Prenatal exposure to low-level methylmercury alters the child's fine motor skills at the age of 18 months.

PubMed

Prpić, Igor; Milardović, Ana; Vlašić-Cicvarić, Inge; Špiric, Zdravko; Radić Nišević, Jelena; Vukelić, Petar; Snoj Tratnik, Janja; Mazej, Darja; Horvat, Milena

2017-01-01

To compare motor, cognitive and language characteristics in children aged 18 months who were prenatally exposed to low-level methyl-mercury (MeHg), and to analyze the eventual differences in these characteristics in relation to cord blood THg concentration. The total number of 205 child-mother pairs was included in the study, and total cord blood mercury was measured in 198 of them. Out of the 198 already measured samples, 47 of them have also been tested for methyl-mercury in cord blood. Data regarding the 47 samples of MeHg levels has been used for calculating the correlation between cord blood THg and cord blood MeHg. MeHg and THg showed a significant correlation (r=0.95, p<0.05). One month after the delivery, mothers were asked to complete the questionnaire regarding socioeconomic factors, breastfeeding of their infants, and dietary habits during pregnancy. Neurodevelopmental assessment of motor, cognitive and language skills were conducted on 168 children using The Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). Regarding the cord blood THg concentration, 135 children were divided in 4 quartile groups. Their neurodevelopmental characteristics have been compared. The cord blood THg concentration median and inter-quartile range was 2.98ng/g (1.41-5.61ng/g). There was a negative correlation between cord blood THg concentration and fine motor skills (rho=-0.22, p=0.01). It is evident that children grouped in 2nd ,3rd and 4th quartile had statistically significant lower fine motor skills assessment related to those grouped in 1st quartile (2nd quartile -1.24, p=0.03; 3rd quartile -1.28, p=0.03; 4th quartile -1.45, p=0.01). The differences in fine motor skills assessments between children in 2nd and 3rd and 3rd and 4th quartile were not statistically significant. Intrauterine exposure to low-level THg (MeHg) is associated with alterations in fine motor skills at the age of 18 months. Copyright © 2016. Published by Elsevier Inc.

Investigation of the relationship between ionospheric foF2 and earthquakes

NASA Astrophysics Data System (ADS)

Karaboga, Tuba; Canyilmaz, Murat; Ozcan, Osman

2018-04-01

Variations of the ionospheric F2 region critical frequency (foF2) have been investigated statistically before earthquakes during 1980-2008 periods in Japan area. Ionosonde data was taken from Kokubunji station which is in the earthquake preparation zone for all earthquakes. Standard Deviations and Inter-Quartile Range methods are applied to the foF2 data. It is observed that there are anomalous variations in foF2 before earthquakes. These variations can be regarded as ionospheric precursors and may be used for earthquake prediction.

Teaching program for the Unified Dyskinesia Rating Scale.

PubMed

Goetz, Christopher G; Nutt, John G; Stebbins, Glenn T; Chmura, Teresa A

2009-07-15

The Unified Dyskinesia Rating Scale (UDysRS) has been introduced as a comprehensive rating tool for the evaluation of dyskinesias in Parkinson's disease (PD). To enhance a uniform application, we developed a DVD-based training program with instructions, patient examples, and a certification exercise. For training on the objective assessment of dyskinesia, seventy PD patients spanning the gamut of dyskinesias (none to severe) were videotaped during four tasks of daily living (speaking, drinking from a cup, putting on a coat, and walking). Dyskinesia severity in seven body parts was rated by 20 international movement disorder specialists using the UDysRS for impairment. Each task was also rated for disability. Inter-rater reliability was assessed with generalized weighted kappa and intraclass correlation coefficients. For the teaching program, examples of each severity level and each body part were selected based on the criterion that they received a uniform rating (+/- 1 point) by at least 75% of the raters. For the certification exercise, four cases were selected to represent the four quartiles of overall objective UDysRS scores to reflect slight, mild, moderate, and severe dyskinesia. Each selection was based on the highest inter-rater reliability score for that quartile (minimum kappa or intraclass correlation coefficient = 0.6). UDysRS ranges for certification were calculated based on the 95% confidence interval. The teaching program lasts 41 min, and the certification exercise requires 10 min (total 51 min). This training program, based on visual examples of dyskinesia and anchored in scores generated by movement disorder experts is aimed at increasing homogeneity of ratings among and within raters and centers. Large-scale multicenter randomized clinical trials of dyskinesia treatment are strengthened by a uniform standard of scale application. 2009 Movement Disorder Society.

Caregivers' Attitude towards People with Mental Illness and Perceived Stigma: A Cross-Sectional Study in a Tertiary Hospital in Nepal.

PubMed

Neupane, Dipika; Dhakal, Sarmila; Thapa, Sabita; Bhandari, Parash Mani; Mishra, Shiva Raj

2016-01-01

Mental illness is stigmatized in most of the communities and people with such illness are often subjected to defame. Stigma impairs an individual's and their caregiver's physical, social and emotional wellbeing, and health-seeking behavior. Sufficient literature on how often the caregivers of people with mental illness from low and middle-income countries are stigmatized and how they perceive people with mental illness is unavailable. In this study, we examined caregivers' attitude towards people with mental illness and perceived stigma. We conducted face-to-face interviews with 170 caregivers in an outpatient clinic of a hospital in Nepal using a structured questionnaire. We calculated median and inter-quartile range of the attitude and perceived stigma scores. To assess the correlates, Kruskal Wallis H test and Mann Whitney U test were carried out. Overall median score for the domains: attitude (score range: 18-90) and perceived stigma (score range: 12-60) were 42 and 28 respectively, inter-quartile range being 8 each. Attitude score differed significantly by the sex of caregiver (p<0.05), educational status of caregiver (p<0.001), sex of patient (p<0.05) and type of mental illness (p<0.05). Perceived stigma score varied significantly by caregiver's sex (p<0.05), marital status (p<0.001), educational status (p<0.001), occupation (p<0.05), relation with the patient (p<0.005) and use of alternative treatment modalities (p<0.05). Sex of participant, educational status, sex of patient and type of mental illness were the correlates of attitude towards mental illness. Similarly, sex of participant, marital status, educational status, occupation, caregiver's relation with patient and use of alternative treatment modalities were correlates of perceived stigma. Findings of this study suggest that interventions targeting these high-risk populations might be beneficial to help build a positive attitude and overcome the perceived social stigma.

Caregivers’ Attitude towards People with Mental Illness and Perceived Stigma: A Cross-Sectional Study in a Tertiary Hospital in Nepal

PubMed Central

Neupane, Dipika; Dhakal, Sarmila; Thapa, Sabita; Bhandari, Parash Mani; Mishra, Shiva Raj

2016-01-01

Background Mental illness is stigmatized in most of the communities and people with such illness are often subjected to defame. Stigma impairs an individual’s and their caregiver’s physical, social and emotional wellbeing, and health-seeking behavior. Sufficient literature on how often the caregivers of people with mental illness from low and middle-income countries are stigmatized and how they perceive people with mental illness is unavailable. In this study, we examined caregivers’ attitude towards people with mental illness and perceived stigma. Methods We conducted face-to-face interviews with 170 caregivers in an outpatient clinic of a hospital in Nepal using a structured questionnaire. We calculated median and inter-quartile range of the attitude and perceived stigma scores. To assess the correlates, Kruskal Wallis H test and Mann Whitney U test were carried out. Results Overall median score for the domains: attitude (score range: 18–90) and perceived stigma (score range: 12–60) were 42 and 28 respectively, inter-quartile range being 8 each. Attitude score differed significantly by the sex of caregiver (p<0.05), educational status of caregiver (p<0.001), sex of patient (p<0.05) and type of mental illness (p<0.05). Perceived stigma score varied significantly by caregiver’s sex (p<0.05), marital status (p<0.001), educational status (p<0.001), occupation (p<0.05), relation with the patient (p<0.005) and use of alternative treatment modalities (p<0.05). Conclusion Sex of participant, educational status, sex of patient and type of mental illness were the correlates of attitude towards mental illness. Similarly, sex of participant, marital status, educational status, occupation, caregiver’s relation with patient and use of alternative treatment modalities were correlates of perceived stigma. Findings of this study suggest that interventions targeting these high-risk populations might be beneficial to help build a positive attitude and overcome the perceived social stigma. PMID:27336391

What causes EBRI retirement readiness ratings to vary: results from the 2014 Retirement Security Projection Model.

PubMed

VanDerhei, Jack

2014-02-01

RETIREMENT INCOME ADEQUACY IMPROVED SLIGHTLY IN 2013: Due to the increase in financial market and housing values during 2013, the probability that Baby Boomers and Generation Xers would NOT run short of money in retirement increases between 0.5 and 1.6 percentage points, based on the Employee Benefit Research Institute (EBRI) Retirement Readiness Ratings (RRRs). ELIGIBILITY FOR PARTICIPATION IN AN EMPLOYER-SPONSORED DEFINED CONTRIBUTION PLAN REMAINS ONE OF THE MOST IMPORTANT FACTORS FOR RETIREMENT INCOME ADEQUACY: RRR values double for Gen Xers in the lowest-income quartile when comparing those with 20 or more years of future eligibility with those with no years of future eligibility, while those in the middle income quartiles experience increases in RRR values by 27.1-30.3 percentage points. FUTURE SOCIAL SECURITY BENEFITS MAKE A HUGE DIFFERENCE FOR THE RETIREMENT INCOME ADEQUACY OF SOME HOUSEHOLDS, ESPECIALLY GEN XERS IN THE LOWEST-INCOME QUARTILE: If Social Security benefits are subject to proportionate decreases beginning in 2033 (according to the values in Figure 8), the RRR values for those households will drop by more than 50 percent: from 20.9 percent to 10.3 percent. LONGEVITY RISK AND STOCHASTIC HEALTH CARE RISK ARE ASSOCIATED WITH HUGE VARIATIONS IN RETIREMENT INCOME ADEQUACY: For both of these factors, a comparison between the most "risky" quartile with the least risky quartile shows a spread of approximately 30 percentage points for the lowest income range, approximately 25 to 40 percentage points for the highest income range, and even larger spreads for those in the middle income ranges. A GREAT DEAL OF THE VARIABILITY IN RETIREMENT INCOME ADEQUACY COULD BE MITIGATED BY APPROPRIATE RISK-MANAGEMENT TECHNIQUES AT OR NEAR RETIREMENT AGE: For example, the annuitization of a portion of the defined contribution and IRA balances may substantially increase the probability of not running short of money in retirement. Moreover, a well-functioning market in long-term care insurance would appear to provide an extremely useful technique to help control the volatility from the stochastic, long-term health care risk, especially for those in the middle income quartiles.

Factors associated with inter-institutional variations in sepsis rates of very-low-birth-weight infants in 34 Malaysian neonatal intensive care units

PubMed Central

Boo, Nem-Yun; Cheah, Irene Guat-Sim

2016-01-01

INTRODUCTION This study aimed to determine whether patient loads, infant status on admission and treatment interventions were significantly associated with inter-institutional variations in sepsis rates in very-low-birth-weight (VLBW) infants in the Malaysian National Neonatal Registry (MNNR). METHODS This was a retrospective study of 3,880 VLBW (≤ 1,500 g) infants admitted to 34 neonatal intensive care units (NICUs) in the MNNR. Sepsis was diagnosed in symptomatic infants with positive blood culture. RESULTS Sepsis developed in 623 (16.1%) infants; 61 (9.8%) had early-onset sepsis (EOS) and 562 (90.2%) had late-onset sepsis (LOS). The median EOS rate of all NICUs was 1.0% (interquartile range [IQR] 0%, 2.0%). Compared with NICUs reporting no EOS (n = 14), NICUs reporting EOS (n = 20) had significantly higher patient loads (total live births, admissions, VLBW infants, outborns); more mothers with a history of abortions, and antenatal steroids and intrapartum antibiotic use; more infants requiring resuscitation procedures at birth; higher rates of surfactant therapy, pneumonia and insertion of central venous catheters. The median LOS rate of all NICUs was 14.5% (IQR 7.8%, 19.2%). Compared with NICUs with LOS rates below the first quartile (n = 8), those above the third quartile (n = 8) used less intrapartum antibiotics, and had significantly bigger and more mature infants, more outborns, as well as a higher number of sick infants requiring ventilator support and total parenteral nutrition. CONCLUSION Patient loads, resuscitation at birth, status of infants on admission and treatment interventions were significantly associated with inter-institutional variations in sepsis. PMID:26996633

Factors associated with inter-institutional variations in sepsis rates of very-low-birth-weight infants in 34 Malaysian neonatal intensive care units.

PubMed

Boo, Nem-Yun; Cheah, Irene Guat-Sim

2016-03-01

This study aimed to determine whether patient loads, infant status on admission and treatment interventions were significantly associated with inter-institutional variations in sepsis rates in very-low-birth-weight (VLBW) infants in the Malaysian National Neonatal Registry (MNNR). This was a retrospective study of 3,880 VLBW (≤ 1,500 g) infants admitted to 34 neonatal intensive care units (NICUs) in the MNNR. Sepsis was diagnosed in symptomatic infants with positive blood culture. Sepsis developed in 623 (16.1%) infants; 61 (9.8%) had early-onset sepsis (EOS) and 562 (90.2%) had late-onset sepsis (LOS). The median EOS rate of all NICUs was 1.0% (interquartile range [IQR] 0%, 2.0%). Compared with NICUs reporting no EOS (n = 14), NICUs reporting EOS (n = 20) had significantly higher patient loads (total live births, admissions, VLBW infants, outborns); more mothers with a history of abortions, and antenatal steroids and intrapartum antibiotic use; more infants requiring resuscitation procedures at birth; higher rates of surfactant therapy, pneumonia and insertion of central venous catheters. The median LOS rate of all NICUs was 14.5% (IQR 7.8%, 19.2%). Compared with NICUs with LOS rates below the first quartile (n = 8), those above the third quartile (n = 8) used less intrapartum antibiotics, and had significantly bigger and more mature infants, more outborns, as well as a higher number of sick infants requiring ventilator support and total parenteral nutrition. Patient loads, resuscitation at birth, status of infants on admission and treatment interventions were significantly associated with inter-institutional variations in sepsis. Copyright: © Singapore Medical Association.

Risk factors associated with default among retreatment tuberculosis patients on DOTS in Paschim Medinipur district (West Bengal).

PubMed

Sarangi, S S; Dutt, D

2014-07-01

In India in 2010, 14.1% of retreatment of TB patients' treatment outcome was 'default'. Since 2002, in Paschim Midnapur District (West Bengal), it has been around 15-20%. To determine the timing, characteristics and risk factors associated with default among retreatment TB patients on DOTS. It was a case control study, conducted in six TB units (TU) of Paschim Midnapur District, which were selected by simple random sampling. Data was collected from treatment records of TUs/DTC. Data was also collected through interviews of the patients using the same pre-tested semi-structured questionnaire from 87 defaulters and 86 consecutively registered non-defaulters registered in first quarter, 2009 to second quarter, 2010. Median duration of treatment taken before default was 121 days (inter-quartile range of 64-176 days). Median number of doses of treatment taken before default was 36 (inter -quartile range of 26-63 doses). No retrieval action was documented in 57.5% cases. Retrieval was done between 0-7 days of missed doses in 29.9% cases. Multiple logistic regression analysis indicated the following important risk factors for default at 95% confidence interval: male-sex limit: [aOR 3.957 (1.162-13.469)], alcoholic inebriation[ aOR6.076 (2.088-17.675)], distance from DOT centre [aOR 4.066 (1.675-9.872)], number of missed doses during treatment [aOR 1.849 (1.282-2.669)] and no initial home visit [aOR 10.607 (2.286 -49.221)]. In Paschim Midnapur district, default of retreatment TB occurs mostly after a few doses in continuation phase. Initial home visit, patient provider meeting, retrieval action, community-based treatment as per RNTCP guidelines are required to uplift the programme.

A novel method for delivering ramped cooling reveals rat behaviours at innocuous and noxious temperatures: A comparative study of human psychophysics and rat behaviour.

PubMed

Dunham, James P; Hulse, Richard P; Donaldson, Lucy F

2015-07-15

Thermal sensory testing in rodents informs human pain research. There are important differences in the methodology for delivering thermal stimuli to humans and rodents. This is particularly true in cold pain research. These differences confound extrapolation and de-value nociceptive tests in rodents. We investigated cooling-induced behaviours in rats and psychophysical thresholds in humans using ramped cooling stimulation protocols. A Peltier device mounted upon force transducers simultaneously applied a ramped cooling stimulus whilst measuring contact with rat hind paw or human finger pad. Rat withdrawals and human detection, discomfort and pain thresholds were measured. Ramped cooling of a rat hind paw revealed two distinct responses: Brief paw removal followed by paw replacement, usually with more weight borne than prior to the removal (temperature inter-quartile range: 19.1 °C to 2.8 °C). Full withdrawal was evoked at colder temperatures (inter quartile range: -11.3 °C to -11.8 °C). The profile of human cool detection threshold and cold pain threshold were remarkably similar to that of the rat withdrawals behaviours. Previous rat cold evoked behaviours utilise static temperature stimuli. By utilising ramped cold stimuli this novel methodology better reflects thermal testing in patients. Brief paw removal in the rat is driven by non-nociceptive afferents, as is the perception of cooling in humans. This is in contrast to the nociceptor-driven withdrawal from colder temperatures. These findings have important implications for the interpretation of data generated in older cold pain models and consequently our understanding of cold perception and pain. Copyright © 2015. Published by Elsevier B.V.

Urinary Biomarkers for Phthalates Associated with Asthma in Norwegian Children

PubMed Central

Carlsen, Karin C. Lødrup; Calafat, Antonia M.; Hoppin, Jane A.; Håland, Geir; Mowinckel, Petter; Carlsen, Kai-Håkon; Løvik, Martinus

2012-01-01

Background: High-molecular-weight phthalates in indoor dust have been associated with asthma in children, but few studies have evaluated phthalate biomarkers in association with respiratory outcomes. Objectives: We explored the association between urinary concentrations of phthalate metabolites and current asthma. Methods: In a cross-sectional analysis, 11 metabolites of 8 phthalates [including four metabolites of di(2-ethylhexyl) phthalate] were measured in one first morning void collected from 2001 through 2004 from 623 10-year-old Norwegian children. Logistic regression models controlling for urine specific gravity, sex, parental asthma, and income were used to estimate associations between current asthma and phthalate metabolite concentrations by quartiles or as log10-transformed variables. Results: Current asthma was associated with both mono(carboxyoctyl) phthalate (MCOP) and mono(carboxynonyl) phthalate (MCNP), although the association was limited to those in the highest quartile of these chemicals. The adjusted odds ratio (aOR) for current asthma was 1.9 (95% CI: 1.0, 3.3) for the highest MCOP quartile compared with the lowest quartile, and 1.3 (95% CI: 0.98, 1.7) for an interquartile-range increase. The aOR for current asthma was 2.2 (95% CI: 1.2, 4.0) for the highest MCNP quartile and 1.3 (95% CI: 1.0, 1.7) for an interquartile-range increase. The other phthalate metabolites were not associated with current asthma. Conclusions: Current asthma was associated with the highest quartiles of MCOP and MCNP, metabolites of two high molecular weight phthalates, diisononyl phthalate and diisodecyl phthalate, respectively. Given the short biological half-life of the phthalates and the cross-sectional design, our findings should be interpreted cautiously. PMID:23164678

The InterLACE study: Design, data harmonization and characteristics across 20 studies on women's health.

PubMed

Mishra, Gita D; Chung, Hsin-Fang; Pandeya, Nirmala; Dobson, Annette J; Jones, Lee; Avis, Nancy E; Crawford, Sybil L; Gold, Ellen B; Brown, Daniel; Sievert, Lynette L; Brunner, Eric; Cade, Janet E; Burley, Victoria J; Greenwood, Darren C; Giles, Graham G; Bruinsma, Fiona; Goodman, Alissa; Hayashi, Kunihiko; Lee, Jung Su; Mizunuma, Hideki; Kuh, Diana; Cooper, Rachel; Hardy, Rebecca; Obermeyer, Carla Makhlouf; Lee, Kathryn A; Simonsen, Mette Kildevæld; Yoshizawa, Toyoko; Woods, Nancy F; Mitchell, Ellen S; Hamer, Mark; Demakakos, Panayotes; Sandin, Sven; Adami, Hans-Olov; Weiderpass, Elisabete; Anderson, Debra

2016-10-01

The International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events (InterLACE) project is a global research collaboration that aims to advance understanding of women's reproductive health in relation to chronic disease risk by pooling individual participant data from several cohort and cross-sectional studies. The aim of this paper is to describe the characteristics of contributing studies and to present the distribution of demographic and reproductive factors and chronic disease outcomes in InterLACE. InterLACE is an individual-level pooled study of 20 observational studies (12 of which are longitudinal) from ten countries. Variables were harmonized across studies to create a new and systematic synthesis of life-course data. Harmonized data were derived in three domains: 1) socio-demographic and lifestyle factors, 2) female reproductive characteristics, and 3) chronic disease outcomes (cardiovascular disease (CVD) and diabetes). InterLACE pooled data from 229,054 mid-aged women. Overall, 76% of the women were Caucasian and 22% Japanese; other ethnicities (of 300 or more participants) included Hispanic/Latin American (0.2%), Chinese (0.2%), Middle Eastern (0.3%), African/black (0.5%), and Other (1.0%). The median age at baseline was 47 years (Inter-quartile range (IQR): 41-53), and that at the last follow-up was 56 years (IQR: 48-64). Regarding reproductive characteristics, half of the women (49.8%) had their first menstruation (menarche) at 12-13 years of age. The distribution of menopausal status and the prevalence of chronic disease varied considerably among studies. At baseline, most women (57%) were pre- or peri-menopausal, 20% reported a natural menopause (range 0.8-55.6%) and the remainder had surgery or were taking hormones. By the end of follow-up, the prevalence rates of CVD and diabetes were 7.2% (range 0.9-24.6%) and 5.1% (range 1.3-13.2%), respectively. The scale and heterogeneity of InterLACE data provide an opportunity to strengthen evidence concerning the relationships between reproductive health through life and subsequent risks of chronic disease, including cross-cultural comparisons. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Characteristics of meta-analyses and their component studies in the Cochrane Database of Systematic Reviews: a cross-sectional, descriptive analysis

PubMed Central

2011-01-01

Background Cochrane systematic reviews collate and summarise studies of the effects of healthcare interventions. The characteristics of these reviews and the meta-analyses and individual studies they contain provide insights into the nature of healthcare research and important context for the development of relevant statistical and other methods. Methods We classified every meta-analysis with at least two studies in every review in the January 2008 issue of the Cochrane Database of Systematic Reviews (CDSR) according to the medical specialty, the types of interventions being compared and the type of outcome. We provide descriptive statistics for numbers of meta-analyses, numbers of component studies and sample sizes of component studies, broken down by these categories. Results We included 2321 reviews containing 22,453 meta-analyses, which themselves consist of data from 112,600 individual studies (which may appear in more than one meta-analysis). Meta-analyses in the areas of gynaecology, pregnancy and childbirth (21%), mental health (13%) and respiratory diseases (13%) are well represented in the CDSR. Most meta-analyses address drugs, either with a control or placebo group (37%) or in a comparison with another drug (25%). The median number of meta-analyses per review is six (inter-quartile range 3 to 12). The median number of studies included in the meta-analyses with at least two studies is three (inter-quartile range 2 to 6). Sample sizes of individual studies range from 2 to 1,242,071, with a median of 91 participants. Discussion It is clear that the numbers of studies eligible for meta-analyses are typically very small for all medical areas, outcomes and interventions covered by Cochrane reviews. This highlights the particular importance of suitable methods for the meta-analysis of small data sets. There was little variation in number of studies per meta-analysis across medical areas, across outcome data types or across types of interventions being compared. PMID:22114982

Buprenorphine and nor-buprenorphine levels in head hair samples from former heroin users under Suboxone® treatment.

PubMed

Belivanis, Stamatis; Tzatzarakis, Manolis N; Vakonaki, Elena; Kovatsi, Leda; Mantsi, Mary; Alegakis, Athanasios; Kavvalakis, Matthaios P; Vynias, Dionisios; Tsatsakis, Aristidis M

2014-06-01

In the current study, buprenorphine (BUP) and its major metabolite, nor-buprenorphine (NBUP), were determined in hair samples from former heroin users following Suboxone® treatment. Hair samples from 36 subjects were analyzed. The drugs of interest were isolated from hair by solid-liquid extraction with methanol and were determined by liquid chromatography-mass spectrometry, using an electrospray ionization interface. The analytical parameters of the method (such as linearity, limits of quantification, recovery, accuracy, and precision) were determined. The inter-quartile range of BUP levels was from 11.4 to 37.4 pg/mg (mean value 56.6 pg/mg) for the proximal hair segment, from 5.8 to 43.3 pg/mg for the middle hair segment (mean value 25.3 pg/mg), while a range from 4.3 to 33.9 pg/mg (mean value 105.2 pg/mg) for the distant to the root hair segment was determined. For NBUP the corresponding inter-quartile range was from 27.0 to 147.6 for the proximal segment (mean value 95.4 pg/mg), from 21.5 to 164.7 pg/mg for the middle segment (mean value 102.0 pg/mg) and from 20.4 to 103.6 pg/mg for the distant segment (mean value 156.8 pg/mg). The mean BUP/NBUP concentration ratio was 0.5. The daily dose of Suboxone® correlated significantly with BUP and NBUP levels in hair (p = 0.001 and p = 0.023) as well as with the BUP/NBUP ratio (p = 0.010). No significant correlation was found between the levels of BUP and NBUP and the duration of Suboxone® administration. The developed and validated method was successfully used for the determination of BUP and NBUP in hair samples collected from former heroin users under Suboxone® treatment. Copyright © 2014 John Wiley & Sons, Ltd.

The effect of incremental changes in phonotactic probability and neighborhood density on word learning by preschool children

PubMed Central

Storkel, Holly L.; Bontempo, Daniel E.; Aschenbrenner, Andrew J.; Maekawa, Junko; Lee, Su-Yeon

2013-01-01

Purpose Phonotactic probability or neighborhood density have predominately been defined using gross distinctions (i.e., low vs. high). The current studies examined the influence of finer changes in probability (Experiment 1) and density (Experiment 2) on word learning. Method The full range of probability or density was examined by sampling five nonwords from each of four quartiles. Three- and 5-year-old children received training on nonword-nonobject pairs. Learning was measured in a picture-naming task immediately following training and 1-week after training. Results were analyzed using multi-level modeling. Results A linear spline model best captured nonlinearities in phonotactic probability. Specifically word learning improved as probability increased in the lowest quartile, worsened as probability increased in the midlow quartile, and then remained stable and poor in the two highest quartiles. An ordinary linear model sufficiently described neighborhood density. Here, word learning improved as density increased across all quartiles. Conclusion Given these different patterns, phonotactic probability and neighborhood density appear to influence different word learning processes. Specifically, phonotactic probability may affect recognition that a sound sequence is an acceptable word in the language and is a novel word for the child, whereas neighborhood density may influence creation of a new representation in long-term memory. PMID:23882005

Fruit intake and incident diabetic retinopathy with type 2 diabetes.

PubMed

Tanaka, Shiro; Yoshimura, Yukio; Kawasaki, Ryo; Kamada, Chiemi; Tanaka, Sachiko; Horikawa, Chika; Ohashi, Yasuo; Araki, Atsushi; Ito, Hideki; Akanuma, Yasuo; Yamada, Nobuhiro; Yamashita, Hidetoshi; Sone, Hirohito

2013-03-01

Antioxidants and dietary fiber are postulated to have preventive effects on diabetic retinopathy, but evidence is lacking. We investigated this association in a cohort with type 2 diabetes 40-70 years of age with hemoglobin (Hb)A1C ≥6.5%, originally part of the Japan Diabetes Complications Study. After excluding people who did not respond to a dietary survey and patients with diabetic retinopathy or a major ocular disease at baseline, we analyzed 978 patients. Baseline dietary intake was assessed by a food frequency questionnaire based on food groups and 24-hour dietary records. Primary outcome was incident diabetic retinopathy determined using international severity scales. Mean fruit intake in quartiles ranged from 23 to 253 g/day, with increasing trends across quartiles of fruit intake for vitamin C, vitamin E, carotene, retinol equivalent, dietary fiber, potassium, and sodium. Mean energy intake ranged from 1644 to 1863 kcal/day, and fat intake was approximately 25%. HbA1C, body mass index, triglycerides, and systolic blood pressure were well controlled. During the 8-year follow-up, the numbers of incident cases of diabetic retinopathy from the first through the fourth quartiles of fruit intake were 83, 74, 69, and 59. Multivariate-adjusted hazard ratios for the second, third, and fourth quartiles of fruit intake compared with the first quartile were 0.66 (95% confidence interval = 0.46-0.92), 0.59 (0.41-0.85), and 0.48 (0.32-0.71) (test for trend, P < 0.01). There was no substantial effect modification by age, sex, HbA1C, diabetes duration, overweight, smoking, and hypertension. Risk for diabetic retinopathy declined with increased intake of fruits and vegetables, vitamin C, and carotene. Increased fruit intake in ranges commonly consumed was associated with reduced incident diabetic retinopathy among patients adhering to a low-fat energy-restricted diet.

Medical and Genetic Differences in the Adverse Impact of Sleep Loss on Performance: Ethical Considerations for the Medical Profession

PubMed Central

Czeisler, Charles A.

2009-01-01

The Institute of Medicine recently concluded that-on average-medical residents make more serious medical errors and have more motor vehicle crashes when they are deprived of sleep. In the interest of public safety, society has required limitations on work hours in many other safety sensitive occupations, including transportation and nuclear power generation. Those who argue in favor of traditional extended duration resident work hours often suggest that there are inter- individual differences in response to acute sleep loss or chronic sleep deprivation, implying that physicians may be more resistant than the average person to the detrimental effects of sleep deprivation on performance, although there is no evidence that physicians are particularly resistant to such effects. Indeed, recent investigations have identified genetic polymorphisms that may convey a relative resistance to the effects of prolonged wakefulness on a subset of the healthy population, although there is no evidence that physicians are over-represented in this cohort. Conversely, there are also genetic polymorphisms, sleep disorders and other inter-individual differences that appear to convey an increased vulnerability to the performance-impairing effects of 24 hours of wakefulness. Given the magnitude of inter-individual differences in the effect of sleep loss on cognitive performance, and the sizeable proportion of the population affected by sleep disorders, hospitals face a number of ethical dilemmas. How should the work hours of physicians be limited to protect patient safety optimally? For example, some have argued that, in contrast to other professions, work schedules that repeatedly induce acute and chronic sleep loss are uniquely essential to the training of physicians. If evidence were to prove this premise to be correct, how should such training be ethically accomplished in the quartile of physicians and surgeons who are most vulnerable to the effects of sleep loss on performance without unacceptably compromising patient safety? Moreover, once it is possible to identify reliably those most vulnerable to the adverse effects of sleep loss on performance, will academic medical centers have an obligation to evaluate the proficiency of both residents and staff physicians under conditions of acute and chronic sleep deprivation? Should work-hour policy limits be modified to ensure that they are not hazardous for the patients of the most vulnerable quartile of physicians, or should the limits be personalized to enable the most resistant quartile to work longer hours? Given that the prevalence of sleep disorders has increased in our society overall, and increases markedly with age, how should fitness for extended duration work hours be monitored over a physician's career? In the spirit of the dictum to do no harm, advances in understanding the medical and genetic basis of inter-individual differences in the performance vulnerability to sleep loss should be incorporated into the development of work-hour policy limits for both physicians and surgeons. PMID:19768182

Medical and genetic differences in the adverse impact of sleep loss on performance: ethical considerations for the medical profession.

PubMed

Czeisler, Charles A

2009-01-01

The Institute of Medicine recently concluded that-on average-medical residents make more serious medical errors and have more motor vehicle crashes when they are deprived of sleep. In the interest of public safety, society has required limitations on work hours in many other safety sensitive occupations, including transportation and nuclear power generation. Those who argue in favor of traditional extended duration resident work hours often suggest that there are inter- individual differences in response to acute sleep loss or chronic sleep deprivation, implying that physicians may be more resistant than the average person to the detrimental effects of sleep deprivation on performance, although there is no evidence that physicians are particularly resistant to such effects. Indeed, recent investigations have identified genetic polymorphisms that may convey a relative resistance to the effects of prolonged wakefulness on a subset of the healthy population, although there is no evidence that physicians are over-represented in this cohort. Conversely, there are also genetic polymorphisms, sleep disorders and other inter-individual differences that appear to convey an increased vulnerability to the performance-impairing effects of 24 hours of wakefulness. Given the magnitude of inter-individual differences in the effect of sleep loss on cognitive performance, and the sizeable proportion of the population affected by sleep disorders, hospitals face a number of ethical dilemmas. How should the work hours of physicians be limited to protect patient safety optimally? For example, some have argued that, in contrast to other professions, work schedules that repeatedly induce acute and chronic sleep loss are uniquely essential to the training of physicians. If evidence were to prove this premise to be correct, how should such training be ethically accomplished in the quartile of physicians and surgeons who are most vulnerable to the effects of sleep loss on performance without unacceptably compromising patient safety? Moreover, once it is possible to identify reliably those most vulnerable to the adverse effects of sleep loss on performance, will academic medical centers have an obligation to evaluate the proficiency of both residents and staff physicians under conditions of acute and chronic sleep deprivation? Should work-hour policy limits be modified to ensure that they are not hazardous for the patients of the most vulnerable quartile of physicians, or should the limits be personalized to enable the most resistant quartile to work longer hours? Given that the prevalence of sleep disorders has increased in our society overall, and increases markedly with age, how should fitness for extended duration work hours be monitored over a physician's career? In the spirit of the dictum to do no harm, advances in understanding the medical and genetic basis of inter-individual differences in the performance vulnerability to sleep loss should be incorporated into the development of work-hour policy limits for both physicians and surgeons.

The Association between genetic variations of CHI3L1, levels of the encoded glycoprotein YKL-40 and the lipid profile in a Danish population.

PubMed

Thomsen, Stine Brinkløv; Rathcke, Camilla Noelle; Skaaby, Tea; Linneberg, Allan; Vestergaard, Henrik

2012-01-01

The inflammatory biomarker YKL-40 seems to play a role in atherosclerosis and is elevated in patients with obesity, cardiovascular disease and type 2 diabetes. Single nucleotide polymorphisms (SNPs) of the YKL-40 encoding gene, CHI3L1, are associated with inter-individual YKL-40 levels. One study has described an association between a promoter polymorphism of CHI3L1 and levels of low density lipoprotein. The objective of this study was to evaluate the influence of YKL-40 on lipid parameters by determining the association between polymorphisms of CHI3L1, serum YKL-40 and levels of the differentiated lipid profile in a Danish general population. 12 SNPs of CHI3L1 were genotyped, and serum YKL-40 and parameters of the lipid profile were measured in 2,656 Danes. Lipid profile and genotypes were available in another Danish population (n = 6,784) for replication. Cholesterol and triglyceride levels increased with increasing YKL-40 quartile (both p<0.0001), and YKL-40 correlated with triglyceride levels (β = 0.15, p<0.0001). Low density lipoprotein levels increased slightly from the 1(st) to the 3(rd) quartile (p = 0.006). The highest YKL-40 quartile was associated with a greater risk of hypercholesterolemia compared to the lowest YKL-40 quartile (odds ratio 1.36, p = 0.009). Minor homozygosity of rs12123883 was associated with higher triglyceride levels (p = 0.022) and a higher prevalence of low high density lipoprotein (p = 0.012), but these associations could not be confirmed in the replication population. Serum YKL-40 correlates with triglyceride levels in a representative group of the general Danish population. No consistent associations between SNPs of CHI3L1 and lipid levels could be documented.

The addition of locust bean gum but not water delayed the gastric emptying rate of a nutrient semisolid meal in healthy subjects

PubMed Central

Darwiche, Gassan; Björgell, Ola; Almér, Lars-olof

2003-01-01

Background Most of the previous studies regarding the effects of gel-forming fibres have considered the gastric emptying of liquid or solid meals after the addition of pectin or guar gum. The influence of locust bean gum, on gastric emptying of nutrient semisolid meals in humans has been less well studied, despite its common occurrence in foods. Using a standardised ultrasound method, this study was aimed at investigating if the gastric emptying in healthy subjects could be influenced by adding locust been gum, a widely used thickening agent, or water directly into a nutrient semisolid test meal. Methods The viscosity of a basic test meal (300 g rice pudding, 330 kcal) was increased by adding Nestargel (6 g, 2.4 kcal), containing viscous dietary fibres (96.5%) provided as seed flour of locust bean gum, and decreased by adding 100 ml of water. Gastric emptying of these three test meals were evaluated in fifteen healthy non-smoking volunteers, using ultrasound measurements of the gastric antral area to estimate the gastric emptying rate (GER). Results The median value of GER with the basic test meal (rice pudding) was estimated at 63 %, (range 47 to 84 %), (the first quartile = 61 %, the third quartile = 69 %). Increasing the viscosity of the rice pudding by adding Nestargel, resulted in significantly lower gastric emptying rates (p < 0.01), median GER 54 %, (range 7 to 71 %), (the first quartile = 48 %, the third quartile = 60 %). When the viscosity of the rice pudding was decreased (basic test meal added with water), the difference in median GER 65 %, (range 38 to 79 %), (the first quartile = 56 %, the third quartile = 71 %) was not significantly different (p = 0.28) compared to the GER of the basic test meal. Conclusions We conclude that the addition of locust bean gum to a nutrient semisolid meal has a major impact on gastric emptying by delaying the emptying rate, but that the addition of water to this test meal has no influence on gastric emptying in healthy subjects. PMID:12793910

The addition of locust bean gum but not water delayed the gastric emptying rate of a nutrient semisolid meal in healthy subjects.

PubMed

Darwiche, Gassan; Björgell, Ola; Almér, Lars-Olof

2003-06-06

Most of the previous studies regarding the effects of gel-forming fibres have considered the gastric emptying of liquid or solid meals after the addition of pectin or guar gum. The influence of locust bean gum, on gastric emptying of nutrient semisolid meals in humans has been less well studied, despite its common occurrence in foods. Using a standardised ultrasound method, this study was aimed at investigating if the gastric emptying in healthy subjects could be influenced by adding locust been gum, a widely used thickening agent, or water directly into a nutrient semisolid test meal. The viscosity of a basic test meal (300 g rice pudding, 330 kcal) was increased by adding Nestargel (6 g, 2.4 kcal), containing viscous dietary fibres (96.5%) provided as seed flour of locust bean gum, and decreased by adding 100 ml of water. Gastric emptying of these three test meals were evaluated in fifteen healthy non-smoking volunteers, using ultrasound measurements of the gastric antral area to estimate the gastric emptying rate (GER). The median value of GER with the basic test meal (rice pudding) was estimated at 63%, (range 47 to 84%), (the first quartile = 61%, the third quartile = 69%). Increasing the viscosity of the rice pudding by adding Nestargel, resulted in significantly lower gastric emptying rates (p < 0.01), median GER 54%, (range 7 to 71%), (the first quartile = 48%, the third quartile = 60%). When the viscosity of the rice pudding was decreased (basic test meal added with water), the difference in median GER 65%, (range 38 to 79%), (the first quartile = 56%, the third quartile = 71%) was not significantly different (p = 0.28) compared to the GER of the basic test meal. We conclude that the addition of locust bean gum to a nutrient semisolid meal has a major impact on gastric emptying by delaying the emptying rate, but that the addition of water to this test meal has no influence on gastric emptying in healthy subjects.

Study on the association between residential exposure to N, N-dimethylformamide and hospitalization for respiratory disease

NASA Astrophysics Data System (ADS)

Wang, Cui; Tian, WeiLi; Wei, YuMei; Li, XiaoXiao; Zhang, QingYu; Huang, ChanKe

2013-10-01

Some studies have confirmed the adverse effects of N, N-dimethylformamide (DMF) on the different organs in occupational exposure workers. However, to the best of our knowledge, risk assessment in the general population has not been available. In this study, a time series analysis of the relationship between DMF exposure and respiratory hospitalization was performed in Longwan district of China in 2008. Generalized additive model (GAMs) reflected that a 101.0 μg m-3 (inter-quartile range) increase in the 1-day lag concentration of DMF resulted in a 1.17 (95% CI: 1.09-1.25) increased relative risk of hospitalization for respiratory problems. The dose-response curve representing the relationship between DMF and the logarithm of the number of hospitalization was adequately linear at 4-200 μg m-3. We proposed a risk on respiratory disease in non-occupational DMF exposure. More information is required to verify this observation and the other endpoints to general population should be investigated during long-term DMF exposure.

Factors Associated with Delayed Tuberculosis Test-seeking Behavior in the Peruvian Amazon

PubMed Central

Ford, Carolyn M.; Bayer, Angela M.; Gilman, Robert H.; Onifade, Dami; Acosta, Colleen; Cabrera, Lilia; Vidal, Carlos; Evans, Carlton A.

2010-01-01

This study aimed to determine the psychosocial factors associated with delayed test-seeking among tuberculosis patients. The duration of symptoms before seeking medical care was assessed by interview for 108 newly diagnosed pulmonary tuberculosis patients in the city of Iquitos in the Peruvian Amazon, which has high tuberculosis incidence. Beliefs associated with test-seeking behavior and delay was assessed in these patients. The median delay from symptom onset to seeking diagnostic testing was 61 days (inter-quartile range 30–91 days). The belief that tuberculosis is curable was associated with a 100% longer test-seeking delay; the perception that tuberculosis was common was associated with a 57% longer delay; male gender was associated with a 48% longer delay; and education less than complete secondary schooling was associated with a 44% longer delay. In conclusion, current health promotion activities that emphasize tuberculosis curability and high prevalence may paradoxically increase test-seeking delay and therefore require prospective evaluation. PMID:19996443

The InterLACE study: Design, data harmonization and characteristics across 20 studies on women’s health

PubMed Central

Mishra, Gita D.; Chung, Hsin-Fang; Pandeya, Nirmala; Dobson, Annette J.; Jones, Lee; Avis, Nancy E.; Crawford, Sybil L.; Gold, Ellen B.; Brown, Daniel; Sievert, Lynette L.; Brunner, Eric; Cade, Janet E.; Burley, Victoria J.; Greenwood, Darren C.; Giles, Graham G.; Bruinsma, Fiona; Goodman, Alissa; Hayashi, Kunihiko; Lee, Jung Su; Mizunuma, Hideki; Kuh, Diana; Cooper, Rachel; Hardy, Rebecca; Obermeyer, Carla Makhlouf; Lee, Kathryn A.; Simonsen, Mette Kildevæld; Yoshizawa, Toyoko; Woods, Nancy F.; Mitchell, Ellen S.; Hamer, Mark; Demakakos, Panayotes; Sandin, Sven; Adami, Hans-Olov; Weiderpass, Elisabete; Anderson, Debra

2017-01-01

Objectives The International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events (InterLACE) project is a global research collaboration that aims to advance understanding of women’s reproductive health in relation to chronic disease risk by pooling individual participant data from several cohort and cross-sectional studies. The aim of this paper is to describe the characteristics of contributing studies and to present the distribution of demographic and reproductive factors and chronic disease outcomes in InterLACE. Study design InterLACE is an individual-level pooled study of 20 observational studies (12 of which are longitudinal) from ten countries. Variables were harmonized across studies to create a new and systematic synthesis of life-course data. Main outcome measures Harmonized data were derived in three domains: 1) socio-demographic and lifestyle factors, 2) female reproductive characteristics, and 3) chronic disease outcomes (cardiovascular disease (CVD) and diabetes). Results InterLACE pooled data from 229,054 mid-aged women. Overall, 76% of the women were Caucasian and 22% Japanese; other ethnicities (of 300 or more participants) included Hispanic/Latin American (0.2%), Chinese (0.2%), Middle Eastern (0.3%), African/black (0.5%), and Other (1.0%). The median age at baseline was 47 years (Inter-quartile range (IQR): 41–53), and that at the last follow-up was 56 years (IQR: 48–64). Regarding reproductive characteristics, half of the women (49.8%) had their first menstruation (menarche) at 12–13 years of age. The distribution of menopausal status and the prevalence of chronic disease varied considerably among studies. At baseline, most women (57%) were pre- or peri-menopausal, 20% reported a natural menopause (range 0.8–55.6%) and the remainder had surgery or were taking hormones. By the end of follow-up, the prevalence rates of CVD and diabetes were 7.2% (range 0.9–24.6%) and 5.1% (range 1.3–13.2%), respectively. Conclusions The scale and heterogeneity of InterLACE data provide an opportunity to strengthen evidence concerning the relationships between reproductive health through life and subsequent risks of chronic disease, including cross-cultural comparisons. PMID:27621257

Using democracy to award research funding: an observational study.

PubMed

Barnett, Adrian G; Clarke, Philip; Vaquette, Cedryck; Graves, Nicholas

2017-01-01

Winning funding for health and medical research usually involves a lengthy application process. With success rates under 20%, much of the time spent by 80% of applicants could have been better used on actual research. An alternative funding system that could save time is using democracy to award the most deserving researchers based on votes from the research community. We aimed to pilot how such a system could work and examine some potential biases. We used an online survey with a convenience sample of Australian researchers. Researchers were asked to name the 10 scientists currently working in Australia that they thought most deserved funding for future research. For comparison, we used recent winners from large national fellowship schemes that used traditional peer review. Voting took a median of 5 min (inter-quartile range 3 to 10 min). Extrapolating to a national voting scheme, we estimate 599 working days of voting time (95% CI 490 to 728), compared with 827 working days for the current peer review system for fellowships. The gender ratio in the votes was a more equal 45:55 (female to male) compared with 34:66 in recent fellowship winners, although this could be explained by Simpson's paradox. Voters were biased towards their own institution, with an additional 1.6 votes per ballot (inter-quartile range 0.8 to 2.2) above the expected number. Respondents raised many concerns about the idea of using democracy to fund research, including vote rigging, lobbying and it becoming a popularity contest. This is a preliminary study of using voting that does not investigate many of the concerns about how a voting system would work. We were able to show that voting would take less time than traditional peer review and would spread the workload over many more reviewers. Further studies of alternative funding systems are needed as well as a wide discussion with the research community about potential changes.

Spatial representation of organic carbon and active-layer thickness of high latitude soils in CMIP5 earth system models

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

Mishra, Umakant; Drewniak, Beth; Jastrow, Julie D.

Soil properties such as soil organic carbon (SOC) stocks and active-layer thickness are used in earth system models (F.SMs) to predict anthropogenic and climatic impacts on soil carbon dynamics, future changes in atmospheric greenhouse gas concentrations, and associated climate changes in the permafrost regions. Accurate representation of spatial and vertical distribution of these soil properties in ESMs is a prerequisite for redudng existing uncertainty in predicting carbon-climate feedbacks. We compared the spatial representation of SOC stocks and active-layer thicknesses predicted by the coupled Modellntercomparison Project Phase 5 { CMIP5) ESMs with those predicted from geospatial predictions, based on observation datamore » for the state of Alaska, USA. For the geospatial modeling. we used soil profile observations {585 for SOC stocks and 153 for active-layer thickness) and environmental variables (climate, topography, land cover, and surficial geology types) and generated fine-resolution (50-m spatial resolution) predictions of SOC stocks (to 1-m depth) and active-layer thickness across Alaska. We found large inter-quartile range (2.5-5.5 m) in predicted active-layer thickness of CMIP5 modeled results and small inter-quartile range (11.5-22 kg m-2) in predicted SOC stocks. The spatial coefficient of variability of active-layer thickness and SOC stocks were lower in CMIP5 predictions compared to our geospatial estimates when gridded at similar spatial resolutions (24.7 compared to 30% and 29 compared to 38%, respectively). However, prediction errors. when calculated for independent validation sites, were several times larger in ESM predictions compared to geospatial predictions. Primaly factors leading to observed differences were ( 1) lack of spatial heterogeneity in ESM predictions, (2) differences in assumptions concerning environmental controls, and (3) the absence of pedogenic processes in ESM model structures. Our results suggest that efforts to incorporate these factors in F.SMs should reduce current uncertainties associated with ESM predictions of carbon-climate feedbacks.« less

Why do dentists struggle with removable partial denture design? An assessment of financial and educational issues.

PubMed

Lynch, C D; Allen, P F

2006-03-11

Published studies in the international dental literature illustrate that the quality of prescription and fabrication of cobalt-chromium removable partial dentures (CCRPDs) by general dental practitioners frequently fail to comply with ethical and legal requirements. The reasons cited for this in the past have broadly related to either financial or educational issues. The aim of this investigation is to determine the effect of financial and educational factors on the quality of CCRPD design and fabrication by general dental practitioners. This investigation was completed in two parts. (1) A pre-piloted pro-forma was distributed to a number of dental laboratories throughout the UK and Ireland. These sought information relating to the quality of written instructions for CCRPDs received by these laboratories, and details of the remunerative scheme under which they were being provided. Three categories of remunerative scheme were considered, private CCRPDs in Ireland, private CCRPDs in the UK, and CCRPDs being provided by salaried NHS practitioners. (2) A pre-piloted questionnaire was distributed to vocational dental practitioners in the UK and Ireland. This sought information relating to their attitudes, opinions, and educational and clinical experiences of CCRPD design and fabrication. (1) Three hundred completed pro-formas were returned from dental laboratories, 100 of which related to each of the three remunerative schemes. Poor or no written instructions were provided in 47% (n = 47) of CCRPD cases funded privately in the UK, 46% (n = 46) of CCRPD cases funded privately in Ireland, and 50% (n = 50) of CCRPDs being provided by salaried NHS practitioners. (2) One hundred and seven completed questionnaires were returned from vocational trainees. Vocational dental practitioners had completed fewer CCRPDs during VT than in dental school (dental school: median = 4, inter-quartile range = 3 to 5; VT: median = 2, inter-quartile range = 1 to 4). One-fifth of respondents (n = 22) had not completed any CCRPDs during VT. Nine per cent of VT practices (n = 10) had a surveyor on their premises. Only 15% (n = 16) of respondents felt the time they had spent in VT had increased their confidence in the design of CCRPDs. Financial factors did not have as significant an effect on the quality of prescription and fabrication of CCRPDs as did educational factors. Serious deficiencies in the teaching of CCRPDs during vocational training were identified.

Infant feeding-related maternity care practices and maternal report of breastfeeding outcomes.

PubMed

Nelson, Jennifer M; Perrine, Cria G; Freedman, David S; Williams, Letitia; Morrow, Brian; Smith, Ruben A; Dee, Deborah L

2018-02-07

Evidence-based maternity practices and policies can improve breastfeeding duration and exclusivity. Maternity facilities report practices through the Maternity Practices in Infant Nutrition and Care (mPINC) survey, but individual outcomes, such as breastfeeding duration and exclusivity, are not collected. mPINC data on maternity care practices for 2009 were linked to data from the 2009 Pregnancy Risk Assessment Monitoring System (PRAMS), which collects information on mothers' behaviors and experiences around pregnancy. We calculated total mPINC scores (range 0-100). PRAMS data on any and exclusive breastfeeding at 8 weeks were examined by total mPINC score quartile. Of 15 715 women in our sample, 53.7% were breastfeeding any at 8 weeks, and 29.3% were breastfeeding exclusively. They gave birth at 1016 facilities that had a mean total mPINC score of 65/100 (range 19-99). Care dimension subscores ranged from 41 for facility discharge care to 81 for breastfeeding assistance. In multivariable analysis adjusting for covariates, a positive relationship was found between total mPINC score quartile and both any breastfeeding (quartile 2: odds ratio [OR] 1.40 [95% confidence interval {CI} 1.08-1.83], quartile 3: OR 1.50 [95% CI 1.15-1.96], quartile 4: OR 2.12 [95% CI 1.61-2.78] vs quartile 1) and exclusive breastfeeding (quartile 3: OR 1.41 [95% CI 1.04-1.90], quartile 4: OR 1.89 [95% CI 1.41-2.55] vs quartile 1) at 8 weeks. These data demonstrate that evidence-based maternity care practices and policies are associated with better breastfeeding outcomes. Maternity facilities may evaluate their practices and policies to ensure they are helping mothers achieve their breastfeeding goals. © 2018 Wiley Periodicals, Inc.

IgM antibodies to oxidized phosphatidylserine as protection markers in cardiovascular disease among 60-year olds

PubMed Central

Frostegård, Johan; Su, Jun; Sing, Sudhir; Hua, Xiang; Vikström, Max; Leander, Karin; Gigante, Bruna; de Faire, Ulf; Frostegård, Anna G.

2017-01-01

Objective Phosphatidylserine is exposed on apoptotic cells and is prone to oxidation (OxPS). Here we analyze the association of IgM antibodies against OxPS (anti-OxPS) with the risk of cardiovascular disease (CVD). Methods Among sixty-year olds from Stockholm County in Sweden, previously screened for cardiovascular risk factors (2039 men, 2193 women), there were 210 incident CVD-cases identified during a 5-year follow-up. Using a nested case-control design, 622 age- and sex-matched controls were selected. Odds ratios (OR) with 95% intervals (CI) were calculated by conditional logistic regression. IgM anti-OxPS was measured by ELISA. Phagocytosis of apoptotic Jurkat-cells by macrophages was studied by flow cytometry. Results Anti-OxPS levels were lower among cases (median (interquartile range): 80.7 (60.9–101.0 vs. 84.6 (65.8–109.6); p = 0.047); among men (76.6 (55.8–99.2) vs. 82.0 (63.1–105.1); p = 0.022) and among women 89.6 (72.3–110.1) vs. 89.8 (69.9–114.4); p = 0.79). After adjustment for smoking, BMI, diabetes mellitus type II, hypercholesterolaemia and hypertension, and dividing into quartiles, using the highest quartile (quartile 4) as reference, quartile 3 was associated with a OR of 1.74 (CI 1.08–2.81). Quartiles 2 and 1 had similar associations, the later reaching statistical significance. Among men associations were stronger whereas no significant associations were observed in women. The OR of MI/angina comparing quartile 3 with quartile 4 was 2.31 (CI 1.30–4.11). The OR for quartile 2 and 1, respectively, were similar as for quartile 3. Total IgM increased uptake of apoptotic cells, which was reversed if incubated with OxPS. Conclusions IgM anti-OxPS is a novel potential protection marker for CVD, in particular in men. Increased phagocytosis of dying/dead cells could be one potential underlying mechanism. PMID:28430795

Adolescents' Sexual Wellbeing in Southwestern Uganda: A Cross-Sectional Assessment of Body Image, Self-Esteem and Gender Equitable Norms.

PubMed

Kemigisha, Elizabeth; Nyakato, Viola N; Bruce, Katharine; Ndaruhutse Ruzaaza, Gad; Mlahagwa, Wendo; Ninsiima, Anna B; Coene, Gily; Leye, Els; Michielsen, Kristien

2018-02-22

Measures of sexual wellbeing and positive aspects of sexuality in the World Health Organization definition for sexual health are rarely studied and remain poorly understood, especially among adolescents in Sub-Saharan Africa. The objective of this study was to assess sexual wellbeing in its broad sense-i.e., body image, self-esteem, and gender equitable norms-and associated factors in young adolescents in Uganda. A cross-sectional survey of adolescents ages 10-14 years in schools was carried out between June and July 2016. Among 1096 adolescents analyzed, the median age was 12 (Inter-Quartile Range (IQR): 11, 13) and 58% were female. Self-esteem and body image scores were high with median 24 (IQR: 22, 26, possible range: 7-28) and median 22 (IQR: 19, 24, possible range: 5-25) respectively. Gender equitable norms mean score was 28.1 (SD 5.2: possible range 11-44). We noted high scores for self-esteem and body image but moderate scores on gender equitable norms. Girls had higher scores compared to boys for all outcomes. A higher age and being sexually active were associated with lower scores on gender equitable norms. Gender equitable norms scores decreased with increasing age of adolescents. Comprehensive and timely sexuality education programs focusing on gender differences and norms are recommended.

Adolescents’ Sexual Wellbeing in Southwestern Uganda: A Cross-Sectional Assessment of Body Image, Self-Esteem and Gender Equitable Norms

PubMed Central

Kemigisha, Elizabeth; Nyakato, Viola N.; Bruce, Katharine; Ndaruhutse Ruzaaza, Gad; Mlahagwa, Wendo; Ninsiima, Anna B.; Coene, Gily; Leye, Els; Michielsen, Kristien

2018-01-01

Measures of sexual wellbeing and positive aspects of sexuality in the World Health Organization definition for sexual health are rarely studied and remain poorly understood, especially among adolescents in Sub-Saharan Africa. The objective of this study was to assess sexual wellbeing in its broad sense—i.e., body image, self-esteem, and gender equitable norms—and associated factors in young adolescents in Uganda. A cross-sectional survey of adolescents ages 10–14 years in schools was carried out between June and July 2016. Among 1096 adolescents analyzed, the median age was 12 (Inter-Quartile Range (IQR): 11, 13) and 58% were female. Self-esteem and body image scores were high with median 24 (IQR: 22, 26, possible range: 7–28) and median 22 (IQR: 19, 24, possible range: 5–25) respectively. Gender equitable norms mean score was 28.1 (SD 5.2: possible range 11–44). We noted high scores for self-esteem and body image but moderate scores on gender equitable norms. Girls had higher scores compared to boys for all outcomes. A higher age and being sexually active were associated with lower scores on gender equitable norms. Gender equitable norms scores decreased with increasing age of adolescents. Comprehensive and timely sexuality education programs focusing on gender differences and norms are recommended. PMID:29470388

A pilot study on providing ophthalmic training to medical students while initiating a sustainable eye care effort for the underserved.

PubMed

Byrd, Julia M; Longmire, Michelle R; Syme, Noah P; Murray-Krezan, Cristina; Rose, Linda

2014-03-01

We present a method to reintroduce ophthalmic training into the medical school curriculum. To evaluate knowledge and skills acquired when participating in a service project, the Community Vision Project, and to develop a quantitative method for testing skills with the direct ophthalmoscope in patients. Second-year medical students participated in the study. After 1 month, their knowledge was compared with that of peers and graduates (internal medicine residents). Also at 1 month, their direct ophthalmoscope skills were compared with those of upperclassmen who had completed all core clerkships. One year later, after the participants had completed their core clerkships, long-term ophthalmoscope skills retention was tested, and their performance was compared with that of their classmates. Training occurred in mobile eye clinics. Knowledge and skills assessments were performed in the hospital eye clinic among students and residents at The University of New Mexico School of Medicine. Patients were recruited from the hospital eye clinic. Participants attended a 3-hour training session held by an attending physician in the hospital eye clinic and took part in at least 1 mobile eye clinic. A knowledge assessment quiz was administered to participants (n = 12), their classmates (n = 18), and internal medicine residents (n = 33). Skills assessment with the direct ophthalmoscope was performed at 1 month and at 1 year in 5 participants and 5 nonparticipants. Tonometer skills were assessed by comparing participants' readings with those of an ophthalmologist's obtained in patients at the mobile eye clinics. RESULTS Participants' median knowledge assessment scores were 48% higher than those of their classmates and 37% higher than those of internal medicine residents (P < .001 for both). Short-term (1 month) direct ophthalmoscopy median scores were 60% (quartile 1 to quartile 3 range, 40%-80%) for participants and 40% (quartile 1 to quartile 3 range, 20%-60%) for nonparticipating upperclassmen (P = .24). Long-term direct ophthalmoscopy median scores were 100% (quartile 1 to quartile 3 range, 75%-100%) for participants and 0% (quartile 1 to quartile 3 range, 0%-25%) for nonparticipating classmates (P = .11). Participants' tonometer readings were similar to those of the ophthalmologist's; their median reading was 2 mm Hg (quartile 1 to quartile 3 range, 0-4 mm Hg) higher than that of the ophthalmologist's (P = .05, sign test). Service-based learning offered an efficient model for incorporating ophthalmic training into the medical school curriculum. A viable tool for quantitatively testing ophthalmoscope skills is presented.

Ambient air pollution exposure and respiratory, cardiovascular and cerebrovascular mortality in Cape Town, South Africa: 2001–2006.

PubMed

Wichmann, Janine; Voyi, Kuku

2012-11-05

Little evidence is available on the strength of the association between ambient air pollution exposure and health effects in developing countries such as South Africa. The association between the 24-h average ambient PM(10), SO(2) and NO(2) levels and daily respiratory (RD), cardiovascular (CVD) and cerebrovascular (CBD) mortality in Cape Town (2001-2006) was investigated with a case-crossover design. For models that included entire year data, an inter-quartile range (IQR) increase in PM(10) (12 mg/m3) and NO(2) (12 mg/m3) significantly increased CBD mortality by 4% and 8%, respectively. A significant increase of 3% in CVD mortality was observed per IQR increase in NO(2) and SO(2) (8 mg/m3). In the warm period, PM(10) was significantly associated with RD and CVD mortality. NO(2) had significant associations with CBD, RD and CVD mortality, whilst SO(2) was associated with CVD mortality. None of the pollutants were associated with any of the three outcomes in the cold period. Susceptible groups depended on the cause-specific mortality and air pollutant. There is significant RD, CVD and CBD mortality risk associated with ambient air pollution exposure in South Africa, higher than reported in developed countries.

Standardized measures of lobular involution and subsequent breast cancer risk among women with benign breast disease: a nested case-control study.

PubMed

Figueroa, Jonine D; Pfeiffer, Ruth M; Brinton, Louise A; Palakal, Maya M; Degnim, Amy C; Radisky, Derek; Hartmann, Lynn C; Frost, Marlene H; Stallings Mann, Melody L; Papathomas, Daphne; Gierach, Gretchen L; Hewitt, Stephen M; Duggan, Maire A; Visscher, Daniel; Sherman, Mark E

2016-08-01

Lesser degrees of terminal duct-lobular unit (TDLU) involution predict higher breast cancer risk; however, standardized measures to quantitate levels of TDLU involution have only recently been developed. We assessed whether three standardized measures of TDLU involution, with high intra/inter pathologist reproducibility in normal breast tissue, predict subsequent breast cancer risk among women in the Mayo benign breast disease (BBD) cohort. We performed a masked evaluation of biopsies from 99 women with BBD who subsequently developed breast cancer (cases) after a median of 16.9 years and 145 age-matched controls. We assessed three metrics inversely related to TDLU involution: TDLU count/mm(2), median TDLU span (microns, which approximates acini content), and median category of acini counts/TDLU (0-10; 11-20; 21-30; 31-50; >50). Associations with subsequent breast cancer risk for quartiles (or categories of acini counts) of each of these measures were assessed with multivariable conditional logistic regression to estimate odds ratios (ORs) and 95 % confidence intervals (CI). In multivariable models, women in the highest quartile compared to the lowest quartiles of TDLU counts and TDLU span measures were significantly associated with subsequent breast cancer diagnoses; TDLU counts quartile4 versus quartile1, OR = 2.44, 95 %CI 0.96-6.19, p-trend = 0.02; and TDLU spans, quartile4 versus quartile1, OR = 2.83, 95 %CI = 1.13-7.06, p-trend = 0.03. Significant associations with categorical measures of acini counts/TDLU were also observed: compared to women with median category of <10 acini/TDLU, women with >25 acini counts/TDLU were at significantly higher risk, OR = 3.40, 95 %CI 1.03-11.17, p-trend = 0.032. Women with TDLU spans and TDLU count measures above the median were at further increased risk, OR = 3.75 (95 %CI 1.40-10.00, p-trend = 0.008), compared with women below the median for both of these metrics. Similar results were observed for combinatorial metrics of TDLU acini counts/TDLU, and TDLU count. Standardized quantitative measures of TDLU counts and acini counts approximated by TDLU span measures or visually assessed in categories are independently associated with breast cancer risk. Visual assessment of TDLU numbers and acini content, which are highly reproducible between pathologists, could help identify women at high risk for subsequent breast cancer among the million women diagnosed annually with BBD in the US.

Standardized measures of lobular involution and subsequent breast cancer risk among women with benign breast disease: a nested case–control study

PubMed Central

Figueroa, Jonine D.; Pfeiffer, Ruth M.; Brinton, Louise A.; Palakal, Maya M.; Degnim, Amy C.; Radisky, Derek; Hartmann, Lynn C.; Frost, Marlene H.; Mann, Melody L. Stallings; Papathomas, Daphne; Gierach, Gretchen L.; Hewitt, Stephen M.; Duggan, Maire A.; Visscher, Daniel; Sherman, Mark E.

2016-01-01

Lesser degrees of terminal duct-lobular unit (TDLU) involution predict higher breast cancer risk; however, standardized measures to quantitate levels of TDLU involution have only recently been developed. We assessed whether three standardized measures of TDLU involution, with high intra/inter pathologist reproducibility in normal breast tissue, predict subsequent breast cancer risk among women in the Mayo benign breast disease (BBD) cohort. We performed a masked evaluation of biopsies from 99 women with BBD who subsequently developed breast cancer (cases) after a median of 16.9 years and 145 age-matched controls. We assessed three metrics inversely related to TDLU involution: TDLU count/mm2, median TDLU span (microns, which approximates acini content), and median category of acini counts/TDLU (0–10; 11–20; 21–30; 31–50; >50). Associations with subsequent breast cancer risk for quartiles (or categories of acini counts) of each of these measures were assessed with multivariable conditional logistic regression to estimate odds ratios (ORs) and 95 % confidence intervals (CI). In multivariable models, women in the highest quartile compared to the lowest quartiles of TDLU counts and TDLU span measures were significantly associated with subsequent breast cancer diagnoses; TDLU counts quartile4 versus quartile1, OR = 2.44, 95 %CI 0.96–6.19, p-trend = 0.02; and TDLU spans, quartile4 versus quartile1, OR = 2.83, 95 %CI = 1.13–7.06, p-trend = 0.03. Significant associations with categorical measures of acini counts/TDLU were also observed: compared to women with median category of <10 acini/TDLU, women with >25 acini counts/TDLU were at significantly higher risk, OR = 3.40, 95 %CI 1.03–11.17, p-trend = 0.032. Women with TDLU spans and TDLU count measures above the median were at further increased risk, OR = 3.75 (95 %CI 1.40–10.00, p-trend = 0.008), compared with women below the median for both of these metrics. Similar results were observed for combinatorial metrics of TDLU acini counts/TDLU, and TDLU count. Standardized quantitative measures of TDLU counts and acini counts approximated by TDLU span measures or visually assessed in categories are independently associated with breast cancer risk. Visual assessment of TDLU numbers and acini content, which are highly reproducible between pathologists, could help identify women at high risk for subsequent breast cancer among the million women diagnosed annually with BBD in the US. PMID:27488681

Fibroblast Growth Factor 23 and Kidney Disease Progression in Autosomal Dominant Polycystic Kidney Disease.

PubMed

Chonchol, Michel; Gitomer, Berenice; Isakova, Tamara; Cai, Xuan; Salusky, Isidro; Pereira, Renata; Abebe, Kaleab; Torres, Vicente; Steinman, Theodor I; Grantham, Jared J; Chapman, Arlene B; Schrier, Robert W; Wolf, Myles

2017-09-07

Increases in fibroblast growth factor 23 precede kidney function decline in autosomal dominant polycystic kidney disease; however, the role of fibroblast growth factor 23 in autosomal dominant polycystic kidney disease has not been well characterized. We measured intact fibroblast growth factor 23 levels in baseline serum samples from 1002 participants in the HALT-PKD Study A ( n =540; mean eGFR =91±17 ml/min per 1.73 m 2 ) and B ( n =462; mean eGFR =48±12 ml/min per 1.73 m 2 ). We used linear mixed and Cox proportional hazards models to test associations between fibroblast growth factor 23 and eGFR decline, percentage change in height-adjusted total kidney volume, and composite of time to 50% reduction in eGFR, onset of ESRD, or death. Median (interquartile range) intact fibroblast growth factor 23 was 44 (33-56) pg/ml in HALT-PKD Study A and 69 (50-93) pg/ml in Study B. In adjusted models, annualized eGFR decline was significantly faster in the upper fibroblast growth factor 23 quartile (Study A: quartile 4, -3.62; 95% confidence interval, -4.12 to -3.12 versus quartile 1, -2.51; 95% confidence interval, -2.71 to -2.30 ml/min per 1.73 m 2 ; P for trend <0.001; Study B: quartile 4, -3.74; 95% confidence interval, -4.14 to -3.34 versus quartile 1, -2.78; 95% confidence interval, -2.92 to -2.63 ml/min per 1.73 m 2 ; P for trend <0.001). In Study A, higher fibroblast growth factor 23 quartiles were associated with greater longitudinal percentage increase in height-adjusted total kidney volume in adjusted models (quartile 4, 6.76; 95% confidence interval, 5.57 to 7.96 versus quartile 1, 6.04; 95% confidence interval, 5.55 to 6.54; P for trend =0.03). In Study B, compared with the lowest quartile, the highest fibroblast growth factor 23 quartile was associated with elevated risk for the composite outcome (hazard ratio, 3.11; 95% confidence interval, 1.84 to 5.25). Addition of fibroblast growth factor 23 to a model of annualized decline in eGFR≥3.0 ml/min per 1.73 m 2 did not improve risk prediction. Higher serum fibroblast growth factor 23 concentration was associated with kidney function decline, height-adjusted total kidney volume percentage increase, and death in patients with autosomal dominant polycystic kidney disease. However, fibroblast growth factor 23 did not substantially improve prediction of rapid kidney function decline. Copyright © 2017 by the American Society of Nephrology.

Triglyceride and glucose (TyG) index as a predictor of incident hypertension: a 9-year longitudinal population-based study.

PubMed

Zheng, Rongjiong; Mao, Yushan

2017-09-13

Hypertension and the triglyceride and glucose index both have been associated with insulin resistance; however, the longitudinal association remains unclear. This study was designed to investigate the longitudinal association between the triglyceride and glucose index and incident hypertension among the Chinese population. We studied 4686 subjects (3177 males and 1509 females) and followed up for 9 years. The subjects were divided into four groups based on the triglyceride and glucose index. Univariate and multivariate Cox regression models were used to analyse the risk factors of hypertension. After 9 years of follow-up, 2047 subjects developed hypertension. The overall 9-year cumulative incidence of hypertension was 43.7%, ranging from 28.5% in quartile 1 to 36.9% in quartile 2, 49.2% in quartile 3 and 59.8% in quartile 4 (p for trend < 0.001). Cox regression analyses indicated that higher triglyceride and glucose index was associated with an increased risk of subsequent incident hypertension. The triglyceride and glucose index can predict the incident hypertension among the Chinese population.

Neighborhood socioeconomic index and stroke incidence in a national cohort of blacks and whites

PubMed Central

McClure, Leslie A.; Kleindorfer, Dawn O.; Cunningham, Solveig A.; Thrift, Amanda G.; Diez Roux, Ana V.; Howard, George

2016-01-01

Objective: To assess the relationship between neighborhood socioeconomic characteristics and incident stroke in a national cohort of black and white participants. Methods: The study comprised black (n = 10,274, 41%) and white (n = 14,601) stroke-free participants, aged 45 and older, enrolled in 2003–2007 in Reasons for Geographic and Racial Differences in Stroke (REGARDS), a national population-based cohort. A neighborhood socioeconomic score (nSES) was constructed using 6 neighborhood variables. Incident stroke was defined as first occurrence of stroke over an average 7.5 (SD 3.0) years of follow-up. Proportional hazards models were used to estimate associations between nSES score and incident stroke, adjusted for demographics (age, race, sex, region), individual socioeconomic status (SES) (education, household income), and other risk factors for stroke. Results: After adjustment for demographics, compared to the highest nSES quartile, stroke incidence increased with each decreasing nSES quartile. The hazard ratio (95% confidence interval) ranged from 1.28 (1.05–1.56) in quartile 3 to 1.38 (1.13–1.68) in quartile 2 to 1.56 (1.26–1.92) in quartile 1 (p < 0.0001 for linear trend). After adjustment for individual SES, the trend remained marginally significant (p = 0.085). Although there was no evidence of a differential effect by race or sex, adjustment for stroke risk factors attenuated the association between nSES and stroke in both black and white participants, with greater attenuation in black participants. Conclusions: Risk of incident stroke increased with decreasing nSES but the effect of nSES is attenuated through individual SES and stroke risk factors. The effect of neighborhood socioeconomic characteristics that contribute to increased stroke risk is similar in black and white participants. PMID:27742815

Association of serum gamma-glutamyltransferase and alanine aminotransferase activities with risk of type 2 diabetes mellitus independent of fatty liver.

PubMed

Kim, Chul-Hee; Park, Joong-Yeol; Lee, Ki-Up; Kim, Jin-Ho; Kim, Hong-Kyu

2009-01-01

Although elevated serum concentrations of gamma-glutamyltrans- ferase (GGT) or alanine aminotransferase (ALT) have been associated with type 2 diabetes mellitus, it is unclear whether each is an independent predictor of type 2 diabetes or merely a surrogate marker for fatty liver or hepatic injury. We assessed clinical and laboratory findings in 3556 non-diabetic subjects (2217 men, 1339 women; age, 45.7 +/- 8.1 (range 20-79) years) without fatty liver or clinically significant hepatic dysfunction who underwent voluntary medical check-ups at a 5-year interval. The odds ratio of developing type 2 diabetes increased significantly with increasing GGT and ALT levels at baseline. In multiple logistic regression models adjusted for age, sex, alcohol consumption, smoking, body mass index (BMI), triglycerides, high-density lipoprotein (HDL)-cholesterol, fasting glucose, and ALT, the highest quartile of GGT remained significantly associated with type 2 diabetes. Compared with the first GGT quartile, the odds ratios of the second, third, and fourth GGT quartiles were 0.64 (95% CI, 0.25-1.65), 1.12 (0.45-2.78), and 3.07 (1.21-7.76), respectively. The adjusted odds ratios for the second, third, and fourth ALT quartiles in the same logistic regression model were 2.40 (0.83-6.94), 2.85 (1.03-7.90), and 4.31 (1.56-11.88), respectively. The risk of type 2 diabetes was additive with respect to GGT and ALT quartiles. Increased serum GGT and ALT levels are independent, additive risk factors for the development of type 2 diabetes mellitus in subjects without fatty liver or hepatic dysfunction. Copyright 2009 John Wiley & Sons, Ltd.

Neighborhood socioeconomic index and stroke incidence in a national cohort of blacks and whites.

PubMed

Howard, Virginia J; McClure, Leslie A; Kleindorfer, Dawn O; Cunningham, Solveig A; Thrift, Amanda G; Diez Roux, Ana V; Howard, George

2016-11-29

To assess the relationship between neighborhood socioeconomic characteristics and incident stroke in a national cohort of black and white participants. The study comprised black (n = 10,274, 41%) and white (n = 14,601) stroke-free participants, aged 45 and older, enrolled in 2003-2007 in Reasons for Geographic and Racial Differences in Stroke (REGARDS), a national population-based cohort. A neighborhood socioeconomic score (nSES) was constructed using 6 neighborhood variables. Incident stroke was defined as first occurrence of stroke over an average 7.5 (SD 3.0) years of follow-up. Proportional hazards models were used to estimate associations between nSES score and incident stroke, adjusted for demographics (age, race, sex, region), individual socioeconomic status (SES) (education, household income), and other risk factors for stroke. After adjustment for demographics, compared to the highest nSES quartile, stroke incidence increased with each decreasing nSES quartile. The hazard ratio (95% confidence interval) ranged from 1.28 (1.05-1.56) in quartile 3 to 1.38 (1.13-1.68) in quartile 2 to 1.56 (1.26-1.92) in quartile 1 (p < 0.0001 for linear trend). After adjustment for individual SES, the trend remained marginally significant (p = 0.085). Although there was no evidence of a differential effect by race or sex, adjustment for stroke risk factors attenuated the association between nSES and stroke in both black and white participants, with greater attenuation in black participants. Risk of incident stroke increased with decreasing nSES but the effect of nSES is attenuated through individual SES and stroke risk factors. The effect of neighborhood socioeconomic characteristics that contribute to increased stroke risk is similar in black and white participants. © 2016 American Academy of Neurology.

Variation in Red Blood Cell Transfusion Practices During Cardiac Operations Among Centers in Maryland: Results From a State Quality-Improvement Collaborative.

PubMed

Magruder, J Trent; Blasco-Colmenares, Elena; Crawford, Todd; Alejo, Diane; Conte, John V; Salenger, Rawn; Fonner, Clifford E; Kwon, Christopher C; Bobbitt, Jennifer; Brown, James M; Nelson, Mark G; Horvath, Keith A; Whitman, Glenn R

2017-01-01

Variation in red blood cell (RBC) transfusion practices exists at cardiac surgery centers across the nation. We tested the hypothesis that significant variation in RBC transfusion practices between centers in our state's cardiac surgery quality collaborative remains even after risk adjustment. Using a multiinstitutional statewide database created by the Maryland Cardiac Surgery Quality Initiative (MCSQI), we included patient-level data from 8,141 patients undergoing isolated coronary artery bypass (CAB) or aortic valve replacement at 1 of 10 centers. Risk-adjusted multivariable logistic regression models were constructed to predict the need for any intraoperative RBC transfusion, as well as for any postoperative RBC transfusion, with anonymized center number included as a factor variable. Unadjusted intraoperative RBC transfusion probabilities at the 10 centers ranged from 13% to 60%; postoperative RBC transfusion probabilities ranged from 16% to 41%. After risk adjustment with demographic, comorbidity, and operative data, significant intercenter variability was documented (intraoperative probability range, 4% -59%; postoperative probability range, 13%-39%). When stratifying patients by preoperative hematocrit quartiles, significant variability in intraoperative transfusion probability was seen among all quartiles (lowest quartile: mean hematocrit value, 30.5% ± 4.1%, probability range, 17%-89%; highest quartile: mean hematocrit value, 44.8% ± 2.5%; probability range, 1%-35%). Significant variation in intercenter RBC transfusion practices exists for both intraoperative and postoperative transfusions, even after risk adjustment, among our state's centers. Variability in intraoperative RBC transfusion persisted across quartiles of preoperative hematocrit values. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Dietary factors and fibroblast growth factor-23 levels in young adults with African ancestry.

PubMed

Kosk, Dominique; Kramer, Holly; Luke, Amy; Camacho, Pauline; Bovet, Pascal; Rhule, Jacob Plange; Forrester, Terrence; Wolf, Myles; Sempos, Chris; Melamed, Michal L; Dugas, Lara R; Cooper, Richard; Durazo-Arvizu, Ramon

2017-11-01

Fibroblast growth factor-23 (FGF23), a phosphaturic hormone secreted mainly by osteocytes, maintains serum phosphate levels within a tight range by promoting phosphaturia. Previous studies have mainly focused on the link between FGF23 levels and dietary intake of phosphate, but other dietary factors may also influence FGF23 levels. This cross-sectional study pooled three populations of young adults with African ancestry (452 in Chicago, IL, USA; 477 in Victoria, Seychelles; and 482 in Kumasi, Ghana) with estimated glomerular filtration rate >80 ml/min/1.73 m 2 to examine the association of dietary factors based on two 24-h recalls with FGF23 levels measured using a C-terminal assay. Linear regression was used to examine the association between log-transformed FGF23 levels and quartiles of calorie-adjusted dietary factors with adjustment for covariates. In the pooled sample of 1411 study participants, the mean age was 35.2 (6.2) years and 45.3% were male. Median plasma C-terminal FGF23 values in relative units (RU)/ml were 59.5 [interquartile range (IQR) 44.1, 85.3] in the USA, 43.2 (IQR 33.1, 57.9) in Seychelles, and 34.0 (IQR 25.2, 50.4) in Ghana. With adjustment for covariates, increasing quartiles of calcium and animal protein and decreasing quartiles of vegetable protein, fiber, and magnesium intake were associated with significantly higher FGF23 levels compared to the lowest quartile. After further adjustment for dietary factors, significant trends in FGF23 levels were noted only for quartiles of calcium, fiber, and magnesium intake (P < 0.001). Dietary factors other than phosphate are associated with FGF23 levels in young adults.

Paradigm for Distributive & Procedural Justice in Equitable Apportionment of Transboundary Ganges Waters Under Changing Climate & Landuse

NASA Astrophysics Data System (ADS)

Tyagi, H.; Gosain, A. K.; Khosa, R.; Anand, J.

2015-12-01

Rivers have no regard for human demarcated boundaries. Besides, ever increasing demand-supply gap & vested riparian interests, fuel transboundary water conflicts. For resolving such disputes, appropriation doctrines advocating equity & fairness have received endorsement in the Helsinki Rules-1966 & UN Convention-1997. Thus, current study proposes the principle of equitable apportionment for sharing Ganges waters as it balances the interests & deservedness of all stakeholders, namely, India & its 11 states, Bangladesh, Nepal, & China. The study endeavors to derive a reasonable share of each co-basin state by operationalizing the vague concepts of fairness & equity through an objective & quantitative framework encompassing proportionality & egalitarianism for distributive & procedural justice. Equal weightage factors reflecting hydrology, geography & water use potential are chosen for fair share computation, wherein each contender ranks these factors to maximize his entitlement. If cumulative claims exceed the water availability, each claimant puts forth next ranked factor & this process continues till the claims match availability. Due to inter-annual variability in few factors, scenarios for Rabi & Kharif seasons are considered apart from cases for maximum, upper quartile, median, lower quartile & minimum. Possibility of spatial homogeneity & heterogeneity in factors is also recognized. Sometimes lack of technical information hinders transboundary dispute resolution via legal mechanisms. Hence, the study also attempts to bridge this gap between law & technology through GIS-based SWAT hydrologic model by estimating the Ganges water yield, & consequent share of each riparian for range of flows incorporating e-flows as well, under present & future climate & landuse scenarios. 82% of India's territory lies within interstate rivers, & therefore this research is very pertinent as it can facilitate the decision makers in effective interstate water conflict resolution.

Video-assisted structured teaching to improve aseptic technique during neuraxial block.

PubMed

Friedman, Z; Siddiqui, N; Mahmoud, S; Davies, S

2013-09-01

Teaching epidural catheter insertion tends to focus on developing manual dexterity rather than improving aseptic technique which usually remains poor despite increasing experience. The aim of this study was to compare epidural aseptic technique performance, by novice operators after a targeted teaching intervention, with operators taught aseptic technique before the intervention was initiated. Starting July 2008, two groups of second-year anaesthesia residents (pre- and post-teaching intervention) performing their 4-month obstetric anaesthesia rotation in a university affiliated centre were videotaped three to four times while performing epidural procedures. Trained blinded independent examiners reviewed the procedures. The primary outcome was a comparison of aseptic technique performance scores (0-30 points) graded on a scale task-specific checklist. A total of 86 sessions by 29 residents were included in the study analysis. The intraclass correlation coefficient for inter-rater reliability for the aseptic technique was 0.90. The median aseptic technique scores for the rotation period were significantly higher in the post-intervention group [27.58, inter-quartile range (IQR) 22.33-29.50 vs 16.56, IQR 13.33-22.00]. Similar results were demonstrated when scores were analysed for low, moderate, and high levels of experience throughout the rotation. Procedure-specific aseptic technique teaching, aided by video assessment and video demonstration, helped significantly improve aseptic practice by novice trainees. Future studies should consider looking at retention over longer periods of time in more senior residents.

Suicidal behaviour across the African continent: a review of the literature

PubMed Central

2014-01-01

Background Suicide is a major cause of premature mortality worldwide, but data on its epidemiology in Africa, the world’s second most populous continent, are limited. Methods We systematically reviewed published literature on suicidal behaviour in African countries. We searched PubMed, Web of Knowledge, PsycINFO, African Index Medicus, Eastern Mediterranean Index Medicus and African Journals OnLine and carried out citation searches of key articles. We crudely estimated the incidence of suicide and suicide attempts in Africa based on country-specific data and compared these with published estimates. We also describe common features of suicide and suicide attempts across the studies, including information related to age, sex, methods used and risk factors. Results Regional or national suicide incidence data were available for less than one third (16/53) of African countries containing approximately 60% of Africa’s population; suicide attempt data were available for <20% of countries (7/53). Crude estimates suggest there are over 34,000 (inter-quartile range 13,141 to 63,757) suicides per year in Africa, with an overall incidence rate of 3.2 per 100,000 population. The recent Global Burden of Disease (GBD) estimate of 49,558 deaths is somewhat higher, but falls within the inter-quartile range of our estimate. Suicide rates in men are typically at least three times higher than in women. The most frequently used methods of suicide are hanging and pesticide poisoning. Reported risk factors are similar for suicide and suicide attempts and include interpersonal difficulties, mental and physical health problems, socioeconomic problems and drug and alcohol use/abuse. Qualitative studies are needed to identify additional culturally relevant risk factors and to understand how risk factors may be connected to suicidal behaviour in different socio-cultural contexts. Conclusions Our estimate is somewhat lower than GBD, but still clearly indicates suicidal behaviour is an important public health problem in Africa. More regional studies, in both urban and rural areas, are needed to more accurately estimate the burden of suicidal behaviour across the continent. Qualitative studies are required in addition to quantitative studies. PMID:24927746

Cat, dog and house dust mite allergen levels on children's soft toys.

PubMed

Wu, Francis Fu-Sheng; Wu, Mei-Wen; Ting, Ming-Hui; Crane, Julian; Siebers, Rob

2014-02-01

Children's soft toys are known to harbour house dust mite (HDM) allergens, but little is known whether they harbour cat or dog allergens. The objective of the study was to measure cat (Fel d 1), dog (Can f 1) and HDM allergens on children's soft toys. Dust was collected from 40 children's soft toys and their mattresses. Data were collected on pet ownership. Dust samples were analysed for Fel d 1, Can f 1, Der p 1 and Der f 1 by enzyme-linked immunosorbent assay (ELISA) and results are expressed as median levels with inter-quartile ranges. Thirty-five (87.5%) soft toys had detectable Fel d 1 levels (median: 0.73 µg/g; inter-quartile range: 0.26-2.56 µg/g) while 34 (85%) had detectable Can f 1 levels (1.20 µg/g; 0.53-2.68). Correspondingly, 32 (80%) mattresses had detectable Fel d 1 levels (0.18 µg/g, 0.07-1.01) while 34 (85%) had detectable Can f 1 levels (0.50 µg/g; 0.33-1.06). All mattresses and soft toys had detectable HDM allergen (Der p 1 + Der f 1) levels with soft toys containing about three times higher levels than mattresses. In homes with cats (n = 10) Fel d 1 levels were higher on soft toys than homes without cats (2.49 versus 0.48 µg/g; p = 0.0009). In homes with dogs (n = 25) Can f 1 levels were generally higher on soft toys (1.38 versus 0.63 µg/g; p = 0.10). This study has shown that soft toys can harbour cat and dog allergen as well as HDM allergens, some with very high levels. Cat and dog ownership resulted in higher Fel d 1 and Can f 1 levels on soft toys and mattresses. The levels of Fel d 1, Can f 1 and HDM allergens on soft toys could be of importance to sensitized asthmatic children.

Suicidal behaviour across the African continent: a review of the literature.

PubMed

Mars, Becky; Burrows, Stephanie; Hjelmeland, Heidi; Gunnell, David

2014-06-14

Suicide is a major cause of premature mortality worldwide, but data on its epidemiology in Africa, the world's second most populous continent, are limited. We systematically reviewed published literature on suicidal behaviour in African countries. We searched PubMed, Web of Knowledge, PsycINFO, African Index Medicus, Eastern Mediterranean Index Medicus and African Journals OnLine and carried out citation searches of key articles. We crudely estimated the incidence of suicide and suicide attempts in Africa based on country-specific data and compared these with published estimates. We also describe common features of suicide and suicide attempts across the studies, including information related to age, sex, methods used and risk factors. Regional or national suicide incidence data were available for less than one third (16/53) of African countries containing approximately 60% of Africa's population; suicide attempt data were available for <20% of countries (7/53). Crude estimates suggest there are over 34,000 (inter-quartile range 13,141 to 63,757) suicides per year in Africa, with an overall incidence rate of 3.2 per 100,000 population. The recent Global Burden of Disease (GBD) estimate of 49,558 deaths is somewhat higher, but falls within the inter-quartile range of our estimate. Suicide rates in men are typically at least three times higher than in women. The most frequently used methods of suicide are hanging and pesticide poisoning. Reported risk factors are similar for suicide and suicide attempts and include interpersonal difficulties, mental and physical health problems, socioeconomic problems and drug and alcohol use/abuse. Qualitative studies are needed to identify additional culturally relevant risk factors and to understand how risk factors may be connected to suicidal behaviour in different socio-cultural contexts. Our estimate is somewhat lower than GBD, but still clearly indicates suicidal behaviour is an important public health problem in Africa. More regional studies, in both urban and rural areas, are needed to more accurately estimate the burden of suicidal behaviour across the continent. Qualitative studies are required in addition to quantitative studies.

Impact of serum uric acid on incident hypertension in a worksite population of Japanese men.

PubMed

Kansui, Yasuo; Matsumura, Kiyoshi; Morinaga, Yuki; Inoue, Minako; Kiyohara, Kanako; Ohta, Yuko; Goto, Kenichi; Ohtsubo, Toshio; Ooboshi, Hiroaki; Kitazono, Takanari

2018-07-01

Higher levels of serum uric acid are associated with an increased risk of cardiovascular diseases, which may be confounded by comorbidities. We investigated the effects of serum uric acid on the risk of hypertension in Japanese men at a worksite. We evaluated a total of 2335 Japanese male workers without hypertension who ranged in age from 18 to 64 years at a worksite in 2009. These men were followed for 6 years from 2009 to 2015. During the follow-up period, 380 individuals developed hypertension. The odds ratio for the incident hypertension was estimated according to quartiles of serum uric acid levels of 5.1 or less, 5.2-5.8, 5.9-6.6, and at least 6.7 mg/dl. The multivariable-adjusted risk of incident hypertension was significantly higher in the highest serum uric acid quartile than in the lowest: odds ratio 1.00 (reference) for the lowest quartile, 1.34 (0.91-1.97) for the second quartile, 1.42 (0.97-2.06) for the third quartile, and 1.65 (1.14-2.40) for the highest quartile. In stratified analyses, the association between serum uric acid and incident hypertension was significant in the patients of aged below 45 years and without comorbidities, namely diabetes and low levels of high-density lipoprotein-cholesterol. Serum uric acid levels were associated with the future incidence of hypertension, and the association was observed in the younger individuals, those without diabetes, and those with preserved high-density lipoprotein cholesterol levels in a worksite population of Japanese men.

National Survey on Internal Quality Control for HbA(1c) Analytical Instruments in 331 Hospital Laboratories of China.

PubMed

Zeng, Rong; Wang, Wei; Zhao, Haijian; Fei, Yang; Wang, Zhiguo

2015-01-01

The narrow gap of HbA1 value of mass fraction between "normal" (< 6.0%) and "diabetes" (≥ 6.5%) necessitates tight control of inter-assay standardization, assay precision, and trueness. This survey was initiated to obtain knowledge of the current situation of internal quality control (IQC) practice for HbA(1c) in China and find out the most appropriate quality specifications. Data of IQC for HbA(1c) in 331 institutions participating in the national proficiency testing (PT) programs in China were evaluated using four levels of quality specifications, and the percentages of laboratories meeting the quality requirement were calculated to find out the most appropriate quality specifications for control materials of HbA(1c) in China. The IQC data varied vastly among 331 clinical laboratories in China. The measurement of control materials covered a wide range from 4.52% to 12.24% (inter-quartile range) and there were significant differences among the CVs of different methods, including LPLC, CE-HPLC, AC-HPLC, immunoturbidimetry, and others. Among the four main methods, CE-HPLC and AC-HPLC achieved a better precision. As we can see, the performance of laboratories for HbA(1c) has yet to be improved. Clinical laboratories in China should improve their performance with a stricter imprecision criteria.

Age of red blood cells and outcome in acute kidney injury

PubMed Central

2013-01-01

Introduction Transfusion of red blood cells (RBCs) and, in particular, older RBCs has been associated with increased short-term mortality in critically ill patients. We evaluated the association between age of transfused RBCs and acute kidney injury (AKI), hospital, and 90-day mortality in critically ill patients. Methods We conducted a prospective, observational, predefined sub-study within the FINNish Acute Kidney Injury (FINNAKI) study. This study included all elective ICU admissions with expected ICU stay of more than 24 hours and all emergency admissions from September to November 2011. To study the age of RBCs, we classified transfused patients into quartiles according to the age of oldest transfused RBC unit in the ICU. AKI was defined according to KDIGO (Kidney Disease: Improving Global Outcomes) criteria. Results Out of 1798 patients, 652 received at least one RBC unit. The median [interquartile range] age of the oldest RBC unit transfused was 12 [11-13] days in the freshest quartile and 21 [17-27] days in the quartiles 2 to 4. On logistic regression, RBC age was not associated with the development of KDIGO stage 3 AKI. Patients in the quartile of freshest RBCs had lower crude hospital and 90-day mortality rates compared to those in the quartiles of older blood. After adjustments, older RBC age was associated with significantly increased risk for hospital mortality. Age, Simplified Acute Physiology Score II (SAPS II)-score without age points, maximum Sequental Organ Failure Assessment (SOFA) score and the total number of transfused RBC units were independently associated with 90-day mortality. Conclusions The age of transfused RBC units was independently associated with hospital mortality but not with 90-day mortality or KDIGO stage 3 AKI. The number of transfused RBC units was an independent risk factor for 90-day mortality. PMID:24093554

Thyroid Function Within the Normal Range, Subclinical Hypothyroidism, and the Risk of Atrial Fibrillation.

PubMed

Baumgartner, Christine; da Costa, Bruno R; Collet, Tinh-Hai; Feller, Martin; Floriani, Carmen; Bauer, Douglas C; Cappola, Anne R; Heckbert, Susan R; Ceresini, Graziano; Gussekloo, Jacobijn; den Elzen, Wendy P J; Peeters, Robin P; Luben, Robert; Völzke, Henry; Dörr, Marcus; Walsh, John P; Bremner, Alexandra; Iacoviello, Massimo; Macfarlane, Peter; Heeringa, Jan; Stott, David J; Westendorp, Rudi G J; Khaw, Kay-Tee; Magnani, Jared W; Aujesky, Drahomir; Rodondi, Nicolas

2017-11-28

Atrial fibrillation (AF) is a highly prevalent disorder leading to heart failure, stroke, and death. Enhanced understanding of modifiable risk factors may yield opportunities for prevention. The risk of AF is increased in subclinical hyperthyroidism, but it is uncertain whether variations in thyroid function within the normal range or subclinical hypothyroidism are also associated with AF. We conducted a systematic review and obtained individual participant data from prospective cohort studies that measured thyroid function at baseline and assessed incident AF. Studies were identified from MEDLINE and EMBASE databases from inception to July 27, 2016. The euthyroid state was defined as thyroid-stimulating hormone (TSH) 0.45 to 4.49 mIU/L, and subclinical hypothyroidism as TSH 4.5 to 19.9 mIU/L with free thyroxine (fT4) levels within reference range. The association of TSH levels in the euthyroid and subclinical hypothyroid range with incident AF was examined by using Cox proportional hazards models. In euthyroid participants, we additionally examined the association between fT4 levels and incident AF. Of 30 085 participants from 11 cohorts (278 955 person-years of follow-up), 1958 (6.5%) had subclinical hypothyroidism and 2574 individuals (8.6%) developed AF during follow-up. TSH at baseline was not significantly associated with incident AF in euthyroid participants or those with subclinical hypothyroidism. Higher fT4 levels at baseline in euthyroid individuals were associated with increased AF risk in age- and sex-adjusted analyses (hazard ratio, 1.45; 95% confidence interval, 1.26-1.66, for the highest quartile versus the lowest quartile of fT4; P for trend ≤0.001 across quartiles). Estimates did not substantially differ after further adjustment for preexisting cardiovascular disease. In euthyroid individuals, higher circulating fT4 levels, but not TSH levels, are associated with increased risk of incident AF. © 2017 American Heart Association, Inc.

Socially disparate trends in lifespan variation: a trend study on income and mortality based on nationwide Danish register data.

PubMed

Brønnum-Hansen, Henrik

2017-05-17

Social inequality trends in life expectancy are not informative as to changes in social disparity in the age-at-death distribution. The purpose of the study was to investigate social differentials in trends and patterns of adult mortality in Denmark. Register data on income and mortality from 1986 to 2014 were used to investigate trends in life expectancy, life disparity and the threshold age that separates 'premature' and 'late' deaths. Mortality compression was quantified and compared between income quartiles. Since 1986, male life expectancy increased by 4.2 years for the lowest income quartile and by 8.4 years for the highest income quartile. The clear compression of mortality apparent in the highest income quartile did not occur for the lowest income quartile. Premature and late deaths accounted both by 2.1 years of the increase in life expectancy in the lowest income quartile and by 6.0 and 2.4 years, respectively, in the highest income quartile. Life expectancy increased by 5.2 years among women in the lowest income quartile, 2.4 years due to premature deaths and 2.8 years due to late deaths. The gain in life expectancy among women in the highest income quartile of 5.6 years was distributed by 5.0 and 0.6 years due to premature and late deaths, respectively. The study demonstrates that the increasing social gap in mortality appears differently in the change of the age-at-death distribution. Thus, no compression of mortality was seen in the lowest income quartile. The results do not provide support for a uniformly extension of pension age for all. © 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.

Total energy intake according to the level of skeletal muscle mass in Korean adults aged 30 years and older: an analysis of the Korean National Health and Nutrition Examination Surveys (KNHANES) 2008-2011.

PubMed

Jang, Bo Young; Bu, So Young

2018-06-01

Since gain or loss of skeletal muscle mass is a gradual event and occurs due to a combination of lifestyle factors, assessment of dietary factors related to skeletal muscle is complicated. The aim of this study was to investigate the changes in total energy intake according to the level of skeletal muscle mass. A total of 8,165 subjects ≥ 30 years of age from the Korean National Health and Nutrition Examination Surveys (KNHANES) 2008-2011 were included in the analysis, and multivariate-adjusted regression analyses were performed to analyze the association of the quartiles of sarcopenia index (SI) with energy intake of the study population after adjusting for age and metabolic parameters. The increase in SI quartile was in proportion to the gradual decrease in systemic lipids and the anthropometric measurement of fat accumulation ( P < 0.001). Subjects in higher SI quartiles tended to consume more total energy and energy-producing nutrients than those in lower quartiles ( P < 0.001). After age, body weight, alcohol consumption, and metabolic parameters were adjusted in the analysis, total energy intake gradually increased according to the increase in SI quartile, and the association between total energy intake and SI was more pronounced in men. However, the risk (odd ratio) of having a low SI was not affected by any single macronutrient intake. In this study, total energy intake was positively associated with SI and relative skeletal mass in both men and women. However, no significant association or a weak association was observed between any single macronutrient intake and skeletal muscle mass. The data indicated that acquiring more energy intake within the normal range of energy consumption may help to maintain skeletal muscle mass.

Vegetated land cover near residence is associated with ...

EPA Pesticide Factsheets

Abstract Background: Greater exposure to urban green spaces has been linked to reduced risks of depression, cardiovascular disease, diabetes and premature death. Alleviation of chronic stress is a hypothesized pathway to improved health. Previous studies linked chronic stress with biomarker-based measures of physiological dysregulation known as allostatic load. This study aimed to assess the relationship between vegetated land cover near residences and allostatic load. Methods: This cross-sectional population-based study involved 204 adult residents of the Durham-Chapel Hill, North Carolina metropolitan area. Exposure was quantified using high-resolution metrics of trees and herbaceous vegetation within 500 m of each residence derived from the U.S. Environmental Protection Agency’s EnviroAtlas land cover dataset. Eighteen biomarkers of immune, neuroendocrine, and metabolic functions were measured in serum or saliva samples. Allostatic load was defined as a sum of biomarker values dichotomized at specific percentiles of sample distribution. Regression analysis was conducted using generalized additive models with two-dimensional spline smoothing function of geographic coordinates, weighted measures of vegetated land cover allowing decay of effects with distance, and geographic and demographic covariates. Results: An inter-quartile range increase in distance-weighted vegetated land cover was associated with 37% (46%; 27%) reduced allostatic load; significantly

Drinking-water disinfection by-products and semen quality: a cross-sectional study in China.

PubMed

Zeng, Qiang; Wang, Yi-Xin; Xie, Shao-Hua; Xu, Liang; Chen, Yong-Zhe; Li, Min; Yue, Jing; Li, Yu-Feng; Liu, Ai-Lin; Lu, Wen-Qing

2014-07-01

Exposure to disinfection by-products (DBPs) has been demonstrated to impair male reproductive health in animals, but human evidence is limited and inconsistent. We examined the association between exposure to drinking-water DBPs and semen quality in a Chinese population. We recruited 2,009 men seeking semen analysis from the Reproductive Center of Tongji Hospital in Wuhan, China, between April 2011 and May 2012. Each man provided a semen sample and a urine sample. Semen samples were analyzed for sperm concentration, sperm motility, and sperm count. As a biomarker of exposure to drinking-water DBPs, trichloroacetic acid (TCAA) was measured in the urine samples. The mean (median) urinary TCAA concentration was 9.58 (7.97) μg/L (interquartile range, 6.01-10.96 μg/L). Compared with men with urine TCAA in the lowest quartile, increased adjusted odds ratios (ORs) were estimated for below-reference sperm concentration in men with TCAA in the second and fourth quartiles (OR = 1.79; 95% CI: 1.19, 2.69 and OR = 1.51; 95% CI: 0.98, 2.31, respectively), for below-reference sperm motility in men with TCAA in the second and third quartiles (OR = 1.46; 95% CI: 1.12, 1.90 and OR = 1.30; 95% CI: 1.00, 1.70, respectively), and for below-reference sperm count in men with TCAA in the second quartile (OR 1.62; 95% CI: 1.04, 2.55). Nonmonotonic associations with TCAA quartiles were also estimated for semen parameters modeled as continuous outcomes, although significant negative associations were estimated for all quartiles above the reference level for sperm motility. Our findings suggest that exposure to drinking-water DBPs may contribute to decreased semen quality in humans.

Proposed diagnostic reference levels for 3 common cardiac interventional procedures in Ireland

NASA Astrophysics Data System (ADS)

D'Helft, C.; McGee, A. M.; Rainford, L. A.; Mc Fadden, S. L.; Hughes, C. M.; Winder, R. J.; Brennan, P. C.

2007-03-01

Radiation doses for 3 common types of cardiac radiological examinations where investigated: coronary angiography (CA), percutaneous coronary intervention (PCI) and pacemaker insertions (PPI). 22 cardiac imaging suites participated in the study. Radiation dose was monitored for 1804 adult patients using dose area product (DAP) meters. Operational and examination details such as cardiologist grade, patient details and examination complexity were recorded for each examination. Both intra and inter-hospital variations where demonstrated by the results. Individual patient DAP values ranged from 136-23,101cGycm2, 475-41,038cGycm2 and 45- 17,192cGycm2 for CA, PCI and PPI respectively, with third quartile values of 4,173cGycm2, 8,836cGycm2 and 2,051cGycm2. Screening times varied from 0.22-27.6mins, 1.8-98mins and 0.33-54.5mins for CA, PCI and PPI respectively.

Association Between Metabolic Syndrome and the Serum Uric Acid: a Cohort Study.

PubMed

Ren, Ping; Gao, Mengna

2018-05-01

Metabolic syndrome (MS) consists of a cluster of metabolic diseases, and the association between serum uric acid (SUA) and MS has recently been reported in several studies; however, whether SUA is a susceptibility or risk biomarker for the development of MS among Chinese adults is unclear. This study was designed to investigate the relationship between SUA and MS. This study involved 4,988 subjects who were followed up for 9 years. Cox regression model was used to analyze the risk factors of MS. Of the 4,988 subjects, 1,192 subjects developed MS over 9 years of follow-up. The overall 9-year cumulative incidence of MS was 23.9%, ranging from 16.6% in quartile 1 to 35.1% in quartile 4 (p for trend < 0.001). Cox regression analyses indicated that SUA was significantly associated with incident MS (HR comparing quartile 2, 3, and 4 vs. quartile 1, 1.11, 1.33, and 1.78, respectively; p < 0.001) after adjusting for multiple associated parameters. In receiver operating characteristic curve analysis, the cutoff levels for SUA to predict incident MS were 350 μmol/L and 268 μmol/L in males and females, respectively. The results of this study demonstrated that high SUA concentrations may increase the risk of MS among Chinese adults.

Relative validity of micronutrient and fiber intake assessed with two new interactive meal- and Web-based food frequency questionnaires.

PubMed

Christensen, Sara E; Möller, Elisabeth; Bonn, Stephanie E; Ploner, Alexander; Bälter, Olle; Lissner, Lauren; Bälter, Katarina

2014-02-21

The meal- and Web-based food frequency questionnaires, Meal-Q and MiniMeal-Q, were developed for cost-efficient assessment of dietary intake in epidemiological studies. The objective of this study was to evaluate the relative validity of micronutrient and fiber intake assessed with Meal-Q and MiniMeal-Q. The reproducibility of Meal-Q was also evaluated. A total of 163 volunteer men and women aged between 20 and 63 years were recruited from Stockholm County, Sweden. Assessment of micronutrient and fiber intake with the 174-item Meal-Q was compared to a Web-based 7-day weighed food record (WFR). Two administered Meal-Q questionnaires were compared for reproducibility. The 126-item MiniMeal-Q, developed after the validation study, was evaluated in a simulated validation by using truncated Meal-Q data. The study population consisted of approximately 80% women (129/163) with a mean age of 33 years (SD 12) who were highly educated (130/163, 80% with >12 years of education) on average. Cross-classification of quartiles with the WFR placed 69% to 90% in the same/adjacent quartile for Meal-Q and 67% to 89% for MiniMeal-Q. Bland-Altman plots with the WFR and the questionnaires showed large variances and a trend of increasing underestimation with increasing intakes. Deattenuated and energy-adjusted Spearman rank correlations between the questionnaires and the WFR were in the range ρ=.25-.69, excluding sodium that was not statistically significant. Cross-classifications of quartiles of the 2 Meal-Q administrations placed 86% to 97% in the same/adjacent quartile. Intraclass correlation coefficients for energy-adjusted intakes were in the range of .50-.76. With the exception of sodium, this validation study demonstrates Meal-Q and MiniMeal-Q to be useful methods for ranking micronutrient and fiber intake in epidemiological studies with Web-based data collection.

The Ratio of Arginine to Dimethylarginines is Reduced and Predicts Outcomes in Patients with Severe Sepsis

PubMed Central

Gough, Michael S.; Morgan, Mary Anne M.; Mack, Cynthia M.; Darling, Denise C.; Frasier, Lauren M.; Doolin, Kathleen P.; Apostolakos, Michael J.; Stewart, Judith C.; Graves, Brian T.; Arning, Erland; Bottiglieri, Teodoro; Mooney, Robert A.; Frampton, Mark W.; Pietropaoli, Anthony P.

2011-01-01

Objective Arginine deficiency may contribute to microvascular dysfunction, but previous studies suggest that arginine supplementation may be harmful in sepsis. Systemic arginine availability can be estimated by measuring the ratio of arginine to its endogenous inhibitors, asymmetric and symmetric dimethylarginine. We hypothesized that the arginine to dimethylarginine (Arg/DMA) ratio is reduced in patients with severe sepsis and associated with severity of illness and outcomes. Design Case-control and prospective cohort study Setting Medical and surgical intensive care units of an academic medical center Patients and Subjects 109 severe sepsis and 50 control subjects Measurements and Main Results Plasma and urine were obtained in control subjects and within 48 hours of diagnosis in severe sepsis patients. The Arg/DMA ratio was higher in control subjects vs. sepsis patients ((median = 95 [inter-quartile range = 85 – 114]) vs. 34 [24 – 48], p < 0.001), and in hospital survivors vs. non-survivors ((39 [26 – 52]) vs. 27 [19 – 32], p = 0.004). The Arg/DMA ratio was correlated with Acute Physiology and Chronic Health Evaluation II score (Spearman’s correlation coefficient [rho] = − 0.40, p < 0.001) and organ-failure free days (rho = 0.30, p = 0.001). A declining Arg/DMA ratio was independently associated with hospital mortality (odds ratio =1.63 per quartile, 95% confidence interval [CI] = 1.00 – 2.65, p = 0.048) and risk of death over 6 months (hazard ratio = 1.41 per quartile, 95% CI = 1.01 – 1.98, p = 0.043). The Arg/DMA ratio was correlated with the urinary nitrate to creatinine ratio (rho = 0.46, p < 0.001). Conclusions The Arg/DMA ratio is associated with severe sepsis, severity of illness, and clinical outcomes. The Arg/DMA ratio may be a useful biomarker, and interventions designed to augment systemic arginine availability in severe sepsis may still be worthy of investigation. PMID:21378552

Stepwise positive association between APOA5 minor allele frequencies and increasing plasma triglyceride quartiles in random patients with hypertriglyceridemia of unclarified origin.

PubMed

Hadarits, Ferenc; Kisfali, Péter; Mohás, Márton; Maász, Anita; Sümegi, Katalin; Szabó, Melinda; Hetyésy, Katalin; Valasek, Andrea; Janicsek, Ingrid; Wittmann, István; Melegh, Béla

2011-03-01

Apolipoprotein A5 (ApoA5) gene and its protein product play a central role in the complex regulation of circulating triglyceride levels in humans. Naturally occurring variants of the apolipoprotein A5 gene have been associated with increased triglyceride levels and have been found to confer risk for cardiovascular diseases. In our study, four polymorphisms, the T-1131C, IVS3+G476A, T1259C, and C56G alleles of APOA5 were analyzed in a total of 436 patients by polymerase chain reaction-restriction fragment length polymorphism methods. The randomly selected patients were classified into four quartile (q) groups based on triglyceride levels (q1: TG<1.31 mmol/l; q2: 1.31-2.90 mmol/l; q3: 2.91-4.85 mmol/l; q4: TG>4.85 mmol/l). We observed significant stepwise increasing association between the four APOA5 minor allele carrier frequencies and plasma triglyceride quartiles: -1131C (q1: 4.44%; q2: 8.95%; q3: 12.9%; q4: 20.6%), IVS3 + 476A (q1: 4.44%; q2: 5.79%; q3: 11.1%; q4: 19.7%), 1259C (q1: 4.44%; q2: 6.84%; q3: 11.1%; q4: 20.6%) and 56G (q1: 5.64%; q2: 6.31%; q3: 11.16%; q4: 11.9%). The serum total cholesterol and high density lipoprotein-cholesterol levels also showed allele-dependent differences in the quartiles. The findings presented here revealed a special arrangement of APOA5 minor alleles in patients with different serum triglyceride ranges in Hungarians.

Society of Thoracic Surgeons Risk Score predicts hospital charges and resource use after aortic valve replacement.

PubMed

Arnaoutakis, George J; George, Timothy J; Alejo, Diane E; Merlo, Christian A; Baumgartner, William A; Cameron, Duke E; Shah, Ashish S

2011-09-01

The impact of Society of Thoracic Surgeons predicted mortality risk score on resource use has not been previously studied. We hypothesize that increasing Society of Thoracic Surgeons risk scores in patients undergoing aortic valve replacement are associated with greater hospital charges. Clinical and financial data for patients undergoing aortic valve replacement at The Johns Hopkins Hospital over a 10-year period (January 2000 to December 2009) were reviewed. The current Society of Thoracic Surgeons formula (v2.61) for in-hospital mortality was used for all patients. After stratification into risk quartiles, index admission hospital charges were compared across risk strata with rank-sum and Kruskal-Wallis tests. Linear regression and Spearman's coefficient assessed correlation and goodness of fit. Multivariable analysis assessed relative contributions of individual variables on overall charges. A total of 553 patients underwent aortic valve replacement during the study period. Average predicted mortality was 2.9% (±3.4) and actual mortality was 3.4% for aortic valve replacement. Median charges were greater in the upper quartile of patients undergoing aortic valve replacement (quartiles 1-3, $39,949 [interquartile range, 32,708-51,323] vs quartile 4, $62,301 [interquartile range, 45,952-97,103], P < .01]. On univariate linear regression, there was a positive correlation between Society of Thoracic Surgeons risk score and log-transformed charges (coefficient, 0.06; 95% confidence interval, 0.05-0.07; P < .01). Spearman's correlation R-value was 0.51. This positive correlation persisted in risk-adjusted multivariable linear regression. Each 1% increase in Society of Thoracic Surgeons risk score was associated with an added $3000 in hospital charges. This is the first study to show that increasing Society of Thoracic Surgeons risk score predicts greater charges after aortic valve replacement. As competing therapies, such as percutaneous valve replacement, emerge to treat high-risk patients, these results serve as a benchmark to compare resource use. Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Objectively Measured Physical Activity During Physical Education and School Recess and Their Associations With Academic Performance in Youth: The UP&DOWN Study.

PubMed

Esteban-Cornejo, Irene; Martinez-Gomez, David; Garcia-Cervantes, Laura; Ortega, Francisco B; Delgado-Alfonso, Alvaro; Castro-Piñero, José; Veiga, Oscar L

2017-04-01

This study examined the associations of objectively measured physical activity in Physical Education and recess with academic performance in youth. This cross-sectional study was conducted with 1,780 participants aged 6 to 18 years (863 girls). Physical activity was objectively measured by accelerometry and was also classified according to sex- and agespecific quartiles of physical activity intensities. Academic performance was assessed through school records. Physical activity in physical education (PE) and recess was not associated with academic performance (β ranging from -0.038 to -0.003; all P > .05). Youth in the lowest quartile of physical activity in PE engaged in an average of 1.40 min of moderate-to-vigorous physical activity and those in the highest quartile engaged in 21.60 min (for recess: lowest quartile, 2.20 min; highest quartile, 11.15 min). There were no differences in academic performance between quartiles of physical activity in Physical Education and recess. Time spent at different physical activity intensities during PE and recess does not impair academic performance in youth.

Variability of nursing care by APR-DRG and by severity of illness in a sample of nine Belgian hospitals.

PubMed

Pirson, Magali; Delo, Caroline; Di Pierdomenico, Lionel; Laport, Nancy; Biloque, Veronique; Leclercq, Pol

2013-10-10

As soon as Diagnosis related Groups (DRG) were introduced in many hospital financing systems, most nursing research revealed that DRG were not very homogeneous with regard to nursing care. However, few studies are based on All Patient refined Diagnosis related Groups (APR-DRGs) and few of them use recent data. Objectives of this study are: (1) to evaluate if nursing activity is homogeneous by APR-DRG and by severity of illness (SOI) (2) to evaluate the outlier's rate associated with the nursing activity and (3) to compare nursing cost homogeneity per DRG and SOI. Study done in 9 Belgian hospitals on a selection of APR-DRG with more than 30 patients (7 638 inpatient stays). The evaluation of the homogeneity is based on coefficients of variation (CV). The 75th percentile + 1.5 × inter-quartile range was used to select high outliers. 25th percentile -1.5 × inter-quartile range was used to select low outliers. Nursing costs per ward were distributed on inpatient stays of each ward following two techniques (the LOS vs. the number of nursing care minutes per stay). The homogeneity of LOS by DRG and by SOI is relatively good (CV: 0.56). The homogeneity of the nursing activity by DRG is less good (CVs between 0.36 and 1.54) and is influenced by nursing activity outliers (high outliers' rate: 5.19%, low outliers' rate: 0.14%). The outlier's rate varies according to the studied variable. The high outliers' rate is higher for nursing activity than for LOS. The homogeneity of nursing costs is higher when costs are based on the LOS of patients than when based on minutes of nursing care (CVs between 0.26 and 1.46 for nursing costs based on LOS and between 0.49 and 2.04 for nursing costs based on minutes of nursing care). It is essential that the calculation of nursing cost by stay and by DRG for hospital financing purposes was based on nursing activity data, that more reflect resources used in wards, and not on LOS data. The only way to obtain this information is the generalization of computerized nursing files.

Variability of nursing care by APR-DRG and by severity of illness in a sample of nine Belgian hospitals

PubMed Central

2013-01-01

Background As soon as Diagnosis related Groups (DRG) were introduced in many hospital financing systems, most nursing research revealed that DRG were not very homogeneous with regard to nursing care. However, few studies are based on All Patient refined Diagnosis related Groups (APR-DRGs) and few of them use recent data. Objectives of this study are: (1) to evaluate if nursing activity is homogeneous by APR-DRG and by severity of illness (SOI) (2) to evaluate the outlier’s rate associated with the nursing activity and (3) to compare nursing cost homogeneity per DRG and SOI. Methods Study done in 9 Belgian hospitals on a selection of APR-DRG with more than 30 patients (7 638 inpatient stays). The evaluation of the homogeneity is based on coefficients of variation (CV). The 75th percentile + 1.5 × inter-quartile range was used to select high outliers. 25th percentile −1.5 × inter-quartile range was used to select low outliers. Nursing costs per ward were distributed on inpatient stays of each ward following two techniques (the LOS vs. the number of nursing care minutes per stay). Results The homogeneity of LOS by DRG and by SOI is relatively good (CV: 0.56). The homogeneity of the nursing activity by DRG is less good (CVs between 0.36 and 1.54) and is influenced by nursing activity outliers (high outliers’ rate: 5.19%, low outliers’ rate: 0.14%). The outlier’s rate varies according to the studied variable. The high outliers’ rate is higher for nursing activity than for LOS. The homogeneity of nursing costs is higher when costs are based on the LOS of patients than when based on minutes of nursing care (CVs between 0.26 and 1.46 for nursing costs based on LOS and between 0.49 and 2.04 for nursing costs based on minutes of nursing care). Conclusions It is essential that the calculation of nursing cost by stay and by DRG for hospital financing purposes was based on nursing activity data, that more reflect resources used in wards, and not on LOS data. The only way to obtain this information is the generalization of computerized nursing files. PMID:24112381

Observation Status, Poverty, and High Financial Liability Among Medicare Beneficiaries.

PubMed

Goldstein, Jennifer N; Zhang, Zugui; Schwartz, J Sanford; Hicks, LeRoi S

2018-01-01

Medicare beneficiaries hospitalized under observation status are subject to cost-sharing with no spending limit under Medicare Part B. Because low-income status is associated with increased hospital use, there is concern that such beneficiaries may be at increased risk for high use and out-of-pocket costs related to observation care. Our objective was to determine whether low-income Medicare beneficiaries are at risk for high use and high financial liability for observation care compared with higher-income beneficiaries. We performed a retrospective, observational analysis of Medicare Part B claims and US Census Bureau data from 2013. Medicare beneficiaries with Part A and B coverage for the full calendar year, with 1 or more observation stay(s), were included in the study. Beneficiaries were divided into quartiles representing poverty level. The associations between poverty quartile and high use of observation care and between poverty quartile and high financial liability for observation care were evaluated. After multivariate adjustment, the risk of high use was higher for beneficiaries in the poor (Quartile 3) and poorest (Quartile 4) quartiles compared with those in the wealthiest quartile (Quartile 1) (adjusted odds ratio [AOR], 1.21; 95% confidence interval [CI], 1.13-1.31; AOR, 1.24; 95% CI, 1.16-1.33). The risk of high financial liability was higher in every poverty quartile compared with the wealthiest and peaked in Quartile 3, which represented the poor but not the poorest beneficiaries (AOR, 1.17; 95% CI, 1.10-1.24). Poverty predicts high use of observation care. The poor or near poor may be at highest risk for high liability. Copyright © 2018 Elsevier Inc. All rights reserved.

GFR estimated from cystatin C versus creatinine in children born small for gestational age.

PubMed

Franco, Maria C P; Nishida, Sônia K; Sesso, Ricardo

2008-06-01

Low birth weight caused by intrauterine growth restriction may be a risk factor for renal impairment in the adult life. A cross-sectional study. 71 children aged 8 to 13 years living in the community of São Paulo, Brazil, were included in the study. Gestational age was within the normal range. Birth weight (range, 2,052 to 3,560 g) divided into quartiles: 2,500 g or less; 2,501 to 2,740 g; 2,741 to 3,000 g; and greater than 3,000 g. Birth weight ascertained by birth records in 43 and by recall in 28 participants. Cystatin C, creatinine, and glomerular filtration rate (GFR) estimated by equations using cystatin C (eGFR(cys)) or creatinine (eGFR(cr)). Overall, mean serum creatinine level was 0.8 +/- 0.01 (SE) mg/dL (range, 0.7 to 1.1 mg/dL); mean plasma cystatin C level was 0.9 +/- 0.02 mg/L (range, 0.5 to 1.6 mg/L), and eGFR(cr) and eGFR(cys) were 102.4 +/- 2.16 (range, 66 to 140) and 91.8 +/- 2.46 mL/min/1.73 m(2) (range, 49 to 139 mL/min/1.73 m(2)), respectively. No differences were found for serum creatinine or eGFR(cr) values among the birth-weight quartiles. There was a significant linear trend of increasing cystatin C levels (decreasing eGFR(cys)) in the lower birth-weight quartile groups (P = 0.002 and P = 0.02, respectively). Systolic blood pressure correlated with plasma cystatin C level (r = 0.31; P = 0.008) and eGFR(cys) (r = -0.26; P = 0.028). Covariance analysis adjusting for age, sex, body mass index for age compared with standards of the National Center for Health Statistics and expressed as a z score, and systolic blood pressure showed that cystatin C values remained greater in the lowest than highest birth-weight quartile (1.01 +/- 0.05 versus 0.83 +/- 0.05 mg/L; P = 0.02). Ascertainment of birth weight by recall in some participants. Lack of measurement of microalbuminuria, absence of direct GFR measurement, and small sample size. Lower birth weight is associated with higher levels of cystatin C but not creatinine in 8-13 yr. old children born full-term.

WE-FG-202-12: Investigation of Longitudinal Salivary Gland DCE-MRI Changes

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

Ger, R; Howell, R; Li, H

Purpose: To determine the correlation between dose and changes through treatment in dynamic contrast enhanced (DCE) MRI voxel parameters (Ktrans, kep, Ve, and Vp) within salivary glands of head and neck oropharyngeal squamous cell carcinoma (HNSCC) patients. Methods: 17 HNSCC patients treated with definitive radiation therapy completed DCE-MRI scans on a 3T scanner at pre-treatment, mid-treatment, and post-treatment time points. Mid-treatment and post-treatment DCE images were deformably registered to pre-treatment DCE images (Velocity software package). Pharmacokinetic analysis of the DCE images used a modified Tofts model to produce parameter maps with an arterial input function selected from each patient’s perivertebralmore » space on the image (NordicICE software package). In-house software was developed for voxel-by-voxel longitudinal analysis of the salivary glands within the registered images. The planning CT was rigidly registered to the pre-treatment DCE image to obtain dose values in each voxel. Voxels within the lower and upper dose quartiles for each gland were averaged for each patient, then an average of the patients’ means for the two quartiles were compared. Dose-relationships were also assessed by Spearman correlations between dose and voxel parameter changes for each patient’s gland. Results: Changes in parameters’ means between time points were observed, but inter-patient variability was high. Ve of the parotid was the only parameter that had a consistently significant longitudinal difference between dose quartiles. The highest Spearman correlation was Vp of the sublingual gland for the change in the pre-treatment to mid-treatment values with only a ρ=0.29. Conclusion: In this preliminary study, there was large inter-patient variability in the changes of DCE voxel parameters with no clear relationship with dose. Additional patients may reduce the uncertainties and allow for the determination of the existence of parameter and dose relationships.« less

Aspirin resistance are associated with long-term recurrent stroke events after ischaemic stroke.

PubMed

Zhang, Ning; Wang, Zhenhua; Zhou, Lihong

2017-09-01

To investigate the prevalent of aspirin resistance (AR) in stroke and its association with recurrent stroke in 214 patients with ischemic stroke who were receiving aspirin before the stroke onset. Two hundreds and fourteen acute stroke patients who previously received aspirin therapy (100mg/day for ≥7days) were enrolled. Whole blood samples were collected for platelet aggregation testing. The result is expressed in aspirin reaction units (ARU). A cutoff of 550 ARU was used to determine the presence of AR. A follow-up period of 1year was performed to record stroke recurrence events. In this study, the median age was 68 years (IQR, 60-77 years), and 118 (55.1%) were men. A total of 43 of 214 enrolled patients (20.1%) were AR. ARU levels were significantly higher in patients with recurrence than those without (514[IQR: 466-592] vs. 454[IQR: 411-499]; P <0.001). The stroke recurrence distribution across the ARU quartiles ranged between 7.41% (first quartile) to 40.74% (fourth quartile). In multivariate analyses, the 3th and 4th quartile of ARU was significantly associated with stroke recurrence during the observation period compared to the 1st quartile group, and the adjusted risk increased by 215% (OR=3.15 [95% CI 1.96-4.33], P=0.007) and 322% (4.22[2.56-7.16], P<0.001). In multivariate logistic regression analysis, AR was associated with a higher risk of stroke recurrence, and the adjusted risk increased by 365% (OR=4.65; 95% CI=2.99-8.16; P<0.001). In conclusion, AR is not uncommon in Chinese stroke patients who receive anti-platelet medications. Patients with AR may have a greater risk of suffering stroke recurrence events. Copyright © 2017 Elsevier Inc. All rights reserved.

Significance and prognostic value of increased serum direct bilirubin level for lymph node metastasis in Chinese rectal cancer patients.

PubMed

Gao, Chun; Fang, Long; Li, Jing-Tao; Zhao, Hong-Chuan

2016-02-28

To determine the significance of increased serum direct bilirubin level for lymph node metastasis (LNM) in Chinese rectal cancer patients, after those with known hepatobiliary and pancreatic diseases were excluded. A cohort of 469 patients, who were treated at the China-Japan Friendship Hospital, Ministry of Health (Beijing, China), in the period from January 2003 to June 2011, and with a pathological diagnosis of rectal adenocarcinoma, were recruited. They included 231 patients with LNM (49.3%) and 238 patients without LNM. Follow-up for these patients was taken through to December 31, 2012. The baseline serum direct bilirubin concentration was (median/inter-quartile range) 2.30/1.60-3.42 μmol/L. Univariate analysis showed that compared with patients without LNM, the patients with LNM had an increased level of direct bilirubin (2.50/1.70-3.42 vs 2.10/1.40-3.42, P = 0.025). Multivariate analysis showed that direct bilirubin was independently associated with LNM (OR = 1.602; 95%CI: 1.098-2.338, P = 0.015). Moreover, we found that: (1) serum direct bilirubin differs between male and female patients; a higher concentration was associated with poor tumor classification; (2) as the baseline serum direct bilirubin concentration increased, the percentage of patients with LNM increased; and (3) serum direct bilirubin was associated with the prognosis of rectal cancer patients and higher values indicated poor prognosis. Higher serum direct bilirubin concentration was associated with the increased risk of LNM and poor prognosis in our rectal cancers.

Significance and prognostic value of increased serum direct bilirubin level for lymph node metastasis in Chinese rectal cancer patients

PubMed Central

Gao, Chun; Fang, Long; Li, Jing-Tao; Zhao, Hong-Chuan

2016-01-01

AIM: To determine the significance of increased serum direct bilirubin level for lymph node metastasis (LNM) in Chinese rectal cancer patients, after those with known hepatobiliary and pancreatic diseases were excluded. METHODS: A cohort of 469 patients, who were treated at the China-Japan Friendship Hospital, Ministry of Health (Beijing, China), in the period from January 2003 to June 2011, and with a pathological diagnosis of rectal adenocarcinoma, were recruited. They included 231 patients with LNM (49.3%) and 238 patients without LNM. Follow-up for these patients was taken through to December 31, 2012. RESULTS: The baseline serum direct bilirubin concentration was (median/inter-quartile range) 2.30/1.60-3.42 μmol/L. Univariate analysis showed that compared with patients without LNM, the patients with LNM had an increased level of direct bilirubin (2.50/1.70-3.42 vs 2.10/1.40-3.42, P = 0.025). Multivariate analysis showed that direct bilirubin was independently associated with LNM (OR = 1.602; 95%CI: 1.098-2.338, P = 0.015). Moreover, we found that: (1) serum direct bilirubin differs between male and female patients; a higher concentration was associated with poor tumor classification; (2) as the baseline serum direct bilirubin concentration increased, the percentage of patients with LNM increased; and (3) serum direct bilirubin was associated with the prognosis of rectal cancer patients and higher values indicated poor prognosis. CONCLUSION: Higher serum direct bilirubin concentration was associated with the increased risk of LNM and poor prognosis in our rectal cancers. PMID:26937145

Structural equation modeling of the inflammatory response to traffic air pollution

PubMed Central

Baja, Emmanuel S.; Schwartz, Joel D.; Coull, Brent A.; Wellenius, Gregory A.; Vokonas, Pantel S.; Suh, Helen H.

2015-01-01

Several epidemiological studies have reported conflicting results on the effect of traffic-related pollutants on markers of inflammation. In a Bayesian framework, we examined the effect of traffic pollution on inflammation using structural equation models (SEMs). We studied measurements of C-reactive protein (CRP), soluble vascular cell adhesion molecule-1 (sVCAM-1), and soluble intracellular adhesion molecule-1 (sICAM-1) for 749 elderly men from the Normative Aging Study. Using repeated measures SEMs, we fit a latent variable for traffic pollution that is reflected by levels of black carbon, carbon monoxide, nitrogen monoxide and nitrogen dioxide to estimate its effect on a latent variable for inflammation that included sICAM-1, sVCAM-1 and CRP. Exposure periods were assessed using 1-, 2-, 3-, 7-, 14- and 30-day moving averages previsit. We compared our findings using SEMs with those obtained using linear mixed models. Traffic pollution was related to increased inflammation for 3-, 7-, 14- and 30-day exposure periods. An inter-quartile range increase in traffic pollution was associated with a 2.3% (95% posterior interval (PI): 0.0–4.7%) increase in inflammation for the 3-day moving average, with the most significant association observed for the 30-day moving average (23.9%; 95% PI: 13.9–36.7%). Traffic pollution adversely impacts inflammation in the elderly. SEMs in a Bayesian framework can comprehensively incorporate multiple pollutants and health outcomes simultaneously in air pollution–cardiovascular epidemiological studies. PMID:23232970

Impact of urban sprawl on overweight, obesity, and physical activity in Sydney, Australia.

PubMed

Garden, Frances L; Jalaludin, Bin B

2009-01-01

Obesity and inadequate physical activity are major risk factors for many diseases. The built environment plays an important role in influencing participation in physical activity. We aimed to determine whether urban sprawl in Sydney, Australia is associated with overweight/obesity and levels of physical activity. We used a cross-sectional multilevel study design to relate urban sprawl (based on population density) measured at an area level to overweight/obesity and levels of physical activity measured at an individual level whilst controlling for individual and area level covariates in metropolitan Sydney. Individual level data were obtained from the 2002 and 2003 New South Wales Population Health Survey. We had information on 7,290 respondents. The mean population density was 2,168 persons per square kilometer (standard deviation=1,741, range=218-7,045). After controlling for individual and area level covariates, for an inter-quartile increase in sprawl, the odds of being overweight was 1.26 (95% CI=1.10-1.44), the odds of being obese was 1.47 (95% CI=1.24-1.75), the odds of inadequate physical activity was 1.38 (95% CI=1.21-1.57), and the odds of not spending any time walking during the past week was 1.58 (95% CI=1.28-1.93). Living in more sprawling suburbs increases the risk of overweight/obesity and inadequate physical activity despite the relatively low levels of urban sprawl in metropolitan Sydney. Modifications to the urban environment to increase physical activity may be worthwhile.

Skeletal muscle adaptation in response to supervised exercise training for intermittent claudication.

PubMed

Beckitt, T A; Day, J; Morgan, M; Lamont, P M

2012-09-01

There is evidence that the improvement following supervised exercise for claudication results from skeletal muscle adaptation. The myosin heavy chain (MHC) determines muscle fibre type and therefore efficiency. Immunohistochemical analysis has failed to take account of hybrid MHC expression within myofibres. This study sought evidence of differential MHC protein expression following supervised exercise for claudication. 38 claudicants were recruited. Subjects undertook a three-month supervised exercise programme. Controls were patients awaiting angioplasty for claudication. Subjects underwent paired gastrocnemius biopsy. Relative expression of MHC proteins was determined by SDS-PAGE electrophoresis. Non-parametric data is presented as median with the inter-quartile range and parametric as the mean ± standard deviation. Upon completion of the exercise programme there was a 94% increase (124 (106-145) to 241 (193-265) metres, p = 0.002) in maximum walking distance, which was not evident in the control group. An 11.1% (p = 0.02) increase in MHC I expression was observed in the exercise but not the control group (34.3% ± 6.8 to 45.4% ± 4.4). There was a positive correlation between the change in MHC I expression and the improvement in claudication distance (r = 0.69, p < 0.05). Supervised exercise training for claudication results in an increase in the proportion of MHC type I expression within the symptomatic gastrocnemius muscle. Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Pilot study of a novel classroom designed to prevent myopia by increasing children's exposure to outdoor light.

PubMed

Zhou, Zhongqiang; Chen, Tingting; Wang, Mengrui; Jin, Ling; Zhao, Yongyi; Chen, Shangji; Wang, Congyao; Zhang, Guoshan; Wang, Qilin; Deng, Qiaoming; Liu, Yubo; Morgan, Ian G; He, Mingguang; Liu, Yizhi; Congdon, Nathan

2017-01-01

We sought to assess light characteristics and user acceptability of a prototype Bright Classroom (BC), designed to prevent children's myopia by exposing them to light conditions resembling the outdoors. Conditions were measured throughout the school year in the glass-constructed BC, a traditional classroom (TC) and outdoors. Teachers and children completed user questionnaires, and children rated reading comfort at different light intensities. A total of 230 children (mean age 10.2 years, 57.4% boys) and 13 teachers (36.8 years, 15.4% men) completed questionnaires. The median (Inter Quartile Range) light intensity in the BC (2,540 [1,330-4,060] lux) was greater than the TC (477 [245-738] lux, P < 0.001), though less than outdoors (19,500 [8,960-36,000] lux, P < 0.001). A prominent spectral peak at 490-560 nm was present in the BC and outdoors, but less so in the TC. Teachers and children gave higher overall ratings to the BC than TC, and light intensity in the BC in summer and on sunny days (>5,000 lux) was at the upper limit of children's comfort for reading. In summary, light intensity in the BC exceeds TC, and is at the practical upper limit for routine use. Children and teachers prefer the BC.

Spatial variation of pneumonia hospitalization risk in Twin Cities metro area, Minnesota.

PubMed

Iroh Tam, P Y; Krzyzanowski, B; Oakes, J M; Kne, L; Manson, S

2017-11-01

Fine resolution spatial variability in pneumonia hospitalization may identify correlates with socioeconomic, demographic and environmental factors. We performed a retrospective study within the Fairview Health System network of Minnesota. Patients 2 months of age and older hospitalized with pneumonia between 2011 and 2015 were geocoded to their census block group, and pneumonia hospitalization risk was analyzed in relation to socioeconomic, demographic and environmental factors. Spatial analyses were performed using Esri's ArcGIS software, and multivariate Poisson regression was used. Hospital encounters of 17 840 patients were included in the analysis. Multivariate Poisson regression identified several significant associations, including a 40% increased risk of pneumonia hospitalization among census block groups with large, compared with small, populations of ⩾65 years, a 56% increased risk among census block groups in the bottom (first) quartile of median household income compared to the top (fourth) quartile, a 44% higher risk in the fourth quartile of average nitrogen dioxide emissions compared with the first quartile, and a 47% higher risk in the fourth quartile of average annual solar insolation compared to the first quartile. After adjusting for income, moving from the first to the second quartile of the race/ethnic diversity index resulted in a 21% significantly increased risk of pneumonia hospitalization. In conclusion, the risk of pneumonia hospitalization at the census-block level is associated with age, income, race/ethnic diversity index, air quality, and solar insolation, and varies by region-specific factors. Identifying correlates using fine spatial analysis provides opportunities for targeted prevention and control.

Long-term exposure to air pollution and the risk of suicide death: A population-based cohort study.

PubMed

Min, Jin-Young; Kim, Hye-Jin; Min, Kyoung-Bok

2018-07-01

Suicide is a major public health problem. Previous studies have reported a significant association between acute exposure to air pollution and suicide; little attention has been paid to the long-term effects of air pollution on risk of suicide. We investigated whether long-term exposure to particulate matter of ≤10μm in diameter (PM 10 ), nitrogen dioxide (NO 2 ), and sulfur dioxide (SO 2 ) would be associated with a greater risk of death by suicide. The study sample comprised 265,749 adults enrolled in the National Health Insurance Service-National Sample Cohort (2002-2013) in South Korea. Suicide death was defined as per ICD-10 code. Data on air pollution exposure used nationwide monitoring data, and individual exposure levels were assigned using geographic information systems. Air pollution exposure was categorized as the interquartile range (IQR) and quartiles. Hazards ratios (HRs) were calculated for the occurrence of suicide death after adjusting for potential covariates. During the study period, 564 (0.2%) subjects died from suicide. Increases in IQR pollutants (7.5μg/m 3 for PM 10 , 11.8ppb for NO 2 , and 0.8ppb for SO 2 ) significantly increased HR for suicide death [PM 10 : HR=3.09 (95% CI: 2.63-3.63); NO 2 : HR=1.33 (95% CI: 1.09-1.64); and SO 2 : HR=1.15 (95% CI: 1.07-1.24)]. Compared with the lowest level of air pollutants (Quartile 1), the risk of suicide significantly increased in the highest quartile level (Quartile 4) for PM 10 (HR=4.03; 95% CI: 2.97-5.47) and SO 2 (HR=1.65; 95% CI: 1.29-2.11) and in the third quartile for NO 2 (HR=1.52; 95% CI: 1.17-1.96). HRs for subjects with a physical or mental disorder were higher than that those for subjects without the disorder. Subjects living in metropolitan areas were more vulnerable to long-term PM 10 exposure than those living in non-metropolitan areas. Long-term exposure to air pollution was associated with a significantly increased risk of suicide death. People having underlying diseases or living in metropolitan areas may be more susceptible to high air pollution exposure. Copyright © 2018 Elsevier B.V. All rights reserved.

Intracellular metabolites of mercaptopurine in children with lymphoblastic leukaemia: a possible indicator of non-compliance?

PubMed

Lennard, L; Welch, J; Lilleyman, J S

1995-10-01

As part of a programme assessing the pharmacokinetics of oral thiopurines given for lymphoblastic leukaemia, we assayed intracellular metabolites of mercaptopurine in children from all over the United Kingdom who were given a standard dose of the drug. The metabolites we measured, thioguanine nucleotides and methylmercaptopurines, are products of two competing metabolic pathways and would be expected to show an inverse correlation. A total of 327 children from 17 centres in the UK were studied. All were on the same therapeutic schedule of mercaptopurine. All had been on an unattenuated full protocol-directed dose (at least 75 mg m-2) for a minimum of 7 days before assay. There was a very wide variation in the concentration of the two metabolites measured; the thioguanine nucleotides ranged from 0 to 1255 pmol per 8 x 10(8) red cells (median 289, lower quartile 210, upper quartile 377) and the methylmercaptopurine metabolites ranged from 0 to 46.3 nmol per 8 x 10(8) red cells (median 5.18, lower quartile 2.31, upper quartile 11.59). The anticipated negative correlation was not apparent, but the ratio between the two was not randomly distributed. No child had both metabolite concentrations in the upper quartiles, but in 32 (10%) children the concentration of both metabolites was in the lower quartile. Of the 32, only one metabolite was detected in four and none at all in six. The most likely explanation for these findings is that a minority of children with lymphoblastic leukaemia fail to take oral mercaptopurine either totally or intermittently. The extent of the problem is unknown, but we suspect it may be clinically important in at least 10% of patients.

Intracellular metabolites of mercaptopurine in children with lymphoblastic leukaemia: a possible indicator of non-compliance?

PubMed Central

Lennard, L.; Welch, J.; Lilleyman, J. S.

1995-01-01

As part of a programme assessing the pharmacokinetics of oral thiopurines given for lymphoblastic leukaemia, we assayed intracellular metabolites of mercaptopurine in children from all over the United Kingdom who were given a standard dose of the drug. The metabolites we measured, thioguanine nucleotides and methylmercaptopurines, are products of two competing metabolic pathways and would be expected to show an inverse correlation. A total of 327 children from 17 centres in the UK were studied. All were on the same therapeutic schedule of mercaptopurine. All had been on an unattenuated full protocol-directed dose (at least 75 mg m-2) for a minimum of 7 days before assay. There was a very wide variation in the concentration of the two metabolites measured; the thioguanine nucleotides ranged from 0 to 1255 pmol per 8 x 10(8) red cells (median 289, lower quartile 210, upper quartile 377) and the methylmercaptopurine metabolites ranged from 0 to 46.3 nmol per 8 x 10(8) red cells (median 5.18, lower quartile 2.31, upper quartile 11.59). The anticipated negative correlation was not apparent, but the ratio between the two was not randomly distributed. No child had both metabolite concentrations in the upper quartiles, but in 32 (10%) children the concentration of both metabolites was in the lower quartile. Of the 32, only one metabolite was detected in four and none at all in six. The most likely explanation for these findings is that a minority of children with lymphoblastic leukaemia fail to take oral mercaptopurine either totally or intermittently. The extent of the problem is unknown, but we suspect it may be clinically important in at least 10% of patients. PMID:7547211

Dependence of average inter-particle distance upon the temperature of neutrals in dusty plasma crystals

NASA Astrophysics Data System (ADS)

Nikolaev, V. S.; Timofeev, A. V.

2018-01-01

It is often suggested that inter-particle distance in stable dusty plasma structures decreases with cooling as a square root of neutral gas temperature. Deviations from this dependence (up to the increase at cryogenic temperatures) found in the experimental results for the pressures range 0.1-8.0 mbar and for the currents range 0.1-1.0 mA are given. Inter-particle distance dependences on the charge of particles, parameter of the trap and the screening length in surrounding plasma are obtained for different conditions from molecular dynamics simulations. They are well approximated by power functions in the mentioned range of parameters. It is found that under certain assumptions thermophoretical force is responsible for inter-particle distance increase at cryogenic temperatures.

Leukocyte Count is Associated with Increased Platelet Reactivity and Diminished Response to Aspirin in Healthy Individuals with a Family History of Coronary Artery Disease

PubMed Central

Faraday, Nauder; Yanek, Lisa R.; Vaidya, Dhananjay; Kral, Brian; Qayyum, Rehan; Herrera-Galeano, J. Enrique; Moy, Taryn F.; Becker, Diane M.; Becker, Lewis C.

2009-01-01

Background Markers of systemic inflammation, including blood leukocyte count, are associated with increased cardiovascular risk, but the mechanisms underlying this association are unclear. Leukocytes may promote platelet reactivity and thrombus formation, providing a basis for increased risk, but a relation between leukocyte count and platelet function has not been studied. Methods We evaluated the relation of blood leukocyte count, C-reactive protein (CRP), and interleukin-6 (IL-6) to platelet aggregation to collagen, ADP and arachidonic acid, and to urinary excretion of 11-dehydro thromboxane B2. Studies were conducted in 1600 individuals (45.0 ± 12.9 years, 42.7% male) at risk for coronary artery disease (CAD) before and after low dose aspirin. Results At baseline, platelet reactivity increased with increasing quartile of leukocyte count (median counts for each quartile were normal) for all measures of platelet function (P<0.0001). These relations were unchanged by aspirin. The relation between leukocyte count and each measure of platelet reactivity remained significant (P<0.05) after multivariable adjustment for CRP, IL-6, cardiac risk factors, hematologic variables, and platelet thromboxane production. CRP and IL-6 were independently associated with few measures of platelet reactivity. Conclusions Increasing quartile of leukocyte count, even within the normal range, is associated with increasing platelet reactivity in individuals at risk for CAD. This relationship is not altered by aspirin and is independent of inflammatory markers and platelet thromboxane production. Additional studies are needed to determine the mechanism(s) for this association and therapies to reduce cardiovascular risk in patients with elevated leukocyte counts. PMID:19185906

Time averaging and stratigraphic disorder of molluscan assemblages in the Holocene sediments in the NE Adriatic (Piran)

NASA Astrophysics Data System (ADS)

Tomasovych, Adam; Gallmetzer, Ivo; Haselmair, Alexandra; Kaufman, Darrell S.; Zuschin, Martin

2016-04-01

Stratigraphic changes in temporal resolution of fossil assemblages and the degree of their stratigraphic mixing in the Holocene deposits are of high importance in paleoecology, conservation paleobiology and paleoclimatology. However, few studies quantified downcore changes in time averaging and in stratigraphic disorder on the basis of dating of multiple shells occurring in individual stratigraphic layers. Here, we investigate downcore changes in frequency distribution of postmortem ages of the infaunal bivalve Gouldia minima in two, ~150 cm-thick piston cores (separated by more than 1 km) in the northern Adriatic Sea, close to the Slovenian city Piran at a depth of 24 m. We use radiocarbon-calibrated amino acid racemization to obtain postmortem ages of 564 shells, and quantify age-frequency distributions in 4-5 cm-thick stratigraphic intervals (with 20-30 specimens sampled per interval). Inter-quartile range for individual 4-5 cm-thick layers varies between 850 and 1,700 years, and range encompassing 95% of age data varies between 2,000 and 5,000 years in both cores. The uppermost sediments (20 cm) are age-homogenized and show that median age of shells is ~700-800 years. The interval between 20 and 90 cm shows a gradual increase in median age from ~2,000 to ~5,000 years, with maximum age ranging to ~8,000 years. However, the lowermost parts of both cores show a significant disorder, with median age of 3,100-3,300 years. This temporal disorder implies that many shells were displaced vertically by ~1 m. Absolute and proportional abundance of the bivalve Gouldia minima strongly increases towards the top of the both cores. We hypothesize that such increase in abundance, when coupled with depth-declining reworking, can explain stratigraphic disorder because numerically abundant young shells from the top of the core were more likely buried to larger sediment depths than less frequent shells at intermediate sediment depths.

Questionnaire Items Soliciting School Related Alienation from 10,000 Senior High Pupils.

ERIC Educational Resources Information Center

Kunkel, Richard C.; And Others

The questionnaire used in collecting data regarding school-related alienation from 10,000 senior high school students is provided. The questionnaire is comprised of 23 questions for which 3 or more replies are possible. Data are reported at the 1st Quartile, Median, 3rd Quartile, and the Range. (For related document, see TM 002 455.) (DB)

Higher BNP levels within physiological range correlate with beneficial nonfasting lipid profiles in the elderly: a cross-sectional study.

PubMed

He, Wen-Tao; Mori, Masayuki; Yu, Xue-Feng; Kanda, Tsugiyasu

2016-01-05

Emerging studies indicate that B-type natriuretic peptide (BNP), a well-known biomarker for heart failure, also plays pivotal roles in metabolic control. Circulating BNP levels progressively increase as ages grow older. However, the association between BNP levels and lipid metabolism in the elderly remains unknown. A total of 680 eligible volunteers (male/female: 334/346) aged between 60 and 80 years old without overt heart failure (BNP <100 pg/ml) were enrolled. Random nonfasting venous samples were obtained for biochemical analysis. The subjects were stratified based on BNP quartiles: BNP Q1 (range: 2.2-9.0 pg/ml), Q2 (9.1-20.4 pg/ml), Q3 (20.5-44.4 pg/ml) and Q4 (44.6-99.7 pg/ml). Difference of metabolic parameters was compared among the subjects grouped by BNP quartiles. Univariate correlation and multiple linear regression were performed to analyze the association between BNP levels and metabolic parameters. The odds ratios (OR) and 95 % confidence intervals (CI) for dyslipidemia in subjects within BNP Q1-3 relative to subjects within BNP Q4 were calculated. Circulating BNP levels positively correlated with age, while negatively correlated with body mass index (BMI), eGFR and non-HDL. Subjects with lower BNP quartiles had significantly elevated prevalence of dyslipidemia, including hypertriglyceridemia, hyper-LDL-emia and hypercholesterolemia. The OR of hypertriglyceridemia and hypercholesterolemia for subjects within BNP Q1-2 significantly increased relative to BNP Q4. The elderly people with higher BNP levels have significantly reduced risks for nonfasting dyslipidemia. Verification of the cause-effect relationship between BNP and dyslipidemia may bring therapeutic implications.

Vigorous physical activity and longitudinal associations with cardiometabolic risk factors in youth.

PubMed

Carson, V; Rinaldi, R L; Torrance, B; Maximova, K; Ball, G D C; Majumdar, S R; Plotnikoff, R C; Veugelers, P; Boulé, N G; Wozny, P; McCargar, L; Downs, S; Daymont, C; Lewanczuk, R; McGavock, J

2014-01-01

To examine the longitudinal associations between different physical activity (PA) intensities and cardiometabolic risk factors among a sample of Canadian youth. The findings are based on a 2-year prospective cohort study in a convenience sample of 315 youth aged 9-15 years at baseline from rural and urban schools in Alberta, Canada. Different intensities (light, moderate and vigorous) of PA were objectively assessed with Actical accelerometers. The main outcome measures were body mass index (BMI) z-score, waist circumference, cardiorespiratory fitness and systolic blood pressure at 2-year-follow-up and conditional BMI z-score velocity. A series of linear regression models were conducted to investigate the associations after adjusting for potential confounders. At follow-up, cardiorespiratory fitness increased (quartile 1 vs quartile 4=43.3 vs 50.2; P(trend)<0.01) and waist circumference decreased (quartile 1 vs quartile 4=79.0 vs 72.6; P(trend)=0.04; boys only) in a dose-response manner across quartiles of baseline vigorous-intensity PA. A similar trend was observed for systolic blood pressure (quartile 1 vs quartile 4=121.8 vs 115.3; P(trend)=0.07; boys only). Compared with quartile 1 of vigorous-intensity PA, BMI z-score at follow-up and conditional BMI z-score velocity were significantly lower in the quartile 2 and 3 (P<0.05). Waist circumference at follow-up also decreased (quartile 1 vs quartile 4=75.3 vs 73.8; P(trend)=0.04) across quartiles of baseline moderate-intensity PA. Time spent in vigorous-intensity PA was associated with several positive health outcomes 2 years later. These findings suggest that high-intensity activities in youth help to reduce the risk for several chronic diseases.

Anabolic hormone profiles in elite military men: Robust associations with age, stress, and fatigue.

PubMed

Taylor, Marcus K; Padilla, Genieleah A; Hernández, Lisa M

2017-08-01

We recently established stable daily profiles of the anabolic hormones dehydroepiandrosterone (DHEA) and testosterone in 57 elite military men. In this follow-on study, we explored associations of salivary anabolic hormone profiles with demographic (i.e., age, body mass index [BMI]) and biobehavioral health indices (i.e., blood pressure, sleep, perceived stress, fatigue) via correlational models. Next, nuanced patterns were constructed using quartile splits followed by one-way analysis of variance and post hoc subgroup comparisons. Both DHEA (r range: -0.33 to -0.49) and testosterone (r range: -0.19 to -0.41) were inversely associated with age. Quartile comparisons revealed that age-related declines in DHEA were linear, curvilinear, or sigmoidal, depending on the summary parameter of interest. Anabolic hormone profiles did not associate with BMI, blood pressure, or sleep efficiency. Robust linear associations were observed between testosterone and perceived stress (r range: -0.29 to -0.36); concentration-dependent patterns were less discernible. Lower DHEA (r range: -0.22 to -0.30) and testosterone (r range: -0.22 to -0.36) concentrations associated with higher fatigue. Subsequent quartile comparisons suggested a concentration-dependent threshold with respect to evening testosterone. Specifically, those individuals within the lowest quartile (≤68.4pg/mL) endorsed the highest fatigue of the four groups (p=0.01), while the remaining three groups did not differ from each other. This study not only showed that anabolic hormone profiles have distinctive age trajectories, but are also valuable predictors of stress and fatigue in elite military men. This highlights the importance of routine monitoring of anabolic hormone profiles to sustain and optimize health and readiness in chronically stressed populations. Published by Elsevier Inc.

High Serum Phosphorus Level Is Associated with Left Ventricular Diastolic Dysfunction in Peritoneal Dialysis Patients.

PubMed

Ye, Min; Tian, Na; Liu, Yanqiu; Li, Wei; Lin, Hong; Fan, Rui; Li, Cuiling; Liu, Donghong; Yao, Fengjuan

We initiated this study to explore the relationships of serum phosphorus level with left ventricular ultrasound features and diastolic function in peritoneal dialysis (PD) patients. 174 patients with end-stage renal disease (ESRD) receiving PD were enrolled in this retrospective observational study. Conventional echocardiography examination and tissue Doppler imaging (TDI) were performed in each patient. Clinical information and laboratory data were also collected. Analyses of echocardiographic features were performed according to phosphorus quartiles groups. And multivariate regression models were used to determine the association between serum phosphorus and Left ventricular diastolic dysfunction (LVDD). With the increase of serum phosphorus levels, patients on PD showed an increased tissue Doppler-derived E/e' ratio of lateral wall (P < 0.001), indicating a deterioration of left ventricular diastolic function. Steady growths of left atrium and left ventricular diameters as well as increase of left ventricular muscle mass were also observed across the increasing quartiles of phosphorus, while left ventricular ejection fraction remained normal. In a multivariate analysis, the regression coefficient for E/e' ratio in the highest phosphorus quartile was almost threefold higher relative to those in the lowest quartile group. And compared with patients in the lowest phosphorus quartile (<1.34 mmol/L) those in the highest phosphorus quartile (>1.95 mmol/L) had a more than fivefold increased odds of E/e' ratio >15. Our study showed an early impairment of left ventricular diastolic function in peritoneal dialysis patients. High serum phosphorus level was independently associated with greater risk of LVDD in these patients. Whether serum phosphorus will be a useful target for prevention or improvement of LVDD remains to be proved by further studies.

Three Year RSA Evaluation of Vitamin E Diffused Highly Cross-linked Polyethylene Liners and Cup Stability.

PubMed

Sillesen, Nanna H; Greene, Meridith E; Nebergall, Audrey K; Nielsen, Poul T; Laursen, Mogens B; Troelsen, Anders; Malchau, Henrik

2015-07-01

Vitamin E diffusion into highly cross-linked polyethylene (E-XLPE) is a method for enhancing oxidative stability of acetabular liners. The purpose of this study was to evaluate in vivo penetration of E-XLPE using radiostereometric analysis (RSA). Eighty-four hips were recruited into a prospective 10-year RSA. This is the first evaluation of the multicenter cohort after 3-years. All patients received E-XLPE liners (E1, Biomet) and porous-titanium coated cups (Regenerex, Biomet). There was no difference (P=0.450) in median femoral head penetration into the E-XLPE liners at 3-years comparing cobalt-chrome heads (-0.028mm; inter-quartile range (IQR) - 0.065 to 0.047) with ceramic heads (-0.043mm, IQR - 0.143to0.042). The 3-year follow-up indicates minimal E-XLPE liner penetration regardless of head material and minimal early cup movement. Copyright © 2015 Elsevier Inc. All rights reserved.

Descriptive Statistics and Cluster Analysis for Extreme Rainfall in Java Island

NASA Astrophysics Data System (ADS)

E Komalasari, K.; Pawitan, H.; Faqih, A.

2017-03-01

This study aims to describe regional pattern of extreme rainfall based on maximum daily rainfall for period 1983 to 2012 in Java Island. Descriptive statistics analysis was performed to obtain centralization, variation and distribution of maximum precipitation data. Mean and median are utilized to measure central tendency data while Inter Quartile Range (IQR) and standard deviation are utilized to measure variation of data. In addition, skewness and kurtosis used to obtain shape the distribution of rainfall data. Cluster analysis using squared euclidean distance and ward method is applied to perform regional grouping. Result of this study show that mean (average) of maximum daily rainfall in Java Region during period 1983-2012 is around 80-181mm with median between 75-160mm and standard deviation between 17 to 82. Cluster analysis produces four clusters and show that western area of Java tent to have a higher annual maxima of daily rainfall than northern area, and have more variety of annual maximum value.

Complementary Feeding and Diarrhea and Respiratory Infection Among HIV-exposed Tanzanian Infants

PubMed Central

Kamenju, P; Liu, E; Hertzmark, E; Spiegelman, D; Kisenge, R.R.; Kupka, R; Aboud, S; Manji, K.P.; Duggan, C; Fawzi, W.W.

2016-01-01

Objective To examine the association between complementary feeding (CF) and risks of diarrhea and acute respiratory infection (ARI) among HIV-exposed infants aged 6–24 months. Design We prospectively employed an Infant and Child Feeding Index (ICFI) to measure CF practices (breastfeeding status, food consistency, dietary diversity, food group frequency and meal frequency). We determined the association of ICFI and each of its components with the risk of diarrhea and ARI. Generalized estimating equations (GEE) were used to estimate the relative risks for morbidity episodes. Setting Dar es Salaam, Tanzania. Subjects 2092 HIV-exposed infants followed from 6 months of age to 24 months of age. Results The ICFI score ranged from 0 to 9; the median score was 6 (Inter-Quartile Range; IQR=4, 7). Low ICFI scores were likely associated with increased risk of dysentery (low vs. high tertile Risk Ratio, RR: 1.40; 95% CI: 0.93, 2.10; P for trend=0.02) and respiratory infection (low vs. high tertile RR: 1.16; 95% CI: 0.96, 1.41; P for trend=0.01). Low dietary diversity scores were likely associated with higher risk of dysentery (low vs. high tertile RR: 1.47; 95% CI: 0.92, 2.35; P for trend=0.03) and respiratory infection (low vs. high tertile RR: 1.41; 95% CI: 1.13, 1.76; P for trend=0.01). Low food consistency scores were associated with higher risk of respiratory infection (RR: 1.77; 95% CI: 1.40, 2.26; P<0.01). Conclusions In this setting, low ICFI, dietary diversity and food consistency scores were likely associated with increased risk of diarrhea and acute respiratory infection among HIV-exposed infants. PMID:27861238

Dietary Inflammatory Index and Incidence of Cardiovascular Disease in the PREDIMED Study.

PubMed

Garcia-Arellano, Ana; Ramallal, Raul; Ruiz-Canela, Miguel; Salas-Salvadó, Jordi; Corella, Dolores; Shivappa, Nitin; Schröder, Helmut; Hébert, James R; Ros, Emilio; Gómez-Garcia, Enrique; Estruch, Ramon; Lapetra, José; Arós, Fernando; Fiol, Miquel; Serra-Majem, Lluis; Pintó, Xavier; Babio, Nancy; González, José I; Fitó, Montse; Martínez, J Alfredo; Martínez-González, Miguel A

2015-05-29

Previous studies have reported an association between a more pro-inflammatory diet profile and various chronic metabolic diseases. The Dietary Inflammatory Index (DII) was used to assess the inflammatory potential of nutrients and foods in the context of a dietary pattern. We prospectively examined the association between the DII and the incidence of cardiovascular disease (CVD: myocardial infarction, stroke or cardiovascular death) in the PREDIMED (Prevención con Dieta Mediterránea) study including 7216 high-risk participants. The DII was computed based on a validated 137-item food frequency questionnaire. Multivariate-adjusted hazard ratios (HR) and 95% confidence intervals of CVD risk were computed across quartiles of the DII where the lowest (most anti-inflammatory) quartile is the referent. Risk increased across the quartiles (i.e., with increasing inflammatory potential): HR(quartile2) = 1.42 (95%CI = 0.97-2.09); HR(quartile3) = 1.85 (1.27-2.71); and HR(quartile4) = 1.73 (1.15-2.60). When fit as continuous the multiple-adjusted hazard ratio for each additional standard deviation of the DII was 1.22 (1.06-1.40). Our results provide direct prospective evidence that a pro-inflammatory diet is associated with a higher risk of cardiovascular clinical events.

Evaluation of risk for metabolic syndrome according to the fasting insulin concentration in Korean men.

PubMed

Jung, Ju Young; Park, Sung Keun; Choi, Joong-Myung; Hong, Hyun Pyo; Choi, Young-Jun; Ryoo, Jae-Hong

2017-01-01

As a well-known risk factor for cardiovascular disease, metabolic syndrome (MetS) is an important global health problem due to its high worldwide prevalence. The objective of this study is to determine whether the fasting serum insulin concentration influences future incidence of MetS. A total of 14,621 Korean men without MetS participating in a medical health check-up program were followed up from 2005 until 2010. They were divided into 4 groups according to baseline fasting insulin concentrations. The incidence of MetS was compared among the groups, and Cox proportional hazards model was used to determine if MetS was associated with higher fasting insulin concentration. The incidence of MetS increased according to the baseline fasting insulin concentration (first quartile: 8.4%, second quartile: 12.3%, third quartile: 16.3%, fourth quartile: 26.5%, P<0.001). Even after adjusting for multiple covariates, the hazard ratio (95% CI) for MetS was higher for the second (1.13 (0.93-1.37)), third (1.29 (1.06-1.56)) and fourth quartile group (1.70 (1.36-2.13)), compared to the first quartile group (P for trend <0.001). The incidence of MetS increased proportionally to fasting insulin concentration. Additionally, increased fasting insulin concentration was an independent risk factor for the future development of MetS. Copyright © 2016 Elsevier B.V. All rights reserved.

The association between A Body Shape Index and mortality: Results from an Australian cohort.

PubMed

Grant, Janet F; Chittleborough, Catherine R; Shi, Zumin; Taylor, Anne W

2017-01-01

It is well recognised that obesity increases the risk of premature death. A Body Shape Index (ABSI) is a formula that uses waist circumference (WC), body mass index (BMI) and height to predict risk of premature mortality, where a high score (Quartile 4) indicates that a person's WC is more than expected given their height and weight. Our study examines the association between ABSI quartiles and all-cause-, cardiovascular- and cancer-related mortality, and primary cause of death. Self-reported demographic and biomedically measured health-related risk factor and weight data was from the baseline stage of the North West Adelaide Health Study (1999-2003, n = 4056), a longitudinal cohort of Australian adults. Death-related information was obtained from the National Death Index. Primary cause of death across ABSI quartiles was examined. The association between mortality and ABSI (quartile and continuous scores) was investigated using a Cox proportional hazards survival model and adjusting for socioeconomic, and self-reported and biomedical risk factors. The proportion of all three types of mortality steadily increased from ABSI Quartile 1 through to Quartile 4. After adjusting for demographic and health-related risk factors, the risk of all-cause mortality was higher for people in ABSI Quartile 4 (HR 2.64, 95% CI 01.56-4.47), and ABSI Quartile 3 (HR 1.95, 95% CI 1.15-3.33), with a moderate association for the continuous ABSI score (HR 1.32, 95% CI 1.18-1.48). ABSI is therefore positively associated with mortality in Australian adults. Different combined measures of obesity such as the ABSI are useful in examining mortality risk.

Endogenous ouabain and the renin-angiotensin-aldosterone system: distinct effects on Na handling and blood pressure in human hypertension.

PubMed

Manunta, Paolo; Hamlyn, John M; Simonini, Marco; Messaggio, Elisabetta; Lanzani, Chiara; Bracale, Maria; Argiolas, Giuseppe; Casamassima, Nunzia; Brioni, Elena; Glorioso, Nicola; Bianchi, Giuseppe

2011-02-01

To evaluate whether the renin-angiotensin-aldosterone system (RAAS) and endogenous ouabain system differently affect renal Na handling and blood pressure. Three hundred and one patients in whom we compared blood pressure, and renal Na tubular reabsorption in the basal condition and 2 h (T120) after saline infusion. Following multivariate-adjusted linear and quartiles analysis, baseline mean blood pressure (MBP) was significantly higher (113.7 ± 1.33 mmHg) in the fourth versus the first endogenous ouabain quartile (103.8 ± 1.04 mmHg) and the trend across the quartiles was highly significant (β = 0.23, P = 3.53e-04). In contrast, an inverse relationship was present in the renin activity (PRA) quartiles with MBP highest in the first (112.5 ± 1.26) and lowest in the fourth PRA quartile (107.6 ± 1.48, P = 0.039). Following an acute saline load, changes in MBP and the slope of the pressure-natriuresis relationship were inversely related across the PRA quartiles. The fractional excretion of sodium (FENa) showed a negative linear trend going from the first to the third endogenous ouabain quartiles (2.35 ± 0.17 and 1.90 ± 0.14%, P = 0.05). Patients in the fourth endogenous ouabain quartile (>323 pmol/l) showed increased FENa T120 (2.78 ± 0.18%, P < 0.01) and increased Na tubular rejection fraction (P = 0.007) after Na load. After the saline load, there was a biphasic relationship between plasma endogenous ouabain and FENa favoring Na retention at low endogenous ouabain and Na excretion at high endogenous ouabain levels. The RAAS and endogenous ouabain system are two independent and complementary systems having an inverse (RAAS) or a direct (endogenous ouabain system) relationship with hemodynamic parameters.

Associations of long-term fine particulate matter exposure with prevalent hypertension and increased blood pressure in older Americans.

PubMed

Honda, Trenton; Pun, Vivian C; Manjourides, Justin; Suh, Helen

2018-07-01

Hypertension is a highly prevalent cardiovascular risk factor. It is possible that air pollution, also an established cardiovascular risk factor, may contribute to cardiovascular disease through increasing blood pressure. Previous studies evaluating associations between air pollution and blood pressure have had mixed results. We examined the association between long-term (one-year moving average) air pollutant exposures, prevalent hypertension and blood pressure in 4121 older Americans (57+ years) enrolled in the National Social Life, Health, and Aging Project. We estimated exposures to PM 2.5 using spatio-temporal models and used logistic regression accounting for repeated measures to evaluate the association between long-term average PM 2.5 and prevalence odds of hypertension. We additionally used linear regression to evaluate the associations between air pollutants and systolic, diastolic, mean arterial, and pulse pressures. Health effect models were adjusted for a number of demographic, health and socioeconomic covariates. An inter-quartile range (3.91 μg/m 3 ) increase in the one-year moving average of PM 2.5 was associated with increased: Odds of prevalent hypertension (POR 1.24, 95% CI: 1.11, 1.38), systolic blood pressure (0.93 mm Hg, 95% CI: 0.05, 1.80) and pulse pressure (0.89 mm Hg, 95% CI: 0.21, 1.58). Dose-response relationships were also observed. PM 2.5 was associated with increased odds of prevalent hypertension, and increased systolic pressure and pulse pressure in a cohort of older Americans. These findings add to the growing evidence that air pollution may be an important risk factor for hypertension and perturbations in blood pressure. Copyright © 2018 Elsevier Inc. All rights reserved.

Usefulness of the left ventricular myocardial contraction fraction in healthy men and women to predict cardiovascular morbidity and mortality.

PubMed

Chuang, Michael L; Gona, Philimon; Salton, Carol J; Yeon, Susan B; Kissinger, Kraig V; Blease, Susan J; Levy, Daniel; O'Donnell, Christopher J; Manning, Warren J

2012-05-15

We sought to determine whether depressed myocardial contraction fraction (MCF; ratio of left ventricular [LV] stroke volume to myocardial volume) predicts cardiovascular disease (CVD) events in initially healthy adults. A subset (n = 318, 60 ± 9 years old, 158 men) of the Framingham Heart Study Offspring cohort free of clinical CVD underwent volumetric cardiovascular magnetic resonance imaging in 1998 through 1999. LV ejection fraction (EF), mass, and MCF were determined. "Hard" CVD events consisted of cardiovascular death, myocardial infarction, stroke, or new heart failure. A Cox proportional hazards model adjusting for Framingham Coronary Risk Score was used to estimate hazard ratios for incident hard CVD events for gender-specific quartiles of MCF, LV mass, and LVEF. The lowest quartile of LV mass and highest quartiles of MCF and EF served as referents. Kaplan-Meier survival plots and log-rank test were used to compare event-free survival. MCF was greater in women (0.58 ± 0.13) than in men (0.52 ± 0.11, p <0.01). Nearly all participants (99%) had EF ≥0.55. During an up to 9-year follow-up (median 5.2), 31 participants (10%) developed an incident hard CVD event. Lowest-quartile MCF was 7 times more likely to develop a hard CVD (hazard ratio 7.11, p = 0.010) compared to the remaining quartiles, and increased hazards persisted even after adjustment for LV mass (hazard ratio 6.09, p = 0.020). The highest-quartile LV mass/height 2.7 had a nearly fivefold risk (hazard ratio 4.68, p = 0.016). Event-free survival was shorter in lowest-quartile MCF (p = 0.0006) but not in lowest-quartile LVEF. In conclusion, in a cohort of adults initially without clinical CVD, lowest-quartile MCF conferred an increased hazard for hard CVD events after adjustment for traditional CVD risk factors and LV mass. Copyright © 2012 Elsevier Inc. All rights reserved.

Low-level lead exposure and the prevalence of gout: an observational study.

PubMed

Krishnan, Eswar; Lingala, Bharathi; Bhalla, Vivek

2012-08-21

Blood lead levels (BLLs) less than 1.21 µmol/L (<25 µg/dL) among adults are considered acceptable by current national standards. Lead toxicity can lead to gouty arthritis (gout), but whether the low lead exposure in the contemporary general population confers risk for gout is not known. To determine whether BLLs within the range currently considered acceptable are associated with gout. Population-based cross-sectional study. The National Health and Nutrition Examination Survey for 2005 through 2008. 6153 civilians aged 40 years or older with an estimated glomerular filtration rate greater than 10 mL/min per 1.73 m2. Outcome variables were self-reported physician diagnosis of gout and serum urate level. Blood lead level was the principal exposure variable. Additional data collected were anthropometric measures, blood pressure, dietary purine intake, medication use, medical history, and serum creatinine concentration. The prevalence of gout was 6.05% (95% CI, 4.49% to 7.62%) among patients in the highest BLL quartile (mean, 0.19 µmol/L [3.95 µg/dL]) compared with 1.76% (CI, 1.10% to 2.42%) among those in the lowest quartile (mean, 0.04 µmol/L [0.89 µg/dL]). Each doubling of BLL was associated with an unadjusted odds ratio of 1.74 (CI, 1.47 to 2.05) for gout and 1.25 (CI, 1.12 to 1.40) for hyperuricemia. After adjustment for renal function, diabetes, diuretic use, hypertension, race, body mass index, income, and education level, the highest BLL quartile was associated with a 3.6-fold higher risk for gout and a 1.9-fold higher risk for hyperuricemia compared with the lowest quartile. Blood lead level does not necessarily reflect the total body lead burden. Blood lead levels in the range currently considered acceptable are associated with increased prevalence of gout and hyperuricemia.

An assessment technique for computer-socket manufacturing

PubMed Central

Sanders, Joan; Severance, Michael

2015-01-01

An assessment strategy is presented for testing the quality of carving and forming of individual computer aided manufacturing facilities. The strategy is potentially useful to facilities making sockets and companies marketing manufacturing equipment. To execute the strategy, an evaluator fabricates a collection of test models and sockets using the manufacturing suite under evaluation, and then measures their shapes using scanning equipment. Overall socket quality is assessed by comparing socket shapes with electronic file shapes. Then model shapes are compared with electronic file shapes to characterize carving performance. Socket shapes are compared with model shapes to characterize forming performance. The mean radial error (MRE), which is the average difference in radii between the two shapes being compared, provides insight into sizing quality. Inter-quartile range (IQR), the range of radial error for the best matched half of the points on the surfaces being compared, provides insight into shape quality. By determining MRE and IQR for carving and forming separately, the source(s) of socket shape error may be pinpointed. The developed strategy may provide a useful tool to the prosthetics community and industry to help identify problems and limitations in computer aided manufacturing and insight into appropriate modifications to overcome them. PMID:21938663

Validation of integrated water vapor from OMI satellite instrument against reference GPS data at the Iberian Peninsula.

PubMed

Vaquero-Martínez, Javier; Antón, Manuel; Ortiz de Galisteo, José Pablo; Cachorro, Victoria E; Wang, Huiqun; González Abad, Gonzalo; Román, Roberto; Costa, Maria João

2017-02-15

This paper shows the validation of integrated water vapor (IWV) measurements retrieved from the Ozone Monitoring Instrument (OMI), using as reference nine ground-based GPS stations in the Iberian Peninsula. The study period covers from 2007 to 2009. The influence of two factors, - solar zenith angle (SZA) and IWV -, on OMI-GPS differences was studied in detail, as well as the seasonal dependence. The pseudomedian of the relative differences is -1 ± 1% and the inter-quartile range (IQR) is 41%. Linear regressions calculated over each station show an acceptable agreement (R 2 up to 0.77). The OMI-GPS differences display a clear dependence on IWV values. Hence, OMI substantially overestimates the lower IWV data recorded by GPS (∼ 40%), while underestimates the higher IWV reference values (∼ 20%). In connection to this IWV dependence, the relative differences also show an evident SZA dependence when the whole range of IWV values are analyzed (OMI overestimates for high SZA values while underestimates for low values). Finally, the seasonal variation of the OMI-GPS differences is also associated with the strong IWV dependence found in this validation exercise. Copyright © 2016 Elsevier B.V. All rights reserved.

A case control study of nutritional factors and cervical dysplasia.

PubMed

Liu, T; Soong, S J; Wilson, N P; Craig, C B; Cole, P; Macaluso, M; Butterworth, C E

1993-01-01

The association of nutritional factors with cervical dysplasia was examined through a case-control study. Analysis was conducted in 257 cases and 133 controls confirmed both by cytological examination and colposcopic findings. A 24-h dietary recall questionnaire was used to assess nutritional intake. Various risk factors (including age at first intercourse, number of sexual partners, parity, cigarette smoking, oral contraceptive use, human papillomavirus type 16 infection, and age and race) were adjusted for their potential confounding effects. While analyses were also performed to adjust for total calories, results were not changed significantly. Among the nutrients examined, vitamin A intake showed a significantly increased risk at the lowest quartile compared to the highest quartile, with an odds ratio of 2.2 (95% confidence interval, 1.2-4.2). A significant trend of increasing risk was also observed with lower intake of vitamin A (P = 0.05). Riboflavin showed increased risk at the two lower quartiles of intake with a trend test P value of 0.04. Increased risk was also found for lower intakes of vitamin C compared to the highest intake level. For folate, increased risk was found in the second highest quartile compared with the highest quartile with an odds ratio of 2.0 (95% confidence interval, 1.0-3.8). The calcium:phosphorus ratio showed an increased risk at the lowest level (odds ratio, 2.0; 95% confidence interval, 1.0-4.3). Insufficient intake of vitamin A, riboflavin, ascorbate, and folate is associated with an increased risk of cervical dysplasia.

A review of population-based prevalence studies of physical activity in adults in the Asia-Pacific region

PubMed Central

2012-01-01

Background Physical activity (PA) surveillance is an important component of non-communicable disease risk factor monitoring, and occurs through national and international surveillance systems. This review identifies population PA estimates for adults in the Asia-Pacific region, and examines variation in trends and prevalence rates obtained using different PA measures. Methods Data were obtained from a MEDLINE search; World Health Organization's Global Health Infobase; Government websites and reference lists of relevant papers. Inclusion criteria included: national studies or those reporting large scale population-level data; data published from 2000 to 2010 and trend data prior; sample sizes over n = 1000, or fewer subjects in small nations. Results In total, 56 population surveys from 29 Asia-Pacific countries were identified. Data on 'sufficient physical activity' amongst adults were available from 45 studies (80%), with estimates ranging from 7% to 93% (median 62%, inter-quartile range 40%-85%). For 14 countries, estimates of 'sufficient activity' were documented in multiple surveys using different methods, with the largest variation from 18% to 92% in Nepal. Median or mean MET-minutes/day, reported in 20 studies, ranged from 6 to 1356. Serial trend data were available for 11 countries (22%), for periods spanning 2-10 years. Of these, five countries demonstrated increases in physical activity over time, four demonstrated decreases and three showed no changes. Conclusions Many countries in the Asia-Pacific region collect population-level PA data. This review highlights differences in estimates within and between countries. Some differences may be real, others due to variation in the PA questions asked and survey methods used. Use of standardized protocols and measures, and combined reporting of data are essential goals of improved international PA surveillance. PMID:22251660

Drinking-Water Disinfection By-products and Semen Quality: A Cross-Sectional Study in China

PubMed Central

Zeng, Qiang; Wang, Yi-Xin; Xie, Shao-Hua; Xu, Liang; Chen, Yong-Zhe; Li, Min; Yue, Jing; Li, Yu-Feng; Liu, Ai-Lin

2014-01-01

Background: Exposure to disinfection by-products (DBPs) has been demonstrated to impair male reproductive health in animals, but human evidence is limited and inconsistent. Objective: We examined the association between exposure to drinking-water DBPs and semen quality in a Chinese population. Methods: We recruited 2,009 men seeking semen analysis from the Reproductive Center of Tongji Hospital in Wuhan, China, between April 2011 and May 2012. Each man provided a semen sample and a urine sample. Semen samples were analyzed for sperm concentration, sperm motility, and sperm count. As a biomarker of exposure to drinking-water DBPs, trichloroacetic acid (TCAA) was measured in the urine samples. Results: The mean (median) urinary TCAA concentration was 9.58 (7.97) μg/L (interquartile range, 6.01–10.96 μg/L). Compared with men with urine TCAA in the lowest quartile, increased adjusted odds ratios (ORs) were estimated for below-reference sperm concentration in men with TCAA in the second and fourth quartiles (OR = 1.79; 95% CI: 1.19, 2.69 and OR = 1.51; 95% CI: 0.98, 2.31, respectively), for below-reference sperm motility in men with TCAA in the second and third quartiles (OR = 1.46; 95% CI: 1.12, 1.90 and OR = 1.30; 95% CI: 1.00, 1.70, respectively), and for below-reference sperm count in men with TCAA in the second quartile (OR 1.62; 95% CI: 1.04, 2.55). Nonmonotonic associations with TCAA quartiles were also estimated for semen parameters modeled as continuous outcomes, although significant negative associations were estimated for all quartiles above the reference level for sperm motility. Conclusion: Our findings suggest that exposure to drinking-water DBPs may contribute to decreased semen quality in humans. Citation: Zeng Q, Wang YX, Xie SH, Xu L, Chen YZ, Li M, Yue J, Li YF, Liu AL, Lu WQ. 2014. Drinking-water disinfection by-products and semen quality: a cross-sectional study in China. Environ Health Perspect 122:741–746; http://dx.doi.org/10.1289/ehp.1307067 PMID:24695319

Association between overweight and obesity and risk of clinically diagnosed knee, hip, and hand osteoarthritis: a population-based cohort study

PubMed Central

Reyes, Carlen; Leyland, Kirsten M; Peat, George; Cooper, Cyrus; Arden, Nigel K

2016-01-01

Objective Previous cohorts have reported associations between overweight/obesity and knee and hand osteoarthritis (OA). However, no data on the effect of these on the OA burden are available. We aimed to analyse the effect of overweight and obesity on the incidence of routinely diagnosed knee, hip, and hand OA. Methods Design: population-based cohort Setting: primary care records from the SIDIAP database (>5.5 million subjects) covering >80% of the population of Catalonia, Spain. Participants: ≥40 years old with no OA on 01/01/2006 and with body mass index (BMI) data available. Follow-up: from 01/01/2006 to 12/31/2010, loss to follow-up, or death. Measures: BMI World Health Organization categories (exposure), and incident clinical diagnoses of knee, hip, or hand OA (ICD-10 codes). Results 1,764,061 subjects were observed for a median (inter-quartile range) of 4.45 (4.19 to 4.98) years. Incidence rates (per 1000 PY) of knee, hip and hand OA ranged from 3.7 (3.6 to 3.8), 1.7 (1.7 to 1.8) and 2.6 (2.5 to 2.7) amongst normal-weight, to 19.5 (19.1 to 19.9), 3.8 (3.7 to 4.0) and 4.0 (3.9 to 4.2) in the grade II obese respectively. Compared to normal-weight subjects, being overweight or obese increased the risk of OA at all three sites, especially at the knee: overweight and (grade I, II) obesity increased knee OA risk by a factor of 2, 3.1 and 4.7 fold respectively. Conclusions Both overweight and obesity increase the risk of hand, hip, and knee OA, especially for the latter, with a dose-response gradient with increasing BMI. PMID:27059260

Differentiating the associations of black carbon and fine particle with daily mortality in a Chinese city.

PubMed

Geng, Fuhai; Hua, Jing; Mu, Zhe; Peng, Li; Xu, Xiaohui; Chen, Renjie; Kan, Haidong

2013-01-01

There is only limited monitoring data of black carbon for epidemiologic analyses. In the current study, we used the distributed lag models to evaluate the association between mortality outcomes (both total and cause-specific) and exposure to black carbon and fine particle (PM(2.5)) in Shanghai, China. During our research period, the mean daily concentrations of black carbon and PM(2.5) were 3.9 μg/m3 and 53.9 μg/m3, respectively. The regression results showed that black carbon was significantly associated with total and cardiovascular mortality, but not with respiratory mortality. An inter-quartile range increase (2.7 μg/m3) of black carbon corresponded to a 2.3% (95% confidence interval [CI]: 0.6-4.1), 3.2% (95% CI: 0.6-5.7), and 0.6% (95% CI: -4.5 to 5.7) increase in total, cardiovascular and respiratory mortality, respectively. When adjusted for PM(2.5), the effects of black carbon increased and remained statistically significant; in contrast, the associations of PM(2.5) with daily mortality decreased and became statistically insignificant after adjustment for black carbon. To our knowledge, this is the first study in China, or even in Asian developing countries, to report the acute effect of black carbon and PM(2.5) on daily mortality simultaneously. Our findings suggest that black carbon is a valuable additional air quality indicator to evaluate the health risks of ambient particles. Copyright © 2012 Elsevier Inc. All rights reserved.

Cumulative increased risk of incident type 2 diabetes mellitus with increasing triglyceride glucose index in normal-weight people: The Rural Chinese Cohort Study.

PubMed

Zhang, Ming; Wang, Bingyuan; Liu, Yu; Sun, Xizhuo; Luo, Xinping; Wang, Chongjian; Li, Linlin; Zhang, Lu; Ren, Yongcheng; Zhao, Yang; Zhou, Junmei; Han, Chengyi; Zhao, Jingzhi; Hu, Dongsheng

2017-03-01

Risk of type 2 diabetes mellitus (T2DM) is increased in metabolically obese but normal-weight people. However, we have limited knowledge of how to prevent T2DM in normal-weight people. We aimed to evaluate the association between triglyceride glucose (TyG) index and incident T2DM among normal-weight people in rural China. We included data from 5706 people with normal body mass index (BMI) (18.5-23.9 kg/m 2 ) without baseline T2DM in a rural Chinese cohort followed for a median of 6.0 years. A Cox proportional-hazard model was used to assess the risk of incident T2DM by quartiles of TyG index and difference in TyG index between follow-up and baseline (TyG-D), estimating hazard ratios (HRs) and 95% confidence intervals (CIs). A generalized additive plot was used to show the nonparametric smoothed exposure-response association between risk of T2DM and TyG index as a continuous variable. TyG was calculated as ln [fasting triglyceride level (mg/dl) × fasting plasma glucose level (mg/dl)/2]. Risk of incident T2DM was increased with quartiles 2, 3 and 4 versus quartile 1 of TyG index (adjusted HR [aHR] 2.48 [95% CI 1.20-5.11], 3.77 [1.83-7.79], and 5.30 [2.21-12.71], P trend  < 0.001 across quartiles of TyG index). Risk of incident T2DM was increased with quartile 4 versus quartile 1 of TyG-D (aHR 3.91 [2.22-6.87]). The results were consistent when analyses were restricted to participants without baseline metabolic syndrome and impaired fasting glucose level. The generalized additive plot showed cumulative increased risk of T2DM with increasing TyG index. Risk of incident T2DM is increased with increasing TyG index among rural Chinese people, so the index might be an important indicator for identifying people at high risk of T2DM.

Gender and Age Impacts on the Association Between Thyroid Function and Metabolic Syndrome in Chinese

PubMed Central

Meng, Zhaowei; Liu, Ming; Zhang, Qing; Liu, Li; Song, Kun; Tan, Jian; Jia, Qiang; Zhang, Guizhi; Wang, Renfei; He, Yajing; Ren, Xiaojun; Zhu, Mei; He, Qing; Wang, Shen; Li, Xue; Hu, Tianpeng; Liu, Na; Upadhyaya, Arun; Zhou, Pingping; Zhang, Jianping

2015-01-01

Abstract The relationship between thyroid dysfunction and metabolic syndrome (MS) is complex. We aimed to explore the impact of gender and age on their association in a large Chinese cohort. This cross-sectional study enrolled 13,855 participants (8532 male, 5323 female), who self-reported as healthy without any known previous diseases. Clinical data including anthropometric measurements, thyroid function, and serum metabolic parameters were collected. The associations between thyroid function and MS of both genders were analyzed separately after dividing thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and age into subgroups. MS risks were calculated by binary logistic regression models. Young males had significantly higher MS prevalence than females, yet after menopause, females had higher prevalence than males. Females had higher incidence of thyroid dysfunction than males. By using TSH quartiles as the categorical variables and the lowest quartile as reference, significantly increased MS risk was demonstrated in quartile 4 for males, yet quartiles 3 and 4 for females. By using FT3 quartiles as the categorical variables, significantly increased MS risk was demonstrated in quartile 2 to 4 for females only. By using age subgroups as the categorical variables, significantly increased MS risk was shown in both genders, with females (4.408–58.455) higher than males (2.588–4.943). Gender and age had substantial influence on thyroid function and MS. Females with high TSH and high FT3 had higher MS risks than males. Aging was a risk for MS, especially for females. Urgent need is necessary to initiate interventional programs. PMID:26683929

Association of the urinary sodium to urinary specific gravity ratio with metabolic syndrome in Korean children and adolescents: The Korea National Health and Nutrition Examination Survey 2010-2013.

PubMed

So, Cheol Hwan; Jeong, Hwal Rim; Shim, Young Suk

2017-01-01

This study aimed to evaluate the association between sodium intake and metabolic syndrome (MetS) in Korean boys. A total of 1,738 boys aged 10-18 years were included in this study from the Korea National Health and Nutrition Examination Survey (KNHANES) during the years 2010-2013. Sodium intake was assessed using the urinary sodium excretion to urinary specific gravity ratio (U-Na to U-SG ratio). The median U-Na to U-SG ratio was 133.27 mmol/L (interquartile range: 95.66-178.50 mmol/L). Significant positive associations were found between the U-Na to U-SG ratio and the TG (P = 0.001 for trend) and TG concentrations, and these concentrations were significantly higher in boys with a U-Na to U-SG ratio in the highest quartile compared with those with a ratio in the lowest (P = 0.001) and second (P = 0.033) quartiles, as demonstrated through analysis of covariance (ANCOVA) after adjustment for possible confounders, including age, BMI standard deviation score, ferritin, vitamin D, house income, smoking, alcohol intake, physical activity, season, total intake, total energy intake, protein intake, fat intake, carbohydrate intake, and water intake. Significant inverse associations were found for the U-Na to U-SG ratio with the HDL-C (P = 0.033 for trend) and HDL-C levels, and these values were significantly lower in boys with a ratio in the highest quartile compared with those with a ratio in the second quartile (P = 0.020), as demonstrated through an ANCOVA. Although the trends did not reach statistical significance, a higher U-Na to U-SG ratio tended to be associated with higher SBP (P = 0.086 for trend), DBP (P = 0.063 for trend), and glucose levels (P = 0.099 for trend), as illustrated through ANCOVA. Boys with a ratio in the highest quartile exhibited a 1.73-fold increased risk for elevated TG (95% CI, 1.19-2.51) and a 2.66-fold increased risk for MetS (95% CI, 1.11-6.35) compared with those with a ratio in the lowest quartile, as demonstrated through multivariate logistic regression analyses after adjusting for confounders. Our results suggest that high sodium intake may be significantly independently associated with MetS in Korean boys aged 10-18 years.

Inverse association between urbanicity and treatment resistance in schizophrenia.

PubMed

Wimberley, Theresa; Pedersen, Carsten B; MacCabe, James H; Støvring, Henrik; Astrup, Aske; Sørensen, Holger J; Horsdal, Henriette T; Mortensen, Preben B; Gasse, Christiane

2016-07-01

Living in a larger city is associated with increased risk of schizophrenia; and world-wide, consistent evidence shows that the higher the degree of urbanicity the higher the risk of schizophrenia. However, the association between urbanicity and treatment-resistant schizophrenia (TRS) as a more severe form of schizophrenia or separate entity of schizophrenia has not been fully explored yet. We aimed to investigate the association between urbanicity and incidence of TRS. A large Danish population-based cohort of all individuals with a first schizophrenia diagnosis after 1996 was followed until 2013 applying survival analysis techniques. TRS was assessed using a treatment-based proxy, defined as the earliest observed instance of either clozapine initiation or hospital admission due to schizophrenia after having received two prior antipsychotic monotherapy trials of adequate duration. Among the 13,349 schizophrenia patients, 17.3% experienced TRS during follow-up (median follow-up: 7years, inter-quartile range: 3-12years). The 5-year risk of TRS ranged from 10.5% in the capital area to 17.6% in the rural areas. Compared with individuals with schizophrenia residing in the capital area, hazard ratios were 1.44 (1.31-1.59) for provincial areas and 1.60 (1.43-1.79) for rural areas. Higher rates of TRS were found in less urbanized areas. The different direction of urban-rural differences regarding TRS and schizophrenia risk may indicate urban-rural systematic differences in treatment practices, or different urban-rural aetiologic types of schizophrenia. Copyright © 2016 Elsevier B.V. All rights reserved.

Defining payments associated with the treatment of colorectal cancer.

PubMed

Gani, Faiz; Cerullo, Marcelo; Canner, Joseph K; Conca-Cheng, Alison; Harzman, Alan E; Husain, Syed G; Cirocco, William C; Arnold, Mark W; Traugott, Amber; Johnston, Fabian M; Pawlik, Timothy M

2017-12-01

While bundled payments aim to reduce variations in health care spending across the continuum of care, data reporting on variations in payments for privately insured patients undergoing treatment for colon cancer (CC) are lacking. The current study sought to characterize variations in payments received for the treatment of CC using a cohort of commercially insured patients. Patients who underwent a colectomy for CC were identified using the MarketScan Database for 2010-2014. Multivariable regression analysis was used to calculate and compare risk-adjusted payments between patients. A total of 18,337 patients were identified who met inclusion criteria. The median risk-adjusted payment for surgery was $26,408 (IQR: $19,193-$38,037) ranging from $19,762 (IQR: $15,595-$25,636) among patients in the lowest quartile of payments to $33,809 (IQR: $24,783-$48,254) for patients in the highest (+△71.1%). The median risk-adjusted payment for chemotherapy was $70,090 (IQR: $57,813-$83,216); compared with patients in the lowest quartile of payments, payments associated with chemotherapy were 40.4% higher among patients in the highest quartile of payments (Q1 versus Q4: $56,827 [IQR: 49,173-65,353] versus $79,801 [IQR: 67,270-90,999]). When stratified by treatment type, patients in the highest two quartiles of risk-adjusted payments accounted for a total of 58.5% of all payments, whereas patients in the lower two quartiles of risk-adjusted payments accounted for only 41.5% of all payments. A younger patient age, increasing patient comorbidity and undergoing an open operation were associated with higher overall payments. Wide variations in payments exist for the treatment for colon cancer. Episode-based bundle payments for surgery and chemotherapy may differentially impact reimbursement for CC. Copyright © 2017 Elsevier Inc. All rights reserved.

Ultra-processed food products and obesity in Brazilian households (2008-2009).

PubMed

Canella, Daniela Silva; Levy, Renata Bertazzi; Martins, Ana Paula Bortoletto; Claro, Rafael Moreira; Moubarac, Jean-Claude; Baraldi, Larissa Galastri; Cannon, Geoffrey; Monteiro, Carlos Augusto

2014-01-01

Production and consumption of industrially processed food and drink products have risen in parallel with the global increase in overweight and obesity and related chronic non-communicable diseases. The objective of this study was to analyze the relationship between household availability of processed and ultra-processed products and the prevalence of excess weight (overweight plus obesity) and obesity in Brazil. The study was based on data from the 2008-2009 Household Budget Survey involving a probabilistic sample of 55,970 Brazilian households. The units of study were household aggregates (strata), geographically and socioeconomically homogeneous. Multiple linear regression models were used to assess the relationship between the availability of processed and ultra-processed products and the average of Body Mass Index (BMI) and the percentage of individuals with excess weight and obesity in the strata, controlling for potential confounders (socio-demographic characteristics, percentage of expenditure on eating out of home, and dietary energy other than that provided by processed and ultra-processed products). Predictive values for prevalence of excess weight and obesity were estimated according to quartiles of the household availability of dietary energy from processed and ultra-processed products. The mean contribution of processed and ultra-processed products to total dietary energy availability ranged from 15.4% (lower quartile) to 39.4% (upper quartile). Adjusted linear regression coefficients indicated that household availability of ultra-processed products was positively associated with both the average BMI and the prevalence of excess weight and obesity, whereas processed products were not associated with these outcomes. In addition, people in the upper quartile of household consumption of ultra-processed products, compared with those in the lower quartile, were 37% more likely to be obese. Greater household availability of ultra-processed food products in Brazil is positively and independently associated with higher prevalence of excess weight and obesity in all age groups in this cross-sectional study.

Ultra-Processed Food Products and Obesity in Brazilian Households (2008–2009)

PubMed Central

Canella, Daniela Silva; Levy, Renata Bertazzi; Martins, Ana Paula Bortoletto; Claro, Rafael Moreira; Moubarac, Jean-Claude; Baraldi, Larissa Galastri; Cannon, Geoffrey; Monteiro, Carlos Augusto

2014-01-01

Background Production and consumption of industrially processed food and drink products have risen in parallel with the global increase in overweight and obesity and related chronic non-communicable diseases. The objective of this study was to analyze the relationship between household availability of processed and ultra-processed products and the prevalence of excess weight (overweight plus obesity) and obesity in Brazil. Methods The study was based on data from the 2008–2009 Household Budget Survey involving a probabilistic sample of 55,970 Brazilian households. The units of study were household aggregates (strata), geographically and socioeconomically homogeneous. Multiple linear regression models were used to assess the relationship between the availability of processed and ultra-processed products and the average of Body Mass Index (BMI) and the percentage of individuals with excess weight and obesity in the strata, controlling for potential confounders (socio-demographic characteristics, percentage of expenditure on eating out of home, and dietary energy other than that provided by processed and ultra-processed products). Predictive values for prevalence of excess weight and obesity were estimated according to quartiles of the household availability of dietary energy from processed and ultra-processed products. Results The mean contribution of processed and ultra-processed products to total dietary energy availability ranged from 15.4% (lower quartile) to 39.4% (upper quartile). Adjusted linear regression coefficients indicated that household availability of ultra-processed products was positively associated with both the average BMI and the prevalence of excess weight and obesity, whereas processed products were not associated with these outcomes. In addition, people in the upper quartile of household consumption of ultra-processed products, compared with those in the lower quartile, were 37% more likely to be obese. Conclusion Greater household availability of ultra-processed food products in Brazil is positively and independently associated with higher prevalence of excess weight and obesity in all age groups in this cross-sectional study. PMID:24667658

Association between vaginal birth after cesarean delivery and primary cesarean delivery rates.

PubMed

Rosenstein, Melissa G; Kuppermann, Miriam; Gregorich, Steven E; Cottrell, Erika K; Caughey, Aaron B; Cheng, Yvonne W

2013-11-01

To estimate the association between vaginal birth after cesarean delivery (VBAC) rates and primary cesarean delivery rates in California hospitals. Hospital VBAC rates were calculated using birth certificate and discharge data from 2009, and hospitals were categorized by quartile of VBAC rate. Multivariable logistic regression analysis was performed to estimate the odds of cesarean delivery among low-risk nulliparous women with singleton pregnancies at term in vertex presentation (nulliparous term singleton vertex) by hospital VBAC quartile while controlling for many patient-level and hospital-level confounders. There were 468,789 term singleton births in California in 2009 at 255 hospitals, 125,471 of which were low-risk nulliparous term singleton vertex. Vaginal birth after cesarean delivery rates varied between hospitals, with a range of 0-44.6%. Rates of cesarean delivery among low-risk nulliparous term singleton vertex women declined significantly with increasing VBAC rate. When adjusted for maternal and hospital characteristics, low-risk nulliparous term singleton vertex women who gave birth in hospitals in the highest VBAC quartile had an odds ratio of 0.55 (95% confidence interval 0.46-0.66) of cesarean delivery compared with women at hospitals with the lowest VBAC rates. Each percentage point increase in a hospital's VBAC rate was associated with a 0.65% decrease in the low-risk nulliparous term singleton vertex cesarean delivery rate. Hospitals with higher rates of VBAC have lower rates of primary cesarean delivery among low-risk nulliparous women with singleton pregnancies at term in vertex presentation. II.

Modifications in the Consumption of Energy, Sugar, and Saturated Fat among the Mexican Adult Population: Simulation of the Effect When Replacing Processed Foods that Comply with a Front of Package Labeling System.

PubMed

Mendoza, Rosario; Tolentino-Mayo, Lizbeth; Hernández-Barrera, Lucia; Nieto, Claudia; Monterrubio-Flores, Eric A; Barquera, Simón

2018-01-19

A Mexican Committee of Nutrition Experts (MCNE) from the National Institute of Public Health (INSP), free from conflict of interest, established food content standards to place the front-of-package (FOP) logo on foods that meet these nutrition criteria. The objectives were to simulate the effect on nutrient intake in the Mexican adult population (20-59 years old) after replacing commonly consumed processed foods with those that meet the FOP nutrition-labeling criteria. Twenty-four hour dietary recalls were collected from the 2012 Mexican National Health and Nutrition Survey ( n = 2164 adults). A food database from the INSP was used. Weighted medians and 25-75 inter-quartile ranges (IQR) of energy and nutrient intake were calculated for all subjects by sociodemographic characteristics before and after replacing foods. Significant decreases were observed in energy (-5.4%), saturated fatty acids (-18.9%), trans-fatty acids (-20%), total sugar (-36.8%) and sodium (-10.7%) intake and a significant increase in fiber intake (+15.5%) after replacing foods, using the MCNE nutrition criteria. Replacing commonly consumed processed foods in the diet with foods that meet the FOP nutrition-labeling criteria set by the MCNE can lead to improvements in energy and nutrient intake in the Mexican adult population.

Modifications in the Consumption of Energy, Sugar, and Saturated Fat among the Mexican Adult Population: Simulation of the Effect When Replacing Processed Foods that Comply with a Front of Package Labeling System

PubMed Central

Mendoza, Rosario; Tolentino-Mayo, Lizbeth; Hernández-Barrera, Lucia; Monterrubio-Flores, Eric A.; Barquera, Simón

2018-01-01

A Mexican Committee of Nutrition Experts (MCNE) from the National Institute of Public Health (INSP), free from conflict of interest, established food content standards to place the front-of-package (FOP) logo on foods that meet these nutrition criteria. The objectives were to simulate the effect on nutrient intake in the Mexican adult population (20–59 years old) after replacing commonly consumed processed foods with those that meet the FOP nutrition-labeling criteria. Twenty-four hour dietary recalls were collected from the 2012 Mexican National Health and Nutrition Survey (n = 2164 adults). A food database from the INSP was used. Weighted medians and 25–75 inter-quartile ranges (IQR) of energy and nutrient intake were calculated for all subjects by sociodemographic characteristics before and after replacing foods. Significant decreases were observed in energy (−5.4%), saturated fatty acids (−18.9%), trans-fatty acids (−20%), total sugar (−36.8%) and sodium (−10.7%) intake and a significant increase in fiber intake (+15.5%) after replacing foods, using the MCNE nutrition criteria. Replacing commonly consumed processed foods in the diet with foods that meet the FOP nutrition-labeling criteria set by the MCNE can lead to improvements in energy and nutrient intake in the Mexican adult population. PMID:29351257

Short-term effects of airborne pollens on asthma attacks as seen by general practitioners in the Greater Paris area, 2003-2007.

PubMed

Huynh, Bich Tram; Tual, Séverine; Turbelin, Clément; Pelat, Camille; Cecchi, Lorenzo; D'Amato, Gennaro; Blanchon, Thierry; Annesi-Maesano, Isabella

2010-09-01

To investigate for the first time the short-term effects of airborne pollen counts on general practitioner (GP) consultations for asthma attacks in the Greater Paris area between 2003-2007. Counts were available for common pollens (Betula, Cupressa, Fraxinus and Poaceae). Weekly data on GP visits for asthma attacks were obtained from the French GP Sentinel Network. A quasi-Poisson regression with generalised additive models was implemented. Short-term effects of pollen counts were assessed using single and multi-pollen models after adjustment for air pollution and influenza. A mean weekly incidence rate of 25.4 cases of asthma attacks per 100,000 inhabitants was estimated during the study period. The strongest significant association between asthma attacks and pollen counts was registered for grass (Poaceae) in the same week of asthma attacks, with a slight reduction of the effect observed in the multi-pollen model. Adjusted relative risk for Poaceae was 1.54 (95% CI: 1.33-1.79) with an inter-quartile range increase of 17.6 grains/m3 during the pollen season. For the first time, a significant short-term association was observed between Poaceae pollen counts and consultations for asthma attacks as seen by GPs. These findings need to be confirmed by more consistent time-series and investigations on a daily basis.

Pilot study of a novel classroom designed to prevent myopia by increasing children’s exposure to outdoor light

PubMed Central

Wang, Mengrui; Jin, Ling; Zhao, Yongyi; Chen, Shangji; Wang, Congyao; Zhang, Guoshan; Wang, Qilin; Deng, Qiaoming; Liu, Yubo; Morgan, Ian G.; He, Mingguang; Liu, Yizhi

2017-01-01

We sought to assess light characteristics and user acceptability of a prototype Bright Classroom (BC), designed to prevent children’s myopia by exposing them to light conditions resembling the outdoors. Conditions were measured throughout the school year in the glass-constructed BC, a traditional classroom (TC) and outdoors. Teachers and children completed user questionnaires, and children rated reading comfort at different light intensities. A total of 230 children (mean age 10.2 years, 57.4% boys) and 13 teachers (36.8 years, 15.4% men) completed questionnaires. The median (Inter Quartile Range) light intensity in the BC (2,540 [1,330–4,060] lux) was greater than the TC (477 [245–738] lux, P < 0.001), though less than outdoors (19,500 [8,960–36,000] lux, P < 0.001). A prominent spectral peak at 490–560 nm was present in the BC and outdoors, but less so in the TC. Teachers and children gave higher overall ratings to the BC than TC, and light intensity in the BC in summer and on sunny days (>5,000 lux) was at the upper limit of children’s comfort for reading. In summary, light intensity in the BC exceeds TC, and is at the practical upper limit for routine use. Children and teachers prefer the BC. PMID:28759614

Replacement of aprotinin by ε-aminocaproic acid in infants undergoing cardiac surgery: consequences for blood loss and outcome.

PubMed

Martin, K; Gertler, R; MacGuill, M; Mayr, N P; Hapfelmeier, A; Hörer, J; Vogt, M; Tassani, P; Wiesner, G

2013-04-01

Once aprotinin was no longer available for clinical use, ε-aminocaproic acid (EACA) and tranexamic acid became the only two options for antifibrinolytic therapy. We compared aprotinin and EACA with respect to their blood-sparing efficacy and other major clinical outcome criteria in infants undergoing cardiac surgery. We retrospectively analysed data from a large consecutive cohort of infants (n=227) aged 31-365 days undergoing primary cardiac surgery requiring cardiopulmonary bypass encompassing the transition from aprotinin to EACA (aprotinin n=88, EACA n=139); all other aspects including the medical team and departmental protocols remained unchanged. The primary outcome was postoperative blood loss measured as chest tube output (CTO). Secondary outcome parameters were transfusion requirements, reoperation due to bleeding, renal, vascular, and neurological complications, and in-hospital mortality. CTO was significantly higher in the EACA patients {aprotinin 18 (13-27) ml kg(-1) 24 h(-1), EACA 23 (15-37) ml kg(-1) 24 h(-1) [mean (inter-quartile range)], P=0.001}, but transfusion requirements and donor exposures were not significantly different. A sensitivity analysis strengthened our finding that the increased blood loss in the EACA group was attributable to lower efficacy of EACA. There were no significant differences in the other clinical outcome measures. CTO was lower in aprotinin-treated patients. Nonetheless, EACA remains a suitable substitute without measurable differences in other clinical outcome criteria.

Association between health literacy and child and adolescent obesity.

PubMed

Chari, Roopa; Warsh, Joel; Ketterer, Tara; Hossain, Jobayer; Sharif, Iman

2014-01-01

We tested the association between child and parental health literacy (HL) and odds of child and adolescent obesity. We conducted an anonymous cross-sectional survey of a convenience sample of English-speaking child-parent dyads. Newest Vital Sign (NVS) measured HL. We used multivariable logistic regression to test adjusted association between child and parental NVS and obesity. Analyses were stratified for school-aged children (aged 7-11) vs. adolescents (aged 12-19). We surveyed 239 child-parent dyads. Median child age was 11 [inter-quartile range 9-13]; 123 (51%) were male; 84% Medicaid recipients; 27% obese. For children, the odds of obesity [adjusted odds ratio (95% confidence interval)] decreased with higher parent NVS [0.75 (0.56,1.00)] and increased with parent obesity [2.53 (1.08,5.94)]. For adolescents, odds of obesity were higher for adolescents with the lowest category of NVS [5.00 (1.26, 19.8)] and older parental age [1.07 (1.01,1.14)] and lower for Medicaid recipients [0.21 (0.06,0.78)] and higher parental education [0.38 (0.22,0.63)]. Obesity in school-aged children is associated with parental factors (obesity, parental HL); obesity in adolescents is strongly associated with the adolescent's HL. Strategies to prevent and treat obesity should consider limited HL of parents for child obesity and of adolescents for adolescent obesity. Copyright © 2013. Published by Elsevier Ireland Ltd.

Relative Contributions of Agricultural Drift, Para-Occupational ...

EPA Pesticide Factsheets

Background: Increased pesticide concentrations in house dust in agricultural areas have been attributed to several exposure pathways, including agricultural drift, para-occupational, and residential use. Objective: To guide future exposure assessment efforts, we quantified relative contributions of these pathways using meta-regression models of published data on dust pesticide concentrations. Methods: From studies in North American agricultural areas published from 1995-2015, we abstracted dust pesticide concentrations reported as summary statistics (e.g., geometric means (GM)). We analyzed these data using mixed-effects meta-regression models that weighted each summary statistic by its inverse variance. Dependent variables were either the log-transformed GM (drift) or the log-transformed ratio of GMs from two groups (para-occupational, residential use). Results: For the drift pathway, predicted GMs decreased sharply and nonlinearly, with GMs 64% lower in homes 250 m versus 23 m from fields (inter-quartile range of published data) based on 52 statistics from 7 studies. For the para-occupational pathway, GMs were 2.3 times higher (95% confidence interval [CI]: 1.5-3.3; 15 statistics, 5 studies) in homes of farmers who applied pesticides more versus less recently or frequently. For the residential use pathway, GMs were 1.3 (95%CI: 1.1-1.4) and 1.5 (95%CI: 1.2-1.9) times higher in treated versus untreated homes, when the probability that a pesticide was used for

Increased serum C-reactive protein concentrations in dogs with congestive heart failure due to myxomatous mitral valve disease.

PubMed

Reimann, M J; Ljungvall, I; Hillström, A; Møller, J E; Hagman, R; Falk, T; Höglund, K; Häggström, J; Olsen, L H

2016-03-01

Cardiovascular disease in humans and dogs is associated with mildly increased circulating concentrations of C-reactive protein (CRP). Few studies have evaluated associations between circulating CRP and canine myxomatous mitral valve disease (MMVD) and the results reported have been divergent. The aim of this study was to investigate whether serum concentrations of CRP, determined using a novel automated canine-specific high-sensitivity CRP assay (Gentian hsCRP), were associated with severity of MMVD and selected clinical variables in dogs. The study included 188 client-owned dogs with different severities of MMVD. Dogs were classified based on ACVIM consensus statement guidelines (group A, n = 58; group B1, n = 56; group B2, n = 38; group C, n = 36). Data were analysed using descriptive statistics and multiple regression analysis. Dogs with congestive heart failure (CHF; group C) had significantly higher CRP concentrations (median, 2.65 mg/L; quartile 1-quartile 3, 1.09-5.09) compared to dogs in groups A (median, 0.97 mg/L; quartile 1-quartile 3, <0.50-1.97; P = 0.001), B1 (median, 0.78 mg/L; quartile 1-quartile 3, <0.50-1.73, P <0.0001) and B2 (median, 0.60 mg/L; quartile 1-quartile 3, <0.50-1.23; P <0.0001). Other variables reflecting disease severity, including left atrial to aortic root ratio (P = 0.0002, adjusted r(2) = 0.07) and left ventricular end-diastolic diameter normalised for bodyweight (P = 0.0005, adjusted r(2) = 0.06), were positively associated with CRP concentration, but the association disappeared if dogs with CHF were excluded from analysis. In conclusion, slightly higher CRP concentrations were found in dogs with CHF whereas severity of asymptomatic MMVD showed no association with CRP concentrations. Copyright © 2016 Elsevier Ltd. All rights reserved.

TESTOSTERONE LEVELS ACHIEVED BY MEDICALLY TREATED TRANSGENDER WOMEN IN A UNITED STATES ENDOCRINOLOGY CLINIC COHORT.

PubMed

Liang, Jennifer J; Jolly, Divya; Chan, Kelly J; Safer, Joshua D

2018-02-01

Most transgender women depend on medical treatment alone to lower testosterone levels in order to align physical appearance with gender identity. The medical regimen in the United States typically includes spironolactone and estrogens. The purpose of this cross-sectional study was to assess the testosterone suppression achieved among transgender women treated with spironolactone and estrogens. Testosterone and estradiol levels were extracted from the electronic medical records of 98 anonymized transgender women treated with oral spironolactone and oral estrogen therapy at the Endocrinology Clinic at Boston Medical Center. Patients starting therapy required about 9 months to reach a steady-state testosterone, with significant heterogeneity of levels achieved among patients. Patients with normal body mass index (BMI) had higher testosterone levels, whereas patients with obese BMI had lower testosterone levels throughout treatment. Stratification of patients by age or spironolactone dosage revealed no significant difference in testosterone levels achieved. At steady state, patients in the highest suppressing quartile were able to achieve testosterone levels of 27 ng/dL, with a standard deviation of 21 ng/dL. Measured serum estradiol levels did not change over time and did not correlate with dosage of estradiol administered. Among a cohort of transgender women treated with spironolactone and estrogen, the highest suppressing quartile could reliably achieve testosterone levels in the female range at virtually all times. The second highest suppressing quartile could not achieve female levels but remained below the male range virtually all of the time. One quartile was unable to achieve any significant suppression. BMC = Boston Medical Center BMI = body mass index CPY = cyproterone acetate LC-MS/MS = liquid chromatography-tandem mass spectrometry Q = quartile.

Does repeated pleural culture increase the diagnostic yield of Mycobacterium tuberculosis from tuberculous pleural effusion in HIV-negative individuals?

PubMed

Ko, Yousang; Song, Jinkyung; Lee, Suh-Young; Moon, Jin-Wook; Mo, Eun-Kyung; Park, Ji Young; Kim, Joo-Hee; Park, Sunghoon; Hwang, Yong Il; Jang, Seung Hun; Jhun, Byung Woo; Sim, Yun Su; Shin, Tae Rim; Kim, Dong-Gyu; Hong, Ji Young; Lee, Chang Youl; Lee, Myung Goo; Kim, Cheol-Hong; Hyun, In Gyu; Park, Yong Bum

2017-01-01

Despite recent advances in methods for culturing Mycobacterium tuberculosis (MTB), the diagnostic yield of tuberculous pleural effusion (TBPE) remains unsatisfactory. However, unlike repeated sputum cultures of pulmonary tuberculosis, little is known about the role of repeated pleural cultures. We examined whether repeated pleural cultures are associated with increased MTB yield from TBPE. A multicenter, retrospective cohort study was performed from January 2012 to December 2015 in South Korea. Patients were categorized into two groups: single- or repeated-culture groups. The diagnostic yield of MTB and clinical, radiological, and pleural fluid characteristics were evaluated. Among the 329 patients with TBPE, 77 (23.4%) had repeated cultures and 252 (76.5%) had a single culture. Pleural culture was performed twice in all 77 patients in the repeated-culture group at a 1-day interval (inter-quartile range, 1.0-2.0). In the repeated-culture group, the yield of MTB from the first culture was 31.2%, which was similar to that in the single-culture group (31.2% vs. 29.8%, P = 0.887). However, the yield of MTB from the second culture (10/77, 13.0%) was more than that from the first. These results may be attributable to the insufficient immune clearance for MTB invasion into the pleural space between the first and second cultures. Over time, the yield of the second cultures decreased from 17.4% to 6.7% and then 6.3%. Finally, the overall yield of MTB in the repeated- and single-culture groups was 44.2% and 29.8% respectively (P < 0.001). The results showed that repeated pleural cultures increased MTB yield from TBPE in human immunodeficiency virus-negative individuals. Furthermore, repeated cultures may increase yield when carried out for two consecutive days.

Genetic evolution of HIV in patients remaining on a stable HAART regimen despite insufficient viral suppression.

PubMed

Kristiansen, Thomas B; Pedersen, Anders G; Eugen-Olsen, Jesper; Katzenstein, Terese L; Lundgren, Jens D

2005-01-01

Our objective was to investigate whether steadily increasing resistance levels are inevitable in the course of a failing but unchanged Highly Active Antiretroviral Therapy (HAART) regimen. Patients having an unchanged HAART regimen and a good CD4 response (100 cells/microl above nadir) despite consistent HIV-RNA levels above 200 copies/ml were included in the study. The study period spanned at least 12 months and included 47 plasma samples from 17 patients that were sequenced and analysed with respect to evolutionary changes. At inclusion, the median CD4 count was 300 cells/ml (inter-quartile range (IQR): 231-380) and the median HIV-RNA was 2000 copies/ml (IQR: 1301-6090). Reverse transcription inhibitor (RTI) mutations increased 0.5 mutations per y (STD = 0.8 mutations per y), while major protease inhibitor (PI) resistance mutations increased at a rate of 0.2 mutations per y (STD = 0.8 mutations per y) and minor PI resistance mutations increased at a rate of 0.3 mutations per y (STD = 0.7 mutations per y). The rate at which RTI mutations accumulated decreased during the study period (p = 0.035). Interestingly, the rate of mutation accumulation was not associated with HIV-RNA level. The majority of patients kept accumulating new resistance mutations. However, 3 out of 17 patients with viral failure were caught in an apparent mutational deadlock, thus the development of additional resistance during a failing HAART is not inevitable. We hypothesize that certain patterns of mutations can cause a mutational deadlock where the evolutionary benefit of further resistance mutation is limited if the patient is kept on a stable HAART regimen.

Longitudinal study of exposure to entertainment media and alcohol use among german adolescents.

PubMed

Hanewinkel, Reiner; Sargent, James D

2009-03-01

Entertainment media exposure may predict teenager alcohol use, but few longitudinal studies have been reported. A longitudinal study was conducted of 2708 German adolescents aged 10 to 16 years who had never drunk alcohol. Each adolescent was surveyed at school about daily television use, whether they had a television in their bedroom, and their exposure to movie alcohol depictions. Adolescents were resurveyed 12 to 13 months later (retention rate: 85%) to determine onset of drinking alcohol without parental knowledge and binge drinking (>/=5 consecutive drinks). Overall, 885 (33%) students initiated alcohol use without parental knowledge (17% in quartile 1 movie alcohol exposure), and 387 (14%) initiated binge drinking during follow-up. After controlling for baseline covariates, exposure to movie alcohol use significantly increased percent initiating alcohol use (to 24% in exposure quartile 2, 33% in quartile 3 and 34% in quartile 4) and percent initiating binge drinking (to 8.6% in exposure quartile 2, 12% in quartile 3 and 13% in quartile 4). Having a television in the bedroom also predicted both outcomes, but daily television use did not. Movie exposure and having a television in the bedroom are both independent predictors of onset of problematic alcohol use among German teenagers. Media restrictions could play a role in prevention.

Longitudinal Study of Exposure to Entertainment Media and Alcohol Use Among German Adolescents

PubMed Central

Hanewinkel, Reiner; Sargent, James D.

2009-01-01

BACKGROUND Entertainment media exposure may predict teenager alcohol use, but few longitudinal studies have been reported. METHODS A longitudinal study was conducted of 2708 German adolescents aged 10 to 16 years who had never drunk alcohol. Each adolescent was surveyed at school about daily television use, whether they had a television in their bedroom, and their exposure to movie alcohol depictions. Adolescents were resurveyed 12 to 13 months later (retention rate: 85%) to determine onset of drinking alcohol without parental knowledge and binge drinking (≥5 consecutive drinks). RESULTS Overall, 885 (33%) students initiated alcohol use without parental knowledge (17% in quartile 1 movie alcohol exposure), and 387 (14%) initiated binge drinking during follow-up. After controlling for baseline covariates, exposure to movie alcohol use significantly increased percent initiating alcohol use (to 24% in exposure quartile 2, 33% in quartile 3 and 34% in quartile 4) and percent initiating binge drinking (to 8.6% in exposure quartile 2, 12% in quartile 3 and 13% in quartile 4). Having a television in the bedroom also predicted both outcomes, but daily television use did not. CONCLUSIONS Movie exposure and having a television in the bedroom are both independent predictors of onset of problematic alcohol use among German teenagers. Media restrictions could play a role in prevention. PMID:19255030

Prognostic value of uric acid in patients with Type 2 diabetes mellitus and coronary artery disease.

PubMed

Ndrepepa, Gjin; Braun, Siegmund; King, Lamin; Cassese, Salvatore; Tada, Tomohisa; Fusaro, Massimiliano; Hadamitzky, Martin; Haase, Hans-Ullrich; Schömig, Albert; Kastrati, Adnan

2013-02-01

Studies investigating the prognostic role of UA (uric acid) in patients with Type 2 diabetes mellitus have given conflicting findings. We undertook the present study to assess the association between UA and outcome in patients with Type 2 diabetes mellitus and CAD (coronary artery disease). The study included 3705 patients with diabetes mellitus and angiography-proven CAD. UA was measured before coronary angiography. The primary outcome was 1-year all-cause mortality. The UA concentration [median (25th-75th quartiles)] was 6.44 mg/dl (5.40-7.70 mg/dl). There were 264 deaths (7.1%) during follow-up: 45 deaths in patients of the first UA quartile, 43 deaths in patients of the second UA quartile, 51 deaths in patients of the third UA quartile and 125 deaths in patients of the fourth UA quartile {Kaplan-Meier estimates of mortality, 5.1, 4.8, 5.6 and 14.0% respectively; unadjusted HR (hazard ratio), 2.81 [95% CI (confidence interval), 2.21-3.58]; P<0.001 for fourth quartile compared with first-third quartiles combined}. In the multivariable analysis, UA predicted all-cause mortality with an adjusted HR of 1.29 (95% CI, 1.12-1.48; P<0.001), for each S.D. increase in the logarithmic scale of UA level. The inclusion of UA in the multivariable model alongside known cardiovascular risk factors and other relevant variables increased the discriminatory power of the model regarding prediction of all-cause mortality [absolute and relative IDI (integrated discrimination improvement) 0.034 and 20.5% respectively; P<0.001]. In conclusion, in patients with Type 2 diabetes mellitus and confirmed CAD, elevated levels of UA predict mortality independently of known cardiovascular risk factors.

Estimating Time-Varying PCB Exposures Using Person-Specific Predictions to Supplement Measured Values: A Comparison of Observed and Predicted Values in Two Cohorts of Norwegian Women.

PubMed

Nøst, Therese Haugdahl; Breivik, Knut; Wania, Frank; Rylander, Charlotta; Odland, Jon Øyvind; Sandanger, Torkjel Manning

2016-03-01

Studies on the health effects of polychlorinated biphenyls (PCBs) call for an understanding of past and present human exposure. Time-resolved mechanistic models may supplement information on concentrations in individuals obtained from measurements and/or statistical approaches if they can be shown to reproduce empirical data. Here, we evaluated the capability of one such mechanistic model to reproduce measured PCB concentrations in individual Norwegian women. We also assessed individual life-course concentrations. Concentrations of four PCB congeners in pregnant (n = 310, sampled in 2007-2009) and postmenopausal (n = 244, 2005) women were compared with person-specific predictions obtained using CoZMoMAN, an emission-based environmental fate and human food-chain bioaccumulation model. Person-specific predictions were also made using statistical regression models including dietary and lifestyle variables and concentrations. CoZMoMAN accurately reproduced medians and ranges of measured concentrations in the two study groups. Furthermore, rank correlations between measurements and predictions from both CoZMoMAN and regression analyses were strong (Spearman's r > 0.67). Precision in quartile assignments from predictions was strong overall as evaluated by weighted Cohen's kappa (> 0.6). Simulations indicated large inter-individual differences in concentrations experienced in the past. The mechanistic model reproduced all measurements of PCB concentrations within a factor of 10, and subject ranking and quartile assignments were overall largely consistent, although they were weak within each study group. Contamination histories for individuals predicted by CoZMoMAN revealed variation between study subjects, particularly in the timing of peak concentrations. Mechanistic models can provide individual PCB exposure metrics that could serve as valuable supplements to measurements.

Associations between exposure to ambient benzene and PM(2.5) during pregnancy and the risk of selected birth defects in offspring.

PubMed

Tanner, Jean Paul; Salemi, Jason L; Stuart, Amy L; Yu, Haofei; Jordan, Melissa M; DuClos, Chris; Cavicchia, Philip; Correia, Jane A; Watkins, Sharon M; Kirby, Russell S

2015-10-01

A growing number of studies have investigated the association between air pollution and the risk of birth defects, but results are inconsistent. The objective of this study was to examine whether maternal exposure to ambient PM2.5 or benzene increases the risk of selected birth defects in Florida. We conducted a retrospective cohort study of singleton infants born in Florida from 2000 to 2009. Isolated and non-isolated birth defect cases of critical congenital heart defects, orofacial clefts, and spina bifida were identified from the Florida Birth Defects Registry. Estimates of maternal exposures to PM2.5 and benzene for all case and non-case pregnancies were derived by aggregation of ambient measurement data, obtained from the US Environmental Protection Agency Air Quality System, during etiologically relevant time windows. Multivariable Poisson regression was used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for each quartile of air pollutant exposure. Compared to the first quartile of PM2.5 exposure, higher levels of exposure were associated with an increased risk of non-isolated truncus arteriosus (aPR4th Quartile, 8.80; 95% CI, 1.11-69.50), total anomalous pulmonary venous return (aPR2nd Quartile, 5.00; 95% CI, 1.10-22.84), coarctation of the aorta (aPR4th Quartile, 1.72; 95% CI, 1.15-2.57; aPR3rd Quartile, 1.60; 95% CI, 1.07-2.41), interrupted aortic arch (aPR4th Quartile, 5.50; 95% CI, 1.22-24.82), and isolated and non-isolated any critical congenital heart defect (aPR3rd Quartile, 1.13; 95% CI, 1.02-1.25; aPR4th Quartile, 1.33; 95% CI, 1.07-1.65). Mothers with the highest level of exposure to benzene were more likely to deliver an infant with an isolated cleft palate (aPR4th Quartile, 1.52; 95% CI, 1.13-2.04) or any orofacial cleft (aPR4th Quartile, 1.29; 95% CI, 1.08-1.56). An inverse association was observed between exposure to benzene and non-isolated pulmonary atresia (aPR4th Quartile, 0.19; 95% CI, 0.04-0.84). Our results suggest a few associations between exposure to ambient PM2.5 or benzene and specific birth defects in Florida. However, many related comparisons showed no association. Hence, it remains unclear whether associations are clinically significant or can be causally related to air pollution exposures. Copyright © 2015 Elsevier Inc. All rights reserved.

Relationship Between Circulating Thyroid-Stimulating Hormone, Free Thyroxine, and Free Triiodothyronine Concentrations and 9-Year Mortality in Euthyroid Elderly Adults.

PubMed

Ceresini, Graziano; Marina, Michela; Lauretani, Fulvio; Maggio, Marcello; Bandinelli, Stefania; Ceda, Gian P; Ferrucci, Luigi

2016-03-01

To determine the association between plasma thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) levels and all-cause mortality in older adults who had levels of all three hormones in the normal range. Longitudinal. Community-based. Euthyroid Invecchiare in Chianti study participants aged 65 and older (N = 815). Plasma TSH, FT3, and FT4 levels were predictors, and 9-year all-cause mortality was the outcome. Cox proportional hazards models adjusted for confounders were used to examine the relationship between TSH, FT3, and FT4 quartiles and all-cause mortality over 9 years of follow-up. During follow-up (mean person-years 8,643.7, range 35.4-16,985.0), 181 deaths occurred (22.2%). Participants with TSH in the lowest quartile had higher mortality than the rest of the population. After adjusting for multiple confounders, participants with TSH in the lowest quartile (hazard ratio = 2.22, 95% confidence interval = 1.19-4.22) had significantly higher all-cause mortality than those with TSH in the highest quartile. Neither FT3 nor FT4 was associated with mortality. In elderly euthyroid subjects, normal-low TSH is an independent risk factor for all-cause mortality. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Inter-individual variability and pattern recognition of surface electromyography in front crawl swimming.

PubMed

Martens, Jonas; Daly, Daniel; Deschamps, Kevin; Staes, Filip; Fernandes, Ricardo J

2016-12-01

Variability of electromyographic (EMG) recordings is a complex phenomenon rarely examined in swimming. Our purposes were to investigate inter-individual variability in muscle activation patterns during front crawl swimming and assess if there were clusters of sub patterns present. Bilateral muscle activity of rectus abdominis (RA) and deltoideus medialis (DM) was recorded using wireless surface EMG in 15 adult male competitive swimmers. The amplitude of the median EMG trial of six upper arm movement cycles was used for the inter-individual variability assessment, quantified with the coefficient of variation, coefficient of quartile variation, the variance ratio and mean deviation. Key features were selected based on qualitative and quantitative classification strategies to enter in a k-means cluster analysis to examine the presence of strong sub patterns. Such strong sub patterns were found when clustering in two, three and four clusters. Inter-individual variability in a group of highly skilled swimmers was higher compared to other cyclic movements which is in contrast to what has been reported in the previous 50years of EMG research in swimming. This leads to the conclusion that coaches should be careful in using overall reference EMG information to enhance the individual swimming technique of their athletes. Copyright © 2016 Elsevier Ltd. All rights reserved.

Telomere shortening unrelated to smoking, body weight, physical activity, and alcohol intake: 4,576 general population individuals with repeat measurements 10 years apart.

PubMed

Weischer, Maren; Bojesen, Stig E; Nordestgaard, Børge G

2014-03-01

Cross-sectional studies have associated short telomere length with smoking, body weight, physical activity, and possibly alcohol intake; however, whether these associations are due to confounding is unknown. We tested these hypotheses in 4,576 individuals from the general population cross-sectionally, and with repeat measurement of relative telomere length 10 years apart. We also tested whether change in telomere length is associated with mortality and morbidity in the general population. Relative telomere length was measured with quantitative polymerase chain reaction. Cross-sectionally at the first examination, short telomere length was associated with increased age (P for trend across quartiles = 3 × 10(-77)), current smoking (P = 8 × 10(-3)), increased body mass index (P = 7 × 10(-14)), physical inactivity (P = 4 × 10(-17)), but not with increased alcohol intake (P = 0.10). At the second examination 10 years later, 56% of participants had lost and 44% gained telomere length with a mean loss of 193 basepairs. Change in leukocyte telomere length during 10 years was associated inversely with baseline telomere length (P<1 × 10(-300)) and age at baseline (P = 1 × 10(-27)), but not with baseline or 10-year inter-observational tobacco consumption, body weight, physical activity, or alcohol intake. Prospectively during a further 10 years follow-up after the second examination, quartiles of telomere length change did not associate with risk of all-cause mortality, cancer, chronic obstructive pulmonary disease, diabetes mellitus, ischemic cerebrovascular disease, or ischemic heart disease. In conclusion, smoking, increased body weight, and physical inactivity were associated with short telomere length cross-sectionally, but not with telomere length change during 10 years observation, and alcohol intake was associated with neither. Also, change in telomere length did not associate prospectively with mortality or morbidity in the general population.

[Association of age, inflammatory markers and subclinical atherosclerosis in subjects free from cardiovascular disease].

PubMed

Páramo, José A; Orbe, Josune; Beloqui, Oscar; Colina, Inmaculada; Benito, Alberto; Rodríguez, José A; Díez, Javier

2008-09-27

We assessed whether an independent association between inflammatory markers and age-related subclinical atherosclerosis could be found in subjects free from cardiovascular disease. Metabolic parameters, inflammatory and endothelial markers, such as high-sensitivity C-reactive protein, interleukin-6, fibrinogen and von Willebrand factor, as well as the carotid intima-media thickness were assessed in 890 asymptomatic subjects (mean age: 55 years; range: 20-80 years; 80% men) with cardiovascular risk factors. Subjects in the upper quartile (age 61-80 years) showed a significant increase of traditional risk factors, particularly arterial pressure and glucose levels (p < 0.01) as compared with lower quartiles. We also found a significant increase in the levels on inflammatory and endothelial markers (p < 0.001) and intima-media thickness (p < 0.001) in older adults. In the multivarate analysis, after adjustment for cardiovascular risk factors, intima-media thickness was independently associated with inflammation and endothelial dysfunction in older adults (p < 0.01). Besides age, systemic inflammation and vascular damage are associated with subclinical atherosclerosis in asymptomatic subjects. The age-related inflammatory profile may predispose to cardiovascular complications.

Association of the atherogenic index of plasma and oxidative stress status with weight gain during non-complicated pregnancy.

PubMed

Stefanović, Aleksandra; Kotur-Stevuljević, Jelena; Vujović, Ana; Spasić, Slavica; Spasojević-Kalimanovska, Vesna; Jelic-Ivanović, Zorana; Martinović, Jelena; Ardalić, Daniela; Mandić-Marković, Vesna; Miković, Zeljko; Cerović, Nikola

2012-11-01

Pregnancy is a stressful condition linked with altered lipid profile, increased oxidative stress and increased inflammation processes. The purpose of the present study was to determine the associations between those alterations with increased weight gain during pregnancy. The atherogenic index of plasma (AIP) and oxidative stress status parameters were determinated in 50 healthy and 172 pregnant women with non-complicated pregnancy. Pregnant women were divided in four groups according to body mass index (BMI) values (BMI quartiles). Oxidative stress parameters were significantly lower in the control group compared with all the pregnant women quartiles. Unexpectedly, differences in oxidative stress parameters between BMI quartiles groups were not significant. The antioxidant defence parameters remained quite similar in the different BMI quartiles. Weight gain and paraoxonase-1 (PON1) activities were independently associated with increased AIP while weight gain and triglyceride concentration were found to be significant predictors of PON1 activities. The results of our current study indicate the association of maternal weight gain during pregnancy and altered lipid profile, elevated oxidative stress and changed antioxidative capacity of PON1. Taken together all these facts indicate possible increased risk of cardiovascular disease (CVD) development in later life if the weight gain during pregnancy is excessive.

Practice variation in the treatment of rheumatoid arthritis among German rheumatologists.

PubMed

Zink, A; Listing, J; Ziemer, S; Zeidler, H

2001-10-01

To describe practice variation in the treatment of rheumatoid arthritis (RA) among German rheumatologists with regard to drug and non-drug therapy. We used data of 7,326 patients with RA registered in a national German rheumatological database in 1998. In the database, every patient with an inflammatory rheumatic disease seen at one of the German Collaborative Arthritis Centres is registered once a year with a standard clinical data form and a patient questionnaire. We compared health care provided by 29 rheumatological outpatient units. For drug and non-drug treatment unit prescription rates, ranges and outliers were calculated. Logistic regression analysis was used for case mix adjustment and for the identification of practice patterns. We observed variation concerning the frequency of use of single disease modifying antirheumatic drugs (DMARD). The median of the prescription rates in the 29 units for methotrexate (MTX) was 55% in 1998 (1st quartile: 51%, 3rd quartile: 63%); sulfasalazine had a median of 15% (quartiles: 10%/19%), antimalarials a median of 8% (quartiles: 5%/21%). Combination DMARD therapy was used in 11% (quartiles: 6%/18%). Prescriptions of low dose steroids (< or = 7.5 mg) had a median of 45% (quartiles: 35%/55%), and nonsteroidal antiinflammatory drugs (NSAID) had a median prescription rate of 58% (quartiles: 50%/70%). High variation was also found concerning active physiotherapy (median: 41%; quartiles 34%/55%) and passive physical measures (median 14%, quartiles 9%/37%). Differences in case mix (age, sex, rheumatoid factor, disease duration, severity, disability) only explained a small proportion of the total variation. When the units were grouped according to the frequency of prescription of DMARD combination therapy, treatment patterns could be identified. Units with higher rates of DMARD combination therapy used more drugs for the prevention and treatment of osteoporosis, more active physiotherapy but fewer NSAID and fewer passive physical therapies. Variation in drug and non-drug treatment indicates significant differences in health care provision. Trends in the drug management of RA are adopted differentially by the members of the rheumatology community. The large variability in non-drug therapies may, apart from differences in availability, suggest a lack of agreement on therapeutic effectiveness.

Risk and treatment effect heterogeneity: re-analysis of individual participant data from 32 large clinical trials

PubMed Central

Kent, David M; Nelson, Jason; Dahabreh, Issa J; Rothwell, Peter M; Altman, Douglas G; Hayward, Rodney A

2016-01-01

Abstract Background: Risk of the outcome is a mathematical determinant of the absolute treatment benefit of an intervention, yet this can vary substantially within a trial population, complicating the interpretation of trial results. Methods: We developed risk models using Cox or logistic regression on a set of large publicly available randomized controlled trials (RCTs). We evaluated risk heterogeneity using the extreme quartile risk ratio (EQRR, the ratio of outcome rates in the lowest risk quartile to that in the highest) and skewness using the median to mean risk ratio (MMRR, the ratio of risk in the median risk patient to the average). We also examined heterogeneity of treatment effects (HTE) across risk strata. Results: We describe 39 analyses using data from 32 large trials, with event rates across studies ranging from 3% to 63% (median = 15%, 25th–75th percentile = 9–29%). C-statistics of risk models ranged from 0.59 to 0.89 (median = 0.70, 25th–75th percentile = 0.65–0.71). The EQRR ranged from 1.8 to 50.7 (median = 4.3, 25th–75th percentile = 3.0–6.1). The MMRR ranged from 0.4 to 1.0 (median = 0.86, 25th–75th percentile = 0.80–0.92). EQRRs were predictably higher and MMRRs predictably lower as the c-statistic increased or the overall outcome incidence decreased. Among 18 comparisons with a significant overall treatment effect, there was a significant interaction between treatment and baseline risk on the proportional scale in only one. The difference in the absolute risk reduction between extreme risk quartiles ranged from −3.2 to 28.3% (median = 5.1%; 25th–75th percentile = 0.3–10.9). Conclusions: There is typically substantial variation in outcome risk in clinical trials, commonly leading to clinically significant differences in absolute treatment effects. Most patients have outcome risks lower than the trial average reflected in the summary result. Risk-stratified trial analyses are feasible and may be clinically informative, particularly when the outcome is predictable and uncommon. PMID:27375287

Association between methylmercury and cardiovascular risk factors in a native population of Quebec (Canada): a retrospective evaluation.

PubMed

Valera, Beatriz; Dewailly, Eric; Poirier, Paul

2013-01-01

Epidemiological evidence suggests a negative impact of methylmercury (MeHg) on cardiovascular risk factors such as blood pressure (BP) and heart rate (HR). This issue is of concern in Arctic populations such as in the Inuit of Nunavik since this contaminant is accumulated in fish and marine mammals, which still represent the subsistence diet of this population. We examined the associations between MeHg and BP and resting HR among Inuit adults. The "Santé Quebec" health survey was conducted in 1992 in the 14 villages of Nunavik and a complete set of data was obtained for 313 Inuit adults≥18 years. Blood samples were collected in order to determine total mercury, lead, total polychlorinated biphenyls (PCBs), n-3 polyunsaturated fatty acids (PUFAs), fasting glucose and lipid profile while socio-demographic variables were obtained through questionnaires. Anthropometric measurements as well as BP and resting HR were obtained using standardised protocols. Pulse pressure (PP: systolic BP minus diastolic BP) was also calculated. Multiple linear regression was used in order to determine the change in the dependent variables associated with the quartiles of MeHg concentration, taking the quartile 1 as reference. The mean age of the participants was 38±14 years and the sample was composed of 132 men (42.2%) and 181 women (57.8%). MeHg geometric mean was 15.4 μg/L (95%CI: 13.9-17.0) and levels ranged from 0.8 to 112.0 μg/L. Resting HR increased linearly across quartiles of blood MeHg concentration after adjusting for confounders (p for trend=0.02). An increase of 6.9 beats per minute (bpm) between the 4th and 1st quartile was observed after adjusting for confounders. No significant association was observed between blood MeHg and systolic BP, diastolic BP or PP. MeHg was associated with increasing resting HR after considering traditional risk factors as well as other contaminants (lead and total PCBs) and n-3 PUFAs. In contrast, no significant association with blood pressure was observed in this study. Copyright © 2012 Elsevier Inc. All rights reserved.

The prospective association between total and type of fish intake and type 2 diabetes in 8 European countries: EPIC-InterAct Study123

PubMed Central

Patel, Pinal S; Kuijsten, Anneleen; Schulze, Matthias B; van Woudenbergh, Geertruida J; Ardanaz, Eva; Amiano, Pilar; Arriola, Larraitz; Balkau, Beverley; Barricarte, Aurelio; Beulens, Joline WJ; Boeing, Heiner; Buijsse, Brian; Crowe, Francesca L; de Lauzon-Guillan, Blandine; Fagherazzi, Guy; Franks, Paul W; Gonzalez, Carlos; Grioni, Sara; Halkjaer, Jytte; Huerta, José María; Key, Timothy J; Kühn, Tilman; Masala, Giovanna; Nilsson, Peter; Overvad, Kim; Panico, Salvatore; Quirós, Jose Ramón; Rolandsson, Olov; Sacerdote, Carlotta; Sánchez, María-José; Schmidt, Erik B; Slimani, Nadia; Spijkerman, Annemieke MW; Teucher, Birgit; Tjonneland, Anne; Tormo, Maria-Jose; Tumino, Rosario; van der A, Daphne L; van der Schouw, Yvonne T; Sharp, Stephen J; Langenberg, Claudia; Feskens, Edith JM; Riboli, Elio; Wareham, Nicholas J

2012-01-01

Background: Epidemiologic evidence of an association between fish intake and type 2 diabetes (T2D) is inconsistent and unresolved. Objective: The objective was to examine the association between total and type of fish intake and T2D in 8 European countries. Design: This was a case-cohort study, nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) study, with 3.99 million person-years of follow-up, 12,403 incident diabetes cases, and a random subcohort of 16,835 individuals from 8 European countries. Habitual fish intake (lean fish, fatty fish, total fish, shellfish, and combined fish and shellfish) was assessed by country-specific dietary questionnaires. HRs were estimated in each country by using Prentice-weighted Cox regression models and pooled by using a random-effects meta-analysis. Results: No overall association was found between combined fish and shellfish intake and incident T2D per quartile (adjusted HR: 1.00; 95% CI: 0.94, 1.06; P-trend = 0.99). Total fish, lean fish, and shellfish intakes separately were also not associated with T2D, but fatty fish intake was weakly inversely associated with T2D: adjusted HR per quartile 0.97 (0.94, 1.00), with an HR of 0.84 (0.70, 1.01), 0.85 (0.76, 0.95), and 0.87 (0.78, 0.97) for a comparison of the second, third, and fourth quartiles with the lowest quartile of intake, respectively (P-trend = 0.06). Conclusions: These findings suggest that lean fish, total fish, and shellfish intakes are not associated with incident diabetes but that fatty fish intake may be weakly inversely associated. Replication of these findings in other populations and investigation of the mechanisms underlying these associations are warranted. Meanwhile, current public health recommendations on fish intake should remain unchanged. PMID:22572642

The impact of high serum bicarbonate levels on mortality in hemodialysis patients.

PubMed

Chang, Kyung Yoon; Kim, Hyung Wook; Kim, Woo Jeong; Kim, Yong Kyun; Kim, Su-Hyun; Song, Ho Chul; Kim, Young Ok; Jin, Dong Chan; Choi, Euy Jin; Yang, Chul Woo; Kim, Yong-Lim; Kim, Nam-Ho; Kang, Shin-Wook; Kim, Yon-Su; Kim, Young Soo

2017-01-01

The optimal serum bicarbonate level is controversial for patients who are undergoing hemodialysis (HD). In this study, we analyzed the impact of serum bicarbonate levels on mortality among HD patients. Prevalent HD patients were selected from the Clinical Research Center registry for End Stage Renal Disease cohort in Korea. Patients were categorized into quartiles according to their total carbon dioxide (tCO 2 ) levels: quartile 1, a tCO 2 of < 19.4 mEq/L; quartile 2, a tCO 2 of 19.4 to 21.5 mEq/L; quartile 3, a tCO 2 of 21.6 to 23.9 mEq/L; and quartile 4, a tCO 2 of ≥ 24 mEq/L. Cox regression analysis was used to calculate the adjusted hazard ratio (HR) and confidence interval (CI) for mortality. We included 1,159 prevalent HD patients, with a median follow-up period of 37 months. Kaplan-Meier analysis revealed that the all-cause mortality was significantly higher in patients from quartile 4, compared to those from the other quartiles ( p = 0.009, log-rank test). The multivariate Cox proportional hazard model revealed that patients from quartile 4 had significantly higher risk of mortality than those from quartile 1, 2 and 3, after adjusting for the clinical variables in model 1 (HR, 1.99; 95% CI, 1.15 to 3.45; p = 0.01) and model 2 (HR, 1.82; 95% CI, 1.03 to 3.22; p = 0.04). Our data indicate that high serum bicarbonate levels (a tCO2 of ≥ 24 mEq/L) were associated with increased mortality among prevalent HD patients. Further effort might be necessary in finding the cause and correcting metabolic alkalosis in the chronic HD patients with high serum bicarbonate levels.

The Associations Between Increasing Degrees of HOMA-IR and Measurements of Adiposity Among Euglycemic U.S. Adults.

PubMed

Boyer, William R; Johnson, Tammie M; Fitzhugh, Eugene C; Richardson, Michael R; Churilla, James R

2016-03-01

The purpose of this study was to examine the associations between increasing degrees of insulin resistance (using the homeostatic model assessment of insulin resistance [HOMA-IR]) and two measures of adiposity in a nationally representative sample of euglycemic U.S. adults. Sample included adult participants (≥ 20 years of age) [N = 1586 (body mass index, BMI model), N = 1577 (waist circumference, WC model)] from the 1999-2004 National Health and Nutrition Examination Survey (NHANES). HOMA-IR was categorized into quartiles. BMI and WC were examined continuously as the dependent variables. Following adjustment for covariates, those with HOMA-IR values in the second, third, and fourth quartiles had significantly higher BMIs (P < 0.001) compared with subjects in the first quartile. In the model using WC, significantly higher WCs were found in subjects in the second, third, and fourth quartiles of HOMA-IR (P < 0.001) compared with those in the first quartile. A significant moderate correlation was found between HOMA-IR and BMI (R(2) = 0.4171, P < 0.001), as well as HOMA-IR and WC (R(2) = 0.4826, P < 0.001). Having a higher HOMA-IR value is associated with higher BMI and WC values in euglycemic subjects.

Parks and Green Areas Are Associated with Decreased Risk for Hyperlipidemia.

PubMed

Kim, Hye-Jin; Min, Jin-Young; Kim, Hyun-Jin; Min, Kyoung-Bok

2016-12-03

This study aimed to investigate the association between parks and green areas and hyperlipidemia in adults with groups stratified by moderate physical activity as a behavioral modification using the 2009 Korean Community Health Survey data and 212,584 participants enrolled in this study. The geographical codes of study participants were all matched on the basis of the amount of parks and green areas in each administrative district. Compared with participants living in the highest quartile of parks and green areas (Quartile 4), those living in the lowest quartile of green and park area (Quartile 1) were at an increased risk of physician-diagnosed hyperlipidemia and hyperlipidemia currently under treatment. Participants in the lowest quartile of parks and green areas were likely not to engage in any moderate physical activity. After classifying hyperlipidemia risk depending on the presence of moderate physical activity, those participating in moderate physical activity were less likely to have hyperlipidemia in all quartiles of parks and green areas than those not engaging in moderate physical activity. We found that parks and green areas were associated with decreased hyperlipidemia risk. Physical activity, which may benefit from the presence of parks and green areas, may reduce hyperlipidemia risk.

Relationship Between Circulating Concentrations of Thyrotropin, Free Thyroxine, and Free Triiodothyronine and 9-Year Mortality in Euthyroid Elderly Subjects

PubMed Central

Ceresini, Graziano; Marina, Michela; Lauretani, Fulvio; Maggio, Marcello; Bandinelli, Stefania; Ceda, Gian Paolo; Ferrucci, Luigi

2015-01-01

Objectives Thyroid dysfunction in the elderly is associated with adverse clinical outcomes, with mortality being associated with low TSH. However, it is still unknown whether variability of thyroid function test within the reference range is associated with mortality in older adults. We studied the association between plasma levels of TSH, free T3 (FT3), and free T4 (FT4), and all-cause mortality in older adults who had all three hormones within the normal range. Design Longitudinal study Setting Community-based Participants Total of 815 euthyroid participants of the InCHIANTI study, aged 65 years or older Measurements All subjects had TSH, FT3, and FT4 within the reference range at baseline. Plasma TSH, FT3 and FT4 were predictors and 9-year all-cause mortality was the outcome. Cox proportional hazards models adjusted for confounders were used to examine the relationship between quartiles of TSH, FT3, and FT4 and all-cause mortality over 9 years of follow-up. Results During the follow-up (mean persons-years 8643.74 [min-max, 35.36-16985.00]), 181 deaths occurred (22.2%). Participants with TSH in the lower quartile had higher mortality than the rest of the population. After adjusting for multiple confounders, participants with TSH in the lowest quartile (Hazard Ratio: 2.22; 95% Confidence Interval: 1.19–4.22) had significantly higher all-cause mortality than those with TSH in the highest quartile. Neither FT3 nor FT4 were associated with mortality. Conclusions In euthyroid elderly subjects, normal-low TSH represents an independent risk factor for all-cause mortality. PMID:27000328

Examining the Disability Model From the International Classification of Functioning, Disability, and Health Using a Large Data Set of Community-Dwelling Malaysian Older Adults

PubMed Central

Loke, Seng Cheong; Lim, Wee Shiong; Someya, Yoshiko; Hamid, Tengku A.; Nudin, Siti S. H.

2015-01-01

Objective: This study examines the International Classification of Functioning, Disability, and Health model (ICF) using a data set of 2,563 community-dwelling elderly with disease-independent measures of mobility, physical activity, and social networking, to represent ICF constructs. Method: The relationship between chronic disease and disability (independent and dependent variables) was examined using logistic regression. To demonstrate variability in activity performance with functional impairment, graphing was used. The relationship between functional impairment, activity performance, and social participation was examined graphically and using ANOVA. The impact of cognitive deficits was quantified through stratifying by dementia. Results: Disability is strongly related to chronic disease (Wald 25.5, p < .001), functional impairment with activity performance (F = 34.2, p < .001), and social participation (F= 43.6, p < .001). With good function, there is considerable variability in activity performance (inter-quartile range [IQR] = 2.00), but diminishes with high impairment (IQR = 0.00) especially with cognitive deficits. Discussion: Environment modification benefits those with moderate functional impairment, but not with higher grades of functional loss. PMID:26472747

A systematic review and meta-analysis of the efficacy of piracetam and piracetam-like compounds in experimental stroke.

PubMed

Wheble, Philippa C R; Sena, Emily S; Macleod, Malcolm R

2008-01-01

Piracetam was a candidate neuroprotective drug for acute stroke ineffective in clinical trial. Here we use systematic review and meta-analysis to describe the evidence supporting a protective effect of piracetam and its derivatives in animal models of stroke. We present a systematic review of reports describing the use of piracetam and its derivatives in animal models of focal ischaemia, where the outcome was measured as an infarct size or neurological score (Der Simonian and Laird random effects meta-analysis). Only 2 studies, published 10 years after the first clinical trial of piracetam had been initiated, described its efficacy in animal models of stroke. A further 4 studies described the efficacy of related compounds. Piracetam and its derivatives improved the outcome by 30.2% (95% CI = 16.1-44.4). The median study quality was 4/10 (inter-quartile range = 4-6). Piracetam and its derivatives demonstrate neuroprotective efficacy in experimental stroke, but our findings raise concerns about the amount of available data, the quality of the studies and publication bias. (c) 2007 S. Karger AG, Basel.

Elevated fasting insulin levels increase the risk of abdominal obesity in Korean men.

PubMed

Park, Sung Keun; Oh, Chang-Mo; Jung, Taegi; Choi, Young-Jun; Chung, Ju Youn; Ryoo, Jae-Hong

2017-04-01

This study was designed to investigate whether an elevated fasting insulin level predicts abdominal obesity. A cohort study was conducted with 13,707 non-obese Korean men. They were categorized into 4 groups according to the quartile of fasting insulin level, and followed up from 2005 to 2010. Incidence rates of obesity were compared among the 4 groups during follow-up, and a Cox proportional hazards model was used to calculate hazard ratios (HRs) for abdominal obesity according to fasting insulin level. The overall incidence rate of obesity was 16.2%, but the rate increased in proportion to the fasting insulin level (quartiles 1-4: 9.8%, 12.4%, 16.9%, 25.5%, P<0.001). When HR of the 1st quartile was regarded as the reference, HRs for abdominal obesity increased proportionally to baseline fasting insulin level in an unadjusted model. However, after adjustment for covariates, including baseline waist circumference (WC), only in the quartile 4 group was the statistical significance of the association maintained [quartile 2-4; abdominal obesity: 0.89 (0.76-1.02), 1.00 (0.86-1.14) and 1.24 (1.08-1.43), P for trend <0.001]. Although the risk of incident abdominal obesity was highest in the group with the highest fasting insulin levels, an overall proportional relationship between fasting insulin level and incident abdominal obesity was not found. Additionally, this association was largely accounted for by baseline WC. Copyright © 2017 Elsevier B.V. All rights reserved.

Stochastic epigenetic mutations (DNA methylation) increase exponentially in human aging and correlate with X chromosome inactivation skewing in females.

PubMed

Gentilini, Davide; Garagnani, Paolo; Pisoni, Serena; Bacalini, Maria Giulia; Calzari, Luciano; Mari, Daniela; Vitale, Giovanni; Franceschi, Claudio; Di Blasio, Anna Maria

2015-08-01

In this study we applied a new analytical strategy to investigate the relations between stochastic epigenetic mutations (SEMs) and aging. We analysed methylation levels through the Infinium HumanMethylation27 and HumanMethylation450 BeadChips in a population of 178 subjects ranging from 3 to 106 years. For each CpG probe, epimutated subjects were identified as the extreme outliers with methylation level exceeding three times interquartile ranges the first quartile (Q1-(3 x IQR)) or the third quartile (Q3+(3 x IQR)). We demonstrated that the number of SEMs was low in childhood and increased exponentially during aging. Using the HUMARA method, skewing of X chromosome inactivation (XCI) was evaluated in heterozygotes women. Multivariate analysis indicated a significant correlation between log(SEMs) and degree of XCI skewing after adjustment for age (β = 0.41; confidence interval: 0.14, 0.68; p-value = 0.0053). The PATH analysis tested the complete model containing the variables: skewing of XCI, age, log(SEMs) and overall CpG methylation. After adjusting for the number of epimutations we failed to confirm the well reported correlation between skewing of XCI and aging. This evidence might suggest that the known correlation between XCI skewing and aging could not be a direct association but mediated by the number of SEMs.

Endothelial nitric oxide synthase polymorphisms and adaptation of parasympathetic modulation to exercise training.

PubMed

Silva, Bruno M; Neves, Fabricia J; Negrão, Marcelo V; Alves, Cleber R; Dias, Rodrigo G; Alves, Guilherme B; Pereira, Alexandre C; Rondon, Maria U; Krieger, José E; Negrão, Carlos E; DA Nóbrega, Antonio Claudio Lucas

2011-09-01

There is a large interindividual variation in the parasympathetic adaptation induced by aerobic exercise training, which may be partially attributed to genetic polymorphisms. Therefore, we investigated the association among three polymorphisms in the endothelial nitric oxide gene (-786T>C, 4b4a, and 894G>T), analyzed individually and as haplotypes, and the parasympathetic adaptation induced by exercise training. Eighty healthy males, age 20-35 yr, were genotyped by polymerase chain reaction-restriction fragment length polymorphism analysis, and haplotypes were inferred using the software PHASE 2.1. Autonomic modulation (i.e., HR variability and spontaneous baroreflex sensitivity) and peak oxygen consumption (VO(2peak)) were measured before and after training (running, moderate to severe intensity, three times per week, 60 min·day(-1), during 18 wk). Training increased VO(2peak) (P < 0.05) and decreased mean arterial pressure (P < 0.05) in the whole sample. Subjects with the -786C polymorphic allele had a significant reduction in baroreflex sensitivity after training (change: wild type (-786TT) = 2% ± 89% vs polymorphic (-786TC/CC) = -28% ± 60%, median ± quartile range, P = 0.03), and parasympathetic modulation was marginally reduced in subjects with the 894T polymorphic allele (change: wild type (894GG) = 8% ± 67% vs polymorphic (894GT/TT) = -18% ± 59%, median ± quartile range, P = 0.06). Furthermore, parasympathetic modulation percent change was different between the haplotypes containing wild-type alleles (-786T/4b/894G) and polymorphic alleles at positions -786 and 894 (-786C/4b/894T) (-6% ± 56% vs -41% ± 50%, median ± quartile range, P = 0.04). The polymorphic allele at position -786 and the haplotype containing polymorphic alleles at positions -786 and 894 in the endothelial nitric oxide gene were associated with decreased parasympathetic modulation after exercise training.

An ecological quantification of the relationships between water, sanitation and infant, child, and maternal mortality

PubMed Central

2012-01-01

Background Water and sanitation access are known to be related to newborn, child, and maternal health. Our study attempts to quantify these relationships globally using country-level data: How much does improving access to water and sanitation influence infant, child, and maternal mortality? Methods Data for 193 countries were abstracted from global databases (World Bank, WHO, and UNICEF). Linear regression was used for the outcomes of under-five mortality rate and infant mortality rate (IMR). These results are presented as events per 1000 live births. Ordinal logistic regression was used to compute odds ratios for the outcome of maternal mortality ratio (MMR). Results Under-five mortality rate decreased by 1.17 (95%CI 1.08-1.26) deaths per 1000, p < 0.001, for every quartile increase in population water access after adjustments for confounders. There was a similar relationship between quartile increase of sanitation access and under-five mortality rate, with a decrease of 1.66 (95%CI 1.11-1.32) deaths per 1000, p < 0.001. Improved water access was also related to IMR, with the IMR decreasing by 1.14 (95%CI 1.05-1.23) deaths per 1000, p < 0.001, with increasing quartile of access to improved water source. The significance of this relationship was retained with quartile improvement in sanitation access, where the decrease in IMR was 1.66 (95%CI 1.11-1.32) deaths per 1000, p < 0.001. The estimated odds ratio that increased quartile of water access was significantly associated with increased quartile of MMR was 0.58 (95%CI 0.39-0.86), p = 0.008. The corresponding odds ratio for sanitation was 0.52 (95%CI 0.32-0.85), p = 0.009, both suggesting that better water and sanitation were associated with decreased MMR. Conclusions Our analyses suggest that access to water and sanitation independently contribute to child and maternal mortality outcomes. If the world is to seriously address the Millennium Development Goals of reducing child and maternal mortality, then improved water and sanitation accesses are key strategies. PMID:22280473

Consumption of a high glycemic load but not a high glycemic index diet is marginally associated with oxidative stress in young women.

PubMed

Arikawa, Andrea Y; Jakits, Holly E; Flood, Andrew; Thomas, William; Gross, Myron; Schmitz, Kathryn H; Kurzer, Mindy S

2015-01-01

Research studies have suggested that chronic consumption of high glycemic index foods may lead to chronically high oxidative stress. This is important because oxidative stress is suspected to be an early event in the etiology of many disease processes. We hypothesized that dietary glycemic index and glycemic load were positively associated with oxidative stress assessed by plasma F2-isoprostanes in healthy, premenopausal women (body mass index [BMI] = 24.7 ± 4.8 kg/m(2) and age 25.3 ± 3.5 years, mean ± SD). We measured plasma F2-isoprostanes in 306 healthy premenopausal women at the baseline visit for the Women In Steady Exercise Research study, using gas chromatography-mass spectrometry. Dietary glycemic index and load were calculated from the National Cancer Institute Diet History Questionnaire, and participants were divided into quartiles of dietary glycemic index and of glycemic load. Plasma F2-isoprostanes were compared across quartile groups of dietary glycemic index and glycemic load using linear regression models. Plasma F2-isoprostanes (pg/mL) increased with quartile of glycemic load (test for linear trend, P = .033), and also increased with quartile of glycemic index in participants with BMI ≥ 25 (P = .035) but not in those with BMI <25 (P = .924). After adjustment for BMI, alcohol consumption and total energy intake, both these positive trends remained marginally significant (P = .123 for quartiles of glycemic index and P = .065 for quartiles of glycemic load). Copyright © 2015 Elsevier Inc. All rights reserved.

Air Pollution and Subtypes, Severity and Vulnerability to Ischemic Stroke—A Population Based Case-Crossover Study

PubMed Central

Maheswaran, Ravi; Pearson, Tim; Beevers, Sean D.; Campbell, Michael J.; Wolfe, Charles D.

2016-01-01

Background and Purpose Few studies have examined the association between air pollutants and ischemic stroke subtypes. We examined acute effects of outdoor air pollutants (PM10, NO2, O3, CO, SO2) on subtypes and severity of incident ischemic stroke and investigated if pre-existing risk factors increased susceptibility. Methods We used a time stratified case-crossover study and stroke cases from the South London Stroke Register set up to capture all incident cases of first ever stroke occurring amongst residents in a geographically defined area. The Oxford clinical and TOAST etiological classifications were used to classify subtypes. A pragmatic clinical classification system was used to assess severity. Air pollution concentrations from the nearest background air pollution monitoring stations to patients’ residential postcode centroids were used. Lags from 0 to 6 days were investigated. Results There were 2590 incident cases of ischemic stroke (1995–2006). While there were associations at various lag times with several pollutants, overall, there was no consistent pattern between exposure and risk of ischemic stroke subtypes or severity. The possible exception was the association between NO2 exposure and small vessel disease stroke—adjusted odds ratio of 1.51 (1.12–2.02) associated with an inter-quartile range increase in the lag 0–6 day average for NO2. There were no clear associations in relation to pre-existing risk factors. Conclusions Overall, we found little consistent evidence of association between air pollutants and ischemic stroke subtypes and severity. There was however a suggestion that increasing NO2 exposure might be associated with higher risk of stroke caused by cerebrovascular small vessel disease. PMID:27362783

Capacity of Physiotherapy Workforce Production in Thailand: Public-Private Mix, Secular Trend and Geographic Distribution.

PubMed

Kaewsawang, Sarinee; Chongsuvivatwong, Virasakdi; Vongsirinavarat, Mantana

2016-06-01

In Thailand, the shortage of physiotherapists has been an increasing concern because of increased health burden from demographic and epidemiologic changes. This study aims to analyse the current situation of the physiotherapy workforce production system, secular trend, geographical distribution and comparison of public and private physiotherapy training institutes. Longitudinal data related to production capacity of the physiotherapy institutes were applied. Data from 2008 to 2012 were obtained from all 16 physiotherapy institutes in Thailand. Data during 2000-2007 were also retrieved from annual reports from the Ministry of Education. Descriptive statistics were initially used. Comparison was made between public and private physiotherapy institutes in terms of the number of students admitted and graduated, number of teachers, annual tuition fee, student-teacher ratio and dropout rate within 1 year. Predictive factors for graduation within 4 years were determined using logistic regression. In Thailand, there was an average of 800 physiotherapy graduates per year. New private institutes have been recently established and have steadily increased student admission rates. However, this has resulted in a high student-teacher ratio (median 7.1, inter-quartile range (IQR) 5.9-10.0). The first-year dropout rate in 2012 was 29.1%. Geographically, the majority of the institutes are clustered in the central region. Multivariate analysis revealed significantly lower probability of graduation within 4 years among students admitted to the private institutes and those in non-north-east region. The production capacity of the physiotherapy workforce is below an estimated need. Private physiotherapy institutes need more support to improve the situation of staff shortages and student graduation rates. The non-central regions should be encouraged to produce more physiotherapists. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

National Trends and Geographic Variation in Availability of Home Health Care: 2002–2015

PubMed Central

Wang, Yun; Leifheit-Limson, Erica C; Fine, Jonathan; Pandolfi, Michelle M; Gao, Yan; Liu, Fanglin; Eckenrode, Sheila; Lichtman, Judith H

2017-01-01

Objectives To evaluate national trends and geographic variation in the availability of home health care from 2002–2015 and identify county-specific characteristics associated with home health care. Design Observational study Setting All counties in the United States Participants All Medicare-certified home health agencies included in the Centers for Medicare & Medicaid Services Home Health Compare system. Measurements County-specific availability of home health care, defined as the number of available home health agencies that provided services to a given county per 100,000 population aged ≥18 years. Results The study included 15,184 Medicare-certified home health agencies that served 97% of U.S. ZIP codes. Between 2002–2003 and 2014–2015, the county-specific number of available home health agencies per 100,000 population aged ≥18 years increased from 14.7 to 21.8 and the median (inter-quartile range) population that was serviced by at least one home health agency increased from 403,605 (890,329) to 455,488 (1,039,328). Considerable geographic variation in the availability of home health care was observed. The West, North-East, and South Atlantic regions had lower home health care availability than the Central regions, and this pattern persisted over the study period. Counties with higher median income, a larger senior population, higher rates of households without a car and low access to stores, more obesity, greater inactivity, and higher proportions of non-Hispanic white, non-Hispanic black, and Hispanic populations were more likely to have higher availability of home health care. Conclusion The availability of home health care increased nationwide during the study period, but there was much geographic variation. PMID:28322441

Risk of cancer among HIV-infected individuals compared to the background population: impact of smoking and HIV.

PubMed

Helleberg, Marie; Gerstoft, Jan; Afzal, Shoaib; Kronborg, Gitte; Larsen, Carsten S; Pedersen, Court; Bojesen, Stig E; Nordestgaard, Børge G; Obel, Niels

2014-06-19

The relative impact of immune deficiency and lifestyle-related factors on risk of cancer in the HIV-infected population is controversial. We aimed to estimate the population-attributable fractions (PAFs) associated with smoking, being HIV-infected and with immune deficiency. In a Danish, nationwide, population-based cohort study (1995-2011), incidences of cancer were compared between an HIV-infected cohort and a population-based matched cohort in analyses stratified on cancer category, smoking status and for HIV patients: low CD4 cell count. We included 3503 HIV patients [baseline CD4+ 450 cells/μl (inter-quartile range 310-630)] and 12,979 population controls. Smoking-related and virological cancers accounted for 23 and 43% of cancers in the HIV-infected population. The risk of these cancers were higher among HIV patients compared to controls [incidence rate ratio (IRR) 2.8, 95% confidence interval (CI) 1.6-4.9; and IRR 11.5, 95% CI 6.5-20.5], whereas the risk of other cancers did not differ (IRR 1.0, 95% CI 0.7-1.3). Non-smoking HIV patients did not have increased risk of non-virological cancers compared to non-smoking controls (IRR 1.2, 95% CI 0.7-2.1). The PAFs of cancer associated with smoking and with being HIV-infected were 27 and 49%, respectively. For cancers not strongly related to smoking or viral infections, the PAFs associated with being HIV-infected and with immune deficiency were 0%. The risk of cancer is increased in HIV patients compared to the background population. In absence of smoking, the increase in risk is confined to cancers related to viral infections, whereas the risk of other cancers is not elevated and does not seem to be associated with immune deficiency.

Risk factors and consequences of maternal anaemia and elevated haemoglobin levels during pregnancy: a population-based prospective cohort study.

PubMed

Gaillard, Romy; Eilers, Paul H C; Yassine, Siham; Hofman, Albert; Steegers, Eric A P; Jaddoe, Vincent W V

2014-05-01

To determine sociodemographic and life style-related risk factors and trimester specific maternal, placental, and fetal consequences of maternal anaemia and elevated haemoglobin levels in pregnancy. In a population-based prospective cohort study of 7317 mothers, we measured haemoglobin levels in early pregnancy [gestational age median 14.4 weeks (inter-quartile-range 12.5-17.5)]. Anaemia (haemoglobin ≤11 g/dl) and elevated haemoglobin levels (haemoglobin ≥13.2 g/dl) were defined according to the WHO criteria. Maternal blood pressure, placental function and fetal growth were measured in each trimester. Data on gestational hypertensive disorders and birth outcomes was collected from hospitals. Older maternal age, higher body mass index, primiparity and European descent were associated with higher haemoglobin levels (P < 0.05). Elevated haemoglobin levels were associated with increased systolic and diastolic blood pressure throughout pregnancy (mean differences 5.1 mmHg, 95% confidence interval [CI] 3.8, 6.5 and 4.1 mmHg, 95% CI 3.0, 5.2, respectively) and with a higher risk of third trimester uterine artery notching (RR 1.3, 95% CI 1.0, 1.7). As compared with maternal normal haemoglobin levels, not anaemia, but elevated haemoglobin levels were associated with fetal head circumference, length, and weight growth restriction from third trimester onwards (P < 0.05). Elevated haemoglobin levels were associated with increased risks of gestational hypertensive disorders (RR 1.4, 95% CI 1.1, 1.8) and adverse birth outcomes (RR 1.4, 95% CI 1.1, 1.7). In a low-risk population, various sociodemographic and life style factors affect haemoglobin levels during pregnancy. Elevated haemoglobin levels are associated with increased risks of maternal, placental, and fetal complications. © 2014 John Wiley & Sons Ltd.

The pattern of use of non-steroidal anti-inflammatory drugs (NSAIDs) from 1997 to 2005: a nationwide study on 4.6 million people.

PubMed

Fosbøl, Emil Loldrup; Gislason, Gunnar H; Jacobsen, Søren; Abildstrom, Steen Z; Hansen, Morten Lock; Schramm, Tina Ken; Folke, Fredrik; Sørensen, Rikke; Rasmussen, Jeppe N; Køber, Lars; Madsen, Mette; Torp-Pedersen, Christian

2008-08-01

To describe the nationwide pattern of use of non-steroidal anti-inflammatory drugs (NSAIDs) in the Danish population. All Danish citizens aged 10 or above 1 January 1997 were included in the study. The national prescription registry was used to identify all claimed prescriptions for NSAIDs by the cohort until 2005. By individual-level-linkage of nationwide registries, information was acquired concerning hospitalizations, comorbidity, concomitant pharmacotherapy and socioeconomic factors. The population consisted of 4,614,807 individuals, of which 2,663,706 (57.8%) claimed at least one prescription for NSAID from 1997 to 2005. Ibuprofen and diclofenac were the most frequently used non-selective NSAIDs, whereas rofecoxib and celecoxib were the most frequently used selective cyclooxygenase-2 (COX-2) inhibitors. The usage was similar across all age groups. Female sex and increasing age was associated with increased use of NSAID. Factors predicting extensive NSAID use were: rheumatic disease (odds ratio (OR) = 1.79, 95% confidence interval (CI): 1.69-1.90), gout agents (allopurinol) (OR = 2.54, CI: 2.44-2.64) and other pain medication (OR = 3.27, CI: 3.23-3.31). NSAIDs were most often prescribed for use for one distinct treatment interval and for a short period (overall inter-quartile range [IQR]: 9-66 days). High doses were used in a relatively large proportion of the population (8.9% for etodolac to 19.5% for celecoxib) and 54,373 (2.0%) claimed prescriptions for more than one NSAID at the same time. NSAIDs were commonly used in the Danish population. Since NSAIDs have been associated with increased cardiovascular risk, further research on the overall risk associated with these drugs on a national scale is needed.

QRS Score at Presentation Electrocardiogram Is Correlated With Infarct Size and Mortality in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention.

PubMed

Shiomi, Hiroki; Kosuge, Masami; Morimoto, Takeshi; Watanabe, Hiroki; Taniguchi, Tomohiko; Nakatsuma, Kenji; Toyota, Toshiaki; Yamamoto, Erika; Shizuta, Satoshi; Tada, Tomohisa; Furukawa, Yutaka; Nakagawa, Yoshihisa; Ando, Kenji; Kadota, Kazushige; Kimura, Kazuo; Kimura, Takeshi

2017-07-25

In ST-segment elevation myocardial infarction (STEMI), QRS score at presentation ECG may reflect the progression of infarction and facilitate prediction of the degree of myocardial salvage achieved by reperfusion therapy.Methods and Results:Admission electrocardiogram (ECG) was studied in 2,607 patients with STEMI undergoing primary percutaneous coronary intervention (PCI) within 24 h of symptom onset. Patients were classified into 3 groups according to QRS score: low (0-3, n=1,227), intermediate (4-7, n=810), and high (≥8, n=570). An increase of infarct size estimated by median peak creatine phosphokinase was observed as QRS score increased (low score, 1,836 IU/L; inter-quartile range (IQR), 979-3,190 IU/L; intermediate score, 2,488 IU/L; IQR, 1,126-4,640 IU/L; high score, 3,454 IU/L; IQR, 1,759-5,639 IU/L; P<0.001). Higher QRS score was associated with higher long-term mortality (low, intermediate, and high score, 15.6%, 19.7%, and 23.7% at 5 years, respectively; log-rank P<0.001). The positive relationship of QRS score with mortality was consistently seen when stratified by infarct location. The association of high QRS score with increased mortality was most remarkably seen in patients with early (≤2 h) presentation (low, intermediate, and high score: 16.7%, 16.6%, and 28.1% at 5 years, respectively; log-rank P<0.001). Higher QRS score at presentation ECG was associated with larger infarct size, and higher long-term mortality in patients with STEMI undergoing primary PCI. QRS score appears to be important in the early risk stratification for STEMI.

National Trends and Geographic Variation in Availability of Home Health Care: 2002-2015.

PubMed

Wang, Yun; Leifheit-Limson, Erica C; Fine, Jonathan; Pandolfi, Michelle M; Gao, Yan; Liu, Fanglin; Eckenrode, Sheila; Lichtman, Judith H

2017-07-01

To evaluate national trends and geographic variation in the availability of home health care from 2002 to 2015 and identify county-specific characteristics associated with home health care. Observational study. All counties in the United States. All Medicare-certified home health agencies included in the Centers for Medicare & Medicaid Services Home Health Compare system. County-specific availability of home health care, defined as the number of available home health agencies that provided services to a given county per 100,000 population aged ≥18 years. The study included 15,184 Medicare-certified home health agencies that served 97% of U.S. ZIP codes. Between 2002-2003 and 2014-2015, the county-specific number of available home health agencies per 100,000 population aged ≥18 years increased from 14.7 to 21.8 and the median (inter-quartile range) population that was serviced by at least one home health agency increased from 403,605 (890,329) to 455,488 (1,039,328). Considerable geographic variation in the availability of home health care was observed. The West, North East, and South Atlantic regions had lower home health care availability than the Central regions, and this pattern persisted over the study period. Counties with higher median income, a larger senior population, higher rates of households without a car and low access to stores, more obesity, greater inactivity, and higher proportions of non-Hispanic white, non-Hispanic black, and Hispanic populations were more likely to have higher availability of home health care. The availability of home health care increased nationwide during the study period, but there was much geographic variation. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Insights into implementation of sacubitril/valsartan into clinical practice.

PubMed

Martens, Pieter; Beliën, Hanne; Dupont, Matthias; Mullens, Wilfried

2018-06-01

Sacubitril/valsartan significantly reduced heart failure hospitalization and mortality in PARADIGM-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With an Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure). However, real-world data from its use are lacking. We retrospectively assessed all baseline and follow-up data of consecutive heart failure patients with reduced ejection fraction receiving therapy with sacubitril/valsartan for Class I recommendation between December 2016 and July 2017. Baseline characteristics and dose titration of sacubitril/valsartan were compared between patients in clinical practice and in PARADIGM-HF. A total of 120 patients (81% male) were switched from angiotensin-converting enzyme inhibitor or angiotensin receptor blocker to sacubitril/valsartan. A total of 20.1% of patients received dose uptitration. Patients were treated with an equipotential dose of renin-angiotensin system blockers before and after uptitration of sacubitril/valsartan (57 ± 29% vs. 53 ± 29% of target dose indicated by European Society of Cardiology guidelines; P = 0.286). However, they received a lower dose of sacubitril/valsartan in comparison with those in the PARADIGM-HF (219 ± 12 vs. 375 ± 75 mg; P < 0.001). In comparison with the patients receiving sacubitril/valsartan in PARADIGM-HF, patients in clinical practice were older and had a higher serum creatinine, higher New York Heart Association functional classification, and lower left ventricular ejection fraction (all P-value <0.05). Even in comparison with patients who experienced dropout during the run-in phase of PARADIGM-HF, real-world patients exhibited baseline characteristics indicative of more disease severity. Patients were at high absolute baseline risk for adverse outcome as illustrated by the EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure) risk score of 6 (inter-quartile range 3), in comparison with 5 (inter-quartile range 4) in PARADIGM-HF. After initiation of sacubitril/valsartan, New York Heart Association class significantly improved (P < 0.001), but systolic blood pressure dropped more than was reported in PARADIGM-HF (7.1 ± 8.0 vs. 3.2 ± 0.4 mmHg; P < 0.001). Patients in clinical practice exhibit baseline characteristics associated with more severe disease, which might lead to prescription of lower doses. Nevertheless, patients in clinical practice are at high risk of adverse outcome as illustrated by the EMPHASIS-HF risk score, underscoring the large potential for sacubitril/valsartan therapy to reduce the risk of heart failure hospitalization and all-cause mortality. © 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

Reduced lung cancer mortality in dairy farmers: is endotoxin exposure the key factor?

PubMed

Mastrangelo, G; Marzia, V; Marcer, G

1996-11-01

From two areas in the Province of Padova, we selected 2,283 male farmers who worked either in cattle raising or in crop/orchard cultivation. There were 422 cohort deaths from 1970 to 1992. Using the regional population as a reference, the standardized mortality ratio (SMR) was calculated, with 95% confidence intervals (CI) based on the Poisson distribution. Cancer mortality was significantly reduced among the 1,561 dairy farmers (SMR = 0.65; CI = 0.53-0.81); there was a significant decrease in lung cancer (SMR = 0.49; CI = 0.31-0.74), whereas a significant increase from brain tumors was found (SMR = 2.83; CI = 1.04-6.17). Neither overall cancer mortality nor the lung cancer SMR deviated significantly from unity for the 722 crop/orchard farmers. Among dairy farmers, moreover, lung cancer SMRs showed a significant downward trend across the quartiles of increasing length of work, 0.96 in the first quartile, and 0.48, 0.40, and 0.25 in the second, third, and fourth quartiles, respectively. Moreover, lung cancer risk decreased with increasing farm land area, with SMRs in the quartiles of 0.89, 0.37, 0.41 and 0.19. This decrease cannot be attributed to either a selection (healthy worker effect) or a confounding (lower percentage of smokers) bias. Nor was it due to an artifact introduced by differences in age distribution among the quartiles. Dairy farmers are known to be exposed to higher airborne endotoxin concentrations; reasonably, this cumulative exposure increases further with years of work and area of farm. Endotoxins may have protected the dairy farmers against lung cancer through the tumor necrosis factor produced by alveolar macrophages.

Association of serum concentration of TNFR1 with all-cause mortality in patients with type 2 diabetes and chronic kidney disease: follow-up of the SURDIAGENE Cohort.

PubMed

Saulnier, Pierre-Jean; Gand, Elise; Ragot, Stéphanie; Ducrocq, Grégory; Halimi, Jean-Michel; Hulin-Delmotte, Charlotte; Llaty, Pierre; Montaigne, David; Rigalleau, Vincent; Roussel, Ronan; Velho, Gilberto; Sosner, Philippe; Zaoui, Philippe; Hadjadj, Samy

2014-05-01

Renal dysfunction is a key risk factor for all-cause mortality in patients with type 2 diabetes (T2D). Circulating tumor necrosis factor receptor 1 (TNFR1) was recently suggested as a strong biomarker for end-stage renal failure in T2D. However, its relevance regarding all-cause death has yet to be conclusively established. We aimed to assess the prognostic value of serum TNFR1 concentration for all-cause death in T2D and diabetic kidney disease (DKD) from the SURDIAGENE (Survie, Diabete de type 2 et Genetique) study. A total of 522 T2D patients with DKD (estimated glomerular filtration rate [eGFR] <60 and/or urinary albumin-to-creatinine ratio [uACR] >30 mg/mmol) were followed for a median duration of 48 months, and 196 deaths occurred. Incidence rate (95% CI) for death increased as quartiles of TNFR1 concentration increased (first quartile: 4.7% patient-years [3.0-6.3%]; second quartile: 7.7% [5.4-10.0%]; third quartile: 9.3% [6.7-11.9%]; fourth quartile: 15.9% [12.2-19.5%]). In multivariate analysis taking age, diabetes duration, HbA1c, uACR, and eGFR into account, compared with the first quartile, patients from the fourth quartile had an adjusted hazard ratio for death of 2.98 (95% CI 1.70-5.23). The integrated discrimination improvement index was statistically significant when adding TNFR1 concentration to the UK Prospective Diabetes Study outcome equation (P = 0.031). TNFR1 is a strong prognostic factor for all-cause mortality in T2D with renal dysfunction, and its clinical utility is suggested in addition to established risk factors for all-cause mortality.

Blood lead level association with lower body weight in NHANES 1999–2006

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

Scinicariello, Franco, E-mail: fes6@cdc.gov; Buser, Melanie C.; Mevissen, Meike

Background: Lead exposure is associated with low birth-weight. The objective of this study is to determine whether lead exposure is associated with lower body weight in children, adolescents and adults. Methods: We analyzed data from NHANES 1999–2006 for participants aged ≥ 3 using multiple logistic and multivariate linear regression. Using age- and sex-standardized BMI Z-scores, overweight and obese children (ages 3–19) were classified by BMI ≥ 85th and ≥ 95th percentiles, respectively. The adult population (age ≥ 20) was classified as overweight and obese with BMI measures of 25–29.9 and ≥ 30, respectively. Blood lead level (BLL) was categorized bymore » weighted quartiles. Results: Multivariate linear regressions revealed a lower BMI Z-score in children and adolescents when the highest lead quartile was compared to the lowest lead quartile (β (SE) = − 0.33 (0.07), p < 0.001), and a decreased BMI in adults (β (SE) = − 2.58 (0.25), p < 0.001). Multiple logistic analyses in children and adolescents found a negative association between BLL and the percentage of obese and overweight with BLL in the highest quartile compared to the lowest quartile (OR = 0.42, 95% CI: 0.30–0.59; and OR = 0.67, 95% CI: 0.52–0.88, respectively). Adults in the highest lead quartile were less likely to be obese (OR = 0.42, 95% CI: 0.35–0.50) compared to those in the lowest lead quartile. Further analyses with blood lead as restricted cubic splines, confirmed the dose-relationship between blood lead and body weight outcomes. Conclusions: BLLs are associated with lower body mass index and obesity in children, adolescents and adults. - Highlights: • NHANES analysis of BLL and body weight outcomes • Increased BLL associated with decreased body weight in children and adolescent • Increased BLL associated with decreased body weight in adults.« less

Cardio-pulmonary fitness test by ultra-short heart rate variability.

PubMed

Aslani, Arsalan; Aslani, Amir; Kheirkhah, Jalal; Sobhani, Vahid

2011-10-01

It is known that exercise induces cardio-respiratory autonomic modulation. The aim of this study was to assess the cardio-pulmonary fitness by ultra-short heart rate variability. Study population was divided into 3 groups: Group-1 (n = 40) consisted of military sports man. Group-2 (n = 40) were healthy age-matched sedentary male subjects with normal body mass index [BMI = 19 - 25 kg/m(2)). Group-3 (n = 40) were healthy age-matched obese male subjects [BMI > 29 kg/m(2)). Standard deviation of normal-to-normal QRS intervals (SDNN) was recorded over 15 minutes. Bruce protocol treadmill test was used; and, maximum oxygen consumption (VO(2)max) was calculated. WHEN THE STUDY POPULATION WAS DIVIDED INTO QUARTILES OF SDNN (FIRST QUARTILE: < 60 msec; second quartile: > 60 and < 100 msec; third quartile: > 100 and <140 msec; and fourth quartile: >140 msec), progressive increase was found in VO(2)max; and, SDNN was significantly linked with estimated VO(2)max. In conclusion, the results of this study demonstrate that exercise training improves cardio-respiratory autonomic function (and increases heart rate variability). Improvement in cardio-respiratory autonomic function seems to translate into a lower rate of long term mortality. Ultra-short heart rate variability is a simple cardio-pulmonary fitness test which just requires 15 minutes, and involves no exercise such as in the treadmill or cycle test.

Influence of proximities to food establishments on body mass index among children in China.

PubMed

Zhang, Ji; Xue, Hong; Cheng, Xi; Wang, Zhihong; Zhai, Fengying; Wang, Youfa; Wang, Huijun

2016-01-01

Over the past two decades, food environment has changed, and the obesity and overweight rates have increased dramatically in China. Previous studies have suggested an association between food environment and obesity, while most studies were based on the data from developed countries, and few were conducted in developing countries. The current study evaluated the influence of food establishments (distance to and types of grocery store, free market, restaurant, and food stall) on body mass index (BMI) in 348 children aged 6-17 years, surveyed in the 2009 and 2011 China Health and Nutrition Survey in nine provinces. Food establishments were assessed using geographic information system (GIS) data. Weight and height of children were directly measured. Our longitudinal analysis suggested boys in the 2nd quartile of the proximity to the nearest grocery store had higher BMI (by 1.6 kg/m2, 95% CI, 0.07 to 3.24) as compared to those in the 1st quartile, while girls in higher quartiles had lower BMI (-1.78 kg/m2, 95% CI: -3.38 to - 0.18, 2nd quartile; -1.62 kg/m2, 95%: -3.22 to -0.01, 3rd quartile) as compared to those in the 1st quartile. Boys and girls in the 2nd quartile of the proximity to the nearest Chinese restaurant had lower BMI (-1.69 kg/m2, 95% CI: - 3.27 to -0.12; -1.76 kg/m2, 95% CI: -3.26, -0.27, respectively) as compared to those in the 1st quartile. Food environment may affect children's BMI in China, while the association is inconsistent with previous studies. Further research is needed.

Low Calcium Intake in Midpregnancy Is Associated with Hypertension Development within 10 Years after Pregnancy: The Norwegian Mother and Child Cohort Study.

PubMed

Egeland, Grace M; Skurtveit, Svetlana; Sakshaug, Solveig; Daltveit, Anne Kjersti; Vikse, Bjørn E; Haugen, Margaretha

2017-09-01

Background: Low dietary calcium intake may be a risk factor for hypertension, but studies conflict. Objective: We evaluated the ability to predict hypertension within 10 y after delivery based on calcium intake during midpregnancy. Methods: The Norwegian Mother and Child Cohort Study of women delivering in 2004-2009 was linked to the Norwegian Prescription Database (2004-2013) to ascertain antihypertensive medication usage >90 d after delivery. Women with hypertension before pregnancy were excluded, leaving 60,027 mothers for analyses. Age and energy-adjusted cubic splines evaluated dose-response curves, and Cox proportional hazard analyses evaluated HR and 95% CIs by calcium quartiles adjusting for 7 covariates. Analyses were stratified by gestational hypertension and by sodium-to-potassium intake ratio (<0.76 compared with ≥0.76). Results: Participants had a mean ± SD age of 30.5 ± 4.6 y, a body mass index (in kg/m 2 ) of 24.0 ± 4.3 before pregnancy, and a mean follow-up duration of 7.1 ± 1.6 y. Cubic spline graphs identified a threshold effect of low calcium intake only within the range of dietary inadequacy related to increased risk. The lowest calcium quartile (≤738 mg/d; median: 588 mg/d), relative to the highest quartile (≥1254 mg/d), had an HR for hypertension of 1.34 (95% CI: 1.05, 1.70) among women who were normotensive during pregnancy, and an HR of 1.62 (95% CI: 1.14, 2.35) among women who had gestational hypertension, after adjusting for covariates. Women with gestational hypertension, who were in the lowest quartile of calcium intake, and who had a high sodium-to-potassium intake ratio had a risk of hypertension more than double that of their counterparts with a calcium intake in the highest quartile. Results were attenuated by adjusting for covariates (HR: 1.92; 95% CI: 1.09, 3.39). Conclusions: The results suggest that low dietary calcium intake may be a risk factor or risk marker for the development of hypertension, particularly for women with a history of gestational hypertension. © 2017 American Society for Nutrition.

Plasma osmolality predicts mortality in patients with heart failure with reduced ejection fraction.

PubMed

Kaya, HakkI; Yücel, Oğuzhan; Ege, Meltem Refiker; Zorlu, Ali; Yücel, Hasan; Güneş, Hakan; Ekmekçi, Ahmet; Yılmaz, Mehmet Birhan

2017-01-01

Heart failure (HF) is a fatal disease. Plasma osmolality with individual impacts of sodium, blood urea nitrogen (BUN), and glucose has not been studied prognostically in patients with HF. This study aims to investigate the impact of serum osmolality on clinical endpoints in HF patients. A total of 509 patients (383 males, 126 females) with HF with reduced ejection fraction in three HF centres were retrospectively analysed between January 2007 and December 2013. Follow-up data were completed for 496 patients. Plasma osmolality was calculated as (2 × Na) + (BUN/2.8) + (Glucose/18). Quartiles of plasma osmolality were produced, and the possible relationship between plasma osmolality and cardiovascular mortality was investigated. The mean follow-up was 25 ± 22 months. The mean age was 56.5 ± 17.3 years with a mean EF of 26 ± 8%. The mean levels of plasma osmolality were as follows in the quartiles: 1st % = 280 ± 6, 2nd % = 288 ± 1, 3rd % = 293 ± 2 (95% confidence interval [CI] 292.72-293.3), and 4th % = 301 ± 5 mOsm/kg. The EF and B-type natriuretic peptide levels were similar in the four quartiles. Univariate and multivariate analyses in the Cox proportional hazard model revealed a significantly higher rate of mortality in the patients with hypo-osmolality. The Kaplan-Meier plot showed graded mortality curves with the 1st quartile having the worst prognosis, followed by the 4th quartile and the 2nd quartile, while the 3rd quartile was shown to have the best prognosis. Our study results suggest that normal plasma osmolality is between 275 and 295 mOsm/kg. However, being close to the upper limit of normal range (292-293 mOsm/kg) seems to be the optimal plasma osmolality level in terms of cardiovascular prognosis in patients with HF.

Usefulness of the Left Ventricular Myocardial Contraction Fraction in Healthy Men and Women to Predict Cardiovascular Morbidity and Mortality

PubMed Central

Chuang, Michael L.; Gona, Philimon; Salton, Carol J.; Yeon, Susan B.; Kissinger, Kraig V.; Blease, Susan J.; Levy, Daniel; O'Donnell, Christopher J.; Manning, Warren J.

2013-01-01

We sought to determine whether depressed myocardial contraction fraction (MCF, the ratio of left ventricular (LV) stroke volume to myocardial volume) predicts cardiovascular disease (CVD) events in initially healthy adults. A subset (N=318, 60±9 yrs, 158 men) of the Framingham Heart Study Offspring cohort free of clinical CVD underwent volumetric cardiovascular magnetic resonance (CMR) imaging in 1998–1999. LV ejection fraction (EF), mass and MCF were determined. “Hard” CVD events comprised cardiovascular death, myocardial infarction, stroke or new heart failure. A Cox proportional hazards model adjusting for Framingham Coronary Risk Score (FCRS) was used to estimate hazard ratios for incident hard CVD events for sex-specific quartiles of MCF, LV mass and LVEF. The lowest quartile of LV mass and highest quartiles of MCF and EF served as referent. Kaplan-Meier survival plots and the log rank test were used to compare event-free survival. MCF was greater in women (0.58±0.13) than men (0.52±0.11), p<0.01. Nearly all (99%) participants had EF ≥ 0.55. Over up to 9-year (median 5.2) follow-up, 31 participants (10%) experienced an incident hard CVD event. Lowest-quartile MCF was 7 times more likely to develop hard CVD (hazard ratio 7.11, p=0.010) compared to the lowest quartile, and the elevated hazards persisted even after adjustment for LV mass (hazard ratio=6.09, p=0.020). The highest-quartile LV mass/height2.7 had nearly five-fold risk (hazard ratio 4.68, p=0.016). Event-free survival was shorter in lowest-quartile MCF, p = 0.0006, but not in lowest-quartile LVEF. Conclusion: In a cohort of adults initially without clinical CVD, lowest-quartile MCF conferred an increased hazard for hard CVD events after adjustment for traditional CVD risk factors and LV mass. PMID:22381161

Uric acid concentrations are associated with insulin resistance and birthweight in normotensive pregnant women.

PubMed

Laughon, S Katherine; Catov, Janet; Roberts, James M

2009-12-01

We sought to investigate whether uric acid concentrations are increased in pregnant women with insulin resistance and to correlate both with fetal growth. Uric acid, glucose, and insulin were measured in plasma at 20.4 (+/-2.0) weeks' gestation in 263 women. The association between uric acid and insulin resistance, as estimated using the homeostasis model assessment (HOMA), was analyzed and related to birthweights. In 212 (80.6%) women who remained normotensive throughout pregnancy, HOMA increased 1.23 U per 1-mg/dL increase in uric acid (95% confidence interval, 1.07-1.42; P=.003). Infants born to normotensive women in the upper quartile of uric acid and lowest HOMA quartile weighed 435.6 g less than infants of women with highest uric acid and HOMA quartiles (P<.005). Increasing uric acid concentrations were associated with insulin resistance in midpregnancy. Hyperuricemia was associated with lower birthweight in normotensive women, and this effect was attenuated by insulin resistance.

Association of early systolic blood pressure response to exercise with future cardiovascular events in patients with uncomplicated mild-to-moderate hypertension.

PubMed

Cho, Min Soo; Jang, Sun-Joo; Lee, Chang Hoon; Park, Chong-Hun

2012-09-01

The relationship between blood pressure (BP) response during exercise and future cardiovascular events remains unclear. We assessed the association between an increase in early systolic BP (SBP) during exercise tests and future cardiovascular events in patients with sustained hypertension (sHT). Between 2002 and 2005, we enrolled 300 patients newly diagnosed with mild-to-moderate sHT without complications from the Asan Ambulatory Blood Pressure Monitoring registry. All the patients successfully performed treadmill tests, achieving target heart rate according to the Naughton/Balke protocol. The patients were divided into quartiles according to their SBP at 8 min (7.4 metabolic equivalent tasks). The primary outcome was the composite of all-cause death, new-onset ischemic heart disease and stroke. The 5-year survival rates did not differ significantly among quartiles 1-4 (100% vs. 96.6% vs. 94.4% vs. 98.3%, P=0.211). Relative to quartile 1, the 5-year event-free survival rates were significantly lower in patients in quartiles 3 (86.9% vs. 98.3%, P=0.023) and 4 (88.2% vs. 98.3%, P=0.023). After multivariable adjustment for covariates, the risk for the composite end point was higher for patients in quartiles 3 (Hazard ratio (HR) 4.69, 95% confidence interval (CI) 1.28-17.13, P=0.020) and 4 (HR 3.65, 95% CI 0.92-14.50, P=0.065) than in quartiles 1 and 2. Cardiovascular risk was significantly higher in patients with stage 4 SBP (>180 mm Hg) even after adjustment (HR 4.00, 95% CI 1.19-13.44, P=0.025). Increased submaximal SBP response to exercise may be a predictor of future cardiovascular events in patients with mild-to-moderate sHT.

Smoking in Movies and Increased Smoking Among Young Adults

PubMed Central

Song, Anna V.; Ling, Pamela M.; Neilands, Torsten B.; Glantz, Stanton A.

2010-01-01

Objective This study assessed whether smoking in the movies was associated with smoking in young adults. Methods A national web-enabled cross-sectional survey of 1528 young adults, aged 18–25, was performed between September and November 2005. Logistic regression and path analysis using probit regression were used to assess relationships between exposure to smoking in the movies and smoking behavior. Analysis was completed in December 2006. Results Exposure to smoking in the movies predicted current smoking. The adjusted odds of current smoking increased by a factor of 1.21 for each quartile increase in exposure to smoking (p<0.01) in the movies, reaching 1.77 for the top exposure quartile. The unadjusted odds of established smoking (100+ cigarettes with current smoking) increased by 1.23 per quartile (p<0.001) of exposure, reaching 1.86 for the top quartile. This effect on established smoking was mediated by two factors related to smoking in the movies: positive expectations about smoking and exposure to friends and relatives who smoked, with positive expectations accounting for about two thirds of the effect. Conclusions The association between smoking in the movies and young adult smoking behavior exhibited a dose–response relationship; the more a young adult was exposed to smoking in the movies, the more likely he or she would have smoked in the past 30 days or have become an established smoker. PMID:17950405

Smoking in movies and increased smoking among young adults.

PubMed

Song, Anna V; Ling, Pamela M; Neilands, Torsten B; Glantz, Stanton A

2007-11-01

This study assessed whether smoking in the movies was associated with smoking in young adults. A national web-enabled cross-sectional survey of 1528 young adults, aged 18-25, was performed between September and November 2005. Logistic regression and path analysis using probit regression were used to assess relationships between exposure to smoking in the movies and smoking behavior. Analysis was completed in December 2006. Exposure to smoking in the movies predicted current smoking. The adjusted odds of current smoking increased by a factor of 1.21 for each quartile increase in exposure to smoking (p<0.01) in the movies, reaching 1.77 for the top exposure quartile. The unadjusted odds of established smoking (100+ cigarettes with current smoking) increased by 1.23 per quartile (p<0.001) of exposure, reaching 1.86 for the top quartile. This effect on established smoking was mediated by two factors related to smoking in the movies: positive expectations about smoking and exposure to friends and relatives who smoked, with positive expectations accounting for about two thirds of the effect. The association between smoking in the movies and young adult smoking behavior exhibited a dose-response relationship; the more a young adult was exposed to smoking in the movies, the more likely he or she would have smoked in the past 30 days or have become an established smoker.

The initial safe range of motion of the ankle joint after three methods of internal fixation of simulated fractures of the medial malleolus.

PubMed

Shimamura, Yoshio; Kaneko, Kazuo; Kume, Kazuhiko; Maeda, Mutsuhiro; Iwase, Hideaki

2006-07-01

Previous studies have demonstrated the safe passive range of ankle motion for inter-bone stiffness after internal fixation under load but there is a lack of information about the safe range of ankle motion for early rehabilitation in the absence of loading. The present study was designed to assess the effect of ankle movement on inter-bone displacement characteristics of medial malleolus fractures following three types of internal fixation to determine the safe range of motion. Five lower legs obtained during autopsy were used to assess three types of internal fixation (two with Kirschner-wires alone; two with Kirschner-wires plus tension band wiring; and, one with an AO/ASIF malleolar screw alone). Following a simulated fracture by sawing through the medial malleolus the displacement between the fractured bone ends was measured during a passive range of movement with continuous monitoring using omega (Omega) shaped transducers and a biaxial flexible goniometer. Statistical analysis was performed with repeated measures analysis of variance. Inter-bone displacement was not proportional to the magnitude of movement throughout the range of ankle motion as, when separation exceeded 25 microm, there was increasingly wide separation as plantar-flexion or dorsal-flexion was increased. There was no statistical significant difference between the small amount of inter-bone displacement observed with three types of fixation within the safe range of dorsal-flexion and plantar-flexion for early rehabilitation. However the inter-bone separation when fixation utilized two Kirschner-wires alone tended to be greater than when using the other two types of fixation during dorsal-flexion and eversion. The present study revealed a reproducible range of ankle motion for early rehabilitation which was estimated to be within the range of 20 degrees of dorsal-flexion and 10 degrees of plantar-flexion without eversion. Also, internal fixation with two Kirschner-wires alone does not seem to provide stability achieved by the other two forms of fixation.

THE RESULTS OF PARATHYROID HORMONE ASSAY IN PARATHYROID ASPIRATES IN PRE-OPERATIVE LOCALIZATION OF PARATHYROID ADENOMAS FOR FOCUSED PARATHYROIDECTOMY IN PATIENTS WITH NEGATIVE OR SUSPICIOUS TECHNETIUM-99M-SESTAMIBI SCANS.

PubMed

Ozderya, Aysenur; Temizkan, Sule; Cetin, Kenan; Ozugur, Sule; Gul, Aylin Ege; Aydin, Kadriye

2017-09-01

This study aimed to evaluate the results of parathyroid hormone (PTH) assay in parathyroid aspirates to determine uniglandular disease by an endocrinologist-performed ultrasound (US) in patients with discordant or negative technetium-sestamibi scans and to evaluate whether this procedure increases the number of focused parathyroidectomies (FPs). We analyzed the data of 65 patients who underwent an endocrinologist-performed US-guided parathyroid fine-needle aspiration (FNA) with PTH wash-out, retrospectively. The results of PTH wash-out procedure and the reports of parathyroid surgery and pathology were reviewed. Of 65 patients, 54 had positive PTH wash-out results. The median serum PTH level of patients with positive and negative PTH wash-out results was 143 (25 and 75% interquartile range [IQR], 114 to 197) versus 154 (IQR, 115 to 255) pg/mL (P = .45), and the median PTH in FNA was 3,533 (IQR, 1,481 to 3,534) versus 6.0 (IQR, 1 to 6) pg/mL (P<.001), respectively. Forty-five patients underwent surgery. Of the operated patients, 42 had positive PTH wash-out results and had successful FP. Four patients with redo surgery had positive PTH wash-out results and were successfully re-operated with FP. Of 11 patients with negative PTH wash-out results, 3 had bilateral neck exploration (BNE) surgery and 2 patients were successfully operated, while surgery was unsuccessful in 1 patient, despite BNE. Our study results suggest that endocrinologist-performed US and parathyroid FNA with PTH wash-out increases the number and success of FPs. In particular, patients with redo surgery may benefit from this procedure. 4D-CT = four-dimensional computed tomography BNE = bilateral neck exploration FNA = fine-needle aspiration FNAB = fine-needle aspiration biopsy FP = focused parathyroidectomy IQR = 25 and 75% inter-quartile range PHPT = primary hyperparathyroidism PPV = positive predictive value PTH = parathyroid hormone 99m Tc = technetium US = ultrasound.

Deleterious effects of increased body weight associated with intensive insulin therapy for type 1 diabetes: increased blood pressure and worsened lipid profile partially negate improvements in life expectancy.

PubMed

Palmer, Andrew J; Roze, Stéphane; Valentine, William J; Minshall, Michael E; Lammert, Morten; Nicklasson, Lars; Spinas, Giatgen A

2004-08-01

Weight gain is an unwanted side effect of improved glycaemic control in type 1 diabetes, associated with increased blood pressure (BP) and worsening lipid profiles. While improved glycaemic control per se should improve long-term patient outcomes, increases in BP and worsening lipid profiles may counteract these benefits. The aim of this modelling study was to assess whether the increased body weight and associated worsening of lipid profile and blood pressure would negate the improvements in glycaemic control seen with intensive therapy in patients with type 1 diabetes. A validated diabetes model projected life expectancy (LE), quality-adjusted LE (QALE) and total lifetime costs of complications in type 1 diabetes cohorts with the characteristics of patients from the Diabetes Control and Complications Trial (DCCT). The following four cohorts (A-D) were created based on increased body weight under either conventional or intensive therapy: A) conventional glycaemic control in the subgroup with lowest weight-gain quartile after 6.5 years (HbA1c increased by 11% from baseline); B) conventional control in the highest weight-gain quartile (no change in HbA1c from baseline); C) intensive control in the lowest quartile of weight gain (with 16.1% decrease in HbA1c, but no increase in weight or associated BP, and improved lipid profile); D) intensive control in the highest quartile of weight gain (with 21% decrease in HbA1c, increased systolic BP of 6 mmHg, and worsened lipid profile). Data were derived from DCCT and other published sources. Intensive control, even with weight gain, led to major improvements in LE and QALE, and reduction in costs of complications versus conventional therapy. Intensive therapy with no weight increase led to a higher LE (increased by 0.57 years) and higher QALE (increased by 0.28 years) and lower costs of complications (reduced by 523 dollars/patient), compared to intensive therapy with the highest quartile of weight gain. Concerns about weight gain should not deter intensive insulin therapy. However, the value of improving glycaemic control without increasing body weight (and associated increased BP and worsening of lipid profile) has been confirmed.

Exploring the Link between Serum Phosphate Levels and Low Muscle Strength, Dynapenia, and Sarcopenia.

PubMed

Chen, Yuan-Yuei; Kao, Tung-Wei; Chou, Cheng-Wai; Wu, Chen-Jung; Yang, Hui-Fang; Lai, Ching-Huang; Wu, Li-Wei; Chen, Wei-Liang

2018-02-23

Emerging evidences addressed an association between phosphate and muscle function. Because little attention was focused on this issue, the objective of our study was to explore the relationship of phosphate with muscle strength, dynapenia, and sarcopenia. From the National Health and Nutrition Examination Survey, a total of 7421 participants aged 20 years or older were included in our study with comprehensive examinations included anthropometric parameters, strength of the quadriceps muscle, and appendicular lean masses. Within the normal range of serum phosphate, we used quartile-based analyses to determine the potential relationships of serum phosphate with dynapenia, and sarcopenia through multivariate regression models. After adjusting for the pertinent variables, an inverse association between the serum phosphate quartiles and muscle strength was observed and the linear association was stronger than other anthropometric parameters. Notably, the significant association between phosphate and muscle strength was existed in >65 years old age group, not in 20-65 years old. The higher quartiles of phosphate had higher likelihood for predicting the presence of dynapenia rather than sarcopenia in entire population. Our study highlighted that higher quartiles of phosphate had significant association with lower muscle strength and higher risks for predicting the presence of dynapenia.

The Interplay of Socioeconomic Status, Distance to Center, and Interdonor Service Area Travel on Kidney Transplant Access and Outcomes

PubMed Central

Axelrod, David A.; Dzebisashvili, Nino; Schnitzler, Mark A.; Salvalaggio, Paolo R.; Segev, Dorry L.; Gentry, Sommer E.; Tuttle-Newhall, Janet

2010-01-01

Background and objectives: Variation in kidney transplant access across the United States may motivate relocation of patients with ability to travel to better-supplied areas. Design, setting, participants, & measurements: We examined national transplant registry and U.S. Census data for kidney transplant candidates listed in 1999 to 2009 with a reported residential zip code (n = 203,267). Cox's regression was used to assess associations of socioeconomic status (SES), distance from residence to transplant center, and relocation to a different donation service area (DSA) with transplant access and outcomes. Results: Patients in the highest SES quartile had increased access to transplant compared with those with lowest SES, driven strongly by 76% higher likelihood of living donor transplantation (adjusted hazard ratio [aHR] 1.76, 95% confidence interval [CI] 1.70 to 1.83). Waitlist death was reduced in high compared with low SES candidates (aHR 0.86, 95% CI 0.84 to 0.89). High SES patients also experienced lower mortality after living and deceased donor transplant. Patients living farther from the transplant center had reduced access to deceased donor transplant and increased risk of post-transplant death. Inter-DSA travel was associated with a dramatic increase in deceased donor transplant access (HR 1.94, 95% CI 1.88 to 2.00) and was predicted by high SES, white race, and longer deceased-donor allograft waiting time in initial DSA. Conclusions: Ongoing disparities exist in kidney transplantation access and outcomes on the basis of geography and SES despite near-universal insurance coverage under Medicare. Inter-DSA travel improves access and is more common among high SES candidates. PMID:20798250

Prenatal Lead Exposure and Fetal Growth: Smaller Infants Have Heightened Susceptibility

PubMed Central

Rodosthenous, Rodosthenis S.; Burris, Heather H.; Svensson, Katherine; Amarasiriwardena, Chitra J.; Cantoral, Alejandra; Schnaas, Lourdes; Mercado-García, Adriana; Coull, Brent A.; Wright, Robert O.; Téllez-Rojo, Martha M.; Baccarelli, Andrea A.

2016-01-01

Background As population lead levels decrease, the toxic effects of lead may be distributed to more sensitive populations, such as infants with poor fetal growth. Objectives To determine the association of prenatal lead exposure and fetal growth; and to evaluate whether infants with poor fetal growth are more susceptible to lead toxicity than those with normal fetal growth. Methods We examined the association of second trimester maternal blood lead levels (BLL) with birthweight-for-gestational age (BWGA) z-score in 944 mother-infant participants of the PROGRESS cohort. We determined the association between maternal BLL and BWGA z-score by using both linear and quantile regression. We estimated odds ratios for small-for-gestational age (SGA) infants between maternal BLL quartiles using logistic regression. Maternal age, body mass index, socioeconomic status, parity, household smoking exposure, hemoglobin levels, and infant sex were included as confounders. Results While linear regression showed a negative association between maternal BLL and BWGA z-score (β=−0.06 z-score units per log2 BLL increase; 95% CI: −0.13, 0.003; P=0.06), quantile regression revealed larger magnitudes of this association in the <30th percentiles of BWGA z-score (β range [−0.08, −0.13] z-score units per log2 BLL increase; all P values <0.05). Mothers in the highest BLL quartile had an odds ratio of 1.62 (95% CI: 0.99–2.65) for having a SGA infant compared to the lowest BLL quartile. Conclusions While both linear and quantile regression showed a negative association between prenatal lead exposure and birthweight, quantile regression revealed that smaller infants may represent a more susceptible subpopulation. PMID:27923585

Relative Intake of Macronutrients Impacts Risk of Mild Cognitive Impairment or dementia

PubMed Central

Roberts, Rosebud O.; Roberts, Lewis A.; Geda, Yonas E.; Cha, Ruth H.; Pankratz, V. Shane; O’Connor, Helen M.; Knopman, David S.; Petersen, Ronald C.

2012-01-01

High caloric intake has been associated with an increased risk of cognitive impairment. Total caloric intake is determined by the calories derived from macronutrients. The objective of the study was to investigate the association between percent of daily energy (calories) from macronutrients and incident mild cognitive impairment (MCI) or dementia. Participants were a population-based prospective cohort of elderly persons who were followed over a median 3.7 years (interquartile range, 2.5–3.9) of follow-up. At baseline and every 15 months, participants (median age, 79.5 years) were evaluated using the Clinical Dementia Rating scale, a neurological evaluation, and neuropsychological testing for a diagnosis of MCI, normal cognition, or dementia. Participants also completed a 128-item food-frequency questionnaire at baseline; total daily caloric and macronutrient intakes were calculated using an established database. The percent of total daily energy from protein (% protein), carbohydrate (% carbohydrate), and total fat (% fat) was computed. Among 937 subjects who were cognitively normal at baseline, 200 developed incident MCI or dementia. The risk of MCI or dementia (hazard ratio [HR], [95% confidence interval]) was elevated in subjects with high % carbohydrate (upper quartile: 1.89 [1.17–3.06]; P for trend=0.004), but was reduced in subjects with high % fat (upper quartile: 0.56 [0.34–0.91]; P for trend=0.03), and high % protein (upper quartile 0.79 [0.52 – 1.20]; P for trend=0.03) in the fully adjusted models. A dietary pattern with relatively high caloric intake from carbohydrates and low caloric intake from fat and proteins may increase the risk of MCI or dementia in elderly persons. PMID:22810099

Prenatal lead exposure and fetal growth: Smaller infants have heightened susceptibility.

PubMed

Rodosthenous, Rodosthenis S; Burris, Heather H; Svensson, Katherine; Amarasiriwardena, Chitra J; Cantoral, Alejandra; Schnaas, Lourdes; Mercado-García, Adriana; Coull, Brent A; Wright, Robert O; Téllez-Rojo, Martha M; Baccarelli, Andrea A

2017-02-01

As population lead levels decrease, the toxic effects of lead may be distributed to more sensitive populations, such as infants with poor fetal growth. To determine the association of prenatal lead exposure and fetal growth; and to evaluate whether infants with poor fetal growth are more susceptible to lead toxicity than those with normal fetal growth. We examined the association of second trimester maternal blood lead levels (BLL) with birthweight-for-gestational age (BWGA) z-score in 944 mother-infant participants of the PROGRESS cohort. We determined the association between maternal BLL and BWGA z-score by using both linear and quantile regression. We estimated odds ratios for small-for-gestational age (SGA) infants between maternal BLL quartiles using logistic regression. Maternal age, body mass index, socioeconomic status, parity, household smoking exposure, hemoglobin levels, and infant sex were included as confounders. While linear regression showed a negative association between maternal BLL and BWGA z-score (β=-0.06 z-score units per log 2 BLL increase; 95% CI: -0.13, 0.003; P=0.06), quantile regression revealed larger magnitudes of this association in the <30th percentiles of BWGA z-score (β range [-0.08, -0.13] z-score units per log 2 BLL increase; all P values<0.05). Mothers in the highest BLL quartile had an odds ratio of 1.62 (95% CI: 0.99-2.65) for having a SGA infant compared to the lowest BLL quartile. While both linear and quantile regression showed a negative association between prenatal lead exposure and birthweight, quantile regression revealed that smaller infants may represent a more susceptible subpopulation. Copyright © 2016 Elsevier Ltd. All rights reserved.

Socioeconomic status and transient ischaemic attack/stroke: a prospective observational study.

PubMed

Kerr, Gillian D; Higgins, Peter; Walters, Matthew; Ghosh, Sandip K; Wright, Fiona; Langhorne, Peter; Stott, David J

2011-01-01

Lower socioeconomic status (SES) is associated with an increased risk of stroke but the mechanisms are unclear. We aimed to determine whether low-SES stroke/transient ischaemic attack (TIA) patients have a greater burden of vascular risk factors/co-morbidity and reduced health care access. We prospectively studied 467 consecutive stroke and TIA patients from 3 Scottish hospitals (outpatients and inpatients) during 2007/2008. We recorded vascular risk factors, stroke severity, co-morbidity measures, investigations and health service utilisation. SES was derived from postcodes using Scottish Neighbourhood Statistics and analysed in quartiles. TIA/stroke patients in the lowest SES quartile were younger (64 years, SD 14.1) than those in the highest quartile (72 years, SD 12.9; p < 0.0001). They were more likely to be current smokers (42 vs. 22%; p = 0.001) but there was no association with other vascular risk factors/co-morbidity. There was a trend for those with lower SES to have a more severe stroke [modified National Institutes of Health Stroke Scale score and interquartile range: 4 (2-6) vs. 3 (1-5); multivariate p = 0.05]. Lower SES groups were less likely to have neuro-imaging (82 vs. 90%; p = 0.036) or an electrocardiogram (72 vs. 87%; p = 0.003), but differences were no longer significant on multivariate analysis. However, there was equal access to stroke unit care. Low-SES TIA and stroke patients are younger and have a more severe deficit; an increased prevalence of smoking is likely to be a major contributor. We found equal access to stroke unit care for low-SES patients. Copyright © 2010 S. Karger AG, Basel.

The 2015 Dietary Guidelines for Americans is associated with a more nutrient-dense diet and a lower risk of obesity.

PubMed

Jessri, Mahsa; Lou, Wendy Y; L'Abbé, Mary R

2016-11-01

Dietary pattern analysis represents a departure from the traditional focus on single foods and nutrients and provides a comprehensive understanding of the role of the diet in chronic disease prevention and etiology. Dietary patterns of Canadians have not been evaluated comprehensively with the use of an updated a priori dietary quality index. We aimed to update the Dietary Guidelines for Americans Adherence Index (DGAI) on the basis of the 2015 Dietary Guidelines for Americans (DGA), to evaluate the construct validity and reliability of the revised index, and to examine whether closer adherence to this index is associated with a lower risk of obesity with or without an accompanying chronic disease. Data from 11,748 participants (≥18 y of age) in the cross-sectional Canadian Community Health Survey cycle 2.2 were used in weighted multivariate analyses. Multinomial logistic regression was used to test the association between diet quality and obesity risk. With the use of principal component analyses, the multidimensionality of the 2015 DGAI was confirmed, and its reliability was shown with a high Cronbach's α = 0.75. Moving from the first to the fourth (healthiest) quartile of the 2015 DGAI score, there was a trend toward decreased energy (2492 ± 26 compared with 2403 ± 22 kcal, respectively; ±SE) and nutrients of concern (e.g., sodium), whereas intakes of beneficial nutrients increased (P-trend < 0.05). In the age- and sex-adjusted model, a lack of adherence to the 2015 DGA recommendations increased the OR of being unhealthy obese from 1.42 (95% CI: 1.02, 1.99) in quartile 3 to 2.08 (95% CI: 1.49, 2.90) in quartile 2 to 2.31 (95% CI: 1.65, 3.23) in the first quartile of the 2015 DGAI score, compared with the fourth quartile (healthiest) (P-trend < 0.0001). The odds of being obese without a chronic disease (healthy obese) and having a chronic disease without being obese also increased in the lowest DGAI quartile compared with the highest DGAI quartile, albeit not as much as in the unhealthy obese group. The 2015 DGAI provides a valid and reliable measure of diet quality among Canadians. © 2016 American Society for Nutrition.

Evaluating the validity of multiple imputation for missing physiological data in the national trauma data bank.

PubMed

Moore, Lynne; Hanley, James A; Lavoie, André; Turgeon, Alexis

2009-05-01

The National Trauma Data Bank (NTDB) is plagued by the problem of missing physiological data. The Glasgow Coma Scale score, Respiratory Rate and Systolic Blood Pressure are an essential part of risk adjustment strategies for trauma system evaluation and clinical research. Missing data on these variables may compromise the feasibility and the validity of trauma group comparisons. To evaluate the validity of Multiple Imputation (MI) for completing missing physiological data in the National Trauma Data Bank (NTDB), by assessing the impact of MI on 1) frequency distributions, 2) associations with mortality, and 3) risk adjustment. Analyses were based on 170,956 NTDB observations with complete physiological data (observed data set). Missing physiological data were artificially imposed on this data set and then imputed using MI (MI data set). To assess the impact of MI on risk adjustment, 100 pairs of hospitals were randomly selected with replacement and compared using adjusted Odds Ratios (OR) of mortality. OR generated by the observed data set were then compared to those generated by the MI data set. Frequency distributions and associations with mortality were preserved following MI. The median absolute difference between adjusted OR of mortality generated by the observed data set and by the MI data set was 3.6% (inter-quartile range: 2.4%-6.1%). This study suggests that, provided it is implemented with care, MI of missing physiological data in the NTDB leads to valid frequency distributions, preserves associations with mortality, and does not compromise risk adjustment in inter-hospital comparisons of mortality.

Providing feedback following Leadership WalkRounds is associated with better patient safety culture, higher employee engagement and lower burnout

PubMed Central

Sexton, J Bryan; Adair, Kathryn C; Leonard, Michael W; Frankel, Terri Christensen; Proulx, Joshua; Watson, Sam R; Magnus, Brooke; Bogan, Brittany; Jamal, Maleek; Schwendimann, Rene; Frankel, Allan S

2018-01-01

Background There is a poorly understood relationship between Leadership WalkRounds (WR) and domains such as safety culture, employee engagement, burnout and work-life balance. Methods This cross-sectional survey study evaluated associations between receiving feedback about actions taken as a result of WR and healthcare worker assessments of patient safety culture, employee engagement, burnout and work-life balance, across 829 work settings. Results 16 797 of 23 853 administered surveys were returned (70.4%). 5497 (32.7% of total) reported that they had participated in WR, and 4074 (24.3%) reported that they participated in WR with feedback. Work settings reporting more WR with feedback had substantially higher safety culture domain scores (first vs fourth quartile Cohen’s d range: 0.34–0.84; % increase range: 15–27) and significantly higher engagement scores for four of its six domains (first vs fourth quartile Cohen’s d range: 0.02–0.76; % increase range: 0.48–0.70). Conclusion This WR study of patient safety and organisational outcomes tested relationships with a comprehensive set of safety culture and engagement metrics in the largest sample of hospitals and respondents to date. Beyond measuring simply whether WRs occur, we examine WR with feedback, as WR being done well. We suggest that when WRs are conducted, acted on, and the results are fed back to those involved, the work setting is a better place to deliver and receive care as assessed across a broad range of metrics, including teamwork, safety, leadership, growth opportunities, participation in decision-making and the emotional exhaustion component of burnout. Whether WR with feedback is a manifestation of better norms, or a cause of these norms, is unknown, but the link is demonstrably potent. PMID:28993441

Providing feedback following Leadership WalkRounds is associated with better patient safety culture, higher employee engagement and lower burnout.

PubMed

Sexton, J Bryan; Adair, Kathryn C; Leonard, Michael W; Frankel, Terri Christensen; Proulx, Joshua; Watson, Sam R; Magnus, Brooke; Bogan, Brittany; Jamal, Maleek; Schwendimann, Rene; Frankel, Allan S

2018-04-01

There is a poorly understood relationship between Leadership WalkRounds (WR) and domains such as safety culture, employee engagement, burnout and work-life balance. This cross-sectional survey study evaluated associations between receiving feedback about actions taken as a result of WR and healthcare worker assessments of patient safety culture, employee engagement, burnout and work-life balance, across 829 work settings. 16 797 of 23 853 administered surveys were returned (70.4%). 5497 (32.7% of total) reported that they had participated in WR, and 4074 (24.3%) reported that they participated in WR with feedback. Work settings reporting more WR with feedback had substantially higher safety culture domain scores (first vs fourth quartile Cohen's d range: 0.34-0.84; % increase range: 15-27) and significantly higher engagement scores for four of its six domains (first vs fourth quartile Cohen's d range: 0.02-0.76; % increase range: 0.48-0.70). This WR study of patient safety and organisational outcomes tested relationships with a comprehensive set of safety culture and engagement metrics in the largest sample of hospitals and respondents to date. Beyond measuring simply whether WRs occur, we examine WR with feedback, as WR being done well . We suggest that when WRs are conducted, acted on, and the results are fed back to those involved, the work setting is a better place to deliver and receive care as assessed across a broad range of metrics, including teamwork, safety, leadership, growth opportunities, participation in decision-making and the emotional exhaustion component of burnout. Whether WR with feedback is a manifestation of better norms, or a cause of these norms, is unknown, but the link is demonstrably potent. © 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.

Association of triiodothyronine levels with future development of metabolic syndrome in euthyroid middle-aged subjects: a 6-year retrospective longitudinal study.

PubMed

Kim, Hye Jeong; Bae, Ji Cheol; Park, Hyeong Kyu; Byun, Dong Won; Suh, Kyoil; Yoo, Myung Hi; Jae Hwan, Jee; Kim, Jae Hyeon; Min, Yong-Ki; Kim, Sun Wook; Chung, Jae Hoon

2017-04-01

Several cross-sectional studies have reported that thyroid hormone levels are associated with cardiovascular risk markers and metabolic syndrome (MetS) even in euthyroid subjects. However, the prognostic role of serum thyroid hormone levels in the risk of incident MetS has not been elucidated. We aimed to investigate the associations of baseline serum thyroid hormone levels with the development of MetS in healthy subjects. This 6-year, cross-sectional, longitudinal and follow-up study was conducted in 12 037 euthyroid middle-aged subjects without MetS subjected to comprehensive health examinations. Subjects were grouped according to total triiodothyronine (T3) quartiles. The hazard ratio (HR) for the development of MetS according to T3 quartiles was estimated using Cox proportional hazards model. During the 6-year period, 3544 incident cases of MetS (29%) were identified. The proportion of subjects with incident MetS increased across the T3 quartiles ( P for trend <0.001). The HR and 95% confidence interval (CI) for the development of MetS were significantly higher in the highest T3 quartile compared with the lowest T3 quartile even after adjusting for confounding variables including gender, age and smoking (HR: 1.238, 95% CI: 1.128-1.358, P  < 0.001). In euthyroid middle-aged subjects, serum T3 levels are associated with increased risk for future development of MetS. © 2017 European Society of Endocrinology.

Intake of red meat and heterocyclic amines, metabolic pathway genes and bladder cancer risk

PubMed Central

Lin, Jie; Forman, Michele R.; Wang, Jianming; Grossman, H. Barton; Chen, Meng; Dinney, Colin P.; Hawk, Ernest T.; Wu, Xifeng

2012-01-01

We analyzed the association between meat intake, heterocyclic amines (HCAs) and bladder cancer (BC) risk in a large case-control study comprised of 884 BC cases and 878 healthy controls, recruited from 1999 to 2009. Epidemiologic and dietary data were collected via an in-person interview. Compared to the lowest quartile of red meat intake, the odds ratios (ORs) for the second, third and fourth quartiles were 1.17 (95% CI: 0.87–1.58), 1.47 (95% CI: 1.09–1.99) and 1.95 (95% CI: 1.41–2.68), respectively, (p-for trend <0.001). In a subset of participants with intakes of HCAs available, compared with those with the lowest quartile of intake, the ORs for the second, third and fourth quartiles were 1.47 (95% CI: 0.60–3.64), 2.58 (95% CI: 1.09–6.11) and 3.32 (95% CI: 1.37–8.01), respectively, (p for trend <0.001). In cumulative analysis of SNPs in the pathway, compared with subjects carrying 0–4 unfavorable genotypes, subjects carrying 5 and 6 or more unfavorable genotypes were at 1.60-fold (95% CI: 1.20–2.12) and 2.37-fold (95% CI: 1.82–3.10) increased risk, respectively. Moreover, subjects carrying six or more unfavorable genotypes and whose red meat intake was in the highest quartile were at 5.09-fold increased risk (95% CI: 2.89–8.96; p < 0.001). These results strongly support that high red meat intake, high intake of HCAs and carrying high number of unfavorable genotypes in the HCA metabolic pathways are associated with increased risk of BC in the study population. PMID:22261697

Non-microbial sources of microbial volatile organic compounds.

PubMed

Choi, Hyunok; Schmidbauer, Norbert; Bornehag, Carl-Gustaf

2016-07-01

The question regarding the true sources of the purported microbial volatile organic compounds (MVOCs) remains unanswered. To identify microbial, as well as non-microbial sources of 28 compounds, which are commonly accepted as microbial VOCs (i.e. primary outcome of interest is Σ 28 VOCs). In a cross-sectional investigation of 390 homes, six building inspectors assessed water/mold damage, took air and dust samples, and measured environmental conditions (i.e., absolute humidity (AH, g/m(3)), temperature (°C), ventilation rate (ACH)). The air sample was analyzed for volatile organic compounds (μg/m(3)) and; dust samples were analyzed for total viable fungal concentration (CFU/g) and six phthalates (mg/g dust). Four benchmark variables of the underlying sources were defined as highest quartile categories of: 1) the total concentration of 17 propylene glycol and propylene glycol ethers (Σ17 PGEs) in the air sample; 2) 2,2,4-trimethyl-1,3-pentanediol monoisobutyrate (TMPD-MIB) in the air sample; 3) semi-quantitative mold index; and 4) total fungal load (CFU/g). Within severely damp homes, co-occurrence of the highest quartile concentration of either Σ17 PGEs or TMPD-MIB were respectively associated with a significantly higher median concentration of Σ 28 VOCs (8.05 and 13.38μg/m(3), respectively) compared to the reference homes (4.30 and 4.86μg/m(3), respectively, both Ps ≤0.002). Furthermore, the homes within the highest quartile range for Σ fungal load as well as AH were associated with a significantly increased median Σ 28 VOCs compared to the reference group (8.74 vs. 4.32μg/m(3), P=0.001). Within the final model of multiple indoor sources on Σ 28 VOCs, one natural log-unit increase in summed concentration of Σ17 PGEs, plus TMPD-MIB (Σ 17 PGEs + TMPD-MIB) was associated with 1.8-times (95% CI, 1.3-2.5), greater likelihood of having a highest quartile of Σ 28 VOCs, after adjusting for absolute humidity, history of repainting at least one room, ventilation rate, and mold index (P-value =0.001). Homes deemed severely mold damaged (i.e., mold index =1) were associated with 1.7-times (95% CI, 0.8-3.6), greater likelihood of having a highest quartile of Σ 28 VOCs, even though such likelihood was not significant (P-value =0.164). In addition, absolute humidity appeared to positively interact with mold index to significantly elevate the prevalence of the highest quartile category of Σ 28 VOCs. The indoor concentration of Σ 28 VOCs, which are widely accepted as MVOCs, are significantly associated with the markers of synthetic (i.e. Σ17 PGEs and TMPD-MIB), and to less extent, microbial (i.e., mold index) sources. Copyright © 2016 Elsevier Inc. All rights reserved.

Minimum nurse staffing legislation and the financial performance of California hospitals.

PubMed

Reiter, Kristin L; Harless, David W; Pink, George H; Mark, Barbara A

2012-06-01

To estimate the effect of minimum nurse staffing ratios on California acute care hospitals' financial performance. Secondary data from Medicare cost reports, the American Hospital Association's (AHA) Annual Survey, and the California Office of Statewide Health Planning and Development (OSHPD) are combined from 2000 to 2006 for 203 hospitals in California and 407 hospitals in 12 comparison states. The study employs a difference-in-difference analytical approach. Hospitals are grouped into quartiles based on pre-regulation nurse staffing levels in adult medical-surgical and pediatric units (quartile 1=lowest staffing). Differences in operating margin, operating expenses per day, and inpatient operating expenses per discharge for California hospitals within a staffing quartile during the period of regulation are compared to differences at hospitals in comparison states during the same period. Hospital data from Medicare cost reports are merged with nurse staffing measures obtained from AHA and from OSPHD. Relative to hospitals in comparison states, operating margins declined significantly for California hospitals in quartiles 2 and 3. Operating expenses increased significantly in quartiles 1, 2, and 3. Implementation of minimum nurse staffing legislation in California put substantial financial pressure on some hospitals. © Health Research and Educational Trust.

Association between liver function and metabolic syndrome in Chinese men and women

PubMed Central

Wang, Sen; Zhang, Jie; Zhu, Li; Song, Linlin; Meng, Zhaowei; Jia, Qiang; Li, Xue; Liu, Na; Hu, Tianpeng; Zhou, Pingping; Zhang, Qing; Liu, Li; Song, Kun; Jia, Qiyu

2017-01-01

Metabolic syndrome (MS) could be associated with liver function. Our study aimed to investigate the association between liver function and MS in a large cohort of Chinese men and women. We enrolled 32,768 ostensibly healthy participants. The associations between liver function and MS of both genders were analyzed separately after dividing total bilirubin (TBIL), gamma glutamyltransferase (GGT), alanine aminotransferase (ALT) into quartiles. Young males had significantly higher MS prevalence than females, yet after menopause, females had higher MS prevalence. We used TBIL, GGT and ALT quartiles as categorical variables in binary logistic regression models. Significantly decreased MS risks were demonstrated in TBIL quartiles 2 to 4 for males, and quartiles 3 to 4 for females. As to GGT and ALT, significantly increased MS risks were shown in high quartiles for both genders. Aging also resulted in significantly higher MS risks in both genders except for young females. This study displayed close associations between liver function and MS, which were influenced by gender and age. A high TBIL level had protective effect against MS, while high GGT and ALT levels were risk factors for MS. It is meaningful that liver function is used as clinical risk predictors for MS. PMID:28317840

Improving the Accuracy of Laplacian Estimation with Novel Variable Inter-Ring Distances Concentric Ring Electrodes

PubMed Central

Makeyev, Oleksandr; Besio, Walter G.

2016-01-01

Noninvasive concentric ring electrodes are a promising alternative to conventional disc electrodes. Currently, the superiority of tripolar concentric ring electrodes over disc electrodes, in particular, in accuracy of Laplacian estimation, has been demonstrated in a range of applications. In our recent work, we have shown that accuracy of Laplacian estimation can be improved with multipolar concentric ring electrodes using a general approach to estimation of the Laplacian for an (n + 1)-polar electrode with n rings using the (4n + 1)-point method for n ≥ 2. This paper takes the next step toward further improving the Laplacian estimate by proposing novel variable inter-ring distances concentric ring electrodes. Derived using a modified (4n + 1)-point method, linearly increasing and decreasing inter-ring distances tripolar (n = 2) and quadripolar (n = 3) electrode configurations are compared to their constant inter-ring distances counterparts. Finite element method modeling and analytic results are consistent and suggest that increasing inter-ring distances electrode configurations may decrease the truncation error resulting in more accurate Laplacian estimates compared to respective constant inter-ring distances configurations. For currently used tripolar electrode configuration, the truncation error may be decreased more than two-fold, while for the quadripolar configuration more than a six-fold decrease is expected. PMID:27294933

Improving the Accuracy of Laplacian Estimation with Novel Variable Inter-Ring Distances Concentric Ring Electrodes.

PubMed

Makeyev, Oleksandr; Besio, Walter G

2016-06-10

Noninvasive concentric ring electrodes are a promising alternative to conventional disc electrodes. Currently, the superiority of tripolar concentric ring electrodes over disc electrodes, in particular, in accuracy of Laplacian estimation, has been demonstrated in a range of applications. In our recent work, we have shown that accuracy of Laplacian estimation can be improved with multipolar concentric ring electrodes using a general approach to estimation of the Laplacian for an (n + 1)-polar electrode with n rings using the (4n + 1)-point method for n ≥ 2. This paper takes the next step toward further improving the Laplacian estimate by proposing novel variable inter-ring distances concentric ring electrodes. Derived using a modified (4n + 1)-point method, linearly increasing and decreasing inter-ring distances tripolar (n = 2) and quadripolar (n = 3) electrode configurations are compared to their constant inter-ring distances counterparts. Finite element method modeling and analytic results are consistent and suggest that increasing inter-ring distances electrode configurations may decrease the truncation error resulting in more accurate Laplacian estimates compared to respective constant inter-ring distances configurations. For currently used tripolar electrode configuration, the truncation error may be decreased more than two-fold, while for the quadripolar configuration more than a six-fold decrease is expected.

Finite element method modeling to assess Laplacian estimates via novel variable inter-ring distances concentric ring electrodes.

PubMed

Makeyev, Oleksandr; Besio, Walter G

2016-08-01

Noninvasive concentric ring electrodes are a promising alternative to conventional disc electrodes. Currently, superiority of tripolar concentric ring electrodes over disc electrodes, in particular, in accuracy of Laplacian estimation has been demonstrated in a range of applications. In our recent work we have shown that accuracy of Laplacian estimation can be improved with multipolar concentric ring electrodes using a general approach to estimation of the Laplacian for an (n + 1)-polar electrode with n rings using the (4n + 1)-point method for n ≥ 2. This paper takes the next step toward further improving the Laplacian estimate by proposing novel variable inter-ring distances concentric ring electrodes. Derived using a modified (4n + 1)-point method, linearly increasing and decreasing inter-ring distances tripolar (n = 2) and quadripolar (n = 3) electrode configurations are compared to their constant inter-ring distances counterparts using finite element method modeling. Obtained results suggest that increasing inter-ring distances electrode configurations may decrease the estimation error resulting in more accurate Laplacian estimates compared to respective constant inter-ring distances configurations. For currently used tripolar electrode configuration the estimation error may be decreased more than two-fold while for the quadripolar configuration more than six-fold decrease is expected.

Validation of MODIS integrated water vapor product against reference GPS data at the Iberian Peninsula

NASA Astrophysics Data System (ADS)

Vaquero-Martínez, Javier; Antón, Manuel; Ortiz de Galisteo, José Pablo; Cachorro, Victoria E.; Costa, Maria João; Román, Roberto; Bennouna, Yasmine S.

2017-12-01

In this work, the water vapor product from MODIS (MODerate-resolution Imaging Spectroradiometer) instrument, on-board Aqua and Terra satellites, is compared against GPS water vapor data from 21 stations in the Iberian Peninsula as reference. GPS water vapor data is obtained from ground-based receiver stations which measure the delay caused by water vapor in the GPS microwave signals. The study period extends from 2007 until 2012. Regression analysis in every GPS station show that MODIS overestimates low integrated water vapor (IWV) data and tends to underestimate high IWV data. R2 shows a fair agreement, between 0.38 and 0.71. Inter-quartile range (IQR) in every station is around 30-45%. The dependence on several parameters was also analyzed. IWV dependence showed that low IWV are highly overestimated by MODIS, with high IQR (low precision), sharply decreasing as IWV increases. Regarding dependence on solar zenith angle (SZA), performance of MODIS IWV data decreases between 50° and 90°, while night-time MODIS data (infrared) are quite stable. The seasonal cycles of IWV and SZA cause a seasonal dependence on MODIS performance. In summer and winter, MODIS IWV tends to overestimate the reference IWV value, while in spring and autumn the tendency is to underestimate. Low IWV from coastal stations is highly overestimated (∼60%) and quite imprecise (IQR around 60%). On the contrary, high IWV data show very little dependence along seasons. Cloud-fraction (CF) dependence was also studied, showing that clouds display a negligible impact on IWV over/underestimation. However, IQR increases with CF, except in night-time satellite values, which are quite stable.

Predictive value of pulse pressure variation for fluid responsiveness in septic patients using lung-protective ventilation strategies.

PubMed

Freitas, F G R; Bafi, A T; Nascente, A P M; Assunção, M; Mazza, B; Azevedo, L C P; Machado, F R

2013-03-01

The applicability of pulse pressure variation (ΔPP) to predict fluid responsiveness using lung-protective ventilation strategies is uncertain in clinical practice. We designed this study to evaluate the accuracy of this parameter in predicting the fluid responsiveness of septic patients ventilated with low tidal volumes (TV) (6 ml kg(-1)). Forty patients after the resuscitation phase of severe sepsis and septic shock who were mechanically ventilated with 6 ml kg(-1) were included. The ΔPP was obtained automatically at baseline and after a standardized fluid challenge (7 ml kg(-1)). Patients whose cardiac output increased by more than 15% were considered fluid responders. The predictive values of ΔPP and static variables [right atrial pressure (RAP) and pulmonary artery occlusion pressure (PAOP)] were evaluated through a receiver operating characteristic (ROC) curve analysis. Thirty-four patients had characteristics consistent with acute lung injury or acute respiratory distress syndrome and were ventilated with high levels of PEEP [median (inter-quartile range) 10.0 (10.0-13.5)]. Nineteen patients were considered fluid responders. The RAP and PAOP significantly increased, and ΔPP significantly decreased after volume expansion. The ΔPP performance [ROC curve area: 0.91 (0.82-1.0)] was better than that of the RAP [ROC curve area: 0.73 (0.59-0.90)] and pulmonary artery occlusion pressure [ROC curve area: 0.58 (0.40-0.76)]. The ROC curve analysis revealed that the best cut-off for ΔPP was 6.5%, with a sensitivity of 0.89, specificity of 0.90, positive predictive value of 0.89, and negative predictive value of 0.90. Automatized ΔPP accurately predicted fluid responsiveness in septic patients ventilated with low TV.

Assessing the impact of mass rape on the incidence of HIV in conflict-affected countries

PubMed Central

Virginie, Supervie; Yasmin, Halima; Sally, Blower

2010-01-01

Objectives To quantify the potential impact of mass rape on HIV incidence in seven conflict-afflicted-countries (CACs), with severe HIV epidemics, in Sub-Saharan Africa. Design Uncertainty analysis of a risk equation model. Methods A mathematical model was used to evaluate the potential impact of mass rape on increasing HIV incidence in women and girls in: Burundi, Democratic Republic of Congo (DRC), Rwanda, Sierra Leone, Somalia, southern Sudan and Uganda. The model was parameterized with data from UNAIDS/WHO and the US Census Bureau’s International Data Base. Incidence data from UNAIDS/WHO were used for calibration. Results Mass rape could cause ~five HIV infections per 100,000 females per year in the DRC, Sudan, Somalia and Sierra Leone, double that in Burundi and Rwanda, and quadruple that in Uganda. The number of females infected per year due to mass rape is likely to be relatively low in Somalia and Sierra Leone, 127 (median: Inter-Quartile-Range (IQR) 55–254) and 156 (median: IQR 69–305), respectively. Numbers could be high in the DRC and Uganda: 1,120 (median: IQR 527–2,360) and 2,172 (median: IQR 1,031–4,668), respectively. In Burundi, Rwanda and Sudan numbers are likely to be intermediate. Under extreme conditions 10,000 women and girls could be infected per year in the DRC, and 20,000 women and girls in Uganda. Mass rape could increase annual incidence by ~ 7% (median: IQR 3–15). Conclusions Interventions and treatment targeted to rape survivors during armed conflicts could reduce HIV incidence. Support should be provided both on the basis of human rights and public health. PMID:20859191

An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure.

PubMed

Cleland, John G; Abraham, William T; Linde, Cecilia; Gold, Michael R; Young, James B; Claude Daubert, J; Sherfesee, Lou; Wells, George A; Tang, Anthony S L

2013-12-01

Cardiac resynchronization therapy (CRT) with or without a defibrillator reduces morbidity and mortality in selected patients with heart failure (HF) but response can be variable. We sought to identify pre-implantation variables that predict the response to CRT in a meta-analysis using individual patient-data. An individual patient meta-analysis of five randomized trials, funded by Medtronic, comparing CRT either with no active device or with a defibrillator was conducted, including the following baseline variables: age, sex, New York Heart Association class, aetiology, QRS morphology, QRS duration, left ventricular ejection fraction (LVEF), and systolic blood pressure. Outcomes were all-cause mortality and first hospitalization for HF or death. Of 3782 patients in sinus rhythm, median (inter-quartile range) age was 66 (58-73) years, QRS duration was 160 (146-176) ms, LVEF was 24 (20-28)%, and 78% had left bundle branch block. A multivariable model suggested that only QRS duration predicted the magnitude of the effect of CRT on outcomes. Further analysis produced estimated hazard ratios for the effect of CRT on all-cause mortality and on the composite of first hospitalization for HF or death that suggested increasing benefit with increasing QRS duration, the 95% confidence bounds excluding 1.0 at ∼140 ms for each endpoint, suggesting a high probability of substantial benefit from CRT when QRS duration exceeds this value. QRS duration is a powerful predictor of the effects of CRT on morbidity and mortality in patients with symptomatic HF and left ventricular systolic dysfunction who are in sinus rhythm. QRS morphology did not provide additional information about clinical response. NCT00170300, NCT00271154, NCT00251251.

All-cause and cardiovascular mortality in treated patients with severe hypertriglyceridaemia: A long-term prospective registry study.

PubMed

Neil, H A W; Cooper, J; Betteridge, D J; Capps, N; McDowell, I F W; Durrington, P N; Seed, M; Mann, J I; Humphries, S E

2010-08-01

To examine all-cause and cardiovascular mortality in patients with severe hypertriglyceridaemia. 337 patients aged less than 80 years (47 with diabetes, 75 women) with a fasting triglyceride concentration on at least two occasions of >5.0mmol/l were registered by 21 lipid clinics in the United Kingdom and followed prospectively between 1980 and 2008 for 4353 person-years. The standardised mortality ratio (SMR) was calculated by comparison with the general population. The mean untreated total cholesterol concentration was 9.8 (SD 3.6)mmol/l for men and 11.9 (7.2)mmol/l for women and the corresponding geometric mean triglyceride concentration was 12.6 (inter-quartile range 7.3, 21.6) and 15.7 (8.2, 29.2)mmol/l. There were 70 deaths, including 35 from CHD and 7 from stroke. The SMR for CHD was raised at 327 (95% confidence intervals 228, 455; p<0.0001) and remained elevated after excluding patients with diabetes at registration (SMR=287, 95% CI 190, 419; p<0.0001), and after excluding patients with CHD at registration (SMR=259, 95% CI 158, 400; p=0.0003). The increased SMR was most marked in younger men aged 40-59 years (SMR=544, 95% CI 304, 897; p<0.0001). The SMR for stroke for patients aged 20-79 years was raised at 262 (95% CI 105, 540; p=0.04), as was all-cause mortality at 164 (95% CI 129, 208; p<0.001). Severe hypertriglyceridaemia is associated with a substantially increased mortality from cardiovascular disease, even in the absence of diabetes. In addition to lowering triglyceride concentrations to reduce the risk of pancreatitis, treatment should aim to reduce the overall cardiovascular risk. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

Features of human scabies in resource-limited settings: the Cameroon case.

PubMed

Kouotou, Emmanuel Armand; Nansseu, Jobert Richie N; Sieleunou, Isidore; Defo, Defo; Bissek, Anne-Cécile Zoung-Kanyi; Ndam, Elie Claude Ndjitoyap

2015-07-23

The persistent high prevalence of human scabies, especially in low- and middle-income countries prompted us to research the sociodemographic profile of patients suffering from it, and its spreading factors in Cameroon, a resource-poor setting. We conducted a cross-sectional survey from October 2011 to September 2012 in three hospitals located in Yaoundé, Cameroon, and enrolled patients diagnosed with human scabies during dermatologists' consultations who volunteered to take part in the study. We included 255 patients of whom 158 (62 %) were male. Age ranged from 0 to 80 years old with a median of 18 (Inter quartile range: 3-29) years. One to eight persons of our patients' entourage exhibited pruritus (mean = 2.1 ± 1.8). The number of persons per bed/room varied from 1 to 5 (mean = 2.1 ± 0.8). The first dermatologist's consultation occurred 4 to 720 days after the onset of symptoms (mean = 77.1 ± 63.7). The post-scabies pruritus (10.2 % of cases) was unrelated to the complications observed before correct treatment (all p values > 0.05), mainly impetiginization (7.1 %) and eczematization (5.9 %). Human scabies remains preponderant in our milieu. Populations should be educated on preventive measures in order to avoid this disease, and clinicians' knowledges must be strengthened for its proper diagnosis and management.

Urinary triclosan is associated with elevated body mass index in NHANES.

PubMed

Lankester, Joanna; Patel, Chirag; Cullen, Mark R; Ley, Catherine; Parsonnet, Julie

2013-01-01

Triclosan-a ubiquitous chemical in toothpastes, soaps, and household cleaning supplies-has the potential to alter both gut microbiota and endocrine function and thereby affect body weight. We investigated the relationship between triclosan and body mass index (BMI) using National Health and Nutrition Examination Surveys (NHANES) from 2003-2008. BMI and spot urinary triclosan levels were obtained from adults. Using two different exposure measures-either presence vs. absence or quartiles of triclosan-we assessed the association between triclosan and BMI. We also screened all NHANES serum and urine biomarkers to identify correlated factors that might confound observed associations. Compared with undetectable triclosan, a detectable level was associated with a 0.9-point increase in BMI (p<0.001). In analysis by quartile, compared to the lowest quartile, the 2nd, 3rd and 4th quartiles of urinary triclosan were associated with BMI increases of 1.5 (p<0.001), 1.0 (p = 0.002), and 0.3 (p = 0.33) respectively. The one strong correlate of triclosan identified in NHANES was its metabolite, 2,4-dichlorophenol (ρ = 0.4); its association with BMI, however, was weaker than that of triclosan. No other likely confounder was identified. Triclosan exposure is associated with increased BMI. Stronger effect at moderate than high levels suggests a complex mechanism of action.

Physical activity, sedentary behavior and all-cause mortality among blacks and whites with diabetes.

PubMed

Glenn, Kimberly R; Slaughter, James C; Fowke, Jay H; Buchowski, Maciej S; Matthews, Charles E; Signorello, Lisa B; Blot, William J; Lipworth, Loren

2015-09-01

The study objective was to examine the role of physical activity (PA) and sedentary time (ST) on mortality risk among a population of low-income adults with diabetes. Black (n = 11,137) and white (n = 4508) men and women with diabetes from the Southern Community Cohort Study self-reported total PA levels and total ST. Participants were categorized into quartiles of total PA and total ST. Hazard ratios (HRs) and 95% confidence intervals (CIs) for subsequent mortality risk were estimated from Cox proportional hazards analysis with adjustment for potential confounders. During follow-up, 2370 participants died. The multivariable risk of mortality was lower among participants in the highest quartile of PA compared with those in the lowest quartile (HR, 0.64; 95% CI: 0.57-0.73). Mortality risk was significantly increased among participants in the highest compared with the lowest quartile of ST after adjusting for PA (HR, 1.21; 95% CI: 1.08-1.37). Across sex and race groups, similar trends of decreasing mortality with rising PA and increasing mortality with rising ST were observed. Although causality cannot be established from these observational data, the current findings suggest that increasing PA and decreasing ST may help extend survival among individuals with diabetes irrespective of race and sex. Copyright © 2015 Elsevier Inc. All rights reserved.

Urinary Triclosan is Associated with Elevated Body Mass Index in NHANES

PubMed Central

Lankester, Joanna; Patel, Chirag; Cullen, Mark R.; Ley, Catherine; Parsonnet, Julie

2013-01-01

Background Triclosan—a ubiquitous chemical in toothpastes, soaps, and household cleaning supplies—has the potential to alter both gut microbiota and endocrine function and thereby affect body weight. Methods We investigated the relationship between triclosan and body mass index (BMI) using National Health and Nutrition Examination Surveys (NHANES) from 2003–2008. BMI and spot urinary triclosan levels were obtained from adults. Using two different exposure measures—either presence vs. absence or quartiles of triclosan—we assessed the association between triclosan and BMI. We also screened all NHANES serum and urine biomarkers to identify correlated factors that might confound observed associations. Results Compared with undetectable triclosan, a detectable level was associated with a 0.9-point increase in BMI (p<0.001). In analysis by quartile, compared to the lowest quartile, the 2nd, 3rd and 4th quartiles of urinary triclosan were associated with BMI increases of 1.5 (p<0.001), 1.0 (p = 0.002), and 0.3 (p = 0.33) respectively. The one strong correlate of triclosan identified in NHANES was its metabolite, 2,4-dichlorophenol (ρ = 0.4); its association with BMI, however, was weaker than that of triclosan. No other likely confounder was identified. Conclusions Triclosan exposure is associated with increased BMI. Stronger effect at moderate than high levels suggests a complex mechanism of action. PMID:24278238

A novel risk score for mortality in renal transplant recipients beyond the first posttransplant year.

PubMed

Hernández, Domingo; Sánchez-Fructuoso, Ana; González-Posada, José Manuel; Arias, Manuel; Campistol, Josep María; Rufino, Margarita; Morales, José María; Moreso, Francesc; Pérez, Germán; Torres, Armando; Serón, Daniel

2009-09-27

All-cause mortality is high after kidney transplantation (KT), but no prognostic index has focused on predicting mortality in KT using baseline and emergent comorbidity after KT. A total of 4928 KT recipients were used to derive a risk score predicting mortality. Patients were randomly assigned to two groups: a modeling population (n=2452), used to create a new index, and a testing population (n=2476), used to test this index. Multivariate Cox regression model coefficients of baseline (age, weight, time on dialysis, diabetes, hepatitis C, and delayed graft function) and emergent comorbidity within the first posttransplant year (diabetes, proteinuria, renal function, and immunosuppressants) were used to weigh each variable in the calculation of the score and allocated into risk quartiles. The probability of death at 3 years, estimated by baseline cumulative hazard function from the Cox model [P (death)=1-0.993592764 (exp(score/100)], increased from 0.9% in the lowest-risk quartile (score=40) to 4.7% in the highest risk-quartile (score=200). The observed incidence of death increased with increasing risk quartiles in testing population (log-rank analysis, P<0.0001). The overall C-index was 0.75 (95% confidence interval: 0.72-0.78) and 0.74 (95% confidence interval: 0.70-0.77) in both populations, respectively. This new index is an accurate tool to identify high-risk patients for mortality after KT.

Intake of Specific Nonfermented Soy Foods May Be Inversely Associated with Risk of Distal Gastric Cancer in a Chinese Population123

PubMed Central

Kweon, Sun-Seog; Shu, Xiao-Ou; Xiang, Yongbing; Cai, Hui; Yang, Gong; Ji, Bu-Tian; Li, Honglan; Gao, Yu-Tang; Zheng, Wei; Epplein, Meira

2013-01-01

Because the association between soy consumption and gastric cancer is inconsistent, we evaluated the putative preventive effect of soy food on gastric cancer risk in the Shanghai Women’s and Men’s Health Studies, comprising a total of 128,687 participants. Intake of nonfermented soy foods was estimated using 2 validated food-frequency questionnaires. HRs were calculated with 95% CIs for intake amounts of total nonfermented soy food intake, soy protein, and isoflavones as well as individual soy food groups using Cox proportional hazards regression. A total of 493 distal gastric cancer cases were identified by 2010. Although all risk estimates for summary measures of soy food intake above the lowest quartile (quartile 1) were suggestive of a protective effect, no statistically significant associations with risk of distal gastric cancer were found. Among the separate soy food groups, significant reductions in risk of distal gastric cancer by increasing intake of tofu were found in men in quartile 2 (HR: 0.59; 95% CI: 0.40, 0.86), quartile 3 (HR: 0.62; 95% CI: 0.44, 0.88), and quartile 4 (HR: 0.64; 95% CI: 0.42, 0.99), resulting in a significant trend (P-trend = 0.02). Dry bean intake was also inversely associated with decreased risk of gastric cancer, but in postmenopausal women only [quartile 2 (HR: 0.54; 95% CI: 0.30, 0.96); quartile 3 (HR: 0.90; 95% CI: 0.64, 1.27); and quartile 4 (HR: 0.63; 95% CI: 0.43, 0.91)], resulting in a significant trend (P-trend = 0.03). Overall, our study found no statistically significant association between nonfermented soy food intake and distal gastric cancer risk, though the data supported the hypothesis that tofu may protect against distal gastric cancer in men and dry bean consumption may decrease the risk of gastric cancer in postmenopausal women. PMID:23986366

Intake of specific nonfermented soy foods may be inversely associated with risk of distal gastric cancer in a Chinese population.

PubMed

Kweon, Sun-Seog; Shu, Xiao-Ou; Xiang, Yongbing; Cai, Hui; Yang, Gong; Ji, Bu-Tian; Li, Honglan; Gao, Yu-Tang; Zheng, Wei; Epplein, Meira

2013-11-01

Because the association between soy consumption and gastric cancer is inconsistent, we evaluated the putative preventive effect of soy food on gastric cancer risk in the Shanghai Women's and Men's Health Studies, comprising a total of 128,687 participants. Intake of nonfermented soy foods was estimated using 2 validated food-frequency questionnaires. HRs were calculated with 95% CIs for intake amounts of total nonfermented soy food intake, soy protein, and isoflavones as well as individual soy food groups using Cox proportional hazards regression. A total of 493 distal gastric cancer cases were identified by 2010. Although all risk estimates for summary measures of soy food intake above the lowest quartile (quartile 1) were suggestive of a protective effect, no statistically significant associations with risk of distal gastric cancer were found. Among the separate soy food groups, significant reductions in risk of distal gastric cancer by increasing intake of tofu were found in men in quartile 2 (HR: 0.59; 95% CI: 0.40, 0.86), quartile 3 (HR: 0.62; 95% CI: 0.44, 0.88), and quartile 4 (HR: 0.64; 95% CI: 0.42, 0.99), resulting in a significant trend (P-trend = 0.02). Dry bean intake was also inversely associated with decreased risk of gastric cancer, but in postmenopausal women only [quartile 2 (HR: 0.54; 95% CI: 0.30, 0.96); quartile 3 (HR: 0.90; 95% CI: 0.64, 1.27); and quartile 4 (HR: 0.63; 95% CI: 0.43, 0.91)], resulting in a significant trend (P-trend = 0.03). Overall, our study found no statistically significant association between nonfermented soy food intake and distal gastric cancer risk, though the data supported the hypothesis that tofu may protect against distal gastric cancer in men and dry bean consumption may decrease the risk of gastric cancer in postmenopausal women.

Area-level poverty and preterm birth risk: A population-based multilevel analysis

PubMed Central

DeFranco, Emily A; Lian, Min; Muglia, Louis A; Schootman, Mario

2008-01-01

Background Preterm birth is a complex disease with etiologic influences from a variety of social, environmental, hormonal, genetic, and other factors. The purpose of this study was to utilize a large population-based birth registry to estimate the independent effect of county-level poverty on preterm birth risk. To accomplish this, we used a multilevel logistic regression approach to account for multiple co-existent individual-level variables and county-level poverty rate. Methods Population-based study utilizing Missouri's birth certificate database (1989–1997). We conducted a multilevel logistic regression analysis to estimate the effect of county-level poverty on PTB risk. Of 634,994 births nested within 115 counties in Missouri, two levels were considered. Individual-level variables included demographics factors, prenatal care, health-related behavioral risk factors, and medical risk factors. The area-level variable included the percentage of the population within each county living below the poverty line (US census data, 1990). Counties were divided into quartiles of poverty; the first quartile (lowest rate of poverty) was the reference group. Results PTB < 35 weeks occurred in 24,490 pregnancies (3.9%). The rate of PTB < 35 weeks was 2.8% in counties within the lowest quartile of poverty and increased through the 4th quartile (4.9%), p < 0.0001. High county-level poverty was significantly associated with PTB risk. PTB risk (< 35 weeks) was increased for women who resided in counties within the highest quartile of poverty, adjusted odds ratio (adjOR) 1.18 (95% CI 1.03, 1.35), with a similar effect at earlier gestational ages (< 32 weeks), adjOR 1.27 (95% CI 1.06, 1.52). Conclusion Women residing in socioeconomically deprived areas are at increased risk of preterm birth, above other underlying risk factors. Although the risk increase is modest, it affects a large number of pregnancies. PMID:18793437

Area-level poverty and preterm birth risk: a population-based multilevel analysis.

PubMed

DeFranco, Emily A; Lian, Min; Muglia, Louis A; Schootman, Mario

2008-09-15

Preterm birth is a complex disease with etiologic influences from a variety of social, environmental, hormonal, genetic, and other factors. The purpose of this study was to utilize a large population-based birth registry to estimate the independent effect of county-level poverty on preterm birth risk. To accomplish this, we used a multilevel logistic regression approach to account for multiple co-existent individual-level variables and county-level poverty rate. Population-based study utilizing Missouri's birth certificate database (1989-1997). We conducted a multilevel logistic regression analysis to estimate the effect of county-level poverty on PTB risk. Of 634,994 births nested within 115 counties in Missouri, two levels were considered. Individual-level variables included demographics factors, prenatal care, health-related behavioral risk factors, and medical risk factors. The area-level variable included the percentage of the population within each county living below the poverty line (US census data, 1990). Counties were divided into quartiles of poverty; the first quartile (lowest rate of poverty) was the reference group. PTB < 35 weeks occurred in 24,490 pregnancies (3.9%). The rate of PTB < 35 weeks was 2.8% in counties within the lowest quartile of poverty and increased through the 4th quartile (4.9%), p < 0.0001. High county-level poverty was significantly associated with PTB risk. PTB risk (< 35 weeks) was increased for women who resided in counties within the highest quartile of poverty, adjusted odds ratio (adj OR) 1.18 (95% CI 1.03, 1.35), with a similar effect at earlier gestational ages (< 32 weeks), adj OR 1.27 (95% CI 1.06, 1.52). Women residing in socioeconomically deprived areas are at increased risk of preterm birth, above other underlying risk factors. Although the risk increase is modest, it affects a large number of pregnancies.

Impact of Long-Term Serum Platinum Concentrations on Neuro- and Ototoxicity in Cisplatin-Treated Survivors of Testicular Cancer

PubMed Central

Sprauten, Mette; Darrah, Thomas H.; Peterson, Derick R.; Campbell, M. Ellen; Hannigan, Robyn E.; Cvancarova, Milada; Beard, Clair; Haugnes, Hege S.; Fosså, Sophie D.; Oldenburg, Jan; Travis, Lois B.

2012-01-01

Purpose Cisplatin-induced neurotoxicity and ototoxicity (NTX) are important adverse effects after chemotherapy for testicular cancer (TC). Although serum platinum is measurable years after therapy, its impact on NTX has not been evaluated. Patients and Methods In all, 169 cisplatin-treated survivors of TC provided blood samples at Survey I and reported NTX during Survey I (1998-2002) and Survey II (2007-2008). Serum platinum was quantified by inductively coupled plasma mass spectrometry. Patient-reported outcomes were evaluated with the Scale for Chemotherapy-Induced Neurotoxicity (SCIN), regarding the extent of symptom bother as 0, “not at all”; 1, “a little”; 2, “quite a bit”; or 3, “very much.” Summing the six symptom scores yielded a total SCIN score of 0 to 18. Categorizing total SCIN scores into quartiles yielded similar-sized groups with increasing symptoms. Multivariate ordinal logistic regression analyses evaluated associations between NTX and long-term serum platinum levels, adjusting for cisplatin dose, dosing schedule, and age. Results At Survey I, a significant four- to five-fold association with total SCIN score emerged for the highest serum platinum quartile (odds ratio [OR], 4.69; 95% CI, 1.82 to 12.08). Paresthesias and Raynaud's syndrome (hands and feet) showed significant two- to four-fold increased risks with the highest platinum quartile. At Survey II, total SCIN score remained significantly associated with the highest platinum quartile (OR, 4.28; 95% CI, 1.36 to 13.48). Paresthesias (hands and feet) and tinnitus showed significant three- to four-fold increased risks for the highest platinum quartile. Cumulative cisplatin dose was not associated with total SCIN score or individual SCIN symptoms in multivariate analyses. Conclusion Here we document a significant relationship between increasing levels of residual serum platinum and NTX severity after adjusting for initial cisplatin dose. PMID:22184390

Handgrip strength measurement as a predictor of hospitalization costs.

PubMed

Guerra, R S; Amaral, T F; Sousa, A S; Pichel, F; Restivo, M T; Ferreira, S; Fonseca, I

2015-02-01

Undernutrition status at hospital admission is related to increased hospital costs. Handgrip strength (HGS) is an indicator of undernutrition, but the ability of HGS to predict hospitalization costs has yet to be studied. To explore whether HGS measurement at hospital admission can predict patient's hospitalization costs. A prospective study was conducted in a university hospital. Inpatient's (n=637) HGS and undernutrition status by Patient-Generated Subjective Global Assessment were ascertained. Multivariable linear regression analysis, computing HGS quartiles by sex (reference: fourth quartile, highest), was conducted in order to identify the independent predictors of hospitalization costs. Costs were evaluated through percentage deviation from the mean cost, after adjustment for patients' characteristics, disease severity and undernutrition status. Being in the first or second HGS quartiles at hospital admission increased patient's hospitalization costs, respectively, by 17.5% (95% confidence interval: 2.7-32.3) and 21.4% (7.5-35.3), which translated into an increase from €375 (58-692) to €458 (161-756). After the additional adjustment for undernutrition status, being in the first or second HGS quartiles had, respectively, an economic impact of 16.6% (1.9-31.2) and 20.0% (6.2-33.8), corresponding to an increase in hospitalization expenditure from €356 (41-668) to €428 (133-724). Low HGS at hospital admission is associated with increased hospitalization costs of between 16.6 and 20.0% after controlling for possible confounders, including undernutrition status. HGS is an inexpensive, noninvasive and easy-to-use method that has clinical potential to predict hospitalization costs.

Serum metabolome biomarkers associate low-level environmental perfluorinated compound exposure with oxidative /nitrosative stress in humans.

PubMed

Wang, Xiaofei; Liu, Liangpo; Zhang, Weibing; Zhang, Jie; Du, Xiaoyan; Huang, Qingyu; Tian, Meiping; Shen, Heqing

2017-10-01

Previous in vivo and in vitro studies have linked perfluorinated compound (PFC) exposure with metabolic interruption, but the inter-species difference and high treatment doses usually make the results difficult to be extrapolated to humans directly. The best strategy for identifying the metabolic interruption may be to establish the direct correlations between monitored PFCs data and metabolic data on human samples. In this study, serum metabolome data and PFC concentrations were acquired for a Chinese adult male cohort. The most abundant PFCs are PFOA and PFOS with concentration medians 7.56 and 12.78 nM, respectively; in together they count around 81.6% of the total PFCs. PFC concentration-related serum metabolic profile changes and the related metabolic biomarkers were explored by using partial least squares-discriminant analysis (PLS-DA). Respectively taking PFOS, PFOA and total PFC as the classifiers, serum metabolome can be differentiated between the lowest dose group (1st quartile PFCs) and the highest PFC dose group (4th quartile PFCs). Ten potential PFC biomarkers were identified, mainly involving in pollutant detoxification, antioxidation and nitric oxide (NO) signal pathways. These suggested that low-level environmental PFC exposure has significantly adverse impacts on glutathione (GSH) cycle, Krebs cycle, nitric oxide (NO) generation and purine oxidation in humans. To the best of our knowledge, this is the first report investigating the association of environmental PFC exposure with human serum metabolome alteration. Given the important biological functions of the identified biomarkers, we suggest that PFC could increase the metabolism syndromes risk including diabetes and cardiovascular diseases. Copyright © 2017 Elsevier Ltd. All rights reserved.

Blood lead level is associated with non-alcoholic fatty liver disease in the Yangtze River Delta region of China in the context of rapid urbanization.

PubMed

Zhai, Hualing; Chen, Chi; Wang, Ningjian; Chen, Yi; Nie, Xiaomin; Han, Bing; Li, Qin; Xia, Fangzhen; Lu, Yingli

2017-08-31

China has undergone rapid urbanization in the past three decades. We aimed to report blood lead level (B-Pb) in the most rapidly urbanized Yangtze River Delta Region of China, and explore the association B-Pb and non-alcoholic fatty liver disease (NAFLD). Our data source was the SPECT-China study. We enrolled 2011 subjects from 6 villages in the Yangtze River Delta Region. Lead was measured by atomic absorption spectrometry. According to abdominal ultrasound, residents were divided into normal and NAFLD groups. In total, 824 (41.0%) were diagnosed with NAFLD. Medians (interquartile range) of B-Pb were 5.29 μg/dL (3.60-7.28) [0.25 μmol/L (0.17-0.35)] for men and 4.49 μg/dL (2.97-6.59) [0.22 μmol/L (0.14-0.32)] for women. In both genders, the NAFLD group had significantly greater B-Pb than normal group (both P < 0.001). The prevalence of NAFLD significantly increased with increasing B-Pb quartiles in men (P for trend = 0.032) and women (P for trend = 0.001). Residents in Shanghai had significantly greater B-Pb (P < 0.001) and a higher prevalence of NAFLD (P < 0.001). Compared with women in the lowest quartile of BLL, OR of NAFLD in women in the highest quartile was 1.613 (95%CI 1.082-2.405) (P for trend = 0.019) after multivariable adjustment. In men, this association showed marginal significance (OR 2.168, 95%CI 0.989-4.750, P for trend = 0.063). B-Pb in Chinese residents in the Yangtze River Delta Region were much higher than in developed countries. Elevated B-Pb was associated with an increased risk of NAFLD, especially in women.

High levels of serum fibroblast growth factor (FGF)-23 are associated with increased mortality in long haemodialysis patients.

PubMed

Jean, Guillaume; Terrat, Jean-Claude; Vanel, Thierry; Hurot, Jean-Marc; Lorriaux, Christie; Mayor, Brice; Chazot, Charles

2009-09-01

Fibroblast growth factor (FGF)-23, a novel bone-derived phosphaturic factor involved in mineral metabolism, is increased in chronic kidney disease (CKD); in dialysis patients, it has been linked to increased mortality rates and vascular calcification (VC). The present investigation aimed to study the factors associated with elevated serum FGF-23 levels in patients treated with long haemodialysis (LHD) sessions and to determine whether a relationship exists between serum FGF-23 levels and patient survival. All patients treated in one haemodialysis centre from September 2006 were included in the study. Standard laboratory values, medical history, cardiovascular events and risk factors, medication and FGF-23 levels [ELISA (C-Term) Immutopics] were recorded. Patients received haemodialysis three times a week, on a 5- to 8-h schedule. Patient data were analysed according to FGF-23 quartiles. The effect of FGF-23 on the 2-year survival rate was assessed using the Cox proportional hazard model, adjusted for confounding variables and according to the serum phosphate tertiles. The study included 219 patients. Serum FGF-23 levels were high: 7060 +/- 13 500 RU/mL (median, 2740 RU/mL). In logistical regressions, only calcaemia (P = 0.002), phosphataemia (P = 0.008) and warfarin use (P = 0.04) were associated with the highest FGF-23 quartile. In the subgroup of patients with an estimated VC score, the third and fourth quartiles of the FGF-23 levels were associated with more severe VC. In multivariate linear regressions, only phosphataemia remained significantly correlated with FGF-23 (P = 0.04). The 2-year mortality rate was significantly higher for haemodialysis patients with serum FGF-23 levels in the higher quartile [P = 0.007; hazard ratio, 2.5 (1.3-5)] than in the first quartile, whereas within the phosphataemia tertiles, the lowest serum FGF-23 quartile was associated with lowered mortality. This study demonstrated a high level of circulating FGF-23 in LHD patients, despite infrequent hyperphosphataemia. However, phosphataemia is still the main factor correlating with serum FGF-23. The association of higher serum FGF-23 levels with mortality and VC, regardless of the serum phosphate levels, has thus been confirmed.

Reducing High-Users' Visits to the Emergency Department by a Primary Care Intervention for the Uninsured: A Retrospective Study.

PubMed

Tsai, Meng-Han; Xirasagar, Sudha; Carroll, Scott; Bryan, Charles S; Gallagher, Pamela J; Davis, Kim; Jauch, Edward C

2018-01-01

Reducing avoidable emergency department (ED) visits is an important health system goal. This is a retrospective cohort study of the impact of a primary care intervention including an in-hospital, free, adult clinic for poor uninsured patients on ED visit rates and emergency severity at a nonprofit hospital. We studied adult ED visits during August 16, 2009-August 15, 2011 (preintervention) and August 16, 2011-August 15, 2014 (postintervention). We compared pre- versus post-mean annual visit rates and discharge emergency severity index (ESI; triage and resource use-based, calculated Agency for Healthcare Research and Quality categories) among high-users (≥3 ED visits in 12 months) and occasional users. Annual adult ED visit volumes were 16 372 preintervention (47.5% by high-users), versus 18 496 postintervention. High-users' mean annual visit rates were 5.43 (top quartile) and 0.94 (bottom quartile) preintervention, versus 3.21 and 1.11, respectively, for returning high-users, postintervention (all P < .001). Postintervention, the visit rates of new high-users were lower (lowest and top quartile rates, 0.6 and 3.23) than preintervention high-users' rates in the preintervention period. Visit rates of the top quartile of occasional users also declined. Subgroup analysis of medically uninsured high-users showed similar results. Upon classifying preintervention high-users by emergency severity, postintervention mean ESI increased 24.5% among the lowest ESI quartile, and decreased 12.2% among the top quartile. Pre- and post-intervention sample demographics and comorbidities were similar. The observed reductions in overall ED visit rates, particularly low-severity visits; highest reductions observed among high-users and the top quartile of occasional users; and the pattern of changes in emergency severity support a positive impact of the primary care intervention.

Reducing High-Users’ Visits to the Emergency Department by a Primary Care Intervention for the Uninsured: A Retrospective Study

PubMed Central

Tsai, Meng-Han; Xirasagar, Sudha; Carroll, Scott; Bryan, Charles S.; Gallagher, Pamela J.; Davis, Kim; Jauch, Edward C.

2018-01-01

Reducing avoidable emergency department (ED) visits is an important health system goal. This is a retrospective cohort study of the impact of a primary care intervention including an in-hospital, free, adult clinic for poor uninsured patients on ED visit rates and emergency severity at a nonprofit hospital. We studied adult ED visits during August 16, 2009-August 15, 2011 (preintervention) and August 16, 2011-August 15, 2014 (postintervention). We compared pre- versus post-mean annual visit rates and discharge emergency severity index (ESI; triage and resource use–based, calculated Agency for Healthcare Research and Quality categories) among high-users (≥3 ED visits in 12 months) and occasional users. Annual adult ED visit volumes were 16 372 preintervention (47.5% by high-users), versus 18 496 postintervention. High-users’ mean annual visit rates were 5.43 (top quartile) and 0.94 (bottom quartile) preintervention, versus 3.21 and 1.11, respectively, for returning high-users, postintervention (all P < .001). Postintervention, the visit rates of new high-users were lower (lowest and top quartile rates, 0.6 and 3.23) than preintervention high-users’ rates in the preintervention period. Visit rates of the top quartile of occasional users also declined. Subgroup analysis of medically uninsured high-users showed similar results. Upon classifying preintervention high-users by emergency severity, postintervention mean ESI increased 24.5% among the lowest ESI quartile, and decreased 12.2% among the top quartile. Pre- and post-intervention sample demographics and comorbidities were similar. The observed reductions in overall ED visit rates, particularly low-severity visits; highest reductions observed among high-users and the top quartile of occasional users; and the pattern of changes in emergency severity support a positive impact of the primary care intervention. PMID:29591539

Assessing the relationship between perfluoroalkyl substances, thyroid hormones and binding proteins in pregnant women; a longitudinal mixed effects approach.

PubMed

Berg, Vivian; Nøst, Therese Haugdahl; Hansen, Solrunn; Elverland, Astrid; Veyhe, Anna-Sofía; Jorde, Rolf; Odland, Jon Øyvind; Sandanger, Torkjel Manning

2015-04-01

The mechanisms involved in thyroid homeostasis are complex, and perfluoroalkyl substances (PFASs) have been indicated to interfere at several levels in this endocrine system. Disruption of the maternal thyroid homeostasis during early pregnancy is of particular concern, where subclinical changes in maternal thyroid hormones (THs) may affect embryonic and foetal development. The present study investigated associations between THs, thyroid binding proteins (TH-BPs) and PFAS concentrations in pregnant women from Northern Norway. Women participating in The Northern Norway Mother-and-Child contaminant Cohort Study (MISA) donated a blood sample at three visits related to their pregnancy and postpartum period (during the second trimester, 3 days and 6 weeks after delivery) in the period 2007-2009. Participants were assigned to quartiles according to PFAS concentrations during the second trimester and mixed effects linear models were used to investigate potential associations between PFASs and repeated measurements of THs, TH-BPs, thyroxin binding capacity and thyroid peroxidase antibodies (anti-TPOs). Women within the highest perfluorooctane sulfonate (PFOS) quartile had 24% higher mean concentrations of thyroid stimulating hormone (TSH) compared to the first quartile at all sampling points. Women within the highest quartiles of perfluorodecanoate (PFDA) had 4% lower mean concentrations of triiodothyronine (T3) and women within the highest quartile of perfluoroundecanoate (PFUnDA) had 3% lower mean concentrations of free triiodothyronine (FT3). Further, the difference in concentrations and the changes between three time points were the same for the PFAS quartiles. Thyroxin binding capacity was associated with all the THs and TH-BPs, and was selected as a holistic adjustment for individual changes in TH homeostasis during pregnancy. Finally, adjusting for maternal iodine status did not influence the model predictions. Findings in the present study suggest modifications of TH homeostasis by PFASs in a background exposed maternal population. The variation in levels of THs between PFAS quartiles was within normal reference ranges and may not be of clinical significance in the pregnant woman. However, subtle individual changes in maternal THs may have significant consequences for foetal health. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Clinical value of insulin resistance in fasting normoglycemia].

PubMed

Perova, N V; Ozerova, I N; Aleksandrovich, O V; Metel'skaia, V A; Shal'nova, S A

2011-01-01

Aim of the study was to clarify the question of the presence of manifestations of insulin resistance (IR) in fasting normoglycemia and to assess their association with risk of development and presence of clinically overt cardiovascular diseases (CVD) caused by atherosclerosis. We included into this study 1127 men and women older than 55 years with normal blood serum level of glucose in fasting state (<6.1 mmol/l) without diabetes mellitus selected from a random sample of Moscow inhabitants (n=1186). In participants selected for this study we determined risk factors, calculated indexes of IR (HOMA-IR) and functional capacity of pancreatic -cells (HOMA-%B) using fasting levels of glucose and insulin. The examined subsample was divided into quartiles according to values of HOMA-IR. It was shown that in the 4-th quartile HOMA-%B was substantially higher than in other quartiles. With this values of body mass index and waist circumference were also highest in the 4-th quartile. Fasting insulin level compared with glucose level contributed more to determination of values of indexes of both IR and functional capacity of pancreatic -cells. In the upper 4-th quartile signs of atherogenic dyslipidemia appearing as higher concentration of triglycerides and lowered concentration of high density lipoprotein cholesterol manifested to the greatest degree. At statistical analysis of probability of CVD with clinical manifestations it was shown that in the 4-th quartile of distribution of HOMA-IR (>2.7) values of odds ratio (OR) of development of arterial hypertension (AH), total CVD, angina pectoris, history of brain stroke were elevated. With that in the 3-rd quartile of distribution i.e. at HOMA-IR >1.9 there were higher ORs of development of AH, CVD, angina pectoris. Thus even in the range of normal fasting glucose concentrations in subjects older than 55 years we detected IR associated with elevated risk of development of atherosclerosis related CVD. For detection of IR it is appropriate to measure in blood serum not only concentration of glucose but also fasting insulin level with subsequent calculation of HOMA-IR and HOMA-%B indexes.

The relationship between social deprivation, osteoporosis, and falls.

PubMed

Pearson, Derek; Taylor, Rachel; Masud, Tahir

2004-02-01

The aim of this study was to assess the relationship between heel BMD, risk factors for osteoporosis, falls history, and the Jarman Underprivileged Area Score in an older community population. From the general practice register, 1,187 women (mean age 70, range 60 to 94) were recruited. BMD of the heel was measured using the GE Lunar PIXI densitometer. A T-score cutoff for predicted osteoporosis at the spine or hip of -1.7 was used. A risk factor questionnaire was completed that included fracture history and falls history. The odds ratio (OR) with a 95% confidence interval (CI) was calculated for each risk factor for each quartile of Jarman score and for the diagnosis of osteoporosis. Logistic regression was used to identify the risk factors that predict lone bone mass in the heel. There were no significant differences between women in different quartiles of Jarman score in terms of age and body mass index (BMI). Women in the highest two quartiles of Jarman score (i.e., most deprived) had a significantly higher likelihood of osteoporosis (OR=1.82; 95% CI, 1.03 to 1.63; and OR=1.85; 95% CI, 1.04 to 1.64, respectively) and significantly lower BMD ( p=0.008). Women in these two quartiles were significantly more likely to have had a history of previous fracture (OR=1.66; 95% CI, 1.01 to 1.53), but there was no difference in falls history. Women in the lowest quartile (least deprived) were also significantly less likely to smoke ( p=0.011) but were not significantly different in terms of other risk factors (e.g., dietary calcium and activity). BMI, age, kyphosis, significant visual problems, and quartile of Jarman score were significant risk factors for low bone mass. Risk factors identified those with low bone mass at the heel with a sensitivity and specificity of 72%. In conclusion, women in the lowest quartile of Jarman score (i.e., least deprived) have significantly higher heel BMD compared with the rest of the population.

Mild cognitive impairment: baseline and longitudinal structural MR imaging measures improve predictive prognosis.

PubMed

McEvoy, Linda K; Holland, Dominic; Hagler, Donald J; Fennema-Notestine, Christine; Brewer, James B; Dale, Anders M

2011-06-01

To assess whether single-time-point and longitudinal volumetric magnetic resonance (MR) imaging measures provide predictive prognostic information in patients with amnestic mild cognitive impairment (MCI). This study was conducted with institutional review board approval and in compliance with HIPAA regulations. Written informed consent was obtained from all participants or the participants' legal guardians. Cross-validated discriminant analyses of MR imaging measures were performed to differentiate 164 Alzheimer disease (AD) cases from 203 healthy control cases. Separate analyses were performed by using data from MR images obtained at one time point or by combining single-time-point measures with 1-year change measures. Resulting discriminant functions were applied to 317 MCI cases to derive individual patient risk scores. Risk of conversion to AD was estimated as a continuous function of risk score percentile. Kaplan-Meier survival curves were computed for risk score quartiles. Odds ratios (ORs) for the conversion to AD were computed between the highest and lowest quartile scores. Individualized risk estimates from baseline MR examinations indicated that the 1-year risk of conversion to AD ranged from 3% to 40% (average group risk, 17%; OR, 7.2 for highest vs lowest score quartiles). Including measures of 1-year change in global and regional volumes significantly improved risk estimates (P = 001), with the risk of conversion to AD in the subsequent year ranging from 3% to 69% (average group risk, 27%; OR, 12.0 for highest vs lowest score quartiles). Relative to the risk of conversion to AD conferred by the clinical diagnosis of MCI alone, MR imaging measures yield substantially more informative patient-specific risk estimates. Such predictive prognostic information will be critical if disease-modifying therapies become available. http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101975/-/DC1. RSNA, 2011

A multi-resolution analysis of lidar-DTMs to identify geomorphic processes from characteristic topographic length scales

NASA Astrophysics Data System (ADS)

Sangireddy, H.; Passalacqua, P.; Stark, C. P.

2013-12-01

Characteristic length scales are often present in topography, and they reflect the driving geomorphic processes. The wide availability of high resolution lidar Digital Terrain Models (DTMs) allows us to measure such characteristic scales, but new methods of topographic analysis are needed in order to do so. Here, we explore how transitions in probability distributions (pdfs) of topographic variables such as (log(area/slope)), defined as topoindex by Beven and Kirkby[1979], can be measured by Multi-Resolution Analysis (MRA) of lidar DTMs [Stark and Stark, 2001; Sangireddy et al.,2012] and used to infer dominant geomorphic processes such as non-linear diffusion and critical shear. We show this correlation between dominant geomorphic processes to characteristic length scales by comparing results from a landscape evolution model to natural landscapes. The landscape evolution model MARSSIM Howard[1994] includes components for modeling rock weathering, mass wasting by non-linear creep, detachment-limited channel erosion, and bedload sediment transport. We use MARSSIM to simulate steady state landscapes for a range of hillslope diffusivity and critical shear stresses. Using the MRA approach, we estimate modal values and inter-quartile ranges of slope, curvature, and topoindex as a function of resolution. We also construct pdfs at each resolution and identify and extract characteristic scale breaks. Following the approach of Tucker et al.,[2001], we measure the average length to channel from ridges, within the GeoNet framework developed by Passalacqua et al.,[2010] and compute pdfs for hillslope lengths at each scale defined in the MRA. We compare the hillslope diffusivity used in MARSSIM against inter-quartile ranges of topoindex and hillslope length scales, and observe power law relationships between the compared variables for simulated landscapes at steady state. We plot similar measures for natural landscapes and are able to qualitatively infer the dominant geomorphic processes. Also, we explore the variability in hillslope length scales as a function of hillslope diffusivity coefficients and critical shear stress in natural landscapes and show that we can infer signatures of dominant geomorphic processes by analyzing characteristic topographic length scales present in topography. References: Beven, K. and Kirkby, M. J.: A physically based variable contributing area model of basin hydrology, Hydrol. Sci. Bull., 24, 43-69, 1979 Howard, A. D. (1994). A detachment-limited model of drainage basin evolution.Water resources research, 30(7), 2261-2285. Passalacqua, P., Do Trung, T., Foufoula Georgiou, E., Sapiro, G., & Dietrich, W. E. (2010). A geometric framework for channel network extraction from lidar: Nonlinear diffusion and geodesic paths. Journal of Geophysical. Research: Earth Surface (2003-2012), 115(F1). Sangireddy, H., Passalacqua, P., Stark, C.P.(2012). Multi-resolution estimation of lidar-DTM surface flow metrics to identify characteristic topographic length scales, EP13C-0859: AGU Fall meeting 2012. Stark, C. P., & Stark, G. J. (2001). A channelization model of landscape evolution. American Journal of Science, 301(4-5), 486-512. Tucker, G. E., Catani, F., Rinaldo, A., & Bras, R. L. (2001). Statistical analysis of drainage density from digital terrain data. Geomorphology, 36(3), 187-202.

Analytic assessment of Laplacian estimates via novel variable interring distances concentric ring electrodes.

PubMed

Makeyev, Oleksandr; Besio, Walter G

2016-08-01

Noninvasive concentric ring electrodes are a promising alternative to conventional disc electrodes. Currently, superiority of tripolar concentric ring electrodes over disc electrodes, in particular, in accuracy of Laplacian estimation has been demonstrated in a range of applications. In our recent work we have shown that accuracy of Laplacian estimation can be improved with multipolar concentric ring electrodes using a general approach to estimation of the Laplacian for an (n + 1)-polar electrode with n rings using the (4n + 1)-point method for n ≥ 2. This paper takes the next step toward further improving the Laplacian estimate by proposing novel variable inter-ring distances concentric ring electrodes. Derived using a modified (4n + 1)-point method, linearly increasing inter-ring distances tripolar (n = 2) and quadripolar (n = 3) electrode configurations are analytically compared to their constant inter-ring distances counterparts using coefficients of the Taylor series truncation terms. Obtained results suggest that increasing inter-ring distances electrode configurations may decrease the truncation error of the Laplacian estimation resulting in more accurate Laplacian estimates compared to respective constant inter-ring distances configurations. For currently used tripolar electrode configuration the truncation error may be decreased more than two-fold while for the quadripolar more than seven-fold decrease is expected.

Contrast volume to creatinine clearance ratio for the prediction of contrast-induced nephropathy in patients undergoing coronary angiography or percutaneous intervention.

PubMed

Barbieri, Lucia; Verdoia, Monica; Marino, Paolo; Suryapranata, Harry; De Luca, Giuseppe

2016-06-01

Contrast-induced nephropathy is a common complication of procedures that are likely to use contrast media. The identification of high-risk patients and preventive optimal hydration are key measures to reduce the incidence of contrast-induced nephropathy. The aim of this study was to evaluate the role of the contrast volume to creatinine clearance ratio (V/CrCl) in the prediction of contrast-induced nephropathy after coronary angiography or percutaneous coronary intervention. Our population consisted of 2308 consecutive patients undergoing coronary angiography and/or percutaneous coronary intervention. The risk of contrast-induced nephropathy was evaluated across quartiles of the V/CrCl. Receiver operating characteristic curves were used to identify the best predictive value. Contrast-induced nephropathy was defined as an absolute increase of 0.5 mg/dL or a relative increase of >25% in creatinine levels 24-48 hours after the procedure. The total incidence of contrast-induced nephropathy was 12.2% and was significantly higher in the fourth quartile (first quartile 8.8%, second quartile 8.9%, third quartile 11.6% and fourth quartile 19.4%; P < 0.001). Using receiver operating characteristic curves we identified V/CrCl ≥ 6.15 as the best discriminant value for the prediction of contrast-induced nephropathy, which occurred in 25.1% of patients with V/CrCl ≥ 6.15 versus 9.7% in patients with V/CrCl < 6.15. These results were also confirmed at multivariate analysis after correction for all baseline confounders (adjusted odds ratio (AOR) (95% confidence interval (CI)) 1.81 (1.19-2.76); P = 0.005). The association between V/CrCl > 6.15 and an increased risk of contrast-induced nephropathy was confirmed among diabetic (11% vs. 27.7%; p P < 0.001) and non-diabetic patients (8.9% vs. 23%; Pp < 0.001), also after correction for all baseline confounders. This is one of the largest studies evaluating the association between the V/CrCl ratio and the risk of contrast-induced nephropathy in patients undergoing coronary angiography or percutaneous coronary intervention. We found that a V/CrCl ratio >6.15 was independently associated with an increased risk of contrast-induced nephropathy. © The European Society of Cardiology 2015.

All-cause mortality increased by environmental cadmium exposure in the Japanese general population in cadmium non-polluted areas.

PubMed

Suwazono, Yasushi; Nogawa, Kazuhiro; Morikawa, Yuko; Nishijo, Muneko; Kobayashi, Etsuko; Kido, Teruhiko; Nakagawa, Hideaki; Nogawa, Koji

2015-07-01

The aim of the present study was to evaluate the effect of environmental cadmium (Cd) exposure indicated by urinary Cd on all-cause mortality in the Japanese general population. A 19-year cohort study was conducted in 1067 men and 1590 women aged 50 years or older who lived in three cadmium non-polluted areas in Japan. The subjects were divided into four quartiles based on creatinine adjusted U-Cd (µg g(-1) cre). The hazard ratio (HR) and 95% confidence interval (CI) for continuous U-Cd or the quartiles of U-Cd were estimated for all-cause mortality using a proportional hazards regression.The all-cause mortality rates per 1000 person years were 31.2 and 15.1 in men and women, respectively. Continuous U-Cd (+1 µg g(-1) cre) was significantly related to the all-cause mortality in men (HR 1.05, 95% CI: 1.02-1.09) and women (HR 1.04, 95% CI: 1.01-1.07). Furthermore in men, the third (1.96-3.22 µg g(-1) cre) and fourth quartile (≥3.23 µg g(-1) cre) of U-Cd showed a significant, positive HR (third: HR 1.35, 95% CI: 1.03-1.77, fourth: HR 1.64, 95% CI: 1.26-2.14) for all-cause mortality compared with the first quartile (<1.14 µg g(-1) cre). In women, the fourth quartile of U-Cd (≥4.66 µg g(-1) cre) also showed a significant HR (1.49, 95% CI 1.11-2.00) for all-cause mortality compared with the first quartile (<1.46 µg g(-1) cre).In the present study, U-Cd was significantly associated with increased mortality in the Japanese general population, indicating that environmental Cd exposure adversely affects the life prognosis in Cd non-polluted areas in Japan. Copyright © 2014 John Wiley & Sons, Ltd.

The Effects of Travel Burden on Outcomes After Resection of Extrahepatic Biliary Malignancies: Results from the US Extrahepatic Biliary Consortium.

PubMed

O'Connor, Sean C; Mogal, Harveshp; Russell, Gregory; Ethun, Cecilia; Fields, Ryan C; Jin, Linda; Hatzaras, Ioannis; Vitiello, Gerardo; Idrees, Kamran; Isom, Chelsea A; Martin, Robert; Scoggins, Charles; Pawlik, Timothy M; Schmidt, Carl; Poultsides, George; Tran, Thuy B; Weber, Sharon; Salem, Ahmed; Maithel, Shishir; Shen, Perry

2017-12-01

Surgical resection of extrahepatic biliary malignancies has been increasingly centralized at high-volume tertiary care centers. While this has improved outcomes overall, increased travel burden has been associated with worse survival for many other malignancies. We hypothesized that longer travel distances are associated with worse outcomes for these patients as well. Data was analyzed from the US Extrahepatic Biliary Consortium database, which retrospectively reviewed patients who received resection of extrahepatic biliary malignancies at 10 high-volume centers. Driving distance to the patient's treatment center was measured for 1025 patients. These were divided into four quartiles for analysis: < 24.5, 24.5-57.2, 57.2-117, and < 117 mi. Cox proportional hazard models were then used to measure differences in overall survival. No difference was found between the groups in severity of disease or post-operative complications. The median overall survival in each quartile was as follows: 1st = 1.91, 2nd = 1.60, 3rd = 1.30, and 4th = 1.39 years. Patients in the 3rd and 4th quartile had a significantly lower median household income (p = 0.0001) and a greater proportion Caucasian race (p = 0.0001). However, neither of these was independently associated with overall survival. The two furthest quartiles were found to have decreased overall survival (HR = 1.39, CI = 1.12-1.73 and HR = 1.3, CI = 1.04-1.62), with quartile 3 remaining significant after multivariate analysis (HR = 1.45, CI = 1.04-2.0, p = 0.028). Longer travel distances were associated with decreased overall survival, especially in the 3rd quartile of our study. Patients traveling longer distances also had a lower household income, suggesting that these patients have significant barriers to care.

Vitamin D Levels and the Risk of Cognitive Decline in Chinese Elderly People: the Chinese Longitudinal Healthy Longevity Survey.

PubMed

Matchar, David B; Chei, Choy-Lye; Yin, Zhao-Xue; Koh, Victoria; Chakraborty, Bibhas; Shi, Xiao-Ming; Zeng, Yi

2016-10-01

Vitamin D has a neuroprotective function, potentially important for the prevention of cognitive decline. Prospective studies from Western countries support an association between lower vitamin D level and future cognitive decline in elderly people. No prospective study has examined this association in Asia. This community-based cohort study of elderly people in China follows 1,202 cognitively intact adults aged ≥60 years for a mean duration of 2 years. Plasma vitamin D level was measured at the baseline. Cognitive state of participants was assessed using the Mini-Mental State Examination (MMSE). Cognitive impairment was defined as an MMSE score <18. Cognitive decline was defined as ≥3 points decline from baseline. Multivariable logistic regression models were used to examine the association between quartiles of vitamin D levels with cognitive decline and incidence of cognitive impairment. Participants with low vitamin D level had an increased risk of cognitive decline. Compared with the highest quartile of vitamin D levels, the multivariable odds ratios (ORs; 95% confidence interval) for cognitive decline were 2.1 (1.3-3.4) for the second highest quartile, 2.2 (1.4-3.6) for the third highest quartile, and 2.0 (1.2-3.3) for the lowest quartile. The multivariable ORs of incident cognitive impairment for the second highest, third highest, and lowest versus highest quartiles of vitamin D levels were 1.9 (0.9-4.1), 2.6 (1.2-5.6), and 3.2 (1.5-6.6), respectively. This first follow-up study of elderly people, including the oldest-old, in Asia shows that low vitamin D levels were associated with increased risk of subsequent cognitive decline and impairment. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

High-sensitivity C-reactive protein and cognitive decline: the English Longitudinal Study of Ageing.

PubMed

Zheng, Fanfan; Xie, Wuxiang

2018-06-01

High-sensitivity C-reactive protein (hs-CRP) has been suggested to be involved in the process of cognitive decline. However, the results from previous studies exploring the relationship between hs-CRP concentration and cognitive decline are inconsistent. We employed data from wave 2 (2004-2005) to wave 7 (2014-2015) of the English Longitudinal Study of Ageing. Cognitive function was assessed at baseline (wave 2) and reassessed biennially at waves 3-7. A total of 5257 participants (54.9% women, mean age 65.4 ± 9.4 years) with baseline hs-CRP levels ranged from 0.2 to 210.0 mg/L (median: 2.0 mg/L, interquartile range: 0.9-4.1 mg/L) were studied. The mean follow-up duration was 8.1 ± 2.8 years, and the mean number of cognitive assessment was 4.9 ± 1.5. Linear mixed models show that a one-unit increment in natural log-transformed hs-CRP was associated with faster declines in global cognitive scores [-0.048 points/year, 95% confidence interval (CI) -0.072 to -0.023], memory scores (-0.022 points/year, 95% CI -0.031 to -0.013), and executive function scores (-0.025 points/year, 95% CI -0.043 to -0.006), after multivariable adjustment. Compared with the lowest quartile of hs-CRP, the multivariable-adjusted rate of global cognitive decline associated with the second, third, and highest quartile was faster by -0.043 points/year (95% CI -0.116 to 0.029), -0.090 points/year (95% CI -0.166 to -0.015), -0.145 (95% CI -0.221 to -0.069), respectively (p for trend <0.001). Similarly, memory and executive function also declined faster with increasing quartiles of hs-CRP. A significant association between hs-CRP concentration and long-term cognitive decline was observed in this study. Hs-CRP might serve as a biomarker for cognitive decline.

Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women.

PubMed

Ekelund, Ulf; Steene-Johannessen, Jostein; Brown, Wendy J; Fagerland, Morten Wang; Owen, Neville; Powell, Kenneth E; Bauman, Adrian; Lee, I-Min

2016-09-24

High amounts of sedentary behaviour have been associated with increased risks of several chronic conditions and mortality. However, it is unclear whether physical activity attenuates or even eliminates the detrimental effects of prolonged sitting. We examined the associations of sedentary behaviour and physical activity with all-cause mortality. We did a systematic review, searching six databases (PubMed, PsycINFO, Embase, Web of Science, Sport Discus, and Scopus) from database inception until October, 2015, for prospective cohort studies that had individual level exposure and outcome data, provided data on both daily sitting or TV-viewing time and physical activity, and reported effect estimates for all-cause mortality, cardiovascular disease mortality, or breast, colon, and colorectal cancer mortality. We included data from 16 studies, of which 14 were identified through a systematic review and two were additional unpublished studies where pertinent data were available. All study data were analysed according to a harmonised protocol, which categorised reported daily sitting time and TV-viewing time into four standardised groups each, and physical activity into quartiles (in metabolic equivalent of task [MET]-hours per week). We then combined data across all studies to analyse the association of daily sitting time and physical activity with all-cause mortality, and estimated summary hazard ratios using Cox regression. We repeated these analyses using TV-viewing time instead of daily sitting time. Of the 16 studies included in the meta-analysis, 13 studies provided data on sitting time and all-cause mortality. These studies included 1 005 791 individuals who were followed up for 2-18·1 years, during which 84 609 (8·4%) died. Compared with the referent group (ie, those sitting <4 h/day and in the most active quartile [>35·5 MET-h per week]), mortality rates during follow-up were 12-59% higher in the two lowest quartiles of physical activity (from HR=1·12, 95% CI 1·08-1·16, for the second lowest quartile of physical activity [<16 MET-h per week] and sitting <4 h/day; to HR=1·59, 1·52-1·66, for the lowest quartile of physical activity [<2·5 MET-h per week] and sitting >8 h/day). Daily sitting time was not associated with increased all-cause mortality in those in the most active quartile of physical activity. Compared with the referent (<4 h of sitting per day and highest quartile of physical activity [>35·5 MET-h per week]), there was no increased risk of mortality during follow-up in those who sat for more than 8 h/day but who also reported >35·5 MET-h per week of activity (HR=1·04; 95% CI 0·99-1·10). By contrast, those who sat the least (<4 h/day) and were in the lowest activity quartile (<2·5 MET-h per week) had a significantly increased risk of dying during follow-up (HR=1·27, 95% CI 1·22-1·31). Six studies had data on TV-viewing time (N=465 450; 43 740 deaths). Watching TV for 3 h or more per day was associated with increased mortality regardless of physical activity, except in the most active quartile, where mortality was significantly increased only in people who watched TV for 5 h/day or more (HR=1·16, 1·05-1·28). High levels of moderate intensity physical activity (ie, about 60-75 min per day) seem to eliminate the increased risk of death associated with high sitting time. However, this high activity level attenuates, but does not eliminate the increased risk associated with high TV-viewing time. These results provide further evidence on the benefits of physical activity, particularly in societies where increasing numbers of people have to sit for long hours for work and may also inform future public health recommendations. None. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Association of lipid parameters with insulin resistance in different glycemic among the elderly population].

PubMed

Pang, S J; Man, Q Q; Song, S; Song, P K; Liu, Z; Li, Y Q; He, L; Zhao, W H; Zhang, J

2018-06-06

Objective: This study was to analyze the association of lipid parameters with insulin resistance of Chinese elderly population in different glycemic status. Methods: Data were from China National Chronic Diseases and Nutrition Survey (2015). A total of 15 535 participants aged 60 and above who had completed survey questionnaire, physical examination, fasting blood biochemistry and insulin measurements were included in this study. According to the American Diabetes Association (2010) criteria, the participants were divided into normal glucose regulation, pre-diabetes, newly-diagnosed diabetes and previously-diagnosed diabetes. Multivariable logistic regression was preformed to assess the effects of lipid parameters on insulin resistance in different glycemic among the elderly population. Results: The proportion of normal glucose regulation, pre-diabetes, newly-diagnosed diabetes and previously-diagnosed diabetes was 50.46% ( n =7 839), 22.19% ( n =3 448), 12.46% ( n =1 937) and 14.88% ( n =2 311), respectively. The risk of insulin resistance increased with the elevated per quartile of triglycerides (TG) ( OR= 1.48,95 %CI: 1.35-1.62), non-high-density lipoprotein cholesterol (Non-HDL)/HDL-C ( OR= 1.23, 95 %CI: 1.12-1.35) and TG/HDL-C ( OR= 1.50, 95 %CI: 1.36-1.65) and decreased with the elevated per quartile of HDL-C ( OR= 0.83, 95 %CI: 0.76-0.90) after multivariate adjustment among normal glucose regulation participants. As for pre-diabetes participants, the risk of insulin resistance increased with the elevated per quartile of TG ( OR= 1.26, 95 %CI: 1.14-1.39) and TG/HDL-C ( OR= 1.38, 95 %CI: 1.24-1.54) and decreased with the elevated per quartile of HDL-C ( OR= 0.79, 95 %CI: 0.71-0.87). The risk of insulin resistance increased with the elevated per quartiles of TG/HDL-C ( OR= 1.29, 95 %CI: 1.12-1.48) among newly-diagnosed diabetes. As for previously-diagnosed diabetes, the risk of insulin resistance increased with the elevated per quartile of TG, Non-HDL/HDL-C and TG/HDL-C with adjusted OR (95 %CI ) about 1.28 (1.16-1.41), 1.37(1.21-1.55) and 1.51 (1.33-1.72) repsectivley and decreased with the elevated per quartile of HDL-C ( OR= 0.77, 95 %CI: 0.67-0.87). Conclusion: The relationship between lipid parameters and insulin resistance presented diversely in different glycemic status. The elderly with normal glucose regulation and previously-diagnosed diabetes should pay close attention to the change of TG/HDL-C, TG, HDL-C and Non-HDL/HDL-C. As for prediabetes participants, the TG/HDL-C, TG and HDL-C level change should be focused.

Screenieboppers and extreme screenies: the place of screen time in the time budgets of 10-13 year-old Australian children.

PubMed

Olds, Tim; Ridley, Kate; Dollman, Jim

2006-04-01

Excessive 'screen time' has been associated with a range of psychosocial disturbances and increasing pediatric obesity. This study describes the magnitude, distribution, composition and time-distribution of children's screen use; examines correlates of screen use; and characterises 'extreme' screen users (top quartile). 1,039 South Australian children aged 10-13 years old completed a multimedia 24-hour activity recall diary on 2-4 occasions in 2002, including at least one school day and one non-school day. The median screen time was 229 minutes.d(-1). This was higher in boys (264 vs. 196 minutes; p<0.001) and on non-school days (260 vs. 190 minutes; p<0.001), increased with age (p=0.003), and decreased with socio-economic status (SES; p=0.003). Television consumed 73% of all screen time, video games 19%, non-game computer use 6%, and cinema 2%. The top quartile of screen users were more likely to be boys (OR=3.8), have low physical activity (OR=4.3), spend >25% of screen time playing video games (OR=1.8), sleep less, and be of lower SES. Interventions to reduce screen time should target inactive, low-SES boys, encourage earlier bedtimes, and limit video game use.

Minimum Nurse Staffing Legislation and the Financial Performance of California Hospitals

PubMed Central

Reiter, Kristin L; Harless, David W; Pink, George H; Mark, Barbara A

2012-01-01

Objective To estimate the effect of minimum nurse staffing ratios on California acute care hospitals’ financial performance. Data Sources/Study Setting Secondary data from Medicare cost reports, the American Hospital Association's (AHA) Annual Survey, and the California Office of Statewide Health Planning and Development (OSHPD) are combined from 2000 to 2006 for 203 hospitals in California and 407 hospitals in 12 comparison states. Study Design The study employs a difference-in-difference analytical approach. Hospitals are grouped into quartiles based on pre-regulation nurse staffing levels in adult medical-surgical and pediatric units (quartile 1 = lowest staffing). Differences in operating margin, operating expenses per day, and inpatient operating expenses per discharge for California hospitals within a staffing quartile during the period of regulation are compared to differences at hospitals in comparison states during the same period. Data Collection/Extraction Methods Hospital data from Medicare cost reports are merged with nurse staffing measures obtained from AHA and from OSPHD. Principal Findings Relative to hospitals in comparison states, operating margins declined significantly for California hospitals in quartiles 2 and 3. Operating expenses increased significantly in quartiles 1, 2, and 3. Conclusions Implementation of minimum nurse staffing legislation in California put substantial financial pressure on some hospitals. PMID:22150627

Real price and affordability as challenges for effective tobacco control policies: an analysis for Argentina.

PubMed

Rodríguez-Iglesias, Germán; González-Rozada, Martín; Champagne, Beatriz Marcet; Schoj, Verónica

2015-02-01

To describe the evolution of cigarettes' real price and affordability during the last decade in Argentina. To analyze the real price of cigarettes, the weighted average monthly price of a pack of 20 cigarettes was divided by the consumer price index (CPI) from 2004 to 2014. The relative income price (RIP) was evaluated for the same period, defining RIP as the percentage of the income required to buy 100 packs of 20-per-pack cigarettes. The RIP was calculated for first-quartile, median, and third-quartile income groups. The lower the RIP, the higher the affordability. The nominal price of a pack of 20 cigarettes sold in Argentina increased from AR$ 2.24 in March 2004 to AR$ 14.36 in June 2014 (nominal price increase of about 19.7% per year). The real price fell from AR$ 2.24 in March 2004 to AR$ 2.11 in June 2014 (real price drop of about 0.6% per year). Between June 2004 and June 2014, the RIP decreased about 39% for the 3rd quartile income group (from 31.3% to 19.2%), about 42% for the median (from 55.7% to 32.0%), and about 50% for the 1st quartile (from 104.4% to 51.8%). In Argentina, inflation and rising income were greater than growth in cigarette prices. Cigarette affordability increased for each income group, with the highest shifts occurring among the poorest and most vulnerable income earners. The increased affordability of cigarettes might reduce the impact of implemented tobacco control policies.

Association of high-level humidifier disinfectant exposure with lung injury in preschool children.

PubMed

Park, Dong-Uk; Ryu, Seung-Hun; Roh, Hyun-Suk; Lee, Eun; Cho, Hyun-Ju; Yoon, Jisun; Lee, So-Yeon; Cho, Young Ah; Do, Kyung-Hyun; Hong, Soo-Jong

2018-03-01

Children aged ≤6years reportedly account for 52% of victims of humidifier disinfectant-associated lung injuries. To evaluate the association of humidifier disinfectants with lung injury risk among children aged ≤6years. Patients with humidifier disinfectant-associated lung injuries (n=214) who were clinically evaluated to have a definite (n=108), probable (n=49), or possible (n=57) association with humidifier disinfectants as well as control patients (n=123) with lung injury deemed unlikely to be associated with humidifier disinfectant use were evaluated to determine factors associated with increased risk of humidifier disinfectant-associated lung injury using unconditional multiple logistic regression analysis. For estimated airborne humidifier disinfectant concentrations, risk of humidifier disinfectant-associated lung injury increased ≥two-fold in a dose-dependent manner in the highest quartile (Q4, 135-1443μg/m 3 ) compared with that in the lowest quartile (Q1, ≤33μg/m 3 ). Registered patients using more than two humidifier disinfectant brands were at an increased risk of humidifier disinfectant-associated lung injury (adjusted OR, 2.2; 95% confidence interval, 1.3-3.8) compared with those using only one brand. With respect to the duration of humidifier disinfectant use, risk of humidifier disinfectant-associated lung injury increased ≥two-fold in the lowest quartile (≤5months) compared with that in the highest quartile (≥14months; adjusted OR 0.3; 95% confidence interval, 0.2-0.6). Younger children are more vulnerable to HDLI when exposed to HD chemicals within short period in early life. Copyright © 2017 Elsevier B.V. All rights reserved.

The relationship of insulin resistance estimated by triglyceride glucose index and coronary plaque characteristics.

PubMed

Won, Ki-Bum; Kim, Yun Seok; Lee, Byoung Kwon; Heo, Ran; Han, Donghee; Lee, Ji Hyun; Lee, Sang-Eun; Sung, Ji Min; Cho, Iksung; Park, Hyung-Bok; Cho, In-Jeong; Chang, Hyuk-Jae

2018-05-01

The triglyceride glucose (TyG) index is a useful surrogate marker for insulin resistance, which is an important risk factor for coronary artery disease (CAD). However, data on the relationship of the TyG index and coronary plaque characteristics are limited.This study included 2840 participants with near-normal renal function who underwent coronary computed tomography angiography. CAD was defined as the presence of any plaques, and obstructive CAD was defined as the presence of plaques with ≥50% stenosis. The relationship between the TyG index and noncalcified plaque (NCP), calcified or mixed plaque (CMP), and coronary artery calcium score (CACS) was evaluated.All participants were stratified into 4 groups based on the quartiles of the TyG index. The prevalence of CAD and obstructive CAD significantly increased with increasing quartiles. The risk for NCP and obstructive NCP was not different among all groups. However, compared with group I (lowest quartile), the risk for CMP was higher in groups III (odds ratio [OR]: 1.438) and IV (highest quartile) (OR: 1.895) (P < .05), and that for obstructive CMP was higher in groups II (OR: 1.469), III (OR: 1.595), and IV (OR: 2.168) (P < .05). Multivariate regression analysis showed that the TyG index was associated with an increased risk for CAD (OR: 1.700), obstructive CAD (OR: 1.692), and CACS >400 (OR: 1.448) (P < .05).The TyG index was independently associated with the presence and severity of CAD due to an increased risk for CMP.

Relative validity and reproducibility of a quantitative FFQ for assessing nutrient intakes of vegetarians in Taiwan.

PubMed

Chiu, Tina H T; Huang, Hui-Ya; Chen, Kuan-Ju; Wu, Yu-R U; Chiu, Jason P C; Li, Yi-Hwei; Chiu, Brian C-H; Lin, Chin-Lon; Lin, Ming-Nan

2014-07-01

To assess the relative validity and reproducibility of the quantitative FFQ used in the Tzu Chi Health Study (TCHS). The reproducibility was evaluated by comparing the baseline FFQ with the 2-year follow-up FFQ. The validity was evaluated by comparing the baseline FFQ with 3 d dietary records and biomarkers (serum folate and vitamin B12). Median comparison, cross-classification and Spearman correlation with and without energy adjustment and deattenuation for day-to-day variation were assessed. TCHS is a prospective cohort containing a high proportion of true vegetarians and part-time vegetarians (regularly consuming a vegetarian diet without completely avoiding meat). Subsets of 103, seventy-eight and 1528 TCHS participants were included in the reproducibility, dietary record-validity and biomarker-validity studies, respectively. Correlations assessing the reproducibility for repeat administrations of the FFQ were in the range of 0·46-0·65 for macronutrients and 0·35-0·67 for micronutrients; the average same quartile agreement was 40%. The correlation between FFQ and biomarkers was 0·41 for both vitamin B12 and folate. Moderate to good correlations between the baseline FFQ and dietary records were found for energy, protein, carbohydrate, saturated and monounsaturated fat, fibre, vitamin C, vitamin A, K, Ca, Mg, P, Fe and Zn (average crude correlation: 0·47 (range: 0·37-0·66); average energy-adjusted correlation: 0·43 (range: 0·38-0·55); average energy-adjusted deattenuated correlation: 0·50 (range: 0·44-0·66)) with same quartile agreement rate of 39% (range: 35-45%), while misclassification to the extreme quartile was rare (average: 4% (range: 0-6%)). The FFQ is a reliable and valid tool to rank relative intake of major nutrients for TCHS participants.

Urinary Cadmium Threshold to Prevent Kidney Disease Development.

PubMed

Satarug, Soisungwan; Ruangyuttikarn, Werawan; Nishijo, Muneko; Ruiz, Patricia

2018-05-01

The frequently observed association between kidney toxicity and long-term cadmium (Cd) exposure has long been dismissed and deemed not to be of clinical relevance. However, Cd exposure has now been associated with increased risk of developing chronic kidney disease (CKD). We investigated the link that may exist between kidney Cd toxicity markers and clinical kidney function measure such as estimated glomerular filtration rates (eGFR). We analyzed data from 193 men to 202 women, aged 16−87 years [mean age 48.8 years], who lived in a low- and high-Cd exposure areas in Thailand. The mean (range) urinary Cd level was 5.93 (0.05⁻57) μg/g creatinine. The mean (range) for estimated GFR was 86.9 (19.6−137.8) mL/min/1.73 m². Kidney pathology reflected by urinary β2-microglobulin (β2-MG) levels ≥ 300 μg/g creatinine showed an association with 5.32-fold increase in prevalence odds of CKD ( p = 0.001), while urinary Cd levels showed an association with a 2.98-fold greater odds of CKD prevalence ( p = 0.037). In non-smoking women, Cd in the highest urinary Cd quartile was associated with 18.3 mL/min/1.73 m² lower eGFR value, compared to the lowest quartile ( p < 0.001). Evidence for Cd-induced kidney pathology could thus be linked to GFR reduction, and CKD development in Cd-exposed people. These findings may help prioritize efforts to reassess Cd exposure and its impact on population health, given the rising prevalence of CKD globally.

Botulinum toxin type-A affects mechanics of non-injected antagonistic rat muscles.

PubMed

Ateş, Filiz; Yucesoy, Can A

2018-08-01

Botulinum toxin type A (BTX-A) effects on the mechanics of non-injected antagonistic muscles are unknown. The aim was to test the following hypotheses in a rat model: BTX-A injected into gastrocnemius medialis (GM) and lateralis (GL) (1) decreases forces of the antagonistic tibialis anterior (TA) and extensor digitorum longus (EDL), (2) reduces length range of force exertion and (3) increases passive forces of the TA, and (4) changes inter-antagonistic and inter-synergistic epimuscular myofascial force transmission (EMFT). Two groups of Wistar rats were tested: BTX (0.1 units of BTX-A were injected to the GM and GL, each) and Control (saline injected). Five-days post, TA, EDL, GM-GL, and soleus distal and EDL proximal isometric forces were measured after TA lengthening. BTX-A exposure caused forces of all muscles to decrease significantly. TA and EDL active force drops (maximally by 37.3%) show inter-compartmental spread. Length range of force exertion of the TA did not change, but its passive force increased significantly (by 25%). The percentages of intramuscular connective tissue content of the TA and EDL was higher (BTX: 20.0 ± 4.9% and 19.3 ± 4.1% vs. control: 13.1 ± 5.4% and 14.5 ± 4.0%, respectively). Calf muscles' forces were not affected by TA length changes for both groups indicating lacking inter-antagonistic EMFT. However, BTX-A altered EDL proximo-distal force differences hence, inter-synergistic EMFT. A major novel finding is that BTX-A affects mechanics of non-injected antagonistic muscles in test conditions involving only limited EMFT. The effects indicating a stiffer muscle with no length range increase contradict some treatment aims, which require clinical testing. Copyright © 2018 Elsevier Ltd. All rights reserved.

A single institution study of radiation dose received from CT imaging: A comparison to Malaysian NDRL

NASA Astrophysics Data System (ADS)

Osman, N. D.; Shamsuri, S. B. M.; Tan, Y. W.; Razali, M. A. S. M.; Isa, S. M.

2017-05-01

Advancement of CT technology has led to an increase in CT scanning as it improves the diagnosis. However, it is important to assess health risk of patients associated with ionising radiation received from CT. This study evaluated current dose distributions at Advanced Medical and Dental Institute (AMDI), Malaysia and was used to establish Local Diagnostic Reference Level (LDRL). Dose indicators such as CT Dose Index (CTDIvol and CTDIw) and Dose-Length Product (DLP) were gathered for all routine CT examinations performed at the Imaging Unit, AMDI from January 2015 to June 2016. The first and third quartile values for each dose indicator were determined. A total of 364 CT studies were performed during that period with the highest number of cases being Thorax-Abdomen-Pelvis (TAP) study (57% of total study). The CTDIw ranged between 2.0 mGy to 23.4 mGy per procedure. DLP values were ranged between 94 mGy.cm to 1687 mGy.cm. The local dose data was compared with the national DRL to monitor the current CT practice at AMDI and LDRL will be established from the calculated third quartile values of dose distribution. From the results, some of the local dose values exceeded the Malaysian and further evaluation is important to ensure the dose optimisation for patients.

Reduced total serum bilirubin levels are associated with ulcerative colitis.

PubMed

Schieffer, Kathleen M; Bruffy, Shannon M; Rauscher, Richard; Koltun, Walter A; Yochum, Gregory S; Gallagher, Carla J

2017-01-01

Chronic inflammation associated with inflammatory bowel disease (IBD) results in increased oxidative stress that damages the colonic microenvironment. Low levels of serum bilirubin, an endogenous antioxidant, have been associated with increased risk for Crohn's disease (CD). Therefore, the aim of this study was to examine whether total serum bilirubin levels are associated with ulcerative colitis (UC). We identified a retrospective case-control population (n = 6,649) from a single tertiary care center, Penn State Hershey Medical Center (PSU) and a validation cohort (n = 1,996) from Virginia Commonwealth University Medical Center (VCU). Cases were age- and sex-matched to controls (PSU: CD n = 254, UC n = 187; VCU: CD n = 233, UC n = 124). Total serum bilirubin levels were obtained from de-identified medical records and segregated into quartiles. Logistic regression analysis was performed on each quartile of total serum bilirubin compared to the last quartile (highest bilirubin levels) to determine the association of total serum bilirubin with UC. Similar to CD patients, UC patients demonstrated reduced levels of total serum bilirubin compared to controls at PSU and VCU. The lowest quartile of total serum bilirubin was independently associated with UC for the PSU (OR: 1.98 [95% CI: 1.09-3.63]) and VCU cohorts (OR: 6.07 [95% CI: 3.01-12.75]). Lower levels of the antioxidant bilirubin may reduce the capability of UC patients to remove reactive oxygen species leading to an increase in intestinal injury. Therapeutics that reduce oxidative stress may be beneficial for these patients.

A new technique for hepatic parenchymal transection using an articulating bipolar 5 cm radiofrequency device: results from the first 100 procedures.

PubMed

Takahashi, Hideo; Akyuz, Muhammet; Aksoy, Erol; Aucejo, Federico; Quintini, Cristiano; Miller, Charles; Fung, John; Berber, Eren

2018-04-13

Parenchymal transection(PT) still remains a challenge in liver resection. The outcomes of the first experience of a novel vessel-sealer for hepatic transection were assessed. A bipolar articulating vessel-sealer (Caiman ® , Aesculap Inc., Center Valley, PA) was used in 100 liver resections through both open (OLR) and laparoscopic (LLR) approaches. All data were prospectively collected into an IRB-approved department database, and clinical, surgical and perioperative parameters were analyzed. Fifty patients underwent OLR and 50 patients underwent LLR. Eighty hepatectomies were performed for malignancy. Median number of tumors was 1, with the largest focus measuring an average of 5.1 cm. Forty-nine of the procedures were major liver resections. Parenchymal transection time was 29.9 ± 3.1 min in OLR and 29.9 ± 3.6 min in LLR. Median estimated blood loss was 300 cc (Inter-quartile range (IQR) 100-575 cc). Median hospital stay was 6 days for open and 3 days for laparoscopic procedures. Ninety-day complication rate was 8% without any mortality. Bile leak rate was 4%. Staplers were used for parenchymal transection in 16 cases. This study introduces a new multifunctional device into the armamentarium of the liver surgeon. In our experience, this device facilitated the parenchymal transection by adding speed and consolidating the amount of instrumentation used in liver resection without increasing complications. Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Mapping Patterns and Trends in the Spatial Availability of Alcohol Using Low-Level Geographic Data: A Case Study in England 2003-2013.

PubMed

Angus, Colin; Holmes, John; Maheswaran, Ravi; Green, Mark A; Meier, Petra; Brennan, Alan

2017-04-12

Much literature examines the relationship between the spatial availability of alcohol and alcohol-related harm. This study aims to address an important gap in this evidence by using detailed outlet data to examine recent temporal trends in the sociodemographic distribution of spatial availability for different types of alcohol outlet in England. Descriptive analysis of measures of alcohol outlet density and proximity using extremely high resolution market research data stratified by outlet type and quintiles of area-level deprivation from 2003, 2007, 2010 and 2013 was undertaken and hierarchical linear growth models fitted to explore the significance of socioeconomic differences. We find that overall availability of alcohol changed very little from 2003 to 2013 (density +1.6%), but this conceals conflicting trends by outlet type and area-level deprivation. Mean on-trade density has decreased substantially (-2.2 outlets within 1 km (Inter-Quartile Range (IQR) -3-0), although access to restaurants has increased (+1.0 outlets (IQR 0-1)), while off-trade access has risen substantially (+2.4 outlets (IQR 0-3)). Availability is highest in the most deprived areas ( p < 0.0001) although these areas have also seen the greatest falls in on-trade outlet availability ( p < 0.0001). This study underlines the importance of using detailed, low-level geographic data to understand patterns and trends in the spatial availability of alcohol. There are significant variations in these trends by outlet type and deprivation level which may have important implications for health inequalities and public health policy.

Methodological quality assessment of paper-based systematic reviews published in oral health.

PubMed

Wasiak, J; Shen, A Y; Tan, H B; Mahar, R; Kan, G; Khoo, W R; Faggion, C M

2016-04-01

This study aimed to conduct a methodological assessment of paper-based systematic reviews (SR) published in oral health using a validated checklist. A secondary objective was to explore temporal trends on methodological quality. Two electronic databases (OVID Medline and OVID EMBASE) were searched for paper-based SR of interventions published in oral health from inception to October 2014. Manual searches of the reference lists of paper-based SR were also conducted. Methodological quality of included paper-based SR was assessed using an 11-item questionnaire, Assessment of Multiple Systematic Reviews (AMSTAR) checklist. Methodological quality was summarized using the median and inter-quartile range (IQR) of the AMSTAR score over different categories and time periods. A total of 643 paper-based SR were included. The overall median AMSTAR score was 4 (IQR 2-6). The highest median score (5) was found in the pain dentistry and periodontology fields, while the lowest median score (3) was found in implant dentistry, restorative dentistry, oral medicine, and prosthodontics. The number of paper-based SR per year and the median AMSTAR score increased over time (median score in 1990s was 2 (IQR 2-3), 2000s was 4 (IQR 2-5), and 2010 onwards was 5 (IQR 3-6)). Although the methodological quality of paper-based SR published in oral health has improved in the last few years, there is still scope for improving quality in most evaluated dental specialties. Large-scale assessment of methodological quality of dental SR highlights areas of methodological strengths and weaknesses that can be targeted in future publications to encourage better quality review methodology.

Mapping Patterns and Trends in the Spatial Availability of Alcohol Using Low-Level Geographic Data: A Case Study in England 2003–2013

PubMed Central

Angus, Colin; Holmes, John; Maheswaran, Ravi; Green, Mark A.; Meier, Petra; Brennan, Alan

2017-01-01

Much literature examines the relationship between the spatial availability of alcohol and alcohol-related harm. This study aims to address an important gap in this evidence by using detailed outlet data to examine recent temporal trends in the sociodemographic distribution of spatial availability for different types of alcohol outlet in England. Descriptive analysis of measures of alcohol outlet density and proximity using extremely high resolution market research data stratified by outlet type and quintiles of area-level deprivation from 2003, 2007, 2010 and 2013 was undertaken and hierarchical linear growth models fitted to explore the significance of socioeconomic differences. We find that overall availability of alcohol changed very little from 2003 to 2013 (density +1.6%), but this conceals conflicting trends by outlet type and area-level deprivation. Mean on-trade density has decreased substantially (−2.2 outlets within 1 km (Inter-Quartile Range (IQR) −3–0), although access to restaurants has increased (+1.0 outlets (IQR 0–1)), while off-trade access has risen substantially (+2.4 outlets (IQR 0–3)). Availability is highest in the most deprived areas (p < 0.0001) although these areas have also seen the greatest falls in on-trade outlet availability (p < 0.0001). This study underlines the importance of using detailed, low-level geographic data to understand patterns and trends in the spatial availability of alcohol. There are significant variations in these trends by outlet type and deprivation level which may have important implications for health inequalities and public health policy. PMID:28417941

Malignancy and mortality in pediatric patients with inflammatory bowel disease: a multinational study from the porto pediatric IBD group.

PubMed

de Ridder, Lissy; Turner, Dan; Wilson, David C; Koletzko, Sibylle; Martin-de-Carpi, Javier; Fagerberg, Ulrika L; Spray, Christine; Sladek, Malgorzata; Shaoul, Ron; Roma-Giannikou, Eleftheria; Bronsky, Jiri; Serban, Daniela E; Cucchiara, Salvatore; Veres, Gabor; Ruemmele, Frank M; Hojsak, Iva; Kolho, Kaija L; Davies, Ieuan H; Aloi, Marina; Lionetti, Paolo; Veereman-Wauters, Gigi; Braegger, Christian P; Trindade, Eunice; Wewer, Anne V; Hauer, Almuthe; Levine, Arie

2014-02-01

The combination of the severity of pediatric-onset inflammatory bowel disease (IBD) phenotypes and the need for intense medical treatment may increase the risk of malignancy and mortality, but evidence regarding the extent of the problem is scarce. Therefore, the Porto Pediatric IBD working group of ESPGHAN conducted a multinational-based survey of cancer and mortality in pediatric IBD. A survey among pediatric gastroenterologists of 20 European countries and Israel on cancer and/or mortality in the pediatric patient population with IBD was undertaken. One representative from each country repeatedly contacted all pediatric gastroenterologists from each country for reporting retrospectively cancer and/or mortality of pediatric patients with IBD after IBD onset, during 2006-2011. We identified 18 cases of cancers and/or 31 deaths in 44 children (26 males) who were diagnosed with IBD (ulcerative colitis, n = 21) at a median age of 10.0 years (inter quartile range, 3.0-14.0). Causes of mortality were infectious (n = 14), cancer (n = 5), uncontrolled disease activity of IBD (n = 4), procedure-related (n = 3), other non-IBD related diseases (n = 3), and unknown (n = 2). The most common malignancies were hematopoietic tumors (n = 11), of which 3 were hepatosplenic T-cell lymphoma and 3 Ebstein-Barr virus-associated lymphomas. Cancer and mortality in pediatric IBD are rare, but cumulative rates are not insignificant. Mortality is primarily related to infections, particularly in patients with 2 or more immunosuppressive agents, followed by cancer and uncontrolled disease. At least 6 lymphomas were likely treatment-associated by virtue of their phenotype.

Inter-proximal enamel reduction in contemporary orthodontics.

PubMed

Pindoria, J; Fleming, P S; Sharma, P K

2016-12-16

Inter-proximal enamel reduction has gained increasing prominence in recent years being advocated to provide space for orthodontic alignment, to refine contact points and to potentially improve long-term stability. An array of techniques and products are available ranging from hand-held abrasive strips to handpiece mounted burs and discs. The indications for inter-proximal enamel reduction and the importance of formal space analysis, together with the various techniques and armamentarium which may be used to perform it safely in both the labial and buccal segments are outlined.

WE-AB-303-11: Verification of a Deformable 4DCT Motion Model for Lung Tumor Tracking Using Different Driving Surrogates

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

Woelfelschneider, J; Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, DE; Seregni, M

2015-06-15

Purpose: Tumor tracking is an advanced technique to treat intra-fractionally moving tumors. The aim of this study is to validate a surrogate-driven model based on four-dimensional computed tomography (4DCT) that is able to predict CT volumes corresponding to arbitrary respiratory states. Further, the comparison of three different driving surrogates is evaluated. Methods: This study is based on multiple 4DCTs of two patients treated for bronchial carcinoma and metastasis. Analyses for 18 additional patients are currently ongoing. The motion model was estimated from the planning 4DCT through deformable image registration. To predict a certain phase of a follow-up 4DCT, the modelmore » considers for inter-fractional variations (baseline correction) and intra-fractional respiratory parameters (amplitude and phase) derived from surrogates. In this evaluation, three different approaches were used to extract the motion surrogate: for each 4DCT phase, the 3D thoraco-abdominal surface motion, the body volume and the anterior-posterior motion of a virtual single external marker defined on the sternum were investigated. The estimated volumes resulting from the model were compared to the ground-truth clinical 4DCTs using absolute HU differences in the lung volume and landmarks localized using the Scale Invariant Feature Transform (SIFT). Results: The results show absolute HU differences between estimated and ground-truth images with median values limited to 55 HU and inter-quartile ranges (IQR) lower than 100 HU. Median 3D distances between about 1500 matching landmarks are below 2 mm for 3D surface motion and body volume methods. The single marker surrogates Result in increased median distances up to 0.6 mm. Analyses for the extended database incl. 20 patients are currently in progress. Conclusion: The results depend mainly on the image quality of the initial 4DCTs and the deformable image registration. All investigated surrogates can be used to estimate follow-up 4DCT phases, however uncertainties decrease for three-dimensional approaches. This work was funded in parts by the German Research Council (DFG) - KFO 214/2.« less

Early Exposure to Movie Smoking Predicts Established Smoking by Older Teens and Young Adults

PubMed Central

Dalton, Madeline A.; Beach, Michael L.; Adachi-Mejia, Anna M.; Longacre, Meghan R.; Matzkin, Aurora L.; Sargent, James D.; Heatherton, Todd F.; Titus-Ernstoff, Linda

2009-01-01

OBJECTIVE Movie smoking exposure is a strong predictor of smoking initiation by adolescents; however, we do not know whether it is a long-term predictor of established smoking. We conducted a prospective study to determine whether movie smoking exposure during early adolescence predicts established smoking in older teens and young adults. DESIGN We assessed movie smoking exposure and smoking status through a written school-based survey in 1999, when participants were 10 to 14 years of age. We enrolled 73% (n = 2603) of those who had never tried smoking in a follow-up study. In 2006–2007, we conducted telephone interviews with 69% (n = 1791) of the cohort to ascertain current smoking status. The primary outcome was established smoking, defined as having smoked >100 cigarettes. Mean age at follow-up was 18.7 years. RESULTS Thirteen percent (n = 235) progressed from never smoking to established smoking during the follow-up period. Eighty-nine percent (n = 209) of established smokers smoked during the 30 days before the survey. Even after controlling for a wide range of baseline characteristics, the relative risk for established smoking increased by one third with each successive quartile of movie smoking exposure. Those in the highest quartile for baseline movie smoking exposure were twice as likely to be established smokers at follow-up compared with those in the lowest quartile. CONCLUSIONS Movie smoking exposure significantly predicted progression to established smoking in long-term follow-up. We estimate that 34.9% of established smoking in this cohort can be attributed to movie smoking exposure. PMID:19336346

Association of Fibroblast Growth Factor 23 With Atrial Fibrillation in Chronic Kidney Disease, From the Chronic Renal Insufficiency Cohort Study

PubMed Central

Mehta, Rupal; Cai, Xuan; Lee, Jungwha; Scialla, Julia J.; Bansal, Nisha; Sondheimer, James H.; Chen, Jing; Hamm, L. Lee; Ricardo, Ana C.; Navaneethan, Sankar D.; Deo, Rajat; Rahman, Mahboob; Feldman, Harold I.; Go, Alan S.; Isakova, Tamara; Wolf, Myles

2016-01-01

Importance Levels of fibroblast growth factor 23 (FGF23) are elevated in chronic kidney disease (CKD) and strongly associated with left ventricular hypertrophy, heart failure, and death. Whether FGF23 is an independent risk factor for atrial fibrillation in CKD is unknown. Objective To investigate the association of FGF23 with atrial fibrillation in CKD. Design, Setting, and Participants Prospective cohort study of 3876 individuals with mild to severe CKD who enrolled in the Chronic Renal Insufficiency Cohort Study between June 19, 2003, and September 3, 2008, and were followed up through March 31, 2013. Exposures Baseline plasma FGF23 levels. Main Outcomes and Measures Prevalent and incident atrial fibrillation. Results The study cohort comprised 3876 participants. Their mean (SD) age was 57.7 (11.0) years, and 44.8% (1736 of 3876) were female. Elevated FGF23 levels were independently associated with increased odds of prevalent atrial fibrillation (n = 660) after adjustment for cardiovascular and CKD-specific factors (odds ratio of highest vs lowest FGF23 quartile, 2.30; 95% CI, 1.69-3.13; P < .001 for linear trend across quartiles). During a median follow-up of 7.6 years (interquartile range, 6.3-8.6 years), 247 of the 3216 participants who were at risk developed incident atrial fibrillation (11.9 events per 1000 person-years). In fully adjusted models, elevated FGF23 was independently associated with increased risk of incident atrial fibrillation after adjustment for demographic, cardiovascular, and CKD-specific factors, and other markers of mineral metabolism (hazard ratio of highest vs lowest FGF23 quartile, 1.59; 95% CI, 1.00-2.53; P = .02 for linear trend across quartiles). The results were unchanged when further adjusted for ejection fraction, but individual adjustments for left ventricular mass index, left atrial area, and interim heart failure events partially attenuated the association of elevated FGF23 with incident atrial fibrillation. Conclusions and Relevance Elevated FGF23 is independently associated with prevalent and incident atrial fibrillation in patients with mild to severe CKD. The effect may be partially mediated through a diastolic dysfunction pathway that includes left ventricular hypertrophy, atrial enlargement, and heart failure events. PMID:27434583

Using Quartile-Quartile Lines as Linear Models

ERIC Educational Resources Information Center

Gordon, Sheldon P.

2015-01-01

This article introduces the notion of the quartile-quartile line as an alternative to the regression line and the median-median line to produce a linear model based on a set of data. It is based on using the first and third quartiles of a set of (x, y) data. Dynamic spreadsheets are used as exploratory tools to compare the different approaches and…

Variation in hospital mortality after pancreatoduodenectomy is related to failure to rescue rather than major complications: a nationwide audit.

PubMed

van Rijssen, Lennart B; Zwart, Maurice J; van Dieren, Susan; de Rooij, Thijs; Bonsing, Bert A; Bosscha, Koop; van Dam, Ronald M; van Eijck, Casper H; Gerhards, Michael F; Gerritsen, Josephus J; van der Harst, Erwin; de Hingh, Ignace H; de Jong, Koert P; Kazemier, Geert; Klaase, Joost; van der Kolk, Berendina M; van Laarhoven, Cornelis J; Luyer, Misha D; Molenaar, Isaac Q; Patijn, Gijs A; Rupert, Coen G; Scheepers, Joris J; van der Schelling, George P; Vahrmeijer, Alexander L; Busch, Olivier R C; van Santvoort, Hjalmar C; Groot Koerkamp, Bas; Besselink, Marc G

2018-03-20

In the mandatory nationwide Dutch Pancreatic Cancer Audit, rates of major complications and Failure to Rescue (FTR) after pancreatoduodenectomy between low- and high-mortality hospitals are compared, and independent predictors for FTR investigated. Patients undergoing pancreatoduodenectomy in 2014 and 2015 in The Netherlands were included. Hospitals were divided into quartiles based on mortality rates. The rate of major complications (Clavien-Dindo ≥3) and death after a major complication (FTR) were compared between these quartiles. Independent predictors for FTR were identified by multivariable logistic regression analysis. Out of 1.342 patients, 391 (29%) developed a major complication and in-hospital mortality was 4.2%. FTR occurred in 56 (14.3%) patients. Mortality was 0.9% in the first hospital quartile (4 hospitals, 327 patients) and 8.1% in the fourth quartile (5 hospitals, 310 patients). The rate of major complications increased by 40% (25.7% vs 35.2%) between the first and fourth hospital quartile, whereas the FTR rate increased by 560% (3.6% vs 22.9%). Independent predictors of FTR were male sex (OR = 2.1, 95%CI 1.2-3.9), age >75 years (OR = 4.3, 1.8-10.2), BMI ≥30 (OR = 2.9, 1.3-6.6), histopathological diagnosis of periampullary cancer (OR = 2.0, 1.1-3.7), and hospital volume <30 (OR = 3.9, 1.6-9.6). Variations in mortality between hospitals after pancreatoduodenectomy were explained mainly by differences in FTR, rather than the incidence of major complications. Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Relationship between the type and amount of physical activity and low back pain in Koreans aged 50 years and older.

PubMed

Kim, Won; Jin, Young Soo; Lee, Choon Sung; Hwang, Chang Ju; Lee, Sang Yoon; Chung, Sun G; Choi, Kyoung Hyo

2014-10-01

To examine the association between the type and amount of physical activity (PA) and low back pain (LBP) in people aged ≥50 years. Cross-sectional study. A nationwide survey. Data were obtained from the Fifth Korea National Health and Nutrition Examination Survey, which was conducted in 2010 and 2011. Overall, 1796 men and 2198 women aged ≥50 years were included. PA was categorized as vigorous, moderate, walking, strength exercises, or flexibility exercises. The total amount of PA was presented as quartiles of the total metabolic equivalent (MET)-minutes/week based on the PA questionnaire. Multivariate logistic regression analysis was performed to examine associations between LBP and the type and amount of PA. Odds ratio for LBP according to the type of PA and the quartiles of the total MET-minutes/week. After adjusting for age and body mass index, vigorous and moderate PA were associated with an increased risk of LBP in both men and women, whereas strength exercises were associated with a reduced risk of LBP. These associations were maintained after adjusting for all potential confounders. Subgroup analysis according to age revealed that these trends were most significantly demonstrated in women aged ≥65 years. The PA quartiles for total MET-minutes/week for men showed a U-shaped association with LBP, whereas only the fourth PA quartile for women showed an increased risk of LBP compared with the second quartile. These results suggest that both the type and amount of PA affect the development of LBP in people aged ≥50 years and thus activity modification might be helpful for prevention and management of LBP. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Association between Cardiovascular Health Score and Carotid Intima-Media Thickness: Cross-Sectional Analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) Baseline Assessment.

PubMed

Santos, Itamar S; Goulart, Alessandra C; Pereira, Alexandre C; Lotufo, Paulo A; Benseñor, Isabela M

2016-12-01

The American Heart Association aims to reduce the burden of cardiovascular disease in this decade by improving seven ideal cardiovascular health (CVH) characteristics in the population. The aim of this study was to quantify the association between the American Heart Association's CVH score and values for carotid intima-media thickness (CIMT) in the Brazilian Longitudinal Study of Adult Health baseline assessment. The Brazilian Longitudinal Study of Adult Health is a multicenter cohort study of civil servants aged 35 to 74 years in Brazil. In this study, the investigators analyzed 9,662 individuals with no previous cardiovascular disease. The distribution of CIMT values (categorized into age-, sex-, and race-specific quartiles) was analyzed according to CVH scores using χ 2 trend tests. Linear and multinomial regression models were built to evaluate the association between CIMT and CVH score. A significant increase was observed in the proportion of individuals within the first and second CIMT quartiles, as well as a decrease within the fourth quartile with higher CVH score strata (P for trend < .001). A 1-point increase in CVH score was associated in adjusted models with a decrease of 0.011 mm in CIMT and an odds ratio of 0.79 (95% CI, 0.77-0.81) of having CIMT in the fourth quartile. However, nearly 16% of individuals with optimal CVH scores had CIMT values in the highest quartile. In this study, significant associations were found between CIMT and CVH score in a large sample of middle-aged adults. However, a high CVH score did not warrant the absence of a significant subclinical atherosclerotic burden. Copyright © 2016 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

Coronary disease risk curve of serum creatinine is linear in Turkish men, U-shaped in women.

PubMed

Onat, Altan; Can, Günay; Ademoğlu, Evin; Çelik, Etem; Karagöz, Ahmet; Örnek, Ender

2013-01-01

The highest levels of glomerular filtration rate are associated with increased coronary heart disease (CHD) risk, an issue we investigated in separate sexes in a population prone to metabolic syndrome. In total, 1948 participants of the Turkish Adult Risk Factor study with available creatinine determinations were studied at a mean 3.4 years' follow-up. Using quartiles of creatinine, risk in Cox models of incident CHD or the likelihood of combined prevalent and incident CHD was assessed. Women in the lowest creatinine quartile demonstrated the lowest risk profile across diverse variables, except showing low high-density lipoprotein cholesterol and average apolipoprotein A-I and lipoprotein (a) concentrations implicating impaired atheroprotective properties. Whereas serum creatinine in men was not significantly associated with 6 proinflammatory variables comprised in linear regression analysis, apolipoprotein A-I and lipoprotein (a) were significant positive covariates in women, the latter tending to negative association in women without metabolic syndrome. In men, the highest (>1.10 mg/dL), compared with the lowest, creatinine quartile significantly predicted CHD risk, at 1.85-fold relative risks, after adjustment for established risk factors. The risk curve in women was U-shaped, the top and bottom quartiles tending to display higher risk (odds ratio, 1.28 [95% confidence interval, 0.91-1.80]) compared with the 2 intermediate quartiles. Increasing serum creatinine values are associated strongly and independently with CHD risk in men but not in women in whom the risk curve is U-shaped. The phenomenon of low creatinine levels underlies some hitherto unexplained relevant observations, and low measurements may be attributed to inassayability secondary to involvement in autoimmune activation.

Circadian clock-related genetic risk scores and risk of placental abruption.

PubMed

Qiu, Chunfang; Gelaye, Bizu; Denis, Marie; Tadesse, Mahlet G; Luque Fernandez, Miguel Angel; Enquobahrie, Daniel A; Ananth, Cande V; Sanchez, Sixto E; Williams, Michelle A

2015-12-01

The circadian clock plays an important role in several aspects of female reproductive biology. Evidence linking circadian clock-related genes to pregnancy outcomes has been inconsistent. We sought to examine whether variations in single nucleotide polymorphisms (SNPs) of circadian clock genes are associated with PA risk. Maternal blood samples were collected from 470 PA case and 473 controls. Genotyping was performed using the Illumina Cardio-MetaboChip platform. We examined 119 SNPs in 13 candidate genes known to control circadian rhythms (e.g., CRY2, ARNTL, and RORA). Univariate and penalized logistic regression models were fit to estimate odds ratios (ORs); and the combined effect of multiple SNPs on PA risk was estimated using a weighted genetic risk score (wGRS). A common SNP in the RORA gene (rs2899663) was associated with a 21% reduced odds of PA (P < 0.05). The odds of PA increased with increasing wGRS (Ptrend < 0.001). The corresponding ORs were 1.00, 1.83, 2.81 and 5.13 across wGRS quartiles. Participants in the highest wGRS quartile had a 5.13-fold (95% confidence interval: 3.21-8.21) higher odds of PA compared to those in the lowest quartile. Although the test for interaction was not significant, the odds of PA was substantially elevated for preeclamptics with the highest wGRS quartile (OR = 14.44, 95%CI: 6.62-31.53) compared to normotensive women in the lowest wGRS quartile. Genetic variants in circadian rhythm genes may be associated with PA risk. Larger studies are needed to corroborate these findings and to further elucidate the pathogenesis of this important obstetrical complication. Copyright © 2015 Elsevier Ltd. All rights reserved.

Triglyceride to HDL-C ratio and increased arterial stiffness in apparently healthy individuals.

PubMed

Wen, Jiang-Hua; Zhong, Yu-Yu; Wen, Zhi-Gang; Kuang, Chao-Qun; Liao, Jie-Rong; Chen, Li-Hua; Wang, Pei-Shen; Wu, Yue-Xia; Ouyang, Chu-Jun; Chen, Zhi-Jin

2015-01-01

High triglycerides and low high density lipoprotein cholesterol are important cardiovascular risk factors. Triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) has been reported to be useful in predicting cardiovascular disease. Brachial-ankle pulse wave velocity (baPWV) is a valid and reproducible measurement by which to assess arterial stiffness and a surrogate marker of atherosclerosis. However, there is limited evidence about the relationship between them. Therefore, we tested the hypotheses that TG/HDL-C is associated with baPWV in healthy individuals. Fasting lipid profiles, baPWV and clinical data were measured in 1498 apparently healthy, medication-free subjects (926 men, 572 women) who participated in a routine health screening from 2011 to 2013. Participants were stratified into quartiles of TG/HDL-C ratio. BaPWV > 1400 cm/s was defined as abnormal baPWV, Multivariable logistic regression was used to identify associations of TG/HDL-C quartiles and baPWV, after adjusting for the presence of conventional cardiovascular risk factors. In both genders, we observed positive relationships between TG/HDL-C quartiles and BMI, systolic BP, diastolic BP, fasting glucose, total cholesterol, LDL-C, triglycerides, uric acid, and percentages of high baPWV. Multivariable logistic regression revealed that baPWV abnormality OR value of the highest TG/HDL-C quartiles was 1.91 (95% CI: 1.11-3.30, P < 0.05) and 2.91 (95% CI: 1.02-8.30, P < 0.05) in male and female after adjusting for age, systolic BP, diastolic BP, BMI, fasting plasma glucose, LDL-C, uric acid and estimated glomerular filtration rate when compared with the lowest TG/HDL-C quartiles. Increased TG/HDL-C was independently associated with baPWV abnormality in apparently healthy individuals.

Triglyceride to HDL-C ratio and increased arterial stiffness in apparently healthy individuals

PubMed Central

Wen, Jiang-Hua; Zhong, Yu-Yu; Wen, Zhi-Gang; Kuang, Chao-Qun; Liao, Jie-Rong; Chen, Li-Hua; Wang, Pei-Shen; Wu, Yue-Xia; Ouyang, Chu-Jun; Chen, Zhi-Jin

2015-01-01

Objectives: High triglycerides and low high density lipoprotein cholesterol are important cardiovascular risk factors. Triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) has been reported to be useful in predicting cardiovascular disease. Brachial-ankle pulse wave velocity (baPWV) is a valid and reproducible measurement by which to assess arterial stiffness and a surrogate marker of atherosclerosis. However, there is limited evidence about the relationship between them. Therefore, we tested the hypotheses that TG/HDL-C is associated with baPWV in healthy individuals. Methods: Fasting lipid profiles, baPWV and clinical data were measured in 1498 apparently healthy, medication-free subjects (926 men, 572 women) who participated in a routine health screening from 2011 to 2013. Participants were stratified into quartiles of TG/HDL-C ratio. BaPWV > 1400 cm/s was defined as abnormal baPWV, Multivariable logistic regression was used to identify associations of TG/HDL-C quartiles and baPWV, after adjusting for the presence of conventional cardiovascular risk factors. Results: In both genders, we observed positive relationships between TG/HDL-C quartiles and BMI, systolic BP, diastolic BP, fasting glucose, total cholesterol, LDL-C, triglycerides, uric acid, and percentages of high baPWV. Multivariable logistic regression revealed that baPWV abnormality OR value of the highest TG/HDL-C quartiles was 1.91 (95% CI: 1.11-3.30, P < 0.05) and 2.91 (95% CI: 1.02-8.30, P < 0.05) in male and female after adjusting for age, systolic BP, diastolic BP, BMI, fasting plasma glucose, LDL-C, uric acid and estimated glomerular filtration rate when compared with the lowest TG/HDL-C quartiles. Conclusion: Increased TG/HDL-C was independently associated with baPWV abnormality in apparently healthy individuals. PMID:26064351

Treatment of Amblyopia Using Personalized Dosing Strategies: Statistical Modelling and Clinical Implementation.

PubMed

Wallace, Michael P; Stewart, Catherine E; Moseley, Merrick J; Stephens, David A; Fielder, Alistair R

2016-12-01

To generate a statistical model for personalizing a patient's occlusion therapy regimen. Statistical modelling was undertaken on a combined data set of the Monitored Occlusion Treatment of Amblyopia Study (MOTAS) and the Randomized Occlusion Treatment of Amblyopia Study (ROTAS). This exercise permits the calculation of future patients' total effective dose (TED)-that predicted to achieve their best attainable visual acuity. Daily patching regimens (hours/day) can be calculated from the TED. Occlusion data for 149 study participants with amblyopia (anisometropic in 50, strabismic in 43, and mixed in 56) were analyzed. Median time to best observed visual acuity was 63 days (25% and 75% quartiles; 28 and 91 days). Median visual acuity in the amblyopic eye at start of occlusion was 0.40 logMAR (quartiles 0.22 and 0.68 logMAR) and at end of occlusion was 0.12 (quartiles 0.025 and 0.32 logMAR). Median lower and upper estimates of TED were 120 hours (quartiles 34 and 242 hours), and 176 hours (quartiles 84 and 316 hours). The data suggest a piecewise linear relationship (P = 0.008) between patching dose-rate (hours/day) and TED with a single breakpoint estimated at 2.16 (standard error 0.51) hours/day, suggesting doses below 2.16 hours/day are less effective. We introduce the concept of TED of occlusion. Predictors for TED are visual acuity deficit, amblyopia type, and age at start of occlusion therapy. Dose-rates prescribed within the model range from 2.5 to 12 hours/day and can be revised dynamically throughout treatment in response to recorded patient compliance: a personalized dosing strategy.

Physical Activity Predicts Higher Physical Function in Older Adults: The Osteoarthritis Initiative.

PubMed

Batsis, John A; Germain, Cassandra M; Vásquez, Elizabeth; Zbehlik, Alicia J; Bartels, Stephen J

2016-01-01

Physical activity reduces mobility impairments in elders. We examined the association of physical activity on risk of subjective and objective physical function in adults with and at risk for osteoarthritis (OA). Adults aged ≥ 60 years from the longitudinal Osteoarthritis Initiative, a prospective observational study of knee OA, were classified by sex-specific quartiles of Physical Activity Score for the Elderly scores. Using linear mixed models, we assessed 6-year data on self-reported health, gait speed, Late-Life Function and Disability Index (LLFDI) and chair stand. Of 2252 subjects, mean age ranged from 66 to 70 years. Within each quartile, physical component (PCS) of the Short Form-12 and gait speed decreased from baseline to follow-up in both sexes (all P < .001), yet the overall changes across PASE quartiles between these 2 time points were no different (P = .40 and .69, males and females, respectively). Decline in PCS occurred in the younger age group, but rates of change between quartiles over time were no different in any outcomes in either sex. LLFDI scores declined in the 70+ age group. Adjusting for knee extensor strength reduced the strength of association. Higher physical activity is associated with maintained physical function and is mediated by muscle strength, highlighting the importance of encouraging physical activity in older adults with and at risk for OA.

Relationship between bisphenol A exposure and attention-deficit/ hyperactivity disorder: A case-control study for primary school children in Guangzhou, China.

PubMed

Li, Yanru; Zhang, Haibin; Kuang, Hongxuan; Fan, Ruifang; Cha, Caihui; Li, Guanyong; Luo, Zhiwei; Pang, Qihua

2018-04-01

Bisphenol A (BPA) is an endocrine-disrupting chemical. Studies have shown that the exposure to BPA is associated with attention-deficit/hyperactivity disorder (ADHD) during adolescent development. However the direct clinical evidence is limited. To investigate the possible association between environmental BPA exposure and the altered behavior of children, a case-control study was conducted with children aged 6-12 years in Guangzhou, China. Two hundred fifteen children diagnosed with ADHD and 253 healthy children from Guangzhou were recruited as the case and control groups, respectively. Urinary BPA and 8-hydroxy-2'-deoxyguanosine (8-OHdG, a biomarker of oxidative DNA damage) concentrations were determined by high-performance liquid chromatography/tandem spectrometry. The results showed that concentrations of urinary BPA for the case group were significantly higher than those for the control group (3.44 vs 1.70 μg/L; 4.63 vs 1.71 μg/g Crt. p < .001). A stepwise increase in the odds ratios for ADHD was observed with the increasing quartiles of children's urinary BPA (first quartile: reference category; second quartile adjusted OR: 1.79, 95% CI: 0.95-3.37; third quartile adjusted OR: 7.44, 95% CI: 3.91-14.1; fourth quartile adjusted OR: 9.41, 95% CI: 4.91-18.1). When the BPA levels were stratified by gender, the odds of ADHD among boys and girls increased significantly with urinary BPA concentrations (adjusted OR: 4.58, 95% CI: 2.84-7.37; adjusted OR: 2.83, 95% CI: 1.17-6.84). Urinary 8-OHdG concentrations in the ADHD children were significantly higher than those in the control group. Furthermore, the linear regression analysis results indicated that a significant relationship existed between BPA exposure and 8-OHdG levels (R = 0.257, p < .001). Our findings provide direct evidence that childhood BPA exposure may be related to ADHD and 8-OHdG concentrations for children. Moreover, BPA exposure could increase the higher occurrence of ADHD for boy than for girls. Copyright © 2017 Elsevier Ltd. All rights reserved.

The association between elevated serum uric acid level and an increased risk of renal function decline in a health checkup cohort in China.

PubMed

Cao, Xia; Wu, Liuxin; Chen, Zhiheng

2018-03-01

To investigate whether an elevated serum uric acid (SUA) level is an independent risk factor for rapid decline in renal function or new-onset chronic kidney disease (CKD) in a Chinese health checkup population. A cohort study of 6495 Chinese individuals who underwent health checkups with normal estimated glomerular filtration rate (eGFR) at baseline was carried out from May 2011 to April 2016. Examinations included a questionnaire, physical measurements, and blood sampling. The gender-specific quartiles of blood uric acid were used to present baseline descriptive data. Rapid decline of renal function was defined as eGFR loss of > 3 mL/min/1.73 m 2 /year. New-onset CKD was defined as follow-up eGFR < 60 mL/min/1.73 m 2 or positive proteinuria. Multivariable logistic regression was used to assess the relationship between serum uric acid and the following outcomes: rapid decline of renal function, incident CKD, and combined renal outcomes. During mean follow-up of 52.8 months, 1608 (24.8%) individuals reached combined renal events. Rapid decline in renal function developed in 1506 (23.2%) individuals, and incident CKD was documented in 372 (5.7%) individuals. In a multivariate model adjusted for age, BMI, diabetes, hypertension, alcohol drinking, SBP, total cholesterol, and eGFR, the odds ratio for rapid decline of renal function increased across quartiles of serum uric acid level, reaching a 1.32 (95% CI 1.02-2.97) for the top quartile compared to the lowest quartile (P for trend < 0.001). Meanwhile, higher SUA was also associated with incident CKD in all models. Furthermore, an increased risk of reaching renal outcomes across increasing quartiles of SUA levels appeared to be similar among subgroups stratified according to age, eGFR, and SBP (P < 0.05 in all). These findings suggest that higher SUA may predict progressive renal damage and dysfunction in a health checkup population in China.

Association between climate factors, pollen counts, and childhood hay fever prevalence in the United States.

PubMed

Silverberg, Jonathan I; Braunstein, Marc; Lee-Wong, Mary

2015-02-01

Climate factors and pollen counts may play a role in hay fever. We sought to determine the impact of specific climate factors and pollen counts on the US prevalence of hay fever and statewide variation in prevalence. We used a merged analysis of the 2007 National Survey of Children's Health from a representative sample of 91,642 children aged 0 to 17 years and the 2006-2007 National Climate Data Center and Weather Service measurements of relative humidity (%), indoor heating degree days, precipitation, Palmer Hydrological Drought Index, clear sky and issued ultraviolet indices, stratospheric ozone levels, and outdoor air temperature and National Allergy Bureau total pollen counts. Multivariate survey logistic regression models controlled for sex, race/ethnicity, age, household income, and birthplace. The US prevalence of hay fever in childhood was 18.0% (95% CI, 17.7% to 18.2%), with the highest prevalence in southeastern and southern states. Hay fever prevalence was significantly lower with second and third quartile mean annual relative humidity (logistic regression, P ≤ .01 for both), fourth quartile mean annual Palmer Hydrological Drought Index (P = .02), third and fourth quartile mean annual heating degree days (P < .0001 for both), and third and fourth quartile mean annual stratospheric ozone levels but increased with second, third, and fourth quartile mean annual temperature (P ≤ .02 for both), fourth quartile mean annual precipitation (P = .0007), mean total pollen counts (P = .01), and second, third, and fourth quartile issued ultraviolet index (P ≤ .0001 for all). Principal-component analysis was also used to determine the combined effects of correlated climate variables and pollen counts. This study provides evidence of the influence of climate on the US prevalence of childhood hay fever. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Association between weight fluctuation and fasting insulin concentration in Japanese men.

PubMed

Yatsuya, H; Tamakoshi, K; Yoshida, T; Hori, Y; Zhang, H; Ishikawa, M; Zhu, S; Kondo, T; Toyoshima, H

2003-04-01

To investigate whether long-term weight fluctuation is associated with the fasting serum insulin concentration. Weight histories of 1932 male Japanese workers aged 40-59 y were analyzed in relation to their current fasting serum insulin concentration. Individual weight fluctuation was calculated by root mean square error (RMSE) along the linear regression line of weight measured at five to six different ages. The mean RMSE and fasting insulin concentration were 1.22 kg and 4.5 microU/ml, respectively. The multivariate adjusted insulin level became higher with the increase in weight fluctuation. Subanalysis stratified by current body mass index (BMI) showed that the multivariate adjusted insulin level in individuals in the top quartile of fluctuation was 4.3 microU/ml, against 3.9 microU/ml in those in the bottom quartile (P=0.018, analysis of covariance (ANCOVA)) in the normal weight subgroup with current BMI below 25 kg/m(2). In the overweight subgroup with BMI 25 kg/m(2) or above, the level was 6.9 microU/ml in individuals in the top quartile and 6.2 microU/ml in those in the bottom quartile (P=0.054, ANCOVA). The results suggest that weight fluctuation increases the risk of developing hyperinsulinemia. Prospective observations together with measurement of changes in adiposity are needed for confirmation.

Maternal Exposure to Air Pollutants and Risk of Gestational Diabetes Mellitus in Taiwan.

PubMed

Shen, Hsiu-Nien; Hua, Sheng-Yuan; Chiu, Chang-Ta; Li, Chung-Yi

2017-12-20

Mounting evidence has shown an increased risk of gestational diabetes mellitus (GDM) in association with elevated exposure to air pollution. However, limited evidence is available concerning the effect of specific air pollutant(s) on GDM incidence. We conducted this case-control study on 6717 mothers with GDM diagnosed in 2006-2013 and 6717 age- and year of delivery-matched controls to further address the risk of GDM in relation to specific air pollutant. Both cases and controls were selected from a cohort of 1-million beneficiaries of Taiwan's National Health Insurance program registered in 2005. Maternal exposures to mean daily air pollutant concentration, derived from 76 fixed air quality monitoring stations within the 12-week period prior to pregnancy and during the 1st and 2nd trimesters, were assessed by the spatial analyst method (i.e., ordinary kriging) with the ArcGIS software. After controlling for potential confounders and other air pollutants, an increase in pre-pregnancy exposure of 1 inter-quartile range (IQR) for PM 2.5 and SO₂ was found to associate with a significantly elevated odds ratio (OR) of GDM at 1.10 (95% confidence interval (CI) 1.03-1.18 and 1.37 (95% CI 1.30-1.45), respectively. Exposures to PM 2.5 and SO₂ during the 1st and 2nd trimesters were also associated with significantly increased ORs, which were 1.09 (95% CI 1.02-1.17) and 1.07 (95% CI 1.01-1.14) for PM 2.5 , and 1.37 (95% CI 1.30-1.45) and 1.38 (95% CI 1.31-1.46) for SO₂. It was concluded that higher pre- and post-pregnancy exposures to PM 2.5 and SO₂ for mothers were associated with a significantly but modestly elevated risk of GDM.

The Impact of Socioeconomic Status on Patients Supported with a Left Ventricular Assist Device: An Analysis of the UNOS Database

PubMed Central

Clerkin, Kevin J.; Garan, A. Reshad; Wayda, Brian; Givens, Raymond C.; Yuzefpolskaya, Melana; Nakagawa, Shunichi; Takeda, Koji; Takayama, Hiroo; Naka, Yoshifumi; Mancini, Donna M.; Colombo, Paolo C.; Topkara, Veli K.

2016-01-01

Background Low socioeconomic status (SES) is a known risk factor for heart failure, mortality among those with heart failure, and poor post heart transplant (HT) outcomes. This study sought to determine if SES is associated with decreased waitlist survival while on LVAD support and after HT. Methods and Results 3,361 adult patients bridged to primary HT with an LVAD between May 2004 and April 2014 were identified in the UNOS database. SES was measured using the AHRQ SES index using data from the 2014 American Community Survey. In the study cohort, SES did not have an association with the combined endpoint of death or delisting on LVAD support (p=0.30). In a cause-specific unadjusted model, those in the top (HR 1.55, 95% CI 1.14–2.11, p=0.005) and second greatest SES quartile (HR 1.50, 95% CI 1.10–2.04, p=0.01) had an increased risk of death on device support compared to the lowest SES quartile. Adjusting for clinical risk factors mitigated the increased risk. There was no association between SES and complications. Post-HT survival, both crude and adjusted, was decreased for patients in the lowest quartile of SES index compared to all other SES quartiles. Conclusions Freedom from waitlist death or delisting was not impacted by SES. Patients with a higher SES had an increased unadjusted risk of waitlist mortality during LVAD support, which was mitigated by adjusting for increased comorbid conditions. Low SES was associated with worse post-HT outcomes. Further study is needed to confirm and understand a differential effect of SES on post-transplant outcomes that was not seen during LVAD support prior to HT. PMID:27758810

Kitchen PM2.5 concentrations and child acute lower respiratory infection in Bhaktapur, Nepal: The importance of fuel type.

PubMed

Bates, Michael N; Pokhrel, Amod K; Chandyo, Ram K; Valentiner-Branth, Palle; Mathisen, Maria; Basnet, Sudha; Strand, Tor A; Burnett, Richard T; Smith, Kirk R

2018-02-01

Globally, solid fuels are used by about 3 billion people for cooking and a smaller number use kerosene. These fuels have been associated with acute lower respiratory infection (ALRI) in children. Previous work in Bhaktapur, Nepal, showed comparable relationships of biomass and kerosene cooking fuels with ALRI in young children, compared to those using electricity for cooking. We examine the relationship of kitchen PM 2.5 concentrations to ALRI in those households. ALRI cases and age-matched controls were enrolled from a cohort of children 2-35 months old. 24-h PM 2.5 was measured once in each participant's kitchen. The main analysis was carried out with conditional logistic regression, with PM 2.5 measures specified both continuously and as quartiles. In the kitchens of 393 cases and 431 controls, quartiles of increasing PM 2.5 concentration were associated with a monotonic increase in odds ratios (OR): 1.51 (95% CI: 1.00, 2.27), 2.22 (1.47, 3.34), 2.48 (1.63, 3.77), for the 3 highest exposure quartiles. The general kitchen concentration-response shape across all stoves was supralinear. There was evidence for increased risk with biomass stoves, but the slope for kerosene stoves was steeper, the highest quartile OR being 5.36 (1.35, 21.3). Evidence for increased risk was also found for gas stoves. Results support previous reports that biomass and kerosene cooking fuels are both ALRI risk factors, but suggests that PM 2.5 from kerosene is more potent on a unit mass basis. Further studies with larger sample sizes and preferably using electricity as the baseline fuel are needed. Copyright © 2017 Elsevier Inc. All rights reserved.

ASSOCIATION BETWEEN SOCIAL MEDIA USE AND DEPRESSION AMONG U.S. YOUNG ADULTS.

PubMed

Lin, Liu Yi; Sidani, Jaime E; Shensa, Ariel; Radovic, Ana; Miller, Elizabeth; Colditz, Jason B; Hoffman, Beth L; Giles, Leila M; Primack, Brian A

2016-04-01

Social media (SM) use is increasing among U.S. young adults, and its association with mental well-being remains unclear. This study assessed the association between SM use and depression in a nationally representative sample of young adults. We surveyed 1,787 adults ages 19 to 32 about SM use and depression. Participants were recruited via random digit dialing and address-based sampling. SM use was assessed by self-reported total time per day spent on SM, visits per week, and a global frequency score based on the Pew Internet Research Questionnaire. Depression was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression Scale Short Form. Chi-squared tests and ordered logistic regressions were performed with sample weights. The weighted sample was 50.3% female and 57.5% White. Compared to those in the lowest quartile of total time per day spent on SM, participants in the highest quartile had significantly increased odds of depression (AOR = 1.66, 95% CI = 1.14-2.42) after controlling for all covariates. Compared with those in the lowest quartile, individuals in the highest quartile of SM site visits per week and those with a higher global frequency score had significantly increased odds of depression (AOR = 2.74, 95% CI = 1.86-4.04; AOR = 3.05, 95% CI = 2.03-4.59, respectively). All associations between independent variables and depression had strong, linear, dose-response trends. Results were robust to all sensitivity analyses. SM use was significantly associated with increased depression. Given the proliferation of SM, identifying the mechanisms and direction of this association is critical for informing interventions that address SM use and depression. © 2016 Wiley Periodicals, Inc.

Association between Social Media Use and Depression among U.S. Young Adults

PubMed Central

Lin, Liu yi; Sidani, Jaime E.; Shensa, Ariel; Radovic, Ana; Miller, Elizabeth; Colditz, Jason B.; Hoffman, Beth L.; Giles, Leila M.; Primack, Brian A.

2016-01-01

Background Social media (SM) use is increasing among U.S. young adults, and its association with mental well-being remains unclear. This study assessed the association between SM use and depression in a nationally-representative sample of young adults. Methods We surveyed 1,787 adults ages 19 to 32 about SM use and depression. Participants were recruited via random digit dialing and address-based sampling. SM use was assessed by self-reported total time per day spent on SM, visits per week, and a global frequency score based on the Pew Internet Research Questionnaire. Depression was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression Scale Short Form. Chi-squared tests and ordered logistic regressions were performed with sample weights. Results The weighted sample was 50.3% female and 57.5% White. Compared to those in the lowest quartile of total time per day spent on SM, participants in the highest quartile had significantly increased odds of depression (AOR=1.66, 95% CI=1.14–2.42) after controlling for all covariates. Compared with those in the lowest quartile, individuals in the highest quartiles of SM site visits per week and those with a higher global frequency score had significantly increased odds of depression (AOR=2.74, 95% CI=1.86–4.04; AOR=3.05, 95% CI=2.03–4.59, respectively). All associations between independent variables and depression had strong, linear, dose-response trends. Results were robust to all sensitivity analyses. Conclusions SM use was significantly associated with increased depression. Given the proliferation of SM, identifying the mechanisms and direction of this association is critical for informing interventions that address SM use and depression. PMID:26783723

Relationship between high white blood cell count and insulin resistance (HOMA-IR) in Korean children and adolescents: Korean National Health and Nutrition Examination Survey 2008-2010.

PubMed

Park, J-M; Lee, D-C; Lee, Y-J

2017-05-01

Increasing evidence has indicated that insulin resistance is associated with inflammation. However, few studies have investigated the association between white blood cell (WBC) count and insulin resistance, as measured by a homeostasis model assessment of insulin resistance (HOMA-IR) in a general pediatric population. This study aimed to examine the association between WBC count and insulin resistance as measured by HOMA-IR in a nationally representative sample of children and adolescents. In total, 2761 participants (1479 boys and 1282 girls) aged 10-18 years were selected from the 2008-2010 Korean National Health and Nutrition Examination Survey. Insulin resistance was defined as a HOMA-IR value greater than the 90th percentile. The odds ratios and 95% confidence intervals for insulin resistance were determined using multiple logistic regression analysis. The mean values of most cardiometabolic variables tended to increase proportionally with WBC count quartiles. The prevalence of insulin resistance significantly increased in accordance with WBC count quartiles in both boys and girls. Compared to individuals in the lowest WBC count quartile, the odds ratio for insulin resistance for individuals in the highest quartile was 2.84 in boys and 3.20 in girls, after adjusting for age, systolic blood pressure, body mass index, and waist circumference. A higher WBC count was positively associated with an increased risk of insulin resistance in Korean children and adolescents. This study suggests that WBC count could facilitate the identification of children and adolescents with insulin resistance. Copyright © 2017 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Elevated leukocyte count is associated with periodontitis in Korean adults: the 2012-2014 KNHANES.

PubMed

Kwon, Y-J; Jeon, K-J; Chung, T-H; Lee, Y-J

2017-03-01

Both an elevated leukocyte count and periodontitis share well-recognized associations with cardiometabolic diseases. This cross-sectional study aimed to identify whether the leukocyte count is associated with periodontitis in a nationally representative Korean adult population. Data from 9391 participants (3659 males and 5732 females) enrolled in 2012-2014 Korean National Health and Nutrition Examination Survey were analyzed. Leukocyte quartiles were categorized as follows: 3000 ≤ Q1 ≤ 4870, 4880 ≤ Q2 ≤5790, 5800 ≤ Q3 ≤ 6840, and 6850 ≤ Q4 ≤ 10000 cells/μl. Periodontitis was defined as scoring greater than or equal to 'code 3' in at least one site according to the WHO's Community Periodontal Index. The odds ratios (ORs) and 95% confidence intervals (95% CIs) for periodontitis in each leukocyte count quartile were calculated using multiple logistic regression analyses. The prevalence of periodontitis was directly correlated with increasing leukocyte quartiles: 19%, 20.4%, 24.3%, and 30.3%. Compared with the lowest leukocyte quartile group, the OR (95% CI) for periodontitis of the highest leukocyte quartile was 1.558 (1.285-1.891) after controlling for confounding factors. An elevated leukocyte count was positively associated with the presence of periodontitis. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Intimate Partner Violence and Neighborhood Income: A Longitudinal Analysis

PubMed Central

Bonomi, Amy E.; Trabert, Britton; Anderson, Melissa L.; Kernic, Mary A.; Holt, Victoria L.

2017-01-01

This investigation used a longitudinal design to examine the relationship between neighborhood-level income, individual-level predictors, and police-reported intimate partner violence in 5,994 urban couples followed over 2 years. At the baseline abuse incident, intimate partner violence rates were highest in the poorest neighborhoods (13.8 per 1,000 women in the lowest income quartile, followed by 12.1, 8.2, and 5.0 in the respective higher income quartiles). However, in the longitudinal analysis, weapon use at the baseline abuse event was a much stronger predictor of repeat abuse (incident rate ratios ranging from 1.72 for physical abuse to 1.83 for non-physical abuse) than neighborhood income. PMID:24476760

Homeostasis model assessment of insulin resistance in relation to the poor functional outcomes in nondiabetic patients with ischemic stroke

PubMed Central

Li, Siou; Yin, Changhao; Zhao, Weina; Zhu, Haifu; Xu, Dan; Xu, Qing; Jiao, Yang; Wang, Xue; Qiao, Hong

2018-01-01

Whether insulin resistance (IR) predicts worse functional outcome in ischemic stroke is still a matter of debate. The aim of the present study is to determine the association between IR and risk of poor outcome in 173 Chinese nondiabetic patients with acute ischemic stroke. This is a prospective, population-based cohort study. Insulin sensitivity, expressed by the homeostasis model assessment (HOMA) of insulin sensitivity (HOMA index = (fasting insulin × fasting glucose)/22.5). IR was defined by HOMA-IR index in the top quartile (Q4). Functional impairment was evaluated at discharge using the modified Rankin scale (mRS). The median (interquartile range) HOMA-IR was 2.14 (1.17–2.83), and Q4 was at least 2.83. There was a significantly positive correlation between HOMA-IR and National Institutes of Health Stroke Scale (r = 0.408; P<0.001). In multivariate analyses, patients in IR group were associated with a higher risk of poor functional outcome (odds ratio (OR) = 3.23; 95% confidence interval (CI) = 1.75–5.08; P=0.001). In multivariate models comparing the third and fourth quartiles against the first quartile of the HOMA-IR, levels of HOMA-IR were associated with poor outcome, and the adjusted risk of poor outcome increased by 207% (OR = 3.05 (95% CI 1.70–4.89), P=0.006) and 429% (5.29 (3.05–9.80), P<0.001). In a receiver operating characteristic curve (ROC) analysis of poor outcome, the area under the curve (AUC) increased from 0.80 to 0.84 (95% CI: 0.79–0.88) by adding HOMA-IR to clinical examination variables (P=0.02). High HOMA-IR index is associated with a poor functional outcome in nondiabetic patients with acute ischemic stroke. PMID:29588341

α2-Macroglobulin Is a Significant In Vivo Inhibitor of Activated Protein C and Low APC:α2M Levels Are Associated with Venous Thromboembolism.

PubMed

Martos, Laura; Ramón, Luis Andrés; Oto, Julia; Fernández-Pardo, Álvaro; Bonanad, Santiago; Cid, Ana Rosa; Gruber, Andras; Griffin, John H; España, Francisco; Navarro, Silvia; Medina, Pilar

2018-04-01

 Activated protein C (APC) is a major regulator of thrombin formation. Two major plasma inhibitors form complexes with APC, protein C inhibitor (PCI) and α 1 -antitrypsin (α 1 AT), and these complexes have been quantified by specific enzyme-linked immunosorbent assays (ELISAs). Also, complexes of APC with α 2 -macroglobulin (α 2 M) have been observed by immunoblotting. Here, we report an ELISA for APC:α 2 M complexes in plasma.  Plasma samples were pre-treated with dithiothreitol and then with iodoacetamide. The detection range of the newly developed APC:α 2 M assay was 0.031 to 8.0 ng/mL of complexed APC. Following infusions of APC in humans and baboons, complexes of APC with α 2 M, PCI and α 1 AT were quantified. These complexes as well as circulating APC were also measured in 121 patients with a history of venous thromboembolism (VTE) and 119 matched controls.  In all the in vivo experiments, α 2 M was a significant APC inhibitor. The VTE case-control study showed that VTE patients had significantly lower APC:α 2 M and APC levels than the controls ( p  < 0.001). Individuals in the lowest quartile of APC:α 2 M or the lowest quartile of APC had approximately four times more VTE risk than those in the highest quartile of APC:α 2 M or of APC. The risk increased for individuals with low levels of both parameters.  The APC:α 2 M assay reported here may be useful to help monitor the in vivo fate of APC in plasma. In addition, our results show that a low APC:α 2 M level is associated with increased VTE risk. Schattauer GmbH Stuttgart.

Inflammatory Biomarkers Interleukin-6 and C-Reactive Protein and Outcomes in Stable Coronary Heart Disease: Experiences From the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) Trial.

PubMed

Held, Claes; White, Harvey D; Stewart, Ralph A H; Budaj, Andrzej; Cannon, Christopher P; Hochman, Judith S; Koenig, Wolfgang; Siegbahn, Agneta; Steg, Philippe Gabriel; Soffer, Joseph; Weaver, W Douglas; Östlund, Ollie; Wallentin, Lars

2017-10-24

Evaluation of cardiovascular prognosis in patients with stable coronary heart disease is based on clinical characteristics and biomarkers indicating dysglycemia, dyslipidemia, renal dysfunction, and possibly cardiac dysfunction. Inflammation plays a key role in atherosclerosis, but the association between inflammatory biomarkers and clinical outcomes is less studied in this population. Overall, 15 828 patients with coronary heart disease in the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial were randomized to treatment with darapladib or placebo and observed for a median of 3.7 years. In 14 611 patients, levels of interleukin-6 (IL-6) and high-sensitivity C-reactive protein were measured in plasma samples: median levels were 2.1 (interquartile range, 1.4-3.2) ng/L and 1.3 (interquartile range, 0.6-3.1) mg/L, respectively. Associations between continuous levels or quartile groups and adjudicated outcomes were evaluated by spline graphs and Cox regression adjusted for clinical factors and cardiovascular biomarkers. IL-6 was associated with increased risk of major adverse cardiovascular events (quartile 4 versus quartile 1 hazard ratio [HR], 1.60; 95% confidence interval [CI], 1.30-1.97; P <0.0001); cardiovascular death (HR, 2.15; 95% CI, 1.53-3.04; P <0.0001); myocardial infarction (HR, 1.53; 95% CI, 1.14-2.04; P <0.05); all-cause mortality (HR, 2.11; 95% CI, 1.62-2.76; P <0.0001); and risk of hospitalization for heart failure (HR, 2.28; 95% CI, 1.34-3.89; P <0.001). Cancer death was doubled in the highest IL-6 quartile group (HR, 2.34; 95% CI, 1.20-4.53; P <0.05). High-sensitivity C-reactive protein was associated with both cardiovascular and non-cardiovascular events in the unadjusted model, but these did not remain after multivariable adjustments. IL-6, an upstream inflammatory marker, was independently associated with the risk of major adverse cardiovascular events, cardiovascular and all-cause mortality, myocardial infarction, heart failure, and cancer mortality in patients with stable coronary heart disease. IL-6 might reflect a pathophysiological process involved in the development of these events. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00799903. © 2017 The Authors and GlaxoSmithKline. Published on behalf of the American Heart Association, Inc., by Wiley.

Breakfast intake among adults with type 2 diabetes: is bigger better?

PubMed Central

Jarvandi, Soghra; Schootman, Mario; Racette, Susan B.

2015-01-01

Objective To assess the association between breakfast energy and total daily energy intake among individuals with type 2 diabetes. Design Cross-sectional study. Daily energy intake was computed from a 24-h dietary recall. Multiple regression models were used to estimate the association between daily energy intake (dependent variable) and quartiles of energy intake at breakfast (independent variable) expressed as either absolute or relative (% of total daily energy intake) terms. Orthogonal polynomial contrasts were used to test for linear and quadratic trends. Models were controlled for sex, age, race/ethnicity, body mass index, physical activity and smoking. In addition, we used separate multiple regression models to test the effect of quartiles of absolute and relative breakfast energy on intake at lunch, dinner, and snacks. Setting The 1999–2004 National Health and Nutrition Examination Survey (NHANES). Subjects Participants aged ≥ 30 years with self-reported history of diabetes (N = 1,146). Results Daily energy intake increased as absolute breakfast energy intake increased (linear trend, P < 0.0001; quadratic trend, P = 0.02), but decreased as relative breakfast energy intake increased (linear trend, P < 0.0001). In addition, while higher quartiles of absolute breakfast intake had no associations with energy intake at subsequent meals, higher quartiles of relative breakfast intake were associated with lower energy intake during all subsequent meals and snacks (P < 0.05). Conclusions Consuming a breakfast that provided less energy or comprised a greater proportion of daily energy intake was associated with lower total daily energy intake in adults with type 2 diabetes. PMID:25529061

Reduced total serum bilirubin levels are associated with ulcerative colitis

PubMed Central

Schieffer, Kathleen M.; Bruffy, Shannon M.; Rauscher, Richard; Koltun, Walter A.; Gallagher, Carla J.

2017-01-01

Chronic inflammation associated with inflammatory bowel disease (IBD) results in increased oxidative stress that damages the colonic microenvironment. Low levels of serum bilirubin, an endogenous antioxidant, have been associated with increased risk for Crohn’s disease (CD). Therefore, the aim of this study was to examine whether total serum bilirubin levels are associated with ulcerative colitis (UC). We identified a retrospective case-control population (n = 6,649) from a single tertiary care center, Penn State Hershey Medical Center (PSU) and a validation cohort (n = 1,996) from Virginia Commonwealth University Medical Center (VCU). Cases were age- and sex-matched to controls (PSU: CD n = 254, UC n = 187; VCU: CD n = 233, UC n = 124). Total serum bilirubin levels were obtained from de-identified medical records and segregated into quartiles. Logistic regression analysis was performed on each quartile of total serum bilirubin compared to the last quartile (highest bilirubin levels) to determine the association of total serum bilirubin with UC. Similar to CD patients, UC patients demonstrated reduced levels of total serum bilirubin compared to controls at PSU and VCU. The lowest quartile of total serum bilirubin was independently associated with UC for the PSU (OR: 1.98 [95% CI: 1.09–3.63]) and VCU cohorts (OR: 6.07 [95% CI: 3.01–12.75]). Lower levels of the antioxidant bilirubin may reduce the capability of UC patients to remove reactive oxygen species leading to an increase in intestinal injury. Therapeutics that reduce oxidative stress may be beneficial for these patients. PMID:28594959

The associations between increasing degrees of homeostatic model assessment for insulin resistance and muscular strengthening activities among euglycaemic US adults.

PubMed

Boyer, William R; Johnson, Tammie M; Fitzhugh, Eugene C; Richardson, Michael R; Churilla, James R

2015-11-01

To examine the associations between the homeostatic model assessment for insulin resistance and self-reported muscular strengthening activity in a nationally representative sample of euglycaemic US adults. Sample included euglycaemic adults (⩾20 years of age (n = 2009)) from the 1999 to 2004 National Health and Nutrition Examination Survey. Homeostatic model assessment for insulin resistance was categorized into quartiles and was the primary independent variable of interest. No reported muscular strengthening activity was the dependent variable. Following adjustment for covariates, those with homeostatic model assessment for insulin resistance values in fourth (odds ratio: 2.04, 95% confidence interval: 1.35-3.06, p < 0.001) quartile were found to have significantly greater odds of reporting no muscular strengthening activity. Following further adjustment for non-muscular strengthening activity specific aerobic leisure-time physical activity, results remained significant for the fourth (odds ratio: 2.30, 95% confidence interval: 1.50-3.52, p < 0.001) quartile. A significant trend was seen across quartiles of homeostatic model assessment for insulin resistance for increasing prevalence of no muscular strengthening activity (p < 0.001). Having a higher homeostatic model assessment for insulin resistance value is associated with greater odds of reporting no muscular strengthening activity among euglycaemic US adults. This implies that subjects with an increasing degree of insulin resistance are more likely to not engage in muscular strengthening activity, an exercise modality that has been shown to reduce the risk of several cardiometabolic diseases and improve glycaemic status. © The Author(s) 2015.

The EVEREST study: an international collaboration.

PubMed

Caskey, Fergus J; Stel, Vianda S; Elliott, Robert F; Jager, Kitty J; Covic, Adrian; Cusumano, Ana; Geue, Claudia; Kramer, Anneke; Stengel, Benedicte; MacLeod, Alison M

2010-02-01

Rates of initiation of renal replacement therapy (RRT), use of home modalities of treatment and patient outcomes vary considerably between countries. This paper reports the methods and baseline characteristics of countries participating in the EVEREST study (n = 46), a global collaboration examining the association between medical and non-medical factors and RRT incidence, modality mix and survival. Numbers of incident and prevalent patients were collected for current (2003-05) and historic (1983-85, 1988-90, 1993-95 and 1998-2000) periods stratified, where available, by age, gender, treatment modality and cause of end stage renal disease (diabetic versus non-diabetic). General population age and health indicators and national-level macroeconomic data were collected from secondary data sources. National experts provided primary data on renal service funding, resources and organization. The median (inter quartile range) RRT incidence per million of the population (pmp) was 130 pmp (102-167 pmp). The general population life expectancy at 60 was 22.1 years (19.7-23.1 years) and 6.9% had diabetes mellitus (5.4-9.0%). Healthcare spending as a percentage of gross domestic product was 8.1% (5.6-9.3%). Countries averaged nine dialysis facilities pmp (4-12 pmp), with 69.0% (43.9-99.0%) owned by the public or private not-for-profit sector. The number of nephrologists ranged from 0.5 to 48 pmp (median 12 pmp). The heterogeneity of EVEREST countries will enable modelling to examine the independent association between medical and non-medical factors on RRT epidemiology.

Characteristics and outcome of patients brought to an emergency department by police under the provisions (Section 10) of the Mental Health Act in Victoria, Australia.

PubMed

Al-Khafaji, Karim; Loy, John; Kelly, Anne-Maree

2014-01-01

The aim of this study is to describe the characteristics and outcome of patients brought to an emergency department by police under Section 10 of Mental Health Act (Victoria, Australia). Retrospective medical record review. Patients referred under Section 10 provisions treated in calendar year 2009 were identified from ED database. Data collected included demographics, incident details, patient management, final diagnosis and disposition. Primary outcomes of interest were ED diagnosis and disposition. Secondary outcomes were length of stay in ED and use of restraint or sedation. One hundred and ninety seven presentations by 164 patients were identified. Patients were predominantly male (58%) with median age of 35 years (IQR 22-44, range 16-69). The most common presenting complaint (65%) was threat of self harm. No sedation or restraint was used in 61%. Sixty seven percent were deemed safe for discharge home while 26% were admitted to a psychiatric ward (equally divided between voluntary and involuntary admission). The predominant discharge diagnosis was self harm ideation or intent (35%). Median ED length of stay was 156 min (inter-quartile range 79-416). Most patients brought to ED by police under Section 10 provisions were for threat of self harm and did not require sedation or restraint. The majority are discharged home. Further work exploring less restrictive or traumatic processes to facilitate psychiatric assessment of this group of patients is warranted. Copyright © 2014 Elsevier Ltd. All rights reserved.

Association of serum ferritin with metabolic syndrome and diabetes mellitus in the South Korean general population according to the Korean National Health and Nutrition Examination Survey 2008.

PubMed

Lee, Byung-Kook; Kim, Yangho; Kim, Young-Il

2011-10-01

We examined the association of serum ferritin levels with metabolic syndrome (MS) and diabetes mellitus in a representative sample of the adult South Korean population using data from the 2008 Korean National Health and Nutrition Examination Survey. We conducted a cross-sectional study of 6311 adults older than 20 years who participated in the 2008 Korean National Health and Nutrition Examination Survey. Metabolic syndrome was defined as the presence of at least 3 of the following: elevated blood pressure, low high-density lipoprotein cholesterol, elevated serum triglycerides, elevated plasma glucose, and abdominal obesity. Diabetes mellitus was defined as fasting glucose of at least 126 mg/dL. Insulin resistance was determined using the homeostasis model assessment estimate of insulin resistance. In a representative sample of the adult Korean population, MS was more prevalent in the highest quartile compared with the lowest quartile of serum ferritin concentrations in women following adjustments for age, education, smoking, alcohol intake, body mass index, aspartate aminotransferase, and alanine aminotransferase. Diabetes mellitus was more prevalent in the highest quartile compared with the lowest quartile of serum ferritin concentrations in premenopausal women and men. The geometric means of fasting insulin and insulin resistance determined using the homeostasis model assessment of insulin resistance in the fourth serum ferritin quartiles of postmenopausal women and men were significantly higher compared with those in the first quartile of the respective groups. The present study demonstrates that elevated serum ferritin concentrations are associated with an increased risk of MS and diabetes mellitus in a representative sample of the adult South Korean population. Copyright © 2011. Published by Elsevier Inc.

Hemoglobin Concentration and Risk of Incident Stroke in Community-Living Adults.

PubMed

Panwar, Bhupesh; Judd, Suzanne E; Warnock, David G; McClellan, William M; Booth, John N; Muntner, Paul; Gutiérrez, Orlando M

2016-08-01

In previous observational studies, hemoglobin concentrations have been associated with an increased risk of stroke. However, these studies were limited by a relatively low number of stroke events, making it difficult to determine whether the association of hemoglobin and stroke differed by demographic or clinical factors. Using Cox proportional hazards analysis and Kaplan-Meier plots, we examined the association of baseline hemoglobin concentrations with incident stroke in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a cohort of black and white adults aged ≥45 years. A total of 518 participants developed stroke over a mean 7±2 years of follow-up. There was a statistically significant interaction between hemoglobin and sex (P=0.05) on the risk of incident stroke. In Cox regression models adjusted for demographic and clinical variables, there was no association of baseline hemoglobin concentration with incident stroke in men, whereas in women, the lowest (<12.4 g/dL) and highest (>14.0 g/dL) quartiles of hemoglobin were associated with higher risk of stroke when compared with the second quartile (12.4-13.2 g/dL; quartile 1: hazard ratio, 1.59; 95% confidence interval, 1.09-2.31; quartile 2: referent; quartile 3: hazard ratio, 0.91; 95% confidence interval, 0.59-1.38; quartile 4: hazard ratio, 1.59; 95% confidence interval, 1.08-2.35). Similar results were observed in models stratified by hemoglobin and sex and when hemoglobin was modeled as a continuous variable using restricted quadratic spline regression. Lower and higher hemoglobin concentrations were associated with a higher risk of incident stroke in women. No such associations were found in men. © 2016 American Heart Association, Inc.

Different effects of dietary factors on reflux esophagitis and non-erosive reflux disease in 11,690 Korean subjects.

PubMed

Nam, Su Youn; Park, Bum Joon; Cho, Yeong-Ah; Ryu, Kum Hei; Choi, Il Ju; Park, Sohee; Kim, Young-Woo

2017-07-01

Although dietary factors seem to be associated with gastroesophageal reflux symptoms, their effects on reflux esophagitis and non-erosive reflux disease (NERD) are unclear. We evaluate dietary effects on NERD and reflux esophagitis. A total of 11,690 health check-up persons completed questionnaires for reflux symptoms and 3-day recordings for dietary intake and underwent esophagogastroduodenoscopy from 2004 to 2008. Multiple logistic regression with odds ratio (OR) and 95% confidence interval (CI) was used to evaluate the relationship of dietary components with NERD or reflux esophagitis. Prevalence of NERD and reflux esophagitis was 7.7 and 7.2%, respectively. In adjusted analysis, highest quartile of beans (OR 0.78, 95% CI 0.64-0.95), 3rd quartile of vegetables (OR 0.74, 95% CI 0.60-0.91), 4th quartile of fruit (OR 0.78, 95% CI 0.64-0.95), 4th quartile of egg (OR 0.78, 95% CI 0.64-0.96), and 3rd quartile of fish (OR 0.80, 95% CI 0.66-0.98), and 4th quartile of milk (OR 0.78, 95% CI 0.65-0.94) reduced NERD. Reflux esophagitis had no association with food groups, whereas it was related with men, absence of H. pylori, hiatal hernia, BMI, and total energy intake. Furthermore, dietary effect on NERD was similar in men and women, whereas highest tertile of potato (OR 1.91) and milk (OR 1.87) increased reflux esophagitis only in women. While many food groups affected NERD, reflux esophagitis was associated with BMI and total energy intake rather than dietary component. These results may suggest different approaches toward dietary management of NERD and reflux esophagitis.

Impact of Income Inequality on the Nation's Health.

PubMed

López, Diego B; Loehrer, Andrew P; Chang, David C

2016-10-01

Income inequality in the United States has been increasing in recent decades. It is unclear whether income inequality has an independent effect on health outcomes, or whether it simply correlates with increasing levels of poverty. The goal of this study was to evaluate whether income inequality is significantly associated with US county health care expenditures and health care use. Cross-sectional analysis of county health expenditure data from the Health Resources and Services Administration's Area Resources File, county income inequality measures (Gini coefficient) from the Census' American Community Survey, and estimates of potentially preventable admissions and potentially discretionary procedures from the Nationwide Inpatient Sample (1998 to 2011). Datasets were linked via county Federal Information Processing Standard codes. Multivariable linear and Poisson regression analyses were performed at the county level adjusting for county characteristics. A total of 1,237 counties (of 3,144) were included. Income inequality was associated with higher health care expenditures, with each 1 percentage-point increase in county Gini coefficient associated with a US$40,008 increase in annual county Medicare cost (p = 0.003), and an increase of 174.7 total county Medicare inpatient days per year (p < 0.001). Even after accounting for poverty level and county characteristics, counties with higher inequality had higher potentially preventable admission (eg 4.86 rate ratio for low-birth-weight hospital admissions in the top income inequality quartile compared with bottom quartile; p < 0.001) and a higher incidence of potentially discretionary procedures (eg 1.79 rate ratio for prostatectomy for benign prostatic hyperplasia in the top income inequality quartile compared with bottom quartile; p < 0.001). Income inequality is independently associated with higher health care expenditures and more health care use, with increases in both potentially discretionary procedures and in potentially preventable admissions. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Hospital volume and cesarean delivery among low-risk women in a nationwide sample.

PubMed

Clapp, M A; James, K E; Melamed, A; Ecker, J L; Kaimal, A J

2018-02-01

We sought to determine if hospital delivery volume was associated with a patient's risk for cesarean delivery in low-risk women. This study retrospectively examines a cohort of 1 657 495 deliveries identified in the 2013 Nationwide Readmissions Database. Hospitals were stratified by delivery volume quartiles. Low-risk patients were identified using the Society for Maternal-Fetal Medicine definition (n=845 056). A multivariable logistic regression accounting for hospital-level clustering was constructed to assess the factors affecting a patient's odds for cesarean delivery. The range of cesarean delivery rates was 2.4-51.2% among low-risk patients, and the median was 16.5% (IQR 12.8-20.5%). The cesarean delivery rate was higher in the top two-volume-quartile hospitals (17.4 and 18.2%) compared to the bottom quartiles (16.4 and 16.3%) (P<0.001). Hospital volume was not associated with a patient's odds for cesarean delivery after adjusting for patient and other hospital characteristics (P=0.188). Hospital delivery volume is not an independent predictor of cesarean delivery in this population.

Association of body mass index and aerobic physical fitness with cardiovascular risk factors in children☆

PubMed Central

Gonçalves, Reginaldo; Szmuchrowski, Leszek Antony; Damasceno, Vinícius Oliveira; de Medeiros, Marcelo Lemos; Couto, Bruno Pena; Lamounier, Joel Alves

2014-01-01

Objective: To identify the association between both, body mass index and aerobic fitness, with cardiovascular disease risk factors in children. Methods: Cross-sectional study, carried out in Itaúna-MG, in 2010, with 290 school children ranging from 6 to 10 years-old of both sexes, randomly selected. Children from schools located in the countryside and those with medical restrctions for physical activity were not included. Blood sample was collected after a 12-hour fasting period. Blood pressure, stature and weight were evaluated in accordance with international standards. The following were considered as cardiovascular risk factors: high blood pressure, high total cholesterol, LDL, triglycerides and insulin levels, and low HDL. The statistical analysis included the Spearman's coefficient and the logistic regression, with cardiovascular risk factors as dependent variables. Results: Significant correlations were found, in both sexes, among body mass index and aerobic fitness with most of the cardiovascular risk factors. Children of both sexes with body mass index in the fourth quartile demonstrated increased chances of having high blood insulin and clustering cardiovascular risk factors. Moreover, girls with aerobic fitness in the first quartile also demonstrated increased chances of having high blood insulin and clustering cardiovascular risk factors. Conclusion: The significant associations and the increased chances of having cardiovascular risk factors in children with less aerobic fitness and higher levels of body mass index justify the use of these variables for health monitoring in Pediatrics. PMID:25479851

Biofeedback training effects on minimum toe clearance variability during treadmill walking.

PubMed

Tirosh, Oren; Cambell, Amity; Begg, Rezaul K; Sparrow, W A

2013-08-01

A number of variability analysis techniques, including Poincaré plots and detrended fluctuation analysis (DFA) were used to investigate minimum toe clearance (MTC) control during walking. Ten young adults walked on a treadmill for 10 min at preferred speed in three conditions: (i) no-intervention baseline, (ii) with biofeedback of MTC within a target range, and (iii) no-biofeedback retention. Mean, median, standard deviation (SD), and inter quartile range of MTC during biofeedback (45.57 ± 11.65, 44.98 ± 11.57, 7.08 ± 2.61, 8.58 ± 2.77 mm, respectively) and retention (56.95 ± 20.31, 56.69 ± 20.94, 10.68 ± 5.41, 15.38 ± 10.19 mm) were significantly greater than baseline (30.77 ± 9.49, 30.51 ± 9.49, 3.04 ± 0.77, 3.66 ± 0.91 mm). Relative to baseline, skewness was reduced in biofeedback and retention but only significantly for retention (0.88 ± 0.51, 0.63 ± 0.55, and 0.40 ± 0.40, respectively). Baseline Poincaré measures (SD1 = 0.25, SD2 = 0.34) and DFA (α1 = 0.72 and α2 = 0.64) were lower than biofeedback (SD1 = 0.58, SD2 = 0.83, DFA α1 = 0.76 and α2 = 0.92) with significantly greater variability in retention compared to biofeedback only in the long-term SD2 and α2 analyses. Increased DFA longer-term correlations α2 in retention confirm that a novel gait pattern was acquired with a longer-term variability structure. Short- and long-term variability analyses were both useful in quantifying gait adaptations with biofeedback. The findings provide evidence that MTC can be modified with feedback, suggesting future applications in gait training procedures for impaired populations designed to reduce tripping risk.

Climate model uncertainty in impact assessments for agriculture: A multi-ensemble case study on maize in sub-Saharan Africa

NASA Astrophysics Data System (ADS)

Dale, Amy; Fant, Charles; Strzepek, Kenneth; Lickley, Megan; Solomon, Susan

2017-03-01

We present maize production in sub-Saharan Africa as a case study in the exploration of how uncertainties in global climate change, as reflected in projections from a range of climate model ensembles, influence climate impact assessments for agriculture. The crop model AquaCrop-OS (Food and Agriculture Organization of the United Nations) was modified to run on a 2° × 2° grid and coupled to 122 climate model projections from multi-model ensembles for three emission scenarios (Coupled Model Intercomparison Project Phase 3 [CMIP3] SRES A1B and CMIP5 Representative Concentration Pathway [RCP] scenarios 4.5 and 8.5) as well as two "within-model" ensembles (NCAR CCSM3 and ECHAM5/MPI-OM) designed to capture internal variability (i.e., uncertainty due to chaos in the climate system). In spite of high uncertainty, most notably in the high-producing semi-arid zones, we observed robust regional and sub-regional trends across all ensembles. In agreement with previous work, we project widespread yield losses in the Sahel region and Southern Africa, resilience in Central Africa, and sub-regional increases in East Africa and at the southern tip of the continent. Spatial patterns of yield losses corresponded with spatial patterns of aridity increases, which were explicitly evaluated. Internal variability was a major source of uncertainty in both within-model and between-model ensembles and explained the majority of the spatial distribution of uncertainty in yield projections. Projected climate change impacts on maize production in different regions and nations ranged from near-zero or positive (upper quartile estimates) to substantially negative (lower quartile estimates), highlighting a need for risk management strategies that are adaptive and robust to uncertainty.

Cadmium Exposure and Pancreatic Cancer in South Louisiana

PubMed Central

Luckett, Brian G.; Su, L. Joseph; Rood, Jennifer C.; Fontham, Elizabeth T. H.

2012-01-01

Cadmium has been hypothesized to be a pancreatic carcinogen. We test the hypothesis that cadmium exposure is a risk factor for pancreatic cancer with a population-based case-control study sampled from a population with persistently high rates of pancreatic cancer (south Louisiana). We tested potential dietary and nondietary sources of cadmium for their association with urinary cadmium concentrations which reflect long-term exposure to cadmium due to the accumulation of cadmium in the kidney cortex. Increasing urinary cadmium concentrations were significantly associated with an increasing risk of pancreatic cancer (2nd quartile OR = 3.34, 3rd = 5.58, 4th = 7.70; test for trend P ≤ 0.0001). Potential sources of cadmium exposure, as documented in the scientific literature, found to be statistically significantly associated with increased risk of pancreatic cancer included working as a plumber, pipefitter or welder (OR = 5.88) and high consumption levels of red meat (4th quartile OR = 6.18) and grains (4th quartile OR = 3.38). Current cigarette smoking, at least 80 pack years of smoking, occupational exposure to cadmium and paints, working in a shipyard, and high consumption of grains were found to be statistically significantly associated with increased concentrations of urinary cadmium. This study provides epidemiologic evidence that cadmium is a potential human pancreatic carcinogen. PMID:23319964

Linkage of the Soil and Water Assessment Tool and the Texas Water Availability Model to simulate the effects of brush management on monthly storage of Canyon Lake, south-central Texas, 1995-2010

USGS Publications Warehouse

Asquith, William H.; Bumgarner, Johnathan R.

2014-01-01

The mean monthly offset storages of Canyon Lake during the Drought Quartile were 110 acre-ft (20 percent); 448 acre-ft (40 percent); 754 acre-ft (60 percent); 1,080 acre-ft (80 percent); and 1,090 acre-ft (100 percent). A particular mean was interpreted as follows: the value of 754 acre-ft for the 60-percent brush-management scenario implies that, on average, this scenario indicates an additional 754 acre-ft per month of storage in Canyon Lake relative to the baseline during the Drought Quartile. All of the five scenarios resulted in an increase on average to water supply relative to the baseline scenario during the Drought Quartile through the SWAT-WAM linkage.

The Role of Plasma Triglyceride/High-Density Lipoprotein Cholesterol Ratio to Predict New Cardiovascular Events in Essential Hypertensive Patients.

PubMed

Turak, Osman; Afşar, Barış; Ozcan, Fırat; Öksüz, Fatih; Mendi, Mehmet Ali; Yayla, Çagrı; Covic, Adrian; Bertelsen, Nathan; Kanbay, Mehmet

2016-08-01

Triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C) has been suggested as a simple method to identify unfavorable cardiovascular outcomes in the general population. The effect of the TG/HDL-C ratio on essential hypertensive patients is unclear. About 900 consecutive essential hypertensive patients (mean age 52.9±12.6 years, 54.2% male) who visited our outpatient hypertension clinic were analyzed. Participants were divided into quartiles based on baseline TG/HDL-C ratio and medical records were obtained periodically for the occurrence of fatal events and composite major adverse cardiovascular events (MACEs) including transient ischemic attack, stroke, aortic dissection, acute coronary syndrome, and death. Participants were followed for a median of 40 months (interquartile range, 35-44 months). Overall, a higher quartile of TG/HDL-C ratio at baseline was significantly linked with higher incidence of fatal and nonfatal cardiovascular events. Using multivariate Cox regression analysis, plasma TG/HDL-C ratio was independently associated with increased risk of fatal events (hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.13-1.37; P≤.001] and MACEs (HR, 1.13; 95% CI, 1.06-1.21; P≤.001). Increased plasma TG/HDL-C ratio was associated with more fatal events and MACEs in essential hypertensive patients. © 2015 Wiley Periodicals, Inc.

Timing of malaria messages for target audience on radio airwaves

PubMed Central

2012-01-01

Background Due to the limitations of face-to-face communication to teach families how to manage, control and prevent malaria, national and local malaria programmes try to reach people through the radio. However, information regarding the timing of radio messages for the target audiences is lacking. Methods Within a large-scale trial (Clinicaltrials.gov: NCT00565071), data regarding the time at which people listen to the radio was collected from 1,628 consenting outpatients (and caregivers for minors) attending six rural government primary level health care centres in Bushenyi and Iganga districts of Uganda from February to July 2011. Results The majority of households, 1,099 (67.5%) owned a radio. The majority, 1,221 (86.3%), participants had heard about malaria from the radio. Some participants started listening to the radio at about 06.00 East African local time (EAT). The peak hours at which people listen to the radio are 12.00-14.00 and 18.00-23.00 local time. The median time of listening to the radio by men is 20.00 (inter-quartile range (IQR): 18.30-21.00) and women 19.30 (IQR: 13.00-20.30). Conclusion Planners of malaria radio interventions need to broadcast their messages within the two peak EAT of 12.00-14.00 and 18.00-23.00. PMID:22905781

Environmental exposure to polycyclic aromatic hydrocarbons (PAHs): The correlation with and impact on reproductive hormones in umbilical cord serum.

PubMed

Yin, Shanshan; Tang, Mengling; Chen, Fangfang; Li, Tianle; Liu, Weiping

2017-01-01

Polycyclic aromatic hydrocarbons (PAHs) are a type of ubiquitous pollutant with the potential ability to cause endocrine disruption that would have an adverse health impact on the general population. To assess the maternal exposure to PAHs in neonates and evaluate the possible impact of PAHs on reproductive hormone levels, the concentration of PAHs and reproductive hormone levels in the umbilical cord serum of 98 mother-infant pairs in the Shengsi Islands were investigated. The median concentration of total PAHs was determined to be 164 (Inter-Quartile Range, IQR 93.6-267) ng g -1 lipid, and 68% of the PAHs were lower-molecule congeners. The highest level was found for pyrene (PYR) and naphthalene (NAP), which contributed 54.6% of all the PAHs present in the samples. The exposure to PAHs negatively affected estradiol (E2) and Anti-Mullerian hormones (AMH) and positively affected FSH in the umbilical cord serum. The result expanded the database of the human burden of PAHs and suggested that PAHs can act as a type of Endocrine-Disrupting Chemical (EDC). These results may help to understand the complex pathways involved in disorders of human reproductive health associated with prenatal exposure to PAHs. Copyright © 2016 Elsevier Ltd. All rights reserved.

Timing of malaria messages for target audience on radio airwaves.

PubMed

Batwala, Vincent; Magnussen, Pascal; Mirembe, Justine; Mulogo, Edgar; Nuwaha, Fred

2012-08-20

Due to the limitations of face-to-face communication to teach families how to manage, control and prevent malaria, national and local malaria programmes try to reach people through the radio. However, information regarding the timing of radio messages for the target audiences is lacking. Within a large-scale trial (Clinicaltrials.gov: NCT00565071), data regarding the time at which people listen to the radio was collected from 1,628 consenting outpatients (and caregivers for minors) attending six rural government primary level health care centres in Bushenyi and Iganga districts of Uganda from February to July 2011. The majority of households, 1,099 (67.5%) owned a radio. The majority, 1,221 (86.3%), participants had heard about malaria from the radio. Some participants started listening to the radio at about 06.00 East African local time (EAT). The peak hours at which people listen to the radio are 12.00-14.00 and 18.00-23.00 local time. The median time of listening to the radio by men is 20.00 (inter-quartile range (IQR): 18.30-21.00) and women 19.30 (IQR: 13.00-20.30). Planners of malaria radio interventions need to broadcast their messages within the two peak EAT of 12.00-14.00 and 18.00-23.00.

Observation of the long-term effects of lifestyle intervention during balneotherapy in metabolic syndrome.

PubMed

Gin, Henri; Demeaux, Jean-Louis; Grelaud, Angela; Grolleau, Adeline; Droz-Perroteau, Cécile; Robinson, Philip; Lassalle, Régis; Abouelfath, Abdelilah; Boisseau, Michel; Toussaint, Christian; Moore, Nicholas

2013-01-01

Estimate the effect of lifestyle adjustment activities in patients with metabolic syndrome treated by prescribed balneotherapy. Observational pilot cohort study with 12-month follow-up after multidimensional lifestyle training (physical, dietary, educational) during 3-week standard stay in the spa town of Eugénie-les-Bains. Of 145 eligible patients, 97 were included; 63 were followed and analysable. At inclusion all had ≥3 National cholesterol education program-Adult treatment panel III (NCEP-ATPIII) criteria defining metabolic syndrome, 76.2% were female, mean age was 61.2 years. At the end of follow-up (median:10.4 months, Inter-Quartile Range: [6.7;11.4]), 48 of these 63 patients (76.2%) no longer had metabolic syndrome (95%CI [65.7;86.7]). These 48 patients without metabolic syndrome at the end of follow-up represented 49.5% of the 97 included (95%CI [39.5;59.4]). Future studies of lifestyle interventions taking advantage of the spa environment can be expected to find least one third of patients free of metabolic syndrome at the end of 12-month follow-up in the intervention group. © 2013 Société Française de Pharmacologie et de Thérapeutique.

Automatic detection of motor unit innervation zones of the external anal sphincter by multichannel surface EMG.

PubMed

Ullah, Khalil; Cescon, Corrado; Afsharipour, Babak; Merletti, Roberto

2014-12-01

A method to detect automatically the location of innervation zones (IZs) from 16-channel surface EMG (sEMG) recordings from the external anal sphincter (EAS) muscle is presented in order to guide episiotomy during child delivery. The new algorithm (2DCorr) is applied to individual motor unit action potential (MUAP) templates and is based on bidimensional cross correlation between the interpolated image of each MUAP template and two images obtained by flipping upside-down (around a horizontal axis) and left-right (around a vertical axis) the original one. The method was tested on 640 simulated MUAP templates of the sphincter muscle and compared with previously developed algorithms (Radon Transform, RT; Template Match, TM). Experimental signals were detected from the EAS of 150 subjects using an intra-anal probe with 16 equally spaced circumferential electrodes. The results of the three algorithms were compared with the actual IZ location (simulated signal) and with IZ location provided by visual analysis (VA) (experimental signals). For simulated signals, the inter quartile error range (IQR) between the estimated and the actual locations of the IZ was 0.20, 0.23, 0.42, and 2.32 interelectrode distances (IED) for the VA, 2DCorr, RT and TM methods respectively. Copyright © 2014 Elsevier Ltd. All rights reserved.

Comparison of two fertility-sparing approaches for bilateral borderline ovarian tumours: a randomized controlled study.

PubMed

Palomba, S; Zupi, E; Russo, T; Falbo, A; Del Negro, S; Manguso, F; Marconi, D; Tolino, A; Zullo, F

2007-02-01

During the childbearing years, the standard fertility-sparing treatment for bilateral borderline ovarian tumours (BOTs) is the unilateral oophorectomy plus controlateral cystectomy. The aim of the present study was to compare the effects of two laparoscopic fertility-sparing surgical procedures for the treatment of bilateral BOTs on recurrence and fertility in young women who desire to conceive as soon as possible. Thirty-two women affected by bilateral early-stage BOTs who desired to conceive were randomized to receive bilateral cystectomy (experimental group, n=15) or oophorectomy plus controlateral cystectomy (control group, n=17). At the first recurrence after childbearing completion, each patient was treated with non-conservative standard treatment. Recurrences and reproductive events were recorded. After a follow-up period of 81 months (19 inter-quartile; 60-96 range), the cumulative pregnancy rate (CPR) (14/15 versus 9/17; P=0.003) and the cumulative probability of first pregnancy (P= 0.011) were significantly higher in the experimental than in control group. No significant (P=0.358) difference between groups was detected in cumulative probability of first recurrence. The laparoscopic bilateral cystectomy followed by non-conservative treatment performed at the first recurrence after the childbearing completion is an effective surgical strategy for patients with bilateral early-stage BOTs who desire to conceive as soon as possible.

Blood concentrations of lead, cadmium, mercury and their association with biomarkers of DNA oxidative damage in preschool children living in an e-waste recycling area.

PubMed

Xu, Xijin; Liao, Weitang; Lin, Yucong; Dai, Yifeng; Shi, Zhihua; Huo, Xia

2017-06-16

Reactive oxygen species (ROS)-induced DNA damage occurs in heavy metal exposure, but the simultaneous effect on DNA repair is unknown. We investigated the influence of co-exposure of lead (Pb), cadmium (Cd), and mercury (Hg) on 8-hydroxydeoxyguanosine (8-OHdG) and human repair enzyme 8-oxoguanine DNA glycosylase (hOGG1) mRNA levels in exposed children to evaluate the imbalance of DNA damage and repair. Children within the age range of 3-6 years from a primitive electronic waste (e-waste) recycling town were chosen as participants to represent a heavy metal-exposed population. 8-OHdG in the children's urine was assessed for heavy metal-induced oxidative effects, and the hOGG1 mRNA level in their blood represented the DNA repair ability of the children. Among the children surveyed, 88.14% (104/118) had a blood Pb level >5 μg/dL, 22.03% (26/118) had a blood Cd level >1 μg/dL, and 62.11% (59/95) had a blood Hg level >10 μg/dL. Having an e-waste workshop near the house was a risk factor contributing to high blood Pb (r s  = 0.273, p < 0.01), while Cd and Hg exposure could have come from other contaminant sources. Preschool children of fathers who had a college or university education had significantly lower 8-OHdG levels (median 242.76 ng/g creatinine, range 154.62-407.79 ng/g creatinine) than did children of fathers who had less education (p = 0.035). However, we did not observe a significant difference in the mRNA expression levels of hOGG1 between the different variables. Compared with children having low lead exposure (quartile 1), the children with high Pb exposure (quartiles 2, 3, and 4) had significantly higher 8-OHdG levels (β Q2  = 0.362, 95% CI 0.111-0.542; β Q3  = 0.347, 95% CI 0.103-0.531; β Q4  = 0.314, 95% CI 0.087-0.557). Associations between blood Hg levels and 8-OHdG were less apparent. Compared with low levels of blood Hg (quartile 1), elevated blood Hg levels (quartile 2) were associated with higher 8-OHdG levels (β Q2  = 0.236, 95% CI 0.039-0.406). Compared with children having low lead exposure (quartile 1), the children with high Pb exposure (quartiles 2, 3, and 4) had significantly higher 8-OHdG levels.

Plasma Lactate Dehydrogenase Levels Predict Mortality in Acute Aortic Syndromes: A Diagnostic Accuracy and Observational Outcome Study.

PubMed

Morello, Fulvio; Ravetti, Anna; Nazerian, Peiman; Liedl, Giovanni; Veglio, Maria Grazia; Battista, Stefania; Vanni, Simone; Pivetta, Emanuele; Montrucchio, Giuseppe; Mengozzi, Giulio; Rinaldi, Mauro; Moiraghi, Corrado; Lupia, Enrico

2016-02-01

In acute aortic syndromes (AAS), organ malperfusion represents a key event impacting both on diagnosis and outcome. Increased levels of plasma lactate dehydrogenase (LDH), a biomarker of malperfusion, have been reported in AAS, but the performance of LDH for the diagnosis of AAS and the relation of LDH with outcome in AAS have not been evaluated so far.This was a bi-centric prospective diagnostic accuracy study and a cohort outcome study. From 2008 to 2014, patients from 2 Emergency Departments suspected of having AAS underwent LDH assay at presentation. A final diagnosis was obtained by aortic imaging. Patients diagnosed with AAS were followed-up for in-hospital mortality.One thousand five hundred seventy-eight consecutive patients were clinically eligible, and 999 patients were included in the study. The final diagnosis was AAS in 201 (20.1%) patients. Median LDH was 424 U/L (interquartile range [IQR] 367-557) in patients with AAS and 383 U/L (IQR 331-460) in patients with alternative diagnoses (P < 0.001). Using a cutoff of 450 U/L, the sensitivity of LDH for AAS was 44% (95% confidence interval [CI] 37-51) and the specificity was 73% (95% CI 69-76). Overall in-hospital mortality for AAS was 23.8%. Mortality was 32.6% in patients with LDH ≥ 450 U/L and 16.8% in patients with LDH < 450 U/L (P = 0.006). Following stratification according to LDH quartiles, in-hospital mortality was 12% in the first (lowest) quartile, 18.4% in the second quartile, 23.5% in the third quartile, and 38% in the fourth (highest) quartile (P = 0.01). LDH ≥ 450 U/L was further identified as an independent predictor of death in AAS both in univariate and in stepwise logistic regression analyses (odds ratio 2.28, 95% CI 1.11-4.66; P = 0.025), in addition to well-established risk markers such as advanced age and hypotension. Subgroup analysis showed excess mortality in association with LDH ≥ 450 U/L in elderly, hemodynamically stable and in nonsurgically treated patients.Plasma LDH constitutes a biomarker of poor outcome in patients with AAS. LDH is a rapid and universally available assay that could be used to improve risk stratification and to individualize treatment in patient groups where options are controversial.

Plasma Lactate Dehydrogenase Levels Predict Mortality in Acute Aortic Syndromes

PubMed Central

Morello, Fulvio; Ravetti, Anna; Nazerian, Peiman; Liedl, Giovanni; Veglio, Maria Grazia; Battista, Stefania; Vanni, Simone; Pivetta, Emanuele; Montrucchio, Giuseppe; Mengozzi, Giulio; Rinaldi, Mauro; Moiraghi, Corrado; Lupia, Enrico

2016-01-01

Abstract In acute aortic syndromes (AAS), organ malperfusion represents a key event impacting both on diagnosis and outcome. Increased levels of plasma lactate dehydrogenase (LDH), a biomarker of malperfusion, have been reported in AAS, but the performance of LDH for the diagnosis of AAS and the relation of LDH with outcome in AAS have not been evaluated so far. This was a bi-centric prospective diagnostic accuracy study and a cohort outcome study. From 2008 to 2014, patients from 2 Emergency Departments suspected of having AAS underwent LDH assay at presentation. A final diagnosis was obtained by aortic imaging. Patients diagnosed with AAS were followed-up for in-hospital mortality. One thousand five hundred seventy-eight consecutive patients were clinically eligible, and 999 patients were included in the study. The final diagnosis was AAS in 201 (20.1%) patients. Median LDH was 424 U/L (interquartile range [IQR] 367–557) in patients with AAS and 383 U/L (IQR 331–460) in patients with alternative diagnoses (P < 0.001). Using a cutoff of 450 U/L, the sensitivity of LDH for AAS was 44% (95% confidence interval [CI] 37–51) and the specificity was 73% (95% CI 69–76). Overall in-hospital mortality for AAS was 23.8%. Mortality was 32.6% in patients with LDH ≥ 450 U/L and 16.8% in patients with LDH < 450 U/L (P = 0.006). Following stratification according to LDH quartiles, in-hospital mortality was 12% in the first (lowest) quartile, 18.4% in the second quartile, 23.5% in the third quartile, and 38% in the fourth (highest) quartile (P = 0.01). LDH ≥ 450 U/L was further identified as an independent predictor of death in AAS both in univariate and in stepwise logistic regression analyses (odds ratio 2.28, 95% CI 1.11–4.66; P = 0.025), in addition to well-established risk markers such as advanced age and hypotension. Subgroup analysis showed excess mortality in association with LDH ≥ 450 U/L in elderly, hemodynamically stable and in nonsurgically treated patients. Plasma LDH constitutes a biomarker of poor outcome in patients with AAS. LDH is a rapid and universally available assay that could be used to improve risk stratification and to individualize treatment in patient groups where options are controversial. PMID:26871831

Fungal exposure, atopy, and asthma exacerbations in Puerto Rican children.

PubMed

Blatter, Joshua; Forno, Erick; Brehm, John; Acosta-Pérez, Edna; Alvarez, María; Colón-Semidey, Angel; Thorne, Peter S; Metwali, Nervana; Canino, Glorisa; Celedón, Juan C

2014-07-01

Glucan is a component of the fungal cell wall that is used as a marker of fungal exposure. Little is known about indoor glucan, atopy, and asthma exacerbations among children living in tropical environments such as Puerto Rico. Our objective was to examine whether glucan exposure is associated with degree of atopy or visits to the emergency department (ED)/urgent care for asthma in Puerto Rican children. This was a cross-sectional study of 317 children aged 6 to 14 years with (cases, n = 160) and without (control subjects, n = 157) asthma in San Juan, Puerto Rico. Our primary outcomes were the number of positive skin tests to allergens (range, 0-15) and (in cases only) having had at least one visit to the ED/urgent care for asthma in the prior year. Levels of glucan, endotoxin, peptidoglycan, and five allergens (Der p 1, Bla g 2, Fel d 1, Can f 1, and Mus m 1) were measured in samples of house dust. Linear or logistic regression was used for the multivariate analysis. In a multivariate analysis adjusting for case-control status, mouse allergen, and other covariates, children exposed to glucan levels in the second and third quartiles had approximately two more positive skin tests than those in the lowest quartile (P < 0.01 in both instances). Among children with asthma, exposure to the highest quartile of glucan was associated with nearly ninefold greater odds of one or more visits to the ED/urgent care for asthma (95% confidence interval for adjusted odds ratio, 2.7-28.4; P < 0.001). Our results suggest that indoor fungal exposure leads to an increased degree of atopy and visits to the ED/urgent care for asthma in Puerto Rican children.

Fungal Exposure, Atopy, and Asthma Exacerbations in Puerto Rican Children

PubMed Central

Blatter, Joshua; Forno, Erick; Brehm, John; Acosta-Pérez, Edna; Alvarez, María; Colón-Semidey, Angel; Thorne, Peter S.; Metwali, Nervana; Canino, Glorisa

2014-01-01

Background: Glucan is a component of the fungal cell wall that is used as a marker of fungal exposure. Little is known about indoor glucan, atopy, and asthma exacerbations among children living in tropical environments such as Puerto Rico. Our objective was to examine whether glucan exposure is associated with degree of atopy or visits to the emergency department (ED)/urgent care for asthma in Puerto Rican children. Methods: This was a cross-sectional study of 317 children aged 6 to 14 years with (cases, n = 160) and without (control subjects, n = 157) asthma in San Juan, Puerto Rico. Our primary outcomes were the number of positive skin tests to allergens (range, 0–15) and (in cases only) having had at least one visit to the ED/urgent care for asthma in the prior year. Levels of glucan, endotoxin, peptidoglycan, and five allergens (Der p 1, Bla g 2, Fel d 1, Can f 1, and Mus m 1) were measured in samples of house dust. Linear or logistic regression was used for the multivariate analysis. Measurements and Main Results: In a multivariate analysis adjusting for case-control status, mouse allergen, and other covariates, children exposed to glucan levels in the second and third quartiles had approximately two more positive skin tests than those in the lowest quartile (P < 0.01 in both instances). Among children with asthma, exposure to the highest quartile of glucan was associated with nearly ninefold greater odds of one or more visits to the ED/urgent care for asthma (95% confidence interval for adjusted odds ratio, 2.7–28.4; P < 0.001). Conclusions: Our results suggest that indoor fungal exposure leads to an increased degree of atopy and visits to the ED/urgent care for asthma in Puerto Rican children. PMID:24915164

Association between mobile phone use and depressed mood in Japanese adolescents: a cross-sectional study.

PubMed

Ikeda, Kayoko; Nakamura, Kazutoshi

2014-05-01

Mobile phones are commonly used by adolescents. The aim of this study was to clarify associations between duration of mobile phone use and psychological mood in high school students. This cross-sectional study included 2,785 high school students in Niigata, Japan. A self-administered questionnaire was used to elicit information on sex, school year, hours of mobile phone use, psychological mood status, and possible confounders. Psychological mood outcomes were evaluated with the Mood Inventory, developed and validated in 1994, which includes five subcomponents with total scores ranging from 8 to 32 (higher score indicates stronger feeling): "Tension and excitement," "Refreshing mood," "Fatigue," "Depressed mood," and "Anxious mood." Analysis of covariance with Bonferroni's multiple comparison was used to compare mean values among quartiles of hours of mobile phone use. Among the respondents, mean mobile phone use per week was 24 (median 18) h. Long-duration mobile phone use was associated with female students, no participation in sports club activities, early mobile phone use, and fewer hours spent sleeping (all P < 0.001). Overall associations between hours of mobile phone use and total scores were significant for "Depressed mood" (P for trend = 0.005), "Tension and excitement" (P for trend <0.001), and "Fatigue" (P for trend < 0.001). Total scores for "Depressed mood," "Tension and excitement," and "Fatigue" of the fourth quartile (≥33 h/week) of mobile phone use were significantly higher than for other quartiles (all P < 0.05). Increased duration of mobile phone use is associated with unfavorable psychological mood, in particular, a depressed mood. Decreasing mobile phone use may help maintain appropriate mental health in very long-duration users.

Population Survey of Knowledge about Oral Cancer and Related Factors in the Capital of Iran.

PubMed

Azimi, Somayyeh; Ghorbani, Zahra; Tennant, Marc; Kruger, Estie; Safiaghdam, Hannaneh; Rafieian, Nasrin

2017-08-24

Knowledge about oral cancer risk factors and signs is thought to improve prevention and early diagnosis, and in turn, increases survival. In this population-based survey, knowledge about oral cancer was assessed in Iran. A total of 1800 self-administered questionnaires (collecting sociodemographic data and questions regarding oral cancer risk factors and signs) were distributed through random sampling. Final scores ranged between 0 and 15 for the risk factors and 0-11 for the signs. Scores below the median indicated a low level of knowledge, scores representing the third quartile of correct answers indicated a moderate level of knowledge, and scores representing the upper quartile indicated a high level of knowledge. Statistical tests were used for analysis of knowledge level in different sociodemographic categories. A total of 1312 participants completed the questionnaires. The average of knowledge scores for risk factors was 5.3 ± 3.0 and for signs was 4.5 ± 2.9. Overall, 75 and 56% respectively were able to identify major risk factors (smoking and alcohol); 23.5% could not define any related signs and symptoms. Dividing scores into quartiles indicated that three out of four people had "low" knowledge about risk factors and 58% had "low" knowledge about signs and symptoms. Females and highly educated people had more knowledge of oral cancer. Significant difference was found between job and level of knowledge (P = 0.001). This survey revealed that public knowledge of oral cancer was not satisfactory in Iran. Efforts should be done to inform and educate people with risk factors, initial clinical presentation, and symptoms, in order to improve prevention and promote early diagnosis.

Dietary Protein Intake Is Protective Against Loss of Grip Strength Among Older Adults in the Framingham Offspring Cohort

PubMed Central

McLean, Robert R.; Mangano, Kelsey M.; Hannan, Marian T.; Kiel, Douglas P.

2016-01-01

Abstract Background: Age-related decline in muscle strength is an important public health issue for older adults. Dietary protein has been associated with maintenance of muscle mass, yet its relation to muscle strength remains unclear. Methods: We determined the association of dietary protein (total, animal, and plant) intake, measured by food frequency questionnaire, with change in grip strength over 6 years in 1,746 men and women from the Framingham Offspring cohort. Results: Mean age at baseline was 58.7 years (range: 29–85), and mean total, animal, and plant protein intakes were 79, 57, and 22g/d, respectively. Adjusted baseline mean grip strength did not differ across quartiles of energy-adjusted total, animal or protein intake. Greater protein intake, regardless of source, was associated with less decrease in grip strength (all p for trend ≤.05): participants in the lowest quartiles lost 0.17% to 0.27% per year while those in the highest quartiles gained 0.52% to 0.60% per year. In analyses stratified by age, participants aged 60 years or older ( n = 646) had similar linear trends on loss of grip strength for total and animal (all p for trend <.03) but not plant protein, while the trends in participants younger than 60 years ( n = 896) were not statistically significant. Conclusions: Higher dietary intakes of total and animal protein were protective against loss of grip strength in community-dwelling adults aged 60 years and older. Increasing intake of protein from these sources may help maintain muscle strength and support prevention of mobility impairment in older adults. PMID:26525088

Clinical picture of meningitis in the adult patient and its relationship with age.

PubMed

Magazzini, Simone; Nazerian, Peiman; Vanni, Simone; Paladini, Barbara; Pepe, Giuseppe; Casanova, Barbara; Crugnola, Carolina; Grifoni, Stefano

2012-08-01

To analyze the clinical characteristics of acute meningitis and their relationship with age in adult patients presenting to the emergency department. We retrospectively investigated consecutive adult patients admitted with a diagnosis of bacterial or viral meningitis from 2002 to 2006. Data about patient's history, symptoms and signs at presentation, etiology and clinical course were collected. To investigate the relationship of clinical presentation with age, we divided patients in four age quartiles (<30 years, between 30 and 36 years, between 37 and 56 years, >56 years). Among the 202 patients considered in the study (mean age 42.8 ± 18.7 years, range 14-90), 162 (80.2%) patients had viral and 40 (19.8%) bacterial meningitis. Specific signs, such as neck stiffness or Kernig or Brudzinski signs, were more common in the first than in the fourth quartile (73.1 vs. 45.7% P = 0.041). Conversely, altered consciousness expressed as Glasgow Coma Scale (GCS) <15 was more frequent in the fourth (80.4%) than in the first (9.6%) quartile (P < 0.001). The linear regression analysis confirmed a significant decrease of GCS with the increasing of patient's age (r = -0.69, P < 0.001). At multivariate analysis, aging was associated with altered level of consciousness (OR 16.7, P < 0.001) independent of viral or bacterial etiology of the presence of comorbidities and of clinical severity (presence of severe sepsis or septic shock). Meningitis presentation largely differs with aging in adult patients. Level of consciousness is frequently altered in the older patients, when other specific signs become more rare, independent of etiology, comorbidities and clinical severity.

Risk-adjusted cesarean section rates for the assessment of physician performance in Taiwan: a population-based study.

PubMed

Tang, Chao-Hsiun; Wang, Han-I; Hsu, Chun-Sen; Su, Hung-Wen; Chen, Mei-Ju; Lin, Herng-Ching

2006-10-09

Over the past decade, about one-third of all births nationwide in Taiwan were delivered by cesarean section (CS). Previous studies in the US and Europe have documented the need for risk adjustment for fairer comparisons among providers. In this study, we set out to determine the impact that adjustment for patient-specific risk factors has on CS among different physicians in Taiwan. There were 172,511 live births which occurred in either hospitals or obstetrics/gynecology clinics between 1 January and 31 December 2003, and for whom birth certificate data could be linked with National Health Insurance (NHI) claims data, available as the sample for this study. Physicians were divided into four equivalent groups based upon the quartile distribution of their crude (actual) CS rates. Stepwise logistic regressions were conducted to develop a predictive model and to determine the expected (risk-adjusted) CS rate and 95% confidence interval (CI) for each physician. The actual rates were then compared with the expected CS rates to see the proportion of physicians whose actual rates were below, within, or above the predicted CI in each quartile. The proportion of physicians whose CS rates were above the predicted CI increased as the quartile moved to the higher level. However, more than half of the physicians whose actual rates were higher than the predicted CI were not in the highest quartile. Conversely, there were some physicians (40 of 258 physicians) in the highest quartile who were actually providing obstetric care that was appropriate to the risk. When a stricter standard was applied to the assessment of physician performance by excluding physicians in quartile 4 for predicting CS rates, as many as 60% of physicians were found to have higher CS rates than the predicted CI, and indeed, the CS rates of no physicians in either quartile 3 or quartile 4 were below the predicted CI. Overall, our study found that the comparison of unadjusted CS rates might not provide a valid reflection of the quality of obstetric care delivered by physicians, and may ultimately lead to biased judgments by purchasers. Our study has also shown that when we changed the standard of quality assessment, the evaluation results also changed.

Association Between Uric Acid and Metabolic Syndrome in Elderly Women.

PubMed

Wang, Hui-Juan; Shi, Lei-Zhi; Liu, Cun-Fei; Liu, Shi-Min; Shi, Song-Tao

2018-01-01

To investigate the relationship between uric acid and metabolic syndrome (MetS) in elderly women. A total of 468 women aged ≥60 years participating in a health examination were enrolled. The association between uric acid and MetS and its individual variables was evaluated by univariate and multivariate logistic regression models. A dose-response relationship was observed for the prevalence of MetS and uric acid quartiles. Subjects in the second, third and fourth quartile of uric acid had a 2.23-fold, 2.25-fold and 4.41-fold increased risk, respectively, of MetS than those in the first uric acid quartile (p for trend <0.001). Furthermore, each 1 mg/dl increment of serum uric acid level had a 1.38-fold increased risk of MetS (OR 1.38; 95% CI, 1.14-1.69; p=0.001). Our present study demonstrated that elevated uric acid was positively associated with the prevalence of MetS in elderly women. Further random control trials are needed to elucidate the effectiveness of treatment of hyperuricaemia in reducing the incidence of MetS in elderly women.

A prospective study of serum 25-hydroxyvitamin d levels and mortality among African Americans and non-African Americans.

PubMed

Signorello, Lisa B; Han, Xijing; Cai, Qiuyin; Cohen, Sarah S; Cope, Elizabeth L; Zheng, Wei; Blot, William J

2013-01-15

The beneficial biologic effects attributed to vitamin D suggest a potential to influence overall mortality. Evidence addressing this hypothesis is limited, especially for African Americans who have a high prevalence of vitamin D insufficiency. The authors conducted a nested case-control study within the prospective Southern Community Cohort Study to relate baseline serum levels of 25-hydroxyvitamin D (25(OH)D) with subsequent mortality. Cases were 1,852 participants who enrolled from 2002 to 2009 and died >12 months postenrollment. Controls (n = 1,852) were matched on race, sex, age, enrollment site, and blood collection date. The odds ratios for quartile 1 (<10.18 ng/mL) versus quartile 4 (>21.64 ng/mL) levels of 25(OH)D were 1.60 (95% confidence interval (CI): 1.20, 2.14) for African Americans and 2.11 (95% CI: 1.39, 3.21) for non-African Americans. The effects were strongest for circulatory disease death, where quartile 1 versus quartile 4 odds ratios were 2.53 (95% CI: 1.44, 4.46) and 3.25 (95% CI: 1.33, 7.93) for African Americans and non-African Americans, respectively. The estimated odds of total mortality were minimized in the 25(OH)D range of 35-40 ng/mL. These findings provide support for the hypothesis that vitamin D status may have an important influence on mortality for both African Americans and non-African Americans.

Treatment Complexity in Cystic Fibrosis: Trends over Time and Associations with Site-Specific Outcomes

PubMed Central

Sawicki, Gregory S.; Ren, Clement L.; Konstan, Michael W.; Millar, Stefanie J.; Pasta, David J.; Quittner, Alexandra L.

2014-01-01

Background Patients with cystic fibrosis (CF) have increasing treatment complexity and high treatment burden. We describe trends in treatment complexity and evaluate its relationship with health outcomes. Methods Using Epidemiologic Study of Cystic Fibrosis (ESCF) data, we developed a treatment complexity score (TCS) from 37 chronic therapies and assessed change by age group (6–13, 14–17, and 18+ years) over a three year period. Differences in average site TCS were evaluated by quartiles based on FEV1, BMI, or Treatment Burden score on the Cystic Fibrosis Questionnaire-Revised (CFQ-R). Results TCS scores were calculated for 7252 individual patients (42% child, 16% adolescent, 43% adult) across 153 sites. In 2003, mean TCS was 11.1 for children, 11.8 for adolescents, and 12.1 for adults. In all 3 age groups, TCS increased over 3 years; the increase in TCS from 2003–2005 for children was 1.25 (95% CI 1.16–1.34), for adolescents 0.77 (0.62–0.93), and for adults 1.20 (1.08–1.31) (all p<0.001 for trend over time). At the site level, there were no significant differences in mean TCS based on FEV1 quartile. Mean TCS was higher in the highest BMI z-score quartile. Across all 3 versions of the CFQ-R, mean TCS was lower at sites in the highest quartiles (lowest burden) for CFQ-R Treatment Burden scores. Conclusion Treatment complexity was highest among adults with CF, although over 3 years, we observed a significant increase in treatment complexity in all age groups. Such increases in treatment complexity pose a challenge to patient self-management and adherence. Future research is needed to understand the associations between treatment complexity and subsequent health outcomes to reduce treatment burden and improve disease management. PMID:23352205

The Leading Group Effect: Illusionary Declines in Scholastic Standard Scores of Mid-Range Japanese Junior High School Pupils

ERIC Educational Resources Information Center

Mori, Kazuo; Uchida, Akitoshi

2012-01-01

Longitudinal change in the average Z scores for four groups of pupils sorted by quartiles was examined for its stability over three years. The data, collected from 1998 to 2009, was obtained from nine cohorts of Japanese junior high school pupils totaling 1,962 subjects. It showed illusionary declines among the mid-range pupils but improvements…

Relationships between seminal plasma metals/metalloids and semen quality, sperm apoptosis and DNA integrity.

PubMed

Wang, Yi-Xin; Wang, Peng; Feng, Wei; Liu, Chong; Yang, Pan; Chen, Ying-Jun; Sun, Li; Sun, Yang; Yue, Jing; Gu, Long-Jie; Zeng, Qiang; Lu, Wen-Qing

2017-05-01

This study aimed to investigate the relationships between environmental exposure to metals/metalloids and semen quality, sperm apoptosis and DNA integrity using the metal/metalloids levels in seminal plasma as biomarkers. We determined 18 metals/metalloids in seminal plasma using an inductively coupled plasma-mass spectrometry among 746 men recruited from a reproductive medicine center. Associations of these metals/metalloids with semen quality (n = 746), sperm apoptosis (n = 331) and DNA integrity (n = 404) were evaluated using multivariate linear and logistic regression models. After accounting for multiple comparisons and confounders, seminal plasma arsenic (As) quartiles were negatively associated with progressive and total sperm motility using multivariable linear regression analysis, which were in accordance with the trends for increased odds ratios (ORs) for below-reference semen quality parameters in the logistic models. We also found inverse correlations between cadmium (Cd) quartiles and progressive and total sperm motility, whereas positive correlations between zinc (Zn) quartiles and sperm concentration, between copper (Cu) and As quartiles and the percentage of tail DNA, between As and selenium (Se) quartiles and tail extent and tail distributed moment, and between tin (Sn) categories and the percentage of necrotic spermatozoa (all P trend <0.05). These relationships remained after the simultaneous consideration of various elements. Our results indicate that environmental exposure to As, Cd, Cu, Se and Sn may impair male reproductive health, whereas Zn may be beneficial to sperm concentration. Copyright © 2017 Elsevier Ltd. All rights reserved.

Serum ferritin levels are associated with arterial stiffness in healthy Korean adults.

PubMed

Ha, Ji Yoon; Kim, Min Kyung; Kang, Shinae; Nam, Ji Sun; Ahn, Chul Woo; Kim, Kyung Rae; Park, Jong Suk

2016-08-01

Although an association between serum ferritin and atherosclerosis has been suggested, limited epidemiologic data are available regarding the association between ferritin and arterial stiffness in healthy adults. A total of 2932 healthy subjects were enrolled in this study. Anthropometric and biochemical profiles including ferritin were measured. The arterial stiffness was measured using brachial-ankle pulse wave velocity (baPWV). Serum ferritin levels were classified into quartiles and baPWV values gradually increased with each ferritin quartile. Multiple regression analysis showed that ferritin levels were independently correlated with baPWV. After adjusting for multiple risk factors, as compared with the lowest quartile, the odds ratios for high baPWV (>75(th) percentile) were 1.15 (0.84-1.56), 1.37 (0.97-1.73), and 1.46 (1.29-2.17) among men (p for trend < 0.05) and 1.24 (0.87-1.79), 1.53 (1.09-2.16), and 1.80 (1.25-2.82) among women (p for trend < 0.05), for the second, third, and fourth quartiles of ferritin, respectively. In conclusion, serum ferritin levels are independently associated with arterial stiffness in healthy Korean adults. © The Author(s) 2016.

Increased plasma dipeptidyl peptidase-4 activities are associated with high prevalence of subclinical atherosclerosis in Chinese patients with newly diagnosed type 2 diabetes: a cross-sectional study.

PubMed

Zheng, T P; Liu, Y H; Yang, L X; Qin, S H; Liu, H B

2015-10-01

Hyperglycemia, insulin resistance, dislipidemia, oxidative stress and inflammation are well-documented risk factors for subclinical atherosclerosis. Dipeptidyl peptidase-4(DPP4) is a newly identified adipokine related to these risk factors. Hence, we aimed to investigate the association between plasma DPP4 activities and subclinical atherosclerosis in type 2 diabetes. A total of 985 newly diagnosed type 2 diabetic subjects were studied. Plasma DPP4 activity, mannose 6-phosphate receptor (M6P-R), oxidative stress parameters, inflammatory markers and common carotid artery Intima-Media Thickness (c-IMT) were measured in all participants. Participants in the highest quartile of DPP4 activity had higher HbA1c, homeostatic model assessment of insulin resistance(HOMA-IR), triglyceride, low-density lipoprotein cholesterol(LDL-C), oxidized LDL, nitrotyrosine, 8-iso-PGF2a, interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), M6P-R, c-IMT compared with participants in the lowest quartile (all P < 0.001). DPP4 activities were associated positively with HbA1c, HOMA-IR, triglyceride, LDL-C, oxidized LDL, nitrotyrosine, 8-iso-PGF2a, IL-6, hs-CRP, M6P-R and c-IMT (all P < 0.05). The ORs for insulin resistance, dislipidemia, oxidative stress and inflammation were higher with increasing DPP4 quartiles (P < 0.001 for trend). In the highest DPP4 quartile, subclinical atherosclerosis risk was significantly higher (OR 4.97; 95% CI 3.03-8.17) than in the lowest quartile. This association remained strong (2.17; 1.21-3.89) after further controlling for HbA1c, HOMA-IR, triglyceride, oxidized LDL, nitrotyrosine, and IL-6. This study shows that increased DPP4 activities are positively and independently associated with subclinical atherosclerosis in type 2 diabetes. Our findings suggest of potential role of DPP4 in the pathogenesis of subclinical atherosclerosis and in the prevention and management of this disease. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Strong Association between Plasma Dipeptidyl Peptidase-4 Activity and Impaired Cognitive Function in Elderly Population with Normal Glucose Tolerance.

PubMed

Chen, Bo; Zheng, Tianpeng; Qin, Linyuan; Hu, Xueping; Zhang, Xiaoxi; Liu, Yihong; Liu, Hongbo; Qin, Shenghua; Li, Gang; Li, Qinghua

2017-01-01

Objective: Inflammation, oxidative stress, and decreased glucagon-like peptide-1 (GLP-1) are risk factors for cognitive impairment. Dipeptidyl peptidase-4 (DPP4) was identified as a novel adipokine capable of enhancing these risk factors. Hence, we investigated the relationship between plasma DPP4 activity and impaired cognitive function in elderly Chinese population with normal glucose tolerance (NGT). Methods: We performed a cross-sectional study using data from 1229 elderly participants (60 years or older) in Guilin. Plasma DPP4 activity, oxidative stress parameters, fasting active GLP-1, and inflammatory markers were measured in all participants. Impaired cognitive function was diagnosed according to the National Institute on Aging-Alzheimer's Association workgroups criteria. Results: Participants in the upper quartile of plasma DPP4 activity had higher C-reactive protein (CRP), interleukin-6 (IL-6), 8-iso-PGF2a, nitrotyrosine, and lower GLP-1 and Montreal Cognitive Assessment (MoCA) scores compared with those in the lowest quartile ( P < 0.001). The odds ratios (ORs) for increased CRP, IL-6, 8-iso-PGF2a, nitrotyrosine, and decreased active GLP-1 were higher with increasing DPP4 quartiles after adjustment for confounders (all P < 0.001). In the highest DPP4 quartile, impaired cognitive function risk was higher (OR, 2.26; 95% confidence interval, 1.36-3.76) than in the lowest quartile after adjustment for potential confounders. The risk for impaired cognitive function increased more with higher levels of DPP4 activity, nitrotyrosine and 8-iso-PGF2a ( P < 0.05), but not with higher IL-6, CRP or lower GLP-1. Conclusion: Plasma DPP4 activity is significantly and independently associated with impaired cognitive function, mainly executive, in elderly Chinese population with NGT. The underlying mechanisms for this association may be partly attributed to the effect of DPP4 on oxidative stress. Plasma DPP4 activity might serve as a risk biomarker or therapeutic target for the prevention and treatment of impaired cognitive function.

Increased levels of lead in the blood and frequencies of lymphocytic micronucleated binucleated cells among workers from an electronic-waste recycling site.

PubMed

Wang, Qian; He, An M; Gao, Bo; Chen, Lan; Yu, Qiang Z; Guo, Huan; Shi, Bin J; Jiang, Pu; Zhang, Zeng Y; Li, Ping L; Sheng, Ying G; Fu, Mo J; Wu, Chun T; Chen, Min X; Yuan, Jing

2011-01-01

In recent years, adverse health effects of chemicals from electronic waste (e-waste) have been reported. However, little is known about the genotoxic effects of chemicals in e-waste. In the present study, air concentrations of the toxic metals at e-waste and control sites were analyzed using inductively-coupled plasma mass spectrometry. Levels of toxic metals (lead, copper and cadmium) in blood and urine were detected using atomic absorption spectrophotometry in 48 exposed individuals and 56 age- and sex-matched controls. The frequencies of lymphocytic micronucleated binucleated cells (MNBNCs) were determined using a cytokinesis-block micronucleus assay. Results indicated that blood lead levels were significantly higher in the exposed group (median: 11.449 μg/dL, 1st/3rd quartiles: 9.351-14.410 μg/dL) than in the control group (median: 9.104 μg/dL, 1st/3rd quartiles: 7.275-11.389 μg/dL). The exposed group had higher MNBNCs frequencies (median: 4.0 per thousand, 1st/3rd quartiles: 2.0-7.0 per thousand) compared with the controls (median: 1.0 per thousand, 1st/3rd quartiles: 0.0-2.0 per thousand). Additionally, MNBNCs frequencies and blood lead levels were positively correlated (r = 0.254, p<0.01). Further analysis suggested that a history of working with e-waste was a predictor for increased blood lead levels and MNBNCs frequencies in the subjects. The results suggest that both the living and occupational environments at the e-waste site may be risk factors for increased MNBNCs frequencies among those who are exposed.

Risk of HPV-16/18 Infections and Associated Cervical Abnormalities in Women Seropositive for Naturally Acquired Antibodies: Pooled Analysis Based on Control Arms of Two Large Clinical Trials.

PubMed

Safaeian, Mahboobeh; Castellsagué, Xavier; Hildesheim, Allan; Wacholder, Sholom; Schiffman, Mark H; Bozonnat, Marie-Cécile; Baril, Laurence; Rosillon, Dominique

2018-06-05

Studies on the role of antibodies produced after infection with human papillomavirus 18 (HPV-18) and subsequent protection from HPV-18 infection have been conflicting, mainly due to inadequate sample size. We pooled data from the control arms of the Costa Rica Vaccine Trial and the PATRICIA trial. Using Poisson regression we compared the risk of newly detected 1-time HPV-18 infection, HPV-18 1-year persistent infection (12MPI), and HPV-18-associated atypical squamous cells of undetermined significance or greater (ASC-US+) lesions between HPV-18 seropositive and seronegative women. High HPV-18 antibodies at enrollment was associated with reduced subsequent HPV-18 detection (P trend = 0.001; relative rate [RR] = 0.69; 95% confidence interval [CI], 0.47-1.01 for the third quartile; RR = 0.63; 95% CI, 0.43-0.94 for the fourth quartile, compared to seronegative). The risk of 12MPI showed a decreasing trend with increasing antibodies (P trend = 0.06; RR = 0.72; 95% CI, 0.29-1.77; RR = 0.42; 95% CI, 0.13-1.32 for the third and fourth quartiles, respectively). Lastly, we observed a significant decreased risk of HPV-18 ASC-US+ with increasing antibody (P trend = 0.01; RR = 0.46; 95% CI, 0.21-0.97 for the fourth quartile). We also observed a significant decreased risk of HPV-16 infection, 12MPI, and ASC-US+ with increasing HPV-16 antibody level. High HPV-18 naturally acquired antibodies were associated with partial protection from future HPV-18 infections and associated lesions. NCT00128661 and NCT001226810.

25-Hydroxyvitamin D and TSH as Risk Factors or Prognostic Markers in Thyroid Carcinoma

PubMed Central

Danilovic, Debora Lucia Seguro; Ferraz-de-Souza, Bruno; Fabri, Amanda Wictky; Santana, Nathalie Oliveira; Kulcsar, Marco Aurelio; Cernea, Claudio Roberto; Marui, Suemi; Hoff, Ana Oliveira

2016-01-01

Objective The increasing incidence of thyroid nodules demands identification of risk factors for malignant disease. Several studies suggested the association of higher TSH levels with cancer, but influence of 25-hydroxyvitamin D (25OHD) is controversial. This study aimed to identify the relationship of thyroid cancer with higher TSH levels and hypovitaminosis D and to evaluate their influence on prognostic characteristics of papillary thyroid carcinomas (PTC). Methods We retrospectively evaluated 433 patients submitted to thyroidectomy for thyroid nodules. Patients were categorized according to quartiles of TSH and 25OHD levels. Clinicopathological features were analyzed. Results Subjects with thyroid carcinomas were more frequently male and younger compared to those with benign disease. Their median TSH levels were higher and adjusted odds-ratio (OR) for cancer in the highest-quartile of TSH (> 2.4 mUI/mL) was 2.36 (1.36–4.09). Although vitamin D deficiency/insufficiency was prevalent in our cohort (84%), no significant differences in 25OHD levels or quartile distribution were observed between benign and malignant cases. Among 187 patients with PTC, analyses of prognostic features revealed increased risk of lymph nodes metastases for subjects with highest-quartile TSH levels (OR = 3.7, p = 0.029). Decreased 25OHD levels were not overtly associated with poor prognosis in PTC. Conclusions In this cross-sectional cohort, higher TSH levels increased the risk of cancer in thyroid nodules and influenced its prognosis, particularly favoring lymph nodes metastases. On the other hand, no association was found between 25OHD levels and thyroid carcinoma risk or prognosis, suggesting that serum 25OHD determination may not contribute to risk assessment workup of thyroid nodules. PMID:27737011

Vitamin D status and the risk of type 2 diabetes: the Melbourne Collaborative Cohort Study.

PubMed

Heath, Alicia K; Williamson, Elizabeth J; Hodge, Allison M; Ebeling, Peter R; Eyles, Darryl W; Kvaskoff, David; O'Dea, Kerin; Giles, Graham G; English, Dallas R

2018-05-18

Inverse associations between vitamin D status and risk of type 2 diabetes observed in epidemiological studies could be biased by confounding and reverse causality. We investigated the prospective association between vitamin D status and type 2 diabetes and the possible role of reverse causality. We conducted a case-cohort study within the Melbourne Collaborative Cohort Study (MCCS), including a random sample of 628 participants who developed diabetes and a sex-stratified random sample of the cohort (n=1,884). Concentration of 25-hydroxyvitamin D (25(OH)D) was measured using liquid chromatography-tandem mass spectrometry in samples collected at recruitment. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of type 2 diabetes for quartiles of 25(OH)D relative to the lowest quartile and per 25 nmol/L increase in 25(OH)D, adjusting for confounding variables. The ORs for the highest versus lowest 25(OH)D quartile and per 25 nmol/L increase in 25(OH)D were 0.60 (95% CI: 0.44, 0.81) and 0.76 (95% CI: 0.63, 0.92; p=0.004), respectively. In participants who reported being in good/very good/excellent health approximately four years after recruitment, ORs for the highest versus lowest 25(OH)D quartile and per 25 nmol/L increase in 25(OH)D were 0.46 (95% CI: 0.29, 0.72) and 0.71 (95% CI: 0.56, 0.89; p=0.003), respectively. In this sample of middle-aged Australians, vitamin D status was inversely associated with the risk of type 2 diabetes, and this association did not appear to be explained by reverse causality. Copyright © 2018. Published by Elsevier B.V.

Cystatin C and Risk of Hip Fractures in Older Women

PubMed Central

Ensrud, Kristine E.; Parimi, Neeta; Cauley, Jane A.; Ishani, Areef; Slinin, Yelena; Hillier, Teresa A.; Taylor, Brent C.; Steffes, Michael; Cummings, Steven R.

2013-01-01

To test the hypothesis that older women with higher cystatin C are at increased risk of hip fracture independent of traditional risk factors including hip bone mineral density (BMD), we performed a case-cohort analysis nested in a cohort of 4709 white women attending a Year 10 (1997–1998) examination of the Study of Osteoporotic Fractures that included a random sample of 1170 women and the first 300 women with incident hip fracture occurring after Year 10 examination. Serum cystatin C and creatinine were measured in Year 10 sera. In a model adjusted for age, clinical site, body mass index and total hip BMD, higher cystatin C was associated with an increased risk of hip fracture (p for linear trend 0.008) with women in quartile 4 having a 1.9-fold higher risk (hazard ratio (HR) 1.91, 95% confidence (CI) 1.24–2.95) compared with those in quartile 1 (referent group). Further adjustment for additional risk factors only slightly attenuated the association; the risk for hip fracture was 1.7-fold (HR 1.74, 95% CI 1.11–2.72) higher in women in quartile 4 compared with those in quartile 1. In contrast, neither serum creatinine nor creatinine-based estimated glomerular filtration rate (eGFRCr) were associated with risk of hip fracture. Older women with higher cystatin C, but not higher serum creatinine or lower eGFRCr, have an increased risk of hip fracture independent of traditional risk factors. These findings suggest that cystatin C may be a promising biomarker for identification of older adults at high risk of hip fracture. PMID:23300153

Factors influencing endometrial thickness in postmenopausal women.

PubMed

Hebbar, S; Chaya, V; Rai, L; Ramachandran, A

2014-07-01

Cut-off values for endometrial thickness (ET) in asymptomatic postmenopausal woman have been standardized. However, there are no comprehensive studies to document how various factors can influence the ET after the age of menopause. To study the various factors influencing the ET in postmenopausal women. This was a prospective observational study. A total of 110 postmenopausal women underwent detailed history taking, clinical examination, and transvaginal scan for uterine volume and ovarian volume. The volumes were calculated by using ellipsoid formula: Width × thickness × height × 0.523. The variation in ET with respect to the influencing factors such as age, duration of menopause, parity, body mass index (BMI), medical illness like diabetes/hypertension, drugs like tamoxifen, presence of myoma, uterine volume, ovarian volume, and serum estradiol (in selected patients) were measured. Descriptive analysis was performed using SPSS software (version 16, Chicago II, USA) to obtain mean, standard deviation (SD), 95% confidence intervals (CIs) and inter quartile ranges. Comparison of means was carried out using analysis of variance. The mean (SD) age of the patients was 55.4 (6.91) years (95% CI, 54.1, 56.7). The mean (SD) age at menopause was 47.95 (3.90) years (95% CI, 47.2, 48.7) and the mean (SD) duration of menopause was 7.27 (6.65) years (95% CI, 6.01, 8.53). The mean (SD) ET was 3.8 (2.3) mm (95% CI, 3.36, 4.23). Medical illness like diabetes and hypertension did not alter the ET. ET increased as BMI increased and it was statistically significant. The presence of myoma increased uterine volume significantly and was associated with thick endometrial stripe. Similarly, whenever the ovaries were visualized and as the ovarian volume increased, there was an increase in ET. When ET was > 4 mm (n = 37), they were offered endocel, of which 16 agreed to undergo the procedure. None were found to have endometrial cancer. This study suggests that parity, BMI, presence of myoma, tamoxifen usage, uterine volume, ovarian volume and serum estradiol influence the ET in postmenopausal women.

Sex education and adolescent sexual behavior: do community characteristics matter?

PubMed

Kraft, Joan Marie; Kulkarni, Aniket; Hsia, Jason; Jamieson, Denise J; Warner, Lee

2012-09-01

Studies point to variation in the effects of formal sex education on sexual behavior and contraceptive use by individual and community characteristics. Using the 2002 National Survey of Family Growth, we explored associations between receipt of sex education and intercourse by age 15, intercourse by the time of the interview and use of effective contraception at first sex among 15-19-year-olds, stratified by quartiles of three community characteristics and adjusted for demographics. Across all quartiles of community characteristics, sex education reduced the odds of having sex by age 15. Sex education resulted in reduced odds of having sex by the date of the interview and increased odds of using contraception in the middle quartiles of community characteristics. Variation in the effects of sex education should be explored. Research might focus on programmatic differences by community type and programmatic needs in various types of communities. Published by Elsevier Inc.

Proinflammatory diet is associated with increased risk of squamous cell head and neck cancer.

PubMed

Mazul, A L; Shivappa, N; Hébert, J R; Steck, S E; Rodriguez-Ormaza, N; Weissler, M; Olshan, A F; Zevallos, J P

2018-04-26

Diets high in fruits and vegetables and low in red meat intake have been associated with decreased risk of head and neck cancer. Additionally, chronic inflammation pathways and their association with cancer have been widely described. We hypothesized a pro-inflammatory diet, as measured by the Dietary Inflammatory Index (DII®), is associated with increased risk of head and neck cancer. We used the Carolina Head and Neck Cancer (CHANCE) study, a population-based case-control study of head and neck squamous cell carcinoma. Cases were recruited from a 46-county region in central North Carolina. Controls, frequency-matched on age, race, and sex, were identified through the North Carolina Department of Motor Vehicle records. The DII score, adjusted for energy using the density approach (E-DII), was calculated from a food frequency questionnaire and split into four quartiles based on the distribution among controls. Adjusted odds ratios (ORs) were estimated with unconditional logistic regression. Cases had higher E-DII scores (i.e., a more pro-inflammatory diet) compared with controls (Mean: -0.14 versus -1.50; p-value <0.001). When compared with the lowest quartile, the OR for the highest quartile was 2.91 (95% confidence interval (CI): 2.16-3.95), followed by 1.93 (95% CI: 1.43-2.62) for the 3 rd quartile, and 1.37 (95% CI: 1.00-1.89) for the 2 nd quartile. Both alcohol and smoking had a significant additive interaction with E-DII (smoking relative excess risk due to interaction (RERI): 2.83; 95% CI: 1.36-4.30 and alcohol RERI: 1.75; 95% CI: 0.77-2.75). These results provide additional evidence for the association between pro-inflammatory diet and head and neck cancer. This article is protected by copyright. All rights reserved. © 2018 UICC.

Baseline Quality of Life and Risk of Stroke in the ALLHAT Study (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial).

PubMed

Shams, Tanzila; Auchus, Alexander P; Oparil, Suzanne; Wright, Clinton B; Wright, Jackson; Furlan, Anthony J; Sila, Cathy A; Davis, Barry R; Pressel, Sara; Yamal, Jose-Miguel; Einhorn, Paula T; Lerner, Alan J

2017-11-01

The visual analogue scale is a self-reported, validated tool to measure quality of life (QoL). Our purpose was to determine whether baseline QoL predicted strokes in the ALLHAT study (Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial) and evaluate determinants of poststroke change in QoL. In the ALLHAT study, among the 33 357 patients randomized to treatment arms, 1525 experienced strokes; 1202 (79%) strokes were nonfatal. This study cohort includes 32 318 (97%) subjects who completed the baseline visual analogue scale QoL estimate. QoL was measured on a visual analogue scale and adjusted using a Torrance transformation (transformed QoL [TQoL]). Kaplan-Meier curves and adjusted proportional hazards analyses were used to estimate the effect of TQoL on the risk of stroke, on a continuous scale (0-1) and by quartiles (≤0.81, >0.81≤0.89, >0.89≤0.95, >0.95). We analyzed the change from baseline to first poststroke TQoL using adjusted linear regression. After adjusting for multiple stroke risk factors, the hazard ratio for stroke events for baseline TQoL was 0.93 (95% confidence interval, 0.89-0.98) per 0.1 U increase. The lowest baseline TQoL quartile had a 20% increased stroke risk (hazard ratio=1.20 [95% confidence interval, 1.00-1.44]) compared with the reference highest quartile TQoL. Poststroke TQoL change was significant within all treatment groups ( P ≤0.001). Multivariate regression analysis revealed that baseline TQoL was the strongest predictor of poststroke TQoL with similar results for the untransformed QoL. The lowest baseline TQoL quartile had a 20% higher stroke risk than the highest quartile. Baseline TQoL was the only factor that predicted poststroke change in TQoL. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000542. © 2017 American Heart Association, Inc.

A diabetes-predictive amino acid score and future cardiovascular disease.

PubMed

Magnusson, Martin; Lewis, Gregory D; Ericson, Ulrika; Orho-Melander, Marju; Hedblad, Bo; Engström, Gunnar; Ostling, Gerd; Clish, Clary; Wang, Thomas J; Gerszten, Robert E; Melander, Olle

2013-07-01

We recently identified a metabolic signature of three amino acids (tyrosine, phenylalanine, and isoleucine) that strongly predicts diabetes development. As novel modifiable targets for intervention are needed to meet the expected increase of cardiovascular disease (CVD) caused by the diabetes epidemic, we investigated whether this diabetes-predictive amino acid score (DM-AA score) predicts development of CVD and its functional consequences. We performed a matched case-control study derived from the population-based Malmö Diet and Cancer Cardiovascular Cohort (MDC-CC), all free of CVD. During 12 years of follow-up, 253 individuals developed CVD and were matched for age, sex, and Framingham risk score with 253 controls. Amino acids were profiled in baseline plasma samples, using liquid chromatography-tandem mass spectrometry, and relationship to incident CVD was assessed using conditional logistic regression. We further examined whether the amino acid score also correlated with anatomical [intima-media thickness (IMT) and plaque formation] and functional (exercise-induced myocardial ischaemia) abnormalities. Compared with the lowest quartile of the DM-AA score, the odds ratio (95% confidence interval) for incident CVD in subjects belonging to quartiles 2, 3, and 4 was 1.27 (0.72-2.22), 1.96 (1.07-3.60), and 2.20 (1.12-4.31) (Ptrend = 0.010), respectively, after multivariate adjustment. Increasing quartile of the DM-AA score was cross-sectionally related to carotid IMT (Ptrend = 0.037) and with the presence of at least one plaque larger than 10 mm(2) (Ptrend = 0.001). Compared with the lowest quartile of the DM-AA score, the odds ratio (95% confidence interval) for inducible ischaemia in subjects belonging to quartiles 2, 3, and 4 was 3.31 (1.05-10.4), 4.24 (1.36-13.3), and 4.86 (1.47-16.1) (Ptrend = 0.011), respectively. This study identifies branched-chain and aromatic amino acids as novel markers of CVD development and as an early link between diabetes and CVD susceptibility.

Addison’s Disease Symptoms – A Cross Sectional Study in Urban South Africa

PubMed Central

Ross, Ian Louis; Levitt, Naomi S.

2013-01-01

Background Addison’s disease is a potentially life-threatening disorder, and prompt diagnosis, and introduction of steroid replacement has resulted in near normal life-expectancy. There are limited data describing the clinical presentation of Addison’s disease in South Africa. It is hypothesised that patients may present in advanced state of ill-health, compared to Western countries. Patients A national database of patients was compiled from primary care, referral centres and private practices. 148 patients were enrolled (97 white, 34 mixed ancestry, 5 Asian and 12 black). Methods Demographic and clinical data were elicited using questionnaires. Biochemical data were obtained from folder reviews and laboratory archived results. Results The majority of the cohort was women (62%). The median and inter-quartile age range (IQR) of patients at enrolment was 46.0 (32.0–61.0) years, with a wide range from 2.8–88.0 years. The median and IQR age at initial diagnosis was 34.0 (20.0–45.0) years (range 0.02–77.0) years, indicating that at the time of enrolment, the patients, on average, were diagnosed with Addison’s disease 12 years previously. Hyperpigmentation was observed in 76%, nausea and vomiting occurred in more than 40%, and weight loss was noted in 25%. Loss of consciousness as a presenting feature was recorded in 20%. with a 95% confidence interval [CI] of (14–28%) and shock occurred in 5% CI (1.5–8.5%). Case-finding was recorded at 3.1 per million. Conclusions The usual constellation of hyperpigmentation, nausea, vomiting and weight loss suggests Addison’s disease, but a significant proportion present with an advanced state of ill-health and Addisonian crises. A lower prevalence rate, compared to Western countries is suggested. PMID:23308244

Addison's disease symptoms--a cross sectional study in urban South Africa.

PubMed

Ross, Ian Louis; Levitt, Naomi S

2013-01-01

Addison's disease is a potentially life-threatening disorder, and prompt diagnosis, and introduction of steroid replacement has resulted in near normal life-expectancy. There are limited data describing the clinical presentation of Addison's disease in South Africa. It is hypothesised that patients may present in advanced state of ill-health, compared to Western countries. A national database of patients was compiled from primary care, referral centres and private practices. 148 patients were enrolled (97 white, 34 mixed ancestry, 5 Asian and 12 black). Demographic and clinical data were elicited using questionnaires. Biochemical data were obtained from folder reviews and laboratory archived results. The majority of the cohort was women (62%). The median and inter-quartile age range (IQR) of patients at enrolment was 46.0 (32.0-61.0) years, with a wide range from 2.8-88.0 years. The median and IQR age at initial diagnosis was 34.0 (20.0-45.0) years (range 0.02-77.0) years, indicating that at the time of enrolment, the patients, on average, were diagnosed with Addison's disease 12 years previously. Hyperpigmentation was observed in 76%, nausea and vomiting occurred in more than 40%, and weight loss was noted in 25%. Loss of consciousness as a presenting feature was recorded in 20%. with a 95% confidence interval [CI] of (14-28%) and shock occurred in 5% CI (1.5-8.5%). Case-finding was recorded at 3.1 per million. The usual constellation of hyperpigmentation, nausea, vomiting and weight loss suggests Addison's disease, but a significant proportion present with an advanced state of ill-health and Addisonian crises. A lower prevalence rate, compared to Western countries is suggested.

The relation between resting heart rate and cancer incidence, cancer mortality and all-cause mortality in patients with manifest vascular disease.

PubMed

van Kruijsdijk, Rob C M; van der Graaf, Yolanda; Bemelmans, Remy H H; Nathoe, Hendrik M; Peeters, Petra H M; Visseren, Frank L J

2014-12-01

Previous studies suggest that elevated resting heart rate (RHR) is related to an increased risk of cancer mortality. The aim of this study was to evaluate the relation between RHR and cancer incidence and mortality in patients with vascular disease. Patients with manifest vascular disease (n=6007) were prospectively followed-up for cancer incidence and mortality. At baseline, RHR was obtained from an electrocardiogram. The relation between RHR and cancer incidence, cancer mortality and total mortality was assessed using competing risks models. During a median follow-up of 6.0 years (interquartile range: 3.1-9.3) 491 patients (8%) were diagnosed with cancer and 907 (15%) patients died, 248 (27%) died from cancer. After adjustment for potential confounders, the hazard ratio (HR) for incident cancer per 10 beats/min increase in RHR was 1.00 (95% confidence interval [CI]: 0.93-1.07). There was a trend toward an increased risk of colorectal cancer in patients with higher RHR (HR 1.15, 95% CI 0.97-1.36). The risk of all-cause mortality was increased in patients in the highest quartile of RHR compared to the lowest quartile (HR 1.86, 95% CI 1.53-2.27), but no effect of RHR on cancer mortality was observed (HR 1.01, 95% CI 0.70-1.46). In patients with manifest vascular disease, elevated RHR was related to a higher risk of premature all-cause mortality, but this was not due to increased cancer mortality. RHR was not related to risk of overall cancer incidence, although a relation between elevated RHR and incident colorectal cancer risk could not be ruled out. Copyright © 2014 Elsevier Ltd. All rights reserved.

Improvement of the low knowledge, attitude and practice of hepatitis B virus infection among Saudi national guard personnel after educational intervention

PubMed Central

2012-01-01

Background Although the risk of hepatitis B virus (HBV) was reported to be higher in military personnel than the general population in Saudi Arabia (SA), there is lack of studies assessing HBV awareness among them. The objective was to evaluate the knowledge, attitude and practice (KAP) of HBV infection among military personnel. Methods An intervention design with pre- and post-education KAP questionnaire was completed among National Guard soldiers working in Jeddah during January 2009. Educational intervention was provided through educational leaflets, group and individual discussions, visual show, and a lecture. A score was created from the correct answers to 58 questions. Results A total of 400 male soldiers with mean age 30.7 ± 6.1 years completed both questionnaires. The majority had school education (96.8%) and in the lower military ranks (66.0%). Only 19.5% of soldiers reported HBV vaccine intake. The low median and inter-quartile range of the pre-intervention score (16, 6–26) markedly increased after education (to 53, 50–55, p<0.001). The overall improvement of mean KAP score (204%) was also observed in all its component scores; disease nature (272%), methods of transmission (206%), prevention and control (109%), attitude (155%), and practice (192%). The improvement was evident irrespective of socio-demographic characteristics and history of HBV vaccine. KAP scores were significantly associated with higher educational levels, higher monthly income, administrative jobs, and higher job ranks. Conclusion We are reporting a low level of HBV awareness among Saudi military population. The study confirms the need and effectiveness of focused multifaceted educational campaigns among the military population. PMID:23111118

Stepping to the Beat: Feasibility and Potential Efficacy of a Home-Based Auditory-Cued Step Training Program in Chronic Stroke.

PubMed

Wright, Rachel L; Brownless, Simone Briony; Pratt, David; Sackley, Catherine M; Wing, Alan M

2017-01-01

Hemiparesis after stroke typically results in a reduced walking speed, an asymmetrical gait pattern and a reduced ability to make gait adjustments. The purpose of this pilot study was to investigate the feasibility and preliminary efficacy of home-based training involving auditory cueing of stepping in place. Twelve community-dwelling participants with chronic hemiparesis completed two 3-week blocks of home-based stepping to music overlaid with an auditory metronome. Tempo of the metronome was increased 5% each week. One 3-week block used a regular metronome, whereas the other 3-week block had phase shift perturbations randomly inserted to cue stepping adjustments. All participants reported that they enjoyed training, with 75% completing all training blocks. No adverse events were reported. Walking speed, Timed Up and Go (TUG) time and Dynamic Gait Index (DGI) scores (median [inter-quartile range]) significantly improved between baseline (speed = 0.61 [0.32, 0.85] m⋅s -1 ; TUG = 20.0 [16.0, 39.9] s; DGI = 14.5 [11.3, 15.8]) and post stepping training (speed = 0.76 [0.39, 1.03] m⋅s -1 ; TUG = 16.3 [13.3, 35.1] s; DGI = 16.0 [14.0, 19.0]) and was maintained at follow-up (speed = 0.75 [0.41, 1.03] m⋅s -1 ; TUG = 16.5 [12.9, 34.1] s; DGI = 16.5 [13.5, 19.8]). This pilot study suggests that auditory-cued stepping conducted at home was feasible and well-tolerated by participants post-stroke, with improvements in walking and functional mobility. No differences were detected between regular and phase-shift training with the metronome at each assessment point.

Effect of low cost public health staff training on exclusive breastfeeding.

PubMed

Agampodi, Suneth Buddhika; Agampodi, Thilini Chanchala

2008-11-01

To assess the effectiveness and feasibility of on the job staff training and supportive supervision to improve six months Exclusive Breastfeeding (EBF). A longitudinal study was conducted in a public health field practice area-Sri Lanka in 2006-2007. Three breastfeeding counseling sessions were conducted for public health midwives. Supportive supervision and on the job training were done by two public health physicians. Pre and post intervention independent cross sectional studies were conducted to assess the effectiveness of the programme. The study sample consisted of mother-infant pairs where infants were aging 6 to 12 months, attending child welfare clinics. Primary outcome measure was the proportion of infants who received EBF up to 6 months. Logistic regressing model was used for analysis of predictors of EBF. Study sample consisted of 336 mother-infant pairs (pre 139, post 197). Proportion of mothers who breastfed their infants exclusively for six months improved from 19% to 70% after the intervention. The median duration of EBF increased from 4 months to 6 months (inter-quartile range 2-6 and 5-6 months respectively). Unconfounded effect of intervention on 6 months EBF in logistic regression model was highly significant (OR=13.67. p<0.001). Intervention significantly reduced the bottle feeding rate (OR=0.212, p<0.001) but not formula feeding (OR=1.146. p=0.642). Of potential predictors assessed. Sinhalese mothers than Muslim mothers (OR=3.37, p<0.001) and employed mothers compared to housewives (OR=4.45. p=0.014) were more likely to breastfeed their infants upto six months. Parity, maternal education and maternal age were not significantly associated with six months EBF. The existing public health infrastructure can be used effectively to improve six months EBF in places where the care is given primarily by public health system.

Using nicotine in scalp hair to assess maternal passive exposure to tobacco smoke.

PubMed

Li, Zhenjiang; Li, Zhiwen; Zhang, Jingxu; Huo, Wenhua; Zhu, Yibing; Xie, Jing; Lu, Qun; Wang, Bin

2017-03-01

Quantifying population exposure level to tobacco smoke is important for investigating its adverse effects on human health. We aimed to investigate the feasibility and application of using population hair concentrations of nicotine and cotinine to indicate their exposure level to tobacco smoke among pregnant women. Our study recruited 256 mothers who delivered healthy babies and collected their hair samples from scalp, of which 172 mothers were self-reported non-passive smokers and the other 84 mothers were self-reported passive smokers. We analyzed nicotine and cotinine concentrations of the hair section grown during the early pregnancy. The linear relationship between cotinine and nicotine was developed and validated by internal cross-validation method. Our results revealed that self-reported passive smokers had higher concentrations of nicotine [2.08 (1.00-4.46) ng/mg hair, i.e. median value (inter-quartile range)] and cotinine [0.063 (0.041-0.148) ng/mg hair] than non-passive smokers [1.35 (0.58-2.59) ng/mg hair of nicotine and 0.049 (0.022-0.087) ng/mg hair of cotinine, respectively]. There existed a linear regression model between hair cotinine and nicotine concentrations, i.e. [cotinine] = 0.024 × [nicotine]+0.0184 (R 2  = 0.756) for this population. The internal cross-validation squared correlation coefficient slightly increased from 0.689 to 0.734 with the training subjects varying from 20% to 90%, suggesting that this regression model had high robustness and predictive accuracy. It was concluded that nicotine in maternal hair can evaluate the hair cotinine level and reflect maternal passive exposure level to ambient tobacco smoke with high sensitivity. Copyright © 2016 Elsevier Ltd. All rights reserved.

Extending total parenteral nutrition hang time in the neonatal intensive care unit: is it safe and cost effective?

PubMed

Balegar V, Kiran Kumar; Azeem, Mohammad Irfan; Spence, Kaye; Badawi, Nadia

2013-01-01

To investigate the effects of prolonging hang time of total parenteral nutrition (TPN) fluid on central line-associated blood stream infection (CLABSI), TPN-related cost and nursing workload. A before-after observational study comparing the practice of hanging TPN bags for 48 h (6 February 2009-5 February 2010) versus 24 h (6 February 2008-5 February 2009) in a tertiary neonatal intensive care unit was conducted. The main outcome measures were CLABSI, TPN-related expenses and nursing workload. One hundred thirty-six infants received 24-h TPN bags and 124 received 48-h TPN bags. Median (inter-quartile range) gestation (37 weeks (33,39) vs. 36 weeks (33,39)), mean (±standard deviation) admission weight of 2442 g (±101) versus 2476 g (±104) and TPN duration (9.7 days (±12.7) vs. 9.9 days (±13.4)) were similar (P > 0.05) between the 24- and 48-h TPN groups. There was no increase in CLABSI with longer hang time (0.8 vs. 0.4 per 1000 line days in the 24-h vs. 48-h group; P < 0.05). Annual cost saving using 48-h TPN was AUD 97,603.00. By using 48-h TPN, 68.3% of nurses indicated that their workload decreased and 80.5% indicated that time spent changing TPN reduced. Extending TPN hang time from 24 to 48 h did not alter CLABSI rate and was associated with a reduced TPN-related cost and perceived nursing workload. Larger randomised controlled trials are needed to more clearly delineate these effects. © 2012 The Authors. Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

THE PREVALENCE OF COLONIC POLYPS IN PATIENTS WITH ACROMEGALY: A CASE-CONTROL, NESTED IN A COHORT COLONOSCOPIC STUDY.

PubMed

Gonzalez, Baldomero; Vargas, Guadalupe; Mendoza, Victoria; Nava, Mariana; Rojas, Moisés; Mercado, Moisés

2017-05-01

Acromegaly is associated with an increased risk of colonic polyps. The magnitude of such risk is controversial, and the characteristics that distinguish patients who develop polyps from those who do not are not well established. This study was performed to determine the prevalence of colonic polyps upon the diagnosis of acromegaly and to compare the clinical and biochemical features of patients with and without polyps. Out of 165 patients who underwent a full colonoscopy upon diagnosis of acromegaly, 53 were found to harbor colonic lesions (cases), whereas the remaining 112 were used as controls. Demographic, clinical, and biochemical characteristics were compared between the 2 groups. The prevalence of colonic polyps was 32%, with an estimated relative risk of 6.21 (95% confidence interval [CI] 4.08-9.48). Adenomatous and nonadenomatous polyps were found in 22 and 31 patients, respectively. The most common location was the descending colon. Compared to patients without polyps, subjects with polyps were somewhat older and had significantly higher insulin-like growth factor-1 (IGF-1) levels and a higher prevalence of diabetes. Upon multivariate analysis, only IGF-1 level at diagnosis remained significantly associated with colonic polyps in general and with hyperplastic polyps in particular. Acromegaly is associated with an elevated risk of developing colonic polyps, particularly, distally located hyperplastic lesions. Except for a higher IGF-1 level at diagnosis, no distinctive clinical or biochemical features can be found among those who develop polyps compared to those who do not. CI = confidence interval GH = growth hormone IGF-1 = insulin-like growth factor 1 IQR = inter-quartile range RR = relative risk ULN = upper limit of normal.

Modern modeling techniques had limited external validity in predicting mortality from traumatic brain injury.

PubMed

van der Ploeg, Tjeerd; Nieboer, Daan; Steyerberg, Ewout W

2016-10-01

Prediction of medical outcomes may potentially benefit from using modern statistical modeling techniques. We aimed to externally validate modeling strategies for prediction of 6-month mortality of patients suffering from traumatic brain injury (TBI) with predictor sets of increasing complexity. We analyzed individual patient data from 15 different studies including 11,026 TBI patients. We consecutively considered a core set of predictors (age, motor score, and pupillary reactivity), an extended set with computed tomography scan characteristics, and a further extension with two laboratory measurements (glucose and hemoglobin). With each of these sets, we predicted 6-month mortality using default settings with five statistical modeling techniques: logistic regression (LR), classification and regression trees, random forests (RFs), support vector machines (SVM) and neural nets. For external validation, a model developed on one of the 15 data sets was applied to each of the 14 remaining sets. This process was repeated 15 times for a total of 630 validations. The area under the receiver operating characteristic curve (AUC) was used to assess the discriminative ability of the models. For the most complex predictor set, the LR models performed best (median validated AUC value, 0.757), followed by RF and support vector machine models (median validated AUC value, 0.735 and 0.732, respectively). With each predictor set, the classification and regression trees models showed poor performance (median validated AUC value, <0.7). The variability in performance across the studies was smallest for the RF- and LR-based models (inter quartile range for validated AUC values from 0.07 to 0.10). In the area of predicting mortality from TBI, nonlinear and nonadditive effects are not pronounced enough to make modern prediction methods beneficial. Copyright © 2016 Elsevier Inc. All rights reserved.

Variability in utilization of drug eluting stents in United States: Insights from nationwide inpatient sample.

PubMed

Panaich, Sidakpal S; Badheka, Apurva O; Arora, Shilpkumar; Patel, Nileshkumar J; Thakkar, Badal; Patel, Nilay; Singh, Vikas; Chothani, Ankit; Deshmukh, Abhishek; Agnihotri, Kanishk; Jhamnani, Sunny; Lahewala, Sopan; Manvar, Sohilkumar; Panchal, Vinaykumar; Patel, Achint; Patel, Neil; Bhatt, Parth; Savani, Chirag; Patel, Jay; Savani, Ghanshyambhai T; Solanki, Shantanu; Patel, Samir; Kaki, Amir; Mohamad, Tamam; Elder, Mahir; Kondur, Ashok; Cleman, Michael; Forrest, John K; Schreiber, Theodore; Grines, Cindy

2016-01-01

We studied the trends and predictors of drug eluting stent (DES) utilization from 2006 to 2011 to further expound the inter-hospital variability in their utilization. We queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (NIS) between 2006 and 2011 using ICD-9-CM procedure code, 36.06 (bare metal stent) or 36.07 (drug eluting stents) for Percutaneous Coronary Intervention (PCI). Annual hospital volume was calculated using unique identification numbers and divided into quartiles for analysis. We built a hierarchical two level model adjusted for multiple confounding factors, with hospital ID incorporated as random effects in the model. About 665,804 procedures (weighted n = 3,277,884) were analyzed. Safety concerns arising in 2006 reduced utilization DES from 90% of all PCIs performed in 2006 to a nadir of 69% in 2008 followed by increase (76% of all stents in 2009) and plateau (75% in 2011). Significant between-hospital variation was noted in DES utilization irrespective of patient or hospital characteristics. Independent patient level predictors of DES were (OR, 95% CI, P-value) age (0.99, 0.98-0.99, <0.001), female(1.12, 1.09-1.15, <0.001), acute myocardial infarction(0.75, 0.71-0.79, <0.001), shock (0.53, 0.49-0.58, <0.001), Charlson Co-morbidity index (0.81,0.77-0.86, <0.001), private insurance/HMO (1.27, 1.20-1.34, <0.001), and elective admission (1.16, 1.05-1.29, <0.001). Highest quartile hospital (1.64, 1.25-2.16, <0.001) volume was associated with higher DES placement. There is significant between-hospital variation in DES utilization and a higher annual hospital volume is associated with higher utilization rate of DES. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

Medical History, Lifestyle, Family History, and Occupational Risk Factors for Marginal Zone Lymphoma: The InterLymph Non-Hodgkin Lymphoma Subtypes Project

PubMed Central

Benavente, Yolanda; Turner, Jennifer J.; Paltiel, Ora; Slager, Susan L.; Vajdic, Claire M.; Norman, Aaron D.; Cerhan, James R.; Chiu, Brian C. H.; Becker, Nikolaus; Cocco, Pierluigi; Dogan, Ahmet; Nieters, Alexandra; Holly, Elizabeth A.; Kane, Eleanor V.; Smedby, Karin E.; Maynadié, Marc; Spinelli, John J.; Roman, Eve; Glimelius, Bengt; Wang, Sophia S.; Sampson, Joshua N.; Morton, Lindsay M.; de Sanjosé, Silvia

2014-01-01

Background Marginal zone lymphoma (MZL), comprised of nodal, extranodal, and splenic subtypes, accounts for 5%–10% of non-Hodgkin lymphoma cases. A detailed evaluation of the independent effects of risk factors for MZL and its subtypes has not been conducted. Methods Data were pooled from 1052 MZL cases (extranodal [EMZL] = 633, nodal [NMZL] = 157, splenic [SMZL] = 140) and 13766 controls from 12 case–control studies. Adjusted unconditional logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs). Results Novel findings for MZL subtypes include increased risk for B-cell activating autoimmune conditions (EMZL OR = 6.40, 95% CI = 4.24 to 9.68; NMZL OR = 7.80, 95% CI = 3.32 to 18.33; SMZL OR = 4.25, 95% CI = 1.49 to 12.14), hepatitis C virus seropositivity (EMZL OR = 5.29, 95% CI = 2.48 to 11.28), self-reported peptic ulcers (EMZL OR = 1.83, 95% CI = 1.35 to 2.49), asthma without other atopy (SMZL OR = 2.28, 95% CI = 1.23 to 4.23), family history of hematologic cancer (EMZL OR = 1.90, 95% CI = 1.37 to 2.62) and of non-Hodgkin lymphoma (NMZL OR = 2.82, 95% CI = 1.33 to 5.98), permanent hairdye use (SMZL OR = 6.59, 95% CI = 1.54 to 28.17), and occupation as a metalworker (NMZL OR = 3.56, 95% CI = 1.67 to 7.58). Reduced risks were observed with consumption of any alcohol (EMZL fourth quartile OR = 0.48, 95% CI = 0.28 to 0.82) and lower consumption of wine (NMZL first to third quartile ORs < 0.45) compared with nondrinkers, and occupation as a teacher (EMZL OR = 0.58, 95% CI = 0.37 to 0.88). Conclusion Our results provide new data suggesting etiologic heterogeneity across MZL subtypes although a common risk of MZL associated with B-cell activating autoimmune conditions was found. PMID:25174026

Medical history, lifestyle, family history, and occupational risk factors for marginal zone lymphoma: the InterLymph Non-Hodgkin Lymphoma Subtypes Project.

PubMed

Bracci, Paige M; Benavente, Yolanda; Turner, Jennifer J; Paltiel, Ora; Slager, Susan L; Vajdic, Claire M; Norman, Aaron D; Cerhan, James R; Chiu, Brian C H; Becker, Nikolaus; Cocco, Pierluigi; Dogan, Ahmet; Nieters, Alexandra; Holly, Elizabeth A; Kane, Eleanor V; Smedby, Karin E; Maynadié, Marc; Spinelli, John J; Roman, Eve; Glimelius, Bengt; Wang, Sophia S; Sampson, Joshua N; Morton, Lindsay M; de Sanjosé, Silvia

2014-08-01

Marginal zone lymphoma (MZL), comprised of nodal, extranodal, and splenic subtypes, accounts for 5%-10% of non-Hodgkin lymphoma cases. A detailed evaluation of the independent effects of risk factors for MZL and its subtypes has not been conducted. Data were pooled from 1052 MZL cases (extranodal [EMZL] = 633, nodal [NMZL] = 157, splenic [SMZL] = 140) and 13766 controls from 12 case-control studies. Adjusted unconditional logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs). Novel findings for MZL subtypes include increased risk for B-cell activating autoimmune conditions (EMZL OR = 6.40, 95% CI = 4.24 to 9.68; NMZL OR = 7.80, 95% CI = 3.32 to 18.33; SMZL OR = 4.25, 95% CI = 1.49 to 12.14), hepatitis C virus seropositivity (EMZL OR = 5.29, 95% CI = 2.48 to 11.28), self-reported peptic ulcers (EMZL OR = 1.83, 95% CI = 1.35 to 2.49), asthma without other atopy (SMZL OR = 2.28, 95% CI = 1.23 to 4.23), family history of hematologic cancer (EMZL OR = 1.90, 95% CI = 1.37 to 2.62) and of non-Hodgkin lymphoma (NMZL OR = 2.82, 95% CI = 1.33 to 5.98), permanent hairdye use (SMZL OR = 6.59, 95% CI = 1.54 to 28.17), and occupation as a metalworker (NMZL OR = 3.56, 95% CI = 1.67 to 7.58). Reduced risks were observed with consumption of any alcohol (EMZL fourth quartile OR = 0.48, 95% CI = 0.28 to 0.82) and lower consumption of wine (NMZL first to third quartile ORs < 0.45) compared with nondrinkers, and occupation as a teacher (EMZL OR = 0.58, 95% CI = 0.37 to 0.88). Our results provide new data suggesting etiologic heterogeneity across MZL subtypes although a common risk of MZL associated with B-cell activating autoimmune conditions was found. Published by Oxford University Press 2014.

Effect of inter- and intra-annual thermohaline variability on acoustic propagation

NASA Astrophysics Data System (ADS)

Chu, Peter C.; McDonald, Colleen M.; Kucukosmanoglu, Murat; Judono, Albert; Margolina, Tetyana; Fan, Chenwu

2017-05-01

This paper is to answer the question "How can inter- and intra-annual variability in the ocean be leveraged by the submarine Force?" through quantifying inter- and intra-annual variability in (T, S) fields and in turn underwater acoustic characteristics such as transmission loss, signal excess, and range of detection. The Navy's Generalized Digital Environmental Model (GDEM) is the climatological monthly mean data and represents mean annual variability. An optimal spectral decomposition method is used to produce a synoptic monthly gridded (SMG) (T, S) dataset for the world oceans with 1° ×1° horizontal resolution, 28 vertical levels (surface to 3,000 m depth), monthly time increment from January 1945 to December 2014 now available at the NOAA/NCEI website: http://data.nodc.noaa.gov/cgibin/iso?id=gov.noaa.nodc:0140938. The sound velocity decreases from 1945 to 1975 and increases afterwards due to global climate change. Effect of the inter- and intra-annual (T, S) variability on acoustic propagation in the Yellow Sea is investigated using a well-developed acoustic model (Bellhop) in frequencies from 3.5 kHz to 5 kHz with sound velocity profile (SVP) calculated from GDEM and SMG datasets, various bottom types (silty clay, fine sand, gravelly mud, sandy mud, and cobble or gravel) from the NAVOCEANO`s High Frequency Environmental Algorithms (HFEVA), source and receiver depths. Acoustic propagation ranges are extended drastically due to the inter-annual variability in comparison with the climatological SVP (from GDEM). Submarines' vulnerability of detection as its depth varies and avoidance of short acoustic range due to inter-annual variability are also discussed.

Intra and inter-rater reliability of infrared image analysis of masticatory and upper trapezius muscles in women with and without temporomandibular disorder.

PubMed

Costa, Ana C S; Dibai Filho, Almir V; Packer, Amanda C; Rodrigues-Bigaton, Delaine

2013-01-01

Infrared thermography is an aid tool that can be used to evaluate several pathologies given its efficiency in analyzing the distribution of skin surface temperature. To propose two forms of infrared image analysis of the masticatory and upper trapezius muscles, and to determine the intra and inter-rater reliability of both forms of analysis. Infrared images of masticatory and upper trapezius muscles of 64 female volunteers with and without temporomandibular disorder (TMD) were collected. Two raters performed the infrared image analysis, which occurred in two ways: temperature measurement of the muscle length and in central portion of the muscle. The Intraclass Correlation Coefficient (ICC) was used to determine the intra and inter-rater reliability. The ICC showed excellent intra and inter-rater values for both measurements: temperature measurement of the muscle length (TMD group, intra-rater, ICC ranged from 0.996 to 0.999, inter-rater, ICC ranged from 0.992 to 0.999; control group, intra-rater, ICC ranged from 0.993 to 0.998, inter-rater, ICC ranged from 0.990 to 0.998), and temperature measurement of the central portion of the muscle (TMD group, intra-rater, ICC ranged from 0.981 to 0.998, inter-rater, ICC ranged from 0.971 to 0.998; control group, intra-rater, ICC ranged from 0.887 to 0.996, inter-rater, ICC ranged from 0.852 to 0.996). The results indicated that temperature measurements of the masticatory and upper trapezius muscles carried out by the analysis of the muscle length and central portion yielded excellent intra and inter-rater reliability.

Derivation and Internal Validation of a Clinical Prediction Tool for 30-Day Mortality in Lower Gastrointestinal Bleeding.

PubMed

Sengupta, Neil; Tapper, Elliot B

2017-05-01

There are limited data to predict which patients with lower gastrointestinal bleeding are at risk for adverse outcomes. We aimed to develop a clinical tool based on admission variables to predict 30-day mortality in lower gastrointestinal bleeding. We used a validated machine learning algorithm to identify adult patients hospitalized with lower gastrointestinal bleeding at an academic medical center between 2008 and 2015. The cohort was split randomly into derivation and validation cohorts. In the derivation cohort, we used multiple logistic regression on all candidate admission variables to create a prediction model for 30-day mortality, using area under the receiving operator characteristic curve and misclassification rate to estimate prediction accuracy. Regression coefficients were used to derive an integer score, and mortality risk associated with point totals was assessed. In the derivation cohort (n = 4044), 8 variables were most associated with 30-day mortality: age, dementia, metastatic cancer, chronic kidney disease, chronic pulmonary disease, anticoagulant use, admission hematocrit, and albumin. The model yielded a misclassification rate of 0.06 and area under the curve of 0.81. The integer score ranged from -10 to 26 in the derivation cohort, with a misclassification rate of 0.11 and area under the curve of 0.74. In the validation cohort (n = 2060), the score had an area under the curve of 0.72 with a misclassification rate of 0.12. After dividing the score into 4 quartiles of risk, 30-day mortality in the derivation and validation sets was 3.6% and 4.4% in quartile 1, 4.9% and 7.3% in quartile 2, 9.9% and 9.1% in quartile 3, and 24% and 26% in quartile 4, respectively. A clinical tool can be used to predict 30-day mortality in patients hospitalized with lower gastrointestinal bleeding. Copyright © 2017 Elsevier Inc. All rights reserved.

Estimating Time-Varying PCB Exposures Using Person-Specific Predictions to Supplement Measured Values: A Comparison of Observed and Predicted Values in Two Cohorts of Norwegian Women

PubMed Central

Nøst, Therese Haugdahl; Breivik, Knut; Wania, Frank; Rylander, Charlotta; Odland, Jon Øyvind; Sandanger, Torkjel Manning

2015-01-01

Background Studies on the health effects of polychlorinated biphenyls (PCBs) call for an understanding of past and present human exposure. Time-resolved mechanistic models may supplement information on concentrations in individuals obtained from measurements and/or statistical approaches if they can be shown to reproduce empirical data. Objectives Here, we evaluated the capability of one such mechanistic model to reproduce measured PCB concentrations in individual Norwegian women. We also assessed individual life-course concentrations. Methods Concentrations of four PCB congeners in pregnant (n = 310, sampled in 2007–2009) and postmenopausal (n = 244, 2005) women were compared with person-specific predictions obtained using CoZMoMAN, an emission-based environmental fate and human food-chain bioaccumulation model. Person-specific predictions were also made using statistical regression models including dietary and lifestyle variables and concentrations. Results CoZMoMAN accurately reproduced medians and ranges of measured concentrations in the two study groups. Furthermore, rank correlations between measurements and predictions from both CoZMoMAN and regression analyses were strong (Spearman’s r > 0.67). Precision in quartile assignments from predictions was strong overall as evaluated by weighted Cohen’s kappa (> 0.6). Simulations indicated large inter-individual differences in concentrations experienced in the past. Conclusions The mechanistic model reproduced all measurements of PCB concentrations within a factor of 10, and subject ranking and quartile assignments were overall largely consistent, although they were weak within each study group. Contamination histories for individuals predicted by CoZMoMAN revealed variation between study subjects, particularly in the timing of peak concentrations. Mechanistic models can provide individual PCB exposure metrics that could serve as valuable supplements to measurements. Citation Nøst TH, Breivik K, Wania F, Rylander C, Odland JØ, Sandanger TM. 2016. Estimating time-varying PCB exposures using person-specific predictions to supplement measured values: a comparison of observed and predicted values in two cohorts of Norwegian women. Environ Health Perspect 124:299–305; http://dx.doi.org/10.1289/ehp.1409191 PMID:26186800

TV Viewing and BMI by Race/Ethnicity and Socio-Economic Status

PubMed Central

Shuval, Kerem; Gabriel, Kelley Pettee; Leonard, Tammy

2013-01-01

Objective To assess the association between TV viewing and obesity by race/ethnicity and socio-economic status. Design Cross-sectional analysis of 5,087 respondents to the Health Information National Trends Survey (HINTS), a nationally representative sample of US adults. Multivariate regression models were computed to assess the association between quartiles of TV viewing and BMI, stratified by race/ethnicity, educational attainment, employment and health insurance status. Results Findings indicate that increased TV viewing was associated with higher odds for being overweight/obese in the entire sample, while adjusting for physical activity and other confounders. After stratification by race/ethnicity, increased odds for overweight/obesity in the 3rd and 4th quartiles of TV viewing (e.g., 3rd quartile- cumulative OR = 1.43, 95%CI 1.07–1.92) was observed in non-Hispanic whites, with statistical significance. In non-Hispanic blacks and Hispanics, the odds were similar to whites, but did not reach statistical significance. Significant relations between greater TV viewing and increased BMI were observed in college graduates and non-graduates, those with health insurance and the employed. Conclusions This study extends previous research by examining potential inconsistencies in this association between various racial/ethnic groups and some socio-economic variables, which primarily were not found. PMID:23691070

High normal urine albumin-to-creatinine ratio predicts development of hypertension in Korean men.

PubMed

Park, Sung Keun; Moon, Soo Young; Oh, Chang-Mo; Ryoo, Jae-Hong; Park, Min Suk

2014-01-01

Microalbuminuria is known as a risk factor for hypertension. Recently it was suggested that urine albumin-to-creatinine ratio (UACR), even within the normal range, can be associated with hypertension, but the temporal relationship between normal range UACR and hypertension was not confirmed. Therefore the aim of this study was to verify an association between normal range UACR and the development of hypertension in Korean men. This prospective cohort study was performed on 1,284 initially non-hypertensive Korean men. The total follow-up period was 4,109.5 person-years and the mean follow-up period was 3.2±1.51 years. Cox proportional hazards model was used to estimate the hazard ratios (HR) for the risk of hypertension development. After adjusting for multiple covariates, the HR (95% confidence interval [CI]) for incident hypertension, comparing the second to the fourth quartiles of UACR level to the first quartile, were 1.35 (95% CI: 0.93-1.97), 1.55 (95% CI: 1.07-2.25) and 1.89 (95% CI: 1.31-2.71), respectively (P for trend=0.001). High UACR within the normal range was significantly associated with hypertension development. Furthermore, this association remained significant after adjusting for multiple baseline covariates. 

Red blood cell distribution width and long-term outcome in patients undergoing percutaneous coronary intervention in the drug-eluting stenting era: a two-year cohort study.

PubMed

Yao, Hai-Mu; Sun, Tong-Wen; Zhang, Xiao-Juan; Shen, De-Liang; Du, You-You; Wan, You-Dong; Zhang, Jin-Ying; Li, Ling; Zhao, Luo-Sha

2014-01-01

Previous studies suggest the higher the red blood cell distribution width (RDW) the greater the risk of mortality in patients with coronary artery disease (CAD). However, the relationship between RDW and long-term outcome in CAD patients undergoing percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) remains unclear. This study was designed to evaluate the long-term effect of RDW in patients treated with drug-eluting stent for CAD. In total of 2169 non-anemic patients (1468 men, mean age 60.2 ± 10.9 years) with CAD who had undergone successful PCI and had at least one drug-eluting stent were included in this study. Patients were grouped according to their baseline RDW: Quartile 1 (RDW<12.27%), Quartile 2 (12.27% ≤ RDW <13%), Quartile 3 (13% ≤ RDW<13.5%), and Quartile 4 (RDW ≥ 13.5). The incidence of in-hospital mortality and death or myocardial infarction was significantly higher in Quartiles 3 and 4 compared with Quartile 1 (P<0.05). After a follow-up of 29 months, the incidence of all-cause death and stent thrombosis in Quartile 4 was higher than in Quartiles 1, 2, and 3 (P<0.05). The incidence of death/myocardial infarction/stroke and cardiac death in Quartile 4 was higher than in Quartiles 1 and 2 (P<0.05). Multivariate Cox regression analysis showed that RDW was an independent predictor of all-cause death (hazard ratio (HR) = 1.37, 95% confidence interval (CI) = 1.15-1.62, P<0.001) and outcomes of death/myocardial infarction/stroke (HR = 1.21, 95% CI = 1.04-1.39, P = 0.013). The cumulative survival rate of Quartile 4 was lower than that of Quartiles 1, 2, and 3 (P<0.05). High RDW is an independent predictor of long-term adverse clinical outcomes in non-anemic patients with CAD treated with DES.

Dermatology Life Quality Index: influence of an illustrated version.

PubMed

Loo, W J; Diba, V; Chawla, M; Finlay, A Y

2003-02-01

An illustrated version of the Dermatology Life Quality Index (DLQI) was developed in order to improve the ease with which this standard questionnaire is answered. To compare the illustrated version with the text-only version of the DLQI. The two versions were administered to 206 patients attending Dermatology outpatient clinics. The time taken to complete either the illustrated or the text-only version was noted in 52 additional patients. One hundred and ninety-one of 206 patients completed both questionnaires satisfactorily. Their mean DLQI scores were 6.4 (median 4.0, lower quartile 1.0, upper quartile 11.0) for the illustrated version and 6.3 (median 4.0, lower quartile 1.0, upper quartile 10.0) for the text-only version. For the 98 patients who answered the illustrated version first, the mean DLQI scores were 6.9 (median 4.0, lower quartile 1.9, upper quartile 11.9) for the illustrated version and 6.4 (median 4.0, lower quartile 1.8, upper quartile 11.0) for the text-only version. For the 93 patients who answered the text-only version first, the mean DLQI scores were 5.9 (median 4.0, lower quartile 1.7, upper quartile 10.2) for the illustrated version and 6.2 (median 5.0, lower quartile 0.5, upper quartile 9.5) for the text-only version. The median time taken to complete the text-only version was 124 s (mean +/- SD 126 +/- 65, n = 27) and 88 s (mean +/- SD 101 +/- 52, n = 25) for the illustrated version (P = 0.08). There was a very close correlation (r = 0.98) between the scores of the text-only and the illustrated versions; 82.2% of patients either scored the same or had a DLQI score difference of only 1. One hundred and seven (59.8%) patients preferred using the illustrated version and 66 (36.9%) preferred the text-only version. One hundred and four (57.5%) found the illustrated version easier to use. The illustrated version was superior to the text-only version in terms of patient preference and ease of use, but it was not possible to demonstrate exact equivalence between the two versions.

Pre-natal exposure to dichlorodiphenyldichloroethylene and infant lower respiratory tract infections and wheeze.

PubMed

Gascon, Mireia; Vrijheid, Martine; Martínez, David; Ballester, Ferran; Basterrechea, Mikel; Blarduni, Elizabeth; Esplugues, Ana; Vizcaino, Esther; Grimalt, Joan O; Morales, Eva; Sunyer, Jordi

2012-05-01

The aim of our study was to examine whether pre-natal exposure to dichlorodiphenyldichloroethylene (DDE) increases the risk of lower respiratory tract infections (LRTIs) and wheeze in infants. The study is based on a birth cohort of 1,455 mother-child pairs. Maternal serum concentrations of DDE, polychlorinated biphenyls (PCBs) and hexachlorobenzene (HCB) were measured during pregnancy. Parental reports on LRTI and wheeze were obtained when children were 12-14 months old. 35.4% of children developed at least one LRTI episode and 33.6% at least one wheezing episode during their first 12-14 months of life. Median DDE, PCBs and HCB concentrations were 116.3, 113.7 and 46.4 ng · g(-1) lipid, respectively. DDE concentrations were associated with LRTI risk (relative risk (RR) per 10% increase 1.11, 95% CI 1.00-1.22), also after adjustment for PCBs and HCB. In all quartiles of DDE exposure, the risk of LRTI was increased compared with the lowest quartile, but the increase was statistically significant only in the third quartile (RR 1.33, 95% CI 1.08-1.62). No association was observed for PCBs and HCB. Results were similar for wheeze. This study suggests that pre-natal DDE exposure is associated with a higher risk of LRTI and wheeze in infants independently of exposure to other organochlorine compounds.

Impact of Socioeconomic Status on Patients Supported With a Left Ventricular Assist Device: An Analysis of the UNOS Database (United Network for Organ Sharing).

PubMed

Clerkin, Kevin J; Garan, Arthur Reshad; Wayda, Brian; Givens, Raymond C; Yuzefpolskaya, Melana; Nakagawa, Shunichi; Takeda, Koji; Takayama, Hiroo; Naka, Yoshifumi; Mancini, Donna M; Colombo, Paolo C; Topkara, Veli K

2016-10-01

Low socioeconomic status (SES) is a known risk factor for heart failure, mortality among those with heart failure, and poor post heart transplant (HT) outcomes. This study sought to determine whether SES is associated with decreased waitlist survival while on left ventricular assist device (LVADs) support and after HT. A total of 3361 adult patients bridged to primary HT with an LVAD between May 2004 and April 2014 were identified in the UNOS database (United Network for Organ Sharing). SES was measured using the Agency for Healthcare Research and Quality SES index using data from the 2014 American Community Survey. In the study cohort, SES did not have an association with the combined end point of death or delisting on LVAD support (P=0.30). In a cause-specific unadjusted model, those in the top (hazard ratio, 1.55; 95% confidence interval, 1.14-2.11; P=0.005) and second greatest SES quartile (hazard ratio 1.50; 95% confidence interval, 1.10-2.04; P=0.01) had an increased risk of death on device support compared with the lowest SES quartile. Adjusting for clinical risk factors mitigated the increased risk. There was no association between SES and complications. Post-HT survival, both crude and adjusted, was decreased for patients in the lowest quartile of SES index compared with all other SES quartiles. Freedom from waitlist death or delisting was not affected by SES. Patients with a higher SES had an increased unadjusted risk of waitlist mortality during LVAD support, which was mitigated by adjusting for increased comorbid conditions. Low SES was associated with worse post-HT outcomes. Further study is needed to confirm and understand a differential effect of SES on post-transplant outcomes that was not seen during LVAD support before HT. © 2016 American Heart Association, Inc.

Effects of energy-dense nutrient-poor snacks on the incidence of metabolic syndrome: a prospective approach in Tehran Lipid and Glucose Study.

PubMed

Mirmiran, Parvin; Bahadoran, Zahra; Delshad, Hossein; Azizi, Fereidoun

2014-05-01

Increased consumption of energy-dense, nutrient-poor snacks is one of the major, growing concerns in relation to the alarming trend of overweight, obesity, and metabolic disorders worldwide. The aim of this study was to investigate whether consumption of energy-dense snacks could affect the occurrence of metabolic syndrome after 3 y of follow-up in adults. This longitudinal study was conducted within the framework of the Tehran Lipid and Glucose Study between 2006 and 2008 and 2009 and 2011, on 1466 adults, ages 19 to 70 y. The usual intake of participants was measured using a validated semiquantitative food frequency questionnaire at baseline. Biochemical and anthropometric measurements were assessed at baseline and 3 y later. Multiple logistic regression models were used to estimate the occurrence of metabolic syndrome (MetS) in each quartile of energy-dense snacks. Participants in the highest quartile of energy-dense snack consumption were significantly younger (33.8 versus 43.1 y; P < 0.01). There were non-significant increased risks for MetS in the highest quartile of biscuits and cakes (odds ratio [OR], 1.13; 95% confidence interval [CI], 0.77-1.66), and candies and chocolates (OR, 1.31; 95% CI, 0.88-1.94). The risk for MetS in participants with highest consumption of salty snacks increased more than 50% (OR, 1.56; 95% CI, 1.01-2.40). Consumption of soft drinks had a borderline effect on the risk for MetS. More than 361 kcal/d from total energy-dense snacks independently increased the occurrence of MetS in the fourth compared the first quartile category (OR, 1.53; 95% CI, 1.03-2.29). The findings of this study demonstrated that higher consumption of energy-dense snacks could be a dietary risk factor for development of MetS. Copyright © 2014 Elsevier Inc. All rights reserved.

A qualitative theory guided analysis of stroke survivors' perceived barriers and facilitators to physical activity.

PubMed

Nicholson, Sarah L; Donaghy, Marie; Johnston, Marie; Sniehotta, Falko F; van Wijck, Frederike; Johnston, Derek; Greig, Carolyn; McMurdo, Marion E T; Mead, Gillian

2014-01-01

After stroke, physical activity and physical fitness levels are low, impacting on health, activity and participation. It is unclear how best to support stroke survivors to increase physical activity. Little is known about the barriers and facilitators to physical activity after stroke. Thus, our aim was to explore stroke survivors' perceived barriers and facilitators to physical activity. Semi-structured interviews with 13 ambulatory stroke survivors exploring perceived barriers and facilitators to physical activity post stroke were conducted in participants' homes, audio-recorded and transcribed verbatim. The Theoretical Domains Framework (TDF) informed content analysis of the interview transcripts. Data saturation was reached after interviews with 13 participants (median age of 76 years (inter-quartile range (IQR) = 69-83 years). The median time since stroke was 345 d (IQR = 316-366 d). The most commonly reported TDF domains were "beliefs about capabilities", "environmental context and resources" and "social influence". The most commonly reported perceived motivators were: social interaction, beliefs of benefits of exercise, high self-efficacy and the necessity of routine behaviours. The most commonly reported perceived barriers were: lack of professional support on discharge from hospital and follow-up, transport issues to structured classes/interventions, lack of control and negative affect. Stroke survivors perceive several different barriers and facilitators to physical activity. Stroke services need to address barriers to physical activity and to build on facilitators to promote physical activity after stroke. Physical activity post stroke can improve physical fitness and function, yet physical activity remains low among stroke survivors. Understanding stroke survivors' perceived barriers and facilitators to physical activity is essential to develop targeted interventions to increase physical activity. Beliefs about capabilities, environmental context and resources and social influences were the mostly commonly report influences on stroke survivors' perceived barriers and facilitators to physical activity.

Associations between fine particle, coarse particle, black carbon and hospital visits in a Chinese city.

PubMed

Wang, Xi; Chen, Renjie; Meng, Xia; Geng, Fuhai; Wang, Cuicui; Kan, Haidong

2013-08-01

China is one of the countries with the highest ambient particle levels in the world; however, there have been no epidemiologic studies examining the effects of fine particle (PM2.5), coarse particle (PM10-2.5) and black carbon (BC) simultaneously on morbidity outcomes. In this study, we conducted a time-series analysis to evaluate the acute effects of PM2.5, PM10-2.5, and BC on daily hospital visits in Shanghai, China. During our study period, the mean daily concentrations of PM2.5, PM10-2.5 and BC were 53.9 μg/m(3), 38.4 μg/m(3) and 3.9 μg/m(3), respectively. We found significant associations of PM2.5, PM 10-2.5, and BC with daily hospital visits. An inter-quartile range increase of the average concentrations of the current and previous days in PM2.5, PM10-2.5 and BC was associated with a 1.88% (95% CI: 0.69% to 3.06%), a 1.30% (95% CI: 0.25% to 2.34%) and a 1.33% (95% CI: 0.34% to 2.32%) increase in emergency-room visits, respectively. For outpatient visits, the corresponding estimated changes were -2.44% (95% CI: -6.62% to 1.74%), 1.09% (95% CI: -2.72% to 4.90%) and 3.34% (95% CI: 0.10% to 6.57%) respectively. The effects of BC were more robust than the effects of PM2.5 and PM10-2.5 in two-pollutant models. To our knowledge, this is the first study in China, or even in Asian developing countries, to report the effect of PM2.5, PM10-2.5, and BC simultaneously on morbidity. Our findings also suggest that BC could serve as a valuable air quality indicator that reflects the health risks of airborne particles. Copyright © 2013 Elsevier B.V. All rights reserved.

Air pollution and asthma severity in adults

PubMed Central

Rage, Estelle; Siroux, Valérie; Künzli, Nino; Pin, Isabelle; Kauffmann, Francine

2009-01-01

Objectives There is evidence that exposure to air pollution affects asthma, but the effect of air pollution on asthma severity has not been addressed. The aim was to assess the relation between asthma severity during the past 12 months and home outdoor concentrations of air pollution. Methods Asthma severity over the last 12 months was assessed in two complementary ways among 328 adult asthmatics from the French Epidemiological study on the Genetics and Environment of Asthma (EGEA) examined between 1991 and 1995. The 4-class severity score integrated clinical events and type of treatment. The 5-level asthma score is based only on the occurrence of symptoms. Nitrogen dioxide (NO2), sulphur dioxide (SO2) and ozone (O3) concentrations were assigned to each residence using two different methods. The first was based on the closest monitor data from 1991–1995. The second consisted in spatial models that used geostatistical interpolations and then assigned air pollutants to the geo-coded residences (1998). Results Higher asthma severity score was significantly related to the 8-hour average of ozone during April-September (O3-8hr) and the number of days (O3-days) with 8-hour ozone averages above 110 μg.m−3 (for a 36-day increase, equivalent to the inter quartile range, in O3-days, odds ratio (95% confidence interval) 2.22 (1.61–3.07) for one class difference in score). Adjustment for age, sex, smoking habits, occupational exposure, and educational level did not alter results. Asthma severity was unrelated to NO2. Both exposure assessment methods and severity scores resulted in very similar findings. SO2 correlated with severity but reached statistical significance only for the model based assignment of exposure. Conclusions The observed associations between asthma severity and air pollution, in particular O3, support the hypothesis that air pollution at levels far below current standards increases asthma severity. PMID:19017701

Exposure to arsenic in drinking water is associated with increased prevalence of diabetes: a cross-sectional study in the Zimapán and Lagunera regions in Mexico.

PubMed

Del Razo, Luz M; García-Vargas, Gonzalo G; Valenzuela, Olga L; Castellanos, Erika Hernández; Sánchez-Peña, Luz C; Currier, Jenna M; Drobná, Zuzana; Loomis, Dana; Stýblo, Miroslav

2011-08-24

Human exposures to inorganic arsenic (iAs) have been linked to an increased risk of diabetes mellitus. Recent laboratory studies showed that methylated trivalent metabolites of iAs may play key roles in the diabetogenic effects of iAs. Our study examined associations between chronic exposure to iAs in drinking water, metabolism of iAs, and prevalence of diabetes in arsenicosis-endemic areas of Mexico. We used fasting blood glucose (FBG), fasting plasma insulin (FPI), oral glucose tolerance test (OGTT), glycated hemoglobin (HbA1c), and insulin resistance (HOMA-IR) to characterize diabetic individuals. Arsenic levels in drinking water and urine were determined to estimate exposure to iAs. Urinary concentrations of iAs and its trivalent and pentavalent methylated metabolites were measured to assess iAs metabolism. Associations between diabetes and iAs exposure or urinary metabolites of iAs were estimated by logistic regression with adjustment for age, sex, hypertension and obesity. The prevalence of diabetes was positively associated with iAs in drinking water (OR 1.13 per 10 ppb, p < 0.01) and with the concentration of dimethylarsinite (DMAsIII) in urine (OR 1.24 per inter-quartile range, p = 0.05). Notably, FPI and HOMA-IR were negatively associated with iAs exposure (β -2.08 and -1.64, respectively, p < 0.01), suggesting that the mechanisms of iAs-induced diabetes differ from those underlying type-2 diabetes, which is typically characterized by insulin resistance. Our study confirms a previously reported, but frequently questioned, association between exposure to iAs and diabetes, and is the first to link the risk of diabetes to the production of one of the most toxic metabolites of iAs, DMAsIII.

Exposure to arsenic in drinking water is associated with increased prevalence of diabetes: a cross-sectional study in the Zimapán and Lagunera regions in Mexico

PubMed Central

2011-01-01

Background Human exposures to inorganic arsenic (iAs) have been linked to an increased risk of diabetes mellitus. Recent laboratory studies showed that methylated trivalent metabolites of iAs may play key roles in the diabetogenic effects of iAs. Our study examined associations between chronic exposure to iAs in drinking water, metabolism of iAs, and prevalence of diabetes in arsenicosis-endemic areas of Mexico. Methods We used fasting blood glucose (FBG), fasting plasma insulin (FPI), oral glucose tolerance test (OGTT), glycated hemoglobin (HbA1c), and insulin resistance (HOMA-IR) to characterize diabetic individuals. Arsenic levels in drinking water and urine were determined to estimate exposure to iAs. Urinary concentrations of iAs and its trivalent and pentavalent methylated metabolites were measured to assess iAs metabolism. Associations between diabetes and iAs exposure or urinary metabolites of iAs were estimated by logistic regression with adjustment for age, sex, hypertension and obesity. Results The prevalence of diabetes was positively associated with iAs in drinking water (OR 1.13 per 10 ppb, p < 0.01) and with the concentration of dimethylarsinite (DMAsIII) in urine (OR 1.24 per inter-quartile range, p = 0.05). Notably, FPI and HOMA-IR were negatively associated with iAs exposure (β -2.08 and -1.64, respectively, p < 0.01), suggesting that the mechanisms of iAs-induced diabetes differ from those underlying type-2 diabetes, which is typically characterized by insulin resistance. Conclusions Our study confirms a previously reported, but frequently questioned, association between exposure to iAs and diabetes, and is the first to link the risk of diabetes to the production of one of the most toxic metabolites of iAs, DMAsIII. PMID:21864395

Management Ratios 1. For Colleges & Universities.

ERIC Educational Resources Information Center

Minter, John, Ed.

Ratios that enable colleges and universities to select other institutions for comparison are presented. The ratios and underlying data also enable colleges to rank order institutions and to calculate means, quartiles, and ranges for these groups. The data are based on FY 1983 U.S. Department of Education Statistics. The ratios summarize the…

Dietary Fiber Intake Is Inversely Associated with Periodontal Disease among US Adults.

PubMed

Nielsen, Samara Joy; Trak-Fellermeier, Maria Angelica; Joshipura, Kaumudi; Dye, Bruce A

2016-12-01

Approximately 47% of adults in the United States have periodontal disease. Dietary guidelines recommend a diet providing adequate fiber. Healthier dietary habits, particularly an increased fiber intake, may contribute to periodontal disease prevention. Our objective was to evaluate the relation of dietary fiber intake and its sources with periodontal disease in the US adult population (≥30 y of age). Data from 6052 adults participating in NHANES 2009-2012 were used. Periodontal disease was defined (according to the CDC/American Academy of Periodontology) as severe, moderate, mild, and none. Intake was assessed by 24-h dietary recalls. The relation between periodontal disease and dietary fiber, whole-grain, and fruit and vegetable intakes were evaluated by using multivariate models, adjusting for sociodemographic characteristics and dentition status. In the multivariate logistic model, the lowest quartile of dietary fiber was associated with moderate-severe periodontitis (compared with mild-none) compared with the highest dietary fiber intake quartile (OR: 1.30; 95% CI: 1.00, 1.69). In the multivariate multinomial logistic model, intake in the lowest quartile of dietary fiber was associated with higher severity of periodontitis than dietary fiber intake in the highest quartile (OR: 1.27; 95% CI: 1.00, 1.62). In the adjusted logistic model, whole-grain intake was not associated with moderate-severe periodontitis. However, in the adjusted multinomial logistic model, adults consuming whole grains in the lowest quartile were more likely to have more severe periodontal disease than were adults consuming whole grains in the highest quartile (OR: 1.32; 95% CI: 1.08, 1.62). In fully adjusted logistic and multinomial logistic models, fruit and vegetable intake was not significantly associated with periodontitis. We found an inverse relation between dietary fiber intake and periodontal disease among US adults ≥30 y old. Periodontal disease was associated with low whole-grain intake but not with low fruit and vegetable intake. © 2016 American Society for Nutrition.

Elevated protein concentrations in newborn blood and the risks of autism spectrum disorder, and of social impairment, at age 10 years among infants born before the 28th week of gestation.

PubMed

Korzeniewski, Steven J; Allred, Elizabeth N; O'Shea, T Michael; Leviton, Alan; Kuban, Karl C K

2018-06-08

Among the 1 of 10 children who are born preterm annually in the United States, 6% are born before the third trimester. Among children who survive birth before the 28th week of gestation, the risks of autism spectrum disorder (ASD) and non-autistic social impairment are severalfold higher than in the general population. We examined the relationship between top quartile inflammation-related protein concentrations among children born extremely preterm and ASD or, separately, a high score on the Social Responsiveness Scale (SRS total score ≥65) among those who did not meet ASD criteria, using information only from the subset of children whose DAS-II verbal or non-verbal IQ was ≥70, who were assessed for ASD, and who had proteins measured in blood collected on ≥2 days (N = 763). ASD (N = 36) assessed at age 10 years is associated with recurrent top quartile concentrations of inflammation-related proteins during the first post-natal month (e.g., SAA odds ratio (OR); 95% confidence interval (CI): 2.5; 1.2-5.3) and IL-6 (OR; 95% CI: 2.6; 1.03-6.4)). Top quartile concentrations of neurotrophic proteins appear to moderate the increased risk of ASD associated with repeated top quartile concentrations of inflammation-related proteins. High (top quartile) concentrations of SAA are associated with elevated risk of ASD (2.8; 1.2-6.7) when Ang-1 concentrations are below the top quartile, but not when Ang-1 concentrations are high (1.3; 0.3-5.8). Similarly, high concentrations of TNF-α are associated with heightened risk of SRS-defined social impairment (N = 130) (2.0; 1.1-3.8) when ANG-1 concentrations are not high, but not when ANG-1 concentrations are elevated (0.5; 0.1-4.2).

Serum Cholinesterase Is Inversely Associated with Body Weight Change in Men Undergoing Routine Health Screening.

PubMed

Oda, Eiji

2015-01-01

The purpose of this study is to investigate the relationships between serum cholinesterase and body weight change, in addition to incident obesity defined as a body mass index (BMI) of 25 kg/m(2) or greater. A retrospective 5-year follow-up study was conducted. The crude incidence and hazard ratios (HRs) of obesity adjusted for the BMI and other confounders were calculated for cholinesterase quartiles in 1,412 men and 921 women. Partial correlation coefficients (PCCs) were calculated between cholinesterase and changes in the BMI during the 5-year follow-up period adjusted for age and other confounders and the change in the BMI were compared among cholinesterase quartiles in 1,223 men and 681 women. During the 5-year follow-up period, 149 men (10.6%) and 65 women (7.1%) developed obesity. The adjusted HRs of obesity decreased, although the crude incidence of obesity increased along the quartiles of cholinesterase in men. The adjusted HRs of obesity for the first (lowest), second and third quartiles of cholinesterase were 2.02 (p=0.006), 1.45 (p=0.122), and 1.28 (p=0.265), respectively compared with the highest quartile in men. The PCC between the baseline level of cholinesterase and change in the BMI was -0.16 (p<0.001) in men. The mean changes in BMI for 5 years were 0.31 kg/m(2), 0.17 kg/m(2), 0.01 kg/m(2) and -0.04 kg/m(2), respectively in the first, second, third and fourth quartiles of cholinesterase in men (p=0.005). Neither incident obesity nor weight gain was significantly associated with cholinesterase in women. The serum cholinesterase level was inversely associated with body weight change, as well as incident obesity, after adjusted for the BMI in men.

Spacing behaviour of juvenile corn mice, Calomys musculinus , at the beginning of the breeding period, in absence of adult males

NASA Astrophysics Data System (ADS)

Steinmann, Andrea; Priotto, José; Sommaro, Lucia; Polop, Jaime

2006-05-01

This research was carried out to examine the hypothesis that the absence of fathers promotes a different spacing behaviour in juveniles Calomys musculinus at the beginning of the breeding period. The study was carried out in four 0.25-ha enclosures (two control and two experimental), in a natural pasture, between November 2003 and February 2004. In this study the fathers were removed from the experimental enclosures after juveniles were born. Home-range size depended on sex of juveniles and treatment (father removal). In control and experimental enclosures, female home-range sizes were always smaller than male home-ranges. Male home-ranges were always larger in experimental enclosures than in control enclosures. Treatment and overlap type (intra- and inter-sexual) were not independent. The overlap proportions of male home-ranges were greatest in experimental enclosures than in control enclosures, in both the overlap types (male/male, males/females). The intra- (females/females) and inter-sexual (females/males) overlap proportions of female home-ranges were independent of treatment. In C. musculinus, at the beginning of the breeding period and in absence of adult males, juvenile males increase their home-range size and therefore the degree of inter- and intra-sexual home-range overlap as a mechanism for enlarging the number of receptive females that they encounter.

[Association of body mass index and aerobic physical fitness with cardiovascular risk factors in children].

PubMed

Gonçalves, Reginaldo; Szmuchrowski, Leszek Antony; Damasceno, Vinícius Oliveira; de Medeiros, Marcelo Lemos; Couto, Bruno Pena; Lamounier, Joel Alves

2014-09-01

To identify the association between both, body mass index and aerobic fitness, with cardiovascular disease risk factors in children. Cross-sectional study, carried out in Itaúna-MG, in 2010, with 290 school children ranging from 6 to 10 years-old of both sexes, randomly selected. Children from schools located in the countryside and those with medical restrctions for physical activity were not included. Blood sample was collected after a 12-hour fasting period. Blood pressure, stature and weight were evaluated in accordance with international standards. The following were considered as cardiovascular risk factors: high blood pressure, high total cholesterol, LDL, triglycerides and insulin levels, and low HDL. The statistical analysis included the Spearman's coefficient and the logistic regression, with cardiovascular risk factors as dependent variables. Significant correlations were found, in both sexes, among body mass index and aerobic fitness with most of the cardiovascular risk factors. Children of both sexes with body mass index in the fourth quartile demonstrated increased chances of having high blood insulin and clustering cardiovascular risk factors. Moreover, girls with aerobic fitness in the first quartile also demonstrated increased chances of having high blood insulin and clustering cardiovascular risk factors. The significant associations and the increased chances of having cardiovascular risk factors in children with less aerobic fitness and higher levels of body mass index justify the use of these variables for health monitoring in Pediatrics. Copyright © 2014 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

Red Meat Intake and Risk of ESRD

PubMed Central

Lew, Quan-Lan Jasmine; Jafar, Tazeen Hasan; Koh, Hiromi Wai Ling; Jin, Aizhen; Chow, Khuan Yew; Yuan, Jian-Min

2017-01-01

Randomized controlled trials suggest that protein restriction may retard the progression of CKD toward ESRD. However, the effects of dietary protein intake level and the food sources of dietary protein on the risk of ESRD in the general population remain unclear. We investigated these effects in the Singapore Chinese Health Study, a prospective population-based cohort that recruited 63,257 Chinese adults aged 45–74 years from 1993 to 1998. We collected habitual diet information via a validated semiquantitative food frequency questionnaire and identified ESRD via record linkage with a nationwide registry. In all, 951 cases of ESRD occurred over a mean follow-up of 15.5 years. Regarding total protein intake, compared with the lowest quartile, the three higher quartiles combined had a hazard ratio for ESRD of 1.24 (95% confidence interval [95% CI], 1.05 to 1.46), but the dose-dependent association across the quartiles was not statistically significant (Ptrend=0.16). Red meat intake strongly associated with ESRD risk in a dose-dependent manner (hazard ratio for highest quartile versus lowest quartile,1.40 [95% CI, 1.15 to 1.71; Ptrend<0.001]). Intake of poultry, fish, eggs, or dairy products did not associate with risk of ESRD. In substitution analysis, replacing one serving of red meat with other food sources of protein associated with a maximum relative risk reduction of 62.4% (95% CI, 33.1 to 78.9; P<0.01). Our study shows that red meat intake may increase the risk of ESRD in the general population and substituting alternative sources of protein may reduce the incidence of ESRD. PMID:27416946

Target organ damage in primary hypertensive patients: role of the morning heart rate surge.

PubMed

Zhan, Yuliang; Kang, Ting; Wei, Yunfeng

The morning heart rate surge (MHRS) and morning blood pressure surge (MBPS) may be responsible for the high prevalence of cardiovascular events during the morning period. The clinical significance of the MBPS has been well established, but that of the MHRS remains unclear. Thus, we evaluated the association between the MHRS and target organ damage (TOD). A cross-sectional study of 580 hypertensive patients was performed. MHRS and heart rate variability (HRV) were analyzed by 24 h electrocardiogram. TOD was assessed by estimated glomerular filtration rate, carotid intima-media thickness (IMT), and left ventricular mass index. The prevalence of TOD tended to decrease with sleep-trough MHRS (first to fourth quartiles: 71%, 70.3%, 58.6%, and 52.7%, respectively) or prewaking MHRS quartiles (first to fourth quartiles: 65.3%, 73.6%, 61.4%, and 54.2%, respectively), whereas the opposite trend was observed for standard deviation of all normal NN intervals (SDNN). Moreover, sleep-trough MHRS, prewaking MHRS, SDNN, and SDNN index were significantly lower in patients with TOD than in those without TOD. According to four logistic regression models, the associations of prewaking MHRS, SDNN, and SDNN index with TOD were lost after adjustment for age and BP. Patients in the first (≤11.125 bpm) and second sleep-trough MHRS quartiles (11.125-15.75 bpm) had a 1.95-2.06-fold increased risk of TOD compared with those in the fourth quartile (p < 0.05). A blunted sleep-trough MHRS, which may serve as a surrogate marker for autonomic imbalance, was independently associated with TOD in primary hypertensive patients.

Organize to manage reliability

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

Ricketts, R.

An analysis of maintenance costs in hydrocarbon processing industry (HPI) plants has revealed that attitudes and practices of personnel are the major single bottom line factor. In reaching this conclusion, Solomon Associates examined comparative analysis of plant records over the past decade. The authors learned that there was a wide range of performance independent of refinery age, capacity, processing complexity, and location. Facilities of all extremes in these attributes are included in both high-cost and low-cost categories. Those in the lowest quartile of performance posted twice the resource consumption as the best quartile. Furthermore, there was almost no similarity betweenmore » refineries within a single company. The paper discusses cost versus availability, maintenance spending, two organizational approaches used (repair focused and reliability focused), and organizational style and structure.« less

How much can we gain from improved efficiency? An examination of performance of national HIV/AIDS programs and its determinants in low- and middle-income countries

PubMed Central

2012-01-01

Background The economic downturn exacerbates the inadequacy of resources for combating the worldwide HIV/AIDS pandemic and amplifies the need to improve the efficiency of HIV/AIDS programs. Methods We used data envelopment analysis (DEA) to evaluate efficiency of national HIV/AIDS programs in transforming funding into services and implemented a Tobit model to identify determinants of the efficiency in 68 low- and middle-income countries. We considered the change from the lowest quartile to the average value of a variable a "notable" increase. Results Overall, the average efficiency in implementing HIV/AIDS programs was moderate (49.8%). Program efficiency varied enormously among countries with means by quartile of efficiency of 13.0%, 36.4%, 54.4% and 96.5%. A country's governance, financing mechanisms, and economic and demographic characteristics influence the program efficiency. For example, if countries achieved a notable increase in "voice and accountability" (e.g., greater participation of civil society in policy making), the efficiency of their HIV/AIDS programs would increase by 40.8%. For countries in the lowest quartile of per capita gross national income (GNI), a notable increase in per capita GNI would increase the efficiency of AIDS programs by 45.0%. Conclusions There may be substantial opportunity for improving the efficiency of AIDS services, by providing more services with existing resources. Actions beyond the health sector could be important factors affecting HIV/AIDS service delivery. PMID:22443135

Association between serum ferritin, hemoglobin, iron intake, and diabetes in adults in Jiangsu, China.

PubMed

Shi, Zumin; Hu, Xiaoshu; Yuan, Baojun; Pan, Xiaoqun; Meyer, Haakon E; Holmboe-Ottesen, Gerd

2006-08-01

To investigate the association between iron status, iron intake, and diabetes among Chinese adults. This cross-sectional household survey was carried out in 2002 in Jiangsu Province, China. The sample contained 2,849 men and women aged > or =20 years with a response rate of 89.0%. Iron intake was assessed by food weighing plus consecutive individual 3-day food records. Fasting plasma glucose (FPG), serum ferritin, and hemoglobin were measured. The prevalence of anemia was 18.3% in men and 31.5% in women. Mean hemoglobin and serum ferritin increased across groups with increasing FPG. The prevalence of anemia among women was 15.0% in individuals with FPG >7.0 mmol/l compared with 32.6% in individuals with FPG <5.6 mmol/l. There was a similar, however not significant, trend among men. In women, after adjusting for known risk factors, the odds ratio (OR) of diabetes was 2.15 (95% CI 1.03-4.51) for subjects in the upper quartile of hemoglobin compared with the rest, and the corresponding OR for the upper quartile of serum ferritin was 3.79 (1.72-8.36). Iron intake was positively associated with diabetes in women; fourth quartile intake of iron yielded an OR of 5.53 (1.47-20.44) compared with the first quartile in the multivariate analyses. In men, similar trends were suggested, although they were not statistically significant. Iron status and iron intake was independently associated with risk of diabetes in Chinese women but not in men.

Social Media Use and Perceived Emotional Support Among US Young Adults

PubMed Central

Shensa, Ariel; Sidani, Jaime E.; Lin, Liu yi; Bowman, Nicholas; Primack, Brian A.

2015-01-01

Low emotional support is associated with poor health outcomes. Engagement with face-to-face social networks is one way of increasing emotional support. However, it is not yet known whether engagement with proliferating electronic social networks is similarly associated with increased emotional support. Thus, the purpose of this study was to assess associations between social media use and perceived emotional support in a large, nationally-representative sample. In October 2014, we collected data from 1,796 U.S. adults ages 19-32. We assessed social media use using both total time spent and frequency of visits to each of the 11 most popular social media platforms. Our dependent variable was perceived emotional support as measured by the brief Patient-Reported Outcomes Measurement Information System (PROMIS) emotional support scale. A multivariable model including all sociodemographic covariates and accounting for survey weights demonstrated that, compared with the lowest quartile of time on social media, being in the highest quartile (spending two or more hours per day) was significantly associated with decreased odds of having higher perceived emotional support (AOR = 0.62, 95% CI = 0.40, 0.94). However, compared with those in the lowest quartile, being in the highest quartile regarding frequency of social media use was not significantly associated with perceived emotional support (AOR = 0.70, 95% CI = 0.45, 1.09). In conclusion, while the cross-sectional nature of these data hinder inference regarding directionality, it seems that heavy users of social media may actually feel less and not more emotional support. PMID:26613936

Social Media Use and Perceived Emotional Support Among US Young Adults.

PubMed

Shensa, Ariel; Sidani, Jaime E; Lin, Liu Yi; Bowman, Nicholas D; Primack, Brian A

2016-06-01

Low emotional support is associated with poor health outcomes. Engagement with face-to-face social networks is one way of increasing emotional support. However, it is not yet known whether engagement with proliferating electronic social networks is similarly associated with increased emotional support. Thus, the purpose of this study was to assess associations between social media use and perceived emotional support in a large, nationally-representative sample. In October 2014, we collected data from 1796 U.S. adults ages 19-32. We assessed social media use using both total time spent and frequency of visits to each of the 11 most popular social media platforms. Our dependent variable was perceived emotional support as measured by the brief Patient-Reported Outcomes Measurement Information System (PROMIS) emotional support scale. A multivariable model including all sociodemographic covariates and accounting for survey weights demonstrated that, compared with the lowest quartile of time on social media, being in the highest quartile (spending two or more hours per day) was significantly associated with decreased odds of having higher perceived emotional support (AOR 0.62, 95 % CI 0.40, 0.94). However, compared with those in the lowest quartile, being in the highest quartile regarding frequency of social media use was not significantly associated with perceived emotional support (AOR 0.70, 95 % CI 0.45, 1.09). In conclusion, while the cross-sectional nature of these data hinder inference regarding directionality, it seems that heavy users of social media may actually feel less and not more emotional support.

Unconventional natural gas development and birth outcomes in Pennsylvania, USA

PubMed Central

Casey, Joan A.; Savitz, David A.; Rasmussen, Sara G.; Ogburn, Elizabeth L.; Pollak, Jonathan; Mercer, Dione G.; Schwartz, Brian S.

2015-01-01

Background Unconventional natural gas development has expanded rapidly. In Pennsylvania the number of producing wells increased from zero in 2005 to 3689 in 2013. To our knowledge, no prior publications have focused on unconventional natural gas development and birth outcomes. Methods We performed a retrospective cohort study using electronic health record data on 9384 mothers linked to 10946 neonates in the Geisinger Health System from January 2009-January 2013. We estimated cumulative exposure to unconventional natural gas development activity with an inverse-distance squared model that incorporated distance to the mother’s home; dates and durations of well pad development, drilling, and hydraulic fracturing; and production volume during the pregnancy. We used multilevel linear and logistic regression models to examine associations between activity index quartile and term birth weight, preterm birth, low 5 minute Apgar score and small size for gestational age, while controlling for potential confounding variables. Results In adjusted models, there was an association between unconventional natural gas development activity and preterm birth that increased across quartiles, with a fourth quartile odds ratio of 1.4 (95% CI: 1.0-1.9). There were no associations of activity with Apgar score, small for gestational age, or term birth weight (after adjustment for year). In a post-hoc analysis, there was an association with physician-recorded high-risk pregnancy identified from the problem list (fourth vs. first quartile, 1.3 [95% CI: 1.1-1.7]). Conclusion Prenatal residential exposure to unconventional natural gas development activity was associated with two pregnancy outcomes, adding to evidence that unconventional natural gas development may impact health. PMID:26426945

Plasma concentrations of ascorbic acid and C-reactive protein, and risk of future coronary artery disease, in apparently healthy men and women: the EPIC-Norfolk prospective population study.

PubMed

Boekholdt, S Matthijs; Meuwese, Marijn C; Day, Nicholas E; Luben, Robert; Welch, Ailsa; Wareham, Nicholas J; Khaw, Kay-Tee

2006-09-01

High plasma concentrations of ascorbic acid, a marker of fruit and vegetable intake, are associated with low risk of coronary artery disease. Whether this relationship is explained by a reduction in systemic inflammation is unclear. We investigated the relationship between ascorbic acid plasma concentration and coronary artery disease risk, and in addition whether this relationship depended on classical risk factors and C-reactive protein (CRP) concentration. We used a prospective nested case-control design. The study consisted of 979 cases and 1794 controls (1767 men and 1006 women). Increasing ascorbic acid quartiles were associated with lower age, BMI, systolic and diastolic blood pressure, and CRP concentration, but with higher HDL-cholesterol concentration. No associations existed between ascorbic acid concentration and total cholesterol concentration or LDL-cholesterol concentration. When data from men and women were pooled, the risk estimates decreased with increasing ascorbic acid quartiles such that people in the highest ascorbic acid quartile had an odds ratio for future coronary artery disease of 0.67 (95 % CI 0.52, 0.87) compared with those in the lowest quartile (P for linearity=0.001). This relationship was independent of sex, age, diabetes, smoking, BMI, LDL-cholesterol, HDL-cholesterol, systolic blood pressure and CRP level. These data suggest that the risk reduction associated with higher ascorbic acid plasma concentrations, a marker of fruit and vegetable intake, is independent of classical risk factors and also independent of CRP concentration.

Associations between intimate partner violence and reproductive and maternal health outcomes in Bihar, India: a cross-sectional study.

PubMed

Dhar, Diva; McDougal, Lotus; Hay, Katherine; Atmavilas, Yamini; Silverman, Jay; Triplett, Daniel; Raj, Anita

2018-06-19

Bihar, India has higher rates of intimate partner violence (IPV) and maternal and infant mortality relative to India as a whole. This study assesses whether IPV is associated with poor reproductive and maternal health outcomes, as well as whether poverty exacerbates any observed associations, among women who gave birth in the preceding 23 months in Bihar, India. A cross-sectional analysis of data from a representative household sample of mothers of children 0-23 months old in Bihar, India (N = 13,803) was conducted. Associations between lifetime IPV (physical and/or sexual violence) and poor reproductive health outcomes ever (miscarriage, stillbirth, and abortion) as well as maternal complications for the index pregnancy (early and/or prolonged labor complications, other complications during pregnancy or delivery) were assessed using multivariable logistic regression, adjusting for demographics and fertility history of the mother. Models were then stratified by wealth index to determine whether observed associations were stronger for poorer versus wealthier women. IPV was reported by 45% of women in the sample. A history of miscarriage, stillbirth, and abortion was reported by 8.7, 4.6, and 1.3% of the sample, respectively. More than one in 10 women (10.7%) reported labor complications during the last pregnancy, and 16.3% reported other complications during pregnancy or delivery. Adjusted regressions revealed significant associations between IPV and miscarriage (AOR = 1.35, 95% CI = 1.11-1.65) and stillbirth (AOR = 1.36, 95% CI = 1.02-1.82) ever, as well as with labor complications (AOR = 1.27, 95% CI = 1.04-1.54) and other pregnancy/delivery complications (AOR = 1.68, 95% CI = 1.42-1.99). Women in the poorest quartile (Quartile 1) saw no associations between IPV and miscarriage (Quartile 1 AOR = 0.98, 95% CI = 0.67-1.45) or stillbirth (Quartile 1 AOR = 1.17, 95% CI = 0.69-1.98), whereas women in the higher wealth quartile (Quartile 3) did see associations between IPV and miscarriage (Quartile 3 AOR = 1.55, 95% CI = 1.07, 2.25) and stillbirth (Quartile 3 AOR = 1.79, 95% CI = 1.04, 3.08). IPV is highly prevalent in Bihar and is associated with increased risk for miscarriage, stillbirth, and maternal health complications. Associations between IPV and miscarriage and stillbirth do not hold true for the poorest women, possibly because other risks attached to poverty and deprivation may be greater contributors.

Inflammatory Dietary Pattern, IL-17F Genetic Variant, and the Risk of Colorectal Cancer.

PubMed

Cho, Young Ae; Lee, Jeonghee; Oh, Jae Hwan; Chang, Hee Jin; Sohn, Dae Kyung; Shin, Aesun; Kim, Jeongseon

2018-06-05

A proinflammatory diet may increase the risk of colorectal cancer, but its role may differ according to individuals' genetic variants. We aimed to examine whether a specific dietary pattern reflecting inflammation was associated with a risk of colorectal cancer and whether IL-17F genetic variant altered this association. In a study of 695 colorectal cancer cases and 1846 controls, we derived a reduced rank regression dietary pattern using 32 food groups as predictors and the plasma C-reactive protein (CRP) concentration as the response. High CRP levels were associated with a high risk of colorectal cancer (OR (95% CI) = 3.58 (2.65⁻4.82) for the highest quartile vs. lowest quartile). After adjusting for potential confounding factors, high pattern scores were associated with a high risk of colorectal cancer (OR (95% CI) = 9.98 (6.81⁻14.62) for the highest quartile vs. lowest quartile). When stratified by the IL-17F rs763780 genotype, this association was stronger for individuals carrying the C allele ( p for interaction = 0.034), particularly for individuals with rectal cancer ( p for interaction = 0.011). In conclusion, a dietary pattern reflecting inflammation was significantly associated with colorectal cancer risk. Moreover, this association could be modified according to the IL-17F rs763780 genotype and anatomic site.

Association between serum triglyceride to high-density lipoprotein cholesterol ratio and sarcopenia in elderly Korean males: The Korean National Health and Nutrition Examination Survey.

PubMed

Chung, Tae-Ha; Kwon, Yu-Jin; Shim, Jae-Yong; Lee, Yong-Jae

2016-12-01

We investigated the association between the triglycerides to high-density lipoprotein cholesterol (TG/HDL) ratio and sarcopenia in elderly Korean males. We examined the relationship between the TG/HDL ratio and sarcopenia in 879 elderly males ≥60years who participated in the 2010-2011 KNHANES. Sarcopenia was defined as an appendicular skeletal muscle mass (ASM) divided by the weight (%), which is >1 SD below the mean for young adults. The odds ratios (ORs) for sarcopenia were calculated using multiple logistic regression across the TG/HDL ratio quartiles (Q1: ≤1.4, Q2: 1.5-2.4, Q3: 2.5-3.8 and Q4: ≥3.9) after adjusting for confounding variables. The prevalence of sarcopenia significantly increased in accordance with TG/HDL ratio quartiles. Compared with the lowest quartile of the TG/HDL ratio, the corresponding OR (95% CI) of the highest quartile of the TG/HDL ratio for sarcopenia was 2.10 (1.12-3.91) after adjusting for age, body mass index (BMI), cigarette smoking, alcohol intake and physical activity. TG/HDL ratio was positively related with a higher risk of sarcopenia in elderly Korean males. Copyright © 2016 Elsevier B.V. All rights reserved.

Infective endocarditis in Ethiopian children: a hospital based review of cases in Addis Ababa.

PubMed

Moges, Tamirat; Gedlu, Etsegenet; Isaakidis, Petros; Kumar, Ajay; Van Den Berge, Rafael; Khogali, Mohammed; Mekasha, Amha; Hinderaker, Sven Gudmund

2015-01-01

Infective endocarditis is an infection of the endocardial lining of the heart mainly associated with congenital and rheumatic heart disease. Although it is a rare disease in children, it is associated with high morbidity and mortality; death due to infective endocarditis has been reported to be as high as 26% in sub-Saharan Africa. This was a retrospective review of routinely collected data from patient records. A total of 40 children (71% female) with 41 episodes of infective endocarditis admitted to a general paediatric ward in Addis Ababa, Ethiopia between 2008 and 2013. Age ranged from 7 months to 14 years, with a median of 9 years (Inter quartile Range: 7-12 years). Rheumatic and congenital heart diseases were underlying risk factors in 49% and 51% of cases respectively. Congestive heart failure, systemic embolization and death occurred in 66%, 12% and 7.3% respectively. Death was associated with the occurrence of systemic embolization (P-value=0.03). Rheumatic heart disease was an important predisposing factor for infective endocarditis in Ethiopian children. Late presentations of cases were evidenced by high proportion of complications such as congestive heart failure. A low rate of clinically evident systemic embolization in this study may be a reflection of the diagnostic challenges. High proportion of prior antibiotic intake might explain the cause of significant BCNE. Preventive measures like primary and secondary prophylaxis of rheumatic fever may decrease the associated morbidity and mortality. Early detection and referral of cases, awareness creation about indiscriminate use of antimicrobials, and proper history taking and documentation of information recommended.

Air pollution and ED visits for asthma in Australian children: a case-crossover analysis.

PubMed

Jalaludin, Bin; Khalaj, Behnoosh; Sheppeard, Vicky; Morgan, Geoff

2008-08-01

We aimed to determine the effects of ambient air pollutants on emergency department (ED) visits for asthma in children. We obtained routinely collected ED visit data for asthma (ICD9 493) and air pollution (PM(10), PM(2.5), O(3), NO(2), CO and SO(2)) and meteorological data for metropolitan Sydney for 1997-2001. We used the time stratified case-crossover design and conditional logistic regression to model the association between air pollutants and ED visits for four age-groups (1-4, 5-9, 10-14 and 1-14 years). Estimated relative risks for asthma ED visits were calculated for an exposure corresponding to the inter-quartile range in pollutant level. We included same day average temperature, same day relative humidity, daily temperature range, school holidays and public holidays in all models. Associations between ambient air pollutants and ED visits for asthma in children were most consistent for all six air pollutants in the 1-4 years age-group, for particulates and CO in the 5-9 years age-group and for CO in the 10-14 years age-group. The greatest effects were most consistently observed for lag 0 and effects were greater in the warm months for particulates, O(3) and NO(2). In two pollutant models, effect sizes were generally smaller compared to those derived from single pollutant models. We observed the effects of ambient air pollutants on ED attendances for asthma in a city where the ambient concentrations of air pollutants are relatively low.

The EVEREST study: an international collaboration*

PubMed Central

Caskey, Fergus J.; Stel, Vianda S.; Elliott, Robert F.; Jager, Kitty J.; Covic, Adrian; Cusumano, Ana; Geue, Claudia; Kramer, Anneke; Stengel, Benedicte; MacLeod, Alison M.

2010-01-01

Rates of initiation of renal replacement therapy (RRT), use of home modalities of treatment and patient outcomes vary considerably between countries. This paper reports the methods and baseline characteristics of countries participating in the EVEREST study (n = 46), a global collaboration examining the association between medical and non-medical factors and RRT incidence, modality mix and survival. Numbers of incident and prevalent patients were collected for current (2003–05) and historic (1983–85, 1988–90, 1993–95 and 1998–2000) periods stratified, where available, by age, gender, treatment modality and cause of end stage renal disease (diabetic versus non-diabetic). General population age and health indicators and national-level macroeconomic data were collected from secondary data sources. National experts provided primary data on renal service funding, resources and organization. The median (inter quartile range) RRT incidence per million of the population (pmp) was 130 pmp (102–167 pmp). The general population life expectancy at 60 was 22.1 years (19.7–23.1 years) and 6.9% had diabetes mellitus (5.4–9.0%). Healthcare spending as a percentage of gross domestic product was 8.1% (5.6–9.3%). Countries averaged nine dialysis facilities pmp (4–12 pmp), with 69.0% (43.9–99.0%) owned by the public or private not-for-profit sector. The number of nephrologists ranged from 0.5 to 48 pmp (median 12 pmp). The heterogeneity of EVEREST countries will enable modelling to examine the independent association between medical and non-medical factors on RRT epidemiology. PMID:25949402

Plasma apelin levels, blood pressure and cardiovascular risk factors in a coastal Chinese population.

PubMed

Zhu, Pengli; Huang, Feng; Lin, Fan; Yuan, Yin; Chen, Falin; Li, Qiaowei

2013-11-01

To describe the relationship of plasma apelin levels with blood pressure in a coastal Chinese population. This cross-sectional study included a total of 1031 subjects from the coastal areas of China. One-way analysis of variance (ANOVA) and linear trend test, Pearson's correlation analysis, as well as multivariate linear regression analysis were used to evaluate the association between plasma apelin levels and blood pressure. Plasma apelin levels dropped with increasing quartiles of systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MABP) (all P<0.001). SBP, DBP, and MABP values decreased as the apelin levels increased within the quartiles. After adjusting for age and gender, the significant differences in SBP, DBP, and MABP between the groups within the apelin quartiles remained (all P<0.05). A significant negative correlation between SBP, DBP, as well as MABP and apelin levels was observed (all P<0.01); even after adjusting for cardiovascular confounding factors, this negative correlation remained (all P<0.001). A negative correlation between plasma apelin levels and blood pressure was found in this 1000-population-based epidemiological study. Apelin may become a potential therapeutic target of anti-hypertensive treatment.

Introducing a GP copayment in Australia: Who would carry the cost burden?

PubMed

Elkins, Rosemary Kate; Schurer, Stefanie

2017-05-01

Recent policy changes designed to contain unsustainable health expenditure growth imply that many more Australians may soon be charged a copayment to consult a GP. We explore the distributional consequences associated with a range of hypothetical GP copayment scenarios using nationally-representative Australian survey data. For each scenario, we estimate the cost burden that individuals and households across the income distribution would need to absorb to maintain their current GP service utilisation. Even when concessional patients are charged a third or a quarter of the non-concessional copayment rate, the average estimated cost burden in the lowest income quartile is typically between three and six times that of the highest, and the average cost burden for women is significantly higher than for men within every income quartile. These disparities are intensified for those with a chronic illness. We conclude that the widespread implementation of GP copayments would disproportionately burden lower-income families, who experience higher rates of chronic illness, higher demand for GP services, and lower capacity to absorb price increases. The regressive nature of GP copayments is reduced when concessional and child patients are exempted entirely, highlighting the importance of supporting GPs-particularly in disadvantaged areas-to maintain bulk-billing arrangements for vulnerable patient groups. Copyright © 2017 Elsevier B.V. All rights reserved.

Stroke-induced immunodepression and dysphagia independently predict stroke-associated pneumonia - The PREDICT study.

PubMed

Hoffmann, Sarah; Harms, Hendrik; Ulm, Lena; Nabavi, Darius G; Mackert, Bruno-Marcel; Schmehl, Ingo; Jungehulsing, Gerhard J; Montaner, Joan; Bustamante, Alejandro; Hermans, Marcella; Hamilton, Frank; Göhler, Jos; Malzahn, Uwe; Malsch, Carolin; Heuschmann, Peter U; Meisel, Christian; Meisel, Andreas

2017-12-01

Stroke-associated pneumonia is a frequent complication after stroke associated with poor outcome. Dysphagia is a known risk factor for stroke-associated pneumonia but accumulating evidence suggests that stroke induces an immunodepressive state increasing susceptibility for stroke-associated pneumonia. We aimed to confirm that stroke-induced immunodepression syndrome is associated with stroke-associated pneumonia independently from dysphagia by investigating the predictive properties of monocytic HLA-DR expression as a marker of immunodepression as well as biomarkers for inflammation (interleukin-6) and infection (lipopolysaccharide-binding protein). This was a prospective, multicenter study with 11 study sites in Germany and Spain, including 486 patients with acute ischemic stroke. Daily screening for stroke-associated pneumonia, dysphagia and biomarkers was performed. Frequency of stroke-associated pneumonia was 5.2%. Dysphagia and decreased monocytic HLA-DR were independent predictors for stroke-associated pneumonia in multivariable regression analysis. Proportion of pneumonia ranged between 0.9% in the higher monocytic HLA-DR quartile (≥21,876 mAb/cell) and 8.5% in the lower quartile (≤12,369 mAb/cell). In the presence of dysphagia, proportion of pneumonia increased to 5.9% and 18.8%, respectively. Patients without dysphagia and normal monocytic HLA-DR expression had no stroke-associated pneumonia risk. We demonstrate that dysphagia and stroke-induced immunodepression syndrome are independent risk factors for stroke-associated pneumonia. Screening for immunodepression and dysphagia might be useful for identifying patients at high risk for stroke-associated pneumonia.

High protein and cholesterol intakes associated with emergence of glucose intolerance in a low-risk Canadian Inuit population.

PubMed

Sefidbakht, Saghar; Johnson-Down, Louise; Young, T Kue; Egeland, Grace M

2016-07-01

The rate of type 2 diabetes mellitus among Inuit is 12·2 % in individuals over 50 years of age, similar to the Canadian prevalence. Given marked dietary transitions in the Arctic, we evaluated the dietary and other correlates of not previously diagnosed glucose intolerance, defined as type 2 diabetes mellitus, impaired fasting glucose or impaired glucose tolerance. Cross-sectional analyses were limited to adults with a completed 2 h oral glucose tolerance test and without pre-existing diabetes. Anthropometric assessments, health and medication usage questionnaires and a 24 h dietary recall were administered. Canadian International Polar Year Inuit Health Survey (2007-2008). Inuit adults (n 777). Glucose intolerance was associated with older age and adiposity. Percentage of energy from protein above the Acceptable Macronutrient Distribution Range of 35 %, compared with intake within the range, was associated with increased odds of glucose intolerance (OR=1·98; 95 % CI 1·09, 3·61) in multivariable analyses. Further, cholesterol intake in the highest three quartiles combined (median exposures of 207, 416 and 778 mg/d, respectively) compared with the lowest quartile (median intake of 81 mg/d) was associated with glucose intolerance (OR=2·15; 95 % CI 1·23, 3·78) in multivariable analyses. Past-day traditional food consumption was borderline protective of glucose intolerance (P=0·054) and high fibre intake was not significantly protective (P=0·08). The results contribute to the existing literature on high protein and cholesterol intakes as they may relate to diabetes risk.

Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range.

PubMed

Luo, Dehui; Wan, Xiang; Liu, Jiming; Tong, Tiejun

2018-06-01

The era of big data is coming, and evidence-based medicine is attracting increasing attention to improve decision making in medical practice via integrating evidence from well designed and conducted clinical research. Meta-analysis is a statistical technique widely used in evidence-based medicine for analytically combining the findings from independent clinical trials to provide an overall estimation of a treatment effectiveness. The sample mean and standard deviation are two commonly used statistics in meta-analysis but some trials use the median, the minimum and maximum values, or sometimes the first and third quartiles to report the results. Thus, to pool results in a consistent format, researchers need to transform those information back to the sample mean and standard deviation. In this article, we investigate the optimal estimation of the sample mean for meta-analysis from both theoretical and empirical perspectives. A major drawback in the literature is that the sample size, needless to say its importance, is either ignored or used in a stepwise but somewhat arbitrary manner, e.g. the famous method proposed by Hozo et al. We solve this issue by incorporating the sample size in a smoothly changing weight in the estimators to reach the optimal estimation. Our proposed estimators not only improve the existing ones significantly but also share the same virtue of the simplicity. The real data application indicates that our proposed estimators are capable to serve as "rules of thumb" and will be widely applied in evidence-based medicine.

Water vapor radiative effects on short-wave radiation in Spain

NASA Astrophysics Data System (ADS)

Vaquero-Martínez, Javier; Antón, Manuel; Ortiz de Galisteo, José Pablo; Román, Roberto; Cachorro, Victoria E.

2018-06-01

In this work, water vapor radiative effect (WVRE) is studied by means of the Santa Barbara's Disort Radiative Transfer (SBDART) model, fed with integrated water vapor (IWV) data from 20 ground-based GPS stations in Spain. Only IWV data recorded during cloud-free days (selected using daily insolation data) were used in this study. Typically, for SZA = 60.0 ± 0.5° WVRE values are around - 82 and - 66 Wm-2 (first and third quartile), although it can reach up - 100 Wm-2 or decrease to - 39 Wm-2. A power dependence of WVRE on IWV and cosine of solar zenith angle (SZA) was found by an empirical fit. This relation is used to determine the water vapor radiative efficiency (WVEFF = ∂WVRE/∂IWV). Obtained WVEFF values range from - 9 and 0 Wm-2 mm-1 (- 2.2 and 0% mm-1 in relative terms). It is observed that WVEFF decreases as IWV increases, but also as SZA increases. On the other hand, when relative WVEFF is calculated from normalized WVRE, an increase of SZA results in an increase of relative WVEFF. Heating rates were also calculated, ranging from 0.2 Kday-1 to 1.7 Kday-1. WVRE was also calculated at top of atmosphere, where values ranged from 4 Wm-2 to 37 Wm-2.

Dealing with missing standard deviation and mean values in meta-analysis of continuous outcomes: a systematic review.

PubMed

Weir, Christopher J; Butcher, Isabella; Assi, Valentina; Lewis, Stephanie C; Murray, Gordon D; Langhorne, Peter; Brady, Marian C

2018-03-07

Rigorous, informative meta-analyses rely on availability of appropriate summary statistics or individual participant data. For continuous outcomes, especially those with naturally skewed distributions, summary information on the mean or variability often goes unreported. While full reporting of original trial data is the ideal, we sought to identify methods for handling unreported mean or variability summary statistics in meta-analysis. We undertook two systematic literature reviews to identify methodological approaches used to deal with missing mean or variability summary statistics. Five electronic databases were searched, in addition to the Cochrane Colloquium abstract books and the Cochrane Statistics Methods Group mailing list archive. We also conducted cited reference searching and emailed topic experts to identify recent methodological developments. Details recorded included the description of the method, the information required to implement the method, any underlying assumptions and whether the method could be readily applied in standard statistical software. We provided a summary description of the methods identified, illustrating selected methods in example meta-analysis scenarios. For missing standard deviations (SDs), following screening of 503 articles, fifteen methods were identified in addition to those reported in a previous review. These included Bayesian hierarchical modelling at the meta-analysis level; summary statistic level imputation based on observed SD values from other trials in the meta-analysis; a practical approximation based on the range; and algebraic estimation of the SD based on other summary statistics. Following screening of 1124 articles for methods estimating the mean, one approximate Bayesian computation approach and three papers based on alternative summary statistics were identified. Illustrative meta-analyses showed that when replacing a missing SD the approximation using the range minimised loss of precision and generally performed better than omitting trials. When estimating missing means, a formula using the median, lower quartile and upper quartile performed best in preserving the precision of the meta-analysis findings, although in some scenarios, omitting trials gave superior results. Methods based on summary statistics (minimum, maximum, lower quartile, upper quartile, median) reported in the literature facilitate more comprehensive inclusion of randomised controlled trials with missing mean or variability summary statistics within meta-analyses.

Association of Marine Omega-3 Fatty Acid Levels With Telomeric Aging in Patients With Coronary Heart Disease

PubMed Central

Farzaneh-Far, Ramin; Lin, Jue; Epel, Elissa S.; Harris, William S.; Blackburn, Elizabeth H.; Whooley, Mary A.

2010-01-01

Context Increased dietary intake of marine omega-3 fatty acids is associated with prolonged survival in patients with coronary heart disease. However, the mechanisms underlying this protective effect are poorly understood. Objective To investigate the association of omega-3 fatty acid blood levels with temporal changes in telomere length, an emerging marker of biological age. Design, Setting, and Participants Prospective cohort study of 608 ambulatory outpatients in California with stable coronary artery disease recruited from the Heart and Soul Study between September 2000 and December 2002 and followed up to January 2009 (median, 6.0 years; range, 5.0-8.1 years). Main Outcome Measures We measured leukocyte telomere length at baseline and again after 5 years of follow-up. Multivariable linear and logistic regression models were used to investigate the association of baseline levels of omega-3 fatty acids (docosahexaenoic acid [DHA] and eicosapentaenoic acid [EPA]) with subsequent change in telomere length. Results Individuals in the lowest quartile of DHA3EPA experienced the fastest rate of telomere shortening (0.13 telomere-to-single-copy gene ratio [T/S] units over 5 years; 95% confidence interval [CI], 0.09-0.17), whereas those in the highest quartile experienced the slowest rate of telomere shortening (0.05 T/S units over 5 years; 95% CI, 0.02-0.08; P<.001 for linear trend across quartiles). Levels of DHA+EPA were associated with less telomere shortening before (unadjusted β coefficient × 10−3=0.06; 95% CI, 0.02-0.10) and after (adjusted β coefficient × 10−3=0.05; 95% CI, 0.01-0.08) sequential adjustment for established risk factors and potential confounders. Each 1-SD increase in DHA+EPA levels was associated with a 32% reduction in the odds of telomere shortening (adjusted odds ratio, 0.68; 95% CI, 0.47-0.98). Conclusion Among this cohort of patients with coronary artery disease, there was an inverse relationship between baseline blood levels of marine omega-3 fatty acids and the rate of telomere shortening over 5 years. PMID:20085953

Ambient Air Pollution and Traffic Exposures and Congenital Heart Defects in the San Joaquin Valley of California

PubMed Central

Padula, Amy M.; Tager, Ira B.; Carmichael, Suzan L.; Hammond, S. Katharine; Yang, Wei; Lurmann, Frederick; Shaw, Gary M.

2013-01-01

Background Congenital anomalies are a leading cause of infant morbidity and mortality. Studies suggest associations between environmental contaminants and some anomalies, although evidence is limited. Methods We used data from the California Center of the National Birth Defects Prevention Study and the Children's Health and Air Pollution Study to estimate the odds of 27 congenital heart defects with respect to quartiles of 7 ambient air pollutant and traffic exposures in California during the first two months of pregnancy, 1997–2006 (N=813 cases and N=828 controls). Results Particulate matter <10 microns (PM10) was associated with pulmonary valve stenosis (aOR4th Quartile=2.6; 95% CI: 1.2, 5.7) and perimembranous ventricular septal defects (aOR3rd Quartile=2.1; 95% CI: 1.1, 3.9) after adjusting for maternal race-ethnicity, education and multivitamin use. PM2.5 was associated with transposition of the great arteries (aOR3rd Quartile=2.6; 95% CI: 1.1, 6.5) and inversely associated with perimembranous ventricular septal defects (aOR4th Quartile=0.5; 95% CI: 0.2, 0.9). Secundum atrial septal defects were inversely associated with carbon monoxide (aOR4th Quartile=0.4; 95% CI: 0.2, 0.8) and PM2.5 (aOR4th Quartile=0.5; 95% CI: 0.3, 0.8). Traffic density was associated with muscular ventricular septal defects (aOR4th Quartile=3.0, 95% CI: 1.2, 7.8) and perimembranous ventricular septal defects (aOR3rd Quartile =2.4; 95% CI: 1.3, 4.6), and inversely associated with transposition of the great arteries (aOR4th Quartile=0.3; 95% CI: 0.1, 0.8). Conclusions PM10 and traffic density may contribute to the occurrence of pulmonary valve stenosis and ventricular septal defects, respectively. The results were mixed for other pollutants and had little consistency with previous studies. PMID:23772934

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

PubMed

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

2013-12-01

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

All-Cause and Cause-Specific Mortality by Socioeconomic Status Among Employed Persons in 27 US States, 1984–1997

PubMed Central

Steenland, Kyle; Hu, Sherry; Walker, James

2004-01-01

Objectives. We investigated mortality differences according to socioeconomic status (SES) for employed persons in 27 states during 1984–1997. Methods. SES was determined for persons aged 35–64 years according to the “usual occupation” listed on their death certificates. We used US Census denominator data. Results. For all-cause mortality, rate ratios from lowest to highest SES quartile for men and women were 2.02, 1.69, 1.25, and 1.00 and 1.29, 1.01, 1.07, and 1.00, respectively. Percentage of all deaths attributable to being in the lowest 3 SES quartiles was 27%. Inverse SES gradients were strong for most major causes of death except breast cancer and colorectal cancer. Heart disease mortality for highest and lowest SES quartiles dropped 45% and 25%, respectively, between 1984 and 1997. Conclusions. Mortality differences by SES were sustained through the 1990s and are increasing for men. PMID:15249312

Increased glycemic variability and decrease of the postprandial glucose contribution to HbA1c in obese subjects across the glycemic continuum from normal glycemia to first time diagnosed diabetes.

PubMed

Fysekidis, Marinos; Cosson, Emmanuel; Banu, Isabela; Duteil, Régine; Cyrille, Chantal; Valensi, Paul

2014-12-01

The contribution of postprandial glycemia (PPG) to hyperglycemia has been shown to decrease as HbA1c increased in type 2 diabetic patients. This study aimed at examining, in a series of overweight/obese patients without known glycemic disorder, the contribution of PPG to a "relative" hyperglycemia (glucose values≥5.5 mmol/L) and the presence of glycemic variability according to HbA1c levels. Seventy overweight/obese inpatients (body mass index 35.2±6.8 kg/m2) without known glycemic disorder were included. Participants were classified according to an oral glucose tolerance test (according to the American Diabetes Association criteria) as patients with normoglycemia (n=33), with intermediate hyperglycemia (n=24) or diabetes (n=13). They were separated into HbA1c quartiles (Q1 to Q4). A 24 hour continuous glucose monitoring was used under a 1800 kcal diet and minimal physical activity. We assessed PPG contribution (3 hour period after each meal) to the "relative" 24 hour hyperglycemia (glucose values ≥5.5 mmol/L); the remaining time was considered as the fasting/post-absorptive period. HbA1c range was from 5.1% to 7.4% (32 to 57 mmol/mmol). From the lowest to the highest HbA1c quartile, the area under the curve (AUC) for the "relative" hyperglycemia presented a 17-fold increase for the fasting/post-absorptive (p<0.001) period and a 7-fold increase postprandially (p<0.001). The percent of PPG contribution to the "relative" hyperglycemia was calculated with the following formula [100×(postprandial 3 hour AUC-3 h AUC for a constant 5.5 mmol/L glycemia)/(total 24 h AUC-24 h AUC for constant 5. 5 mmol/L glycemia)] and decreased from Q1 to Q4 of HbA1c (81.2%, 66%, 65.8%, 57%; p<0.001). Increasing HbA1c quartiles were associated with higher daily mean blood glucose level (p<0.001) and higher levels of daily glucose variability indices, including mean amplitude of glycemic excursions (p<0.01). In overweight/obese patients, HbA1c was associated with lower PPG contribution to "relative" hyperglycemia and greater glycemic variability. The present findings support the importance of postprandial period in glycemic exposure even before the appearance of diabetes. Copyright © 2014 Elsevier Inc. All rights reserved.

Tinnitus after Simultaneous and Sequential Bilateral Cochlear Implantation.

PubMed

Ramakers, Geerte G J; Kraaijenga, Véronique J C; Smulders, Yvette E; van Zon, Alice; Stegeman, Inge; Stokroos, Robert J; Free, Rolien H; Frijns, Johan H M; Huinck, Wendy J; Van Zanten, Gijsbert A; Grolman, Wilko

2017-01-01

There is an ongoing global discussion on whether or not bilateral cochlear implantation should be standard care for bilateral deafness. Contrary to unilateral cochlear implantation, however, little is known about the effect of bilateral cochlear implantation on tinnitus. To investigate tinnitus outcomes 1 year after bilateral cochlear implantation. Secondarily, to compare tinnitus outcomes between simultaneous and sequential bilateral cochlear implantation and to investigate long-term follow-up (3 years). This study is a secondary analysis as part of a multicenter randomized controlled trial. Thirty-eight postlingually deafened adults were included in the original trial, in which the presence of tinnitus was not an inclusion criterion. All participants received cochlear implants (CIs) because of profound hearing loss. Nineteen participants received bilateral CIs simultaneously and 19 participants received bilateral CIs sequentially with an inter-implant interval of 2 years. The prevalence and severity of tinnitus before and after simultaneous and sequential bilateral cochlear implantation were measured preoperatively and each year after implantation with the Tinnitus Handicap Inventory (THI) and Tinnitus Questionnaire (TQ). The prevalence of preoperative tinnitus was 42% (16/38). One year after bilateral implantation, there was a median difference of -8 (inter-quartile range (IQR): -28 to 4) in THI score and -9 (IQR: -17 to -9) in TQ score in the participants with preoperative tinnitus. Induction of tinnitus occurred in five participants, all in the simultaneous group, in the year after bilateral implantation. Although the preoperative and also the postoperative median THI and TQ scores were higher in the simultaneous group, the median difference scores were equal in both groups. In the simultaneous group, tinnitus scores fluctuated in the 3 years after implantation. In the sequential group, four patients had an additional benefit of the second CI: a total suppression of tinnitus compared with their unilateral situation. While bilateral cochlear implantation can have a positive effect on preoperative tinnitus complaints, the induction of (temporary or permanent) tinnitus was also reported. Dutch Trial Register NTR1722.

Red Meat Intake and Risk of ESRD.

PubMed

Lew, Quan-Lan Jasmine; Jafar, Tazeen Hasan; Koh, Hiromi Wai Ling; Jin, Aizhen; Chow, Khuan Yew; Yuan, Jian-Min; Koh, Woon-Puay

2017-01-01

Randomized controlled trials suggest that protein restriction may retard the progression of CKD toward ESRD. However, the effects of dietary protein intake level and the food sources of dietary protein on the risk of ESRD in the general population remain unclear. We investigated these effects in the Singapore Chinese Health Study, a prospective population-based cohort that recruited 63,257 Chinese adults aged 45-74 years from 1993 to 1998. We collected habitual diet information via a validated semiquantitative food frequency questionnaire and identified ESRD via record linkage with a nationwide registry. In all, 951 cases of ESRD occurred over a mean follow-up of 15.5 years. Regarding total protein intake, compared with the lowest quartile, the three higher quartiles combined had a hazard ratio for ESRD of 1.24 (95% confidence interval [95% CI], 1.05 to 1.46), but the dose-dependent association across the quartiles was not statistically significant (P trend =0.16). Red meat intake strongly associated with ESRD risk in a dose-dependent manner (hazard ratio for highest quartile versus lowest quartile,1.40 [95% CI, 1.15 to 1.71; P trend <0.001]). Intake of poultry, fish, eggs, or dairy products did not associate with risk of ESRD. In substitution analysis, replacing one serving of red meat with other food sources of protein associated with a maximum relative risk reduction of 62.4% (95% CI, 33.1 to 78.9; P<0.01). Our study shows that red meat intake may increase the risk of ESRD in the general population and substituting alternative sources of protein may reduce the incidence of ESRD. Copyright © 2016 by the American Society of Nephrology.

A low arm and leg muscle mass to total body weight ratio is associated with an increased prevalence of metabolic syndrome: The Korea National Health and Nutrition Examination Survey 2010-2011.

PubMed

Kim, Yong Hwan; So, Wi-Young

2016-09-14

The aim of this study was to investigate the association between metabolic syndrome (MetS) and arm and leg muscle mass to total weight ratios in Korean adults. This was a randomized, controlled, cross-sectional study. Data from 2,383 adults (1,030 men and 1,353 women) were collected from the Korea National Health and Nutrition Examination Survey 2010-2011. Blood lipid profiles, blood pressure, and anthropometric characteristics, including weight, height, waist circumference, and muscle mass on dual energy X-ray absorptiometry (DXA), were evaluated in the participants. MetS was defined according to the criteria of the National Cholesterol Education Program Adult Treatment Panel III. The average mass of both arms and legs was determined using regional muscle analysis by DXA. Afterwards, the arm and leg muscle mass to total body weight ratio was determined and classified into 4 quartiles (i.e., quartile 1 [highest muscle ratio] to quartile 4 [lowest muscle ratio]). According to the arm muscle and leg muscle ratios, there was a higher prevalence of MetS in quartile 4 than in quartile 1 in both men and women. A low arm and leg muscle mass to body weight ratio was associated with a higher prevalence of MetS after adjusting for age, physical activity, frequency of smoking, and frequency of alcohol consumption. In conclusion, MetS patients demonstrated a lower arm and leg muscle mass to body weight ratio. Strength training for the lower and upper extremities is recommended because it can have a positive effect on MetS prevention.

Importance of Abnormal Chloride Homeostasis in Stable Chronic Heart Failure.

PubMed

Grodin, Justin L; Verbrugge, Frederik H; Ellis, Stephen G; Mullens, Wilfried; Testani, Jeffrey M; Tang, W H Wilson

2016-01-01

The aim of this analysis was to determine the long-term prognostic value of lower serum chloride in patients with stable chronic heart failure. Electrolyte abnormalities are prevalent in patients with chronic heart failure. Little is known regarding the prognostic implications of lower serum chloride. Serum chloride was measured in 1673 consecutively consented stable patients with a history of heart failure undergoing elective diagnostic coronary angiography. All patients were followed for 5-year all-cause mortality, and survival models were adjusted for variables that confounded the chloride-risk relationship. The average chloride level was 102 ± 4 mEq/L. Over 6772 person-years of follow-up, there were 547 deaths. Lower chloride (per standard deviation decrease) was associated with a higher adjusted risk of mortality (hazard ratio 1.29, 95% confidence interval 1.12-1.49; P < 0.001). Chloride levels net-reclassified risk in 10.4% (P = 0.03) when added to a multivariable model (with a resultant C-statistic of 0.70), in which sodium levels were not prognostic (P = 0.30). In comparison to those with above first quartile chloride (≥ 101 mEq/L) and sodium (≥ 138 meq/L), subjects with first quartile chloride had a higher adjusted mortality risk, whether they had first quartile sodium (hazard ratio 1.35, 95% confidence interval 1.08-1.69; P = 0.008) or higher (hazard ratio 1.43, 95% confidence interval 1.12-1.85; P = 0.005). However, subjects with first quartile sodium but above first quartile chloride had no association with mortality (P = 0.67). Lower serum chloride levels are independently and incrementally associated with increased mortality risk in patients with chronic heart failure. A better understanding of the biological role of serum chloride is warranted. © 2015 American Heart Association, Inc.

The Importance of Abnormal Chloride Homeostasis in Stable Chronic Heart Failure

PubMed Central

Grodin, Justin L.; Verbrugge, Frederik H.; Ellis, Stephen G.; Mullens, Wilfried; Testani, Jeffrey M.; Wilson Tang MD, W. H.

2015-01-01

Background The aim of this analysis was to determine the long-term prognostic value of lower serum chloride in patients with stable chronic heart failure. Electrolyte abnormalities are prevalent in patients with chronic heart failure. Little is known regarding the prognostic implications of lower serum chloride. Methods and Results Serum chloride was measured in 1,673 consecutively consented stable patients with a history of heart failure undergoing elective diagnostic coronary angiography. All patients were followed for 5-year all-cause mortality, and survival models were adjusted for variables that confounded the chloride-risk relationship. The average chloride level was 102±4 mEq/L. Over 6,772 person-years of follow-up, there were 547 deaths. Lower chloride (per standard deviation decrease) was associated with a higher adjusted risk of mortality (HR 1.29, 95%CI 1.12–1.49, P<0.001). Chloride levels net-reclassified risk in 10.4% (P=0.03) when added to a multivariable model (with a resultant C-statistic of 0.70), in which sodium levels were not prognostic (P=0.30). In comparison to those with above first quartile chloride (≥101 mEq/L) and sodium (≥138 meq/L), subjects with first quartile chloride had a higher adjusted mortality risk, whether they had first quartile sodium (HR 1.35, 95%CI 1.08–1.69, P=0.008) or higher (HR 1.43, 95%CI 1.12–1.85, P=0.005). However, subjects with first quartile sodium but above first quartile chloride had no association with mortality (P=0.67). Conclusions Lower serum chloride levels are independently and incrementally associated with increased mortality risk in patients with chronic heart failure. A better understanding of the biological role of serum chloride is warranted. PMID:26721916

Uric Acid Level Has a J-Shaped Association with Arterial Stiffness in Korean Postmenopausal Women.

PubMed

Lee, Hyungbin; Jung, Young-Hyo; Kwon, Yu-Jin; Park, Byoungjin

2017-11-01

Uric acid has been reported to function both as an oxidant or antioxidant depending on the context. A previous study in the Korean population reported a positive linear association between serum uric acid level and arterial stiffness in men, but little is known about how serum uric acid level is related to the risk of increased arterial stiffness in Korean postmenopausal women. We performed a cross-sectional study of 293 subjects who participated in a health examination program run by the health promotion center of Gangnam Severance Hospital between October 2007 and July 2010. High brachial-ankle pulse wave velocity was defined as a brachial-ankle pulse wave velocity of more than 1,450 cm/s. The odds ratios (ORs) for high brachial-ankle pulse wave velocity were calculated using multivariate logistic regression analysis across uric acid quartiles after adjusting for other indicators of cardiovascular risk. The 293 postmenopausal women were divided into quartiles according to uric acid level. The mean brachial-ankle pulse wave velocity values of each quartile were as follows: Q1, 1,474 cm/s; Q2, 1,375 cm/s; Q3, 1,422 cm/s; Q4, 1,528 cm/s. The second quartile was designated as the control group based on mean brachial-ankle pulse wave velocity value. Multivariate adjusted ORs (95% confidence intervals) for brachial-ankle pulse wave velocity across the uric acid quartiles were 2.642 (Q1, 1.095-6.3373), 1.00, 4.305 (Q3, 1.798-10.307), and 4.375 (Q4, 1.923-9.949), after adjusting for confounding variables. Serum uric acid level has a J-shaped association with arterial stiffness in Korean postmenopausal women.

Dietary B Vitamins and Serum C-Reactive Protein in Persons With Human Immunodeficiency Virus Infection: The Positive Living With HIV (POLH) Study.

PubMed

Poudel-Tandukar, Kalpana; Chandyo, Ram Krishna

2016-12-01

B vitamins may have beneficial roles in reducing inflammation; however, research on the role of B vitamins in inflammation among HIV-infected persons is lacking. This study assessed the association between B vitamins and serum C-reactive protein (CRP) concentrations in HIV-infected persons. A cross-sectional survey was conducted among 314 HIV-infected persons (180 men and 134 women) aged 18 to 60 years residing in the Kathmandu, Nepal. High-sensitive and regular serum CRP concentrations were measured by the latex agglutination nephelometry and latex agglutination turbidimetric method, respectively. Dietary intake was assessed using 2 nonconsecutive 24-hour dietary recalls. The relationships between B vitamins and serum CRP concentrations were assessed using multiple regression analysis. The multivariate-adjusted geometric mean of serum CRP concentrations was significantly decreased with an increasing B vitamins intake across quartiles of niacin (P for trend = .007), pyridoxine (P for trend = .042), and cobalamin (P for trend = .037) in men. In men, the mean serum CRP concentrations in the highest quartiles of niacin, pyridoxine, and cobalamin were 63%, 38%, and 58%, respectively, lower than that in the lowest quartile. In women, the mean serum CRP concentrations in the highest quartiles of riboflavin (P for trend = .084) and pyridoxine (P for trend = .093) were 37% and 47%, respectively, lower than that in the lowest quartile. High intake of niacin, pyridoxine, or cobalamin was independently associated with decreased serum CRP concentrations among HIV-infected men. Further prospective studies are warranted to confirm the role of B vitamins in inflammation among HIV-infected persons. © The Author(s) 2016.

Association between hypertension and chronic arsenic exposure in drinking water: a cross-sectional study in Bangladesh.

PubMed

Islam, Mohammad Rafiqul; Khan, Ismail; Attia, John; Hassan, Sheikh Mohammad Nazmul; McEvoy, Mark; D'Este, Catherine; Azim, Syed; Akhter, Ayesha; Akter, Shahnaz; Shahidullah, Sheikh Mohammad; Milton, Abul Hasnat

2012-12-07

Chronic arsenic exposure and its association with hypertension in adults are inconclusive and this cross-sectional study investigated the association. The study was conducted between January and July 2009 among 1,004 participants from 1,682 eligible women and men aged ≥30 years living in rural Bangladesh who had continuously consumed arsenic-contaminated drinking water for at least 6 months. Hypertension was defined as systolic blood pressure ≥140 mmHg (systolic hypertension) and diastolic blood pressure ≥90 mmHg (diastolic hypertension). Pulse pressure was calculated by deducting diastolic from systolic pressure and considered to be increased when the difference was ≥55 mmHg. The prevalence of hypertension was 6.6% (95% CI: 5.1-8.3%). After adjustment for other factors, no excess risk of hypertension was observed for arsenic exposure >50 μg/L or to that of arsenic exposure as quartiles or as duration. Arsenic concentration as quartiles and >50 μg/L did show a strong relationship with increased pulse pressure (adjusted OR: 3.54, 95% CI: 1.46-8.57), as did arsenic exposure for ≥10 years (adjusted OR: 5.25, 95% CI: 1.41-19.51). Arsenic as quartiles showed a dose response relationship with increased pulse pressure. Our study suggests an association between higher drinking water arsenic or duration and pulse pressure, but not hypertension.

Association between Hypertension and Chronic Arsenic Exposure in Drinking Water: A Cross-Sectional Study in Bangladesh

PubMed Central

Islam, Mohammad Rafiqul; Khan, Ismail; Attia, John; Hassan, Sheikh Mohammad Nazmul; McEvoy, Mark; D’Este, Catherine; Azim, Syed; Akhter, Ayesha; Akter, Shahnaz; Shahidullah, Sheikh Mohammad; Milton, Abul Hasnat

2012-01-01

Chronic arsenic exposure and its association with hypertension in adults are inconclusive and this cross-sectional study investigated the association. The study was conducted between January and July 2009 among 1,004 participants from 1,682 eligible women and men aged ≥30 years living in rural Bangladesh who had continuously consumed arsenic-contaminated drinking water for at least 6 months. Hypertension was defined as systolic blood pressure ≥140 mmHg (systolic hypertension) and diastolic blood pressure ≥90 mmHg (diastolic hypertension). Pulse pressure was calculated by deducting diastolic from systolic pressure and considered to be increased when the difference was ≥55 mmHg. The prevalence of hypertension was 6.6% (95% CI: 5.1–8.3%). After adjustment for other factors, no excess risk of hypertension was observed for arsenic exposure >50μg/L or to that of arsenic exposure as quartiles or as duration. Arsenic concentration as quartiles and >50 μg/L did show a strong relationship with increased pulse pressure (adjusted OR: 3.54, 95% CI: 1.46–8.57), as did arsenic exposure for ≥10 years (adjusted OR: 5.25, 95% CI: 1.41–19.51). Arsenic as quartiles showed a dose response relationship with increased pulse pressure. Our study suggests an association between higher drinking water arsenic or duration and pulse pressure, but not hypertension. PMID:23222207

Quantifying risk of early relapse in patients with first demyelinating events: Prediction in clinical practice.

PubMed

Spelman, Tim; Meyniel, Claire; Rojas, Juan Ignacio; Lugaresi, Alessandra; Izquierdo, Guillermo; Grand'Maison, Francois; Boz, Cavit; Alroughani, Raed; Havrdova, Eva; Horakova, Dana; Iuliano, Gerardo; Duquette, Pierre; Terzi, Murat; Grammond, Pierre; Hupperts, Raymond; Lechner-Scott, Jeannette; Oreja-Guevara, Celia; Pucci, Eugenio; Verheul, Freek; Fiol, Marcela; Van Pesch, Vincent; Cristiano, Edgardo; Petersen, Thor; Moore, Fraser; Kalincik, Tomas; Jokubaitis, Vilija; Trojano, Maria; Butzkueven, Helmut

2017-09-01

Characteristics at clinically isolated syndrome (CIS) examination assist in identification of patient at highest risk of early second attack and could benefit the most from early disease-modifying drugs (DMDs). To examine determinants of second attack and validate a prognostic nomogram for individualised risk assessment of clinical conversion. Patients with CIS were prospectively followed up in the MSBase Incident Study. Predictors of clinical conversion were analysed using Cox proportional hazards regression. Prognostic nomograms were derived to calculate conversion probability and validated using concordance indices. A total of 3296 patients from 50 clinics in 22 countries were followed up for a median (inter-quartile range (IQR)) of 1.92 years (0.90, 3.71). In all, 1953 (59.3%) patients recorded a second attack. Higher Expanded Disability Status Scale (EDSS) at baseline, first symptom location, oligoclonal bands and various brain and spinal magnetic resonance imaging (MRI) metrics were all predictors of conversion. Conversely, older age and DMD exposure post-CIS were associated with reduced rates. Prognostic nomograms demonstrated high concordance between estimated and observed conversion probabilities. This multinational study shows that age at CIS onset, DMD exposure, EDSS, multiple brain and spinal MRI criteria and oligoclonal bands are associated with shorter time to relapse. Nomogram assessment may be useful in clinical practice for estimating future clinical conversion.

The impact of early hyperglycaemia on children with traumatic brain injury.

PubMed

Fu, Yue-Qiang; Chong, Shu-Ling; Lee, Jan Hau; Liu, Cheng-Jun; Fu, Sheng; Loh, Tsee Foong; Ng, Kee Chong; Xu, Feng

2017-01-01

Hyperglycaemia is common amongst children with traumatic brain injury (TBI). We aim to investigate the association between early hyperglycaemia and poor clinical outcomes in children with moderate to severe TBI. We performed a retrospective study in a tertiary paediatric hospital between May 2012 and October 2014 of all patients with TBI who were aged <16 years with a Glasgow Coma Scale (GCS) of ≤13. The primary outcome was death. Secondary outcomes were 14 ventilation-free, 14 paediatric intensive care unit (PICU)-free and 28 hospital-free days. We defined hyperglycaemia as glucose >11.1 mmol/L (200 mg/dL). There were 109 patients with a median age of 54 months [inter-quartile range (IQR): 17-82]. Median glucose on arrival was 6.1 mmol/L (IQR: 5.2-9.8). Median GCS in our cohort was 8 (IQR: 6-12). Multivariate logistic regression demonstrated that initial hyperglycaemia [odds ratio (OR): 15.23; 95% confidence interval (CI): 3.74-62.00; P < 0.001], and GCS <8 (OR: 13.02; 95% CI: 2.31-73.33; P = 0.004) were risk factors for mortality. Multivariate linear regression showed that initial hyperglycaemia was a risk factor for reduced ventilation-free, PICU-free and hospital-free days. Early hyperglycaemia predicts for in-hospital mortality, reduced ventilation-free, PICU-free and hospital-free days in children with moderate to severe TBI.

Global Epidemiology of Amyotrophic Lateral Sclerosis: a Systematic Review of the Published Literature

PubMed Central

Chiò, A; Logroscino, G; Traynor, BJ; Collins, J; Simeone, JC; Goldstein, LA; White, LA

2014-01-01

Background Amyotrophic lateral sclerosis (ALS) is relatively rare, yet the economic and social burden is substantial. Having accurate incidence and prevalence estimates would facilitate efficient allocation of healthcare resources. Objective To provide a comprehensive and critical review of the epidemiologic literature on ALS. Methods MEDLINE and EMBASE (1995–2011) databases of population-based studies on ALS incidence and prevalence reporting quantitative data were analyzed. Data extracted included study location and time, design and data sources, case ascertainment methods, and incidence and/or prevalence rates. Medians and inter-quartile ranges (IQRs) were calculated, and ALS case estimates derived using 2010 population estimates. Results In all, 37 articles met inclusion criteria. In Europe, the median (IQR) incidence rate (/100,000 population) was 2.08 (1.47–2.43), corresponding to an estimated 15,355 (10,852–17,938) cases. Median (IQR) prevalence (/100,000 population) was 5.40 (4.06–7.89), or 39,863 (29,971–58,244) prevalent cases. Conclusions Disparity in rates among ALS incidence and prevalence studies may be due to differences in study design or true variations in population demographics, such as age, and geography, including environmental factors and genetic predisposition. Additional large-scale studies that use standardized case ascertainment methods are needed to more accurately assess the true global burden of ALS. PMID:23860588

[Health care waste management of potentially infectious medical waste by healthcare professionals in a private medical practice: a study of practices].

PubMed

Brunot, Alain; Thompson, Céline

2010-01-01

A cross-sectional study was conducted with a sample of 278 health professionals (GPs and specialists, dentists, physical therapists and nurses) in a private medical practice in Paris to study the medical waste management practices related to the production and disposal of potentially hazardous health care waste. With the exception of physical therapists, most professionals produced medical waste (72% to 96,2% according to occupation), with a monthly median of 3 liters (inter-quartile range 1-15 liters). All sharp objects and needles were separated and 91% of them eliminated via a specific process for that sector. These percentages were respectively 84% and 69% concerning contaminated waste that was neither needles or used for cutting. 48% of the professionals reported the existence of documents that could track the disposal of their medical waste. To improve practice, professionals cited collection on-site at the office (74%) and reliability of the contracted service provider to collect the waste (59%). The study showed that health professionals need information on the regulations regarding potentially infectious medical waste, in particular on the traceability of its elimination. They also noted the lack of clarity and precision with regard to the definition of risk of infection: 31,7% of professionals only declare the production of sharp or cutting waste without having specified criteria for risk of infection.

Processed Meat Intake Is Unfavorably and Fish Intake Favorably Associated with Semen Quality Indicators among Men Attending a Fertility Clinic123

PubMed Central

Afeiche, Myriam C.; Gaskins, Audrey J.; Williams, Paige L.; Toth, Thomas L.; Wright, Diane L.; Tanrikut, Cigdem; Hauser, Russ; Chavarro, Jorge E.

2014-01-01

Emerging literature suggests that men’s diets may affect spermatogenesis as reflected in semen quality indicators, but literature on the relation between meat intake and semen quality is limited. Our objective was to prospectively examine the relation between meat intake and indicators of semen quality. Men in subfertile couples presenting for evaluation at the Massachusetts General Hospital Fertility Center were invited to participate in an ongoing study of environmental factors and fertility. A total of 155 men completed a validated food-frequency questionnaire and subsequently provided 338 semen samples over an 18-mo period from 2007–2012. We used linear mixed regression models to examine the relation between meat intake and semen quality indicators (total sperm count, sperm concentration, progressive motility, morphology, and semen volume) while adjusting for potential confounders and accounting for within-person variability across repeat semen samples. Among the 155 men (median age: 36.1 y; 83% white, non-Hispanic), processed meat intake was inversely related to sperm morphology. Men in the highest quartile of processed meat intake had, on average, 1.7 percentage units (95% CI: −3.3, −0.04) fewer morphologically normal sperm than men in the lowest quartile of intake (P-trend = 0.02). Fish intake was related to higher sperm count and percentage of morphologically normal sperm. The adjusted mean total sperm count increased from 102 million (95% CI: 80, 131) in the lowest quartile to 168 million (95% CI: 136, 207) sperm in the highest quartile of fish intake (P-trend = 0.005). Similarly, the adjusted mean percentages of morphologically normal sperm for men in increasing quartiles of fish intake were 5.9 (95% CI: 5.0, 6.8), 5.3 (95% CI: 4.4, 6.3), 6.3 (95% CI: 5.2, 7.4), and 7.5 (95% CI: 6.5, 8.5) (P-trend = 0.01). Consuming fish may have a positive impact on sperm counts and morphology, particularly when consumed instead of processed red meats. PMID:24850626

Processed meat intake is unfavorably and fish intake favorably associated with semen quality indicators among men attending a fertility clinic.

PubMed

Afeiche, Myriam C; Gaskins, Audrey J; Williams, Paige L; Toth, Thomas L; Wright, Diane L; Tanrikut, Cigdem; Hauser, Russ; Chavarro, Jorge E

2014-07-01

Emerging literature suggests that men's diets may affect spermatogenesis as reflected in semen quality indicators, but literature on the relation between meat intake and semen quality is limited. Our objective was to prospectively examine the relation between meat intake and indicators of semen quality. Men in subfertile couples presenting for evaluation at the Massachusetts General Hospital Fertility Center were invited to participate in an ongoing study of environmental factors and fertility. A total of 155 men completed a validated food-frequency questionnaire and subsequently provided 338 semen samples over an 18-mo period from 2007-2012. We used linear mixed regression models to examine the relation between meat intake and semen quality indicators (total sperm count, sperm concentration, progressive motility, morphology, and semen volume) while adjusting for potential confounders and accounting for within-person variability across repeat semen samples. Among the 155 men (median age: 36.1 y; 83% white, non-Hispanic), processed meat intake was inversely related to sperm morphology. Men in the highest quartile of processed meat intake had, on average, 1.7 percentage units (95% CI: -3.3, -0.04) fewer morphologically normal sperm than men in the lowest quartile of intake (P-trend = 0.02). Fish intake was related to higher sperm count and percentage of morphologically normal sperm. The adjusted mean total sperm count increased from 102 million (95% CI: 80, 131) in the lowest quartile to 168 million (95% CI: 136, 207) sperm in the highest quartile of fish intake (P-trend = 0.005). Similarly, the adjusted mean percentages of morphologically normal sperm for men in increasing quartiles of fish intake were 5.9 (95% CI: 5.0, 6.8), 5.3 (95% CI: 4.4, 6.3), 6.3 (95% CI: 5.2, 7.4), and 7.5 (95% CI: 6.5, 8.5) (P-trend = 0.01). Consuming fish may have a positive impact on sperm counts and morphology, particularly when consumed instead of processed red meats. © 2014 American Society for Nutrition.

Dietary pattern, serum magnesium, ferritin, C-reactive protein and anaemia among older people.

PubMed

Xu, Xiaoyue; Hall, John; Byles, Julie; Shi, Zumin

2017-04-01

Epidemiological data of dietary patterns and anaemia among older Chinese remains extremely scarce. We examined the association between dietary patterns and anaemia in older Chinese, and to assess whether biomarkers of serum magnesium, C-reactive protein (CRP) and serum ferritin can mediate these associations. We analysed the 2009 China Health and Nutrition Survey data (2401 individuals aged ≥60 years for whom both dietary and biomarker data are available). Dietary data was obtained using 24 h-recall over three consecutive days. Fasting blood samples and anthropometry measurement were also collected. Factor analysis was used to identify dietary patterns. Factor scores representing dietary patterns were used in Poisson regression models to explore the association between each dietary pattern and anaemia. Of the 2401 participants, 18.9% had anaemia, 1.9% had anaemia related to inflammation (AI), and 1.3% had iron-deficiency anaemia (IDA). A traditional dietary pattern (high intake of rice, pork and vegetables) was positively associated with anaemia; a modern dietary pattern (high intake of fruit and fast food) was inversely associated with anaemia. Progressively lower magnesium and BMI levels were associated with increasing traditional dietary quartiles; while a progressively higher magnesium and BMI levels were associated with increasing modern dietary quartiles (p < 0.001). There were no significant differences (p > 0.05) in CRP and serum ferritin across quartiles for either dietary pattern. In the fully adjusted model, the prevalence ratio (PR) of anaemia, comparing the fourth quartile to the first quartile, was 1.75 (95% CI: 1.33; 2.29) for a traditional dietary pattern, and 0.89 (95% CI: 0.68; 1.16) for a modern dietary pattern. The association between dietary patterns and anaemia is mediated by serum magnesium. Traditional dietary pattern is associated with a higher prevalence of anaemia among older Chinese. Future studies need to examine whether correcting micronutrient deficiency (e.g. magnesium) by promoting overall healthy diet, rather than iron supplementation, is a suitable strategy for anaemia prevention in older Chinese people. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Rate of Second and Third Trimester Weight Gain and Preterm Delivery Among Underweight and Normal Weight Women.

PubMed

Sharma, Andrea J; Vesco, Kimberly K; Bulkley, Joanna; Callaghan, William M; Bruce, F Carol; Staab, Jenny; Hornbrook, Mark C; Berg, Cynthia J

2016-10-01

Objectives Low gestational weight gain (GWG) in the second and third trimesters has been associated with increased risk of preterm delivery (PTD) among women with a body mass index (BMI) < 25 mg/m(2). However, few studies have examined whether this association differs by the assumptions made for first trimester gain or by the reason for PTD. Methods We examined singleton pregnancies during 2000-2008 among women with a BMI < 25 kg/m(2) who delivered a live-birth ≥28 weeks gestation (n = 12,526). Women received care within one integrated health care delivery system and began prenatal care ≤13 weeks. Using antenatal weights measured during clinic visits, we interpolated GWG at 13 weeks gestation then estimated rate of GWG (GWGrate) during the second and third trimesters of pregnancy. We also estimated GWGrate using the common assumption of a 2-kg gain for all women by 13 weeks. We examined the covariate-adjusted association between quartiles of GWGrate and PTD (28-36 weeks gestation) using logistic regression. We also examined associations by reason for PTD [premature rupture of membranes (PROM), spontaneous labor, or medically indicated]. Results Mean GWGrate did not differ among term and preterm pregnancies regardless of interpolated or assumed GWG at 13 weeks. However, only with GWGrate estimated from interpolated GWG at 13 weeks, we observed a U-shaped relationship where odds of PTD increased with GWGrate in the lowest (OR 1.36, 95 % CI 1.10, 1.69) or highest quartile (OR 1.49, 95 % CI 1.20, 1.85) compared to GWGrate within the second quartile. Further stratifying by reason, GWGrate in the lowest quartile was positively associated with spontaneous PTD while GWGrate in the highest quartile was positively associated with PROM and medically indicated PTD. Conclusions Accurate estimates of first trimester GWG are needed. Common assumptions applied to all pregnancies may obscure the association between GWGrate and PTD. Further research is needed to fully understand whether these associations are causal or related to common antecedents.

Socioeconomic disparities and sexual dimorphism in neurotoxic effects of ambient fine particles on youth IQ: A longitudinal analysis

PubMed Central

Younan, Diana; Franklin, Meredith; Lurmann, Fred; Wu, Jun; Baker, Laura A.; Chen, Jiu-Chiuan

2017-01-01

Mounting evidence indicates that early-life exposure to particulate air pollutants pose threats to children’s cognitive development, but studies about the neurotoxic effects associated with exposures during adolescence remain unclear. We examined whether exposure to ambient fine particles (PM2.5) at residential locations affects intelligence quotient (IQ) during pre-/early- adolescence (ages 9–11) and emerging adulthood (ages 18–20) in a demographically-diverse population (N = 1,360) residing in Southern California. Increased ambient PM2.5 levels were associated with decreased IQ scores. This association was more evident for Performance IQ (PIQ), but less for Verbal IQ, assessed by the Wechsler Abbreviated Scale of Intelligence. For each inter-quartile (7.73 μg/m3) increase in one-year PM2.5 preceding each assessment, the average PIQ score decreased by 3.08 points (95% confidence interval = [-6.04, -0.12]) accounting for within-family/within-individual correlations, demographic characteristics, family socioeconomic status (SES), parents’ cognitive abilities, neighborhood characteristics, and other spatial confounders. The adverse effect was 150% greater in low SES families and 89% stronger in males, compared to their counterparts. Better understanding of the social disparities and sexual dimorphism in the adverse PM2.5–IQ effects may help elucidate the underlying mechanisms and shed light on prevention strategies. PMID:29206872

Ultra-processed food consumption and adiposity trajectories in a Brazilian cohort of adolescents: ELANA study.

PubMed

Cunha, Diana Barbosa; da Costa, Teresa Helena Macedo; da Veiga, Gloria Valeria; Pereira, Rosangela Alves; Sichieri, Rosely

2018-05-25

In Brazil, the increase in obesity rates has been accompanied by increased consumption of ultra-processed food (UPF). The objective of this paper was to evaluate body mass index (BMI) and body fat percentage (%BF) trajectories in adolescents over a 3-year follow-up according to the frequency of UPF consumption. Data of three consecutive years (2010, 2011, and 2012) were obtained from the Adolescent Nutritional Assessment Longitudinal Study (ELANA) that aimed to assess changes in anthropometric indicators of nutritional status, and 1035 adolescents enrolled in the 1st year of high school from six schools (four private and two public) in the metropolitan area of Rio de Janeiro, Brazil were included. At three follow-ups, they had their weights and heights measured. Body composition was measured at the first and second follow-ups. Mixed linear regression models were used to estimate BMI and %BF trajectories based on quartiles of UPF intake, adjusting for type of school, sex, physical activity, and underreporting. Compared to their counterparts in the 1st quartile, adolescents in the 4th quartile of UPF consumption had a lower daily intake of fruits, cooked vegetables, and raw vegetables and a higher intake of total sugar and physical activity levels (p < 0.001). There was an inverse association between UPF consumption and BMI both at baseline and at follow-up. Values for %BF followed the same trend. Adolescents in the 4th quartile had the greatest level of physical activity and lowest total energy intake. This study confirmed that greater intake of UPF is a marker of an unhealthy diet, but did not support the hypothesis of a high rate of change in BMI associated with greater UPF consumption, even after adjusting for physical activity.

Unconventional Natural Gas Development and Birth Outcomes in Pennsylvania, USA.

PubMed

Casey, Joan A; Savitz, David A; Rasmussen, Sara G; Ogburn, Elizabeth L; Pollak, Jonathan; Mercer, Dione G; Schwartz, Brian S

2016-03-01

Unconventional natural gas development has expanded rapidly. In Pennsylvania, the number of producing wells increased from 0 in 2005 to 3,689 in 2013. Few publications have focused on unconventional natural gas development and birth outcomes. We performed a retrospective cohort study using electronic health record data on 9,384 mothers linked to 10,946 neonates in the Geisinger Health System from January 2009 to January 2013. We estimated cumulative exposure to unconventional natural gas development activity with an inverse-distance squared model that incorporated distance to the mother's home; dates and durations of well pad development, drilling, and hydraulic fracturing; and production volume during the pregnancy. We used multilevel linear and logistic regression models to examine associations between activity index quartile and term birth weight, preterm birth, low 5-minute Apgar score and small size for gestational age birth, while controlling for potential confounding variables. In adjusted models, there was an association between unconventional natural gas development activity and preterm birth that increased across quartiles, with a fourth quartile odds ratio of 1.4 (95% confidence interval = 1.0, 1.9). There were no associations of activity with Apgar score, small for gestational age birth, or term birth weight (after adjustment for year). In a posthoc analysis, there was an association with physician-recorded high-risk pregnancy identified from the problem list (fourth vs. first quartile, 1.3 [95% confidence interval = 1.1, 1.7]). Prenatal residential exposure to unconventional natural gas development activity was associated with two pregnancy outcomes, adding to evidence that unconventional natural gas development may impact health.See Video Abstract at http://links.lww.com/EDE/B14.

A national study of socioeconomic status and tuberculosis rates by country of birth, United States, 1996-2005.

PubMed

Olson, Nicole A; Davidow, Amy L; Winston, Carla A; Chen, Michael P; Gazmararian, Julie A; Katz, Dolores J

2012-05-18

Tuberculosis (TB) in developed countries has historically been associated with poverty and low socioeconomic status (SES). In the past quarter century, TB in the United States has changed from primarily a disease of native-born to primarily a disease of foreign-born persons, who accounted for more than 60% of newly-diagnosed TB cases in 2010. The purpose of this study was to assess the association of SES with rates of TB in U.S.-born and foreign-born persons in the United States, overall and for the five most common foreign countries of origin. National TB surveillance data for 1996-2005 was linked with ZIP Code-level measures of SES (crowding, unemployment, education, and income) from U.S. Census 2000. ZIP Codes were grouped into quartiles from low SES to high SES and TB rates were calculated for foreign-born and U.S.-born populations in each quartile. TB rates were highest in the quartiles with low SES for both U.S.-born and foreign-born populations. However, while TB rates increased five-fold or more from the two highest to the two lowest SES quartiles among the U.S.-born, they increased only by a factor of 1.3 among the foreign-born. Low SES is only weakly associated with TB among foreign-born persons in the United States. The traditional associations of TB with poverty are not sufficient to explain the epidemiology of TB among foreign-born persons in this country and perhaps in other developed countries. TB outreach and research efforts that focus only on low SES will miss an important segment of the foreign-born population.

Glycemic control, cognitive function, and family support among middle-aged and older Hispanics with diabetes: The Hispanic Community Health Study/Study of Latinos.

PubMed

Strizich, Garrett; Kaplan, Robert C; González, Hector M; Daviglus, Martha L; Giachello, Aida L; Teng, Yanping; Lipton, Richard B; Grober, Ellen

2016-07-01

To examine among Hispanics in the U.S., a population with increased reliance on informal healthcare support structures, (1) the association between cognitive function and control of diabetes; and (2) whether this association is modified by family support. The Digit Symbol Substitution Test (DSST), word fluency, and learning and delayed recall components of the Spanish English Verbal Learning Test were administered to 1794 Hispanic adults aged 45-76years with diagnosed diabetes. An executive function index and global cognitive function index (GCFI) were derived. Uncontrolled diabetes (HbA1c⩾7% [53mmol/mol]) was compared across quartiles of cognitive function using multivariable logit models with interaction terms for cognitive function and family support. After adjustment, lower DSST scores were associated with uncontrolled diabetes (P=0.03). Family support modified the relationship between other measures of cognition and diabetes control (Pinteraction: 0.002, 0.09). Among individuals with low family support, as cognitive function declined, the odds of uncontrolled diabetes increased (P-trend across quartiles of the GCFI, 0.015). Among those with low family support, persons in the lowest quartile of global cognitive function were more than twice as likely to have uncontrolled diabetes as those in the highest performing quartile (OR=2.31; 95% CI: 1.17, 4.55). There was no similar effect among those with high family support. Family support may buffer the negative association between low cognitive functioning and diabetes control in US Hispanics/Latinos. Educational programs targeted at family members of middle-age and older persons with diabetes regardless of neurocognitive status may help improve population-level glycemic control. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Associations between serum ghrelin and knee symptoms, joint structures and cartilage or bone biomarkers in patients with knee osteoarthritis.

PubMed

Wu, J; Wang, K; Xu, J; Ruan, G; Zhu, Q; Cai, J; Ren, J; Zheng, S; Zhu, Z; Otahal, P; Ding, C

2017-09-01

The roles of ghrelin in knee osteoarthritis (OA) are unclear. This study aimed to examine cross-sectional associations of ghrelin with knee symptoms, joint structures and cartilage or bone biomarkers in patients with knee OA. This study included 146 patients with symptomatic knee OA. Serum levels of ghrelin and cartilage or bone biomarkers including cartilage oligomeric matrix protein (COMP), cross linked C-telopeptide of type I collagen (CTXI), cross linked N-telopeptide of type I collagen (NTXI), N-terminal procollagen III propeptide (PIIINP), and matrix metalloproteinase (MMP)-3, 10, 13 were measured using Enzyme-linked immunosorbent assay (ELISA). Knee symptoms were assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Infrapatellar fat pad (IPFP) volume, IPFP signal intensity alternation, cartilage defects, bone marrow lesions (BMLs) and effusion-synovitis were assessed using the (MRI). Osteophytes and joint space narrowing (JSN) were assessed using the Osteoarthritis Research Society International atlas. After adjustment for potential confounders, ghrelin quartiles were positively associated with knee symptoms including pain, stiffness, dysfunction and total score (quartile 4 vs 1: β 24.19, 95% CI 8.13-40.25). Ghrelin quartiles were also significantly associated with increased IPFP signal intensity alteration (quartile 4 vs 1: OR 3.57, 95% CI 1.55-8.25) and NTXI, PIIINP, MMP3 and MMP13. Ghrelin was not significantly associated with other joint structures and biomarkers. Serum levels of ghrelin were significantly associated with increased knee symptoms, IPFP signal intensity alteration and serum levels of MMP3, MMP13, NTXI and PIIINP, suggesting that ghrelin may have a role to play in knee OA. Copyright © 2017 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Relationship between metabolic syndrome and objective masticatory performance in a Japanese general population: The Suita study.

PubMed

Kikui, Miki; Ono, Takahiro; Kokubo, Yoshihiro; Kida, Momoyo; Kosaka, Takayuki; Yamamoto, Masaaki; Nokubi, Takashi; Watanabe, Makoto; Maeda, Yoshinobu; Miyamoto, Yoshihiro

2017-01-01

An association between metabolic syndrome (MetS) and periodontal status has recently been focused on. However, no study has investigated the relationship between the prevalence of MetS and the decline of masticatory performance. We aimed to clarify the relationship between MetS and objective masticatory performance using the standardized test food in a general urban Japanese population. We studied 1780 Japanese men and women (mean age, 66.5 years) using the Suita study. MetS was defined using the uniform definition proposed in the 2009 Joint Interim Statement. Masticatory performance was evaluated by a chewing test using gummy jelly. Prevalence of MetS among quartiles of masticatory performance was compared using multiple logistic regression analysis adjusting for sex, age, drinking and smoking status, and periodontal status evaluated by the Community Periodontal Index. Compared to the highest quartile of masticatory performance, the 2nd quartile showed a 1.46-fold increase in the prevalence of MetS (trend P=0.159). In addition, Analysis by age showed 1.67-, 1.90- and 1.74-fold increases in the prevalence of MetS in the 3rd, 2nd and 1st quartiles among individuals in their 70s, respectively (trend P=0.094). However, individuals in their 50s and 60s showed no significant relationship between masticatory performance and MetS. These findings suggested that masticatory performance are inversely associated with the prevalence of MetS independent of periodontal disease, especially in the elderly. Declines in objective masticatory performance might be associated with the prevalence of MetS, independent of periodontitis. Given our results, treatments aimed at maintaining and recovering masticatory performance may represent important dental care to mitigate the risk of MetS. Copyright © 2016 Elsevier Ltd. All rights reserved.

Low serum insulin-like growth factor-I (IGF-I) level is associated with increased risk of vascular dementia.

PubMed

Quinlan, Patrick; Horvath, Alexandra; Nordlund, Arto; Wallin, Anders; Svensson, Johan

2017-12-01

Insulin-like growth factor-I (IGF-I) is important for the adult brain, but little is known of the role of IGF-I in Alzheimeŕs disease (AD) or vascular dementia (VaD). A prospective study of 342 patients with subjective or objective mild cognitive impairment recruited at a single memory clinic. We determined whether serum IGF-I concentrations at baseline were associated with the risk of all-cause dementia, AD, or VaD. Patients developing mixed forms of AD and VaD were defined as suffering from VaD. The statistical analyses included Cox proportional hazards regression analysis. During the follow-up (mean 3.6 years), 95 (28%) of the patients developed all-cause dementia [AD, n=37 (11%) and VaD, n=42 (12%)]. Low as well as high serum IGF-I (quartile 1 or 4 vs. quartiles 2-3) did not associate with all-cause dementia [crude hazard ratio (HR) 1.30, 95% confidence interval (CI): 0.81-2.08 and crude HR 1.05, 95% CI: 0.63-1.75, respectively] or AD (crude HR 0.79, 95% CI: 0.35-1.79 and crude HR 0.94, 95% CI: 0.43-2.06, respectively]. In contrast, low serum IGF-I concentrations were associated with increased risk of VaD (quartile 1 vs. quartiles 2-3, crude HR 2.22, 95% CI: 1.13-4.36). The latter association remained significant also after adjustment for multiple covariates. In a memory clinic population, low serum IGF-I was a risk marker for subsequent VaD whereas low IGF-I did not associate with the risk of AD. High serum IGF-I was not related to the risk of conversion to dementia. Copyright © 2017 Elsevier Ltd. All rights reserved.

Insulin-like growth factor I, IGF-binding protein 3, and lung cancer risk in a prospective study of men in China.

PubMed

London, Stephanie J; Yuan, Jian-Min; Travlos, Gregory S; Gao, Yu-Tang; Wilson, Ralph E; Ross, Ronald K; Yu, Mimi C

2002-05-15

Insulin-like growth factor I (IGF-I) stimulates cell proliferation and inhibits apoptosis in the lung and other tissues by interacting with the IGF-I receptor. The major binding protein for IGF-I, insulin-like growth factor-binding protein 3 (IGFBP-3), modulates the effects of IGF-I but also inhibits cell growth and induces apoptosis independent of IGF-I and its receptor. In a prospective study of men in Shanghai, China, we examined the association between serum levels of IGF-I and IGFBP-3 and the subsequent risk of lung cancer. From 1986 to 1989, serum was collected from 18,244 men aged 45-64 years living in Shanghai without a history of cancer. We analyzed IGF-I and IGFBP-3 levels in serum from 230 case patients who developed incident lung cancer during follow-up and from 740 control subjects. Among 230 case patients and 659 matched control subjects, increased IGF-I levels were not associated with increased risk of lung cancer. However, for subjects in the highest quartile relative to the lowest quartile of IGFBP-3, the odds ratio (OR) for lung cancer, adjusted for smoking and IGF-I, was 0.50 (95% confidence interval [CI] = 0.25 to 1.02). When the analysis was restricted to ever smokers (184 case patients and 344 matched control subjects), the OR for lung cancer in men in the highest quartile of IGFBP-3 relative to those in the lowest quartile, adjusted for smoking and IGF-I, was 0.41 (95% CI = 0.18 to 0.92). In this prospective study of Chinese men, higher serum levels of IGF-I did not increase the risk of lung cancer. However, subjects with higher serum levels of IGFBP-3 were at reduced risk of lung cancer. This finding is consistent with experimental data that indicate that IGFBP-3 can inhibit cellular proliferation and induce apoptosis independent of IGF-I and the IGF-I receptor.

Future Extreme Event Vulnerability in the Rural Northeastern United States

NASA Astrophysics Data System (ADS)

Winter, J.; Bowen, F. L.; Partridge, T.; Chipman, J. W.

2017-12-01

Future climate change impacts on humans will be determined by the convergence of evolving physical climate and socioeconomic systems. Of particular concern is the intersection of extreme events and vulnerable populations. Rural areas of the Northeastern United States have experienced increased temperature and precipitation extremes, especially over the past three decades, and face unique challenges due to their physical isolation, natural resources dependent economies, and high poverty rates. To explore the impacts of future extreme events on vulnerable, rural populations in the Northeast, we project extreme events and vulnerability indicators to identify where changes in extreme events and vulnerable populations coincide. Specifically, we analyze future (2046-2075) maximum annual daily temperature, minimum annual daily temperature, maximum annual daily precipitation, and maximum consecutive dry day length for Representative Concentration Pathways (RCP) 4.5 and 8.5 using four global climate models (GCM) and a gridded observational dataset. We then overlay those projections with estimates of county-level population and relative income for 2060 to calculate changes in person-events from historical (1976-2005), with a focus on Northeast counties that have less than 250,000 people and are in the bottom income quartile. We find that across the rural Northeast for RCP4.5, heat person-events per year increase tenfold, far exceeding decreases in cold person-events and relatively small changes in precipitation and drought person-events. Counties in the bottom income quartile have historically (1976-2005) experienced a disproportionate number of heat events, and counties in the bottom two income quartiles are projected to experience a greater heat event increase by 2046-2075 than counties in the top two income quartiles. We further explore the relative contributions of event frequency, population, and income changes to the total and geographic distribution of climate change impacts on rural, vulnerable areas of the Northeast.

Has sclerostin a true endocrine metabolic action complementary to osteocalcin in older men?

PubMed

Confavreux, C B; Casey, R; Varennes, A; Goudable, J; Chapurlat, R D; Szulc, P

2016-07-01

The reported association between sclerostin and diabetes mellitus or abdominal fat may be biased by body size and bone mass. In older men, the association between serum sclerostin levels and metabolic syndrome lost significance after adjustment for bone mass. The association between sclerostin and energy metabolism needs further clarification. Sclerostin is associated with abdominal fat, but this relationship may be biased since both are associated with body size and bone mass. Osteocalcin is a bone-derived hormone regulating energy metabolism. We assessed the association between serum sclerostin and metabolic syndrome (MetS) accounting for whole body mineral content (BMC) and osteocalcin. We studied 694 men aged 51-85 who had serum osteocalcin and sclerostin measurements. Sclerostin was higher in 216 men with MetS compared with those without MetS (p < 0.005). Average sclerostin level increased significantly across the increasing number of MetS components. In multivariable models, higher sclerostin was associated with higher odds of MetS (odds ratio (OR) = 1.24/1 standard deviation (SD) increase [95 % confidence interval (95 % CI), 1.01-1.51]; p < 0.05). After further adjustment for BMC, the association of MetS with sclerostin lost significance, whereas that with osteocalcin remained significant. Men who were simultaneously in the highest sclerostin quartile and the lowest osteocalcin quartile had higher odds of MetS (OR = 2.14 [95 % CI, 1.15-4.18]; p < 0.05) vs. men being in the three lower sclerostin quartiles and three upper osteocalcin quartiles. After adjustment for whole body BMC, the association lost significance. Higher sclerostin level is associated with MetS severity; however, this association may be related to higher whole body BMC. The adjustment for BMC had no impact on the association between MetS and osteocalcin. Clinical cross-sectional studies do not elucidate the potential role of sclerostin in the regulation of energy metabolism and direct experimental approach is necessary.

Exposure amount and timing of solar irradiation during pregnancy and the risk of sensitization in children.

PubMed

Koh, Hyun Yong; Cho, Eunhae; Lee, So-Yeon; Kim, Woo Kyung; Park, Yong Mean; Kim, Jihyun; Ahn, Kangmo; Lee, Seung Won; Kim, Mi Ae; Hahm, Myung-Il; Chae, Yoomi; Lee, Kee-Jae; Kwon, Ho-Jang; Han, Man Yong

2018-04-01

Solar irradiation affects sensitization to aeroallergens and the prevalence of allergic diseases. Little is known, however, about how the time and amount of solar irradiation during pregnancy affects such risks in children. We aimed to find out how solar irradiation during pregnancy affects sensitization to aero-allergens and the prevalence of allergic diseases in children. This population-based cross-sectional study involved 7301 aged 6 years and aged 12 years children. Maternal exposure to solar irradiation during pregnancy was evaluated using data from weather stations closest to each child's birthplace. Monthly average solar irradiation during the second and third trimesters was calculated with rank by quartiles. Risks of allergic sensitization and allergic disease were estimated. Relative to the first (lowest) quartile, the adjusted odds ratio (aOR) for allergic sensitization in the fourth (highest) quartile was lowest within solar irradiation during pregnancy months 5-6 (aOR = 0.823, 95% CI 0.720-0.942, p < 0.05). During months 9-10, the aOR for allergic sensitization for the fourth was higher than the first quartile of solar irradiation (aOR = 1.167, 95% CI 1.022-1.333, p < 0.05). Similar results were observed when solar irradiation was analyzed as a continuous variable during months 5 (aOR = 0.975, 95% CI 0.962-0.989, p < 0.001) and month 9 (aOR = 1.018, 95% CI 1.004-1.031, p = 0.003). Increased solar irradiation during months 7-8 increased the risk of asthma (aOR = 1.309, 95% CI 1.024-1.674, p = 0.032). Maternal exposure to solar irradiation during the second trimester of pregnancy associated with reduced aeroallergen sensitization, whereas solar irradiation during the third trimester was related to increased sensitization to aeroallergens. Copyright © 2017 Japanese Society of Allergology. Production and hosting by Elsevier B.V. All rights reserved.

Relationship between blood levels of heavy metals and lung function based on the Korean National Health and Nutrition Examination Survey IV–V

PubMed Central

Leem, Ah Young; Kim, Se Kyu; Chang, Joon; Kang, Young Ae; Kim, Young Sam; Park, Moo Suk; Kim, Song Yee; Kim, Eun Young; Chung, Kyung Soo; Jung, Ji Ye

2015-01-01

Background Heavy metal exposure may contribute to inflammation in the lungs via increased oxidative stress, resulting in tissue destruction and obstructive lung function (OLF). In this study, we evaluated the relationship between lead and cadmium levels in blood, and lung function in the Korean population. Methods Pooled cross-sectional data from 5,972 subjects who participated in the Korean National Health and Nutrition Examination Survey 2008–2012 were used for this study. OLF was defined as forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) <0.7. Graphite-furnace atomic absorption spectrometry was used to measure levels of lead and cadmium in blood. Results Adjusted means for age, sex, body mass index, and smoking status in blood lead and cadmium levels were increased with age and were higher in men and current smokers. The FEV1/FVC ratio was lower in the highest quartile group of lead (78.4% vs 79.0%; P=0.025) and cadmium (78.3% vs 79.2%; P<0.001) concentrations, compared with those in the lowest quartile groups. Multiple linear regression demonstrated an inverse relationship between the FEV1/FVC ratio and concentrations of lead (estimated −0.002; P=0.007) and cadmium (estimated −0.005; P=0.001). Of the 5,972 subjects, 674 (11.3%) were classified into the OLF group. Among current smokers, the risk of OLF was higher in subjects in the highest quartile group of cadmium concentration than in those in the lowest quartile group (odds ratio 1.94; 95% confidence interval 1.06–3.57). Conclusion We demonstrated a significant association between the FEV1/FVC ratio and blood concentrations of lead and cadmium in the Korean population. The risk for OLF was elevated with increasing concentrations of cadmium among current smokers. PMID:26345298

Water-Quality Characteristics for Selected Sites Within the Milwaukee Metropolitan Sewerage District Planning Area, Wisconsin, February 2004-September 2005

USGS Publications Warehouse

Thomas, Judith C.; Lutz, Michelle A.; Bruce, Jennifer L.; Graczyk, David J.; Richards, Kevin D.; Krabbenhoft, David P.; Westenbroek, Stephen M.; Scudder, Barbara C.; Sullivan, Daniel J.; Bell, Amanda H.

2007-01-01

The Milwaukee Metropolitan Sewerage District (MMSD) Corridor Study is a three-phase project designed to improve the understanding of water resources in the MMSD planning area to assist managers and policy makers in their decisions. Phase I of the Study involved the compilation of existing data from multiple agencies into a single database. These data were analyzed to identify spatial, temporal, and technological gaps in the planning area, and were used to develop Phase II of the Study. Phase II, the subject of this report, involved an intensive data-collection effort by the U.S. Geological Survey (USGS) in cooperation with MMSD (from February, 2004, through September, 2005). This phase addressed the data gaps identified in Phase I and completed a baseline assessment of water quality for selected stream and harbor sites in the MMSD planning area. This baseline assessment included evaluations of surface-water chemistry and microbial concentrations in the streams and harbor sites; additionally, stream sites were evaluated for discharge, sediment chemistry, fish-tissue chemistry, habitat, and the quality of biological communities (including fish, macroinvertebrates, and algae). In all, data were collected at 15 stream and 6 harbor sites within the MMSD planning area, including manual sampling and analysis for more than 220 water-quality properties and constituents at all 21 sites, stream-discharge data for 14 stream sites, and automated water-quality sampling at 4 stream sites. A bioassessment during autumn 2004 included collection of biologic-community data and stream-habitat data at wadeable streams. Quartiles of Phase II aggregate bioassessment rankings were used to divide the 14 wadeable stream sites into four groups to investigate relations between bioassessment data and site characteristic and water-quality data. Quartile numbers reflect relative water quality: quartile 1 contained sites where the bioassessment data indicated the least-degraded water quality among those sampled, and quartile 4 contained sites that indicated the most-degraded water quality. Quartiles contained the following stream sites: Quartile 1: Milwaukee River near Cedarburg, Milwaukee River at Milwaukee, Jewel Creek, and Menomonee River at Menomonee Falls; Quartile 2: Willow Creek, Root River near Franklin, and Root River at Grange Avenue; Quartile 3: Menomonee River at Wauwatosa, Oak Creek, and Little Menomonee River; and Quartile 4: Honey Creek, Underwood Creek, Lincoln Creek, and Kinnickinnic River. Site characteristics (in this case, drainage area and land use) and selected water-quality data were summarized based on the four bioassessment quartiles to determine if there were relations with the aggregate bioassessment rankings. In general, sites having the largest drainage basins with the lowest proportion of urban land use were in quartile 1, and the smallest drainage basins with the highest proportion of urban land use were in quartile 4. Major ions, indicator organisms, and wastewater compounds generally had the lowest overall results in quartile 1 and highest overall results in quartile 4, with intermediate results in quartiles 2 and 3. Results for other constituent types (nutrients, mercury, pathogenic organisms, and bed sediment) were mixed, with results for some constituents decreasing from quartile 1 to quartile 4. Where sufficient Phase I data were available, summary statistics (including medians) for chemical and biological data were calculated, allowing some comparisons to be made between Phase I and Phase II data. Comparisons between Phase I and Phase II results indicated a variety of changes with respect to water quality. Concentrations of chloride, nitrate, chlorophyll a, total phosphorus in water; arsenic in bed sediment; and fish Index of Biotic Integrity ratings generally indicated declines in water quality. However, concentrations of total nitrogen, suspended sediment, and fecal coliform in water; some trace eleme

Southern Dietary Pattern is Associated With Hazard of Acute Coronary Heart Disease in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.

PubMed

Shikany, James M; Safford, Monika M; Newby, P K; Durant, Raegan W; Brown, Todd M; Judd, Suzanne E

2015-09-01

The association of overall diet, as characterized by dietary patterns, with risk of incident acute coronary heart disease (CHD) has not been studied extensively in samples including sociodemographic and regional diversity. We used data from 17 418 participants in Reasons for Geographic and Racial Differences in Stroke (REGARDS), a national, population-based, longitudinal study of white and black adults aged ≥45 years, enrolled from 2003 to 2007. We derived dietary patterns with factor analysis and used Cox proportional hazards regression to examine hazard of incident acute CHD events - nonfatal myocardial infarction and acute CHD death - associated with quartiles of consumption of each pattern, adjusted for various levels of covariates. Five primary dietary patterns emerged: Convenience, Plant-based, Sweets, Southern, and Alcohol and Salad. A total of 536 acute CHD events occurred over a median (interquartile range) 5.8 (2.1) years of follow-up. After adjustment for sociodemographics, lifestyle factors, and energy intake, highest consumers of the Southern pattern (characterized by added fats, fried food, eggs, organ and processed meats, and sugar-sweetened beverages) experienced a 56% higher hazard of acute CHD (comparing quartile 4 with quartile 1: hazard ratio, 1.56; 95% confidence interval, 1.17-2.08; P for trend across quartiles=0.003). Adding anthropometric and medical history variables to the model attenuated the association somewhat (hazard ratio, 1.37; 95% confidence interval, 1.01-1.85; P=0.036). A dietary pattern characteristic of the southern United States was associated with greater hazard of CHD in this sample of white and black adults in diverse regions of the United States. © 2015 American Heart Association, Inc.

Diagnostic Ability of Automated Pupillography in Glaucoma.

PubMed

Rao, Harsha L; Kadambi, Sujatha V; Mehta, Pooja; Dasari, Srilakshmi; Puttaiah, Narendra K; Pradhan, Zia S; Rao, Dhanraj A S; Shetty, Rohit

2017-05-01

To evaluate the diagnostic ability of automated pupillography measurements in glaucoma and study the effect of inter-eye asymmetry in glaucomatous damage on the diagnostic ability. In an observational, cross-sectional study, 47 glaucoma patients and 42 control subjects underwent automated pupillography using a commercially available device. Diagnostic abilities of the pupillary response measurements were evaluated using area under receiver operating characteristic (ROC) curves (AUC) and sensitivities at fixed specificities. Influence of inter-eye asymmetry in glaucoma [inter-eye mean deviation (MD) difference on visual fields (VF)] on the diagnostic ability of pupillography parameters was evaluated by ROC regression approach. The AUCs of automated pupillography parameters ranged from 0.60 (amplitude score with peripheral blue stimulus) to 0.82 (amplitude score with full field white stimulus, Amp-FF-W). Sensitivity at 95% specificity ranged between 5% (amplitude score with full field blue stimulus) and 45% (amplitude score with full field green stimulus). Inter-eye MD difference significantly affected the diagnostic performance of automated pupillography parameters (p < 0.05). AUCs of Amp-FF-W at inter-eye MD difference of 0 dB, 5 dB, 10 dB and 15 dB were 0.71, 0.80, 0.87 and 0.93, respectively, according to the regression model. The corresponding sensitivities at 95% specificity were 20%, 34%, 50% and 66%, respectively. The diagnostic abilities of even the best automated pupillography parameters were only moderate in glaucoma. The performance of these pupillography measurements in detecting glaucoma significantly increased with greater inter-eye asymmetry in the glaucomatous damage.

Oscillations, networks, and their development: MEG connectivity changes with age.

PubMed

Schäfer, Carmen B; Morgan, Benjamin R; Ye, Annette X; Taylor, Margot J; Doesburg, Sam M

2014-10-01

Magnetoencephalographic (MEG) investigations of inter-regional amplitude correlations have yielded new insights into the organization and neurophysiology of resting-state networks (RSNs) first identified using fMRI. Inter-regional MEG amplitude correlations in adult RSNs have been shown to be most prominent in alpha and beta frequency ranges and to express strong congruence with RSN topologies found using fMRI. Despite such advances, little is known about how oscillatory connectivity in RSNs develops throughout childhood and adolescence. This study used a novel fMRI-guided MEG approach to investigate the maturation of resting-state amplitude correlations in physiologically relevant frequency ranges within and among six RSNs in 59 participants, aged 6-34 years. We report age-related increases in inter-regional amplitude correlations that were largest in alpha and beta frequency bands. In contrast to fMRI reports, these changes were observed both within and between the various RSNs analyzed. Our results provide the first evidence of developmental changes in spontaneous neurophysiological connectivity in source-resolved RSNs, which indicate increasing integration within and among intrinsic functional brain networks throughout childhood, adolescence, and early adulthood. Copyright © 2014 Wiley Periodicals, Inc.

The association of ambient air pollution and traffic exposures with selected congenital anomalies in the San Joaquin Valley of California.

PubMed

Padula, Amy M; Tager, Ira B; Carmichael, Suzan L; Hammond, S Katharine; Lurmann, Frederick; Shaw, Gary M

2013-05-15

Congenital anomalies are a leading cause of infant mortality and are important contributors to subsequent morbidity. Studies suggest associations between environmental contaminants and some anomalies, although evidence is limited. We aimed to investigate whether ambient air pollutant and traffic exposures in early gestation contribute to the risk of selected congenital anomalies in the San Joaquin Valley of California, 1997-2006. Seven exposures and 5 outcomes were included for a total of 35 investigated associations. We observed increased odds of neural tube defects when comparing the highest with the lowest quartile of exposure for several pollutants after adjusting for maternal race/ethnicity, education, and multivitamin use. The adjusted odds ratio for neural tube defects among those with the highest carbon monoxide exposure was 1.9 (95% confidence interval: 1.1, 3.2) compared with those with the lowest exposure, and there was a monotonic exposure-response across quartiles. The highest quartile of nitrogen oxide exposure was associated with neural tube defects (adjusted odds ratio = 1.8, 95% confidence interval: 1.1, 2.8). The adjusted odds ratio for the highest quartile of nitrogen dioxide exposure was 1.7 (95% confidence interval: 1.1, 2.7). Ozone was associated with decreased odds of neural tube defects. Our results extend the limited body of evidence regarding air pollution exposure and adverse birth outcomes.

Relationship between estimated glomerular filtration rate, albuminuria, and oxidant status in the Japanese population

PubMed Central

2013-01-01

Background In the general population, reported levels of oxidative stress and antioxidant potential seem to vary. The aim of this study was to investigate the levels of oxidant status markers in relation to estimated glomerular filtration rate (eGFR) and albuminuria in Japanese population. Methods Data were analyzed from 8335 individuals who underwent a general health screening test. For the estimation of albuminuria, urinary albumin-to-creatinine ratio (UAER) was calculated. Oxidant status was determined by assessing derivatives of reactive oxygen metabolites (d-ROMs) and biological antioxidant potential (BAP). Results After adjusting for age, high blood pressure, depressor agent use, CRP, smoking status, multivariate logistic regression analysis showed that the lowest eGFR quartile was associated negatively with the top d-ROM quartile in men (odds ratio 0.78 [95% CI 0.62-0.98, P = 0.034]) and the highest UAER was associated with the top d-ROM in men (odds ratio 1.68) [95% CI 1.35-2.10, P < 0.001]. In addition, both the first eGFR quartile and the fourth UAER quartile showed significant positive association with low BAP levels in men, but not in women. Conclusions Among men who underwent general health screening, lower eGFR and increased albuminuria was negatively and positively, respectively, associated with higher oxidative stress levels, whereas both conditions were positively associated with lower antioxidant potential levels. PMID:24016221

The Association of Ambient Air Pollution and Traffic Exposures With Selected Congenital Anomalies in the San Joaquin Valley of California

PubMed Central

Padula, Amy M.; Tager, Ira B.; Carmichael, Suzan L.; Hammond, S. Katharine; Lurmann, Frederick; Shaw, Gary M.

2013-01-01

Congenital anomalies are a leading cause of infant mortality and are important contributors to subsequent morbidity. Studies suggest associations between environmental contaminants and some anomalies, although evidence is limited. We aimed to investigate whether ambient air pollutant and traffic exposures in early gestation contribute to the risk of selected congenital anomalies in the San Joaquin Valley of California, 1997–2006. Seven exposures and 5 outcomes were included for a total of 35 investigated associations. We observed increased odds of neural tube defects when comparing the highest with the lowest quartile of exposure for several pollutants after adjusting for maternal race/ethnicity, education, and multivitamin use. The adjusted odds ratio for neural tube defects among those with the highest carbon monoxide exposure was 1.9 (95% confidence interval: 1.1, 3.2) compared with those with the lowest exposure, and there was a monotonic exposure-response across quartiles. The highest quartile of nitrogen oxide exposure was associated with neural tube defects (adjusted odds ratio = 1.8, 95% confidence interval: 1.1, 2.8). The adjusted odds ratio for the highest quartile of nitrogen dioxide exposure was 1.7 (95% confidence interval: 1.1, 2.7). Ozone was associated with decreased odds of neural tube defects. Our results extend the limited body of evidence regarding air pollution exposure and adverse birth outcomes. PMID:23538941

Waist circumference as a marker for screening nonalcoholic fatty liver disease in obese adolescents

PubMed Central

Clemente, Ana Paula Grotti; Dal Molin, Bárbara; de Carvalho-Ferreira, Joana Pereira; Campos, Raquel Munhoz da Silveira; Ganen, Aline de Piano; Tock, Lian; de Mello, Marco Túlio; Dâmaso, Ana Raimunda

2016-01-01

Abstract Objective: To assess the relationship between the degree of waist circumference (WC) and nonalcoholic fatty liver disease (NAFLD) in obese adolescents of both genders, analyzed according to quartiles of WC. Methods: Cross-sectional study that involved 247 obese adolescents aged 12–19 years. Mean values of the nutritional parameters and serum analyses were compared with the groups using the independent t-test. Pearson correlation coefficient was used to determine the relationship of the parameters studied. Chi-square test for trend was used to determine the relationship between the prevalence of the NAFLD and WC quartile by gender. Results: NAFLD were presented in 60% of the study participants. Obese adolescents in the 3rd and 4th quartiles of WC presented higher prevalence of NAFLD when compared with that in the 1st quartile in both genders. The NAFLD patients had significantly higher values for body weight, BMI (body mass index), BAZ-score (BMI-for-age z-scores), total fat (% and kg), WC, visceral fat, insulin, insulin resistance index (HOMA-IR), aspartate aminotransferase and alanine aminotransferase, when compared with non-NAFLD obese adolescents. Conclusions: In conclusion, the results presented here suggest that an increase in WC can reliably predict the risk of NAFLD in obese adolescents. This is a low cost and easy-to-use tool that can help in screening in adolescents. PMID:26830602

Osteoprotegerin is associated with hip fracture incidence: the Tromso Study.

PubMed

Jørgensen, Lone; Hansen, John-Bjarne; Ahmed, Luai; Bjørnerem, Åshild; Emaus, Nina; Joakimsen, Ragnar; Mathiesen, Ellisiv; Størmer, Jan; Vik, Anders; Jacobsen, Bjarne K

2012-08-01

Osteoprotegerin (OPG) is a cytokine essential for the regulation of bone resorption, but large longitudinal studies on its relationship to fracture risk in humans are lacking. In this population-based study of 2740 men and 2857 post-menopausal women, it was examined whether serum OPG was associated with hip fracture incidence. The participants were followed for 15 years. Baseline measurements included height, weight and serum OPG, and information about lifestyle, prevalent diseases and use of medication. Men with OPG in the highest quartile were 2.79-fold [95% confidence interval (CI) 1.34-5.82] more likely to have a hip fracture during follow-up, compared with those with OPG in the lowest quartile (P-trend over OPG quartiles ≤ 0.001, after adjustments for age and other confounders). In women not using post-menopausal hormone therapy (HT), the risk of hip fracture was 1.64-fold higher (95% CI 0.94-2.86) in the highest quartile compared with the lowest OPG quartile (P-trend over OPG quartiles = 0.05). No relationship was found in post-menopausal women using HT (P-trend over OPG quartiles = 0.23). In men, OPG was positively associated with the incidence of hip fracture. In post-menopausal women not using HT a similar, but weaker, relationship was found.

Effects of particulate matter exposure on blood 5-hydroxymethylation: results from the Beijing truck driver air pollution study

PubMed Central

Sanchez-Guerra, Marco; Zheng, Yinan; Osorio-Yanez, Citlalli; Zhong, Jia; Chervona, Yana; Wang, Sheng; Chang, Dou; McCracken, John P; Díaz, Anaite; Bertazzi, Pier Alberto; Koutrakis, Petros; Kang, Choong-Min; Zhang, Xiao; Zhang, Wei; Byun, Hyang-Min; Schwartz, Joel; Hou, Lifang; Baccarelli, Andrea A

2015-01-01

Previous studies have reported epigenetic changes induced by environmental exposures. However, previous investigations did not distinguish 5-methylcytosine (5mC) from a similar oxidative form with opposite functions, 5-hydroxymethylcytosine (5hmC). Here, we measured blood DNA global 5mC and 5hmC by ELISA and used adjusted mixed-effects regression models to evaluate the effects of ambient PM10 and personal PM2.5 and its elemental components—black carbon (BC), aluminum (Al), calcium (Ca), potassium (K), iron (Fe), sulfur (S), silicon (Si), titanium (Ti), and zinc (Zn)—on blood global 5mC and 5hmC levels. The study was conducted in 60 truck drivers and 60 office workers in Beijing, China from The Beijing Truck Driver Air Pollution Study at 2 exams separated by one to 2 weeks. Blood 5hmC level (0.08%) was ∼83-fold lower than 5mC (6.61%). An inter-quartile range (IQR) increase in same-day PM10 was associated with increases in 5hmC of 26.1% in office workers (P = 0.004), 20.2% in truck drivers (P = 0.014), and 21.9% in all participants combined (P < 0.001). PM10 effects on 5hmC were increasingly stronger when averaged over 4, 7, and 14 d preceding assessment (up to 132.6% for the 14-d average in all participants, P < 0.001). PM10 effects were also significant after controlling for multiple testing (family-wise error rate; FWER < 0.05). 5hmC was not correlated with personal measures of PM2.5 and elemental components (FWER > 0.05). 5mC showed no correlations with PM10, PM2.5, and elemental components measures (FWER > 0.05). Our study suggests that exposure to ambient PM10 affects 5hmC over time, but not 5mC. This finding demonstrates the need to differentiate 5hmC and 5mC in environmental studies of DNA methylation. PMID:25970091

A prospective study of endothelial activation biomarkers, including plasma angiopoietin-1 and angiopoietin-2, in Kenyan women initiating antiretroviral therapy.

PubMed

Graham, Susan M; Rajwans, Nimerta; Tapia, Kenneth A; Jaoko, Walter; Estambale, Benson B A; McClelland, R Scott; Overbaugh, Julie; Liles, W Conrad

2013-06-04

HIV-1-related inflammation is associated with increased levels of biomarkers of vascular adhesion and endothelial activation, and may increase production of the inflammatory protein angiopoietin-2 (ANG-2), an adverse prognostic biomarker in severe systemic infection. We hypothesized that antiretroviral therapy (ART) initiation would decrease endothelial activation, reducing plasma levels of ANG-2. Antiretroviral-naïve Kenyan women with advanced HIV infection were followed prospectively. Endothelial activation biomarkers including soluble intercellular adhesion molecule-1 (ICAM-1), vascular adhesion molecule-1 (VCAM-1), and E-selectin, and plasma ANG-2 and angiopoietin-1 (ANG-1) were tested in stored plasma samples from 0, 6, and 12 months after ART initiation. We used Wilcoxon matched-pairs signed rank tests to compare endothelial activation biomarkers across time-points, generalized estimating equations to analyze associations with change in log10-transformed biomarkers after ART initiation, and Cox proportional-hazards regression to analyze associations with mortality. The 102 HIV-1-seropositive women studied had advanced infection (median CD4 count, 124 cells/μL). Soluble ICAM-1 and plasma ANG-2 levels decreased at both time-points after ART initiation, with concomitant increases in the beneficial protein ANG-1. Higher ANG-2 levels after ART initiation were associated with higher plasma HIV-1 RNA, oral contraceptive pill use, pregnancy, severe malnutrition, and tuberculosis. Baseline ANG-2 levels were higher among five women who died after ART initiation than among women who did not (median 2.85 ng/mL [inter-quartile range (IQR) 2.47-5.74 ng/mL] versus median 1.32 ng/mL [IQR 0.35-2.18 ng/mL], p = 0.01). Both soluble ICAM-1 and plasma ANG-2 levels predicted mortality after ART initiation. Biomarkers of endothelial activation decreased after ART initiation in women with advanced HIV-1 infection. Changes in plasma ANG-2 were associated with HIV-1 RNA levels over 12 months of follow-up. Soluble ICAM-1 and plasma ANG-2 levels represent potential biomarkers for adverse outcomes in advanced HIV-1 infection.

The Dose–Response Decrease in Heart Rate Variability: Any Association with the Metabolites of Polycyclic Aromatic Hydrocarbons in Coke Oven Workers?

PubMed Central

Deng, Huaxin; Zhang, Wangzhen; Kuang, Dan; Deng, Qifei; Dai, Xiayun; Lin, Dafeng; Huang, Suli; Xin, Lili; He, Yunfeng; Huang, Kun; He, Meian; Guo, Huan; Zhang, Xiaomin; Wu, Tangchun

2012-01-01

Background Air pollution has been associated with an increased risk of cardiopulmonary mortality and decreased heart rate variability (HRV). However, it is unclear whether coke oven emissions (COEs) and polycyclic aromatic hydrocarbons (PAHs) are associated with HRV. Objectives Our goal in the present study was to investigate the association of exposure to COEs and the urinary metabolite profiles of PAHs with HRV of coke oven workers. Methods We measured benzene soluble matter, carbon monoxide, sulfur dioxide, particulate matters, and PAHs at different workplaces of a coke oven plant. We determined 10 urinary PAH metabolites and HRV indices of 1333 workers using gas chromatography–mass spectrometry and a 3-channel digital Holter monitor, respectively. Results Our results showed that there was a significant COEs-related dose-dependent decrease in HRV, and an inverse relationship between the quartiles of urinary 2-hydroxynaphthalene and five HRV indices (p trend<0.01 for all). After adjustment for potential confounders, elevation per interquartile range (IQR) (1.81 µg/mmol creatinine) of urinary 2-hydroxynaphthalene was associated with a 5.46% (95% CI, 2.50–8.32) decrease in standard deviation of NN intervals (SDNN). As workers worked more years, SDNN gradually declined in the same quartiles of 2-hydroxynaphthalene levels (p trend = 1.40×10−4), especially in workers with the highest levels of 2-hydroxynaphthalene. Conclusions Occupational exposure to COEs is associated with a dose-response decrease in HRV. In particular, increased exposure to 2-hydroxynaphthalene is associated with significantly decreased HRV. Increase of working years and exposure levels has resulted in a gradual decline of HRV. PMID:23024753

The dose-response decrease in heart rate variability: any association with the metabolites of polycyclic aromatic hydrocarbons in coke oven workers?

PubMed

Li, Xiaohai; Feng, Yingying; Deng, Huaxin; Zhang, Wangzhen; Kuang, Dan; Deng, Qifei; Dai, Xiayun; Lin, Dafeng; Huang, Suli; Xin, Lili; He, Yunfeng; Huang, Kun; He, Meian; Guo, Huan; Zhang, Xiaomin; Wu, Tangchun

2012-01-01

Air pollution has been associated with an increased risk of cardiopulmonary mortality and decreased heart rate variability (HRV). However, it is unclear whether coke oven emissions (COEs) and polycyclic aromatic hydrocarbons (PAHs) are associated with HRV. Our goal in the present study was to investigate the association of exposure to COEs and the urinary metabolite profiles of PAHs with HRV of coke oven workers. We measured benzene soluble matter, carbon monoxide, sulfur dioxide, particulate matters, and PAHs at different workplaces of a coke oven plant. We determined 10 urinary PAH metabolites and HRV indices of 1333 workers using gas chromatography-mass spectrometry and a 3-channel digital Holter monitor, respectively. Our results showed that there was a significant COEs-related dose-dependent decrease in HRV, and an inverse relationship between the quartiles of urinary 2-hydroxynaphthalene and five HRV indices (p(trend)<0.01 for all). After adjustment for potential confounders, elevation per interquartile range (IQR) (1.81 µg/mmol creatinine) of urinary 2-hydroxynaphthalene was associated with a 5.46% (95% CI, 2.50-8.32) decrease in standard deviation of NN intervals (SDNN). As workers worked more years, SDNN gradually declined in the same quartiles of 2-hydroxynaphthalene levels (p(trend) = 1.40×10(-4)), especially in workers with the highest levels of 2-hydroxynaphthalene. Occupational exposure to COEs is associated with a dose-response decrease in HRV. In particular, increased exposure to 2-hydroxynaphthalene is associated with significantly decreased HRV. Increase of working years and exposure levels has resulted in a gradual decline of HRV.

Do Hospitals Performing Frequent Neuraxial Anesthesia for Hip and Knee Replacements Have Better Outcomes?

PubMed

Memtsoudis, Stavros G; Poeran, Jashvant; Zubizarreta, Nicole; Olson, Ashley; Cozowicz, Crispiana; Mörwald, Eva E; Mariano, Edward R; Mazumdar, Madhu

2018-06-07

Neuraxial anesthesia is increasingly recommended for hip/knee replacements as some studies show improved outcomes on the individual level. With hospital-level studies lacking, we assessed the relationship between hospital-level neuraxial anesthesia utilization and outcomes. National data on 808,237 total knee and 371,607 hip replacements were included (Premier Healthcare 2006 to 2014; 550 hospitals). Multivariable associations were measured between hospital-level neuraxial anesthesia volume (subgrouped into quartiles) and outcomes (respiratory/cardiac complications, blood transfusion/intensive care unit need, opioid utilization, and length/cost of hospitalization). Odds ratios (or percent change) and 95% CI are reported. Volume-outcome relationships were additionally assessed by plotting hospital-level neuraxial anesthesia volume against predicted hospital-specific outcomes; trend tests were applied with trendlines' R statistics reported. Annual hospital-specific neuraxial anesthesia volume varied greatly: interquartile range, 3 to 78 for hips and 6 to 163 for knees. Increasing frequency of neuraxial anesthesia was not associated with reliable improvements in any of the study's clinical outcomes. However, significant reductions of up to -14.1% (95% CI, -20.9% to -6.6%) and -15.6% (95% CI, -22.8% to -7.7%) were seen for hospitalization cost in knee and hip replacements, respectively, both in the third quartile of neuraxial volume. This coincided with significant volume effects for hospitalization cost; test for trend P < 0.001 for both procedures, R 0.13 and 0.41 for hip and knee replacements, respectively. Increased hospital-level use of neuraxial anesthesia is associated with lower hospitalization cost for lower joint replacements. However, additional studies are needed to elucidate all drivers of differences found before considering hospital-level neuraxial anesthesia use as a potential marker of quality.

Relationship between activated clotting time and ischemic or hemorrhagic complications: analysis of 4 recent randomized clinical trials of percutaneous coronary intervention.

PubMed

Brener, Sorin J; Moliterno, David J; Lincoff, A Michael; Steinhubl, Steven R; Wolski, Kathy E; Topol, Eric J

2004-08-24

Unfractionated heparin (UFH) is the most widely used antithrombin during percutaneous coronary intervention (PCI). Despite significant pharmacological and mechanical advancements in PCI, uncertainty remains about the optimal activated clotting time (ACT) for prevention of ischemic or hemorrhagic complications. We analyzed the outcome of all UFH-treated patients enrolled in 4 large, contemporary PCI trials with independent adjudication of ischemic and bleeding events. Of 9974 eligible patients, maximum ACT was available in 8369 (84%). The median ACT was 297 seconds (interquartile range 256 to 348 seconds). The incidence of death, myocardial infarction, or revascularization at 48 hours, by ACT quartile, was 6.2%, 6.8%, 6.0%, and 5.7%, respectively (P=0.40 for trend). Covariate-adjusted rate of ischemic complications was not correlated with maximal procedural ACT (continuous value, P=0.29). Higher doses of UFH (>5000 U, or up to 90 U/kg) were independently associated with higher rates of events. The incidence of major or minor bleeding at 48 hours, by ACT quartile, was 2.9%, 3.5%, 3.8%, and 4.0%, respectively (P=0.04 for trend). In a multivariable logistic model with a spline transformation for ACT, there was a linear increase in risk of bleeding as the ACT approached 365 seconds (P=0.01), which leveled off beyond that value. Increasing UFH weight-indexed dose was independently associated with higher bleeding rates (OR 1.04 [1.02 to 1.07] for each 10 U/kg, P=0.001). In patients undergoing PCI with frequent stent and potent platelet inhibition use, ACT does not correlate with ischemic complications and has a modest association with bleeding complications, driven mainly by minor bleeding. Lower values do not appear to compromise efficacy while increasing safety.

Associations of Conventional Echocardiographic Measures with Incident Heart Failure and Mortality: The Chronic Renal Insufficiency Cohort.

PubMed

Dubin, Ruth F; Deo, Rajat; Bansal, Nisha; Anderson, Amanda H; Yang, Peter; Go, Alan S; Keane, Martin; Townsend, Ray; Porter, Anna; Budoff, Matthew; Malik, Shaista; He, Jiang; Rahman, Mahboob; Wright, Jackson; Cappola, Thomas; Kallem, Radhakrishna; Roy, Jason; Sha, Daohang; Shlipak, Michael G

2017-01-06

Heart failure is the most frequent cardiac complication of CKD. Left ventricular hypertrophy is common and develops early in CKD, but studies have not adequately evaluated the association of left ventricular mass index with heart failure incidence among men and women with CKD. We evaluated echocardiograms of 2567 participants without self-reported heart failure enrolled in the Chronic Renal Insufficiency Cohort Study. Two-dimensional echocardiograms were performed at the year 1 study visit and interpreted at a central core laboratory. Left ventricular mass index was calculated using the linear method, indexed to height 2.7 , and analyzed using sex-specific quartiles. The primary outcomes of incident heart failure and all-cause mortality were adjudicated over a median of 6.6 (interquartile range, 5.7-7.6) years. Among 2567 participants, 45% were women, and 54% were nonwhite race; mean (SD) age was 59±11 years old, and mean eGFR was 44±17 ml/min per 1.73 m 2 . During a median follow-up period of 6.6 years, 262 participants developed heart failure, and 470 participants died. Compared with participants in the first quartile of left ventricular mass index, those in the highest quartile had higher rates of incident heart failure (hazard ratio, 3.96; 95% confidence interval, 1.96 to 8.02) and mortality (hazard ratio, 1.86; 95% confidence interval, 1.22 to 2.85), even after adjustment for B-type natriuretic peptide, troponin T, mineral metabolism markers, and other cardiovascular disease risk factors. Those in the lowest quartile of ejection fraction had higher rates of incident heart failure (hazard ratio, 3.01; 95% confidence interval, 1.94 to 4.67) but similar mortality rates (hazard ratio, 1.18; 95% confidence interval, 0.89 to 1.57) compared with those in the highest quartile. Diastolic dysfunction was not significantly associated with heart failure or death. Among persons with CKD and without history of cardiovascular disease, left ventricular mass index is strongly associated with incident heart failure, even after adjustment for major cardiovascular risk factors and biomarkers. Copyright © 2016 by the American Society of Nephrology.

Associations of Conventional Echocardiographic Measures with Incident Heart Failure and Mortality: The Chronic Renal Insufficiency Cohort

PubMed Central

Deo, Rajat; Bansal, Nisha; Anderson, Amanda H.; Yang, Peter; Go, Alan S.; Keane, Martin; Townsend, Ray; Porter, Anna; Budoff, Matthew; Malik, Shaista; He, Jiang; Rahman, Mahboob; Wright, Jackson; Cappola, Thomas; Kallem, Radhakrishna; Roy, Jason; Sha, Daohang; Shlipak, Michael G.

2017-01-01

Background and objectives Heart failure is the most frequent cardiac complication of CKD. Left ventricular hypertrophy is common and develops early in CKD, but studies have not adequately evaluated the association of left ventricular mass index with heart failure incidence among men and women with CKD. Design, setting, participants, & measurements We evaluated echocardiograms of 2567 participants without self–reported heart failure enrolled in the Chronic Renal Insufficiency Cohort Study. Two-dimensional echocardiograms were performed at the year 1 study visit and interpreted at a central core laboratory. Left ventricular mass index was calculated using the linear method, indexed to height2.7, and analyzed using sex-specific quartiles. The primary outcomes of incident heart failure and all-cause mortality were adjudicated over a median of 6.6 (interquartile range, 5.7–7.6) years. Results Among 2567 participants, 45% were women, and 54% were nonwhite race; mean (SD) age was 59±11 years old, and mean eGFR was 44±17 ml/min per 1.73 m2. During a median follow-up period of 6.6 years, 262 participants developed heart failure, and 470 participants died. Compared with participants in the first quartile of left ventricular mass index, those in the highest quartile had higher rates of incident heart failure (hazard ratio, 3.96; 95% confidence interval, 1.96 to 8.02) and mortality (hazard ratio, 1.86; 95% confidence interval, 1.22 to 2.85), even after adjustment for B–type natriuretic peptide, troponin T, mineral metabolism markers, and other cardiovascular disease risk factors. Those in the lowest quartile of ejection fraction had higher rates of incident heart failure (hazard ratio, 3.01; 95% confidence interval, 1.94 to 4.67) but similar mortality rates (hazard ratio, 1.18; 95% confidence interval, 0.89 to 1.57) compared with those in the highest quartile. Diastolic dysfunction was not significantly associated with heart failure or death. Conclusions Among persons with CKD and without history of cardiovascular disease, left ventricular mass index is strongly associated with incident heart failure, even after adjustment for major cardiovascular risk factors and biomarkers. PMID:28062676

Relationship Between Hospital Performance on a Patient Satisfaction Survey and Surgical Quality.

PubMed

Sacks, Greg D; Lawson, Elise H; Dawes, Aaron J; Russell, Marcia M; Maggard-Gibbons, Melinda; Zingmond, David S; Ko, Clifford Y

2015-09-01

The Centers for Medicare and Medicaid Services include patient experience as a core component of its Value-Based Purchasing program, which ties financial incentives to hospital performance on a range of quality measures. However, it remains unclear whether patient satisfaction is an accurate marker of high-quality surgical care. To determine whether hospital performance on a patient satisfaction survey is associated with objective measures of surgical quality. Retrospective observational study of participating American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) hospitals. We used data from a linked database of Medicare inpatient claims, ACS NSQIP, the American Hospital Association annual survey, and Hospital Compare from December 2, 2004, through December 31, 2008. A total of 103 866 patients older than 65 years undergoing inpatient surgery were included. Hospitals were grouped by quartile based on their performance on the Hospital Consumer Assessment of Healthcare Providers and Systems survey. Controlling for preoperative risk factors, we created hierarchical logistic regression models to predict the occurrence of adverse postoperative outcomes based on a hospital's patient satisfaction scores. Thirty-day postoperative mortality, major and minor complications, failure to rescue, and hospital readmission. Of the 180 hospitals, the overall mean patient satisfaction score was 68.0% (first quartile mean, 58.7%; fourth quartile mean, 76.7%). Compared with patients treated at hospitals in the lowest quartile, those at the highest quartile had significantly lower risk-adjusted odds of death (odds ratio = 0.85; 95% CI, 0.73-0.99), failure to rescue (odds ratio = 0.82; 95% CI, 0.70-0.96), and minor complication (odds ratio = 0.87; 95% CI, 0.75-0.99). This translated to relative risk reductions of 11.1% (P = .04), 12.6% (P = .02), and 11.5% (P = .04), respectively. No significant relationship was noted between patient satisfaction and either major complication or hospital readmission. Using a national sample of hospitals, we demonstrated a significant association between patient satisfaction scores and several objective measures of surgical quality. Our findings suggest that payment policies that incentivize better patient experience do not require hospitals to sacrifice performance on other quality measures.

Assessing Student Learning about the Earth through the InTeGrate Project

NASA Astrophysics Data System (ADS)

Gilbert, L. A.; Iverson, E. A. R.; Steer, D. N.; Birnbaum, S. J.; Manduca, C. A.

2016-12-01

InTeGrate, a five-year community-based project comprised of faculty in the sciences and other disciplines, educational specialists, and evaluation experts at diverse institutions, instills learning about Earth in the context of societal issues through teaching materials developed into 2-3 week modules or courses. Materials were tested by over 135 materials authors and faculty interested in using these materials in undergraduate courses at a range of institution types across the US in geoscience, engineering, humanities, and social science courses. To assess impact on student learning, the InTeGrate project has collected student work from over 4,600 students enrolled in courses using these materials. To evaluate the influence of the materials on learning gains related to geoscience literacy, a set of 8 multiple choice items were developed, tested, and then administered in the first and last week of class in approximately 180 courses. The items were developed by 14 community members with assessment expertise and address content and concepts in the Earth, Climate, Atmosphere, and Ocean Science literacy documents. In a sample of 2,023 paired first and last week responses, students exhibit a 10% normalized gain (equivalent to 1 point of a 12 point total) regardless of their initial score. Students in the lowest quartile at the beginning of the course demonstrate the highest gains (4th quartile gain of 1.8) versus the higher quartile where a ceiling effect is present. In addition, a free-response essay was administered in the last week of the course which tests students' understanding for how Earth system interactions influence people's ability to make decisions about global societal challenges. Analysis of these essays demonstrates a strong relationship between the InTeGrate content and the subject matter of the student essay. These preliminary findings suggest that the use of InTeGrate materials increases students' understanding of geoscience literacies and the materials give students a topical hook for connecting learning about Earth to societal challenges.

The TG/HDL Cholesterol Ratio Predicts All Cause Mortality in Women With Suspected Myocardial Ischemia A Report from the Women’s Ischemia Syndrome Evaluation (WISE)

PubMed Central

Bittner, Vera; Johnson, B. Delia; Zineh, Issam; Rogers, William J.; Vido, Diane; Marroquin, Oscar C.; Bairey-Merz, C. Noel; Sopko, George

2009-01-01

High triglycerides (TG) and low high density lipoprotein cholesterol (HDL-C) are important cardiovascular risk factors in women. The prognostic utility of the TG/HDL-C ratio, a marker for insulin resistance and small dense low density lipoprotein particles, is unknown among high risk women. Methods We studied 544 women without prior myocardial infarction or coronary revascularization, referred for clinically indicated coronary angiography and enrolled in the Women’s Ischemia Syndrome Evaluation (WISE). Fasting lipid profiles and detailed demographic and clinical data were obtained at baseline. Multi-variate Cox-proportional hazards models for all cause mortality and cardiovascular events (death, myocardial infarction, heart failure, stroke) over a median follow-up of 6 years were constructed using log TG/HDL-C ratio as a predictor variable and accounting for traditional cardiovascular risk factors. Results Mean age was 57±11 years, 84% were white, 55% hypertensive, 20% diabetic, 50% current or prior smokers. TG/HDL-C ranged from 0.3 to 18.4 (median 2.2, first quartile 0.35 to <1.4, fourth quartile 3.66–18.4). Deaths (n=33) and CV events (n=83) increased across TG/HDL-C quartiles (both p<0.05 for trend). TG/HDL-C was a strong independent predictor of mortality in models adjusted for age, race, smoking, hypertension, diabetes, and angiographic coronary disease severity (HR 1.95, 95% CI 1.05, 3.64, p=0.04). For cardiovascular events, the multivariate HR was 1.54 (95% CI 1.05, 2.22, p=0.03) when adjusted for demographic and clinical variables, but became non-significant when angiographic results were included. Conclusion Among women with suspected ischemia, the TG/HDL-C ratio is a powerful independent predictor of all cause mortality and cardiovascular events. PMID:19249427

Association of low baseline free thyroxin levels with progression of coronary artery calcification over 4 years in euthyroid subjects: the Kangbuk Samsung Health Study.

PubMed

Park, Hye-Jeong; Kim, Jihyun; Han, Eun Jin; Park, Se Eun; Park, Cheol-Young; Lee, Won-Young; Oh, Ki-Won; Park, Sung-Woo; Rhee, Eun-Jung

2016-06-01

Overt and subclinical hypothyroidism are risk factors for atherosclerosis and cardiovascular diseases. It is unclear whether thyroid hormone levels within the normal range are also associated with atherosclerosis measured by coronary artery calcium (CAC). This study aimed to examine the relationship between normal variations in thyroid function and changes in CAC. We conducted a 4-year retrospective study of 2173 apparently healthy men and women with normal thyroid hormone levels. Their free thyroxin (FT4), free triiodothyronin (FT3) and thyroid-stimulating hormone (TSH) levels were measured by electrochemiluminescent immunoassay. The CAC score (CACS) of each subject was measured by multidetector computed tomography in both 2010 and 2014. Progression of CAC was defined as a CACS change over 4 years > 0. The mean CACS changes over 4 years by quartiles of baseline FT4 level (lowest to highest) were 12·9, 8·43, 7·82 and 7·81 (P = 0·028). CAC progression was not significantly associated with either the baseline FT3 or TSH levels. The odds ratios (OR) for CAC progression over 4 years (highest vs lowest quartile for baseline FT4) were 0·647 (95% confidence interval (CI) 0·472-0·886) after adjustment for confounding factor, which were attenuated with further adjustment for lipid profiles, homoeostasis model assessment of insulin resistance, high-sensitivity C-reactive protein and hypertension [0·747 (95% CI 0·537-1·038)]. Quartiles of baseline FT3 or TSH level did not show any increased OR for CAC progression after adjustment for confounding factors. In this cohort of euthyroid men and women, a low baseline FT4 level was associated with a high risk of CACS progression over 4 years. © 2015 John Wiley & Sons Ltd.

The imperative of culture: a quantitative analysis of the impact of culture on workforce engagement, patient experience, physician engagement, value-based purchasing, and turnover.

PubMed

Owens, Katie; Eggers, Jim; Keller, Stephanie; McDonald, Audrey

2017-01-01

Current uncertainty for the future of the health care landscape is placing an increasing amount of pressure on leadership teams to be prepared to steer their organization forward in a number of potential directions. It is commonly recognized among health care leaders that culture will either enable or disable organizational success. However, very few studies empirically link culture to health care-specific performance outcomes. Nearly every health care organization in the US specifies its cultural aspirations through mission and vision statements and values. Ambitions of patient-centeredness, care for the community, workplace of choice, and world-class quality are frequently cited; yet, little definitive research exists to quantify the importance of building high-performing cultures. Our study examined the impact of cultural attributes defined by a culture index (Cronbach's alpha = 0.88) on corresponding performance with key health care measures. We mapped results of the culture index across data sets, compared results, and evaluated variations in performance among key indicators for leaders. Organizations that perform in the top quartile for our culture index statistically significantly outperformed those in the bottom quartile on all but one key performance indicator tested. The culture top quartile organizations outperformed every domain for employee engagement, physician engagement, patient experience, and overall value-based purchasing performance with statistical significance. Culture index top quartile performers also had a 3.4% lower turnover rate than the bottom quartile performers. Finally, culture index top quartile performers earned an additional 1% on value-based purchasing. Our findings demonstrate a meaningful connection between performance in the culture index and organizational performance. To best impact these key performance outcomes, health care leaders should pay attention to culture and actively steer workforce engagement in attributes that represent the culture index, such as treating patients as valued customers, having congruency between employee and organizational values, promoting employee pride, and encouraging the feeling that being a member of the organization is rewarding, in order to leverage culture as a competitive advantage.

The imperative of culture: a quantitative analysis of the impact of culture on workforce engagement, patient experience, physician engagement, value-based purchasing, and turnover

PubMed Central

Owens, Katie; Eggers, Jim; Keller, Stephanie; McDonald, Audrey

2017-01-01

Current uncertainty for the future of the health care landscape is placing an increasing amount of pressure on leadership teams to be prepared to steer their organization forward in a number of potential directions. It is commonly recognized among health care leaders that culture will either enable or disable organizational success. However, very few studies empirically link culture to health care-specific performance outcomes. Nearly every health care organization in the US specifies its cultural aspirations through mission and vision statements and values. Ambitions of patient-centeredness, care for the community, workplace of choice, and world-class quality are frequently cited; yet, little definitive research exists to quantify the importance of building high-performing cultures. Our study examined the impact of cultural attributes defined by a culture index (Cronbach’s alpha = 0.88) on corresponding performance with key health care measures. We mapped results of the culture index across data sets, compared results, and evaluated variations in performance among key indicators for leaders. Organizations that perform in the top quartile for our culture index statistically significantly outperformed those in the bottom quartile on all but one key performance indicator tested. The culture top quartile organizations outperformed every domain for employee engagement, physician engagement, patient experience, and overall value-based purchasing performance with statistical significance. Culture index top quartile performers also had a 3.4% lower turnover rate than the bottom quartile performers. Finally, culture index top quartile performers earned an additional 1% on value-based purchasing. Our findings demonstrate a meaningful connection between performance in the culture index and organizational performance. To best impact these key performance outcomes, health care leaders should pay attention to culture and actively steer workforce engagement in attributes that represent the culture index, such as treating patients as valued customers, having congruency between employee and organizational values, promoting employee pride, and encouraging the feeling that being a member of the organization is rewarding, in order to leverage culture as a competitive advantage. PMID:29355220

Dietary Inflammatory Index and Incidence of Cardiovascular Disease in the PREDIMED Study

PubMed Central

Garcia-Arellano, Ana; Ramallal, Raul; Ruiz-Canela, Miguel; Salas-Salvadó, Jordi; Corella, Dolores; Shivappa, Nitin; Schröder, Helmut; Hébert, James R.; Ros, Emilio; Gómez-Garcia, Enrique; Estruch, Ramon; Lapetra, José; Arós, Fernando; Fiol, Miquel; Serra-Majem, Lluis; Pintó, Xavier; Babio, Nancy; González, José I.; Fitó, Montse; Martínez, J. Alfredo; Martínez-González, Miguel A.

2015-01-01

Previous studies have reported an association between a more pro-inflammatory diet profile and various chronic metabolic diseases. The Dietary Inflammatory Index (DII) was used to assess the inflammatory potential of nutrients and foods in the context of a dietary pattern. We prospectively examined the association between the DII and the incidence of cardiovascular disease (CVD: myocardial infarction, stroke or cardiovascular death) in the PREDIMED (Prevención con Dieta Mediterránea) study including 7216 high-risk participants. The DII was computed based on a validated 137-item food frequency questionnaire. Multivariate-adjusted hazard ratios (HR) and 95% confidence intervals of CVD risk were computed across  quartiles of the DII where the lowest (most anti-inflammatory) quartile is the referent. Risk increased across the quartiles (i.e., with increasing inflammatory potential): HRquartile2 = 1.42 (95%CI = 0.97–2.09); HRquartile3 = 1.85 (1.27–2.71); and HRquartile4 = 1.73 (1.15–2.60). When fit as continuous the multiple-adjusted hazard ratio for each additional standard deviation of the DII was 1.22 (1.06–1.40). Our results provide direct prospective evidence that a pro-inflammatory diet is associated with a higher risk of cardiovascular clinical events. PMID:26035241

Association between urinary sodium excretion and uric acid, and its interaction on the risk of prehypertension among Chinese young adults.

PubMed

Wang, Yang; Hu, Jia-Wen; Qu, Peng-Fei; Wang, Ke-Ke; Yan, Yu; Chu, Chao; Zheng, Wen-Ling; Xu, Xian-Jing; Lv, Yong-Bo; Ma, Qiong; Gao, Ke; Yuan, Yue; Li, Hao; Yuan, Zu-Yi; Mu, Jian-Jun

2018-05-17

High uric acid (UA) level and high salt intake are reportedly associated with cardiovascular disease. This study investigated the association between UA and urinary sodium excretion, as well as its interaction on the risk of prehypertension. A total of 1869 participants without hypertension were recruited from a previously established cohort in Shaanxi Province, China. The participants were classified as normotensive or prehypertensive on the basis of their blood pressure. Increasing quartiles of sodium excretion were associated with high urinary UA/creatinine levels in prehypertensive participants. Estimated sodium excretion positively correlated with urinary UA/creatinine excretions in the prehypertensive group. In addition, the multivariate-adjusted odds ratios for prehypertension compared with normotension were 1.68 (1.27-2.22) for sodium excretion and 1.71 (1.21-2.42) for serum UA. Increasing sodium excretion and serum UA were associated with higher risk of prehypertension. Compared with the lowest quartiles, the highest sodium excretion and serum UA quartiles entailed 3.48 times greater risk of prehypertension. Sodium excretion is associated with urinary UA excretion in prehypertensive participants. The present study shows that high levels of salt intake and serum UA simultaneously are associated with a higher risk of prehypertension.

High and low body mass index may predict severe disease course in children with inflammatory bowel disease.

PubMed

Yerushalmy-Feler, Anat; Ben-Tov, Amir; Weintraub, Yael; Amir, Achiya; Galai, Tut; Moran-Lev, Hadar; Cohen, Shlomi

2018-04-24

Inflammatory bowel disease (IBD) has been historically associated with underweight and malnutrition. The impact of both underweight and obesity on the clinical course of IBD in adults is controversial. This study described the association between body mass index (BMI) at diagnosis to disease course in children with IBD. We reviewed the medical records of children with IBD from the database of the 'Dana-Dwek' Children's Hospital between 2010 and 2016. Demographic and anthropometric data were collected as were disease characteristics, course and therapy. Patients were categorized in quartiles according to BMI percentiles at diagnosis (Q1-Q4). Of 100 children who were identified, 62 had Crohn's disease (CD) and 38 had ulcerative colitis (UC). The median age (interquartile range, IQR) at diagnosis was 13.7 (range 11.9-15.2) years. The median (IQR) follow-up was 2.1 (1.2-3.8) years. At diagnosis, 46 children (46%) were in Q1, 20 (20%) in Q2, 19 (19%) in Q3 and 15 (15%) in Q4. Prolonged time to diagnosis was associated with BMI in Q1 and Q4, as well as high disease activity at diagnosis (p < .001). In a multivariate analysis, BMI in the lower and upper quartiles was associated with disease exacerbation (HR 3.212 and 4.651, respectively, p = .016) and anti-tumor necrosis factor (TNF) therapy (HR 4.489 and 3.972, respectively, p = .021). BMI in the lower and upper quartiles was associated with more severe disease course in children with IBD. BMI may serve as a simple and highly accessible predictor of pediatric IBD course and prognosis.

Hospital variation in time to defibrillation after in-hospital cardiac arrest.

PubMed

Chan, Paul S; Nichol, Graham; Krumholz, Harlan M; Spertus, John A; Nallamothu, Brahmajee K

2009-07-27

Delays to defibrillation are associated with worse survival after in-hospital cardiac arrest, but the degree to which hospitals vary in defibrillation response times and hospital predictors of delays remain unknown. Using hierarchical models, we evaluated hospital variation in rates of delayed defibrillation (>2 minutes) and its impact on survival among 7479 adult inpatients with cardiac arrests at 200 hospitals within the National Registry of Cardiopulmonary Resuscitation. Adjusted rates of delayed defibrillation varied substantially among hospitals (range, 2.4%-50.9%), with hospital-level effects accounting for a significant amount of the total variation in defibrillation delays after adjusting for patient factors. We found a 46% greater odds of patients with identical covariates getting delayed defibrillation at one randomly selected hospital compared with another. Among traditional hospital factors evaluated, however, only bed volume (reference category: <200 beds; 200-499 beds: odds ratio [OR], 0.62 [95% confidence interval {CI}, 0.48-0.80]; >or=500 beds: OR, 0.74 [95% CI, 0.53-1.04]) and arrest location (reference category: intensive care unit; telemetry unit: OR, 1.92 [95% CI, 1.65-2.22]; nonmonitored unit: OR, 1.90 [95% CI, 1.61-2.24]) were associated with differences in rates of delayed defibrillation. Wide variation also existed in adjusted hospital rates of survival to discharge (range, 5.3%-49.6%), with higher survival among hospitals in the top-performing quartile for defibrillation time (compared with the bottom quartile: OR for top quartile, 1.41 [95% CI, 1.11-1.77]). Rates of delayed defibrillation vary widely among hospitals but are largely unexplained by traditional hospital factors. Given its association with improved survival, future research is needed to better understand best practices in the delivery of defibrillation at top-performing hospitals.

Genetic Risk Prediction of Atrial Fibrillation

PubMed Central

Lubitz, Steven A.; Yin, Xiaoyan; Lin, Henry J.; Kolek, Matthew; Smith, J. Gustav; Trompet, Stella; Rienstra, Michiel; Rost, Natalia S.; Teixeira, Pedro L.; Almgren, Peter; Anderson, Christopher D.; Chen, Lin Y.; Engström, Gunnar; Ford, Ian; Furie, Karen L.; Guo, Xiuqing; Larson, Martin G.; Lunetta, Kathryn L.; Macfarlane, Peter W.; Psaty, Bruce M.; Soliman, Elsayed Z.; Sotoodehnia, Nona; Stott, David J.; Taylor, Kent D.; Weng, Lu-Chen; Yao, Jie; Geelhoed, Bastiaan; Verweij, Niek; Siland, Joylene E.; Kathiresan, Sekar; Roselli, Carolina; Roden, Dan; van der Harst, Pim; Darbar, Dawood; Jukema, J. Wouter; Melander, Olle; Rosand, Jonathan; Rotter, Jerome I.; Heckbert, Susan R.; Ellinor, Patrick T.; Alonso, Alvaro; Benjamin, Emelia J.

2017-01-01

Background Atrial fibrillation (AF) is common and has a substantial genetic basis. Identification of individuals at greatest AF risk could minimize the incidence of cardioembolic stroke. Methods To determine whether genetic data can stratify risk for development of AF, we examined associations between AF genetic risk scores and incident AF in five prospective studies comprising 18,919 individuals of European ancestry. We examined associations between AF genetic risk scores and ischemic stroke in a separate study of 509 ischemic stroke cases (202 cardioembolic [40%]) and 3,028 controls. Scores were based on 11 to 719 common variants (≥5%) associated with AF at P-values ranging from <1×10−3 to <1×10−8 in a prior independent genetic association study. Results Incident AF occurred in 1,032 (5.5%) individuals. AF genetic risk scores were associated with new-onset AF after adjusting for clinical risk factors. The pooled hazard ratio for incident AF for the highest versus lowest quartile of genetic risk scores ranged from 1.28 (719 variants; 95%CI, 1.13–1.46; P=1.5×10−4) to 1.67 (25 variants; 95%CI, 1.47–1.90; P=9.3×10−15). Discrimination of combined clinical and genetic risk scores varied across studies and scores (maximum C statistic, 0.629–0.811; maximum ΔC statistic from clinical score alone, 0.009–0.017). AF genetic risk was associated with stroke in age- and sex-adjusted models. For example, individuals in the highest quartile of a 127-variant score had a 2.49-fold increased odds of cardioembolic stroke, versus those in the lowest quartile (95%CI, 1.39–4.58; P=2.7×10−3). The effect persisted after excluding individuals (n=70) with known AF (odds ratio, 2.25; 95%CI, 1.20–4.40; P=0.01). Conclusions Comprehensive AF genetic risk scores were associated with incident AF beyond clinical AF risk factors, with magnitudes of risk comparable to other clinical risk factors, though offered small improvements in discrimination. AF genetic risk was also associated with cardioembolic stroke in age- and sex-adjusted analyses. Efforts to determine whether AF genetic risk may improve identification of subclinical AF or distinguish stroke mechanisms are warranted. PMID:27793994

Ambient air pollution and traffic exposures and congenital heart defects in the San Joaquin Valley of California.

PubMed

Padula, Amy M; Tager, Ira B; Carmichael, Suzan L; Hammond, S Katharine; Yang, Wei; Lurmann, Frederick; Shaw, Gary M

2013-07-01

Congenital anomalies are a leading cause of infant morbidity and mortality. Studies suggest associations between environmental contaminants and some anomalies, although evidence is limited. We used data from the California Center of the National Birth Defects Prevention Study and the Children's Health and Air Pollution Study to estimate the odds of 27 congenital heart defects with respect to quartiles of seven ambient air pollutant and traffic exposures in California during the first 2 months of pregnancy, 1997-2006 (n = 822 cases and n = 849 controls). Particulate matter < 10 microns (PM10 ) was associated with pulmonary valve stenosis [adjusted odds ratio (aOR)Fourth Quartile  = 2.6] [95% confidence intervals (CI) 1.2, 5.7] and perimembranous ventricular septal defects (aORThird Quartile  = 2.1) [95% CI 1.1, 3.9] after adjusting for maternal race/ethnicity, education and multivitamin use. PM2.5 was associated with transposition of the great arteries (aORThird Quartile  = 2.6) [95% CI 1.1, 6.5] and inversely associated with perimembranous ventricular septal defects (aORFourth Quartile  = 0.5) [95% CI 0.2, 0.9]. Secundum atrial septal defects were inversely associated with carbon monoxide (aORFourth Quartile  = 0.4) [95% CI 0.2, 0.8] and PM2.5 (aORFourth Quartile  = 0.5) [95% CI 0.3, 0.8]. Traffic density was associated with muscular ventricular septal defects (aORFourth Quartile  = 3.0) [95% CI 1.2, 7.8] and perimembranous ventricular septal defects (aORThird Quartile  = 2.4) [95% CI 1.3, 4.6], and inversely associated with transposition of the great arteries (aORFourth Quartile  = 0.3) [95% CI 0.1, 0.8]. PM10 and traffic density may contribute to the occurrence of pulmonary valve stenosis and ventricular septal defects, respectively. The results were mixed for other pollutants and had little consistency with previous studies. © 2013 John Wiley & Sons Ltd.

Linking Inter-Individual Variability in Functional Brain Connectivity to Cognitive Ability in Elderly Individuals

PubMed Central

Li, Rui; Yin, Shufei; Zhu, Xinyi; Ren, Weicong; Yu, Jing; Wang, Pengyun; Zheng, Zhiwei; Niu, Ya-Nan; Huang, Xin; Li, Juan

2017-01-01

Increasing evidence suggests that functional brain connectivity is an important determinant of cognitive aging. However, the fundamental concept of inter-individual variations in functional connectivity in older individuals is not yet completely understood. It is essential to evaluate the extent to which inter-individual variability in connectivity impacts cognitive performance at an older age. In the current study, we aimed to characterize individual variability of functional connectivity in the elderly and to examine its significance to individual cognition. We mapped inter-individual variability of functional connectivity by analyzing whole-brain functional connectivity magnetic resonance imaging data obtained from a large sample of cognitively normal older adults. Our results demonstrated a gradual increase in variability in primary regions of the visual, sensorimotor, and auditory networks to specific subcortical structures, particularly the hippocampal formation, and the prefrontal and parietal cortices, which largely constitute the default mode and fronto-parietal networks, to the cerebellum. Further, the inter-individual variability of the functional connectivity correlated significantly with the degree of cognitive relevance. Regions with greater connectivity variability demonstrated more connections that correlated with cognitive performance. These results also underscored the crucial function of the long-range and inter-network connections in individual cognition. Thus, individual connectivity–cognition variability mapping findings may provide important information for future research on cognitive aging and neurocognitive diseases. PMID:29209203

Ambulatory Pulse Wave Velocity Is a Stronger Predictor of Cardiovascular Events and All-Cause Mortality Than Office and Ambulatory Blood Pressure in Hemodialysis Patients.

PubMed

Sarafidis, Pantelis A; Loutradis, Charalampos; Karpetas, Antonios; Tzanis, Georgios; Piperidou, Alexia; Koutroumpas, Georgios; Raptis, Vasilios; Syrgkanis, Christos; Liakopoulos, Vasilios; Efstratiadis, Georgios; London, Gérard; Zoccali, Carmine

2017-07-01

Arterial stiffness and augmentation of aortic blood pressure (BP) measured in office are known cardiovascular risk factors in hemodialysis patients. This study examines the prognostic significance of ambulatory brachial BP, central BP, pulse wave velocity (PWV), and heart rate-adjusted augmentation index [AIx(75)] in this population. A total of 170 hemodialysis patients underwent 48-hour ambulatory monitoring with Mobil-O-Graph-NG during a standard interdialytic interval and followed-up for 28.1±11.2 months. The primary end point was a combination of all-cause death, nonfatal myocardial infarction, and nonfatal stroke. Secondary end points included: (1) all-cause mortality; (2) cardiovascular mortality; and (3) a combination of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, resuscitation after cardiac arrest, coronary revascularization, or hospitalization for heart failure. During follow-up, 37(21.8%) patients died and 46(27.1%) had cardiovascular events. Cumulative freedom from primary end point was similar for quartiles of predialysis-systolic BP (SBP), 48-hour peripheral-SBP, and central-SBP, but was progressively longer for increasing quartiles for 48-hour peripheral-diastolic BP and central-diastolic BP and shorter for increasing quartiles of 48-hour central pulse pressure (83.7%, 71.4%, 69.0%, 62.8% [log-rank P =0.024]), PWV (93.0%, 81.0%, 57.1%, 55.8% [log-rank P <0.001]), and AIx(75) (88.4%, 66.7%, 69.0%, 62.8% [log-rank P =0.014]). The hazard ratios for all-cause mortality, cardiovascular mortality, and the combined outcome were similar for quartiles of predialysis-SBP, 48-hour peripheral-SBP, and central-SBP, but were increasing with higher ambulatory PWV and AIx(75). In multivariate analysis, 48-hour PWV was the only vascular parameter independently associated with the primary end point (hazard ratios, 1.579; 95% confidence intervals, 1.187-2.102). Ambulatory PWV, AIx(75), and central pulse pressure are associated with increased risk of cardiovascular events and mortality, whereas office and ambulatory SBP are not. These findings further support that arterial stiffness is the prominent cardiovascular risk factor in hemodialysis. © 2017 American Heart Association, Inc.

Dialkyl phosphate urinary metabolites and chromosomal abnormalities in human sperm.

PubMed

Figueroa, Zaida I; Young, Heather A; Meeker, John D; Martenies, Sheena E; Barr, Dana Boyd; Gray, George; Perry, Melissa J

2015-11-01

The past decade has seen numerous human health studies seeking to characterize the impacts of environmental exposures, such as organophosphate (OP) insecticides, on male reproduction. Despite an extensive literature on OP toxicology, many hormone-mediated effects on the testes are not well understood. This study investigated environmental exposures to OPs and their association with the frequency of sperm chromosomal abnormalities (i.e., disomy) among adult men. Men (n=159) from a study assessing the impact of environmental exposures on male reproductive health were included in this investigation. Multi-probe fluorescence in situ hybridization (FISH) for chromosomes X, Y, and 18 was used to determine XX18, YY18, XY18 and total disomy in sperm nuclei. Urine was analyzed using gas chromatography coupled with mass spectrometry for concentrations of dialkyl phosphate (DAP) metabolites of OPs [dimethylphosphate (DMP); dimethylthiophosphate (DMTP); dimethyldithiophosphate (DMDTP); diethylphosphate (DEP); diethylthiophosphate (DETP); and diethyldithiophosphate (DEDTP)]. Poisson regression was used to model the association between OP exposures and disomy measures. Incidence rate ratios (IRRs) were calculated for each disomy type by exposure quartiles for most metabolites, controlling for age, race, BMI, smoking, specific gravity, total sperm concentration, motility, and morphology. A significant positive trend was seen for increasing IRRs by exposure quartiles of DMTP, DMDTP, DEP and DETP in XX18, YY18, XY18 and total disomy. A significant inverse association was observed between DMP and total disomy. Findings for total sum of DAP metabolites concealed individual associations as those results differed from the patterns observed for each individual metabolite. Dose-response relationships appeared nonmonotonic, with most of the increase in disomy rates occurring between the second and third exposure quartiles and without additional increases between the third and fourth exposure quartiles. This is the first epidemiologic study of this size to examine the relationship between environmental OP exposures and human sperm disomy outcomes. Our findings suggest that increased disomy rates were associated with specific DAP metabolites, suggesting that the impacts of OPs on testis function need further characterization in epidemiologic studies. Copyright © 2015 Elsevier Inc. All rights reserved.

Sex-specific association between serum uric acid and self-reported snoring in rural China: a cross-sectional study.

PubMed

Wang, Haoyu; Li, Zhao; Chen, Yintao; Ye, Ning; Wang, Pengbo; Sun, Yingxian

2017-12-01

Until now, information has been rare on the association of serum uric acid (SUA) with self-reported snoring. Therefore, the purpose of this study was to explore the sex-specific relationship between SUA and self-reported snoring in a general Chinese population. A large cross-sectional study of 10,912 participants aged ≥35 years old were recruited from rural areas of Liaoning Province in China during 2012 to 2013. SUA were divided into quartiles separated for males and females. Anthropometric measurements and blood biochemical indexes were examined according to standard protocols. Sleep duration and self-reported snoring status were investigated by trained personnel using a structured questionnaire. The prevalence of self-reported snoring was 37.9% (n = 2197) among females and 47.4% (n = 2420) among males, respectively. The proportion of self-reported snoring presented a significant linear increase across the quartile of SUA level in both sexes. In multivariate logistic regression analysis adjusted for possible confounders, the odds ratio (OR) for SUA with regard to self-reported snoring was significantly higher in females. The OR of self-reported snoring associated with per 1 SD increase in SUA was 1.208 (95%CI 1.118-1.305, P<0.001). The highest quartile of SUA (>293 μmol/L) conferred an independently increased risk for self-reported snoring with OR of 1.643 (95%CI 1.384-1.950, p < 0.001) compared to the lowest quartile of SUA (<209 μmol/L). However, there were no significant relationships between SUA and self-reported snoring among males in all the models. Our study showed that in rural China, SUA was positively correlated with an increased risk for self-reported snoring in females but not in males. The strong association of SUA levels with self-reported snoring in females emphasizes the necessity of stratifying the sex in investigations of self-reported snoring and encourages exploration of SUA as an effective clinical tool of self-reported snoring risk.

Systematic reviews need to consider applicability to disadvantaged populations: inter-rater agreement for a health equity plausibility algorithm

PubMed Central

2012-01-01

Background Systematic reviews have been challenged to consider effects on disadvantaged groups. A priori specification of subgroup analyses is recommended to increase the credibility of these analyses. This study aimed to develop and assess inter-rater agreement for an algorithm for systematic review authors to predict whether differences in effect measures are likely for disadvantaged populations relative to advantaged populations (only relative effect measures were addressed). Methods A health equity plausibility algorithm was developed using clinimetric methods with three items based on literature review, key informant interviews and methodology studies. The three items dealt with the plausibility of differences in relative effects across sex or socioeconomic status (SES) due to: 1) patient characteristics; 2) intervention delivery (i.e., implementation); and 3) comparators. Thirty-five respondents (consisting of clinicians, methodologists and research users) assessed the likelihood of differences across sex and SES for ten systematic reviews with these questions. We assessed inter-rater reliability using Fleiss multi-rater kappa. Results The proportion agreement was 66% for patient characteristics (95% confidence interval: 61%-71%), 67% for intervention delivery (95% confidence interval: 62% to 72%) and 55% for the comparator (95% confidence interval: 50% to 60%). Inter-rater kappa, assessed with Fleiss kappa, ranged from 0 to 0.199, representing very low agreement beyond chance. Conclusions Users of systematic reviews rated that important differences in relative effects across sex and socioeconomic status were plausible for a range of individual and population-level interventions. However, there was very low inter-rater agreement for these assessments. There is an unmet need for discussion of plausibility of differential effects in systematic reviews. Increased consideration of external validity and applicability to different populations and settings is warranted in systematic reviews to meet this need. PMID:23253632

Systematic reviews need to consider applicability to disadvantaged populations: inter-rater agreement for a health equity plausibility algorithm.

PubMed

Welch, Vivian; Brand, Kevin; Kristjansson, Elizabeth; Smylie, Janet; Wells, George; Tugwell, Peter

2012-12-19

Systematic reviews have been challenged to consider effects on disadvantaged groups. A priori specification of subgroup analyses is recommended to increase the credibility of these analyses. This study aimed to develop and assess inter-rater agreement for an algorithm for systematic review authors to predict whether differences in effect measures are likely for disadvantaged populations relative to advantaged populations (only relative effect measures were addressed). A health equity plausibility algorithm was developed using clinimetric methods with three items based on literature review, key informant interviews and methodology studies. The three items dealt with the plausibility of differences in relative effects across sex or socioeconomic status (SES) due to: 1) patient characteristics; 2) intervention delivery (i.e., implementation); and 3) comparators. Thirty-five respondents (consisting of clinicians, methodologists and research users) assessed the likelihood of differences across sex and SES for ten systematic reviews with these questions. We assessed inter-rater reliability using Fleiss multi-rater kappa. The proportion agreement was 66% for patient characteristics (95% confidence interval: 61%-71%), 67% for intervention delivery (95% confidence interval: 62% to 72%) and 55% for the comparator (95% confidence interval: 50% to 60%). Inter-rater kappa, assessed with Fleiss kappa, ranged from 0 to 0.199, representing very low agreement beyond chance. Users of systematic reviews rated that important differences in relative effects across sex and socioeconomic status were plausible for a range of individual and population-level interventions. However, there was very low inter-rater agreement for these assessments. There is an unmet need for discussion of plausibility of differential effects in systematic reviews. Increased consideration of external validity and applicability to different populations and settings is warranted in systematic reviews to meet this need.

The Systolic Blood Pressure Difference Between Arms and Cardiovascular Disease in the Framingham Heart Study

PubMed Central

Weinberg, Ido; Gona, Philimon; O’Donnell, Christopher J.; Jaff, Michael R.; Murabito, Joanne M.

2014-01-01

Background An increased inter-arm systolic blood pressure difference is an easily determined physical examination finding. The relationship between inter-arm systolic blood pressure difference and risk of future cardiovascular disease is uncertain. We described the prevalence and risk factor correlates of inter-arm systolic blood pressure difference in the Framingham Heart Study (FHS) original and offspring cohorts and examined the association between inter-arm systolic blood pressure difference and incident cardiovascular disease and all-cause mortality. Methods An increased inter-arm systolic blood pressure difference was defined as ≥10mmHg using the average of initial and repeat blood pressure measurements obtained in both arms. Participants were followed through 2010 for incident cardiovascular disease events. Multivariable Cox proportional hazards regression analyses were performed to investigate the effect of inter-arm systolic blood pressure difference on incident cardiovascular disease. Results We examined 3,390 (56.3% female) participants aged 40 years and older, free of cardiovascular disease at baseline, mean age of 61.1 years, who attended a FHS examination between 1991 and 1994 (original cohort) and from 1995 to 1998 (offspring cohort). The mean absolute inter-arm systolic blood pressure difference was 4.6 mmHg (range 0 to 78). Increased inter-arm systolic blood pressure difference was present in 317 (9.4%) participants. The median follow-up time was 13.3 years, during which time 598 participants (17.6%) experienced a first cardiovascular event including 83 (26.2%) participants with inter-arm systolic blood pressure difference ≥10 mmHg. Compared to those with normal inter-arm systolic blood pressure difference, participants with an elevated inter-arm systolic blood pressure difference were older (63.0 years vs. 60.9 years), had a greater prevalence of diabetes mellitus (13.3% vs. 7.5%,), higher systolic blood pressure (136.3 mmHg vs. 129.3 mmHg), and a higher total cholesterol level (212.1 mg/dL vs. 206.5 mg/dL). Inter-arm systolic blood pressure difference was associated with a significantly increased hazard of incident cardiovascular events in the multivariable adjusted model (hazard ratio 1.38, 95% CI, 1.09 to 1.75). For each 1-standard deviation unit increase in absolute interarm systolic blood pressure difference, the hazard ratio for incident cardiovascular events was 1.07 (CI, 1.00 to 1.14) in the fully-adjusted model. There was no such association with mortality (hazard ratio 1.02, 95% CI 0.76 to 1.38). Conclusions In this community-based cohort, an inter-arm systolic blood pressure difference is common and associated with a significant increased risk for future cardiovascular events, even when the absolute difference in arm systolic blood pressure is modest. These findings support research to expand clinical use of this simple measurement. PMID:24287007

Relationship of Iron Deficiency and Serum Ferritin Levels with Pulmonary Hypertension: The Jackson Heart Study.

PubMed

Jankowich, Matthew; Elston, Beth; Evans, Samuel K; Wu, Wen-Chih; Choudhary, Gaurav

2016-01-01

Iron deficiency is prevalent in idiopathic pulmonary arterial hypertension (IPAH), but whether iron deficiency or ferritin levels are associated with pulmonary hypertension (PH) in the general population is unknown. We performed a cross-sectional analysis of data on iron deficiency (exposure), and PH (pulmonary artery systolic pressure>40mmHg on echocardiogram) (outcome) on subjects with complete data on exposures and outcomes as well as covariates (n = 2,800) enrolled in the Jackson Heart Study, a longitudinal prospective observational cohort study of heart disease in African-Americans from Jackson, Mississippi. Iron deficiency was defined as a serum ferritin level < 15ng/mL (females); < 30ng/mL (males). We determined crude prevalence ratios (PRs) for PH in iron deficient versus non-iron deficient groups using modified Poisson regression modeling. We also analyzed the prevalence of PH by sex-specific quartiles of ferritin (Females ≤ 47ng/mL; > 47ng/mL- 95ng/mL; > 95ng/mL- 171ng/mL; > 171ng/mL; Males ≤ 110ng/mL; > 110ng/mL- 182ng/mL; > 182ng/mL- 294ng/mL; > 294ng/mL), using the same modeling technique with the lowest quartile as the referent. Median pulmonary artery systolic pressure was 27mmHg (interquartile range 23-31mmHg) in the study cohort. 147 subjects (5.2%) had PH and 140 (5.0%) had iron deficiency. However, of the 147 subjects with PH, only 4 were also iron deficient. The crude PH PR was 0.5 (95% CI 0.2-1.4) in iron-deficiency compared to non-deficient. In analysis by quartiles of ferritin, adjusting for age and sex, there was no evidence of association with PH in quartiles 2 (PR 1.1, 95% CI 0.7-1.6), 3 (PR 0.8, 95% CI 0.5-1.3), or 4 (PR 0.8, 95% CI 0.5-1.2) compared with quartile 1 (referent group, PR 1). Further analyses of the relationship between PH and ferritin as a log-transformed continuous variable or by quartiles of serum iron showed similar results. In the Jackson Heart Study, the prevalence of PH was similar in iron-deficient and non-iron deficient subjects. There was no evidence of association between ferritin (or serum iron) levels and PH. Iron deficiency has been associated with IPAH, a rare disorder. However, in a large community-based sample of African-Americans, there was no evidence that iron deficiency or low iron levels were associated with PH.

Pre-Antiretroviral Therapy Serum Selenium Concentrations Predict WHO Stages 3, 4 or Death but not Virologic Failure Post-Antiretroviral Therapy

PubMed Central

Shivakoti, Rupak; Gupte, Nikhil; Yang, Wei-Teng; Mwelase, Noluthando; Kanyama, Cecilia; Tang, Alice M.; Pillay, Sandy; Samaneka, Wadzanai; Riviere, Cynthia; Berendes, Sima; Lama, Javier R.; Cardoso, Sandra W.; Sugandhavesa, Patcharaphan; Semba, Richard D.; Christian, Parul; Campbell, Thomas B.; Gupta, Amita

2014-01-01

A case-cohort study, within a multi-country trial of antiretroviral therapy (ART) efficacy (Prospective Evaluation of Antiretrovirals in Resource Limited Settings (PEARLS)), was conducted to determine if pre-ART serum selenium deficiency is independently associated with human immunodeficiency virus (HIV) disease progression after ART initiation. Cases were HIV-1 infected adults with either clinical failure (incident World Health Organization (WHO) stage 3, 4 or death by 96 weeks) or virologic failure by 24 months. Risk factors for serum selenium deficiency (<85 μg/L) pre-ART and its association with outcomes were examined. Median serum selenium concentration was 82.04 μg/L (Interquartile range (IQR): 57.28–99.89) and serum selenium deficiency was 53%, varying widely by country from 0% to 100%. In multivariable models, risk factors for serum selenium deficiency were country, previous tuberculosis, anemia, and elevated C-reactive protein. Serum selenium deficiency was not associated with either clinical failure or virologic failure in multivariable models. However, relative to people in the third quartile (74.86–95.10 μg/L) of serum selenium, we observed increased hazards (adjusted hazards ratio (HR): 3.50; 95% confidence intervals (CI): 1.30–9.42) of clinical failure but not virologic failure for people in the highest quartile. If future studies confirm this relationship of high serum selenium with increased clinical failure, a cautious approach to selenium supplementation might be needed, especially in HIV-infected populations with sufficient or unknown levels of selenium. PMID:25401501

Association of sleep disturbances with cognitive impairment and depression in maintenance hemodialysis patients.

PubMed

Rodriguez, Luke; Tighiouart, Hocine; Scott, Tammy; Lou, Kristina; Giang, Lena; Sorensen, Eric; Weiner, Daniel E; Sarnak, Mark J

2013-01-01

There are few data on the relationship of sleep with measures of cognitive function and symptoms of depression in dialysis patients. We evaluated the relationship of sleep with cognitive function and symptoms of depression in 168 hemodialysis patients, using multivariable linear and logistic regression. Sleep disturbances were assessed using the sleep subscale battery of the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Health Experience Questionnaire. The cognitive battery assessed a broad range of functioning including global ability, verbal intelligence, supraspan learning, auditory retention, visual retention, attention/mental processing speed, visual construction/fluid reasoning and motor speed. Depressive symptoms were assessed using the Center for Epidemiological Studies of Depression (CESD) Scale, with depression indicated by a CESD score >16. Mean (SD) age of participants was 62 (17) years, 49% were women, 30% were African American and 33% had diabetes. There was no significant relationship between sleep score and performance on any neurocognitive test (p>0.13, for all multivariable analyses). The prevalence of depression increased from 16% in the highest quartile (best) of sleep score, to 31% in the lowest quartile (worst) of sleep score. In multivariable analyses, each 1 SD increase in sleep score was associated with a 2.18 (95% confidence interval, 1.07-3.29, p<0.001) lower CESD score. Results were consistent when considering individual components of both the CESD and sleep score. Disturbances in sleep are associated with symptoms of depression but not measures of cognitive function. Dialysis patients with disturbances in sleep should be screened for depression.

Salivary and serum cortisol levels in newborn infants.

PubMed

Forclaz, María V; Moratto, Eduardo; Pennisi, Alicia; Falco, Silvina; Olsen, Graciela; Rodríguez, Patricia; Papazian, Regina; Bergadá, Ignacio

2017-06-01

Given that serum cortisol level interpretation in newborn infants (NBIs) is hard, the objective of this study was to correlate baseline salivary and serum cortisol levels and to describe salivary cortisol levels in the first month of life. Descriptive, prospective, longitudinal, and correlational study. Term NBIs were selected from the Division of Neonatology of Hospital Nacional Profesor Alejandro Posadas in 2014. Cortisol was measured in saliva specimens while cortisol, cortisol-binding globulin, and albumin were measured in blood specimens. A linear correlation was performed to relate serum and salivary cortisol levels; Friedman test was conducted to compare cortisol levels during the first month of life, and the difference was used to analyze the performance of values equal to or lower than the first quartile. Fifty-five NBIs were studied. Serum cortisol: 7.65 (1.0-18.1 gg/dL); salivary cortisol: 35.88 (5.52-107.64 mmol/L); cortisol-binding globulin: 22.07 (16.5-33.0 gg/mL), expressed as median and range. The correlation coefficient between serum and salivary cortisol was 0.54, P = 0.001. Cortisol performance during the first month of life showed no statistically significant differences, and the difference between the second and the first specimen of values equal to or lower than the first quartile increased in 10 out of 12 patients. The measurement of cortisol in saliva reflects serum cortisol levels in normal NBIs. Some patients had low levels of cortisol at 36 hours of life and showed a trend towards a spontaneous increase during the first month of life.

Nickel exposure is associated with the prevalence of type 2 diabetes in Chinese adults.

PubMed

Liu, Gang; Sun, Liang; Pan, An; Zhu, Mingjiang; Li, Zi; ZhenzhenWang, Zhenzhen; Liu, Xin; Ye, Xingwang; Li, Huaixing; Zheng, He; Ong, Choon Nam; Yin, Huiyong; Lin, Xu; Chen, Yan

2015-02-01

Nickel exposure can induce hyperglycaemia in rodents, but little is known about its association with abnormal glucose metabolism in humans. We aimed to investigate the association of nickel exposure with the prevalence of type 2 diabetes in Chinese adults. A total of 2115 non-institutionalized men and women aged 55 to 76 years from Beijing and Shanghai were included, and urinary nickel concentration was assessed by inductively coupled plasma mass spectroscopy. The prevalence of type 2 diabetes was compared across urinary nickel quartiles. Fasting plasma glucose, insulin, lipids, C-reactive protein and glycated haemoglobin A1c, as well as urinary albumin and creatinine were measured. The median concentration of urinary nickel was 3.63 mg/l (interquartile range: 2.29–5.89 mg/l), and the prevalence of diabetes was 35.3% (747 cases/2115 persons). Elevated levels of urinary nickel were associated with higher fasting glucose, glycated haemoglobin A1c, insulin and homeostatic model assessment of insulin resistance (all P<0.01). The odds ratios (95% confidence interval) for diabetes across the increasing urinary nickel quartiles were 1.27 (0.97–1.67), 1.78 (1.36–2.32) and 1.68 (1.29–2.20), respectively (referencing to 1.00), after multivariate adjustment including lifestyle factors, body mass index and family history of diabetes (P for trend <0.001). The association remained unchanged after further controlling for urinary creatinine and C-reactive protein (P for trend <0.001). Increased urinary nickel concentration is associated with elevated prevalence of type 2 diabetes in humans.

Socio economic position in TB prevalence and access to services: results from a population prevalence survey and a facility-based survey in Bangladesh.

PubMed

Hossain, Shahed; Quaiyum, Mohammad Abdul; Zaman, Khalequ; Banu, Sayera; Husain, Mohammad Ashaque; Islam, Mohammad Akramul; Cooreman, Erwin; Borgdorff, Martien; Lönnroth, Knut; Salim, Abdul Hamid; van Leth, Frank

2012-01-01

In Bangladesh DOTS has been provided free of charge since 1993, yet information on access to TB services by different population group is not well documented. The objective of this study was to assess and compare the socio economic position (SEP) of actively detected cases from the community and the cases being routinely detected under National Tuberculosis Control Programme (NTP) in Bangladesh. SEP was assessed by validated asset item for each of the 21,427 households included in the national tuberculosis prevalence survey 2007-2009. A principal component analysis generated household scores and categorized in quartiles. The distribution of 33 actively identified cases was compared with the 240 NTP cases over the identical SEP quartiles to evaluate access to TB services by different groups of the population. The population prevalence of tuberculosis was 5 times higher in the lowest quartiles of population (95.4, 95% CI: 48.0-189.7) to highest quartile population (19.5, 95% CI: 6.9-55.0). Among the 33 cases detected during survey, 25 (75.8%) were from lower two quartiles, and the rest 8 (24.3%) were from upper two quartiles. Among TB cases detected passively under NTP, more than half of them 137 (57.1%) were from uppermost two quartiles, 98 (41%) from the second quartile, and 5 (2%) in the lowest quartile of the population. This distribution is not affected when adjusted for other factors or interactions among them. The findings indicate that despite availability free of charge, DOTS is not equally accessed by the poorer sections of the population. However, these figures should be interpreted with caution since there is a need for additional studies that assess in-depth poverty indicators and its determinants in relation to access of the TB services provided in Bangladesh.

The association of neighborhood characteristics with obesity and metabolic conditions in older women.

PubMed

Corriere, Mark D; Yao, W; Xue, Q L; Cappola, A R; Fried, L P; Thorpe, R J; Szanton, S L; Kalyani, Rita R

2014-11-01

Previous studies exploring the relationship of neighborhood characteristics with metabolic conditions have focused on middle-aged adults but none have comprehensively investigated associations in older adults, a potentially vulnerable population. The aim was to explore the relationship of neighborhood characteristics with metabolic conditions in older women. Cross-sectional analysis. We studied 384 women aged 70-79 years, representing the two-thirds least disabled women in the community, enrolled in the Women's Health and Aging Study II at baseline. Neighborhood scores were calculated from census-derived data on median household income, median house value, percent earning interest income, percent completing high school, percent completing college, and percent with managerial or executive occupation. Participants were categorized by quartile of neighborhood score with a higher quartile representing relative neighborhood advantage. Logistic regression models were created to assess the association of neighborhood quartiles to outcomes, adjusting for key covariates. Primary outcomes included metabolic conditions: obesity, diabetes, hypertension, and hyperlipidemia. Secondary outcomes included BMI, HbA1c, blood pressure and lipids. Higher neighborhood quartile score was associated with a lower prevalence of obesity (highest quartile=13.5% versus lowest quartile=36.5%; p<0.001 for trend). A lower prevalence of diabetes was also observed in highest (6.3%) versus lowest (14.4%) neighborhood quartiles, but was not significantly different (p= 0.24 for trend). Highest versus lowest neighborhood quartile was associated with lower HbA1c (-0.31%, p=0.02) in unadjusted models. Women in the highest versus lowest neighborhood quartile had lower BMI (-2.01 kg/m2, p=0.001) and higher HDL-cholesterol (+6.09 mg/dL, p=0.01) after accounting for age, race, inflammation, and smoking. Worse neighborhood characteristics are associated with adiposity, hyperglycemia, and low HDL. Further longitudinal studies are needed and can inform future interventions to improve metabolic status in older adults.

Soluble CD30 levels in recipients undergoing heart transplantation do not predict post-transplant outcome.

PubMed

Ypsilantis, Efthymios; Key, Timothy; Bradley, J Andrew; Morgan, C Helen; Tsui, Stephen; Parameshwar, Jayan; Taylor, Craig J

2009-11-01

The pre-transplant serum level of soluble CD30 (sCD30), a proteolytic derivative of the lymphocyte surface receptor CD30, has been suggested as a biomarker for immunologic risk after organ transplantation. Pre-transplant serum sCD30 levels were determined in 200 consecutive adult heart transplant recipients undertaken at a single center. Transplant outcome (acute rejection in the first 12 months and patient survival up to 5 years post-transplant) was determined. Patients treated with a left ventricular assist device (LVAD) prior to transplantation (n = 28) had higher levels of sCD30 (median 64 U/ml, range 12 to 112 U/ml) than those (n = 172) with no LVAD (median 36 U/ml, range 1 to 158 U/ml, p < 0.0001). Recipients were categorized according to whether sCD30 levels were "low" (lower quartile, <24 U/ml, n = 50), "intermediate" (24 to 58 U/ml, n = 100) or "high" (upper quartile, >58 U/ml, n = 50). Neither acute rejection nor recipient survival differed according to sCD30 level, with values (mean +/- SEM) of 0.30 +/- 0.04, 0.23 +/- 0.03 and 0.30 +/- 0.05 acute rejection episodes per 100 days in the low, intermediate and high groups, respectively, with recipient survival rates at 1 year of 77.7%, 84.9% and 86% and at 5 years of 73.6%, 67.9% and 75.8%, respectively. Pre-transplant serum sCD30 level does not predict acute allograft rejection or recipient survival after heart transplantation, although sCD30 levels are increased by LVAD, possibly as a result of biomaterial-host immune interaction.

Parental work absenteeism is associated with increased symptom complaints and school absence in adolescent children.

PubMed

Hysing, Mari; Petrie, Keith J; Bøe, Tormod; Sivertsen, Børge

2017-05-12

Previous studies have proposed that having parents out of work may influence adolescent illness behaviour and school attendance. However, prior research investigating this question has been limited by retrospective reporting and case control studies. In a large epidemiological study we investigated whether parental work absence was associated with symptom complaints and increased school absenteeism in adolescents. We analysed data from a large epidemiological study of 10,243 Norwegian adolescents aged 16-19. Participants completed survey at school, which included demographic data, parental work absence and current health complaints. An official registry provided school attendance data. Parental work absence was significantly related to the number of adolescent symptom complaints as well as school absenteeism. Having a father out of work was associated with an increased likelihood of being in the highest quartile of symptom reporting by an odds-ratio of 2.2 and mother by 1.6 (compared to the lowest quartile). Similarly, parental work absenteeism was associated with an increased likelihood of being in the highest quartile for school absence by an odds-ratio of 1.9 for a father being out of work and 1.5 for a mother out of work. We found that the number of adolescent symptom complaints mediated the relationship between parental work absenteeism and school absenteeism. We found that parental work absence was significantly associated with the number of adolescent symptom complaints and school absenteeism. The results suggest that parents may play a critical modelling role in the intergenerational transmission of illness and disability behaviour.

Association of urinary sodium/creatinine ratio with bone mineral density in postmenopausal women: KNHANES 2008-2011.

PubMed

Kim, Sung-Woo; Jeon, Jae-Han; Choi, Yeon-Kyung; Lee, Won-Kee; Hwang, In-Ryang; Kim, Jung-Guk; Lee, In-Kyu; Park, Keun-Gyu

2015-08-01

Accumulating evidence shows that high sodium chloride intake increases urinary calcium excretion and may be a risk factor for osteoporosis. However, the effect of oral sodium chloride intake on bone mineral density (BMD) and risk of osteoporosis has been inadequately researched. The aim of the present study was to determine whether urinary sodium excretion (reflecting oral sodium chloride intake) associates with BMD and prevalence of osteoporosis in postmenopausal women. This cross-sectional study involved a nationally representative sample consisting of 2,779 postmenopausal women who participated in the Korea National Health and Nutritional Examination Surveys in 2008-2011. The association of urinary sodium/creatinine ratio with BMD and other osteoporosis risk factors was assessed. In addition, the prevalence of osteoporosis was assessed in four groups with different urinary sodium/creatinine ratios. Participants with osteoporosis had significantly higher urinary sodium/creatinine ratios than the participants without osteoporosis. After adjusting for multiple confounding factors, urinary sodium/creatinine ratio correlated inversely with lumbar spine BMD (P = 0.001). Similarly, when participants were divided into quartile groups according to urinary sodium/creatinine ratio, the average BMD dropped as the urinary sodium/creatinine ratio increased. Multiple logistic regression analysis revealed that compared to quartile 1, quartile 4 had a significantly increased prevalence of lumbar spine osteoporosis (odds ratios 1.346, P for trend = 0.044). High urinary sodium excretion was significantly associated with low BMD and high prevalence of osteoporosis in lumbar spine. These results suggest that high sodium chloride intake decreases lumbar spine BMD and increases the risk of osteoporosis in postmenopausal women.

Insulin-Like Growth Factor-1 Bioactivity Plays a Prosurvival Role in Older Participants

PubMed Central

2013-01-01

The aim of this study was to address the intriguing issue of the role of the insulin-like growth factor (IGF)-1 system in longevity looking at the role of different components of IGF system. Vital status was ascertained in 1,197 men and women aged greater than or equal to 65 years from the InCHIANTI study. Hormonal levels were categorized into quartiles, and ratio of IGF-1 to IGF-binding protein (IGFBP)-1 was calculated. The relationship between hormones and mortality was tested by Cox proportional hazard models adjusted for age, sex, and confounders. During the 8-year follow-up period, 240 died and 957 survived. Lowest quartiles of IGF-1 and IGFBP-1 were considered as reference. Compared with the lowest quartiles, IGF-1 in upper quartiles was a negative predictor of mortality independent of age and sex (p = .01) but not independent of IGFBP-1 and other confounders. IGFBP-1 in second–third quartiles was negatively associated and that in the fourth quartiles was positively associated with risk of death. IGF-1/IGFBP-1 ratio in the lowest quartiles was a strong positive predictor of mortality, in age- and sex-adjusted model (p = .005), and independent of additional confounders (p = .037). High IGFBP-1 and low IGF-1/IGFBP-1 ratio are associated with all-cause mortality in older population. PMID:23671288

Insulin-like growth factor-1 bioactivity plays a prosurvival role in older participants.

PubMed

Maggio, Marcello; Cattabiani, Chiara; Lauretani, Fulvio; Bandinelli, Stefania; De Vita, Francesca; Dall'Aglio, Elisabetta; Corsonello, Andrea; Lattanzio, Fabrizia; Paolisso, Giuseppe; Ferrucci, Luigi; Ceda, Gian Paolo

2013-11-01

The aim of this study was to address the intriguing issue of the role of the insulin-like growth factor (IGF)-1 system in longevity looking at the role of different components of IGF system. Vital status was ascertained in 1,197 men and women aged greater than or equal to 65 years from the InCHIANTI study. Hormonal levels were categorized into quartiles, and ratio of IGF-1 to IGF-binding protein (IGFBP)-1 was calculated. The relationship between hormones and mortality was tested by Cox proportional hazard models adjusted for age, sex, and confounders. During the 8-year follow-up period, 240 died and 957 survived. Lowest quartiles of IGF-1 and IGFBP-1 were considered as reference. Compared with the lowest quartiles, IGF-1 in upper quartiles was a negative predictor of mortality independent of age and sex (p = .01) but not independent of IGFBP-1 and other confounders. IGFBP-1 in second-third quartiles was negatively associated and that in the fourth quartiles was positively associated with risk of death. IGF-1/IGFBP-1 ratio in the lowest quartiles was a strong positive predictor of mortality, in age- and sex-adjusted model (p = .005), and independent of additional confounders (p = .037). High IGFBP-1 and low IGF-1/IGFBP-1 ratio are associated with all-cause mortality in older population.

Reproducibility of African giant pouched rats detecting Mycobacterium tuberculosis.

PubMed

Ellis, Haylee; Mulder, Christiaan; Valverde, Emilio; Poling, Alan; Edwards, Timothy

2017-04-24

African pouched rats sniffing sputum samples provided by local clinics have significantly increased tuberculosis case findings in Tanzania and Mozambique. The objective of this study was to determine the reproducibility of rat results. Over an 18-month period 11,869 samples were examined by the rats. Intra-rater reliability was assessed through Yule's Q. Inter-rater reliability was assessed with Krippendorff's alpha. Intra-rater reliability was high, with a mean Yule's Q of 0.9. Inter-rater agreement was fair, with Krippendorf's alpha ranging from 0.15 to 0.45. Both Intra- and Inter-rater reliability was independent of the sex of the animals, but they were positively correlated with age. Both intra- and inter-rater agreement was lowest for samples designated as smear-negative by the clinics. Overall, the reproducibility of tuberculosis detection rat results was fair and diagnostic results were therefore independent of the rats used.

Soft tissue displacement over pelvic anatomical landmarks during 3-D hip movements.

PubMed

Camomilla, V; Bonci, T; Cappozzo, A

2017-09-06

The position, in a pelvis-embedded anatomical coordinate system, of skin points located over the following anatomical landmarks (AL) was determined while the hip assumed different spatial postures: right and left anterior superior and posterior superior iliac spines, and the sacrum. Postures were selected as occurring during walking and during a flexion-extension and circumduction movement, as used to determine the hip joint centre position (star-arc movement). Five volunteers, characterised by a wide range of body mass indices (22-37), were investigated. Subject-specific MRI pelvis digital bone models were obtained. For each posture, the pose of the pelvis-embedded anatomical coordinate system was determined by registering this bone model with points digitised over bony prominences of the pelvis, using a wand carrying a marker-cluster and stereophotogrammetry. The knowledge of how the position of the skin points varies as a function of the hip posture provided information regarding the soft tissue artefact (STA) that would affect skin markers located over those points during stereophotogrammetric movement analysis. The STA was described in terms of amplitude (relative to the position of the AL during an orthostatic posture), diameter (distance between the positions of the AL which were farthest away from each other), and pelvis orientation. The STA amplitude, exhibited, over all postures, a median [inter-quartile] value of 9[6] and 16[11]mm, for normal and overweight volunteers, respectively. STA diameters were larger for the star-arc than for the walking postures, and the direction was predominantly upwards. Consequent errors in pelvic orientation were in the range 1-9 and 4-11 degrees, for the two groups respectively. Copyright © 2017 Elsevier Ltd. All rights reserved.

Nutritional status and complementary feeding among HIV-exposed infants: a prospective cohort study.

PubMed

Kamenju, Pili; Liu, Enju; Hertzmark, Ellen; Spiegelman, Donna; Kisenge, Rodrick; Kupka, Roland; Aboud, Said; Manji, Karim P; Duggan, Christopher; Fawzi, Wafaie W

2017-07-01

Complementary feeding is crucial for improving child survival and promoting growth and development, particularly among HIV-exposed children who have higher risk of morbidity and mortality than their un-exposed peers. This prospective study employed an infant and child feeding index (ICFI) to measure complementary feeding and determine its association with nutritional status among 2092 HIV-exposed infants followed from 6 to 24 months of age in Dar es Salaam, Tanzania. The ICFI measured both quality and quantity of complementary feeding, including current breastfeeding status, food consistency, dietary diversity scores (DDS), food group frequency score, and meal frequency. The ICFI score ranged from 0 to 9; the median score was 6 (Inter-Quartile Range, IQR= 4-7). After adjusting for potential confounders, high ICFI scores were associated with reduced risk of stunting (high vs. low tertile hazard ratio, HR: 0.72; 95% confidence interval, CI: 0.57, 0.91; P< 0.01) and underweight (high vs. low tertile HR: 0.79; 95% CI: 0.61, 1.02; P= 0.07). Low DDS were associated with higher risk of stunting (low vs. high tertile HR: 1.59; 95% CI: 1.23, 2.07; P< 0.01) and underweight (low vs. high tertile HR: 1.48; 95% CI: 1.12, 1.96; P= 0.01). In this setting, high DDS and ICFI scores were protective of stunting and underweight. We recommend for nutrition programs in low-income countries to emphasize educating HIV-exposed children's caregivers on the importance of dietary diversity and optimal complementary feeding to improve nutritional status in this important subpopulation. © 2016 John Wiley & Sons Ltd.

Edge-to-Stem Variability in Wet-Canopy Evaporation From an Urban Tree Row

NASA Astrophysics Data System (ADS)

Van Stan, John T.; Norman, Zachary; Meghoo, Adrian; Friesen, Jan; Hildebrandt, Anke; Côté, Jean-François; Underwood, S. Jeffrey; Maldonado, Gustavo

2017-11-01

Evaporation from wet-canopy (E_C) and stem (E_S) surfaces during rainfall represents a significant portion of municipal-to-global scale hydrologic cycles. For urban ecosystems, E_C and E_S dynamics play valuable roles in stormwater management. Despite this, canopy-interception loss studies typically ignore crown-scale variability in E_C and assume (with few indirect data) that E_S is generally {<}2% of total wet-canopy evaporation. We test these common assumptions for the first time with a spatially-distributed network of in-canopy meteorological monitoring and 45 surface temperature sensors in an urban Pinus elliottii tree row to estimate E_C and E_S under the assumption that crown surfaces behave as "wet bulbs". From December 2015 through July 2016, 33 saturated crown periods (195 h of 5-min observations) were isolated from storms for determination of 5-min evaporation rates ranging from negligible to 0.67 mm h^{-1}. Mean E_S (0.10 mm h^{-1}) was significantly lower (p < 0.01) than mean E_C (0.16 mm h^{-1}). But, E_S values often equalled E_C and, when scaled to trunk area using terrestrial lidar, accounted for 8-13% (inter-quartile range) of total wet-crown evaporation (E_S+E_C scaled to surface area). E_S contributions to total wet-crown evaporation maximized at 33%, showing a general underestimate (by 2-17 times) of this quantity in the literature. Moreover, results suggest wet-crown evaporation from urban tree rows can be adequately estimated by simply assuming saturated tree surfaces behave as wet bulbs, avoiding problematic assumptions associated with other physically-based methods.

Implementation of smart phone video plethysmography and dependence on lighting parameters.

PubMed

Fletcher, Richard Ribón; Chamberlain, Daniel; Paggi, Nicholas; Deng, Xinyue

2015-08-01

The remote measurement of heart rate (HR) and heart rate variability (HRV) via a digital camera (video plethysmography) has emerged as an area of great interest for biomedical and health applications. While a few implementations of video plethysmography have been demonstrated on smart phones under controlled lighting conditions, it has been challenging to create a general scalable solution due to the large variability in smart phone hardware performance, software architecture, and the variable response to lighting parameters. In this context, we present a selfcontained smart phone implementation of video plethysmography for Android OS, which employs both stochastic and deterministic algorithms, and we use this to study the effect of lighting parameters (illuminance, color spectrum) on the accuracy of the remote HR measurement. Using two different phone models, we present the median HR error for five different video plethysmography algorithms under three different types of lighting (natural sunlight, compact fluorescent, and halogen incandescent) and variations in brightness. For most algorithms, we found the optimum light brightness to be in the range 1000-4000 lux and the optimum lighting types to be compact fluorescent and natural light. Moderate errors were found for most algorithms with some devices under conditions of low-brightness (<;500 lux) and highbrightness (>4000 lux). Our analysis also identified camera frame rate jitter as a major source of variability and error across different phone models, but this can be largely corrected through non-linear resampling. Based on testing with six human subjects, our real-time Android implementation successfully predicted the measured HR with a median error of -0.31 bpm, and an inter-quartile range of 2.1bpm.

Acid and non-acid reflux during physiotherapy in young children with cystic fibrosis.

PubMed

Doumit, Michael; Krishnan, Usha; Jaffé, Adam; Belessis, Yvonne

2012-02-01

Gastro-esophageal reflux (GOR) may contribute to lung disease in children with cystic fibrosis (CF). There is conflicting evidence regarding the effect of chest physiotherapy (CPT) in the head-down position on GOR. Furthermore, there is currently no evidence on the impact of physiotherapy on GOR as assessed by pH-multichannel intraluminal impedance (pH-MII). (1) To characterize GOR in young children with CF. (2) To determine whether the head-down position during physiotherapy exacerbates GOR. Children were studied using pH-MII monitoring over 24-hr, during which they received two 20-min sessions of CPT. One session was performed in "modified" drainage positions with no head-down tilt and the alternate session in "gravity-assisted" drainage positions, which included 20° head-down tilt. Twenty children with CF (8 males), median age 12 months (range 8-34) were recruited. A total of 1,374 reflux episodes were detected in all children, of which 869 (63%) were acid and 505 (37%) were non-acid. Seventy-two percent of the episodes migrated proximally. During CPT, there was no significant difference between total number of reflux episodes in the modified or gravity-assisted positions, median [inter-quartile range (IQR)] 1 (0-2.5) compared to 1 (0.75-3) episode, respectively, P = 0.63. There was also no significant difference between the number of reflux episodes which migrated proximally, median (IQR) 1 (0-2) compared to 0 (0-2) episodes, respectively, P = 0.75. In young children with CF, GOR is primarily acidic and proximal migration is common. Physiotherapy in the head-down position does not appear to exacerbate GOR. The impact of GOR on lung disease remains to be elucidated. Copyright © 2011 Wiley Periodicals, Inc.

Severe Anemia in Papua New Guinean Children from a Malaria-Endemic Area: A Case-Control Etiologic Study

PubMed Central

Manning, Laurens; Laman, Moses; Rosanas-Urgell, Anna; Michon, Pascal; Aipit, Susan; Bona, Cathy; Siba, Peter; Mueller, Ivo; Davis, Timothy M. E.

2012-01-01

Background There are few detailed etiologic studies of severe anemia in children from malaria-endemic areas and none in those countries with holoendemic transmission of multiple Plasmodium species. Methodology/Principal Findings We examined associates of severe anemia in 143 well-characterized Papua New Guinean (PNG) children aged 0.5–10 years with hemoglobin concentration <50 g/L (median [inter-quartile range] 39 [33]–[44] g/L) and 120 matched healthy children (113 [107–119] g/L) in a case-control cross-sectional study. A range of socio-demographic, behavioural, anthropometric, clinical and laboratory (including genetic) variables were incorporated in multivariate models with severe anemia as dependent variable. Consistent with a likely trophic effect of chloroquine or amodiaquine on parvovirus B19 (B19V) replication, B19V PCR/IgM positivity had the highest odds ratio (95% confidence interval) of 75.8 (15.4–526), followed by P. falciparum infection (19.4 (6.7–62.6)), vitamin A deficiency (13.5 (5.4–37.7)), body mass index-for-age z-score <2.0 (8.4 (2.7–27.0)) and incomplete vaccination (2.94 (1.3–7.2)). P. vivax infection was inversely associated (0.12 (0.02–0.47), reflecting early acquisition of immunity and/or a lack of reticulocytes for parasite invasion. After imputation of missing data, iron deficiency was a weak positive predictor (6.4% of population attributable risk). Conclusions/Significance These data show that severe anemia is multifactorial in PNG children, strongly associated with under-nutrition and certain common infections, and potentially preventable through vitamin A supplementation and improved nutrition, completion of vaccination schedules, and intermittent preventive antimalarial treatment using non-chloroquine/amodiaquine-based regimens. PMID:23272266

Salivary cortisol day curves in Addison's disease in patients on hydrocortisone replacement.

PubMed

Ross, I L; Levitt, N S; Van der Walt, J S; Schatz, D A; Johannsson, G; Haarburger, D H; Pillay, T S

2013-01-01

Using salivary cortisol (SC) measurements, cortisol exposure in Addison's disease patients on hydrocortisone replacement was determined and compared with healthy controls. Cortisol pharmacokinetics was assessed in 31 patients with Addison's disease on replacement hydrocortisone doses (median daily dose 20 mg; range 5-50 mg) and 30 healthy control subjects. Saliva samples (n=16) were collected between 08:00 and 00:00 h in 1 day, using a passive drool technique. Cortisol exposure was evaluated by noncompartmental approach. In the patients, cortisol exposure was significantly higher than in controls: median inter-quartile range (IQR) peak cortisol (C(max)) 174.5 (59.3-837.0) vs. 6.50 (4.7-19.3) nmol/l, p=0.0001; area under the curve (AUC) 390.1 (177.1-928.9) vs. 21.4 (14.6-28.4) minutes*nmol/l, p=0.0001, trough cortisol level (C(min)) 0.49 (0.49-0.96) vs. 0.49 (0.49-0.49) nmol/l, p=0.02, occurring at 480.0 (0.1-660.0) vs. 405.0 (180.0-570.0) min, p=0.56. First peak cortisol was 174.5 (53.0-754.7) vs. 6.27 (3.90-8.47) nmol/l, p=0.0001 and second peak cortisol 18.90 (5.22-76.9) vs. 3.12 (1.76-4.79) nmol/l, p=0.0001. The time to first peak cortisol differed between the 2 groups, 30 (30-75) vs. 0.1 (0.1-30) minutes; p=0.0001. At doses studied, hydrocortisone replacement therapy results in cortisol pharmacokinetics being markedly different from endogenous cortisol profiles in healthy control subjects. Addison's disease patients had significantly higher SC levels compared to healthy control subjects. © Georg Thieme Verlag KG Stuttgart · New York.

Establishing Key Performance Indicators [KPIs] and Their Importance for the Surgical Management of Inflammatory Bowel Disease-Results From a Pan-European, Delphi Consensus Study.

PubMed

Morar, Pritesh S; Hollingshead, James; Bemelman, Willem; Sevdalis, Nick; Pinkney, Thomas; Wilson, Graeme; Dunlop, Malcolm; Davies, R Justin; Guy, Richard; Fearnhead, Nicola; Brown, Steven; Warusavitarne, Janindra; Edwards, Cathryn; Faiz, Omar

2017-10-27

Key performance indicators [KPIs] exist across a range of areas in medicine. They help to monitor outcomes, reduce variation, and drive up standards across services. KPIs exist for inflammatory bowel disease [IBD] care, but none specifically cover inflammatory bowel disease [IBD] surgical service provision. This was a consensus-based study using a panel of expert IBD clinicians from across Europe. Items were developed and fed through a Delphi process to achieve consensus. Items were ranked on a Likert scale from 1 [not important] to 5 [very important]. Consensus was defined when the inter quartile range was ≤ 1, and items with a median score > 3 were considered for inclusion. A panel of 21 experts [14 surgeons and 7 gastroenterologists] was recruited. Consensus was achieved on procedure-specific KPIs for ileocaecal and perianal surgery for Crohn's disease, [N = 10] with themes relating to morbidity [N = 7], multidisciplinary input [N = 2], and quality of life [N = 1]; and for subtotal colectomy, proctocolectomy and ileoanal pouch surgery for ulcerative colitis [N = 11], with themes relating to mortality [N = 2], morbidity [N = 8], and service provision [N = 1]. Consensus was also achieved for measures of the quality of IBD surgical service provision and quality assurance in IBD surgery. This study has provided measurable KPIs for the provision of surgical services in IBD. These indicators cover IBD surgery in general, the governance and structures of the surgical services, and separate indicators for specific subareas of surgery. Monitoring of IBD services with these KPIs may reduce variation across services and improve quality. Copyright © 2017 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com

Pulmonary nodule detection with digital projection radiography: an ex-vivo study on increased latitude post-processing.

PubMed

Biederer, Juergen; Gottwald, Tobias; Bolte, Hendrik; Riedel, Christian; Freitag, Sandra; Van Metter, Richard; Heller, Martin

2007-04-01

To evaluate increased image latitude post-processing of digital projection radiograms for the detection of pulmonary nodules. 20 porcine lungs were inflated inside a chest phantom, prepared with 280 solid nodules of 4-8 mm in diameter and examined with direct radiography (3.0x2.5 k detector, 125 kVp, 4 mAs). Nodule position and size were documented by CT controls and dissection. Four intact lungs served as negative controls. Image post-processing included standard tone scales and increased latitude with detail contrast enhancement (log-factors 1.0, 1.5 and 2.0). 1280 sub-images (512x512 pixel) were centred on nodules or controls, behind the diaphragm and over free parenchyma, randomized and presented to six readers. Confidence in the decision was recorded with a scale of 0-100%. Sensitivity and specificity for nodules behind the diaphragm were 0.87/0.97 at standard tone scale and 0.92/0.92 with increased latitude (log factor 2.0). The fraction of "not diagnostic" readings was reduced (from 208/1920 to 52/1920). As an indicator of increased detection confidence, the median of the ratings behind the diaphragm approached 100 and 0, respectively, and the inter-quartile width decreased (controls: p<0.001, nodules: p=0.239) at higher image latitude. Above the diaphragm, accuracy and detection confidence remained unchanged. Here, the sensitivity for nodules was 0.94 with a specificity from 0.96 to 0.97 (all p>0.05). Increased latitude post-processing has minimal effects on the overall accuracy, but improves the detection confidence for sub-centimeter nodules in the posterior recesses of the lung.

Area-level socioeconomic inequalities in the use of mammography screening: A multilevel analysis of the Health of Houston Survey

PubMed Central

Calo, William A.; Vernon, Sally W.; Lairson, David R.; Linder, Stephen H.

2015-01-01

Background An emerging literature reports that women who reside in socioeconomically deprived communities are less likely to adhere to mammography screening. This study explored associations between area-level socioeconomic measures and mammography screening among a racially and ethnically diverse sample of women in Texas. Methods We conducted a cross-sectional multilevel study linking individual-level data from the 2010 Health of Houston Survey and contextual data from the U.S. Census. Women ages 40–74 years (N=1,541) were included in the analyses. We examined tract-level poverty, unemployment, education, Hispanic and Black composition, female-headed householder families, and crowding as contextual measures. Using multilevel logistic regression modeling, we compared most disadvantaged tracts (quartiles 2–4) to the most advantaged tract (quartile 1). Results Overall, 64% of the sample was adherent to mammography screening. Screening rates were lower (P<.05) among Hispanics, those foreign born, women aged 40–49 years, and those with low educational attainment, unemployed, and without health insurance coverage. Women living in areas with high levels of poverty (quartile 2 vs. quartile 1: OR=0.50; 95% CI: 0.30–0.85), Hispanic composition (quartile 3 vs. quartile 1: OR=0.54; 95% CI: 0.32–0.90), and crowding (quartile 4 vs. quartile 1: OR=0.53; 95% CI: 0.29–0.96) were less likely to have up-to-date mammography screening, net of individual-level factors. Conclusion Our findings highlight the importance of examining area-level socioeconomic inequalities in mammography screening. The study represents an advance on previous research because we examined multiple area measures, controlled for key individual-level covariates, used data aggregated at the tract level, and accounted for the nested structure of the data. PMID:26809487

Organizational Leadership and Adaptive Reserve in Blood Pressure Control: The Heart Health NOW Study.

PubMed

Henderson, Kamal H; DeWalt, Darren A; Halladay, Jacquie; Weiner, Bryan J; Kim, Jung I; Fine, Jason; Cykert, Samuel

2018-04-01

Our purpose was to assess whether a practice's adaptive reserve and high leadership capability in quality improvement are associated with population blood pressure control. We divided practices into quartiles of blood pressure control performance and considered the top quartile as the benchmark for comparison. Using abstracted clinical data from electronic health records, we performed a cross-sectional study to assess the association of top quartile hypertension control and (1) the baseline practice adaptive reserve (PAR) scores and (2) baseline practice leadership scores, using modified Poisson regression models adjusting for practice-level characteristics. Among 181 practices, 46 were in the top quartile, which averaged 68% or better blood pressure control. Practices with higher PAR scores compared with lower PAR scores were not more likely to reside in the top quartile of performance (prevalence ratio [PR] = 1.92 for highest quartile; 95% CI, 0.9-4.1). Similarly, high quality improvement leadership capability compared with lower capability did not predict better blood pressure control performance (PR = 0.94; 95% CI, 0.57-1.56). Practices with higher proportions of commercially insured patients were more likely than practices with lower proportions of commercially insured patients to have top quartile performance (37% vs 26%, P =.002), whereas lower proportions of the uninsured (8% vs 14%, P =.055) were associated with better performance. Our findings show that adaptive reserve and leadership capability in quality improvement implementation are not statistically associated with achieving top quartile practice-level hypertension control at baseline in the Heart Health NOW project. Our findings, however, may be limited by a lack of patient-related factors and small sample size to preclude strong conclusions. © 2018 Annals of Family Medicine, Inc.

Association between the triglyceride to high-density lipoprotein cholesterol ratio and insulin resistance in Korean adolescents: a nationwide population-based study.

PubMed

Park, Jae-Min; Lee, Jee-Yon; Dong, Jae June; Lee, Duk-Chul; Lee, Yong-Jae

2016-11-01

Studies have suggested the triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) as a surrogate marker of insulin resistance. However, few studies have examined the association between TG/HDL-C and insulin resistance in the general adolescent population. This study aimed to examine the association between TG/HDL-C and insulin resistance in a nationally representative sample of Korean adolescents. A total of 2649 participants aged 12-18 years were selected from the 2007 to 2010 Korean National Health and Nutrition Examination Survey (KNHANES). Insulin resistance was defined as the homeostatic model assessment of insulin resistance (HOMA-IR) values greater than the 80th percentile. The mean values of most cardiometabolic variables increased proportionally with TG/HDL-C quartiles. Compared to individuals in the lowest TG/HDL-C quartile, the odds ratio for insulin resistance for individuals in the highest quartile was 2.91 in boys and 2.38 in girls after adjusting for confounding variables. This study suggests that TG/HDL-C could be a convenient marker for identifying Korean adolescents with insulin resistance.

Physical attractiveness and reproductive success in humans: Evidence from the late 20 century United States.

PubMed

Jokela, Markus

2009-09-01

Physical attractiveness has been associated with mating behavior, but its role in reproductive success of contemporary humans has received surprisingly little attention. In the Wisconsin Longitudinal Study (1244 women, 997 men born between 1937 and 1940) we examined whether attractiveness assessed from photographs taken at age ~18 predicted the number of biological children at age 53-56. In women, attractiveness predicted higher reproductive success in a nonlinear fashion, so that attractive (second highest quartile) women had 16% and very attractive (highest quartile) women 6% more children than their less attractive counterparts. In men, there was a threshold effect so that men in the lowest attractiveness quartile had 13% fewer children than others who did not differ from each other in the average number of children. These associations were partly but not completely accounted for by attractive participants' increased marriage probability. A linear regression analysis indicated relatively weak directional selection gradient for attractiveness (β=0.06 in women, β=0.07 in men). These findings indicate that physical attractiveness may be associated with reproductive success in humans living in industrialized settings.

Influence of the mental health status on a new measure of objective functional impairment in lumbar degenerative disc disease.

PubMed

Stienen, Martin N; Smoll, Nicolas R; Joswig, Holger; Snagowski, Jan; Corniola, Marco V; Schaller, Karl; Hildebrandt, Gerhard; Gautschi, Oliver P

2017-06-01

The Timed Up and Go (TUG) test has recently been proposed as a simple and standardized measure for objective functional impairment (OFI) in patients with lumbar degenerative disc disease (DDD). The study aimed to explore the relationship between a patient's mental health status and both patient-reported outcome measures (PROMs) and TUG test results. This is a prospective institutional review board-approved two-center study. The sample was composed of 375 consecutive patients scheduled for lumbar spine surgery and a healthy cohort of 110 control subjects. Patients and control subjects were assessed with the TUG test and a comprehensive panel of subjective PROMs of pain intensity (visual analog scale [VAS]), functional impairment (Roland-Morris Disability Index [RMDI]), Oswestry Disability Index [ODI]), as well as health-related quality of life (hrQoL; Euro-Qol [EQ]-5D). Standardized age- and sex-adjusted TUG test T-scores were calculated. The dependent variable was the short-form (SF)-12 mental component summary (MCS) quartiles, and the independent variables were the TUG T-scores and PROMs. Direct and adjusted analyses of covariance were performed to estimate the interaction between the SF-12 MCS quartiles and the independent variables. In patients, there was a significant decrease in the subjective PROMs, notably the VAS back pain (p=.001) and VAS leg pain (p=.035), as well as significant increase in the RMDI (p<.001), ODI (p<.001), and the EQ-5D index (p<.001) with every increase in the quartile of the SF-12 MCS. There were no significant group differences of OFI as measured by the TUG T-scores across the SF-12 MCS quartiles (p=.462). In the healthy control group, a significant decrease in VAS leg pain (p=.028), RMDI (p=.013), and ODI (p<.001), as well as a significant increase in the EQ-5D index (p<.001), was seen across the SF-12 MCS quartiles, whereas TUG T-scores remained stable (p=.897). There are significant influences of mental hrQoL on subjective measures of pain, functional impairment, and hrQoL that might lead to bias when evaluating patients with lumbar DDD who suffer from reduced mental hrQoL. The TUG test appears to be a stable instrument and especially helpful in the evaluation of patients with lumbar DDD and mental health problems. Copyright © 2016 Elsevier Inc. All rights reserved.

Investigating the association between birth weight and complementary air pollution metrics: a cohort study.

PubMed

Laurent, Olivier; Wu, Jun; Li, Lianfa; Chung, Judith; Bartell, Scott

2013-02-17

Exposure to air pollution is frequently associated with reductions in birth weight but results of available studies vary widely, possibly in part because of differences in air pollution metrics. Further insight is needed to identify the air pollution metrics most strongly and consistently associated with birth weight. We used a hospital-based obstetric database of more than 70,000 births to study the relationships between air pollution and the risk of low birth weight (LBW, <2,500 g), as well as birth weight as a continuous variable, in term-born infants. Complementary metrics capturing different aspects of air pollution were used (measurements from ambient monitoring stations, predictions from land use regression models and from a Gaussian dispersion model, traffic density, and proximity to roads). Associations between air pollution metrics and birth outcomes were investigated using generalized additive models, adjusting for maternal age, parity, race/ethnicity, insurance status, poverty, gestational age and sex of the infants. Increased risks of LBW were associated with ambient O(3) concentrations as measured by monitoring stations, as well as traffic density and proximity to major roadways. LBW was not significantly associated with other air pollution metrics, except that a decreased risk was associated with ambient NO(2) concentrations as measured by monitoring stations. When birth weight was analyzed as a continuous variable, small increases in mean birth weight were associated with most air pollution metrics (<40 g per inter-quartile range in air pollution metrics). No such increase was observed for traffic density or proximity to major roadways, and a significant decrease in mean birth weight was associated with ambient O3 concentrations. We found contrasting results according to the different air pollution metrics examined. Unmeasured confounders and/or measurement errors might have produced spurious positive associations between birth weight and some air pollution metrics. Despite this, ambient O(3) was associated with a decrement in mean birth weight and significant increases in the risk of LBW were associated with traffic density, proximity to roads and ambient O(3). This suggests that in our study population, these air pollution metrics are more likely related to increased risks of LBW than the other metrics we studied. Further studies are necessary to assess the consistency of such patterns across populations.

Investigating the association between birth weight and complementary air pollution metrics: a cohort study

PubMed Central

2013-01-01

Background Exposure to air pollution is frequently associated with reductions in birth weight but results of available studies vary widely, possibly in part because of differences in air pollution metrics. Further insight is needed to identify the air pollution metrics most strongly and consistently associated with birth weight. Methods We used a hospital-based obstetric database of more than 70,000 births to study the relationships between air pollution and the risk of low birth weight (LBW, <2,500 g), as well as birth weight as a continuous variable, in term-born infants. Complementary metrics capturing different aspects of air pollution were used (measurements from ambient monitoring stations, predictions from land use regression models and from a Gaussian dispersion model, traffic density, and proximity to roads). Associations between air pollution metrics and birth outcomes were investigated using generalized additive models, adjusting for maternal age, parity, race/ethnicity, insurance status, poverty, gestational age and sex of the infants. Results Increased risks of LBW were associated with ambient O3 concentrations as measured by monitoring stations, as well as traffic density and proximity to major roadways. LBW was not significantly associated with other air pollution metrics, except that a decreased risk was associated with ambient NO2 concentrations as measured by monitoring stations. When birth weight was analyzed as a continuous variable, small increases in mean birth weight were associated with most air pollution metrics (<40 g per inter-quartile range in air pollution metrics). No such increase was observed for traffic density or proximity to major roadways, and a significant decrease in mean birth weight was associated with ambient O3 concentrations. Conclusions We found contrasting results according to the different air pollution metrics examined. Unmeasured confounders and/or measurement errors might have produced spurious positive associations between birth weight and some air pollution metrics. Despite this, ambient O3 was associated with a decrement in mean birth weight and significant increases in the risk of LBW were associated with traffic density, proximity to roads and ambient O3. This suggests that in our study population, these air pollution metrics are more likely related to increased risks of LBW than the other metrics we studied. Further studies are necessary to assess the consistency of such patterns across populations. PMID:23413962

The Association Between Blood Mercury Levels and Risk for Overweight in a General Adult Population: Results from the Korean National Health and Nutrition Examination Survey.

PubMed

Lee, Seunghyun; Yoon, Jin-Ha; Won, Jong-Uk; Lee, Wanhyung; Lee, June-Hee; Seok, Hongdeok; Kim, Yeong-Kwang; Kim, Chi-Nyon; Roh, Jaehoon

2016-06-01

The primary objective of this study was to estimate the association between blood mercury levels and overweight in Korean adults. We analyzed cross-sectional data from 9228 participants (4283 men and 4945 women) who completed the Korean National Health and Nutrition Examination Survey (KNHANES), 2007-2013. The population was divided into two groups according to the body mass index (BMI) and waist circumference (WC). Blood mercury levels were analyzed using a gold amalgam method with a DMA-80 instrument, categorized into quartiles, and stratified by sex. After adjusting for all covariates, blood mercury was significantly associated with overweight in all subjects. According to the BMI criteria, the adjusted odds ratio of being in the highest blood mercury quartile was 1.75 (95 % confidence interval [CI], 1.53-2.01) overall, 2.09 (95 % CI, 1.71-2.55) in men, and 1.58 (95 % CI, 1.32-1.89) in women. According to the WC criteria, the adjusted odds ratio of being in the highest blood mercury quartile was 1.85 (95 % CI, 1.49-2.30) in men and 1.96 (95 % CI, 1.62-2.36) in women compared to the lowest quartile. Additionally, a trend in overweight across increasing blood mercury levels was observed by the p for trend test in the multiple diagnostic criteria.

Association of childhood and teen school performance and obesity in young adulthood in the US National Longitudinal Survey of Youth.

PubMed

Sobol-Goldberg, Shira; Rabinowitz, Jonathan

2016-08-01

The literature suggests an association between poor school performance and obesity. However, little is known about academic achievement and behavior as possible risk factors for future obesity. The analysis was based on data from 3172 participants aged 6 to 25years from the US National Longitudinal Survey conducted 1986 to 2010. Academic achievement, behavior problems and body mass index (BMI) were assessed at childhood (6-9) and teenhood (10-14). Height and weight were self-reported at pre-young adulthood (15-18) and young adulthood (19-25). Based on logistic regression stratified by sex and race/ethnicity, academic and behavioral deficiencies during childhood and teenhood were risk factors for young adult obesity with some sex and ethnic/racial differences. The highest prevalence rates of obesity by race/ethnicity and sex are as follows: black/Hispanic females, those in the lowest quartile of teen reading and math (32.8%); black/Hispanic males, those in lowest quartile of teen reading (26.1%); white males, those in the highest quartile of behavioral problems (21.9%); and white females, those in the lowest quartile teen math (23.2%). Poor school performance in childhood and teenhood is associated with an increased risk of adult obesity. Prospective studies should further examine the association of school performance and adult obesity and whether programs directed at improving school performance may have secondary gains in preventing obesity. Copyright © 2016 Elsevier Inc. All rights reserved.

Maternal psychosocial stress and children's ADHD diagnosis: a prospective birth cohort study.

PubMed

Okano, Lauren; Ji, Yuelong; Riley, Anne W; Wang, Xiaobin

2018-05-23

Examine the association of mothers' psychosocial stressors before and during pregnancy with their children's diagnosis of attention deficit hyperactivity disorder (ADHD). This study included 2140 mother-child pairs who had at least one postnatal pediatric visit at the Boston Medical Center between 2003 and 2015. Child ADHD was determined via International Classification of Diseases, Ninth Revision (ICD-9) codes documented in electronic medical records. Latent factors of maternal stress and social support and measures of the physical home environment and psychosocial adversities were constructed using exploratory factor analysis. The association between the latent factors and child ADHD diagnosis was examined using multiple logistic regression, controlling for known risk factors for ADHD. Children were 1.45 (95% CI: 1.06, 1.99) and 3.03 (95% CI: 2.19, 4.20) times more likely to receive an ADHD diagnosis if their mother experienced a major stressful event during pregnancy or reported a high level of perceived stress, respectively. The number of family adversities increases the risk of ADHD diagnosis [second quartile: OR = 1.90; CI (1.31, 2.77); third quartile: OR = 1.96 CI (1.34, 2.88); fourth quartile: OR = 2.89 CI (2.01, 4.16)] compared to first quartile. In this prospective, predominantly urban, low-income, minority birth cohort, mothers' psychosocial stress before and during pregnancy appears to be an independent risk factor for the development of ADHD in their children.

Empirical, dimensionless, cumulative-rainfall hyetographs developed from 1959-86 storm data for selected small watersheds in Texas

USGS Publications Warehouse

Williams-Sether, Tara; Asquith, William H.; Thompson, David B.; Cleveland, Theodore G.; Fang, Xing

2004-01-01

A database of incremental cumulative-rainfall values for storms that occurred in small urban and rural watersheds in north and south central Texas during the period from 1959 to 1986 was used to develop empirical, dimensionless, cumulative-rainfall hyetographs. Storm-quartile classifications were determined from the cumulative-rainfall values, which were divided into data groups on the basis of storm-quartile classification (first, second, third, fourth, and first through fourth combined), storm duration (0 to 6, 6 to 12, 12 to 24, 24 to 72, and 0 to 72 hours), and rainfall amount (1 inch or more). Removal of long leading tails, in effect, shortened the storm duration and, in some cases, affected the storm-quartile classification. Therefore, two storm groups, untrimmed and trimmed, were used for analysis. The trimmed storms generally are preferred for interpretation. For a 12-hour or less trimmed storm duration, approximately 49 percent of the storms are first quartile. For trimmed storm durations of 12 to 24 and 24 to 72 hours, 47 and 38 percent, respectively, of the storms are first quartile. For a trimmed storm duration of 0 to 72 hours, the first-, second-, third-, and fourth-quartile storms accounted for 46, 21, 20, and 13 percent of all storms, respectively. The 90th-percentile curve for first-quartile storms indicated about 90 percent of the cumulative rainfall occurs during the first 20 percent of the storm duration. The 10th-percentile curve for first-quartile storms indicated about 30 percent of the cumulative rainfall occurs during the first 20 percent of the storm duration. The 90th-percentile curve for fourth-quartile storms indicated about 33 percent of the cumulative rainfall occurs during the first 20 percent of the storm duration. The 10th-percentile curve for fourth-quartile storms indicated less than 5 percent of the cumulative rainfall occurs during the first 20 percent of the storm duration. Statistics for the empirical, dimensionless, cumulative-rainfall hyetographs are presented in the report along with hyetograph curves and tables. The curves and tables presented do not present exact mathematical relations but can be used to estimate distributions of rainfall with time for small drainage areas of less than about 160 square miles in urban and small rural watersheds in north and south central Texas.

Prenatal and childhood exposure to per- and polyfluoroalkyl substances (PFASs) and child cognition.

PubMed

Harris, Maria H; Oken, Emily; Rifas-Shiman, Sheryl L; Calafat, Antonia M; Ye, Xiaoyun; Bellinger, David C; Webster, Thomas F; White, Roberta F; Sagiv, Sharon K

2018-06-01

Per- and polyfluoroalkyl substances (PFASs) are suspected developmental toxicants, but epidemiological evidence on neurodevelopmental effects of PFAS exposure is inconsistent. We examined associations of prenatal and childhood PFAS exposure with performance on assessments of cognition in children. We included mother-child pairs from Project Viva, a longitudinal Boston-area birth cohort enrolled during 1999-2002. We quantified concentrations of eight PFASs, including perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), and perfluorohexane sulfonate (PFHxS), in plasma collected from women during pregnancy (median 9.7 weeks gestation) and from children at a visit in mid-childhood (median age 7.7 years). In early childhood (median age 3.2 years) we administered standardized assessments of visual motor skills and vocabulary comprehension, and in mid-childhood we assessed visual motor skills, visual memory, and verbal and non-verbal intelligence. Using multivariable regression, we estimated associations of prenatal and childhood PFAS plasma concentrations with children's cognitive assessment scores, adjusted for relevant covariates including breastfeeding, maternal intelligence, parental education, and household income. Samples sizes ranged from 631 to 971, depending on analysis. Prenatal PFAS concentrations were associated with both better and worse cognitive performance; children with top quartile prenatal concentrations of some PFASs had better visual motor abilities in early childhood and non-verbal IQ and visual memory in mid-childhood, while children with upper quartile prenatal PFOA and PFOS had lower mid-childhood visual-motor scores. In cross-sectional analyses of mid-childhood PFAS concentrations and cognitive assessments, visual-motor scores on the Wide Range Assessment of Visual Motor Abilities (WRAVMA) (standardized mean = 100, standard deviation = 15) were lower among children with higher PFHxS (fourth quartile (Q4) vs. Q1: -5.0, 95% confidence interval (CI): -9.1, -0.8). Upper quartiles of childhood PFOA and PFOS were also associated with somewhat lower childhood WRAVMA scores, but childhood PFASs were not associated with verbal or non-verbal IQ or visual memory. We present evidence suggesting associations of prenatal and childhood PFAS exposure with lower childhood visual motor abilities. Other results were inconsistent, with higher prenatal PFASs associated in some cases with better cognitive outcomes. Copyright © 2018 Elsevier Ltd. All rights reserved.

Positive emotions in early life and longevity: findings from the nun study.

PubMed

Danner, D D; Snowdon, D A; Friesen, W V

2001-05-01

Handwritten autobiographies from 180 Catholic nuns, composed when participants were a mean age of 22 years, were scored for emotional content and related to survival during ages 75 to 95. A strong inverse association was found between positive emotional content in these writings and risk of mortality in late life (p < .001). As the quartile ranking of positive emotion in early life increased, there was a stepwise decrease in risk of mortality resulting in a 2.5-fold difference between the lowest and highest quartiles. Positive emotional content in early-life autobiographies was strongly associated with longevity 6 decades later. Underlying mechanisms of balanced emotional states are discussed.