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Possible Confounders (possible + confounder)
Selected AbstractsIncidence and risk of venous thromboembolism in patients with verified arterial thrombosis: a population study based on 23 796 consecutive autopsiesJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 9 2006Å. ELIASSON Summary.,Background:,The relationship between atherothrombotic disease and venous thromboembolism (VTE) remains unclear. Patients and methods:,In a cohort of 23 796 consecutive autopsies, performed using a standardized procedure and representing 84% of all in-hospital deaths between 1970 and 1982 in an urban Swedish population, we investigated the relationship between verified arterial thrombosis and VTE, with the hypothesis that patients with thrombosis in major artery segments have increased odds of VTE. Results:,We found an increased risk of VTE in patients with arterial thrombosis (Odds ratio; OR adjusted for gender and age 1.4, 95% confidence interval; CI 1.3,1.5) (P < 0.001). Patients with cervico-cranial and peripheral artery thrombosis had an excess risk even when controlling for age and major concomitant diseases. A negative association between coronary thrombosis and VTE in the univariate analysis (OR 0.7; 95% CI 0.6,0.8) (P < 0.001), was less pronounced in the multivariate analysis (OR 0.8; 95% CI 0.7,1.0) (P = 0.016). Conclusions:,A positive association between atherothrombosis and VTE was confirmed, except in patients with coronary thrombosis, where IHD as competing death cause is a possible confounder. Our findings indicate a potential for directed prevention, but may also imply similarities in etiology. [source] Ratio of myeloid and plasmacytoid dendritic cells and TH2 skew in CRS with nasal polypsALLERGY, Issue 1 2010H. Kirsche Abstract Background:, The role of myeloid and plasmacytoid dendritic cells and its consequences for the TH2 skew in chronic rhinosinusitis (CRS) with nasal polyps (CRSNP+) should be detailed. Methods:, In 18 CRS patients without nasal polyps (CRSNP,), 35 CRSNP+ patients and 22 patients with nasal structural abnormalities without rhinosinusitis (controls), dendritic cells (DC) were differentiated into myeloid (mDC) and plasmacytoid (pDC) subtypes using an antibody cocktail including CD1c (BDCA-1) and CD303 (BDCA-2) in peripheral blood mononuclear cells (PBMC) and single cell preparations of sinonasal mucosa by flow cytometry. Moreover, cells were analysed for expression of CD45, CD3, CD4, CXCR3 (TH1) and CCR4 (TH2) and IFN-,, IL-5, TGF-,1, TGF-,2, ECP and total IgE in nasal secretions were determined. As a possible confounder, Staphylococcus aureus in nasal lavages was detected. Results:, The tissue mDC/pDC-ratio was 1.7 (1.0,2.4) in controls, 3.0 (1.8,4.0) in CRSNP, and 0.8 (0.6,1.0) in CRSNP+ (P < 0.01). In tissue samples, the TH1/TH2 ratio was 12.6 (6.4,16.0) in controls, 12.5 (6.9,21.2) in CRSNP, and 1.8 (1.3,3.6) in CRSNP+ (median and interquartile range, P < 0.001). Less pronounced differences were found in PBMC. S. aureus detection rates or TGF-, levels did not differ between patient groups and S. aureus detection had no influence on the parameters investigated. Conclusion:, A significant TH2 skew in CRSNP+ could be confirmed on the cellular level. It was driven by low myeloid dendritic cell numbers. The TH2 skew did not correlate with S. aureus detection. The data support the concept that CRSNP+ and CRSNP, are pathophysiologically distinct. [source] Prospective studies of exposure to an environmental contaminant: The challenge of hypothesis testing in a multivariate correlational contextPSYCHOLOGY IN THE SCHOOLS, Issue 6 2004Joseph L. Jacobson In this paper, we respond to the criticisms and concerns raised by D.V. Cicchetti, A.S. Kaufman, & S.S. Sparrow (this issue) in their review of the PCB literature, with particular attention to our own research in Michigan. We agree that multiple comparisons and functional significance are issues that would benefit from more discussion. However, because the effects associated with exposure to environmental contaminants are generally subtle, the risk of Type II error would be unacceptably high if researchers were to adopt the authors' recommendation to use a Bonferroni correction. We describe the hierarchical approach we have used to deal with the issue of multiple comparisons, which emphasizes the need to base interpretation on consistent patterns in the data and on replicated findings. The issue of confounding is one that has received considerable attention in the PCB studies and, given that one can never measure every possible confounder, the range of control variables that have been evaluated is impressive. We disagree with the authors' assertion that only standardized test scores are sufficiently reliable for use in these studies; behavioral teratogens often involve subtle effects, which can be identified most effectively by innovative, narrow-band tests that have not yet been normed. Moreover, longitudinal statistical analysis is not necessarily the method of choice for the issues being addressed in this literature. One important new development that Cicchetti et al. fail to note is the emergence of evidence from both the Michigan and Dutch cohorts indicating that breast-fed children are markedly less vulnerable. It is not yet clear to what degree this protective effect is attributable to nutrients in breast milk or to more optimal intellectual stimulation by nursing mothers, or both. However, the discovery of effect modifiers that can explain individual differences in vulnerability marks an important advance in our growing understanding of the teratogenic effects of exposure to environmental contaminants on child development. © 2004 Wiley Periodicals, Inc. Psychol Schs 41: 625,637, 2004. [source] Binge drinking and depressive symptoms: a 5-year population-based cohort studyADDICTION, Issue 7 2009Tapio Paljärvi ABSTRACT Background Only few prospective population studies have been able so far to investigate depression and drinking patterns in detail. Therefore, little is known about what aspect of alcohol consumption best predicts symptoms of depression in the general population. Participants and design In this prospective population-based two-wave cohort study, a cohort of alcohol-drinking men and women (n = 15 926) were followed-up after 5 years. A postal questionnaire was sent in 1998 (response proportion 40%) and again in 2003 (response proportion 80% of the baseline participants) to Finnish adults aged 20,54 years at baseline. Measurements Alcohol consumption was measured by average intake (g/week) and by measures of binge drinking (intoxications, hangovers and alcohol-induced pass-outs). Depressive symptoms were assessed with the 21-item Beck Depression Inventory. In addition, information from hospital discharge register for depression and alcohol abuse were linked to the data. Findings This study found a positive association between baseline binge drinking and depressive symptoms 5 years later. Adjustment for several possible confounders attenuated the observed relationships only slightly, suggesting that binge drinking contributes independently to the occurrence of depressive symptoms. Binge drinking was related to symptoms of depression independently of average intake. Conclusions This study supports the hypothesis that heavy drinking, and in particular a binge pattern involving intoxications, hangovers or pass-outs, produces depressive symptoms in the general population. The frequency of hangovers was the best predictor for depressive symptoms. [source] The impact of later trading hours for hotels on levels of impaired driver road crashes and driver breath alcohol levelsADDICTION, Issue 9 2006Tanya Chikritzhs ABSTRACT Aim To examine the impact of later trading hours for licensed hotels in Perth, Western Australia on levels of associated impaired driver road crashes and driver breath alcohol levels (BALs). Design Police data on the ,last place of drinking' for impaired drivers involved in road crashes and their corresponding BALs were examined to identify those associated with Perth hotels between 1 July 1990 and 30 June 1997. During this period, 43 (23%) of the 186 hotels meeting study criteria were granted an Extended Trading Permit for 1 a.m. closing (ETP hotels), while the rest continued to close at midnight (non-ETP hotels). Time-series analyses employing multiple linear regressions were applied to determine whether an association existed between the introduction of extended trading and (i) monthly levels of impaired driver road crashes associated with ETP hotels and (ii) driver BALs associated with ETP hotels. Trends associated with non-ETP hotels were included as controls and possible confounders were considered. Findings After controlling for the trend in crash rates associated with non-ETP hotels and the introduction of mobile police breath testing stations to Perth freeways, a significant increase in monthly crash rates for ETP hotels was found. This relationship was largely accounted for by higher volumes of high-alcohol content beer, wine and spirits purchased by ETP hotels. No relation was found between driver BALs and the introduction of ETPs. Conclusions Late trading was associated with increased levels of impaired driver road crashes and alcohol consumption, particularly high-risk alcoholic beverages. Greater numbers of patrons and characteristics specific to clientele of hotels which applied for late trading hours (i.e. younger age, greater propensity to drunk-drive, preference for high-risk beverages) were suggested as having contributed to this increase. [source] Navigating toward Fetal and Maternal Health: The Challenge of Treating Epilepsy in PregnancyEPILEPSIA, Issue 10 2004Torbjörn Tomson Summary:, A rational approach to the treatment of women of childbearing potential with epilepsy has been hampered by the lack of conclusive data on the comparative teratogenic potential of different antiepileptic drugs (AEDs). Although, several cohort studies on birth defects associated with AED use during pregnancy have been published, these have generally failed to demonstrate differences in malformation rates between AEDs, probably mainly due to insufficient power. In particular, pregnancies with new generation AEDs have been too few. In recent years, pregnancy registries have been introduced to overcome this problem,EURAP (an international collaboration), the North American, and the U.K. AED and pregnancy registries are observational studies that prospectively assess pregnancy outcome after AED exposure using slightly different methods. Each has enlisted 3,5,000 pregnancies in women with epilepsy, and the North American and the U.K. have released preliminary observations. Thus the U.K. registry reported a higher malformation rate with valproate, 5.9% (4.3,8.2%; 95% CI), than with carbamazepine, 2.3% (1.4,3.7%), and lamotrigine, 2.1% (1.0,4.0%). Most of the more recent cohort studies have also identified a nonsignificant trend toward a higher teratogenicity with valproate. These signals need to be interpreted with some caution since none of the studies to date have fully assessed the impact of possible confounders, such as type of epilepsy, family history of birth defects, etc. However, with increasing number of pregnancies it should be possible in the near future for the pregnancy registries to take such confounding factors into account and thus make more reliable assessments of the causal relationship between exposure to specific AEDs and teratogenic risks. While awaiting more conclusive results, it appears reasonable to be cautious in prescribing valproate to women considering to become pregnant if other suitable treatment alternatives, and with less teratogenic potential, are available. Any attempt to change treatment should, however, be accomplished well before conception. The importance of maintained seizure control must also be kept in mind, and the woman who needs valproate to control her seizures should not be discouraged from pregnancy, provided that counseling at the best of available knowledge is given. [source] Research Submission: Mixture Analysis of Age at Onset in Migraine Without Aura: Evidence for Three SubgroupsHEADACHE, Issue 8 2010Carlo Asuni MD (Headache 2010;50:1313-1319) Objective. , To verify the presence of different age at onset (AAO) subgroups of patients in a sample of patients with migraine without aura (MWA) and compare clinical correlates among them. Background., MWA is a long-lasting disease whose prognosis has not yet been fully investigated. Patients may present complete remission, partial clinical remission, persistence and progression (migraine attack frequency and disability may increase over time leading to chronic migraine). Limited evidence exists regarding the identification of risk factors or predictors which might influence migraine prognosis. AAO has been proven a useful tool in the investigation of the clinical, biological, and genetic characteristics able to influence the prognosis of a number of neuropsychiatric disorders. AAO distribution was studied using mixture analysis, a statistical approach that breaks down the empirical AAO distribution observed into a mixture of normal components. Methods., A sample of 334 outpatients affected by MWA, recruited in a clinical genetic study at our Headache Center from 2004 to 2008, was enrolled for this study. Diagnosis was made according to International Headache Society criteria 2004. AAO distribution in patients was studied using mixture analysis. Chi-square test was used to compare clinical correlates among identified subgroups. Logistic regression was performed in order to correct for effect of possible confounders. Results., Mixture analysis broke up the observed distribution of AAO into 3 normal theoretical distributions. Informational criteria clearly showed a better 3-component model rather than the 2-component one. An early-onset (,7 years of age), an intermediate-onset (,8 and ,22), and a late-onset group (,23) were identified. Comparison of clinical correlates among subgroups by means of chi-square test showed a statistically significant result for migraine frequency (,2 = 7.41, P = .02). Considering the frequency of migraine attacks as a main outcome, the regression model showed a higher AAO is associated with low frequency (odds ratio = 0.95; P = .02). Conclusions., The significant association between AAO and attack frequency found in our study supports the hypothesis that AAO could act as a predictor factor able to influence prognosis. AAO could represent a phenotype suitable for identifying MWA susceptibility genes. [source] Causality and Causal Models: A Conceptual Perspective,INTERNATIONAL STATISTICAL REVIEW, Issue 3 2006Benito V. Frosini Summary This paper aims at displaying a synthetic view of the historical development and the current research concerning causal relationships, starting from the Aristotelian doctrine of causes, following with the main philosophical streams until the middle of the twentieth century, and commenting on the present intensive research work in the statistical domain. The philosophical survey dwells upon various concepts of cause, and some attempts towards picking out spurious causes. Concerning statistical modelling, factorial models and directed acyclic graphs are examined and compared. Special attention is devoted to randomization and pseudo-randomization (for observational studies) in view of avoiding the effect of possible confounders. An outline of the most common problems and pitfalls, encountered in modelling empirical data, closes the paper, with a warning to be very cautious in modelling and inferring conditional independence between variables. Résumé Le but de cet article est d'offrir une vue d'ensemble sur le thème des relations causales, à partir de la doctrine philosophique aristotélique, et ensuite étendues et formalisées dans le champ de l'analyse statistique multivarée. Dans la revue philosophique on analyse plusieurs conceptions de cause, et les essais de reconnâtre les causes "fausses". La partie centrale du travail s'occupe de modèles causals en forme graphique, qui constituent l'instrument électif de plusieurs recherches causales, et met en evidence la différence entre conditionnement et intervention sur une variable. On a dedié une particulière attention aux procédures de randomization dans le but d'éviter de possible confusions. L'article termine en conseillant d'user de la prudence dans la modelage de l'independence conditionnelle et dans son contrôl empirique. [source] Patterns of Presentation, Diagnosis, and Treatment in Older Patients with Colon Cancer and Comorbid DementiaJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2004Supriya K. Gupta MD Objectives: To estimate patterns of colon cancer presentation, diagnosis, and treatment according to history of dementia using National Cancer Institute (NCI) Surveillance, Epidemiology, and End-Result (SEER) Medicare data. Design: Population-level cohort study. Setting: NCI's SEER-Medicare database. Participants: A total of 17,507 individuals aged 67 and older with invasive colon cancer (Stage I-IV) were identified from the 1993,1996 SEER file. Medicare files were evaluated to determine which patients had an antecedent diagnosis of dementia. Measurements: Parameters relating to the cohort's patterns of presentation and care were estimated using logistic regressions. Results: The prevalence of dementia in the cohort of newly diagnosed colon cancer patients was 6.8% (1,184/17,507). Adjusting for possible confounders, dementia patients were twice as likely to have colon cancer reported after death (i.e., autopsy or death certificate) (adjusted odds ratio (AOR)=2.31, 95% confidence interval (CI)=1.79,3.00). Of those diagnosed before death (n=17,049), dementia patients were twice as likely to be diagnosed noninvasively than with tissue evaluation (i.e., positive histology) (AOR=2.02 95% CI=1.63,2.51). Of patients with Stage I -III disease (n=12,728), patients with dementia were half as likely to receive surgical resection (AOR=0.48, 95% CI=0.33,0.70). Furthermore, of those with resected Stage III colon cancer (n=3,386), dementia patients were 78% less likely to receive adjuvant 5-fluorouracil (AOR=0.22, 95% CI=0.13,0.36). Conclusion: Although the incidences of dementia and cancer rise with age, little is known about the effect of dementia on cancer presentation and treatment. Elderly colon cancer patients are less likely to receive invasive diagnostic methods or curative-intent therapies. The utility of anticancer therapies in patients with dementia merits further study. [source] Sex Differences in the Effect of Heart Rate on Mortality in the ElderlyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2003Gila Perk MD Objectives:, To examine the association between heart rate and mortality risk in the elderly. Design:, Longitudinal cohort. Setting:, Outpatient. Participants: Four hundred twenty-two people, aged 70 upon entry, were surveyed and followed for 6 years. Measurements: Pulse rate was measured manually, while sitting and standing, and heart rate was measured from electrocardiogram recordings. The population was divided into quartiles of heart rate, with the top quartile comprising those with heart rate greater than 77 beats per minute (bpm) and the bottom quartile those with heart rate less than 60 bpm. Results: After controlling for possible confounders, there was a clear correlation (r) between heart rate and all-cause mortality in elderly women (r=0.25, P=.0003). The correlation in women was observed using the three different methods for measuring heart rate. Heart rate was associated with all-cause and cardiovascular mortality. There was no relationship between heart rate and level of exercise or smoking status. In multiple regression analysis, the increased risk of death in the women was independent of previous cardiovascular or cerebrovascular disease, hypertension, anemia, congestive heart failure, smoking, and level of exercise or activities of daily living (relative odds ratio (ROR)=3.37, 95% confidence interval (CI)=0.96,11.8). When women using beta-blockers were excluded, this relationship became even stronger (ROR=8.5, 95% CI=1.19,60.1). Conclusion: Elevated heart rate is related to increased mortality in elderly women, thus representing a simple index of general health status in this population. Elevated heart rate did not predict mortality in elderly men. [source] Hyperkyphotic Posture and Risk of Future Osteoporotic Fractures: The Rancho Bernardo Study,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 3 2006Mei-Hua Huang Abstract It is unknown whether kyphosis of the thoracic spine is an independent risk factor for future osteoporotic fractures. In 596 community-dwelling women, we found that with increasing kyphosis, there was a significant trend of increasing fracture risk that was independent of previous history of fractures or BMD. Introduction: It is unknown whether kyphosis of the thoracic spine is an independent risk factor for future osteoporotic fractures. Materials and Methods: We conducted a prospective cohort study of 596 community-dwelling women, 47-92 years of age. Between 1988 and 1991, BMD of the hip and spine and kyphosis were measured. Kyphosis was measured by counting the number of 1.7-cm blocks necessary to place under the occiput so participants could lie flat without neck hyperextension. New fractures were reported over an average follow-up of 4 years. Results: Using a cut-off of at least one block, 18% of the participants had hyperkyphotic posture (range, one to nine blocks). There were 107 women who reported at least one new fracture (hip, spine, wrist, clavicle, shoulder, arm, hand, rib, pelvis, leg, or ankle). In logistic regression analyses, older women with hyperkyphotic posture (defined as at least one block) had a 1.7-fold increased risk of having a future fracture independent of age, prior fracture, and spine or hip BMD (95% CI: 1.00-2.97; p = 0.049). There was a significant trend of increasing fracture risk with increasing number of blocks, with ORs ranging from 1.5 to 2.6 as the number of blocks increased from one to at least three blocks compared with those with zero blocks (trend p = 0.03; models adjusted for age, baseline fracture, spine or hip BMD). Stratification by baseline fracture status and controlling for other possible confounders or past year falls did not change the results. Conclusions: Whereas hyperkyphosis may often result from vertebral fractures, our study findings suggest that hyperkyphotic posture itself may be an important risk factor for future fractures, independent of low BMD or fracture history. [source] The enigma of increased non-cancer mortality after weight loss in healthy men who are overweight or obeseJOURNAL OF INTERNAL MEDICINE, Issue 1 2002P. M. NILSSON Abstract.,Nilsson PM, Nilsson J-A, Hedblad B, Berglund G, Lindgärde F. (University Hospital, Malmö, Sweden). The enigma of increased non-cancer mortality after weight loss in healthy men who are overweight or obese. J Intern Med 2002; 252: 70,78. Objective.,To study effects on non-cancer mortality of observational weight loss in middle-aged men stratified for body mass index (BMI), taking a wide range of possible confounders into account. Design.,Prospective, population based study. Setting.,Male population of Malmö, Sweden. Participants.,In all 5722 men were screened twice with a mean time interval of 6 years in Malmö, southern Sweden. They were classified according to BMI category at baseline (<21, 22,25, overweight: 26,30, and obesity: 30+ kg m,2) and weight change category until second screening (weight stable men defined as having a baseline BMI ± 0.1 kg m,2 year,1 at follow-up re-screening). Main outcome measures.,Non-cancer mortality calculated from national registers during 16 years of follow-up after the second screening. Data from the first year of follow-up were excluded to avoid bias by mortality caused by subclinical disease at re-screening. Results.,The relative risk (RR; 95% CI) for non-cancer mortality during follow-up was higher in men with decreasing BMI in all subgroups: RR 2.64 (1.46,4.71, baseline BMI <21 kg m,2), 1.39 (0.98,1.95, baseline BMI 22,25 kg m,2), and 1.71 (1.18,2.47, baseline BMI 26+ kg m,2), using BMI-stable men as reference group. Correspondingly, the non-cancer mortality was also higher in men with increasing BMI, but only in the obese group (baseline BMI 26+ kg m,2) with RR 1.86 (1.31,2.65). In a subanalysis, nonsmoking obese (30+ kg m,2) men with decreased BMI had an increased non-cancer mortality compared with BMI-stable obese men (Fischer's test: P=0.001). The mortality risk for nonsmoking overweight men who increased their BMI compared with BMI-stable men was also significant (P=0.006), but not in corresponding obese men (P=0.094). Conclusions.,Weight loss in self-reported healthy but overweight middle-aged men, without serious disease, is associated with an increased non-cancer mortality, which seems even more pronounced in obese, nonsmoking men, as compared with corresponding but weight-stable men. The explanation for these observational findings is still enigmatic but could hypothetically be because of premature ageing effects causing so-called weight loss of involution. [source] Incidence of Cancer Among Female Flight Attendants: A Meta-AnalysisJOURNAL OF TRAVEL MEDICINE, Issue 3 2006Osamu Tokumaru MD Background Airline flight personnel work in a unique environment with exposure to known or suspected carcinogens and mutagens including ionizing cosmic radiation. A meta-analysis was conducted to study whether the occupational exposure of female flight attendants (FA) increased their relative risk of cancer incidence. Methods A bibliographical computer search from 1966 to 2005 of cancer incidence cohort studies of female FA was performed. Combined relative risks (RRc) in cancer incidence were calculated by means of meta-analysis. Results RRc and 95% confidence interval (CI) for malignant melanoma and breast cancer in female FA were 2.13 (95% CI: 1.58,2.88) and 1.41 (1.22,1.62) (p < 0.0001). Excess risk was not significant for all-site cancer with RRc of 1.10 (0.99,1.21). Conclusions The meta-analysis confirmed the significantly increased risks for malignant melanoma and breast cancer in female FA. Increased exposure to cosmic radiation during flight has been suggested as a potential occupational risk factor. Ultraviolet radiation exposure on board seems an unlikely occupational risk, but nonoccupational leisure time sun exposure is a possible risk factor. The etiology of the observed increase in incidence of some cancers remains controversial because assessment of possible confounders, especially nonoccupational exposure factors, has thus far been limited. [source] The influence of maternal cigarette smoking, snuff use and passive smoking on pregnancy outcomes: the Birth To Ten StudyPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 2 2006Krisela Steyn Summary Steyn K, de Wet T, Saloojee Y, Nel H, Yach D. The influence of maternal cigarette smoking, snuff use and passive smoking on pregnancy outcomes: the Birth To Ten Study. Paediatric and Perinatal Epidemiology 2006; 20: 90,99. This article describes the patterns and effects of maternal snuff use, cigarette smoking and exposure to environmental tobacco smoke during pregnancy on birthweight and gestational age, in women living in Johannesburg and Soweto in 1990. A cohort of 1593 women with singleton live births provided information about their own and household members' usage of tobacco products during pregnancy. The women completed a questionnaire while attending antenatal services. Data on gestational age and birthweight were obtained from birth records. Women who smoked cigarettes or used snuff during pregnancy accounted for 6.1% and 7.5% of the study population respectively. The mean birthweight of non-tobacco users was 3148 g [95% CI 3123, 3173] and that of the smokers 2982 g [95% CI 2875, 3090], resulting in a significantly lower mean birthweight of 165 g for babies of smoking mothers (P = 0.005). In contrast, women using snuff gave birth to infants with a mean birthweight of 3118 g [95% CI 3043, 3192], which is a non-significant (P = 0.52) decrease (29.4 g) in their infants' birthweights compared with those not using tobacco. A linear regression analysis identified short gestational age, female infant, a mother without hypertension during pregnancy, coloured (mixed racial ancestry), and Asian infants compared with black infants, lower parity, less than 12 years of education and smoking cigarettes as significant predictors of low birthweight, while the use of snuff during pregnancy was not associated with low birthweight. The snuff users, however, had a significant shorter gestational age than the other two groups of women. The birthweight reduction adjusted for possible confounders was 137 g [95% CI 26.6, 247.3 (P = 0.015)] for cigarette smokers and 17.1 g [95% CI ,69.5, ,102.7, P = 0.69] for snuff users respectively, compared with the birthweight of non-tobacco users. Among women who did not smoke cigarettes or use snuff, exposure to environmental tobacco smoke did not result in significant effects on the birthweight of their infants. In conclusion, infants of cigarette smokers had significantly lower birthweights than those of non-tobacco users or snuff users who are exposed to nicotine during pregnancy. Passive smoking did not affect birthweight significantly in this population. [source] Malnutrition and neutropenia in children treated for Burkitt lymphoma in MalawiPEDIATRIC BLOOD & CANCER, Issue 1 2009Trijn Israëls MD Abstract Background Infection in neutropenic children is a major cause of morbidity and mortality in children treated for cancer. In developing countries, children with cancer are often malnourished at diagnosis. In Blantyre, Malawi, children with Burkitt lymphoma are treated with a local protocol with limited toxicity. The aim of this study was to evaluate the incidence and outcome of febrile neutropenia during this treatment and the association with malnutrition at diagnosis. Methods We documented nutritional status, febrile and/or neutropenic episodes, antibiotic therapy and short term outcome of all children with Burkitt lymphoma treated according to the local protocol and admitted from January 2007 to March 2008. Results Fifty eight (69%) of 84 patients were acutely malnourished at diagnosis with an arm muscle area (AMA) below the 5th percentile. Malnutrition at diagnosis was associated with a significantly higher rate of profound neutropenia. This association remained significant (OR 12; 95% C.I. 1.5 - infinitely; P,=,0.012) after control for clinical stage of disease, bone marrow involvement and HIV infection which are possible confounders. All patients with profound neutropenia, prolonged neutropenia and treatment related deaths were malnourished at diagnosis. Four (4.9%) of 81 patients died of treatment related causes; three of them due to a Gram negative septicaemia. Conclusion Acute malnutrition at diagnosis is associated with significantly more treatment related profound neutropenia. The intensity of chemotherapeutic regimens has to be adapted to the level of available supportive care and patients' nutritional status and tolerance to avoid unacceptable morbidity and mortality. This local treatment protocol for Burkitt lymphoma has a treatment related mortality of 5% in patients in Malawi. Pediatr Blood Cancer 2009;53:47,52. © 2009 Wiley-Liss, Inc. [source] Is wheezing associated with decreased sleep quality in Sri Lankan children?PEDIATRIC PULMONOLOGY, Issue 7 2007A questionnaire study Abstract Aim To investigate the association between wheezing and impaired sleep in Sri Lankan children, aged 6,12 years; and, to report the prevalence of asthma-related symptoms in these subjects. Methods The International Study of Asthma and Allergies in Childhood questionnaire and a separate sleep questionnaire were completed. Results Of 800 originally distributed questionnaires, 652 were analyzed. Wheezing was present in 89 children (14%). Within this group, 66% reported wheezing in the last 12 months. Wheezing children had a significantly higher presence of snoring, restless sleep, nocturnal awakenings and daytime tiredness. Wheezing was found to be independently associated with restless sleep (odds ratio (OR),=,2.4). There was no association between wheezing and difficulties falling asleep, nocturnal awakenings, apneas, and daytime sleepiness and tiredness. After adjusting for possible confounders, the following significant associations were present: snoring and apneas (OR,=,1.6), chronic rhinitis and apneas (OR,=,1.6), snoring and restless sleep (OR,=,3.2), chronic rhinitis and restless sleep (OR,=,2.1), and hayfever and daytime tiredness (OR,=,4.3). Wheezing was related to an increased risk of snoring (OR,=,2.8) and subjects with chronic rhinitis had also an increased risk of snoring (OR,=,1.7), adjusting for possible confounders. Conclusion The sleep of wheezing children was impaired compared with their non-wheezing peers, resulting in an increased prevalence of daytime tiredness. Upper airway symptoms, such as chronic rhinitis or hayfever, should be carefully considered in these children, as they might be responsible for these sleep problems. Pediatr Pulmonol. 2007; 42:579,583. © 2007 Wiley-Liss, Inc. [source] Neuromotor effects of short-term and long-term exposures to trichloroethylene in workers,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 9 2010Katsuyuki Murata MD Abstract Background Health effects of long-term exposure to organic solvents at low levels are a major concern in industrialized countries. To assess the neuromotor impact of trichloroethylene objectively, static postural sway and hand tremor parameters, along with urinary trichloroethanol (TCOH) and trichloroacetic acid (TCAA) levels, were investigated in 57 workers without obvious neurological disorders and 60 control subjects. Methods The workers had been occupationally exposed to trichloroethylene for 0.1,37 years. The cumulative exposure index (CEI) was calculated from their occupational history and total trichloro-compounds (TCOH,+,TCAA). Results Median levels in the workers were 1.7,mg/L for TCOH and 2.5,mg/L for TCAA, and the maximum ambient trichloroethylene concentration was estimated to be <22,ppm from the previously reported equation using TCOH,+,TCAA. Sway parameters with eyes open and tremor intensity in dominant hand were significantly larger in the exposed workers than in the control subjects when adjusting for possible confounders. A significant dose,effect association was seen between two sway parameters and urinary TCOH level in the workers. Tremor intensities in non-dominant hand differed significantly among three groups of the workers divided according to the CEI. Conclusions These findings suggest that trichloroethylene exposure, even at low levels of less than the short-term exposure limit by the ACGIH, can affect the neuromotor function of workers. The postural instability appears to result from recent exposure, and the increased tremor may occur due to short-term and long-term exposures. Hereafter, such objective measures, along with subjective symptoms, should be carefully used for the occupational exposure limit setting. Am. J. Ind. Med. 53:915,921, 2010. © 2010 Wiley-Liss, Inc. [source] Cohort study for the effect of chronic noise exposure on blood pressure among male workers in Busan, KoreaAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 6 2009Ji Ho Lee MD Abstract Objective It has not yet been established whether exposure to chronic noise induces an increase in blood pressure or an increase in the development of hypertension. Therefore, a cohort study was performed to identify the effects of chronic noise exposure on blood pressure. Methods Five hundred thirty male workers at a metal manufacturing factory in Busan, Korea, were enrolled in the study. They were monitored with an annual health check-ups for nine consecutive years from 1991 to 1999. The subjects were divided into four groups which were determined by noise level categories (NLCs) according to the exposure of noise intensity; NLC-I: office workers who were exposed to <60 dBA at work; NLC-II: worksite technical supporters or inspectors who were intermittently exposed to noise and were not using hearing protection devices; NLC-III: worksite workers exposed to a noise below 85 dBA (TWA) and used one type of hearing protection device, earplug or earmuff; NLC-IV: worksite workers who were exposed to a noise level of 85 dBA or higher in average and used both earplug and earmuff. Results After controlling the possible confounders, such as baseline age, smoking, alcohol intake, exercise, family history of hypertension, systolic blood pressure (SBP), or diastolic blood pressure (DBP), and changes in body mass index (BMI), we determined that the mean values for the SBP over the duration of this study were 3.8, 2.0, and 1.7 mmHg higher in groups NLC-IV, NLC-III, and NLC-II, respectively, in comparison to that of the NLC-I group. There was no significant difference in DBP among the groups. Conclusion This study suggests that chronic noise exposure increases SBP independently, among male workers. Am. J. Ind. Med. 52:509,517, 2009. © 2009 Wiley-Liss, Inc. [source] Body Mass Index But Not Pulse Pressure Is Associated with Lesser Penile,Vaginal Intercourse Frequency in Healthy Young MenTHE JOURNAL OF SEXUAL MEDICINE, Issue 5 2010Stuart Brody PhD ABSTRACT Introduction., A growing literature links aspects of sexual and cardiovascular function. Recent research revealed that pulse pressure (systolic minus diastolic) was associated with poorer erectile function (and hypogonadism) in male patients with erectile dysfunction. It is unclear to what degree pulse pressure (and body mass index) would be associated with aspects of sexual function in a younger, healthy sample (controlling for possible confounders). Aims., To examine the associations of frequency of specific sexual behaviors with both resting pulse pressure and body mass index. Methods., Sixty-five healthy young men (mean age 25.2 ± 4.6 years) had their resting blood pressure, weight, and height recorded, and reported the frequency of their various sexual activities. Main Outcome Measures., Correlations of pulse pressure with different sexual behaviors (univariate and adjusted for possible confounding variables including age, mean blood pressure, body mass index, social desirability responding score, and cohabitation status). Results., For these healthy young men, on univariate and adjusted analyses, pulse pressure was not significantly associated with frequencies of penile,vaginal intercourse, other partnered sexual activity, or masturbation. In contrast, body mass index was associated with lesser frequency of penile,vaginal intercourse but not other sexual behaviors. Conclusions., The association of pulse pressure with sexual function previously observed in older men was not observed in this younger healthy sample. Other measures of arterial stiffness might be indicated in a healthy young population. Even within the normal range and adjusted for possible confounders, increasing body mass index (a rough proxy for body fat) is associated with reduced frequency of specifically penile,vaginal intercourse, which might be a result of some combination of characterological and hormonal factors. Brody S. Body mass index but not pulse pressure is associated with lesser penile,vaginal intercourse frequency in healthy young men. J Sex Med 2010;7:1853,1857. [source] Centers for Disease Control ,High-Risk' Donors and Kidney UtilizationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2010K. I. Duan The aims of this study were to determine whether Centers for Disease Control high risk (CDCHR) status of organ donors affects kidney utilization and recipient survival. Data from the Scientific Registry of Transplant Recipients were used to examine utilization rates of 45 112 standard criteria donor (SCD) deceased donor kidneys from January 1, 2005, and February 2, 2009. Utilization rates for transplantation were compared between CDCHR and non-CDCHR kidneys, using logistic regression to control for possible confounders. Cox regression was used to determine whether CDCHR status independently affected posttransplant survival among 25 158 recipients of SCD deceased donor kidneys between January 1, 2005, and February 1, 2008. CDCHR kidneys were 8.2% (95% CI 6.9,9.5) less likely to be used for transplantation than non-CDCHR kidneys; after adjusting for other factors, CDCHR was associated with an odds ratio of utilization of 0.67 (95% CI 0.61,0.74). After a median 2 years follow-up, recipients of CDCHR kidneys had similar posttransplant survival compared to recipients of non-CDCHR kidneys (hazard ratio 1.06, 95% CI 0.89,1.26). These findings suggest that labeling donor organs as ,high risk' may result in wastage of approximately 41 otherwise standard kidneys per year. [source] Geographic Variation in Organ Availability Is Responsible for Disparities in Liver Transplantation between Hispanics and CaucasiansAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2009M. L. Volk The aims of this study were to determine whether disparities in waiting list outcomes exist for Hispanics and African Americans during the post-MELD era, and to investigate interactions between disparities and geography. Scientific Registry of Transplant Recipients data were used to compare Hispanics and African Americans to Caucasians listed between 2003 and 2008. Endpoints included (i) receipt of a liver transplant and (ii) death or removal from the waiting list for being too sick or medically unsuitable. Adjustment for possible confounders was performed using multivariate Cox regression, with adjustment for geographic variation using a fixed-effects multilevel model. In multivariate analysis, African Americans have similar hazard of transplantation and death/removal as Caucasians during the post-MELD era. However, Hispanics are less likely to receive a transplant than Caucasians despite adjustment for potential confounders (HR 0.80, 95% CI 0.77,0.83), while having a similar hazard of death/removal. This effect disappeared after adjusting for unequal regional distribution of Hispanics, who represent 8% of patients in donation service areas (DSAs) having median waiting times of ,155 days versus 19% in DSAs with median waiting times of >155 days. In conclusion, disparities in liver transplantation exist for Hispanics during the post-MELD era, caused by geographic variation in organ availability. [source] A Method for Improving Arrival-to-electrocardiogram Time in Emergency Department Chest Pain Patients and the Effect on Door-to-balloon Time for ST-segment Elevation Myocardial InfarctionACADEMIC EMERGENCY MEDICINE, Issue 10 2009Kevin M. Takakuwa MD Abstract Objectives:, The objectives were to determine if an emergency department (ED) could improve the adherence to a door-to-electrocardiogram (ECG) time goal of 10 minutes or less for patients who presented to an ED with chest pain and the effect of this adherence on door-to-balloon (DTB) time for ST-segment elevation myocardial infarction (STEMI) cardiac catheterization (cath) alert patients. Methods:, This was a planned 1-month before-and-after interventional study design for implementing a new process for obtaining ECGs in patients presenting to the study ED with chest pain. Prior to the change, patients were registered and triaged before an ECG was obtained. The new procedure required registration clerks to identify those with chest pain and directly overhead page or call a designated ECG technician. This technician had other ED duties, but prioritized performing ECGs and delivering them to attending physicians. A full registration process occurred after the clinical staff performed their initial assessment. The primary outcome was the total percentage of patients with chest pain who received an ECG within 10 minutes of ED arrival. The secondary outcome was DTB time for patients with STEMI who were emergently cath alerted. Data were analyzed using mean differences, 95% confidence intervals (CIs), and relative risk (RR) regression to adjust for possible confounders. Results:, A total of 719 patients were studied: 313 before and 405 after the intervention. The mean (±standard deviation [SD]) age was 50 (±16) years, 54% were women, 57% were African American, and 36% were white. Patients walked in 89% of the time; 11% arrived by ambulance. Thirty-nine percent were triaged as emergent and 61% as nonemergent. Patients presented during daytime 68% of the time, and 32% presented during the night. Before the intervention, 16% received an ECG at 10 minutes or less. After the intervention, 64% met the time requirement, for a mean difference of 47.3% (95% CI = 40.8% to 53.3%, p < 0.0001). Results were not affected by age, sex, race, mode of arrival, triage classification, or time of arrival. For patients with STEMI cath alerts, four were seen before and seven after the intervention. No patients before the intervention had ECG time within 10 minutes, and one of four had DTB time of <90 minutes. After the intervention, all seven patients had ECG time within 10 minutes; the three arriving during weekday hours when the cath team was on site had DTB times of <90 minutes, but the four arriving at night and on weekends when the cath team was off site had DTB times of >90 minutes. Conclusions:, The overall percentage of patients with a door-to-ECG time within 10 minutes improved without increasing staffing. An ECG was performed within 10 minutes of arrival for all patients who were STEMI cath alerted, but DTB time under 90 minutes was achieved only when the cath team was on site. [source] The Association between Emergency Department Crowding and Analgesia Administration in Acute Abdominal Pain PatientsACADEMIC EMERGENCY MEDICINE, Issue 7 2009Angela M. Mills MD Abstract Objectives:, The authors assessed the effect of emergency department (ED) crowding on the nontreatment and delay in treatment for analgesia in patients who had acute abdominal pain. Methods:, This was a secondary analysis of prospectively enrolled nonpregnant adult patients presenting to an urban teaching ED with abdominal pain during a 9-month period. Each patient had four validated crowding measures assigned at triage. Main outcomes were the administration of and delays in time to analgesia. A delay was defined as waiting more than 1 hour for analgesia. Relative risk (RR) regression was used to test the effects of crowding on outcomes. Results:, A total of 976 abdominal pain patients (mean [±standard deviation] age = 41 [±16.6] years; 65% female, 62% black) were enrolled, of whom 649 (67%) received any analgesia. Of those treated, 457 (70%) experienced a delay in analgesia from triage, and 320 (49%) experienced a delay in analgesia after room placement. After adjusting for possible confounders of the ED administration of analgesia (age, sex, race, triage class, severe pain, final diagnosis of either abdominal pain not otherwise specified or gastroenteritis), increasing delays in time to analgesia from triage were independently associated with all four crowding measures, comparing the lowest to the highest quartile of crowding (total patient-care hours RR = 1.54, 95% confidence interval [CI] = 1.32 to 1.80; occupancy rate RR = 1.64, 95% CI = 1.42 to 1.91; inpatient number RR = 1.57, 95% CI = 1.36 to 1.81; and waiting room number RR = 1.53, 95% CI = 1.31 to 1.77). Crowding measures were not associated with the failure to treat with analgesia. Conclusions:, Emergency department crowding is associated with delays in analgesic treatment from the time of triage in patients presenting with acute abdominal pain. [source] Clindamycin and taste disordersBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 4 2007Mark C. H. De Groot What is already known about this subject. ,,The antibiotic clindamycin has a bitter taste when it is used orally. What this study adds ,,A case series on oral as well as i.v. use of clindamycin associated with taste disorders is presented. ,,After corrections in a case-by-case analysis for several possible confounders such as indication, clindamycin is disproportionally associated with taste disorders. ,,Serum and hence saliva and sputum clindamycin levels seem to be responsible for this reversible adverse drug reaction. Aims Topical use of clindamycin has been associated with taste disorders in the literature, but little is known about the nature of this adverse drug reaction. The aim of this article was to describe reports of clindamycin-induced taste disorders and to analyse the factors involved. Methods The adverse drug reaction database of the Netherlands Pharmacovigilance Centre was searched for reports concerning taste disorders with antibiotics. Clinical review of the cases and statistical analysis with logistic regression were performed. Characteristics of patients who reported taste disorders were compared for age, gender and formulation in clindamycin vs. other antibiotic users. Results Taste disorders were reported in seven (18%) of the clindamycin cases. In five reports an oral formulation was involved, in one report intravenous (i.v.) administration and in one report both formulations were used. Latency was <1 day after start and in one case taste disorders were present repeatedly at 10 min after every i.v. application. The adjusted reporting odds ratio was 7.0 (95% confidence interval 2.8, 17.3) and supports a possible causal relationship. Conclusions The association of clindamycin and taste disorders is supported by disproportionality analysis and seems to be independent of possible confounders such as age, gender and infections. The case reports suggest a role for clindamycin concentrations excreted in body fluids like saliva. [source] A Pilot Study of Ultrasound Analysis before Pediatric Peripheral Vein Cannulation AttemptACADEMIC EMERGENCY MEDICINE, Issue 5 2007David Schnadower MD ObjectivesTo determine whether peripheral veins can be detected by ultrasound (US) and to determine vein characteristics, as measured by US, that are associated with successful peripheral venous (PV) catheterization in young children. MethodsThe authors conducted an observational study in the pediatric emergency department (ED), with a convenience sample of children younger than 7 years. They evaluated attempts at PV catheterization in two groups on the basis of the visibility and palpability of the patients' veins: 1) clinically apparent (visible or palpable) and 2) not clinically apparent (nonvisible and nonpalpable). The authors obtained sonographic measurements in a transverse view (vertical diameter, circumference, and area) and in a longitudinal view (maximal uninterrupted length). Practitioners blinded to the US images then attempted to catheterize veins in the usual manner. The proportion of clinically apparent veins and the proportion of veins that were successfully catheterized that were identified by US were assessed, and the association between ultrasonographic vein measurements and success at catheterization, controlling for possible confounders, was determined. ResultsThe authors assessed 120 attempts (90 clinically apparent and 30 not clinically apparent) at PV catheterization in 83 patients. US detected all 90 clinically apparent veins, and cannulation success rate was 62/90 (69%). In the not clinically apparent vein group, the rate of success was only 3/30 (10%), and US detected all successfully catheterized veins. In no instance was cannulation successful when the vein was not detected by US. Maximal vein length in longitudinal view was an independent predictor of cannulation success in multivariate analysis. ConclusionsUltrasound appears to be capable of detecting peripheral veins in children younger than 7 years of age, with lack of US vein visualization likely leading to unsuccessful PV placement. Greater vein length visualization may be a useful predictor of successful PV catheterization. [source] Risk factors of neonatal respiratory distress following vaginal delivery and caesarean section in the German populationACTA PAEDIATRICA, Issue 1 2009Andrea Heinzmann Abstract Background: The incidence of caesarean section (CS) is steadily rising world-wide. In particular, CS on maternal demand is performed more frequently. In parts, this might be due to insufficient information of pregnant women about neonatal risks of CS. We sought to specify neonatal outcomes following different modes of delivery, i.e. vaginal delivery, primary CS and secondary CS and to define risk factors for respiratory morbidity and hospitalization. Methods: We analysed 2073 births (gestational age > 35 weeks) during a two-year period at a tertiary obstetric and neonatal centre in Germany. Statistical analyses were performed for single parameters by SPSS as well as by logistic regression to account for possible confounders. Furthermore, extensive model calculation was done. Results: Respiratory morbidity was increased following primary and secondary CS (p = 0.001). By multiple logistic regression, the strongest effect on respiratory symptoms was seen with gestational age, each week more in utero reducing the risk by an odds ratio (OR) of 0.69 (95% CI: [0.61; 0.79]; p = 1.9 × 10,8). Furthermore, a significant interaction between mode of delivery and gestational age was found for the risk of respiratory symptoms (p = 0.0035). Conclusion: For every eight newborns delivered by primary CS one more than expected with vaginal delivery is hospitalized. It is highly relevant to recognize that each week of gestational age reduces the risk of respiratory symptoms, especially if primary CS is performed. The higher rate of respiratory morbidity and neonatal admission following CS should be clearly recognized in counselling of pregnant women. [source] IPD meta-analysis shows no effect of LC-PUFA supplementation on infant growth at 18 monthsACTA PAEDIATRICA, Issue 1 2009Eva Rosenfeld Abstract Aim: Clinical trials on the effects of long-chain polyunsaturated fatty acids (LC-PUFA) supplementation of formula milk on growth of term and preterm children have shown conflicting results. We examined the effects of LC-PUFAs , especially docosahexaenoic acid (DHA) and arachidonic acid (AA) , on growth at 18 months. Methods: We performed a meta-analysis based on individual patient data (IPD) of 901 children from four large, randomised clinical trials of formula milk with and without LC-PUFAs. Anthropometrics were assessed by z-scores based on weight for age, length for age, head circumference for age and body mass index (BMI) for age at 18 months. The studies differed in LC-PUFA composition and infant characteristics (two studies on preterm children, two on term children). Results: Multivariate regression analyses including the possible confounders, sex, gestational age, birth weight, smoking in the last trimester and maternal age, as well as interaction terms showed no significant effects of LC-PUFA supplementation on any z-score. Subgroup analyses on trials with high amounts of DHA and on studies with duration of supplementation of at least 6 months yielded the same result. These findings cannot be explained by the lack of power. Conclusion: Our IPD meta-analysis shows no evidence that LC-PUFA supplementation affects children's growth at 18 months of age. [source] Mycobacterium tuberculosis infection may protect against allergy in a tuberculosis endemic areaCLINICAL & EXPERIMENTAL ALLERGY, Issue 1 2006C. C. Obihara Summary Background Epidemiological studies have shown an inverse relation of mycobacterial infection and the frequency of allergic diseases and asthma. Recent evidence suggests that allergic inflammation may be inhibited in the presence of chronic and persistent infections, such as that by Mycobacterium tuberculosis (MTB). The relation of tuberculin skin test (TST) size, an accepted marker of MTB infection and the frequency of allergic disease symptoms has not been reported from an area where MTB infection is endemic. Objective To investigate the association of TST and allergic disease symptoms, in children living in a tuberculosis (TB) endemic area. Methods In this cross-sectional study, 841 children aged 6,14 years from randomly selected household addresses in two poor communities of Cape Town, South Africa, were investigated with TST and standardized International Study on Asthma and Allergies in Childhood-based questionnaire on allergic disease symptoms. Results Children with positive TST (10 mm) were significantly less likely to have allergic disease symptoms, in particular allergic rhinitis (AR) (adjusted odds ratio 0.43; 95% confidence interval 0.24,0.79) than those with negative TST. This association remained significant after adjusting for possible confounders and correcting for the effect of clustering (>1 child per household address) in the sample. There was a significant inverse linear trend in the relation of TST size in millimetre and the frequency of allergic disease symptoms, in particular AR (P<0.001). Conclusions These results of inverse association of strong TST reaction and allergic disease symptoms in children from a TB endemic area are in support of the hypotheses that allergic inflammation may be inhibited by chronic infections, such as MTB. [source] Interactions between TCF7L2 genotype and growth hormone-induced changes in glucose homeostasis in small for gestational age childrenCLINICAL ENDOCRINOLOGY, Issue 1 2010Sandra W. K. De Kort Summary Context, The Transcription factor 7-like 2 (TCF7L2) rs7903146 gene polymorphism has been associated with risk of developing type 2 diabetes mellitus (DM), possibly by decreasing insulin secretion. Small for gestational age (SGA) birth has been associated with type 2 DM in later life. Growth hormone (GH) treatment reduces insulin sensitivity and increases insulin secretion. Therefore, GH-treated SGA children are an ideal group to investigate whether the TCF7L2 rs7903146 genotype is associated with changes in glucose homeostasis. Objective, To determine the impact of the TCF7L2 rs7903146 polymorphism on changes in insulin secretion and insulin sensitivity during 4 years of GH treatment in children born SGA. Subjects, A total of 246 Caucasian short children born SGA, with a median age of 7·8 years. Outcome measures, Insulin sensitivity and insulin secretion were measured by the frequently sampled intravenous glucose tolerance test (FSIGT) (n = 68) and homeostasis model assessment (HOMA) calculations (all). Results, There was no association between rs7903146 genotype and insulin sensitivity or insulin secretion at baseline but after adjustment for possible confounders, insulin secretion was higher in the CT/TT group than in the CC group. During GH treatment, carriers of the rs7903146 T allele had an increase in insulin secretion similar to that of carriers of the CC genotype. The decrease in insulin sensitivity was only significant in the CT/TT group, but the difference in decrease between genotype groups did not reach significance (P = 0·06). The disposition index (insulin secretion × insulin sensitivity), which is an estimate of beta cell function, was not associated with genotype and did not change during GH treatment. Conclusion, The TCF7L2 rs7903146 polymorphism is not associated with the change in insulin secretion during GH treatment in short SGA children. [source] | ||||||||||||||||||||||||||||