Biomedical subjects

Chirayath Suchindran

Publications and source records attributed to Chirayath Suchindran.

16 recordsLinked to original sources

PubMed2006

The relationship between pregnancy weight gain and glucose tolerance status among black and white women in central North Carolina.

OBJECTIVE: The objective of the study was to examine weight and its relationship to glucose intolerance during pregnancy. STUDY DESIGN: Women were classified into mutually exclusive glucose tolerance groups; impaired glucose tolerance of pregnancy defined as 1 high value on the oral glucose tolerance test, gestational diabetes mellitus as 2 high values, and normal glucose tolerance as a normal value on the universal screen test. Logistic regression was used to examine the relationship between prepregnancy body mass index and weight gain, and glucose tolerance status and predicted probabilities were calculated. RESULTS: Weight gain ratio (observed/expected) was significantly higher for women with gestational diabetes mellitus, compared with women with normal glucose tolerance. The likelihood of developing gestational diabetes mellitus was significantly increased by both prepregnancy overweight (odds ratio 2.2, 95% confidence interval 1.1-4.3) and obese status (odds ratio 3.7, 95% confidence interval 2.2-6.3) but only marginally by weight gain ratio. In contrast, the likelihood of developing impaired glucose tolerance was increased by weight gain ratio for women who started pregnancy overweight. CONCLUSION: Prepregnancy weight was strongly associated with gestational diabetes mellitus, whereas weight gain during pregnancy was associated with impaired glucose tolerance only among overweight women.

Adult↗

PubMed2006

HIV testing among young adults in the United States: associations with financial resources and geography.

We estimated prevalence and odds ratios for self-reported HIV testing among sexually experienced young adults using nationally representative data obtained from Wave III of the National Longitudinal Study of Adolescent Health (Add Health). The prevalence of testing in the past year was 18.8%. Young adults who had private or no health insurance were less likely to report testing than were young adults who had public health insurance, particularly in the South. Respondents with functional income were less likely to report testing than were those without functional income, particularly in the South and Northeast. Variable HIV testing based on finances and insurance should be addressed.

AIDS Serodiagnosis↗

PubMed2005

Assessing the effects of the dating violence prevention program "safe dates" using random coefficient regression modeling.

The Safe Dates Project is a randomized trial for evaluating a school-based adolescent dating violence prevention program. Five waves of data were used to examine the effects of Safe Dates over time including primary and secondary prevention effects, moderators, and mediators of program effects. Using random coefficients models, with multiple imputation of missing data, significant program effects were found at all four follow-up periods on psychological, moderate physical, and sexual dating violence perpetration and moderate physical dating violence victimization. Marginal effects were found on sexual victimization. Effects on severe physical perpetration at all four follow-up periods were moderated by prior involvement in that type of violence. Primary and secondary prevention effects were found and the program was equally effective for males and females and for whites and non-whites. Program effects were mediated by changes in dating violence norms, gender-role norms, and awareness of community services.

Adolescent↗

PubMed2005

The association between diet and height in the postinfancy period changes with age and socioeconomic status in Filipino youths.

Whether the determinants of linear growth can have independent effects beyond the critical infancy period has been questioned. This research uses uniquely suited data from >2000 youths from the Cebu Longitudinal Health and Nutrition Study in the Philippines to examine the association between diet and height in the postinfancy period. Anthropometric, diet, and other data were collected bimonthly from 0 to 2 y, and at the mean ages of 8, 11.5, 15.5, and 18.5 y. Generalized Estimating Equations were used to quantify the mean effects of diet diversity and energy intake on height across increments demarcated by the postinfancy data (2-8.5, 8.5-11.5, 11.5-15.5, and 15.5-18.5 y). We examined whether the effects differed by socioeconomic status (SES) and age. Effects with P < 0.05 were considered significant. Each additional unit of diet variety (range 0-8 U) was associated with a significant 0.33-cm increase in height in boys. Each additional 100 kcal (4186 kJ) was associated with significant increases in height of 0.05 cm in boys, and 0.02 cm in girls. Significant interactions (P < 0.15) with SES showed that each 100 kcal increase in energy intake was associated with a 0.08-cm increase in height at low SES with no difference at high SES. In both boys and girls, the effects of energy intake decreased with age, as shown by a significant age interaction (P < 0.15). The methods used incorporate the longitudinal nature of the data to offer a unique examination of the association between diet and height in the postinfancy period.

Adolescent↗

PubMed2004

Eye involvement in inherited epidermolysis bullosa: experience of the National Epidermolysis Bullosa Registry.

PURPOSE: To determine the frequency of ocular manifestations in inherited epidermolysis bullosa (EB) within the continental United States and to define the estimated cumulative risks of developing nonscarring (blisters or erosions) and scarring corneal manifestations within each major EB subtype over time. DESIGN: Observational (cross-sectional and longitudinal). METHODS: Up to 16 years of longitudinal follow-up was conducted on 3,280 consecutively enrolled patients in the National EB Registry, an epidemiologic study funded by the National Institutes of Health. Data were stratified by major EB type and subtype. Frequencies of occurrence were determined for eight variables (corneal erosions or blistering; corneal scarring; symblepharons; blepharitis; ectropions; lacrimal duct obstruction; impaired vision; blindness) by contingency tables, and cumulative risks were generated by life table analysis technique. RESULTS: The most common ocular manifestations were corneal erosions and blisters. Frequencies mirrored relative severity of skin disease, with 74.10% of all patients with recessive dystrophic EB, Hallopeau-Siemens (RDEB-HS) and 47.50% of all patients with junctional EB, Herlitz (JEB-H) experiencing at least one episode. Lower frequencies were noted for corneal scarring. Symblepharons and ectropions were most commonly seen in inversa RDEB and JEB-H, respectively. Blindness was reported in 6.47% of RDEB-HS patients. The cumulative risks of nonscarring and scarring corneal lesions in JEB-H at age 5 are 83.18% and 27.08% and at age 25 are 83.18% and 72.22%. With time, the cumulative risk of each in RDEB-HS approached that reported in JEB-H patients. CONCLUSION: Ocular disease activity, particularly corneal, is common in some EB subtypes. Careful ophthalmologic examination should become an integral part of the management of all patients with inherited EB.

Adolescent↗

PubMed2004

Chemoprevention of squamous cell carcinoma in recessive dystrophic epidermolysis bullosa: results of a phase 1 trial of systemic isotretinoin.

BACKGROUND: Patients with recessive dystrophic epidermolysis bullosa (RDEB) are at high risk of developing squamous cell carcinoma on or after midadolescence, and most patients die of metastatic squamous cell carcinoma within 5 years of diagnosis of their first squamous cell carcinoma. OBJECTIVE: We sought to determine whether isotretinoin can be safely administered to patients with RDEB as a possible chemopreventive agent. METHODS: A total of 20 patients with RDEB aged 15 years or older were treated daily for 8 months with isotretinoin (with a targeted dosage of 0.5 mg/kg/d). RESULTS: No unusual adverse reactions were noted in this patient population. Several patients experienced reduced blistering at lower doses and increased mechanical fragility at maintenance dosage. CONCLUSIONS: Isotretinoin, at least up to a dosage of 0.5 mg/kg/d, may be safely used in patients with RDEB. Although increased fragility may occur, patients tolerated this drug well and were receptive to its long-term use for possible chemoprevention of cancer. Whether such an effect will occur is yet to be proven.

Adolescent↗

PubMed2004

Longitudinal predictors of serious physical and sexual dating violence victimization during adolescence.

BACKGROUND: This study identifies potentially modifiable risk factors for the onset of and chronic victimization from serious physical and sexual dating violence. METHODS: One thousand two hundred ninety-one 8th and 9th graders from a county in North Carolina were assessed annually for 5 and 4 years, respectively. RESULTS: For males, having been hit by an adult with the intention of harm, having low self-esteem, and having been in a physical fight with a peer predicted onset of serious physical dating violence victimization. Those variables, plus having a friend who has been a victim of dating violence, alcohol use, and being white, predicted chronic victimization for males. For females, onset of serious physical dating violence victimization was predicted by having been hit by an adult; that variable, plus living in a single-parent household, predicted chronic victimization from serious physical violence. Also for females, onset of sexual violence victimization was predicted by having a friend who has been the victim of dating violence and being depressed; those variables and gender stereotyping predicted chronic victimization from sexual dating violence. CONCLUSIONS: The findings identify high-risk groups and risk factors to target for intervention and have implications for approaches to delivering dating violence prevention programs.

Adolescent↗

PubMed2004

Physical activity as a predictor of body composition in American Indian children.

OBJECTIVE: To examine physical activity in second grade American Indian children as a predictor of percentage body fat 3 years later. RESEARCH METHODS AND PROCEDURES: Physical activity was assessed as average vector magnitude (AVM) counts from an accelerometer in 454 second grade children as part of the Pathways study. BMI was assessed, and skinfolds and bioelectrical impedance were used to estimate fat mass, fat-free body mass, and percentage body fat in validated prediction equations. Associations were examined using mixed models regression controlling for baseline body composition. RESULTS: In normal-weight children, higher AVM counts were significantly associated with decreases in percentage body fat. Among overweight children, higher AVM counts were significantly associated with increases in BMI, fat mass, and fat-free mass but not percentage body fat. DISCUSSION: Higher physical activity levels in second grade were associated with lower levels of percentage body fat in fifth grade in normal-weight but not in overweight children. BMI showed no association with physical activity among normal-weight children, and increases in BMI were associated with increasing amounts of physical activity among overweight children. These findings emphasize the importance of valid body composition measures and may indicate important differences in associations between physical activity and adiposity in normal-weight as compared with overweight children.

Body Composition↗

PubMed2004

Genitourinary complications of inherited epidermolysis bullosa: experience of the national epidermylosis bullosa registry and review of the literature.

PURPOSE: We determined the frequency with which 6 genitourinary tract complications (urethral meatal stenosis, urinary retention, bladder hypertrophy, hydronephrosis secondary to ureteral strictures, pyelonephritis and cystitis) occur in inherited epidermolysis bullosa (EB) in the American EB population. MATERIALS AND METHODS: Up to 16 years of longitudinal followup was done in 3,280 consecutively enrolled patients in the National EB Registry, a National Institutes of Health funded epidemiological study covering the entire continental United States. Data were stratified by major EB type and subtype. Frequencies of occurrence were determined for each of 6 genitourinary tract variables and stratified into 10 mutually exclusive, major EB subtypes. RESULTS: Urinary tract complications occurred in a minority of patients across all major EB subtypes with the highest frequency seen in Herlitz junctional EB (JEB-H). Urethral meatus stenosis was the most common complication, occurring in 11.6% and 8.0% of patients with JEB-H and Hallopeau-Siemens recessive dystrophic EB (RDEB), respectively. Urinary retention, hydronephrosis and bladder hypertrophy occurred in 9.3%, 7.0% and 4.6% of JEB-H cases, respectively. In contrast, pyelonephritis and cystitis were most often seen in the setting of generalized EB simplex (Koebner variant) and inversa RDEB. CONCLUSIONS: The urinary tract may be involved in any subtype of inherited EB, although these complications usually arise in patients with the most severe subtypes of junctional and recessive dystrophic disease. Chronic surveillance for the presence of genitourinary tract disease activity is warranted, especially in patients with JEB and RDEB, given the potential for longterm kidney injury if untreated.

Epidermolysis Bullosa↗

PubMed2004

Assessing the long-term effects of the Safe Dates program and a booster in preventing and reducing adolescent dating violence victimization and perpetration.

OBJECTIVES: This study determined 4-year postintervention effects of Safe Dates on dating violence, booster effects, and moderators of the program effects. METHODS: We gathered baseline data in 10 schools that were randomly allocated to a treatment condition. We collected follow-up data 1 month after the program and then yearly thereafter for 4 years. Between the 2- and 3-year follow-ups, a randomly selected half of treatment adolescents received a booster. RESULTS: Compared with controls, adolescents receiving Safe Dates reported significantly less physical, serious physical, and sexual dating violence perpetration and victimization 4 years after the program. The booster did not improve the effectiveness of Safe Dates. CONCLUSIONS: Safe Dates shows promise for preventing dating violence but the booster should not be used.

Adolescent↗

PubMed2004

Inherited epidermolysis bullosa and the risk of death from renal disease: experience of the National Epidermolysis Bullosa Registry.

BACKGROUND: Isolated case reports and limited clinical series suggested that renal failure may occur in some patients with inherited epidermolysis bullosa (EB). Reported causes have included poststreptococcal glomerulonephritis, secondary amyloidosis, and chronic mechanical obstruction. To date, no data exist that permit an accurate estimation of the risk for death from renal failure in patients with this disease. METHODS: Life table analyses were performed using 16 years of data from the National EB Registry, a federally funded longitudinal epidemiological study encompassing the entire continental United States. Data were stratified so that cumulative and conditional risks for death from renal failure could be estimated. Renal failure as cause of death was identified by death certificates and verified from hospital records and interviews with the patients' immediate families. RESULTS: The cumulative risk for death from renal failure among patients with Hallopeau-Siemens recessive dystrophic EB (RDEB-HS) was 12.3% by age 35 years. In addition, deaths from renal failure also were reported rarely in patients with other subtypes of generalized RDEB and in junctional EB (JEB). CONCLUSION: Renal failure is an important cause of death among adults with RDEB-HS, surpassed only by death from metastatic squamous cell carcinoma. It also rarely may occur in the setting of JEB and other subtypes of generalized RDEB. Given our data, medical surveillance for early renal involvement should become part of the routine evaluation of all adults with RDEB and JEB.

Adolescent↗

PubMed2003

Impact of the Pathways intervention on dietary intakes of American Indian schoolchildren.

BACKGROUND: The Pathways study was a randomized, 3-year trial of obesity prevention in American Indian Children. An important goal of the Pathways intervention was to significantly decrease the percentage of calories eaten as fat by the intervention children, relative to controls. This paper reports the effects of the Pathways intervention on dietary intake. METHODS: Two types of dietary data were analyzed from random samples of children in 41 schools: direct observation of school lunch intake at baseline (2nd grade) and follow-up (5th grade) (n=470), and 24-hour dietary recalls at follow-up only (n=620). Nutrient contents of school meals and recalls were calculated by NDS and NDS-R software (University of Minnesota), using vendor products and recipes from each school. RESULTS: Based on lunch observations, the intervention was associated with significant decreases in mean percentage of calories from total fat (3.6%) and saturated fat (2.1%) relative to controls, and a significant increase in the percentage of calories from total carbohydrate (3.7%). Compared with the control children, intervention children reported significantly smaller 24-hour intakes of energy (263 kcal), protein (9.5 g), total fat (15.1 g), saturated fat (6.0 g), and polyunsaturated fat (2.3 g); and as a percent of calories, total fat (2.5%) and saturated fat (1.1%). Mean intake of carbohydrates as a percentage of calories was significantly greater in intervention children by 2.5%, compared with controls. CONCLUSIONS: The Pathways intervention successfully reduced the intake of percent calories from fat and saturated fat, at school lunch and over the whole day.

Child↗

PubMed2003

Changes in the nutrient content of school lunches: results from the Pathways study.

BACKGROUND: Pathways, a randomized trial, evaluated the effectiveness of a school-based multicomponent intervention to reduce fatness in American-Indian schoolchildren. The goal of the Pathways food service intervention component was to reduce the fat in school lunches to no more than 30% of energy from fat while maintaining recommended levels of calories and key nutrients. METHODS: The intervention was implemented by school food service staff in intervention schools over a 3-year period. Five consecutive days of school lunch menu items were collected from 20 control and 21 intervention schools at four time periods, and nutrient content was analyzed. RESULTS: There was a significantly greater mean reduction in percent energy from fat and saturated fat in the intervention schools compared to the control schools. Mean percentages of energy from fat decreased from 33.1% at baseline to 28.3% at the end of the study in intervention schools compared to 33.2% at baseline and 32.2% at follow-up in the control schools (P<0.003). There were no statistically significant differences for calories or nutrients between intervention and control schools. CONCLUSIONS: The Pathways school food lunch intervention documented the feasibility of successfully lowering the percent of energy from fat, as part of a coordinated obesity prevention program for American-Indian children.

Child↗

PubMed2003

A spatial analysis of county-level variation in hospitalization rates for low back problems in North Carolina.

Hospitalization rates for low back problems vary widely. In previous non-spatial analyses, population-level socioeconomic and health resource characteristics have explained little of the variation in rates. This study examines geographic variation in hospitalization rates for low back problems while controlling for spatial dependence in the data. County-level surgical and medical hospitalization rates were calculated using North Carolina hospital (USA) discharge data from 1990-92. Non-spatial and spatial regression models were estimated using socioeconomic and health resource predictors. Both surgical and medical rates varied significantly among the 100 counties. Non-spatial models explained 62% of variation in log-transformed surgical rates and 66% of variation in log-transformed medical rates; however, residuals showed significant spatial dependence. Spatial lag models were therefore applied. Using simple contiguity spatial weights, surgery rates increased with higher percent urban population, primary care physician density, and discharge rate for other causes, and decreased with higher percent college graduates, percent disabled, occupied hospital bed density, and unoccupied hospital bed density. There was a nonlinear relationship between surgery rates and percent employed in heavy lifting/transportation industries. Medical rates increased with higher other-cause discharge rate and with MRI/CT scanner availability, and decreased with higher percent urban population, percent nonwhite population, percent in heavy lifting/transportation industries, and unoccupied hospital bed density. The results show that population-level socioeconomic and health resource characteristics are important determinants of variation in low back hospitalization rates. Independent of these variables, a separate spatial process produces geographic clustering of high-rate counties. Spatial effects are important and should be considered in small area analyses.

Catchment Area, Health↗

PubMed2001

The public health impact of Alzheimer's disease, 2000-2050: potential implication of treatment advances.

Recent developments in basic research suggest that therapeutic breakthroughs may occur in Alzheimer's disease treatment over the coming decades. To model the potential magnitude and nature of the effect of these advances, historical data from congestive heart failure and Parkinson's disease were used. Projections indicate that therapies which delay disease onset will markedly reduce overall disease prevalence, whereas therapies to treat existing disease will alter the proportion of cases that are mild as opposed to moderate/severe. The public health impact of such changes would likely involve both the amount and type of health services needed. Particularly likely to arise are new forms of outpatient services, such as disease-specific clinics and centers. None of our models predicts less than a threefold rise in the total number of persons with Alzheimer's disease between 2000 and 2050. Therefore, Alzheimer's care is likely to remain a major public health problem during the coming decades.

Alzheimer Disease↗

PubMedDate not supplied

Validating the self-reported fertility status of rural Malawian women.

This study uses data from a population-based survey to examine the fertility schedules of 704 women in a rural district of Malawi. The main objective is to assess self-reported fecundity status as a measure of fertility impairment. Life tables are used to examine the timing and tempo of births for women reporting difficulty getting pregnant as compared to women with no reported fecundity difficulties. Results of the analysis indicate that women with self-reported fecundity difficulties are older at each birth and have longer median birth intervals than do women with no reported difficulties. Cox proportional hazards models show that the report of a difficulty getting pregnant is significantly associated with at least a 30% lower likelihood of a first, second, or third birth. The relationships are not modified when accounting for demographic characteristics, previous sexual behaviors, or STI status.

Adolescent↗