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Sectional Study (sectional + study)
Kinds of Sectional Study Selected AbstractsExploring potential associations of suicidal ideation and ideas of self-harm in patients with congestive heart failureDEPRESSION AND ANXIETY, Issue 8 2009Nicole Lossnitzer Ph.D. Abstract Objective: To determine the factors, which are associated with suicidal ideation and ideas of self-harm in patients with congestive heart failure (CHF). Methods: We examined 294 patients with documented CHF, New York Heart Association (NYHA) functional class II-IV, in a cross sectional study at three cardiac outpatient departments. Measures included self-reports of suicidal ideation and self-harm (PHQ-9), depression (SCID), health-related quality of life (SF-36), multimorbidity (CIRS-G), consumption of alcoholic beverages, as well as comprehensive clinical status. Data were analyzed using logistic regression analyses. Results: 50 patients (17.1%) reported experiencing suicidal ideation and/or ideas of self-harm on at least several days over the past two weeks. The final regression model revealed significant associations with health-related quality of life, physical component (odds ratio [OR] 0.56; 95% confidence interval [CI]: 0.35,0.91), and mental component (OR 0.50; 95% CI: 0.31,0.82), consumption of alcoholic beverages (OR 1.27; 95% CI: 1.05,1.54), first-episode depression (OR 3.92; 95% CI: 1.16,13.22), and lifetime depression (OR 10.89; 95% CI: 2.49,47.72). Age was only significant in the univariable (P=.03) regression analysis. NYHA functional class, left ventricular ejection fraction (LVEF), etiology of CHF, medication, cardiovascular interventions, multimorbidity, gender, and living situation were not significantly associated with suicidal ideation or ideas of self-harm. Conclusions: Lifetime depression, in particular, increases the risk of suicidal ideation and ideas of self-harm in CHF patients. Furthermore, the findings of our study underline the necessity of differentiating between first-episode and lifetime depression in CHF-patients in future research and clinical practice. Depression and Anxiety, 2009. © 2009 Wiley-Liss, Inc. [source] Hepatitis C virus risk behaviors within the partnerships of young injecting drug usersADDICTION, Issue 7 2010Judith A. Hahn ABSTRACT Aims Young injection drug users (IDU) are at high risk for hepatitis C virus (HCV). We sought to determine whether perceiving one's injecting partner to be HCV positive was associated with decreased odds of engaging in receptive needle/syringe sharing (RNS) or ancillary equipment sharing (AES) with that partner. Design Cross sectional study. Setting 2003 to 2007 in San Francisco. Participants 212 young (under age 30) IDU who were HCV antibody negative reported on 492 injecting partnerships. Measurements Self-reported RNS and AES within injecting partnerships. Findings RNS and AES (in the absence of RNS) occurred in 23% and 64% of injecting partnerships in the prior month. The odds of engaging in RNS were significantly lower for relationships in which the participant reported that his/her partner was HCV positive (odds ratio [OR] 0.49; 95% confidence interval [CI] 0.25,0.95). This association was attenuated when adjusted for reusing one's own needle/syringe (adjusted OR 0.57; 95% CI 0.28,1.15). The odds of engaging in AES were lower for participants who did not know the HCV status of their partner, only among non-sexual partnerships (OR 0.47; 95% CI 0.29,0.76). Conclusions Because perceiving one's partner to be HCV positive was associated with decreased RNS, increased HCV testing and partner disclosure may be warranted. AES was common and was decreased only among non-sexual partnerships in which the HCV status of the partner was not known. This suggests that interventions to reduce AES in young IDU must be widespread. [source] Haematological reference values in Spanish adolescents: the AVENA studyEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 6 2009Javier Romeo Abstract Objectives:, To provide reference values for haematological indices in Spanish adolescents according to age and gender. Methods:, A cross sectional study conducted in five Spanish cities was performed. Blood was drawn from a representative sample of 581 adolescents with age ranging from 13 to 17,18.5 yr. Age- and gender-specific means, standard deviations and percentiles were determined for the following parameters: total red blood cell counts (RBC), haemoglobin concentration (Hb), haematocrit percentage (Hct), mean corpuscular volume (MCV), mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, red cell distribution width and total white blood cell (WBC) counts as well as counts and percentage of neutrophils, lymphocytes, monocytes, eosinophils and basophils; platelet count (PLT), mean platelet volume and plateletcrit percentage. Results:, Younger male subjects presented lower RBC, Hb, Hct and MCV means that their older counterpart. By contrast these differences were not observed in female subjects. As expected, RBC, Hb and Hct mean values in males were found significantly higher than in girls for all studied age groups. No significant differences were observed in WBC by age and gender. PLT values gradually decreased with age, except for females aged 17,18.5 yr. Conclusion:, The present study provides reference data on the distribution of haematological indices of Spanish adolescents. These data can be useful biomarkers of the nutritional status in adolescents. [source] Health-care problems of Turner syndrome in the adult woman: a cross sectional study of a Victorian cohort and a case for transitionINTERNAL MEDICINE JOURNAL, Issue 1 2006C. C. Pedreira Abstract The aim of this study was to assess current care and to survey comorbidity in a cohort of 39 adult women with Turner syndrome in Victoria. Patients with Turner syndrome (TS) drift away from medical care as they achieve adulthood, despite the need for regular surveillance and management of associated conditions, which would reduce morbidity and prevent complications. Clinical assessment was undertaken for 39 women with TS, mean age 30.1 (±11.7) years and information was gathered through personal communication regarding past growth hormone use, oestrogen treatment, hearing loss and health problems. Twenty-four (63.2%) had regular follow-up, but only 17 (43.6%) had adequate recommended surveillance for comorbidities. Forty-three percent had two or more cardiovascular risk factors. Thirty-four (87.2%) were identified with one or more associated disorders. Uterine size was of normal adult dimensions in patients who had received oestrogen before age of 15 years. Adult care for adults with TS is suboptimal and assessment of comorbidities remains sporadic. Adequate transition guidelines and patient education are needed for long-term management of women with TS, to impact on quality of life and longevity. [source] Long term care staff beliefs about evidence based practices for the management of dementia and agitationINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 2 2009Liat Ayalon Abstract Context Despite a growing literature on effective interventions for Alzheimer's disease (AD) and agitation, the management of these conditions in long term care (LTC) often is inadequate. The goals of the present study were: (a) to evaluate existing beliefs about evidence based practices (EBP) for the management of Alzheimer's disease and agitation among LTC staff; and (b) to evaluate the contribution of demographic and attitudinal variables to LTC staff beliefs about these EBP. Method A cross sectional study of 371 LTC staff members completed an EBP questionnaire, a short demographic questionnaire, and an attitudinal questionnaire about AD and agitation. Results Paraprofessional caregivers, those of lower educational level, and ethnic minorities were more likely to be in disagreement with the EBP views examined in this study. Those in disagreement with the EBP views also reported a preference towards not working with residents with AD and agitation and a sense of helplessness associated with such work. Disagreement with EBP views was associated with both normalization and stigmatization of AD and agitation. Conclusions Paraprofessional caregivers, ethnic minorities, and people of lower educational level are most at need for educational activities about AD and neuropsychiatric symptoms. Educational efforts geared towards changing the belief system of LTC staff should target not only EBP but also information about AD and agitation as conditions that are deviant from the normal aging process, yet non-stigmatizing. It is expected that following EBP will empower staff and improve staff motivation to work with residents with AD and agitation. Copyright © 2008 John Wiley & Sons, Ltd. [source] Correlates of knowledge and beliefs about depression among long-term care staffINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2008Liat Ayalon Abstract Context Despite the high prevalence of depression in long-term care (LTC), it often is unrecognized and inadequately treated. Thus, the goals of the present study were to evaluate LTC staff characteristics that are associated with knowledge and beliefs about depression. Methods A cross sectional study of 371 LTC staff members completed a knowledge and beliefs about depression questionnaire, a short demographic questionnaire, a burden measure, and a questionnaire about attitudes associated with working with depressed residents. Results Relative to nurses, social workers, and activity staff, paraprofessional caregivers had a lower score on the depression measure and a higher score on the burden measure. Paraprofessional caregivers were more likely to view depression as a normal phenomenon, held less accurate beliefs about signs and symptoms of depression, and were less familiar with the effectiveness of specific treatments of depression. Conclusions Educational interventions about depression should be specifically geared to meet the needs of paraprofessional caregivers who provide the majority of care to LTC residents, yet possess less knowledge about depression and its treatments. Copyright © 2007 John Wiley & Sons, Ltd. [source] Depression levels in chronic orofacial pain patients: a pilot studyJOURNAL OF ORAL REHABILITATION, Issue 10 2004R. S. Tesch summary, The assessment of depressive behaviour in chronic pain patients is especially important, because depression is commonly associated with chronic pain. The aim of this pilot study was to compare depression levels between patients with head and neck cancer pain and temporomandibular disorders (TMD), and to determine whether there is an association between depression levels and chronic pain severity. This study was an observational and sectional study and the sample consisted of 40 patients, uniformly divided into those with chronic orofacial pain related to cancer and those with painful TMD classified with research diagnostic criteria for temporomandibular disorders (RDC/TMD) axis I. Depression levels, pain intensity and severity were assessed with RDC/TMD axis II. The study demonstrated statistically significant differences in depression levels present in the head and neck cancer pain group and the painful TMD group, with the occurrence of a moderate statistically significant correlation between depression levels and chronic pain severity. [source] Adherence to the Mediterranean diet and fresh fruit intake are associated with improved asthma controlALLERGY, Issue 7 2008R. Barros Background:, The traditional Mediterranean diet is claimed to possess antioxidant and immune-regulatory properties in several chronic diseases. Typical Mediterranean foods have recently been associated with improvement of symptoms of asthma and rhinitis in children. However the effect of adherence to Mediterranean diet on adult asthma outcomes is unknown. We aimed to investigate the association between adherence to Mediterranean diet and asthma control. Methods:, Cross sectional study of 174 asthmatics, mean (SD) age of 40 (15) years. The patients were defined as controlled, in contrast to noncontrolled, if they showed FEV1 , 80% of predicted, exhaled nitric oxide (NO) ,35 ppb, and Asthma Control Questionnaire score <1. Dietary intake was obtained by a food frequency questionnaire, and Mediterranean diet was assessed by alternate Mediterranean Diet (aMED) Score. Logistic regression models adjusting for confounders were performed to estimate the association between Mediterranean diet and asthma control. Results:, Controlled asthmatics (23%) had significantly higher aMED Score, intake of fresh fruit, and lower intake of ethanol compared to noncontrolled (77%). High adherence to Mediterranean diet reduced 78% the risk of noncontrolled asthma after adjusting for gender, age, education, inhaled corticosteroids and energy intake (OR = 0.22; 95% CI = 0.05,0.85; P -trend = 0.028). The higher intake of fresh fruit decreased the probability of having noncontrolled asthma (OR = 0.29; 95% CI = 0.10,0.83; P -trend = 0.015), while the higher intake of ethanol had the opposite effect (OR = 3.16; 95% CI = 1.10,9.11; P -trend = 0.035). Conclusion:, High adherence to traditional Mediterranean diet increased the likelihood of asthma to be under control in adults. The study introduces a novel link between diet and asthma control, as measured by symptoms, lung function and exhaled NO. [source] Unstimulated whole saliva flow rate in relation to sicca symptoms in HungaryORAL DISEASES, Issue 5 2008K Márton Objective:, To assess the prevalence of xerostomia and the related oral and extraoral dryness symptoms in Hungary, to evaluate the association of those symptoms with the unstimulated whole saliva (UWS) flow rate, and to find correlation between the level of UWS flow rate and the oral health status of the questioned patients. Subjects And Methods:, A total of 600 patients between the age of 18 and 92 years, 265 male, 335 female, were selected in accordance with the current regional age and residence distribution scheme of the Hungarian Statistical Office. A questionnaire was designed to determine the subjective presence or absence of the sicca symptoms. UWS flow rate and the dental and periodontal status were determined. Results:, The percentages of subjective symptoms in the questioned subjects were oral dryness, 34%; reduced salivation, 11%; mucous saliva, 15%; dysphagia, 13%; glossopyrosis, 7%; dysphonia, 31%; dysgeusia, 9%; nasal dryness, 32%; ocular dryness, 21%; itching, 40% and xeroderma, 60%. Vaginal dryness was 14%, vaginal itching was 16% in the interviewed women. The grade of xerostomia, dysphagia, tiredness, and additionally the gingival bleeding index showed a negative correlation with the UWS flow rate. After all decayed, missing and filled teeth (DMF-T) mean values, gingival bleeding index and plaque index were significantly higher in hyposalivators, compared with those who had normal flow rates Conclusion:, This cross sectional study, representative of the Hungarian population, clearly shows that one-third of the adult population suffers from xerostomia. The clinical severity of the xerostomia demonstrated a strong relationship with the lower levels of UWS flow rate. Reduced levels of UWS flow rate in this study were also shown to be associated with dysphagia, fatigue, and increased DMF-T numbers. The data show that oral dryness, its associated desiccation symptoms and its clinical manifestations are significant health problems in Hungary. [source] Total body bone measurements: A cross-sectional study in children with acute lymphoblastic leukemia during and following completion of therapyPEDIATRIC BLOOD & CANCER, Issue 1 2009Kara M. Kelly MD Abstract Background Abnormalities in bone mineral density (BMD) occur in children treated for acute lymphoblastic leukemia (ALL). However, BMD estimates have been performed using varied instruments, reference data, and interpretations. This exploratory cross sectional study to evaluate bone mass in children with ALL, uses an algorithm that serially adjusts for variables known to affect pediatric bone measures by dual energy X-ray absorptiometry (DXA), based on models developed in 1,218 healthy children and adolescents. Procedure Anthropometry, DXA scans, and factors with possible influence on bone mass were evaluated in 21 ALL patients receiving chemotherapy and 20 in the follow-up phase. Main outcome was treatment group differences in Z -scores for total body bone mineral content (BMC), bone area (Area), and areal BMD (aBMD). Results Mean Z -scores for the entire study population for BMC, Area, and aBMD were significantly less than zero. Among possible contributing factors, only calcium intake was a significant co-variate. Comparison between treatment groups showed that least-square mean Z -scores for patients on-therapy for at least 12 months were significantly lower than those off therapy for at least 12 months (P: 0.0008,0.044), except for BMC at last step of the algorithm (adjusted for sex, age, ethnicity, height, weight, and bone area). Conclusions Evaluation of total body DXA by this algorithm is consistent with better general bone status in those off-therapy. However, in this small exploratory study, the lack of significant difference between Z -scores for fully adjusted BMC in on- versus off-therapy groups suggests possible risk of low peak bone mass. Additional longitudinal evaluation is warranted. Pediatr Blood Cancer 2009;52:33,38. © 2008 Wiley-Liss, Inc. [source] Frequency and Correlates of Sexual Dysfunction in Women with Diabetes MellitusTHE JOURNAL OF SEXUAL MEDICINE, Issue 12 2009Anthonia Okeoghene Ogbera MPH, FACP ABSTRACT Introduction., Sexual dysfunction (SD) in women with diabetes mellitus (DM) is an important but understudied aspect of DM complications in women with DM. Aim., This report is an attempt to document the prevalence, clinical correlates, and determinants of SD in a cross sectional study of women with diabetes mellitus (DM). Main Outcome Measures., The main outcome measures were demographic, clinical parameters, psychological morbidity, and frequency of SD. Methods., A total of 58 married women with type 2 DM and 30 age-matched women who did not have DM had their sexual function and psychological status assessed using the Female Sexual Function Index (FSFI) and General Health questionnaires (GHQ 12) respectively. Glycemic control was assessed using glycosylated hemoglobin. Results., The prevalence of SD in women with DM and in the control population was 88% and 80%, respectively. The mean (standard deviation) FSFI score in the women with DM was significantly lower than that of the control group (16.2 [9.5] vs. 21 [8.5], P = 0.02). Women with DM attempted sex less frequently than those in the control group. Poor mental health status which was found to be associated with SD was noted more in women with DM than those in the control group. Conclusions., SD is high in women with and without DM. A possible determinant of SD in women with DM is psychological morbidity. Ogbera AO, Chinenye S, Akinlade A, Eregie A, and Awobusuyi J. Frequency and correlates of sexual dysfunction in women with diabetes mellitus. J Sex Med 2009;6:3401,3406. [source] Variations in Cervical IL-10 and IL-8 Concentrations Throughout Gestation in Normal PregnanciesAMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 6 2007Myriam Mondestin-Sorrentino Problem Data regarding cervical interleukin 18 (IL-8) and IL-10 concentrations during pregnancy is limited. Method of study This was a cross sectional study of healthy pregnant women. Specimens were collected from the cervical os secretions. IL-8 and IL-10 levels were measured by using enzyme-linked immunosorbent assay. Median (range) cytokine concentrations were derived for each trimester and compared across trimesters. The relationship between gestational age and cytokine levels was assessed by regression analysis. The mean of the ratios of IL-8 to IL-10 was compared in each trimester using anova. Results The median (range) IL-8 concentrations in cervical secretions were in pg/mL: 1562 (1210,4100), 2460 (1047,4688), 3660 (1451,4748) (P < 0.0021); the median (range) IL-10 concentrations in cervical secretions were in pg/mL: 38.3 (6.8,227.9), 10.9 (0,263.3), 9.5 (0,35.6); the mean IL10/IL-8 × 100 (+/, standard deviation) concentrations were: 3.33 ± 0.65, 1.47 ± 0.41, 0.38 ± 0.52 (P = 0.0035) during the first, second and third trimesters, respectively. Conclusion The patterns of cervical IL-8 concentration is inversely related to gestational age, and the ratio of IL-10/IL-8 decreases with advancing gestation. [source] Chromosomal aberrations in lymphocytes of employees in transformer and generator production exposed to electromagnetic fields and mineral oilBIOELECTROMAGNETICS, Issue 3 2001Knut Skyberg Abstract The objective was to study the risk of cytogenetic damage among high voltage laboratory workers exposed to electromagnetic fields and mineral oil. This is a cross sectional study of 24 exposed and 24 matched controls in a Norwegian transformer factory. The exposure group included employees in the high voltage laboratory and in the generator soldering department. Electric and magnetic fields and oil mist and vapor were measured. Blood samples were analyzed for chromosomal aberrations in cultured lymphocytes. In addition to conventional cultures, the lymphocytes were also treated with hydroxyurea and caffeine. This procedure inhibits DNA synthesis and repair in vitro, revealing in vivo genotoxic lesions that are repaired during conventional culturing. In conventional cultures, the exposure group and the controls showed similar values for all cytogenetic parameters. In the DNA synthesis- and repair-inhibited cultures, generator welders showed no differences compared to controls. Among high voltage laboratory testers, compared to the controls, the median number of chromatid breaks was doubled (5 vs. 2.5 per 50 cells; P<0.05) the median number of chromosome breaks was 2 vs. 0.5 (P>0.05) and the median number of aberrant cells was 5 vs. 3.5 (P<0.05). Further analysis of the inhibited culture data from this and a previous study indicated that years of exposure and smoking increase the risk of aberrations. We conclude that there was no increase in cytogenetic damage among exposed workers compared to controls in the conventional lymphocyte assay. In inhibited cultures, however, there were indications that electromagnetic fields in combination with mineral oil exposure may produce chromosomal aberrations. Bioelectromagnetics 22:150,160, 2001. © 2001 Wiley-Liss, Inc. [source] Cystatin-C and beta trace protein as markers of renal function in pregnancyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2005Ayub Akbari Objective To assess the validity of Cystatin-C (Cys-C) and beta trace protein (BTP) as clinical markers of glomerular filtration rate (GFR) in pregnant women. Design Prospective cross sectional study. Setting Obstetric unit of a tertiary care hospital. Population One hundred and thirty-seven normal pregnant women and 13 women postpartum. Methods Twenty-four hour creatinine clearance (CrCl), serum creatinine, Cys-C and BTP concentrations were measured on normal pregnant women in the first trimester (n= 5), second trimester (n= 68) and third trimester (n= 64) and in 13 women postpartum. Data are given as median (2.5th centile, 97.5th centile). Main outcome measures Serum concentrations of Cys-C and BTP compared with creatinine clearance and serum creatinine. Results The median serum creatinine throughout gestation was 53 ,mol/L (39, 71), and median CrCl was 143 mL/minute (91 to 216). Postpartum, creatinine rose to 74 ,mol/L (58, 86) and CrCl decreased to 104 mL/minute (71, 159). For Cys-C, the median concentration was 0.70 mg/L (0.46, 1.32), and 0.54 mg/L (0.36, 0.96) for BTP. Comparing the second and third trimesters, there was no significant difference between CrCl (median 145 vs 141 mL/minute) and BTP concentrations (median 0.51 vs 0.55 mg/L), while median Cys-C was significantly higher in the third trimester (0.61 vs 0.88 mg/L; P < 0.001). Unlike creatinine and BTP, Cys-C levels decreased to 0.72 mg/L (0.57, 0.95) postpartum. The only significant relationship of either of these markers to the standard used for GFR was between Cys-C and CrCl in the third trimester, and the correlation was weak (r= 0.27 for 1/Cys-C vs CrCl). Conclusion These data demonstrate that despite claims to the contrary, Cys-C is a poor marker of GFR during pregnancy. Similarly, BTP shows little promise. [source] Soy, fat and other dietary factors in relation to premenstrual symptoms in Japanese womenBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2004Chisato Nagata Objective To evaluate the relations of intakes of soy, fat and other dietary components to premenstrual symptoms. Design Cross sectional study. Setting Three colleges and two nursing schools. Population One hundred and eighty-nine Japanese women aged 19 to 34 years. Methods Intakes of nutrients and foods, including soy products and isoflavones, were estimated by a semiquantitative food frequency questionnaire. Change in menstrual cycle symptoms were assessed by the Moos Menstrual Distress Questionnaire (MDQ). Main outcome measures Spearman rank correlation of soy and other dietary factors with changes in MDQ scores between the follicular and the premenstrual phases after controlling for age, marital status, exercise, smoking status, age at menarche and number of days of bleeding. Results Neither soy product nor isoflavone intake was significantly associated with change in MDQ score in the premenstrual phase. Intakes of total, saturated and monounsaturated fats were significantly correlated with change in scores for total MDQ and subscale ,pain' in the premenstrual phase after controlling for the covariates. Intake of cereals/potatoes/starches was significantly inversely correlated with a change in total MDQ score in the premenstrual phase. Conclusions High intake of fats and low intake of foods with high concentration of carbohydrate may be associated with premenstrual symptoms. [source] Cross sectional study of automated blood pressure measurements throughout pregnancyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2004N. Ochsenbein-Kölble Objective To generate reliable new reference ranges for pregnancy blood pressure from a large population. Design A prospective cross sectional study. Setting Obstetric outpatient clinic, Zurich University Hospital. Sample Accurately dateable singleton pregnancies (Caucasian: n= 3234; Asian [predominantly from Sri Lanka, Thailand and the Philippines]: n= 577; Black n= 212). Methods Between January 1996 and February 2000 blood pressure was determined in 4023 pregnant women using an oscillometric automated device (Dinamap) according to British Hypertension Society recommendations. Women receiving antihypertensive medication were excluded. Main outcome measure Blood pressure. Results Only the means of duplicate measures at the booking visit (5,42 weeks) were used in the analysis. Mean blood pressure decreased from early to mid pregnancy before increasing to levels 4 mmHg higher at term than in early pregnancy. Values >130/80 and <90/50 mmHg were above the 95th and below the 5th centiles, respectively. Parity, age and body mass index were significant determinants in Caucasians. Blood pressure was slightly lower in Asians and Blacks. Conclusions The current World Health Organisation definition of high diastolic blood pressure (,90 mmHg on two occasions) reflects values >2 standard deviations from the mean. This may be too conservative as threshold for detecting women at risk of pre-eclampsia. Further studies are required to determine the prognostic implications of gestational values ,95th centile (,130/80 mmHg) and ,5th centile (,90/50 mmHg). [source] The risk of preterm delivery in women from different ethnic groupsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 8 2002Paul Aveyard Objective To examine whether routinely measured variables explained the increased risk of preterm delivery in some UK ethnic groups. Design Cross sectional study of deliveries recorded in the Child Health Record System. Setting North Birmingham, UK. Population All North Birmingham women delivering singletons, 1994,1997 inclusive. Method Logistic regression. Main outcome measures Odds ratio (OR) and 95% confidence interval (CI) for preterm delivery, defined as less than 37 weeks, less than 34 weeks and less than 28 weeks, unadjusted and adjusted for maternal age, an area-based socio-economic status measure, and marital status, year of birth, fetal sex and past obstetric history. Results For Afro-Caribbean women, the ORs (95% CIs) were: for delivery less than 37 weeks, 1.44 (1.26,1.64) unadjusted and 1.22 (1.07,1.41) adjusted; for delivery less than 34 weeks, 1.55 (1.25,1.92) unadjusted and 1.29 (1.02,1.61) adjusted; for delivery less than 28 weeks, 1.66 (1.08,2.55) unadjusted and 1.32 (0.84,2.06) adjusted. For African women, the risk of delivery less than 37 weeks was not significantly raised; for delivery less than 34 weeks, the OR (95% CI) was 1.88 (0.99,3.58) unadjusted and 1.78 (0.93,3.40) adjusted; for delivery less than 28 weeks, the OR (95% CI) was 4.02 (1.60,10.12) unadjusted and 4.10 (1.66,10.16) adjusted. In Afro-Caribbeans, deprivation and marital status explained the differences between the unadjusted and adjusted ORs. There was a linear relation between deprivation and preterm delivery for all ethnic groups, except for Asians. Conclusions Factors associated with deprivation and marital status explain about half of the excess of preterm births in Afro-Caribbeans, but not Africans. The risk of preterm delivery might not be related to deprivation in Asians. [source] Lack of Agreement in Pediatric Emergency Department Discharge Diagnoses from Clinical and Administrative Data SourcesACADEMIC EMERGENCY MEDICINE, Issue 7 2007MSCE, Marc H. Gorelick MD Background:Diagnosis information from existing data sources is used commonly for epidemiologic, administrative, and research purposes. The quality of such data for emergency department (ED) visits is unknown. Objectives:To determine the agreement on final diagnoses between two sources, electronic administrative sources and manually abstracted medical records, for pediatric ED visits, in a multicenter network. Methods:This was a cross sectional study at 19 EDs nationwide. The authors obtained data from two sources at each ED during a three-month period in 2003: administrative sources for all visits and abstracted records for randomly selected visits during ten days over the study period. Records were matched using unique identifiers and probabilistic linkage. The authors recorded up to three diagnoses from each abstracted medical record and up to ten for the administrative data source. Diagnoses were grouped into 104 groups using a modification of the Clinical Classification System. Results:A total of 8,860 abstracted records had at least one valid diagnosis code (with a total of 12,895 diagnoses) and were successfully matched to records in the administrative source. Overall, 67% (95% confidence interval = 66% to 68%) of diagnoses from the administrative and abstracted sources were within the same diagnosis group. Agreement varied by site, ranging from 54% to 77%. Agreement varied substantially by diagnosis group; there was no difference by method of linkage. Clustering clinically similar diagnosis groups improved agreement between administrative and abstracted data sources. Conclusions:ED diagnoses retrieved from electronic administrative sources and manual chart review frequently disagree, even if similar diagnosis codes are grouped. Agreement varies by institution and by diagnosis. Further work is needed to improve the accuracy of diagnosis coding; development of a grouping system specific to pediatric emergency care may be beneficial. [source] Development of the Video Assessment of Propensity to Use Emergency Restraints Scale (VAPERS): Results of the VAPERS Study GroupACADEMIC EMERGENCY MEDICINE, Issue 6 2007Darryl Macias MD Background:Emergency physicians (EPs) may disagree on when or whether patients need restraints. There is no good objective measure of the likelihood of EPs to restrain patients. Objectives:To 1) develop a scale to determine the likelihood that an EP would restrain a patient, 2) develop subscale scoring, and 3) determine a shortened version that correlates highly with the full scale. Methods:This was a prospective cross sectional study. The Video Assessment of Propensity to use Emergency Restraints Scale (VAPERS), consisting of 17 scenarios utilizing actors, was videotaped to produce a research video assessment tool. The VAPERS was designed by development experts to reflect the spectrum of patients who are considered for restraint in an emergency department. The VAPERS was piloted among a 22-member pilot panel of EPs (faculty and residents). The pilot panel was asked to determine the degree to which each video patient possessed the following patient characteristics: medical instability, trauma, belligerence, agitation, and altered mental status. Each "degree of characteristic" was measured on a separate 100-mm visual analog scale. Participants were then asked whether or not they would restrain each patient and whether the patient exhibited the potential to harm him- or herself or others. VAPERS subscales were developed for the likelihood to restrain patients with each of the patient characteristics. Spearman correlations were used for all comparisons. Linear regression was used to determine which patient characteristics were most related to likelihood to restrain and to develop a reduced scale to predict the overall likelihood to restrain. Results:The overall VAPERS score ranged from 0 to 100, with a median of 50 (interquartile range [IQR], 24,88). The visual analog scale results of how likely each video patient possessed specific characteristics were as follows: medical instability ranged from 0 to 100 (median, 32; IQR, 12,64), trauma ranged from 0 to 69 (median, 0; IQR, 0,31), belligerence ranged from 20 to 93 (median, 28; IQR, 14,63), agitation ranged from 3 to 84 (median, 52; IQR, 23,72), and altered mental status ranged from 1 to 93 (median, 29; IQR, 16,69). Linear regression indicated that two characteristic variables (danger to self and degree of agitation) in the video scenarios were highly correlated (0.87) with overall likelihood to restrain. Based on the results, the authors developed a shortened video assessment tool consisting of five of the original videos that were highly correlated (R= 0.94) with the full VAPERS scale on overall likelihood to restrain. Conclusions:The VAPERS scale covers a wide range of important variables in emergency situations. It successfully measured likelihood to restrain in this pilot study for overall situations, and for subgroups, based on patient characteristics. A shortened five-video VAPERS also successfully measured the overall likelihood to restrain. [source] Clinical Predictors of Occult Pneumonia in the Febrile ChildACADEMIC EMERGENCY MEDICINE, Issue 3 2007Charles G. Murphy MD Background: The utility of chest radiographs (CXRs) for detecting occult pneumonia (OP) among pediatric patients without lower respiratory tract signs has been previously studied, but no predictors other than white blood cell count (WBC) and height of fever have been investigated. Objectives: To identify predictors of OP in pediatric patients in the postconjugate pneumococcal vaccination era. Methods: This was a retrospective cross sectional study that was conducted in a large urban pediatric hospital. Physician records of emergency department (ED) patients of age 10 years or less who presented with fever (,38°C) and had a CXR obtained for suspected pneumonia were reviewed. Patients were classified into two groups: "signs of pneumonia" and "no signs of pneumonia" on the basis of the presence or absence of respiratory distress, tachypnea, or lower respiratory tract findings. Occult pneumonia was defined as radiographic pneumonia in a patient without signs of pneumonia. Results: Two thousand one hundred twenty-eight patients were studied. Among patients categorized as having no signs of pneumonia (n = 1,084), 5.3% (95% CI = 4.0% to 6.8%) had OP. Presence of cough and longer duration of cough (greater than 10 days) had positive likelihood ratios (LR+) of 1.24 (95% CI = 1.15 to 1.33) and 2.25 (95% CI = 1.21 to 4.20), respectively. Absence of cough had a negative likelihood ratio (LR,) of 0.19 (95% CI = 0.05 to 0.75). The likelihood of OP increased with increasing duration of fever (LR+ for more than three days and more than five days of fever, respectively: 1.62; 95% CI = 1.13 to 2.31 and 2.24; 95% CI = 1.35 to 3.71). When obtained (56% of patients), WBC was a predictor of OP, with a LR+ of 1.76 (95% CI = 1.40 to 2.22) and 2.17 (95% CI = 1.58 to 2.96) for WBC of >15,000/mm3 and >20,000/mm3, respectively. Conclusions: Occult pneumonia was found in 5.3% of patients with fever and no lower respiratory tract findings, tachypnea, or respiratory distress. There is limited utility in obtaining a CXR in febrile children without cough. The likelihood of pneumonia increased with longer duration of cough or fever or in the presence of leukocytosis. [source] Intensity of Nordic Walking in young females with different peak O2 consumptionCLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 5 2009Toivo Jürimäe Summary The purpose of this cross - sectional study was to determine the physiological reaction to the different intensity Nordic Walking exercise in young females with different aerobic capacity values. Twenty-eight 19,24-year-old female university students participated in the study. Their peak O2 consumption (VO2 peak kg,1) and individual ventilatory threshold (IVT) were measured using a continuous incremental protocol until volitional exhaustion on treadmill. The subjects were analysed as a whole group (n = 28) and were also divided into three groups based on the measured VO2 peak kg,1 (Difference between groups is 1 SD) as follows: 1. >46 ml min,1 kg,1 (n = 8), 2. 41,46 ml min,1 kg,1 (n = 12) and 3. <41 ml min,1 kg,1 (n = 8). The second test consisted of four times 1 km Nordic Walking with increasing speed on the 200 m indoor track, performed as a continuous study (Step 1 , slow walking, Step 2 , usual speed walking, Step 3 , faster speed walking and Step 4 , maximal speed walking). During the walking test expired gas was sampled breath-by-breath and heart rate (HR) was recorded continuously. Ratings of perceived exertion (RPE) were asked using the Borg RPE scale separately for every 1 km of the walking test. No significant differences emerged between groups in HR of IVT (172·4 ± 10·3,176·4 ± 4·9 beats min,1) or maximal HR (190·1 ± 7·3,191·6 ± 7·8 beats min,1) during the treadmill test. During maximal speed walking the speed (7·4 ± 0·4,7·5 ± 0·6 km h,1) and O2 consumption (30·4 ± 3·9,34·0 ± 4·5 ml min,1 kg,1) were relatively similar between groups (P > 0·05). However, during maximal speed walking, the O2 consumption in the second and third groups was similar with the IVT (94·9 ± 17·5% and 99·4 ± 15·5%, respectively) but in the first group it was only 75·5 ± 8·0% from IVT. Mean HR during the maximal speed walking was in the first group 151·6 ± 12·5 beats min,1, in the second (169·7 ± 10·3 beats min,1) and the third (173·1 ± 15·8 beats min,1) groups it was comparable with the calculated IVT level. The Borg RPE was very low in every group (11·9 ± 2·0,14·4 ± 2·3) and the relationship with VO2and HR was not significant during maximal speed Nordic Walking. In summary, the present study indicated that walking is an acceptable exercise for young females independent of their initial VO2 peak level. However, females with low initial VO2 peak can be recommended to exercise with the subjective ,faster speed walking'. In contrast, females with high initial VO2 peak should exercise with maximal speed. [source] | ||||||||||||||||||||||