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Selected AbstractsUncovering Symptom Progression History from Disease Registry Data with Application to Young Cystic Fibrosis PatientsBIOMETRICS, Issue 2 2010Jun Yan Summary The growing availability of various disease registry data has brought precious opportunities to epidemiologists to understand the natural history of the registered diseases. It also presents challenges to the traditional data analysis techniques because of complicated censoring/truncation schemes and temporal dynamics of covariate influences. In a case study of the Cystic Fibrosis Foundation Patient Registry data, we propose analyses of progressive symptoms using temporal process regressions, as an alternative to the commonly employed proportional hazards models. Two endpoints are considered, the prevalence of ever positive and currently positive for Pseudomonas aeruginosa (PA) infection in the lungs, which capture different aspect of the disease process. The analysis of ever PA positive via a time-varying coefficient model demonstrates the lack of fit, as well as the potential loss of information, in the standard proportional hazards analysis. The analysis of currently PA positive yields results that are clinically meaningful and have not previously been reported in the cystic fibrosis literature. Our analyses demonstrate that prenatal/neonatal screening results in lower prevalence of PA infection compared to traditional diagnosis via signs and symptoms, but this benefit attenuates with age. Calendar years of diagnosis also affect the risk of PA infection; patients diagnosed in more recent cohort show higher prevalence of ever PA positive but lower prevalence of currently PA positive. [source] THE SHORT-TERM EFFECTS OF EXECUTIONS ON HOMICIDES: DETERRENCE, DISPLACEMENT, OR BOTH?,CRIMINOLOGY, Issue 4 2009KENNETH C. LAND Does the death penalty save lives? In recent years, a new round of research has been using annual time-series panel data from the 50 U.S. states for 25 or so years from the 1970s to the late 1990s that claims to find many lives saved through reductions in subsequent homicide rates after executions. This research, in turn, has produced a round of critiques, which concludes that these findings are not robust enough to model even small changes in specifications that yield dramatically different results. A principal reason for this sensitivity of the findings is that few state-years exist (about 1 percent of all state-years) in which six or more executions have occurred. To provide a different perspective, we focus on Texas, a state that has used the death penalty with sufficient frequency to make possible relatively stable estimates of the homicide response to executions. In addition, we narrow the observation intervals for recording executions and homicides from the annual calendar year to monthly intervals. Based on time-series analyses and independent-validation tests, our best-fitting model shows that, from January 1994 through December 2005, evidence exists of modest, short-term reductions in homicides in Texas in the first and fourth months that follow an execution,about 2.5 fewer homicides total. Another model suggests, however, that in addition to homicide reductions, some displacement of homicides may be possible from one month to another in the months after an execution, which reduces the total reduction in homicides after an execution to about .5 during a 12-month period. Implications for additional research and the need for future analysis and replication are discussed. [source] Highly active antiretroviral therapy (HAART) among HIV-infected drug users: a prospective cohort study of sexual risk and injecting behaviourADDICTION, Issue 3 2006Colette Smit ABSTRACT Aims To study sexual risk and injecting behaviour among HIV-infected drug users (DU) receiving highly active antiretroviral therapy (HAART)., Design and setting As part of an ongoing prospective cohort study, HIV-infected DU who commenced HAART (n = 67) were matched with those not starting HAART (n = 130) on CD4 cell counts, duration of cohort participation, age and calendar year of visit. Immunological and virological responses of the HAART-treated DU were compared with the HAART-treated homosexual men from the same cohort (n = 212). Measurements Trends in behaviour and therapeutic response were tested with a logistic regression model adjusted for repeated measurements and a piecewise random effects model, respectively. Findings Non-HAART users reported more episodes of injecting than HAART users. In both groups injecting declined over time with no effect of HAART initiation. Before HAART initiation an increase in sexual risk behaviour was observed among those who had been assigned to receive HAART; their sexual risk behaviour declined thereafter. No change in sexual risk behaviour was found among non-HAART users. Relative to homosexual men, DU had a similar initial therapeutic response, but DU started HAART at lower CD4 cell counts and higher viral load levels. Conclusion DU who are treated with HAART are not increasing their risk behaviour, and their early response to HAART is similar to homosexual men. However, before the treated DU received HAART they were seen to inject less often than those not treated with HAART. This suggests that selection of potential HAART starters is based on limited drug use. Although the DU who commence HAART are a selected group, our results show that HIV-infected DU can be treated effectively. [source] Establishing climate,growth relationships for yelloweye rockfish (Sebastes ruberrimus) in the northeast Pacific using a dendrochronological approachFISHERIES OCEANOGRAPHY, Issue 5 2008BRYAN A. BLACK Abstract We applied dendrochronology (tree-ring) methods to develop multidecadal growth chronologies from the increment widths of yelloweye rockfish (Sebastes ruberrimus) otoliths. Chronologies were developed for the central California coast, a site just north of Vancouver Island, British Columbia, and at Bowie Seamount west of the Queen Charlotte Islands, British Columbia. At each site, synchronous growth patterns were matched among otoliths via the process of cross-dating, ensuring that the correct calendar year was assigned to all increments. Each time series of growth-increment measurements was divided by the values predicted by a best-fit negative exponential function, thereby removing age-related trends. These detrended time series were averaged into a master chronology for each site, and chronologies were correlated with monthly averages of sea surface temperatures, upwelling, the Northern Oscillation Index, and the Pacific Decadal Oscillation. The two northern growth chronologies positively correlated with indices of warm ocean conditions, especially from the prior summer through the spring of the current year. During the same period, the California chronology positively correlated with indices of cool ocean conditions, indicating an opposing productivity regime for yelloweye rockfish between the California Current and the Gulf of Alaska. Overall, this study demonstrates how tree-ring techniques can be applied to quickly develop annually resolved chronologies and establish climate,growth relationships across various temporal and spatial scales. [source] Can a publicly funded home care system successfully allocate service based on perceived need rather than socioeconomic status?HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2007A Canadian experience Abstract The present quantitative study evaluates the degree to which socioeconomic status (SES), as opposed to perceived need, determines utilisation of publicly funded home care in Ontario, Canada. The Registered Persons Data Base of the Ontario Health Insurance Plan was used to identify the age, sex and place of residence for all Ontarians who had coverage for the complete calendar year 1998. Utilisation was characterised in two dimensions: (1) propensity , the probability that an individual received service, which was estimated using a multinomial logit equation; and (2) intensity , the amount of service received, conditional on receipt. Short- and long-term service intensity were modelled separately using ordinary least squares regression. Age, sex and co-morbidity were the best predictors (P < 0.0001) of whether or not an individual received publicly funded home care as well as how much care was received, with sicker individuals having increased utilisation. The propensity and intensity of service receipt increased with lower SES (P < 0.0001), and decreased with the proportion of recent immigrants in the region (P < 0.0001), after controlling for age, sex and co-morbidity. Although the allocation of publicly funded home care service was primarily based on perceived need rather than ability to pay, barriers to utilisation for those from areas with a high proportion of recent immigrants were identified. Future research is needed to assess whether the current mix and level of publicly funded resources are indeed sufficient to offset the added costs associated with the provision of high-quality home care. [source] Effect of an Expenditure Cap on Low-Income Seniors' Drug Use and Spending in a State Pharmacy Assistance ProgramHEALTH SERVICES RESEARCH, Issue 3 2009Christine E. Bishop Objective. To estimate the impact of a soft cap (a ceiling on utilization beyond which insured enrollees pay a higher copayment) on low-income elders' use of prescription drugs. Data Sources and Setting. Claims and enrollment files for the first year ( June 2002 through May 2003) of the Illinois SeniorCare program, a state pharmacy assistance program, and Medicare claims and enrollment files, 2001 through 2003. SeniorCare enrolled non-Medicaid-eligible elders with income less than 200 percent of Federal Poverty Level. Minimal copays increased by 20 percent of prescription cost when enrollee expenditures reached $1,750. Research Design. Models were estimated for three dependent variables: enrollees' average monthly utilization (number of prescriptions), spending, and the proportion of drugs that were generic rather than brand. Observations included all program enrollees who exceeded the cap and covered two periods, before and after the cap was exceeded. Principle Findings. On average, enrollees exceeding the cap reduced the number of drugs they purchased by 14 percent, monthly expenditures decreased by 19 percent, and the proportion generic increased by 4 percent, all significant at p<.01. Impacts were greater for enrollees with greater initial spending, for enrollees without one of five chronic illness diagnoses in the previous calendar year, and for enrollees with lower income. Conclusions. Near-poor elders enrolled in plans with caps or coverage gaps, including Part D plans, may face sharp declines in utilization when they exceed these thresholds. [source] Seasonal variations in [3H]citalopram platelet binding between healthy controls and violent offenders in FinlandHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 7 2005James Callaway Abstract Monthly binding densities (Bmax) of [3H]citalopram to the platelet serotonin transporter (SERT) was measured longitudinally over 1 year in a control group of 18 healthy Finnish male volunteers. Single platelet samples were also analysed from 33 men who were incarcerated for violent crimes during the same calendar year. A statistically significant seasonal variation in SERT Bmax was observed in both data sets, and bi-monthly floating averages for SERT Bmax were calculated and then fit to an annual sinusoidal curve for both groups. The Bmax for platelet [3H]citalopram binding showed a statistically significant (p,=,0.001) seasonal variance between a winter (January,February) maximum of 1590 fmol/mg protein and a summer (July,August) minimum of 1216 fmol/mg protein for the control group, with an R2 of 70% for the annual sinusoidal curve fit. A statistically significant (p,=,0.007) seasonal variance was also observed between a winter (January,February) maximum of 1980 fmol/mg protein and an autumnal (August,September) minimum of 1234 fmol/mg protein for the violent offenders, again with an R2 of 70% for the annual sinusoidal curve fit. This observation lends additional support to the idea that violent human behavior and impulsivity may be directly linked to values of SERT Bmax, which can be affected by various psychoactive drugs and also varies with the natural change of seasons. Copyright © 2005 John Wiley & Sons, Ltd. [source] Survival in Danish patients with breast cancer and inflammatory bowel disease: A nationwide cohort study,INFLAMMATORY BOWEL DISEASES, Issue 4 2008Kirstine Kobberøe Søgaard BA Abstract Background: Incidences of inflammatory bowel disease (IBD) and of breast cancer have increased over the last decades. The influence of IBD on breast cancer prognosis, however, is unknown. We therefore examined the impact of IBD on treatment receipt and survival in breast cancer patients. Methods: Information on breast cancer patients (stage and treatment) diagnosed between 1980 and 2004 was sourced from the Danish Cancer Registry. Data on IBD and potential confounders were extracted from the Danish National Registry of Patients covering all Danish hospitals. Cox regression was used to compute mortality rate ratios (MRRs) among breast cancer patients with IBD, compared to their non-IBD counterparts, adjusting for age, stage, comorbidity measured by the Charlson Index, and calendar year. Results: We identified 71,148 breast cancer cases; 67 also had Crohn's disease (CD) and 216 had ulcerative colitis (UC). Patients with CD had more advanced stage and received radiotherapy less, and chemotherapy more, frequently than patients without IBD. In the adjusted analyses there was no substantial survival difference in breast cancer patients with and without IBD (MRRCD = 1.22; 95% confidence interval [CI] = 0.85,1.75; MRRUC = 1.09; 95% CI = 0.86,1.38). In a stratified analysis, chemotherapy was associated with poorer survival in patients with CD (MRRCD = 1.93; 95% CI = 1.00,3.72). Conclusions: Breast cancer patients with UC receive the same treatment and have similar survival to breast cancer without IBD. In contrast, breast cancer patients with CD are treated with radiotherapy less often. Survival of breast cancer in patients with CD treated with chemotherapy is poorer compared to survival in patients without IBD. (Inflamm Bowel Dis 2007) [source] Growth of the tufted-tailed ratINTEGRATIVE ZOOLOGY (ELECTRONIC), Issue 4 2007Vololomboahangy R. RANDRIANJAFY Abstract Eliurus myoxinus (Rodentia: Nesomyidae, Nesomyinae) is one of the four species of endemic Malagasy rodents known to exist in the Ankarafantsika National Park, northwestern Madagascar. In order to study growth parameters and to determine at which age E. myoxinus commences breeding, we used two different techniques: captive breeding and a capture-mark-release field program in the species' natural habitat. The data collected on the breeding of E. myoxinus in captivity demonstrated that females can give birth to a litter of up to four pups, with up to four litters per calendar year. Reproduction of E. myoxinus was more likely to be continuous in captivity than under natural habitat conditions. If parturition failed, then post-partum mating occurred. Pups had a rapid linear growth phase from birth until 1 month of age. Between 1.5 and 2 months of age, the growth rate continued to increase, but then decreased at around the time of weaning, which occurred by 3.5 months of age. The successive maximum method of age determination showed that individuals at the "young" stage had an average body length of 90 mm and a weight of 30 g and were between 1.5 and 2 months old. The greatest variation in measurements of juveniles occurred at the age of 3.5 months. At this stage, sub-adults resembled adults but their external genitalia were not well developed. Individuals were classified as adults if they had reached a body length of 110 mm and a body weight of 40 g. This occurred at more than 4.5 months of age when the animals were generally reproductively active. The Vo n Bertalanffy method indicated that individuals reach the adult stage by 6 to 7 months. Males grew more rapidly than females, reaching adulthood by 5.5 months of age, whereas females only reached adulthood several weeks later. This species is polygamous. The sex ratio of pups at birth favored females by approximately 3:1. The higher proportion of female pups at birth may represent a survival strategy of this species, possibly associated with ecological conditions. [source] New malignancies following childhood cancer in the United States, 1973,2002INTERNATIONAL JOURNAL OF CANCER, Issue 10 2007Peter D. Inskip Abstract The objectives of our study were to quantify risks for developing new malignancies among childhood cancer survivors, identify links between particular types of first and subsequent cancer, and evaluate the possible role of treatment. A cohort of 25,965 2-month survivors of childhood cancer diagnosed in the U.S. during 1973,2002 was identified and followed through SEER cancer registries. Observed-to-expected ratios (O/E) were calculated, and Poisson regression was used to compare risks among treatment groups. Childhood cancer survivors were at nearly 6-fold risk of developing a new cancer relative to the general population (O/E = 5.9, 95% CI: 5.4,6.5). Most common were subsequent primary cancers of the female breast, central nervous system, bone, thyroid gland and soft tissue, as well as cutaneous melanoma and acute non-lymphocytic leukemia (ANLL). The greatest risks of subsequent cancers occurred among patients diagnosed previously with Hodgkin lymphoma (HL), Ewing sarcoma, primitive neuroectodermal tumor, or retinoblastoma. Risk of subsequent solid cancers was higher among persons whose initial treatment for childhood cancer included radiotherapy, whereas the excess of subsequent ANLL was strongly related to chemotherapy. The O/E for subsequent ANLL increased with increasing calendar year of initial cancer diagnosis among survivors of cancers other than HL, most likely due to increasing use of leukemogenic drugs for solid cancers and non-Hodgkin lymphoma. Childhood cancer survivors are at markedly increased risk of developing a variety of new cancers relative to the general population, but the magnitude of excess risk and specific types of second cancer vary widely by type of first cancer. © 2007 Wiley-Liss, Inc. [source] Evidence for an age-related influence of microsatellite instability on colorectal cancer survivalINTERNATIONAL JOURNAL OF CANCER, Issue 6 2002Susan M. Farrington Abstract It is well established that microsatellite instability (MSI), the hallmark of defective DNA mismatch repair (MMR), is associated with prolonged survival in colorectal cancer compared with tumours that are microsatellite stable (MSS). MSI in sporadic colorectal tumours is primarily due to epigenetic silencing of MLH1. However, there are no prospective population-based studies of survival in patients with germline MMR gene mutations who develop cancer. Although MSI is almost universal in tumours from HNPCC family members, there is a potential confounding effect of ascertainment and other biases that could explain the apparent survival benefit in HNPCC families. Resolving whether germline MMR gene mutations impact on survival is important because it potentially undermines the rationale for surveillance of mutation carriers. Here, we report an investigation of the influence of MSI on survival in cohorts of cancer patients (aged < 30 years at diagnosis, n = 118; non-age-selected, n = 181) in the context of clinicopathologic variables. There was a substantial age-related influence of tumour MSI status on survival. In young patients with tumour MSI, 65% of patients with MSI tumours had germline MSH2 or MLH1 mutations. Clinicopathologic variables and tumour MSI of the cohort were studied with respect to survival and compared with control groups. Young patients had excess MSI tumours (p < 0.000001), mucinous tumours (p < 0.01), advanced disease (p , 0.001) and poorer 5-year survival compared with older cases. Cox proportional hazard analysis identified Dukes' stage, age at diagnosis and calendar year of treatment as independent predictors of survival. There was no detectable association between tumour MSI and survival in young patients, although we confirmed previous observations that MSI is associated with better prognosis in later onset cohorts. These findings underscore the rationale for surveillance and early identification of tumours in MMR gene carriers as well as refining understanding of the influence of MSI on cancer progression. © 2002 Wiley-Liss, Inc. [source] Intraseasonal oscillations and the South China Sea summer monsoon onsetINTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 12 2005Wen Zhou Abstract This paper investigates the role of intraseasonal oscillations (ISOs) in the onset of the South China Sea summer monsoon (SCSSM). Two major components of ISO (10,20-day and 30,60-day modes) are identified. The coupling of these two intraseasonal modes during the pre-monsoon period of the SCSSM are investigated by examining the filtered outgoing longwave radiation (OLR), low-level circulation, apparent heat source and apparent moisture sink from October of a previous calendar year to September of a calendar year. The zonal and meridional propagations of the 10,20-day and 30,60-day modes are found to be different, which reflects their different roles in the establishment and development of the SCSSM. The northwestward propagation of the 10,20-day mode is associated with the weakening of the subtropical high over the western Pacific, while the northeastward propagation of the 30,60-day mode originates from convection over the equatorial Indian Ocean. A hypothesis is then proposed to explain the observed variabilities in the SCSSM onset. When the equatorial Indian Ocean exhibits a 30,60-day mode oscillation, an initially weak convection develops into a large convection band (or monsoon trough). Meanwhile, a convective disturbance of the 10,20-day mode is induced when this monsoon trough extends to the western Pacific. These two processes then collaborate to cause a weakening of the subtropical anticyclone over the South China Sea. Because the monsoon trough associated with the 30,60-day mode subsequently propagates northward into the Bay of Bengal (BOB), the induced vortex together with the 10,20-day westward-migrating convection from the equatorial western Pacific will substantially increase the effect of horizontal advection of moisture and heat, thus destabilizing the atmosphere and weakening the subtropical ridge there. Westerlies can then penetrate and prevail over the SCS region, and the SCSSM onset occurs. Copyright © 2005 Royal Meteorological Society. [source] Seasonality in Fund Performance: An Examination of the Portfolio Holdings and Trades of Investment ManagersJOURNAL OF BUSINESS FINANCE & ACCOUNTING, Issue 7-8 2006David R. Gallagher Abstract:, This study examines the extent to which seasonal variation arises across calendar months in the performance of active Australian equity managers. While it is well documented that there is seasonality in equity market returns, it is unknown whether calendar month variation in managed fund performance exists. Employing a unique database of monthly stock holdings, we find evidence consistent with systematic variation in the risk-adjusted performance of active investment managers over the calendar year. Specifically, we find fund performance is higher in the months when corporate earnings are announced. We also document that the performance of fund managers is lower in the months preceding the tax year-end. Finally, we report evidence that investment manager performance is greater than normal in December, possibly due to both window dressing and the Christmas holiday effect. These findings have important implications for investors attempting to exploit anomalies in fund returns by timing their entry and exit points from active equity funds. [source] Different transmission patterns of hepatitis A virus for two main risk groups as evidenced by molecular cluster analysis,JOURNAL OF MEDICAL VIROLOGY, Issue 5 2007Grace Tjon Abstract Men who have sex with men and traveling children are the most important risk groups for transmission of hepatitis A virus (HAV) in Amsterdam, The Netherlands. Between these two risk groups, different HAV genotypes are found. In this study the patterns of introduction and transmission of HAV were investigated in the two groups. HAV sequences from Amsterdam patients were divided according to risk: (I) travelers and their contacts, (II) homosexual men and their contacts. The sequences in each risk group were then grouped into clusters based on the genetic distances between the sequences. Among travelers many sporadic cases were found, the clusters were small, and introduced frequently into the population, mostly in the second half of each calendar year, indicating a seasonal pattern of introduction and transmission after the summer holidays. Among men who have sex with men the clusters were bigger and remained present for a longer time; sporadic cases were few, and introduction of new strains occurred only occasionally but throughout the year. Our findings indicate that new HAV strains are frequently imported into Amsterdam by travelers, but they are limited in the extent and season of their spread. In contrast, HAV is only occasionally imported into the male homosexual and bisexual population, but remains endemic and spreads to a large number of individuals without a seasonal pattern. J. Med. Virol. 79:488,494, 2007. © 2007 Wiley-Liss, Inc. [source] Medicaid's Role in Financing Health Care for Children With Behavioral Health Care Needs in the Special Education System: Implications of the Deficit Reduction ActJOURNAL OF SCHOOL HEALTH, Issue 10 2008David S. Mandell ScD ABSTRACT Background:, Recent changes to Medicaid policy may have unintended consequences in the education system. This study estimated the potential financial impact of the Deficit Reduction Act (DRA) on school districts by calculating Medicaid-reimbursed behavioral health care expenditures for school-aged children in general and children in special education in particular. Methods:, Medicaid claims and special education records of youth ages 6 to 18 years in Philadelphia, PA, were merged for calendar year 2002. Behavioral health care volume, type, and expenditures were compared between Medicaid-enrolled children receiving and not receiving special education. Results:, Significant overlap existed among the 126,533 children who were either Medicaid enrolled (114,257) or received special education (27,620). Medicaid-reimbursed behavioral health care was used by 21% of children receiving special education (37% of those Medicaid enrolled) and 15% of other Medicaid-enrolled children. Total expenditures were $197.8 million, 40% of which was spent on the 5728 children in special education and 60% of which was spent on 15,092 other children. Conclusions:, Medicaid-reimbursed behavioral health services disproportionately support special education students, with expenditures equivalent to 4% of Philadelphia's $2 billion education budget. The results suggest that special education programs depend on Medicaid-reimbursed services, the financing of which the DRA may jeopardize. [source] Recurrent venous thromboembolism after surgery-provoked versus unprovoked thromboembolismJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 5 2010R. H. WHITE Summary.,Background: The incidence of recurrent venous thromboembolism (VTE) varies depending on the nature of the initial provoking risk factor(s). Objectives: To compare the incidence and time course of recurrent VTE after unprovoked VTE vs. VTE provoked by nine different types of surgery. Methods: Retrospective analysis of linked California hospital and emergency department discharge records. Between 1997 and 2007, all surgery-provoked VTE cases had a first-time VTE event diagnosed within 60 days after undergoing a major operation. The incidence of recurrent VTE was compared during specified follow-up periods by matching each surgery-provoked case with three unprovoked cases based on age, race, gender, VTE event, calendar year and co-morbidity. Results: The 4-year Kaplan,Meier cumulative incidence of recurrent VTE was 14.7% (95%CI: 14.2,15.1) in the matched unprovoked VTE group vs. 7.6% (CI: 7.0,8.2) in 11 797 patients with surgery-provoked VTE (P < 0.001). The overall risk reduction was 48%, which ranged from 64% lower risk (P < 0.001) after coronary bypass surgery to 25% lower risk (P = 0.06) after disc surgery. The risk of recurrent VTE 1,5 years after the index event was significantly lower in the surgery group (HR = 0.47, CI: 0.41,0.53). Within the surgery-provoked group, the risk of recurrent VTE was similar in men and women (HR = 1.0, CI: 0.8,1.3). Conclusions: The risk of recurrent VTE after surgery-provoked VTE was approximately 50% lower than after unprovoked VTE, confirming the view that provoked VTE is associated with a lower risk of recurrent VTE. However, there was appreciable heterogeneity in the relative risk of recurrent VTE associated with different operations. [source] Variation in 24 hemostatic genes and associations with non-fatal myocardial infarction and ischemic strokeJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 1 2008N. L. SMITH Summary., Background:, Arterial thrombosis involves platelet aggregation and clot formation, yet little is known about the contribution of genetic variation in fibrin-based hemostatic factors to arterial clotting risk. We hypothesized that common variation in 24 coagulation,fibrinolysis genes would contribute to risk of incident myocardial infarction (MI) or ischemic stroke (IS). Methods:, We conducted a population-based, case,control study. Subjects were hypertensive adults and postmenopausal women 30,79 years of age, who sustained a first MI (n = 856) or IS (n = 368) between 1995 and 2002, and controls matched on age, hypertension status, and calendar year (n = 2689). We investigated the risk of MI and IS associated with (i) global variation within each gene as measured by common haplotypes and (ii) individual haplotypes and single nucleotide polymorphisms (SNPs). Significance was assessed using a 0.2 threshold of the false discovery rate q -value, which accounts for multiple testing. Results:, After accounting for multiple testing, global genetic variation in factor (F) VIII was associated with IS risk. Two haplotypes in FVIII and one in FXIIIa1 were significantly associated with increased IS risk (all q -values < 0.2). A plasminogen gene SNP was associated with MI risk. All are new discoveries not previously reported. Another 24 tests had P -values < 0.05 and q -values > 0.2 in MI and IS analyses, 23 of which are new and hypothesis generating. Conclusions:, Apart from the association of FVIII variation with IS, we found little evidence that common variation in the 24 candidate fibrin-based hemostasis genes strongly influences arterial thrombotic risk, but our results cannot rule out small effects. [source] Validity of registry data: Agreement between cancer records in an end-stage kidney disease registry (voluntary reporting) and a cancer register (statutory reporting)NEPHROLOGY, Issue 4 2010ANGELA C WEBSTER ABSTRACT: Aims: End-stage kidney disease registries inform outcomes and policy. Data quality is crucial but difficult to measure objectively. We assessed agreement between incident cancer reported to the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) and to the Central Cancer Registry (CCR) in New South Wales. Methods: ANZDATA records were linked to CCR using probabilistic matching. We calculated agreement between registries for patients with ,1 cancers, all cancers and site-specific cancer using the kappa statistic (,). We investigated cases where records disagreed and compared estimates of cancer risk based either on ANZDATA or on CCR using standardized incidence ratios (indirect standardization by age, sex and calendar year). Results: From 1980 to 2001, 9453 residents had dialysis or transplantation. ANZDATA recorded 867 cancers in 779 (8.2%) registrants; CCR 867 cancers in 788 (8.3%). ANZDATA recorded 170 patients with cancer that CCR did not, CCR recorded 179 patients that ANZDATA did not (, = 0.76). ANZDATA had sensitivity 77.3% (confidence interval (CI) 74.2,80.2), specificity 98.1% (CI 97.7,98.3) if CCR records were regarded as the reference standard. Agreement was similar for diagnoses while receiving dialysis (, = 0.78) or after transplantation (, = 0.79), but varied by cancer type. Agreement was poorest for melanoma (, = 0.61) and myeloma (, = 0.47) and highest for lymphoma (, = 0.80), leukaemia (, = 0.86) and breast cancer (, = 0.85). Artefact accounted for 20.8% of the non-concordance but error and misclassification did occur in both registries. Estimates of cancer risk based on ANZDATA or CCR records did not differ in any important way. Conclusion: Agreement of cancer records between both registries was high and differences largely explicable. It is likely that both ANZDATA and CCR have some inaccuracies, for reasons that are now more explicit, with themes similar to those likely to be experienced by other registries. [source] Prevalence of overweight in the Seychelles: 15 year trends and association with socio-economic statusOBESITY REVIEWS, Issue 6 2008P. Bovet Summary We assessed the 15-year trends in the distribution of body mass index (BMI) and the prevalence of overweight in the Seychelles (Indian Ocean, African Region) and the relationship with socio-economic status (SES). Three population-based examination surveys were conducted in 1989, 1994 and 2004. Occupation was categorized as ,labourer', ,intermediate' or ,professional'. Education was also assessed in 1994 and 2004. Between 1989 and 2004, mean BMI increased markedly in all sex and age categories (overall: 0.16 kg m,2 per calendar year, which corresponds to 0.46 kg per calendar year). The prevalence of overweight (including obesity, BMI , 25 kg m,2) increased from 29% to 52% in men and from 50% to 67% in women. The prevalence of obesity (BMI , 30 kg m,2) increased from 4% to 15% in men and from 23% to 34% in women. Overweight was associated inversely with occupation in women and directly in men in all surveys. In multivariate analysis, overweight was associated similarly (direction and magnitude) to occupation and education. In conclusion, the increasing prevalence of overweight and obesity over time in all age, sex and SES categories suggests large-scale changes in societal obesogenic factors. The sex-specific association of SES with overweight suggests that prevention measures should be tailored accordingly. [source] Methylphenidate use in children and risk of cancer at 18 sites: results of surveillance analyses,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 12 2007Nina Oestreicher PhD Abstract Purpose A recent report linked methylphenidate (MPH) use in children to cytologic abnormalities in plasma lymphocytes, a possible cancer biomarker. The purpose of this study was to investigate the association of MPH use and childhood cancer risk. Methods Using automated pharmacy databases and the SEER-affiliated cancer registry of the Kaiser Permanente Medical Care Program (KPMCP), we compared cancer rates at 18 sites among 35 400 MPH users who received it before age 20 to rates among KPMCP membership (age, sex, and calendar year standardized). Medical records of MPH exposed cancer cases were reviewed to identify the presence of established risk factors. Results There were 23 cancers among MPH users, versus 20.4 expected (standardized morbidity ratio, SMR,=,1.13, 95% confidence interval (0.72, 1.70)). Given the small number of cancers, site-specific SMR estimates were imprecise. Only one SMR was statistically significant at the p,<,0.05 level, which given the number of comparisons is consistent with the absence of a true association at any site. MPH use was associated with increased risk of lymphocytic leukemia (SMR,=,2.64 (1.14, 5.20)), based on eight observed cases). The medical records of these exposed cases did not reveal any lymphocytic leukemia risk factors (prior cancer, radiotherapy or chemotherapy, or Down syndrome). Conclusions Our results are consistent with no moderate or strong association between MPH use and cancer risk in children, although our ability to examine dose and duration of use or risk at specific sites was limited by small numbers. Further study of MPH use and lymphocytic leukemia risk is needed to determine whether our results are due to chance alone. Copyright © 2007 John Wiley & Sons, Ltd. [source] Cancer risks in thiazolidinedione users compared to other anti-diabetic agents,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 5 2007Carol Koro PhD Abstract Purpose We conducted three nested case-control studies to evaluate the risk of breast, colon, and prostate cancers developing in patients exposed to thiazolidinediones (TZDs) compared with other anti-diabetic agents. Methods Cancer cases were matched to five controls by age, gender, calendar year, and time in the database from a cohort of 1,26,971 diabetic patients taking anti-diabetic medication in the US Integrated Healthcare Information Services database. Five hundred thirteen breast cancer cases were matched with 2557 controls, 408 cases of colon cancer were matched with 2027 controls and 643 cases of prostate cancer were matched with 3176 controls. Exposure to an anti-diabetic agent within 90 days preceding the index date was defined as recent exposure and at any time during the follow-up was defined as ever exposed. Results The adjusted odds ratios and 95%CI of cancer from ever exposure to TZDs compared to oral monotherapy, oral dual therapy, oral triple therapy, insulin monotherapy, insulin and oral therapy and all non-TZD anti-diabetic agents were, respectively for breast cancer: 0.91 (0.69,1.20), 0.80 (0.56,1.14), 0.87 (0.32,2.35), 1.27 (0.61,2.67), 0.71 (0.36,1.37), 0.89 (0.68,1.15); for colon cancer: 1.06 (0.80,1.40), 1.12 (0.77,1.63), 1.73 (0.39,7.78), 4.46 (1.05,19.00), 1.06 (0.50,2.26) 1.03 (0.80,1.32) and for prostate cancer: 1.08 (0.85,1.37), 0.89 (0.66,1.21); 0.82 (0.33,2.06); 1.80 (0.79,4.07), 1.10 (0.55,2.18), 1.04 (0.83,1.31). Results for exposure within 90 days of the date of the cancer were similar. Conclusions Our findings suggest that the effect of TZDs on the likelihood of development of the cancers studied (colon, prostate and breast) appears to be neutral and do not support a beneficial or deleterious effect of TZD on the cancers studied. Copyright © 2006 John Wiley & Sons, Ltd. [source] Kin influence on the decision to start using modern contraception: A longitudinal study from rural GambiaAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 4 2009Ruth Mace In earlier work in rural Gambia, we found that kin influence reproductive success: matrilineal kin, especially mothers, maternal grandmothers and unmarried older sisters all helped to promote the survival and nutrition of young children; in contrast patrilineal kin, especially husband's mother, promoted fertility. These differing influences of maternal and paternal lineage are predicted on the basis of kin selection and sexual conflict theory, because the costs of reproduction fall more heavily on the mother than the father. These studies covered the period 1950,1975, when this population was essentially "natural fertility, natural mortality." It is not possible to tell whether these effects were due to kin influencing active reproductive decision-making, or due to indirect effects such as kin improving nutrition by helping. Since 1976, modern contraception has become available in this community. In an analysis of the behavioral ecology of the decision to start using modern contraception, we found that high parity for your age was a key determinant of the decision, as was village and calendar year. Here, we examine whether the presence or absence of kin and also whether the contraceptive status of kin influenced the decision to start using contraception. We find little evidence that kin directly influence contraceptive uptake, either by their presence/absence or as models for social learning. However, death of a first husband (i.e., widowhood) does accelerate contraceptive uptake. We discuss our results from an evolutionary demography perspective, in particular regarding theories of sexual conflict, biased cultural transmission, and social learning. Am. J. Hum. Biol., 2009. © 2009 Wiley-Liss, Inc. [source] Excessive longitudinal FEV1 decline and risks to future health: A case,control study,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 12 2009Mei Lin Wang MD Abstract Background Accelerated loss of forced expiratory volume in 1,s (FEV1) in an individual is considered an indicator of developing lung disease. Methods We investigated longitudinal FEV1 slopes, calculated by simple linear regression, and adverse health outcomes after 10,30 years, among 1,428 chemical plant workers. Cases were defined by FEV1 slopes below 5th percentile values for the cohort. Cases were matched with controls (107 pairs) for race, gender, smoking status, year of birth, age, height, and calendar year at first test. Matched pair statistics were used for comparisons. Results Cases had a higher proportion, compared to controls, of diagnosis of COPD or emphysema (17.8% vs. 1.9%, P,=,0.0002), medication use for respiratory diseases (24.3% vs. 4.7%, P,<,0.0001), dyspnea (15% vs. 3.7%, P,=,0.0042), and wheezing or rhonchi on examination (10.3% vs. 1.9%, P,=,0.0225). Conclusions Chemical plant workers who experienced accelerated FEV1 declines experienced four to nine times as many adverse health conditions over 10,30 years. Am. J. Ind. Med. 52:909,915, 2009. © 2009 Wiley-Liss, Inc. [source] Asbestos-related disease among sheet metal workers 1986,2004: Radiographic changes over time,,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 7 2009FACOEM, Laura S. Welch MD Abstract Background In 1985, the Sheet Metal Workers International Association and the Sheet Metal and Air Conditioning National Association formed The Sheet Metal Occupational Health Institute Trust (SMOHIT) to examine the health hazards of the sheet metal industry. Between 1986 and 2004 18,211 individuals were examined. At the time of the first examination 9.6% of all participants (1,745) had findings consistent with parenchymal disease (ILO,>,1/0), and 21% (3,827) had pleural scarring. Methods 2181-Two thousand hundred eighty-one who had no radiographic evidence of pneumoconiosis on baseline examination underwent a second examination. Results By the second examination, 5.3% had developed parenchymal disease on chest radiograph; an additional 12.4% had developed pleural scarring without parenchymal disease. Factors that predicted new cases of pneumoconiosis on radiograph were the calendar year the worker entered the sheet metal trade, smoking, and shipyard work. Forty-seven percent of those smoking at the time of initial exam reported having quit smoking by the second examination. Conclusions Asbestosis is still occurring 50 years after first exposure. Exposed workers benefit from medical screening programs that incorporate smoking cessation. Am. J. Ind. Med. 52:519,525, 2009. © 2009 Wiley-Liss, Inc. [source] Late Marriage and Less Marriage in JapanPOPULATION AND DEVELOPMENT REVIEW, Issue 1 2001Robert D. Retherford Between 1975 and 1995, the singulate mean age at marriage in Japan increased from 24.5 to 27.7 years for women and from 27.6 to 30.7 years for men, making Japan one of the latest-marrying populations in the world. Over the same period, the proportion of women who will never marry, calculated from age-specific first-marriage probabilities pertaining to a particular calendar year, increased from 5 to 15 percent for women and from 6 to 22 percent for men,behaviors sharply different from those characterizing the universal-marriage society of earlier years. This article investigates how and why these changes have come about. The reasons are bound up with rapid educational gains by women, massive increases in the proportion of women who work for pay outside the home, major changes in the structure and functioning of the marriage market, extraordinary increases in the prevalence of premarital sex, and far-reaching changes in values relating to marriage and family life. [source] Chronic Recurrent Rhinosinusitis: Disease Severity and Clinical CharacterizationTHE LARYNGOSCOPE, Issue 2 2005Neil Bhattacharyya MD Objectives/Hypothesis: The objective was to clinically characterize and determine disease severity parameters for chronic recurrent rhinosinusitis (CRRS). Study Design: Prospective. Methods: A consecutive series of adult patients undergoing evaluation for CRRS was prospectively evaluated. Patients with four or more acute rhinosinusitis episodes in the previous calendar year with an absence of symptoms between episodes were considered as manifesting CRRS. Symptom severity and disease data from the Rhinosinusitis Symptom Inventory was obtained, as well as Lund staging information from the paranasal sinus CT scan. The Lund staging scores for patients with CRRS were compared with a control group of patients without CRRS. Symptom domain scores and disease severity parameters were compared between the CRRS group and a third group of patients with chronic persistent rhinosinusitis. Results: In all, 30 patients met inclusion criteria for the diagnosis of CRRS. Mean age was 40.9 years with a 3:1 female preponderance. The mean Lund score for patients with CRRS was 3.79. Patients with CRRS failed to demonstrate a statistically different Lund score from control patients (mean Lund score, 4.26 [P = .538]). Symptom severity scores according to Rhinosinusitis Symptom Inventory domains were largely similar for the nasal, facial, and total symptom domains between patients with CRRS versus chronic persistent rhinosinusitis. However, patients with CRRS demonstrated statistically significant increases in oropharyngeal and systemic symptom domain scores. Patients with CRRS also had significant increases in number of antibiotic courses (4.8 vs. 2.9 [P < .001]) and number of missed workdays (8.8 vs. 4.6 d [P = .046]) attributable to rhinosinusitis. Conclusion: Chronic recurrent rhinosinusitis is a distinct form of chronic rhinosinusitis differing somewhat from chronic persistent rhinosinusitis. However, patients with CRRS still experience significant symptoms associated with this diagnosis, which results in significant medication usage and workplace impact. [source] Mortality related to anaesthesia in France: analysis of deaths related to airway complications,ANAESTHESIA, Issue 4 2009Y. Auroy Summary Death certificates from the French national mortality database for the calendar year 1999 were reviewed to analyse cases in which airway complications had contributed to peri-operative death. Respiratory deaths (and comas) found in a previous national 1978,82 French survey (1 : 7960; 95% CI 1 : 12 700 to 1 : 5400) were compared with the death rate found in the present one: 1 : 48 200 (95% CI 1 : 140 000 to 1 : 27 500). In 1999, deaths associated with failure of the breathing circuit and equipment were no longer encountered and no death was found to be related to undetected hypoxia in the recovery unit. Deaths related to difficult intubation also occurred at a lower rate than in the previous report (1 : 46 000; 95% CI 1 : 386 000 to 1 : 13 000) in 1978,82 vs 1 : 176 000 (95% CI 1 : 714 000 to 1 : 46 000) in 1999, a fourfold reduction. In most cases, there were both inadequate practice and systems failure (inappropriate communication between staff, inadequate supervision, poor organisation). This large French survey shows that deaths associated with respiratory complications during anaesthesia have been strikingly reduced during this 15-year period. [source] Cancer preceding giant cell arteritis: A case,control study,ARTHRITIS & RHEUMATISM, Issue 6 2010Tanaz A. Kermani Objective To study the association between previous cancer and giant cell arteritis (GCA). Methods Using the resources of the Rochester Epidemiology Project, we identified incident cases of GCA diagnosed between January 1, 1950 and December 31, 2004. Each GCA patient was matched for age, sex, and length of medical history to 2 subjects without GCA from the same population. Medical records were reviewed. Diagnosis of cancer was confirmed by histopathologic analysis. Results We identified 204 GCA cases and 407 controls. The GCA group included 163 women (80%) and 41 men (20%). Their mean ± SD age was 76.0 ± 8.2 years. The non-GCA group consisted of 325 women (80%) and 82 men (20%). Their mean ± SD age was 75.6 ± 8.4 years. At the index date, 45 GCA patients (22%) and 125 non-GCA patients (31%) had had a previous cancer. The odds ratio (OR) for previous cancer in cases compared with controls, adjusted for age, sex, and calendar year, was 0.63, and the 95% confidence interval (95% CI) was 0.42,0.94 (P = 0.022). The mean age at diagnosis of the first cancer before the index date was similar in the cases (67.5 ± 11.9 years) and the controls (64.9 ± 13.2 years) (P = 0.32). The mean ± SD duration from the first cancer to the index date was 9.8 ± 9.9 years in the cases and 11.7 ± 10.8 years in the controls (P = 0.31). Cancer types were similar in both groups, but fewer gynecologic malignancies were noted in GCA patients (OR 0.39 [95% CI 0.13,1.15], P = 0.09). Colon cancer also appeared less commonly in the cases compared with the controls (OR 0.22 [95% CI 0.03,1.74], P = 0.15). Conclusion The findings of this population-based case,control study indicate that GCA patients had significantly fewer malignancies prior to the index date as compared with controls. [source] The protective effect of antimalarial drugs on thrombovascular events in systemic lupus erythematosusARTHRITIS & RHEUMATISM, Issue 3 2010Hyejung Jung Objective The antimalarial medication hydroxychloroquine has been proposed as a thromboprotective agent in systemic lupus erythematosus (SLE), but studies thus far have been limited by the possibility of confounding by indication. This study was conducted to assess whether exposure to antimalarial drugs is associated with a decrease in thrombovascular events (TEs) in patients with SLE. Methods The study was designed as a nested case,control study embedded in an inception cohort of patients with SLE, which allowed adjustments for possible confounding by calendar year, duration of disease, duration of observation, and severity of lupus. After controlling for the possible confounding variables in conditional logistic regression models, the use of antimalarial drugs was assessed for its effects on the development of TEs in lupus patients. Results Fifty-four cases of TE were identified, and these were matched with 108 control subjects (lupus patients without TEs). Univariate analyses identified older age (odds ratio [OR] 1.04, 95% confidence interval [95%CI] 1.01,1.07) or being older than age 50 years (OR 3.5, 95% CI 1.4,8.6) and ever having hypertension (OR 2.5, 95% CI 1.0,5.8) as being associated with an increased risk of TEs, whereas use of antimalarial drugs (OR 0.31, 95% CI 0.13,0.71) was associated with a decreased risk of TEs. Separate analyses were done for arterial and venous TEs, which yielded similar results. In multivariate analyses, use of antimalarial drugs (OR 0.32, 95% CI 0.14,0.74) and older age (OR 1.04, 95% CI 1.01,1.07) were the only 2 variables that remained significant. Conclusion The results from this nested case,control study demonstrate that, after accounting for the effects of disease severity, disease duration, and calendar year, antimalarial drugs were found to be thromboprotective, being associated with a 68% reduction in the risk of all TEs, with a range of risk reduction of at least 26% up to as high as 86%. [source] Life expectancy of screen-detected invasive breast cancer patients compared with women invited to the Nijmegen screening programCANCER, Issue 3 2010Johannes D. M. Otten Abstract BACKGROUND: Screening can lead to earlier detection of breast cancer and thus to an improvement in survival. The authors studied the life expectancy of women with screen-detected invasive breast cancer (patients) compared with women invited to the breast cancer screening program in Nijmegen, the Netherlands (comparison group). METHODS: Each patient diagnosed between 1975 and 2006 was randomly age-matched with a woman invited in the same calendar year and free from breast cancer at the time of diagnosis of the patient. Survival analyses were performed to study differences in life expectancy. RESULTS: The life expectancy for 858 patients was 6 years shorter than for the comparison group. However, for 360 patients with small (<15 mm) invasive breast cancer, life expectancy was similar to that of the comparison group. In contrast, for patients detected with larger tumors (,15 mm) the life expectancy was 6 to 12 years shorter, depending on tumor size. Furthermore, life expectancy was modified by screening history. For patients who had a negative screening examination 2 years before the detection of their breast cancer, the difference in life expectancy from the comparison group became smaller for the larger tumor sizes (,15 mm). CONCLUSIONS: In conclusion, about 40% (360 of 858) of all women with invasive screen-detected breast cancer have the same life expectancy as women from the comparison group (reflecting the general population). For women diagnosed with larger tumors at diagnosis, life expectancy diminishes with increasing tumor size and is modified by screening history. Cancer 2010. © 2009 American Cancer Society. [source] | ||||||||||||||||||||||