Linear Mixed-effects Regression Analysis Research Articles

Gestational hormone trajectories and early pregnancy failure: a reassessment

BackgroundStudies have commonly assessed the endocrinolgical status of women once miscarriage is threatened or suspected; few studies have explored the antecedent hormonal environment or used a longitudinal strategy. Using refined statistical techniques, we sought to re-evaluate whether gestational hormone trajectories in early pregnancy can identify future miscarriage in asymptomatic pregnancies.MethodsThis prospective cohort study followed 105 women over-conception; 72 had normal term pregnancy outcomes while 33 experienced early pregnancy failure between 35 and 115 days of gestation. Participants attended a pre-conception and antenatal clinic at Newcastle University, United Kingdom (UK). Evaluation methods included ultrasound, clinical assessments of pregnancy progress and serial measurements of gestational hormones by radioimmunoassays. Linear mixed-effects regression analysis examined hormone relationships with pregnancy outcomes.ResultsDetailed longitudinal illustration of gestational hormones, antecedent to miscarriage indications, revealed early pathophysiological trends. In particular, oestradiol showed as marked a deviation from normal as progesterone before miscarriage was evident, reflecting a deficiency in the ovarian response to rising human chorionic gonadotrophin (hCG) levels. Regression analysis provided equations for gestational hormone slopes that significantly differentiated asymptomatic women with subsequent early pregnancy failure, compared to women with normal term pregnancies. Both progesterone and oestradiol displayed negative mean slopes in pregnancies destined for failure; in this group, both human placental lactogen (hPL) and hCG revealed mean positive trajectories that imitated normal pregnancies but at slower rates of increase.ConclusionsOestradiol, progesterone and hCG trajectories, from 50 days of gestation, have good potential for revealing pathophysiology and for identifying which asymptomatic pregnancies are destined for subsequent failure. In asymptomatic patients where there is concern about viability and ultrasound diagnosis is ambiguous, a combined hormonal profile could contribute to guiding patient care decisions.

Obesity in Inflammatory Bowel Disease: Gains in Adiposity despite High Prevalence of Myopenia and Osteopenia.

Background: Rising rates of obesity have been reported in patients with inflammatory bowel disease (IBD); however, prospective data is lacking. The aim of this study is to prospectively evaluate body composition in adults with IBD over 24 months. Methods: Whole body dual energy X-ray absorptiometry (DXA) data was performed at 0 months, 12 months, and 24 months. Bone mineral density (BMD), fat mass index (FMI (kg)/height (m2)), appendicular skeletal muscle index (ASMI (kg)/height (m2)), visceral adipose tissue and the visceral adipose height index (VHI, VAT area (cm3)/height (m2)), and clinical and anthropometric assessments were performed at each time point. Multivariable linear mixed effects regression analyses were performed. Results: Initially, 154 participants were assessed at baseline (70% Crohn’s disease, 55% male, median age 31 years), of whom 129 underwent repeated DXA at 12 months, and 110 underwent repeated DXA at 24 months. Amongst those undergoing repeated DXA, their body mass index (BMI) significantly increased over time, such that by 24 months, 62% of patients were overweight or obese (annual change BMI β = 0.43, 95%CI = [0.18, 0.67], p = 0.0006). Gains in BMI related to increases in both FMI and VHI (β = 0.33, 95%CI = [0.14, 0.53], p = 0.0007; β = 0.08, 95%CI = [0.02, 0.13], p = 0.001; respectively), whereas ASMI decreased (β = −0.07, 95%CI = [−0.12, −0.01], p = 0.01) with a concordant rise in rates of myopenia (OR = 3.1 95%CI = [1.2, 7.7]; p = 0.01). Rates of osteopenia and osteoporosis were high (37%), but remained unchanged over time (p = 0.23). Conclusion: Increasing rates of obesity in patients with IBD coincide with decreases in lean muscle mass over time, while high rates of osteopenia remain stable. These previously undocumented issues warrant attention in routine care to prevent avoidable morbidity.

Factors Related To Depression and Post-Traumatic Stress Disorder in Shelter-Based Abused Women.

In this study, linear mixed-effects regression analyses were used to examine whether sociodemographic variables, abuse-related variables, and well-being variables were associated with symptoms of depression and post-traumatic stress disorder (PTSD) in abused women residing in shelters. Results pointed out that symptoms of depression severity were positively associated with migration background and the experience of physical abuse and negatively associated with self-esteem and social support. PTSD symptoms were positively associated with the experience of sexual abuse and negatively associated with self-esteem. Within women’s shelters, staff could be sensitive to improving the social integration of women, especially those with a non-Dutch background, and strengthening the women’s social networks and their self-esteem.

Association Between Smoking Behavior and Cognitive Functioning in Patients With Psychosis, Siblings, and Healthy Control Subjects: Results From a Prospective 6-Year Follow-Up Study.

The high prevalence of smoking and cognitive deficits in schizophrenia patients is well known, but findings regarding the association between the two are contradictory, and longitudinal studies are lacking. The authors sought to examine the multi-cross-sectional association between smoking behavior and performance in specific cognitive domains and the longitudinal association between change in smoking behavior and change in cognitive functioning in a large prospective study. The authors conducted a cohort study of patients with nonaffective psychosis (N=1,094), their siblings (N=1,047), and healthy control subjects (N=579). At baseline and at 3- and 6-year follow-ups, smoking behavior was assessed with the Composite International Diagnostic Interview and cognitive functioning with a test battery. Multivariate linear mixed-effects regression analyses were conducted to assess associations between smoking and cognitive domains while adjusting for variation in demographic factors, psychopathology, medication, and substance use. Bonferroni correction for multiple testing was applied. At baseline, 66.6% of the patients smoked, compared with 38.3% of the siblings and 25.2% of the control subjects. Significant multi-cross-sectional associations were found between smoking and lower processing speed in the patient and control groups compared with the nonsmoking patient group (estimate=-2.38, SE=0.84) and the nonsmoking control group (estimate=-3.13, SE=1.06). In siblings, smoking was significantly associated with lower performance in working memory and reasoning and problem solving compared with nonsmoking. Also, the number of cigarettes smoked per day was negatively associated with these domains. Patients, but not siblings and control subjects, who quit smoking showed a significant improvement in processing speed (estimate=4.90, SE=1.73). The study findings indicate that smoking is associated with poorer cognitive performance in patients, their siblings, and healthy control subjects compared with nonsmoking. Smoking cessation may improve processing speed in patients.

Socioeconomic status and time in glucose target range in people with type 2 diabetes: a baseline analysis of the GP-OSMOTIC study

BackgroundOptimal glycaemia, reflected by glycated haemoglobin (HbA1c) levels, is key in reducing type 2 diabetes (T2D) complications. However, most people with T2D have suboptimal recall and understanding of HbA1c. Continuous glucose monitoring (CGM) measures glucose levels every 5 to 15-min over days and may be more readily understood. Given that T2D is more common in lower socioeconomic settings, we aim to study relationships between socioeconomic status (SES) and percentage time in glucose target range (TIR) which is a key metric calculated from CGM.MethodsAnalysis of baseline data from the General Practice Optimising Structured MOnitoring To Improve Clinical outcomes (GP-OSMOTIC) randomised controlled trial (October 2016 – November 2017) of 300 people with T2D from 25 Victorian General Practices. FreeStyle Libre Pro® sensor patch was used for this study. SES was defined by the Index of Relative Socio-economic Disadvantage (IRSD) and educational attainment. Univariable and multivariable mixed-effects linear regression analyses controlling for age, BMI, diet, exercise and study arm were performed.ResultsOne hundred and sixty-seven (60.1%) participants were male, the mean (SD) participant age was 61.0 (9.7) years, and the mean (SD) duration of CGM use was 12.3 (2.5) days. The 10th IRSD decile (least disadvantaged) was associated with a 15% higher TIR vs. the 1st decile (most disadvantaged) (95% CI 5, 25; p = 0.003) and a 0.6% lower HbA1c (95% CI 0.1, 1; p = 0.03). There was no evidence of an association between educational attainment and TIR/HbA1c.ConclusionHigher SES measured at an area level is associated with better achievement of glycaemic target using complementary measures of HbA1c and TIR in the GP-OSMOTIC cohort. Given that TIR may be more easily used in patient education and self-management support compared to HbA1c values, the social gradient identified in TIR provides an opportunity for clinicians and policy makers to address health inequities in T2D.Trial registrationAustralian and New Zealand Clinical Trials Registry Trial ACTRN12616001372471, prospective, Date registered 4/10/2016.

CYP2D6 genotype and endoxifen plasma concentration do not predict hot flash severity during tamoxifen therapy.

Tamoxifen is frequently prescribed to prevent breast cancer recurrence. Tamoxifen is a prodrug and requires bioactivation by CYP2D6. Tamoxifen use is often limited by adverse effects including severe hot flashes. There is paucity of prospectively collected data in terms of CYP2D6 genotype and measured tamoxifen, 4-hydroxytamoxifen and endoxifen concentrations in relation to hot flash severity during tamoxifen therapy. We conducted a longitudinal prospective study of breast cancer patients on tamoxifen (n = 410). At each visit, blood samples were collected, and patients completed a standardized hot flash survey (n = 1144) that reflected hot flash severity during the 7 days prior to the visit. Plasma concentrations of tamoxifen, 4-hydroxytamoxifen, and endoxifen were measured using liquid chromatography-tandem mass spectrometry and genotyping was carried out for CYP2D6. A linear mixed-effects regression analysis assessed the association of covariates in relation to the hot flash severity score (HFSS). Median age at first assessment was 50years with 61.9% of patients considered peri-menopausal. Most patients (92.2%) experienced hot flash symptoms with 51.0% having low HFSS (0-4) and 7.32% experiencing HFSS > 25. Age was significantly associated with hot flash severity, with patients aged 45-59 more likely to have higher HFSS. Neither duration of tamoxifen therapy nor observed tamoxifen, endoxifen and 4-hydroxy tamoxifen plasma concentration predicted hot flash severity. Genetic variation in CYP2D6 or CYP3A4 was not predictive of hot flash severity. Hot flash severity during tamoxifen therapy can not be accounted for by CYP2D6 genotype or observed plasma concentration of tamoxifen, 4-hydroxytamoxifen, or endoxifen.

An Increase in Low-Grade Spot Urine Protein Excretion During the First Year after Kidney Transplantation Associates with Subclinical De-Novo Donor-Specific Antibodies and Microvascular Inflammation at 1-Year Surveillance Biopsies

The presence of microvascular inflammation (MVI) in kidney transplant biopsies often relates to occurrence of donor-specific antibodies (DSA) and antibody-mediated rejection. Here we investigated whether an increase in spot urine protein excretion during the first year after kidney transplantation associates with subclinical de-novo DSA and different Banff MVI scores at 1-year surveillance biopsies. Patients and Methods This prospective observational study included 79 consecutive non-sensitized patients who received a deceased donor kidney transplant between Dec 2013 and Jan 2016. All patients received basiliximab induction and tacrolimus-based immunosuppression. Estimated protein excretion rate (ePER) was calculated monthly from spot urine protein-to-creatinine ratios. At 1 year, all recipients underwent surveillance graft biopsy and were screened for de-novo DSA. Screening-positive sera were subjected to single antigen bead (SAB) testing (LABScreen SAB assays; One Lambda). The presence of subclinical de-novo DSA was determined on the basis of SAB reactivity patterns using a mean fluorescence intensity threshold >1000 and stable graft function within the first year (variability in serum creatinine <25% from baseline). Biopsies were read by a single pathologist and presence of MVI (any glomerulitis [g] and/or peritubular capillaritis [ptc] score >0) was graded in accordance with Banff 2013 criteria. Results Among the 79 study patients, 10 (13%) developed de-novo DSA at 1 year after transplant (5 patients class I, 5 patients class II). At 1-year surveillance biopsy, 12 patients (15%) had histologic evidence of MVI with g and/or ptc score >0. Among them, 7 patients had mild MVI with [g+ptc] <2, and 5 patients had moderate MVI with [g+ptc] ≥2 and g ≥1. There was no evidence of transplant glomerulopathy or peritubular capillary basement membrane multilayering in electron microscopy. At 1 year, patients with de-novo DSA had significantly greater mean ePER than those without DSA (870, 95% CI 770–1040 mg/day/1.73m2 versus 192, 95% CI 178–206 mg/day/1.73m2; P<0.001). Compared with absence of MVI, mild and moderate MVI were associated with a progressive increase in mean ePER at 1 year (no MVI: 190, 95% CI 178–202 mg/day/1.73m2 versus mild MVI: 740, 95% CI 578–926 mg/day/1.73m2 versus moderate MVI: 1022, 95% CI 884–1226 mg/day/1.73m2; P<0.001). Linear mixed effect regression analyses demonstrated a progressive increase and a significant difference in slope of ePER during the first year between patients with no DSA and de-novo DSA at 1 year (P<0.001), and between patients with no MVI, mild MVI, and moderate MVI at 1-year surveillance biopsies (P<0.001) [Figure].Conclusions An increase in low-grade ePER during the first year after kidney transplantation associates with subclinical de-novo DSA and the degree of MVI at 1-year surveillance biopsies and may be used as a noninvasive clinical biomarker of endothelial cell injury. The study was financially supported by the research project of the Slovenian Research Agency (Project ID L3-7582).

Step Activity After Surgical Treatment of Ankle Arthritis

Category: Ankle Arthritis Introduction/Purpose: We used step counts as objective measures of activity as a compliment to patient self-reported outcomes in treatment of ankle arthritis to validate success or failure of treatment. Methods: 234 patients who were treated with ankle arthrodesis or ankle replacement wore step activity monitors before treatment and after treatment at 6 months, 12 months, 24 months and 36 months. Total steps taken as well as low, medium and high activity, sustained activity, and an activity index were measured in each group. In addition, step activity was compared with the subjects’ self-reported outcome using the MFA and SF-36. We measured change from baseline and compared treatment type. Linear mixed-effects regression analysis was used to test for improvement in step activity (the dependent variables) across follow-up (the fixed effect, modeled as 4 dummy variables representing differences from pre-op at 6, 12, 24 and 36 months), with fixed covariates age, sex, body mass index (BMI) and surgical treatment. Results: Both treatment groups improved significantly. Objective and PROM were not parallel. While PROM plateaued at 6 months, steps continued to increase at 36 months. Step counts increases did correlate with improving PROM however. Patients undergoing arthrodesis had slower improvement than arthroplasty patients with greater differences in the early stages of recovery (i.e., 6 and 12-month post-op) than at 36 months where improvements were similar across groups. (See table 2 for data). The trajectory of recovery was different but there were no significant differences in improvement by surgery procedure. Conclusion: Patients increase the number and the intensity of steps after treatment. Improvement after arthrodesis and ankle replacement follow different trajectories. For step totals, high intensity steps and the sustained activity metrics, arthroplasty patients showed more improvement than arthrodesis patients early in recovery. Step data are consistent with patient reported outcomes but do not parallel them. Unlike PROM which improve dramatically in the first six months then plateau, step activity demonstrated mild or no improvement at 6 months but later had improvement that increased gradually across follow-up out to three years. Objective outcome measures add value to measurement of treatment outcomes.

Novel Gonioscopy Score and Predictive Factors for Intraocular Pressure Lowering After Phacoemulsification.

To evaluate a novel gonioscopy score as a potential predictor for intraocular pressure (IOP) reduction after cataract surgery. This was a prospective study that included consecutive patients with or without glaucoma, either with open or narrow angles but without peripheral anterior synechiae, who underwent phacoemulsification. Eyes with intraoperative complications and secondary glaucoma were excluded. A preoperative gonioscopy score was created, summing the Shaffer gonioscopy grading in 4 quadrants (range, 0 to 16). To determine variables associated with IOP change at 6 months, univariate and multivariate linear mixed-effects regression analysis was performed adjusting for age, sex, and preoperative IOP. In total, 188 eyes from 137 patients were enrolled. The mean age of the patients was 75.0 (±8.5) years and the average preoperative IOP was 15.6 (±3.6) mm Hg with 0.7 (range, 0 to 4) glaucoma medications. The mean IOP reduction after phacoemulsification was 3.0 (±2.6) mm Hg at postoperative month 6. After multivariate analysis, preoperative IOP [β=0.49 (0.41-0.58), P<0.0001], gonioscopy score [β=-0.17 (-0.24 to -0.09), P<0.0001], anterior chamber depth (ACD) [β=-0.88 (-1.64 to -0.14), P=0.02], and IOP/ACD ratio [β=0.45 (0.07 to 0.83) P=0.021] were associated with IOP reduction at 6 months. Preoperative predictors for IOP reduction after cataract surgery were preoperative IOP, ACD, gonioscopy score, and IOP/ACD ratio. The IOP/ACD ratio and gonioscopy score can be easy parameters to obtain and may help clinicians to estimate the IOP reduction after phacoemulsification.

Selective Serotonin Reuptake Inhibitors Reduce Longitudinal Growth in Risperidone-Treated Boys

To examine whether selective serotonin reuptake inhibitors (SSRIs) inhibit longitudinal growth in children and adolescents, particularly in the early stages of puberty, using a sample of convenience comprising risperidone-treated boys. Data from four clinic-based studies in risperidone-treated 5- to 17-year-old boys with no general medical conditions were combined for this analysis. Anthropometric measurements and psychotropic treatment history were extracted from the medical and pharmacy records. Linear mixed effects regression analyses examined the association between SSRI use and change in age-sex-specific height and body mass index z scores, after adjusting for relevant confounders. Risperidone-treated boys (n = 267; age: 12.7 ± 2.7 years), 71% of whom had ever taken an SSRI, contributed to the analysis. After adjusting for age, psychostimulant and antipsychotic use, and time in the study, both the duration of SSRI use as well as the cumulative dose were inversely associated with height z score after age 11 years (P < .0001). After adjusting for baseline height, duration of SSRI use was most strongly inversely associated with height z score in Tanner stages 3 and 4 boys who took SSRIs continuously (r = -0.69, P < .009). No association was observed with body mass index z score. In risperidone-treated boys, SSRI use is associated with reduced longitudinal growth, particularly in those undergoing puberty. Whether adult height or other metabolic or psychological outcomes are affected remains to be determined.

Long-term changes in oral health-related quality of life over a period of 5 years in patients treated with narrow diameter implants: A prospective clinical study

ObjectivesThe aim of this study was to assess long-term changes in oral health-related quality of life (OHRQoL) over a period of 5 years in patients treated with narrow diameter implants (NDI) in the mandible for support of an overdenture. MethodsIn this prospective clinical study, a consecutive sample of 20 edentulous patients who had worn sufficient complete dentures for at least 12 weeks was provided with four immediately loaded one-piece titanium NDIs in the mandible. The German 49-item version of the Oral Health Impact Profile (OHIP) was applied to assess OHRQoL at baseline and all follow-ups (4 and 8 weeks, 3, 6, and 12 months, and 3 and 5 years after treatment was finished). ResultsBefore treatment, OHRQoL was substantially impaired indicated by high OHIP summary score (39.9 points). Four weeks after treatment, a substantial treatment-induced drop of OHRQoL impairment was observed (21.8 OHIP points), and at all follow-ups, OHIP scores were lower than at baseline (15.9–26.5 OHIP points; ANOVA: p<.001). Based on mixed-effect linear regression analyses, the treatment-induced effect on OHRQoL improvement over the entire study period was statistically significant for the OHIP summary scores as well as for all four OHIP domains: Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact (all: p<.001). ConclusionsThis study suggests that four immediately loaded NDIs for the support of conventional complete dentures in edentulous patients with substantially impaired OHRQoL may lead to a long-lasting treatment-induced improvement in OHRQoL. Clinical significanceThe provision of four NDI in the edentulous mandible is a promising treatment option for patients with substantial OHRQoL impairment and a positive attitude towards implant treatment. Furthermore, patients can be informed that improvements in OHRQoL are expected to last for at least 5 years.

Reading Derived Words by Italian Children With and Without Dyslexia: The Effect of Root Length.

Children with dyslexia are extremely slow at reading long words but they are faster with stimuli composed of roots and derivational suffixes (e.g., CASSIERE, ‘cashier’) than stimuli not decomposable in morphemes (e.g., CAMMELLO, ‘camel’). The present study assessed whether root length modulates children’s morphological processing. For typically developing readers, root activation was expected to be higher for longer than shorter roots because longer roots are more informative access units than shorter ones. By contrast, readers with dyslexia were not expected to be facilitated by longer roots because these roots might exceed dyslexics’ processing capacities. Two groups of Italian 6th graders, with and without dyslexia, read aloud low-frequency derived words, with familiar roots and suffixes. Word reaction times (RTs) and mispronunciations were recorded. Linear mixed-effects regression analyses on RTs showed the inhibitory effect of word length and the facilitating effect of root frequency for both children with and without dyslexia. Root length predicted RTs of typically developing readers only, with faster RTs for longer roots, over and above the inhibitory effect of word length. Furthermore, typically developing children had faster RTs on words with more frequent suffixes while children with dyslexia were faster when roots had a small family size. Generalized linear regression analyses on accuracy showed facilitating effects of word frequency and suffix frequency, for both groups. The large word length effect on latencies confirmed laborious whole-word processing in children when reading low-frequency derived words. The absence of a word frequency effect along with the facilitating effect of root frequency indicated morphemic processing in all readers. The reversed root length effect in typically developing readers pointed to a stronger activation for longer roots in keeping with the idea that these represent particularly informative units for word decoding. For readers with dyslexia the facilitating effect of root frequency (not modulated by root length) confirmed a pervasive benefit of root activation while the lack of root length modulation indicated that the longest roots were for them too large units to be processed within a single fixation.

PP3 - Estimating the Health State Utility of Patients with HER2– gBRCA+ Metastatic Breast Cancer Treated with Olaparib or Chemotherapy Via A Mapping Analysis of Eortc QLQ-C30 Data Collected in the Olympiad Clinical Trial

To estimate the health state utility (HSU) of patients with human epidermal growth factor (HER2)-negative and germline BReast CAncer (gBRCA+) mutation positive metastatic breast cancer (mBC) randomised to olaparib or single-agent chemotherapy in the OlympiAD registration trial (NCT02000622). EORTC QLQ-C30 questionnaires collected at baseline, and every 6 weeks up to progression, were mapped to EQ-5D HSU using a published algorithm from women with locally advanced BC identified via an online mapping registry. HSU were summarised by treatment arm and for baseline, and pre- and post-progression survival (investigator assessment) using descriptive and multivariate linear mixed effects regression (LMER) analysis conducted in R. All analyses were performed on the intention to treat population. 1665 HSU values were generated from EORTC QLQ-C30 questionnaires collected in OlympiAD. Mean HSU in OlympiAD (0.84) was higher than reported in the algorithm study (0.76), with a greater than 5-point difference in mean emotional, physical and insomnia QLQ scores between studies. Mean HSU at baseline, pre- and post-progression survival were 0.827, 0.848, and 0.812 for olaparib, and 0.810, 0.802 and 0.753 for chemotherapy. The LMER showed that after adjusting for baseline HSU, patients randomised to olaparib experienced a statistically improved HSU versus chemotherapy (+0.048, p-value=0.001) with progression being associated with a statistically significant reduction in HSU (-0.039 (p<0.001)). The mapping analysis generated plausible HSU from EORTC QLQ-C30 data in OlympiAD that can be used to inform future cost-effectiveness studies of olaparib in mBC. Key trends include an improved HSU in patients randomised to olaparib, which is consistent with the planned exploratory analysis of EORTC QLQ-C30 in OlympiAD, and a significant negative impact of progression on HSU consistent with other mBC HSU studies. Key limitations include the open-label design of OlympiAD and uncertainty surrounding the extrapolation of a mapping algorithm for locally advanced to mBC.

The Relationship Between Physical Activity Level of Parents and That of Their Adolescent Children.

Intergenerational transmission, which refers to the similarity between parent and their children, is a possible explanation of adolescent physical activity (PA). However, only a few existing studies explore the relationship of parent-adolescent PA in East Asian countries. Therefore, this study aimed to investigate the association of parent-adolescent PA using a nationally representative data in Korea with a large sample size. Data were collected from the Korean National Health and Nutrition Examination Survey conducted from 2010 to 2014. The authors performed a linear mixed effects regression analysis with 1342 cases after using log conversion of parent and adolescent moderate- to vigorous-intensity physical activity (MVPA) levels. In the study, the median MVPA of adolescents was 150 (interquartile range: 360) minutes per week. Adolescent MVPA levels were significantly correlated with their mother's MVPA (β = 0.055, P = .02). Similar findings of greater association in girls and younger adolescents (age: 13-15y) were found in subgroup analysis (girls: β = 0.073, P = .05; younger adolescents: β = 0.103, P = .001). Increasing maternal PA levels could stimulate their adolescent's PA levels. Therefore, intervention at the family level may lead to an increase in adolescent PA levels.

Socioeconomic multi-domain health inequalities in Dutch primary school children.

This study assesses socio-economic health inequalities (SEHI) over primary school-age (4- to 12-years old) across 13 outcomes (i.e. body-mass index [BMI], handgrip strength, cardiovascular fitness, current physical conditions, moderate to vigorous physical activity, sleep duration, daily fruit and vegetable consumption, daily breakfast, exposure to smoking, mental strengths and difficulties, self-efficacy, school absenteeism and learning disabilities), covering four health domains (i.e. physical health, health behaviour, mental health and academic health). Multilevel mixed effect (linear and logistic) regression analyses were applied to cross-sectional data of a Dutch quasi-experimental study that included 1403 pupils from nine primary schools. Socioeconomic background (high-middle-low) was indicated by maternal education (n = 976) and parental material deprivation (n = 784). Pupils with higher educated mothers had lower BMIs, higher handgrip strength and higher cardiovascular fitness; their parents reported more daily fruit and vegetable consumption, daily breakfast and less exposure to smoking. Furthermore these pupils showed less mental difficulties and less school absenteeism compared with pupils whose mothers had a lower education level. When using parental material deprivation as socio-economic indicator, similar results were found for BMI, cardiovascular fitness, sleep duration, exposure to smoking and mental strengths and difficulties. Socio-economic differences in handgrip strength, cardiovascular fitness and sleep duration were larger in older than in younger pupils. Childhood SEHI are clearly found across multiple domains, and some are larger in older than in younger pupils. Interventions aiming to tackle SEHI may therefore need a comprehensive and perhaps more fundamental approach.

Processing speed in children treated for brain tumors: effects of radiation therapy and age

ABSTRACTThe current study examined processing speed in children two years post-treatment for brain tumors (BT) with radiation therapy (RT) compared to those treated with without RT. Participants included 59 children (4–17 years) with BT assessed as part of the Brain Radiation Investigative Study Consortium (BRISC). Processing speed was assessed at two time points: Time1 (3–9 months post-surgery) for 26 children who received whole brain or focal RT (RT group) and 33 treated without RT (no-RT group), and again two years later (Time2) for 42 participants (17 RT, 25 no-RT). Linear mixed effects (LME) regression analyses examined differences in cognitive and motor speed between groups and across visits, with age at Time1 (age1) treated as a moderating variable, and sex and primary tumor size as covariates. No effects for treatment group or visit were found for motor speed (Pegboard) or mean reaction time (Attention Network Task). On the Wechsler Processing Speed Index (PSI), the no-RT group performed better than the RT group, with a group-by-age interaction such that across visits, the difference between the no-RT and RT groups was larger among children who were older at initial treatment (≥10 years) than among those who were younger (<10 years). Cumulative brain injury earlier in life (tumor, surgery, plus RT) may result in greater impact on more complex tasks of cognitive efficiency. Children receiving RT showed reduced processing speed over time, with a larger group difference among those who were over 10 years at treatment.

Skipping breakfast, overconsumption of soft drinks and screen media: longitudinal analysis of the combined influence on weight development in primary schoolchildren

BackgroundRegular breakfast and well-balanced soft drink, and screen media consumption are associated with a lower risk of overweight and obesity in schoolchildren. The aim of this research is the combined examination of these three parameters as influencing factors for longitudinal weight development in schoolchildren in order to adapt targeted preventive measures.MethodsIn the course of the Baden-Württemberg Study, Germany, data from direct measurements (baseline (2010) and follow-up (2011)) at schools was available for 1733 primary schoolchildren aged 7.08 ± 0.6 years (50.8% boys). Anthropometric measurements of the children were taken according to ISAK-standards (International Standard for Anthropometric Assessment) by trained staff. Health and lifestyle characteristics of the children and their parents were assessed in questionnaires. A linear mixed effects regression analysis was conducted to examine influences on changes in waist-to-height-ratio (WHtR), weight, and body mass index (BMI) measures. A generalised linear mixed effects regression analysis was performed to identify the relationship between breakfast, soft drink and screen media consumption with the prevalence of overweight, obesity and abdominal obesity at follow-up.ResultsAccording to the regression analyses, skipping breakfast led to increased changes in WHtR, weight and BMI measures. Skipping breakfast and the overconsumption of screen media at baseline led to higher odds of abdominal obesity and overweight at follow-up. No significant association between soft drink consumption and weight development was found.ConclusionTargeted prevention for healthy weight status and development in primary schoolchildren should aim towards promoting balanced breakfast habits and a reduction in screen media consumption. Future research on soft drink consumption is needed. Health promoting interventions should synergistically involve children, parents, and schools.Trial registrationThe Baden-Württemberg Study is registered at the German Clinical Trials Register (DRKS) under the DRKS-ID: DRKS00000494.

The role of gesture delay in coda /r/ weakening: An articulatory, auditory and acoustic study.

The cross-linguistic tendency of coda consonants to weaken, vocalize, or be deleted is shown to have a phonetic basis, resulting from gesture reduction, or variation in gesture timing. This study investigates the effects of the timing of the anterior tongue gesture for coda /r/ on acoustics and perceived strength of rhoticity, making use of two sociolects of Central Scotland (working- and middle-class) where coda /r/ is weakening and strengthening, respectively. Previous articulatory analysis revealed a strong tendency for these sociolects to use different coda /r/ tongue configurations-working- and middle-class speakers tend to use tip/front raised and bunched variants, respectively; however, this finding does not explain working-class /r/ weakening. A correlational analysis in the current study showed a robust relationship between anterior lingual gesture timing, F3, and percept of rhoticity. A linear mixed effects regression analysis showed that both speaker social class and linguistic factors (word structure and the checked/unchecked status of the prerhotic vowel) had significant effects on tongue gesture timing and formant values. This study provides further evidence that gesture delay can be a phonetic mechanism for coda rhotic weakening and apparent loss, but social class emerges as the dominant factor driving lingual gesture timing variation.

Improving Functional Status in African Americans With Cancer Pain: A Randomized Clinical Trial

To determine the efficacy of the Power Over Pain-Coaching (POP-C) intervention to improve functional status among African American outpatients with cancer pain. . 310 African American patients were recruited from an urban comprehensive cancer center. The study took place in the patients' homes. . A two-group randomized design with repeated measures was used. Data were analyzed with linear mixed effects regression analysis and structural equation change score models. Variables were pain, pain-related distress, functional status, perceived control over pain, and the following antecedents to control. Functional status was improved in POP-C participants relative to control group participants (p < 0.05). Distress also was differentially decreased (p < 0.05). Pain intensity ratings decreased significantly in all patients (p < 0.05). The largest intervention effects were observed in the living with pain component. . Perceived control over pain was strongly related to functional status and is amenable to interventions using the POP-C intervention components described in this article.

Clinical correlates of longitudinal MRI changes in CADASIL

Previous studies showed that various types of cerebral lesions, as assessed on MRI, largely contribute to the clinical severity of CADASIL. However, the clinical impact of longitudinal changes of classical markers of small vessel disease on conventional MRI has been only poorly investigated. One hundred sixty NOTCH3 mutation carriers (mean age ± SD, 49.8 ± 10.9 years) were followed over three years. Validated methods were used to determine the percent brain volume change (PBVC), number of incident lacunes, change of volume of white matter hyperintensities and change of number of cerebral microbleeds. Multivariable logistic regression analyses were performed to assess the independent association between changes of these MRI markers and incident clinical events. Mixed-effect multiple linear regression analyses were used to assess their association with changes of clinical scales. Over a mean period of 3.1 ± 0.2 years, incident lacunes are found independently associated with incident stroke and change of Trail Making Test Part B. PBVC is independently associated with all incident events and clinical scale changes except the modified Rankin Scale at three years. Our results suggest that, on conventional MRI, PBVC and the number of incident lacunes are the most sensitive and independent correlates of clinical worsening over three years in CADASIL.