Relation between type A behavior pattern and the extent of coronary atherosclerosis in Japanese women

This study examined the relation of Type A behavior pattern and its components to angiographically documented coronary atherosclerosis in 198 Japanese women. A questionnaire-based interview elicited psychosocial and other factors. Type A behavior pattern was measured by 12 questions. Significant coronary stenosis was defined when a 75% or greater luminal narrowing occurred atoneor more major coronary arteries or 50% or greater narrowing occurred at the left main artery. Gensini’s score also was calculated. Logistic regression analysis was used to calculate odds ratios and 95% confidence intervals with adjustment for traditional coronary risk factors and the presence of a job. Global Type A behavior pattern showed no material association with the severity of coronary atherosclerosis assessed by both Gensini’s score and the presence of significant coronary stenosis. However, its subcomponents, enthusiasm and competitiveness, were positively related to the severity of coronary atherosclerosis, whereas self-confidence and perfectionism were negatively related. These findings suggest overall a null association between global Type A and coronary atherosclerosis as well as the presence of toxic or beneficial components of Type A behaviors in Japanese women.     

Macro-level determinants of young people's subjective health and health inequalities: A multilevel analysis in 27 welfare states

ObjectivesCross-national studies have rarely focused on young people. The aim of this study is to investigate whether macro-level determinants are associated with health and socioeconomic inequalities in young people's health.Study designData were collected from the Health Behaviour in School-aged Children (HBSC) study in 2006, which included 11- to 15-year old adolescents from 27 European and North American countries (n = 134,632). This study includes national income, health expenditure, income inequality, and welfare regime dummy-variables as macro-level determinants, using hierarchical regression modelling.Main outcome measurePsychosomatic health complaints and socioeconomic inequalities in psychosomatic health complaints.ResultsAdolescents in countries with higher income inequality and with liberal welfare tradition were associated with more health complaints and a stronger relationship between socioeconomic status and macro-level determinants compared to adolescents from countries with lower income inequality or the Social Democratic regime. National income and health expenditure were not related to health complaints. Countries with higher national income, public health expenditure and income inequality showed stronger associations between socioeconomic status and psychosomatic health complaints.ConclusionResults showed that macro-level characteristics are relevant determinants of health and health inequalities in adolescence.     

Risk factors for the development of bronchiolitis obliterans in children with severe adenovirus pneumonia: A retrospective study with dose-response analysis

To investigate and analyze the relevant risk factors for bronchiolitis obliterans (BO) in children with severe adenovirus pneumonia, a retrospective study of children with severe adenovirus pneumonia was performed in 34 cases that developing BO and 105 cases not developing BO in Children's hospital of Chongqing Medical University from January 2015 to February 2019. The multivariate logistic regression analysis was used to identify factors which were significantly associated with development of BO after the univariate analysis, and receiver operating characteristic (ROC) curve analysis was performed to find out the cut-off value for the significant relevant factors. A nonlinear dose-response relationship between risk factors and the risk of BO was assessed by restricted cubic spline model. Three factors were independently associated with development of BO, which were length of fever (OR 1.129, 95% CI 1.033-1.234), dyspnea (OR 3.922, 95% CI 1.060-14.514) and invasive mechanical ventilation (OR 6.861, 95% CI 1.854-25.387). The cut-off value of length of fever were 10.5 days. A linear dose-response relationship between length of fever and occurrence of BO was observed (P = .57 for nonlinearity). Children with severe adenovirus pneumonia who have a longer duration of fever (especially more than 10.5 days), have dyspnea or require invasive mechanical ventilation in the acute phase are more likely to develop BO.     

Prevalence and correlates of multiple non-communicable diseases risk factors among male and female adults in Sudan: results of the first national STEPS survey in 2016

BackgroundNon-communicable diseases (NCDs) are on the rise in low- and middle-income countries. The aim of this study was to assess the prevalence and correlates of multiple NCD risk factors (inadequate fruit and vegetable intake, low physical activity, tobacco use, heavy alcohol use, diabetes, hypertension, raised total cholesterol and overweight/obesity) among adults in Sudan.MethodsWe conducted a cross-sectional study using nationally representative data. The analytic cohort included 7,722 participants who were between the ages of 18–69 years old individuals (median age=36 years) that took part in the “2016 Sudan STEPS survey.”ResultsIn all, 34.2% had 0–1 NCD risk factor, 33.5% 2 risk factors, and 32.4% 3 or more NCD risk factors. In adjusted ordinal logistic regression analysis, the odds of having a higher count of NCD risk factors increased from 2.04 to 3.52 from the age group of 35–49 years to age group of 50–69 years when compared to the younger people aged 18–34 years. Men had higher odds (1.21) of higher NCD risk factor count than women. Individuals residing in urban areas had higher odds (1.86) of higher NCD risk factor count than individuals residing in rural areas.ConclusionAlmost one in three participants had three or more NCD risk factors and several associated variables were identified for men and women that can facilitate in designing intervention programmes.     

International variation in adherence to referral guidelines for suspected cancer: a secondary analysis of survey data

Background

Variation in cancer survival persists between comparable nations and appears to be due, in part, to primary care practitioners (PCPs) having different thresholds for acting definitively in response to cancer-related symptoms.

Aim

To explore whether cancer guidelines, and adherence to them, differ between jurisdictions and impacts on PCPs’ propensity to take definitive action on cancer-related symptoms.

Design and setting

A secondary analysis of survey data from six countries (10 jurisdictions) participating in the International Cancer Benchmarking Partnership.

Method

PCPs’ responses to five clinical vignettes presenting symptoms and signs of lung (n = 2), colorectal (n = 2), and ovarian cancer (n = 1) were compared with investigation and referral recommendations in cancer guidelines.

Results

Nine jurisdictions had guidelines covering the two colorectal vignettes. For the lung vignettes, although eight jurisdictions had guidelines for the first, the second was covered by a Swedish guideline alone. Only the UK and Denmark had an ovarian cancer guideline. Survey responses of 2795 PCPs (crude response rate: 12%) were analysed. Guideline adherence ranged from 20–82%. UK adherence was lower than other jurisdictions for the lung vignette covered by the guidance (47% versus 58%; P <0.01) but similar (45% versus 46%) or higher (67% versus 38%; P <0.01) for the two colorectal vignettes. PCPs took definitive action least often when a guideline recommended a non-definitive action or made no recommendation. UK PCPs adhered to recommendations for definitive action less than their counterparts (P <0.01). There wasno association between jurisdictional guideline adherence and 1-year survival.

Conclusion

Cancer guideline content is variable between similarly developed nations and poor guideline adherence does not explain differential survival. Guidelines that fail to cover high-risk presentations or that recommend non-definitive action may reduce definitive diagnostic action.     

The covariation of multiple risk factors in primary care: a latent class analysis

There is a need to advance the quality of healthcare by increasing knowledge about multiple risk factors and how to intervene to improve health outcomes. In an effort to better describe the presentation of multiple risks, this study involved a database review to describe the prevalence and covariation of multiple risk factors in individuals presenting to primary care. Patients with a primary care encounter from January 1, 2005 to June 30, 2005 (N = 10,043) were identified from the Department of Veteran’s Affair’s medical database and information about the following risk factors was extracted: alcohol use, psychiatric distress, body mass, smoking status, blood pressure, and posttraumatic stress. Exploratory and confirmatory latent class analyses identified three classes of individuals. Class 1 consisted of individuals with an overall lower level of risk for health problems, but a moderately high likelihood of elevated blood pressure. Individuals in Class 2 appeared to have the greatest need for intervention because they had a moderate to high likelihood of reporting at risk alcohol use, smoking, depression, and posttraumatic stress. Class 3 consisted of individuals reporting the co-occurrence of at risk alcohol use, smoking, and elevated blood pressure. Similar to past research, the findings highlight the need for addressing multiple risk factors in primary care. In addition, this study expands on the literature by identifying specific patterns of covariation among different risk factors that suggest avenues for research and program development. All authors have contributed equally to this work.     

Assessing unmet anaesthesia need in Sierra Leone: a secondary analysis of a cluster-randomized,cross-sectional,countrywide survey

ObjectivesTo determine the unmet anaesthesia need in a low resource region.IntroductionSurgery and anæsthesia services in low- and middle-income countries (LMICs) are under-equipped, under-staffed, and unable to meet current surgical need. There is little objective measure as to the true extent and nature of unmet need. Without such an understanding it is impossible to formulate solutions. Therefore, we re-examined Surgeons OverSeas (SOSAS) unmet surgical need data to extrapolate unmet anaesthesia need.MethodsFor the untreated surgical conditions identified by SOSAS, we assigned anaesthetic technique required to carry out the procedure. The chosen anaesthetic was based on common practice in the region. Procedures were categorized into minimal anaesthesia, spinal anæsthesia, regional anaesthesia, ketamine/monitored anaesthesia care (MAC), and general endotracheal anæsthesia (GETA).DiscussionsNinety-two per cent (687 of 745) of untreated surgical conditions in Sierra Leone would require some form of anaesthesia. Seventeen per cent (125 of 745) would require MAC, 22% (167 of 745) would require spinal anaesthesia, and 53% (395 of 745) would require GETA.ConclusionAnalyses such as this can provide guidance as to the rational and efficient production and distribution of personnel, drugs and equipment.     

Increasing constructive anger verbal behavior decreases resting blood pressure: A secondary analysis of a randomized controlled hostility intervention

We hypothesized that increasing anger verbal behavior in an assertive, constructively motivated style should decrease resting blood pressure (BP) and that this behavior may be one mechanism through which hostility relates to BP. We tested this hypothesis by conducting secondary analyses on a single-blind, matched, randomized controlled study of hostility modification and BP. A total of 22 high-hostile male patients with coronary heart disease were matched on age and hostility level and were randomly assigned to either an 8-week cognitive-behavioral hostility treatment (n = 10) or an information-control group (n = 12). Patients were reassessed after treatment and at 2-month follow-up on hostility, observed anger expression, and resting BP. We found that decreases in hostility predicted increases in constructive anger behavior-verbal component, which in turn predicted decreases in resting BP at follow-up. Thus, one of the mechanisms underlying the hostility-BP association may be the lack of constructive anger expression.     

A simple algebraic demonstration of the validity of DeFries-Fulker analysis in unselected samples with multiple kinship levels

DeFries and Fulker's (Behav. Genet. 15, 467–473, 1985) regression procedure (DF analysis) to estimatec ² andh ² was originally applied to selected twin data. Since then, DF analysis has been applied more broadly in unselected data and with multiple (nontwin) kinship levels. Theoretical work based on the matrix algebra of variance-covariance matrices has shown that estimates ofc ² andh ² are unbiased in selected two-group settings. In this article, a simple proof is presented supporting the validity of DF analysis in broader settings. We use scalar algebra to show that parameter estimates ofh ² andc ² are unbiased in unselected settings with multiple (more than two) kinship levels. Caveats are offered, and other DF analysis problems are identified.     

A gender comparison of psychological distress among medical students in Nigeria during the Coronavirus pandemic: a cross-sectional survey

BackgroundThe Coronavirus disease (COVID-19) pandemic as a large scale stressor could have negative effects on the mental health of medical students. Since gender differences in mental health may exist, it is important to see if a large scale stressor like the pandemic may be associated with variances in the psychological distress between both genders.ObjectivesTo assess and compare the psychological distress of male and female medical students during the COVID-19 pandemic.MethodsA cross-sectional survey was carried out among 1010 medical students from three universities in southwestern Nigeria within the first six months of the first reported case of the COVID-19 pandemic. The respondents were purposively selected. Data was obtained online on participants'' demographic and psychological distress using the General Health Questionnaire 12 (GHQ-12). Data was analyzed using the SPSS version 21, student t and chi-square tests were used to assess gender differences, and multivariate regression to assess the predictors of psychological distress among both genders. p values less than 0.05were considered statistically significant.ResultsOverall, female participants (OR=1.455, 95% CI= 1.095–1.936) were twice more likely to have experienced psychological distress than males during the COVID-19 pandemic. Age (OR=0.922, 95% CI= 0.867–0.979), being in pre-clinical years (OR= 1.394, 95% CI= 1.004–1.938), having a family income less than 100,000 naira (OR= 1.379, 95% CI=1.442–6.723) a previous history of mental illness (OR=3.077, 95% CI= 1.430–6.615) and having a relative/acquaintance diagnosed with COVID 19(OR=1.646, 95% CI= 1.062–2.551) were independently associated with psychological distress among the respondents. When comparing both genders, among females, age (OR=0.886, 95% CI= 0.803–0.978), family income less than 100,000 naira (OR=1.898, 95% CI= 1.306–2.759) and a previous history of mental illness (OR=5.266, 95% CI= 1.894–14.635) were associated with psychological distress, while, being in pre-clinical years (OR= 1.713, 95% CI= 1.052–2.790) was associated with psychological distress among males.ConclusionFemales had more psychological distress compared to male students. It is recommended that gender-specific interventions addressing psychological distress among medical students are instituted.     

A randomized controlled trial for the primary prevention of osteoporosis among preadolescent girl scouts: 1-year outcomes of a behavioral program

OBJECTIVE: To provide 1-year outcomes for a randomized controlled trial of a behavioral-educational intervention for the primary prevention of osteoporosis among 247 preadolescent girls. METHODS: Girl Scout troops were randomly assigned to one of two intervention groups-a group comprising girls only (n = 73) and girls with their mothers (n = 94)-and a healthy-lifestyles control group (n = 80). Multilevel (hierarchical) models were employed to account for clustering of girls within troops. RESULTS: Among girls who met the recommended levels of Ca at baseline, those in the intervention were significantly more likely to maintain or improve their intake at follow-up compared to controls. No significant group differences were found for changes in WBPA. CONCLUSIONS: A behavioral intervention for the primary prevention of osteoporosis holds promise for maintaining adequate Ca intake among preadolescent females.     

Implications of the 2021 ESC cardiovascular risk classification among 283,000 European immigrants living in a low-risk region: a population-based analysis in Catalonia

IntroductionThe ESC recently classified European countries into 4 cardiovascular risk regions. However, whether Europeans from higher-risk countries living in lower-risk regions may benefit from intensive cardiovascular prevention efforts is unknown. We described the burden of risk factors and cardiovascular disease (CVD) among European-born immigrants living in Catalonia, a low-risk region.Material and methodsA retrospective cohort study of 5.6 million adults of European origin living in Catalonia in 2019, including 282,789 European-born immigrants, was performed. We used the regionwide healthcare database and classified participants into 5 groups: low-, moderate-, high-, and very high-risk, and local-born. Age-standardized prevalence was estimated as of December 31^st, 2019 and incidence was computed during 2019 among at-risk individuals.ResultsThe very high-risk group was the largest immigrant group (N = 136,910; 48.4%), while the high-risk group was the smallest (N = 15,739; 5.6%). These two had the highest burden of coronary heart disease across all groups evaluated, in both men and women. The very high-risk group also had the highest prevalence of hypertension and obesity at young-to-middle age, and the burden of risk factors newly diagnosed during 2019 was highest in high- and very high-risk participants. The mean age at first diagnosis of risk factors and CVD was lower in these groups.ConclusionsIn Catalonia, residents born in high- and very-high-risk European countries are at increased risk of coronary heart disease and newly diagnosed risk factors. Low-risk European countries may consider tailored prevention efforts, early screening of risk factors, and adequate healthcare resource planning to better address the health needs of men and women from higher-risk countries.     

Family attitudes in youth as a possible precursor of cancer among physicians: A search for explanatory mechanisms

A measure of youthful family attitudes, the Closeness to Parents Scale, has continued to be predictive of cancer among physicians in a prospective study of medical students. Nonetheless, questions have remained concerning the meaning and reliability of this measure and whether its predictive value is diminishing over time. Perhaps more important, it is necessary to ascertain whether the relationship is the result of some methodological artifact or whether it is mediated by an association with known risk factors, such as smoking, drinking, and radiation exposure. Each of these issues was examined in turn, using a variety of statistical techniques to refine the scale and to equate cancer and control groups with respect to risk factors as well as possible artifacts. In a group of 913 men, it was found that the scale is primarily a function of good father-son relationships and that its association with later cancer persists even after the influence of possible mediating and artifactual variables is statistically controlled. Several possible explanations for these findings are discussed.This work was supported by National Cancer Institute Grant 1 R18 CA24416-02, National Institute on Aging Grant 1 RO1 GM25822-01, and The Johns Hopkins University.     

Morphological classification and identification of neurons in the inferior colliculus: a multivariate analysis

In this paper a modern statistical method is applied to an old cell classification and identification problem in the central nucleus of the inferior colliculus. In a recent computer-based reconstruction study of Golgi-impregnated neurons in the rat, two types of cell with flattened dendritic arbors, flat (F) and less flat (LF), were defined. Both types contributed to the anisotropic and laminar pattern of the nucleus. The classification was based on five morphological features of complete dendritic arbors, two assessed visually and three numerically. With respect to the latter criteria, the two types were classified by preselected cut-off values. The distinction of the two types was supported, among other things, by a prevailing spatial segregation into laminar and interlaminar compartments. The cell sample was too small, however, to validate the classification and segregation definitively. In the present study, the classification is tested by the partial least squares regression method which is independent of the preselected cut-off values, and is able to handle small sample sizes and interdependent variables. In the plots, the F and LF cells are clearly separated into two distinct clusters, strongly supporting the distinction of the two types. The different density of the two clusters shows that the F cells are more homogeneous that the LF cells. The relative importance of the classification criteria is also evaluated. The three-dimensional (3D) inspection and the 3D convex hull-based form factor were found to be the most powerful criteria for identifying the two cell types, while the 2D evaluation of camera lucida drawings, a standard method in neuroanatomy, proved to have the least predictive value.     

A four year seasonal survey of the relationship between outdoor climate and epidemiology of viral respiratory tract infections in a temperate climate

BackgroundThe relation between weather conditions, viral transmission and seasonal activity of respiratory viruses is not fully understood.ObjectivesTo investigate the impact of outdoor weather in a temperate climate setting on the seasonal epidemiology of viruses causing respiratory tract infections, particularly influenza A (IFA).Study designIn total, 20,062 clinical nasopharyngeal swab samples referred for detection of respiratory pathogens using a multiplex PCR panel, between October 2010 and July 2013, were included. Results of PCR detection were compared with local meteorological data for the same period.ResultsLow temperature and vapor pressure (VP) were associated with weekly incidence of IFA, respiratory syncytial virus, metapneumovirus, bocavirus and adenovirus but no association with relative humidity was found. The incidence of human rhinovirus and enterovirus was independent of temperature. During seasonal IFA outbreaks, the weekly drop of average temperature (compared with the week before) was strongly associated with the IFA incidence recorded the following week.ConclusionA sudden drop in outdoor temperature might activate the annual influenza epidemic in a temperate climate by facilitating aerosol spread in dry air. These conditions also seem to affect the incidence of other respiratory pathogens but not human rhino- or enterovirus, suggesting that routes of infection other than aerosol may be relevant for these agents.     

Family analysis of Werner's syndrome: A survey of 42 Japanese families with a review of the literature

Forty-two Japanese families, including 80 individuals with Werner's syndrome were studied, confirming that this syndrome is inherited as an autosomal recessive trait. The incidence of malignancy was relatively high in these families and individuals with Werner's syndrome, although the incidence was not so high as was reported previously. HLA typing revealed no significant linkage with Werner's syndrome. The frequency of Werner's syndrome in Japan was estimated using two methods which indicated approximately 300 cases among 100 million people.