Confidence Interval (confidence + interval)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Confidence Interval

  • approximate confidence interval
  • asymptotic confidence interval
  • bootstrap confidence interval
  • constructing confidence interval
  • corresponding 95% confidence interval
  • corresponding confidence interval
  • exact confidence interval
  • percent confidence interval

  • Terms modified by Confidence Interval

  • confidence interval coverage

  • Selected Abstracts


    Jonathan E. Leightner
    This paper develops confidence intervals for BD-RTPLS and uses BD-RTPLS to estimate the relationship between the exchange rate (e) and gross domestic product (GDP) using annual data from 1984 to 2000 for 23 developing Asian and Pacific countries. BD-RTPLS produces estimates for the exchange rate multiplier (dGDP/de) for these countries and shows how omitted variables affected these multipliers across countries and over time. [source]


    Paul Kabaila
    Summary We consider a linear regression model, with the parameter of interest a specified linear combination of the components of the regression parameter vector. We suppose that, as a first step, a data-based model selection (e.g. by preliminary hypothesis tests or minimizing the Akaike information criterion , AIC) is used to select a model. It is common statistical practice to then construct a confidence interval for the parameter of interest, based on the assumption that the selected model had been given to us,a priori. This assumption is false, and it can lead to a confidence interval with poor coverage properties. We provide an easily computed finite-sample upper bound (calculated by repeated numerical evaluation of a double integral) to the minimum coverage probability of this confidence interval. This bound applies for model selection by any of the following methods: minimum AIC, minimum Bayesian information criterion (BIC), maximum adjusted,R2, minimum Mallows' CP and,t -tests. The importance of this upper bound is that it delineates general categories of design matrices and model selection procedures for which this confidence interval has poor coverage properties. This upper bound is shown to be a finite-sample analogue of an earlier large-sample upper bound due to Kabaila and Leeb. [source]

    Obesity and lifestyle risk factors for gastroesophageal reflux disease, Barrett esophagus and esophageal adenocarcinoma

    P. J. Veugelers
    SUMMARY., The aim of this study was to examine the association of obesity with esophageal adenocarcinoma, and with the precursor lesions Barrett esophagus and gastroesophageal reflux disease (GERD). This case-control study included cases with GERD (n = 142), Barrett esophagus (n = 130), and esophageal adenocarcinoma (n = 57). Controls comprised 102 asymptomatic individuals. Using logistic regression methods, we compared obesity rates between cases and controls adjusting for differences in age, gender, and lifestyle risk factors. Relative to normal weight, obese individuals were at increased risk for esophageal adenocarcinoma (Odds Ratio [OR] 4.67, 95% Confidence Interval [CI] 1.27,17.9). Diets high in vitamin C were associated with a lower risk for GERD (OR 0.40, 95% CI 0.19,0.87), Barrett esophagus (OR 0.44, 95% CI 0.20,0.98), and esophageal adenocarcinoma (OR 0.21, 95% CI 0.06,0.77). For the more established risk factors, we confirmed that smoking was a significant risk factor for esophageal adenocarcinoma, and that increased liquor consumption was associated with GERD and Barrett esophagus. In light of the current obesity epidemic, esophageal adenocarcinoma incidence rates are expected to continue to increase. Successful promotion of healthy body weight and diets high in vitamin C may substantially reduce the incidence of this disease. [source]

    Mortality and incidence trends from esophagus cancer in selected geographic areas of China circa 1970,90

    Li Ke
    Abstract China was one of the countries with the highest esophagus cancer risk in the world during the 1970s. This report provides data on time trends of esophagus cancer incidence and mortality during the 1970s,90s in selected geographic areas of China. Information on newly diagnosed cancer cases and cancer deaths is based on data collected by local population-based registries and Disease Surveillance Points (DSP). For the whole country, esophagus cancer mortality decreased slightly, 17.4 per 105 populations during 1990,92 in contrast to 18.8 per 105 populations in 1973,75. In the Linxian area, trends in the incidence and mortality rates for esophagus+gastric cardia cancer reversed over time; incidence rates increased significantly during 1959,72 but were decreased significantly on average ,2.26% (95% Confidence Interval [CI]: ,1.74, ,2.77) and ,1.10% (95% CI = ,0.58, ,1.62) per year for males and females, respectively, during 1972,97. In urban Shanghai, incidence trend for esophagus cancer decreased monotonically and significantly on average by ,4.99% (95% CI = ,4.28, ,5.70) and ,5.18% (95% CI = ,4.99, ,5.70) per year for males and females, respectively. In Nanao islet, esophagus+gastric cardia cancer mortality rates increased during 1970,82 but decreased slowly from 1982,99 (,0.96% per year; 95% CI = ,0.14, ,1.78). Our study indicates that incidence and mortality rates for esophagus or esophagus+gastric cardia cancer are now decreasing in China. The declines may be due to an unplanned success of prevention, such as changes in population dietary patterns and food preservation methods. © 2002 Wiley-Liss, Inc. [source]

    The role of patient personality in the identification of depression in older primary care patients

    Laura W. McCray
    Abstract Background Our aim was to evaluate whether personality factors significantly contribute to the identification of depression in older primary care patients, even after controlling for depressive symptoms. Methods We examined the association between personality factors and the identification of depression among 318 older adults who participated in the Spectrum study. Results High neuroticism (unadjusted Odds Ratio (OR) 2.36, 95% Confidence Interval (CI) [1.42, 3.93]) and low extraversion (adjusted OR 2.24, CI [1.26, 4.00]) were associated with physician identification of depression. Persons with high conscientiousness were less likely to be identified as depressed by the doctor (adjusted OR 0.45, CI [0.22, 0.91]). Conclusion Personality factors influence the identification of depression among older persons in primary care over and above the relationship of depressive symptoms with physician identification. Knowledge of personality may influence the diagnosis and treatment of depression in primary care. Copyright © 2007 John Wiley & Sons, Ltd. [source]

    The effects of memory, attention, and executive dysfunction on outcomes of depression in a primary care intervention trial: the PROSPECT study

    Hillary R. Bogner
    Abstract Objective To describe the influence of domains of cognition on remission and response of depression in an intervention trial among older primary care patients. Methods Twenty primary care practices were randomly assigned to Usual Care or to an Intervention consisting of a depression care manager offering algorithm-based care for depression. In all, 599 adults 60 years and older with a depression diagnosis were included in these analyses. Depression severity and remission of depression were assessed by the 24-item Hamilton Depression Rating Scale. The Mini-Mental State Examination (MMSE) was our global measure of cognitive function. Verbal memory was assessed with the memory subscale of the Dementia Rating Scale. Attention was measured with the digit span from the Weschler Adult Intelligence Test. Response inhibition, one of the executive functions, was assessed with the Stroop Color-Word test. Results The intervention was associated with improved remission and response rates regardless of cognitive impairment. Response inhibition as measured by the Stroop Color-Word test appeared to significantly modify the intervention versus usual care difference in remission and response at 4 months. Patients in the poorest performance quartile at baseline on the Stroop Color-Word test in the Intervention Condition were more likely to achieve remission of depression at 4 months than comparable patients in Usual Care [odds ratio (OR),=,17.76, 95% Confidence Interval (CI), 3.06, 103.1]. Conclusions Depressed older adults in primary care with executive dysfunction have low remission and response rates when receiving usual care but benefit from depression care management. Copyright © 2007 John Wiley & Sons, Ltd. [source]

    Are MADIT II Criteria for Implantable Cardioverter Defibrillator Implantation Appropriate for Chinese Patients?

    MADIT II Criteria for Implantable Cardioverter.,Background: MADIT-II demonstrated that prophylactic implantation of an implantable cardioverter-defibrillator (ICD) device prevents sudden cardiac death (SCD) in patients with myocardial infarction (MI) and impaired left ventricular ejection fraction (LVEF). It remains unclear whether the MADIT-II criteria for ICD implantation are appropriate for Chinese patients. Methods and Results: We compared the clinical characteristics and outcome for a cohort of consecutive Chinese patients who satisfied MADIT-II criteria for ICD implantation with the original published MADIT-II population. Seventy consecutive patients who satisfied MADIT-II criteria but did not undergo ICD implantation (age: 67 years, male: 77%) were studied. Their baseline demographics were comparable with the original MADIT-II cohort with the exception of a higher incidence of diabetes mellitus. After follow-up of 35 months, most deaths (78%) were due to cardiac causes (72% due to SCD). The 2-year SCD rate (10.0%) was comparable with that of the MADIT-II conventional group (12.1%), but higher than the MADIT-II defibrillator group (4.9%). Similarly, the 2-year non-SCD rate was 3.0%, also comparable with the MADIT-II conventional group (4.6%), but lower than the MADIT-II defibrillator group (7.0%). Cox regression analysis revealed that advance NYHA function class (Hazard Ratio [HR]: 3.5, 95% Confidence Interval [CI]: 1.48,8.24, P = 0.004) and the lack of statin therapy (HR: 3.7, 95%CI: 1.35,10.17, P = 0.011) were independent predictors for mortality in the MADIT-II eligible patients. Conclusion: Chinese patients who satisfy MADIT-II criteria for ICD implantation are at similar risk of SCD and non-SCD as the original MADIT-II subjects. Implantation of an ICD in Chinese patients is appropriate. (J Cardiovasc Electrophysiol, Vol. 21, pp. 231,235, March 2010) [source]

    Substrate and Procedural Predictors of Outcomes After Catheter Ablation for Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy

    Background: Hypertrophic cardiomyopathy (HCM) is often accompanied by atrial fibrillation (AF) due to diastolic dysfunction, elevated left atrial pressure, and enlargement. Although catheter ablation for drug-refractory AF is an effective treatment, the efficacy in HCM remains to be established. Methods: Thirty-three consecutive patients (25 male, age 51 ± 11 years) with HCM underwent pulmonary vein (PV) isolation (n = 8) or wide area circumferential ablation with additional linear ablation (n = 25) for drug-refractory AF. Twelve-lead and 24-hour ambulating ECGs, echocardiograms, event monitor strips, and SF 36 quality of life (QOL) surveys were obtained before ablation and for routine follow-up. Results: Twenty-one (64%) patients had paroxysmal AF and 12 (36%) had persistent/permanent AF for 6.2 ± 5.2 years. The average ejection fraction was 0.63 ± 0.12. The average left atrial volume index was 70 ± 24 mL/m2. Over a follow-up of 1.5 ± 1.2 years, 1-year survival with AF elimination was 62%(Confidence Interval [CI]: 66-84) and with AF control was 75%(CI: 66-84). AF control was less likely in patients with a persistent/chronic AF, larger left atrial volumes, and more advanced diastolic disease. Additional linear ablation may improve outcomes in patient with severe left atrial enlargement and more advanced diastolic dysfunction. Two patients had a periprocedureal TIA, one PV stenosis, and one died after mitral valve replacement from prosthetic valve thrombosis. QOL scores improved from baseline at 3 and 12 months. Conclusion: Outcomes after AF ablation in patients with HCM are favorable. Diastolic dysfunction, left atrial enlargement, and AF subtype influence outcomes. Future studies of rhythm management approaches in HCM patients are required to clarify the optimal clinical approach. [source]

    The subjective incremental cost of informed consent and documentation in hospital care: a multicentre questionnaire survey in Japan

    Haruhisa Fukuda MPH
    Abstract Objective, To reveal the amount of time and financial cost required to obtain informed consent and to preserve documentation. Methods, The questionnaire was delivered to all staff in six acute care public hospitals in Japan. We examined health care staff perceptions of the time they spent obtaining informed consent and documenting information. All data were collected in 2006 and estimates in the past week in 2006 were compared to estimates of time spent in a week in 1999. We also calculated the economic costs of incremental amounts of time spent in these procedures. Results, In 2006, health care staff took about 3.89 hours [95% Confidence Interval (CI) 3.71,4.07] per week to obtain informed consent and 6.64 hours (95% CI 6.40,6.88) per week to write documentation on average. Between 1999 and 2006, the average amount of time for conducting informed consent was increased to 0.67 (P < 0.001) hours per person-week, and the average amount of time for documentation was increased to 0.70 (P < 0.001) hours per person-week. The annual economic cost of activities for informed consent and documentation in a 100-bed hospital increased from 117 755 to 449 402 US dollars. Conclusions, We found a considerable increase in time spent on informed consent and documentation, and associated cost over a 7-year time period. Although greater attention to the informed consent process should be paid to ensure the notions of patient autonomy and self-determination, the increased resources devoted to these practices must be considered in light of current cost containment policies. [source]

    Optimization of treatment parameters for Foscan®-PDT of basal cell carcinomas

    Christian S. Betz MD
    Abstract Background and Objective Basal cell carcinomas (BCCs) are the most common form of skin cancers with high and increasing incidence rates. Photodynamic therapy (PDT) with mTHPC (Foscan®) has shown to be a promising treatment alternative with good cosmetic results. The current study was aimed to determine optimal treatment parameters for this indication. Study Design/Materials and Methods mTHPC-PDT was performed in 117 patients with a total of 460 BCCs with diagnosis confirmed by scratch cytology. Treatment parameters were altered as follows: Foscan® dose 0.03,0.15 mg/kg, drug-light interval (DLI) 1,96 hours, total energy density 20,120 J/cm2. Outcomes were assessed 8 weeks post-PDT following WHO guidelines. Results The overall rate of complete remissions (CR) was 96.7% and the cosmetic outcome was very good. In the largest subgroup (n,=,80) where low-dose Foscan® was applied (0.05 mg/kg mTHPC; 48 hours DLI; 50 J/cm2 total energy density), a CR rate of 100% with a high and narrow 95% Confidence Interval of 0.955,1.000 was achieved. Smaller variations of the treatment parameters (i.e., reducing the photosensitizer dose to 0.04 mg/kg or shortening the DLI to 24 hours) yielded similarly good results. Side effects were encountered in 52 out of 133 PDT sessions. They were more common in patients who had received high drug doses (0.06,0.15 mg/kg) and comprised mostly pain and phototoxic reactions. Three patients developed severe sunburns with subsequent scarring at the injection site following bright sunlight exposure 15,19 days after photosensitizer administration. Conclusions The presented data suggest that mTHPC-PDT with the treatment parameters mentioned above seems to be an effective treatment option for BCCs. If sensibly applied, it is well tolerated and provides mostly excellent cosmetic results. Long-term results are yet to be evaluated. Lesers Surg. Med. 40:300,311, 2008. © 2008 Wiley-Liss, Inc. [source]


    Andrew J. Read
    We conducted a mark-recapture survey of bottlenose dolphins Tursiops truncatus in the bays, sounds, and estuaries of North Carolina during July 2000, using photographic identification techniques. During this survey we took 7,682 photographs of dolphins and, of these, 3,457 images were of sufficient quality for analysis. We identified 306 dolphins from distinctive nicks and notches on their dorsal fins. Eighry-six dolphins were photographed on more than one occasion during the course of the survey; one dolphin was photographed on four separate days. We then applied the results of our photographic analyses to several mark-recapture models and examined potential violations of the assumptions of these models, including an unexpected correlation between photo quality and mark distinctiveness. Our analysis suggests that our results are robusr to possible violations of these assumptions. The resulting estimates were then scaled to account for the proportion (0.46) of unmarked dolphins in the population. Our best estimate of the number of dolphins present in the inshore waters of North Carolina during July 2000 is 1,033 with a 95% Confidence Interval of 860,1,266 (CV = 0.099). Most dolphins were found in the northern part of the study area, which includes the second largest estuarine system in the United States. [source]

    Factors associated with the temporomandibular disorder, pain dysfunction syndrome (PDS): Manchester case,control study

    ORAL DISEASES, Issue 6 2001
    TV Macfarlane
    OBJECTIVES:,To determine the individual and combined effects of potential risk factors in relation to the temporomandibular disorder, Pain Dysfunction Syndrome (PDS). DESIGN:,Case,control study. MATERIAL AND METHODS:,Cases were new referrals to the temporomandibular disorder clinic of the University Dental Hospital of Manchester, diagnosed with PDS. Controls were randomly selected from 24 dental practices. Using a postal questionnaire information was collected on socio-demographic, local mechanical, psychological factors, co-morbidities and illness behaviour. The adjusted participation rate was similar in cases and controls (64%), and 131 cases and 196 controls finally participated in the study. RESULTS:,Compared with the controls, the cases were more likely to report that their teeth felt as though they did not fit together properly [odds ratio (OR) 8, 95% Confidence Interval (CI) 6,13] and report history of facial trauma (OR 3, 95% CI 2,6). Both diurnal and nocturnal grinding were significantly associated with PDS, and individuals who reported grinding their teeth both during the day and at night had a risk of 6; 95% CI 3,13 for PDS compared with those who did not. A history of orthodontic treatment, having any dentures, having missing teeth, use of chewing gum or biting the fingernails did not show any relationship with PDS. People who took medication for the bowels had a higher risk of PDS (OR 2, 95% CI 1,4). Participants with frequent headaches had a threefold increase in risk of having PDS (OR 3, 95% CI 2,5) while having pain in parts of the body other than the head was associated with an OR of 3 (95% CI 2,5). An increased propensity to have PDS was seen in those individuals with higher levels of psychological distress (OR 3; 95% CI 1,4 in the highest category, test for trend P < 0.001) and sleep disturbance (OR 5; 95% CI 2,94 in the highest category, test for trend P < 0.001). Aspects of illness behaviour, such as disease conviction (OR 4; 95% CI 2,9 in the highest category) and perception of illness (0.3; 95% CI 0.2,0.5) were associated with PDS. The result for the denial scale became statistically significant after adjustment for age and gender (2; 95% CI 1,3). CONCLUSIONS:,The current case,control study provides complementary epidemiological information on oro-facial pain (OFP) and supports a multifactorial aetiology of PDS, with factors from many domains, including local mechanical factors, psychological and co-morbidities. People with PDS were characterized by frequent headaches, history of facial trauma, teeth grinding, sleep problems, pain elsewhere in the body and high levels of psychological distress. From the results of current study and available evidence it seems inappropriate to consider PDS in isolation and future research should adopt a multidisciplinary approach to OFP. [source]

    Synovial sarcoma in children and adolescents: Thirty three years of experience with multimodal therapy,

    PEDIATRIC BLOOD & CANCER, Issue 2 2001
    M. Fatih Okcu MD
    Abstract Background Synovial sarcoma (SS) is the most common type of non-rhabdomyosarcoma soft tissue sarcoma in childhood, with controversies about its prognosis and treatment. Procedure We reviewed medical records of 42 children and adolescents with SS treated at our institution between 1966 and 1999 to determine treatment results and assess prognostic factors. Results With a median follow-up duration of 7.8 years (range 0.2,22.4 years), 5-year progression free survival (PFS) and overall survival (OS) rates were 75.6% (95% Confidence Interval [CI] 62,89.2%) and 87.7% (95% CI 77.3,98.1%) respectively. Eleven patients were dead and four others had progressed but were alive without evidence of disease after further therapy. IRS grouping and tumor invasiveness were found to be significant prognostic indicators (P,<,0.01 and =,0.02, respectively). Patients with initial gross total resection (IRS I and II) and non-invasive tumors (T1) were most likely to have prolonged PFS and OS. Patients with small tumors (<,5 cm) (P,=,0.09) or with monophasic histology (P,=,0.14) had better PFS and OS. Conclusions Achieving a complete resection or gross total resection with microscopic residual disease is vital for survival of patients with localized SS. Patients with localized disease who received radiotherapy had improved local control. Chemotherapy did not seem to impact PFS or OS. Future large multi-institutional trials are needed to address whether post-operative chemotherapy is necessary for patients with localized, surgically removed tumors, whether radiotherapy is necessary for patients with completely resected tumors, and to ascertain the order of importance of all the candidate prognostic markers. Med Pediatr Oncol 2001;37:90,96. © 2001 Wiley-Liss, Inc. [source]

    COX-2 inhibitors: complex association with lower risk of hospitalization for gastrointestinal events compared to traditional NSAIDs plus proton pump inhibitors,

    Michiel W. van der Linden MDPhD
    Abstract Purpose To compare hospitalization rates for serious upper and lower gastrointestinal (GI) events between chronic and acute users of a traditional non-steroidal anti-inflammatory drugs (tNSAID),+,proton pump inhibitor (PPI) and users of a COX-2 selective inhibitor (Coxib). Methods The PHARMO Record Linkage System, including linked drug-dispensing and hospital records of approximately 3 million individuals in the Netherlands was used. We selected new Coxib or tNSAID users (01/01/2000,31/12/2004) with ,1,year history before the first NSAID dispensing and ,1,year follow-up ending at the first hospitalization for GI event (the outcome), last dispensing, or end of the study period. Chronic users were patients who used any NSAIDs for ,60,days during the first year (n,=,58,770); others were acute users (n,=,538,420). Multivariate analysis was performed by Poisson regression adjusted for gender, age, and duration of follow-up, tNSAID and Coxib dose, NSAID/PPI adherence, use of other gastroprotective agents, anticoagulants, acetaminophen, corticosteroids, and cardiovascular disease. Results The cohort included 23,999 new tNSAIDs,+,PPI users and 25,977 new Coxib users, with main characteristics: mean,±,SD age 58.1,±,15.5 vs. 56.7,±,17.5; female 55.3% vs. 62.2%; duration of treatment (days): 137,±,217 vs. 138,±,179, respectively. Among acute users, adjusted hazard ratios (95% Confidence Interval) were 0.21 (0.14,0.32) for upper and 0.26 (0.16,0.42) for lower GI events, for Coxib versus tNSAIDs,+,PPI users. Among chronic users, these were 0.35 (0.22,0.55) for upper GI and 0.43 (0.25,0.75) for lower GI events. Conclusions Coxib users had significantly lower rates of GI events. Further research should elucidate the possible impact of selection bias. Copyright © 2009 John Wiley & Sons, Ltd. [source]

    Estimating ethnic differences in self-reported new use of antidepressant medications: results from the Multi-Ethnic Study of Atherosclerosis

    Joseph A. C. Delaney PhD
    Abstract Introduction There is evidence that the utilization of antidepressant medications (ADM) may vary between different ethnic groups in the United States population. Methods The Multi-Ethnic Study of Atherosclerosis (MESA) is a population-based prospective cohort study of 6814 US adults from 4 different ethnic groups. After excluding baseline users of ADM, we examined the relation between baseline depression and new use of ADM for 4 different ethnicities: African,Americans (n,=,1822), Asians (n,=,784) Caucasians (n,=,2300), and Hispanics (n,=,1405). Estimates of the association of ethnicity and ADM use were adjusted for age, study site, gender, Center for Epidemiologic Studies Depression Scale (CES-D), alcohol use, smoking, blood pressure, diabetes, education, and exercise. Non-random loss to follow-up was present and estimates were adjusted using inverse probability of censoring weighting (IPCW). Results Of the four ethnicities, Caucasian participants had the highest rate of ADM use (12%) compared with African,American (4%), Asian (2%), and Hispanic (6%) participants. After adjustment, non-Caucasian ethnicity was associated with reduced ADM use: African,American (HR: 0.42; 95% Confidence Interval (CI): 0.31,0.58), Asian (HR: 0.14; 95%CI: 0.08,0.26), and Hispanic (HR: 0.47; 95%CI: 0.31,0.65). Applying IPCW to correct for non-random loss to follow-up among the study participants weakened but did not eliminate these associations: African,American (HR: 0.48; 95%CI: 0.30,0.57), Asian (HR: 0.23; 95%CI: 0.13,0.37), and Hispanic (HR: 0.58; 95%CI: 0.47,0.67). Conclusion Non-Caucasian ethnicity is associated with lower rates of new ADM use. After IPCW adjustment, the observed ethnicity differences in ADM use are smaller although still statistically significant. Copyright © 2009 John Wiley & Sons, Ltd. [source]

    Validity of the Center for Epidemiologic Studies Depression Scale as a screening instrument of major depressive disorder among Japanese workers

    Koji Wada MD
    Abstract Background The Center for Epidemiologic Studies Depression Scale (CES-D) is used at workplaces to screen depressive disorders. The aim of this study was to examine the validity of the CES-D for depression in a workplace. Methods The CES-D was administered to 2,219 workers (84.2% men; age 21,68 years) at a manufacturing company in Japan. Concomitantly all workers had an interview with the Mini International Neuropsychiatric Interview (MINI) as a gold standard for diagnosing major depressive disorder (MDD). The validity was evaluated by a receiver operating characteristic (ROC) curve. Results The area under the ROC curve of the CES-D was 0.96 [95% Confidence Interval (CI): 0.94,0.99]. The optimal cut-off score of MDD was 19 for screening. Conclusions The validity of CES-D is confirmed and it is a valid instrument for detecting MDD in working populations in Japan. Am. J. Ind. Med. 50:8,12, 2007. © 2006 Wiley-Liss, Inc. [source]

    The influence of maternal insulin-dependent diabetes on fetal nuchal translucency thickness and first-trimester maternal serum biochemical markers of aneuploidy

    PRENATAL DIAGNOSIS, Issue 10 2005
    Kevin Spencer
    Abstract Objective To evaluate the influence of maternal insulin dependent diabetes mellitus (IDDM) on maternal serum free ,-hCG, PAPP-A and fetal nuchal translucency (NT), thickness at 11 to 13+6 weeks of gestation in a large cohort of women screened prospectively for chromosomal anomalies. Methods Information on maternal IDDM status, maternal serum biochemical marker levels and fetal NT were collected from the prenatal screening computer records in two first-trimester screening centres. In total the control group included 33 301 pregnancies of which 16 366 had NT and maternal serum biochemistry results and 16 305 with NT only. The IDDM group included 195 pregnancies of which 79 had NT and maternal serum biochemistry results and 127 with NT only. The median maternal weight corrected free ,-hCG and PAPP-A, expressed as multiple of the median (MoM), and fetal NT, expressed as delta values, in the IDDM and non-IDDM groups were compared. Results There were no significant differences between the IDDM and non-IDDM groups in median maternal weight corrected free ,-hCG (IDDM 0.87 MoM, 95% Confidence Interval 0.75 to 1.16 MoM, non-IDDM 1.00 MoM), median maternal weight corrected PAPP-A (IDDM 1.02 MoM, 95% Confidence Interval 0.83 to 1.05 MoM, non-IDDM 1.01 MoM), or mean delta NT (IDDM 0.0358 mm, non-IDDM 0.0002 mm). Conclusions In pregnancies with maternal IDDM, first-trimester screening for chromosomal defects does not require adjustments for the measured fetal NT. However, more data are required before the possible reduction in maternal serum free ,-hCG and the reduction of PAPP-A suggested by the published world series can be considered sufficiently important to take into account in the calculation of risks for chromosomal defects. Copyright © 2005 John Wiley & Sons, Ltd. [source]

    Factors Affecting Satisfaction Levels of Japanese Volunteers in Meal Delivery Services for the Elderly

    Hisayo Yanagisawa
    ABSTRACT Objectives: The purpose of this study was to investigate the factors affecting satisfaction with volunteer work of participants in a meal delivery service for the elderly. Design: A cross-sectional study with a self-administered survey was carried out. Sample: Of 364 volunteers assisting with a meal delivery service for the elderly in rural towns A (80), B (159), and C (125), 247 responded (response rate: 68%). Method: An anonymous self-administered questionnaire survey was administered seeking information about basic attributes, sense of satisfaction with volunteer work, and working circumstances such as human relationships with fellow volunteers, meal service users or professional staff members, opportunities for meetings or workshop, publicity through public relations magazines, and the like. Results: In multivariate logistic analysis, the sense of satisfaction of volunteers was closely associated with human relations among volunteers (odds ratio [OR] 5.15, 95% Confidence Interval (CI) 1.84,14.40, p<.01), meal service users (OR 3.84, 95% CI 1.37,10.77, p<.05), and professional staff members supervising the meal delivery service (OR 3.53, 95% CI 1.27,9.84, p<.05). Human relations were also affected by the emphasis on communication, consultation with supervisory staff members, having opportunities for meetings, having friends with whom to confer, and publicity through public relations magazines. Conclusion: Satisfaction levels of volunteers in meal delivery services for the elderly were most affected by human relations with fellow volunteers, meal service users, and professional staff members. Increasing opportunities for communication may be important to promote good human relationships among volunteers and volunteer activities. [source]

    Smoking and acute urinary retention: The Olmsted County study of urinary symptoms and health status among men

    THE PROSTATE, Issue 7 2009
    Aruna V. Sarma PhD
    Abstract BACKGROUND Previous reports have suggested an inverse relationship between smoking and surgery for benign prostatic hyperplasia (BPH). We hypothesized that acute urinary retention (AUR), an adverse outcome of this disease and indication for surgical treatment, may be related to smoking. METHODS Study subjects were randomly selected from Olmsted County men aged 40,79 identified through the Rochester Epidemiology Project. Of the 3,854 eligible men, 2,089 (54%) completed a questionnaire that included the American Urological Association Symptom Score and assessed smoking status. Community medical records were examined for occurrence of AUR with documented catheterization in the subsequent 10 years and occurrence of BPH surgery. Proportional hazard models were used to assess the relationship between baseline smoking status and subsequent retention. RESULTS In the 18,307 person-years of follow-up, 114 men had AUR. When compared to 727 never-smokers, there was a trend among the 336 current smokers to be at lower risk (Relative risk (RR),=,0.62, 95% Confidence Interval (CI),=,0.33, 1.18) whereas the 1,026 former smokers were at similar risk to non-smokers (RR,=,1.0, 95%CI,=,0.67, 1.46). Among men with moderate-severe symptoms at baseline, current smokers were at lower risk of retention compared to non-smokers (RR,=,0.65, 95%CI,=,0.22, 1.91) but the association approached the null among those with none-mild symptoms (RR,=,0.91, 95% CI,=,0.40, 2.06). CONCLUSIONS Community-dwelling men who currently smoke may be at a modestly reduced risk of AUR. The magnitude of this association is sufficiently small that it seems unlikely that this explains a sizable proportion of the inverse association between smoking and surgically treated BPH. Prostate 69: 699,705, 2009. © 2009 Wiley-Liss, Inc. [source]

    Similar Outcomes with Different Rates of Delayed Graft Function May Reflect Center Practice, Not Center Performance

    S. K. Akkina
    To better understand the implications for considering delayed graft function (DGF) as a performance measure, we compared outcomes associated with a 2- to 3-fold difference in the incidence of DGF at two transplant centers. We analyzed 5072 kidney transplantations between 1984 and 2006 at the University of Minnesota Medical Center (UMMC) and Hennepin County Medical Center (HCMC). In logistic regression the adjusted odds ratio for DGF at HCMC versus UMMC was 3.11 (95% Confidence Interval [CI]= 2.49,3.89) for deceased donors and 2.24 (CI = 1.45,3.47) for living donors. In Cox analysis of 4957 transplantations, slow graft function (SGF; creatinine ,3.0 mg/dL [230 ,mol/L] on day 5 without dialysis) was associated with graft failure at UMMC (Relative Risk [RR]= 1.43, CI = 1.25,1.64), but not HCMC (RR = 0.99, CI = 0.77,1.28). RR's of DGF were similar at both centers. Thus, the lower incidence of DGF at UMMC likely resulted in a higher incidence and higher risk of SGF compared to HCMC. Indeed, graft survival for recipients with DGF at HCMC was similar (p = 0.3741) to that of recipients with SGF at UMMC. We conclude that dialysis per se is likely not a cause of worse graft outcomes. A better definition is needed to measure early graft dysfunction and its effects across transplant programs. [source]

    Unwanted sexual advances at work: variations by employment arrangement in a sample of working Australians

    Anthony D. LaMontagne
    Abstract Objective: We tested the hypothesis that the risk of experiencing unwanted sexual advances at work (UWSA) is greater for precariously-employed workers in comparison to those in permanent or continuing employment. Methods: A cross-sectional population-based telephone survey was conducted in Victoria (66% response rate, N=1,101). Employment arrangements were analysed using eight differentiated categories, as well as a four-category collapsed measure to address small cell sizes. Self-report of unwanted sexual advances at work was modelled using multiple logistic regression in relation to employment arrangement, controlling for gender, age, and occupational skill level. Results: Forty-seven respondents reported UWSA in our sample (4.3%), mainly among women (37 of 47). Risk of UWSA was higher for younger respondents, but did not vary significantly by occupational skill level or education. In comparison to Permanent Full-Time, three employment arrangements were strongly associated with UWSA after adjustment for age, gender, and occupational skill level: Casual Full-Time OR = 7.2 (95% Confidence Interval 1.7-30.2); Fixed-Term Contract OR = 11.4 (95% CI 3.4-38.8); and Own-Account Self-Employed OR = 3.8 (95% CI 1.2-11.7). In analyses of females only, the magnitude of these associations was further increased. Conclusions: Respondents employed in precarious arrangements were more likely to report being exposed to UWSA, even after adjustment for age and gender. Implications: Greater protections from UWSA are likely needed for precariously employed workers. [source]

    Extremely low frequency (ELF) electric and magnetic field exposure limits: Rationale for basic restrictions used in the development of an Australian standard,

    Andrew W. Wood
    Abstract There are large disparities between basic restrictions for exposure to extremely low-frequency (0,3 kHz) Electric and Magnetic Fields set by two major international bodies. Both bodies agree that these basic restrictions should prevent neuro-stimulatory effects: the retinal phosphene at frequencies up to a few hundred Hertz and peripheral nervous stimulation (PNS) at higher frequencies. The disparity arises from differences in estimated thresholds and frequency dependence, and whether restrictions should be of tissue induced current density or electric field. This paper argues that the latter metric more directly relates to neurostimulatory processes. By analysing available literature, a threshold for retinal phosphenes occurrence is found to be 56 mV/m (95% Confidence Interval 2,1330 mV/m), with a characteristic frequency of 20 Hz. Similarly, the smallest PNS sensation threshold is identified at 2 V/m (characteristic frequency above 3 kHz). In the case of the former, the large range of uncertainty suggests a ,power of ten' value of 100 mV/m. For the latter, because of the small margin between sensation and pain threshold, and because of the large individual variation, the smallest estimate of sensation threshold (2 V/m) represents a basic restriction with precaution incorporated. Bioelectromagnetics 29:414,428, 2008. © 2008 Wiley-Liss, Inc. [source]

    Unconditional Confidence Interval for the Difference between Two Proportions

    A. Martín Andrés
    Abstract In applied statistics it is customary to have to obtain a one- or two-tail confidence interval for the difference d = p2 , p1 between two independent binomial proportions. Traditionally, one is looking for a classic and non-symmetric interval (with respect to zero) of the type d , [,L;,U], d , ,0 or d , ,0. However, in clinical trials, equivalence studies, vaccination efficacy studies, etc., and even after performing the classic homogeneity test, intervals of the type |d| , ,0 or |d| , ,0, where ,0 > 0, may be necessary. In all these cases it is advisable to obtain the interval by inverting the appropriate test. The advantage of this procedure is that the conclusions obtained using the test are compatible with those obtained using the interval. The article shows how this is done using the new exact and asymptotic unconditional tests published. The programs for performing these tests may be obtained at URL [source]

    A New Method for Choosing Sample Size for Confidence Interval,Based Inferences

    BIOMETRICS, Issue 3 2003
    Michael R. Jiroutek
    Summary. Scientists often need to test hypotheses and construct corresponding confidence intervals. In designing a study to test a particular null hypothesis, traditional methods lead to a sample size large enough to provide sufficient statistical power. In contrast, traditional methods based on constructing a confidence interval lead to a sample size likely to control the width of the interval. With either approach, a sample size so large as to waste resources or introduce ethical concerns is undesirable. This work was motivated by the concern that existing sample size methods often make it difficult for scientists to achieve their actual goals. We focus on situations which involve a fixed, unknown scalar parameter representing the true state of nature. The width of the confidence interval is defined as the difference between the (random) upper and lower bounds. An event width is said to occur if the observed confidence interval width is less than a fixed constant chosen a priori. An event validity is said to occur if the parameter of interest is contained between the observed upper and lower confidence interval bounds. An event rejection is said to occur if the confidence interval excludes the null value of the parameter. In our opinion, scientists often implicitly seek to have all three occur: width, validity, and rejection. New results illustrate that neglecting rejection or width (and less so validity) often provides a sample size with a low probability of the simultaneous occurrence of all three events. We recommend considering all three events simultaneously when choosing a criterion for determining a sample size. We provide new theoretical results for any scalar (mean) parameter in a general linear model with Gaussian errors and fixed predictors. Convenient computational forms are included, as well as numerical examples to illustrate our methods. [source]

    Amniotomy for Shortening Spontaneous Labour

    BIRTH, Issue 2 2001
    W.D. Fraser
    A substantive amendment to this systematic review was last made on 25 June 1999. Cochrane reviews are regularly checked and updated if necessary. ABSTRACT Background: Early amniotomy has been advocated as a component of the active management of labour. Several randomised trials comparing routine amniotomy to an attempt to conserve the membranes have been published. Their limited sample sizes limit their ability to address the effects of amniotomy on indicators of maternal and neonatal morbidity. Objectives: To study the effects of amniotomy on the rate of Cesarean delivery and on other indicators of maternal and neonatal morbidity (Apgar less than 7 at 5 minutes, admission to NICU). Search strategy: The register of clinical trials maintained and updated by the Cochrane Pregnancy and Childbirth Group. Selection criteria: All acceptably controlled trials of amniotomy during first stage of labour were eligible. Data collection and analysis: Data were extracted by two trained reviewers from published reports. Trials were assigned methodological quality scores based on a standardised rating system. Typical odds ratios (ORs) were calculated using Peto's method. Main results: Amniotomy was associated with a reduction in labour duration of between 60 and 120 minutes. There was a marked trend toward an increase in the risk of Cesarean delivery: OR = 1.26; 95% Confidence Interval (CI) = 0.96,1.66. The likelihood of a 5-minute Apgar score less than 7 was reduced in association with early amniotomy (OR = 0.54; 95% CI = 0.30,0.96). Groups were similar with respect to other indicators of neonatal status (arterial cord pH, NICU admissions). There was a statistically significant association of amniotomy with a decrease in the use of oxytocin: OR = 0.79; 95% CI = 0.67,0.92. Reviewers' conclusions: Routine early amniotomy is associated with both benefits and risks. Benefits include a reduction in labour duration and a possible reduction in abnormal 5-minute Apgar scores. The meta-analysis provides no support for the hypothesis that routine early amniotomy reduces the risk of Cesarean delivery. Indeed there is a trend toward an increase in Cesarean section. An association between early amniotomy and Cesarean delivery for fetal distress is noted in one large trial. This suggests that amniotomy should be reserved for women with abnormal labour progress. Citation: Fraser WD, Turcot L, Krauss I, Brisson-Carrol G. Amniotomy for shortening spontaneous labour (Cochrane Review). In: The Cochrane Library, 1, 2001. Oxford: Update Software. MeSH: Amnion/*surgery; Cesarean Section; Female; Human; *Labor; Labor Complications/*prevention & control; Pregnancy The preceding reports are abstracts of regularly updated, systematic reviews prepared and maintained by the Cochrane Collaboration. The full text of the reviews are available in The Cochrane Library (ISSN 1464-780X). The Cochrane Library is prepared and published by Update Software Ltd. All rights reserved. See or contact Update Software,, for information on subscribing to The Cochrane Library in your area. Update Software Ltd, Summertown Pavilion, Middle Way, Oxford OX2 7LG, United Kingdom. (Tel: +44 1865 513902; Fax: +44 1865 516918). [source]

    Influence of short-term exposure to airborne Der p 1 and volatile organic compounds on skin barrier function and dermal blood flow in patients with atopic eczema and healthy individuals

    J. Huss-Marp
    Summary Background Epidemiological studies indicate environmental pollutants to be involved in the increase in the prevalence of allergic diseases. In human exposure studies, volatile organic compounds (VOCs) have been shown to cause exacerbations of allergic asthma whereas, no data concerning atopic eczema (AE) are available. Objective We investigated the effect of airborne VOCs on the skin of patients with AE and controls in the presence or absence of house dust mite allergen, Der p 1. Methods In a double-blind crossover study, 12 adults with AE and 12 matched healthy volunteers were exposed on their forearms to Der p 1 and subsequently to a mixture of 22 VOCs (M22, 5 mg/m3) in a total body exposure chamber for 4 h. Transepidermal water loss (TEWL) and skin blood flow were measured in all subjects before, during and after exposure. Additionally, an atopy patch test (APT) with Der p 1 was applied to the skin after exposure. Results A significant increase in transepidermal water loss was observed 48 h after exposure to VOCs as compared with exposure with filtered air in all individuals (mean difference: +34%; 95% Confidence Interval: 7,69%). Prior Der p 1 exposure resulted in a significant rise of dermal blood flow after 48 h in patients with AE but not in controls. Six out of seven patients showed enhanced atopy patch test (APT) reactions to HDM allergen after previous exposure to VOCs. Conclusion Our results show that exposure to VOCs , at concentrations commonly found in indoor environments , can damage the epidermal barrier and enhance the adverse effect of Der p 1 on sensitized subjects with AE. These findings may contribute to a better understanding of the mechanisms underlying the increase in prevalence and exacerbation of AE. [source]

    Long-acting insulin analogues vs.

    NPH human insulin in type 1 diabetes.
    Aim:, Basal insulin in type 1 diabetes can be provided using either NPH (Neutral Protamine Hagedorn) human insulin or long-acting insulin analogues, which are supposed to warrant a better metabolic control with reduced hypoglycaemic risk. Aim of this meta-analysis is the assessment of differences with respect to HbA1c (Glycated hemoglobin), incidence of hypoglycaemia, and weight gain, between NPH human insulin and each long-acting analogue. Methods:, Of 285 randomized controlled trials with a duration > 12 weeks comparing long-acting insulin analogues (detemir or glargine) with NPH insulin in type 1 diabetic patients identified through Medline search and searches on, 20 met eligibility criteria (enrolling 3693 and 2485 in the long-acting analogues and NPH group respectively). Data on HbA1c and body mass index at endpoint, and incidence of any, nocturnal and severe hypoglycaemia, were extracted and meta-analysed. Results:, Long-acting analogues had a small, but significant effect on HbA1c [-0.07 (,0.13; ,0.01)%; p = 0.026], in comparison with NPH human insulin. When analysing the effect of long-acting analogues on body weight, detemir was associated with a significantly smaller weight gain than human insulin [by 0.26 (0.06;0.47) kg/m2; p = 0.012]. Long-acting analogues were associated with a reduced risk for nocturnal and severe hypoglycaemia [OR (Odd Ratio, 95% Confidence Intervals) 0.69 (0.55; 0.86), and OR 0.73 (0.60; 0.89) respectively; all p < 0.01]. Conclusions:, The switch from NPH to long-acting analogues as basal insulin replacement in type 1 diabetic patients had a small effect on HbA1c, and also reduced the risk of nocturnal and severe hypoglycaemia. [source]

    The neuropsychological profile in dementia with Lewy bodies and Alzheimer's disease

    Haruhiko Oda
    Abstract Objective To demonstrate the exact nature of the cognitive profile of dementia with Lewy bodies (DLB) on standardized neuropsychological tests including the Wechsler Adult Intelligence Scale,,Revised (WAIS-R) and the Wechsler Memory Scale,,Revised (WMS-R). Design We examined the WAIS-R and the WMS-R of 26 patients with probable DLB (based on the Consensus Criteria for the clinical diagnosis of DLB) and of 78 patients with probable Alzheimer's disease (AD) (based on criteria of the National Institute for Neurological and Communicative Disorders and Stroke-Alzheimer's disease and Related Disorders Association) who were matched to the patients with DLB 3:1 by Mini-Mental State Examination score. Results The DLB group scored significantly lower on the Block Design, Object Assembly and Digit Symbol of WAIS-R and significantly higher on the Logical Memory I, Verbal Paired Associates I, Logical Memory II, Visual Paired Associates II, Verbal Paired Associates II and Visual Reproduction II of WMS-R (p,<,0.0016 to p,<,0.0001). In a comparison between the DLB group and the AD group, a logistic regression analysis revealed that the weighted sum score of the Object Assembly and the Logical Memory II may differentiate DLB from AD with a sensitivity of 0.81 [95% Confidence Intervals (CI),=,0.66,0.96] and a specificity of 0.76 (95% CI,=,0.66,0.85). Conclusions The WAIS-R and the WMS-R can help to differentiate DLB from AD. Copyright © 2008 John Wiley & Sons, Ltd. [source]

    Depression and chronic medical illnesses in Asian older adults: the role of subjective health and functional status

    Matthew Niti
    Abstract Objective Depression in elderly is reportedly associated with a number of specific chronic illnesses. Whether each of these co-morbid associations results uniquely from disease-specific psychobiological responses or is mediated by non-specific factors like subjective health and functional status is unclear. Method Analysis of data of 2,611 community-dwelling Chinese aged 55 and older, including depressive symptoms defined by Geriatric Depression Scale score,,,5 and self-reports of specific chronic illnesses. Results The prevalence of depressive symptoms was 13.3%, lower in those without chronic illness (7.5%), and higher in those with illnesses (13.2,24.2%). Crude Odds Ratios (OR) were significantly elevated for hypertension, eye disorders, diabetes, arthritis, ischemic heart disease, asthma/COPD, stroke, osteoporosis, heart failure, thyroid problem, and gastric problem. In multivariable analyses, only asthma/COPD [OR:2.85, 95% Confidence Intervals (CI): 1.36, 5.98], gastric problem (OR:2.64, 95% CI: 1.11, 6.29), arthritis (OR:1.87, 95% CI: 1.02, 3.42) and heart failure (OR:2.11, 95% CI: 0.98, 4.58) remained independently associated with depressive symptoms, after adjusting for comorbidities, subjective health and functional status, cognitive functioning, smoking, alcohol, psychosocial and demographic variables. Conclusion Most comorbid associations of depressive symptoms with specific chronic illnesses are explained by accompanying poor self-reported health and functional status, but some illnesses probably have a direct psychobiological basis. Copyright © 2007 John Wiley & Sons, Ltd. [source]

    Reaching the population with dementia drugs: what are the challenges?

    Fiona E Matthews
    Abstract Background Systematic evidence became available in the late 1990s on efficacy of cholinesterase inhibitors (CHEIs) for patients with mild to moderate Alzheimer's disease (AD) and they began to be used sporadically. Since January 2001 UK based guidelines indicated that one of three cholinesterase inhibitors (CHEIs) could be prescribed for these patients. Since then the cost of prescription in England and Wales has risen. There has been little investigation of uptake at the population level. Objective To estimate the population uptake of CHEIs in a population based study of dementia spanning this period. Design Using data from a 10-year follow up and a later 12 year interview of the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS), a UK population based longitudinal cohort study of people originally aged 65 years and above, we investigated who was taking CHEIs during the period 2001,2004. We sought information from respondents taking part in the study what medication they were taking on a regular basis. Results Only 12, of the 219 individuals who received a study diagnosis of dementia were prescribed CHEIs [5%, 95% Confidence Intervals (CI) 3%,9%]) in 2001/2003 and none of the 28 individuals with a study diagnosis of dementia (0%, 95% CI 0,18%) in 2004 were prescribed CHEIs. Uptake was biased towards individuals with more education and higher social class. Conclusions These data suggest that any impact on AD progression at the population level will be negligible as prescription of CHEIs and uptake in the age group at highest risk is so limited. There is little evidence that this has changed over time. Copyright © 2006 John Wiley & Sons, Ltd. [source]