Hierarchical Multivariate Regression Analysis Research Articles

Psychosocial functioning in Dutch foster children: The relationship with child, family, and placement characteristics

Foster care is the preferred alternative for out-of-home care, but not necessarily beneficial for foster children's psychosocial functioning. This dilemma leaves researchers with a challenge to find out more about the factors related to foster children's social and emotional functioning. In a sample of 446 Dutch foster children we examined the extent to which three clusters of characteristics, those akin to the foster child, the foster family, or foster placement, were related to foster children's functioning at the time of research. Multivariate three-step hierarchical regression analyses were performed for three outcome variables: externalizing problems, internalizing problems, and prosocial behavior. We found that all three clusters of foster care characteristics were significantly related to foster children's functioning. Foster placement characteristics, in particular interventions aimed at foster children, explained the largest amount of variance in behavior problems. Children receiving interventions had more externalizing and internalizing problems. A possible explanation is that interventions are indicated for those foster children who are in the highest need of additional support. Prosocial behavior was particularly related to foster family characteristics. The results were mostly in line with international research. Careful screening and monitoring of the social and emotional functioning of foster children may help to identify problems at an early stage. In addition (preventive) support should be offered to those foster children and families who are in need of it.

Impaired emotion recognition is linked to alexithymia in heroin addicts.

Several investigations document altered emotion processing in opiate addiction. Nevertheless, the origin of this phenomenon remains unclear. Here we examined the role of alexithymia in the ability (i.e., number of errors—accuracy and reaction times—RTs) of thirty-one heroin addicts and thirty-one healthy controls to detect several affective expressions. Results show generally lower accuracy and higher RTs in the recognition of facial expressions of emotions for patients, compared to controls. The hierarchical multivariate regression analysis shows that alexithymia might be responsible of the between groups difference with respect to the RTs in emotion detection. Overall, we provide new insights in the clinical interpretation of affective deficits in heroin addicts suggesting a role of alexithymia in their ability to recognize emotions.

Specific personality changes in subjects with MCI and mild dementia are associated with cerebral Alzheimer's pathology as measured by CSF biomarkers

IntroductionSpecific changes in personality profiles may represent early symptoms of Alzheimer's disease (AD). Knowledge about relationship between personality changes and biomarkers of cerebral pathology can contribute to early diagnosis of AD.ObjectivesTo investigate to what extent the personality changes predict the cerebral AD pathology.AimsTo describe the relationship between the personality changes and pathological cerebro-spinal fluid (CSF) biomarkers.MethodOne hundred and ten subjects, of whom 57 patients with mild cognitive impairment (MCI), 9 subjects with mild dementia, and 44 healthy controls had an extensive medical and neuropsychological examination as well as lumbar puncture to evaluate concentrations of CSF biomarkers of AD pathology [amyloid-β1-42 (Aβ1-42), phosphorylated tau (ptau-181), and total-tau (tau)]. The proxies of the participants completed the Revised NEO Personality Inventory (NEO-PI-R) to assess subjects’ personality at the time being and 5 years retrospectively.ResultsIn a hierarchical multivariate regression analysis, including age, gender, education, Mini Mental State Examination (MMSE), and APOEe4 status, lower Aβ1-42 concentrations in CSF were associated with increasing neuroticism, and decreasing extraversion and conscientiousness. Decreasing extraversion, openness to experience and conscientiousness were associated with higher tau/Aβ1-42 ratio, and higher ptau-181/Aβ1-42 ratio was related to decreasing extraversion. Personality changes in the domain of agreeableness did not yield any significant effect as a predictor on any of CSF biomarkers.ConclusionsOur findings suggest that early and specific changes in personality traits are associated with cerebral AD pathology, in particular with amyloid pathology, and may serve as clinical signs to consider when evaluating MCI and mild dementia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Predictors of Oral Health Behaviors in Female Students: An Application of the Health Belief Model.

Background:Oral and dental health diseases can affect the general health of students.Objectives:The aim of this study was to identify the predictors of oral and dental health behavior using the health belief model (HBM) in female students in Teheran, Iran.Patients and Methods:This was a cross-sectional study framed by the HBM, including 400 female students living in district 5 of Tehran, Iran. The sampling technique used in this study was multi-stage stratified random sampling. The data on the HBM constructs (perceived severity, perceived susceptibility, perceived benefits, perceived barriers, cues to action, and self-efficacy) and demographic characteristics were collected using a self-administered questionnaire. Descriptive statistics, bivariate correlations, and linear regression were performed to analyze the data, using the SPSS software, version 18.Results:The results showed that there were relationships between the knowledge, perceived barriers, cues to action, and mother’s education with oral health behaviors. A multivariate hierarchical regression analysis was conducted with the barrier entered at step one, knowledge at step two, and cues to action at step three. Finally, the three variables accounted for 17% of the total variance in the oral and dental health behavior.Conclusions:The current study provided evidence for the utility of the belief-based model in the prediction of oral health behaviors. It could be suggested that oral health behavior can be promoted by reducing the perceived barriers and enhancing the students’ knowledge of oral and dental hygiene.

Advanced Activities of Daily Living (AADLs) and cognitive performance in community-dwelling elderly persons: Data from the FIBRA Study - UNICAMP

Objective The aim of this study was to investigate the relationship between participation in advanced activities of daily living (AADLs) and cognitive performance in community-dwelling elderly persons. Method The data presented is drawn from the population-based study entitled Frailty Profile of Elderly Brazilians (FIBRA-Unicamp). The sample comprised 2,549 older adults without cognitive impairments suggestive of dementia. Data was collected relating to socio-demographic characteristics (sex, age, years of education and family income), health status (number of diseases and depressive symptoms), cognitive performance (Mini-Mental State Examination - MMSE) and self-reported social, physical and intellectual AADLs. Results Mean MMSE scores were significantly higher among men, younger individuals and those with more years of education, higher income, fewer diseases and fewer depressive symptoms. Multivariate linear regression analysis and hierarchical regression analysis showed that years of education, family income and participation in intellectual AADLs were positively associated with cognitive performance. Conclusion The findings suggest that these factors may have a protective role in cognitive aging and that participation in intellectual AADLs can represent a feasible strategy for the promotion of mental health among older adults.

Assessing the Costs Associated with Volume-Based Referral for Hepatic Surgery

BackgroundAlthough proposed as a means for quality improvement, little is known regarding the economic consequences of volume-based referral. The objective of the current study was to investigate the relationship between inpatient costs and hospital volume. MethodsPatients undergoing elective liver surgery were identified using the Nationwide Inpatient Sample from 2001 to 2012. Multivariable hierarchical regression analyses were performed to calculate and compare risk-adjusted costs and postoperative outcomes across hospital volume terciles. ResultsA total of 27,813 patients underwent surgery at 2207 hospitals. Although costs were comparable across the three volume groups (all p > 0.05), patients who developed a postoperative complication incurred a higher overall cost (complication vs. no complication; median costs $17,974 [IQR 13,865–25,623] vs. $41,731 [IQR 27,008–64,266], p < 0.001). In contrast, while the incidence of postoperative complications (low vs. intermediate vs. high; 22.0 vs. 19.2 vs. 13.0 %, p < 0.001) and subsequent failure-to-rescue (low vs. intermediate vs. high; 16.6 vs. 24.7 vs. 15.1 %, p < 0.001) was lower at high-volume hospitals, costs associated with “rescue” were substantially higher at high-volume hospitals (low vs. intermediate vs. high; $39,289 vs. $36,157 vs. $48,559, both p < 0.001). ConclusionsCompared with lower volume hospitals, improved outcomes among patients who developed a complication at high-volume hospitals were associated with an increased cost.

The Influence of Insurance Status on the Surgical Treatment of Acute Spinal Fractures.

A retrospective, propensity score, multivariate analysis of the National Trauma Data Bank (NTDB) between 2008 and 2011. The aim of this study was to determine the relationship between insurance status and rates of surgery for acute spinal fractures with and without spinal cord injury (SCI). The decision for surgery in patients with spinal fractures is often based on fracture pattern and stability, associated SCI, and the presence of ligamentous and other associated injuries. It is poorly understood how nonclinical factors, such as insurance status, influence the decision for surgical intervention in patients sustaining spinal trauma. Using NTDB admission years 2008 to 2011, we included patients 18 to 64 years old who sustained a fracture of the cervical or thoracolumbar spine. Patients were excluded if they sustained polytrauma (Injury Severity Score ≥27) or a major injury (Abbreviated Injury Scale severity ≥3) to the head, thorax, or abdomen. Our main outcome measure was surgical versus nonsurgical treatment for spinal injury; our main predictor was insurance status. Hierarchical multivariate regression analysis and propensity scores were used to determine the relationship between insurance status and surgical treatment, controlling for other factors. We calculated adjusted odds ratios (ORs) for rates of surgery. Our propensity score multivariate analysis demonstrated significantly higher rates of surgery in patients with SCI (OR = 11.76, P < 0.001), insurance (OR = 1.27, P < 0.001), white (OR = 1.21, P = 0.018) versus black race, blunt trauma (OR = 5.63, P < 0.001), shock (OR = 1.62, P < 0.001), higher Glasgow Coma Scale (GCS) score (OR = 1.02, P = 0.002), transfer from lower acuity hospital (OR = 1.51, P < 0.001), and treatment at teaching hospitals (OR = 1.49, P < 0.001). Multivariable subgroup analysis of SCI patients similarly revealed higher surgical rates for insured patients (OR = 1.46, P < 0.001) than those without insurance. Patients with traumatic spine fractures were more likely to receive surgery if they were insured, regardless of the presence of SCI.

The Optimal Body Size Index with Which to Determine Iodine Dose for Hepatic Dynamic CT: A Prospective Multicenter Study.

To identify the body size parameter that exhibits the best correlation with aortic and hepatic enhancement at hepatic dynamic computed tomography (CT) in a large patient population enrolled in a multicenter study. This prospective study was approved by the ethics committee of each of the 31 participating institutions where 1342 patients were enrolled between April 2012 and September 2013. All patients provided either written or oral informed consent. All patients underwent hepatic dynamic CT, which included preenhanced, hepatic arterial phase (HAP), and portal venous phase (PVP) scanning, performed with the routine scanning protocol of each institution. Changes in CT number (in Hounsfield units) per gram of iodine in the aorta (eA/I) and liver (eL/I) during HAP and PVP scanning were recorded for each patient. Hierarchical multivariate linear regression analysis was performed in which the outcome variable was either eA/I or eL/I; the independent variables were age, sex, one body size parameter (height, body weight, body mass index, lean body weight [LBW], or body surface area), and liver function (aspartate aminotransferase, albumin, and total bilirubin levels). A two-level hierarchical model in which patients were level 1 and the institution was level 2 was used. Hierarchical multivariate linear regression analysis revealed that in the population not stratified by sex, body size was significantly correlated with eA/I and eL/I (P < .001) and that LBW exhibited the strongest correlation with eA/I and eL/I (r = -0.561 and r = -0.601, respectively). Sex-stratified analysis showed that LBW was more strongly correlated with eA/I and eL/I in women (r = -0.779 and r = -0.948, respectively) than in men (r = -0.500 and r = -0.494, respectively) or in the nonstratified total population. Among body size parameters, LBW exhibited the strongest correlation with aortic and hepatic enhancement, especially in women.

The Association Between Depressive Symptoms and Age in Cancer Patients: A Multicenter Cross-Sectional Study

ContextThere is controversy around the association between depressive symptoms and age in adult cancer patients. ObjectivesThe aim of this study was to evaluate the following hypotheses: 1) cancer patients' depressive symptoms decrease with age, and 2) in individuals aged 65 years or older, depressive symptoms increase because of the effect of somatic symptoms. MethodsWe retrospectively analyzed a database of 356 cancer patients who were consecutively recruited in a previous multicenter cross-sectional study. Depressive symptoms were assessed by the Patient Health Questionnaire-9 (PHQ-9), and correlations with age and other factors were assessed by hierarchical multivariate regression analysis. Age was entered as the dependent variable in the first step, patient characteristics and cancer-related variables were entered in the second step, and somatic symptoms were entered in the last step. We analyzed this model for both the total sample and the subpopulation aged 65 years or older. ResultsIn the total sample, the PHQ-9 score was significantly associated with lower age, fatigue, and shortness of breath (adjusted R2 14.2%). In the subpopulation aged 65 years or older, no factor was associated with the PHQ-9 score (adjusted R2 7.3%). ConclusionThe finding that depressive symptoms in cancer patients decreased with age was concordant with our first hypothesis, but the second hypothesis was not supported. Younger cancer patients were vulnerable to depressive symptoms and should be monitored carefully. Further studies using more representative samples are needed to examine in detail the association between depressive symptoms and age in older cancer patients.

Response to: A Commentary on "Antipsychotic-Induced Parkinsonism is Associated with Working Memory Deficits in Schizophrenia-Spectrum Disorders".

Response to: A Commentary on "Antipsychotic-Induced Parkinsonism is Associated with Working Memory Deficits in Schizophrenia-Spectrum Disorders".

Fractionation of Palliative Radiation Therapy for Bone Metastases in Ontario: Do Practice Guidelines Guide Practice?

To evaluate the effect of a provincial practice guideline on the fractionation of palliative radiation therapy for bone metastases (PRT.B) in Ontario. The present retrospective study used electronic treatment records linked to Ontario's population-based cancer registry. Hierarchical multivariable regression analysis was used to evaluate temporal trends in the use of single fractions (SFs), controlling for patient-related factors associated with the use of SFs. From 1984 to 2012, 43.9% of 161,835 courses of PRT.B were administered as SFs. The percentage of SF courses was greater for older patients (age <50 years, 39.8% vs age >80 years, 52.5%), those with a shorter life expectancy (survival >12 months, 36.9% vs < 1 month, 53.6%), and those who lived farther from a radiation therapy center (<10 km, 42.1% vs > 50 km, 47.3%). The percentage of SFs to spinal fields was lower than that to other skeletal sites (31.5% vs 57.1%). The percentage of SFs varied among the cancer centers (range, 26.0%-67.8%). These differences were all highly significant in the multivariable analysis (P<.0001). In 2004, Cancer Care Ontario released a practice guideline endorsing the use of SFs for uncomplicated bone metastases. The rate of use of SFs increased from 42.3% in the pre-guideline period (1999-2003) to 52.6% in the immediate post-guideline period (2004-2007). However, it subsequently decreased again to 44.0% (2009-2012). These temporal trends were significant after controlling for patient-related factors in the multivariable analysis (P<.0001). Large intercenter variations in the use of SFs persisted after publication of the guideline. The publication of an Ontario practice guideline endorsing the use of SF PRT.B was associated with only a transient increase in the use of SFs in Ontario and did little to reduce intercenter variations in fractionation.

Environmental influences on indoor walking behaviours of assisted living residents

Regular walking behaviours can improve older people's physical, psychological and social health. This project examined the relationships between assisted living facilities’ design features and residents’ indoor walking behaviours through surveys and field evaluations. Surveys were conducted in 18 assisted living facilities in the US state of Texas. Researchers gathered information from 343 residents about their walking behaviours, participation in other activities, health and demographic status, and perceptions of the environment. Field evaluations were conducted to collect objective physical environment measures. Facility information was provided by the administrators. Multivariate hierarchical regression analysis showed significant influences of physical environments on indoor walking behaviours. Indoor recreational walking was related negatively to the number of stories of the building and positively to the perception of looped corridors. Different types of utilitarian walking, such as ‘walk to other activities’, ‘walk to front entry' and ‘walk to mailbox' were influenced by specific design features. The number of utilitarian walking types was marginally influenced by the number of stories of the building. These findings will help inform the design of activity-friendly assisted living facilities and the creation of health promotion programmes for frail older people.

Aspects of protected mealtimes are associated with improved mealtime energy and protein intakes in hospitalized adult patients on medical and surgical wards over 2 years.

Protected mealtimes programs aim to improve inpatient intakes. Yet its efficacy has not yet been established. We aimed to determine which patient-related factors and aspects of protected mealtimes, for example, mealtime assistance and meal within reach, were associated with energy and protein intakes of adult inpatients on medical and surgical wards. Patient characteristics and dietary intake data were collected at main meals over 2 years. Proportions of individual foods and drinks consumed were visually estimated and converted to nutrients using averaged ready reckoner data. Mealtime factors associated with energy and protein intakes were determined using multivariate linear hierarchical regression analyses. Over 2 years, mealtime nutrient intakes of 798 inpatients were calculated ((63 ± 19) years, 52% male). Average intakes at main meals were 1419 ± 614 kJ and 15 ± 7 g protein. Inpatient intakes were significantly associated with gender, age, season, stopping or refusing a meal, time until discharge and eating at dinner (B = -829-222 kJ, B = -8.8 to 2.2 g protein, P = 0.000-0.032). Protected mealtimes program implementation was not associated with inpatient intake (P=0.094-0.157). However, aspects of protected mealtimes were associated with intake. This included requiring and documenting the need for mealtime assistance, introduction of mealtime volunteers, time to eat and appropriate positioning during mealtimes (B = 177-296 kJ, B = 0.07-3.9 g protein, P=0.000-0.014, R(2) = 0.148-0.154). In those specifically requiring mealtime assistance, inpatient protein intake was associated with mealtime volunteers and appropriate positioning (B = 4.1-4.4 g protein, P = 0.013-0.026, R(2) = 0.197). Aspects of protected mealtimes were associated with improved intake. Identifying these achievable aspects during planning and ensuring successful implementation of protected mealtimes may be critical for optimizing acute inpatient intake.

Psychopharmacological treatment differences in autogenous and reactive obsessions: A retrospective chart review

Background: Identification of homogeneous subgroups of obsessive compulsive disorder (OCD) patients may have important implications for improving effective treatment options. It has been proposed that obsessive thoughts can be classified into two subtypes, i.e. autogenous and reactive obsessions. Although it has been shown that patients with autogenous obsessions may display a worse response to treatment, no studies have yet addressed whether there is a different need for the psychopharmacological treatment options in the subtypes of OCD patients. Aim: To investigate the clinical characteristics and treatment differences between autogenous (A-OCD) and reactive (R-OCD) subtypes of OCD patients. Methods: Both OCD subgroups (n = 50 for A-OCD, n = 130 for R-OCD) were compared with each other in terms of their demographic and clinical parameters. Odds ratio values for gender, treatment options, co-morbidity, severity of OCD, and response to treatment were computed. Multivariate hierarchical regression analyses were performed to identify any predictors for treatment options, severity of OCD, and response to treatment. Results: Our results indicated that the A-OCD and R-OCD groups differed from each other on some demographic and clinical variables in addition to their psychopharmacological treatment needs. Patients in the A-OCD group were found to be prescribed an atypical antipsychotic 2.3 times more likely than the R-OCD group. The odds for a combination treatment, or the improvement of OCD symptoms from baseline levels did not differ between the two subtypes of obsession groups. Conclusions: Autogenous and reactive subtypes of obsessions may need to be offered different psychopharmacological treatment options.

Left ventricular diastolic dysfunction in peritoneal dialysis: a forgotten risk factor.

Left ventricular diastolic dysfunction (LVDD) is common among patients undergoing peritoneal dialysis (PD). We examined the relationship between LVDD, major adverse cardiovascular events (MACE), and mortality in PD patients. A total of 149 patients undergoing PD with preserved left ventricular systolic function were included and followed for 3.5 years. LVDD was diagnosed (according to the European Society of Cardiology guidelines) by conventional and tissue Doppler echocardiography. Serum high-sensitivity C-reactive protein (hsCRP) was measured. The location and volume of adipose tissue were assessed by computed tomography (CT) at the level of the fourth lumbar vertebra. Subjects with LVDD had higher levels of hsCRP, and more visceral and peritoneal fat than controls. The relationship between adjusted visceral adipose tissue and LVDD became nonsignificant when hsCRP and baseline demographic data were introduced into the logistic regression model (odds ratio = 1.52, P = 0.07). Subsequent hierarchical multivariate Cox regression analysis showed that LVDD was one of the most powerful determinants of MACE and mortality after adjusting for all confounding factors (hazard ratio [HR]: 1.71, 95% confidence interval [CI]: 1.43-3.51, P = 0.02 and HR: 2.25, 95% CI: 1.45-2.91, P = 0.04, respectively). Systemic inflammation (hsCRP) was also significantly associated with MACE and mortality (HR: 2.03, P = 0.03 and HR: 2.16, P = 0.04, respectively). LVDD is associated with systemic inflammation and increased visceral fat in patients undergoing PD. LVDD is also a sensitive, independent indicator of future MACE and mortality in PD patients.

Regional variation in antenatal corticosteroid use: a network-level quality improvement study.

Examination of regional care patterns in antenatal corticosteroid use (ACU) rates may be salient for the development of targeted interventions. Our objective was to assess network-level variation using California perinatal care regions as a proxy. We hypothesized that (1) significant variation in ACU exists within and between California perinatal care regions, and (2) lower performing regions exhibit greater NICU-level variability in ACU than higher performing regions. We undertook cross-sectional analysis of 33,610 very low birth weight infants cared for at 120 hospitals in 11 California perinatal care regions from 2005 to 2011. We computed risk-adjusted median ACU rates and interquartile ranges (IQR) for each perinatal care region. The degree of variation was assessed using hierarchical multivariate regression analysis with NICU as a random effect and region as a fixed effect. From 2005 to 2011, mean ACU rates across California increased from 82% to 87.9%. Regional median (IQR) ACU rates ranged from 68.4% (24.3) to 92.9% (4.8). We found significant variation in ACU rates among regions (P < .0001). Compared with Level IV NICUs, care in a lower level of care was a strongly significant predictor of lower odds of receiving antenatal corticosteroids in a multilevel model (Level III, 0.65 [0.45-0.95]; Level II, 0.39 [0.24-0.64]; P < .001). Regions with lower performance in ACU exhibited greater variability in performance. We found significant variation in ACU rates among California perinatal regions. Regional quality improvement approaches may offer a new avenue to spread best practice.

우리나라 성인남녀의 골밀도 관련요인: 국민건강영양조사 제 5기 1, 2차 년도(2010년, 2011년)

This study was based on the data from the 2010-2011 Korean National Health and Nutrition Examination Survey (KNHANES, 2010∼2011) V. Among 8,473 subjects of the survey, who were adults 19 years old or over with bone mineral density data, the current study excluded those whose data include a missing study variable or the response of 'I don't know', and finally analyzed the data of 5,986 subjects (2,692 males and 3,294 females). This study employed the following statistical methods of analysis: t-test, analysis of variance (ANOVA), and hierarchical multivariate linear regression analysis.

Emotional distress in parents of long-term survivors of childhood acute lymphoblastic leukemia.

The current study investigated the occurrence of emotional distress in parents of long-term survivors of childhood acute lymphoblastic leukemia (ALL) and identified factors associated with parent emotional distress symptoms. Parents of 127 long-term survivors of childhood ALL treated on a chemotherapy-only protocol at St. Jude Children's Research Hospital participated in the study. Parents completed standard ratings of emotional distress, caregiver strain, and child physical, emotional, and psychosocial functioning. Multivariable hierarchical linear regression analyses were used to examine associations between symptoms of caregiver strain, survivor functioning, and parent emotional distress. Covariates included parent education, survivor age, survivor sex, and time since childhood cancer diagnosis. On average, few parents reported significant symptoms of emotional distress. Clinically significant levels of anxiety and depression were reported by 7.1% and 3.1% of parents, respectively. Only 3.9% of parents endorsed significant symptoms of posttraumatic stress. Perceived caregiver strain was significantly associated with symptoms of parent anxiety, depression, and posttraumatic stress. Parent-report of child emotional functioning was significantly associated with symptoms of parent anxiety. Most parents of long-term survivors of ALL exhibit low levels of emotional distress in the context of rates observed in the general population. Perceived caregiver strain was significantly associated with parent emotional distress. Further research is required to examine specific sources of caregiver strain, as well as other risk and protective factors associated with parent emotional distress symptoms.

The best triathletes are older in longer race distances - a comparison between Olympic, Half-Ironman and Ironman distance triathlon.

The purpose of this study was (i) to determine the age of peak triathlon performance for world class athletes competing in Olympic, Half-Ironman and Ironman distance races and (ii) to investigate a potential change in the age of the annual fastest athletes across years. Data of ages and race times of all finishers in the international top races over the three distances between 2003 and 2013 were collected and the annual top ten women and men were analysed using linear, non-linear and hierarchical multivariate regression analyses. The age of peak male performance was 27.1 ± 4.9 years in the Olympic, 28.0 ± 3.8 years in the Half-Ironman and 35.1 ± 3.6 years in the Ironman distance and the age of peak male performance was higher in the Ironman compared to the Olympic (p < 0.05) and the Half-Ironman distance (p < 0.05) triathlon. The age of peak female performance was 26.6 ± 4.4 years in the Olympic, 31.6 ± 3.4 years in the Half-Ironman and 34.4 ± 4.4 years in the Ironman distance and the age of peak female performance was lower in the Olympic compared to the Half-Ironman (p < 0.05) and Ironman distance (p < 0.05) triathlon. The age of the annual top ten women and men remained unchanged over the last decade in the Half-Ironman and the Ironman distance. In the Olympic distance, however, the age of the annual top ten men decreased slightly. To summarize, the age of peak triathlon performance was higher in the longer triathlon race distances (i.e. Ironman) and the age of the annual top triathletes remained mainly stable over the last decade. With these findings top athletes competing at world class level can plan their career more precisely as they are able to determine the right time in life to switch from the shorter (i.e. Olympic distance) to the longer triathlon race distances (i.e. Half-Ironman and Ironman) in order to continuously compete in triathlon races at world class level.

Hospital Delirium and Psychological Distress at 1 Year and Health-Related Quality of Life After Moderate-to-Severe Traumatic Injury Without Intracranial Hemorrhage

ObjectivesTo determine whether delirium during the hospital stay predicted health-related quality of life (HRQOL) at 1 year after injury in trauma intensive care unit (ICU) survivors without intracranial hemorrhage, and to examine the association between depressive and posttraumatic stress disorder (PTSD) symptoms and each of the HRQOL domains at 1-year follow-up. DesignPrognostic cohort with a 1-year follow-up. SettingLevel 1 trauma ICU. ParticipantsAdult patients without intracranial hemorrhage (N=173) admitted to a level 1 trauma ICU. InterventionsNot applicable. Main Outcome MeasuresHRQOL was measured with the Medical Outcomes Study 36-Item Short-Form Health Survey at 1 year after traumatic injury. ResultsAverage delirium duration ± SD was .51±1.1 days. Hierarchical multivariable linear regression analyses did not find a statistical relationship between delirium and HRQOL at 1-year follow-up. However, increased levels of depressive symptoms at 1 year were statistically associated with poorer functioning in all physical and mental health HRQOL domains, whereas PTSD at 1 year was statistically associated with all HRQOL domains except role-physical (P<.05). ConclusionsThere was no statistical association between delirium during the hospital stay and HRQOL at 1 year, which may be due to the short time spent in delirium by our study population. Depressive symptoms demonstrated a stronger relationship with mental and physical HRQOL domains at 1 year than PTSD, indicating their own unique pathway after trauma. Findings lend support for the separate assessment and management of depression and PTSD. Additional research on the duration and subtypes of delirium is needed within the trauma ICU population, as the effects are not widely known.