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Strongest Determinant (strongest + determinant)
Selected AbstractsDiurnal triglyceridaemia and insulin resistance in mildly obese subjects with normal fasting plasma lipidsJOURNAL OF INTERNAL MEDICINE, Issue 1 2004C. J. M. Halkes Abstract. Objective., A novel method has been developed to study diurnal triglyceride (TG) profiles using repeated capillary self-measurements in an ,out-of-hospital' situation. We assessed the diurnal capillary TG (TGc) profile in males with mild obesity and evaluated the use of plasma and capillary TG as markers of insulin resistance. Design., Cross-sectional study. Setting and Subjects., Fifty-four lean (body mass index, BMI < 25 kg m,2) and 27 mildly obese (25 < BMI < 30 kg m,2), normolipidaemic males measured capillary TG concentrations on six fixed time-points over a 3-day period in an ,out-of-hospital' situation. Main outcome measures., The total area under the TGc curve (TGc-AUC) and incremental area under the TGc curve (TGc-IAUC) were used as estimation of diurnal triglyceridaemia. Fasting blood samples were obtained once. Food intake was recorded by all participants. Results., Obese and lean subjects had comparable fasting capillary TG concentrations (1.37 ± 0.40 mmol L,1 and 1.32 ± 0.53 mmol L,1, respectively). However, during the day, obese subjects showed a greater TG increase, resulting in significantly higher TGc-AUC (27.1 ± 8.4 and 23.0 ± 6.3 mmol h,1 l,1, respectively; P < 0.05) and TGc-IAUC (7.9 ± 5.8 and 4.6 ± 6.6 mmolh,1 L,1, respectively; P < 0.05). The total group of 81 males was divided into quartiles based on fasting plasma TG, fasting capillary TG, TGc-AUC and TGc-IAUC. Amongst these variables, TGc-AUC was the only significant discriminator of subjects with high homeostasis model assessment (HOMA) (insulin resistance) compared with low HOMA (insulin sensitive). Overall, BMI was the strongest determinant of HOMA. Conclusions., Diurnal TG profiles can be used to investigate postprandial lipaemia in both lean and mildly obese subjects and may help to detect subjects with an underlying disposition for hypertriglyceridaemia related to insulin resistance, i.e. the metabolic syndrome. [source] Nationwide linkage analysis in Scotland implicates age as the critical overall determinant of mortality in ulcerative colitisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 12 2010R. J. NICHOLLS Aliment Pharmacol Ther,31, 1310,1321 Summary Background, Recent data associated higher mortality with medical rather than surgical intervention in patients with ulcerative colitis who require hospitalization. Aim, To examine factors influencing UC-related mortality in Scotland. Method, Using the national record linkage database 1998,2000, 3-year mortality was determined after four admission types: colectomy-elective or emergency; no colectomy-elective or emergency. Results, Of 1078 patients, crude 3-year mortality rates were: colectomy elective 5.6% (n = 177) and emergency 9.0% (100); no colectomy elective 9.8% (244) and emergency 16.0% (557). Using elective colectomy as reference, multivariate analysis [OR (95% CI)] showed that admission age >50 years [OR 5.46 (2.29,11.95)], male gender [OR 1.92 (1.23,3.02)], comorbidity [OR 2.2 (1.38,3.51)], length of stay >15 days [OR 2.04 (1.08,3.84)] and prior IBD admission [OR 1.66 (1.06,2.61)] were independently related to mortality. Age was the strongest determinant. No patient <30 years died. Mortality of patients aged <50 years [10/587 (1.7%)] was significantly lower than mortality of those aged 50,64 years [26/246 (10.6%)] (,2 = 32.91; P < 0.0000001) and >65 [96/245 (39.2%)] (,2 = 218.2; P < 0.0000001). For those patients aged more than 65 years, mortality in the four groups was 29.4%, 33.3%, 28.1% and 44.7%, all greater than expected in the Scottish population on assessment of standardized mortality ratios. Conclusion, Hospital admission in UC patients >65 is associated with high mortality. Management strategies should consider this by treatment in specialist units, early investigation, focused medical treatment and earlier surgical referral. [source] Clinical and demographic determinants of heart rate variability in patients post myocardial infarction: Insights from the cardiac arrhythmia suppression trial (CAST)CLINICAL CARDIOLOGY, Issue 3 2000Phyllis K. Stein PH.D. Abstract Background: Clinical and demographic determinants of heart rate variability (HRV), an almost universal predictor of increased mortality, have not been systematically investigated in patients post myocardial infarction (MI). Hypothesis: The study was undertaken to evaluate the relationship between pretreatment clinical and demographic variables and HRV in the Cardiac Arrhythmia Suppression Trial (CAST). Methods: CAST patients were post MI and had , 6 ventricular premature complexes/h on pretreatment recording. Patients in this substudy (n = 769) had usable pretreatment and suppression tapes and were successfully randomized on the first antiarrhythmic treatment. Tapes were rescanned; only time domain HRV was reported because many tapes lacked the calibrated timing signal needed for accurate frequency domain analysis. Independent predictors of HRV were determined by stepwise selection. Results: Coronary artery bypass graft surgery (CABG) after the qualifying MI was the strongest determinant of HRV. The markedly decreased HRV associated with CABG was not associated with increased mortality. Ejection fraction and diabetes were also independent predictors of HRV. Other predictors for some indices of HRV included beta-blocker use, gender, time from MI to Holter, history of CABG before the qualifying MI, and systolic blood pressure. Decreased HRV did not predict mortality for the entire group. For patients without CABG or diabetes, decreased standard deviation of all NN intervals (SDANN) predicted mortality. Clinical and demographic factors accounted for 31% of the variance in the average of normal-to-normal intervals (AVGNN) and 13,26% of the variance in other HRV indices. Conclusions: Heart rate variability post MI is largely independent of clinical and demographic factors. Antecedent CABG dramatically reduces HRV. Recognition of this is necessary to prevent misclassification of risk in patients post infarct. [source] Determinants of vertebrate invasion success in Europe and North AmericaGLOBAL CHANGE BIOLOGY, Issue 9 2006JONATHAN M. JESCHKE Abstract Species that are frequently introduced to an exotic range have a high potential of becoming invasive. Besides propagule pressure, however, no other generally strong determinant of invasion success is known. Although evidence has accumulated that human affiliates (domesticates, pets, human commensals) also have high invasion success, existing studies do not distinguish whether this success can be completely explained by or is partly independent of propagule pressure. Here, we analyze both factors independently, propagule pressure and human affiliation. We also consider a third factor directly related to humans, hunting, and 17 traits on each species' population size and extent, diet, body size, and life history. Our dataset includes all 2362 freshwater fish, mammals, and birds native to Europe or North America. In contrast to most previous studies, we look at the complete invasion process consisting of (1) introduction, (2) establishment, and (3) spread. In this way, we not only consider which of the introduced species became invasive but also which species were introduced. Of the 20 factors tested, propagule pressure and human affiliation were the two strongest determinants of invasion success across all taxa and steps. This was true for multivariate analyses that account for intercorrelations among variables as well as univariate analyses, suggesting that human affiliation influenced invasion success independently of propagule pressure. Some factors affected the different steps of the invasion process antagonistically. For example, game species were much more likely to be introduced to an exotic continent than nonhunted species but tended to be less likely to establish themselves and spread. Such antagonistic effects show the importance of considering the complete invasion process. [source] Predictors of colorectal cancer screening from patients enrolled in a managed care health plan,CANCER, Issue 6 2008Melissa M. Farmer PhD Abstract BACKGROUND Despite the growing recognition of the importance of colorectal cancer (CRC) screening in reducing cancer mortality, national screening rates are low, indicating a critical need to understand the barriers and remedies for underutilization of CRC screening tests. METHODS Using results from independent cross-sectional telephone surveys with patients aged ,50 years performed before (2000; n = 498) and after (2003; n = 482) a quality improvement intervention for CRC screening within a large managed care health plan, the trends and predictors of CRC screening with fecal occult blood test (FOBT) and/or endoscopy (flexible sigmoidoscopy/colonoscopy) were examined from a patient perspective. RESULTS In 2000, patient reported screening rates within guidelines were 38% for any test, 23% for endoscopy, and 22% for FOBT. In 2003, screening rates increased to 50% for any test, 39% for endoscopy, and 24% for FOBT. Having discussed CRC with a doctor significantly increased the odds of being screened (FOBT: odds ratio [OR], 2.09 [95% confidence interval (95% CI), 1.47,2.96]; endoscopy: OR, 2.33 [95% CI, 1.67,3.26]; and any test: OR, 2.86 [95% CI, 2.06,3.96]), and reporting barriers to CRC in general decreased the odds of being screened (FOBT: OR, 0.76 [95% CI, 0.60,0.95]; endoscopy: OR, 0.74 [95% CI, 0.60,0.92]; and any test: OR, 0.66 [95% CI, 0.54,0.80]). CONCLUSIONS Although screening rates increased over the 3-year period, evidence was found of ongoing underutilization of CRC screening. The 2 strongest determinants of obtaining CRC screening were provider influence and patient barriers related to CRC screening in general, pointing to the need for multilevel interventions that target both the provider and patient. Cancer 2008. © 2008 American Cancer Society. [source] | ||||||||||