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Greater Prevalence (greater + prevalence)
Selected AbstractsGreater Prevalence and Incidence of Dementia in Older Veterans with Posttraumatic Stress DisorderJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2010[See editorial comments by Dr. Soo Borson, pp 1797-1798] OBJECTIVES: To explore the association between posttraumatic stress disorder (PTSD) and dementia in older veterans. DESIGN: Administrative database study of individuals seen within one regional division of the Veterans Affairs healthcare network. SETTING: Veterans Integrated Service Network 16. PARTICIPANTS: Veterans aged 65 and older who had a diagnosis of PTSD or who were recipients of a Purple Heart (PH) and a comparison group of the same age with no PTSD diagnosis or PH were divided into four groups: those with PTSD and no PH (PTSD+/PH,, n=3,660), those with PH and no PTSD (PTSD,/PH+, n=1,503), those with PTSD and a PH (PTSD+/PH+, n=153), and those without PTSD or a PH (PTSD,/PH,, n=5,165). MEASUREMENTS: Incidence and prevalence of dementia after controlling for confounding factors in multivariate logistic regression. RESULTS: The PTSD+/PH, group had a significantly higher incidence and prevalence of dementia than the groups without PTSD with or without a PH. The prevalence and incidence of a dementia diagnosis remained two times as high in the PTSD+/PH, group as in the PTSD,/PH+ or PTSD,/PH, group after adjusting for the confounding factors. There were no statistically significant differences between the other groups. CONCLUSION: The incidence and prevalence of dementia is greater in veterans with PTSD. It is unclear whether this is due to a common risk factor underlying PTSD and dementia or to PTSD being a risk factor for dementia. Regardless, this study suggests that veterans with PTSD should be screened more closely for dementia. Because PTSD is so common in veterans, this association has important implications for veteran care. [source] On the Association Between Valproate and Polycystic Ovary SyndromeEPILEPSIA, Issue 3 2001Pierre Genton Summary: Recent studies by Isojärvi et al. have raised the issue of an increased incidence of polycystic ovary syndrome (PCOS) in women with epilepsy treated with valproate (VPA) and have proposed replacement with lamotrigine (LTG). Polycystic ovaries (PCO) are a common finding, with a prevalence >20% in the general population, and are easily detected by pelvic or vaginal ultrasonography, whereas PCOS is comparatively rare: few women with PCO have fully developed PCOS, which includes hirsutism, acne, obesity, hypofertility, hyperandrogenemia, and menstrual disorders. From an extensive review of the current literature, it appears that there are no reliable data on the actual prevalence of PCOS in normal women and in women with epilepsy. The pathogenesis of PCO is multifactorial, including genetic predisposition and the intervention of environmental factors, among which weight gain and hyperinsulinism with insulin resistance may play a part. The roles of central (hypothalamic/pituitary), peripheral, and local ovarian factors are still debated. PCO and PCOS appear to be more frequent in women with epilepsy, but there are no reliable data showing a greater prevalence after VPA. The recent studies by Isojärvi et al. may have been biased by the retrospective selection of patients. To date, there is no reason to contraindicate the use of VPA in women with epilepsy. However, patients should be informed about the risk of weight gain and its consequences. [source] Paraoxonase activity in two healthy populations with differing rates of coronary heart diseaseEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 1 2000Mackness Background The rate of coronary heart disease is over three-fold greater in Belfast than in Toulouse and the excess risk cannot be totally explained by ,classical' risk factors such as total cholesterol, LDL-cholesterol, smoking, etc. Design The effect of the human serum paraoxonase (PON1) 192-genetic polymorphism on plasma lipid and lipoprotein concentrations and on PON1 activity and concentration was investigated in 186 randomly selected healthy subjects from Toulouse and 165 from Belfast. Results The frequency of the R allele of PON1, which has been related to the risk of coronary heart disease, was significantly higher in Belfast (0.33) than in Toulouse (0.24; ,2 = 7.229, P = 0.0072). Subjects from Belfast also had significantly higher serum cholesterol, triglycerides, LDL-cholesterol, and apolipoprotein B, and significantly lower HDL-cholesterol and apolipoprotein A1, but these lipoprotein parameters were independent of the PON1 192-polymorphisms. PON1 activity towards paraoxon was significantly higher in the Belfast population than in Toulouse (median values: 179.7 vs. 129.4 nmol min,1 mL,1 serum, respectively; P < 0.05), which is consistent with our finding of a greater prevalence of the R allele. The median serum concentration of PON1 was 56.3 ,g mL,1 in Belfast, which was significantly lower (P < 0.005) than the level of 71 ,g mL,1 in Toulouse. Conclusions Our results thus provide further support for the hypothesis that populations at increased CHD risk have diminished serum PON1 concentration and an increased prevalence of the R allele of PON1. They are also consistent with reports that the ability of PON1 to hydrolyse paraoxon is inversely related to its capacity to hydrolyse lipid-peroxides, and thus to its antiatherogenic action. [source] Seeking Information About Sexual Health: Applying the Theory of Motivated Information ManagementHUMAN COMMUNICATION RESEARCH, Issue 1 2006Walid A. Afifi Although considerable research attention has been devoted to studying the spread of HIV, recent attention to general sexual health has refocused attention to the far greater prevalence of other sexually transmitted infections. One way we might help control the spread of these infections is by better understanding the information management process as it relates to sexual health. Toward that effort, this investigation offers an empirical test of the Theory of Motivated Information Management (W. A. Afifi & Weiner, 2004), applying it to college students' search for target-related sexual health information. The results contribute to our understanding of information-seeking processes, offer mixed results regarding the theory's utility in this context, and show an association between information seeking and safer-sex behavior. [source] CEOs with a functional background in operations: Reviewing their performance and prevalence in the top postHUMAN RESOURCE MANAGEMENT, Issue 5 2010Burak Koyuncu Abstract With this study, we update research by Ocasio and Kim (1999) by testing whether the trends that favored the prevalence of CEOs with an operations background in the 1980s and early 1990s continued between 1992 and 2005. Given that supply chain management became a top business priority during this period, we expect a greater prevalence of CEOs with an operations background. This is because, traditionally, executives belonging to the operations function have assumed responsibility for supply chain management issues. Our results, based on a sample of 437 CEOs who lead large-sized U.S. firms in eight industries, provide partial support for the hypothesis that CEOs with a functional background in operations attain higher post-succession performance than CEOs with other functional backgrounds. In addition, we find that the likelihood that newly appointed CEOs have a background in operations is greater in succession events that have taken place more recently and in situations that occurred in the face of poor firm financial performance. © 2010 Wiley Periodicals, Inc. [source] Inflammatory bowel disease: Epidemiology, pathogenesis, and therapeutic opportunitiesINFLAMMATORY BOWEL DISEASES, Issue 5 2006Stephen B Hanauer MD Abstract Ulcerative colitis (UC) and Crohn's disease (CD), the primary constituents of inflammatory bowel disease (IBD), are precipitated by a complex interaction of environmental, genetic, and immunoregulatory factors. Higher rates of IBD are seen in northern, industrialized countries, with greater prevalence among Caucasians and Ashkenazic Jews. Racial gaps are closing, indicating that environmental factors may play a role. IBD is multigenic, with the most clearly established genetic link between certain NOD2 variants and CD. Regardless of the underlying genetic predisposition, a growing body of data implicates a dysfunctional mucosal immune response to commensal bacteria in the pathogenesis of IBD, especially CD. Possible triggers include a chronic inflammatory response precipitated by infection with a particular pathogen or virus or a defective mucosal barrier. The characteristic inflammatory response begins with an infiltration of neutrophils and macrophages, which then release chemokines and cytokines. These in turn exacerbate the dysfunctional immune response and activate either TH1 or TH2 cells in the gut mucosa, respectively associated with CD and, less conclusively, with UC. Elucidation of immunological and genetic factors indicate multiple points at which the inflammatory cascade may be interrupted, yielding the possibility of precise, targeted therapies for IBD. [source] Periapical status and quality of endodontic treatment in an adult Irish populationINTERNATIONAL ENDODONTIC JOURNAL, Issue 2 2005J. J. Loftus Abstract Aim, To determine the prevalence of apical periodontitis and the quality of root fillings in an adult Irish population using a retrospective analysis of orthopantomograms (OPGs). Methodology, A systematic sample of clinical records and OPGs of 302 adult patients attending the Dublin Dental Hospital, Ireland, were screened by two examiners to determine the quality of root canal treatment and the prevalence of apical periodontitis. The operators who carried out the treatment were unknown. Two examiners inspected OPGs after inter-examiner correlation. European Society of Endodontology (ESE) guidelines were used to determine adequacy of root treatment. Results, Of the 7427 teeth examined 2% had root fillings. Apical periodontitis was evident in 1.6% of all nonroot filled teeth whilst 33.1% of the subjects had at least one tooth with apical periodontitis. Of the root filled teeth, 25% had apical periodontitis and 52.6% were considered technically inadequate by ESE guidelines. There was a statistically significant (P < 0.05) negative correlation between the quality of the root fillings and the prevalence of apical periodontitis. Posterior root filled teeth (premolars and molars) had a greater prevalence of apical periodontitis than anterior root filled teeth. Conclusions, The technical quality of root fillings in an adult Irish population was poor and was consistent with a high prevalence of apical periodontitis. [source] Prevalence and longitudinal stability of negative symptoms in healthy participantsINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2009Lindsay C. Emmerson Abstract Objective Although negative symptoms are prominent in older patients with schizophrenia, it is unknown whether this pattern is prevalent in healthy participants. The objective of this study was to evaluate whether negative symptoms are present in healthy populations and to determine whether they are linked to illness-related processes or normal aging. Methods A systemic review of 26 studies that have administered negative symptom assessments to healthy participants was conducted. In addition, 213 (age,>,40,years old) healthy participants completed PANSS and SANS ratings at both baseline and 1-year follow-up. One-hundred participants also completed ratings after 3 years. Results Across all reviewed studies, negative symptoms were absent in the majority of participants. Comparable results were found in the current study's large longitudinal evaluation with middle-aged to older adults. Conclusions Taken together, the data suggest that healthy volunteers do not suffer from prominent negative symptoms. This finding is consistent with the hypothesis that the greater prevalence and severity of negative symptoms in older patients is not related to normal aging but to illness-related processes. Copyright © 2009 John Wiley & Sons, Ltd. [source] Medical comorbidity in late-life depressionINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2004Warren D. Taylor Abstract Objectives Medical comorbidity is common in elderly patients with depression, however the difference between depressed and non-depressed elderly populations is not well established. Additionally, differences between subgroups of depressed populations, including those with MRI-defined vascular depression and those with late-onset compared with early-onset depression are not well described. Methods We compared self-report of medical disorders between 370 depressed elders and 157 non-depressed control subjects. Subjects were additionally dichotomized based on presence or absence of subcortical MRI lesions and age of onset. Medical comorbidity was assessed by self report only, and depressed subjects were additionally assessed by the clinician-rated Cumulative Illness Rating Scale. Results When compared with the non-depressed group, depressed subjects were significantly more likely to report the presence of hypertension, heart disease, gastrointestinal ulcers, and ,hardening of the arteries'. Analyses of subjects with subcortical disease demonstrated they were significantly older, more likely to have depression, and more likely to report the presence of hypertension. Finally, the depressed cohort with late-onset depression (occurring after age 50 years) had more male subjects, exhibited greater CIRS scores, and greater prevalence of hypertension, but these did not reach a level of statistical significance after applying a Bonferroni correction. Conclusions Vascular comorbidities are common in depressed elders. The differences in the report of hypertension supports past work investigating a vascular contribution to late-life depression. Given the association between depression and poor medical outcomes of cardiac disease, this population deserves clinical scrutiny and further research. Copyright © 2004 John Wiley & Sons, Ltd. [source] Geriatric Oncology and Primary Care: Promoting Partnerships in Practice and ResearchJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2009Julia Hannum Rose PhD This supplement is a compilation of original work that was presented at an interdisciplinary conference on "Geriatric Oncology and Primary Care: Promoting Partnerships in Practice and Research" held in Cleveland, Ohio, April 3 to 4, 2008. An audience of 77 clinicians and researchers attended this conference, primarily coming from Ohio and adjacent states. Articles are organized around a conceptual framework to consider primary and shared care roles of primary care physicians (PCPs) and oncologists in the care of older patients with cancer and their families. Articles in Section One focus on evidence-based clinical practice and recommendations. Section Two includes articles on original psychosocial and health services research that inform this topic. Papers in this conference were developed in recognition of the greater prevalence and growing incidence of cancer in older adults; the unique geriatric expertise and practice considerations essential to the prevention and control of cancer in older adults; the important and effective roles that PCPs may play in such care; and the need to develop shared care models that foster collaboration between PCPs and oncologists, from cancer prevention through long-term survivorship and end-of-life care of older adults. Models of shared care between oncologists and PCPs should be tested and compared for optimal care of older patients with cancer and their families. Potential implications of ideally shared care include more-informed patient-centered decision-making, better adherence to treatment, improved match between older patient goals and treatments, and thus better outcomes. [source] Obesity in adults with Down syndrome: a case,control studyJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 2 2005C. A. Melville Abstract Background Obesity has a negative impact upon mortality and morbidity. Studies report that obesity is more prevalent in individuals with Down syndrome than individuals with intellectual disabilities (ID) not associated with Down syndrome. However, there have been no studies using a methodology of matched comparison groups and findings from previous studies are contradictory. Methods A detailed method was used to identify all adults with ID in Leicestershire. Individuals were invited to participate in a medical examination , that included measurement of their height and weight, from which body mass index (BMI) was calculated. For each person with Down syndrome, an individual matched for gender, age and accommodation type was identified, from the Leicestershire ID database. Results The data for 247 matched pairs is reported. Women with Down syndrome had lower mean height and weight, but greater mean BMI than the matched pairs. Men with Down syndrome had a lower mean height and weight but there was no statistical difference in BMI compared to the matched pairs. Using World Health Organization categories of BMI, women with Down syndrome were more likely to be overweight or obese than their matched pairs (odds ratio = 2.17). Men with Down syndrome were more likely to be in the overweight category than their matched pairs but were less likely to be obese (odds ratio = 0.85). Conclusions This study demonstrates that, compared to a matched sample, there is a greater prevalence of obesity amongst women with Down syndrome but not men. As the impact on the health of people with Down syndrome of being overweight or obese is uncertain, this is an area that requires further study. [source] Health characteristics and health services utilization in older adults with intellectual disability living in community residencesJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 4 2002M. P. Janicki Abstract Background The health status and health needs of adults with intellectual disability (ID) change with advancing age, and are often accompanied by difficulties with vision, hearing, mobility, stamina and some mental processes. Aim The present study collected health status information on a large cohort of adults with ID aged , 40 years living in small group, community-based residences in two representative areas of New York State, USA. Method Adult group home residents with ID aged between 40 and 79 years (n = 1371) were surveyed to determine their health status and patterns of morbidity. Results Most subjects were characterized as being in good health. The frequency of cardiovascular, musculoskeletal and respiratory conditions, and sensory impairments increased with age, while neurological, endocrine and dermatological diseases did not. Psychiatric and behavioural disorders declined with increasing age, at least through 70 years of age. Although most conditions increased with age, their frequency varied by sex and level of ID. Frequencies of age-related organ system morbidity were compared to data from the National Health and Nutrition Evaluation Survey III. It was found that adults with ID had a lower overall reported frequency of cardiovascular risk factors, including hypertension and hyperlipidaemia, and adult-onset diabetes. Inconsistencies with mortality data among older adults with ID were observed (which showed equal if not greater prevalence of deaths as a result of cardiovascular disease and cancer). Conclusion These results suggest that either a cohort effect is operating (i.e. contemporary populations are healthier than previous populations), or that there may be under-recognition of select risk factors and diseases. [source] Spinal degenerative disk disease (DDD) in female macaque monkeys: epidemiology and comparison with womenJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 3 2002Patricia Ann Kramer Spinal degenerative disk disease (DDD) in a radiographic, cross-sectional sample of 192 female macaque monkeys, approximately 5,30 years old, is described. The presence and extent of disk space narrowing (DSN) and anterior osteophytosis were assessed with reference to age, average lifetime body mass, and distribution within the thoracolumbar spine. Age was a strong correlate of disk narrowing and osteophytosis, with early signs appearing at equivalent ages in both species and increasing in prevalence thereafter. Macaques showed a far greater prevalence of DDD, especially in the oldest age group, than has been reported in the human data. Body mass was associated with disk narrowing in the macaque, but not with osteophytosis. The two species differed little in the pattern of distribution of DDD along the spine. Our results suggest that bipedality is not the singular, or even the most important, biomechanical factor in the development of human DDD. Rather, others shared postural regimes, e.g., sitting, may be responsible for the onset and progression of DDD in both species. The macaque model could substantially add to the under-standing and, potentially, treatment of this oftentimes debilitating condition. © 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved. [source] The Remarkably High Prevalence of Epilepsy and Seizure History in Fetal Alcohol Spectrum DisordersALCOHOLISM, Issue 6 2010Stephanie H. Bell Background:, Fetal alcohol spectrum disorder (FASD) is the umbrella term that describes the range of adverse developmental outcomes that may occur in the offspring of mothers who drink alcohol during pregnancy. FASD is associated with several comorbidities including epilepsy. The objective of the study was to evaluate the prevalence of epilepsy or a history of seizures in subjects with FASD and the contribution of relevant risk factors. Methods:, A retrospective chart review was conducted on all active charts (N = 1063) at two FASD clinics. After exclusion of subjects without a confirmed diagnosis, a total of 425 subjects between the ages of 2,49 were included in the analysis. The relationships between FASD diagnosis and other risk factors for co-occurrence of epilepsy or a seizure disorder (e.g., extent of exposure to alcohol and other drugs, type of birth, and trauma) were examined using chi-square and multivariate multinomial logistic regression. Results:, Twenty-five (5.9%) individuals in the study population had a confirmed diagnosis of epilepsy, and 50 (11.8%) had at least one documented seizure episode, yielding an overall prevalence of 17.7% in this population. Importantly, a history of epilepsy or seizures was not different across the three diagnostic subgroups. In those subjects with available maternal drinking histories, first trimester exposure or drinking throughout all three trimesters were the predominant forms of fetal exposure. None of the other risk factors were associated with a greater prevalence of epilepsy or seizures. Conclusions:, There is a remarkably high prevalence of epilepsy/seizures in the FASD population. [source] Psychiatric Comorbidity in Long-Term Abstinent Alcoholic IndividualsALCOHOLISM, Issue 5 2007Victoria Di Sclafani Background: A high prevalence of comorbid psychiatric disorders has been demonstrated in individuals with an alcohol use disorder in both community and treatment samples, with higher comorbidity in treatment samples. In this study, we examined lifetime and current psychiatric diagnoses in long-term abstinent alcoholic individuals (LTAA; mean abstinence=6.3 years; n=52) compared with age and gender-comparable non-alcoholic controls (NC; n=48). We asked the following questions: (1) to achieve long-term abstinence, must an individual be relatively psychiatrically healthy (i.e., comparable with NC) and (2) can ongoing abstinence be maintained in the face of a current psychiatric disorder? Methods: Lifetime and current (prior 12 months) psychiatric diagnoses were assessed in the mood, anxiety, and externalizing disorder domains using the computerized Diagnostic Interview Schedule (c-DIS). Results: Over 85% of LTAA had a lifetime psychiatric diagnosis, compared with 50% of NC. Long-term abstinent alcoholic individuals had a higher prevalence than NC of lifetime mood, anxiety, and externalizing disorder diagnoses. Long-term abstinent alcoholic individuals also had a greater prevalence than NC of current mood and anxiety diagnoses. Although LTAA had a greater lifetime prevalence of an antisocial personality disorder (ASPD) than NC, no LTAA or NC had a current ASPD diagnosis. Finally, there was no association of duration of abstinence with lifetime or current psychiatric diagnoses, consistent with psychiatric diagnoses having little effect on relapse. Conclusions: Our results suggest that: (1) the presence of a lifetime psychiatric diagnosis does not militate against achieving long-term abstinence, (2) abstinence can be maintained in the presence of a current mood or anxiety disorder, and (3) a current diagnosis of ASPD may not be compatible with long-term abstinence. The relatively low levels of antisocial behavior compared with preabstinence (as indicated by no LTAA meeting current criteria for ASPD) raises the question of whether the neurobiology underlying antisocial behavior is changed in abstinence, or brought under increased executive control, or both. [source] Long-term prognosis for transplant-free survivors of paracetamol-induced acute liver failureALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2010P. Jepsen Aliment Pharmacol Ther 2010; 32: 894,900 Summary Background, The prognosis for transplant-free survivors of paracetamol-induced acute liver failure remains unknown. Aim, To examine whether paracetamol-induced acute liver failure increases long-term mortality. Methods, We followed up all transplant-free survivors of paracetamol-induced acute liver injury, hospitalized in a Danish national referral centre during 1984,2004. We compared age-specific mortality rates from 1 year post-discharge through 2008 between those in whom the liver injury led to an acute liver failure and those in whom it did not. Results, We included 641 patients. On average, age-specific mortality rates were slightly higher for the 101 patients whose paracetamol-induced liver injury had caused an acute liver failure (adjusted mortality rate ratio = 1.70, 95% CI 1.02,2.85), but the association was age-dependent, and no survivors of acute liver failure died of liver disease, whereas suicides were frequent in both groups. These observations speak against long-term effects of acute liver failure. More likely, the elevated mortality rate ratio resulted from incomplete adjustment for the greater prevalence of substance abuse among survivors of acute liver failure. Conclusions, Paracetamol-induced acute liver failure did not affect long-term mortality. Clinical follow-up may be justified by the cause of the liver failure, but not by the liver failure itself. [source] Spontaneous Feline Hypertension: Clinical and Echocardiographic Abnormalities, and Survival RateJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2003Valerie Chetboul Systemic hypertension was diagnosed in 58 of 188 untreated cats referred for evaluation of suspected hypertension-associated ocular, neurologic, cardiorespiratory, and urinary disease, or diseases frequently associated with hypertension (hyperthyroidism and chronic renal failure). Hypertensive cats were significantly older than normotensive subjects (13.0 ± 3.5 years versus 9.6 ± 5.0 years; P < .01), and had a greater prevalence of retinal lesions (48 versus 3%; P < .001), gallop rhythm (16 versus 0%; P < .001), and polyuria-polydipsia (53 versus 29%; P < .01). Blood pressure was significantly higher (P < .001) in cats with retinopathies (262 ± 34 mm Hg) than in other hypertensive animals (221 ± 34 mm Hg). Hypertensive cats had a thicker interventricular septum (5.8 ± 1.7 versus 3.7 ± 0.64 mm; P < .001) and left ventricular free wall (6.2 ± 1.6 versus 4.1 ± 0.51 mm; P < .001) and a reduced diastolic left ventricular internal diameter (13.5 ± 3.2 versus 15.8 ± 0.72 mm; P < .001) than control cats. Left ventricular geometry was abnormal in 33 of 39 hypertensive subjects. No significant difference was found in age or blood pressure at the initial visit between cats that died or survived over a 9-month period after initial diagnosis of hypertension. Mean survival times were not significantly different between hypertensive cats with normal and abnormal left ventricular patterns. Further prospective studies are needed to clearly identify the factors involved in survival time in hypertensive cats. [source] Recurrence of primary sclerosing cholangitis after liver transplantationLIVER TRANSPLANTATION, Issue 7 2002Ivo W. Graziadei MD Orthotopic liver transplantation (OLT) has become the only effective therapeutic option for patients with end-stage liver disease caused by primary sclerosing cholangitis (PSC). Excellent long-term outcome has been reported, with 5-year patient survival rates of approximately 80%. In the last few years, increasing evidence has emerged that PSC recurs after OLT. The diagnosis of PSC is based on well-defined cholangiographic features combined with biochemical and histological findings. However, none of these features is specific for PSC, particularly after OLT, because biliary strictures in the liver allograft can occur from a variety of causes other than recurrence. Therefore, PSC recurrence remains a controversial issue, especially because of a lack of a gold standard for diagnosis and well-established diagnostic criteria. Some reports provided cholangiographic evidence that post-OLT biliary strictures occurred more frequently in patients with PSC than in those who underwent OLT for other liver diseases (including patients with a Roux-en-Y biliary reconstruction). Because no other possible cause of biliary strictures could be invoked to explain the greater prevalence of these strictures, recurrent disease has been implicated. There also is histological evidence suggesting that PSC recurs after OLT. Histological findings suggestive of PSC were found more often in PSC allografts compared with a control group. Furthermore, histological features typical for PSC (fibro-obliterative lesions) were seen exclusively in liver biopsy specimens from patients with PSC. Recurrence of PSC was defined in a recent study from the Mayo Clinic by means of strict cholangiographic and histological criteria in a large cohort of patients with PSC in whom other causes of biliary strictures were excluded. PSC recurrence was found in 20% of patients. No risk factor for PSC recurrence could be found, and recurrent disease did not influence patient or graft survival after a mean follow-up of 4.5 years. In conclusion, several studies provided convincing evidence that PSC recurs after OLT, with an incidence of 5% to 20% and an interval to diagnosis of at least 1 year after OLT. To date, patient and graft survival do not appear to be negatively affected by disease recurrence in the intermediate term of follow-up. (Liver Transpl 2002;8:575-581.) [source] Changes in the timing of SIDS deaths in 1989 and 1999: indirect evidence of low homicide prevalence among reported casesPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 1 2006Harold A. Pollack Summary An unknown proportion of cases diagnosed as sudden infant death syndrome (SIDS) are misdiagnosed, and in some cases are homicides. Because recent SIDS prevention measures were unlikely to reduce homicides, changes in the reported timing of SIDS cases provide an indirect measure of covert homicides in this group. This paper uses United States vital statistics microdata to explore these questions. The sample includes all reported infant deaths to singletons with birthweight > 500 g in the 1989 and 1999 US birth cohorts. Deaths attributed to SIDS (n = 7708), homicide (n = 597), or object inhalation and mechanical suffocation (n = 860) are specifically examined. If reported SIDS cases were a mixture of ,true' cases and misdiagnosed homicides, it is hypothesised that the age-at-death distribution of SIDS deaths would have changed to reflect greater prevalence of misdiagnosed homicide. We find that the age-at-death distribution of reported SIDS cases was virtually unchanged in the two cohorts, showing no increase during periods of infancy when relative homicide risk is most pronounced. One cannot reject the hypothesis that the timing was drawn from the same distribution ( = 62.2, P = 0.157). Analogous results hold for infants born in circumstances associated with high homicide risk ( = 61.5, P = 0.12). The stable age-at-death distribution of reported SIDS cases between 1989 and 1999 suggests that covert homicides are a small fraction of reported SIDS cases. [source] Strong association between birth month and reproductive performance of Vietnamese womenAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 1 2009Susanne Huber Epidemiological studies on premodern and modern Western societies indicate that birth season may influence female reproduction. Nothing is known, however, about this effect in developing economies. Many of the latter are characterised by tropical climates with a rainy season associated with lower food availability and a greater prevalence of infectious diseases. We therefore predict that an association between birth month and reproductive output, if it exists, should be related to the rainy season. To test this prediction, we analysed census data of Vietnam obtained from IPUMS-International (Vietnam 1999 Population and Housing Census). Based on 493,853 women born between 1950 and 1977 and thus aged 22 to 49 years, we found that the time series of mean offspring count per month of birth has a highly significant period of 12 months (power = 46.871, P < 0.00001). Our results further indicate that the 12-month periodic signal has a maximum in July and a minimum in January. Accordingly, the peak corresponds to birth during the rainy season, the low if the third pregnancy month concurs with the rainy season. The month of birth is therefore clearly associated with the later reproductive performance of Vietnamese women, strongly supporting the assumption that environmental and maternal conditions during early development exert long-term effects on reproductive functioning. Provided the rainy season adversely affects developmental processes due to inadequate food and/or high infection risk, the association reported here points to a critical period of reproductive development during early pregnancy. Am. J. Hum. Biol., 2009. © 2008 Wiley-Liss, Inc. [source] The health of California's immigrant hired farmworkersAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 4 2010Don Villarejo BS Abstract Background Hispanic immigrant workers dominate California's hired farm workforce. Little is known about their health status; even less is known about those lacking employment authorization. Methods The California Agricultural Workers Health Survey (CAWHS) was a statewide cross-sectional household survey conducted in 1999. Six hundred fifty-four workers completed in-person interviews, comprehensive physical examinations, and personal risk behavior interviews. Results The CAWHS PE Sample is comprised mostly of young Mexican men who lack health insurance and present elevated prevalence of indicators of chronic disease: overweight, obesity, high blood pressure, and high serum cholesterol. The self-reported, cumulative, farm work career incidence of paid claims for occupational injury under workers compensation was 27% for males and 11% for females. Conclusions The survey finds elevated prevalence of indicators of chronic disease but lack of health care access. Participants without employment authorization reported a greater prevalence of high-risk behaviors, such as binge drinking, and were less knowledgeable about workplace protections. Am. J. Ind. Med. 53:387,397, 2010. © 2010 Wiley-Liss, Inc. [source] Lumbar vertebral morphology and isthmic spondylolysis in a British medieval populationAMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Issue 2 2010Carol V. Ward Abstract The British medieval population from Wharram Percy, England, has a greater prevalence of isthmic spondylolysis (11.9% of skeletons, 8.5% at the L5 level) than in modern populations (3%,6%). This may in part be due to differences in activity patterns between groups. However, Ward and Latimer (Spine 30 [2005] 1808,1814) proposed that the likelihood of developing and maintaining spondylolytic defects is also influenced by a lack of sufficient increase in mediolateral separation between articular processes in the lowest lumbar segments, given the human lumbar lordosis. Here, we demonstrate that spondylolytic individuals from Wharram Percy tend to have a less pronounced difference between mediolateral facet joint spacing of adjacent segments in the lowest lumbar region than do unaffected individuals, as seen in modern clinical and skeletal populations. These comparisons suggest that regardless of lifestyle, insufficient mediolateral increase in facet spacing predisposes people to spondylolytic defects, and so interfacet spacing patterns may have predictive utility in a clinical context. We also compare the Wharram Percy sample to a modern sample from the Hamann Todd collection with a typically modern prevalence rate. Data do not support the hypothesis that the Wharram Percy individuals had a less pronounced interfacet increase than the Hamann Todd, although they do have narrower lumbar facet spacing at the lowest three levels. Further investigation of anatomical variation underlying population-specific prevalence rates needs to be conducted. Am J Phys Anthropol 2010. © 2009 Wiley-Liss, Inc. [source] Assessing Tribal Youth Physical Activity and Programming Using a Community-Based Participatory Research ApproachPUBLIC HEALTH NURSING, Issue 2 2010Cynthia Perry ABSTRACT Objective: American Indian youth experience a greater prevalence of obesity compared with the general U.S. population. One avenue to reverse the trend toward increasing obesity prevalence is through promoting physical activity. The goal of this project was to understand tribal youths' current patterns of physical activity behavior and their beliefs and preferences about physical activity. Design and Sample: This assessment used a community-based participatory research approach. Sample included 35 Native youth aged 8,18. Measures: A Community Advisory Board was created that specifically developed an exercise survey for this assessment to explore physical activity patterns, preferences, and determinants. Twenty-six youth completed the survey. Descriptive statistics were analyzed, exploring differences by age group. Nine youth participated in 2 focus groups. Qualitative data were analyzed with thematic analysis. Results: Youth distinguished between sports and exercise, with each possessing different determinants. Common motivators were friends, coach, and school, and barriers were lack of programs and school or work. None of the youth reported meeting the recommended 60 min of strenuous exercise daily. Conclusions: This tribal academic partnership responded to a tribal concern by developing an exercise survey and conducting focus groups that addressed tribal-specific questions. The results are informing program development. [source] Significance of Cigarette Smoking Among Youths with Bipolar DisorderTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 5 2008Benjamin I. Goldstein MD Cigarette smoking among adults with bipolar disorder (BP) correlates with psychosis, substance use disorders (SUD), and suicidality. Little is known regarding smoking among youths with BP. Youths with BP (n = 441) were divided into three smoking groups: Never, Ever, and Daily. Twenty-five percent reported any smoking (11% daily, 14% ever). Ever and Daily subjects had significantly greater lifetime prevalence of suicide attempts, physical abuse, conduct disorder, and SUD compared to Never subjects. Daily heavy smokers had greater prevalence of SUD and suicide attempts, and worse depression versus daily light smokers. Smoking among youths with BP is independently associated with suicide attempts and SUD. [source] Levodopa, methylmalonic acid, and neuropathy in idiopathic Parkinson diseaseANNALS OF NEUROLOGY, Issue 1 2010Cory Toth MD Objective Peripheral neuropathy (PN) is thought to be coincidental in patients with idiopathic Parkinson disease (IPD). We sought to examine the prevalence of PN in a population of IPD patients and a potential relationship to levodopa use and fasting methylmalonic acid (MMA) levels. Methods In a prospective cohort study, IPD patients randomly selected from a comprehensive database were compared to control subjects regarding the presence and severity of PN using clinical and electrophysiological measures. IPD severity was determined using the Unified Parkinson's Disease Rating Scale (UPDRS). We determined the relation of levodopa use with serum levels of cobalamin, MMA, and homocysteine (Hcy). We also explored the association between presence and severity of PN and age, duration of IPD, cumulative levodopa dosing, cobalamin, MMA, and Hcy levels. Results Fifty-eight randomly selected IPD patients were compared to 58 age- and sex-matched controls. PN was present in 55% of IPD patients and 9% of controls. Patients with IPD had greater prevalence of PN and fasting MMA/Hcy levels than controls. IPD patients with PN were older and exhibited higher UPDRS scores, fasting MMA/Hcy levels, and cumulative levodopa exposure. PN severity in IPD subjects positively correlated with both levodopa exposure and MMA levels. Interpretation IPD patients have a higher prevalence of PN than controls. Although causality is not established, levodopa exposure is associated with MMA elevation and sensorimotor neuropathy in IPD patients. Cobalamin replacement concurrent with levodopa therapy should be considered to protect against development of PN in IPD patients. ANN NEUROL 2010;67:28,36 [source] Total knee replacement in the morbidly obese: a literature reviewANZ JOURNAL OF SURGERY, Issue 9 2010Anthony J. Samson Abstract Background:, The ,obesity epidemic' is expected to result in an increased incidence of knee osteoarthritis and hence total knee replacements (TKRs). Reviews have demonstrated the conflicting results of TKR for all obese (body mass index (BMI) >30). The aim of this literature review was to specifically evaluate outcomes of TKR in patients with morbid obesity (MO; BMI >40). Methods:, A systematic review of medical databases (PubMed, Medline, Cochrane Library, ScienceDirect) by use of keywords from January 1990 to September 2009 was undertaken. Results:, Clinical and functional Knee Society Scores (KSS) improve after TKR for patients with MO. The post-operative functional KSS was, in general, less than in controls. Radiographic analysis was inconclusive because of small study populations and short duration of follow-up. All studies reporting complications noted a greater prevalence in MO patients (10,30%). Of concern was the significantly higher prevalence of deep prosthetic infection (3,9-times that of controls). The morbidly obese also had a significantly higher incidence of wound complications. TKR did not result in weight loss for MO patients, and therefore has no benefit on weight-related medical conditions. Bariatric surgery in MO under 65 years of age has been shown to be a cost-effective and clinically effective method of weight reduction. This surgery also results in significant improvement in weight-related medical conditions, the KSS and knee pain. Conclusions:, Given the increase in complications for MO patients after TKR, these patients should be advised to lose weight before surgery and, if suitable, would probably benefit from bariatric surgery. [source] Insurer and out-of-pocket costs of osteoarthritis in the US: Evidence from national survey dataARTHRITIS & RHEUMATISM, Issue 12 2009Harry Kotlarz Objective Osteoarthritis (OA) is a major debilitating disease affecting ,27 million persons in the US. Yet, the financial costs to patients and insurers remain poorly understood. The purpose of this study was to quantify by multivariate analyses the relationships between OA and annual health care expenditures borne by patients and insurers. Methods Data from the Medical Expenditure Panel Survey (MEPS) for the years 1996,2005 were used. MEPS is a large, nationally representative US database that includes information on health care expenditures, medical conditions, health insurance status, and sociodemographic characteristics. Individual and nationally aggregated cost estimates are provided. Results OA was found to contribute substantially to health care expenditures. Among women, OA increased out-of-pocket (OOP) expenditures by $1,379 per annum (2007 dollars) and insurer expenditures by $4,833. Among men, OA increased OOP expenditures by $694 per annum and insurer expenditures by $4,036. Given the high prevalence of OA, the aggregate effects on health care expenditures were very large. OA raised aggregate annual medical care expenditures by $185.5 billion. Of that amount, insurer expenditures were $149.4 billion and OOP expenditures were $36.1 billion. Because of the greater prevalence of OA in women and their more intensive use of health care, total expenditures for this group accounted for $118 billion, or almost two-thirds of the total increase in health care expenditures resulting from OA. Conclusion The health care cost burden associated with OA is quite large for all groups examined and is disproportionately higher for women. Although insurers bear the brunt of treatment costs for OA, the OOP costs are also substantial. [source] Persistent iodine deficiency in a cohort of Tasmanian school children: associations with socio-economic status, geographical location and dietary factorsAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 5 2004Kristen L. Hynes Objective: To determine the adequacy of iodine nutrition of Tasmanian primary school-aged children and to examine possible associations with socio-economic status (SES), location and dietary factors. Methods: Urinary iodine levels and measures of SES, geographical information and dietary habits were surveyed in a population-based sample of 170 children (4 to 12 years) at baseline (1998/99) and at follow-up (2000/01). Results: Median urinary iodine concentration in 1989-99 and 2000-01 were 75 ,g/L (range 15 ,g/L to 240 ,g/L) and 76 ,g/L (range 18 ,g/L to 480 ,g/L) respectively. No significant associations with SES or geographical location were found. More frequent or recent intake of foods that are likely to be dietary sources of iodine tended to be associated with greater prevalence of adequate urinary iodine, particularly consumption of yoghurt and ,fruche' (p=0.04). Conclusions: After several decades of iodine sufficiency, Tasmanian primary school-aged children are again mildly iodine-deficient by WHO criteria. Despite reduction in iodophor use by the dairy industry in the past decade, consumption of dairy products continues to be associated with higher levels of iodine nutrition. Implications: The lack of association of iodine levels with SES and geographical location within Tasmania found in our study, and the results of studies of iodine levels in Melbourne and Sydney, suggest that inadequate iodine nutrition is a widespread problem in south-eastern Australia. Our study suggests that milk-containing products continue to be an important source of iodine for children. [source] Increased rates of white matter hyperintensities in late-onset bipolar disorderBIPOLAR DISORDERS, Issue 7 2008Jaqueline Hatsuko Tamashiro Objectives:, Magnetic resonance imaging (MRI) studies have reported an increased frequency of white matter hyperintensities (WMH) in association with late-onset (LO) depression, and this has supported the notion that vascular-related mechanisms may be implicated in the pathophysiology of LO mood disorders. Recent clinical studies have also suggested a link between LO bipolar disorder (LO-BD) and cerebrovascular risk factors, but this has been little investigated with neuroimaging techniques. In order to ascertain whether there could be a specific association between WMH and LO-BD, we directly compared WMH rates between LO-BD subjects (illness onset , 60 years), early-onset BD subjects (EO-BD, illness onset <60 years), and elderly healthy volunteers. Methods:, T2-weighted MRI data were acquired in LO-BD subjects (n = 10, age = 73.60 ± 4.09), EO-BD patients (n = 49, age = 67.78 ± 4.44), and healthy subjects (n = 24, age = 69.00 ± 7.22). WMH rates were assessed using the Scheltens scale. Results:, There was a greater prevalence of WMH in LO-BD patients relative to the two other groups in the deep parietal region (p = 0.018) and basal ganglia (p < 0.045). When between-group comparisons of mean WMH scores were conducted taking account of age differences (ANCOVA), there were more severe scores in LO-BD patients relative to the two other groups in deep frontal and parietal regions, as well as in the putamen (p < 0.05). Conclusions:, Our results provide empirical support to the proposed link between vascular risk factors and LO-BD. If extended in future studies with larger samples, these findings may help to clarify the pathophysiological distinctions between bipolar disorder emerging at early and late stages of life. [source] Coeliac disease associated with psoriasisBRITISH JOURNAL OF DERMATOLOGY, Issue 6 2009S. Birkenfeld Summary Background, Psoriasis is a chronic inflammatory disorder of the skin reported to be associated with systemic comorbidities. Objectives, To investigate the association between psoriasis and coeliac disease (CD). Methods, Patients with psoriasis were compared with age- and sex-matched controls regarding the prevalence of CD in a case,control study. ,2 and t -tests were used for univariate analysis and a logistic regression model was used for multivariate analysis. The study was performed utilizing the medical database of Clalit Health Services. Results, The study included 12 502 patients with psoriasis aged > 20 years and 24 285 age- and sex-matched controls. The prevalence of CD in patients with psoriasis was increased compared with the prevalence in controls (0·29% and 0·11%, respectively, P < 0·001). In a multivariate analysis psoriasis was associated with CD (odds ratio 2·73, 95% confidence interval 1·65,4·53). Conclusions, Patients with psoriasis have a greater prevalence of CD than matched controls. Recent studies showed a possibility of undiagnosed CD among patients with psoriasis. Therefore, physicians treating patients with psoriasis should be aware of this possible association. [source] | |||||||||||||||||||||||||||||||