Outcome Odds Ratio Research Articles

Prevalence and determinants of malnutrition among women of reproductive age in Bangladesh

BackgroundMalnutrition among women of reproductive age is an important public health issue with significant implications for maternal and child health. A complex interplay of socioeconomic, cultural, and environmental factors influences the prevalence and determinants of malnutrition in this demographic status.This study aims to determine the socioeconomic, cultural, and demographic factors that significantly impact the nutritional status of women of reproductive age in Bangladesh. MethodsThis study considered 19798 women who underwent nutritional status assessment from the Bangladesh Demographic and Health Survey 2017–18 (BDHS 2017–18). A chi-square test of association and multinomial logistic regression analysis were performed to identify the factors that substantially influenced nutritional status. ResultsOdds ratios (OR) and 95% confidence intervals (CI) were used to evaluate the risk factors associated with body mass index (BMI). This study revealed that the average body mass index of ever-married women in Bangladesh was 23.32 ±4.24 kg/m². The odds ratio of being overweight and obese was higher among women who lived in urban areas (OR=1.094 and 1.254, p<0.05) and those who lived in the Chattogram division (OR=4.249 and 6.341, p<0.05). In addition, those exposed to mass media (OR=1.247 and 1.882) and involved in business (OR=1.644 and 2.162, p<0.05) were found to be overweight compared to their complementary group. ConclusionEffective prevention and control programs should be implemented to target women with a higher risk of developing the disease to reduce the prevalence of malnutrition.

Sex-based differences in odds of motor vehicle crash injury outcomes

ObjectiveSeveral studies have documented the relative risk or odds of injury and fatality for females versus males in motor vehicle crashes (Parenteau et al. 2013, Forman et al. 2019, Brumbelow and Jermakian, 2022; Noh et al. 2022). Though, none combined National Automotive Sampling System–Crashworthiness Data System (NASS-CDS) and Crash Investigation Sampling System (CISS). The aim of this study was to document the relative odds of various injury outcomes for females versus males while considering a broad range of crash types, pre-crash and crash variables, and occupant characteristics. MethodsMultivariable logistic regression was carried out to study the odds of injury for females versus males. A select imputation method (Hot Deck, Approximate Bayesian Bootstrap) was applied as part of efforts to create multivariable logistic regression models for 25 different injury outcomes associated with occupants (age 13 years and older) involved in passenger vehicle crashes published in NASS-CDS (2000 to 2015) and CISS (2017–2021). Both pre-crash (n=7) and crashworthiness (n=22) predictor variables were considered, but only significant variables at p≤0.10 level were retained in final models. Six crash-type models were produced for each injury outcome; one that included all crashes, one for each of four different planar crash types (frontal, near-side, far-side, rear), and one for crashes involving rollover. These six sets of crash-type models were expanded further to include a model version that included both pre-crash/environment and crashworthiness predictor variables and one model limited to crashworthiness predictors only. Different than other recent studies, all crash types, occupant restraint conditions, and seating positions were considered. Occupant sex was retained in all models to facilitate female versus male injury outcome odds ratio (OR) assessments. ResultsFemale versus male injury OR estimates for 300 unique models are presented. Females had significantly higher odds of injury than males in 36 models (OR>1.0, p-value ≤0.05). This contrasts with 43 models where females had significantly lower odds (OR<1.0, p≤0.05). For the remaining 221 models, there was a near even split in how often the odds of injury were non-significantly higher (n=103) and non-significantly lower (n=114) for females as compared to males (p>0.05). In four cases, the OR estimate was 1.00. Amongst the results, there was a trend for females to have higher odds of AIS 2+ injuries (MAIS 2+ OR=1.75 and 1.69 for Full and Crashworthiness models, respectively for the All Crashes dataset). These increases included higher estimates for lower extremity injuries in frontal crashes, consistent with earlier studies (e.g., Forman et al. 2019). However, for certain AIS 2+ (neck, thorax) and AIS 3+ injuries (head, neck, thorax), females had significantly lower odds of injury (p≤0.05). The trends for reduced odds of injury for females were most prevalent in non-frontal crash models.

Life’s Essential 8 and Life’s Simple 7 in Relation to Coronary Atherosclerosis: Results From the Population-Based SCAPIS Project

ObjectiveTo examine the associations between the American Heart Association scores (“Life’s Essential 8” [LE8] and “Life’s Simple 7” [LS7]) and 2 subclinical coronary atherosclerosis indicators: coronary computed tomographic angiography (CCTA)-stenosis and coronary artery calcium (CAC). Patients and MethodsWe included a population-based sample, aged 50 to 64 years, recruited between 2013 and 2018 from the Swedish Cardiopulmonary Bioimage Study (n=24,819, 50.3% women). CCTA-stenosis was graded as no stenosis, stenosis (1%-49%) or severe stenosis (≥50%), whereas CAC was graded as 0, 1 to 99, 100 to 399, or ≥400 Agatston units. Multinomial logistic regression and receiver operating characteristic (ROC) curves were used to study the associations between cardiovascular health scores and subclinical coronary atherosclerosis. ResultsOdds ratios (ORs) for CCTA-stenosis and severe CCTA-stenosis between the lowest (<50 points) vs the highest (≥80 points) LE8 group were 4.18 (95% CI, 3.56 to 4.91) and 11.17 (95% CI, 8.36 to 14.93), respectively. For corresponding CAC results, ORs were 3.36 (95% CI, 2.84 to 3.98), 7.72 (95% CI, 6.03 to 9.89), and 14.94 (95% CI, 10.47 to 21.31) for CAC scores of 1 to 99, 100 to 399, and ≥400, respectively. Area under ROC curves for predicting any stenosis were 0.642 (95% CI, 0.635 to 0.649) and 0.631 (95% CI, 0.624 to 0.638, P<.001) for LE8 and LS7, respectively. ConclusionOur data indicate that LE8 showed a strong, graded, and inverse association with CCTA-stenosis and CAC score. The capacity to predict CCTA-stenosis was comparable between LE8 and LS7, although LE8 had slightly higher prediction capacity of any stenosis. This study provides novel evidence that the LE8 score may be a useful tool for monitoring cardiovascular health.

Hormone exposure and venous thromboembolism in commercially insured women aged 50 to 64 years

BackgroundMenopausal hormone therapy (MHT) can elevate venous thromboembolism (VTE) risk, but less is known about formulations and routes of exposures. ObjectiveTo estimate hormone-associated VTE risk by route and formulation in exposed and unexposed women aged 50 to 64 years in the US. MethodsIn a nested case-control study of US commercially insured women aged 50 to 64 years (2007-2019), cases were defined as incident VTE diagnoses and matched to 10 controls by date of VTE and age, excluding prior VTE, inferior vena cava filter placement, or anticoagulants. Filled prescriptions in the prior year defined hormone exposures. International Classification of Diseases and Current Procedural Terminology codes identified risk factors and comorbidities. ResultsOdds ratios (ORs) were estimated with conditional logistic regression controlling for differences between cases (n = 20,359) and controls (n = 203,590) in comorbidities and VTE risk factors. For exposures within 60 days, oral MHT risk was almost twice as high as transdermal MHT (OR = 1.92; 95% CI, 1.43-2.60); transdermal MHT did not elevate risk compared with no exposure (unopposed OR = 0.70; 95% CI, 0.59-0.83; combined OR = 0.73; 95% CI, 0.56-0.96). Risk was highest for MHT combinations with ethinyl estradiol, followed by conjugated equine estrogen (CEE) (ethinyl estradiol-CEE: OR = 1.55; 95% CI, 1.07-2.25), and lowest for estradiol (CEE-estradiol: OR = 1.33; 95% CI, 1.02-1.72). Combined hormonal contraceptives elevated risk 5 times higher than no exposure (OR = 5.22; 95% CI, 4.67-5.84) and 3 times higher than oral MHT (OR = 3.65; 95% CI, 3.09-4.31). ConclusionThe risk of VTE is much lower with MHT than combined hormone contraceptives and varies by hormone formulation and route of exposure. Transdermal MHT did not elevate risk. Oral MHT combinations with estradiol were lower risk than other forms of estrogen. Oral combined hormone contraceptives had much higher risk than oral combined hormonal MHT.

Effectiveness of Live Attenuated Varicella-Zoster Vaccine in Adults Older than 50 Years in Japan: A Retrospective Cohort Study.

Background: In Japan, freeze-dried live attenuated varicella-zoster vaccine BIKEN is available for adults aged ≥50 years to prevent herpes zoster (HZ). A prospective cohort study of 1200 healthy adults and 300 patients with underlying illness confirmed vaccine safety between 2016 and 2017. However, evidence of vaccine effectiveness (VE) is limited. Methods: VE against HZ and postherpetic neuralgia (PHN) was evaluated in the vaccinated cohort of the previous safety study in a follow-up study between 2021 and 2022 and compared with unvaccinated family members. Self-administered questionnaires determined retrospective experiences of HZ and PHN diagnosis. Logistic regression estimated the VE by calculating the outcome odds ratio (OR) in vaccinated vs. unvaccinated groups: VE = (1 - OR) × 100(%). Results: Overall, 1098 vaccinated and 518 unvaccinated subjects were analysed. Between 2016 and 2022, 26 vaccinated (2.4%) and 22 unvaccinated (4.2%) subjects reported HZ diagnosis, and 3 vaccinated (0.3%) and 2 unvaccinated (0.4%) subjects reported PHN. Adjusted VE against a clinical diagnosis was 41% for HZ [-6% to 67%], with marginal significance, and 16% [-408% to 86%] for PHN. Stratification by age, sex, or comorbidities had an adjusted VE against HZ of ~40%, which was similar between strata. Conclusion: Freeze-dried live attenuated varicella-zoster vaccine reduces the risk of HZ regardless of age, sex, or comorbidities.

Acute and Subacute Clinical Markers After Sport-Related Concussion

This study aimed to determine the association of a range of off-field symptoms reported by athletes retrospectively with on-field concussion signs and in-office symptoms among rugby union players. Players with sports concussion experience multiple symptoms. Understanding the association between these symptoms and clinical markers of concussion would facilitate a targeted approach to symptom assessment and treatment. Cross-sectional study. We consecutively enrolled 92 adult rugby union players, within the first 72 hours after sport concussion. Ten symptoms assessed using a retrospective symptoms interview were examined for their association with observed concussion signs and post-concussion symptoms using the Post-Concussion Symptoms Scale (PCSS). Odds ratios revealed that athletes who was overtly symptomatic based on retrospective concussion interview at the time of the concussion were over 2.6 times more likely (p = 0.047) to have exhibited post-traumatic amnesia when compared with athletes who was asymptomatic. There were no differences between groups in terms of on-field loss of consciousness or confusion. Off-field symptoms reported by athlete were associated with symptoms reporting on the Beck Depression Inventory (OR 2.8; 95% CI 1.14-6.88), headache (OR 4.9; 95% CI 1.92-12.79), memory concerns (OR 3.15; 95% CI 1.06-9.34), pressure in head (OR 2.8; 95% CI 1.03-8.08), and visual disturbances (OR 3.9; 95% CI 1.05-14.50) within the first 72 hours after concussion. Symptomatic concussed rugby athletes have increased odds for sustaining on-field concussion signs that can be observed by others and persistent symptoms within the first 72 hours after concussion. Information from the on-field and off-field assessment is essential in understanding the severity of sports concussion.

O22 ANDROGEN DEPRIVATION THERAPY AND THE RISK FOR INGUINAL HERNIA

Abstract Aim To investigate whether androgen deprivation therapy (ADT) for prostate cancer increases the risk for inguinal hernia. Material and Methods A population-based nested case-control study based on data from the Prostate Cancer Database Sweden. The cohort included men with prostate cancer who had not received curative treatment. Men who had been diagnosed with inguinal hernia or had undergone inguinal hernia repair (n = 1324) were cases and controls were men, not diagnosed, nor operated on for inguinal hernia, matched on birth year (n = 13 240). Conditional multivariate logistic regression models were used to assess any temporal association between ADT and inguinal hernia, adjusting for confounders. Results Odds Ratio [OR] for repair of inguinal hernia 0-1 years from start of ADT was 0.5 (95% confidence Interval (CI)) 0.38-0.68), between 1 and 3 years after, the OR was 0.35 (95% CI 0.26-0.47), 3-5 years after, the OR was 0.39 (95% CI 0.26-0.56), 5-7 years after, the OR was 0.6, (95% CI: 0.41-0.97), and &amp;gt; 9 years after, the OR was 3.68 (95% CI 2.45-5.53). Conclusions The marked increase in OR for inguinal hernia after 9 years of ADT supports the hypothesis that low testosterone levels increase the risk for inguinal hernia. The low risk for inguinal hernia during the first eight years on ADT is likely caused by selection of men with advanced cancer unlikely to be diagnosed or treated for inguinal hernia. This finding may support the hypothesis that sex hormones plays a crucial role in inguinal hernia development.

Cardiovascular risks and bleeding with non-vitamin K antagonist oral anticoagulant versus warfarin in patients with type 2 diabetes: a tapered matching cohort study

BackgroundWe compared the risk of bleeding and cardiovascular disease (CVD) events between non-vitamin K antagonist oral anticoagulant (NOAC) and warfarin in people with type 2 diabetes (T2DM).Methods862 Incident NOAC users and 626 incident warfarin users with T2DM were identified from within 40 UK general practice (1/4/2017–30/9/2018). Outcomes included incident hospitalisation for bleeding, CVD and re-hospitalisation for CVD within 12 months since first anticoagulant prescription, identified from linked hospitalisation data. A tapered matching method was applied to form comparison cohorts: coarsened exact matching restricted the comparison to areas of sufficient overlap in missingness and characteristics: (i) demographic characteristics; (ii) clinical measurements; (iii) prior bleeding and CVD history; (iv) prescriptions with bleeding; (v) anti-hypertensive treatment(s); (vi) anti-diabetes treatment(s). Entropy balancing sequentially balanced NOAC and warfarin users on their distribution of (i–vi). Weighted logistic regression modelling estimated outcome odds ratios (ORs), using entropy balancing weights from steps i–vi.ResultsThe 12-month ORs of bleeding with NOAC (n = 582) vs matched/balanced warfarin (n = 486) were 1.93 (95% confidence interval 0.97–3.84), 2.14 (1.03–4.44), 2.31 (1.10–4.85), 2.42 (1.14–5.14), 2.41 (1.12–5.18), and 2.51 (1.17–5.38) through steps i–vi. ORs for CVD re-hospitalisation was increased with NOAC treatment through steps i–vi: 2.21 (1.04–4.68), 2.13 (1.01–4.52), 2.47 (1.08–5.62), 2.46 (1.02–5.94), 2.51 (1.01–6.20), and 2.66 (1.02–6.94).ConclusionsIncident NOAC use among T2DM is associated with increased risk of bleeding hospitalisation and CVD re-hospitalisation compared with incident warfarin use. For T2DM, caution is required in prescribing NOACs as first anticoagulant treatment. Further large-scale replication studies in external datasets are warranted.

Detection of anti‐domain I antibodies by chemiluminescence enables the identification of high‐risk antiphospholipid syndrome patients: A multicenter multiplatform study

BackgroundClassification of the antiphospholipid syndrome (APS) relies predominantly on detecting antiphospholipid antibodies (aPLs). Antibodies against a domain I (DI) epitope of anti‐β2glycoprotein I (β2GPI) proved to be pathogenic, but are not included in the current classification criteria. ObjectivesInvestigate the clinical value of detecting anti‐DI IgG in APS. Patients/MethodsFrom eight European centers 1005 patients were enrolled. Anti‐cardiolipin (CL) and anti‐β2GPI were detected by four commercially available solid phase assays; anti‐DI IgG by the QUANTA Flash® β2GPI domain I assay. ResultsOdds ratios (ORs) of anti‐DI IgG for thrombosis and pregnancy morbidity proved to be higher than those of the conventional assays. Upon restriction to patients positive for anti‐β2GPI IgG, anti‐DI IgG positivity still resulted in significant ORs. When anti‐DI IgG was added to the criteria aPLs or used as a substitute for anti‐β2GPI IgG/anti‐CL IgG, ORs for clinical symptoms hardly improved. Upon removing anti‐DI positive patients, lupus anticoagulant remained significantly correlated with clinical complications. Anti‐DI IgG are mainly present in high‐risk triple positive patients, showing higher levels. Combined anti‐DI and triple positivity confers a higher risk for clinical symptoms compared to only triple positivity. ConclusionsDetection of anti‐DI IgG resulted in higher ORs for clinical manifestations than the current APS classification criteria. Regardless of the platform used to detect anti‐β2GPI/anti‐CL, addition of anti‐DI IgG measured by QUANTA Flash® did not improve the clinical associations, possibly due to reduced exposure of the pathogenic epitope of DI. Our results demonstrate that anti‐DI IgG potentially helps in identifying high‐risk patients.

The relationships of blood lead level, body mass index, and osteoarthritis in postmenopausal women

ObjectivesIt is unclear whether blood lead level (BLL) is associated with osteoarthritis (OA). The objectives of this study were to address the relationship between BLL and OA and to assess whether degree of obesity, evaluated as body mass index (BMI), mediates BLL-related OA. Study designThis study was performed using data obtained from 884 postmenopausal women (≥55 years old) in the Korea National Health and Nutrition Examination Survey 2010-2012. OA in back, hip, and knee was assessed by radiographic examination (rOA) and radiographic examination and symptoms (sxOA). Multivariable logistic regression analyses were performed to investigate the BLL–OA relationship. Mediation analyses were performed to address the contribution of BMI to BLL-related OA. ResultsOdds ratio (OR) for knee rOA with the highest tertile of BLL was 1.56 [95% confidence interval (CI) = 1.08–2.25] compared with the lowest tertile; there were significant linear trends across tertiles. With adjustments for confounders without BMI, continuous BLL was significantly associated with rOA (OR = 1.89, 95% CI = 1.27–2.80) and sxOA (OR = 1.69, 95% CI = 1.03–2.80) in the knee. After further adjusting for BMI, however, these significances were attenuated or disappeared. BMI was significantly associated with BLL, rOA of knee, and sxOA of knee and back. BMI significantly mediated the BLL–rOA association of the knee (21.1%) and back (46.5%) and the BLL–sxOA association of the knee (22.0%). The population-attributable fraction of rOA caused by BLL greater than the median (2.216 μg/dL) was 8.7% (95% CI = 1.1%–16.2%, P value = 0.024). ConclusionsBLL was significantly associated with knee OA in Korean postmenopausal women. BMI considerably mediated the effects of BLL on knee OA.

Evaluating the predictive value of measures of susceptibility to tobacco and alternative tobacco products

BackgroundThe “cigarette susceptibility index” has been adapted for other products, yet, the validity of these adapted measures–particularly among youth who have used other tobacco products–has not been evaluated. MethodsWe used prospective data from the Southern California Children's Health Study to evaluate the association of questionnaire measures assessing susceptibility to e-cigarette, cigarette, hookah and cigar/cigarillo/little cigar use at wave 1 (W1; 11th/12th grade) with subsequent initiation between W1 and W2 (16 months later, N = 1453). We additionally examined whether each effect estimate differed by use of other tobacco products at W1. ResultsOdds ratios, attributable risk%, and risk differences for product initiation among susceptible vs. non-susceptible youth were consistently higher among never users of any tobacco product than among youth with any tobacco use history. For example, susceptible (vs. non-susceptible) youth with no prior tobacco use had 3.64 times the odds of subsequent initiation of e-cigarettes (95%CI:2.61,5.09), while among users of another product, susceptible (vs. non-susceptible) youth had 1.95 times the odds of e-cigarette initiation (95%CI:0.98,3.89; p-interaction = 0.016). 60.4% of e-cigarette initiation among never users of any product could be attributed to susceptibility, compared to 19.8% among users of another product. The e-cigarette absolute risk difference between susceptible and non-susceptible youth was 21.9%(15.2,28.6) for never users, vs. 15.4%(0.2,30.7) for users of another product. ConclusionTobacco product-specific susceptibility associations with initiation of use at W2 were markedly attenuated among prior users of other products, demonstrating reduced utility for these measures among subjects using other products.

Is smaller worse? New insights about associations of PM1 and respiratory health in children and adolescents

Background and objectivesLittle is known about PM1 effects on respiratory health, relative to larger size fractions (PM2.5). To address this literature gap, we assessed associations between PM1 exposure and asthmatic symptoms in Chinese children and adolescents, compared with PM2.5. MethodsA total of 59,754 children, aged 2–17 years, were recruited from 94 kindergartens, elementary and middle schools in the Seven Northeast Cities (SNEC) study, during 2012–2013. We obtained information on asthma and asthma-related symptoms including wheeze, persistent phlegm, and persistent cough using a standardized questionnaire developed by the American Thoracic Society. PM1 and PM2.5 concentrations were estimated using a spatial statistical model matched to the children's geocoded home addresses. To examine the associations, mixed models with school/kindergarten as random intercept were used, controlling for covariates. ResultsOdds ratios (ORs) of doctor-diagnosed asthma associated with a 10-μg/m3 increase for PM1 and PM2.5 were 1.56 (95% CI: 1.46–1.66) and 1.50 (1.41–1.59), respectively, and similar pattern were observed for other outcomes. Interaction analyses indicated that boys and the individuals with an allergic predisposition may be vulnerable subgroups. For example, among children with allergic predisposition, the ORs for doctor diagnosed asthma per 10 μg/m3 increase in PM1 was 1.71 (95% CI: 1.60–1.83), which was stronger than in their counterparts (1.46; 1.37–1.56) (pfor interaction < 0.05). ConclusionsThis study indicated that long-term exposure to PM1 may increase the risk of asthma and asthma-related symptoms, especially among boys and those with allergic predisposition. Furthermore, these positive associations for PM1 were very similar to those for PM2.5.

Enriching the Interpretation of the Erectile Dysfunction Inventory of Treatment Satisfaction: Characterizing Success in Treatment Satisfaction

BackgroundPatient-reported outcomes, such as the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) index, are essential for successful evaluation and treatment of patients with erectile dysfunction. AimTo enrich interpretation of the EDITS index score and to complement the existing 0 to 100 scoring. MethodsThis supplemental analysis evaluated EDITS questionnaire data (11 items; index score range = 0–100; higher scores indicate more treatment satisfaction) after completion of an 8-week double-blinded trial of 279 men 18 to 65 years old with erectile dysfunction randomized to sildenafil 100 mg, sildenafil 50 mg, or placebo. Response options for each EDITS item were grouped into “success” (the 2 most satisfied or favorable responses) and “no success” (the remaining 3 responses). The binary response (success or no success) for each item was expressed as a function of overall EDITS score in a simple logistic regression model with all treatments combined. OutcomesOdds ratios and success probabilities (using Wald χ2 tests) were calculated for specified point differences and total EDITS index scores, respectively. ResultsEDITS index score increases corresponded with significant increases in odds of success in different EDITS aspects (P < .0001 for all comparisons). For instance, a 10-point EDITS index score difference was associated with odds ratios of 11.3, 42.0, 17.7, and 6.8 for overall treatment satisfaction, treatment meeting expectations, satisfaction with treatment quickness, and satisfaction with how long treatment lasts, respectively. For a given EDITS index score, likelihood of success was determined for different aspects of treatment satisfaction. For example, a mean EDITS index score of 78 (sildenafil 100 mg; SD = 18) corresponded to 96%, 88%, 94%, and 88% chances of success for the 4 EDITS items referenced earlier, respectively. Corresponding probabilities for a mean EDITS index score of 50 (placebo; SD = 18) were 3%, less than 0.1%, 1%, and 4%, respectively. Clinical ImplicationsInterpretation of the EDITS index score can be augmented using key aspects of treatment satisfaction as reported by the patient. Strengths and LimitationsThis analysis used a well-established anchor-based approach to interpret EDITS index scores. The methodology used and corresponding results are appropriate for clinical practice and clinical trial settings. Limitations include data evaluation only for the Patient EDITS and not the complementary Partner EDITS and use of data from a clinical trial enrolling a well-defined patient population only in stable relationships. ConclusionThese results enable a meaningful interpretation of EDITS index scores, facilitating decision making by stakeholders for better-informed health care choices.Cappelleri JC, Tseng L-J, Stecher V, Goldstein I. Enriching the Interpretation of the Erectile Dysfunction Inventory of Treatment Satisfaction: Characterizing Success in Treatment Satisfaction. J Sex Med 2018;15:732–740.

Risk of gestational diabetes mellitus in relation to plasma concentrations of amino acids and acylcarnitines: A nested case-control study

AimsGestational diabetes mellitus (GDM) affects between 5 and 10% of all pregnancies in Canada and can lead to adverse health outcomes in both the mother and fetus. Amino acids (AA) and acylcarnitines (AC) have been identified as early biomarkers of type 2 diabetes but their usefulness in screening for GDM has yet to be demonstrated. MethodsWe conducted a nested case-control study involving 50 controls and 50 GDM cases diagnosed between the 24th and 28th week of gestation. Heparinized plasma samples were obtained during the first and early second trimester of pregnancy. Case and controls were matched according to date of recruitment, maternal age, gestational age at blood sampling as well as pre-pregnancy body mass index. Eight AA and eight AC were quantified using an ultra-high pressure liquid-chromatography quadrupole time-of-flight mass spectrometry platform. Conditional regression analyses adjusted for matching factors and smoking habits during pregnancy were performed to identify plasma metabolites associated with GDM risk. ResultsOdds ratio (OR) and 95% confidence interval (CI) for the prediction of GDM per one standard deviation increase of AA or AC in plasma levels were 0.25 (0.08–0.79) for butyrylcarnitine, 0.31 (0.12–0.79) for glutamic acid, 2.5 (1.2–5.3) for acetylcarnitine, 2.9 (1.3–6.8) for isobutyrylcarnitine and 5.3 (1.7–17.0) for leucine. These five metabolites were selected by stepwise conditional logistic regression to create a predictive model with an OR of 2.7 (1.5–4.9). ConclusionWhether the identified metabolites can predict the risk of developing GDM requires additional studies in a larger sample of pregnant women.

TGFβ C-509T, TGFβ T869C, XRCC1 Arg194Trp, IKBα C642T, IL4 C-590T Genetic polymorphisms combined with socio-economic, lifestyle, diet factors and gastric cancer risk: A case control study in South Indian population

BackgroundGastric cancer is worldwide the third major cause of cancer related death. Risk factors for gastric cancer includes Helicobacter pylori infection, gastric ulcer, less hygienic condition, use of tobacco, alcohol consumption, use of salted, smoked food, genetic alterations etc. In order to identify the risk factors associated with gastric cancer in South Indian population a case-control study involving 200 proven gastric cancer cases and 400 controls was conducted. MethodsA structured questionnaire was used to interview all the subjects who participated in our study. Genotyping assay was performed using Taqman allelic discrimination assay for 5 Single Nucleotide Polymorphisms (SNPs)-TGFβ C-509T, TGFβ T869C, XRCC1 Arg194Trp, IkBα C642T and IL4C-590T. ResultsOdds Ratios (ORs) and 95% confidence intervals (CIs) were calculated using conditional logistic regression. Statistical analysis on socio-economic factors, lifestyle factors had showed that subjects from low socio economic status, use of tobacco and consumption of non-vegetarian food had increased risk of developing gastric cancer. Multi-factorial analysis for the SNPs adjusting for the risk factors obtained in this study showed that TGFΒ C-509T TT genotypes had four fold increased risk of gastric cancer (OR = 4.11, CI = 1.02–16.56) and TGFβ T869C CC genotype had a decreased risk of gastric cancer (OR = 0.21, CI = 0.05–0.85). ConclusionEconomic status, tobacco use and food habits play a significant role in gastric cancer development. TT genotype for TGFβ C-509T had an increased risk and CC genotype for TGFβ T869C had a decreased risk of gastric cancer in south Indian population after adjusting for socio-economic factors and lifestyle factors.

Epinephrine dosing interval and survival outcomes during pediatric in-hospital cardiac arrest

BackgroundCurrent guidelines recommend epinephrine every 3–5min during cardiopulmonary resuscitation. For adults with in-hospital cardiac arrest (IHCA), longer dosing intervals are associated with improved survival to discharge. This study investigates whether longer epinephrine dosing intervals were associated with improved survival to discharge during pediatric IHCA. MethodsRetrospective review of AHA Get With The Guidelines-Resuscitation registry identified 1630 pediatric IHCAs that met inclusion criteria. Average epinephrine dosing interval was defined by dividing duration of resuscitation after first dose of epinephrine by total doses. Average dosing intervals were categorized as 1–5min, >5 to <8min, and 8 to <10min/dose. Primary outcome was survival to hospital discharge. Multivariable logistic regression models controlled for age, gender, illness category, location of arrest, arrest duration, time of day, and time to first epinephrine dose. Secondary analysis separated patients on vasoactive infusion at the time of arrest from those without an infusion in place. ResultsOdds ratios (OR) calculated using 1–5min/dose interval as reference. For the total cohort, adjusted OR for survival to hospital discharge for >5 to <8min was 1.81 (95% CI 1.26–2.59), and 8 to <10min 2.64 (95% CI 1.53–4.55). For patients not receiving vasoactive infusion, adjusted OR for survival to discharge for >5 to <8min was 1.99 (95% CI 1.29-3.06) and 8 to <10min 2.67 (95% CI 1.14–5.04). ConclusionsLonger average dosing intervals than currently recommended for epinephrine administration during pediatric IHCA were associated with improved survival to hospital discharge.

Coincident alcohol dependence and depression increases risk of suicidal ideation among Army National Guard soldiers

PurposeSuicide rates among military service members have risen dramatically, while drivers remain poorly understood. We examined the relationship between coincident alcohol dependence and depression in shaping risk of suicidal ideation among National Guard forces. MethodsWe performed a longitudinal analysis using a randomly selected, population-based sample of Ohio Army National Guard soldiers. Telephone-based surveys of 1582 soldiers who participated in both wave 1 (2008–2009) and wave 2 (2009–2010) were analyzed. ResultsOdds ratios (ORs) for suicidal ideation among those with versus without alcohol dependence were similar among nondepressed (OR = 3.85 [95% confidence intervals (CIs) = 1.18–12.52]) and depressed individuals (OR = 3.13 [95% CI = 0.88–11.14]); multiplicative interaction was not observed. In contrast, the risk differences (RDs) among those with versus without alcohol dependence diverged for those without depression (RD = 0.04 [95% CI = 0.02–0.07]) compared with those with depression (RD = 0.11 [95% CI = 0.06–0.18]); strong evidence of additive interaction was observed. ConclusionsWe found that alcohol dependence and depression interact statistically in shaping risk for incident suicidal ideation among Army National Guard service members. A high-risk prevention approach including population-based screening for suicidality among patients with alcohol dependence, depression, and particularly those with both conditions is warranted in military populations.

18F-FDG PET/CT features of spinal tuberculosis

Objective To investigate the diagnostic value of 18F-FDG PET/CT features of spinal tuberculosis. Methods 18F-FDG PET/CT imaging manifestation of 125 cases(70 males, 55 females, average age 44.3 years) with osseous or mixed vertebra bone destruction from January 2006 to June 2014 were analyzed retrospectively. The patients included 32 cases with spinal tuberculosis (50 lesions, study group) and 93 cases with other diseases (150 lesions, control group). The corresponding FDG PET/CT features were analyzed by two classification logistic regression (Forward: LR), then FDG PET/CT features with statistical significance in diagnosis of spinal tuberculosis were obtained. The sensitivity and specificity of those FDG PET/CT features were calculated. Results Odds ratio (OR) of FDG PET/CT features with statistical significance in diagnosis of spinal tuberculosis from high to low were paraspinalcold abscess(20.790),cold zone(10.528), intervertebral disc involvement(5.394), continuous vertebral involvement(3.493). The diagnostic sensitivity and specificity were 22.0%(11/50), 99.3%(149/150) forcold abscess, 70.0%(35/50), 90.0%(135/150) forcold zone, 82.0%(41/50), 83.0%(125/150) for intervertebral disc involvement, 82.0%(41/50), 78.0%(117/150) for continuous vertebral involvement, respectively. Spinal tuberculosis often had two or more signs. Thecontinuous vertebral involvement + intervertebral disc involvementwas most common, with the diagnostic sensitivity and specificity of 78.0%(39/50) and 88.7%(133/150). The diagnostic sensitivity and specificity ofcontinuous vertebral involvement+ intervertebral disc involvement+ cold zonewere 58.0%(29/50), 96.0%(144/150), and those of four features concurrence were 14.0%(7/50), 100%(150/150), respectively. Conclusion Regression analysis shows that FDG PET/CT features with statistical significance in diagnosis of spinal tuberculosis are paraspinalcold abscess,cold zone, intervertebral disc involvement, continuous vertebral involvement, which have high diagnostic sensitivity and specificity. Key words: Spinal tuberculosis; Tomography, emission-computed; Tomography, X-ray computed; Deoxyglucose

Prenatal exposure to cooking gas and respiratory health in infants is modified by tobacco smoke exposure and diet in the INMA birth cohort study

BackgroundStudies that have evaluated the association between exposure to gas appliances emissions at home with respiratory health in children obtained heterogeneous and limited results. The aim of this study is to analyze the association between the use of gas cooking at home during pregnancy and respiratory problems in children during their first year of life.MethodsIn the years 2003 through 2008 pregnant women were enrolled in 4 Spanish areas and visited in different age-points following a common protocol. Outcomes studied (from a questionnaire) were any episode of lower respiratory tract infection (LRTI), wheezing, persistent cough, chestiness and otitis. The association between exposure to gas cooking at home and respiratory outcomes was assessed using logistic regression and adjusting by confounding variables. Some potential effect modifiers (i.e. smoking, fruit and vegetables consumption) were examined.ResultsAmong the 2003 children included in the study, a total of 731 (36.6%) had a LRTI episode, 693 (34.6%) experienced wheezing, 302 (15.5%) a persistent cough, 939 (47.4%) chestiness and 620 (31.2%) had an episode of otitis during their first year of life. Gas cookers were present in 45.5% of homes. Exposure to gas cooking in homes was not associated with respiratory outcomes Odds Ratios (OR) were close to 1 and not statistically significant. However, a positive association was found for otitis among infants whose mothers reported low intakes of fruit and vegetables during pregnancy [OR (95% CI) = 1.38 (1.01-1.9)] and also wheezing and chestiness were associated with gas cookers among those children whose mothers smoked during pregnancy.ConclusionsIn susceptible subjects (those whose mothers smoke and consumed below average fruit and vegetables) we found an association between exposure to gas cooking during pregnancy and risk of wheezing, chestiness and otitis during the first year of life. But more research is needed regarding not only gas cooking and respiratory health but also the possible effect modifier role of diet and tobacco.

Several clinical interests regarding lung volume reduction surgery for severe emphysema: meta-analysis and systematic review of randomized controlled trials

ObjectivesWe aim to address several clinical interests regarding lung volume reduction surgery (LVRS) for severe emphysema using meta-analysis and systematic review of randomized controlled trials (RCTs).MethodsEight RCTs published from 1999 to 2010 were identified and synthesized to compare the efficacy and safety of LVRS vs conservative medical therapy. One RCT was obtained regarding comparison of median sternotomy (MS) and video-assisted thoracoscopic surgery (VATS). And three RCTs were available evaluating clinical efficacy of using bovine pericardium for buttressing, autologous fibrin sealant and BioGlue, respectively.ResultsOdds ratio (95%CI), expressed as the mortality of group A (the group underwent LVRS) versus group B (conservative medical therapies), was 5.16(2.84, 9.35) in 3 months, 3(0.94, 9.57) in 6 months, 1.05(0.82, 1.33) in 12 months, respectively. On the 3rd, 6th and 12th month, all lung function indices of group A were improved more significantly as compared with group B. PaO2 and PaCO2 on the 6th and 12th month showed the same trend. 6MWD of group A on the 6th month and 12th month were improved significantly than of group B, despite no difference on the 3rd month. Quality of life (QOL) of group A was better than of group B in 6 and 12 months. VATS is preferred to MS, due to the earlier recovery and lower cost. And autologous fibrin sealant and BioGlue seems to be the efficacious methods to reduce air leak following LVRS.ConclusionsLVRS offers the more benefits regarding survival, lung function, gas exchange, exercise capacity and QOL, despite the higher mortality in initial three postoperative months. LVRS, with the optimization of surgical approach and material for reinforcement of the staple lines, should be recommended to patients suffering from severe heterogeneous emphysema.