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PubMed1998

Quantitative evaluation of the optic nerve head in early glaucoma.

AIMS: Progressive loss of neuroretinal rim tissue is known to occur early in glaucoma and measurement of the neuroretinal rim area is possible by magnification corrected analysis of optic disc photographs (planimetry). This study was performed to determine whether the facility to distinguish between glaucomatous and normal optic discs could be improved upon by: (a) taking into account the known relation between optic disc size and neuroretinal rim area, and (b) measuring rim area in a number of segments, in order to detect focal changes. METHODS: Planimetric examination of the optic disc photographs of 88 control subjects and 51 patients with early visual field defects was performed. In the control group, multiple linear regression analysis was performed between neuroretinal rim area and optic disc area, age, sex, eye side, refraction, and keratometry. This was repeated for the whole disc and for each of twelve 30 degree segments. Normal ranges were defined by the 98% prediction intervals of the regression analysis and the sensitivity and specificity for correct identification of optic discs in the two groups determined. RESULTS: Multiple linear regression demonstrated significant associations between the neuroretinal rim area and optic disc area and age in normal subjects. Sensitivity and specificity for glaucoma diagnosis, using the cut off derived from the 98% prediction intervals, was 37.7% and 98.9% respectively when total neuroretinal rim area alone was considered, and 88.7% and 94.3% respectively when the 30 degree segments were included. The most frequent pattern of neuroretinal rim loss was diffuse, followed by thinning in more than one sector and then by thinning in the inferotemporal sector alone. CONCLUSIONS: This method of optic disc analysis enables the examiner to identify glaucomatous optic discs at the stage of early perimetric loss with a high degree of precision. Optic disc photography is simple, and fundus cameras are widely available. This method for glaucoma case identification may therefore be suitable for the primary care setting as well as hospital practice.

Adult↗

PubMed2006

Effect of massive weight loss induced by bariatric surgery on serum levels of interleukin-18 and monocyte-chemoattractant-protein-1 in morbid obesity.

BACKGROUND: Morbid obesity is associated with insulin resistance (IR), chronic inflammation and premature atherosclerosis. Since vascular inflammation may contribute to the increased risk of cardiovascular morbidity and mortality of these patients, we studied circulating Interleukin-18 (L-18) and monocyte-chemoattractant-protein-1 (MCP-1) levels in 37 patients with morbid obesity before and after significant weight loss induced by bariatric surgery and their preoperative and postoperative associations with C-reactive protein (CRP) and IR-associated factors. METHODS: High sensitivity assays were used to measure concentrations of fasting CRP, IL-18 and MCP-1. Differences between patients before and after bariatric surgery were analyzed by Student's paired t-test. To investigate the associations of the observed reductions of values, delta of parameters were calculated and preoperative, postoperative and delta data were tested by univariate and multivariate linear regression. RESULTS: After a mean follow-up period of 26.5 months and a massive weight loss of 35 kg induced by bariatric surgery, circulating IL-18 levels decreased by 37% (P<0.001) and circulating MCP-1 levels by 47% (P<0.001). Multiple linear regression of delta values of IL-18 showed that only 2-hour glucose (P=0.008) remained independently and significantly associated with IL-18, whereas multiple linear regression analysis of delta values of MCP-1 revealed that only delta of HOMA-IR (P<0.001) remained independently and significantly associated with MCP-1, respectively. CONCLUSIONS: Because both biomarkers have been shown to play an important role in the development and progression of atherosclerosis, the observations presented in this study could be of clinical relevance for morbidly obese patients undergoing bariatric surgery.

Adult↗

PubMed2006

Duration of breast feeding and cognitive function: Population based cohort study.

Some evidence suggests that breast feeding is weakly but positively associated with cognitive function. This association has been robust to adjustment for various confounders. The aim of this paper is to determine if duration of breast feeding is associated with cognitive function in late childhood. Data was abstracted from the 1970 British Cohort Study. 11004 liveborn white singletons born during 5-11 April 1970 in the United Kingdom were followed from birth to 10 years. Cognitive function at 10 years is the dependent variable, a latent construct composed of one ability test and three performance measures. Estimates derived from multiple linear regression and structural equation modeling were compared. Effect sizes were estimated using standardized coefficients (SC). Differences in cognitive function according to breast feeding duration were estimated to be small by multiple linear regression (SC = 0.07) and much smaller and non-significant as estimated by structural equation modeling (SC = 0.02) after adjusting for parental socioeconomic status (SES), birth weight, parity, gestational age, maternal age and maternal smoking. Differences in cognitive function according to duration of breast feeding appear to be small and of little clinical importance as estimated by structural equation modeling.

Breast Feeding↗

PubMed1982

Relationship between concentration and anticoagulant effect of heparin in plasma of hospitalized patients: magnitude and predictability of interindividual differences.

The anticoagulant effect of heparin as reflected by the slope (S) of the relationship between heparin concentration and natural log of activated partial thromboplastin time (APTT) was determined in citrated plasma of 31 hospitalized, 21- to 80-yr-old patients (including many typical candidates for heparin therapy). Also determined were level of factors II, V, VII to XII, albumin, individual globulins, calcium, antithrombin III, fibrinogen, alpha-1-acid glycoprotein, alpha-1-antitrypsin, and alpha-2-macroglobulin and prothrombin time and hematocrit. Baseline APTT was 24.1 to 60.3 sec and S was 1.80 to 4.27 ml/u. S correlated with baseline APTT, hematocrit, total protein, functional antithrombin III, prothrombin time, beta-globulin, and factors II, VII, X, XI, and XII. A multiple linear regression equation with baseline APTT, total protein concentration, and factor XI as independent variables was "best" for predicting the S of these patients (r = 0.807, P less than 0.0001). A multiple linear regression equation with baseline APTT and hematocrit as independent variables, obtained in a previous study on healthy subjects, overpredicted the patients' S values. An equation with baseline APTT and gamma-globulins as independent variables yielded the best correlation predicted and actual S values for the combined group of patients and normal subjects (r = 0.715, P less than 0.0001). Our observations indicate that it may be possible to predict the heparin concentration-anticoagulant effect (APTT) relationship for individual patients before institution of heparin therapy.

Adult↗

PubMed2000

Factors explaining the geographical differences in Disability Free Life Expectancy in Spain.

OBJECTIVE: To study the geographical variations in Disability Free Life Expectancy (DFLE) at birth (DFLEb) and at 65 years (DFLE65) in Spain and to identify the main factors that explain these variations. DESIGN: Ecological study with the 50 provinces of Spain as the units of analysis. Sullivan's method is used to calculate DFLE for each province based on information from the death registry and the survey on disabilities, impairments and handicaps. Information on the independent variables-socioeconomic level, factors related with the health system and risk factors-was taken from various sources. MAIN OUTCOME MEASURE: Simple correlation coefficients were obtained between each dependent variable (DFLEb and DLFE65) and the independent variables. Two multiple linear regression models were fit to obtain the best set of factors that explain the geographical distribution of DFLEb and DLFE65. RESULTS: Both DFLEb and DLFE65 vary widely among provinces. The multiple linear regression analysis shows that the illiteracy rate, the percentage of the unemployed and the percentage of smokers in the population were the main factors associated with the geographical variation of DFLE. The models explained approximately 40% of the variance for DFLEb and 30% for DLFE65. CONCLUSIONS: The results obtained show the influence of education, the unemployment rate and smoking on the geographical differences of DFLE. The DFLE indicators are shown to be valid for use in health policy.

Adolescent↗

PubMed1994

Human lung impedance from spontaneous breathing frequencies to 32 Hz.

Lung impedance (ZL) was measured from 0.1875 to 32 Hz in spontaneously breathing healthy subjects by spectral analysis of the pressure and flow signals generated simultaneously by the muscular generator of breathing and by a forced oscillation system. This method did not require cooperation from the subject to perform panting or special ventilatory maneuvers and therefore allowed us to analyze the frequency dependence of lung resistance, reactance, and elastance (-2 pi.frequency.reactance) at the physiological conditions of normal breathing. Resistance and elastance parameters were also computed by multiple linear regression of the time-domain pressure and flow data on a simple resistance-elastance model. Resistances and elastances computed at the breathing frequency by spectral analysis and by multiple linear regression were similar (nonsignificant differences < 4 and 10%, respectively). The results obtained when comparing ZL from the breathing component (0.1875-0.75 Hz) of the recorded signals and from the forced oscillation component (2-32 Hz) were fairly consistent. ZL (0.1875-10 Hz) was interpreted in terms of a model consisting of an airway compartment, including a resistance and an inertance, in series with a viscoelastic tissue compartment (J. Hildebrandt. J. Appl. Physiol. 28: 365-372, 1970) characterized by two parameters. The model analysis provided parameter values (resistance 2.49 +/- 0.58 hPa.l-1.s, inertance 1.70 +/- 0.29 Pa.l-1.s2, Hildebrandt parameters 4.87 +/- 2.28 and 0.73 +/- 0.99 hPa/l) consistent with the hypothesis that lung tissue in healthy humans during spontaneous breathing behaves as a viscoelastic structure with a hysteresivity of approximately 0.10.

Adult↗

PubMed2005

Do economic stresses influence child work hours on family farms?

BACKGROUND: Economic stresses are a frequently cited reason for children doing farm work. OBJECTIVE: To explore the relationship between economic indicators and child agricultural work hours between January 2001 and October 2003. METHODS: This ecologic study design compares trends in aggregate child work hours with national and regional economic indicators. Child work hours were obtained from quarterly surveillance data from a randomized field trial of agricultural task guidelines for children. 2,360 children living or working on 845 farms in central New York participated in the original study. The relationship between child work hours and three economic indicators: national all farm index (AFI) ratio, national fuel index, and regional milk prices was analyzed using times series plots, correlation, and multiple linear regression. RESULTS: The AFI ratio was positively correlated with child work hours (r = 0.49, p = 0.008) but there was no significant correlation between child work hours and fuel or milk prices. Multiple linear regression demonstrated that the relationship between AFI and child work hours is independent of a seasonal effect. CONCLUSIONS: Increased child work hours may be associated with periods of higher farm sector productivity, rather than economic stress per se. Findings are limited by the ecologic study design, use of national economic indicators, and the limited number of cycles of child work hours available for time series analysis. Economic conditions may influence decisions about children's farm work.

Accidents, Occupational↗

PubMedDate not supplied

[Prediction of binding affinities of protein-ligand complexes using nonlinear models].

A network model for prediction of the free energy changes in protein-ligand complexes has been developed. The 150 complexes of different nature were used as a training set. The computational physics-chemical parameters of these complexes were used as independent variables. Both classical models of multiple linear regression and several network models with one hidden layer were created and the best was chosen. Significant improvement was shown for network model prediction quality in comparison with classical model of multiple linear regression (R2 on training--0.81 and 0.54; R2 on "leave-one-out" procedure--0.74 and 0.52 respectively).

Ligands↗

PubMed2003

Pulmonary blood pressure, not flow, is associated with net endothelin-1 production in the lungs of patients with congenital heart disease and normal pulmonary vascular resistance.

OBJECTIVE: Endothelin-1 concentrations are increased in patients with increased mean pulmonary arterial pressure, pulmonary blood flow, and pulmonary vascular resistance. However, endothelin-1 concentrations have not been well characterized in patients with congenital heart disease and normal pulmonary vascular resistance. In particular, it is unclear whether pressure or flow is the key regulator of endothelin- 1 in this setting. We tested the hypothesis that pulmonary blood pressure and not flow is associated with net endothelin-1 production in patients with congenital heart disease and normal pulmonary vascular resistance. METHODS: With a commercially available immunoassay, we measured endothelin-1 concentrations in pulmonary arterial and pulmonary venous plasma of 56 consecutive patients with congenital heart disease and pulmonary vascular resistance less than 2 U. m(2) undergoing cardiac catheterization. We used multiple linear regression to analyze the effect of demographic and hemodynamic variables on pulmonary arterial and venous endothelin-1 concentrations and on the change of endothelin-1 concentration over the pulmonary vascular bed. RESULTS: Multiple linear regression revealed that of all the hemodynamic variables tested, mean pulmonary arterial pressure had the greatest effect on increasing the change of endothelin-1 concentration over the pulmonary vascular bed (P <.0001). Pulmonary blood flow did not have any effect on endothelin-1 concentrations or on the change of endothelin-1 concentration over the pulmonary vascular bed. CONCLUSIONS: This study shows that pulmonary blood pressure and not flow is associated with net endothelin-1 production in patients with congenital heart disease and normal pulmonary vascular resistance.

Blood Pressure↗

PubMedDate not supplied

Costs of asthma in a cohort of Swiss adults: associations with exacerbation status and severity.

OBJECTIVE: This article will address the effect of exacerbation status, disease severity (defined by medication required), and other variables on resource use and costs for asthma in Switzerland in 1996 to 1997. METHODS: A retrospective chart-based study was performed. A sample of 422 adults was analyzed. Target variables were stratified by disease severity and exacerbation status. Bivariate associations were assessed. Multiple linear regression was performed on the logarithm of direct medical costs. RESULTS: The probability of exacerbations was positively associated with disease severity. Resource use and costs were associated with both of these variables. Multiple linear regression identified age, presence of asthma-related comorbidities, degree of severity, exacerbation status, quick reliever versus controller therapy, and diagnosis or treatment by a pulmonologist as independent influences on direct costs. An interaction between severity and exacerbation status was also noted. Regression identified direct costs in the highest severity group to be 2.5 times higher than those in the lowest group, if there were no exacerbations. If exacerbations were present, costs were 5.7 times higher. CONCLUSIONS: Because of its high prevalence, asthma has a high impact on public health. This impact depends on disease severity and, according to these findings, may also depend on the extent to which exacerbations are avoided or at least controlled.

Acute Disease↗

PubMed2006

Relationship between insulin sensitivity and in vivo mitochondrial function in skeletal muscle.

Recent data have shown that individuals with low insulin sensitivity (S(I)) also have reduced whole body maximal oxygen uptake. The objectives of this study were to determine 1) whether muscle mitochondrial function was independently related to S(I) after being adjusted for known determinants of S(I) and 2) whether lower S(I) among African-American (AA) vs. Caucasian-American (CA) women was due to lower muscle mitochondrial function among AA women. Subjects were 37 CA and 22 AA premenopausal women (age: 33.6 +/- 6.3 yr). Mitochondrial function [time constant of ADP (ADP(tc))] was assessed during a 90-s unilateral isometric contraction using (31)P magnetic resonance spectroscopy, S(I) with an intravenous glucose tolerance test, body composition by dual-energy X-ray absorptiometry, and visceral adipose tissue (VAT) with computed tomography. ANOVA was used to compare AA and CA groups, and multiple linear regression modeling was used to identify independent predictors of S(I). Between-race comparisons indicated that muscle oxidative capacity was lower among AAs vs. CAs (ADP(tc): 25.6 +/- 9.8 vs. 21.4 +/- 9.9 s). Multiple linear regression models for the dependent variable S(I) contained 1) VAT and race and 2) VAT, race, and ADP(tc). Significant independent effects for all predictor variables were observed in both the first (r(2) = 0.345) and second (r(2) = 0.410) models. The partial correlation for race was lower in the second model (-0.404 vs. -0.300), suggesting that muscle mitochondrial function contributed to the racial difference in S(I). Lower muscle mitochondrial function among AAs may in part explain lower S(I) among them.

Absorptiometry, Photon↗

PubMed2003

School league tables: a new population based predictor of dental restorative treatment need.

AIM: To test whether dental restorative treatment need was related to the school league tables and level of social deprivation of the school ward. DESIGN: An ecological study using clinical data aggregated at school level, collected in the school dental screening examinations (1996-97), National Census (1991) and the results of the UK school league tables--Key Stage 2 SATs (1996-97). SETTING: State primary schools in the Greenwich District of SE London, UK (1996-97). SUBJECTS: 12,854 pupils (6-11 years of age) in 62 schools. OUTCOME MEASURE: The percentage of 6 to 11 year old pupils per school requiring dental restorative treatment. RESULTS: Deprivation as measured by the overall Jarman Under Privileged Area Index (UPA) of the school ward was not associated with dental restorative treatment need (p > 0.05). Only two components of the Jarman Index, level of unemployment and the number of lone parent families in the school ward were found to be significantly associated with dental restorative treatment need (p < 0.05). Results of stepwise multiple linear regression analysis showed that the association with the school league table results in all three subjects, English, Mathematics and Science remained statistically significant after adjusting for levels of unemployment and single parents. Results of multiple linear regression analysis showed that a high level of dental restorative treatment need was significantly associated with poor school league table results in English, Mathematics and Science (p < 0.05) after adjusting for the overall Jarman score of the school ward. A separate analysis for the 11-year-old pupils aggregated by school (n = 46 schools) gave similar results. CONCLUSIONS: Aggregate measures of academic achievement may be a potential indicator of dental restorative treatment need.

Child↗

PubMed2000

Anal sphincter electromyography after vaginal delivery: neuropathic insufficiency or normal wear and tear?

The study was performed to evaluate the potential role of vaginal delivery on innervation of the external anal sphincter (EAS) muscle. Forty-four women, 18 nulliparous and 26 of varying parity (1-4), without genitourinary prolapse, major urogynecological, anorectal, or neurological dysfunction were included. Participants' histories were evaluated by a questionnaire. Quantitative concentric needle electromyography (EMG) using multi-MUP analysis for sampling motor unit potentials (MUPs) in all volunteers, and "turn/amplitude" analysis for interference pattern (IP) analysis in 13 nulliparous and 23 parous women were applied. Pools of MUPs and IPs of parous and nulliparous women were formed and compared using the Mann-Whitney U test. Multiple linear regression analysis was used for evaluation of parity and obstetric variables. No difference between the groups was found in any MUP parameter, while a significant difference was found in two of five IP parameters. On multiple linear regression analysis, the number of deliveries was related to several MUP and IP parameters: the time elapsed since last delivery to MUP, and slight stress urinary incontinence to IP parameters. A group of parous women with (slight) stress incontinence had less "pathologic" MUP parameters, compared to those without. Vaginal delivery is indeed related to EAS muscle EMG abnormalities. However, these are minor and seem not to indicate loss of sphincter function. Our study casts some doubt on the commonly accepted preconception that significant damage to peripheral innervation of the EAS occurs even during uncomplicated deliveries.

Adult↗

PubMed1999

A significant correlation between clonogenic radiosensitivity and the simultaneous assessment of micronucleus and apoptotic cell frequencies.

PURPOSE: To study the relationship between clonogenic radiosensitivity and a simultaneous assessment of the percentages of radiation-induced micronuclei (MN) and apoptotic cells. MATERIALS AND METHODS: Five mammalian cell lines were studied. Following irradiation, measurements were made of the percentages of MN, apoptotic cells and floating cells. Each factor was compared, both alone and as the simple sum of the factors, with cell survival. The factors were also evaluated using a multiple linear regression analysis. RESULTS: The simple sum of the MN and apoptotic cell percentages, the sum of the MN and floating cell percentages, and the sum of all three factors correlated with cell survival. However, the multiple linear regression analysis was the best method of predicting cell survival. CONCLUSIONS: These results suggest the usefulness of the simultaneous assessment of the MN frequency and the detection of floating cells in culture medium or apoptotic cells among attached cells to predict cellular intrinsic radiosensitivity. In order to predict cell survival after irradiation from these factors, the use of multivariate analyses is more useful than simple summation.

Animals↗

PubMed2004

Risk factors for hospitalization and infection in Canadian Inuit infants over the first year of life--a pilot study.

OBJECTIVES: Inuit infants experience higher mortality and poorer health than other Canadian infants, and suffer disproportionately from bacterial and viral infections. A wide range of inter-related factors affect their health and susceptibility to infection. The objective of the study was to describe hospitalization and morbidity patterns in a cohort of 46 healthy Inuit infants from Iqaluit, Nunavut, over their first year of life. STUDY DESIGN: Risk factors for hospitalization and infections were assessed using multiple linear regression. RESULTS: Infants experienced an average of four respiratory tract infections (RTIs) annually, which accounted for half of the hospitalizations in the cohort. Some interesting trends were evident from the assessment of risk factors using multiple linear regression. Adoption was associated with adverse health effects in addition to those that would be expected due to lack of breast-freeding alone; among infants who were not breast-fed, adopted infants had three more RTIs per year than non-adopted infants. CONCLUSION: The results of this pilot study provide support for undertaking larger epidemiological studies in order to clarify the role of these risk factors, so that future preventive efforts can be informed and effective.

Adoption↗

PubMed1983

Epidemiology and genetics of endemic goiter. I. Epidemiological aspects.

This study dealt with approximately 2,000 children and their parents living in a hyperendemic goiter area in Central Brazil, which is bounded by the jungle to the north and by a large plain to the south. The determination of goiter was made according to the methods and classification adopted by WHO. Conspicuous forms of goiter were found in 41% of the children examined. Multiple linear regression analysis showed an increase with age in the frequency of goiter in both sexes. Although data from the literature show that Mulattoes and Negroes have statistically higher frequencies of goiter than do Whites, our multiple linear regression analysis revealed no evidence for an effect of race on the endemism. There was no significant association with socioeconomic level. The presence of goiter in parents was shown to be statistically associated with its occurrence in the children.

Adolescent↗

PubMed1998

Use of indapamide in hospital and community clinics and its effect on plasma potassium in Chinese patients.

OBJECTIVES: To investigate the usage pattern of indapamide and other antihypertensive drugs in patients attending a community-based government outpatient clinic (GOPC) or a hospital-based specialist clinic (SC). The plasma potassium concentrations of patients receiving indapamide and other diuretics were also examined. METHOD: Prescriptions from the SC and the GOPC were reviewed and collected during January 1998. Patients' plasma potassium concentrations and the date of initiation of each medication were retrieved from the hospital computer databases at SC. An age- and sex-matched control group of patients on non-diuretic antihypertensive drugs was identified. RESULTS: A total of 1648 and 773 prescriptions were collected from the SC during a 1-week period and GOPC during a 1-month period, respectively. Approximately half (45%) of the patients received antihypertensive treatment. Indapamide was five times more frequently prescribed in GOPC than SC (84.7 vs. 17.7%, P<0.001). Calcium channel blocking agents were the commonest antihypertensive drugs used in both clinics. The mean plasma potassium concentration of patients taking indapamide was lower than that of the control group (P = 0.037). Multiple linear regression analysis showed that consumption of indapamide (P =0.002) and duration of diuretic therapy (P = 0.023) were significantly related to changes in plasma potassium concentrations [multiple regression equation for potassium level = 4.09-0.145 (thiazide = 1)-0.377 (indapamide = 1) -0.00468 (duration of diuretic therapy in months)]. CONCLUSION: Indapamide was used extensively in the community clinic and less in the hospital-based outpatient clinic. Patients receiving indapamide had a significantly lower plasma potassium concentration as compared to other diuretics or antihypertensive groups and this was predicted by a multiple linear regression model. Monitoring plasma electrolytes before initiation of indapamide treatment and at regular intervals thereafter is essential for detecting the hypokalaemia that may occur in Chinese patients.

Aged↗

PubMed2001

Quality of life and psychological adaptation after surgical treatment for localized renal cell carcinoma: impact of the amount of remaining renal tissue.

OBJECTIVES: To analyze the quality of life and psychological adjustment after surgical therapy for localized renal cell carcinoma. METHODS: Postal questionnaires including measures of quality of life (SF-36) and the impact of the stress of cancer (Impact of Events Scale) were completed by 97 patients who had undergone radical or partial nephrectomy for localized renal cell carcinoma. Data were analyzed for the group as a whole and comparing the partial nephrectomy and radical nephrectomy groups. The variables examined included the impact of the type of partial nephrectomy (elective versus mandatory) and the amount of self-reported renal tissue remaining. RESULTS: The quality of life for the group as a whole was good, with no significant differences between the sample and U.S. norms for an age and sex-matched community sample on both the mental and physical health composite scores. Having undergone a partial versus a radical nephrectomy did not influence the patients' overall quality of life. Multiple linear regression modeling demonstrated that having more remaining renal parenchyma was an independent predictor of better self-reported physical health on the SF-36 (P <0.001). The entire sample had low mean scores on both avoidance and intrusion on the Impact of Events Scale, suggesting a lack of daily anxiety about cancer. Multiple linear regression modeling showed that patients who reported having more remaining renal parenchyma had lower intrusion and avoidance scores (P = 0.002 and 0.01, respectively). Multiple logistic regression modeling also demonstrated that the patients' perception of their remaining renal parenchyma was associated with less concern about cancer recurrence (P = 0.018) and less impact of cancer on patients' overall health (P <0.001). CONCLUSIONS: Most survivors of localized kidney cancer have normal physical and mental health regardless of the type of nephrectomy performed. The quality of life is better for patients with more renal parenchyma remaining after surgery for localized renal cell carcinoma.

Adaptation, Psychological↗