Respective Adjusted Odds Ratios Research Articles

Role of Patient Sex in Early Recovery from Alcohol-Related Cognitive Impairment: Women Penalized.

Background: The objective was to explore the role of patient sex in cognitive recovery and to identify predictive factors for non-recovery in alcohol use disorder (AUD). Methods: All patients with AUD admitted to a residential addictions treatment center were systematically assessed at admission and after 6 weeks of abstinence in a controlled environment. The inclusion criteria were that patients were admitted for AUD with baseline alcohol-related cognitive impairment (baseline total Montreal Cognitive Assessment (MoCA) score < 26) and reassessed at 6 weeks (n = 395). A logistic regression model was built to determine the influence of sex on recovery status (MoCA < or ≥ 26) taking into account the interaction effect of sex with alcohol consumption on cognitive function. Results: The mean age was 50.10 years (SD = 9.79), and 27.41% were women. At baseline, the mean MoCA scores were 21.36 (SD = 3.04). Participants who did not achieve recovery (59.3% of women vs 53.8% of men) had lower total MoCA scores at baseline. The 2 factors that was significantly and independently associated with non-recovery and with a non-zero coefficient was being a woman and initial MoCA score (respective adjusted odds ratios (AOR) = 1.5 and 0.96, p-values < 0.05). Conclusions: These results could influence the time required in a controlled environment to maintain abstinence and the duration of in-care for women.

Community College Pathways to Medical School and Family Medicine Residency Training.

Medical students who attend community college are more likely to express intention to train in family medicine. This study examined whether community college attendance is associated with family medicine residency training in a national sample of US medical school graduates. We performed a cross-sectional analysis using the Association of American Medical Colleges matriculant files of residency trainees who graduated from medical school between 2010 to 2012. Residency specialty (family medicine vs other) was modeled using logistic regression analysis; the key independent variable was community college attendance, with categories of non-community college (reference); community college while in high school; community college after graduating from high school, then transfer to 4-year university; and community college after graduating from a 4-year university or as a postbaccalaureate. The logistic model adjusted for age, sex, race/ethnicity, years in medical school, parental education (a marker of socioeconomic status), and high school US region. Of the 43,382 medical school graduates studied, 25.9% attended community college and 8.7% trained in family medicine. In unadjusted analysis, graduates attending community college while in high school, after graduating from high school with transfer to 4-year university, or after graduating from a 4-year university or as a postbaccalaureate (12.0%, 12.7%, and 10.8%, respectively) were more likely to train in family medicine compared with their peers who did not attend community college (7.7%). Respective adjusted odds ratios were 1.47 (95% CI, 1.33-1.63; P <.001), 1.27 (95% CI, 1.06-1.52; P = .009), and 1.17 (95% CI, 1.06-2.29; P = .002). Among family medicine residents, 32.7% of those who were white, 35.2% of those Asian, 50.8% of those Latino, and 32.7% of those black or African American attended community college. US medical school graduates who attended community college were more likely to train in family medicine, suggesting community college is an important pathway for increasing the primary care workforce.

Clinical Characteristics and Outcome of Methamphetamine-Associated Pulmonary Arterial Hypertension and Dilated Cardiomyopathy

ObjectivesThis study sought to characterize patients with methamphetamine-associated pulmonary arterial hypertension (MA-PAH) and cardiomyopathy (MA-CMP), to compare with MA controls (MA-CTL), users with structurally normal hearts, with the aim of identifying risk factors for these conditions. BackgroundMA-PAH and MA-CMP are 2 poorly understood cardiac complications in MA users. MethodsWe retrospectively studied the clinical characteristics and outcomes of 50 MA-PAH, 296 MA-CMP, and 356 MA-CTL patients, whom we evaluated between 2010 and 2017. ResultsAfter a median follow-up of 20.0 months (interquartile range [IQR]: 7.6 to 42.6 months), all-cause mortality was 18.0% for MA-PAH, 15.2% for MA-CMP, and 4.5% for MA-CTL group (p < 0.001). More women (58%) were in the MA-PAH group than in the MA-CMP (14%; p < 0.001) and MA-CTL (42%; p = 0.028) groups, whereas the MA-CMP group was predominantly male (86% vs. 58% in the MA-CTL group; p < 0.001). More MA-CMP patients had hypertension (p < 0.001) or alcoholism (p < 0.001) than MA-CTL patients. Logistic regression analyses identified male sex, alcoholism, and hypertension as independent factors associated with MA-CMP with the following respective adjusted odds ratios (OR) of 3.791 (95% confidence interval [CI]: 2.508 to 5.730), OR of 2.959 (95% CI: 2.084 to 4.203), and OR of 2.111 (95% CI: 1.486 to 2.999), whereas female sex was the only factor associated with MA-PAH. ConclusionsBoth MA-PAH and MA-CMP patients carried significant disease burden and mortality risk. Male sex, hypertension, and alcoholism were strongly associated with MA-CMP, whereas female sex and other unknown factors may influence development of MA-PAH. This study adds to the understanding of MA-associated cardiac complications and highlights directions for future investigation.

Health reforms in china: the public's choices for first-contact care in urban areas.

To examine the public's views towards their choice of first-contact care and its associated factors in urban China. A mixed-method study was adopted using individual interviews, focus group interviews and a cross-sectional survey. The study was conducted among the general public between September 2014 and September 2015 in Zhejiang province, China. Six focus groups and 13 individual interviews were conducted. The questionnaire was completed by 1248 respondents with a response rate of 83%. Survey results showed that 70% of the respondents preferred hospital-based services for first-contact care, it is especially the case with paediatric patients (83.3%). The qualitative data revealed that a major cause was the public distrust in the competence of primary care practitioners with lower educational qualifications. In the decision-making process, compared to cost factors like medical expenses and waiting times, participants attached greater emphasis on organizational characteristics. Respondents who rated sophisticated medical equipment, reputation of the facility, average education of doctors as important were significantly more inclined to choose hospital services. Respective adjusted odds ratios (AOR) were 2.14 (P < 0.001), 1.83 (P < 0.001) and 1.40 (P = 0.043) for their own conditions and 2.19 (P = 0.004), 1.94 (P = 0.002) and 1.86 (P = 0.003) for their children's conditions. Availability of medications and perceived severity of illness were also significantly associated with their choice of hospital services for their children. The public's preference for hospital-based services for first-contact care places a huge obstacle to promoting community-based primary care. Addressing the public's concerns about the primary care practitioners' competence is worth more efforts.

RISK REGRESSION ANALYSIS FOR OPENCAST MINE DUMPER OPERATORS

This regression analysis studies of dumper drivers were conducted for an opencast mine located in one of mine of Jharia Coal field, Jharkhand, India. Statistical tools have been developed in the light of analylitical principles to see whether there is any role of some personal and impersonal factors in the occurrence of coal miners’ injuries. With the progress in exploitation of minerals, safety of persons employed became a matter of concern. Occupational injuries in mines are attributed to many factors. Raw data on personal and organizational factors based on the questionnaire (samples were collected from 113 dumper drivers) and other methods were collected from the mine and thereafter they were analyzed. A logistic regression model is used in this research work. With this model both the prediction of group membership and the analysis were done in the form of an odds ratio. On the basis of binary logistic regression for both injury vs no injury and reportable vs no injury cases, then on the basis of ordinal logistic regression results the factors which were found to be most important among the initial factors were selected. The variables those show distinct relationship and considered to be significant with the degree of injury are the personal factors, environmental condition, machinery condition, job satisfaction and risk taking behavior and their respective adjusted odds ratios were found 12.17, 5.26, 6.35, 5.04 and 9.85 for significant risk factors in relation to injury vs No injury case. Similarly, 9.54, 8.40, 4.86 and 9.28 respectively for reportable vs no injury cases. In other words the above mentioned high risky significant factors are 12.17, 5.26, 6.35, 5.04 and 9.85 times more susceptible to injury in comparison to reference category. Out of the above 5 factors most highly significant categories are personal factor and risk taking behavior.

Standard assessments of frailty are validated predictors of mortality in hospitalized patients with cirrhosis

The risk of morbidity and mortality for hospitalized patients with cirrhosis is high and incompletely captured by conventional indices. We sought to evaluate the predictive role of frailty in an observational cohort study of inpatients with decompensated cirrhosis between 2010 and 2013. The primary outcome was 90-day mortality. Secondary outcomes included discharge to a rehabilitation hospital, 30-day readmission, and length of stay. Frailty was assessed with three metrics: activities of daily living (ADL), the Braden Scale, and the Morse fall risk score. A predictive model was validated by randomly dividing the population into training and validation cohorts: 734 patients were admitted 1358 times in the study period. The overall 90-day mortality was 18.3%. The 30-day readmission rate was 26.6%, and the rate of discharge to a rehabilitation facility was 14.3%. Adjusting for sex, age, Model for End-Stage Liver Disease, sodium, and Charlson index, the odds ratio for the effect of an ADL score of less than 12 of 15 on mortality is 1.83 (95% confidence interval [CI] 1.05-3.20). A predictive model for 90-day mortality including ADL and Braden Scale yielded C statistics of 0.83 (95% CI 0.80-0.86) and 0.77 (95% CI 0.71-0.83) in the derivation and validation cohorts, respectively. Discharge to a rehabilitation hospital is predicted by both the ADL (<12) and Braden Scale (<16), with respective adjusted odds ratios of 3.78 (95% CI 1.97-7.29) and 6.23 (95% CI 2.53-15.4). Length of stay was associated with the Braden Scale (<16) (hazard ratio = 0.63, 95% CI 0.44-0.91). No frailty measure was associated with 30-day readmission. Readily available, standardized measures of frailty predict 90-day mortality, length of stay, and rehabilitation needs for hospitalized patients with cirrhosis.

Cardiovascular Safety of Inhaled Long-Acting Bronchodilators in Individuals With Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a common and deadly disease. Long-acting inhaled β-agonists and anticholinergics, first-line medications for COPD, have been associated with increased risk of cardiovascular outcomes. When choosing between the medications, patients and physicians would benefit from knowing which has the least risk. To assess the association of these classes of medications with the risk of hospitalizations and emergency department visits for cardiovascular events. We conducted a nested case-control analysis of a retrospective cohort study. We compared the risk of events between patients newly prescribed inhaled long-acting β-agonists and anticholinergics, after matching and adjusting for prognostic factors. Health care databases from Ontario, the largest province of Canada, with a multicultural population of approximately 13 million. All individuals 66 years or older meeting a validated case definition of COPD, based on health administrative data, and treated for COPD from September 1, 2003, through March 31, 2009. New use of an inhaled long-acting β-agonist or long-acting anticholinergic. An emergency department visit or a hospitalization for a cardiovascular event. Of 191 005 eligible patients, 53 532 (28.0%) had a hospitalization or an emergency department visit for a cardiovascular event. Newly prescribed long-acting inhaled β-agonists and anticholinergics were associated with a higher risk of an event compared with nonuse of those medications (respective adjusted odds ratios, 1.31 [95% CI, 1.12-1.52; P < .001] and 1.14 [1.01-1.28; P = .03]). We found no significant difference in events between the 2 medications (adjusted odds ratio of long-acting inhaled β-agonists compared with anticholinergics, 1.15 [95% CI, 0.95-1.38; P = .16]). Among older individuals with COPD, new use of long-acting β-agonists and anticholinergics is associated with similar increased risks of cardiovascular events. Close monitoring of COPD patients requiring long-acting bronchodilators is needed regardless of drug class.

Cemented Femoral Stem Loosening of Hip Arthroplasty: Ten-year Radiographic Analysis

Objectives: To review the radiological features of femoral stem loosening of cemented hip arthroplasty on plain radiographs and to determine their usefulness. Methods: Between January 2002 and December 2011, 21 patients who had undergone revision of hip arthroplasty in a regional hospital in Hong Kong with cemented femoral stem loosening were retrospectively studied with respect to plain radiography indicating stem loosening. Thirty-three patients who had hip arthroplasty with cemented femoral stems between January 2004 and December 2007, without clinical suspicion of stem loosening, were included as controls. Statistical analysis was performed on the six specific radiological features: (1) osteolysis (non-linear radiolucency of >5 mm), (2) increased cement-bone interface of >2 mm, (3) radiolucent line between stem and cement at superolateral part of stem of >2 mm (subsidence), (4) radiolucent line between stem and cement in all Gruen zones of >1 mm, (5) sclerosis and thickening of bone at level of stem tip, and (6) inadequate cementation (grade C or D according to Barrack et al or cement thickness of <2 mm in any Gruen zone). Results: Of the six radiological features, increased cement-bone interface, subsidence, and inadequate cementation were indicative of cemented femoral stem loosening, respective adjusted odds ratios being 17.4 (p = 0.003), 10.3 (p = 0.026), and 7.5 (p = 0.040). Inter-rater consistency was highest for subsidence and increased cement-bone interface (with kappa values of 0.60 and 0.56, respectively). Conclusion: Features of increased cement-bone interface, subsidence, and inadequate cementation on plain radiographs are the strongest indicators of cemented femoral stem loosening.

Abstract 149: Disparities In Utilization Of Drug-eluting Stents By Payer Across Racial Groups

Background: Payer and race differences in utilization of drug-eluting stents (DES) have been reported, but the interaction between payer and race has not been well studied. Objectives: To examine if the impact of payer on utilization of DES is dependent on race. Methods and Results: A total of 77,142 stenting procedures performed between July 2006 and December 2007 were identified from the California’s hospital discharge database. Compared to private insurance, Medicaid, Medicare, and self-pay were associated with lower likelihood of receiving DES, the respective adjusted odds ratios (ORs) for receiving DES instead of bare-metal stents were 0.71 (95% confidence interval (CI): 0.66-0.77, P&lt;0.0001), 0.82 (95% CI: 0.78-0.87, P&lt;0.0001), and 0.46 (95% CI: 0.41-0.51, P&lt;0.0001), controlling for patient characteristics including race/ethnicity. The adjusted ORs for Medicaid in comparison to private insurance ranged from 0.56 (P&lt;0.001) in black to 0.74 (P=0.01) in Asian patients; the adjusted ORs for Medicare in comparison to private insurance ranged from 0.68 (P&lt;0.001) in black to 0.97 (P=0.69) in Asian patients; and the adjusted ORs for self-pay in comparison to private insurance ranged from 0.35 (P&lt;0.001) in black to 0.50 (P&lt;0.001) in white patients. Conclusions: The disparities in utilization of DES by payer are in general consistent across race/ethnicity groups.

Angiotensin-Converting Enzyme Genotype and Peripheral Arterial Disease in Diabetic Patients

We investigated the effect of traditional risk factors (hypertension, dyslipidemia and smoking) on the association between angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and peripheral arterial disease (PAD) in 945 (454 men and 491 women) Taiwanese type 2 diabetic patients with a mean age of 63.5 (SD: 11.4) years. Among them, 81 (31 men and 50 women) had PAD (ankle-brachial index <0.9). The adjusted odds ratios (95% confidence intervals) were 2.48 (1.18–5.21), 1.69 (1.00–2.85) and 1.64 (1.12–2.39), respectively, for recessive (DD versus II + ID), dominant (DD + ID versus II) and additive (II = 0, ID = 1 and DD = 2) models. While analyzing the interaction between DD and the individual risk factor of hypertension, smoking and dyslipidemia, patients with the risk factor and with DD had the highest risk compared to referent patients without the risk factor and with II/ID. The respective adjusted odds ratios were 5.41 (2.05–14.31), 7.38 (1.87–29.06) and 4.64 (1.70–12.64). We did not find a significant interaction between DD and any of the risk factors under multiplicative or additive scale. In conclusion, traditional risk factors (hypertension, smoking and dyslipidemia) play an important role in the association between ACE genotypes and PAD. Patients with DD genotype and traditional risk factors are at the highest risk.

Folate intake associated with lung function, breathlessness and the prevalence of chronic obstructive pulmonary disease.

A case-control study was conducted in central Japan to investigate the relationship between dietary intake of folate and lung function, breathlessness and chronic obstructive pulmonary disease (COPD). A total of 278 referred patients (244 men and 34 women) aged 50-75 years with COPD diagnosed within the past four years and 340 community-based controls (272 men and 68 women) were assessed for dyspnoea and undertook spirometric measurements of lung function. A structured questionnaire was administered face-to-face to obtain information on demographics, lifestyle and habitual food consumption. Folate intake was derived from the Japanese food composition tables. The COPD patients had significantly lower habitual intake of folate (mean 231, SD 90 microg/day) than control subjects (mean 261, SD 110 microg/day), p<0.001. Lung function measures were found to be positively associated with dietary folate level. Reductions in prevalence of COPD and especially breathlessness were observed, the respective adjusted odds ratio (OR) being 0.74 (95% confidence interval (CI) 0.35 to 1.58) and 0.43 (95% CI 0.21 to 0.91) for the highest versus lowest quartile of folate intake. The corresponding tests for linear trend were also significant (p<0.05). In conclusion, an inverse association was evident between dietary folate intake and the prevalence of breathlessness for Japanese adults, together with a significant dose-response relationship for the COPD risk. Moreover, increased folate intake might be beneficial to lung function.

Joint effects of hypertension, smoking, dyslipidemia and obesity and angiotensin-converting enzyme DD genotype on albuminuria in Taiwanese patients with type 2 diabetes mellitus

Objective We investigated the individual and joint effects of hypertension, smoking, dyslipidemia, and obesity and angiotensin-converting enzyme (ACE) DD genotype on albuminuria in Taiwanese type 2 diabetic patients. Designs and methods ACE genotypes were determined in 519 (287 men and 232 women) patients aged 58.5 (SD: 9.0) years. Among them, 240 had albuminuria (urinary albumin-to-creatinine ratio ≥ 30 μg/mg). Logistic regression was used to evaluate the individual and joint effects of risk factors and DD classified by two-by-four table. Results The adjusted odds ratios were significant for hypertension, smoking and obesity but not for DD and dyslipidemia in models evaluating individual effects. However, while analyzing the joint effects of DD and hypertension, smoking, dyslipidemia and obesity, the respective adjusted odds ratios were 3.253 (1.261–8.391), 3.016 (1.086–8.376), 2.385 (1.010–5.630) and 2.508 (1.117–5.631). Conclusion Hypertension, smoking, dyslipidemia and obesity jointly play an important role with DD genotype in mediating albuminuria.

Dietary intake of isoflavones and polyunsaturated fatty acids associated with lung function, breathlessness and the prevalence of chronic obstructive pulmonary disease: Possible protective effect of traditional Japanese diet

The Japanese diet is high in soy products and fish. A case-control study was conducted in Japan to investigate the relationship between dietary intake of isoflavones and fatty acids and lung function, breathlessness and chronic obstructive pulmonary disease (COPD). A total of 278 referred patients aged 50-75 years with COPD diagnosed within the past 4 years, and 340 community-based controls were assessed for respiratory symptoms and undertook spirometric measurements of lung function. A validated food frequency questionnaire was administered face-to-face to obtain information on habitual food consumption. Dietary intakes of isoflavones and fatty acids were derived from the Japanese food composition tables. The COPD patients had significantly lower habitual intakes of isoflavones (genistein and daidzein) and polyunsaturated fatty acids (PUFA; both omega-3 and omega-6) than control subjects. Lung function measures were found to be positively associated with isoflavones and PUFA intake. Substantial reductions in prevalence of COPD and breathlessness were observed for isoflavones, the respective adjusted odds ratio being 0.36 (95% confidence interval 0.19-0.68) and 0.60 (95% confidence interval 0.33-1.10) for the highest versus lowest levels of total isoflavone intake. The corresponding tests for linear trend were significant. High intakes of PUFA and omega-6 fatty acids (derived from foods excluding oils and fats as seasonings) also appeared to reduce the risks of COPD and breathlessness symptom, but no evidence of association was found for other types of fatty acids. The study provided evidence of possible protective effect of traditional Japanese diet against tobacco carcinogens.

Occurrence of Placental Abruption in Relatives

Both genetic and environmental factors may influence the incidence and rate of recurrence of placental abruption in women and their families. The influence of heredity on the severity of recurrent disease is unknown. This population-based prospective observational study investigated the effect of heritability on rates of recurrence of placental abruption and severity of recurrence in the same woman or her sister and the partner of her brother. From 1967 to 2005, data obtained from the Medical Birth Registry of Norway on 2,274,850 births identified 377,902 sisters with 767,395 pregnancies and 168,142 families with 2 to 10 sisters, and 346,385 brothers with 717,604 pregnancies of their partners. Multiple births were excluded. Severe disease was defined as cases of placental abruption with birth before 37 weeks' gestation, and birth weight below 2500 gm or perinatal death. Other cases were defined as mild. Multilevel logistic regression models were used to calculate odds ratios. The likelihood of recurrence of severe disease in women who initially had severe placental abruption was higher in comparison to those with initial mild disease; the respective adjusted odds ratios (aOR) were 11.5 (95% confidence interval [CI], 9.1-14.6) and 6.5 (95% CI, 4.2-10.3). These ratios compare to risks of 0.2 and 0.3 in women without a history of placental abruption. Severe placental abruption was associated consistently with significantly higher recurrence rates between sisters compared to mild placental abruption (aOR: severe 1.7 and 2.1 vs. mild 0.8 and 1.1 ). The heritability estimated between sisters of severe placental abruption was 16%. After an initial severe placental abruption, no excess recurrence of placental abruption was observed between sisters and the partners of their brothers, or from brothers' partners to their sisters. Following a second placental abruption (mild or severe) and a second severe abruption in the same woman, the risk of placental abruption in a subsequent pregnancy was very high; the odds ratios were 38.7 (19%, 11/58) and 50.1 (24%, 10/42), respectively. The investigators conclude from these findings that pregnancies following a second placental abruption in women who have had severe placental abruption should be considered very high-risk and monitored accordingly.

Waist‐to‐height Ratio and Coronary Artery Disease in Taiwanese Type 2 Diabetic Patients

Waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHeiR), and BMI are indicators for obesity. This study examined the usefulness of these indicators for coronary artery disease (CAD) in Taiwanese type 2 diabetic patients. A total of 1,345 (646 men and 699 women) patients aged 63.3 +/- 11.5 years were studied. CAD was defined by history or Minnesota-coded electrocardiogram. The relative importance was evaluated by the magnitude of adjusted odds ratio per 1-s.d. increment, the decrease in -2 log likelihood after adding the index to the logistic model, the c-index, and the Akaiki's information criterion (AIC). Results showed that the four indices were highly intercorrelated and except BMI for men, all indices differed significantly between patients with and without CAD in either sex. In logistic regressions, the respective adjusted odds ratios for WC, WHR, WHeiR, and BMI for every 1-s.d. increment were 1.209 (1.010-1.448), 1.109 (0.935-1.316), 1.231 (1.027-1.474), and 1.207 (0.997-1.461) for men; and were 1.176 (0.995-1.390), 1.105 (0.923-1.322), 1.280 (1.079-1.518), and 1.277 (1.083-1.507) for women. Only WHeiR was significant for both sexes and it also showed the greatest decrease in -2 log likelihood, the largest magnitude of odds ratio, and the smallest AIC while compared with the other indices in either sex. It is concluded that WHeiR has the superiority of independent association with CAD and the highest magnitude of association than WC, WHR, and BMI in both sexes. The usefulness of WHeiR should not be neglected in clinical practice.

Lipid abnormalities associated with urinary albumin excretion rate in Taiwanese type 2 diabetic patients

The purpose of this study was to examine the lipid abnormalities associated with urinary albumin excretion rate (UAER) in type 2 diabetic patients. A total of 275 (122 men and 153 women; aged 60.6 +/- 11.1 years) patients were selected with stringent criteria to prevent confounders. Normoalbuminuria (N= 152) and albuminuria (N= 123) were defined as urinary albumin-to-creatinine ratio (ACR) of <30 and > or =30 microg/mg, respectively. Total cholesterol, triglycerides, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, and apolipoproteins A1 (ApoA1) and B (ApoB) were measured and non-HDL cholesterol calculated. The subjects were divided into four phenotypes based on triglycerides (<1.5 or > or =1.5 mmol/L) and ApoB (<1.2 or > or =1.2 g/L). Total cholesterol, ApoB, and non-HDL cholesterol were significantly (P < 0.05) higher in patients with albuminuria. For quartiles of the lipid parameters, prevalences of albuminuria showed significant association with ApoB and non-HDL cholesterol (P trend <0.05). After adjusting for age, systolic blood pressure and hemoglobin A(1c) (HbA(1c)) correlation coefficients between the natural logarithm (ln) ACR and lipid parameters, odds ratios for albuminuria, and standardized regression coefficients for ln ACR, were significant for total cholesterol, ApoB and non-HDL cholesterol in all subjects and in men, but only ApoB was significant in women. For patients with normoalbuminuria, frequencies of normotriglycerides/normo-ApoB, hypertriglycerides/normo-ApoB, normotriglycerides/hyper-ApoB, and hypertriglycerides/hyper-ApoB were 44.7%, 28.9%, 10.5%, and 15.8%, respectively; and were 30.1%, 19.5%, 15.4%, and 35.0% for patients with albuminuria (P < 0.001). The respective adjusted odds ratio for albuminuria for the four phenotypes was 1.00, 1.04 (0.54 to 2.00), 2.25 (1.02 to 5.00), and 3.38 (1.75 to 6.53). Increased UAER is associated with ApoB-containing lipoproteins and the phenotype of hypertriglycerides/hyper-ApoB is associated with the highest risk of albuminuria. The surrogate marker of non-HDL cholesterol for ApoB is more applicable to the diabetic men.

Active and passive smoking and risk of renal cell carcinoma in Canada

This study aimed to assess the role of active and passive smoking in the development of renal cell carcinoma (RCC). Mailed questionnaires were completed by 1279 incident RCC cases and 5370 population controls between 1994 and 1997 in eight Canadian provinces. Data were collected on socio-economic status, smoking habits, diet and passive smoking status, as well as residential and occupational history. The study found an increased risk of RCC associated with active smoking. Elevated risk of RCC was also observed with passive smoking; compared with those never exposed to either passive or active smoking, men and women with 43 or more years of passive residential and/or occupational exposure had respective adjusted Odds Ratios (ORs) of 3.9 (95% Confidence Interval (CI) 1.4–10.6) and 1.8 (95% CI 1.0–3.3) ( P = 0.001 and P = 0.09, respectively). Both active and passive smoking might play a role in the aetiology of RCC.

Lack of association between angiotensin-converting enzyme gene polymorphism and peripheral vascular disease in type 2 diabetic patients in Taiwan.

A total of 361 Chinese patients with type 2 diabetes were studied for the association between peripheral vascular disease (PVD) and the insertion/deletion polymorphism involving a 287-bp alu repeat sequence at intron 16 of the angiotensin-converting enzyme (ACE) gene. The patients were divided into PVD (+) (n=45) and PVD (-) (n=316) based on an ankle-brachial index <0.9 and > or =0.9, respectively. Polymerase chain reaction was used to identify gene polymorphism. Results showed that D allele frequency in the patients without and with PVD was 31.8% and 33.3%, respectively (p=NS). The prevalence rates of II, ID and DD genotypes in the PVD (-) group were 45.6%, 45.3% and 9.2%, respectively; and the respective values for the PVD (+) group were 44.4%, 44.4% and 11.1% (p=NS). Prevalence rates of PVD in genotypes II, ID, and DD were 12.2%, 12.3% and 14.7%, respectively (p=NS). In logistic regression analyses, the unadjusted and adjusted odds ratios for DD vs II and ID vs II genotypes for PVD were not statistically significant. The respective adjusted odds ratios were 1.88 (0.56-6.29) and 1.33 (0.63-2.80). In conclusion, there was not a significant association between the ACE genotype and PVD in Chinese type 2 diabetic patients. However, a type 2 error can not be ruled out.

Foetal Growth Restriction in Children with Prothrombotic Risk Factors

Placental infarction is frequently observed in low birth weight children. To evaluate whether low birth weight in healthy term neonates is associated with foetal inherited prothrombotic risk factors this retrospective study was conducted. Outcome measures were "birth weight in the lowest quartile" and "birth weight in the lowest decile" in singletons with a gestational age of > or =37 weeks. The analyses were based on 375 Caucasian children screened at the Monster childhood thrombophilia centre with complete data for all prothrombotic risk factors (factor V G1691A, prothrombin G20210A, elevated lipoprotein (a), protein C-, protein S-, antithrombin-deficiency). The proportion of children in the lowest birth weight quartile increased from 23.7% to 30.5% to 48.0% for children with no, only single heterozygous and multiple or homozygous defects respectively. The respective adjusted odds ratios (95% confidence intervals) of thrombophilia for birth weight in the lowest quartile (lowest decile) were 1.53 (0.76-3.08) in carriers of one prothrombotic risk factor and 4.01 (1.48-10.84) in subjects carrying multiple or homozygous defects. We identified foetal thrombophilia as an additional cause of low birth weight.

ILLICIT DRUG USE AND THE RISK OF NEW-ONSET SEIZURES

The authors studied the use of heroin, marijuana, and cocaine before the onset of a first seizure in 308 patients with seizures and 294 controls at Harlem Hospital Center, New York City, between 1981 and 1984. Heroin use, both past and present, appeared to be a risk factor for all first seizures (adjusted odds ratio = 2.80, 95% confidence interval (CI) 1.53-5.74). For unprovoked seizures, the adjusted odds ratio was 2.58 (95% CI 1.36-4.90) for ever heroin use and 4.70 (95% CI 0.86-25.78) for heroin use within 24 hours of hospitalization. For provoked seizures, respective adjusted odds ratios were 3.65 (95% CI 1.54-8.65) and 27.74 (95% CI 3.57-215.52). Marijuana use appeared to be a protective factor against first seizures in men. For men with unprovoked seizures, the adjusted odds ratio was 0.42 (95% CI 0.22-0.82) for ever marijuana use and 0.36 (95% CI 0.18-0.74) for marijuana use within 90 days of hospitalization. For men with provoked seizures, respective adjusted odds ratios were 1.03 (95% CI 0.36-2.89) and 0.18 (95% CI 0.04-0.84). Cocaine use, while common among study subjects, was not shown to be a significant risk factor either for all first seizures or for subgroups of seizures, regardless of the time of last use. The authors conclude that heroin use is a risk factor and marijuana use a protective factor for new-onset seizures.