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PubMed2004

Compliance with drug therapies for the treatment and prevention of osteoporosis.

OBJECTIVES: This study used paid claims data from real-world treatment settings to investigate the impact of hormone replacement therapy (HRT), bisphosphonate and raloxifene on patients with a recorded diagnosis of osteoporosis. METHODS: Data from a large health insurer were used to identify 58,109 osteoporosis patients who initiated drug therapy for osteoporosis. Multivariate statistical models were developed for duration of therapy, compliance at 1 year, time to discontinuation or a change in therapy, health care costs and risk of fracture over 1 year. RESULTS: One-year compliance rates were below 25% for all osteoporosis therapies. The mean unadjusted duration of continuous therapy was 221 days for raloxifene, 245 days for bisphosphonate, 262 for estrogen-only and 292 days for estrogen plus progestin. Raloxifene patients were consistently less compliant than estrogen-only patients after adjusting for differences in patient characteristics. Estrogen plus progestin patients were generally more compliant while bisphosphonate did not differentiate from estrogen-only. Compliance reduced the risk of hip fracture (o.r. = 0.382, P < 0.01) and vertebral fracture (o.r. = 0.601, P < 0.05). Compliant patients used fewer physicians services (-US dollars 56, P < 0.0001), hospital outpatient services (-US dollars 38, P < 0.05) and hospital care (-US dollars 155, P < 0.01). Bisphosphonate patients were twice as likely as estrogen-only patients to experience vertebral, Colles and other fractures and experienced higher health care costs (+US dollars 420, P < 0.01). The effectiveness of both raloxifene and bisphosphonate medications relative to estrogen-only improved significantly with the age of the patient. CONCLUSIONS: Compliance with drug therapies for osteoporosis over 1 year is poor leaving patients at risk for fractures and higher health care costs.

Age Factors↗
PubMed1990

A cross-sectional study of bluetongue virus and Mycoplasma bovis infections in dairy cattle: I. The association between a positive antibody response and production efficiency.

In a cross-sectional study of bluetongue virus (BTV) and Mycoplasma bovis (M. bovis) infections, a sample of 572 California dairy cows was tested for the presence of antibodies to answer the question: Is it possible to identify and to assess quantitatively the associations between positive antibody test and production? Serum samples collected from these cows during December 1986 were tested for the presence of antibodies to BTV and M. bovis using the enzyme-linked immunosorbent assay (ELISA). Data on milk production were extracted from individual cow sheets of the California Dairy Herd Improvement Association (DHIA) record-keeping system and interfaced with percentage ELISA results for analysis. Univariate and multivariate statistical analyses, using the chi 2 test for categorical variables or Student's t-test for continuous variables and multiple logistic regression respectively, were carried out to evaluate for possible associations between positive antibody tests to each agent and each production variable of interest. Complete data on all variables studied were obtained for 289 (50.5%) cows for M. bovis and 423 (74%) cows for BTV. For cows with complete data on all variables, estimates of the point prevalence of antibodies to BTV and M. bovis were 70.5% and 66.1%, respectively. Results of this study indicated that Guernsey cows were more likely to have a positive BTV test than Holstein cows and that cows in higher lactations were more likely to test positive to BTV ELISA than those in lower lactations (p less than 0.05). Because all cows except those on one farm were Holstein, our confidence in the effect of breed is limited. The association between lactation number and BTV seropositive test may be an age factor identified earlier in the study. For M. bovis, the results of the analysis indicated that seropositive cows were more likely to produce less milk, on a mature equivalent basis (ORadj = 0.96, p = 0.034), and that they had less extended 305 day milk production potential (ORadj = 0.90, p less than 0.0001) than seronegative cows.

Analysis of Variance↗
PubMed2006

Fourier transform infrared spectroscopy, detection and identification of Escherichia coli O157:H7 and Alicyclobacillus strains in apple juice.

Fourier Transform Infrared (FT-IR) spectroscopy (4000-400 cm(-1)) combined with multivariate statistical methods were used to identify and detect Escherichia coli O157:H7 from Alicyclobacillus spp. recovered from apple juice. Four treatments and a control in triplicate experiments (N=3) were studied; the first three treatments of pasteurized apple juice were inoculated with E. coli O157:H7 ATCC 35150, Alicyclobacillus acidoterrestris 1016 and Alicyclobacillus spp. C-Fugi-6 respectively. The fourth treatment was a 1:1 (v:v) mixed culture of both A. acidoterrestris 1016 and Alicyclobacillus spp. C-Fugi-6. The control was uninoculated pasteurized apple juice. The second derivative transformation and loadings plot over the range of 1800-900 cm(-1) highlighted the most distinctive variations among bacterial spectra. Loadings 1 and 2 were distinctively representative of the bacterial spectral data and accounted for 73% of the total variability. Treatments were noticeably segregated with distinct clustering by principal component analysis (PCA). Using soft independent modeling of class analogy (SIMCA) analysis, 88.3% of (E. coli O157:H7 ATCC 35150) spectra, 75.0% of (A. acidoterrestris 1016) spectra, 88.3% of (Alicyclobacillus spp. C-Fuji-6) spectra, and 80.0% of the mixed culture of both Alicyclobacillus strains spectra were correctly classified. Using the spectral features of bacterial cellular constituents such as nucleic acids, proteins, phospholipids, peptidoglycan, and lipopolysaccharides from examined bacterial cells, pure and mixed cultures of Alicyclobacillus spp. cells, and the pathogenic E. coli cells could be detected in apple juice.

Beverages↗
PubMed2006

Rapid discrimination of lactobacilli isolated from kefir grains by FT-IR spectroscopy.

Fourier transform infrared (FT-IR) spectroscopy was used in combination with multivariate statistical analysis for differentiation of lactic bacteria isolated from kefir grains. Twelve reference strains and 42 lactobacilli isolates from four local kefir grains, previously identified by biochemical traditional techniques at species level were included in this study. The spectra were analysed by hierarchical clustering analysis (HCA) using Pearson's product-moment correlation coefficient and Ward's algorithm. The differentiation between homo- and heterofermentative lactobacilli, proposed as a first level in the classification scheme, was performed with vector normalized first derivatives spectra in the windows 1789-1700, 1059-935, 3000-2927 and 896-833 cm(-1). For heterofermentative lactobacilli the windows 1780-1750, 1500-1200, 2950-2930 and 900-700 cm(-1) were found to contribute to the maximal separation among L. kefir, L. parakefir and Lactobacillus brevis. It was also demonstrated that although this model was robust against small variations in growth temperature (+/-5 degrees C) and growth time (+/-5 h), the make of culture medium used (Biokar or Difco) affected the separation of heterofermentative lactobacilli at species level. For homofermentative lactobacilli the spectral regions 1230-900, 1777-1690, 1357-1240 and 2960-2870 cm(-1), were selected for discrimination among 5 different species that are normally present in kefir grains: L. plantarum, L. acidophilus, L. kefirgranum, L. kefiranofaciens and L. cassei. The classification and discrimination schemes proposed in this work completely matched with the identification obtained by classical biochemical techniques at species level.

Cluster Analysis↗
PubMed2003

Functional magnetic resonance imaging (fMRI) "brain reading": detecting and classifying distributed patterns of fMRI activity in human visual cortex.

Traditional (univariate) analysis of functional MRI (fMRI) data relies exclusively on the information contained in the time course of individual voxels. Multivariate analyses can take advantage of the information contained in activity patterns across space, from multiple voxels. Such analyses have the potential to greatly expand the amount of information extracted from fMRI data sets. In the present study, multivariate statistical pattern recognition methods, including linear discriminant analysis and support vector machines, were used to classify patterns of fMRI activation evoked by the visual presentation of various categories of objects. Classifiers were trained using data from voxels in predefined regions of interest during a subset of trials for each subject individually. Classification of subsequently collected fMRI data was attempted according to the similarity of activation patterns to prior training examples. Classification was done using only small amounts of data (20 s worth) at a time, so such a technique could, in principle, be used to extract information about a subject's percept on a near real-time basis. Classifiers trained on data acquired during one session were equally accurate in classifying data collected within the same session and across sessions separated by more than a week, in the same subject. Although the highest classification accuracies were obtained using patterns of activity including lower visual areas as input, classification accuracies well above chance were achieved using regions of interest restricted to higher-order object-selective visual areas. In contrast to typical fMRI data analysis, in which hours of data across many subjects are averaged to reveal slight differences in activation, the use of pattern recognition methods allows a subtle 10-way discrimination to be performed on an essentially trial-by-trial basis within individuals, demonstrating that fMRI data contain far more information than is typically appreciated.

Adult↗
PubMed1996

Patterns and prediction of orthodontic treatment course.

Most attempts at the identification and prediction of treatment-related changes and outcome in orthodontics thus far have relied upon single biometric parameters instead of employing a systemic and ecological approach. The concept of facial harmony and the availability of sophisticated multivariate statistics offer new chances for a deeper understanding of the mechanisms of change. A longitudinal study has been conducted on approximately 500 youths aged 9-11 years, on average. Numerous parameters of cephalometric analysis, study casts, growth, treatment regimen and patient co-operation were assessed at the onset of treatment (T0) and after 1 year (T1) to determine treatment-related changes under therapy with removable appliances. Exploratory cluster analyses were based on five fundamental cephalometric parameters (SNA, SNB, ML-NSL, NL-NSL, NS-Ba) that establish an operational approach to harmonious facial relations (Segner and Hasund, 1991). As a first step, analyses were restricted to 281 Class II division 1 patients selected for good co-operation by an expert rating by the first author on a three-point rating scale. They all were treated with bionators either with anterior or posterior traction. Both subgroups were studied separately. Based on cluster analytic procedures, different patterns of change were identified for both types of appliance. A slight tendency toward harmonization of the initial skeletal relations was observed throughout all subgroups, with reactions being most obvious in the maxilla. The clusters produced for either appliance group were then screened for additional predictors of group membership by means of discriminant analysis. The findings are discussed in terms of the suitability of the methodological approach chosen.

Activator Appliances↗
PubMed1999

Behavioral biomarkers of aging: illustration of a multivariate approach for detecting age-related behavioral changes.

The goal of the current project is to develop a multivariate statistical strategy for the formation of behavioral indices of performance and, further, to apply this strategy to establish the relationship between age and important characteristics of performance. The strategy was to begin with a large set of measures that span a broad range of behaviors. The behavioral effects of the following variables were examined: Age (4, 12, 24, and 30 months), genotype [Fischer 344 and a hybrid (F1) of Fischer 344 and Brown Norway (F344xBN)], gender (Fischer 344 males and Fischer 344 females), long-term diet (ad lib diet or dietary restriction beginning at 4 months of age), and short-term diet (ad lib diet or dietary restriction during testing). The behavioral measures were grouped into conceptually related indicators. The indicators within a set were submitted to a principal component analysis to help identify the summary indices of performance, which were formed with the assumption that these component scores would offer more reliable and valid measures of relevant aspects of behavioral performance than would individual measures taken alone. In summary, this approach has made a number of important contributions. It has provided sensitive and selective measures of performance that indicated contributions of all variables: psychological process, age, genotype, gender, long-term and short-term diet and has increased the sensitivity of behavioral measures to age-related behavioral impairment. It has also improved task-manageability by decreasing the number of meaningful variables without losing important information, consequently providing a simplification of the pattern of changes.

Age Factors↗
PubMed1999

Magnetic resonance imaging white matter hyperintensities and mechanism of ischemic stroke.

BACKGROUND AND PURPOSE: We sought to determine the relations between infarct subtype and white matter hyperintensities (WMHIs) on MRI. MATERIALS AND METHODS: We studied 395 ischemic stroke patients with 1. 0-T MRI. The number of lacunar, border-zone, and cortical infarcts was registered. WMHIs were analyzed in 6 areas. Univariate and multivariate statistical analyses were used to find the risk factors for different infarct subtypes and to study the connections between WMHIs and brain infarcts. RESULTS: Lacunar infarcts were associated with hypertension (odds ratio [OR], 1.79; 95% CI, 1.17 to 2.73), alcohol consumption (OR, 1.96; 95% CI, 1.17 to 3.28), and age (OR, 1. 03; 95% CI, 1.00 to 1.06). Border-zone infarcts were associated with carotid atherosclerosis (OR, 2.20; 95% CI, 1.15 to 4.19). Atrial fibrillation (OR, 3.02; 95% CI, 1.66 to 5.50) and carotid atherosclerosis (OR, 1.94; 95% CI, 1.12 to 3.36) were independent positive predictors, and history of hyperlipidemia (OR, 0.44; 95% CI, 0.26 to 0.75) and migraine (OR, 0.48; 95% CI, 0.25 to 0.93) were negative predictors for cortical infarcts. Patients with lacunar infarcts had more severe WMHIs than patients with nonlacunar infarcts in all WM areas (P</=0.001). Patients with border-zone infarcts showed severe periventricular lesions (P=0.002), especially around posterior horns (P=0.003). The extent of WMHIs in patients with cortical infarcts did not differ from that in those without cortical infarcts. CONCLUSIONS: Various infarct subtypes have different risk profiles. The association between lacunar infarcts and WMHIs supports the concept of small-vessel disease underlying these 2 phenomena. The connection between border-zone infarcts and periventricular WMHIs again raises the question of the disputed periventricular vascular border zone.

Aged↗
PubMed2002

Multidimensional scaling of integrated neurocognitive function and schizophrenia as a disconnexion disorder.

Multidimensional scaling (MDS) is a multivariate statistical technique that can be used to define subsystems of functionally connected brain regions based on the analysis of functional magnetic resonance imaging (fMRI) data. Here we introduce three-way multidimensional scaling as a method for the analysis of a group of fMRI data, which yields both a generic interregional configuration in low-dimensional space and a measure of each individual's deviation from the generic configuration. The distance between two generic interregional configurations obtained by MDS of two groups of data can be minimized by generalized Procrustes analysis, and the probability under the null hypothesis (that the two groups are sampled from the same population) of any residual group difference in interregional configurations can be assessed by a permutation test. These methods are developed and applied to activated fMRI time series acquired from 19 patients with schizophrenia and 20 normal comparison subjects during the performance of a semantic categorization and subvocal rehearsal task. The first three scaling dimensions are interpretable in terms of the major anatomical or functional subsystems of the activated system: "left-right," "input processing-other," and "subvocal output-other". We found no significant global or local differences between groups in interregional configurations in this 3D space. However, there was significantly greater variability of interregional configurations within the group of patients with schizophrenia. The implications for schizophrenia as a disconnexion disorder are discussed.

Adult↗
PubMed1989

Interpretation of cancer prevention trials.

Principles and methods to guide interpretation require a different emphasis for cancer trials. Assumptions used to design a trial must be validated and modified during the trial to avoid limitations. To maximize information from such trials, recruitment strategies for commonly free-living subjects, measurements of safety and compliance, and ascertainment with pathologic review of endpoints must be obtained. Consideration of multiple endpoints may provide a better interpretation of cancer prevention for skin, colon, and transient occurrences illustrated by cervical dysplasia or biochemical precursors. A careful definition of the limitations of preventive trials is required. These include the actual size of the intervention groups, completeness and duration of follow-up, and comparison between trial participants and a defined source population. To obtain a valid interpretation with adequate precision of intervention effectiveness, time to endpoints should be evaluated using statistical multivariate methods such as Cox proportional hazard or relative risk models. These permit adjustment for important confounding and risk modifiers such as compliance, dietary intake, and drift in control group. The magnitude of the intervention efficacy and the generalizability of results of the trial will be negatively impacted if the intervention has a delayed (latent) effect. Such delay in intervention effect requires added considerations with possible extension of trial duration. Use of confidence limits for intervention effectiveness provides added insight and improved interpretation of prevention trials. The final component of a cancer prevention trial, as with any study, is to interpret and report its results. Providing a valid interpretation with adequate precision to hypotheses of a cancer prevention trial requires added emphasis on the accuracy of the assumptions made to design the trial and the duration of the trial. Design assumptions regarding compliance to the prescribed interventions, time until the experimental intervention achieves full effect, and the frequency of endpoints directly impact on the number of endpoints observed. Terminating a cancer prevention trial before adequate information is obtained, thus severely flawing its interpretation, requires ongoing awareness. Interpretation of a cancer prevention trial should include several added steps: first, investigators to critically review the actual manner in which the trial was conducted; second, carry out an appropriate analysis of the data; and third, review the results and note exceptions or limitations in the data. The results of the trial should be contrasted with previous studies. Implications of the results to future trials should be considered. Finally, these interpretations should be documented in a written report and made available to the scientific community.

Clinical Trials as Topic↗
PubMed2005

A national profile of health care utilization and expenditures for children with special health care needs.

OBJECTIVES: To provide the first nationally representative data on total health care expenses, out-of-pocket health care expenses, and information on the extent to which out-of-pocket expenses are financially burdensome for families of children with special health care needs (CSHCN). To also compare utilization and expenditure patterns for children with and without special health care needs. DESIGN: We used data from the 2000 Medical Expenditure Panel Survey (MEPS). We present univariate, bivariate, and multivariate statistics on utilization and expenditures adjusted for the complex sample design. PARTICIPANTS: The 2000 MEPS data set contains 6965 children younger than 18 years. Using the CSHCN definition adopted by the federal Maternal and Child Health Bureau and operationalized using the CSHCN Screener, 949 children (15.6%) were identified as children with special health care needs. MAIN OUTCOME MEASURES: Compared with other children, CSHCN had 3 times higher health care expenditures (2099 dollars vs 628 dollars; P<.01). The 15.6% of CSHCN accounted for 42.1% of total medical care costs (excluding dental costs) and 33.6% of total health care costs (including dental costs) attributed to children in 2000. Families of CSHCN were best protected against inpatient hospital care expenses and most exposed to dental care expenses. Families of CSHCN experiencing high out-of-pocket expenses (exceeding 5% of family income) were approximately 11 times more likely to be from households with incomes below 200% of the federal poverty level (odds ratio, 10.9; 95% confidence interval, 3.55-33.76) than to be from families with incomes at or above 400% of the federal poverty level. CONCLUSIONS: Families with CSHCN experience much higher expenditures, including out-of-pocket expenditures, than other children. Insurance plays an important protective role for families of CSHCN, but it still provides incomplete protection. Health policy changes that would extend the breadth and depth of insurance coverage are needed to ensure that all families of CSHCN are protected against burdensome expenses.

Adolescent↗
PubMed2001

Obstructive sleep apnea: a canonical correlation of cephalometric and selected demographic variables in obese and nonobese patients.

One hundred male obstructive sleep apnea (OSA) patients were classified into 2 groups on the basis of body mass index (BMI): 43 nonobese (BMI < 30 kg/m2) and 57 obese (BMI > or = 30 kg/m2) patients. A comprehensive cephalometric analysis with a multivariate statistical method was performed in order to define the different principal components (PCs) of cervico-craniofacial skeletal and upper airway soft tissue morphology in each group and how they contributed to selected elements of the patient demographic data, ie, apnea-hypopnea index (AHI), nocturnal oxyhemoglobin saturation, and BMI. Thirty cephalometric variables of cervico-craniofacial skeletal morphology were reduced to 8 PCs describing 84.4% and 85.4% of the total variance in obese and nonobese OSA patients, respectively. Sixteen cephalometric variables of hyoid bone position and head posture were reduced to 4 PCs describing 84.4% and 85.9% of the total variance in obese and nonobese OSA patients, respectively. Twenty cephalometric variables of upper airway soft tissue morphology were reduced to 7 PCs describing 89.5% and 84.6% of the total variance in obese and nonobese OSA patients, respectively. For further analysis of PCs, a stepwise multiple regression analysis was chosen. Two dependent variables of interest are the minimal distance of the posterior pharyngeal airway space (PASmin) and AHI. PASmin accounted for 95.3% (obese OSA group) and 74.3% (nonobese OSA group) with 7 PCs and AHI for 46% with 3 PCs in both groups. Three canonical variables and their correspondents with different loadings were established differently for both OSA groups. A canonical correlation successfully clarified the complexity of simultaneous relationship of the relevant variables. These analyses are proved useful to demonstrate the relationship of cervico-craniofacial skeletal and upper airway soft tissue morphology and selected demographic data. This lays down a basis for understanding the complicated pathogenic components of obese and nonobese OSA patients.

Adult↗
PubMed2006

Demand of elderly people for residential care: an exploratory study.

BACKGROUND: Because of the rapid aging population, the demand for residential care exceeds availability. This paper presents the results of a study that focuses on the demand of elderly people for residential care and determinants (elderly people's personal characteristics, needs and resources) that are associated with this demand. Furthermore, the accuracy of the waiting list as a reflection of this demand has been examined. METHODS: 67 elderly people waiting for admission into a home for the elderly, are subjected to semi-structured interviews. The data are analyzed by using multivariate statistics. RESULTS: Elderly people who indicate that they would refuse an offer of admission into a home for the elderly feel healthier (p = 0.02), have greater self-care agency (p = 0.02) and perceive less necessity of admission (p < 0.01), compared to those who would accept such an offer. Especially the inability to manage everyday activities and the lack of a social network are highly associated with the elderly people's demand for residential care. Furthermore, it is evident that waiting lists for homes for the elderly do not accurately reflect the demand for residential care, since 35% of the elderly people on a waiting list did not actually experience an immediate demand for residential care and stated that they would not accept an offer of admission. Quite a lot of respondents just registered out of a sense of precaution; a strategic decision dictated by current shortages in care provision and a vulnerable health status. CONCLUSION: The results contribute to the understanding of waiting lists and the demand for residential care. It became apparent that not everybody who asks for admission into a home for the elderly, really needed it. The importance of elderly people's resources like social networks and the ability to manage everyday activities in relation to the demand for care became clear. These findings are important because they indicate that resources also play a role in predicting elderly people's demand and as a result can guide the development and the (re)design of adequate health care services.

Aged↗
PubMed2005

Assuring adequate health insurance: results of the National Survey of Children with Special Health Care Needs.

OBJECTIVE: The purpose of this article is to report the findings of the 2001 National Survey of Children With Special Health Care Needs regarding the extent to which children with special health care needs (CSHCN) have access to public or private health insurance that meets their needs. METHODOLOGY: As part of its effort to develop systems of care for CSHCN, the US Maternal and Child Health Bureau established a health insurance core outcome. Successful attainment was measured on the basis of whether the child met 3 distinct components at the time of the interview: presence of public or private coverage; continuity of coverage over the previous 12 months; and adequacy of coverage. Adequacy of coverage was measured from the family's perspective of whether their insurance covered needed services, covered a reasonable share of costs, and allowed families to see the providers they felt were best for their child. Bivariate and multivariate statistical methods were used to assess independent predictors of respondents meeting the health insurance core outcome. RESULTS: Results of the survey indicated that 59.6% of CSHCN nationally met the health insurance core outcome using the 3 components of presence of insurance coverage, continuity of coverage, and adequacy of coverage. Poverty status, race/ethnicity, and functional ability were significant factors in whether a child met the health insurance core outcome as well as each of the 3 components. Of Hispanic and non-Hispanic black CSHCN, 45.2% and 57.6%, respectively, met the health insurance core outcome, compared with 62.5% of their white counterparts. Children with the most limited functional ability were 50% less likely to meet the health insurance core outcome than CSHCN without limitations. More than 10% of Hispanic CSHCN were uninsured at the time of the interview, and 20% of Hispanic CSHCN experienced gaps in coverage. Although insurance met the needs of most families, more than one fourth of families reported that uncovered costs were not reasonable. Children who did not meet the health insurance core outcome were also more likely to have unmet needs. CONCLUSIONS: Results of the survey demonstrated that although the majority of CSHCN have adequate health insurance, additional work is needed to improve the adequacy of insurance, particularly for children below the poverty line, Hispanic children, and children with the most limited functional ability. The survey results also demonstrated the importance of continuous and adequate health insurance, because children who met the health insurance core outcome had fewer unmet needs.

Adolescent↗
PubMed2004

Hepatitis B virus infection in Haemodialysis Centres from Santa Catarina State, Southern Brazil. Predictive risk factors for infection and molecular epidemiology.

BACKGROUND: Patients under haemodialysis are considered at high risk to acquire hepatitis B virus (HBV) infection. Since few data are reported from Brazil, our aim was to assess the frequency and risk factors for HBV infection in haemodialysis patients from 22 Dialysis Centres from Santa Catarina State, south of Brazil. METHODS: This study includes 813 patients, 149 haemodialysis workers and 772 healthy controls matched by sex and age. Serum samples were assayed for HBV markers and viraemia was detected by nested PCR. HBV was genotyped by partial S gene sequencing. Univariate and multivariate statistical analyses with stepwise logistic regression analysis were carried out to analyse the relationship between HBV infection and the characteristics of patients and their Dialysis Units. RESULTS: Frequency of HBV infection was 10.0%, 2.7% and 2.7% among patients, haemodialysis workers and controls, respectively. Amidst patients, the most frequent HBV genotypes were A (30.6%), D (57.1%) and F (12.2%). Univariate analysis showed association between HBV infection and total time in haemodialysis, type of dialysis equipment, hygiene and sterilization of equipment, number of times reusing the dialysis lines and filters, number of patients per care-worker and current HCV infection. The logistic regression model showed that total time in haemodialysis, number of times of reusing the dialysis lines and filters, and number of patients per worker were significantly related to HBV infection. CONCLUSIONS: Frequency of HBV infection among haemodialysis patients at Santa Catarina state is very high. The most frequent HBV genotypes were A, D and F. The risk for a patient to become HBV positive increase 1.47 times each month of haemodialysis; 1.96 times if the dialysis unit reuses the lines and filters > or = 10 times compared with haemodialysis units which reuse < 10 times; 3.42 times if the number of patients per worker is more than five. Sequence similarity among the HBV S gene from isolates of different patients pointed out to nosocomial transmission.

Adolescent↗
PubMed1998

Actinomyces naeslundii genospecies 1 and 2 express different binding specificities to N-acetyl-beta-D-galactosamine, whereas Actinomyces odontolyticus expresses a different binding specificity in colonizing the human mouth.

A total of 102 strains of Actinomyces were isolated from teeth, buccal mucosa and tongue in eight individuals. The isolates were characterized by multivariate statistical analyses of phenotypic characteristics, serotyping and binding to beta-linked galactosamine (N-acetyl-beta-D-galactosamine) and acidic proline-rich protein structures. Based on these characteristics, isolates were classified into three major groups: (i) Isolates of Actinomyces naeslundii genospecies 2 were the dominant species on teeth and buccal mucosa and bound commonly to N-acetyl-beta-D-galactosamine (63 of 63 isolates) and acidic proline-rich proteins (63 of 63 isolates), regardless of tissue origin. They all exhibited a N-acetyl-beta-D-galactosamine binding specificity signified by N-acetyl-beta-D-galactosamine-inhibitable coaggregation with the streptococcal strains LVG1, GVE1, 24892 and MPB1; (ii) Isolates of A. naeslundii genospecies 1 were prevalent on teeth in certain individuals and bound commonly to N-acetyl-beta-D-galactosamine (20 of 20 isolates), but less commonly to acidic proline-rich proteins (5 of 20 isolates). They all possessed another N-acetyl-beta-D-galactosamine specificity, i.e. N-acetyl-beta-D-galactosamine-inhibitable coaggregation with the same streptococcal strains except for strain MPB1; (iii) Isolates of Actinomyces odontolyticus, the dominant species on the tongue (17 of 19 isolates), bound commonly to unknown structures on streptococci (17 of 19 isolates) but rarely to N-acetyl-beta-D-galactosamine (2 of 19 isolates) or acidic proline-rich proteins (3 of 19 isolates). In conclusion, A. naeslundii genospecies 1 and 2 exhibit different patterns of N-acetyl-beta-D-galactosamine and acidic proline-rich protein specificities to colonize dental and buccal mucosa surfaces, whereas A. odontolyticus utilizes another specificity to colonize the tongue.

Acetylgalactosamine↗
PubMed2000

Surgical treatment of infective mitral valve endocarditis: predictors of early and late outcome.

BACKGROUND AND AIMS OF THE STUDY: The study aim was to review our experience in surgical treatment of infective mitral valve endocarditis, and to identify predictors of early and late outcome. METHODS: Ninety-one consecutive patients (52 males, 39 females, mean age 55.6 years) underwent surgery between 1973 and 1997 for endocarditis of isolated mitral (n = 65, 71%), mitral and aortic (n = 25, 28%) and mitral, aortic and tricuspid valves (n = 1, 1%). Native valve endocarditis (NVE) was present in 60 patients (66%) and prosthetic valve endocarditis (PVE) in 31 (34%). The main indications for surgery were heart failure in 32 patients, valve dysfunction in 23, vegetations in 21, and persistent sepsis in 11. Eighty-six patients (95%) were in NYHA classes III-IV, and 58 (64%) had active culture-positive endocarditis at surgery. Mechanical valves were implanted in 73 patients and bioprosthetic valves in 13; valves were repaired in five patients. The impact of 46 parameters on early and late outcome was defined by means of univariate and multivariate statistical analysis. Follow up was complete (mean 5.5 years; range: 0-23.1 years; total 507.3 patient-years). RESULTS: Operative mortality rate was 11% (n = 10). Recurrent infection was recorded in five patients (6%), and reoperation was required in eight (9%). Freedom from recurrent infection and reoperation at 10 years was 89.1% and 87.8% respectively. There were 22 late deaths, 15 from cardiac causes. Actuarial survival rates for all patients at 5, 10 and 15 years were 73.0%, 62.7% and 58.7% (for hospital survivors, the corresponding rates were 81.9%, 69.7% and 66.0%). On multiple logistic regression and Cox proportional hazards models, the following were independent predictors: preoperative pulmonary edema (p = 0.01) for operative mortality; PVE (p = 0.02) for recurrence; younger age (p = 0.02) and PVE (p = 0.02) for reoperation; male gender (p = 0.004) and longer ITU stay for survival (if all patients were included); male gender (p = 0.01) and myocardial invasion by infection (p = 0.02) for survival (if only the hospital survivors were analyzed). CONCLUSION: Surgery for infective mitral valve endocarditis carries a relatively high, though acceptable, risk but provides satisfactory freedom from recurrent infection, reoperation and improved long-term survival. Analysis of these data demonstrated that the preoperative hemodynamic status was the major predictor of in-hospital outcome, PVE increased the risk for recurrent infection and reoperation, whereas male gender and myocardial invasion by the infective process critically reduced the probability of long-term survival. The type of offending pathogen, the activity of infection and the involvement of more than one valve did not appear to influence early and/or late outcome.

Actuarial Analysis↗
PubMed2004

Synonymous codon usage in Lactococcus lactis: mutational bias versus translational selection.

In this study codon usage bias of all experimentally known genes of Lactococcus lactis has been analyzed. Since Lactococcus lactis is an AT rich organism, it is expected to occur A and/or T at the third position of codons and detailed analysis of overall codon usage data indicates that A and/or T ending codons are predominant in this organism. However, multivariate statistical analyses based both on codon count and on relative synonymous codon usage (RSCU) detect a large number of genes, which are supposed to be highly expressed are clustered at one end of the first major axis, while majority of the putatively lowly expressed genes are clustered at the other end of the first major axis. It was observed that in the highly expressed genes C and T ending codons are significantly higher than the lowly expressed genes and also it was observed that C ending codons are predominant in the duets of highly expressed genes, whereas the T endings codons are abundant in the quartets. Abundance of C and T ending codons in the highly expressed genes suggest that, besides, compositional biases, translational selection are also operating in shaping the codon usage variation among the genes in this organism as observed in other compositionally skewed organisms. The second major axis generated by correspondence analysis on simple codon counts differentiates the genes into two distinct groups according to their hydrophobicity values, but the same analysis computed with relative synonymous codon usage values could not discriminate the genes according to the hydropathy values. This suggests that amino acid composition exerts constraints on codon usage in this organism. On the other hand the second major axis produced by correspondence analysis on RSCU values differentiates the genes into two groups according to the synonymous codon usage for cysteine residues (rarest amino acids in this organism), which is nothing but a artifactual effect induced by the RSCU values. Other factors such as length of the genes and the positions of the genes in the leading and lagging strand of replication have practically no influence in the codon usage variation among the genes in this organism.

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