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P Trend (p + trend)
Selected AbstractsAssociations Between Lower Extremity Ischemia, Upper and Lower Extremity Strength, and Functional Impairment with Peripheral Arterial DiseaseJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2008Mary M. McDermott MD OBJECTIVES: To identify associations between lower extremity ischemia and leg strength, leg power, and hand grip in persons with and without lower extremity peripheral arterial disease (PAD). To determine whether poorer strength may mediate poorer lower extremity performance in persons with lower arterial brachial index (ABI) levels. DESIGN: Cross-sectional. SETTING: Academic medical centers. PARTICIPANTS: Four hundred twenty-four persons with PAD and 271 without PAD. MEASUREMENTS: Isometric knee extension and plantarflexion strength and handgrip strength were measured using a computer-linked strength chair. Knee extension power was measured using the Nottingham leg rig. ABI, 6-minute walk, and usual and fastest 4-m walking velocity were measured. Results were adjusted for potential confounders. RESULTS: Lower ABI values were associated with lower plantarflexion strength (P trend=.04) and lower knee extension power (P trend <.001). There were no significant associations between ABI and handgrip or knee extension isometric strength. Significant associations between ABI and measures of lower extremity performance were attenuated after additional adjustment for measures of strength. CONCLUSION: These results are consistent with the hypothesis that lower extremity ischemia impairs strength specifically in distal lower extremity muscles. Associations between lower extremity ischemia and impaired lower extremity strength may mediate associations between lower ABI values and greater functional impairment. [source] Lipids, lipoproteins and the risk of benign prostatic hyperplasia in community-dwelling menBJU INTERNATIONAL, Issue 3 2008J. Kellogg Parsons OBJECTIVE To examine the associations of serum lipids and lipoproteins with benign prostatic hyperplasia (BPH) in community-dwelling men. SUBJECTS AND METHODS This analysis was conducted within the Rancho Bernardo Study, a prospective, community-based cohort study. BPH was defined as a history of prostate surgery for other than cancer, or a medical diagnosis of BPH. Logistic regression modelling, with adjustments for age and stratification by diabetes diagnosis, was used to estimate the odds ratio (OR) of BPH associated with fasting serum concentrations of total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and the triglyceride to HDL ratio. RESULTS Among 531 eligible participants, 259 (48%) reported BPH and 272 (52%) reported no BPH. Men with BPH, with a mean (range) age of 75.8 (76.1,80.1) years, were older than men without BPH , at 72.7 (72.4,74.0) years. There were no significant associations of total cholesterol (P trend, 0.52), HDL cholesterol (0.56), triglycerides (0.30), or triglyceride to HDL ratio (0.13) with the risk of BPH. In a subset analysis in men with diabetes, those in the highest tertile (>133 mg/dL) of LDL cholesterol, compared with those in the lowest tertile (<110 mg/dL), were four times more likely to have BPH (odds ratio 4.00, 95% confidence interval 1.27,12.63, P trend 0.02). These results were not explained by the use of statins. CONCLUSIONS In these community-dwelling men, higher serum LDL was associated with a greater risk of BPH among diabetics. These data suggest that diabetic men with increased LDL cholesterol are at greater risk of BPH. This observation is consistent with the concept that cardiac risk factors are involved with the pathogenesis of BPH. [source] Dietary intakes of ,-6 and ,-3 polyunsaturated fatty acids and the risk of breast cancerINTERNATIONAL JOURNAL OF CANCER, Issue 4 2009Anne C.M. Thiébaut Abstract Experimental studies suggest detrimental effects of ,-6 polyunsaturated fatty acids (PUFA), and beneficial effects of ,-3 PUFAs on mammary carcinogenesis, possibly in interaction with antioxidants. However, PUFA food sources are diverse in human diets and few epidemiologic studies have examined whether associations between dietary PUFAs and breast cancer risk vary according to food sources or antioxidant intakes. The relationship between individual PUFA intakes estimated from diet history questionnaires and breast cancer risk was examined among 56,007 French women. During 8 years of follow-up, 1,650 women developed invasive breast cancer. Breast cancer risk was not related to any dietary PUFA overall; however, opposite associations were seen according to food sources, suggesting other potential effects than PUFA per se. Breast cancer risk was inversely associated with ,-linolenic acid (ALA) intake from fruit and vegetables [highest vs. lowest quintile, hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.63, 0.88; p trend < 0.0001], and from vegetable oils (HR 0.83; 95% CI 0.71, 0.97; p trend 0.017). Conversely, breast cancer risk was positively related to ALA intake from nut mixes (p trend 0.004) and processed foods (p trend 0.068), as was total ALA intake among women in the highest quintile of dietary vitamin E (p trend 0.036). A significant interaction was also found between ,-6 and long-chain ,-3 PUFAs, with breast cancer risk inversely related to long-chain ,-3 PUFAs in women belonging to the highest quintile of ,-6 PUFAs (p interaction 0.042). These results emphasize the need to consider food sources, as well as interactions between fatty acids and with antioxidants, when evaluating associations between PUFA intakes and breast cancer risk. © 2008 Wiley-Liss, Inc. [source] Dietary zinc, copper and selenium, and risk of lung cancerINTERNATIONAL JOURNAL OF CANCER, Issue 5 2007Somdat Mahabir Abstract Zinc, copper and selenium are important cofactors for several enzymes that play a role in maintaining DNA integrity. However, limited epidemiologic research on these dietary trace metals and lung cancer risk is available. In an ongoing study of 1,676 incident lung cancer cases and 1,676 matched healthy controls, we studied the associations between dietary zinc, copper and selenium and lung cancer risk. Using multiple logistic regression analysis, the odds ratios (OR) and 95% confidence intervals (CI) of lung cancer for all subjects by increasing quartiles of dietary zinc intake were 1.0, 0.80 (0.65,0.99), 0.64 (0.51,0.81), 0.57 (0.42,0.75), respectively (p trend = 0.0004); similar results were found for men. For dietary copper, the ORs and 95% CI for all subjects were 1.0, 0.59 (0.49,0.73), 0.51 (0.41,0.64), 0.34 (0.26,0.45), respectively (p trend < 0.0001); similar reductions in risk and trend were observed by gender. Dietary selenium intake was not associated with risk, except for a significant inverse trend (p = 0.04) in men. Protective trends (p < 0.05) against lung cancer with increased dietary zinc intake were also found for all ages, BMI > 25, current smokers, pack-years ,30, light drinkers and participants without emphysema. Increased dietary copper intake was associated with protective trends (p < 0.05) across all ages, BMI, smoking and vitamin/mineral supplement categories, pack-years ,30 and 30.1,51.75 and participants without emphysema. Our results suggest that dietary zinc and copper intakes are associated with reduced risk of lung cancer. Given the known limitations of case,control studies, these findings must be interpreted with caution and warrant further investigation. © 2006 Wiley-Liss, Inc. [source] The Influence of an Insulin-Like Growth Factor I Gene Promoter Polymorphism on Hip Bone Geometry and the Risk of Nonvertebral Fracture in the Elderly: The Rotterdam Study,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 8 2004Fernando Rivadeneira Abstract The absence of the wildtype allele of a promoter polymorphism of the IGF-I gene is associated with increased risk (1.5; 95% CI, 1.1-2.0) of fragility fracture in women (n = 4212) but not in men (n = 2799). An approximation of hip bone geometry (from DXA) suggested the polymorphism is associated with bone strength and stability in gender-specific ways. Introduction: Previously, we found a CA-repeat promoter polymorphism in the insulin-like growth factor I (IGF-I) gene associated with IGF-I levels and BMD in postmenopausal women, but the relationship with fractures is unclear. In this large population-based study of elderly men and women, we examined the association between this IGF-I promoter polymorphism with parameters of bone geometry and the occurrence of fractures. Material and Methods: Within the Rotterdam Study, a prospective population-based cohort, the IGF-I polymorphism was analyzed in relation to incident nonvertebral fractures in 2799 men and 4212 women followed on average for 8.6 years. Furthermore, we estimated structural parameters of hip bone geometry indirectly from DXA outputs of the femoral neck in 2372 men and 3114 women. We studied neck width, cortical thickness, and the cortical buckling ratio and the section modulus as indexes of bone stability and bending strength. Results: Women heterozygotes and noncarriers of the allele had, respectively, 1.2 (95% CI, 1.0-1.5) and 1.5 (95% CI, 1.1-2.0) increased risk of having a fragility fracture at older age compared with homozygotes for the 192-bp allele (p trend = 0.0007). In men, fracture risk was not influenced by the polymorphism. Compared with homozygotes for the 192-bp allele, noncarrier males had ,1% narrower femoral necks and 2.2% lower section moduli (p trend < 0.05). Noncarrier females had 1.7% thinner cortices and 1.6% higher buckling ratios (p trend < 0.05) but no significant differences in femoral neck widths and section moduli. In women with low body mass index, genotype differences in bone strength (section modulus) and fracture risk were accentuated (p interaction = 0.05). The genotype-dependent differences in hip bone geometry did not fully explain the genotype-dependent differences in fracture risk. Conclusions: The CA-repeat promoter polymorphism in the IGF-I gene is associated with the risk for fragility fracture at old age in women and with bone structure in both genders. [source] Declining Antibiotic Prescriptions for Upper Respiratory Infections, 1993,2004ACADEMIC EMERGENCY MEDICINE, Issue 4 2007Stefan G. Vanderweil BA Abstract Objectives: To examine antibiotic prescribing trends for U.S. emergency department (ED) visits with upper respiratory tract infections (URIs) between 1993 and 2004. Methods: Data were compiled from the National Hospital Ambulatory Medical Care Survey (NHAMCS). URI visits were identified by using ICD-9-CM code 465.9, whereas antibiotics were identified using the National Drug Code Directory class Antimicrobials. A multivariate logistic regression model revealed sociodemographic and geographic factors that were independently associated with receipt of an antibiotic prescription for URIs. Results: There were approximately 23.4 million ED visits diagnosed as URIs between 1993 and 2004. Although the proportion of URI diagnoses remained relatively stable (p trend = 0.26), a significant decrease in provision of antibiotic prescriptions for URIs occurred during this 12-year period, from a maximum of 55% in 1993, to a minimum of 35% in 2004. Patients who were prescribed antibiotics were more likely to be white than African American and to have been treated in EDs located in the southern United States. Conclusions: Antibiotic prescribing for URIs continues to decrease, a favorable trend that suggests that national efforts to reduce inappropriate antibiotic usage are having some success. Nevertheless, the frequency of antibiotic treatment for URI in the ED remains high (35%). Future efforts to reduce inappropriate antibiotic prescribing may focus on patients and physicians in southern U.S. EDs. Additional work is needed to address continued evidence of race-related disparities in care. [source] | ||||||||||