Small Independent Effect Research Articles

Has a fast treatment transition from surgical to endovascular operations improved the survival of aneurysmal subarachnoid hemorrhage?

BackgroundSeveral studies have attributed decreasing case fatality rates (CFRs) of aneurysmal subarachnoid hemorrhage (aSAH) to the gradually increasing use of endovascular treatment without considering improvements in other outcome-affecting factors. To assess the independent effect of a treatment modality on CFRs, we investigated CFR changes in a high-volume center rapidly transitioning from surgical to endovascular operations as the first-line treatment for all aSAH patients except those with middle cerebral artery (MCA) aneurysms.MethodsWe identified all surgically/endovascularly treated aSAH patients in Helsinki University Hospital (HUH) during 2012–2017. As the treatment shift occurred in 2015, we defined two treatment eras: surgical (2012–2014) and endovascular (2015–2017). We compared time-dependent changes in 1-year CFRs between non-MCA and MCA patients using a Poisson regression model. To analyze consistency in operation rates, we also identified sudden-death and conservatively treated aSAHs in the HUH catchment area via two externally validated registers.ResultsOf all 665 hospitalized aSAH cases in the HUH catchment area, 557 (84%) received operative treatment; 367 (66%) underwent surgical and 190 (34%) endovascular operations. Between the treatment eras, endovascular treatment for non-MCA cases increased from 21 to 79%, whereas 99% of the MCA cases were treated surgically during the whole study-period. Among the operatively treated patients, the 1-year CFRs decreased similarly in patients with non-MCA (42%; from 14 to 8%; adjusted risk ratio (aRR) = 0.66 (95% CI 0.37–1.19)) and MCA aneurysms (42%; from 15 to 9%; aRR = 0.66 (0.16–1.60)). The proportion of operatively treated patients, their clinical condition on admission, and amount of bleeding on the first CT-scan remained unchanged over time.ConclusionsWe found similar CFR decreases in aSAH groups with and without undergoing a fast transition from surgery to endovascular operations, providing real-world evidence on the small independent effect of endovascular treatment on the decreasing CFRs in high-volume centers.

Experience of childhood adversity and maladaptive personality traits: Magnitude and specificity of the association in a clinical sample of adult outpatients.

The relationship between the experience of childhood adversity (CA) and the development of personality disorders (PDs) has been well documented. The dimensional PD alternative model (AMPD) has been introduced in nosography in 2013, and so far it is been used for CA research mostly on non-clinical samples. We included in our study 137 psychiatric outpatients who were screened for history of maternal antipathy (MA), paternal antipathy (PA), maternal neglect (MN), paternal neglect (PN), maternal physical abuse (MPA), paternal physical abuse (PPA) and sexual abuse (SA) using the Childhood Experience of Care and Abuse Questionnaire (CECA.Q) and underwent personality assessment using the Personality Inventory for DSM-5. Applying CECA.Q cut-off scores, rates of participants reporting CA were as follows: 14.6% MA; 13.9% PA; 13.1% MN; 10.2% PN; 25.5% MPA; 24.8% PPA; and 22.6% SA. In multivariate regression models, accounting for age, gender and exposure to other types of CA, exposure to MA was associated with increased negative affect, detachment, disinhibition and psychoticism; exposure to PA with increased disinhibition; and exposure to SA with increased antagonism, disinhibition and psychoticism. All effect sizes were small, except for a moderate effect of SA on psychoticism. Results pointed to a small but specific and independent effect of MA on most maladaptive personality traits; a possible specific role of the paternal figure for externalizing traits; and a moderate effect of SA on psychoticism. The cumulative exposure to multiple CAs significantly predicted all maladaptive personality traits, with much larger effect sizes compared to those calculated for single CAs. CA explained the higher proportion of variance for antagonism and psychoticism. In conclusion, exposure to specific forms of childhood abuse was associated with specific maladaptive traits in psychiatric outpatients, even if the effect of cumulative multiple CAs was larger.

Early childhood inequalities: the rocky path from observation to action

Abstract The article on early childhood inequalities by Cattan and colleagues identifies a broad range of socio- and geo-demographic correlates of children’s cognitive and social–emotional development in early life through analyses of three UK population cohort studies. The findings suggest that early life inequalities are driven by a complex nexus of multiple, often inter-correlated factors that each have a small independent effect size. In this commentary, I discuss three key implications for research and practice that follow from the work of Cattan et al.: (1) the urgent need for a theoretical framework to identify and test the mechanisms that drive early life inequalities; (2) the persistent obstacles to ameliorating early childhood inequality; and (3) the immense value of population cohort studies for understanding socio-historical trends and developing evidence-based policies.

Interacting adult-child relationships and school adjustment: Findings from growing up in Ireland

Although children's relationships with their parents and teachers contribute to their school adjustment and achievement, few studies have examined interactions between these relationships, particularly for father-child relationships. Using the Growing Up in Ireland birth cohort (N = 7507, 50.3% male), we examined child-adult relationship quality – rated by parents at age 3 and by teachers at age 5 – as predictors of teacher-rated behavioural adjustment and academic achievement at age 9 (indexed by self-reported academic self-concepts and performance on formal reading assessments). Controlling for prior levels of problem behaviours, verbal ability, and family SES, our results indicated that children's relationships with parents and teachers showed small and comparable independent effects on school adjustment and achievement. For mothers and teachers, moderation analyses showed a cumulative risk pattern for conflictual relationships and a compensatory pattern for close relationships. Children are likely to benefit from improving closeness and reducing conflict in adult-child relationships as well as interventions that involve mothers, fathers, and teachers.

Multivariate analysis of independent roles of socioeconomic status, occupational physical activity, reproductive factors, and postmenopausal hormonal therapy in risk of breast cancer

PurposeThis case–control study assesses the independent roles of reproductive history, postmenopausal hormonal therapy (HT), socioeconomic status (SES), and occupational physical activity on the risk of breast cancer (BC).MethodsOdds ratios (OR) were estimated from conditional logistic multivariate regression model in a data set of 19,253 Finnish women diagnosed with BC between 1994 and 2013 and 96,265 age-matched population controls.ResultsBoth pre- and postmenopausal white-collar workers had significantly increased risk of ductal and lobular BC as compared to manual workers. Moderate occupational physical activity reduced risk of lobular BC by 14%. There was a transient increase in the risk of BC observed after each birth followed by a protective effect starting some years after the delivery. As the number of children increased, the short-term excess risk was lower and protective effect was observed earlier. Continuous estrogen-progestin therapy (EPT) significantly increased the risk of both ductal and lobular BC and the magnitude of risk was directly proportional to duration of use (OR for 5+ years of use 2.26, 95% confidence interval 2.12–2.42). Monthly EPT for 5+ years increased the risk (OR 1.32, 95% CI 1.20–1.45). Users of estradiol plus levonorgestrel intrauterine system devices showed ORs of 1.56 (95% CI 1.45–1.69) and 2.18 (95% CI 1.81–2.64) for ductal and lobular BC, respectively.ConclusionThis study concludes that pregnancy has a dual effect on BC risk, with a transient increase in risk followed by a long-term protective effect. The SES and HT have a large effect on BC risk while occupational physical activity has only a small independent effect.

Recommendations for a More Organized and Effective Approach to the Early Detection of Pancreatic Cancer From the PRECEDE (Pancreatic Cancer Early Detection) Consortium

Recommendations for a More Organized and Effective Approach to the Early Detection of Pancreatic Cancer From the PRECEDE (Pancreatic Cancer Early Detection) Consortium

The Influence of Mental Health Literacy, Migration, and Education on the Duration of Untreated Psychosis.

Background: Duration of untreated psychosis (DUP) is associated with outcome in psychotic disorders and influenced by contextual factors such as immigration. Here we aimed to investigate the effect of mental health literacy (MHL) on duration of untreated psychosis considering the influence of migration and education.Methods: A total of 269 participants who received their first adequate medical treatment for a psychotic disorder within the current or past year were included to the Thematically Organized Psychosis study in Oslo, Norway. Sociodemographic and clinical information was collected through systematic interviews. MHL was measured as “recognition of psychotic symptoms” and assessed by “The Attitudes and Beliefs about Mental Health Problems” schizophrenia version. Influence of education, migration and MHL on DUP was analyzed with hierarchical block-wise multiple regression analysis.Results: Recognition of psychotic symptoms explained a small but unique variance (2.3%) in DUP after the effects of other important predictors were controlled for. Longer DUP was also associated with less education, lower premorbid social, and academic functioning, a diagnosis within schizophrenia spectrum disorder, and earlier age of onset. The model explained 26% of variance in DUP. Migration after the age of six and length of education were associated with MHL but did not have a significant interaction with MHL in predicting DUP.Conclusions: MHL, measured as recognition of psychotic symptoms, has a small but significant independent effect on DUP. The effect of MHL was larger than years of education and migration history, and did not interact with either, in predicting DUP. This suggests that MHL is an independent factor in prevention strategies for early psychosis.

Residential exposure to traffic-borne pollution as a risk factor for acute cardiocerebrovascular events: a population-based retrospective cohort study in a highly urbanized area.

BackgroundLong-term exposure to traffic-borne noise and air pollution has been variably associated with incidence of acute vascular events, namely acute myocardial infarction, ischaemic stroke and haemorrhagic stroke. This study aims at exploring this association within a highly urbanized city.MethodsThis is a population-based retrospective dynamic cohort study including all residents aged ≥ 35 years in the municipality of Milan over the years 2011–18 (1 087 110 inhabitants). Residential exposure to road traffic noise (day-evening-night levels) and nitrogen dioxide was estimated using a noise predictive model and a land use regression model, respectively. Cox proportional hazards regression analyses were performed to assess the incidence of acute vascular events and specific outcomes in single-exposure and two-exposure models including adjustment for sociodemographic confounders, fine particulate matter and surrounding greenness.ResultsA total of 27 282 subjects (2.5%) had an acute vascular event. Models using nitrogen dioxide produced inconsistent results. The strongest effect was observed for noise, with an optimal cut-off for dichotomization set at 70 dBA (hazard ratio 1.025, 95% confidence interval 1.000–1.050). This association was observed specifically for ischaemic and haemorrhagic stroke. When stratifying by age group and sex, a remarkable effect was found for haemorrhagic stroke in men aged <60 years (hazard ratio 1.439, 95% confidence interval 1.156–1.792).ConclusionsLiving by roads with a day-evening-night noise level above 70 dBA exerts a small but tangible independent effect on the risks of both ischaemic and haemorrhagic stroke. It is urgent to propose mitigation measures against pollution and noise originating from vehicular traffic in order to reduce their impact, especially in the population younger than 60 years.

Assessment of Obstructive Sleep Apnea in Association with Severity of COVID-19: A Prospective Observational Study.

IntroductionOSA has been postulated to be associated with mortality in COVID-19, but studies are lacking thereof. This study was done to estimate the prevalence of OSA in patients with COVID-19 using various screening questionnaires and to assess effect of OSA on outcome of disease.MethodologyIn this prospective observational study, consecutive patients with RT-PCR confirmed COVID-19 were screened for OSA by different questionnaires (STOPBANG, Berlin Questionnaire, NoSAS, and Epworth Scale). Association between OSA, outcome (mortality) and requirement for respiratory support was assessed.ResultsIn study of 213 patients; screening questionnaires for OSA [STOPBANG, Berlin Questionnaire (BQ), NoSAS] were more likely to be positive in patients who died compared to patients who survived. On binary logistic regression analysis, age ≥ 55 and STOPBANG score ≥ 5 were found to have small positive but independent effect on mortality even after adjusting for other variables. Proportion of patients who were classified as high risk for OSA by various OSA screening tools significantly increased with increasing respiratory support (p < 0.001 for STOPBANG, BQ, ESS and p = 0.004 for NoSAS).ConclusionThis is one of the first prospective studies of sequentially hospitalized patients with confirmed COVID-19 status who were screened for possible OSA could be an independent risk factor for poor outcome in patients with COVID-19.

BMI in early childhood

There is concern about obesity in childhood throughout the world. There has been a focus on changes in weight and BMI in early childhood as a predictor of later obesity. Many national data sets, such as NHANES in the US, are cross-sectional. These data sources leave open the question of longitudinal trends. In this volume of The Journal, Jabakhanji et al use data from the nationally representative, longitudinal Growing Up in Ireland study to evaluate height, weight, and BMI at 9 months, 3 years, and 5 years of age to evaluate change over time. They found that differences at birth and infancy are most strongly associated with BMI at all ages. However, other factors, such as ethnicity, caregiver weight status, breastfeeding, sex, sleep, and socio-economic status also have small independent effects on weight status. Some of these risk factors are potentially modifiable, but we know that changing such things as caregiver weight status or breastfeeding can be quite difficult. Article page 106 ▶ Body Mass Index Changes in Early ChildhoodThe Journal of PediatricsVol. 202PreviewTo longitudinally investigate body mass index (BMI) in young children in Ireland and identify factors and critical time points associated with changes in BMI. Full-Text PDF

Adult attachment's unique contribution in the prediction of postpartum depressive symptoms, beyond personality traits

BackgroundPersonality traits such as neuroticism can help identify pregnant women at risk of postpartum depressive symptoms (PPDS). However, it is unclear whether attachment style could have an additional contribution to this risk elevation. This study aimed to examine the overlap of adult attachment insecurity and neuroticism/trait anxiety as PPDS predictors, taking into account baseline depressive symptoms. MethodsA Swedish population-based sample of pregnant women reported on adult attachment and either neuroticism (n = 1063) or trait anxiety (n = 555). Depressive symptoms were assessed at baseline, and at six weeks and six months postpartum. Correlations between attachment and neuroticism/trait anxiety were calculated. Generalized linear models of PPDS tested the effect of attachment anxiety and avoidance, adjusting for neuroticism/trait anxiety and baseline depression. Logistic regression models with combined high attachment anxiety and neuroticism/trait anxiety visualized their value as risk factors beyond antenatal depression. ResultsAttachment and neuroticism/trait anxiety were highly correlated (r = .55–.77). Attachment anxiety exerted a partially independent effect on PPDS at six weeks (p < .05) and at six months (p < .05) adjusting for neuroticism. Among antenatally non-depressed, combined high attachment anxiety and high neuroticism or trait anxiety was predictive of PPDS at both assessment points. LimitationsLow acceptance rate, exclusive use of self-reports. ConclusionsBeyond personality, attachment anxiety had a small independent effect on the risk of PPDS. Combining items of adult attachment and neuroticism/trait anxiety could prove useful in antenatal screening for high risk of PPDS.

Disentangling the relationships between staff nurses’ workplace empowerment and job satisfaction

The primary aim of this study was to examine the relationships between structural empowerment, psychological empowerment and job satisfaction among staff nurses, after controlling for their leaders' use of empowering behaviours. Nurses' job satisfaction is a critical factor in health-care organisations because of its association with nurse turnover and quality of patient care. Nurses continue to report high levels of job dissatisfaction. Cross-sectional data for 1007 Canadian staff nurses were analysed using hierarchical multiple regression. Structural empowerment was the strongest independent predictor of job satisfaction, followed by leader empowering behaviours and psychological empowerment. After accounting for the effects of structural empowerment and leader empowering behaviours, the four dimensions of psychological empowerment showed only small independent effects on job satisfaction. Psychological empowerment did not mediate the effects of structural empowerment on job satisfaction. Nurses' job satisfaction is most influenced by their access to organisational empowerment structures. Leader empowering behaviours, structural empowerment, and psychological empowerment, operating together, enhance nurses' job satisfaction. Nurse leaders should use a variety of empowerment strategies that are important to nurses' job satisfaction and potentially to the quality of patient care and nurse turnover.

Statistical analysis of tracking and parametric estimation errors in a 2-link robot based on Lyapunov function

A convergence analysis of the angular position and velocity tracking errors and parametric estimation errors for a 2-link robot dynamics in the absence of noise exist in the literature (Slotine and Li in Applied nonlinear control. Prentice- Hall Inc, Englewood Cliffs, NJ, 1991). In this paper, we consider the effect of noise on the robot dynamics as well as on the parameter update equation. Noise in the robot dynamics arises due to errors in reading \(q,\dot{q}\), i.e., the angular positions and velocities of the robot link that are used for calculating the errors e, \(\dot{e}\) used to generate the feedback torque via the PD controller. Noise is chosen as Gaussian because it is produced as the cumulative effect of several small independent random effects like electrons moving in the motor wire and dust friction, and we know from the central limit theorem that the sum of a large number of small independent effects has a Gaussian distribution. Noise in the parametric update equation arises due to finite register effects in the digital computer. Both of these noises are modeled as white Gaussian, and the robot and parametric update dynamics have thus been modeled as nonlinear coupled stochastic differential equations. Using linearization of this coupled SDE system around the non-random components of the trajectory estimation error and parametric estimation errors, we first derive stochastic integral expressions for the random components in these errors. We then evaluate the average rate of change of the Lyapunov energy function using Ito calculus and obtain conditions on the noise amplitude so that the limiting value of this average rate of change is negative, guaranteeing asymptotic average stability of the system and parametric estimation algorithm. One of the novelties of this work is the new algorithm for parameter estimation which enables us to improve on the algorithm convergence rate as compared to previous work (Slotine and Li 1991). Finally, our stochastic algorithm is verified by performing hardware experiments with the actual PHANToM Omni robot.

Does residence time affect responses of alien species richness to environmental and spatial processes?

One of the most robust emerging generalisations in invasion biology is that the probability of invasion increases with the time since introduction (residence time). We analysed the spatial distribution of alien vascular plant species in a region of north-eastern Italy to understand the influence of residence time on patterns of alien species richness. Neophytes were grouped according to three periods of arrival in the study region (1500–1800, 1800–1900, and > 1900). We applied multiple regression (spatial and nonspatial) with hierarchical partitioning to determine the influence of climate and human pressure on species richness within the groups. We also applied variation partitioning to evaluate the relative importance of environmental and spatial processes. Temperature mainly influenced groups with species having a longer residence time, while human pressure influenced the more recently introduced species, although its influence remained significant in all groups. Partial regression analyses showed that most of the variation explained by the models is attributable to spatially structured environmental variation, while environment and space had small independent effects. However, effects independent of environment decreased, and spatially independent effects increased, from older to the more recent neophytes. Our data illustrate that the distribution of alien species richness for species that arrived recently is related to propagule pressure, availability of novel niches created by human activity, and neutral-based (dispersal limitation) processes, while climate filtering plays a key role in the distribution of species that arrived earlier. This study highlights the importance of residence time, spatial structure, and environmental conditions in the patterns of alien species richness and for a better understanding of its geographical variation.

Evaluating the Effect of Clinical Decision Units on Patient Flow in Seven Canadian Emergency Departments

To evaluate the effect of emergency department (ED) clinical decision units (CDUs) on overall ED patient flow in a pilot project funded in 2008 by the Ontario Ministry of Health and Long-Term Care (MOHLTC). A retrospective analysis of unscheduled ED visits at seven CDU pilot and nine control sites was conducted using administrative data. The authors examined trends in CDU utilization and compared outcomes between pilot-CDU and control sites 1 year prior to implementation, with the first 18 months of CDU operation. Sites that were unsuccessful in their applications for CDU program funding served as controls. Outcomes included ED length of stay (LOS), admission rates, and ED revisit rates. At CDU sites, roughly 4% of ED patients were admitted to CDUs. The presence of a pilot-CDU was independently associated with a small reduction in ED LOS for all low-acuity patients (-0.14 hour, 95% confidence interval [CI]=-0.22 to -0.07) and nonadmitted patients (-0.11 hour, 95% CI=-0.16 to -0.07). A small independent effect on absolute hospital admission rate for all high-acuity patients (-0.8%, 95% CI=-1.5% to -0.03%) and moderate-acuity patients (-0.6%, 95% CI=-1.1% to -0.2%) was also observed. Pilot-CDUs were not associated with changes in ED revisit rates. With only 4% of ED patients admitted to CDUs, the potential for efficiency gains in these EDs was limited. Nonetheless, these findings suggest small improvements in the operation of the ED through CDU implementation. Although marginal, the observed effects of CDU operation were in the desired direction of reduced ED LOS, reduced admission rate, and no increase in ED revisit rate.

Mo1853 Prostaglandin E2 Mediates Acid-Induced Esophageal Sensation in Healthy Volunteers

BACKGROUND Visceral hypersensitivity is frequent in IBS. Vandenberghe et al (Gut 2005) hypothesized that isolated sensitization of pain-specific (nociceptive) pathways would only increase the intensity of perceived painful sensations in hypersensitive patients, whereas sensitization of multimodal pathways would increase the perceived intensities of both painful and non-painful sensations. In hypersensitive patients with functional dyspepsia and IBS indirect evidence has been found favouring the latter mechanism. However, potentially important confounding factors such as somatization, anxiety and depression were not considered in previous studies. AIM To explore the impact of anxiety, depression and somatization in the analysis of sensitization of multimodal versus nociceptive afferent pathways in IBS patients with hypersensitivity. METHOD An ascending method of limits rectal distension protocol was performed in 138 patients with IBS according to Rome II criteria. After each distension the intensity of unpleasantness was reported on a visual analogue scale (VAS). Sensory thresholds for first sensation, urge to defecate, discomfort and pain were determined. The mean pain threshold -2 SD in healthy controls defined hypersensitivity in IBS. The anxiety, depression and somatization subscales of the SCL-90R were completed by all patients. RESULTS Sixty IBS patients (43.5%) were hypersensitive to rectal distension. There were no significant differences in sex, anxiety or depression between hyperand normosensitive patients, but hypersensitive patients were younger and reported higher levels of somatization (Table 1). The hypersensitive patients had lower sensory thresholds (first sensation 7±1 vs. 10±4 mmHg, urge to defecate 11±4 vs. 16±7 mmHg, discomfort 16±5 vs. 27±10 mmHg and pain 23±5 vs. 43±10 mmHg, all p<0.0001). The unpleasantness ratings at each distention step were higher in hypersensitive vs. normosensitive patients (Table 2). Somatization, depression and anxiety scores were then entered as covariates in separate repeated measures ANCOVAs, and the difference between hypersensitive and normosensitive patients in VAS ratings remained significant in all three models (partial eta squared (ηp2) 0.25-0.27; p<0.0001). Small independent effects on the unpleasantness ratings were noted for anxiety (ηp2 0.086; p=0.001) and depression (ηp2 0.068; p=0.004), but not for somatization (ηp2 0.025; p=0.09). CONCLUSIONS This study supports previous findings that multimodal afferent pathways and not only pain-specific pathways are implicated in the generation of visceral hypersensitivity in IBS. Somatization, anxiety or depression do not seem to explain the observed differences in perceived unpleasantness to non-painful rectal distensions in hypersensitive versus normosensitive IBS patients; the effect of anxiety and depression was independent of sensitivity. Descriptives

Framework for interpretation of genetic variations in pancreatitis patients

Chronic pancreatitis (CP) is defined by irreversible damage to the pancreas as a result of inflammation-driven pancreatic tissue destruction and fibrosis occurring over many years. The disorder is complex, with multiple etiologies leading to the same tissue pathology, and unpredictable clinical courses with variable pain, exocrine and endocrine organ dysfunction, and cancer. Underlying genetic variants are central CP susceptibility and progression. Three genes, with Mendelian genetic biology (PRSS1, CFTR, and SPINK1) have been recognized for over a decade, and little progress has been made since then. Furthermore, application of high-throughput genetic techniques, including genome-wide association studies (GWAS) and next generation sequencing (NGS) will provide a large volume of new genetic variants that are associated with CP, but with small independent effect that are impossible to apply in the clinic. The problem of interpretation is using the old framework of the germ theory of disease to understand complex genetic disorders. To understand these variants and translate them into clinically useful information requires a new framework based on modeling and simulation of physiological processes with or without genetic, metabolic and environmental variables considered at the cellular and organ levels, with integration of the immune system, nervous system, tissue injury and repair system, and DNA repair system. The North American Pancreatitis Study 2 (NAPS2) study was designed to capture this type of date and construct a time line to understand and later predict rates of disease progression from the initial symptom to end-stage disease. This effort is needed to target the etiology of pancreatic dysfunction beginning at the first signs of disease and thereby prevent the development of irreversible damage and the complications of CP. The need for a new framework and the rational for implementing it into clinical practice are described.

Trends in Hospitalization for Diabetic Ketoacidosis in Diabetic Patients in Taiwan: Analysis of National Claims Data, 1997–2005

Diabetic ketoacidosis (DKA) is a fatal complication of diabetes, and is strongly related to the quality of diabetes care. This study aimed to establish recent secular trends of incidence density (ID) of DKA in patients with diabetes in Taiwan and to explore the effects of age and sex on the risk of a DKA emergency. Using the National Health Insurance claims data, we identified annual diabetic cohorts (around 650,000 diabetic patients annually) from 1997 to 2005, and searched for possible admissions due to DKA emergencies. We performed log-linear regression analysis to assess the trend in ID of DKA and to assess the independent effects of age and sex on the risk of DKA. Although the annual ID of DKA showed a slight but significant declining trend over the study period, from 6/1000 to 5/1000 person-years, the age/sex-specific analysis indicated that female patients aged ≤ 34 years showed a significantly increasing trend. Multivariate analysis revealed that calendar year and sex had significant but small independent effects on risk of DKA admission. In contrast, age was strongly associated with risk of DKA emergency. Compared with patients aged > 65 years, notably high adjusted rate ratios (ARRs) of DKA were observed in patients aged <15 years (ARR = 48.84) and 15-34 years (ARR =15.21). Although the overall ID of DKA linearly decreased between 1997 and 2005, significant rising trends were still observed in female diabetic patients aged < 35 years. More aggressive diabetic care programs aimed at young female patients should be considered to reduce this emergency and possibly fatal diabetic complications.

Developmental and Genetic Outcomes in Children Conceived Through Assisted Reproductive Technologies

After completing this article, readers should be able to: 1. Describe the outcomes of assisted reproductive technologies (ART) for singleton, twin, and other multiple births. 2. Describe the role of fertility in adverse outcomes seen with ART births. 3. Review the association of birth defects with ART. 4. Delineate the association of disease of genomic imprinting with ART. 5. Describe the relationship between ART and the subsequent incidence of neurodevelopmental sequelae. In the 1977 ruling “Carey v. Population Services International,” the United States Supreme Court ruled that the decision to bear children is constitutionally protected. (1) Significant interest already had been shown in the development and improvements of in vitro fertilization (IVF) for infertile couples. The first human pregnancy and human birth using IVF were reported by Steptoe and Edwards in the United Kingdom. (2) Their work resulted in the first baby born via reproductive technologies, Louise Brown, born on July 25, 1978, at Oldham General Hospital in Oldham, United Kingdom. (3) She was born via a planned cesarean section, and her birthweight was 2.61 kg. The first successful viable IVF in the United States was performed by Jones and Seager-Jones in 1981 in Norfolk, Virginia. (4) Assisted reproductive technologies (ART) have seen a recent surge in popularity. The Centers for Disease Control and Prevention (CDC) reported that 122,872 cycles of ART were initiated in 2003, resulting in the delivery of 48,756 neonates, (5) accounting for approximately 1% of all neonates delivered in the United States. The percentage is higher in many countries, including Denmark, where it is estimated that 5% of all deliveries are with the assistance of ART. (6) Couples pursue ART for myriad reasons, including tubal transport factors, ovulatory dysfunction, uterine factors, endometriosis, male- and female-specific factors, and when a cause of infertility is unknown. (5) It would be very …

The weighty issue of Australian television food advertising and childhood obesity

The aim of this paper is to provide an accessible overview of research literature on the link between childhood obesity and food advertising on Australian television. A systematic review of current medical, public health, psychological and marketing research literature surrounding the topics of childhood obesity and television food advertising, with emphasis on Australian data. Childhood obesity rates have tripled since 1985, mirrored by increases in consumption of energy-dense foods. Energy-dense food advertising is ubiquitous in children's television programming, but children's ability to perceive the commercial intent of advertisements only emerges gradually as a function of age. Until such time, children are trusting, and hence vulnerable, to food advertising, influencing their desires and purchase requests to parents. There is robust evidence to suggest that television viewing and childhood obesity are related. However, the direction of causation and specific contribution of food advertising remains equivocal. Moreover, the link between television and childhood obesity is surprisingly weak, with only a small independent effect size (approximately 1%). Television food advertising seems to have only a very small, indirect link to childhood obesity.