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PubMed2006

Alcohol use and health-related quality of life among youth in Taiwan.

PURPOSE: To examine the extent to which the use of the three most commonly consumed drugs in Taiwan (i.e., alcohol, tobacco, and betel nut) is related with health-related quality of life among adolescents. We probe whether the relationship linking alcohol use with health-related quality varies by health-orientated domains (e.g., physical, social, or emotional) and if it differs with other drug involvement. METHOD: The data for this study come from a representative sample of 2235 adolescents (aged 12-18 years) collected as part of the 2001 National Health Interview Survey (NHIS), conducted in Taiwan. Recent alcohol, tobacco, and betel nut experiences were assessed by face-to-face interview. The 36-item short form Health Survey (SF-36) was used to assess respondents' generic health status. RESULTS: Youth with recent alcohol use tend to experience a poorer level of health-related quality of life. The estimated associations were not constant over the eight domains of general health examined, and multivariate modeling with generalized linear models and generalized estimating equations found that the strongest inverse relationship appears in the domain of role limitation due to emotional problems (beta = -10.5, 95% confidence interval [CI]: -16.9-4.12, p < .001). Greater deleterious effects were not found among youth also using tobacco and/or betel nut. CONCLUSIONS: Alcohol use was shown to be associated with impaired levels of health-related quality of life in adolescents. Although the temporality between alcohol involvement and lower levels of mental health is not explicit, the findings suggest that youth who are actively drinking might be a possible target group to intervene and avert mental health-related problems.

Adolescent↗

PubMed2026

Does impulsivity predict treatment outcomes in PTSD with borderline personality disorder features? Results from a randomized clinical trial.

BACKGROUND: Trauma-focused psychotherapies are first-line treatments for posttraumatic stress disorder (PTSD). However, a substantial proportion of clients do not respond adequately or drop out of therapy prematurely. This has sparked interest in identifying individual-level predictors of treatment outcomes, including improvement in PTSD severity and dropout. Impulsivity may be a predictor because it may interfere with key therapeutic processes, such as cognitive restructuring and emotional processing. Consequently, we present a hypothesis-driven secondary analysis of a 15-month randomized clinical trial comparing Dialectical Behavior Therapy for PTSD (DBT-PTSD) and Cognitive Processing Therapy (CPT) in women with childhood abuse-related PTSD and borderline personality disorder features to test whether impulsivity, assessed at baseline, predicts PTSD improvement and dropout. We further explore whether the dimensions of impulsivity (non-planning, attentional impulsivity, and motor impulsivity) differentially affect the outcomes in DBT-PTSD vs. CPT. METHODS: A total of 193 cis women with PTSD related to childhood abuse and borderline personality disorder features were assessed using the Clinician-Administered PTSD Scale (CAPS) and the Barratt Impulsiveness Scale (BIS-10). Separate probit models and general linear models were applied to predict dropout and pre-to-post changes in PTSD severity (ΔCAPS) from total impulsivity and subscale scores, i.e. non-planning, attentional and motor impulsivity. RESULTS: Overall, dropout rates were higher for participants with higher baseline impulsivity scores (p = 0.049), particularly for those with higher non-planning impulsivity (p = 0.012). In participants randomized to CPT improvement in PTSD symptom severity (ΔCAPS) was negatively related to baseline total impulsivity (p = 0.021). In participants randomized to DBT-PTSD this relation was not significant. CONCLUSIONS: The results suggest that impulsivity may predict treatment outcomes. Specifically, patients with elevated impulsivity may be less likely to respond adequately to CPT. If replicated, these findings have implications for personalization of treatment.

Humans↗

PubMed2005

Spatial distribution of Escherichia coli O157-positive farms in Scotland.

Using a sample of 949 Scottish farms with finishing cattle, the spatial distribution of Escherichia coli O157-positive farms was investigated using disease mapping models. The overall prevalence of E. coli O157-positive farms was estimated as 22%. The regions used in this study were the 16 postcode areas of Scotland. For each region, the posterior relative risk (RR) was estimated as a model-based alternative to the saturated standardized morbidity ratio (SMR), i.e., the ratio between observed and expected cases in a region. Three Bayesian hierarchical models with generalized linear modeling of the area-specific risks were used to estimate the posterior relative risk of E. coli O157-positive farms in the postcode areas: a random-effects model incorporating only spatially uncorrelated heterogeneity; a model incorporating both spatially correlated and uncorrelated heterogeneity; and a pseudo-mixture model with unstructured correlation and a weighted mix of two variance components representing the spatial correlation and a jump structure. None of the models identified any areas with a significant increase or decrease in risk. The deviance information criteria slightly favored the simplest model (RR range: 0.92--1.09). However, this model appeared to smooth out more of the variation in the RR compared to the pseudo-mixture model, which gave a more informative pattern of the posterior relative risks (range: 0.81--1.22).

Animals↗

PubMed2005

Risk factors predicting survival of liver transplantation.

Prognostic models were developed for analyzing graft survival in a single-center study consisting of all 388 adult liver transplantations performed during 20 years. Proportional hazard models and generalized linear models were used to assess which risk factors, related to donor and recipient characteristics as well as graft preservation and operation, had an effect on graft survival. The prognostic modeling evidenced favorable trends in graft survival time during the successive quinquennials 1982-1987, 1988-1992, and 1993-1997, in comparison to the referent time period 1998-2002. Significant predictors of graft survival time were donor's age, recipient-donor gender compatibility, recipient's blood group, intraoperative blood transfusion, size of the transplanted organ, and indication for transplantation. Conventional histocompatibility matching did not correlate with graft outcome.

Adult↗

PubMed1998

Pharmacodynamics of variable patient compliance: implications for pharmaceutical value.

Pharmaceutical value, a multidimensional factor that includes proven efficacy, is now crucial to market success. A key parameter of value is reliability in use, determined by the several sources of variance in drug response, e.g. the Harter-Peck model, based on linear pharmacometrics of theophylline, whose dose-response has an estimated 80% coefficient of variation, due mainly to variable pharmacokinetics and non-compliance. The main forms of non-compliance are multiday intervals between doses, the impact of which is difficult to assess because too little is known of the time-course of drug actions after dosing stops ('off-responses'). Omeprazole, the best-selling drug, is an exception, and its off-response data reveal markedly non-linear pharmacodynamics that appear to filter most of the variance that a linear model passes, projecting a big gain in reliability. The impact of variable compliance is attenuated by 'forgiveness', the post-dose duration of effective action (4-5 days for omeprazole) minus its recommended dosing interval.

Journal Article↗

PubMed1999

Multiple modes of inner hair cell stimulation.

Most current theories of cochlear mechanics assume that the pattern of cochlear partition vibration is simple, similar to that of a bending beam. Recent evidence suggests, however, that the vibration of the organ of Corti can be complex and that multiple vibrational modes may play an important role in cochlear transduction. Inner hair cell (IHC) and auditory nerve responses to pure tones can exhibit large phase shifts and complex response waveforms with increasing stimulus level. In contrast, the comparable basilar membrane (BM) responses are much less complex, exhibiting only small phase shifts and relatively sinusoidal waveforms. To reconcile the differences observed between the published BM data and the IHC data, we have recorded receptor potentials from IHCs and compared these waveform data to the output of two computational models: a traditional linear model where IHC excitation depends only on BM displacement and a new model that assumes that outer hair cell (OHC) force production provides the major mechanical input to the IHC along with two additional mechanical components. Comparisons of the output of the two models with the experimental data show that the new model is capable of reproducing the very complex voltage responses of the IHC recorded in vivo whereas the traditional model performed poorly.

Acoustic Stimulation↗

PubMedDate not supplied

Longitudinal investigation of exposure to arsenic, cadmium, chromium and lead via beverage consumption.

Semi-quantitative food checklists and duplicate beverage samples were collected from up to 80 individuals in Maryland in 1995-1996 in as many as six approximately equally spaced sampling cycles as part of a pilot longitudinal exposure investigation. The duplicate beverage samples were homogenized and analyzed for arsenic (As), cadmium (Cd), chromium (Cr) and lead (Pb) using inductively coupled plasma mass spectrometry (ICP-MS). Metal concentrations (microg/kg) and weights of the duplicate beverage samples (kg/day) were used to derive average daily exposure (microg/day) for each metal. Mixed models and generalized linear models were used to evaluate temporal and population variability of the beverage consumption rates, the log-transformed metal concentrations in the beverage samples, and the associated exposures. The mean number of beverage servings consumed per day was 3.4 (SD 1.9). The temporal variability of the total beverage consumption rates was found to be significant (p = 0.0476). As, Cd, Cr, and Pb were present at quantifiable levels in 93.5, 76.0, 93.5, and 96.7% of the beverage samples, respectively. The mean concentration in the samples was 2.0 (SD 4.4) microg/kg for As, 0.9 (1.6) for Cd, 29.2 (138.5) for Cr, and 2.0 (2.4) for Pb. The mean log-transformed concentrations for As, Cr and Pb and exposure for As varied by as much as a factor of 3 across sampling cycles and were statistically significantly different (p<0.05). Concentrations and exposures of all four metals varied significantly among participants. These findings are discussed with respect to the data collection methods, results from comparable studies, and implications for exposure and risk assessment.

Arsenic↗

PubMed2004

Influence of relatively low level of particulate ar pollution on hospitalization for COPD in elderly people.

To assess the association between relatively low levels of size-fractioned particulate matter (PM) and hospitalization for chronic obstructive pulmonary disease (COPD), we conducted a time-series analysis among elderly people 65 yr of age or more living in Vancouver between June 1995 and March 1999. Measures of thoracic PM (PM(10)), fine PM (PM(2.5)), coarse PM (PM(10-2.5)), and coefficient of haze (COH) were examined over periods varying from 1 to 7 days prior to hospital admissions. Generalized additive models (GAMs; general linear models, GLMs) were used, and temporal trends and seasonal and subseasonal cycles in COPD hospitalizations were removed by using GLM with parametric natural cubic splines. The relative risks were calculated based on an incremental exposure corresponding to the interquartile range of these measures, and were adjusted for daily weather conditions and gaseous pollutants. PM measures had a positive effect on COPD hospitalization, especially 0 to 2 days prior to the admissions, before copollutants were accounted for. For 3-day average levels of exposure the relative risk estimates were 1.13 (95% confidence interval: 1.05-1.21) for PM(10), 1.08 (1.02-1.15) for PM(2.5), 1.09 (1.03-1.16) for PM(10-2.5), and 1.05 (1.01-1.09) for COH. The associations were no longer significant when NO(2) was included in the models. We concluded that the particle-related measures were significantly associated with COPD hospitalization in the Vancouver area, where the level of air pollution is relatively low, but the effects were not independent of other air pollutants.

Aged↗

PubMed2005

Spatial ascariasis risk estimation using socioeconomic variables.

Frequently, disease incidence is mapped as area data, for example, census tracts, districts or states. Spatial disease incidence can be highly heterogeneous inside these areas. Ascariasis is a highly prevalent disease, which is associated with poor sanitation and hygiene. Geostatistics was applied to model spatial distribution of Ascariasis risk and socioeconomic risk events in a poor community in Rio de Janeiro, Brazil. Data were gathered from a coproparasitologic and a domiciliary survey in 1550 children aged 1-9. Ascariasis risk and socioeconomic risk events were spatially estimated using Indicator Kriging. Cokriging models with a Linear Model of Coregionalization incorporating one socioeconomic variable were implemented. If a housewife attended school for less than four years, the non-use of a home water filter, a household density greater than one, and a household income lower than one Brazilian minimum wage increased the risk of Ascariasis. Cokriging improved spatial estimation of Ascariasis risk areas when compared to Indicator Kriging and detected more Ascariasis very-high risk areas than the GIS Overlay method.

Adolescent↗

PubMed2000

Effect of the fine fraction of particulate matter versus the coarse mass and other pollutants on daily mortality in Santiago, Chile.

Daily counts of non-accidental deaths in Santiago, Chile, from 1988 to 1996 were regressed on six air pollutants--fine particles (PM2.5), coarse particles (PM10-2.5), CO, SO2, NO2, and O3. Controlling for seasonal and meteorological conditions was done using three different models--a generalized linear model, a generalized additive model, and a generalized additive model on previously filtered data. Single- and two-pollutant models were tested for lags of 1-5 days and the average of the previous 2-5 days. The increase in mortality associated with the mean levels of air pollution varied from 4 to 11%, depending on the pollutants and the way season of the year was considered. The results were not sensitive to the modeling approaches, but different effects for warmer and colder months were found. Fine particles were more important than coarse particles in the whole year and in winter, but not in summer. NO2 and CO were also significantly associated with daily mortality, as was O3 in the warmer months. No consistent effect was observed for SO2. Given particle composition in Santiago, these results suggest that combustion-generated pollutants, especially from motor vehicles, may be associated with increased mortality. Temperature was closely associated with mortality. High temperatures led to deaths on the same day, while low temperatures lead to deaths from 1 to 4 days later.

Adolescent↗

PubMed1985

Estimates of lifetime lung cancer risks resulting from Rn progeny exposure.

Data on five mining populations exposed to Rn progeny have been used to estimate the lifetime risk of lung cancer resulting from occupational and environmental exposure under current standards. Slopes of dose-response relations for lung cancer show a tendency to decrease with increasing dose. Our best estimate of curvilinearity is given by raising dose to the power 0.92 +/- 0.07, but the improvement in fit beyond simple linearity is not significant. On the other hand, the addition of a cell-killing term significantly improves the fit of the linear model. In any event, linear extrapolation is unlikely to underestimate the excess risk at low doses by more than a factor of 1.5. However, these inferences about curvilinearity are highly subject to error from the choice of reference populations, dosimetry, and latency. Under the linear-cell-killing model, our best estimate of excess relative risk is 2.28 +/- 0.35 per 100 working level month (WLM) (a doubling dose of 44 WLM). Attributable risks in these five studies range from 3.4-17.8 per 10(6) person-yr WLM-1. Risks from Rn progeny appear to interact with age and smoking in a form intermediate between additive and multiplicative. The "relative risk" model is therefore preferable for projecting lifetime risks, but life-table projections are described for a wide variety of assumptions. Our best estimate of the effect of a 50-yr occupational exposure to 4 WLM yr-1 is 130 excess lung cancer deaths per 1000 persons (0.65 per 1000 person-WLM), with a range from 60-250 per 1000. Similar calculations for lifetime exposure to an additional 0.02 working level (WL) beyond normal background produces an estimate of 20 excess lung cancers per 1000 persons.

Adolescent↗

PubMed2006

Work hours affect spouse's cortisol secretion--for better and for worse.

OBJECTIVE: In a sample of 52 German dual-earner couples with at least one child under age 5, we examined the bodily costs and benefits of the amount of time each spouse spent on productive activities. METHODS: Diary reports of time allocated to formal and informal work activities were analyzed according to the Actor-Partner Interdependence model. RESULTS: Hierarchical linear models showed that each hour an individual allocated to market, as well as household work, increased his or her total cortisol concentration (by 192 and 134 nmol/l, respectively). Unexpectedly, the time the spouse allocated to paid work also raised an individual's total cortisol concentration (by 64 nmol/l). In line with our expectations, there was a tendency for the time the spouse allocated to household work to decrease the individual's cortisol concentration (by 81 nmol/l). CONCLUSIONS: This study contributes to the body of evidence on the complex nature of social relationships and complements the literature on specific working conditions and couples' well-being.

Adult↗

PubMed2006

Implementing the Institute of Medicine definition of disparities: an application to mental health care.

OBJECTIVE: In a recent report, the Institute of Medicine (IOM) defines a health service disparity between population groups to be the difference in treatment or access not justified by the differences in health status or preferences of the groups. This paper proposes an implementation of this definition, and applies it to disparities in outpatient mental health care. DATA SOURCES: Health Care for Communities (HCC) reinterviewed 9,585 respondents from the Community Tracking Study in 1997-1998, oversampling individuals with psychological distress, alcohol abuse, drug abuse, or mental health treatment. The HCC is designed to make national estimates of service use. STUDY DESIGN: Expenditures are modeled using generalized linear models with a log link for quantity and a probit model for any utilization. We adjust for group differences in health status by transforming the entire distribution of health status for minority populations to approximate the white distribution. We compare disparities according to the IOM definition to other methods commonly used to assess health services disparities. PRINCIPAL FINDINGS: Our method finds significant service disparities between whites and both blacks and Latinos. Estimated disparities from this method exceed those for competing approaches, because of the inclusion of effects of mediating factors (such as income) in the IOM approach. CONCLUSIONS: A rigorous definition of disparities is needed to monitor progress against disparities and to compare their magnitude across studies. With such a definition, disparities can be estimated by adjusting for group differences in models for expenditures and access to mental health services.

Adolescent↗

PubMed2025

Associations Between Walking Pace, APOE-ε4 Genotype, and Brain Health in Middle-Aged to Older Adults.

PURPOSE: This study aimed to investigate whether self-reported walking pace (a marker of physical function) and the presence of APOE-ε4 allele interact to modify brain health outcomes. METHODS: We used data from a prospective cohort study of middle-aged to older adults from the UK Biobank who self-reported walking pace (slow or steady-to-brisk) and who were initially free of dementia ( n = 415,110). Incident all-cause dementia was obtained from hospital and death registry records, and structural brain volumes (right and left hippocampus volumes, total gray matter volume, and volume of white matter hyperintensities) were measured from a subset of participants ( n = 33,113). Cox proportional hazard models and generalized linear models were used to assess associations between exposures and outcomes. RESULTS: Slow walking pace and the presence of APOE-ε4 allele were associated with increased dementia risk (HR = 1.79 [95% CI = 1.66-1.93], P < 0.001; HR = 3.06 [2.90-3.23], P < 0.001, respectively), and there was an interaction between these associations, indicating that the association of walking pace with dementia risk is modified by APOE-ε4 status (reference group: HR Steady-Brisk/APOE-ε4- = 1; HR Slow/APOE-ε4- = 2.03 [1.84-2.25], P < 0.001; HR Steady-Brisk/APOE-ε4+ = 3.21 [3.02-3.41], P < 0.001; HR Slow/APOE-ε4+ = 4.99 [4.48-5.58], P < 0.001). Slow self-reported walking pace was associated with worse brain volume outcomes, and these associations were not modified by APOE-ε4 genotype. CONCLUSIONS: These results suggest walking pace and APOE-ε4 status independently influence brain volume outcomes, but both factors independently and jointly contribute to increased dementia risk. Individuals with both risk factors (slow walking pace and APOE-ε4 allele) show the strongest associations with dementia risk.

Self Report↗

PubMed2006

Coal home heating and environmental tobacco smoke in relation to lower respiratory illness in Czech children, from birth to 3 years of age.

OBJECTIVE: The objective of this study was to evaluate how indoor pollution from tobacco and home heating may adversely affect respiratory health in young children. DESIGN: A birth cohort was followed longitudinally for 3 years to determine incidence of lower respiratory illness (LRI). PARTICIPANTS: A total of 452 children born 1994-1996 in two districts in the Czech Republic participated. EVALUATIONS: Indoor combustion exposures were home heating and cooking fuel, mother's smoking during pregnancy, and other adult smokers in the household. Diagnoses of LRI (primarily acute bronchitis) from birth to 3 years of age were abstracted from pediatric records. Questionnaires completed at delivery and at 3-year follow-up provided covariate information. LRI incidence rates were modeled with generalized linear models adjusting for repeated measures and for numerous potential confounders. RESULTS: LRI diagnoses occurred more frequently in children from homes heated by coal [vs. other energy sources or distant furnaces ; rate ratio (RR) = 1.45 ; 95% confidence interval (CI) , 1.07-1.97]. Maternal prenatal smoking and other adult smokers also increased LRI rates (respectively: RR = 1.48 ; 95% CI, 1.10-2.01 ; and RR = 1.29 ; 95% CI, 1.01-1.65) . Cooking fuels (primarily electricity, natural gas, or propane) were not associated with LRI incidence. For children never breast-fed, coal home heating and mother's smoking conferred substantially greater risks: RR = 2.77 (95% CI, 1.45-5.27) and RR = 2.52 (95% CI, 1.31-4.85) , respectively. CONCLUSIONS: Maternal smoking and coal home heating increased risk for LRI in the first 3 years of life, particularly in children not breast-fed. RELEVANCE: Few studies have described effects of coal heating fuel on children's health in a Western country. Breast-feeding may attenuate adverse effects of prenatal and childhood exposures to combustion products.

Air Pollution, Indoor↗

PubMed2006

An energy-saving development initiative increases birth rate and childhood malnutrition in rural Ethiopia.

BACKGROUND: Evolutionary life history theory predicts that, in the absence of contraception, any enhancement of maternal condition can increase human fertility. Energetic trade-offs are likely to be resolved in favour of maximizing reproductive success rather than health or longevity. Here we find support for the hypothesis that development initiatives designed to improve maternal and child welfare may also incur costs associated with increased family sizes if they do not include a family planning component. METHODS AND FINDINGS: Demographic and anthropometric data were collected in a rural Ethiopian community benefiting from a recent labour-saving development technology that reduces women's energetic expenditure (n = 1,976 households). Using logistic hazards models and general linear modelling techniques, we found that whilst infant mortality has declined, the birth rate has increased, causing greater scarcity of resources within households. CONCLUSIONS: This study is, to our knowledge, the first to demonstrate a link between a technological development intervention and an increase in both birth rate and childhood malnutrition. Women's nutritional status was not improved by the energy-saving technology, because energy was diverted into higher birth rates. We argue that the contribution of biological processes to increased birth rates in areas of the developing world without access to modern contraception has been overlooked. This highlights the continued need for development programmes to be multisectoral, including access to and promotion of contraception.

Adolescent↗

PubMed2004

Clinical features associated with receipt of alcohol treatment.

OBJECTIVE: In this study, we sought to identify specific clinical features of alcohol dependence and other characteristics of recent drinkers that might help differentiate drinkers who receive treatment. METHOD: In 1998, field staff for the National Household Survey on Drug Abuse assessed 18,722 sampled adults, including 12,437 who reported drinking in the year prior to survey, most of whom self-marked answers to standard items on drug experiences, including clinical features of alcohol dependence and receipt of treatment. Statistical analyses took into account the complex sampling procedures and the interdependencies between individual responses. RESULTS: Multivariate modeling with generalized linear model and generalized estimating equations with statistical adjustment for age, gender and race revealed that individuals who received treatment reported all seven clinical features more often than drinkers who did not receive treatment, with the greatest differences observed for alcohol-related emotional problems (adjusted odds ratio [adj. OR] = 15.0), health problems (adj. OR = 13.5), reduced important activities (adj. OR = 10.4) and inability to cut down (adj. OR = 10.1) (all p values < .05). The observed treatment-related differences were less pronounced for other clinical features (e.g., reported tolerance [adj. OR = 4.8], using more than was intended [adj. OR = 6.2] and salience of alcohol-related behavior [adj. OR = 6.2]; all p values < .05). Further statistical adjustment for frequency of alcohol use and age of first alcohol use did not alter these estimates appreciably. CONCLUSIONS: Reasons for observed excess occurrence of alcohol-related problems among community samples of drinkers who receive treatment deserve more attention in future research. A key research question is whether self-awareness of alcohol-related problems motivates drinkers to seek treatment or if treatment promotes awareness and decreases denial about alcohol problems.

Adolescent↗

PubMed2003

Effect of pH and Release on two life stages of four anuran amphibians.

Using three native Canadian and one exotic anuran species, the interactive toxicity of pH and the forestry used-herbicide Release (triclopyr [3,5,6-trichloro-2-pyridl-oxyacetic acid]) was assessed. Embryonic and larval (Gosner 25) stages of Rana pipiens, Rana clamitans, Bufo americanus, and Xenopus laevis were exposed to treatments for at least 96 h in a static-renewal system using a central composite rotatable design. Mortality and the prevalence of malformations were modeled using generalized linear models with a profile deviance approach to obtain confidence intervals. Consistent trends of greater toxicity with lower pH were observed, with the majority of models (five of seven models) showing significant (p < 0.05) inverse relations. Larval lethal concentration estimates were eight to twenty-three times less than those observed for embryos, indicating that the larval stages were more sensitive to treatments. Further, the median lethal concentration (LC50) values for the larvae were below the expected environmental concentration (EEC) as calculated by Canadian regulatory authorities for Release. Species sensitivity was similar, with an average larval 96-h LC50 of 0.89 mg acid equivalents (AE)/L at pH 5.5 and 1.6 mg AE/L at pH 7, suggesting that X. laevis is a reasonable surrogate for native amphibians in laboratory toxicity testing. For the embryo tests, R. pipiens were slightly less sensitive in comparison with the other three species. Based on a hazard quotient analysis (EEC/LC50 > 1) for the most sensitive larval life stages, higher tier ecotoxicological testing under more realistic environmental conditions is strongly recommended.

Animals↗