Significant Increase In Odds Ratio Research Articles

Comorbid Conditions in a Cohort of Inpatients with SARS-CoV-2 and their Association with In-Hospital Mortality During the Early Phases of the Pandemic.

Introduction: Studies determined that age and associated comorbidities are associated with worse outcomes for COVID-19 patients. The aim of the present study is to examine previous electronic health records of SARS-CoV-2 patients to identify which chronic conditions are associated with in-hospital mortality in a nationally representative sample. Materials and Methods: The actual study is a cross-sectional analysis of SARS-CoV-2 infected patients who were treated in repurposed hospitals. The study includes a cohort of patients treated from 06-11-2020 to 15-03-2021 for COVID-19 associated pneumonia. To examine the presence of comorbidities, electronic health records were examined and analyzed. Results: A total of 1486 in-patients were treated in the specified period, out of which 1237 met the criteria for case. The median age of the sample was 65 years. The overall in-hospital mortality in the sample was 25.5%, while the median length of stay was 11 days. From whole sample, 16.0% of the patients did not have established diagnoses in their electronic records, while the most prevalent coexisting condition was arterial hypertension (62.7%), followed by diabetes mellitus (27.3%). The factors of age, male gender, and the number of diagnoses showed a statistically significant increase in odds ratio (OR) for in-hospital mortality. The presence of chronic kidney injury was associated with the highest increase of OR (by 3.37) for in-hospital mortality in our sample. Conclusion: The study reaffirms the findings that age, male gender, and the presence of comorbidities are associated with in-hospital mortality in COVID-19 treated and unvaccinated patients. Our study suggests that chronic kidney injury showed strongest association with the outcome, when adjusted for age, gender, and coexisting comorbidities.

The Relationship Between Specific Age-Related Chronic Conditions of Comorbidity and Depression Scores Among Men in an Elderly Population: A Cross-Sectional Study.

ObjectiveThere had been an observed increase in the prevalence of depression as well as many chronic conditions of comorbidity among the elderly population of Ireland above the age of 50. The relationship between different prominent conditions of comorbidity and depression scores amongst older adult men in Ireland was sought to be examined and explored.MethodsA cross-sectional analysis of data from wave 1 of The Irish Longitudinal Study on Aging (TILDA) had been used for statistical analysis, which served to be the representative cohort study sample of elderly adults living in Ireland aged 50 and older. Summary statistics (cross-tabulation, t-test, analysis of variance/ANOVA and odds ratio) were used to explore the relationship between depression scores and different conditions of comorbidity.ResultsResults were drawn from the three different tests conducted; cross-tabulation, t-test, and analysis of variance/ANOVA. Cross-tabulation served to provide the total population of men who suffered from depression (CES-D score ≥ 16), which totaled 123 (1.4%) of the entire 8,504 available candidates. Of the participants that met the criteria for having a significant risk of clinical depression along with an accompanying chronic illness odds ratio (OR) had been calculated. All but one of the conditions yielded a significant increase in OR between having a chronic condition and depression; with the exception of chronic lung disease. Congestive heart failure demonstrated the highest OR of 4.40 (CI 95% 1.77-10.95), followed by arthritis, diabetes and cancer. Subsequent t-tests used to construct an ANOVA then illustrated the mean CES-D score for males suffering from one of the five concomitant illnesses selected (congestive heart failure, chronic lung disease, arthritis, cancer, and diabetes) as well as those free of the selected diseases of the study, with a total count of 2,117. All results had been deemed to be significant with p-values < 0.05, with men suffering from congestive heart failure having the highest mean score of 7.28 (n=39). Those who do not suffer from any of the five conditions reported the lowest scores and also accounted for the largest population group with 3.88 and 1,387, respectively.ConclusionsConsistent and significant findings of elderly men suffering from a chronic condition of comorbidity demonstrated having elevated OR and CES-D scores in comparison to those who are disease-free. The findings of this study can be used to evaluate alternative preventative management of chronic diseases of comorbidity in order to improve the depression scores of patients.

How Does Health Literacy Modify Indicators of Health Behaviour and of Health? A Longitudinal Study with Trainees in North Germany.

Background: Health literacy (HL) is a resource that can help individuals to achieve more control over their health and over factors that influence health. In the present follow-up study, we have investigated the extent to which HL in trainees changes over time and whether or to what extent HL influences health behaviour and health. Methods: In 2017, we performed a baseline survey (T0) of trainees from six different branches, who were contacted through vocational colleges in four northern federal states in Germany. The survey was repeated at the midpoint of their training in 2019 (T1). Demographic data were surveyed, together with information on HL (HLS-EU-Q16), health behaviour and on health status (psychological well-being, subjective health status). Multivariate regression analyses were performed in SPSS 26. Results: Three hundred and ninety-one (391) data sets were evaluated, with a follow-up rate of 27%; 79% of the trainees were female. The mean age was 21.2 years. Over all subjects, the mean HL increased over time ( (SD): 11.9 (2.9) to 12.2 (2.9), p = 0.070). This increase was only statistically significant for the health service trainees ( (SD): 12.1 (2.8) to 12.5 (2.9), p = 0.019). Relative to persons with adequate HL, the odds ratio over time for impaired psychological well-being was increased by 230% in persons with inadequate HL (OR: 3.3, 95% CI: 1.70–6.32, p < 0.001). For persons with problematical HL, the corresponding increase in odds ratio was 110% (OR: 2.1, 95% CI: 1.30–3.38, p = 0.002). Relative to persons with adequate HL, trainees with inadequate HL exhibited a significant increase in odds ratio of 2.8 over time for poor or less good subjective health status (OR: 2.8, 95% CI: 1.23–6.33, p = 0.014). Conclusions: We observed a positive longitudinal association between HL and health. A significant increase in HL was observed in trainees in the health service. Thus the study shows that the concept of HL may provide a potential preventive approach for trainees.

Central Venous Disease Increases the Risk of Microbial Colonization in Hemodialysis Catheters.

Objectives: Tunneled-cuffed catheters (TCCs) are widely used in maintenance hemodialysis patients. However, microbial colonization in catheters increases the likelihood of developing various complications, such as catheter-related infection (CRI), catheter failure, hospitalization, and death. Identification of the risk factors related to microorganism colonization may help us reduce the incidence of these adverse events. Therefore, a retrospective analysis of patients who underwent TCC removal was conducted.Methods: From a pool of 389 adult patients, 145 were selected for inclusion in the study. None of the patients met the diagnostic criteria for CRI within 30 days before recruitment. The right internal jugular vein was the unique route evaluated. The catheter removal procedure was guided by digital subtraction angiography. Catheter tips were collected for culture. Biochemical and clinical parameters were collected at the time of catheter removal.Results: The average age of this cohort was 55.46 ± 17.25 years. A total of 45/145 (31.03%) patients were verified to have a positive catheter culture. The proportions of gram-positive bacteria, gram-negative bacteria, and fungi were 57.8, 28.9, and 13.3%, respectively. History of CRI [odds ratio (OR) = 2.44, 95% confidence interval (CI) 1.09 to 5.49], fibrin sheath (OR = 2.93, 95% CI 1.39–6.19), white blood cell (WBC) count ≥5.9 × 109/l (OR = 2.31, 95% CI 1.12–4.77), moderate (OR = 4.87, 95% CI 1.61–14.78) or severe central venous stenosis (CVS) (OR = 4.74, 95% CI 1.16–19.38), and central venous thrombosis (CVT) (OR = 3.41, 95% CI 1.51–7.69) were associated with a significantly increased incidence of microbial colonization in a univariate analysis. Central venous disease (CVD) elevated the risk of microbial colonization, with an OR of 3.37 (1.47–7.71, P = 0.004). A multivariate analysis showed that both CVS and CVT were strongly associated with catheter microbial colonization, with ORs of 3.06 (1.20–7.78, P = 0.019) and 4.13 (1.21–14.05, P = 0.023), respectively. As the extent of stenosis increased, the relative risk of catheter microbial colonization also increased. In patients with moderate and severe stenosis, a sustained and significant increase in OR from 5.13 to 5.77 was observed.Conclusions: An elevated WBC count and CVD can put hemodialysis patients with TCCs at a higher risk of microbial colonization, even if these patients do not have the relevant symptoms of infection. Avoiding indwelling catheters is still the primary method for preventing CRI.

Silica Dust Exposure Increases Risk for Rheumatoid Arthritis: A Swedish National Registry Case-Control Study.

Objective:Rheumatoid arthritis (RA) is an inflammatory disease with unknown etiology. This study examines if silica dust exposure increases the risk for seropositive and seronegative RA.Methods:A nationwide registry case–control study was conducted that included all cases of RA in Sweden between 2005 and 2016. In total, 31,139 cases with two matched controls were included. A JEM was used to estimate exposure.Results:Silica dust exposure was associated with a statistically significant increase in odds ratio (OR) for seropositive (OR 1.22, 95% CI 1.05 to 1.40) and seronegative (OR 1.23, 95% CI 1.04 to 1.46) RA among men.Conclusion:This study found an increased OR for RA in silica-exposed men. The OR was equal for seropositive and seronegative RA. These findings further support the hypothesis that silica dust may be a trigger for RA.

A Meta-analysis of Complication Rates Among Various Surgical Modifications of Pectoralis Major Myocutaneous Flap.

The purpose of this study is to aggregate and summarize the complication rates among various modified techniques of pectoralis major myocutaneous flap harvesting. Various databases were searched from its inception to September 2020. Studies describing surgical management of head and neck oncologic reconstruction using pectoralis major myocutaneous flap and its surgical modifications were included in study. All included studies: (1) described a pectoralis major flap harvesting technique categorized by author as conventional technique, bipaddle or bilobed flap, segmental flap, flap transfer using subclavicular route, skin paddle over Pectoralis Major, Flap with Multiple vascular supply, U shaped skin paddle, modified short incision technique; and (2) reported the number of postoperative complications in participants. Meta-analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total 183 studies were included. Segmental flap (0.20%), flap with multiple vascular supply (5.18%) and parasternal skin flap (6.38%) had the highest rates of total complications and were the only techniques to show a statistically significant increase in odds ratio compared with conventional technique (odds ratio 1.89, 9.05 and 7.26, respectively, P < 0.05). Bipaddle flap (57.48%) and u shaped skin flap (78.05%) show statistically significant decrease in odds ratio as compared to conventional technique. Among all the modifications in surgical technique of pectoralis major myocutaneous flap harvesting bipaddle flap and u shaped skin flap show least total complication rates. But on the contrary rates of partial flap necrosis and fistula are significantly higher in bipaddle flap as compared to conventional technique. As such, the choice of surgical technique should primarily be made based on the defect size, patient selection and surgeons' discretion rather than the presumed complicationrate.

Transarterial radioembolization vs chemoembolization for hepatocarcinoma patients: A systematic review and meta-analysis.

To compare the efficacy and safety of yttrium-90 radioembolization (Y90RE) and transarterial chemoembolization (TACE) in hepatocellular carcinoma patients. Bibliographic research was conducted on main scientific databases. When there was no statistically significant heterogeneity, pooled effects were calculated using a fixed-effects model by means of Mantel-Haenszel test, otherwise, a random-effects model was used with DerSimonian and Laird test. Summary estimates were expressed in terms of odds ratios (ORs) and 95%CI. The probability of publication bias was assessed using funnel plots and with Begg and Mazumdar's test. Sensitivity analysis was finally conducted using the method of excluding extreme data. A total of 10 studies were analyzed, of which 2 randomized controlled trials. Survival rate (SR) assessed at 1 year showed an absolute similarity between the two treatment groups (OR = 1.01, 95%CI: 0.78-1.31, P = 0.93). As long as time elapsed since the treatment, ORs for survival rate tended to significantly increase, thus meaning better long-term outcomes in patients who underwent Y90RE (2-year SR: OR = 1.43, 1.08-1.89, P = 0.01; 3-year SR: OR = 1.48, 1.03-2.13, P = 0.04). Meta-analysis of plotted hazard ratios (HRs) determined a non-significant overall estimate in favor of Y90RE (HR = 0.91, 0.80-1.04, P = 0.16). Y90RE showed a statistically significant benefit as compared to TACE in terms of higher progression-free survival rate assessed at 1 year (OR = 1.67; 95%CI: 1.10-2.55; P = 0.02). Pooled analyses do not revealed a statistically significant increase in OR for tumor objective responses after Y90RE with respect to TACE (OR = 1.22, 95%CI: 0.69-2.16, P = 0.50). A non-significant trend in favor of Y90RE was observed according to adverse event rate (OR = 0.70, 0.38-1.30, P = 0.26). Our meta-analysis reveals that Y90RE and TACE show similar effects in terms of survival, response rate and safety profile, although tumor progression is delayed after radioembolization.

Age at menarche and its association with the metabolic syndrome in Taiwan

The average age at menarche in the Taiwanese population is falling. Contrarily, the prevalence of metabolic syndrome (MetS) showed a worldwide increase in the past two decades. The aim of this study was to examine the association between age at menarche and MetS. A total of 3292 women aged 19-91 years old were enrolled in two databases from 2004 to 2008. MetS was defined according to American Heart Association's criteria. Age at menarche was obtained from self-reported questionnaires. Multiple logistic regression analyses were used to estimate the association between age at menarche and MetS with adjustment for potential confounding variables. The prevalence of MetS increased with age. After adjusting age, lifestyle status, and reproductive factors as variables, subjects who had menarche at a younger age showed significantly higher risk of MetS. The adjusted odds ratio of having MetS in <12 and 12-14 years old menarche age groups were 1.71 (1.07-2.71) and 1.22 (1.00-1.50), respectively. The significant increase in odds ratio for MetS in early age menarche also reveals a dose-response effect. Early onset of menarche is an important risk factor of MetS and may help identify women at risk of MetS.

Maternal Thyroid Disease and Preterm Birth: Systematic Review and Meta-Analysis.

Thyroid disease in pregnancy is increasing with rising average maternal ages in developed countries. The evidence for an association between preterm birth and thyroid disease has been confounded by small studies with varying outcomes and methodology. The aim of this meta-analysis is to review the literature regarding thyroid disease including subclinical and overt hypothyroidism, hyperthyroidism, and isolated hypothyroxinemia and the specific outcome of preterm birth. A search of PubMed and Embase databases was performed in May 2015. A fixed-effects model was used to calculate the overall combined odds ratio (OR) with its corresponding 95% confidence interval (95% CI) to evaluate the relationship between thyroid disease and preterm delivery. Studies were considered eligible if they met the following criteria: prospective cohort study or a case control study; the exposure of interest was maternal thyroid disease, including subclinical hypothyroidism, overt hypothyroidism, hyperthyroidism, or isolated hypothyroxinemia; the outcome of interest was preterm delivery; and data regarding numbers of preterm births in each cohort were reported. Data were recorded in a database evidence table including any incidence data for maternal thyroid disease and preterm birth compared to a reference group. Fourteen cohort studies and one case control study involving 2 532 704 participants were included. The combined OR of preterm delivery for pregnant women with overt hypothyroidism compared with the reference group was 1.19 (95% CI, 1.12-1.26; P < .00001). There was also a significant risk of preterm birth in women with hyperthyroidism (OR, 1.24 [95%, CI 1.17-1.31]; P < .00001). Subclinical hypothyroidism and isolated hypothyroxinemia showed no significant increase in OR. Sensitivity analysis made no change to these results. Both overt hypothyroidism and hyperthyroidism are associated with a small but statistically significant increase in OR for preterm birth not seen in subclinical hypothyroidism or isolated hypothyroxinemia.

Early gestational weight gains within current recommendations result in increased risk of gestational diabetes mellitus among Korean women

We prospectively assessed whether maternal weight gain at 24-28 weeks of gestation (MWG24) influences the risk of developing gestational complications, such as gestational diabetes mellitus (GDM) and other adverse pregnancy outcomes, in pregnant Korean women. Maternal weight gain from self-reported pre-pregnancy weight until 24-28 weeks of gestation was measured in 731 pregnant women, and an expected MWG24 was determined using the Institute of Medicine 2009 guidelines. Glucose tolerance, insulin resistance, insulin secretory capacity, anthropometric measurements, lipid profiles, nutrient intakes and pregnancy outcomes were evaluated at 24-28 weeks of gestation. The adjusted odds ratios (ORs) for GDM, large-for-gestational-age infants, small-for-gestational-age infants and preterm delivery were determined according to maternal weight gain by logistic regression analysis after adjusting for covariates. Compared with a normal MWG24, an inadequate MWG24 reduced the OR (0.565) for GDM, but an excessive MWG24 did not affect the OR (0.854). However, ORs for preterm delivery were significantly higher in both inadequate and excessive MWG24 groups in comparison with the normal MWG24. There were no other adverse pregnancy outcomes due to the inadequate MWG24. MWG24 was not associated with a significant increase in ORs for delivering large-for-gestational-age or small-for-gestational-age infants or delivery by caesarean section. Although energy intake was less than the estimated energy requirement in all groups, MWG24 was linearly associated with energy intake such that energy balance was positive in the excessive MWG24 group. This study suggests that both target weight gain and energy intake recommendations for early pregnancy may not be optimal for Korean women and that race-specific recommendations are needed to decrease the risk of GDM without increasing adverse pregnancy outcomes.

Serum homocysteine level is positively associated with chronic kidney disease in a Taiwan Chinese population

Both hyperhomocysteinemia and chronic kidney disease (CKD) increase risk of cardiovascular disease. In this study, we investigated the association between serum homocysteine level and CKD. A total of 1,581 participants were recruited from a health check-up center in a tertiary hospital in Taiwan between 2006 and 2008. Two groups were created based on serum homocysteine levels above or below 12.24 μmol/l. Estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease equation; we defined CKD as an eGFR below 60 ml/min/1.73 m(2). Multivariate logistic and linear regression analyses were used to estimate the associations between serum homocysteine levels and kidney function. Subjects with elevated homocysteine levels were older and had higher body mass index, blood pressures, fasting plasma glucose, total cholesterol, triglycerides, and eGFR than those with normal serum homocysteine level. Using multiple logistic regression analyses after adjustment for age, sex, lifestyle habits (smoking, alcohol consumption, and betel nut chewing) and chronic diseases (hypertension, diabetes, dyslipidemia), the odds ratio (95 % confidence interval) of having CKD was 5.76 (2.99-11.1) among subjects with elevated serum homocysteine levels compared to subjects with normal serum homocysteine levels. The significant increase in odds ratios for CKD in progressive homocysteine levels reveals a dose-response effect. After adjustment for confounders, at multiple linear regression analyses serum homocysteine level resulted significantly and negatively correlated to eGFR. Elevated serum homocysteine levels appear to be closely associated with CKD. Serum homocysteine levels are negatively associated with eGFR.

Subclinical hypothyroidism is associated with elevated high-sensitive C-reactive protein among adult Taiwanese

Subjects with subclinical hypothyroidism (SCH) are at increased risk for cardiovascular disease (CVD). High-sensitivity C-reactive protein (hsCRP) is one of the inflammatory markers related to CVD. It is unclear whether inflammation is a mechanistic intermediary between SCH and CVD. We aimed to investigate the association between SCH and hsCRP in a Taiwanese population. A baseline cohort of 2,494 participants over the age of 19 was recruited in Taiwan from 2006 to 2008. SCH was defined as a serum thyroid-stimulating hormone (TSH) level of 5.61-19.9 mIU/L with normal thyroxine concentrations (a total T4 level of 4.9-12.0 μg/dL). Euthyroidism was defined as a serum TSH level of 0.34-5.60 mIU/L. HsCPR was grouped using quartiles. Multiple logistic and linear regression analyses were used to evaluate the relationship between hsCRP and SCH. After adjusting for gender and betel nut chewing, stepwise multiple logistic regression analyses revealed that hsCRP groups were significantly associated with SCH. Compared to the lowest hsCRP quartile, the adjusted odds ratio of having SCH for hsCRP quartile II, III, and IV were 1.38 (0.48-3.98), 1.48 (0.56-3.96), and 2.59 (1.01-6.67), respectively. The significant increase in odds ratios for SCH in progressive hsCRP quartiles reveals a dose-response effect (p < 0.05). Moreover, stepwise multiple linear regression analyses showed that hsCRP was significantly positively associated with serum TSH level after adjusting for potential confounders. Adult Taiwanese with SCH were associated with elevated hsCRP quartiles.

Albuminuria is strongly associated with arterial stiffness, especially in diabetic or hypertensive subjects—A population-based study (Taichung Community Health Study, TCHS)

ObjectiveAlbuminuria is recognized as a marker of vascular dysfunction. Brachial–ankle pulse wave velocity (baPWV) reflects the stiffness of central and peripheral muscular arteries. Limited information is available for the association between albuminuria and arterial stiffness in Chinese. We aimed to assess the association between albuminuria and arterial stiffness in a middle-aged population-based study. MethodsA total of 2180 subjects aged 40 years and over were recruited in 2004 in Taiwan. Albuminuria was defined as urinary albumin-to-creatinine ratio (ACR)≥30mg/g creatinine. BaPWV was divided by quartile. Multiple logistic and linear regression analyses were used to evaluate the relationship between baPWV and albuminuria. ResultsAfter adjusting for age, body mass index, mean arterial pressure, fasting glucose, triglycerides, total cholesterol, chronic kidney disease, smoking, alcohol drinking, and physical activity status, multiple logistic regression analyses revealed baPWV groups were significantly associated with albuminuria. Compared to the lowest baPWV quartile, the adjusted odds ratio of having albuminuria for baPWV quartile II, III, and IV were 1.12(0.63–2.02), 2.04(1.15–3.60), and 2.45(1.29–4.65). The significant increase in odds ratios for albuminuria in progressive baPWV quartiles reveals a dose–response effect (p<0.001). Among diabetic, hypertensive, and macroalbuminuria subjects, these relationships were stronger than in subjects without diabetes, hypertension, and microalbuminuria. Moreover, multiple linear regression analyses showed that baPWV was significantly associated with urinary ACR after adjusting for potential confounders. ConclusionAlbuminuria was strongly related to arterial stiffness among Chinese middle-aged adults. These relationships were enhanced in subjects with hypertension, diabetes, or macroalbuminuria.

Decreased levels of plasma adiponectin associated with increased risk of colorectal cancer

To investigate the association between adiponectin levels and risk of colorectal adenoma and cancer (early and advanced). A cross-sectional study in a cohort of hospital-based patients was conducted between January 2004 and March 2006 at Yamagata University Hospital. Male subjects, who had colorectal tumors detected by endoscopic examination, were enrolled according to inclusion and exclusion criteria. Based on the T factor of the TNM system, intraepithelial carcinoma and submucosally invasive carcinoma were defined as early cancer, and invasion into the muscularis propria or deeper was defined as advanced cancer. The plasma levels of glucose, insulin, total cholesterol, triglyceride, high sensitivity C-reactive protein, insulin like growth factor (IGF)-1, IGF binding protein-3, adiponectin, leptin, and resistin were measured. Each factor level was designated low or high, and the risk of adenoma or cancer was estimated by univariate and multivariate logistic regression analysis. We enrolled 124 male subjects (47 with adenoma, 34 with early cancer, 17 with advanced cancer, and 26 without tumors as controls). In patients with adenoma, high triglyceride and low adiponectin were associated with a significant increase in the odds ratio (OR) by univariate analysis. Only a low adiponectin level was related to increased adenoma risk, with an adjusted OR for low level (< 11 microg/mL) to high (>or=11 microg/mL) of 5.762 (95% confidence interval (CI): 1.683-19.739, P = 0.005). In the patients with early cancer, high body mass index, high triglyceride, and low adiponectin were associated with a significant increase in OR in univariate analysis. In multivariate analysis, only low adiponectin was significantly associated with early cancer, with an adjusted OR of 4.495 (95% CI: 1.090-18.528, P = 0.038). However, in patients with advanced cancer, low adiponectin was not recognized as a significant risk factor for advanced cancer. A decreased level of adiponectin is strongly associated with an increased risk of colorectal adenoma and early cancer. These data call for further investigation, including a controlled prospective study.

High altitude and early childhood growth retardation: new evidence from Tibet

To assess possible effect of high altitude on early childhood growth in Tibet. A cross-sectional survey on child health and nutrition was conducted in Tibet with stratified multistage cluster random sampling technique. Height and weight status of Tibetan children <36 months of age was measured. A questionnaire was administered to mothers of children for information on family background, child feeding practice and health care and maternal care. A total of 1458 children with complete information were used for analysis. A logistic regression model was used to control for selected potential confounding factors and then observed altitude effect on growth of Tibetan children. Positive association of stunting with altitude was observed for each age group, even after controlling for selected potential affecting factors. Children above 3500 m had two to six times risk of getting stunting compared with those at 3000 m when socioeconomic and other factors were controlled. Effect of altitude on underweight was observed only among children <24 months old and significant increase in odds ratio appeared only above 4000 m after controlling for those confounding factors. Indicator of wasting was not related to altitude. Altitude might result in a delay in height of younger Tibetan children, independent of socioeconomic and other factors operating through nutrition and disease, and took adverse effect persistently through birth to 3 years old. Its adverse effect on weight could be limited. For comparison and assessment of nutritional status of Tibetan children, the effect of altitude on growth should be taken into account.

Distribution and prevalence of colorectal hyperplastic polyps using magnifying pan‐mucosal chromoendoscopy and its relationship with synchronous colorectal cancer: Prospective study

Patients with multiple (hyperplastic polyposis) or large hyperplastic polyps (HPs) predominantly in the right-sided colon, have been reported to have an increased risk of colorectal cancer (CRC). This prospective study was conducted to clarify the distribution of various sized HPs using magnifying pan-mucosal chromoendoscopy and its relationship with synchronous CRC. Patients eligible for this study had an initial total colonoscopy. Indigo carmine dye was sprayed throughout the whole colon and rectum, and diagnoses were made using magnifying colonoscopy. A total of 263 patients were enrolled, and a total of 3060 HPs were observed in 226 (86%) patients. The prevalence of patients with intermediate size (> or = 6 mm) HPs was 8.7% (n = 23) and that of patients with large HPs (> or = 10 mm) was 0.8% (n = 2). Of 3060 HPs, the numbers of diminutive (< 6 mm), intermediate size and large HPs were 3020, 38 and two, respectively, and 5.0%, 42.1% and 100% of these were located in the right-sided colon, respectively. Synchronous CRC was observed in 64 (24%) of 263 patients. Compared to patients without HPs, patients with intermediate size HPs showed a significant increase in odds ratio (OR) for synchronous CRC (OR = 4.9: 95% CI [1.3-18.2]), but there was no significant association between synchronous CRC and patients with diminutive or large HPs. Compared to diminutive HPs, intermediate size and large HPs were predominantly located in the right-side colon. Moreover, intermediate size HPs were significantly correlated with synchronous CRC.

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As Dr. Russo highlights, we found serum sodium, at the date of listing for liver transplantation and at any time while on the wait list, to be strongly associated with wait-list mortality, independent of the MELD score.1 For a serum sodium <126 mEq/L at any point while on the wait list, the lowest excess risk consistent with our results was 2.9 times that of those with higher serum sodium concentrations (hazard ratio of 6.26, 95% CI 2.92-13.4). Serum sodium as a continuous variable also had a significant association with wait-list mortality with 7% increase risk of wait-list mortality for each unit decrease in listing serum sodium. Heuman et al. found that the association with serum sodium and wait-list mortality was limited to patients with MELD <21.2 When we examined the effect of different MELD scores (<16, 16-30, and >30) on strength of association between the serum sodium and wait-list mortality, serum sodium as a continuous variable and as a dichotomous variable (< or ≤126 and > or ≥131), at listing and at any time point, the serum sodium variables were statistically significant across the spectrum of MELD scores. There was no specific cutoff MELD score identifiable that resulted in loss of statistical significance of serum sodium as a predictor of mortality. Logistic regression models provided another way to evaluate the association between hyponatremia and wait-list mortality at 3 and 6 months. In comparison to MELD alone, the addition of serum sodium <126 mEq/L as a dichotomous variable plus MELD led to an increase of the accuracy (c-statistic) of predicting 3- and 6-month wait-list mortality by 3.4% (from 0.883 to 0.917) and 5% (from 0.871 to 0.921), respectively. The estimated incremental improvement with the addition of serum sodium to MELD was sizable considering the shift from CTP to MELD for organ allocation was largely based on a 7% change in the c-statistic (from 0.76 to 0.83) reported by Wiesner et al.3 Russo indicates that the P values comparing ROC curves for MELD alone versus MELD plus serum sodium did not achieve statistical significance. This is true, but the c-statistic represents only one way to assess for significance. The uniform increase in area under the ROC curves (c-statistic) with the additional of serum sodium to the model and the significant increase in odds ratios in the logistic regression models are indicative of a significant independent impact of serum sodium predicting wait-list mortality. Moreover, an equally important measure of the statistical significance of the adding serum sodium to MELD is reflected by the 95% confidence intervals for the bivariate logistic regression models that generate the ROC curves. These results showed that the increase in odds of 3- and 6-month wait-list mortality, controlling for MELD score, was at least 4% and 5%, respectively, for each unit decrease in listing serum sodium concentration. Russo comments that the model by Heumann et al. is more “encouraging,” possibly because the findings of that study are in keeping with his clinical intuition. However, our conclusions that serum sodium adds to MELD in predicting wait-list mortality is strongly supported by the survival analyses and logistic regression models. Clearly, in the future, we look toward confirmation and extension of our findings in larger, multicenter databases. With UNOS currently collecting serum sodium values, we anticipate such studies will be forthcoming in the very near future. Scott Biggins M.D.*, Norah Terrault M.D., M.P.H.*, * University of California San Francisco, San Francisco, CA

Familial Clustering of Type II Diabetes Mellitus (Dm) Diagnosed Under the Age of 40 Yars in Yemen: Is it Early-Onset Type II dm or Maturity-Onset Diabetes of the Young?

Clinical presentation of type II diabetes mellitus (DM) has frequently been observed at an early age in developing countries, probably as a result of genetic, epidemiological and demographic factors. This study aimed to investigate the pattern of familial clustering of type II DM in patients who developed clinical diabetes before the age of 40 years. The study involved family pedigrees, clinical assessments and laboratory investigations of 191 patients with type II DM, and 260 age-matched randomly selected non-diabetic controls. The prevalence of type II DM was found to be statistically higher among parents (P<0.0001), fullsiblings (P<0.0001), half-siblings (P<0.001), uncles (P<0.01) and aunts (P<0.001) of the index patients, as compared to the corresponding relatives of nondiabetic controls. The odds ratio of the family history index (FHI), in association with type II DM in probands who had no family history of diabetes (FHI=0.0), was significantly negative (OR=0.34; 95% CI 0.23, 0.52; P<0.0001). At an FHI level of 0.5-1.0, there was a slight nonsignificant increase in odds ratio for diabetes (OR=1.53; 95% CI 0.95, 2.45; P=0.08). A higher level of FHI (A(3)1.5) was associated with a significant increase in odds ratio for diabetes (OR=3.75; 95% CI 2.13, 6.64; P<0.0001). The age-corrected relative risk of type II DM for the offspring of diabetic parents was found to be progressively increasing from a nonconsanguineous diabetic father (22%) or mother (26.5%), to nonconsanguineous conjugal diabetic parents (27%) and to the offspring of consanguineous single or conjugal diabetic parents (37.5%). On the contrary, the age-corrected relative risk for the offspring of nonconsanguineous and consanguineous nondiabetic parents was characteristically lower (14% for each). Maturityonset diabetes of the young (MODY) was suspected in 10 probands (5%), and early-onset type II DM in the offspring of conjugal diabetic parents in 16 probands (9%). The remaining 165 probands (86%) were unclassified due to lack of specific classification criteria. The considerable familial clustering of type II DM diagnosed under the age of 40 years in this study population reflects the presence of a strong genetic component in its etiology. In addition, the development of early-onset type II DM was more likely associated with a consanguineous and/or conjugal diabetic parents and probably MODY subtype among a substantial number of patients. Epidemiological and demographic factors might have been implicated, especially in those with negative parental diabetic history.

Ischaemic stroke and combined oral contraceptives: results of an international, multicentre, case-control study

Background The association between use of oral contraceptives (OCs) and cerebral infarction was established in studies from northern Europe and the USA during the 1960s and 1970s. Since then, the constituents of hormonal OCs have changed and now contain lower doses of oestrogen and progestagen. Current recommendations restrict OC use to younger women who do not have other risk factors for cardiovascular disease, in this international study we assessed the risk of CC-associated first stroke in women from Europe and other countries throughout Vie world.Methods In this hospital-based, case-control study, we assessed the risk of ischaemic stroke in association with current use of combined OCs in 697 cases, aged 20-44 years, and 1962 age-matched hospital controls in 21 centres in Africa, Asia, Europe, and Latin America. The diagnosis of ischaemic stroke was almost exclusively based on computed tomography (CT), magnetic resonance imaging (MRI), or cerebral angiography carried out within 3 weeks of the clinical event. Ail cases and controls were interviewed while in hospital with the same questionnaire, which included information on medical and personal history, details of lifetime contraceptive use, and blood-pressure measurements before the most recent episode of OC use.Findings The overall odds ratio of ischaemic stroke was 2 . 99 (95% CI 1 . 65-5 . 40) in Europe and 2 . 93 (2 . 15-4 . 00) in the non-European (developing) countries, Odds ratios were lower in younger women and those who did not smoke, and less than 2 in women who did not have hypertension and who reported that their blood pressure had been checked before the current episode of OC use. By contrast, among current OC users with a history of hypertension, the odds ratio was 10 . 7 (2 . 04-56 . 6) in Europe and 14 . 5 (5 . 36-39 . 0) in the developing countries. In Europe, the odds ratio associated with current use of low-dose OCs (<50 mu g oestrogen) was 1 . 53 (0 . 71-3 . 31), whereas for higher-dose preparations it was 5 . 30 (2 . 56-11 . 0). In the developing countries, there was no significant difference between overall estimates of risk associated with use of low-dose or higher-dose OCs (3 . 26 [2 . 19-4 . 86] vs 2 . 71 [1 . 75-4 . 19]), This differential effect of dose in Europe and the developing countries is likely to be due to different levels of other risk factors among users of low-dose and higher-dose OCs in the two groups of countries. There was no significant increase in odds ratios with increasing duration of OC use among current users; odds ratios were not significantly increased after cessation of OC use.Interpretation The incidence of ischaemic stroke is low in women of reproductive age and any risk attributable to OC use is small. The risk can be further reduced if users are younger than 35 years, do not smoke, do not have a history of hypertension, and have blood pressure measured before the start of QC use. In such women OC preparations with low oestrogen doses may be associated with even lower risk.

Liver Cirrhosis in Relation to Hepatitis B Virus, Blood Transfusion, and Alcohol Consumption

A hospital based case-control study was carried out to assess the association of Hepatitis B surface antigen (HBsAg), past history of blood transfusion, and alcohol consumption with the development of liver cirrhosis between April 1986 and June 1989. During the study period, 215 liver cirrhosis outpatients (125 males and 90 females) were identified in Kurume University Hospital. Each case was matched with one control (1 : 1 matching) on age, sex, and residence who was the patient admitted to either of two affiliated general hospital in Kurume City. Odds ratios of 4.25 (95% CI : 1.18-15.27) for male and 10.18 (95% Cl : 1.35-76.64) for female after controlling for other factors indicated that HBsAg positive seemed to have a significant contribution to the development of liver cirrhosis for both sexes. Cases had a tendency to have a higher proportion of past history of blood transfusion than controls for both sexes. In particular, significant increase in odds ratio was noticed with increasing years elapsed from the first blood transfusion for female (OR=0.97, 7.80, 14.61 for 0-9 yrs, 10-19 yrs, and 20 yrs+, respectively). No significant association was detected for alcohol drinking. J Epidemiol, 1993; 3 : 121-127.