Polychotomous Logistic Regression Analysis Research Articles

Prevalence of and factors associated with multimorbidity among adults in Kuwait

BackgroundThis cross-sectional study aimed to assess the prevalence of morbidity i.e., one morbidity and multimorbidity (≥ 2 morbid conditions) among adults in Kuwait and to examine the sociodemographic and lifestyle factors associated with morbidity as a multinomial outcome in the study population.MethodsThe data were collected from January 26, 2021, to February 3, 2021, using an electronic questionnaire, which was distributed on social media platforms. The consent form was attached with the questionnaire and the participants were requested to sign the consent form before completing the questionnaire. The prevalences (%) of each morbidity and multimorbidity were computed. Multivariable polychotomous logistic regression analysis was used to evaluate the association between the demographic and lifestyle factors with morbidity as a multinomial outcome.ResultsOf 3572 respondents included, 89% were Kuwaiti, 78.3% females and 66% were 21- 40 years old. The prevalence of multimorbidity and one morbidity respectively was 27.4% and 29.7%. The prevalence of multimorbidity with two, three, four or five ill-health conditions were 14.3%, 7.4%, 3.5%, and 1.2%, respectively. A higher prevalence of multimorbidity was among respondents over 60 years of age (71%) and Kuwaiti nationals (28.9%). The final multivariable polychotomous logistic regression model revealed that age, sex, nativity, sedentary lifestyle, smoking, and alcohol drinking were significantly (p < 0.05) associated with multimorbidity. However, age and alcohol drinking were significant (p < 0.05) predictors of one morbidity.ConclusionThis study provides evidence that multimorbidity is more prevalent among the elderly, females, and Kuwaiti nationals. Sedentary behaviour, smoking and alcohol consumption were significantly and independently associated with multimorbidity. These findings highlight the burden of multimorbidity and should be considered in the development of future prevention programs.

Rice varietal preference of farmers in rice bowl region of bihar: A polychotomous logistic regression analysis

Rice is the principal crop of Bihar in terms of area so Rice Bowl district of Bihar was selected purposively. Through random sampling farmers were selected from each of the four selected villages in two blocks constituting a sample of 160 respondents. The study revealed that the most preferred variety of rice was Nata Mahsuri. Apropos rice varietal preference viz., least preferred (0), less preferred (1), preferred (2) and most preferred (3) Quadripartite Polychotomous Logistic Regression was applied having Nagelkerke pseudo-R-Square value of 0.719. One unit increase in average yield will increase the probability to maneuver from least preferred to most preferred variety by 343.70 per cent [odds ratio (OR), 4.437; 95 per cent CI of Estimate (E) = 1.720 to 11.445]. The research concluded that early sowing and high yielding varieties should be promoted in the study local along with that awareness should be given to the large farmers for the improved variety.

The development of a prediction score of in-hospital death in coronary care unit patients

Objective To identify the risk factors of in-hospital death in coronary care unit patients and to develop a score for relevant risks. Methods Totally 1 067 patients from the coronary care unit between February 2013 and December 2016 were retrospectively selected from the medical record system of He'nan Provincial People's Hospital. The univariate and polychotomous Logistic regression analysis was used to identify the independent risk factors of death in coronary care unit patients. A Logistic regression model was built, and its performance in prediction and identification was tested by the area under the curve (AUC) of receiver operating characteristic (ROC) , Hosmer-Lemeshow goodness-of-fit (GOF) and O/E value. Results According to the polychotomous Logistic regression analysis, finally six risk independent risks factors were included in the score model, and they were scored as follows: age (1) , history of coronary heart disease (CHD, 1) , admission cardiac function level (2) , consciousness (1) , systolic pressure (2) and oxygen saturation (2) . The test suggested that the score's identification and calibration for the occurrence of in-hospital death among coronary care unit patients was high (AUC=0.97; Hosmer-Lemeshow GOF: P=0.995; O/E value=1.13) . Conclusions The final death risk score includes six risk factors, each scored between 1 and 6, and the total score is 21. The patients scored lower than 7 is defined as the low-risk group; the patients scored between 7 and 10 is defined as the medium-risk group; the patients scored between 11 and 14 is defined as high-risk group; and the patients scored higher than 15 is defined as the extremely high-risk group. This death risk score can predict the occurrence of in-hospital death among coronary care unit patients accurately. Key words: Death; Patients; Coronary care unit; Risk prediction

Association of Alcohol Drinking Patterns With Presence of Impaired Fasting Glucose and Diabetes Mellitus Among South Korean Adults.

BackgroundWe aimed to investigate the association between alcohol drinking patterns and the presence of impaired fasting glucose (IFG) and diabetes mellitus (DM).MethodsWe used data from the Korean National Health and Nutrition Examination Survey, 2010–2014. The participants were aged ≥30 years and had no previous diagnosis of DM. High-risk drinking was defined as alcohol consumption of ≥7 glasses at a sitting for men, and ≥5 glasses for women. After adjusting for confounding factors, a polychotomous logistic regression analysis was performed to assess the association of drinking patterns with IFG and DM.ResultsFor men, high-risk drinking was associated with higher odds ratios (ORs) of IFG (2–4/month, OR 1.51; 95% confidence interval [CI], 1.13–2.04; 2–3/week, OR 1.79; 95% CI, 1.38–2.33; and ≥4/week, OR 2.24; 95% CI, 1.65–3.03) and of DM (2–4/month, OR 2.12; 95% CI, 1.20–3.77; 2–3/week, OR 1.78; 95% CI, 1.05–3.03; and ≥4/week, OR 2.98; 95% CI, 1.72–5.17). For women, high-risk drinking was associated with higher risk of IFG (2–4/month, OR 1.51; 95% CI, 1.04–2.21; 2–3/week, OR 3.19; 95% CI, 2.20–4.64; and ≥4/week, OR 2.23; 95% CI, 1.23–4.06), but not of DM, compared with non-high-risk drinkers who consumed alcohol ≤1 day/month. Non-high-risk drinkers who consumed alcohol ≥4 days/week had higher ORs of DM in men, but lower ORs of DM in women compared with non-high risk drinkers who consumed alcohol ≤1 day/month.ConclusionsCompared with non-high-risk alcohol drinking, even occasional high-risk alcohol drinking was associated with a higher risk of IFG in men and women, and DM in men. Nearly daily non-high-risk alcohol drinking was associated with a higher risk of DM in men and lower risk of DM in women.

Low Estimated Glomerular Filtration Rate (eGFR) is Associated with Skeletal Muscle Function Deficit in Elderly Persons

Physical performance is closely associated with chronic diseases and dysfunction of numerous organ systems. Old persons with chronic renal failure have shown the apparent decline in physical performance, especially in the end-stage. However, it is unclear whether the subclinical kidney dysfunction is associated with skeletal muscle function deficit in the elderly population. PURPOSE: To determine the association between renal function and skeletal muscle function deficit in old persons without nephropathy. METHODS: Eight hundred fifty-four Korean elderly (female, 75.3%) aged 65 to 89 years were included in this cross-sectional study. All participants were interviewed face-to-face and received measure of anthropometry, body composition and serum biomarkers of metabolic diseases. eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation based on serum creatinine concentration. The following physical performance tests were performed: handgrip strength (absolute and relative values), timed up-and-go (TUG), chair stand, 2 min stationary walking, figure-eight walk and sit-and-reach. Skeletal muscle function deficit was defined as a combination of weakness and slowness based on the relative handgrip strength (men <1.32, women <0.792) and converted TUG to walking speed (<0.8 m/s), respectively. RESULTS: Of the subjects, the prevalence of 30≤ eGFR <45 mL/min/1.73m2 was 16.2%. The subjects with 30≤ eGFR <45 mL/min/1.73m2 showed significantly lower physical performance for muscular strength and functional mobility than those with 45≤ eGFR <60 and eGFR ≥60 mL/min/1.73m2, respectively (all for p<0.05). Multinomial (polychotomous) logistic regression analysis, with three categories of eGFR as the dependent variable, showed the significant association between eGFR and skeletal muscle function status even after adjustment for potential confounders (odds ratios [95% CI] were 4.8 [1.3-17.2] for a GFR of 45 to 59, 12.9 [3.1-52.9] for above 60 mL/min/1.73m2, p for trend <0.01). CONCLUSION: Taken together, skeletal muscle function status is associated with even moderately reduced eGFR in an older population. This finding suggests that maintenance of physical and functional fitness may be a contributory factor for preserving renal function in elderly persons.

Gambling and Problem Behavior Among 14- to 16-Year-Old Boys and Girls in Finland

The aim of this study is to examine the associations between problem behavior and gambling frequency among eighth- and ninth-grade boys and girls (N = 101,167). Data were obtained from the cross-sectional School Health Promotion Study. Outcome measures were adolescents' truancy, bullying, delinquency, and substance use. Polychotomous logistic regression analyses were used to study the relationship between gambling frequency and risk behaviors in a total sample, as well as separately for boys and girls. In 2010, 62% of the adolescents had gambled during the previous year, and in 2011, 61% of the adolescents had done so. Engaging in different levels of truancy, bullying, delinquency, and substance abuse were associated with higher risks for frequent gambling. Similar patterns of associations were found among boys and girls. Adolescents who engaged in gambling on a daily or weekly basis were the most vulnerable group for problem behavior. However, even infrequent gambling was associated with different problem behaviors.

Association of oral health behaviors and status with depression: results from the Korean National Health and Nutrition Examination Survey, 2010

To examine the association of depression with oral health behaviors and oral health status in a large nationwide sample of Korean adults. This study included 6,139 participants aged 19 years or older who participated in the fifth Korean National Health and Nutrition Examination Survey. Binary and polychotomous logistic regression analyses were used to estimate adjusted odds ratios (AORs) and 95 percent confidence intervals (CIs). Participants with lifetime depression (self-report of past or present depression) brushed their teeth less frequently (AOR = 1.30, 95 percent CI 1.03-1.65) and were more likely not to receive treatment when experiencing dental problems (AOR = 1.43, 95 percent CI 1.23-1.66) than those without lifetime depression after adjusting for sociodemographic factors, gender, and age. After adjusting for significant oral health behaviors, current smoking status, and sociodemographic factors, participants with lifetime depression had poorer oral health status than those without this disorder: uncomfortable mastication (AOR = 1.25, 95 percent CI 1.05-1.50), toothache (AOR = 1.18, 95 percent CI 1.01-1.39), temporomandibular joint symptoms (AOR = 1.41, 95 percent CI 1.08-1.85), and maxillary periodontal bleeding (AOR = 1.29, 95 percent CI 1.03-1.61 for the right side; AOR = 1.40, 95 percent CI 1.13-1.74 for the left side). Depression was significantly associated with oral health status, even after adjusting for the impact of oral health behaviors in Korean adults. Thus, our findings suggest the necessity of further investigation to detect underlying mechanisms in the relationship between depression and oral health that are not mediated by oral health behavior.

An updated prostate cancer staging nomogram (Partin tables) based on cases from 2006 to 2011

To update the 2007 Partin tables in a contemporary patient population. The study population consisted of 5,629 consecutive men who underwent RP and staging lymphadenectomy at the Johns Hopkins Hospital between January 1, 2006 and July 30, 2011 and met inclusion criteria. Polychotomous logistic regression analysis was used to predict the probability of each pathologic stage category: organ-confined disease (OC), extraprostatic extension (EPE), seminal vesicle involvement (SV+), or lymph node involvement (LN+) based on preoperative criteria. Preoperative variables included biopsy Gleason score (6, 3+4, 4+3, 8, and 9-10), serum PSA (0-2.5, 2.6-4.0, 4.1-6.0, 6.1-10.0, greater than 10.0 ng/mL), and clinical stage (T1c, T2c, and T2b/T2c). Bootstrap re-sampling with 1000 replications was performed to estimate 95% confidence intervals for predicted probabilities of each pathologic state. The median PSA was 4.9 ng/mL, 63% had Gleason 6 disease, and 78% of men had T1c disease. 73% of patients had OC disease, 23% had EPE, 3% had SV+ but not LN+, and 1% had LN+ disease. Compared to the previous Partin nomogram, there was no change in the distribution of pathologic state. The risk of LN+ disease was significantly higher for tumours with biopsy Gleason 9-10 than Gleason 8 (O.R. 3.2, 95% CI 1.3-7.6). The c-indexes for EPE vs. OC, SV+ vs. OC, and LN+ vs. OC were 0.702, 0.853, and 0.917, respectively. Men with biopsy Gleason 4+3 and Gleason 8 had similar predicted probabilities for all pathologic stages. Most men presenting with Gleason 6 disease or Gleason 3+4 disease have <2% risk of harboring LN+ disease and may have lymphadenectomy omitted at RP. The distribution of pathologic stages did not change at our institution between 2000-2005 and 2006-2011. The updated Partin nomogram takes into account the updated Gleason scoring system and may be more accurate for contemporary patients diagnosed with prostate cancer.

Association of Sequence Variation in the CX3CR1 Gene with Geographic Atrophy Age-related Macular Degeneration in a Greek Population

Purpose: To explore the association of two single nucleotide polymorphisms (SNPs) in the CX3CR1 gene with grades of age-related macular degeneration (AMD) in a population-based setting.Methods: The Thessaloniki Eye study is a cross-sectional population-based epidemiologic study of chronic eye diseases in Thessaloniki, Greece. A total of 371 subjects were included and classified according to their AMD status. Subjects with AMD Grades 0–1 (n = 188) were compared to those with AMD Grades 2–3 (n = 138), to those with AMD Grade 4 (geographic atrophy) (n = 20) and to those with AMD Grade 5 (neovascular AMD) (n = 25) with regard to the presence of CX3CR1 polymorphisms (V249I and T280M). Polychotomous logistic regression analysis adjusted for age, gender, and smoking was conducted and the log-additive allelic model was preferred.Results: Participants with AMD Grade 4 were approximately three times more likely to carry the VI249 and nine times more likely to carry the II249 alleles, compared to those with AMD Grades 0–1, whereas those with AMD Grades 2–3 or Grade 5 did not differ. The T280M polymorphism was not associated with either AMD Grades 2–3 or AMD Grades 4 or 5.Conclusion: In this Greek population, after adjusting for known risk factors, increased risk of geographic atrophy (GA) AMD among the carriers of the V249I polymorphism in the CX3CR1 gene was found. Our study failed to reveal any association with the T280M polymorphism reported in previous studies. Additional studies in different ethnic populations using standardized methodology are needed in order to confirm this association.

Socio-demographics and the development of malaria elimination strategies in the low transmission setting

This analysis presents a comprehensive description of malaria burden and risk factors in Peruvian Amazon villages where malaria transmission is hypoendemic. More than 9000 subjects were studied in contrasting village settings within the Department of Loreto, Peru, where most malaria occurs in the country. Plasmodium vivax is responsible for more than 75% of malaria cases; severe disease from any form of malaria is uncommon and death rare. The association between lifetime malaria episodes and individual and household covariates was studied using polychotomous logistic regression analysis, assessing effects on odds of some vs. no lifetime malaria episodes. Malaria morbidity during lifetime was strongly associated with age, logging, farming, travel history, and living with a logger or agriculturist. Select groups of adults, particularly loggers and agriculturists acquire multiple malaria infections in transmission settings outside of the main domicile, and may be mobile human reservoirs by which malaria parasites move within and between micro-regions within malaria endemic settings. For example, such individuals might well be reservoirs of transmission by introducing or reintroducing malaria into their home villages and their own households, depending on vector ecology and the local village setting. Therefore, socio-demographic studies can identify people with the epidemiological characteristic of transmission risk, and these individuals would be prime targets against which to deploy transmission blocking strategies along with insecticide treated bednets and chemoprophylaxis.

The Type of Diabetes Mellitus and the Odds of Gleason Score 8 to 10 Prostate Cancer

In addition to increasing age and PSA level, family history and African-American (AA) race, it has been recently shown that diabetes mellitus (DM) is significantly associated with the likelihood of presenting with high-grade prostate cancer (PCa) or Gleason score (GS) 8 - 10 ; however whether this association holds for both type I and II DM is unknown. In this study we evaluated whether DM type I, II or both are associated with high-grade PCa after adjusting for known predictors of high-grade disease. Between 1991 and 2010, 15,330 men, newly diagnosed with PCa and treated with radiation therapy at 1 of 26 centers, were analyzed. A polychotomous logistic regression analysis was performed to evaluate whether a diagnosis of type I or II DM was associated with the odds of GS 7 or 8 to 10 compared to 6 or less PCa, adjusting for AA race, age, PSA level, and digital rectal examination (DRE) findings. As shown in the table, men with type I DM (Adjusted Odds Ratio (AOR), 2.05; 95% Confidence Interval (CI), 1.28 - 3.27; P = 0.003) or type II DM (AOR, 1.58; 95% CI, 1.26 - 1.99; P<0.001) were significantly more likely to be diagnosed with GS 8 to 10 PCa compared to non-diabetics. However this was not true for GS 7 where these respective results were AOR, 1.30; 95% CI, 0.93 - 1.82; P = 0.12 and AOR, 1.13; 95% CI, 0.98 - 1.32; P = 0.10. Type I and II DM were associated with a higher odds of being diagnosed with Gleason score 8 to 10 but not 7 PCa. Pending validation, similar to African American men, consideration of early prostate cancer screening could be given to men with DM particularly those with type I DM whose onset is typically during adolescence.Tabled 1Odds Ratio of GS7 vs GS6 or lower, or GS8 - 10 vs GS6 or lower at time of diagnosisClinical FactorGleason scoreAOR [95% CI]p-valueDM I71.30 [0.93 - 1.82]0.12DM I8 to 102.05 [1.28 - 3.27]0.003DM II71.13 [0.98 - 1.32]0.10DM II8 to 101.58 [1.26 - 1.99]<0.001AA race71.47 [1.26 - 1.72]<0.001AA race8 to 101.45 [1.10 - 1.92]0.008PSA, Age, Abnormal DRE71.50 [1.42 - 1.60], 1.02 [1.02 - 1.03], 2.24 [2.08 - 2.42]<0.001, <0.001, <0.001PSA, Age, Abnormal DRE8 to 101.98 [1.80 - 2.19], 1.06 [1.05 - 1.07], 3.12 [2.74 - 3.55]<0.001,<0.001,<0.001 Open table in a new tab

Type of Diabetes Mellitus and the Odds of Gleason Score 8 to 10 Prostate Cancer

It has been recently shown that diabetes mellitus (DM) is significantly associated with the likelihood of presenting with high-grade prostate cancer (PCa) or Gleason score (GS) 8 to 10; however, whether this association holds for both Type 1 and 2 DM is unknown. In this study we evaluated whether DM Type 1, 2, or both are associated with high-grade PCa after adjusting for known predictors of high-grade disease. Between 1991 and 2010, a total of 15,330 men diagnosed with PCa and treated with radiation therapy were analyzed. A polychotomous logistic regression analysis was performed to evaluate whether Type 1 or 2 DM was associated with odds of GS 7 or GS 8 to 10 compared with 6 or lower PCa, adjusting for African American race, age, prostate-specific antigen (PSA) level, and digital rectal examination findings. Men with Type 1 DM (adjusted odds ratio [AOR], 2.05; 95% confidence interval [CI], 1.28-3.27; p = 0.003) or Type 2 DM (AOR, 1.58; 95% CI, 1.26-1.99; p < 0.001) were significantly more likely to be diagnosed with GS 8 to 10 PCa compared with nondiabetic men. However this was not true for GS 7, for which these respective results were AOR, 1.30; 95% CI, 0.93-1.82; p = 0.12 and AOR, 1.13; 95% CI, 0.98-1.32; p = 0.10. Type 1 and 2 DM were associated with a higher odds of being diagnosed with Gleason score 8 to 10 but not 7 PCa. Pending validation, men who are diagnosed with Type I DM with GS 7 or lower should be considered for additional workup to rule out occult high-grade disease.

Antacid Drug Use and Risk of Esophageal and Gastric Adenocarcinomas in Los Angeles County

Concern has been expressed that antacid drugs increase the risk of esophageal and gastric adenocarcinomas. This population-based case-control study recruited patients with incident esophageal adenocarcinoma (n = 220), gastric cardiac adenocarcinoma (n = 277), or distal gastric adenocarcinoma (n = 441) diagnosed between 1992 and 1997, and 1,356 control participants in Los Angeles County. Unconditional polychotomous multivariable logistic regression analyses were done to evaluate the association between antacid drug use and these cancers. Among participants who took nonprescription acid neutralizing agents for >3 years, the odds ratio for esophageal adenocarcinoma was 6.32 compared with never users (95% confidence interval, 3.14-12.69; P(trend) < 0.01). Analyses stratified by history of physician diagnosed upper gastrointestinal (UGI) disorders revealed a greater increase in esophageal adenocarcinoma risk associated with nonprescription antacid use among persons with no UGI disorder than among those with an UGI disorder (homogeneity of trends P = 0.07). Regular use of nonprescription acid neutralizing agents was not associated with risk of adenocarcinomas of the gastric cardia or distal stomach. Regular use of prescription acid suppressive drugs was not associated with risk for any of these cancers. We found risk of esophageal adenocarcinoma was greater among long-term nonprescription acid neutralizing drugs in participants without physician-diagnosed UGI conditions than among those with these conditions; this may represent self medication for undiagnosed precursor conditions or it may be that nonprescription acid neutralizing drugs, taken without limitation on amount used when symptoms are most intense, may permit alkaline bile reflux into the lower esophagus, thereby increasing esophageal adenocarcinoma risk.

Validation of Partin Tables and Development of a Preoperative Nomogram for Japanese Patients With Clinically Localized Prostate Cancer Using 2005 International Society of Urological Pathology Consensus on Gleason Grading: Data From the Clinicopathological Research Group for Localized Prostate Cancer

We validated the 2001 Partin tables and developed an original nomogram for Japanese patients using the 2005 International Society of Urological Pathology consensus on Gleason grading. Prostatectomy specimens from 1,188 Japanese men who underwent radical prostatectomy for clinically localized prostate cancer (cT1-2) between 1997 and 2005 were analyzed. Polychotomous logistic regression analysis was used to construct a nomogram to predict final pathological stage (organ confined disease, extraprostatic extension, seminal vesicle invasion and lymph node involvement) from 3 variables, including serum prostate specific antigen, clinical stage and biopsy Gleason score. The area under the ROC curve was used to compare the new nomogram with the Partin tables. Preoperative serum prostate specific antigen and biopsy Gleason score were higher in the Japanese cohort than in the Partin cohort. The distribution of clinical and final pathological stages was similar in the 2 cohorts. The AUC for predicting organ confined disease was 0.699 and 0.717 for data applied to the Partin tables and to the new nomogram, respectively. The AUC for predicting lymph node involvement was 0.793 and 0.863, respectively. To our knowledge this is the first preoperative nomogram developed for clinically localized prostate cancer in Japanese patients. Although the new nomogram predicted the pathological stage of prostate cancer in Japanese patients more accurately than the Partin tables, it did not satisfactorily predict organ confined disease. However, other predictive variables, such as more detailed pathological features of biopsy specimens or magnetic resonance imaging, may further improve prediction accuracy.

Trends in Obesity in Pregnancy

ArticlePlus Click on the links below to access all the ArticlePlus for this article. Please note that ArticlePlus files may launch a viewer application outside of your web browser. https://links.lww.com/EDE/A233 To the Editor: There is a strong relationship between a woman’s weight just prior to pregnancy, or in early pregnancy, and her risk of gestational diabetes mellitus, preeclampsia, placental dysfunction, and adverse perinatal events1–5 In the past decade, the prevalence of obesity among pregnant women may have increased.6,7 Less is known about ethnic-specific temporal trends in maternal weight and the risk of obesity in pregnancy. Examining these trends is the goal of the Trends in Obesity in Pregnancy Study, which is a population-based study, derived using an administrative database, as described elsewhere.4 Briefly, since late 1993, standardized maternal serum screening has been available to all women in Ontario, at 15 to 20 weeks’ gestation, through their physician or midwife. Steady uptake has occurred from 1994 onward. Data about maternal date of birth, parity, ethnicity, and weight are recorded in a standardized fashion on a form, completed by the caregiver at the time of the screening. We defined the mutually exclusive overweight, obese, and severely obese states as presented in the footnote to the Table 1.8,9 The prevalence of each state in the years 1994 and 2000 were compared using polychotomous logistic regression analysis. The resulting odds ratios were adjusted for maternal age, ethnicity, parity, gestational age at weight measurement and presence of a multifetal pregnancy.TABLE 1: General Characteristics of Participants at the Time of Maternal Serum Screening in Ontario, 1994–2000A total of 369,740 women underwent maternal serum screening, at an average of 16.3 weeks’ gestation (Table 1). In each ethnic group, the median gravidity was 2 and the median parity 1. Among all women, as well as within each of the 4 ethnic groups, there was a significant increase in mean maternal weight over time, based on a time- series model incorporating a linear trend term (P < 0.001; Fig. 1 available with the electronic version of this article at www.epidem.com). Among all women, the prevalence of the overweight state increased from 9.6% in 1994 to 11.4% in 2000 (adjusted odds ratio = 1.37; 95% confidence interval = 1.31–1.43). The prevalence of obesity rose from 4.0% to 5.6% (1.7; 1.6–1.8), and severe obesity increased from 0.99% to 1.5% (1.8;1.6–2.0). As a limitation, height was not recorded in TOPS, and body mass index was not calculated. At the same time, maternal weight approximates BMI quite well,10,11 and by limiting our assessment of mean weight to each ethnic group, we were able to control, to a degree, for the variation in height between racial groups.12 Since maternal weight was recorded at around the same gestational age, and we further adjusted for gestational age, ethnicity and other factors, variance and confounding were likely minimized. The data from this study are consistent with other studies of temporal weight trends in pregnancy.6,13 These data also parallel rising trends of obesity among children and adolescents in the United Kingdom8 and United States.9 Together, they emphasize that the rate of obesity and morbid obesity in pregnancy is likely to increase over the next decade. This study provides novel information about weight trends according to broad ethnic groups, and the results highlight the need to consider preventive strategies among all ethnic groups, including those traditionally deemed to be at “low risk,” such as women of Asian ancestry. Given that weight loss during pregnancy may have untoward effects, preventing maternal obesity requires action before a woman reaches her reproductive years. Promoting controlled calorie-energy intake and higher energy expenditure in childhood or adolescence may be the most sensible approach.14,15 Ongoing epidemiologic surveillance is needed to detect any change in the incidence of preeclampsia, gestational diabetes mellitus, operative or preterm delivery or perinatal mortality, also stratified by maternal weight or BMI before, or in early pregnancy. Joel G. Ray Departments of Medicine, Obstetrics and Gynecology, and Health Policy Management and Evaluation [email protected] Rosane Nisenbaum Gita Singh Centre for Research on Inner City Health Chris Meier Department of Medical Affairs St. Michael’s Hospital University of Toronto Toronto, Ontario Andrea Guerin Schulich School of Medicine & Dentistry University of Western Ontario London, Ontario Philip R. Wyatt Department of Genetics York Central Hospital Richmond Hill, Ontario Marian J. Vermeulen Institute for Clinical Evaluative Sciences University of Toronto Toronto, Ontario

Predictors of Endoscopic Findings After Roux-en-Y Gastric Bypass

To evaluate predictors of endoscopic findings in symptomatic patients after Roux-en-Y gastric bypass (RYGBP) for obesity. A retrospective chart review of 1,001 RYGBP procedures was performed. Two hundred twenty-six (23%) patients were identified as having endoscopy to evaluate upper gastrointestinal symptoms following surgery. Polychotomous logistic regression analysis was used to assess predictors of normal endoscopy, marginal ulcers, stomal stenosis, and staple-line dehiscence. The most common endoscopic findings were 99 (44%) normal postsurgical anatomy, 81 (36%) marginal ulcer, 29 (13%) stomal stenosis, and 8 (4%) staple-line dehiscence. Factors that significantly increase the risk of marginal ulcers following surgery include smoking (AOR = 30.6, 95% CI 6.4-146) and NSAID use (AOR = 11.5, 95% CI 4.8-28). PPI therapy following surgery was protective against marginal ulcers (AOR = 0.33, 95% CI 0.11-0.97). Median time for diagnosis of marginal ulcers following surgery was 2 months, and 77 of 81 (95%) presented within 12 months. Following RYGBP surgery for obesity, smoking and NSAID use significantly increase the risk of marginal ulceration, and PPI therapy is protective. Because a significant majority of marginal ulcers present within 12 months of surgery, it may be reasonable to consider prophylactic PPI therapy during this time period, especially for high risk patients.

CT Analysis of the Anterior Mediastinum in Idiopathic Pulmonary Fibrosis and Nonspecific Interstitial Pneumonia

ObjectiveWe wanted to determine whether the amount and shape of the anterior mediastinal fat in the patients suffering with usual interstitial pneumonia (UIP) or nonspecific interstitial pneumonia (NSIP) was different from those of the normal control group.Materials and MethodsWe selected patients who suffered with UIP (n = 26) and NSIP (n = 26) who had undergone CT scans. Twenty-six controls were selected from individuals with normal CT findings and normal pulmonary function tests. All three groups (n = 78) were individually matched for age and gender. The amounts of anterior mediastinal fat, and the retrosternal anteroposterior (AP) and transverse dimensions of the anterior mediastinal fat were compared by one-way analysis of variance and Bonferroni's test. The shapes of the anterior mediastinum were compared using the Chi-square test. Exact logistic regression analysis and polychotomous logistic regression analysis were employed to assess whether the patients with NSIP or UIP had a tendency to show a convex shape of their anterior mediastinal fat.ResultsThe amount of anterior mediastinal fat was not different among the three groups (p = 0.175). For the UIP patients, the retrosternal AP dimension of the anterior mediastinal fat was shorter (p = 0.037) and the transverse dimension of the anterior mediastinal fat was longer (p = 0.001) than those of the normal control group. For the NSIP patients, only the transverse dimension was significantly longer than those of the normal control group (p < 0.001). The convex shape of the anterior mediastinum was predictive of NSIP (OR = 19.7, CI 3.32 -∞, p < 0.001) and UIP (OR = 24.42, CI 4.06 -∞, p < 0.001).ConclusionFor UIP patients, the retrosternal AP and transverse dimensions are different from those of normal individuals, whereas the amounts of anterior mediastinal fat are similar. UIP and NSIP patients have a tendency to have a convex shape of their anterior mediastinal fat.

Randomized clinical trial on continuous 7-days-a-week postoperative radiotherapy for high-risk squamous cell head-and-neck cancer: A report on acute normal tissue reactions

Background and purpose To analyse acute mucosal reactions in patients treated with continuous accelerated postoperative irradiation ( p-CAIR) compared to conventionally fractionated postoperative radiotherapy ( p-CF). Patients and methods The patients were randomly assigned to receive 63 Gy in 1.8 Gy fractions 7-days-a-week given over a period of 5 weeks ( n=88), or 63 Gy in 1.8 Gy fractions given 5-days-a-week over 7 weeks ( n=87). It represents 65% of an overall trial size. Acute mucosal reactions were scored using modified Dische system. Polychotomous logistic regression was used to estimate the influence of the selected variables on maximum grade of mucositis, and percent of the body weight loss during radiotherapy. Results The average maximum Dische score and percent of the patients with confluent mucositis were higher in patients treated with p-CAIR, compared to p-CF (13.3 vs. 10.8 and 54 vs. 27%). Polychotomous logistic regression analysis revealed that fractionation scheme and tumour site have significantly influenced maximum Dische score. Tumour site (laryngeal vs. other) had even stronger influence on maximum Dische score than fractionation scheme. The average residual Dische score 8 weeks after radiotherapy was higher in p-CAIR compared to p-CF (2.1 vs. 1.4), and was, most frequently, related to persistent mucosal erythema (70 vs. 57% of pts.). No severe consequential toxicity of radiotherapy was observed, so far, in the trial. Conclusions While the incidence, intensity and duration of mucosal reactions was higher in p-CAIR than in p-CF the accelerated treatment can be considered tolerable with respect to acute toxicity. In both arms of the trial slight or moderate mucosal erythema was the most frequent acute side effect, which did not completely subside within 8 weeks after irradiation.

Placement movement in out-of-home care: patterns and predictors

The present study examines retrospectively the placement patterns of a cohort of 430 children between the ages of 1–16 who entered out-of-home care in San Diego County between May 1990 and October 1991, and were still in placement after 18 months. It investigates movement through out-of-home care across different placement settings for children who spent an equal amount of time in out-of-home care. Using an inductive methodology, patterns of movement are classified along two main dimensions: The timing and duration of the longest placement and movement along degree of restrictiveness. This paper describes the development of the pattern criteria. It further presents findings of subsequent polychotomous logistic regression analysis, which identifies significant non-clinical and clinical predictors of these patterns.

Prevalence of diabetes and/or ischaemic heart disease in classes of increasing carotid artery atherosclerosis: an ultrasonographic study.

To evaluate the prevalence of non-diabetic subjects and diabetic patients, with or without ischaemic heart disease (IHD), in different classes of increasing carotid atherosclerotic damage. Using high-resolution B-mode ultrasound, we studied 598 subjects without known cardiovascular disease (CVD) or diabetes, 74 diabetic patients without CVD, 74 non-diabetic subjects with IHD and 36 patients with both diabetes and IHD. Carotid atherosclerosis was classified as: normal; thickened intima-media; non-stenotic plaque; stenotic plaque. Compared with subjects without diabetes or CVD, the frequency of patients with diabetes without known CVD increased significantly from 'normal' to 'stenotic plaque' (4.1%, 6.4%, 13%, 14.8% for normal, thickened intima-media, non-stenotic plaque and stenotic plaque, respectively; P = 0.0057). The same figures were 6%, 7.6%, 10.2%, 23.3% (P = 0.0007) for non-diabetic subjects with IHD, and 0%, 2%, 5.6%, 15.9% (P < 0.0001) for diabetic patients with IHD. No difference was found comparing subjects with diabetes without CVD with non-diabetic patients with IHD (P = 0.56). Using polychotomous logistic regression analysis, diabetic patients without CVD and non-diabetic subjects with IHD showed a similar association with the increasing degree of carotid atherosclerosis (P = 0.59), but significantly stronger compared with subjects without diabetes or CVD (P < 0.03 for both). Diabetic patients without known CVD show an advanced degree of carotid atherosclerotic damage similar to non-diabetic subjects with IHD and significantly higher compared with non-diabetic subjects without CVD. Our data support the need for an aggressive early prevention of CVD in diabetic subjects.