Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of OR

  • adjusted or
  • crude or
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  • Terms modified by OR

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  • Selected Abstracts

    Mozart Among the Theologians

    MODERN THEOLOGY, Issue 4 2000
    David J. Gouwens
    The essay compares and contrasts the philosophical, theological, and aesthetic approaches to Mozart in the writings of Søren Kierkegaard's aesthete A (Either/Or, I), Karl Barth (primarily Wolfgang Amadeus Mozart), and Hans Küng (Mozart: Traces of Transcendence). Whereas Kierkegaard's A outlines a non-religious ,daemonic Mozart', Barth and Küng depict two contrasting theological understandings of Mozart's music. Barth's Mozart reflects a Reformed aesthetic, with Mozart as a ,parable' of gospel, whereas Küng's Mozart reflects a Roman Catholic ,sacramental' vision of music and religious faith. The essay explores how these different visions of Mozart are shaped by both their theological and aesthetic commitments. [source]

    Premature cessation of breastfeeding in infants: development and evaluation of a predictive model in two Argentinian cohorts: the CLACYD study,, 1993,1999

    ACTA PAEDIATRICA, Issue 5 2001
    S Berra
    The objective of this study was to develop a model to predict premature cessation of breastfeeding of newborns, in order to detect at-risk groups that would benefit from special assistance programmes. The model was constructed using 700 children with a birthweight of 2000 g or more, in 2 representative cohorts in 1993 and 1995 (CLACYD I sample) in Córdoba, Argentina. Data were analysed from 632 of the cases. Mothers were selected during hospital admittance for childbirth and interviewed in their homes at 1 mo and 6 mo. To evaluate the model, an additional sample with similar characteristics was drawn during 1998 (CLACYD II sample). A questionnaire was administered to 347 mothers during the first 24,48 h after birth and a follow-up was completed at 6 mo, with weaning information on 291 cases. Premature cessation of breastfeeding was considered when it occurred prior to 6 mo. A logistic regression model was fitted to predict premature end of breastfeeding, and was applied to the CLACYD II sample. The calibration (Hosmer-Lemeshow C statistic) and the discrimination [area under the receiver operating characteristics (ROC) curve] of the model were evaluated. The predictive factors of premature end of breastfeeding were: mother breastfed for less than 6 mo [odds ratio (OR) = 1.84,95% confidence interval (CI) 1.26,2.70], breastfeeding of previous child for less than 6 mo (OR = 4.01, 95% CI 2.58,6.20), the condition of the firstborn child (OR = 2.75, 95% CI 1.79,4.21), the first mother-child contact occurring after 90min of life (OR =1.88; 95% CI 1.22,2.91) and having an unplanned pregnancy (OR = 1.50, 95% CI 1.05,2.15). The calibration of the model was acceptable in the CLACYD I sample (p= 0.54), as well as in the CLACYD II sample (p= 0.18). The areas under the ROC curve were 0.72 and 0.68, respectively. Conclusion: A model has been suggested that provides some insight onto background factors for the premature end of breastfeeding. Although some limitations prevent its general use at a population level, it may be a useful tool in the identification of women with a high probability of early weaning. [source]

    Parental reported apnoea, admissions to hospital and sudden infant death syndrome

    ACTA PAEDIATRICA, Issue 4 2001
    EA Mitchell
    Three studies were undertaken: (i) a nation-wide case-control study for sudden infant death syndrome (SIDS), with 393 cases and 1592 controls, examined the association between parental reported apnoea and SIDS; (ii) a case-cohort study, with 84 cases of parental reported apnoea and 1502 controls, aimed to identify risk factors for apnoea; and (ii) national hospital admission data for ALTE and national SIDS mortality data were compared for the years 1986 to 1994. Parental reported apnoea was associated with a significant increased risk of SIDS [adjusted odds ratio (OR) 1.86; 95% confidence interval (CI) 1.12, 3.09]. The population attributable risk was 8%. There was a significant increased risk for parental reported apnoea in infants who did not die after adjustment for potential confounders with maternal smokers, short gestation and admission to the neonatal unit. There was no association with prone sleeping position, co-sleeping and bottle feeding. The mean annual admission rate for ALTE was 9.4/1000 live births. This did not change significantly over the study period (1986,1994). In contrast, the SIDS mortality rate decreased from over 4/ 1000 to 2.1/1000. Admission rates were higher for Maori infants and boys. Conclusion: It may be concluded that the relationship between parental reported apnoea and SIDS is tenuous. [source]

    Congenital malformations in infants whose mothers reported the use of folic acid in early pregnancy in Sweden.

    A prospective population study
    ABSTRACT The use of folic acid prior to conception is generally recommended for the prevention of birth defects, notably neural tube defects. In a previous study from Sweden, based on interviews of women in early pregnancy, no such effect was found on the general malformation rate, but data for neural tube defects were scarce. Using data from the Swedish Medical Birth Register for the years 1995,2004, 20 891 women were identified who reported the use of folic acid in early pregnancy, but not of anticonvulsants. These women were compared to all other women who gave birth during the study period. Malformations in the infants born were identified from multiple sources. No reduction in the general malformation rate was seen among infants born to women who reported the use of folic acid (OR = 1.09, 95% CI 1.02,1.17) and no effect of neural tube defect rate was seen (RR = 1.35, 95% CI 0.82,2.22), based on 16 infants with neural tube defect whose mother reported the use of folic acid. No effect was seen on the rates of other malformations except for cardiac defects, where a statistically significant increased risk (notably for severe defects) was found (OR = 1.19, 95% CI 1.05,1.35). The effect of various deficiencies in data collection is discussed, but is unlikely to explain the lack of protective effect noticed. So far, it has not been possible to demonstrate a beneficial effect of folic acid supplementation on malformation risk in Sweden. A more complete ascertainment and detailed timing and dosage of folic acid use in a prospective study is recommended. [source]

    A Risk Adjusted Method for Comparing Adverse Outcomes among Practitioners in Pediatric and Congenital Cardiac Catheterization

    Lisa Bergersen MD
    ABSTRACT Objective., We sought to develop a method to adjust for case mix diversity and allow comparison of adverse outcome rates among practitioners in pediatric and congenital cardiac catheterization. Patients and Methods., A single institutional database that captured demographic and procedural data was used to identify patient and procedural characteristics associated with adverse events (AE) and any high severity event classified as preventable or possibly preventable (P/PP). Diagnostic and procedural risk groups were created and indicators of hemodynamic vulnerability were defined. Expected event rates by the practitioners adjusting for case mix were calculated. Standardized adverse event ratios (SAER), defined as the observed rate divided by the expected rate for each practitioner were calculated with 95% confidence intervals. Results., The database included 1727 hemodynamic (30%) and interventional (70%) cases performed by seven practitioners in 18 months. During 147 cases, at least one P/PP AE occurred; among the seven practitioners observed, event rates ranged from 3.2 to 14.2%. In multivariable analysis, risk factors for all P/PP events included highest procedure risk group (odds ratio [OR] 2.1 for group 2, and 2.8 for group 3, relative to group 1, P = .001 and P < .001, respectively) and weight less than 4 kg (OR 2.8, P < .001). High severity P/PP events occurred in 67 cases with rates ranging from 2.0 to 6.6% by the practitioners. For these events, risk factors included: highest procedure risk group (OR 4.5 for group 2, and 4.9 for group 3, both P < .001) and an indicator of hemodynamic vulnerability (OR 1.8, P = .026). For the seven practitioners, the SAER ranged from 0.41 to 1.32 for any P/PP AE and from 0.69 to 1.44 for P/PP high severity events. In this cohort, we did not identify any statistically significant performance differences. Conclusion., Despite wide variations in case mix complexity in pediatric and congenital cardiac catheterization, this study demonstrates a method for risk adjustment which allows equitable comparisons among practitioners at a single institution. [source]

    Patient and Physician Determinants of Implantable Cardioverter Defibrillator Use in the Heart Failure Population

    Sanders H. Chae MD
    Recent studies report surprisingly low rates of implantable cardioverter defibrillator (ICD) placement for primary prevention against sudden cardiac death among patients with heart failure and left ventricular systolic dysfunction. Reasons for the low rates of utilization are not well understood. The authors examined ICD implantation rates at a university-based tertiary care center and used multivariable analysis to identify independent factors associated with ICD utilization. The ICD implantation rate for 850 eligible patients was 70%. Forty-seven (18%) patients refused implantation; women were twice as likely to refuse compared to men (8% vs 4%, P=.013). Race was not associated with utilization. On multivariable analysis, independent predictors of implantation included having a heart failure specialist (odds ratio [OR], 8.13; P<.001) or general cardiologist (OR, 2.23; P=.13) managing care, age range 70 to 79 (OR, 0.55; P<.001) or 80 and older (OR, 0.26; P<.001), female sex (OR, 0.49; P<.001), QRS interval (OR, 1.016; P<.001), diastolic blood pressure (OR, 0.979; P=.011), cerebrovascular disease (OR, 0.44; P=.007), and dementia (OR, 0.13; P=.002). Our registry of patients with cardiomyopathy and heart failure reveals that high rates of utilization are possible. Factors closely associated with ICD utilization include type of physician coordinating care, age, and comorbidities. Congest Heart Fail. 2010;16:141,146. © 2010 Wiley Periodicals, Inc. [source]

    Epidemiologic Analysis of Factors Associated with Local Disappearances of Native Ranid Frogs in Arizona

    análisis de factores de riesgo; declinación de anfibios; declinación de ranas; epidemiología de vida silvestre; métodos de control de casos Abstract:,We examined factors that may independently or synergistically contribute to amphibian population declines. We used epidemiologic case,control methodology to sample and analyze a large database developed and maintained by the Arizona Game and Fish Department that describes historical and currently known ranid frog localities in Arizona, U.S.A. Sites with historical documentation of target ranid species (n= 324) were evaluated to identify locations where frogs had disappeared during the study period (case sites) and locations where frog populations persisted (control sites). Between 1986 and 2003, 117 (36%) of the 324 sites became case sites, of which 105 were used in the analyses. An equal number of control sites were sampled to control for the effects of time. Risk factors, or predictor variables, were defined from environmental data summarized during site surveys and geographic information system data layers. We evaluated risk factors with univariate and multifactorial logistic-regression analyses to derive odds ratios (OR). Odds for local population disappearance were significantly related to 4 factors in the multifactorial model. Disappearance of frog populations increased with increasing elevation (OR = 2.7 for every 500 m, p < 0.01). Sites where disappearances occurred were 4.3 times more likely to have other nearby sites that also experienced disappearances (OR = 4.3, p < 0.01), whereas the odds of disappearance were 6.7 times less (OR = 0.15, p < 0.01) when there was a source population nearby. Sites with disappearances were 2.6 times more likely to have introduced crayfish than were control sites (OR = 2.6, p= 0.04). The identification of factors associated with frog disappearances increases understanding of declines occurring in natural populations and aids in conservation efforts to reestablish and protect native ranids by identifying and prioritizing implicated threats. Resumen:,Examinamos los factores que pueden contribuir independiente o sinérgicamente a la declinación de poblaciones de anfibios. Utilizamos una metodología epidemiológica de control de casos para muestrear y analizar una base de datos desarrollada y mantenida por el Departamento de Caza y Pesca de Arizona que describe las localidades históricas y actuales de ranas en Arizona, E. U. A. Los sitios con documentación histórica de las especies de ránidos (n= 324) fueron evaluados para identificar localidades donde las ranas desaparecieron durante el período de estudio (sitios caso) y localidades donde las poblaciones de ranas persistieron (sitios control). Entre 1986 y 2003, 36% (117) de los 324 sitios se volvieron sitios caso, de los cuales 105 fueron utilizados en los análisis. El mismo número de sitios control fueron muestreados para controlar los efectos del tiempo. Los factores de riesgo, o variables predictivas, fueron definidos a partir de datos ambientales obtenidos de los muestreos en los sitios y de capas de datos de un sistema información geográfica. Evaluamos los factores de riesgo con análisis de regresión logística univariada y multivariada para derivar proporciones de probabilidades (PP). Las probabilidad para la desaparición de una población local estuvo relacionada significativamente con 4 factores en el modelo multifactorial. La desaparición de poblaciones de ranas incrementó con la elevación (PP = 2.7 por cada 500 m, p < 0.01). Los sitios donde ocurrieron las desapariciones fueron 4.3 veces más propensos a estar cerca de otros sitios donde ocurrieron desapariciones (PP = 4.3, p < 0.01), mientras que la probabilidad de desaparición fue 6.7 veces menos (PP = 0.15, p < 0.01) cuando había una población fuente cercana. Los sitios con desapariciones fueron 2.6 veces más propensos a tener langostinos introducidos que los sitios control (PP = 2.6, p= 0.04). La identificación de factores asociados con la desaparición de ranas incrementa el conocimiento de las declinaciones de poblaciones naturales y ayuda a los esfuerzos de conservación para el reestablecimiento y la protección de ránidos nativos mediante la identificación y priorización de las amenazas implicadas. [source]

    Oestrogen receptor-alpha activation augments post-exercise myoblast proliferation

    ACTA PHYSIOLOGICA, Issue 1 2010
    A. Thomas
    Abstract Aim:, Our laboratory has shown that oestrogen acts to augment myoblast (satellite cell) activation, proliferation and total number and that this may occur through an oestrogen receptor (OR)-mediated mechanism. The purpose of this study was to further investigate the mechanism of oestrogen influence on augmentation of post-exercise myoblast numbers through use of a specific OR-, agonist, propyl pyrazole triol (PPT). Methods:, Ovariectomized rats were used (n = 64) and separated into four groups: sham, oestrogen supplemented, agonist supplemented, and a combined oestrogen and agonist supplemented group. These groups were further subdivided into control (unexercised) and exercise groups. Surgical removal of white vastus and soleus muscles was performed 72 h post-exercise. Muscle samples were immunostained for the myoblast markers Pax7 and MyoD. Results:, A significant increase in total (Pax7-positive) and activated (MyoD-positive) myoblasts was found in all groups post-exercise. A further significant augmentation of total and activated myoblasts occurred in oestrogen supplemented, agonist supplemented and the combined oestrogen and agonist supplemented groups post-exercise in white vastus and soleus muscles relative to unsupplemented animals. Conclusion:, These results demonstrate that both oestrogen and the specific OR-, receptor agonist, PPT, can significantly and to similar degrees augment myoblast number and activation following exercise-induced muscle damage. This suggests that oestrogen acts through an OR-mediated mechanism to stimulate myoblast proliferation following exercise, with OR-, playing a primary role. [source]

    Contact allergy to farnesol in 2021 consecutively patch tested patients.

    CONTACT DERMATITIS, Issue 3 2004
    Results of the IVDK
    Farnesol is one of the fragrances considered to be a significant contact allergen. Therefore, it was decided by the European Union to label products containing farnesol. Farnesol was tested [5% petrolatum (pet.)] together with the standard series between 1 January 2003 and 30 June 2003 in 2021 consecutive patients, 1243 females and 778 males. Of these, 22 [1.1%, 95% confidence interval (CI): 0.7,1.6%] had a positive reaction to farnesol. 147 (8.1%) of those 1825 tested to Myroxylon pereirae resin (balsam of Peru, 25% pet.) at the same time reacted positively, 143 (7.8%) of those 1823 tested to the fragrance mix (FM) (8% pet.) and 34 (1.9%) of 1831 tested to propolis (10% pet.). With regard to concomitant reactions in farnesol-positive patients, 5 of 22 reacted additionally to the FM [odds ratio (OR): 4.3; CI: 1.53,12.15] and 2 (of these 5) additionally to M. pereirae resin (OR: 1.27; CI: 0.29,5.54). The strongest association was seen to propolis (OR: 6.2; 95% CI: 1.4,27.7). Compared to those with negative reactions to farnesol, the group of patients allergic to farnesol was characterized by a higher proportion of young females and office workers, and the hand and the face were more often affected. In conclusion, farnesol is an important allergen. We recommend that farnesol should be included in a fragrance patch-test preparation and that its use should be regulated for consumer safety reasons. Furthermore, the extent of exposure to farnesol should be further studied. [source]

    P02 Analysis of coupled patch test reactions to nickel, cobalt and chromate

    CONTACT DERMATITIS, Issue 3 2004
    Janice Hegewald
    Concomitant sensitizations to Nickel, Cobalt and Chromate are often observed among patch test patients. However, the reasons for being sensitized to two or more of these substances are not completely understood. Examination of IVDK (http://www.ivdk.org) patch test results with multivariate procedures has been conducted to further elucidate the mechanisms involved with these sensitizations and potential exposure factors that may have led to the concomitant sensitizations. Gender, age, occupational dermatitis, and construction work were considered and examined with multivariate logistic regression models with the dependent response variable being concurrent reactions to a metal pair versus no reactions. In addition to the aforementioned anamnestic data, examination of a poly-sensitizations variable (reactions to 1, 2, or 3 standard series allergens other than Nickel, Cobalt or Chromate) provided information regarding general susceptibility to positive patch test reactions. Combined reactions to Cobalt and Chromate were strongly linked to construction work (OR = 11.23 (7.46, 16.90)) and occupational dermatitis. Female patch test patients had a higher odds of a positive patch test reaction to both Nickel and Cobalt (OR = 4.73 (3.81, 5.87)). Sensitization to other, unrelated standard series substances was associated with concurrent reactions to all of the metal pairs. The association between construction work and Cobalt-Chromate reactions corresponds with the hypothesis that cement exposures lead to cobalt-chromate sensitizations. Individual susceptibility to delayed-type sensitizations, as represented by the poly-sensitization variable, also appears to be associated with coupled sensitizations to metals and warrants further examination. [source]

    QTc-interval abnormalities in a forensic population

    Sobhi Girgis
    Background,Antipsychotic drugs have been linked to sudden death among psychiatric patients, with a suggestion that prolongation of the QT-interval detectable on a standard electrocardiogram may be linked to fatal cardiac arrhythmias in these circumstances. Patients in secure forensic psychiatric facilities may be particularly likely to be on high-dose antipsychotic medication, and yet, as far as the authors are aware, no study of QT-intervals among such patients has been reported. Aim,To investigate the prevalence of QT-interval abnormalities and associated known risk factors for fatal cardiac arrhythmias in a sample of forensic patients. Method,Participants had a 12-lead electrocardiogram taken at 50 mm/s. Information was collected on their age, gender, psychiatric diagnosis, history of cardiovascular, liver and kidney diseases, and smoking, on all medications and on history of seclusion over the previous 12 months. Analysis was carried out using binary logistic regression. Results,Lower rates of QT-interval abnormalities than might be expected for this population were found. It was also found that a high dose of antipsychotics was associated with QTc prolongation (Adjusted OR = 9.5, 95% CI 2.6,34.2), a result consistent with previous literature. Conclusion,Forensic patients need not be at increased risk of QTc abnormality provided risk factors are properly managed. A high dose of antipsychotic medication increases the risk of QTc prolongation. Copyright © 2007 John Wiley & Sons, Ltd. [source]

    10-Year trends in the treatment and outcomes of patients with first-episode schizophrenia

    J. Nielsen
    Nielsen J, le Quach P, Emborg C, Foldager L, Correll CU. 10-Year trends in the treatment and outcomes of patients with first-episode schizophrenia. Objective:, The first episode of schizophrenia is a critical period for illness course and outcomes. We aimed to investigate treatments and outcomes during the first year after the diagnosis of schizophrenia. Method:, Pharmacoepidemiologic inception cohort study of all newly diagnosed patients with schizophrenia in Denmark (n = 13 600) 1996,2005. Results:, From 1996 to 2005, the mean age at first diagnosis decreased significantly (29.2,26.1 years), more patients received antipsychotics (67.2,80.7%, annual OR = 1.07, CI: 1.06,1.09, P < 0.001) and antipsychotic polypharmacy for >4 months (16.7,37.1%, OR = 1.14, CI: 1.12,1.57, P < 0.001). The antipsychotic defined daily dosage (DDD) doubled (150,332 DDD, P < 0.001), use of antidepressants (24.3,40.6%, P < 0.001). Bed days [89.9 days (CI: 81.8,98.8) to 71.8 days, CI: 63.7,80.8, P < 0.0001] decreased, whereas outpatient contacts [10.2 (CI: 9.5,11.0) to 21.4 (CI: 19.9,21.0), P < 0.0001] doubled. Conclusion:, Between 1996 and 2005, there was an earlier recognition of schizophrenia, intensified outpatient treatment, increased use and dosing of antipsychotics and antidepressants, but also more antipsychotic polypharmacy. [source]

    The association between incisor trauma and occlusal characteristics in individuals 8,50 years of age

    Jay D. Shulman
    Abstract,,, To explore the association between incisal trauma and occlusal characteristics using oral examination and health interview data from the Third National Health and Nutrition Examination Survey 1988,1994 (NHANES III). Incisal trauma examinations were performed on 15 364 individuals 6,50 years of age using an ordinal scale developed by the National Institute of Dental and Craniofacial Research. Occlusal examinations were performed on 13 057 individuals 8,50 years of age. We fitted separate multivariate logistic regression models for maxillary and mandibular incisor trauma adjusting for socio-demographic variables (age, gender, race-ethnicity) and occlusal characteristics (overbite, overjet, open bite). 23.45% of all individuals evidenced trauma on at least one incisor, with trauma more than four times more prevalent on maxillary (22.59%) than on mandibular incisors (4.78%). Males (OR = 1.67) had greater odds of trauma than females; Whites (OR = 1.37) and non-Hispanic Blacks (OR = 1.37) had greater odds of trauma than Mexican,Americans. The odds of trauma increased with age, peaked from age 21 to 30 (OR = 2.92), and declined. As overjet increased, so did the odds of trauma. Compared to individuals with ,0-mm overjet, odds of trauma increased from 1,3 mm (OR = 1.42) to 4,6 mm (OR = 2.42) to 7,8 mm (OR = 3.24) to >8 mm (OR = 12.47). Trauma to incisors is prevalent but mostly limited to enamel. Trauma to maxillary incisors is associated with overjet, gender, race-ethnicity, and age, while trauma to mandibular incisors is associated with gender, age, and overbite. [source]

    Exploring potential associations of suicidal ideation and ideas of self-harm in patients with congestive heart failure

    Nicole Lossnitzer Ph.D.
    Abstract Objective: To determine the factors, which are associated with suicidal ideation and ideas of self-harm in patients with congestive heart failure (CHF). Methods: We examined 294 patients with documented CHF, New York Heart Association (NYHA) functional class II-IV, in a cross sectional study at three cardiac outpatient departments. Measures included self-reports of suicidal ideation and self-harm (PHQ-9), depression (SCID), health-related quality of life (SF-36), multimorbidity (CIRS-G), consumption of alcoholic beverages, as well as comprehensive clinical status. Data were analyzed using logistic regression analyses. Results: 50 patients (17.1%) reported experiencing suicidal ideation and/or ideas of self-harm on at least several days over the past two weeks. The final regression model revealed significant associations with health-related quality of life, physical component (odds ratio [OR] 0.56; 95% confidence interval [CI]: 0.35,0.91), and mental component (OR 0.50; 95% CI: 0.31,0.82), consumption of alcoholic beverages (OR 1.27; 95% CI: 1.05,1.54), first-episode depression (OR 3.92; 95% CI: 1.16,13.22), and lifetime depression (OR 10.89; 95% CI: 2.49,47.72). Age was only significant in the univariable (P=.03) regression analysis. NYHA functional class, left ventricular ejection fraction (LVEF), etiology of CHF, medication, cardiovascular interventions, multimorbidity, gender, and living situation were not significantly associated with suicidal ideation or ideas of self-harm. Conclusions: Lifetime depression, in particular, increases the risk of suicidal ideation and ideas of self-harm in CHF patients. Furthermore, the findings of our study underline the necessity of differentiating between first-episode and lifetime depression in CHF-patients in future research and clinical practice. Depression and Anxiety, 2009. © 2009 Wiley-Liss, Inc. [source]

    Gender differences in obsessive,compulsive symptom dimensions

    Javier Labad M.D.
    Abstract The aim of our study was to assess the role of gender in OCD symptom dimensions with a multivariate analysis while controlling for history of tic disorders and age at onset of OCD. One hundred and eighty-six consecutive outpatients with a DSM-IV diagnosis of OCD were interviewed. Yale-Brown Obsessive,Compulsive Scale (YBOC-S), YBOC-S Symptom Checklist, and Hamilton Depression and Anxiety Scales were administered to all patients. Lifetime history of tic disorders was assessed with the tic inventory section of the Yale Global Tic Severity Scale. Age at onset of OCD was assessed by direct interview. Statistical analysis was carried out through logistic regression to calculate adjusted female:male odds ratios (OR) for each dimension. A relationship was found between gender and two main OCD dimensions: contamination/cleaning (higher in females; female:male OR=2.02, P=0.03) and sexual/religious (lower in females; female:male OR=0.41, P=0.03). We did not find gender differences in the aggressive/checking, symmetry/ordering, or hoarding dimensions. We also found a greater history of tic disorders in those patients with symptoms from the symmetry/ordering, dimension (P<0.01). Both symmetry/ordering and sexual/religious dimensions were associated with an earlier age at onset of OCD (P<0.05). Gender is a variable that plays a role in the expression of OCD, particularly the contamination/cleaning and sexual/religious dimensions. Our results underscore the need to examine the relationship between OCD dimensions and clinical variables such as gender, tics, age at onset and severity of the disorder to improve the identification of OCD subtypes. Depression and Anxiety 2007. © 2007 Wiley-Liss, Inc. [source]

    Seasonal allergies and suicidality: results from the National Comorbidity Survey Replication

    E. 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]

    Metabolic syndrome abnormalities are associated with severity of anxiety and depression and with tricyclic antidepressant use

    A. K. B. Van Reedt Dortland
    van Reedt Dortland AKB, Giltay EJ, van Veen T, Zitman FG, Penninx BWJH. Metabolic syndrome abnormalities are associated with severity of anxiety and depression and with tricyclic antidepressant use. Objective:, The metabolic syndrome (MetSyn) predisposes to cardiovascular disease and diabetes mellitus. There might also be an association between the MetSyn and anxiety and depression, but its nature is unclear. We aimed to investigate whether diagnosis, symptom severity and antidepressant use are associated with the MetSyn. Method:, We addressed the odds for the MetSyn and its components among 1217 depressed and/or anxious subjects and 629 controls, and their associations with symptom severity and antidepressant use. Results:, Symptom severity was positively associated with prevalence of the MetSyn, [adjusted odds ratio (OR) 2.21 for very severe depression: 95% confidence interval (CI): 1.06,4.64, P = 0.04], which could be attributed to abdominal obesity and dyslipidemia. Tricyclic antidepressant (TCA) use also increased odds for the MetSyn (OR 2.30, 95% CI: 1.21,4.36, P = 0.01), independent of depression severity. Conclusion:, The most severely depressed people and TCA users more often have the MetSyn, which is driven by abdominal adiposity and dyslipidemia. [source]

    The relationship between childhood trauma history and the psychotic subtype of major depression

    B. A. Gaudiano
    Gaudiano BA, Zimmerman M. The relationship between childhood trauma history and the psychotic subtype of major depression. Objective:, Increasing evidence exists linking childhood trauma and primary psychotic disorders, but there is little research on patients with primary affective disorders with psychotic features. Method:, The sample consisted of adult out-patients diagnosed with major depressive disorder (MDD) at clinic intake using a structured clinical interview. Patients with MDD with (n = 32) vs. without psychotic features (n = 591) were compared as to their rates of different types of childhood trauma. Results:, Psychotic MDD patients were significantly more likely to report histories of physical (OR = 2.81) or sexual abuse (OR = 2.75) compared with non-psychotic MDD patients. These relationships remained after controlling for baseline differences. Within the subsample with comorbid post-traumatic stress disorder, patients with psychotic MDD were significantly more likely to report childhood physical abuse (OR = 3.20). Conclusion:, Results support and extend previous research by demonstrating that the relationship between childhood trauma and psychosis is found across diagnostic groups. [source]

    Interferon Alfa-2b or Not 2b?

    Significant Differences Exist in the Decision-Making Process between Melanoma Patients Who Accept or Decline High-Dose Adjuvant Interferon Alfa-2b Treatment
    BACKGROUND Patients with thick (Breslow >4 mm) primary melanoma and/or regional nodal metastasis have a high risk of tumor recurrence. High-dose adjuvant interferon (IFN) alfa-2b offers ,10% improvement in relapse-free survival and overall survival with significant toxicity. OBJECTIVE The objective was to determine which prognostic factors and patient characteristics are significant in the decision to undergo IFN therapy. METHODS Of 781 patients who underwent sentinel lymph node (SLN) biopsy, 135 of 781 (17.3%) had positive SLN or thick melanomas and were informed of a ,50% risk of recurrence/disease-related mortality and offered IFN. Telephone surveys delineated reasons behind patients' decisions to accept IFN. RESULTS Acceptors, 60 of 135 (45%), decided to take IFN alfa-2b whereas 75 of 135 (55%) declined. Being female (OR, 2.4; 95% CI, 1.17,5.03; p=.017) and positive SLN status (OR, 2.2; 95% CI, 1.01,4.97; p=.048) were strongly associated with patients who chose IFN. Acceptors of IFN were younger, more influenced by physicians, and less affected by depression and side effect profile (p<.05 for all). Decliners were more concerned by strained relationships with family and social life (p<.05). CONCLUSIONS Gender and positive SLN were predictive of high-risk melanoma patients' acceptance of IFN treatment. Physician insight into melanoma patients' therapeutic decision-making process can guide patients through this difficult disease. [source]

    Experience of trauma and conversion to psychosis in an ultra-high-risk (prodromal) group

    A. Bechdolf
    Bechdolf A, Thompson A, Nelson B, Cotton S, Simmons MB, Amminger GP, Leicester S, Francey SM, McNab C, Krstev H, Sidis A, McGorry PD, Yung AR. Experience of trauma and conversion to psychosis in an ultra-high-risk (prodromal) group. Objective:, We aimed to replicate a recent finding of high prevalence of trauma history in patients at ,ultra-high risk' (UHR) of psychotic disorder and to investigate whether trauma predicts conversion to psychosis in this population. Method:, A consecutive sample of UHR patients was assessed. History of trauma was accessed with the General Trauma Questionnaire. Cox regression models were used to explore relationship between conversion to psychosis and trauma. Results:, Of 92 UHR patients nearly 70% had experienced a traumatic event and 21.7% developed psychosis during follow-up (mean 615 days). Patients who had experienced a sexual trauma (36%) were significantly more likely to convert to first-episode psychosis (OR 2.96) after controlling for meeting multiple UHR intake groups. Conclusion:, UHR patients have a high prevalence of history of trauma. Previous sexual trauma may be a predictor of onset of psychotic disorder in this population. [source]

    Psychotic-like experiences are associated with suicidal feelings and deliberate self-harm behaviors in adolescents aged 12,15 years

    A. Nishida
    Nishida A, Sasaki T, Nishimura Y, Tanii H, Hara N, Inoue K, Yamada T, Takami T, Shimodera S, Itokawa M, Asukai N, Okazaki Y. Psychotic-like experiences are associated with suicidal feelings and deliberate self-harm behaviors in adolescents aged 12,15 years. Objective:, Psychotic disorders are a significant risk factor for suicide, especially among young people. Psychotic-like experiences (PLEs) in the general population may share an etiological background with psychotic disorders. Therefore, the present study examined the association between PLEs and risk of suicide in a community sample of adolescents. Method:, Psychotic-like experiences, suicidal feelings, and self-harm behaviors were studied using a self-report questionnaire administered to 5073 Japanese adolescents. Depression and anxiety were evaluated using the 12-item General Health Questionnaire (GHQ). Results:, The presence of PLEs was significantly associated with suicidal feelings (OR = 3.1, 95% CI = 2.2,4.5) and deliberate self-harm behaviors (OR = 3.1, 95% CI = 2.0,4.8) after controlling for the effects of age, gender, GHQ-12 score, victimization, and substance use. Suicidal feelings and behaviors were more prevalent in subjects with a greater number of PLEs. Conclusion:, Psychotic-like experiences may increase the risk of suicidal problems among adolescents. [source]

    No evidence for switching the antidepressant: systematic review and meta-analysis of RCTs of a common therapeutic strategy

    T. Bschor
    Bschor T, Baethge C. No evidence for switching the antidepressant: systematic review and meta-analysis of RCTs of a common therapeutic strategy. Objective:, Switching antidepressants is a common strategy for managing treatment-resistant depressed patients. However, no systematic reviews have been conducted to date. Method:, We systematically searched MEDLINE/EMBASE/Cochrane Central Register of Controlled Trials and additional sources. We included double-blind studies of patients with depressive symptomatology who were not responding to initial antidepressant monotherapy and were subsequently randomized to another antidepressant or to continue the same antidepressant. Results were pooled for meta-analysis of response + remission rates using a fixed-effects model. Results:, A total of three studies were included. Switching to another antidepressant was not superior to continuing the initial antidepressant in any of these studies. Our meta-analysis showed no significant advantages to either strategy and no significant heterogeneity of results [OR for response rates: 0.85 (95% CI: 0.55,1.30) favoring continuing]. Conclusion:, There is a discrepancy between the published evidence and the frequent decision to switch antidepressants, indicating an urgent need for more controlled studies. Pending such studies we recommend that physicians rely on more thoroughly evaluated strategies. [source]

    The current status of urban-rural differences in psychiatric disorders

    J. Peen
    Peen J, Schoevers RA, Beekman AT, Dekker J. The current status of urban,rural differences in psychiatric disorders. Objective:, Reviews of urban,rural differences in psychiatric disorders conclude that urban rates may be marginally higher and, specifically, somewhat higher for depression. However, pooled results are not available. Method:, A meta-analysis of urban,rural differences in prevalence was conducted on data taken from 20 population survey studies published since 1985. Pooled urban,rural odds ratios (OR) were calculated for the total prevalence of psychiatric disorders, and specifically for mood, anxiety and substance use disorders. Results:, Significant pooled urban,rural OR were found for the total prevalence of psychiatric disorders, and for mood disorders and anxiety disorders. No significant association with urbanization was found for substance use disorders. Adjustment for various confounders had a limited impact on the urban,rural OR. Conclusion:, Urbanization may be taken into account in the allocation of mental health services. [source]

    Gender differences in bipolar disorder type I and II

    K. Suominen
    Objective:, We investigated gender differences in bipolar disorder (BD) type I and II in a representative cohort of secondary care psychiatric in- and out-patients. Method:, In the prospective, naturalistic Jorvi Bipolar Study of 191 secondary care psychiatric in- and out-patients, 160 patients (85.1%) could be followed up for 18 months with a life chart. Results:, After adjusting for confounders, no marked differences in illness-related characteristics were found. However, female patients with BD had more lifetime comorbid eating disorders (P < 0.001, OR = 5.99, 95% CI 2.12,16.93) but less substance use disorders (P < 0.001, OR = 0.29, 95% CI 0.16,0.56) than males. Median time to recurrence after remission was 3.1 months longer among men than women, female gender carrying a higher hazard of recurrence (P = 0.006, HR = 2.00, 95% CI 1.22,3.27). Conclusion:, Men and women with type I and II BD have fairly similar illness-related clinical characteristics, but their profile of comorbid disorders may differ significantly, particularly regarding substance use and eating disorders. In medium-term follow-up, females appear to have a higher hazard of recurrence than males. [source]

    Psychotic and behavioural symptoms in a population-based sample of the very elderly subjects

    S. Östling
    Objective:, The aim was to elucidate the relationship between psychotic and behavioural symptoms in the elderly. Method:, A representative sample of 85 year old subjects living in Gothenburg, Sweden (n = 451) was assessed with neuropsychiatric examinations, key informant interviews and record reviews. Results:, Fourteen percent of these very elderly subjects had paranoid symptoms with concomitant anxious agitation and/or irritability/anger. Hallucinations and paranoid symptoms were both associated with a pattern of behavioural symptoms including both anxious agitation and irritability/anger simultaneously in both demented [hallucinations, Odds ratio (OR) 2.8, Confidence interval (CI) 1.2,6.7, paranoid symptoms OR 5.6 CI 2.2,14.2] and non-demented (hallucinations OR 3.2 CI 1.2,8.3, paranoid symptoms OR 4.8 CI 2.0,11.8). Conclusion:, Psychotic symptoms are associated with behavioural symptoms regardless of dementia status. Since these symptoms lead to decreased ability to function in daily life and increased caregiver burden, it is important for health professionals to identify and treat these symptoms also in non-demented. [source]

    Subjective quality of life of Nigerian schizophrenia patients: sociodemographic and clinical correlates

    A. O. Adewuya
    Objective:, Subjective quality of life (QOL) is dependent upon culture and its evaluation based on one's particular belief system. This study aimed to examine the subjective QOL of Nigerian out-patients with schizophrenia and its correlates. Method:, Out-patients with Schizophrenia (n = 99) completed the WHOQOL-BREF as a measure of their subjective QOL. Sociodemographic, illness related and medication related details were also obtained. Results:, Overall, 21 patients (21.2%) were categorised as having ,good' and 36 (36.4%) as having ,poor' subjective QOL. ,Poor' subjective QOL correlated with anxiety/depression symptoms (OR 4.88, 95% CI 2.93,11.48), comorbid medical problems (OR 4.75, 95% CI 1.43,16.33), unemployment (OR 3.75, 95% CI 1.25,11.72) and poor social support (OR 4.60, 95% CI 1.49,14.28). Conclusion:, Efforts to improve the QOL of patients with schizophrenia in this environment should encompass the identified variables. Larger, longitudinal and multi-centred studies are needed to adequately identify factors predicting QOL in this environment. [source]

    Sub-threshold manic symptoms in recurrent major depressive disorder are a marker for poor outcome

    D. J. Smith
    Objective:, A small but significant proportion of patients with major depressive disorder (MDD) report mild manic symptoms which are below the diagnostic threshold for a hypomanic episode. Method:, We tested for an association between sub-threshold manic symptoms and clinical outcome in almost 600 patients with recurrent MDD who also had no known family history of bipolar disorder. Results:, 9.6% of this large sample had a life-time history of sub-threshold manic symptoms. These patients were significantly more likely to have a history of poor response to antidepressants (OR 2.84; 95% CI 1.23,6.56; P < 0.02) and more likely to have experienced psychosis (OR 2.07; 95% CI 1.05,4.09; P < 0.04). They had also experienced more depressive episodes on average (P = 0.006) and were more likely to have been admitted to hospital (P < 0.03). Conclusion:, Sub-threshold manic symptoms in patients with recurrent MDD may be a useful clinical marker for poor response to antidepressants and a more morbid long-term clinical course. [source]

    Limited Opportunities for Paramedic Student Endotracheal Intubation Training in the Operating Room

    Bradford D. Johnston MD
    Abstract Background Paramedics, who often are the first to provide emergency care to critically ill patients, must be proficient in endotracheal intubation (ETI). Training in the controlled operating room (OR) setting is a common method for learning basic ETI technique. Objectives To determine the quantity and nature of OR ETI training currently provided to paramedic students. Methods The authors surveyed directors of paramedic training programs accredited by the Commission on Accreditation of Allied Health Education Programs. An anonymous 12-question, structured, closed-response survey instrument was used that requested information regarding the duration and nature of OR training provided to paramedic students. The results were analyzed by using descriptive statistics. Results From 192 programs, 161 completed surveys were received (response rate, 85%). OR training was used at 156 programs (97%) but generally was limited (median, 17,32 hours per student). Half of the programs provided fewer than 16 OR hours per student. Students attempted a limited number of OR ETI (median, 6,10 ETI). Most respondents (61%) reported competition from other health care students for OR ETI. Other identified hindering factors included the increasing OR use of laryngeal mask airways and physicians' medicolegal concerns. Respondents from 52 (33%) programs reported a recent reduction in OR access, and 56 (36%) programs expected future OR opportunities to decrease. Conclusions Despite its key role in airway management education, the quantity and nature of OR ETI training that is available to paramedic students is limited in comparison to that available to other ETI providers. [source]

    Ethnicity, social disadvantage and psychotic-like experiences in a healthy population based sample

    C. Morgan
    Objective: We sought to investigate the prevalence and social correlates of psychotic-like experiences in a general population sample of Black and White British subjects. Method: Data were collected from randomly selected community control subjects, recruited as part of the ÆSOP study, a three-centre population based study of first-episode psychosis. Results: The proportion of subjects reporting one or more psychotic-like experience was 19% (n = 72/372). These were more common in Black Caribbean (OR 2.08) and Black African subjects (OR 4.59), compared with White British. In addition, a number of indicators of childhood and adult disadvantage were associated with psychotic-like experiences. When these variables were simultaneously entered into a regression model, Black African ethnicity, concentrated adult disadvantage, and separation from parents retained a significant effect. Conclusion: The higher prevalence of psychotic-like experiences in the Black Caribbean, but not Black African, group was explained by high levels of social disadvantage over the life course. [source]

    Depressive symptoms predispose females to metabolic syndrome: a 7-year follow-up study

    M. Vanhala
    Objective:, To evaluate the risk for developing metabolic syndrome when having depressive symptoms. Method:, The prevalence of depressive symptoms and metabolic syndrome at baseline, and after a 7-year follow-up as measured with Beck depression inventory (BDI), and using the modified National Cholesterol Education Program , Adult Treatment Panel III criteria for metabolic syndrome (MetS) were studied in a middle-aged population-based sample (n = 1294). Results:, The logistic regression analysis showed a 2.5-fold risk (95% CI: 1.2,5.2) for the females with depressive symptoms (BDI ,10) at baseline to have MetS at the end of the follow-up. The risk was highest in the subgroup with more melancholic symptoms evaluated with a summary score of the melancholic items in BDI (OR 6.81, 95% CI: 2.09,22.20). In men, there was no risk difference. Conclusion:, The higher risks for MetS in females with depressive symptoms at baseline suggest that depression may be an important predisposing factor for the development of MetS. [source]