Gender-adjusted Odds Ratio Research Articles

Elevated Epstein–Barr virus seroreactivity among unaffected members of families with nasopharyngeal carcinoma

Serum antibodies to Epstein-Barr virus (EBV) antigens can be used to predict the risk of nasopharyngeal carcinoma (NPC). To investigate whether EBV seropositivity rates were higher among healthy family members from multiplex and sporadic families with NPC (i.e., families with multiple or single cases) compared to the general population, a study was conducted on 2,665 unaffected individuals from 140 multiplex and 413 sporadic families. The titers of the IgA antibody to the EBV capsid antigen (VCA-IgA) were compared to those of 904 controls from the general population. The VCA-IgA titer was correlated among sibling pairs to a high significance in both family types (P < 0.0001 and P = 0.0005 for the multiplex and the sporadic families, respectively); parent-offspring pairs also showed significant correlation (P < 0.0001 and P = 0.0002, respectively); and spouse pairs were correlated, but at lower significance levels (P = 0.0790 and P = 0.0040, respectively). When compared to the controls, among first-degree relatives in the multiplex families, the age- and gender-adjusted odds ratio (OR) was 2.06 (95% confidence interval 1.56-2.71), 3.55 (2.24-5.64), and 2.25 (1.57-3.23) for siblings, parents, and children, respectively. In the sporadic families, the adjusted OR was 1.55 (1.21-2.00) and 2.08 (1.51-2.86) for siblings and parents, respectively. The adjusted P-value of spouses lost significance in the multiplex families, but remained significant in the sporadic families (P = 0.0146). In conclusion, EBV seropositivity rates were elevated among unaffected family members in both multiplex and sporadic families with NPC.

Association of a BLVRA Common Polymorphism with Essential Hypertension and Blood Pressure in Kazaks

Biliverdin reductase A (BLVRA) is a powerful intracellular antioxidant enzyme and an antagonist to insulin-mediated glucose uptake by the cells. Increased oxidative stress and insulin-resistance (IR) are associated with increased risk for hypertension. Therefore, we hypothesized that BLVRA might be attributable to the variation of susceptibility to essential hypertension, and investigated single nucleotide polymorphism (SNP) rs699512 (Thr3Ala), the only common non-synonymous SNP within BLVRA, in population-based samples of 999 Kazak herdsmen from the villages in Xinjiang, China. The minor allele of SNP rs699512 reduced the risk of essential hypertension (age- and gender-adjusted odds ratio 0.76; 95% confidence interval 0.61–0.94; p = 0.010). Single nucleotide polymorphism rs699512 showed association with both systolic and diastolic blood pressures: the minor allele homozygous carriers had lowest systolic and diastolic blood pressures (139.6 mmHg, 89.6mmHg), followed by heterozygous carriers (145.3 mmHg, 92.3 mmHg), and then major allele homozygous carriers (150.3 mmHg, 95.1 mmHg) (p = 0.005 and 0.009, respectively). These findings provide the first genetic evidence for the role of BLVRA on the susceptibility to human essential hypertension and blood pressure.

Methylenetetrahydrofolate reductase C677T polymorphism in patients with lung cancer in a Korean population

BackgroundThis study was designed to investigate an association between methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and the risk of lung cancer in a Korean population.MethodsWe conducted a large-scale, case-control study involving 3938 patients with newly diagnosed lung cancer and 1700 healthy controls. Genotyping was performed with peripheral blood DNA for MTHFR C677T polymorphisms. Statistical significance was estimated by logistic regression analysis.ResultsThe MTHFR C677T frequencies of CC, CT, and TT genotypes were 34.5%, 48.5%, and 17% among lung cancer patients, and 31.8%, 50.7%, and 17.5% in the controls, respectively. The MTHFR 677CT and TT genotype showed a weak protection against lung cancer compared with the homozygous CC genotype, although the results did not reach statistical significance. The age- and gender-adjusted odds ratio (OR) of overall lung cancer was 0.90 (95% confidence interval (CI), 0.77-1.04) for MTHFR 677 CT and 0.88 (95% CI, 0.71-1.07) for MTHFR 677TT. However, after stratification analysis by histological type, the MTHFR 677CT genotype showed a significantly decreased risk for squamous cell carcinoma (age- and gender-adjusted OR, 0.78; 95% CI, 0.64-0.96). The combination of 677 TT homozygous with 677 CT heterozygous also appeared to have a protection effect on the risk of squamous cell carcinoma. We observed no significant interaction between the MTHFR C677T polymorphism and age and gender or smoking habit.ConclusionsThis is the first reported study focusing on the association between MTHFR C677T polymorphisms and the risk of lung cancer in a Korean population. The T allele was found to provide a weak protective association with lung squamous cell carcinoma.

Association of Restrictive Ventilatory Dysfunction with Insulin Resistance and Type 2 Diabetes in Koreans

To investigate associations of obstructive and restrictive patterns of ventilatory dysfunction with insulin resistance and type 2 diabetes mellitus (DM) in Koreans. We cross-sectionally examined clinical, laboratory, and pulmonary function data on 35,456 Korean adults (age 18-93 years, 40% women) recorded during regular health check-ups. Insulin resistance (IR) was determined from fasting serum insulin concentration and homeostasis model assessment (HOMA). Individuals with type 2 DM and those with pre-diabetes (impaired fasting glucose levels) showed a higher prevalence of both restrictive (18% and 11%, respectively, VS. 8%; P<0.01) and obstructive (4.3% and 3.2%, respectively, VS. 2.3%; P<0.01) ventilatory dysfunction than did individuals with normal fasting glucose levels. Compared to subjects with normal ventilatory function, those with restrictive or obstructive ventilatory dysfunction were older, had higher systolic and diastolic blood pressure, and had elevated glucose and HbA1c levels. However, serum triglyceride, fasting insulin, and HOMA-IR were higher only in subjects with restrictive ventilatory dysfunction, and not in those with obstructive ventilatory dysfunction. On logistic regression analysis, the age and gender-adjusted odds ratio (OR) of restrictive ventilatory dysfunction for type 2 DM was 1.59 (95% confidence interval, 1.43-1.78). The increased OR remained significant after controlling for exercise, drinking, and smoking habits, presence of hypertension, body mass index, and waist circumference (OR=1.38 [1.23-1.55]). However, further adjustment for HOMA-IR attenuated the OR (1.11 [0.97-1.26]), making the OR statistically insignificant. In contrast, obstructive ventilatory dysfunction was not independently related to type 2 DM status. Restrictive ventilatory dysfunction is independently associated with type 2 DM, probably VIA insulin resistance.

Waist Circumference as a Predictor of Pediatric Hypertension Among Normal-Weight Taiwanese Children

Background Although the association between increased waist circumference (WC) and hypertension has been established in adults, it has not been thoroughly studied in Asian children. The present study investigates the association between WC and hypertension risk in normal-weight children and subsequently examines the ability of WC to effectively predict hypertension in 7-year-old Taiwanese children. Design The body height, weight, neck circumference, WC, and blood pressure (BP) data of 2253 of 7-year-old elementary school children (1st grade) were collected. Methods BP was measured twice, and prehypertension and hypertension were defined as mean systolic and/or diastolic BP greater than or equal to 90th or 95th percentile, respectively, according to sex, age, and height (as defined by standard U.S. BP tables). Results The prevalence of prehypertension and hypertension across all subjects was 10.47% and 18.11%, respectively. The gender-adjusted odds ratio [95% confidence interval (CI)] of hypertension associated with a 1-standard deviation higher level of WC was 2.13 (95% CI: 1.75–2.59) for normal-weight children; 1.88 (95% CI: 1.31–2.71) for overweight children; and 1.72 (95% CI: 1.15–2.57) for obese children. Regarding hypertension status, the areas under the receiver operating characteristic curve for body mass index and WC were 0.64 and 0.69, respectively. Conclusion The results of this study suggested that WC is a simple measurement that may be more efficient than body mass index in predicting the risk of pediatric hypertension among normal-weight, 7-year-old children.

Association Between Internet Gambling and Problematic Internet Use Among Adolescents

The study objectives were to evaluate the correlates and psychosocial implications of internet gambling among adolescents, as well as the association between internet gambling and problematic internet use. A cross-sectional study design was applied among a random sample (N=484) of adolescents (71.2% boys; 28.8% girls; mean age±standard deviation, SD=14.88±0.55years). Self-completed questionnaires, including internet gambling practices, internet use characteristics, Young Internet Addiction Test, and Strengths and Difficulties Questionnaire were utilized. The prevalence of internet gambling was 15.1%. Internet gambling was associated with psychosocial maladjustment, including Abnormal Conduct Problems (gender adjusted odds ratio, AOR=3.83; 95% confidence interval, 95% CI: 1.86-7.92) and Borderline Peer Problems (AOR=2.04; 95% CI: 1.09-3.85). The likelihood of concomitant problematic internet use was significantly higher among internet gamblers (AOR=1.81; 95% CI: 1.03-3.19). Multivariate regression analyses indicated that among all characteristics of internet use assessed, utilizing the internet for the purposes of gambling practices was independently associated with problematic internet use among adolescents (AOR=3.43; 95% CI: 1.40-8.39). Thus, the study findings suggest that adolescents who participate in internet gambling practices are more likely to concomitantly present with problematic internet use.

Novel Association of Smaller Anterior Chamber Width with Angle Closure in Singaporeans

To describe variations in anterior chamber width (ACW) and investigate its association with the presence of narrow angles. Cross-sectional study. We recruited 2047 subjects aged 50 years or more from a community polyclinic and 111 subjects with primary angle closure (PAC) or primary angle closure glaucoma (PACG) from an eye hospital in Singapore. All participants underwent gonioscopy, anterior chamber depth (ACD) and axial length (AL) measurement (IOLMaster; Carl Zeiss, Jena, Germany), and anterior-segment optical coherence tomography (AS-OCT, Visante, Carl Zeiss Meditec, Dublin, CA). Customized software was used to measure the ACW, defined as the distance between the scleral spurs in the horizontal (nasal-temporal) axis of AS-OCT scans. An eye was deemed to have narrow angles if the posterior trabecular meshwork was not visible for at least 180 degrees on non-indentation gonioscopy with the eye in the primary position. Anterior chamber width and narrow angles. Data on 1465 community-based subjects were available for analysis. Anterior chamber width was significantly smaller in women compared with men (11.70 mm vs. 11.81 mm, respectively, P<0.001) and decreased significantly with age (P for trend <0.001). Significant predictors of smaller ACW were lower educational level, lower body mass index, shorter AL, shallower ACD, and Chinese race. Of the 1465 subjects, 315 (21.5%) had narrow angles on gonioscopy. Mean ACW was smaller in eyes with narrow angles compared with those without narrow angles (11.60 mm vs. 11.80 mm, P<0.001). The age- and gender-adjusted odds ratio for the highest quartile compared with the lower 3 quartiles of ACW with the presence of narrow angles was 3.4 (95% confidence interval, 2.3-5.0; P for trend <0.001). Hospital-based subjects with PAC/PACG had even smaller ACW than community subjects with narrow angles (11.33 mm vs. 11.60 mm, P<0.001). In this cross-sectional study, ACW was smaller in women, Chinese persons, and older persons, and was associated with narrow angles in 2 different study populations. These data suggest that a smaller ACW may represent a novel risk indicator for angle closure.

Abstract 1860: Association of esophageal cancer risk with genetic polymorphisms of xenobiotic metabolizing genes, DNA repair genes, and inflammation-regulating genes in Huaian, China

Abstract Accumulating evidences suggest that both exposure to environmental carcinogens and individual susceptibility factors contribute to the formation of esophageal cancer. Huaian City is one of the highest risk areas of esophageal cancer in China with the annual incidence over 100/100,000 people. To explore etiological risk factors contributing to the high rate of esophageal cancer, a population-based case-control study was conducted in 185 esophageal squamous cell carcinoma (ESCC) cases and 515 age-, gender-, and residency-matched healthy controls in Huaian. Our previous study found an association between dietary fumonisin exposure and ESCC risk in this population. In the present study, we further investigated the association between ESCC and polymorphic genes involving in xenobiotic metabolizing activities, DNA repair, and inflammation regulation including GSTM1, GSTT1, XPD (Lys751Gln), hOGG1 (Ser326Cys), TNF-α (G308A), NF-κB (−94ins/delATTG), COX-2 (G765C), and iNOS (Ser608Leu). Genetic polymorphisms of GSTM1 and GSTT1 were determined by multiplex PCR and other polymorphisms were determined by PCR-restriction fragment length polymorphism (RFLP) analysis using genomic DNA samples obtained from lymphocytes of study subjects. The prevalence of GSTT1 null genotype was significantly higher in cases (53.51%) than in controls (41.94%) (p=0.0067), with an age- and gender-adjusted odds ratio (OR) of 1.68 and 95% confidence interval (CI) of 1.18 − 2.39. After stratifying by gender, GSTT1 null type was found more prevalent in male cases (57.14%) than in male controls (42.64%) (p=0.0117). XPD Lys751Gln polymorphism was associated with increased ESCC risk (age- and gender-adjusted OR=1.74, 95% CI: 1.11-2.74). XPD heterozygous and mutant genotypes (Lys/Gln+Gln/Gln) were more prevalent in cases (20.54%) than in controls (14.26%) (p=0.0453), and in female cases (24.32%) than in female controls (13.01%) (p=0.0187). Heterozygous genotype of TNF-α was found in 12.97% of cases and 7.65% of controls, showing a marginal increased risk of ESCC (adjusted OR=1.68, 95% CI: 0.95-2.98). These results suggest that polymorphisms of GSTT1, XPD and TNF-α gene may contribute to ESCC risk in this high-risk population. (Supported by NIH/NCI grants, CA94683 and CA90997). Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 1860.

Chronic Kidney Disease and Intraocular Pressure: The Singapore Malay Eye Study

To examine the relationship of chronic kidney disease (CKD) with intraocular pressure (IOP) and glaucoma in Malay adults in Singapore. Population-based, cross-sectional study. We included 3280 (78.8% response rate) Malay adults aged 40 to 79 years living in Singapore. Participants underwent a standardized interview, ocular examination, imaging, and laboratory investigations. Goldmann applanation tonometry was used to measure IOP. Glaucoma was diagnosed using the International Society of Geographic and Epidemiological Ophthalmology classification. Non-fasting serum glucose, glycosylated hemoglobin, and creatinine were obtained from all participants. Estimated glomerular filtration rate (eGFR) and microalbuminuria were also determined. We defined CKD as eGFR < 60 ml/min/1.73 m(2) or presence of micro/macroalbuminuria, defined as urinary albumin-to-creatinine ratio > or =17 mg/g for men and > or =25 mg/g for women. We assessed CKD, IOP, and glaucoma. The overall prevalence of CKD was 27.92% and glaucoma 4.5%. The mean (standard deviation [SD]) IOP was 15.41 (3.7) mmHg. After adjustments for age and gender, IOP was significantly higher in participants with CKD compared with those without CKD (15.8 vs 15.3 mmHg; P<0.0001). The IOP was also higher with lower levels of eGFR (P<0.001). These associations remained significant in separate stratified analyses of persons with and without diabetes, glaucoma, or both. In multiple linear regression models, persons with CKD had on average IOP that was 0.305 mmHg higher than that of persons without CKD. No association between CKD and glaucoma (age and gender adjusted odds ratio [OR], 0.82; 95% confidence interval [CI], 0.56-1.20; and multivariate adjusted OR, 0.87; 95% CI, 0.58-1.29) was found. Our population-based study in Malay adults showed that CKD is associated with higher IOP, independent of age, diabetes, and glaucoma status.

Loss of external rotation after open Bankart repair: an important prognostic factor for patient satisfaction

The repair of the capsuloligamentous complex during shoulder stabilisation procedures can be followed by a persistent restricted capacity of external rotation. The prognostic importance of this loss in external rotation for patient satisfaction has not previously been evaluated. We therefore followed 68 consecutive patients operated for recurrent traumatic unidirectional anterior instability of the glenohumeral joint to assess the association between loss of external rotation and patient satisfaction. All patients underwent open Bankart repair. Two independent observers carried out a follow-up (5 years on average) after surgery. At follow-up, recurrent dislocation had developed in four of the 68 patients (6%). The median pre-operative Rowe score was 65 (range 42-87), which can be compared with 92 (range 46-100) at the follow-up. Three patients rated their outcome as poor, 13 as fair, 23 as good and 29 as excellent. There was a five-fold increased risk for a poor or fair outcome among patients with loss of external rotation in 0 degrees of abduction (age- and gender-adjusted odds ratio [OR] 5.3; 95% confidence interval [CI] 1.3-22.0, P = 0.0007). A linear association between the degree of loss in external rotation and patient dissatisfaction was found. The risk of being dissatisfied, independent of recurrent dislocation, occasional pain, positive apprehension test, age and gender, more than doubled (OR 2.6; 95% CI 1.4-4.8, P = 0.002) for every 10 degrees of post-operative loss of external rotation. Loss of external rotation almost explained all of the variation in patient satisfaction with a population attributable risk of 0.85 (95% CI 0.20-0.94). We conclude that open Bankart repair with a modified Rowe procedure is an excellent surgical option regarding stability, but restriction in external rotation reduces the likelihood of a satisfied patient.

Ankylosing spondylitis: a risk factor for myocardial infarction?

ObjectiveTo ascertain the prevalence of myocardial infarction (MI) in ankylosing spondylitis (AS) relative to that in the general population.MethodsA questionnaire was sent to 593 patients with AS, aged between 50...

Disability pensioning: Can ethnic divides be explained by occupation, income, mental distress, or health?

We aimed to test the hypothesis that differences in disability pensioning among different ethnic groups were attributable to differences in occupation, income, health, and mental distress. In a health survey conducted between 2000 and 2001 in Oslo, nearly half (48.7%; 11,072) of all inhabitants aged 40, 45 and 59-60 years participated. Survey data related to work, general health and mental distress were linked to disability pension data from the National Insurance Administration, and to income and country of origin data from Statistics Norway. A total of 9195 persons were eligible for disability pension at the end of 2000. Approximately 5% received a disability pension in the 4 years following the health survey. An age- and gender-adjusted odds ratio of 2.27 (95% confidence interval (CI) 1.55-3.23) among immigrants from developing countries and Eastern Europe as compared to ethnic Norwegians was reduced to 0.88 (95% CI 0.46-1.67) after adjusting for occupation, working conditions, and income. The odds ratio was further reduced to 0.63 (95% CI 0.32-1.25) when self-reported health and mental distress were added to the model. The higher risk of receiving a disability pension among immigrants from developing countries and Eastern Europe than among ethnic Norwegians was largely explained by work factors and level of income. The addition of mental distress and self-reported health to the multivariate model further reduced the risk, although not significantly different from ethnic Norwegians.

Early Changes in Blood Urea Nitrogen Predict Mortality in Acute Pancreatitis

Routine laboratory tests that reflect intravascular volume status can play an important role in the early assessment of acute pancreatitis (AP). The objective of this study was to evaluate accuracy of serial blood urea nitrogen (BUN) versus serial hemoglobin (Hgb) measurement for prediction of in-hospital mortality in AP. We performed an observational cohort study on data from 69 US hospitals from January 2003 to December 2006. Repeated measures analysis was used to examine the relationship between early trends in BUN and Hgb with respect to mortality. Multivariate logistic regression was used to evaluate the impact of admission BUN, change in BUN, admission Hgb, and change in Hgb on mortality. Time-specific receiver operating characteristic curves and multivariable logistic regression compared accuracy of BUN, Hgb, and additional routine laboratory tests. BUN levels were persistently higher among nonsurvivors than survivors during the first 48 hours of hospitalization (F-test; P < .0001). No such relationship existed for Hgb (F-test; P = .33). For every 5-mg/dl increase in BUN during the first 24 hours, the age- and gender-adjusted odds ratio for mortality increased by 2.2 (95% confidence limits, 1.8, 2.7). Of the 6 routine laboratory tests examined, BUN yielded the highest area under the concentration-time curve (AUC) for predicting mortality at admission (AUC = 0.79), 24 hours (AUC = 0.89), and 48 hours (AUC = 0.90). Combining admission BUN and change in BUN at 24 hours produced an AUC of 0.91 for mortality. In a large, hospital-based cohort study, we identified serial BUN measurement as the most valuable single routine laboratory test for predicting mortality in AP.

Prevalence and associations of epiretinal membranes in an adult Japanese population: the Funagata study

To determine the prevalence and risk factors of epiretinal membranes (ERM) in a Japanese population. The Funagata Study examined 1758 Japanese aged 35 years or older (42% of eligible) from June 2000 to June 2002. A total of 1723 (98.0%) participants had non-mydriatic fundus photographs of the right eye to grade the presence of ERM, using the Blue Mountains Eye Study (BMES) protocol. After age standardization, the prevalence of ERM in the right eyes of the participants included in this study was compared with that reported from right eyes of participants in the BMES and the Beaver Dam Eye Study (BDES). ERM detected in eyes with diabetic retinopathy and other retinal lesions were excluded from the analysis of associations. Multiple logistic regression models were used to determine risk factors for the presence of ERM, adjusting for age and gender. There were 84 right eyes with ERM, representing 5.44% of this sample. After age standardization, the prevalence rate (5.7%) was within the range reported in the BMES (3.5%) and the BDES (6.9%). Older age (gender-adjusted odds ratio (OR) per 10 years: 1.72, 95% confidence interval (CI): 1.40-2.11) and diabetes (age-gender-adjusted OR: 1.84, 95% CI: 1.01-3.37) were the only two factors associated with ERM. We found a similar prevalence of ERM in the Japanese as in mainly white populations. Increasing age and diabetes were risk factors for ERM in this adult Japanese population.

Poor metabolic and blood pressure control in patients with diabetic retinopathy attending a tertiary ophthalmic hospital in Australia

Aim To determine the adherence to recommended glycemic and blood pressure levels in patients with diabetic retinopathy (DR). Methods A retrospective study in a tertiary eye clinic in Melbourne, Australia. Data pertaining to blood pressure (BP) and glycosylated hemoglobin (HbA1c) level were extracted from charts over a 3-month period. Optimal HbA1c was defined as levels <7%, and optimal BP control was defined as systolic/diastolic <130/80 mmHg. Results Of the 483 patients with DR in this study, only 54% (259/482) had a recorded HbA1c measurement. Of these, only 14% (36/259) had an optimal HbA1c level. Patients with longer diabetes duration were less likely to attain optimal HbA1c levels (age and gender adjusted odds ratio (OR) 0.23; 95% confidence intervals (CIs) 0.08–0.71 for diabetes duration 11–19 years, and OR 0.18%, 95% CI 0.06–0.58 for duration >20 years versus ≤5 years). Optimal BP control was attained in only 18% (86/483) and was associated with younger age (OR 0.98; 95% CI 0.96–0.99, per year increase in age). Conclusion Adherence to clinical guidelines for glycemic and BP control in patients with DR was low, even in a well-developed healthcare system with free ophthalmic care access.

Species and Antimicrobial Resistance of Uropathogens Isolated from Patients with Urinary Catheter

A large number of hospitalized patients have an indwelling urinary tract catheter (IUC) placed at some time during their hospital stay and may suffer from catheter-associated urinary tract infections, the leading cause of nosocomial infections. Here we investigated the prevalence of uropathogens associated with catheter-associated urinary tract infections and assessed the resistances of these pathogens to commonly prescribed antibiotics. In total, 2,997 urine samples were examined at a regional hospital in Taipei, Taiwan in 2004: 1,948 (65%) samples from hospitalized patients and 1,049 (35%) samples from outpatients. Patients with IUCs accounted for 1,381 samples (46%). Stratified analyses were used to calculate the age- and gender-adjusted odds ratio (OR) of antimicrobial resistance associated with the use of IUCs. Compared to the urine specimens of the patients without IUCs, those isolated from catheterized patients had a lower prevalence rate of Escherichia (E.) coli (23.4% vs 36.8%) and higher rates of resistant strains including Pseudomonas species (16.4% vs 8.6%) and rare gram-negative bacilli (5.8% vs 4.5%). Additionally, IUCs significantly increased the antimicrobial resistance of E. coli (OR 2.41-3.07), other species of Enterobacteriaceae (OR 1.57-2.38), and rare gram-negative bacilli (OR 2.41-5.21) to nearly all antibiotics tested, such as trimethoprim/sulfamethoxazole. Thus, IUCs increased the prevalence of urinary tract infections caused by some highly resistant pathogens. Moreover, IUCs were associated with the increased risk of concurrent resistance of Enterobacteriaceae. Clinicians are advised to exercise better management of urinary catheter in order to further reduce and control catheter-associated urinary tract infections in hospitals.

Effect of Albendazole Treatments on the Prevalence of Atopy in Children Living in Communities Endemic for Geohelminth Parasites: A Cluster-Randomized Trial

Cooper PJ, Chico ME, Vaca MG, et al. Lancet. 2006;367:1598–1603 PURPOSE OF THE STUDY. To determine if repeated antihelminthic treatments with albendazole affect the prevalence of atopy and clinical indices of allergy among children who live in parasite-endemic communities. STUDY POPULATION. Children (N = 2373) attending the second to seventh year of primary education at 1 of 68 rural schools in a tropical and subtropical region of Ecuador. METHODS. Children were cluster randomized by school to receive albendazole treatment every 2 months for 12 months or no treatment. The primary outcome was the proportion of children with at least 1 positive skin-test result to an environmental allergen after 12 months; secondary outcomes included the proportion of children with reported allergy symptoms, flexural dermatitis, and exercise-induced bronchospasm. No placebo was used, but the investigators who evaluated the children were blinded to their treatment-group assignment. RESULTS. At baseline, there was an inverse association between geohelminth infection and skin-test reactivity (odds ratio: 0.78; 95% confidence interval: 0.65–0.95). Of children who attended albendazole-allocated schools, 91.5% received all 7 albendazole doses; albendazole treatment by parents was reported for 29.4% of the children allocated to no-treatment schools. After 12 months, the prevalence of geohelminth infection declined from 69.3% to 20.5% in the treatment group and from 74.6% to 65.7% in the no-treatment group. There was no evidence of an increase in the prevalence of atopy among children who received albendazole (17%) compared with those in the no-treatment group (17%; age- and gender-adjusted odds ratio: 0.97; 95% CI: 0.68–1.39). Both groups had similar reported allergy symptoms, flexural dermatitis, and exercise-induced bronchospasm after 12 months. CONCLUSIONS. After 12 months, the prevalence of atopy did not increase among school-aged children who were treated with albendazole, compared with children who were not treated. REVIEWER COMMENTS. Management of allergic conditions has increasingly focused on prevention and reduction of risk factors. Small intervention studies have shown increased atopy associated with regular antihelminthic treatment. Although this study was larger, it had a high dropout rate (31%), and antihelminthic treatment of children in the no-treatment group may have biased the results toward the null. It is important to note that the protective effect of geohelminth exposure against atopy may be greater during the first few years of life than by school age. However, these results suggest that treatment of school-aged children with antihelminthics over 12 months does not put them at greater risk of atopy.

Risk of carotid atherosclerosis associated with genetic polymorphisms of apolipoprotein E and inflammatory genes among arsenic exposed residents in Taiwan

Arsenic had been reported to be associated with carotid atherosclerosis. However, there were few studies to evaluate the association between the susceptible gene of lipid metabolism and inflammation and carotid atherosclerosis among arsenic exposure residents. The aim of the study was to investigate the associations between the genetic polymorphisms of APOE and MCP-1 and the risk of carotid atherosclerosis among residents of Lanyang Basin in Taiwan which was a newly confirmed arsenic-endemic area. In total, 479 residents who had been genotyped of these two genes and examined the severity of carotid atherosclerosis were included in this study. The study subjects with carotid intima media thickness (IMT) ≥ 1.0 mm or with the observable plaque in the extracranial carotid artery were diagnosed as carotid atherosclerosis. A significantly age- and gender-adjusted odds ratio of 2.0 for the development of carotid atherosclerosis was observed in study subjects with ε4 allele of APOE than those without ε4 allele. Compared with study subjects who carried wild genotypes of APOE and MCP-1, those with both risk genotypes of APOE and MCP-1 had 2.5-fold risk of carotid atherosclerosis after adjustment for age and gender, revealing a significant dose–response relationship between number of risk genotypes of these genes and risk of carotid atherosclerosis. Additionally, study subjects with two risk genotypes of APOE and MCP-1 and either had ingested well water contained arsenic level > 10 μg/L or had arsenic exposure > 0.22 mg/L-year would have strikingly highest risk of 10.3-fold and 15.7-fold, respectively, for the development carotid atherosclerosis, showing significant joint effect of arsenic exposure and risk genotypes of APOE and MCP-1.

Association of a Serotonin Transporter Polymorphism (5-HTTLPR) With Depression, Perceived Stress, and Norepinephrine in Patients With Coronary Disease: The Heart and Soul Study

The short allele of a functional polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR) has been shown to interact with stressful life events to predict depression in otherwise healthy individuals. Whether the short allele increases risk for depression associated with the stress of a chronic illness has not been established. In a cross-sectional genetic association study, the authors examined the association of 5-HTTLPR with current depression (measured by the Computerized Diagnostic Interview Schedule), perceived stress (measured by the Perceived Stress Scale), and 24-hour urinary norepinephrine excretion in 557 outpatients with chronic coronary disease. Among individuals carrying an s allele, 25% (97 of 383) had current depression, compared with 17% (29 of 174) of l/l homozygotes. The unadjusted odds ratio was 1.6, with a 95% confidence interval (CI) of 1.0-2.6; the age- and gender-adjusted odds ratio was also 1.6 (95% CI=1.0-2.5). Participants carrying an s allele had a higher mean score for perceived stress than l/l homozygotes (5.4 versus 4.7) and a higher rate of moderate or high perceived stress (adjusted odds ratio=1.6, 95% CI=1.1-2.3). Mean 24-hour norepinephrine excretion was higher in s allele carriers (55.6 versus 50.2 mg/day), who were more likely to have norepinephrine values in the highest quartile (adjusted odds ratio=1.7, 95% CI=1.0-3.0). Among patients with chronic illness, carriers of the s allele of 5-HTTLPR are more vulnerable to depression, perceived stress, and high norepinephrine secretion. These factors may contribute to worse cardiovascular outcomes in these patients.

Recent changes in stroke history, mobility status and life expectancy at admission among nursing home residents in Japan

We investigated changes in the condition of elderly people at admission to nursing homes, their prognosis after admission and recent changes of mortality risk factors among the residents. We then examine the possible relationship between the changes identified and discuss the possible effects of changes in social policy. A retrospective cohort study using survival analysis was conducted among 407 residents of three nursing homes in Toyama, Japan who were admitted between 1976 and 1990. By reviewing medical and care notes, we abstracted the admission date, gender, age at admission, stroke history, physical activity and date of discharge or death for each subject. Positive stroke history was defined as medical certification of thromboembolic or haemorrhagic stroke before admission. The level of physical activity at admission was classified as either mobile or immobile, according to whether it was possible to get out of bed without assistance from another person. Data were compared for subjects admitted during the two periods of 1976–82 and 1983–90. The latter period includes the year, 1985, when the Medical Service Law in Japan was amended for the purpose of effective allocation of medical resources. In comparison with that for the first admission period, the mean age at admission for the second period was significantly higher in both males and females. The age- and gender-adjusted odds ratio of stroke history to immobile status decreased from 4.7 for the first admission period to 2.2 for the second. The 5-year survival rate decreased, from 51 to 30% (P≤ 0.0001). In multivariate analysis, the relative hazard (RH) of mortality of the subjects in the later admission period to those in the earlier period was 2.0 [95% confidence interval (CI): 1.4–2.8], while the RH was not significant for either gender or age. Immobile status without stroke history showed the highest RH. The RH of the interaction of mobile status with stroke history and late admission period was significantly lower than 1.0. The study indicates that: the relative importance of stroke history in immobile status has decreased among the nursing home population, stroke history among the mobile subjects has become less predictive of poor prognosis after admission, the life expectancy after admission has declined, and the increased mortality is related to factors other than physical activity status and may be attributable to the recent reorganization of medical resources.