Stratified Age Groups Research Articles

Anaemia and associated factors in homeless children in the Paris region: the ENFAMS survey.

Food insecurity is a major concern in homeless population, however nutritional consequences remain poorly documented, especially for children. The objective of this study was to assess the prevalence of anaemia and to investigate the relation between both food insecurity and dietary intake to moderate-to-severe anaemia (MSA) in homeless sheltered children. In 2013, a cross-sectional survey was conducted on a random sample of 801 sheltered homeless families in the Paris region. Haemoglobin concentration was measured in 630 mother/child dyads and questionnaires administrated to mothers collected socio-demographic, socioeconomic, health and dietary data. Factors associated with MSA were analysed in two stratified child age groups; 0.5-5 and 6-12 years old. Anaemia was detected in 39.9% of the children and 50.6% of the mothers, and MSA in 22.3% and 25.6%, respectively. In both age groups, MSA was positively associated with maternal MSA. In the 0.5-5 years group, it was also positively associated with child food insecurity, no cooking facilities and household monthly income. In the 6-12 years group, it was positively associated with household food insecurity and children's age. A higher food insecurity score was associated with greater prevalence of moderate-to-severe anaemia in children. Considering the high prevalence of anaemia among homeless mothers and their children, these findings highlight the need for reducing food insecurity in shelters so as to prevent anaemia in this vulnerable population.

Non-Apnea Sleep Disorder Increases the Risk of Subsequent Female Infertility-A Nationwide Population-Based Cohort Study.

Non-apnea sleep disorder (NASD) increases the risk of hypertension, type 2 diabetes mellitus, chronic kidney disease, cardiovascular disease, and stroke. However, the risk and the time interval of NASD to female infertility has not been thoroughly understood. Our study aimed to determine whether NASD increases the subsequent risk of female infertility. This study utilized outpatient and inpatient data from the Longitudinal Health Insurance Database between 2000 and 2010 in Taiwan. We enrolled 50,154 females aged 20 to 45 years old and diagnosed with NASD as outpatients ≥2 times or hospitalized, 16,718 of them who matched our criteria were assigned to the study group. For each NASD patient, two comparison patients were frequency matched by age (each 5-year span), index date, and comorbidities as the control cohort with a total of 33,436 patients. We conducted Cox proportional hazard regression analysis to estimate the effects of NASD on female infertility. The NASD cohort had an adjusted hazard ratio (HR) of subsequent female infertility of 3.718-fold higher than that of the cohort without sleep disorders. In the stratified age group, NASD had the highest impact on 26-30 years old, with an adjusted HR of 5.146 followed by 31-35 years old (adjusted HR = 3.356). The Kaplan-Meier analysis also showed that in the sixth year of follow-up, the incidence of female infertility was higher in the NASD cohort than in the general population cohort till the end of the follow-up. Our study demonstrates that NASD patients are at a higher risk of developing female infertility.

The Relationship between Age, Common Bile Duct Diameter and Diagnostic Probability in Suspected Choledocholithiasis

Background: Aging has been associated with increasing common bile duct (CBD) diameter and reported as independently predictive of the likelihood of choledocolithiasis. These associations are controversial with uncertain diagnostic utility in patients presenting with symptomatic disease. The current study examined the relationship between age, CBD size, and the diagnostic probability of choledocolithiasis. Methods: Symptomatic patients undergoing evaluation for suspected choledocolithiasis from January 2008 to February 2011 were reviewed. In the cohort without choledocolithiasis, the relationship between aging and CBD size was examined as a continuous variable and by comparing mean CBD size across stratified age groups. Multivariate analysis examined the relationship between increasing age and diagnostic probability of choledocolithiasis in all patients. Results: Choledocolithasis was diagnosed by MR cholangiopancreatography (MRCP) or endoscopic retrograde (ERCP) in 496 of 1,000 patients reviewed. Mean CBD was 6.0 mm (±2.8 mm) in the 504 of 1,000 patients without choledocolithiasis on ERCP/MRCP. Increasing age had no correlation with CBD size as a continuous variable (r² = 0.011, p = 0.811). No difference occurred across age groups (Kruskal-Wallis, p = 0.157). Age had no association with diagnostic likelihood of choledocolithiasis (AOR [95% CI] 0.99 [0.98-1.01], adjusted-p = 0.335). Conclusion: In a large population undergoing investigation for biliary disease, increasing age was neither associated with increasing CBD diameter nor predictive of the likelihood of choledocolithiasis.

Prognosis of prostate cancer with initial prostate-specific antigen >1,000 ng/mL at diagnosis.

PurposeProstate cancer patients with surprisingly high prostate-specific antigen (PSA) are encountered clinically. However, descriptions of this group of patients are extremely rare in the published literature. This study reports treatment outcome and long-term prognosis for this group of patients.Patients and methodsBetween January 2007 and December 2012, 2,064 patients with PCa diagnosed at a tertiary medical center were retrospectively reviewed. A total of 90 PCa cases were identified with initial PSA (iPSA) >1,000 ng/mL at diagnosis. A retrospective study was conducted in this cohort, with comparison among stratified patient age groups, PSA, treatment options, and overall survival.ResultsThe mean PSA at PCa diagnosis in this cohort was 3,323 ng/mL (1,003–23,126, median: 2,050 ng/mL). Most patients were in the age group 65–79 years (55/90, 61%). Males older than 80 years had a poor prognosis (P<0.001). Forty-six patients (51%) underwent orchiectomy with a median follow-up period of 16.2 (1.3–72.7) months, compared to 44 patients treated with medical castration and a median follow-up of 9.1 (0.3–70.5) months. Kaplan–Meier analysis revealed survival benefit from treatment with orchiectomy (P<0.001). PSA reduction >90% of iPSA following primary androgen deprivation therapy (reaching true nadir) could be a predictor of longer survival (P<0.001). Cox regression revealed the hazard ratio (HR) of variables were age (HR: 4.57, 95% confidence interval [CI]: 1.45–14.37, P=0.009), reaching true nadir (HR: 0.12, 95% CI: 0.03–0.58, P=0.008), and the treatment option with orchiectomy (HR: 0.22, 95% CI: 0.65–0.76, P=0.016).ConclusionAge ≥80 years indicated poor overall survival in PCa patients with iPSA >1,000 ng/mL. Reaching a true nadir of PSA following primary androgen deprivation therapy could be a predictor of longer survival. Bilateral orchiectomy is recommended for this group of patients.

Reducing Mental Health Emergency Services for Children Served Through California's Full Service Partnerships.

Children's Full Service Partnerships (FSP), created through California's Mental Health Services Act of 2004 are comprehensive treatment and support programs incorporating a wraparound model designed to serve undertreated families with children who have a serious emotional disturbance and are at risk for suicide, violence, residential instability, criminal justice involvement, or involuntary hospitalization. This study investigated whether FSP programs resulted in reduced crisis-related mental health emergency services (MHES) for the children they served. Using a statewide data set for 464,880 children and youth ages 11to <18 served by California's county mental health systems between 2004 and 2012, the study compared age-related trajectories of MHES use for FSP-served children before and after treatment alongside children in usual care. Estimates were made within stratified age groups (11 to <15 and 15 to <18), utilizing propensity score adjusted random effects for each child's increasing age to control individual differences in MHES likelihood and trajectory, while controlling for age, cohort, county of service, and clinical and demographic covariates. Before treatment in FSP, FSP-served children showed higher and increasing MHES rates initially, reflecting greater severity. After FSP treatment, FSP-served children's MHES trajectory declined more rapidly than those of controls. There is strong evidence for the success of FSP's aggressive approach in reducing dangerous, increasing trajectories in MHES use. More research is needed, but key efficacious components within the program may be candidates for broader application when providing community-based, crisis-averting care for the most socially and economically vulnerable, seriously mentally ill children and youth.

Comparison of Age at Diagnosis, Cytogenetic Risk, and Overall Survival Between Acute Myeloid Leukemia Patients of White and South Asian Race/Ethnicity in the United States

Introduction:Acute myeloid leukemia (AML) is more frequent among older patients in the United States (US), with a median age at diagnosis of 67 years old. A recent case series of AML patients from India reported a median age at diagnosis of 40 years old, suggesting that the pathogenesis of AML may differ between these populations (British Journal of Haematology 2015;170:110). In this study, we examined whether differences exist in the age at diagnosis, cytogenetic risk, and overall survival (OS) of White and South Asian patients diagnosed with AML in the US.Methods:We used the 1973-2012 Surveillance, Epidemiology, and End Results Program (SEER) database to identify adults, age 20 years or older, diagnosed with AML between 2000 and 2012. We included patients with documented race/ethnicity and known age at diagnosis. We compared age at diagnosis, cytogenetic risk, and OS according to White or South Asian race/ethnicity, based on patient surname as defined by SEER. We stratified age at diagnosis into age groups, defined as 20-24, 25-34, 35-44, 45-54, 55-64, and >65 years old, to compare the White and South Asian populations. Using the 2012 US Census population age distributions, we directly standardized the distribution of age at diagnosis of AML in SEER, weighted according to the age distribution of the total White and South Asian populations in the US. We categorized SEER-reported cytogenetic profiles as having favorable or adverse prognosis based on accepted definitions. We compared cytogenetic risk and OS between White and South Asian populations according to stratified age group at diagnosis. Differences in age at diagnosis were calculated using the Mann-Whitney test. OS was compared by the Log-rank test and estimated by the method of Kaplan and Meier. P-values <0.05 were considered significant.Results:39,192 patients, age 20 years old and above, were diagnosed with AML from 2000 to 2012 and had documented race/ethnicity at diagnosis in the SEER database. South Asian patients in the US were diagnosed with AML at a significantly younger age compared to White patients (Figure 1A, median age at diagnosis of 57 vs. 69.5 years old for South Asians (n=265) vs. Whites (n=33,419), p=<0.0001). Along with younger age at diagnosis, South Asians had a greater reported frequency of favorable cytogenetic risk (17.7% vs. 9.7% favorable cytogenetic risk for South Asians vs. Whites). Analysis of the demographics of the US population also showed that the South Asian population was significantly younger than the White population (median age of 40 vs. 50 years old for South Asians (n=2,447,009) vs. Whites (n=172,366,410), p=<0.0001). Direct standardization of the age at AML diagnosis with the age distributions of White and South Asian census populations in the US abrogated the differences in age at diagnosis between these groups (Figure 1B, p=0.8718). Standardization by age distribution also narrowed the difference in favorable cytogenetic risk between Whites and South Asians (17.9 vs. 19.1 cases per one million people, respectively). OS was not different between Whites and South Asians in the 20-49 year old age group (median OS: 46 vs. 60 months for Whites (n=5,272) vs. South Asians (n=96), p=0.4986), the 50-64 year old age group (median OS: 13.5 vs. 16 months for Whites (n=6,066) vs. South Asians (n=62), p=0.5088), or the >65 year old age group (median OS: 3 vs. 4.5 months for Whites (n=13,692) vs. South Asians (n=66), p=0.8491).Conclusions:In the US, AML patients of South Asian descent are diagnosed at a younger age and have more favorable cytogenetic risk profiles as compared to their White counterparts, which is of epidemiologic importance. Nevertheless, these findings appear to reflect the younger age distribution of the entire South Asian population as compared to the total White population in the US, rather than a difference in the inherent biology or pathogenesis of AML. These data highlight the importance of directly standardizing age distributions in population outcomes research. [Display omitted] DisclosuresFathi:Agios Pharmaceuticals: Other: Advisory Board participation; Merck: Other: Advisory Board participation; Seattle Genetics: Other: Advisory Board participation, Research Funding.

Risk relation between rhinitis and acute ischemic stroke.

Chronic inflammation that triggers endothelial dysfunction and atherosclerosis may promote the evolution of cardiovascular diseases, including acute ischemic stroke (AIS). In this study, we assessed the association between rhinitis (RN), an immunoglobulin E-related atopic disease, and the risk of AIS. We used a Taiwan national insurance claims data set of 1 million enrollees to distinguish 61,899 patients with RN and 123,798 randomly selected age- and sex-matched controls from January 1, 2000, to December 31, 2010. Both cohorts were followed up until the occurrence of stroke or the end of follow-up. The risk of AIS was evaluated by using the Cox proportional hazards regression model. After adjustment of the relevant covariates, the RN group showed a lower risk of AIS (adjusted hazard ratio [aHR] 0.74 [95% confidence interval {CI}, 0.70-0.79]) compared with the control cohort at the end of follow-up. Among the participants without comorbidities, the RN cohort still had a lower risk of AIS compared with the control cohort (aHR 0.69 [95% CI, 0.59-0.81]). Moreover, in the three stratified age groups, RN was associated with a significantly decreased risk of AIS (ages ≤49 years: aHR 0.77 [95% CI, 0.63-0.95]; ages 50-64 years: aHR 0.72 [95% CI, 0.64-0.81]; ages ≥65 years: aHR 0.78 [95% CI, 0.71-0.85]). RN was associated with a decreased risk of developing AIS. Although a reduction in risk of AIS was observed, it warrants further consideration to prevent AIS in patients with RN.

Association between mitral valve prolapse and open-angle glaucoma

ObjectiveProteoglycans and glycosoaminoglycans play many roles in connective tissue formation, their accumulation in myxomatous tissues may influence the associated mechanical behaviour of the mitral valve, as well as the extracellular...

Deranged Serum Fasting Lipid Profile in Children and Adolescent with Thalassemia Major

Introduction: Serum fasting lipid profile has been studied in various clinical spectrum of β-thalassemia syndrome. Premature cardiac impairment in thalassemia major (TM) appears primarily due to iron accumulation and oxidative injury; however it might be a sequel of abnormal lipoprotein concentrations. Recent studies revealed impaired lipid profile and atherosclerosis in TM as an emerging complication in patients with prolonged survival. As these children are at risk of premature atherosclerosis, sub clinical atherosclerosis probably begins early in their life might evolve into coronary heart diseases in later life.The rational of this prospective cross sectional study is to analyze the serum fasting lipid profile in cardiovascular disease free thalassemia major patients and to establish any correlation with age, gender, hematological parameters, liver enzymes and serum ferritin.Method: The study group comprises of thirty six patients with β-thalassemia major, who were enrolled from March 2012 to March 2014. Fasting blood lipid levels (total lipid, cholesterol, triglycerides, HDL and LDL-cholesterol), liver function test and serum ferritin were measured in all study participants on Hitachi 912 through photometric assay (for lipid profile and liver function test) and by immunoturbidity methodology for serumferritin. Hematological parameters were determined by Cell Dyne Ruby (Abbot, Architect, USA). Patients were stratified in two groups, age ≤ 15 years and >15 years, to determine the possible lipid profile distinction in relation to increasing age.Results: Of the 36 patients, 17 were males (15.5±5.9 years) and 19 were females (10.1±4.5 years) with the mean age of 12.69±5.85 (range 5-24) years. Mean hemoglobin was 7.4±1.9gm/dl with the hematocrit of 23.1±5.7% while serum ferritin was markedly elevated 4699.7±3089ng/ml. The mean total lipid, cholesterol and triglycerides levels were 494.7 ± 114.5, 90.3 ±23.9 and 150.5±95.1 mg/dl respectively. High triglycerides were detected in 36.1%. While HDL cholesterol and LDL cholesterol were markedly low 17.7±9.2 and 42.3±22.0 mg/dl respectively. The mean total cholesterol to HDL ratio was significantly elevated, 6.21± 3.06 (normal <5.0). In addition, total-cholesterol to HDL-cholesterol ratios were increased irrespective of gender, that is 6.0±2.0 and 6.4± 3.8 in males and females respectively (P=0.6). Data analysis revealed that 22.2% females and 13.8% males had high triglyceride levels (P=0.05). No statistically significant difference was noted in two stratified age groups in respect to lipid profile (table-1).We established positive correlation of elevated total bilirubin with cholesterol, HDL and LDL cholesterol (P<0.05). Cholesterol ratio was also significantly high in patients with hemoglobin > 8gm/dl (P<0.05). Low HDL cholesterol was correlated positively with LDL cholesterol levels. While no significant correlation of serum lipid could be established with age, gender, high ferritins and with liver enzymes.Conclusion: Our study revealed that lipid profile impairment is not unusual in β-thalassemia major patients irrespective of age. Considerable deficiency of high density cholesterol and significantly high total-cholesterol to HDL-cholesterol ratio may strongly be associated with occurrence of coronary heart disease in later life. We propose that lipid profile should be regularly done in these patients particularly those with hemoglobin > 8gm/dl and high total bilirubin levels. Whilst total to HDL ratio, underlines as a significant diagnostic marker for future cardiac events in these patients.Keywords: β-thalassemia major, triglyceride, HDL-cholesterol, LDL-cholesterol.Table 1:Comparative analysis of serum lipid profile in relation to ageParametersAge ≤15 yearsn= 24Age >15 yearsn= 12P- valueTotal lipid515.7± 121.1452.9 ±90.60.1 *Cholesterol95.0±17.680.9±32.10.09 *Serum triglyceride168.1 ± 109.7115.2± 40.10.1 *HDL cholesterol19.4±10.214.4± 5.90.1 *LDL cholesterol43.1±19.940.9±26.60.7 *Cholesterol ratio6.3± 3.46.0 ±2.10.8 **Not significant DisclosuresNo relevant conflicts of interest to declare.

Prevalence of triangular fibrocartilage complex abnormalities regardless of symptoms rise with age: systematic review and pooled analysis.

Triangular fibrocartilage complex abnormalities seem to be more common with age, but the degree to which this is so, and the degree to which the presence of an abnormality is associated with symptoms, are topics of controversy. We wished to perform a systematic review to determine the prevalence of triangular fibrocartilage complex abnormalities, and to determine if the prevalence of abnormalities are greater with increasing age. In addition, we stratified age groups based on symptoms. We searched MEDLINE, EMBASE, and the Cochrane Library through August 15, 2013. Studies that reported triangular fibrocartilage complex abnormalities by age were included. Fifteen studies including 977 wrists met our criteria and reported a total of 368 (38%) triangular fibrocartilage complex abnormalities. Eight studies included symptomatic patients; the remainder studied cadavers (six studies) or asymptomatic volunteers (one study). Patients were divided into four age groups (< 30, 30-49, 50-69, and 70 years and older) for pooled analysis, comparing the proportions of patients with and without abnormalities between groups using chi-square analysis. We also evaluated the proportions after stratifying each age group by symptoms. Overall, the prevalence of triangular fibrocartilage complex abnormalities increased with age, from 27% (80/301) in patients younger than 30 years to 49% (130/265) in patients 70 years and older (p < 0.001), odds ratio (OR), 2.7, 95% CI, 1.9-3.8 (p < 0.001). In asymptomatic patients, triangular fibrocartilage complex prevalence abnormality increased from 15% (24/159) to 49% (129/263) in the same age groups (p < 0.001), OR, 5.4, 95% CI, 3.3-8.9 (p < 0.001). For symptomatic patients prevalence ranged from 39% (56/142) to 70% (14/20) in patients between 50 and 69 years old (p < 0.034), OR, 3.6, 95% CI, 1.3-9.9 (p < 0.014). Triangular fibrocartilage complex abnormalities are common in symptomatic and asymptomatic wrists, and they are increasingly common with age. As in all situations where abnormalities are so common that they may be incidental, we need (1) a reliable and accurate method for determining whether these abnormalities are the cause of symptoms; and (2) evidence that treatment of these abnormalities improves symptoms better than placebo. Level III, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.

Changing prognostic factors in osteosarcoma: analysis of 381 cases from two institutions.

Osteosarcoma occurs most commonly in children and young adults, with a historic second incidence peak in the elderly. Most studies have focused on those occurring in adolescence. Detailed information on descriptive features and prognostic factors in patients of different age groups is lacking. We analyzed 381 osteosarcomas diagnosed between 1973 and 2012 to identify factors significantly associated with survival in various age groups. The peak incidence was seen in patients age <25, followed by a steady incidence rate thereafter until the sixth decade, when it started to decline. In the early onset diseases, significant factors for recurrence-free survival (RFS) were tumor site and size; whereas those for overall survival (OS) were gender, tumor site, type, grade and size. In patients age 25 to 54, tumor type and grade were significant for RFS, and the pathologic type was significant for OS. In those age ≥55, race and tumor size were significant for RFS; tumor site and size were significant for OS. In multivariate analysis, tumor size remained significant for RFS; gender, tumor site and size maintained their significance for OS in patients age <25. While no independent factor was identified in patients age 25 to 54, tumor size remained significant for RFS in those age ≥55. Chemotherapy-induced tumor necrosis was a prognosticator for RFS in patients age 25 to 54 by univariate analysis, but not as an independent factor in any stratified age group. Our data indicate that the distinctive prognostic factors differed significantly among different age groups, thus providing a rationale for age-based management strategies.

A New Index of Abdominal Obesity which Effectively Predicts Risk of Colon Tumor Development in Female Japanese

A relation between abdominal obesity and colorectal tumor development has been reported repeatedly, and is believed to be more remarkable in man than in women. However, the details vary depending on scientific reports. This may be due at least partly to the selected surface anthropometric index in addition to the influence of gender and ethnic groups. To cope with this, we considered a new index of abdominal obesity and evaluated its risk prediction potential. Six hundred ninety five Japanese (262 women and 433 men) who had a colonoscopy were studied. The new index was named as waist circumference to height index (WHI) and was calculated by the formula of waist circumference (cm)/height (m)/height (m). Biochemical and lifestyle factors were investigated preceding the colonoscopy. Statistical analysis was performed using SPSS for Windows. Increase of WHI was associated with altered metabolism of carbohydrate and lipid in both women and men. WHI was positively related with the development of colon tumor of women, while not with that of men. Logistic regression analysis performed for stratified age groups (45-54, 55-64 and 65-74 years) showed that WHI significantly increased odds ratio to 1.31 (CI 1.05-1.64 p=0.01) in women of 55-65 years. In contrast, in men this index WHI reduced the odds ratio insignificantly, while low density lipoprotein and triglyceride significantly increased the odds ratio to 1.01 (CI 1.00-1.03 p=0.02) in the 55-65 year group and to 1.02 (CI 1.00-1.03 p=0.02) in the 45-55 year group. In Japanese the risk factors for colon tumor development are different between women and men. WHI is a simple and efficient predictor of colon tumor risk in Japanese women and may be used to select those who should have colonoscopy.

Impact of age on functional exercise correlates in patients with advanced lung cancer

BackgroundThe functional exercise capacity and its correlates in advanced cancer patients in stratified age groups were examined.Materials and methodsA total of 105 patients with advanced lung cancer were recruited prospectively and stratified into young (≤50 years), middle (51–65 years), and old (>65 years) age groups. Respiratory performances, which included maximal inspiratory and expiratory pressure, forced expiratory volume in 1 second, and forced vital capacity were measured. The distance ambulated in a 6-minute walk test was used as an indicator for functional capacity.ResultsThe young age group had lowest baseline pulmonary function and performed worse on the 6-minute walk test among the three age groups. The risk factors for poor functional capacity were female, lower percent predicted maximal expiratory pressure, worse dyspnea, and lower hemoglobin in the young age group; lower percent predicated forced expiratory volume in 1 second and forced vital capacity, and greater weight loss in the middle age group; and only worse dyspnea in the old age group. The above identified risk factors accounted for 73.6%, 58.5%, and 42.1% variance in 6-minute walk distance for the young, middle, and old age group, respectively.ConclusionThe impacts of these factors on functional exercise capacity should be carefully considered while designing exercise intervention according to age.

Ten-year time trend of dioxins in human serum obtained from metropolitan populations in Seoul, Korea

Polychlorinated dibenzo-p-dioxin/furans (PCDD/Fs) and dioxin-like polychlorinated biphenyls (DL-PCBs) were measured in 954 and 539 human serum samples obtained, respectively, from incinerator workers and residents living near and far from municipal solid waste incinerators (MSWIs) during a 10-year period from 2001 to 2011 in Seoul, Korea. The mean toxic equivalent (TEQ) concentrations of PCDD/Fs and DL-PCBs were 9.29 and 5.39pgTEQ/g lipid, respectively. All populations exhibited similar concentrations and profiles, and 2,3,4,7,8-PeCDF, 1,2,3,7,8-PeCDD, and PCB126 were identified as major contributors to TEQs. However, the levels of PCDD/Fs and DL-PCBs were found to have positive associations with age when considering stratified age groups and showed a slight trend toward reduction. Differences in concentrations of these compounds among age groups slightly but continuously decreased from 2001 to 2011. The measured PCDD/F levels were compared to the predicted concentrations by using a single-compartment pharmacokinetic model on the basis of the daily intake of PCDD/Fs. The predicted concentration was 5.24pgTEQ/g lipid, which was approximately half of the measured concentration, reflecting the present exposures. These results suggest that current data on the levels of PCDD/Fs in foodstuffs might be useful to predict the future levels of dioxins in humans, which are expected to decline with time.

Analysis of traditional knowledge in medicinal plants used by Yuan in Thailand

Ethnopharmacological relevanceWe studied traditional knowledge of medicinal plants use of the Yuan in northern Thailand, documenting and analysing traditional medical practices and its trend in the younger generations. Aim of the studyTo providing useful information for appropriate and sustainable management under the urbanization and other developments and use of natural resources in their communities. In addition, traditional medicinal plant used, and knowledge that leads to discovery of new medicines can be promoted. Materials and methodsTraditional medicinal plant knowledge of the Yuan in Lamphun province was studied from October 2009 through September 2011 in order to determine the important medicinal plant species and dominant use-categories in 5 villages. In each village, questionnaire interviews about medicinal plants uses were applied to 30 informants (5 informants per each of six stratified age groups). The relative importance of plant species was captured by calculation of use value (UV). Likewise, the dominant use-categories were determined by calculation of the informant agreement ratio (IAR). Correlations between informants’ age and number of medicinal plants known by them were determined with the coefficient of determination (R2). ResultsA total of 93 medicinal plant species in 82 genera and 49 families were recorded in the five villages. The most important species of medicinal plants were Aloe vera (L.) Burm.f., Andrographis paniculata Ness, Chromolaena odorata (L.) R.M.King and H.Rob., Jatropha podagrica Hook., and Thunbergia laurifolia Lindl. which had UVs of 1.02, 1.01, 0.75, 0.71, and 0.65, respectively. Likewise, the most dominant use-categories were injuries, which accounted for 0.91 of the IAR. The age of informants and medicinal plants reported by each of them were positively correlated (R2=0.96, p<0.01). ConclusionsMost of the Yuan's traditional medicinal plant knowledge is used for treating basic ailments. However we should be concerned that there is an imminent danger that it will be lost in the near future because their lifestyle was changing.

Introducing BRAINscreen: Web-Based Real-Time Examination and Interpretation of Cognitive Function

Psychometrically sound screening of cognitive functioning can be advantageous in identifying persons most likely at risk for some specified condition or in need of further diagnostic study, and where brevity is required—whether because of the press of patients who may benefit from an assessment or because the patient's condition may preclude a lengthy assessment (Lezak, Howieson, & Loring, 2004). Moreover, computerized screening can improve access for underserved patients, who by virtue of economic, socioeconomic, geographical, logistical, or cultural reasons are not referred for, or cannot access, needed services (Bauer et al., 2012). With these provisos in mind, we set out to examine the psychometric properties of a Web-based real-time examination of cognitive functioning called BRAINscreen. The present study demonstrates how the measure was developed, its technical properties and features, the normative sample from which prospective performance is compared, and the relationship between accuracy of performance and reaction time on BRAINscreen test items across stratified age and education groups along with differential sensitivity of the test between healthy controls and various clinical populations. The present findings demonstrate that BRAINscreen may be a reliable and valid screening measure of cognitive functioning.

The Pavagada Pediatric Eye Disease Study: Objectives, Methodology and Participant Characteristics

ABSTRACTPurpose: To explain the objectives and methodology of a population-based survey of children ≤15 years in rural South India.Methods: A population-based cross sectional survey was performed by trained field workers (1st phase). Children with eye disease were referred to the peripheral rural hospital (2nd phase) to be examined by a general ophthalmologist. If major eye disease (cataract, strabismus) was identified they were referred to a pediatric ophthalmologist (3rd phase).Results: The sample size was 29,850. In the 1st phase, 23,100 children were screened (response rate 77.39%). There were about 33% of children in each of the three stratified age groups (0–5, 6–10 and 11–15 years), with a nearly equal sex distribution in each group (range 47% to 52%). Of the 23,100 screened, 1538 were referred to the peripheral rural hospital. The general ophthalmologist evaluated 647 patients (42%) who came to the peripheral rural hospital (2nd phase) and referred 59 children to the pediatric ophthalmologist (3rd phase). The pediatric ophthalmologist, in addition to evaluating the 59 children referred from the 2nd phase, also evaluated those who did not report (891/1538) to the peripheral rural hospital. This evaluation was done in the field itself. All the 1538 children referred by the field workers were thus seen by an ophthalmologist (647 by the general ophthalmologist, 891 by the pediatric ophthalmologist and 59 by both).Conclusion: The study is expected to provide information about the prevalence of pediatric ocular morbidity that could help plan intervention strategies in this area.

The association between higher serum ferritin level and lower bone mineral density is prominent in women ≥45 years of age (KNHANES 2008–2010)

Data gathered from a nationally representative cohort demonstrate that higher serum ferritin levels are significantly associated with lower bone mass at various skeletal sites and the increased prevalence of osteoporosis and fractures, especially in women ≥45 years of age. Despite extensive in vitro and in vivo studies showing the detrimental effects of iron on bone metabolism, the clinical studies relating to osteoporosis-related phenotypes have not been evaluated extensively. In the present study, we investigated and compared the association between serum ferritin and bone mineral density (BMD), depending on the stratified age groups in both genders. This is a population-based, cross-sectional study from the Korea National Health and Nutrition Examination Surveys, including 14,017 Koreans (6,817 men and 7,200 women) aged 10-80 years. BMD was measured using dual X-ray absorptiometry, and osteoporosis was diagnosed by the World Health Organization definition. Initially, we divided the subjects into three age groups, based on the patterns of age-related BMD changes in this national cohort (i.e., ≤24, 25-44, and ≥45 years old). Serum ferritin concentrations were inversely associated with BMD values at all measured sites after adjustment for confounders, only in women ≥45 years of age (P = 0.041 to <0.001). Furthermore, when we divided these women into serum ferritin quartiles, the odds for prevalent osteoporosis and fractures were 1.55-fold (95 % CI = 1.09-2.23) and 1.52-fold (95 % CI = 1.02-2.27) higher, respectively, in subjects in the highest quartile compared with those in the lowest quartile. These results provide the first clinical evidence that the associations between serum ferritin level and bone parameters could be the most prominent in women ≥45 years of age.

Effect of age on cervical spine injury in pediatric population: a National Trauma Data Bank review

Background The objective of this study was to characterize the incidence, risk factors, and patterns of cervical spine injury (CSI) in different pediatric developmental ages. Methods A retrospective review of the National Trauma Data Bank was conducted for the period of January 2002 through December 2006 to identify pediatric patients admitted following blunt trauma. Patients were stratified into 4 developmental age groups: infants/toddlers (age 0-3 years), preschool/young children (age 4-9 years), preadolescents (age 10-13 years), and adolescents (age 14-17 years). Patients with a CSI were identified by the International Classification of Diseases, Ninth Revision codes. Demographics, clinical injury data, level of CSI, and outcomes were abstracted and analyzed. Results A total of 240,647 patients met the inclusion criteria. Of these, 1.3% (n = 3,035) sustained a CSI. The incidence of CSI in the stratified age groups was 0.4% in infants/toddlers, 0.4% in preschool/young children, 0.8% in preadolescents, and 2.6% in adolescents. The level of CSI (upper [C1-C4] vs lower [C5-C7]) according to the age groups was as follows: infants and toddlers, 70% vs 25%; preschool/young children, 74% vs 17%; preadolescents, 52% vs 37%; and adolescents, 40% vs 45%, respectively. The adjusted risk for CSI increased 2-fold in preadolescents and 5-fold in adolescents. Conclusion The incidence of pediatric CSI increases in a stepwise fashion after 9 years of age. We noted an increase in lower CSI and a decrease in upper CSI after the age of 9 years. The incidence of upper CSI compared with lower CSI was higher in preadolescents (52% vs 37%) and almost equal in adolescents (40% vs 45%).

The Anatomic Relationship Between the Common Femoral Artery and Common Femoral Vein in Frog Leg Position Versus Straight Leg Position in Pediatric Patients

Overlap of the femoral artery (FA) on the femoral vein (FV) has been shown to occur in pediatric patients. This overlap may increase complications such as arterial puncture and failed insertions of central venous lines (CVLs). Knowledge of the anatomic relationship between the FV and FA may be important in avoiding these complications. The objective was to evaluate the anatomic relationship of the FA and FV in straight leg position and frog leg position. This was a prospective, descriptive study of a convenience sample of 80 total subjects (16 subjects from each of five predetermined stratified age groups). Each subject underwent a standardized ultrasound examination in both the straight and the frog leg positions. The location of the FA in relation to the FV was measured at three locations: immediately distal, 1 cm distal, and 3 cm distal to the inguinal ligament. Overlap of the FA on the FV and the diameter of the FV was noted at each location. Measurements were repeated in both the straight leg and the frog leg positions. For the left leg, immediately distal to the inguinal ligament, the FV was overlapped by the FA in 36% of patients in straight leg position and by 45% of patients in frog leg position. At 1 cm distal to the ligament, overlap was observed in 75% of patients in straight leg position and 88% of patients in the frog leg position. At 3 cm distal to the ligament, overlap was observed in 93% of patients in straight leg position and 86% of patients in the frog leg position. The percentage of vessels with overlap was similar in the right leg at each location for both the straight and the frog leg positions. Pooled mean (+/-SD) FV diameters for the left leg immediately distal to the inguinal ligament were 0.64 (+/-0.23) cm in the straight leg position and 0.76 (+/-0.28) cm in the frog leg position; at 1 cm distal to the ligament, 0.66 (+/-0.23) and 0.78 (+/-0.29) cm; and at 3 cm distal to the ligament, 0.65 (+/-0.27) and 0.69 (+/-0.29) cm. FV diameters for the right leg were similar to the left. A significant percentage of children have FAs that overlap their FVs. This overlap may be responsible for complications such as FA puncture with CVL placement. Ultrasound-guided techniques may decrease these risks. Placing children in the frog leg position increases the diameter of the FV visualized on ultrasound.