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Logistic Regression Models (logistic + regression_models)
Kinds of Logistic Regression Models Selected AbstractsLogistic Regression Models for Polymorphic and Antagonistic Pleiotropic Gene Action on Human Aging and LongevityANNALS OF HUMAN GENETICS, Issue 6 2003Qihua Tan Summary In this paper, we apply logistic regression models to measure genetic association with human survival for highly polymorphic and pleiotropic genes. By modelling genotype frequency as a function of age, we introduce a logistic regression model with polytomous responses to handle the polymorphic situation. Genotype and allele-based parameterization can be used to investigate the modes of gene action and to reduce the number of parameters, so that the power is increased while the amount of multiple testing minimized. A binomial logistic regression model with fractional polynomials is used to capture the age-dependent or antagonistic pleiotropic effects. The models are applied to HFE genotype data to assess the effects on human longevity by different alleles and to detect if an age-dependent effect exists. Application has shown that these methods can serve as useful tools in searching for important gene variations that contribute to human aging and longevity. [source] Treatment of major depressive disorder in the Finnish general populationDEPRESSION AND ANXIETY, Issue 11 2009Juha Hämäläinen M.D.M.A. Abstract Background: Few general population studies of the treatment of major depressive disorder (MDD) have included the whole spectrum of treatments. We estimated the rates of different treatments and the effect of individual and disorder characteristics plus provider type on treatment received. Methods: In the Health 2000 Study, a representative sample (n=6,005) from the adult Finnish population (,30 years) were interviewed (CIDI) in 2000,2001 for the presence of DSM-IV mental disorders during the past 12 months. Logistic regression models were used to examine factors influencing the type of treatment: either pharmacotherapies (antidepressants, anxiolytics, sedatives/hypnotics, antipsychotics) or psychological treatment. Results: Of the individuals with MDD (n=288), currently 24% used antidepressants, 11% anxiolytics, 16% sedatives/hypnotics, 5% antipsychotics, and 17% reported having received psychological treatment. Overall, 31% received antidepressants or psychological treatment or both; 18% received minimally adequate treatment. Of those 33% (n=94) using health care services for mental reasons, 76% received antidepressants or psychological treatment or both; 54% received minimal adequate treatment. In logistic regression models, the use of antidepressants was associated with female sex, being single, severe MDD, perceived disability, and comorbid dysthymic disorder; psychological treatment with being divorced, perceived disability, and comorbid anxiety disorder. Conclusions: Due to the low use of health services for mental reasons, only one-third of subjects with MDD use antidepressants, and less than one-fifth receives psychological treatment. The treatments provided are determined mostly by clinical factors such as severity and comorbidity, in part by sex and marital status, but not education or income. Depression and Anxiety 26:1049,1059, 2009. © 2009 Wiley-Liss, Inc. [source] Seasonal allergies and suicidality: results from the National Comorbidity Survey ReplicationACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2010E. Messias Messias E, Clarke DE, Goodwin RD. Seasonal allergies and suicidality: results from the National Comorbidity Survey Replication. Objective:, Studies have shown an association between allergies and suicidality, and a seasonality of suicide has also been described. We hypothesize an association between history of seasonal allergies and suicide ideation and attempt. Method:, Data came from the National Comorbidity Survey Replication, a nationally representative sample (n = 5692) of adults living in the US. Logistic regression models were used to calculate adjusted odds ratios (OR) controlling for the following: age, sex, race, smoking, asthma and depression. Results:, After weighting and adjustment, a positive and statistically significant association was found between history of seasonal allergies and history of suicidal ideation [adjusted OR = 1.27 (1.01,1.58)]. We found no association between history of seasonal allergies and history of suicide attempts [adjusted OR = 1.17 (0.89,1.52)]. Conclusion:, Findings from a population-based sample support the hypothesized relationship between allergies and suicidal ideation. [source] Early detection of relapse in panic disorderACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2004M. R. Mavissakalian Objective:, To explore predictive models of relapsing based on change in symptoms at a time when panic disorder patients are still in remission following discontinuation of antidepressants. Method:, Forty-seven subjects, who were randomized to double-blind placebo and who had valid data at four time points: pretreatment, randomization to placebo substitution, an assessment on placebo prior to the last assessment or relapse and their last assessment (relapsers n = 15, non-relapsers n = 32) were studied using descriptive, growth curve analysis and logistic regression methodologies. Results:, Measures of generalized anxiety, fearfulness and disability at work and at home were better predictors of relapse than measures of panic and anxiety sensitivity. Logistic regression models using any one of these four general variables and its linear change correctly predicted relapse for 78.7,84.4% of the study subjects. Conclusion:, It is possible to gauge, with a fair degree of accuracy, the probability of relapsing in panic disorder patients who have discontinued serotonergic antidepressants 2 months prior to the return of panic. [source] A comparison of risk factors for habitual violence in pre-trial subjectsACTA PSYCHIATRICA SCANDINAVICA, Issue 2002S. Z. Kaliski Objective: Pre-trial referrals to the Valkenberg Hospital forensic unit over a 6-month period were studied. Habitually violent offenders were compared with those with no history of violence. Methods:, Risk factors known to be associated with violent behaviour were elicited, i.e. demographics, behaviour during index offence (such as impulsivity, identity of victim, use of weapon, accomplices, intoxication, psychotic symptoms), psychiatric and family histories, history of suicide attempts, past child abuse, head injury, criminal record, psychiatric diagnosis and presence of medical disorders. EEG's, Barratt's Impulsivity, Zuckerman's Sensation Seeking and Mini-Mental Scales were administered. Behaviour in the ward during the 30 days was also appraised. Logistic regression models were used to determine relative risks. Results:, There were 155 subjects; 89.7% were male, 71.6% were single and 58.7% were unemployed. For 44.5% the index offence was violent, and 9.7% had committed sexual offences; 61.9% had histories of habitual violence. A psychotic disorder was diagnosed in 32.3% and a personality disorder in 48.4%. Habitually violent subjects were distin- guished by a history of issuing threats (OR=3.68; CI=3.19,4.16; P= 0.000), delusions of persecution (OR=3.43; CI=2.67,4.17; P=0.001), history of conduct disorder (OR=1.95; CI=1.70,2.19; P=0.006), alcohol/substance abuse (OR=2.08; CI=1.53,2.61; P=0.008) and violent index offence (OR=1.66; CI=1.54,2.61; P=0.035). Conclusion: This seems to confirm the relationship between threats, feeling threatened, psychosis, a history of antisocial behaviour and alcohol abuse. [source] Individual, partner and relationship factors associated with non-medical use of prescription drugsADDICTION, Issue 8 2010Gregory G. Homish ABSTRACT Aims The objective of the current report was to examine individual, partner and relationship factors (e.g. relationship satisfaction) associated with the non-medical use of prescription drugs (NMUPD) in a community sample of married adults. Design The current report used two waves of data from an ongoing study of couples who were recruited at the time they applied for their marriage license and are now in the 10th year of follow-up. Logistic regression models examined the relation between individual, partner and relationship factors and NMUPD. Participants This report is based on 273 couples. Measurements Participants completed questionnaires that assessed prescription drug use, alcohol use, other substance use, depression, marital satisfaction and socio-demographic factors. Findings Among wives, there was evidence that a partner's prescription drug use and relationship factors were associated with increased risk for NMUPD. There was some evidence suggesting that it was the increased access or availability, and not the partner's use per se, that was related to the NMUPD. These results persisted after controlling for other illicit drug use, heavy drinking, depressive symptomatology and socio-demographic factors. Among men, neither partner use nor relationship factors were associated with NMUPD after considering the impact of individual-level risk factors. Conclusion Prevention and intervention efforts directed at reducing the risk for NMUPD should consider the influence of partner and relationship factors in addition to individual-level risk factors. [source] Substance use disorder among older adults in the United States in 2020ADDICTION, Issue 1 2009Beth Han ABSTRACT Aims This study aimed to project the number of people aged 50 years or older with substance use disorder (alcohol/illicit drug dependence or abuse) in the United States in 2020. Design Logistic regression models were applied to estimate parameters predicting past-year substance use disorder using the 2002,06 National Survey on Drug Use and Health data. We applied these parameters to the projected US 2020 population to estimate the number of adults aged 50 or older with substance use disorder in 2020. Setting Non-institutionalized US residences. Participants Representative sample of the US civilian, non-institutionalized population. Measurements Substance use disorder is classified based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Findings Due to the large population size and high substance use rate of the baby-boom cohort, the number of adults aged 50 or older with substance use disorder is projected to double from 2.8 million (annual average) in 2002,06 to 5.7 million in 2020. Increases are projected for all examined gender, race/ethnicity and age groups. Conclusions Our estimates provide critical information for policymakers to allocate resources and develop prevention and treatment approaches to address future needs of the US older adult population with substance use disorder. [source] Impact of Alternative Interventions on Changes in Generic Dispensing RatesHEALTH SERVICES RESEARCH, Issue 5 2006A. James O'Malley Objectives. To evaluate the effectiveness of four alternative interventions (member mailings, advertising campaigns, free generic drug samples to physicians, and physician financial incentives) used by a major health insurer to encourage its members to switch to generic drugs. Methods. Using claim-level data from Blue Cross Blue Shield of Michigan, we evaluated the success of four interventions implemented during 2000,2003 designed to increase the use of generic drugs among its members. Around 13 million claims involving seven important classes of drugs were used to assess the effectiveness of the interventions. For each intervention a control group was developed that most closely resembled the corresponding intervention group. Logistic regression models with interaction effects between the treatment group (intervention versus control) and the status of the intervention (active versus not active) were used to evaluate if the interventions had an effect on the generic dispensing rate (GDR). Because the mail order pharmacy was considered more aggressive at converting prescriptions to generics, separate generic purchasing models were fitted to retail and mail order claims. In secondary analyses separate models were also fitted to claims involving a new condition and claims refilled for preexisting conditions. Results. The interventions did not appear to increase the market penetration of generic drugs for either retail or mail order claims, or for claims involving new or preexisting conditions. In addition, we found that the ratio of copayments for brand name to generic drugs had a large positive effect on the GDR. Conclusions. The interventions did not appear to directly influence the GDR. Financial incentives expressed to consumers through benefit designs have a large influence on their switching to generic drugs and on the less-costly mail-order mode of purchase. [source] Alcohol consumption and risk of prostate cancer in middle-aged menINTERNATIONAL JOURNAL OF CANCER, Issue 1 2005W. Marieke Schoonen Abstract Alcohol consumption is a modifiable lifestyle factor that may affect prostate cancer risk. Alcohol alters the hormonal milieu and contains chemical substances such as flavonoids (red wine), which may alter tumor cell growth. Data from a population-based case-control study in King County, WA, were utilized to evaluate the association of alcohol consumption with prostate cancer in middle-aged men. A total of 753 newly diagnosed prostate cancer cases, 40,64 years of age, participated in the study. Seven hundred three control subjects, frequency matched to cases by age, were selected through random digit dialing. All participants completed an in-person interview on lifetime alcohol consumption and other risk factors for prostate cancer. Logistic regression models were used to estimate odds ratios (OR) and assess significance (95% confidence intervals [CI]). All tests of statistical significance were two-sided. No clear association with prostate cancer risk was seen for overall alcohol consumption. Each additional glass of red wine consumed per week showed a statistically significant 6% decrease in relative risk (OR = 0.94; 95% CI = 0.90,0.98), and there was evidence for a decline in risk estimates across increasing categories of red wine intake (trend p = 0.02). No clear associations were seen for consumption of beer or liquor. Our present study suggests that consumption of beer or liquor is not associated with prostate cancer. There may be, however, a reduced relative risk associated with increasing level of red wine consumption. Further research is needed to evaluate the potential negative association between red wine intake and prostate cancer risk. [source] Use of a novel technology for presenting screening measures to detect mild cognitive impairment in elderly patientsINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 9 2010D. W. Wright Summary Background:, Available screening tools for mild cognitive impairment (MCI), often a precursor to Alzheimer's disease, are insensitive or not feasible for administration in a busy primary care setting. Display Enhanced TEsting for Cognitive impairment and Traumatic brain injury (DETECTÔ) addresses these issues by creating an immersive environment for the brief administration of neuropsychological (NP) measures. Objective:, The aim of this study was to determine if the DETECTÔ cognitive subtests can identify MCI patients as accurately as standard pen and paper NP tests. Methods:, Twenty patients with MCI recruited from a memory disorders clinic and 20 age-matched controls were given both a full battery of NP tests (standard NP) and the DETECTÔ screen. Logistic regression models were used to determine whether individual tests were predictive of group membership (MCI or control). Demographic variables including age, race, education and gender were adjusted as covariates. Selection methods were used to identify subset models that exhibited maximum discrimination between MCI patients and controls for both testing methods. Results:, Both the standard NP model (C-index = 0.836) and the DETECTÔ model (C-index = 0.865) showed very good discrimination and were not significantly different (p = 0.7323). Conclusion:, The DETECTÔ system shows good agreement with standard NP tests and is capable of identifying elderly patients with cognitive impairment. [source] Differences in depression symptoms in patients with Alzheimer's and Parkinson's diseases: evidence from the 15-item Geriatric Depression Scale (GDS-15)INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2007Daniel Weintraub Abstract Objective Depression occurs frequently in patients with both Alzheimer's disease (AD) and Parkinson's disease (PD), but there has been little comparison of depression symptoms in the two populations. Method The 15-item Geriatric Depression Scale (GDS-15) was administered as a depression screening instrument to 232,AD patients and 266,PD specialty care patients with at most mild dementia. Logistic regression models were used to determine disease-specific associations with individual GDS-15 items, and factor analysis was used to assess GDS-15 factor structure in the two populations. Results Controlling for total GDS-15 score and other covariates, AD patients reported more dissatisfaction with life (p,=,0.03) and memory problems (p,<,0.001), while PD patients reported more fearfulness (p,=,0.01), helplessness (p,<,0.01), a preference to stay at home (p,=,0.02), and diminished energy (p,<,0.01). Three factors were generated in PD (explaining 55% of the total variance) and five in AD (explaining 59% of the total variance), and the two main factors generated in both populations related primarily to unhappiness and negative thoughts. Conclusions The factor structure of the GDS-15 is similar in AD and PD patients with at most mild stage dementia, but between-group differences on 6 of the GDS-15 items suggests the non-specificity of certain items in the two populations. Copyright © 2007 John Wiley & Sons, Ltd. [source] Vitamin D receptor gene polymorphisms are associated with increased risk and progression of renal cell carcinoma in a Japanese populationINTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2007Wataru Obara Aim: Biological and epidemiologic data suggest that 1 alpha, 25 dihydroxyvitamin D3 (1,25(OH)2D3) levels may influence development of renal cell carcinoma. The vitamin D receptor (VDR) is a crucial mediator for the cellular effects of 1,25(OH)2D3 and additionally interacts with other cell signaling pathways that influence cancer progression. VDR gene polymorphisms may play an important role in risk of incidence for various malignant tumors. This study investigated whether VDR gene polymorphisms were associated with increased risk and prognosis of renal cell carcinoma (RCC) in a Japanese population. Methods: To analyze risk of RCC depending on VDR polymorphism, a case,control association study was performed. The VDR gene polymorphisms at three locations, BsmI, ApaI and TaqI, were genotyped in 135 RCC patients and 150 controls in a Japanese population. Logistic regression models were used to assess the genetic effects on prognosis. Results: Significant differences in the ApaI genotype were observed between RCC patients and controls (,2 = 6.90, P = 0.032). No statistical significant difference was found in the BsmI and TaqI polymorphisms. The frequency of the AA genotype in the ApaI polymorphism was significantly higher in the RCC patients than in the controls (odds ratio, 2.59; 95% confidence intervals, 1.21,5.55; P = 0.012). Multivariate regression analysis showed that the AA genotype was an independent prognostic factor for cause-specific survival (relative risk 3.3; P = 0.038). Conclusion: The AA genotype at the ApaI site of the VDR gene may be a risk of incidence and poor prognosis factor for RCC in the Japanese population. Additional studies with a large sample size and investigation of the functional significance of the ApaI polymorphism in RCC cells are warranted. [source] Type 2 Diabetes Mellitus and Risk of Developing Urinary IncontinenceJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2005Karen L. Lifford MD Objectives: To evaluate the association between type 2 diabetes mellitus (DM) and development of urinary incontinence in women. Design: Prospective, observational study. Setting: The Nurses' Health Study cohort. Participants: Eighty-one thousand eight hundred forty-five women who reported information on urinary function in 1996. Measurements: Self-reported, physician-diagnosed DM was ascertained using questionnaire from 1976 to 1996 and confirmed using standard criteria. Self-reported urinary incontinence, defined as leakage at least weekly, was ascertained in 1996 and 2000. Logistic regression models were used to calculate multivariate-adjusted relative risks (RRs) and 95% confidence intervals (CIs) for the relationship between DM (as of 1996) and prevalent and incident incontinence. Results: The risk of prevalent incontinence (multivariate RR=1.28, 95% CI=1.18,1.39) and incident incontinence (multivariate RR=1.21, 95% CI=1.02,1.43) was significantly greater in women with DM than women without. Using a validated severity index, risk of developing severe incontinence was even more substantial in women with DM than in those without (multivariate RR=1.40, 95% CI=1.15,1.71 for leakage enough to wet the underwear; RR=1.97, 95% CI=1.24,3.12 for leakage enough to wet the outer clothing). In addition, risk of incontinence increased with duration of DM (P -trend=.03 for prevalent incontinence; P=.001 for incident incontinence). Conclusion: DM independently increases risk of urinary incontinence in women. Because risk of incontinence appeared associated with longer duration of DM, even delaying the onset of DM could have important public health implications. [source] Persistent Nonmalignant Pain and Analgesic Prescribing Patterns in Elderly Nursing Home ResidentsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2004(See editorial comments by Dr. Debra Weiner on pp 1020, 1022) Objectives: To determine the prevalence of analgesics used, their prescribing patterns, and associations with particular diagnoses and medications in patients with persistent pain. Design: Cross-sectional study. Setting: Nursing homes from 10 U.S. states. Participants: A total of 21,380 nursing home residents aged 65 and older with persistent pain. Measurements: Minimum Data Set (MDS) assessments on pain, analgesics, cognitive, functional, and emotional status were summarized. Logistic regression models identified diagnoses associated with different analgesic classes. Results: Persistent pain as determined using the MDS was identified in 49% of residents with an average age of 83; 83% were female. Persistent pain was prevalent in patients with a history of fractures (62.9%) or surgery (63.6%) in the past 6 months. One-quarter received no analgesics. The most common analgesics were acetaminophen (37.2%), propoxyphene (18.2%), hydrocodone (6.8%), and tramadol (5.4%). Only 46.9% of all analgesics were given as standing doses. Acetaminophen was usually prescribed as needed (65.6%), at doses less than 1,300 mg per day. Nonsteroidal antiinflammatory drugs (NSAIDs) were prescribed as a standing dose more than 70% of the time, and one-third of NSAIDs were prescribed at high doses. Conclusion: In nursing home residents, persistent pain is highly prevalent, there is suboptimal compliance with geriatric prescribing recommendations, and acute pain may be an important contributing source of persistent pain. More effective provider education and research is needed to determine whether treatment of acute pain could prevent persistent pain. [source] Divalproex sodium vs. valproic acid: drug utilization patterns, persistence rates and predictors of hospitalization among VA patients diagnosed with bipolar disorderJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 6 2007S. U. Iqbal MBA MPH MD Summary Objectives:, To compare divalproex sodium and valproic acid for therapeutic patterns, persistence rates and predictors of hospitalization among bipolar patients on monotherapy in the Veterans Affairs (VA) healthcare system. Methods:, Using VA administrative data bases, we conducted a retrospective inception cohort study of VA patients', 18 years of age who had at least one outpatient diagnoses of bipolar disorder and two continuous prescription records for the study drugs in the VA PBM pharmacy database during the study period of 1st April 2001 to 30th September 2003. Persistence for the comparative drugs was reported as continuous variable and compared using t -tests. Logistic regression models were used to examine the risk of hospitalization whereas Cox proportional hazard regression models were used to evaluate the time to hospitalization and time to interruption of therapy for the two drug groups. Results:, We identified 4624 bipolar patients on monotherapy with valproic acid (n = 4036) and divalproex sodium (n = 588) during the study period. The descriptive statistics included sociodemographics, disability and comorbidity status and were similar for the two groups. For the crude persistence rates there were no statistically significant differences between divalproex sodium (120 days) and valproic acid (110 days). The logistic regression model for risk of hospitalization showed no statistically significant difference between the two comparators [odds ratio = 1·06, 95% confidence interval (CI) = 0·787,1·444]. The Cox model for time to interruption of therapy showed an insignificant hazard ratio (HR) for divalproex sodium vs. valproic acid (HR = 0·928, 95% CI = 0·844,1·020) and for time to hospitalization also no statistically significant difference in the HR for the two drugs (HR = 0·984, 95% CI = 0·784,1·295). Conclusion:, The study showed a comparable profile of generic valproic acid with divalproex sodium for persistence and predictors of hospitalization for bipolar patients on monotherapy in the VA. Results have important healthcare implications for treatment and costs. [source] Risk prediction for Down's syndrome in young pregnant women using maternal serum biomarkers: determination of cut-off risk from receiver operating characteristic curve analysisJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2007Hsiao-Lin Hwa MD PhD Abstract Objective, The aim of this study was to establish a predictive model for Down's syndrome using maternal age as well as maternal serum levels of alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG), and to identify an optimal cut-off risk in women under the age of 35 years to improve sensitivity. Methods, Logistic regression models were utilized to predict fetal Down's syndrome as a function of maternal age and logarithm of levels of AFP as well as hCG using training data of 20 pregnancies with fetal Down's syndrome and 9730 unaffected pregnancies. Validation was performed using data of another nine affected pregnancies and 3496 unaffected pregnancies. Receiver operating characteristic (ROC) curves were plotted. Results, Based on the newly established logistic regression equations, the optimal cut-off risk from the ROC curve analysis was at 1:499, with a 17.8% false-positive rate and a 90.0% sensitivity. A suboptimal cut-off risk was estimated at 1:332, with a 12.0% false-positive rate and an 80% sensitivity. Conclusion, A predictive model for Down's syndrome was developed using logistic regression. By ROC curve analysis and clinical consideration, the cut-off risk for young pregnant women could be determined. [source] Hazardous Drinking: Prevalence and Associations in the Finnish General PopulationALCOHOLISM, Issue 9 2008Jukka T. Halme Background:, Hazardous drinking, defined as consuming alcohol on a risky level and not meeting the diagnostic criteria of alcohol use disorders (AUDs), has been suggested for a new complementary nondependence diagnosis. This study aimed to investigate the prevalence and associations of hazardous drinking in comparison to AUDs, moderate drinking, and abstinence. Methods:, A national representative sample of Finns was examined in the Health 2000 Survey. For 4477 subjects aged 30 to 64 years (76%, 2341 females), both the quantity frequency data about alcohol consumption and Composite International Diagnostic Interview (CIDI) data concerning AUD diagnoses were available. The nationally recommended limits for hazardous dinking were used (males: 24 drinks, females: 16 drinks/wk). Logistic regression models were used to analyze associations. Results:, The prevalence of hazardous drinking was 5.8%. Hazardous drinking was more prevalent among males than females (8.5% vs. 3.1%). It was most prevalent among the subjects aged 40 to 49 years (7.3%), divorced or separated (8.3%), unemployed (8.2%) and subjects living in the southern (Helsinki) region (7.5%). AUDs versus hazardous drinking were more likely to be in males versus females and in the unemployed versus employed. Subjects aged 40 and over had higher odds for hazardous drinking versus AUDs. The odds for hazardous versus moderate drinking were higher for males versus females (adjusted odds ratio = 3.24), for subjects aged over 40 years, unemployed versus employed and cohabiting, divorced/separated or unmarried subjects versus married subjects. Conclusion:, The high prevalence of hazardous drinking makes it an important public health concern. Hazardous drinkers have different sociodemographic characteristics as compared to people in other alcohol use categories. [source] Thrombin generation during reperfusion after coronary artery bypass surgery associates with postoperative myocardial damageJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 7 2006P. RAIVIO Summary.,Background: Cardiopulmonary bypass and coronary artery bypass grafting (CABG) result in significant thrombin generation and activation of fibrinolysis. Thrombin contributes to myocardial ischemia,reperfusion injury in animal studies, but the role of thrombin in myocardial damage after CABG is unknown. Objectives: We measured thrombin generation and fibrin turnover during reperfusion after CABG to evaluate their associations with postoperative hemodynamic changes and myocardial damage. Methods: One hundred patients undergoing primary, elective, on-pump CABG were prospectively enrolled. Plasma prothrombin fragment F1+2 and D-dimer were measured preoperatively and at seven time points thereafter. Mass of the Mb fraction of creatine kinase (Ck-Mbm) and troponin T (TnT) were measured on the first postoperative day. Results: Reperfusion induced an escalation of thrombin generation and fibrin turnover despite full heparinization. F1+2 during early reperfusion associated with postoperative pulmonary vascular resistance index. F1+2 at 6 h after protamine administration correlated with Ck-Mbm (r = 0.40, P < 0.001) and TnT (r = 0.44, P < 0.001) at 18 h postoperatively. Patients with evidence of myocardial damage (highest quintiles of plasma Ck-Mbm and TnT) had significantly higher F1+2 during reperfusion than others (P < 0.002). Logistic regression models identified F1+2 during reperfusion to independently associate with postoperative myocardial damage (odds ratios 2.5,4.4, 95% confidence intervals 1.04,15.7). Conclusions: Reperfusion caused a burst in thrombin generation and fibrin turnover despite generous heparinization. Thrombin generation during reperfusion after CABG associated with pulmonary vascular resistance and postoperative myocardial damage. [source] Place of Residence, Party Preferences, and Political Attitudes in Canadian Cities and SuburbsJOURNAL OF URBAN AFFAIRS, Issue 3 2004R. Alan Walks As of yet, there has been very little research done on this topic in Canada. Logistic regression models derived from the 1965, 1984 and 2000 Canadian national election surveys confirm that Canadian inner cities and (particularly, outer) suburbs are diverging, and place of residence has become increasingly important in explaining this divergence. Over the study period, residents of inner cities in Canada became more likely to vote for parties of the left and to hold attitudes that would be considered on the left of the political spectrum, while suburban residents were increasingly likely to vote for parties of the right and to hold attitudes on the right of the political spectrum. The research suggests that in Canada, as in the US, the place and context of suburbia is a factor in the shift to the right. This has implications for the future direction of welfare state policy. [source] Adherence to the Mediterranean diet and fresh fruit intake are associated with improved asthma controlALLERGY, Issue 7 2008R. Barros Background:, The traditional Mediterranean diet is claimed to possess antioxidant and immune-regulatory properties in several chronic diseases. Typical Mediterranean foods have recently been associated with improvement of symptoms of asthma and rhinitis in children. However the effect of adherence to Mediterranean diet on adult asthma outcomes is unknown. We aimed to investigate the association between adherence to Mediterranean diet and asthma control. Methods:, Cross sectional study of 174 asthmatics, mean (SD) age of 40 (15) years. The patients were defined as controlled, in contrast to noncontrolled, if they showed FEV1 , 80% of predicted, exhaled nitric oxide (NO) ,35 ppb, and Asthma Control Questionnaire score <1. Dietary intake was obtained by a food frequency questionnaire, and Mediterranean diet was assessed by alternate Mediterranean Diet (aMED) Score. Logistic regression models adjusting for confounders were performed to estimate the association between Mediterranean diet and asthma control. Results:, Controlled asthmatics (23%) had significantly higher aMED Score, intake of fresh fruit, and lower intake of ethanol compared to noncontrolled (77%). High adherence to Mediterranean diet reduced 78% the risk of noncontrolled asthma after adjusting for gender, age, education, inhaled corticosteroids and energy intake (OR = 0.22; 95% CI = 0.05,0.85; P -trend = 0.028). The higher intake of fresh fruit decreased the probability of having noncontrolled asthma (OR = 0.29; 95% CI = 0.10,0.83; P -trend = 0.015), while the higher intake of ethanol had the opposite effect (OR = 3.16; 95% CI = 1.10,9.11; P -trend = 0.035). Conclusion:, High adherence to traditional Mediterranean diet increased the likelihood of asthma to be under control in adults. The study introduces a novel link between diet and asthma control, as measured by symptoms, lung function and exhaled NO. [source] Swimming pool attendance and hay fever rates later in lifeALLERGY, Issue 11 2006Y. Kohlhammer Background:, Exposure to chlorination by-products through swimming pool attendance showed adverse health effects on children. The aim of our study was to assess whether pool attendance in childhood would be related to higher rates of allergic diseases in adulthood, with special regard to hay fever. Methods:, 2606 adults aged 35,74 years provided retrospectively collected information on swimming pool attendance and medical history, including data on atopic diseases. Information was assessed by a combination of a personal interview and a self-administered questionnaire. Logistic regression models were applied to study associations between hay fever and swimming pool attendance, adjusted for potentially relevant confounders, such as age, gender, region, education and smoking. Results:, Higher rates of hay fever could be seen when frequently exposed at school age (aOR: 1.74, 95% CI: 1.09,2.77), frequently exposed during the past 12 months (aOR: 1.32, 95% CI: 0.92,1.89) and ever exposed (aOR: 1.65, 95% CI: 0.98,2.78). Strongest associations were found for the youngest subjects and were dose-related to the extent of current and school-age pool attendance. Conclusions:, Impaired integrity of the lung epithelial by exposure to chlorination by-products might facilitate a closer contact to allergens and therefore could result in higher rates of hay fever. [source] Influence of physical inactivity on the prevalence of hay feverALLERGY, Issue 11 2006Y. Kohlhammer Background:, Atopic diseases constitute a major public health problem, increasing constantly in frequency and severity. While treatments are improving, the main cause for an increasing trend of hay fever and its definite triggers remain unclear. The aim of our study was to assess whether physical inactivity could be a risk factor for hay fever. Methods:, We analysed data of a cohort of children aged 5,14 years at baseline (1992,1993) who were followed up until 2003,2005. Parental-reported information on physical activity (being active, doing sports) was obtained for 2429 children participating at the baseline survey (active: n = 1923; semi-active: n = 364; inactive: n = 142). A total of 1703 children (70.1%) were reapproached at least once during follow-up. Logistic regression models were applied to study associations between hay fever, allergic sensitization and physical activity, adjusted for potentially relevant confounders such as age, gender, study site, parental education, breastfeeding, crowding, daycare, dampness or visible moulds, contact to cats, current or prior environmental tobacco smoke exposure and parental atopy. Results:, Significantly higher rates of hay fever were seen for inactive children [aOR 2.39 (95% CI 1.31,4.36) for baseline survey 1992,1993 and aOR 1.76 (95% CI 1.14,2.71) for the follow-up-period until 2005]. In addition, the relative risk of incident cases of hay fever increased depending on inactivity [aRR 1.50 (95% CI 1.05,2.13)]. No association was found between physical inactivity and allergic sensitization assessed by radioallergosorbent test determinations. Conclusions:, Although the underlying biological mechanisms could not be clarified, increasing physical activity in childhood is suggested to prevent hay fever. [source] The Asian birth outcome gapPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 4 2006Cheng Qin Summary Asians are often considered a single group in epidemiological research. This study examines the extent of differences in maternal risks and birth outcomes for six Asian subgroups. Using linked birth/infant death certificate data from the State of California for the years 1992,97, we assessed maternal socio-economic risks and their effect on birthweight, preterm delivery (PTD), neonatal, post-neonatal and infant mortality for Filipino (87 120), Chinese (67 228), Vietnamese (45 237), Korean (23 431), Cambodian/Laotian (21 239) and Japanese (18 276) live singleton births. The analysis also included information about non-Hispanic whites and non-Hispanic blacks in order to give a sense of the magnitude of risks among Asians. Logistic regression models explored the effect of maternal risk factors and PTD on Asian subgroup differences in neonatal and post-neonatal mortality, using Japanese as the reference group. Across Asian subgroups, the differences ranged from 2.5- to 135-fold for maternal risks, and 2.2-fold for infant mortality rate. PTD was an important contributor to neonatal mortality differences. Maternal risk factors contributed to the disparities in post-neonatal mortality. Significant differences in perinatal health across Asian subgroups deserve ethnicity-specific interventions addressing PTD, teen pregnancy, maternal education, parity and access to prenatal care. [source] Somnolence effects of antipsychotic medications and the risk of unintentional injury,,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2008Qayyim Said PhD Abstract Purpose This study examined the relationship between antipsychotic medications, categorized by published somnolence effects, and unintentional injury (UI). Methods The study population included patients of 18,64 years of age in a healthcare insurance database with claims from 2001 to 2004 and diagnoses of schizophrenia or affective disorder. A nested case-control design was used with cases defined by an E-code claim (a specified external cause of injury) for selected UIs. For cases, the index date referred to the first injury. For controls, the "control index date" was the date of claim if there was only a single medical claim; for patients with ,2 claims, one was selected at random as the "control index date." Both groups had a prescription for a first-generation antipsychotic (FGA) or second-generation antipsychotic (SGA) overlapping the index date. Potential somnolence effects were defined as: low (referent) , aripiprazole/ziprasidone; medium , risperidone; high , olanzapine/quetiapine: or any single FGA. Logistic regression models were used to estimate odds ratio (OR) and 95% confidence interval (CI) for UI, adjusted for gender, age, concomitant drug, and psychiatric diagnosis. Results Among 648 cases and 5214 controls, high-somnolence SGAs were associated with an OR of 1.41 95%CI (1.03,1.93) for risk of UI, while medium-somnolence SGAs, and FGAs had ORs of 1.17 95%CI (0.83,1.64) and 1.17 95%CI (0.79,1.74), respectively. When quetiapine and olanzapine were disaggregated, ORs were 1.61 95%CI (1.15,2.25) and 1.25 95%CI (0.89,1.74), respectively. Conclusions High-somnolence SGAs may lead to UI among patients. When prescribing antipsychotics, clinicians should consider potential somnolence. Copyright © 2008 John Wiley & Sons, Ltd. [source] How well do patients report noncompliance with antihypertensive medications?: a comparison of self-report versus filled prescriptionsPHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 1 2004Philip S. Wang MD Abstract Purpose To address poor patient compliance with antihypertensives, clinicians and researchers need accurate measures of adherence with prescribed regimens. Although self-reports are often the only means available in routine practice, their accuracy and agreement with other data sources remain questionable. Methods A telephone survey was conducted on 200 hypertensive patients treated with a single antihypertensive agent in a large health maintenance organization (HMO) or a Veterans Affairs medical center (VAMC) to obtain self-reports of the frequency of missing antihypertensive therapy. We then analyzed records of all filled prescriptions to calculate the number of days that patients actually had antihypertensive medications available for use. Agreement between the two data sources was measured with correlation coefficients and kappa statistics. Logistic regression models were used to identify demographic, clinical and psychosocial correlates of overstating compliance. Results There was very poor agreement between self-reported compliance and days actually covered by filled prescriptions (Spearman correlation coefficient,=,0.15; 95%CI: 0.01, 0.28). Very poor agreement was also observed between a categorical measure of self-reported compliance (ever vs. never missing a dose) and categories of actual compliance defined by filled prescriptions (<,80% vs >,80% of days covered; kappa,=,0.12, 95%CI: ,0.02, 0.26). Surprisingly, few factors were associated with inaccurate self-reporting in either crude or adjusted analyses; fewer visits to health care providers was significantly associated with overstating compliance. Conclusions Compliance was markedly overstated in this sample of patients and few characteristics identified those who reported more versus less accurately. Clinicians and researchers who rely on self-reports should be aware of these limits and should take steps to enhance their accuracy. Copyright © 2003 John Wiley & Sons, Ltd. [source] Effort,reward imbalance at work and self-rated health of Las Vegas hotel room cleanersAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 4 2010Niklas Krause MD Abstract Background This study investigates the relationship between effort-reward-imbalance (ERI) at work and self-rated health (SF-36) among 941 Las Vegas hotel room cleaners (99% female, 84% immigrant). Methods Logistic regression models adjust for age, health behaviors, physical workload and other potential confounders. Results 50% reported ERI and 60% poor or fair general health. Significant associations were found between ERI and all SF-36 health measures. Workers in the upper quartile of the efforts/rewards ratio were 2,5 times more likely to experience poor or fair general health, low physical function, high levels of pain, fatigue, and role limitations due to physical and mental health problems. Conclusions The cross-sectional design limits causal interpretation of these associations. However, the development of interventions to reduce ERI and to improve general health among room cleaners deserves high priority considering that both high ERI and low self-rated health have predicted chronic diseases and mortality in prospective studies. Am. J. Ind. Med. 53:372,386, 2010. © 2009 Wiley-Liss, Inc. [source] Predictors of delayed return to work after back injury: A case,control analysis of union carpenters in Washington StateAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 11 2009Kristen L. Kucera PhD Abstract Methods Union administrative records identified 20,642 union carpenters who worked in Washington State from 1989 to 2003. The Department of Labor and Industries provided records of workers' compensation claims and associated medical care. Work-related back claims (n,=,4,241) were identified by ANSI codes (back, trunk, or neck/back) or ICD-9 codes relevant to medical care consistent with a back injury. Cases (n,=,738) were defined as back injury claims with >90 days of paid lost time; controls (n,=,699) resulted in return to work within 30 days. Logistic regression models estimated odds ratios and 95% confidence intervals (OR, 95% CI) of delayed return to work (DRTW). Results Thirty percent of case claims and 8% of control claims were identified by an ICD-9 code. DRTW after back injury was associated with being female (2.7, 95% CI: 1.3,5.5), age 30,44 (1.2, 95% CI: 0.9,1.7) and age over 45 (1.6, 95% CI: 1.1,2.3), four or more years union experience (1.4, 95% CI: 1.1,1.8), previous paid time loss back claim (1.8, 95% CI: 1.3,2.5), and ,30-day delay to medical care (3.6, 95% CI: 2.1, 6.1). Evidence of more acute trauma was also associated with DRTW. Conclusions Use of ICD-9 codes identified claims with multiple injuries that would otherwise not be captured by ANSI codes alone. Though carpenters of younger age and inexperience were at increased risk for a paid lost time back injury claim, older carpenters and more experienced workers, once injured, were more likely to have DRTW as were those who experienced acute events. Am. J. Ind. Med. 52:821,830, 2009. © 2009 Wiley-Liss, Inc. [source] Differences in access to wage replacement benefits for absences due to work-related injury or illness in CanadaAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 4 2009Peter M. Smith Abstract Background The objective of this article is to examine the factors associated with differences in access to income replacement benefits for workers experiencing a work-related injury or illness of 1-week or longer in the Canadian labor force. Methods This study utilized data from the Survey of Labour and Income Dynamics, a representative longitudinal survey conducted by Statistics Canada. A total of 3,352 work-related absences were identified. Logistic regression models examined factors at the individual, occupational, and geographic level that were associated with the probability of receiving compensation. Results The probability of not receiving employer or workers' compensation benefits was higher among women, immigrants in their first 10 years in Canada, younger workers, respondents who were in their first year of a job, those who were not members of a union or collective bargaining agreement, and part-time workers. Conclusions More research is required to understand why almost 50% of respondents with 1-week or longer work-related absences did not report receiving workers' compensation payments following their absence. More importantly, research is required to understand why particular groups of workers are more likely to be excluded from any type of compensation for lost earnings after a work-related injury and illness in Canada. Am. J. Ind. Med. 52:341,349, 2009. © 2009 Wiley-Liss, Inc. [source] Ethnic differences in participation in prenatal screening for Down syndrome: A register-based studyPRENATAL DIAGNOSIS, Issue 10 2010Mirjam P. Fransen Abstract Objective To assess ethnic differences in participation in prenatal screening for Down syndrome in the Netherlands. Methods Participation in prenatal screening was assessed for the period 1 January 2009 to 1 July 2009 in a defined postal code area in the southwest of the Netherlands. Data on ethnic origin, socio-economic background and age of participants in prenatal screening were obtained from the Medical Diagnostic Centre and the Department of Clinical Genetics. Population data were obtained from Statistics Netherlands. Logistic regression models were used to assess ethnic differences in participation, adjusted for socio-economic and age differences. Results The overall participation in prenatal screening was 3865 out of 15 093 (26%). Participation was 28% among Dutch women, 15% among those from Turkish ethnic origin, 8% among those from North-African origin, 15% among those from Aruban/Antillean origin and 26% among women from Surinamese origin. Conclusions Compared to Dutch women, those from Turkish, North-African, Aruban/Antillean and other non-Western ethnic origin were less likely to participate in screening. It was unexpected that women from Surinamese origin equally participated. It should be further investigated to what extent participation and non-participation in these various ethnic groups was based on informed decision-making. Copyright © 2010 John Wiley & Sons, Ltd. [source] Identification of second trimester screen positive pregnancies at increased risk for congenital heart defectsPRENATAL DIAGNOSIS, Issue 6 2009Laura L. Jelliffe-Pawlowski Abstract Objective To examine whether second trimester biomarkers could be used to identify screen positive pregnancies at increased risk for congenital heart defects (CHDs) and measure the effect of using different biomarker cut points on the detection of CHDs and on the performance of predictive models. Methods Included were 19,402 pregnancies without chromosomal defects, which were screen positive for Down syndrome or other birth defects based on maternal serum measurements of alpha-fetoprotein (AFP), human chorionic gonadotrophin (hCG), and unconjugated estriol (uE3). Logistic regression models were built that compared biomarkers for CHD cases compared to controls. Results CHD cases were more likely to be screen positive for trisomy-18, to have a nuchal fold (NF) , 5 mm, and/or to have an hCG multiple of the median (MoM) , 95th percentile in models that considered screen positive grouping. In models that did not consider screen positive grouping, cases were more likely to have a NF , 5 mm, an AFP MoM ,10th percentile, an hCG MoM ,25th percentile, and/or an hCG MoM , 75th percentile. Conclusion Along with NF, second trimester maternal serum biomarkers may be useful indicators for fetal and newborn evaluation for CHDs in screen positive pregnancies without identified chromosomal defects. Copyright © 2009 John Wiley & Sons, Ltd. [source] | ||||||||||||||||||||||||||||||||||||||||||||||