scholarly journals Plasmodium falciparum and helminth coinfections increase IgE and parasite-specific IgG responses

2021 ◽  
Author(s):  
Rebeca Santano ◽  
Rocío Rubio ◽  
Berta Grau-Pujol ◽  
Valdemiro Escola ◽  
Osvaldo Muchisse ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Positive Association ◽  
Strongyloides Stercoralis ◽  
Total Ige ◽  
Luminex Technology ◽  
Current Infection ◽  
Multivariable Regression ◽  
Specific Igg ◽  
Antibody Profile ◽  
Multivariable Regression Models

Coinfection with Plasmodium falciparum and helminths may impact the immune response to these parasites since they induce different immune profiles. We studied the effects of coinfections on the antibody profile in a cohort of 715 Mozambican children and adults using the Luminex technology with a panel of 16 antigens from P. falciparum and 11 antigens from helminths (Ascaris lumbricoides, hookworm, Trichuris trichiura, Strongyloides stercoralis and Schistosoma spp.) and measured antigen-specific IgG and total IgE responses. We compared the antibody profile between groups defined by P. falciparum and helminth previous exposure (based on serology) and/or current infection (determined by microscopy and/or qPCR). In multivariable regression models adjusted by demographic, socioeconomic, water and sanitation variables, individuals exposed/infected with P. falciparum and helminths had significantly higher total IgE and antigen-specific IgG levels, magnitude (sum of all levels) and breadth of response to both types of parasites compared to individuals exposed/infected with only one type of parasite (p≤ 0.05). There was a positive association between exposure/infection to P. falciparum and exposure/infection to helminths or the number of helminth species, and vice versa (p≤ 0.001). In addition, children coexposed/coinfected tended (p= 0.062) to have higher P. falciparum parasitemia than those single exposed/infected. Our results suggest that an increase in the antibody responses in coexposed/coinfected individuals may reflect higher exposure and be due to a more permissive immune environment to infection in the host.

scholarly journals Plasmodium falciparum and Helminth Coinfections Increase IgE and Parasite-Specific IgG Responses

2021 ◽  
Author(s):  
Rebeca Santano ◽  
Rocío Rubio ◽  
Berta Grau-Pujol ◽  
Valdemiro Escola ◽  
Osvaldo Muchisse ◽  
...  
Keyword(s):  
Immune Response ◽  
Plasmodium Falciparum ◽  
Previous Exposure ◽  
Content Type ◽  
Current Infection ◽  
Specific Igg ◽  
Antibody Profile

Coinfection with Plasmodium falciparum and helminths may impact the immune response to these parasites because they induce different immune profiles. We compared the antibody profile between groups of Mozambican individuals defined by P. falciparum and helminth previous exposure and/or current infection.

scholarly journals The Impact of Weather and Seasons on Falls and Physical Activity among Older Adults with Glaucoma: A Longitudinal Prospective Cohort Study

Sensors ◽  
2021 ◽  
Vol 21 (10) ◽  
pp. 3415
Author(s):  
Hursuong Vongsachang ◽  
Aleksandra Mihailovic ◽  
Jian-Yu E ◽  
David S. Friedman ◽  
Sheila K. West ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Fall Prevention ◽  
Regression Models ◽  
Activity Promotion ◽  
Injurious Fall ◽  
Multivariable Regression ◽  
Multivariable Regression Models ◽  
The Impact ◽  
The Relationship

Understanding periods of the year associated with higher risk for falling and less physical activity may guide fall prevention and activity promotion for older adults. We examined the relationship between weather and seasons on falls and physical activity in a three-year cohort of older adults with glaucoma. Participants recorded falls information via monthly calendars and participated in four one-week accelerometer trials (baseline and per study year). Across 240 participants, there were 406 falls recorded over 7569 person-months, of which 163 were injurious (40%). In separate multivariable regression models incorporating generalized estimating equations, temperature, precipitation, and seasons were not significantly associated with the odds of falling, average daily steps, or average daily active minutes. However, every 10 °C increase in average daily temperature was associated with 24% higher odds of a fall being injurious, as opposed to non-injurious (p = 0.04). The odds of an injurious fall occurring outdoors, as opposed to indoors, were greater with higher average temperatures (OR per 10 °C = 1.46, p = 0.03) and with the summer season (OR = 2.69 vs. winter, p = 0.03). Falls and physical activity should be understood as year-round issues for older adults, although the likelihood of injury and the location of fall-related injuries may change with warmer season and temperatures.

scholarly journals Pregnancy outcomes in women with preexisting thyroid diseases: a French cohort study

2020 ◽  
pp. 1-10
Author(s):  
Marion Lecorguillé ◽  
Juliane Léger ◽  
Anne Forhan ◽  
Marie Cheminat ◽  
Marie-Noëlle Dufourg ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Gestational Diabetes ◽  
Head Circumference ◽  
Thyroid Diseases ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Fetal Head ◽  
History Of ◽  
Multivariable Regression ◽  
Multivariable Regression Models

Abstract Women with thyroid diseases at the beginning of pregnancy may have suboptimal thyroid hormone levels because of potential difficulties in compensating for the physiological thyroid hormone changes occurring in pregnancy. Our objective was to study the association between preexisting thyroid diseases, pregnancy complications, and neonatal anthropometry. In total, 16,395 women from the ELFE French longitudinal birth cohort were included, and 273 declared pre-pregnancy thyroid diseases. Associations were investigated with multivariable regression models, with adjustment for relevant potential confounders. Body mass index (BMI) was additionally adjusted for in a second stage. As compared with other women, women with pre-pregnancy thyroid diseases were more frequently obese (19.6% vs. 9.8%) and had greater odds of gestational diabetes development (odds ratio [OR] = 1.58 [95% confidence interval [CI] 1.08, 2.30]) or had undergone treatment for infertility (OR = 1.57 [95% CI 1.07, 2.31]). After adjustment for BMI, the association with gestational diabetes was no longer significant (OR = 1.27 [95% CI 0.86, 1.88]). After excluding women with another medical history, those with pre-pregnancy thyroid diseases had increased odds of premature rupture of membranes (OR = 1.51 [95% CI 1.01, 2.25]). Children born from mothers with hypothyroidism before conception due to a disease or as a potential side effect of treatment had a smaller head circumference at birth than other children (β = −0.23 [95% CI −0.44, −0.01] cm). In conclusion, pre-pregnancy thyroid diseases were associated with risk of infertility treatment, gestational diabetes, and premature rupture of membranes. The association between history of hypothyroidism and moderate adverse effects on fetal head circumference growth needs replication.

Abstract 3572: Clinical Outcomes of the “Stroke100 Club”

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Amy K Guzik ◽  
Rema Raman ◽  
Kain Ernstrom ◽  
Dawn M Meyer ◽  
Ajeet Sodhi ◽  
...  
Keyword(s):  
Regression Models ◽  
Young Patients ◽  
Older Age ◽  
Advanced Age ◽  
Stroke Severity ◽  
Old Patients ◽  
Multivariable Regression ◽  
Independent Variable ◽  
Poor Outcomes ◽  
Multivariable Regression Models

Background: Patients with advanced age or high NIHSS have poorer tPA outcomes. When combined, old age (≥80yo) and elevated NIHSS (≥20) may have an even worse outcome. Patients who are also in this “Stroke100 Club” (any combination of age and NIHSS ≥100) by other means, have not been fully assessed. We evaluated discharge destination, 90-day mRS, sICH and death in treated and untreated Stroke100 Club patients. We further compared patients with age ≥ 80 and NIHSS ≥ 20 (“80/20s”), those who reached 100 without both characteristics (“non80/20s”) and ‘controls’. Methods: The UCSD SPOTRIAS prospectively collected database was analyzed for AIS patients (with and without tPA). Multivariable regression models including the Stroke100 group as an independent variable was used. Outcomes were adjusted for baseline mRS. For comparing categorical outcomes between controls, “80/20s” and “non80/20s” subgroups, a Fisher’s exact was used. Results: The IV tPA subset included 257 patients (mean age 71, 52% male, 85% white, mean NIHSS 12). 53 were in the “Stroke100 Club” (28 80/20, 25 non80/20), with more women (68% p= 0.002), higher NIHSS (22.5 p<0.0001), older age (mean age 86.4 p<0.0001), higher pre stroke mRS (34.6% mRS 3-6 vs 7.84%, p<0.0001), more HTN (p=0.045) and more afib (p= 0.008). There were 284 non tPA patients (mean age 69.52, 54% male, 85% white, mean NIHSS 5.92). 21 were in the “Stroke100 Club” (14 80/20, 7 non80/20), with higher NIHSS (23 p<0.0001), older age (mean 86.2 p<0.0001), higher pre stroke mRS (45.5% 3-6 vs 9.5%, p= 0.0001), and more afib (p= 0.0002). Stroke100 Club 90day mRS(3-6) outcomes were worse in both tPA treated patients (OR=6.77, p= 0.0001) and nontreated patients (OR 31.57, p= 0.001). sICH rates (in tPA subjects) were not different (3.8% vs 3.4%, p> 0.99). Conclusions: There is a question of treatment outcome in patients with various permutations of stroke severity and advanced age. Our data corroborates the concern of poor outcomes for Stroke100 Club patients, but notes no increased sICH with tPA. Though outcome may be poor, withholding tPA should be discouraged as worse outcomes were not due to sICH. Young patients with severe strokes or old patients with mild strokes may have outcomes similar to the standard “80/20” Stroke100 patients, however further adjusted analysis is ongoing. In addition, further analyses are being done to compare tPA to non tPA patients.

Abstract 51: Access to Primary Stroke Centers for Older Adults and Implications for Travel Times, and Mortality

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Kimon Bekelis ◽  
Kendrew Wong ◽  
Nancy Marth ◽  
Weiping Zhou ◽  
Jonathan Skinner
Keyword(s):  
Regional Variation ◽  
Fee For Service ◽  
Travel Times ◽  
Stroke Patients ◽  
Multivariable Regression ◽  
Potential Impact ◽  
One Year ◽  
Multivariable Regression Models ◽  
Regionalization Of Care

Background: Regionalization of care to primary stroke centers (PSC) may improve outcomes for stroke patients. We evaluated the current access of Medicare stroke patients to PSC, and its potential impact on mortality. Methods: We performed a retrospective cohort study of a 100% sample of Medicare fee-for-service claims data for patients admitted with stroke in 2008-2009, with one-year follow-up through 2010. Population weighted centroids were created, helicopter pad locations were identified, and driving distances were calculated based on real road network data. Driving and flying speeds, dispatch, scene, and pre-hospital times were estimated using validated models, adjusted for population density. The association of 30-day mortality with travel times, and treatment at a PSC was investigated using multivariable regression models. Results: During the study period, 510,822 patients (mean age 79.6 years, 59.7% females) had a stroke. There was significant regional variation in our cohort, (Figure) with 8.6% of stroke patients having ground access to a PSC within 30 minutes, 14.9% from 30 to 45 minutes, 11.1% from 45 to 60 minutes, 43.9% from 1 to 4.5 hours, and 21.5% over 4.5 hours. The latter group could be limited to 0.1% of stroke patients, if existing helicopter services were used optimally. 164,485 (32.2%) patients received treatment in a PSC, and had modestly decreased mortality (OR, 0.97; 95% CI, 0.95-0.99). For this group, actual travel time to the PSC was not associated with mortality for patients within one hour of the PSC. On the contrary, travel times from 1 to 4.5 hours (OR, 1.15; 95% CI, 1.08-1.22), and over 4.5 hours (OR, 1.41; 95% CI, 1.29-1.54) were associated with increased mortality. Conclusions: There is significant regional variation in access to PSC for elderly stroke patients, with a potential impact on outcomes. Optimal use of helicopter services may address these disparities. Funding: NIH (P01-AG19783, and U01-AG046830-01).

scholarly journals Influence of financial and reputational incentives on primary care performance: a longitudinal study

2018 ◽  
Vol 68 (677) ◽  
pp. e811-e818
Author(s):  
Thomas Allen ◽  
William Whittaker ◽  
Evangelos Kontopantelis ◽  
Matt Sutton
Keyword(s):  
Fixed Effects ◽  
Pay For Performance ◽  
Additional Patient ◽  
Financial Reward ◽  
Percentage Points ◽  
Practice Performance ◽  
Multivariable Regression ◽  
Quality And Outcomes ◽  
General Practices ◽  
Multivariable Regression Models

BackgroundThe Quality and Outcomes Framework has generated reputational as well as financial rewards for general practices because the number of quality points a practice receives is publicly reported. These rewards vary across diseases and practices, and over time.AimTo determine the relative effects on performance of the financial and reputational rewards resulting from a pay-for-performance programme.Design and settingObservational study of the published performance on 42 indicators of 8929 practices in England between 2004 and 2013.MethodThe authors calculated the revenue offered (financial reward, measured in £100s) and the points offered (reputational reward) per additional patient treated for each indicator for each practice in each year. Fixed-effects multivariable regression models were used to estimate whether the percentage of eligible patients treated responded to changes in these financial and reputational rewards.ResultsBoth the offered financial rewards and reputational rewards had small but statistically significant associations with practice performance. The effect of the financial reward on performance decreased from 0.797 percentage points per £100 (95% confidence interval [CI] = 0.614 to 0.979) in 2004, to 0.092 (95% CI = 0.045 to 0.138) in 2013. The effect of the reputational reward increased from −0.121 percentage points per quality point (95% CI = −0.220 to −0.022) in 2004, to 0.209 (95% CI = 0.147 to 0.271) in 2013.ConclusionIn the short term, general practices were more sensitive to revenue than reputational rewards. In the long term, general practices appeared to divert their focus towards the reputational reward, once benchmarks of performance became established.

scholarly journals Autonomy in the Operating Room: A Multicenter Study of Gender Disparities During Surgical Training

2021 ◽  
Vol 13 (5) ◽  
pp. 666-672
Author(s):  
Jenny X. Chen ◽  
Edward H. Chang ◽  
Francis Deng ◽  
Shari Meyerson ◽  
Brian George ◽  
...  
Keyword(s):  
Surgical Training ◽  
Gender Disparities ◽  
Training Level ◽  
Surgical Performance ◽  
Surgical Trainees ◽  
Significant Difference ◽  
Multivariable Regression ◽  
Operative Performance ◽  
And Performance ◽  
Multivariable Regression Models

ABSTRACT Background Gender disparities are prevalent in medicine, but their impact on surgical training is not well studied. Objective To quantify gender disparities in trainee intraoperative experiences and explore the variables associated with ratings of surgical autonomy and performance. Methods From September 2015 to May 2019, attending surgeons and trainees from 71 programs assessed trainee autonomy on a 4-level Zwisch scale and performance on a 5-level modified Dreyfus scale after surgical procedures. Multivariable regression models were used to examine the association of trainee gender with autonomy and performance evaluations. Results A total of 3255 trainees and attending surgeons completed 94 619 evaluations. Attendings gave lower ratings of operative autonomy to female trainees than male trainees when controlling for training level, attending, and surgical procedure (effect size B = −0.0199, P = .008). There was no difference in ratings of autonomy at the beginning of training (P = .32); the gap emerged as trainees advanced in years (B = −0.0163, P = .020). The gender difference in autonomy was largest for the most complex cases (B = −0.0502, P = .002). However, there was no difference in attending ratings of surgical performance for female trainees compared to male trainees (B = −0.0124, P = .066). Female trainees rated themselves as having less autonomy and worse performance than males when controlling for training level, attending, procedure, case complexity, and attending ratings (autonomy B = −0.0669, P &lt; .001; performance B = −0.0704, P &lt; .001). Conclusions While there was no significant difference in ratings of operative performance, a small difference between ratings of operative autonomy for female and male surgical trainees was identified.

scholarly journals 1300Associations between self-reported or measured anthropometric variables and cardiometabolic biomarkers in a Danish cohort

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Jie Zhang ◽  
Anja Olsen ◽  
Jytte Halkjær ◽  
Kristina Elin Nielsen Petersen ◽  
Anne Tjønneland ◽  
...  
Keyword(s):  
Smoking Status ◽  
Cost Effective ◽  
Epidemiological Studies ◽  
Self Report ◽  
Anthropometric Indices ◽  
Multivariable Regression ◽  
Highly Correlated ◽  
Study Participants ◽  
Multivariable Regression Models ◽  
Metabolic Biomarkers

Abstract Background It is easy and cost-effective to ask study participants to self-report height and weight and self-reported anthropometry is therefore widely used in epidemiological studies. However, it is questioned to what degree self-reported adiposity indices are a solid proxy of measured indices in terms of estimates of health outcomes. The current study aimed to quantify the agreement between self-reported and measured anthropometrics, including height, weight, body mass index (BMI), weight circumference (WC), and weight-to-height ratio (WHtR) in a contemporary cohort of adults, and to assess whether anthropometric indices misreporting yielded inaccurate estimates of associations with cardiometabolic biomarkers. Methods Self-reported and measured anthropometric variables were obtained from the Diet, Cancer, and Health-Next Generation Cohort (n = 39,514). Pearson correlations and Lin’s concordance correlations evaluated the correlation between self-report and measured anthropometrics. Misreporting in relation to age, sex and smoking status was investigated. Multivariable regression models and ROC analyses were used to assess the associations of cardiometabolic biomarkers with self-reported and measured general obesity and abdominal obesity. Results Self-reported height was overreported by 1.07 cm, weight was underreported by 0.32 kg on average, which led to self-reported BMI 0.42 kg/m2 lower than measured. Self-reported and measured height, weight, BMI, WC and WHtR were highly correlated (r = 0.98, 0.99, 0.98, 0.88, 0.86, respectively). Associations between self-reported indices and cardiometabolic biomarkers were comparable to associations assessed with measured anthropometrics. Conclusions The self-reported anthropometric indices were reliable when estimating associations with metabolic biomarkers. Key messages This study found overall agreement between self-reported and measured anthropometric variables.

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