations over time) dosing exposures was used to selectively validate our quantitative assessment of the combined killing effect. Model fits in all single-agent TKS were satisfactory (r2 > 0.97). An enhanced combined overall killing effect was seen in the cefepime-amikacin combination (interactive index, 0.698; 95% confidence interval [CI], 0.675 to 0.722) and the cefepime-levofloxacin combination (interactive index, 0.929; 95% CI, 0.903 to 0.956), but no significant difference in the combined overall killing effect for the levofloxacin-amikacin combination was observed (interactive index, 0.994; 95% CI, 0.982 to 1.005). These assessments were consistent with observations in HFIM validation studies. Our method could be used to objectively rank the combined killing activities of two antimicrobial agents when used together against a multidrug-resistant A. baumannii isolate. It may offer better insights into the effectiveness of various antimicrobial combinations and warrants further investigations. PMID:18505848

The effects of weight change on glomerular filtration rate

PubMed Central

Chang, Alex; Greene, Tom H.; Wang, Xuelei; Kendrick, Cynthia; Kramer, Holly; Wright, Jackson; Astor, Brad; Shafi, Tariq; Toto, Robert; Lewis, Julia; Appel, Lawrence J.; Grams, Morgan

2015-01-01

Background Little is known about the effect of weight loss/gain on kidney function. Analyses are complicated by uncertainty about optimal body surface indexing strategies for measured glomerular filtration rate (mGFR). Methods Using data from the African-American Study of Kidney Disease and Hypertension (AASK), we determined the association of change in weight with three different estimates of change in kidney function: (i) unindexed mGFR estimated by renal clearance of iodine-125-iothalamate, (ii) mGFR indexed to concurrently measured BSA and (iii) GFR estimated from serum creatinine (eGFR). All models were adjusted for baseline weight, time, randomization group and time-varying diuretic use. We also examined whether these relationships were consistent across a number of subgroups, including tertiles of baseline 24-h urine sodium excretion. Results In 1094 participants followed over an average of 3.6 years, a 5-kg weight gain was associated with a 1.10 mL/min/1.73 m2 (95% CI: 0.87 to 1.33; P < 0.001) increase in unindexed mGFR. There was no association between weight change and mGFR indexed for concurrent BSA (per 5 kg weight gain, 0.21; 95% CI: −0.02 to 0.44; P = 0.1) or between weight change and eGFR (−0.09; 95% CI: −0.32 to 0.14; P = 0.4). The effect of weight change on unindexed mGFR was less pronounced in individuals with higher baseline sodium excretion (P = 0.08 for interaction). Conclusion The association between weight change and kidney function varies depending on the method of assessment. Future clinical trials should examine the effect of intentional weight change on measured GFR or filtration markers robust to changes in muscle mass. PMID:26085555

XRD and FTIR crystallinity indices in sound human tooth enamel and synthetic hydroxyapatite.

PubMed

Reyes-Gasga, José; Martínez-Piñeiro, Esmeralda L; Rodríguez-Álvarez, Galois; Tiznado-Orozco, Gaby E; García-García, Ramiro; Brès, Etienne F

2013-12-01

The crystallinity index (CI) is a measure of the percentage of crystalline material in a given sample and it is also correlated to the degree of order within the crystals. In the literature two ways are reported to measure the CI: X-ray diffraction and infrared spectroscopy. Although the CI determined by these techniques has been adopted in the field of archeology as a structural order measure in the bone with the idea that it can help e.g. in the sequencing of the bones in chronological and/or stratigraphic order, some debate remains about the reliability of the CI values. To investigate similarities and differences between the two techniques, the CI of sound human tooth enamel and synthetic hydroxyapatite (HAP) was measured in this work by X-ray diffraction (XRD) and Fourier Transform Infrared spectroscopy (FTIR), at room temperature and after heat treatment. Although the (CI)XRD index is related to the crystal structure of the samples and the (CI)FTIR index is related to the vibration modes of the molecular bonds, both indices showed similar qualitative behavior for heat-treated samples. At room temperature, the (CI)XRD value indicated that enamel is more crystalline than synthetic HAP, while (CI)FTIR indicated the opposite. Scanning (SEM) and transmission (TEM) images were also used to corroborate the measured CI values. © 2013.

Left ventricular diastolic dysfunction in type 2 diabetes patients: a novel 2D strain analysis based on cardiac magnetic resonance imaging.

PubMed

Chen, Qiang; Gan, Yan; Li, Zhi-Yong

2016-09-01

This study was to develop a strain analysis method to evaluate the left ventricular (LV) functions in type 2 diabetic patients with an asymptomatic LV diastolic dysfunction. Two groups (10 asymptomatic type 2 diabetic subjects and 10 control ones) were considered. All of the subjects had normal ejection fraction values but impaired diastolic functions assessed by the transmitral blood flow velocity. For each subject, based on cardiac MRI, global indexes including LV volume, LV myocardial mass, cardiac index (CI), and transmitral peak velocity, were measured, and regional indexes (i.e., LV deformation, strain and strain rate) were calculated through an image-registration technology. Most of the global indexes did not differentiate between the two groups, except for the CI, LV myocardial mass and transmitral peak velocity. While for the regional indexes, the global LV diastolic dysfunction of the diabetic indicated an increased strain (0.08 ± 0.044 vs. -0.031 ± 0.077, p = 0.001) and a reduced strain rate (1.834 ± 0.909 vs. 3.791 ± 2.394, p = 0.033) compared to the controls, moreover, the local LV diastolic dysfunction reflected by the strain and strain rate varied, and the degree of dysfunction gradually decreased from the basal level to the apical level. The results showed that the strain and strain rates are effective to capture the subtle alterations of the LV functions, and the proposed method can be used to estimate the LV myocardial function based on cardiac MRI.

Predicting Drug Combination Index and Simulating the Network-Regulation Dynamics by Mathematical Modeling of Drug-Targeted EGFR-ERK Signaling Pathway

NASA Astrophysics Data System (ADS)

Huang, Lu; Jiang, Yuyang; Chen, Yuzong

2017-01-01

Synergistic drug combinations enable enhanced therapeutics. Their discovery typically involves the measurement and assessment of drug combination index (CI), which can be facilitated by the development and applications of in-silico CI predictive tools. In this work, we developed and tested the ability of a mathematical model of drug-targeted EGFR-ERK pathway in predicting CIs and in analyzing multiple synergistic drug combinations against observations. Our mathematical model was validated against the literature reported signaling, drug response dynamics, and EGFR-MEK drug combination effect. The predicted CIs and combination therapeutic effects of the EGFR-BRaf, BRaf-MEK, FTI-MEK, and FTI-BRaf inhibitor combinations showed consistent synergism. Our results suggest that existing pathway models may be potentially extended for developing drug-targeted pathway models to predict drug combination CI values, isobolograms, and drug-response surfaces as well as to analyze the dynamics of individual and combinations of drugs. With our model, the efficacy of potential drug combinations can be predicted. Our method complements the developed in-silico methods (e.g. the chemogenomic profile and the statistically-inferenced network models) by predicting drug combination effects from the perspectives of pathway dynamics using experimental or validated molecular kinetic constants, thereby facilitating the collective prediction of drug combination effects in diverse ranges of disease systems.

Estimating fat mass in heart failure patients.

PubMed

Trippel, Tobias Daniel; Lenk, Julian; Gunga, Hanns-Christian; Doehner, Wolfram; von Haehling, Stephan; Loncar, Goran; Edelmann, Frank; Pieske, Burkert; Stahn, Alexander; Duengen, Hans-Dirk

2016-01-01

Body composition (BC) assessments in heart failure (HF) patients are mainly based on body weight, body mass index and waist-to-hip ratio. The present study compares BC assessments by basic anthropometry, dual energy X-ray absorptiometry (DXA), bioelectrical impedance spectroscopy (BIS), and air displacement plethysmography (ADP) for the estimation of fat (FM) and fat-free mass (FFM) in a HF population. In this single-centre, observational pilot study we enrolled 52 patients with HF (33 HF with reduced ejection fraction (HFrEF), 19 HF with preserved ejection fraction (HFpEF); mean age was 67.7 ±9.9 years, 41 male) and 20 healthy controls. DXA was used as a reference standard for the measurement of FM and FFM. In the HF population, linear regression for DXA-FM and waist-to-hip ratio ( r = -0.05, 95% CI: (-0.32)-0.23), body mass index ( r = 0.47, 95% CI: 0.23-0.669), and body density ( r = -0.87, 95% CI: (-0.93)-(-0.87)) was obtained. In HF, Lin's concordance correlation coefficient of DXA-FM (%) with ADP-FM (%) was 0.76 (95% CI: 0.64-0.85) and DXA-FFM [kg] with DXA-ADP [kg] was 0.93 (95% CI: 0.88-0.96). DXA-FM (%) for BIS-FM (%) was 0.69 (95% CI: 0.54-0.80) and 0.73 (95% CI: 0.60-0.82) for DXA-FFM [kg] and BIS-FFM [kg]. Body density is a useful surrogate for FM. ADP was found suitable for estimating FM (%) and FFM [kg] in HF patients. BIS showed acceptable results for the estimation of FM (%) in HFrEF and for FFM [kg] in HFpEF patients. We encourage selecting a suitable method for BC assessment according to the compartment of interest in the HF population.

Informed community mobilization for dengue prevention in households with and without a regular water supply: Secondary analysis from the Camino Verde trial in Nicaragua.

PubMed

Cárcamo, Alvaro; Arosteguí, Jorge; Coloma, Josefina; Harris, Eva; Ledogar, Robert J; Andersson, Neil

2017-05-30

Studies in different countries have identified irregular water supply as a risk factor for dengue virus transmission. In 2013, Camino Verde, a cluster-randomised controlled trial in Managua, Nicaragua, and Mexico's Guerrero State, demonstrated impact of evidence-based community mobilisation on recent dengue infection and entomological indexes of infestation by Aedes aegypti mosquitoes. This secondary analysis of data from the trial impact survey asks: (1) what is the importance of regular water supply in neighbourhoods with and without the trial intervention and (2) can community interventions like Camino Verde reasonably exclude households with adequate water supply? Entomological data collected in the dry season of 2013 in intervention and control communities allow contrasts between households with regular and irregular water supplies. Indicators of entomological risk included the House Index and pupa positive household index. Generalised linear mixed models with cluster as a random effect compared households with and without regular water, and households in intervention and control communities. For the House Index, regular water supply was associated with a protection in both intervention households (OR 0.7, 95%CI 0.6-0.9) and control households (OR 0.6, 95%CI 0.5-0.8). For the pupa positive household index, we found a similar protection from regular water supply in intervention households (OR 0.6, 95%CI 0.4-0.8) and control households (OR 0.7, 95%CI 0.5-0.9). The Camino Verde intervention had a similar impact on House Index in households with regular water supply (OR 0.7, 95%CI 0.5-1.0) and irregular water supply (OR 0.6, 95%CI 0.4-0.8); for the pupa positive household index, the effect of the intervention was very similar in households with regular (OR0.5, 95%CI 0.3-0.8) and irregular (OR 0.5, 95%CI 0.3-0.9) water supply. While Aedes aegypti control efforts based on informed community mobilisation had a strong impact on households without a regular water supply, this intervention also impacted entomological indices in households with a regular water supply. These households should not be excluded from community mobilisation efforts to reduce the Aedes aegypti vector. ISRCTN27581154 .

Breast Cancer Risk From Modifiable and Non-Modifiable Risk Factors among Women in Southeast Asia: A Meta-Analysis

PubMed

Nindrea, Ricvan Dana; Aryandono, Teguh; Lazuardi, Lutfan

2017-12-28

Objective: The aim of this study was to determine breast cancer risk from modifiable and non-modifiable factors among women in Southeast Asia. Methods: This meta-analysis was performed on research articles on breast cancer risk factors in PubMed, ProQuest and EBSCO databases published between 1997 and October 2017. Pooled odds ratios (OR) are calculated using fixed and random-effect models. Data were processed using Review Manager 5.3 (RevMan 5.3). Results: From a total of 1,211 articles, 15 studies (1 cohort and 14 case control studies) met the criteria for systematic review. Meta-analysis results showed that of the known modifiable risk factors for breast cancer, parity (nulipara) had the highest odd ratio (OR = 1.85 [95% CI 1.47-2.32]) followed by body mass index (overweight) (OR = 1.61 [95% CI 1.43-1.80]) and use of oral contraceptives (OR = 1.27 [95% CI 1.07-1.51]). Of non-modifiable risk factors, family history of breast cancer had the highest odd ratio (OR = 2.53 [95% CI 1.25-5.09]), followed by age (≥ 40 years) (OR = 1.53 [95% CI 1.34-1.76]) and menopausal status (OR = 1.44 [95% CI 1.26-1.65]). Conclusion: This analysis confirmed associations between both modifiable risk factors (parity, body mass index and use of oral contraceptives) and non-modifiable risk factors (family history of breast cancer, age and menopausal status) with breast cancer. Creative Commons Attribution License

Green spaces and mortality due to cardiovascular diseases in the city of Rio de Janeiro

PubMed Central

da Silveira, Ismael Henrique; Junger, Washington Leite

2018-01-01

ABSTRACT OBJECTIVE Investigate the association between exposure to green spaces and mortality from ischemic heart and cerebrovascular diseases, and the role of socioeconomic status in this relationship, in the city of Rio de Janeiro, Brazil. METHODS Ecological study, with the census tracts as unit of analysis. This study used data from deaths due to ischemic heart and cerebrovascular diseases among residents aged over 30 years, from 2010 to 2012. Exposure to green was estimated using the Normalized Difference Vegetation Index based on satellite images. The associations between exposure to green spaces and mortality rates due to ischemic heart and cerebrovascular diseases, standardized by gender and age, were analyzed using conditional autoregressive models, adjusted for the density of light and heavy traffic routes, pollution proxy, and by the socioeconomic situation, measured by the Social Development Index. Analyzes stratified by socioeconomic levels were also carried out, given by the tertiles of the Social Development Index. RESULTS Among the greener sectors, with a Normalized Difference Vegetation Index above the third quartile, the reduction in mortality due to ischemic heart disease was 6.7% (95%CI 3.5–9.8) and cerebrovascular was 4.7% (95%CI 1.2–8.0). In the stratified analysis, the protective effect of green spaces on ischemic heart disease mortality was observed among the greenest sectors of all strata, and it was higher for those with a lower socioeconomic level (8.6%, 95%CI 1.8–15.0). In the case of mortality due to cerebrovascular diseases, the protective effect was verified only for the greenest sectors of the lowest socioeconomic level (9.6%, 95%CI 2.3–16.5). CONCLUSIONS Mortality rates for ischemic heart and cerebrovascular diseases are inversely associated with exposure to green spaces when controlling socioeconomic status and air pollution. The protective effect of green spaces is greater among the tracts of lower socioeconomic level. PMID:29723390

Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors.

PubMed

Mazur, Katarzyna; Wilczyński, Krzysztof; Szewieczek, Jan

2016-01-01

Inpatient geriatric falls are a frequent complication of hospital care that results in significant morbidity and mortality. Evaluate factors associated with falls in geriatric inpatients after implementation of the fall prevention program. Prospective observational study comprised of 788 consecutive patients aged 79.5±7.6 years ( [Formula: see text] ± standard deviation) (66% women and 34% men) admitted to the subacute geriatric ward. Comprehensive geriatric assessment (including Mini-Mental State Examination, Barthel Index of Activities of Daily Living, and modified Get-up and Go Test) was performed. Confusion Assessment Method was used for diagnosis of delirium. Patients were categorized into low, moderate, or high fall risk groups after clinical and functional assessment. About 15.9%, 21.1%, and 63.1% of participants were classified into low, moderate, and high fall risk groups, respectively. Twenty-seven falls were recorded in 26 patients. Increased fall probability was associated with age ≥76 years ( P <0.001), body mass index (BMI) <23.5 ( P =0.007), Mini-Mental State Examination <20 ( P =0.004), Barthel Index <65 ( P =0.002), hemoglobin <7.69 mmol/L ( P =0.017), serum protein <70 g/L ( P =0.008), albumin <32 g/L ( P =0.001), and calcium level <2.27 mmol/L. Four independent factors associated with fall risk were included in the multivariate logistic regression model: delirium (odds ratio [OR] =7.33; 95% confidence interval [95% CI] =2.76-19.49; P <0.001), history of falls (OR =2.55; 95% CI =1.05-6.19; P =0.039), age (OR =1.14; 95% CI =1.05-1.23; P =0.001), and BMI (OR =0.91; 95% CI =0.83-0.99; P =0.034). Delirium, history of falls, and advanced age seem to be the primary risk factors for geriatric falls in the context of a hospital fall prevention program. Higher BMI appears to be associated with protection against inpatient geriatric falls.

Toward Semi-automated Assessment of Target Volume Delineation in Radiotherapy Trials: The SCOPE 1 Pretrial Test Case

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

Gwynne, Sarah, E-mail: Sarah.Gwynne2@wales.nhs.uk; Spezi, Emiliano; Wills, Lucy

2012-11-15

Purpose: To evaluate different conformity indices (CIs) for use in the analysis of outlining consistency within the pretrial quality assurance (Radiotherapy Trials Quality Assurance [RTTQA]) program of a multicenter chemoradiation trial of esophageal cancer and to make recommendations for their use in future trials. Methods and Materials: The National Cancer Research Institute SCOPE 1 trial is an ongoing Cancer Research UK-funded phase II/III randomized controlled trial of chemoradiation with capecitabine and cisplatin with or without cetuximab for esophageal cancer. The pretrial RTTQA program included a detailed radiotherapy protocol, an educational package, and a single mid-esophageal tumor test case that weremore » sent to each investigator to outline. Investigator gross tumor volumes (GTVs) were received from 50 investigators in 34 UK centers, and CERR (Computational Environment for Radiotherapy Research) was used to perform an assessment of each investigator GTV against a predefined gold-standard GTV using different CIs. A new metric, the local conformity index (l-CI), that can localize areas of maximal discordance was developed. Results: The median Jaccard conformity index (JCI) was 0.69 (interquartile range, 0.62-0.70), with 14 of 50 investigators (28%) achieving a JCI of 0.7 or greater. The median geographical miss index was 0.09 (interquartile range, 0.06-0.16), and the mean discordance index was 0.27 (95% confidence interval, 0.25-0.30). The l-CI was highest in the middle section of the volume, where the tumor was bulky and more easily definable, and identified 4 slices where fewer than 20% of investigators achieved an l-CI of 0.7 or greater. Conclusions: The available CIs analyze different aspects of a gold standard-observer variation, with JCI being the most useful as a single metric. Additional information is provided by the l-CI and can focus the efforts of the RTTQA team in these areas, possibly leading to semi-automated outlining assessment.« less

Psychometric Properties of the Persian Language Version of Yang Internet Addiction Questionnaire: An Explanatory Factor Analysis

PubMed Central

Mohammadsalehi, Narges; Mohammadbeigi, Abolfazl; Jadidi, Rahmatollah; Anbari, Zohreh; Ghaderi, Ebrahim; Akbari, Mojtaba

2015-01-01

Background: Reliability and validity are the key concepts in measurement processes. Young internet addiction test (YIAT) is regarded as a valid and reliable questionnaire in English speaking countries for diagnosis of Internet-related behavior disorders. Objectives: This study aimed at validating the Persian version of YIAT in the Iranian society. Patients and Methods: A pilot and a cross-sectional study were conducted on 28 and 254 students of Qom University of Medical Sciences, respectively, in order to validate the Persian version of YIAT. Forward and backward translations were conducted to develop a Persian version of the scale. Reliability was measured by test-retest, Cronbach’s alpha and interclass correlation coefficient (ICC). Face, content and construct validity were approved by the importance score index, content validity ratio (CVR), content validity index (CVI), correlation matrix and factor analysis. The SPSS software was used for data analysis. Results: The Cronbach’s alpha was 0.917 (CI 95%; 0.901 - 0.931). The average of scale-level CVI was calculated to be 0.74; the CVI index for each item was higher than 0.83 and the average of CVI index was equal to 0.89. Factor analysis extracted three factors including personal activities disorder (PAD), emotional and mood disorder (EMD) and social activities disorder (SAD), with more than 55.8% of total variances. The ICC for different factors of Persian version of Young Questionnaire including PAD, EMD and for SAD was r = 0.884; CI 95%; 0.861 - 0.904, r = 0.766; CI 95%; 0.718 - 0.808 and r = 0.745; CI 95%; 0.686 - 0.795, respectively. Conclusions: Our study showed that the Persian version of YIAT is good and usable on Iranian people. The reliability of the instrument was very good. Moreover, the validity of the Persian translated version of the scale was sufficient. In addition, the reliability and validity of the three extracted factors of YIAT were evaluated and were acceptable. PMID:26495253

SU-E-T-06: A Comparison of IMRT Treatment of Esophageal Carcinoma in Elekta-Precise and Varian23EX Linac

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

Bai, W; Fan, X; Qiu, R

2014-06-01

Purpose: To compare and analyze the characteristics of static intensity-modulated radiotherapy (IMRT) plans designed on Elekta and Varian Linac in different esophageal cancer(EC), exploring advantages and disadvantages of different vendor Linac, thus can be better serve for clinical. Methods: Twenty-four patients with EC were selected, including 6 cases located in the cervical, upper, middle and the lower thorax, respectively. Two IMRT plans were generated with the Oncentra planning system: in Elekta and Varian Linac, prescription dose of 60Gy in 30 fractions to the PTV. We examined the dose-volume histogram parameters of PTV and the organs at risk (OAR) such asmore » lungs, spinal cord and heart, and additional Monitor units(MU), treatment time, Homogeneity index(HI), Conformity index(CI) and Gamma index comparisons were performed. Results: All plans resulted in abundant dose coverage of PTV for EC of different locations. The doses to PTV, HI and OAR in Elekta plans were not statistically different in comparison with Varian plans, with the following exceptions: in cervical, upper and lower thoracic EC the PTV's CI, and in middle thorax EC PTV's D2, D50, V105 and PTV-average were better in Elekta plans than in Varian plans. In the cervical, upper and the middle thorax EC, treatment time were significantly decreased in Varian plans as against Elekta plans, while in the lower thoracic EC treatment time were no striking difference. MUs and gamma index were similar between the two Linac plans. Conclusion: For the the middle thorax EC Varian plans is better than Elekta plans, not only in treatment time but in the PTV dose; while for the lower thorax EC Elekta plans is the first choice for better CI; for the other part of the EC usually Elekta plans can increase the CI, while Varian plans can reduce treatment time, can be selected according to the actual situation of the patient treatment.« less

Age-related incidence of desaturation events and the cardiac responses on stroke index, cardiac index, and heart rate measured by continuous bioimpedance noninvasive cardiac output monitoring in infants and children undergoing general anesthesia.

PubMed

King, Michael R; Anderson, T Anthony; Sui, Jinghu; He, Guoluo; Poon, Kwun Yee T; Coté, Charles J

2016-08-01

To assess the effects of desaturation on stroke index (SI), cardiac index (CI), and heart rate (HR) using the ICON continuous noninvasive cardiac output monitor in children undergoing general anesthesia. Retrospective analysis of a prospectively collected data set. Pediatric operating rooms in a tertiary academic medical center. Children younger than 20 years who experienced desaturation while undergoing general anesthesia. All records were retrospectively searched for desaturation events defined as a recorded Spo2 ≤ 90%. We compared the data from the prior 4 minutes (baseline) with mild, moderate, and severe levels of desaturation. The relationship between Spo2 and percent change in SI, CI, and HR from baseline was assessed using a generalized linear model with repeated measures and the least-squares method. Data from 446 patients were reviewed; 38 events were eligible for analysis after exclusions. There were significant decreases in SI at all saturation ranges below 95%: -6.5% (P < .001) for 85%-95%, -8.9% (P = .002) for 71%-84%, and -11% (P < .001) for ≤70%. Based on the result from the regression, Spo2 was associated with change in SI with borderline significance (P = .053) but not that of HR and CI. There was a strong relationship to desaturation events with young age (P < .001), particularly infants younger than 6 months. Events associated with desaturation in children under general anesthesia were significantly associated with decreased SI with a greater effect with lower saturation nadirs. It is unclear if other concurrent events could have also contributed to adverse hemodynamic responses during desaturation. In most children, a compensatory increase in HR generally offsets concurrent decreases in CI. It would appear that bradycardia is a late manifestation of hypoxemia. Copyright © 2016 Elsevier Inc. All rights reserved.

Hemodynamic response to fluid removal during hemodialysis: categorization of causes of intradialytic hypotension.

PubMed

Levin, Nathan W; de Abreu, Marcia H F G; Borges, Lucas E; Tavares Filho, Helcio A; Sarwar, Rabia; Gupta, Surendra; Hafeez, Tahir; Lev, Shaul; Williams, Caroline

2018-04-14

Intradialytic hypotension is a clinically significant problem, however, the hemodynamics that underlie ultrafiltration and consequent hypotensive episodes has not been studied comprehensively. Intradialytic cardiac output, cardiac power and peripheral resistance changes from pretreatment measurements were evaluated using a novel regional impedance cardiographic device (NICaS, NI Medical, Peta Tikva, Israel) in 263 hemodialysis sessions in 54 patients in dialysis units in the USA and Brazil with the goal of determining the various hemodynamic trends as blood pressure decreases. Hypotensive episodes occurred in 99 (13.5%) of 736 intra- and postdialytic evaluations. The hemodynamic profiles of the episodes were categorized: (i) The cardiac power index significantly decreased in 35% of episodes by 36%, from 0.66 [95% confidence interval (CI) 0.60-0.72] to 0.43 (95% CI 0.37-0.48) [w/m2] with a small reduction in the total peripheral resistance index. (ii) The total peripheral resistance index significantly decreased in 37.4% of episodes by 33%, from 3342 (95% CI 2824-3859) to 2251 (95% CI 1900-2602) [dyn × s/cm5 × m2] with a small reduction in the cardiac power index. (iii) Both the cardiac power index and total peripheral resistance index significantly decreased in 27.3% of episodes, the cardiac power index by 25% from 0.63 (95% CI 0.57-0.70) to 0.48 (95% CI 0.42-0.53) [w/m2] and the total peripheral resistance index by 23% from 2964 (95% CI 2428-3501) to 2266 (95% CI 1891-2642). The hemodynamic profiles clearly define specific hemodynamic mechanisms of cardiac power reduction and/or vasodilatation as underlying intradialytic hypotensive episodes. A reduction in cardiac power (reduction of both blood pressure and cardiac output) could be the result of preload reduction due to a high ultrafiltration rate with not enough refilling or low target weight. A reduction in peripheral resistance (reduction in blood pressure and increase in cardiac output) could be the result of relative vasodilatation as arteries do not contract to compensate for volume reduction due to autonomous dysfunction. As both phenomena are independent, they may appear at the same time. Based on these results, a reduction of ultrafiltration rate and an increase in target weight to improve preload or immediate therapeutic actions to increase peripheral resistance are rational measures that could be taken to maintain blood pressure and prevent hypotensive ischemic complications in dialysis patients.

Factors associated with lack of effective contraception among obese women in the United States.

PubMed

Callegari, Lisa S; Nelson, Karin M; Arterburn, David E; Prager, Sarah W; Schiff, Melissa A; Schwarz, Eleanor Bimla

2014-09-01

To identify factors associated with contraceptive nonuse and use of less effective methods among obese women in the US. We analyzed data from sexually active obese women (body mass index >30 kg/m²) age 20-44 using the 2006-2010 National Survey of Family Growth. We conducted multinomial logistic regression to assess associations between current contraceptive use and demographic, reproductive and health services factors. Specifically, we compared contraceptive nonusers, behavioral method users (withdrawal and fertility awareness) and barrier method users (condoms) to prescription method users (pill, patch, ring, injection, implant and intrauterine device). Of 1345 obese respondents, 21.5% used no method, 10.3% behavioral methods, 20.8% barrier methods and 47.4% prescription methods. Only 42.4% of respondents overall and 20.4% of nonprescription method users reported discussing contraception with a provider in the past year. Similar to findings in the general population, behavioral method users were more likely to have previously discontinued a contraceptive method due to dissatisfaction [adjusted RR (aRR), 1.93; 95% confidence interval (CI), 1.09-3.44], and nonusers were more likely to perceive difficulty becoming pregnant (aRR, 3.86; 95% CI, 2.04-7.29), compared to prescription method users. Respondents using nonprescription methods were significantly less likely to have discussed contraception with a healthcare provider (nonusers: aRR, 0.16; 95% CI, 0.10-0.27; behavioral methods: aRR, 0.13; 95% CI, 0.06-0.25, barrier methods: aRR, 0.15; 95% CI, 0.09-0.25) than prescription method users. Obese women who discuss contraception with a provider are more likely to use effective contraception and may be less likely to experience unintended pregnancy; however, over half report no recent discussion of contraception with a provider. Efforts are needed to increase contraceptive counseling for obese women, who face increased risks of morbidity from unintended pregnancy. Published by Elsevier Inc.

Impact of hypoglycemic events and HbA1c level on sulfonylurea discontinuation and down-titration.

PubMed

Laires, Pedro A; Tang, Jackson; Fan, Chun Po Steve; Li, Zhiyi; Qiu, Ying; Iglay, Kristy

2017-04-01

A retrospective cohort study using GE Centricity electronic medical records assessed the association between post-index hypoglycemia and HbA1c with discontinuation and down-titration of sulfonylureas among patients with Type 2 diabetes mellitus. Adult patients with an index prescription for a sulfonylurea and ≥12 months' continuous records pre- and post-index were eligible. Sulfonylurea discontinuation and down-titration was assessed 1-year post-index. Discontinuation occurred if the date of a prescription was >90 days from the preceding prescription plus days of supply. Down-titration occurred when a subsequent prescription was lower than the index dose. Cox regression assessed the association between post-index hypoglycemia and HbA1c with time to sulfonylurea discontinuation and down-titration, as well as other factors. 28,371 participants were included in the study; 13,459 (47.4%) were discontinuers, 717 (2.5%) were down-titraters, and 14,195 (50.0%) were continuers. 0.6% of continuers experienced hypoglycemia 1-year post-index, compared with 3.1% of down-titraters and 0.8% of discontinuers (p < 0.0001). Patients with post-index hypoglycemia had a significantly higher rate of discontinuation (hazard ratio [HR] = 1.82, 95% CI: 1.47-2.23) and down-titration (HR = 4.25, 95% CI: 1.92-8.03). Patients with higher post-index HbA1c and use of 2 nd generation sulfonylureas had an increased rate of discontinuation (HR = 1.05, 95% CI: 1.04-1.06; HR = 1.19, 95% CI: 1.14-1.24, respectively). Approximately half of participants who initiated sulfonylureas discontinued or down-titrated therapy within one year. Both post-index hypoglycemia and higher HbA1c were significant risk factors for sulfonylurea treatment change.

[Index of Nutritional Purchasing Power Parity: comparison of caloric costs of a healthy versus an unhealthy diet].

PubMed

Mendoza Velázquez, Alfonso

2012-01-01

Develop the Index of Nutritional Purchasing Power Parity (Nut3-CiO) as an instrument to compare the caloric costs of a healthy versus an unhealthy diet between regions or cities in a country over time. Indices of caloric prices were constructed and the "law of one price" was used to derive the Nut3-CiO index. Caloric inflation rates were obtained using basic descriptive statistics. The Nut3-CiO was applied in the major cities of Mexico during the period from January 1996 to December 2010. The statistical behavior of the Nut3-CiO revealed that, in Mexican cities, products for a typical diet are less expensive than products for a healthy diet. The findings showed a cyclical behavior to the index, a high correlation between inflation for the typical diet and inflation for the market basket, and a high persistence of prices. The Nut3-CiO index makes it possible to periodically compare the price differential of two types of diets-typical and healthy-between cities in a single country. This instrument could help health authorities identify the cities where it is easier or more difficult for consumers to access a typical or healthy diet in terms of cost. Furthermore, it makes it possible to estimate the percentage adjustment necessary in each city to attain levels of nutritional purchasing power parity.

Internet-Delivered Cognitive Behavioral Therapy to Treat Insomnia: A Systematic Review and Meta-Analysis

PubMed Central

Seyffert, Michael; Lagisetty, Pooja; Landgraf, Jessica; Chopra, Vineet; Pfeiffer, Paul N.; Conte, Marisa L.; Rogers, Mary A. M.

2016-01-01

Background Insomnia is of major public health importance. While cognitive behavioral therapy is beneficial, in-person treatment is often unavailable. We assessed the effectiveness of internet-delivered cognitive behavioral therapy for insomnia. Objectives The primary objectives were to determine whether online cognitive behavioral therapy for insomnia could improve sleep efficiency and reduce the severity of insomnia in adults. Secondary outcomes included sleep quality, total sleep time, time in bed, sleep onset latency, wake time after sleep onset, and number of nocturnal awakenings. Data Sources We searched PubMed/MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycInfo, Cochrane Library, Embase, and the Web of Science for randomized trials. Methods Studies were eligible if they were randomized controlled trials in adults that reported application of cognitive behavioral therapy for insomnia via internet delivery. Mean differences in improvement in sleep measures were calculated using the Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis. Results We found 15 trials, all utilizing a pretest-posttest randomized control group design. Sleep efficiency was 72% at baseline and improved by 7.2% (95% CI: 5.1%, 9.3%; p<0.001) with internet-delivered cognitive behavioral therapy versus control. Internet-delivered cognitive behavioral therapy resulted in a decrease in the insomnia severity index by 4.3 points (95% CI: -7.1, -1.5; p = 0.017) compared to control. Total sleep time averaged 5.7 hours at baseline and increased by 20 minutes with internet-delivered therapy versus control (95% CI: 9, 31; p = 0.004). The severity of depression decreased by 2.3 points (95% CI: -2.9, -1.7; p = 0.013) in individuals who received internet-delivered cognitive behavioral therapy compared to control. Improvements in sleep efficiency, the insomnia severity index and depression scores with internet-delivered cognitive behavioral therapy were maintained from 4 to 48 weeks after post-treatment assessment. There were no statistically significant differences between sleep efficiency, total sleep time, and insomnia severity index for internet-delivered versus in-person therapy with a trained therapist. Conclusion In conclusion, internet-delivered cognitive behavioral therapy is effective in improving sleep in adults with insomnia. Efforts should be made to educate the public and expand access to this therapy. Registration Number, Prospero: CRD42015017622 PMID:26867139

Strategies for partner notification for sexually transmitted infections, including HIV.

PubMed

Ferreira, Adel; Young, Taryn; Mathews, Catherine; Zunza, Moleen; Low, Nicola

2013-10-03

Partner notification (PN) is the process whereby sexual partners of an index patient are informed of their exposure to a sexually transmitted infection (STI) and the need to obtain treatment. For the person (index patient) with a curable STI, PN aims to eradicate infection and prevent re-infection. For sexual partners, PN aims to identify and treat undiagnosed STIs. At the level of sexual networks and populations, the aim of PN is to interrupt chains of STI transmission. For people with viral STI, PN aims to identify undiagnosed infections, which can facilitate access for their sexual partners to treatment and help prevent transmission. To assess the effects of different PN strategies in people with STI, including human immunodeficiency virus (HIV) infection. We searched electronic databases (the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE) without language restrictions. We scanned reference lists of potential studies and previous reviews and contacted experts in the field. We searched three trial registries. We conducted the most recent search on 31 August 2012. Published or unpublished randomised controlled trials (RCTs) or quasi-RCTs comparing two or more PN strategies. Four main PN strategies were included: patient referral, expedited partner therapy, provider referral and contract referral. Patient referral means that the patient notifies their sexual partners, either with (enhanced patient referral) or without (simple patient referral) additional verbal or written support. In expedited partner therapy, the patient delivers medication or a prescription for medication to their partner(s) without the need for a medical examination of the partner. In provider referral, health service personnel notify the partners. In contract referral, the index patient is encouraged to notify partner, with the understanding that the partners will be contacted if they do not visit the health service by a certain date. We analysed data according to paired partner referral strategies. We organised the comparisons first according to four main PN strategies (1. enhanced patient referral, 2. expedited partner therapy, 3. contract referral, 4. provider referral). We compared each main strategy with simple patient referral and then with each other, if trials were available. For continuous outcome measures, we calculated the mean difference (MD) with 95% confidence intervals (CI). For dichotomous variables, we calculated the risk ratio (RR) with 95% CI. We performed meta-analyses where appropriate. We performed a sensitivity analysis for the primary outcome re-infection rate of the index patient by excluding studies with attrition of greater than 20%. Two review authors independently assessed the risk of bias and extracted data. We contacted study authors for additional information. We included 26 trials (17,578 participants, 9015 women and 8563 men). Five trials were conducted in developing countries. Only two trials were conducted among HIV-positive patients. There was potential for selection bias, owing to the methods of allocation used and of performance bias, owing to the lack of blinding in most included studies. Seven trials had attrition of greater than 20%, increasing the risk of bias.The review found moderate-quality evidence that expedited partner therapy is better than simple patient referral for preventing re-infection of index patients when combining trials of STIs that caused urethritis or cervicitis (6 trials; RR 0.71, 95% CI 0.56 to 0.89, I(2) = 39%). When studies with attrition greater than 20% were excluded, the effect of expedited partner therapy was attenuated (2 trials; RR 0.8, 95% CI 0.62 to 1.04, I(2) = 0%). In trials restricted to index patients with chlamydia, the effect was attenuated (2 trials; RR 0.90, 95% CI 0.60 to 1.35, I(2) = 22%). Expedited partner therapy also increased the number of partners treated per index patient (three trials) when compared with simple patient referral in people with chlamydia or gonorrhoea (MD 0.43, 95% CI 0.28 to 0.58) or trichomonas (MD 0.51, 95% CI 0.35 to 0.67), and people with any STI syndrome (MD 0.5, 95% CI 0.34 to 0.67). Expedited partner therapy was not superior to enhanced patient referral in preventing re-infection (3 trials; RR 0.96, 95% CI 0.60 to 1.53, I(2) = 33%, low-quality evidence). Home sampling kits for partners (four trials) did not result in lower rates of re-infection in the index case (measured in one trial), or higher numbers of partners elicited (three trials), notified (two trials) or treated (one trial) when compared with simple patient referral. There was no consistent evidence for the relative effects of provider, contract or other patient referral methods. In one trial among men with non-gonococcal urethritis, more partners were treated with provider referral than with simple patient referral (MD 0.5, 95% CI 0.37 to 0.63). In one study among people with syphilis, contract referral elicited treatment of more partners than provider referral (MD 2.2, 95% CI 1.95 to 2.45), but the number of partners receiving treatment was the same in both groups. Where measured, there was no statistical evidence of differences in the incidence of adverse effects between PN strategies. The evidence assessed in this review does not identify a single optimal strategy for PN for any particular STI. When combining trials of STI causing urethritis or cervicitis, expedited partner therapy was more successful than simple patient referral for preventing re-infection of the index patient but was not superior to enhanced patient referral. Expedited partner therapy interventions should include all components that were part of the trial intervention package. There was insufficient evidence to determine the most effective components of an enhanced patient referral strategy. There are too few trials to allow consistent conclusions about the relative effects of provider, contract or other patient referral methods for different STIs. More high-quality RCTs of PN strategies for HIV and syphilis, using biological outcomes, are needed.

Vital capacity and selected metabolic diseases in middle-aged Japanese men

PubMed Central

Sakuta, Hidenari; Suzuki, Takashi; Yasuda, Hiroko; Ito, Teizo

2006-01-01

OBJECTIVE To elucidate the association between vital capacity and the presence of selected metabolic diseases in middle-aged Japanese men. METHODS A cross-sectional analysis of the associations among forced vital capacity (FVC), static vital capacity as a percentage of that predicted (%VC) and the presence of metabolic diseases was performed. RESULTS In a univariate linear regression analysis, FVC and %VC were inversely associated with poor vegetable intake, cigarette smoking and body mass index, but not with physical activity or ethanol consumption. In a logistic regression analysis adjusted for lifestyle factors, body mass index and age, the odds ratios for the presence of metabolic disease per 0.54 L (1 SD) decrease in FVC were 1.24 (95% CI 1.03 to 1.50) for type II diabetes, 1.21 (95% CI 1.02 to 1.42) for hypertension, 1.34 (95% CI 1.11 to 1.63) for hypertriglyceridemia, 1.23 (95% CI 1.03 to 1.46) for high gamma-glutamyl transferase levels and 1.63 (95% CI 1.10 to 2.41) for an episode of cardiovascular disease. FVC did not correlate with hyperhomocysteinemia, hypercholesterolemia or high white blood cell count. Similar results were also obtained for the association between %VC and metabolic diseases. CONCLUSIONS A decrease in FVC or %VC was associated with the presence of some metabolic diseases. The association may partly explain the reported association between low FVC and cardiovascular disease. PMID:16550264

External validation of the PROFUND index in polypathological patients from internal medicine and acute geriatrics departments in Aragón.

PubMed

Díez-Manglano, Jesús; Cabrerizo García, José Luis; García-Arilla Calvo, Ernesto; Jimeno Saínz, Araceli; Calvo Beguería, Eva; Martínez-Álvarez, Rosa M; Bejarano Tello, Esperanza; Caudevilla Martínez, Aránzazu

2015-12-01

The objective of the study was to validate externally and prospectively the PROFUND index to predict survival of polypathological patients after a year. An observational, prospective and multicenter study was performed. Polypathological patients admitted to an internal medicine or geriatrics department and attended by investigators consecutively between March 1 and June 30, 2011 were included. Data concerning age, gender, comorbidity, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, socio-familial Gijon scale, delirium, number of drugs and number of admissions during the previous year were gathered for each patient. The PROFUND index was calculated. The follow-up lasted 1 year. A Cox proportional regression model was calculated, and was used to analyze the association of the variables to mortality and C-statistic. 465 polypathological patients, 333 from internal medicine and 132 from geriatrics, were included. One-year mortality is associated with age [hazard ratio (HR) 1.52 95 % CI 1.04-2.12; p = 0.01], presence of neoplasia [HR 2.68 95 % CI 1.71-4.18; p = 0.0001] and dependence for basic activities of daily living [HR 2.34 95 % CI 1.61-3.40; p = 0.0009]. In predicting mortality, the PROFUND index shows good discrimination in patients from internal medicine (C-statistics 0.725 95 % CI 0.670-0.781), but a poor one in those from geriatrics (0.546 95 % CI 0.448-0.644). The PROFUND index is a reliable tool for predicting mortality in internal medicine PP patients.

Hypertension and arterial stiffness in heart transplantation patients

PubMed Central

de Souza-Neto, João David; de Oliveira, Ítalo Martins; Lima-Rocha, Hermano Alexandre; Oliveira-Lima, José Wellington; Bacal, Fernando

2016-01-01

OBJECTIVES: Post-transplantation hypertension is prevalent and is associated with increased cardiovascular morbidity and subsequent graft dysfunction. The present study aimed to identify the factors associated with arterial stiffness as measured by the ambulatory arterial stiffness index. METHODS: The current study used a prospective, observational, analytical design to evaluate a group of adult heart transplantation patients. Arterial stiffness was obtained by monitoring ambulatory blood pressure and using the ambulatory arterial stiffness index as the surrogate outcome. Multivariate logistic regression analyses were performed to control confounding. RESULTS: In a group of 85 adult heart transplantation patients, hypertension was independently associated with arterial stiffness (OR 4.98, CI 95% 1.06-23.4) as well as systolic and diastolic blood pressure averages and nighttime descent. CONCLUSIONS: Measurement of ambulatory arterial stiffness index is a new, non-invasive method that is easy to perform, may contribute to better defining arterial stiffness prognosis and is associated with hypertension. PMID:27652829

Association between foot type and lower extremity injuries: systematic literature review with meta-analysis.

PubMed

Tong, Jasper W K; Kong, Pui W

2013-10-01

Systematic literature review with meta-analysis. To investigate the association between nonneutral foot types (high arch and flatfoot) and lower extremity and low back injuries, and to identify the most appropriate methods to use for foot classification. A search of 5 electronic databases (PubMed, Embase, CINAHL, SPORTDiscus, and ProQuest Dissertations and Theses), Google Scholar, and the reference lists of included studies was conducted to identify relevant articles. The review included comparative cross-sectional, case-control, and prospective studies that reported qualitative/quantitative associations between foot types and lower extremity and back injuries. Quality of the selected studies was evaluated, and data synthesis for the level of association between foot types and injuries was conducted. A random-effects model was used to pool odds ratio (OR) and standardized mean difference (SMD) results for meta-analysis. Twenty-nine studies were included for meta-analysis. A significant association between nonneutral foot types and lower extremity injuries was determined (OR = 1.23; 95% confidence interval [CI]: 1.11, 1.37; P<.001). Foot posture index (OR = 2.58; 95% CI: 1.33, 5.02; P<.01) and visual/physical examination (OR = 1.17; 95% CI: 1.06, 1.28; P<.01) were 2 assessment methods using distinct foot-type categories that showed a significant association with lower extremity injuries. For foot-assessment methods using a continuous scale, measurements of lateral calcaneal pitch angle (SMD, 1.92; 95% CI: 1.44, 2.39; P<.00001), lateral talocalcaneal angle (SMD, 1.36; 95% CI: 0.93, 1.80; P<.00001), and navicular height (SMD, 0.34; 95% CI: 0.16, 0.52; P<.001) showed significant effect sizes in identifying high-arch foot, whereas the navicular drop test (SMD, 0.45; 95% CI: 0.03, 0.87; P<.05) and relaxed calcaneal stance position (SMD, 0.49; 95% CI: 0.01, 0.97; P<.05) displayed significant effect sizes in identifying flatfoot. Subgroup analyses revealed no significant associations for children with flatfoot, cross-sectional studies, or prospective studies on high arch. High-arch and flatfoot foot types are associated with lower extremity injuries, but the strength of this relationship is low. Although the foot posture index and visual/physical examination showed significance, they are qualitative measures. Radiographic and navicular height measurements can delineate high-arch foot effectively, with only anthropometric measures accurately classifying flatfoot. Prognosis, level 2a.

Validating a Method to Assess Lipreading, Audiovisual Gain, and Integration During Speech Reception With Cochlear-Implanted and Normal-Hearing Subjects Using a Talking Head.

PubMed

Schreitmüller, Stefan; Frenken, Miriam; Bentz, Lüder; Ortmann, Magdalene; Walger, Martin; Meister, Hartmut

Watching a talker's mouth is beneficial for speech reception (SR) in many communication settings, especially in noise and when hearing is impaired. Measures for audiovisual (AV) SR can be valuable in the framework of diagnosing or treating hearing disorders. This study addresses the lack of standardized methods in many languages for assessing lipreading, AV gain, and integration. A new method is validated that supplements a German speech audiometric test with visualizations of the synthetic articulation of an avatar that was used, for it is feasible to lip-sync auditory speech in a highly standardized way. Three hypotheses were formed according to the literature on AV SR that used live or filmed talkers. It was tested whether respective effects could be reproduced with synthetic articulation: (1) cochlear implant (CI) users have a higher visual-only SR than normal-hearing (NH) individuals, and younger individuals obtain higher lipreading scores than older persons. (2) Both CI and NH gain from presenting AV over unimodal (auditory or visual) sentences in noise. (3) Both CI and NH listeners efficiently integrate complementary auditory and visual speech features. In a controlled, cross-sectional study with 14 experienced CI users (mean age 47.4) and 14 NH individuals (mean age 46.3, similar broad age distribution), lipreading, AV gain, and integration of a German matrix sentence test were assessed. Visual speech stimuli were synthesized by the articulation of the Talking Head system "MASSY" (Modular Audiovisual Speech Synthesizer), which displayed standardized articulation with respect to the visibility of German phones. In line with the hypotheses and previous literature, CI users had a higher mean visual-only SR than NH individuals (CI, 38%; NH, 12%; p < 0.001). Age was correlated with lipreading such that within each group, younger individuals obtained higher visual-only scores than older persons (rCI = -0.54; p = 0.046; rNH = -0.78; p < 0.001). Both CI and NH benefitted by AV over unimodal speech as indexed by calculations of the measures visual enhancement and auditory enhancement (each p < 0.001). Both groups efficiently integrated complementary auditory and visual speech features as indexed by calculations of the measure integration enhancement (each p < 0.005). Given the good agreement between results from literature and the outcome of supplementing an existing validated auditory test with synthetic visual cues, the introduced method can be considered an interesting candidate for clinical and scientific applications to assess measures important for AV SR in a standardized manner. This could be beneficial for optimizing the diagnosis and treatment of individual listening and communication disorders, such as cochlear implantation.

Reexamination of the coronal index of solar activity

NASA Astrophysics Data System (ADS)

Rybanský, M.; Rušin, V.; Minarovjech, M.; Klocok, L.; Cliver, E. W.

2005-08-01

The coronal index (CI) of solar activity is the irradiance of the Sun as a star in the coronal green line (Fe XIV, 530.3 nm or 5303 Å). It is derived from ground-based observations of the green corona made by the network of coronal stations (currently Kislovodsk, Lomnický Štít, Norikura, and Sacramento Peak). The CI was introduced by Rybanský (1975) to facilitate comparison of ground-based green line measurements with satellite-based extreme ultraviolet and soft X-ray observations. The CI since 1965 is based on the Lomnický Štít photometric scale; the CI was extended to earlier years by Rybanský et al. (1994) based on cross-calibrations of Lomnický Štít data with measurements made at Pic du Midi and Arosa. The resultant 1939-1992 CI had the interesting property that its value at the peak of the 11-year cycle increased more or less monotonically from cycle 18 through cycle 22 even though the peak sunspot number of cycle 20 exhibited a significant local minimum between that of cycles 19 and 21. Rušin and Rybanský (2002) recently showed that the green line intensity and photospheric magnetic field strength were highly correlated from 1976 to 1999. Since the photospheric magnetic field strength is highly correlated with sunspot number, the lack of close correspondence between the sunspot number and the CI from 1939 to 2002 is puzzling. Here we show that the CI and sunspot number are highly correlated only after 1965, calling the previously-computed coronal index for earlier years (1939-1965) into question. We can use the correlation between the CI and sunspot number (also the 2800 MHz radio flux and the cosmic ray intensity) to recompute daily values of the CI for years before 1966. In fact, this method can be used to obtain CI values as far back as we have reliable sunspot observations (˜1850). The net result of this exercise is a CI that closely tracks the sunspot number at all times. We can use the sunspot-CI relationship (for 1966-2002) to identify which coronal stations can be used as a basis for the homogeneous coronal data set (HDS) before 1966. Thus we adopt the photometric scale of the following observatories for the indicated times: Norikura (1951-1954; the Norikura photometric scale was also used from 1939 to 1954); Pic du Midi (1955-1959); Kislovodsk (1960-1965). Finally, we revised the post-1965 HDS and made several small corrections and now include data from Kislovodsk, Norikura, and Sacramento Peak to fill gaps at Lomnický Štít.

[A case-control study: association between oral hygiene and oral cancer in non-smoking and non-drinking women].

PubMed

Wu, J F; Lin, L S; Chen, F; Liu, F Q; Huang, J F; Yan, L J; Liu, F P; Qiu, Y; Zheng, X Y; Cai, L; He, B C

2017-08-06

Objective: To evaluate the influence of oral hygiene on risk of oral cancer in non-smoking and non-drinking women. Methods: From September 2010 to February 2016, 242 non-smoking and non-drinking female patients with pathologically confirmed oral cancer were recruited in a hospital of Fuzhou, and another 856 non-smoking and non-drinking healthy women from health examination center in the same hospital were selected as control group. Five oral hygiene related variables including the frequency of teeth brushing, number of teeth lost, poor prosthesis, regular dental visits and recurrent dental ulceration were used to develop oral hygiene index model. Unconditional logistic regression was used to calculate odds ratios ( OR ) and 95% confidence intervals (95 %CI ). The area under the receiver operating characteristic curve (AUROC) was used to evaluate the predictability of the oral hygiene index model. Multivariate logistic regression model was used to analyze the association between oral hygiene index and the incidence of oral cancer. Results: Teeth brushing <2 twice daily, teeth lost ≥5, poor prosthesis, no regular dental visits, recurrent dental ulceration were risk factors for the incidence of oral cancer in non-smoking and non-drinking women, the corresponding OR (95 %CI ) were 1.50 (1.08-2.09), 1.81 (1.15-2.85), 1.51 (1.03-2.23), 1.73 (1.15-2.59), 7.30 (4.00-13.30), respectively. The AUROC of the oral hygiene index model was 0.705 9, indicating a high predictability. Multivariate logistic regression showed that the oral hygiene index was associated with risk of oral cancer. The higher the score, the higher risk was observed. The corresponding OR (95 %CI ) of oral hygiene index scores (score 1, score 2, score 3, score 4-5) were 2.51 (0.84-7.53), 4.68 (1.59-13.71), 6.47 (2.18-19.25), 15.29 (5.08-45.99), respectively. Conclusion: Oral hygiene could influence the incidence of oral cancer in non-smoking and non-drinking women, and oral hygiene index has a certain significance in assessing the combined effects of oral hygiene.

Mental Health of Transgender and Gender Nonconforming Youth Compared With Their Peers

PubMed Central

Becerra-Culqui, Tracy A.; Liu, Yuan; Nash, Rebecca; Cromwell, Lee; Flanders, W. Dana; Getahun, Darios; Giammattei, Shawn V.; Hunkeler, Enid M.; Lash, Timothy L.; Millman, Andrea; Quinn, Virginia P.; Robinson, Brandi; Roblin, Douglas; Sandberg, David E.; Silverberg, Michael J.; Tangpricha, Vin; Goodman, Michael

2018-01-01

BACKGROUND Understanding the magnitude of mental health problems, particularly life-threatening ones, experienced by transgender and/or gender nonconforming (TGNC) youth can lead to improved management of these conditions. METHODS Electronic medical records were used to identify a cohort of 588 transfeminine and 745 transmasculine children (3–9 years old) and adolescents (10–17 years old) enrolled in integrated health care systems in California and Georgia. Ten male and 10 female referent cisgender enrollees were matched to each TGNC individual on year of birth, race and/or ethnicity, study site, and membership year of the index date (first evidence of gender nonconforming status). Prevalence ratios were calculated by dividing the proportion of TGNC individuals with a specific mental health diagnosis or diagnostic category by the corresponding proportion in each reference group by transfeminine and/or transmasculine status, age group, and time period before the index date. RESULTS Common diagnoses for children and adolescents were attention deficit disorders (transfeminine 15%; transmasculine 16%) and depressive disorders (transfeminine 49%; transmasculine 62%), respectively. For all diagnostic categories, prevalence was severalfold higher among TGNC youth than in matched reference groups. Prevalence ratios (95% confidence intervals [CIs]) for history of self-inflicted injury in adolescents 6 months before the index date ranged from 18 (95% CI 4.4–82) to 144 (95% CI 36–1248). The corresponding range for suicidal ideation was 25 (95% CI 14–45) to 54 (95% CI 18–218). CONCLUSIONS TGNC youth may present with mental health conditions requiring immediate evaluation and implementation of clinical, social, and educational gender identity support measures. PMID:29661941

Left ventricular torsion assessed by two-dimensional echocardiography speckle tracking as a predictor of left ventricular remodeling and short-term outcome following primary percutaneous coronary intervention for acute myocardial infarction: A single-center experience.

PubMed

Awadalla, Hany; Saleh, Mohamed Ayman; Abdel Kader, Mohamed; Mansour, Amr

2017-08-01

Left ventricular (LV) torsion is a novel method to assess systolic LV function. This study aimed at exploring the utility of 2D speckle tracking-based assessment of left ventricular torsion in patients with acute myocardial infarction (AMI) undertaking primary percutaneous intervention (pPCI) in predicting left ventricular remodeling. The study included 115 patients (mean±SD, age 52.2±9.67, males 84.3%) who underwent pPCI for AMI. Echocardiographic assessment of LV torsion by two-dimensional speckle tracking was performed early after the index pPCI. Patients underwent repeat echocardiography at 6 months to detect remodeling. LV torsion in the acute setting was significantly lower in those who demonstrated LV remodeling at follow-up compared to those without remodeling (7.56±1.95 vs 15.16±4.65; P<.005). Multivariate analysis identified peak CK & CK-MB elevation (β=-0.767 and -0.725; P<.001), SWMA index (β=-0.843; P<.001), and Simpson's derived LV ejection fraction (LVEF; β=0.802; P<.001) as independent predictors of baseline LV torsion. It also identified peak LV torsion (β: 0.27; 95% CI: 0.15-0.5, P=.001) and SWMA index (β: 1.07, 95% CI: 1.03-1.12, P=.005) as independent predictors of LV remodeling. Baseline Killip's grades II and higher (β: 48.6; 95% CI 5.5-428, P<.001) and diabetes mellitus (β: 29.7; 95% CI 1.1-763, P<.05) were independent predictors of mortality. Left ventricular torsion in acute MI setting is impaired and predicts subsequent LV remodeling at 6-month follow-up. © 2017, Wiley Periodicals, Inc.

Socio-Economic and Clinical Factors as Predictors of Disease Evolution and Acute Events in COPD Patients

PubMed Central

Pandolfi, Paolo; Zanasi, Alessandro; Musti, Muriel Assunta; Stivanello, Elisa; Pisani, Lara; Angelini, Sabrina; Maffei, Francesca; Hrelia, Silvana; Angeloni, Cristina; Zenesini, Corrado; Hrelia, Patrizia

2015-01-01

Background Socio-economic, cultural and environmental factors are becoming increasingly important determinants of chronic obstructive pulmonary disease (COPD). We conducted a study to investigate socio-demographic, lifestyle and clinical factors, and to assess their role as predictors of acute events (mortality or hospitalization for respiratory causes) in a group of COPD patients. Methods Subjects were recruited among outpatients who were undertaking respiratory function tests at the Pneumology Unit of the Sant’Orsola-Malpighi Hospital, Bologna. Patients were classified according to the GOLD Guidelines. Results 229 patients with COPD were included in the study, 44 with Mild, 68 Moderate, 52 Severe and 65 Very Severe COPD (GOLD stage). Significant differences among COPD stage, in terms of smoking status and fragility index, were detected. COPD stage significantly affected the values of all clinical tests (spirometry and ABG analysis). Kaplan-Meier estimates showed a significant difference between survival curves by COPD stage with lower event-free probability in very severe COPD stage. Significant risk factors for acute events were: underweight (HR = 4.08; 95% CI 1.01–16.54), having two or more comorbidities (HR = 4.71; 95% CI 2.52–8.83), belonging to moderate (HR = 3.50; 95% CI 1.01–12.18) or very severe COPD stage (HR = 8.23; 95% CI 2.35–28.85). Conclusions Our findings indicate that fragility is associated with COPD stage and that comorbidities and the low body mass index are predictors of mortality or hospitalization. Besides spirometric analyses, FeNO measure and comorbidities, body mass index could also be considered in the management and monitoring of COPD patients. PMID:26252571

Smoking and mortality in stroke survivors: can we eliminate the paradox?

PubMed

Levine, Deborah A; Walter, James M; Karve, Sudeep J; Skolarus, Lesli E; Levine, Steven R; Mulhorn, Kristine A

2014-07-01

Many studies have suggested that smoking does not increase mortality in stroke survivors. Index event bias, a sample selection bias, potentially explains this paradoxical finding. Therefore, we compared all-cause, cardiovascular disease (CVD), and cancer mortality by cigarette smoking status among stroke survivors using methods to account for index event bias. Among 5797 stroke survivors of 45 years or older who responded to the National Health Interview Survey years 1997-2004, an annual, population-based survey of community-dwelling US adults, linked to the National Death Index, we estimated all-cause, CVD, and cancer mortality by smoking status using Cox proportional regression and propensity score analysis to account for demographic, socioeconomic, and clinical factors. Mean follow-up was 4.5 years. From 1997 to 2004, 18.7% of stroke survivors smoked. There were 1988 deaths in this stroke survivor cohort, with 50% of deaths because of CVD and 15% because of cancer. Current smokers had an increased risk of all-cause mortality (hazard ratio [HR], 1.36; 95% confidence interval [CI], 1.14-1.63) and cancer mortality (HR, 3.83; 95% CI, 2.48-5.91) compared with never smokers, after controlling for demographic, socioeconomic, and clinical factors. Current smokers had an increased risk of CVD mortality controlling for age and sex (HR, 1.29; 95% CI, 1.01-1.64), but this risk did not persist after controlling for socioeconomic and clinical factors (HR, 1.15; 95% CI, .88-1.50). Stroke survivors who smoke have an increased risk of all-cause mortality, which is largely because of cancer mortality. Socioeconomic and clinical factors explain stroke survivors' higher risk of CVD mortality associated with smoking. Published by Elsevier Inc.

Road Traffic and Railway Noise Exposures and Adiposity in Adults: A Cross-Sectional Analysis of the Danish Diet, Cancer, and Health Cohort.

PubMed

Christensen, Jeppe Schultz; Raaschou-Nielsen, Ole; Tjønneland, Anne; Overvad, Kim; Nordsborg, Rikke B; Ketzel, Matthias; Sørensen, Thorkild Ia; Sørensen, Mette

2016-03-01

Traffic noise has been associated with cardiovascular and metabolic disorders. Potential modes of action are through stress and sleep disturbance, which may lead to endocrine dysregulation and overweight. We aimed to investigate the relationship between residential traffic and railway noise and adiposity. In this cross-sectional study of 57,053 middle-aged people, height, weight, waist circumference, and bioelectrical impedance were measured at enrollment (1993-1997). Body mass index (BMI), body fat mass index (BFMI), and lean body mass index (LBMI) were calculated. Residential exposure to road and railway traffic noise exposure was calculated using the Nordic prediction method. Associations between traffic noise and anthropometric measures at enrollment were analyzed using general linear models and logistic regression adjusted for demographic and lifestyle factors. Linear regression models adjusted for age, sex, and socioeconomic factors showed that 5-year mean road traffic noise exposure preceding enrollment was associated with a 0.35-cm wider waist circumference (95% CI: 0.21, 0.50) and a 0.18-point higher BMI (95% CI: 0.12, 0.23) per 10 dB. Small, significant increases were also found for BFMI and LBMI. All associations followed linear exposure-response relationships. Exposure to railway noise was not linearly associated with adiposity measures. However, exposure > 60 dB was associated with a 0.71-cm wider waist circumference (95% CI: 0.23, 1.19) and a 0.19-point higher BMI (95% CI: 0.0072, 0.37) compared with unexposed participants (0-20 dB). The present study finds positive associations between residential exposure to road traffic and railway noise and adiposity.

Biomechanical CT Metrics Are Associated With Patient Outcomes in COPD

PubMed Central

Bodduluri, Sandeep; Bhatt, Surya P; Hoffman, Eric A.; Newell, John D.; Martinez, Carlos H.; Dransfield, Mark T.; Han, Meilan K.; Reinhardt, Joseph M.

2017-01-01

Background Traditional metrics of lung disease such as those derived from spirometry and static single-volume CT images are used to explain respiratory morbidity in patients with chronic obstructive pulmonary disease (COPD), but are insufficient. We hypothesized that the mean Jacobian determinant, a measure of local lung expansion and contraction with respiration, would contribute independently to clinically relevant functional outcomes. Methods We applied image registration techniques to paired inspiratory-expiratory CT scans and derived the Jacobian determinant of the deformation field between the two lung volumes to map local volume change with respiration. We analyzed 490 participants with COPD with multivariable regression models to assess strengths of association between traditional CT metrics of disease and the Jacobian determinant with respiratory morbidity including dyspnea (mMRC), St Georges Respiratory Questionnaire (SGRQ) score, six-minute walk distance (6MWD), and the BODE index, as well as all-cause mortality. Results The Jacobian determinant was significantly associated with SGRQ (adjusted regression co-efficient β = −11.75,95%CI −21.6 to −1.7;p=0.020), and with 6MWD (β=321.15, 95%CI 134.1 to 508.1;p<0.001), independent of age, sex, race, body-mass-index, FEV1, smoking pack-years, CT emphysema, CT gas trapping, airway wall thickness, and CT scanner protocol. The mean Jacobian determinant was also independently associated with the BODE index (β= −0.41, 95%CI −0.80 to −0.02; p = 0.039), and mortality on follow-up (adjusted hazards ratio = 4.26, 95%CI = 0.93 to 19.23; p = 0.064). Conclusion Biomechanical metrics representing local lung expansion and contraction improve prediction of respiratory morbidity and mortality and offer additional prognostic information beyond traditional measures of lung function and static single-volume CT metrics. PMID:28044005

Sibling feeding behavior: Mothers as role models during mealtimes.

PubMed

Mosli, Rana H; Miller, Alison L; Peterson, Karen E; Lumeng, Julie C

2016-01-01

Siblings may act as caregivers and role models during mealtimes, and develop caregiving skills by observing and imitating the behavior of their mothers. The objective of this study was to examine the association between maternal feeding behaviors and encouragements to eat delivered from the sibling to the index child during mealtimes. Index children aged 4-8 years (n = 69) were videotaped while eating a routine evening meal at home with one sibling present. Encouragements to eat delivered from the sibling to the index child were coded from the videotapes. Mothers completed the Child Feeding Questionnaire and the Caregiver's Feeding Styles Questionnaire. Poisson regression was used to examine the association of maternal Pressure to Eat, Restriction, Monitoring, Verbal Direction, and Coercion with number of encouragements to eat delivered from the sibling to the index child. Models were adjusted for index child's age, sex, and race/ethnicity, and maternal education. Results showed that maternal Pressure to Eat (Rate Ratio (RR): 1.39, 95% confidence interval (CI): 1.19, 1.69), Restriction (RR: 1.31, 95% CI: 1.07, 1.60), Verbal Direction (RR: 2.04, 95% CI: 1.68, 2.47), and Coercion (RR: 1.58, 95% CI: 1.29, 1.92) were each positively associated with the number of encouragements to eat delivered from the sibling to the index child. Maternal Monitoring was not associated with the number of encouragements to eat delivered from the sibling to the index child (RR: 0.92, 97% CI: 0.78, 1.09). Findings suggest that maternal behavior during mealtimes may affect the index child indirectly by shaping the behavior of siblings. Since controlling feeding behaviors have been associated with greater child obesity risk, future studies may evaluate the compounded effect of experiencing controlling feeding behaviors from both mothers and siblings. Copyright © 2015. Published by Elsevier Ltd.

A healthy lifestyle index is associated with reduced risk of colorectal adenomatous polyps among non-users of non-steroidal anti-inflammatory drugs.

PubMed

Tabung, Fred K; Steck, Susan E; Burch, James B; Chen, Chin-Fu; Zhang, Hongmei; Hurley, Thomas G; Cavicchia, Philip; Alexander, Melannie; Shivappa, Nitin; Creek, Kim E; Lloyd, Stephen C; Hebert, James R

2015-02-01

In a Columbia, South Carolina-based case-control study, we developed a healthy lifestyle index from five modifiable lifestyle factors (smoking, alcohol intake, physical activity, diet, and body mass index), and examined the association between this lifestyle index and the risk of colorectal adenomatous polyps (adenoma). Participants were recruited from a local endoscopy center and completed questionnaires related to lifestyle behaviors prior to colonoscopy. We scored responses on each of five lifestyle factors as unhealthy (0 point) or healthy (1 point) based on current evidence and recommendations. We added the five scores to produce a combined lifestyle index for each participant ranging from 0 (least healthy) to 5 (healthiest), which was dichotomized into unhealthy (0-2) and healthy (3-5) lifestyle scores. We used logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI) for adenoma with adjustment for multiple covariates. We identified 47 adenoma cases and 91 controls. In the main analyses, there was a statistically nonsignificant inverse association between the dichotomous (OR 0.54; 95% CI 0.22, 1.29) and continuous (OR 0.75; 95% CI 0.51, 1.10) lifestyle index and adenoma. Odds of adenoma were significantly modified by the use of non-steroidal anti-inflammatory drugs (NSAIDs) (p(interaction) = 0.04). For participants who reported no use of NSAIDs, those in the healthy lifestyle category had a 72% lower odds of adenoma as compared to those in the unhealthy category (OR 0.28; 95% CI 0.08, 0.98), whereas a one-unit increase in the index significantly reduced odds of adenoma by 53% (OR 0.47; 95% CI 0.26, 0.88). Although these findings should be interpreted cautiously given our small sample size, our results suggest that higher scores from this index are associated with reduced odds of adenomas, especially in non-users of NSAIDs. Lifestyle interventions are required to test this approach as a strategy to prevent colorectal adenomatous polyps.

Novel, Objective, Multivariate Biomarkers Composed of Plasma Amino Acid Profiles for the Diagnosis and Assessment of Inflammatory Bowel Disease

PubMed Central

Hisamatsu, Tadakazu; Okamoto, Susumu; Hashimoto, Masaki; Muramatsu, Takahiko; Andou, Ayatoshi; Uo, Michihide; Kitazume, Mina T.; Matsuoka, Katsuyoshi; Yajima, Tomoharu; Inoue, Nagamu; Kanai, Takanori; Ogata, Haruhiko; Iwao, Yasushi; Yamakado, Minoru; Sakai, Ryosei; Ono, Nobukazu; Ando, Toshihiko; Suzuki, Manabu; Hibi, Toshifumi

2012-01-01

Background Inflammatory bowel disease (IBD) is a chronic intestinal disorder that is associated with a limited number of clinical biomarkers. In order to facilitate the diagnosis of IBD and assess its disease activity, we investigated the potential of novel multivariate indexes using statistical modeling of plasma amino acid concentrations (aminogram). Methodology and Principal Findings We measured fasting plasma aminograms in 387 IBD patients (Crohn's disease (CD), n = 165; ulcerative colitis (UC), n = 222) and 210 healthy controls. Based on Fisher linear classifiers, multivariate indexes were developed from the aminogram in discovery samples (CD, n = 102; UC, n = 102; age and sex-matched healthy controls, n = 102) and internally validated. The indexes were used to discriminate between CD or UC patients and healthy controls, as well as between patients with active disease and those in remission. We assessed index performances using the area under the curve of the receiver operating characteristic (ROC AUC). We observed significant alterations to the plasma aminogram, including histidine and tryptophan. The multivariate indexes established from plasma aminograms were able to distinguish CD or UC patients from healthy controls with ROC AUCs of 0.940 (95% confidence interval (CI): 0.898–0.983) and 0.894 (95%CI: 0.853–0.935), respectively in validation samples (CD, n = 63; UC, n = 120; healthy controls, n = 108). In addition, other indexes appeared to be a measure of disease activity. These indexes distinguished active CD or UC patients from each remission patients with ROC AUCs of 0.894 (95%CI: 0.853–0.935) and 0.849 (95%CI: 0.770–0.928), and correlated with clinical disease activity indexes for CD (rs = 0.592, 95%CI: 0.385–0.742, p<0.001) or UC (rs = 0.598, 95%CI: 0.452–0.713, p<0.001), respectively. Conclusions and Significance In this study, we demonstrated that established multivariate indexes composed of plasma amino acid profiles can serve as novel, non-invasive, objective biomarkers for the diagnosis and monitoring of IBD, providing us with new insights into the pathophysiology of the disease. PMID:22303484

Haematopoietic cancer mortality among vehicle mechanics.

PubMed Central

Hunting, K L; Longbottom, H; Kalavar, S S; Stern, F; Schwartz, E; Welch, L S

1995-01-01

OBJECTIVE AND METHODS--This historical cohort study investigated causes of death among car and mobile equipment mechanics in the District of Columbia's Department of Public Works. Men who were employed for at least one year between 1977 and 1989 were eligible for inclusion in the cohort; follow up was up to the end of 1991. Three cases of leukaemia (index cases) had been reported among these workers before the inception of this study. This research was undertaken to estimate the relative risk of haematological cancer among mechanics working for the District of Columbia. RESULTS--Among the 335 male fleet maintenance workers, the all cause standardised mortality ratio (SMR) was 0.50 (33 observed deaths, 95% confidence interval (95% CI) 0.35-0.70), and the all cancer SMR was 0.55 (nine deaths, 95% CI 0.25-1.05). Three deaths from lymphatic and haematopoietic cancer were observed; the SMR was 3.63 (95% CI 0.75-10.63). In the subgroup with highest potential for exposure to fuels and solvents, the SMR for leukaemia and aleukaemia was 9.26 (two deaths, 95% CI 1.12-33.43), and the SMR for other lymphatic and haematopoietic neoplasms was 2.57 (one death from malignant lymphoma, 95% CI 0.06-14.27). All three lymphatic and haematopoietic cancer deaths were among car and mobile equipment mechanics (one was an index case). The two additional index cases were a fourth mechanic who died of leukaemia in 1992, after mortality follow up ended, and a fifth mechanic who was diagnosed with leukaemia in 1988 and is still alive. CONCLUSION--Many garage mechanics in this cohort regularly used petrol to clean parts and to wash their hands; some workers would occasionally siphon petrol by mouth. Benzene, a recognised cause of haematological cancer, is a component of petrol. Previous research indicates that garage mechanics may be at risk of leukaemia and other haematological cancers, presumably due to exposure to petrol; this study supports those findings. PMID:7489058

CT of Patients With Hip Fracture: Muscle Size and Attenuation Help Predict Mortality

PubMed Central

Boutin, Robert D.; Bamrungchart, Sara; Bateni, Cyrus P.; Beavers, Daniel P.; Beavers, Kristen M.; Meehan, John P.; Lenchik, Leon

2018-01-01

OBJECTIVE Our objective was to determine the association between muscle cross-sectional area and attenuation, as measured on routine CT scans, and mortality in older patients with hip fracture. MATERIALS AND METHODS A retrospective 10-year study of patients with hip fracture was conducted with the following inclusion criteria: age 65 years or older, first-time hip fracture treated with surgery, and CT of the chest, abdomen, or pelvis. This yielded 274 patients (70.4% women; mean [± SD] age, 81.3 ± 8.3 years). On each CT scan, two readers independently measured the size (cross-sectional area, indexed for patient height) and attenuation of the paravertebral muscle at T12 and the psoas muscle at L4. We then determined the association between overall mortality and the muscle size and muscle attenuation, while adjusting for demographic variables (age, sex, ethnicity, and body mass index), American Society of Anesthesiologists (ASA) classification, and Charlson comorbidity index (CCI). RESULTS The overall mortality rate increased from 28.3% at 1 year to 79.5% at 5 years. Mortality was associated with decreased thoracic muscle size (odds ratio [OR], 0.66; 95% CI, 0.49–0.87). This association persisted after adjusting for demographic variables (OR, 0.69; 95% CI, 0.50–0.95), the ASA classification (OR, 0.70; CI, 0.51–0.97), and the CCI (OR, 0.72; 95% CI, 0.52–1.00). Similarly, decreased survival was associated with decreased thoracic muscle attenuation after adjusting for all of these combinations of covariates (OR, 0.67–0.72; 95% CI, 0.49–0.99). Decreased lumbar muscle size and attenuation trended with decreased survival but did not reach statistical significance. CONCLUSION In older adults with hip fractures, CT findings of decreased thoracic paravertebral muscle size and attenuation are associated with decreased overall survival. PMID:28267356

CT-angiography source images indicate less fatal outcome despite coma of patients in the Basilar Artery International Cooperation Study.

PubMed

Pallesen, Lars P; Khomenko, Andrei; Dzialowski, Imanuel; Barlinn, Jessica; Barlinn, Kristian; Zerna, Charlotte; van der Hoeven, Erik Jrj; Algra, Ale; Kapelle, L Jaap; Michel, Patrik; Bodechtel, Ulf; Demchuk, Andrew M; Schonewille, Wouter; Puetz, Volker

2017-02-01

Background Coma is associated with poor outcome in patients with basilar artery occlusion. Aims We sought to assess whether the posterior circulation Acute Stroke Prognosis Early CT Score and the Pons-Midbrain Index applied to CT angiography source images predict the outcome of comatose patients in the Basilar Artery International Cooperation Study. Methods Basilar Artery International Cooperation Study was a prospective, observational registry of patients with acute basilar artery occlusion with 48 recruiting centers worldwide. We applied posterior circulation Acute Stroke Prognosis Early CT Score and Pons-Midbrain Index to CT angiography source images of Basilar Artery International Cooperation Study patients who presented with coma. We calculated adjusted risk ratios to assess the association of dichotomized posterior circulation Acute Stroke Prognosis Early CT Score (≥8 vs. <8) and Pons-Midbrain Index (<3 vs. ≥3) with mortality and favourable outcome (modified Rankin Scale score 0-3) at one month. Results Of 619 patients in the Basilar Artery International Cooperation Study registry, CT angiography source images were available for review in 158 patients. Among these, 78 patients (49%) presented with coma. Compared to non-comatose patients, comatose patients were more likely to die (risk ratios 2.34; CI 95% 1.56-3.52) and less likely to have a favourable outcome (risk ratios 0.44; CI 95% 0.24-0.80). Among comatose patients, a Pons-Midbrain Index < 3 was related to reduced mortality (adjusted RR 0.66; 95% CI 0.46-0.96), but not to favourable outcome (adjusted RR 1.19; 95% CI 0.39-3.62). Posterior circulation Acute Stroke Prognosis Early CT Score dichotomized at ≥ 8 vs. <8 was not significantly associated with death (adjusted RR 0.70; 95% CI 0.46-1.05). Conclusion In comatose patients with basilar artery occlusion, the extent of brainstem ischemia appears to be related to mortality but not to favourable outcome.

Influence of social deprivation, overcrowding and family structure on emergency medical admission rates.

PubMed

Conway, R; Byrne, D; O'Riordan, D; Cournane, S; Coveney, S; Silke, B

2016-10-01

Patients from deprived backgrounds have a higher in-patient mortality following emergency medical admission. To evaluate the influence of Deprivation Index, overcrowding and family structure on hospital admission rates. Retrospective cohort study. All emergency medical admissions from 2002 to 2013 were evaluated. Based on address, each patient was allocated to an electoral division, whose small area population statistics were available from census data. Patients were categorized by quintile of Deprivation Index, overcrowding and family structure, and these were evaluated against hospital admission rate, calculated as rate/1000 population. Univariate and multivariable risk estimates (Odds Ratios or Incidence Rate Ratios) were calculated, using logistic or zero truncated Poisson regression as appropriate. There were 66 861 admissions in 36 214 patients over the 12-year study period. Deprivation Index quintile independently predicted the admission rate, with rates of Q1 12.0 (95% CI 11.8-12.2), Q2 19.5 (95% CI 19.3-19.6), Q3 33.7 (95% CI 33.3-34.0), Q4 31.4 (95% CI 31.2-31.6) and Q5 38.1 (95% CI 37.7-38.5). Similarly the proportions of families with children <15 years old, was an independent predictor of the admission rate with rates of Q1 20.8 (95% CI 20.4-21.1), Q2 23.0 (95% CI 22.7-23.3), Q3 32.2 (95% CI 31.9-32.5), Q4 32.4 (95% CI 32.2-32.7) and Q5 37.2 (95% CI 36.6-37.8). The proportion of families with children ≥15-years old was also predictive but quintile of overcrowding was only predictive in the univarate model. Deprivation Index and family structure strongly predict emergency medical hospital admission rates. © The Author 2016. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Effects of Cerebral Blood Flow and Vessel Conditions on Speech Recognition in Patients With Postlingual Adult Cochlear Implant: Predictable Factors for the Efficacy of Cochlear Implant.

PubMed

Ishino, Takashi; Ragaee, Mahmoud Ali; Maruhashi, Tatsuya; Kajikawa, Masato; Higashi, Yukihito; Sonoyama, Toru; Takeno, Sachio; Hirakawa, Katsuhiro

Cochlear implantation (CI) has been the most successful procedure for restoring hearing in a patient with severe and profound hearing loss. However, possibly owing to the variable brain functions of each patient, its performance and the associated patient satisfaction are widely variable. The authors hypothesize that peripheral and cerebral circulation can be assessed by noninvasive and globally available methods, yielding superior presurgical predictive factors of the performance of CI in adult patients with postlingual hearing loss who are scheduled to undergo CI. Twenty-two adult patients with cochlear implants for postlingual hearing loss were evaluated using Doppler sonography measurement of the cervical arteries (reflecting cerebral blood flow), flow-mediated dilation (FMD; reflecting the condition of cerebral arteries), and their pre-/post-CI best score on a monosyllabic discrimination test (pre-/post-CI best monosyllabic discrimination [BMD] score). Correlations between post-CI BMD score and the other factors were examined using univariate analysis and stepwise multiple linear regression analysis. The prediction factors were calculated by examining the receiver-operating characteristic curve between post-CI BMD score and the significantly positively correlated factors. Age and duration of deafness had a moderately negative correlation. The mean velocity of the internal carotid arteries and FMD had a moderate-to-strong positive correlation with the post-CI BMD score in univariate analysis. Stepwise multiple linear regression analysis revealed that only FMD was significantly positively correlated with post-CI BMD score. Analysis of the receiver-operating characteristic curve showed that a FMD cutoff score of 1.8 significantly predicted post-CI BMD score. These data suggest that FMD is a convenient, noninvasive, and widely available tool for predicting the efficacy of cochlear implants. An FMD cutoff score of 1.8 could be a good index for determining whether patients will hear well with cochlear implants. It could also be used to predict whether cochlear implants will provide good speech recognition benefits to candidates, even if their speech discrimination is poor. This FMD index could become a useful predictive tool for candidates with poor speech discrimination to determine the efficacy of CI before surgery.

Neighborhood contextual characteristics and leisure-time physical activity: Pró-Saúde Study.

PubMed

Boclin, Karine de Lima Sírio; Faerstein, Eduardo; Leon, Antônio Carlos Monteiro Ponce de

2014-04-01

To estimate the association between neighborhood contextual variables and leisure-time physical activity. Data were analyzed for 2,674 adults from Rio de Janeiro, RJ, Southeastern Brazil, participating in the longitudinal study in 1999. Leisure-time physical activity in the two preceding weeks was assessed dichotomously. Sex, age, income, education and marital status were analyzed as individual variables. Neighborhood contextual characteristics were the social development index, the Theil index and the proportion of the area occupied by parks, squares and gardens, categorized in quintiles. The unadjusted and adjusted odds ratios and 95% confidence intervals were estimated using multilevel logistic regression. The prevalence of leisure-time physical activity was higher in residents in neighborhoods with higher indices of social development (between 32.3% and 53.1%) and a greater proportion of parks, squares and gardens (between 35.8% and 53.1%). Regarding the social development index, the adjusted odds ratios for physical activity were 1.22 (95%CI 0.93;1.61), 1.44 (95%CI 1.09;1.89), 1.75 (95%CI 1.31;2.34) and 2.25 (95%CI 1.70;3.00) for residents in neighborhoods in the second, third, fourth and fifth quintiles, respectively, compared with residents in neighborhoods in the first quintile. The odds ratios for the proportion of parks, squares and gardens were 0.90 (95%CI 0.69;1.19), 1.41 (95%CI 1.04;1.90), 1.63 (95%CI 1.24;2.14) and 1.05 (95%CI 0.80;1.38) for residents in neighborhoods in the second, third, fourth and fifth quintiles. After adjusting for the other variables, only the social development index continued to be associated with leisure-time physical activity, with odds ratios of 1.41 (95%CI 1.02;1.95); 1.54 (95%CI 1.12;2.12); 1.65 (95%CI 1.14;2.39) and 2.13 (95%CI 1.40;3.25) for residents in neighborhoods in the second, third, fourth and fifth quintiles. Leisure-time physical activity was more common in residents in neighborhoods with higher social development indices. No association was observed between access to leisure areas and income inequality.

Characteristics Associated With Treatment Response in Women Undergoing OnabotulinumtoxinA and Sacral Neuromodulation for Refractory Urgency Urinary Incontinence

PubMed Central

Richter, HE; Amundsen, CL; Erickson, SW; Jelovsek, JE; Komesu, Y; Chermansky, C; Harvie, H; Albo, M; Myers, D; Gregory, WT; Wallace, D

2017-01-01

Purpose To identify clinical and demographic characteristics associated with onabotulinumtoxinA and sacral neuromodulation treatment response in women with refractory urgency urinary incontinence. Material and Methods Data were analyzed from the Refractory Overactive Bladder: Sacral Neuromodulation vs Botulinum Toxin Assessment trial. Baseline participant characteristics and clinical variables associated with two definitions of treatment response: 1) reduction in mean daily urgency incontinence episodes over 6 months 2) ≥50% decrease in urgency incontinence episodes across 6 months were identified. Linear and logistic regression models were fit to estimate mean reductions in incontinence episodes and adjusted odds ratios for incidence of ≥50% decrease with 95% confidence intervals, respectively. Results For both treatments, a greater reduction in mean daily urgency incontinence episodes was associated with higher Health Utility Index scores (P=0.002) and higher baseline incontinence episodes (P<0.001). Increased age was associated with less reduction in incontinence episodes (P<0.001). Increasing body mass index (aOR 0.82 per 5 points, 95% CI 0.70, 0.96) was associated with reduced achievement of ≥50% decrease in incontinence episodes after both treatments. Greater age (aOR 0.44 per 10 years, 95% CI 0.30, 0.65) and higher functional comorbidity index (aOR 0.84 per point, 95% CI 0.71, 0.99) were associated with reduced achievement of ≥50% decrease in urgency incontinence episodes in the onabotulinuntoxinA group only (P=0.016; P=0.031, respectively). Conclusion Increasing age, body mass index, and functional comorbidity are negatively associated with treatment response while greater incontinence frequency and health utility is associated with a greater response to third line treatments for refractory urgency incontinence. PMID:28501541

Estrogen Alone and Health Outcomes in Black Women by African Ancestry: A Secondary Analyses of a Randomized Controlled Trial

PubMed Central

Chlebowski, Rowan T.; Barrington, Wendy; Aragaki, Aaron K.; Manson, JoAnn E.; Sarto, Gloria; O’Sullivan, Mary Jo; Wu, Daniel; Cauley, Jane A.; Qi, Lihong; Wallace, Robert L.; Prentice, Ross L.

2016-01-01

OBJECTIVE In postmenopausal Black women in the Women’s Health Initiative (WHI) randomized trial, estrogen alone reduced breast cancers but its comprehensive influence on health outcomes in Black women is unknown. Therefore, we examined this issue in the WHI overall and by African ancestry. METHODS 1,616 Black women with prior hysterectomy, including 1061 with percent African ancestry determination, at 40 US centers were randomly assigned to conjugated equine estrogen (0.625 mg/d) or placebo for 7.2 years (median) intervention with 13 years cumulative follow-up. Coronary heart disease (CHD) and breast cancer were primary efficacy and safety outcomes, respectively. A global index also included stroke, colorectal cancer, hip fracture, pulmonary embolism and death. RESULTS Black women in the estrogen alone group compared to Black women in the placebo group had fewer breast cancers (17 vs. 40, hazard ratio [HR] 0.47 95% confidence interval [CI] 0.26–0.82). In women with >80% African ancestry, breast cancer HR was lower (0.32 95% CI 0.12–0.86, trend p=0.04 for ancestry effect). Most other outcomes including CHD, stroke, hip fracture and the global index were null with estrogen use in Black women; a global index effect was more favorable in younger Black women (HR 0.65 95% CI 0.43–0.98). CONCLUSIONS In Black postmenopausal women with prior hysterectomy, estrogen alone significantly reduced breast cancer incidence with no adverse influence on CHD, venous thromboembolism or all-cause mortality. Favorable estrogen alone global index effects in younger Black women warrant further study. PMID:27749739

A Risk Prediction Index for Advanced Colorectal Neoplasia at Screening Colonoscopy.

PubMed

Schroy, Paul C; Wong, John B; O'Brien, Michael J; Chen, Clara A; Griffith, John L

2015-07-01

Eliciting patient preferences within the context of shared decision making has been advocated for colorectal cancer screening. Risk stratification for advanced colorectal neoplasia (ACN) might facilitate more effective shared decision making when selecting an appropriate screening option. Our objective was to develop and validate a clinical index for estimating the probability of ACN at screening colonoscopy. We conducted a cross-sectional analysis of 3,543 asymptomatic, mostly average-risk patients 50-79 years of age undergoing screening colonoscopy at two urban safety net hospitals. Predictors of ACN were identified using multiple logistic regression. Model performance was internally validated using bootstrapping methods. The final index consisted of five independent predictors of risk (age, smoking, alcohol intake, height, and a combined sex/race/ethnicity variable). Smoking was the strongest predictor (net reclassification improvement (NRI), 8.4%) and height the weakest (NRI, 1.5%). Using a simplified weighted scoring system based on 0.5 increments of the adjusted odds ratio, the risk of ACN ranged from 3.2% (95% confidence interval (CI), 2.6-3.9) for the low-risk group (score ≤2) to 8.6% (95% CI, 7.4-9.7) for the intermediate/high-risk group (score 3-11). The model had moderate to good overall discrimination (C-statistic, 0.69; 95% CI, 0.66-0.72) and good calibration (P=0.73-0.93). A simple 5-item risk index based on readily available clinical data accurately stratifies average-risk patients into low- and intermediate/high-risk categories for ACN at screening colonoscopy. Uptake into clinical practice could facilitate more effective shared decision-making for CRC screening, particularly in situations where patient and provider test preferences differ.

The effect of past antibiotic exposure on diabetes risk

PubMed Central

Boursi, Ben; Mamtani, Ronac; Haynes, Kevin; Yang, Yu-Xiao

2015-01-01

Objective Gut microbiota influence metabolic pathways relevant to the pathogenesis of obesity, insulin-resistance and diabetes. Antibiotic therapy can alter the microbiota and is commonly used in western countries. We sought to evaluate whether past antibiotic exposure increases diabetes risk. Research design and methods We conducted a nested case-control study using a large population-based database from the United Kingdom (UK). Cases were defined as those with incident diagnosis of diabetes. For every case, 4 eligible controls matched on age, sex, practice-site, and duration of follow-up before index-date were selected using incidence-density sampling. Exposure of interest was antibiotic therapy >1 year before index-date. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression. The risk was adjusted for body mass index (BMI), smoking, last glucose level and number of infections before index-date, as well as past medical history of coronary artery disease and hyperlipidemia. Results The study included 208,002 diabetic cases and 815,576 matched controls. Exposure to a single antibiotic prescription was not associated with higher adjusted diabetes risk. Treatment with 2–5 antibiotic courses was associated with increase in diabetic risk for penicillin, cephalosporins, macrolides and quinolones with adjusted OR ranging from 1.08 (95%CI 1.05–1.11) for penicillin to 1.15 (95%CI 1.08–1.23) for quinolones. The risk increased with the number of antibiotic courses and reached 1.37 (95%CI 1.19–1.58) for >5 courses of quinolones. There was no association between exposure to anti-virals and anti-fungals and diabetes risk. Conclusions Exposure to certain antibiotic groups increases diabetes risk. PMID:25805893

Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients.

PubMed

Schwartz-Neiderman, Anat; Braun, Tali; Fallach, Noga; Schwartz, David; Carmeli, Yehuda; Schechner, Vered

2016-10-01

OBJECTIVE Carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) are extremely drug-resistant pathogens. Screening of contacts of newly identified CP-CRE patients is an important step to limit further transmission. We aimed to determine the risk factors for CP-CRE acquisition among patients exposed to a CP-CRE index patient. METHODS A matched case-control study was performed in a tertiary care hospital in Israel. The study population was comprised of patients who underwent rectal screening for CP-CRE following close contact with a newly identified CP-CRE index patient. Cases were defined as positive tests for CP-CRE. For each case patient, 2 matched controls were randomly selected from the pool of contacts who tested negative for CP-CRE following exposure to the same index case. Bivariate and multivariate analyses were conducted using conditional logistic regression. RESULTS In total, 53 positive contacts were identified in 40 unique investigations (896 tests performed on 735 contacts) between October 6, 2008, and June 7, 2012. bla KPC was the only carbapenemase identified. In multivariate analysis, risk factors for CP-CRE acquisition among contacts were (1) contact with an index patient for ≥3 days (odds ratio [OR], 9.8; 95% confidence interval [CI], 2.0-48.9), (2) mechanical ventilation (OR, 4.1; 95% CI, 1.4-11.9), and (3) carriage or infection with another multidrug-resistant organism (MDRO; OR, 2.6; 95% CI, 1.0-7.1). Among patients who received antibiotics, cephalosporins were associated with a lower risk of acquisition. CONCLUSIONS Patient characteristics (ventilation and carriage of another MDRO) as well as duration of contact are risk factors for CP-CRE acquisition among contacts. The role of cephalosporins requires further study. Infect Control Hosp Epidemiol 2016;1-7.

The influence of removable partial dentures on the periodontal health of abutment and non-abutment teeth

PubMed Central

Dula, Linda J.; Shala, Kujtim Sh.; Pustina–Krasniqi, Teuta; Bicaj, Teuta; Ahmedi, Enis F.

2015-01-01

Objective: The aim of this study was to evaluate the influence of removable partial dentures (RPD) on the periodontal health of abutment and non-abutment teeth. Materials and Methods: A total 107 patients with RPD participated in this study. It was examined 138 RPD, they were 87 with clasp-retained and 51 were RPD with attachments. The following periodontal parameters were evaluated for abutment and non-abutment teeth, plaque index (PLI), calculus index (CI), bleeding on probing (BOP), probing depth (PD) (mm) and tooth mobility (TM) index. These clinical measurements were taken immediately before insertion the RPD, then one and 3 months after insertion. The level of significance was set at (P < 0.05). Results: The mean scores for PLI, CI, BOP, PD, and TM index, of the abutment teeth and non-abutment teeth were no statistically significant at the time of insertion of RPD. After 1-month, PLI was statistically significant (0.57 ± 0.55 for abutment and 0.30 ± 0.46 for non-abutment teeth). After 3 months, there were significant differences between abutment and non-abutment teeth with regard to the BOP (1.53 ± 0.50 and 1.76 ± 0.43 respectively), PD (0.28 ± 0.45 and 0.12 ± 0.33 respectively) and PLI (1.20 ± 0.46 and 0.75 ± 0.64 respectively). No significant mean difference in TM and CI was found between the abutment and non-abutment teeth (P > 0.05). Conclusions: With carefully planned prosthetic treatment and adequate maintenance of the oral and denture hygiene, we can prevent the periodontal diseases. PMID:26430367

The Drivers of Discretionary Utilization: Clinical History Versus Physician Supply

PubMed Central

Ruhnke, Gregory W.; Manning, Willard G.; Rubin, David T.; Meltzer, David O.

2016-01-01

Purpose Since the effect of physician supply on utilization remains controversial, literature based on non-Medicare populations is sparse, and a physician supply expansion is underway, the potential for physician-induced demand across diverse populations is important to understand. A substantial proportion of gastrointestinal endoscopies may be inappropriate. The authors analyzed the impact of physician supply, practice patterns, and clinical history on esophagogastroduodenoscopy (EGD, defined as discretionary) among patients hospitalized with lower gastrointestinal bleeding (LGIB). Method Among 34,344 patients hospitalized for LGIB from 2004–2009, 43.1% and 21.3% had a colonoscopy or EGD, respectively, during the index hospitalization or within 6 months after. Linking to the Dartmouth Atlas via patients’ hospital referral region, gastroenterologist density and hospital care intensity (HCI) index were ascertained. Adjusting for age, gender, comorbidities, and race/education indicators, the association of gastroenterologist density, HCI index, and history of upper GI disease with EGD was estimated using logistic regression. Results EGD was not associated with gastroenterologist density or HCI index, but was associated with a history of any upper gastrointestinal disease (OR 2.30, 95% CI) 2.17–2.43), peptic ulcer disease (OR 4.82, 95% CI 4.26–5.45), and liver disease (OR 1.34, 95% CI 1.18–1.54). Conclusions Among patients hospitalized with LGIB, large variation in gastroenterologist density did not predict EGD, but relevant clinical history did, with association strengths commensurate with risk for upper gastrointestinal bleeding. In the scenario studied, the authors found no evidence that specialty physician supply increases will result in more discretionary care within commercially insured populations. PMID:28441679

Medical journals, impact and social media: an ecological study of the Twittersphere

PubMed Central

Cosco, Theodore D.

2015-01-01

Background: Twitter is an increasingly popular means of research dissemination. I sought to examine the relation between scientific merit and mainstream popularity of general medical journals. Methods: I extracted impact factors and citations for 2014 for all general medical journals listed in the Thomson Reuters InCites Journal Citation Reports. I collected Twitter statistics (number of followers, number following, number of tweets) between July 25 and 27, 2015 from the Twitter profiles of journals that had Twitter accounts. I calculated the ratio of observed to expected Twitter followers according to citations via the Kardashian Index. I created the (Fifty Shades of) Grey Scale to calculate the analogous ratio according to impact factor. Results: Only 28% (43/153) of journals had Twitter profiles. The scientific and social media impact of journals were correlated: in adjusted models, Twitter followers increased by 0.78% (95% confidence interval [CI] 0.38%–1.18%) for every 1% increase in impact factor and by 0.62% (95% CI 0.34%–0.90%) for every 1% increase in citations. Kardashian Index scores above the 99% CI were obsverved in 16% (7/43) of journals, including 6 of the 7 highest ranked journals by impact factor, whereas 58% (25/43) had scores below this interval. For the Grey Scale, 12% (5/43) of journals had scores above and 35% (15/43) had scores below the 99% CI. Interpretation: The size of a general medical journal’s Twitter following is strongly linked to its impact factor and citations, suggesting that higher quality research received more mainstream attention. Many journals have not capitalized on this dissemination method, although others have used it to their advantage. PMID:26644544

Is the status of diabetes socioeconomic inequality changing in Kurdistan province, west of Iran? A comparison of two surveys

PubMed Central

Moradi, Ghobad; Majdzadeh, Reza; Mohammad, Kazem; Malekafzali, Hossein; Jafari, Saeede; Holakouie-Naieni, Kourosh

2016-01-01

Background: About 80% of deaths in 350 million cases of diabetes in the world occur in low and middle income countries. The aim of this study was to determine the status of diabetes socioeconomic inequality and the share of determinants of inequalities in Kurdistan Province, West of Iran, using two surveys in 2005 and 2009. Methods: Data were collected from non-communicable disease surveillance surveys in Kurdistan in 2005 and 2009. In this study, the socioeconomic status (SES) of the participants was determined based on the residential area and assets using principal component analysis statistical method. We used concentration index and logistic regression to determine inequality. Decomposition analysis was used to determine the share of each determinant of inequality. Results: The prevalence of diabetes expressed by individuals changed from 0.9% (95% CI: 0.6-1.3) in 2005 to 3.1% (95% CI: 2-4) in 2009. Diabetes Concentration Index changed from -0.163 (95% CI: -0.301- -0.024) in 2005 to 0.273 (95% CI: 0.101-0.445) in 2009. The results of decomposition analysis revealed that in 2009, 67% of the inequality was due to low socioeconomic status and 16% to area of residence; i.e., living in rural areas. Conclusion: The prevalence of diabetes significantly increased, and the diabetes inequality shifted from the poor people to groups with better SES. Increased prevalence of diabetes among the high SES individuals may be due to their better responses to diabetes control and awareness programs or due to the type of services they were provided during these years. PMID:27493919

Estimating numbers of greater prairie-chickens using mark-resight techniques

USGS Publications Warehouse

Clifton, A.M.; Krementz, D.G.

2006-01-01

Current monitoring efforts for greater prairie-chicken (Tympanuchus cupido pinnatus) populations indicate that populations are declining across their range. Monitoring the population status of greater prairie-chickens is based on traditional lek surveys (TLS) that provide an index without considering detectability. Estimators, such as immigration-emigration joint maximum-likelihood estimator from a hypergeometric distribution (IEJHE), can account for detectability and provide reliable population estimates based on resightings. We evaluated the use of mark-resight methods using radiotelemetry to estimate population size and density of greater prairie-chickens on 2 sites at a tallgrass prairie in the Flint Hills of Kansas, USA. We used average distances traveled from lek of capture to estimate density. Population estimates and confidence intervals at the 2 sites were 54 (CI 50-59) on 52.9 km 2 and 87 (CI 82-94) on 73.6 km2. The TLS performed at the same sites resulted in population ranges of 7-34 and 36-63 and always produced a lower population index than the mark-resight population estimate with a larger range. Mark-resight simulations with varying male:female ratios of marks indicated that this ratio was important in designing a population study on prairie-chickens. Confidence intervals for estimates when no marks were placed on females at the 2 sites (CI 46-50, 76-84) did not overlap confidence intervals when 40% of marks were placed on females (CI 54-64, 91-109). Population estimates derived using this mark-resight technique were apparently more accurate than traditional methods and would be more effective in detecting changes in prairie-chicken populations. Our technique could improve prairie-chicken management by providing wildlife biologists and land managers with a tool to estimate the population size and trends of lekking bird species, such as greater prairie-chickens.

Prognostic Relevance of the Peritoneal Surface Disease Severity Score Compared to the Peritoneal Cancer Index for Colorectal Peritoneal Carcinomatosis

PubMed Central

Ng, Jia Lin; Ong, Whee Sze; Chia, Claramae Shulyn; Tan, Grace Hwei Ching; Soo, Khee-Chee; Teo, Melissa Ching Ching

2016-01-01

Background. Peritoneal Carcinomatosis Index (PCI) is a widely established scoring system that describes disease burden in isolated colorectal peritoneal carcinomatosis (CPC). Its significance may be diminished with complete cytoreduction. We explore the utility of the recently described Peritoneal Surface Disease Severity Score (PSDSS) and compare its prognostic value against PCI. Methods. The endpoints were overall survival (OS), progression-free survival (PFS), and survival less than 18 months (18 MS). Results. Fifty patients underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for CPC from 2003 to 2014, with 98% achieving complete cytoreduction. Median OS was 28.8 months (95% CI, 18.0–39.1); median PFS was 9.4 months (95% CI, 7.7–13.9). Univariate analysis showed that higher PCI was significantly associated with poorer OS (HR 1.11; 95% CI, 1.03–1.20) and PFS (HR 1.09; 95% CI, 1.03–1.14). Conversely, PSDSS was not associated with either endpoint. Multivariate analysis showed that PCI, but not PSDSS, was predictive of OS and PFS. PCI was also able to discriminate survival outcomes better than PSDSS for both OS and PFS. There was no association between 18 MS and either score. Conclusion. PCI is superior to PSDSS in predicting OS and PFS and remains the prognostic score of choice in CPC patients undergoing CRS/HIPEC. PMID:27006828

Relationship between sjögren syndrome and periodontal status: A systematic review.

PubMed

de Goés Soares, Luana; Rocha, Ricardo Lopes; Bagordakis, Elizabete; Galvão, Endi Lanza; Douglas-de-Oliveira, Dhelfeson Willya; Falci, Saulo Gabriel Moreira

2018-03-01

This study aimed to examine whether Sjögren syndrome (SS) is related to periodontal status. A systematic review was performed on the basis of PRISMA (PROSPERO: CRD42017055202). A search was performed in the PubMed/MEDLINE, LILACS, Web of Science, and Science Direct databases. Hand searches and review of the gray literature were also performed. Three researchers independently selected studies, extracted data, and assessed methodologic quality. Studies that correlated primary and/or secondary SS with plaque index, gingival index, probing depth, and bleeding on probing were included. The risk of bias was estimated on the basis of the Newcastle-Ottawa scale. Seventeen studies were included in the review and 9 included in the meta-analysis, with a total of 518 and 544 patients, with or without SS, respectively. The mean difference of plaque index (0.29; 95% confidence interval [CI] 0.17-0.41), gingival index (0.52; 95% CI 0.14-0.89), and bleeding on probing (9.92; 95% CI 4.37-15.47) were larger in patients with SS than in controls. In primary SS (0.47; 95% CI 0.10-0.83) and secondary SS (0.74; 95% CI 0.10-1.38), only the mean gingival index was larger compared with that in control group. The majority of the included studies were judged as having a high risk of bias. The present review did not provide strong evidence that periodontal status is affected by SS. Copyright © 2017 Elsevier Inc. All rights reserved.

Body Adiposity Index Performance in Estimating Body Fat Percentage in Colombian College Students: Findings from the FUPRECOL-Adults Study.

PubMed

Ramírez-Vélez, Robinson; Correa-Bautista, Jorge Enrique; González-Ruíz, Katherine; Vivas, Andrés; Triana-Reina, Héctor Reynaldo; Martínez-Torres, Javier; Prieto-Benavides, Daniel Humberto; Carrillo, Hugo Alejandro; Ramos-Sepúlveda, Jeison Alexander; Villa-González, Emilio; García-Hermoso, Antonio

2017-01-17

Recently, a body adiposity index (BAI = (hip circumference)/((height)(1.5)) -18 ) was developed and validated in adult populations. The aim of this study was to evaluate the performance of BAI in estimating percentage body fat (BF%) in a sample of Colombian collegiate young adults. The participants were comprised of 903 volunteers (52% females, mean age = 21.4 years ± 3.3). We used the Lin's concordance correlation coefficient, linear regression, Bland-Altman's agreement analysis, concordance correlation coefficient ( ρc ) and the coefficient of determination ( R ²) between BAI, and BF%; by bioelectrical impedance analysis (BIA)). The correlation between the two methods of estimating BF% was R ² = 0.384, p < 0.001. A paired-sample t -test showed a difference between the methods (BIA BF% = 16.2 ± 3.1, BAI BF% = 30.0 ± 5.4%; p < 0.001). For BIA, bias value was 6.0 ± 6.2 BF% (95% confidence interval (CI) = -6.0 to 18.2), indicating that the BAI method overestimated BF% relative to the reference method. Lin's concordance correlation coefficient was poor ( ρc = 0.014, 95% CI = -0.124 to 0.135; p = 0.414). In Colombian college students, there was poor agreement between BAI- and BIA-based estimates of BF%, and so BAI is not accurate in people with low or high body fat percentage levels.

Maternal obesity, gestational weight gain and childhood cardiac outcomes: role of childhood body mass index.

PubMed

Toemen, L; Gishti, O; van Osch-Gevers, L; Steegers, E A P; Helbing, W A; Felix, J F; Reiss, I K M; Duijts, L; Gaillard, R; Jaddoe, V W V

2016-07-01

Maternal obesity may affect cardiovascular outcomes in the offspring. We examined the associations of maternal prepregnancy body mass index and gestational weight gain with childhood cardiac outcomes and explored whether these associations were explained by parental characteristics, infant characteristics or childhood body mass index. In a population-based prospective cohort study among 4852 parents and their children, we obtained maternal weight before pregnancy and in early, mid- and late pregnancy. At age 6 years, we measured aortic root diameter (cm) and left ventricular dimensions. We calculated left ventricular mass (g), left ventricular mass index (g m(-2.7)), relative wall thickness ((2 × left ventricular posterior wall thickness)/left ventricular diameter), fractional shorting (%), eccentric left ventricular hypertrophy and concentric remodeling. A one standard deviation score (SDS) higher maternal prepregnancy body mass index was associated with higher left ventricular mass (0.10 SDS (95% confidence interval (CI) 0.08, 0.13)), left ventricular mass index (0.06 SDS (95% CI 0.03, 0.09)) and aortic root diameter (0.09 SDS (95% CI 0.06, 0.12)), but not with relative wall thickness or fractional shortening. A one SDS higher maternal prepregnancy body mass index was associated with an increased risk of eccentric left ventricular hypertrophy (odds ratio 1.21 (95% CI 1.03, 1.41)), but not of concentric remodeling. When analyzing the effects of maternal weight in different periods simultaneously, only maternal prepregnancy weight and early pregnancy weight were associated with left ventricular mass, left ventricular mass index and aortic root diameter (P-values<0.05), independent of weight in other pregnancy periods. All observed associations were independent of parental and infant characteristics, but attenuated to non-significance after adjustment for childhood body mass index. Maternal prepregnancy body mass index and weight gain in early pregnancy are both associated with offspring cardiac structure in childhood, but these associations seem to be fully explained by childhood body mass index.

Indexation of cardiac output to biometric parameters in critically ill patients: A systematic analysis of a transpulmonary thermodilution-derived database.

PubMed

Saugel, Bernd; Mair, Sebastian; Götz, Simon Q; Tschirdewahn, Julia; Frank, Johanna; Höllthaler, Josef; Schmid, Roland M; Huber, Wolfgang

2015-10-01

Cardiac output (CO) (liters per minute) is usually normalized (ie, indexed) to the patient's body surface area (BSA) resulting in the hemodynamic variable cardiac index (CI) (liters per minute per square meter). We aimed (1) to evaluate the impact of different body weight-based CO indexations on the resulting CI values and (2) to identify biometric parameters independently associated with CO in critically ill patients. The study is an analysis of a database containing transpulmonary thermodilution-derived hemodynamic variables of 234 medical intensive care unit patients. Cardiac index indexed to actual BSA was statistically significantly lower compared with CI indexed to predicted BSA in the totality of patients and in the subgroups of patients with body mass index greater than or equal to 25 kg/m(2) but less than 30 kg/m(2) and body mass index greater than or equal to 30 kg/m(2) (with a statistically significant difference in the proportion of low and high CI measurements). Multivariate analysis of the first CO measurement of each patient demonstrated that CO was independently associated with age (P < .001), height (P = .001), and actual body weight (BWact) (P = .030). Multivariate analysis of the mean of the patients' CO measurements confirmed age (P < .001), height (P = .001), and BWact (P < .001) as biometric factors independently associated with CO. Age was identified as the most important factor with each year of age decreasing CO by 66 mL/min (95% confidence interval, 47-86 mL/min). The indexation of CO to BSA is highly dependent on the body weight estimation formula used to calculate BSA. Cardiac output is independently associated with the biometric factors age, height, and BWact. These factors might be considered for indexation of CO. Copyright © 2015 Elsevier Inc. All rights reserved.

Socio-Economic Inequality of Chronic Non-Communicable Diseases in Bangladesh

PubMed Central

Biswas, Tuhin; Islam, Md. Saimul; Linton, Natalie; Rawal, Lal B.

2016-01-01

Introduction Chronic non-communicable diseases (NCDs) are a major public health challenge, and undermine social and economic development in much of the developing world, including Bangladesh. Epidemiologic evidence on the socioeconomic status (SES)-related pattern of NCDs remains limited in Bangladesh. This study assessed the relationship between three chronic NCDs and SES among the Bangladeshi population, paying particular attention to the differences between urban and rural areas. Materials and Method Data from the 2011 Bangladesh Demographic and Health Survey were used for this study. Using a concentration index (CI), we measured relative inequality across pre-diabetes, diabetes, pre-hypertension, hypertension, and BMI (underweight, normal weight, and overweight/obese) in urban and rural areas in Bangladesh. A CI and its associated curve can be used to identify whether socioeconomic inequality exists for a given health variable. In addition, we estimated the health achievement index, integrating mean coverage and the distribution of coverage by rural and urban populations. Results Socioeconomic inequalities were observed across diseases and risk factors. Using CI, significant inequalities observed for pre-hypertension (CI = 0.09, p = 0.001), hypertension (CI = 0.10, p = 0.001), pre-diabetes (CI = -0.01, p = 0.005), diabetes (CI = 0.19, p<0.001), and overweight/obesity (CI = 0.45, p<0.001). In contrast to the high prevalence of the chronic health conditions among the urban richest, a significant difference in CI was observed for pre-hypertension (CI = -0.20, p = 0.001), hypertension (CI = -0.20, p = 0.005), pre-diabetes (CI = -0.15, p = 0.005), diabetes (CI = -0.26, p = 0.004) and overweight/obesity (CI = 0.25, p = 0.004) were observed more among the low wealth quintiles of rural population. In the same vein, the poorest rural households had more co-morbidities compared to the richest rural households (p = 0.003), and prevalence of co-morbidities was much higher for the richest urban households compared to the poorest urban households. On the other hand in rural the “disachievement” of health indicators is more noticeable than the urban ones. Conclusion The findings indicate the high burden of selected NCDs among the low wealth quintile populations in rural areas and wealthy populations in urban areas. Particular attentions may be necessary to address the problem of NCDs among these groups. PMID:27902760

A Protein Microarray for the Rapid Screening of Patients Suspected of Infection with Various Food-Borne Helminthiases

PubMed Central

Ai, Lin; Chen, Jun-Hu; Chen, Shao-Hong; Zhang, Yong-Nian; Cai, Yu-Chun; Zhu, Xing-Quan; Zhou, Xiao-Nong

2012-01-01

Background Food-borne helminthiases (FBHs) have become increasingly important due to frequent occurrence and worldwide distribution. There is increasing demand for developing more sensitive, high-throughput techniques for the simultaneous detection of multiple parasitic diseases due to limitations in differential clinical diagnosis of FBHs with similar symptoms. These infections are difficult to diagnose correctly by conventional diagnostic approaches including serological approaches. Methodology/Principal Findings In this study, antigens obtained from 5 parasite species, namely Cysticercus cellulosae, Angiostrongylus cantonensis, Paragonimus westermani, Trichinella spiralis and Spirometra sp., were semi-purified after immunoblotting. Sera from 365 human cases of helminthiasis and 80 healthy individuals were assayed with semi-purified antigens by both a protein microarray and the enzyme-linked immunosorbent assay (ELISA). The sensitivity, specificity and simplicity of each test for the end-user were evaluated. The specificity of the tests ranged from 97.0% (95% confidence interval (CI): 95.3–98.7%) to 100.0% (95% CI: 100.0%) in the protein microarray and from 97.7% (95% CI: 96.2–99.2%) to 100.0% (95% CI: 100.0%) in ELISA. The sensitivity varied from 85.7% (95% CI: 75.1–96.3%) to 92.1% (95% CI: 83.5–100.0%) in the protein microarray, while the corresponding values for ELISA were 82.0% (95% CI: 71.4–92.6%) to 92.1% (95% CI: 83.5–100.0%). Furthermore, the Youden index spanned from 0.83 to 0.92 in the protein microarray and from 0.80 to 0.92 in ELISA. For each parasite, the Youden index from the protein microarray was often slightly higher than the one from ELISA even though the same antigen was used. Conclusions/Significance The protein microarray platform is a convenient, versatile, high-throughput method that can easily be adapted to massive FBH screening. PMID:23209851

Intestinal Parasite Infections and Accuracy of Direct Thin and Thick Smear, Formol-Ether Sedimentation, Centrifugal Flotation, and Mini-FLOTAC Techniques Among Patients with Gastrointestinal Tract Disorders from the Greater Cairo Region, Egypt

PubMed Central

Hussein, Atef H.; Rashed, Samia M.; El-Hayawan, Ibrahim A.; Aly, Nagwa S. M.; Abou Ouf, Eman A.; Ali, Amira T.

2017-01-01

The aim of the present study was to assess the frequency of intestinal parasitic infection among patients with gastrointestinal tract disorders from the Greater Cairo region, Egypt. In addition, a comparison was made of the accuracy of direct thin and thick smear, formol-ether sedimentation (FEC), centrifugal flotation (CF), and mini-FLOTAC techniques in the diagnosis of infection. Out of 100 patients, the overall prevalence of parasitic infection was 51%. Only 6% had dual infection. Giardia lamblia was the most common parasite (26%), followed by Hymenolepis nana (20%), Entamoeba coli (8%), and Enterobius vermicularis (3%). Except the statistically significant association between E. vermicularis infection and perianal itching and insomnia (P < 0.001), age, gender, and complaints of the examined individuals had no association with prevalence of parasitic infection. Both FEC and CF were equally the most accurate techniques (accuracy = 98.2%, confidence interval [CI] = 0.95–1.0, and κ index = 0.962), whereas the Kato-Katz method was the least accurate (accuracy = 67.5%, CI = 0.57–0.78, and κ index = 0.333). However, mini-FLOTAC-ZnSO4 was the most accurate for diagnosis of helminthic infection, and FEC was more accurate for diagnosis of protozoal infection (accuracy = 100%, CI = 1.0–1.0, and κ index = 1). PMID:28093543

Screening for dry eye disease using infrared ocular thermography.

PubMed

Tan, Li Li; Sanjay, Srinivasan; Morgan, Philip B

2016-12-01

To evaluate the efficacy of infrared (IR) ocular thermography in screening for dry eye disease (DED). IR ocular thermography was performed on 62 dry eye and 63 age- and sex-matched control subjects. Marking of ocular surface and temperature acquisition was done using a novel 'diamond' demarcation method. 30 static- and 30 dynamic-metrics were studied and receiver operating characteristic curves were plotted. Efficacy of the temperature metrics in detecting DED were evaluated singly and in combination in terms of their area under the curve (AUC), Youden's index and discrimination power (DP). Absolute temperature of the extreme nasal conjunctiva 5s and 10s after eye opening were best detectors for DED. With threshold value for the first metric set at 34.7°C, sensitivity and specificity was 87.1% (95% CI: 76.2-94.3%) and 50.8% (95% CI: 37.9-63.6%) respectively. With threshold value for the second metric set at 34.5°C, sensitivity and specificity was 77.6% (95% CI: 64.7-87.5%) and 61.9% (95% CI: 48.8-73.9%) respectively. The two metrics had moderate accuracy and limited performances with AUC of 72% (95% CI: 63-81%) and 73% (95% CI: 64-82%); Youden index of about 0.4 and DP of 1.07 and 1.05 respectively. None of the dynamic metrics was good detector for DED. Combining metrics was not able to increase the AUC. This work suggests some utility for the application of IR ocular thermography for evaluation of dry eye patients. Copyright © 2016 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Planus Foot Posture and Pronated Foot Function are Associated with Foot Pain: The Framingham Foot Study

PubMed Central

Menz, Hylton B.; Dufour, Alyssa B.; Riskowski, Jody L.; Hillstrom, Howard J.; Hannan, Marian T.

2014-01-01

Objective To examine the associations of foot posture and foot function to foot pain. Methods Data were collected on 3,378 members of the Framingham Study who completed foot examinations in 2002–2008. Foot pain (generalized and at six locations) was based on the response to the question “On most days, do you have pain, aching or stiffness in either foot?” Foot posture was categorized as normal, planus or cavus using static pressure measurements of the arch index. Foot function was categorized as normal, pronated or supinated using the center of pressure excursion index from dynamic pressure measurements. Sex-specific multivariate logistic regression models were used to examine the effect of foot posture and function on generalized and location-specific foot pain, adjusting for age and weight. Results Planus foot posture was significantly associated with an increased likelihood of arch pain in men (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.01 – 1.90), while cavus foot posture was protective against ball of foot pain (OR 0.74, 95% CI 0.55 – 1.00) and arch pain (OR 0.64, 95% CI 0.48 – 0.85) in women. Pronated foot function was significantly associated with an increased likelihood of generalized foot pain (OR 1.28, 95% CI 1.04 – 1.56) and heel pain (OR 1.54, 95% CI 1.04 – 2.27) in men, while supinated foot function was protective against hindfoot pain in women (OR 0.74, 95% CI 0.55 – 1.00). Conclusion Planus foot posture and pronated foot function are associated with foot symptoms. Interventions that modify abnormal foot posture and function may therefore have a role in the prevention and treatment of foot pain. PMID:23861176

Personalising the decision for prolonged dual antiplatelet therapy: development, validation and potential impact of prognostic models for cardiovascular events and bleeding in myocardial infarction survivors

PubMed Central

Pasea, Laura; Chung, Sheng-Chia; Pujades-Rodriguez, Mar; Moayyeri, Alireza; Denaxas, Spiros; Fox, Keith A.A.; Wallentin, Lars; Pocock, Stuart J.; Timmis, Adam; Banerjee, Amitava; Patel, Riyaz; Hemingway, Harry

2017-01-01

Aims The aim of this study is to develop models to aid the decision to prolong dual antiplatelet therapy (DAPT) that requires balancing an individual patient’s potential benefits and harms. Methods and results Using population-based electronic health records (EHRs) (CALIBER, England, 2000–10), of patients evaluated 1 year after acute myocardial infarction (MI), we developed (n = 12 694 patients) and validated (n = 5613) prognostic models for cardiovascular (cardiovascular death, MI or stroke) events and three different bleeding endpoints. We applied trial effect estimates to determine potential benefits and harms of DAPT and the net clinical benefit of individuals. Prognostic models for cardiovascular events (c-index: 0.75 (95% CI: 0.74, 0.77)) and bleeding (c index 0.72 (95% CI: 0.67, 0.77)) were well calibrated: 3-year risk of cardiovascular events was 16.5% overall (5.2% in the lowest- and 46.7% in the highest-risk individuals), while for major bleeding, it was 1.7% (0.3% in the lowest- and 5.4% in the highest-risk patients). For every 10 000 patients treated per year, we estimated 249 (95% CI: 228, 269) cardiovascular events prevented and 134 (95% CI: 87, 181) major bleeding events caused in the highest-risk patients, and 28 (95% CI: 19, 37) cardiovascular events prevented and 9 (95% CI: 0, 20) major bleeding events caused in the lowest-risk patients. There was a net clinical benefit of prolonged DAPT in 63–99% patients depending on how benefits and harms were weighted. Conclusion Prognostic models for cardiovascular events and bleeding using population-based EHRs may help to personalise decisions for prolonged DAPT 1-year following acute MI. PMID:28329300

A U-Shaped Relationship between Body Mass Index and Dysmenorrhea: A Longitudinal Study

PubMed Central

Ju, Hong; Jones, Mark; Mishra, Gita D.

2015-01-01

Background Both obesity and dysmenorrhea are prevalent among women. Few population-based longitudinal studies investigate the association between body mass index (BMI) and dysmenorrhea yielding mixed results, especially for obesity. This study aims to investigate the long-term association between BMI and dysmenorrhea. Methods 9,688 women from a prospective population-based cohort study were followed for 13 years. Data were collected through self-reported questionnaires. The longitudinal association between dysmenorrhea and BMI or BMI change was investigated by logistic regression analysis using generalized estimating equations to account for the repeated measures. Results When the women were aged 22 to 27 years, approximately 11% were obese, 7% underweight, and 25% reported dysmenorrhea. Compared to women with a normal weight, significantly higher odds of reporting dysmenorrhea were detected for both women who were underweight (odds ratio (OR) 1.34, 95% confidence interval (CI) 1.15, 1.57) and obese (OR 1.22, 95% CI 1.11, 1.35). Compared to women who remained at normal weight or overweight over time, significant risk was detected for women who: remained underweight or obese (OR 1.33, 95% CI 1.20, 1.48), were underweight despite weight gain (OR 1.33, 95% CI 1.12, 1.58), became underweight (OR 1.28, 95% CI 1.02, 1.61). However the higher risk among obese women disappeared when they lost weight (OR 1.06, 95% CI 0.85, 1.32). Conclusions A U-shaped association was revealed between dysmenorrhea and BMI, revealing a higher risk of dysmenorrhea for both underweight and obese women. Maintaining a healthy weight over time may be important for women to have pain-free periods. PMID:26218569

Longitudinal associations between television in the bedroom and body fatness in a UK cohort study

PubMed Central

Heilmann, A; Rouxel, P; Fitzsimons, E; Kelly, Y; Watt, R G

2017-01-01

Objective: To assess longitudinal associations between screen-based media use (television (TV) and computer hours, having a TV in the bedroom) and body fatness among UK children. Methods: Participants were 12 556 children from the UK Millennium Cohort Study who were followed from age 7 to age 11 years. Associations were assessed between screen-based media use and the following outcomes: body mass index (BMI), fat mass index (FMI), and overweight. Results: In fully adjusted models, having a bedroom TV at age 7 years was associated with significantly higher BMI and FMI (excess BMI for boys=0.29, 95% confidence interval (CI) 0.06–0.52; excess BMI for girls=0.57, 95% CI 0.31–0.84; excess FMI for boys=0.20, 95% CI 0.04–0.37; excess FMI for girls=0.39, 95% CI 0.21–0.57) and increased risk of being overweight (relative risk (RR) for boys=1.21, 95% CI 1.07–1.36; RR for girls=1.31, 95% CI 1.15–1.48) at age 11 years, compared with having no bedroom TV. Hours spent watching TV or digital versatile disks were associated with increased risk of overweight among girls only. Computer use at age 7 years was not related to later body fatness for either gender. Conclusion: Having a TV in the child’s bedroom was an independent risk factor for overweight and increased body fatness in this nationally representative sample of UK children. Childhood obesity prevention strategies should consider TVs in children’s bedrooms as a risk factor for obesity. PMID:28566749

Increased immunization coverage addresses the equity gap in Nepal

PubMed Central

Nelin, Viktoria; Raaijmakers, Hendrikus; Kim, Hyung Joon; Singh, Chahana; Målqvist, Mats

2017-01-01

Abstract Objective To compare immunization coverage and equity distribution of coverage between 2001 and 2014 in Nepal. Methods We used data from the Demographic and Health Surveys carried out in 2001, 2006 and 2011 together with data from the 2014 Multiple Indicator Cluster Survey. We calculated the proportion, in mean percentage, of children who had received bacille Calmette–Guérin (BCG) vaccine, three doses of polio vaccine, three doses of diphtheria–pertussis–tetanus (DPT) vaccine and measles vaccine. To measure inequities between wealth quintiles, we calculated the slope index of inequality (SII) and relative index of inequality (RII) for all surveys. Findings From 2001 to 2014, the proportion of children who received all vaccines at the age of 12 months increased from 68.8% (95% confidence interval, CI: 67.5–70.1) to 82.4% (95% CI: 80.7–84.0). While coverage of BCG, DPT and measles immunization statistically increased during the study period, the proportion of children who received the third dose of polio vaccine decreased from 93.3% (95% CI: 92.7–93.9) to 88.1% (95% CI: 86.8–89.3). The poorest wealth quintile showed the greatest improvement in immunization coverage, from 58% to 77.9%, while the wealthiest quintile only improved from 84.8% to 86.0%. The SII for children who received all vaccines improved from 0.070 (95% CI: 0.061–0.078) to 0.026 (95% CI: 0.013–0.039) and RII improved from 1.13 to 1.03. Conclusion The improvement in immunization coverage between 2001 and 2014 in Nepal can mainly be attributed to the interventions targeting the disadvantaged populations. PMID:28479621

Maternal Body Mass Index Moderates the Influence of Smoking Cessation on Breast Feeding

PubMed Central

2014-01-01

Introduction: Smoking cessation is associated with greater breast feeding in newly postpartum women, while being overweight or obese is associated with lower rates of breast feeding. The purpose of this study is to examine whether the increases in breast feeding associated with smoking cessation are moderated by maternal body mass index (BMI). To our knowledge, the interaction of maternal smoking status and overweight/obesity on breast feeding has not been previously reported. Methods: Participants (N = 370) were current or recent smokers at the start of prenatal care who participated in controlled trials on smoking cessation or relapse prevention during/after pregnancy. Study participants were followed from the start of prenatal care through 24 weeks postpartum. Smoking status was biochemically verified, and maternal reports of breast feeding were collected at 2-, 4-, 8-, 12-, and 24-week postpartum assessments. Results: Women who reported postpartum smoking abstinence or had a normal/underweight prepregnancy BMI (<25) were more likely to be breast feeding at the time that smoking status was ascertained (odds ratio [OR] = 3.02, confidence interval [CI] = 2.09–4.36, and OR = 2.07, CI = 1.37–3.12, respectively). However, smoking status and BMI interacted such that (a) normal/underweight women showed a stronger association between smoking abstinence and breast feeding (OR = 4.58, CI = 2.73–7.66) than overweight/obese women (OR = 1.89, CI = 1.11–3.23), and (b) abstainers showed an association between normal/underweight BMI and breast feeding (OR = 3.53, CI = 1.96–6.37), but smokers did not (OR = 1.46, CI = 0.88–2.44). Conclusions: Overweight/obesity attenuates the positive relationship between smoking abstinence and greater breast feeding among newly postpartum women. PMID:24203932

Development of a Telephone Interview Version of the Chedoke-McMaster Stroke Assessment Activity Inventory

PubMed Central

Miller, Patricia A.; Pooyania, Sepideh; Stratford, Paul

2016-01-01

Purpose: To develop a telephone version of the Chedoke-McMaster Stroke Assessment Activity Inventory (CMSA–AI) and estimate the test–retest reliability, interrater reliability (between participant and proxy), and construct validity of the scores for individuals with stroke. Methods: Adults with stroke and their caregivers or proxies were included. Participants were assessed with the CMSA–AI at discharge from a stroke rehabilitation unit and interviewed using the telephone version (TCMSA–AI). Two months after discharge, participants were evaluated with the CMSA–AI and interviewed over the phone using the TCMSA–AI on two occasions 2–3 days apart. Proxies were interviewed with the TCMSA–AI within another 2–3 days. Results: The mean age of the 53 participants with stroke was 62 years; 59% were male; 43% had right-side hemiparesis; 42 completed follow-up interviews; and 18 had proxies who also participated. Test–retest reliability showed an intra-class correlation coefficient of 0.98 (95% CI: 0.96, 0.99) for the total score, 0.96 (95% CI: 0.91, 0.98) for the Gross Motor Function Index, and 0.96 (95% CI: 0.91, 0.98) for the Walking Index, and an interrater reliability (between participant and proxy) of 0.75 (95% CI: 0.28, 0.90) for total score. Spearman's rho correlation between CMSA–AI and TCMSA–AI total scores was 0.62 (lower-sided 95% CI: 0.42) at discharge and 0.90 (lower-sided 95% CI: 0.82) at 2 months after discharge. Correlations between the change scores of the CMSA–AI and TCMSA–AI were 0.50 or lower. Conclusion: There is potential for remote evaluation of the functional mobility of individuals with stroke in research and clinical settings. PMID:27909370

Development of a Telephone Interview Version of the Chedoke-McMaster Stroke Assessment Activity Inventory.

PubMed

Barclay, Ruth; Miller, Patricia A; Pooyania, Sepideh; Stratford, Paul

Purpose: To develop a telephone version of the Chedoke-McMaster Stroke Assessment Activity Inventory (CMSA-AI) and estimate the test-retest reliability, interrater reliability (between participant and proxy), and construct validity of the scores for individuals with stroke. Methods: Adults with stroke and their caregivers or proxies were included. Participants were assessed with the CMSA-AI at discharge from a stroke rehabilitation unit and interviewed using the telephone version (TCMSA-AI). Two months after discharge, participants were evaluated with the CMSA-AI and interviewed over the phone using the TCMSA-AI on two occasions 2-3 days apart. Proxies were interviewed with the TCMSA-AI within another 2-3 days. Results: The mean age of the 53 participants with stroke was 62 years; 59% were male; 43% had right-side hemiparesis; 42 completed follow-up interviews; and 18 had proxies who also participated. Test-retest reliability showed an intra-class correlation coefficient of 0.98 (95% CI: 0.96, 0.99) for the total score, 0.96 (95% CI: 0.91, 0.98) for the Gross Motor Function Index, and 0.96 (95% CI: 0.91, 0.98) for the Walking Index, and an interrater reliability (between participant and proxy) of 0.75 (95% CI: 0.28, 0.90) for total score. Spearman's rho correlation between CMSA-AI and TCMSA-AI total scores was 0.62 (lower-sided 95% CI: 0.42) at discharge and 0.90 (lower-sided 95% CI: 0.82) at 2 months after discharge. Correlations between the change scores of the CMSA-AI and TCMSA-AI were 0.50 or lower. Conclusion: There is potential for remote evaluation of the functional mobility of individuals with stroke in research and clinical settings.

Road Traffic and Railway Noise Exposures and Adiposity in Adults: A Cross-Sectional Analysis of the Danish Diet, Cancer, and Health Cohort

PubMed Central

Christensen, Jeppe Schultz; Raaschou-Nielsen, Ole; Tjønneland, Anne; Overvad, Kim; Nordsborg, Rikke B.; Ketzel, Matthias; Sørensen, Thorkild IA; Sørensen, Mette

2015-01-01

Background Traffic noise has been associated with cardiovascular and metabolic disorders. Potential modes of action are through stress and sleep disturbance, which may lead to endocrine dysregulation and overweight. Objectives We aimed to investigate the relationship between residential traffic and railway noise and adiposity. Methods In this cross-sectional study of 57,053 middle-aged people, height, weight, waist circumference, and bioelectrical impedance were measured at enrollment (1993–1997). Body mass index (BMI), body fat mass index (BFMI), and lean body mass index (LBMI) were calculated. Residential exposure to road and railway traffic noise exposure was calculated using the Nordic prediction method. Associations between traffic noise and anthropometric measures at enrollment were analyzed using general linear models and logistic regression adjusted for demographic and lifestyle factors. Results Linear regression models adjusted for age, sex, and socioeconomic factors showed that 5-year mean road traffic noise exposure preceding enrollment was associated with a 0.35-cm wider waist circumference (95% CI: 0.21, 0.50) and a 0.18-point higher BMI (95% CI: 0.12, 0.23) per 10 dB. Small, significant increases were also found for BFMI and LBMI. All associations followed linear exposure–response relationships. Exposure to railway noise was not linearly associated with adiposity measures. However, exposure > 60 dB was associated with a 0.71-cm wider waist circumference (95% CI: 0.23, 1.19) and a 0.19-point higher BMI (95% CI: 0.0072, 0.37) compared with unexposed participants (0–20 dB). Conclusions The present study finds positive associations between residential exposure to road traffic and railway noise and adiposity. Citation Christensen JS, Raaschou-Nielsen O, Tjønneland A, Overvad K, Nordsborg RB, Ketzel M, Sørensen TI, Sørensen M. 2016. Road traffic and railway noise exposures and adiposity in adults: a cross-sectional analysis of the Danish Diet, Cancer, and Health cohort. Environ Health Perspect 124:329–335; http://dx.doi.org/10.1289/ehp.1409052 PMID:26241990

Adherence to a healthy Nordic food index and risk of myocardial infarction in middle-aged Danes: the diet, cancer and health cohort study.

PubMed

Gunge, V B; Andersen, I; Kyrø, C; Hansen, C P; Dahm, C C; Christensen, J; Tjønneland, A; Olsen, A

2017-05-01

For decades, the Mediterranean diet has been in focus regarding healthy eating as it has been associated with reduced risk of non-communicable diseases. Less interest has been given to health benefits of other regional diets. The aim of the present study was to assess whether adherence to a healthy Nordic food index was associated with lower risk of myocardial infarction (MI) among middle-aged Danes. Data were obtained from the Danish Diet, Cancer and Health cohort study of 57 053 men and women aged 50-64 years recruited between 1993 and 1997. The healthy Nordic food index comprised healthy Nordic food items selected a priori (fish, cabbage, rye bread, oatmeal, apple and pears and root vegetables). Information on incident MI was ascertained through linkage with national registries. Hazard ratios (HR) with 95% confidence intervals (CI) were estimated from sex-specific Cox proportional hazard models. In total, 1669 men and 653 women developed MI during follow-up (13.6 median years). In adjusted models, those with an index score of 5-6 points (highest scores) had significantly lower MI risk (men: HR=0.77, 95% CI=0.62, 0.97; women: HR=0.55, 95% CI=0.37, 0.82) relative to those scoring 0 points in the index (lowest score). A significantly lower MI risk was found per 1-point increment in the index in both men (HR=0.95, 95% CI=0.92, 0.99) and women (HR=0.93, 95% CI=0.88, 0.98). A healthy Nordic diet is associated with lower MI risk among middle-aged Danes, suggesting that Nordic diets should be considered in recommendations for dietary changes in the promotion of coronary health.

Fatty liver index vs waist circumference for predicting non-alcoholic fatty liver disease.

PubMed

Motamed, Nima; Sohrabi, Masoudreza; Ajdarkosh, Hossein; Hemmasi, Gholamreza; Maadi, Mansooreh; Sayeedian, Fatemeh Sima; Pirzad, Reza; Abedi, Khadijeh; Aghapour, Sivil; Fallahnezhad, Mojtaba; Zamani, Farhad

2016-03-14

To determine the discriminatory performance of fatty liver index (FLI) for non-alcoholic fatty liver disease (NAFLD). The data of 5052 subjects aged over 18 years were analyzed. FLI was calculated from body mass index, waist circumference (WC), triglyceride, and gamma glutamyl transferase data. Logistic regression analysis was conducted to determine the association between FLI and NAFLD. The discriminatory performance of FLI in the diagnosis of NAFLD was evaluated by receiver operating characteristic analysis. Area under the curves (AUCs) and related confidence intervals were estimated. Optimal cutoff points of FLI in the diagnosis of NAFLD were determined based on the maximum values of Youden's index. The mean age of men and women in the study population were 44.8 ± 16.8 and 43.78 ± 15.43, respectively (P = 0.0216). The prevalence of NAFLD was 40.1% in men and 44.2% in women (P < 0.0017). FLI was strongly associated with NAFLD, so that even a one unit increase in FLI increased the chance of developing NAFLD by 5.8% (OR = 1.058, 95%CI: 1.054-1.063, P < 0.0001). Although FLI showed good performance in the diagnosis of NAFLD (AUC = 0.8656 (95%CI: 0.8548-0.8764), there was no significant difference with regards to WC (AUC = 0.8533, 95%CI: 0.8419-0.8646). The performance of FLI was not significantly different between men (AUC = 0.8648, 95%CI: 0.8505-0.8791) and women (AUC = 0.8682, 95%CI: 0.8513-0.8851). The highest performance with regards to age was related to the 18-39 age group (AUC = 0.8930, 95%CI: 0.8766-0.9093). The optimal cutoff points of FLI were 46.9 in men (sensitivity = 0.8242, specificity = 0.7687, Youden's index = 0.5929) and 53.8 in women (sensitivity = 0.8233, specificity = 0.7655, Youden's index = 0.5888). Although FLI had acceptable discriminatory power in the diagnosis of NAFLD, WC was a simpler and more accessible index with a similar performance.

TyG Index Change Is More Determinant for Forecasting Type 2 Diabetes Onset Than Weight Gain

PubMed Central

Navarro-González, David; Sánchez-Íñigo, Laura; Fernández-Montero, Alejandro; Pastrana-Delgado, Juan; Martinez, Jose Alfredo

2016-01-01

Abstract The risk of type 2 diabetes associated with obesity appears to be influenced by other metabolic abnormalities, and there is controversy about the harmless condition of the metabolically healthy obese (MHO) state. The aim of this study is to assess the risk of diabetes and the impact of changes in weight and in triglyceride-glucose index (TyG index), according to the metabolic health and obesity states. We analyzed prospective data of the Vascular Metabolic CUN cohort, a population-based study among a White European population (mean follow-up, 8.9 years). Incident diabetes was assessed in 1923 women and 3016 men with a mean age at baseline of 55.33 ± 13.68 and 53.78 ± 12.98 years old. A Cox proportional-hazard analysis was conducted to estimate the hazard ratio (HR) of diabetes on metabolically healthy nonobese (MHNO), metabolically healthy obese, metabolically unhealthy nonobese (MUNO), and metabolically unhealthy obese (MUO). A continuous standardized variable (z-score) was derived to compute the HR for diabetes per 1-SD increment in the body mass index (BMI) and the TyG index. MHO, MUNO, and MUO status were associated with the development of diabetes, HR of 2.26 (95% CI: 1.25–4.07), 3.04 (95% CI: 1.69–5.47), and 4.04 (95% CI: 2.14–7.63), respectively. MUNO individuals had 1.82 greater risk of diabetes compared to MHO subjects (95% CI: 1.04–3.22). The HRs for incident diabetes per 1-SD increment in BMI and TyG indexes were 1.23 (95% CI: 1.04–1.44) and 1.54 (95% CI: 1.40–1.68). The increase in BMI did not raise the risk of developing diabetes among metabolically unhealthy subjects, whereas increasing the TyG index significantly affect the risk in all metabolic health categories. Metabolic health is more important determinant for diabetes onset than weight gain. The increase in weight does not raise the risk of developing diabetes among metabolically unhealthy subjects. PMID:27175686

TyG Index Change Is More Determinant for Forecasting Type 2 Diabetes Onset Than Weight Gain.

PubMed

Navarro-González, David; Sánchez-Íñigo, Laura; Fernández-Montero, Alejandro; Pastrana-Delgado, Juan; Martinez, Jose Alfredo

2016-05-01

The risk of type 2 diabetes associated with obesity appears to be influenced by other metabolic abnormalities, and there is controversy about the harmless condition of the metabolically healthy obese (MHO) state. The aim of this study is to assess the risk of diabetes and the impact of changes in weight and in triglyceride-glucose index (TyG index), according to the metabolic health and obesity states.We analyzed prospective data of the Vascular Metabolic CUN cohort, a population-based study among a White European population (mean follow-up, 8.9 years). Incident diabetes was assessed in 1923 women and 3016 men with a mean age at baseline of 55.33 ± 13.68 and 53.78 ± 12.98 years old.A Cox proportional-hazard analysis was conducted to estimate the hazard ratio (HR) of diabetes on metabolically healthy nonobese (MHNO), metabolically healthy obese, metabolically unhealthy nonobese (MUNO), and metabolically unhealthy obese (MUO). A continuous standardized variable (z-score) was derived to compute the HR for diabetes per 1-SD increment in the body mass index (BMI) and the TyG index.MHO, MUNO, and MUO status were associated with the development of diabetes, HR of 2.26 (95% CI: 1.25-4.07), 3.04 (95% CI: 1.69-5.47), and 4.04 (95% CI: 2.14-7.63), respectively. MUNO individuals had 1.82 greater risk of diabetes compared to MHO subjects (95% CI: 1.04-3.22). The HRs for incident diabetes per 1-SD increment in BMI and TyG indexes were 1.23 (95% CI: 1.04-1.44) and 1.54 (95% CI: 1.40-1.68). The increase in BMI did not raise the risk of developing diabetes among metabolically unhealthy subjects, whereas increasing the TyG index significantly affect the risk in all metabolic health categories.Metabolic health is more important determinant for diabetes onset than weight gain. The increase in weight does not raise the risk of developing diabetes among metabolically unhealthy subjects.

Reactive case detection for malaria elimination: real-life experience from an ongoing program in Swaziland.

PubMed

Sturrock, Hugh J W; Novotny, Joe M; Kunene, Simon; Dlamini, Sabelo; Zulu, Zulisile; Cohen, Justin M; Hsiang, Michelle S; Greenhouse, Bryan; Gosling, Roly D

2013-01-01

As countries move towards malaria elimination, methods to identify infections among populations who do not seek treatment are required. Reactive case detection, whereby individuals living in close proximity to passively detected cases are screened and treated, is one approach being used by a number of countries including Swaziland. An outstanding issue is establishing the epidemiologically and operationally optimal screening radius around each passively detected index case. Using data collected between December 2009 and June 2012 from reactive case detection (RACD) activities in Swaziland, we evaluated the effect of screening radius and other risk factors on the probability of detecting cases by reactive case detection. Using satellite imagery, we also evaluated the household coverage achieved during reactive case detection. Over the study period, 250 cases triggered RACD, which identified a further 74 cases, showing the value of RACD over passive surveillance alone. Results suggest that the odds of detecting a case within the household of the index case were significantly higher than in neighbouring households (odds ratio (OR) 13, 95% CI 3.1-54.4). Furthermore, cases were more likely to be detected when RACD was conducted within a week of the index presenting at a health facility (OR 8.7, 95% CI 1.1-66.4) and if the index household had not been sprayed with insecticide (OR sprayed vs not sprayed 0.11, 95% CI 0.03-0.46). The large number of households missed during RACD indicates that a 1 km screening radius may be impractical in such resource limited settings such as Swaziland. Future RACD in Swaziland could be made more effective by achieving high coverage amongst individuals located near to index cases and in areas where spraying has not been conducted. As well as allowing the programme to implement RACD more rapidly, this would help to more precisely define the optimal screening radius.

[Experience, prevalence and severity of dental caries and its association with nutritional status in Mexican infants 17-47 months].

PubMed

Zúñiga-Manríquez, Ana Gabriela; Medina-Solís, Carlo Eduardo; Lara-Carrillo, Edith; Márquez-Corona, María de Lourdes; Robles-Bermeo, Norma Leticia; Scougall-Vilchis, Rogelio José; Maupomé, Gerardo

2013-01-01

To determine the experience, prevalence and severity of dental caries and its relationship with nutritional status in nursery infants 17 to 47 months of age. A cross-sectional study in 152 infants 17 to 47 months of age attending one of five day care centers of the city of Pachuca, Hidalgo was performed. Clinical examinations were performed using the methods recommended by the World Health Organization for epidemiologic studies on dental caries. We calculated the caries index (dmft), the significant caries index (SiC) as well as the treatment needs index (TNI) and the care index (CI). Nutritional status was determined using the weight and height for age, in Federico Gomez's scale. In the statistical analysis nonparametric tests were used. Mean age was 2.52 ± 0.76 years; 51.3% were boys. With regard to nutritional status, 19.1% were classified as malnourished and 19.1% were overweight/obese. The dmft index was 1.53 ± 2.52. The SiC index was 4.14, the TNI 86.3% and the CI 13.7%. Caries prevalence was 48.0%. It was observed that 33.5% of children had 1 to 3 teeth with caries experience and 14.5% had 4 or more teeth affected. Statistically significant differences for tooth decay were identified (p < 0.05) by age, height and weight but not (p> 0.05) by sex and nutritional status. This study shows that nearly half of children examined had caries experience. High treatment needs for dental caries were observed. A correlation was found between dmft index and age, weight and height. No association was identified between experience, prevalence and severity of dental caries and nutritional status of infants. It appears necessary to improve oral health preventive measures in these infants.

Redox-active ionic-liquid-assisted one-step general method for preparing gold nanoparticle thin films: applications in refractive index sensing and catalysis.

PubMed

Dinda, Enakshi; Rashid, Md Harunar; Biswas, Mrinmoy; Mandal, Tarun K

2010-11-16

We describe a general one-step facile method for depositing gold nanoparticle (GNP) thin films onto any type of substrates by the in situ reduction of AuCl(3) using a newly designed redox-active ionic liquid (IL), tetrabutylphosphonium citrate ([TBP][Ci]). Various substrates such as positively charged glass, negatively charged glass/quartz, neutral hydrophobic glass, polypropylene, polystyrene, plain paper, and cellophane paper are successfully coated with a thin film of GNPs. This IL ([TBP][Ci]) is prepared by the simple neutralization of tetrabutylphosphonium hydroxide with citric acid. We also demonstrate that the [TBP][Ci] ionic liquid can be successfully used to generate GNPs in an aqueous colloidal suspension in situ. The deposited GNP thin films on various surfaces are made up of mostly discrete spherical GNPs that are well distributed throughout the film, as confirmed by field-emission scanning electron microscopy. However, it seems that some GNPs are arranged to form arrays depending on the nature of surface. We also characterize these GNP thin films via UV-vis spectroscopy and X-ray diffractometry. The as-formed GNP thin films show excellent stability toward solvent washing. We demonstrate that the thin film of GNPs on a glass/quartz surface can be successfully used as a refractive index (RI) sensor for different polar and nonpolar organic solvents. The as-formed GNP thin films on different surfaces show excellent catalytic activity in the borohydride reduction of p-nitrophenol.

Risk of Metachronous High-Risk Adenomas and Large Serrated Polyps in Individuals With Serrated Polyps on Index Colonoscopy: Data From the New Hampshire Colonoscopy Registry.

PubMed

Anderson, Joseph C; Butterly, Lynn F; Robinson, Christina M; Weiss, Julia E; Amos, Christopher; Srivastava, Amitabh

2018-01-01

Surveillance guidelines for serrated polyps (SPs) are based on limited data on longitudinal outcomes of patients. We used the New Hampshire Colonoscopy Registry to evaluate risk of clinically important metachronous lesions associated with SPs detected during index colonoscopies. We collected data from a population-based colonoscopy registry that has been collecting and analyzing data on colonoscopies across the state of New Hampshire since 2004, including rates of adenoma and SP detection. Patients completed a questionnaire to determine demographic characteristics, health history, and risk factors for colorectal cancer, and were followed from index colonoscopy through all subsequent surveillance colonoscopies. Our analyses included 5433 participants (median age, 61 years; 49.7% male) with 2 colonoscopies (median time to surveillance, 4.9 years). We used multivariable logistic regression models to assess effects of index SPs (n = 1016), high-risk adenomas (HRA, n = 817), low-risk adenomas (n = 1418), and no adenomas (n = 3198) on subsequent HRA or large SPs (>1 cm) on surveillance colonoscopy (metachronous lesions). Synchronous SPs, within each index risk group, were assessed for size and by histology. SPs comprise hyperplastic polyps, sessile serrated adenomas/polyps (SSA/Ps), and traditional serrated adenomas. In this study, SSA/Ps and traditional serrated adenomas are referred to collectively as STSAs. HRA and synchronous large SP (odds ratio [OR], 5.61; 95% confidence interval [CI], 1.72-18.28), HRA with synchronous STSA (OR, 16.04; 95% CI, 6.95-37.00), and HRA alone (OR, 3.86; 95% CI, 2.77-5.39) at index colonoscopy significantly increased the risk of metachronous HRA compared to the reference group (no index adenomas or SPs). Large index SPs alone (OR, 14.34; 95% CI, 5.03-40.86) or index STSA alone (OR, 9.70; 95% CI, 3.63-25.92) significantly increased the risk of a large metachronous SP. In an analysis of data from a population-based colonoscopy registry, we found index large SP or index STSA with no index HRA increased risk of metachronous large SPs but not metachronous HRA. HRA and synchronous SPs at index colonoscopy significantly increased risk of metachronous HRA. Individuals with HRA and synchronous large SP or any STSA could therefore benefit from close surveillance. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

Infused cardioplegia index: A new tool to improve myocardial protection. A cohort study.

PubMed

Jiménez Rivera, J J; Llanos Jorge, C; Iribarren Sarrías, J L; Brouard Martín, M; Lacalzada Almeida, J; Pérez Vela, J L; Avalos Pinto, R; Pérez Hernández, R; Ramos de la Rosa, S; Yanes Bowden, G; Martínez Sanz, R

2018-05-19

Strategies for cardio-protection are essential in coronary artery bypass graft surgery. The authors explored the relationship between cardioplegia volume, left ventricular mass index and ischemia time by means of the infused cardioplegia index and its relationship with post-operative low cardiac output syndrome. All patients undergoing coronary artery bypass graft surgery between January 2013 and December 2015 were included. Low cardiac output syndrome was defined according to criteria of the SEMICYUC's consensus document. The perioperative factors associated with low cardiac output syndrome were estimated, and using a ROC curve, the optimum cut-off point for the infused cardioplegia index to predict the absence of low cardiac output syndrome was calculated. Of 360 patients included, 116 (32%) developed low cardiac output syndrome. The independent risk predictors were: New York Heart Association Functional Classification (OR 1.8 [95% CI=1.18-2.55]), left ventricle ejection fraction (OR 0.95 (95% CI=0.93-0.98]), ICI (OR 0.99 [95% CI=0.991-0.996]) and retrograde cardioplegia (OR 1.2 [95% CI=1.03-1.50]). The infused cardioplegia index showed an area under the ROC curve of 0.77 (0.70-0.83; P<.001) for the absence of postoperative low cardiac output syndrome using the optimum cut-off point of 23.6ml·min -1 (100g/m 2 of LV) -1 . The infused cardioplegia index presents an inverse relationship with the development of post-operative low cardiac output syndrome. This index could form part of new strategies aimed at optimising cardio-protection. The total volume of intermittent cardioplegia, especially that of maintenance, should probably be individualised, adjusting for ischemia time and left ventricle mass index. Copyright © 2018 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Diets with High or Low Protein Content and Glycemic Index for Weight-Loss Maintenance

PubMed Central

Larsen, Thomas Meinert; Dalskov, Stine-Mathilde; van Baak, Marleen; Jebb, Susan A.; Papadaki, Angeliki; Pfeiffer, Andreas F.H.; Martinez, J. Alfredo; Handjieva-Darlenska, Teodora; Kunešová, Marie; Pihlsgård, Mats; Stender, Steen; Holst, Claus; Saris, Wim H.M.; Astrup, Arne

2012-01-01

Background Studies of weight-control diets that are high in protein or low in glycemic index have reached varied conclusions, probably owing to the fact that the studies had insufficient power. Methods We enrolled overweight adults from eight European countries who had lost at least 8% of their initial body weight with a 3.3-MJ (800-kcal) low-calorie diet. Participants were randomly assigned, in a two-by-two factorial design, to one of five ad libitum diets to prevent weight regain over a 26-week period: a low-protein and low-glycemic-index diet, a low-protein and high-glycemic-index diet, a high-protein and low-glycemic-index diet, a high-protein and high-glycemic-index diet, or a control diet. Results A total of 1209 adults were screened (mean age, 41 years; body-mass index [the weight in kilograms divided by the square of the height in meters], 34), of whom 938 entered the low-calorie-diet phase of the study. A total of 773 participants who completed that phase were randomly assigned to one of the five maintenance diets; 548 completed the intervention (71%). Fewer participants in the high-protein and the low-glycemic-index groups than in the low-protein–high-glycemic-index group dropped out of the study (26.4% and 25.6%, respectively, vs. 37.4%; P = 0.02 and P = 0.01 for the respective comparisons). The mean initial weight loss with the low-calorie diet was 11.0 kg. In the analysis of participants who completed the study, only the low-protein–high-glycemic-index diet was associated with subsequent significant weight regain (1.67 kg; 95% confidence interval [CI], 0.48 to 2.87). In an intention-to-treat analysis, the weight regain was 0.93 kg less (95% CI, 0.31 to 1.55) in the groups assigned to a high-protein diet than in those assigned to a low-protein diet (P = 0.003) and 0.95 kg less (95% CI, 0.33 to 1.57) in the groups assigned to a low-glycemic-index diet than in those assigned to a high-glycemic-index diet (P = 0.003). The analysis involving participants who completed the intervention produced similar results. The groups did not differ significantly with respect to diet-related adverse events. Conclusions In this large European study, a modest increase in protein content and a modest reduction in the glycemic index led to an improvement in study completion and maintenance of weight loss. (Funded by the European Commission; ClinicalTrials.gov number, NCT00390637.) PMID:21105792

IS THE IMMUNOCROMATOGRAPHIC FECAL ANTIGEN TEST EFFECTIVE FOR PRIMARY DIAGNOSIS OF HELICOBACTER PYLORI INFECTION IN DYSPEPTIC PATIENTS?

PubMed

Dalla Nora, Magali; Hörner, Rosmari; De Carli, Diego Michelon; Rocha, Marta Pires da; Araujo, Amanda Faria de; Fagundes, Renato Borges

2016-01-01

The diagnosis of H. pylori infection can be performed by non-invasive and invasive methods.The identification through a fecal antigen test is a non-invasive, simple, and relatively inexpensive test. To determine the diagnostic performance of fecal antigen test in the identification of H. pylori infection. H. pylori antigens were identified in the stools of dyspeptic patients undergoing upper gastrointestinal endoscopy. For the identification of H. pylori antigen, we use ImmunoCard STAT! HpSA with immunochromatography technique. Histopathology plus urease test were the gold standard. We studied 163 patients, 51% male, mean age of 56.7± 8.5years. H. pylori infection was present in 49%. Fecal test presented: sensitivity 67.5% (CI95% 60.6-72.9); specificity 85.5% (CI95% 78.9-90.7); positive predictive value 81.8% (CI95% 73.4-88.4) and negative predictive value 73,2% (CI95% 67.5-77.6); Positive likelihood ratio was 4.7 (CI95% 2.9-7.9) and Negative Likelihood Ratio 0.4 (CI95% 0.3-0.5). The prevalence odds ratio for a positive test was 12.3 (CI95% 5.7-26.3).The index kappa between FAT and histology/urease test was 0.53 (CI95% 0.39-0.64). Immunochromatographic FAT is less expensive than the other methods and readily accepted by the patients but its diagnostic performance does not recommend its use in the primary diagnosis, when the patient may have an active infection.

Self-reported Violence-related Outcomes for Adolescents Within Eight Weeks Of Emergency Department Treatment For Assault Injury

PubMed Central

Blackstone, Mercedes M.; Mollen, Cynthia J.; Culyba, Alison J.; Fein, Joel A.

2011-01-01

Purpose To estimate, using a novel interactive voice response (IVR) survey, the incidence of self-reported violence-related experiences of adolescent assault-injured patients in the weeks following Emergency Department (ED) discharge. Methods In an urban ED, a prospective cohort study with eight week follow-up IVR survey either weekly, bi-weekly or monthly after discharge was conducted with patients aged 12-19 years presenting with assault-related injuries. Survival analysis methods were used to estimate cumulative risks of self-reported violence experience within four and eight weeks. Results Ninety-five patients were enrolled; 42 (44.2%) reported to the IVR survey. As a result of the ED index event, an estimated 18.2% (CI=9.1-34.6%) reported being assaulted (no weapon), 2.9% (CI=0.4-19.1%) had been shot or stabbed, 20.7% (CI=10.9-37.3%) had assaulted someone else (no weapon), and 2.9% (CI=0.4-19.1%) shot or stabbed someone else. Additionally, 54.6% (CI=39.6-70.9%) had avoided going certain places, 47.0% (CI=32.5-64.1%) considered retaliating, 38.1% (CI=24.3-56.3%) had been threatened, and 27.0% (CI=15.4-44.6%) had carried a weapon. Most outcome occurrences happened within four weeks. There was evidence that intent to retaliate when asked at baseline was associated with an elevated risk of several outcomes. Conclusions The risk for subsequent violence among assault-injured adolescent ED patients appears high within weeks of discharge. PMID:22031979

Age-adjusted Charlson comorbidity index score as predictor of survival of patients with digestive system cancer who have undergone surgical resection.

PubMed

Tian, Yaohua; Jian, Zhong; Xu, Beibei; Liu, Hui

2017-10-03

Comorbidities have considerable effects on survival outcomes. The primary objective of this retrospective study was to examine the association between age-adjusted Charlson comorbidity index (ACCI) score and postoperative in-hospital mortality in patients with digestive system cancer who have undergone surgical resection of their cancers. Using electronic hospitalization summary reports, we identified 315,464 patients who had undergone surgery for digestive system cancer in top-rank (Grade 3A) hospitals in China between 2013 and 2015. The Cox proportional hazard regression model was applied to evaluate the effect of ACCI score on postoperative mortality, with adjustments for sex, type of resection, anesthesia methods, and caseload of each healthcare institution. The postoperative in-hospital mortality rate in the study cohort was 1.2% (3,631/315,464). ACCI score had a positive graded association with the risk of postoperative in-hospital mortality for all cancer subtypes. The adjusted HRs for postoperative in-hospital mortality scores ≥ 6 for esophagus, stomach, colorectum, pancreas, and liver and gallbladder cancer were 2.05 (95% CI: 1.45-2.92), 2.00 (95% CI: 1.60-2.49), 2.54 (95% CI: 2.02-3.21), 2.58 (95% CI: 1.68-3.97), and 4.57 (95% CI: 3.37-6.20), respectively, compared to scores of 0-1. These findings suggested that a high ACCI score is an independent predictor of postoperative in-hospital mortality in Chinese patients with digestive system cancer who have undergone surgical resection.

CYTOLOGY ASSESSMENT CAN PREDICT SURVIVAL FOR PATIENTS WITH METASTATIC PANCREATIC NEUROENDOCRINE NEOPLASMS

PubMed Central

Sigel, Carlie S.; Guo, Huimin; Sigel, Keith M.; Zhang, Ming; Rekhtman, Natasha; Lin, Oscar; Klimstra, David S.; Jungbluth, Achim A.; Tang, Laura K.

2017-01-01

Background Histological features and Ki67 index have known utility for predicting prognosis and guiding therapy for metastatic pancreatic neuroendocrine neoplasms. Fine needle aspiration (FNA) may offer advantages for Ki67 assessment because the technique obtains highly cellular, well-preserved specimens with potential for broader tumor sampling. We evaluated concordance for grade and differentiation between concurrent core biopsy and cytology preparations. Secondly, cytological features and grade were correlated with survival. Methods Differentiation, grade by Ki67 index, and correlation of these features with survival were compared between concurrent core biopsy and cytology from 44 metastatic pancreatic neuroendocrine neoplasms. Results Differentiation by cytology smear was 38 (86%) well and 6 (14%) poor. Agreement for differentiation between smear and cell block, smear and biopsy, and cell block and biopsy was: 88%, 94%, and 83%, respectively and agreement for grade were: 68%, 54%, and 22%, respectively. Cytology differentiation and cytology grade were strong predictors of outcome with respective hazard ratio of 8.3 (95% CI: 3.1–22.1; p<0.001) and 1.9 (95% CI: 1.2–2.9) for each ascending grade. Cytology median disease specific survival projections (months) were G1= 121 (95% CI: 57–185 (estimated)); G2= 45 (95% CI 29–87); and G3=19 (95% CI 1–44) and WD=45; PD= 3; (P<.001)). Conclusions Pancreatic neuroendocrine neoplasm grading on cytology may not exactly correlate with concurrent core biopsy, but cytology differentiation and grade are predictive of survival based on stage-adjusted analysis. PMID:28094897

The effect of oral appliances that advanced the mandible forward and limited mouth opening in patients with obstructive sleep apnea: a systematic review and meta-analysis of randomised controlled trials.

PubMed

Okuno, K; Sato, K; Arisaka, T; Hosohama, K; Gotoh, M; Taga, H; Sasao, Y; Hamada, S

2014-07-01

Oral appliances (OAs) have demonstrated efficacy in treating obstructive sleep apnea (OSA), but many different OA devices are available. The Japanese Academy of Dental Sleep Medicine supported the use of OAs that advanced the mandible forward and limited mouth opening and suggested an evaluation of their effects in comparison with untreated or CPAP. A systematic search was undertaken in 16 April 2012. The outcome measures of interest were as follows: Apnea Hypopnea Index (AHI), lowest SpO2 , arousal index, Epworth Sleepiness Scale (ESS), the SF-36 Health Survey. We performed this meta-analysis using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Five studies remained eligible after applying the exclusion criteria. Comparing OA and control appliance, OA significantly reduced the weighted mean difference (WMD) in both AHI and the arousal index (favouring OA, AHI: -7.05 events h(-1) ; 95% CI, -12.07 to -2.03; P = 0.006, arousal index: -6.95 events h(-1) ; 95% CI, -11.75 to -2.15; P = 0.005). OAs were significantly less effective at reducing the WMD in AHI and improving lowest SpO2 and SF-36 than CPAP, (favouring OA, AHI: 6.11 events h(-1) ; 95% CI, 3.24 to 8.98; P = 0.0001, lowest SpO2 : -2.52%; 95% CI, -4.81 to -0.23; P = 0.03, SF-36: -1.80; 95% CI, -3.17 to -042; P = 0.01). Apnea Hypopnea Index and arousal index were significantly improved by OA relative to the untreated disease. Apnea Hypopnea Index, lowest SpO2 and SF-36 were significantly better with CPAP than with OA. The results of this study suggested that OAs improve OSA compared with untreated. CPAP appears to be more effective in improving OSA than OAs. © 2014 John Wiley & Sons Ltd.

Firearm-related hospitalization and risk for subsequent violent injury, death, or crime perpetration: a cohort study.

PubMed

Rowhani-Rahbar, Ali; Zatzick, Douglas; Wang, Jin; Mills, Brianna M; Simonetti, Joseph A; Fan, Mary D; Rivara, Frederick P

2015-04-07

Risk for violent victimization or crime perpetration after firearm-related hospitalization (FRH) must be determined to inform the need for future interventions. To compare the risk for subsequent violent injury, death, or crime perpetration among patients with an FRH, those hospitalized for noninjury reasons, and the general population. Retrospective cohort study. All hospitals in Washington. Patients with an FRH and a random sample of those with a non-injury-related hospitalization in 2006 to 2007 (index hospitalization). Primary outcomes included subsequent FRH, firearm-related death, and the combined outcome of firearm- or violence-related arrest ascertained through 2011. Among patients with an index FRH (n = 613), rates of subsequent FRH, firearm-related death, and firearm- or violence-related arrest were 329 (95% CI, 142 to 649), 100 (CI, 21 to 293), and 4221 (CI, 3352 to 5246) per 100 000 person-years, respectively. Compared with the general population, standardized incidence ratios among patients with an index FRH were 30.1 (CI, 14.9 to 61.0) for a subsequent FRH and 7.3 (CI, 2.4 to 22.9) for firearm-related death. In survival analyses that accounted for competing risks, patients with an index FRH were at greater risk for subsequent FRH (subhazard ratio [sHR], 21.2 [CI, 7.0 to 64.0]), firearm-related death (sHR, 4.3 [CI, 1.3 to 14.1]), and firearm- or violence-related arrest (sHR, 2.7 [CI, 2.0 to 3.5]) than those with a non-injury-related index hospitalization. Lack of information on whether patients continued to reside in Washington during follow-up may have introduced outcome misclassification. Hospitalization for a firearm-related injury is associated with a heightened risk for subsequent violent victimization or crime perpetration. Further research at the intersection of clinical care, the criminal justice system, and public health to evaluate the effectiveness of interventions delivered to survivors of firearm-related injury is warranted. Seattle City Council and University of Washington Royalty Research Fund.

Annexin V-MACS in infertile couples as method for separation of sperm without DNA fragmentation.

PubMed

Troya, Jhon; Zorrilla, Ingrid

2015-05-01

To determine the effect of using MACS technology on clinical pregnancy, as a method for separation of damaged sperm in infertile patients. 136 infertile men having normal semen parameters in accordance with WHO 2010 criterion, undergoing ICSI cycle were enrolled during the course of the study. The patients were prospectively randomized and enrolled after oocyte retrieval and were assigned to the ICSI group, PICSI group or MACS group. Embryo development and clinical pregnancy were assessed. In 17 randomized MACS patients, sperm DNA fragmentation was tested in the presumptive apoptotic and no apoptotic spermatozoa fractions. Similar results were obtained between groups for the following parameters: fertilization rates of 78.97% (95% confidence interval [CI]:74.37-83.57), 70.15 %(95% CI:63.98-76.33) and 80.28%(95% CI:73.74-86.81) for ICSI, PICSI and MACS group, respectively; Number of Day-3 embryos was 5.04 (95% CI:4.09-5.98), 5.17(95% CI:4.24-6.10) and 5.59(95% CI:4.31-6.87) for ICSI, PICSI and MACS group, respectively; number of freezing embryos in blastocyst stage was 0.78 (95% CI:0.25- 1.31), 0.70(95% CI:0.27-1.14) and 1 (95% CI:0.37-1.6) for ICSI, PICSI and MACS group, respectively. However, clinical pregnancy rates of 58.1% for MACS group versus 40.4% and 27.3% for PICSI and ICSI group, respectively, were showed statistical difference (P=0.019). DNA fragmentation index for the two sperm MACS fraction showed statistical differences (P=0.000), MACS reduced the D.F.I of the sperm sample. The use of MACS technology improves the clinical pregnancy on infertile couples and can be applied as a method for sperm separation, discriminating sperm with high DNA fragmentation.

Breast Cancer Risk and Mammographic Density Assessed with Semiautomated and Fully Automated Methods and BI-RADS.

PubMed

Jeffers, Abra M; Sieh, Weiva; Lipson, Jafi A; Rothstein, Joseph H; McGuire, Valerie; Whittemore, Alice S; Rubin, Daniel L

2017-02-01

Purpose To compare three metrics of breast density on full-field digital mammographic (FFDM) images as predictors of future breast cancer risk. Materials and Methods This institutional review board-approved study included 125 women with invasive breast cancer and 274 age- and race-matched control subjects who underwent screening FFDM during 2004-2013 and provided informed consent. The percentage of density and dense area were assessed semiautomatically with software (Cumulus 4.0; University of Toronto, Toronto, Canada), and volumetric percentage of density and dense volume were assessed automatically with software (Volpara; Volpara Solutions, Wellington, New Zealand). Clinical Breast Imaging Reporting and Data System (BI-RADS) classifications of breast density were extracted from mammography reports. Odds ratios and 95% confidence intervals (CIs) were estimated by using conditional logistic regression stratified according to age and race and adjusted for body mass index, parity, and menopausal status, and the area under the receiver operating characteristic curve (AUC) was computed. Results The adjusted odds ratios and 95% CIs for each standard deviation increment of the percentage of density, dense area, volumetric percentage of density, and dense volume were 1.61 (95% CI: 1.19, 2.19), 1.49 (95% CI: 1.15, 1.92), 1.54 (95% CI: 1.12, 2.10), and 1.41 (95% CI: 1.11, 1.80), respectively. Odds ratios for women with extremely dense breasts compared with those with scattered areas of fibroglandular density were 2.06 (95% CI: 0.85, 4.97) and 2.05 (95% CI: 0.90, 4.64) for BI-RADS and Volpara density classifications, respectively. Clinical BI-RADS was more accurate (AUC, 0.68; 95% CI: 0.63, 0.74) than Volpara (AUC, 0.64; 95% CI: 0.58, 0.70) and continuous measures of percentage of density (AUC, 0.66; 95% CI: 0.60, 0.72), dense area (AUC, 0.66; 95% CI: 0.60, 0.72), volumetric percentage of density (AUC, 0.64; 95% CI: 0.58, 0.70), and density volume (AUC, 0.65; 95% CI: 0.59, 0.71), although the AUC differences were not statistically significant. Conclusion Mammographic density on FFDM images was positively associated with breast cancer risk by using the computer assisted methods and BI-RADS. BI-RADS classification was as accurate as computer-assisted methods for discrimination of patients from control subjects. © RSNA, 2016.

Analysis of Environmental Chemical Mixtures and Non-Hodgkin Lymphoma Risk in the NCI-SEER NHL Study

PubMed Central

Czarnota, Jenna; Gennings, Chris; Colt, Joanne S.; De Roos, Anneclaire J.; Cerhan, James R.; Severson, Richard K.; Hartge, Patricia; Ward, Mary H.

2015-01-01

Background There are several suspected environmental risk factors for non-Hodgkin lymphoma (NHL). The associations between NHL and environmental chemical exposures have typically been evaluated for individual chemicals (i.e., one-by-one). Objectives We determined the association between a mixture of 27 correlated chemicals measured in house dust and NHL risk. Methods We conducted a population-based case–control study of NHL in four National Cancer Institute–Surveillance, Epidemiology, and End Results centers—Detroit, Michigan; Iowa; Los Angeles County, California; and Seattle, Washington—from 1998 to 2000. We used weighted quantile sum (WQS) regression to model the association of a mixture of chemicals and risk of NHL. The WQS index was a sum of weighted quartiles for 5 polychlorinated biphenyls (PCBs), 7 polycyclic aromatic hydrocarbons (PAHs), and 15 pesticides. We estimated chemical mixture weights and effects for study sites combined and for each site individually, and also for histologic subtypes of NHL. Results The WQS index was statistically significantly associated with NHL overall [odds ratio (OR) = 1.30; 95% CI: 1.08, 1.56; p = 0.006; for one quartile increase] and in the study sites of Detroit (OR = 1.71; 95% CI: 1.02, 2.92; p = 0.045), Los Angeles (OR = 1.44; 95% CI: 1.00, 2.08; p = 0.049), and Iowa (OR = 1.76; 95% CI: 1.23, 2.53; p = 0.002). The index was marginally statistically significant in Seattle (OR = 1.39; 95% CI: 0.97, 1.99; p = 0.071). The most highly weighted chemicals for predicting risk overall were PCB congener 180 and propoxur. Highly weighted chemicals varied by study site; PCBs were more highly weighted in Detroit, and pesticides were more highly weighted in Iowa. Conclusions An index of chemical mixtures was significantly associated with NHL. Our results show the importance of evaluating chemical mixtures when studying cancer risk. Citation Czarnota J, Gennings C, Colt JS, De Roos AJ, Cerhan JR, Severson RK, Hartge P, Ward MH, Wheeler DC. 2015. Analysis of environmental chemical mixtures and non-Hodgkin lymphoma risk in the NCI-SEER NHL Study. Environ Health Perspect 123:965–970; http://dx.doi.org/10.1289/ehp.1408630 PMID:25748701

Study of conicity index, body mass index and waist circumference as predictors of coronary artery disease.

PubMed

Caitano Fontela, Paula; Winkelmann, Eliane Roseli; Nazario Viecili, Paulo Ricardo

2017-05-01

Obesity is a major risk factor for cardiovascular disease. This study was designed to assess whether the conicity index (CI), body mass index (BMI) and waist circumference (WC) can be used as predictors of coronary artery disease (CAD) and mortality in a middle-aged population of the north-western region of Rio Grande do Sul, Brazil. This was a retrospective, longitudinal cohort study, based on the medical records of patients seen in a cardiology institution in a rural area of Rio Grande do Sul. The sample consisted of 2396 individuals. The primary endpoint was diagnosis of CAD, with mortality as the secondary endpoint. CI, BMI and WC were assessed using logistic regression, Cox regression and receiver operating characteristic curve analysis. The study showed that none of the anthropometric measures could be considered independent factors for either a diagnosis of CAD or mortality. Female gender was associated with a significantly lower risk of CAD (odds ratio [OR]: 0.31; 95% confidence interval [CI]: 0.22-0.44), as was absence of diabetes (OR: 0.52; 95% CI: 0.33-0.82), while there was a significantly higher risk of mortality associated with the presence of CAD (OR: 3.56; 95% CI: 2.00-6.32) and alcohol consumption (OR: 3.55; 95% CI: 1.60-7.90). These anthropometric measures were not independent predictive factors for CAD diagnosis or mortality in a population in southern Brazil. Our results support the conclusion that determination of CI, BMI and WC alone is insufficient to assess the risk of CAD and mortality in the general population. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

Effect of prenatal and postnatal malnutrition on intellectual functioning in early school-aged children in rural western China.

PubMed

Li, Chao; Zhu, Ni; Zeng, Lingxia; Dang, Shaonong; Zhou, Jing; Yan, Hong

2016-08-01

The aim of this study was to evaluate the effect of prenatal and postnatal malnutrition on the intellectual functioning of early school-aged children. We followed the offspring of women who had participated in a trial of prenatal supplementation with different combinations of micronutrients and who remained resident in the study field. We measured their intellectual functioning using the Wechsler intelligence scale for children (WISC-IV). Height-for-age, weight-for-age, and body mass index (BMI)-for-age were used as anthropometric nutritional status indices. Four of the 5 composite scores derived from the WISC-IV, except for working memory index (WMI), were significantly lower in low birth weight children after adjusting for confounds. All 5 composite scores, including full-scale intelligence quotient (FSIQ), verbal comprehension index (VCI), WMI, perceptual reasoning index (PRI), and processing speed index (PSI) were significant lower in stunted and underweight children. The differences in the means of WISC-IV test scores were greatest between stunted and nonstunted children. The means for FSIQ, VCI, WMI, PRI, and PSI were as follows: 5.88 (95% confidence interval [CI]: 2.84-8.92), 5.08 (95% CI: 1.12-8.41), 4.71 (95% CI: 1.78-7.66), 6.13 (95% CI: 2.83-9.44), and 5.81 (95% CI: 2.61-9.00). These means were lower in stunted children after adjusting for confounds. Our results suggest the important influences of low birth weight and postnatal malnutrition (stunting, low body weight) on intellectual functioning in early school-aged children.

Reproductive outcomes following hydroxychloroquine use for autoimmune diseases: a systematic review and meta‐analysis

PubMed Central

Ozsarfati, Jak; Nickel, Cheri; Koren, Gideon

2016-01-01

Aims The objective of this meta‐analysis was to determine whether gestational use of hydroxychloroquine (HCQ) for autoimmune disorders leads to an increase in the risk for adverse pregnancy outcomes. Methods MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials databases were searched from inception to November 21 2014. Studies which reported the outcomes of pregnant women after exposure to HCQ during pregnancy and including a control (unexposed) group were included. Two independent reviewers carried out the review and the quality assessment using the Methodological Index for Non‐Randomized Studies (MINORS). A random effects method was used to calculate the odds ratios (OR) for the outcomes. Results The meta‐analysis reported no significant increases in rates of major congenital (OR 1.13, 95% confidence interval (CI) 0.59, 2.17), craniofacial (OR 0.62, 95% CI 0.13, 3.03), cardiovascular (OR 1.06, 95% CI 0.29, 3.86), genitourinary (OR 1.38, 95% CI 0.42, 4.53), nervous system malformations (OR 1.81, 95% CI 0.31, 10.52), stillbirth (OR 0.69, 95% CI 0.35, 1.34), low birth weight (OR 0.69, 95% CI 0.21, 2.27) or prematurity (OR 1.75, 95% CI 0.95, 3.24). The rate of spontaneous abortions, however, was found to be significantly increased in HCQ exposed pregnancies (OR 1.85, 95% CI 1.10, 3.13). No significant heterogeneity was detected among the studies for the evaluated outcomes except prematurity. Conclusions Prenatal exposure to HCQ for autoimmune diseases does not appear to increase the risk of adverse pregnancy outcomes except spontaneous abortion rate, which may be associated with the underlying disease activity (bias by indication) and needs further investigation. PMID:26700396

Measurement of cardiac output in children by pressure-recording analytical method.

PubMed

Urbano, Javier; López, Jorge; González, Rafael; Solana, María José; Fernández, Sarah N; Bellón, José M; López-Herce, Jesús

2015-02-01

We evaluated two pressure-recording analytical method (PRAM) software versions (v.1 and v.2) to measure cardiac index (CI) in hemodynamically stable critically ill children and investigate factors that influence PRAM values. The working hypothesis was that PRAM CI measurements would stay within normal limits in hemodynamically stable patients. Ninety-five CI PRAM measurements were analyzed in 47 patients aged 1-168 months. Mean CI was 4.1 ± 1.4 L/min/m(2) (range 2.0-7.0). CI was outside limits defined as normal (3-5 L/min/m(2)) in 53.7% of measurements (47.8% with software v.1 and 69.2% with software v.2, p = 0.062). Moreover, 14.7% of measurements were below 2.5 L/min/m(2), and 13.6% were above 6 L/min/m(2). CI was significantly lower in patients with a clearly visible dicrotic notch than in those without (3.7 vs. 4.6 L/min/m(2), p = 0.004) and in children with a radial arterial catheter (3.5 L/min/m(2)) than in those with a brachial (4.4 L/min/m(2), p = 0.021) or femoral catheter (4.7 L/min/m(2), p = 0.005). By contrast, CI was significantly higher in children under 12 months (4.2 vs. 3.6 L/min/m(2), p = 0.034) and weighing under 10 kg (4.2 vs. 3.6 L/min/m(2), p = 0.026). No significant differences were observed between cardiac surgery patients and the rest of children. A high percentage of CI measurements registered by PRAM were outside normal limits in hemodynamically stable, critically ill children. CI measured by PRAM may be influenced by the age, weight, location of catheter, and presence of a dicrotic notch.

Association between gingival bleeding and gingival enlargement and oral health-related quality of life (OHRQoL) of subjects under fixed orthodontic treatment: a cross-sectional study.

PubMed

Zanatta, Fabricio Batistin; Ardenghi, Thiago Machado; Antoniazzi, Raquel Pippi; Pinto, Tatiana Militz Perrone; Rösing, Cassiano Kuchenbecker

2012-11-27

There are scarce evidences that evaluated the impact of periodontal disease on oral health-related quality of life (OHRQoL) taking marginal gingival alterations into consideration. Thus, this study aimed to verify the association between OHRQoL and gingival enlargement and gingival bleeding in subjects under fixed orthodontic treatment (FOT). 330 participants under FOT for at least 6 months were examined by a single, calibrated examiner for periodontal variables and dental aesthetic index. Socio-economic background, body mass index, time with orthodontic appliances, and use of dental floss were assessed by oral interviews. OHRQoL was evaluated using the oral health impact profile (OHIP-14) questionnaire. The assessment of associations used unadjusted and adjusted Poisson regression models. Higher impacts on the OHIP-14 overall were observed in subjects who presented higher levels of anterior gingival enlargement (RR 2.83; 95% CI 2.60-3.09), were non-whites (RR 1.29; 95% CI 1.15-1.45), had household income lower than five national minimum wages (RR 1.85; 95% CI 1.30-2.61), presented body mass index>25 (RR 1.14; 95% CI 1.01-1.29), and showed a dental aesthetic index>30 (RR 1.32; 95% CI 1.20-1.46). Anterior gingival enlargement seems to influence the OHRQoL in subjects receiving orthodontic treatment.

The effects of a household conditional cash transfer programme on coverage and quality of antenatal care: a secondary analysis of Indonesia's pilot programme.

PubMed

Triyana, Margaret; Shankar, Anuraj H

2017-10-22

To analyse the effectiveness of a household conditional cash transfer programme (CCT) on antenatal care (ANC) coverage reported by women and ANC quality reported by midwives. The CCT was piloted as a cluster randomised control trial in 2007. Intent-to-treat parameters were estimated using linear regression and logistic regression. Secondary analysis of the longitudinal CCT impact evaluation survey, conducted in 2007 and 2009. This included 6869 pregnancies and 1407 midwives in 180 control subdistricts and 180 treated subdistricts in Indonesia. ANC component coverage index, a composite measure of each ANC service component as self-reported by women, and ANC provider quality index, a composite measure of ANC service provided as self-reported by midwives. Each index was created by principal component analysis (PCA). Specific ANC component items were also assessed. The CCT was associated with improved ANC component coverage index by 0.07 SD (95% CI 0.002 to 0.141). Women were more likely to receive the following assessments: weight (OR 1.56 (95% CI 1.25 to 1.95)), height (OR 1.41 (95% CI 1.247 to 1.947)), blood pressure (OR 1.36 (95% CI 1.045 to 1.761)), fundal height measurements (OR 1.65 (95% CI 1.372 to 1.992)), fetal heart beat monitoring (OR 1.29 (95% CI 1.006 to 1.653)), external pelvic examination (OR 1.28 (95% CI 1.086 to 1.505)), iron-folic acid pills (OR 1.42 (95% CI 1.081 to 1.859)) and information on pregnancy complications (OR 2.09 (95% CI 1.724 to 2.551)). On the supply side, the CCT had no significant effect on the ANC provider quality index based on reports from midwives. The CCT programme improved ANC coverage for women, but midwives did not improve ANC quality. The results suggest that enhanced ANC utilisation may not be sufficient to improve health outcomes, and steps to improve ANC quality are essential for programme impact. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A novel conformity index for intensity modulated radiation therapy plan evaluation

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

Cheung, Fion W. K.; Law, Maria Y. Y.; Medical Physics and Research Department, Hong Kong Sanatorium and Hospital, 999077 Hong Kong

2012-09-15

Purpose: Intensity modulated radiation therapy (IMRT) has gained popularity in the treatment of cancers. Manual evaluation of IMRT plans for head-and-neck cancers has been especially challenging necessitating efficient and objective assessment tools. In this work, the authors address this issue by developing a personalized conformity index (CI) for comparison of IMRT plans for head-and-neck cancers and evaluating its plan quality discerning power in comparison with other widely used CIs. Methods: A two-dimensional CI with dose and distance incorporated (CI{sub DD}) was developed using the MATLAB program language, to quantify the planning target volume (PTV) coverage. Valuable information contained in themore » digital imaging and communication in medicine (DICOM) RT objects were harvested for computation of each of the CI{sub DD} components. Apart from the dose penalty factor, a distance-based exponential function was employed by varying the penalty weight associated with the location of cold spots within the PTV. With the goal of deriving a customized penalty factor, the distances between individual pixel and its nearest PTV boundary was found. Using the exponential function, the impact of distance penalty was substantially larger for cold spots closer to the PTV centroid but petered out quickly wherever they were situated in the vicinity of PTV border. In order to evaluate the CI{sub DD} scoring system, three CT image data sets of nasopharyngeal carcinoma (NPC) patients were collected. Ten IMRT plans with degrading qualities were generated from each dataset and were ranked based on CI{sub DD} and other existing indices. The coefficient of variance was calculated for each dataset to compare the degree of variation. Results: The CI{sub DD} scoring system that considered spatial importance of each voxel within the PTV was successfully developed. The results demonstrated that the CI{sub DD} including four discrete factors could provide accurate rankings of plan quality by examining the relative importance of each cold spot within the PTVs. Apart from the dose penalty factor, a distance-based exponential function was employed taking the specific tumor geometry into account. Compared with other commonly used CIs, the CI{sub DD} resulted in the largest coefficient of variance among the ten IMRT plans for each dataset, indicating that its discerning power was the best among the CIs being compared. Conclusions: The CI{sub DD} scoring system was successfully developed to incorporate patient-specific spatial dose information and provide a geometry-based physical index for comparison of IMRT plans for head-and-neck cancers. By taking individual tumor geometry into account, the superiority of CI{sub DD} in plan discerning power was demonstrated. The use of CI{sub DD} could provide an effective means of benchmarking performance, reducing treatment plan variability, and advancing the quality of current IMRT planning.« less

Body weight dissatisfaction by socioeconomic status among obese, preobese and normal weight women and men: results of the cross-sectional KORA Augsburg S4 population survey

PubMed Central

2012-01-01

Background Body weight dissatisfaction is an important factor in preventing weight gain and promoting weight loss or maintenance. This study focuses on differences in the rates of body weight dissatisfaction among obese, preobese and normal weight women and men by socioeconomic status within a general adult population in Germany. Methods Data were analyzed from 4186 adults aged 25 to 74 who participated in a cross-sectional, representative population-based health survey (KORA S4, 1999–2001, Augsburg region/Germany). Body mass was measured anthropometrically and indexed following international standards. Among the 2123 women participating in the survey, 40.3% had a normal weight, 34.9% were preobese, and 24.8% were obese (compared to 25.9%, 51.4% and 22.6% among men, respectively). Body weight dissatisfaction, educational level, household income and occupational status were assessed by computer-aided personal interviewing. An index for socioeconomic status was calculated and categorized into quintiles. Multiple logistic regressions were performed to test for differences in the odds of body weight dissatisfaction across socioeconomic strata in normal weight, preobese and obese groups. Body mass index, age, family status, place of residence and health behaviors were adjusted for. Results Overall, being dissatisfied with one’s body weight was more prevalent in women (48.3%) than in men (33.2%). In the normal weight group, no significant differences in the odds of being dissatisfied were found across socioeconomic groups among women or men. Among preobese men, compared to the lowest socioeconomic stratum, increased odds of being dissatisfied with one’s body weight were associated with the highest socioeconomic index group (OR = 2.3, 95% CI: 1.4–3.8), middle and high educational level (OR = 1.6, 95% CI: 1.1–2.3, and OR = 1.9, 95% CI: 1.3–3.7), high income (OR = 1.8, 95% CI: 1.2–2.7), and middle and high occupational status (both OR = 1.8, 95% CI: 1.2–2.6). Among preobese women, the odds of being dissatisfied were only significantly elevated in those with a middle educational level (OR = 1.6, 95% CI: 1.1–2.3). Among obese men, elevated odds were found in the highest socioeconomic index group (OR = 3.7, 95% CI: 1.8–7.5) and in those with a high educational level (OR = 2.3, 95% CI: 1.3–4.1), high income (OR = 2.6, 95% CI: 1.4–4.7), and middle and high occupational status (both OR = 2.2, 95% CI: 1.3–3.6). The odds of dissatisfaction among obese women were not associated with socioeconomic status as a whole, but were associated with a high educational level, albeit with a comparatively large confidence interval (OR = 3.6, 95% CI: 1.0–12.8). Conclusions In Germany, body weight dissatisfaction is more prevalent among obese and preobese men in high socioeconomic status groups, a pattern not found in women. The exception to this is a greater prevalence of dissatisfaction among obese and preobese women with a high educational level (albeit inconsistently). Moreover, there is a social gradient in body weight dissatisfaction, especially in obese men, which may partly explain why obesity is more prevalent in men with low socioeconomic status. It also suggests that they are a target group for obesity care in which body weight satisfaction is an important topic. PMID:22571239

Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis

PubMed Central

Newman, Phil; Witchalls, Jeremy; Waddington, Gordon; Adams, Roger

2013-01-01

Background Medial tibial stress syndrome (MTSS) affects 5%–35% of runners. Research over the last 40 years investigating a range of interventions has not established any clearly effective management for MTSS that is better than prolonged rest. At the present time, understanding of the risk factors and potential causative factors for MTSS is inconclusive. The purpose of this review is to evaluate studies that have investigated various risk factors and their association with the development of MTSS in runners. Methods Medical research databases were searched for relevant literature, using the terms “MTSS AND prevention OR risk OR prediction OR incidence”. Results A systematic review of the literature identified ten papers suitable for inclusion in a meta-analysis. Measures with sufficient data for meta-analysis included dichotomous and continuous variables of body mass index (BMI), ankle dorsiflexion range of motion, navicular drop, orthotic use, foot type, previous history of MTSS, female gender, hip range of motion, and years of running experience. The following factors were found to have a statistically significant association with MTSS: increased hip external rotation in males (standard mean difference [SMD] 0.67, 95% confidence interval [CI] 0.29–1.04, P<0.001); prior use of orthotics (risk ratio [RR] 2.31, 95% CI 1.56–3.43, P<0.001); fewer years of running experience (SMD −0.74, 95% CI −1.26 to −0.23, P=0.005); female gender (RR 1.71, 95% CI 1.15–2.54, P=0.008); previous history of MTSS (RR 3.74, 95% CI 1.17–11.91, P=0.03); increased body mass index (SMD 0.24, 95% CI 0.08–0.41, P=0.003); navicular drop (SMD 0.26, 95% CI 0.02–0.50, P=0.03); and navicular drop >10 mm (RR 1.99, 95% CI 1.00–3.96, P=0.05). Conclusion Female gender, previous history of MTSS, fewer years of running experience, orthotic use, increased body mass index, increased navicular drop, and increased external rotation hip range of motion in males are all significantly associated with an increased risk of developing MTSS. Future studies should analyze males and females separately because risk factors vary by gender. A continuum model of the development of MTSS that links the identified risk factors and known processes is proposed. These data can inform both screening and countermeasures for the prevention of MTSS in runners. PMID:24379729

Body Mass Index Is Associated with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

PubMed Central

Tang, Yuchen; Xu, Fei; Yu, Chaohui; Li, Youming; Pankaj, Prasoon; Dai, Ning

2015-01-01

Background Prior work suggested that patients with inflammatory bowel diseases (IBD) have lower body mass index (BMI) than controls and patients with lower BMI have more serious complications. Goal The study was aimed to find relationship between BMI in patients with and without IBD, investigate effects of medicine therapy and disease stages on patients’ BMI. Methods Potentially eligible studies were identified through searching PubMed, Cochrane and Embase databases. Outcome measurements of mean BMI and the number of patients from each study were pooled by a random-effect model. Publication bias test, sensitivity analysis and subgroup analysis were conducted. Results A total of 24 studies containing 1442 patients and 2059 controls were included. Main results were as follows: (1) BMI in Crohn’s disease (CD) patients was lower than that in health controls (-1.88, 95% CI -2.77 to -1.00, P< 0.001); (2) Medical therapy significantly improved BMI of CD patients (with therapy: -1.58, -3.33 to 0.16; without: -2.09, 95% CI -3.21 to -0.98) while on the contrary not significantly improving BMI of UC patients (with therapy: -0.24, 95% CI -3.68 to 3.20; without: -1.34, 95% CI -2.87 to 0.20, P = 0.57); (3) Both CD and UC patients in active phase showed significantly greater BMI difference compared with controls than those in remission (CD patients: remission: -2.25, 95% CI -3.38 to -1.11; active phase: -4.25, 95% CI -5.58 to -2.92, P = 0.03; UC patients: remission: 0.4, 95% CI -2.05 to 2.84; active phase: -5.38, -6.78 to -3.97, P = 0.001). Conclusions BMI is lower in CD patients; medical therapy couldn’t improve BMI of IBD patients; the state of disease affects BMI of CD patients and UC patients. PMID:26658675

Association Between Body Mass Index and Gastroesophageal Reflux Symptoms in Both Normal Weight and Overweight Women

PubMed Central

Jacobson, Brian C.; Somers, Samuel C.; Fuchs, Charles S.; Kelly, Ciarán P.; Camargo, Carlos A.

2009-01-01

Background Overweight and obese individuals are at increased risk for gastroesophageal reflux disease (GERD). An association between body mass index (BMI) and GERD symptoms among normal weight individuals has not been demonstrated. Methods In 2000, a supplemental questionnaire was used to determine the frequency, severity, and duration of GERD symptoms among randomly-selected participants of the Nurses’ Health Study. After categorizing women by BMI as measured in 1998, we used logistic regression models to study the association between BMI and GERD symptoms. Results Among 10,545 women who completed the questionnaire (86% response rate), 2,310 (22%) reported experiencing symptoms at least once a week (55% of whom described their symptoms as moderate in severity). We observed a dose-dependent relationship between increasing BMI and frequent reflux symptoms (multivariate P for trend <0.001). Compared to women with BMI 20–22.49 kg/m2, the multivariate odds ratios (ORs) were 1.38 (95% CI 1.13–1.67) for BMI 22.5–24.9; 2.20 (95% CI 1.81–2.66) for BMI 25–27.4; 2.43 (95% CI 1.96–3.01) for BMI 27.5–29.9; 2.92 (95% CI 2.35–3.62) for BMI 30–34.9, 2.93 (95% CI 2.24–3.85) for BMI ≥35, and 0.67 (95% CI 0.48–0.93) for BMI <20. Even among women with normal baseline BMI, weight gain between 1984 and 1998 was associated with increased risk of frequent reflux symptoms (OR 2.8 (95% CI 1.63–4.82) for BMI increase >3.5). Conclusion BMI is associated with GERD symptoms in both normal weight and overweight individuals. Our findings suggest that even modest weight gain among normal weight individuals may cause or exacerbate reflux symptoms. PMID:16738270

The Alternative Healthy Eating Index Is Associated with a Lower Risk of Fatal and Nonfatal Acute Myocardial Infarction in a Chinese Adult Population123

PubMed Central

Neelakantan, Nithya; Naidoo, Nasheen; Koh, Woon-Puay; Yuan, Jian-Min; van Dam, Rob M

2016-01-01

Background: Indexes to quantify adherence to recommended dietary patterns have been developed for Western populations, but it is unclear whether these indexes can predict acute myocardial infarction (AMI) in Asian populations. Objectives: We aimed to investigate the association between the Alternative Healthy Eating Index (AHEI)–2010 and risk of AMI and to evaluate potential mediation by traditional cardiovascular risk factors in a Chinese population. Methods: A nested case-control study in 751 incident cases of AMI (564 nonfatal and 288 fatal) and 1443 matched controls was conducted within the prospective Singapore Chinese Health Study, a cohort of ethnic Chinese men and women aged 45–75 y. At baseline, habitual diet was assessed by using a validated, semiquantitative food-frequency questionnaire. AMI cases were ascertained via linkage with nationwide hospital databases (confirmed through medical record review) and the Singapore Birth and Death Registry. We evaluated the association between the AHEI-2010 and cardiovascular risk factors, including glycated hemoglobin, high-sensitivity C-reactive protein, creatinine, plasma lipids (LDL and HDL cholesterol, triglycerides), and blood pressure. ORs and 95% CIs were computed by using multivariable-adjusted conditional logistic regression models. Results: Higher AHEI-2010 scores were associated with a lower risk of AMI (OR for the highest quartile compared with the lowest quartile: 0.62; 95% CI: 0.47, 0.81; P-trend < 0.001), with similar associations for fatal (OR: 0.60; 95% CI: 0.39, 0.94; P-trend = 0.009) and nonfatal (OR: 0.59; 95% CI: 0.43, 0.81; P-trend = 0.002) AMI. This association was only slightly attenuated after adjustment for potential biological intermediates (OR: 0.64; 95% CI: 0.48, 0.86; P-trend = 0.003). Conclusions: Adherence to dietary recommendations as reflected in the AHEI-2010 was associated with a substantially lower risk of fatal and nonfatal AMI in an Asian population, and this association was largely independent of traditional cardiovascular risk factors. PMID:27306893

The Relative Associations of β-Cell Function and Insulin Sensitivity with Glycemic Status and Incident Glycemic Progression in Migrant Asian Indians in the United States: the MASALA study

PubMed Central

Gujral, UP; Narayan, KMV; Kahn, SE; Kanaya, AM

2013-01-01

AIMS We assessed the relative associations of β-cell dysfunction and insulin sensitivity with baseline glycemic status and incident glycemic progression among Asian Indians in the United States. METHODS A 5-sample oral glucose tolerance test was obtained at baseline. Normoglycemia, impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and type 2 diabetes (T2DM) were defined by ADA criteria. The Matsuda Index (ISIM) estimated insulin sensitivity, and the Disposition Index (DIo) estimated β-cell function. Visceral fat was measured by abdominal CT. After 2.5 years, participants underwent a 2-sample oral glucose tolerance test. Standardized polytomous logistic regression was used to examine associations with prevalent and incident glycemia. RESULTS Mean age was 57±8 years and BMI 26.1±4.6 kg/m2. Log ISIM and log DIo were associated with prediabetes and T2DM after adjusting for age, sex, BMI, family history of diabetes, hypertension, and smoking. After adjusting for visceral fat, only DIo remained associated with prediabetes (OR per SD 0.17, 95% CI: 0.70, 0.41) and T2DM (OR 0.003, 95% CI: 0.0001, 0.03). Incidence rates (per 1,000 person-year) were: normoglycemia to IGT: 82.0, 95% CI (40, 150); to IFG: 8.4, 95% CI (0, 41); to T2DM: 8.6, 95% CI (0, 42); IGT to T2DM: 55.0, 95% CI (17, 132); IFG to T2DM: 64.0, 95% CI (3, 316). The interaction between sex and the change in waist circumference (OR 1.8, per SD 95% CI: 1.22, 2.70) and the change in log HOMA-β(OR 0.37, per SD 95% CI: 0.17, 0.81) were associated with glycemic progression. CONCLUSIONS The association of DIo with baseline glycemia after accounting for visceral fat as well as the association of the change in log HOMA-β with incident glycemic progression implies innate β-cell susceptibility in Asian Indians for glucose intolerance or dysglycemia. PMID:24211090

Sagittal Abdominal Diameter as a Surrogate Marker of Insulin Resistance in an Admixtured Population—Brazilian Metabolic Syndrome Study (BRAMS)

PubMed Central

Cassani, Roberta S. L.; Forti, Adriana C. e; Vilela, Brunna S.; Tambascia, Marcos Antonio

2015-01-01

Background Sagittal abdominal diameter (SAD) has been proposed as a surrogate marker of insulin resistance (IR). However, the utilization of SAD requires specific validation for each ethnicity. We aimed to investigate the potential use of SAD, compared with classical anthropometrical parameters, as a surrogate marker of IR and to establish the cutoff values of SAD for screening for IR. Methods A multicenter population survey on metabolic disorders was conducted. A race-admixtured sample of 824 adult women was assessed. The anthropometric parameters included: BMI, waist circumference (WC), waist-to-hip ratio and SAD. IR was determined by a hyperglycemic clamp and the HOMA-IR index. Results After adjustments for age and total body fat mass, SAD (r = 0.23 and r = -0.70) and BMI (r = 0.20 and r = -0.71) were strongly correlated with the IR measured by the HOMA-IR index and the clamp, respectively (p < 0.001). In the ROC analysis, the optimal cutoff for SAD in women was 21.0 cm. The women with an increased SAD presented 3.2 (CI 95%: 2.1-5.0) more likelihood of having IR, assessed by the HOMA-IR index compared with those with normal SAD (p < 0.001); whereas women with elevated BMI and WC were 2.1 (95% CI: 1.4-3.3) and 2.8 (95% CI: 1.7-4.5) more likely to have IR (p < 0.001), respectively. No statistically significant results were found for waist-to-hip ratio. Conclusions SAD can be a suitable surrogate marker of IR. Understanding and applying routine and simplified methods is essential because IR is associated with an increased risk of obesity-related diseases even in the presence of normal weight, slight overweight, as well as in obesity. Further prospective analysis will need to verify SAD as a determinant of clinical outcomes, such as type 2 diabetes and cardiovascular events, in the Brazilian population. PMID:25951458

Institutional Racism and Pregnancy Health: Using Home Mortgage Disclosure Act Data to Develop an Index for Mortgage Discrimination at the Community Level

PubMed Central

Mendez, Dara D.; Hogan, Vijaya K.; Culhane, Jennifer

2011-01-01

Objectives We used Home Mortgage Disclosure Act (HMDA) data to demonstrate a method for constructing a residential redlining index to measure institutional racism at the community level. We examined the application of the index to understand the social context of health inequities by applying the residential redlining index among a cohort of pregnant women in Philadelphia. Methods We used HMDA data from 1999–2004 to create residential redlining indices for each census tract in Philadelphia County, Pennsylvania. We linked the redlining indices to data from a pregnancy cohort study and the 2000 Census. We spatially mapped the levels of redlining for each census tract for this pregnancy cohort and tested the association between residential redlining and other community-level measures of segregation and individual health. Results From 1999–2004, loan applicants in Philadelphia County, Pennsylvania, of black race/ethnicity were almost two times as likely to be denied a mortgage loan compared with applicants who were white (e.g., 1999 odds ratio [OR] = 2.00, 95% confidence interval [CI] 1.63, 2.28; and 2004 OR=2.26, 95% CI 1.98, 2.58). The majority (77.5%) of the pregnancy cohort resided in redlined neighborhoods, and there were significant differences in residence in redlined areas by race/ethnicity (p<0.001). Among the pregnancy cohort, redlining was associated with residential segregation as measured by the percentage of black population (r=0.155), dissimilarity (r=0.250), exposure (r=–0.115), and isolation (r=0.174) indices. Conclusions The evidence of institutional racism may contribute to our understanding of health disparities. Residential redlining and mortgage discrimination against communities may be a major factor influencing neighborhood structure, composition, development, and wealth attainment. This residential redlining index as a measure for institutional racism can be applied in health research to understand the unique social and neighborhood contexts that contribute to health inequities. PMID:21836743

Socioeconomic Inequalities in Secondhand Smoke Exposure at Home and at Work in 15 Low- and Middle-Income Countries

PubMed Central

Lee, John Tayu; Arora, Monika; Millett, Christopher

2016-01-01

Introduction: In high-income countries, secondhand smoke (SHS) exposure is higher among disadvantaged groups. We examine socioeconomic inequalities in SHS exposure at home and at workplace in 15 low- and middle-income countries (LMICs). Methods: Secondary analyses of cross-sectional data from 15 LMICs participating in Global Adult Tobacco Survey (participants ≥ 15 years; 2008–2011) were used. Country-specific analyses using regression-based methods were used to estimate the magnitude of socioeconomic inequalities in SHS exposure: (1) Relative Index of Inequality and (2) Slope Index of Inequality. Results: SHS exposure at home ranged from 17.4% in Mexico to 73.1% in Vietnam; exposure at workplace ranged from 16.9% in Uruguay to 65.8% in Bangladesh. In India, Bangladesh, Thailand, Malaysia, Philippines, Vietnam, Uruguay, Poland, Turkey, Ukraine, and Egypt, SHS exposure at home reduced with increasing wealth (Relative Index of Inequality range: 1.13 [95% confidence interval [CI] 1.04–1.22] in Turkey to 3.31 [95% CI 2.91–3.77] in Thailand; Slope Index of Inequality range: 0.06 [95% CI 0.02–0.11] in Turkey to 0.43 [95% CI 0.38–0.48] in Philippines). In these 11 countries, and in China, SHS exposure at home reduced with increasing education. In India, Bangladesh, Thailand, and Philippines, SHS exposure at workplace reduced with increasing wealth. In India, Bangladesh, Thailand, Philippines, Vietnam, Poland, Russian Federation, Turkey, Ukraine, and Egypt, SHS exposure at workplace reduced with increasing education. Conclusion: SHS exposure at homes is higher among the socioeconomically disadvantaged in the majority of LMICs studied; at workplaces, exposure is higher among the less educated. Pro-equity tobacco control interventions alongside targeted efforts in these groups are recommended to reduce inequalities in SHS exposure. Implications: SHS exposure is higher among the socioeconomically disadvantaged groups in high-income countries. Comprehensive smoke-free policies are pro-equity for certain health outcomes that are strongly influenced by SHS exposure. Using nationally representative Global Adult Tobacco Survey (2008–2011) data from 15 LMICs, we studied socioeconomic inequalities in SHS exposure at homes and at workplaces. The study showed that in most LMICs, SHS exposure at homes is higher among the poor and the less educated. At workplaces, SHS exposure is higher among the less educated groups. Accelerating implementation of pro-equity tobacco control interventions and strengthening of efforts targeted at the socioeconomically disadvantaged groups are needed to reduce inequalities in SHS exposure in LMICs. PMID:26610936

Assessing interactions between HLA-DRB1*15 and infectious mononucleosis on the risk of multiple sclerosis.

PubMed

Disanto, Giulio; Hall, Carolina; Lucas, Robyn; Ponsonby, Anne-Louise; Berlanga-Taylor, Antonio J; Giovannoni, Gavin; Ramagopalan, Sreeram V

2013-09-01

Gene-environment interactions may shed light on the mechanisms underlying multiple sclerosis (MS). We pooled data from two case-control studies on incident demyelination and used different methods to assess interaction between HLA-DRB1*15 (DRB1-15) and history of infectious mononucleosis (IM). Individuals exposed to both factors were at substantially increased risk of disease (OR=7.32, 95% CI=4.92-10.90). In logistic regression models, DRB1-15 and IM status were independent predictors of disease while their interaction term was not (DRB1-15*IM: OR=1.35, 95% CI=0.79-2.23). However, interaction on an additive scale was evident (Synergy index=2.09, 95% CI=1.59-2.59; excess risk due to interaction=3.30, 95%CI=0.47-6.12; attributable proportion due to interaction=45%, 95% CI=22-68%). This suggests, if the additive model is appropriate, the DRB1-15 and IM may be involved in the same causal process leading to MS and highlights the benefit of reporting gene-environment interactions on both a multiplicative and additive scale.

Association of Classic Cardiovascular Risk Factors and Lifestyles With the Cardio-ankle Vascular Index in a General Mediterranean Population.

PubMed

Elosua-Bayés, Marc; Martí-Lluch, Ruth; García-Gil, María Del Mar; Camós, Lourdes; Comas-Cufí, Marc; Blanch, Jordi; Ponjoan, Anna; Alves-Cabratosa, Lia; Elosua, Roberto; Grau, María; Marrugat, Jaume; Ramos, Rafel

2018-06-01

The cardio-ankle vascular index (CAVI) assesses arterial stiffness. We aimed to describe the distribution of CAVI in a Mediterranean population, to determine the proportion of CAVI ≥ 9 by sex and coronary risk level, and to assess the association of CAVI with classic cardiovascular risk factors and lifestyle patterns. This cross-sectional study was based on the population of Girona province. The CAVI was measured using the VaSera VS-1500. Of 2613 individuals included in this study, the prevalence of CAVI ≥ 9 was 46.8% in men and 36.0% in women and significantly increased with coronary risk: from 21.1% and 24.8%, respectively to 76.7%, in the low-risk group, and 61.9% in the high-risk group. The CAVI increased with age in both sexes, being higher in men across all age groups. In men, CAVI ≥ 9 was associated with hypertension (OR, 2.70; 95%CI, 1.90-3.87) and diabetes (OR, 2.38; 95%CI, 1.52-3.78), body mass index (BMI) ≤ 25 to < 30 (OR, 0.44; 95%CI, 0.27-0.72) and BMI ≥ 30 (OR, 0.28; 95%CI, 0.14-0.58), and physical activity (OR, 0.66; 95%CI, 0.47-0.92). In women, CAVI ≥ 9 was associated with hypertension (OR, 2.22; 95%CI, 1.59-3.09), hypercholesterolemia (OR, 1.40; 95%CI, 1.01-1.94), and BMI ≥ 30 (OR, 0.38; 95%CI, 0.20-0.71). The CAVI increases with age and is higher in men than in women. This index is associated with classic risk factors and coronary risk. It could be a good predictive biomarker, but further follow-up studies are required to assess its added value to cardiovascular risk stratification. Copyright © 2017. Published by Elsevier España, S.L.U.

Propagation of Obesity Across Generations: The Roles of Differential Realized Fertility and Assortative Mating by Body Mass Index

PubMed Central

Dawson, John A.; Dhurandhar, Emily J.; Vazquez, Ana I.; Peng, Bo; Allison, David B.

2013-01-01

Background/Aims To quantify the extent to which the increase in obesity observed across recent generations of the American population is associated with the individual or combined effects of assortative mating for body mass index (BMI; kg/m2) and differential realized fertility by BMI. Methods A Monte Carlo framework is formed and informed using data collected from the National Longitudinal Survey of Youth (NLSY). The model has two portions, one that generates childbirth events on an annual basis and another that produces a BMI for each child. Once the model is informed using the data, a reference distribution of offspring BMIs is simulated. We quantify the effects of our factors of interest by removing them from the model and comparing the resulting offspring BMI distributions with that of the baseline scenario. Results An association between maternal BMI and number of offspring is evidenced in the NLSY data, as well as the presence of assortative mating. These two factors combined are associated with increased mean BMI (+0.067, C.I. [0.056, 0.078]), increased BMI variance (+0.578, C.I. [0.418, 0.736]) and increased prevalence of obesity (RR 1.032, 95% C.I. [1.023, 1.041]) and BMIs over 40 (RR 1.083, 95% C.I. [1.053, 1.118]) among offspring. Conclusion Our investigation suggests that both differential realized fertility and assortative mating by BMI appear to play a role in the increasing prevalence of obesity in America. PMID:24081235

Comparison of body adiposity index (BAI) and air displacement plethysmograph with estimations of % body fat in adults with Down's syndrome.

PubMed

Rossato, M; Dellagrana, R A; de Souza Bezerra, E; da Costa, R M; Dos Santos, J O L; Silva, D A S; Diefenthaeler, F

2017-11-01

The aim of this study was to verify the agreement between body fat percentage (%BF) values evaluated by air displacement plethysmograph (ADP) and body adiposity index (BAI) in adults with Down's syndrome (DS). Forty-five adults with DS volunteered to participate in this study (19 women; age 28.7±8.5 years and 26 men; age 29.1±8.8 years). The %BF was measured by ADP (%BF ADP ) and estimated by anthropometric measures [%BF=(hip circumference/height) 1.5 -18] (%BF BAI ). Agreement between methods was evaluated by paired t-test, Pearson's correlation coefficient and Bland-Altman analysis. Although high correlation coefficients were found between %BF ADP and %BF BAI for women (r=0.78, P<0.05) and men (r=0.87, P<0.05), significant differences were observed between methods for both sexes (38.9±8.9 vs 42.5±8.5% for women, and 25.8±11.3 vs 32.6±5.4% for men in %BF ADP and %BF BAI , respectively). Moreover, Bland-Altman analysis showed that the mean error estimate was +3.6 (95%CI, -7.59 to 14.79) in women and +6.74 (95%CI, -7.25 to 20.72) in men. The results indicate that BAI seems to be a limited method to evaluate %BF in women and in men with DS.

Development and Validation of a Deep Neural Network Model for Prediction of Postoperative In-hospital Mortality.

PubMed

Lee, Christine K; Hofer, Ira; Gabel, Eilon; Baldi, Pierre; Cannesson, Maxime

2018-04-17

The authors tested the hypothesis that deep neural networks trained on intraoperative features can predict postoperative in-hospital mortality. The data used to train and validate the algorithm consists of 59,985 patients with 87 features extracted at the end of surgery. Feed-forward networks with a logistic output were trained using stochastic gradient descent with momentum. The deep neural networks were trained on 80% of the data, with 20% reserved for testing. The authors assessed improvement of the deep neural network by adding American Society of Anesthesiologists (ASA) Physical Status Classification and robustness of the deep neural network to a reduced feature set. The networks were then compared to ASA Physical Status, logistic regression, and other published clinical scores including the Surgical Apgar, Preoperative Score to Predict Postoperative Mortality, Risk Quantification Index, and the Risk Stratification Index. In-hospital mortality in the training and test sets were 0.81% and 0.73%. The deep neural network with a reduced feature set and ASA Physical Status classification had the highest area under the receiver operating characteristics curve, 0.91 (95% CI, 0.88 to 0.93). The highest logistic regression area under the curve was found with a reduced feature set and ASA Physical Status (0.90, 95% CI, 0.87 to 0.93). The Risk Stratification Index had the highest area under the receiver operating characteristics curve, at 0.97 (95% CI, 0.94 to 0.99). Deep neural networks can predict in-hospital mortality based on automatically extractable intraoperative data, but are not (yet) superior to existing methods.

SU-E-T-617: Plan Quality Estimation of Intensity-Modulated Radiotherapy Cases for Lung Cancer

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

Koo, J; Yoon, M; Chung, W

Purpose: To estimate the planning quality of intensity-modulated radiotherapy in lung cancer cases and to provide preliminary data for the development of a planning quality assurance algorithm. Methods: 42 IMRT plans previously used in cases of solitary lung cancers were collected. Organs in or near the thoracic cavity, such as lung (ipsilateral, contralateral), heart, liver, esophagus, cord and bronchus were considered as organs at risk (OARs) in this study. The coverage index (CVI), conformity index (CI), homogeneity index (HI), volume, irregularity (standard deviation of center-surface distance) were used to compare PTV dose characteristics. The effective uniform dose (EUD), V10Gy, andmore » V20Gy of the OARs were used to compare OAR dose characteristics. Results: Average CVI, CI, HI values were 0.9, 0.8, 0.1, respectively. CVI and CI had narrow Gaussian distribution curves without a singular value, but one case had a relatively high (0.25) HI because of location and irregular shape (Irregularity of 18.5 when average was 12.5) of PTV. EUDs tended to decrease as OAR-PTV distance increased and OAR-PTV overlap volume decreased. Conclusion: This work indicates the potential for significant plan quality deviation of similar lung cancer cases. Considering that this study were from a single department, differences in the treatment results for a given patient would be much more pronounced if multiple departments (and therefore more planners) were involved. Therefore, further examination of QA protocols is needed to reduce deviations in radiation treatment planning.« less

Target dose conformity in 3-dimensional conformal radiotherapy and intensity modulated radiotherapy.

PubMed

Wu, Vincent W C; Kwong, Dora L W; Sham, Jonathan S T

2004-05-01

Dose conformity to the planning target volume is an important criterion in radiotherapy treatment planning, for which the conformity index is a useful assessment tool. The purpose of this study is to compare the differences in CI for the treatment planning of four cancers including the nasopharynx, oesophagus, lung and prostate. Seventy patients with cancers of nasopharynx (30), oesophagus (15), lung (15) and prostate (10) were recruited. Each of these patients was planned with three sets of treatment plans using the FOCUS treatment planning system: the forward and inverse 3DCRT plans and the IMRT plan. The CI was generated for each treatment plan. The mean CI from each cancer patient group was calculated and compared with the other three cancer groups. The mean value of CI was also compared among the three planning methods. The oesophageal and lung cancers demonstrated relatively higher overall mean CI values (0.64 and 0.62, respectively), whereas that of the nasopharynx and prostate were lower (0.54 and 0.50, respectively). With regards to the planning method groups, the IMRT plans produced the highest overall mean CI (0.62), while those for the forward and inverse 3DCRT were similar (0.57 and 0.55, respectively). For the four selected cancers, oesophageal and lung cancers were easier to conform than the nasopharyngeal and prostate cancers. The IMRT plans were more effective in achieving better dose conformity than that of the 3DCRT.

Body Adiposity Index Performance in Estimating Body Fat Percentage in Colombian College Students: Findings from the FUPRECOL—Adults Study

PubMed Central

Ramírez-Vélez, Robinson; Correa-Bautista, Jorge Enrique; González-Ruíz, Katherine; Vivas, Andrés; Triana-Reina, Héctor Reynaldo; Martínez-Torres, Javier; Prieto-Benavides, Daniel Humberto; Carrillo, Hugo Alejandro; Ramos-Sepúlveda, Jeison Alexander; Villa-González, Emilio; García-Hermoso, Antonio

2017-01-01

Recently, a body adiposity index (BAI = (hip circumference)/((height)(1.5))−18) was developed and validated in adult populations. The aim of this study was to evaluate the performance of BAI in estimating percentage body fat (BF%) in a sample of Colombian collegiate young adults. The participants were comprised of 903 volunteers (52% females, mean age = 21.4 years ± 3.3). We used the Lin’s concordance correlation coefficient, linear regression, Bland–Altman’s agreement analysis, concordance correlation coefficient (ρc) and the coefficient of determination (R2) between BAI, and BF%; by bioelectrical impedance analysis (BIA)). The correlation between the two methods of estimating BF% was R2 = 0.384, p < 0.001. A paired-sample t-test showed a difference between the methods (BIA BF% = 16.2 ± 3.1, BAI BF% = 30.0 ± 5.4%; p < 0.001). For BIA, bias value was 6.0 ± 6.2 BF% (95% confidence interval (CI) = −6.0 to 18.2), indicating that the BAI method overestimated BF% relative to the reference method. Lin’s concordance correlation coefficient was poor (ρc = 0.014, 95% CI = −0.124 to 0.135; p = 0.414). In Colombian college students, there was poor agreement between BAI- and BIA-based estimates of BF%, and so BAI is not accurate in people with low or high body fat percentage levels. PMID:28106719

Optimal antiretroviral therapy adherence as evaluated by CASE index score tool is associated with virological suppression in HIV-infected adults in Dakar, Senegal.

PubMed

Byabene, A K; Fortes-Déguénonvo, L; Niang, K; Manga, M N; Bulabula, A N H; Nachega, J B; Seydi, M

2017-06-01

To determine the prevalence and factors associated with optimal antiretroviral therapy (ART) adherence and virological failure (VLF) among HIV-infected adults enrolled in the national ART programme at the teaching hospital of Fann, Dakar, Senegal. Cross-sectional study from 1 September 2013 to 30 January 2014. (1) optimal ART adherence by the Center for Adherence Support Evaluation (CASE) Index Score (>10) and (2) VLF (HIV RNA > 1000 copies/ml). Diagnostic accuracy of CASE Index Score assessed using sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and corresponding 95% confidence intervals (CIs). Multivariate logistic regression analysis was performed to identify independent factors associated with optimal adherence and VLF. Of 98 HIV-infected patients on ART, 68% were female. The median (IQR) age was 42 (20-50) years. A total of 57 of 98 (60%) were on ART more than 3 years, and majority (88%) were on NNRTI-based first-line ART regimen. A total of 79 of 98 (80%) patients reported optimal ART adherence, and only five of 84 (5.9%) had documented VLF. Patients with VLF were significantly more likely to have suboptimal ART adherence (17.7% vs. 2.9%; P = 0.02). CASE Index Score showed the best trade-off in Se (78.9%, 95% CI: 54.4-93.9%), Sp (20.0%, 95% CI: 11.1-31.7), PPV (22.4, 95% CI: 13.1-34.2%) and NPV (76.5%, 95% CI: 50.1-93.2), when used VLF threshold of HIV RNA >50 copies/ml. Factors independently associated with VLF were CASE Index Score <10 ([aOR] = 13.0, 95% CI: 1.1-147.9; P = 0.04) and being a boosted PI-based ART regimen ([aOR] = 27.0, 95% CI: 2.4-309.4; P = 0.008). Optimal ART adherence is achievable in a high proportion of HIV-infected adults in this study population. CASE Index Score was independently associated with virological outcomes, supporting usefulness of this low-cost ART adherence monitoring tool in this setting. © 2017 John Wiley & Sons Ltd.

Adolescents and female patients are at increased risk for contralateral anterior cruciate ligament reconstruction: a cohort study from the Swedish National Knee Ligament Register based on 17,682 patients.

PubMed

Snaebjörnsson, Thorkell; Hamrin Senorski, Eric; Sundemo, David; Svantesson, Eleonor; Westin, Olof; Musahl, Volker; Alentorn-Geli, Eduard; Samuelsson, Kristian

2017-12-01

The impact of different surgical techniques in index ACL reconstruction for patients undergoing contralateral ACL reconstruction was investigated. The study was based on data from the Swedish National Knee Ligament Register. Patients undergoing index ACL reconstruction and subsequent contralateral ACL reconstruction using hamstring graft under the study period were included. The following variables were evaluated: age at index surgery, gender, concomitant meniscal or cartilage injury registered at index injury, transportal femoral bone tunnel drilling and transtibial femoral bone tunnel drilling. The end-point of primary contralateral ACL surgery was analysed as well as the time-to-event outcomes using survivorship methods including Kaplan-Meier estimation and Cox proportional hazards regression models. A total of 17,682 patients [n = 10,013 males (56.6%) and 7669 females (43.4%)] undergoing primary ACL reconstruction from 1 January 2005 through 31 December 2014 were included in the study. A total of 526 (3.0%) patients [n = 260 males (49.4%) and 266 females (50.6%)] underwent primary contralateral ACL reconstruction after index ACL reconstruction during the study period. Females had a 33.7% greater risk of contralateral ACL surgery [HR 1.337 (95% CI 1.127-1.586); (P = 0 0.001)]. The youngest age group (13-15 years) showed an increased risk of contralateral ACL surgery compared with the reference (36-49) age group [HR 2.771 (95% CI 1.456-5.272); (P = 0.002)]. Decreased risk of contralateral ACL surgery was seen amongst patients with concomitant cartilage injury at index surgery [HR 0.765 (95% CI 0.623-0.939); (P = 0.010)]. No differences in terms of the risk of contralateral ACL surgery were found between anatomic and non-anatomic techniques of primary single-bundle ACL reconstruction, comparing transportal anatomic technique to transtibial non-anatomic, anatomic and partial-anatomic. Age and gender were identified as risk factors for contralateral ACL reconstruction; hence young individuals and females were more prone to undergo contralateral ACL reconstruction. Patients with concomitant cartilage injury at index ACL reconstruction had lower risk for contralateral ACL reconstruction. No significant differences between various ACL reconstruction techniques could be related to increased risk of contralateral ACL reconstruction. Retrospective Cohort Study, Level III.

Vesicoureteral Reflux Index: Predicting Primary Vesicoureteral Reflux Resolution in Children Diagnosed after Age 24 Months.

PubMed

Garcia-Roig, Michael; Ridley, Derrick E; McCracken, Courtney; Arlen, Angela M; Cooper, Christopher S; Kirsch, Andrew J

2017-04-01

The Vesicoureteral Reflux Index is a validated tool that reliably predicts spontaneous resolution of reflux or at least 2 grades of improvement for patients diagnosed before age 24 months. We evaluated the Vesicoureteral Reflux Index in children older than 2 years. Patients younger than 18 years who were diagnosed with primary vesicoureteral reflux after age 24 months and had undergone 2 or more voiding cystourethrograms were identified. Disease severity was scored using the Vesicoureteral Reflux Index, a 6-point scale based on gender, reflux grade, ureteral abnormalities and reflux timing. Proportional subdistribution hazard models for competing risks identified variables associated with resolution/improvement at different time points. A total of 21 males and 250 females met inclusion criteria. Mean ± SD age was 4.0 ± 2.1 years and patients had a median vesicoureteral reflux grade of 2. The Vesicoureteral Reflux Index score improved by 1 point in 1 patient (100%), 2 points in 25 (67.6%), 3 points in 48 (37%), 4 points in 18 (21.4%) and 5 to 6 points in 4 (18.2%). Female gender (p = 0.005) and vesicoureteral reflux timing (late filling, p = 0.002; early/mid filling, p <0.001) independently predicted nonresolution. Median resolution time based on Vesicoureteral Reflux Index score was 2 months or less in 15.6% of patients (95% CI 11.0-13.8), 3 months in 34.7% (95% CI 25.4-44.1), 4 months in 55.9% (95% CI 40.1 to infinity) and 5 months or more in 30.3% (95% CI 29.5 to infinity). High grade (IV or V) reflux was not associated with resolution at any point. Ureteral abnormalities were associated with lack of resolution in the first 12 to 18 months (HR 0.29, 95% CI 0.29-0.80) but not in later followup. Vesicoureteral Reflux Index scores of 3, 4 and 5 were significantly associated with lack of resolution/improvement compared to scores of 2 or less (p = 0.031). The Vesicoureteral Reflux Index reliably predicts primary vesicoureteral reflux improvement/resolution in children diagnosed after age 24 months. Spontaneous resolution/improvement is less likely as Vesicoureteral Reflux Index score and time from diagnosis increase. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Body mass index and hand osteoarthritis susceptibility: an updated meta-analysis.

PubMed

Jiang, Liying; Xie, Xiaohua; Wang, Yidan; Wang, Yingchen; Lu, Yihua; Tian, Tian; Chu, Minjie; Shen, Yi

2016-12-01

Numerous epidemiologic studies have evaluated the association between overweight and hand osteoarthritis; However, the existing results are inconsistent. Systematic searches were performed and reference lists from the retrieved trials were searched. This meta-analysis and meta-regression was executed to identify all English-language articles that quantitatively assess the strength of associations between body mass index and hand osteoarthritis risk. Study-specific incremental estimates were standardized to determine the risk associated with a 5 kg/m 2 increase in body mass index. We conducted the study according to the guidelines for the meta-analysis of observational studies in epidemiology. Of the 21 studies included, 13 were cross-sectional studies, three were case control studies and five were cohort studies. The pooled summary estimates were 1.10 (95%CI: 0.98-1.24) with no significant difference (P = 0.09). Subgroup analysis shows that body mass index was positively associated with hand osteoarthritis in cross-sectional studies (1.05 [95%CI: 1.02-1.08] P < 0.01), while with no significant difference was found in case-control studies (1.28 [95%CI: 0.87-1.88]) and in cohort studies (1.06 [95%CI: 0.71-1.58]) (P = 0.21 and P = 0.77, respectively). A weak but significant effect on radiographic hand osteoarthritis risk was found. The summary estimates were 1.06 (95%CI: 1.02-1.10) in studies defined by radiography and 1.25 (95%CI: 1.06-1.49) by radiography and clinically (P < 0 .01 and P = 0.01, respectively). It appears that increased body mass index contributes to a positively moderate effect on susceptibility to hand osteoarthritis, as defined radiographically and/or radiographically and clinically. The effects vary by study design and osteoarthritis definition. © 2016 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

Socio-economic influences on anthropometric status in urban South African adolescents: sex differences in the Birth to Twenty Plus cohort.

PubMed

Pradeilles, Rebecca; Griffiths, Paula L; Norris, Shane A; Feeley, Alison B; Rousham, Emily K

2015-11-01

To investigate the associations of household and neighbourhood socio-economic position (SEP) with indicators of both under- and overnutrition in adolescents and to explore sex differences. Analysis of anthropometric, household and neighbourhood SEP data from the Birth to Twenty Plus cohort born in 1990. Anthropometric outcomes were BMI (thinness, overweight and obesity) and percentage body fat (%BF; low, high). Associations between these and the household wealth index, caregiver education and neighbourhood SEP tertile measures were examined using binary logistic regression. Johannesburg-Soweto, South Africa. Adolescents aged 17-19 years (n 2019; 48·2% men). Women had a significantly higher combined prevalence of overweight/obesity (26·2%) than men (8·2%) whereas men had a significantly higher prevalence of thinness than women (22·2% v. 10·6%, respectively). Having a low neighbourhood social support index was associated with higher odds of high %BF in women (OR=1·59; 95% CI 1·03, 2·44). A low household wealth index was associated with lower odds of both overweight (OR=0·31; 95% CI 0·12, 0·76) and high %BF in men (OR=0·28; 95% CI 0·10, 0·78). A low or middle household wealth index was associated with higher odds of being thin in men (OR=1·90; 95% CI 1·09, 3·31 and OR=1·80; 95% CI 1·03, 3·15, respectively). For women, a low household wealth index was associated with lower odds of being thin (OR=0·49; 95% CI 0·25, 0·96). The study highlights that even within a relatively small urban area the nutrition transition manifests itself differently in men and women and across SEP indicators. Understanding the challenges for different sexes at different ages is vital in helping to plan public health services.

Occupation and educational inequalities in laryngeal cancer: the use of a job index

PubMed Central

2013-01-01

Background Previous studies tried to assess the association between socioeconomic status and laryngeal cancer. Alcohol and tobacco consumption explain already a large part of the social inequalities. Occupational exposures might explain a part of the remaining but the components and pathways of the socioeconomic contribution have yet to be fully disentangled. The aim of this study was to evaluate the role of occupation using different occupational indices, differentiating between physical, psycho-social and toxic exposures and trying to summarize the occupational burden into one variable. Methods A population-based case–control study conducted in Germany in 1998–2000 included 208 male cases and 702 controls. Information on occupational history, smoking, alcohol consumption and education was collected with face-to-face interviews. A recently developed job-classification index was used to account for the occupational burden. A sub-index focussed on jobs involving potentially carcinogenic agents (CAI) for the upper aero digestive tract. Results When adjusted for smoking and alcohol consumption, higher odds ratios (ORs) were found for lower education. This OR decreased after further adjustment using the physical and psycho-social job indices (OR = 3.2, 95%-CI: 1.5-6.8), similar to the OR using the sub-index CAI (OR = 3.0, 95%-CI: 1.4-6.5). Conclusions The use of an easily applicable control variable, simply constructed on standard occupational job classifications, provides the possibility to differentiate between educational and occupational contributions. Such an index might indirectly reflect the effect of carcinogenic agents, which are not collected in many studies. PMID:24246148

A novel fibrosis index comprising a non-cholesterol sterol accurately predicts HCV-related liver cirrhosis.

PubMed

Ydreborg, Magdalena; Lisovskaja, Vera; Lagging, Martin; Brehm Christensen, Peer; Langeland, Nina; Buhl, Mads Rauning; Pedersen, Court; Mørch, Kristine; Wejstål, Rune; Norkrans, Gunnar; Lindh, Magnus; Färkkilä, Martti; Westin, Johan

2014-01-01

Diagnosis of liver cirrhosis is essential in the management of chronic hepatitis C virus (HCV) infection. Liver biopsy is invasive and thus entails a risk of complications as well as a potential risk of sampling error. Therefore, non-invasive diagnostic tools are preferential. The aim of the present study was to create a model for accurate prediction of liver cirrhosis based on patient characteristics and biomarkers of liver fibrosis, including a panel of non-cholesterol sterols reflecting cholesterol synthesis and absorption and secretion. We evaluated variables with potential predictive significance for liver fibrosis in 278 patients originally included in a multicenter phase III treatment trial for chronic HCV infection. A stepwise multivariate logistic model selection was performed with liver cirrhosis, defined as Ishak fibrosis stage 5-6, as the outcome variable. A new index, referred to as Nordic Liver Index (NoLI) in the paper, was based on the model: Log-odds (predicting cirrhosis) = -12.17+ (age × 0.11) + (BMI (kg/m(2)) × 0.23) + (D7-lathosterol (μg/100 mg cholesterol)×(-0.013)) + (Platelet count (x10(9)/L) × (-0.018)) + (Prothrombin-INR × 3.69). The area under the ROC curve (AUROC) for prediction of cirrhosis was 0.91 (95% CI 0.86-0.96). The index was validated in a separate cohort of 83 patients and the AUROC for this cohort was similar (0.90; 95% CI: 0.82-0.98). In conclusion, the new index may complement other methods in diagnosing cirrhosis in patients with chronic HCV infection.

The association between the environmental endocrine disruptor bisphenol A and polycystic ovary syndrome: a systematic review and meta-analysis.

PubMed

Hu, Ying; Wen, Shu; Yuan, Dongzhi; Peng, Le; Zeng, Rujun; Yang, Zhilan; Liu, Qi; Xu, Liangzhi; Kang, Deying

2018-05-01

To investigate the association between bisphenol A (BPA) and polycystic ovary syndrome (PCOS). A systematic review and meta-analysis using STATA software for observational studies. Nine studies involving 493 PCOS patients and 440 controls were included in this review. The meta-analysis demonstrated that PCOS patients had significantly higher BPA levels compared with control groups (standardized mean difference (SMD): 2.437, 95% confidence interval (CI): (1.265, 3.609), p < .001). For studies of serum samples detected by enzyme-linked immunosorbent assay (ELISA), subgroup analyses according to ethnicity, body mass index (BMI), sample size, detection method (high-performance liquid chromatography (HPLC) and ELISA), PCOS-to-control ratio and study quality displayed that high BPA levels were significantly associated with Caucasian PCOS patients (SMD: 0.615, 95% CI: (0.308, 0.922), p < .001), high BMI (SMD: 0.512, 95% CI: (0.180, 0.843), p = .002), high quality (SMD: 0.624, 95% CI: (0.391, 0.856), p < .001), and high HOMA-IR (SMD: 0.467, 95% CI: (0.121, 0.813), p = .008). Serum BPA may be positively associated with women with PCOS and BPA might be involved in the insulin-resistance and hyperandrogenism of PCOS. More evidence from high quality studies, advanced detection methods, and larger cohorts for observational trials are needed to further confirm the association between BPA and PCOS.

Standard-b-Value Versus Low-b-Value Diffusion-Weighted Imaging in Hepatic Lesion Discrimination: A Meta-analysis.

PubMed

Xiong, Hui; Zeng, Yuan-Lin

2016-01-01

We sought to determine the comparative diagnostic performance of standard-b-value (500-1000s/mm) versus low-b-value (≤500 s/mm) diffusion-weighted imaging (DWI) in the discrimination of hepatic lesions. A total of 1775 hepatic malignant lesions and 1120 benign hepatic lesions from 21 studies were included. (1) The global sensitivity was 0.86 (95% confidence interval [CI], 0.847-0.879), the specificity was 0.82 (95% CI, 0.797-0.842), the positive likelihood ratio (PLR) was 6.234 (95% CI, 4.260-9.123), the negative likelihood ratio (NLR) was 0.175 (95% CI, 0.135-0.227), and diagnostic odds ratio (DOR) was 42.836 (95% CI, 24.134-76.031). The area under the curve (AUC) and Q* index were 0.93 and 0.87. Publication bias was not present (P > 0.05). (2)The sensitivity of a subgroup meta-analysis of standard-b-value DWI was 0.858 (95% CI, 0.835-0.880), the specificity was 0.836 (95% CI, 0.807-0.863), the PLR was 6.527 (95% CI, 3.857-11.046), the NLR was 0.168 (95% CI, 0.123-0.239), and the DOR was 49.716 (95% CI, 22.897-107.98). The AUC and Q* index were 0.941 and 0.88. (3)The sensitivity of a subgroup meta-analysis of low-b-value DWI was 0.87 (95% CI, 0.84-0.89), the specificity was 0.80 (95% CI, 0.76-0.83), the PLR was 6.22 (95% CI, 3.29-11.76), the NLR was 0.19 (95% CI, 0.12-0.29), and the DOR was 37.14 (95% CI, 14.80-93.18). The AUC and Q* index were 0.922 and 0.86. Hepatic DWI is useful in differentiating between malignant and benign hepatic lesions. Standard-b-value DWI displayed an overall superior diagnostic accuracy over low-b-value DWI. Further trials needed to determine whether increasing b values beyond 1000 s/mm affects the diagnostic accuracy of hepatic lesion discrimination.

Effect of prenatal and postnatal malnutrition on intellectual functioning in early school-aged children in rural western China

PubMed Central

Li, Chao; Zhu, Ni; Zeng, Lingxia; Dang, Shaonong; Zhou, Jing; Yan, Hong

2016-01-01

Abstract The aim of this study was to evaluate the effect of prenatal and postnatal malnutrition on the intellectual functioning of early school-aged children. We followed the offspring of women who had participated in a trial of prenatal supplementation with different combinations of micronutrients and who remained resident in the study field. We measured their intellectual functioning using the Wechsler intelligence scale for children (WISC-IV). Height-for-age, weight-for-age, and body mass index (BMI)-for-age were used as anthropometric nutritional status indices. Four of the 5 composite scores derived from the WISC-IV, except for working memory index (WMI), were significantly lower in low birth weight children after adjusting for confounds. All 5 composite scores, including full-scale intelligence quotient (FSIQ), verbal comprehension index (VCI), WMI, perceptual reasoning index (PRI), and processing speed index (PSI) were significant lower in stunted and underweight children. The differences in the means of WISC-IV test scores were greatest between stunted and nonstunted children. The means for FSIQ, VCI, WMI, PRI, and PSI were as follows: 5.88 (95% confidence interval [CI]: 2.84–8.92), 5.08 (95% CI: 1.12–8.41), 4.71 (95% CI: 1.78–7.66), 6.13 (95% CI: 2.83–9.44), and 5.81 (95% CI: 2.61–9.00). These means were lower in stunted children after adjusting for confounds. Our results suggest the important influences of low birth weight and postnatal malnutrition (stunting, low body weight) on intellectual functioning in early school-aged children. PMID:27495020

The Design, Development and Evaluation of the Vegetarian Lifestyle Index on Dietary Patterns among Vegetarians and Non-Vegetarians.

PubMed

Le, Lap T; Sabaté, Joan; Singh, Pramil N; Jaceldo-Siegl, Karen

2018-04-26

Traditionally, healthful diets and lifestyles have been examined only in relation to single nutrients, foods, or food groups in terms of dietary exposure. An alternative approach is to conceptualize an index based on vegetarian food pyramid guidelines as a measure of overall diet and lifestyle quality. Our objectives were to: (1) develop the Vegetarian Lifestyle Index (VLI); and (2) evaluate adherence to the Vegetarian Food Guide Pyramid (VFGP) among a low-risk population of Adventists. The index was based on the operationalization of 14 dietary and lifestyle components. All components were equally weighted. Higher score reflected greater adherence to the VFGP. The analytic sample ( n = 90,057) comprised 47.7% non-vegetarians, 5.6% semi-, 10.1% pesco-, and 29.0% lacto-ovo-vegetarians, and 7.7% vegans, of which 1.1% were current smokers and 9.9% were alcohol consumers. Population mean VLI score was 7.43 (SD = 1.75) ranging from 1 to 12.5. Non-vegetarians (6.14; 95% confidence interval (CI), 6.06⁻6.21) had a significantly lower mean compared to semi- (7.31; 95% CI, 7.22⁻7.40), pesco- (7.41; 95% CI, 7.32⁻7.49), and lacto-ovo-vegetarians (8.16; 95% CI, 8.08⁻8.24), as well as vegans (8.88; 95% CI, 8.78⁻8.96). Vegetarians scored on average 1.18 to 2.73 more points than their non-vegetarian counterparts. Results demonstrate that the index has strong discriminant ability across distinct dietary patterns. Additionally, the VLI provides a useful measure of diet and lifestyle adherence to further refine vegetarian food pyramid guidelines.

The Design, Development and Evaluation of the Vegetarian Lifestyle Index on Dietary Patterns among Vegetarians and Non-Vegetarians

PubMed Central

Le, Lap T.; Singh, Pramil N.; Jaceldo-Siegl, Karen

2018-01-01

Traditionally, healthful diets and lifestyles have been examined only in relation to single nutrients, foods, or food groups in terms of dietary exposure. An alternative approach is to conceptualize an index based on vegetarian food pyramid guidelines as a measure of overall diet and lifestyle quality. Our objectives were to: (1) develop the Vegetarian Lifestyle Index (VLI); and (2) evaluate adherence to the Vegetarian Food Guide Pyramid (VFGP) among a low-risk population of Adventists. The index was based on the operationalization of 14 dietary and lifestyle components. All components were equally weighted. Higher score reflected greater adherence to the VFGP. The analytic sample (n = 90,057) comprised 47.7% non-vegetarians, 5.6% semi-, 10.1% pesco-, and 29.0% lacto-ovo-vegetarians, and 7.7% vegans, of which 1.1% were current smokers and 9.9% were alcohol consumers. Population mean VLI score was 7.43 (SD = 1.75) ranging from 1 to 12.5. Non-vegetarians (6.14; 95% confidence interval (CI), 6.06–6.21) had a significantly lower mean compared to semi- (7.31; 95% CI, 7.22–7.40), pesco- (7.41; 95% CI, 7.32–7.49), and lacto-ovo-vegetarians (8.16; 95% CI, 8.08–8.24), as well as vegans (8.88; 95% CI, 8.78–8.96). Vegetarians scored on average 1.18 to 2.73 more points than their non-vegetarian counterparts. Results demonstrate that the index has strong discriminant ability across distinct dietary patterns. Additionally, the VLI provides a useful measure of diet and lifestyle adherence to further refine vegetarian food pyramid guidelines. PMID:29701727

Association between different measurements of blood pressure variability by ABP monitoring and ankle-brachial index.

PubMed

Wittke, Estefânia; Fuchs, Sandra C; Fuchs, Flávio D; Moreira, Leila B; Ferlin, Elton; Cichelero, Fábio T; Moreira, Carolina M; Neyeloff, Jeruza; Moreira, Marina B; Gus, Miguel

2010-11-05

Blood pressure (BP) variability has been associated with cardiovascular outcomes, but there is no consensus about the more effective method to measure it by ambulatory blood pressure monitoring (ABPM). We evaluated the association between three different methods to estimate BP variability by ABPM and the ankle brachial index (ABI). In a cross-sectional study of patients with hypertension, BP variability was estimated by the time rate index (the first derivative of SBP over time), standard deviation (SD) of 24-hour SBP; and coefficient of variability of 24-hour SBP. ABI was measured with a doppler probe. The sample included 425 patients with a mean age of 57 ± 12 years, being 69.2% women, 26.1% current smokers and 22.1% diabetics. Abnormal ABI (≤ 0.90 or ≥ 1.40) was present in 58 patients. The time rate index was 0.516 ± 0.146 mmHg/min in patients with abnormal ABI versus 0.476 ± 0.124 mmHg/min in patients with normal ABI (P = 0.007). In a logistic regression model the time rate index was associated with ABI, regardless of age (OR = 6.9, 95% CI = 1.1- 42.1; P = 0.04). In a multiple linear regression model, adjusting for age, SBP and diabetes, the time rate index was strongly associated with ABI (P < 0.01). None of the other indexes of BP variability were associated with ABI in univariate and multivariate analyses. Time rate index is a sensible method to measure BP variability by ABPM. Its performance for risk stratification of patients with hypertension should be explored in longitudinal studies.

FAT-FREE MASS, METABOLICALLY HEALTHY OBESITY, AND TYPE 2 DIABETES IN SEVERELY OBESE ASIAN ADULTS.

PubMed

Pramyothin, Pornpoj; Limpattanachart, Vichol; Dawilai, Suwitcha; Sarasak, Rungnapha; Sukaruttanawong, Chariya; Chaiyasoot, Kusuma; Keawtanom, Songsri; Yamwong, Preyanuj

2017-08-01

To determine whether fat free mass (FFM) is independently associated with the metabolically healthy obesity (MHO) phenotype, the metabolic syndrome (MS), and type 2 diabetes (T2D) in obese Asian adults. Obese patients (body mass index [BMI] ≥25 kg/m 2 ) seeking weight management at an academic medical center from 2007 to 2016 were included. FFM was measured by bioelectrical impedance. Of the 552 patients (67.0% female, median age 40.5 years, median BMI 38.3 kg/m 2 ), MHO was present in 19%, MS in 55.4%, and T2D in 32.6%. In multivariate models, higher fat-free mass index (FFMI) was independently associated with the metabolically abnormal obesity (MAO) phenotype, (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.09-1.37), and increased risk of MS (OR 1.12, 95% CI 1.03-1.22) in women but not in men. Older age was independently associated with the MAO phenotype (OR 1.06, 95% CI 1.04-1.09 in women; OR 1.06, 95% CI 1.02-1.09 in men), MS (OR 1.05, 95% CI 1.03-1.06 in women; OR 1.05, 95% CI 1.02-1.07 in men), and T2D (OR 1.07, 95% CI 1.05-1.09 in women; OR 1.06, 95% CI 1.04-1.09 in men). Waist-hip ratio was independently associated with the MAO phenotype in men (OR 1.08, 95% CI 1.01-1.15), while waist circumference was associated with T2D in women (OR 1.03, 95% CI 1.01-1.05). Older age, central fat distribution, and-in contrast to previous findings-an increase in FFMI among women were independent predictors of adverse metabolic health in this cohort of middle-aged obese Asian adults. Further studies are required to elucidate underlying mechanisms and therapeutic implications of these findings. BIA = bioelectrical impedance analysis BMI = body mass index CI = confidence interval DXA = dual-energy X-ray absorptiometry FFM = fat-free mass FFMI = fat-free mass index FM = fat mass HbA1c = glycated hemoglobin A1c MAO = metabolically abnormal obesity MHO = metabolically healthy obesity MS = metabolic syndrome OR = odds ratio T2D = type 2 diabetes WC = waist circumference WHR = waist-hip-ratio.

Socioeconomic Inequalities in Nonuse of Seatbelts in Cars and Helmets on Motorcycles among People Living in Kurdistan Province, Iran

PubMed Central

MORADI, Ghobad; MALEKAFZALI ARDAKANI, Hossein; MAJDZADEH, Reza; BIDARPOUR, Farzam; MOHAMMAD, Kazem; HOLAKOUIE-NAIENI, Kourosh

2014-01-01

Abstract Background The aim of this study was to determine the socioeconomic inequalities in nonuse of seatbelts in cars and helmets on motorcycles in Kurdistan Province, west of Iran, 2009. Methods The data used in this study was collected from the data gathered in non-communicable disease surveillance system (NCDSS) in 2009 in Kurdistan. A total of 1000 people were included in this study. The outcome variable of this study was the nonuse of seatbelts and helmets. The socio-economic status (SES) was calculated based on participants’ residential area and assets using Principal Component Analysis (PCA) method. The concentration index, concentration curve, and comparison of Odds Ratio (OR) in different SES groups were used to measure the socioeconomic inequalities using logistic regression. In order to determine the contribution of determinants of inequality, decomposition analysis was used. Results The prevalence of nonuse of seatbelts in cars and helmets on motorcycles were 47.5%, 95%CI [44%, 55%], respectively. The Concentration index was -0.097, CI [-0.148, -0.046]. The OR of nonuse of seatbelts in cars and helmets on motorcycles in the richest group compared with the poorest group was 0.39, 95%CI [0.23, 0.68]. The results of the decomposition analysis showed that 34% of inequalities were due to SES, 47% were due to residential area, and 12% were due to unknown factors. Conclusion There is a reverse association between SES and nonuse of seatbelts in cars and helmets on motorcycles. This issue must be considered while planning to reduce traffic accidents injuries. PMID:26175978

The product of triglycerides and glucose in comparison with fasting plasma glucose did not improve diabetes prediction.

PubMed

Janghorbani, Mohsen; Almasi, Siedeh Zinab; Amini, Masoud

2015-08-01

Previous study has reported that triglycerides-glucose (TyG) index, a product of triglycerides and fasting plasma glucose (FPG), might be useful in the prediction of incident type 2 diabetes (T2D). We evaluated the ability of the TyG index compared to FPG and OGTT as possible diabetes predictor in nondiabetic first-degree relatives (FDRs) of patients with T2D. A total of 1,488 FDRs without diabetes of consecutive patients with T2D 30-70 years old (361 men and 1,127 women) were examined and followed for a mean (SD) of 6.9 (1.7) years for diabetes incidence. We examined the incidence of diabetes across quartiles of the TyG index and plotted a receiver operating characteristic (ROC) curve to assess discrimination. At baseline and through follow-up, participants underwent a standard 75-g two-hour oral glucose tolerance test. During 10,124 person-years of follow-up, 41 men and 154 women developed T2D. Those in the top quartile of TyG index were 3.4 times more likely to develop T2D than those in the bottom quartile (odds ratio 3.36; 95 % CI 1.83, 6.19). On ROC curve analysis, a higher area under the ROC was found for FPG (76.2; 95 % CI 71.9, 80.6), 1-hPG (81.0, 95 % CI 77.2, 84.9) and 2-hPG (76.5; 95 % CI 72.3, 80.8) than for TyG index (65.1; 95 % CI 60.5, 69.7). TyG index is predicted T2D in high-risk individuals in Iran but FPG, 1-hPG and 2-hPG appeared to be more robust predictor of T2D in our study population.

Ability of Cytokeratin-18 Fragments and FIB-4 Index to Diagnose Overall and Mild Fibrosis Nonalcoholic Steatohepatitis in Japanese Nonalcoholic Fatty Liver Disease Patients.

PubMed

Kobayashi, Natsuko; Kumada, Takashi; Toyoda, Hidenori; Tada, Toshifumi; Ito, Takanori; Kage, Masayoshi; Okanoue, Takeshi; Kudo, Masatoshi

2017-01-01

Several laboratory markers used in lieu of liver biopsy are reportedly useful in the diagnosis of nonalcoholic steatohepatitis (NASH). In the present study, we investigated the diagnostic impact of various non-invasive markers for predicting NASH. A total of 229 nonalcoholic fatty liver disease (NAFLD) patients who underwent liver biopsy were enrolled for the study. The diagnostic ability of various markers to diagnose NASH from NAFLD was investigated. A total of 140 patients were histologically diagnosed with NASH. Of these, 104 had degree 0-2 fibrosis (F0-2), and 36 had degree 3-4 fibrosis (F3-4). Multiple logistic regression analysis identified hyaluronic acid (HA) (OR 1.014; 95% CI 1.002-1.026; p = 0.024), FIB-4 index (OR 2.097; 95% CI 1.177-3.735; p = 0.012), and cytokeratin-18 fragments (CK-18F) (OR 1.002; 95% CI 1.001-1.002; p < 0.001) as factors independently associated with the diagnosis of NASH. The areas under the receiver operating characteristic curves (AUROCs) of HA, FIB-4 index, and CK-18F for the diagnosis of NASH were 0.77, 0.76, and 0.72, respectively. In addition, FIB-4 index (OR 1.907; 95% CI 1.063-3.419; p = 0.03) and CK-18F (OR 1.002; 95% CI 1.001-1.002; p < 0.001) could differentiate between NASH and NAFL, even when NASH patients with advanced fibrosis (F3-4) were excluded. AUROCs of FIB-4 index and CK-18F for the diagnosis of NASH with mild fibrosis (F0-2) from NAFLD were 0.70 and 0.70, respectively. FIB-4 index and CK-18F have good diagnostic abilities not only for NASH overall, but also for NASH with mild fibrosis. © 2017 S. Karger AG, Basel.

The effect of temporal gap identification on speech perception by users of cochlear implants

PubMed Central

Sagi, Elad; Kaiser, Adam R.; Meyer, Ted A.; Svirsky, Mario A.

2008-01-01

Purpose This study examined the ability of listeners using cochlear implants (CIs) and listeners with normal-hearing (NH) to identify silent gaps of different duration, and the relation of this ability to speech understanding in CI users. Method Sixteen NH adults and eleven postlingually deafened adults with CIs identified synthetic vowel-like stimuli that were either continuous or contained an intervening silent gap ranging from 15 to 90 ms. Cumulative d’, an index of discriminability, was calculated for each participant. Consonant and CNC word identification tasks were administered to the CI group. Results Overall, the ability to identify stimuli with gaps of different duration was better for the NH group than for the CI group. Seven CI users had cumulative d' scores that were no higher than those of any NH listener, and their CNC word scores ranged from 0 to 30%. The other four CI users had cumulative d’ scores within the range of the NH group, and their CNC word scores ranged from 46% to 68%. For the CI group, cumulative d’ scores were significantly correlated with their speech testing scores. Conclusions The ability to identify silent gap duration may help explain individual differences in speech perception by CI users. PMID:18806216

Factors associated with health-related quality of life, hip function, and health utility after operative management of femoral neck fractures.

PubMed

Sprague, S; Bhandari, M; Heetveld, M J; Liew, S; Scott, T; Bzovsky, S; Heels-Ansdell, D; Zhou, Q; Swiontkowski, M; Schemitsch, E H

2018-03-01

Aims The primary aim of this prognostic study was to identify baseline factors associated with physical health-related quality of life (HRQL) in patients after a femoral neck fracture. The secondary aims were to identify baseline factors associated with mental HRQL, hip function, and health utility. Patients and Methods Patients who were enrolled in the Fixation using Alternative Implants for the Treatment of Hip Fractures (FAITH) trial completed the 12-item Short Form Health Survey (SF-12), Western Ontario and McMaster Universities Arthritis Index, and EuroQol 5-Dimension at regular intervals for 24 months. We conducted multilevel mixed models to identify factors potentially associated with HRQL. Results The following were associated with lower physical HRQL: older age (-1.42 for every ten-year increase, 95% confidence interval (CI) -2.17 to -0.67, p < 0.001); female gender (-1.52, 95% CI -3.00 to -0.05, p = 0.04); higher body mass index (-0.69 for every five-point increase, 95% CI -1.36 to -0.02, p = 0.04); American Society of Anesthesiologists class III ( versus class I) (-3.19, 95% CI -5.73 to -0.66, p = 0.01); and sustaining a displaced fracture (-2.18, 95% CI -3.88 to -0.49, p = 0.01). Additional factors were associated with mental HRQL, hip function, and health utility. Conclusion We identified several baseline factors associated with lower HRQL, hip function, and utility after a femoral neck fracture. These findings may be used by clinicians to inform treatment and outcomes. Cite this article: Bone Joint J 2018;100-B:361-9.

The prognostic value of CT radiomic features for patients with pulmonary adenocarcinoma treated with EGFR tyrosine kinase inhibitors

PubMed Central

Kim, Hyungjin; Park, Sang Joon; Kim, Miso; Kim, Tae Min; Kim, Dong-Wan; Heo, Dae Seog; Goo, Jin Mo

2017-01-01

Purpose To determine if the radiomic features on CT can predict progression-free survival (PFS) in epidermal growth factor receptor (EGFR) mutant adenocarcinoma patients treated with first-line EGFR tyrosine kinase inhibitors (TKIs) and to identify the incremental value of radiomic features over conventional clinical factors in PFS prediction. Methods In this institutional review board–approved retrospective study, pretreatment contrast-enhanced CT and first follow-up CT after initiation of TKIs were analyzed in 48 patients (M:F = 23:25; median age: 61 years). Radiomic features at baseline, at 1st first follow-up, and the percentage change between the two were determined. A Cox regression model was used to predict PFS with nonredundant radiomic features and clinical factors, respectively. The incremental value of radiomic features over the clinical factors in PFS prediction was also assessed by way of a concordance index. Results Roundness (HR: 3.91; 95% CI: 1.72, 8.90; P = 0.001) and grey-level nonuniformity (HR: 3.60; 95% CI: 1.80, 7.18; P<0.001) were independent predictors of PFS. For clinical factors, patient age (HR: 2.11; 95% CI: 1.01, 4.39; P = 0.046), baseline tumor diameter (HR: 1.03; 95% CI: 1.01, 1.05; P = 0.002), and treatment response (HR: 0.46; 95% CI: 0.24, 0.87; P = 0.017) were independent predictors. The addition of radiomic features to clinical factors significantly improved predictive performance (concordance index; combined model = 0.77, clinical-only model = 0.69, P<0.001). Conclusions Radiomic features enable PFS estimation in EGFR mutant adenocarcinoma patients treated with first-line EGFR TKIs. Radiomic features combined with clinical factors provide significant improvement in prognostic performance compared with using only clinical factors. PMID:29099855

Prevalence and Trends of Symptomatic Pelvic Floor Disorders in U.S. Women

PubMed Central

Wu, Jennifer M.; Vaughan, Camille P.; Goode, Patricia S.; Redden, David T.; Burgio, Kathryn L.; Richter, Holly E.; Markland, Alayne D.

2014-01-01

Objective To estimate the prevalence and trends of these pelvic floor disorders in U.S. women from 2005–2010. Methods We utilized the National Health and Nutritional Examination Survey (NHANES) from 2005–2006, 2007–2008, and 2009–2010. A total of 7,924 non-pregnant women (aged 20 years or older) were categorized as having: urinary incontinence – moderate to severe (3 or higher on a validated urinary incontinence (UI) severity index, range 0–12); fecal incontinence – at least monthly (solid, liquid, or mucus stool); and pelvic organ prolapse – seeing or feeling a bulge. Potential risk factors included age, race and ethnicity, parity, education, poverty income ratio, body mass index (BMI) (<25, 25–29, ≥30 kg/m2), co-morbidity count, and reproductive factors. Using appropriate sampling weights, weighted chi square analysis and multivariable logistic regression models with odds ratios (OR) and 95% confidence intervals (95% CI) were reported. Results The weighted prevalence rate of one or more pelvic floor disorder was 25.0% (95% CI 23.6, 26.3), including 17.1% (95% CI 15.8, 18.4) of women with moderate-to-severe urinary incontinence, 9.4% (95% CI 8.6, 10.2) with fecal incontinence, and 2.9% (95% CI 2.5, 3.4) with prolapse. From 2005 to 2010, no significant differences were found in the prevalence rates of any individual disorder or for all disorders combined (p>0.05). After adjusting for potential confounders, higher BMI, greater parity, and hysterectomy were associated with higher odds of one or more pelvic floor disorder. Conclusion Although rates of pelvic floor disorders did not change from 2005–2010, these condition remain common with one quarter of adult U.S. women reporting at least one disorder. PMID:24463674

Effects of Demographic Factors, Body Mass Index, Alcohol Drinking and Smoking Habits on Irritable Bowel Syndrome: A Case Control Study

PubMed Central

Farzaneh, N; Ghobaklou, M; Moghimi-Dehkordi, B; Naderi, N; Fadai, F

2013-01-01

Background: Irritable Bowel Syndrome (IBS) is a common functional gastrointestinal disorder. Aims: To identify demographic factors in patients with IBS. Subjects and Methods: One-hundred and fifty three IBS patients seen at Taleghani Hospital Gastroenterology Clinic and met the Rome III criteria and 163 peoples who did not meet IBS criteria were consecutively enrolled. Both groups were asked to complete a self-rating questionnaire containing information, which included questions about age, sex, monthly income, education level, marital status, height, weight, alcohol drinking and smoking habits. Student's t-test, Pearson's Chi-square and logistic regression were used to statistical analysis. Results: The mean (SD) age for IBS patients 36.3 (13.5) years and 33.1 (9.9) years in non-IBS group (P < 0.001). Frequency of IBS defined by Rome III criteria was higher in females and younger individuals. Univariate analysis showed that IBS in males was associated with a lower monthly income and educational level and in females younger age, single, lower monthly income and educational level, body mass index (BMI), and unemployment status. Multivariate logistic regression identified a low level of education in males (Odds ratio [OR] = 3.6, 95% Confidence interval [CI]: 1.4-9.6) and in females, lower education level (OR = 2.4, 95% CI: 1.1-5.2), lower BMI (OR = 0.94, 95% CI: 0.89-0.99), unemployed (OR = 0.31, 95% CI: 0.11-0.85) and smoking (OR = 6.2, 95% CI: 1.03-37.2). Conclusion: We identified demographic factors in IBS patients. Being single and having a lower educational level, income, lower BMI and being unemployed were the most important factors associated with IBS, particularly in females. PMID:24116320

Associations of Foot Posture and Function to Lower Extremity Pain: The Framingham Foot Study

PubMed Central

Riskowski, JL; Dufour, AB; Hagedorn, TJ; Hillstrom, Howard; Casey, VA; Hannan, MT

2014-01-01

Objective Studies have implicated foot posture and foot function as risk factors for lower extremity pain. Empirical population-based evidence for this assertion is lacking; therefore, the purpose of this study was to evaluate cross-sectional associations of foot posture and foot function to lower extremity joint pain in a population-based study of adults. Methods Participants were members of the Framingham Foot Study. lower extremity joint pain was determined by the response to the NHANES-type question, “On most days do you have pain, aching or stiffness in your [hips, knees, ankles, or feet]?” Modified Arch Index (MAI) classified participants as having planus, rectus (referent) or cavus foot posture. Center of Pressure Excursion Index (CPEI) classified participants as having over-pronated, normal (referent) or over-supinated foot function. Crude and adjusted (age, gender, BMI) logistic regression determined associations of foot posture and function to lower extremity pain. Results Participants with planus structure had higher odds of knee (1.57, 95% CI: 1.24– 1.99) or ankle (1.47, 95% CI: 1.05–2.06) pain, whereas those with a cavus foot structure had increased odds of ankle pain only (7.56, 95% CI: 1.99–28.8) and pain at one lower extremity site (1.37, 95% CI: 1.04–1.80). Associations between foot function and lower extremity joint pain were not statistically significant, except for a reduced risk of hip pain in those with an over-supinated foot function (0.69, 95% CI: 0.51–0.93). Conclusions These findings offer a link between foot posture and lower extremity pain, highlighting the need for longitudinal or intervention studies. PMID:24591410

Brain tumours and exposure to pesticides: a case–control study in southwestern France

PubMed Central

Provost, Dorothée; Cantagrel, Anne; Lebailly, Pierre; Jaffré, Anne; Loyant, Véronique; Loiseau, Hugues; Vital, Anne; Brochard, Patrick; Baldi, Isabelle

2007-01-01

Background Brain tumours are often disabling and rapidly lethal; their aetiology is largely unknown. Among potential risk factors, pesticides are suspected. Objective To examine the relationship between exposure to pesticides and brain tumours in adults in a population‐based case–control study in southwestern France. Methods Between May 1999 and April 2001, 221 incident cases of brain tumours and 442 individually matched controls selected from the general population were enrolled. Histories of occupational and environmental exposures, medical and lifestyle information were collected. A cumulative index of occupational exposure to pesticides was created, based on expert review of lifelong jobs and tasks. Separate analyses were performed for gliomas and meningiomas. Results A non‐statistically significant increase in risk was found for brain tumours when all types of occupational exposure to pesticides were considered (OR = 1.29, 95% CI 0.87 to 1.91) and slightly higher but still non‐statistically significant when gliomas were considered separately (OR = 1.47, 95% CI 0.81 to 2.66). In the highest quartile of the cumulative index, a significant association was found for brain tumours (OR = 2.16, 95% CI 1.10 to 4.23) and for gliomas (OR = 3.21, 95% CI 1.13 to 9.11), but not for meningiomas. A significant increase in risk was also seen for the treatment of home plants (OR = 2.24, 95% CI 1.16 to 4.30) owing to environmental exposure to pesticides. Conclusions These data suggest that a high level of occupational exposure to pesticides might be associated with an excess risk of brain tumours, and especially of gliomas. PMID:17537748

A longitudinal investigation of mortality in anorexia nervosa and bulimia nervosa.

PubMed

Franko, Debra L; Keshaviah, Aparna; Eddy, Kamryn T; Krishna, Meera; Davis, Martha C; Keel, Pamela K; Herzog, David B

2013-08-01

OBJECTIVE Although anorexia nervosa has a high mortality rate, our understanding of the timing and predictors of mortality in eating disorders is limited. The authors investigated mortality in a long-term study of patients with eating disorders. METHOD Beginning in 1987, 246 treatment-seeking female patients with anorexia nervosa or bulimia nervosa were interviewed every 6 months for a median of 9.5 years to obtain weekly ratings of eating disorder symptoms, comorbidity, treatment participation, and psychosocial functioning. From January 2007 to December 2010 (median follow-up of 20 years), vital status was ascertained with a National Death Index search. RESULTS Sixteen deaths (6.5%) were recorded (lifetime anorexia nervosa, N=14; bulimia nervosa with no history of anorexia nervosa, N=2). The standardized mortality ratio was 4.37 (95% CI=2.4-7.3) for lifetime anorexia nervosa and 2.33 (95% CI=0.3-8.4) for bulimia nervosa with no history of anorexia nervosa. Risk of premature death among patients with lifetime anorexia nervosa peaked within the first 10 years of follow-up, resulting in a standardized mortality ratio of 7.7 (95% CI=3.7-14.2). The standardized mortality ratio varied by duration of illness and was 3.2 (95% CI=0.9-8.3) for patients with lifetime anorexia nervosa for 0 to 15 years (4/119 died), and 6.6 (95% CI=3.2-12.1) for those with lifetime anorexia nervosa for >15 to 30 years (10/67 died). Multivariate predictors of mortality included alcohol abuse, low body mass index, and poor social adjustment. CONCLUSIONS These findings highlight the need for early identification and intervention and suggest that a long duration of illness, substance abuse, low weight, and poor psychosocial functioning raise the risk for mortality in anorexia nervosa.

Validation of the Hematopoietic Cell Transplantation-Specific Comorbidity Index in a retrospective cohort of children and adolescents who received an allogeneic transplantation in Argentina.

PubMed

Figueroa Turienzo, Carlos M; Cernadas, Carolina; Roizen, Mariana; Pizzi, Silvia; Staciuk, Raquel

2016-08-01

Hematopoietic cell transplantationis a therapy with a risk of transplant-related mortality (TRM), which may vary depending on prior comorbidities. The Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) is an instrument developed to measure this risk. There are very few reports on its use in pediatrics. The objective of this study was to validate the HCT-CI in a pediatric cohort of allogeneic hematopoietic-cell transplantation recipients in Argentina. Retrospective cohort made up of 140 transplant patients a, Hospital J. P. Garrahan between 2008 and 2012. Medical records were reviewed to identify patient history and course. The HCT-CI was estimated for each patient, who was classified as having a low (score: 0), intermediate (score: 1-2) or high (score: >3) risk. Survival was estimated for each group using the Kaplan-Meier method and compared with the log-rank test. For malignancies, relapse was considered an event consistent with TRM. A p value 〈 0.05 was considered significant. The median score in the HCT-CI was 1 (r: 0-6). A score of 0 was observed in 45.7% of patients, 1-2 in 40.7%, and >3 in 13.6%. The most common comorbidities included obesity, infection, pulmonary and liver involvement. TRM was 14.1% among patients with a score of 0; 43.7% with a score of 1-2, and 52.6% with a score >3. Differences were observed among the survival curves of the three groups (p = 0.01). The HCT-CI demonstrated to be an effective tool to predict the risk of TRM in our setting. comorbidity, hematopoietic stem cell transplantation, non-relapse mortality, pediatrics. Sociedad Argentina de Pediatría.

U.S. Civil Air Show Crashes, 1993 to 2013: Burden, Fatal Risk Factors, and Evaluation of a Risk Index for Aviation Crashes.

PubMed

Ballard, Sarah-Blythe; Osorio, Victor B

2015-01-01

This study provides new public health data about U.S. civil air shows. Risk factors for fatalities in civil air show crashes were analyzed. The value of the FIA score in predicting fatal outcomes was evaluated. With the use of the FAA's General Aviation and Air Taxi Survey and the National Transportation Safety Board's data, the incidence of civil air show crashes from 1993 to 2013 was calculated. Fatality risk factors for crashes were analyzed by means of regression methods. The FIA index was validated to predict fatal outcomes by using the factors of fire, instrument conditions, and away-from-airport location, and was evaluated through receiver operating characteristic (ROC) curves. The civil air show crash rate was 31 crashes per 1,000 civil air events. Of the 174 civil air show crashes that occurred during the study period, 91 (52%) involved at least one fatality; on average, 1.1 people died per fatal crash. Fatalities were associated with four major risk factors: fire [adjusted odds ratio (AOR) = 7.1, 95% confidence interval (CI) = 2.4 to 20.6, P < .001], pilot error (AOR = 5.2, 95% CI = 1.8 to 14.5, P = .002), aerobatic flight (AOR = 3.6, 95% CI = 1.6 to 8.2, P = .002), and off-airport location (AOR = 3.4, 95% CI = 1.5 to 7.5, P = .003). The area under the FIA score's ROC curve was 0.71 (95% CI = 0.64 to 0.78). Civil air show crashes were marked by a high risk of fatal outcomes to pilots in aerobatic performances but rare mass casualties. The FIA score was not a valid measurement of fatal risk in civil air show crashes.

Housing index, urbanisation level and lifetime prevalence of depressive and anxiety disorders: a cross-sectional analysis of the Colombian national mental health survey

PubMed Central

Rincon, Carlos Javier; Tamayo Martínez, Nathalie; Rodriguez, Nelcy; Tiemeier, Henning; Mackenbach, Johan P; Gómez-Restrepo, Carlos; Guarnizo-Herreño, Carol C

2018-01-01

Objectives To study socioeconomic inequalities in mental health in rural and urban Colombia, a country with a history of internal conflict and large socioeconomic inequalities. Recent survey data are available to study this understudied topic in a middle-income country. Methods Using data from 9656 respondents from the 2015 Colombian Mental Health survey, we investigated the association between lifetime prevalence of depressive and anxiety disorders and quality of dwellings and access to public services housing score (HS). We calculated the relative index of inequality (RII) and slope index of inequality (SII) for HS in urban and rural areas, adjusting for potential confounders and mediating factors. Outcomes The lifetime prevalence of anxiety and depression (combined) was 9.6% in urban versus 6.9% in rural areas (p<0.001). HS was not associated with prevalence of anxiety and depression in urban settings, whereas a higher HS (poorer housing quality) was associated with fewer mental disorders in rural areas in both univariate and multivariate models (multivariate RIIurban0.96 (95% CI 0.51 to 1.81); RIIrural0.11 (95% CI 0.04 to 0.32)). In rural areas, the prevalence of mental health problems was 12% points lower in persons living in the poorest quality dwellings than in those living in high-quality dwellings (SII −0.12 (95% CI −0.18 to −0.06)). Interestingly, within rural areas, persons living in ‘populated centres’ (small towns, villages) had a higher lifetime prevalence of any mental health disorder (9.8% (95% CI 6.9 to 13.6)) compared with those living in more isolated, dispersed areas (6.0% (95% CI 4.6 to 7.7)). Interpretation In rural Colombia, those living in the poorest houses and in dispersed areas had a lower prevalence of mental health problems. Further understanding of this phenomenon of a seemingly inverse association of prevalence of mental disorders with poverty and/or urbanisation in rural areas is needed. Particularly, considering the progressive urbanisation process in Colombia, it is important to monitor mental health in populations migrating to the cities. PMID:29880561

Laparoscopic versus open ventral hernia repair: longitudinal outcomes and cost analysis using statewide claims data.

PubMed

Ecker, Brett L; Kuo, Lindsay E Y; Simmons, Kristina D; Fischer, John P; Morris, Jon B; Kelz, Rachel R

2016-03-01

There is still considerable debate regarding the best operative approach to ventral hernia repair. Using two large statewide databases, this study sought to evaluate the longitudinal outcomes and associated costs of laparoscopic and open ventral hernia repair. All patients undergoing elective ventral hernia repair from 2007-2011 were identified from inpatient discharge data from California and New York. In-hospital morbidity, in-hospital mortality, incidence of readmission, and incidence of revisional ventral hernia repair were evaluated as a function of surgical technique. The associated costs of medical care for laparoscopic versus open ventral hernia repair were evaluate for both the index procedure and all subsequent admissions and procedures within the study period. A total of 13,567 patients underwent elective ventral hernia repair with mesh; 9228 (69%) underwent OVHR and 4339 (31%) underwent LVHR. At time of the index procedure, LVHR was associated with a lower incidence of reoperation (OR 0.29, CI 0.12-0.58, p = 0.001), wound disruption (OR 0.35, CI 0.16-0.78, p = 0.01), wound infection (OR 0.50, CI 0.25-0.70, p < 0.001), blood transfusion (OR 0.47, CI 0.36-0.61, p < 0.001), ARDS (OR 0.74, CI 0.54-0.99, p < 0.05), and total index visit complications (OR 0.72, CI 0.64-0.80, p < 0.001). LVHR was associated with significantly fewer readmissions (OR 0.81, CI 0.75-0.88, p < 0.001) and a lower risk for revisional VHR (OR 0.75, CI 0.64-0.88, p < 0.001). LVHR was associated with lower total costs at 1 year ($3451, CI 1892-5011, p < 0.001). Open ventral hernia repair was associated with a higher incidence of perioperative complications, postoperative readmissions and need for revisional hernia repair when compared to laparoscopic ventral hernia repair, even when controlling for patient sociodemographics. In congruence, open ventral hernia repair was associated with higher costs for both the index hernia repair and tallied over the length of follow-up for readmissions and revisional hernia repair.

High Staphylococcus epidermidis Colonization and Impaired Permeability Barrier in Facial Seborrheic Dermatitis

PubMed Central

An, Qian; Sun, Meng; Qi, Rui-Qun; Zhang, Li; Zhai, Jin-Long; Hong, Yu-Xiao; Song, Bing; Chen, Hong-Duo; Gao, Xing-Hua

2017-01-01

Background: Seborrheic dermatitis (SD) is a common inflammatory skin condition. The etiology is unclear, although overgrowth of Malassezia on the skin has been suggested to cause SD. This study investigated whether colonization with Staphylococcus plays a role in facial SD, which was not well addressed previously. Methods: The study was conducted from September 1, 2011 to February 20, 2012 in the First Hospital of China Medical University. In the first phase, the study evaluated the level of transepidermal water loss (TEWL) and the number of colony-forming units (CFU) of Staphylococcus in defined skin areas of SD patients who were human immunodeficiency virus (HIV) seropositive (HIV [+] SD [+] group, n = 13), classical SD (HIV [−] SD [+] group, n = 24) patients, HIV seropositive-non-SD (HIV [+] SD [−] group, n = 16) patients, and healthy volunteers (HIV [−] SD [−] group, n = 16). In the second phase, we enrolled another cohort of HIV (−) SD (+) patients who applied topical fusidic acid (n = 15), tacrolimus (n = 16), or moisturizer (n = 12). Changes in the Seborrheic Dermatitis Area Severity Index (SDASI), TEWL, and Staphylococcus density were evaluated 2 weeks later. Comparisons of each index were performed using analysis of variance (ANOVA) and least significant difference method. Results: The level of TEWL was greater through lesional sites in the HIV (+) SD (+) group than that in HIV (+) SD (−) and HIV (−) SD (−) groups (95% confidence interval [CI]: 18.873–47.071, P < 0.001 and 95% CI: 28.755–55.936, P < 0.001, respectively). The number of CFU of Staphylococcus was greater in the HIV (+) SD (+) group than that in HIV (+) SD (−) and HIV (−) SD (−) groups (95% CI: 37.487–142.744, P = 0.001 and 95% CI: 54.936–156.400, P < 0.001, respectively). TEWL was significantly more improved in patients treated with tacrolimus and fusidic acid than that in those treated with moisturizers (95% CI: 7.560–38.987, P = 0.004 and 95% CI: 4.659–37.619, P = 0.011, respectively). Topical tacrolimus and fusidic acid were significantly associated with decreased SDASI as compared with moisturizer (95% CI: 0.03–0.432, P = 0.025 and 95% CI: 0.033–0.44, P = 0.024, respectively). Conclusions: High colonization with Staphylococcus epidermidis, along with impaired skin permeability barrier function, contributes to the occurrence of SD. PMID:28685715

Prognostic Factors in Severe Chagasic Heart Failure

PubMed Central

Costa, Sandra de Araújo; Rassi, Salvador; Freitas, Elis Marra da Madeira; Gutierrez, Natália da Silva; Boaventura, Fabiana Miranda; Sampaio, Larissa Pereira da Costa; Silva, João Bastista Masson

2017-01-01

Background Prognostic factors are extensively studied in heart failure; however, their role in severe Chagasic heart failure have not been established. Objectives To identify the association of clinical and laboratory factors with the prognosis of severe Chagasic heart failure, as well as the association of these factors with mortality and survival in a 7.5-year follow-up. Methods 60 patients with severe Chagasic heart failure were evaluated regarding the following variables: age, blood pressure, ejection fraction, serum sodium, creatinine, 6-minute walk test, non-sustained ventricular tachycardia, QRS width, indexed left atrial volume, and functional class. Results 53 (88.3%) patients died during follow-up, and 7 (11.7%) remained alive. Cumulative overall survival probability was approximately 11%. Non-sustained ventricular tachycardia (HR = 2.11; 95% CI: 1.04 - 4.31; p<0.05) and indexed left atrial volume ≥ 72 mL/m2 (HR = 3.51; 95% CI: 1.63 - 7.52; p<0.05) were the only variables that remained as independent predictors of mortality. Conclusions The presence of non-sustained ventricular tachycardia on Holter and indexed left atrial volume > 72 mL/m2 are independent predictors of mortality in severe Chagasic heart failure, with cumulative survival probability of only 11% in 7.5 years. PMID:28443956

Long-term monitoring of endangered Laysan ducks: Index validation and population estimates 1998–2012

USGS Publications Warehouse

Reynolds, Michelle H.; Courtot, Karen; Brinck, Kevin W.; Rehkemper, Cynthia; Hatfield, Jeffrey

2015-01-01

Monitoring endangered wildlife is essential to assessing management or recovery objectives and learning about population status. We tested assumptions of a population index for endangered Laysan duck (or teal; Anas laysanensis) monitored using mark–resight methods on Laysan Island, Hawai’i. We marked 723 Laysan ducks between 1998 and 2009 and identified seasonal surveys through 2012 that met accuracy and precision criteria for estimating population abundance. Our results provide a 15-y time series of seasonal population estimates at Laysan Island. We found differences in detection among seasons and how observed counts related to population estimates. The highest counts and the strongest relationship between count and population estimates occurred in autumn (September–November). The best autumn surveys yielded population abundance estimates that ranged from 674 (95% CI = 619–730) in 2003 to 339 (95% CI = 265–413) in 2012. A population decline of 42% was observed between 2010 and 2012 after consecutive storms and Japan’s To¯hoku earthquake-generated tsunami in 2011. Our results show positive correlations between the seasonal maximum counts and population estimates from the same date, and support the use of standardized bimonthly counts of unmarked birds as a valid index to monitor trends among years within a season at Laysan Island.

High-Quality Diets Associate With Reduced Risk of Colorectal Cancer: Analyses of Diet Quality Indexes in the Multiethnic Cohort.

PubMed

Park, Song-Yi; Boushey, Carol J; Wilkens, Lynne R; Haiman, Christopher A; Le Marchand, Loïc

2017-08-01

Healthy eating patterns assessed by diet quality indexes (DQIs) have been related to lower risk of colorectal cancer-mostly among whites. We investigated the associations between 4 DQI scores (the Healthy Eating Index 2010 [HEI-2010], the Alternative Healthy Eating Index 2010 [AHEI-2010], the alternate Mediterranean diet score [aMED], and the Dietary Approaches to Stop Hypertension score) and colorectal cancer risk in the Multiethnic Cohort. We analyzed data from 190,949 African American, Native Hawaiian, Japanese American, Latino, and white individuals, 45 to 75 years old, who entered the Multiethnic Cohort study from 1993 through 1996. During an average 16 years of follow-up, 4770 invasive colorectal cancer cases were identified. Scores from all 4 DQIs associated inversely with colorectal cancer risk; higher scores associated with decreasing colorectal cancer risk (all P's for trend ≤ .003). Associations were not significant for AHEI-2010 and aMED scores in women after adjustment for covariates: for the highest vs lowest quintiles, the hazard ratio for the HEI-2010 score in men was 0.69 (95% confidence interval [CI], 0.59-0.80) and in women was 0.82 (95% CI, 0.70-0.96); for the AHEI-2010 score the hazard ratio in men was 0.75 (95% CI, 0.65-0.85) and in women was 0.90 (95% CI, 0.78-1.04); for the aMED score the hazard ratio in men was 0.84 (95% CI, 0.73-0.97) and in women was 0.96 (95% CI, 0.82-1.13); for the Dietary Approaches to Stop Hypertension score the hazard ratio in men was 0.75 (95% CI, 0.66-0.86) and in women was 0.86 (95% CI, 0.75-1.00). Associations were limited to the left colon and rectum for all indexes. The inverse associations were less strong in African American individuals than in the other 4 racial/ethnic groups. Based on an analysis of data from the Multiethnic Cohort Study, high-quality diets are associated with a lower risk of colorectal cancer in most racial/ethnic subgroups. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Biomarkers S100B and neuron-specific enolase predict outcome in hypothermia-treated encephalopathic newborns*.

PubMed

Massaro, An N; Chang, Taeun; Baumgart, Stephen; McCarter, Robert; Nelson, Karin B; Glass, Penny

2014-09-01

To evaluate if serum S100B protein and neuron-specific enolase measured during therapeutic hypothermia are predictive of neurodevelopmental outcome at 15 months in children with neonatal encephalopathy. Prospective longitudinal cohort study. A level IV neonatal ICU in a freestanding children's hospital. Term newborns with moderate to severe neonatal encephalopathy referred for therapeutic hypothermia during the study period. Serum neuron-specific enolase and S100B were measured at 0, 12, 24, and 72 hours of hypothermia. Of the 83 infants enrolled, 15 (18%) died in the newborn period. Survivors were evaluated by the Bayley Scales of Infant Development-II at 15 months. Outcomes were assessed in 49 of 68 survivors (72%) at a mean age of 15.2 ± 2.7 months. Neurodevelopmental outcome was classified by Bayley Scales of Infant Development-II Mental Developmental Index and Psychomotor Developmental Index scores, reflecting cognitive and motor outcomes, respectively. Four-level outcome classifications were defined a priori: normal = Mental Developmental Index/Psychomotor Developmental Index within 1 SD (> 85), mild = Mental Developmental Index/Psychomotor Developmental Index less than 1 SD (70-85), moderate/severe = Mental Developmental Index/Psychomotor Developmental Index less than 2 SD (< 70), or died. Elevated serum S100B and neuron-specific enolase levels measured during hypothermia were associated with increasing outcome severity after controlling for baseline and socioeconomic characteristics in ordinal regression models. Adjusted odds ratios for cognitive outcome were 2.5 (95% CI, 1.3-4.8) for S100B and 2.1 (95% CI, 1.2-3.6) for neuron-specific enolase, and for motor outcome, 2.6 (95% CI, 1.2-5.6) for S100B and 2.1 (95% CI, 1.2-3.6) for neuron-specific enolase. Serum S100B and neuron-specific enolase levels in babies with neonatal encephalopathy are associated with neurodevelopmental outcome at 15 months. These putative biomarkers of brain injury may help direct care during therapeutic hypothermia.

Lymphatic invasion and the Shields index in predicting melanoma metastases.

PubMed

Špirić, Zorica; Erić, Mirela; Eri, Živka

2017-11-01

Findings of the prognostic significance of lymphatic invasion are contradictory. To determine an as efficient cutaneous melanoma metastasis predictor as possible, Shields et al. created a new prognostic index. This study aimed to examine whether the lymphatic invasion analysis and the Shields index calculation can be used in predicting lymph node status in patients with cutaneous melanoma. Lymphatic invasion of 100 melanoma specimens was detected by dual immunohistochemistry staining for the lymphatic endothelial marker D2-40 and melanoma cell S-100 protein. The Shields index was calculated as a logarithm by multiplying the melanoma thickness, square of peritumoural lymphatic vessel density and the number "2" for the present lymphatic invasion. No statistically significant difference was observed between lymph node metastatic and nonmetastatic melanomas regarding the lymphatic invasion. Metastatic melanomas showed a significantly higher Shields index value than nonmetastatic melanomas (p = 0.00). Area under the receiver operator characteristic (ROC) curve (AUC) proved that the Shields index (AUC = 0.86, 95% confidence interval (CI) 0.79-0.93, p = 0.00) was the most accurate predictor of lymph node status, followed by the melanoma thickness (AUC = 0.76, 95% CI 0.67-0.86, p = 0.00) and American Joint Committee on Cancer (AJCC) staging (AUC = 0.75, 95% CI 0.66-0.85, p = 0.00), while lymphatic invasion was not successful in predicting (AUC = 0.56, 95% CI 0.45-0.67, p = 0.31). The Shields index achieved 81.3% sensitivity and 75% specificity (cut-off mean value). Our findings show that D2-40/S-100 immunohistochemical analysis of lymphatic invasion cannot be used for predicting the lymph node status, while the Shields index calculation predicts disease outcome more accurately than the melanoma thickness and AJCC staging. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

The impact of human development on individual health: a causal mediation analysis examining pathways through education and body mass index.

PubMed

Wang, Aolin; Arah, Onyebuchi A

2017-01-01

The macro environment we live in projects what we can achieve and how we behave, and in turn, shapes our health in complex ways. Policymaking will benefit from insights into the mechanisms underlying how national socioeconomic context affects health. This study examined the impact of human development on individual health and the possible mediating roles of education and body mass index (BMI). We analyzed World Health Survey data on 109,448 participants aged 25 or older from 42 low- and middle-income countries with augmented human development index (HDI) in 1990. We used principal components method to create a health score based on measures from eight health state domains, used years of schooling as education indicator and calculated BMI from self-reported height and weight. We used causal mediation analysis technique with random intercepts to account for the multilevel structure. Below a reference HDI level of 0.48, HDI was negatively associated with good health (total effect at HDI of 0.23: b  =  - 3.44, 95% CI [-6.39--0.49] for males and b  =  - 5.16, 95% CI [-9.24,--1.08] for females) but was positively associated with good health above this reference level (total effect at HDI of 0.75: b  = 4.16, 95% CI [-0.33-8.66] for males and b  = 6.62, 95% CI [0.85-12.38] for females). We found a small positive effect of HDI on health via education across reference HDI levels ( b ranging from 0.24 to 0.29 for males and 0.40 to 0.49 for females) but not via pathways involving BMI only. Human development has a non-linear effect on individual health, but the impact appears to be mainly through pathways other than education and BMI.

Thyroid Dysfunction, Thyroid Hormone Replacement and Colorectal Cancer Risk

PubMed Central

Boursi, Ben; Haynes, Kevin; Mamtani, Ronac

2015-01-01

Background: Current screening guidelines for colorectal cancer (CRC) do not consider thyroid dysfunction as a risk factor for disease development. We sought to determine the risk of developing CRC in patients with thyroid dysfunction, with and without thyroid hormone replacement (THR). Methods: We conducted a nested case-control study using a large population-based medical records database from the United Kingdom. Study case patients were defined as those with any medical code of CRC. Subjects with familial colorectal cancer syndromes or inflammatory bowel disease (IBD) were excluded. For every case patient, four eligible control patients matched on age, sex, practice site, and duration of follow-up before index date were selected using incidence density sampling. Exposure was THR therapy before index date. We further divided the THR unexposed group into patients with hypothyroidism (TSH > 4mg/dl), patients with hyperthyroidism (TSH < 0.4mg/dl), and subjects without documented thyroid abnormality. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for CRC were estimated using conditional logistic regression. All statistical tests were two-sided. Results: We identified 20990 CRC patients and 82054 control patients. The adjusted odds ratio for CRC associated with THR was 0.88 (95% CI = 0.79 to 0.99, P = .03) and 0.68 (95% CI = 0.55 to 0.83, P < .001) for treatment initiated five to 10 years and more than 10 years before index date, respectively. This protective association increased with cumulative duration of therapy. In contrast, hyperthyroidism (adjusted OR = 1.21, 95% CI = 1.08 to 1.36, P = .001) or untreated hypothyroidism (adjusted OR = 1.16, 95% CI = 1.08 to 1.24, P < .001) were associated with increased risk of CRC. Conclusion: Long-term THR is associated with a decreased risk of CRC. Hyperthyroidism and untreated hypothyroidism are associated with modestly elevated risk of CRC. PMID:25855726

Comparison of generic-to-brand switchback patterns for generic and authorized generic drugs

PubMed Central

Hansen, Richard A.; Qian, Jingjing; Berg, Richard; Linneman, James; Seoane-Vazquez, Enrique; Dutcher, Sarah K.; Raofi, Saeid; Page, C. David; Peissig, Peggy

2018-01-01

Background While generic drugs are therapeutically equivalent to brand drugs, some patients and healthcare providers remain uncertain about whether they produce identical outcomes. Authorized generics, which are identical in formulation to corresponding brand drugs but marketed as a generic, provide a unique post-marketing opportunity to study whether utilization patterns are influenced by perceptions of generic drugs. Objectives To compare generic-to-brand switchback rates between generics and authorized generics. Methods A retrospective cohort study was conducted using claims and electronic health records data from a regional U.S. healthcare system. Ten drugs with authorized generics and generics marketed between 1999 and 2014 were evaluated. Eligible adult patients received a brand drug during the 6 months preceding generic entry, and then switched to a generic or authorized generic. Patients in this cohort were followed for up to 30 months from the index switch date to evaluate occurrence of generic-to-brand switchbacks. Switchback rates were compared between patients on authorized generics versus generics using Kaplan-Meier curves and Cox proportional hazards models, controlling for individual drug effects, age, sex, Charlson comorbidity score, pre-index drug use characteristics, and pre-index healthcare utilization. Results Among 5,542 unique patients that switched from brand-to-generic or brand-to-authorized generic, 264 (4.8%) switched back to the brand drug. Overall switchback rates were similar for authorized generics compared with generics (HR=0.86; 95% CI 0.65-1.15). The likelihood of switchback was higher for alendronate (HR=1.64; 95% CI 1.20-2.23) and simvastatin (HR=1.81; 95% CI 1.30-2.54) and lower for amlodipine (HR=0.27; 95% CI 0.17-0.42) compared with other drugs in the cohort. Conclusions Overall switchback rates were similar between authorized generic and generic drug users, indirectly supporting similar efficacy and tolerability profiles for brand and generic drugs. Reasons for differences in switchback rates among specific products need to be further explored. PMID:28152215

Income Differences in Smoking Prevalences in 245 Districts of South Korea: Patterns by Area Deprivation and Urbanity, 2008-2014

PubMed Central

2017-01-01

Objectives The aim of this study was to measure income differences in smoking prevalence at the district level and to investigate correlations among area deprivation, smoking prevalence, and income differences in smoking prevalence, stratified by urbanity. Methods Data were pooled from the Community Health Survey data of South Korea between 2008 and 2014. The age-standardized prevalence of smoking and its interquintile income differences were calculated. We conducted correlation analyses to investigate the association of the deprivation index with smoking prevalence and interquintile differences in smoking prevalence. Results Across 245 districts, the median prevalence of smoking in men was 45.9% (95% confidence interval [CI], 43.4 to 48.5%), with an interquartile range (IQR) of 4.6% points. In women, the median prevalence was 3.0% (95% CI, 2.4 to 3.6%) and IQR was 1.6% points. The median interquintile difference in smoking prevalence was 7.4% points (95% CI, 1.6 to 13.2% points) in men and 2.7% points (95% CI, 0.5 to 4.9% points) in women. The correlation coefficients for the association between the deprivation index and smoking prevalence was 0.58, 0.15, -0.22 in metropolitan, urban, and rural areas, respectively, among men, and 0.54, -0.33, -0.43 among women. No meaningful correlation was found between area deprivation and interquintile difference in smoking prevalence. The correlation between smoking prevalence and interquintile difference in smoking prevalence was more evident in women than in men. Conclusions This study provides evidence of geographical variations in smoking prevalence and interquintile difference in smoking prevalence. Neither smoking prevalence nor the deprivation index was closely correlated with interquintile income difference in smoking prevalence. Measuring inequalities in smoking prevalence is crucial to developing policies aimed at reducing inequalities in smoking. PMID:28372354

The efficacy and tolerability of rotigotine on patients with periodic limb movement in sleep: A systematic review and meta-analysis

PubMed Central

Chen, Tien-Yu; Chen, Yen-Wen; Liou, Li-Min; Lin, Pao-Yen

2018-01-01

Objective There is still no consensus on the treatment for periodic limb movement in sleep (PLMS). This study aimed to determine the efficacy and tolerability of rotigotine in patients suffering from PLMS. Methods Publications listed in PubMed, ScienceDirect, The Cochrane Library, and ClinicalTrials.gov were reviewed to assess the efficacy of rotigotine on PLMS. Analyses of PLMS frequency before and after rotigotine treatments (pre- and post-intervention studies) and PLMS frequency between placebo and rotigotine treatments (placebo-controlled trial studies) were included in our study. A systematic review and meta-analysis was conducted. Results Five publications involving 197 participants were included in this study. Among these articles, pre- and post-intervention data involving 55 participants were available from three articles, while placebo-controlled trial data from 107 participants receiving rotigotine and 70 participants receiving a placebo were available from an additional three articles. In the pre- and post-intervention studies, the periodic limb movement index was significantly decreased after therapy with rotigotine with a difference in means of −5.866/h (95% CI, −10.570 to −1.162, p = 0.015). In comparison with the placebo, the use of rotigotine significantly lowered the periodic limb movement index, with a difference in means of −32.105/h (95% CI, −42.539 to −21.671, p < 0.001), reduced the PLMS with arousal index, with a difference in means of −7.160/h (95% CI, −9.310 to −5.010, p < 0.001), and increased the withdrawal rate, with an odds ratio of 3.421 (95% CI, 1.230 to 9.512, p = 0.018). Conclusions This meta-analysis revealed the considerable efficacy of rotigotine in alleviating the frequency of PLMS. However, the high withdrawal rate should be taken into account. PMID:29668694

Socioeconomic Status and Overweight Prevalence in Polish Adolescents: The Impact of Single Factors and a Complex Index of Socioeconomic Status in Respect to Age and Sex

PubMed Central

KOWALKOWSKA, Joanna; WADOLOWSKA, Lidia; WERONIKA WUENSTEL, Justyna; SŁOWIŃSKA, Małgorzata Anna; NIEDŹWIEDZKA, Ewa

2014-01-01

Abstract Background The aim of this study was to analyze the association between overweight prevalence and socioeconomic status (SES) measured by complex SES index and single SES factors in Polish adolescents in respect to age and sex. Methods This cross-sectional study was conducted in 2010-2011. A total of 1,176 adolescents aged 13.0-18.9 years were included. The respondents were students of junior-high and high schools from northern, eastern and central Poland. Quota sampling by sex and age was used. The SES was determined by: place of residence, self-declared economic situation, and parental education level. Respondents with low, average or high SES index (SESI) were identified. The level of overweight was assessed using Polish and international standards. Results The odds ratio (OR) for overweight prevalence in the oldest girls (aged 17.0-18.9 years) with high SESI was 0.34 (95%CI:0.13-0.92; P < 0.05) by Polish standards and 0.22 (95%CI:0.05-0.95; P < 0.05) by international standards, in comparison to the reference group (low SESI). In total girls who had mothers with higher education level, the OR adjusted for age was 0.44 (95%CI:0.21-0.90; P <0.05) by Polish standards and 0.35 (95%CI:0.15-0.81; P < 0.05) by international standards, in comparison to the reference group (maternal elementary education). The other single SES factors were not significant for overweight prevalence Conclusions The relationship between socioeconomic status and prevalence of overweight was related to sex and age. The high socioeconomic status strongly lowered the risk of overweight prevalence in the oldest girls, but not in boys, irrespective of age. Maternal education level lowered risk of overweight prevalence in girls. PMID:25909059

Diagnostic Yield of Recommendations for Chest CT Examination Prompted by Outpatient Chest Radiographic Findings

PubMed Central

Harvey, H. Benjamin; Gilman, Matthew D.; Wu, Carol C.; Cushing, Matthew S.; Halpern, Elkan F.; Zhao, Jing; Pandharipande, Pari V.; Shepard, Jo-Anne O.

2015-01-01

Purpose To evaluate the diagnostic yield of recommended chest computed tomography (CT) prompted by abnormalities detected on outpatient chest radiographic images. Materials and Methods This HIPAA-compliant study had institutional review board approval; informed consent was waived. Reports of all outpatient chest radiographic examinations performed at a large academic center during 2008 (n = 29 138) were queried to identify studies that included a recommendation for a chest CT imaging. The radiology information system was queried for these patients to determine if a chest CT examination was obtained within 1 year of the index radiographic examination that contained the recommendation. For chest CT examinations obtained within 1 year of the index chest radiographic examination and that met inclusion criteria, chest CT images were reviewed to determine if there was an abnormality that corresponded to the chest radiographic finding that prompted the recommendation. All corresponding abnormalities were categorized as clinically relevant or not clinically relevant, based on whether further work-up or treatment was warranted. Groups were compared by using t test and Fisher exact test with a Bonferroni correction applied for multiple comparisons. Results There were 4.5% (1316 of 29138 [95% confidence interval {CI}: 4.3%, 4.8%]) of outpatient chest radiographic examinations that contained a recommendation for chest CT examination, and increasing patient age (P < .001) and positive smoking history (P = .001) were associated with increased likelihood of a recommendation for chest CT examination. Of patients within this subset who met inclusion criteria, 65.4% (691 of 1057 [95% CI: 62.4%, 68.2%) underwent a chest CT examination within the year after the index chest radiographic examination. Clinically relevant corresponding abnormalities were present on chest CT images in 41.4% (286 of 691 [95% CI: 37.7%, 45.2%]) of cases, nonclinically relevant corresponding abnormalities in 20.6% (142 of 691 [95% CI: 17.6%, 23.8%]) of cases, and no corresponding abnormalities in 38.1% (263 of 691 [95% CI: 34.4%, 41.8%]) of cases. Newly diagnosed, biopsy-proven malignancies were detected in 8.1% (56 of 691 [95% CI: 6.2%, 10.4%]) of cases. Conclusion A radiologist recommendation for chest CT to evaluate an abnormal finding on an outpatient chest radiographic examination has a high yield of clinically relevant findings. © RSNA, 2014 PMID:25531242

Urban sprawl, physical activity, and body mass index: Nurses' Health Study and Nurses' Health Study II.

PubMed

James, Peter; Troped, Philip J; Hart, Jaime E; Joshu, Corinne E; Colditz, Graham A; Brownson, Ross C; Ewing, Reid; Laden, Francine

2013-02-01

We evaluated the association between the county sprawl index, a measure of residential density and street accessibility, and physical activity and body mass index (BMI). We conducted a multilevel cross-sectional analysis in a sample of Nurses' Health Study participants living throughout the United States in 2000 to 2001 (n = 136 592). In analyses adjusted for age, smoking status, race, and husband's education, a 1-SD (25.7) increase in the county sprawl index (indicating a denser, more compact county) was associated with a 0.13 kilograms per meters squared (95% confidence interval [CI] = -0.18, -0.07) lower BMI and 0.41 (95% CI = 0.17, 0.65) more metabolic equivalent (MET) hours per week of total physical activity, 0.26 (95% CI = 0.19, 0.33) more MET hours per week of walking, and 0.47 (95% CI = 0.34, 0.59) more MET hours per week of walking, bicycling, jogging, and running. We detected potential effect modification for age, previous disease status, husband's education level (a proxy for socioeconomic status), and race. Our results suggest that living in a dense, compact county may be conducive to higher levels of physical activity and lower BMI in women.

International study on microcirculatory shock occurrence in acutely ill patients.

PubMed

Vellinga, Namkje A R; Boerma, E Christiaan; Koopmans, Matty; Donati, Abele; Dubin, Arnaldo; Shapiro, Nathan I; Pearse, Rupert M; Machado, Flavia R; Fries, Michael; Akarsu-Ayazoglu, Tulin; Pranskunas, Andrius; Hollenberg, Steven; Balestra, Gianmarco; van Iterson, Mat; van der Voort, Peter H J; Sadaka, Farid; Minto, Gary; Aypar, Ulku; Hurtado, F Javier; Martinelli, Giampaolo; Payen, Didier; van Haren, Frank; Holley, Anthony; Pattnaik, Rajyabardhan; Gomez, Hernando; Mehta, Ravindra L; Rodriguez, Alejandro H; Ruiz, Carolina; Canales, Héctor S; Duranteau, Jacques; Spronk, Peter E; Jhanji, Shaman; Hubble, Sheena; Chierego, Marialuisa; Jung, Christian; Martin, Daniel; Sorbara, Carlo; Tijssen, Jan G P; Bakker, Jan; Ince, Can

2015-01-01

Microcirculatory alterations are associated with adverse outcome in subsets of critically ill patients. The prevalence and significance of microcirculatory alterations in the general ICU population are unknown. We studied the prevalence of microcirculatory alterations in a heterogeneous ICU population and its predictive value in an integrative model of macro- and microcirculatory variables. Multicenter observational point prevalence study. The Microcirculatory Shock Occurrence in Acutely ill Patients study was conducted in 36 ICUs worldwide. A heterogeneous ICU population consisting of 501 patients. None. Demographic, hemodynamic, and laboratory data were collected in all ICU patients who were 18 years old or older. Sublingual Sidestream Dark Field imaging was performed to determine the prevalence of an abnormal capillary microvascular flow index (< 2.6) and its additional value in predicting hospital mortality. In 501 patients with a median Acute Physiology and Chronic Health Evaluation II score of 15 (10-21), a Sequential Organ Failure Assessment score of 5 (2-8), and a hospital mortality of 28.4%, 17% exhibited an abnormal capillary microvascular flow index. Tachycardia (heart rate > 90 beats/min) (odds ratio, 2.71; 95% CI, 1.67-4.39; p < 0.001), mean arterial pressure (odds ratio, 0.979; 95% CI, 0.963-0.996; p = 0.013), vasopressor use (odds ratio, 1.84; 95% CI, 1.11-3.07; p = 0.019), and lactate level more than 1.5 mEq/L (odds ratio, 2.15; 95% CI, 1.28-3.62; p = 0.004) were independent risk factors for hospital mortality, but not abnormal microvascular flow index. In reference to microvascular flow index, a significant interaction was observed with tachycardia. In patients with tachycardia, the presence of an abnormal microvascular flow index was an independent, additive predictor for in-hospital mortality (odds ratio, 3.24; 95% CI, 1.30-8.06; p = 0.011). This was not true for nontachycardic patients nor for the total group of patients. In a heterogeneous ICU population, an abnormal microvascular flow index was present in 17% of patients. This was not associated with mortality. However, in patients with tachycardia, an abnormal microvascular flow index was independently associated with an increased risk of hospital death.

Rehabilitation Outcomes After Inpatient Rehabilitation for Lower Extremity Amputations in Patients With Diabetes.

PubMed

Venkataraman, Kavita; Fong, Ngan Phoon; Chan, Kin Ming; Tan, Boon Yeow; Menon, Edward; Ee, Chye Hua; Lee, Kok Keng; Koh, Gerald Choon-Huat

2016-09-01

To identify factors associated with functional gain, discharge destination, and long-term survival after inpatient rehabilitation in patients with lower extremity amputation and diabetes. Retrospective medical records review. All community hospitals. Patients with diabetes (N=256) admitted for inpatient rehabilitation after lower extremity amputation. Not applicable. Absolute functional gain (AFG) using the Shah-modified Barthel Index, discharge destination, and long-term survival for each patient. Length of stay (B=.15; 95% confidence interval [CI], .08-.21; P<.001) and admission functional status (B=-.09; 95% CI, -.18 to -.01; P=.032) were significantly associated with AFG. Availability of caregiver (foreign domestic worker: odds ratio [OR], 16.39; 95% CI, 4.65-57.78; P<.001; child: OR, 3.82; 95% CI, 1.31-11.12; P=.014; spouse: OR, 2.82; 95% CI, 1.07-7.46; P=.037 vs none), Charlson Comorbidity Index of 1 (OR, 4.32; 95% CI, 1.34-13.93; P=.014 vs ≥4), and younger age (OR, .96; 95% CI, .93-.99; P=.02) were significantly associated with being discharged home. Admission functional status (hazard ratio [HR], .98; 95% CI, .97-.99; P<.001), AFG (HR, .99; 95% CI, 0.97-1.00; P=.058), Charlson Comorbidity Index (1 vs ≥4: HR, .42; 95% CI, .24-.77; P=.004), ischemic heart disease (HR, 2.25; 95% CI, 1.27-4.00; P=.006), discharge destination (other vs home: HR, 1.82; 95% CI, 1.02-3.23; P=.041), age (HR, 1.02; 95% CI, 1.00-1.03; P=.082), and ethnicity (Malay vs Chinese: HR, .37; 95% CI, .16-.87; P=.022) predicted survival postamputation. Admission functional status predicted both functional gain during rehabilitation and survival in these patients. We also found ethnic differences in outcomes, with Malays having better survival after amputation. Lastly, there appears to be greater reliance on foreign domestic workers as caregivers, with patients with foreign domestic workers as their primary caregiver having the highest odds of being discharged home. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Nutritional status assessed by the Patient-Generated Subjective Global Assessment (PG-SGA) is associated with qualities of diet and life in Korean cerebral infarction patients.

PubMed

Lim, Hyun Jung; Choue, Ryowon

2010-01-01

Assessment of the nutritional status of patients with cerebral infarction (CI) is important because their nutritional status influences disease outcome. The purpose of this study was to assess the nutritional status of patients with CI using the scored Patient-Generated Subjective Global Assessment (PG-SGA) and to investigate the relation of the quality of their diet and life with their nutritional status. Seventy-three patients with CI were recruited from Kyung Hee University Oriental Medical Center in Seoul, Korea, from May to July 2007. The subjects' PG-SGA, dietary quality (Dietary Diversity Score, Dietary Variety Score, and Diet Quality Index-International), and quality of life (Stroke-Specific Quality of Life, modified Barthel Index, and Beck Depression Inventory) were investigated. The patients were classified by PG-SGA categories as well nourished (26.0%), moderately malnourished (49.3%), or severely malnourished (24.7%). Quality of diet assessed by the Dietary Diversity Score and Dietary Variety Score was significantly lower in severely malnourished patients (P < 0.001). The overall dietary quality expressed by the Diet Quality Index-International was significantly greater in the well-nourished group, followed by the moderately malnourished and severely malnourished groups. Quality of life assessed by the Stroke-Specific Quality of Life and modified Barthel Index was significantly lower in the malnourished group (P < 0.05). Quality of diet (P < 0.001) and life (P < 0.05) in patients with CI were significantly correlated with their nutritional status. The PG-SGA is a useful nutritional assessment tool for patients with CI with stable vital signs. When patients with CI were categorized according to their PG-SGA score, well-nourished patients demonstrated better diet quality and better quality of life. 2010 Elsevier Inc. All rights reserved.

Diagnostic performance of body mass index to identify excess body fat in children with cerebral palsy.

PubMed

Duran, Ibrahim; Schulze, Josefa; Martakis, KyriakoS; Stark, Christina; Schoenau, Eckhard

2018-03-07

To assess the diagnostic performance of body mass index (BMI) cut-off values according to recommendations of the World Health Organization (WHO), the World Obesity Federation (WOF), and the German Society for Adiposity (DAG) to identify excess body fat in children with cerebral palsy (CP). The present study was a monocentric retrospective analysis of prospectively collected data among children and adolescents with CP participating in a rehabilitation programme. Excess body fat was defined as a body fat percentage above the 85th centile assessed by dual-energy X-ray absorptiometry. In total, 329 children (181 males, 148 females) with CP were eligible for analysis. The mean age was 12 years 4 months (standard deviation 2y 9mo). The BMI cut-off values for 'overweight' according to the WHO, WOF, and DAG showed the following sensitivities and specificities for the prediction of excess body fat in our population: WHO: sensitivity 0.768 (95% confidence interval [CI] 0.636-0.870), specificity 0.894 (95% CI 0.851-0.928); WOF: sensitivity 0.696 (95% CI 0.559-0.812), specificity 0.934 (95% CI 0.898-0.960); DAG: sensitivity 0.411 (95% CI 0.281-0.550), specificity 0.993 (95% CI 0.974-0.999). Body mass index showed high specificity, but low sensitivity in children with CP. Thus, 'normal-weight obese' children with CP were overlooked, when assessing excess body fat only using BMI. Excess body fat in children with cerebral palsy (CP) is less common than previously reported. Body mass index (BMI) had high specificity but low sensitivity in detecting excess body fat in children with CP. BMI evaluation criteria of the German Society for Adiposity could be improved in children with CP. © 2018 Mac Keith Press.

Adherence to dietary guidelines and cardiovascular disease risk in the EPIC-NL cohort.

PubMed

Struijk, Ellen A; May, Anne M; Wezenbeek, Nick L W; Fransen, Heidi P; Soedamah-Muthu, Sabita S; Geelen, Anouk; Boer, Jolanda M A; van der Schouw, Yvonne T; Bueno-de-Mesquita, H Bas; Beulens, Joline W J

2014-09-20

Global and national dietary guidelines have been created to lower chronic disease risk. The aim of this study was to assess whether greater adherence to the WHO guidelines (Healthy Diet Indicator (HDI)); the Dutch guidelines for a healthy diet (Dutch Healthy Diet-index (DHD-index)); and the Dietary Approaches to Stop Hypertension (DASH) diet was associated with a lower risk of cardiovascular disease (CVD), coronary heart disease (CHD) or stroke. A prospective cohort study was conducted among 33,671 healthy Dutch men and women aged 20-70 years recruited into the EPIC-NL study during 1993-1997. We used Cox regression adjusted for relevant confounders to estimate the hazard ratios per standard deviation increase in score and 95% confidence intervals (CI) of the associations between the dietary guidelines and CVD, CHD and stroke risk. After an average follow-up of 12.2 years, 2752 CVD cases were documented, including 1630 CHD cases and 527 stroke cases. We found no association between the HDI (0.98, 95% CI 0.94; 1.02) or DHD-index (0.96, 95% CI 0.92; 1.00) and CVD incidence. Similar results were found for these guidelines and CHD or stroke incidence. Higher adherence to the DASH diet was significantly associated with a lower CVD (0.92, 95% CI 0.89; 0.96), CHD (0.91, 95% CI 0.86; 0.95), and stroke (0.90, 95% CI 0.82; 0.99) risk. The HDI and the DHD-index were not associated with CVD risk, while the DASH diet was significantly associated with a lower risk of developing CVD, CHD and stroke. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Kangaroo Mother Care and Neonatal Outcomes: A Meta-analysis

PubMed Central

Dastjerdi, Roya; Spiegelman, Donna; Fawzi, Wafaie W.; Missmer, Stacey A.; Lieberman, Ellice; Kajeepeta, Sandhya; Wall, Stephen; Chan, Grace J.

2016-01-01

CONTEXT: Kangaroo mother care (KMC) is an intervention aimed at improving outcomes among preterm and low birth weight newborns. OBJECTIVE: Conduct a systematic review and meta-analysis estimating the association between KMC and neonatal outcomes. DATA SOURCES: PubMed, Embase, Web of Science, Scopus, African Index Medicus (AIM), Latin American and Caribbean Health Sciences Information System (LILACS), Index Medicus for the Eastern Mediterranean Region (IMEMR), Index Medicus for the South-East Asian Region (IMSEAR), and Western Pacific Region Index Medicus (WPRIM). STUDY SELECTION: We included randomized trials and observational studies through April 2014 examining the relationship between KMC and neonatal outcomes among infants of any birth weight or gestational age. Studies with <10 participants, lack of a comparison group without KMC, and those not reporting a quantitative association were excluded. DATA EXTRACTION: Two reviewers extracted data on study design, risk of bias, KMC intervention, neonatal outcomes, relative risk (RR) or mean difference measures. RESULTS: 1035 studies were screened; 124 met inclusion criteria. Among LBW newborns, KMC compared to conventional care was associated with 36% lower mortality(RR 0.64; 95% [CI] 0.46, 0.89). KMC decreased risk of neonatal sepsis (RR 0.53, 95% CI 0.34, 0.83), hypothermia (RR 0.22; 95% CI 0.12, 0.41), hypoglycemia (RR 0.12; 95% CI 0.05, 0.32), and hospital readmission (RR 0.42; 95% CI 0.23, 0.76) and increased exclusive breastfeeding (RR 1.50; 95% CI 1.26, 1.78). Newborns receiving KMC had lower mean respiratory rate and pain measures, and higher oxygen saturation, temperature, and head circumference growth. LIMITATIONS: Lack of data on KMC limited the ability to assess dose-response. CONCLUSIONS: Interventions to scale up KMC implementation are warranted. PMID:26702029

Kangaroo Mother Care and Neonatal Outcomes: A Meta-analysis.

PubMed

Boundy, Ellen O; Dastjerdi, Roya; Spiegelman, Donna; Fawzi, Wafaie W; Missmer, Stacey A; Lieberman, Ellice; Kajeepeta, Sandhya; Wall, Stephen; Chan, Grace J

2016-01-01

Kangaroo mother care (KMC) is an intervention aimed at improving outcomes among preterm and low birth weight newborns. Conduct a systematic review and meta-analysis estimating the association between KMC and neonatal outcomes. PubMed, Embase, Web of Science, Scopus, African Index Medicus (AIM), Latin American and Caribbean Health Sciences Information System (LILACS), Index Medicus for the Eastern Mediterranean Region (IMEMR), Index Medicus for the South-East Asian Region (IMSEAR), and Western Pacific Region Index Medicus (WPRIM). We included randomized trials and observational studies through April 2014 examining the relationship between KMC and neonatal outcomes among infants of any birth weight or gestational age. Studies with <10 participants, lack of a comparison group without KMC, and those not reporting a quantitative association were excluded. Two reviewers extracted data on study design, risk of bias, KMC intervention, neonatal outcomes, relative risk (RR) or mean difference measures. 1035 studies were screened; 124 met inclusion criteria. Among LBW newborns, KMC compared to conventional care was associated with 36% lower mortality(RR 0.64; 95% [CI] 0.46, 0.89). KMC decreased risk of neonatal sepsis (RR 0.53, 95% CI 0.34, 0.83), hypothermia (RR 0.22; 95% CI 0.12, 0.41), hypoglycemia (RR 0.12; 95% CI 0.05, 0.32), and hospital readmission (RR 0.42; 95% CI 0.23, 0.76) and increased exclusive breastfeeding (RR 1.50; 95% CI 1.26, 1.78). Newborns receiving KMC had lower mean respiratory rate and pain measures, and higher oxygen saturation, temperature, and head circumference growth. Lack of data on KMC limited the ability to assess dose-response. Interventions to scale up KMC implementation are warranted. Copyright © 2016 by the American Academy of Pediatrics.

Association of Body Mass Index with Depression, Anxiety and Suicide-An Instrumental Variable Analysis of the HUNT Study.

PubMed

Bjørngaard, Johan Håkon; Carslake, David; Lund Nilsen, Tom Ivar; Linthorst, Astrid C E; Davey Smith, George; Gunnell, David; Romundstad, Pål Richard

2015-01-01

While high body mass index is associated with an increased risk of depression and anxiety, cumulative evidence indicates that it is a protective factor for suicide. The associations from conventional observational studies of body mass index with mental health outcomes are likely to be influenced by reverse causality or confounding by ill-health. In the present study, we investigated the associations between offspring body mass index and parental anxiety, depression and suicide in order to avoid problems with reverse causality and confounding by ill-health. We used data from 32,457 mother-offspring and 27,753 father-offspring pairs from the Norwegian HUNT-study. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale and suicide death from national registers. Associations between offspring and own body mass index and symptoms of anxiety and depression and suicide mortality were estimated using logistic and Cox regression. Causal effect estimates were estimated with a two sample instrument variable approach using offspring body mass index as an instrument for parental body mass index. Both own and offspring body mass index were positively associated with depression, while the results did not indicate any substantial association between body mass index and anxiety. Although precision was low, suicide mortality was inversely associated with own body mass index and the results from the analysis using offspring body mass index supported these results. Adjusted odds ratios per standard deviation body mass index from the instrumental variable analysis were 1.22 (95% CI: 1.05, 1.43) for depression, 1.10 (95% CI: 0.95, 1.27) for anxiety, and the instrumental variable estimated hazard ratios for suicide was 0.69 (95% CI: 0.30, 1.63). The present study's results indicate that suicide mortality is inversely associated with body mass index. We also found support for a positive association between body mass index and depression, but not for anxiety.

Urinary Triclosan Concentrations Are Inversely Associated with Body Mass Index and Waist Circumference in the US General Population: Experience in NHANES 2003-2010

PubMed Central

Li, Shengxu; Zhao, Jinying; Wang, Guangdi; Zhu, Yun; Rabito, Felicia; Krousel-Wood, Marie; Chen, Wei; Whelton, Paul K

2015-01-01

Background Humans are extensively exposed to triclosan, an antibacterial and antifungal agent. Triclosan’s effects on human health, however, have not been carefully investigated. Objective To examine whether triclosan exposure is associated with obesity traits. Methods This study included 2,898 children (6-19 years old) and 5,066 adults (20 years or older) who participated in the National Health and Nutrition Examination Surveys (NHANES) 2003-2010 and had a detectable level of urinary triclosan. Multiple linear regression models were used to examine the association between urinary triclosan and both body mass index (BMI) and waist circumference. Results Each standard deviation increase in urinary triclosan was associated with a 0.34 (95% confidence interval, CI: 0.05, 0.64) kg/m2 lower level of BMI (p=0.02) and 0.92 (95% CI: 0.09, 1.74) cm smaller waist circumference (p=0.03) in boys, and a 0.62 (95% CI: 0.31, 0.94) kg/m2 lower level of BMI (p=0.0002) and 1.32 (95% CI: 0.54, 2.09) cm smaller waist circumference in girls (P=0.001); a 0.42 (95% CI: 0.06, 0.77) kg/m2 lower level of BMI (P=0.02) and 1.35 (95% CI: 0.48, 2.22) cm smaller waist circumference (P=0.003) in men, and a 0.71 (95% CI: 0.34, 1.07) kg/m2 lower level of BMI (P=0.0002) and 1.68 (95% CI: 0.86, 2.50) cm smaller waist circumference (P=0.0001) in women. In both children and adults, there was a consistent trend for lower levels of BMI and smaller waist circumference with increasing levels of urinary triclosan, from the lowest to the highest quartile of urinary triclosan (P≤0.001 in all cases). Conclusion Triclosan exposure is inversely associated with BMI and waist circumference. The biological mechanisms linking triclosan exposure to obesity await further investigation. PMID:25823951

‘Only Fathers Smoking’ Contributes the Most to Socioeconomic Inequalities: Changes in Socioeconomic Inequalities in Infants’ Exposure to Second Hand Smoke over Time in Japan

PubMed Central

Saito, Junko; Tabuchi, Takahiro; Shibanuma, Akira; Yasuoka, Junko; Nakamura, Masakazu; Jimba, Masamine

2015-01-01

Background Exposure to second hand smoke (SHS) is one of the major causes of premature death and disease among children. While socioeconomic inequalities exist for adult smoking, such evidence is limited for SHS exposure in children. Thus, this study examined changes over time in socioeconomic inequalities in infants’ SHS exposure in Japan. Methods This is a repeated cross-sectional study of 41,833 infants born in 2001 and 32,120 infants born in 2010 in Japan from nationally representative surveys using questionnaires. The prevalence of infants’ SHS exposure was determined and related to household income and parental education level. The magnitudes of income and educational inequalities in infants’ SHS exposure were estimated in 2001 and 2010 using both absolute and relative inequality indices. Results The prevalence of SHS exposure in infants declined from 2001 to 2010. The relative index of inequality increased from 0.85 (95% confidence interval [CI], 0.80 to 0.89) to 1.47 (95% CI, 1.37 to 1.56) based on income and from 1.22 (95% CI, 1.17 to 1.26) to 2.09 (95% CI, 2.00 to 2.17) based on education. In contrast, the slope index of inequality decreased from 30.9 (95% CI, 29.3 to 32.6) to 20.1 (95% CI, 18.7 to 21.5) based on income and from 44.6 (95% CI, 43.1 to 46.2) to 28.7 (95% CI, 27.3 to 30.0) based on education. Having only a father who smoked indoors was a major contributor to absolute income inequality in infants’ SHS exposure in 2010, which increased in importance from 45.1% in 2001 to 67.0% in 2010. Conclusions The socioeconomic inequalities in infants’ second hand smoke exposure increased in relative terms but decreased in absolute terms from 2001 to 2010. Further efforts are needed to encourage parents to quit smoking and protect infants from second hand smoke exposure, especially in low socioeconomic households that include non-smoking mothers. PMID:26431400

The relation between umbilical cord characteristics and the outcome of external cephalic version.

PubMed

Kuppens, Simone M I; Waerenburgh, Evelyne R; Kooistra, Libbe; van der Donk, Riet W P; Hasaart, Tom H M; Pop, Victor J M

2011-05-01

Umbilical cords of fetuses in breech presentation differ in length and coiling from their cephalic counterparts and it might be hypothesised that these cord characteristics may in turn affect ECV outcome. To investigate the relation between umbilical cord characteristics and the outcome of external cephalic version (ECV). Prospective cohort study. Women (>35 weeks gestation) with a singleton fetus in breech presentation, suitable for external cephalic version. Demographic, lifestyle and obstetrical parameters were assessed at intake. ECV success was based on cephalic presentation on ultrasound post-ECV. Umbilical cord length (UCL) and umbilical coiling index (UCI) were measured after birth. The relation between umbilical cord characteristics (cord length and coiling) and the success of external cephalic version. ECV success rate was overall 79/146 (54%), for multiparas 37/46(80%) and for nulliparas 42/100 (42%). Multiple logistic regression showed that UCL (OR: 1.04, CI: 1.01-1.07), nulliparity (OR: 0.20, CI: 0.08-0.51), frank breech (OR: 0.37, 95% CI: 0.15-0.90), body mass index (OR: 0.85, CI: 0.76-0.95), placenta anterior (OR: 0.27, CI: 0.12-0.63) and birth weight (OR: 1.002, CI: 1.001-1.003) were all independently related to ECV success. Umbilical cord length is independently related to the outcome of ECV, whereas umbilical coiling index is not. Copyright © 2011 Elsevier Ltd. All rights reserved.

Development of a site fidelity index based on population capture-recapture data

PubMed Central

Ferrari, Mariano A.; Crespo, Enrique A.; Coscarella, Mariano A.

2018-01-01

Background Site fidelity is considered as an animal’s tendency to return to a previously occupied place; this is a component of animal behaviour that allows us to understand movement patterns and aspects related to the animal’s life history. Although there are many site fidelity metrics, the lack of standardisation presents a considerable challenge in terms of comparability among studies. Methods This investigation focused on the theoretical development of a standardised composite site fidelity index and its statistical distribution in order to obtain reliable population-level site fidelity comparisons. The arithmetic and harmonic means were used as mathematical structures in order to create different indexes by combining the most commonly used indicators for site fidelity such as Occurrence, Permanence and Periodicity. The index performance was then evaluated in simulated populations and one real population of Commerson’s dolphins (Cephalorhynchus commersonii (Lacépède 1804)). In the first case, the indexes were evaluated based on how they were affected by different probability values such as the occurrence of the individual within the study area (φ) and capture probability (p). As a precision measure for the comparison of the indexes, the Wald confidence interval (CI) and the mean square error were applied. Given that there was no previous data concerning the distribution parameters of this population, bootstrap CIs were applied for the study case. Results Eight alternative indexes were developed. The indexes with an arithmetic mean structure, in general, had a consistently inferior performance than those with a harmonic mean structure. The index IH4, in particular, achieved the best results in all of the scenarios and in the study case. Additionally, this index presented a normal distribution. As such, it was proposed as a standardised measure for site fidelity (Standardised Site Fidelity Index—SSFI). Discussion The SSFI is the first standardised metric that quantifies site fidelity at a populational level. It is an estimator that varies between zero and one and works in situations where detection is not perfect and effort can be constant or not. Moreover, it has an associated CI that allows users to make comparisons. PMID:29761064

Psychometric properties of the Numeric Pain Rating Scale and Neck Disability Index in patients with cervicogenic headache.

PubMed

Young, Ian A; Dunning, James; Butts, Raymond; Cleland, Joshua A; Fernández-de-Las-Peñas, César

2018-01-01

Background Self-reported disability and pain intensity are commonly used outcomes in patients with cervicogenic headaches. However, there is a paucity of psychometric evidence to support the use of these self-report outcomes for individuals treated with cervicogenic headaches. Therefore, it is unknown if these measures are reliable, responsive, or result in meaningful clinically important changes in this patient population. Methods A secondary analysis of a randomized clinical trial (n = 110) examining the effects of spinal manipulative therapy with and without exercise in patients with cervicogenic headaches. Reliability, construct validity, responsiveness and thresholds for minimal detectable change and clinically important difference values were calculated for the Neck Disability Index and Numeric Pain Rating Scale. Results The Neck Disability Index exhibited excellent reliability (ICC = 0.92; [95 % CI: 0.46-0.97]), while the Numeric Pain Rating Scale exhibited moderate reliability (ICC = 0.72; [95 % CI: 0.08-0.90]) in the short term. Both instruments also exhibited adequate responsiveness (area under the curve; range = 0.78-0.93) and construct validity ( p < 0.001) in this headache population. Conclusions Both instruments seem well suited as short-term self-report measures for patients with cervicogenic headaches. Clinicians and researchers should expect at least a 2.5-point reduction on the numeric pain rating scale and a 5.5-point reduction on the neck disability index after 4 weeks of intervention to be considered clinically meaningful.

A Frailty Index from Next-of-Kin Data: A Cross-Sectional Analysis from the Mexican Health and Aging Study.

PubMed

Pérez-Zepeda, Mario Ulises; Cesari, Matteo; Carrillo-Vega, María Fernanda; Salinas-Escudero, Guillermo; Tella-Vega, Pamela; García-Peña, Carmen

2017-01-01

Objectives. To construct a frailty index from next-of-kin information of the last year of life of community-dwelling 50 years old or older adults and test its association with health services utilization. Methods. Cross-sectional analysis from next-of-kin data available from the last wave of the Mexican Health and Aging Study (MHAS). Measurements. Along with descriptive statistics, the frailty index (FI) was tested in regression models to assess its association with adverse outcomes previous to death: number of hospitalized days in the previous year and number of visits to a physician in the previous year, in unadjusted and adjusted models. Results. From a total of 2,649 individuals the mean of age was 74.8 (±11.4) and 56.3% ( n = 1,183) were women. The mean of the FI was of 0.279 (±SD 0.131, R = 0.0-0.738) and distribution was biased to the right. There was a significant association ( p < 0.001) between the FI and number of hospitalized days ( β = 45.7, 95% CI 36.1-55.4, p < 0.001) and for the number of visits to a physician ( β = 25.93, 95% CI 19.27-32.6, p < 0.001) both models adjusted for age and sex. Conclusion. The FI constructed with next-of-kin data showed similar characteristics to similar indexes of older adults. It was independently associated with health care use.

Impact of County-Level Socioeconomic Status on Oropharyngeal Cancer Survival in the United States.

PubMed

Megwalu, Uchechukwu C

2017-04-01

Objective To evaluate the impact of county-level socioeconomic status on survival in patients with oropharyngeal cancer in the United States. Study Design Retrospective cohort study via a large population-based cancer database. Methods Data were extracted from the SEER 18 database (Surveillance, Epidemiology, and End Results) of the National Cancer Institute. The study cohort included 18,791 patients diagnosed with oropharyngeal squamous cell carcinoma between 2004 and 2012. Results Patients residing in counties with a low socioeconomic status index had worse overall survival (56.5% vs 63.0%, P < .001) and disease-specific survival (62.7% vs 70.3%, P < .001) than patients residing in counties with a high socioeconomic status index. On multivariable analysis, residing in a county with a low socioeconomic status index was associated with worse overall survival (hazard ratio, 1.21; 95% CI, 1.14-1.29; P < .001) and disease-specific survival (hazard ratio, 1.21; 95% CI, 1.12-1.30; P < .001), after adjusting for race, age, sex, marital status, year of diagnosis, site, American Joint Committee on Cancer stage group, presence of distant metastasis, presence of unresectable tumor, histologic grade, surgical resection of primary site, treatment with neck dissection, and radiation therapy. Conclusion Residing in a county with a low socioeconomic status index is associated with worse survival. Further research is needed to elucidate the mechanism by which socioeconomic status affects survival in oropharyngeal cancer.

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

PubMed

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

2016-05-01

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

Gender disparities in high-quality research revealed by Nature Index journals.

PubMed

Bendels, Michael H K; Müller, Ruth; Brueggmann, Doerthe; Groneberg, David A

2018-01-01

The present study aims to elucidate the state of gender equality in high-quality research by analyzing the representation of female authorships in the last decade (from 2008 to 2016). Based on the Gendermetrics platform, 293,557 research articles from 54 journals listed in the Nature Index were considered covering the categories Life Science, Multidisciplinary, Earth & Environmental and Chemistry. The core method was the combined analysis of the proportion of female authorships and the female-to-male odds ratio for first, co- and last authorships. The distribution of prestigious authorships was measured by the Prestige Index. 29.8% of all authorships and 33.1% of the first, 31.8% of the co- and 18.1% of the last authorships were held by women. The corresponding female-to-male odds ratio is 1.19 (CI: 1.18-1.20) for first, 1.35 (CI: 1.34-1.36) for co- and 0.47 (CI: 0.46-0.48) for last authorships. Women are underrepresented at prestigious authorships compared to men (Prestige Index = -0.42). The underrepresentation accentuates in highly competitive articles attracting the highest citation rates, namely, articles with many authors and articles that were published in highest-impact journals. More specifically, a large negative correlation between the 5-Year-Impact-Factor of a journal and the female representation at prestigious authorships was revealed (r(52) = -.63, P < .001). Women publish fewer articles compared to men (39.0% female authors are responsible for 29.8% of all authorships) and are underrepresented at productivity levels of more than 2 articles per author. Articles with female key authors are less frequently cited than articles with male key authors. The gender-specific differences in citation rates increase the more authors contribute to an article. Distinct differences at the journal, journal category, continent and country level were revealed. The prognosis for the next decades forecast a very slow harmonization of authorships odds between the two genders.

Neighborhood Socioeconomic Circumstances and the Co-Occurrence of Unhealthy Lifestyles: Evidence from 206,457 Australians in the 45 and Up Study

PubMed Central

Feng, Xiaoqi; Astell-Burt, Thomas

2013-01-01

Background Research on the co-occurrence of unhealthy lifestyles has tended to focus mainly upon the demographic and socioeconomic characteristics of individuals. This study investigated the relevance of neighborhood socioeconomic circumstance for multiple unhealthy lifestyles. Method An unhealthy lifestyle index was constructed for 206,457 participants in the 45 and Up Study (2006–2009) by summing binary responses on smoking, alcohol, physical activity and five diet-related variables. Higher scores indicated the co-occurrence of unhealthy lifestyles. Association with self-rated health, quality of life; and risk of psychological distress was investigated using multilevel logistic regression. Association between the unhealthy lifestyle index with neighborhood characteristics (local affluence and geographic remoteness) were assessed using multilevel linear regression, adjusting for individual-level characteristics. Results Nearly 50% of the sample reported 3 or 4 unhealthy lifestyles. Only 1.5% reported zero unhealthy lifestyles and 0.2% had all eight. Compared to people who scored zero, those who scored 8 (the ‘unhealthiest’ group) were 7 times more likely to rate their health as poor (95%CI 3.6, 13.7), 5 times more likely to report poor quality of life (95%CI 2.6, 10.1), and had a 2.6 times greater risk of psychological distress (95%CI 1.8, 3.7). Higher scores among men decreased with age, whereas a parabolic distribution was observed among women. Neighborhood affluence was independently associated with lower scores on the unhealthy lifestyle index. People on high incomes scored higher on the unhealthy lifestyle index if they were in poorer neighborhoods, while those on low incomes had fewer unhealthy lifestyles if living in more affluent areas. Interpretation Residents of deprived neighborhoods tend to report more unhealthy lifestyles than their peers in affluent areas, regardless of their individual demographic and socioeconomic characteristics. Future research should investigate the trade-offs of population-level versus geographically targeted multiple lifestyle interventions. PMID:23977335

SU-G-BRC-04: Collimator Angle Optimization in Volumetric Modulated Arc Therapy

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

Andersen, A; Johnson, C; Bartlett, G

2016-06-15

Purpose: Volumetric modulated arc therapy (VMAT) has revolutionized radiation treatment by decreasing treatment time and monitor units, thus reducing scattered and whole body radiation dose. As the collimator angle changes the apparent leaf gap becomes larger which can impact plan quality, organ at risk (OAR) sparing as well as IMRT QA passing rate which is investigated. Methods: Two sites (prostate and head and neck) that have maximum utilization of VMAT were investigated. Two previously treated VMAT patients were chosen. For each patient 10 plans were created by maintaining constant optimization constraints while varying collimator angles from 0-90 deg at anmore » interval of 10 degrees for the first arc and the appropriate complimentary angle for the second arc. Plans were created with AAA algorithm using 6 MV beam on a Varian IX machine with Millennium 120 MLC. The dose-volume histogram (DVH) for each plan was exported and dosimetric parameters (D98, D95, D50, D2) as well homogeneity index (HI) and conformity index (CI) were computed. Each plan was validated for QA using ArcCheck with gamma index passing criteria of 2%/2 mm and 3%/3 mm. Additionally, normal tissue complication probability (NTCP) for each OAR was computed using Uzan-Nahum software. Results: The CI values for both sites had no impact as target volume coverage in every collimator angle were the same since it was optimized for adequate coverage. The HI which is representative of DVH gradient or dose uniformity in PTV showed a clear trend in both sites. The NTCP for OAR (brain and cochlea) in H&N plan and (bladder and rectum) in prostate plan showed a distinct superiority for collimator angles between 15-30 deg. The gamma passing rates were not correlated with angle. Conclusion: Based on CI, HI, NTCP and gamma passing index, it can be concluded that collimator angles should be maintained within 15–30 deg.« less

Aetiology and risk factors of musculoskeletal disorders in physically active conscripts: a follow-up study in the Finnish Defence Forces

PubMed Central

2010-01-01

Background Musculoskeletal disorders (MSDs) are the main reason for morbidity during military training. MSDs commonly result in functional impairment leading to premature discharge from military service and disabilities requiring long-term rehabilitation. The purpose of the study was to examine associations between various risk factors and MSDs with special attention to the physical fitness of the conscripts. Methods Two successive cohorts of 18 to 28-year-old male conscripts (N = 944, median age 19) were followed for six months. MSDs, including overuse and acute injuries, treated at the garrison clinic were identified and analysed. Associations between MSDs and risk factors were examined by multivariate Cox's proportional hazard models. Results During the six-month follow-up of two successive cohorts there were 1629 MSDs and 2879 health clinic visits due to MSDs in 944 persons. The event-based incidence rate for MSD was 10.5 (95% confidence interval (CI): 10.0-11.1) per 1000 person-days. Most MSDs were in the lower extremities (65%) followed by the back (18%). The strongest baseline factors associated with MSDs were poor result in the combined outcome of a 12-minute running test and back lift test (hazard ratio (HR) 2.9; 95% CI: 1.9-4.6), high waist circumference (HR 1.7; 95% CI: 1.3-2.2), high body mass index (HR 1.8; 95% CI: 1.3-2.4), poor result in a 12-minute running test (HR 1.6; 95% CI: 1.2-2.2), earlier musculoskeletal symptoms (HR 1.7; 95% CI: 1.3-2.1) and poor school success (educational level and grades combined; HR 2.0; 95% CI: 1.3-3.0). In addition, risk factors of long-term MSDs (≥10 service days lost due to one or several MSDs) were analysed: poor result in a 12-minute running test, earlier musculoskeletal symptoms, high waist circumference, high body mass index, not belonging to a sports club and poor result in the combined outcome of the 12-minute running test and standing long jump test were strongly associated with long-term MSDs. Conclusions The majority of the observed risk factors are modifiable and favourable for future interventions. An appropriate intervention based on the present study would improve both aerobic and muscular fitness prior to conscript training. Attention to appropriate waist circumference and body mass index would strengthen the intervention. Effective results from well-planned randomised controlled studies are needed before initiating large-scale prevention programmes in a military environment. PMID:20602765

Medical History, Lifestyle, Family History, and Occupational Risk Factors for Diffuse Large B-Cell Lymphoma: The InterLymph Non-Hodgkin Lymphoma Subtypes Project

PubMed Central

Kricker, Anne; Paltiel, Ora; Flowers, Christopher R.; Wang, Sophia S.; Monnereau, Alain; Blair, Aaron; Maso, Luigino Dal; Kane, Eleanor V.; Nieters, Alexandra; Foran, James M.; Miligi, Lucia; Clavel, Jacqueline; Bernstein, Leslie; Rothman, Nathaniel; Slager, Susan L.; Sampson, Joshua N.; Morton, Lindsay M.; Skibola, Christine F.

2014-01-01

Background Although risk factors for diffuse large B-cell lymphoma (DLBCL) have been suggested, their independent effects, modification by sex, and association with anatomical sites are largely unknown. Methods In a pooled analysis of 4667 cases and 22639 controls from 19 studies, we used stepwise logistic regression to identify the most parsimonious multivariate models for DLBCL overall, by sex, and for selected anatomical sites. Results DLBCL was associated with B-cell activating autoimmune diseases (odds ratio [OR] = 2.36, 95% confidence interval [CI] = 1.80 to 3.09), hepatitis C virus seropositivity (OR = 2.02, 95% CI = 1.47 to 2.76), family history of non-Hodgkin lymphoma (OR = 1.95, 95% CI = 1.54 to 2.47), higher young adult body mass index (OR = 1.58, 95% CI = 1.12 to 2.23, for 35+ vs 18.5 to 22.4 kg/m2), higher recreational sun exposure (OR = 0.78, 95% CI = 0.69 to 0.89), any atopic disorder (OR = 0.82, 95% CI = 0.76 to 0.89), and higher socioeconomic status (OR = 0.86, 95% CI = 0.79 to 0.94). Additional risk factors for women were occupation as field crop/vegetable farm worker (OR = 1.78, 95% CI = 1.22 to 2.60), hairdresser (OR = 1.65, 95% CI = 1.12 to 2.41), and seamstress/embroider (OR = 1.49, 95% CI = 1.13 to 1.97), low adult body mass index (OR = 0.46, 95% CI = 0.29 to 0.74, for <18.5 vs 18.5 to 22.4 kg/m2), hormone replacement therapy started age at least 50 years (OR = 0.68, 95% CI = 0.52 to 0.88), and oral contraceptive use before 1970 (OR = 0.78, 95% CI = 0.62 to 1.00); and for men were occupation as material handling equipment operator (OR = 1.58, 95% CI = 1.02 to 2.44), lifetime alcohol consumption (OR = 0.57, 95% CI = 0.44 to 0.75, for >400kg vs nondrinker), and previous blood transfusion (OR = 0.69, 95% CI = 0.57 to 0.83). Autoimmune disease, atopy, and family history of non-Hodgkin lymphoma showed similar associations across selected anatomical sites, whereas smoking was associated with central nervous system, testicular and cutaneous DLBCLs; inflammatory bowel disease was associated with gastrointestinal DLBCL; and farming and hair dye use were associated with mediastinal DLBCL. Conclusion Our results support a complex and multifactorial etiology for DLBCL with some variation in risk observed by sex and anatomical site. PMID:25174023

The Role of Body Adiposity Index in Determining Body Fat Percentage in Colombian Adults with Overweight or Obesity.

PubMed

Ramírez-Vélez, Robinson; Correa-Bautista, Jorge Enrique; González-Ruíz, Katherine; Tordecilla-Sanders, Alejandra; García-Hermoso, Antonio; Schmidt-RioValle, Jacqueline; González-Jiménez, Emilio

2017-09-21

The aim of this study is to investigate the accuracy of body adiposity index (BAI) as a convenient tool for assessing body fat percentage (BF%) in a sample of adults with overweight/obesity using bioelectrical impedance analysis (BIA). The study population was composed of 96 volunteers (60% female, mean age 40.6 ± 7.5 years old). Anthropometric characteristics (body mass index, height, waist-to-height ratio, hip and waist circumference), socioeconomic status, and diet were assessed, and BF% was measured by BIA-BF% and by BAI-BF%. Pearson's correlation coefficient was used to evaluate the correlation between BAI-BF% and BF% assessed by BIA-BF%, while controlling for potential confounders. The concordance between the BF% measured by both methods was obtained with a paired sample t -test, Lin's concordance correlation coefficient, and Bland-Altman plot analysis. Overall, the correlation between BF% obtained by BIA-BF% and estimated by BAI-BF% was r = 0.885, p < 0.001, after adjusting for potential confounders (age, socioeconomic status, and diet). Lin's concordance correlation coefficient was moderate in both sexes. In the men, the paired t-test showed a significant mean difference in BF% between the methods (-5.6 (95%CI -6.4 to -4.8); p < 0.001). In the women, these differences were (-3.6 (95%CI -4.7 to -2.5); p < 0.001). Overall, the bias of the BAI-BF% was -4.8 ± 3.2 BF%; p < 0.001), indicating that the BAI-BF% method significantly underestimated the BF% in comparison with the reference method. In adults with overweight/obesity, the BAI presents low agreement with BF% measured by BIA-BF%; therefore, we conclude that BIA-BF% is not accurate in either sex when body fat percentage levels are low or high. Further studies are necessary to confirm our findings in different ethnic groups.

The Role of Body Adiposity Index in Determining Body Fat Percentage in Colombian Adults with Overweight or Obesity

PubMed Central

González-Ruíz, Katherine; Schmidt-RioValle, Jacqueline

2017-01-01

The aim of this study is to investigate the accuracy of body adiposity index (BAI) as a convenient tool for assessing body fat percentage (BF%) in a sample of adults with overweight/obesity using bioelectrical impedance analysis (BIA). The study population was composed of 96 volunteers (60% female, mean age 40.6 ± 7.5 years old). Anthropometric characteristics (body mass index, height, waist-to-height ratio, hip and waist circumference), socioeconomic status, and diet were assessed, and BF% was measured by BIA-BF% and by BAI-BF%. Pearson’s correlation coefficient was used to evaluate the correlation between BAI-BF% and BF% assessed by BIA-BF%, while controlling for potential confounders. The concordance between the BF% measured by both methods was obtained with a paired sample t-test, Lin’s concordance correlation coefficient, and Bland-Altman plot analysis. Overall, the correlation between BF% obtained by BIA-BF% and estimated by BAI-BF% was r = 0.885, p < 0.001, after adjusting for potential confounders (age, socioeconomic status, and diet). Lin’s concordance correlation coefficient was moderate in both sexes. In the men, the paired t-test showed a significant mean difference in BF% between the methods (−5.6 (95% CI −6.4 to −4.8); p < 0.001). In the women, these differences were (−3.6 (95% CI −4.7 to −2.5); p < 0.001). Overall, the bias of the BAI-BF% was −4.8 ± 3.2 BF%; p < 0.001), indicating that the BAI-BF% method significantly underestimated the BF% in comparison with the reference method. In adults with overweight/obesity, the BAI presents low agreement with BF% measured by BIA-BF%; therefore, we conclude that BIA-BF% is not accurate in either sex when body fat percentage levels are low or high. Further studies are necessary to confirm our findings in different ethnic groups. PMID:28934175

Insulin resistance and hyperandrogenism drive steatosis and fibrosis risk in young females with PCOS.

PubMed

Petta, Salvatore; Ciresi, Alessandro; Bianco, Jessica; Geraci, Vincenzo; Boemi, Roberta; Galvano, Luigi; Magliozzo, Franco; Merlino, Giovanni; Craxì, Antonio; Giordano, Carla

2017-01-01

Nonalcoholic fatty liver disease (NAFLD) and polycystic ovary syndrome (PCOS) recognize obesity and insulin resistance (IR) as common pathogenic background. We assessed 1) whether PCOS is a risk factor for steatosis, and 2) the impact, in PCOS patients, of IR and hyperandrogenism on steatosis and fibrosis. We considered 202 consecutive Italian PCOS nondiabetic patients and 101 age-matched controls. PCOS was diagnosed applying the Rotterdam diagnostic criteria. Steatosis was diagnosed if hepatic steatosis index (HSI) >36, while fibrosis by using the FIB-4 score. As surrogate estimate of insulin sensitivity we considered the insulin sensitivity index (ISI). Free androgen index (FAI) was calculated as estimate of biochemical hyperandrogenism. In the entire population, steatosis was observed in 68.8% of patients with PCOS, compared to 33.3 of controls (p<0.001), this association being maintained after adjusting for metabolic confounders (OR 3.73, 95% CI 1.74-8.02; P = 0.001). In PCOS patients, steatosis was independently linked to WC (OR 1.04, 95% CI 1.01-1.08; P = 0.006) and ISI Matsuda (OR 0.69, 95% CI 0.53-0.88; P = 0.004), not to free androgen index (OR 1.10, 95% CI 0.96-1.26; P = 0.14). Notably, ISI Matsuda was confirmed as independently associated with steatosis in both obese (OR 0.42, 95% CI 0.23-0.77, P = 0.005) and nonobese (OR 0.69, 95% CI 0.53-0.91, P = 0.009), patients, while FAI (OR 1.45, 95% CI 1.12-1.87; P = 0.004) emerged as an independent risk factor only in nonobese PCOS. Similarly, higher FIB-4 was independently associated with higher FAI (p = 0.02) in nonobese and with lower ISI Matsuda (p = 0.04) in obese patients. We found that PCOS is an independent risk factor for steatosis, and that, IR and hyperandrogenism, this last especially in nonobese patients, are the key players of liver damage in PCOS.

Failure of anticoagulant thromboprophylaxis: risk factors in medical-surgical critically ill patients*.

PubMed

Lim, Wendy; Meade, Maureen; Lauzier, Francois; Zarychanski, Ryan; Mehta, Sangeeta; Lamontagne, Francois; Dodek, Peter; McIntyre, Lauralyn; Hall, Richard; Heels-Ansdell, Diane; Fowler, Robert; Pai, Menaka; Guyatt, Gordon; Crowther, Mark A; Warkentin, Theodore E; Devereaux, P J; Walter, Stephen D; Muscedere, John; Herridge, Margaret; Turgeon, Alexis F; Geerts, William; Finfer, Simon; Jacka, Michael; Berwanger, Otavio; Ostermann, Marlies; Qushmaq, Ismael; Friedrich, Jan O; Cook, Deborah J

2015-02-01

To identify risk factors for failure of anticoagulant thromboprophylaxis in critically ill patients in the ICU. Multivariable regression analysis of thrombosis predictors from a randomized thromboprophylaxis trial. Sixty-seven medical-surgical ICUs in six countries. Three thousand seven hundred forty-six medical-surgical critically ill patients. All patients received anticoagulant thromboprophylaxis with low-molecular-weight heparin or unfractionated heparin at standard doses. Independent predictors for venous thromboembolism, proximal leg deep vein thrombosis, and pulmonary embolism developing during critical illness were assessed. A total of 289 patients (7.7%) developed venous thromboembolism. Predictors of thromboprophylaxis failure as measured by development of venous thromboembolism included a personal or family history of venous thromboembolism (hazard ratio, 1.64; 95% CI, 1.03-2.59; p = 0.04) and body mass index (hazard ratio, 1.18 per 10-point increase; 95% CI, 1.04-1.35; p = 0.01). Increasing body mass index was also a predictor for developing proximal leg deep vein thrombosis (hazard ratio, 1.25; 95% CI, 1.06-1.46; p = 0.007), which occurred in 182 patients (4.9%). Pulmonary embolism occurred in 47 patients (1.3%) and was associated with body mass index (hazard ratio, 1.37; 95% CI, 1.02-1.83; p = 0.035) and vasopressor use (hazard ratio, 1.84; 95% CI, 1.01-3.35; p = 0.046). Low-molecular-weight heparin (in comparison to unfractionated heparin) thromboprophylaxis lowered pulmonary embolism risk (hazard ratio, 0.51; 95% CI, 0.27-0.95; p = 0.034) while statin use in the preceding week lowered the risk of proximal leg deep vein thrombosis (hazard ratio, 0.46; 95% CI, 0.27-0.77; p = 0.004). Failure of standard thromboprophylaxis using low-molecular-weight heparin or unfractionated heparin is more likely in ICU patients with elevated body mass index, those with a personal or family history of venous thromboembolism, and those receiving vasopressors. Alternate management or incremental risk reduction strategies may be needed in such patients.

Feeding Practices in Infancy Associated with Caries Incidence in Early Childhood

PubMed Central

Chaffee, Benjamin W.; Feldens, Carlos Alberto; Rodrigues, Priscila Humbert; Vítolo, Márcia Regina

2015-01-01

Early-life feeding behaviors foretell later dietary habits and health outcomes. Few studies have examined infant dietary patterns and caries occurrence prospectively. OBJECTIVE Assess whether patterns in food and drink consumption before age 12 months are associated with caries incidence by preschool age. METHODS We collected early-life feeding data within a birth cohort from low-income families in Porto Alegre, Brazil. Three dietary indexes were defined, based on refined sugar content and/or previously reported caries associations: a count of sweet foods or drinks introduced <6-months (e.g., candy, cookies, soft drinks), a count of other, non-sweet items introduced <6-months (e.g., beans, meat), and a count of sweet items consumed at 12 months. Incidence of severe early childhood caries (S-ECC) at age 38 months (N=458) was compared by score tertile on each index, adjusted for family, maternal, and child characteristics using regression modeling. RESULTS Introduction to a greater number of presumably cariogenic items in infancy was positively associated with future caries. S-ECC incidence was highest in the uppermost tertile of the “6-month sweet index” (adjusted cumulative incidence ratio, RR, versus lowest tertile: 1.46; 95% CI: 0.97, 2.04) and the uppermost tertile of the “12-month sweet index” (RR: 1.55; 95% CI: 1.17, 2.23). The association was specific for sweet items: caries incidence did not differ by tertile of the “6-month non-sweet index” (RR: 1.00; 95% CI: 0.70, 1.40). Additionally, each one-unit increase on the 6-month and the 12-month sweet indexes, but not the 6-month non-sweet index, was statistically significantly associated with greater S-ECC incidence and associated with more decayed, missing or restored teeth. Results were robust to minor changes in the items constituting each index and persisted if liquid items were excluded. CONCLUSIONS Dietary factors observed before age 12-months were associated with S-ECC at preschool age, highlighting a need for timely, multi-level intervention. PMID:25753518

Ultrasonographic evaluation of myometrial thickness and prediction of a successful external cephalic version.

PubMed

Buhimschi, Catalin S; Buhimschi, Irina A; Wehrum, Mark J; Molaskey-Jones, Sherry; Sfakianaki, Anna K; Pettker, Christian M; Thung, Stephen; Campbell, Katherine H; Dulay, Antonette T; Funai, Edmund F; Bahtiyar, Mert O

2011-10-01

To test the hypothesis that myometrial thickness predicts the success of external cephalic version. Abdominal ultrasonographic scans were performed in 114 consecutive pregnant women with breech singletons before an external cephalic version maneuver. Myometrial thickness was measured by a standardized protocol at three sites: the lower segment, midanterior wall, and the fundal uterine wall. Independent variables analyzed in conjunction with myometrial thickness were: maternal age, parity, body mass index, abdominal wall thickness, estimated fetal weight, amniotic fluid index, placental thickness and location, fetal spine position, breech type, and delivery outcomes such as final mode of delivery and birth weight. Successful version was associated with a thicker ultrasonographic fundal myometrium (unsuccessful: 6.7 [5.5-8.4] compared with successful: 7.4 [6.6-9.7] mm, P=.037). Multivariate regression analysis showed that increased fundal myometrial thickness, high amniotic fluid index, and nonfrank breech presentation were the strongest independent predictors of external cephalic version success (P<.001). A fundal myometrial thickness greater than 6.75 mm and an amniotic fluid index greater than 12 cm were each associated with successful external cephalic versions (fundal myometrial thickness: odds ratio [OR] 2.4, 95% confidence interval [CI] 1.1-5.2, P=.029; amniotic fluid index: OR 2.8, 95% CI 1.3-6.0, P=.008). Combining the two variables resulted in an absolute risk reduction for a failed version of 27.6% (95% CI 7.1-48.1) and a number needed to treat of four (95% CI 2.1-14.2). Fundal myometrial thickness and amniotic fluid index contribute to success of external cephalic version and their evaluation can be easily incorporated in algorithms before the procedure. III.

Diet quality and the risk of cardiovascular disease: the Women's Health Initiative (WHI)123

PubMed Central

Belin, Rashad J; Greenland, Philip; Allison, Matthew; Martin, Lisa; Shikany, James M; Larson, Joseph; Tinker, Lesley; Howard, Barbara V; Lloyd-Jones, Donald

2011-01-01

Background: The association between diet quality and risk of incident cardiovascular disease (CVD) or heart failure (HF) in postmenopausal women is uncertain. Objective: This study aimed to determine whether a conventional index [Alternate Healthy Eating Index (AHEI)] or a novel index [Women's Health Initiative (WHI) Dietary Modification Index (DMI)] of diet quality was associated with the risk of incident CVD or HF in the WHI Observational Study (WHI-OS). Design: The WHI-OS is an observational cohort study of 93,676 women aged 50–79 y of diverse ethnicity and backgrounds followed for an average of 10.0 y for CVD events. The individual components of the AHEI and DMI were determined from the baseline WHI food-frequency questionnaire. Incident CVD was a composite of nonfatal myocardial infarction, coronary heart disease death, stroke, coronary revascularization, and incident HF. The association between AHEI or DMI and incident CVD or incident HF was determined by using Cox models adjusted for traditional CVD and HF risk factors. Results: Women with a DMI in the highest quintile had hazard ratios (HRs) of 0.88 (95% CI: 0.80, 0.95) and 0.91 (95% CI: 0.78, 1.06) for incident CVD and HF, respectively. Women with an AHEI in the highest quintile had HRs of 0.77 (95% CI: 0.70, 0.84) and 0.70 (95% CI: 0.59, 0.82) for incident CVD and HF, respectively. Conclusion: Overall, adherence to current nutrient guidelines (as indexed by the DMI) are associated with lower total CVD risk, and additional dietary factors (as indexed by the AHEI) were associated with a lower risk of CVD and HF. PMID:21613562

The determinants of chronic bronchitis in Aboriginal children and youth

PubMed Central

Hossain, Alomgir; Konrad, Stephanie; Dosman, James A; Senthilselvan, Ambikaipakan; McCrosky, Jesse; Pahwa, Punam

2012-01-01

BACKGROUND: There is limited knowledge concerning chronic bronchitis (CB) in Canadian Aboriginal peoples. OBJECTIVE: To determine the prevalence (crude and adjusted) of CB and its associated risk factors in Canadian Aboriginal children and youth six to 14 years of age. METHODS: Data from the cross-sectional Aboriginal Peoples Survey were analyzed in the present study. Logistic regression analysis was used to determine risk factors influencing the prevalence of CB among Aboriginal children and youth. The balanced repeated replication method was used to compute standard errors of regression coefficients to account for clustering inherent in the study design. The outcome of interest was based on the question: “Have you been told by a doctor, nurse or other health professional that you have chronic bronchitis?” Demographics, environment and population characteristics (predisposing and enabling resources) were tested for an association with CB. RESULTS: The prevalence of CB was 3.1% for boys and 2.8% for girls. Other significant risk factors of CB were age (OR 1.38 [95% CI 1.24 to 1.52] for 12 to 14 year olds versus six to eight year olds), income (OR 2.28 [95% CI 2.02 to 2.59] for income category <$25,000/year versus ≥$85,000/year), allergies (OR 1.96 [95% CI 1.78 to 2.16] for having allergies versus no allergies), asthma (OR 7.61 [ 95% CI 6.91 to 8.37] for having asthma versus no asthma) and location of residence (rural/urban and geographical location). A significant two-way interaction between sex and body mass index indicated that the relationship between the prevalence of CB and body mass index was modified by sex. DISCUSSION: The prevalence of CB was related to well-known risk factors among adults, including older age and lower annual income. PMID:23248806

Shift work schedule and night work load: Effects on body mass index - a four-year longitudinal study.

PubMed

Buchvold, Hogne Vikanes; Pallesen, Ståle; Waage, Siri; Bjorvatn, Bjørn

2018-05-01

Objectives The aim of this study was to investigate changes in body mass index (BMI) between different work schedules and different average number of yearly night shifts over a four-year follow-up period. Methods A prospective study of Norwegian nurses (N=2965) with different work schedules was conducted: day only, two-shift rotation (day and evening shifts), three-shift rotation (day, evening and night shifts), night only, those who changed towards night shifts, and those who changed away from schedules containing night shifts. Paired student's t-tests were used to evaluate within subgroup changes in BMI. Multiple linear regression analysis was used to evaluate between groups effects on BMI when adjusting for BMI at baseline, sex, age, marital status, children living at home, and years since graduation. The same regression model was used to evaluate the effect of average number of yearly night shifts on BMI change. Results We found that night workers [mean difference (MD) 1.30 (95% CI 0.70-1.90)], two shift workers [MD 0.48 (95% CI 0.20-0.75)], three shift workers [MD 0.46 (95% CI 0.30-0.62)], and those who changed work schedule away from [MD 0.57 (95% CI 0.17-0.84)] or towards night work [MD 0.63 (95% CI 0.20-1.05)] all had significant BMI gain (P<0.01) during the follow-up period. However, day workers had a non-significant BMI gain. Using adjusted multiple linear regressions, we found that night workers had significantly larger BMI gain compared to day workers [B=0.89 (95% CI 0.06-1.72), P<0.05]. We did not find any significant association between average number of yearly night shifts and BMI change using our multiple linear regression model. Conclusions After adjusting for possible confounders, we found that BMI increased significantly more among night workers compared to day workers.

Association of the ankle-brachial index with history of myocardial infarction and stroke.

PubMed

Jones, W Schuyler; Patel, Manesh R; Rockman, Caron B; Guo, Yu; Adelman, Mark; Riles, Thomas; Berger, Jeffrey S

2014-04-01

Ankle-brachial index (ABI) testing is a simple, noninvasive method to diagnose peripheral artery disease (PAD) and is associated with all-cause mortality. The association of ABI levels and myocardial infarction (MI) and stroke is less certain. We sought to further characterize the association between ABI levels and history of MI and stroke. Using data from the Life Line Screening program, 3.6 million self-referred participants from 2003 to 2008 completed a medical questionnaire and had bilateral ABIs performed. Logistic regression was used to estimate the association between ABI cutoff points (ABI <0.90 and ABI >1.40) and ABI levels with history of MI, stroke, and MI or stroke (MI/stroke). Models were adjusted for age, sex, race/ethnicity, smoking, diabetes, hypertension, hypercholesterolemia, physical activity, and family history of cardiovascular disease. Separate sex-specific models were performed. Overall, 155,552 (4.5%) had an ABI <0.90, and 42,890 (1.2%) had an ABI >1.40. An ABI <0.90 was associated with higher odds of MI (adjusted odds ratio [OR] 1.67, 95% CI 1.63-1.71), stroke (OR 1.77, 95% CI 1.72-1.82), and MI/stroke (OR 1.71, 95% CI 1.67-1.74), all P < .001. An ABI >1.40 was also associated with higher odds of MI (OR 1.19, 95% CI 1.14-1.24), stroke (OR 1.30, 95% CI 1.22-1.38), and MI/stroke (OR 1.22, 95% CI 1.17-1.27), all P < .001. The ORs for MI/stroke for different ABI levels formed a reverse J-shaped curve in both women and men. In a large national screening database, there is a strong, consistent relationship between ABI levels and a history of prevalent MI, stroke, and MI/stroke. Copyright © 2014 Mosby, Inc. All rights reserved.

Use of antibiotics during pregnancy and risk of spontaneous abortion

PubMed Central

Muanda, Flory T.; Sheehy, Odile; Bérard, Anick

2017-01-01

BACKGROUND: Although antibiotics are widely used during pregnancy, evidence regarding their fetal safety remains limited. Our aim was to quantify the association between antibiotic exposure during pregnancy and risk of spontaneous abortion. METHODS: We conducted a nested case–control study within the Quebec Pregnancy Cohort (1998–2009). We excluded planned abortions and pregnancies exposed to fetotoxic drugs. Spontaneous abortion was defined as having a diagnosis or procedure related to spontaneous abortion before the 20th week of pregnancy. The index date was defined as the calendar date of the spontaneous abortion. Ten controls per case were randomly selected and matched by gestational age and year of pregnancy. Use of antibiotics was defined by filled prescriptions between the first day of gestation and the index date and was compared with (a) non-exposure and (b) exposure to penicillins or cephalosporins. We studied type of antibiotics separately using the same comparator groups. RESULTS: After adjustment for potential confounders, use of azithromycin (adjusted odds ratio [OR] 1.65, 95% confidence interval [CI] 1.34–2.02; 110 exposed cases), clarithromycin (adjusted OR 2.35, 95% CI 1.90–2.91; 111 exposed cases), metronidazole (adjusted OR 1.70, 95% CI 1.27–2.26; 53 exposed cases), sulfonamides (adjusted OR 2.01, 95% CI 1.36–2.97; 30 exposed cases), tetracyclines (adjusted OR 2.59, 95% CI 1.97–3.41; 67 exposed cases) and quinolones (adjusted OR 2.72, 95% CI 2.27–3.27; 160 exposed cases) was associated with an increased risk of spontaneous abortion. Similar results were found when we used penicillins or cephalosporins as the comparator group. INTERPRETATION: After adjustment for potential confounders, use of macro-lides (excluding erythromycin), quinolones, tetracyclines, sulfonamides and metronidazole during early pregnancy was associated with an increased risk of spontaneous abortion. Our findings may be of use to policy-makers to update guidelines for the treatment of infections during pregnancy. PMID:28461374

The value of three-dimensional photogrammetry in isolated sagittal synostosis: Impact of age and surgical technique on intracranial volume and cephalic index─a retrospective cohort study.

PubMed

Mertens, Christian; Wessel, Eline; Berger, Moritz; Ristow, Oliver; Hoffmann, Jürgen; Kansy, Katinka; Freudlsperger, Christian; Bächli, Heidrun; Engel, Michael

2017-12-01

The aim of this study was to compare the outcome of intracranial volume (ICV) and cephalic index (CI) between two different techniques for surgical therapy of sagittal synostosis. Between 2011 and 2015, all patients scheduled for surgical therapy of sagittal synostosis were consecutively enrolled. All patients younger than 6 months underwent early extended strip craniectomy (ESC group), and patients older than 6 months underwent late modified pi-procedure (MPP group). To measure ICV and CI, data acquisition was performed via three-dimensional photogrammetry, 1 day before (T0) and between 10 and 12 weeks after surgery (T1). Results were compared with an age-matched reference group of healthy children. Perioperative parameters, as duration of surgery and the amount of blood loss of both surgical procedures were analyzed. A total of 85 patients were enrolled. Of the patients, 48 underwent an extended strip craniotomy with parietal osteotomies and biparietal widening and 37 patients underwent a late modified pi-procedure. There was no significant difference between the ESC group and the MPP group regarding the efficacy of improving CI (p > 0.05). Both techniques were able to normalize CI and to improve head shape. ICV was normal compared to age-matched norm-groups with both techniques, pre- and postoperatively. However, duration of the surgical procedure and calculated blood loss were significantly lower in the ESC group (p < 0.05). ESC and MPP were effective techniques to normalize cephalic index (CI) and improve head shape at their recommended time of surgery. Measurement of ICV and CI with 3D photogrammetry is a valid method to objectively evaluate patients before and after surgery without exposing pediatric patients to ionizing radiation. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Interaction between body mass index and hormone-receptor status as a prognostic factor in lymph-node-positive breast cancer

PubMed Central

Chung, Il Yong; Park, Yu Rang; Min, Yul Ha; Lee, Yura; Yoon, Tae In; Sohn, Guiyun; Lee, Sae Byul; Kim, Jisun; Kim, Hee Jeong; Ko, Beom Seok; Son, Byung Ho; Ahn, Sei Hyun

2017-01-01

The aim of this study was to determine the relationship between the body mass index (BMI) at a breast cancer diagnosis and various factors including the hormone-receptor, menopause, and lymph-node status, and identify if there is a specific patient subgroup for which the BMI has an effect on the breast cancer prognosis. We retrospectively analyzed the data of 8,742 patients with non-metastatic invasive breast cancer from the research database of Asan Medical Center. The overall survival (OS) and breast-cancer-specific survival (BCSS) outcomes were compared among BMI groups using the Kaplan-Meier method and Cox proportional-hazards regression models with an interaction term. There was a significant interaction between BMI and hormone-receptor status for the OS (P = 0.029), and BCSS (P = 0.013) in lymph-node-positive breast cancers. Obesity in hormone-receptor-positive breast cancer showed a poorer OS (adjusted hazard ratio [HR] = 1.51, 95% confidence interval [CI] = 0.92 to 2.48) and significantly poorer BCSS (HR = 1.80, 95% CI = 1.08 to 2.99). In contrast, a high BMI in hormone-receptor-negative breast cancer revealed a better OS (HR = 0.44, 95% CI = 0.16 to 1.19) and BCSS (HR = 0.53, 95% CI = 0.19 to 1.44). Being underweight (BMI < 18.50 kg/m2) with hormone-receptor-negative breast cancer was associated with a significantly worse OS (HR = 1.98, 95% CI = 1.00–3.95) and BCSS (HR = 2.24, 95% CI = 1.12–4.47). There was no significant interaction found between the BMI and hormone-receptor status in the lymph-node-negative setting, and BMI did not interact with the menopause status in any subgroup. In conclusion, BMI interacts with the hormone-receptor status in a lymph-node-positive setting, thereby playing a role in the prognosis of breast cancer. PMID:28248981

[The value of fasting plasma glucose and lipid profiles between 7 and 15 gestational weeks in the prediction of gestational diabetes mellitus].

PubMed

Zhao, M; Li, G H

2016-11-25

Objective: To explore the value of using fasting plasma glucose (FPG) and lipid profiles between 7 and 15 gestational weeks to predict gestational diabetes mellitus (GDM). Methods: The medical records of 2 138 pregnant women who had prenatal care in Beijing Obstetrics and Gynecology Hospital from August 2011 to February 2012 were analyzed retrospectively. According to results of the oral glucose tolerance tests, women were devided into the GDM group ( n =240) and the normal group ( n= 1 898). Maternal characteristics, FPG and lipid levels between 7 and 15 gestational weeks were compared between the two groups. Logistic regression analysis and receiver operator characteristics(ROC) curve were used in the analysis. Results: Potential markers for the prediction of GDM included total cholesterol, triglyceride (TG) , low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratios (LDL-C/HDL-C) , triglyceride to high-density lipoprotein cholesterol ratios (TG/HDL-C) and FPG. After adjustment of confounding factors, age ( OR= 1.046, 95% CI: 1.003-1.090), pre- pregnancy body mass index ( OR= 1.104, 95% CI: 1.049-1.161), gravidity>3 ( OR= 1.768, 95% CI: 1.071-2.920), FPG ( OR= 8.137, 95% CI: 5.412-12.236), TG ( OR= 1.460, 95% CI: 1.148-1.858) were independently associated with the risk of developing GDM. Equation, P GDM =1/{1+exp[-(-16.542+0.045×age+0.103×pre-pregnancy body mass index+0.551×gravidity>3+2.110×FPG+0.372×TG)]}, was constructed by the logistic regression analysis. Sensitivity (67.5%) and specificity (70.5%) were determined by the calculated risk score, with a cut-off value of 0.11 (area under the curve: 0.751, 95% CI: 0.718-0.783, P< 0.001). Conclusions: FPG and TG, together with clinical characteristics may have a better predictive value for the risk of GDM.

Cell kinetics and genetic instabilities in differentiated type early gastric cancers with different mucin phenotype.

PubMed

Shibata, Naomi; Watari, Jiro; Fujiya, Mikihiro; Tanno, Satoshi; Saitoh, Yusuke; Kohgo, Yutaka

2003-01-01

To clarify the biological impact and molecular pathogenesis of cellular phenotype in differentiated-type gastric cancers (DGCs), we investigated cell kinetics and genetic instabilities in early stage of DGCs. A total of 43 early gastric cancers (EGCs) were studied. EGCs were divided into 3 phenotypic categories: gastric (G type, n = 11), ordinary (O type, n = 20), and complete intestinal (CI type, n = 12) based on the combination of HGM, ConA, MUC2, and CD10. Proliferative index (PI), apoptotic index (AI), and p53 overexpression were investigated by immunohistochemical staining with anti-Ki-67, the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling method, and p53 antibody, respectively. Using a high-resolution fluorescent microsatellite analysis system, microsatellite instability (MSI) and loss of heterozygosity (LOH) were examined. Frameshift mutation analysis of transforming growth factor-beta type II receptor (TGF-betaRII) and bcl-2-associated X (BAX) in cancers with MSI was also performed. The mean AI/PI ratio values were 0.04 for G-type, 0.10 for O-type, and 0.13 for CI-type cancers--significantly lower in G type than in O and CI types (P = 0.02 and P = 0.001, respectively). No difference in the incidence of MSI and LOH was seen among the 3 cellular phenotypes. However, the major pattern of MSI, which showed drastic and widely dispersed changes and is related to an increased risk for cancer, was significantly higher in G and O types than in CI type (P <0.005). No frame shift mutations of TGF-betaRII or BAX were found in CI-type cancers. These results indicate that G-type cancers are likely to show more aggressive behaviors than CI-type cancers, and that O-type cancers show the intermediate characteristics of both types. However, the molecular pathogenesis of each phenotypic cancer is not associated with microsatellite alterations. Copyright 2003, Elsevier Science (USA). All rights reserved.

Suicide After Deliberate Self-Harm in Adolescents and Young Adults.

PubMed

Olfson, Mark; Wall, Melanie; Wang, Shuai; Crystal, Stephen; Bridge, Jeffrey A; Liu, Shang-Min; Blanco, Carlos

2018-04-01

Among adolescents and young adults with nonfatal self-harm, our objective is to identify risk factors for repeated nonfatal self-harm and suicide death over the following year. A national cohort of patients in the Medicaid program, aged 12 to 24 years ( n = 32 395), was followed for up to 1 year after self-harm. Cause of death information was obtained from the National Death Index. Repeat self-harm per 1000 person-years and suicide deaths per 100 000 person-years were determined. Hazard ratios (HRs) of repeat self-harm and suicide were estimated by Cox proportional hazard models. Suicide standardized mortality rate ratios were derived by comparison with demographically matched general population controls. The 12-month suicide standardized mortality rate ratio after self-harm was significantly higher for adolescents (46.0, 95% confidence interval [CI]: 29.9-67.9) than young adults (19.2, 95% CI: 12.7-28.0). Hazards of suicide after self-harm were significantly higher for American Indians and Alaskan natives than non-Hispanic white patients (HR: 4.69, 95% CI: 2.41-9.13) and for self-harm patients who initially used violent methods (HR: 18.04, 95% CI: 9.92-32.80), especially firearms (HR: 35.73, 95% CI: 15.42-82.79), compared with nonviolent self-harm methods (1.00, reference). The hazards of repeat self-harm were higher for female subjects than male subjects (HR: 1.25, 95% CI: 1.18-1.33); patients with personality disorders (HR: 1.55, 95% CI: 1.42-1.69); and patients whose initial self-harm was treated in an inpatient setting (HR: 1.65, 95% CI: 1.49-1.83) compared with an emergency department (HR: 0.62, 95% CI: 0.55-0.69) or outpatient (1.00, reference) setting. After nonfatal self-harm, adolescents and young adults were at markedly elevated risk of suicide. Among these high-risk patients, those who used violent self-harm methods, particularly firearms, were at especially high risk underscoring the importance of follow-up care to help ensure their safety. Copyright © 2018 by the American Academy of Pediatrics.

Third molar maturity index (I3M) for assessing age of majority in a black African population in Botswana.

PubMed

Cavrić, Jelena; Galić, Ivan; Vodanović, Marin; Brkić, Hrvoje; Gregov, Jelena; Viva, Serena; Rey, Laura; Cameriere, Roberto

2016-07-01

Assessment of legal age, also known as age of majority, is a controversial issue as there are few body biomarkers or evidence during late adolescence differentiating a subject from being a minor or adult. The third molar was recognized as a suitable site for age examination in late adolescence. We analyzed the development of the left mandibular third molar by the third molar maturity index (I3M) and a specific cut-off value of I3M = 0.08, established by Cameriere et al. in 2008 and used it for discriminating between minors and adult black Africans from Gaborone, Botswana. A final sample of panoramic radiographs (OPTs) of 1294 people (582 males and 712 females) aged between 13 and 23 years was evaluated. The real age decreased as I3M gradually increased. There was no statistically significant difference in the third molar development evaluated using I3M between males and females (p > 0.05) across different I3M classes. Results of 2 × 2 contingency tables for different cut-off values indicated that I3M = 0.08 was useful in discriminating between adults and minors. Precisely, for I3M = 0.08, the values of accuracy or overall fraction of correctly classified were 0.91 in males with a 95 % confidence interval (95 % CI) of 0.88 to 0.93 and 0.92 (95 % CI, 0.90 to 0.93) in females. Values of sensitivity of the test or the proportion of participants being 18 years and older were 0.88 (95 % CI, 0.87 to 0.90) in males and 0.88 (95 % CI, 0.90 to 0.93) in females, while values of specificity or proportion of individuals younger than 18 who have I3M <0.08 were 0.94 (95 % CI, 0.91 to 0.96) in males and 0.96 (95 % CI, 0.94 to 0.98) in females. Positive predictive values of the test, where the participants whose I3M <0.08 were adults, were 0.94 (95 % CI 0.91 to 0.96) in males and 0.97 (95 % CI, 0.94 to 0.98) in females, while negative predictive values of the test, where the participants whose I3M was ≥0.08 were minors, were 0.88 (95 % CI 0.85 to 0.90) in males and 0.97 (95 % CI, 0.94 to 0.98) in females. The likelihood ratios of the positive test (LR+) were 13.67 (95 % CI, 9.21 to 21.02) in males and 23.73 (95 % CI, 14.20 to 42.28) in females, while likelihood ratios of the negative test (LR-) were 0.12 (95 % CI 0.10 to 0.16) in males and 0.12 (95 % CI, 0.11 to 0.15) in females. Bayes post-test probabilities, p, were 0.94 (95 % CI 0.90 to 0.98) in males and 0.97 (95 %CI, 0.93 to 1.00) in females. These results indicate with high accuracy that I3M may be a useful alternative method in legal and forensic practice to discriminate individuals of black African origin who are around the legal adult age of 18 years in Botswana. Further studies should address the usefulness of this method and specific cut-off for different adolescent populations.

General Certificate of Secondary Education performance in very low birthweight infants

PubMed Central

Pharoah, P; Stevenson, C; West, C

2003-01-01

Aim: To compare children of very low birth weight with matched controls for their performance in the General Certificate of Secondary Education (GCSE). Methods: GCSE examination results of 167 children of birth weight ⩽1500 g attending mainstream schools and without clinical disability and 167 individually matched classroom controls were analysed. Results: In 143 instances, both children of a matched pair were entered for examination in one or more GCSE subjects. The total points score obtained was greater in the comparison group than in the index cases (difference between means 4.45: 95% CI 0.95 to 7.94; p = 0.01). The mean point score per examination subject was also significantly greater in the comparison group than in the index cases (mean of differences 0.43: 95% CI 0.12 to 0.73; p < 0.01). Conclusions: As the children were closely matched for school and several social variables, factors acting during fetal or early postnatal development of very low birthweight infants probably compromise performance in the GCSE examination to a greater extent than school or childhood social environmental factors. PMID:12651749

Laughter is the Best Medicine? A Cross-Sectional Study of Cardiovascular Disease Among Older Japanese Adults

PubMed Central

Hayashi, Kei; Kawachi, Ichiro; Ohira, Tetsuya; Kondo, Katsunori; Shirai, Kokoro; Kondo, Naoki

2016-01-01

Background We sought to evaluate the associations between frequency of daily laughter with heart disease and stroke among community-dwelling older Japanese women and men. Methods We analyzed cross-sectional data in 20 934 individuals (10 206 men and 10 728 women) aged 65 years or older, who participated in the Japan Gerontological Evaluation Study in 2013. In the mail-in survey, participants provided information on daily frequency of laughter, as well as body mass index, demographic and lifestyle factors, and diagnoses of cardiovascular disease, hyperlipidemia, hypertension, and depression. Results Even after adjustment for hyperlipidemia, hypertension, depression, body mass index, and other risk factors, the prevalence of heart diseases among those who never or almost never laughed was 1.21 (95% CI, −1.03–1.41) times higher than those who reported laughing every day. The adjusted prevalence ratio for stroke was 1.60 (95% CI, 1.24–2.06). Conclusions Daily frequency of laughter is associated with lower prevalence of cardiovascular diseases. The association could not be explained by confounding factors, such as depressive symptoms. PMID:26972732

Relationship between risk factors and activities of daily living using modified Shah Barthel Index in stroke patients

NASA Astrophysics Data System (ADS)

Kusumaningsih, W.; Rachmayanti, S.; Werdhani, R. A.

2017-08-01

Hypertension and diabetes mellitus are the most common risk factors of stroke. The study aimed to determine the relationship between hypertension and diabetes mellitus risk factors and dependence on assistance with activities of daily living in chronic stroke patients. The study used an analytical observational cross-sectional design. The study’s sample included 44 stroke patients selected using the quota sampling method. The relationship between the variables was analyzed using the bivariate chi-squared test and multivariate logistic regression. Based on the chi-squared test, the relationship between the Modified Shah Barthel Index (MSBI) score and hypertension and diabetes mellitus as stroke risk factors, were p = 0.122 and p = 0.002, respectively. The logistic regression results suggest that hypertension and diabetes mellitus are stroke risk factors related to the MSBI score: p = 0.076 (OR 4.076; CI 95% 0.861-19.297) and p = 0.007 (OR 22.690; CI 95% 2.332-220.722), respectively. Diabetes mellitus is the most prominent risk factor of severe dependency on assistance with activities of daily living in chronic stroke patients.

Effects of prolonged exercise versus multiple short exercise sessions on risk for metabolic syndrome and the atherogenic index in middle-aged obese women: a randomised controlled trial.

PubMed

Chung, JinWook; Kim, KwangJun; Hong, Jeeyoung; Kong, Hyoun-Joong

2017-08-22

Many people, although they may recognise the positive effects of exercise, do not exercise regularly owing to lack of time. This study aimed to investigate the effects of prolonged single-session exercise and multiple short sessions of exercise on the risk of metabolic syndrome and the atherogenic index in middle-aged obese women. Thirty-six participants were divided into the single-session group, multiple-session group, and control group. The single-session group engaged in one session of treadmill exercise for 30 min a day; the multiple-session group had three sessions of 10 min a day. Both groups exercised 3 days/week for 12 weeks. The control group did not perform any exercise. The single-session group showed decreases in weight (0.97 kg [95% C.I. = 0.09-1.83], p < .05), body mass index (0.43 kg/m 2 [95% C.I. = 0.03-0.81], p < .05), and fat mass (1.65 kg, [95% C.I. = 0.78-2.51], p < .01). Systolic blood pressure dropped in the single-session group (6.66 mmHg, [95% C.I. = 1.44-11.88], p < .05), and diastolic blood pressure dropped in the multiple-session group (3.38 mmHg, [95% C.I. = 1.44-5.88], p < .01). High-density lipoprotein cholesterol rose in the single-session group (4.08 mg/dL, [95% C.I. = -8.08-(-)0.07], p < .05) and dropped in the control group (10.75 mg/dL [95% C.I. = 1.95-19.54], p < .01). According to post hoc analysis, high-density lipoprotein cholesterol increased more in the single-session group than the control group (95% C.I. = 0.61-21.88, p < .05). Glucose levels decreased in both the single-session group (16 mg/dL [95% C.I. = 5.64-26.35], p < .01) and the multiple-session group (12.16 mg/dL, [95% C.I. = 2.18-22.14], p < .05). Waist circumference decreased in the single-session group (2.65 cm [95% C.I. = 1.46-3.83], p < .001) and multiple-session group (2.04 cm, [95% C.I. = 1.51-2.73], p < .001). Low-density lipoprotein cholesterol levels rose in both the multiple-session group (-15.79 mg/dL [95% C.I. = -34.24-(-)3.78], p < .05) and the control group (-22.94 mg/dL [95% C.I. = -44.63-(-)1.24], p < .05). The atherogenic index increased in the control group (-1.06 [95% C.I. = -1.69-(-)0.41], p < .01). The findings indicate that prolonged exercise is superior to multiple short sessions for improving the risk of metabolic syndrome and the atherogenic index in middle-aged obese women. However, multiple short sessions can be recommended as an alternative to prolonged exercise when the goal is to decrease blood glucose or waist circumference.

Increased long-term recreational physical activity is associated with older age at natural menopause among heavy smokers: the California Teachers Study

PubMed Central

Emaus, Aina; Dieli-Conwright, Christina; Xu, Xinxin; Lacey, James V.; Ingles, Sue A.; Reynolds, Peggy; Bernstein, Leslie; Henderson, Katherine D.

2012-01-01

Objective Although physical activity modulates the hypothalamic-ovarian-pituitary axis, the few studies investigating whether physical activity is associated with age at natural menopause have had mixed results. We set out to determine whether physical activity is associated with the timing of natural menopause in a large cohort of California women, overall, and by smoking history. Methods We investigated the association between long-term physical activity (hours/week/year) and age at natural menopause among 97,945 women in the California Teachers Study. Multivariable Cox proportional hazards regression methods were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). The impact of cigarette smoking (never smoker, former-light smoker, former-heavy smoker, current-light smoker, current-heavy smoker) as an effect modifier was evaluated. Results In a multivariable model adjusting for body mass index at age 18, age at menarche, race/ethnicity, and age at first full-term pregnancy, increased physical activity was statistically significantly associated with older age at natural menopause (ptrend=0.005). Higher body mass index at age 18 (ptrend=0.0003) and older age at menarche (ptrend=0.0003) were also associated with older age at natural menopause. Hispanic ethnicity (vs. non-Hispanic whites, HR 1.17, 95% CI 1.09–1.26), current smokers (vs. never smokers, HR 1.68, 95% CI 1.60–1.75 for current-light smokers; HR 1.38, 95% CI 1.33–1.44 for current-heavy smokers) and older age at first full-term pregnancy (HR≥29, 2+ full-term pregnancies vs. <29, 2+ full-term pregnancies 1.10, 95% CI 1.06–1.14) were associated with earlier age at natural menopause. Upon stratification by smoking history, increased physical activity was statistically significantly associated with older natural menopause among heavy smokers only (HRHighest vs. Lowest quartile 0.88, 95% CI 0.81–0.97, ptrend=0.02 for former-heavy smokers; HRHighest vs. Lowest quartile 0.89, 95% CI 0.80–0.99, ptrend=0.04 for current-heavy smokers). Conclusion Age at natural menopause is a complex trait; the determinants of age at natural menopause, including physical activity, may differ by smoking status. PMID:23435025

The association of cardiovascular disease with impaired health-related quality of life among patients with type 2 diabetes mellitus

PubMed Central

Tan, Mun Chieng; Ng, Ooi Chuan; Wong, Teck Wee; Hejar, Abdul Rahman; Anthony, Joseph; Sintonen, Harri

2014-01-01

INTRODUCTION The aim of this study was to evaluate the health-related quality of life (HRQoL) of Malaysian patients with type 2 diabetes mellitus (T2DM) who have cardiovascular disease (CVD), as well as identify the determinants of HRQoL among this cohort of patients. METHODS This study was an analytical cross-sectional study involving 313 patients aged 30–78 years (150 men, 163 women; mean age 55.7 ± 9.2 years) who were diagnosed with T2DM (mean duration of T2DM 10.1 ± 8.1 years) at two tertiary Malaysian government hospitals. The patients’ sociodemographic, lifestyle, clinical and laboratory data were collected prospectively from medical records and via face-to-face interviews. HRQoL was assessed using the 15D instrument – a generic, 15-dimensional and standardised measure of HRQoL that can be used as both a profile and a single index score measure. RESULTS T2DM patients with CVD were found to have significantly lower 15D HRQoL scores than their non-CVD counterparts (p < 0.001). The HRQoL of T2DM patients with CVD was significantly lower than those without CVD (p < 0.05) in all of the 15 dimensions of the 15D instrument. Multinomial logistic regression analysis using backward stepwise method revealed a significant association between CVD and impaired HRQoL (odds ratio [OR] 11.746, 95% confidence interval [CI] 4.898–28.167). Age (OR 1.095, 95% CI 1.054–1.137), duration of T2DM (OR 1.085, 95% CI 1.032–1.140), ethnicity (OR 0.411, 95% CI 0.187–0.903), body mass index (OR 1.074, 95% CI 1.006–1.148), and physical activity level (OR 3.506, 95% CI 1.415–8.689) were also significant predictors of HRQoL. CONCLUSION In T2DM patients, the presence of CVD was significantly associated with a lower HRQoL. Therefore, the importance of tertiary prevention to minimise the potential deterioration of the HRQoL of T2DM patients with CVD should be highly emphasised. PMID:24763837

Mortality risk prediction in COPD by a prognostic biomarker panel.

PubMed

Stolz, Daiana; Meyer, Anja; Rakic, Janko; Boeck, Lucas; Scherr, Andreas; Tamm, Michael

2014-12-01

Chronic obstructive pulmonary disease (COPD) is a complex disease with various phenotypes. The simultaneous determination of multiple biomarkers reflecting different pathobiological pathways could be useful in identifying individuals with an increased risk of death. We derived and validated a combination of three biomarkers (adrenomedullin, arginine vasopressin and atrial natriuretic peptide), assessed in plasma samples of 385 patients, to estimate mortality risk in stable COPD. Biomarkers were analysed in combination and defined as high or low. In the derivation cohort (n = 142), there were 73 deaths during the 5-year follow-up. Crude hazard ratios for mortality were 3.0 (95% CI 1.8-5.1) for one high biomarker, 4.8 (95% CI 2.4-9.5) for two biomarkers and 9.6 (95% CI 3.3-28.3) for three high biomarkers compared with no elevated biomarkers. In the validation cohort (n = 243), 87 individuals died. Corresponding hazard ratios were 1.9 (95% CI 1.1-3.3), 3.1 (95% CI 1.8-5.4) and 5.4 (95% CI 2.5-11.4). Multivariable adjustment for clinical variables as well as the BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity) index and stratification by the Global Initiative for Chronic Obstructive Lung Disease stages provided consistent results. The addition of the panel of three biomarkers to the BODE index generated a net reclassification improvement of 57.9% (95% CI 21.7-92.4%) and 45.9% (95% CI 13.9-75.7%) at 3 and 5 years, respectively. Simultaneously elevated levels of adrenomedullin, arginine vasopressin and atrial natriuretic peptide are associated with increased risk of death in patients with stable COPD. ©ERS 2014.

Prenatal Stress, Methylation in Inflammation-Related Genes, and Adiposity Measures in Early Childhood: the Programming Research in Obesity, Growth Environment and Social Stress Cohort Study.

PubMed

Wu, Shaowei; Gennings, Chris; Wright, Rosalind J; Wilson, Ander; Burris, Heather H; Just, Allan C; Braun, Joseph M; Svensson, Katherine; Zhong, Jia; Brennan, Kasey J M; Dereix, Alexandra; Cantoral, Alejandra; Schnaas, Lourdes; Téllez-Rojo, Martha Maria; Wright, Robert O; Baccarelli, Andrea A

2018-01-01

Maternal stress during pregnancy may influence childhood growth and adiposity, possibly through immune/inflammatory programming. We investigated whether exposure to prenatal stress and methylation in inflammation-related genes were associated with childhood adiposity in 424 mother-child pairs in Mexico City, Mexico. A stress index was created based on four prenatally administered stress-related scales (Exposure to Violence, Crisis in Family Systems, State-Trait Anxiety Inventory, and Edinburgh Postnatal Depression Scale). We measured weight, height, body fat mass (BFM), percentage body fat (PBF), and waist circumference in early childhood (age range, 4-6 years). Body mass index (BMI) z scores were calculated according to World Health Organization standards. DNA methylation in gene promoters of tumor necrosis factor α, interleukin 8, and interleukin 6 (IL6) in umbilical cord blood were determined by pyrosequencing. An interquartile range increase in stress index (27.3) was associated with decreases of 0.14 unit in BMI z score (95% confidence interval [CI] = -0.28 to -0.005), 5.6% in BFM (95% CI = -9.7 to -1.4), 3.5% in PBF (95% CI = -6.3 to -0.5), and 1.2% in waist circumference (95% CI = -2.4 to -0.04) in multivariable-adjusted models. An interquartile range increase in IL6 methylation (3.9%) was associated with increases of 0.23 unit in BMI z score (95% CI = 0.06-0.40), 8.1% (95% CI = 2.3-14.3) in BFM, 5.5% (95% CI = 1.7-9.5) in PBF, and 1.7% (95% CI = 0.2-3.3) in waist circumference. Prenatal stress was associated with decreased childhood adiposity, whereas cord blood IL6 methylation was associated with increased childhood adiposity in Mexican children.

Evaluation of natural language processing from emergency department computerized medical records for intra-hospital syndromic surveillance

PubMed Central

2011-01-01

Background The identification of patients who pose an epidemic hazard when they are admitted to a health facility plays a role in preventing the risk of hospital acquired infection. An automated clinical decision support system to detect suspected cases, based on the principle of syndromic surveillance, is being developed at the University of Lyon's Hôpital de la Croix-Rousse. This tool will analyse structured data and narrative reports from computerized emergency department (ED) medical records. The first step consists of developing an application (UrgIndex) which automatically extracts and encodes information found in narrative reports. The purpose of the present article is to describe and evaluate this natural language processing system. Methods Narrative reports have to be pre-processed before utilizing the French-language medical multi-terminology indexer (ECMT) for standardized encoding. UrgIndex identifies and excludes syntagmas containing a negation and replaces non-standard terms (abbreviations, acronyms, spelling errors...). Then, the phrases are sent to the ECMT through an Internet connection. The indexer's reply, based on Extensible Markup Language, returns codes and literals corresponding to the concepts found in phrases. UrgIndex filters codes corresponding to suspected infections. Recall is defined as the number of relevant processed medical concepts divided by the number of concepts evaluated (coded manually by the medical epidemiologist). Precision is defined as the number of relevant processed concepts divided by the number of concepts proposed by UrgIndex. Recall and precision were assessed for respiratory and cutaneous syndromes. Results Evaluation of 1,674 processed medical concepts contained in 100 ED medical records (50 for respiratory syndromes and 50 for cutaneous syndromes) showed an overall recall of 85.8% (95% CI: 84.1-87.3). Recall varied from 84.5% for respiratory syndromes to 87.0% for cutaneous syndromes. The most frequent cause of lack of processing was non-recognition of the term by UrgIndex (9.7%). Overall precision was 79.1% (95% CI: 77.3-80.8). It varied from 81.4% for respiratory syndromes to 77.0% for cutaneous syndromes. Conclusions This study demonstrates the feasibility of and interest in developing an automated method for extracting and encoding medical concepts from ED narrative reports, the first step required for the detection of potentially infectious patients at epidemic risk. PMID:21798029

Demographic and Psychosocial Profile of Smoking Among Pregnant Women in Lebanon: Public Health Implications

PubMed Central

Chaaya, Monique; Awwad, Johnny; Campbell, Oona M.R.; Sibai, Abla; Kaddour, Afamia

2006-01-01

Objectives To assess the prevalence and determinants of smoking prior to and during pregnancy in Lebanon. Methods A cross-sectional study using two structured instruments. One instrument included information on demographic characteristics, smoking patterns in the index pregnancy and previous pregnancies, use of prenatal health services, stressful life events, and social support during pregnancy. The second was the Arabic General Health Questionnaire (GHQ-12). Women who delivered in 11 randomly selected hospitals in Beirut and its suburbs within 24 hours were asked to consent to participate in the study. The total sample interviewed was 576 women. Results The prevalence of pre-pregnancy smoking was 32% and 20% for smoking in pregnancy. Considering argileh smoking, the prevalence of tobacco use in pregnancy increased to 27% in Beirut and 25% in the suburbs. Pre-pregnancy smoking was associated with older maternal age [OR = 1.08, 95% CI (1.03, 1.14)], low and medium education [OR = 2.22, 95% CI (1.22, 4.04)], increased psychiatric distress [OR = 3.11, 95% CI (1.77, 5.46)], and a husband who smoked [OR = 5.00, 95% CI (2.98, 8.39)]. Continued smoking during pregnancy was associated with low and medium education [OR = 3.77, 95% CI (1.31, 10.8)], younger age [OR = 1.11, 95% CI (1.02–1.20)], and a heavy pre-pregnancy smoking pattern [OR = 13.9, 95% CI (1.40, 137.4)]. Conclusion Policies and programs to eliminate or reduce smoking during pregnancy should be targeted toward young and less educated females and involving the spouse. Obstetricians should promote smoking cessation during pregnancy using evidence-based methods. PMID:14509413

Distribution of intraocular pressure and its determinants in an Iranian adult population

PubMed Central

Hashemi, Hassan; Khabazkhoob, Mehdi; Emamian, Mohammad Hassan; Shariati, Mohammad; Yekta, Abbasali; Fotouhi, Akbar

2016-01-01

AIM To determine the distribution of intraocular pressure (IOP) and its determinants in an Iranian population. METHODS In a cross-sectional survey, random cluster sampling was conducted from the 40-64 years old population of Shahroud, in the north of Iran. All participants had optometry and ophthalmic exams. IOP was determined using the Goldmann tonometry method and biometric components were measured. RESULTS Of the 6311 people selected for the study, 5190 (82.2%) participated. The mean age of the participants was 50.9±6.2y and 58.7% of them were female. Mean IOP was 12.87±2.27 mm Hg. In this study 0.3% of the participants had an IOP higher than 21 mm Hg. The multiple linear regression model revealed that sex (Coef=-0.30; 95% CI: -0.43 to -0.17), diabetes (Coef=0.43; 95% CI: 0.19 to 0.67), high systolic blood pressure (Coef=0.02; 95% CI: 0.01 to 0.02), high body mass index (BMI) (Coef=0.03; 95% CI: 0.01 to 0.04), higher education (Coef=0.02, 95% CI: 0.01 to 0.04), thicker central corneal thickness (Coef=0.01; 95% CI: 0.01 to 0.02), and myopic shift in spherical equivalent (Coef=-0.14; 95% CI: -0.18 to -0.10) significantly correlated with high IOP. CONCLUSION The IOP in this 40-64 years old population is low overall. In the north of Iran, average IOP is statistically significantly correlated with female sex, diabetes, higher BMI, systolic blood pressure, higher education, thicker cornea, and myopic refractive error. PMID:27588277

Diet quality as assessed by the Healthy Eating Index, the Alternate Healthy Eating Index, the Dietary Approaches to Stop Hypertension score, and health outcomes: a systematic review and meta-analysis of cohort studies.

PubMed

Schwingshackl, Lukas; Hoffmann, Georg

2015-05-01

Dietary patterns consider synergistic effects compared with isolated foods or nutrients on health outcomes. The aim of this systematic review and meta-analysis was to examine the associations of diet quality as assessed by the Healthy Eating Index (HEI), the Alternate Healthy Eating Index (AHEI), and the Dietary Approaches to Stop Hypertension (DASH) score and the risk of all-cause mortality, cardiovascular mortality or incidence, cancer mortality or incidence, type 2 diabetes mellitus, and neurodegenerative diseases. A literature search was performed using the electronic databases MEDLINE, SCOPUS, and EMBASE with an end date of May 10, 2014. Study-specific risk ratios were pooled using a random effect model by the Cochrane software package Review Manager 5.2. Fifteen cohort studies (34 reports), including 1,020,642 subjects, met the criteria and were included in the meta-analysis. Diets of the highest quality, as assessed by the HEI, AHEI, and DASH score, resulted in a significant risk reduction (RR) for all-cause mortality (RR 0.78, 95% CI 0.76 to 0.80; P<0.00001; I²=61%, 95% CI 20% to 81%), cardiovascular disease (incidence or mortality) (RR 0.78, 95% CI 0.75 to 0.81; P<0.00001; I²=45%, 95% CI 13% to 66%), cancer (incidence or mortality) (RR 0.85, 95% CI 0.82 to 0.88; P<0.00001; I²=77%, 95% CI 68% to 84%), and type 2 diabetes mellitus (RR 0.78, 95% CI 0.72 to 0.85; P<0.00001; I²=74%, 95% CI 52% to 86%). Differences observed for neurodegenerative diseases were not significant. Egger regression tests provided no evidence of publication bias. Diets that score highly on the HEI, AHEI, and DASH are associated with a significant reduction in the risk of all-cause mortality, cardiovascular disease, cancer, and type 2 diabetes mellitus by 22%, 22%, 15%, and 22%, respectively, and therefore is of high public health relevance. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Local Residential Segregation Matters: Stronger Association of Census Tract Compared to Conventional City-Level Measures with Fatal and Non-Fatal Assaults (Total and Firearm Related), Using the Index of Concentration at the Extremes (ICE) for Racial, Economic, and Racialized Economic Segregation, Massachusetts (US), 1995-2010.

PubMed

Krieger, Nancy; Feldman, Justin M; Waterman, Pamela D; Chen, Jarvis T; Coull, Brent A; Hemenway, David

2017-04-01

Research on residential segregation and health, primarily conducted in the USA, has chiefly employed city or regional measures of racial segregation. To test our hypothesis that stronger associations would be observed using local measures, especially for racialized economic segregation, we analyzed risk of fatal and non-fatal assault in Massachusetts (1995-2010), since this outcome is strongly associated with residential segregation. The segregation metrics comprised the Index of Concentration at the Extremes (ICE), the Index of Dissimilarity, and poverty rate, with measures computed at both the census tract and city/town level. Key results were that larger associations between fatal and non-fatal assaults and residential segregation occurred for models using the census tract vs. city/town measures, with the greatest associations observed for racialized economic segregation. For fatal assaults, comparing the bottom vs. top quintiles, the incidence rate ratio (and 95% confidence interval (CI)) in models using the census tract measures equaled 3.96 (95% CI 3.10, 5.06) for the ICE for racialized economic segregation, 3.26 (95% CI 2.58, 4.14) for the ICE for income, 3.14 (95% CI 2.47, 3.99) for poverty, 2.90 (95% CI 2.21, 3.81) for the ICE for race/ethnicity, and only 0.93 (95% CI 0.79, 1.11) for the Index of Dissimilarity; in models that included both census tract and city/town ICE measures, this risk ratio for the ICE for racialized economic segregation was higher at the census tract (3.29; 95% CI 2.43, 4.46) vs. city/town level (1.61; 95% CI 1.12, 2.32). These results suggest that, at least in the case of fatal and non-fatal assaults, research on residential segregation should employ local measures, including of racialized economic segregation, to avoid underestimating the adverse impact of segregation on health.

Gestational Weight Gain, Body Mass Index, and Risk of Hypertensive Disorders of Pregnancy in a Predominantly Puerto Rican Population.

PubMed

Chasan-Taber, Lisa; Silveira, Marushka; Waring, Molly E; Pekow, Penelope; Braun, Barry; Manson, JoAnn E; Solomon, Caren G; Markenson, Glenn

2016-09-01

Objectives To prospectively evaluate the association between gestational weight gain (GWG), prepregnancy body mass index (BMI), and hypertensive disorders of pregnancy using the revised Institute of Medicine (IOM) Guidelines. Methods We examined these associations among 1359 participants in Proyecto Buena Salud, a prospective cohort study conducted from 2006 to 2011 among women from the Caribbean Islands. Information on prepregnancy BMI, GWG, and incident diagnoses of hypertension in pregnancy were based on medical record abstraction. Results Four percent (n = 54) of women were diagnosed with hypertension in pregnancy, including 2.6 % (n = 36) with preeclampsia. As compared to women who gained within IOM GWG guidelines (22.8 %), those who gained above guidelines (52.5 %) had an odds ratio of 3.82 for hypertensive disorders (95 % CI 1.46-10.00; ptrend = 0.003) and an odds ratio of 2.94 for preeclampsia (95 % CI 1.00-8.71, ptrend = 0.03) after adjusting for important risk factors. Each one standard deviation (0.45 lbs/week) increase in rate of GWG was associated with a 1.74 odds of total hypertensive disorders (95 % CI 1.34-2.27) and 1.86 odds of preeclampsia (95 % CI 1.37-2.52). Conclusions for Practice Findings from this prospective study suggest that excessive GWG is associated with hypertension in pregnancy and could be a potentially modifiable risk factor in this high-risk ethnic group.

Combined endosulfan and cypermethrin-induced toxicity to embryo-larval development of Rhinella arenarum.

PubMed

Svartz, Gabriela V; Aronzon, Carolina M; Pérez Coll, Cristina S

2016-01-01

The combined effects of two widely used pesticides, endosulfan and cypermethrin, on survival of embryo-larval development of the South American toad (Rhinella arenarum) were examined. The toxicity bioassays were performed according to the AMPHITOX test. Embryos and larvae were exposed to mixtures of these pesticides at equitoxic ratios from acute or chronic exposure to evaluate interaction effects. The results were analyzed using both Marking's additive index and combination index (CI)-isobologram methods. Acute (96-h) and intermediate (168-h) toxicity of endosulfan-cypermethrin mixtures remained almost constant for larvae and embryos, but when exposure duration was increased, there was a significant elevation in toxicity, obtaining chronic (240-h) no-observed-effect concentrations (NOEC) values of 0.045 and 0.16 mg/L for embryos and larvae, respectively. These are environmentally relevant concentrations that reflect a realistic risk of this pesticide mixture to this native amphibian species. The toxicity increment with the exposure duration was coincident with the central nervous system development on embryos reaching the larval period, the main target organ of these pesticides. The interactions of the pesticide mixtures at acute and chronic exposure were antagonistic for embryo development (CI > 1), and additive (CI = 1) for larvae, while chronic exposure interactions were synergistic (CI < 1) for both developmental periods. Data indicated that endosulfan-cypermethrin mixtures resulted in different interaction types depending on duration and developmental stage exposed. As a general pattern and considering conditions of overall developmental period and chronic exposure, this pesticide mixture usually applied in Argentine crop fields is synergistic with respect to toxicity for this native amphibian species.

Is the status of diabetes socioeconomic inequality changing in Kurdistan province, west of Iran? A comparison of two surveys.

PubMed

Moradi, Ghobad; Majdzadeh, Reza; Mohammad, Kazem; Malekafzali, Hossein; Jafari, Saeede; Holakouie-Naieni, Kourosh

2016-01-01

About 80% of deaths in 350 million cases of diabetes in the world occur in low and middle income countries. The aim of this study was to determine the status of diabetes socioeconomic inequality and the share of determinants of inequalities in Kurdistan Province, West of Iran, using two surveys in 2005 and 2009. Data were collected from non-communicable disease surveillance surveys in Kurdistan in 2005 and 2009. In this study, the socioeconomic status (SES) of the participants was determined based on the residential area and assets using principal component analysis statistical method. We used concentration index and logistic regression to determine inequality. Decomposition analysis was used to determine the share of each determinant of inequality. The prevalence of diabetes expressed by individuals changed from 0.9% (95% CI: 0.6-1.3) in 2005 to 3.1% (95% CI: 2-4) in 2009. Diabetes Concentration Index changed from -0.163 (95% CI: -0.301- -0.024) in 2005 to 0.273 (95% CI: 0.101-0.445) in 2009. The results of decomposition analysis revealed that in 2009, 67% of the inequality was due to low socioeconomic status and 16% to area of residence; i.e., living in rural areas. The prevalence of diabetes significantly increased, and the diabetes inequality shifted from the poor people to groups with better SES. Increased prevalence of diabetes among the high SES individuals may be due to their better responses to diabetes control and awareness programs or due to the type of services they were provided during these years.

Spatial Patterns and Socioecological Drivers of Dengue Fever Transmission in Queensland, Australia

PubMed Central

Clements, Archie; Williams, Gail; Tong, Shilu; Mengersen, Kerrie

2011-01-01

Background: Understanding how socioecological factors affect the transmission of dengue fever (DF) may help to develop an early warning system of DF. Objectives: We examined the impact of socioecological factors on the transmission of DF and assessed potential predictors of locally acquired and overseas-acquired cases of DF in Queensland, Australia. Methods: We obtained data from Queensland Health on the numbers of notified DF cases by local government area (LGA) in Queensland for the period 1 January 2002 through 31 December 2005. Data on weather and the socioeconomic index were obtained from the Australian Bureau of Meteorology and the Australian Bureau of Statistics, respectively. A Bayesian spatial conditional autoregressive model was fitted at the LGA level to quantify the relationship between DF and socioecological factors. Results: Our estimates suggest an increase in locally acquired DF of 6% [95% credible interval (CI): 2%, 11%] and 61% (95% CI: 2%, 241%) in association with a 1-mm increase in average monthly rainfall and a 1°C increase in average monthly maximum temperature between 2002 and 2005, respectively. By contrast, overseas-acquired DF cases increased by 1% (95% CI: 0%, 3%) and by 1% (95% CI: 0%, 2%) in association with a 1-mm increase in average monthly rainfall and a 1-unit increase in average socioeconomic index, respectively. Conclusions: Socioecological factors appear to influence the transmission of DF in Queensland, but the drivers of locally acquired and overseas-acquired DF may differ. DF risk is spatially clustered with different patterns for locally acquired and overseas-acquired cases. PMID:22015625

Immigration Policies and Mental Health Morbidity among Latinos: A State-Level Analysis

PubMed Central

Hatzenbuehler, Mark L.; Prins, Seth; Flake, Morgan; Philbin, Morgan; Frazer, Somjen; Hagen, Daniel; Hirsch, Jennifer

2017-01-01

Rationale Despite abundant state-level policy activity in the U.S. related to immigration, no research has examined the mental health impact of the overall policy climate for Latinos, taking into account both inclusionary and exclusionary legislation. Objective To examine associations between the state-level policy climate related to immigration and mental health outcomes among Latinos. Methods We created a multi-sectoral policy climate index that included 14 policies in four domains (immigration, race/ethnicity, language, and agricultural worker protections). We then examined the relation of this policy climate index to two mental health outcomes (days of poor mental health and psychological distress) among Latinos from 31 states in the 2012 Behavioral Risk Factor Surveillance System (BRFSS), a population-based health survey of non-institutionalized individuals aged 18 years or older. Results Individuals in states with more exclusionary immigration policies had higher rates of poor mental health days than participants in states with less exclusionary policies (RR: 1.05, 95% CI: 1.00, 1.10). The association between state policies and the rate of poor mental health days was significantly higher among Latinos versus non-Latinos (RR for interaction term: 1.03, 95% CI: 1.01, 1.06). Furthermore, Latinos in states with more exclusionary policies had 1.14 (95% CI: 1.04, 1.25) times the rate of poor mental health days than Latinos in states with less exclusionary policies. Results were robust to individual- and state-level confounders. Sensitivity analyses indicated that results were specific to immigration policies, and not indicators of state political climate or of residential segregation. No relationship was observed between the immigration policy index and psychological distress. Conclusion These results suggest that restrictive immigration policies may be detrimental to the mental health of Latinos in the United States. PMID:28043019

The effects of weight change on glomerular filtration rate.

PubMed

Chang, Alex; Greene, Tom H; Wang, Xuelei; Kendrick, Cynthia; Kramer, Holly; Wright, Jackson; Astor, Brad; Shafi, Tariq; Toto, Robert; Lewis, Julia; Appel, Lawrence J; Grams, Morgan

2015-11-01

Little is known about the effect of weight loss/gain on kidney function. Analyses are complicated by uncertainty about optimal body surface indexing strategies for measured glomerular filtration rate (mGFR). Using data from the African-American Study of Kidney Disease and Hypertension (AASK), we determined the association of change in weight with three different estimates of change in kidney function: (i) unindexed mGFR estimated by renal clearance of iodine-125-iothalamate, (ii) mGFR indexed to concurrently measured BSA and (iii) GFR estimated from serum creatinine (eGFR). All models were adjusted for baseline weight, time, randomization group and time-varying diuretic use. We also examined whether these relationships were consistent across a number of subgroups, including tertiles of baseline 24-h urine sodium excretion. In 1094 participants followed over an average of 3.6 years, a 5-kg weight gain was associated with a 1.10 mL/min/1.73 m(2) (95% CI: 0.87 to 1.33; P < 0.001) increase in unindexed mGFR. There was no association between weight change and mGFR indexed for concurrent BSA (per 5 kg weight gain, 0.21; 95% CI: -0.02 to 0.44; P = 0.1) or between weight change and eGFR (-0.09; 95% CI: -0.32 to 0.14; P = 0.4). The effect of weight change on unindexed mGFR was less pronounced in individuals with higher baseline sodium excretion (P = 0.08 for interaction). The association between weight change and kidney function varies depending on the method of assessment. Future clinical trials should examine the effect of intentional weight change on measured GFR or filtration markers robust to changes in muscle mass. © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

An inexpensive and worldwide available digital image analysis technique for histological fibrosis quantification in chronic hepatitis C.

PubMed

Campos, C F F; Paiva, D D; Perazzo, H; Moreira, P S; Areco, L F F; Terra, C; Perez, R; Figueiredo, F A F

2014-03-01

Hepatic fibrosis staging is based on semiquantitative scores. Digital imaging analysis (DIA) appears more accurate because fibrosis is quantified in a continuous scale. However, high cost, lack of standardization and worldwide unavailability restrict its use in clinical practice. We developed an inexpensive and widely available DIA technique for fibrosis quantification in hepatitis C, and here, we evaluate its reproducibility and correlation with semiquantitative scores, and determine the fibrosis percentage associated with septal fibrosis and cirrhosis. 282 needle biopsies staged by Ishak and METAVIR scores were included. Images of trichrome-stained sections were captured and processed using Adobe(®) Photoshop(®) CS3 and Adobe(®) Bridge(®) softwares. The percentage of fibrosis (fibrosis index) was determined by the ratio between the fibrosis area and the total sample area, expressed in pixels calculated in an automated way. An excellent correlation between DIA fibrosis index and Ishak and METAVIR scores was observed (Spearman's r = 0.95 and 0.92; P < 0.001, respectively). Excellent intra-observer reproducibility was observed in a randomly chosen subset of 39 biopsies with an intraclass correlation index of 0.99 (95% CI, 0.95-0.99). The best cut-offs associated with septal fibrosis and cirrhosis were 6% (AUROC 0.97, 95% CI, 0.95-0.99) and 27% (AUROC 1.0, 95% CI, 0.99-1), respectively. This new DIA technique had high correlation with semiquantitative scores in hepatitis C. This method is reproducible, inexpensive and available worldwide allowing its use in clinical practice. The incorporation of DIA technique provides a more complete evaluation of fibrosis adding the quantification to architectural patterns. © 2013 John Wiley & Sons Ltd.

Incorporating Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio in Place of Neutrophil Count and Platelet Count Improves Prognostic Accuracy of the International Metastatic Renal Cell Carcinoma Database Consortium Model

PubMed Central

Chrom, Pawel; Stec, Rafal; Bodnar, Lubomir; Szczylik, Cezary

2018-01-01

Purpose The study investigated whether a replacement of neutrophil count and platelet count by neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) within the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model would improve its prognostic accuracy. Materials and Methods This retrospective analysis included consecutive patients with metastatic renal cell carcinoma treated with first-line tyrosine kinase inhibitors. The IMDC and modified-IMDC models were compared using: concordance index (CI), bias-corrected concordance index (BCCI), calibration plots, the Grønnesby and Borgan test, Bayesian Information Criterion (BIC), generalized R2, Integrated Discrimination Improvement (IDI), and continuous Net Reclassification Index (cNRI) for individual risk factors and the three risk groups. Results Three hundred and twenty-one patients were eligible for analyses. The modified-IMDC model with NLR value of 3.6 and PLR value of 157 was selected for comparison with the IMDC model. Both models were well calibrated. All other measures favoured the modified-IMDC model over the IMDC model (CI, 0.706 vs. 0.677; BCCI, 0.699 vs. 0.671; BIC, 2,176.2 vs. 2,190.7; generalized R2, 0.238 vs. 0.202; IDI, 0.044; cNRI, 0.279 for individual risk factors; and CI, 0.669 vs. 0.641; BCCI, 0.669 vs. 0.641; BIC, 2,183.2 vs. 2,198.1; generalized R2, 0.163 vs. 0.123; IDI, 0.045; cNRI, 0.165 for the three risk groups). Conclusion Incorporation of NLR and PLR in place of neutrophil count and platelet count improved prognostic accuracy of the IMDC model. These findings require external validation before introducing into clinical practice. PMID:28253564

Dietary Glycemic Index during Pregnancy Is Associated with Biomarkers of the Metabolic Syndrome in Offspring at Age 20 Years

PubMed Central

Danielsen, Inge; Granström, Charlotta; Haldorsson, Thorhallur; Rytter, Dorte; Hammer Bech, Bodil; Henriksen, Tine Brink; Vaag, Allan Arthur; Olsen, Sjurdur Frodi

2013-01-01

Objective Growing evidence indicates that metabolic syndrome is rooted in fetal life with a potential key role of nutrition during pregnancy. The objective of the study was to assess the possible associations between the dietary glycemic index (GI) and glycemic load (GL) during pregnancy and biomarkers of the metabolic syndrome in young adult offspring. Methods Dietary GI and GL were assessed by questionnaires and interviews in gestation week 30 and offspring were clinically examined at the age of 20 years. Analyses based on 428 mother-offspring dyads were adjusted for maternal smoking during pregnancy, height, pre-pregnancy body mass index (BMI), education, energy intake, and the offspring’s ambient level of physical activity. In addition, possible confounding by gestational diabetes mellitus was taken into account. Outcome Measures Waist circumference, blood pressure, HOMA insulin resistance (HOMA-IR) and plasma levels of fasting glucose, triglycerides, HDL cholesterol, LDL cholesterol, total cholesterol, insulin, and leptin were measured in the offspring. Results Significant associations were found between dietary GI in pregnancy and HOMA-IR (the relative increase in HOMA-IR per 10 units’ GI increase was 1.09 [95% CI: 1.01, 1.16], p = 0.02), insulin (1.09 [95% CI: 1.02, 1.16], p = 0.01) and leptin (1.21 [95% CI: 1.06, 1.38], p = 0.01) in the offspring; whereas no associations were detected for GL. Conclusions Our data suggests that high dietary GI in pregnancy may affect levels of markers for the metabolic syndrome in young adult offspring in a potentially harmful direction. PMID:23741411

[Effect of parents' occupational and life environment exposure during six months before pregnancy on executive function of preschool children].

PubMed

Ni, Lingling; Shao, Ting; Tao, Huihui; Sun, Yanli; Yan, Shuangqin; Gu, Chunli; Cao, Hui; Huang, Kun; Tao, Fangbiao; Tong, Shilu

2016-02-01

To examine the effect of parents' occupational and life exposure during six months before pregnancy on executive function of preschool children. Pregnant women involved in the study came from the Ma'anshan Birth Cohort Study,a part of the China-Anhui Birth Cohort Study. Between October 2008 and October 2010, pregnant women who accepted pregnancy care in four municipal medical and health institutions in Ma'anshan city were recruited as study objects. A total of 5,084 pregnant women and 4,669 singleton live births entered in this cohort. Between April 2014 and April 2015, a total of 3,803 pre-school children were followed up. Finally, except 32 preschool children did not have EF evaluation result, there were 3,771 children included in this study. By using self-designed " Maternal health handbook", we researched parents' general demographic characteristics, and life and occupational exposure during six months before pregnancy. To research preschool children's executive function, we used the Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P). Univariate and multivariate statistical method was used to analyze the association of parents' life and occupational exposure during six months before pregnancy and preschool children's EF. 3,771 preschool children's detected rate of inhibitory self-control index (ISCI), flexibility index (FI), emergent metacognition index (EMI) and global executive composite (GEC) dysplasia were 4.8% (182), 2.3% (88), 16.5% (623) and 8.6% (324) respectively. During six months before pregnancy, children whose parents were lived in a noise environment (OR=1.86, 95% CI: 1.36-2.54), whose maternal were exposed to pesticides were the risk of ISCI dysplasia(OR=3.60, 95% CI: 1.45-8.95). During six months before pregnancy, children whose maternal were exposed to pesticides (OR=6.72, 95% CI: 2.50-18.07) and whose father were exposed to occupational lead (OR=2.10, 95% CI: 1.25-3.54) were the risk of FI dysplasia. During six months before pregnancy, children whose parents were lived in a noise environment (OR=1.42, 95%CI: 1.18-1.71) and whose father were exposed to occupational lead (OR=1.30, 95%CI: 1.02-1.65) were the risk of EMI dysplasia. During six months before pregnancy, children whose parents were lived in a noise environment (OR=1.58, 95% CI: 1.24-2.01) and whose maternal were exposed to pesticides (OR=2.39, 95% CI: 1.02-5.58) were the risk of GEC dysplasia. The development of executive function is worse among preschool children whose parents live in noise environment, mother exposed to pesticides, and father exposed to occupational lead during six months before pregnancy.

[The relevance of the ankle-arm index to the reclassification of cardiovascular risk in asymptomatic hypertensive middle-aged males].

PubMed

Oliveras, Víctor; Martín-Baranera, Montserrat; Gracia, Maya; Del Val, José Luís; Plans, Miquel; Pujol-Moix, Núria

2015-05-21

The ankle-brachial index allows for the detection of subclinical cardiovascular disease and risk, by diagnosing peripheral arterial disease and arterial calcification. Asymptomatic hypertensive men, between 45-55 years and with the suspicion of low risk, could be an important population group to benefit from this technique. The aim of the study was to compare the frequency of abnormal ankle-brachial index (subclinical peripheral arterial disease and arterial calcification) between asymptomatic hypertensive and non-hypertensive men, of the same age and suspicion of low risk. Two hundred and forty-four asymptomatic men (122 hypertensive and 122 non-hypertensive), between 45 and 55 years and an REGICOR index<10, were voluntarily recruited using consecutive sampling. Complete anamnesis, physical examination, laboratory tests and ankle-brachial index determination were carried out on all patients. We detected abnormal ankle-brachial index values in 9.8% (12 cases) of the hypertensive subjects and in 1.6% (2 cases) of non-hypertensive subjects (P=.006). In the multivariate analysis, hypertension was significantly associated with an abnormal ankle-brachial index (P<.026) (odds ratio [OR] 5.9, 95% confidence interval [95% CI] 1.2-28.3), smoking (P=.018) (OR 2.7; 95% CI 1.2-6.2) and abdominal obesity (P=.005) (OR 2.8; 95% CI 1.3-5.9). The population group analyzed in this study might be considered as an overriding segment for detecting subclinical cardiovascular disease and risk with the ankle-brachial index. Further studies are needed to establish the prevalence of abnormal ankle-brachial index in this population in order to assess its efficiency. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

Validation of a Cytotechnologist Manual Counting Service for the Ki67 Index in Neuroendocrine Tumors of the Pancreas and Gastrointestinal Tract.

PubMed

Cottenden, Jennielee; Filter, Emily R; Cottreau, Jon; Moore, David; Bullock, Martin; Huang, Weei-Yuarn; Arnason, Thomas

2018-03-01

- Pathologists routinely assess Ki67 immunohistochemistry to grade gastrointestinal and pancreatic neuroendocrine tumors. Unfortunately, manual counts of the Ki67 index are very time consuming and eyeball estimation has been criticized as unreliable. Manual Ki67 counts performed by cytotechnologists could potentially save pathologist time and improve accuracy. - To assess the concordance between manual Ki67 index counts performed by cytotechnologists versus eyeball estimates and manual Ki67 counts by pathologists. - One Ki67 immunohistochemical stain was retrieved from each of 18 archived gastrointestinal or pancreatic neuroendocrine tumor resections. We compared pathologists' Ki67 eyeball estimates on glass slides and printed color images with manual counts performed by 3 cytotechnologists and gold standard manual Ki67 index counts by 3 pathologists. - Tumor grade agreement between pathologist image eyeball estimate and gold standard pathologist manual count was fair (κ = 0.31; 95% CI, 0.030-0.60). In 9 of 20 cases (45%), the mean pathologist eyeball estimate was 1 grade higher than the mean pathologist manual count. There was almost perfect agreement in classifying tumor grade between the mean cytotechnologist manual count and the mean pathologist manual count (κ = 0.910; 95% CI, 0.697-1.00). In 20 cases, there was only 1 grade disagreement between the 2 methods. Eyeball estimation by pathologists required less than 1 minute, whereas manual counts by pathologists required a mean of 17 minutes per case. - Eyeball estimation of the Ki67 index has a high rate of tumor grade misclassification compared with manual counting. Cytotechnologist manual counts are accurate and save pathologist time.

Spatial comparability of drought characteristics and related return periods in mainland China over 1961-2013

NASA Astrophysics Data System (ADS)

Ayantobo, Olusola O.; Li, Yi; Song, Songbai; Yao, Ning

2017-07-01

The proper understanding of the spatiotemporal characteristics of multi-year droughts and return periods is important for drought risk assessment. This study evaluated and compared the spatiotemporal variations of drought characteristics and return periods within mainland China between 1961 and 2013. Standardized Precipitation Index (SPI), Standardized Precipitation Evapotranspiration Index (SPEI) and Composite Index (CI) were calculated at multiple timescales, the run theory was used for objective identification and characterization of drought events while Kendall's τ method was used to analyze their dependencies. Within the univariate framework, marginal distributions of duration, severity, and peak were derived by fitting Exponential, Weibull and GDP distributions respectively and the drought return periods was investigated and mapped. Comparison of drought indices showed that SPEI and CI performed better than SPI in delineating spatial patterns of drought characteristics. This might be attributed to the temperature effect on evapotranspiration and therefore on drought index. Considering the increasing trend in reference evapotranspiration in the 21st century, the importance of utilizing temperature-based drought index is imperative. Severe and extreme droughts occurred in the late 1990s in many places in China while persistent multi-year severe droughts occurred more frequently over North China, Northeast China, Northwest China and Southwest China. The spatial patterns showed that regions characterized by higher drought severity were associated with higher drought duration. The North China, Northwest China, and Southwest China had much longer drought durations during the 1990s and 2000s. As droughts normally cover large areas, regional drought return periods has been showed to be more effective in providing support for drought management than station based drought return periods. Studies on the spatial comparability of drought return periods across mainland China have therefore been undertaken for drought mitigation and effective utilization of water resources.

The Value of Elastic Modulus Index as a Novel Surrogate Marker for Cardiovascular Risk Stratification by Dimensional Speckle-Tracking Carotid Ultrasonography

PubMed Central

Yoon, Ji Hyun; Cho, In-Jeong; Sung, Ji Min; Lee, Jinyong; Ryoo, Hojin; Shim, Chi Young; Hong, Geu-Ru; Chung, Namsik

2016-01-01

Background Carotid intima media thickness (CIMT) and the presence of carotid plaque have been used for risk stratification of cardiovascular disease (CVD). To date, however, the association between multi-directional functional properties of carotid artery and CVD has not been fully elucidated. We sought to explore the multi-directional mechanics of the carotid artery in relation to cardiovascular risk. Methods Four hundred one patients who underwent carotid ultrasound were enrolled between January 2010 and April 2013. A high risk of CVD was defined as more than 20% of 10-year risk based on the Framingham risk score. Using a speckle-tracking technique, the longitudinal and radial movements were analyzed in the B-mode images. Peak longitudinal and radial displacements, strain and strain rate were also measured. Beta stiffness and elastic modulus index were calculated from the radial measurements. Results Of the overall sample, 13% (52) of patients comprised the high-risk group. In multivariate logistic regression, CIMT and elastic modulus index were independently associated with a high-risk of CVD {odds ratio (OR): 1.810 [95% confidence interval (CI) 1.249–2.622] and OR: 1.767 (95% CI: 1.177–2.652); p = 0.002, 0.006, respectively}. The combination of CIMT and elastic modulus index correlated with a high-risk of CVD more so than CIMT alone. Conclusion The elastic modulus index of the carotid artery might serve as a novel surrogate marker of high-risk CVD. Measurement of the multi-directional mechanics of the carotid artery using the speckle tracking technique has potential for providing further information over conventional B-mode ultrasound for stratification of CVD risk. PMID:27721952

Detection of prostate cancer index lesions with multiparametric magnetic resonance imaging (mp-MRI) using whole-mount histological sections as the reference standard.

PubMed

Russo, Filippo; Regge, Daniele; Armando, Enrico; Giannini, Valentina; Vignati, Anna; Mazzetti, Simone; Manfredi, Matteo; Bollito, Enrico; Correale, Loredana; Porpiglia, Francesco

2016-07-01

To evaluate the sensitivity of multiparametric magnetic resonance imaging (mp-MRI) for detecting prostate cancer foci, including the largest (index) lesions. In all, 115 patients with biopsy confirmed prostate cancer underwent mp-MRI before radical prostatectomy. A single expert radiologist recorded all prostate cancer foci including the index lesion 'blinded' to the pathologist's biopsy report. Stained whole-mount histological sections were used as the reference standard. All lesions were contoured by an experienced uropathologist who assessed their volume and pathological Gleason score. All lesions with a volume of >0.5 mL and/or pathological Gleason score of >6 were defined as clinically significant prostate cancer. Multivariate analysis was used to ascertain the characteristics of lesions identified by MRI. In all, 104 of 115 index lesions were correctly diagnosed by mp-MRI (sensitivity 90.4%; 95% confidence interval [CI] 83.5-95.1%), including 98/105 clinically significant index lesions (93.3%; 95% CI 86.8-97.3%), among which three of three lesions had a volume of <0.5 mL and Gleason score of >6. Overall, mp-MRI detected 131/206 lesions including 13 of 68 'insignificant' prostate cancers. The multivariate logistic regression modelling showed that pathological Gleason score (odds ratio [OR] 11.7, 95% CI 2.3-59.8; P = 0.003) and lesion volume (OR 4.24, 95% CI 1.3-14.7; P = 0.022) were independently associated with the detection of index lesions at MRI. This study shows that mp-MRI has a high sensitivity for detecting clinically significant prostate cancer index lesions, while having disappointing results for the detection of small-volume, low Gleason score prostate cancer foci. Thus, mp-MRI could be used to stratify patients according to risk, allowing better treatment selection. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

Trends of obesity prevalence among Spanish adults with diabetes, 1987-2012.

PubMed

Basterra-Gortari, Francisco Javier; Bes-Rastrollo, Maira; Ruiz-Canela, Miguel; Gea, Alfredo; Sayón-Orea, Carmen; Martínez-González, Miguel Ángel

2018-04-24

Our aim was to examine the secular trends in obesity prevalence among Spanish adults with diabetes. Data were collected from 8 waves (from 1987 to 2012) of the National Health Surveys (NHS). NHS are cross-sectional studies conducted in representative samples of the Spanish adult population. Data of 7378 adults (≥16 years) who reported having been diagnosed of diabetes were analyzed. Previously validated self-reported weight and height were used to estimate body mass index (BMI). Obesity was defined as a BMI of 30kg/m 2 or greater. Age-adjusted obesity prevalence for each wave was calculated by the direct standardization method. From 1987 to 2012 age-adjusted prevalence of obesity among persons with diabetes increased from 18.2% (95% confidence interval [CI]: 14.2-22.2%) to 39.8% (95% CI: 36.8-42.8%). Age-adjusted prevalence of obesity in males with diabetes increased from 13.2% (95% CI: 7.3-19.1%) to 38.0% (95% CI: 33.8-42.1%) and in females from 23.0% (95% CI: 17.6-28.4%) to 42.3% (95% CI: 38.0-46.6%). Between 1987 and 2012 the prevalence of obesity markedly increased in Spain among adults with diabetes. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

Mean cerebral blood volume is an effective diagnostic index of recurrent and radiation injury in glioma patients: A meta-analysis of diagnostic test.

PubMed

Li, Zhanzhan; Zhou, Qin; Li, Yanyan; Yan, Shipeng; Fu, Jun; Huang, Xinqiong; Shen, Liangfang

2017-02-28

We conducted a meta-analysis to evaluate the diagnostic values of mean cerebral blood volume for recurrent and radiation injury in glioma patients. We performed systematic electronic searches for eligible study up to August 8, 2016. Bivariate mixed effects models were used to estimate the combined sensitivity, specificity, positive likelihood ratios, negative likelihood ratios, diagnostic odds ratios and their 95% confidence intervals (CIs). Fifteen studies with a total number of 576 participants were enrolled. The pooled sensitivity and specificity of diagnostic were 0.88 (95%CI: 0.82-0.92) and 0.85 (95%CI: 0.68-0.93). The pooled positive likelihood ratio is 5.73 (95%CI: 2.56-12.81), negative likelihood ratio is 0.15 (95%CI: 0.10-0.22), and the diagnostic odds ratio is 39.34 (95%CI:13.96-110.84). The summary receiver operator characteristic is 0.91 (95%CI: 0.88-0.93). However, the Deek's plot suggested publication bias may exist (t=2.30, P=0.039). Mean cerebral blood volume measurement methods seems to be very sensitive and highly specific to differentiate recurrent and radiation injury in glioma patients. The results should be interpreted with caution because of the potential bias.

Obesity prevalence in Norwegian adults assessed by body mass index, waist circumference and fat mass percentage.

PubMed

Kjaer, I G H; Kolle, E; Hansen, B H; Anderssen, S A; Torstveit, M K

2015-08-01

The prevalence of obesity presents serious public health challenges worldwide and is most commonly estimated by the categorization of body mass index (BMI). The purpose of this study was (i) to describe the sensitivity of BMI, waist circumference (WC) and fat mass percentage in the classification of overweight and obesity and (ii) to describe the prevalence of overweight and obesity using different measurement methods in a national sample of Norwegians. A total of 904 Norwegians (20-85 years) were randomly enrolled. Body weight, height, WC and skinfold thickness were measured; BMI and fat mass percentage (FP(skf) ) were calculated. The sensitivity and specificity varied from 77.0% to 86.9% and from 60.6% to 82.3%, respectively. Area under the curve was 0.837 (95% confidence interval [CI]: 0.801-0.872) for the ability of BMI to predict obesity by FP(skf) and 0.811 (95% CI: 0.770-0.852) for WC. A total of 12.7% (male: 12.1%, female: 13.4%) were obese based on BMI classifications, 29.1% (male: 36.5%, female: 20.0%) of the sample were obese based on FP(skf) and 24.3% of men and 37.8% of women were abdominally obese by WC. The agreement between selected measuring methods was fair to good, although the variation in obesity prevalence rates between the different assessments methods varied markedly. © 2015 World Obesity.

Carotid artery intima-media thickness measurement in children with normal and increased body mass index: a comparison of three techniques.

PubMed

El Jalbout, Ramy; Cloutier, Guy; Cardinal, Marie-Hélène Roy; Henderson, Mélanie; Lapierre, Chantale; Soulez, Gilles; Dubois, Josée

2018-05-09

Common carotid artery intima-media thickness is a marker of subclinical atherosclerosis. In children, increased intima-media thickness is associated with obesity and the risk of cardiovascular events in adulthood. To compare intima-media thickness measurements using B-mode ultrasound, radiofrequency (RF) echo tracking, and RF speckle probability distribution in children with normal and increased body mass index (BMI). We prospectively measured intima-media thickness in 120 children randomly selected from two groups of a longitudinal cohort: normal BMI and increased BMI, defined by BMI ≥85th percentile for age and gender. We followed Mannheim recommendations. We used M'Ath-Std for automated B-mode imaging, M-line processing of RF signal amplitude for RF echo tracking, and RF signal segmentation and averaging using probability distributions defining image speckle. Statistical analysis included Wilcoxon and Mann-Whitney tests, and Pearson correlation coefficient and intra-class correlation coefficient (ICC). Children were 10-13 years old (mean: 11.7 years); 61% were boys. The mean age was 11.4 years (range: 10.0-13.1 years) for the normal BMI group and 12.0 years (range: 10.1-13.5 years) for the increased BMI group. The normal BMI group included 58% boys and the increased BMI group 63% boys. RF echo tracking method was successful in 79 children as opposed to 114 for the B-mode method and all 120 for the probability distribution method. Techniques were weakly correlated: ICC=0.34 (95% confidence interval [CI]: 0.27-0.39). Intima-media thickness was significantly higher in the increased BMI than normal BMI group using the RF techniques and borderline for the B-mode technique. Mean differences between weight groups were: B-mode, 0.02 mm (95% CI: 0.00 to 0.04), P=0.05; RF echo tracking, 0.03 mm (95% CI: 0.01 to 0.05), P=0.01; and RF speckle probability distribution, 0.03 mm (95% CI: 0.01 to 0.05), P=0.002. Though techniques are not interchangeable, all showed increased intima-media thickness in children with increased BMI. RF echo tracking method had the lowest success rate at calculating intima-media thickness. For patient follow-up and cohort comparisons, the same technique should be used throughout.

Dietary patterns in Canadian men and women ages 25 and older: relationship to demographics, body mass index, and bone mineral density

PubMed Central

2010-01-01

Background Previous research has shown that underlying dietary patterns are related to the risk of many different adverse health outcomes, but the relationship of these underlying patterns to skeletal fragility is not well understood. The objective of the study was to determine whether dietary patterns in men (ages 25-49, 50+) and women (pre-menopause, post-menopause) are related to femoral neck bone mineral density (BMD) independently of other lifestyle variables, and whether this relationship is mediated by body mass index. Methods We performed an analysis of 1928 men and 4611 women participants in the Canadian Multicentre Osteoporosis Study, a randomly selected population-based longitudinal cohort. We determined dietary patterns based on the self-administered food frequency questionnaires in year 2 of the study (1997-99). Our primary outcome was BMD as measured by dual x-ray absorptiometry in year 5 of the study (2000-02). Results We identified two underlying dietary patterns using factor analysis and then derived factor scores. The first factor (nutrient dense) was most strongly associated with intake of fruits, vegetables, and whole grains. The second factor (energy dense) was most strongly associated with intake of soft drinks, potato chips and French fries, certain meats (hamburger, hot dog, lunch meat, bacon, and sausage), and certain desserts (doughnuts, chocolate, ice cream). The energy dense factor was associated with higher body mass index independent of other demographic and lifestyle factors, and body mass index was a strong independent predictor of BMD. Surprisingly, we did not find a similar positive association between diet and BMD. In fact, when adjusted for body mass index, each standard deviation increase in the energy dense score was associated with a BMD decrease of 0.009 (95% CI: 0.002, 0.016) g/cm2 for men 50+ years old and 0.004 (95% CI: 0.000, 0.008) g/cm2 for postmenopausal women. In contrast, for men 25-49 years old, each standard deviation increase in the nutrient dense score, adjusted for body mass index, was associated with a BMD increase of 0.012 (95% CI: 0.002, 0.022) g/cm2. Conclusions In summary, we found no consistent relationship between diet and BMD despite finding a positive association between a diet high in energy dense foods and higher body mass index and a strong correlation between body mass index and BMD. Our data suggest that some factor related to the energy dense dietary pattern may partially offset the advantages of higher body mass index with regard to bone health. PMID:20109205

Body shape, adiposity index, and mortality in postmenopausal women: Findings from the Women's Health Initiative.

PubMed

Thomson, Cynthia A; Garcia, David O; Wertheim, Betsy C; Hingle, Melanie D; Bea, Jennifer W; Zaslavsky, Oleg; Caire-Juvera, Graciela; Rohan, Thomas; Vitolins, Mara Z; Thompson, Patricia A; Lewis, Cora E

2016-05-01

Studies evaluating the relationship between body mass index (BMI) and mortality demonstrate a U-shaped association. To expand, this study evaluated the relationship between adiposity indices, a body shape index (ABSI) and body adiposity index (BAI), and mortality in 77,505 postmenopausal women. A prospective cohort analysis was conducted in the Women's Health Initiative to ascertain the independent relationships between adiposity indices and mortality in order to inform on the clinical usefulness of alternate measures of mortality risk. ABSI (waist circumference (cm)/[BMI(2/3) × height (cm)(1/2) ]), BAI (hip circumference (cm)/[height (m)(1.5) ] - 18), weight, BMI, and waist circumference (WC) were evaluated in relation to mortality risk using adjusted Cox proportional hazards regression models. ABSI showed a linear association with mortality (HR, 1.37; 95% CI, 1.28-1.47 for quintile 5 vs. 1) while BMI and BAI had U-shaped relationships with HR of 1.30; 95% CI, 1.20-1.40 for obesity II/III BMI and 1.06, 95% CI, 0.99-1.13 for BAI. Higher WC (HR, 1.21; 95% CI, 1.13-1.29 for quintile 5 vs. 1) showed relationships similar to BMI. ABSI appears to be a clinically useful measure for estimating mortality risk, perhaps more so than BAI and BMI in postmenopausal women. © 2016 The Obesity Society.

Relationships of Musculoskeletal Symptoms, Sociodemographics, and Body Mass Index With Leisure-Time Physical Activity Among Nurses.

PubMed

Nam, Soohyun; Song, MinKyoung; Lee, Soo-Jeong

2018-05-01

Nurses have a high prevalence of musculoskeletal symptoms from patient handling tasks such as lifting, transferring, and repositioning. Comorbidities such as musculoskeletal symptoms may negatively affect engagement in leisure-time physical activity (LTPA). However, limited data are available on the relationship between musculoskeletal symptoms and LTPA among nurses. The purpose of this study was to describe musculoskeletal symptoms and LTPA, and to examine the relationships of musculoskeletal symptoms, sociodemographics, and body mass index with LTPA among nurses. Cross-sectional data on sociodemographics, employment characteristics, musculoskeletal symptoms, body mass index, and LTPA were collected from a statewide random sample of 454 California nurses from January to July 2013. Descriptive statistics, bivariate and multiple logistic regressions were performed. We observed that non-White nurses were less likely to engage in regular aerobic physical activity than White nurses (odds ratio [OR] = 0.61; 95% confidence interval [CI] = [0.40, 0.94]). Currently working nurses were less likely to engage in regular aerobic physical activity than their counterparts (OR = 0.48; 95% CI = [0.25, 0.91]). Nurses with higher body mass index were less likely to perform regular aerobic physical activity (OR = 0.93; 95% CI = [0.89, 0.97]) or muscle-strengthening physical activity (OR = 0.92; 95% CI = [0.88, 0.96]). This study found no evidence that musculoskeletal symptoms may interfere with regular engagement in LTPA. Physical activity promotion interventions should address employment-related barriers, and particularly target racial minority nurses and those who have a high body mass index.

Emergency readmission following acute upper gastrointestinal bleeding.

PubMed

Strömdahl, Martin; Helgeson, Johan; Kalaitzakis, Evangelos

2017-01-01

To assess the occurrence, clinical predictors, and associated mortality of all-cause emergency readmissions after acute upper gastrointestinal bleeding (AUGIB). All patients with AUGIB from an area of 600 000 inhabitants in Sweden admitted in a single institution in 2009-2011 were retrospectively identified. All medical records were scrutinized and relevant data (such as comorbid illness and medications, endoscopy, rebleeding, inhospital mortality, and 30-day emergency readmission) were extracted. The Charlson comorbidity index was calculated. A total of 174 out of 1056 patients discharged alive following AUGIB (16.5%) had an emergency readmission within 30 days. Nineteen percent of readmissions were because of rebleeding, whereas the rest were because of other reasons, mainly bacterial infections (9.8%) and cardiovascular events (8%). Inhospital mortality did not differ significantly between index admissions and readmissions (13.7 vs. 9.8%, P=0.181). In logistic regression analysis, only a higher Charlson comorbidity index [odds ratio (OR): 1.154, 95% confidence interval (CI): 1.056-1.261] was related to emergency readmission. Bisphosphonate use (OR: 3.933, 95% CI: 1.264-12.233), previous AUGIB (OR: 2.407, 95% CI: 1.157-5.009), and length of stay at index admission (>5 days; OR: 0.246, 95% CI: 0.093-0.649) were found to be independent predictors of postdischarge rebleeding. All-cause emergency readmission following AUGIB is frequent. It is related to rebleeding in one-fifth of cases and mortality is similar to that in index admissions. The presence of comorbid illness appears to predict readmissions. Reduced length of stay and bisphosphonate use appear to be important, potentially modifiable, predictors of postdischarge rebleeding.

Geomagnetic storms can trigger stroke: evidence from 6 large population-based studies in Europe and Australasia.

PubMed

Feigin, Valery L; Parmar, Priya G; Barker-Collo, Suzanne; Bennett, Derrick A; Anderson, Craig S; Thrift, Amanda G; Stegmayr, Birgitta; Rothwell, Peter M; Giroud, Maurice; Bejot, Yannick; Carvil, Phillip; Krishnamurthi, Rita; Kasabov, Nikola

2014-06-01

Although the research linking cardiovascular disorders to geomagnetic activity is accumulating, robust evidence for the impact of geomagnetic activity on stroke occurrence is limited and controversial. We used a time-stratified case-crossover study design to analyze individual participant and daily geomagnetic activity (as measured by Ap Index) data from several large population-based stroke incidence studies (with information on 11 453 patients with stroke collected during 16 031 764 person-years of observation) in New Zealand, Australia, United Kingdom, France, and Sweden conducted between 1981 and 2004. Hazard ratios and corresponding 95% confidence intervals (CIs) were calculated. Overall, geomagnetic storms (Ap Index 60+) were associated with 19% increase in the risk of stroke occurrence (95% CI, 11%-27%). The triggering effect of geomagnetic storms was most evident across the combined group of all strokes in those aged <65 years, increasing stroke risk by >50%: moderate geomagnetic storms (60-99 Ap Index) were associated with a 27% (95% CI, 8%-48%) increased risk of stroke occurrence, strong geomagnetic storms (100-149 Ap Index) with a 52% (95% CI, 19%-92%) increased risk, and severe/extreme geomagnetic storms (Ap Index 150+) with a 52% (95% CI, 19%-94%) increased risk (test for trend, P<2×10(-16)). Geomagnetic storms are associated with increased risk of stroke and should be considered along with other established risk factors. Our findings provide a framework to advance stroke prevention through future investigation of the contribution of geomagnetic factors to the risk of stroke occurrence and pathogenesis. © 2014 American Heart Association, Inc.

Disproportionate Fetal Growth and the Risk for Congenital Cerebral Palsy in Singleton Births

PubMed Central

Streja, Elani; Miller, Jessica E.; Wu, Chunsen; Bech, Bodil H.; Pedersen, Lars Henning; Schendel, Diana E.; Uldall, Peter; Olsen, Jørn

2015-01-01

Objective To investigate the association between proportionality of fetal and placental growth measured at birth and the risk for congenital cerebral palsy (CP). Study Design We identified all live-born singletons born in Denmark between 1995 and 2003 and followed them from 1 year of age until December 31st, 2008. Information on four indices of fetal growth: ponderal index, head circumference/ abdominal circumference ratio, cephalization index and birth weight/ placenta weight ratio was collected. Cox proportional hazards regression models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI). All measurements were evaluated as gestational age and sex specific z-scores and in z-score percentile groups, adjusted for potential confounders, and stratified on gestational age groups (<32, 32-36, 37-38, 39, 40, ≥41 weeks). Results We identified 503,784 singleton births, of which 983 were confirmed cases of CP. Head/ abdominal circumference ratio (aHR:1.12; 95%CI:1.07-1.16) and cephalization index (aHR:1.14; 95%CI:1.11-1.16) were associated with the risk of CP irrespective of gestational age. Birth weight-placental weight ratio was also associated with CP in the entire cohort (aHR:0.90; 95%CI:0.83-0.97). Ponderal index had a u-shaped association with CP, where both children with low and high ponderal index were at higher risk of CP. Conclusions CP is associated with disproportions between birth weight, birth length, placental weight and head circumference suggesting pre and perinatal conditions contribute to fetal growth restriction in children with CP. PMID:25974407

Determinants of Modern Contraceptive Uptake among Nigerian Women: Evidence from the National Demographic and Health Survey.

PubMed

Johnson, Ofonime E

2017-09-01

Family planning is a key strategy in the control of fertility among women. This study sought to determine various factors that influence modern family planning use in Nigeria. The study used data from Nigeria Demographic and Health Survey (NDHS) 2013. Analysis was carried out using Stata version 12.1. Multivariate logistic regression was used to determine association between various factors and use of modern family planning methods. A total of 119,386 women aged 15-49 years participated in the study. The mean age of respondents was 35.9 ± 8.1 years. Overall, contraceptive prevalence rate of modern methods was 10.3%. The highest proportion of use was 26.7% in the South West, while the lowest was 2.7% in the North West. Predictors of modern family planning use were higher education (OR=4.49, 95% CI: 4.10-4.92), richest wealth quintile (OR=3.71 CI: 3.29-4.19), being from South West (OR=3.42, 95% CI: 3.15-3.70), age 25-49 years (OR=1.55, 95% CI: 1.42-1.69) and urban residence (OR=1.08, 95% CI: 1.03-1.13) (p <0.001). The highest predictors of modern contraceptive use were education and wealth index. These indices were poorest in North Western Nigeria. Measures should be taken to improve female literacy and employment as these will most likely improve uptake of modern contraceptives among women in Nigeria.

Continuing professional education in Eritrea taught by local obstetrics and gynaecology residents: Effects on work environment and patient outcomes.

PubMed

Marzolf, Susan; Zekarias, Berhane; Tedla, Kifleyesus; Woldeyesus, Dawit Estifanos; Sereke, Dawit; Yohannes, Abraham; Asrat, Kibreab; Weaver, Marcia R

2015-01-01

Education and training can improve the quality of health care. We evaluated a course taught by Obstetrics/Gynaecology residents on the work environment and maternal/neonatal outcomes at Orotta Maternity Hospital. Participants were given a Standardised Safety Attitudes Questionnaire (SAQ) to measure work environment before and after training. Maternal/neonatal outcomes were extracted from hospital logbooks. Neonatal quality indicators were: adverse score index, weighted score index and severity score index. SAQ response rate was 77.6% (45/58) pre-training and 95.6% (43/45) post-training. Mean total SAQ score increased from 3.07 to 3.32 out of 5 points (p < 0.05). Changes in relative risk (RR) were not statistically significant for maternal [maternal death ratio of RR (RRR) =1.08, 95% CI: 0.20-5.84 and blood transfusion RRR = 0.90, 95% CI: 0.74 -1.09] or neonatal outcomes (intrapartum death RRR = 1.24, 95% CI: 0.57-2.75, neonatal death RRR = 0.93, 95% CI: 0.26-3.24, neonatal transfer RRR = 1.02, 95% CI: 0.81-1.27, and Apgar < 7 at 5 minutes RRR = 1.20, 95% CI: 0.83-1.73). Neonatal quality indicators did not change significantly. Utilising residents to teach staff-developed training within a hospital setting was feasible and may improve the work environment. Impact on maternal/neonatal outcomes is not evident but continued follow-up is important.

Validation of Thwaites Index for diagnosing tuberculous meningitis in a Colombian population.

PubMed

Saavedra, Juan Sebastián; Urrego, Sebastián; Toro, María Eugenia; Uribe, Carlos Santiago; García, Jenny; Hernández, Olga; Arango, Juan Carlos; Pérez, Ángela Beatriz; Franco, Andrés; Vélez, Isabel Cristina; Del Corral, Helena

2016-11-15

To determine the diagnostic accuracy of Thwaites Index (TI) in a Colombian population to distinguish meningeal tuberculosis (MTB) from bacterial meningitis (BM) and from non-tuberculous meningitis. Exploratory analyses were conducted to assess the TI's validity for patients with human immunodeficiency virus (HIV) and children above six-years-old. The study included 527 patients, the TI was calculated and results compared with those of a reference standard established by expert neurologists. Sensitivity, specificity, area under the curve of receiver-operator characteristics (AUC-ROC) and likelihood ratios were calculated. The AUC-ROC to distinguish MTB from non-tuberculous meningitis was 0.72 (95% CI: 0.67-0.77) for HIV negative adults. AUC-ROC was 0.62 (95% CI: 0.50-0.74) for HIV positive adults and 0.83 (95% CI: 0.68-0.97) for children. For distinguishing MTB from BM the AUC-ROC was 0.78 (95% CI: 0.73-0.83); furthermore, the AUC-ROC was 0.57 (95% CI: 0.31-0.83) for HIV positive adults and 0.86 (95% CI: 0.73-0.99) for children. The TI was sensitive but not specific when used to distinguish MTB from BM in HIV negative adults. In HIV positive adults the index had low diagnostic accuracy. Moreover, the TI showed discrimination capability for children over 6years; however, research with larger samples is required in these. Copyright © 2016 Elsevier B.V. All rights reserved.

The quest for small family size among Pakistani women--is voluntary termination of pregnancy a matter of choice or necessity?

PubMed

Saleem, Sarah; Fikree, Fariyal F

2005-07-01

To present the socio-biologic predictors of induced abortion among married women residing in low income squatter settlements of Karachi, Pakistan. A cross-sectional survey was conducted in three squatter settlements of Karachi from June to August 1997. Interviews were conducted on 1,214 married women assessing past pregnancy history, literacy and employment status of self and spouse and specifically probing for past history of seeking an induced abortion. Fifty women reported an induced abortion during last three years prior to survey. Of these, forty percent (20/50) of abortion seekers were using some method of family planning before conceiving the index pregnancy. Post abortion family planning method use was adopted by 50% (25/50) of the abortion seekers. The most parsimonious multivariate logistic regression model included grand-multigravidity (OR 2.6 CI, 1.3 - 5.2), literate status of the woman (OR 1.9 CI, 1.0 - 3.4) and the 26-35 age group (OR 3.0 CI, 1.4 - 6.6). Unplanned/mistimed pregnancies generally result from high unmet need and ineffective use of contraceptives and culminate through induced abortions. We propose that improvement in the quality of family planning counseling should be targeted to effective use of a method, back-up support in case of method failure and the health consequences of unsafe abortions.

Hemodynamic comparison of mild and severe preeclampsia: concept of stroke systemic vascular resistance index.

PubMed

Scardo, J; Kiser, R; Dillon, A; Brost, B; Newman, R

1996-01-01

Our purpose was to compare baseline hemodynamic parameters of mild and severe preeclampsia. Patients admitted to the Medical University Labor and Delivery Unit with the diagnosis of preeclampsia who had not received prior antihypertensive or magnesium sulfate therapy were recruited for noninvasive hemodynamic monitoring with thoracic electrical bioimpedance. After stabilization in the lateral recumbent position, hemodynamic monitoring was begun. Baseline hemodynamic parameters, mean arterial pressure (MAP), heart rate (HR), systemic vascular resistance index (SVRI), cardiac index (CI), and stroke index (SI) were recorded. Stroke systemic vascular resistance index (SSVRI), the resistance imposed by vasculature on each beat of the heart, was calculated for each patient by multiplying SVRI by HR. For statistical analysis, unpaired Student's t-tests (two-tailed) were utilized (P < 0.01). Forty-one preeclamptic patients (20 mild, 21 severe) were enrolled. Mean gestational age of severe patients was 32.2 +/- 4.0 and of mild patients was 37.0 +/- 3.5. MAP, SBP, diastolic blood pressure, HR, and SSVRI were higher in the severe group. SVRI, CI, cardiac output, and SI did not differ significantly between groups. Severe preclampsia appears to be a more intensely vasoconstricted state than mild preeclampsia. Although CI is inversely proportional to SVRI, increased HR in severe preeclampsia prevents this expected decrease in cardiac output.

Socioeconomic inequality in oral health behavior in Iranian children and adolescents by the Oaxaca-Blinder decomposition method: the CASPIAN- IV study.

PubMed

Safiri, Saeid; Kelishadi, Roya; Heshmat, Ramin; Rahimi, Ali; Djalalinia, Shirin; Ghasemian, Anoosheh; Sheidaei, Ali; Motlagh, Mohammad Esmaeil; Ardalan, Gelayol; Mansourian, Morteza; Asayesh, Hamid; Sepidarkish, Mahdi; Qorbani, Mostafa

2016-09-14

The present study set to describe the socioeconomic inequality associated with oral hygiene behavior among Iranian pediatric population. A representative sample of 13486 school students aged 6-18 years was selected through multistage random cluster sampling method from urban and rural areas of 30 provinces in Iran. Principle Component Analyses (PCA) correlated variables summarized as socioeconomic status (SES). Association of independent variables with tooth brushing was assessed through logistic regression analysis. Decomposition of the gap in tooth brushing between the first and fifth SES quintiles was assessed using the counterfactual decomposition technique. To assess the relation between tooth brushing and each socioeconomic category, Concentration Index (C) and the slope index of inequality (SII) were used, representing the linear regression coefficient. The participation rate was 90.6 % (50.7 % boys and 75.6 % urban inhabitants). The mean age of participants was 12.47 ± 3.36 years. The frequency of tooth brushing increased across SES quintiles, prevalence of tooth brushing between the first and fifth quintile, under 20 % difference, increased from 58.22 (95 % CI: 56.24,60.20) to 78.61 (95 % CI: 77.00,80.24). Only 3 % of the difference is explained by the factors considered in the study, and 17 % remained unknown. Residence area, family size, and smoking status made a significant contribution to the gap between the first and last SE groups. Residence area [ -2.01 (95 % CI: -3.46, -0.55)] was along the maximum levels of gaps between SE categories. The findings revealed a socio-economic inequality in oral health behavior in Iranian children and adolescents. Also, factors influencing oral health are addressed to develop and implement complementary public health actions.

Scientific Production of Research Fellows at the Zagreb University School of Medicine, Croatia

PubMed Central

Polašek, Ozren; Kolčić, Ivana; Buneta, Zoran; Čikeš, Nada; Pećina, Marko

2006-01-01

Aim To evaluate scientific production among research fellows employed at the Zagreb University School of Medicine and identify factors associated with their scientific output. Method We conducted a survey among research fellows and their mentors during June 2005. The main outcome measure was publication success, defined for each fellow as publishing at least 0.5 articles per employment year in journals indexed in the Current Contents bibliographic database. Bivariate methods and binary logistic regression were used in data analysis. Results A total of 117 fellows (response rate 95%) and 83 mentors (100%) were surveyed. The highest scientific production was recorded among research fellows employed in public health departments (median 3.0 articles, interquartile range 4.0), compared with those from pre-clinical (median 0.0, interquartile range 2.0) and clinical departments (median 1.0, interquartile range 2.0) (Kruskal-Wallis, P = 0.003). A total of 36 (29%) research fellows published at least 0.5 articles per employment year and were considered successful. Three variables were associated with fellows’ publication success: mentor’s scientific production (odds ratio [OR], 3.14; 95% confidence interval [CI], 1.31-7.53), positive mentor’s assessment (OR, 3.15; 95% CI, 1.10-9.05), and fellows’ undergraduate publication in journals indexed in the Current Contents bibliographic database (OR, 4.05; 95% CI, 1.07-15.34). Conclusion Undergraduate publication could be used as one of the main criteria in selecting research fellows. One of the crucial factors in a fellow’s scientific production and career advancement is mentor’s input, which is why research fellows would benefit most from working with scientifically productive mentors. PMID:17042070

Genetic effects on refraction and correlation with hemodynamic variables: a twin study.

PubMed

Toth, G Zs; Tarnoki, Adam Domonkos; Tarnoki, D L; Racz, A; Szekelyhidi, Z; Littvay, L; Karlinger, K; Lannert, A; Molnar, A A; Garami, Zs; Berczi, V; Suveges, I; Nemeth, J

2014-09-01

Spherical equivalent (SE) has not been linked to increased cardiovascular morbidity. Methods: 132 Hungarian twins(age 43.3±16.9 years) underwent refraction measurements (Huvitz MRK-3100 Premium AutoRefractokeratometer)and oscillometry (TensioMed Arteriograph). Results: Heritability analysis indicated major role for genetic components in the presence of right and left SE (82.7%, 95%CI, 62.9 to 93.7%, and 89.3%, 95%CI, 72.8 to 96.6%),while unshared environmental effects accounted for 17% (95%CI, 6.3% to 37%), and 11% (95%CI, 3.4% to 26.7%)of variations adjusted for age and sex. Bilateral SE showed weak age-dependent correlations with augmentation index (AIx), aortic pulse wave velocity (r ranging between 0.218 and 0.389, all p < 0.01), aortic systolic blood pressure and pulse pressure (r between 0.188 and 0.289, p < 0.05). Conclusions: These findings support heritability of spherical equivalent, which does not coexist with altered hemodynamics (e.g. accelerated arterial aging).Accordingly, SE and the investigated hemodynamic parameters seem neither phenotypically nor genetically associated.

Diet, lifestyle and chronic widespread pain: Results from the 1958 British Birth Cohort Study

PubMed Central

VanDenKerkhof, Elizabeth G; Macdonald, Helen M; Jones, Gareth T; Power, Chris; Macfarlane, Gary J

2011-01-01

OBJECTIVES: To examine the relationship between diet and lifestyle, and chronic widespread pain (CWP). If persons with CWP have dietary and lifestyle habits consistent with an increased risk of cancer or cardiovascular disease, it may partially explain evidence in the literature suggesting an association between CWP and these diseases. METHODS: The 1958 British Birth Cohort Study comprises individuals born in England, Scotland and Wales in the United Kingdom during one week in March 1958. At 45 years of age, pain was recorded using a self-completion questionnaire. CWP was classified using the American College of Rheumatology definition for fibromyalgia. Data were collected on diet and lifestyle at 33 and 42 years of age. RESULTS: A total of 8572 participants provided pain data at 45 years of age, of whom 12% reported CWP. Women with CWP, compared with those without, reported an unhealthy diet (ie, fruit/vegetable consumption less than once per week [OR 2.0; 95% CI 1.3 to 3.1], and fatty food [OR 1.7; 95% CI 1.1 to 2.7] and chips (french fries) [OR 1.5; 95% CI 1.0 to 2.4] at least once per day) that may have predisposed them to other chronic diseases such as cancer and cardiovascular disease. Women with CWP were also more likely to be unemployed (adjusted OR 1.4; 95% CI 1.1 to 1.8), to have had high physical exertion at work (adjusted OR 1.6; 95% CI 1.2 to 2.2) and elevated body mass index (overweight – adjusted OR 1.5, 95% CI 1.2 to 1.9; obese – adjusted OR 1.8, 95% CI 1.3 to 2.5). Similar relationships between lifestyle (but not diet) and the risk of CWP were identified in men. CONCLUSIONS: The findings for smoking, body mass index and (for women) diet offer support for the hypothesis that lifestyle factors may partially explain the association between CWP and cancer or cardiovascular disease. Prospective studies are necessary to confirm this relationship. PMID:21499583

Internet-Delivered Cognitive Behavioral Therapy to Treat Insomnia: A Systematic Review and Meta-Analysis.

PubMed

Seyffert, Michael; Lagisetty, Pooja; Landgraf, Jessica; Chopra, Vineet; Pfeiffer, Paul N; Conte, Marisa L; Rogers, Mary A M

2016-01-01

Insomnia is of major public health importance. While cognitive behavioral therapy is beneficial, in-person treatment is often unavailable. We assessed the effectiveness of internet-delivered cognitive behavioral therapy for insomnia. The primary objectives were to determine whether online cognitive behavioral therapy for insomnia could improve sleep efficiency and reduce the severity of insomnia in adults. Secondary outcomes included sleep quality, total sleep time, time in bed, sleep onset latency, wake time after sleep onset, and number of nocturnal awakenings. We searched PubMed/MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycInfo, Cochrane Library, Embase, and the Web of Science for randomized trials. Studies were eligible if they were randomized controlled trials in adults that reported application of cognitive behavioral therapy for insomnia via internet delivery. Mean differences in improvement in sleep measures were calculated using the Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis. We found 15 trials, all utilizing a pretest-posttest randomized control group design. Sleep efficiency was 72% at baseline and improved by 7.2% (95% CI: 5.1%, 9.3%; p<0.001) with internet-delivered cognitive behavioral therapy versus control. Internet-delivered cognitive behavioral therapy resulted in a decrease in the insomnia severity index by 4.3 points (95% CI: -7.1, -1.5; p = 0.017) compared to control. Total sleep time averaged 5.7 hours at baseline and increased by 20 minutes with internet-delivered therapy versus control (95% CI: 9, 31; p = 0.004). The severity of depression decreased by 2.3 points (95% CI: -2.9, -1.7; p = 0.013) in individuals who received internet-delivered cognitive behavioral therapy compared to control. Improvements in sleep efficiency, the insomnia severity index and depression scores with internet-delivered cognitive behavioral therapy were maintained from 4 to 48 weeks after post-treatment assessment. There were no statistically significant differences between sleep efficiency, total sleep time, and insomnia severity index for internet-delivered versus in-person therapy with a trained therapist. In conclusion, internet-delivered cognitive behavioral therapy is effective in improving sleep in adults with insomnia. Efforts should be made to educate the public and expand access to this therapy. Registration Number, Prospero: CRD42015017622.

Predictive Validity of the Body Adiposity Index in Overweight and Obese Adults Using Dual-Energy X-ray Absorptiometry

PubMed Central

Ramírez-Vélez, Robinson; Correa-Bautista, Jorge Enrique; González-Ruíz, Katherine; Vivas, Andrés; García-Hermoso, Antonio; Triana-Reina, Hector Reynaldo

2016-01-01

The body adiposity index (BAI) is a recent anthropometric measure proven to be valid in predicting body fat percentage (BF%) in some populations. However, the results have been inconsistent across populations. This study was designed to verify the validity of BAI in predicting BF% in a sample of overweight/obese adults, using dual-energy X-ray absorptiometry (DEXA) as the reference method. A cross-sectional study was conducted in 48 participants (54% women, mean age 41.0 ± 7.3 years old). DEXA was used as the “gold standard” to determine BF%. Pearson’s correlation coefficient was used to evaluate the association between BAI and BF%, as assessed by DEXA. A paired sample t-test was used to test differences in mean BF% obtained with BAI and DEXA methods. To evaluate the concordance between BF% as measured by DEXA and as estimated by BAI, we used Lin’s concordance correlation coefficient and Bland–Altman agreement analysis. The correlation between BF% obtained by DEXA and that estimated by BAI was r = 0.844, p < 0.001. Paired t-test showed a significant mean difference in BF% between methods (BAI = 33.3 ± 6.2 vs. DEXA 39.0 ± 6.1; p < 0.001). The bias of the BAI was −6.0 ± 3.0 BF% (95% CI = −12.0 to 1.0), indicating that the BAI method significantly underestimated the BF% compared to the reference method. Lin’s concordance correlation coefficient was considered stronger (ρc = 0.923, 95% CI = 0.862 to 0.957). In obese adults, BAI presented low agreement with BF% measured by DEXA; therefore, BAI is not recommended for BF% prediction in this overweight/obese sample studied. PMID:27916871

Loss to follow-up in the Australian HIV Observational Database

PubMed Central

McManus, Hamish; Petoumenos, Kathy; Brown, Katherine; Baker, David; Russell, Darren; Read, Tim; Smith, Don; Wray, Lynne; Giles, Michelle; Hoy, Jennifer; Carr, Andrew; Law, Matthew

2015-01-01

Background Loss to follow-up (LTFU) in HIV-positive cohorts is an important surrogate for interrupted clinical care which can potentially influence the assessment of HIV disease status and outcomes. After preliminary evaluation of LTFU rates and patient characteristics, we evaluated the risk of mortality by LTFU status in a high resource setting. Methods Rates of LTFU were measured in the Australian HIV Observational Database for a range of patient characteristics. Multivariate repeated measures regression methods were used to identify determinants of LTFU. Mortality by LTFU status was ascertained using linkage to the National Death Index. Survival following combination antiretroviral therapy initiation was investigated using the Kaplan-Meier (KM) method and Cox proportional hazards models. Results Of 3,413 patients included in this analysis, 1,632 (47.8%) had at least one episode of LTFU after enrolment. Multivariate predictors of LTFU included viral load (VL)>10,000 copies/ml (Rate ratio (RR) 1.63 (95% confidence interval (CI):1.45–1.84) (ref ≤400)), time under follow-up (per year) (RR 1.03 (95% CI: 1.02–1.04)) and prior LTFU (per episode) (RR 1.15 (95% CI: 1.06–1.24)). KM curves for survival were similar by LTFU status (p=0.484). LTFU was not associated with mortality in Cox proportional hazards models (univariate hazard ratio (HR) 0.93 (95% CI: 0.69–1.26) and multivariate HR 1.04 (95% CI: 0.77–1.43)). Conclusions Increased risk of LTFU was identified amongst patients with potentially higher infectiousness. We did not find significant mortality risk associated with LTFU. This is consistent with timely re-engagement with treatment, possibly via high levels of unreported linkage to other health care providers. PMID:25377928

A study on scientific collaboration and co-authorship patterns in library and information science studies in Iran between 2005 and 2009

PubMed Central

Siamaki, Saba; Geraei, Ehsan; Zare- Farashbandi, Firoozeh

2014-01-01

Background: Scientific collaboration is among the most important subjects in scientometrics, and many studies have investigated this concept to this day. The goal of the current study is investigation of scientific collaboration and co-authorship patterns of researchers in the field of library and information science in Iran between years 2005 and 2009. Materials and Methods: The current study uses scientometrics method. The statistical population consists of 942 documents published in Iranian library and information science journals between years 2005 and 2009. Collaboration coefficient, collaboration index (CI), and degree of collaboration (DC) were used for data analysis. Findings: The findings showed that among 942 investigated documents, 506 documents (53.70%) was created by one individual researcher and 436 documents (46.30%) were the result of collaboration between two or more researchers. Also, the highest rank of different authorship patterns belonged to National Journal of Librarianship and Information Organization (code H). Conclusion: The average collaboration coefficient for the library and information science researchers in the investigated time frame was 0.23. The closer this coefficient is to 1, the higher is the level of collaboration between authors, and a coefficient near zero shows a tendency to prefer individual articles. The highest collaboration index with an average of 1.92 authors per paper was seen in year 1388. The five year collaboration index in library and information science in Iran was 1.58, and the average degree of collaboration between researchers in the investigated papers was 0.46, which shows that library and information science researchers have a tendency for co-authorship. However, the co-authorship had increased in recent years reaching its highest number in year 1388. The researchers’ collaboration coefficient also shows relative increase between years 1384 and 1388. National Journal of Librarianship and Information Organization has the highest rank among all the investigated journals based on collaboration coefficient, collaboration index (CI), and degree of collaboration (DC). PMID:25250365

Alternate Healthy Eating Index 2010, Dietary Inflammatory Index and risk of mortality: results from the Whitehall II cohort study and meta-analysis of previous Dietary Inflammatory Index and mortality studies.

PubMed

Shivappa, Nitin; Hebert, James R; Kivimaki, Mika; Akbaraly, Tasnime

2017-08-01

We aimed to examine the association between the Alternative Healthy Eating Index updated in 2010 (AHEI-2010), the Dietary Inflammatory Index (DIITM) and risk of mortality in the Whitehall II study. We also conducted a meta-analysis on the DII-based results from previous studies to summarise the overall evidence. Data on dietary behaviour assessed by self-administered repeated FFQ and on mortality status were available for 7627 participants from the Whitehall II cohort. Cox proportional hazards regression models were performed to assess the association between cumulative average of AHEI-2010 and DII scores and mortality risk. During 22 years of follow-up, 1001 participants died (450 from cancer, 264 from CVD). Both AHEI-2010 (mean=48·7 (sd 10·0)) and DII (mean=0·37 (sd 1·41)) were associated with all-cause mortality. The fully adjusted hazard ratio (HR) per sd, were 0·82; 95 % CI 0·76, 0·88 for AHEI-2010 and 1·18; 95 % CI 1·08, 1·29 for DII. Significant associations were also observed with cardiovascular and cancer mortality risk. For DII, a meta-analysis (using fixed effects) from this and four previous studies showed a positive association of DII score with all-cause (HR=1·04; 95 % CI 1·03, 1·05, 28 891deaths), cardiovascular (HR=1·05; 95 % CI 1·03, 1·07, 10 424 deaths) and cancer mortality (HR=1·05; 95 % CI 1·03, 1·07, n 8269).The present study confirms the validity to assess overall diet through AHEI-2010 and DII in the Whitehall II cohort and highlights the importance of considering diet indices related to inflammation when evaluating all-cause, cardiovascular and cancer mortality risk.

Anxiety disorders and childhood maltreatment as predictors of outcome in bipolar disorder.

PubMed

Pavlova, Barbara; Perroud, Nader; Cordera, Paolo; Uher, Rudolf; Alda, Martin; Dayer, Alexandre; Aubry, Jean-Michel

2018-01-01

Comorbid anxiety disorders and childhood maltreatment have each been linked with unfavourable outcomes in people with bipolar disorder. Because childhood maltreatment is associated with anxiety disorders in this population, their respective predictive value remains to be determined. In 174 adults with bipolar disorder, we assessed childhood maltreatment using the Childhood Trauma Questionnaire and lifetime anxiety disorders with the MINI International Neuropsychiatric Interview. We constructed an overall index of severity of bipolar disorder as a sum of six indicators (unemployment, psychotic symptoms, more than five manic episodes, more than five depressive episodes, suicide attempt, and hospital admission). We tested the relationship between childhood maltreatment, the number of anxiety disorders and the overall severity index using ordered logistic regression. The number of lifetime anxiety disorders was associated with the overall severity index (OR = 1.43, 95%CI = 1.01-2.04, p = 0.047). This relationship was only slightly attenuated when controlled for childhood maltreatment (OR = 1.39, 95%CI = 0.97-2.00, p = 0.069). The relationship between childhood maltreatment and the overall severity index was not statistically significant (OR = 1.26, 95%CI = 0.92-1.74, p = 0.151). Secondary analyses revealed that childhood maltreatment was associated with suicide attempts (OR = 1.70, 95%CI = 1.15-2.51, p = 0.008) and obsessive compulsive disorder was associated with the overall severity index (OR = 9.56, 95%CI = 2.20-41.47, p = 0.003). This was a cross-sectional study with a moderate-sized sample recruited from a specialist program. While comorbid anxiety disorders are associated with the overall severity of bipolar disorder, childhood maltreatment is specifically associated with suicide attempts. Clinicians should systematically assess both factors. Interventions to improve outcomes of people with bipolar disorder with comorbid anxiety disorders and history of childhood maltreatment are needed. Copyright © 2017 Elsevier B.V. All rights reserved.

Body mass index-percent forced vital capacity-respiratory hospitalization: new staging for idiopathic pulmonary fibrosis patients.

PubMed

Kishaba, Tomoo; Nagano, Hiroaki; Nei, Yuichiro; Yamashiro, Shin

2016-12-01

Idiopathic pulmonary fibrosis (IPF) is relentless progressive interstitial lung disease. Evaluating predictor of mortality for IPF patients is crucial. The aim of this study was to evaluate the serial trend of important indicators of prognosis and create a useful staging method for IPF patients. We retrospectively searched medical records, pulmonary function tests (PFTs), and chest high resolution computed tomography (HRCT) scans from January 1, 2008 through June 30, 2015 at our hospital. We also evaluated the same parameters 1-year later. We identified 65 IPF patients. The mean age was 71.9±1.8 years (range, 22-85 years). In terms of PFTs, mean percent predicted forced vital capacity (%FVC) was 69.8±2.7. Baseline mean body mass index (BMI) was 24.3±0.6 kg/mm 2 . Mean survival was 39.2 months (range, 0.9-158.9 months). Cox proportional hazard ratios (HRs) showed the following to be predictors of mortality in IPF patients: 1-year BMI (HR: 0.899; 95% CI: 0.825-0.979; P=0.021); 1-year %FVC (HR: 0.932; 95% CI: 0.887-0.979; P=0.005) and 1-year respiratory hospitalization (HR: 3.307; 95% CI: 2.149-5.090; P<0.001). On the basis of these date, we created a new staging method for predicting mortality for IPF patients, consisting of delta BMI, delta %FVC and respiratory hospitalization within a year following diagnosis of IPF (BFR staging). We stratified patients into one of three groups according to the composite points. Mean survival of stages 1, 2, and 3 was 77.9 (30.8-158.9), 43.9 (0.9-145.2) and 14.8 (3.5-32) months (P<0.001), respectively. In our cohort of IPF patients, this new staging method, including delta BMI and delta %FVC and respiratory hospitalization within 1-year showed a clear survival difference.

Hypertension among HIV-infected adults receiving highly active antiretroviral therapy (HAART) in Malaysia.

PubMed

Hejazi, Nazisa; Huang, M S L; Lin, Khor Geok; Choong, Lee Christopher Kwok

2013-12-01

There are increasing researches about non-communicable disease such as elevated blood pressure among people living with HIV before and after initiation of highly active antiretroviral therapy (HAART). This cross-sectional study was designed to determine the prevalence of hypertension and associated risk factors among 340 HIV-infected patients on antiretroviral therapy at a Malaysian public hospital providing HIV-related treatment. Data on socioeconomic background, anthropometry, medical history and dietary intake of the patients were collected. Hypertension is defined as blood pressure >=130/85 (mm Hg). Prevalence of hypertension was 45.60% (n=155) of which 86.5% of the hypertensive group were male (n=134). The results showed that increase in age (OR 1.051, 95% confidence interval (CI) 1.024-1.078), higher body mass index (OR 1.18, 95%CI 1.106-2.71), bigger waist circumference (OR 1.18, 95%CI 1.106-2.71), higher waist-hip ratio (OR 1.070, 95%CI 1.034-1.106), higher fasting plasma glucose (OR 1.332, 95%CI 0.845-2.100) and percentage energy intake from protein >15 (OR 2.519, 95%CI 1.391-4.561) were significant risk factors for hypertension (p<0.001). After adjusting for other variables, increasing age (adjusted odds ratio (aOR) 1.069 95%CI 1.016-1.124, p=0.010), being male (aOR 3.026, 95%CI 1.175-7.794, p=0.022) and higher body mass index (aOR 1.26, 95%CI 1.032-1.551, p=0.024) were independently associated with hypertension. None of the antiretroviral therapy and immunologic factors was linked to hypertension. In conclusion hypertension among PLHIV was linked to the well-known risk factors such as age, gender and body mass index. With HAART, people can live longer by making monitoring and control of some reversible factors, especially excessive weight gain for maintaining quality of life.

Severity of illness index for surgical departments in a Cuban hospital: a revalidation study.

PubMed

Armas-Bencomo, Amadys; Tamargo-Barbeito, Teddy Osmin; Fuentes-Valdés, Edelberto; Jiménez-Paneque, Rosa Eugenia

2017-03-08

In the context of the evaluation of hospital services, the incorporation of severity indices allows an essential control variable for performance comparisons in time and space through risk adjustment. The severity index for surgical services was developed in 1999 and validated as a general index for surgical services. Sixteen years later the hospital context is different in many ways and a revalidation was considered necessary to guarantee its current usefulness. To evaluate the validity and reliability of the surgical services severity index to warrant its reasonable use under current conditions. A descriptive study was carried out in the General Surgery service of the "Hermanos Ameijeiras" Clinical Surgical Hospital of Havana, Cuba during the second half of 2010. We reviewed the medical records of 511 patients discharged from this service. Items were the same as the original index as were their weighted values. Conceptual or construct validity, criterion validity and inter-rater reliability as well as internal consistency of the proposed index were evaluated. Construct validity was expressed as a significant association between the value of the severity index for surgical services and discharge status. A significant association was also found, although weak, with length of hospital stay. Criterion validity was demonstrated through the correlations between the severity index for surgical services and other similar indices. Regarding criterion validity, the Horn index showed a correlation of 0.722 (95% CI: 0.677-0.761) with our index. With the POSSUM score, correlation was 0.454 (95% CI: 0.388-0.514) with mortality risk and 0.539 (95% CI: 0.462-0.607) with morbidity risk. Internal consistency yielded a standardized Cronbach's alpha of 0.8; inter-rater reliability resulted in a reliability coefficient of 0.98 for the quantitative index and a weighted global Kappa coefficient of 0.87 for the ordinal surgical index of severity for surgical services (IGQ). The validity and reliability of the proposed index was satisfactory in all aspects evaluated. The surgical services severity index may be used in the original context and is easily adaptable to other contexts as well.

Comparative study between the hand-wrist method and cervical vertebral maturation method for evaluation skeletal maturity in cleft patients.

PubMed

Manosudprasit, Montian; Wangsrimongkol, Tasanee; Pisek, Poonsak; Chantaramungkorn, Melissa

2013-09-01

To test the measure of agreement between use of the Skeletal Maturation Index (SMI) method of Fishman using hand-wrist radiographs and the Cervical Vertebral Maturation Index (CVMI) method for assessing skeletal maturity of the cleft patients. Hand-wrist and lateral cephalometric radiographs of 60 cleft subjects (35 females and 25 males, age range: 7-16 years) were used. Skeletal age was assessed using an adjustment to the SMI method of Fishman to compare with the CVMI method of Hassel and Farman. Agreement between skeletal age assessed by both methods and the intra- and inter-examiner reliability of both methods were tested by weighted kappa analysis. There was good agreement between the two methods with a kappa value of 0.80 (95% CI = 0.66-0.88, p-value <0.001). Reliability of intra- and inter-examiner of both methods was very good with kappa value ranging from 0.91 to 0.99. The CVMI method can be used as an alternative to the SMI method in skeletal age assessment in cleft patients with the benefit of no need of an additional radiograph and avoiding extra-radiation exposure. Comparing the two methods, the present study found better agreement from peak of adolescence onwards.

Socioeconomic Inequality in Childhood Obesity.

PubMed

Moradi, Ghobad; Mostafavi, Farideh; Azadi, Namamali; Esmaeilnasab, Nader; Ghaderi, Ebrahim

2017-08-15

The aim of this study was to assess the socioeconomic inequalities in obesity and overweight in children aged 10 to 12 yr old. A cross-sectional study. This study was conducted on 2506 children aged 10 to 12 yr old in the city of Sanandaj, western Iran in 2015. Body mass index (BMI) was calculated. Considering household situation and assets, socioeconomic status (SES) of the subjects was determined using Principal Component Analysis (PCA). Concentration Index was used to measure inequality and Oaxaca decomposition was used to determine the share of different determinants of inequality. The prevalence of overweight was 24.1% (95% CI: 22.4, 25.7). 11.5% (95% CI: 10.0, 12.0) were obese. The concentration index for overweight and obesity, respectively, was 0.10 (95% CI: 0.05, 0.15), and 0.07 (95% CI:0.00, 0.14) which indicated inequality and a higher prevalence of obesity and overweight in higher SES. The results of Oaxaca decomposition suggested that socioeconomic factors accounted for 75.8% of existing inequalities. Residential area and mother education were the most important causes of inequality. To reduce inequalities in childhood obesity, mother education must be promoted and special attention must be paid to residential areas and children gender.

[Vasopressin intravenous infusion causes dose dependent adverse cardiovascular effects in anesthetized dogs.

PubMed

Martins, Luiz Cláudio; Sabha, Maricene; Paganelli, Maria Ondina; Coelho, Otávio Rizzi; Ferreira-Melo, Silvia Elaine; Moreira, Marcos Mello; Cavalho, Adriana Camargo de; Araujo, Sebastião; Moreno Junior, Heitor

2010-01-15

BACKGROUND: Arginine vasopressin (AVP) has been broadly used in the management of vasodilatory shock. However, there are many concerns regarding its clinical use, especially in high doses, as it can be associated with adverse cardiovascular events. OBJECTIVE: To investigate the cardiovascular effects of AVP in continuous IV infusion on hemodynamic parameters in dogs. METHODS: Sixteen healthy mongrel dogs, anesthetized with pentobarbital were intravascularly catheterized, and randomly assigned to: control (saline-placebo; n=8) and AVP (n=8) groups. The study group was infused with AVP for three consecutive 10-minute periods at logarithmically increasing doses (0.01; 0.1 and 1.0U/kg/min), at them 20-min intervals. Heart rate (HR) and intravascular pressures were continuously recorded. Cardiac output was measured by the thermodilution method. RESULTS: No significant hemodynamic effects were observed during 0.01U/kg/min of AVP infusion, but at higher doses (0.1 and 1.0U/kg/min) a progressive increase in mean arterial pressure (MAP) and systemic vascular resistance index (SVRI) were observed, with a significant decrease in HR and the cardiac index (CI). A significant increase in the pulmonary vascular resistance index (PVRI) was also observed with the 1.0U/kg/min dose, mainly due to the decrease in the CI. CONCLUSION: AVP, when administered at doses between 0.1 and 1.0U/kg/min, induced significant increases in MAP and SVRI, with negative inotropic and chronotropic effects in healthy animals. Although these doses are ten to thousand times greater than those routinely used for the management of vasodilatory shock, our data confirm that AVP might be used carefully and under strict hemodynamic monitoring in clinical practice, especially if doses higher than 0.01 U/kg/min are needed. Martins, LC et al.

Core temperature variation is associated with heart rate variability independent of cardiac index: a study of 278 trauma patients.

PubMed

Mowery, Nathan T; Morris, John A; Jenkins, Judith M; Ozdas, Asli; Norris, Patrick R

2011-10-01

The purpose of this study is to determine if temperature extremes are associated with reduced heart rate variability (HRV) and "cardiac uncoupling." This was a retrospective, observational cohort study performed on 278 trauma intensive care unit admissions that had continuous HR, cardiac index (CI), and core temperature data from "thermodilution" Swan-Ganz catheter. Dense (captured second-by-second) physiologic data were divided into 5-minute intervals (N = 136 133; 11 344 hours of data). Mean CI, mean temperature, and integer HR SD were computed for each interval. Critically low HRV was defined as HR SD from 0.3 to 0.6 beats per minute. Temperature extremes were defined as less than 36°C or greater than 39°C. Low HRV and CI vary with temperature. Temperature extremes are associated with increased risk for critically low HRV (odds ratio, >1.8). Cardiac index increases with temperature until hyperthermia (>40°C). At temperature extremes, changes in CI were not explained solely by changes in HR. The conclusions of this study are (1) temperature extremes are associated with low HRV, potentially reflecting cardiac autonomic dysfunction; (2) CI increases with temperature; and (3) HRV provides additional physiologic information unobtainable via current invasive cardiac monitoring and current vital signs. Copyright © 2011 Elsevier Inc. All rights reserved.

Anemia Status in Relation to Body Mass Index Among Women of Childbearing Age in Bangladesh.

PubMed

Ghose, Bishwajit; Yaya, Sanni; Tang, Shangfeng

2016-10-01

Undernutrition and micronutrient deficiency disorders together constitute a major public health concern in Bangladesh. Among many vitamin and mineral deficiency diseases, iron-deficiency anemia remains the most persistent and has been shown to contribute to high maternal and child morbidity and mortality in the country. In parallel with micronutrient malnutrition, the country is also experiencing a rising epidemic of overweight and obesity due to changing pattern in dietary behavior and body mass index status. Previous empirical studies have demonstrated a strong correlation between body weight and anemia status. However, results remain inconclusive and for Bangladesh such evidence is nonexistent. To this end, we conducted this study using Bangladesh Demographic and Health Survey 2011 data with an aim to explore the association between body mass index and anemia status among adult women in Bangladesh. According to the findings, age between 15 and 29 years ( P < .001, OR = 1.30, 95% CI = 1.12-1.49), experiencing first birth before reaching the age of 18 years ( P < .001, OR = 1.31, 95% CI = 1.15-1.50), lack of access to potable water ( P = .013, OR = 1.467, 95%CI = 1.085- 1.982), being underweight ( P < .001, 95% CI = 1.208-1.570) and normal weight ( P < .001, 95% CI = 1.819-2.516) were significantly associated with anemia status.

Monitoring of intrathoracic volemia and cardiac output in critically ill children.

PubMed

Cecchetti, C; Stoppa, F; Vanacore, N; Barbieri, M A; Raucci, U; Pasotti, E; Tomasello, C; Marano, M; Pirozzi, N

2003-12-01

Hemodynamic monitoring is an important step in the management of critically ill children despite the difficulty in measuring preload indices continuously. The aim of the study was to analyze cardiac output parameters and preload indices after acute changes in mean airway pressure and volemia. Twenty-three children treated at our unit were enrolled in a prospective non randomized cohort study. Respiration was supported by controlled mechanical ventilation with positive expiratory-end pressure (PEEP), peak inspiratory pressure <20 cm H(2)O and mean airway pressure <10 cm H(2)O, and hemodynamic monitoring using the PiCCO system. Hemodynamic parameters were measured at T0 (base line), T(1) (after an increase in PEEP of 5 cm H(2)O for 10 min), and T(2) (after fluid challenge). The statistical analysis (BMPD New System software package) comprised comparison of changes at T(0) vs T(1), T(1) vs T(2) and T(0) vs T(2), construction of 3 correlation matrices and multiple linear regression analysis. Sixty-nine hemodynamic parameters were measured in the 23 patients. A comparison between T(0) and T(1) showed no significant changes; differences between T(0) and T(2) were found for cardiac index (CI), (p=0.003); between T(0) and T(2) significant differences were found for CI (p=0.0015), intrathoracic blood volume index (ITBVI) (p=0.04) and stroke volume index (SVI) (p=0.06). The analysis of the correlation matrices yielded ITBVI with CI (p=0.0006), ITBVI with SVI (p=1 x 10(-5)), CI with SVI (p=0.002); a significant correlation between CI and extravascular lung water index (EVLWI) was found only at T(1). Multiple linear regression analysis showed that ITBVI and SVI were predictive for variance of CI at each time point. ITBVI measured by a volumetric monitoring system such as the PiCCO may be considered a sensitive preload indicator also in critically ill children.

How robust is the calculation of health inequality trends by educational attainment in England and Wales using the Longitudinal Study?

PubMed

Flanagan, L; McCartney, G

2015-06-01

Inequalities in mortality by educational attainment are wider in Eastern Europe than in West and Central Europe, but have thus far been largely limited to cross-sectional analyses. This study explored the potential to use the Longitudinal Study to describe trends in mortality inequality by educational attainment in England and Wales from 1971 to 2009 and the limitations in the available data. Comparison of cohort studies. Data from the Office for National Statistics Longitudinal Study were used which takes a sample of respondees from each Census (1971-2001) and links them to death certification. Age-standardized mortality was calculated by educational attainment for those aged 25-69 years as was the Relative Index of Inequality and Slope Index of Inequality for men and women for each time period. Overall mortality declined in all categories of educational attainment for men and women from 1971. Limited data were collected on educational attainment in the Censuses prior to 2001, combined with the high proportion of respondents with missing data or reporting 'no education', meant that estimates of inequalities for the period 1971 to 2000 were very imprecise and likely to be misleading. For 2001-2009, the slope index of inequality was 268 (95% CI 57-478) and relative index of inequality was 0.61 (95% CI 0.13-1.10) for the total population; 354 (95% CI 72-636) and 0.67 (95% CI 0.14-1.21) respectively for men; and 231 (95% CI 72-389) and 0.66 (95% CI 0.21-1.11) respectively for women. Limited educational data in the Censuses prior to 2001 makes calculation of mortality inequalities by educational attainment in England and Wales imprecise and potentially misleading. International comparisons and time trend analyses using these data prior to 2001 should be done with great caution. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Photon Recollision Probability: a Useful Concept for Cross Scale Consistency Check between Leaf Area Index and Foliage Clumping Products

NASA Astrophysics Data System (ADS)

Pisek, J.

2017-12-01

Clumping index (CI) is the measure of foliage aggregation relative to a random distribution of leaves in space. CI is an important factor for the correct quantification of true leaf area index (LAI). Global and regional scale CI maps have been generated from various multi-angle sensors based on an empirical relationship with the normalized difference between hotspot and darkspot (NDHD) index (Chen et al., 2005). Ryu et al. (2011) suggested that accurate calculation of radiative transfer in a canopy, important for controlling gross primary productivity (GPP) and evapotranspiration (ET) (Baldocchi and Harley, 1995), should be possible by integrating CI with incoming solar irradiance and LAI from MODIS land and atmosphere products. It should be noted that MODIS LAI/FPAR product uses internal non-empirical, stochastic equations for parameterization of foliage clumping. This raises a question if integration of the MODIS LAI product with empirically-based CI maps does not introduce any inconsistencies. Here, the consistency is examined independently through the `recollision probability theory' or `p-theory' (Knyazikhin et al., 1998) along with raw LAI-2000/2200 Plant Canopy Analyzer (PCA) data from > 30 sites, surveyed across a range of vegetation types. The theory predicts that the amount of radiation scattered by a canopy should depend only on the wavelength and the spectrally invariant canopy structural parameter p. The parameter p is linked to the foliage clumping (Stenberg et al., 2016). Results indicate that integration of the MODIS LAI product with empirically-based CI maps is feasible. Importantly, for the first time it is shown that it is possible to obtain p values for any location solely from Earth Observation data. This is very relevant for future applications of photon recollision probability concept for global and local monitoring of vegetation using Earth Observation data.

Glasgow prognostic score is superior to other inflammation-based scores in predicting survival of diffuse large B-cell lymphoma

PubMed Central

Wei, Xiaolei; Zhou, Lizhi; Wei, Qi; Zhang, Yuankun; Huang, Weimin; Feng, Ru

2017-01-01

Inflammation-based prognostic scores, such as the glasgow prognostic score (GPS), prognostic index (PI), prognostic nutritional index (PNI), neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) were related to survival in many solid tumors. Recent study showed that GPS can be used to predict outcome in diffuse large B-cell lymphoma (DLBCL). However, other inflammation related scores had not been reported and it also remained unknown which of them was the most useful to evaluate the survival in DLBCLs. In this retrospective study, a number of 252 newly diagnosed and histologically proven DLBCLs from January 2003 to December 2014 were included. The high GPS, high PI, high NLR, high PLR and low PNI were all associated with poor overall survival (p < 0.05) and event-free survival (p < 0.05) in univariate analysis. Multivariate analysis indicated that GPS (HR = 1.781, 95% CI = 1.065–2.979, p = 0.028) remained an independent prognostic predictor in DLBCL. The c-index of GPS (0.735, 95% CI = 0.645–0.824) was greater than that of PI (0.710, 95% CI = 0.621–0.799, p = 0.602), PNI (0.600, 95% CI = 0.517–0.683, p = 0.001), PLR (0.599, 95% CI = 0.510–0.689, p = 0.029) and NLR (0.572, 95% CI = 0.503–0.642, p = 0.005) by Harrell's concordance index. Especially in DLBCLs treated with R-CHOP, GPS still remained the most powerful prognostic score when comparing with others (p = 0.001 and p < 0.001, respectively for OS and EFS). In conclusion, it is indicated that inflammation-based prognostic scores such as GPS, PI, NLR, PNI and PLR all could be used to predict the outcome of DLBCLs. Among them, GPS is the most powerful indicator in predicting survival in DLBCLs, even in the rituximab era. PMID:29100345

Effectiveness of new antiplatelets in the prevention of recurrent myocardial infarction.

PubMed

Grimaldi-Bensouda, Lamiae; Danchin, Nicolas; Dallongeville, Jean; Falissard, Bruno; Furber, Alain; Cottin, Yves; Bonello, Laurent; Morel, Olivier; Leclercq, Florence; Puymirat, Etienne; Ghanem, Fahmi; Delarche, Nicolas; Benichou, Jacques; Abenhaim, Lucien

2018-03-13

To compare ticagrelor and prasugrel with clopidogrel for recurrent fatal and non-fatal myocardial infarction (reMI) in real-life conditions. Case-referent study using the Pharmacoepidemiological General Research eXtension (PGRx)-acute coronary syndrome (ACS) registry. Cases were patients with reMI from a cohort with index ACS or external to the cohort (same sites). Referents from the cohort, without recurrent event, were matched on index ACS type and date, age and sex with reMI cases. Multivariate conditional logistic regression assessed the OR (95% CI) for reMI associated with ticagrelor and prasugrel vs clopidogrel, adjusted for aspirin use and cardiovascular risk factors. 1047 cases and 2234 matched referents were included. Compared with clopidogrel, ticagrelor and prasugrel were associated with respective ORs of 0.65 (95% CI 0.52 to 0.81) and 0.71 (95% CI 0.53 to 0.96) for reMI occurrence. ORs for ticagrelor and prasugrel vs clopidogrel were: 0.50 (95% CI 0.38 to 0.67) and 0.66 (95% CI 0.45 to 0.95), 0.39 (95% CI 0.24 to 0.62) and 0.44 (95% CI 0.26 to 0.75), 0.63 (95% CI 0.43 to 0.92) and 1.20 (95% CI 0.69 to 2.07), 1.11 (95% CI 0.72 to 1.72) and 0.82 (95% CI 0.44 to 1.54) when index ACS was a first MI, a first ST-elevated MI (STEMI), a first non-STEMI and a recurrent ACS, respectively, and 0.63 (95% CI 0.45 to 0.87) and 0.77 (95% CI 0.41 to 1.45) forpatients aged ≥70 years. This real-world study showed a significant reduction of reMI with new antiplatelets compared with clopidogrel, ticagrelor being associated with a greater decrease of risk notably for first, either STEMI or non-STEMI. The larger magnitude of effect may be attributed to potential residual confounding or higher effectiveness compared with efficacy reported in trials (EMA Post Authorisation Study Registry Number EUPAS5905). © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Understanding the temporal dimension of the red-edge spectral region for forest decline detection using high-resolution hyperspectral and Sentinel-2a imagery.

PubMed

Zarco-Tejada, P J; Hornero, A; Hernández-Clemente, R; Beck, P S A

2018-03-01

The operational monitoring of forest decline requires the development of remote sensing methods that are sensitive to the spatiotemporal variations of pigment degradation and canopy defoliation. In this context, the red-edge spectral region (RESR) was proposed in the past due to its combined sensitivity to chlorophyll content and leaf area variation. In this study, the temporal dimension of the RESR was evaluated as a function of forest decline using a radiative transfer method with the PROSPECT and 3D FLIGHT models. These models were used to generate synthetic pine stands simulating decline and recovery processes over time and explore the temporal rate of change of the red-edge chlorophyll index (CI) as compared to the trajectories obtained for the structure-related Normalized Difference Vegetation Index (NDVI). The temporal trend method proposed here consisted of using synthetic spectra to calculate the theoretical boundaries of the subspace for healthy and declining pine trees in the temporal domain, defined by CI time=n /CI time=n+1 vs. NDVI time=n /NDVI time=n+1 . Within these boundaries, trees undergoing decline and recovery processes showed different trajectories through this subspace. The method was then validated using three high-resolution airborne hyperspectral images acquired at 40 cm resolution and 260 spectral bands of 6.5 nm full-width half-maximum (FWHM) over a forest with widespread tree decline, along with field-based monitoring of chlorosis and defoliation (i.e., 'decline' status) in 663 trees between the years 2015 and 2016. The temporal rate of change of chlorophyll vs. structural indices, based on reflectance spectra extracted from the hyperspectral images, was different for trees undergoing decline, and aligned towards the decline baseline established using the radiative transfer models. By contrast, healthy trees over time aligned towards the theoretically obtained healthy baseline . The applicability of this temporal trend method to the red-edge bands of the MultiSpectral Imager (MSI) instrument on board Sentinel-2a for operational forest status monitoring was also explored by comparing the temporal rate of change of the Sentinel-2-derived CI over areas with declining and healthy trees. Results demonstrated that the Sentinel-2a red-edge region was sensitive to the temporal dimension of forest condition, as the relationships obtained for pixels in healthy condition deviated from those of pixels undergoing decline.

Behavioral and Emotional Problems Associated With Convergence Insufficiency in Children: An Open Trial.

PubMed

Borsting, Eric; Mitchell, G Lynn; Arnold, L Eugene; Scheiman, Mitchell; Chase, Christopher; Kulp, Marjean; Cotter, Susan

2016-10-01

This study investigated behavioral and emotional characteristics of children with convergence insufficiency (CI), before and after treatment with office-based vergence accommodative therapy (OBVAT). Parents of 44 children ages 9 to 17 years with symptomatic CI completed the Conners 3 ADHD Index and the Child Behavior Checklist (CBCL) before and after OBVAT. Pre-treatment scores were compared with normative data and post-treatment scores were compared with baseline using the Wilcoxon sign rank test. Following OBVAT, CI children showed a significant mean improvement (p < .0001, effect size of 0.58) on the Conners 3 ADHD Index with the largest changes occurring in the 23 children who scored the highest at baseline. On the CBCL, anxious/depressed, somatic, and internalizing problems improved significantly (p < .001, effect sizes of -0.36, -1.15, and -0.67, respectively). In an open trial, attention and internalizing problems improved significantly following treatment for CI. © The Author(s) 2013.

The effects of malnutrition on cardiac function in African children.

PubMed

Silverman, Jonathan A; Chimalizeni, Yamikani; Hawes, Stephen E; Wolf, Elizabeth R; Batra, Maneesh; Khofi, Harriet; Molyneux, Elizabeth M

2016-02-01

Cardiac dysfunction may contribute to high mortality in severely malnourished children. Our objective was to assess the effect of malnutrition on cardiac function in hospitalised African children. Prospective cross-sectional study. Public referral hospital in Blantyre, Malawi. We enrolled 272 stable, hospitalised children ages 6-59 months, with and without WHO-defined severe acute malnutrition. Cardiac index, heart rate, mean arterial pressure, stroke volume index and systemic vascular resistance index were measured by the ultrasound cardiac output monitor (USCOM, New South Wales, Australia). We used linear regression with generalised estimating equations controlling for age, sex and anaemia. Our primary outcome, cardiac index, was similar between those with and without severe malnutrition: difference=0.22 L/min/m(2) (95% CI -0.08 to 0.51). No difference was found in heart rate or stroke volume index. However, mean arterial pressure and systemic vascular resistance index were lower in children with severe malnutrition: difference=-8.6 mm Hg (95% CI -12.7 to -4.6) and difference=-200 dyne s/cm(5)/m(2) (95% CI -320 to -80), respectively. In this largest study to date, we found no significant difference in cardiac function between hospitalised children with and without severe acute malnutrition. Further study is needed to determine if cardiac function is diminished in unstable malnourished children. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Adherence to the Healthy Eating Index and Alternative Healthy Eating Index dietary patterns and mortality from all causes, cardiovascular disease and cancer: a meta-analysis of observational studies.

PubMed

Onvani, S; Haghighatdoost, F; Surkan, P J; Larijani, B; Azadbakht, L

2017-04-01

This meta-analysis investigated the association of diet quality indices, as assessed by HEI and AHEI, and the risk of all-cause, cardiovascular and cancer mortality. We used PubMed, ISI Web of Science and Google Scholar to search for eligible articles published before July 2015. A total of 12 cohort studies (38 reports) and one cross-sectional study (three reports) met the inclusion criteria and were included in our meta-analysis. The highest level of adherence to the Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI) was significantly associated with a reduced risk of all-cause mortality [relative risk (RR) = 0.77, 95% confidence intterval (CI) = 0.76-0.78], cardiovascular mortality (RR = 0.77, 95% CI = 0.74-0.80) and cancer mortality (RR = 0.83, 95% CI = 0.81-0.86). Egger regression tests provided no evidence of publication bias. The present study indicates that high adherence to HEI and AHEI dietary patterns, indicating high diet quality, are associated with reduced risk of all-cause mortality (as well as cardiovascular mortality and cancer mortality). © 2016 The British Dietetic Association Ltd.

The use of sonographic subjective tumor assessment, IOTA logistic regression model 1, IOTA Simple Rules and GI-RADS system in the preoperative prediction of malignancy in women with adnexal masses.

PubMed

Koneczny, Jarosław; Czekierdowski, Artur; Florczak, Marek; Poziemski, Paweł; Stachowicz, Norbert; Borowski, Dariusz

2017-01-01

Sonography based methods with various tumor markers are currently used to discriminate the type of adnexal masses. To compare the predictive value of selected sonography-based models along with subjective assessment in ovarian cancer prediction. We analyzed data of 271 women operated because of adnexal masses. All masses were verified by histological examination. Preoperative sonography was performed in all patients and various predictive models includ¬ing IOTA group logistic regression model LR1 (LR1), IOTA simple ultrasound-based rules by IOTA (SR), GI-RADS and risk of malignancy index (RMI3) were used. ROC curves were constructed and respective AUC's with 95% CI's were compared. Of 271 masses 78 proved to be malignant including 6 borderline tumors. LR1 had sensitivity of 91.0%, specificity of 91.2%, AUC = 0.95 (95% CI: 0.92-0.98). Sensitivity for GI-RADS for 271 patients was 88.5% with specificity of 85% and AUC = 0.91 (95% CI: 0.88-0.95). Subjective assessment yielded sensitivity and specificity of 85.9% and 96.9%, respectively with AUC = 0.97 (95% CI: 0.94-0.99). SR were applicable in 236 masses and had sensitivity of 90.6% with specificity of 95.3% and AUC = 0.93 (95% CI 0.89-0.97). RMI3 was calculated only in 104 women who had CA125 available and had sensitivity of 55.3%, specificity of 94% and AUC = 0.85 (95% CI: 0.77-0.93). Although subjective assessment by the ultrasound expert remains the best current method of adnexal tumors preoperative discrimination, the simplicity and high predictive value favor the IOTA SR method, and when not applicable, the IOTA LR1 or GI-RADS models to be primarily and effectively used.

Obesity risk in rural, urban and rural-to-urban migrants: prospective results of the PERU MIGRANT study

PubMed Central

Carrillo-Larco, R M; Bernabé-Ortiz, A; Pillay, T D; Gilman, R H; Sanchez, J F; Poterico, J A; Quispe, R; Smeeth, L; Miranda, J J

2016-01-01

Background: Although migration and urbanization have been linked with higher obesity rates, especially in low-resource settings, prospective information about the magnitude of these effects is lacking. We estimated the risk of obesity and central obesity among rural subjects, rural-to-urban migrants and urban subjects. Methods: Prospective data from the PERU MIGRANT Study were analyzed. Baseline data were collected in 2007–2008 and participants re-contacted in 2012–2013. At follow-up, outcomes were obesity and central obesity measured by body mass index and waist circumference. At baseline, the primary exposure was demographic group: rural, rural-to-urban migrant and urban. Other exposures included an assets index and educational attainment. Cumulative incidence, incidence ratio (IR) and 95% confidence intervals (95% CI) for obesity and central obesity were estimated with Poisson regression models. Results: At baseline, mean age (±s.d.) was 47.9 (±12.0) years, and 53.0% were females. Rural subjects comprised 20.2% of the total sample, whereas 59.7% were rural-to-urban migrants and 20.1% were urban dwellers. A total of 3598 and 2174 person-years were analyzed for obesity and central obesity outcomes, respectively. At baseline, the prevalence of obesity and central obesity was 20.0 and 52.5%. In multivariable models, migrant and urban groups had an 8- to 9.5-fold higher IR of obesity compared with the rural group (IR migrants=8.19, 95% CI=2.72–24.67; IR urban=9.51, 95% CI=2.74–33.01). For central obesity, there was a higher IR only among the migrant group (IR=1.95; 95% CI=1.22–3.13). Assets index was associated with a higher IR of central obesity (IR top versus bottom tertile 1.45, 95% CI=1.03–2.06). Conclusions: Peruvian urban individuals and rural-to-urban migrants show a higher incidence of obesity compared with their rural counterparts. Given the ongoing urbanization occurring in middle-income countries, the rapid development of increased obesity risk by rural-to-urban migrants suggests that measures to reduce obesity should be a priority for this group. PMID:26228458

Four ECG left ventricular hypertrophy criteria and the risk of cardiovascular events and mortality in patients with vascular disease.

PubMed

van Kleef, Monique E A M; Visseren, Frank L J; Vernooij, Joris W P; Nathoe, Hendrik M; Cramer, Maarten-Jan M; Bemelmans, Remy H H; van der Graaf, Yolanda; Spiering, Wilko

2018-06-06

The relation between different electrocardiographic left ventricular hypertrophy (ECG-LVH) criteria and cardiovascular risk in patients with clinical manifest arterial disease is unclear. Therefore, we determined the association between four ECG-LVH criteria: Sokolow-Lyon, Cornell product, Cornell/strain index and Framingham criterion; and risk of cardiovascular events and mortality in this population. Risk of cardiovascular events was estimated in 6913 adult patients with clinical manifest arterial disease originating from the Secondary Manifestations of ARTerial disease (SMART) cohort. Cox proportional regression analysis was used to estimate the risk of the four ECG-LVH criteria and the primary composite outcome: myocardial infarction (MI), stroke or cardiovascular death; and secondary outcomes: MI, stroke and all-cause mortality; adjusted for confounders. The highest prevalence of ECG-LVH was observed for Cornell product (10%) and Cornell/strain index (9%). All four ECG-LVH criteria were associated with an increased risk of the primary composite endpoint: Sokolow-Lyon (hazard ratio 1.37, 95% CI 1.13-1.66), Cornell product (hazard ratio 1.54, 95% CI 1.30-1.82), Cornell/strain index (hazard ratio 1.70, 95% CI 1.44-2.00) and Framingham criterion (hazard ratio 1.78, 95% CI 1.21-2.62). Cornell product, Cornell/strain index and Framingham criterion ECG-LVH were additionally associated with an elevated risk of secondary outcomes. Cardiovascular risk increased whenever two, or three or more ECG-LVH criteria were present concurrently. All four ECG-LVH criteria are associated with an increased risk of cardiovascular events. As Cornell/strain index is both highly prevalent and carries a high cardiovascular risk, this is likely the most relevant ECG-LVH criterion for clinical practice.

Cardiovascular medication use in patients with undiagnosed obstructive sleep apnoea

PubMed Central

Otake, K; Delaive, K; Walld, R; Manfreda, J; Kryger, M

2002-01-01

Background: A study was undertaken in patients with undiagnosed sleep apnoea/hypopnoea syndrome (OSAS) to document the use of prescribed medications, especially those used in cardiovascular diseases, in the year before the OSAS diagnosis was confirmed. Methods: A total of 549 patients with OSAS (401 men of mean age 47.2 years, mean body mass index (BMI) 35.5 kg/m2, mean apnoea/hypopnoea index (AHI) 47.2 and148 women of mean age 50.2 years, BMI 39.6 kg/m2, AHI 32.6) were each matched to one general population control by age, sex, geographical location, and family physician. Medication use was evaluated for patients and controls using a database containing information about all prescriptions completed in the province of Manitoba, Canada. Results: In the year before OSAS was diagnosed, prescribed medication costs were $155.91 (Can) (95 % CI $91.34 to $220.49) greater for cases than for controls. Cases were dispensed 3.3 (95% CI 1.5 to 5.2) more prescriptions, were on 1.2 (95% CI 0.8 to 1.6) more medications, and were supplied with 157.4 (95% CI 95.9 to 218.8) more daily doses of medication. The odds ratio of OSAS cases being on a prescribed medication was 1.88 relative to controls (95% CI 1.38 to 2.54, p<0.0001). In the same year 36.6% of cases and 19.7% of controls were using medications for cardiovascular disease (OR 2.82, 95% CI 2.05 to 3.89, p<0.0001), consuming 79.4 (95% CI 48.9 to 109.8) more daily doses of medication, having been dispensed 1.7 (95% CI 1.0 to 2.4) more prescriptions, and at a $75.26 (95% CI $44.03 to $106.50) greater cost. The odds ratio of patients with OSAS being on medications indicated for the treatment of systemic hypertension was 2.71 (95% CI 1.96 to 3.77) relative to controls; however, such medications might also be prescribed for other indications such as angina pectoris and congestive heart failure, and for the secondary prevention of myocardial infarction. The use of medications indicated for the treatment of systemic hypertension was predicted significantly by age (odds ratio (OR) 1.10 per year), BMI (OR 1.05 per unit), and AHI (OR 1.01 per unit). Conclusions: In the year before OSAS was diagnosed, patients with OSAS were heavy users of medications, particularly those used to treat cardiovascular diseases. PMID:11978918

[Red meat intake among employees of floating population aged 18-59 years old in China, 2012].

PubMed

Yin, Xiangjun; Wang, Limin; Li, Yichong; Zhang, Mei; Wang, Zhihui; Deng, Qian; Wang, Linhong

2014-11-01

To evaluate the level of daily red meat intake and prevalence of excessive red meat intake among employees of floating population in China. 48 511 employees of floating population aged 18 to 59 from 170 counties of 31 provinces (autonomous regions and municipalities) and Xinjiang Production and Construction Corps (District) were selected by stratified cluster sampling method. Information on red meat intake was collected by semi-quantitative food frequency questionnaire. Average intake of 100 g/day, recommended by the World Cancer Research Fund, was used as the cut-off point to estimate the prevalence of excessive red meat intake. After performing the complex weighted analysis, level of daily red meat intake and prevalence of excessive red meat intake were calculated by demographic characteristics including age, education, industries and body mass index etc. 1)The mean daily red meat intake was 125.9 g (95%CI: 116.5 g-132.5 g), higher in men (141.6 g, 95%CI:131.3 g-148.9 g)than in women (104.7 g, 95%CI: 95.8 g-111.2 g) (P < 0.01). Results from the Tendency Test did not show statistically significant changes on the red meat intake related to age, education level or body mass index (P values for trend were all greater than 0.05). The standardized mean daily intake of red meat, adjusted by 2010 census data of China, was 121.0 g (95% CI:113.4 g-128.7 g). 2) The prevalence of excessive red meat intake was 36.2% (95% CI:33.0%-39.3%) significantly higher in males (42.4% , 95% CI:38.9%-45.8%) than in females (27.8%, 95%CI:27.1%-31.0%) (P < 0.01). The prevalence was estimated to be the highest among the population aged 30-39, with 43.5% (95%CI:39.7%-47.4%) in males and 30.1% (95%CI:26.5%-33.9%)in females. The standardized prevalence, adjusted by 2010 census data of China, appeared to be 34.6% (95%CI:31.9%-38.0%). The level of daily red meat intake was higher than 100 g/d, the standard recommended by the World Cancer Foundation, among floating population of China. Both the mean daily red meat intake and prevalence of excessive red meat intake were higher in floating population than that in the local residents in China.

Association between heart rate variability and manual pulse rate.

PubMed

Hart, John

2013-09-01

One model for neurological assessment in chiropractic pertains to autonomic variability, tested commonly with heart rate variability (HRV). Since HRV may not be convenient to use on all patient visits, more user-friendly methods may help fill-in the gaps. Accordingly, this study tests the association between manual pulse rate and heart rate variability. The manual rates were also compared to the heart rate derived from HRV. Forty-eight chiropractic students were examined with heart rate variability (SDNN and mean heart rate) and two manual radial pulse rate measurements. Inclusion criteria consisted of participants being chiropractic students. Exclusion criteria for 46 of the participants consisted of a body mass index being greater than 30, age greater than 35, and history of: a) dizziness upon standing, b) treatment of psychiatric disorders, and c) diabetes. No exclusion criteria were applied to the remaining two participants who were also convenience sample volunteers. Linear associations between the manual pulse rate methods and the two heart rate variability measures (SDNN and mean heart) were tested with Pearson's correlation and simple linear regression. Moderate strength inverse (expected) correlations were observed between both manual pulse rate methods and SDNN (r = -0.640, 95% CI -0.781, -0.435; r = -0.632, 95% CI -0.776, -0.425). Strong direct (expected) relationships were observed between the manual pulse rate methods and heart rate derived from HRV technology (r = 0.934, 95% CI 0.885, 0.962; r = 0.941, 95% CI 0.897, 0.966). Manual pulse rates may be a useful option for assessing autonomic variability. Furthermore, this study showed a strong relationship between manual pulse rates and heart rate derived from HRV technology.

Lifestyle and Health Factors Associated with Progressing and Remitting Trajectories of Untreated Lower Urinary Tract Symptoms among Elderly Men

PubMed Central

Marshall, Lynn M.; Holton, Kathleen F.; Parsons, J. Kellogg; Lapidus, Jodi A.; Ramsey, Katrina; Barrett-Connor, Elizabeth

2014-01-01

Background Knowledge of factors associated with the course of lower urinary tract symptoms (LUTS) before treatment is needed to inform preventive interventions. In a prospective study of elderly men untreated for LUTS, we identified factors associated with symptom progression and remission. Methods In community dwelling U.S. men age ≥ 65 years, the American Urological Association Symptom Index (AUA-SI) was repeated four times, once at baseline (2000–2002) and then every two years thereafter. Analyses included 1740 men with all four AUA-SI assessments, who remained free from diagnosed prostate cancer, and who reported no treatment for LUTS or benign prostatic hyperplasia (BPH) during follow-up that averaged 6.9 (±0.4) years. LUTS change was determined with group-based trajectory modeling of the repeated AUA-SI measures. Multivariable logistic regression was then used to determine the baseline factors associated with progressing compared to stable trajectories, and with remitting compared to progressing trajectories. Lifestyle, body mass index (BMI) (kg/m2), mobility, mental health (Short-Form 12), medical history, and prescription medications were considered for selection. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for variables in each model. Results We identified 10 AUA-SI trajectories: four stable (1 277 men, 73%), three progressing (345 men, 20%), two remitting (98 men, 6%), and one mixed (20 men, 1%). Men in progressing compared to stable trajectories were more likely to have mobility limitations (OR=2.0, 95% CI: 1.0–3.8), poor mental health (OR=1.9, 95% CI: 1.1–3.4), BMI ≥ 25.0 kg/m2 (OR=1.7, 95% CI: 1.0–2.8), hypertension (OR=1.5, 95% CI: 1.0–2.4), and back pain (OR=1.5, 95% CI: 1.0–2.4). Men in remitting compared to progressing trajectories more often used central nervous system medications (OR=2.3, 95% CI: 1.1–4.9) and less often had a history of problem drinking (OR=0.4. 95% CI: 0.2–0.9). Conclusions Several non-urological lifestyle and health factors were independently associated with risk of LUTS progression in older men. PMID:25000909

Monetary diet cost is positively associated with diet quality and obesity: an analysis of school-aged children in Southwest China.

PubMed

Zhang, Xiao; Gong, Yunhui; Jia, Peng; Zhang, Jieyi; Xue, Hongmei; Quan, Liming; Tian, Guo; Xiong, Jingyuan; Zhang, Lishi; Wang, Yu; Zhang, Lin; Cheng, Guo

2018-06-18

Little is known about the relationships between diet cost, dietary intake and obesity in Chinese populations. This study explored how diet cost was related to diet quality and obesity among school-aged children in Southwest China. Data from a cross-sectional study was analysed. Diet cost was estimated based on dietary intake assessed with 24-h dietary recalls and retail food prices. Diet quality was measured using the Chinese Children Dietary Index. Body height, weight, waist circumference and skinfold thicknesses were measured, and their body mass index standard deviation score (BMISDS), waist-to-height ratio (WHtR), fat mass index (FMI) and fat-free mass index (FFMI) were calculated. Multivariate regression models were used to explore the relevance of diet cost to diet quality and obesity. After adjustment for potential confounders, a positive association was observed between diet quality and energy-adjusted diet cost (β = 0.143, 95% confidence interval, CI: 0.014-0.285, Pfor-trend = 0.0006). Energy-adjusted diet cost also showed a positive association with FMI (β = 0.0354, 95% CI: 0.0001-0.0709, Pfor-trend = 0.01), BMISDS (β = 0.0200, 95% CI: 0.0006-0.0394, Pfor-trend = 0.002) and WHtR (β = 0.0010, 95% CI: 0.0003-0.0017, Pfor-trend = 0.02). Energy-adjusted diet cost was independently and positively associated with diet quality and obesity among Chinese school-aged children.

School attendance and daily respiratory symptoms in children: influence of moisture damage.

PubMed

Casas, L; Espinosa, A; Pekkanen, J; Asikainen, A; Borràs-Santos, A; Jacobs, J; Krop, E J M; Täubel, M; Hyvärinen, A; Heederik, D; Zock, J-P

2017-03-01

We investigated the effect of weekends and school holidays on the daily frequency and severity of respiratory and other symptoms among children attending schools with (index) or without (reference) moisture damage in Spain, the Netherlands, and Finland. Throughout 1 year, parents of 419 children with a respiratory condition attending index (n=15) or reference (n=10) primary schools completed three symptom diaries. We assessed associations between lower respiratory tract, upper respiratory tract or allergy, and other symptom scores and school day, weekend, or summer holiday using mixed regression models stratified by country and moisture damage. We evaluated interactions between moisture damage and type of day. We combined country-specific estimates (incidence rate ratios [IRRs] and 95% confidence interval [CI]) in meta-analyses. Symptom scores were lower during weekends and holiday. Lower respiratory tract symptoms were statistically significantly less common during holiday with strongest effect in index schools (IRR=0.7; CI=0.6-0.8). Reporting of other symptoms was more reduced during holiday in index (IRR=0.6; CI=0.4-0.9) than in reference (IRR=0.95; CI=0.8-1.2) schools (interaction P<.01). In conclusion, symptoms were less frequent and/or severe during summer holiday and weekends. This pattern was stronger among children attending moisture-damaged schools, suggesting potential improvement in moisture damage-related symptoms during school breaks. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

Are the barriers for physical activity practice equal for all peripheral artery disease patients?

PubMed

Cavalcante, Bruno R; Farah, Breno Q; dos A Barbosa, João Paulo; Cucato, Gabriel Grizzo; da Rocha Chehuen, Marcel; da Silva Santana, Fábio; Wolosker, Nelson; de Moraes Forjaz, Cláudia Lúcia; Ritti-Dias, Raphael M

2015-02-01

To investigate barriers to physical activity related to the sociodemographic comorbidities and clinical variables of patients with intermittent claudication. Cross-sectional study. Ambulatory care. The medical histories of patients (N=145) aged ≥50 years with intermittent claudication were examined. Not applicable. Sociodemographic data (sex, race, level of education, socioeconomic status, marital status), comorbidities (overweight, hypertension, dyslipidemia, diabetes, currently smoking, heart disease), and clinical variables (initial claudication distance, total walking distance, ankle-brachial index). Information on personal and environmental barriers was obtained by questionnaire. Low economic status was most associated with "being afraid of falling" (odd ratios [OR]=2.22; 95% confidence interval [CI], 1.08-4.54). Low education level was most associated with "lack of street pedestrian crossing" (OR=3.34; 95% CI, 1.48-7.52). Diabetes was associated with lack of energy (OR=3.38; 95% CI, 1.68-6.79) and other medical conditions (eg, arthritis, angina) (OR=3.44; 95% CI, 1.65-7.16). Ankle brachial index was associated with "some difficulty in getting to a place where physical activity can be performed" (OR=2.75; 95% CI, 1.22-6.21). Walking capacity was strongly associated with barriers relating to leg pain (OR=7.39; 95% CI, 1.66-32.88). Older patients, those with a low education level, patients with diabetes, low ankle brachial index, and those with a lower walking capacity are more likely to experience barriers to physical activity. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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

Lu, J-Y; Huang, B-T; Zhang, W-Z

Purpose: To compare volumetric modulated arc radiotherapy (VMAT) technique with fixed-gantry intensity-modulated radiotherapy (IMRT) technique for early-stage nasopharyngeal carcinoma. Methods: CT datasets of ten patients with early-stage nasopharyngeal carcinoma were included. Dual-arc VMAT and nine-field IMRT plans were generated for each case, and were then compared in terms of planning-target-volume (PTV) coverage, conformity index (CI) and homogeneity index (HI), as well as organ-at-risk (OAR) sparing, planning time, monitor units (MUs) and delivery time. Results: Compared with the IMRT plans, the VMAT plans provided comparable HI and CI of PTVnx (PTV of primary tumor of nasopharynx), superior CI and inferior HImore » of PTVnd (PTV of lymph nodes), as well as superior CI and comparable HI of PTV60 (high-risk PTV). The VMAT plans provided better sparing of the spinal cord, oral cavity and normal tissue, but inferior sparing of the brainstem planning OAR volume (PRV), larynx and parotids, as well as comparable sparing of the spinal cord PRV, brainstem, lenses, optic nerves, optic chiasm. Moreover, the average planning time (181.6 ± 36.0 min) for the VMAT plans was 171% more than that of the IMRT plans (68.1 ± 7.6 min). The MUs of the VMAT plans (609 ± 43) were 70% lower than those of the IMRT plans (2071 ± 262), while the average delivery time (2.2 ± 0.1 min) was 66% less than that of the IMRT plans (6.6 ± 0.4 min). Conclusion: Compared with the IMRT technique, the VMAT technique can achieve similar or slightly superior target dose distribution, with no significant advantages on OAR sparing, and it can achieve significant reductions of MUs and delivery time.« less

Relationship between perception of malocclusion and the psychological impact of dental aesthetics in university students

PubMed Central

Montiel-Company, José-María; Pinho, Teresa; Almerich-Silla, José-Manuel

2015-01-01

Introduction and Objectives: The objectives were to assess the relationship between perceived smile aesthetics and perceived psychological impact as measured by the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), and their own perception of it using the Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN-AC) and a Visual Analog Scale (VAS); relate the IOTN-AC and VAS to the PIDAQ; and study the predictive capacity of the scales for psychological impact. Material and Methods: A cross-sectional study was conducted in 447 college students in Spain and Portugal (average age 20.4 years, 33.1% men and 66.9% women). The online self-completed surveys used the recently-validated Spanish and Portuguese versions of the PIDAQ to assess the self–reported psychological impact of the students’ dental aesthetics and IOTN-AC and an ad hoc 100 mm VAS for their perception of their dental aesthetics. Results: PIDAQ was linearly correlated with IOTN AC and VAS. Pearson’s coefficient was 0.55 for PIDAQ and IOTN-AC (CI 95% 0.48-0.61) and -0.72 for PIDAQ and VAS (CI 95% -0.66 - -0.76). VAS and IOTN-AC were predictive variables in a linear regression model of the total PIDAQ score. The VAS diagnosed individuals whose dental aesthetics had a self-perceived psychological impact (area under the curve 0.827, CI 95% 0.787-0.868) more precisely than the IOTN-AC (area under the curve 0.742, CI 95% 0. 696-0.788). Conclusions: In adults patients, there is a significant linear relationship between perceived smile aesthetics and self-perceived psychological impact. Key words:Visual Analog Scale, Index of Orthodontic Treatment Need, malocclusion, psychological, aesthetics. PMID:25810834

Medication Nonadherence is Associated with Increased Subsequent Acute Care Utilization among Medicaid Beneficiaries with Systemic Lupus Erythematosus

PubMed Central

Feldman, Candace H.; Yazdany, Jinoos; Guan, Hongshu; Solomon, Daniel H.; Costenbader, Karen H.

2015-01-01

Objective We examined whether nonadherence to hydroxychloroquine (HCQ) or immunosuppressive medications (IS) was associated with higher subsequent acute care utilization among Medicaid beneficiaries with systemic lupus erythematosus (SLE). Methods We utilized U.S. Medicaid data from 2000–2006 to identify adults 18–64 years with SLE who were new users of HCQ or IS. We defined the index date as receipt of HCQ or IS without use in the prior six months. We measured adherence using the medication possession ratio (MPR), the proportion of days covered by total days supply dispensed, for one-year post-index date. Our outcomes were all-cause and SLE-related emergency department (ED) visits and hospitalizations in the subsequent year. We used multivariable Poisson regression models to examine the association between nonadherence (MPR<80%) and acute care utilization adjusting for sociodemographics and comorbidities. Results We identified 9,600 HCQ new users and 3,829 IS new users with SLE. The mean MPR for HCQ was 47.8% (SD 30.3) and for IS, 42.7% (SD 30.7). 79% of HCQ users and 83% of IS users were nonadherent (MPR<80%). In multivariable models, among HCQ users, the incidence rate ratio (IRR) of ED visits was 1.55 (95% CI 1.43–1.69) and the IRR of hospitalizations was 1.37 (95% CI 1.25–1.50), comparing nonadherers to adherers. For IS users, the IRR of ED visits was 1.64 (95% CI 1.42–1.89) and of hospitalizations was 1.67 (95% CI 1.41–1.96) for nonadherers versus adherers. Conclusion In this cohort, nonadherence to HCQ and IS was common and was associated with significantly higher subsequent acute care utilization. PMID:26097166

Medical journals, impact and social media: an ecological study of the Twittersphere.

PubMed

Cosco, Theodore D

2015-12-08

Twitter is an increasingly popular means of research dissemination. I sought to examine the relation between scientific merit and mainstream popularity of general medical journals. I extracted impact factors and citations for 2014 for all general medical journals listed in the Thomson Reuters InCites Journal Citation Reports. I collected Twitter statistics (number of followers, number following, number of tweets) between July 25 and 27, 2015 from the Twitter profiles of journals that had Twitter accounts. I calculated the ratio of observed to expected Twitter followers according to citations via the Kardashian Index. I created the (Fifty Shades of) Grey Scale to calculate the analogous ratio according to impact factor. Only 28% (43/153) of journals had Twitter profiles. The scientific and social media impact of journals were correlated: in adjusted models, Twitter followers increased by 0.78% (95% confidence interval [CI] 0.38%-1.18%) for every 1% increase in impact factor and by 0.62% (95% CI 0.34%-0.90%) for every 1% increase in citations. Kardashian Index scores above the 99% CI were obsverved in 16% (7/43) of journals, including 6 of the 7 highest ranked journals by impact factor, whereas 58% (25/43) had scores below this interval. For the Grey Scale, 12% (5/43) of journals had scores above and 35% (15/43) had scores below the 99% CI. The size of a general medical journal's Twitter following is strongly linked to its impact factor and citations, suggesting that higher quality research received more mainstream attention. Many journals have not capitalized on this dissemination method, although others have used it to their advantage. © 2015 Canadian Medical Association or its licensors.

Maternal Mortality in Colombia in 2011: A Two Level Ecological Study

PubMed Central

Cárdenas-Cárdenas, Luz Mery; Cotes-Cantillo, Karol; Chaparro-Narváez, Pablo Enrique; Fernández-Niño, Julián Alfredo; Paternina-Caicedo, Angel; Castañeda-Orjuela, Carlos; De la Hoz-Restrepo, Fernando

2015-01-01

Objective Maternal mortality reduction is a Millennium Development Goal. In Colombia, there is a large disparity in the maternal mortality ratio (MMR) between and into departments (states) and also between municipalities. We examined socioeconomics variables at the municipal and departmental levels which could be associated to the municipal maternal mortality in Colombia. Methods A multilevel ecology study was carried out using different national data sources in Colombia. The outcome variable was the MMR at municipal level in 2011 with multidimensional poverty at municipal and department level as the principal independent variables and other measures of the social and economic characteristics at municipal and departmental level were also considered explicative variables (overall fertility municipal rate, percentage of local rural population, health insurance coverage, per capita territorial participation allocated to the health sector, transparency index and Gini coefficient). The association between MMR and socioeconomic contextual conditions at municipal and departmental level was assessed using a multilevel Poisson regression model. Results The MMR in the Colombian municipalities was associated significantly with the multidimensional poverty (relative ratio of MMR: 3.52; CI 95%: 1.09-11.38). This association was stronger in municipalities from departments with the highest poverty (relative ratio of MMR: 7.14; CI 95%: 2.01-25.35). Additionally, the MMR at municipal level was marginally associated with municipally health insurance coverage (relative ratio of MMR: 0.99; CI 95%: 0.98-1.00), and significantly with transparency index at departmental level (relative ratio of MMR: 0.98; CI 95%: 0.97-0.99). Conclusion Poverty and transparency in a contextual level were associated with the increase of the municipal MMR in Colombia. The results of this study are useful evidence for informing the public policies discussion and formulation processes with a differential approach. PMID:25785719

Ankle-Brachial Index and Cardiovascular Outcomes in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial

PubMed Central

Abbott, J. Dawn; Lombardero, Manuel S.; Barsness, Gregory W.; Pena-Sing, Ivan; Buitrón, L. Virginia; Singh, Premranjan; Woodhead, Gail; Tardif, Jean-Claude; Kelsey, Sheryl F.

2012-01-01

Background Peripheral arterial disease (PAD) increases cardiovascular risk in many patient populations. The risks associated with an abnormal ankle-brachial index (ABI) in patients with type 2 diabetes (T2D) and stable coronary artery disease (CAD) have not been well described with respect to thresholds and types of cardiovascular events. Methods We examined 2368 patients in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial that underwent ABIassessment at baseline. Death and major cardiovascular events (death, myocardial infarction (MI) and stroke) during follow-up (average 4.3 years) were assessed across the ABI spectrum and by categorizedABI: low (≤0.90), normal (0.91–1.3), high (>1.3), or non-compressible. Results A total of 12,568 person-years were available for mortality analysis. During follow-up, 316 patients died and 549 suffered major cardiovascular events. After adjustment for potential confounders, with normal ABI as the referent group, a low ABI conferred an increased risk of death (relative risk (RR) 1.6; C.I. 1.2, 2.2; p=.0005) and major cardiovascular events (RR 1.4; C.I. 1.1, 1.7; p=.004). Patients with a high ABI had similar outcomes as patients with a normal ABI, but risk again increased in patients with a non-compressible ABI with a risk of death (RR1.9; C.I. 1.3, 2.8; p=.001) and major cardiovascular event (RR 1.5, C.I. 1.1, 2.1; p=.01). Conclusions In patients with CAD and T2D ABI screening and identification of ABI abnormalities including a low ABI (<1.0) or non-compressible artery provide incremental prognostic information. PMID:23067918

Predictors of Clinical Response and Remission at One year among a Multicenter Cohort of Patients with Inflammatory Bowel Disease Treated with Vedolizumab

PubMed Central

Allegretti, Jessica R.; Barnes, Edward L.; Stevens, Betsey; Storm, Margaret; Ananthakrishnan, Ashwin; Yajnik, Vijay; Korzenik, Joshua

2017-01-01

Background Vedolizumab (VDZ) has demonstrated long term efficacy in Crohn’s disease (CD) and ulcerative colitis (UC) in phase III trials. Aims Our aim was to evaluate the efficacy of VDZ at week 54 in inflammatory bowel disease (IBD) in a multicenter cohort of patients. Methods Adult patients completing induction therapy with VDZ were eligible for this study. Clinical response and remission was assessed using the Harvey Bradshaw index (HBI) for CD, the simple clinical colitis activity index (SCCAI) for UC and physician assessment. Results Among 136 total patients (96 CD and 40 UC), 76 (56%) demonstrated clinical response or remission at week 54. In univariate analysis, for patients with CD concomitant initiation of immunomodulator therapy (2.71, 95% CI 1.11 – 6.57), the addition of an immunomodulator (OR 11.49, 3.16 – 41.75) and CRP <3 (4.92, 95% CI 1.99 – 12.15) were associated with increased odds of clinical response or remission at week 54. For UC patients hospitalization after VDZ induction was associated with decreased odds of response or remission at week 54 ( OR 0.22, 95%CI 0.05–0.88). On multivariate analysis in CD, addition of an immunomodulator (OR 8.33, 95% CI 2.15–32.26) remained significant predictors of clinical response or remission at week 54. Conclusions Among a multicenter cohort of patients with IBD demonstrating primary response to VDZ, the addition of combination therapy with an immunomodulator is a significant predictor of clinical response or remission at week 54 in patients with CD. PMID:28357697

Effects of Reproductive History on Symptoms of Menopause: A Brief Report

PubMed Central

Nelson, Deborah B.; Sammel, Mary D.; Patterson, Freda; Lin, Hui; Gracia, Clarisa R.; Freeman, Ellen W.

2011-01-01

Objective To examine the relationship between reproductive history and menopausal symptoms among urban women. Methods A cohort study of women aged 35–47 recruited in Philadelphia, PA. Two hundred and ninety one pre-menopausal women meeting study eligibility criteria and contributing reproductive health history and infertility information completed assessments of occurrence and severity of several menopausal symptoms over a 14 year period. Reproductive history included the number of pregnancies, live births, preterm deliveries and miscarriages. Trying to get pregnant for more than one year was used as an assessment of infertility. The occurrence of severe hot flashes, vaginal dryness and decreased libido were evaluated. Results Women scoring positive on the infertility index were significantly more likely to report severe decreased libido (OR=1.86, 95% CI: 1.05–3.31) and over twice as likely to report severe vaginal dryness (OR=2.79, 95% CI: 1.19–6.94) in multivariable models. None of the other reproductive health indices were related to report of severe hot flashes, vaginal dryness or decreased libido. The race-specific models continued to find a significant, increased risk of severe vaginal dryness (OR=2.79, 95% CI: 1.22–6.36) and decreased libido (OR=1.87, 95% CI: 1.04–3.34) among white women scoring positive on the infertility index; however the relationship did not remain significant among African-American women. Conclusions Severe vaginal dryness and decreased libido are common and important considerations of the menopausal transition and the experience of infertility problems may influence the report of severe vaginal dryness and decreased libido particularly among white women. PMID:21552165

Association between body mass index and mortality in patients with glioblastoma mutliforme.

PubMed

Jones, Lee W; Ali-Osman, Francis; Lipp, Eric; Marcello, Jennifer E; McCarthy, Bridget; McCoy, Lucie; Rice, Terri; Wrensch, Margaret; Il'yasova, Dora

2010-12-01

To examine the association between obesity and survival in patients with glioblastoma mutliforme (GBM) METHODS: Using a prospective design, 1,259 patients with previously untreated GBM were recruited between 1991 and 2008. Height and weight were self-reported or abstracted from medical records at study entry and used to calculate body mass index (BMI) [weight (kg)/[height (m)](2). Cox proportional models were used to estimate the risk of death associated with BMI as a continuous variable or categorized using established criteria (normal weight, 18.5-24.9 kg/m(2); overweight, 25.0-29.9 kg/m(2); obese, ≥ 30.0 kg/m(2)). Median follow-up was 40 months, and 1,069 (85%) deaths were observed during this period. For all patients, minimal adjusted analyses indicated no significant association between BMI treated as a continuous variable and survival. Compared with patients with a BMI 18.5-24.9 kg/m(2), the minimally adjusted HR for overall survival was 1.08 (95% CI, 0.94-1.24) for a BMI 25-29.9 kg/m(2) and 1.08 (95% CI, 0.91-28) for a BMI ≥ 30.0 kg/m(2). After additional adjustment for adjuvant therapy, the HR for those with a BMI of 25.0-29.9 kg/m(2) was 1.14 (95% CI, 0.99-1.32) and 1.09 (95% CI, 0.91-1.30) for those with a BMI ≥ 30.0 kg/m(2). No significant interactions were revealed for BMI and any demographic variables. BMI was not associated with survival in newly diagnosed and previously untreated patients with GBM. Further research investigating the prognostic significance of alternative, quantitative measures of body habitus, and functional performance are required.

Body Mass Index and Kidney Stones: A Cohort Study of Japanese Men

PubMed Central

Yoshimura, Eiichi; Sawada, Susumu S.; Lee, I-Min; Gando, Yuko; Kamada, Masamitsu; Matsushita, Munehiro; Kawakami, Ryoko; Ando, Ryosuke; Okamoto, Takashi; Tsukamoto, Koji; Miyachi, Motohiko; Blair, Steven N.

2016-01-01

Background In Japan, the incidence of kidney stones has increased markedly in recent decades. Major causes of kidney stones remain unclear, and limited data are available on the relationship between overweight/obesity and the incidence of kidney stones. We therefore evaluated body mass index (BMI) and the incidence of kidney stones in Japanese men. Methods Of the workers at a gas company, 5984 males aged 20–40 years underwent a medical examination in 1985 (baseline). This study includes 4074 of the men, who were free of kidney stones at baseline and underwent a second medical examination performed between April 2004 and March 2005. BMI was calculated from measured height and weight in 1985, and men were categorized into tertiles. The development of kidney stones during follow-up was based on self-reports from questionnaires at the second medical examination. Results The average duration of follow-up was 19 years, with 258 participants developing kidney stones during this period. Using the lowest BMI (1st tertile) group as a reference, the hazard ratios (95% confidence intervals [CIs]) for the 2nd and 3rd BMI tertiles were: 1.26 (95% CI, 0.92–1.73) and 1.44 (95% CI, 1.06–1.96), respectively (P for trend = 0.019). After additionally adjusting for potential confounders, such as age, systolic blood pressure, cardiorespiratory fitness, cigarette smoking, and alcohol consumption, the hazard ratios were 1.28 (95% CI, 0.93–1.76) and 1.41 (95% CI, 1.02–1.97), respectively (P for trend = 0.041). Conclusions These results suggest that increased BMI is a risk factor for kidney stones in Japanese men. PMID:26616396

The effect of change in body mass index on volumetric measures of mammographic density

PubMed Central

Hart, Vicki; Reeves, Katherine W.; Sturgeon, Susan R.; Reich, Nicholas G.; Sievert, Lynnette Leidy; Kerlikowske, Karla; Ma, Lin; Shepherd, John; Tice, Jeffrey A.; Mahmoudzadeh, Amir Pasha; Malkov, Serghei; Sprague, Brian L.

2015-01-01

Background Understanding how changes in body mass index (BMI) relate to changes in mammographic density is necessary to evaluate adjustment for BMI gain/loss in studies of change in density and breast cancer risk. Increase in BMI has been associated with a decrease in percent density, but the effect on change in absolute dense area or volume is unclear. Methods We examined the association between change in BMI and change in volumetric breast density among 24,556 women in the San Francisco Mammography Registry from 2007-2013. Height and weight were self-reported at the time of mammography. Breast density was assessed using single x-ray absorptiometry measurements. Cross-sectional and longitudinal associations between BMI and dense volume (DV), non-dense volume (NDV) and percent dense volume (PDV) were assessed using multivariable linear regression models, adjusted for demographics, risk factors, and reproductive history. Results In cross-sectional analysis, BMI was positively associated with DV (β=2.95 cm3, 95% CI 2.69, 3.21) and inversely associated with PDV (β=-2.03%, 95% CI -2.09, -1.98). In contrast, increasing BMI was longitudinally associated with a decrease in both DV (β=-1.01 cm3, 95% CI -1.59, -0.42) and PDV (β=-1.17%, 95% CI -1.31, -1.04). These findings were consistent for both pre- and postmenopausal women. Conclusion Our findings support an inverse association between change in BMI and change in PDV. The association between increasing BMI and decreasing DV requires confirmation. Impact Longitudinal studies of PDV and breast cancer risk, or those using PDV as an indicator of breast cancer risk, should evaluate adjustment for change in BMI. PMID:26315554

The Impact of Subclinical Hypothyroidism or Thyroid Autoimmunity on Coronary Vasospasm in Patients without Associated Cardiovascular Risk Factors

PubMed Central

Lee, Sea-Won; Kim, Hyun-Su; Heo, Jung-Ho; Cha, Tae-Joon

2015-01-01

Background and Objectives Subclinical hypothyroidism is associated with endothelial dysfunction and impaired coronary flow reserve. However, the effect of subclinical hypothyroidism or thyroid autoimmunity on variant angina has yet to be determined. Subjects and Methods Among 385 consecutive patients without associated cardiovascular risk factors who underwent coronary angiography with the ergonovine provocation test (EPT), 165 had a positive EPT {EPT(+)} and 220 had a negative EPT {EPT(-)}. The relationship between coronary artery spasm and the presence of subclinical thyroid dysfunction as well as serum thyroid peroxidase autoantibody (TPO Ab) was evaluated. Results The proportion of patients with subclinical hypothyroidism among those who were EPT(+) was significantly higher than that in those who were EPT(-) (18% vs. 11%, p=0.001). However, there was no significant difference in the proportion of patients with subclinical hyperthyroidism between the groups. Moreover, EPT(+) patients showed significantly more positive TPO Ab (33% vs. 14%, p<0.001) than those with EPT(-). There was a positive correlation between EPT(+) and TPO positivity (r=0.226, p<0.001), subclinical hypothyroidism (r=0.112, p=0.033), and body mass index (r=0.123, p=0.018). Binary logistic regression analysis revealed that the significant predictors of EPT(+) were body mass index {adjusted odds ratio (OR)=1.042, 95% confidence interval (CI)=1.005-1.080}, presence of subclinical hypothyroidism (OR=3.047, 95% CI=1.083-8.572), TPO Ab titer (OR=1.028, 95% CI=1.015-1.041), and the presence of TPO Ab (OR=4.904, 95% CI=1.544-15.567). Conclusion Subclinical hypothyroidism and the presence of TPO Ab are significantly associated with coronary vasospasm in patients without cardiovascular risk factors. PMID:25810734

Population-Based Burden of COPD-Related Visits in the ED

PubMed Central

Lippmann, Steven J.; Waller, Anna E.; Hassmiller Lich, Kristen; Travers, Debbie; Weinberger, Morris; Donohue, James F.

2013-01-01

Background: Little is known about the population-based burden of ED care for COPD. Methods: We analyzed statewide ED surveillance system data to quantify the frequency of COPD-related ED visits, hospital admissions, and comorbidities. Results: In 2008 to 2009 in North Carolina, 97,511 COPD-related ED visits were made by adults ≥ 45 years of age, at an annual rate of 13.8 ED visits/1,000 person-years. Among patients with COPD (n = 33,799), 7% and 28% had a COPD-related return ED visit within a 30- and 365-day period of their index visit, respectively. Compared with patients on private insurance, Medicare, Medicaid, and noninsured patients were more likely to have a COPD-related return visit within 30 and 365 days and have three or more COPD-related visits within 365 days. There were no differences in return visits by sex. Fifty-one percent of patients with COPD were admitted to the hospital from the index ED visit. Subsequent hospital admission risk in the cohort increased with age, peaking at 65 to 69 years (risk ratio [RR], 1.41; 95% CI, 1.26-1.57); there was no difference by sex. Patients with congestive heart failure (RR, 1.29; 95% CI, 1.22-1.37), substance-related disorders (RR, 1.35; 95% CI, 1.13-1.60), or respiratory failure/supplemental oxygen (RR, 1.25; 95% CI, 1.19-1.31) were more likely to have a subsequent hospital admission compared with patients without these comorbidities. Conclusions: The population-based burden of COPD-related care in the ED is significant. Further research is needed to understand variations in COPD-related ED visits and hospital admissions. PMID:23579283

Educational inequality in the occurrence of abdominal obesity: Pró-Saúde Study

PubMed Central

Alves, Ronaldo Fernandes Santos; Faerstein, Eduardo

2015-01-01

OBJECTIVE To estimate the degree of educational inequality in the occurrence of abdominal obesity in a population of non-faculty civil servants at university campi. METHODS In this cross-sectional study, we used data from 3,117 subjects of both genders aged 24 to 65-years old, regarding the baseline of Pró-Saúde Study, 1999-2001. Abdominal obesity was defined according to abdominal circumference thresholds of 88 cm for women and 102 cm for men. A multi-dimensional, self-administered questionnaire was used to evaluate education levels and demographic variables. Slope and relative indices of inequality, and Chi-squared test for linear trend were used in the data analysis. All analyses were stratified by genders, and the indices of inequality were standardized by age. RESULTS Abdominal obesity was the most prevalent among women (43.5%; 95%CI 41.2;45.9), as compared to men (24.3%; 95%CI 22.1;26.7), in all educational strata and age ranges. The association between education levels and abdominal obesity was an inverse one among women (p < 0.001); it was not statistically significant among men (p = 0.436). The educational inequality regarding abdominal obesity in the female population, in absolute terms (slope index of inequality), was 24.0% (95%CI 15.5;32.6). In relative terms (relative index of inequality), it was 2.8 (95%CI 1.9;4.1), after the age adjustment. CONCLUSIONS Gender inequality in the prevalence of abdominal obesity increases with older age and lower education. The slope and relative indices of inequality summarize the strictly monotonous trend between education levels and abdominal obesity, and it described educational inequality regarding abdominal obesity among women. Such indices provide relevant quantitative estimates for monitoring abdominal obesity and dealing with health inequalities. PMID:26465669

Routine Angiographic Follow-Up versus Clinical Follow-Up after Percutaneous Coronary Intervention in Acute Myocardial Infarction

PubMed Central

Kim, Yong Hoon; Her, Ae-Young; Choi, Byoung Geol; Shim, Minsuk; Choi, Se Yeon; Byun, Jae Kyeong; Li, Hu; Kim, Woohyeun; Kang, Jun Hyuk; Choi, Jah Yeon; Park, Eun Jin; Park, Sung Hun; Lee, Sunki; Na, Jin Oh; Choi, Cheol Ung; Lim, Hong Euy; Kim, Eung Ju; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo

2017-01-01

Purpose Differences in the utility of routine angiographic follow-up (RAF) and clinical follow-up (CF) after percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) are not well understood. The present study aimed to compare the 3-year clinical outcomes of RAF and CF in AMI patients who underwent PCI with drug-eluting stents (DES). Materials and Methods A total of 774 consecutive AMI patients who underwent PCI with DES were enrolled. RAF was performed at 6 to 9 months after index PCI (n=425). The remaining patients were medically managed and clinically followed (n=349); symptom-driven events were captured. To adjust for any potential confounders, a propensity score matched analysis was performed using a logistic regression model, and two propensity-matched groups (248 pairs, n=496, C-statistic=0.739) were generated. Cumulative clinical outcomes up to 3 years were compared between RAF and CF groups. Results During the 3-year follow-up period, the cumulative incidences of revascularization [target lesion revascularization: hazard ratio (HR), 2.40; 95% confidence interval (CI), 1.18–4.85; p=0.015, target vessel revascularization (TVR): HR, 3.33; 95% CI, 1.69–6.58; p=0.001, non-TVR: HR, 5.64; 95% CI, 1.90–16.6; p=0.002] and major adverse cardiac events (MACE; HR, 3.32; 95% CI, 1.92–5.73; p<0.001) were significantly higher in the RAF group than the CF group. However, the 3-year incidences of death and myocardial infarction were not different between the two groups. Conclusion RAF following index PCI with DES in AMI patients was associated with increased incidences of revascularization and MACE. Therefore, CF seems warranted for asymptomatic patients after PCI for AMI. PMID:28540983

Capsaicin Cough Sensitivity and the Association with Clinical Parameters in Bronchiectasis

PubMed Central

Lin, Zhi-ya; Tang, Yan; Li, Hui-min; Lin, Zhi-min; Zheng, Jin-ping; Chen, Rong-chang; Zhong, Nan-shan

2014-01-01

Background Cough hypersensitivity has been common among respiratory diseases. Objective To determine associations of capsaicin cough sensitivity and clinical parameters in adults with clinically stable bronchiectasis. Methods We recruited 135 consecutive adult bronchiectasis patients and 22 healthy subjects. History inquiry, sputum culture, spirometry, chest high-resolution computed tomography (HRCT), Leicester Cough Questionnaire scoring, Bronchiectasis Severity Index (BSI) assessment and capsaicin inhalation challenge were performed. Cough sensitivity was measured as the capsaicin concentration eliciting at least 2 (C2) and 5 coughs (C5). Results Despite significant overlap between healthy subjects and bronchiectasis patients, both C2 and C5 were significantly lower in the latter group (all P<0.01). Lower levels of C5 were associated with a longer duration of bronchiectasis symptoms, worse HRCT score, higher 24-hour sputum volume, BSI and sputum purulence score, and sputum culture positive for P. aeruginosa. Determinants associated with increased capsaicin cough sensitivity, defined as C5 being 62.5 µmol/L or less, encompassed female gender (OR: 3.25, 95%CI: 1.35–7.83, P<0.01), HRCT total score between 7–12 (OR: 2.57, 95%CI: 1.07–6.173, P = 0.04), BSI between 5–8 (OR: 4.05, 95%CI: 1.48–11.06, P<0.01) and 9 or greater (OR: 4.38, 95%CI: 1.48–12.93, P<0.01). Conclusion Capsaicin cough sensitivity is heightened in a subgroup of bronchiectasis patients and associated with the disease severity. Gender and disease severity, but not sputum purulence, are independent determinants of heightened capsaicin cough sensitivity. Current testing for cough sensitivity diagnosis may be limited because of overlap with healthy subjects but might provide an objective index for assessment of cough in future clinical trials. PMID:25409316

Exposures to Walkability and Particulate Air Pollution in a Nationwide Cohort of Women

PubMed Central

James, Peter; Hart, Jaime E.; Laden, Francine

2015-01-01

Background Features of neighborhoods associated with walkability (i.e., connectivity, accessibility, and density) may also be correlated with levels of ambient air pollution, which would attenuate the health benefits of walkability. Objectives We examined the relationship between neighborhood walkability and ambient air pollution in a cross-sectional analysis of a cohort study spanning the entire United States using residence-level exposure assessment for ambient air pollution and the built environment. Methods Using data from the Nurses’ Health Study, we used linear regression to estimate the association between a neighborhood walkability index, combining neighborhood intersection count, business count, and population density (defined from Census data, infoUSA business data, and StreetMap USA data), and air pollution, defined from a GIS-based spatiotemporal PM2.5 model. Results After adjustment for Census tract median income, median home value, and percent with no high school education, the highest tertile of walkability index, intersection count, business count, and population density was associated with a with 1.58 (95% CI 1.54, 1.62), 1.20 (95% CI 1.16, 1.24), 1.31 (95% CI 1.27, 1.35), and 1.84 (95% CI 1.80, 1.88) μg/m3 higher level of PM2.5 respectively, compared to the lowest tertile. Results varied somewhat by neighborhood socioeconomic status and greatly by region. Conclusions This nationwide analysis showed a positive relationship between neighborhood walkability and modeled air pollution levels, which were consistent after adjustment for neighborhood-level socioeconomic status. Regional differences in the air pollution-walkability relationship demonstrate that there are factors that vary across region that allow for walkable neighborhoods with low levels of air pollution. PMID:26397775

The Association between Peace and Life Expectancy: An Empirical Study of the World Countries

PubMed Central

YAZDI FEYZABADI, Vahid; HAGHDOOST, Aliakbar; MEHROLHASSANI, Mohammad Hossein; AMINIAN, Zahra

2015-01-01

Background: Although theoretically peace affects health, few published evidence for such an association was empirically available. This study aimed to explore the association between peace and life expectancy (LE) among the world countries. Methods: In an ecological study and using random effects regression model, we examined the association between peace and LE among world countries between 2007 and 2012. The LE at birth and global peace index (GPI: a score between 1 and 5, higher score means lower peace) were selected as outcome and main predictor variables, respectively. We adjusted their association for the gross national income (GNI) per capita and education index (EI). Data were obtained from the Institute for Economics and Peace (IEP) and UNDP (United Nations Development Programme (UNDP). Numbers of included countries were 158 based on the available data. Results: GPI had a negative, considerable, and statistically significant effect on LE (standardized coefficient −0.039; 95% CI: −0.058, −0.019). This association was also significant even after the adjustment for EI (−0.019; 95% CI: −0.035, −0.003), GNI (−0.035; 95% CI: −0.055, −0.015), and both EI and GNI (−0.017; 95% CI: −0.033, −0.001). The full model showed that around 0.61 of the variation of LE among countries may be explained by the GPI, EI and GNI per capita. Conclusion: The contribution of peace as a global determinant of LE was empirically considerable even after the adjustment for the economic and education levels of countries. This implies that governments should make efforts to settle peace through implementing good governance based on interactions with both public and other countries. PMID:25905077

The Association Between Operating Room Personnel and Turnover With Surgical Site Infection in More Than 12 000 Neurosurgical Cases.

PubMed

Wathen, Connor; Kshettry, Varun R; Krishnaney, Ajit; Gordon, Steven M; Fraser, Thomas; Benzel, Edward C; Modic, Michael T; Butler, Sam; Machado, Andre G

2016-12-01

Surgical site infection (SSI) contributes significantly to postoperative morbidity and mortality and greatly increases the cost of care. To identify the impact of workflow and personnel-related risk factors contributing to the incidence of SSIs in a large sample of neurological surgeries. Data were obtained using an enterprisewide electronic health record system, operating room, and anesthesia records for neurological procedures conducted between January 1, 2009, and November 30, 2012. SSI data were obtained from prospective surveillance by infection preventionists using Centers for Disease Control and Prevention definitions. A multivariate model was constructed and refined using backward elimination logistic regression methods. The analysis included 12 528 procedures. Most cases were elective (94.5%), and the average procedure length was 4.8 hours. The average number of people present in the operating room at any time during the procedure was 10.0. The overall infection rate was 2.3%. Patient body mass index (odds ratio, 1.03; 95% confidence interval [CI], 1.01-1.04) and sex (odds ratio, 1.36; 95% CI, 1.07-1.72) as well as procedure length (odds ratio, 1.19 per additional hour; 95% CI, 1.15-1.23) and nursing staff turnovers (odds ratio, 1.095 per additional turnover; 95% CI, 1.02-1.21) were significantly correlated with the risk of SSI. This study found that patient body mass index and male sex were associated with an increased risk of SSI. Operating room personnel turnover, a modifiable, work flow-related factor, was an independent variable positively correlated with SSI. This study suggests that efforts to reduce operating room turnover may be effective in preventing SSI. OR, operating roomSSI, surgical site infection.

Prevalence of sun exposure and its associated factors in southern Brazil: a population-based study*

PubMed Central

Duquia, Rodrigo Pereira; Menezes, Ana Maria Baptista; de Almeida, Hiram Larangeira; Reichert, Felipe Fossati; dos Santos, Iná da Silva; Haack, Ricardo Lanzetta; Horta, Bernardo Lessa

2013-01-01

BACKGROUND Sunlight exposure is responsible for a large number of dermatological diseases. OBJECTIVE We estimated the prevalence of sunlight exposure and its associated factors in adults from southern Brazil in a cross-sectional, population-based study. METHODS We investigated a representative sample of individuals aged ≥ 20 years (n=3,136). Sunlight exposure and its associated factors were evaluated in two distinct situations: at leisure time and at work. The time period investigated ranged from December 2004 to March 2005, comprising 120 days of the highest ultraviolet index in the urban area of the city of Pelotas, in southern Brazil. The participants were asked about sunlight exposure for at least 20 minutes between 10 A.M. and 4 P.M. The analysis was stratified by sex, and sunlight exposure was grouped into five categories. RESULTS Among the 3,136 participants, prevalence of sunlight exposure at the beach was 32.8% (95% CI, 30.3 - 35.2) and 26.3% (95% CI, 24.2 28.3) among men and women, respectively. The prevalence at work was 39.8% (95% CI, 37.2 - 42.4) among men and 10.5% (95% CI, 9.1 - 12.0) among women. Age was inversely associated with sunlight exposure. Family income and achieved schooling were positively associated with sunlight exposure at leisure time and inversely associated with sunglight exposure at work. Self-reported skin color was not associated. Knowledge of any friend or relative who has been affected by skin cancer was positively associated with sunlight exposure among men at work. CONCLUSION Despite the media campaigns on the harmful effects of excessive sunlight exposure, we found a high prevalence of sunlight exposure during a period of high ultraviolet index. PMID:24068126

The Impact of the Estimation of the Parameters Values on the Accuracy of Predicting the Impacts of Mining Exploitation / Wpływ Oszacowania Wartości Parametrów Modelu Na Dokładność Prognozowania Wpływów Eksploatacji Górniczej

NASA Astrophysics Data System (ADS)

Niedojadło, Zygmunt; Gruszczyński, Wojciech

2015-03-01

The possibility of the assessment of the probability that the acceptable values of deformation indexes will be exceeded and the introduction of the coefficient of safety are more and more seriously considered in case of predicting the impacts of exploitation both on the surface and the shaft tube. This article presents the mentioned above issue focusing on the authors' project of the exploitation in the protective pillars of the shafts of the Legnica and Głogów Copper Area (LGOM). To assess the accuracy of the predicted deformation indexes Monte Carlo method (often used in statistics) was proposed as well as the strict and approximate analysis using the law of error propagation. The values of vertical strains were analysed, as the most important at the assessment of the state of deformation of the shaft tube. The comparison of the results obtained with different methods confirmed the correctness of the carried out calculations. The applied methods allowed the analysis of the impact of individual parameters of the model on the prediction of the accuracy of forecast. This article makes the continuation of the solutions of the article (Niedojadło & Gruszczyński, 2010) thus some contents essential for the continuity of understanding were repeated here. Możliwość oceny prawdopodobieństwa przekroczenia dopuszczalnych wartości wskaźników deformacji oraz wprowadzenie współczynnika bezpieczeństwa coraz częściej są brane pod uwagę w przypadku prognozowania wpływów eksploatacji tak na powierzchnię jak i rurę szybową. W niniejszym artykule przedstawiono powyższe zagadnienie na przykładzie autorskiego projektu eksploatacji w filarach ochronnych szybów LGOM. Do oceny dokładności prognozowanych wskaźników deformacji zaproponowano wykorzystywaną w statystyce metodę Monte Carlo oraz analizę ścisłą i przybliżoną wykorzystującą prawo przenoszenia się błędów średnich. Analizowano wartości odkształceń pionowych, jako najistotniejsze przy ocenie stanu deformacji rury szybowej. Porównanie wyników uzyskanych różnymi metodami potwierdziły poprawność wykonanych obliczeń. Zastosowane metody pozwoliły na analizę wpływu poszczególnych parametrów modelu na dokładność prognozy. Niniejszy artykuł stanowi kontynuację rozważań zawartych w artykule (Niedojadło & Gruszczyński, 2010) stąd pewne treści niezbędne dla zachowania ciągłości rozumowania zostały powtórzone.

Validity of the modified Charlson Comorbidity Index as predictor of short-term outcome in older stroke patients.

PubMed

Denti, Licia; Artoni, Andrea; Casella, Monica; Giambanco, Fabiola; Scoditti, Umberto; Ceda, Gian Paolo

2015-02-01

The modified Charlson Comorbidity Index (MCCI) has been proposed as a tool for adjusting the outcomes of stroke for comorbidity, but its validity in such a context has been evaluated in only a few studies and needs to be further explored, especially in elderly patients. We aimed to retrospectively assess the validity of the MCCI as a predictor of the short-term outcomes in a cohort of 297 patients with first-ever ischemic stroke, older than 60 years, and managed according to a clinical pathway. The poor outcome (PO) at 1 month, defined as a modified Rankin Scale score of 3-6, was the primary end point. Furthermore, a new comorbidity index has been developed, specific to our cohort, according to the same statistical approach used for the original CCI. The MCCI showed a positive association with PO (odds ratio [OR] 1.62; 95% confidence interval [CI] .98-2.68) and mortality (hazard ratio [HR] 1.85; 95% CI .94-3.61), not statistically significant and totally dependent on its association with the severity of neurologic impairment at onset. The new comorbidity index showed, as expected, a significant association with the PO and mortality with higher point estimates of OR (2.74; 95% CI 1.64-4.59) and HR (2.73; 95% CI 1.51-4.94), but this association was also dependent on stroke severity and premorbid disability. Our results do not support the validity of the MCCI as a predictor of the short-term outcomes in elderly stroke patients nor could we develop a more valid index from the available data. This suggests the need for development of disease- and age-specific indexes, possibly according to a prospective design. In any case, initial stroke severity, a strong predictor of outcome, is associated with the degree of comorbidity. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Association between ratio indexes of body composition phenotypes and metabolic risk in Italian adults.

PubMed

Powell, M; Lara, J; Mocciaro, G; Prado, C M; Battezzati, A; Leone, A; Tagliabue, A; de Amicis, R; Vignati, L; Bertoli, S; Siervo, M

2016-12-01

The ratio between fat mass (FM) and fat-free mass (FFM) has been used to discriminate individual differences in body composition and improve prediction of metabolic risk. Here, we evaluated whether the use of a visceral adipose tissue-to-fat-free mass index (VAT:FFMI) ratio was a better predictor of metabolic risk than a fat mass index to fat-free mass index (FMI:FFMI) ratio. This is a cross-sectional study including 3441 adult participants (age range 18-81; men/women: 977/2464). FM and FFM were measured by bioelectrical impedance analysis and VAT by ultrasonography. A continuous metabolic risk Z score and harmonised international criteria were used to define cumulative metabolic risk and metabolic syndrome (MetS), respectively. Multivariate logistic and linear regression models were used to test associations between body composition indexes and metabolic risk. In unadjusted models, VAT:FFMI was a better predictor of MetS (OR 8.03, 95%CI 6.69-9.65) compared to FMI:FFMI (OR 2.91, 95%CI 2.45-3.46). However, the strength of association of VAT:FFMI and FMI:FFMI became comparable when models were adjusted for age, gender, clinical and sociodemographic factors (OR 4.06, 95%CI 3.31-4.97; OR 4.25, 95%CI 3.42-5.27, respectively). A similar pattern was observed for the association of the two indexes with the metabolic risk Z score (VAT:FFMI: unadjusted b = 0.69 ± 0.03, adjusted b = 0.36 ± 0.03; FMI:FFMI: unadjusted b = 0.28 ± 0.028, adjusted b = 0.38 ± 0.02). Our results suggest that there is no real advantage in using either VAT:FFMI or FMI:FFMI ratios as a predictor of metabolic risk in adults. However, these results warrant confirmation in longitudinal studies. © 2016 World Obesity Federation.

Prevalence of Thinness in Adolescent Girls in Low- and Middle-Income Countries and Associations With Wealth, Food Security, and Inequality.

PubMed

Candler, Toby; Costa, Silvia; Heys, Michelle; Costello, Anthony; Viner, Russell M

2017-04-01

Adequate nutrition during adolescence is important for optimal physical and cognitive development and for pregnancy either during adolescence or later life. Thinness among adolescent girls in low- and middle-income countries has been little studied. We used body mass index data from 40 countries from the Global School Health Survey to estimate the prevalence of moderate and severe thinness in 12- to 18-year-olds using the World Health Organization 2007 growth reference. Self-report data on going to bed hungry were used as a proxy for household food insecurity. We used multilevel models to assess whether national wealth (gross domestic product), income inequality (Gini index), national gender inequality (Gender Inequality Index), and food security (Global Food Security Index) were associated with undernutrition. Prevalence rates of moderate and severe thinness across 61,603 girls from 40 countries were 6.30% (95% confidence interval [CI]: 5.71-6.95) and 1.34% (1.12-1.59), respectively, with higher rates in Asia. Combined moderate/severe thinness was more common among early (12-14 years) than later adolescents (15-18 years). Going to bed hungry sometimes was associated with increased risk of moderate/severe thinness (odds ratio [OR]: 1.102; 95% CI: 1.007-1.206). A significant inverse relationship was found between thinness and gross domestic product (OR: .94; 95% CI: .88-.99) and Global Food Security Index (OR: .96; 95% CI: .93-.99) but not Gini or Gender Inequality Index. Thinness remains prevalent in adolescent schoolgirls in low- and middle-income countries and poses a significant threat to their health and that of the next generation. Further research is needed to assess potential interventions for this group. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

A pooled analysis of dietary sugar/carbohydrate intake and esophageal and gastric cardia adenocarcinoma incidence and survival in the USA.

PubMed

Li, Nan; Petrick, Jessica L; Steck, Susan E; Bradshaw, Patrick T; McClain, Kathleen M; Niehoff, Nicole M; Engel, Lawrence S; Shaheen, Nicholas J; Risch, Harvey A; Vaughan, Thomas L; Wu, Anna H; Gammon, Marilie D

2017-12-01

During the past 40 years, esophageal/gastric cardia adenocarcinoma (EA/GCA) incidence increased in Westernized countries, but survival remained low. A parallel increase in sugar intake, which may facilitate carcinogenesis by promoting hyperglycaemia, led us to examine sugar/carbohydrate intake in association with EA/GCA incidence and survival. We pooled 500 EA cases, 529 GCA cases and 2027 controls from two US population-based case-control studies with cases followed for vital status. Dietary intake, assessed by study-specific food frequency questionnaires, was harmonized and pooled to estimate 12 measures of sugar/carbohydrate intake. Multivariable-adjusted odds ratios (ORs) and hazard ratios [95% confidence intervals (CIs)] were calculated using multinomial logistic regression and Cox proportional hazards regression, respectively. EA incidence was increased by 51-58% in association with sucrose (ORQ5vs.Q1 = 1.51, 95% CI = 1.01-2.27), sweetened desserts/beverages (ORQ5vs.Q1 = 1.55, 95% CI = 1.06-2.27) and the dietary glycaemic index (ORQ5vs.Q1 = 1.58, 95% CI = 1.13-2.21). Body mass index (BMI) and gastro-esophageal reflux disease (GERD) modified these associations (Pmultiplicative-interaction ≤ 0.05). For associations with sucrose and sweetened desserts/beverages, respectively, the OR was elevated for BMI < 25 (ORQ4-5vs.Q1-3 = 1.79, 95% CI = 1.26-2.56 and ORQ4-5vs.Q1-3 = 1.45, 95% CI = 1.03-2.06), but not BMI ≥ 25 (ORQ4-5vs.Q1-3 = 1.05, 95% CI = 0.76-1.44 and ORQ4-5vs.Q1-3 = 0.85, 95% CI = 0.62-1.16). The EA-glycaemic index association was elevated for BMI ≥ 25 (ORQ4-5vs.Q1-3 = 1.38, 95% CI = 1.03-1.85), but not BMI < 25 (ORQ4-5vs.Q1-3 = 0.88, 95% CI = 0.62-1.24). The sucrose-EA association OR for GERD < weekly was 1.58 (95% CI = 1.16-2.14), but for GERD ≥ weekly was 1.01 (95% CI = 0.70-1.47). Sugar/carbohydrate measures were not associated with GCA incidence or EA/GCA survival. If confirmed, limiting intake of sucrose (e.g. table sugar), sweetened desserts/beverages, and foods that contribute to a high glycaemic index, may be plausible EA risk reduction strategies. Published by Oxford University Press on behalf of the International Epidemiological Association 2017. This work is written by US Government employees and is in the public domain in the United States.

Focused Ultrasound-Induced Blood-Brain Barrier Opening: Association with Mechanical Index and Cavitation Index Analyzed by Dynamic Contrast-Enhanced Magnetic-Resonance Imaging

NASA Astrophysics Data System (ADS)

Chu, Po-Chun; Chai, Wen-Yen; Tsai, Chih-Hung; Kang, Shih-Tsung; Yeh, Chih-Kuang; Liu, Hao-Li

2016-09-01

Focused ultrasound (FUS) with microbubbles can temporally open the blood-brain barrier (BBB), and the cavitation activities of microbubbles play a key role in the BBB-opening process. Previous attempts used contrast-enhanced magnetic resonance imaging (CE-MRI) to correlate the mechanical index (MI) with the scale of BBB-opening, but MI only partially gauged acoustic activities, and CE-MRI did not fully explore correlations of pharmacodynamic/pharmacokinetic behaviors. Recently, the cavitation index (CI) has been derived to serve as an indicator of microbubble-ultrasound stable cavitation, and may also serve as a valid indicator to gauge the level of FUS-induced BBB opening. This study investigates the feasibility of gauging FUS-induced BBB opened level via the two indexes, MI and CI, through dynamic contrast-enhanced (DCE)-MRI analysis as well as passive cavitation detection (PCD) analysis. Pharmacodynamic/pharmacokinetic parameters derived from DCE-MRI were characterized to identify the scale of FUS-induced BBB opening. Our results demonstrated that DCE-MRI can successfully access pharmacodynamic/pharmacokinetic BBB-opened behavior, and was highly correlated both with MI and CI, implying the feasibility in using these two indices to gauge the scale of FUS-induced BBB opening. The proposed finding may facilitate the design toward using focused ultrasound as a safe and reliable noninvasive CNS drug delivery.

Focused Ultrasound-Induced Blood-Brain Barrier Opening: Association with Mechanical Index and Cavitation Index Analyzed by Dynamic Contrast-Enhanced Magnetic-Resonance Imaging.

PubMed

Chu, Po-Chun; Chai, Wen-Yen; Tsai, Chih-Hung; Kang, Shih-Tsung; Yeh, Chih-Kuang; Liu, Hao-Li

2016-09-15

Focused ultrasound (FUS) with microbubbles can temporally open the blood-brain barrier (BBB), and the cavitation activities of microbubbles play a key role in the BBB-opening process. Previous attempts used contrast-enhanced magnetic resonance imaging (CE-MRI) to correlate the mechanical index (MI) with the scale of BBB-opening, but MI only partially gauged acoustic activities, and CE-MRI did not fully explore correlations of pharmacodynamic/pharmacokinetic behaviors. Recently, the cavitation index (CI) has been derived to serve as an indicator of microbubble-ultrasound stable cavitation, and may also serve as a valid indicator to gauge the level of FUS-induced BBB opening. This study investigates the feasibility of gauging FUS-induced BBB opened level via the two indexes, MI and CI, through dynamic contrast-enhanced (DCE)-MRI analysis as well as passive cavitation detection (PCD) analysis. Pharmacodynamic/pharmacokinetic parameters derived from DCE-MRI were characterized to identify the scale of FUS-induced BBB opening. Our results demonstrated that DCE-MRI can successfully access pharmacodynamic/pharmacokinetic BBB-opened behavior, and was highly correlated both with MI and CI, implying the feasibility in using these two indices to gauge the scale of FUS-induced BBB opening. The proposed finding may facilitate the design toward using focused ultrasound as a safe and reliable noninvasive CNS drug delivery.

Racial and ethnic differences in the risk of postpartum venous thromboembolism: a population-based, case-control study.

PubMed

Blondon, M; Harrington, L B; Righini, M; Boehlen, F; Bounameaux, H; Smith, N L

2014-12-01

Venous thromboembolism (VTE) is a major contributor of maternal morbidity and mortality. Whether maternal race/ethnicity is associated with the risk of postpartum VTE remains unclear. We conducted a population-based, case-control study in Washington State, from 1987 through 2011. Cases comprised all women with selected International Classification of Diseases, Ninth Edition, Clinical Modification codes for hospitalized VTE within 3 months post-delivery. Controls were randomly selected postpartum women who did not experience a VTE. Characteristics of women and their deliveries were abstracted from birth certificates. Using logistic regression models, we compared the risk of postpartum VTE in black, Asian, and Hispanic women with that in non-Hispanic white women, after adjustment for maternal characteristics (age, body mass index, parity, education), pregnancy complications, and delivery methods. Our study comprised 688 cases and 10 246 controls. Among controls, the mean age and body mass index were 27.5 years and 26.3 kg m(-2) , respectively. Compared with white women, black and Asian women had a greater and lower risk of postpartum VTE (adjusted odds ratio [OR] 1.50, 95% confidence interval [CI] 1.10-2.04 and OR 0.67, 95%CI 0.48-0.94, respectively). A lower risk was present in Hispanic women (adjusted OR 0.80, 95% CI 0.61-1.06) but was not statistically significant. In subgroup analyses, we observed an increased risk for black compared with white women among women who delivered via cesarean section (OR 2.03, 95% CI 1.34-3.07) but not among vaginal deliveries (OR 1.03, 95% CI 0.61-1.74). Maternal race/ethnicity is associated with the risk of postpartum VTE, independently of other risk factors, and should be considered when assessing the use of thromboprophylaxis after delivery. © 2014 International Society on Thrombosis and Haemostasis.

Diabetes, Triglyceride Levels, and Other Risk Factors for Glaucoma in the National Health and Nutrition Examination Survey 2005–2008

PubMed Central

Ko, Fang; Boland, Michael V.; Gupta, Priya; Gadkaree, Shekhar K.; Vitale, Susan; Guallar, Eliseo; Zhao, Di; Friedman, David S.

2016-01-01

Purpose To determine risk factors for glaucoma in a population-based study in the United States. Methods Participants age 40 and older from the National Health and Nutrition Examination Survey underwent questionnaires, physical examination, laboratory tests, and vision tests including fundus imaging. Glaucoma was determined based on expert grading of fundus photographs. Regression modeling of glaucoma risk factors was performed. Results Participants with glaucoma (172) were older (mean age 68.1 [95% confidence interval (CI) 65.6–70.7] vs. 56.4 years [95% CI 55.6–57.2, P < 0.001]), likely to have less than high school education (25.1% vs. 18.1%, P = 0.05), to have diabetes (23.1% vs. 10.8%, P < 0.001), to have central obesity (72.5% vs. 60.7%, P = 0.01), to have systolic hypertension (30.3% vs. 20.1%, P = 0.01), to have diastolic hypotension (30.3% vs. 13.9%, P < 0.001), and to be nonsmokers (91.0% vs. 79.3%, P = 0.002). Sex, poverty, access to health care, fasting glucose, insulin dependence, body mass index, cholesterol levels, diastolic hypertension, systolic hypotension, obstructive sleep apnea, and marijuana were not associated with glaucoma. Multivariable modeling showed associations between glaucoma and older age (odds ratio [OR] 1.09 per year, 95% CI 1.04–1.14), black race (OR 4.40, 95% CI 1.71–11.30), and poverty (OR 3.39, 95% CI 1.73–6.66). Diabetes was no longer associated with glaucoma after adjustment for triglyceride levels. Sex, education, insurance status, body mass index, blood pressure, obstructive sleep apnea, and smoking were not associated with glaucoma. Conclusions People who are older, of black race, and with lower income levels have a higher prevalence of glaucoma. A novel association between diabetes, triglyceride levels, and glaucoma is also identified. PMID:27111561

Dietary inflammatory index and risk of upper aerodigestive tract cancer in Japanese adults

PubMed Central

Abe, Makiko; Shivappa, Nitin; Ito, Hidemi; Oze, Isao; Abe, Tetsuya; Shimizu, Yasuhiro; Hasegawa, Yasuhisa; Kiyohara, Chikako; Nomura, Masatoshi; Ogawa, Yoshihiro; Hebert, James R.; Matsuo, Keitaro

2018-01-01

Background The inflammatory potential of diet that has been shown to be associated with cancer risk. We examined the association between dietary inflammatory potential as measured by the dietary inflammatory index (DII®) and risk of upper aerodigestive tract cancers in a Japanese case-control study. Results A positive association was observed between increasing DII scores and overall upper aerodigestive tract cancers, and across anatomic subsites. For upper aerodigestive tract cancers, the ORQ4vsQ1 = 1.73 (95% CI: 1.37–2.20); head and neck cancer, the ORQ4vsQ1 was 1.92 (95% CI: 1.42–2.59); and for esophageal cancer, the ORQ4vsQ1 was1.71 (95% CI: 1.54–1.90). Risks for hypopharyngeal and nasopharyngeal cancers were greatly elevated: (ORQ4vsQ1 = 4.05 (95% CI: 1.24–13.25) for hypopharyngeal cancer and ORQ4vsQ1 = 4.99 (95% CI: 1.14–21.79) for nasopharyngeal cancer. Conclusion A more pro-inflammatory diet was associated with an elevated risk of upper aerodigestive tract cancers after accounting for important confounders. All anatomic subsites, except larynx, showed the consistently elevated risk with increasing DII score. Those subsites with known etiological associations with persistent infection showed the largest elevation in risk. These results warrant further evaluation in future studies. Materials and Methods This is a case-control study of 1,028 cases and 3,081 age- and sex-matched non-cancer controls recruited at Aichi Cancer Center. DII scores were computed based on estimates of macro- and micro-nutrients from a self-administered food frequency questionnaire. Scores were further categorized into quartiles (based on the distribution in controls). Conditional logistic regression models were fit to estimate odds ratio (OR) and 95% confidence intervals (CIs) adjusted for smoking, ethanol consumption, alcohol flushing, number of teeth, and occupation group. PMID:29844870

Body Mass Index in Mild Cognitive Impairment According to Age, Sex, Cognitive Intervention, and Hypertension and Risk of Progression to Alzheimer's Disease.

PubMed

Joo, Soo Hyun; Yun, Se Hee; Kang, Dong Woo; Hahn, Chang Tae; Lim, Hyun Kook; Lee, Chang Uk

2018-01-01

Introduction: Mild cognitive impairment (MCI) is a prodromal stage of dementia. The association of body mass index (BMI) and progression to Alzheimer's disease (AD) in MCI subjects according to age, sex, and cognitive intervention remains unknown. We investigated the relationship between BMI and the risk of progression to AD in subjects with MCI, as well as the effect of BMI on progression to AD depending on age, sex, cognitive intervention, and chronic diseases. Methods: Three hundred and eighty-eight MCI subjects were followed for 36.3 ± 18.4 months, prospectively. They underwent neuropsychological testing more than twice during the follow-up period. The MCI subjects were categorized into underweight, normal weight, overweight, and obese subgroups. The associations between baseline BMI and progression to AD over the follow-up period were estimated using Cox proportional hazard regression models. Data were analyzed after stratification by age, sex, cognitive intervention, and chronic diseases. Results: After adjustment for the covariates, the underweight MCI group had a higher risk of progression to AD [hazard ratio (HR): 2.38, 95% confidence interval (CI): 1.17-4.82] relative to the normal weight group. After stratifying by age, sex, cognitive intervention, and chronic diseases, this effect remained significant among females (HR: 3.15, 95% CI: 1.40-7.10), the older elderly ≥75 years old (HR: 3.52, 95% CI: 1.42-8.72), the non-intervention group (HR: 3.06, 95%CI: 1.18-7.91), and the hypertensive group (HR: 4.71, 95% CI: 1.17-18.99). Conclusion: These data indicate that underweight could be a useful marker for identifying individuals at increased risk for AD in MCI subjects. This association is even stronger in females, older elderly subjects, the non-cognitive intervention group, and the hypertensive group.

Asthma and risk of appendicitis in children: a population-based case-control study

PubMed Central

Hasassri, M. Earth; Jackson, Eric R.; Ghawi, Husam; Ryoo, Eell; Wi, Chung-Il; Bartlett, Mark G.; Volcheck, Gerald W.; Moir, Christopher R.; Ryu, Euijung; Juhn, Young J.

2017-01-01

Objective To assess whether asthma is associated with risk of appendicitis in children. Methods We used a population-based case-control study design utilizing a comprehensive medical record review and predetermined criteria for appendicitis and asthma. All children (age<18 years) who resided in Olmsted County, Minnesota, and developed appendicitis between 2006 and 2012 were matched to controls (1:1) with regard to birthday, gender, registration date, and index date. Asthma status was ascertained using predetermined criteria. Active (current) asthma was defined as the presence of asthma symptoms or asthma-related events (eg, medication use, clinic visits, emergency department, or hospitalization) within one year prior to the index date. Inactive asthma was defined as subjects without these events. A conditional logistic regression model was used. Results Among the 309 appendicitis cases identified, when stratified by asthma status, active asthma was associated with significantly increased risk of appendicitis when compared to inactive asthma (OR=2.48; 95% CI, 1.22–5.03) and to no asthma (OR=1.88; 95% CI, 1.07–3.27) (overall p-value=0.035). When controlling for potential confounders such as gender, age, and smoking status, active asthma was associated with a higher odds of developing appendicitis compared to non-asthmatics (adjusted OR=1.75, 95% CI 0.99–3.11) whereas inactive asthma was not (overall p-value=0.049). Tobacco smoke exposure within three months was associated with an increased risk of appendicitis (adjusted OR=1.66; 95% CI, 1.02, 2.69). Among asthma medications, leukotriene receptor antagonists reduced the risk of appendicitis (OR=0.18; 95% CI, 0.04–0.74). Conclusions Active asthma may be an unrecognized risk factor for appendicitis in children while a history of inactive asthma does not pose such risk. Further investigation exploring the underlying mechanisms is warranted. PMID:27964827

Do Mortality Rates in Eating Disorders Change over Time? A Longitudinal Look at Anorexia Nervosa and Bulimia Nervosa

PubMed Central

Franko, Debra L.; Keshaviah, Aparna; Eddy, Kamryn T.; Krishna, Meera; Davis, Martha C.; Keel, Pamela K.; Herzog, David B.

2014-01-01

Objective Although anorexia nervosa has a high mortality rate, our understanding of the timing and predictors of mortality in eating disorders is limited. The authors investigated mortality in a long-term study of patients with eating disorders. Method Beginning in 1987, 246 treatment-seeking women with anorexia nervosa or bulimia nervosa were interviewed every 6 months for a median of 9.5 years to obtain weekly ratings of eating disorder symptoms, comorbidity, treatment participation, and psychosocial functioning. From January 2007 to December 2010 (median follow-up of 20 years), vital status was ascertained with a National Death Index search. Results Sixteen deaths (6.5%) were recorded (lifetime anorexia nervosa, N=14; bulimia nervosa with no history of anorexia nervosa, N=2). The standardized mortality ratio was 4.37 [95% CI=2.4-7.3] for lifetime anorexia nervosa and 2.33 [95% CI=0.3-8.4] for bulimia nervosa with no history of anorexia nervosa. Risk of premature death among women with lifetime anorexia nervosa peaked within the first 10 years of follow-up resulting in a standardized mortality ratio of 7.7 [95% CI=3.7-14.2]. The standardized mortality ratio varied by duration of illness and was 3.2 [95% CI=0.9-8.3] for women with lifetime anorexia nervosa for 0-15 years (4/119 died), and 6.6 [95% CI=3.2-12.1] for women with lifetime anorexia nervosa for >15-30 years (10/67 died). Multivariate predictors of mortality included alcohol abuse (p<0.0001), low body mass index (p=0.0005), and poor social adjustment (p=0.0090). Conclusions These findings highlight the need for early identification and intervention and suggest that a long duration of illness, substance abuse, low weight, and/or poor psychosocial functioning raise the risk for mortality in anorexia nervosa. PMID:23771148

Comparison of Magnetic Resonance Imaging and Computed Tomography for Breast Target Volume Delineation in Prone and Supine Positions

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

Pogson, Elise M.; Liverpool and Macarthur Cancer Therapy Centres, Liverpool; Ingham Institute for Applied Medical Research, Liverpool

2016-11-15

Purpose: To determine whether T2-weighted MRI improves seroma cavity (SC) and whole breast (WB) interobserver conformity for radiation therapy purposes, compared with the gold standard of CT, both in the prone and supine positions. Methods and Materials: Eleven observers (2 radiologists and 9 radiation oncologists) delineated SC and WB clinical target volumes (CTVs) on T2-weighted MRI and CT supine and prone scans (4 scans per patient) for 33 patient datasets. Individual observer's volumes were compared using the Dice similarity coefficient, volume overlap index, center of mass shift, and Hausdorff distances. An average cavity visualization score was also determined. Results: Imaging modalitymore » did not affect interobserver variation for WB CTVs. Prone WB CTVs were larger in volume and more conformal than supine CTVs (on both MRI and CT). Seroma cavity volumes were larger on CT than on MRI. Seroma cavity volumes proved to be comparable in interobserver conformity in both modalities (volume overlap index of 0.57 (95% Confidence Interval (CI) 0.54-0.60) for CT supine and 0.52 (95% CI 0.48-0.56) for MRI supine, 0.56 (95% CI 0.53-0.59) for CT prone and 0.55 (95% CI 0.51-0.59) for MRI prone); however, after registering modalities together the intermodality variation (Dice similarity coefficient of 0.41 (95% CI 0.36-0.46) for supine and 0.38 (0.34-0.42) for prone) was larger than the interobserver variability for SC, despite the location typically remaining constant. Conclusions: Magnetic resonance imaging interobserver variation was comparable to CT for the WB CTV and SC delineation, in both prone and supine positions. Although the cavity visualization score and interobserver concordance was not significantly higher for MRI than for CT, the SCs were smaller on MRI, potentially owing to clearer SC definition, especially on T2-weighted MR images.« less

Association Between Albuminuria and Duration of Diabetes and Myocardial Dysfunction and Peripheral Arterial Disease Among Patients With Stable Coronary Artery Disease in the BARI 2D Study

PubMed Central

Escobedo, Jorge; Rana, Jamal S.; Lombardero, Manuel S.; Albert, Stewart G.; Davis, Andrew M.; Kennedy, Frank P.; Mooradian, Arshag D.; Robertson, David G.; Srinivas, V. S.; Gebhart, Suzanne S. P.

2010-01-01

OBJECTIVE: To evaluate the effect of prior duration of diabetes, glycated hemoglobin level at study entry, and microalbuminuria or macroalbuminuria on the extent and severity of coronary artery disease (CAD) and peripheral arterial disease. PATIENTS AND METHODS: We studied baseline characteristics of the 2368 participants of the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) study, a randomized clinical trial that evaluates treatment efficacy for patients with type 2 diabetes and angiographically documented stable CAD. Patients were enrolled from January 1, 2001, through March 31, 2005. Peripheral arterial disease was ascertained by an ankle-brachial index (ABI) of 0.9 or less, and extent of CAD was measured by presence of multivessel disease, a left ventricular ejection fraction (LVEF) of less than 50%, and myocardial jeopardy index. RESULTS: Duration of diabetes of 20 or more years was associated with increased risk of ABI of 0.9 or less (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.04-2.26), intermittent claudication (OR, 1.61; 95% CI, 1.10-2.35), and LVEF of less than 50% (OR, 2.03; 95% CI, 1.37-3.02). Microalbuminuria was associated with intermittent claudication (OR, 1.53; 95% CI, 1.16-2.02) and ABI of 0.9 or less (OR, 1.31; 95% CI, 0.98-1.75), whereas macroalbuminuria was associated with abnormal ABI, claudication, and LVEF of less than 50%. There was a significant association between diabetes duration and extent of CAD as manifested by number of coronary lesions, but no other significant associations were observed between duration of disease, glycated hemoglobin levels, or albumin-to-creatinine ratio and other manifestations of CAD. CONCLUSION: Duration of diabetes and microalbuminuria or macroalbuminuria are important predictors of severity of peripheral arterial disease and left ventricular dysfunction in a cohort of patients selected for the presence of CAD. PMID:20042560

A Predictive Model for Assessing Surgery-Related Acute Kidney Injury Risk in Hypertensive Patients: A Retrospective Cohort Study

PubMed Central

Liu, Xing; Ye, Yongkai; Mi, Qi; Huang, Wei; He, Ting; Huang, Pin; Xu, Nana; Wu, Qiaoyu; Wang, Anli; Li, Ying; Yuan, Hong

2016-01-01

Background Acute kidney injury (AKI) is a serious post-surgery complication; however, few preoperative risk models for AKI have been developed for hypertensive patients undergoing general surgery. Thus, in this study involving a large Chinese cohort, we developed and validated a risk model for surgery-related AKI using preoperative risk factors. Methods and Findings This retrospective cohort study included 24,451 hypertensive patients aged ≥18 years who underwent general surgery between 2007 and 2015. The endpoints for AKI classification utilized by the KDIGO (Kidney Disease: Improving Global Outcomes) system were assessed. The most discriminative predictor was selected using Fisher scores and was subsequently used to construct a stepwise multivariate logistic regression model, whose performance was evaluated via comparisons with models used in other published works using the net reclassification index (NRI) and integrated discrimination improvement (IDI) index. Results Surgery-related AKI developed in 1994 hospitalized patients (8.2%). The predictors identified by our Xiang-ya Model were age, gender, eGFR, NLR, pulmonary infection, prothrombin time, thrombin time, hemoglobin, uric acid, serum potassium, serum albumin, total cholesterol, and aspartate amino transferase. The area under the receiver-operating characteristic curve (AUC) for the validation set and cross validation set were 0.87 (95% CI 0.86–0.89) and (0.89; 95% CI 0.88–0.90), respectively, and was therefore similar to the AUC for the training set (0.89; 95% CI 0.88–0.90). The optimal cutoff value was 0.09. Our model outperformed that developed by Kate et al., which exhibited an NRI of 31.38% (95% CI 25.7%-37.1%) and an IDI of 8% (95% CI 5.52%-10.50%) for patients who underwent cardiac surgery (n = 2101). Conclusions/Significance We developed an AKI risk model based on preoperative risk factors and biomarkers that demonstrated good performance when predicting events in a large cohort of hypertensive patients who underwent general surgery. PMID:27802302

Epidemiologic Evidence That Excess Body Weight Increases Risk of Cervical Cancer by Decreased Detection of Precancer.

PubMed

Clarke, Megan A; Fetterman, Barbara; Cheung, Li C; Wentzensen, Nicolas; Gage, Julia C; Katki, Hormuzd A; Befano, Brian; Demarco, Maria; Schussler, John; Kinney, Walter K; Raine-Bennett, Tina R; Lorey, Thomas S; Poitras, Nancy E; Castle, Philip E; Schiffman, Mark

2018-04-20

Purpose Obesity has been inconsistently linked to increased cervical cancer incidence and mortality; however, the effect of obesity on cervical screening has not been explored. We investigated the hypothesis that increased body mass might decrease detection of cervical precancer and increase risk of cervical cancer even in women undergoing state-of-the-art screening. Methods We conducted a retrospective cohort study of 944,227 women age 30 to 64 years who underwent cytology and human papillomavirus DNA testing (ie, cotesting) at Kaiser Permanente Northern California (January 2003 to December 2015). Body mass index was categorized as normal/underweight (< 25 kg/m 2 ), overweight (25 to < 30 kg/m 2 ), or obese (≥ 30 kg/m 2 ). We estimated 5-year cumulative risks of cervical precancer and cancer by category of body mass index using logistic Weibull survival models. Results We observed lower risk of cervical precancer (n = 4,489) and higher risk of cervical cancer (n = 490) with increasing body mass index. Specifically, obese women had the lowest 5-year risk of precancer (0.51%; 95% CI, 0.48% to 0.54% v 0.73%; 95% CI, 0.70% to 0.76% in normal/underweight women; P trend < .001). In contrast, obese women had the highest 5-year risk of cancer (0.083%; 95% CI, 0.072% to 0.096% v 0.056%; 95% CI, 0.048% to 0.066% in normal/underweight women; P trend < .001). Results were consistent in subgroups defined by age (30 to 49 v 50 to 64 years), human papillomavirus status (positive v negative), and histologic subtype (glandular v squamous). Approximately 20% of cervical cancers could be attributed to overweight or obesity in the women in our study who underwent routine cervical screening. Conclusion In this large, screened population, overweight and obese women had an increased risk of cervical cancer, likely because of underdiagnosis of cervical precancer. Improvements in equipment and/or technique to assure adequate sampling and visualization of women with elevated body mass might reduce cervical cancer incidence.

Pulse wave velocity and augmentation index are not independently associated with carotid atherosclerosis in patients with rheumatoid arthritis.

PubMed

Robustillo-Villarino, M; Alegre-Sancho, J J; Rodilla-Sala, E; Corrales, A; Llorca, J; Gonzalez-Gay, M A; Dessein, P H

2017-11-01

Arterial stiffness can enhance cardiovascular risk by increasing atherogenesis or adverse hemodynamic effects. We examined whether the arterial stiffness markers of aortic pulse wave velocity (PWV) and the augmentation index (AIx) are independently associated with carotid artery intima-media thickness (IMT) and plaque in patients with rheumatoid arthritis (RA). PWV and AIx were determined by brachial oscillometry using the Mobil-O-Graph® system and carotid IMT and plaque by ultrasound in 194 consecutive RA patients without established cardiovascular disease, chronic kidney disease, and diabetes at disease onset. In crude analysis, PWV was associated with IMT (β (95% CI) = 0.04 (0.03 to 0.05), p value < 0.0001) and plaque (OR (95% CI) = 1.69 (1.40 to 2.04), p value < 0.0001). Upon adjustment for the confounders of age, sex, mean blood pressure, body height, and cardiovascular risk factors comprising smoking, the atherogenic index, and diabetes, PWV was not related to IMT (β (95% CI) = 0.01 (-0.02 to 0.04), p value = 0.5) or plaque (OR (95% CI) = 0.99 (0.96 to 1.01), p value = 0.3). AIx was not associated with IMT in crude (β (95% CI) = -0.002 (-0.004 to 0.007), p value = 0.2) and adjusted analyses (β (95% CI) = -0.002 (-0.004 to 0.000), p value = 0.06). AIx was also unrelated to carotid plaque in crude (OR (95% CI) = 1.04 (0.60 to 1.82), p value = 0.9) and adjusted analyses (OR (95% CI) = 0.97 (0.94 to 1.01), p value = 0.1). PWV and AIx are not independently associated with subclinical carotid atherosclerosis in RA.

Heritability and familial aggregation of diverticular disease: a population-based study of twins and siblings.

PubMed

Strate, Lisa L; Erichsen, Rune; Baron, John A; Mortensen, Jakob; Pedersen, Jacob Krabbe; Riis, Anders H; Christensen, Kaare; Sørensen, Henrik Toft

2013-04-01

Little is known about the role of heritable factors in diverticular disease. We evaluated the contribution of heritable factors to the development of diverticular disease diagnosed at a hospitalization or outpatient visit. Using nationwide patient registries, we identified 142,123 incident cases of diverticular disease diagnosed at a hospitalization (1977-2011) or an outpatient hospital visit (1995-2011) in Denmark, including cases in 10,420 index siblings and 923 twins. We calculated standardized incidence ratios for siblings versus the general population and concordance rates for monozygotic versus dizygotic twin pairs as measures of relative risk (RR). The RR for diverticular disease in siblings of index cases was 2.92 (95% confidence interval [CI], 2.50-3.39) compared with the general population. The RRs were similar irrespective of the sex of the sibling or index case and were particularly strong in siblings of hospitalized cases and cases that underwent surgery. The proband-wise concordance rate for monozygotic twins was double that of dizygotic twins (0.16 [95% CI, 0.11-0.22] vs 0.07 [95% CI, 0.05-0.11], respectively). The RR of diverticular disease in one twin when the other had diverticular disease was 14.5 (95% CI, 8.9-23) for monozygotic twins compared with 5.5 (95% CI, 3.3-8.6) for dizygotic twins. Associations were stronger in female monozygotic twins compared with male twins (tetrachoric correlation, 0.60 [95% CI, 0.49-0.70] vs 0.33 [95% CI, 0.13-0.51]; P = .03 in an analysis stratified by sex and zygosity). We estimate that 53% (95% CI, 45%-61%) of susceptibility to diverticular disease results from genetic factors. Based on a population-based study in Denmark, genetic factors appear to contribute to development of diverticular disease. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

Effects of metronidazole combined probiotics over metronidazole alone for the treatment of bacterial vaginosis: a meta-analysis of randomized clinical trials.

PubMed

Tan, Hongying; Fu, Yunque; Yang, Chunlin; Ma, Jianting

2017-06-01

To evaluate the curative effect of metronidazole combined probiotics over metronidazole alone in the treatment of BV. We are searching randomized controlled trials on major online databases including PubMed, Science Direct, and Cochrane Database between 1990 and 2015. The primary outcome measure was the cure rate of BV. Cochran's Chi-square test (Q test) was used to test for heterogeneity among trials, and the I 2 index. We used mixed-effects modeling for parameters of the summary hazard ratios (HRs), odds ratios (ORs), and their 95% confidence intervals (CIs). Analysis suggests the cure rate of BV [RR = 1.12, 95% CI (0.94-1.32), p = 0.20], and the I 2 index was 83%. The value of I 2 index decreased to 16% after removing the study of Anukam et al., and Amsel 1.04 (95% CI 0.96-1.13) (p = 0.35), Nugent 1.02 (95% CI 0.94-1.11), short-term 1.01 (95% CI 0.93-1.10) (p = 0.79), long-term 1.06 (95% CI 0.98-1.14) (p = 0.13), Europe 1.06 (95% CI 0.95-1.19) (p = 0.32), Non-Europe 0.99 (95% CI 0.94-1.05) (p = 0.83). When the two same groups data were combined, respectively, the RRs for all studies were the same as 1.03 (95% CI 0.96-1.09) (p = 0.42) showing that there is not statistically significant in relevant stratums. The result has showed an overall little significance for the efficacy of metronidazole combined probiotics over metronidazole alone for the treatment of BV. We need more further studies to provide enough evidence to confirm the benefits of probiotics in the treatment of BV.

Nomogram-based prediction of survival in patients with advanced oesophagogastric adenocarcinoma receiving first-line chemotherapy: a multicenter prospective study in the era of trastuzumab.

PubMed

Custodio, A; Carmona-Bayonas, A; Jiménez-Fonseca, P; Sánchez, M L; Viudez, A; Hernández, R; Cano, J M; Echavarria, I; Pericay, C; Mangas, M; Visa, L; Buxo, E; García, T; Rodríguez Palomo, A; Álvarez Manceñido, F; Lacalle, A; Macias, I; Azkarate, A; Ramchandani, A; Fernández Montes, A; López, C; Longo, F; Sánchez Bayona, R; Limón, M L; Díaz-Serrano, A; Hurtado, A; Madero, R; Gómez, C; Gallego, J

2017-06-06

To develop and validate a nomogram and web-based calculator to predict overall survival (OS) in Caucasian-advanced oesophagogastric adenocarcinoma (AOA) patients undergoing first-line combination chemotherapy. Nine hundred twenty-four AOA patients treated at 28 Spanish teaching hospitals from January 2008 to September 2014 were used as derivation cohort. The result of an adjusted-Cox proportional hazards regression was represented as a nomogram and web-based calculator. The model was validated in 502 prospectively recruited patients treated between October 2014 and December 2016. Harrell's c-index was used to evaluate discrimination. The nomogram includes seven predictors associated with OS: HER2-positive tumours treated with trastuzumab, Eastern Cooperative Oncology Group performance status, number of metastatic sites, bone metastases, ascites, histological grade, and neutrophil-to-lymphocyte ratio. Median OS was 5.8 (95% confidence interval (CI), 4.5-6.6), 9.4 (95% CI, 8.5-10.6), and 14 months (95% CI, 11.8-16) for high-, intermediate-, and low-risk groups, respectively (P<0.001), in the derivation set and 4.6 (95% CI, 3.3-8.1), 12.7 (95% CI, 11.3-14.3), and 18.3 months (95% CI, 14.6-24.2) for high-, intermediate-, and low-risk groups, respectively (P<0.001), in the validation set. The nomogram is well-calibrated and reveals acceptable discriminatory capacity, with optimism-corrected c-indices of 0.618 (95% CI, 0.591-0.631) and 0.673 (95% CI, 0.636-0.709) in derivation and validation groups, respectively. The AGAMENON nomogram outperformed the Royal Marsden Hospital (c-index=0.583; P=0.00046) and Japan Clinical Oncology Group prognostic indices (c-index=0.611; P=0.03351). We developed and validated a straightforward model to predict survival in Caucasian AOA patients initiating first-line polychemotherapy. This model can contribute to inform clinical decision-making and optimise clinical trial design.

Cigarettes and suicide: a prospective study of 50,000 men.

PubMed Central

Miller, M; Hemenway, D; Rimm, E

2000-01-01

OBJECTIVES: This study examined the relation between smoking and suicide, controlling for various confounders. METHODS: More than 50,000 predominantly White, middle-aged and elderly male health professionals were followed up prospectively with biennial questionnaires from 1986 through 1994. The primary end point was suicide. Characteristics controlled for included age, marital status, body mass index, physical activity, alcohol intake, coffee consumption, and history of cancer. RESULTS: Eighty-two members of the cohort committed suicide during the 8-year follow-up period. In age-adjusted analyses with never smokers as the comparison group, the relative risk of suicide was 1.4 (95% confidence interval [CI] = 0.8, 2.3) among former smokers, 2.6 (95% CI = 0.9, 7.5) for light smokers (< 15 cigarettes/day), and 4.5 (95% CI = 2.3, 8.8) among heavier smokers. After adjustment for potential confounders, the relative risks were 1.4 (95% CI = 0.9, 2.4), 2.5 (95% CI = 0.9, 7.3), and 4.3 (95% CI = 2.2, 8.5), respectively. CONCLUSION: We found a positive, dose-related association between smoking and suicide among White men. Although inference about causality is not justified, our findings indicate that the smoking-suicide connection is not entirely due to the greater tendency among smokers to be unmarried, to be sedentary, to drink heavily, or to develop cancers. PMID:10800427

Association between telomere length and diabetes mellitus: A meta-analysis.

PubMed

Wang, Jianfei; Dong, Xu; Cao, Li; Sun, Yangyang; Qiu, Yu; Zhang, Yi; Cao, Ruoqiong; Covasa, Mihai; Zhong, Li

2016-12-01

Objective We investigated the relationship between diabetes and telomere length by meta-analysis. Methods We searched five popular databases for articles published between 1990 and 2015 using "diabetes" and "telomere" as search terms. Data were processed with RevMan5, and random- or fixed-effects meta-analysis was applied. The effects of geographical region, diabetes type, body mass index (BMI), age and sex were examined. Funnel plots were applied to evaluate publication bias. Results Seventeen articles were obtained from 571 references. We identified a significant association between telomere length and diabetes mellitus (standardized mean difference [SMD]: -3.41; 95% confidence interval [CI]: -4.01, -2.80; heterogeneity, I 2  = 99%) by comparing 5575 patients with diabetes and 6349 healthy individuals. The pooled SMD by geographic region indicated a significant association between shortened telomere length and diabetes mellitus (SMD: -3.41; 95% CI: -4.01, -2.80; heterogeneity, I 2  = 99%). In addition, telomere length was significantly associated with age (SMD: -3.41; 95% CI: -4.01, -2.80), diabetes type (SMD: -3.41; 95% CI: -4.01, -2.80), BMI (SMD: -1.61; 95% CI: -1.98, -1.23) and sex (SMD: -4.94; 95% CI: -9.47, -0.40). Conclusions The study demonstrated a close relationship between diabetes mellitus and telomere length, which was influenced by region, age, diabetes type, BMI and sex.

A comprehensive classification method for VOC emission sources to tackle air pollution based on VOC species reactivity and emission amounts.

PubMed

Li, Guohao; Wei, Wei; Shao, Xia; Nie, Lei; Wang, Hailin; Yan, Xiao; Zhang, Rui

2018-05-01

In China, volatile organic compound (VOC) control directives have been continuously released and implemented for important sources and regions to tackle air pollution. The corresponding control requirements were based on VOC emission amounts (EA), but never considered the significant differentiation of VOC species in terms of atmospheric chemical reactivity. This will adversely influence the effect of VOC reduction on air quality improvement. Therefore, this study attempted to develop a comprehensive classification method for typical VOC sources in the Beijing-Tianjin-Hebei region (BTH), by combining the VOC emission amounts with the chemical reactivities of VOC species. Firstly, we obtained the VOC chemical profiles by measuring 5 key sources in the BTH region and referencing another 10 key sources, and estimated the ozone formation potential (OFP) per ton VOC emission for these sources by using the maximum incremental reactivity (MIR) index as the characteristic of source reactivity (SR). Then, we applied the data normalization method to respectively convert EA and SR to normalized EA (NEA) and normalized SR (NSR) for various sources in the BTH region. Finally, the control index (CI) was calculated, and these sources were further classified into four grades based on the normalized CI (NCI). The study results showed that in the BTH region, furniture coating, automobile coating, and road vehicles are characterized by high NCI and need to be given more attention; however, the petro-chemical industry, which was designated as an important control source by air quality managers, has a lower NCI. Copyright © 2017. Published by Elsevier B.V.

History of oral contraceptive use and risk of spontaneous abortion

PubMed Central

Hahn, Kristen A.; Hatch, Elizabeth E.; Rothman, Kenneth J.; Mikkelsen, Ellen M.; Brogly, Susan B.; Sørensen, Henrik T.; Riis, Anders H.; Wise, Lauren A.

2015-01-01

Purpose To examine the association between pregravid oral contraceptive (OC) use and spontaneous abortion (SAB). Methods In an Internet-based preconception cohort study of 4,862 Danish pregnancy planners, we used Cox proportional hazards models to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the association between OC use and SAB. We controlled for maternal age, physical activity, parity, education, alcohol and caffeine consumption, body mass index, and smoking. Results Compared with women who discontinued OCs >1 year before conception, HRs were 0.95 (95% CI: 0.77, 1.17), 0.99 (95% CI: 0.82, 1.19), and 0.80 (95% CI: 0.60, 1.06) for women who discontinued OCs 7-12, 2-6, and 0-1 months before conception, respectively. Compared with <4 years of OC use, HRs for 4-7, 8-11, and ≥12 years of OC use were 1.05 (95% CI: 0.80, 1.37), 0.92 (95% CI: 0.71, 1.19), and 0.88 (95% CI: 0.65, 1.19), respectively. Dose of estrogen and generation of progestin were not materially associated with SAB risk. Conclusions We found no evidence that pregravid OC use is associated with an increase in SAB. Use within one month of conception was associated with a slightly lower risk of SAB, but this may be due to increased reproductive fitness in women who conceive quickly after discontinuation of OCs. PMID:26452607

Body composition of children with cancer during treatment and in survivorship.

PubMed

Murphy, Alexia J; White, Melinda; Elliott, Sarah A; Lockwood, Liane; Hallahan, Andrew; Davies, Peter Sw

2015-10-01

Malnutrition as assessed with the use of body-composition measurements is a poorly understood short- and long-term complication of childhood cancer. We aimed to evaluate the body composition of 2 childhood cancer cohorts as follows: 1) children currently undergoing cancer treatment and 2) childhood cancer survivors. We also aimed to compare the prevalence of obesity and undernutrition between the cancer groups and investigate the impact of cancer type on body composition. Eighty-two children during the treatment of cancer and 53 childhood cancer survivors were involved in the study. Height, weight, body cell mass, percentage of fat, fat mass index, and fat-free mass index were assessed. Subjects were compared with age- and sex-matched healthy controls. The on-treatment group had a higher percentage of fat (P = 0.0001) and fat mass index (P = 0.0001) and a significantly lower body cell mass index (P = 0.0001) and fat-free mass index (P = 0.003) than did matched controls. The survivor group had a significantly higher percentage of fat (P = 0.03) and fat mass index (P = 0.04) and significantly lower body cell mass index (P = 0.0001) than did matched controls. The prevalence of undernutrition was high in both groups with 48% (95% CI: 36%, 60%) of the on-treatment group and 53% (95% CI: 40%, 66%) of the survivors considered undernourished. According to the percentage of fat cutoffs, significantly more on-treatment patients were obese (55%; 95% CI: 40%, 60%) than were survivors (26%; 95% CI: 14%, 38%) (P = 0.005). There were no statistically significant differences in body composition between cancer types in either the on-treatment or the survivor group. Overnutrition and undernutrition are major concerns in the short and long term for children with cancer. Children treated for cancer have increased fat mass and decreased body cell mass, which are evident during treatment and in survivorship. This trial was registered at http://www.ANZCTR.org.au as ACTRN12614001279617 and ACTRN12614001269628. © 2015 American Society for Nutrition.

The Renal Arterial Resistance Index Predicts Worsening Renal Function in Chronic Heart Failure Patients

PubMed Central

Iacoviello, Massimo; Monitillo, Francesco; Leone, Marta; Citarelli, Gaetano; Doronzo, Annalisa; Antoncecchi, Valeria; Puzzovivo, Agata; Rizzo, Caterina; Lattarulo, Maria Silvia; Massari, Francesco; Caldarola, Pasquale; Ciccone, Marco Matteo

2016-01-01

Background/Aim The renal arterial resistance index (RRI) is a Doppler measure, which reflects abnormalities in the renal blood flow. The aim of this study was to verify the value of RRI as a predictor of worsening renal function (WRF) in a group of chronic heart failure (CHF) outpatients. Methods We enrolled 266 patients in stable clinical conditions and on conventional therapy. Peak systolic velocity and end diastolic velocity of a segmental renal artery were obtained by pulsed Doppler flow, and RRI was calculated. Creatinine serum levels were evaluated at baseline and at 1 year, and the changes were used to assess WRF occurrence. Results During follow-up, 34 (13%) patients showed WRF. RRI was associated with WRF at univariate (OR: 1.13; 95% CI: 1.07–1.20) as well as at a forward stepwise multivariate logistic regression analysis (OR: 1.09; 95% CI: 1.03–1.16; p = 0.005) including the other univariate predictors. Conclusions Quantification of arterial renal perfusion provides a new parameter that independently predicts the WRF in CHF outpatients. Its possible role in current clinical practice to better define the risk of cardiorenal syndrome progression is strengthened. PMID:27994601

Dietary Inflammatory Index and risk of esophageal squamous cell cancer in a case-control study from Iran

PubMed Central

Shivappa, Nitin; Hébert, James R.; Rashidkhani, Bahram

2015-01-01

Background Diet and inflammation have been suggested to be important risk factors for esophageal squamous cell carcinoma (ESCC). In this study, we examined the ability of the dietary inflammatory index (DII) to predict ESCC in a case-control study conducted in Iran. Methods This study included 47 ESCC cases and 96 controls hospitalized for acute non-neoplastic diseases. The DII was computed based on dietary intake assessed by a previously validated food frequency questionnaire. Logistic regression models were used to estimate odds ratios (ORs) adjusted for age, energy, sex, BMI, years of education, physical activity, smoking and gastro-esophageal reflux. Results Subjects with higher DII scores (i.e., with a more pro-inflammatory diet) had a higher risk of ESCC, with the DII being used as both a continuous variable (ORcontinuous 3.58, 95% confidence interval, CI, 1.76–7.26; one unit increase corresponding to ≈16% of its range in the current study) and a categorical variable (ORdii>1.20 vs ≤ 1.208.24, 95%CI 2.03–33.47). Conclusion These results indicate that a pro-inflammatory diet is associated with increased risk of ESCC. PMID:26400625

Efficacy, acceptability and tolerability of the combined contraceptive ring, NuvaRing, compared with an oral contraceptive containing 30 microg of ethinyl estradiol and 3 mg of drospirenone.

PubMed

Ahrendt, Hans-Joachim; Nisand, Israel; Bastianelli, Carlo; Gómez, Maria Angeles; Gemzell-Danielsson, Kristina; Urdl, Wolfgang; Karskov, Birgit; Oeyen, Luc; Bitzer, Johannes; Page, Geert; Milsom, Ian

2006-12-01

This randomized multicenter, open-label, trial compared efficacy, acceptability, tolerability and compliance of NuvaRing with a combined oral contraceptive (COC), containing 30 microg of ethinyl estradiol (EE) and 3 mg of drospirenone. In this 13-cycle study, 983 women were randomized and treated (intent-to-treat population) with NuvaRing or COC. One in-treatment pregnancy occurred with NuvaRing (Pearl Index=0.25) (95% confidence interval [CI]: 0.006, 1.363) and four with the COC (Pearl Index=0.99) (95% CI: 0.269, 2.530). For both groups, compliance (89.2% NuvaRing, 85.5% COC) and satisfaction (84% NuvaRing; 87% COC) were high; the vast majority of women found NuvaRing easy to insert (96%) and remove (97%). Tolerability was similar; the most frequent adverse events with NuvaRing were related to ring use, whereas estrogen-related events were more common with the COC. NuvaRing has comparable efficacy and tolerability to a COC containing 30 microg of EE and 3 mg drospirenone. User acceptability of both methods was high.

History and mobility exam index to identify community-dwelling elderly persons at risk of falling.

PubMed

Covinsky, K E; Kahana, E; Kahana, B; Kercher, K; Schumacher, J G; Justice, A C

2001-04-01

Falls are common in community-dwelling elderly persons and are a frequent source of morbidity. Simple indices to prospectively stratify people into categories at different fall-risk would be useful to health care practitioners. Our goal was to develop a fall-risk index that discriminated between people at high and low risk of falling. We evaluated the risk of falling over a one-year period in 557 elderly persons (mean age 81.6) living in a retirement community. On the baseline interview, we asked subjects if they had fallen in the previous year and evaluated risk factors in six additional conceptual categories. On the follow-up interview one year later, we again asked subjects if they had fallen in the prior year. We evaluated risk factors in the different conceptual categories and used logistic regression to determine the independent predictors of falling over a one-year period. We used these independent predictors to create a fall-risk index. We compared the ability of a prior falls history with other risk factors and with the combination of a falls history and other risk factors to discriminate fallers from nonfallers. A fall in the previous year (OR = 2.42, 95% CI = 1.49-3.93), a symptom of either balance difficulty or dizziness (OR = 1.83, 95% CI = 1.16-2.89), or an abnormal mobility exam (OR = 2.64, 95% CI = 1.64-4.26) were independent predictors of falling over the subsequent year. These three risk factors together (c statistic =.71) discriminated fallers from nonfallers better than previous history of falls alone (c statistic =.61) or the symptomatic and exam risk factors alone (c statistic =.68). When combined into a risk index, the three independent risk factors stratify people into groups whose risk for falling over the subsequent year ranges from 10% to 51%. A history of falling over the prior year, a risk factor that can be obtained from a clinical history (balance difficulty or dizziness), and a risk factor that can be obtained from a physical exam (mobility difficulty) stratify people into groups at low and high risk of falling over the subsequent year. This risk index may provide a simple method of assessing fall risk in community-dwelling elderly persons. However, it requires validation in other subjects before it can be recommended for widespread use.

Accuracy of physical examination for chronic lumbar radiculopathy

PubMed Central

2013-01-01

Background Clinical examination of patients with chronic lumbar radiculopathy aims to clarify whether there is nerve root impingement. The aims of this study were to investigate the association between findings at clinical examination and nerve root impingement, to evaluate the accuracy of clinical index tests in a specialised care setting, and to see whether imaging clarifies the cause of chronic radicular pain. Methods A total of 116 patients referred with symptoms of lumbar radiculopathy lasting more than 12 weeks and at least one positive index test were included. The tests were the straight leg raising test, and tests for motor muscle strength, dermatome sensory loss, and reflex impairment. Magnetic resonance imaging (n = 109) or computer tomography (n = 7) were imaging reference standards. Images were analysed at the level of single nerve root(s), and nerve root impingement was classified as present or absent. Sensitivities, specificities, and positive and negative likelihood ratios (LR) for detection of nerve root impingement were calculated for each individual index test. An overall clinical evaluation, concluding on the level and side of the radiculopathy, was performed. Results The prevalence of disc herniation was 77.8%. The diagnostic accuracy of individual index tests was low with no tests reaching positive LR >4.0 or negative LR <0.4. The overall clinical evaluation was slightly more accurate, with a positive LR of 6.28 (95% CI 1.06–37.21) for L4, 1.74 (95% CI 1.04–2.93) for L5, and 1.29 (95% CI 0.97–1.72) for S1 nerve root impingement. An overall clinical evaluation, concluding on the level and side of the radiculopathy was also performed, and receiver operating characteristic (ROC) analysis with area under the curve (AUC) calculation for diagnostic accuracy of this evaluation was performed. Conclusions The accuracy of individual clinical index tests used to predict imaging findings of nerve root impingement in patients with chronic lumbar radiculopathy is low when applied in specialised care, but clinicians’ overall evaluation improves diagnostic accuracy slightly. The tests are not very helpful in clarifying the cause of radicular pain, and are therefore inaccurate for guidance in the diagnostic workup of the patients. The study population was highly selected and therefore the results from this study should not be generalised to unselected patient populations in primary care nor to even more selected surgical populations. PMID:23837886

Gendermetrics of cancer research: results from a global analysis on lung cancer.

PubMed

Bendels, Michael H K; Brüggmann, Dörthe; Schöffel, Norman; Groneberg, David A

2017-11-24

Cancer research is critically dependent on a continuous recruitment of junior research staff that devotes its academic life not only to clinical duties but also to basic and translational research. The present study aims to elucidate the success concerning gender equality in cancer research in the last decade (from 2008 to 2016) with lung cancer as the target parameter. On the basis of the Gendermetrics Platform, a total of 19,724 articles related to lung cancer research were analyzed. The key method was the combined analysis of the proportion of female authorships and the female-to-male odds ratio for first, co- and last authorships. The distribution of prestigious authorships was measured by the Prestige Index. 31.3% of all authorships and 35.2% of the first, 32.2% of the co- and 22.1% of the last authorships were held by women. The corresponding female-to-male odds ratio is 1.22 (CI: 1.18-1.27) for first, 1.19 (CI: 1.16-1.23) for co- and 0.59 (CI: 0.57-0.61) for last authorships. Women are underrepresented at prestigious authorships compared to men (Prestige Index = -0.22). The female underrepresentation accentuates in articles with many authors that attract the highest citation rates. While the current system promotes early career promotion of women, men still outnumber women in leadership positions. However, this male-female career dichotomy has been narrowed in the last decade and will likely be further reduced in the next decade.

Pre-eclampsia in American Indians/Alaska Natives and Whites: The Significance of Body Mass Index.

PubMed

Zamora-Kapoor, Anna; Nelson, Lonnie A; Buchwald, Dedra S; Walker, Leslie R; Mueller, Beth A

2016-11-01

Introduction The prevalence of pre-eclampsia, a major cause of maternal morbidity, varies by race, being greater in African Americans, and lower in Asians and Hispanics than in White women. Little is known about its prevalence in American Indians/Alaska Natives (AI/ANs). We estimated pre-eclampsia risk in AI/ANs compared to Whites, with consideration of the potential effect of obesity, a major risk factor for pre-eclampsia, and a condition disproportionately affecting AI/AN women. Methods This retrospective cohort study of linked birth-hospital discharge data from Washington State (2003-2013) included all AI/AN women and a sample of White first-time mothers with singleton deliveries. Logistic regression was used to estimate odds ratio (OR) and 95 % confidence intervals (CI) for pre-eclampsia risk in AI/ANs compared to Whites, first controlling for several important risk factors, and subsequently with additional adjustment for pre-pregnancy body mass index (BMI). Results AI/ANs had an increased risk of pre-eclampsia compared to Whites after controlling for all covariates except BMI (OR 1.17, 95 % CI 1.06-1.29). After further adjustment for BMI, the racial disparity in pre-eclampsia risk was greatly attenuated (OR 1.05, 95 % CI 0.95-1.16). Discussion This population-based study suggests that any increased risk in AI/ANs relative to Whites may be at least partly due to differences in BMI.

The Joint Effects of Lifestyle Factors and Comorbidities on the Risk of Colorectal Cancer: A Large Chinese Retrospective Case-Control Study

PubMed Central

Hu, Hai; Zhou, Yangyang; Ren, Shujuan; Wu, Jiajin; Zhu, Meiying; Chen, Donghui; Yang, Haiyan; Wang, Liwei

2015-01-01

Background Colorectal cancer (CRC) is a major cause of cancer morbidity and mortality. In previous epidemiologic studies, the respective correlation between lifestyle factors and comorbidity and CRC has been extensively studied. However, little is known about their joint effects on CRC. Methods We conducted a retrospective case-control study of 1,144 diagnosed CRC patients and 60,549 community controls. A structured questionnaire was administered to the participants about their socio-demographic factors, anthropometric measures, comorbidity history and lifestyle factors. Logistic regression model was used to calculate the odds ratio (ORs) and 95% confidence intervals (95%CIs) for each factor. According to the results from logistic regression model, we further developed healthy lifestyle index (HLI) and comorbidity history index (CHI) to investigate their independent and joint effects on CRC risk. Results Four lifestyle factors (including physical activities, sleep, red meat and vegetable consumption) and four types of comorbidity (including diabetes, hyperlipidemia, history of inflammatory bowel disease and polyps) were found to be independently associated with the risk of CRC in multivariant logistic regression model. Intriguingly, their combined pattern- HLI and CHI demonstrated significant correlation with CRC risk independently (ORHLI: 3.91, 95%CI: 3.13–4.88; ORCHI: 2.49, 95%CI: 2.11–2.93) and jointly (OR: 10.33, 95%CI: 6.59–16.18). Conclusions There are synergistic effects of lifestyle factors and comorbidity on the risk of colorectal cancer in the Chinese population. PMID:26710070

Pre-eclampsia in American Indians/Alaska Natives and Whites: The Significance of Body Mass Index

PubMed Central

Nelson, Lonnie A.; Buchwald, Dedra S.; Walker, Leslie R.; Mueller, Beth A.

2016-01-01

Introduction The prevalence of pre-eclampsia, a major cause of maternal morbidity, varies by race, being greater in African Americans, and lower in Asians and Hispanics than in White women. Little is known about its prevalence in American Indians/Alaska Natives (AI/ANs). We estimated pre-eclampsia risk in AI/ANs compared to Whites, with consideration of the potential effect of obesity, a major risk factor for pre-eclampsia, and a condition disproportionately affecting AI/AN women. Methods This retrospective cohort study of linked birth-hospital discharge data from Washington State (2003–2013) included all AI/AN women and a sample of White first-time mothers with singleton deliveries. Logistic regression was used to estimate odds ratio (OR) and 95 % confidence intervals (CI) for pre-eclampsia risk in AI/ANs compared to Whites, first controlling for several important risk factors, and subsequently with additional adjustment for pre-pregnancy body mass index (BMI). Results AI/ANs had an increased risk of pre-eclampsia compared to Whites after controlling for all covariates except BMI (OR 1.17, 95 % CI 1.06–1.29). After further adjustment for BMI, the racial disparity in pre-eclampsia risk was greatly attenuated (OR 1.05, 95 % CI 0.95–1.16). Discussion This population-based study suggests that any increased risk in AI/ANs relative to Whites may be at least partly due to differences in BMI. PMID:27461024

Characteristics of pertussis outbreaks in Catalonia, Spain, 1997 to 2010.

PubMed

Crespo, Inma; Broner, Sonia; Soldevila, Núria; Martínez, Ana; Godoy, Pere; Sala-Farré, Maria-Rosa; Company, Maria; Rius, Cristina; Domínguez, Angela; Group Of Catalonia, The Pertussis Working

2015-01-01

In Catalonia, pertussis outbreaks must be reported to the Department of Health. This study analyzed pertussis outbreaks between 1997 and 2010 in general and according to the characteristics of the index cases. The outbreak rate, hospitalization rate and incidence of associated cases and their 95%CI were calculated. Index cases were classified in two groups according to age (<15 years and ≥15 years) and the vaccine type received: whole cell vaccine (DTwP) or acellular vaccine (DTaP). During the study period, 230 outbreaks were reported. The outbreak rate was 2.43 × 10(-6) persons-year, and outbreaks ranged from 2 to 32 cases, with a median duration of 18 days. There were 771 associated cases, with an incidence rate of 0.8 × 10(-5) persons-year.   After classifying outbreaks according to the age of the index case, 126 outbreaks (1.3 × 10(-6) persons-year) had an index case aged <15 y and 87 (0.87 × 10(-6) person-year) had an index case aged ≥15 y (RR = 1.44, 95%CI 1.10-1.90; P = 0.007). Between 2003 and 2010, after the introduction of the acellular vaccine, the index case was vaccinated with DTwP vaccine in 25 outbreaks (0.43 × 10(-6) persons-year) and with DTaP vaccine in 32 outbreaks (0.55 × 10(-6) person-year) (RR = 0.78, 95%CI 0.46-1.31; P = 0.35). Of cases, 37.2% were correctly vaccinated, suggesting waning immunity of pertussis vaccine protection and endogenous circulation of pertussis. A greater number of outbreaks had an index case aged <15 y. No changes in the disease incidence, associated cases and hospitalization rate were observed after the introduction of DTaP.

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.

The impact of urbanization on the community food environment in China.

PubMed

Wu, Yang; Xue, Hong; Wang, Huijun; Su, Chang; Du, Shufa; Wang, Youfa

2017-05-01

Research on how urbanization has influenced the food environment in China is limited. The study aimed to examine the impact of urbanization on the food environment in China. Longitudinal data collected during 1989-2009 from the China Health and Nutrition Survey were used, which covered 9 provinces in China. Urbanicity index (0-10) was assessed using an urbanicity scale. Final analyses included 216 communities. Random-effect models were used in analyses. Urbanization (higher urbanicity index) increased the odds of having fast food restaurants (OR=2.78, 95% CI: 2.18-3.54) and other indoor restaurants (OR=2.93, 95% CI: 2.28-3.76) within the community, the odds of having supermarkets (OR=2.43, 95% CI: 2.04-2.89) and free markets (OR=2.56, 95% CI: 1.77-3.70) within 30 minutes' bus ride from the community. Food prices for apples (β=0.06, 95% CI: 0.04-0.08) and lean pork (β =0.02, 95% CI: 0.01-0.03) increased with urbanicity, while prices for other food did not. Urbanicity was positively associated with community norms for fast food consumption (RR=1.28, 95% CI: 1.22-1.33), fast food preferences (RR=1.09, 95% CI: 1.06-1.12) and nutrition knowledge (RR=1.02, 95% CI: 1.01-1.03). Urbanization is associated with food environment in China. The findings provide insight for future economic development and public health efforts related to urbanization.

Hematopoietic cell transplantation comorbidity index (HCT-CI) is predictive of adverse events and overall survival in older allogeneic transplant recipients.

PubMed

Keller, Jesse W; Andreadis, Charalambos; Damon, Lloyd E; Kaplan, Lawrence D; Martin, Thomas G; Wolf, Jeffrey L; Ai, Weiyun Z; Venstrom, Jeffrey M; Smith, Catherine C; Gaensler, Karin M L; Hwang, Jimmy; Olin, Rebecca L

2014-07-01

Our goal was to evaluate the ability of the hematopoietic cell transplantation comorbidity index (HCT-CI) to predict outcomes after allogeneic stem cell transplant (SCT) within the context of an older patient population, where multiple comorbidities are common. We performed a retrospective cohort study of SCT patients ≥50years of age at our institution, identifying 59 patients with complete HCT-CI data collected prospectively. HCT-CI category distribution in our sample was disproportionate, with almost half of patients having scores ≥3. High HCT-CI score (≥3 vs <3) was associated with significantly inferior OS (median OS not reached for HCT-CI <3 vs 14months for HCT-CI ≥3; hazard ratio (HR) 2.2, p=0.02). HCT-CI score was a better predictor of OS than age, performance status or conditioning intensity. When adjusted for disease relapse risk, HCT-CI score conferred a worse prognosis in the low risk group (HR 1.43, p=0.03) but not in the intermediate/high risk group (HR 1.08, p=0.65). NRM was low in the total sample (6% at one year) and was not associated with HCT-CI score. Grade 3-4 non-hematologic adverse events within the first 100days after SCT were significantly more common in the higher HCT-CI groups (p=0.02). In our older patient cohort with a high incidence of multiple comorbidities, HCT-CI score ≥3 was significantly associated with OS, particularly in the subset of patients with a low disease relapse risk. Copyright © 2014 Elsevier Inc. All rights reserved.

Tire-breeding mosquitoes of public health importance along an urbanisation gradient in Buenos Aires, Argentina.

PubMed

Rubio, Alejandra; Cardo, María Victoria; Vezzani, Darío

2011-09-01

Used vehicle tires are a source of mosquito vectors and a means of their introduction and expansion. With the aim of assessing the effects of urbanisation on the main mosquito vectors in temperate Argentina, the infestation levels of Aedes aegypti (L.) and Culex pipiens L. were studied in used tires from highly urbanised cities to low-urbanised small towns in Buenos Aires. Immatures of both species accounted for 96% of the 9,722 individuals collected; the total individuals collected represented seven species. The percentage of water-filled tires containing mosquitoes [container index (CI)] was 33% and the percentage of infested sites [site index (SI)] was 65.2%. These indexes decreased significantly from low to high urbanisation levels for both mosquito species. The relative abundance (RA) of Ae. aegypti immatures was slightly higher toward large cities, but showed no difference for Cx. pipiens. The CI of shaded tires was significantly higher than the CI of exposed tires for both mosquito species. There was no difference in RA values between shaded and sunlit tires. The CI and the SI were highest during the summer across the urbanisation levels, except for Cx. pipiens, which continued to increase during the autumn in small towns. Results related to urbanisation gradient, sunlit exposure and seasonality are discussed.

New scoring system combining the FIB-4 index and cytokeratin-18 fragments for predicting steatohepatitis and liver fibrosis in patients with nonalcoholic fatty liver disease.

PubMed

Tada, Toshifumi; Kumada, Takashi; Toyoda, Hidenori; Saibara, Toshiji; Ono, Masafumi; Kage, Masayoshi

To establish a new scoring system as a noninvasive tool for predicting steatohepatitis and liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). A total of 170 patients histologically diagnosed with nonalcoholic steatohepatitis (NASH) (n = 130) or nonalcoholic fatty liver (NAFL) (n = 40) were enrolled. We analyzed receiver operating characteristic (ROC) curves and performed multivariate analysis to predict steatohepatitis and liver fibrosis. Multivariate analysis showed that cytokeratin-18 fragment (CK18-F) levels (≥278 U/L) (odds ratio [OR], 4.46; 95% confidence interval [CI], 1.42-14.00; p = 0.010) and the FIB-4 index (≥1.46) (OR, 4.54; 95% CI, 1.93-29.50; p = 0.004) were independently associated with prediction of NASH. We then established a new scoring system (named the FIC-22 score) for predicting NASH using CK18-F levels and FIB-4 index. The areas under the ROC curve (AUROCs) of the FIC-22 score and NAFIC score were 0.82 (95% CI, 0.75-0.89) and 0.71 (95% CI, 0.62-0.78) (p = 0.044). Additionally, the AUROC of the FIC-22 score for predicting the presence of fibrosis (F ≥ 1) was 0.78 (95% CI, 0.70-0.85). In patients with NAFLD, the FIC-22 score had high predictive accuracy not only for steatohepatitis but also for the presence of liver fibrosis.

Objective Assessment of Changes in Physical Activity and Sedentary Behavior: Pre-through 3-Years Post- Bariatric Surgery

PubMed Central

King, Wendy C; Chen, Jia-Yuh; Bond, Dale S; Belle, Steven H; Courcoulas, Anita P; Patterson, Emma J; Mitchell, James E; Inabnet, William B; Dakin, George F; Flum, David R; Cook, Brian; Wolfe, Bruce M

2015-01-01

Objective To evaluate change in sedentary behavior (SB) and physical activity (PA) over three years following bariatric surgery. Methods A subset of participants in an observational study (n=473 of 2458; 79% female, median body mass index 45kg/m2) wore an activity monitor pre-surgery and at 1–3 annual post-surgery assessments. Results Over the first year, on average, sedentary time decreased from 573 (95%CI 563–582) to 545 (95%CI 534–555) min/d and moderate-to-vigorous intensity PA (MVPA) increased from 77 (95%CI: 71–84) to 106 (95%CI: 98–116) min/wk, or 7 (95%CI: 5–10) to 24 (95%CI: 18–29) min/wk in MVPA bouts ≥10 minutes. There were no changes in these parameters from years 1 to 3 (P for all>.05). The percentage of participants achieving ≥150 min/wk of bout-related MVPA was not different at year 3 [6.5% (95%CI: 3.1–12.7)] vs. pre-surgery [3.4% (95%CI: 1.8–5.0); p=.45]. Most participants followed SB and PA trajectories that paralleled mean change and were consistent with their pre-surgery position in relation to the group. Conclusions On average, bariatric surgical patients make small reductions in SB and increases in PA during the first post-surgery year, which are maintained through 3 years. Still, post-surgery PA levels fall short of PA guidelines for general health or weight control. PMID:26010326

Revisit rates and associated costs after an emergency department encounter: a multistate analysis.

PubMed

Duseja, Reena; Bardach, Naomi S; Lin, Grace A; Yazdany, Jinoos; Dean, Mitzi L; Clay, Theodore H; Boscardin, W John; Dudley, R Adams

2015-06-02

Return visits to the emergency department (ED) or hospital after an index ED visit strain the health system, but information about rates and determinants of revisits is limited. To describe revisit rates, variation in revisit rates by diagnosis and state, and associated costs. Observational study using the Healthcare Cost and Utilization Project databases. 6 U.S. states. Adults with ED visits between 2006 and 2010. Revisit rates and costs. Within 3 days of an index ED visit, 8.2% of patients had a revisit; 32% of those revisits occurred at a different institution. Revisit rates varied by diagnosis, with skin infections having the highest rate (23.1% [95% CI, 22.3% to 23.9%]). Revisit rates also varied by state. For skin infections, Florida had higher risk-adjusted revisit rates (24.8% [CI, 23.5% to 26.2%]) than Nebraska (10.6% [CI, 9.2% to 12.1%]). In Florida, the only state with complete cost data, total revisit costs for the 19.8% of patients with a revisit within 30 days were 118% of total index ED visit costs for all patients (including those with and without a revisit). Whether a revisit reflects inadequate access to primary care, a planned revisit, the patient's nonadherence to ED recommendations, or poor-quality care at the initial ED visit remains unknown. Revisits after an index ED encounter are more frequent than previously reported, in part because many occur outside the index institution. Among ED patients in Florida, more resources are spent on revisits than on index ED visits. Agency for Healthcare Research and Quality.

The Impact of Pyrethroid Resistance on the Efficacy of Insecticide-Treated Bed Nets against African Anopheline Mosquitoes: Systematic Review and Meta-Analysis

PubMed Central

Strode, Clare; Donegan, Sarah; Garner, Paul; Enayati, Ahmad Ali; Hemingway, Janet

2014-01-01

Background Pyrethroid insecticide-treated bed nets (ITNs) help contribute to reducing malaria deaths in Africa, but their efficacy is threatened by insecticide resistance in some malaria mosquito vectors. We therefore assessed the evidence that resistance is attenuating the effect of ITNs on entomological outcomes. Methods and Findings We included laboratory and field studies of African malaria vectors that measured resistance at the time of the study and used World Health Organization–recommended impregnation regimens. We reported mosquito mortality, blood feeding, induced exophily (premature exit of mosquitoes from the hut), deterrence, time to 50% or 95% knock-down, and percentage knock-down at 60 min. Publications were searched from 1 January 1980 to 31 December 2013 using MEDLINE, Cochrane Central Register of Controlled Trials, Science Citation Index Expanded, Social Sciences Citation Index, African Index Medicus, and CAB Abstracts. We stratified studies into three levels of insecticide resistance, and ITNs were compared with untreated bed nets (UTNs) using the risk difference (RD). Heterogeneity was explored visually and statistically. Included were 36 laboratory and 24 field studies, reported in 25 records. Studies tested and reported resistance inconsistently. Based on the meta-analytic results, the difference in mosquito mortality risk for ITNs compared to UTNs was lower in higher resistance categories. However, mortality risk was significantly higher for ITNs compared to UTNs regardless of resistance. For cone tests: low resistance, risk difference (RD) 0.86 (95% CI 0.72 to 1.01); moderate resistance, RD 0.71 (95% CI 0.53 to 0.88); high resistance, RD 0.56 (95% CI 0.17 to 0.95). For tunnel tests: low resistance, RD 0.74 (95% CI 0.61 to 0.87); moderate resistance, RD 0.50 (95% CI 0.40 to 0.60); high resistance, RD 0.39 (95% CI 0.24 to 0.54). For hut studies: low resistance, RD 0.56 (95% CI 0.43 to 0.68); moderate resistance, RD 0.39 (95% CI 0.16 to 0.61); high resistance, RD 0.35 (95% CI 0.27 to 0.43). However, with the exception of the moderate resistance category for tunnel tests, there was extremely high heterogeneity across studies in each resistance category (chi-squared test, p<0.00001, I 2 varied from 95% to 100%). Conclusions This meta-analysis found that ITNs are more effective than UTNs regardless of resistance. There appears to be a relationship between resistance and the RD for mosquito mortality in laboratory and field studies. However, the substantive heterogeneity in the studies' results and design may mask the true relationship between resistance and the RD, and the results need to be interpreted with caution. Our analysis suggests the potential for cumulative meta-analysis in entomological trials, but further field research in this area will require specialists in the field to work together to improve the quality of trials, and to standardise designs, assessment, and reporting of both resistance and entomological outcomes. Please see later in the article for the Editors' Summary PMID:24642791

A comparison of confidence/credible interval methods for the area under the ROC curve for continuous diagnostic tests with small sample size.

PubMed

Feng, Dai; Cortese, Giuliana; Baumgartner, Richard

2017-12-01

The receiver operating characteristic (ROC) curve is frequently used as a measure of accuracy of continuous markers in diagnostic tests. The area under the ROC curve (AUC) is arguably the most widely used summary index for the ROC curve. Although the small sample size scenario is common in medical tests, a comprehensive study of small sample size properties of various methods for the construction of the confidence/credible interval (CI) for the AUC has been by and large missing in the literature. In this paper, we describe and compare 29 non-parametric and parametric methods for the construction of the CI for the AUC when the number of available observations is small. The methods considered include not only those that have been widely adopted, but also those that have been less frequently mentioned or, to our knowledge, never applied to the AUC context. To compare different methods, we carried out a simulation study with data generated from binormal models with equal and unequal variances and from exponential models with various parameters and with equal and unequal small sample sizes. We found that the larger the true AUC value and the smaller the sample size, the larger the discrepancy among the results of different approaches. When the model is correctly specified, the parametric approaches tend to outperform the non-parametric ones. Moreover, in the non-parametric domain, we found that a method based on the Mann-Whitney statistic is in general superior to the others. We further elucidate potential issues and provide possible solutions to along with general guidance on the CI construction for the AUC when the sample size is small. Finally, we illustrate the utility of different methods through real life examples.

Prognostic value of SUVmax measured by pretreatment 18F-FDG PET/CT in patients with primary gastric lymphoma.

PubMed

Hwang, Jae Pil; Lim, Ilhan; Byun, Byung Hyun; Kim, Byung Il; Choi, Chang Woon; Lim, Sang Moo

2016-12-01

The aim of this retrospective study was to determine whether glucose metabolism assessed by fluorine-18 fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) provides prognostic information independent of established prognostic factors in patients with gastric lymphoma. We reviewed the medical records of 86 patients retrospectively (men, 42; women, 44; mean age 58±13 years) with pathologically proven gastric lymphoma (34 mucosa-associated lymphoid tissue and 52 aggressive non-Hodgkin's lymphoma). They underwent F-FDG PET/CT as part of a pretreatment work-up from February 2004 to July 2012. For the analysis, patients were classified by age, sex, Musshoff stage, serum lactate dehydrogenase, International Prognostic Index score, extragastric spread, and visual intensity [visual assessment and maximum standardized uptake value (SUVmax), respectively]. The relationship between F-FDG uptake and survival was analyzed using the Kaplan-Meier method with a log-rank test and Cox's proportional-hazard regression method. The median survival of all 86 study participants was 1117 days and the median SUV measured by PET/CT was 6.1 (range, 1.9-32.7). Patients with an SUVmax less than or equal to 5.2 survived significantly longer than patients with an SUVmax more than 5.2 (median, 1163 vs. 1004 days; P=0.003). Survival was also found to be significantly related to age (P=0.0005), histological type (P=0.004), extragastric spread (P=0.0004), International Prognostic Index score (P<0.0001), serum lactate dehydrogenase (P=0.02), stage (P<0.0001), and visual intensity (P=0.041). A multivariate analysis showed that patients with a higher SUVmax [P=0.021; 95% confidence interval (CI), 1.52-8.14; hazard ratio (HR)=6.29], older age (P=0.001; 95% CI, 4.64-219.96; HR=18.8), more aggressive histologic type (P=0.006; 95% CI, 2.20-70.63; HR=12.76), and higher stage (P=0.0006; 95% CI, 5.81-206.43; HR=17.48) showed worse survival. A higher SUVmax on pretreatment F-FDG PET/CT can predict poorer survival in patients with gastric lymphoma.

Prenatal exposure to maternal very severe obesity is associated with impaired neurodevelopment and executive functioning in children.

PubMed

Mina, Theresia H; Lahti, Marius; Drake, Amanda J; Denison, Fiona C; Räikkönen, Katri; Norman, Jane E; Reynolds, Rebecca M

2017-07-01

BackgroundPrenatal maternal obesity has been associated with an increased risk of neurocognitive problems in childhood, but there are fewer studies on executive functioning.MethodsTests and questionnaires to assess neurodevelopment, executive functioning, and the ability to delay gratification were conducted in 113 children (mean (SD)=4.24 (0.63) years of age) born to mothers with very severe obesity (SO, body mass index (BMI)⩾40 kg/m 2 , n=51) or to lean mothers (BMI⩽25 kg/m 2 , n=62).ResultsPrenatal maternal SO predicted poorer neurodevelopment (unstandardized regression coefficient (B)=-0.42, 95% confidence interval (CI) (-0.82; -0.02)), worse problem-solving (odd ratio (OR)=0.60, 95% CI (1.13; 0.07)), and fine motor skills (OR=4.91, 95% CI (1.27; 19.04)), poorer executive functioning in areas of attention, inhibitory control, and working memory (standardized B=3.75, 95% CI (1.01; 13.93)) but not in self-gratification delay. The effects were independent of maternal concurrent psychological well-being and child's BMI, but not independent of maternal education.ConclusionFuture studies should investigate whether perinatal management of maternal obesity could prevent adverse outcomes in child neurodevelopment.

Carbon Dioxide Versus Air Insufflation for Elective Colonoscopy: A Meta-Analysis and Systematic Review of Randomized Controlled Trials.

PubMed

Memon, Muhammed A; Memon, Breda; Yunus, Rossita M; Khan, Shahjahan

2016-04-01

The aim of this study was to conduct a meta-analysis and systematic review of randomized controlled trials (RCTs) comparing 2 methods of colonic insufflation for elective colonoscopy, that is, carbon dioxide (CO2) or air, and to evaluate their efficiency, safety, and side effects. Prospective RCTs comparing CO2 versus air insufflation for colonic distension during colonoscopy were selected by searching PubMed, Medline, Embase, Science Citation Index, Current Contents, and the Cochrane Central Register of Controlled Trials published between January 1980 and October 2014. The outcome variables analyzed included procedural and immediate postprocedural pain (during, end, or within 15 min after procedure), early postprocedural pain (between 30 and 120 min), intermediate postprocedural pain (360 min) and late postprocedural pain (720 to 1140 min), cecal/ileal intubation rate, cecal/ileal intubation time, and total colonoscopy examination time. These outcomes were unanimously decided to be important as they influence the practical approach toward patient management within and outside of hospital. Random effects model was used to calculate the effect size of both binary and continuous data. Heterogeneity among the outcome variables of these trials was determined by the Cochran Q statistic and I2 index. The meta-analysis was prepared in accordance with PRISMA guidelines. Twenty-four RCTs totaling 3996 patients (CO2=2017, Air=1979) were analyzed. Statistically significant differences for the pooled effect size were observed for procedural and immediate postprocedural pain [weighted mean difference (WMD)=0.49; 95% confidence interval (CI), 0.32, 0.73; P=0.0005], early postprocedural pain between 30 and 120 minutes (WMD=0.25; 95% CI, 0.12, 0.49; P<0.0001), intermediate postprocedural pain, that is, 360 minutes after completion (WMD=0.35; 95% CI, 0.23, 0.52; P<0.0001), and late postprocedural pain between 720 and 1440 minutes (WMD=0.53; 95% CI, 0.34, 0.84; P=0.0061). Comparable effects were noted for cecal/ileal intubation rate (WMD=0.86; 95% CI, 0.61, 1.22; P=0.3975), cecal/ileal intubation time (WMD=-0.64; 95% CI, -1.38, 0.09; P=0.0860), and total examination time (WMD=-0.20; 95% CI, -0.96, 0.57; P=0.6133). On the basis of our meta-analysis and systematic review, we conclude that CO2 insufflation significantly reduces abdominal pain during and following the procedure lasting up to 24 hours. There is no difference in the cecal/ileal intubation rate and time and total examination time between the 2 methods. CO2 retention with CO2 insufflation during and after the colonoscopy shows inconsequential variation compared with air insufflation and has no adverse effect on patients. CO2 instead of air should be routinely utilized for colonoscopy.

[Mortality in early-stage, surgically resected non-small cell lung cancer less than 3 cm of size: Competing risk analysis].

PubMed

Jordá Aragón, Carlos; Peñalver Cuesta, Juan Carlos; Mancheño Franch, Nuria; de Aguiar Quevedo, Karol; Vera Sempere, Francisco; Padilla Alarcón, José

2015-09-07

Survival studies of non-small cell lung cancer (NSCLC) are usually based on the Kaplan-Meier method. However, other factors not covered by this method may modify the observation of the event of interest. There are models of cumulative incidence (CI), that take into account these competing risks, enabling more accurate survival estimates and evaluation of the risk of death from other causes. We aimed to evaluate these models in resected early-stage NSCLC patients. This study included 263 patients with resected NSCLC whose diameter was ≤ 3 cm without node involvement (N0). Demographic, clinical, morphopathological and surgical variables, TNM classification and long-term evolution were analysed. To analyse CI, death by another cause was considered to be competitive event. For the univariate analysis, Gray's method was used, while Fine and Gray's method was employed for the multivariate analysis. Mortality by NSCLC was 19.4% at 5 years and 14.3% by another cause. Both curves crossed at 6.3 years, and probability of death by another cause became greater from this point. In multivariate analysis, cancer mortality was conditioned by visceral pleural invasion (VPI) (P=.001) and vascular invasion (P=.020), with age>50 years (P=.034), smoking (P=.009) and the Charlson index ≥ 2 (P=.000) being by no cancer. By the method of CI, VPI and vascular invasion conditioned cancer death in NSCLC >3 cm, while non-tumor causes of long-term death were determined. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Curiosity predicts smoking experimentation independent of susceptibility in a US national sample.

PubMed

Nodora, Jesse; Hartman, Sheri J; Strong, David R; Messer, Karen; Vera, Lisa E; White, Martha M; Portnoy, David B; Choiniere, Conrad J; Vullo, Genevieve C; Pierce, John P

2014-12-01

To improve smoking prevention efforts, better methods for identifying at-risk youth are needed. The widely used measure of susceptibility to smoking identifies at-risk adolescents; however, it correctly identifies only about one third of future smokers. Adding curiosity about smoking to this susceptibility index may allow us to identify a greater proportion of future smokers while they are still pre-teens. We use longitudinal data from a recent national study on parenting to prevent problem behaviors. Only oldest children between 10 and 13years of age were eligible. Participants were identified by RDD survey and followed for 6years. All baseline never smokers with at least one follow-up assessment were included (n=878). The association of curiosity about smoking with future smoking behavior was assessed. Then, curiosity was added to form an enhanced susceptibility index and sensitivity, specificity and positive predictive value were calculated. Among committed never smokers at baseline, those who were 'definitely not curious' were less likely to progress toward smoking than both those who were 'probably not curious' (ORadj=1.89; 95% CI=1.03-3.47) or 'probably/definitely curious' (ORadj=2.88; 95% CI=1.11-7.45). Incorporating curiosity into the susceptibility index increased the proportion identified as at-risk to smoke from 25.1% to 46.9%. The sensitivity (true positives) for this enhanced susceptibility index for both experimentation and established smoking increased from 37-40% to over 50%, although the positive predictive value did not improve. The addition of curiosity significantly improves the identification and classification of which adolescents will experiment with smoking or become established smokers. Copyright © 2014 Elsevier Ltd. All rights reserved.

Equity trends in ownership of insecticide-treated nets in 19 sub-Saharan African countries

PubMed Central

Florey, Lia; Ye, Yazoume

2017-01-01

Abstract Objective To examine the change in equity of insecticide-treated net (ITN) ownership among 19 malaria-endemic countries in sub-Saharan Africa before and after the launch of the Cover The Bed Net Gap initiative. Methods To assess change in equity in ownership of at least one ITN by households from different wealth quintiles, we used data from Demographic and Health Surveys and Malaria Indicator Surveys. We assigned surveys conducted before the launch (2003–2008) as baseline surveys and surveys conducted between 2009–2014 as endpoint surveys. We did country-level and pooled multicountry analyses. Pooled analyses based on malaria transmission risk, were done by dividing geographical zones into either low- and intermediate-risk or high-risk. To assess changes in equity, we calculated the Lorenz concentration curve and concentration index (C-index). Findings Out of the 19 countries we assessed, 13 countries showed improved equity between baseline and endpoint surveys and two countries showed no changes. Four countries displayed worsened equity, two favouring the poorer households and two favouring the richer. The multicountry pooled analysis showed an improvement in equity (baseline survey C-index: 0.11; 95% confidence interval, CI: 0.10 to 0.11; and endpoint survey C-index: 0.00; 95% CI: −0.01 to 0.00). Similar trends were seen in both low- and intermediate-risk and high-risk zones. Conclusion The mass ITN distribution campaigns to increase coverage, linked to the launch of the Cover The Bed Net Gap initiative, have led to improvement in coverage of ITN ownership across sub-Saharan Africa with significant reduction in inequity among wealth quintiles. PMID:28479633

Infection with hepatitis viruses, FIB-4 index and risk of hepatocellular carcinoma in southern Italy: a population-based cohort study.

PubMed

Fusco, Mario; Piselli, Pierluca; Virdone, Saverio; Di Cicco, Pietro; Scognamiglio, Paola; De Paoli, Paolo; Ciullo, Valerio; Verdirosi, Diana; D'Orazio, Michele; Dal Maso, Luigino; Girardi, Enrico; Franceschi, Silvia; Serraino, Diego

2016-01-01

The incidence of hepatocellular carcinoma (HCC) and its association with hepatitis C (HCV) and hepatitis B virus (HBV) infections, FIB-4 index and liver enzymes was assessed in an area of the province of Naples covered by a population-based cancer registry. We conducted a cohort investigation on 4492 individuals previously enrolled in a population-based seroprevalent survey on HCV and HBV infections. The diagnosis of HCC was assessed through a record linkage with the cancer registry. Hepatic metabolic activity was measured through serum alanine transaminase, aspartate aminotransferase, gamma-glutamyl-transferase, and platelet. The FIB-4 index was used as a marker of fibrosis. We computed HCC incidence rates (IR) for 100,000 (10 5 ) person-years of observation, and multivariable hazard ratios (HR) with 95 % confidence intervals (CI) to assess risk factors for HCC. Twenty two cases of HCC were diagnosed during follow-up (IR = 63.3 cases/10 5 ). Significantly increased HCC risks were documented in individuals with higher than normal liver enzymes and low platelet count; in the 239 HCV RNA-positives (HR = 61.8, 95 % CI:13.3-286); and in the 95 HBsAg-positives (HR = 75.0) -as compared to uninfected individuals. The highest FIB-4 score was associated with a 17.6-fold increased HCC risk. An elevated FIB-4 index turned out to be an important predictor of HCC occurrence. Although the standard method to assess hepatic fibrosis in chronic hepatitis remains the histologic staging of liver biopsy specimen, the assessment of FIB-4 in HCV RNA-positive individuals may help in identifying the highest HCC-risk individuals who need anti-HCV treatment most urgently.

Body adiposity index as marker of obesity and cardiovascular risk in adults from Bogotá, Colombia.

PubMed

García, Ana Isabel; Niño-Silva, Laura Andrea; González-Ruíz, Katherine; Ramírez-Vélez, Robinson

2015-03-01

To assess the value of body adiposity index (BAI) as a marker of obesity and predictor of cardiovascular disease (CVD). A cross-sectional study in 527 volunteers from the education and automotive sector in Bogotá, Colombia. BAI was calculated using the Bergman et al. equation ([hip circumference in cm)/[height in m(2)](1,5)-18]). Anthropometric, clinical and laboratory data were collected, cholesterol/HDL-C, LDL-C/HDL-C; triglycerides/HDL-C and lipid-metabolic index (LMI) ratios were calculated. Prevalence rates and means, according to tertiles (T), and multivariate analysis between the BAI and anthropometric, clinical, and laboratory markers were estimated. Obesity prevalence was 33.9% (BAI>27.5%). Subjects with lower BAI (T-1) had lower cholesterol, triglycerides/HDL-C, and cholesterol/HDL-C levels and better LMI; P<.001. The multivariate model showed in T-3 subjects an OR 3.33 (95% CI 2.16 to 5.13) for central obesity and an OR 3.39 (95% CI 2.34 to 4.90) for increased visceral fat. As regards lipid and carbohydrate metabolism, BAI was able to predict the risk OR 7.95 (95% CI 4.88 to 12.94), OR 1.60 (95% CI 1.03 to 2.41), OR 1.69 (95% CI 1.06 to 2.70) and OR 9.27 (95% CI 2.01 to 21.80), shows a significant association between cholesterol, triglycerides, LDL cholesterol and glucose respectively, P<0.001. A high prevalence of obesity by BAI was observed, and statistically positive associations with cardiovascular risk factors were shown. Copyright © 2014 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

Obesity and its socioeconomic determinants in Iran.

PubMed

Emamian, Mohammad Hassan; Fateh, Mansooreh; Hosseinpoor, Ahmad Reza; Alami, Ali; Fotouhi, Akbar

2017-08-01

To investigate the socioeconomic inequality of obesity and its determinants in Iran. Data was from Iran's surveillance system for risk factors of non-communicable diseases which was conducted on 89,400 individuals aged 15-64 years in 2005. Principal component analysis was used to create a new variable for defining socioeconomic status of participants. We assessed inequality by calculating a slop index of inequality and concentration index for obesity. Oaxaca-Blinder decomposition analysis was used to determine the determinants of inequality. The slop index of inequality and concentration index for obesity was -13.1 (95% Confidence Intervals [CI]: -16.3 to -9.8) percentage points and -0.123, respectively. The level of inequality varied widely between different provinces in Iran and was more severe in women and urban population. Obesity persisted in 20.2% (95% CI: 19.4-20.9) of the low-socioeconomic group and 11.0% (95% CI: 10.5-11.6) of the high-socioeconomic group. More than 90% of this gap was due to differences of independent variables (mainly age, gender and marital status) in two socioeconomic status groups. A pro-rich inequality existed in the obesity in Iran. Older age, female gender and rural residency contributed most to the economic inequality of obesity. Copyright © 2017 Elsevier B.V. All rights reserved.

Walkability and walking for transport: characterizing the built environment using space syntax.

PubMed

Koohsari, Mohammad Javad; Owen, Neville; Cerin, Ester; Giles-Corti, Billie; Sugiyama, Takemi

2016-11-24

Neighborhood walkability has been shown to be associated with walking behavior. However, the availability of geographical data necessary to construct it remains a limitation. Building on the concept of space syntax, we propose an alternative walkability index, space syntax walkability (SSW). This study examined associations of the full walkability index and SSW with walking for transport (WT). Data were collected in 2003-2004 from 2544 adults living in 154 Census Collection Districts (CCD) in Adelaide, Australia. Participants reported past week WT frequency. Full walkability (consisting of net residential density, intersection density, land use mix, and net retail area ratio) and SSW (consisting of gross population density and a space syntax measure of street integration) were calculated for each CCD using geographic information systems and space syntax software. Generalized linear models with negative binomial variance and logarithmic link functions were employed to examine the associations of each walkability index with WT frequency, adjusting for socio-demographic variables. Two walkability indices were closely correlated (ρ = 0.76, p < 0.01). The associations of full walkability and SSW with WT frequency were positive, with regression coefficients of 1.12 (95% CI: 1.08, 1.17) and 1.14 (95% CI: 1.10, 1.19), respectively. SSW employs readily-available geographic data, yet is comparable to full walkability in its association with WT. The concept and methods of space syntax provide a novel approach to further understanding how urban design influences walking behaviors.

Lack of correlation between left ventricular outflow tract velocity time integral and stroke volume index in mechanically ventilated patients.

PubMed

Blancas, R; Martínez-González, Ó; Ballesteros, D; Núñez, A; Luján, J; Rodríguez-Serrano, D; Hernández, A; Martínez-Díaz, C; Parra, C M; Matamala, B L; Alonso, M A; Chana, M

2018-02-07

To assess the correlation between left ventricular outflow tract velocity time integral (LVOT VTI) and stroke volume index (SVI) calculated by thermodilution methods in ventilated critically ill patients. A prospective, descriptive, multicenter study was performed. Five intensive care units from university hospitals. Patients older than 17 years needing mechanical ventilation and invasive hemodynamic monitoring were included. LVOT VTI was measured by pulsatile Doppler echocardiography. Calculations of SVI were performed through a floating pulmonary artery catheter (PAC) or a Pulse index Contour Cardiac Output (PiCCO ® ) thermodilution methods. The relation between LVOT VTI and SVI was tested by linear regression analysis. One hundred and fifty-six paired measurements were compared. Mean LVOT VTI was 20.83±4.86cm and mean SVI was 41.55±9.55mL/m 2 . Pearson correlation index for these variables was r=0.644, p<0.001; ICC was 0.52 (CI 95% 0.4-0.63). When maximum LVOT VTI was correlated with SVI, Pearson correlation index was r=0.62, p<0.001. Correlation worsened for extreme values, especially for those with higher LVOT VTI. LVOT VTI could be a complementary hemodynamic evaluation in selected patients, but does not eliminate the need for invasive monitoring at the present time. The weak correlation between LVOT VTI and invasive monitoring deserves additional assessment to identify the factors affecting this disagreement. Copyright © 2018 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Obesity, Abdominal Obesity, Physical Activity, and Caloric Intake in U.S. Adults: 1988-2010

PubMed Central

Ladabaum, Uri; Mannalithara, Ajitha; Myer, Parvathi A.; Singh, Gurkirpal

2014-01-01

Background Obesity and abdominal obesity are independently associated with morbidity and mortality. Physical activity attenuates these risks. We examined trends in obesity, abdominal obesity, physical activity, and caloric intake in U.S. adults from 1988 to 2010. Methods Univariate and multivariate analyses were performed using National Health and Nutrition Examination Survey (NHANES) data. Results Average body-mass index (BMI) increased by 0.37% (95% CI, 0.30-0.44%) per year in both women and men. Average waist circumference increased by 0.37% (95% CI, 0.30-0.43%) and 0.27% (95% CI, 0.22-0.32%) per year in women and men, respectively. The prevalence of obesity and abdominal obesity increased substantially, as did the prevalence of abdominal obesity among overweight adults. Younger women experienced the greatest increases. The proportion of adults who reported no leisure-time physical activity increased from 19.1% (95% CI, 17.3-21.0%) to 51.7% (95% CI, 48.9-54.5%) in women, and from 11.4% (95% CI, 10.0-12.8%) to 43.5% (95% CI, 40.7-46.3%) in men. Average daily caloric intake did not change significantly. BMI and waist circumference trends were associated with physical activity level, but not caloric intake. The associated changes in adjusted BMIs were 8.3% (95% CI, 6.9-9.6%) higher among women and 1.7% (95% CI, 0.68-2.8%) higher among men with no leisure-time physical activity compared to those with an ideal level of leisure-time physical activity. Conclusions Our analyses highlight important dimensions of the public health problem of obesity, including trends in younger women and in abdominal obesity, and lend support to the emphasis placed on physical activity by the Institute of Medicine. PMID:24631411

Reproductive outcomes following hydroxychloroquine use for autoimmune diseases: a systematic review and meta-analysis.

PubMed

Kaplan, Yusuf Cem; Ozsarfati, Jak; Nickel, Cheri; Koren, Gideon

2016-05-01

The objective of this meta-analysis was to determine whether gestational use of hydroxychloroquine (HCQ) for autoimmune disorders leads to an increase in the risk for adverse pregnancy outcomes. MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials databases were searched from inception to November 21 2014. Studies which reported the outcomes of pregnant women after exposure to HCQ during pregnancy and including a control (unexposed) group were included. Two independent reviewers carried out the review and the quality assessment using the Methodological Index for Non-Randomized Studies (MINORS). A random effects method was used to calculate the odds ratios (OR) for the outcomes. The meta-analysis reported no significant increases in rates of major congenital (OR 1.13, 95% confidence interval (CI) 0.59, 2.17), craniofacial (OR 0.62, 95% CI 0.13, 3.03), cardiovascular (OR 1.06, 95% CI 0.29, 3.86), genitourinary (OR 1.38, 95% CI 0.42, 4.53), nervous system malformations (OR 1.81, 95% CI 0.31, 10.52), stillbirth (OR 0.69, 95% CI 0.35, 1.34), low birth weight (OR 0.69, 95% CI 0.21, 2.27) or prematurity (OR 1.75, 95% CI 0.95, 3.24). The rate of spontaneous abortions, however, was found to be significantly increased in HCQ exposed pregnancies (OR 1.85, 95% CI 1.10, 3.13). No significant heterogeneity was detected among the studies for the evaluated outcomes except prematurity. Prenatal exposure to HCQ for autoimmune diseases does not appear to increase the risk of adverse pregnancy outcomes except spontaneous abortion rate, which may be associated with the underlying disease activity (bias by indication) and needs further investigation. © 2015 The British Pharmacological Society.

Accuracy and trending ability of the fourth-generation FloTrac/Vigileo System™ in patients undergoing abdominal aortic aneurysm surgery.

PubMed

Maeda, Takuma; Hattori, Kohshi; Sumiyoshi, Miho; Kanazawa, Hiroko; Ohnishi, Yoshihiko

2018-06-01

The fourth-generation FloTrac/Vigileo™ improved its algorithm to follow changes in systemic vascular resistance index (SVRI). This revision may improve the accuracy and trending ability of CI even in patients who undergo abdominal aortic aneurysm (AAA) surgery which cause drastic change of SVRI by aortic clamping. The purpose of this study is to elucidate the accuracy and trending ability of the fourth-generation FloTrac/Vigileo™ in patients with AAA surgery by comparing the FloTrac/Vigileo™-derived CI (CI FT ) with that measured by three-dimensional echocardiography (CI 3D ). Twenty-six patients undergoing elective AAA surgery were included in this study. CI FT and CI3 D were determined simultaneously in eight points including before and after aortic clamp. We used CI 3D as the reference method. In the Bland-Altman analysis, CI FT had a wide limit of agreement with CI 3D showing a percentage error of 46.7%. Subgroup analysis showed that the percentage error between CO 3D and CO FT was 56.3% in patients with cardiac index < 2.5 L/min/m 2 and 28.4% in patients with cardiac index ≥ 2.5 L/min/m 2 . SVRI was significantly higher in patients with cardiac index < 2.5 L/min/m 2 (1703 ± 330 vs. 2757 ± 798; p < 0.001). The tracking ability of fourth generation of FloTrac/Vigileo™ after aortic clamp was not clinically acceptable (26.9%). The degree of accuracy of the fourth-generation FloTrac/Vigileo™ in patients with AAA surgery was not acceptable. The tracking ability of the fourth-generation FloTrac/Vigileo™ after aortic clamp was below the acceptable limit.

Effect of stressful life events on changes in smoking among the French: longitudinal findings from GAZEL

PubMed Central

Okechukwu, Cassandra; Marino, Miguel; Guéguen, Alice; Goldberg, Marcel; Zins, Marie

2015-01-01

Background: Changes in life events may play a contributing role in changes in smoking behaviors. The objective was to examine the impact of stressful life events (SLEs) on smoking among French adults. Methods: We examined smoking prevalence in 20 625 employees of the French GAZEL cohort for up to 5 years before and after a SLE during three time periods (years −1 vs. −5; years +1 vs. −1; years +5 vs. +1). Repeated measures analysis of time series data indexed to events were used, employing generalized estimating equations. Results: For women, comparing 1 year after vs. 1 year before SLEs, decreased odds of smoking were found for employment promotion (OR: 0.80; 95% CI = 0.67–0.95), marriage (OR: 0.57; 95% CI = 0.48–0.68) and divorce (OR: 0.78; 95% CI = 0.68–0.90). Comparing 5 years after to 1 year after SLEs, women had decreased odds of smoking for important purchase (OR: 0.87; 95% CI = 0.79–0.96), children leaving home (OR: 0.83; 95% CI = 0.74–0.93), retirement (OR: 0.73; 95% CI = 0.64–0.83) and death of loved one (OR: 0.86; 95% CI = 0.79–0.93). For men, decreased odds of smoking were observed in all three time periods for all SLEs except when comparing 1 year before to 5 years before marriage (OR: 1.66; 95% CI = 1.09–2.52) and divorce (OR: 1.49; 95% CI = 1.25–1.77). Conclusion: Time surrounding SLEs during which individuals are susceptible to changing smoking behaviors may be an important consideration. PMID:25762691

Body weight dissatisfaction by socioeconomic status among obese, preobese and normal weight women and men: results of the cross-sectional KORA Augsburg S4 population survey.

PubMed

von Lengerke, Thomas; Mielck, Andreas

2012-05-09

Body weight dissatisfaction is an important factor in preventing weight gain and promoting weight loss or maintenance. This study focuses on differences in the rates of body weight dissatisfaction among obese, preobese and normal weight women and men by socioeconomic status within a general adult population in Germany. Data were analyzed from 4186 adults aged 25 to 74 who participated in a cross-sectional, representative population-based health survey (KORA S4, 1999-2001, Augsburg region/Germany). Body mass was measured anthropometrically and indexed following international standards. Among the 2123 women participating in the survey, 40.3% had a normal weight, 34.9% were preobese, and 24.8% were obese (compared to 25.9%, 51.4% and 22.6% among men, respectively). Body weight dissatisfaction, educational level, household income and occupational status were assessed by computer-aided personal interviewing. An index for socioeconomic status was calculated and categorized into quintiles. Multiple logistic regressions were performed to test for differences in the odds of body weight dissatisfaction across socioeconomic strata in normal weight, preobese and obese groups. Body mass index, age, family status, place of residence and health behaviors were adjusted for. Overall, being dissatisfied with one's body weight was more prevalent in women (48.3%) than in men (33.2%). In the normal weight group, no significant differences in the odds of being dissatisfied were found across socioeconomic groups among women or men. Among preobese men, compared to the lowest socioeconomic stratum, increased odds of being dissatisfied with one's body weight were associated with the highest socioeconomic index group (OR = 2.3, 95% CI: 1.4-3.8), middle and high educational level (OR = 1.6, 95% CI: 1.1-2.3, and OR = 1.9, 95% CI: 1.3-3.7), high income (OR = 1.8, 95% CI: 1.2-2.7), and middle and high occupational status (both OR = 1.8, 95% CI: 1.2-2.6). Among preobese women, the odds of being dissatisfied were only significantly elevated in those with a middle educational level (OR = 1.6, 95% CI: 1.1-2.3). Among obese men, elevated odds were found in the highest socioeconomic index group (OR = 3.7, 95% CI: 1.8-7.5) and in those with a high educational level (OR = 2.3, 95% CI: 1.3-4.1), high income (OR = 2.6, 95% CI: 1.4-4.7), and middle and high occupational status (both OR = 2.2, 95% CI: 1.3-3.6). The odds of dissatisfaction among obese women were not associated with socioeconomic status as a whole, but were associated with a high educational level, albeit with a comparatively large confidence interval (OR = 3.6, 95% CI: 1.0-12.8). In Germany, body weight dissatisfaction is more prevalent among obese and preobese men in high socioeconomic status groups, a pattern not found in women. The exception to this is a greater prevalence of dissatisfaction among obese and preobese women with a high educational level (albeit inconsistently). Moreover, there is a social gradient in body weight dissatisfaction, especially in obese men, which may partly explain why obesity is more prevalent in men with low socioeconomic status. It also suggests that they are a target group for obesity care in which body weight satisfaction is an important topic.

Predicting mortality rates: Comparison of an administrative predictive model (hospital standardized mortality ratio) with a physiological predictive model (Acute Physiology and Chronic Health Evaluation IV)--A cross-sectional study.

PubMed

Toua, Rene Elaine; de Kock, Jacques Erasmus; Welzel, Tyson

2016-02-01

Direct comparison of mortality rates has limited value because most deaths are due to the disease process. Predicting the risk of death accurately remains a challenge. A cross-sectional study compared the expected mortality rate as calculated with an administrative model to a physiological model, Acute Physiology and Chronic Health Evaluation IV. The combined cohort and stratified samples (<0.1, 0.1-0.5, or >0.5 predicted mortality) were considered. A total of 47,982 patients were scored from 1 July 2013 to 30 June 2014, and 46,061 records were included in the analysis. A moderate correlation was shown for the combined cohort (Pearson correlation index, 0.618; 95% confidence interval [CI], 0.380-0.779; R(2) = 0.38). A very good correlation for the less than 10% stratum (Pearson correlation index, 0.884; R(2) = 0.78; 95% CI, 0.79-0.937) and a moderate correlation for 0.1 to 0.5 predicted mortality rates (Pearson correlation index, 0.782; R(2) = 0.61; 95% CI, 0.623-0.879). There was no significant positive correlation for the greater than 50% predicted mortality stratum (Pearson correlation index, 0.087; R(2) = 0.007; 95% CI, -0.23 to 0.387). At less than 0.1, the models are interchangeable, but in spite of a moderate correlation, greater than 0.1 hospital standardized mortality ratio cannot be used to predict mortality. Copyright © 2015 Elsevier Inc. All rights reserved.

Prediction of postoperative pulmonary complications in a population-based surgical cohort.

PubMed

Canet, Jaume; Gallart, Lluís; Gomar, Carmen; Paluzie, Guillem; Vallès, Jordi; Castillo, Jordi; Sabaté, Sergi; Mazo, Valentín; Briones, Zahara; Sanchis, Joaquín

2010-12-01

Current knowledge of the risk for postoperative pulmonary complications (PPCs) rests on studies that narrowly selected patients and procedures. Hypothesizing that PPC occurrence could be predicted from a reduced set of perioperative variables, we aimed to develop a predictive index for a broad surgical population. Patients undergoing surgical procedures given general, neuraxial, or regional anesthesia in 59 hospitals were randomly selected for this prospective, multicenter study. The main outcome was the development of at least one of the following: respiratory infection, respiratory failure, bronchospasm, atelectasis, pleural effusion, pneumothorax, or aspiration pneumonitis. The cohort was randomly divided into a development subsample to construct a logistic regression model and a validation subsample. A PPC predictive index was constructed. Of 2,464 patients studied, 252 events were observed in 123 (5%). Thirty-day mortality was higher in patients with a PPC (19.5%; 95% [CI], 12.5-26.5%) than in those without a PPC (0.5%; 95% CI, 0.2-0.8%). Regression modeling identified seven independent risk factors: low preoperative arterial oxygen saturation, acute respiratory infection during the previous month, age, preoperative anemia, upper abdominal or intrathoracic surgery, surgical duration of at least 2 h, and emergency surgery. The area under the receiver operating characteristic curve was 90% (95% CI, 85-94%) for the development subsample and 88% (95% CI, 84-93%) for the validation subsample. The risk index based on seven objective, easily assessed factors has excellent discriminative ability. The index can be used to assess individual risk of PPC and focus further research on measures to improve patient care.

Clinics in Orthopedic Surgery's Evolution into an International Journal Based on Journal Metrics.

PubMed

Huh, Sun

2016-06-01

This article is aimed at providing evidence of increased international recognition of Clinics in Orthopedic Surgery (CiOS) based on journal metrics. Since 7 years have passed since its launch in 2009, it is time to reflect on the journal's efforts to be recognized as a top-notch journal. The following journal metrics were analyzed from the journal's homepage and Web of Science Core Collection database: number of citable and noncitable articles; number of original articles supported by grants; editorial board members' countries; authors' countries; citing authors' countries; source titles of citing articles; impact factor; total citations; comparison of impact factor with 3 Science Citation Index Expanded journals; and Hirsch index (H-index). Of the total 392 articles, 378 were citable articles (96.4%). Of the total 282 original articles, 52 (18.4%) were supported by research grants. The editorial board members were from 13 countries. Authors were from 20 countries. The number of countries of citing authors was 66. The number of source titles of citing articles was more than 100. The total citations of CiOS have increased from 0 in 2009 to 374 in 2015. The impact factors without self-citations of CiOS were the greatest among 4 Asian journals in 2013 and 2014. The 2015 impact factor was calculated as 0.79 in January 2016. The H-index was 13. CiOS can be considered to have reached the level of top-notch journal in the orthopedic field based on journal metrics. The inclusion of the journal in PubMed Central appears to have increased international relevance of the journal.

Tonsillectomy in adults with obstructive sleep apnea.

PubMed

Holmlund, Thorbjörn; Franklin, Karl A; Levring Jäghagen, Eva; Lindkvist, Marie; Larsson, Torbjörn; Sahlin, Carin; Berggren, Diana

2016-12-01

To study whether tonsillectomy is effective on obstructive sleep apnea (OSA) in adults with large tonsils. A multicenter prospective interventional study. The study comprised 28 patients with OSA, an apnea-hypopnea index of > 10, large tonsils (Friedman tonsil size 3 and 4), and age 18 to 59 years. They were derived from 41 consecutive males and females with large tonsils referred for a suspicion of sleep apnea to the ear, nose, and throat departments in Umeå, Skellefteå, and Sunderbyn in northern Sweden. The primary outcome was the apnea-hypopnea index, measured with polygraphic sleep apnea recordings 6 months after surgery. Secondary outcomes included daytime sleepiness, as measured with the Epworth Sleepiness Scale, and swallowing function, using video-fluoroscopy. The apnea-hypopnea index was reduced from a mean of 40 units per hour (95% confidence interval [CI] 28-51) to seven units per hour (95% CI 3-11), P < 0.001, at the 6-month follow-up after surgery. The apnea-hypopnea index was reduced in all patients and 18 (64%) were cured. The Epworth Sleepiness Scale was reduced from a mean of 11 (95% CI 8-13) to 6.0 (95% CI 4-7), P < 0.001. A swallowing dysfunction was found in seven of eight investigated patients before surgery. Of those, swallowing function improved in five patients after surgery, whereas no one deteriorated. Tonsillectomy may be effective treatment for adult patients with OSA and large tonsils. Tonsillectomy may be suggested for adults with OSA and large tonsils. 4. Laryngoscope, 126:2859-2862, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Genotype-Specific Measles Transmissibility: A Branching Process Analysis.

PubMed

Ackley, Sarah F; Hacker, Jill K; Enanoria, Wayne T A; Worden, Lee; Blumberg, Seth; Porco, Travis C; Zipprich, Jennifer

2018-04-03

Substantial heterogeneity in measles outbreak sizes may be due to genotype-specific transmissibility. Using a branching process analysis, we characterize differences in measles transmission by estimating the association between genotype and the reproduction number R among postelimination California measles cases during 2000-2015 (400 cases, 165 outbreaks). Assuming a negative binomial secondary case distribution, we fit a branching process model to the distribution of outbreak sizes using maximum likelihood and estimated the reproduction number R for a multigenotype model. Genotype B3 is found to be significantly more transmissible than other genotypes (P = .01) with an R of 0.64 (95% confidence interval [CI], .48-.71), while the R for all other genotypes combined is 0.43 (95% CI, .28-.54). This result is robust to excluding the 2014-2015 outbreak linked to Disneyland theme parks (referred to as "outbreak A" for conciseness and clarity) (P = .04) and modeling genotype as a random effect (P = .004 including outbreak A and P = .02 excluding outbreak A). This result was not accounted for by season of introduction, age of index case, or vaccination of the index case. The R for outbreaks with a school-aged index case is 0.69 (95% CI, .52-.78), while the R for outbreaks with a non-school-aged index case is 0.28 (95% CI, .19-.35), but this cannot account for differences between genotypes. Variability in measles transmissibility may have important implications for measles control; the vaccination threshold required for elimination may not be the same for all genotypes or age groups.

Home visits during pregnancy and after birth for women with an alcohol or drug problem.

PubMed

Turnbull, Catherine; Osborn, David A

2012-01-18

One potential method of improving outcome for pregnant or postpartum women with a drug or alcohol problem is with home visits. To determine the effects of home visits during pregnancy and/or after birth for women with a drug or alcohol problem. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2011), CENTRAL (The Cochrane Library 2011, Issue 4 of 4), MEDLINE (1966 to 30 November 2011), EMBASE (1980 to 30 November 2011), CINAHL (1982 to 30 November 2011) and PsycINFO (1974 to 30 November 2011) supplemented by searches of citations from previous reviews and trials and contact with experts. Studies using random or quasi-random allocation of pregnant or postpartum women with a drug or alcohol problem to home visits. Trials enrolling high-risk women of whom more than 50% were reported to use drugs or alcohol were also eligible. Review authors performed assessments of trials independently. We performed statistical analyses using fixed-effect and random-effects models where appropriate. Seven studies (reporting 803 mother-infant pairs) compared home visits mostly after birth with no home visits. Visitors included community health nurses, paediatric nurses, trained counsellors, paraprofessional advocates, midwives and lay African-American women. Several studies had significant methodological limitations. There was no significant difference in continued illicit drug use (three studies, 384 women; risk ratio (RR) 1.05, 95% confidence interval (CI) 0.89 to 1.24), continued alcohol use (three studies, 379 women; RR 1.18, 95% CI 0.96 to 1.46), failure to enrol in a drug treatment program (two studies, 211 women; RR 0.45, 95% CI 0.10 to 1.94), not breastfeeding at six months (two studies, 260 infants; RR 0.95, 95% CI 0.83 to 1.10), incomplete six-month infant vaccination schedule (two studies, 260 infants; RR 1.09, 95% CI 0.91 to 1.32), the Bayley Mental Development Index (three studies, 199 infants; mean difference 2.89, 95% CI -1.17 to 6.95) or Psychomotor Index (MD 3.14, 95% CI -0.03 to 6.32), child behavioural problems (RR 0.46, 95% CI 0.21 to 1.01), infants not in care of biological mother (two studies, 254 infants; RR 0.83, 95% CI 0.50 to 1.39), non-accidental injury and non-voluntary foster care (two studies, 254 infants; RR 0.16, 95% CI 0.02 to 1.23) or infant death (three studies, 288 infants; RR 0.70, 95% CI 0.12 to 4.16). Individual studies reported a significant reduction in involvement with child protective services (RR 0.38, 95% CI 0.20 to 0.74) and failure to use postpartum contraception (RR 0.41, 95% CI 0.20 to 0.82). There is insufficient evidence to recommend the routine use of home visits for pregnant or postpartum women with a drug or alcohol problem. Further large, high-quality trials are needed.

[Definition of risk of the aphthous stomatitis by hygienic indices].

PubMed

Koridze, Kh

2005-04-01

Investigation of the state of oral cavity in 61 patients with stomatitis and 62 patients with others diseases of not inflammatory origin was performed in Tbilisi VA hospital. Hygienic indices (HI), particularly Fiodorova-Volodkina index and Stellard index dedicated for assessment of hygiene of the oral cavity. In patients with aphthous stomatitis the average values of hygienic indices were higher in comparison with the control group. This indicates to the role of the hygienic status on the development of the illness. The relative chance of an aphthous stomatitis is low in the cases with good (OR=0,16, 95% CI:0,03-0,74) and satisfactory (OR=0,46, 95%; CI:0,22-0,95) hygienic indices, and is high when hygienic indices are bad (OR=10,56, 95%; CI:1,29-86,12) and very bad (OR=5,88, 95%; CI:1,23-28,09). Statistically significant correlations were documented between the severity of aphthous stomatitis and the levels of hygiene of the oral cavity.

Socioeconomic Inequalities in Secondhand Smoke Exposure at Home and at Work in 15 Low- and Middle-Income Countries.

PubMed

Nazar, Gaurang P; Lee, John Tayu; Arora, Monika; Millett, Christopher

2016-05-01

In high-income countries, secondhand smoke (SHS) exposure is higher among disadvantaged groups. We examine socioeconomic inequalities in SHS exposure at home and at workplace in 15 low- and middle-income countries (LMICs). Secondary analyses of cross-sectional data from 15 LMICs participating in Global Adult Tobacco Survey (participants ≥ 15 years; 2008-2011) were used. Country-specific analyses using regression-based methods were used to estimate the magnitude of socioeconomic inequalities in SHS exposure: (1) Relative Index of Inequality and (2) Slope Index of Inequality. SHS exposure at home ranged from 17.4% in Mexico to 73.1% in Vietnam; exposure at workplace ranged from 16.9% in Uruguay to 65.8% in Bangladesh. In India, Bangladesh, Thailand, Malaysia, Philippines, Vietnam, Uruguay, Poland, Turkey, Ukraine, and Egypt, SHS exposure at home reduced with increasing wealth (Relative Index of Inequality range: 1.13 [95% confidence interval [CI] 1.04-1.22] in Turkey to 3.31 [95% CI 2.91-3.77] in Thailand; Slope Index of Inequality range: 0.06 [95% CI 0.02-0.11] in Turkey to 0.43 [95% CI 0.38-0.48] in Philippines). In these 11 countries, and in China, SHS exposure at home reduced with increasing education. In India, Bangladesh, Thailand, and Philippines, SHS exposure at workplace reduced with increasing wealth. In India, Bangladesh, Thailand, Philippines, Vietnam, Poland, Russian Federation, Turkey, Ukraine, and Egypt, SHS exposure at workplace reduced with increasing education. SHS exposure at homes is higher among the socioeconomically disadvantaged in the majority of LMICs studied; at workplaces, exposure is higher among the less educated. Pro-equity tobacco control interventions alongside targeted efforts in these groups are recommended to reduce inequalities in SHS exposure. SHS exposure is higher among the socioeconomically disadvantaged groups in high-income countries. Comprehensive smoke-free policies are pro-equity for certain health outcomes that are strongly influenced by SHS exposure. Using nationally representative Global Adult Tobacco Survey (2008-2011) data from 15 LMICs, we studied socioeconomic inequalities in SHS exposure at homes and at workplaces. The study showed that in most LMICs, SHS exposure at homes is higher among the poor and the less educated. At workplaces, SHS exposure is higher among the less educated groups. Accelerating implementation of pro-equity tobacco control interventions and strengthening of efforts targeted at the socioeconomically disadvantaged groups are needed to reduce inequalities in SHS exposure in LMICs. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.

Fully automatic GBM segmentation in the TCGA-GBM dataset: Prognosis and correlation with VASARI features.

PubMed

Rios Velazquez, Emmanuel; Meier, Raphael; Dunn, William D; Alexander, Brian; Wiest, Roland; Bauer, Stefan; Gutman, David A; Reyes, Mauricio; Aerts, Hugo J W L

2015-11-18

Reproducible definition and quantification of imaging biomarkers is essential. We evaluated a fully automatic MR-based segmentation method by comparing it to manually defined sub-volumes by experienced radiologists in the TCGA-GBM dataset, in terms of sub-volume prognosis and association with VASARI features. MRI sets of 109 GBM patients were downloaded from the Cancer Imaging archive. GBM sub-compartments were defined manually and automatically using the Brain Tumor Image Analysis (BraTumIA). Spearman's correlation was used to evaluate the agreement with VASARI features. Prognostic significance was assessed using the C-index. Auto-segmented sub-volumes showed moderate to high agreement with manually delineated volumes (range (r): 0.4 - 0.86). Also, the auto and manual volumes showed similar correlation with VASARI features (auto r = 0.35, 0.43 and 0.36; manual r = 0.17, 0.67, 0.41, for contrast-enhancing, necrosis and edema, respectively). The auto-segmented contrast-enhancing volume and post-contrast abnormal volume showed the highest AUC (0.66, CI: 0.55-0.77 and 0.65, CI: 0.54-0.76), comparable to manually defined volumes (0.64, CI: 0.53-0.75 and 0.63, CI: 0.52-0.74, respectively). BraTumIA and manual tumor sub-compartments showed comparable performance in terms of prognosis and correlation with VASARI features. This method can enable more reproducible definition and quantification of imaging based biomarkers and has potential in high-throughput medical imaging research.

The Femoro-Epiphyseal Acetabular Roof (FEAR) Index: A New Measurement Associated With Instability in Borderline Hip Dysplasia?

PubMed

Wyatt, Michael; Weidner, Jan; Pfluger, Dominik; Beck, Martin

2017-03-01

The definition of osseous instability in radiographic borderline dysplastic hips is difficult. A reliable radiographic tool that aids decision-making-specifically, a tool that might be associated with instability-therefore would be very helpful for this group of patients. (1) To compare a new radiographic measurement, which we call the Femoro-Epiphyseal Acetabular Roof (FEAR) index, with the lateral center-edge angle (LCEA) and acetabular index (AI), with respect to intra- and interobserver reliability; (2) to correlate AI, neck-shaft angle, LCEA, iliocapsularis volume, femoral antetorsion, and FEAR index with the surgical treatment received in stable and unstable borderline dysplastic hips; and (3) to assess whether the FEAR index is associated clinical instability in borderline dysplastic hips. We defined and validated the FEAR index in 10 standardized radiographs of asymptomatic controls using two blinded independent observers. Interrater and intrarater coefficients were calculated, supplemented by Bland-Altman plots. We compared its reliability with LCEA and AI. We performed a case-control study using standardized radiographs of 39 surgically treated symptomatic borderline radiographically dysplastic hips and 20 age-matched controls with asymptomatic hips (a 2:1 ratio), the latter were patients attending our institution for trauma unrelated to their hips but who had standardized pelvic radiographs between January 1, 2016 and March 1, 2016. Patient demographics were assessed using univariate Wilcoxon two-sample tests. There was no difference in mean age (overall: 31.5 ± 11.8 years [95% CI, 27.7-35.4 years]; stable borderline group: mean, 32.1± 13.3 years [95% CI, 25.5-38.7 years]; unstable borderline group: mean, 31.1 ± 10.7 years [95% CI, 26.2-35.9 years]; p = 0.96) among study groups. Treatment received was either a periacetabular osteotomy (if the hip was unstable) or, for patients with femoroacetabular impingement, either an open or arthroscopic femoroacetabular impingement procedure. The association of received treatment categories with the variables AI, neck-shaft angle, LCEA, iliocapsularis volume, femoral antetorsion, and FEAR index were evaluated first using Wilcoxon two-sample tests (two-sided) followed by stepwise multiple logistic regression analysis to identify the potential associated variables in a combined setting. Sensitivity, specificity, and receiver operator curves were calculated. The primary endpoint was the association between the FEAR index and instability, which we defined as migration of the femoral head either already visible on conventional radiographs or recentering of the head on AP abduction views, a break of Shenton's line, or the appearance of a crescent-shaped accumulation of gadolinium in the posteroinferior joint space at MR arthrography. The FEAR index showed excellent intra- and interobserver reliability, superior to the AI and LCEA. The FEAR index was lower in the stable borderline group (mean, -2.1 ± 8.4; 95% CI, -6.3 to 2.0) compared with the unstable borderline group (mean, 13.3 ± 15.2; 95% CI, 6.2-20.4) (p < 0.001) and had the highest association with treatment received. A FEAR index less than 5° had a 79% probability of correctly assigning hips as stable and unstable, respectively (sensitivity 78%; specificity 80%). A painful hip with a LCEA of 25° or less and FEAR index less than 5° is likely to be stable, and in such a situation, the diagnostic focus might more productively be directed toward femoroacetabular impingement as a potential cause of a patient's pain, rather than instability. Level III, diagnostic study.

Impact of functional status on 6-month mortality in elderly patients with acute venous thromboembolism: results from a prospective cohort.

PubMed

Gómez-Cuervo, Covadonga; Díaz-Pedroche, Carmen; Pérez-Jacoiste Asín, María Asunción; Lalueza, Antonio; Del Pozo, Roberto; Díaz-Simón, Raquel; Trapiello, Francisco; Paredes, Diana; Lumbreras, Carlos

2018-06-05

Functional status linked to a poor outcome in a broad spectrum of medical disorders. Barthel Activities of Daily Life Index (BADLI) is one of the most extended tools to quantify functional dependence. Whether BADLI can help to predict outcomes in elderly patients with acute venous thromboembolism (VTE) is unknown. The current study aimed to ascertain the influence of BADLI on 6-month all-cause mortality in aged patients with VTE. This is a prospective observational study. We included consecutive patients older than 75-year-old with an acute VTE between April 2015 and April 2017. We analyzed several variables as mortality predictors, including BADLI-measured functional status. Afterward, we performed a multivariate analysis, using logistic regression, to identify all-cause mortality independent predictive factors. Two hundred and two subjects were included. Thirty-five (17%) patients died in the first 6 months. The leading cause of death was cancer (59%). After multivariable logistic regression, we identified BADLI and Charlson index as independent predictors for 6-months mortality [BADLI (every decrease of 10 points) OR 1.21 95% CI (1.03-1.42) and Charlson index OR 1.71 95% CI (1.21-2.43)]. Body mass index (BMI) values were inversely related to mortality [OR 0.85 95% CI (0.75-0.95)]. In conclusion, BADLI, BMI, and Charlson index scores are independent predictive factors for 6-month all-cause mortality in old patients with VTE.

Imaging modalities for characterising focal pancreatic lesions.

PubMed

Best, Lawrence Mj; Rawji, Vishal; Pereira, Stephen P; Davidson, Brian R; Gurusamy, Kurinchi Selvan

2017-04-17

Increasing numbers of incidental pancreatic lesions are being detected each year. Accurate characterisation of pancreatic lesions into benign, precancerous, and cancer masses is crucial in deciding whether to use treatment or surveillance. Distinguishing benign lesions from precancerous and cancerous lesions can prevent patients from undergoing unnecessary major surgery. Despite the importance of accurately classifying pancreatic lesions, there is no clear algorithm for management of focal pancreatic lesions. To determine and compare the diagnostic accuracy of various imaging modalities in detecting cancerous and precancerous lesions in people with focal pancreatic lesions. We searched the CENTRAL, MEDLINE, Embase, and Science Citation Index until 19 July 2016. We searched the references of included studies to identify further studies. We did not restrict studies based on language or publication status, or whether data were collected prospectively or retrospectively. We planned to include studies reporting cross-sectional information on the index test (CT (computed tomography), MRI (magnetic resonance imaging), PET (positron emission tomography), EUS (endoscopic ultrasound), EUS elastography, and EUS-guided biopsy or FNA (fine-needle aspiration)) and reference standard (confirmation of the nature of the lesion was obtained by histopathological examination of the entire lesion by surgical excision, or histopathological examination for confirmation of precancer or cancer by biopsy and clinical follow-up of at least six months in people with negative index tests) in people with pancreatic lesions irrespective of language or publication status or whether the data were collected prospectively or retrospectively. Two review authors independently searched the references to identify relevant studies and extracted the data. We planned to use the bivariate analysis to calculate the summary sensitivity and specificity with their 95% confidence intervals and the hierarchical summary receiver operating characteristic (HSROC) to compare the tests and assess heterogeneity, but used simpler models (such as univariate random-effects model and univariate fixed-effect model) for combining studies when appropriate because of the sparse data. We were unable to compare the diagnostic performance of the tests using formal statistical methods because of sparse data. We included 54 studies involving a total of 3,196 participants evaluating the diagnostic accuracy of various index tests. In these 54 studies, eight different target conditions were identified with different final diagnoses constituting benign, precancerous, and cancerous lesions. None of the studies was of high methodological quality. None of the comparisons in which single studies were included was of sufficiently high methodological quality to warrant highlighting of the results. For differentiation of cancerous lesions from benign or precancerous lesions, we identified only one study per index test. The second analysis, of studies differentiating cancerous versus benign lesions, provided three tests in which meta-analysis could be performed. The sensitivities and specificities for diagnosing cancer were: EUS-FNA: sensitivity 0.79 (95% confidence interval (CI) 0.07 to 1.00), specificity 1.00 (95% CI 0.91 to 1.00); EUS: sensitivity 0.95 (95% CI 0.84 to 0.99), specificity 0.53 (95% CI 0.31 to 0.74); PET: sensitivity 0.92 (95% CI 0.80 to 0.97), specificity 0.65 (95% CI 0.39 to 0.84). The third analysis, of studies differentiating precancerous or cancerous lesions from benign lesions, only provided one test (EUS-FNA) in which meta-analysis was performed. EUS-FNA had moderate sensitivity for diagnosing precancerous or cancerous lesions (sensitivity 0.73 (95% CI 0.01 to 1.00) and high specificity 0.94 (95% CI 0.15 to 1.00), the extremely wide confidence intervals reflecting the heterogeneity between the studies). The fourth analysis, of studies differentiating cancerous (invasive carcinoma) from precancerous (dysplasia) provided three tests in which meta-analysis was performed. The sensitivities and specificities for diagnosing invasive carcinoma were: CT: sensitivity 0.72 (95% CI 0.50 to 0.87), specificity 0.92 (95% CI 0.81 to 0.97); EUS: sensitivity 0.78 (95% CI 0.44 to 0.94), specificity 0.91 (95% CI 0.61 to 0.98); EUS-FNA: sensitivity 0.66 (95% CI 0.03 to 0.99), specificity 0.92 (95% CI 0.73 to 0.98). The fifth analysis, of studies differentiating cancerous (high-grade dysplasia or invasive carcinoma) versus precancerous (low- or intermediate-grade dysplasia) provided six tests in which meta-analysis was performed. The sensitivities and specificities for diagnosing cancer (high-grade dysplasia or invasive carcinoma) were: CT: sensitivity 0.87 (95% CI 0.00 to 1.00), specificity 0.96 (95% CI 0.00 to 1.00); EUS: sensitivity 0.86 (95% CI 0.74 to 0.92), specificity 0.91 (95% CI 0.83 to 0.96); EUS-FNA: sensitivity 0.47 (95% CI 0.24 to 0.70), specificity 0.91 (95% CI 0.32 to 1.00); EUS-FNA carcinoembryonic antigen 200 ng/mL: sensitivity 0.58 (95% CI 0.28 to 0.83), specificity 0.51 (95% CI 0.19 to 0.81); MRI: sensitivity 0.69 (95% CI 0.44 to 0.86), specificity 0.93 (95% CI 0.43 to 1.00); PET: sensitivity 0.90 (95% CI 0.79 to 0.96), specificity 0.94 (95% CI 0.81 to 0.99). The sixth analysis, of studies differentiating cancerous (invasive carcinoma) from precancerous (low-grade dysplasia) provided no tests in which meta-analysis was performed. The seventh analysis, of studies differentiating precancerous or cancerous (intermediate- or high-grade dysplasia or invasive carcinoma) from precancerous (low-grade dysplasia) provided two tests in which meta-analysis was performed. The sensitivity and specificity for diagnosing cancer were: CT: sensitivity 0.83 (95% CI 0.68 to 0.92), specificity 0.83 (95% CI 0.64 to 0.93) and MRI: sensitivity 0.80 (95% CI 0.58 to 0.92), specificity 0.81 (95% CI 0.53 to 0.95), respectively. The eighth analysis, of studies differentiating precancerous or cancerous (intermediate- or high-grade dysplasia or invasive carcinoma) from precancerous (low-grade dysplasia) or benign lesions provided no test in which meta-analysis was performed.There were no major alterations in the subgroup analysis of cystic pancreatic focal lesions (42 studies; 2086 participants). None of the included studies evaluated EUS elastography or sequential testing. We were unable to arrive at any firm conclusions because of the differences in the way that study authors classified focal pancreatic lesions into cancerous, precancerous, and benign lesions; the inclusion of few studies with wide confidence intervals for each comparison; poor methodological quality in the studies; and heterogeneity in the estimates within comparisons.

Prevalence of peptic ulcer in Iran: Systematic review and meta-analysis methods

PubMed Central

Sayehmiri, Kourosh; Abangah, Ghobad; Kalvandi, Gholamreza; Tavan, Hamed; Aazami, Sanaz

2018-01-01

Background: Peptic ulcer is a prevalent problem and symptoms include epigastria pain and heartburn. This study aimed at investigating the prevalence and causes of peptic ulcers in Iran using systematic review and meta-analysis. Materials and Methods: Eleven Iranian papers published from 2002 to 2016 are selected using valid keywords in the SID, Goggle scholar, PubMed and Elsevier databases. Results of studies pooled using random effects model in meta-analysis. The heterogeneity of the sample was checked using Q test and I2 index. Results: Total sample size in this study consist of 1335 individuals with peptic ulcer (121 samples per article). The prevalence of peptic ulcers was estimated 34% (95% CI= 0.25 – 0.43). The prevalence of peptic ulcers was 30% and 60% in woman and man respectively. The highest environmental factor (cigarette) has been addressed in 30% (95% CI= 0.23-0.37) of patients. The prevalence of Helicobacter pylori was estimated in 62% (95% CI= 0.49-0.75) of patients. Conclusion: The results of this study show that prevalence of peptic ulcers in Iran (34%) is higher that worldwide rate (6% to 15%). There was an increasing trend in the prevalence of peptic ulcer over a decade from 2002 to 2016. PMID:29456565

Nontargeted, Rapid Screening of Extra Virgin Olive Oil Products for Authenticity Using Near-Infrared Spectroscopy in Combination with Conformity Index and Multivariate Statistical Analyses.

PubMed

Karunathilaka, Sanjeewa R; Kia, Ali-Reza Fardin; Srigley, Cynthia; Chung, Jin Kyu; Mossoba, Magdi M

2016-10-01

A rapid tool for evaluating authenticity was developed and applied to the screening of extra virgin olive oil (EVOO) retail products by using Fourier-transform near infrared (FT-NIR) spectroscopy in combination with univariate and multivariate data analysis methods. Using disposable glass tubes, spectra for 62 reference EVOO, 10 edible oil adulterants, 20 blends consisting of EVOO spiked with adulterants, 88 retail EVOO products and other test samples were rapidly measured in the transmission mode without any sample preparation. The univariate conformity index (CI) and the multivariate supervised soft independent modeling of class analogy (SIMCA) classification tool were used to analyze the various olive oil products which were tested for authenticity against a library of reference EVOO. Better discrimination between the authentic EVOO and some commercial EVOO products was observed with SIMCA than with CI analysis. Approximately 61% of all EVOO commercial products were flagged by SIMCA analysis, suggesting that further analysis be performed to identify quality issues and/or potential adulterants. Due to its simplicity and speed, FT-NIR spectroscopy in combination with multivariate data analysis can be used as a complementary tool to conventional official methods of analysis to rapidly flag EVOO products that may not belong to the class of authentic EVOO. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Magnetic Resonance Imaging in the Prognostic Evaluation of Patients with Pulmonary Arterial Hypertension

PubMed Central

Capener, Dave; Johns, Chris; Hamilton, Neil; Rothman, Alex; Elliot, Charlie; Condliffe, Robin; Charalampopoulos, Athanasios; Rajaram, Smitha; Lawrie, Allan; Campbell, Michael J.; Wild, Jim M.; Kiely, David G.

2017-01-01

Rationale: Prognostication is important when counseling patients and defining treatment strategies in pulmonary arterial hypertension (PAH). Objectives: To determine the value of magnetic resonance imaging (MRI) metrics for prediction of mortality in PAH. Methods: Consecutive patients with PAH undergoing MRI were identified from the ASPIRE (Assessing the Spectrum of Pulmonary Hypertension Identified at a Referral Centre) pulmonary hypertension registry. Measurements and Main Results: During the follow-up period of 42 (range, 17–142) months 576 patients were studied and 221 (38%) died. A derivation cohort (n = 288; 115 deaths) and validation cohort (n = 288; 106 deaths) were identified. We used multivariate Cox regression and found two independent MRI predictors of death (P < 0.01): right ventricular end-systolic volume index adjusted for age and sex, and the relative area change of the pulmonary artery. A model of MRI and clinical data constructed from the derivation cohort predicted mortality in the validation cohort at 1 year (sensitivity, 70 [95% confidence interval (CI), 53–83]; specificity, 62 [95% CI, 62–68]; positive predictive value [PPV], 24 [95% CI, 16–32]; negative predictive value [NPV], 92 [95% CI, 87–96]) and at 3 years (sensitivity, 77 [95% CI, 67–85]; specificity, 73 [95% CI, 66–85]; PPV, 56 [95% CI, 47–65]; and NPV, 87 [95% CI, 81–92]). The model was more accurate in patients with idiopathic PAH at 3 years (sensitivity, 89 [95% CI, 65–84]; specificity, 76 [95% CI, 65–84]; PPV, 60 [95% CI, 46–74]; and NPV, 94 [95% CI, 85–98]). Conclusions: MRI measurements reflecting right ventricular structure and stiffness of the proximal pulmonary vasculature are independent predictors of outcome in PAH. In combination with clinical data MRI has moderate prognostic accuracy in the evaluation of patients with PAH. PMID:28328237

Intimate Partner Violence Is Associated with Stress-Related Sleep Disturbance and Poor Sleep Quality during Early Pregnancy

PubMed Central

Sanchez, Sixto E.; Islam, Suhayla; Zhong, Qiu-Yue; Gelaye, Bizu; Williams, Michelle A.

2016-01-01

Objectives To examine the associations of Intimate partner violence (IPV) with stress-related sleep disturbance (measured using the Ford Insomnia Response to Stress Test [FIRST]) and poor sleep quality (measured using the Pittsburgh Sleep Quality Index [PSQI]) during early pregnancy. Methods This cross-sectional study included 634 pregnant Peruvian women. In-person interviews were conducted in early pregnancy to collect information regarding IPV history, and sleep traits. Adjusted odds ratios (aOR) and 95% confidence intervals (95%CIs) were calculated using logistic regression procedures. Results Lifetime IPV was associated with a 1.54-fold increased odds of stress-related sleep disturbance (95% CI: 1.08–2.17) and a 1.93-fold increased odds of poor sleep quality (95% CI: 1.33–2.81). Compared with women experiencing no IPV during lifetime, the aOR (95% CI) for stress-related sleep disturbance associated with each type of IPV were: physical abuse only 1.24 (95% CI: 0.84–1.83), sexual abuse only 3.44 (95%CI: 1.07–11.05), and physical and sexual abuse 2.51 (95% CI: 1.27–4.96). The corresponding aORs (95% CI) for poor sleep quality were: 1.72 (95% CI: 1.13–2.61), 2.82 (95% CI: 0.99–8.03), and 2.50 (95% CI: 1.30–4.81), respectively. Women reporting any IPV in the year prior to pregnancy had increased odds of stress-related sleep disturbance (aOR = 2.07; 95% CI: 1.17–3.67) and poor sleep quality (aOR = 2.27; 95% CI: 1.30–3.97) during pregnancy. Conclusion Lifetime and prevalent IPV exposures are associated with stress-related sleep disturbance and poor sleep quality during pregnancy. Our findings suggest that sleep disturbances may be important mechanisms that underlie the lasting adverse effects of IPV on maternal and perinatal health. PMID:27023005

Hemodynamic response to exercise as measured by the solar IKG impedance cardiography module and correlation with metabolic variables.

PubMed

Ziegeler, Stephan; Grundmann, Ulrich; Fuerst, Oliver; Raddatz, Alexander; Kreuer, Sascha

2007-02-01

Impedance Cardiography (ICG) has been shown to be a feasible and accurate method for non-invasive measurement of cardiac index (CI). Aim of this investigation was the correlation of hemodynamic variables under exercise as measured by a specific ICG-monitor (Solar IKG-Modul, Version 3.0, GE-Healthcare, Freiburg, Germany) with metabolic variables. Ten healthy volunteers were included in the investigation doing ergometer exercise (5 min equilibration followed by 5 min each at 50, 75, 100 and 125 W). Hemodynamic parameters were obtained by ICG. Metabolic variables were assessed by indirect calorimetry with the Deltatrac II Metabolic monitor using a helmet system for spontaneous respiration. CI increased throughout exercise (baseline: 3.0 +/- 0.4 l/min/m(2); 125 W: 4.8 +/- 0.5 l/min/m(2)). Heart rate (baseline: 87.2 +/- 13.4 bpm; 125 W: 152.7 +/- 22.4 bpm) and contractility (velocity index) (baseline: 48.9 +/- 9.3/1000 s; 125 W: 70.5 +/- 10.0/1000 s) showed a continuous rise while the stroke index decreased after an initial rise (baseline: 35.0 +/- 4.6 ml/m(2); 50 W: 37.6 +/- 4.9 ml/m(2); 75 W: 41.2 +/- 5.9 ml/m(2); 125 W: 32.3 +/- 6.1 ml/m(2)). VO(2) (baseline: 335.2 +/- 84.1 ml/min; 125 W: 1298.9 +/- 282.3 ml/min) and VCO(2)(baseline: 255.4 +/- 74.5 ml/min; 125 W: 1342.5 +/- 282.5 ml/min) increased throughout exercise. There was a good correlation in the individual fits between hemodynamic and metabolic variables. CI in healthy volunteers, as measured by the Solar IKG-Modul, correlates well with O(2)-consumption and CO(2)-production in individual subjects, thus indicating the metabolic needs under exercise conditions in healthy individuals.

B-type natriuretic peptides and mortality after stroke

PubMed Central

García-Berrocoso, Teresa; Giralt, Dolors; Bustamante, Alejandro; Etgen, Thorleif; Jensen, Jesper K.; Sharma, Jagdish C.; Shibazaki, Kensaku; Saritas, Ayhan; Chen, Xingyong; Whiteley, William N.

2013-01-01

Objective: To measure the association of B-type natriuretic peptide (BNP) and N-terminal fragment of BNP (NT-proBNP) with all-cause mortality after stroke, and to evaluate the additional predictive value of BNP/NT-proBNP over clinical information. Methods: Suitable studies for meta-analysis were found by searching MEDLINE and EMBASE databases until October 26, 2012. Weighted mean differences measured effect size; meta-regression and publication bias were assessed. Individual participant data were used to estimate effects by logistic regression and to evaluate BNP/NT-proBNP additional predictive value by area under the receiver operating characteristic curves, and integrated discrimination improvement and categorical net reclassification improvement indexes. Results: Literature-based meta-analysis included 3,498 stroke patients from 16 studies and revealed that BNP/NT-proBNP levels were 255.78 pg/mL (95% confidence interval [CI] 105.10–406.47, p = 0.001) higher in patients who died; publication bias entailed the loss of this association. Individual participant data analysis comprised 2,258 stroke patients. After normalization of the data, patients in the highest quartile had double the risk of death after adjustment for clinical variables (NIH Stroke Scale score, age, sex) (odds ratio 2.30, 95% CI 1.32–4.01 for BNP; and odds ratio 2.63, 95% CI 1.75–3.94 for NT-proBNP). Only NT-proBNP showed a slight added value to clinical prognostic variables, increasing discrimination by 0.028 points (integrated discrimination improvement index; p < 0.001) and reclassifying 8.1% of patients into correct risk mortality categories (net reclassification improvement index; p = 0.003). Neither etiology nor time from onset to death affected the association of BNP/NT-proBNP with mortality. Conclusion: BNPs are associated with poststroke mortality independent of NIH Stroke Scale score, age, and sex. However, their translation to clinical practice seems difficult because BNP/NT-proBNP add only minor predictive value to clinical information. PMID:24186915

Mobile Phone Apps to Promote Weight Loss and Increase Physical Activity: A Systematic Review and Meta-Analysis

PubMed Central

Ferré-Grau, Carme; Montaña-Carreras, Xavier

2015-01-01

Background To our knowledge, no meta-analysis to date has assessed the efficacy of mobile phone apps to promote weight loss and increase physical activity. Objective To perform a systematic review and meta-analysis of studies to compare the efficacy of mobile phone apps compared with other approaches to promote weight loss and increase physical activity. Methods We conducted a systematic review and meta-analysis of relevant studies identified by a search of PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus from their inception through to August 2015. Two members of the study team (EG-F, GF-M) independently screened studies for inclusion criteria and extracted data. We included all controlled studies that assessed a mobile phone app intervention with weight-related health measures (ie, body weight, body mass index, or waist circumference) or physical activity outcomes. Net change estimates comparing the intervention group with the control group were pooled across studies using random-effects models. Results We included 12 articles in this systematic review and meta-analysis. Compared with the control group, use of a mobile phone app was associated with significant changes in body weight (kg) and body mass index (kg/m2) of -1.04 kg (95% CI -1.75 to -0.34; I2 = 41%) and -0.43 kg/m2 (95% CI -0.74 to -0.13; I2 = 50%), respectively. Moreover, a nonsignificant difference in physical activity was observed between the two groups (standardized mean difference 0.40, 95% CI -0.07 to 0.87; I2 = 93%). These findings were remarkably robust in the sensitivity analysis. No publication bias was shown. Conclusions Evidence from this study shows that mobile phone app-based interventions may be useful tools for weight loss. PMID:26554314

Role of LA Shape in Predicting Embolic Cerebrovascular Events in Mitral Stenosis

PubMed Central

Nunes, Maria Carmo P.; Handschumacher, Mark D.; Levine, Robert A.; Barbosa, Marcia M.; Carvalho, Vinicius T.; Esteves, William A.; Zeng, Xin; Guerrero, J. Luis; Zheng, Hui; Tan, Timothy C.; Hung, Judy

2015-01-01

OBJECTIVES This study was designed to assess the role of left atrial (LA) shape in predicting embolic cerebrovascular events (ECE) in patients with mitral stenosis (MS). BACKGROUND Patients with rheumatic MS are at increased risk for ECE. LA remodeling in response to MS involves not only chamber dilation but also changes in the shape. We hypothesized that a more spherical LA shape may be associated with increased embolic events due to predisposition to thrombus formation or to atrial arrhythmias compared with an elliptical-shaped LA of comparable volume. METHODS A total of 212 patients with MS and 20 control subjects were enrolled. LA volume, LA emptying fraction, and cross-sectional area were measured by 3-dimensional (3D) transthoracic echocardiography. LA shape was expressed as the ratio of measured LA end-systolic volume to hypothetical sphere volume ([4/3π r3] where r was obtained from 3D cross-sectional area). The lower the LA shape index, the more spherical the shape. RESULTS A total of 41 patients presented with ECE at the time of enrollment or during follow-up. On multivariate analysis, LA 3D emptying fraction (adjusted odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.92 to 0.99; p = 0.028) and LA shape index (OR: 0.73; 95% CI: 0.61 to 0.87; p < 0.001) emerged as important factors associated with ECE, after adjustment for age and anticoagulation therapy. In patients in sinus rhythm, LA shape index remained associated with ECE (OR: 0.79; 95% CI: 0.67 to 0.94; p = 0.007), independent of age and LA function. An in vitro phantom atrial model demonstrated more stagnant flow profiles in spherical compared with ellipsoidal chamber. CONCLUSIONS In rheumatic MS patients, differential LA remodeling affects ECE risk. A more spherical LA shape was independently associated with an increased risk for ECE, adding incremental value in predicting events beyond that provided by age and LA function. PMID:24831206

SU-F-T-455: Is Contouring the Whole Breast Necessary for Two-Field 3D Breast Planning?

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

Desai, A; Ku, Eric; Fang, D

Purpose: To investigate the effect of contouring the whole breast on reducing the radiation dose to the heart and affected lung in tangential field-in-field 3D breast planning. We hypothesize that contouring the whole breast will simplify the plan normalization process, reduce dose to critical structures, while maintaining treatment plan quality and consistency. Methods: Twenty previously treated breast cancer patients using tangential field-in-field 3D planning technique were randomly selected. The affected breast was contoured following the RTOG breast atlas guideline. Breast PTV was created by shrinking 5 mm from the breast contour. The same plan has been pasted to the newmore » contour and normalized to 95% of the Breast PTV receiving the prescribed isodose line. Lung V20 Gy% and Heart V25 Gy% were the primary study endpoints. Homogeneity Index (HI) and Conformity Index (CI) were calculated based on the following equations. HI= Dmax/ D95 and Nakamura’s Conformity Index= PIV/TVPIV × TV/TVPIV. Results: The average CI for previous plans was 1.68 vs. 1.66 for the new hybrid plan: both plans were conformal to the breast with similar quality. The HI for both the previous and the new hybrid plan was 1.24. Lung V 20% slightly increased from 4.27% to 4.82%. Heart V 25% for LT breast patients slightly decreased from 0.38% to 0.29%. Heart V 25% for RT breast patients was close to zero in both cases. Conclusion: With similar conformal and homogeneity indices for the plan quality, by contouring the whole breast following RTOG breast atlas guideline will simplify the planning process. The study showed that contouring the whole breast for patients with left-sided breast cancer reduced the heart V 25%, although not significantly, while maintaining the CI and HI. There was no measurable gain seen with whole breast contour for right-sided breast cancer patients.« less

Socioeconomic and Demographic Factors Affecting Body Mass Index of Adolescents Students Aged 10–19 in Ambo (a Rural Town) in Ethiopia

PubMed Central

Yetubie, Mesert; Haidar, Jemal; Kassa, Hailu; Fallon, Fleming

2010-01-01

Background: Body mass index (BMI) is a commonly used anthropometric measurement to estimate the level of nutritional indices (underweight/overweight) of adolescents and adults. Knowledge of the factors affecting BMI is essential for developing intervention programs. This study was conducted to measure BMI and determine the socioeconomic and demographic factors affecting the relative weight of adolescents living in rural districts in Ethiopia. Methods: A randomized cross-sectional study of 425 adolescent students living in the Ambo region of Ethiopia was conducted. A pre-tested questionnaire was used to collect the socioeconomic and demographic status of the participants. BMI (weight/height2, kg/m2) was measured and used as index of relative weight. Data were analyzed using SPSS version 15. A stepwise backward logistic regression analysis was applied to identify the major determinant abnormal weight of the adolescents while controlling for co-linearity. Results: The prevalence of underweight was 27.2% with male preponderance. The proportion of normal weight females was higher than that of males. There was no significant difference in the proportion of overweight males and females. Age, number of meals, parental education level, source of food, and number of cattle owned were correlated with being underweight. After adjusting for confounding variables only being a member of the younger age group (AOR=1.99; 95% CI=1.01 to 3.57), source of food (AOR=2.4; 95% CI=1.24 to 4.74), and a greater number of cattle owned (AOR=4.9; 95% CI=1.27 to 19.28 were positively correlated with being underweight. Conclusion: Younger age adolescents, those who come from homes with no or few cattle, and their parents purchased food were likely to be underweight. This study will help local governments, educators and community groups develop programs to assist underweight adolescents attending schools. PMID:23675209

Sagittal Abdominal Diameter as a Surrogate Marker of Insulin Resistance in an Admixtured Population--Brazilian Metabolic Syndrome Study (BRAMS).

PubMed

Vasques, Ana Carolina J; Cassani, Roberta S L; Forti, Adriana C e; Vilela, Brunna S; Pareja, José Carlos; Tambascia, Marcos Antonio; Geloneze, Bruno

2015-01-01

Sagittal abdominal diameter (SAD) has been proposed as a surrogate marker of insulin resistance (IR). However, the utilization of SAD requires specific validation for each ethnicity. We aimed to investigate the potential use of SAD, compared with classical anthropometrical parameters, as a surrogate marker of IR and to establish the cutoff values of SAD for screening for IR. A multicenter population survey on metabolic disorders was conducted. A race-admixtured sample of 824 adult women was assessed. The anthropometric parameters included: BMI, waist circumference (WC), waist-to-hip ratio and SAD. IR was determined by a hyperglycemic clamp and the HOMA-IR index. After adjustments for age and total body fat mass, SAD (r = 0.23 and r = -0.70) and BMI (r = 0.20 and r = -0.71) were strongly correlated with the IR measured by the HOMA-IR index and the clamp, respectively (p < 0.001). In the ROC analysis, the optimal cutoff for SAD in women was 21.0 cm. The women with an increased SAD presented 3.2 (CI 95%: 2.1-5.0) more likelihood of having IR, assessed by the HOMA-IR index compared with those with normal SAD (p < 0.001); whereas women with elevated BMI and WC were 2.1 (95% CI: 1.4-3.3) and 2.8 (95% CI: 1.7-4.5) more likely to have IR (p < 0.001), respectively. No statistically significant results were found for waist-to-hip ratio. SAD can be a suitable surrogate marker of IR. Understanding and applying routine and simplified methods is essential because IR is associated with an increased risk of obesity-related diseases even in the presence of normal weight, slight overweight, as well as in obesity. Further prospective analysis will need to verify SAD as a determinant of clinical outcomes, such as type 2 diabetes and cardiovascular events, in the Brazilian population.

SU-E-T-449: Hippocampal Sparing Radiotherapy Using Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy

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

Moon, S; Kyung Hee University Hospital at Gangdong, Gangdong-gu; Kim, D

2015-06-15

Purpose: The hippocampus sparing during the cranial irradiation has become interesting because it may mitigate radiation-induced neurocognitive toxicity. Herein we report our preliminary study for sparing the hippocampus with and without tilling condition for patient with brain metastases. Methods: Ten patients previously treated with whole brain were reviewed. Five patients tilted the head to around 30 degrees and others were treated without tilting. Treatment plans of linear accelerator (Linac)-based volumetric modulated arc therapy (VMAT) and intensity modulated radiotherapy (IMRT) were generated for prescription dose of 30 Gy in 15 fractions. Hippocampal avoidance regions were created with 5-mm volumetric expansion aroundmore » the hippocampus. Whole brain, hippocampus and hippocampal avoidance volume were 1372cm3, 6cm3 and 30cm3 and hippocampal avoidance volume was 2.2% of the whole brain planned target volume in average. Organs at risk (OARs) are hippocampus, eyes, lens, and cochleae. Coverage index (CVI), conformity index (CI), homogeneity index (HI) and mean dose to OARs were used to compare dose characteristic of tilted and non-tilted cases. Results: In IMRT, when CI, CVI and HI of whole brain were 0.88, 0.09 and 0.98 in both tilted and non-tilted cases, absorbed dose of hippocampal avoidance volume in tilted cases were 10% lower than non-tilted cases. Doses in other OARs such as eyes, lens, and cochleae were also decreased about 20% when tilting the head. When CI, HI and CVI in VMAT were 0.9, 0.08 and 0.99, the dose-decreased ratio of OARs in both with and without tilting cases were almost the same with IMRT. But absolute dose of hippocampal avoidance volume in VMAT was 30% lower than IMRT. Conclusion: This study confirms that dose to hippocampus decreases if patients tilt the head. When treating the whole brain with head tilted, patients can acquire the same successful treatment Result and also preserve their valuable memory.« less

Characteristics of Asthmatic Patients with and without Repeat Emergency Department Visits at an Inner City Hospital

PubMed Central

Pai, Sucheta; Mancuso, Carol A.; Loganathan, Raghu; Boutin-Foster, Carla; Basir, Riyad; Kanna, Balavenkatesh

2014-01-01

Objective The objective of this study was to document the frequency and clinical characteristics associated with repeat emergency department (ED) visits for asthma in an inner city population with a high burden of asthma. Methods During an ED visit for asthma in an inner city hospital (‘index visit’), patients completed a valid survey addressing disease and behavioral factors. Hospital records were reviewed for information about ED visits and hospitalizations for asthma during the 12 months before and the 90 days after the index visit. Results 192 patients were enrolled; the mean age was 42 years, 69% were women, 36% were black, 54% were Latino, 69% had Medicaid, and 17% were uninsured. 100 patients (52%) were treated and released from the ED, 88 patients (46%) were hospitalized, and 4 patients (2%) left against medical advice. During the subsequent 90 days, 64 patients (33%) had at least one repeat ED visit for asthma and 27 (14%) were hospitalized for asthma. In a multivariate model, more past ED visits (OR 1.7, 95% CI 1.4, 2.1; p<.0001) and male gender (OR 2.5, 95% CI 1.2, 5.4; p=.02) remained associated with having a repeat ED visit. Most patients had the first repeat ED visit within 30 days and 18 returned within only 7 days. Among all patients with a repeat visit, those who were not hospitalized for the index visit were more likely to have a repeat visit within 7 days (37%) compared to those who were hospitalized (17%) (p=.05 in multivariate analysis). Conclusions Repeat ED visits were prevalent among inner city asthma patients and most occurred shortly after the index visit. The strongest predictors of repeat visits were male gender and more ED visits in the 12 months before the index visit. PMID:24588683

Institutional racism and pregnancy health: using Home Mortgage Disclosure act data to develop an index for Mortgage discrimination at the community level.

PubMed

Mendez, Dara D; Hogan, Vijaya K; Culhane, Jennifer

2011-01-01

We used Home Mortgage Disclosure Act (HMDA) data to demonstrate a method for constructing a residential redlining index to measure institutional racism at the community level. We examined the application of the index to understand the social context of health inequities by applying the residential redlining index among a cohort of pregnant women in Philadelphia. We used HMDA data from 1999-2004 to create residential redlining indices for each census tract in Philadelphia County, Pennsylvania. We linked the redlining indices to data from a pregnancy cohort study and the 2000 Census. We spatially mapped the levels of redlining for each census tract for this pregnancy cohort and tested the association between residential redlining and other community-level measures of segregation and individual health. From 1999-2004, loan applicants in Philadelphia County, Pennsylvania, of black race/ethnicity were almost two times as likely to be denied a mortgage loan compared with applicants who were white (e.g., 1999 odds ratio [OR] = 2.00, 95% confidence interval [CI] 1.63, 2.28; and 2004 OR=2.26, 95% CI 1.98, 2.58). The majority (77.5%) of the pregnancy cohort resided in redlined neighborhoods, and there were significant differences in residence in redlined areas by race/ethnicity (p<0.001). Among the pregnancy cohort, redlining was associated with residential segregation as measured by the percentage of black population (r=0.155), dissimilarity (r=0.250), exposure (r=-0.115), and isolation (r=0.174) indices. The evidence of institutional racism may contribute to our understanding of health disparities. Residential redlining and mortgage discrimination against communities may be a major factor influencing neighborhood structure, composition, development, and wealth attainment. This residential redlining index as a measure for institutional racism can be applied in health research to understand the unique social and neighborhood contexts that contribute to health inequities.

Failure of a systemic lupus erythematosus response index developed from clinical trial data: lessons examined and learned.

PubMed

Forbess, L J; Bresee, C; Wallace, D J; Weisman, M H

2017-08-01

Background Our primary goal was to create an outcome change score index similar to a standard rheumatoid arthritis (RA) model utilizing real-world data in systemic lupus erythematosus (SLE) patients that occurred during their phase 3 trials with a Food and Drug Administration-approved drug. Methods We utilized raw data from trials of belimumab for the treatment of SLE. Data were split 80/20 into training/validation sets. Index variables present in a majority of patients and with face validity were selected. Variables were scored for each patient as percentage improvement from baseline after one year. The percentage of placebo- and drug-treated patients considered improved after the application of various criteria was ascertained. Logistic regression was employed to determine the ability of the new index to predict treatment assignment. Results A total of 1693 subjects had data for analyses. Eight variables were chosen: arthritis, rash, physician global assessment, fatigue, anti-double stranded DNA antibodies, C3, C4 and C-reactive protein. In the training dataset, ≥20% improvement in ≥4 of eight variables produced the largest difference between placebo- and drug-treated patients (22.1%) with an acceptable rate of improved placebo-treated patients (25%). This resulted in an odds ratio for belimumab (10 mg/kg) vs placebo of 2.7 (95% CI: 2.0-3.6; p < 0.001). However, in the validate dataset the odds ratio was not significant at 1.3 (95% CI: 0.8-2.2; p = 0.863). Conclusions The index created from training data did not achieve statistical significance when tested in the validation set. We have speculated why this happened. Is the lack of success of therapeutics for SLE caused by ineffective medications, study design and outcome instruments that fail to inform us, or is the heterogeneity of the disease too daunting? The lessons learned here can help direct future endeavors intended to improve SLE outcome instruments.

Changes in Aortic Pulse Wave Velocity and the Predictors of Improvement in Arterial Stiffness Following Aortic Valve Replacement

PubMed Central

Cantürk, Emir; Çakal, Beytullah; Karaca, Oğuz; Omaygenç, Onur; Salihi, Salih; Akçevin, Atıf

2017-01-01

Background: The interaction between valvular aortic stenosis (AS) and arterial stiffness, as well as the impact of aortic valve replacement (AVR) on arterial stiffness, remains unclear. In this study, we aimed to evaluate the degree of AS severity on non-invasive pulse wave velocity (PWV) measurements. We also searched whether the AVR procedure favorably affects PWV. Methods: In all, 38 patients undergoing AVR for chronic AS were included. The degree of aortic stiffness was measured with PWV at both baseline and 6 months after AVR. Improvement in aortic stiffness was defined as the absolute decrease in PWV at 6 months compared to the baseline value. Results: The study population had a mean age of 59 ± 16 years, mean aortic gradient of 47.1 ± 6.4 mmHg, and mean aortic valve area (AVA) index of 0.45 ± 0.11 cm2/m2. Baseline PWV values correlated positively with the mean aortic gradient (r = 0.350, p = 0.031) and negatively with the AVA index (r = −0.512, p = 0.001). The mean PWV improved in 20 patients (53%) and worsened in 18 patients (47%). The baseline New York Heart Association (NYHA) class (odds ratio [OR] = 1.023, 95% confidence interval [CI] = 1.005–1.041, p = 0.041) and AVA index (OR = 1.040, 96% CI = 1.023–1.057, p = 0.028) emerged as the independent predictors of improvement in PWV following AVR. Conclusion: The severity of AS was significantly associated with baseline PWV. In general, the mean PWV did not change with AVR. Baseline NYHA class and the AVA index independently predicted PWV improvement following AVR. Since the change in PWV after AVR was polarized based on the patients’ characteristics, such as preoperative NYHA functional class or AVA index, further studies are needed to confirm clinical significance of PWV change following AVR in severe AS patients. PMID:28890466

Multiple regression analysis of anthropometric measurements influencing the cephalic index of male Japanese university students.

PubMed

Hossain, Md Golam; Saw, Aik; Alam, Rashidul; Ohtsuki, Fumio; Kamarul, Tunku

2013-09-01

Cephalic index (CI), the ratio of head breadth to head length, is widely used to categorise human populations. The aim of this study was to access the impact of anthropometric measurements on the CI of male Japanese university students. This study included 1,215 male university students from Tokyo and Kyoto, selected using convenient sampling. Multiple regression analysis was used to determine the effect of anthropometric measurements on CI. The variance inflation factor (VIF) showed no evidence of a multicollinearity problem among independent variables. The coefficients of the regression line demonstrated a significant positive relationship between CI and minimum frontal breadth (p < 0.01), bizygomatic breadth (p < 0.01) and head height (p < 0.05), and a negative relationship between CI and morphological facial height (p < 0.01) and head circumference (p < 0.01). Moreover, the coefficient and odds ratio of logistic regression analysis showed a greater likelihood for minimum frontal breadth (p < 0.01) and bizygomatic breadth (p < 0.01) to predict round-headedness, and morphological facial height (p < 0.05) and head circumference (p < 0.01) to predict long-headedness. Stepwise regression analysis revealed bizygomatic breadth, head circumference, minimum frontal breadth, head height and morphological facial height to be the best predictor craniofacial measurements with respect to CI. The results suggest that most of the variables considered in this study appear to influence the CI of adult male Japanese students.

Does a better adherence to dietary guidelines reduce mortality risk and environmental impact in the Dutch sub-cohort of the European Prospective Investigation into Cancer and Nutrition?

PubMed

Biesbroek, Sander; Verschuren, W M Monique; Boer, Jolanda M A; van de Kamp, Mirjam E; van der Schouw, Yvonne T; Geelen, Anouk; Looman, Moniek; Temme, Elisabeth H M

2017-07-01

Guidelines for a healthy diet aim to decrease the risk of chronic diseases. It is unclear as to what extent a healthy diet is also an environmentally friendly diet. In the Dutch sub-cohort of the European Prospective Investigation into Cancer and Nutrition, the diet was assessed with a 178-item FFQ of 40 011 participants aged 20-70 years between 1993 and 1997. The WHO's Healthy Diet Indicator (HDI), the Dietary Approaches to Stop Hypertension (DASH) score and the Dutch Healthy Diet index 2015 (DHD15-index) were investigated in relation to greenhouse gas (GHG) emissions, land use and all-cause mortality risk. GHG emissions were associated with HDI scores (-3·7 % per sd increase (95 % CI -3·4, -4·0) for men and -1·9 % (95 % CI -0·4, -3·4) for women), with DASH scores in women only (1·1 % per sd increase, 95 % CI 0·9, 1·3) and with DHD15-index scores (-2·5 % per sd increase (95 % CI -2·2, -2·8) for men and -2·0 % (95 % CI -1·9, -2·2) for women). For all indices, higher scores were associated with less land use (ranging from -1·3 to -3·1 %). Mortality risk decreased with increasing scores for all indices. Per sd increase of the indices, hazard ratios for mortality ranged from 0·88 (95 % CI 0·82, 0·95) to 0·96 (95 % CI 0·92, 0·99). Our results showed that adhering to the WHO and Dutch dietary guidelines will lower the risk of all-cause mortality and moderately lower the environmental impact. The DASH diet was associated with lower mortality and land use, but because of high dairy product consumption in the Netherlands it was also associated with higher GHG emissions.