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Additional Adjustment (additional + adjustment)
Selected AbstractsORIGINAL ARTICLE: Prevalence and correlates of metabolic syndrome based on a harmonious definition among adults in the US,JOURNAL OF DIABETES, Issue 3 2010Earl S. FORD Abstract Background:, Recently, a Joint Scientific Statement bridged differences between previous definitions of metabolic syndrome. Our objective was to estimate the prevalence of metabolic syndrome in a representative sample of US adults and to examine its correlates. Methods:, We analyzed data for up to 3461 participants aged ,20 years of the 2003,2006 National Health and Nutrition Examination Survey. Results:, Using waist circumference thresholds of ,102 cm for men and ,88 cm for women, the age-adjusted prevalence of metabolic syndrome was 34.3% among all adults, 36.1% among men, and 32.4% among women. Using racial- or ethnic-specific International Diabetes Federation criteria for waist circumference, the age-adjusted prevalence of metabolic syndrome was 38.5% for all participants, 41.9% for men, and 35.0% for women. Prevalence increased with age, peaking among those aged 60,69 years. Prevalence was lower among African American men than White or Mexican American men, and lower among White women than among African American or Mexican American women. In a multivariate regression model, significant independent associations were noted for age (positive), gender (men higher than women), race or ethnicity (African Americans and participants of another race lower than Whites), educational status (inverse), hypercholesterolemia (positive), concentrations of C-reactive protein (positive), leisure time physical activity (inverse), microalbuminuria (positive), and hyperinsulinemia (positive). Additional adjustment for body mass index weakened many of the associations, with educational status and microalbuminuria no longer significant contributors to the model. Conclusion:, Metabolic syndrome continues to be highly prevalent among adults in the US. [source] Are employment shifts into non-manufacturing industries partially responsible for the decline in occupational injury rates?AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 10 2009Tim F. Morse PhD Abstract Background Bureau of Labor Statistics figures have shown declines in injury and illness rates over the past 25 years. It is unclear what factors are contributing to that decline. Methods Connecticut injury and illness data was industry-adjusted to account for the shifts in employment by industry sector for the 25-year period from 1976 to 2000. Additional adjustment was made for manufacturing sub-sectors, since declines in manufacturing employment accounted for the largest proportion of the shift in injuries over that period. Results Approximately 18% of the decline in injury and illness rates was associated with a shift in employment from more hazardous to less hazardous industries. Shifts in manufacturing sub-sectors accounted for an additional 5.7% of the decline. Conclusion A significant proportion of the decline in injury and illness rates appears to be due to demographic shifts in industry composition. Am. J. Ind. Med. 52:735,741, 2009. © 2009 Wiley-Liss, Inc. [source] Mortality after uveal and conjunctival melanoma: which tumour is more deadly?ACTA OPHTHALMOLOGICA, Issue 2 2009Emma Kujala Abstract. Purpose:, We aimed to model and compare mortality rates for uveal melanoma (UM) and conjunctival melanoma (CM) by adjusting for differences in tumour size and local recurrence. Methods:, Population-based mortality data for 240 and 85 patients with primary UM and CM and 91 and 23 patients with disseminated UM and CM, respectively, were compared with cumulative incidence analysis. Cox proportional hazards multivariate regression with time-dependent variables was used to adjust for differences in tumour diameter, thickness and recurrence rates. Results:, The 10-year cumulative incidences of metastatic death from UM and CM were 39% (95% confidence interval [CI] 33,45) and 32% (95% CI 21,44), respectively. After adjusting for tumour size, risk of death from CM was higher than from UM (hazard ratio [HR] 1.9; p = 0.039). Additional adjustment for more frequent local recurrence of CM diminished the difference (HR 1.5; p = 0.25). Survival periods after systemic metastasis of UM and CM were comparable (median 8 months). Conclusions:, Clinical observations show longer survival after primary CM than after primary UM. This reflects the smaller average size of CM. However, a primary CM of a given size is more deadly than a UM of equivalent size because primary CM tends to recur after treatment and, possibly, because additional lymphatic dissemination occurs with CM. [source] Association between serum bicarbonate and death in hemodialysis patients: Is it better to be acidotic or alkalotic?HEMODIALYSIS INTERNATIONAL, Issue 1 2005D.Y.J. Wu The optimal acid base status for survival in maintenance hemo-dialysis (MHD) patients (pts) remains controversial. According to some reports acidosis is associated with improved survival in MHD pts, i.e., reverse epidemiology. We examined associations between baseline (first 3-month averaged) serum bicarbonate (HCO3), divided into 12 categories, and 2-yr mortality in 56,376 MHD pts across the US after controlling for confounding effects of malnutrition-inflammation complex syndrome (MICS). Three sets of Cox regression models were evaluated to estimate hazard ratios (HR) of death and 95% confidence intervals (CI): (1) Unadjusted; (2) Multivariate adjusted for case-mix (age, gender, diabetes, race, insurance, marital status, vintage, standardized mortality ratio, residual renal function, dialysate HCO3, and Kt/V); and (3) Additional adjustments for 8 markers of MICS (body mass index, serum albumin, creatinine, ferritin, TIBC, dietary protein intake, WBC and lymphocyte counts). See Figure for HR and 95% CI: We conclude that, although high HCO3 levels appear to be associated with increased mortality in MHD pts, this paradoxical effect is almost entirely due to the overwhelming impact of MICS on survival. [source] Primary Headache in Italian Early Adolescents: The Role of Perceived Teacher UnfairnessHEADACHE, Issue 3 2009Massimo Santinello BA Background., The impact of perceived teacher unfairness on headache incidence has previously been insufficiently investigated. Objective., The aims of the study are to analyze the prevalence of headache among Italian early adolescents as well as to examine the role of perceived teacher unfairness and classmate social support in predicting this health outcome. Methods., Data were taken from the "Health Behaviour in School Aged Children," a cross-sectional survey investigating health behaviors among early adolescents in selected European countries. Headache, perceived teacher unfairness, and classmate social support were measured through a self-administered questionnaire filled out by a representative sample of 4386 (48.4% males) Italian students (11, 13, and 15 years old). Covariates included demographic characteristics (age, gender) and socioeconomic status (parental educational attainment), and other confounding psychological factors (eg, family empowerment, bullying). Results., Prevalence of frequent headaches (at least once a week) was about 40%. Girls were more likely to report frequent headaches compared with boys. Prevalence of frequent headaches increased with age. After adjusting for age and gender, teacher unfairness showed a significant association with frequent headache (P < .001). This relationship remained significant even after additional adjustment for several psychosocial factors. Classmate social support seems to act as a protective factor, but not as a buffering mechanism against the negative effects of teacher unfairness. Conclusions., Italian early adolescents show a quite high prevalence of frequent headache. Results show that characteristics of the school setting, such as teacher unfairness and classmate social support, can be significant predictors of frequent headache among early adolescents. Longitudinal research is needed to delineate causal relationships between school factors and recurrent headache. [source] Associations Between Lower Extremity Ischemia, Upper and Lower Extremity Strength, and Functional Impairment with Peripheral Arterial DiseaseJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2008Mary M. McDermott MD OBJECTIVES: To identify associations between lower extremity ischemia and leg strength, leg power, and hand grip in persons with and without lower extremity peripheral arterial disease (PAD). To determine whether poorer strength may mediate poorer lower extremity performance in persons with lower arterial brachial index (ABI) levels. DESIGN: Cross-sectional. SETTING: Academic medical centers. PARTICIPANTS: Four hundred twenty-four persons with PAD and 271 without PAD. MEASUREMENTS: Isometric knee extension and plantarflexion strength and handgrip strength were measured using a computer-linked strength chair. Knee extension power was measured using the Nottingham leg rig. ABI, 6-minute walk, and usual and fastest 4-m walking velocity were measured. Results were adjusted for potential confounders. RESULTS: Lower ABI values were associated with lower plantarflexion strength (P trend=.04) and lower knee extension power (P trend <.001). There were no significant associations between ABI and handgrip or knee extension isometric strength. Significant associations between ABI and measures of lower extremity performance were attenuated after additional adjustment for measures of strength. CONCLUSION: These results are consistent with the hypothesis that lower extremity ischemia impairs strength specifically in distal lower extremity muscles. Associations between lower extremity ischemia and impaired lower extremity strength may mediate associations between lower ABI values and greater functional impairment. [source] Method to describe curing in large epoxy samplesADVANCES IN POLYMER TECHNOLOGY, Issue 4 2009Krzysztof Kasza Abstract Curing kinetics models used in numerical simulations describe the exothermic chemical reaction of thermosetting materials. The mathematical formula known as Kamal's model is discussed in the following paper. Traditionally, the coefficients of Kamal's equations are estimated based on differential scanning calorimetry (DSC) measurements and results from an experimental verification of such created curing kinetics model are presented. Furthermore, an inverse analysis is proposed for additional adjustment of the model. The new coefficients thus found provide better accuracy in the computer simulations. The methodology of development of the curing kinetics model is proposed as an alternative solution to the standard DSC measurements. Particularly, it could be useful for materials with a complex structure, such as composites. © 2010 Wiley Periodicals, Inc. Adv Polym Techn 28:267,275, 2009; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/adv.20162 [source] Estimation of variance components due to imprinting effects with DFREML and VCE: results of a simulation studyJOURNAL OF ANIMAL BREEDING AND GENETICS, Issue 1 2002A. ESSL Treating gametes as homozygous diploid individuals, TIER and SÖLKNER (Theor. Appl. Genet. 85: 868,872, 1993) proposed a method which manages the use of available computer programs with a common animal model to estimate variance components caused by imprinting effects. Despite some relevant model restrictions, this approach has already been used in some field data analyses by an adapted version of the widely used DFREML computer program, subsequently indicated by DFREMLa. The main objective of this study was to ascertain the properties of DFREMLa by computer simulation and to examine other alternative estimation approaches. The most important results may be summarized as follows: (1) Treating gametes as homozygous diploid individuals has the consequence that one-half of the actually realized gametic effect is totally abstracted in variance component estimation. Thus, an additional adjustment of the phenotypic variance calculated by DFREMLa is necessary to get correct values of estimated variance component ratios. (2) Adjusted DFREMLa estimates yielded correct results when animals were unselected and only maternal or paternal imprinting (not both simultaneously) occurred. (3) When the model did not adequately account for the additive genetic component within a maternal lineage, significant upward biases for the cytoplasmic component were observed. (4) The use of a simple dam and sire model with appropriate relationship matrices can be recommended when only the difference of maternal and paternal imprinting effects is of primary interest and the covariance between maternal halfsibs is not substantially increased by common environmental effects. (5) An adequate estimation of variance components for all possible imprinting situations requires the use of an animal model augmented by both maternal and paternal gametic effects. Unfortunately, a computer program on the basis of such a model does not yet exist. Schätzung von Varianzkomponenten für Imprintingeffekte mittels DFREML und VCE: Ergebnisse einer Simulationsstudie TIER and SÖLKNER (Theor. Appl. Genet. 85: 868,872, 1993) schlugen eine Methode zur Schätzung von imprintingbedingten Varianzkomponenten vor, die mit einem einfach zu adaptierenden Computerprogramm auf der Basis eines üblichen Tiermodells vorgenommen werden kann, indem sie Gameten wie homozygot diploide Individuen behandelten. Obwohl dieser Ansatz einige praxisrelevante Einschränkungen hat, wurde er bereits bei einigen Felddatenanalysen verwendet. Für diesen Zweck wurde eine entsprechend adaptierte Version des häufig verwendeten Computerprogrammes DFREML eingesetzt, die im folgenden mit DFREMLa bezeichnet wird. Das Ziel der vorliegen Untersuchung lag darin, die Eigenschaften von DFREMLa bei verschiedenen Imprintingsituationen zu überprüfen und weiters die Brauchbarkeit anderer möglicher Schätzansätze zu überprüfen. (1) Werden Gameten wie diploide homozygote Individuen aufgefaßt, dann geht bei der Schätzung von Varianzkomponenten mit DFREMLa eine Hälfte des tatsächlich wirksamen Gameteneffektes völlig verloren. Das heißt, die von DFREMLa ausgewiesenen Ergebnisse müssen nachträglich entsprechend adjustiert werden, um korrekte Schätzergebnisse für alle jene Quotienten von Varianzkomponenten zu erhalten, bei denen die gesamte phänotypische Varianz im Nenner steht. (2) Die adjustierten DFREMLa Schätzwerte lieferten in all jenen Fällen korrekte Ergebnisse, wo keine Selektion der Tiere erfolgte und entweder nur maternales oder paternales Imprinting (nicht beide gleichzeitig) auftrat. (3) Alle Modelle, bei denen die additiv genetische Komponente innerhalb einer Kuhfamilie keine adäquate Berücksichtigung fand, führten zu einer systematischen Überschätzung der zytoplasmatischen Varianzkomponente. (4) Ist nur jene Varianzkomponente von Interesse, die durch unterschiedlich starkes maternales bzw. paternales Imprinting erklärt werden kann, dann kann auch die Verwendung einfacher Vater-bzw. Muttermodelle empfohlen werden. Voraussetzung hierfür ist allerdings, daß die Kovarianz zwischen mütterlichen Halbgeschwistern durch keine gemeinsame Umwelt erhöht ist. (5) Eine für alle Imprintingsituationen problemadäquate Schätzung von Varianzkomponenten verlangt die Anwendung eines Tiermodelles, erweitert um beide imprintingbedingten Gameteneffekte. Leider fehlt gegenwärtig hierfür noch ein entsprechendes Computerprogramm. [source] Increased Bone Resorption Is Associated With Increased Risk of Cardiovascular Events in Men: The MINOS Study,,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 12 2009Pawel Szulc Abstract Better assessment of the association between cardiovascular disease and osteoporosis in older men may help identify shared etiologies for bone and heart health in this population. We assessed the association of BMD and bone turnover markers (BTMs) with risk of cardiovascular events (myocardial infarction or stroke) in 744 men ,50 yr of age. During the 7.5-yr prospective follow-up, 43 strokes and 40 myocardial infarctions occurred in 79 men. After adjustment for confounders (age, weight, height, smoking, education, physical activity, self-reported history of diabetes, hypertension, and prevalent ischemic heart disease), men in the lowest quartile of BMD at the spine, whole body, and forearm had a 2-fold increased risk of cardiovascular events. Men in the highest quartile of bone resorption markers (deoxypyridinoline [DPD], C-telopeptide of type I collagen) had a 2-fold increased risk of cardiovascular events (e.g., multivariable-adjusted hazard ratio [including additional adjustment for BMD] was 2.11 [95% CI: 1.26,3.56], for the highest quartile of free DPD relative to the lowest three quartiles). The results were similar for men without prevalent ischemic heart disease and for myocardial infarction and stroke analyzed separately. Our data suggest that men with low BMD or high bone resorption may be at increased risk of myocardial infarction and stroke in addition to fracture. Thus, men with osteoporosis may benefit from screening for cardiovascular disease. Further study to elucidate the biological mechanism shared by bone and vascular disease may help efforts to identify men at risk or develop treatment. [source] Habitual Levels of Physical Activity Influence Bone Mass in 11-Year-Old Children From the United Kingdom: Findings From a Large Population-Based Cohort,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 1 2007Jon H Tobias MD Abstract We examined the influence of habitual levels of physical activity on bone mass in childhood by studying the relationship between accelerometer recordings and DXA parameters in 4457 11-year-old children. Physical activity was positively related to both BMD and bone size in fully adjusted models. However, further exploration revealed that this effect on bone size was modified by fat mass. Introduction: Exercise interventions have been reported to increase bone mass in children, but it is unclear whether levels of habitual physical activity also influence skeletal development. Materials and Methods: We used multivariable linear regression to analyze associations between amount of moderate and vigorous physical activity (MVPA), derived from accelerometer recordings for a minimum of 3 days, and parameters obtained from total body DXA scans in 4457 11-year-old boys and girls from the Avon Longitudinal Study of Parents and Children. The influence of different activity intensities was also studied by stratification based on lower and higher accelerometer cut-points for moderate (3600 counts/minute) and vigorous (6200 counts/minute) activity, respectively. Results: MVPA was positively associated with lower limb BMD and BMC adjusted for bone area (aBMC; p < 0.001, adjusted for age, sex, socio-economic factors, and height, with or without additional adjustment for lean and fat mass). MVPA was inversely related to lower limb bone area after adjusting for height and lean mass (p = 0.01), whereas a positive association was observed when fat mass was also adjusted for (p < 0.001). Lower limb BMC was positively related to MVPA after adjusting for height and lean and fat mass (p < 0.001), whereas little relationship was observed after adjusting for height and lean mass alone (p = 0.1). On multivariable regression analysis using the fully adjusted model, moderate activity exerted a stronger influence on lower limb BMC compared with light activity (light activity: 2.9 [1.2,4.7, p = 0.001]; moderate activity: 13.1 [10.6,15.5, p < 0.001]; regression coefficients with 95% confidence intervals and p values). Conclusions: Habitual levels of physical activity in 11-year-old children are related to bone size and BMD, with moderate activity exerting the strongest influence. The effect on bone size (as reflected by DXA-based measures of bone area) was modified by adjustment for fat mass, such that decreased fat mass, which is associated with higher levels of physical activity, acts to reduce bone size and thereby counteract the tendency for physical activity to increase bone mass. [source] Sleep disturbances as a predictor of occupational injuries among public sector workersJOURNAL OF SLEEP RESEARCH, Issue 1p2 2010SIMO SALMINEN Summary The association between disturbed sleep and increased risk of occupational injury has been observed in several cross-sectional and case,control studies, but prospective evidence is lacking. We examined prospectively whether sleep disturbances predicted occupational injuries in a large population of Finnish public sector employees. A total of 48 598 employees working in 10 municipalities and 21 hospitals in various parts of Finland were included. Sleep disturbances were assessed with the four-item Jenkins Sleep Problems Scale. Records of sickness absence due to occupational injury during the year following the survey were obtained from employers' registers. A proportion (9076; 22%) of participants reported disturbed sleep, and 978 (2.4%) had a recorded occupational injury. After adjustment for socio-demographic characteristics, the odds ratio (OR) for occupational injury was 1.38 [95% confidence interval (CI) 1.02,1.87] times higher for men with experiences of disturbed sleep than for those without sleep disturbances, but not significant for women. Of the sub-dimensions of sleep disturbances, the OR for occupational injury was 1.69 (95% CI 1.26,2.26) for women with difficulties initiating sleep, but not significant for men. These associations remained after additional adjustment for work stress, sleep length, obesity, alcohol use and mental health. This study suggests that sleep disturbances are a significant predictor of occupational injuries even after accounting for a range of covariates. [source] Bowel movement frequency in late-life and incidental Lewy bodiesMOVEMENT DISORDERS, Issue 11 2007Robert D. Abbott PhD Abstract It is not known if constipation is associated with the preclinical phase of Parkinson's disease (PD), often characterized by the presence of incidental Lewy bodies (ILB). Such an association could provide evidence that constipation is an early symptom of PD. The purpose of this report is to examine the association between late-life bowel movement frequency and ILB. Bowel movement frequency was assessed from 1991 to 1993 in 245 men aged 71 to 93 years in the Honolulu-Asia Aging Study who later received postmortem examinations. All were without clinical PD and dementia. Brains were examined for ILB in the substantia nigra and locus ceruleus. Among the decedents, 30 men had ILB (12.2%). After age-adjustment, the percent of brains with ILB declined with increasing bowel movement frequency (P = 0.013). For men with <1, 1, and >1 bowel movement/day, corresponding percents were 24.1, 13.5, and 6.5%. Findings persisted after additional adjustment for time to death, mid-life pack-years of smoking and coffee intake, physical activity, and cognitive function. Infrequent bowel movements are associated with ILB. Findings provide evidence that constipation can predate the extrapyramidal signs of PD. Constipation could be one of the earliest markers of the beginning of PD processes. © 2007 Movement Disorder Society [source] Mitigating on-call symptoms through organizational justice and job control: a cross-sectional study among Finnish anesthesiologistsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2009P. M. LINDFORS Background: On-call duty has been shown to be associated with health problems among physicians. However, it cannot be abolished, as patient safety has to be assured. Thus, we need to find factors that could mitigate the negative health effects of on-call duty. Methods: The cross-sectional questionnaire of the buffering effects of organizational justice, job control, and social support on on-call stress symptoms was sent to all working Finnish anesthesiologists (n=550). Results: The response rate was 60% (n=328, 53% men). High organizational justice, job control, and social support were associated with a low number of symptoms while on call or the day after in crude analysis and when adjusted for age, gender, and place of work. Only the association between justice and symptoms was robust to additional adjustments for on-call burden and self-rated health. In the interaction analysis among those being on call at the hospital, we found that the higher the levels of job control or organizational justice, the lower the number of symptoms. Conclusions: Job control and organizational justice successfully mitigated stress symptoms among those who had on-call hospital duties. It would be worth enhancing decision-making procedures, interpersonal treatment, and job control routines when aiming to prevent on-call stress and related symptoms. [source] Inflammation in Areas of Tubular Atrophy in Kidney Allograft Biopsies: A Potent Predictor of Allograft FailureAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2010R. B. Mannon The Banff scoring schema provides a common ground to analyze kidney transplant biopsies. Interstitial inflammation (i) and tubulitis (t) in areas of viable tissue are features in scoring acute rejection, but are excluded in areas of tubular atrophy (TA). We studied inflammation and tubulitis in a cohort of kidney transplant recipients undergoing allograft biopsy for new-onset late graft dysfunction (N = 337). We found inflammation (,iatr') and tubulitis (,tatr') in regions of fibrosis and atrophy to be strongly correlated with each other (p < 0.0001). Moreover, iatr was strongly associated with death-censored graft failure when compared to recipients whose biopsies had no inflammation, even after adjusting for the presence of interstitial fibrosis (Hazard Ratio = 2.31, [1.10,4.83]; p = 0.0262) or TA (hazard ratio = 2.42, [1.16,5.08]; p = 0.191), serum creatinine at the time of biopsy, time to biopsy and i score. Further, these results did not qualitatively change after additional adjustments for C4d staining or donor specific antibody. Stepwise regression identified the most significant markers of graft failure which include iatr score. We propose that a more global assessment of inflammation in kidney allograft biopsies to include inflammation in atrophic areas may provide better prognostic information. Phenotypic characterization of these inflammatory cells and appropriate treatment may ameliorate late allograft failure. [source] | ||||||||||