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Quintile
Kinds of Quintile Selected AbstractsJ-shaped relationship between waist circumference and subsequent risk for Type 2 diabetes: an 8-year follow-up of relatively lean Japanese individualsDIABETIC MEDICINE, Issue 8 2009M. Sakurai Abstract Aims, This study investigated the relationship between waist circumference and the subsequent incidence of Type 2 diabetes and the association with insulin resistance and pancreatic B-cell function in relatively lean Japanese individuals. Methods, The study participants were 3992 employees (2533 men and 1459 women, aged 35,55 years) of a metal-products factory in Japan. The incidence of diabetes was determined in annual medical examinations during an 8-year follow-up. We calculated age- and sex-adjusted hazard ratios (HRs) according to the sex-specific quintile of waist circumference at baseline. Differences in baseline insulin resistance [homeostatis model assessment (HOMA)-IR] and pancreatic B-cell function (HOMA-B) were compared between participants who developed diabetes and those who did not. Results, During the follow-up, 218 participants developed diabetes. Age- and sex-adjusted HRs across the quintiles of waist circumference were 1.78, 1.00 (reference), 1.59, 3.11 and 3.30, respectively (P for trend, < 0.0001). The HR for the lowest quintile was significantly higher than that for the second quintile. Among participants with waist circumference of the lowest quintile, HOMA-B was lower in those who developed diabetes than in those who did not [33.1 (24.1,45.0) vs. 54.3 (37.9,74.6) median (interquartile range), P < 0.0001], but HOMA-IR did not differ between these groups. Conclusions, There was a J-shaped relationship between waist circumference and subsequent risk for Type 2 diabetes in relatively lean Japanese individuals; lower pancreatic B-cell function may also increase the risk of diabetes in very lean Japanese people. [source] Factors predictive of nephropathy in DCCT Type 1 diabetic patients with good or poor metabolic controlDIABETIC MEDICINE, Issue 7 2003L. Zhang Abstract Aims The study aim was to assess the time-related risk of developing diabetic nephropathy [albumin excretion rate (AER) , 40 mg/24 h] from baseline covariates in Type 1 diabetic patients with either good or poor metabolic control (MC). Methods Based on material from the Diabetes Control and Complications Trial study (n = 1441), patients were considered as under good or poor MC if their HbA1c mean level up to last visit fell in the lowest (, 6.9%) or highest (, 9.5%) quintile of the overall HbA1c distribution, respectively. Prevalence cases of nephropathy were excluded from the study. Survival analysis and Cox regression were applied to the data. Results Among patients with good MC (n = 277), 15% had developed nephropathy at the end of the study. Conversely, among patients with poor MC (n = 268), the proportion without the complication was 52%. When adjusting for MC, time to diabetic nephropathy was related to age (P < 0.0001), AER (P < 0.001), duration of diabetes (P < 0.005), body mass index (BMI) (P < 0.005), all at baseline, and to gender (P < 0.01). Patients with upper normal range AER levels, longer duration of diabetes and lower BMI were at higher risk, regardless of MC. The adverse effect of younger age on diabetic nephropathy was more marked in good than in poor MC. Although women tended to develop the complication more often under good MC, they appeared to be better protected under poor MC. Conclusions This study confirms occurrence of diabetic nephropathy under good MC and non-occurrence of the complication despite poor MC. It also demonstrates that some baseline covariates can affect, in a differential manner, time to diabetic nephropathy depending on MC. Diabet. Med. 20, 580,585 (2003) [source] The geography of hospital admission in a national health service with patient choiceHEALTH ECONOMICS, Issue 9 2010Daniele Fabbri Abstract Each year about 20% of the 10 million hospital inpatients in Italy get admitted to hospitals outside the Local Health Authority of residence. In this paper we carefully explore this phenomenon and estimate gravity equations for ,trade' in hospital care using a Poisson pseudo-maximum likelihood method. Consistency of the PPML estimator is guaranteed under the null of independence provided that the conditional mean is correctly specified. In our case we find that patients' flows are affected by network autocorrelation. We correct for it by relying upon spatial filtering. Our results suggest that the gravity model is a good framework for explaining patient mobility in most of the examined diagnostic groups. We find that the ability to restrain patients' outflows increases with the size of the pool of enrollees. Moreover, the ability to attract patients' inflows is reduced by the size of pool of enroless for all LHAs except for the very big LHAs. For LHAs in the top quintile of size of enrollees, the ability to attract inflows increases with the size of the pool. Copyright © 2010 John Wiley & Sons, Ltd. [source] The role of private providers in treating child diarrhoea in Latin AmericaHEALTH ECONOMICS, Issue 1 2008Hugh R. Waters Abstract Diarrhoeal disease, a leading cause of child mortality, disproportionately affects children in low-income countries , where private and non-governmental providers are often an important source of health care. We use 10 Living Standards Measurement Surveys from Latin America to model the choice of care for child diarrhoea in the private sector compared to the public sector. A total of 36.8% of children in the combined data set saw a private provider rather than a public one when taken for treatment. Each additional quintile of household economic status is associated with an increase of 6.5 percentage points in the probability that a child with diarrhoea is taken to a private provider (p<0.001). However, treatments provided in the private sector are manifestly of worse quality than in the public sector. A total of 33.0% of children visiting a public provider received Oral Rehydration Solution, compared to 13.7% of those visiting a private provider. Conversely, children treated by a private provider are more likely to receive drugs, most commonly unnecessary antibiotics. Ironically, when it comes to treatment for child diarrhoea, wealthier and better educated households in Latin America are paying for treatment in the private sector that is ineffective in comparison with treatments that are commonly and inexpensively available. Copyright © 2007 John Wiley & Sons, Ltd. [source] Semen quality and sedentary work positionINTERNATIONAL JOURNAL OF ANDROLOGY, Issue 1 2004Julie Støy Summary Increased scrotal temperature can, in experimental settings, markedly disturb the production of semen. Sedentary work position may increase the temperature of the scrotum, but previous studies have failed to determine whether changes in scrotal temperature caused by sedentary work actually do affect semen quality. This study was carried out to elucidate the possible harmful effects of sedentary work on sperm count and other semen characteristics. In 1981,1983 a semen sample was obtained from 3119 men who attended an infertility workup in one of four Danish fertility centres. A total of 2517 men returned a postal questionnaire with information on life style, leisure time activities, occupational history and job duties. Information on job specific work position was obtained from The Danish Work Environment Cohort study 1990 (DWECS). In this analysis DWECS data for a total of 1747 men was included from men aged 18,39 years with >30 h of work per week. For all job titles represented in the DWECS, the mean proportion of sedentary work was estimated. The sperm cell concentration was 30.6 million/mL among men in the quintile with lowest job specific sedentary work compared with 40.5 million/mL in the highest quintile. The difference was, however, not statistically significant. Stratification on infertility period, educational level of the man, fertility centre, and fertility-related disease of the spouse did not influence the results. The analyses do not suggest that sedentary work is a risk factor for abnormal semen characteristics. [source] Dietary intakes of ,-6 and ,-3 polyunsaturated fatty acids and the risk of breast cancerINTERNATIONAL JOURNAL OF CANCER, Issue 4 2009Anne C.M. Thiébaut Abstract Experimental studies suggest detrimental effects of ,-6 polyunsaturated fatty acids (PUFA), and beneficial effects of ,-3 PUFAs on mammary carcinogenesis, possibly in interaction with antioxidants. However, PUFA food sources are diverse in human diets and few epidemiologic studies have examined whether associations between dietary PUFAs and breast cancer risk vary according to food sources or antioxidant intakes. The relationship between individual PUFA intakes estimated from diet history questionnaires and breast cancer risk was examined among 56,007 French women. During 8 years of follow-up, 1,650 women developed invasive breast cancer. Breast cancer risk was not related to any dietary PUFA overall; however, opposite associations were seen according to food sources, suggesting other potential effects than PUFA per se. Breast cancer risk was inversely associated with ,-linolenic acid (ALA) intake from fruit and vegetables [highest vs. lowest quintile, hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.63, 0.88; p trend < 0.0001], and from vegetable oils (HR 0.83; 95% CI 0.71, 0.97; p trend 0.017). Conversely, breast cancer risk was positively related to ALA intake from nut mixes (p trend 0.004) and processed foods (p trend 0.068), as was total ALA intake among women in the highest quintile of dietary vitamin E (p trend 0.036). A significant interaction was also found between ,-6 and long-chain ,-3 PUFAs, with breast cancer risk inversely related to long-chain ,-3 PUFAs in women belonging to the highest quintile of ,-6 PUFAs (p interaction 0.042). These results emphasize the need to consider food sources, as well as interactions between fatty acids and with antioxidants, when evaluating associations between PUFA intakes and breast cancer risk. © 2008 Wiley-Liss, Inc. [source] Coffee, tea, caffeine and risk of breast cancer: A 22-year follow-upINTERNATIONAL JOURNAL OF CANCER, Issue 9 2008Davaasambuu Ganmaa Abstract The relation between consumption of coffee, tea and caffeine and risk of breast cancer remains unsettled. We examined data from a large, long-term cohort study to evaluate whether high intake of coffee and caffeine is associated with increased risk of breast cancer. This was a prospective cohort study with 85,987 female participants in the Nurses' Health Study. Consumption of coffee, tea and caffeine consumption was assessed in 1980, 1984, 1986, 1990, 1994, 1998 and the follow-up continued through 2002. We documented 5,272 cases of invasive breast cancer during 1,715,230 person-years. The multivariate relative risks (RRs) of breast cancer across categories of caffeinated coffee consumption were: 1.0 for <1cup/month (reference category), 1.01 (95% confidence interval: 0.92,1.12) for 1 month to 4.9 week, 0.92 (0.84,1.01) for 5 week to 1.9 days, 0.93 (0.85,1.02) for 2,3.9 days, 0.92 (0.82,1.03) for ,4 cups per day (p for trend = 0.14). Intakes of tea and decaffeinated coffee were also not significantly associated with risk of breast cancer. RRs (95% CI) for increasing quintiles of caffeine intake were 1.00, 0.98 (0.90,1.07), 0.92 (0.84,1.00), 0.94 (0.87,1.03) and 0.93 (0.85,1.01) (p for trend = 0.06). A significant inverse association of caffeine intake with breast cancers was observed among postmenopausal women; for the highest quintile of intake compared to the lowest RR 0.88 (95% CI = 0.79,0.97, p for trend = 0.03). We observed no substantial association between caffeinated and decaffeinated coffee and tea consumption and risk of breast cancer in the overall cohort. However, our results suggested a weak inverse association between caffeine-containing beverages and risk of postmenopausal breast cancer. © 2008 Wiley-Liss, Inc. [source] A case,control study on the dietary intake of mushrooms and breast cancer risk among Korean womenINTERNATIONAL JOURNAL OF CANCER, Issue 4 2008Seo Ah Hong Abstract To evaluate the association between dietary mushroom intake and breast cancer risk, a total of 362 women between the ages of 30 and 65 years who were histologically confirmed to have breast cancer were matched to controls by age (±2 years) and menopausal status. Mushroom intake was measured via a food frequency questionnaire that was administered by well-trained interviewers. The associations between the daily intake and the average consumption frequency of mushrooms with breast cancer risk were evaluated using matched data analysis. Both the daily intake (5th vs. 1st quintile, OR = 0.48, 95% CI = 0.30,0.78, p for trend 0.030) and the average consumption frequency of mushrooms (4th vs. 1st quartile, OR = 0.54, 95% CI = 0.35,0.82, p for trend 0.008) were inversely associated with breast cancer risk after adjustment for education, family history of breast cancer, regular exercise [,22.5 MET (metabolic equivalent)-hr/week], BMI (body mass index, Kg/m2), number of children and whether they are currently smoking, drinking or using multivitamin supplements. Further adjustments were made for energy-adjusted carbohydrate, soy protein, folate and vitamin E levels, which tended to attenuate these results. After a stratification was performed according to menopausal status, a strong inverse association was found in postmenopausal women (OR = 0.16, 95% CI = 0.04,0.54, p for trend = 0.0058 for daily intake; OR = 0.17, 95% CI = 0.05,0.54, p for trend = 0.0037 for average frequency), but not in premenopausal women. In conclusion, the consumption of dietary mushrooms may decrease breast cancer risk in postmenopausal women. © 2007 Wiley-Liss, Inc. [source] A prospective study of dietary flavonoid intake and incidence of epithelial ovarian cancerINTERNATIONAL JOURNAL OF CANCER, Issue 10 2007Margaret A. Gates Abstract Flavonoids are antioxidant compounds found in plants, including fruits, vegetables and tea. No prior prospective studies have examined the association between intake of flavonoids in the flavonol and flavone subclasses and ovarian cancer risk. We analyzed the association between intake of 5 common dietary flavonoids and incidence of epithelial ovarian cancer among 66,940 women in the Nurses' Health Study. We calculated each participant's intake of myricetin, kaempferol, quercetin, luteolin and apigenin from dietary data collected at multiple time points, and used Cox proportional hazards regression to model the incidence rate ratio (RR) of ovarian cancer for each quintile of intake. Our analysis included 347 cases diagnosed between 1984 and 2002, and 950,347 person-years of follow-up. There was no clear association between total intake of the 5 flavonoids examined and incidence of ovarian cancer (RR = 0.75 for the highest versus lowest quintile, 95% confidence interval [CI] = 0.51,1.09). However, there was a significant 40% decrease in ovarian cancer incidence for the highest versus lowest quintile of kaempferol intake (RR = 0.60, 95% CI = 0.42,0.87; p -trend = 0.002), and a significant 34% decrease in incidence for the highest versus lowest quintile of luteolin intake (RR = 0.66, 95% CI = 0.49,0.91; p -trend = 0.01). There was evidence of an inverse association with consumption of tea (nonherbal) and broccoli, the primary contributors to kaempferol intake in our population. These data suggest that dietary intake of certain flavonoids may reduce ovarian cancer risk, although additional prospective studies are needed to further evaluate this association. If confirmed, these results would provide an important target for ovarian cancer prevention. © 2007 Wiley-Liss, Inc. [source] Dietary patterns, the Alternate Healthy Eating Index and plasma sex hormone concentrations in postmenopausal womenINTERNATIONAL JOURNAL OF CANCER, Issue 4 2007Teresa T. Fung Abstract To evaluate the association between overall diet and sex hormones concentrations, we collected blood from 578 postmenopausal women ages 43 and 69 years in 1989 or 1990. Food intake was measured in 1990 via a food frequency questionnaire. We calculated the Alternate Healthy Eating Index (AHEI), and dietary patterns were identified by factor analysis. The cross-sectional association between diet and estrogens, sex hormone binding globulin (SHBG) were evaluated with linear regression and adjusted for energy and other potential confounders. We found a higher AHEI score was associated with lower concentrations of estradiol, free estradiol, and higher concentrations of SHBG. The prudent pattern, with higher intakes of fruits, vegetables, and whole grains, was not associated with any sex hormones. The Western pattern, which represents higher intakes of red and processed meats, refined grains, sweets and desserts, was associated with a higher level of estradiol and lower concentrations of SHBG. Further adjustment for BMI attenuated these results except for free estradiol (5th vs. 1st quintile = 0.09 vs. 0.11 pg/mL, p for trend = 0.03). In addition, the AHEI was inversely associated with estradiol among those with BMI > 25, and Western pattern with SHBG among those with BMI < 25. In conclusion, we observed inverse associations between the AHEI score and several estrogens, and it was positively associated with plasma levels of SHBG. In contrast, the Western pattern was positively associated with estrogen levels and inversely with SHBG. However, these associations appeared to be largely accounted for by BMI. © 2007 Wiley-Liss, Inc. [source] Micronutrients and the risk of renal cell cancer: A case-control study from ItalyINTERNATIONAL JOURNAL OF CANCER, Issue 4 2007Cristina Bosetti Abstract The role of various micronutrients on the risk of renal cell cancer (RCC) was examined in a multicentric case-control study from Italy, in which information on dietary habits were collected using a validated food-frequency questionnaire. Cases were 767 patients (494 men and 273 women) with incident, histologically confirmed RCC; controls were 1,534 subjects (988 men and 546 women) admitted to the same hospitals as cases for a wide spectrum of acute, nonneoplastic conditions. After allowing for energy and other major covariates, a significant inverse association was found for vitamin E (odds ratio, OR, for the highest quintile of intake versus the lowest one 0.56, 95% confidence interval, CI 0.41,0.75), and vitamin C (OR = 0.72, 95% CI = 0.54,0.96), although the trend in risk for vitamin C was of borderline significance. No significant trend of decreasing risk was found for other micronutrients analyzed, although for most of them the risk estimates were below unity for intakes above the lowest. The ORs for the upper quintile of intake when compared with the lowest one were 0.80 (95% confidence interval, CI = 0.59,1.08) for retinol, 0.82 (95% CI = 0.61,1.10) for ,-carotene, 0.90 (95% CI = 0.68,1.20) for ,-carotene, 0.94 (95% CI = 0.73,1.21) for ,-criptoxanthin, 0.85 (95% CI = 0.63,1.14) for lutein/zeaxanthin, 0.76 (95% CI = 0.57,1.01) for vitamin D, 0.75 (95% CI = 0.55,1.01) for thiamine, 0.88 (95% CI = 0.66,1.19) for riboflavin, 0.85 for vitamin B6 (95% CI = 0.64,1.13), 0.85 (95% CI = 0.64,1.12) for folate and 0.80 (95% CI = 0.60,1.07) for niacin. No meaningful associations emerged for lycopene (OR = 1.11). The present findings support a possible beneficial effect of vitamin E and C on RCC. © 2006 Wiley-Liss, Inc. [source] Prospective study of body mass index, height, physical activity and incidence of bladder cancer in US men and womenINTERNATIONAL JOURNAL OF CANCER, Issue 1 2007Crystal N. Holick Abstract We evaluated prospectively the association between body mass index (BMI), height, recreational physical activity and the risk of bladder cancer among US adults. Data were used from 2 ongoing cohorts, the Health Professionals Follow-up Study and the Nurses' Health Study, with 3,542,012 years of follow-up and 866 incident bladder cancer cases (men = 507; women = 359) for the anthropometric analysis and 1,890,476 years of follow-up and 706 incident bladder cancer cases (men = 502; women = 204) for the physical activity analysis. Cox proportional hazard models were used to estimate incidence rate ratios (RR) and 95% confidence intervals (CI) between BMI, height, physical activity and bladder cancer risk adjusting for age, pack-years of cigarette smoking and current smoking. Estimates from each cohort were pooled using a random-effects model. We observed no association between baseline BMI and bladder cancer risk, even when we compared a BMI of ,30 kg/m2 to a BMI of 18,22.9 kg/m2 [pooled multivariate (MV) RR, 1.16; 95% CI: 0.89,1.52]. A weak, but statistically significant, association was observed for the same comparison after excluding bladder cancer cases diagnosed within the first 4 years of follow-up (pooled MV RR, 1.33; 95% CI: 1.01,1.76). Height was not related to bladder cancer risk (pooled MV RR, 0.82; 95% CI: 0.65,1.03, top vs. bottom quintile). Total recreational physical activity also was not associated with the risk of bladder cancer (pooled MV RR, 0.97; 95% CI: 0.77,1.24, top vs. bottom quintile). Our findings do not support a role for BMI, height or physical activity in bladder carcinogenesis. © 2006 Wiley-Liss, Inc. [source] Dietary acrylamide and human cancerINTERNATIONAL JOURNAL OF CANCER, Issue 2 2006Claudio Pelucchi Abstract Low levels of acrylamide have been found in several foods cooked at high temperatures. While there is sufficient evidence for the carcinogenicity of acrylamide in experimental animals, the few epidemiologic studies conducted to date on occupational and dietary exposure to acrylamide have found no consistent evidence of association with human cancer risk. Using data from an integrated network of Italian and Swiss hospital-based case-control studies, we analyzed the relation between dietary acrylamide intake and cancers of the oral cavity and pharynx (749 cases, 1,772 controls), esophagus (395 cases, 1,066 controls), large bowel (1,394 cases of colon, 886 cases of rectal cancer, 4,765 controls), larynx (527 cases, 1,297 controls), breast (2,900 cases, 3,122 controls), ovary (1,031 cases, 2,411 controls) and prostate (1,294 cases, 1,451 controls). All the studies included incident, histologically confirmed cancer cases and controls admitted to the same network of hospitals for acute nonneoplastic conditions. We calculated odds ratios (ORs) using multivariate logistic regression models, adjusted for energy intake and other major covariates of interest. The ORs for the highest versus the lowest quintile of acrylamide intake were 1.12 (95% CI = 0.76,1.66) for cancer of the oral cavity/pharynx, 1.10 (95% CI = 0.65,1.86) for esophageal, 0.97 (95% CI = 0.80,1.18) for colorectal, 1.23 (95% CI = 0.80,1.90) for laryngeal, 1.06 (95% CI = 0.88,1.28) for breast, 0.97 (95% CI = 0.73,1.31) for ovarian and 0.92 (95% CI = 0.69,1.23) for prostate cancer. None of the trend in risk was significant. This uniquely large and comprehensive data set does not show any consistent association between intake of acrylamide and the risk of breast and several other common cancers. © 2005 Wiley-Liss, Inc. [source] Prediagnostic levels of C-peptide, IGF-I, IGFBP -1, -2 and -3 and risk of endometrial cancer,INTERNATIONAL JOURNAL OF CANCER, Issue 2 2004Annekatrin Lukanova Abstract Conditions related to chronic hyperinsulinemia, such as obesity, noninsulin dependent diabetes mellitus and polycystic ovary syndrome, are associated with an increased risk of endometrial cancer. Elevated plasma IGF-I and decreased levels of IGF-binding proteins have been shown to be associated with increased risk of several cancer types that are frequent in affluent societies. We investigated for the first time in a prospective study the association of pre-diagnostic blood concentrations of C-peptide (a marker of pancreatic insulin production), IGF-I, IGFBP-1, -2 and -3 with endometrial cancer risk. A case-control study was nested within 3 cohorts in New York (USA), Umeå (Sweden) and Milan (Italy). It included 166 women with primary invasive endometrial cancer and 315 matched controls, of which 44 case and 78 control subjects were premenopausal at recruitment. Endometrial cancer risk increased with increasing levels of C-peptide (ptrend = 0.0002), up to an odds ratio (OR) of 4.76 [95% confidence interval (CI) = 1.91,11.8] for the highest quintile. This association remained after adjustment for BMI and other confounders [OR for the top quintile = 4.40 (1.65,11.7)]. IGFBP-1 levels were inversely related to endometrial cancer [ptrend = 0.002; OR in the upper quintile = 0.30 (0.15,0.62)], but the association was weakened and lost statistical significance after adjustment for confounders [ptrend = 0.06; OR in the upper quintile = 0.49 (0.22,1.07)]. Risk was unrelated to levels of IGF-I, IGFBP-2 and IGFBP-3. Chronic hyperinsulinemia, as reflected by increased circulating C-peptide, is associated with increased endometrial cancer risk. Decrease in the prevalence of chronic hyperinsulinemia, through changes in lifestyle or medication, is expected to prevent endometrial cancer. © 2003 Wiley-Liss, Inc. [source] Trends in suicide from drug overdose in the elderly in England and Wales, 1993,1999INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 5 2002Rajen Shah Abstract Background Drug overdose is a common method of suicide in the elderly. Hence, an understanding of current trends in epidemiology of these deaths is important when considering measures to decrease suicide rates. Methods Analysis of the Office for National Statistics (ONS) database of deaths from overdose and poisoning. Suicide and undetermined deaths from drug overdose between 1993,1999 in the over 65 year olds were studied. Socio-demographic data from the four drug groups most commonly used in overdose were extracted, and age and sex specific mortality rates calculated. Enumeration districts were ranked into five quintiles based on their Carstairs scores, and death rates in each quintile for men and women calculated. Results There were 1864 deaths from drug overdose during the study period. Suicide and undetermined death rates from drug overdose remained stable between 1993,1999. Drugs most commonly used in overdose were (in order) paracetamol (and related compounds), benzodiazepines, antidepressants, and opiates. Women comprised 62% of deaths. Death rates increased with age, with highest rates in men over 75 (37.7 deaths per million). Benzodiazepines showed the most marked increase with age. Co-proxamol comprised 32% of deaths from paracetamol compounds, and 95% of antidepressant deaths were due to tricyclic antidepressants. There was no association in women between Carstairs area deprivation and suicide rates; in men rates were highest in the most deprived areas. Conclusion Suicides in the over 65 year olds may be decreased by changes in prescription practice. Paracetamol, co-proxamol, tricyclic antidepressants and benzodiazepines should be prescribed with caution to the elderly with depression or at high risk of depression. Copyright © 2002 John Wiley & Sons, Ltd. [source] Endogenous Estrogen Levels and the Effects of Ultra-Low-Dose Transdermal Estradiol Therapy on Bone Turnover and BMD in Postmenopausal Women,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 11 2007Alison J Huang Abstract In a randomized controlled trial of a 0.014 mg/d transdermal estradiol patch, serum bone turnover markers decreased to a greater degree in postmenopausal women with lower versus higher endogenous estradiol levels. This suggests that the protective effects of ultra-low-dose estrogen therapy on the postmenopausal skeletal health may depend critically on women's endogenous estrogen levels before treatment. Introduction: Postmenopausal women with very low or undetectable estradiol levels have lower BMD, increased bone turnover, and increased risk of hip and vertebral fracture. We assessed whether the effects of ultra-low-dose 0.014 mg/d transdermal estradiol (Menostar; Berlex, Montvale, NJ, USA) on bone turnover and BMD are influenced by endogenous estradiol levels. Materials and Methods: We analyzed data from postmenopausal women (mean age, 66 yr) randomized to an 0.014-mg/d transdermal estradiol patch or placebo in the ultra-low-dose transdermal estrogen (ULTRA) trial. The free estradiol index (FEI), calculated as the ratio of total estradiol (by mass spectometry) to sex hormone-binding globulin (SHBG; by immunoradiometric assay) × 100, was used to estimate bioavailable estradiol at baseline. Among the 382 women who adhered to ,80% of study medication, we examined change in serum osteocalcin and bone-specific alkaline phosphatase levels at 12 mo and total hip and lumbar spine BMD at 24 mo in each quintile of FEI. Results: Compared with women in the highest quintile of FEI, those in the lowest quintile of FEI had a 26% greater reduction in bone-specific alkaline phosphatase and 15% greater reduction in osteocalcin in response to ultra-low estradiol treatment (p for trend across quintiles < 0.05). There was a trend toward greater improvement in total hip BMD (p = 0.06) but not spine BMD (p = 0.90) in those with lower versus higher FEI levels. Conclusions: The beneficial effects of ultra-low-dose 0.014-mg/d transdermal estrogen therapy on skeletal health may depend critically on women's endogenous estrogen levels before treatment. [source] Serum concentrations of vitamin D and parathyroid hormone and prevalent metabolic syndrome among adults in the United StatesJOURNAL OF DIABETES, Issue 4 2009Earl S. FORD Abstract Background:, Some reports suggest that concentrations of vitamin D are inversely, whereas concentrations of parathyroid hormone (PTH) are directly, associated with prevalent metabolic syndrome. Because of lingering uncertainty about these associations, we examined the cross-sectional associations between serum concentrations of 25-hydroxyvitamin D3 and PTH with metabolic syndrome in a representative sample of adults in the US. Methods:, We used data from 1705 participants in the 2005,2006 National Health and Nutrition Examination Survey. Vitamin D was measured by radioimmunoassay, whereas PTH was measured using an electrochemiluminescent process. Results:, The mean concentration of vitamin D for participants with and without metabolic syndrome was 20.3 and 22.9 ng/mL, respectively (P = 0.001). The mean concentration of PTH for participants with and without metabolic syndrome was 44.5 and 41.0 pg/mL, respectively (P = 0.002). The age-adjusted mean concentrations of vitamin D (P for linear trend <0.001) decreased linearly, whereas PTH (P for linear trend = 0.002) increased linearly, as the number of components of metabolic syndrome increased. After adjusting for age, gender, physical activity, urinary albumin creatinine ratio, and concentrations of C-reactive protein and calcium, concentrations in the highest quintile of vitamin D [prevalence ratio (PR) = 0.59; 95% confidence interval (CI) 0.44,0.79], but not PTH (PR = 1.18; 95% CI 0.97,1.43), was significantly associated with prevalent metabolic syndrome. Conclusion:, Concentrations of vitamin D, but not PTH, were significantly associated with prevalent metabolic syndrome among US adults. [source] Birth weight and cardiovascular risk factors in a cohort followed until 80 years of age: the study of men born in 1913JOURNAL OF INTERNAL MEDICINE, Issue 2 2004M. Eriksson Abstract. Objectives., To analyse whether there is a relation-ship between birth weight and cardiovascular risk factors given the influence of potential modifying factors from birth time, former generations and adult life. Design., Population-based cohort followed until 80 years of age. Setting., Sweden. Subjects., A total of 478 singleton men born in 1913 and participating in a population study in Gothenburg, Sweden, from age 50. Main outcome measures., Systolic blood pressure (SBP), antihypertensive treatment, incident diabetes mellitus, and serum total cholesterol, serum triglycerides and waist circumference as both continuous variables and in the highest quintiles of their distributions. Results., After adjustment for the influence of birth time variables, hereditary factors and anthropometric and socio-economic adult life variables, SBP decreased by 3.7 mmHg per 1000 g increase of birth weight, the prevalence of antihypertensive treatment decreased by 32%, diabetes decreased by 53%, serum total cholesterol decreased by 0.20 mmol L,1 and being in the top quintile of serum cholesterol decreased by 23%. The population risk percentage due to a birth weight ,3000 g was for all three outcomes 3.8% and for antihypertensive treatment, diabetes and cholesterol 0.2, 18 and 2.5%, respectively. Conclusions., Low birth weight thus seems to affect the development of increasing SBP, antihypertensive treatment, diabetes and high cholesterol even when potential effect modifiers from birth time, former generations and adult life were taken into account. In the general population, the risk percentage due to a birth weight ,3000 g was largest for diabetes. [source] Alcohol and Atherosclerotic Vascular Disease Risk Factors in French Men: Relationships Are Linear, J-Shaped, and U-ShapedALCOHOLISM, Issue 1 2005Philippe Rouillier Background: Although it is well admitted that alcohol displays a U-shaped relationship with atherosclerotic vascular disease, individual relationships between alcohol and atherosclerosis risk factors may be different and have not been determined precisely for several of them. Methods: A cross-sectional study within the SU.VI.MAX French cohort study was performed to assess the curve of potential relationships between alcohol and atherosclerosis risk factors in 2126 healthy men. Mean daily alcohol intake was derived from 37 alcoholic beverages in twelve 24-hr dietary recalls. Logistic models were adjusted for age. Results: Apolipoprotein B (ApoB), fasting glucose, body mass index, waist-to-hip ratio, and waist circumference displayed a linear relationship with alcohol. The odds ratios and 95% confidence intervals associated with abnormal values of the markers for the highest quintile of alcohol intake were 1.45 (1.06,1.97) for ApoB, 1.98 (1.40,2.80) for fasting glucose, and 1.74 (1.30,2.34) for body mass index. An inverse J-shaped relationship was assumed for ApoA1 and ApoB/ApoA1 ratio, whereas a U-shaped relationship was observed for serum triglycerides and mixed hyperlipidemia. Only the highest quintile of alcohol was associated with hypertension, although the test for linearity was also significant. No association was observed for Lp(a) or homocysteine. Associations were unmodified by further adjustment for carbohydrates, fiber, lipids, tobacco, or exercise. Conclusions: The aggregate of the disparate alcohol risk factor relationships suggests probable net benefit at 15 to 25 g of alcohol/day. [source] Dietary patterns and adult asthma: population-based case,control studyALLERGY, Issue 5 2010I. Bakolis To cite this article: Bakolis I, Hooper R, Thompson RL, Shaheen SO. Dietary patterns and adult asthma: population-based case,control study. Allergy 2010; 65: 606,615. Abstract Background:, Epidemiological studies of diet and asthma have focused on relations with intakes of individual nutrients and foods and evidence has been conflicting. Few studies have examined associations with dietary patterns. Methods:, We carried out a population-based case,control study of asthma in adults aged between 16 and 50 in South London, UK. Information about usual diet was obtained by food frequency questionnaire and we used principal components analysis to define five dietary patterns in controls. We used logistic and linear regression, controlling for confounders, to relate these patterns to asthma, asthma severity, rhinitis and chronic bronchitis in 599 cases and 854 controls. Results:, Overall, there was weak evidence that a ,vegetarian' dietary pattern was positively associated with asthma [adjusted odds ratio comparing top vs bottom quintile of pattern score 1.43 (95% CI: 0.93,2.20), P trend 0.075], and a ,traditional' pattern (meat and vegetables) was negatively associated [OR 0.68 (0.45,1.03), P trend 0.071]. These associations were stronger amongst nonsupplement users (P trend 0.030 and 0.001, respectively), and the association with the ,vegetarian' pattern was stronger amongst whites (P trend 0.008). No associations were observed with asthma severity. A ,prudent' dietary pattern (wholemeal bread, fish and vegetables) was positively associated with chronic bronchitis [OR 2.61 (1.13,6.05), P trend 0.025], especially amongst nonsupplement users (P trend 0.002). Conclusions:, Overall there were no clear relations between dietary patterns and adult asthma; associations in nonsupplement users and whites require confirmation. The finding for chronic bronchitis was unexpected and also requires replication. [source] The relationship between uric acid levels and Huntington's disease progression,MOVEMENT DISORDERS, Issue 2 2010Peggy Auinger MS Abstract Uric acid (UA) may be associated with the progression of Parkinson's disease and related neurodegenerative conditions; however, its association with Huntington's disease (HD) progression has not been explored. A secondary analysis of 347 subjects from the CARE-HD clinical trial was performed to examine the relationship between baseline UA levels and the level of functional decline in HD. Outcomes included change in scores at 30 months for the Unified Huntington's Disease Rating Scale components. There was less worsening of total functional capacity over time with increasing baseline UA levels (adjusted mean worsening in scores: 3.17, 2.99, 2.95, 2.28, 2.21, from lowest to highest UA quintile, P = 0.03). These data suggest a possible association between higher UA levels and slower HD progression, particularly as measured by total functional capacity. If confirmed, UA could be an important predictor and potentially modifiable factor affecting the rate of HD progression. © 2009 Movement Disorder Society [source] Disparities in the prevalence of cognitive delay: how early do they appear?PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 3 2009Marianne M. Hillemeier Summary Cognitively delayed children are at risk for poor mental and physical health throughout their lives. The economically disadvantaged and some race/ethnic groups are more likely to experience cognitive delay, but the age at which delays first emerge and the underlying mechanisms responsible for disparities are not well understood. The objective of this study was to determine when sociodemographic disparities in cognitive functioning emerge, and identify predictors of low cognitive functioning in early childhood. Data were from 7308 singleton and 1463 multiple births in the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), a nationally representative cohort of children born in the USA in 2001. Multiple logistic regression analyses examined associations between sociodemographic characteristics and low cognitive functioning at 9 and 24 months, and tested whether gestational and birth-related factors mediate these associations. Sociodemographic characteristics were statistically significant predictors of low cognitive functioning among singletons at 24 months, including the three lowest quintiles of socio-economic status [lowest quintile, odds ratio (OR) = 2.7, 95% confidence interval [CI][1.7, 4.1]], non-white race/ethnicity (African American OR = 1.8 [95% CI 1.3, 2.5], Hispanic OR = 2.3 [95% CI 1.6, 3.2]), and gender (male OR = 2.1, [95% CI 1.7, 2.5]). Gestational and birth characteristics associated with low cognitive function at 9 months included very low and moderately low birthweight (OR = 55.0 [95% CI 28.3, 107.9] and OR = 3.6 [95% CI 2.6, 5.1]), respectively, and very preterm and moderately preterm delivery (OR = 3.6 [95% CI 2.0, 6.7] and OR = 2.4 [95% CI 1.7, 3.5]), respectively, but they had weaker effects by 24 months (ORs for birthweight: 3.7 [95% CI 2.3, 5.9] and 1.8 [95% CI 1.4, 2.3]; ORs for preterm: 1.8 [95% CI 1.1, 2.9] and 0.9 [95% CI 0.7, 1.3]). Results for multiple births were similar. Sociodemographic disparities in poor cognitive functioning emerged by 24 months of age, but were not mediated by gestational or birth characteristics. Further investigation of processes whereby social disadvantage adversely affects development prior to 24 months is needed. [source] Adiponectin and type 2 diabetes in Samoan adultsAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 3 2009Julia R. Dibello Objective: Previous studies have established an association between adiponectin and type 2 diabetes. It is unclear whether adiponectin will be useful among Samoan Islanders, characterized by markedly elevated levels of obesity, in differentiating those at risk of developing type 2 diabetes. Methods: Cross-sectional, genetic epidemiology study of obesity in American Samoa and Samoa 2002,2003 (n = 1,599). Logistic regression provided adjusted odds ratios and 95% confidence intervals for the association between adiponectin, diabetes, and prediabetes (impaired fasting glucose). Results: There is a significant decreasing trend in the odds of diabetes and prediabetes across increasing quintiles of adiponectin with an OR of 2.8 (95% CI: 1.6, 5.0) and 2.9 (95% CI: 1.5, 5.7), respectively, in the lowest relative to the highest quintile of adiponectin (P -for-trend = 0.004 and 0.001). Conclusions: Adiponectin is an important correlate, independent of other risk factors, of the pathogenesis of type 2 diabetes among Samoan islanders and may help distinguish those at higher risk of developing this disease. Am. J. Hum. Biol. 2009. © 2008 Wiley-Liss, Inc. [source] Latin America and the Social Contract: Patterns of Social Spending and TaxationPOPULATION AND DEVELOPMENT REVIEW, Issue 4 2009Karla Breceda This article analyzes the incidence of social spending and taxation by income quintile for seven Latin American countries, the United Kingdom, and the United States. Absolute levels of social spending in Latin America are fairly flat across income quintiles, a pattern similar to that in the United States and differing from the more progressive pattern of spending in the United Kingdom. The structure of taxation in Latin America is also similar to that of the United States. Because of high income inequality in Latin America and the US, the rich bear of most the burden, whereas the United Kingdom taxes the middle class to a greater extent. The analysis suggests that many Latin American countries are trapped in a vicious cycle in which the rich resist the expansion of the welfare state (because they bear most of its tax burden without receiving commensurate benefits), and their opposition to its expansion in turn maintains long-term inequalities. [source] Prospective study of caffeine consumption and risk of Parkinson's disease in men and womenANNALS OF NEUROLOGY, Issue 1 2001Alberto Ascherio MD, DrPH Results of case-control studies and of a prospective investigation in men suggest that consumption of coffee could protect against the risk of Parkinson's disease, but the active constituent is not clear. To address the hypothesis that caffeine is protective against Parkinson's disease, we examined the relationship of coffee and caffeine consumption to the risk of this disease among participants in 2 ongoing cohorts, the Health Professionals' Follow-Up Study (HPFS) and the Nurses' Health Study (NHS). The study population comprised 47,351 men and 88,565 women who were free of Parkinson's disease, stroke, or cancer at baseline. A comprehensive life style and dietary questionnaire was completed by the participants at baseline and updated every 2,4 years. During the follow-up (10 years in men, 16 years in women), we documented a total of 288 incident cases of Parkinson's disease. Among men, after adjustment for age and smoking, the relative risk of Parkinson's disease was 0.42 (95% CI: 0.23,0.78; p for trend < 0.001) for men in the top one-fifth of caffeine intake compared to those in the bottom one-fifth. An inverse association was also observed with consumption of coffee (p for trend = 0.004), caffeine from noncoffee sources (p for trend < 0.001), and tea (p for trend = 0.02) but not decaffeinated coffee. Among women, the relationship between caffeine or coffee intake and risk of Parkinson's disease was U-shaped, with the lowest risk observed at moderate intakes (1,3 cups of coffee/day, or the third quintile of caffeine consumption). These results support a possible protective effect of moderate doses of caffeine on risk of Parkinson's disease. [source] Systemic lupus erythematosus in a multiethnic US cohort: XXXIV.ARTHRITIS & RHEUMATISM, Issue 6 2006Deficient mannose-binding lectin exon 1 polymorphisms are associated with cerebrovascular but not with other arterial thrombotic events Objective To study the association between deficient mannose-binding lectin (MBL) genotypes and arterial thrombotic events in systemic lupus erythematosus (SLE). Methods Patients with SLE of Hispanic, African American, and Caucasian ethnicity from LUMINA (LUpus in MInorities, NAture versus nurture), a multiethnic, longitudinal study of outcome, were studied. Arterial thrombotic events (myocardial infarction, angina, coronary artery bypass graft surgery, stroke, claudication, gangrene, or tissue loss and/or peripheral arterial thrombosis) that occurred after diagnosis were recorded. Genotyping for MBL gene polymorphisms was performed and their distribution was compared between patients who did and did not have thrombotic events. Results There were 58 events (21 cardiovascular, 27 cerebrovascular, and 10 peripheral vascular) in 48 patients. Patients who had thrombotic events were older and were more likely to be smokers, to have more severe disease, and to have accrued more damage overall. Also, a larger proportion of these patients had C-reactive protein values in the highest quintile of distribution. No significant difference in arterial thrombotic events was found in patients homozygous for MBL-deficient alleles compared with others. Similar results were seen within ethnic groups. Caucasians who developed potential thrombotic events exhibited a higher frequency of MBL-deficient alleles, but the difference was not statistically significant for all events together or for cardiovascular and cerebrovascular events combined. However, when only the cerebrovascular events were considered, the difference became statistically significant. Conclusion Age, smoking, and measures of activity and damage were associated with arterial thrombotic events in patients with SLE, but MBL-deficient genotypes were not, with cerebrovascular events in Caucasians being the exception. The relationship between MBL-variant alleles and arterial thrombotic events may exist only within select ethnic groups and event types. [source] Socio-economic gradients in self-reported diabetes for Indigenous and non-Indigenous Australians aged 18,64AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2010Joan Cunningham Abstract Objective: To examine and compare socio-economic gradients in diabetes among Indigenous and non-Indigenous Australians. Methods: I analysed weighted data on self-reported diabetes and a range of socio-economic status (SES) measures for 5,417 Indigenous and 15,432 non-Indigenous adults aged 18,64 years from two nationally representative surveys conducted in parallel by the Australian Bureau of Statistics in 2004,05. Results: After adjusting for age, diabetes prevalence was significantly higher among those of lower SES in both Indigenous and non-Indigenous populations. The age- and sex-adjusted odds ratios (OR) for diabetes for the lowest versus the highest SES group were similar for the two populations on many variables. For example, the OR for the lowest quintile of equivalised household income (compared with quintiles 3,5 combined) was 2.3 (95% CI 1.6,3.4) for the Indigenous population and 2.0 (95% CI 1.5,2.8) for the non-Indigenous population. However, Indigenous people of high SES had greater diabetes prevalence than low SES non-Indigenous people on every SES measure examined. Conclusion: Socio-economic status explains some but not all of the difference in diabetes prevalence between Indigenous and non-Indigenous Australians. Other factors that may operate across the socio-economic spectrum, such as racism, stress, loss and grief, may also be relevant and warrant further examination. Implications: Indigenous Australians do not constitute a homogeneous group with respect to socio-economic status or diabetes prevalence, and this diversity must be recognised in developing measures to redress Indigenous health disadvantage. [source] Assessing the effects of the introduction of the New Zealand Smokefree Environment Act 2003 on Acute Myocardial Infarction hospital admissions in Christchurch, New ZealandAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 6 2009Ross Barnett Abstract Objective: To examine trends in Acute Myocardial Infarction (AMI) hospital admissions in Christchurch, New Zealand before and after the implementation of the New Zealand Smokefree Environments Act 2003 in December 2004. Methods: Data on AMI hospital admissions to Christchurch Public Hospital were extracted for the period 2003 to 2006. Poisson regression was used to calculate rate ratios by comparing for AMI rates of hospital admissions before (2003/04) and after (2005/06) the introduction of the Smokefree legislation, and to assess whether there was a significant change over time. Results: The introduction of the smokefree legislation was associated with a 5% reduction in AMI admissions. The 55-74 age group recorded the greatest decrease in admissions (9%) and this figure rose to 13% among never smokers in this group. Reductions were more marked for men. Adding the effects of area deprivation increased the reduction to 21% among 55-74 year olds living in more affluent (quintile 2) areas. Overall however, the statistical association of changing levels of AMI admissions with smoking status and with deprivation was not consistently significant. Conclusion: At this early stage following the smokefree legislation, there are hints emerging of a positive impact on AMI admissions but these suggestions cannot yet be treated with certainty. Further research could usefully evaluate the longer-term effects of smoking legislation on the prevalence of smoking and exposure to second hand smoke, especially in more deprived urban communities. [source] A whole of population-based series of radical prostatectomy in Victoria, 1995 to 2000AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 6 2009Damien Bolton Abstract Objective: Radical prostatectomy (RP) as a first line treatment of prostate cancer was rare prior to the advent of prostate specific antigen (PSA) testing, yet little is known of its use and outcomes in a population setting. We described baseline characteristics of cases in the Victorian Radical Prostatectomy Register (VRPR), investigated possible associations between demographic characteristics and characteristics at diagnosis and at surgery and trends over time. Methods: The VRPR is a population-based series of all RPs performed in Victoria from July 1995 to December 2000 (n=2,154). Results: On average, socio-economic status for cases was higher than for the general Victorian population (34% vs 20% in the highest quintile respectively, p<0.0001). The proportion of PSA-detected cases increased from 53% in 1995 to 79% in 2000 (p for linear trend=0.0004). Age at surgery and PSA levels at diagnosis decreased over time (p=0.006 and p=0.04 respectively). The proportion of cases with Gleason score ,5 from RP decreased from 35% in 1995 to 14% in 2000, while cases with Gleason score 6-7 increased from 60% to 79%. Similar trends were observed for Gleason score from biopsy. We found little evidence of significant trends over time in other pathological characteristics relevant to prognosis. Conclusion and Implications: The VRPR provides a unique whole of population based description of radical prostatectomy in Victoria, confirms findings previously reported in single institution clinical series overseas such as migration to younger age at surgery and to Gleason scores 6 to 7, and provides a resource for evaluating RP outcomes in the future. [source] Avoidable mortality in Victoria between 1979 and 2001AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 1 2007Leonard S. Piers Objective:To describe trends in avoidable mortality (AM) in Victoria by sex, degree of socio-economic disadvantage and remoteness. Methods:The analysis is based on mortality and population data for 1979,2001 supplied by the Australian Bureau of Statistics (ABS) for Victoria. Total and disease-specific AM rates were age standardised using the direct method. For the period between 1997 and 2001, comparisons of total AM rates by sex were made between metropolitan and rural local government areas (LGAs), and between LGAs grouped into quintiles based on socio-economic disadvantage and categories of remoteness. Results:Total AM rates declined significantly (p<0.05) in both males and females between 1979 and 2001, but were significantly higher in males compared with females. Total AM rates were significantly higher in rural compared with metropolitan LGAs, from 1997 to 2001 in males and in 1998 in females. Total AM rates in the least disadvantaged quintile were significantly lower than those in the most disadvantaged quintile over the entire five-year period in males and in three years in females. Total AM rates were highest in remote LGAs and lowest in highly accessible LGAs. There were significant declines in ischaemic heart disease, stroke and road traffic accident AM rates among males. In females, IHD, stroke, breast and colon cancer AM rates declined significantly. Conclusions and Implications:Despite large declines in AM in Victoria, there are significant differences in rates between the sexes and in the population based on socio-economic status or remoteness. These results provide opportunities for policy makers to prioritise public health and health services interventions, targeting population groups and specific disease conditions to reduce health inequalities. [source] | |||||||||||||||||||||||||||||||||||||