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Selected AbstractsFast food and neighborhood stroke risk,ANNALS OF NEUROLOGY, Issue 2 2009Lewis B. Morgenstern MD Objective To investigate the association between the number of fast food restaurants and ischemic stroke in neighborhoods. Methods This work was a prespecified part of the Brain Attack in Corpus Christi (BASIC) project. Ischemic stroke cases were prospectively ascertained in Nueces County, Texas. Home addresses were geocoded and used to establish the census tract for each stroke case. Census tracts were used as proxies for neighborhoods (n = 64). Using a standard definition, fast food restaurants were identified from a commercial list. Poisson regression was used to study the association between the number of fast food restaurants in the neighborhood, using a 1-mile buffer around each census tract, and the risk of stroke in the neighborhood. Models were adjusted for demographics and neighborhood socioeconomic status (SES). Results There were 1,247 completed ischemic strokes from January 2000 through June 2003 and 262 fast food restaurants. The median number of fast food restaurants per census tract including buffer was 22 (interquartile range, 12,33). Adjusting for neighborhood demographics and SES, the association of fast food restaurants with stroke was significant (p = 0.02). The association suggested that the risk of stroke in a neighborhood increased by 1% for every fast food restaurant (relative risk, 1.01; 95% confidence interval [CI], 1.00,1.01). The relative risk of stroke comparing neighborhoods in the 75th to the 25th percentile of the distribution of fast food restaurants was 1.13 (95% CI, 1.02,1.25). Interpretation Controlling for demographic and SES factors, there was a significant association between fast food restaurants and stroke risk in neighborhoods in this community-based study. Ann Neurol 2009;66:165,170 [source] Nonagenarian surgical admissions for the acute abdomen: who benefits?INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 11 2010Z. Toumi Summary Introduction:, Patients 90 years and older form an increasing proportion of the general population. Outcomes of their acute surgical admissions are not well documented. Methods and materials:, Surgical management of 49 consecutive nonagenarian admissions (median age: 92 years) with an acute abdomen was compared with the management and outcome of 50 younger patients (median age: 53.5) admitted with a suspected acute abdomen over the same period. Results:, Nonagenarian group consisted of mainly women (71% vs. 50%; p = 0.003). The use of laboratory investigations and imaging was similar for the patients aged over 90 and the younger patients, although proportionately fewer nonagenarians were investigated by abdominal CT scan (8% vs. 24%). Of the 49 nonagenarian patients admitted, only 4% (n = 2) were operated on. In contrast, 38% (n = 19) of patients aged 50,59 (p = 0.0001) underwent a surgical intervention. A much greater proportion of nonagenarians died in hospital than patients in the 50,59 comparator group (16% nonagenarians vs. 4% comparator patients; p = 0.04). The very large majority of survivors in both age groups were discharged back to their preadmission domicile [39 (95%) nonagenarians vs. 46 (96%) comparator 50,59 year group]. Conclusions:, In this study, when compared with younger patients, very few nonagenarian patients (2%) with a suspected acute abdomen benefited from surgical admission. Instead, the large majority of nonagenarians either died or were discharged back to their home address without surgery. [source] Use of over-the-counter medicines in childrenINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 4 2003John McIntyre senior lecturer in child health ABSTRACT Objective To assess the reasons for over-the-counter (OTC) medicine use in children and the sociodemographic factors influencing this choice of self-care rather than GP consultation. Method Questionnaires were sent to the home address of a randomly generated list of children under 12 years of age from three GP practices in the East Midlands selected to represent bottom, middle and top tertiles of deprivation on the basis of the Jarman score. Analysis using chi-square and Mann-Whitney tests was used to identify associated factors (number of carers in the home, number of children, deprivation score, parent/carer's age, age and number of children in the house) of the responses. Setting Primary care setting in the East Midlands region of England. Key findings From 424 completed questionnaires returned (response rate 61%), 413 parents/carers had purchased OTC medicines. Fifty-one different products had been purchased, with analgesic/antipyretic and cough/cold remedies the most frequently bought. The most commonly reported reasons for parent/carer initiated medication were to avoid troubling the GP with minor childhood ailments (79% of respondents) and to have medicines available in case of future need (74%). Cost was a barrier to buying OTC medicines for the more deprived. Advice-seeking behaviour was associated with the symptom, the number of children, affluence and the age of the child. Conclusion Parent/carer initiated use of OTC medication is widespread, particularly for analgesic/antipyretic and cough/cold remedies. Differences in advice-seeking behaviour are associated with the presenting symptom and a variety of sociodemographic factors. [source] Total serum IgE levels are associated with ambient ozone concentration in asthmatic adultsALLERGY, Issue 1 2009E. Rage Background:, Effects of air pollution exposure on IgE-mediated response in asthmatics are poorly investigated. The aim was to examine the relationship between air pollution concentrations and total IgE levels in adult asthmatics. Methods:, The present study relates to the 369 asthmatic adults from the French Epidemiological study on Genetics and Environment of Asthma (EGEA), with availability of data on both total serum IgE measurements and air pollution concentrations. Geo-statistical models were performed on 4 × 4 km grids to assess individual outdoor air pollution exposure. Annual outdoor concentrations of ozone (O3), nitrogen dioxide (NO2), sulphur dioxide (SO2), and particulate matter smaller than 10 ,m size (PM10), and concentrations of summer ozone were assigned to subject's home address. Results:, The geometric mean of total IgE was 161 IU/ml and the average of O3 exposure was 44.9 ± 9.5 ,g/m3. Ozone concentrations were positively related to total IgE levels and an increase of 10 ,g/m3 of O3 resulted in an increase of 20.4% (95% CI = 3.0,40.7) in total IgE levels. Adjustment for age, gender, smoking habits and previous life in the countryside did not change the results, and an increase of 19.1% (2.4,38.6) in total IgE was observed with O3. Negative associations observed between NO2 and total IgE levels disappeared after including O3 in the models. Neither SO2 nor PM10 were correlated with total IgE levels. Conclusions:, Results suggest that O3 or related ambient pollutants may up-regulate total IgE levels among asthmatic adults. [source] Relationships between air pollution and preterm birth in CaliforniaPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 6 2006Mary Huynh Summary Air pollution from vehicular emissions and other combustion sources is related to cardiovascular and respiratory outcomes. However, few studies have investigated the relationship between air pollution and preterm birth, a primary cause of infant mortality and morbidity. This analysis examined the effect of fine particulate matter (PM2.5) and carbon monoxide (CO) on preterm birth in a matched case,control study. PM2.5 and CO monitoring data from the California Air Resources Board were linked to California birth certificate data for singletons born in 1999,2000. Each birth was mapped to the closest PM monitor within 5 miles of the home address. County-level CO measures were utilised to increase sample size and maintain a representative population. After exclusion of implausible birthweight,gestation combinations, preterm birth was defined as birth occurring between 24 and 36 weeks' gestation. Each of the 10 673 preterm cases was matched to three controls of term (39,44 weeks) gestation with a similar date of last menstrual period. Based on the case's gestational age, CO and PM2.5 exposures were calculated for total pregnancy, first month of pregnancy, and last 2 weeks of pregnancy. Exposures were divided into quartiles; the lowest quartile was the reference. Because of the matched design, conditional logistic regression was used to adjust for maternal race/ethnicity, age, parity, marital status and education. High total pregnancy PM2.5 exposure was associated with a small effect on preterm birth, after adjustment for maternal factors (adjusted odds ratio [AOR] = 1.15, [95% CI 1.07, 1.24]). The odds ratio did not change after adjustment for CO. Results were similar for PM2.5 exposure during the first month of pregnancy (AOR = 1.21, 95% CI [1.12, 1.30]) and the last 2 weeks of pregnancy (AOR = 1.17, 95% CI [1.09, 1.27]). Conversely, CO exposure at any time during pregnancy was not associated with preterm birth (AORs from 0.95 to 1.00). Maternal exposure to PM2.5, but not CO, is associated with preterm birth. This analysis did not show differences by timing of exposure, although more detailed examination may be needed. [source] Preoperative prediction of long-term outcome following laparoscopic fundoplicationANZ JOURNAL OF SURGERY, Issue 7 2002Colm J. O'Boyle Background: Although long-term outcomes following laparoscopic fundoplication for gastro-oesophageal disease have now been reported as very satisfactory, a small, but important, minority of patients are unhappy with the outcome, often due to recurrent reflux symptoms or new-onset dysphagia. In this study, we sought to establish whether various parameters that can be determined before surgery, can predict the long-term outcome of surgery. Methods: Data collected prospectively were evaluated to determine factors that were associated with outcome at 5 years following laparoscopic fundoplication. Inclusion criteria were complete preoperative assessment data and 5-year follow-up data. Data examined included information on preoperative age, sex, weight, home address, health insurance status, duration of reflux symptoms, previous surgery, operating surgeon, endoscopy and 24-h pH monitoring. In addition, lower oesophageal sphincter resting and residual relaxation pressures were evaluated before and after surgery. The postoperative symptoms of heartburn and dysphagia, as well as overall satisfaction 5 years following surgery was determined using a 0,10 visual analogue scale. The association of the pre- and perioperative factors and outcome at 5 years was determined by univariate and linear regression analysis. Results: Two hundred and sixty-two patients from an overall experience of over 1000 laparoscopic anti-reflux procedures met the entry criteria. There was no association between patient address, age, weight, duration of symptoms, the presence of endoscopically proven oesophagitis, operating surgeon, the necessity for conversion to an open procedure, change in lower oesophageal sphincter residual relaxation pressure and the outcome parameters. Using univariate analysis, a higher heartburn score was associated with previous abdominal surgery, female sex, no private health insurance, and a normal preoperative 24-h pH study. A higher dysphagia score was associated with a normal preoperative pH study, a postoperative increase in lower oesophageal sphincter resting pressure of more than 6 mmHg, and previous abdominal surgery. Overall satisfaction with the outcome at 5 years was higher among male patients, private patients, patients who had a hiatus hernia, and patients who had an abnormal preoperative pH study. Linear regression analysis confirmed that private insurance, male sex, and the absence of previous abdominal surgery, were the strongest predictors of an improved heartburn score, whereas male sex and private health insurance were the strongest predictors of greater satisfaction with the overall outcome. Conclusions: There are parameters that can be assessed before or during laparoscopic Nissen fundoplication that correlate with late outcome parameters. In particular, male patients and those from higher socioeconomic groups appear to have a better long-term outcome. [source] The effect of structural empowerment and perceived organizational support on middle level nurse managers' role satisfactionJOURNAL OF NURSING MANAGEMENT, Issue 1 2006ALLISON PATRICK RN Background, The restructuring of Canadian health care organizations during the past decade has reduced the visibility of nursing leadership. This has resulted in job conditions that have disempowered nurse managers and influenced their ability to create positive work environments, mentor potential nurse leaders, and gain satisfaction in the leadership role. These conditions threaten the retention of a cadre of high quality nurse leaders in today's chaotic health care setting. Objective, The purpose of this study was to examine the relationship between structural empowerment and perceived organizational support and the effect of these factors on the role satisfaction of middle level nurse managers. Method, A secondary analysis was conducted as part of a larger study of 126 middle level nurse managers working in Canadian acute care hospitals, randomly selected from the Ontario provincial registry. Eighty-four nurse managers responded to a questionnaire mailed to their home addresses. Results, Structural empowerment was positively associated with middle level nurse managers' perceived organizational support. The combination of empowerment and perceptions of organizational support were significant predictors of middle level nurse managers' role satisfaction. Conclusions, The findings support R.M. Kanter's (1977, 1993; Men and Women of the Corporation. Basic Books, New York) contention that empowering work conditions have an impact on employees' feelings of support and sense of accomplishment at work. Positive perceptions of organizational support may play an important role in retaining current middle managers, and possibly attracting future leaders to management positions. [source] Sexual and gender-related harassment in medical education and research training: results from a Swedish surveyMEDICAL EDUCATION, Issue 1 2003Charlotte Larsson Objective, The aims of this study were to establish the level of perceived sexual and gender-related harassment in undergraduate and doctoral studies, in which environment the events occurred, which categories of persons had committed the harassment, and other aspects of sexual harassment at the Faculty of Medicine, Gothenburg University. Methods, A questionnaire was distributed to all registered male and female undergraduate students (n= 605) and doctoral students (n=743) by mail to their home addresses. Results, The response rate was 62% (840/1348). Of the total study population, 59% (495/840) of respondents reported at least one experience of derogatory jokes and comments, 54% (454/840) of respondents reported at least one experience of gender-related discrimination, and 22% (187/840) of respondents reported at least one incident of sexual harassment. More severe types of sexual harassment were reported by 9% (79/840) of respondents. Women, and especially undergraduate women, were more often exposed to all kinds of harassment than were men. Lecturers/professors, doctors and co-students were the categories most often identified as the harassers. The harassment mostly occurred during lectures, clinical work and coffee breaks. The most common types of self-perceived mistreatment were derogatory jokes and comments. Conclusion, This survey shows that sexual harassment happens to both men and women, although it is more commonly experienced by female undergraduate and doctoral students, and that it occurs in both the university and hospital environments. Universities should develop action plans to prevent such events. Students and teachers should be well informed about appropriate measures to take in situations where harassment is known or suspected to occur. [source] ORIGINAL ARTICLE: The relationship between patients' perception of the effects of neurofibromatosis type 2 and the domains of the Short Form-36CLINICAL OTOLARYNGOLOGY, Issue 4 2010W.J. Neary Clin. Otolaryngol. 2010, 35, 291,299 Objectives:, To investigate the relationship between those issues concerning quality of life in patients with neurofibromatosis type 2 (NF2) as identified by the closed set NF2 questionnaire and the eight norm-based measures and the physical component summary (PCS) and mental component summary (MCS) scores of the Short Form-36 (SF-36) Questionnaire. Design:, Postal questionnaire study. Setting:, Questionnaires sent to subjects' home addresses. Participants:, Eighty-seven adult subjects under the care of the Manchester Multidisciplinary NF2 Clinic were invited to participate. Main outcome measures:, Sixty-two (71%) completed sets of closed set NF2 questionnaires and SF-36 questionnaires were returned. Results:, Subjects with NF2 scored less than the norm of 50 on both the physical component summary and mental component summary scores and the eight individual norm-based measures of the Short Form-36 questionnaire. Correlations (using Kendall's tau) were examined between patients' perceptions of their severity of difficulty with the following activities and the eight norm-based measures and the physical component summary and mental component summary scores of the Short Form-36 questionnaire: Communicating with spouse/significant other (N = 61). The correlation coefficients were significant at the 0.01 level for the mental component summary score, together with three of the norm-based scores [vitality (VT), social functioning and role emotional]. Social communication (N = 62). All 10 correlations were significant at the 0.01 or 0.001 level. Balance (N = 59). All 10 correlations were highly significant at the P < 0.001 level. Hearing difficulties (N = 61). All correlations were significant at either the 0.01 level or less apart from the mental component summary score and three of the norm-based scores (role physical, VT and mental health). Mood change (N = 61). All correlations were significant at the 0.01 level or less, apart from one norm-based score (role physical). Conclusions:, The Short Form-36 questionnaire has allowed us to relate patients' perceptions of their difficulties, as identified by the closed set NF2 questionnaire, to the physical and mental domains measured by this validated and widely used scale, and has provided further insight into areas of functioning affected by NF2. [source] | ||||||||||