OR Range Research Articles

Gender-related differences in the associations between sexual impulsivity and psychiatric disorders

ObjectiveSexual impulsivity (SI) has been associated with conditions that have substantial public health costs, such as sexually transmitted infections and unintended pregnancies. However, SI has not been examined systematically with respect to its relationships to psychopathology. We aimed to investigate associations between SI and psychopathology, including gender-related differences. MethodWe performed a secondary data analysis of Wave-2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a national sample of 34,653 adults in the United States. DSM-IV-based diagnoses of mood, anxiety, drug and personality disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Scheduled DSM-IV Version. ResultsThe prevalence of SI was considerable (14.7%), with greater acknowledgment by men than women (18.9% versus 10.9%; p < 0.0001). For both women and men, SI was positively associated with most Axis-I and Axis-II psychiatric disorders (OR range: Women, Axis-I:1.89–6.14, Axis-II:2.10–10.02; Men, Axis-I:1.92–6.21, Axis-II:1.63–6.05). Significant gender-related differences were observed. Among women as compared to men, SI was more strongly associated with social phobia, alcohol abuse/dependence, and paranoid, schizotypal, antisocial, borderline, narcissistic, avoidant and obsessive-compulsive personality disorders. ConclusionThe robust associations between SI and psychopathology across genders suggest the need for screening and interventions related to SI for individuals with psychiatric concerns. The stronger associations between SI and psychopathology among women as compared to men emphasize the importance of a gender-oriented perspective in targeting SI. Longitudinal studies are needed to determine the extent to SI predates, postdates or co-occurs with specific psychiatric conditions.

Estrogen receptor β variants modify risk for Alzheimer's disease in a multiethnic female cohort.

Few studies of gene variants that affect estrogen activity investigate their association with age at onset of Alzheimer's disease (AD) in women of different ethnicities. We investigated the influence of ESR2 polymorphisms on age at onset of AD in a multiethnic cohort of women. To determine whether gene variants would affect risk for AD differently in women of different population ancestries. Among 1,686 women participating in the Washington Heights Inwood Columbia Aging Project (WHICAP), association with risk for AD was assessed for 20 ESR2 single-nucleotide polymorphisms (SNPs) using multivariate logistic regression, adjusting for age at time of study enrollment, presence of an APOE ε4 allele, years of education, and body mass index. Increased risk for AD was associated with four ESR2 SNPs in women of predominantly Caucasian AIMS-defined ancestry: rs944045, rs1256062, rs10144225, and rs2274705 (OR range 1.6-1.9, empiric p-value range 0.002-0.004). A separate SNP (rs10137185) was associated with decreased risk for AD in women who identified themselves as Black (OR 0.6, 95% CI = 0.4-0.9). When vascular risk factors were included in the model, a separate SNP (rs1256059) was associated with increased risk for AD in women of admixed/Hispanic ancestry (OR 1.5, 95% CI = 1.1-2.4). ESR2 polymorphisms affect risk for AD in women, and risk alleles vary by AIMs-defined ancestry and self-identified ethnicity. These effects are possibly due to different linkage disequilibrium patterns or differences in comorbid risk factors mediating SNP effect on risk for AD by group.

Clinical relevance of vilazodone treatment in patients with major depressive disorder: categorical improvement in symptoms.

Objective: To assess clinically relevant symptom improvement in patients with major depressive disorder (MDD) receiving vilazodone by using the Montgomery-Asberg Depression Rating Scale (MADRS), a clinician-rated scale used to measure MDD symptom severity and improvement.Method: Pooled data from 2 positive, phase 3, 8-week, double-blind, randomized, placebo-controlled trials in patients with MDD were analyzed. Patients received vilazodone 40 mg/d or placebo; post hoc analyses were conducted on study completers. Depression symptom improvement was evaluated by analyzing the proportions of patients who shifted from the baseline MADRS single-item symptom severity category of ≥ 2 (mild to severe symptoms) to an end-of-study category < 2 (minimal to no symptoms) or from ≥ 4 (moderate to severe symptoms) to ≤ 2 (mild to no symptoms). The proportion of patients who shifted from anxious depression to no anxious depression was also analyzed.Results: The percentage of patients who completed these studies with severity category shift from baseline ≥ 2 to end of study < 2 was significantly higher for vilazodone versus placebo on all MADRS items (odds ratio [OR] range, 1.4–1.7, P < .05) except reduced appetite (OR = 1.3, P = .232). A significantly greater proportion of vilazodone-treated versus placebo-treated patients shifted from baseline ≥ 4 to end of study ≤ 2 on MADRS items of apparent sadness, reported sadness, inner tension, reduced sleep, and lassitude (OR range, 1.5–2.0, P < .05). Additionally, a significantly greater proportion of vilazodone-treated versus placebo-treated patients shifted from anxious depression at baseline to no anxious depression at end of study (OR = 1.5, P = .031).Conclusions: These results suggest that vilazodone treatment is associated with clinically relevant changes in depression symptoms in patients with MDD.Trial Registration: ClinicalTrials.gov identifiers: NCT00285376 and NCT00683592

Restless legs symptoms in adolescents: Epidemiology, heritability, and pubertal effects

AimsWe aimed to determine the prevalence, pubertal effect, familial aggregation, and heritability of restless legs (RLS) symptoms in Chinese adolescents. In addition, the correlates and consequences of RLS symptoms were examined. MethodsThis was a population-based family study that involved 1549 adolescents (probands), their parents and siblings. RLS symptoms were assessed by a single question measuring the core features of RLS. Subjects with RLS symptoms for at least once per week were considered as abnormal. Impairment of daytime functions, behavioral problems, health status, and lifestyle practice were also documented. ResultsThe prevalence of RLS symptoms was 2.8% in adolescents and 7.4% in their parents with female preponderance. Gender difference of RLS symptoms emerged in mid-pubertal adolescents (Tanner stage 3 or above). RLS symptoms were closely associated with various sleep problems (range of ORs=2.24 to 32.5, p<0.05), except habitual snoring. They were also independently associated with impairment of daytime functions, poor general health and frequent temper outbursts but not caffeine or alcohol intake or cigarette smoking after adjustment for age, sex, and other comorbid sleep problems. RLS symptoms presented with a modest familial aggregation and heritability (h2±SE=0.17±0.04, p<0.001).InterpretationRLS symptoms are common in Chinese adolescents with significant health repercussions. Puberty plays a critical role in the emergence of gender difference of RLS symptoms, which are accounted for by both genetic and environmental factors.

Restless legs symptoms in adolescents: epidemiology, heritability, and pubertal effects

The onset of sex differences in restless legs syndrome (RLS) is poorly understood. In addition, the epidemiology and heritability of RLS need further clarification in Chinese population. We aimed to determine the prevalence, pubertal effect, familial aggregation, and heritability of restless legs (RLS) symptoms in Chinese adolescents. In addition, the correlates and consequences of RLS symptoms were examined. This was a population-based family study recruiting 1549 adolescents (probands), their parents and siblings. RLS symptoms were assessed by a single question measuring the core features of RLS. Subjects with RLS symptoms for at least once per week were considered as abnormal. Daytime functioning impairments, behavioural problems, health conditions, and lifestyle practice were also documented. The prevalence of RLS symptoms was 2.7% in adolescents and 7.4% in their parents with female preponderance. The sex difference of RLS symptoms emerged in mid-puberty adolescents (Tanner stage 3 or above). RLS symptoms were closely associated with various sleep problems (range of ORs = 2.24–32.5, p < 0.05), except for habitual snoring. RLS symptoms were independently associated with daytime functioning impairments and self- perceived poor general health but not behavioural problems, mental health, or lifestyle practices after adjustment for age, sex, and other comorbid sleep problems. RLS symptoms presented with a modest familial aggregation and heritability (h2 ¡‘Ó SE = 0.17 ¡‘Ó 0.04, p < 0.001). RLS symptoms are not uncommon in Chinese adolescents and their parents. Puberty plays a critical role in the emergence of sex difference of RLS symptoms. RLS symptoms are accounted for by both genetic and environmental factors. This study was part of the epidemiological study funded by Health and Health Services Research Fund (HHSRF) grant (reference number 08090011) from Food and Health Bureau of Hong Kong SAR, China.

Postinfancy growth, schooling, and cognitive achievement: Young Lives

Background: Early life growth failure and resulting cognitive deficits are often assumed to be very difficult to reverse after infancy.Objective: We used data from Young Lives, which is an observational cohort of 8062 children in Ethiopia, India, Peru, and Vietnam, to determine whether changes in growth after infancy are associated with schooling and cognitive achievement at age 8 y.Design: We represented the growth by height-for-age z score at 1 y [HAZ(1)] and height-for-age z score at 8 y that was not predicted by the HAZ(1). We also characterized growth as recovered (stunted at age 1 y and not at age 8 y), faltered (not stunted at age 1 y and stunted at age 8 y), persistently stunted (stunted at ages 1 and 8 y), or never stunted (not stunted at ages 1 and 8 y). Outcome measures were assessed at age 8 y.Results: The HAZ(1) was inversely associated with overage for grade and positively associated with mathematics achievement, reading comprehension, and receptive vocabulary. Unpredicted growth from 1 to 8 y of age was also inversely associated with overage for grade (OR range across countries: 0.80–0.84) and positively associated with mathematics achievement (effect-size range: 0.05–0.10), reading comprehension (0.02–0.10), and receptive vocabulary (0.04–0.08). Children who recovered in linear growth had better outcomes than did children who were persistently stunted but were not generally different from children who experienced growth faltering.Conclusions: Improvements in child growth after early faltering might have significant benefits on schooling and cognitive achievement. Hence, although early interventions remain critical, interventions to improve the nutrition of preprimary and early primary school–age children also merit consideration.

Cross-sectional prevalence survey of intimate partner violence perpetration and victimization in Canadian military personnel.

BackgroundIntimate partner violence (IPV) is prevalent and is associated with a broad range of adverse consequences. In military organizations, IPV may have special implications, such as the potential of service-related mental disorders to trigger IPV. However, the Canadian Armed Forces (CAF) have limited data to guide their prevention and control efforts.MethodsSelf-reported IPV perpetration, victimization, and their correlates were assessed on a cross-sectional survey of a stratified random sample of currently-serving Canadian Regular Forces personnel (N = 2157). The four primary outcomes were perpetration or victimization of any physical and/or sexual or emotional and/or financial IPV over the lifespan of the current relationship.ResultsAmong the 81% of the population in a current relationship, perpetration of any physical and/or sexual IPV was reported in 9%; victimization was reported in 15%. Any emotional and/or financial abuse was reported by 19% (perpetration) and 22% (victimization). Less physically injurious forms of abuse predominated. Logistic regression modelling showed that relationship dissatisfaction was independently associated with all four outcomes (OR range = 2.3 to 3.7). Probable depression was associated with all outcomes except physical and/or sexual IPV victimization (OR range = 2.5 – 2.7). PTSD symptoms were only associated with physical and/or sexual IPV perpetration (OR = 3.2, CI = 1.4 to 7.9). High-risk drinking was associated with emotional and/or financial abuse. Risk of IPV was lowest in those who had recent deployment experience; remote deployment experience (vs. never having deployed) was an independent risk factor for all IPV outcomes (OR range = 2.0 – 3.4).ConclusionsIPV affects an important minority of military families; less severe cases predominate. Mental disorders, high-risk drinking, relationship dissatisfaction, and remote deployment were independently associated with abuse outcomes. The primary limitations of this analysis are its use of self-report data from military personnel (not their intimate partners) and the cross-sectional nature of the survey. Prevention efforts in the CAF need to target the full spectrum of IPV. Mental disorders, high-risk drinking, and relationship dissatisfaction are potential targets for risk reduction. Additional research is needed to understand the association of remote deployment with IPV.

Patients récurrents aux urgences psychiatriques : analyse démographique et clinique

Frequent visitors of psychiatric emergency wards are an important health care problem. Previous studies underlined that 2 % to 9 % of patients induce 15 % to 33 % of total clinical activity. Those patients have chronic and severe mental illness such as schizophrenia, associated with social and financial difficulties. The aim of this study was to describe demographic and clinical characteristics of frequent visitors to a psychiatric emergency ward in a French Academic hospital over 6years in comparison to non-frequent visitors. The study is based on a retrospective review of the psychiatric emergency wards' administrative and medical computer databases; data that included demographic, financial, clinical, and management information. During this 6-year study, the psychiatric ward recorded 16,754 care episodes for 8800 different patients. We compared frequent visitors with other visitors using univariate and multivariate analyses. Frequent visitors were defined by a number of visits greater than 2 of the mean standard deviation. Two percent of patients (n=192) had nine or more visits during the period. These patients caused 21 % of the total number of the visits. In the univariate analysis, the most significant reasons for referral in frequent visitors versus others (P<0.001) were: more frequent anxiety (37.6 % vs. 32.1 %), less frequent disruptive behavior (8.4 % vs. 12.9 %), depression (7.8 % vs. 17.2 %) and suicide attempt (4.5 % vs. 11.1 %). Factors associated with frequent visitors (P<0.001), after including all significant or confounding variables (multivariate analysis), were: schizophrenia and schizophrenia spectrum disorders (OR=29.5, IC: 11.4-76), DSM-IV cluster B personality disorders (OR=5.5, IC: 3.6-8.4), mental and behavioral disorders due to psychoactive substance use (OR=4.6, IC: 3.1-7), financial assistance through social government programs (OR range: 9.1-2.4, all significant) and being homeless (OR=2.7, IC: 1.8-4). Factors associated with non-frequent visitors were mood disorders (OR=0.07, IC: 0.03-0.19) and neurotic, stress-related, and somatoform disorders (OR=0.14, IC: 0.05-0.4). Sex and age were not significant in multivariate analysis. This study identifies significant demographic and clinical factors associated with frequent visits in psychiatric emergency ward in accordance with the large majority of previous studies. We found that psychotic disorders or schizophrenia were the main diagnosis of these patients. Moreover, precariousness (homeless, financial assistance) is an important demographic factor associated with recurrence. However, contrary to numerous studies, we found no effect of sex or age. Due to this important economical and clinical burden, more specific care and alternative solutions to emergency care have to be proposed to this population of patients.

Sociodemographic disparities and behavioral factors in clinical oral health status during pregnancy

Although oral health (OH) problems are common during pregnancy, little is known about individual characteristics or behaviors relating to clinically assessed OH during pregnancy. This cross-sectional study describes the clinical OH status of a sample of pregnant women, examines relationships between sociodemographic factors and OH, behavioral factors and OH, and the influence of behavior on the relationships between sociodemographic clusters and OH. Baseline data were utilized from a pilot intervention study promoting OH during pregnancy. Participants (n=99), recruited from CenteringPregnancy(®) prenatal care groups completed questionnaires addressing race/ethnicity, income, education, dental insurance, oral hygiene practices, and dental care utilization; and clinical examinations for periodontal probing depths (PD), bleeding on probing (BOP), plaque assessment, and visual detection of untreated decay. Chi-squares and one-way anovas with Tukey's studentized range test of planned comparisons were conducted to examine bivariable relationships between both sociodemographic and behavioral characteristics to OH status. Multivariable logistic regression analyses tested whether the effects of sociodemographic variables on OH status might be mediated by behaviors, including self-reported oral hygiene and recent dental visits. Forty-five percent of the sample had untreated decay and the mean percentage of sites with BOP=18%. Bivariable analyses of sociodemographic factors indicated that compared with Whites, Hispanic women had greater % of sites with: BOP, PD ≥5mm plus BOP, and Plaque Index (PI) scores of ≥2, all P=0.05; and greater untreated decay (Chi-square 13.3, P<0.001). Lower income was related to greater untreated decay (Chi-square 7.6, P<0.01). Compared with the highest education level, the lowest level group had higher % BOP, P<0.05. Public dental insurance (versus private) was associated with greater % BOP, PD ≥5mm plus BOP, both P<0.05, and greater untreated decay (Chi-square 16.9, P<0.001). Regarding behaviors, lacking a past 6-month dental visit was related to greater: BOP, PD ≥5mm plus BOP, and PI ≥2 (F range 6.2-8.7, P<0.01-0.05); and greater untreated decay (Chi-square 12.0, P<0.001). Self-reported optimal oral hygiene was related to lower % BOP and PD ≥5mm plus BOP (F range 4.5-6.7, both P<0.05). Mediation analyses indicated that there were significant indirect effects of racial/ethnic differences on OH outcomes via having a recent dental visit (OR range 1.2-1.9). However, significant differences between the Hispanic and White groups remained. This study highlights sociodemographic disparities in clinical OH during pregnancy, the importance of dental care, and provides useful findings for tailoring interventions for expectant mothers and their infants.

Posttraumatic stress disorder and odds of major invasive procedures among U.S. Veterans Affairs patients

ObjectivesAlthough individuals with posttraumatic stress disorder (PTSD) are at heightened risk for several serious health conditions, research has not examined how having PTSD impacts receipt of invasive procedures that may alleviate these problems. We examined whether PTSD, after controlling for major depression, was associated with odds of receiving common types of major invasive procedures, and whether race, ethnicity, and gender was associated with odds of procedures. MethodsVeterans Health Administration patients with PTSD and/or depression were age-matched with patients without these disorders. The odds of invasive hip/knee, digestive system, coronary artery bypass graft/percutaneous coronary intervention (CABG/PCI), and vascular procedures during FY2006–2009 were modeled for the full sample of 501,489 patients and for at-risk subsamples with medical conditions alleviated by the procedures examined. ResultsAdjusting for demographic covariates and medical comorbidity, PTSD without depression was associated with decreased odds of all types of procedures (odds ratios [OR] range 0.74–0.82), as was depression without PTSD (OR range 0.59–0.77). In analyses of at-risk patients, those with PTSD only were less likely to undergo hip/knee (OR=0.78) and vascular procedures (OR=0.73) but not CABG/PCI. African-Americans and women at-risk patients were less likely to undergo hip/knee, vascular, and CABG/PCI procedures (OR range 0.31–0.82). ConclusionWith the exception of CABG/PCI among at-risk patients, Veterans with PTSD and/or depression were less likely to undergo all types of procedures examined. Future studies should examine the reasons for this disparity and whether it is associated with subsequent adverse outcomes.

Impacts of adverse childhood experiences on health, mental health, and substance use in early adulthood: A cohort study of an urban, minority sample in the U.S.

Research has shown that adverse childhood experiences (ACEs) increase the risk of poor health-related outcomes in later life. Less is known about the consequences of ACEs in early adulthood or among diverse samples. Therefore, we investigated the impacts of differential exposure to ACEs on an urban, minority sample of young adults. Health, mental health, and substance use outcomes were examined alone and in aggregate. Potential moderating effects of sex were also explored. Data were derived from the Chicago Longitudinal Study, a panel investigation of individuals who were born in 1979 or 1980. Main-effect analyses were conducted with multivariate logistic and OLS regression. Sex differences were explored with stratified analysis, followed by tests of interaction effects with the full sample. Results confirmed that there was a robust association between ACEs and poor outcomes in early adulthood. Greater levels of adversity were associated with poorer self-rated health and life satisfaction, as well as more frequent depressive symptoms, anxiety, tobacco use, alcohol use, and marijuana use. Cumulative adversity also was associated with cumulative effects across domains. For instance, compared to individuals without an ACE, individuals exposed to multiple ACEs were more likely to have three or more poor outcomes (OR range=2.75–10.15) and four or more poor outcomes (OR range=3.93–15.18). No significant differences between males and females were detected. Given that the consequences of ACEs in early adulthood may lead to later morbidity and mortality, increased investment in programs and policies that prevent ACEs and ameliorate their impacts is warranted.

Reading, Mathematics, and Behavioral Difficulties Interrelate: Evidence from a Cross-Lagged Panel Design and Population-Based Sample of US Upper Elementary Students

We examined three questions. First, do reading difficulties increase children's risk of behavior difficulties? Second, do behavioral difficulties increase children's risk of reading difficulties? Third, do mathematics difficulties increase children's risk of reading or behavioral difficulties? We investigated these questions using a sample of 9,324 children followed from third to fifth grade as they participated in a nationally representative dataset, conducting multilevel logistic regression modeling and including statistical control for many potential confounds. Results indicated that poor readers in third grade were significantly more likely to display poor task management, poor self-control, poor interpersonal skills, internalizing behavior problems, and externalizing behavior problems in fifth grade (odds ratio [OR] range = 1.30 - 1.57). Statistically controlling for a prior history of reading difficulties, children with poor mathematics skills in third grade were also significantly more likely to display poor task management, poor interpersonal skills, internalizing behavior problems, and reading difficulties in fifth grade (OR range = 1.38 - 5.14). In contrast, only those children exhibiting poor task management, but not other types of problem behaviors, in third grade were more likely to be poor readers in fifth grade (OR = 1.49).

Ethnic differences in problem perception and perceived need as determinants of referral in young children with problem behaviour

An underrepresentation of ethnic minority children in mental health care settings is consistently reported. Parents of ethnic minority children are, however, less likely to perceive problem behaviour in their children. Our hypothesis was that, as a result of ethnic differences in problem perception, referral to care by a child health professional (CHP) would be lower for 5- to 6-year-old (high-risk) children from ethnic minority backgrounds than for their peers from the ethnic majority (Dutch origin). For 10,951 children in grade two of elementary school, parents and/or teachers completed the Strengths and Difficulties Questionnaire (SDQ) as well as questions on problem perception (PP) and perceived need for professional care (PN). Referral information was obtained from the Electronic Child Records (ECR) for 1,034 of these children. These children had a high (>90th percentile) SDQ score, and were not receiving mental health care. CHP's referred 144 children (14%) during the routine health assessments. A lower problem perception was reported by parents of ethnic minority children (40-72%) than by parents of the ethnic majority group (80%; p<0.001), but there were no ethnic differences in referral (OR range 0.9-1.9-p>0.05). No ethnic differences were found for parental PN, nor for teacher's PP or PN. Despite a lower problem perception in ethnic minority parents when compared to ethnic majority parents, no ethnic differences were found in referral of children with problem behaviour in a preventive health care setting.

Psychometric properties of the List of Threatening Experiences—LTE and its association with psychosocial factors and mental disorders according to different scoring methods

BackgroundThe List of Threatening Experiences (LTE) questionnaire is frequently used to assess stressful events; however, studies of its psychometric properties are scarce. We examined the LTE's reliability, factorial structure, construct validity and explored the association between LTE scores and psychosocial variables and mental disorders. MethodThis study involved interviewing 5442 primary care attendees from Spain. Associations between four different methods of quantifying LTE scores, psychosocial factors, major depression (CIDI), anxiety disorders (PRIME-MD), alcohol misuse and dependence (AUDIT) were measured. ResultsThe LTE showed high test–retest reliability (Kappa range=0.61–0.87) and low internal consistency (α=0.44). Tetrachoric factorial analysis yielded four factors (spousal and relational problems; employment and financial problems; personal problems; illness and bereavement in close persons). Logistic multilevel regression found a strong association between greater social support and a lower occurrence of stressful events (OR range=0.36–0.79). The association between religious–spiritual beliefs and the LTE, was weaker. The association between mental disorders and LTE scores was greater for depression (OR range=1.64–2.57) than anxiety (OR range=1.35–1.97), though the highest ORs were obtained with alcohol dependence (OR range=2.86–4.80). The ordinal score (ordinal regression) was more sensitive to detect the strength of association with mental disorders. LimitationsWe are unable to distinguish the direction of the association between stressful events, psychosocial factors and mental disorders, due to our cross-sectional design of the study. ConclusionsThe LTE is a valid and reliable measure of stress in mental health, and the strength of association with mental disorders depends on the method of quantifying LTE scores.

Colon cancer: association of histopathological parameters and patients' survival with clinical presentation

Available data correlating symptoms of colon cancer patients with the severity of the disease are very limited. In a population-based setting, we correlated information on symptoms of colon cancer patients with several pathological tumor parameters and survival. Information on all patients diagnosed with colon cancer in Iceland in 1995-2004 for this retrospective, population-based study was obtained from the Icelandic Cancer Registry. Information on symptoms of patients and blood hemoglobin was collected from patients' files. Pathological parameters were obtained from a previously performed standardized tumor review. A total of 768 patients entered this study; the median age was 73 years. Tumors in patients presenting at diagnosis with visible blood in stools were significantly more likely to be of lower grade, having pushing border, conspicuous peritumoral lymphocytic infiltration, and lower frequency of vessel invasion. Patients with abdominal pain and anemia were significantly more likely to have vessel invasion. Logistic regression showed that visible blood in stools was significantly associated with protecting pathological factors (OR range 0.38-0.83, p < 0.05). Tumors in patients presenting with abdominal pain were strongly associated with infiltrative margin and scarce peritumoral lymphocytic infiltration (OR = 1.95; 2.18 respectively, p < 0.05). Changes in bowel habits were strongly associated with vessel invasion (OR = 2.03, p < 0.05). Cox regression showed that blood in stools predicted survival (HR = 0.54). In conclusion, visible blood in stools correlates significantly with all the beneficial pathological parameters analyzed and with better survival of patients. Anemia, general symptoms, changes in bowel habits, acute symptoms, and abdominal pain correlate with more aggressive tumor characteristics and adverse outcome for patients.

Su1758 Macrophage Migration Inhibitory Factor (MIF) Promoter Polymorphisms Are Not Susceptibility Factors for Inflammatory Bowel Disease

Background: The disease course in Crohn's disease (CD) is highly heterogeneous, with the majority of patients developing complications over time, such as strictures and fistulae, requiring surgical intervention. Tools to stratify patients could improve patient care and allow targeted therapeutic approaches. Several genetic variants, including NOD2/CARD15, have been linked to complicated CD courses. Aims: Exploratory cross sectional analysis for an association of genetic variants and serology in CD patients with the occurrence of complications, need for surgery and early disease onset. Methods: 323 CD patients (mean age at diagnosis: 28.5±11.8 years, mean age at sample procurement 35.7±11.9 years, 52.9% female) from a German referral center were genotyped for 94 IBD associated polymorphisms (Wellcome Trust Case Control Consortium investigation (Nature 2007, 447(7145):661-78)). The serum anti-glycan antibodies gASCA, AMCA, ACCA, ALCA, Anti-L and Anti-C were measured by ELISA. Complete clinical information was recorded in a prospectively maintained database, including complications, surgery, disease location and early age at disease onset (defined as ,40 years). Results: During the median follow-up time of 8.3 years (interquartile range (IQR) 4.6 14) 79.3% of the patients developed complications, 74.3% underwent surgery and 86.7% had early disease onset. After adjusting for ileal disease location and age of disease onset and using a dominant genetic model 5 genetic variants were associated with complications (FAF1 RS11205760, IL10C592A RS1800872, NOD2 SNP12 RS2066845, 3' UTR FAF1 RS2484676, UTR near AGTR1 RS1462651; OR range 1.8 6.25, p,0.05), 4 were linked to need for surgery (FAF1 RS11205760, MDR1 RS3789243, MPP1 RS2048294, 3' UTR FAF1 RS2484676; OR range 1.8 2.2, p ,0.05) and 4 to early disease onset (CYLD RS17223195, HERC2 RS916977, STAT3 RS744166, TJP2 RS3750551; OR range 2.1 2.4, p,0.05). NOD2 SNP12 (RS2066845) was the overall strongest determinant of complicated CD (OR 6.26 (95% CI 1.16, 33.3). When adding the above genetic variants to positivity for at least two anti-glycan antibodies the discriminatory capability (area under the curve) increased for complication versus no complication for FAF1 RS11205760, IL10C592A RS1800872 and UTR near AGTR1 RS1462651 (p,0.05), increased for surgery versus no surgery for FAF1 RS11205760, MDR1 RS3789243 and 3' UTR FAF1 RS2484676 (p,0.05), but did not increase for early disease onset. Conclusion: IBD associated susceptibility genes may increase the risk for complicated CD, need for surgery and early disease onset and could enhance the accuracy of anti-glycan antibodies. We are currently developing a risk prediction model including clinical predictors, anti-glycan antibodies and the abovementioned genotypes for patients at risk for complicated CD courses.

Su1757 Genetic Risk Profiling Alone or in Combination With Serum Anti-Microbial Antibodies for the Stratification of Complicated Crohn's Disease Courses

Background: The disease course in Crohn's disease (CD) is highly heterogeneous, with the majority of patients developing complications over time, such as strictures and fistulae, requiring surgical intervention. Tools to stratify patients could improve patient care and allow targeted therapeutic approaches. Several genetic variants, including NOD2/CARD15, have been linked to complicated CD courses. Aims: Exploratory cross sectional analysis for an association of genetic variants and serology in CD patients with the occurrence of complications, need for surgery and early disease onset. Methods: 323 CD patients (mean age at diagnosis: 28.5±11.8 years, mean age at sample procurement 35.7±11.9 years, 52.9% female) from a German referral center were genotyped for 94 IBD associated polymorphisms (Wellcome Trust Case Control Consortium investigation (Nature 2007, 447(7145):661-78)). The serum anti-glycan antibodies gASCA, AMCA, ACCA, ALCA, Anti-L and Anti-C were measured by ELISA. Complete clinical information was recorded in a prospectively maintained database, including complications, surgery, disease location and early age at disease onset (defined as ,40 years). Results: During the median follow-up time of 8.3 years (interquartile range (IQR) 4.6 14) 79.3% of the patients developed complications, 74.3% underwent surgery and 86.7% had early disease onset. After adjusting for ileal disease location and age of disease onset and using a dominant genetic model 5 genetic variants were associated with complications (FAF1 RS11205760, IL10C592A RS1800872, NOD2 SNP12 RS2066845, 3' UTR FAF1 RS2484676, UTR near AGTR1 RS1462651; OR range 1.8 6.25, p,0.05), 4 were linked to need for surgery (FAF1 RS11205760, MDR1 RS3789243, MPP1 RS2048294, 3' UTR FAF1 RS2484676; OR range 1.8 2.2, p ,0.05) and 4 to early disease onset (CYLD RS17223195, HERC2 RS916977, STAT3 RS744166, TJP2 RS3750551; OR range 2.1 2.4, p,0.05). NOD2 SNP12 (RS2066845) was the overall strongest determinant of complicated CD (OR 6.26 (95% CI 1.16, 33.3). When adding the above genetic variants to positivity for at least two anti-glycan antibodies the discriminatory capability (area under the curve) increased for complication versus no complication for FAF1 RS11205760, IL10C592A RS1800872 and UTR near AGTR1 RS1462651 (p,0.05), increased for surgery versus no surgery for FAF1 RS11205760, MDR1 RS3789243 and 3' UTR FAF1 RS2484676 (p,0.05), but did not increase for early disease onset. Conclusion: IBD associated susceptibility genes may increase the risk for complicated CD, need for surgery and early disease onset and could enhance the accuracy of anti-glycan antibodies. We are currently developing a risk prediction model including clinical predictors, anti-glycan antibodies and the abovementioned genotypes for patients at risk for complicated CD courses.

480 DOES REGIONAL VARIATION IN BLADDER AUGMENTATION RATES CORRELATE WITH VARIATION IN RENAL OUTCOMES AMONG CHILDREN WITH SPINA BIFIDA?

You have accessJournal of UrologyPediatrics: Neuropathic Bladder/Reconstruction1 Apr 2013480 DOES REGIONAL VARIATION IN BLADDER AUGMENTATION RATES CORRELATE WITH VARIATION IN RENAL OUTCOMES AMONG CHILDREN WITH SPINA BIFIDA? Jessica Lloyd, Sherry Ross, John Wiener, and Jonathan Routh Jessica LloydJessica Lloyd Durham, NC More articles by this author , Sherry RossSherry Ross Durham, NC More articles by this author , John WienerJohn Wiener Durham, NC More articles by this author , and Jonathan RouthJonathan Routh Durham, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1872AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder augmentation (BA) is a urologic surgical intervention for children with spina bifida (SB) and may be used to prevent renal failure. Recent research has suggested that the use of BA varies significantly between institutions. Our objectives were to (1) determine whether variation in rates of BA and other surgical procedures correlates with variation in urologic outcomes and (2) determine what factors are associated with variation in urologic surgery rates in children with SB. METHODS We used the 4 most recent years of the Kids' Inpatient Database (KID) (2000, 2003, 2006, & 2009) to identify hospitalized children with SB. Using ICD-9 codes from each inpatient hospitalization, we determined rates of BA and renal failure by state. We broadly defined renal outcomes as a diagnosis of acute or chronic renal failure or a procedure code for dialysis or renal transplant. We defined urologic surgery in SB children as BA, bladder outlet procedures or urinary diversion (eg, vesicostomy or ileal conduit). We calculated Spearman's correlation coefficients and used multivariate logistic regression to assess the relationship between surgical rates, renal failure rates, and other clinical predictors of interest. RESULTS We identified 32,259 inpatient SB admissions in 35 states. Of these, 863 (2.7%) were associated with a diagnosis of renal failure and 768 (2.4%) with BA. Renal failure rates in individual states varied from 1 to 9%, while BA rates varied from 0.4 to 6% between states. There was only a weak correlation between each state's rates of BA and renal failure (r=0.17, p<0.001). On multivariate analysis, urologic surgery rates were most closely associated with the specific state in which a patient was treated (OR range 0.2-6.9, p<0.001), patient age (OR 0.05/year, p<0.001), hospital teaching status (OR 4.1, p<0.001), lesion level (OR 6.9, p<0.001), and year of admission (OR 1.1, p<0.001. Renal failure was not associated with BA (p=0.34). These results were similar when analyzing either BA alone or BA in combination with other urologic surgeries. CONCLUSIONS There is significant between-state variation in the rates of both BA and renal failure. BA rates are only weakly correlated with renal failure, and on multivariate analysis renal failure was not associated with urologic surgery. The factors most strongly associated with variation in surgery rates were the state in which a patient was treated, patient age, hospital teaching status, level of SB lesion, and year of treatment. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byWang H, Lloyd J, Wiener J and Routh J (2016) Nationwide Trends and Variations in Urological Surgical Interventions and Renal Outcome in Patients with Spina BifidaJournal of Urology, VOL. 195, NO. 4 Part 2, (1189-1195), Online publication date: 1-Apr-2016. Volume 189Issue 4SApril 2013Page: e197 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jessica Lloyd Durham, NC More articles by this author Sherry Ross Durham, NC More articles by this author John Wiener Durham, NC More articles by this author Jonathan Routh Durham, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Examining the Risk of Cardiovascular Disease in Patients with Psoriasis: A Critical Review

Increased prevalence of cardiovascular disease (CVD) in psoriasis patients could be due to a greater prevalence of traditional cardiovascular (CV) risk factors or increased inflammatory disease burden. To critically evaluate evidence on the etiology and magnitude of CV risk in psoriasis patients. A total of 497 articles were identified for review through a PubMed search using the terms "CVD and psoriasis"; 43 were selected. Data measuring the risk of comorbidities and CV risk factors in psoriasis were retrieved. Psoriasis patients have an increased prevalence of CV risk factors. Evidence suggests an increased risk of CV morbidity and mortality associated with psoriasis itself. Risk estimates vary across studies (OR range 1.13-6.48), possibly due to heterogeneous study design and incomplete data. Although additional data are required, increased awareness of the association of psoriasis with CV risk factors could lead to early diagnosis and treatment of comorbidities, with resultant improvement in morbidity and mortality.

Mediterranean Diet Score and prostate cancer risk in a Swedish population-based case-control study.

Several individual components of the Mediterranean diet have been shown to offer protection against prostate cancer. The present study is the first to investigate the association between adherence to the Mediterranean diet and the relative risk of prostate cancer. We also explored the usefulness of the Mediterranean Diet Score (MDS) in a non-Mediterranean population. FFQ data were obtained from 1482 incident prostate cancer patients and 1108 population-based controls in the Cancer of the Prostate in Sweden (CAPS) study. We defined five MDS variants with different components or using either study-specific intakes or intakes in a Greek reference population as cut-off values between low and high intake of each component. Unconditional logistic regression was used to estimate the relative risk of prostate cancer for high and medium v. low MDS, as well as potential associations with the individual score components. No statistically significant association was found between adherence to the Mediterranean diet based on any of the MDS variants and prostate cancer risk (OR range: 0·96-1·19 for total prostate cancer, comparing high with low adherence). Overall, we found little support for an association between the Mediterranean diet and prostate cancer in this Northern European study population. Despite potential limitations inherent in the study or in the build-up of a dietary score, we suggest that the original MDS with study-specific median intakes as cut-off values between low and high intake is useful in assessing the adherence to the Mediterranean diet in non-Mediterranean populations.