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PubMed1997

Influence of APOH protein polymorphism on apoH levels in normal and diabetic subjects.

Apolipoprotein (apo)H (also known as beta 2 glycoprotein-I) is a glycoprotein synthesized by liver cells and it is present in the blood associated with plasma lipoproteins. APOH displays a genetically determined structural polymorphism: three alleles (APOH*1, APOH*2, APOH*3) at a single locus on chromosome 17 code for different isoforms, and population studies have shown that APOH*2 is the most frequent allele. This paper assesses the relation between APOH phenotypes and plasma apoH levels in a population composed of 278 healthy subjects (243 H2/2, 32 H3/2, 2 H3/3, 1 H2/1; allele frequencies APOH*1 0.002, APOH*2 0.934, APOH*3 0.064) and 245 diabetics (212 H2/2, 30 H3/2, 3 H3/3; allele frequencies APOH*2 0.927 and APOH*3 0.073). Determination of apoH levels by competitive ELISA gave a mean value of 26.3 +/- 9.8 mg/dl for all subjects, 22.6 +/- 7.7 in normals vs 30.6 +/- 10.3 in diabetics (p = 0.0001), and 23.0 +/- 7.9, 19.3 +/- 5.4 and 18.5 +/- 3.5 mg/dl for H2/2, H3/2 and H3/3 in normals and 31.1 +/- 10.1, 28.2 +/- 10.8 and 15.7 +/- 9.0 mg/dl in diabetics, respectively. ANCOVA of the adjusted data revealed a significant difference in apoH levels for the three phenotypes in both the normal subjects (p = 0.01) and the diabetics (p = 0.02). ANCOVA of the whole samples of subjects, controlling for diabetes as well as age, sex and total cholesterol, indicated a substantial effect of phenotype, independent of the other variables (p = 0.0007).

Adult↗
PubMedDate not supplied

Comparing the discriminative validity of two generic and one disease-specific health-related quality of life measures in a sample of patients with dry eye.

OBJECTIVE: The purpose of this study was to compare the discriminative properties of two generic health-related quality of life (QoL) instruments (SF-36 and EQ-5D) and a newly developed disease-specific patient-reported outcomes instrument (Impact of Dry Eye on Everyday Life (IDEEL)) to distinguish between different levels of dry eye severity. METHODS: Assessment of 210 people: 130 with non-Sjogren's Keratoconjunctivitis Sicca (non-SS KCS), 32 with Sjögren's Syndrome (SS) and 48 controls; comparison of SF-36, EQ-5D, and IDEEL age-adjusted data by dry eye severity levels. Severity was assessed based on diagnosis (non-SS KCS, SS, control), patient-report (none, very mild, mild, moderate, severe, extremely severe) and clinician-report (none, mild, moderate, severe). RESULTS: Discriminative validity results were consistent for all instruments. Significant differences between severity levels were found with most SF-36 scales (P < 0.05), all EQ-5D scales (P < 0.05), and all IDEEL scales (P < 0.0001), except for Treatment Satisfaction. IDEEL scales consistently outperformed the generic QoL measures regardless of the severity criterion used. Most SF-36 scales outperformed the EQ-5D QoL scale, but the EQ-5D visual analog scale outperformed the SF-36 scales, except for General Health Perceptions. CONCLUSIONS: The disease-specific IDEEL scales are better able to discriminate between severity levels than the majority of the generic QoL scales. Preliminary evidence demonstrates that the IDEEL will be sensitive to QoL changes over time, although further testing in controlled longitudinal studies is needed.

Adult↗
PubMed1996

Analysis of Hispanic motor vehicle trauma victims in Illinois, 1991-1992.

OBJECTIVE: 1) To develop a profile of Hispanic motor vehicle trauma victims in Illinois, 2) to ascertain whether differences exist between Hispanic and general-Illinois-population motor vehicle trauma victims, and 3) to identify potential target areas for future injury intervention programs. METHODS: A retrospective analysis of Illinois motor vehicle trauma patients admitted from July 1991 to June 1992 was made. Participants were motor vehicle trauma victims (drivers and passengers) who presented to one of 73 level I or level II trauma centers throughout Illinois and were entered into the Illinois Trauma Registry (ITR) from July 1, 1991, through June 30, 1992. RESULTS: Of the 12,299 motor vehicle trauma victims in the ITR, 771 (6.3%) were Hispanic, 8,979 (73.0%) were white, 1,115 (9.1%) were black, and 1,434 (11.6%) were other. When compared with the other racial groups, the group of Hispanic victims were younger (25.2 vs 33.2 years), had higher male predominance (72.8% vs 60.9%), and had the lowest rate of safety equipment/occupant restraint use (21.7% vs 34.7%). A high alcohol use rate (30.7%) and high mean serum ethanol levels (44 mmol/L; 0.2 mg%) were noted. When contrasted with other racial/ethnic groups, the Hispanic victims had lower Injury Severity Scale scores (p < 0.001), but mean hospital charges tended to be higher, with fewer alternative sources of payment (p < 0.001). CONCLUSION: Using age-adjusted data from the ITR, Hispanic motor vehicle trauma victim features differ significantly from those of other racial groups. Effective health maintenance and injury prevention strategies should address the basis for these differences.

Accident Prevention↗
PubMed2000

The reference child and adolescent models of body composition. A contemporary comparison.

Changes in the relative proportions of bone, muscle, water, visceral tissues, and body fat occur during growth. In the 1980s, reference models of body composition for children and adolescents were constructed by adjusting data on total body water (TBW), total body potassium (TBK), and regional bone mineral (BMC) data from several different Caucasian populations. In our study, we measured TBW, TBK, and total body BMC in 856 healthy European-American, African-American, and Mexican-American children. When we reconstructed the reference models using our contemporary data, we found that the body's bone, protein, and fat compartments are slightly but significantly different from the earlier models. Our study provides the range of normal body composition of healthy children, aged 5-18 years, and accounts for differences related to gender and ethnicity.

Adolescent↗
PubMedDate not supplied

Reducing length of stay through rapid clinical redesign.

The SETON Healthcare Network in Austin, TX, significantly reduced length of stay in six diagnostic-related groupings by successfully combining medical management activities and cost-savings targets. This article describes how organizational infrastructure, leadership, clinical redesign, and risk-adjusted data were combined to drive performance improvements and create enthusiasm for change.

Cost-Benefit Analysis↗
PubMed1979

Masking of filtered noise bursts by synthetic vowels.

The present investigation assessed the simultaneous and temporal masking produced by computer-generated synthetic vowels. The durations (100 and 200 ms) of each of four vowel-like maskers were employed. The masker was presented at 70 dB SPL. The probe signals were three filtered noise bursts whose spectral distributions corresponded to regions of high spectral energy in three English stop consonants. Quiet and masked thresholds were determined using the method of adjustment. Data are reported for two experienced listeners who participated in all the listening conditions. The results were generally in accord with the results of masking experiments using nonspeech signals in that both the frequency specificity of masking and temporal masking effects were demonstrated.

Computers↗
PubMed2026

Neonatal outcomes following antenatal corticosteroid administration before planned caesarean birth at late preterm or early term (36-38 weeks' gestation): a retrospective cohort study.

OBJECTIVE: To investigate the benefits and harms associated with antenatal corticosteroids (ACS) prior to planned caesarean birth at late preterm or early term. DESIGN: Retrospective cohort study. SETTING: South Australia, Australia, 2005-2018. PATIENTS: Women with singleton pregnancies undergoing planned caesarean birth between 36+0 and 38+6 weeks' gestation. METHODS: We used routinely collected electronic maternity and neonatal data. Adjusted risk differences (aRD) with 95% CIs were calculated for neonatal and maternal outcomes. OUTCOME MEASURES: Neonatal outcomes included respiratory distress requiring oxygen, hypoglycaemia requiring glucose, neonatal unit (NNU) admission and prolonged NNU admission (&#x2265;48&#x2009;hours). RESULTS: Among the cohort of 4049 women, the proportion receiving ACS was 54.8%, 48.4% and 5.6% at 36, 37 and 38 completed weeks' gestation, respectively. ACS administration was associated with a significant reduction in respiratory distress across all gestations, with the greatest reduction seen at 36 weeks' gestation (aRD -12.5%; 95% CI -21.4% to -3.6%). At 38 weeks' gestation, ACS administration was associated with an increased risk of neonatal hypoglycaemia (aRD 5.7%; 95% CI 1.1% to 10.2%), NNU admission (aRD 5.4%; 95% CI 0.1% to 10.7%) and prolonged NNU admission (aRD 4.6%; 95% CI 0.2% to 8.9%). CONCLUSIONS: ACS administration prior to late preterm and early term planned caesarean birth was associated with reduced risk of respiratory distress. The net benefit of ACS administration before planned caesarean birth remains unclear; however, there was evidence of potential neonatal harm when birth occurred after 37 weeks' gestation.

Epidemiology↗
PubMed1996

Associations between health behaviours and health related fitness.

OBJECTIVE: To examine relations between health behaviours and health related fitness. METHODS: Subjects were a convenience sample of 350 healthy adults (172 men, 178 women). Covariance analysis adjusted data for significant influences of age and socioeconomic status. Obesity was assessed by anthropometry and body density. Cardiovascular fitness was assessed and various metabolic measurements were made. Questionnaires on physical activity and health related behaviours were completed. RESULTS: Cigarette abstinence was associated with a small abdominal circumference (men) and a low trunk/extremity skinfold ratio (women). Obesity indices (body mass index, total skinfolds, percent fat, and abdominal circumference) were negatively associated with perceived fitness. Leisure activity and exercise frequency were also negatively linked to some obesity indices. Blood glucose, cholesterol, HDL-cholesterol, and triglycerides were favourably influenced by perceived activity, exercise frequency, and perceived fitness, but not by exercise intensity. Abstinence from coffee was associated with a low cholesterol/HDL ratio (men only). Principal component, discriminant, and multiple logistic regression analyses showed only weak clustering of habitual physical activity with other positive health behaviours. CONCLUSIONS: Although multiphasic health promotion programmes are economical, favourable interactions between individual programme elements seem likely to be quite limited.

Adolescent↗
PubMed2002

Birth weight of offspring and insulin resistance in late adulthood: cross sectional survey.

OBJECTIVE: To investigate the association between birth weight of offspring and mothers' insulin resistance in late adulthood. DESIGN: Cross sectional survey. SETTING: General practitioner's surgeries in 23 towns in Great Britain. PARTICIPANTS: 4286 women aged 60-79 years. MAIN OUTCOME MEASURES: Maternal insulin resistance. RESULTS: Birth weight of offspring was inversely related to maternal insulin resistance in late adulthood. For each 1 kg higher birth weight of offspring, women had a 15% reduction in the odds of being in the fourth with highest insulin resistance, compared to other fourths (odds ratio 0.85; 95% confidence interval 0.71 to 1.00). This increased to 27% (0.73; 0.60 to 0.90) after adjusting data for potential confounders. A U shaped relation between birth weight of offspring and diabetes in older age was found; women with the lightest and heaviest offspring had the highest prevalence of diabetes. CONCLUSIONS: Birth weight of offspring is inversely related to the mother's insulin resistance in late adulthood, despite the association of glucose intolerance during pregnancy with heavier offspring at birth. Common genetic factors contribute to the relation between birth weight and risk of cardiovascular disease and diabetes in adults.

Adult↗
PubMed1987

Atopy, smoking, and chronic bronchitis.

The aim was to test the hypothesis that atopy increases the occurrence of chronic bronchitis. Relations between atopy, smoking, and chronic bronchitis were studied in farmers. The data were from two successive postal surveys and a skin prick tested subsample. The cross-sectional study consisted of 9017 farmers. Those 6899 farmers who did not have chronic bronchitis at the beginning and who continued farming were followed for three years. A sample of 150 farmers was skin-tested with 36 allergens. The prevalence of chronic bronchitis (rate per 1000), standardised for age and sex, was 41 in non-atopic non-smokers, 101 in atopic non-smokers, 106 in non-atopic smokers, and 257 in atopic smokers (effect of atopy: p less than 0.001; effect of smoking: p less than 0.001). The standardised incidence rates of chronic bronchitis (per 1000 farming years) were 14, 34, 36, and 50, respectively (atopy: p less than 0.001; smoking p less than 0.001). The relative risk of chronic bronchitis, calculated from the incidence data adjusting for the effects of age, sex, smoking or atopy by logistic regression analysis was 2.2 for atopy (95% confidence interval 1.8-2.7) and 2.3 for smoking (1.8-2.9). Only 20 farmers had chronic bronchitis in the skin-tested subjects; the results were consistent with the findings in the surveys but did not reach statistical significance for atopy. In conclusion, atopy and smoking have independent and additive effects on the occurrence of chronic bronchitis at least in dusty farming work.

Adult↗
PubMed1989

Nephropathy in cadmium workers: assessment of risk from airborne occupational exposure to cadmium.

To assess the quantitative relation between exposure to airborne cadmium and various markers of renal tubular and glomerular function, 45 male workers employed at a plant that recovers cadmium from industrial waste and 32 male hospital workers of similar age and geographical location were examined. Cumulative external exposure to airborne cadmium (dose) was estimated from historical air sampling data, adjusted for respirator use. Increasing cadmium dose was associated with multiple renal tubular functional abnormalities, including reduced reabsorption of beta-2-microglobulin (beta-2), retinol binding protein (RBP), calcium, and phosphate. Serum creatinine concentration also increased with cadmium dose, suggesting impaired glomerular function. Mean systolic and diastolic blood pressures were higher in the cadmium workers than in the unexposed (134 v 120 mm Hg and 80 v 73 mm Hg respectively), but only systolic blood pressure was significantly associated with cadmium dose in multivariate analyses. Cadmium dose remained the most important predictor of serum creatinine concentration after controlling for age, blood pressure, body size, and other extraneous factors. Logistic regression to model the probability (prevalence) of various renal abnormalities with increasing dose of cadmium was used. The probability of multiple tubular abnormalities and raised serum creatinine concentration increased sharply at cumulative cadmium exposures exceeding 300 mg/m3 days, corresponding to working for 4.3 years at the current permissible United States exposure limit for cadmium dust.

Air Pollutants, Occupational↗
PubMed2002

Effects of air pollution on general practitioner consultations for upper respiratory diseases in London.

OBJECTIVES: Few published studies have examined the effect of air pollution on upper respiratory conditions. Furthermore, most epidemiological studies on air pollution focus on mortality or hospital admissions as the main health outcomes, but very rarely consider the effect in primary care. If pollution effects do exist then the public health impact could be considerable because of the many patient contacts involved. We investigated the relation between air pollution and upper respiratory disease as reflected in number of consultations made at family practices in London. METHODS: The study used non-parametric methods of analysis of time series data, adjusting for seasonal factors, day of the week, holiday effects, influenza, weather, pollen concentrations, and serial correlation. RESULTS: It was estimated that a 10-90th percentile change (13-31 microg/m(3)) in sulphur dioxide (SO(2)) measures resulted in a small increase in numbers of childhood consultation: 3.5% (95% confidence interval (95% CI 1.4% to 5.8%). Stronger associations were found in the case of a 10-90th percentile change (16-47 microg/m(3)) in fine particles (PM(10)) in adults aged 15-64 5.7% (2.9% to 8.6%), and in adults aged 65 and over: 10.2% (5.3% to 15.3%). In general, associations were strongest in elderly people, weakest in the children, and were largely found in the winter months for these two age groups, and in the summer months for adults aged 15-64. An apparent decrease in consultations was associated with ozone concentrations but this was most pronounced in colder months when ozone concentrations were at their lowest. CONCLUSIONS: The results suggest an adverse effect of air pollution on consultations for upper respiratory symptoms, in particular in the case of PM(10) and SO(2). The effects are relatively small; however, due to the many consultations made in primary care, the impact on demand for services could be considerable.

Adolescent↗
PubMed1998

Differences in asthma management between white European and Indian subcontinent ethnic groups living in socioeconomically deprived areas in the Birmingham (UK) conurbation.

BACKGROUND: Hospital admission rates for asthma have been higher for Asian (Indian subcontinent, ISC) ethnic minority groups in the UK than for white Europeans (W/E). As this may in part be due to differences in the uptake or delivery of preventative health care strategies, the extent to which targeted education and treatment programmes reach these groups needs to be determined. METHODS: Six hundred and eighty nine asthmatic subjects (345 W/E, 344 ISC) of mean (SD) age 34.5 (15) years (range 11-59) and mean forced expiratory volume in one second (FEV1) 80% predicted from districts of high ethnicity and socioeconomic deprivation within inner city Birmingham were reviewed in the appropriate dialect (English, Punjabi, Hindi, Urdu) in a community based study. RESULTS: Data adjusted for age and analysed separately for men (M) and women (F) showed no significant differences in the numbers reporting previous asthma education, assessment of delivery techniques, or being taught about medications, but there were significant differences for advice on trigger factors (M: 52% vs 42%; F: 56% vs 42%), recognition of symptoms (M: 51% vs 43%; F: 53% vs 33%), and ownership of peak flow meters (M: 35% vs 22%; F: 36% vs 24%) for W/E and ISC groups, respectively. Anti-inflammatory asthma medications were highly prescribed, but self reported drug compliance (M: 73% vs 62%), understanding medications (F: 59% vs 39%), and self management (F: 23% vs 12%) varied significantly. Asthma follow up in the community was low for both groups with more of the ISC subjects also being followed up by hospital. CONCLUSIONS: The management of both ethnic groups has centred on drug prescription, delivery techniques and compliance, but has been deficient, particularly in the ISC group, in developing understanding of the disease and self management.

Adult↗
PubMed1998

Energy requirements and physical activity in free-living older women and men: a doubly labeled water study.

Determinants of daily energy needs and physical activity are unknown in free-living elderly. This study examined determinants of daily total energy expenditure (TEE) and free-living physical activity in older women (n = 51; age = 67 +/- 6 yr) and men (n = 48; age = 70 +/- 7 yr) by using doubly labeled water and indirect calorimetry. Using multiple-regression analyses, we predicted TEE by using anthropometric, physiological, and physical activity indexes. Data were collected on resting metabolic rate (RMR), body composition, peak oxygen consumption (VO2 peak), leisure time activity, and plasma thyroid hormone. Data adjusted for body composition were not different between older women and men, respectively (in kcal/day): TEE, 2,306 +/- 647 vs. 2,456 +/- 666; RMR, 1,463 +/- 244 vs. 1,378 +/- 249; and physical activity energy expenditure, 612 +/- 570 vs. 832 +/- 581. In a subgroup of 70 women and men, RMR and VO2 peak explained approximately two-thirds of the variance in TEE (R2 = 0.62; standard error of the estimate = +/-348 kcal/day). Crossvalidation of this equation in the remaining 29 women and men was successful, with no difference between predicted and measured TEE (2,364 +/- 398 and 2,406 +/- 571 kcal/day, respectively). The strongest predictors of physical activity energy expenditure (P < 0.05) for women and men were VO2 peak (r = 0.43), fat-free mass (r = 0.39), and body mass (r = 0.34). In summary, RMR and VO2 peak are important independent predictors of energy requirements in the elderly. Furthermore, cardiovascular fitness and fat-free mass are moderate predictors of physical activity in free-living elderly.

Adolescent↗
PubMed2002

The effect of the living situation on the severity of dementia at diagnosis.

INTRODUCTION: Previous studies have shown that social determinants not directly involved in the disease process may be implicated in the timing of dementia diagnosis. This study explores the relationship between a patient's living situation and the severity of dementia at diagnosis. METHODS: Data were collected from the baseline interviews of 1,325 patients with cognitive decline enrolled in the Consortium for the Investigation of Vascular Impairment of Cognition study. Data collected included: age, sex, living situation and scores on the Mini-Mental State Examination (MMSE), Global Deterioration Scale (GDS), the Functional Rating Scale (FRS), the Disability Assessment for Dementia (DAD) scale and the Cumulative Illness Rating Scale (CIRS). Living situation was grouped as: (1) lives alone, (2) lives with spouse, (3) lives with child, relative or other and (4) lives in a nursing home. A general linear model univariate analysis was used to compare patients by their respective living situations for differences in mean scores on each of the 4 measures of dementia severity. RESULTS: Statistical analysis of both unadjusted data and data adjusted for age, sex and CIRS scores showed significant differences among the groups. Those who lived alone were diagnosed at an earlier stage (mean scores: MMSE 21.4, GDS 3.6, FRS 20.0, DAD 29.8) followed by those who lived with a spouse (mean scores: MMSE 20.5, GDS 3.7, FRS 20.4, DAD 28.0), those who lived with a child or other (mean scores: MMSE 19.3, GDS 3.9, FRS 22.5, DAD 24.9) and finally those who lived in a nursing home (mean scores: MMSE 15.2, GDS 4.8, FRS 27.5, DAD 16.9). CONCLUSION: Living situation is related to the severity of dementia at diagnosis. Primary care providers should have a low threshold for case-finding in older adults who live with family or friends.

Aged↗
PubMedDate not supplied

Seasonal variation of fluoride intake by children in a subtropical region.

Since the optimum fluoride concentration in drinking water established for temperate countries has been considered not to be appropriate for tropical and subtropical climates, this study was conducted in Piracicaba, a subtropical, optimally fluoridated Brazilian community. The daily fluoride intake by 23 children (aged 20-30 months) from diet (liquids and solids) during the four seasons of the year was evaluated. Duplicate-plate samples of foods and beverages were collected for 2 days in each season of the year. The difference of fluoride intake during the 4 seasons was not statistically significant (p>0.05). However, the adjusted data, based on the volume of the diet collected and on the assumption of a constant fluoride concentration in the drinking water, showed that fluoride intake during spring-summer was statistically higher than that observed during the fall-winter seasons (p<0.05). The fluoride dose to which the children were submitted during the hot seasons would be 19% higher than that found during the cold ones. Although this dose difference would not to be a concern for a subtropical area, it could be relevant for a region with a genuine tropical climate.

Analysis of Variance↗
PubMed2004

Can erythropoietin therapy improve survival?

The presence of anaemia in patients with cancer is correlated with poor clinical outcome, a reduced tumour response to anticancer therapy and an increased risk of mortality. This observation has led to speculation as to whether treatment of anaemia can enhance survival rates. The majority of studies have suggested that erythropoietic therapy either does not change or improves disease-free and/or overall survival. Only two studies, one in breast cancer and the other in head and neck cancer, both of which used epoetin outside its approved indications, have observed a decrease in survival in epoetin-treated patients compared with controls. Methodological issues and baseline imbalances between groups in prognostic factors for survival that may have favoured placebo treatment have complicated the interpretation of these studies. In contrast, a Cochrane meta-analysis of randomised, controlled trials of epoetin in anaemic patients with cancer that reported survival identified 19 trials up to the end of 2001 with 2,865 patients. This meta-analysis reported a hazard ratio for overall survival of 0.81 (95% CI 0.67-0.99) for adjusted data and a hazard ratio of 0.84 (95% CI 0.69-1.02) for unadjusted data. A recent meta-analysis of nine randomised, controlled trials of epoetin beta (n = 1,413) suggests that use of this therapy is associated with a reduced risk of tumour progression. This meta-analysis also showed that no association existed between the risk of overall mortality or thromboembolic mortality and epoetin beta therapy. These results suggest that treatment of anaemic patients with cancer with epoetin beta is effective and safe.

Anemia, Hypochromic↗
PubMed1982

A genetic study of total IgE levels in the Amish.

Relevant to the investigation of genetic factors involved in allergic response is the mode of inheritance of IgE levels, an important factor in allergic disease. Serum total IgE levels in 208 Pennsylvania Amish individuals from 23 nuclear families were studied. Males had a significantly higher mean in IgE level than females. There was also a significant negative relationship between age and IgE levels. Segregation analysis was used to fit a major gene model to the age- and sex-adjusted data. The environmental model was rejected (x2 = 41.12, p less than 0.005). The Mendelian codominant model was not rejected x2 = 8.84, p approximately or equal to 0.03) and gave a better fit to the data than the Mendelian dominant or recessive model.

Adolescent↗