scholarly journals Association between dairy intake and fracture in an Australian-based cohort of women: a prospective study

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e031594 ◽  
Author(s):  
Hajara Aslam ◽  
Kara L Holloway-Kew ◽  
Mohammadreza Mohebbi ◽  
Felice N Jacka ◽  
Julie A Pasco
Keyword(s):  
High Sensitivity ◽  
Serum Markers ◽  
Self Report ◽  
Milk Consumption ◽  
Cross Sectional ◽  
Procollagen Type ◽  
Dairy Consumption ◽  
Geelong Osteoporosis Study ◽  
A Prospective Study

ObjectiveGiven the inconsistent evidence on dairy consumption and risk of fracture, we assessed the association between milk/total dairy consumption and major osteoporotic fracture (MOF) in women from the Geelong Osteoporosis Study (GOS).MethodsWomen aged ≥50 years (n=833) were followed from baseline (1993–1997) to date of first fracture, death or 31 December 2017, whichever occurred first. Dairy consumption was assessed by self-report at baseline and the follow-up phases. MOFs (hip, forearm, clinical spine and proximal humerus) were confirmed radiologically. Multivariable-adjusted Cox proportional hazard models were used to determine associations between milk/total dairy (milk, cheese, yoghurt, ice cream) consumption and MOFs. Cross-sectional associations between milk/total dairy consumption and serum high-sensitivity C reactive protein (hsCRP), C-terminal telopeptide (CTx) and procollagen type 1 N-terminal propeptide (P1NP) at baseline were investigated using multivariable linear regression.ResultsDuring follow-up (11 507 person-years), 206 women had an MOF. Consuming >500 mL/d of milk was not significantly associated with increased HR for MOF. Non-milk (1.56; 95% CI 0.99 to 2.46) drinkers and consumption of ≥800 g/d total dairy (1.70; 95% CI 0.99 to 2.93) had marginally higher HR for MOF compared with consuming <250 mL/d of milk and 200–399 g/d of total dairy, respectively. Milk consumption was inversely associated with serum hsCRP and CTx, but total dairy consumption was not associated with these serum markers.ConclusionHigher milk consumption did not increase the risk for MOF in older women. However, a trend for increased MOF was detected in zero milk and higher total dairy consuming women.

scholarly journals Comparing Patient and Endoscopist Perceptions of the Colonoscopy Indication

2010 ◽  
Vol 24 (11) ◽  
pp. 656-660 ◽  
Author(s):  
Maida J Sewitch ◽  
Dara Stein ◽  
Lawrence Joseph ◽  
Alain Bitton ◽  
Robert J Hilsden ◽  
...  
Keyword(s):  
Kappa Statistic ◽  
Cross Sectional Study ◽  
Routine Screening ◽  
Self Report ◽  
Administrative Databases ◽  
Screening Colonoscopy ◽  
Cross Sectional ◽  
Simple Method ◽  
Patient Questionnaires

BACKGROUND: Determining whether a colonoscopy is performed for screening or nonscreening purposes can facilitate clinical practice and research. However, there is no simple method to determine the colonoscopy indication using patient medical files or health administrative databases.OBJECTIVE: To determine patient-endoscopist agreement on the colonoscopy indication.METHODS: A cross-sectional study was conducted among staff endoscopists and their patients at seven university-affiliated hospitals in Montreal, Quebec. The study participants were 50 to 75 years of age, they were able to understand English or French, and were about to undergo colonoscopy. Self- (endoscopist) and interviewer-administered (patient) questionnaires ascertained information that permitted classification of the colonoscopy indication. Patient colonoscopy indication was defined as the following: perceived screening (routine screening, family history, age); perceived nonscreening (follow-up); medical history that implied nonscreening; and a combination of the three preceding indications. Agreement between patient and endoscopist indications was measured using concordance and Kappa statistic.RESULTS: In total, 702 patients and 38 endoscopists participated. The three most common reasons for undergoing colonoscopy were routine screening/regular check-up (33.8%), follow-up to a previous problem (30.2%) and other problem (24.6%). Concordance (range 0.79 to 0.85) and Kappa (range 0.58 to 0.70) were highest for perceived nonscreening colonoscopy. Recent large bowel symptoms accounted for 120 occurrences of disagreement in which the patient perceived a nonscreening colonoscopy while the endoscopist perceived a screening colonoscopy.CONCLUSIONS: Patient self-report may be an acceptable means for rapidly assessing whether a colonoscopy is performed for screening or nonscreening purposes. Delivery of patient-centred care may help patients and endoscopists reach a shared understanding of the reason for colonoscopy.

scholarly journals Doctors' experience of a bespoke physician consultation service: cross-sectional investigation

2011 ◽  
Vol 35 (6) ◽  
pp. 206-212 ◽  
Author(s):  
Maja Meerten ◽  
Julia Bland ◽  
Samantha R. Gross ◽  
Antony I. Garelick
Keyword(s):  
Self Report ◽  
Consultation Service ◽  
Cross Sectional ◽  
Specialist Services ◽  
Before And After ◽  
Consultation Model ◽  
Evaluation Outcome ◽  
Cross Sectional Design ◽  
Case Note Review

Aims and methodOur aim was to follow-up on a cohort of self-referred doctors who attended MedNet. We used a two-point cross-sectional design. Measures included three standardised self-report questionnaires administered before and after consultation. Doctors were also asked to complete a service user questionnaire, and data regarding engagement and onward referrals were gathered through case-note review.ResultsA statistically significant improvement in scores on all three questionnaires was found after intervention; however, scores on one subscale, the risk domain of the Clinical Outcomes in Routine Evaluation – Outcome Measure, did not change significantly. Of the doctors at no risk of suicide at intake, nearly two-thirds (n = 41/70, 59%) were sufficiently helped by the consultations provided to not need further treatment. Of the doctors at some risk of suicide at intake, two-thirds (n = 34/51, 67%) did need an onward referral. Only one doctor required hospital admission, an outcome that suggests the approach used is containing and clinically responsive.Clinical implicationsThis paper highlights the efficacy, need and importance of specialist services for doctors in difficulty. We found that the bespoke consultation model provided at MedNet is valued highly by the doctors as service users.

Screening for Borderline Personality Disorder With the McLean Screening Instrument: A Review and Critique of the Literature

2019 ◽  
pp. 1-11 ◽  
Author(s):  
Mark Zimmerman ◽  
Caroline Balling
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
High Sensitivity ◽  
Screening Instrument ◽  
Borderline Personality ◽  
Self Report ◽  
Cutoff Score ◽  
Cutoff Scores ◽  
Diagnostic Detection

Borderline personality disorder (BPD) is underdiagnosed in clinical practice. One approach towards improving diagnostic detection is the use of screening questionnaires. It is important for a screening test to have high sensitivity because the more time-intensive/expensive follow-up diagnostic inquiry will presumably only occur in patients who are positive on the initial screen. The most commonly studied self-report scale specific for BPD is the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD). We summarize the performance of the scale across studies, examine the performance of the scale using different cutoff scores, and highlight the approach used by investigators in recommending a cutoff score. Most studies of the scale have taken a case-finding approach in deriving the cutoff score on the scale instead of a screening approach. For the purposes of screening, it may be more appropriate for the cutoff score on the MSI-BPD to be less than the currently recommended cutoff of 7.

Echocardiographic follow-up of percutaneous closure of the arterial duct in infants

1992 ◽  
Vol 2 (4) ◽  
pp. 335-337
Author(s):  
Luis Fernández Piñeda ◽  
Hugo Torrealday ◽  
Ramón Bermúdez Cañete ◽  
María J. Maitre Azcárate ◽  
Manuel Quero Jiménez
Keyword(s):  
Pulmonary Artery ◽  
Left Atrium ◽  
Color Doppler ◽  
Excellent Result ◽  
High Sensitivity ◽  
Left Pulmonary Artery ◽  
Left Ventricular ◽  
Cross Sectional ◽  
Arterial Duct

SummarySince February 1990, we have attempted nonsurgical occlusion of persistent patency of the arterial duct using the Rashkind double-disk occluding device, of either 12 or 17 mm diameter. Results are presented from 31 patients (23 female and eight male, ages 15 months to 16 years). M-Mode, cross-sectional, Doppler and color Doppler echocardiographic studies were made prior to closure, in the following 24 hours, and six months later. Left ventricular diastolic dimension and shortening fraction, systolic intervals, and left atrium/aortic ratio were evaluated by M-Mode echo. We examined carefully the location of the device relative to the left pulmonary artery and descending aorta, also checking for disturbed flows and residual shunts. These studies showed a clear tendency for the left ventricular diameter to decrease, and revealed a significant normalization of the left atrium/aortic ratio. Successful closure of the duct was achieved in 27 cases. Follow-up studies six months later showed residual shunting in four cases. In one patient, a second device was implanted with an excellent result. At the immediate follow-up, turbulences were noted in the area of the device (nine cases) and in the left pulmonary artery (seven cases). Distortion of the anatomic orientation of the left pulmonary artery was observed in three cases in which we discovered 20 mm Hg systolic gradients. In our opinion, echocardiography is the best technique with which to follow-up these patients. The high sensitivity of color Doppler echocardiography revealed minimal distortion of the left pulmonary artery, probably generated by regional anatomic adjustment to the insertion of the device.

Assessing the need for a nurse-led breast cancer telephone follow-up clinic in Alberta, Canada.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 111-111
Author(s):  
Sasha M. Lupichuk ◽  
Cindy Railton ◽  
Jenny J. Ko ◽  
Jennifer McCormick ◽  
Lihong Zhong ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Telephone Interview ◽  
Tertiary Care ◽  
Unmet Need ◽  
Self Report ◽  
Specialist Care ◽  
Cross Sectional ◽  
Perceived Need

111 Background: Routine follow-up of breast cancer (BC) patients is largely transferred to primary care due to limited tertiary care resources and evidence supporting the acceptability and safety of this approach. It is unknown how BC survivors are faring in the community with treatment and surveillance goals, and if there is an unmet need for access to specialist care. Objectives of this cross-sectional study of BC survivors were to examine: concordance with endocrine therapy and follow-up recommendations; perceived need for help with achieving these recommendations; and, perceived need for a telephone follow-up clinic. Methods: Eligible participants were women with stage I-III BC diagnosed June 2006-September 2009 who had been seen in consultation at a tertiary cancer centre (TCC) in Alberta, Canada. 960 potentially eligible women were invited to participate via mail-out from the Alberta Cancer Registry. Consenting participants completed a structured telephone interview. Further patient, disease, endocrine therapy and surveillance data were obtained from the electronic chart and pharmacy databases. Results: 240 participants completed the telephone interview. 68.8% had been discharged from a TCC. 87.1% reported having had a clinical breast examination, and 97.1% with remaining breast tissue reported having had a surveillance mammogram within the past year. Concordance with endocrine therapy varied between pharmacy dispensing records (95.4%) versus self-report (82.0%). Top participant-identified gaps in post-treatment services were: side effect management, achieving body weight and physical activity goals, psychosocial health, and sexual health. 71.7% of participants reported that they would have used a telephone follow-up clinic. Factors associated with telephone follow-up clinic use included younger age, no endocrine therapy, fatigue, and non-urban residence. Conclusions: Concordance with measurable follow-up goals (exam, mammography, endocrine therapy) was better than expected. Despite this, interest in a nurse-led BC telephone follow-up clinic was high. Perceived needs included management of symptoms plus support for life-style behavior change.

scholarly journals A Prospective Investigation of the Impact of Distinct Posttraumatic (PTSD) Symptom Clusters on Suicidal Ideation

2017 ◽  
Vol 41 (4) ◽  
pp. 645-653 ◽  
Author(s):  
Maria Panagioti ◽  
Ioannis Angelakis ◽  
Nicholas Tarrier ◽  
Patricia Gooding
Keyword(s):  
Depressive Symptoms ◽  
Suicidal Ideation ◽  
Ptsd Symptom ◽  
Symptom Clusters ◽  
Self Report ◽  
Ptsd Symptoms ◽  
Cross Sectional ◽  
The Impact

AbstractInconsistent findings have been reported by previous cross-sectional studies regarding the association between specific posttraumatic stress disorder (PTSD) symptom clusters and suicidality. To advance the understanding of the role of specific PTSD symptoms in the development of suicidality, the primary aim of this study was to investigate the predictive effects of the three specific PTSD symptom clusters on suicidal ideation prospectively. Fifty-six individuals diagnosed with PTSD completed a two-stage research design, at baseline and 13–15 months follow-up. The clinician administered PTSD scale (CAPS) was used to assess the severity of the PTSD symptom clusters and validated self-report measures were used to assess suicidal ideation, severity of depressive symptoms and perceptions of defeat entrapment. The results showed that only the hyperarousal symptom cluster significantly predicted suicidal ideation at follow-up after controlling for baseline suicidal ideation, severity of depressive symptoms and perceptions of defeat and entrapment. These findings suggest that both disorder-specific and transdiagnostic factors are implicated in the development of suicidal ideation in PTSD. Important clinical implications are discussed in terms of predicting and treating suicidality in those with PTSD.

scholarly journals Predictive values of multiple serum biomarkers in women with suspected preeclampsia: a prospective study

2020 ◽  
Author(s):  
Jing Wang ◽  
Honghai Hu ◽  
Xiaowei Liu ◽  
Shenglong Zhao ◽  
Yuanyuan Zheng ◽  
...  
Keyword(s):  
Plasminogen Activator Inhibitor ◽  
Serum Levels ◽  
Serum Markers ◽  
Serum Biomarkers ◽  
Operating Characteristics ◽  
Serum Samples ◽  
Predictive Values ◽  
A Prospective Study ◽  
Activator Inhibitor

Abstract Background: Preeclampsia prediction improves maternal and fetal outcomes in pregnancy. We aimed to evaluate the preeclampsia prediction values of a series of serum biomarkers. Methods: Singleton pregnant women with preeclampsia-related clinical and/or laboratory presentations were recruited and had blood drawn at their first visits. The prospective cohort was further divided into preeclampsia-positive and preeclampsia-negative groups based on the follow-up results. The following markers were tested using the collected serum samples: soluble fms-like tyrosine kinase-1 ( sFlt-1); placental growth factor (PlGF); thrombomodulin (TM); tissue plasminogen activator inhibitor complex (tPAI-C); compliment factors C1q, B, and H; glycosylated fibronectin (GlyFn); pregnancy-associated plasma protein-A2 ( PAPP-A2); blood urea nitrogen (BUN); creatinine (Cre); uric acid (UA); and cystatin C (Cysc). Results: A total of 196 women with suspected preeclampsia were recruited with follow-up medical records. Twenty-five percent (n=49) of the recruited subjects developed preeclampsia before delivery, and 75% remained preeclampsia-negative (n=147). The serum levels of sFlt-1, BUN, Cre, UA, Cysc and PAPP-A2 were significantly elevated, and the PlGF level was significantly decreased in the preeclampsia-positive patients. In the receiver operating characteristics (ROC) analyses, the area under the curves were listed in the order of decreasing values: 0.73 (UA), 0.67 (sFlt-1/PlGF), 0.66 (Cysc), 0.65 (GlyFn/PlGF), 0.64 (PAPP-A2/PlGF), 0.63 (BUN), 0.63 (Cre), and 0.60 (PAPP-A2). With the cut-off values obtained from the ROC analyses, the positive predictive values of these serum markers were between 33.1% and 58.5%, and the negative predictive values were between 80.9% and 89.5%. Conclusions: Further studies are warranted to confirm the clinical utilities of the serum markers in preeclampsia prediction

scholarly journals Non-adherence to Immunosuppressant after Lung Transplantation – A Common Risk Behavior

2019 ◽  
Vol 13 (1) ◽  
pp. 108-115 ◽  
Author(s):  
Lennerling Annette ◽  
Kisch Annika ◽  
Forsberg Anna
Keyword(s):  
Lung Transplantation ◽  
Immunosuppressive Treatment ◽  
Graft Loss ◽  
Symptom Burden ◽  
Well Being ◽  
Self Report ◽  
Full Time ◽  
Cross Sectional ◽  
Immunosuppressive Medication

Background: After lung transplantation, life-long treatment with immunosuppressive medication is required to prevent rejection and graft loss but adherence to immunosuppressive treatment may be difficult for the lung recipient. Adherence is essential and non-adherence to immunosuppressive treatment can lead to graft loss and death. Objective: The aim of this cross-sectional study was to investigate the prevalence of non-adherence 1 to 5 years after lung transplantation in relation to symptom burden, health literacy, psychological well-being and relevant demographic variables. Methods: 117 adult lung recipients, due for their annual follow-up 1-5 years after lung transplantation, participated. Four self-report instruments were used for assessment: the Basel Assessment of Adherence with Immunosuppressive Medication Scale, the Newest Vital Sign, the Psychological General Well-Being and the Organ Transplant Symptom and Wellbeing Instrument. Statistical analysis was performed. Results: Thirty percent of the lung recipients were non-adherent. The most common non-adherence dimension was not taking a dose (43%) and not being punctual with the regimen (80%). Of those working full time or part time, 43% were non-adherent (p=.032). A higher level of non-adherence was reported a long time after LuTx with the highest level at the 3-year follow-up. Conclusion: The level of non-adherence among lung recipients was high. The highest levels were found among those who had returned to work. Non-adherence increased with time after lung transplantation.

Nonwillingness to Return to the Emergency Department and Nonattendance of Follow-Up Care Arrangements Following an Initial Suicide-Related Presentation

Crisis ◽  
2021 ◽  
Author(s):  
Hannah Y. Rosebrock ◽  
Philip J. Batterham ◽  
Nicola A. Chen ◽  
Lauren McGillivray ◽  
Demee Rheinberger ◽  
...  
Keyword(s):  
Emergency Department ◽  
Online Survey ◽  
Cross Sectional Study ◽  
Self Report ◽  
Local Health ◽  
Cross Sectional ◽  
South Wales ◽  
Patients Experience ◽  
Suicidal Crisis

Abstract. Background: For people experiencing a suicidal crisis the emergency department (ED) is often the only option to find help. Aims: The aims of this study were (a) to identify predictors of patients' nonwillingness to return to the ED for help with a future suicidal crisis, and (b) whether nonwillingness to return was associated with follow-up appointment nonattendance. Method: This study utilized baseline data from the RESTORE online survey, and included 911 participants who had presented to an ED for suicidal crisis in the past 18 months, across participating local health districts in the Australian Capital Territory and New South Wales. Results: Patients who reported a more negative ED experience and longer triage wait times were less willing to return. Those who were less willing to return were also less likely to attend their follow-up appointment. Limitations: Due to the cross-sectional study design, causal inferences are not possible. Additionally, the self-report measures used are susceptible to recall bias. Conclusion: Patients' experience of service at EDs is a key indicator to drive improvement of patient outcomes for individuals experiencing a suicidal crisis.

FC 133HEMODIAFILTRATION IS ASSOCIATED WITH REDUCED INFLAMMATION AND INCREASED BONE TURNOVER COMPARED TO CONVENTIONAL HEMODIALYSIS IN CHILDREN - THE HDF, HEART AND HEIGHT (3H) STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Dagmar-Christiane Fischer ◽  
Colette Smith ◽  
Francesca De Zan ◽  
Varvara Askiti ◽  
Aysun Karabay Bayazit ◽  
...  
Keyword(s):  
Bone Formation ◽  
Bone Turnover ◽  
Inflammatory Markers ◽  
Fibroblast Growth Factor 23 ◽  
High Sensitivity ◽  
Tartrate Resistant Acid Phosphatase ◽  
Cross Sectional ◽  
Bone Specific Alkaline Phosphatase ◽  
Conventional Hemodialysis

Abstract Background and Aims Children on dialysis have a high burden of bone related comorbidities and fractures. We report a post-hoc analysis of the HDF-Hearts-Height study to determine the prevalence and risk factors for mineral bone disease in children on hemodiafiltration (HDF) and conventional hemodialysis (HD). Method 144 children were included in baseline cross-sectional analysis, of which 103 (61 HD, 42 HDF) completed 12-month follow-up. Biomarkers of bone formation and resorption, inflammatory markers, fibroblast growth factor-23 (FGF23) and klotho were measured. Results Inflammatory markers interleukin-6 [IL-6], tumor necrosis factor-alfa [TNF-α], and high-sensitivity CRP [hsCRP] were lower in the HDF compared to HD cohorts at baseline and 12 months (p&lt;0.001). Concentrations of bone formation (bone-specific alkaline phosphatase, BAP) and resorption (tartrate-resistant acid phosphatase 5b [TRAP5b]) markers were comparable between cohorts at baseline, but after 12-months the BAP/TRAP5b ratio increased in HDF (p=0.004) and was unchanged in HD (p=0.44). On adjusted analysis the BAP/TRAP5b ratio was 2.66-fold lower (95%CI -3.91, -1.41; p&lt;0.0001) in HD compared to HDF. FGF23 was comparable between groups at baseline (p=0.52) but increased in HD (p&lt;0.0001) and remained static in HDF (p=0.34) at 12-months. Klotho levels were similar between groups and unchanged during follow-up. The FGF23/klotho ratio was 3.86-fold higher (95% CI 2.15, 6.93; p&lt;0.0001) in HD compared to HDF. Conclusion We conclude that children on HDF have increased bone turnover, an attenuated inflammatory profile and lower FGF23/klotho ratios compared to those on HD. Long-term studies are required to determine the effect, if any, of an improved bone biomarker profile on fracture risk and growth.

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