P6225Uric acid visit-by-visit variability is an independent risk factor of CHD - and all-cause mortality

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
U Goldbourt
Keyword(s):  
Urban Areas ◽  
Civil Servants ◽  
Trend Test ◽  
Hazard Ratios ◽  
Municipal Employees ◽  
All Cause Mortality ◽  
Z Scores ◽  
The Difference ◽  
The Individual

Abstract Variability of serum uric acid (SUA) has been seldom examined in connection with long-term morbidity and mortality. We present results from a study of male civil servants and municipal employees, estimating associations of visit-by-visit variability of SUA with long-term all-cause as well as cause-specific mortality. Patients and methods There were 10,059 men, aged 40–65, tenured civil servants and municipal employees in the territories of the three most populated urban areas. Of these, 8822 participated in three extensive examinations in 1963, 1965 and 1968 and underwent assessment of diabetes and coronary morbidity status. We conducted analysis examining whether the standard deviations of Z-scores of SUA (SUA-Z), across the three study visits, predicted fatal outcomes. SUA-Z was defined as the difference between the individual SUA and the mean of SUA, divided by the standard deviation (SD) for the pertinent examination, namely separately for the 1963, 1965 and 1968 means and SD. Hazard ratios (HR) associated with the SD of SUA-Z were calculated for 18-yr stroke and CHD mortality (1968 to 1986) and the 18-yr all-cause mortality associated with quartiles of the above variability. The lowest quartile served as the referent, adjusting for age. A subsequent model adjusted additionally for the baseline value of SUA as well as for baseline frequency of diabetes mellitus and coronary heart disease (CHD) Results Multivariate analysis of 18-yr CHD mortality (1968–1986, 906 deaths among 8822 men) yielded a significant association with the 1963–1968 SD of SUA-Z with age adjusted HR of CD mortality of 0.99, 1.12 and 1.43 for quartiles 2 to 4 respectively (P using Mantel trend test=0.0002). Further adjustment for baseline prevalence of diabetes and CHD somewhat decreased the above HR estimates to 0.98, 1.04 and 1.29, respectively, with a HR=1.15 (95% CI, 1.07–1.23) per 1 mg/Dl increment of the 1963 SUA serum level. The results for the 18-yr all-cause mortality (2836 deaths, 1968–1986) strongly indicated increasing age-adjusted mortality risk with increasing SD of SUA-Z: HRs= 1.08 (95% CI,0.97–1.21), 1.15 (1.03–1.28), and 1.37 (1.23–1.51). No association was observed between the SD of SUA-Z and 18 years stroke mortality. Sensitivity analysis, incorporating the last (1968) SUA levels assessed, rather than the 1963 ones, yielded virtually identical HRs. Conclusion In this cohort of tenured male workers, with diverse occupation, higher variability of SUA measurement taken in 1963–5-8 were clearly predictive of 18-year CHD and all-cause mortality, above and beyond the SUA levels proper.

scholarly journals A Study of the Understated Violence Within Social Contexts Against Adolescent Girls

2017 ◽  
Vol 8 (2) ◽  
pp. 29-41
Author(s):  
Shivangi Nigam ◽  
Niranjana Soperna
Keyword(s):  
Adolescent Girls ◽  
Rural Areas ◽  
Urban Areas ◽  
Social Issues ◽  
Well Being ◽  
Structured Interview ◽  
Social Contexts ◽  
The Social ◽  
The Difference ◽  
The Individual

Violence against women is linked to their disadvantaged position in the society. It is rooted in unequal power relationships between men and women in society and is a global problem which is not limited to a specific group of women in society. An adolescent girl’s life is often accustomed to the likelihood of violence, and acts of violence exert additional power over girls because the stigma of violence often attaches more to a girl than to the  perpetrator. The experience of violence is distressing at the individual emotional and physical level. The field of research and programmes for adolescent girls has traditionally focused on sexuality, reproductive health, and behaviour, neglecting the broader social issues that underpin adolescent girls’ human rights, overall development, health, and well-being. This paper is an endeavour to address the understated or disguised form of violence which the adolescent girls experience within the social contexts. The parameters exposed under this research had been ignored to a large extent when it comes to studying the dimension of violence under the social domain. Hence, the researchers attempted to explore this camouflaged form of violence and discovered some specific parameters such as: Diminished Self Worth and Esteem, Verbal Abuse, Menstruation Taboo and Social Rigidity, Negligence of Medical and Health Facilities and Complexion- A Prime Parameter for Judging Beauty. The study was conducted in the districts of Haryana (India) where personal interviews were taken from both urban and rural adolescent girls (aged 13 to 19 years) based on  a structured interview schedule. The results revealed that the adolescent girls, both in urban as well as rural areas were quite affected with the above mentioned issues. In urban areas, however, due to the higher literacy rate, which resulted in more rational thinking, the magnitude was comparatively smaller, but the difference was still negligible.  

scholarly journals Differences in Sickness Allowance Receipt between Swedish Speakers and Finnish Speakers in Finland

2017 ◽  
Vol 52 ◽  
pp. 43-58 ◽  
Author(s):  
Kaarina S. Reini ◽  
Jan Saarela
Keyword(s):  
Regression Models ◽  
Health Condition ◽  
Logistic Regression Models ◽  
Individual Level ◽  
Objective Health ◽  
Language Groups ◽  
Health Measure ◽  
All Cause Mortality ◽  
The Difference ◽  
The Individual

Previous research has documented lower disability retirement and mortality rates of Swedish speakers as compared with Finnish speakers in Finland. This paper is the first to compare the two language groups with regard to the receipt of sickness allowance, which is an objective health measure that reflects a less severe poor health condition. Register-based data covering the years 1988-2011 are used. We estimate logistic regression models with generalized estimating equations to account for repeated observations at the individual level. We find that Swedish-speaking men have approximately 30 percent lower odds of receiving sickness allowance than Finnish-speaking men, whereas the difference in women is about 15 percent. In correspondence with previous research on all-cause mortality at working ages, we find no language-group difference in sickness allowance receipt in the socially most successful subgroup of the population.

New Approaches to Regional Branding through Green Production and Utilization of Existing Natural Advantages

2015 ◽  
pp. 121-139
Author(s):  
Alexander Trukhachev
Keyword(s):  
Urban Areas ◽  
Balanced Development ◽  
Alternative Employment ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Rural Economies ◽  
Green Production ◽  
Stavropol Region ◽  
The Individual

The chapter aims at the identification of existing natural, environmental, and rural resources that have worked together to promote the individual brand of Stavropol Region as a producer of green agricultural commodities and food, as well as a resort area, attractive by its unique environmental conditions. The perspectives of the development of green production are accessed in order to exploit existing regional resources in the long term, encourage local/regional producers and stimulate their economies, which is vital to quality of life in the countryside and a balanced development of rural and urban areas. Special attention is paid to the elaboration of possible ways to increase effectiveness of natural management as an approach to improve the competitiveness and sustainability of rural economies whilst at the same time opening up alternative employment opportunities for rural people.

New Approaches to Regional Branding through Green Production and Utilization of Existing Natural Advantages

2017 ◽  
pp. 1758-1778
Author(s):  
Alexander Trukhachev
Keyword(s):  
Urban Areas ◽  
Balanced Development ◽  
Alternative Employment ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Rural Economies ◽  
Green Production ◽  
Stavropol Region ◽  
The Individual

The chapter aims at the identification of existing natural, environmental, and rural resources that have worked together to promote the individual brand of Stavropol Region as a producer of green agricultural commodities and food, as well as a resort area, attractive by its unique environmental conditions. The perspectives of the development of green production are accessed in order to exploit existing regional resources in the long term, encourage local/regional producers and stimulate their economies, which is vital to quality of life in the countryside and a balanced development of rural and urban areas. Special attention is paid to the elaboration of possible ways to increase effectiveness of natural management as an approach to improve the competitiveness and sustainability of rural economies whilst at the same time opening up alternative employment opportunities for rural people.

scholarly journals Does vitamin D status track through adolescence?

2015 ◽  
Vol 102 (5) ◽  
pp. 1025-1029 ◽  
Author(s):  
Machuene A Poopedi ◽  
Shane A Norris ◽  
Lisa K Micklesfield ◽  
John M Pettifor
Keyword(s):  
Vitamin D ◽  
Age Groups ◽  
Vitamin D Status ◽  
Hydroxyvitamin D ◽  
Disease States ◽  
Cast Doubt ◽  
Z Scores ◽  
The Individual ◽  
Time Point

ABSTRACT Background: To our knowledge, no studies have reported on the long-term variability of vitamin D status in adolescents. Objective: To determine whether tracking of vitamin D status occurs in healthy adolescents, we assessed the variability of 25-hydroxyvitamin D [25(OH)D] every 2 y over a 10-y period in a longitudinal cohort of adolescents living in Johannesburg, South Africa (latitude 26°S). Design: Healthy adolescents who had blood samples available on ≥3 occasions between 11 and 20 y of age were included in the study. Of the cohort of 504 children, 99 met the criteria. The mean 25(OH)D concentration at each time point was measured, and the individual 25(OH)D z scores based on year 11 values were used as the reference. All 25(OH)D concentrations for a subject were measured in a single assay. Results: No significant correlation was found between 25(OH)D in the earlier and later years of adolescence, although significant correlations were found between year 11 and year 13 (r = 0.71, P < 0.0001) and between years 15, 17, and 20 (r ≥ 0.65, P < 0.0001). The percentage of adolescents whose 25(OH)D concentration changed by >20 nmol/L from year 11 was calculated for all age groups: 12% of the cohort had a change of >20 nmol/L at 13 y of age compared with 46% at 20 y of age. Just more than one-half (53%) of the cohort changed their category of vitamin D status between the ages of 11 and 20 y, and one-third of adolescents changed from being replete to insufficient over the same period. Conclusions: The data suggest that the measurement of 25(OH)D at a single time point does not reflect the long-term vitamin D status of an adolescent. These findings may cast doubt on the veracity of those studies that suggest an association of vitamin D status with various disease states in which vitamin D status was measured only once.

A Novel Postoperative Seizure Classification for Long-term Mortality of Patients With Intractable Epilepsy: Comparison With the Engel System

Neurosurgery ◽  
2011 ◽  
Vol 69 (1) ◽  
pp. 64-71 ◽  
Author(s):  
Yang-Hsin Shih ◽  
Amy Ming-Fang Yen ◽  
Der-Jen Yen ◽  
Ling-Pin Hung ◽  
Hsiu-Hsi Chen ◽  
...  
Keyword(s):  
Intractable Epilepsy ◽  
Temporal Lobectomy ◽  
Trend Test ◽  
Standardized Mortality Ratio ◽  
Anterior Temporal Lobectomy ◽  
Hazard Ratios ◽  
Mortality Ratio ◽  
Long Term Mortality

Abstract BACKGROUND: To explore the association of clinical seizure pattern with the long-term prognosis after epilepsy surgery is important for patient counseling and risk management. OBJECTIVE: To study the long-term mortality after surgery of intractable epilepsy patients with a novel classification of clinical patterns by long-term frequency and duration of seizure compared with the Engel classification. METHODS: We conducted a longitudinal cohort study by enrolling 280 patients with epilepsy who underwent anterior temporal lobectomy between 1987 and 2002. In addition to the Engel classification, we proposed a novel classification of clinical patterns pertaining to at least 1 year of follow-up of the frequency and duration of seizures after surgery (inactive, delayed, intermittent, and intensive groups). We followed the vital status of these members until 2007 to obtain a 15-year survival rate for each classification. The standardized mortality ratio and hazard ratios with proportional hazards regression model by the extent of severity were estimated. RESULTS: The overall 15-year survival rate for patients who underwent anterior temporal lobectomy was 95.1%. The standardized mortality ratio estimates (95% confidence interval) for our classification showed a gradient relationship from 0.6 (0.1-2.3), 2.5 (0.7-6.3), 7.6 (0.8-27.3), and 8.9 (3.2-19.3) for inactive, delayed, intermittent, and intensive groups, respectively (Trend test, P = .04), whereas the corresponding estimates were 0.8 (0.2-2.2), 5.9 (1.2-17.2), 6.7 (2.5-14.7), and 7.2 (0.8-25.9) for Engel I to IV, respectively, which showed a less increasing trend (Trend test, P = .82). Similar findings were noted for hazard ratios for the 2 classifications. CONCLUSION: The proposed novel classification with long-term observed frequency and duration of seizures after surgery is more informative for predicting long-term mortality than the Engel classification.

On-treatment blood pressure and long-term outcomes in chronic kidney disease

2021 ◽  
Author(s):  
Hae Hyuk Jung
Keyword(s):  
Cardiovascular Events ◽  
Composite Outcome ◽  
Long Term Outcomes ◽  
Major Cardiovascular Events ◽  
Hazard Ratios ◽  
All Cause Mortality ◽  
Composite Risk ◽  
Information Database

ABSTRACT Background The treatment BP target in CKD remains unclear, and whether the benefit of intensive BP-lowering is comparable between CKD and non-CKD patients is debated. Methods Using the Korean National Health Information Database, 359,492 CKD patients who had received antihypertensives regularly were identified from 12.1 million participants of nationwide health screening. The composite risk of major cardiovascular events, kidney failure, and all-cause mortality was assessed according to timely-averaged, on-treatment systolic BP. Results Over 9-year follow-up, the composite outcome noted in 18.4% of 239,700 participants with eGFR &lt;60 ml/min/1.73 m2 and 18.9% of 155,004 with dipstick albuminuria. The thresholds of systolic BP, above which the composite risk increased significantly, in the reduced eGFR and the proteinuric population were 135 mm Hg and 125 mm Hg, respectively. For all-cause mortality, the respective thresholds were 145 mm Hg and 135 mm Hg. When comparing the composite risk between propensity score-matched groups, the hazard ratios of on-treatment BP of systolic 135–144 mm Hg (reference, 115–124 mm Hg) in the reduced eGFR and non-CKD pairs were 1.18 and 0.98, respectively (P = 0.13 for interaction), and those in the proteinuria and non-CKD pairs were 1.30 and 1.01, respectively (P = 0.003 for interaction). Conclusions The findings support the recommendation that, based on office BP, the systolic target in CKD with proteinuria is ≤ 130 mm Hg, and the target in CKD with no proteinuria is ≤ 140 mm Hg. The benefit of intensive BP-lowering may be greater in CKD patients particularly with proteinuria than in their non-CKD counterparts.

scholarly journals Non-persistence with anti-platelet therapy and long-term mortality after ischemic stroke: A nationwide study

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0244718
Author(s):  
Seung Jae Kim ◽  
Oh Deog Kwon ◽  
Ho Chun Choi ◽  
Eung-Joon Lee ◽  
BeLong Cho
Keyword(s):  
Ischemic Stroke ◽  
Total Population ◽  
Medication Possession Ratio ◽  
National Sample ◽  
All Cause Mortality ◽  
Korean National Health Insurance ◽  
The Difference ◽  
Long Term Mortality ◽  
Cvd Mortality

Background We tried to investigate the effect of non-persistence with antiplatelets after ischemic stroke on long-term all-cause mortality (ACM). Methods and findings We selected newly diagnosed ischemic stroke patients aged ≥20years who were newly treated with aspirin or clopidogrel from 2003–2010 Korean National Health Insurance Service-National Sample Cohort, a random sample of 2.2% of total population. Subjects were divided into two pairs of groups according to persistence with antiplatelets at 6 and 12 months: those who discontinued antiplatelets within 6 months (DA6M) and those who continued them for 6 or months or more (CA6M); and those who discontinued antiplatelets within 12 months (DA12M) and those who continued them for 12 months or more (CA12M). Those who died within 6 months among DA6M and those who died within 12 months among DA12M were excluded along with those with medication possession ratio<80% among CA6M and CA12M. Subjects were followed-up until death or December 31, 2013. Among 3,559 total subjects, DA6M were 1,080 and CA6M were 2,479 while, out of 3,628 total patients, DA12M were 1,434 and CA12M were 2,194. The risks of ACM [adjusted hazard ratio (aHR), 2.25; 95% confidence interval (CI), 1.94–2.61], cerebro-cardiovascular disease (CVD) death (aHR, 2.52; 95% CI, 1.96–3.24) and non-CVD death (aHR, 2.11; 95% CI, 1.76–2.64) of DA6M were all significantly increased compared to CA6M. DA12M also had significantly higher risks of ACM (aHR, 1.93; 95% CI, 1.65–2.25), CVD mortality (aHR, 2.13; 95% CI; 1.63–2.77) and non-CVD mortality (aHR, 1.83;95% CI 1.51–2.22) than DA12M but aHRs were lower than that between DA6M and CA6M. The difference rates of ACM, CVD death, and non-CVD death between non-persistent and persistent groups all continuously widened over time but the degree of difference was gradually decreased. Conclusions Maintaining antiplatelets for the first 12 months after ischemic stroke reduces long-term risks of both CVD death and non-CVD death.

scholarly journals Prognostic value of long-term gamma-glutamyl transferase variability in individuals with diabetes: a nationwide population-based study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Da Young Lee ◽  
Kyungdo Han ◽  
Ji Hee Yu ◽  
Sanghyun Park ◽  
Ji A Seo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Value ◽  
Population Based ◽  
Gamma Glutamyl Transferase ◽  
Population Based Study ◽  
Gamma Glutamyl ◽  
Hazard Ratios ◽  
All Cause Mortality ◽  
Glutamyl Transferase

Abstract We examined whether long-term gamma-glutamyl transferase (GGT) variability can predict cardiovascular disease (CVD) and mortality in individuals with diabetes. We included 698,937 Koreans diabetes patients older than 40 years without histories of CVD, chronic liver disease, or heavy alcoholics who received health exams supported by the Korean government more than once in 2009–2012 (baseline). We used Cox proportional analyses to estimate the risk of stroke, myocardial infarction (MI), and all-cause mortality until December 31, 2016, according to the quartiles of the average successive variability (ASV) of GGT measured during the five years before the baseline. A total 26,119, 15,103, and 39,982 cases of stroke, MI, and death, respectively, were found. GGT ASV quartile 4 had a significantly higher risk of stroke and all-cause mortality than quartile 1, with adjustment for risk factors, such as baseline glucose and GGT level, and comorbidities. Hazard ratios (95% confidence intervals) for GGT ASV quartile 4 were 1.06 (1.03–1.10) and 1.23 (1.20–1.27) for stroke and mortality, respectively. This significant association was shown consistently across the baseline GGT quartiles. GGT variability was related to the risk of stroke and all-cause mortality. The effect was most pronounced in all-cause mortality, irrespective of baseline GGT level.

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