Lower OR Research Articles

Dietary, anthropometric, and biochemical determinants of uric acid in free-living adults.

BackgroundHigh plasma uric acid (UA) is a prerequisite for gout and is also associated with the metabolic syndrome and its components and consequently risk factors for cardiovascular diseases. Hence, the management of UA serum concentrations would be essential for the treatment and/or prevention of human diseases and, to that end, it is necessary to know what the main factors that control the uricemia increase. The aim of this study was to evaluate the main factors associated with higher uricemia values analyzing diet, body composition and biochemical markers.Methods415 both gender individuals aged 21 to 82 years who participated in a lifestyle modification project were studied. Anthropometric evaluation consisted of weight and height measurements with later BMI estimation. Waist circumference was also measured. The muscle mass (Muscle Mass Index – MMI) and fat percentage were measured by bioimpedance. Dietary intake was estimated by 24-hour recalls with later quantification of the servings on the Brazilian food pyramid and the Healthy Eating Index. Uric acid, glucose, triglycerides (TG), total cholesterol, urea, creatinine, gamma-GT, albumin and calcium and HDL-c were quantified in serum by the dry-chemistry method. LDL-c was estimated by the Friedewald equation and ultrasensitive C-reactive protein (CRP) by the immunochemiluminiscence method. Statistical analysis was performed by the SAS software package, version 9.1. Linear regression (odds ratio) was performed with a 95% confidence interval (CI) in order to observe the odds ratio for presenting UA above the last quartile (♂UA > 6.5 mg/dL and ♀ UA > 5 mg/dL). The level of significance adopted was lower than 5%.ResultsIndividuals with BMI ≥ 25 kg/m2 OR = 2.28(1.13-4.6) and lower MMI OR = 13.4 (5.21-34.56) showed greater chances of high UA levels even after all adjustments (gender, age, CRP, gamma-gt, LDL, creatinine, urea, albumin, HDL-c, TG, arterial hypertension and glucose). As regards biochemical markers, higher triglycerides OR = 2.76 (1.55-4.90), US-CRP OR = 2.77 (1.07-7.21) and urea OR = 2.53 (1.19-5.41) were associated with greater chances of high UA (adjusted for gender, age, BMI, waist circumference, MMI, glomerular filtration rate, and MS). No association was found between diet and UA.ConclusionsThe main factors associated with UA increase were altered BMI (overweight and obesity), muscle hypotrophy (MMI), higher levels of urea, triglycerides, and CRP. No dietary components were found among uricemia predictors.

Coeliac disease, diet adherence and depressive symptoms

ObjectivesWe aimed to investigate whether long-term adherence to a gluten-free diet is related to depressive symptoms in coeliac disease (CD) patients. MethodsA cross-sectional survey was performed in 2265 adult CD patients recruited through the Dutch Coeliac Association. Self-reported diet adherence was compared among groups based on self-reported depressive symptoms (categorized into current [1-month], remitted, and never). ResultsThe life-time prevalence rate of self-reported depressive symptoms was 39.0% (n=883), of whom 270 (11.9%) suffered from current depressive symptoms. Adherence to gluten-free diet was strict in 50.2% of patients, sufficient in 46.3%, and insufficient in 3.6%. Insufficient adherence was not associated with current depressive symptoms (odds ratio [OR] 0.95; 95% confidence interval [CI]: 0.48–1.92). Keeping a gluten-free diet for longer than five years was associated with lower OR of current depressive symptoms compared to being on a diet for less than two years (OR 0.69; 95% CI: 0.50–0.95). ConclusionsLifetime depressive symptoms may be present in one third of the CD patients who adhere to gluten-free diet. Long-term adherence to the gluten-free diet may reduce the risk of current depressive symptoms.

THE RELATIONSHIP BETWEEN CHRONIC OCCUPATIONAL STRESS AND ARTERIAL STIFFNESS: A CROSS-SECTIONAL STUDY IN CHINESE WORKERS

Objectivesexposure to occupational stress increases the risk of cardiovascular disease. However, few reports focused on the association between occupational stress and arterial stiffness as a suitable marker of early stage...

228 ADEQUATE SOCIAL SUPPORT IS ASSOCIATED WITH LOWER RISK OF DIABETES INDEPENDENT OF OBESITY IN URBAN WORKERS

Background: Work-related cardiovascular death, or Karoshi is now a social problem in Asia. It has been shown that work stress increases the risk of hypertension and diabetes. It is unknown, however, that what component of work stress is most closely related to the risk of hypertension or diabetes. Methods: We studied work-related stress on decision latitude, social support, job-demand, skill underutilization and job strength by means of NIOSH stress questionnaire in 3092 workers living in Shanghai,China (2994 Chinese and 98 Japanese, mean age 45 yrs, 59% men). Demographyc data, supine blood pressure by means of oscillometric method (form PWV/ABI, Japan) and fasting blood were examined. The relationship between hypertension (treatment or ≧140/90 mmHg) or diabetes (treatment or ≧HbA1c 6.1%) and work stress was examined by logistic regression analysis. Results: Each work stress was graded into four levels according to the scores. In univariate analysis, lowest decision latitude was associated with higher OR for diabetes (1.62; 95%CI;1.21-2.14) compared with highest decision latitude group. Second highest social support was associated with significantly lower OR for diabetes (0.63:95%CI;0.47–0.84). Multiple logistic regression analysis after adjusting for age, sex, BMI, smoking, drinking, exercise habits and kind of work, second highest social support still showed a significantly lower OR for diabetes (0.59; 95%CI;0.40-0.85). In univariate analysis, lowest decision latitude and lowest skill use showed higher OR for hypertension compared their highest counterpart but those relationships became insignificant after multivariate adjustments. Conclusions: Adequate social support may reduce the risk of diabetes in urban workers, suggesting a good strategy for the prevention of Karoshi.

Prevalence of Arteriovenous Fistulas in Incident Hemodialysis Patients: Correlation With Patient Factors That May Be Associated With Maturation Failure

Lok et al previously reported a risk equation for arteriovenous fistula (AVF) maturation failure. It is unclear whether this model or a more comprehensive model correlates with incident AVF use in the US hemodialysis population. Cross-sectional study. 195,756 adult patients initiating outpatient hemodialysis therapy in the United States between July 1, 2005, and December 31, 2009, with 6 months or more prior nephrology care. Patient characteristics (age, peripheral vascular disease, coronary artery disease, and race) populating the AVF maturation failure risk equation and other demographic and clinical variables from the Centers for Medicare & Medicaid Services (CMS) Medical Evidence Report (CMS 2728). AVF use at first outpatient dialysis treatment as recorded on the CMS 2728. Using the risk categories defined by Lok et al, AVF use varied from 19.0% (very high risk) to 25.6% (low risk). In a model using only these risk categories, logistic regression showed lower ORs for moderate-, 0.90 (95% CI, 0.88-0.93); high-, 0.80 (95% CI, 0.78-0.83); and very high-risk patients, 0.68 (95% CI, 0.63-0.73) compared with low risk. In the expanded model, odds were lower for women, blacks, Hispanics, age older than 85 years, diabetes, peripheral vascular disease, congestive heart failure, other cardiac disease, and underweight. Odds were higher for hypertension, overweight, obesity, 12 months or more nephrologist care, most insurance types, and each successive year after 2005. Despite associations, the C statistic for the expanded model was 0.64. This analysis is limited by lack of access creation history before dialysis therapy initiation and minimal external validation of CMS 2728 data. Clinical risk factors identified by Lok and expanded in this analysis have limited ability to predict incident AVF use. Even patients judged at highest risk can have successful AVF construction and initiate dialysis therapy through a functioning AVF.

Comparative effectiveness and safety of biological treatment options after tumour necrosis factor α inhibitor failure in rheumatoid arthritis: systematic review and indirect pairwise meta-analysis

BackgroundOptimal treatment for rheumatoid arthritis (RA) after inadequate response (IR) to tumour necrosis factor α inhibitors (TNFi) remains uncertain.ObjectiveTo compare the efficacy and safety of biological agents after TNFi-IR.MethodsA systematic...

The Influence of Prenatal Exposure to Tobacco Smoke on Neonatal Body Proportions

The objective of this study was to determine neonatal anthropometric indices such as: birth weight, crown-heel length, head and chest circumference and ponderal index, in relation to the maternal smoker status (active and passive smoking). The study included 147 neonates born in 2003-2004 at the Princess Anna Mazowiecka University Hospital in Warsaw admitted to the Neonatal and Intensive Care Department of Warsaw Medical University. Neonates were assigned to one of three groups: babies of mothers who were active smokers, passive smokers and non-smokers based on a questionnaire concerning exposure to tobacco smoke and on the concentration of cotinine in maternal urine. The babies of mothers who were active smokers were born with lower birth weight (p=0.033), lower crown-heel length (p=0.026), lower head circumference (p=0.002) and lower chest circumference (p=0.021) significantly more often than babies of non-smoker mothers. Babies whose mothers were active smokers had an increased risk of lower head circumference or 3, 9 (1, 4-10, 7, CI 95%), and an increased risk of lower chest circumference OR 4, 0 (1, 5-10, 9, CI 95%). The babies of mothers who were passive smokers also had lower anthropometric indices, but the differences were not statistically significant. No effect on ponderal index was observed among the neonates whose mothers were active and passive smokers. Smoking during pregnancy causes symmetrical restriction of intrauterine growth.

Reasons for inappropriate prescribing of antibiotics in a high-complexity pediatric hospital

Determine the reasons for inappropriate prescription of antibiotics and identify opportunities to improve prescription of these drugs in pediatric patients hospitalized in intermediate and intensive care units. A prospective, descriptive longitudinal study was conducted of pediatric patients in intermediate and intensive care units who received parenteral administration of antibiotics, with the exception of newborns, burn unit patients, and surgical prophylaxis patients. A univariate analysis and multiple logistic regression were performed. A total of 376 patients with a median of age of 50 months were studied (interquartile range [IQR] 14.5-127 months). Out of the total patients studied, 75% had one or more underlying conditions. A total of 40.6% of these patients had an oncologic pathology and 33.5% had neurological conditions. The remaining 25.9% had other underlying conditions. Antibiotic treatment was inappropriate in 35.6% of the patients studied (N = 134). In 73 (54.4%) of the 134 cases, inappropriate use was due to the type of antibiotic prescribed, the dose administered, or the treatment period. The 61 (45.5%) remaining cases did not require antibiotic treatment. In the multivariate analysis, the risk factors for inappropriate use of antibiotics were: administration of ceftriaxone OR 2 (95% CI, 1.3-3.7; P = 0.02); acute lower respiratory tract infection OR 1.8 (95% CI, 1.1-3.3; P < 0.04); onset of fever of unknown origin in hospital inpatients OR 5.55 (95% CI, 2.5-12; P < 0.0001); and febrile neutropenia OR 0.3 (95% CI, 0.1-0.7; P = 0.009). Inappropriate use of antibiotics was less common in the clinical conditions that were well-characterized. Prescribing practices that could be improved were identified through the preparation and circulation of guidelines for antibiotic use in hospital inpatients.

Association between parental smoking behavior and children's respiratory morbidity: 5‐year study in an urban city of South Korea

After intensive tobacco control efforts in recent decades, the prevalence of active smoking has decreased. However, the hazardous effect of indirect exposure to cigarette smoke is often underestimated, especially in children. We aimed to investigate the effect of parental smoking on the respiratory morbidity of the children of parents who smoke by evaluating the relationship between parental smoking behavior and children's respiratory symptoms. We conducted a cross-sectional follow-up study of 31,584 children aged 6-11 in an urban community in Anyang City, Korea. The children's parents were asked about their smoking status and completed questionnaires regarding their children's symptoms related to asthma and other upper or lower respiratory illnesses. Our analysis focused on a comparison of the frequency of respiratory and ocular symptoms according to parental smoking status, whether it was non-smoking (Non-S), indirect passive smoking (third-hand smoking, THS) or direct passive smoking (second-hand smoking, SHS). The children with Non-S patients were 40.9%, THS group 40.6%, and SHS group 18.5%. THS group showed lower ORs for most respiratory symptoms when compared with those of SHS group, however, THS group revealed increased ORs compared with Non-S in cough-related symptoms. There was a linear trend in frequencies of cough and sputum-related symptoms according to the degree of exposure to cigarette smoke (P < 0.05). The prevalence of respiratory symptoms increased in children exposed to parental smoking including SHS and THS. To avoid the risk of respiratory and allergic disease by environmental tobacco smoke, absolute smoking cessation by parents is strongly recommended.

IL28B, HLA-C, and KIR Variants Additively Predict Response to Therapy in Chronic Hepatitis C Virus Infection in a European Cohort: A Cross-Sectional Study

To date, drug response genes have not proved as useful in clinical practice as was anticipated at the start of the genomic era. An exception is in the treatment of chronic hepatitis C virus (HCV) genotype 1 infection with pegylated interferon-alpha and ribavirin (PegIFN/R). Viral clearance is achieved in 40%-50% of patients. Interleukin 28B (IL28B) genotype predicts treatment-induced and spontaneous clearance. To improve the predictive value of this genotype, we studied the combined effect of variants of IL28B with human leukocyte antigen C (HLA-C), and its ligands the killer immunoglobulin-like receptors (KIR), which have previously been implicated in HCV viral control. We genotyped chronic hepatitis C (CHC) genotype 1 patients with PegIFN/R treatment-induced clearance (n = 417) and treatment failure (n = 493), and 234 individuals with spontaneous clearance, for HLA-C C1 versus C2, presence of inhibitory and activating KIR genes, and two IL28B SNPs, rs8099917 and rs12979860. All individuals were Europeans or of European descent. IL28B SNP rs8099917 "G" was associated with absence of treatment-induced clearance (odds ratio [OR] 2.19, p = 1.27×10(-8), 1.67-2.88) and absence of spontaneous clearance (OR 3.83, p = 1.71×10(-14), 2.67-5.48) of HCV, as was rs12979860, with slightly lower ORs. The HLA-C C2C2 genotype was also over-represented in patients who failed treatment (OR 1.52, p = 0.024, 1.05-2.20), but was not associated with spontaneous clearance. Prediction of treatment failure improved from 66% with IL28B to 80% using both genes in this cohort (OR 3.78, p = 8.83×10(-6), 2.03-7.04). There was evidence that KIR2DL3 and KIR2DS2 carriage also altered HCV treatment response in combination with HLA-C and IL28B. Genotyping for IL28B, HLA-C, and KIR genes improves prediction of HCV treatment response. These findings support a role for natural killer (NK) cell activation in PegIFN/R treatment-induced clearance, partially mediated by IL28B.

Is increased workforce mobility and commuting a threat for a sustainable working life? A cross-sectional study in southern Sweden

ObjectivesThe need for a mobile workforce inevitably means that the length of the total work day (work and travel time) will increase, but apart from perceived stress and the benefits...

A population-based study of the prevalence and sociodemographic risk factors of self-reported epilepsy among adults in the United Kingdom

Background Few studies have investigated the prevalence of self-reported epilepsy among adults in the United Kingdom and none has focused on identifying risk factors associated with epilepsy. Methods Data were obtained from the 2009 British Household Panel Survey, a population-based cohort study of adults ≥16 years of age residing in the United Kingdom ( n = 14,419). Cases were ascertained by identifying individuals who responded “yes” to having epilepsy. Prevalence rates were age- and sex-adjusted using mid-2009 population data and 95% confidence intervals (CI) were calculated. Logistic regression identified risk factors for self-reported epilepsy. Results A total of 112 individuals reported having epilepsy, resulting in a point prevalence of 8.6 per 1000 (95% CI: 6.6, 10.5). There were no differences in prevalence rates across strata of age, sex, marital status, employment status, employment satisfaction, academic or vocational qualifications, and socioeconomic status. Among males, the prevalence rate for the >75 age group was significantly lower compared to the 30–44 ( p = 0.0243) and 45–59 age groups ( p = 0.0099). Individuals who were younger OR = 0.91 (0.85, 0.98), not married OR = 0.80 (0.67, 0.95), had less education OR = 0.84 (0.74, 0.95), were less satisfied with their employment OR = 0.66 (0.57, 0.77), and had lower income OR = 0.87 (0.78, 0.98) were more likely to have epilepsy. Conclusions The prevalence rates reported are similar to those described previously. The rationale for observing these specific risk factors for self-reported epilepsy are discussed in terms of public attitudes and stigma associated with epilepsy.

P1-313 Work-related factors of insomnia among hospital doctors

IntroductionThis study aimed to elucidate the relationship of night duty, on-call duty, average working hours and job stress to insomnia among hospital doctors.MethodsQuestionnaires including job factors and the Brief Job...

Is activation of transversus abdominis and obliquus internus abdominis associated with long-term changes in chronic low back pain? A prospective study with 1-year follow-up

ObjectiveTo investigate associations between deep abdominal muscle activation and long-term pain outcome in chronic non-specific low back pain (LBP).MethodsRecruitment of transversus abdominis and obliquus internus abdominis during the abdominal drawing-in...

Participation in leisure activities and binge drinking in adults: Findings from a Swedish general population sample

The aim of this cross-sectional study was to estimate the associations between participation in different leisure activities and binge drinking in Swedish adults. The study was based on a questionnaire in a general population sample (n = 3567) of individuals aged 19–64 years old. Men and women were defined as binge drinkers if they reported that they had consumed alcohol at least once a month, and stated that at a typical drinking occasion they consumed five or more standard glasses (12 g of alcohol). Multivariate analyses found associations between binge drinking and socializing with friends among men aged 19–30 years (odds ratio, OR 2.88), in the 31–64 years old age group (OR 1.87). Corresponding results was found in younger women (OR 2.36). A higher OR was also found for younger men who regularly attended sporting events as spectators (OR 1.83), and among respondents in the older age group who regularly played computer or video games (OR 2.11 for women and 1.61 for men). A lower OR for binge drinking was found for men who regularly participated in religious services in both age-groups. Lower prevalence of binge drinking among women was only found in the younger group among those who regularly participated in sports/athletics or other training (OR 0.51). Our findings suggest that prevention strategies could benefit from an everyday life approach, but also that different interventions should be used in relation to specific leisure activities.

LBP-1.13 LEEP conisation and the risk for preterm birth: new health registry based data from Finland

ObjectivesTo study whether the increasing severity of cervical intraepithelial neoplasia (CIN) by LEEP (loop electrosurgical excicion procedure) cone correlates with the risk for preterm birth. We also wanted to study...

Determinants of folic acid use in a multi-ethnic population of pregnant women: a cross-sectional study

To investigate the possible differences in folic acid use and to identify the determinants of antenatal folic acid use among multi-ethnic pregnant women. Three hundred and fifty pregnant women participated in this cross-sectional study in a university hospital in Brussels, Belgium. A questionnaire was used to obtain data on socio-demographic characteristics and folic acid use. χ(2)-tests and binary logistic regression analyses were performed using SPSS 17. In the overall cohort, 59.2% used folic acid supplements during pregnancy. This supplement use was associated with an age of 26-35 years, being of Western origin, with high education and employment status, understanding physician's instructions, and early booking for antenatal care. Education (odds ratio, OR: 2.24; 95% confidence interval, CI: 1.08-4.63) and early booking for antenatal care OR: 2.45; 95% CI: 1.11-5.40) were the most important determinants. In particular for Arab/Turkish women, a lower employment status OR: 0.42; 95% CI: 0.24-0.73) was associated with a higher risk of not using folic acid supplements. The lower use of folic acid supplements in Arab/Turkish ethnicities, which may be associated with an increased risk of neural tube defects, is related to socio-economic factors rather than to lower educational attainment. As recommended by other studies, fortification of ethnic minority food may be warranted to reduce the risk of neural tube defects.

Association of Resident Fatigue and Distress With Perceived Medical Errors

Results The mean response rate to individual surveys was 67.5%. Of the 356 participants providing error data (93.7%), 139 (39%) reported making at least 1 major medical error during the study period. In univariate analyses, there was an association of subsequent self-reported error with the Epworth Sleepiness Scale score (odds ratio [OR], 1.10 per unit increase; 95% confidence interval [CI], 1.03-1.16; P=.002) and fatigue score (OR, 1.14 per unit increase; 95% CI, 1.08-1.21; P.001). Subsequent error was also associated with burnout (ORs per 1-unit change: depersonalization OR, 1.09; 95% CI, 1.05-1.12; P.001; emotional exhaustion OR, 1.06; 95% CI, 1.041.08;P.001; lower personal accomplishment OR, 0.94; 95% CI, 0.92-0.97; P.001), a positive depression screen (OR, 2.56; 95% CI, 1.76-3.72;P.001), and overall QOL (OR, 0.84 per unit increase; 95% CI, 0.79-0.91; P.001). Fatigue and distress variables remained statistically significant when modeled together with little change in the point estimates of effect. Sleepiness and distress, when modeled together, showed little change in point estimates of effect, but sleepiness no longer had a statistically significant association with errors when adjusted for burnout or depression. Conclusion Among internal medicine residents, higher levels of fatigue and distress are independently associated with self-perceived medical errors.

Physician and patient factors associated with follow up of high grade dysplasias of the cervix: A population-based study

Objective This population-based study characterizes available physician and patient factors involved in the follow up of abnormal Pap smear results. Methods Women with a first time high grade diagnosis on Pap smear between 2000 and 2005 were identified utilizing a centralized cervical screening database. Databases containing information on healthcare delivery and physician practice characteristics in a setting of universal health care were linked. Follow up is defined as referral to colposcopy or any excisional procedure associated with management of severe dysplasia. Multivariate analysis followed by logistic regression was performed addressing follow up as the dependant factor. Results The study population contained 43,792 women with a first time high grade cervical abnormality. The loss to follow up rate was 26%. Physician factors significantly associated with follow up included practice duration of less than 5 years OR 1.28 CI (1.09–1.5); a non-gynecologic practice was associated with lower follow up, OR 0.69 CI (0.65–0.73). Patient factors associated with lower follow up included older age OR 0.97 CI (0.97–0.98) and a lower comorbidity score OR 0.58 CI (0.48–0.7); a lower socioeconomic status was associated with a higher rate of follow up OR 1.17 CI (1.1–1.2). Conclusions While patient and physician factors impact appropriate follow up for women with abnormal Pap smears, none of those captured have a high level of influence other than a gynecologic practice. In order to improve upon the high loss to follow up rate, more information is needed on the practice settings of physicians and the screening program components and policies.

Robust Replication of Genotype-Phenotype Associations across Multiple Diseases in an Electronic Medical Record

Large-scale DNA databanks linked to electronic medical record (EMR) systems have been proposed as an approach for rapidly generating large, diverse cohorts for discovery and replication of genotype-phenotype associations. However, the extent to which such resources are capable of delivering on this promise is unknown. We studied whether an EMR-linked DNA biorepository can be used to detect known genotype-phenotype associations for five diseases. Twenty-one SNPs previously implicated as common variants predisposing to atrial fibrillation, Crohn disease, multiple sclerosis, rheumatoid arthritis, or type 2 diabetes were successfully genotyped in 9483 samples accrued over 4 mo into BioVU, the Vanderbilt University Medical Center DNA biobank. Previously reported odds ratios (OR(PR)) ranged from 1.14 to 2.36. For each phenotype, natural language processing techniques and billing-code queries were used to identify cases (n = 70-698) and controls (n = 808-3818) from deidentified health records. Each of the 21 tests of association yielded point estimates in the expected direction. Previous genotype-phenotype associations were replicated (p < 0.05) in 8/14 cases when the OR(PR) was > 1.25, and in 0/7 with lower OR(PR). Statistically significant associations were detected in all analyses that were adequately powered. In each of the five diseases studied, at least one previously reported association was replicated. These data demonstrate that phenotypes representing clinical diagnoses can be extracted from EMR systems, and they support the use of DNA resources coupled to EMR systems as tools for rapid generation of large data sets required for replication of associations found in research cohorts and for discovery in genome science.