scholarly journals Association between Anxiety Levels and Weight Change in the Multiethnic Study of Atherosclerosis

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Katherine Rieke ◽  
Ramon Durazo-Arvizu ◽  
Kiang Liu ◽  
Erin D. Michos ◽  
Amy Luke ◽  
...  
Keyword(s):  
Weight Change ◽  
Inclusion Criteria ◽  
Mixed Effect ◽  
Effect Model ◽  
Lower Baseline ◽  
Multiethnic Cohort ◽  
Baseline Weight ◽  
Study Population ◽  
The Relationship

Objective. To examine the association between anxiety and weight change in a multiethnic cohort followed for approximately 10 years.Methods. The study population consisted of participants of the multiethnic study of atherosclerosis who met specified inclusion criteria (n= 5,799). Weight was measured at baseline and four subsequent follow-up exams. Anxiety was analyzed as sex-specific anxiety quartiles (QANX). The relationship between anxiety level and weight change was examined using a mixed-effect model with weight as the dependent variable, anxiety and time as the independent variables, and adjusted for covariates.Results. Average annual weight change (range) was −0.17 kg (−6.04 to 4.38 kg) for QANX 1 (lowest anxiety), −0.16 kg (−10.71 to 4.45 kg) for QANX 2, −0.15 kg (−8.69 to 6.39 kg) for QANX 3, and −0.20 kg (−7.12 to 3.95 kg) for QANX 4 (highest anxiety). No significant association was noted between QANX and weight change. However, the highest QANX was associated with a −2.48 kg (95% CI = −3.65, −1.31) lower baseline weight compared to the lowest QANX after adjustment for all covariates.Conclusions. Among adults, age 45–84, higher levels of anxiety, defined by the STPI trait anxiety scale, are associated with lower average baseline weight but not with weight change.

The association between lymphopenia and serious infection risk in rheumatoid arthritis

Rheumatology ◽  
2019 ◽  
Vol 59 (4) ◽  
pp. 762-766
Author(s):  
Sujith Subesinghe ◽  
Alexander Kleymann ◽  
Andrew Ian Rutherford ◽  
Katie Bechman ◽  
Sam Norton ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Mixed Effect ◽  
Proportional Hazards Regression ◽  
Effect Model ◽  
Serious Infection ◽  
Patients At Risk ◽  
Using Data ◽  
The Relationship

Abstract Objectives To investigate the relationship between occurrence of serious infection (SI) and lymphocyte counts in patients with RA using data from a single centre. Methods We used routinely captured data from a single tertiary rheumatology centre to explore the relationship between lymphopenia and SI risk. Adult RA patients were included over a 5-year follow-up period. Admissions due to confirmed SI were considered. SI rate with 95% confidence intervals was calculated. The association between SI with baseline lymphocyte counts, time-averaged lymphocyte counts throughout all follow-up, and a nadir lymphocyte count was assessed using Cox proportional hazards regression. The relationship between lymphopenia over time and SI was analysed using a mixed-effect model of lymphocyte counts prior to SI. Results This analysis included 1095 patients with 205 SIs during 2016 person-years of follow-up. The SI rate was 4.61/100 patient-years (95% CI: 3.76, 5.65). Compared with patients with nadir lymphocyte counts >1.5 × 109 cells/l, nadir lymphopenia <1 × 109 cells/l was significantly associated with higher SI risk (HR 3.28; 95% CI: 1.59, 6.76), increasing to HR 8.08 (95% CI: 3.74, 17.44) in patients with lymphopenia <0.5 × 109 cells/l. Lymphocyte counts were observed to be reduced in the 30-day period prior to SI. Conclusion Lymphocyte counts below <1.0 × 109 cells/l were associated with higher SI risk in RA patients; the strongest association between lymphopenia and SI was observed when lymphocyte counts were below <0.5 × 109 cells/l. Lymphopenia may be used as a measure to stratify patients at risk of SI.

scholarly journals Influence of uric acid on the correlation between waist circumference and triglyceride glucose index: an analysis from CHARLS

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Jia Zheng ◽  
Min Jiang ◽  
Yanxia Xie
Keyword(s):  
Uric Acid ◽  
Waist Circumference ◽  
Mediation Effects ◽  
Panel Model ◽  
Triglyceride Glucose Index ◽  
Study Population ◽  
Relationship Of ◽  
The Relationship ◽  
Longitudinal Relationships

Abstract Background Waist circumference (WC) and uric acid (UA) are significantly related. Still, their temporal sequence and how the sequence works on future risk of triglyceride glucose (TyG) are unknown, especially in the Chinese population. Methods Cross-lagged panel model was used to analyze the reciprocal, longitudinal relationships among a set of interrelated variables. The mediation model was constructed to test the effect of the relationship between WC and UA on TyG. Results A total of 5727 subjects were enrolled in our study population, of which 53.5% were women, and the mean age was 59.0 (standard deviation, 8.62) years. After adjusting for traditional confounding factors, the results showed that a higher level of baseline WC was significantly associated with a higher level of follow-up UA (β = 0.003, P = 0.031) and follow-up TyG (β = 0.003, P < 0.001);. Simultaneously, there was no statistical association between the level of baseline UA and the level of follow-up WC (β = − 0.009, P = 0.951). The mediation effects of UA on WC-TyG were estimated to be 18.1% in adults, and 36.2% in women. Conclusions The current study demonstrated that higher baseline level of WC probably preceded UA’ level in general population. In addition, UA mediated the relationship of WC to TyG, especially in females. And the possible mechanism would require further clarification.

scholarly journals Hypertension Burden and the Risk of New-Onset Atrial Fibrillation

Hypertension ◽  
2021 ◽  
Vol 77 (3) ◽  
pp. 919-928
Author(s):  
So-Ryoung Lee ◽  
Chan Soon Park ◽  
Eue-Keun Choi ◽  
Hyo-Jeong Ahn ◽  
Kyung-Do Han ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Total Study Population ◽  
Increased Risk ◽  
Burden Scale ◽  
History Of ◽  
Study Population ◽  
Korean National Health Insurance ◽  
Stage 1 ◽  
The Relationship

The association between the cumulative hypertension burden and the development of atrial fibrillation (AF) is unclear. We aimed to investigate the relationship between hypertension burden and the development of incident AF. Using the Korean National Health Insurance Service database, we identified 3 726 172 subjects who underwent 4 consecutive annual health checkups between 2009 and 2013, with no history of AF. During the median follow-up of 5.2 years, AF was newly diagnosed in 22 012 patients (0.59% of the total study population; 1.168 per 1000 person-years). Using the blood pressure (BP) values at each health checkup, we determined the burden of hypertension (systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg), stratified as 0 to 4 per the hypertension criteria. The subjects were grouped according to hypertension burden scale 1 to 4: 20% (n=742 806), 19% (n=704 623), 19% (n=713 258), 21% (n=766 204), and 21% (n=799 281). Compared with normal people, subjects with hypertension burdens of 1, 2, 3, and 4 were associated with an 8%, 18%, 26%, and 27% increased risk of incident AF, respectively. On semiquantitative analyses with further stratification of stage 1 (systolic BP of 130–139 mm Hg or diastolic BP of 80–89 mm Hg) and stage 2 (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg) hypertension, the risk of AF increased with the hypertension burden by up to 71%. In this study, both a sustained exposure and the degree of increased BP were associated with an increased risk of incident AF. Tailored BP management should be emphasized to reduce the risk of AF.

Abstract 240: Serum Cholesterol and Angiotensin-Induced Abdominal Aortic Aneurysm in Hypercholesterolemic Mice

2013 ◽  
Vol 33 (suppl_1) ◽  
Author(s):  
Petra A Prins ◽  
Michael Hill ◽  
David Airey ◽  
Sam Nwosu ◽  
Prudhvidhar R Perati ◽  
...  
Keyword(s):  
Aortic Aneurysms ◽  
Cholesterol Concentration ◽  
Linear Mixed Effect Model ◽  
Hemodynamic Parameters ◽  
Mixed Effect ◽  
Regression Methods ◽  
Effect Model ◽  
Abdominal Aortic ◽  
And Control ◽  
The Relationship

Background Although hyperlipidemia is known to augment the incidence of abdominal aortic aneurysms (AAA) in the AngII-induced model of apolipoprotein E -/- mice, its relationship to AAA size is unknown. Therefore, we evaluated the relationship between total cholesterol concentration (TC) and change (delta) in aortic diameter. Methods TC was measured in 36 male mice that underwent a 4-week infusion period with saline (n=9) or AngII (1500 ng/kg/min; n=27), along with serial measurements of pulse rate (PR), and pulse (PP), mean arterial (MAP), systolic (SBP) and diastolic (DBP) pressure. A linear mixed effect model was used to assess the relationship between all hemodynamic parameters and delta. Nonparametric and linear regression methods were used to evaluate TC in relation to delta. Results TC did not differ between AngII and control mice (Figure, bottom left) (p=0.18). The burden of atherosclerosis was greater among AngII-exposed mice versus control, but did not differ by presence or size of AAA (Figure, bottom right). None of the hemodynamic parameters were predictive of delta (SBP, p = 0.66; DBP, p = 0.66; MAP, p = 0.55; PP, p = 0.66; and PR, p = 0.39). Mean TC was higher among mice with large versus small AAA (552.6 vs. 393.5 mg/ ml, p<0.05; Figure, top right). The nonparametric smoothing line (Figure, top left) suggests a first order relationship between delta and TC (p for trend < 0.001). AngII (ß = 0.48, p < 0.001) and TC (ß = 0.0015, p = 0.003) were independent predictors in the linear model for delta. Conclusions Our findings suggest that TC is incrementally associated with AAA size. These findings may have potential clinical relevance for risk assessment in AAA patients. Figure

scholarly journals Weight change over two years in people prescribed olanzapine, quetiapine and risperidone in UK primary care: Cohort study in THIN, a UK primary care database

2018 ◽  
Vol 32 (10) ◽  
pp. 1098-1103 ◽  
Author(s):  
David PJ Osborn ◽  
Irene Petersen ◽  
Nick Beckley ◽  
Kate Walters ◽  
Irwin Nazareth ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Weight Gain ◽  
Confidence Interval ◽  
Weight Change ◽  
Antipsychotic Treatment ◽  
Weight Changes ◽  
Baseline Weight ◽  
Care Database

Background: Follow-up studies of weight gain related to antipsychotic treatment beyond a year are limited in number. We compared weight change in the three most commonly prescribed antipsychotics in a representative UK General Practice database. Method: We conducted a cohort study in United Kingdom primary care records of people newly prescribed olanzapine, quetiapine or risperidone. The primary outcome was weight in each six month period for two years after treatment initiation. Weight changes were compared using linear regression, adjusted for age, baseline weight and diagnosis. Results: N = 6338 people received olanzapine, 12,984 quetiapine and 6556 risperidone. Baseline weight was lowest for men treated with olanzapine (80.8 kg versus 83.5 kg quetiapine, 82.0 kg risperidone) and women treated with olanzapine (67.7 kg versus 71.5 kg quetiapine 68.4 kg risperidone. Weight gain occurred during treatment with all three drugs. Compared with risperidone mean weight gain was higher with olanzapine (adjusted co-efficient +1.24 kg (95% confidence interval: 0.69–1.79 kg per six months) for men and +0.77 kg (95% confidence interval: 0.29–1.24 kg) for women). Weight gain with quetiapine was lower in unadjusted models compared with risperidone, but this difference was not significant after adjustment. Conclusion: Olanzapine is more commonly prescribed to people with lower weight. However, after accounting for baseline weight, age, sex and diagnosis, olanzapine is still associated with greater weight gain over two years than risperidone or quetiapine. Baseline weight does not ameliorate the risks of weight gain associated with antipsychotic medication. Weight gain should be assertively discussed and managed for people prescribed antipsychotics, especially olanzapine.

scholarly journals Early outcome of acute peripartum cardiomyopathy in eastern part of Nepal

2017 ◽  
Vol 14 (1) ◽  
pp. 13-15
Author(s):  
Rajesh Nepal ◽  
Madhav Bista ◽  
Sita Ghimire
Keyword(s):  
Post Partum ◽  
Complete Recovery ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Inclusion Criteria ◽  
Predictors Of Outcome ◽  
Medical College ◽  
Term Delivery ◽  
Study Population

Background and Aims: Peripartum cardiomyopathy (PPCM) is an uncommon complication of pregnancy with variable outcome. There is paucity of data related to its outcomes in Nepal. We studied the clinical and echocardiographic outcome of PPCM patients in eastern part of Nepal.Methods: In this prospectively designed study all patients admitted with the diagnosis of acute severe PPCM at Nobel Medical College, Biratnagar, meeting the inclusion criteria over a period of 14 month, were enrolled and followed up for 3 months post partum.The LVEF and Left ventricular end diastolic dimension (LVEDD) was assessed by echocardiography at baseline and 3 months postpartum. Mortality and survival with normal or depressed ejection fraction were determined. Predictors of outcome were evaluated. Statistical analysis were done using SPSS version 17.Results: Mean age of the study population was 27.6}5.6 years. Ninety five percent of patient had term delivery. Sixty four percent were primigravida. Eighty four percent had the symptoms onset in post partum period. Pulmonary edema was present in 64% during first hospital admission. Mortality was 9% during 3-month follow up period. Thirty six percent had complete recovery of LVEF at 3 months. Fifty five percent survived with depressed LVEF. Age, LVEF less than 30% and LVEDD more than 60 mm at study entry did not correlate significantly with poor clinical recovery at 3 months.Conclusion: This study demonstrates that survival outcome is better even in the patients with severe acute PPCM with early diagnosis and proper management of heart failure.  

scholarly journals ROLE OF THE BUDGET IN RAISING THE EFFICIENCY OF FINANCIAL ‎ PERFORMANCE IN THE DIRECTORATE OF EDUCATION IN THE NORTHERN ‎GOVERNORATES

2021 ◽  
Vol 03 (06) ◽  
pp. 366-383
Author(s):  
Wafaa Mohammad ASHOUR ◽  
Narmeen Ismat ZATARA
Keyword(s):  
Financial Performance ◽  
Preparation Process ◽  
Ministry Of Education ◽  
Open Questions ◽  
Study Population ◽  
Training Courses ◽  
The Relationship ◽  
Academic Year

The study aimed to identify the role of the budget in raising the efficiency of financial ‎performance in the Directorate of Education in the northern governorates. The two ‎researchers used: qualitative research.‎ The interview tool was adopted: it consisted of (3) main themes. The first axis: about ‎budget preparation and included (8) questions. The second axis: about the implementation ‎of the budget, and included (7) questions. The third axis: about the relationship between ‎the budget and the efficiency of financial performance. The interview questions included ‎open questions and closed questions.‎ The study population is made up of members of the Finance Committee and is responsible ‎for the budget preparation process. They number (68) in the second semester of the ‎academic year 2020-2021. The sample size is (19) by 28%. The most important results are: ‎ o The budget plays a major role in raising the efficiency of financial performance, as ‎it is one of the activities planning tools, as the revenue amounts are distributed ‎among the budget items.‎ o The budget has a role in raising the efficiency of financial performance in the ‎education directorates through its oversight role on performance.‎ Recommendations: ‎ o Increasing the powers of education directorates in the budget preparation process ‎by the Ministry of Education in order to achieve a higher level of flexibility in it to ‎meet the needs within the priorities.‎ o Conducting training courses on budget preparation, implementation, and follow-‎up by the Ministry of Education in cooperation with the Ministry of Finance, and ‎not to be limited to department heads only, but extend to all employees in the ‎directorate's departments and those willing and qualified to prepare budgets‎.

scholarly journals Therapeutic Plasma Exchange (PLEX) in Thrombotic Microangiopathy (TMA): Experiences of an Inner-City Hospital over a Decade

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3691-3691
Author(s):  
Aakash Putta ◽  
Hafeez Shaka ◽  
Shristi Upadhyay Banskota ◽  
Sunny R K Singh ◽  
Sindhu Malapati ◽  
...  
Keyword(s):  
Inner City ◽  
Validation Studies ◽  
Patient Population ◽  
Final Diagnosis ◽  
Safety Net ◽  
Inclusion Criteria ◽  
Safety Net Hospital ◽  
Study Population ◽  
Time Of Presentation

Introduction: There are multiple mechanisms of occurrence of TMA. Some of the etiologies are associated with high morbidity and mortality, but there are very subtle differences in presentation. A high index of suspicion is recommended for thrombotic thrombocytopenic purpura (TTP) due to the time sensitive nature of treatment initiation and poor outcomes associated with delay in treatment. Due to this, treatment with PLEX is often initiated empirically before diagnostic test results are available. We aim to report the management and outcomes of TMA along with the predictive value of the PLASMIC score in our patient population, over a 10-year period in an inner-city safety net hospital. Methods: This is a single center observational study including patients who underwent PLEX for a diagnosis of TMA, due to concern for TTP between January 2009 and May 2019 at an inner-city safety net hospital. Patients were identified from blood bank records and data was collected by review of electronic medical record. We excluded patients &lt;18 years old and who received PLEX for indications other than that described previously. Data was collected until death or last follow-up. Statistical analysis was done using STATA. Results: A total of 40 patients met the inclusion criteria. Of these, 57.5% (n=23) were male, 17.5% (n=7) had a known malignancy and 15% (n=6) had human immunodeficiency virus infection. Study population was predominantly African American and Hispanic- comprising 75% (n=30) and 17.5% respectively- which differentiates our study from other validation studies for the PLASMIC score. Symptoms at presentation to emergency department, time to initiation of PLEX from presentation, and lab parameters before and after PLEX are shown in the attached table. ADAMTS13 activity level is available in 65% (n=26) patients, 57.7% of which were sent before initiation of PLEX. Average number of PLEX sessions during the admission was 9.4 (range: 2-30). As part of treatment, 85% (n=34) received steroids and 17.5% (n=7) received hemodialysis. 5 patients received rituximab and 2 received eculizumab. Final diagnoses included TTP in 62.5% (n=25), complement mediated TMA in 5% (n=2), drug induced TMA in 10% (n=4), TMA from sepsis or rheumatological condition in 15% (n=6), bone marrow suppression due to chemotherapy in 5% (n=2) and unsure in 2.5% (n=1). Average length of stay was 22.2 days (range: 6-85 days). Of the total 40 patients, 7.5% (n=3) died on the same admission, 10% (n=4) died after discharge and 3 were readmitted for repeat PLEX. Duration of follow-up after discharge ranged from 9 to 3319 days (mean 1102.6 days). We retrospectively estimated the PLASMIC score at the time of presentation for all the patients. Amongst the patients eventually diagnosed with TTP, 50% had a PLASMIC score of &gt;5 and 70.83% had a score ≥5 at the time of presentation. Among non-TTP TMA, 25% had a score of &gt;5 and 62.5% had a score ≥5. The sensitivity, specificity and positive predictive value of PLASMIC score for prediction of final diagnosis of TTP was calculated for all patients who met inclusion criteria and is shown in the attached table. Of those who underwent PLEX in the setting of TMA for the concern of TTP, only about a third were started on PLEX within 24 hours. Conclusion:Among our study population, only about a third were started on PLEX within 24 hours which is concerning and highlights the need for quality improvement initiatives to increase provider awareness and decrease time to PLEX. Final diagnosis of TTP was made in 62.5% of the patients but notably, the performance of PLASMIC score in our patient population was inferior compared to prior validation studies. One possible explanation for this could be the difference in baseline patient demographics, with our patients belonging mostly to minority groups. There is a need for further studies with derivation and validation cohorts in this patient population to derive a scoring system that is more predictive. Table Disclosures No relevant conflicts of interest to declare.

scholarly journals 1179. PCV13 Pediatric Routine Schedule Completion and Adherence Before and During the COVID-19 Pandemic in the US

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S682-S682
Author(s):  
Liping Huang ◽  
Jennifer L Nguyen ◽  
Johnna Perdrizet ◽  
Tamuno Alfred ◽  
Adriano Arguedas
Keyword(s):  
Booster Dose ◽  
Unintended Consequences ◽  
Mitigation Measures ◽  
Full Time ◽  
Primary Dose ◽  
The Us ◽  
Study Population ◽  
The Difference ◽  
The Relationship

Abstract Background Coronavirus Disease 2019 (COVID) mitigation measures may have unintended consequences, such as reduced or delayed access to routine immunizations. This study examined (1) PCV13 routine vaccination completion and adherence (C&A) among US infants before and during the COVID pandemic and (2) the relationship between primary dose C&A and booster dose C&A. Methods Retrospective data from the Optum’s de-identified Clinformatics Data Mart Database were used to create 3 cohorts: C1, Pre-COVID; C2, During COVID; C3, Cross-COVID (Figure 1). The completion was defined as number of PCV13 doses received within 8 months of birth, and the adherence was defined number of doses received at ACIP recommended time (@2, 4, 6 months, +/- 5 days). Univariable logistic regression was used to compare the odds of primary dose C&A in cohorts C1 and C3 vs C2 and descriptive analyses were used to explore primary dose C&A in relation to booster dose C&A. Figure 1: Study population and inclusion criteria Results A total of 172,916, 70,049, and 34,854 infants were included in C1, C2, and C3. Among infants with &gt; 8 months of follow-up from birth (N=132,183 for C1&C3, 16,522 for C3), 3-primary dose completion was statistically significantly higher before COVID than during COVID (crude OR = 1.10, 95% CI: 1.06-1.15). The 3-primary dose adherence was also higher before COVID than during COVID (crude OR = 1.10, 95% CI: 1.05-1.15). Among infants with ≥2, 4 and 6 months of follow-up, adherence of each individual dose was consistently higher before COVID than during COVID (1st dose: OR = 1.03, 95% CI: 1.01–1.04; 2nd dose: OR = 1.04, 95% CI: 1.01 – 1.06; 3rd dose: OR = 1.12, 95% CI: 1.08 – 1.15) (Table 1). Booster dose completion was higher in infants who completed or adhered to 3 primary doses than infants who completed or adhered to only 1 or 2 primary doses (Figure 2, Overall) and booster dose C&A was generally higher before COVID than during COVID (Figure 2, Cohort 1 vs. Cohort 3). Table 1. Comparison of completion and adherence of primary dosing series per-COVID vs. during-COVID era Figure 2: Booster dose completion and adherence in relation to primary dosing completion (A) and adherence (B) Conclusion These results indicated that PCV13 full completion was statistically lower during COVID, but the magnitude of the difference in infants was not extensive. Infants who completed or adhered to all three primary doses were more likely to complete or adhere to the booster dose. Further research is warranted as structured datasets mature to capture the full time span of COVID-19 mitigation measures. Disclosures Liping Huang, MD, MA, MS, Pfizer Inc (Employee) Jennifer L Nguyen, ScD, MPH, Pfizer Inc. (Employee) Johnna Perdrizet, MPH, Pfizer Inc (Employee) Tamuno Alfred, PhD, Pfizer Inc. (Employee) Adriano Arguedas, MD, Pfizer (Employee)

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