Response times follow lognormal or gamma distribution in arthritis patients

ObjectiveThis study evaluated the statistical distribution of time to treatment response in patients with rheumatic diseases.Study Design and SettingThe study used a secondary data analysis design. Data from the trial of etanercept and methotrexate with radiographic patient outcomes were used to model the response times for etanercept (ETN), methotrexate (MTX), and combined ETN + MTX in patients with rheumatoid arthritis. The German etanercept registry was used to evaluate the response time distributions in patients with juvenile idiopathic arthritis.ResultsFor MTX, the lognormal distribution was considered to be the best model for the outcome American College of Rheumatology (ACR20), lognormal, generalized gamma, and log-logistic distributions for ACR50, and lognormal and generalized gamma for ACR70. For ETN, the lognormal model was best for ACR20, the generalized gamma for ACR50, and both lognormal and generalized gamma distributions for ACR70. For combined treatment, the best model was the log-logistic distribution for ACR20, generalized gamma for ACR50, and both lognormal and generalized gamma distributions for ACR70. For the German etanercept registry, the lognormal distribution was the best model for all three outcomes of pediatric ACR30, ACR50, and ACR70 without interval censoring.ConclusionStudy designs might be more efficient if the response distributions are taken into consideration during planning.     

Correlates of problematic eating behaviors in less acculturated Latinas

We examined whether body weight, depression, and body dissatisfaction could predict problematic eating behaviors in a community sample of less acculturated adult Latina women. Three hundred and forty-nine Latina women ages 20-40 were classified as non-overeater (n=244), eating disorder not otherwise specified-binge eating disorder features (EDNOS-BED) (n=65), or eating disorder not otherwise specified-bulimia nervosa features (EDNOS-BN) (n=40). Participants completed measures of problematic eating behaviors, depression, and body image. Results revealed that normal weight and overweight women were at a higher risk only for EDNOS-BN, while obese women were at a higher risk for either EDNOS-BN or EDNOS-BED. Women with high depression scores were 16 times more likely to be assigned to the EDNOS-BN group than women with lower depression scores. Results illustrate the important role of depression and body weight in predicting problematic eating in less acculturated Latinas.     

Effect of paracentesis on metabolic activity in patients with advanced cirrhosis and ascites

Objective Patients with decompensated cirrhosis often suffer from malnutrition. To enable appropriate nutritional supplementation a correct estimation of resting energy expenditure (REE) is needed. It is, however, unclear whether the volume of ascites should be included or not in the calculations of the REE. Material and methods In 19 patients with cirrhosis and ascites, measurements of REE by indirect calorimetry were performed before paracentesis, after paracentesis, and four weeks after paracentesis. Moreover, handgrip strength (HGS), dual X-ray absorptiometry (DXA), and biochemistry were assessed. Results Calculated and measured REE differed more than 10% in 63% of the patients at baseline. By including the weight of ascites in the calculation of REE, the REE was overestimated by 283 (?602–1381)?kJ/day (p?=?0.69). By subtracting the weight of ascites in the calculation of REE, it was underestimated by??379 (?1915???219) kJ/day, (p??=?0.06). Patients in whom measured REE decreased after paracentesis had higher middle arterial pressure (MAP) (p?=?0.02) and p-sodium (p?=?0.02) at baseline. Low HGS (M:?<30 kg; W?Conclusions The presence of ascites seems to increase REE, why we suggest that when REE is calculated, the weight of ascites should be included. Indirect calorimetry is, however, preferable for REE estimation. More than two-third of patients with ascites suffer from muscle weakness and/or osteopenia.     

Insufficient and excessive amounts of sleep increase the risk of premature death from cardiovascular and other diseases: The Multiethnic Cohort Study

Objective

To explore an independent association between self-reported sleep duration and cause-specific mortality.

Methods

Data were obtained from the Multiethnic Cohort Study conducted in Los Angeles and Hawaii.

Results

Among 61,936 men and 73,749 women with no history of cancer, heart attack or stroke, 19,335 deaths occurred during an average 12.9 year follow-up. Shorter (≤ 5 h/day) and longer (≥ 9 h/day) sleepers of both sexes (vs. 7 h/day) had an increased risk of all-cause and cardiovascular disease (CVD) mortality, but not of cancer mortality. Multivariable hazard ratios for CVD mortality were 1.13 (95% CI 1.00–1.28) for ≤ 5 h/day and 1.22 (95% CI 1.09–1.35) for ≥ 9 h/day among men; and 1.20 (95% CI 1.05–1.36) for ≤ 5 h/day and 1.29 (95% CI 1.13–1.47) for ≥ 9 h/day among women. This risk pattern was not heterogeneous across specific causes of CVD death among men (P_hetero 0.53) or among women (P_hetero 0.72). The U-shape association for all-cause and CVD mortality was observed in all five ethnic groups included in the study and by subgroups of age, smoking status, and body mass index.

Conclusion

Insufficient or excessive amounts of sleep were associated with increased risk of mortality from CVD and other diseases in a multiethnic population.     

The Effects of Soy Consumption before Diagnosis on Breast Cancer Survival: The Multiethnic Cohort Study

This study tested the hypothesis that prediagnostic soy intake was inversely associated with all-cause and breast cancer-specific mortality. The analyses included 3842 women in the Multiethnic Cohort (MEC) study of African Americans, Native Hawaiians, Japanese Americans, Latinos, and Caucasians, who completed a quantitative food frequency questionnaire, aged ≥50 yr at cohort entry, and diagnosed with primary invasive breast cancer following cohort entry (1993–2007). Hazard ratios (HR) and 95% confidence intervals (CI) were estimated from Cox proportional hazards regression with adjustment for known clinical and lifestyle factors. During a mean follow-up after diagnosis of invasive breast cancer of 6.2 ± 3.8 yr, there were 804 deaths including 376 breast cancer-specific deaths. The HR (95%CI) for all-cause and breast cancer-specific morality comparing the highest versus lowest tertiles were 1.03 (0.81–1.33) and 1.03 (0.71–1.50) for soy products and 0.99 (0.82–1.20) and 0.95 (0.71–1.28) for total isoflavones, respectively (P_trend > 0.60 for all). There was limited evidence of differences by hormone receptor status, tumor stage, or ethnic group. Prediagnostic soy intake was unrelated to mortality in postmenopausal women. Our findings are consistent with the literature that soy consumption does not adversely affect breast cancer survival in women.     

Inhibitory effect of inositol phosphates on parathyroid hormone-induced bone resorption in organ cultures

This study investigates the ability of phytic acid, its inositol phosphate derivatives (inositol penta-, tetra-, tri-, di-, and monophosphate), and inorganic phosphate to inhibit parathyroid hormone (PTH)-induced resorption of fetal rat long bones in organ culture. Pregnant rats injected with 45Ca on the 18th day of gestation were killed the next day and their fetuses removed. Half of each pair of dissected long bones was incubated in a chemically defined control medium, while the contralateral half was incubated in medium containing PTH or PTH plus the phosphate compound to be tested. 45Ca released into the medium was indicative of the amount of bone resorption. All phosphate compounds tested inhibited resorption. The inositol phosphates should be studied further to assess their suitability as therapeutic agents for treatment of metabolic bone diseases involving increased turnover.     

Obesity and non-Hodgkin lymphoma survival in an ethnically diverse population: the Multiethnic Cohort study

Purpose

Obesity increases mortality for several malignancies, but for non-Hodgkin lymphoma (NHL), the association between body mass index (BMI) and survival is unclear. We examined the association of pre-diagnostic BMI with overall and NHL-specific survival in the multiethnic cohort (MEC) study of African Americans, Native Hawaiians, Japanese Americans, Latinos, and Caucasians.

Methods

MEC participants free of NHL at cohort entry and diagnosed with NHL during follow-up were included in the analyses (n = 1,331). BMI was based on self-reported weight and height at cohort entry and after 6.1 years of cohort entry. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95 % confidence intervals (CI) with BMI as time-varying exposure in relation to all-cause and NHL-specific mortality while adjusting for known confounders.

Results

The mean age at NHL diagnosis was 70.5 (range 45–89) years. After a mean follow-up of 4.3 ± 3.5 years, 667 deaths including 450 NHL-specific deaths occurred. In multivariable models, obese patients (BMI ≥30.0 kg/m²) had higher all-cause (HR 1.46, 95 % CI 1.13–1.87) and NHL-specific (HR 1.77, 95 % CI 1.30–2.41) mortality compared with patients with high-normal BMI (22.5–24.9 kg/m²). For overweight patients (BMI = 25.0–29.9 kg/m²), the respective HRs were 1.21 (95 % CI 0.99–1.49) and 1.36 (95 % CI 1.06–1.75). Cases with low-normal BMI (<22.5 kg/m²) experienced a significant 45 % higher all-cause and a 40 % higher NHL-specific mortality. After stratification by NHL type, the adverse effect of BMI was stronger for chronic lymphocytic leukemia/small lymphocytic lymphoma than for diffuse large B cell lymphoma and follicular lymphoma.

Conclusions

Pre-diagnostic BMI may be a suitable prognostic marker for NHL patients.     

Association of <Emphasis Type="Italic">Helicobacter pylori </Emphasis>infection and diet on the risk of gastric cancer: a case–control study in Hawaii

Objective  The risk factors most strongly associated with gastric cancer are the gastric bacteria Helicobacter pylori and diet. Utilizing data from a case–control study among residents in Hawaii, we examined the association of diet, presence of H. pylori, and non-cardia gastric cancer risk. Methods  Serum taken at diagnosis for cases (n = 212) and at interview for controls (n = 336) was assayed for IgG antibodies to H. pylori group antigens and to a recombinant fragment of the cytotoxin-associated antigen A (CagA) protein, and subjects completed food frequency questionnaires. Risk measures were calculated using logistic regression. The likelihood ratio test was used to assess interactions. Results  Inverse associations were found between gastric cancer risk and increasing intake of several micronutrients and vegetables among all individuals. For H. pylori/CagA-positive subjects, significant trends were present for total, green, and yellow vegetables, while a significant trend was present only for yellow vegetables among H. pylori/CagA-negative individuals. For intestinal gastric cancer, there was a suggestion that intake of vegetables, especially cruciferous vegetables, had a stronger protective effect for the H. pylori/CagA-positive group. Conclusions  Diet may play a greater role in the etiology of non-cardia gastric cancer among individuals with evidence of H. pylori infection than among those without. G. N. Stemmermann is now deceased.     

Do insertion-related problems affect subsequent IUD performance?

This investigation compares the IUD performance of 372 women who had an insertion-related problem (most with moderate or severe pain) and 372 matched women who had no such problem; all women had interval insertion. A woman in the Problem Cohort and her matched counterpart in the Comparison Cohort were inserted with the same IUD type by the same insertor on the same day or on close dates. The six IUD types used by these women were Lippes Loop D, Copper-7, Copper T-200, Copper T-380 Ag, Multiload Copper 250 and Multiload Copper 375. Cumulative gross life-table rates of the pertinent events (accidental pregnancy, expulsion and medical removal for bleeding and pain), adjusted for age and parity, were calculated. Between the Problem Cohort and the Comparison Cohort, no differences were detected in the event rates that were of either statistical or practical significance. Results from this preliminary study suggest that the insertion-related problems usually encountered during interval insertion such as insertion pain, syncope and/or mild cervical laceration are not associated with an increased risk of IUD discontinuation due to pertinent events.