scholarly journals No Association between Daily Walking and Knee Structural Changes in People at Risk of or with Mild Knee Osteoarthritis. Prospective Data from the Multicenter Osteoarthritis Study

2015 ◽  
Vol 42 (9) ◽  
pp. 1685-1693 ◽  
Author(s):  
Britt Elin Øiestad ◽  
Emily Quinn ◽  
Daniel White ◽  
Frank Roemer ◽  
Ali Guermazi ◽  
...  

Objective.We investigated the association between objectively measured daily walking and knee structural change, defined either as radiographic worsening or as cartilage loss, in people at risk of or with knee osteoarthritis (OA).Methods.Participants from the Multicenter Osteoarthritis Study (MOST) with Kellgren-Lawrence grades 0–2 and daily walking (measured with the StepWatch) at the 60-month visit were included. Participants had fixed-flexion, weight-bearing radiographs and knee magnetic resonance images (MRI) at 60 and 84 months. Radiographic worsening was read in both knees using the Osteoarthritis Research Society International grading, and MRI were read for 1 knee using the Whole-Organ MRI Score semiquantitative scoring. OR and 95% CI were calculated comparing those in the middle tertile against the lowest and highest tertiles of daily walking using logistic regression models and generalized estimating equations. Data on walking with moderate to vigorous intensity (min with > 100 steps/min/day) were associated to structural change using multivariate and logistic regression models.Results.The 1179 study participants (59% women) were 67.0 years old (± 7.6), with a mean (± SD) body mass index of 29.8 kg/m2 (± 5.3) who walked 6981 (± 2630) steps/day. After adjusting for confounders, we found no significant associations between daily walking and radiographic worsening or cartilage loss. More time spent walking at a moderate to vigorous intensity was not associated with either radiographic worsening or cartilage loss.Conclusion.Results from the MOST study indicated no association between daily walking and structural changes over 2 years in the knees of people at risk of or with mild knee OA.

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Elizabeth Baraban ◽  
Lindsay Lucas ◽  
Kateri Spinelli

Introduction/Objective: Recent studies show that targeted interventions on lifestyle factors such as weight management and diet can be successful in reducing ischemic stroke (ISC) and transient ischemic attack (TIA) rates. The objective of this study was to examine which subpopulations of patients at risk for secondary stroke presenting to a hospital with an ISC or TIA were more likely to receive interventions in a multi-hospital health system. Methods: Data from 26 hospitals participating in a multi-state healthcare system stroke registry, from January 2009 to December 2015, were used. Patients admitted with a diagnosis of ISC or TIA discharged to home were included. Patients on comfort care or those not discharged home were excluded. At-risk groups included patients with Body Mass Index (BMI) ≥ 25 and those prescribed medication for hypertension or high cholesterol in-hospital. Risk-related interventions included educational material given to patients during admission. Mixed effects logistic regression models with backward elimination were used to identify significant predictors of receiving the intervention from the following variables: year of discharge, age, insurance (private, Medicare, other/self-pay), BMI grouping, ambulation status, length of stay, stroke severity, and medical histories of family stroke, previous stroke or TIA, atrial fibrillation, coronary artery disease, heart failure, dyslipidemia, hypertension, and drug/alcohol abuse. Results: A total of 19,661 patients met the inclusion criteria. Of the 8,334 patients with a BMI ≥ 25, 57% (n=4,717) received weight management intervention. Of the 9,676 prescribed medication for hypertension, 55% (n=5,348) received information on antihypertensive diet. Of the 10,999 patients prescribed medication to lower cholesterol, 64% (n=7,088) received cholesterol lowering diet information. From 2009 to 2015, interventions increased for patients with a BMI ≥ 25 (40% to 66%), prescribed medication for hypertension (37% to 53%), and prescribed medication to lower cholesterol (39% to 67%). The mixed effects logistic regression models showed that all risk groups were significantly less likely to receive intervention if they had lower BMIs, were unable to ambulate versus able to ambulate alone, and had no family history of stroke. For those on medication for cholesterol, patients with Medicare were significantly less likely to receive the intervention compared to those on private insurance or other payment types (AOR=0.78, p<0.001). Conclusions: This large patient cohort demonstrates there are improvement opportunities for in-hospital secondary stroke prevention efforts. Over time, prevention efforts have increased for at-risk patients, but many are still not receiving it. The disparity in intervention rates suggest that a more targeted strategy to educate at-risk populations may need to be developed.


2017 ◽  
Vol 1 (1) ◽  
pp. 8-18
Author(s):  
Adam Christian Haupt ◽  
Jonathan Alt ◽  
Samuel Buttrey

Purpose This paper aims to use a data-driven approach to identify the factors and metrics that provide the best indicators of academic attrition in the Korean language program at the Defense Language Institute Foreign Language Center. Design methodology approach This research develops logistic regression models to aid in the identification of at-risk students in the Defense Language Institute’s Korean language school. Findings The results from this research demonstrates that this methodology can detect significant factors and metrics that identify students at-risk. Additionally, this research shows that school policy changes can be detected using logistic regression models and stepwise regression. Originality value This research represents a real-world application of logistic regression modeling methods applied to the problem of identifying at-risk students for the purpose of academic intervention or other negative outcomes. By using logistic regression, the authors are able to gain a greater understanding of the problem and identify statistically significant predictors of student attrition that they believe can be converted into meaningful policy change.


2009 ◽  
Vol 34 (1) ◽  
pp. 35-42 ◽  
Author(s):  
M Muller-Bolla ◽  
F Courson ◽  
D Droz ◽  
L Lupi-Pégurier ◽  
AM Velly

The objective of this descriptive study was to define the at-risk occlusal surface to guide the practitioner in the decision of whether to seal or not. Method: All dentists affiliated with the French Society of Pediatric Odontology (SFOP) and general practitioners (GP) registered in postgraduate courses in three French dental schools answered the same questionnaire illustrating four occlusal surfaces of permanent molars. It was focused on obtaining an optimal definition of an at-risk occlusal surface. The corresponding four molars were later sectioned to check the answers. Univariate logistic regression analyses and multivariate logistic regression models were tested to identify the factors associated with the at-risk occlusal surface. Results:Eighty-six SFOP dentists and 136 GP filled in the form. Multivariate logistic regression models stratified by type of practice demonstrated that stained fissures (p=0.001) were only associated with at-risk occlusal surface among GP and the morphology of primary fissure (p=0.001) when considering SFOP dentists alone. The multivariate analyses demonstrated that stained fissures, and primary and secondary fissures were linked to the perception of an at-risk occlusal surface. Conclusion: An at-risk occlusal surface has narrow and deep primary fissures. Numerous secondary fissures could increase the risk. The coloration of fissures should not be used in the definition because it depends on tooth integrity.


2021 ◽  
Author(s):  
Marko Kerac ◽  
Philip Thomas James ◽  
Marie McGrath ◽  
Eilise Brennan ◽  
Charles Opondo ◽  
...  

Background There is increasing global focus on malnutrition in infants aged under 6 months (u6m) but evidence on how best to identify and manage at-risk individuals is sparse. Our objectives were to: explore data quality of commonly used anthropometric indicators; describe prevalence and disease burden of infant u6m malnutrition; compare wasting and underweight as measures of malnutrition by determining the strength and consistency of associations with biologically plausible risk factors. Methods We performed a cross-sectional secondary analysis of Demographic and Health Survey (DHS) datasets, focussing on infants u6m. We calculated underweight (low weight-for-age), wasting (low weight-for-length), stunting (low length-for-age), and concurrent wasting and stunting. We explored data quality by recording extreme (flagged, as per standard criteria) or missing values. We calculated the population-weighted prevalence of each type of malnutrition and extrapolated the burden to all low- and middle- income countries (LMICs). We explored associations between infant, maternal and household risk factors with underweight and wasting using logistic regression models. Results We analysed 54 DHS surveys. Data quality in terms of refusals and missingness was similar for both weight and length. There were more extreme (flagged) values for length-based measures (6.1% flagged for weight-for-length, 4.8% for length-for-age) than for weight-for-age (1.0% flagged). Overall, 20.1% of infants (95% CI: 19.5, 20.7) were underweight, 21.3% (95% CI: 20.7, 22.3) were wasted, 17.6% (95% CI: 17.0, 18.2) were stunted, and 2.0% (95% CI: 1.8, 2.2) were concurrently wasted and stunted. This corresponds to an estimated burden in LMICs of 23.8m underweight infants, 24.5m wasted infants, 21.5m stunted infants and 2.2m concurrently wasted and stunted. Logistic regression models showed that numerous risk factors were associated with wasting and underweight. Effect sizes of risk factors tended to be stronger and more consistently associated with underweight compared to wasting. Conclusion Malnutrition in infants u6m is a major problem in LMICs. This is true whether assessed by underweight, wasting or stunting. Our data build on other evidence suggesting that underweight may be a better anthropometric case definition than wasting: data quality is better when length is not involved; biologically plausible risk factors are better reflected by an infant being underweight. Future research, ideally from intervention trials, should further explore how best to identify malnourished (small and nutritionally at-risk) infants u6m. For now, treatment programmes should note that many factors might underlie problems in this age group: services should thus consider how to address maternal health and wider social circumstances as well as caring for infants themselves.


2009 ◽  
Vol 13 (2) ◽  
pp. 163-171 ◽  
Author(s):  
Genevieve Mercille ◽  
Olivier Receveur ◽  
Ann C Macaulay

AbstractObjectiveTo understand more specifically how the quality, quantity and frequency of snack food consumption differs in different BMI categories.DesignFour hundred and forty-nine school-aged children (grade 4–6) from a Kanien’kehaka (Mohawk) community provided a 24 h recall and their height and weight in 1994, 1998 and 2002, in three independent cross-sectional samples. Food consumed between two consecutive meals was defined as a snacking occasion. ANOVA and χ2 tests were used to compare food choices between BMI categories according to food quality criteria and food groups in 2006. Logistic regression models were performed to compare results between normal-weight children and those at risk of overweight and between normal-weight and overweight children.ResultsEnergy intake from snacks tended to be higher for children at risk of overweight, compared with the other two BMI categories. Food groups with a higher energy density were also consumed more frequently by these children, with larger average portions of cereal bars (P < 0·05). Except for dessert consumption, which was less frequent among overweight children, no other variable distinguished risk of overweight in the two logistic regression models tested.ConclusionsDifferences detected in snack food intake between normal-weight children and children at risk of overweight could explain in part the relationship between food choices and risk of overweight. Studies of dietary differences in conjunction with body weight would benefit from considering children at risk of overweight and normal-weight children, rather than children with excess weight only.


Objective: While the use of intraoperative laser angiography (SPY) is increasing in mastectomy patients, its impact in the operating room to change the type of reconstruction performed has not been well described. The purpose of this study is to investigate whether SPY angiography influences post-mastectomy reconstruction decisions and outcomes. Methods and materials: A retrospective analysis of mastectomy patients with reconstruction at a single institution was performed from 2015-2017.All patients underwent intraoperative SPY after mastectomy but prior to reconstruction. SPY results were defined as ‘good’, ‘questionable’, ‘bad’, or ‘had skin excised’. Complications within 60 days of surgery were compared between those whose SPY results did not change the type of reconstruction done versus those who did. Preoperative and intraoperative variables were entered into multivariable logistic regression models if significant at the univariate level. A p-value <0.05 was considered significant. Results: 267 mastectomies were identified, 42 underwent a change in the type of planned reconstruction due to intraoperative SPY results. Of the 42 breasts that underwent a change in reconstruction, 6 had a ‘good’ SPY result, 10 ‘questionable’, 25 ‘bad’, and 2 ‘had areas excised’ (p<0.01). After multivariable analysis, predictors of skin necrosis included patients with ‘questionable’ SPY results (p<0.01, OR: 8.1, 95%CI: 2.06 – 32.2) and smokers (p<0.01, OR:5.7, 95%CI: 1.5 – 21.2). Predictors of any complication included a change in reconstruction (p<0.05, OR:4.5, 95%CI: 1.4-14.9) and ‘questionable’ SPY result (p<0.01, OR: 4.4, 95%CI: 1.6-14.9). Conclusion: SPY angiography results strongly influence intraoperative surgical decisions regarding the type of reconstruction performed. Patients most at risk for flap necrosis and complication post-mastectomy are those with questionable SPY results.


Author(s):  
Mike Wenzel ◽  
Felix Preisser ◽  
Matthias Mueller ◽  
Lena H. Theissen ◽  
Maria N. Welte ◽  
...  

Abstract Purpose To test the effect of anatomic variants of the prostatic apex overlapping the membranous urethra (Lee type classification), as well as median urethral sphincter length (USL) in preoperative multiparametric magnetic resonance imaging (mpMRI) on the very early continence in open (ORP) and robotic-assisted radical prostatectomy (RARP) patients. Methods In 128 consecutive patients (01/2018–12/2019), USL and the prostatic apex classified according to Lee types A–D in mpMRI prior to ORP or RARP were retrospectively analyzed. Uni- and multivariable logistic regression models were used to identify anatomic characteristics for very early continence rates, defined as urine loss of ≤ 1 g in the PAD-test. Results Of 128 patients with mpMRI prior to surgery, 76 (59.4%) underwent RARP vs. 52 (40.6%) ORP. In total, median USL was 15, 15 and 10 mm in the sagittal, coronal and axial dimensions. After stratification according to very early continence in the PAD-test (≤ 1 g vs. > 1 g), continent patients had significantly more frequently Lee type D (71.4 vs. 54.4%) and C (14.3 vs. 7.6%, p = 0.03). In multivariable logistic regression models, the sagittal median USL (odds ratio [OR] 1.03) and Lee type C (OR: 7.0) and D (OR: 4.9) were independent predictors for achieving very early continence in the PAD-test. Conclusion Patients’ individual anatomical characteristics in mpMRI prior to radical prostatectomy can be used to predict very early continence. Lee type C and D suggest being the most favorable anatomical characteristics. Moreover, longer sagittal median USL in mpMRI seems to improve very early continence rates.


SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A305-A306
Author(s):  
Jesse Moore ◽  
Ellita Williams ◽  
Collin Popp ◽  
Anthony Briggs ◽  
Judite Blanc ◽  
...  

Abstract Introduction Literature shows that exercise moderates the relationship between sleep and emotional distress (ED.) However, it is unclear whether different types of exercise, such as aerobic and strengthening, affect this relationship differently. We investigated the moderating role of two types of exercise (aerobic and strengthening) regarding the relationship between ED and sleep. Methods Our analysis was based on data from 2018 National Health Interview Survey (NHIS), a nationally representative study in which 2,814 participants provided all data. Participants were asked 1) “how many days they woke up feeling rested over the past week”, 2) the Kessler 6 scale to determine ED (a score &gt;13 indicates ED), and 3) the average frequency of strengthening or aerobic exercise per week. Logistic regression analyses were performed to determine if the reported days of waking up rested predicted level of ED. We then investigated whether strengthening or aerobic exercise differentially moderated this relationship. Covariates such as age and sex were adjusted in the logistic regression models. Logistic regression analyses were performed to determine if subjective reporting of restful sleep predicted level of ED. We investigated whether strengthening exercise or aerobic exercise differentially moderated this relationship. Covariates such as age and sex were adjusted in the logistic regression models. Results On average, participants reported 4.41 restful nights of sleep (SD =2.41), 3.43 strengthening activities (SD = 3.19,) and 8.47 aerobic activities a week (SD=5.91.) We found a significant association between days over the past week reporting waking up feeling rested and ED outcome according to K6, Χ2(1) = -741, p= &lt;.001. The odds ratio signified a decrease of 52% in ED scores for each unit of restful sleep (OR = .48, (95% CI = .33, .65) p=&lt;.001.) In the logistic regression model with moderation, aerobic exercise had a significant moderation effect, Χ2(1) = .03, p=.04, but strengthening exercise did not. Conclusion We found that restful sleep predicted reduction in ED scores. Aerobic exercise moderated this relationship, while strengthening exercise did not. Further research should investigate the longitudinal effects of exercise type on the relationship between restful sleep and ED. Support (if any) NIH (K07AG052685, R01MD007716, K01HL135452, R01HL152453)


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