Significant Higher Odds Ratio Research Articles

Indoor volatile organic compounds exposures and risk of childhood acute leukemia: a case-control study in shanghai

A case-control study was conducted to investigate the relationship between indoor air pollution and childhood acute leukemia (AL) in Shanghai. 97 cases and 148 gender-, age-, and residence-matched controls were included. Indoor air pollution was evaluated by questionnaires and quantitative measurement including 14 volatile organic compounds (VOCs) and nitrogen dioxide (NO2) in the homes of the two groups. The levels of individual VOCs, VOC families, TVOC (sum of the concentrations of the individual VOCs) and NO2 were compared between the two groups. Exposure to styrene and butyl alcohol were associated with an increased risk of childhood AL (styrene: odds ratio (OR)=2.33, 95% confidence interval (CI): 1.07-5.07; butyl alcohol: OR = 2.51, 95%CI: 1.19-5.28); 4th quartile of chlorinated hydrocarbons (OR = 2.52, 95%CI: 1.02-6.26) and 3rd quartile of TVOC (OR = 4.03, 95%CI: 1.06-6.81) had significant higher ORs for childhood AL compared with that in the lowest quartiles. Elevated levels of individual VOCs, VOC families and TVOC were also associated with self-reported risk factors. Our findings suggest that VOCs exposure was associated with an elevated risk of childhood AL, underscore that more attention should be paid to indoor air pollution as a risk factor of childhood AL.

Regional Nerve Block Complication Analysis Following Peripheral Nerve Block During Foot and Ankle Surgical Procedures

Category:Other; Ankle; Ankle Arthritis; BunionIntroduction/Purpose:Foot and ankle surgeries are often be accompanied by a peripheral nerve block as a method of reducing post-operative pain. The major nerve targeted is the popliteal nerve. The nerve can be supplemented with a target of the adductor canal or saphenous nerve. Higher than expected complication rates with peripheral nerve blocks has led to increased concern among both surgeons as well as patients. To our knowledge, no study has been able to identify risk factors that may predispose a patient to one of these complications. Our goal was to attempt to identify those risk factors.Methods:We reviewed patient charts who underwent a foot and ankle procedure between 2014 and 2018 as performed by the senior author. The review yielded 992 procedures performed across four surgical locations. Of these, 137 procedures were removed because no regional block was used. The remaining cases were analyzed for nerve complications, defined as sensory (paresthesia, numbness, tingling, or burning pain) or motor (weakness or paralysis) deficits along the distribution of a peripheral nerve. The patients were divided into blocked patients with and without complications. The groups were evaluated for demographic differences. The categories consisted of age, sex, diabetic status, smoking, previous procedures, previously diagnosed neuropathies, surgical location, body mass index (BMI), race, and insurance provider. Statistical analysis was performed using SAS software. To determine significance of these different factors, Chi-square values were obtained for each data set. Additionally, a regression analysis was performed to identify odds ratio for individual factors.Results:The overall complication rate was 10.1% with a total of 855 blocks given. The significant factors associated with a complication were age (p=0.0061), BMI (p=0.0031), location (p=0.0016), and smoking status (p=0.0026). Factors that were not significantly associated with complications were sex, diabetes status, previous procedures requiring a block, previously diagnosed neuropathies, race, and insurance provider. A regression analysis was performed to determine odds ratio for individual factors. Those with significant higher odds ratio were age between 40-65 years, normal or underweight BMI, surgery occurring at an Outpatient Surgery Center, and current smoker.Conclusion:Current literature has reviewed operative variables such as tourniquet time and epinephrine use, while others have looked at diabetes and age as predictors of nerve block complications. Our study focuses more on epidemiological factors that can predict an increased risk. Our study helped to reinforce the findings previous literature has found in regards to age and diabetes status. This study has also introduced some new factors that can help the surgeon decide if a nerve block is necessary for each surgical patient.

Long-term Survival Analysis of Total Ankle Arthroplasty and Patient Risk Factor for Failure

Category:Ankle; Ankle ArthritisIntroduction/Purpose:The aim of current study is to perform long-term survival analysis for TAA of 5619 cases, and identify patient risk for failure of TAA.Methods:Total of 7516 cases of TAA were identified from national insurance claim data of South Korea during 2007 to 2018. After exclusion of bilateral cases and cases performed on 2018, total 5619 cases of primary TAA cases were included. TAA failure was defined as case with revision arthroplasty or case with TAA implant removal and arthrodesis after primary TAA. Patient age, hospital size, comorbidities were included for survival analysis. Kaplan-Meier survival analysis was performed during study period, and Multivariable Cox regression analysis were performed.Results:During study period, five-year survival rate was 95.4%, and 10-year survival rate was 91.1%, and mean survival duration was 9.6 years. Regression analysis revealed that younger age (< 65, adjusted hazard ration (AHR), 1.812; p< 0.001), chronic pulmonary disease (AHR, 1.476; p= 0.013), diabetes (AHR, 1.443; p= 0.014), alcohol consumption (AHR, 1.524; p= 0.032) showed significant high odds ratio for TAA failure.Conclusion:Current study was performed with largest cohort with TAA procedures in literature. 10-year survival rate was 91.4%, young age and some comorbidities revealed as significant predictor for TAA failure.

Sjogren\u2019s syndrome is associated with higher rate of non-home discharge after primary hip arthroplasty and higher transfusion rates after primary hip or knee arthroplasty: a U.S. cohort study

BackgroundTo assess whether Sjogren’s Syndrome (SS) is associated with outcomes after total knee or hip arthroplasty (TKA/THA).MethodsWe used the 1998–2014 U.S. National Inpatient Sample data. We performed multivariable-adjusted logistic regression analyses to assess the association of SS with healthcare utilization (hospital charges, length of hospital stay, discharge to non-home setting), and in-hospital complications (implant infection, revision, transfusion, mortality), controlling for important covariates and confounders. In sensitivity analyses, we additionally adjusted the main models for hospital location/teaching status, bed size, and region.ResultsWe examined 4,116,485 primary THAs and 8,127,282 primary TKAs performed from 1998 to 2014; 12,772 (0.2%) primary TKAs and 6222 (0.2%) primary THAs were done in people with SS. In multivariable-adjusted models, SS was associated with a statistically significant higher odds ratio (OR; 95% confidence interval (CI)) of discharge to a rehabilitation/inpatient facility post-THA, 1.13 (1.00, 1.28), but not post-TKA, 0.93 (0.86, 1.02). We noted no differences in the length of hospital stay or hospital charges. SS was associated with significantly higher adjusted odds of in-hospital transfusion post-THA, 1.37 (1.22, 1.55) and post-TKA, 1.21 (1.10, 1.34). No significant differences by SS diagnosis were seen in hospital stay, hospital charges implant infection, implant revision or mortality rates.ConclusionsPeople with SS had higher transfusion rate post-TKA/THA, and higher rate of discharge to non-home setting post-THA. The lack of association of SS with post-arthroplasty complications should reassure patients, surgeons and policy-makers about the utility of TKA/THA in people with SS undergoing these procedures.

Associations between degrees of task delegation and adherence to COPD guidelines on spirometry testing in general practice - a national cross-sectional study

BackgroundThe healthcare systems in the western world have in recent years faced major challenges caused by demographic changes and altered patterns of diseases as well as political decisions influencing the organisation of healthcare provisions. General practitioners are encouraged to delegate more clinical tasks to their staff in order to respond to the changing circumstances. Nevertheless, the degree of task delegation varies substantially between general practices, and how these different degrees affect the quality of care for the patients is currently not known. Using chronic obstructive pulmonary disease (COPD) as our case scenario, the aim of the study was to investigate associations between degrees of task delegation in general practice and spirometry testing as a measure of quality of care.MethodsWe carried out a cross-sectional study comprising all general practices in Denmark and patients suffering from chronic obstructive pulmonary disease. General practitioners (GPs) were invited to participate in a survey investigating degrees of task delegation in their clinics. Data were linked to national registers on spirometry testing among patients with COPD. We investigated associations using multilevel mixed-effects logit models and adjusted for practice and patient characteristics.ResultsGPs from 895 practices with staff managing COPD-related tasks responded, and 61,223 COPD patients were linked to these practices. Hereof, 24,685 (40.3%) had a spirometry performed within a year. Patients had a statistically significant higher odds ratio (OR) of having an annual spirometry performed in practices with medium or maximal degrees of task delegation compared to practices with a minimal degree (OR = 1.27 and OR = 1.33, respectively).ConclusionDelegating more complex tasks to practice staff implies that COPD-patients are more likely to be treated according to evidence-based recommendations on spirometry testing.

Evaluation of FTO rs9939609 and MC4R rs17782313 Polymorphisms as Prognostic Biomarkers of Obesity: A Population-based Cross-sectional Study.

ObjectivesObesity is a significant risk factor for a number of chronic diseases, including diabetes, cardiovascular diseases, and cancer. Obesity usually results from a combination of causes and contributing factors, including genetics and lifestyle choices. Many studies have shown an association of single nucleotide polymorphisms (SNPs) in the fat mass and obesity-associated (FTO) and the melanocortin-4 receptor (MC4R) genes with body mass index (BMI). Therefore, recognizing the main genes and their relevant genetic variants will aid prediction of obesity risk. The aim of our study was to investigate the frequency of rs9939609 and rs17782313 polymorphisms in FTO and MC4R genes in an Iranian population.MethodsWe enrolled 130 obese patients and 83 healthy weight controls and calculated their BMI. Genomic DNA was extracted from peripheral blood and the frequency of rs9939609 and rs17782313 polymorphisms in FTO and MC4R genes was determined using the tetra-primer amplification refractory mutation system-polymerase chain reaction (ARMS-PCR).ResultsSignificant associations were found between FTO rs9939609 and BMI. Where homozygous risk allele carriers (A-A) have significant higher odds ratio (OR) of being obese than individuals with normal BMI (OR = 6.927, p < 0.005, 95% confidence interval (CI): 3.48–13.78). No significant correlation between MC4R rs17782313 and obesity were observed when compared to healthy weight individuals. Although subjects with C-C genotype had higher odds of obesity (OR = 1.889, p = 0.077, 95%CI: 0.92–3.84).ConclusionsThis study shows a relationship between FTO polymorphism and increased BMI, therefore, SNP in the FTO gene influence changes in BMI and can be considered a prognostic marker of obesity risk.

Elevated Plasma Transforming Growth Factor β1 Levels Predict the Development of Hypertension in Normotensives: The 14-Year Follow-Up Study.

Transforming growth factor β1 (TGF-β1) is a multifunctional cytokine. There is growing evidence that TGF-β1 is involved in the pathogenesis of hypertension and the development of target organ damage in hypertensives. Although several studies have shown that TGF-β1 induced vascular hypertrophy and remodelling in various vascular diseases, there are no longitudinal data on hypertension in the epidemiological studies. The present study tested the hypothesis whether elevated TGF-β1 levels can predict the development of hypertension. In 2002-2004, 528 subjects received health examinations in Uku town, southwestern Japan. We examined blood pressure (BP), body mass index, and blood test. Data on fasting plasma TGF-β1 were obtained from 528 individuals. Of these, 149 normotensives (BP <140/90 mm Hg without antihypertensive medications) at baseline were followed-up for 14 years. The receiver-operating characteristic curve was used and the calculated cutoff value was 8.9 ng/ml. Of 149 normotensives at baseline, 59 subjects developed hypertension. Plasma TGF-β1 levels were significantly associated with the development of hypertension after adjustment for confounding factors. To further examine the association between them, we performed logistic regression analysis. We divided the baseline plasma TGF-β1 levels into 2 groups using a cutoff value. The significant high odds ratio [3.582 (95% confidence interval, 1.025-12.525)] for the development of hypertension was found in the highest group of TGF-β1 level vs. the lowest group after adjustment for confounders. This is the first report demonstrating the causal relationship between them. Elevated plasma TGF-β1 levels predicted the development of hypertension in normotensives in a population of community-dwelling Japanese.

Modifiable cardiovascular risk factors in Rheumatoid Arthritis.

Objective:To determine the frequency of modifiable cardiovascular risk factors in Rheumatoid Arthritis patients at tertiary care hospital.Methods:During this study 246 patients of Rheumatoid Arthritis were enrolled from outpatients department of Medicine of Central Park Medical College Hospital, Lahore from July 1, 2016 to January 31, 2017. Demographic data and questions related to study were noted. After 14 hours of fasting 5ml of venous blood was drawn for Cholesterol, triglycerides, HDL and blood sugar level. Blood tests were performed on COBAS c III (ROCHE), Framingham 10 year Risk score was calculated for every individual.Results:The mean age of male population was (50.2 ±7.5) and females (48.4±7.6) and female gender was common. Seventy eight (78%) of study population has one modifiable risk factor. Most frequent risk factor found in this study was BMI>30 in 48.4% (n=119), High LDL 43.5% (n=107), moderate to high FRS score 40.2% (n=99), Hypertension 37.4% (n=92), Diabetes Mellitus was present in 22.8% (n=56), while smoking was least frequent risk factors with frequency of 15.9% (n=39). Framingham cardiovascular risk score was significantly different, males were having higher mean 10 year risk score (19.7%) and females (8.7%) with (p-<0.01). Regression analysis revealed that older patients of Rheumatoid Arthritis with disease duration of more than seven years are four times more likely to have High Framingham risk score, moderate to high LDL and diabetes mellitus with significant high Odds ratio (p-value <0.05).Conclusion:Rheumatoid Arthritis patients are having increased chances of developing cardiovascular risk factors leading to cardiovascular events with male sex, increasing age and disease duration.

Case–control study on perfluorinated alkyl acids (PFAAs) and the risk of prostate cancer

Perfluorinated alkyl acids (PFAAs) are emerging environmental contaminants. Possible health effects for humans include increased risk for cancer but the knowledge is limited. In this study serum concentrations of certain perfluorinated sulfonates (PFHxS and PFOS) and carboxylates (PFOA, PFNA, PFDA, PFUnDA) were analyzed among 201 cases with prostate cancer and 186 population based control subjects. All blood samples were collected during 2007–2011 and no case had been treated with radio- or chemotherapy before enrolment in the study. The blood concentrations did not differ statistically significant between cases and controls except for PFDA with higher concentration among the cases (p=0.03). Analyses based on Gleason score and prostate specific antigen (PSA) level did not change the results. Heredity was a risk factor for prostate cancer yielding odds ratio (OR)=1.8, 95% confidence interval (CI)=1.01–3.1. The analyzed PFAAs yielded statistically significant higher ORs in cases with a first degree relative reporting prostate cancer, e.g., PFOA gave OR=2.6, 95% CI=1.2–6.0 and PFOS gave OR=2.7, 95% CI=1.04–6.8. The results showed a higher risk for prostate cancer in cases with heredity as a risk factor. In further studies interaction between gene and environment should be considered.

Fried foods associated health risks in Gujarati housewives

PurposeGujarati households are known for high consumption of edible oil and fried foods. However, there is lack of information on their knowledge about its use for various preparations and associated health risks. The paper aims to discuss these issues.Design/methodology/approachGuajarati housewives in the age group of 30‐65 years were surveyed from five different zones of Vadodara. Information on their knowledge about the use of edible oils and associated health risks was collected using a pre‐tested structured questionnaire and food frequency questionnaire.FindingsOnly 5 percent subjects consumed deep fried foods daily. Odds ratio showed high association (OR=4.50) between daily consumption of deep fried food and obesity. Significant association (p&lt;0.05) and high odds ratio (5.13) were seen between daily consumption of shallow fried foods and presence of diabetes. Obesity and hypertension were seen in 54.1 and 15.8 percent subjects, respectively. About 24 percent families used hydrogenated vegetable oil (vanaspati) for cooking purposes. Butter and ghee rich in saturated fats were regularly used by most families.Practical implicationsPoor knowledge amongst the Gujarati housewives on the correct use of fats and oils in their daily diets calls for an exhaustive education program to reduce high prevalence of obesity and other co‐morbidities prevalent in this part of the country.Originality/valueThis is an original research work completed in September 2011.

Racial/ethnic disparities in HIV infection among people who inject drugs: an international systematic review and meta‐analysis

The Ethnic Minority Meta-Analysis (EMMA) aims to assess racial/ethnic disparities in HIV infection among people who inject drugs (PWID) across various countries. This is the first report of the data. Standard systematic review/meta-analysis methods were utilized, including searching for, screening and coding published and unpublished reports and meta-analytical statistics. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines for reporting methods. Disparities were measured with the odds ratio (OR) for HIV prevalence among ethnic minority PWID compared to ethnic majority PWID; an OR >1.0 indicated higher prevalence among ethnic minorities. Racial/ethnic disparities in HIV prevalence among PWID were examined in 131 prevalence reports, with 214 racial/ethnic minority to majority comparisons, comprising 106 715 PWID. Overall, the pooled OR indicates an increased likelihood of higher HIV prevalence among racial/ethnic minority compared to racial/ethnic majority PWID [OR = 2.09, 95% confidence interval (CI): 1.92-2.28]. Among 214 comparisons, 106 produced a statistically significant higher OR for minorities; in 102 comparisons the OR was not significantly different from 1.0; six comparisons produced a statistically significant higher OR for majority group members. Disparities were particularly large in the United States, pooled OR = 2.22 (95% CI: 2.03-2.44). There was substantial variation in ORs-I(2) = 75.3%: interquartile range = 1.38-3.56-and an approximate Gaussian distribution of the log ORs. Among people who inject drugs, ethnic minorities are approximately twice as likely to be HIV seropositive than ethnic majorities. The great heterogeneity and Gaussian distribution suggest multiple causal factors and a need to tailor interventions to local conditions.

Increased incidence of metabolic syndrome in older men with high normotension

Introduction: Hypertension and prehypertension are correlated with future cardiovascular disease (CVD) and diabetes. Whether these harmful effects of the blood pressure (BP) could be found in normotensive is of interest. Methods: In this cross-sectional study, totally 2388 normotensive older men aged 65–80 years undergoing routine health examinations were enrolled. To eliminate the influence of age on BP, subjects were initially grouped in each age stratum. Then in each age-stratum, subjects were further grouped into low, middle and high-tertile systolic BP (SBP) subgroups. Finally, all the low-tertile subgroups in each age stratum were gathered to form Group-1. Similarly, Group-2 (middle-tertile) and Group-3 (high-tertile) were also created. Metabolic syndrome (MetS) was regarded as having risks for future CVD and diabetes. Results: Age, waist circumstance (WC), fasting plasma glucose (FPG) and log triglyceride (TG) were independently and significantly correlated with SBP by multiple linear regression analysis. On the other hand, logistic regression showed that Group-3 had significant higher odds ratios (ORs) for having abnormal WC, FPG and TG. In addition, Group-3 presented a 1.55–fold OR (p < 0.001) for having MetS than Group-1. Conclusions: In normotensive older men, the risk for having MetS was significantly associated with higher SBP. Primary prevention of hypertension should be stressed.

Copy number variations of chromosome 17p13.1 might be linked to high risk of lung cancer in heavy smokers

Lung cancer is the most common cause of cancer death worldwide. Smoking is known as the strongest single factor in the development of lung cancer. However, there are inherited genetic factors that cause different responses to cigarette smoking exposure among individuals. We tried to identify these differences in heavy smokers by examining copy number variations (CNVs) between lung cancer patients and healthy controls. Analysis by array comparative genomic hybridization which was tested with 20-person training set (10 lung cancer patients, 10 healthy controls) showed 26 significant (adjusted P < 0.05) clones with either copy number gains or losses. Three genes, KCTD11, FGF11, and PTPRH on chromosomal regions 17p13.1 (KCTD11 and FGF11) and 19q13.42 (PTPRH), were selected (adjusted P < 0.001) and tested by real-time quantitative PCR with 34 healthy controls and 54 lung cancer patients. KCTD11 on the chromosomal region 17p13.1 showed significant high odds ratio (OR = 16.0) in heavy smokers, implying that this is a susceptibility region for lung cancer in this group. Therefore, CNVs of 17p13.1 is a promising candidate to identify individuals with a high genetic risk for the development of lung cancer.

Twenty‐four‐hour shift work, depressive symptoms, and job dissatisfaction among Japanese firefighters

The influence of a 24-hr shift-work burden on firefighters' mental health has not been fully investigated. The purpose of this study is to clarify the relationships between specific workload items among firefighters engaged in 24-hr shift work and job stress as estimated by the generic job-stress questionnaire on depressive symptoms and job dissatisfaction from the National Institute for Occupational Safety and Health (NIOSH). The subjects were 1,301 firefighters. The questionnaire covered age, gender, job type, job class, marital status, smoking and drinking habits, number of attendances, turnout time, extra work hours, average nap-time, the Center for Epidemiologic Studies Depression Scale (CES-D), and questions from the NIOSH generic job-stress questionnaire, including those on job satisfaction. In multivariate logistic regression analyses, a model that included all variables except the measures from the NIOSH generic job-stress questionnaire showed that shorter nap-time had significant higher odds ratios (ORs) for depressive symptoms and job dissatisfaction, but the significances disappeared in a fully adjusted model. In fully adjusted logistic regression analyses, low quantitative workload, low variance in workload, high intra- and intergroup conflict, low social support from a supervisor, high role conflict and ambiguity, and low self-esteem had significant higher ORs for depressive symptoms and/or job dissatisfaction. Amount of workload, variance in workload, intra- and intergroup conflict, social support from a supervisor, role conflict and ambiguity, and self-esteem were significantly related to depressive symptoms and/or job dissatisfaction among Japanese firefighters. Moreover, inadequate nap-time may affect their mental health.

Insomnia is Associated with Psychological and Physical Problems in Japanese Male Workers.

Objectives To elucidate sociodemographic, lifestyle, psychological, and physical factors associated with two subtypes of insomnia in Japanese male workers.Design A cross-sectional study using the annual health examination database of a Japanese company.Setting N/AParticipants Middle-aged male participants in the 1998 health examination at an employee health management center of a Japanese company (n=22, 185) .Main outcome measures Self-reported insomnia, including difficulty initiating sleep (DIS) and difficulty maintaining sleep (DMS) .Results In the young age (<45 years old) group: Significant higher odds ratio (OR) for DIS was found in living alone, shift work, smoking, lack of having three meals, psychological problems, and hypertension, with significant lower OR in overtime work and alcohol drinking. Significant higher OR for DMS was found in living alone, alcohol drinking, psychological problems, and hypertension, with significant lower OR in overtime work. In the old age (≥45 years old) group: Significant higher OR for DIS was found in living alone, smoking, lack of having three meals, lack of exercise, and psychological problems, with significant lower OR in overtime work, alcohol drinking, and hypertension. Significant higher OR for DMS was found in alcohol drinking, lack of walk, psychological problems, and diabetes, with significant lower OR in overtime work and smoking.Conclusions Insomnia was associated with psychological and physical problems, besides lifestyles, in Japanese male workers.