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PubMed1999

Perinatal mortality in Taiwan.

Information on perinatal deaths was obtained from 310 women by collecting detailed obstetric histories dating from marriage to the start of the survey. These histories were compared to those of 688 age matched controls. Potential risk factors, levels and time trends of perinatal mortality in Taiwan were examined and factors underlying stillbirths and early neonatal deaths were also compared using conditional logistic regression analyses. A nearly 56% decline of the perinatal mortality rate during the 35 y, approximately, prior to the survey was observed. Risk of stillbirths was increased among those who had abused illegal drugs during pregnancy, those who reported that the pregnancy was unwanted and those with Thalassemia trait. Body mass index was log-linearly related with stillbirths, with higher body mass associated with higher risk. For early neonatal deaths, those mothers aged 19 y or less, those giving birth to either their first children or to their fifth or later child, those who had their first prenatal care visit after the first three months of pregnancy were associated with increased risk in the logistic model. Those with a birth interval of less than two years and those with less education were associated with increased risk in both perinatal death groups. While some of these factors have already been associated with perinatal deaths, others have not; the new associations provide clues to mechanisms by which the risk of death increases before or after delivery.

Age Factors↗

PubMed1990

Differential survival rates among low-birth-weight black and white infants in a tertiary care hospital.

Birth-weight-specific mortality is lower for black prematures than white prematures of similar low birth weight. The reason for this well-recognized phenomenon is unknown. We investigated the extent to which black and white infants differ in their gestational maturity and incidence of potentially lethal risk factors, and the effect these factors might have on differential mortality risk. The population studied comprised babies born alive in a tertiary care hospital with birth weights from 700 to 1800 g over a 4 1/2-year period. Univariate analysis showed no important difference between races for the incidence of lung disease, Apgar scores, birth weight, or gestational age. Infants with a birth weight below the 10th percentile (small for gestational age) were more likely to be black, and infants with a birth weight above the 90th percentile (large for gestational age) who had a survival disadvantage were usually white. The crude odds ratio for the white race was 1.79 (1.18-2.73). When the demographic, morbidity, and growth variables were put into a logistic model, the odds ratio changed only slightly, to 1.52 (1.14-2.03). We conclude that the majority of the black-white difference in birth-weight-specific survival is not due to a higher incidence of black small-for-gestational-age infants, nor is it due to differences in major morbidities associated with death.

Academic Medical Centers↗

PubMed1998

Predicting survival, length of stay, and cost in the surgical intensive care unit: APACHE II versus ICISS.

BACKGROUND: Risk stratification of patients in the intensive care unit (ICU) is an important tool because it permits comparison of patient populations for research and quality control. Unfortunately, currently available scoring systems were developed primarily in medical ICUs and have only mediocre performance in surgical ICUs. Moreover, they are very expensive to purchase and use. We conceived a simple risk-stratification tool for the surgical ICU that uses readily available International Classification of Diseases, Ninth Revision, codes to predict outcome. Called ICISS (International Classification of Disease Illness Severity Score), our score is the product of the survival risk ratios (obtained from an independent data set) for all International Classification of Diseases, Ninth Revision, diagnosis codes. METHODS: A total of 5,322 noncardiac patients admitted to a surgical ICU during an 8-year period had their Acute Physiology and Chronic Health Evaluation (APACHE) II scores compared with their ICISS as predictors of outcome (survival/nonsurvival, length of stay, and charges). RESULTS: ICISS proved to be a much better predictor of survival than APACHE (receiver operating characteristic (ROC) APACHE = 0.806; Hosmer-Lemeshow (HL) APACHE = 22.56; ROC ICISS = 0.892; HL ICISS = 12.06) or the APACHE survival probability (ROC = 0.836; HL = 34.47). These differences were highly statistically significant (p < 0.001). ICISS was also better correlated with ICU length of stay (APACHE R2 = 0.06; ICISS R2 = 0.32) and ICU charges (APACHE R2 = 0.07; ICISS R2 = 0.39). When combined in a logistic model with ICISS, APACHE II added slightly to the predictive power of ICISS alone (combined ROC = 0.903) but degraded the calibration of the model (combined HL = 16.29; p = 0.038). CONCLUSION: Because ICISS is both more accurate and much less expensive to calculate than APACHE II score, ICISS should replace APACHE II score as the standard risk stratification tool in surgical ICUs.

APACHE↗

PubMed1996

Associations of types of lens opacities between and within eyes of individuals: an application of second-order generalized estimating equations. The Framingham Eye Studies Group.

The lens opacity characteristics of individuals constitute multivariate data. Our goal was to estimate the associations between the three main types of age-related lens opacities (nuclear, cortical, posterior subcapsular) both between and within eyes of individuals using cross-sectional data from the Framingham (Massachusetts) Eye Studies. We describe use of a recently proposed extension of the generalized estimating equations approach to marginal logistic models (GEE2), and we demonstrate that a variety of research problems can be investigated with this methodology. For example, in our data, there were strong associations of the same opacity types between the two eyes of individuals and weak associations between different types of opacities. We also note that estimation of such associations may be limited in other epidemiologic settings.

Age Factors↗

PubMed2003

Psychosocial factors predict coronary heart disease, but what predicts psychosocial risk in women.

OBJECTIVES: Psychosocial factors, including depression, anger, and social isolation, have been associated with increased morbidity and mortality from coronary heart disease (CHD), but predictors of psychosocial burden among women with CHD are poorly defined. The purpose of this study was to determine whether readily measured demographic and risk factors could identify women with psychosocial risk factors that are more difficult to assess in a clinical setting. METHODS: Baseline data on 304 women (mean age 62 years, 52% minority) hospitalized with CHD at 3 academic medical centers participating in a clinical study of adherence to prevention guidelines were evaluated. Standardized questionnaires were used to measure depression (4-item self-report tool from the Primary Care Evaluation of Mental Disorders questionnaire) and anger (Spielberger Trait Anger Scale). One self-report question was used to assess social isolation. RESULTS: Thirty-seven percent of women with CHD reported depression, 50% reported anger, and 41% reported social isolation. In a logistical model controlling for confounders, independent predictors of depression were having dependents (odds ratio [OR] = 2.27, p = .006), age (< or = 65 years) (OR = 1.91, p = .02), and exercise (< 3 days/week) (OR = 3.92, p < .001). Anger was associated with having dependents (OR = 3.16, p < .001), age (< or = 65 years) (OR = 1.95, p = .02), and smoking (OR = 2.05, p = .04). Subjects who had dependents (OR = 2.24, p = .005), were unemployed (OR = 1.93, p = .03), and who did not get enough exercise (< 3 days/week) (OR = 2.07, p = .03) reported higher isolation in adjusted models. Differences in prevalence of psychosocial factors by ethnicity were not statistically significant. However, there was a trend toward increased prevalence of psychosocial risk factors among white women, possibly reflecting the need for more culturally sensitive screening tools. CONCLUSION: These data may be helpful in identifying women who are at risk of increased CHD morbidity and mortality because of psychosocial burden.

Adult↗

PubMed1993

Prognostic factors for groin node metastasis in squamous cell carcinoma of the vulva (a Gynecologic Oncology Group study)

From 1977 to 1984 the Gynecologic Oncology Group (GOG) conducted a prospective clinical and surgical staging protocol of squamous cell carcinoma of the vulva (n = 637). The patients with superficial (5 mm or less invasion) lesions were the subject of a previous report (n = 272). The subject of this report is on factors that predict groin node metastasis based on all 588 evaluable patients. Comparisons between the two reports are made. Almost half of this group (49.3%) had minimal tumor thickness (< or = mm). Almost one-third of patients had small vulvar lesions (< or = cm). Groin node metastasis was 18.9% for the < or = 2-cm diameter tumors and 41.6% for the > 2-cm diameter lesions. The inaccuracy of clinical palpation of the groin nodes (23.9% false negative) largely accounts for underestimation of extent of disease. Body weight was not related to the sensitivity of detecting positive groin nodes (P = 0.26). Using the logistic model, independent predictors of positive groin nodes were identified (in order of importance): less tumor differentiation by GOG criteria (P < 0.0001), suspicious or fixed/-ulcerated nodes (P < 0.0001), presence of capillary-lymphatic involvement (P < 0.0001), older age (P = 0.0002), and greater tumor thickness (invasion) (P = 0.03). Lesion size and location were not independent predictors of positive groin nodes.

Aged↗

PubMed2004

Analysis of two sling procedures using polypropylene mesh for treatment of stress urinary incontinence.

OBJECTIVES: To evaluate and compare the surgical outcome between the innovative tension-free vaginal tape (TVT) and conventional pubovaginal sling (PVS) procedures using polypropylene mesh. METHODS: Eighty consecutive women with urodynamic stress urinary incontinence (SUI), who chose to undergo either a TVT (n=23) or a PVS (n=57) procedure using polypropylene mesh based on financial consideration, were recruited for this study. The surgical results were analyzed and compared subjectively and objectively. RESULTS: The mean follow-up interval was 23 months for the TVT and 20 months for the PVS procedure (P=0.062). Postoperatively, SUI (91.3% vs. 93.0%), concomitant urge symptoms (85.0% vs. 85.3%) and the negative impact of incontinence and urogenital distress on patients' quality of life (79.8% vs. 77.8%) (77.4% vs. 68.8%) had improved markedly. After a multivariable logistic regression analysis, the treatment outcome of SUI was found to be independent of the main effects of patient age, parity, concurrent gynecological surgeries, intrinsic sphincter deficiency, previous failed incontinence surgeries, and concomitant urge symptoms. However, it was significantly related to treatment procedures (TVT vs. PVS) and their interaction with patient body mass index (BMI). Based on the fitted logistic model, we see that TVT performs better than PVS when BMI is less than 27.27 kg/m2, and the advantage of TVT decreases as BMI increases. CONCLUSION: Both TVT and PVS procedures using polypropylene mesh are effective treatment modalities for female SUI. However, TVT was not as effective in treating overweight or obese women as PVS.

Adult↗

PubMed2002

Risk factors for L. monocytogenes contamination of dairy products in Switzerland, 1990-1999.

Our purpose was to identify the main hazards associated with the spread of Listeria monocytogenes in dairy products in Switzerland and to determine the changes in predominant serotypes of the isolates, using databases on dairy-processing and environments from the Swiss Dairy Research Station during the years 1990-1999. Overall, of 76,271 samples collected, 3722 (4.9%) were positive for the presence of L. monocytogenes. Cheese-ripening facilities had the highest proportion of positive samples (7.6%), followed by small-scale local dairies (4.4%). By sample type, the highest proportion of positive samples (9.5%) was observed in water samples used for cheese-washing, followed by cheese-surface swabs (5.0%). During the 10-year period, no positive samples were obtained from cream, ice cream, milk powder, yogurt, or fresh cheese. Of 3722 L. monocytogenes isolates, 1328 (35.7%) were serologically typeable. Serotypes 1/2a, 1/2b, and 4b accounted for 92.7% of the 1328 isolates. Until 1995, the most-prevalent serotype was 1/2b (annual proportional prevalence 39.3-72.2%)--whereas since 1996, 1/2a was the most prevalent (34.7-54.7%). During 1996-1999, serotype 1/2a increased by 88%, compared to the average of 1990-1995. In the final random-effect multivariable logistic model, the strongest predictor of a positive culture was samples from cheese-ripening plant (OR=1.54; 95% CI: 1.14, 2.08) and the second-strongest predictor was samples collected by someone who was employed by the plant (OR=1.48; 1.29, 1.71). Hard and semi-hard cheeses were more likely to be associated with serotype 1/2b and soft cheeses with serotype 1/2a.

Animals↗

PubMed1999

Geometry of proximal femur in the prediction of hip fracture in osteoporotic women.

111 White post-menopausal women with hip fracture and 329 healthy controls were studied in order to determine whether proximal femur geometry predicts hip fracture and improves the discriminant ability of femoral neck bone mineral density (BMD) in elderly women. All subjects underwent dual X-ray photon absorptiometry (DXA) of the hip from which the femoral neck BMD, hip axis length, femoral neck width and femoral neck-shaft angle were measured. Fractured subjects had a lower femoral neck BMD, a longer hip axis length and a more valgus neck-shaft angle. The hip axis length correlated significantly with neck-shaft angle, femoral neck width and age. No significant correlation was found between neck-shaft angle and age. On standardized logistic regression, the hip axis length and the neck-shaft angle predicted fracture independently of BMD after correction for age, weight and femoral neck BMD. The femoral neck BMD significantly discriminated fractured subjects after correction for all potential confounders. The logistic models containing simultaneously one femoral geometric parameter and the neck BMD discriminated significantly better than those containing the same variables as single predictor. Our data suggest that hip axis length may play a role in fracture risk and supports a similar role for neck-shaft angle. Combining proximal femur geometric measurements and femoral neck BMD improved the discriminant ability of each measurement.

Absorptiometry, Photon↗

PubMed2001

Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients.

Although various studies reported that pulse pressure, an indirect index of arterial stiffening, was an independent risk factor for mortality, a direct relationship between arterial stiffness and all-cause and cardiovascular mortality remained to be established in patients with essential hypertension. A cohort of 1980 essential hypertensive patients who attended the outpatient hypertension clinic of Broussais Hospital between 1980 and 1996 and who had a measurement of arterial stiffness was studied. At entry, aortic stiffness was assessed from the measurement of carotid-femoral pulse-wave velocity (PWV). A logistic regression model was used to estimate the relative risk of all-cause and cardiovascular deaths. Selection of classic risk factors for adjustment of PWV was based on their influence on mortality in this cohort in univariate analysis. Mean age at entry was 50+/-13 years (mean+/-SD). During an average follow-up of 112+/-53 months, 107 fatal events occurred. Among them, 46 were of cardiovascular origin. PWV was significantly associated with all-cause and cardiovascular mortality in a univariate model of logistic regression analysis (odds ratio for 5 m/s PWV was 2.14 [95% confidence interval, 1.71 to 2.67, P<0.0001] and 2.35 [95% confidence interval, 1.76 to 3.14, P<0.0001], respectively). In multivariate models of logistic regression analysis, PWV was significantly associated with all-cause and cardiovascular mortality, independent of previous cardiovascular diseases, age, and diabetes. By contrast, pulse pressure was not significantly and independently associated to mortality. This study provides the first direct evidence that aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in patients with essential hypertension.

Adult↗

PubMed1998

Sex differences in the association between childhood experiences and adult depression.

BACKGROUND: In the present paper, sex differences in the association between adult depression and childhood experiences were examined. METHODS: The study series of the Finnish UKKI Study consisted of a population sample of 501 men and 499 women. Information concerning childhood experiences was gathered retrospectively in a baseline survey carried out in 1969-72. After the initial phase, the mental health of the subjects was evaluated by interviews, questionnaires and register data at the 5-year follow-up (1974-6) and at the 16-year follow-up (1985-7). RESULTS: Twelve per cent of men and 21% of women had suffered from depression during the 16-year follow-up period. A disturbed mother-child relationship and neurotic symptoms in childhood were associated with depression in women but not in men in the logistic model that included gender interaction. In separate analyses by gender several childhood factors showed statistically significant associations with depression in women but only a few in men. CONCLUSIONS: The finding suggests that childhood experiences are more highly predisposing factors to depression in women than in men.

Adolescent↗

PubMed2006

Changes in the prevalence of alcohol use during pregnancy among recent and at-risk drinkers in the NLSY cohort.

PURPOSE: To support efforts to prevent fetal alcohol syndrome (FAS), population-based data are needed on the prevalence of alcohol use at any time during gestation, particularly among women who were recent and at-risk drinkers. METHODS: We used National Longitudinal Survey of Labor Market Experiences in Youth (NLSY) files to estimate the prevalence of any drinking during pregnancy and to evaluate alcohol history risk factors among 6676 births reported by women with prepregnancy drinking data. Prevalence estimates were obtained for 2-year intervals for all 1982-1995 births and for subsets with prepregnancy recent and at-risk drinking. RESULTS: Among all births, drinking during pregnancy declined from 38.3% in 1982-1983 to 23.0% in 1994-1995 (p < 0.0001). Drinking during pregnancy also declined over time among recent and at-risk drinkers (p < 0.0001), but the 1994-1995 prevalences were still high (39.3% and 29.0%, respectively). Adjusted logistic models confirmed both the decrease in risk for the later birth years and the persistent heightened risk for births among recent and at-risk drinkers. CONCLUSIONS: In addition to ongoing universal prevention strategies that have helped reduce the prevalence of drinking during pregnancy, selective and indicated prevention approaches are needed to encourage abstinence during pregnancy among recent and at-risk drinkers.

Adolescent↗

PubMed1995

Toothbrushing and the occurrence of salivary mutans streptococci children at day care centers.

Risk factors for the occurrence of salivary mutans streptococci (MS) were surveyed in 677 children aged 1-8 years (4.9 +/- 1.2; mean +/- SD) at 20 municipal day care centers in Oulu. As a part of an intervention program to reduce the spread of infectious diseases, toothbrushing was discontinued in 10 centers, the other 10 serving as controls. The test for MS was performed on 506 children before the 8-month intervention, on 358 at the end and on 345 on both occasions. Past caries experience was recorded from the children's dental health cards (dmf). Dental health habits were evaluated by means of questionnaires filled in by the parents. The occurrence of MS varied from 43.4 to 48.0%. Although those children who cleaned their teeth regularly at home carried less MS than those who did so irregularly (46.4 vs. 64.9%, p < 0.001), the withdrawal of toothbrushing at the day care center did not increase the incidence of MS. The occurrence of MS was increased by consumption of sweets containing sucrose (p < 0.01) and reduced by the regular use of fluoride tablets (p < 0.02). Logistic modeling showed a positive MS test to be associated significantly with older age (p < 0.01) and female sex (p < 0.05) in addition to toothbrushing at home (p < 0.001). The children with positive tests had significantly higher mean (+/- SD) dmf than those with negative ones (1.6 +/- 2.7 vs. 0.3 +/- 1.2, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

PubMed1996

Relation of maternal race to the risk of preterm, non-low birth weight infants: a population study.

The authors used 1982-1983 Illinois vital records and 1980 US Census income data to determine the contribution of maternal race to the risk of preterm (< 260 days), non-low birth weight (> 2,500 g) infants. This older cohort was chosen to avoid the confounding effect of cocaine associated with its increased local availability after 1985. In Chicago, the unadjusted preterm, non-low birth weight rate was 14% for African Americans (n = 43,059) compared with 9% for Mexican Americans (n = 10,397) and 7% for whites (n = 26,152) (odds ratio = 1.7, 95% confidence interval 1.6-1.8; odds ratio = 2.4, 95% confidence interval 2.3-2.5, respectively). In logistic models that included maternal sociodemographic and prenatal care variables, the adjusted odds ratio of preterm, non-low birth weight for. African Americans compared with Mexican Americans and whites was 1.6 (95% confidence interval 1.4-1.8) and 1.5 (95% confidence interval 1.2-1.7), respectively. The authors conclude that some factor closely linked to the African-American race, not underserved minority status per se, is a fundamental cause of preterm, non-low birth weight.

Adult↗

PubMed1999

Prenatal and perinatal risk factors for autism.

AIM: To identify pre- and perinatal risk factors for autism. METHOD: Case control study. We matched names of patients from North Dakota who met DSM criteria for autism, a pervasive developmental disorder, and autistic disorder with their birth certificates. Five matched controls were selected for each case. RESULTS: Univariate analysis of the 78 cases and 390 controls identified seven risk factors. Logistic modeling to control for confounding produced a five variable model. The model parameters were chi 2 = 36.6 and p < 0.001. The five variables in the model were decreased birth weight, low maternal education, later start of prenatal care, and having a previous termination of pregnancy. Increasing father's age was associated with increased risk of autism. CONCLUSION: This methodology may provide an inexpensive method for clinics and public health providers to identify risk factors and to identify maternal characteristics of patients with mental illness and developmental disorders.

Age Factors↗

PubMedDate not supplied

[Risk profiles for mental disorders in the general population].

This study examined, in the general population, the effect which different sociodemographic variables and the presence of physical illness esserted on the probability of suffering from mental disorders. For this we applied, among other instruments, the GHQ-60 to a random sample of 1.223 persons from a community of Cantabria. The estimated probable prevalence of mental disorders detected with the GHQ-60 was 14.7% (6.5% for males and 19.6% for females). the analysis, by means of logistic modelling, of the influence which 6 sociodemographic variables and physical illness exerted on the probability of suffering from psychiatric illness revelled that is possible to establish for each sex a specific profile of risk of suffering from psychiatric disorders. Two factors, physical illness, in both sexes, and absence of work, exclusively on males, appears to have a significant influence on the probability of suffering from minor psychiatric disorders.

Adolescent↗

PubMed1999

Effectiveness of in-ward management of femoral access after invasive procedures using large sheaths.

BACKGROUND: The cost-effectiveness of expensive suture mediation devices for the management of femoral access is currently under investigation, while the effectiveness of in-ward femoral access management by standard care has not yet been assessed. METHODS: To determine whether a logistic model that includes management of femoral access by the cardiology ward staff is effective, 945 consecutive invasive procedures using > or = 8 Fr sheaths were prospectively screened over a 6-month study period. Vascular complications included: any need for surgical or endovascular repair, ultrasound-guided compression, any femoral or iliac bleeding requiring blood transfusion. RESULTS: During the study period there were 581 diagnostic procedures, and 364 interventional procedures. Interventional procedures included 98 primary PTCA, 42 coronary atherectomies, and 39 intraaortic balloon pump supported PTCA. Vascular complication rate was 1.6% (surgical repair 0.2%, ultrasound-guided compression 1.1%, blood transfusion 0.3%). CONCLUSIONS: The vascular access management by the cardiology ward staff was associated with a very low rate of vascular complications. This policy may play a role in reducing costs and improving logistics.

Aged↗

PubMed2001

Smoking habit and interleukin lB C-31T polymorphism.

Recent studies suggest that smoking habit may relate to genetic traits. This study examines the association with a polymorphism (C-31T) of interleukin 1B (IL-1B), which encodes IL-1beta, a multifunctional pro-inflammatory cytokine. Since the T allele makes a TATA box, the allele is thought to be responsible for a higher potency of IL-1B expression, indicating that individuals harboring the T allele are prone to inflammation. The study subjects were two different populations; 241 non-cancer outpatients (118 males and 123 females) at a cancer hospital and 462 examinees (127 males and 335 females) of a health checkup program provided by a local government. Current smokers were 36.4% for the male outpatients, 9.8% for the female outpatients, 38.6% for the male examinees, and 5.6% for the female examinees. The sex-age-adjusted odds ratios of current smokers were calculated for the genotypes with the T allele relative to the CC genotype by an unconditional logistic model. The estimate was 0.45 (95% confidence interval, 0.21-0.97) for the outpatients, and 0.83 (0.42-1.61) for the examinees. Although not significant for the examinees, the observed associations suggest that this polymorphism may influence smoking behavior through an inflammatory response of the respiratory tract to cigarette smoke.

Adult↗