CONGESTIVE HEART FAILURE, Issue 3 2008
Yohannes Gebreegziabher MD
The authors assessed the relationship between glycemia and length of hospital stay (LOS) in a prospective cohort study of patients with diabetes mellitus and heart failure (HF). Of 212 patients with acute HF exacerbation, 119 (56%) also had diabetes. The mean age of the cohort was 63±0.87 years, and the mean body mass index was 29.3 kg/m2. Diabetic patients had significantly longer LOS compared with the nondiabetics (5.0±0.29 vs 3.4±0.19; P<.001). In patients with diabetes, the mean glycated hemoglobin A1c was 8.3%, admission blood glucose (BG) was 169±7.7 mg/dL, and average BG was 196±8.1 mg/dL. After adjusting for age, sex, weight, hypertension, renal function, and anemia, LOS was significantly correlated with admission BG (r=0.31; P<.001) and average BG (r=0.34; P=.001). In patients with acute HF exacerbation, diabetes significantly prolonged LOS. Hyperglycemia correlated with LOS. [source]

Metalworking exposures and persistent skin symptoms in the ECRHS II and SAPALDIA 2 cohorts

CONTACT DERMATITIS, Issue 5 2009
Maria C. Mirabelli
Background:, Diseases of the skin are important and often preventable conditions occurring among workers with dermal exposures to irritant and sensitizing agents. Objective:, We conducted this analysis to assess the associations between metalworking exposures and current and persistent skin symptoms among male and female participants in two population-based epidemiologic studies. Methods:, We pooled data from the European Community Respiratory Health Survey II (ECRHS II) and the Swiss Cohort Study on Air Pollution and Lung and Heart Disease in Adults 2 (SAPALDIA 2), two prospective cohort studies in Europe. Each participant completed interviewer-administered questionnaires to provide information about symptoms and exposures related to selected occupations, including metalworking, during the follow-up periods. We assessed associations between skin symptoms and the frequency of metalworking exposures among 676 ECRHS II/SAPALDIA 2 respondents. Results:, Current skin symptoms were reported by 10% of metalworkers and were associated with frequent use, defined as four or more days per week, of oil-based metalworking fluids [prevalence ratio (PR): 1.76, 95% confidence interval (CI): 1.25,2.49)] and organic solvent/degreasing agents (PR: 2.06, 95% CI: 1.21,3.50). Conclusions:, Skin symptom prevalence is associated with increasing frequency of oil-based metalworking fluid and degreasing agent use. Our findings justify assessing strategies for reducing the frequency of metal-related exposures. [source]

Assessing immunophenotyping performance: Proficiency-validation for adopting improved flow cytometry methods

CYTOMETRY, Issue 4 2007
Lance E. Hultin
Abstract Background: The continuous improvement and evolution of immune cell phenotyping requires periodic upgrading of laboratory methods and technology. Flow cytometry laboratories that are participating in research protocols sponsored by the NIAID are required to perform "switch" studies to validate performance before methods for T-cell subset analysis can be changed. Methods: Switch studies were conducted among the four flow cytometry laboratories of the Multicenter AIDS Cohort Study (MACS), comparing a 2-color, lyse-wash method and a newer, 3-color, lyse no-wash method. Two of the laboratories twice failed to satisfy the criteria for acceptable differences from the previous method. Rather than repeating more switch studies, these laboratories were allowed to adopt the 3-color, lyse no-wash method. To evaluate the impact of the switch to the new method at these two sites, their results with the new method were evaluated within the context of all laboratories participating in the NIH-NIAID-Division of AIDS Immunology Quality Assurance (IQA) proficiency-testing program. Results: Laboratory performance at these two sites substantially improved relative to the IQA standard test results. Variation across the four MACS sites and across replicate samples was also reduced. Conclusions: Although switch studies are the conventional method for assessing comparability of laboratory methods, two alternatives to the requirement of repeating failed switch studies should be considered: (1) test the new method and assess performance on the proficiency testing reference panel, and (2) prior to adoption of the new methods, use both the old and the new method on the reference panel samples and demonstrate that performance with the new method is better according to standard statistical procedures. These alternatives may help some laboratories' transition to a new and superior methodology more quickly than if they are required to attempt multiple, serial switch studies. © 2007 Clinical Cytometry Society [source]

The incidence of anxiety and depression among employees,the role of psychosocial work characteristics

DEPRESSION AND ANXIETY, Issue 11 2009
Helene Andrea Ph.D.
Abstract Background: Anxiety and depression are prevalent among employees and are associated with functional disability and work impairment. To date, little is known about the incidence and possible risk factors for developing anxiety and depression in the working population. Study aims were to (a) determine the incidence of subclinical anxiety and depression in a general working population and (b) identify the psychosocial work characteristics associated with the onset of subclinical anxiety and depression. Methods: This prospective study is based on 3,707 employees participating in the Maastricht Cohort Study on Fatigue at Work. Psychosocial work characteristics were measured in May 2000; anxiety and depression were measured with the Hospital Anxiety and Depression Scale in April 2002. Results: The cumulative 23-month incidence for subclinical anxiety and depression was 4.6 and 3.3%, respectively. High psychological job demands increased the risk for both subsequent anxiety and depression. Moreover, low social support was predictive for the onset of anxiety, whereas job insecurity increased the risk for the onset of depression. These prospective associations were independent of potential confounding variables and the other psychosocial work characteristics. Conclusions: Adverse psychosocial work characteristics are significant predictors for the onset of subclinical anxiety and depression in the general working population. These findings encourage intervention studies testing whether modifying the psychosocial work environment reduces both anxiety and depressive symptoms among employees. Depression and Anxiety 26:1040,1048, 2009. © 2009 Wiley-Liss, Inc. [source]

Diameter of Involved Nerves Predicts Outcomes in Cutaneous Squamous Cell Carcinoma with Perineural Invasion: An Investigator-Blinded Retrospective Cohort Study

DERMATOLOGIC SURGERY, Issue 12 2009
AMY S. ROSS MD
BACKGROUND Perineural invasion (PNI) has been associated with poor prognosis in cutaneous squamous cell carcinoma (CSCC), but it is unclear how different degrees of nerve involvement affect prognosis. OBJECTIVE To determine whether the diameter of nerves invaded by CSCC affects outcomes of recurrence, metastasis, and disease-specific and overall survival. METHODS A retrospective cohort study was conducted of patients with CSCC with PNI. Dermatopathologists blinded to subject outcomes determined the diameter of the largest involved nerve. RESULTS Data were obtainable for 48 patients. Small-caliber nerve invasion (SCNI) of nerves less than 0.1 mm in diameter was associated with significantly lower risks of all outcomes of interest. Disease-specific death was 0% in subjects with SCNI, versus 32% in those with large-caliber nerve invasion (LCNI) (p=.003). Other factors associated with significantly worse survival were recurrent or poorly differentiated tumors or tumor diameter of 2 cm or greater or depth of 1 cm or greater. On multivariate analysis, only tumor diameter and age predicted survival. CONCLUSIONS The individual prognostic significance of factors associated with poor survival remains uncertain. Small-caliber nerve invasion may not adversely affect outcomes. Defining PNI as tumor cells within the nerve sheath and routine recording of diameter of involved nerves, tumor depth, and histologic differentiation on pathology reports will facilitate further study. [source]

Prenatal growth, postnatal growth and trait anxiety in late adulthood , the Helsinki Birth Cohort Study

ACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2010
J. Lahti
Lahti J, Räikkönen K, Pesonen A-K, Heinonen K, Kajantie E, Forsén T, Osmond C, Barker DJP, Eriksson JG. Prenatal growth, postnatal growth and trait anxiety in late adulthood , the Helsinki Birth Cohort Study. Objective:, Trait anxiety may predispose to anxiety disorders and cardiovascular events. We tested whether prenatal growth or postnatal growth from birth to 11 years of age and in adulthood predict trait anxiety in late adulthood. Method:, Women (n = 951) and men (n = 753) reported trait anxiety using the Spielberger Trait Anxiety Scale at an average age of 63.4 years and growth was estimated from records. Results:, Higher trait anxiety was predicted by smaller body size at birth, in infancy and in adulthood. Moreover, faster growth particularly from seven to 11 years of age and slower growth between 11 and 63 years predicted higher trait anxiety. Conclusion:, We found a pattern of pre- and postnatal growth that predisposed to higher trait anxiety in late adulthood. This pattern resembles that found to increase the risk of cardiovascular events and, thus, points to a shared common origin in a suboptimal prenatal and childhood developmental milieu. [source]

Brachial-ankle pulse wave velocity and cardiovascular risk factors in the non-diabetic and newly diagnosed diabetic Chinese: Guangzhou Biobank Cohort Study-CVD

DIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 2 2010
Lin Xu
Abstract Background Increased arterial stiffness is an important cause of cardiovascular disease (CVD). We examined determinants of arterial stiffness in subjects across strata of glycaemic status. Methods A total of 1249 subjects from a sub-study of the Guangzhou Biobank Cohort Study (GBCS-CVD) had brachial-ankle pulse wave velocity (baPWV) measured by automatic oscillometric method. Major cardiovascular risk factors including glycosylated haemoglobin A1c (HbA1c), high sensitivity C-reactive protein (hsCRP), fasting triglyceride, low- and high-density lipoprotein cholesterol and both fasting and post 2-h oral glucose-load glucose, systolic and diastolic blood pressure were assessed. Results In all, 649, 479 and 121 subjects were classified into normoglycaemia, impaired glucose metabolism (IGM) and newly diagnosed diabetes groups, respectively. Both age and systolic blood pressure were significantly associated with increased baPWV in all three groups (all p < 0.001). In both normoglycaemic and IGM groups, hsCRP and HbA1c were positively associated with baPWV (p from 0.04 to < 0.001), whereas current smoking and triglyceride were associated with baPWV in the normoglycaemic and IGM group, respectively (p = 0.04 and 0.001). No gender difference in baPWV was observed in the normoglycaemic or IGM groups. However, in the newly diagnosed diabetes group, men had higher baPWV than women (p = 0.01). Conclusions In the normoglycaemic and IGM subjects, after adjusting for age, blood pressure and other confounders, increasing HbA1c was associated with increased baPWV, suggesting a pathophysiological role of chronic glycaemia that can contribute to vascular disease risk in persons without diabetes. Copyright © 2010 John Wiley & Sons, Ltd. [source]

The relationship between depression and diabetes mellitus: findings from the Hertfordshire Cohort Study

DIABETIC MEDICINE, Issue 6 2009
R. I. G. Holt
Abstract Aims, To assess the relationship between depression scores and diabetes, glucose and insulin in a cross-sectional population-based study. Methods, One thousand, five hundred and seventy-nine men and 1418 women from the Hertfordshire Cohort Study were assessed for diabetes. Plasma glucose and insulin concentrations were measured at 0, 30 and 120 min during a standard 75-g oral glucose tolerance test. Depressive and anxiety symptoms were measured using the Hospital Anxiety and Depression Scale (HADS). Results, Overall, 431 (14.6%) were diagnosed with diabetes [232 men (14.9%) and 199 women (14.3%)]. One hundred and eight (47%) men and 74 (37%) women had known diabetes. The remainder were previously undiagnosed. Fifty-nine (3.7%) men and 65 (4.6%) women had possible depression (HAD-D scores 8,10) and 17 (1.1%) men and 20 (1.4%) women had probable depression (HAD-D scores , 11). Probable depression was associated with an adjusted odds ratio for diabetes of 3.89 [95% confidence interval (CI) 1.28,11.88] in men and 1.51 (95% CI 0.47,4.84) in women. In men without previously diagnosed diabetes, fasting insulin (P = 0.035), 2-h glucose concentrations (P = 0.028) and insulin resistance (P = 0.032) were significantly associated with HAD-D scores. With the exception of 2-h glucose concentrations (P = 0.034), the associations were not significant in women. Conclusions, These data support the hypothesis that depression may increase the risk for diabetes. The relationship between depression score and metabolic variables extends across the whole population and is not confined to those with either diagnosed depression or diabetes. This relationship should lead clinicians to consider screening for diabetes in those with depression and vice versa. [source]

Impact of injecting drug use on mortality in Danish HIV-infected patients: a nation-wide population-based cohort study

ADDICTION, Issue 3 2010
Mette V. Larsen
ABSTRACT Objectives To estimate the impact of injecting drug use (IDU) on mortality in HIV-infected patients in the highly active antiretroviral therapy (HAART) era. Design Population-based, nation-wide prospective cohort study in Denmark (the Danish HIV Cohort Study). Methods A total of 4578 HIV-infected patients were followed from 1 January 1997 or date of HIV diagnosis. We calculated mortality rates stratified on IDU. One-, 5- and 10-year survival probabilities were estimated by Kaplan,Meier methods, and Cox regression analyses were used to estimate mortality rate ratios (MRR). Results Of the patients, 484 (10.6%) were categorized as IDUs and 4094 (89.4%) as non-IDUs. IDUs were more likely to be women, Caucasian, hepatitis C virus (HCV) co-infected and younger at baseline; 753 patients died during observation (206 IDUs and 547 non-IDUs). The estimated 10-year survival probabilities were 53.2% [95% confidence interval (CI): 48.1,58.3] in the IDU group and 82.1% (95% CI: 80.7,83.6) in the non-IDU group. IDU as route of HIV infection more than tripled the mortality in HIV-infected patients (MRR: 3.2; 95% CI: 2.7,3.8). Adjusting for potential confounders did not change this estimate substantially. The risk of HIV-related death was not increased in IDUs compared to non-IDUs (MRR 1.1; 95% CI 0.7,1.7). Conclusions Although Denmark's health care system is tax paid and antiretroviral therapy is provided free of charge, HIV-infected IDUs still suffer from substantially increased mortality in the HAART era. The increased risk of death seems to be non-HIV-related and is due probably to the well-known risk factors associated with intravenous drug abuse. [source]

Ethnic Differences in Birth Outcomes in England,

FISCAL STUDIES, Issue 1 2006
Lorraine Dearden
Abstract This paper uses the Millennium Cohort Study to look at ethnic differences in birth outcomes for a cohort of English children born in 2000 and 2001. There is an increasingly large literature showing that longer gestation and higher birthweight are positively associated with cognitive and non-cognitive outcomes later in life, so understanding sources of ethnic differences in these outcomes and identifying factors that may influence birth outcomes has a lot of potential policy interest. This paper shows that even after controlling for background characteristics in a number of ways, there still remain unexplained differences in both gestation and birthweight outcomes across broad ethnic groups. It also suggests, however, that there may be potential policy levers that could be used to narrow this ethnic gap in birth outcomes, such as reducing the proportion of underweight Asian mothers and overweight Black mothers and increasing ethnic minority attendance at antenatal classes. [source]

Non-pecuniary returns to higher education: the effect on smoking intensity in the UK

HEALTH ECONOMICS, Issue 8 2010
Massimiliano Bratti
Abstract This paper investigates whether higher education (HE) produces non-pecuniary returns via a reduction in the intensity of consumption of health-damaging substances. In particular, it focuses on current smoking intensity of the British individuals sampled in the 29-year follow-up survey of the 1970 British Cohort Study. We estimate endogenous dummy ordinal response models for cigarette consumption and show that HE is endogenous with respect to smoking intensity and that even when endogeneity is accounted for, HE is found to have a strong negative effect on smoking intensity. Moreover, pecuniary channels, such as occupation and income, mediate only a minor part of the effect of HE. Our results are robust to modelling individual self-selection into current smoking participation (at age 29) and to estimating a dynamic model in which past smoking levels affect current smoking levels. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Primary Care Quality and Addiction Severity: A Prospective Cohort Study

HEALTH SERVICES RESEARCH, Issue 2 2007
Theresa W. Kim
Background. Alcohol and drug use disorders are chronic diseases that require ongoing management of physical, psychiatric, and social consequences. While specific addiction-focused interventions in primary care are efficacious, the influence of overall primary care quality (PCQ) on addiction outcomes has not been studied. The aim of this study was to prospectively examine if higher PCQ is associated with lower addiction severity among patients with substance use disorders. Study Population. Subjects with alcohol, cocaine, and/or heroin use disorders who initiated primary care after being discharged from an urban residential detoxification program. Measurements. We used the Primary Care Assessment Survey (PCAS), a well-validated, patient-completed survey that measures defining attributes of primary care named by the Institute of Medicine. Nine summary scales cover two broad areas of PCQ: the patient,physician relationship (communication, interpersonal treatment, thoroughness of the physical exam, whole-person knowledge, preventive counseling, and trust) and structural/organizational features of care (organizational access, financial access, and visit-based continuity). Each of the three addiction outcomes (alcohol addiction severity (ASI-alc), drug addiction severity (ASI-drug), and any drug or heavy alcohol use) were derived from the Addiction Severity Index and assessed 6,18 months after PCAS administration. Separate longitudinal regression models included a single PCAS scale as the main predictor variable as well as variables known to be associated with addiction outcomes. Main Results. Eight of the nine PCAS scales were associated with lower alcohol addiction severity at follow-up (p,.05). Two measures of relationship quality (communication and whole- person knowledge of the patient) were associated with the largest decreases in ASI-alc (,0.06). More whole-person knowledge, organizational access, and visit-based continuity predicted lower drug addiction severity (ASI-drug: ,0.02). Two PCAS scales (trust and whole-person knowledge of the patient) were associated with lower likelihood of subsequent substance use (adjusted odds ratio, [AOR]=0.76, 95 percent confidence interval [95% CI]=0.60, 0.96 and AOR=0.66, 95 percent CI=0.52, 0.85, respectively). Conclusion. Core features of PCQ, particularly those reflecting the quality of the physician,patient relationship, were associated with positive addiction outcomes. Our findings suggest that the provision of patient-centered, comprehensive care from a primary care clinician may be an important treatment component for substance use disorders. [source]

Tooth Loss and Helicobacter pylori Seropositivity: the Newcastle Thousand Families Cohort Study at Age 49,51 Years

HELICOBACTER, Issue 1 2005
Mark S. Pearce
ABSTRACT Background.,Helicobacter pylori, one of the commonest chronic bacterial infections of humankind, is an important risk factor for gastric carcinoma. It has also been suggested to be present in dental plaque. This study investigated the potential link between the number of teeth lost and H. pylori seropositivity at age 50 years. Methods.,H. pylori seropositivity at age 50 years was investigated among 334 individuals born in Newcastle upon Tyne, United Kingdom, in May and June 1947 and related to the number of teeth lost, after adjusting for socioeconomic status. Results., The unadjusted risk of being seropositive for H. pylori increased with increasing number of teeth lost (odds ratio per tooth 1.03, 95% confidence interval 1.01,1.06, p = .019). However, after adjustment for socioeconomic status at birth and at age 50 years, the relationship was no longer significant (p = .36). Conclusions., Our results, obtained using prospectively collected data, suggest that any relationship between poor oral health and seropositivity to H. pylori may be due to both tooth loss and H. pylori colonization being associated with socioeconomic status and related factors. [source]

How reliable is an undetectable viral load?

HIV MEDICINE, Issue 8 2009
C Combescure
Objectives An article by the Swiss AIDS Commission states that patients with stably suppressed viraemia [i.e. several successive HIV-1 RNA plasma concentrations (viral loads, VL) below the limits of detection during 6 months or more of highly active antiretroviral therapy (HAART)] are unlikely to be infectious. Questions then arise: how reliable is the undetectability of the VL, given the history of measures? What factors determine reliability? Methods We assessed the probability (henceforth termed reliability) that the n+1 VL would exceed 50 or 1000 HIV-1 RNA copies/mL when the nth one had been <50 copies/mL in 6168 patients of the Swiss HIV Cohort Study who were continuing to take HAART between 2003 and 2007. General estimating equations were used to analyse potential factors of reliability. Results With a cut-off at 50 copies/mL, reliability was 84.5% (n=1), increasing to 94.5% (n=5). Compliance, the current type of HAART and the first antiretroviral therapy (ART) received (HAART or not) were predictive factors of reliability. With a cut-off at 1000 copies/mL, reliability was 97.5% (n=1), increasing to 99.1% (n=4). Chart review revealed that patients had stopped their treatment, admitted to major problems with compliance or were taking non-HAART ART in 72.2% of these cases. Viral escape caused by resistance was found in 5.6%. No explanation was found in the charts of 22.2% of cases. Conclusions After several successive VLs at <50 copies/mL, reliability reaches approximately 94% with a cut-off of 50 copies/mL and approximately 99% with a cut-off at 1000 copies/mL. Compliance is the most important factor predicting reliability. [source]

Lipodystrophy and weight changes: data from the Swiss HIV Cohort Study, 2000,2006

HIV MEDICINE, Issue 3 2008
A Nguyen
Background and Objectives Combination antiretroviral therapy (cART) is changing, and this may affect the type and occurrence of side effects. We examined the frequency of lipodystrophy (LD) and weight changes in relation to the use of specific drugs in the Swiss HIV Cohort Study (SHCS). Methods In the SHCS, patients are followed twice a year and scored by the treating physician as having ,fat accumulation', ,fat loss', or neither. Treatments, and reasons for change thereof, are recorded. Our study sample included all patients treated with cART between 2003 and 2006 and, in addition, all patients who started cART between 2000 and 2003. Results From 2003 to 2006, the percentage of patients taking stavudine, didanosine and nelfinavir decreased, the percentage taking lopinavir, nevirapine and efavirenz remained stable, and the percentage taking atazanavir and tenofovir increased by 18.7 and 22.2%, respectively. In life-table Kaplan,Meier analysis, patients starting cART in 2003,2006 were less likely to develop LD than those starting cART from 2000 to 2002 (P<0.02). LD was quoted as the reason for treatment change or discontinuation for 4% of patients on cART in 2003, and for 1% of patients treated in 2006 (P for trend <0.001). In univariate and multivariate regression analysis, patients with a weight gain of ,5 kg were more likely to take lopinavir or atazanavir than patients without such a weight gain [odds ratio (OR) 2, 95% confidence interval (CI) 1.3,2.9, and OR 1.7, 95% CI 1.3,2.1, respectively]. Conclusions LD has become less frequent in the SHCS from 2000 to 2006. A weight gain of more than 5 kg was associated with the use of atazanavir and lopinavir. [source]

Hepatitis B virus and HIV coinfection: relationship of different serological patterns to survival and liver disease

HIV MEDICINE, Issue 5 2007
MK Osborn
Objectives Eighty per cent of HIV-positive patients show evidence of past or current infection with hepatitis B virus (HBV). The impact of chronic HBV infection or the presence of isolated HBV core antibody on survival in the era of highly active antiretroviral therapy (HAART) has not been well studied. Methods This retrospective analysis included patients from the HIV Atlanta Veterans Affairs Cohort Study (HAVACS). This cohort comprises 2818 HIV-positive patients followed since 1982. For this analysis, 1685 patients with available HBV serologies were included, based on laboratory records available since 1992. Adjusted survival analyses were performed for patients showing any of four serological patterns for HBV: (1) surface antigen positive (chronic HBV infection), (2) isolated core antibody, (3) surface antibody with or without core antibody (resolved/vaccinated) and (4) no HBV markers (negative group). Risk factors for liver disease were identified. Results A trend was seen for a lower survival rate from AIDS to death in the chronic HBV infection group compared with the negative group [hazard ratio (HR) 1.43; P=0.118]. The only independent predictor of lower survival rate was hepatitis C virus positivity (HR 1.62; P=0.008). Protective factors were use of HAART (HR 0.40; P=0.0003), use of lamivudine (HR 0.36; P<0.0001) and use of tenofovir (HR 0.23; P<0.0001). Survival from HIV diagnosis to death was not different among the HBV groups. Isolated core antibody patients did not have a lower survival rate compared with those with resolved HBV infection. Patients with chronic HBV infection were 3.5 times more likely to have liver disease than those with no HBV infection (P<0.02). Conclusions There is a trend towards a lower survival rate in patients with HIV and chronic HBV infection, but the difference did not reach statistical significance. The presence of isolated core antibody was not associated with a lower survival rate. [source]

Prevalence of risk factors for cardiovascular disease in HIV-infected patients over time: the Swiss HIV Cohort Study

HIV MEDICINE, Issue 6 2006
TR Glass
Objective Metabolic changes caused by antiretroviral therapy (ART) may increase the risk of coronary heart disease (CHD). We evaluated changes in the prevalence of cardiovascular risk factors (CVRFs) and 10-year risk of CHD in a large cohort of HIV-infected individuals. Methods All individuals from the Swiss HIV Cohort Study (SHCS) who completed at least one CVRF questionnaire and for whom laboratory data were available for the period February 2000 to February 2006 were included in the analysis. The presence of a risk factor was determined using cut-offs based on the guidelines of the National Cholesterol Education Program (NCEP ATP III), the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7), the American Diabetes Association, and the Swiss Society for Cardiology. Results Overall, 8033 individuals completed at least one CVRF questionnaire. The most common CVRFs in the first completed questionnaire were smoking (57.0%), low high-density lipoprotein (HDL) cholesterol (37.2%), high triglycerides (35.7%), and high blood pressure (26.1%). In total, 2.7 and 13.8% of patients were categorized as being at high (>20%) and moderate (10,20%) 10-year risk for CHD, respectively. Over 6 years the percentage of smokers decreased from 61.4 to 47.6% and the percentage of individuals with total cholesterol >6.2 mmol/L decreased from 21.1 to 12.3%. The prevalence of CVRFs and CHD risk was higher in patients currently on ART than in either pretreated or ART-naive patients. Conclusion During the 6-year observation period, the prevalence of CVRFs remains high in the SHCS. Time trends indicate a decrease in the percentage of smokers and individuals with high cholesterol. [source]

Birth outcomes in women with eating disorders in the Norwegian Mother and Child cohort study (MoBa)

INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 1 2009
Cynthia M. Bulik PhD
Abstract Objective We explored the impact of eating disorders on birth outcomes in the Norwegian Mother and Child Cohort Study. Method Of 35,929 pregnant women, 35 reported broad anorexia nervosa (AN), 304 bulimia nervosa (BN), 1,812 binge eating disorder (BED), and 36 EDNOS-purging type (EDNOS-P) in the six months before or during pregnancy. The referent comprised 33,742 women with no eating disorder. Results Pre-pregnancy body mass index (BMI) was lower in AN and higher in BED than the referent. AN, BN, and BED mothers reported greater gestational weight gain, and smoking was elevated in all eating disorder groups. BED mothers had higher birth weight babies, lower risk of small for gestational age, and higher risk of large for gestational age and cesarean section than the referent. Pre-pregnancy BMI and gestational weight gain attenuated the effects. Conclusion BED influences birth outcomes either directly or via higher maternal weight and gestational weight gain. The absence of differences in AN and EDNOS-P may reflect small numbers and lesser severity in population samples. Adequate gestational weight gain in AN may mitigate against adverse birth outcomes. Detecting eating disorders in pregnancy could identify modifiable factors (e.g., high gestational weight gain, binge eating, and smoking) that influence birth outcomes. © 2008 by Wiley Periodicals, Inc. Int J Eat Disord 2009 [source]

Chronic Kidney Disease and Cognitive Function in Older Adults: Findings from the Chronic Renal Insufficiency Cohort Cognitive Study

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2010
Kristine Yaffe MD
OBJECTIVES: To investigate cognitive impairment in older, ethnically diverse individuals with a broad range of kidney function, to evaluate a spectrum of cognitive domains, and to determine whether the relationship between chronic kidney disease (CKD) and cognitive function is independent of demographic and clinical factors. DESIGN: Cross-sectional. SETTING: Chronic Renal Insufficiency Cohort Study. PARTICIPANTS: Eight hundred twenty-five adults aged 55 and older with CKD. MEASUREMENTS: Estimated glomerular filtration rate (eGFR, mL/min per 1.73 m2) was estimated using the four-variable Modification of Diet in Renal Disease equation. Cognitive scores on six cognitive tests were compared across eGFR strata using linear regression; multivariable logistic regression was used to examine level of CKD and clinically significant cognitive impairment (score ,1 standard deviations from the mean). RESULTS: Mean age of the participants was 64.9, 50.4% were male, and 44.5% were black. After multivariable adjustment, participants with lower eGFR had lower cognitive scores on most cognitive domains (P<.05). In addition, participants with advanced CKD (eGFR<30) were more likely to have clinically significant cognitive impairment on global cognition (adjusted odds ratio (AOR) 2.0, 95% CI=1.1,3.9), naming (AOR=1.9, 95% CI=1.0,3.3), attention (AOR=2.4, 95% CI=1.3,4.5), executive function (AOR=2.5, 95% CI=1.9,4.4), and delayed memory (AOR=1.5, 95% CI=0.9,2.6) but not on category fluency (AOR=1.1, 95% CI=0.6,2.0) than those with mild to moderate CKD (eGFR 45,59). CONCLUSION: In older adults with CKD, lower level of kidney function was associated with lower cognitive function on most domains. These results suggest that older patients with advanced CKD should be screened for cognitive impairment. [source]

The Poor Outcome of Ischemic Stroke in Very Old People: A Cohort Study of Its Determinants

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2010
Licia Denti MD
OBJECTIVES: To assess how much of the excess risk of poor outcome from stroke in people aged 80 and older aging per se explains, independent of other prognostic determinants. DESIGN: Cohort, observational. SETTING: University hospital. PARTICIPANTS: One thousand five hundred fifty-five patients with first-ever ischemic stroke consecutively referred to an in-hospital Clinical Pathway program were studied. MEASUREMENTS: The relationship between age and 1-month outcome (death, disability (modified Rankin Scale 3,5), and poor outcome (modified Rankin Scale 3,6)) was assessed, with adjustment for several prognostic factors. RESULTS: Six hundred twelve patients aged 80 and older showed worse outcome after 1 month than those who were younger, in terms of mortality (19% vs 5%, hazard ratio (HR)=3.85, 95% confidence interval (CI)=2.8,5.4) and disability (51% vs 33%, odds ratio (OR)=3.16, 95% CI=2.5,4.0), although in multivariate models, the adjusted HR for mortality decreased to 1.47 (95% CI=1.0,2.16) and the ORs for disability and poor outcome decreased to 1.76 (95% CI=1.32,2.3.) and 1.83 (95% CI=137,2.43), respectively. Stroke severity, the occurrence of at least one medical complication, and premorbid disability explained most of the risk excess in the oldest-old. CONCLUSION: Stroke outcome is definitely worse in very old people, and most of the excess risk of death and disability is attributable to the higher occurrences of the most-severe clinical stroke syndromes and of medical complications in the acute phase. These represent potential targets for preventive and therapeutical strategies specifically for elderly people. [source]

Clinical Features to Identify Urinary Tract Infection in Nursing Home Residents: A Cohort Study

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2009
(See editorial comments by Lindsay Nicolle on pp 111, 1114)
OBJECTIVES: To identify clinical features associated with bacteriuria plus pyuria in noncatheterized nursing home residents with clinically suspected urinary tract infection (UTI). DESIGN: Prospective, observational cohort study from 2005 to 2007. SETTING: Five New Haven, Connecticut area nursing homes. PARTICIPANTS: Five hundred fifty-one nursing home residents each followed for 1 year for the development of clinically suspected UTI. MEASUREMENTS: The combined outcome of bacteriuria (>100,000 colony forming units from urine culture) plus pyuria (>10 white blood cells from urinalysis). RESULTS: After 178,914 person-days of follow-up, 228 participants had 399 episodes of clinically suspected UTI with a urinalysis and urine culture performed; 147 episodes (36.8%) had bacteriuria plus pyuria. The clinical features associated with bacteriuria plus pyuria were dysuria (relative risk (RR)=1.58, 95% confidence interval (CI)=1.10,2.03), change in character of urine (RR=1.42, 95% CI=1.07-1.79), and change in mental status (RR=1.38, 95% CI=1.03,1.74). CONCLUSION: Dysuria, change in character of urine, and change in mental status were significantly associated with the combined outcome of bacteriuria plus pyuria. Absence of these clinical features identified residents at low risk of having bacteriuria plus pyuria (25.5%), whereas presence of dysuria plus one or both of the other clinical features identified residents at high risk of having bacteriuria plus pyuria (63.2%). Diagnostic uncertainty still remains for the vast majority of residents who meet only one clinical feature. If validated in future cohorts, these clinical features with bacteriuria plus pyuria may serve as an evidence-based clinical definition of UTI to assist in management decisions. [source]

Short-Term Mortality in Relation to Age and Comorbidity in Older Adults with Community-Acquired Bacteremia: A Population-Based Cohort Study

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2008
Mette Søgaard DVM
OBJECTIVES: To assess 30-day mortality from bacteremia in relation to age and comorbidity and the association between age and mortality with increasing comorbidity. DESIGN: Population-based cohort study. SETTING: North Jutland County, Denmark. PARTICIPANTS: Adults in medical wards with community-acquired bacteremia, 1995 to 2004. MEASUREMENTS: Smoothed mortality curves and computed mortality rate ratios (MRRs) using Cox regression analysis. RESULTS: Two thousand eight hundred fifty-one patients, 851 aged 15 to 64, 1,092 aged 65 to 79, and 909 aged 80 and older were included. Mortality increased linearly with age. Compared with patients younger than 65, adjusted MRRs in patients aged 65 to 79 and 80 and older were 1.5 (95% confidence interval (CI)=1.2,2.0) and 1.8 (95% CI=1.4,2.3), respectively. Mortality also increased with level of comorbidity. Compared with patients with low comorbidity, adjusted MRRs in patients with medium and high comorbidity were 1.5 (95% CI=1.2,1.8) and 1.7 (95% CI=1.4,2.2), respectively. Regardless of the level of comorbidity, MRRs were consistently higher in older than in younger patients. CONCLUSION: Older age and greater comorbidity predicted mortality, and increasing age-related comorbidity did not explain the effect of age. [source]

Lower Levels of Serum Albumin and Total Cholesterol Associated with Decline in Activities of Daily Living and Excess Mortality in a 12-Year Cohort Study of Elderly Japanese

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2008
Tomonori Okamura MD
OBJECTIVES: To examine the association between levels of serum albumin and total cholesterol (TC) and risk of subsequent mortality and future decline in activities of daily living (ADLs) in elderly people. DESIGN: Population-based cohort study. SETTING: National Integrated Project for Prospective Observation of Non-Communicable Disease and Its Trends in the Aged, 1980. PARTICIPANTS: One thousand eight hundred forty-four Japanese individuals aged 60 to 74 randomly selected throughout Japan and followed for 12.4 years. MEASUREMENTS: Decline in ADLs and mortality. RESULTS: After adjusting for other covariates, the multivariable odds ratios (ORs) of impaired ADLs were highest in the lowest albumin quartile (,40 g/L) for women. The multivariable OR of having a composite outcome of death or impaired ADL for the lowest albumin quartile compared with the highest was 1.56 (95% confidence interval (CI)=1.94,2.57) for men and 3.06 (95% CI=1.89,4.95) for women. Serum albumin was significantly and inversely associated with a composite outcome of death or impaired ADLs in the group below the median of TC in both sexes (multivariable OR for 1-g/L increase in serum albumin=0.88 for men (95% CI=0.79,0.97) and 0.79 for women (95% CI=0.72,0.87)), which was not significantly associated in the group with TC at or above the median. CONCLUSION: In the Japanese general population, low-normal serum albumin and TC levels are associated with loss of activity during old age, especially for women. [source]

Age-Varying Association Between Blood Pressure and Risk of Dementia in Those Aged 65 and Older: A Community-Based Prospective Cohort Study

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2007
Ge Li MD
OBJECTIVES: To assess variation in the association between blood pressure (BP) and risk for dementia across a spectrum of older ages and to examine BP changes before dementia onset. DESIGN: Prospective cohort study. SETTING: A large health maintenance organization in Seattle, Washington. PARTICIPANTS: A cohort of 2,356 members of a large health maintenance organization aged 65 and older who were initially without dementia. MEASUREMENTS: Dementia diagnosis was assessed biennially, and systolic (SBP) and diastolic BP (DBP) were measured at baseline and at four follow-up assessments. Cox proportional hazards models were used to estimate hazard ratios (HRs) for dementia and Alzheimer's disease (AD) associated with baseline BP in different age groups. RESULTS: Within the youngest age group (65,74 at enrollment) a greater risk for dementia was found in participants with high SBP (,160 mmHg) (hazard ratio (HR)=1.60, 95% confidence interval (CI)=1.01,2.55) or borderline-high DBP (80,89 mmHg) (HR=1.59, 95% CI=1.07,2.35) than for those with normal BP (SBP <140 mmHg and DBP <80 mmHg). The dementia risk associated with SBP declined with increasing age (SBP-by-age interaction, P=.01). SBP declined similarly with aging in subjects who developed dementia and those who did not. Thus, in this sample, the association between SBP and dementia risk was not dependent on when BP was measured in relation to onset of dementia. CONCLUSION: High SBP was associated with greater risk of dementia in the young elderly (<75) but not in older subjects. Adequate control of hypertension in early old age may reduce the risk for dementia. [source]

More Broken Bones: A 4-Year Double Cohort Study of Young Girls With and Without Distal Forearm Fractures

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 10 2000
A. Goulding
Abstract Predictors of childhood fractures have not been investigated previously. This study was undertaken to determine whether a previous history of forearm fracture, low bone mineral density (BMD; both areal bone mineral density [aBMD, g/cm2] and volumetric bone mineral apparent density [BMAD, g/cm3]), or anthropometry, influence fracture risk in young girls. At baseline, two cohorts of girls, aged 3,15 years, were evaluated: 100 had recently broken a forearm (group 1) and 100 were fracture free (group 2). Four years later we restudied 170 of these girls (82 from group l and 88 from group 2). We now report the relationships of previous fracture history, baseline BMD (measured by dual-energy X-ray absorptiometry), baseline weight, and height to risk of new fracture. More new fractures occurred in group l (37 fractures in 24 girls) than in group 2 (8 fractures in 7 girls; p = 0.0007). The independent predictors for occurrence of a new fracture at any skeletal site in a multivariate model adjusting for age, weight, total body aBMD, and fracture history were previous fracture (hazard ratio [HR], 3.28; 95% CI, 1.41-7.64); age (HR per l-year increase, 0.91; 95% CI, 0.84-0.99); total body aBMD (HR per l SD decrease, 1.92; 95% CI, 1.31-2.81); and body weight (HR per l SD increase, 1.49; 95% CI, 1.06-2.08). Girls with two risk factors together had substantially greater fracture risk: previous fracture and low spinal BMAD (HR, 9.4; 95% CI, 2.8-32.0), previous fracture and high body weight (HR, 10.2; 95% CI, 2.8-37.6), or previous fracture and low total body aBMD (HR, 13.0; 95% CI, 3.9-43.1). We conclude that previous forearm fracture, low total body aBMD, low spinal BMAD, and high body weight each increase risk of new fractures within 4 years in young girls. Interventions to reduce the risk of fractures, particularly forearm fractures, in girls warrant further study. [source]

Investigation of pre-diagnostic virological markers for progressive multifocal leukoencephalopathy in human immunodeficiency virus-infected patients

JOURNAL OF MEDICAL VIROLOGY, Issue 7 2009
Mary K. Grabowski
Abstract Progressive multifocal leukoencephalopathy (PML) is a severe neurological disorder due to JC virus (JCV) infection. Pre-diagnostic biological markers and risk factors for PML are not well understood. We conducted a case,control study nested within the Multicenter AIDS Cohort Study to examine the association between JCV viruria and viremia and serum antibody to JCV capsids, in relation to subsequent PML diagnoses, 5 months to 12 years later. Other demographic and immunologic factors were also examined. The study population included 28 incident cases of PML, 26 matched HIV-positive controls, and 50 HIV-negative controls. Prevalence of JCV viruria was 37% in cases, 42% in HIV-positive controls, and 28% in HIV-negative controls (P,=,0.43). Among persons with JCV viruria, persistent viruria was more common in cases (89%) than in HIV-positive controls (33%) (P,=,0.02). Presence of JCV viruria was not related to the time to PML diagnosis (OR: 1.03, 95% CI: 0.8,1.4); however, the urinary concentration of JCV DNA increased with proximity to the date of PML diagnosis in cases. JCV seropositivity did not differ between cases or controls (P,=,0.42). Four cases tested JCV seronegative, including one case only 5 months prior to diagnosis with PML. JCV DNA was detected in the serum of one HIV-positive control. Smoking was the only demographic variable analyzed associated with an increased risk for PML (MOR: 9.0, 95% CI: 1.2,394.5). The results suggest that persistent JCV viruria and increasing urinary concentration of JCV DNA may be predictive of PML for some patients. J. Med. Virol. 81:1140,1150, 2009. © 2009 Wiley-Liss, Inc. [source]

Exploring social mobility with latent trajectory groups

JOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES A (STATISTICS IN SOCIETY), Issue 1 2008
Patrick Sturgis
Summary., We present a new methodological approach to the study of social mobility. We use a latent class growth analysis framework to identify five qualitatively distinct social class trajectory groups between 1980 and 2000 for male respondents to the 1970 British Cohort Study. We model the antecedents of trajectory group membership via multinomial logistic regression. Non-response, which is a considerable problem in long-term panels and cohort studies, is handled via direct maximum likelihood estimation, which is consistent and efficient when data are missing at random. Our results suggest a combination of meritocratic and ascriptive influences on the probability of membership in the different trajectory groups. [source]

Common Health Hazards in French Pilgrims During the Hajj of 2007: A Prospective Cohort Study

JOURNAL OF TRAVEL MEDICINE, Issue 6 2009
Philippe Gautret MD
Background. The majority of published studies on Hajj-related diseases were based on hospitalized patient cohorts. Methods. A total of 545 Hajj pilgrims from Marseille were enrolled in a prospective epidemiological study to evaluate the incidence of common health hazards. They were administered a questionnaire before traveling addressing demographic factors and health status indicators and a post-travel questionnaire about travel-associated diseases. Results. Respondents had a median age of 61 years and originated mainly from North Africa (81%). A significant proportion of individuals had chronic medical disorders such as walking disability (26%), diabetes mellitus (21%), and hypertension (21%). A total of 462 pilgrims were administered a questionnaire on returning home. A proportion of 59% of travelers presented at least one health problem during the pilgrimage and 44% of the cohort attended a doctor during travel; 3% were hospitalized. Cough was the main complaint among travelers (attack rate of 51%), followed by headache, heat stress, and fever. Few travelers suffered diarrhea and vomiting. Cardiovascular diseases, neurological disorders, trauma, skin and gastrointestinal problems were not frequently observed in our survey, suggesting that their prevalence among the causes of admission to Saudi hospitals reflects a bias of selection. Cough episodes were significantly more frequent in individuals >55 years. We also evidenced that women were more likely to present underlying chronic cardiovascular disorder and diabetes compared to men and that they more frequently suffered from cough episodes associated with fever during the Hajj. Conclusions. Health risks associated with the Hajj in our experience are much more related to crowding conditions than to travel. Our work suggests that the studies performed in Saudi specialized units probably overestimate the part of certain diseases within the spectrum of Hajj-associated diseases. Our results also suggest that old female Hajjes should be considered as a high-risk population and that preventive measures should be reinforced before departing for Saudi Arabia. [source]

Outcomes in hepatitis C virus,infected recipients of living donor vs. deceased donor liver transplantation,,§¶

LIVER TRANSPLANTATION, Issue 1 2007
Norah A. Terrault
In this retrospective study of hepatitis C virus (HCV),infected transplant recipients in the 9-center Adult to Adult Living Donor Liver Transplantation Cohort Study, graft and patient survival and the development of advanced fibrosis were compared among 181 living donor liver transplant (LDLT) recipients and 94 deceased donor liver transplant (DDLT) recipients. Overall 3-year graft and patient survival were 68% and 74% in LDLT, and 80% and 82% in DDLT, respectively. Graft survival, but not patient survival, was significantly lower for LDLT compared to DDLT (P = 0.04 and P = 0.20, respectively). Further analyses demonstrated lower graft and patient survival among the first 20 LDLT cases at each center (LDLT ,20) compared to later cases (LDLT > 20; P = 0.002 and P = 0.002, respectively) and DDLT recipients (P < 0.001 and P = 0.008, respectively). Graft and patient survival in LDLT >20 and DDLT were not significantly different (P = 0.66 and P = 0.74, respectively). Overall, 3-year graft survival for DDLT, LDLT >20, and LDLT ,20 were 80%, 79% and 55%, with similar results conditional on survival to 90 days (84%, 87% and 68%, respectively). Predictors of graft loss beyond 90 days included LDLT ,20 vs. DDLT (hazard ratio [HR] = 2.1, P = 0.04), pretransplant hepatocellular carcinoma (HCC) (HR = 2.21, P = 0.03) and model for end-stage liver disease (MELD) at transplantation (HR = 1.24, P = 0.04). In conclusion, 3-year graft and patient survival in HCV-infected recipients of DDLT and LDLT >20 were not significantly different. Important predictors of graft loss in HCV-infected patients were limited LDLT experience, pretransplant HCC, and higher MELD at transplantation. Liver Transpl 13:122,129, 2007. © 2006 AASLD. [source]

Methodological challenges when monitoring the diet of pregnant women in a large study: experiences from the Norwegian Mother and Child Cohort Study (MoBa)

MATERNAL & CHILD NUTRITION, Issue 1 2008
Helle Margrete Meltzer
Abstract The aim of this article is to describe the main methodological challenges in the monitoring of dietary intake in the Norwegian Mother and Child Cohort Study (MoBa), a pregnancy cohort aiming to include 100 000 participants. The overall challenge was to record dietary patterns in sufficient detail to support future testing of a broad range of hypotheses, while at the same time limiting the burden on the participants. The main questions to be answered were: which dietary method to choose, when in pregnancy to ask, which time period should the questions cover, which diet questions to include, how to perform a validation study, and how to handle uncertainties in the reporting. Our decisions were as follows: using a semi-quantitative food frequency questionnaire (FFQ) (in use from 1 March 2002), letting the participants answer in mid-pregnancy, and asking the mother what she has eaten since she became pregnant. The questions make it possible to estimate intake of food supplements, antioxidants and environmental contaminants in the future. Misreporting is handled by consistency checks. Reports with a calculated daily energy intake of <4.5 and >20 MJ day,1 are excluded, about 1% in each end of the scale. A validation study confirmed that the included intakes are realistic. The outcome of our methodological choices indicates that our FFQ strikes a reasonable balance between conflicting methodological and scientific interests, and that our approach therefore may be of use to others planning to monitor diet in pregnancy cohorts. [source]