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Sample records for clinical cohort study

  1. Biomarkers in differentiating clinical dengue cases: A prospective cohort study

    Directory of Open Access Journals (Sweden)

    Gary Kim Kuan Low

    2015-12-01

    Full Text Available Objective: To evaluate five biomarkers (neopterin, vascular endothelial growth factor-A, thrombomodulin, soluble vascular cell adhesion molecule 1 and pentraxin 3 in differentiating clinical dengue cases. Methods: A prospective cohort study was conducted whereby the blood samples were obtained at day of presentation and the final diagnosis were obtained at the end of patients’ follow-up. All patients included in the study were 15 years old or older, not pregnant, not infected by dengue previously and did not have cancer, autoimmune or haematological disorder. Median test was performed to compare the biomarker levels. A subgroup Mann-Whitney U test was analysed between severe dengue and non-severe dengue cases. Monte Carlo method was used to estimate the 2-tailed probability (P value for independent variables with unequal number of patients. Results: All biomarkers except thrombomodulin has P value < 0.001 in differentiating among the healthy subjects, non-dengue fever, dengue without warning signs and dengue with warning signs/severe dengue. Subgroup analysis for all the biomarkers between severe dengue and non-severe dengue cases was not statistically significant except vascular endothelial growth factor-A (P < 0.05. Conclusions: Certain biomarkers were able to differentiate the clinical dengue cases. This could be potentially useful in classifying and determining the severity of dengue infected patients in the hospital.

  2. Clinical disorders in a post war British cohort reaching retirement: evidence from the First National Birth Cohort Study

    OpenAIRE

    Pierce , MB; Silverwood, RJ; Nitsch, D.; Adams, JE; Stephen, AM; Nip, W; Macfarlane, P; Wong, A.; Richards, M.; Hardy, R; Kuh, D.; on behalf of the NSHD Scientific and Data Collection Teams

    2012-01-01

    Background The medical needs of older people are growing because the proportion of the older population is increasing and disease boundaries are widening. This study describes the distribution and clustering of 15 common clinical disorders requiring medical treatment or supervision in a representative British cohort approaching retirement, and how health tracked across adulthood. Methods and Findings The data come from a cohort of 2661 men and women, 84% of the target sample, fo...

  3. Psoriasis is associated with clinically significant cardiovascular risk: a Danish nationwide cohort study

    DEFF Research Database (Denmark)

    Ahlehoff, O; Gislason, G H; Charlot, M;

    2011-01-01

    Southern Denmark, Copenhagen; Copenhagen University Hospital Gentofte, Hellerup; University of Copenhagen, Copenhagen, Denmark) Psoriasis is associated with clinically significant cardiovascular risk: a Danish nationwide cohort study. J Intern Med 2010; doi: 10.1111/j.1365-2796.2010.02310.x. Objective. The...... magnitude of the cardiovascular risk from psoriasis and psoriatic arthritis is debated. We therefore investigated the psoriasis-related risk of adverse cardiovascular events and mortality. Design, setting and subjects. We conducted a cohort study of the entire Danish population aged =18 years followed from...

  4. Development in Children with Achondroplasia: A Prospective Clinical Cohort Study

    Science.gov (United States)

    Ireland, Penelope J.; Donaghey, Samantha; McGill, James; Zankl, Andreas; Ware, Robert S.; Pacey, Verity; Ault, Jenny; Savarirayan, Ravi; Sillence, David; Thompson, Elizabeth; Townshend, Sharron; Johnston, Leanne M.

    2012-01-01

    Aim: Achondroplasia is characterized by delays in the development of communication and motor skills. While previously reported developmental profiles exist across gross motor, fine motor, feeding, and communication skills, there has been no prospective study of development across multiple areas simultaneously. Method: This Australasian…

  5. Clinical disorders in a post war British cohort reaching retirement: evidence from the First National Birth Cohort study.

    Directory of Open Access Journals (Sweden)

    Mary B Pierce

    Full Text Available BACKGROUND: The medical needs of older people are growing because the proportion of the older population is increasing and disease boundaries are widening. This study describes the distribution and clustering of 15 common clinical disorders requiring medical treatment or supervision in a representative British cohort approaching retirement, and how health tracked across adulthood. METHODS AND FINDINGS: The data come from a cohort of 2661 men and women, 84% of the target sample, followed since birth in England, Scotland and Wales in 1946, and assessed at 60-64 years for: cardio and cerebro-vascular disease, hypertension, raised cholesterol, renal impairment, diabetes, obesity, hypothyroidism, hyperthyroidism, anaemia, respiratory disease, liver disease, psychiatric problems, cancers, atrial fibrillation on ECG and osteoporosis. We calculated the proportions disorder-free, with one or more disorders, and the level of undiagnosed disorders; and how these disorders cluster into latent classes and relate to health assessed at 36 years. Participants had, on average, two disorders (range 0-9; only 15% were disorder-free. The commonest disorders were hypertension (54.3%, 95% CI 51.8%-56.7%, obesity (31.1%, 28.8%-33.5%, raised cholesterol (25.6%, 23.1-28.26%, and diabetes or impaired fasting glucose (25.0%, 22.6-27.5%. A cluster of one in five individuals had a high probability of cardio-metabolic disorders and were twice as likely than others to have been in the poorest health at 36 years. The main limitations are that the native born sample is entirely white, and a combination of clinical assessments and self reports were used. CONCLUSIONS: Most British people reaching retirement already have clinical disorders requiring medical supervision. Widening disease definitions and the move from a disease-based to a risk-based medical model will increase pressure on health services. The promotion of healthy ageing should start earlier in life and consider the

  6. 1970 British Cohort Study

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    Matt Brown

    2014-10-01

    Full Text Available The 1970 British Cohort Study (BCS70 is one of Britain’s world famous national longitudinal birth cohort studies, three of which are run by the Centre for Longitudinal Studies at the Institute of Education, University of London. BCS70 follows the lives of more than 17,000 people born in England, Scotland and Wales in a single week of 1970. Over the course of cohort members lives, the BCS70 has collected information on health, physical, educational and social development, and economic circumstances among other factors. Since the birth survey in 1970, there have been nine ‘sweeps’ of all cohort members at ages 5, 10, 16, 26, 30, 34, 38 and most recently at 42. Data has been collected from a number of different sources (the midwife present at birth, parents of the cohort members, head and class teachers, school health service personnel and the cohort members themselves. The data has been collected in a variety of ways including via paper and electronic questionnaires, clinical records, medical examinations, physical measurements, tests of ability, educational assessments and diaries. The majority of can be accessed by bona fide researchers through the a href="http://discover.ukdataservice.ac.uk/series/?sn=200001" UK Data Service at the University of Essex.

  7. 1970 British Cohort Study

    Directory of Open Access Journals (Sweden)

    Matt Brown

    2014-10-01

    Full Text Available The 1970 British Cohort Study (BCS70 is one of Britain’s world famous national longitudinal birth cohort studies, three of which are run by the Centre for Longitudinal Studies at the Institute of Education, University of London.  BCS70 follows the lives of more than 17,000 people born in England, Scotland and Wales in a single week of 1970. Over the course of cohort members lives, the BCS70 has collected information on health, physical, educational and social development, and economic circumstances among other factors. Since the birth survey in 1970, there have been nine ‘sweeps’ of all cohort members at ages 5, 10, 16, 26, 30, 34, 38 and most recently at 42. Data has been collected from a number of different sources (the midwife present at birth, parents of the cohort members, head and class teachers, school health service personnel and the cohort members themselves. The data has been collected in a variety of ways including via paper and electronic questionnaires, clinical records, medical examinations, physical measurements, tests of ability, educational assessments and diaries. The majority of BCS70 survey data can be accessed by bona fide researchers through the UK Data Service at the University of Essex.

  8. Dengue infection in children in Ratchaburi, Thailand: a cohort study. II. Clinical manifestations.

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    Chukiat Sirivichayakul

    Full Text Available BACKGROUND: Dengue infection is one of the most important mosquito-borne diseases. More data regarding the disease burden and the prevalence of each clinical spectrum among symptomatic infections and the clinical manifestations are needed. This study aims to describe the incidence and clinical manifestations of symptomatic dengue infection in Thai children during 2006 through 2008. STUDY DESIGN: This study is a school-based prospective open cohort study with a 9,448 person-year follow-up in children aged 3-14 years. Active surveillance for febrile illnesses was done in the studied subjects. Subjects who had febrile illness were asked to visit the study hospital for clinical and laboratory evaluation, treatment, and serological tests for dengue infection. The clinical data from medical records, diary cards, and data collection forms were collected and analyzed. RESULTS: Dengue infections were the causes of 12.1% of febrile illnesses attending the hospital, including undifferentiated fever (UF (49.8%, dengue fever (DF (39.3% and dengue hemorrhagic fever (DHF (10.9%. Headache, anorexia, nausea/vomiting and myalgia were common symptoms occurring in more than half of the patients. The more severe dengue spectrum (i.e., DHF had higher temperature, higher prevalence of nausea/vomiting, abdominal pain, rash, diarrhea, petechiae, hepatomegaly and lower platelet count. DHF cases also had significantly higher prevalence of anorexia, nausea/vomiting and abdominal pain during day 3-6 and diarrhea during day 4-6 of illness. The absence of nausea/vomiting, abdominal pain, diarrhea, petechiae, hepatomegaly and positive tourniquet test may predict non-DHF. CONCLUSION: Among symptomatic dengue infection, UF is most common followed by DF and DHF. Some clinical manifestations may be useful to predict the more severe disease (i.e., DHF. This study presents additional information in the clinical spectra of symptomatic dengue infection.

  9. The UK clinical aptitude test and clinical course performance at Nottingham: a prospective cohort study

    OpenAIRE

    Yates, Janet; James, David

    2013-01-01

    Background The UK Clinical Aptitude Test (UKCAT) was introduced in 2006 as an additional tool for the selection of medical students. It tests mental ability in four distinct domains (Verbal Reasoning, Quantitative Reasoning, Abstract Reasoning, and Decision Analysis), and the results are available to students and admission panels in advance of the selection process. Our first study showed little evidence of any predictive validity for performance in the first two years of the Nottingham un...

  10. Safety of bevacizumab in clinical practice for recurrent ovarian cancer: A retrospective cohort study

    Science.gov (United States)

    SELLE, FRÉDÉRIC; EMILE, GEORGE; PAUTIER, PATRICIA; ASMANE, IRÈNE; SOARES, DANIELE G.; KHALIL, AHMED; ALEXANDRE, JEROME; LHOMMÉ, CATHERINE; RAY-COQUARD, ISABELLE; LOTZ, JEAN-PIERRE; GOLDWASSER, FRANÇOIS; TAZI, YOUSSEF; HEUDEL, PIERRE; PUJADE-LAURAINE, ERIC; GOUY, SÉBASTIEN; TREDAN, OLIVIER; BARBAZA, MARIE O.; ADY-VAGO, NORA; DUBOT, CORALINE

    2016-01-01

    The poor outcome of patients with recurrent ovarian cancer constitutes a continuous challenge for decision-making in clinical practice. In this setting, molecular targets have recently been identified, and novel compounds are now available. Bevacizumab has been introduced for the treatment of patients with ovarian cancer and is, to date, the most extensively investigated targeted therapy in this setting. However, potential toxicities are associated with the use of this monoclonal antibody. These toxicities have been reported in clinical trials, and can also be observed outside of trials. As limited data is currently available regarding the safety of bevacizumab treatment in daily clinical practice, the current retrospective study was designed to evaluate this. Data from 156 patients with recurrent ovarian cancer who had received bevacizumab treatment between January 2006 and June 2009 were retrospectively identified from the institutional records of five French centers. In contrast to clinical trials, the patients in the present study were not selected and had a heterogeneous profile according to their prior medical history, lines of treatment prior to bevacizumab introduction and number of relapses. The results first confirm the effect of heavy pretreatment on the occurrence of serious and fatal adverse events in clinical practice, as previously reported for clinical trials and for other retrospective cohort studies. Importantly, the data also demonstrates, for the first time, that medical history of hypertension is an independent predictive risk factor for the development of high-grade hypertension during bevacizumab treatment. These results thus suggest that treating physicians must consider all risk factors for managing bevacizumab toxicity prior to its introduction. Such risk factors include the time of bevacizumab introduction, a patient's history of hypertension and a low incidence of pre-existing obstructive disease. PMID:26998090

  11. Diabetes Is Associated with Worse Clinical Presentation in Tuberculosis Patients from Brazil: A Retrospective Cohort Study.

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    Leonardo Gil-Santana

    Full Text Available The rising prevalence of diabetes mellitus (DM worldwide, especially in developing countries, and the persistence of tuberculosis (TB as a major public health issue in these same regions, emphasize the importance of investigating this association. Here, we compared the clinical profile and disease outcomes of TB patients with or without coincident DM in a TB reference center in Brazil.We performed a retrospective analysis of a TB patient cohort (treatment naïve of 408 individuals recruited at a TB primary care center in Brazil between 2004 and 2010. Data on diagnosis of TB and DM were used to define the groups. The study groups were compared with regard to TB disease presentation at diagnosis as well as to clinical outcomes such as cure and mortality rates upon anti-tuberculosis therapy (ATT initiation. A composite score utilizing clinical, radiological and microbiological parameters was used to compare TB severity between the groups.DM patients were older than non-diabetic TB patients. In addition, diabetic individuals more frequently presented with cough, night sweats, hemoptysis and malaise than those without DM. The overall pattern of lung lesions assessed by chest radiographic examination was similar between the groups. Compared to non-diabetic patients, those with TB-diabetes exhibited positive acid-fast bacilli in sputum samples more frequently at diagnosis and at 30 days after ATT initiation. Notably, higher values of the TB severity score were significantly associated with TB-diabetes comorbidity after adjustment for confounding factors. Moreover, during ATT, diabetic patients required more frequent transfers to TB reference hospitals for complex clinical management. Nevertheless, overall mortality and cure rates were indistinguishable between the study groups.These findings reinforce the idea that diabetes negatively impacts pulmonary TB severity. Our study argues for the systematic screening for DM in TB reference centers in endemic

  12. The Clinical Research Center for Depression Study: Baseline Characteristics of a Korean Long-Term Hospital-Based Observational Collaborative Prospective Cohort Study

    OpenAIRE

    Kim, Tae-Suk; Jeong, Seung Hee; Kim, Jung-Bum; Lee, Min-Soo; Kim, Jae-Min; Yim, Hyeon-Woo; Jun, Tae-Youn

    2010-01-01

    Objective The Clinical Research Center for Depression (CRESCEND) study is a 9-year observational collaborative prospective cohort study for the clinical outcomes in participants with depressive disorders in Korea. In this study, we examined the baseline characteristics of the depressive participants as the hospital-based cohort. Methods Participants were assessed using various instruments including the Clinical Global Impression scale, 17-item Hamilton Depression Rating Scale (HDRS-17), Hamil...

  13. Biomarkers in differentiating clinical dengue cases:A prospective cohort study

    Institute of Scientific and Technical Information of China (English)

    Gary Kim Kuan Low; Seng Chiew Gan; Shu Cheow Ho

    2015-01-01

    Objective:To evaluate five biomarkers (neopterin, vascular endothelial growth factor-A, thrombomodulin, soluble vascular cell adhesion molecule 1 and pentraxin 3) in differentiating clinical dengue cases. Methods:A prospective cohort study was conducted whereby the blood samples were obtained at day of presentation and the final diagnosis were obtained at the end of patients’ follow-up. All patients included in the study were 15 years old or older, not pregnant, not infected by dengue previously and did not have cancer, autoimmune or haematological disorder. Median test was performed to compare the biomarker levels. A subgroup Mann-WhitneyU test was analysed between severe dengue and non-severe dengue cases. Monte Carlo method was used to estimate the 2-tailed probability (P) value for independent variables with unequal number of patients. Results: All biomarkers except thrombomodulin hasPvalue < 0.001 in differentiating among the healthy subjects, non-dengue fever, dengue without warning signs and dengue with warning signs/severe dengue. Subgroup analysis for all the biomarkers between severe dengue and non-severe dengue cases was not statistically significant except vascular endothelial growth factor-A (P < 0.05). Conclusions: Certain biomarkers were able to differentiate the clinical dengue cases. This could be potentially useful in classifying and determining the severity of dengue infected patients in the hospital.

  14. Clinical and Immunological Markers of Dengue Progression in a Study Cohort from a Hyperendemic Area in Malaysia

    OpenAIRE

    Anusyah Rathakrishnan; Benjamin Klekamp; Seok Mui Wang; Thamil Vaani Komarasamy; Santha Kumari Natkunam; Jameela Sathar; Azliyati Azizan; Aurora Sanchez-Anguiano; Rishya Manikam; Shamala Devi Sekaran

    2014-01-01

    Background With its elusive pathogenesis, dengue imposes serious healthcare, economic and social burden on endemic countries. This study describes the clinical and immunological parameters of a dengue cohort in a Malaysian city, the first according to the WHO 2009 dengue classification. Methodology and Findings This longitudinal descriptive study was conducted in two Malaysian hospitals where patients aged 14 and above with clinical symptoms suggestive of dengue were recruited with informed c...

  15. Translation of clinical prediction rules for febrile children to primary care practice: an observational cohort study

    Science.gov (United States)

    van Ierland, Yvette; Elshout, Gijs; Berger, Marjolein Y; Vergouwe, Yvonne; de Wilde, Marcel; van der Lei, Johan; Mol, Henriëtte A; Oostenbrink, Rianne

    2015-01-01

    Background Clinical prediction rules (CPRs) to identify children with serious infections lack validation in low-prevalence populations, which hampers their implementation in primary care practice. Aim To evaluate the diagnostic value of published CPRs for febrile children in primary care. Design and setting Observational cohort study among febrile children (<16 years) who consulted five GP cooperatives (GPCs) in the Netherlands. Method Alarm signs of serious infection and clinical management were extracted from routine clinical practice data and manually recoded with a structured electronic data-entry program. Eight CPRs were selected from literature. CPR-variables were matched with alarm signs and CPRs were applied to the GPC-population. ‘Referral to emergency department (ED)’ was used as a proxy outcome measure for ‘serious infection’. CPR performance was assessed by calibration analyses, sensitivity, specificity, and area under the ROC-curve (ROC-area). Results A total of 9794 GPC-contacts were eligible, 54% male, median age 2.3 years (interquartile range 1.0–4.6 years) and 8.1% referred to ED. Frequencies of CPR-variables varied from 0.5% (cyanosis, drowsy) to 25% (temperature ≥40°C). Alarm signs frequently included in CPRs were ‘ill appearance’, ‘inconsolable’, and ‘abnormal circulatory or respiratory signs’. The height of the CPR’s predicted risks generally corresponded with being (or not being) referred to the ED in practice. However, calibration-slopes indicated that three CPRs underestimated the risk of serious infection in the GPC-population. Sensitivities ranged from 42% to 54%, specificities from 68% to 89%. ROC-areas ranged from 0.52 to 0.81, with best performance of CPRs for children aged <3 months. Conclusion Published CPRs performed moderately well in the primary out-of-hours care population. Advice is given on how to improve translation of CPRs to primary care practice. PMID:25824182

  16. Clinical and hepatic evaluation in adult dengue patients: a prospective two-month cohort study

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    Ricardo Tristão-Sá

    2012-12-01

    Full Text Available INTRODUCTION: To analyze the liver dysfunction and evolution of signs and symptoms in adult dengue patients during a two-month follow-up period. METHODS: A prospective cohort study was conducted in Campos dos Goytacazes, Rio de Janeiro, Brazil, from January to July, 2008. The evolution of laboratory and clinical manifestations of 90 adult dengue patients was evaluated in five scheduled visits within a two-month follow-up period. Twenty controls were enrolled for the analysis of liver function. Patients with hepatitis B, hepatitis C, those known to be human immunodeficiency virus (HIV seropositive and pregnant women were excluded from the study. RESULTS: At the end of the second month following diagnosis, we observed that symptoms persisted in 33.3% (30/90 of dengue patients. We also observed that, 57.7% (15/26 of the symptoms persisted at the end of the second month. The most persistent symptoms were arthralgia, fatigue, weakness, adynamia, anorexia, taste alteration, and hair loss. Prior dengue virus (DENV infection did not predispose patients to a longer duration of symptoms. Among hepatic functions, transaminases had the most remarkable elevation and in some cases remained elevated up to the second month after the disease onset. Alanine aminotransferase (ALT levels overcame aspartate aminotransferase (AST during the convalescent period. Male patients were more severely affected than females. CONCLUSIONS: Dengue fever may present a wide number of symptoms and elevated liver transaminases at the end of the second month.

  17. Psoriasis is associated with clinically significant cardiovascular risk: a Danish nationwide cohort study

    DEFF Research Database (Denmark)

    Ahlehoff, Ole; Gislason, Gunnar Hilmar; Charlot, Mette Gitz;

    2011-01-01

    Objective. The magnitude of the cardiovascular risk from psoriasis and psoriatic arthritis is debated. We therefore investigated the psoriasis-related risk of adverse cardiovascular events and mortality. Design, setting and subjects. We conducted a cohort study of the entire Danish population aged...

  18. Predictive validity of the UK clinical aptitude test in the final years of medical school: a prospective cohort study

    OpenAIRE

    Husbands, Adrian; Mathieson, Alistair; Dowell, Jonathan; Cleland, Jennifer; MacKenzie, Rhoda

    2014-01-01

    Background The UK Clinical Aptitude Test (UKCAT) was designed to address issues identified with traditional methods of selection. This study aims to examine the predictive validity of the UKCAT and compare this to traditional selection methods in the senior years of medical school. This was a follow-up study of two cohorts of students from two medical schools who had previously taken part in a study examining the predictive validity of the UKCAT in first year. Methods The sample consisted of ...

  19. Adherence to physiotherapy clinical guideline acute ankle injury and determinants of adherence: a cohort study

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    van Beers Hans

    2007-05-01

    Full Text Available Abstract Background Clinical guidelines are considered important instruments to improve quality in health care. In physiotherapy, insight in adherence to guidelines is limited. Knowledge of adherence is important to identify barriers and to enhance implementation. Purpose of this study is to investigate the ability to adherence to recommendations of the guideline Acute ankle injury, and to identify patient characteristics that determine adherence to the guideline. Methods Twenty-two physiotherapists collected data of 174 patients in a prospective cohort study, in which the course of treatment was systematically registered. Indicators were used to investigate adherence to recommendations. Patient characteristics were used to identify prognostic factors that may determine adherence to the guideline. Correlation between patient characteristics and adherence to outcome-indicators (treatment sessions, functioning of patient, accomplished goals was calculated using univariate logistic regression. To calculate explained variance of combined patient characteristics, multivariate analysis was performed. Results Adherence to individual recommendations varied from 71% to 100%. In 99 patients (57% the physiotherapists showed adherence to all indicators. Adherence to preset maximum of six treatment sessions for patients with severe ankle injury was 81% (132 patients. The odds to receive more than six sessions were statistically significant for three patient characteristics: females (OR:3.89; 95%CI: 1.41–10.72, recurrent sprain (OR: 6.90; 95%CI: 2.34 – 20.37, co-morbidity (OR: 25.92; 95% CI: 6.79 – 98.93. All factors together explained 40% of the variance. Inclusion of physiotherapist characteristics in the regression model showed that work-experience reduced the odds to receive more than six sessions (OR: 0.2; 95%CI: 0.06 – 0.77, and increased explained variance to 45%. Conclusion Adherence to the clinical guideline Acute ankle sprain showed that the

  20. Clinical factors influencing normalization of prothrombin time after stopping warfarin: a retrospective cohort study

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    Zondag Michelle

    2008-10-01

    Full Text Available Abstract Background Anticoagulation with warfarin should be stopped 4–6 days before invasive procedures to avoid bleeding complications. Despite this routine, some patients still have high International Normalized Ratio (INR values on the day of surgery and the procedure may be cancelled. We sought to identify easily available clinical characteristics that may influence the rate of normalization of prothrombin time when warfarin is stopped before surgery or invasive procedures. Methods Clinical data were collected retrospectively from consecutive cases from two cohorts, who stopped warfarin 6 days before surgery. An INR value of 1.6 or higher on the day of surgery or requirement for reversal with vitamin K the day before surgery were criteria for slow return (S to normal INR. Results Of 202 patients, 14 (7% were classified as S. Eight of the S-patients required reversal with vitamin K one day before surgery and in another case surgery was cancelled due to high INR. Baseline INR was the only variable significantly associated with classification as S in stepwise logistic regression analysis (p = 0.003. The odds ratio for being in the normal group was 0.27 (95% confidence interval 0.12–0.62 for each unit baseline INR increased. The positive predictive value of baseline INR with a cut off at > 3.0 was only 15% and for INR > 3.5 it was 33%. Conclusion Baseline INR, but not the size of the maintenance dose, is associated with the rate of normalization of prothrombin time after stopping warfarin, but it has limited utility as predictor in clinical practice. Whenever normal hemostasis is considered crucial for the safety, the INR should be checked again before the invasive procedure.

  1. Birch pollen influence the severity of atopic eczema – prospective clinical cohort pilot study and ex vivo penetration study

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    Fölster-Holst R

    2015-10-01

    Full Text Available Regina Fölster-Holst,1 Jagoda Galecka,1 Sigo Weißmantel,1 Ute Dickschat,2 Frank Rippke,3 Kerstin Bohnsack,3 Thomas Werfel,4 Katja Wichmann,4 Matthias Buchner,1 Thomas Schwarz,1 Annika Vogt,5 Jürgen Lademann,5 Martina C Meinke5 1Department of Dermatology, Venerology and Allergy, University of Kiel, 2Wörth, 3Beiersdorf AG, Hamburg, 4Department of Dermatology, Venerology and Allergy, Division of Immunodermatology and Allergy Research, Hannover Medical School, Hannover, 5Department of Dermatology, Venerology and Allergology, Charité – Universitätsmedizin Berlin, Berlin, Germany Abstract: There is little clinical evidence for a correlation between the severity of atopic eczema (AE and pollen exposition. To obtain more data, we performed a clinical cohort pilot study about the influence of pollen on AE between sensitized and nonsensitized subjects and an experimental study addressing the cutaneous penetration of pollen into the skin. Fifty-five patients were monitored during birch pollen season. To study the cutaneous penetration, grass pollen allergens were applied on excised skin and the uptake in CD1c-expressing dendritic cells was investigated. The correlation between environmental pollen load and severity of the Scoring Atopic Dermatitis (SCORAD score and pruritus was observed, regardless of the status of sensitization. The sensitized group recovered significantly worse after the birch pollen season. Remarkably higher amounts of pollen allergens taken up by CD1c cells were detected in epidermal cells derived from skin explants with a disturbed epidermal barrier. These findings suggest an exacerbating role of pollen in AE utilizing the epidermal route. Keywords: aeroallergens, atopic eczema, seasonality, skin antigen-presenting cells, skin barrier penetration

  2. The value of the UK Clinical Aptitude Test in predicting pre-clinical performance: a prospective cohort study at Nottingham Medical School

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    James David

    2010-07-01

    Full Text Available Abstract Background The UK Clinical Aptitude Test (UKCAT was introduced in 2006 as an additional tool for the selection of medical students. It tests mental ability in four distinct domains (Quantitative Reasoning, Verbal Reasoning, Abstract Reasoning, and Decision Analysis, and the results are available to students and admissions panels in advance of the selection process. As yet the predictive validity of the test against course performance is largely unknown. The study objective was to determine whether UKCAT scores predict performance during the first two years of the 5-year undergraduate medical course at Nottingham. Methods We studied a single cohort of students, who entered Nottingham Medical School in October 2007 and had taken the UKCAT. We used linear regression analysis to identify independent predictors of marks for different parts of the 2-year preclinical course. Results Data were available for 204/260 (78% of the entry cohort. The UKCAT total score had little predictive value. Quantitative Reasoning was a significant independent predictor of course marks in Theme A ('The Cell', (p = 0.005, and Verbal Reasoning predicted Theme C ('The Community' (p Conclusion This limited study from a single entry cohort at one medical school suggests that the predictive value of the UKCAT, particularly the total score, is low. Section scores may predict success in specific types of course assessment. The ultimate test of validity will not be available for some years, when current cohorts of students graduate. However, if this test of mental ability does not predict preclinical performance, it is arguably less likely to predict the outcome in the clinical years. Further research from medical schools with different types of curriculum and assessment is needed, with longitudinal studies throughout the course.

  3. The distinct clinical profile of chronically critically ill patients: a cohort study

    OpenAIRE

    Estenssoro, Elisa; Reina, Rosa; Canales, Héctor S; Saenz, María Gabriela; Gonzalez, Francisco E; Aprea, María M; Laffaire, Enrique; Gola, Victor; Dubin, Arnaldo

    2006-01-01

    Introduction Our goal was to describe the epidemiology, clinical profiles, outcomes, and factors that might predict progression of critically ill patients to chronically critically ill (CCI) patients, a still poorly characterized subgroup. Methods We prospectively studied all patients admitted to a university-affiliated hospital intensive care unit (ICU) between 1 July 2002 and 30 June 2005. On admission, we recorded epidemiological data, the presence of organ failure (multiorgan dysfunction ...

  4. Determinants of the clinical course of musculoskeletal complaints in general practice: design of a cohort study

    OpenAIRE

    van der Windt Daniëlle AWM; Terwee Caroline B; Bot Sandra DM; van der Waal Johanna M; Bouter Lex M; Dekker Joost

    2003-01-01

    Abstract Background Musculoskeletal complaints are frequent and have large consequences for public health. Information about the prognosis after presentation in general practice is far from complete. Knowledge about determinants of the clinical course of musculoskeletal complaints is essential for management decisions and to inform patients about their prognosis. The purpose of this study is to provide information about the prognosis of musculoskeletal complaints other than low back pain by s...

  5. Convergent and discriminant validity of psychiatric symptoms reported in The Norwegian Mother and Child Cohort Study at age 3 years with independent clinical assessment in the Longitudinal ADHD Cohort Study

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    Guido Biele

    2014-12-01

    Full Text Available Epidemiological studies often use parent questionnaires to assess children's development and mental health. To date, few studies have investigated the validity of parent questionnaires with standardized clinical assessments as criterion. The current study examines discriminant and convergent validity of parent questionnaires for symptoms of Attention Deficit Hyperactivity Disorder (ADHD, Oppositional Defiance Disorder (ODD, and Conduct Disorder (CD as well as symptoms of Separation Anxiety employed in the Norwegian Mother and Child Cohort Study by using structured clinical interviews performed 5 months later in the Longitudinal ADHD Cohort Study as a criterion. The comparison of confirmatory factor analysis models and examination of factor correlations indicate convergent and discriminant validity of MoBa parent questionnaires for preschool children, especially for the assessment of ADHD and ODD/CD. Future research should attempt to further improve parent questionnaires, examine their validity in representative samples, and explicitly test their utility for screening.

  6. Social and clinical determinants of quality of life in Parkinson's disease in a Russian cohort study.

    Science.gov (United States)

    Winter, Yaroslav; von Campenhausen, Sonja; Popov, Georgy; Reese, Jens P; Balzer-Geldsetzer, Monika; Kukshina, Anastasia; Zhukova, Tatyana V; Bertschi, Natalia; Bötzel, Kai; Gusev, Eugene; Oertel, Wolfgang H; Dodel, Richard; Guekht, Alla

    2010-05-01

    Parkinson's disease (PD) is a chronic neurodegenerative disorder that has a major impact on health and longevity in Eastern countries. Studies investigating health-related quality of life (HRQoL) in Eastern European and Asian countries are scarce. The objective of this cross-sectional survey was to assess HRQoL in Russian patients with PD and identify its social and clinical determinants. The study included 100 outpatients with idiopathic PD and 100 controls. Patients were consecutively recruited from the neurological department of the Russian Medical State University in Moscow between October 2004 and December 2005. Regional healthy controls were matched for age and sex. The evaluation of HRQoL was performed using the EuroQol instrument (EQ-5D and EQ VAS). Disease severity was assessed using the Unified Parkinson's Disease Rating Scale (UPDRS). Multivariate regression analyses were used to identify independent determinants of HRQoL. HRQoL was more notably decreased in PD patients than in controls (98% versus 74% of individuals with moderate or severe problems in at least one dimension of the EQ-5D (p < 0.001), respectively). As compared to patients, the controls reported a higher mean EQ VAS score (74.0 +/- 16.0 versus 47.7 +/- 16.7, p < 0.001). Social and clinical determinants of HRQoL were age, disease severity, dystonia, depression, dementia and social support. While the HRQoL of patients with PD in Western countries is predominately affected by clinical parameters, social factors play an important role in Eastern countries. Our data should be considered in the development of national healthcare programs that seek to provide better social services support for patients with PD. PMID:20022549

  7. A Clinical Algorithm to Identify HIV Patients at High Risk for Incident Active Tuberculosis: A Prospective 5-Year Cohort Study.

    Directory of Open Access Journals (Sweden)

    Susan Shin-Jung Lee

    Full Text Available Predicting the risk of tuberculosis (TB in people living with HIV (PLHIV using a single test is currently not possible. We aimed to develop and validate a clinical algorithm, using baseline CD4 cell counts, HIV viral load (pVL, and interferon-gamma release assay (IGRA, to identify PLHIV who are at high risk for incident active TB in low-to-moderate TB burden settings where highly active antiretroviral therapy (HAART is routinely provided.A prospective, 5-year, cohort study of adult PLHIV was conducted from 2006 to 2012 in two hospitals in Taiwan. HAART was initiated based on contemporary guidelines (CD4 count < = 350/μL. Cox regression was used to identify the predictors of active TB and to construct the algorithm. The validation cohorts included 1455 HIV-infected individuals from previous published studies. Area under the receiver operating characteristic (ROC curve was calculated.Seventeen of 772 participants developed active TB during a median follow-up period of 5.21 years. Baseline CD4 < 350/μL or pVL ≥ 100,000/mL was a predictor of active TB (adjusted HR 4.87, 95% CI 1.49-15.90, P = 0.009. A positive baseline IGRA predicted TB in patients with baseline CD4 ≥ 350/μL and pVL < 100,000/mL (adjusted HR 6.09, 95% CI 1.52-24.40, P = 0.01. Compared with an IGRA-alone strategy, the algorithm improved the sensitivity from 37.5% to 76.5%, the negative predictive value from 98.5% to 99.2%. Compared with an untargeted strategy, the algorithm spared 468 (60.6% from unnecessary TB preventive treatment. Area under the ROC curve was 0.692 (95% CI: 0.587-0.798 for the study cohort and 0.792 (95% CI: 0.776-0.808 and 0.766 in the 2 validation cohorts.A validated algorithm incorporating the baseline CD4 cell count, HIV viral load, and IGRA status can be used to guide targeted TB preventive treatment in PLHIV in low-to-moderate TB burden settings where HAART is routinely provided to all PLHIV. The implementation of this algorithm will avoid unnecessary

  8. Hip and fragility fracture prediction by 4-item clinical risk score and mobile heel BMD: a women cohort study

    Directory of Open Access Journals (Sweden)

    Thulesius Hans

    2010-03-01

    Full Text Available Abstract Background One in four Swedish women suffers a hip fracture yielding high morbidity and mortality. We wanted to revalidate a 4-item clinical risk score and evaluate a portable heel bone mineral density (BMD technique regarding hip and fragility fracture risk among elderly women. Methods In a population-based prospective cohort study we used clinical risk factors from a baseline questionnaire and heel BMD to predict a two-year hip and fragility fracture outcome for women, in a fracture preventive program. Calcaneal heel BMD was measured by portable dual X-ray laser absorptiometry (DXL and compared to hip BMD, measured with stationary dual X-ray absorptiometry (DXA technique. Results Seven women suffered hip fracture and 14 women fragility fracture/s (at hip, radius, humerus and pelvis among 285 women; 60% having heel BMD ≤ -2.5 SD. The 4-item FRAMO (Fracture and Mortality Index combined the clinical risk factors age ≥80 years, weight Conclusions In a follow-up study we identified high risk groups for hip and fragility fracture with our plain 4-item risk model. Increased fracture risk was also related to decreasing heel BMD in calcaneal bone, measured with a mobile DXL technique. A combination of high FRAMO Index, prior fragility fracture, and very low BMD restricted the high risk group to 11%, among whom most hip fractures occurred (71%. These practical screening methods could eventually reduce hip fracture incidence by concentrating preventive resources to high fracture risk women.

  9. Clinical and immunological markers of dengue progression in a study cohort from a hyperendemic area in Malaysia.

    Directory of Open Access Journals (Sweden)

    Anusyah Rathakrishnan

    Full Text Available With its elusive pathogenesis, dengue imposes serious healthcare, economic and social burden on endemic countries. This study describes the clinical and immunological parameters of a dengue cohort in a Malaysian city, the first according to the WHO 2009 dengue classification.This longitudinal descriptive study was conducted in two Malaysian hospitals where patients aged 14 and above with clinical symptoms suggestive of dengue were recruited with informed consent. Among the 504 participants, 9.3% were classified as non-dengue, 12.7% without warning signs, 77.0% with warning signs and 1.0% with severe dengue based on clinical diagnosis. Of these, 37% were misdiagnosed as non-dengue, highlighting the importance of both clinical diagnosis and laboratory findings. Thrombocytopenia, prolonged clotting time, liver enzymes, ALT and AST served as good markers for dengue progression but could not distinguish between patients with and without warning signs. HLA-A*24 and -B*57 were positively associated with Chinese and Indians patients with warning signs, respectively, whereas A*03 may be protective in the Malays. HLA-A*33 was also positively associated in patients with warning signs when compared to those without. Dengue NS1, NS2A, NS4A and NS4B were found to be important T cell epitopes; however with no apparent difference between with and without warning signs patients. Distinction between the 2 groups of patients was also not observed in any of the cytokines analyzed; nevertheless, 12 were significantly differentially expressed at the different phases of illness.The new dengue classification system has allowed more specific detection of dengue patients, however, none of the clinical parameters allowed distinction of patients with and without warning signs. While the HLA-A*33 may be predictive marker for development of warning signs; larger studies will be needed to support this findings.

  10. Determinants of the clinical course of musculoskeletal complaints in general practice: design of a cohort study

    Directory of Open Access Journals (Sweden)

    van der Windt Daniëlle AWM

    2003-02-01

    Full Text Available Abstract Background Musculoskeletal complaints are frequent and have large consequences for public health. Information about the prognosis after presentation in general practice is far from complete. Knowledge about determinants of the clinical course of musculoskeletal complaints is essential for management decisions and to inform patients about their prognosis. The purpose of this study is to provide information about the prognosis of musculoskeletal complaints other than low back pain by studying the course of these complaints in general practice and to identify determinants of this course. Methods Patients of 18 years and older, who present in general practice with a new episode of a musculoskeletal complaint of the neck, shoulder, elbow, wrist, hand, arm, hip, knee, ankle or foot, are recruited by their general practitioner (GP. Participants will receive complaint-specific questionnaires by mail at baseline and after 3, 6, 12 and 18 months. The following putative determinants of the course of the complaints will be investigated: sociodemographic characteristics, characteristics of the complaint, psychosocial job characteristics, physical workload, physical activity during leisure time, pain coping, mood, kinesiophobia, social support, optimism. The primary outcomes are perceived recovery, pain, functional status, sick leave and overall quality of life.

  11. Inconsistent reporting of surrogate outcomes in randomised clinical trials: cohort study

    DEFF Research Database (Denmark)

    La Cour, Jeppe Lerche; Brok, Jesper; Gøtzsche, Peter C

    2010-01-01

    To assess if authors of randomised clinical trials convey the fact that they have used surrogate outcomes and discussed their validity.......To assess if authors of randomised clinical trials convey the fact that they have used surrogate outcomes and discussed their validity....

  12. PROMIS--Prostate MR imaging study: A paired validating cohort study evaluating the role of multi-parametric MRI in men with clinical suspicion of prostate cancer.

    OpenAIRE

    El-Shater Bosaily, A.; Parker, C.; Brown, L. C.; Gabe, R; Hindley, R. G.; Kaplan, R; Emberton, M.; Ahmed, H. U.; PROMIS Group

    2015-01-01

    BACKGROUND: Transrectal ultrasound-guided prostate biopsies are prone to detection errors. Multi-parametric MRI (MP-MRI) may improve the diagnostic pathway. METHODS: PROMIS is a prospective validating paired-cohort study that meets criteria for level 1 evidence in diagnostic test evaluation. PROMIS will investigate whether multi-parametric (MP)-MRI can discriminate between men with and without clinically-significant prostate cancer who are at risk prior to first biopsy. Up to 714 men will hav...

  13. Clinical effectiveness of posaconazole versus fluconazole as antifungal prophylaxis in hematology–oncology patients: a retrospective cohort study

    International Nuclear Information System (INIS)

    In preventing invasive fungal disease (IFD) in patients with acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS), clinical trials demonstrated efficacy of posaconazole over fluconazole and itraconazole. However, effectiveness of posaconazole has not been investigated in the United States in real-world setting outside the environment of controlled clinical trial. We performed a single-center, retrospective cohort study of 130 evaluable patients ≥18 years of age admitted to Duke University Hospital between 2004 and 2010 who received either posaconazole or fluconazole as prophylaxis during first induction or first reinduction chemotherapy for AML or MDS. The primary endpoint was possible, probable, or definite breakthrough IFD. Baseline characteristics were well balanced between groups, except that posaconazole recipients received reinduction chemotherapy and cytarabine more frequently. IFD occurred in 17/65 (27.0%) in the fluconazole group and in 6/65 (9.2%) in the posaconazole group (P = 0.012). Definite/probable IFDs occurred in 7 (10.8%) and 0 patients (0%), respectively (P = 0.0013). In multivariate analysis, fluconazole prophylaxis and duration of neutropenia were predictors of IFD. Mortality was similar between groups. This study demonstrates superior effectiveness of posaconazole over fluconazole as prophylaxis of IFD in AML and MDS patients. Such superiority did not translate to reductions in 100-day all-cause mortality

  14. Clinically relevant QTc prolongation due to overridden drug-drug interaction alerts: A retrospective cohort study

    NARCIS (Netherlands)

    I.H. van der Sijs (Heleen); R. Kowlesar (Ravi); A.P.J. Klootwijk (Peter); S.P. Nelwan (Stefan); A.G. Vulto (Arnold); T. van Gelder (Teun)

    2009-01-01

    textabstractAIMS: To investigate whether, in patients in whom drug-drug interaction (DDI) alerts on QTc prolongation were overridden, the physician had requested an electrocardiogram (ECG), and if these ECGs showed clinically relevant QTc prolongation. METHODS: For all patients with overridden DDI a

  15. The clinical application of "jetting suture" technique in annular repair under microendoscopic discectomy: A prospective single-cohort observational study.

    Science.gov (United States)

    Qi, Lei; Li, Mu; Si, Haipeng; Wang, Liang; Jiang, Yunpeng; Zhang, Shuai; Li, Le

    2016-08-01

    To introduce a new designed suture technique in annular repair under the microendoscopic discectomy (MED) surgery and to evaluate the clinical application of the technique in annular repair under MED with at least 2-year follow-up period.A new method of annular repair was designed and named "jetting suture" technique. Thirty consecutive patients with lumbar disc herniation were enrolled in the prospective single-cohort observational study. Patients were followed up at intervals of preoperative, postoperative 1 week, 3 months, 6 months, 1 year, and last follow-up. The clinical outcomes were evaluated by using Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index, and modified Mcnab criteria.The procedure was successfully performed in all cases. No case required conversion to an open procedure. The mean age of patients was 36.6 years. Average blood loss was 45.8 ± 10.2 mL. The preoperative symptoms were alleviated significantly after surgery. All the standardized measures improved significantly at the last follow-up, including JOA score (10.1 to 26.6; P disc herniation was reported.The designed "jetting suture" technique in annular repair under MED can be performed safely and effectively. It could be a viable alternative to annular repair under lumbar discectomy. PMID:27495101

  16. Oral contraceptive use and the clinical course of Crohn's disease: a prospective cohort study

    OpenAIRE

    Cosnes, J; Carbonnel, F; Carrat, F; Beaugerie, L; Gendre, J

    1999-01-01

    BACKGROUND—Women with Crohn's disease are usually advised not to take oral contraceptives, but, unlike smoking, there is no clear association between current oral contraceptive use and more severe disease.
AIM—To assess the effect of oral contraceptive use on the clinical course of Crohn's disease.
PATIENTS—331 women, aged 16-50 years, with Crohn's disease and Crohn's disease activity index

  17. Characterisation of patients receiving moxifloxacin for acute bacterial rhinosinusitis in clinical practice: results from an international, observational cohort study.

    Directory of Open Access Journals (Sweden)

    Ralph Mösges

    Full Text Available We conducted a prospective, non-controlled, multi-centre Phase IV observational cohort study of patients with acute bacterial rhinosinusitis who were treated with moxifloxacin in clinical practice in 19 countries in Asia Pacific, Europe and the Middle East. With the data collected we evaluated the presentation and course of the current disease episode, particularly in terms of the principal clinical signs and symptoms of acute rhinosinusitis and diagnostic procedures. A final assessment of moxifloxacin therapy was made to evaluate the impact of the sinusitis episode on activities of daily life and on sleep disturbance, and to evaluate the clinical outcome of treatment. A total of 7,090 patients were enrolled, of whom 3909 (57.6% were included in the valid for clinical outcome and safety population. Regional differences were observed in the main symptoms of acute rhinosinusitis and, according to several characteristics, disease episodes appeared to be more severe in patients in Europe than in the Asia Pacific or Middle East regions. The sinusitis episode impacted on daily living for mean (SD periods of 3.6 (3.2, 4.6 (3.9 and 3.1 (3.0 days and disturbed sleep for 3.6 (3.2, 4.6 (3.9 and 3.1 (3.0 nights in the Asia Pacific, Europe and Middle East regions, respectively. With moxifloxacin treatment, the mean (SD time to improvement of symptoms was 3.0 (1.5, 3.4 (1.6 and 3.2 (1.5 days, and the time to resolution of symptoms was 4.8 (2.6 days, 5.7 (2.4 days and 5.5 (2.5 days, in the Asia Pacific, Europe and Middle East regions, respectively. In conclusion, acute rhinosinusitis remains a substantial health burden with significant impact on patients' quality of life, and there are differences between global regions in the clinical presentation, diagnosis and clinical course of disease episodes. Moxifloxacin was an effective and well-tolerated treatment option in the overall population.ClinicalTrials.gov Identifier: NCT00930488.

  18. Risk factors for hip-related clinical signs in a prospective cohort study of four large dog breeds in Norway.

    Science.gov (United States)

    Krontveit, Randi I; Trangerud, Cathrine; Sævik, Bente K; Skogmo, Hege K; Nødtvedt, Ane

    2012-02-01

    We conducted a prospective cohort study including privately owned dogs from the breeds Newfondland (NF), Labrador Retriever (LR), Leonberger (LEO), and Irish Wolfhound (IW) followed from birth until age 9 yrs. We wanted to investigate whether radiological hip dysplasia status given at approximately age 12-18 mos and other factors during growth influenced development of clinical signs due to hip-joint disease necessitating veterinary consultation. Whether or not such signs occurred due to hip dysplasia or due to secondary or primary DJD could not be distinguished, and we therefore used the term "owner-reported veterinary-diagnosed hip-related clinical signs" ("the event"). The included dogs were followed from birth to the event or until a maximum of 9 yrs of age. Our objectives were to describe breed differences in time to incidence and to evaluate potential risk factors for the time to event. We used Kaplan-Meier curves to describe time to incidence, and potential risk factors were assessed by use of a Cox proportional-hazards model. We enrolled 494 dogs from 103 litters, and 46 dogs were reported as having had the event during the observation period. We observed a significant time-varying effect (TVE): LR and LEO developed clinical signs later in life than NF. If the radiological hip status was either mild, moderate, or severe the hazard of experiencing the event was significantly increased. Access to off-leash exercise at age 12 mos decreased the hazard of the event, and the hazard varied by litter. The findings supported the hypothesis that radiological hip status at screening and exercise conditions during growth influenced the time to incidence of the event and that there were breed differences in time to the event. PMID:21982689

  19. Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study

    DEFF Research Database (Denmark)

    Jepsen, Peter; Ott, Peter; Andersen, Per Kragh; Sørensen, Henrik Toft; Vilstrup, Hendrik

    2010-01-01

    -risks methods. At diagnosis of alcoholic cirrhosis, 24% of patients had no complications, 55% had ascites alone, 6% had variceal bleeding alone, 4% had ascites and variceal bleeding, and 11% had hepatic encephalopathy. One-year mortality was 17% among patients with no initial complications, 20% following......) or hepatic encephalopathy first (4% within 1 year). Subsequent complications occurred in an unpredictable order among patients with ascites or variceal bleeding. CONCLUSION: Patients with alcoholic cirrhosis had a high prevalence of complications at the time of cirrhosis diagnosis. The presence and......The clinical course of alcoholic cirrhosis, a condition with a high mortality, has not been well described. We examined prevalence, risk, chronology, and mortality associated with three complications of cirrhosis: ascites, variceal bleeding, and hepatic encephalopathy. We followed a population...

  20. Next Generation Sequencing in the Clinic: a Patterns of Care Study in a Retrospective Cohort of Subjects Referred to a Genetic Medicine Clinic for Suspected Lynch Syndrome.

    Science.gov (United States)

    Gallego, Carlos J; Perez, Matthew L; Burt, Amber; Amendola, Laura M; Shirts, Brian H; Pritchard, Colin C; Hisama, Fuki M; Bennett, Robin L; Veenstra, David L; Jarvik, Gail P

    2016-06-01

    Next generation sequencing (NGS) gene panels are increasingly used in medical genetics clinics for the evaluation of common inherited cancer syndromes, but the clinical efficacy of these tests, and the factors driving clinical providers to order them are unclear. We conducted a patterns-of-care study to compare patients evaluated with NGS gene panels with a reference group. We abstracted demographic, socioeconomic, and clinical information in a retrospective cohort of patients referred to a large medical genetics clinic for evaluation of inherited colorectal cancer and polyposis syndromes. Patients tested with NGS gene panels were more likely to be insured compared to the reference group (85.3 % vs. 69.2 %, p = 0.0068),less likely to have prior tumor tissue testing (29.4 % vs. 54.3 %, p = 0.0004), and less likely to have an abnormal tumor tissue test result (46.7 % vs. 74.5 %, p = 0.01). No significant differences were found between groups in age, gender, race, employment status, personal history of colorectal cancer, or proportion of patients fulfilling Lynch syndrome clinical criteria. Patients with NGS testing were less likely to have a pathogenic/likely pathogenic variant detected (13.7 % vs. 31.9 %, p = 0.002). Patients referred for NGS testing to evaluate inherited colorectal cancer/polyposis risk appear to undergo tumor tissue testing less frequently than non-NGS testing patients. Further studies are needed to assess the most effective and cost-effective approach to genomic diagnosis in this patient population. PMID:26637299

  1. Accuracy of the “traffic light” clinical decision rule for serious bacterial infections in young children with fever: a retrospective cohort study

    OpenAIRE

    Sukanya; Williams, Gabrielle J; Hayen, Andrew; Macaskill, Petra; McCaskill, Mary; Isaacs, David; Craig, Jonathan C.

    2013-01-01

    Objectives To determine the accuracy of a clinical decision rule (the traffic light system developed by the National Institute for Health and Clinical Excellence (NICE)) for detecting three common serious bacterial infections (urinary tract infection, pneumonia, and bacteraemia) in young febrile children. Design Retrospective analysis of data from a two year prospective cohort study Setting A paediatric emergency department. Participants 15 781 cases of children under 5 years of age presentin...

  2. Clinical characteristics, cardiac events and coronary angiographic findings in the prospective PREVEND cohort : an observational study

    NARCIS (Netherlands)

    Geluk, C. A.; Tio, R. A.; Tijssen, J. G. P.; van Dijk, R. B.; Dijk, W. A.; Hillege, H. L.; de Jong, P. E.; van Gilst, W. H.; Zijlstra, F.

    2007-01-01

    Background. The use of invasive procedures has mostly been studied in retrospective (multi)national registries. Limited evidence exists on the association between microalbuminuria and coronary artery disease (CAD). Methods: The incidence of major adverse cardiac events (MACE) and invasive cardiac pr

  3. The characteristics and clinical outcome of drug-induced liver injury in a Chinese hospital: A retrospective cohort study.

    Science.gov (United States)

    Chen, Sheng-Sen; Yu, Kang-Kang; Huang, Chong; Li, Ning; Zheng, Jian-Ming; Bao, Su-Xia; Chen, Ming-Quan; Zhang, Wen-Hong

    2016-08-01

    The aim of this cohort study was to determine the characteristics and clinical outcome of 287 patients with drug-induced liver injury (DILI) in a Chinese hospital.Between January 2008 and January 2013, individuals who were diagnosed with DILI were selected. The complete medical records of each case were reviewed, and factors for the outcome of patients with DILI were extracted and analyzed using univariate and multivariate analysis.Two hundred eighty-seven cases identified as DILI were included in the study. A total of 105 different drugs were considered to be related to the hepatotoxicity. The main causative group of drugs was Chinese herb (n = 111). Liver failure developed in 9 (3.1%) patients, and 2 died (0.7%). Overall, complete recovery occurred in 92 (32.1%) patients. Univariate analysis and binary logistic regression analysis identified the digestive symptoms, jaundice, total bilirubin (TBIL), and direct bilirubin (DBIL) as independent factors for the non-recovery of DILI. Then the prediction model, including digestive symptoms, jaundice, TBIL, and DBIL, was built by using binary logistic regression analysis again. Receiver operating characteristic curve validated the strong power (area under the curve (AUC) = 0.907) of prediction model for predicting the DILI non-recovery.DILI is an important cause of liver test abnormalities, and Chinese herb represented the most common drug group. The factors such as digestive symptoms, jaundice, TBIL, and DBIL have effect on DILI outcomes. The prediction model, including digestive symptoms, jaundice, TBIL, and DBIL, established in this study is really an excellent predictive tool for non-recovery of DILI patients. PMID:27559976

  4. Evidence for the selective reporting of analyses and discrepancies in clinical trials: a systematic review of cohort studies of clinical trials.

    Directory of Open Access Journals (Sweden)

    Kerry Dwan

    2014-06-01

    Full Text Available Most publications about selective reporting in clinical trials have focussed on outcomes. However, selective reporting of analyses for a given outcome may also affect the validity of findings. If analyses are selected on the basis of the results, reporting bias may occur. The aims of this study were to review and summarise the evidence from empirical cohort studies that assessed discrepant or selective reporting of analyses in randomised controlled trials (RCTs.A systematic review was conducted and included cohort studies that assessed any aspect of the reporting of analyses of RCTs by comparing different trial documents, e.g., protocol compared to trial report, or different sections within a trial publication. The Cochrane Methodology Register, Medline (Ovid, PsycInfo (Ovid, and PubMed were searched on 5 February 2014. Two authors independently selected studies, performed data extraction, and assessed the methodological quality of the eligible studies. Twenty-two studies (containing 3,140 RCTs published between 2000 and 2013 were included. Twenty-two studies reported on discrepancies between information given in different sources. Discrepancies were found in statistical analyses (eight studies, composite outcomes (one study, the handling of missing data (three studies, unadjusted versus adjusted analyses (three studies, handling of continuous data (three studies, and subgroup analyses (12 studies. Discrepancy rates varied, ranging from 7% (3/42 to 88% (7/8 in statistical analyses, 46% (36/79 to 82% (23/28 in adjusted versus unadjusted analyses, and 61% (11/18 to 100% (25/25 in subgroup analyses. This review is limited in that none of the included studies investigated the evidence for bias resulting from selective reporting of analyses. It was not possible to combine studies to provide overall summary estimates, and so the results of studies are discussed narratively.Discrepancies in analyses between publications and other study documentation

  5. Clinically Diagnosed Insomnia and Risk of All-Cause and Diagnosis-Specific Disability Pension: A Nationwide Cohort Study

    OpenAIRE

    Catarina Jansson; Kristina Alexanderson; Göran Kecklund; Torbjörn Åkerstedt

    2013-01-01

    Background. Insomnia and disability pension are major health problems, but few population-based studies have examined the association between insomnia and risk of disability pension. Methods. We conducted a prospective nationwide cohort study based on Swedish population-based registers including all 5,028,922 individuals living in Sweden on December 31, 2004/2005, aged 17–64 years, and not on disability or old age pension. Those having at least one admission/specialist visit with a diagnosis ...

  6. Phyllodes tumor of the breast: a clinic-pathologic study of 77 cases in a Hispanic cohort

    Directory of Open Access Journals (Sweden)

    Carlos Andres Ossa Gomez

    2015-10-01

    Full Text Available Introduction:Breast Phyllodes tumors are rare breast tumors present in less than 1% of new cases of breast cancer, usually occurring among middle-aged women (40-50 yrs.Objective:This study shows diagnostic experience, surgical management and follows up of patients with this disease during a period of ten years in a oncology referral center.Methods:Retrospectively, breast cancer registries at the institution were reviewed, identifying 77 patients with Phyllodes tumors between 2002 and 2012, who had been operated on at the Instituto de Cancerología - Clínica Las Américas, in Medellín (Colombia. Clinical and histopathological data belonging to these cases was captured and analyzed and descriptive statistics were used.Results:The follow up median was 22.5 months (IQR: 10.5-60.0, average age was 47.2 yrs (SD: 12.4, mean tumor size was 3.6 cm (SD: 4.6, 88.3% of the patients (68 cases presented negative margins and none of them received adjuvant chemotherapy. Of the patients with Phyllodes tumors; 33.8% had benign, 31.2% had borderline and 35.0% had malignant tumor. Disease-free survival was 85.8% and overall survival was 94.5%.Discussion:Reported data in this article is in accordance with what has been reported in worldwide literature. In our cohort even the high mean size of the tumors, the risk of local relapse and metastatic disease is low than previously reported in literature. Trials with longer follow up and molecular trials in Phyllodes tumors are necessary to understand the behavior of these tumors in Hispanics population.

  7. Clinical and radiographic results of cervical artificial disc arthroplasty: over three years follow-up cohort study

    Institute of Scientific and Technical Information of China (English)

    TIAN Wei; HAN Xiao; LIU Bo; LI Qin; HU Lin; LI Zhi-yu; YUAN Qiang; HE Da; XING Yong-gang

    2010-01-01

    Background Theoretic advantages of cervical disc arthroplasty include preservation of normal motion and biomechanics in the cervical spine, and reduction of adjacent-segment degeneration. The clinical and radiographic effects of cervical disc arthroplasty in short term have been ascertained. The aim of this study is to research the data of mid-term results.Methods In this prospective cohort study, 50 patients who underwent cervical disc arthroplasty from December 2003 to January 2006 were enrolled. There were 39 patients who received 1-level disc arthroplasty, and 11 patients received 2-level disc arthroplasty, with an average age of 50.9 years (range from 29 to 73). The median follow-up was 41.85months (range from 36.00-55.63 months). Patients were followed prospectively with respect to their symptoms,neurologic signs, and radiographic results.Results The median value of Japanese Orthopaedic Association (JOA) score was 14.0 before surgery, and 16.5 at the most recent follow-up (P <0.01). The median value of the recovery rate of the JOA score was 92.2%. The preoperative range of motion (ROM) at the indexed level was (10.40±4.97)°, which has significantly correlated with the most recent follow-up ROM which was (8.56±4.76)° (P <0.05, r=0.33). The ROM at the operative level at the most recent follow-upwas greater than the value at the 3-month follow-up of (7.52±3.37)° (P <0.05). The preoperative functional spinal unit (FSU) angulation was (-0.96±6.52)°, which was not significantly correlated with that of the most recent follow-up value of (-2.65±7.95)° (P <0.01, r=0.53). The preoperative endplate angulation was (2.61±4.85)°, which had no significant correlation with that of the most recent follow-up value of (0.71±6.41)° (p >0.05).Conclusions The clinical and radiographic results of cervical disc arthroplasty are good in mid-term follow-up. The normal range of motion of the operated level and the biomechanics in the cervical spine are well

  8. Epidemiology and clinical outcome of virus-positive respiratory samples in ventilated patients: a prospective cohort study.

    OpenAIRE

    Daubin, Cédric; Parienti, Jean-Jacques; Vincent, Sophie; Vabret, Astrid; du Cheyron, Damien; Ramakers, Michel; Freymuth, François; Charbonneau, Pierre

    2006-01-01

    INTRODUCTION: Respiratory viruses are a major cause of respiratory tract infections. The prevalence of a virus-positive respiratory sample and its significance in patients requiring mechanical ventilation remain unknown. METHODS: We conducted a cohort study in all consecutive adults ventilated for more than 48 hours admitted to a 22-bed medical intensive care unit during a 12-month period. Respiratory samples at the time of intubation were assessed by culture, by indirect immunofluorescence a...

  9. Review of Cohort Studies for Mood Disorders.

    Science.gov (United States)

    Jeon, Hong Jin; Baek, Ji Hyun; Ahn, Yong-Min; Kim, Se Joo; Ha, Tae Hyun; Cha, Boseok; Moon, Eunsoo; Kang, Hee-Ju; Ryu, Vin; Cho, Chul-Hyun; Heo, Jung-Yoon; Kim, Kiwon; Lee, Heon-Jeong

    2016-05-01

    This paper aimed to review currently available cohort studies of subjects with mood disorders such as major depressive disorder (MDD) and bipolar disorder (BD). Using the PubMed and KoreaMed databases, we reviewed eight major cohort studies. Most studies recruited participants with MDD and BD separately, so direct comparison of factors associated with diagnostic changes was difficult. Regular and frequent follow-up evaluations utilizing objective mood ratings and standardized evaluation methods in a naturalistic fashion are necessary to determine detailed clinical courses of mood disorders. Further, biological samples should also be collected to incorporate clinical findings in the development of new diagnostic and therapeutic approaches. An innovative cohort study that can serve as a platform for translational research for treatment and prevention of mood disorders is critical in determining clinical, psychosocial, neurobiological and genetic factors associated with long-term courses and consequences of mood disorders in Korean patients. PMID:27247592

  10. Scaling-Up Access to Antiretroviral Therapy for Children: A Cohort Study Evaluating Care and Treatment at Mobile and Hospital-Affiliated HIV Clinics in Rural Zambia

    OpenAIRE

    van Dijk, Janneke H.; Moss, William J; Hamangaba, Francis; Munsanje, Bornface; Sutcliffe, Catherine G.

    2014-01-01

    Background Travel time and distance are barriers to care for HIV-infected children in rural sub-Saharan Africa. Decentralization of care is one strategy to scale-up access to antiretroviral therapy (ART), but few programs have been evaluated. We compared outcomes for children receiving care in mobile and hospital-affiliated HIV clinics in rural Zambia. Methods Outcomes were measured within an ongoing cohort study of HIV-infected children seeking care at Macha Hospital, Zambia from 2007 to 201...

  11. Trends in Clinically Significant Pain Prevalence Among Hospitalized Cancer Patients at an Academic Hospital in Taiwan: A Retrospective Cohort Study.

    Science.gov (United States)

    Wang, Wei-Yun; Ho, Shung-Tai; Wu, Shang-Liang; Chu, Chi-Ming; Sung, Chun-Sung; Wang, Kwua-Yun; Liang, Chun-Yu

    2016-01-01

    Clinically significant pain (CSP) is one of the most common complaints among cancer patients during repeated hospitalizations, and the prevalence ranges from 24% to 86%. This study aimed to characterize the trends in CSP among cancer patients and examine the differences in the prevalence of CSP across repeated hospitalizations. A hospital-based, retrospective cohort study was conducted at an academic hospital. Patient-reported pain intensity was assessed and recorded in a nursing information system. We examined the differences in the prevalence of worst pain intensity (WPI) and last evaluated pain intensity (LPI) of ≥ 4 or ≥ 7 points among cancer inpatients from the 1st to the 18th hospitalization. Linear mixed models were used to determine the significant difference in the WPI and LPI (≥ 4 or ≥ 7 points) at each hospitalization. We examined 88,133 pain scores from the 1st to the 18th hospitalization among cancer patients. The prevalence of the 4 CSP types showed a trend toward a reduction from the 1st to the 18th hospitalization. There was a robust reduction in the CSP prevalence from the 1st to the 5th hospitalization, except in the case of LPI ≥ 7 points. The prevalence of a WPI ≥ 4 points was significantly higher (0.240-fold increase) during the 1st hospitalization than during the 5th hospitalization. For the 2nd, 3rd, and 4th hospitalizations, there was a significantly higher prevalence of a WPI ≥ 4 points compared with the 5th hospitalization. We also observed significant reductions in the prevalence of a WPI ≥ 7 points during the 1st to the 4th hospitalizations, an LPI ≥ 4 points during the 1st to the 3rd hospitalizations, and an LPI ≥ 7 points during the 1st to the 2nd hospitalization. Although the prevalence of the 4 CSP types decreased gradually, it is impossible to state the causative factors on the basis of this observational and descriptive study. The next step will examine the factors that determine the CSP prevalence among cancer

  12. Couples' voluntary counselling and testing and nevirapine use in antenatal clinics in two African capitals: a prospective cohort study

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    Conkling Martha

    2010-03-01

    Full Text Available Abstract Background With the accessibility of prevention of mother to child transmission (PMTCT services in sub-Saharan Africa, more women are being tested for HIV in antenatal care settings. Involving partners in the counselling and testing process could help prevent horizontal and vertical transmission of HIV. This study was conducted to assess the feasibility of couples' voluntary counseling and testing (CVCT in antenatal care and to measure compliance with PMTCT. Methods A prospective cohort study was conducted over eight months at two public antenatal clinics in Kigali, Rwanda, and Lusaka, Zambia. A convenience sample of 3625 pregnant women was enrolled. Of these, 1054 women were lost to follow up. The intervention consisted of same-day individual voluntary counselling and testing (VCT and weekend CVCT; HIV-positive participants received nevirapine tablets. In Kigali, nevirapine syrup was provided in the labour and delivery ward; in Lusaka, nevirapine syrup was supplied in pre-measured single-dose syringes. The main outcome measures were nurse midwife-recorded deliveries and reported nevirapine use. Results In eight months, 1940 women enrolled in Kigali (984 VCT, 956 CVCT and 1685 women enrolled in Lusaka (1022 VCT, 663 CVCT. HIV prevalence was 14% in Kigali, and 27% in Lusaka. Loss to follow up was more common in Kigali than Lusaka (33% vs. 24%, p = 0.000. In Lusaka, HIV-positive and HIV-negative women had significantly different loss-to-follow-up rates (30% vs. 22%, p = 0.002. CVCT was associated with reduced loss to follow up: in Kigali, 31% of couples versus 36% of women testing alone (p = 0.011; and in Lusaka, 22% of couples versus 25% of women testing alone (p = 0.137. Among HIV-positive women with follow up, CVCT had no impact on nevirapine use (86-89% in Kigali; 78-79% in Lusaka. Conclusions Weekend CVCT, though new, was feasible in both capital cities. The beneficial impact of CVCT on loss to follow up was significant, while

  13. Antibiotic use and clinical outcomes in the acute setting under management by an infectious diseases acute physician versus other clinical teams: a cohort study

    Science.gov (United States)

    Jones, Nicola; Mistry, Vikash; Crook, Derrick; Peto, Tim; Walker, A Sarah

    2016-01-01

    Objectives To assess the magnitude of difference in antibiotic use between clinical teams in the acute setting and assess evidence for any adverse consequences to patient safety or healthcare delivery. Design Prospective cohort study (1 week) and analysis of linked electronic health records (3 years). Setting UK tertiary care centre. Participants All patients admitted sequentially to the acute medical service under an infectious diseases acute physician (IDP) and other medical teams during 1 week in 2013 (n=297), and 3 years 2012–2014 (n=47 585). Primary outcome measure Antibiotic use in days of therapy (DOT): raw group metrics and regression analysis adjusted for case mix. Secondary outcome measures 30-day all-cause mortality, treatment failure and length of stay. Results Antibiotic use was 173 vs 282 DOT/100 admissions in the IDP versus non-IDP group. Using case mix-adjusted zero-inflated Poisson regression, IDP patients were significantly less likely to receive an antibiotic (adjusted OR=0.25 (95% CI 0.07 to 0.84), p=0.03) and received shorter courses (adjusted rate ratio (RR)=0.71 (95% CI 0.54 to 0.93), p=0.01). Clinically stable IDP patients of uncertain diagnosis were more likely to have antibiotics held (87% vs 55%; p=0.02). There was no significant difference in treatment failure or mortality (adjusted p>0.5; also in the 3-year data set), but IDP patients were more likely to be admitted overnight (adjusted OR=3.53 (95% CI 1.24 to 10.03), p=0.03) and have longer length of stay (adjusted RR=1.19 (95% CI 1.05 to 1.36), p=0.007). Conclusions The IDP-led group used 30% less antibiotic therapy with no adverse clinical outcome, suggesting antibiotic use can be reduced safely in the acute setting. This may be achieved in part by holding antibiotics and admitting the patient for observation rather than prescribing, which has implications for costs and hospital occupancy. More information is needed to indicate whether any such longer admission will

  14. Validity of a self-reported diagnosis of depression among participants in a cohort study using the Structured Clinical Interview for DSM-IV (SCID-I

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    Pla Jorge

    2008-06-01

    Full Text Available Abstract Background Depression assessment in population studies is usually based on depressive symptoms scales. However, the use of scales could lead to the choice of an arbitrary cut-off point depending on the sample characteristics and on the patient diagnosis. Thus, the use of a medical diagnosis of depression could be a more appropriate approach. Objective To validate a self-reported physician diagnosis of depression using the Structured Clinical Interview for DSM-IV (SCID-I as Gold Standard and to assess the factors associated to a valid self-reported diagnosis. Methods The SUN Project is a cohort study based on university graduates followed-up through postal questionnaires. The response to the question included in the questionnaire: Have you ever been diagnosed of depression by a physician? was compared to that obtained through the SCID-I applied by a psychiatrist or a clinical psychologist. The percentages of confirmed depression and non-depression were assessed for the overall sample and according to several characteristics. Logistic regression models were fitted to ascertain the association between different factors and a correct classification regarding depression status. Results The percentage of confirmed depression was 74.2%; 95% confidence interval (95% CI = 63.3–85.1. Out of 42 participants who did not report a depression diagnosis in the questionnaire, 34 were free of the disease (%confirmed non-depression = 81.1%; 95% CI = 69.1–92.9. The probability of being a true positive was higher among ex-smokers and non-smokers and among those overweight or obese but the differences were not statistically significant. Conclusion The validity of a self-reported diagnosis of depression in the SUN cohort is adequate. Thus, this question about depression diagnosis could be used in further investigations regarding this disease in this graduate cohort study.

  15. Clinically Diagnosed Insomnia and Risk of All-Cause and Diagnosis-Specific Disability Pension: A Nationwide Cohort Study

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    Catarina Jansson

    2013-01-01

    Full Text Available Background. Insomnia and disability pension are major health problems, but few population-based studies have examined the association between insomnia and risk of disability pension. Methods. We conducted a prospective nationwide cohort study based on Swedish population-based registers including all 5,028,922 individuals living in Sweden on December 31, 2004/2005, aged 17–64 years, and not on disability or old age pension. Those having at least one admission/specialist visit with a diagnosis of disorders of initiating and maintaining sleep (insomnias (ICD-10: G47.0 during 2000/2001–2005 were compared to those with no such inpatient/outpatient care. All-cause and diagnosis-specific incident disability pension were followed from 2006 to 2010. Incidence rate ratios (IRRs and 95% confidence intervals (CIs were estimated by Cox regression. Results. In models adjusted for prior sickness absence, sociodemographic factors, and inpatient/specialized outpatient care, associations between insomnia and increased risks of all-cause disability pension (IRR 1.35, 95% CI 1.09–1.67 and disability pension due to mental diagnoses (IRR 1.86, 95% CI 1.38–2.50 were observed. After further adjustment for insomnia medications these associations disappeared. No associations between insomnia and risk of disability pension due to cancer, circulatory, or musculoskeletal diagnoses were observed. Conclusion. Insomnia seems to be positively associated with all-cause disability pension and disability pension due to mental diagnoses.

  16. Treated versus non-treated subjects with depression from a 30-year cohort study: prevalence and clinical covariates.

    Science.gov (United States)

    Hengartner, Michael P; Angst, Felix; Ajdacic-Gross, Vladeta; Rössler, Wulf; Angst, Jules

    2016-03-01

    The aim of this study was to determine prevalence rates of several components of depression (unipolar and bipolar major, minor, recurrent brief depression, and dysthymia) and to identify covariates of treatment. We analysed a representative population-based, long-term prospective cohort study from age 20 to 50. Across the seven semi-structured interviews, generalized estimating equations examined the associations between diagnoses and treatment status during the course. The results show that the mean annual treatment rate across 30 years in persons with MDE was 39.2%. The weighted treatment prevalence for any depressive disorder was 23.4% (15.7% for MDE, 4.3% for minor depressive disorders and 3.4% for non-diagnosed subjects). Persons were more likely to seek treatment as they grew older. Women with MDE had triple the treatment prevalence of men (23.8 vs. 7.4%). Variables of distress/suffering under depression (OR 1.36-1.52) and the number of diagnostic depressive symptoms (OR 1.47) were statistically significant predictors of treatment, as were episode duration (OR 2.21) and various variables assessing impairment due to depression (OR 4.65-8.02). In conclusion, only a minority of persons with depressive disorders seek professional treatment in the year of disorder onset. Women and subjects suffering from high levels of depressive symptoms, frequent episodes, long episode duration and consecutive high distress and impairment were more likely to seek treatment. PMID:26499773

  17. Sub-clinical enterovirus infections in Norwegian infants: A prospective cohort study on viral circulation and predictors of infection

    OpenAIRE

    2009-01-01

    Background: Enteroviruses are common in infancy, but usually sub-clinical and self-limiting. Most previous data on enterovirus circulation derive from analyses of specimens from individuals with disease. Studies of enterovirus circulation in healthy populations antedate the advent of molecular technologies. Population-based studies that use molecular approaches for diagnosing are needed to obtain unbiased estimates of enterovirus circulation. Objectives: The objectives of the present studies ...

  18. Association of Clinical Benign Prostate Hyperplasia with Prostate Cancer Incidence and Mortality Revisited: A Nationwide Cohort Study of 3 009 258 Men

    DEFF Research Database (Denmark)

    Ørsted, David Dynnes; Bojesen, Stig E; Nielsen, Sune F; Nordestgaard, Børge G

    2011-01-01

    315), information on PCa mortality (n=25 459), and ascertained clinical BPH (not histologically proven BPH) through hospitalization (n=187 591) and/or surgery (n=77 698) from 1980 to 2006 and the use of a-adrenergic receptor antagonists (n=143 365) and/or the use of 5a-reductase inhibitors (5-ARIs) (n...... surgery. For age-matched cohort studies, corresponding HRs for PCa incidence were 3.04 (2.96-3.13) for hospitalization, 2.60 (2.47-2.73) for surgery, 4.49 (4.33-4.65) for a-adrenergic receptor antagonist use, and 2.54 (2.40-2.68) for 5-ARI use. Each category of clinical BPH has limitations, but...

  19. Comparisons of Prognosis between Surgically and Clinically Diagnosed Idiopathic Pulmonary Fibrosis Using Gap Model: A Korean National Cohort Study.

    Science.gov (United States)

    Lee, Sang Hoon; Kim, Song Yee; Kim, Dong Soon; Kim, Young Whan; Chung, Man Pyo; Uh, Soo Taek; Park, Choon Sik; Jeong, Sung Hwan; Park, Yong Bum; Lee, Hong Lyeol; Shin, Jong Wook; Lee, Eun Joo; Lee, Jin Hwa; Jegal, Yangin; Lee, Hyun Kyung; Kim, Yong Hyun; Song, Jin Woo; Park, Moo Suk

    2016-03-01

    Although a multidisciplinary approach has become an important criterion for an idiopathic pulmonary fibrosis (IPF) diagnosis, lung biopsies remain crucial. However, the prognosis of patients with surgically diagnosed IPF (sIPF) is uncertain. We aimed to investigate the prognosis of patients with clinically diagnosed IPF (cIPF) and sIPF.In this retrospective observational study, the Korean Interstitial Lung Disease Study Group conducted a national survey to evaluate the clinical, physiological, radiological, and survival characteristics of patients with IPF from January 1, 2003 to December 31, 2007. Patients were recruited from 54 universities and teaching hospitals across the Republic of Korea. IPF diagnoses were established according to the 2002 American Thoracic Society (ATS)/European Respiratory Society criteria (ERS) guideline. A total of 1685 patients with IPF (1027 cIPF and 658 sIPF) were enrolled.Patients with sIPF were significantly younger, predominantly female, and nonsmokers (all P influence on patient prognosis. However, there was no significant difference in prognosis between the cIPF and sIPF groups after adjusting for GAP (gender, age, physiology) stage.The patients with sIPF had better clinical features than those with cIPF. However, after adjusting for GAP stage, the sIPF group showed similar prognoses as the cIPF group. This study showed that after adjusting for GAP stage, the prognosis of patients with IPF is the same regardless of the diagnostic method used. PMID:26986154

  20. Care needs and clinical outcomes of older people with dementia: a population-based propensity score-matched cohort study.

    Directory of Open Access Journals (Sweden)

    Fei-Yuan Hsiao

    Full Text Available To explore the healthcare resource utilization, psychotropic drug use and mortality of older people with dementia.A nationwide propensity score-matched cohort study.National Health Insurance Research database.A total of 32,649 elderly people with dementia and their propensity-score matched controls (n=32,649.Outpatient visits, inpatient care, psychotropic drug use, in-hospital mortality and all-cause mortality at 90 and 365 days.Compared to the non-dementia group, a higher proportion of patients with dementia used inpatient services (1 year after index date: 20.91% vs. 9.55%, and the dementia group had more outpatient visits (median [standard deviation]: 7.00 [8.87] vs. 3.00 [8.30]. Furthermore, dementia cases with acute admission had the highest psychotropic drug utilization both at baseline and at the post-index dates (difference-in-differences: all <0.001. Dementia was associated with an increased risk of all-cause mortality (90 days, Odds ratio (OR=1.85 [95%CI 1.67-2.05], p<0.001; 365 days, OR=1.59 [1.50-1.69], p<0.001 and in-hospital mortality (90 days, OR=1.97 [1.71-2.27], p<0.001; 365 days, OR=1.82 [1.61-2.05], p<0.001 compared to matched controls.When older people with dementia are admitted for acute illnesses, they may increase their use of psychotropic agents and their risk of death, particularly in-hospital mortality.

  1. Methodology Series Module 1: Cohort Studies

    OpenAIRE

    Maninder Singh Setia

    2016-01-01

    Cohort design is a type of nonexperimental or observational study design. In a cohort study, the participants do not have the outcome of interest to begin with. They are selected based on the exposure status of the individual. They are then followed over time to evaluate for the occurrence of the outcome of interest. Some examples of cohort studies are (1) Framingham Cohort study, (2) Swiss HIV Cohort study, and (3) The Danish Cohort study of psoriasis and depression. These studies may be pro...

  2. Symptomatic reactions, clinical outcomes and patient satisfaction associated with upper cervical chiropractic care: A prospective, multicenter, cohort study

    Directory of Open Access Journals (Sweden)

    Hurwitz Eric L

    2011-10-01

    Full Text Available Abstract Background Observational studies have previously shown that adverse events following manipulation to the neck and/or back are relatively common, although these reactions tend to be mild in intensity and self-limiting. However, no prospective study has examined the incidence of adverse reactions following spinal adjustments using upper cervical techniques, and the impact of this care on clinical outcomes. Methods Consecutive new patients from the offices of 83 chiropractors were recruited for this practice-based study. Clinical outcome measures included 1 Neck pain disability index (100-point scale, 2 Oswestry back pain index (100-point scale, 3 11-point numerical rating scale (NRS for neck, headache, midback, and low back pain, 4 treatment satisfaction, and 5 Symptomatic Reactions (SR. Data were collected at baseline, and after approximately 2 weeks of care. A patient reaching sub-clinical status for pain and disability was defined as a follow-up score 30% based on an 11-point numeric rating scale occurring Results A total of 1,090 patients completed the study having 4,920 (4.5 per patient office visits requiring 2,653 (2.4 per patient upper cervical adjustments over 17 days. Three hundred thirty- eight (31.0% patients had SRs meeting the accepted definition. Intense SR (NRS ≥8 occurred in 56 patients (5.1%. Outcome assessments were significantly improved for neck pain and disability, headache, mid-back pain, as well as lower back pain and disability (p 5 million career upper cervical adjustments without a reported incidence of serious adverse event. Conclusions Upper cervical chiropractic care may have a fairly common occurrence of mild intensity SRs short in duration (

  3. Cohort Profile Update: The China Jintan Child Cohort Study.

    Science.gov (United States)

    Liu, Jianghong; Cao, Siyuan; Chen, Zehang; Raine, Adrian; Hanlon, Alexandra; Ai, Yuexian; Zhou, Guoping; Yan, Chonghuai; Leung, Patrick W; McCauley, Linda; Pinto-Martin, Jennifer

    2015-10-01

    The China Jintan Child Cohort study began in 2004 with 1656 pre-school participants and a research focus on studying the impact of environmental exposures, such as lead, on children's neurobehavioural outcomes. This population cohort now includes around 1000 of the original participants, who have been assessed three times over a period of 10 years. Since the original IJE cohort profile publication in 2010, participants have experienced a critical developmental transition from pre-school to school age and then adolescence. The study has also witnessed an increase in breadth and depth of data collection from the original aim of risk assessment. This cohort has added new directions to investigate the mechanisms and protective factors for the relationship between early health factors and child physical and mental health outcomes, with an emphasis on neurobehavioural consequences. The study now encompasses 11 domains, composed of repeated measures of the original variables and new domains of biomarkers, sleep, psychophysiology, neurocognition, personality, peer relationship, mindfulness and family dynamics. Depth of evaluation has increased from parent/teacher report to self/peer report and intergenerational family report. Consequently, the cohort has additional directions to include: (i) classmates of the original cohort participants for peer relationship assessment; and (ii) parental and grandparental measures to assess personality and dynamics within families. We welcome interest in our study and ask investigators to contact the corresponding author for additional information on data acquisition. PMID:26323725

  4. The Correlation of Endoscopic Findings and Clinical Features in Korean Patients with Scrub Typhus: A Cohort Study.

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    Jun Lee

    Full Text Available Scrub typhus is an infectious disease caused by Orientia tsutsugamushi-induced systemic vasculitis, but the involvement of the gastrointestinal tract and the endoscopic findings associated with scrub typhus are not well understood. We performed a prospective study and recommend performing esophagogastroduodenoscopy (EGD for all possible scrub typhus patients, regardless of gastrointestinal symptoms. Gastrointestinal symptoms, endoscopic findings and clinical severity based on organ involvement and ICU admission were analyzed. Gastrointestinal symptoms occurred in up to 76.4% of scrub typhus patients. The major endoscopic findings were ulcers (43/127, 33.9%. Interestingly, 7.1% (9/127 of the patients presented with esophageal candidiasis. There was no correlation between the presence or absence of gastrointestinal symptoms and the endoscopic grade (P = 0.995. However, there was a positive correlation between the clinical severity and the endoscopic findings (P = 0.001. Sixty-three percent of the patients presented with erosion or ulcers on prospectively performed endoscopic evaluations, irrespective of gastrointestinal symptoms. Gastrointestinal symptoms did not reflect the need for endoscopy. Scrub typhus patients could have significant endoscopic abnormalities even in the absence of gastrointestinal symptoms.

  5. Mycoplasma genitalium Prevalence, Coinfection, and Macrolide Antibiotic Resistance Frequency in a Multicenter Clinical Study Cohort in the United States.

    Science.gov (United States)

    Getman, Damon; Jiang, Alice; O'Donnell, Meghan; Cohen, Seth

    2016-09-01

    The prevalence rates of Mycoplasma genitalium infections and coinfections with other sexually transmitted organisms and the frequency of a macrolide antibiotic resistance phenotype were determined in urogenital specimens collected from female and male subjects enrolled in a multicenter clinical study in the United States. Specimens from 946 subjects seeking care from seven geographically diverse clinical sites were tested for M. genitalium and for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis Sequencing was used to assess macrolide antibiotic resistance among M. genitalium-positive subjects. M. genitalium prevalence rates were 16.1% for females and 17.2% for males. Significant risk factors for M. genitalium infections were black race, younger age, non-Hispanic ethnicity, and female symptomatic status. Female M. genitalium infections were significantly more prevalent than C. trachomatis and N. gonorrhoeae infections, while the M. genitalium infection rate in males was significantly higher than the N. gonorrhoeae and T. vaginalis infection rates. The macrolide-resistant phenotype was found in 50.8% of females and 42% of males. These results show a high prevalence of M. genitalium single infections, a lower prevalence of coinfections with other sexually transmitted organisms, and high rates of macrolide antibiotic resistance in a diverse sample of subjects seeking care across a wide geographic area of the United States. PMID:27307460

  6. Contribution of Genetic Background and Clinical Risk Factors to Low-Trauma Fractures in Human Immunodeficiency Virus (HIV)-Positive Persons: The Swiss HIV Cohort Study

    Science.gov (United States)

    Junier, Thomas; Rotger, Margalida; Biver, Emmanuel; Ledergerber, Bruno; Barceló, Catalina; Bartha, Istvan; Kovari, Helen; Schmid, Patrick; Fux, Christoph; Bernasconi, Enos; Brun del Re, Claudia; Weber, Rainer; Fellay, Jacques; Tarr, Philip E.

    2016-01-01

    Background. The impact of human genetic background on low-trauma fracture (LTF) risk has not been evaluated in the context of human immunodeficiency virus (HIV) and clinical LTF risk factors. Methods. In the general population, 6 common single-nucleotide polymorphisms (SNPs) associate with LTF through genome-wide association study. Using genome-wide SNP arrays and imputation, we genotyped these SNPs in HIV-positive, white Swiss HIV Cohort Study participants. We included 103 individuals with a first, physician-validated LTF and 206 controls matched on gender, whose duration of observation and whose antiretroviral therapy start dates were similar using incidence density sampling. Analyses of nongenetic LTF risk factors were based on 158 cases and 788 controls. Results. A genetic risk score built from the 6 LTF-associated SNPs did not associate with LTF risk, in both models including and not including parental hip fracture history. The contribution of clinical LTF risk factors was limited in our dataset. Conclusions. Genetic LTF markers with a modest effect size in the general population do not improve fracture prediction in persons with HIV, in whom clinical LTF risk factors are prevalent in both cases and controls.

  7. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies

    Science.gov (United States)

    Bartsch, Emily; Medcalf, Karyn E; Park, Alison L

    2016-01-01

    Objective To develop a practical evidence based list of clinical risk factors that can be assessed by a clinician at ≤16 weeks’ gestation to estimate a woman’s risk of pre-eclampsia. Design Systematic review and meta-analysis of cohort studies. Data sources PubMed and Embase databases, 2000-15. Eligibility criteria for selecting studies Cohort studies with ≥1000 participants that evaluated the risk of pre-eclampsia in relation to a common and generally accepted clinical risk factor assessed at ≤16 weeks’ gestation. Data extraction Two independent reviewers extracted data from included studies. A pooled event rate and pooled relative risk for pre-eclampsia were calculated for each of 14 risk factors. Results There were 25 356 688 pregnancies among 92 studies. The pooled relative risk for each risk factor significantly exceeded 1.0, except for prior intrauterine growth restriction. Women with antiphospholipid antibody syndrome had the highest pooled rate of pre-eclampsia (17.3%, 95% confidence interval 6.8% to 31.4%). Those with prior pre-eclampsia had the greatest pooled relative risk (8.4, 7.1 to 9.9). Chronic hypertension ranked second, both in terms of its pooled rate (16.0%, 12.6% to 19.7%) and pooled relative risk (5.1, 4.0 to 6.5) of pre-eclampsia. Pregestational diabetes (pooled rate 11.0%, 8.4% to 13.8%; pooled relative risk 3.7, 3.1 to 4.3), prepregnancy body mass index (BMI) >30 (7.1%, 6.1% to 8.2%; 2.8, 2.6 to 3.1), and use of assisted reproductive technology (6.2%, 4.7% to 7.9%; 1.8, 1.6 to 2.1) were other prominent risk factors. Conclusions There are several practical clinical risk factors that, either alone or in combination, might identify women in early pregnancy who are at “high risk” of pre-eclampsia. These data can inform the generation of a clinical prediction model for pre-eclampsia and the use of aspirin prophylaxis in pregnancy. PMID:27094586

  8. Clinic Attendance for Medication Refills and Medication Adherence amongst an Antiretroviral Treatment Cohort in Uganda: A Prospective Study

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    Setor Kunutsor

    2010-01-01

    Full Text Available Background. Regular clinic attendance for antiretroviral (ARV drug refills is important for successful clinical outcomes in HIV management. Methods. Clinic attendance for ARV drug refills and medication adherence using a clinic-based pill count in 392 adult patients receiving antiretroviral therapy (ART in a district hospital in Uganda were prospectively monitored over a 28-week period. Results. Of the 2267 total scheduled clinic visits, 40 (1.8% were missed visits. Among the 392 clients, 361 (92% attended all appointments for their refills (regular attendance. Clinic attendance for refills was statistically significantly associated with medication adherence with regular attendant clients having about fourfold greater odds of achieving optimal (≥95% medication adherence [odds ratio (OR=3.89, 95% CI: 1.48 to 10.25, exact P=.013]. In multivariate analysis, clients in age category 35 years and below were less likely to achieve regular clinic attendance. Conclusion. Monitoring of clinic attendance may be an objective and effective measure and could be a useful adjunct to an adherence measure such as pill counting in resource-constrained settings. Where human resource constraints do not allow pill counts or other time-consuming measures, then monitoring clinic attendance and acting on missed appointments may be an effective proxy measure.

  9. What Difference Does Patient and Public Involvement Make and What Are Its Pathways to Impact? Qualitative Study of Patients and Researchers from a Cohort of Randomised Clinical Trials

    OpenAIRE

    Dudley, Louise; Gamble, Carrol; Preston, Jennifer; Buck, Deborah; ,; Hanley, Bec; Williamson, Paula; Young, Bridget

    2015-01-01

    Background Patient and public involvement (PPI) is advocated in clinical trials yet evidence on how to optimise its impact is limited. We explored researchers' and PPI contributors' accounts of the impact of PPI within trials and factors likely to influence its impact. Methods Semi-structured qualitative interviews with researchers and PPI contributors accessed through a cohort of randomised clinical trials. Analysis of transcripts of audio-recorded interviews was informed by the principles o...

  10. Effect of infliximab dose increase in rheumatoid arthritis at different trough concentrations: a cohort study in clinical practice conditions

    Directory of Open Access Journals (Sweden)

    Chamaida ePlasencia

    2015-10-01

    Full Text Available BackgroundEvidence supporting treatment intensification in rheumatoid arthritis is limited and controversial. We explored outcomes of infliximab dose increases and accounted for pre-existing trough levels in patients with active rheumatoid arthritis (RA.MethodsThis study was a retrospective study of 42 RA patients who received increased infliximab following an insufficient response (DAS28 > 3.2. Serum concentrations of infliximab and antibodies to infliximab (ATI and DAS28 and EULAR clinical response parameters were recorded for one year. Analyses were performed in three patient groups that were defined by infliximab serum concentration prior to treatment enhancement: No detectable, Low (< 1.1 µg/mL or High (≥ 1.1 µg/mL drug levels. Results No circulating infliximab was detected in 20 patients (47.6 %, but 13 (30.9 % and 9 (21.4 % patients exhibited Low and High levels, respectively. ATI were only detected in patients with No detectable drug levels because the drug interferes with ELISA. DAS28 disease activity globally showed a modest improvement after dose escalation, but this improvement did not persist after 6 and 12 months. Infliximab serum levels increased significantly in the High group (p=0.016, but no increase was achieved in the Low and No detectable groups. The three study groups exhibited similar disease activity over time, and no improvement was observed in the non-responder EULAR rates. ConclusionsThese results suggest that the efficacy of an infliximab dose increase is limited, and the response is independent of the infliximab trough serum concentration that is achieved prior to escalation.

  11. Short communication: feasibility and acceptability of developing a multisite clinical cohort of transgender people with HIV infection.

    Science.gov (United States)

    Poteat, Tonia C; Hanna, David B; Althoff, Keri N

    2015-09-01

    Transgender women bear a disproportionate burden of HIV, yet data among this population are not routinely collected in HIV clinical cohorts. Brief surveys and follow-up qualitative interviews were conducted with principal investigators or designated representatives of 17 HIV clinical cohorts to determine the acceptability and feasibility of pooling transgender-specific data from existing HIV clinical cohort studies. Twelve of 17 sites reported that they already collect gender identity data but not consistently. Others were receptive to collecting this information. Many also expressed interest in a study of clinical outcomes among HIV-infected transgender women using pooled data across cohorts. The collection of longitudinal data on transgender people living with HIV is acceptable and feasible for most North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) cohorts. HIV clinical cohort studies should make efforts to include transgender individuals and develop the tools to collect quality data on this high-need population. PMID:26126154

  12. The value of the UK Clinical Aptitude Test in predicting pre-clinical performance: a prospective cohort study at Nottingham Medical School

    OpenAIRE

    James David; Yates Janet

    2010-01-01

    Abstract Background The UK Clinical Aptitude Test (UKCAT) was introduced in 2006 as an additional tool for the selection of medical students. It tests mental ability in four distinct domains (Quantitative Reasoning, Verbal Reasoning, Abstract Reasoning, and Decision Analysis), and the results are available to students and admissions panels in advance of the selection process. As yet the predictive validity of the test against course performance is largely unknown. The study objective was to d...

  13. Calcium-channel blockers do not alter the clinical efficacy of clopidogrel after myocardial infarction: a nationwide cohort study

    DEFF Research Database (Denmark)

    Olesen, Jonas B; Gislason, Gunnar H; Charlot, Mette G;

    2011-01-01

    which contribute to clopidogrel metabolic activation. This interaction may diminish the efficacy of clopidogrel. Methods All patients surviving 30 days after a first-time MI in the period 2000 to 2006 in Denmark were identified by individual-level linkage of nationwide administrative registers. The...... patients treated and not treated with clopidogrel, with a hazard ratio of 1.15 (95% confidence interval [CI]: 1.07 to 1.24) and 1.05 (95% CI: 1.01 to 1.11), respectively. The increased risk was independent of clopidogrel use; the hazard rate ratio was 1.08 (95% CI: 0.99 to 1.18). Analyses of all additional...... adverse end points and propensity score–matched models provided similar results. Conclusions The clinical efficacy of clopidogrel in patients with a recent MI is not modified by concomitant CCB treatment. This potential drug interaction is unlikely to have clinical significance....

  14. d-dimer testing as an adjunct to ultrasonography in patients with clinically suspected deep vein thrombosis: prospective cohort study

    Science.gov (United States)

    Bernardi, Enrico; Prandoni, Paolo; Lensing, Anthonie W A; Agnelli, Giancarlo; Guazzaloca, Giuliana; Scannapieco, Gianluigi; Piovella, Franco; Verlato, Fabio; Tomasi, Cristina; Moia, Marco; Scarano, Luigi; Girolami, Antonio

    1998-01-01

    Objective To investigate the efficacy of using a rapid plasma d-dimer test as an adjunct to compression ultrasound for diagnosing clinically suspected deep vein thrombosis. Design d-dimer concentrations were determined in all patients with a normal ultrasonogram at presentation. Repeat ultrasonography was performed 1 week later only in patients with abnormal d-dimer test results. Main outcome measure Patients with normal ultrasonograms were not treated with anticoagulants and were followed for 3 months for thromboembolic complications. Setting University research and affiliated centres. Subjects 946 patients with clinically suspected deep vein thrombosis. Results Ultrasonograms were abnormal at presentation in 260 (27.5%) patients. Of the remaining 686 patients tested for d-dimer, 88 (12.8%) had abnormal concentrations. During follow up venous thromboembolic complications occurred in one of the 598 patients who were not treated with anticoagulants and who had an initial normal ultrasonogram and d-dimer concentration, whereas thromboembolic complications occurred in two of the 83 untreated patients who had abnormal d-dimer concentrations but a normal repeat ultrasonogram. The cumulative incidence of venous thromboembolic complications during follow up was 0.4% (95% confidence interval 0% to 0.9%). The rapid plasma d-dimer test used as an adjunct to compression ultrasonography resulted in a reduction in the mean number of repeat ultrasound examinations and additional hospital visits from 0.7 to 0.1 per patient. Conclusions Testing for d-dimer as an adjunct to a normal baseline ultrasound examination decreased the number of subsequent ultrasound examinations considerably without any increased risk of venous thromboembolic complications in patients not receiving anticoagulants. The use of ultrasound and testing for d-dimer enabled treatment decisions to be made at the time of presentation in most patients. Key messagesPatients with clinically suspected deep vein

  15. Epidemiological and clinical characteristics of childhood pandemic 2009 H1N1 virus infection: an observational cohort study

    Directory of Open Access Journals (Sweden)

    Youn You-Sook

    2011-08-01

    Full Text Available Abstract Background There was a pandemic influenza around the world in 2009 including South Korea since last pandemic occurred four decades ago. We aimed to evaluate the epidemiological and clinical characteristics of this infection in childhood. Methods We evaluated the epidemiologic characteristics of all the subjects infected with the 2009 H1N1 influenza A virus (2,971 patients, ≤ 15 years of age, and the clinical and laboratory findings of the inpatients (217 patients, 80 had pneumonia between 1 September 2009 and 31 January 2010 in a single hospital throughout the epidemic. Results The age distribution of all the subjects was relatively even. Over 90% of cases occurred during a two-month period. Two hundred and five patients (94.5% received oseltamivir within 48 h of fever onset, and 97% of inpatients defervesced within 48 h of medication. The group with pneumonia included more males than females, and had higher leukocytes counts with lower lymphocyte differentials than the group without pneumonia. The white blood cell count and lymphocyte differential were associated with the severity of pneumonia. Corticosteroid treatment for severe pneumonia patients was highly effective in preventing disease progression. Conclusion Children of all ages affected with even rates of infection, but males were predominant in pneumonia patients. Pneumonia patients showed lymphopenia and its severity was associated with the severity of illness. Our results suggest that the mechanism of lung injury in 2009 H1N1 virus infection may be associated with the host immune response.

  16. Birth Weight Ratio as an Alternative to Birth Weight Percentile to Express Infant Weight in Research and Clinical Practice: A Nationwide Cohort Study

    Science.gov (United States)

    Kazemier, Brenda M.; Schuit, Ewoud; Mol, Ben Willem J.; Pajkrt, Eva; Ganzevoort, Wessel

    2014-01-01

    Objective. To compare birth weight ratio and birth weight percentile to express infant weight when assessing pregnancy outcome. Study Design. We performed a national cohort study. Birth weight ratio was calculated as the observed birth weight divided by the median birth weight for gestational age. The discriminative ability of birth weight ratio and birth weight percentile to identify infants at risk of perinatal death (fetal death and neonatal death) or adverse pregnancy outcome (perinatal death + severe neonatal morbidity) was compared using the area under the curve. Outcomes were expressed stratified by gestational age at delivery separate for birth weight ratio and birth weight percentile. Results. We studied 1,299,244 pregnant women, with an overall perinatal death rate of 0.62%. Birth weight ratio and birth weight percentile have equivalent overall discriminative performance for perinatal death and adverse perinatal outcome. In late preterm infants (33+0–36+6 weeks), birth weight ratio has better discriminative ability than birth weight percentile for perinatal death (0.68 versus 0.63, P  0.01) or adverse pregnancy outcome (0.67 versus 0.60, P < 0.001). Conclusion. Birth weight ratio is a potentially valuable instrument to identify infants at risk of perinatal death and adverse pregnancy outcome and provides several advantages for use in research and clinical practice. Moreover, it allows comparison of groups with different average birth weights. PMID:25197283

  17. Comparison of 10-year clinical wear of annealed and remelted highly cross-linked polyethylene: A propensity-matched cohort study.

    Science.gov (United States)

    Hamai, Satoshi; Nakashima, Yasuharu; Mashima, Naohiko; Yamamoto, Takuaki; Kamada, Tomomi; Motomura, Goro; Imai, Hiroshi; Fukushi, Jun-Ichi; Miura, Hiromasa; Iwamoto, Yukihide

    2016-06-01

    No previous studies comparing the clinical wear rates of the two different kinds of cross-linked ultra-high-molecular-weight polyethylene (XLPE), annealed and remelted, are available. We compared the creep and steady wear rates of 36 matched pairs (72 hips in total) adjusting for baseline characteristics with propensity score matching techniques. Zirconia femoral heads with 26-mm diameter were used in all cases. The femoral-head cup penetration was measured digitally on radiographs. Significantly greater creep (p=0.006) was detected in the remelted (0.234mm) than annealed (0.159mm) XLPE. However, no significant difference (p=0.19) was found between the steady wear rates (0.003 and 0.008mm/year, respectively) of the annealed and remelted XLPE. Multiple regression analyses showed that remelted XLPE is significant independent variable (pweight, cup size, the liner thickness, cup inclination, follow-up periods, and postoperative Merle d'Aubigné hip score had no significant effects (p>0.05) on the steady wear rates. No patients exhibited above the osteolysis threshold of 0.1mm/year, progressive radiolucencies, osteolysis, or polyethylene fracture. This propensity-matched cohort study document no significant difference in wear resistant performances of annealed and remelted XLPE over an average period of 10 years. PMID:26751705

  18. Early Parkinson’s Disease. Incidence, clinical features and quality of life in a population-based cohort study.

    OpenAIRE

    Müller, Bernd

    2014-01-01

    Background: The prevalence of Parkinson’s Disease (PD) in Norway is about 100/100 000 inhabitants. For planning of health care needs and for research purposes, incidence figures are considered the more valuable information, but have in Norway not been available for PD. Earlier incidence studies have shown variable results, likely due to methodological differences. To improve comparability, research criteria for high quality incidence studies of PD have been proposed in 2003.PD ...

  19. Food assistance is associated with improved body mass index, food security and attendance at clinic in an HIV program in central Haiti: a prospective observational cohort study

    Directory of Open Access Journals (Sweden)

    Ivers Louise C

    2010-08-01

    Full Text Available Abstract Background Few data are available to guide programmatic solutions to the overlapping problems of undernutrition and HIV infection. We evaluated the impact of food assistance on patient outcomes in a comprehensive HIV program in central Haiti in a prospective observational cohort study. Methods Adults with HIV infection were eligible for monthly food rations if they had any one of: tuberculosis, body mass index (BMI 2, CD4 cell count 3 (in the prior 3 months or severe socio-economic conditions. A total of 600 individuals (300 eligible and 300 ineligible for food assistance were interviewed before rations were distributed, at 6 months and at 12 months. Data collected included demographics, BMI and food insecurity score (range 0 - 20. Results At 6- and 12-month time-points, 488 and 340 subjects were eligible for analysis. Multivariable analysis demonstrated that at 6 months, food security significantly improved in those who received food assistance versus who did not (-3.55 vs -0.16; P Conclusions Food assistance was associated with improved food security, increased BMI, and improved adherence to clinic visits at 6 and 12 months among people living with HIV in Haiti and should be part of routine care where HIV and food insecurity overlap.

  20. Clinical characteristics and evaluation of LDL-cholesterol treatment of the Spanish Familial Hypercholesterolemia Longitudinal Cohort Study (SAFEHEART)

    Science.gov (United States)

    Familial hypercholesterolemia (FH) patients are at high risk for premature coronary heart disease (CHD). Despite the use of statins, most patients do not achieve an optimal LDL-cholesterol goal. The aims of this study are to describe baseline characteristics and to evaluate Lipid Lowering Therapy (L...

  1. Couples' voluntary counselling and testing and nevirapine use in antenatal clinics in two African capitals: a prospective cohort study

    OpenAIRE

    Conkling Martha; Shutes Erin L; Karita Etienne; Chomba Elwyn; Tichacek Amanda; Sinkala Moses; Vwalika Bellington; Iwanowski Melissa; Allen Susan A

    2010-01-01

    Abstract Background With the accessibility of prevention of mother to child transmission (PMTCT) services in sub-Saharan Africa, more women are being tested for HIV in antenatal care settings. Involving partners in the counselling and testing process could help prevent horizontal and vertical transmission of HIV. This study was conducted to assess the feasibility of couples' voluntary counseling and testing (CVCT) in antenatal care and to measure compliance with PMTCT. Methods A prospective c...

  2. Ventricular atrophy and its clinical correlates in the imaging cohort from the ADCS MCI Donepezil/Vitamin E study

    OpenAIRE

    Apostolova, Liana G.; Babakchanian, Sona; Hwang, Kristy S; Green, Amity E.; Zlatev, Dimitar; Chou, Yi-Yu; DeCarli, Charlie; Jack, Clifford R.; Petersen, Ronald C.; Aisen, Paul S.; Cummings, Jeffrey L; Toga, Arthur W.; Thompson, Paul M.

    2013-01-01

    We analyzed the baseline and 3-year T1-weighted magnetic resonance imaging data of 110 amnestic mild cognitive impairment (MCI) participants with minimal hippocampal atrophy at baseline from the Alzheimer’s Disease Cooperative Study group (ADCS) MCI Donepezil/Vitamin E trial. 46 subjects converted to AD (MCIc) while 64 remained stable (MCInc). We used the radial distance technique to examine the differences in lateral ventricle shape and size between MCIc and MCInc and the associations betwee...

  3. Strong association between serological status and probability of progression to clinical visceral leishmaniasis in prospective cohort studies in India and Nepal.

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    Epco Hasker

    Full Text Available INTRODUCTION: Asymptomatic persons infected with the parasites causing visceral leishmaniasis (VL usually outnumber clinically apparent cases by a ratio of 4-10 to 1. We assessed the risk of progression from infection to disease as a function of DAT and rK39 serological titers. METHODS: We used available data on four cohorts from villages in India and Nepal that are highly endemic for Leishmania donovani. In each cohort two serosurveys had been conducted. Based on results of initial surveys, subjects were classified as seronegative, moderately seropositive or strongly seropositive using both DAT and rK39. Based on the combination of first and second survey results we identified seroconvertors for both markers. Seroconvertors were subdivided in high and low titer convertors. Subjects were followed up for at least one year following the second survey. Incident VL cases were recorded and verified. RESULTS: We assessed a total of 32,529 enrolled subjects, for a total follow-up time of 72,169 person years. Altogether 235 incident VL cases were documented. The probability of progression to disease was strongly associated with initial serostatus and with seroconversion; this was particularly the case for those with high titers and most prominently among seroconvertors. For high titer DAT convertors the hazard ratio reached as high as 97.4 when compared to non-convertors. The strengths of the associations varied between cohorts and between markers but similar trends were observed between the four cohorts and the two markers. DISCUSSION: There is a strongly increased risk of progressing to disease among DAT and/or rK39 seropositives with high titers. The options for prophylactic treatment for this group merit further investigation, as it could be of clinical benefit if it prevents progression to disease. Prophylactic treatment might also have a public health benefit if it can be corroborated that these asymptomatically infected individuals are infectious

  4. Mercury levels in cord blood and meconium of healthy newborns and venous blood of their mothers: Clinical, prospective cohort study

    International Nuclear Information System (INIS)

    Objectives: The purpose of this study is to investigate the chronic mercury intoxication in pregnant women and newborns living in Istanbul, Turkey. Methods: The research was carried out as a prospective with 143 pregnant women and their newborns. Venous blood from the mother, cord blood from the neonate, and meconium were collected for mercury analysis. Frequency of fish and vegetable-eating and the number of teeth filled were investigated. Analyses were made in cold vapor Atomic Absorption Spectrophotometer (AAS, μg/L). Results: Mercury levels were 0.38 ± 0.5 μg/L (0-2.34) in venous blood of pregnant women, 0.50 ± 0.64 μg/L (0-2.36) in umbilical cord blood and 9.45 ± 13.8 μg/g (0-66.5) in meconium. Maternal blood mercury level was lower than the known toxic limit for humans (EPA, 5 μg/L). Mercury levels of the maternal venous blood were significantly correlated with umbilical cord blood. The primary risk factors affecting mercury levels were eating fishmeals more than twice a week and having filled teeth more than five. The fact that the mother had a regular vegetable diet everyday reduced the mercury levels. Increased levels of mercury in the mother and umbilical cord blood could lead to retarded newborns' weight and height. Conclusion: Pregnant women living in Istanbul may be not under the risk of chronic mercury intoxication. Fish consumption more than twice per week and tooth-filling of mother more than five may increase mercury level. On the contrary, regular diet rich in vegetable decreases the mercury level

  5. Is it possible to diagnose the therapeutic adherence of patients with COPD in clinical practice? A cohort study

    Directory of Open Access Journals (Sweden)

    Prados-Torres Daniel

    2011-01-01

    Full Text Available Abstract Background Therapeutic adherence of patients with chronic obstructive pulmonary disease (COPD is poor. It is therefore necessary to determine the magnitude of non-adherence to develop strategies to correct this behaviour. The purpose of this study was to analyse the diagnostic validity of indirect adherence methods. Methods Sample: 195 COPD patients undergoing scheduled inhaled treatment attending 5 Primary Care Centres of Malaga, Spain. Variables: Sociodemographic profile, illness data, spirometry, quality of life (St. George Respiratory Questionnaire: SGRQ, and inhaled medication counting (count of dose/pill or electronic monitoring were collected. The patient's knowledge of COPD (Batalla test:BT,their attitude towards treatment (Morisky-Green test: MGT and their self-reported therapeutic adherence (Haynes-Sackett test: HST were used as methods of evaluating adherence. The follow-up consisted four visits over one year (the recruitment visit: V0; and after 1 month:V1; 6 months:V2; and 1 year:V3. Results The mean age was 69.59 (95% CI, 68.29-70.89 years old and 93.8% were male. Other findings included: 85.4% had a low educational level, 23.6% were smokers, 71.5% mild-moderate COPD stage with a FEV1 = 56.86 (SD = 18.85; exacerbations per year = 1.41(95% CI, 1-1.8. The total SGRQ score was 44.96 (95% CI, 42.46-47.46, showing a mild self-perceived impairment in health. The prevalence of adherence (dose/pill count was 68.1% (95% CI, 60.9-75.3 at V1, 80% (95% CI, 73-87 at V2 and 84% (95% CI, 77.9 at V3. The MGT showed a specificity of 67.34% at V1, 76.19% at V2 and 69.62% at V3. The sensitivity was 53.33% at V1, 66.66% at V2 and 33.33% at V3.The BT showed a specificity of 55.1% at V1, 70.23% at V2 and 67.09% at V3. The sensitivity was 68.88% at V1, 71.43% at V2 and 46.66% at V3. Considering both tests together, the specificity was 86.73% at V1, 94.04% at V2 and 92.49% at V3 and the sensitivity was 37.77% at V1, 47.62% at V2 and 13.3% at V3

  6. Riyadh Mother and Baby Multicenter Cohort Study: The Cohort Profile

    Science.gov (United States)

    Esmaeil, Samia; Alzeidan, Rasmieh; Elawad, Mamoun; Tabassum, Rabeena; Hansoti, Shehnaz; Magzoup, Mohie Edein; Al-Kadri, Hanan; Elsherif, Elham; Al-Mandil, Hazim; Al-Shaikh, Ghadeer; Zakaria, Nasria

    2016-01-01

    Objectives To assess the effects of non-communicable diseases, such as diabetes, hypertension and obesity, on the mother and the infant. Methods A multicentre cohort study was conducted in three hospitals in the city of Riyadh in Saudi Arabia. All Saudi women and their babies who delivered in participating hospitals were eligible for recruitment. Data on socio-demographic characteristics in addition to the maternal and neonatal outcomes of pregnancy were collected. The cohort demographic profile was recorded and the prevalence of maternal conditions including gestational diabetes, pre-gestational diabetes, hypertensive disorders in pregnancy and obesity were estimated. Findings The total number of women who delivered in participating hospitals during the study period was 16,012 of which 14,568 women participated in the study. The mean age of the participants was 29 ± 5.9 years and over 40% were university graduates. Most of the participants were housewives, 70% were high or middle income and 22% were exposed to secondhand smoke. Of the total cohort, 24% were married to a first cousin. More than 68% of the participants were either overweight or obese. The preterm delivery rate was 9%, while 1.5% of the deliveries were postdate. The stillbirth rate was 13/1000 live birth. The prevalence of gestational diabetes was 24% and that of pre-gestational diabetes was 4.3%. The preeclampsia prevalence was 1.1%. The labour induction rate was 15.5% and the cesarean section rate was 25%. Conclusion Pregnant women in Saudi Arabia have a unique demographic profile. The prevalence of obesity and diabetes in pregnancy are among the highest in the world. PMID:26937965

  7. Riyadh Mother and Baby Multicenter Cohort Study: The Cohort Profile.

    Directory of Open Access Journals (Sweden)

    Hayfaa Wahabi

    Full Text Available To assess the effects of non-communicable diseases, such as diabetes, hypertension and obesity, on the mother and the infant.A multicentre cohort study was conducted in three hospitals in the city of Riyadh in Saudi Arabia. All Saudi women and their babies who delivered in participating hospitals were eligible for recruitment. Data on socio-demographic characteristics in addition to the maternal and neonatal outcomes of pregnancy were collected. The cohort demographic profile was recorded and the prevalence of maternal conditions including gestational diabetes, pre-gestational diabetes, hypertensive disorders in pregnancy and obesity were estimated.The total number of women who delivered in participating hospitals during the study period was 16,012 of which 14,568 women participated in the study. The mean age of the participants was 29 ± 5.9 years and over 40% were university graduates. Most of the participants were housewives, 70% were high or middle income and 22% were exposed to secondhand smoke. Of the total cohort, 24% were married to a first cousin. More than 68% of the participants were either overweight or obese. The preterm delivery rate was 9%, while 1.5% of the deliveries were postdate. The stillbirth rate was 13/1000 live birth. The prevalence of gestational diabetes was 24% and that of pre-gestational diabetes was 4.3%. The preeclampsia prevalence was 1.1%. The labour induction rate was 15.5% and the cesarean section rate was 25%.Pregnant women in Saudi Arabia have a unique demographic profile. The prevalence of obesity and diabetes in pregnancy are among the highest in the world.

  8. Survival and Clinical Behavior of Hypertrophic Cardiomyopathy in a Latin American Cohort in Contrast to Cohorts from the Developed World

    OpenAIRE

    Espinola-Zavaleta, Nilda; Vega, Antonio; Basto, Diego Martínez; Alcantar-Fernández, Ana Cecilia; Guarner Lans, Veronica; Soto,María Elena

    2015-01-01

    Background Hypertrophic cardiomyopathy (HCM) is the most common hereditary heart disease with diverse phenotipyc, genetic expession and clinical presentations. The evolution of patients with HCM in Latin America has not been properly described being the frequency, the long-term prognosis as well as the predominant phenotypic expression still unknown. The aim of this study was to determine the survival rate of HCM patients having different phenotypes in a Mexican cohort of patients. Methods Cl...

  9. Subclinical Hyperthyroidism-A Cohort Study

    International Nuclear Information System (INIS)

    Objective: To compare the development of overt hyperthyroidism in a cohort of patients of subclinical hyperthyroidism (SCR) and in subjects with normal thyroid function tests. Study Design: A cohort study. Place and Duration of study: The study was conducted in the department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi from Sept 2006 to Sept 2007. Patients and Methods: Fifty patients of SCR and almost equal number of age and sex-matched subjects with normal Thyroid function test (TFT) were included in the study as controls. Subclinical hyperthyroid patients and controls were followed for a period of one year on a six monthly basis. The patients were examined for signs and symptoms of hyperthyroidism and serum TSH, total T3 and free T4 were estimated. The clinical history, physical examination and TFT results were recorded. Five ml of blood was collected for serum thyroid profile in plain tube. Hormonal analysis(TSH, T4 and T3) was done for the patients and the controls enrolled in the study. The TFTs was analyzed using Chemiluminescence Immunoassay technique on Immulite 2000 an automated, random access, immunoassay analyzer. Results: Six (12%) out of 50 cases of the SCR patients and 2 (4%) out of 50 controls developed overt hyperthyroidism. SCR had no significant risk for conversion to overt hyperthyroidism as compared to healthy controls in this study. In addition to initial levels of serum TSH were one of important predictor for conversion of SCR to overt hyperthyroidism. Conclusion: Patients with SCR have no significant risk but showed an increase in frequency of conversion to overt hyperthyroidism (12% in this study) as compared to controls. (author)

  10. Implant Optimisation for Primary Hip Replacement in Patients over 60 Years with Osteoarthritis: A Cohort Study of Clinical Outcomes and Implant Costs Using Data from England and Wales.

    Directory of Open Access Journals (Sweden)

    Simon S Jameson

    Full Text Available Hip replacement is one of the most commonly performed surgical procedures worldwide; hundreds of implant configurations provide options for femoral head size, joint surface material and fixation method with dramatically varying costs. Robust comparative evidence to inform the choice of implant is needed. This retrospective cohort study uses linked national databases from England and Wales to determine the optimal type of replacement for patients over 60 years undergoing hip replacement for osteoarthritis.Implants included were the commonest brand from each of the four types of replacement (cemented, cementless, hybrid and resurfacing; the reference prosthesis was the cemented hip procedure. Patient reported outcome scores (PROMs, costs and risk of repeat (revision surgery were examined. Multivariable analyses included analysis of covariance to assess improvement in PROMs (Oxford hip score, OHS, and EQ5D index (9159 linked episodes and competing risks modelling of implant survival (79,775 procedures. Cost of implants and ancillary equipment were obtained from National Health Service procurement data.EQ5D score improvements (at 6 months were similar for all hip replacement types. In females, revision risk was significantly higher in cementless hip prostheses (hazard ratio, HR = 2.22, p<0.001, when compared to the reference hip. Although improvement in OHS was statistically higher (22.1 versus 20.5, p<0.001 for cementless implants, this small difference is unlikely to be clinically important. In males, revision risk was significantly higher in cementless (HR = 1.95, p = 0.003 and resurfacing implants, HR = 3.46, p<0.001, with no differences in OHS. Material costs were lowest with the reference implant (cemented, range £1103 to £1524 and highest with cementless implants (£1928 to £4285. Limitations include the design of the study, which is intrinsically vulnerable to omitted variables, a paucity of long-term implant survival data (reflecting the

  11. Cohort profile: golestan hepatitis B cohort study- a prospective long term study in northern iran ​.

    Science.gov (United States)

    Poustchi, Hossein; Katoonizadeh, Aezam; Ostovaneh, Mohammad Reza; Moossavi, Shirin; Sharafkhah, Maryam; Esmaili, Saeed; Pourshams, Akram; Mohamadkhani, Ashraf; Besharat, Sima; Merat, Shahin; Mohamadnejad, Mehdi; George, Jacob; Malekzadeh, Reza

    2014-10-01

    Hepatitis B virus (HBV) infection is the most common cause of end stage liver disease in Iran and in Golestan province. Large-scale population-based prospective cohort studies with long term follow-up are the method of choice to accurately understand the natural course of HBV infection. To date, several studies of HBV epidemiology, natural history, progression to cirrhosis and association with HCC have been reported from other countries. However, few of these are prospective and fewer still are population-based. Moreover, the underlying molecular mechanisms and immunogenetic determinants of the outcome of HBV infection especially in low and middle income countries remains largely unknown. Therefore, the hepatitis B cohort study (HBCS), nested as part of the Golestan Cohort Study (GCS), Golestan, Iran was established in 2008 with the objective to prospectively investigate the natural course of chronic hepatitis B with reference to its epidemiology, viral/host genetic interactions, clinical features and outcome in the Middle East where genotype D HBV accounts for >90% of infections. In 2008, a baseline measurement of HBV surface antigen (HBsAg) was performed on stored serum samples of all GCS participants. A sub-cohort of 3,505 individuals were found to be HBsAg positive and were enrolled in the Golestan HBCS. In 2011, all first degree relatives of HBsAg positive subjects including their children and spouses were invited for HBV serology screening and those who were positive for HBsAg were also included in the Golestan HBCS. PMID:25349681

  12. A Study of Group Dynamics in Educational Leadership Cohort and Non-Cohort Groups

    Science.gov (United States)

    Greenlee, Bobbie J.; Karanxha, Zorka

    2010-01-01

    The purpose of this study was to examine group dynamics of educational leadership students in cohorts and make comparisons with the group dynamics characteristics of non-cohort students. Cohorts have emerged as dynamic and adaptive entities with attendant group dynamic processes that shape collective learning and action. Cohort (n=42) and…

  13. Baseline Serum Osteopontin Levels Predict the Clinical Effectiveness of Tocilizumab but Not Infliximab in Biologic-Naïve Patients with Rheumatoid Arthritis: A Single-Center Prospective Study at 1 Year (the Keio First-Bio Cohort Study)

    Science.gov (United States)

    Izumi, Keisuke; Kaneko, Yuko; Hashizume, Misato; Yoshimoto, Keiko; Takeuchi, Tsutomu

    2015-01-01

    Objective To explore the baseline predictors of clinical effectiveness after tocilizumab or infliximab treatment in biologic-naïve rheumatoid arthritis patients. Methods Consecutive biologic-naïve patients with rheumatoid arthritis initiating infliximab (n = 57) or tocilizumab (n = 70) treatment were included in our prospective cohort study. Our cohort started in February 2010, and the patients observed for at least 1 year as of April 2013 were analysed. We assessed baseline variables including patients' characteristics (age, sex, disease duration, prednisolone dose, methotrexate dose, other disease-modifying antirheumatic drug use, Clinical Disease Activity Index [CDAI]) and serum biomarker levels (C-reactive protein, immunoglobulin M-rheumatoid factor, anti-cyclic citrullinated protein/peptide antibodies, interferon-γ, interleukin (IL)-1β, IL-2, IL-6, IL-8, IL-10, IL-17, tumor necrosis factor-α, soluble intercellular adhesion molecule-1, bone alkaline phosphatase, osteonectin, osteopontin) to extract factors associated with clinical remission (CDAI≤2.8) at 1 year using univariate analyses, and the extracted factors were entered into a multivariate logistic regression model. Similar analyses were also performed for Simplified Disease Activity Index (SDAI) remission (≤3.3) and Disease Activity Score with 28 joint counts, erythrocyte sedimentation rate (DAS28-ESR) remission (<2.6). Results There were no significant differences in the baseline characteristics except for methotrexate use between the groups. In the multivariate analyses, the low baseline osteopontin levels (OR 0.9145, 95% CI 0.8399–0.9857) were identified as predictors of CDAI remission in the tocilizumab group, whereas no predictors of CDAI remission were found in the infliximab group. Similar results were obtained when using SDAI and DAS28-ESR remission criteria. Conclusion Baseline low serum osteopontin levels predict clinical remission 1 year after tocilizumab treatment and not

  14. The Danish National Cohort Study (DANCOS)

    DEFF Research Database (Denmark)

    Davidsen, Michael; Kjøller, Mette; Helweg-Larsen, Karin

    2011-01-01

    INTRODUCTION: The Danish National Cohort Study (DANCOS) is a nationally representative public health survey based on linkage of information in the repeated Danish Health Interview surveys, 1986-2005, to the national Danish registers on health and welfare. It facilitates studies of self-reported h......INTRODUCTION: The Danish National Cohort Study (DANCOS) is a nationally representative public health survey based on linkage of information in the repeated Danish Health Interview surveys, 1986-2005, to the national Danish registers on health and welfare. It facilitates studies of self...

  15. Brain-Science Based Cohort Studies

    Science.gov (United States)

    Koizumi, Hideaki

    2011-01-01

    This article describes a number of human cohort studies based on the concept of brain-science and education. These studies assess the potential effects of new technologies on babies, children and adolescents, and test hypotheses drawn from animal and genetic case studies to see if they apply to people. A flood of information, virtual media,…

  16. What Difference Does Patient and Public Involvement Make and What Are Its Pathways to Impact? Qualitative Study of Patients and Researchers from a Cohort of Randomised Clinical Trials.

    Directory of Open Access Journals (Sweden)

    Louise Dudley

    Full Text Available Patient and public involvement (PPI is advocated in clinical trials yet evidence on how to optimise its impact is limited. We explored researchers' and PPI contributors' accounts of the impact of PPI within trials and factors likely to influence its impact.Semi-structured qualitative interviews with researchers and PPI contributors accessed through a cohort of randomised clinical trials. Analysis of transcripts of audio-recorded interviews was informed by the principles of the constant comparative method, elements of content analysis and informant triangulation.We interviewed 21 chief investigators, 10 trial managers and 17 PPI contributors from 28 trials. The accounts of informants within the same trials were largely in agreement. Over half the informants indicted PPI had made a difference within a trial, through contributions that influenced either an aspect of a trial, or how researchers thought about a trial. According to informants, the opportunity for PPI to make a difference was influenced by two main factors: whether chief investigators had goals and plans for PPI and the quality of the relationship between the research team and the PPI contributors. Early involvement of PPI contributors and including them in responsive (e.g. advisory groups and managerial (e.g. trial management groups roles were more likely to achieve impact compared to late involvement and oversight roles (e.g. trial steering committees.Those seeking to enhance PPI in trials should develop goals for PPI at an early stage that fits the needs of the trial, plan PPI implementation in accordance with these goals, invest in developing good relationships between PPI contributors and researchers, and favour responsive and managerial roles for contributors in preference to oversight-only roles. These features could be used by research funders in judging PPI in trial grant applications and to inform policies to optimise PPI within trials.

  17. Adhesive capsulitis and dynamic splinting: a controlled, cohort study

    OpenAIRE

    Willis F Buck; Gaspar Paul D

    2009-01-01

    Abstract Background Adhesive Capsulitis (AC) affects patient of all ages, and stretching protocols are commonly prescribed for this condition. Dynamic splinting has been shown effective in contracture reduction from pathologies including Trismus to plantar fasciitis. The purpose of this study was to examine the efficacy of dynamic splinting on patients with AC. Methods This controlled, cohort study, was conducted at four physical therapy, sports medicine clinics in Texas and California. Sixty...

  18. Deep phenotyping of the unselected COPSAC2010 birth cohort study

    DEFF Research Database (Denmark)

    Bisgaard, Hans Flinker; Vissing, Nadja Hawwa; Carson, C. G.;

    2013-01-01

    We hypothesize that perinatal exposures, in particular the human microbiome and maternal nutrition during pregnancy, interact with the genetic predisposition to cause an abnormal immune modulation in early life towards a trajectory to chronic inflammatory diseases such as asthma and others. The aim...... of this study is to explore these interactions by conducting a longitudinal study in an unselected cohort of pregnant women and their offspring with emphasis on deep clinical phenotyping, exposure assessment, and biobanking. Exposure assessments focus on the human microbiome. Nutritional intervention...... during pregnancy in randomized controlled trials are included in the study to prevent disease and to be able to establish causal relationships. Pregnant women from eastern Denmark were invited during 2008–2010 to a novel unselected ‘COPSAC2010’ cohort. The women visited the clinic during pregnancy weeks...

  19. Investigation into the causes of indwelling urethral catheter implementation and its effects on clinical outcomes and health care resources among dementia patients with pneumonia: A retrospective cohort study.

    Science.gov (United States)

    Maeda, Toshiki; Babazono, Akira; Nishi, Takumi; Yasui, Midori; Harano, Yumi

    2016-08-01

    There is a possibility that unnecessary treatments and low-quality medical care, such as inappropriate indwelling urethral catheter use, are being provided to older Japanese individuals.The aim of this study was to investigate contextual effects relating to indwelling urethral catheters in older people with dementia and to clarify the effects of indwelling urethral catheter use on patients' mortality, length of stay (LOS), and health care spending. This retrospective cohort study involved 4501 male and female Japanese participants. Those who were aged 75 or older with dementia and had a primary diagnosis of acute lower respiratory disease with antibiotics administered during hospitalization were eligible for inclusion. Patient mortality, LOS, and total charge during hospitalization were the main study outcomes. This study showed that indwelling urethral catheter use was significantly associated with higher mortality, longer LOS, and higher total charge for hospitalization. The pattern of indwelling urethral catheter use was clustered by care facility level. Physician density was significantly associated with indwelling urethral catheter use; the relationship was not linear but U-shaped, such that the approximate median had the lowest rate of urethral catheter use and this increased gradually toward both lower and higher physician densities. Our study found considerable variation in indwelling urethral catheter use between care facilities in older people with dementia. Additionally, indwelling urethral catheter use was related to poor outcomes. Based on these findings, we consider there to be an urgent need for constructing a framework to measure, report on, and promote the improvement of care quality for older individuals in Japan. PMID:27583898

  20. Risk factors for cardiovascular diseases among Swedish Sami – a controlled cohort study

    OpenAIRE

    Edin-Liljegren, A; S. Hassler; Sjölander, P.; Daerga, L.

    2004-01-01

    Objective. To investigate the occurrence of clinical, psychosocial and behavioural risk factors for cardiovascular diseases (CVD) among reindeer herding (RS) and non-reindeer herding Sami (NRS). Study Design. A retrospective cohort study, comparing risk factors behind CVD between Sami and non-Sami, RS and NRS, and Sami men and women. Methods. A cohort of 611 Swedish Sami (276 men and 335 women) was constructed from national population registers. A twice as large control cohort of non-Sami was...

  1. Cohort Profile: Sympathetic activity and Ambulatory Blood Pressure in Africans (SABPA) prospective cohort study.

    Science.gov (United States)

    Malan, Leoné; Hamer, Mark; Frasure-Smith, Nancy; Steyn, Hendrik S; Malan, Nicolaas T

    2015-12-01

    Adapting to an over-demanding stressful urban environment may exhaust the psychophysiological resources to cope with these demands, and lead to sympathetic nervous system dysfunction. The evidence that an urban-dwelling lifestyle may be detrimental to the cardiometabolic health of Africans motivated the design of the Sympathetic activity and Ambulatory Blood Pressure in African Prospective cohort study. We aimed to determine neural mechanistic pathways involved in emotional distress and vascular remodelling. The baseline sample included 409 teachers representing a bi-ethnic sex cohort from South Africa. The study was conducted in 2008-09 and repeated after 3-year follow-up in 2011-12, with an 87.8% successful follow-up rate. Seasonal changes were avoided and extensive clinical assessments were performed in a well-controlled setting. Data collection included sociodemographics, lifestyle habits, psychosocial battery and genetic analysis, mental stress responses mimicking daily life stress (blood pressure and haemostatic, cardiometabolic, endothelial and stress hormones). Target organ damage was assessed in the brain, heart, kidney, blood vessels and retina. A unique highly phenotyped cohort is presented that can address the role of a hyperactive sympathetic nervous system and neural response pathways contributing to the burden of cardiometabolic diseases in Africans. PMID:25344943

  2. Risk set sampling in epidemiologic cohort studies

    OpenAIRE

    Langholz, Bryan; Goldstein, Larry

    1996-01-01

    Recent work has extended the methods for the analysis of nested case-control studies to accomodate a broad variety of risk set sampling designs. These results have implications for the design of sampled epidemiologic cohort studies. We describe a model which is a natural extension of the Cox proportional hazards model and may be used to estimate parameters from sampled risk set data. We illustrate how these techniques may be used to solve three diverse design and analysis problems from epidem...

  3. Utility of clinical parameters to identify HIV infection in infants below ten weeks of age in South Africa: a prospective cohort study

    OpenAIRE

    Jaspan Heather B; Myer Landon; Madhi Shabir A; Violari Avy; Gibb Diana M; Stevens Wendy S; Dobbels Els; Cotton Mark F

    2011-01-01

    Abstract Background As HIV-infected infants have high mortality, the World Health Organization now recommends initiating antiretroviral therapy as early as possible in the first year of life. However, in many settings, laboratory diagnosis of HIV in infants is not readily available. We aimed to develop a clinical algorithm for HIV presumptive diagnosis in infants < 10 weeks old using screening data from the Children with HIV Early Antiretroviral therapy (CHER) study in South Africa. HIV-infec...

  4. Impact of therapeutic drug monitoring of antiretroviral drugs in routine clinical management of patients infected with human immunodeficiency virus and related health care costs: a real-life study in a large cohort of patients

    Directory of Open Access Journals (Sweden)

    Perrone V

    2014-07-01

    Full Text Available Valentina Perrone,1 Dario Cattaneo,1 Sonia Radice,1 Diego Sangiorgi,2 Augusto B Federici,3 Maria Rita Gismondo,4 Massimo Medaglia,5 Valeria Micheli,4 Stefania Vimercati,5 Enza Pallone,6 Luca Degli Esposti,2 Emilio Clementi1,71Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, L Sacco University Hospital, University of Milan, Milan, 2CliCon Srl, Health, Economics and Outcomes Research, Ravenna, 3Hematology and Transfusion Medicine, Department of Clinical Sciences and Community Health, 4Clinical Microbiology Virology and Diagnosis of Bioemergency, 5Pharmaceutical Department, 6Quality Clinical Risk and Accreditation Unit, L Sacco University Hospital, Milan, 7Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, ItalyBackground: Highly active antiretroviral therapy (HAART has reduced morbidity and mortality in patients infected with human immunodeficiency virus (HIV. Studies have documented high interindividual variability in the pharmacokinetics of antiretroviral drugs, which may impair the success of HAART if not managed properly. Therapeutic drug monitoring (TDM is a useful diagnostic tool that helps clinicians to optimize drug doses so that drug concentrations associated with the highest therapeutic efficacy are obtained with a reduced risk of concentration-dependent adverse effects. The aim of this study was to assess whether use of TDM improves clinical outcomes and cost of illness.Methods: A retrospective cohort study was conducted at L Sacco University Hospital in Milan, Italy, in HIV-infected patients aged ≥18 years with at least one prescription of antiretroviral drugs for which TDM was applied. The inclusion period was from January 2010 to December 2011, with a follow-up period of up to 12 months. Laboratory and administrative databases were analyzed and matched with each other.Results: The cohort consisted of 5,347 patients (3,861 males and 1,486 females of mean age 43.9±12.5 years. We found

  5. A retrospective, multi-center cohort study evaluating the severity- related effects of cerebrolysin treatment on clinical outcomes in traumatic brain injury.

    Science.gov (United States)

    Muresanu, Dafin F; Ciurea, Alexandru V; Gorgan, Radu M; Gheorghita, Eva; Florian, Stefan I; Stan, Horatiu; Blaga, Alin; Ianovici, Nicolai; Iencean, Stefan M; Turliuc, Dana; Davidescu, Horia B; Mihalache, Cornel; Brehar, Felix M; Mihaescu, Anca S; Mardare, Dinu C; Anghelescu, Aurelian; Chiparus, Carmen; Lapadat, Magdalena; Pruna, Viorel; Mohan, Dumitru; Costea, Constantin; Costea, Daniel; Palade, Claudiu; Bucur, Narcisa; Figueroa, Jesus; Alvarez, Anton

    2015-01-01

    Traumatic brain injury (TBI) is a leading cause of death and disability for which there is currently no effective drug therapy available. Because drugs targeting a single TBI pathological pathway have failed to show clinical efficacy to date, pleiotropic agents with effects on multiple mechanisms of secondary brain damage could represent an effective option to improve brain recovery and clinical outcome in TBI patients. In this multicenter retrospective study, we investigated severity-related efficacy and safety of the add-on therapy with two concentrations (20 ml/day or 30 ml/day) of Cerebrolysin (EVER Neuro Pharma, Austria) in TBI patients. Adjunctive treatment with Cerrebrolysin started within 48 hours after TBI and clinical outcomes were ranked according to the Glasgow Outcome Scale and the Modified Rankin Disability Score at 10 and 30 days post-TBI. Analyses of efficacy were performed separately for subgroups of patients with mild, moderate or severe TBI according to Glasgow Coma Scale scores at admission. Compared to standard medical care alone (control group), both doses of Cerebrolysin were associated with improved clinical outcome scores at 10 days post-TBI in mild patients and at 10 and 30 days in moderate and severe cases. A dose-dependent effect of Cerebrolysin on TBI recovery was supported by the dose-related differences and the significant correlations with treatment duration observed for outcome measures. The safety and tolerability of Cerebrolysin in TBI patients was very good. In conclusion, the results of this large retrospective study revealed that early Cerebrolysin treatment is safe and is associated to improved TBI outcome. PMID:25924999

  6. Radiofrequency thermocoagulation for V2/V3 idiopathic trigeminal neuralgia: effect of treatment temperatures on long-term clinical outcomes: A Cohort Study.

    Science.gov (United States)

    Yao, Peng; Deng, Yi-Yong; Hong, Tao; Wang, Zhi-Bin; Ma, Jia-Ming; Zhu, Yong-Qiang; Li, Hong-Xi; Ding, Yuan-Yuan; Pan, Shi-Nong

    2016-06-01

    Radiofrequency thermocoagulation (RFT) is widely used to treat trigeminal neuralgia (TN); however, the optimal temperature at which RFT is most efficacious remains under much debate. Thus, the aim of the present study was to determine the lowest temperature at which morbidity could be minimized and patient outcomes maximized.A multivariate analysis was used to study 1354 patients who underwent computed tomography (CT)-guided RFT for V2/V3 idiopathic trigeminal neuralgia (ITN) during from June 2006 to May 2015. RFT was carried out at 62, 65, and 68°C, while keeping all other RF parameters the same. This was a prospective cohort study, in which we assessed intra- and postoperative complications, pain relief, and long-term health-related quality of life (HRQoL).The intraoperative and in-hospital complications of patients were mainly facial hematoma, mouth and external auditory meatus penetration, nausea, vomiting, dizziness, and headache, which were all treated symptomatically. In long-term follow-up, patients with pain relief (defined as no pain and no required drug intervention) at 62, 65, and 68°C accounted for 94.2%, 98.3%, and 98.8% (at discharge); 83.8%, 90.1%, and 91.4% (at 1 year); 66.7%, 80.5%, and 88.2% (at 3 years); 59.0%, 64.3%, and 77.2% (at 5 years); 48.7%, 57.8%, and 72.3% (at 7 years); 40.6%, 53.7%, and 60.3% (at 9 years), respectively. The number of patients with facial numbness, masticatory atonia, or corneal hypoesthesia was increased with the elevation of temperature, but these complications were all mild. No blindness, deafness, intracranial hemorrhage, or death as a result of the surgical intervention occurred in any patients. SF-36 scores showed highest HRQoL in the group treated at 68°C, followed by the 65 and 62°C groups, respectively.Our results demonstrate that 68°C is a good choice for RFT of V2/V3 ITN. The alternative option is 65 or 62°C for RFT to minimize the occurrence of complications including facial numbness, yet which often

  7. The Danish National Cohort Study (DANCOS)

    DEFF Research Database (Denmark)

    Helweg-Larsen, Karin; Kjøller, Mette; Davidsen, Michael;

    2003-01-01

    -interview survey. As part of the national health interview survey programme, three nation-wide surveys were conducted in 1986/1987, 1991 and 1994. The samples in the three cohorts consisted of 23,096 adult Danes ages 16 years and older, and 18,296 (79.2%) were personally interviewed on socio-economic status...... Service Register recorded 980,043 contacts with general practitioners and specialist physicians. For 1943-1996, the Danish cancer Registry contained information about one or more cancer diseases among 1,432 people. A total of 4,334 people in the 1994 cohort were re-interview in 2000. DANCOS allows...... for a wide range of analysis in a historical prospective design of determinants of morbidity and mortality, of health care utilization and of the social effects of ill health. DANCOS also allows studies of methodological issues, including analyzing the characteristics of non-respondents. Udgivelsesdato: 2003...

  8. Validation of the pooled cohort risk score in an Asian population – a retrospective cohort study

    OpenAIRE

    Chia, Yook Chin; Lim, Hooi Min; Ching, Siew Mooi

    2014-01-01

    Background The Pooled Cohort Risk Equation was introduced by the American College of Cardiology (ACC) and American Heart Association (AHA) 2013 in their Blood Cholesterol Guideline to estimate the 10-year atherosclerotic cardiovascular disease (ASCVD) risk. However, absence of Asian ethnicity in the contemporary cohorts and limited studies to examine the use of the risk score limit the applicability of the equation in an Asian population. This study examines the validity of the pooled cohort ...

  9. Clinical features and predictors of mortality in admitted patients with community- and hospital-acquired legionellosis: A Danish historical cohort study

    Directory of Open Access Journals (Sweden)

    Fine Michael J

    2010-05-01

    Full Text Available Abstract Background Legionella is a common cause of bacterial pneumonia. Community-acquired [CAL] and hospital-acquired legionellosis [HAL] may have different presentations and outcome. We aimed to compare clinical characteristics and examine predictors of mortality for CAL and HAL. Methods We identified hospitalized cases of legionellosis in 4 Danish counties from January 1995 to December 2005 using the Danish national surveillance system and databases at departments of clinical microbiology. Clinical and laboratory data were retrieved from medical records; vital status was obtained from the Danish Civil Registration System. We calculated 30- and 90-day case fatality rates and identified independent predictors of mortality using logistic regression analyses. Results We included 272 cases of CAL and 60 cases of HAL. Signs and symptoms of HAL were less pronounced than for CAL and time from in-hospital symptoms to legionellosis diagnosis was shorter for CAL than for HAL (5.5 days vs. 12 days p 65 years (OR = 2.6, 95% CI: 1.1-5.9 and Charlson comorbidty index ≥2 (OR = 2.7, 95% CI: 1.1-6.5 were associated with an increased risk of death in CAL. We identified no statistically significant predictors of 30-day mortality in HAL. Conclusions Signs and symptoms were less pronounced in HAL compared to CAL. Conversely, 30-day case fatality was almost 3 times higher. Clinical awareness is important for the timely diagnosis and treatment especially of HAL. There is a need for further studies of prognostic factors in order to improve the therapeutic approach to legionellosis and potentially reduce mortality.

  10. Occurrence and clinical management of moderate-to-severe adverse events during drug-resistant tuberculosis treatment: a retrospective cohort study

    OpenAIRE

    2014-01-01

    Objectives To determine the incidence of symptomatic moderate-to-severe adverse events during treatment of drug-resistant tuberculosis, and to compare their risk and outcomes by patients’ human immunodeficiency virus (HIV) co-infection status. Methods We conducted a retrospective cohort analysis of patients treated for drug-resistant tuberculosis between January 2008 and February 2010. Routinely, clinicians monitored and managed patients’ response to treatment until its completion. Any sympto...

  11. Occurrence and clinical management of moderate-to-severe adverse events during drug-resistant tuberculosis treatment : a retrospective cohort study

    OpenAIRE

    Sagwa, Evans L.; Mantel-Teeuwisse, Aukje K.; Ruswa, Nunurai C

    2014-01-01

    OBJECTIVES: To determine the incidence of symptomatic moderate-to-severe adverse events during treatment of drug-resistant tuberculosis, and to compare their risk and outcomes by patients' human immunodeficiency virus (HIV) co-infection status. METHODS: We conducted a retrospective cohort analysis of patients treated for drug-resistant tuberculosis between January 2008 and February 2010. Routinely, clinicians monitored and managed patients' response to treatment until its completion. Any symp...

  12. Rationale, design, and cohort enrolment of a prospective observational study of the clinical performance of the new contraceptive implant (Femplant in Pakistan

    Directory of Open Access Journals (Sweden)

    Azmat SK

    2014-05-01

    Full Text Available Syed Khurram Azmat,1 Waqas Hameed,1 Anja Lendvay,2 Babar Tasneem Shaikh,3 Ghulam Mustafa,1 Muhammad Ahmed Siddiqui,1 Sajid Brohi,1 Asif Karim,1 Muhammad Ishaque,1 Wajahat Hussain,1 Mohsina Bilgrami,1 Paul J Feldblum2 1Research, Monitoring and Evaluation Department, Marie Stopes Society, Karachi, Pakistan; 2FHI 360, Durham, NC, USA; 3Health Services Academy, Islamabad, Pakistan Introduction: The use of hormonal implants has gained positive traction in family planning programs in recent times. Compared to other popular methods, such as long-term reversible intrauterine devices, the use of hormonal implants as a family planning method has distinct advantages in terms of long-term efficiency and better user compliance and availability. This paper presents a study protocol to document and evaluate the efficacy, safety, and acceptability of Femplant (contraceptive implant in Pakistan during the first year of its use among married women of reproductive age (18–44 years at clinics in two provinces of Pakistan (Sindh and Punjab. Materials and methods: A total of 724 married women were enrolled in a noncomparative prospective observational study. The study involved six government clinics from the Population Welfare Department in Sindh Province and 13 clinics run by the Marie Stopes Society (a local nongovernmental organization in both provinces. The participation of women was subject to voluntary acceptance and medical eligibility. All respondents were interviewed at baseline and subsequently at each scheduled visit during the study period. Side effects, complications and adverse events, if any, were recorded for every participant at each visit to the facility. Discussion: Over the next 5-year period (2013–2018, 27 million hormonal implants will be made available in lower- to middle-income countries by international donors and agencies. The evidence generated from this study will identify factors affecting the acceptability and satisfaction of end

  13. Impact of therapeutic drug monitoring of antiretroviral drugs in routine clinical management of patients infected with human immunodeficiency virus and related health care costs: a real-life study in a large cohort of patients

    Science.gov (United States)

    Perrone, Valentina; Cattaneo, Dario; Radice, Sonia; Sangiorgi, Diego; Federici, Augusto B; Gismondo, Maria Rita; Medaglia, Massimo; Micheli, Valeria; Vimercati, Stefania; Pallone, Enza; Esposti, Luca Degli; Clementi, Emilio

    2014-01-01

    Background Highly active antiretroviral therapy (HAART) has reduced morbidity and mortality in patients infected with human immunodeficiency virus (HIV). Studies have documented high interindividual variability in the pharmacokinetics of antiretroviral drugs, which may impair the success of HAART if not managed properly. Therapeutic drug monitoring (TDM) is a useful diagnostic tool that helps clinicians to optimize drug doses so that drug concentrations associated with the highest therapeutic efficacy are obtained with a reduced risk of concentration-dependent adverse effects. The aim of this study was to assess whether use of TDM improves clinical outcomes and cost of illness. Methods A retrospective cohort study was conducted at L Sacco University Hospital in Milan, Italy, in HIV-infected patients aged ≥18 years with at least one prescription of antiretroviral drugs for which TDM was applied. The inclusion period was from January 2010 to December 2011, with a follow-up period of up to 12 months. Laboratory and administrative databases were analyzed and matched with each other. Results The cohort consisted of 5,347 patients (3,861 males and 1,486 females) of mean age 43.9±12.5 years. We found that TDM had been used in 143 of these patients, among whom adherence with therapy was significantly higher than among those in whom TDM had not been used (94% versus 78%). In TDM-controlled patients, the mean length of HIV-related hospitalization stay and mean cost of hospitalization were significantly reduced with respect to those observed in the group in which TDM had not been used (7.21 days versus 29.47 days and €293 versus €688, respectively). Conclusion Inclusion of TDM as part of routine clinical optimization of drug dosing in HIV-infected patients is associated with higher adherence to therapy, reduced length of hospitalization stay, and reduced cost of illness. PMID:25053888

  14. Clinical experience with insulin detemir, biphasic insulin aspart and insulin aspart in people with type 2 diabetes: Results from the Qatar cohort of the A 1 chieve study

    Directory of Open Access Journals (Sweden)

    Mohamed Hasan Daghash

    2013-01-01

    Full Text Available Background: The A 1 chieve, a multicentric (28 countries, 24-week, non-interventional study evaluated the safety and effectiveness of insulin detemir, biphasic insulin aspart and insulin aspart in people with T2DM (n = 66,726 in routine clinical care across four continents. Materials and Methods: Data was collected at baseline, at 12 weeks and at 24 weeks. This short communication presents the results for patients enrolled from Qatar. Results: A total of 91 patients were enrolled in the study. Two insulin analogue regimens were used in the study. Study patients had started on or were switched to biphasic insulin aspart (n = 88, insulin detemir (n = 2, and other insulin combinations (n = 1. At baseline glycaemic control was poor for both insulin naïve (mean HbA 1 c: 10.9% and insulin users (mean HbA 1 c: 9.1% groups. After 24 weeks of treatment, all the study groups showed improvement in HbA 1 c (insulin naïve: −1.8%, insulin users: −1.3%. Major hypoglycaemia did not occur in the study patients. SADRs were reported in 1.4% of insulin users. Conclusion: Starting or switching to insulin analogues was associated with improvement in glycaemic control with a low rate of hypoglycaemia.

  15. Cohort Profile : LifeLines, a three-generation cohort study and biobank

    NARCIS (Netherlands)

    Scholtens, Salome; Smidt, Nynke; Swertz, Morris A.; Bakker, Stephan J. L.; Dotinga, Aafje; Vonk, Judith M.; van Dijk, Freerk; van Zon, Sander K. R.; Wijmenga, Cisca; Wolffenbuttel, Bruce H. R.; Stolk, Ronald P.

    2015-01-01

    The LifeLines Cohort Study is a large population-based cohort study and biobank that was established as a resource for research on complex interactions between environmental, phenotypic and genomic factors in the development of chronic diseases and healthy ageing. Between 2006 and 2013, inhabitants

  16. Using semantic web technologies for cohort identification from electronic health records for clinical research.

    Science.gov (United States)

    Pathak, Jyotishman; Kiefer, Richard C; Chute, Christopher G

    2012-01-01

    The ability to conduct genome-wide association studies (GWAS) has enabled new exploration of how genetic variations contribute to health and disease etiology. One of the key requirements to perform GWAS is the identification of subject cohorts with accurate classification of disease phenotypes. In this work, we study how emerging Semantic Web technologies can be applied in conjunction with clinical data stored in electronic health records (EHRs) to accurately identify subjects with specific diseases for inclusion in cohort studies. In particular, we demonstrate the role of using Resource Description Framework (RDF) for representing EHR data and enabling federated querying and inferencing via standardized Web protocols for identifying subjects with Diabetes Mellitus. Our study highlights the potential of using Web-scale data federation approaches to execute complex queries. PMID:22779040

  17. Clinical experience with insulin detemir, biphasic insulin aspart and insulin aspart in people with type 2 diabetes: Results from the Kolkata cohort of the A 1 chieve study

    Directory of Open Access Journals (Sweden)

    Anirban Majumder

    2013-01-01

    Full Text Available Background: The A 1 chieve, a multicentric (28 countries, 24-week, non-interventional study evaluated the safety and effectiveness of insulin detemir, biphasic insulin aspart and insulin aspart in people with T2DM (n = 66,726 in routine clinical care across four continents. Materials and Methods: Data was collected at baseline, at 12 weeks and at 24 weeks. This short communication presents the results for patients enrolled from Kolkata, India. Results: A total of 576 patients were enrolled in the study. Four different insulin analogue regimens were used in the study. Patients had started on or were switched to biphasic insulin aspart (n = 417, insulin detemir (n = 70, insulin aspart (n = 55, basal insulin plus insulin aspart (n = 19 and other insulin combinations (n = 15. At baseline, glycaemic control was poor for both insulin naïve (mean HbA 1 c: 8.3% and insulin user (mean HbA 1 c: 8.6% groups. After 24 weeks of treatment, both the groups showed improvement in HbA 1 c (insulin naïve: −1.3%, insulin users: −1.4%. SADRs including major hypoglycaemic events or episodes did not occur in any of the study patients. Conclusion: Starting or switching to insulin analogues was associated with improvement in glycaemic control with a low rate of hypoglycaemia.

  18. Valid comparisons and decisions based on clinical registers and population based cohort studies: assessing the accuracy, completeness and epidemiological relevance of a breast cancer query database

    Directory of Open Access Journals (Sweden)

    Jacke Christian Olaf

    2012-12-01

    Full Text Available Abstract Background Data accuracy and completeness are crucial for ensuring both the correctness and epidemiological relevance of a given data set. In this study we evaluated a clinical register in the administrative district of Marburg-Biedenkopf, Germany, for these criteria. Methods The register contained data gathered from a comprehensive integrated breast-cancer network from three hospitals that treated all included incident cases of malignant breast cancer in two distinct time periods from 1996–97 (N=389 and 2003–04 (N=488. To assess the accuracy of this data, we compared distributions of risk, prognostic, and predictive factors with distributions from established secondary databases to detect any deviations from these “true” population parameters. To evaluate data completeness, we calculated epidemiological standard measures as well as incidence-mortality-ratios (IMRs. Results In total, 12% (13 of 109 of the variables exhibited inaccuracies: 9% (5 out of 56 in 1996–97 and 15% (8 out of 53 in 2003–04. In contrast to raw, unstandardized incidence rates, (in- directly age-standardized incidence rates showed no systematic deviations. Our final completeness estimates were IMR=36% (1996–97 and IMR=43% (2003–04. Conclusion Overall, the register contained accurate, complete, and correct data. Regional differences accounted for detected inaccuracies. Demographic shifts occurred. Age-standardized measures indicate an acceptable degree of completeness. The IMR method of measuring completeness was inappropriate for incidence-based data registers. For the rising number of population-based health-care networks, further methodological advancements are necessary. Correct and epidemiologically relevant data are crucial for clinical and health-policy decision-making.

  19. Cohort study of atypical pressure ulcers development.

    Science.gov (United States)

    Jaul, Efraim

    2014-12-01

    Atypical pressure ulcers (APU) are distinguished from common pressure ulcers (PU) with both unusual location and different aetiology. The occurrence and attempts to characterise APU remain unrecognised. The purpose of this cohort study was to analyse the occurrence of atypical location and the circumstances of the causation, and draw attention to the prevention and treatment by a multidisciplinary team. The cohort study spanned three and a half years totalling 174 patients. The unit incorporates two weekly combined staff meetings. One concentrates on wound assessment with treatment decisions made by the physician and nurse, and the other, a multidisciplinary team reviewing all patients and coordinating treatment. The main finding of this study identified APU occurrence rate of 21% within acquired PU over a three and a half year period. Severe spasticity constituted the largest group in this study and the most difficult to cure wounds, located in medial aspects of knees, elbows and palms. Medical devices caused the second largest occurrence of atypical wounds, located in the nape of the neck, penis and nostrils. Bony deformities were the third recognisable atypical wound group located in shoulder blades and upper spine. These three categories are definable and time observable. APU are important to be recognisable, and can be healed as well as being prevented. The prominent role of the multidisciplinary team is primary in identification, prevention and treatment. PMID:23374746

  20. Indoleamine 2,3-dioxygenase (IDO) is frequently expressed in stromal cells of Hodgkin lymphoma and is associated with adverse clinical features: a retrospective cohort study

    International Nuclear Information System (INIS)

    Regulation of tumor microenvironment is closely involved in the prognosis of Hodgkin lymphoma (HL). Indoleamine 2,3-dioxygenase (IDO) is an enzyme acting as immune modulator through suppression of T-cell immunity. This study aims to investigate role of IDO in the microenvironment of HL. A total of 121 cases of HL were enrolled to do immunohistochemistry for IDO, CD163, CD68, CD4, CD8, and FoxP3. Positivity was evaluated from area fractions or numbers of positive cells using automated image analyzer. Correlations between IDO expression and various cellular infiltrates and clinicopathologic parameters were examined and survival analyses were performed. IDO was expressed in histiocytes, dendritic cells and some endothelial cells with variable degrees, but not in tumor cells. IDO positive cells were more frequently found in mixed cellularity type than other histologic types, and in cases with EBV+, high Ann Arbor stages, B symptoms, and high IPS (all p < 0.05). High IDO expression was associated with inferior survival (p < 0.001) and reflects an independent prognostic factor in nodular sclerosis HL. This is the first study suggesting that IDO is the principle immunomodulator and is involved to adverse clinical outcomes of HL

  1. Repeated vertebral augmentation for new vertebral compression fractures of postvertebral augmentation patients: a nationwide cohort study – how useful is the current clinical gold standard for fracture risk?

    Directory of Open Access Journals (Sweden)

    Wilson HCP

    2015-10-01

    Full Text Available Hannah CP Wilson,1 Paul D Abel,2 S Imran A Shah2 1Department of Post-graduate Students, Imperial College London, Charing Cross Hospital, 2Department of surgery and cancer, Imperial College London, Hammersmith Hospital, London, UKFurther to the recent publication on the “Repeated vertebral augmentation for new vertebral compression fractures of postvertebral augmentation patients: a nationwide cohort study”,1 current data highlight the limitations of dual-energy X-ray absorptiometry scans. In this context, at best, dual-energy X-ray absorptiometry scans (which measure bone mineral density can account for no greater than 50% of overall bone strength (defined as the ability to resist fracture. This is because the resulting images are two-dimensional and therefore unable to capture skeletal micro-architecture, which also contributes to bone strength.2 View original article by Liang et al 

  2. Clinical experience with insulin detemir, biphasic insulin aspart and insulin aspart in people with type 2 diabetes: Results from the Rajasthan cohort of the A 1 chieve study

    Directory of Open Access Journals (Sweden)

    Akhil Joshi

    2013-01-01

    Full Text Available Background: The A 1 chieve, a multicentric (28 countries, 24-week, non-interventional study evaluated the safety and effectiveness of insulin detemir, biphasic insulin aspart and insulin aspart in people with T2DM (n = 66,726 in routine clinical care across four continents. Materials and Methods: Data was collected at baseline, at 12 weeks and at 24 weeks. This short communication presents the results for patients enrolled from Rajasthan, India. Results: A total of 477 patients were enrolled in the study. Four different insulin analogue regimens were used in the study. Patients had started on or were switched to biphasic insulin aspart (n = 340, insulin detemir (n = 90, insulin aspart (n = 37, basal insulin plus insulin aspart (n = 7 and other insulin combinations (n = 2. At baseline glycaemic control was poor for both insulin naïve (mean HbA 1 c: 8.3% and insulin user (mean HbA 1 c: 8.4% groups. After 24 weeks of treatment, both the groups showed improvement in HbA 1 c (insulin naïve: −0.9%, insulin users: −1.2%. Major hypoglycaemic events decreased from 0.5 events/patient-year to 0.0 events/patient-year in insulin naïve group while no change from baseline (1.3 events/patients-year was observed for insulin users. SADRs were not reported in any of the study patients. Conclusion: Starting or switching to insulin analogues was associated with improvement in glycaemic control with a low rate of hypoglycaemia.

  3. Identifying Prognostic SNPs in Clinical Cohorts: Complementing Univariate Analyses by Resampling and Multivariable Modeling

    Science.gov (United States)

    Hieke, Stefanie; Benner, Axel; Schlenk, Richard F.; Schumacher, Martin; Bullinger, Lars; Binder, Harald

    2016-01-01

    Clinical cohorts with time-to-event endpoints are increasingly characterized by measurements of a number of single nucleotide polymorphisms that is by a magnitude larger than the number of measurements typically considered at the gene level. At the same time, the size of clinical cohorts often is still limited, calling for novel analysis strategies for identifying potentially prognostic SNPs that can help to better characterize disease processes. We propose such a strategy, drawing on univariate testing ideas from epidemiological case-controls studies on the one hand, and multivariable regression techniques as developed for gene expression data on the other hand. In particular, we focus on stable selection of a small set of SNPs and corresponding genes for subsequent validation. For univariate analysis, a permutation-based approach is proposed to test at the gene level. We use regularized multivariable regression models for considering all SNPs simultaneously and selecting a small set of potentially important prognostic SNPs. Stability is judged according to resampling inclusion frequencies for both the univariate and the multivariable approach. The overall strategy is illustrated with data from a cohort of acute myeloid leukemia patients and explored in a simulation study. The multivariable approach is seen to automatically focus on a smaller set of SNPs compared to the univariate approach, roughly in line with blocks of correlated SNPs. This more targeted extraction of SNPs results in more stable selection at the SNP as well as at the gene level. Thus, the multivariable regression approach with resampling provides a perspective in the proposed analysis strategy for SNP data in clinical cohorts highlighting what can be added by regularized regression techniques compared to univariate analyses. PMID:27159447

  4. Chinese cohort study of chronic kidney disease: design and methods

    Institute of Scientific and Technical Information of China (English)

    Gao Bixia; Zhang Luxia; Wang Haiyan; Zhao Minghui

    2014-01-01

    Background Chronic kidney disease (CKD) is a common disorder associated with multiple adverse clinical consequences,especially cardiovascular risk and end-stage renal disease.A recent national survey demonstrated that CKD has become a leading health problem in China.There is an urgent need to implement an in-depth investigation of the CKD burden and also to explore underlying mechanisms of CKD progression and it association with adverse consequences.Methods The Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE) is the first national CKD cohort in China.It will enroll approximately 3 000 pre-dialysis CKD patients aged between 18 and 74 years and follow-up for at least 5 years.Questionnaires,anthropometric measures,laboratory tests,and biomaterials will be collected at baseline and annually.The principal clinical outcomes of the C-STRIDE consist of renal disease events,cardiovascular events,and death.Based on the longitudinal clinical data and biomaterials,the risk factors with CKD progression and other outcomes will be analyzed,and candidate markers and predicted models will be established.Conclusion The C-STRIDE would provide important evidence for underlying mechanisms of CKD progression,valuable information for clinical guidelines,and healthcare policies in China.

  5. Systematic evaluation of the clinical effects of supportive mistletoe treatment within chemo- and/or radiotherapy protocols and long-term mistletoe application in nonmetastatic colorectal carcinoma: multicenter, controlled, observational cohort study.

    Science.gov (United States)

    Friedel, Walter E; Matthes, Harald; Bock, Paul R; Zänker, Kurt S

    2009-01-01

    In Europe, patients with colorectal carcinoma (CRC) frequently receive mistletoe extracts to improve quality of life and survival. This study was designed to evaluate supportive treatment with mistletoe extract Iscador (ISC) in nonmetastatic CRC patients under routine clinical conditions and to create well-founded hypotheses for future prospective clinical studies. The design of a multicenter, controlled, retrospective, observational cohort study with parallel groups met the Good Epidemiological Practice rules. Anonymous unselected standardized data from eligible patients with surgically treated stage I-III CRC and adjuvant therapy (AT) or conventional aftercare were included. End points were adjuvant therapy-related adverse reactions (AT-ADRs), symptoms, and disease-free survival (DFS). The results were adjusted for confounder effects. Eight hundred four (429 ISC vs 375 control) CRC patients from 26 centers were observed for a median of 58 versus 51 months; the median ISC therapy lasted 52 months. ISC patients showed fewer AT-ADRs (19% vs 48%, p controls. ISC was well tolerated without life-threatening ADRs, drug interactions, or tumor enhancement. These results suggest a beneficial effect of supportive care ISC therapy within AT protocols and long-term ISC treatment in stage I-III CRC patients, particularly improvement in AT-ADRs and symptoms and possible extension of DFS. PMID:19883529

  6. Clinical characteristics and consequences of hand eczema - an 8-year follow-up study of a population-based twin cohort

    DEFF Research Database (Denmark)

    Lerbaek, Anne; Kyvik, Kirsten Ohm; Ravn, Henrik;

    2008-01-01

    affected. Mean hand eczema severity index score in individuals with clinical symptoms was 12.0. Sick leave was reported by 12.4%; job change by 8.5%. Being in the lowest socio-economic group and atopic dermatitis were risk factors for sick leave [odds ratio (OR) = 5.6; 95% confidence interval (95% CI) 1...

  7. Determinants of HbA1c in nondiabetic Dutch adults : genetic loci and clinical and lifestyle parameters, and their interactions in the lifelines cohort study

    NARCIS (Netherlands)

    Jansen, Hanneke; Stolk, R.P.; Nolte, I.M.; Kema, I.P.; Wolffenbuttel, B.H.; Snieder, H.

    2013-01-01

    Jansen H, Stolk RP, Nolte IM, IP Kema, Wolffenbuttel BHR, Snieder H (University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands). Determinants of HbA1c in nondiabetic Dutch adults: genetic loci and clinical and lifestyle parameters, and their interactions in the LifeLin

  8. Cognitive and clinical characteristics of patients with amyotrophic lateral sclerosis carrying a C9orf72 repeat expansion: a population-based cohort study.

    LENUS (Irish Health Repository)

    Byrne, Susan

    2012-03-01

    Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease of upper and lower motor neurons, associated with frontotemporal dementia (FTD) in about 14% of incident cases. We assessed the frequency of the recently identified C9orf72 repeat expansion in familial and apparently sporadic cases of ALS and characterised the cognitive and clinical phenotype of patients with this expansion.

  9. Implementation and effect of intensified case finding on diagnosis of tuberculosis in a large urban HIV clinic in Uganda: a retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Hermans Sabine

    2012-08-01

    Full Text Available Abstract Background Increased detection of tuberculosis (TB using intensified or active case finding (ICF is one of the cornerstones of the Stop TB Strategy, and contrasts with passive case finding (PCF which relies on self-reported symptoms. There is no clear guidance on implementation strategies. We implemented ICF in addition to ongoing PCF in our large urban HIV clinic in July 2010 using a twice-daily announcement screen method by a trained peer educator, asking waiting patients to self-refer to a trained peer supporter for screening of TB symptoms. We sought to determine the associated effect on TB case detection. Methods Suspects were investigated by sputum smear, chest X-ray and ultrasound, if indicated. Routinely collected clinical and laboratory data were merged with the ICF register and TB clinic data for patients attending the clinic in 2010. We compared the yield of TB cases (defined as the prevalence of newly diagnosed TB cases in the screened population, the type of TB diagnosed and the total cost per TB case identified (in United States Dollars [USD] for the period before and after ICF implementation. Results Of the 20,456 patients who visited the clinic in 2010, 614 were identified as TB suspects, 220 pre-ICF and 394 post-ICF (229 via PCF and 165 via ICF. The proportion diagnosed with TB dropped from 66% to 48% (60% in suspects identified through PCF and 31% through ICF. During the post-ICF period, TB suspects identified through ICF compared to PCF identification were more likely to be female, older, on ART and to have been enrolled in HIV care for a longer duration. The yield of combined PCF and ICF screening was 1.4% pre-ICF and 1.7% post-ICF with a cost per TB case identified of 12.29 USD and 21.80 USD, respectively. Conclusions Implementation of ICF in a large HIV clinic yielded more TB suspects and cases, but substantially increased costs and was unable to capture the majority of TB suspects who were referred for diagnosis

  10. Cohort profile: the Spanish WORKing life Social Security (WORKss) cohort study

    Science.gov (United States)

    López Gómez, María Andrée; Durán, Xavier; Zaballa, Elena; Sanchez-Niubo, Albert; Delclos, George L; Benavides, Fernando G

    2016-01-01

    Purpose The global economy is changing the labour market and social protection systems in Europe. The effect of both changes on health needs to be monitored in view of an ageing population and the resulting increase in prevalence of chronic health conditions. The Spanish WORKing life Social Security (WORKss) cohort study provides unique longitudinal data to study the impact of labour trajectories and employment conditions on health, in terms of sickness absence, permanent disability and death. Participants The WORKss cohort originated from the Continuous Working Life Sample (CWLS) generated by the General Directorate for the Organization of the Social Security in Spain. The CWLS contains a 4% representative sample of all individuals in contact with the Social Security system. The WORKss cohort exclusively includes individuals with a labour trajectory from 1981 or later. In 2004, the cohort was initiated with 1 022 779 Social Security members: 840 770 (82.2%) contributors and 182 009 (17.8%) beneficiaries aged 16 and older. Findings to date The WORKss cohort includes demographic characteristics, chronological data about employment history, retirement, permanent disability and death. These data make possible the measurement of incidence of permanent disability, the number of potential years of working life lost, and the number of contracts and inactive periods with the Social Security system. The WORKss cohort was linked to temporary sickness absence registries to study medical diagnoses that lead to permanent disability and consequently to an earlier exit from the labour market in unhealthy conditions. Future plans Thanks to its administrative source, the WORKss cohort study will continue follow-up in the coming years, keeping the representativeness of the Spanish population affiliated to the Social Security system. The linkage between the WORKss cohort and temporary sickness absence registries is envisioned to continue. Future plans include the linkage of

  11. A Clinical Scoring Algorithm for Determination of the Risk of Tuberculosis in HIV-Infected Adults: A Cohort Study Performed at Ethiopian Health Centers

    OpenAIRE

    Balcha, T. T.; Skogmar, S.; Sturegård, E.; Schön, T.; Winqvist, N.; Reepalu, A.; Jemal, Z. H.; Tibesso, G.; Björk, J; Björkman, P.

    2014-01-01

    Background  The World Health Organization (WHO) tuberculosis (TB) symptom screening instrument (WHO-TB) can identify human immunodeficiency virus (HIV)-infected individuals at low risk of tuberculosis (TB); however, many patients report WHO-TB symptoms and require further TB investigations. We hypothesized that further clinical scoring could classify subjects with a positive WHO-TB screening result (WHO-TB+) for the likelihood of TB. Methods  HIV-infected adults eligible to initiate antiretro...

  12. Prevention and control of surgical site infections: review of the Basel Cohort Study

    OpenAIRE

    Junker, Till; Mujagic, Edin; Hoffmann, Henry; Rosenthal, Rachel; Misteli, Heidi; Zwahlen, Marcel; Oertli, Daniel; Tschudin-Sutter, Sarah; Widmer, Andreas F; Marti, Walter R; Weber, Walter P

    2012-01-01

    INTRODUCTION: Surgical site infections (SSI) are the most common hospital-acquired infections among surgical patients, with significant impact on patient morbidity and health care costs. The Basel SSI Cohort Study was performed to evaluate risk factors and validate current preventive measures for SSI. The objective of the present article was to review the main results of this study and its implications for clinical practice and future research. SUMMARY OF METHODS OF THE BASEL SSI COHORT STUDY...

  13. Cohort Profile: Golestan Hepatitis B Cohort Study- A Prospective Long Term Study in Northern Iran ​

    OpenAIRE

    Poustchi, Hossein; Katoonizadeh, Aezam; Ostovaneh, Mohammad Reza; Moossavi, Shirin; Sharafkhah, Maryam; Esmaili, Saeed; Pourshams, Akram; Mohamadkhani, Ashraf; Besharat, Sima; Merat, Shahin; Mohamadnejad, Mehdi; George, Jacob; Malekzadeh, Reza

    2014-01-01

    Hepatitis B virus (HBV) infection is the most common cause of end stage liver disease in Iran and in Golestan province. Large-scale population-based prospective cohort studies with long term follow-up are the method of choice to accurately understand the natural course of HBV infection. To date, several studies of HBV epidemiology, natural history, progression to cirrhosis and association with HCC have been reported from other countries. However, few of these are prospective and fewer still a...

  14. A retrospective cohort study on combined modality therapy with or without surgery for clinical stage I and II small cell lung cancer

    International Nuclear Information System (INIS)

    Objective: To evaluate the treatment effects of surgery plus chemotherapy (± radio- therapy) compared with combined chemotherapy and radiotherapy for clinical staged I and II small cell lung cancer (SCLC). Methods: Out of 358 patients with limited small cell lung cancer, proved cyto-pathologicaily, 89 patients with clinical stage I or II disease made up the material of this paper. Fifty-five patients received surgery and adjuvant chemotherapy with or without radiotherapy ( surgery group). Thirty-four patients were treated by non-surgery method: ie combined chemotherapy and radiotherapy (non-surgery group). The chemotherapy regimen included PE (or CE), CAP or CAV for 4-6 cycles. Irradiation treatment covering the primary tumor, the ipsilateral hilar nodes and mediastinum was delivered once-daily with 6 megavoltage X-ray beam to a median irradiation dose of 58 Gy (56-60 Gy) was given in 5-6 weeks. Results: The overall median survival time (MST) was 48 months. The 1-, 2-, 3-, and 5-year overall survival rates were 95%, 71%, 57%, and 48%. In the surgery group, the median survival time (MST) was 50 months. The 1-, 2-, 3-, and 5-year survival rates were 96%, 70%, 58%, and 52%. Failure in the surgical group included local recurrence (4%), distant metastasis (31%), both local and distant failure (9%), and brain metastasis (18%). In the non-surgery group, the MST was 40 months. The 1-, 2-, 3-, and 5-year survival rates were 94%, 74%, 55%, and 40%. Failure included local recurrence (12%), distant metastasis (44%), both local and distant failure (6%), and brain metastasis (29%). There was no significant difference in the overall survival rates between the two groups (χ2=0.70, P=0.404). Cox regression analysis showed that brain metastasis was an influential factor of prognosis (P=0.001 ). Conclusions: For clinical stage I and II SCLC, both surgery plus chemotherapy (or radiotherapy) or combined chemotherapy and radiotgherapy without surgery could achieve a satisfactory

  15. Are there long-term benefits of experiential, interprofessional education for non-specialists on clinical behaviours and outcomes in diabetes care? A cohort study

    Science.gov (United States)

    Ching, Daniel; Forte, Denise; Aitchison, Elizabeth; Earle, Kenneth

    2016-01-01

    Objectives Our aim was to assess the impact of an educational initiative for non-specialist, healthcare professionals in the community on the process and quality measures of diabetes care delivered, and changes in their learning experiences and clinical management behaviour in the short and long term. Setting Single locality of 26 primary care practices associated with one secondary centre. Participants General practitioners and practice nurses managing 4167 patients with diabetes. Intervention A rolling 10-week, experiential, interprofessional education programme delivered to 57 practitioners and observations in practice. Primary and secondary outcome measures Primary outcomes were changes in the proportion of patients receiving foot care, urine albumin:creatinine ratio assessments and achieving National Quality Outcome Framework targets for blood pressure (86 mmol/mol (10%) and 85 mmol/mol (10%) was significantly higher (44% vs 53% p=0.0001) and lower (12.5% vs 10%; p=0.002) respectively. There was an increase in the proportion (95% CI) of patients receiving foot care reviews (+26.0% (24.0% to 28.1%)), microalbuminuria screening (+29.8% (27.7% to 31.9%)) and who achieved targets for blood pressure (+9.6% (7.5% to 11.6%)) and total cholesterol (+14.4% (12.3% to 16.5%); p<0.001). 241 fewer patients were referred to secondary care. Increases in the healthcare professional's confidence and collaborative clinical behaviour were evident 3 years after completing the programme. Conclusions An experiential, interprofessional intervention can result in significant improvements in quality outcomes in association with a sustained impact on behaviours and practices. PMID:26747032

  16. Prospective validation of a risk calculator which calculates the probability of a positive prostate biopsy in a contemporary clinical cohort

    NARCIS (Netherlands)

    van Vugt, Heidi A.; Kranse, Ries; Steyerberg, Ewout W.; van der Poel, Henk G.; Busstra, Martijn; Kil, Paul; Oomens, Eric H.; de Jong, Igle J.; Bangma, Chris H.; Roobol, Monique J.

    2012-01-01

    Background: Prediction models need validation to assess their value outside the development setting. Objective: To assess the external validity of the European Randomised study of Screening for Prostate Cancer (ERSPC) Risk Calculator (RC) in a contemporary clinical cohort. Methods: The RC calculates

  17. Cohort profile: the Young Lives study.

    Science.gov (United States)

    Barnett, Inka; Ariana, Proochista; Petrou, Stavros; Penny, Mary E; Duc, Le Thuc; Galab, S; Woldehanna, Tassew; Escobal, Javier A; Plugge, Emma; Boyden, Jo

    2013-06-01

    Young Lives is an international longitudinal study investigating the changing nature of childhood poverty in four low-income countries [Ethiopia, India (Andhra Pradesh), Peru and Vietnam] over a 15-year period. In each country, the cohort is comprised of ≈ 2000 children aged between 6 and 18 months and up to 1000 children aged between 7 and 8 years, recruited in 2002 and sampled from 20 sentinel sites. The first survey data collection from primary caregivers and older children took place in 2002, the second in 2006-07 and the third in 2009-10. Data on the community contexts were collected to complement the household surveys. To elaborate and extend the quantitative data, longitudinal qualitative research with a subgroup of the children was carried out in 2007, 2008 and 2010-11. Topic areas covered included nutrition, health and well-being, cognitive and physical development, health behaviours and education, as well as the social, demographic and economic status of the household. Survey data from the study are archived in the International Section of the UK Public Data Archive. PMID:22617687

  18. Vitamin D status and TB treatment outcomes in adult patients in Tanzania: a cohort study

    OpenAIRE

    Mehta, Saurabh; Mugusi, Ferdinand M.; Bosch, Ronald J.; Aboud, Said; Urassa, Willy; Villamor, Eduardo; Fawzi, Wafaie W.

    2013-01-01

    Objectives: Vitamin D is an immunomodulator and can alter response to tuberculosis (TB) treatment, though randomised trials have been inconclusive to date. We present one of the first comprehensive analysis of the associations between vitamin D status and TB treatment, T-cell counts and nutritional outcomes by HIV status. Design: Cohort study. Setting: Outpatient clinics in Tanzania. Participants: 25-hydroxyvitamin D levels were assessed in a cohort of 677 patients with TB (344 HIV infected) ...

  19. Clinical outcomes and costs for people with complex psychosis; a naturalistic prospective cohort study of mental health rehabilitation service users in England

    OpenAIRE

    Killaspy, Helen; Marston, Louise; Green, Nicholas; Harrison, Isobel; Lean, Melanie; Holloway, F.; Jamieson-Craig, Thomas Kern; Leavey, G.; Arbuthnott, Maurice; Koeser, Leonardo Alberto; McCrone, Paul Richard; Omar, Rumana; King, Michael

    2016-01-01

    BackgroundMental health rehabilitation services in England focus on people with complex psychosis. This group tend to have lengthy hospital admissions due to the severity of their problems and, despite representing only 10–20 % of all those with psychosis, they absorb 25–50 % of the total mental health budget. Few studies have investigated the effectiveness of these services and there is little evidence available to guide clinicians working in this area. As part of a programme of research int...

  20. Clinical heterogeneity and a high proportion of novel mutations in a Chinese cohort of patients with dysferlinopathy

    OpenAIRE

    Jianying Xi; Gaelle Blandin; Jiahong Lu; Sushan Luo; Wenhua Zhu; Christophe Beroud; Christophe Pecheux; Veronique Labelle; Nicolas Levy; Jon Andoni Urtizberea; Chongbo Zhao; Martin Krahn

    2014-01-01

    Background and Aims: Dysferlinopathies are a group of autosomal recessive muscular dystrophies caused by mutations in the dysferlin gene. This study presents clinical features and the mutational spectrum in the largest cohort of Chinese patients analyzed to date. Patients and Methods: A total of 36 unrelated Chinese patients with diagnostic suspicion of dysferlinopathy were clinically and genetically characterized. Results: Patients were divided into five phenotypes: 19 patients with limb gir...

  1. Preoperative plasma D-dimer is a predictor of one-year survival in colorectal cancer patients: a prospective clinical cohort study

    DEFF Research Database (Denmark)

    Stender, Mogens; Larsen, Torben Bjerregaard; Frøkjær, J.B.; Sørensen, Henrik Toft; Thorlacius-Ussing, Ole

    cancer and absence of preoperative deep venous thrombosis, we measured the preoperative plasma D-dimer levels and performed compression ultrasonography for deep venous thrombosis prior to surgery, as well as one week, one month, and one year after surgery. RESULTS: The cumulative incidence of deep venous......PURPOSE: The study examined if preoperative plasma D-dimer level was associated with the postoperative cumulative incidence of deep venous thrombosis in patients with colorectal cancer admitted for intended curative surgery. METHODS: In 176 consecutive patients with newly-diagnosed colorectal...... thrombosis up to one year after surgery was 20 percent (95 percent confidence interval, 12 to 31 percent) in the positive D-dimer group compared with 5 percent (95 percent confidence interval, 2 to 12 percent) in the negative D-dimer group. The adjusted hazard ratio of deep venous thrombosis in the positive...

  2. What Drives Teacher Engagement: A Study of Different Age Cohorts

    Science.gov (United States)

    Guglielmi, Dina; Bruni, Ilaria; Simbula, Silvia; Fraccaroli, Franco; Depolo, Marco

    2016-01-01

    Despite the growing body of research on work engagement, little is known about what drives work engagement among different age cohorts. This study aims to investigate whether engagement varies across age cohorts and examines the job resources that foster teacher engagement. A questionnaire was distributed to 537 teachers who were employed in…

  3. Fat distribution and longitudinal anthropometric changes in HIV-infected men with and without clinical evidence of lipodystrophy and HIV-uninfected controls: A substudy of the Multicenter AIDS Cohort Study

    Directory of Open Access Journals (Sweden)

    Palella Frank J

    2009-05-01

    Full Text Available Abstract Background Fat abnormalities are common among HIV-infected persons, but few studies have compared regional body fat distribution, including visceral fat, in HIV-infected and HIV-uninfected persons and their subsequent trajectories in body composition over time. Methods Between 1999 and 2002, 33 men with clinical evidence of lipodystrophy (LIPO+, 23 HIV-infected men without clinical evidence of lipodytrophy (LIPO-, and 33 HIV-uninfected men were recruited from the four sites of the Multicenter AIDS Cohort Study (MACS. Participants underwent dual-energy x-ray absorptiometry, quantitative computerized tomography of the abdomen and thigh, and circumference measurements of the waist, hip and thigh. Circumference measurements at each semi-annual MACS visit between recruitment and 2008 were used to compare average annual anthropometric changes in the 3 groups. Results Body mass index (BMI was lower in LIPO+ men than in the LIPO- men and the HIV- uninfected controls (BMI: 23.6 ± 0.4 vs 26.8 ± 1.5 vs 28.7 ± 0.9 kg/m2, respectively, p 2 compared to the LIPO- men (129 ± 12 cm2, p = 0.03 and the HIV-uninfected group (133 ± 11 cm2, p = 0.07. Subcutaneous adipose tissue (thigh, abdomen and total extremity fat were less in the HIV-infected men (LIPO+ and LIPO- than in the HIV-uninfected men. Over an average of 6 years of follow-up, waist circumference increased at a faster rate in LIPO+ group, compared to the LIPO- men (0.51 cm/year vs 0.08 cm/year, p = 0.02 and HIV-uninfected control men (0.21 cm/year, p = 0.06. The annual changes in hip and thigh circumferences were similar in all three groups Conclusion Subcutaneous lipoatrophy was observed in HIV-infected patients, even those without clinical evidence of lipodystrophy, compared to age-matched HIV-uninfected men. Despite markedly lower BMI, HIV-infected men with lipodystrophy had a similar amount of VAT as HIV-uninfected men and tended to have more rapid increases in waist circumference over 6

  4. Chronic lymphocytic leukemia: a clinical review including Korean cohorts

    Science.gov (United States)

    Jeon, Young-Woo; Cho, Seok-Goo

    2016-01-01

    Only 5th decade ago, chronic lymphocytic leukemia (CLL) was only recognized as disease group of presenting features like peripheral lymphocytosis, organomegaly including of splenomegaly. As understanding of disease biology and molecular diagnostic tools are getting improved gradually, characterization of variation in CLL’s clinical courses was facilitated, resulting in better risk stratification and targeted treatments. Consequently multiple new targeted agents have been used in treatment of CLL, it makes improved clinical outcome. Rituximab containing chemoimmunotherapy (combination of rituximab, fludarabine, and cyclophosphamide) have shown better overall response rate and progression-free survival on fit patients’ group in front-line setting, result in standard first-line therapeutic option for CLL. Furthermore, after introducing that the B-cell receptor is crucial for the evolution and progression of CLL, emerging treatments targeting highly activated surface antigens and oncogenic signaling pathways have been associated with several successes in recent decades. These include new anti-CD 20 monoclonal antibody (obinutuzumab), the bruton tyrosine kinase inhibitor (ibrutinib), the phosphatidylinositol 3-kinase inhibitor (idelalisib), and B-cell CLL/lymphoma 2 inhibitor (ABT-199 and ABT-263). So, we discuss not only general pathophysiology of CLL, but also rapidly advancing treatment strategies that are being studied or approved for treatment of CLL. PMID:27044858

  5. Chronic lymphocytic leukemia: a clinical review including Korean cohorts.

    Science.gov (United States)

    Jeon, Young-Woo; Cho, Seok-Goo

    2016-05-01

    Only 5th decade ago, chronic lymphocytic leukemia (CLL) was only recognized as disease group of presenting features like peripheral lymphocytosis, organomegaly including of splenomegaly. As understanding of disease biology and molecular diagnostic tools are getting improved gradually, characterization of variation in CLL's clinical courses was facilitated, resulting in better risk stratification and targeted treatments. Consequently multiple new targeted agents have been used in treatment of CLL, it makes improved clinical outcome. Rituximab containing chemoimmunotherapy (combination of rituximab, fludarabine, and cyclophosphamide) have shown better overall response rate and progression-free survival on fit patients' group in front-line setting, result in standard first-line therapeutic option for CLL. Furthermore, after introducing that the B-cell receptor is crucial for the evolution and progression of CLL, emerging treatments targeting highly activated surface antigens and oncogenic signaling pathways have been associated with several successes in recent decades. These include new anti-CD 20 monoclonal antibody (obinutuzumab), the bruton tyrosine kinase inhibitor (ibrutinib), the phosphatidylinositol 3-kinase inhibitor (idelalisib), and B-cell CLL/lymphoma 2 inhibitor (ABT-199 and ABT-263). So, we discuss not only general pathophysiology of CLL, but also rapidly advancing treatment strategies that are being studied or approved for treatment of CLL. PMID:27044858

  6. Selective reporting bias of harm outcomes within studies: findings from a cohort of systematic reviews

    Science.gov (United States)

    Saini, Pooja; Loke, Yoon K; Gamble, Carrol; Altman, Douglas G; Williamson, Paula R

    2014-01-01

    Objective To determine the extent and nature of selective non-reporting of harm outcomes in clinical studies that were eligible for inclusion in a cohort of systematic reviews. Design Cohort study of systematic reviews from two databases. Setting Outcome reporting bias in trials for harm outcomes (ORBIT II) in systematic reviews from the Cochrane Library and a separate cohort of systematic reviews of adverse events. Participants 92 systematic reviews of randomised controlled trials and non-randomised studies published in the Cochrane Library between issue 9, 2012 and issue 2, 2013 (Cochrane cohort) and 230 systematic reviews published between 1 January 2007 and 31 December 2011 in other publications, synthesising data on harm outcomes (adverse event cohort). Methods A 13 point classification system for missing outcome data on harm was developed and applied to the studies. Results 86% (79/92) of reviews in the Cochrane cohort did not include full data from the main harm outcome of interest of each review for all of the eligible studies included within that review; 76% (173/230) for the adverse event cohort. Overall, the single primary harm outcome was inadequately reported in 76% (705/931) of the studies included in the 92 reviews from the Cochrane cohort and not reported in 47% (4159/8837) of the 230 reviews in the adverse event cohort. In a sample of primary studies not reporting on the single primary harm outcome in the review, scrutiny of the study publication revealed that outcome reporting bias was suspected in nearly two thirds (63%, 248/393). Conclusions The number of reviews suspected of outcome reporting bias as a result of missing or partially reported harm related outcomes from at least one eligible study is high. The declaration of important harms and the quality of the reporting of harm outcomes must be improved in both primary studies and systematic reviews. PMID:25416499

  7. Familial aggregation of hypospadias: a cohort study

    DEFF Research Database (Denmark)

    Schnack, Tine H; Zdravkovic, Slobodan; Myrup, Charlotte;

    2008-01-01

    hypospadias in a cohort of 1,201,790 boys born in 1973-2005. Using binomial log-linear regression, they estimated recurrence risk ratios of hypospadias for male twin pairs and first-, second-, and third-degree relatives of a hypospadias case, which were 50.8 (95% confidence interval [CI]: 34.2, 75.5), 11...

  8. Late diagnosis among our ageing HIV population: a cohort study

    Directory of Open Access Journals (Sweden)

    Sarah Mensforth

    2014-11-01

    Full Text Available Introduction: With the advent of combined antiretroviral therapy (cART, more people infected with HIV are living into older age; 22% of adults receiving care in the UK are aged over 50 years [1]. Age influences HIV infection; the likelihood of seroconversion illness, mean CD4 count and time from infection to development of AIDs defining illnesses decreases with increasing age. A UK study estimates that half of HIV infections in persons over 50 years are acquired at an age over 50 [2]. Studies exploring sexual practices in older persons have repeatedly shown that we cannot assume there is no risk of STI and HIV infection [3,4]. Physicians should be alert to risk of HIV even in the older cohort, where nearly half diagnoses are made late [2]. Local audit has demonstrated poor testing rates in the over 50's on the Acute Medical Unit. Late diagnosis (CD4<350 results in poorer outcomes and age confounds further; older late presenters are 2.4 times more likely to die within the first year of diagnosis than younger counterparts [2]. Materials and Methods: A retrospective case notes review was conducted of all patients aged 60 years and over attending HIV clinic in the last 2 years. Outcomes audited included features around diagnosis; age, presentation, missed testing opportunities and CD4 count at diagnosis. Results: Of the current cohort of 442 patients, 34 were over 60 years old (8%. Age at diagnosis in this group ranged from 36 to 80 years, mean 56.6 years. Presentation triggers included opportunistic infections or malignancies (n=10, constitutional symptoms (n=6, diagnosis of another STI (n=4, seroconversion illness (n=2, partner status (n=3. Eight patients were diagnosed through asymptomatic screening at Sexual Health. We identified missed opportunities in five patients who were not tested despite diagnoses or symptoms defined as clinical indicators for HIV. Half of older patients had a CD4 count of <200 at diagnosis. Conclusions: It is imperative

  9. perinatal depression in a cohort study of Iranian women

    Directory of Open Access Journals (Sweden)

    Gholam Reza Kheirabadi

    2010-01-01

    Full Text Available Introduction: Childbearing years in the women’s life are associated with the highest risk of depression. Despite the results of some studies that suggested, depression during pregnancy has been associated with poor prenatal care, substance abuse, low birth weight, and preterm delivery and introduced antenatal depression and anxiety as predictors of postnatal depression, researches during past 25 years have focused mostly on postpartum depression so depression during pregnancy is relatively neglected. Materials and methods: We studied depression during third trimester of pregnancy and after delivery, using prospectively gathered data from a cohort of 1898 women. We compared depressive symptom score and the proportion of mothers above a threshold, to indicate probable depressive disorder at each stage. Results: Point prevalence of depressed pregnant women (clinical depression based on BDI score greater than 20 in last trimester of pregnancy, was 22.8% and postnatal rate of depression based on EPD score greater than 12 between 6 to 8 weeks after delivery, was 26.3%. Incidence of PPD in 6 to 8 weeks after delivery in those who were not clinically depressed during pregnancy was, 20.1%. Discussion: We found that history of depression, unplanned pregnancy; being housewife and having 3 or more children were variables with significant relation to ante partum depression. Two main risk factors for post partum depression in this cohort study, were previous history of depression and depression during current pregnancy that highlight the importance of these two variables assessment during pregnancy in order to facilitate timely identification of women at risk.

  10. Exposure Assessment in Cohort Studies of Childhood Asthma

    OpenAIRE

    Arrandale, Victoria H.; Brauer, Michael; Brook, Jeffrey R.; Brunekreef, Bert; Gold, Diane R.; London, Stephanie J.; Miller, J. David; Özkaynak, Halûk; Ries, Nola M.; Sears, Malcolm R; Silverman, Frances S.; Takaro, Tim K

    2010-01-01

    Background The environment is suspected to play an important role in the development of childhood asthma. Cohort studies are a powerful observational design for studying exposure–response relationships, but their power depends in part upon the accuracy of the exposure assessment. Objective The purpose of this paper is to summarize and discuss issues that make accurate exposure assessment a challenge and to suggest strategies for improving exposure assessment in longitudinal cohort studies of ...

  11. European birth cohort studies on asthma and atopic diseases

    DEFF Research Database (Denmark)

    Keil, T; Kulig, M; Simpson, A;

    2006-01-01

    BACKGROUND: The reasons for the rise in asthma and allergies remain unclear. To identify risk or protective factors, it is essential to carry out longitudinal epidemiological studies, preferably birth cohort studies. In Europe, several birth cohort studies on asthma and atopic diseases have been...... initiated over the last two decades. AIM: One of the work packages within the Global Allergy and Asthma European Network (GA(2)LEN) project was designed to identify and compare European birth cohorts on asthma and atopic diseases. The present review (part I) describes their objectives, study settings......, recruitment process and follow-up rates. A subsequent review (part II) will compare outcome and exposure parameters. METHODS: For each birth cohort, we collected detailed information regarding recruitment process, study setting, baseline data (pregnancy, birth, parents/siblings) as well as follow-up rates...

  12. Susceptibility to deterioration of mobility long-term after stroke: a prospective cohort study.

    NARCIS (Netherlands)

    Port, I.G. van de; Kwakkel, G.; Wijk, I. van; Lindeman, E.

    2006-01-01

    BACKGROUND AND PURPOSE: The aim of the present study was to identify clinical determinants able to predict which individuals are susceptible to deterioration of mobility from 1 to 3 years after stroke. METHODS: Prospective cohort study of stroke patients consecutively admitted for inpatient rehabili

  13. Aragon workers’ health study – design and cohort description

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    Casasnovas José A

    2012-06-01

    Full Text Available Abstract Background Spain, a Mediterranean country with relatively low rates of coronary heart disease, has a high prevalence of traditional cardiovascular risk factors and is experiencing a severe epidemic of overweight/obesity. We designed the Aragon Workers’ Health Study (AWHS to characterize the factors associated with metabolic abnormalities and subclinical atherosclerosis in a middle aged population in Spain free of clinical cardiovascular disease. The objective of this paper is to describe the study design, aims and baseline characteristics of participants in the AWHS. Methods/Design Longitudinal cohort study based on the annual health exams of 5,400 workers of a car assembly plant in Figueruelas (Zaragoza, Spain. Study participants were recruited during a standardized clinical exam in 2009–2010 (participation rate 95.6%. Study participants will undergo annual clinical exams and laboratory assays, and baseline and triennial collection of biological materials for biobanking and cardiovascular imaging exams (carotid, femoral and abdominal ultrasonography, coronary calcium score, and ankle-arm blood pressure index. Participants will be followed-up for 10 years. Results The average (SD age, body mass index, and waist circumference were 49.3 (8.7 years, 27.7 (3.6 kg/m2 and 97.2 (9.9 cm, respectively, among males (N = 5,048, and 40.8 (11.6 years, 24.4 (3.8 kg/m2, and 81.9 (9.9 cm, among females (N = 351. The prevalence of overweight, obesity, current smoking, hypertension, hypercholesterolemia, and diabetes were 55.0, 23.1, 37.1, 40.3, 75.0, and 7.4%, respectively, among males, and 23.7, 8.3, 45.0, 12.1, 59.5, and 0.6%, respectively, among females. In the initial 587 study participants who completed all imaging exams (94.5% male, the prevalence of carotid plaque, femoral plaque, coronary calcium score >1 to 100, and coronary calcium score >100 was 30.3, 56.9, 27.0, and 8.8%, respectively. 67.7% of study participants had at least

  14. Does Low Participation in Cohort Studies Induce Bias?

    DEFF Research Database (Denmark)

    Nøhr, Ellen Aagaard; Frydenberg, Morten; Henriksen, Tine Brink; Olsen, Jørn

    2006-01-01

    confidence intervals gave very similar results and a small simulation study showed that the coverage probabilities were close to the 95% nominal level Conclusion: For the three chosen associations the odds ratios were not biased by non-participation. The results are reassuring for studies based on the Danish...... cohort and similar cohorts of pregnant women. The methodology used to compute confidence intervals for the relative odds ratios performed well in the scenarios considered.......Background: Participation rates in large cohort studies have dropped during the last two decades. The consequences of this trend for relative risk estimation are unknown. Methods: The impact of a low participation rate (30%) on the Danish National Birth Cohort was examined among 49,751 women from...

  15. A clinical and radiological profile of neuromyelitis optica and spectrum disorders in an Indian cohort

    Directory of Open Access Journals (Sweden)

    Kavita Sohan Barhate

    2014-01-01

    Full Text Available Background: There is insufficient data on the clinical and radiological features of neuromyelitis optica (NMO and neuromyelitis optica spectrum disorders (NMOSD from India. Objective: The objective of the following study is to examine the clinico-radiological features of NMO and NMOSD in an Indian cohort. Materials and Methods: This retrospective study included 44 consecutive patients who (1 satisfied the 2006 Wingerchuk criteria for NMO (16 seropositive and 7 seronegative; or (2 had isolated or recurrent optic neuritis (ON with seropositivity (n = 4; or (3 had isolated or recurrent myelitis with seropositivity (n = 17. Results: The female:male ratio was 7.8:1 with median age of onset 26.5 (range 8-72. Annualized relapse rate (ARR was comparable across all groups (F [3, 40] = 0.938 and P = 0.431. Various presentations other than ON and myelitis were noted. All 40 patients with myelitis had spinal cord lesions involving ≥3 vertebral segments during the course of the disease. Cervicomedullary involvement was seen in 32.5% (13/40 patients. Brain magnetic resonance imaging was available for 40 patients; eight of these (20% had brain lesions in locations described in multiple sclerosis (MS, 27.5% (11/40 had lesions at sites unusual for MS and 52.5% (21/40 had normal brain imaging. Conclusion: NMO and NMOSD patients in this cohort have comparable ARR regardless of clinical presentation, supporting the emerging trend of treating all patients with immunotherapeutic agents at an early stage. Varied presentations seen in NMO and NMOSD highlight the need for a high index of suspicion for NMO in demyelinating episodes not classical for MS.

  16. Cohort profile: Lifelines DEEP, a prospective, general population cohort study in the northern Netherlands: study design and baseline characteristics

    OpenAIRE

    Tigchelaar, E.F.; Zhernakova, A; Dekens, J.A.M.; Hermes, G.D.A.; Baranska, A.; Mujagic, Z.; M.A. Swertz; Munoz, A.M.; Deelen, P.; Cenit, M. C.; Franke, L; Scholtens, S.; Stolk, R.P.; Wijmenga, C; Feskens, E.J.M.

    2015-01-01

    Purpose: There is a critical need for population-based prospective cohort studies because they follow individuals before the onset of disease, allowing for studies that can identify biomarkers and disease-modifying effects, and thereby contributing to systems epidemiology. Participants: This paper describes the design and baseline characteristics of an intensively examined subpopulation of the LifeLines cohort in the Netherlands. In this unique subcohort, LifeLines DEEP, we included 1539 part...

  17. Opium use and mortality in Golestan Cohort Study: prospective cohort study of 50 000 adults in Iran

    OpenAIRE

    Khademi, Hooman; Malekzadeh, Reza; Pourshams, Akram; Jafari, Elham; Salahi, Rasool; Semnani, Shahryar; Abaie, Behrooz; Islami, Farhad; Nasseri-Moghaddam, Siavosh; Etemadi, Arash; Byrnes, Graham; Abnet, Christian C.; Dawsey, Sanford M.; Day, Nicholas E; Pharoah, Paul D

    2012-01-01

    Objectives To investigate the association between opium use and subsequent risk of death. Design Prospective cohort study. Setting The Golestan Cohort Study in north-eastern Iran collected detailed validated data on opium use and other exposures at baseline. Participants were enrolled between January 2004 and June 2008 and were followed to May 2011, with a follow-up success rate of over 99%. Participants 50 045 participants aged 40-75 at baseline. Main outcomes Mortality, all cause and major ...

  18. Adverse drug reactions to tocolytic treatment for preterm labour : prospective cohort study

    NARCIS (Netherlands)

    de Heus, R.; Mol, B.W.; Erwich, J.J.H.M.; van Geijn, H.P.; Gyselaers, W.J.; Hanssens, M.; Harmark, L.; van Holsbeke, C.D.; Duvekot, J.J.; Schobben, F.F.A.M.; Wolf, Hans; Visser, G.H.A.

    2009-01-01

    Objective To evaluate the incidence of serious maternal complications after the use of various tocolytic drugs for the treatment of preterm labour in routine clinical situations. Design Prospective cohort study. Setting 28 hospitals in the Netherlands and Belgium. Participants 1920 consecutive women

  19. Adverse drug reactions to tocolytic treatment for preterm labour: prospective cohort study

    NARCIS (Netherlands)

    R. de Heus; B.W. Mol; J.J.H.M. Erwich; H.P. van Geijn; W.J. Gyselaers; M. Hanssens; L. Härmark; C.D. van Holsbeke; J.J. Duvekot; F.F.A.M. Schobben; H. Wolf; G.H.A. Visser

    2009-01-01

    Objective To evaluate the incidence of serious maternal complications after the use of various tocolytic drugs for the treatment of preterm labour in routine clinical situations. Design Prospective cohort study. Setting 28 hospitals in the Netherlands and Belgium. Participants 1920 consecutive women

  20. Adverse drug reactions to tocolytic treatment for preterm labour: prospective cohort study

    NARCIS (Netherlands)

    Heus, R.; Mol, B.W.; Erwich, J.J.; Geijn, van H.; Gyselaers, W.J.; Hanssens, M.; Harmark, L.; Holsbeke, van C.D.; Duvekot, J.J.; Schobben, F.F.; Wolf, de H.; Visser, G.H.A.

    2009-01-01

    OBJECTIVE: To evaluate the incidence of serious maternal complications after the use of various tocolytic drugs for the treatment of preterm labour in routine clinical situations. DESIGN: Prospective cohort study. SETTING: 28 hospitals in the Netherlands and Belgium. PARTICIPANTS: 1920 consecutive w

  1. Cohort profile: the Spanish WORKing life Social Security (WORKss) cohort study

    OpenAIRE

    L??pez G??mez, Mar??a Andr??e; Duran Jord??, Xavier, 1974-; Zaballa, Elena; S??nchez Niub??, Albert; Delclos, George L; Benavides, Fernando G.

    2016-01-01

    PURPOSE: The global economy is changing the labour market and social protection systems in Europe. The effect of both changes on health needs to be monitored in view of an ageing population and the resulting increase in prevalence of chronic health conditions. The Spanish WORKing life Social Security (WORKss) cohort study provides unique longitudinal data to study the impact of labour trajectories and employment conditions on health, in terms of sickness absence, permanent disability and deat...

  2. Use of fertility drugs and risk of ovarian cancer: Danish Population Based Cohort Study

    DEFF Research Database (Denmark)

    Jensen, Allan; Sharif, Heidi; Frederiksen, Kirsten;

    2009-01-01

    OBJECTIVE: To examine the effects of fertility drugs on overall risk of ovarian cancer using data from a large cohort of infertile women. DESIGN: Population based cohort study. SETTING: Danish hospitals and private fertility clinics. PARTICIPANTS: 54,362 women with infertility problems referred to...... confounding factors. RESULTS: Analyses within cohort showed no overall increased risk of ovarian cancer after any use of gonadotrophins (rate ratio 0.83, 95% confidence interval 0.50 to 1.37), clomifene (1.14, 0.79 to 1.64), human chorionic gonadotrophin (0.89, 0.62 to 1.29), or gonadotrophin releasing...... all Danish fertility clinics during 1963-98. The median age at first evaluation of infertility was 30 years (range 16-55 years), and the median age at the end of follow-up was 47 (range 18-81) years. Included in the analysis were 156 women with invasive epithelial ovarian cancer (cases) and 1241...

  3. Epidemiological composition, clinical and treatment characteristics of the patient cohort of the german competence network for HIV/AIDS

    Directory of Open Access Journals (Sweden)

    Jansen K

    2009-09-01

    Full Text Available Abstract Objective As its central basis for research, the Competence Network for HIV/AIDS (KompNet established a nationwide cohort study on HIV-positive patients being in medical care in Germany. In this paper, we describe the epidemiological composition, and clinical as well as treatment characteristics of the KompNet cohort over time. Methods The KompNet cohort is an open, retrospective and prospective, multi-center, disease-specific and nationwide cohort study that started gathering data in June 2004. Semiannually, follow up visits of the patients are documented, covering a wide range of clinical and sociodemographic data. At enrolment and three years afterwards, an EDTA-sample is taken; a serum-sample is taken at every follow up. Results As of 20.10.2008, a total of 15,541 patients were enrolled by 44 documenting sites. In September 2007, the cohort size was reduced to ten outpatient clinics and fifteen private practitioners, covering a total of 9,410 patients. The documentation of these patients comprised 24,117 years of follow up-time since enrolment (mean: 2.6 years, 62,862 person years inclusive data documented retrospectively on course of HIV-infection and antiretroviral therapy (ART, mean: 6.7 years. Due to the short period of recruitment till now, rates of death (0.3%-0.8% and losses to follow up (1.1%-5.5% were low. 84.9% of patients were men. Main risk of transmission was sex between men (MSM: 62.9%. Mean age was 45 years. About two third of patients were classified as CDC-stage B or C. Therapy regimens of currently treated patients complied with recent guidelines. Trends of mean CD4 cell count/μl regarding the initial therapy and concerning the population under treatment reflected the developments and the changing standards of antiretroviral therapy over time. Conclusion The KompNet cohort covers about a quarter of all patients estimated as being under treatment in Germany. Its composition can be accounted approximately

  4. Clinical features of gout in a cohort of Italian patients

    Directory of Open Access Journals (Sweden)

    M.A. Cimmino

    2011-06-01

    Full Text Available Objective: To assess the clinical characteristics of gout and its diagnostic approach in a group of Italian patients. Methods: In a retrospective analysis, we evaluated 72 consecutive gouty patients examined in the years 2000-2007.We recorded demographic data, family history, comorbidities and disease characteristics (seasonality of the attacks, joints affected, serum uric acid concentration, and treatment. Result: 63/72 (87.5% patients were men and 9 women, with mean age 61.9±13.7 years. 8/72 (11.1% patients reported a familial history of gout. The first attack occurred mainly in the months of June, July and December. The first metatarsophalangeal joint was affected in 59.7% of patients and the hand in 25%. Treatment changed over the follow- up period, with a decreased use of NSAIDs (p<0.0001 and an increased use of colchicine (p=0.015 and allopurinol (p<0.0001. In 9 (12.5% patients, joint aspiration was performed and monosodium urate crystals were found in synovial fluid or tophi. 42/72 (58.3% patients fulfilled a minimum of 6 clinical criteria of the American College of Rheumatology, necessary for gout diagnosis. 47/72 (65.3% patients, met the EULAR recommendations and had an 82% probability of being affected by gout. Conclusions: The diagnosis of gout is not always easy because of its changing clinical spectrum. Identification of MSU crystals in joint aspirates was obtained only in a minority of patients. In this setting the diagnosis with gout was often based on the observation of an acute intermittent monoarthritis involving mainly the first metatarsophlangeal joint, associated with hyperuricaemia and responsive to colchicine.

  5. PRImary care Streptococcal Management (PRISM) study: identifying clinical variables associated with Lancefield group A β-haemolytic streptococci and Lancefield non-Group A streptococcal throat infections from two cohorts of patients presenting with an acute sore throat

    OpenAIRE

    Little, Paul; Moore, Michael; Hobbs, F D R; Mant, David; McNulty, Cliodna; Williamson, Ian; Cheng, Edith; Stuart, Beth; Kelly, Joanne; Barnett, Jane; Mullee, Mark

    2013-01-01

    Objective: To assess the association between features of acute sore throat and the growth of streptococci from culturing a throat swab. Design: Diagnostic cohort. Setting: UK general practices. Participants: Patients aged 5 or over presenting with an acute sore throat. Patients were recruited for a second cohort (cohort 2, n=517) consecutively after the first (cohort 1, n=606) from similar practices. Main outcome: Predictors of the presence of Lancefield A/C/G streptococci...

  6. Vitamin D deficiency in a cohort of HIV-infected patients: clinical analysis

    Directory of Open Access Journals (Sweden)

    B Vandercam

    2012-11-01

    Full Text Available Purpose of the study: Observational studies have noted very high rates of low serum 25-hydroxyvitamin D [25(OHD3] levels in both general and HIV-infected populations. In HIV-infected patients, low 25(OHD3 levels are secondary to a combination of usual risk factors and HIV-specific risk factors, like antiretroviral therapy [1]. The objective of our study is to analyse the magnitude of vitamin D deficiency or insufficiency and the role of various factors such as age, sex, ethnicity, season, and antiretroviral medications in our cohort of HIV-infected patients. Methods: We prospectively collected data on 25-hydroxyvitamin D levels sampled between January 2009 and June 2011 from our cohort of 930 HIV-infected patients. Vitamin D dosage was performed using immunoassay (‘Diasorin’ - Saluggia, Italy. We divided vitamin D levels into 3 categories: 25-hydroxyvitamin D levels <20 mg/nl were considered deficient, insufficient between 20 and 29 ng/ml. Levels ≥30 ng/ml were defined as normal [2]. Data on demographic features (age, ethnicity, season, heterosexuality vs homosexuality, clinical features and laboratory findings (CD4 cell count, viral load, HAART, BMI were collected from patients’ medical records using our institutional database ‘Medical explorer v3r9, 2009’. Summary of results: Overall, 848 patients were included in our study (Table 1. Low levels of serum 25(OHD3 were seen in 89.3% of the study population, from which 69.5% were deficient and 19.8% were insufficient. On univariate analysis, female sex, high BMI, black African, heterosexuality, undetectable viral load and antiretroviral treatment were all predictors of vitamin D deficiency and insufficiency. Treatment with efavirenz and tenofovir were the most associated with low vitamin D levels. On multivariate analysis (multiple linear regression model only female sex (OR=1.14; 95% CI 0.84–0.96; p<0.001, dosage during winter months (OR=1.14; 95% CI 1–1.15; p<0.05 and HAART (OR=1

  7. Cerebral palsy and placental infection: a case-cohort study

    Directory of Open Access Journals (Sweden)

    Khong T Yee

    2004-01-01

    Full Text Available Abstract Background The association between cerebral palsy in very preterm infants and clinical, histopathologic and microbiological indicators of chorioamnionitis, including the identification of specific micro-organisms in the placenta, was evaluated in a case-cohort study. Methods Children with a diagnosis of cerebral palsy at five years of age were identified from amongst participants in a long-term follow-up program of preterm infants. The comparison group was a subcohort of infants randomly selected from all infants enrolled in the program. The placentas were examined histopathologically for chorioamnionitis and funisitis, and the chorioamnionic interface was aseptically swabbed and comprehensively cultured for aerobic and anaerobic bacteria, yeast and genital mycoplasmas. Associations between obstetric and demographic variables, indicators of chorioamnionitis and cerebral palsy status were examined by univariate analysis. Results Eighty-two infants with cerebral palsy were compared with the subcohort of 207 infants. Threatened preterm labor was nearly twice as common among the cases as in the subcohort (p E. coli was cultured from the placenta in 6/30 (20% of cases as compared with 4/85 (5% of subcohort (p = 0.01. Group B Streptococcus was more frequent among the cases, but the difference was not statistically significant. Conclusions The association between E. coli in the chorioamnion and cerebral palsy in preterm infants identified in this study requires confirmation in larger multicenter studies which include microbiological study of placentas.

  8. Embedding clinical interventions into observational studies.

    Science.gov (United States)

    Newman, Anne B; Avilés-Santa, M Larissa; Anderson, Garnet; Heiss, Gerardo; Howard, Wm James; Krucoff, Mitchell; Kuller, Lewis H; Lewis, Cora E; Robinson, Jennifer G; Taylor, Herman; Treviño, Roberto P; Weintraub, William

    2016-01-01

    Novel approaches to observational studies and clinical trials could improve the cost-effectiveness and speed of translation of research. Hybrid designs that combine elements of clinical trials with observational registries or cohort studies should be considered as part of a long-term strategy to transform clinical trials and epidemiology, adapting to the opportunities of big data and the challenges of constrained budgets. Important considerations include study aims, timing, breadth and depth of the existing infrastructure that can be leveraged, participant burden, likely participation rate and available sample size in the cohort, required sample size for the trial, and investigator expertise. Community engagement and stakeholder (including study participants) support are essential for these efforts to succeed. PMID:26611435

  9. Children and Clinical Studies: Why Clinical Studies Are Important

    Medline Plus

    Full Text Available ... Children & Clinical Studies NHLBI Trials Clinical Trial Websites Children and Clinical Studies Learn more about Children and Clinical Studies Importance of Children in Clinical Studies Children have often had to ...

  10. Risk ratio estimation in case-cohort studies.

    OpenAIRE

    Sato, T

    1994-01-01

    In traditional (cumulative-incidence) case-control studies, the exposure odds ratio can be used as an estimator of the risk ratio only when the disease under study is rare. The case-cohort study is a recently developed useful modification of the case-control study. This design allows direct estimation of the risk ratio from a fixed cohort, but does not require any rare-disease assumption. This article reviews recent developments in risk ratio estimation procedures for the analysis of case-coh...

  11. Adhesive capsulitis and dynamic splinting: a controlled, cohort study

    Directory of Open Access Journals (Sweden)

    Willis F Buck

    2009-09-01

    Full Text Available Abstract Background Adhesive Capsulitis (AC affects patient of all ages, and stretching protocols are commonly prescribed for this condition. Dynamic splinting has been shown effective in contracture reduction from pathologies including Trismus to plantar fasciitis. The purpose of this study was to examine the efficacy of dynamic splinting on patients with AC. Methods This controlled, cohort study, was conducted at four physical therapy, sports medicine clinics in Texas and California. Sixty-two patients diagnosed with Stage II Adhesive Capsulitis were grouped by intervention. The intervention categories were as follows: Group I (Control; Group II (Physical Therapy exclusively with standardized protocols; Group III; (Shoulder Dynasplint system exclusively; Group IV (Combined treatment with Shoulder Dynasplint and standardized Physical Therapy. The duration of this study was 90 days for all groups, and the main outcome measures were change in active, external rotation. Results Significant difference was found for all treatment groups (p Conclusion The difference for the combined treatment group was attributed to patients' receiving the best PT combined with structured "home therapy" that contributed an additional 90 hours of end-range stretching. This adjunct should be included in the standard of care for adhesive Capsulitis. Trial Registration Trial Number: NCT00873158

  12. "Cancer 2015": A Prospective, Population-Based Cancer Cohort-Phase 1: Feasibility of Genomics-Guided Precision Medicine in the Clinic.

    Science.gov (United States)

    Parisot, John P; Thorne, Heather; Fellowes, Andrew; Doig, Ken; Lucas, Mark; McNeil, John J; Doble, Brett; Dobrovic, Alexander; John, Thomas; James, Paul A; Lipton, Lara; Ashley, David; Hayes, Theresa; McMurrick, Paul; Richardson, Gary; Lorgelly, Paula; Fox, Stephen B; Thomas, David M

    2015-01-01

    "Cancer 2015" is a longitudinal and prospective cohort. It is a phased study whose aim was to pilot recruiting 1000 patients during phase 1 to establish the feasibility of providing a population-based genomics cohort. Newly diagnosed adult patients with solid cancers, with residual tumour material for molecular genomics testing, were recruited into the cohort for the collection of a dataset containing clinical, molecular pathology, health resource use and outcomes data. 1685 patients have been recruited over almost 3 years from five hospitals. Thirty-two percent are aged between 61-70 years old, with a median age of 63 years. Diagnostic tumour samples were obtained for 90% of these patients for multiple parallel sequencing. Patients identified with somatic mutations of potentially "actionable" variants represented almost 10% of those tumours sequenced, while 42% of the cohort had no mutations identified. These genomic data were annotated with information such as cancer site, stage, morphology, treatment and patient outcomes and health resource use and cost. This cohort has delivered its main objective of establishing an upscalable genomics cohort within a clinical setting and in phase 2 aims to develop a protocol for how genomics testing can be used in real-time clinical decision-making, providing evidence on the value of precision medicine to clinical practice. PMID:26529019

  13. Study Design and Cohort Description of DEFIB-WOMEN

    DEFF Research Database (Denmark)

    Pedersen, Susanne S; Nielsen, Jens Cosedis; Riahi, Sam;

    2016-01-01

    BACKGROUND: Little systematic evidence is available on potential gender differences in patients with an implantable cardioverter defibrillator (ICD) from a real-world cohort. We designed the DEFIB-WOMEN study to examine gender differences on (i) patient reported outcomes (PROs), (ii) procedure- and...... device-related complications, and (iii) ventricular tachyarrhythmia and mortality. This presents the study design and baseline characteristics of the cohort. METHODS: DEFIB-WOMEN is a national, multi-center, prospective, observational study. First-time implanted patients are asked to complete PROs at...... several time points. Information on baseline and follow-up characteristics are captured from patients' medical records, purpose-designed questions, and the Danish national registers. The DEFIB-WOMEN cohort is comprised of 1790 (19% women; 343/1790) patients implanted between June 2010 and April 2013...

  14. Endometrial thickness, Caucasian ethnicity, and age predict clinical pregnancy following fresh blastocyst embryo transfer: a retrospective cohort

    Directory of Open Access Journals (Sweden)

    Santoro Nanette

    2009-04-01

    Full Text Available Abstract Background In-vitro fertilization (IVF with blastocyst as opposed to cleavage stage embryos has been advocated to improve success rates. Limited information exists on which to predict which patients undergoing blastocyst embryo transfer (BET will achieve pregnancy. This study's objective was to evaluate the predictive value of patient and cycle characteristics for clinical pregnancy following fresh BET. Methods This was a retrospective cohort study from 2003–2007 at an academic assisted reproductive program. 114 women with infertility underwent fresh IVF with embryo transfer. We studied patients undergoing transfer of embryos at the blastocyst stage of development. Our main outcome of interest was clinical pregnancy. Clinical pregnancy and its associations with patient characteristics (age, body mass index, FSH, ethnicity and cycle parameters (thickness of endometrial stripe, number eggs, available cleaving embryos, number blastocysts available, transferred, and cryopreserved, and embryo quality were examined using Student's T test and Mann-Whitney-U tests as appropriate. Multivariable logistic regression models were created to determine independent predictors of CP following BET. Receiver Operating Characteristic analyses were used to determine the optimal thickness of endometrial stripe for predicting clinical pregnancy. Results Patients achieving clinical pregnancy demonstrated a thicker endometrial stripe and were younger preceding embryo transfer. On multivariable logistic regression analyses, Caucasian ethnicity (OR 2.641, 95% CI 1.054–6.617, thickness of endometrial stripe, (OR 1.185, 95% CI 1.006–1.396 and age (OR 0.879, 95% CI 0.789–0.980 predicted clinical pregnancy. By receiver operating characteristic analysis, endometrial stripe ≥ 9.4 mm demonstrated a sensitivity of 83% for predicting clinical pregnancy following BET. Conclusion In a cohort of patients undergoing fresh BET, thicker endometrial stripe, Caucasian

  15. Children and Clinical Studies: Why Clinical Studies Are Important

    Medline Plus

    Full Text Available ... Research Research Resources Research Meeting Summaries Technology Transfer Clinical Trials What Are Clinical Trials? Children & Clinical Studies NHLBI Trials Clinical Trial Websites ...

  16. Increased Risk of Acute Kidney Injury following Pneumococcal Pneumonia: A Nationwide Cohort Study

    Science.gov (United States)

    Lin, Te-Yu; Chen, Yu-Guang; Lin, Cheng-Li; Kao, Chia-Hung

    2016-01-01

    Purpose Pneumococcal disease leads to renal complications ranging from persistent proteinuria to end-stage renal disease. Studies on the association between pneumococcal pneumonia (PP) and acute kidney injury (AKI) are scant. This study assessed the relationship between PP and risk of AKI. Methods This nationwide population-based cohort study examined data from the Taiwan National Health Insurance Research Database for the period 2000–2011. We identified inpatients with newly diagnosed PP according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. In addition, we selected a comparison cohort from inpatient claims without the diagnosis of PP that was randomly frequency-matched with the PP cohort according to age, sex, index year and comorbidities. We analyzed the risks of AKI by using Cox proportional hazards regression models, adjusted for sex, age, and comorbidities. Results A total of 10,069 patients with PP and 10,069 controls were enrolled in this study. After adjustments for age, sex, and comorbidities, patients with PP had a 1.11-fold risk of developing AKI compared with the comparison cohort. Conclusion This study indicates that AKI risks are higher in patients with PP compared with the comparison cohort. Careful follow-up observation and aggressive treatment are necessary for patients with PP to reduce the risk of AKI. PMID:27362355

  17. Clinical characteristics and disease predictors of a large Chinese cohort of patients with autosomal dominant polycystic kidney disease.

    Directory of Open Access Journals (Sweden)

    Dongping Chen

    Full Text Available OBJECTIVE: Autosomal dominant polycystic kidney disease (ADPKD is a relentlessly progressing form of chronic kidney disease for which there is no cure. The aim of this study was to characterize Chinese patients with ADPKD and to identify the factors which predict cyst growth and renal functional deterioration. METHODS: To analyze disease predicting factors we performed a prospective longitudinal observational study in a cohort of 541 Chinese patients with ADPKD and an eGFR ≥ 30 ml/min/1.73 m(2. Patients were followed clinically and radiologically with sequential abdominal magnetic resonance imaging (MRI. Clinical characteristics and laboratory data were related to changes in estimated glomerular filtration rate (eGFR and total kidney volume (TKV. A linear regression model was developed to analyze the factors which determine eGFR and TKV changes. RESULTS: The age range of this unselected cohort ranged from 4 to 77 years. Median follow-up time was 14.3 ± 10.6 months. Although inter-individual differences in eGFR and TKV were large, there was a consistent link between these two parameters. Baseline log10-transformed TKV and urinary protein/creatinine ratio were identified as the major predictors for a faster eGFR decline and were associated with a higher TKV growth rate. Interestingly, a lower thrombocyte count correlated significantly with lower eGFR (r = 0.222 and higher TKV (r = 0.134. CONCLUSIONS: This large cohort of Chinese patients with ADPKD provides unique epidemiological data for comparison with other cohorts of different ethnicity. In Chinese patients we identified a lower thrombocyte count as a significant predictor of disease progression. These results are important for the design of future clinical trials to retard polycystic kidney disease progression.

  18. Epidemiological study of venous thromboembolism in a big Danish cohort

    DEFF Research Database (Denmark)

    Severinsen, Marianne Tang; Kristensen, Søren Risom; Overvad, Kim;

    Introduction: Epidemiological data on venous thromboembolism (VT), i.e. pulmonary emboli (PE) and deep venous thrombosis (DVT) are sparse. We have examined VT-diagnoses registered in a big Danish Cohort study.  Methods: All first-time VT diagnoses in The Danish National Patient Register were...... identified among participants in the Danish cohort study "Diet, Cancer and Health" in which 57,053 50-64 years old persons were included 1993-7. Medical records were retrieved and reviewed by an experienced physician using a detailed standardized form, and information on the diagnostic work-up and presence...

  19. Systematic review of birth cohort studies in Africa

    OpenAIRE

    Alasdair Campbell; Igor Rudan

    2011-01-01

    In sub-Saharan Africa, unacceptably high rates of mortality amongst women and children continue to persist. The emergence of research employing new genomic technologies is advancing knowledge on cause of disease. This review aims to identify birth cohort studies conducted in sub-Saharan Africa and to consider their suitability as a platform to support genetic epidemiological studies.

  20. Investing in Prospective Cohorts for Etiologic Study of Occupational Exposures

    Science.gov (United States)

    Prospective cohorts have played a major role in understanding the role of diet, physical activity, medical conditions, and genes in the development of many diseases, but have not been widely used in the study of occupational exposures. Studies in agriculture are an exception. W...

  1. Determinants of depression in chronic stroke : A prospective cohort study

    NARCIS (Netherlands)

    van de Port, Ingrid G. L.; Kwakkel, Gert; Bruin, Margje; Lindeman, Eline

    2007-01-01

    Purpose. The aim of the study was to identify factors that are significantly related to depression in chronic stroke patients. Methods. Prospective cohort study of stroke patients admitted for rehabilitation. A total of 165 first ever stroke patients over 18 years of age were assessed at one and thr

  2. Prevention and management of chronic disease in Aboriginal and Islander Community Controlled Health Services in Queensland: a quality improvement study assessing change in selected clinical performance indicators over time in a cohort of services

    OpenAIRE

    Panaretto, K S; Gardner, K L; Button, S; Carson, A; Schibasaki, R; Wason, G; Baker, D.; Mein, J.; Dellit, A; Lewis, D; Wenitong, M; Ring, I

    2013-01-01

    Objective To evaluate clinical healthcare performance in Aboriginal Medical Services in Queensland and to consider future directions in supporting improvement through measurement, target setting and standards development. Design Longitudinal study assessing baseline performance and improvements in service delivery, clinical care and selected outcomes against key performance indicators 2009–2010. Setting 27 Aboriginal and Islander Community Controlled Health Services (AICCHSs) in Queensland, w...

  3. Cohorting Dengue Patients Improves the Quality of Care and Clinical Outcome.

    Directory of Open Access Journals (Sweden)

    Lucy C S Lum

    2015-06-01

    Full Text Available The increasing incidence of dengue among adults in Malaysia and other countries has important implications for health services. Before 2004, in order to cope with the surge in adult dengue admissions, each of the six medical wards in a university hospital took turns daily to admit and manage patients with dengue. Despite regular in-house training, the implementation of the WHO 1997 dengue case management guidelines by the multiple medical teams was piecemeal and resulted in high variability of care. A restructuring of adult dengue inpatient service in 2004 resulted in all patients being admitted to one ward under the care of the infectious disease unit. Hospital and Intensive Care Unit admission criteria, discharge criteria and clinical laboratory testing were maintained unchanged throughout the study period.To evaluate the impact of cohorting adult dengue patients on the quality of care and the clinical outcome in a university hospital in Malaysia.A pre (2003 and post-intervention (2005-6 retrospective study was undertaken.Cohorting all dengue patients under the care of the Infectious Disease team in a designated ward in 2004.The number of patients enrolled was 352 in 2003, 785 in 2005 and 1158 in 2006. The evaluation and detection of haemorrhage remained high (>90% and unchanged throughout the study period. The evaluation of plasma leakage increased from 35.4% pre-intervention to 78.8% post-intervention (p = <0.001 while its detection increased from 11.4% to 41.6% (p = <0.001. Examination for peripheral perfusion was undertaken in only 13.1% of patients pre-intervention, with a significant increase post-intervention, 18.6% and 34.2% respectively, p = <0.001. Pre-intervention, more patients had hypotension (21.5% than detected peripheral hypoperfusion (11.4%, indicating that clinicians recognised shock only when patients developed hypotension. In contrast, post-intervention, clinicians recognised peripheral hypoperfusion as an early sign of

  4. Etiology of atopy in infancy: the KOALA Birth Cohort Study.

    Science.gov (United States)

    Kummeling, Ischa; Thijs, Carel; Penders, John; Snijders, Bianca E P; Stelma, Foekje; Reimerink, Johan; Koopmans, Marion; Dagnelie, Pieter C; Huber, Machteld; Jansen, Margje C J F; de Bie, Rob; van den Brandt, Piet A

    2005-12-01

    The aim of the KOALA Birth Cohort Study in the Netherlands is to identify factors that influence the clinical expression of atopic disease with a main focus on lifestyle (e.g., anthroposophy, vaccinations, antibiotics, dietary habits, breastfeeding and breast milk composition, intestinal microflora composition, infections during the first year of life, and gene-environment interaction). The recruitment of pregnant women started in October 2000. First, participants with 'conventional lifestyles' (n = 2343) were retrieved from an ongoing prospective cohort study (n = 7020) on pregnancy-related pelvic girdle pain. In addition, pregnant women (n = 491) with 'alternative lifestyles' with regard to child rearing practices, dietary habits (organic, vegetarian), vaccination schemes and/or use of antibiotics, were recruited through organic food shops, anthroposophic doctors and midwives, Steiner schools, and dedicated magazines. All participants were enrolled between 14 and 18 wk of gestation and completed an intake questionnaire on family history of atopy and infant care intentions. Documentation of other relevant variables started in the pregnant mother and covered the first and third trimester as well as early childhood by repeated questionnaires at 14-18, 30, and 34 wk of gestation and 3, 7, 12, and 24 months post-partum. A subgroup of participants, including both conventional and alternative lifestyles, was asked to consent to maternal blood sampling, breast milk and a faecal sample of the infant at 1 month post-partum, capillary blood at age 1 yr, venous blood and observation of manifestation of atopic dermatitis during home visits at the age of 2 yr (using the UK working party criteria and the severity scoring of atopic dermatitis index), and buccal swabs for DNA isolation from child-parent trios. From the start, ethical approval and informed consent procedures included gene-environment interaction studies. Follow-up at 3 and 7 months post-partum was completed with

  5. Breast density and outcome of mammography screening: a cohort study

    DEFF Research Database (Denmark)

    Olsen, A H; Bihrmann, K; Jensen, M-B;

    2009-01-01

    The purpose of this study was to investigate the effect of breast density on breast cancer (BC) mortality in a mammography screening programme. The cohort included 48 052 women participating in mammography screening in Copenhagen, Denmark, where biennial screening is offered to women aged 50...

  6. Observational cohort study of HIV-infected African children.

    NARCIS (Netherlands)

    Laufer, M.K.; Oosterhout, J.J. van; Perez, M.A.; Kanyanganlika, J.; Taylor, T.E.; Plowe, C.V.; Graham, S.M.

    2006-01-01

    BACKGROUND: Most information about children living with HIV is based on follow up from children identified through mother-to-child transmission studies. Children identified through voluntary counseling and testing (VCT) represent a unique cohort that has not been previously described in the literatu

  7. Adolescent cannabis and tobacco use and educational outcomes at age 16: birth cohort study

    OpenAIRE

    Stiby, Alexander I.; Hickman, Matthew; Munafò, Marcus R.; Heron, Jon; Yip, Vikki L.; Macleod, John

    2015-01-01

    Aims To investigate the relationship between cannabis and tobacco use by age 15 and subsequent educational outcomes. Design Birth cohort study. Setting England. Participants The sample was drawn from the Avon Longitudinal Study of Parents and Children; a core sample of 1155 individuals had complete information on all the variables. Measurements The main exposures were cannabis and tobacco use at age 15 assessed in clinic by computer-assisted questionnaire and serum cotinine. The main outcomes...

  8. Occlusal characteristics in 3-year-old children – results of a birth cohort study

    OpenAIRE

    Wagner, Yvonne; Heinrich-Weltzien, Roswitha

    2015-01-01

    Background Aim of this prospective study was to determine prevalence of malocclusion and associated risk factors in 3-year-old Thuringian children. Methods Subjects (n = 377) were participants in a regional oral health programme, a birth cohort study with the aim to prevent caries (German Clinical Trials Register DRKS00003438). Children received continuous dental care since birth. Occlusal characteristics (overjet, overbite, anterior open bite, canine relationship and posterior crossbite) wer...

  9. Perinatal depression in a cohort study on Iranian women

    Directory of Open Access Journals (Sweden)

    Gholam Reza Kheirabadi

    2010-01-01

    Full Text Available Background: Childbearing years in the women′s life are associated with the highest risk of depression. In this study depression in third trimester of pregnancy and after delivery was studied. Depressive symptom score and the proportion of mothers above a threshold were compared to indicate probable depressive disorder at each stage. Methods: This prospective cohort study was conducted in rural areas of Isfahan province of Iran from September 2007 to January 2008. Subjects were all in their third trimester and followed up from the beginning of the study to 6- 8 weeks postpartum. At all, 2156 pregnant women completed the self report questionnaires but 258 were excluded because they were incomplete and final analysis was done with 1898 samples. At the final stage the sample size was decreased to 1291. Results: The prevalence of depression based on BDI score greater than 20 in last trimester of pregnancy, was 22.8% and rate of depression based on EPD score greater than 12 between 6 to 8 weeks after delivery, was 26.3%. Incidence of Post Partum Depression (PPD in 6 to 8 weeks after delivery in those who were not clinically depressed during preg-nancy was 20.1%. Results showed that history of depression, unplanned pregnancy, being housewife and having 3 or more children had significant relation with ante partum depression. Conclusions: Two main risk factors for post partum depression are previous history of depression and depression during current pregnancy. It is important to assess these variables during pregnancy in order to facilitate timely identifi-cation of women at risk.

  10. ADHD in international adoptees: a national cohort study.

    Science.gov (United States)

    Lindblad, Frank; Weitoft, Gunilla Ringbäck; Hjern, Anders

    2010-01-01

    Several investigators have reported an increased frequency of attention/hyperactivity symptoms in international adoptees, though population-based studies are lacking. In this national cohort study, we aimed to determine the prevalence of ADHD medication in international adoptees in Sweden, in comparison to the general population. A further purpose was to study gender, age at adoption and region of origin as predictors of ADHD medication in international adoptees. The study population consisted of all Swedish residents born in 1985-2000 with Swedish-born parents, divided into 16,134 adoptees, and a comparison population of 1,326,090. ADHD medications were identified in the Swedish Prescribed Drug Register during 2006. Logistic regression was used to calculate the odds ratios. The rates of ADHD medication were higher in international adoptees than in the comparison population for both boys (5.3 vs. 1.5% for 10-15-year olds) and girls (2.1 vs. 0.3% for 10-15-year olds). International adoptees from all regions of birth more often consumed ADHD medication compared with the majority population, but the age and sex adjusted odds ratios were particularly high for adoptees from Eastern Europe, Middle East/Africa and Latin America. Adjusting for maternal education and single parenthood increased the odds ratios even further. The risk also increased with higher age at adoption. Adoptees from Eastern Europe have a very high risk for ADHD medication. A structured identification and support programme should be tailored for this group. Adoptees from other regions have a more moderately increased risk, which should be communicated to adoptive parents and to professionals who care for adoptees in their clinical practice. PMID:19543791

  11. CT maxillary sinus evaluation-A retrospective cohort study

    Science.gov (United States)

    Vaz, Paula; Faria-Almeida, Ricardo; Braga, Ana-Cristina; Felino, António

    2015-01-01

    Background Proximity of the dental roots to the sinus floor makes dental disease a probable cause of maxillary sinusitis. The aim of this study was to find out if maxillary sinus pathologic changes were more prevalent in patients with dental disease and to evaluate the performance of computed tomography (CT) in analyzing and detecting apical periodontitis and other odontogenic causes on the maxillary sinusitis etiology in a Portuguese Caucasian population. Material and Methods Retrospective cohort study. The total sample of 504 patients and their CT was included in this study. The patients were from a private dental clinic, specializing in oral surgery, where the first complaint was not directly related to sinus disease, but with dental pathology. For each patient, the etiological factors of maxillary sinusitis and the imaging CT findings were analyzed. All the axial, coronal and sagittal CT slices were evaluated and general data were registered. The latter was selected based on the maxillary sinus CT published literature. Results 32.40% of patients presented normal sinus (without any etiological factor associated), 29.00% showed presence of etiological and imaging findings in the maxillary sinus, 20.60% had only imaging changes in the maxillary sinus and 18.00% of patients presented only etiological factors and no change in the maxillary sinus. Conclusions Radiological imaging is an important tool for establishing the diagnosis of maxillary sinus pathology. These results indicate that the CT scan should be an excellent tool for complement the odontogenic sinusitis diagnosis. Key words: Maxillary sinusitis/etiology, odontogenic, computed tomography, maxillary sinus. PMID:25858084

  12. Children and Clinical Studies: Why Clinical Studies Are Important

    Medline Plus

    Full Text Available ... NHLBI Trials Clinical Trial Websites Children and Clinical Studies Learn more about Children and Clinical Studies Importance of Children in Clinical Studies Children have often had to accept medicines and ...

  13. Changes in Saturday outpatient volume and billings after introducing the Saturday incentive programme to clinics in South Korea: a longitudinal cohort study using claims data from 2012 to 2014

    OpenAIRE

    Ha, Hyun Ji; Han, Kyu-Tae; Kim, Sun Jung; Sohn, Tae Yong; Jeon, Byungyool; Park, Eun-Cheol

    2016-01-01

    Objective In October 2013, the South Korean government introduced an incentive programme to increase the availability of Saturday treatment at clinics, hoping to increase the role of primary care providers as gatekeepers to medical care. To the best of our knowledge, no one has yet investigated this programme's effect on overall outpatient care. Our study aims to analyse the change in Saturday outpatient volume and billings in clinics that adopted the Saturday incentive programme. Setting Our...

  14. An evaluation of the development of clinical reasoning skills in a cohort of occupational therapy students in Hong Kong: implications of curriculum design

    OpenAIRE

    Dasari, Bhoomiah Dharmiah

    2006-01-01

    The aim of the study was to evaluate how Hong Kong Occupational Therapy students develop their clinical reasoning abilities and progress through the stages of their undergraduate curriculum. The study examines a range of factors that may affect their development of clinical reasoning. The student cohort was composed of a class of 80 BSc (Honours) occupational therapy students at the Hong Kong Polytechnic University. The study was predominantly quantitative; however, focus group intervie...

  15. Risk of venous thromboembolism in people with lung cancer: a cohort study using linked UK healthcare data

    OpenAIRE

    Walker, Alex J.; Baldwin, David R; Card, Tim R; Powell, Helen A; Hubbard, Richard B.; Grainge, Matthew J

    2016-01-01

    Background: Venous thromboembolism is a potentially preventable cause of death in people with lung cancer. Identification of those most at risk and high risk periods may provide the opportunity for better targeted intervention. Methods: We conducted a cohort study using the Clinical Practice Research Datalink linked to Hospital Episode Statistics and Cancer Registry data. Our cohort comprised 10,598 people with lung cancer diagnosed between 1997 and 2006 with follow-up continuing to the ...

  16. Assessment of Allergy to Milk, Egg, Cod, and Wheat in Swedish Schoolchildren: A Population Based Cohort Study

    OpenAIRE

    Winberg, Anna; Christina E West; Strinnholm, Åsa; Nordström, Lisbeth; Hedman, Linnea; Rönmark, Eva

    2015-01-01

    Objectives Knowledge about the prevalence of allergies to foods in childhood and adolescence is incomplete. The purpose of this study was to investigate the prevalence of allergies to milk, egg, cod, and wheat using reported data, clinical examinations, and double-blind placebo-controlled food challenges, and to describe the phenotypes of reported food hypersensitivity in a cohort of Swedish schoolchildren. Methods In a population-based cohort of 12-year-old children, the parents of 2612 (96%...

  17. Perinatal depression in a cohort study on Iranian women

    OpenAIRE

    Gholam Reza Kheirabadi; Mohamad Reza Maracy

    2010-01-01

    Background: Childbearing years in the women′s life are associated with the highest risk of depression. In this study depression in third trimester of pregnancy and after delivery was studied. Depressive symptom score and the proportion of mothers above a threshold were compared to indicate probable depressive disorder at each stage. Methods: This prospective cohort study was conducted in rural areas of Isfahan province of Iran from September 2007 to January 2008. Subjects were all in thei...

  18. Migraine and Cognitive Decline Among Women: Prospective Cohort Study

    OpenAIRE

    Rist, Pamela Marie; Kang, Jae Hee Hee; Buring, Julie Elizabeth; Glymour, Maria Lee; Grodstein, Francine; Kurth, Tobias

    2012-01-01

    Objective: To evaluate the association between migraine and cognitive decline among women. Design Prospective cohort study. Setting Women’s Health Study, United States. Participants 6349 women aged 65 or older enrolled in the Women’s Health Study who provided information about migraine status at baseline and participated in cognitive testing during follow-up. Participants were classified into four groups: no history of migraine, migraine with aura, migraine without aura, and past history of m...

  19. Effects of angiotensin-converting enzyme inhibitors and beta blockers on clinical outcomes in patients with and without coronary artery obstructions at angiography (from a Register-Based Cohort Study on Acute Coronary Syndromes).

    Science.gov (United States)

    Manfrini, Olivia; Morrell, Christine; Das, Rajiv; Barth, Julian H; Hall, Alistair S; Gale, Christopher P; Cenko, Edina; Bugiardini, Raffaele

    2014-05-15

    We sought to determine the effectiveness of angiotensin-converting enzyme (ACE) inhibition and β-blocker treatment as a function of the degree of coronary artery disease (CAD) obstruction at angiography. The Evaluation of Methods and Management of Acute Coronary Events registry enrolled patients who had been hospitalized for an acute coronary syndrome. There were 1,602 patients who had cardiac catheterization that were used for this analysis. The main outcome measures were evidence-based therapies prescribed at discharge and 6-month incidence of all-cause mortality. The cohort consisted of 1,252 patients with obstructive CAD (>50% luminal diameter obstructed) and 350 patients with nonobstructive CAD. Multivariate logistic regression analysis adjusted for further medications and other clinical factors was performed. Patients with nonobstructive CAD had significantly (p <0.001) higher rates of β-blocker (77.8% vs 63.3%) and lower rates of ACE-inhibitor (57.7% vs 66.4%) prescriptions. In patients with nonobstructive CAD, ACE-inhibitor therapy was clearly associated with a lower 6-month mortality (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.03 to 0.78, p = 0.004). No significant association between β-blocker use and death was found. In patients with obstructive CAD, both β blockers (OR 0.47, 95% CI 0.32 to 0.67, p <0.001) and ACE inhibitors (OR 0.47, 95% CI 0.26 to 0.87, p = 0.01) were significantly associated with a reduced risk of 6-month mortality. In conclusion, ACE-inhibitor therapy seems to be an effective first-line treatment for preventing the occurrence of mortality in patients with nonobstructive CAD. PMID:24698468

  20. A cross sectional study of two independent cohorts identifies serum biomarkers for facioscapulohumeral muscular dystrophy (FSHD).

    Science.gov (United States)

    Petek, Lisa M; Rickard, Amanda M; Budech, Christopher; Poliachik, Sandra L; Shaw, Dennis; Ferguson, Mark R; Tawil, Rabi; Friedman, Seth D; Miller, Daniel G

    2016-07-01

    Measuring the severity and progression of facioscapulohumeral muscular dystrophy (FSHD) is particularly challenging because muscle weakness progresses over long periods of time and can be sporadic. Biomarkers are essential for measuring disease burden and testing treatment strategies. We utilized the sensitive, specific, high-throughput SomaLogic proteomics platform of 1129 proteins to identify proteins with levels that correlate with FSHD severity in a cross-sectional study of two independent cohorts. We discovered biomarkers that correlate with clinical severity and disease burden measured by magnetic resonance imaging. Sixty-eight proteins in the Rochester cohort (n = 48) and 51 proteins in the Seattle cohort (n = 30) had significantly different levels in FSHD-affected individuals when compared with controls (p-value ≤ .005). A subset of these varied by at least 1.5 fold and four biomarkers were significantly elevated in both cohorts. Levels of creatine kinase MM and MB isoforms, carbonic anhydrase III, and troponin I type 2 reliably predicted the disease state and correlated with disease severity. Other novel biomarkers were also discovered that may reveal mechanisms of disease pathology. Assessing the levels of these biomarkers during clinical trials may add significance to other measures of quantifying disease progression or regression. PMID:27185459

  1. A cohort study of mortality predictors and characteristics of patients with combined pulmonary fibrosis and emphysema

    OpenAIRE

    Kishaba, Tomoo; Shimaoka, Yousuke; Fukuyama, Hajime; Yoshida, Kyoko; Tanaka, Maki; Yamashiro, Shin; Tamaki, Hitoshi

    2012-01-01

    Objectives Our purpose was to assess the clinical data, predictors of mortality and acute exacerbation (AE) in combined pulmonary fibrosis and emphysema (CPFE) patients. Design Single-centre retrospective cohort study. Setting Teaching hospital in Japan. Participants We identified 93 CPFE patients with high-resolution computed tomographic (HRCT) through multidisciplinary discussion. Patients who had connective tissue disease, drug-associated interstitial lung disease and occupationally relate...

  2. Adverse drug reactions to tocolytic treatment for preterm labour: Prospective cohort study

    OpenAIRE

    Heus, R.; Mol, B. W.; Erwich, J.J.H.M.; van Geijn, H.P.; Gyselaers, W.J.; Hanssens, M.; Harmark, L.; van Holsbeke, C.D.; Duvekot, J.J.; Schobben, F.F.A.M.; Wolf, Hans; Visser, G. H. A.

    2009-01-01

    textabstractObjective To evaluate the incidence of serious maternal complications after the use of various tocolytic drugs for the treatment of preterm labour in routine clinical situations. Design Prospective cohort study. Setting 28 hospitals in the Netherlands and Belgium. Participants 1920 consecutive women treated with tocolytics for threatened preterm labour. Main outcome measures Maternal adverse events (those suspected of being causally related to treatment were considered adverse dru...

  3. The Systemic Inflammatory Response Syndrome (SIRS) in acutely hospitalised medical patients: a cohort study

    OpenAIRE

    Storgaard Merete; Comstedt Pål; Lassen Annmarie T

    2009-01-01

    Abstract Background Sepsis is an infection which has evoked a systemic inflammatory response. Clinically, the Systemic Inflammatory Response Syndrome (SIRS) is identified by two or more symptoms including fever or hypothermia, tachycardia, tachypnoea and change in blood leucocyte count. The relationship between SIRS symptoms and morbidity and mortality in medical emergency ward patients is unknown. Methods We conducted a prospective cohort study of the frequency of SIRS and its relationship t...

  4. Mobilising community-based research on zoonotic infections: A case study of longitudinal cohorts in Vietnam

    OpenAIRE

    Karen Saylors; Tue Ngo Tri; Toan Tran Khanh; Kiet Bach Tuan; Heiman FL Wertheim; Stephen Baker; Hoa Ngo Thi; Bryant, Juliet E

    2015-01-01

    We initiated the Vietnam Initiative on Zoonotic Infections (VIZIONS) research program to better understand the epidemiology of disease transmission at the human–animal interface in Vietnamese rural communities and to integrate One Health approaches to disease surveillance. We established a longitudinal community cohort study of individuals with occupational exposure to animals, which involves concurrent targeted sampling from domestic livestock species and follow-up monitoring of human clinic...

  5. Behavioural and Psychiatric Symptoms in People with Dementia Admitted to the Acute Hospital: Prospective Cohort Study

    OpenAIRE

    Sampson, E L; White, N.; Leurent, B.; Scott, S; Lord, K; Round, J; Jones, L.

    2014-01-01

    BACKGROUND: Dementia is common in older people admitted to acute hospitals. There are concerns about the quality of care they receive. Behavioural and psychiatric symptoms of dementia (BPSD) seem to be particularly challenging for hospital staff. AIMS To define the prevalence of BPSD and explore their clinical associations. METHOD: Longitudinal cohort study of 230 people with dementia, aged over 70, admitted to hospital for acute medical illness, and assessed for BPSD at admission and every 4...

  6. Integration of Antiretroviral Therapy Services into Antenatal Care Increases Treatment Initiation during Pregnancy: A Cohort Study

    OpenAIRE

    Stinson, Kathryn; Jennings, Karen; Myer, Landon

    2013-01-01

    Objectives Initiation of antiretroviral therapy (ART) during pregnancy is critical to promote maternal health and prevent mother-to-child HIV transmission (PMTCT). The separation of services for antenatal care (ANC) and ART may hinder antenatal ART initiation. We evaluated ART initiation during pregnancy under different service delivery models in Cape Town, South Africa. Methods A retrospective cohort study was conducted using routinely collected clinic data. Three models for ART initiation i...

  7. Risk of colorectal cancer after initiation of orlistat: matched cohort study

    OpenAIRE

    Hong, Jin-Liern; Christoph R Meier; Sandler, Robert S.; Jick, Susan S; Stürmer, Til

    2013-01-01

    Objective To examine the risk of colorectal cancer after orlistat initiation in the UK population. Design Retrospective matched cohort study. Setting Data from the UK Clinical Practice Research Datalink from September 1998 to December 2008. Participants 33 625 adults aged 18 years or over who started treatment with orlistat; each orlistat initiator was matched to up to five non-initiators (n=160 347) on age, sex, body mass index, and calendar time. Main outcome measures Associations between o...

  8. Intrinsic risk factors for acute ankle injuries among male soccer players : a prospective cohort study

    OpenAIRE

    Engebretsen, Anders Hauge; Myklebust, Grethe; Holme, Ingar Morten K.; Engebretsen, Lars; Bahr, Roald

    2009-01-01

    This prospective cohort study was conducted to identify risk factors for acute ankle injuries among male soccer players. A total of 508 players representing 31 amateur teams were tested during the 2004 pre-season through a questionnaire on previous injury and function score (foot and ankle outcome score; FAOS), functional tests (balance tests on the floor and a balance mat) and a clinical examination of the ankle. Generalized estimating equations were used in univariate analyses to identify c...

  9. Iron intake, haemoglobin and risk of gestational diabetes: a prospective cohort study

    OpenAIRE

    Helin, Annika; Kinnunen, Tarja Inkeri; Raitanen, Jani; Ahonen, Suvi; Virtanen, Suvi M.; Luoto, Riitta

    2012-01-01

    Objective To investigate the possible association between total daily iron intake during pregnancy, haemoglobin in early pregnancy and the risk of gestational diabetes mellitus (GDM) in women at increased risk of GDM. Design A prospective cohort study (based on a cluster-randomised controlled trial, where the intervention and the usual care groups were combined). Setting Primary healthcare maternity clinics in 14 municipalities in south-western Finland. Participants 399 Pregnant women who wer...

  10. Benzodiazepine discontinuation among community-dwelling older people: a population-based cohort study

    OpenAIRE

    Bell, J Simon; Lavikainen, Piia; Korhonen, Mikko; Hartikainen, Sirpa

    2010-01-01

    Benzodiazepine discontinuation among community-dwelling older people: a population-based cohort study fax: +358-171-62424 (Bell, J. Simon) (Bell, J. Simon) Kuopio Research Centre of Geriatric Care, University of Eastern Finland - P.O. Box 1627 - 70211 - Kuopio - FINLAND (Bell, J. Simon) Clinical Pharmacology and Geriatric Pharmacotherapy Unit, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland - Kuopio - FINLAND (Bell, J. Simon) ...

  11. Gamma-Glutamyltransferase and Cancer Incidence: The Ohsaki Cohort Study

    OpenAIRE

    Tsuboya, Toru; Kuriyama, Shinichi; Nagai, Masato; Hozawa, Atsushi; Sugawara, Yumi; Tomata, Yasutake; Kakizaki, Masako; Nishino, Yoshikazu; Tsuji, Ichiro

    2012-01-01

    Background Although experimental studies have shown that gamma-glutamyltransferase (GGT) has a role in tumor progression, epidemiologic evidence for a relationship between GGT and cancer incidence is limited. The present study investigated the association between GGT and cancer incidence and assessed the role of alcohol consumption in this association. Methods We examined a cohort of 15 031 Japanese adults aged 40 to 79 years who attended a health checkup in 1995 and were free of cancer at th...

  12. Cohort Study of Intracameral Moxifloxacin in Postoperative Endophthalmitis Prophylaxis

    OpenAIRE

    Virgilio Galvis; Alejandro Tello; Mary Alejandra Sánchez; Paul Anthony Camacho

    2014-01-01

    We conducted a cohort study to evaluate post-cataract surgery endophthalmitis rates in relation to prophylactic intracameral moxifloxacin administration. A total of 2332 patients (2674 eyes) who underwent phacoemulsification by a single surgeon from January 2007 through December 2012 were included in the study. A total of 1056 eyes did not receive intracameral prophylactic moxifloxacin and the antibiotic was injected in 1618 eyes. The incidence of presumed postoperative endophthalmitis in the...

  13. Gender differences in postpartum depression. A longitudinal cohort study

    OpenAIRE

    Escribà-Agüir, Vicenta; Artazcoz, Lucía

    2010-01-01

    Abstract Background: The course of depression from pregnancy to one year postpartum and their risk factors among mothers and fathers are not known. This study has two aims: 1) To report the longitudinal patterns of depression from third trimester of pregnancy to one year after childbirth and 2) to determine gender differences between women and their partners in the effect of psychosocial and personal factors on postpartum depression. Methods: A longitudinal cohort study was carr...

  14. Deep phenotyping of the unselected COPSAC2010 birth cohort study

    OpenAIRE

    Bisgaard, Hans Flinker; Vissing, Nadja Hawwa; Carson, C. G.; Bischoff, Anne Louise; Følsgaard, Nilofar Vahman; Kreiner‐Møller, E.; Chawes, Bo Lund Krogsgaard; Stokholm, J.; Pedersen, L.; Bjarnadóttir, E.; Thysen, Anna Hammerich; Nilsson, E; Mortensen, L. J.; Olsen, S. F.; Schjørring, S.

    2013-01-01

    Summary Background We hypothesize that perinatal exposures, in particular the human microbiome and maternal nutrition during pregnancy, interact with the genetic predisposition to cause an abnormal immune modulation in early life towards a trajectory to chronic inflammatory diseases such as asthma and others. Objective The aim of this study is to explore these interactions by conducting a longitudinal study in an unselected cohort of pregnant women and their offspring with emphasis on deep cl...

  15. Risk factors for seabather's eruption: a prospective cohort study.

    OpenAIRE

    Kumar, S.; Hlady, W. G.; Malecki, J M

    1997-01-01

    OBJECTIVE: A prospective cohort study was performed to identify risk factors for seabather's eruption. METHODS: Study participants were recruited at four beaches in Palm Beach County, Florida, during three weekends of May and June 1993. Participants were interviewed by telephone after 48 hours regarding medical history, beach activities, development of rashes, and use of possible preventive measures. RESULTS: Seabather's eruption, defined by the occurrence of a rash within two days of exposur...

  16. Comorbid Depression and Heart Failure: A Community Cohort Study.

    Directory of Open Access Journals (Sweden)

    Bhautesh Dinesh Jani

    Full Text Available To examine the association between depression and clinical outcomes in heart failure (HF in a community cohort.HF patients in Minnesota, United States completed depression screening using the 9-item Patient Health Questionnaire (PHQ-9 between 1st Oct 2007 and 1st Dec 2011; patients with PHQ-9≥5 were labelled "depressed". We calculated the risk of death and first hospitalization within 2 years using Cox regression. Results were adjusted for 10 commonly used prognostic factors (age, sex, systolic blood pressure, estimated glomerular filtration rate, serum sodium, ejection fraction, blood urea nitrogen, brain natriuretic peptide, presence of diabetes and ischaemic aetiology. Area under the curve (AUC, integrated discrimination improvement (IDI and net reclassification improvement (NRI compared depression as a predictor against the aforementioned factors.425 patients (mean age 74, 57.6% males were included in the study; 179 (42.1% had PHQ-9≥5. The adjusted hazard ratio of death was 2.02 (95% CI 1.34-3.04 and of hospitalization was 1.42 (95% CI 1.13-1.80 for those with compared to those without depression. Adding depression to the models did not appreciably change the AUC but led to statistically significant improvements in both the IDI (p = 0.001 and p = 0.005 for death and hospitalization, respectively and NRI (for death and hospitalization, 35% (p = 0.002 and 27% (p = 0.007 were reclassified correctly, respectively.Depression is frequent among community patients with HF and associated with increased risk of hospitalizations and death. Risk prediction for death and hospitalizations in HF patients can be improved by considering depression.

  17. DISTRESS AND PTSD IN PATIENTS WITH CANCER: COHORT STUDY CASE

    Science.gov (United States)

    Pranjic, Nurka; Bajraktarevic, Amila; Ramic, Enisa

    2016-01-01

    Introduction: embarrassed emotional experience may affect the ability to oncology patient effectively cope with cancer, symptoms and treatment. Distress extends a long period, from common, normal feelings of vulnerability, sadness and fears to problems of PTSD, depression, anxiety, panic, social isolation and the perception of spiritual crisis. The aim of the research is to determine the level of distress and PTSD in cancer patients. Patients and Methods: In a prospective, cohort study cases from 2011- 2014 were included patients with cancer who are treated under the supervision of his chosen family medicine doctor. Including a factor for the participation of patients in the study is that from the moment of diagnosis of malignant disease passed 14 days-6 months n=39 patients. To achieve the set goals of the research was used instruments of 3 questionnaires: Questionnaire on the clinical characteristics of patients with malignant disease, demographic and individual characteristics; questionnaire distress oncology patient–hospital scales of depression and anxiety, HADS scale (Hospital Anxiety and Depression Scale - HADS) and a rapid test for self-assessment of the symptoms of PTSD. Results: Age of patients was 54.63 ± 11:46 years, and the age of the respondents when they were diagnosed with cancer 54.34 ± 11.26 years. The prevalence of distress was a high 76% 82x higher than expected), and PTSD 55%. Predictors of burnout syndrome in cancer patients are all important determinants of malignant disease: the time elapsed since the diagnosis of the disease which determines the clinical status of malignant disease (β=0.280; P=0.001; 95% CI, 0742-2259), discovered metastases (β=0.304; P=0.001; 95% CI -2621 to 0978) and treatments (β=0.160; P=0.031, 95% CI 0050 to 1.060). Conclusion: The problem of distress in cancer patients is widespread and has a high prevalence of 76% in our environment, while still absent intervention and treatment. PMID:27047260

  18. Predicting Reading and Spelling Disorders: A 4-Year Prospective Cohort Study

    Science.gov (United States)

    Bigozzi, Lucia; Tarchi, Christian; Caudek, Corrado; Pinto, Giuliana

    2016-01-01

    In this 4-year prospective cohort study, children with a reading and spelling disorder, children with a spelling impairment, and children without a reading and/or spelling disorder (control group) in a transparent orthography were identified in third grade, and their emergent literacy performances in kindergarten compared retrospectively. Six hundred and forty-two Italian children participated. This cohort was followed from the last year of kindergarten to third grade. In kindergarten, the children were assessed in phonological awareness, conceptual knowledge of writing systems and textual competence. In third grade, 18 children with a reading and spelling impairment and 13 children with a spelling impairment were identified. Overall, conceptual knowledge of the writing system was the only statistically significant predictor of the clinical samples. No differences were found between the two clinical samples. PMID:27014145

  19. Reproducibility of Vertebral Fracture Assessment Readings From Dual-energy X-ray Absorptiometry in Both a Population-based and Clinical Cohort: Cohen's and Uniform Kappa.

    Science.gov (United States)

    Aubry-Rozier, Bérengère; Chapurlat, Roland; Duboeuf, François; Iglesias, Katia; Krieg, Marc-Antoine; Lamy, Olivier; Burnand, Bernard; Hans, Didier

    2015-01-01

    Vertebral fracture assessments (VFAs) using dual-energy X-ray absorptiometry increase vertebral fracture detection in clinical practice and are highly reproducible. Measures of reproducibility are dependent on the frequency and distribution of the event. The aim of this study was to compare 2 reproducibility measures, reliability and agreement, in VFA readings in both a population-based and a clinical cohort. We measured agreement and reliability by uniform kappa and Cohen's kappa for vertebral reading and fracture identification: 360 VFAs from a population-based cohort and 85 from a clinical cohort. In the population-based cohort, 12% of vertebrae were unreadable. Vertebral fracture prevalence ranged from 3% to 4%. Inter-reader and intrareader reliability with Cohen's kappa was fair to good (0.35-0.71 and 0.36-0.74, respectively), with good inter-reader and intrareader agreement by uniform kappa (0.74-0.98 and 0.76-0.99, respectively). In the clinical cohort, 15% of vertebrae were unreadable, and vertebral fracture prevalence ranged from 7.6% to 8.1%. Inter-reader reliability was moderate to good (0.43-0.71), and the agreement was good (0.68-0.91). In clinical situations, the levels of reproducibility measured by the 2 kappa statistics are concordant, so that either could be used to measure agreement and reliability. However, if events are rare, as in a population-based cohort, we recommend evaluating reproducibility using the uniform kappa, as Cohen's kappa may be less accurate. PMID:25439454

  20. PP112. Prediction of preeclampsia based on clinical risk factors: A prospective high-risk cohort study : 18th World Congress of the International Society for the Study of Hypertension in Pregnancy, 9-12 July 2012, Geneva, Switzerland

    NARCIS (Netherlands)

    Wong, T.Y.; Groen, H.; Faas, M.M.; van Pampus, M.G.

    2012-01-01

    Introduction Early recognition of preeclampsia (PE) is crucial for better obstetric care. Clinical risk factors are easier to identify than biochemical markers and may be useful in the prediction of PE. Objectives To evaluate which risk factors provide the best prediction for PE in a group at high-r

  1. Counselling for burnout in Norwegian doctors: one year cohort study

    OpenAIRE

    Rø, Karin E Isaksson; Gude, Tore; Tyssen, Reidar; Aasland, Olaf G

    2008-01-01

    Objective To investigate levels and predictors of change in dimensions of burnout after an intervention for stressed doctors. Design Cohort study followed by self reported assessment at one year. Setting Norwegian resource centre. Participants 227 doctors participating in counselling intervention, 2003-5. Interventions Counselling (lasting one day (individual) or one week (group based)) aimed at motivating reflection on and acknowledgement of the doctors’ situation and personal needs. Main ou...

  2. Cohort Profile: The Skin Cancer After Organ Transplant Study

    OpenAIRE

    Madeleine, Margaret M; Johnson, Lisa G.; Daling, Janet R.; Schwartz, Stephen M.; Carter, Joseph J.; Berg, Daniel; Nelson, Karen; Davis, Connie L.; Galloway, Denise A.

    2012-01-01

    The Skin Cancer after Organ Transplant (SCOT) study was designed to investigate the link between genus beta human papillomavirus (HPV) and squamous cell skin cancer (SCSC). We focused on a population receiving immunosuppressive therapy for extended periods, transplant patients, as they are at extremely high risk for developing SCSC. Two complementary projects were conducted in the Seattle area: (i) a retrospective cohort with interview data from 2004 recipients of renal or cardiac transplants...

  3. Screening and cervical cancer cure: population based cohort study

    OpenAIRE

    Andrae, B.; Andersson, T. M.-L.; Lambert, P C; Kemetli, L.; Silfverdal, L.; Strander, B.; Ryd, W; Dillner, J; Tornberg, S; Sparen, P

    2012-01-01

    Objective To determine whether detection of invasive cervical cancer by screening results in better prognosis or merely increases the lead time until death. Design Nationwide population based cohort study. Setting Sweden. Participants All 1230 women with cervical cancer diagnosed during 1999-2001 in Sweden prospectively followed up for an average of 8.5 years. Main outcome measures Cure proportions and five year relative survival ratios, stratified by screening history, mode of detection, age...

  4. Kidney stones and kidney function loss: a cohort study

    OpenAIRE

    Alexander, R Todd; Hemmelgarn, Brenda R; Wiebe, Natasha; Bello, Aminu; Morgan, Catherine; Samuel, Susan; Klarenbach, Scott W; Curhan, Gary C.; Tonelli, Marcello

    2012-01-01

    Objective To investigate whether the presence of kidney stones increase the risk of end stage renal disease (ESRD) or other adverse renal outcomes. Design A registry cohort study using validated algorithms based on claims and facility utilisation data. Median follow-up of 11 years. Setting Alberta, Canada, between 1997 and 2009. Participants 3 089 194 adult patients without ESRD at baseline or a history of pyelonephritis. Of these, 1 954 836 had outpatient serum creatinine measurements and we...

  5. Latent Topic Discovery of Clinical Concepts from Hospital Discharge Summaries of a Heterogeneous Patient Cohort

    Science.gov (United States)

    Lehman, Li-wei; Long, William; Saeed, Mohammed; Mark, Roger

    2016-01-01

    Patients in critical care often exhibit complex disease patterns. A fundamental challenge in clinical research is to identify clinical features that may be characteristic of adverse patient outcomes. In this work, we propose a data-driven approach for phenotype discovery of patients in critical care. We used Hierarchical Dirichlet Process (HDP) as a non-parametric topic modeling technique to automatically discover the latent “topic” structure of diseases, symptoms, and findings documented in hospital discharge summaries. We show that the latent topic structure can be used to reveal phenotypic patterns of diseases and symptoms shared across subgroups of a patient cohort, and may contain prognostic value in stratifying patients’ post hospital discharge mortality risks. Using discharge summaries of a large patient cohort from the MIMIC II database, we evaluate the clinical utility of the discovered topic structure in identifying patients who are at high risk of mortality within one year post hospital discharge. We demonstrate that the learned topic structure has statistically significant associations with mortality post hospital discharge, and may provide valuable insights in defining new feature sets for predicting patient outcomes. PMID:25570320

  6. Latent topic discovery of clinical concepts from hospital discharge summaries of a heterogeneous patient cohort.

    Science.gov (United States)

    Lehman, Li-Wei; Long, William; Saeed, Mohammed; Mark, Roger

    2014-01-01

    Patients in critical care often exhibit complex disease patterns. A fundamental challenge in clinical research is to identify clinical features that may be characteristic of adverse patient outcomes. In this work, we propose a data-driven approach for phenotype discovery of patients in critical care. We used Hierarchical Dirichlet Process (HDP) as a non-parametric topic modeling technique to automatically discover the latent "topic" structure of diseases, symptoms, and findings documented in hospital discharge summaries. We show that the latent topic structure can be used to reveal phenotypic patterns of diseases and symptoms shared across subgroups of a patient cohort, and may contain prognostic value in stratifying patients' post hospital discharge mortality risks. Using discharge summaries of a large patient cohort from the MIMIC II database, we evaluate the clinical utility of the discovered topic structure in identifying patients who are at high risk of mortality within one year post hospital discharge. We demonstrate that the learned topic structure has statistically significant associations with mortality post hospital discharge, and may provide valuable insights in defining new feature sets for predicting patient outcomes. PMID:25570320

  7. Data linkage in an established longitudinal cohort: the Western Australian Pregnancy Cohort (Raine) Study.

    Science.gov (United States)

    Mountain, Jenny A; Nyaradi, Anett; Oddy, Wendy H; Glauert, Rebecca A; de Klerk, Nick H; Straker, Leon M; Stanley, Fiona J

    2016-01-01

    The Western Australian Data Linkage System is one of a few comprehensive, population-based data linkage systems worldwide, creating links between information from different sources relating to the same individual, family, place or event, while maintaining privacy. The Raine Study is an established cohort study with more than 2000 currently active participants. Individual consent was obtained from participants for information in publicly held databases to be linked to their study data. A waiver of consent was granted where it was impracticable to obtain consent. Approvals to link the datasets were obtained from relevant ethics committees and data custodians. The Raine Study dataset was subsequently linked to academic testing data collected by the Western Australian Department of Education. Examination of diet and academic performance showed that children who were predominantly breastfed for at least 6 months scored higher academically at age 10 than children who were breastfed for less than 6 months. A further study found that better diet quality at ages 1, 2 and 3 years was associated with higher academic scores at ages 10 and 12 years. Examination of nutritional intake at 14 years of age found that a better dietary pattern was associated with higher academic performance. The detailed longitudinal data collected in the Raine Study allowed for adjustment for multiple covariates and confounders. Data linkage reduces the burden on cohort participants by providing additional information without the need to contact participants. It can give information on participants who have been lost to follow-up; provide or complement missing data; give the opportunity for validation studies comparing recall of participants with administrative records; increase the population sample of studies by adding control participants from the general population; and allow for the adjustment of multiple covariates and confounders. The Raine Study dataset is extensive and detailed, and can be

  8. Changes in Saturday outpatient volume and billings after introducing the Saturday incentive programme to clinics in South Korea: a longitudinal cohort study using claims data from 2012 to 2014

    Science.gov (United States)

    Ha, Hyun Ji; Han, Kyu-Tae; Kim, Sun Jung; Sohn, Tae Yong; Jeon, Byungyool; Park, Eun-Cheol

    2016-01-01

    Objective In October 2013, the South Korean government introduced an incentive programme to increase the availability of Saturday treatment at clinics, hoping to increase the role of primary care providers as gatekeepers to medical care. To the best of our knowledge, no one has yet investigated this programme's effect on overall outpatient care. Our study aims to analyse the change in Saturday outpatient volume and billings in clinics that adopted the Saturday incentive programme. Setting Our study used 3 types of data from the period October 2012 to March 2014: National Health Insurance Service (NHIS) claims data, hospital evaluation data and medical institution data. Participants These data consisted of 66 825 881 outpatient cases from 2837 clinics. Interventions Introducing the Saturday incentive programme. Outcome measure We performed a multilevel analysis that adjusted for clinic-level and outpatient-level variables to examine the difference in the percentage of Saturday outpatient volume and billings after introducing the Saturday incentive programme. Results The percentages of Saturday outpatient volume and billings were higher after introducing the programme (outpatient volume: β=2.065, p<0.001; outpatient billings: β=3.518, p<0.001). In addition, outpatient volume and billings on Friday and Saturday increased after introducing the programme, while those on weekdays, excluding Friday, decreased. Conclusions Our findings suggest that the Saturday incentive programme has affected clinic outpatient care and is a worthwhile health policy in terms of promoting primary care. Thus, it may improve healthcare accessibility and quality of care, and prevent inappropriate usage such as emergency room visits by providing patients with weekend clinic hours. PMID:27288380

  9. Treatment of pregnancy-related pelvic girdle and/or low back pain after delivery design of a randomized clinical trial within a comprehensive prognostic cohort study [ISRCTN08477490

    Directory of Open Access Journals (Sweden)

    Klabbers Aldegonda BA

    2004-12-01

    Full Text Available Abstract Background Pregnancy-related pelvic girdle and/or low back pain is a controversial syndrome because insight in etiology and prognosis is lacking. The controversy relates to factors eliciting pain and some prognostic factors such as the interpretation of pain at the symphysis. Recent research about treatment strategies also reflects those various opinions, in fact suggesting there is professional uncertainty about the optimal approach. Currently, physiotherapists often prescribe a pain-contingent treatment regime of relative rest and avoiding several day-to-day activities. Additionally, treatment more often includes an exercise program to guide rectification of the muscle imbalance and alignment of the pelvic girdle. Effectiveness of those interventions is not proven and the majority of the studies are methodologically flawed. Investigators draw particular attention to biomedical factors but there is growing evidence that important prognostic issues such as biopsychosocial factors appear to be even more important as point of action in a treatment program. Methods/design This pragmatic randomized controlled trial is designed to evaluate the effectiveness of a tailor-made treatment program with respect to biopsychosocial factors in primary care. The effect of the experimental intervention and usual care are evaluated as they are applied in primary health care. The trial is embedded in a cohort study that is designed as a longitudinal, prospective study, which studies prevalence, etiology, severity and prognosis during pregnancy until one year after delivery. The present paper focuses on choices regarding recruitment procedures, in-/exclusion criteria and the development of a well-timed intervention. Discussion This section briefly discusses the actions taken to minimize bias in the design, the proper time-window for the experimental intervention and the contrast between the experimental intervention and usual care.

  10. Satisfaction with primary care and mental health care among individuals with severe mental illness in a rural area: a seven-year follow-up study of a clinical cohort

    OpenAIRE

    Ruud, Torleif; Aarre, Trond F.; Boeskov, Berit; le Husevåg, Per Stå; Klepp, Rigmor; Kristiansen, Synnøve Alet; Sandvik, Jorunn

    2016-01-01

    Background Most studies of services for people with severe mental illness have been performed in cities. Our 7-year follow-up study aimed to investigate clinical course and satisfaction with services among individuals with severe mental illness who received community mental health services in a rural area. The services were provided by primary care and a community mental health center (CMHC), which worked in close collaboration and emphasized individually tailored case management, relationshi...

  11. Prolactinomas : clinical studies

    NARCIS (Netherlands)

    Kars, Marleen

    2008-01-01

    Prolactinoma are treated with dopamine agonists, which are effective in reducing prolactin and tumor size. Studies reporting clinical and radiological outcome are scarce. The study described in chapter 2, assesses long-term outcome in patients treated with dopamine agonists for macroprolactinoma. An

  12. DEMOGRAPHICAL, VIRO-IMMUNOLOGICAL, CLINICAL AND THERAPEUTICAL CHARACTERISTICS OF HIV INFECTED PATIENTS IN A “EPIDEMIOLOGICALLY UNEXPLORED” REGION OF ITALY (CALABRIA REGION: THE CALABRHIV COHORT.

    Directory of Open Access Journals (Sweden)

    Maria Concetta Postorino

    2015-10-01

    Full Text Available Background and Objectives   HIV epidemics may differ among epidemiological contexts. We aimed at constructing an HIV clinical cohort whose main epidemiological, clinical and therapeutical characteristics are described (the CalabrHIV cohort, Calabria Region, Southern Italy.   Methods   The CalabrHIV cohort includes all HIV patients on active follow-up in all infectious disease centers in the Calabria Region as at October 2014. All information were recorded in a common electronic database. Not-infectious co-morbidities (such as cardiovascular diseases, bone fractures, diabetes, renal failure and hypertension were also studied.   Results   548 patients (68% males; 63% aged 50 years-old patients than in <50 years-old ones (30% vs. 6%; p<0.0001. Co-morbidity was more frequent in HCV and/or HBV co-infected than in HIV mono-infected patients (46.6% vs. 31.7%: p=0.0006.   Conclusion   This cohort presentation study sheds light, for the first time, on HIV patients’ characteristics in the Calabria Region. Despite a small number of officially reported cases, the size of the cohort was substantial. We showed that HIV infected patients with chronic hepatites, were affected by concomitant not-infectious co-morbidities more than the HIV mono-infected individuals. New HCV treatments are eagerly awaited.

  13. Changing relationships between smoking and psychiatric disorders across twentieth century birth cohorts: clinical and research implications.

    Science.gov (United States)

    Talati, A; Keyes, K M; Hasin, D S

    2016-04-01

    As the risks of tobacco use become recognized and smoking becomes stigmatized, new smokers may be increasingly driven to smoke by biological or genetic vulnerabilities rather than social desirability. Given that genetic risk for deviant proneness is shared across other psychiatric and addictive disorders, we predicted that as rates of smoking decreased through the latter half of the twentieth century, associations between smoking and psychopathology would increase. Participants (N=25 412) from a large US study-the National Epidemiologic Survey on Alcohol and Related Conditions, NESARC-were interviewed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule - DSM-IV Version (AUDADIS-IV) and classified into one of five birth cohort decades (1940s to 1980s) and three smoking history (nonsmokers, never-dependent smokers and ever-dependent smokers) groups. We found that the prevalence of smoking decreased across the five birth cohorts, but associations of smoking with drug and AUDs, attention-deficit hyperactivity disorder, bipolar disorder and antisocial personality disorder, each increased monotonically in more recently born cohorts, even after adjusting for concurrent demographic and socioeconomic changes. For drug and AUDs, increases were observed among smokers both with and without a history of nicotine dependence; for other outcomes, increases were entirely driven by nicotine-dependent smokers. Findings suggest that smokers in more recent cohorts have disproportionately high psychiatric vulnerability, and may benefit from greater mental health screenings. Differentiating between casual and dependent smokers may further help prioritize those at greatest risk. Researchers should also be aware of potential variation in psychiatric comorbidity based on cohort of birth when defining groups of smokers, to minimize confounding. PMID:26809837

  14. Good clinical practice in clinical interventional studies

    OpenAIRE

    Pieterse, Herman; Diamant, Zuzana

    2014-01-01

    Good clinical practice (GCP) guidelines should always be implemented and obeyed in clinical interventional studies. In this mini-review, we will address several burning questions relating to GCP in a concise ‘frequently asked questions’ format.While compliance to current rules and regulations is our mission, we also wish to play devil’s advocate attempting to translate the rules into sizeable chunks using a high dose of common sense.Keywords: clinical interventional studies; quality; safety; ...

  15. Reproductive Factors and Kidney Cancer Risk in 2 US Cohort Studies, 1993–2010

    Science.gov (United States)

    Karami, Sara; Daugherty, Sarah E.; Schonfeld, Sara J.; Park, Yikyung; Hollenbeck, Albert R.; Grubb, Robert L.; Hofmann, Jonathan N.; Chow, Wong-Ho; Purdue, Mark P.

    2013-01-01

    Clinical and experimental findings suggest that female hormonal and reproductive factors could influence kidney cancer development. To evaluate this association, we conducted analyses in 2 large prospective cohorts (the National Institutes of Health–AARP Diet and Health Study (NIH-AARP), 1995–2006, and the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO), 1993–2010). Cohort-specific and aggregated hazard ratios and 95% confidence intervals relating reproductive factors and kidney cancer risk were computed by Cox regression. The analysis included 792 incident kidney cancer cases among 283,952 postmenopausal women. Women who had undergone a hysterectomy were at a significantly elevated kidney cancer risk in both NIH-AARP (hazard ratio = 1.28, 95% confidence interval: 1.09, 1.50) and PLCO (hazard ratio = 1.41, 95% confidence interval: 1.06, 1.88). Similar results were observed for both cohorts after analyses were restricted to women who had undergone a hysterectomy with or without an oophorectomy. For the NIH-AARP cohort, an inverse association was observed with increasing age at menarche (P for trend = 0.02) and increasing years of oral contraceptive use (P for trend = 0.02). No clear evidence of an association with parity or other reproductive factors was found. Our results suggest that hysterectomy is associated with increased risk of kidney cancer. The observed associations with age at menarche and oral contraceptive use warrant further investigation. PMID:23624999

  16. Existing data sources for clinical epidemiology: Danish Cancer in Primary Care cohort

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    Jensen H

    2014-07-01

    Full Text Available Henry Jensen,1,2 Marie Louise Tørring,1 Mette Bach Larsen,3 Peter Vedsted11Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care, 2Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus C, 3Department of Public Health Programs, Randers Regional Hospital, Randers NOE, Denmark Background: In this paper, we describe the settings, content, and possibilities of the Danish Cancer in Primary Care (CaP cohort as well as some of the key findings so far. Further, we describe the future potential of the cohort as an international resource for epidemiological and health services research studies. Methods: The CaP cohort comprises information from three Danish subcohorts set up in 2004–2005, 2007–2008, and 2010 on newly diagnosed cancer patients aged 18 years or older. General practitioner (GP-reported and patient-reported data from six questionnaires generated information on causes and consequences of delayed diagnosis of cancer, and these data were supplemented with complete information on, eg, death, migration, health care utilization, medication use, and socioeconomic data from Denmark's comprehensive health and administrative registers. The cohort is followed up in terms of emigration, death, hospitalization, medication, and socioeconomics, and data are updated regularly. Results: In total, we identified 22,169 verified incident cancer cases. Completed GP questionnaires were returned for 17,566 (79% of the verified cases, and patient questionnaires were completed by 8,937 (40% respondents. Patients with participating GPs did not differ from patients with nonparticipating GPs in regard to one-year survival, comorbidity, or educational level. However, compared with nonparticipating GPs, patients listed with participating GPs were more likely to be women, younger, to have a higher disposable income, to have more regional or distant spread of tumors, were also more likely to have

  17. Vegetarianism, low meat consumption and the risk of colorectal cancer in a population based cohort study

    NARCIS (Netherlands)

    Gilsing, A.M.J.; Schouten, L.J.; Goldbohm, R.A.; Dagnelie, P.C.; Brandt, P.A. van den; Weijenberg, M.P.

    2015-01-01

    To study how a vegetarian or low meat diet influences the risk of colorectal cancer compared to a high meat diet, and to assess the explanatory role of factors associated with these diets. In the Netherlands Cohort Study – Meat Investigation Cohort (NLCS-MIC) (cohort of 10,210 individuals including

  18. A Canadian naturalistic study of a community-based cohort treated for bipolar disorder

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    Chandresena Ranjith

    2010-03-01

    Full Text Available Abstract Background Bipolar illness is associated with significant psychosocial morbidity and health resource utilization. Second generation antipsychotics, used alone or in combination with mood stabilizers are effective in treating acute mania in community settings. This study was designed to compare the change in clinical parameters and resource utilization at one month in a group of patients who required treatment intervention for exacerbation of mania. The clinical response at one year was also evaluated. Methods 496 patients were enrolled at 75 psychiatric practices across Canada. The Olanzapine cohort (n = 287 included patients who had olanzapine added to their medication regimen or the dose of olanzapine increased. The Other cohort (n = 209 had a medication other than olanzapine added or the dose adjusted. Changes from baseline in the Young Mania Rating Scale (YMRS, Montgomery Asberg Depression Rating Scale, Beck Anxiety Inventory and SF-12 Health Survey were compared at one month using ANCOVA. Categorical variables at one month for health resource utilization, employment status, abuse/dependency, and the number of suicide attempts were compared using Fisher's Exact test. Patients were followed for one year and a subgroup was evaluated. Results At one month, patients in the Olanzapine cohort recorded a mean reduction in the YMRS of 11.5, significantly greater than the mean reduction in the Other cohort of 9.7 (ANCOVA P = 0.002. The Olanzapine cohort was significantly improved compared to the Other cohort on the scales for depression and anxiety and did not experience the deterioration in physical functioning seen in the Other cohort. No significant differences were detected in health-related quality-of-life measures, employment status, drug abuse/dependency, number of suicide attempts, mental functioning, emergency room visits or inpatient psychiatric hospitalizations. In a subgroup treated for 12 months with a single second generation

  19. Prolactinomas: clinical studies

    OpenAIRE

    Kars, Marleen

    2008-01-01

    Prolactinoma are treated with dopamine agonists, which are effective in reducing prolactin and tumor size. Studies reporting clinical and radiological outcome are scarce. The study described in chapter 2, assesses long-term outcome in patients treated with dopamine agonists for macroprolactinoma. An increased risk of cardiac valve disease has been reported in patients treated with cabergoline for Parkinson’s disease. Stimulation of serotonin receptors on cardiac valves by dopamine agonists re...

  20. Virologic and immunologic effectiveness of darunavir-based salvage therapy in HIV-1-infected adults in a Brazilian clinical practice setting: results of a multicenter and retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Karina Mota Ribeiro

    2014-01-01

    Full Text Available Background: Darunavir has been proven efficacious for antiretroviral-experienced HIV-1-infected patients in randomized trials. However, effectiveness of darunavir-based salvage therapy is understudied in routine care in Brazil. Methods: Retrospective cohort study of HIV-1-infected patients from three public referral centers in Belo Horizonte, who received a darunavir-based therapy between 2008 and 2010, after virologic failure. Primary endpoint was the proportion of patients with viral load <50 copies/mL at week 48. Change in CD4 cell count was also evaluated. Outcome measures were analyzed on an intent-to-treat basis applied to observational studies. Sensitivity analysis was conducted to evaluate the impact of missing data at week 48. Predictors of virologic failure were examined using rare-event, finite sample, bias-corrected logistic regression. Results: Among 108 patients, the median age was 44.2 years, and 72.2% were male. They had long-standing HIV-1 infection (median 11.6 years and advanced disease (76.9% had an AIDS-defining event. All patients had previously received protease inhibitors and nucleoside reverse transcriptase inhibitors, 75% nonnucleoside reverse transcriptase inhibitors, and 4.6% enfuvirtide. The median length of protease inhibitor use was 8.9 years, and 90.8% of patients had prior exposure to unboosted protease inhibitor. Genotypic resistance profile showed a median of three primary protease inhibitor mutations and 10.2% had three or more darunavir resistance-associated mutations. Virologic success at week 48 was achieved by 78.7% (95% CI = 69.7–86% of patients and mean CD4 cell count increase from baseline was 131.5 cells/μL (95% CI = 103.4–159.6. In multiple logistic regression analysis, higher baseline viral load (RR = 1.04 per 10,000 copies/mL increase; 95% CI = 1.01–1.09 and higher number of darunavir resistance-associated mutations (RR = 1.23 per each; 95% CI = 0.95–1.48 were independently associated with

  1. Obstetric risk indicators for labour dystocia in nulliparous women: a multi-centre cohort study

    DEFF Research Database (Denmark)

    Kjaergaard, H.; Olsen, J.; Ottesen, Bent Smedegaard;

    2008-01-01

    BACKGROUND: In nulliparous women dystocia is the most common obstetric problem and its etiology is largely unknown. The frequency of augmentation and cesarean delivery related to dystocia is high although it is not clear if a slow progress justifies the interventions. Studies of risk factors for...... dystocia often do not provide diagnostic criteria for the diagnosis. The aim of the present study was to identify obstetric and clinical risk indicators of dystocia defined by strict and explicit criteria. METHODS: A multi-centre population based cohort study with prospectively collected data from 2810...

  2. The origins of a research community in the Majengo observational cohort study, Nairobi, Kenya

    Directory of Open Access Journals (Sweden)

    Lavery James V

    2010-10-01

    Full Text Available Abstract Background Since the 1980s the Majengo Observational Cohort Study (MOCS has examined sexually transmitted infections, in particular HIV/AIDS, in a cohort of sex workers in Majengo, an impoverished urban village in Nairobi, Kenya. The MOCS investigators have faced criticism since the women have remained in the sex trade for the duration of their participation in the study, prompting concerns about exploitation. Yet despite these concerns, the cohort has survived for almost 30 years. Methods In this retrospective qualitative case study, we examine the community engagement practices of the MOCS and explore the factors that account for its durability. Results Women in sex work in Kenya were a highly stigmatized and disfranchised community. As a result, there was no natural 'community' of sex workers either in Nairobi or in the Majengo village. The Majengo clinic aimed to reduce the barriers to health care the women experienced at the STC clinic by bringing the services closer to them and by providing a non-discriminatory environment. The women acknowledged the fact they had hoped their participation in the MOCS would have helped them find a path out of the sex trade. But our findings also add another dimension to this debate, since every cohort member we interviewed expressed her gratitude for the deep impact the MOCS has had on her life, much of it beyond the improved health status made possible by access to quality healthcare services. Participation in the MOCS has improved and enriched their lives. The CE activities have played a central role in creating a community that did not exist independently of the MOCS. Conclusions Our case study identified 3 distinct phases of community engagement in the MOCS: (1 reaching out: mobilization, dialogue and education; (2 foundations of trust through relationships of care; and (3 leveraging existing social capital to form a cohort community. The findings demonstrate the importance of some of the less

  3. A comparative study of mPCR, MLPA, and muscle biopsy results in a cohort of children with Duchenne muscular dystrophy: A first study

    Directory of Open Access Journals (Sweden)

    M Manjunath

    2015-01-01

    Conclusions: This is the first study from India and possibly in English literature, comparing the sensitivity and pattern of mutations by both mPCR and MLPA in the same cohort of DMD. It further validates that 36.4% of MLPA-negative cases were confirmed to have DMD by IHC. The clinical accuracy has been very high in our cohort. MLPA-negative samples should be subjected for next-generation sequencing before contemplating a biopsy.

  4. Differences in injury pattern and prevalence of cartilage lesions in knee and ankle joints: a retrospective cohort study

    OpenAIRE

    Matthias Aurich; Hofmann, Gunther O; Bernd Rolauffs; Florian Gras

    2014-01-01

    Osteoarthritis (OA) is more common in the knee compared to the ankle joint. This can not be explained exclusively by anatomical and biomechanical differences. The aim of this study is to analyze and compare the injury pattern (clinically) and the cartilage lesions (arthroscopically) of knee and ankle joints in a cohort of patients from the same catchment area. A retrospective study of the clinical data of 3122 patients (2139 outpatients and 983 inpatients) was performed, who were treated due ...

  5. HIV-infected individuals who delay, decline, or discontinue antiretroviral therapy: Comparing clinic- and peer-recruited cohorts

    Directory of Open Access Journals (Sweden)

    Marya eGwadz

    2014-07-01

    Full Text Available A substantial proportion of persons living with HIV/AIDS (PLHA delay, decline, or discontinue antiretroviral therapy (ART when it is medically indicated (40-45%, largely African Americans and Latinos/Hispanics. This study explores the feasibility of locating PLHA who are not on ART (PLHA-NOA through clinics and peer referral; compares the two cohorts on multi-level barriers to ART; and examines readiness to initiate/reinitiate ART, a predictor of treatment outcomes. We recruited adult HIV-infected African American and Latino/Hispanic PLHA-NOA through HIV hospital clinics and peer referral in 2012-13. Participants engaged in structured one-hour assessments with reliable/valid measures on barriers to ART. We found recruitment through peers (63.2%, 60/95 was more feasible than in clinics (36.8%, 35/90. Participants were 48.0 years old and had lived with HIV for 14.7 years on average, and 56.8% had taken ART previously. Most (61.1% were male and African American (76.8%, and 23.2% were Latino/Hispanic. Peer-recruited participants were older, had lived with HIV longer, were less engaged in HIV care, and were more likely to have taken ART previously. The cohorts differed in reasons for discontinuing ART. Levels of ART knowledge were comparable between cohorts (68.5% correct, and there were no differences in attitudes toward ART (e.g., mistrust, which were in the neutral range. In bivariate linear regression, readiness for ART was negatively associated with physician mistrust (B=-10.4, and positively associated with self-efficacy (B=5.5, positive outcome expectancies (B=6.3, beliefs about personal necessity of ART (B=17.5, and positive internal norms (B=7.9. The present study demonstrates the feasibility of engaging this vulnerable population through peer referral. Peer-recruited PLHA evidence particularly high rates of risk factors compared those in clinics. Interventions to support ART initiation and continuation are sorely needed for both subgroups.

  6. Familial risk of venous thromboembolism: a nationwide cohort study

    DEFF Research Database (Denmark)

    Sørensen, H T; Riis, A H; Diaz, L J;

    2011-01-01

    Background: Venous thromboembolism has genetic determinants, but population-based data on familial risks are limited. Objectives: To examine the familial risk of venous thromboembolism. Methods: We undertook a nationwide study of a cohort of patients with deep venous thrombosis or pulmonary...... expected number of venous thromboembolism cases among siblings, using population-specific, gender-specific and age-specific incidence rates. Results: We identified 30 179 siblings of 19 599 cases of venous thromboembolism. The incidence among siblings was 2.2 cases per 1000 person-years, representing a...... with pulmonary embolism. Conclusion: Venous thromboembolism has a strong familial component....

  7. Serum YKL-40 and gestational diabetes - an observational cohort study

    DEFF Research Database (Denmark)

    Gybel-Brask, Dorte; Johansen, Julia S; Christiansen, Ib J;

    2016-01-01

    To examine serum YKL-40 in women developing gestational diabetes mellitus (GDM). In the present large observational cohort study of 1179 pregnant women, we determined serum YKL-40 four times during pregnancy (at gestational age 12, 20, 25, and 32 weeks). Pregnancy outcome was obtained from medical...... records. Sixty-eight women (5.8%) developed GDM. Serum YKL-40 increased from gestational age (GA) 12 weeks and the following weeks in the women who developed GDM and was independent of BMI, parity, and maternal age (OR = 2.69, 95% CI: 1.45-5.00, p = 0.002). No association was found between serum YKL-40...

  8. Psychosocial work environment and antidepressant medication: a prospective cohort study

    DEFF Research Database (Denmark)

    Bonde, Jens Peter; Munch-Hansen, T.; Wieclaw, J.;

    2009-01-01

    antidepressant medication. METHODS: Information on all antidepressant drugs (AD) purchased at pharmacies from 1995 through 2006 was obtained for a cohort of 21,129 Danish public service workers that participated in work climate surveys carried out during the period 2002-2005. Individual self-reports of...... alone. None of the measured psychosocial work environment factors were consistently related to prescription of antidepressant drugs during the follow-up period. CONCLUSION: The study does not indicate that a poor psychosocial work environment among public service employees is related to prescription of...... antidepressant pharmaceuticals. These findings need cautious interpretation because of lacking individual exposure assessments Udgivelsesdato: 2009...

  9. Pathways to the diagnosis of lung cancer in the UK: a cohort study

    Directory of Open Access Journals (Sweden)

    Barrett Jacqueline

    2008-05-01

    Full Text Available Abstract Background Lung cancer is the commonest cause of cancer death in the UK. Patients generally present to their general practitioner, but the pathway of diagnosis from first symptom to diagnosis has not been mapped. We performed a cohort study of 246 patients with lung cancer in Exeter, Devon UK. All patients had their cancer symptoms, referrals and diagnoses identified and dated using their doctors' records. Results Three main routes to diagnosis emerged. The first was the expected route of outpatient referral; 150 (61% of the cohort of patients took this route, although only 110 (45% of the whole cohort, 73% of those referred to outpatients were referred to a respiratory department. 56 (23% were admitted as an emergency, having previously described a lung cancer symptom to their doctor. 26 patients (11% had no symptom of lung cancer reported before their diagnosis. The interval from first symptom to referral was similar across the different pathways. However, the referral to diagnosis interval was longer in patients misdirected to other outpatient departments (66 days, interquartile range 37,110 than those sent to respiratory clinics (29 days, 17,61 or admitted as an emergency (16 days 8,40; p Conclusion Only a minority of lung cancer patients follow the traditional route to diagnosis. Clinical and research efforts need to consider the alternative routes if they are to maximise their impact on speed of diagnosis.

  10. Systematically missing confounders in individual participant data meta-analysis of observational cohort studies

    DEFF Research Database (Denmark)

    Jackson, D.; White, I.; Kostis, J.B.;

    2009-01-01

    One difficulty in performing meta-analyses of observational cohort studies is that the availability of confounders may vary between cohorts, so that some cohorts provide fully adjusted analyses while others only provide partially adjusted analyses. Commonly, analyses of the association between an...

  11. Disease activity in pregnant women with Crohn's disease and birth outcomes: a regional Danish cohort study

    DEFF Research Database (Denmark)

    Nørgård, Bente; Hundborg, Heidi H; Jacobsen, Bent Ascanius;

    2007-01-01

    OBJECTIVES: CD is associated with increased risk of adverse birth outcomes, but existing studies have not assessed the impact of disease activity during pregnancy. We examined the impact of disease activity on birth outcomes: LBW, preterm birth, LBW at term, and CAs. METHODS: All births by CD women...... of clinical details (including disease activity and drug therapy during pregnancy). The exposed cohort (N = 71) constituted pregnancies with low/moderate-high disease activity during pregnancy, and the unexposed cohort (N = 86) those with inactive disease. Logistic regression analyses were used to...... estimate the adjusted relative risks (with 95% confidence intervals) for adverse birth outcomes associated with disease activity in CD pregnancies. In subanalysis, we examined the impact of moderate-high activity. RESULTS: In women with disease activity, the adjusted risks of LBW, LBW at term, preterm...

  12. Limited patient adherence to highly active antiretroviral therapy for HIV-1 infection in an observational cohort study

    NARCIS (Netherlands)

    Nieuwkerk, PT; Sprangers, MAG; Burger, DM; Hoetelmans, RMW; Hugen, PWH; Danner, SA; van der Ende, Marchina E.; Schneider, MME; Schrey, G; Meenhorst, PL; Sprenger, HG; Kauffmann, RH; Jambroes, M; Chesney, MA; de Wolf, F; Lange, JMA

    2001-01-01

    Background: Adherence to highly active antiretroviral therapy (HAART) for human immunodeficiency syndrome type 1 (HIV-1) infection is essential to sustain viral suppression and prevent drug resistance. We investigated adherence to HAART among patients in a clinical cohort study. Methods: Patients re

  13. CLINICAL PRESENTATION AND ASSOCIATION AMONG TUBERCULOSIS PATIENTS; COHORT COMPARISON BETWEEN SMOKERS VERSUS NEVER-SMOKE IN PENANG, MALAYSIA

    OpenAIRE

    Wasif Gillani. S; Juman Abdulelah Ali; Syed Azhar Syed Sulaiman

    2011-01-01

    We aimed to compare the demographic and clinical characteristics with risk determination of TB patients who were smokers vs. non-smokers. The retrospective, observational & cross-sectional cohort survey was done to compare disease characteristic and clinical presentation during treatment of TB. Cluster random sampling employed in Chest Clinic of Penang General Hospital from January/2006 to June/2008. Statistical test were used with p-value ≤ 0.05 were considered statistically significant at 9...

  14. Clinical outcomes in low risk coronary artery disease patients treated with different limus-based drug-eluting stents--a nationwide retrospective cohort study using insurance claims database.

    Directory of Open Access Journals (Sweden)

    Chao-Lun Lai

    Full Text Available The clinical outcomes of different limus-based drug-eluting stents (DES in a real-world setting have not been well defined. The aim of this study was to investigate the clinical outcomes of three different limus-based DES, namely sirolimus-eluting stent (SES, Endeavor zotarolimus-eluting stent (E-ZES and everolimus-eluting stent (EES, using a national insurance claims database. We identified all patients who received implantation of single SES, E-ZES or EES between January 1, 2007 and December 31, 2009 from the National Health Insurance claims database, Taiwan. Follow-up was through December 31, 2011 for all selected clinical outcomes. The primary end-point was all-cause mortality. Secondary end-points included acute coronary events, heart failure needing hospitalization, and cerebrovascular disease. Cox regression model adjusting for baseline characteristics was used to compare the relative risks of different outcomes among the three different limus-based DES. Totally, 6584 patients were evaluated (n=2142 for SES, n=3445 for E-ZES, and n=997 for EES. After adjusting for baseline characteristics, we found no statistically significant difference in the risk of all-cause mortality in three DES groups (adjusted hazard ratio [HR]: 1.14, 95% confidence interval [CI]: 0.94-1.38, p=0.20 in E-ZES group compared with SES group; adjusted HR: 0.77, 95% CI: 0.54-1.10, p=0.15 in EES group compared with SES group. Similarly, we found no difference in the three stent groups in risks of acute coronary events, heart failure needing hospitalization, and cerebrovascular disease. In conclusion, we observed no difference in all-cause mortality, acute coronary events, heart failure needing hospitalization, and cerebrovascular disease in patients treated with SES, E-ZES, and EES in a real-world population-based setting in Taiwan.

  15. Nested Cohort

    Science.gov (United States)

    NestedCohort is an R software package for fitting Kaplan-Meier and Cox Models to estimate standardized survival and attributable risks for studies where covariates of interest are observed on only a sample of the cohort.

  16. Early co-occurrence of a neurologic-psychiatric disease pattern in Niemann-Pick type C disease: a retrospective Swiss cohort study

    OpenAIRE

    Abela, Lucia; Plecko, Barbara; Palla, Antonella; Burda, Patricie; Nuoffer, Jean-Marc; Ballhausen, Diana; Rohrbach, Marianne

    2014-01-01

    Background Niemann-Pick disease type C (NP-C) is a rare autosomal recessive disorder of lysosomal cholesterol transport. The objective of this retrospective cohort study was to critically analyze the onset and time course of symptoms, and the clinical diagnostic work-up in the Swiss NP-C cohort. Methods Clinical, biochemical and genetic data were assessed for 14 patients derived from 9 families diagnosed with NP-C between 1994 and 2013. We retrospectively evaluated diagnostic delays and perio...

  17. Association between Sjogren's syndrome and respiratory failure: put airway, interstitia, and vessels close together: a national cohort study.

    Directory of Open Access Journals (Sweden)

    Jun-Jun Yeh

    Full Text Available OBJECTIVES: Few studies have evaluated the association between Sjogren's syndrome (SS and respiratory failure (RF. Thus, we conducted a retrospective national cohort study to investigate whether Sjogren's syndrome (SS increases the risk of respiratory failure (RF. METHODS: The cohort consisted of 4954 newly diagnosed patients with SS but without a previous diagnosis of RF, and 19816 patients as the comparison cohort from the catastrophic illnesses registry, obtained from the 2000-2005 period. All of the study participants were followed from the index date to December 31, 2011. We analyzed the association between the risk of RF and SS by using a Cox proportional hazards regression model, controlling for sex, age, and comorbidities. RESULTS: The overall incidence rate of RF showed a 3.21-fold increase in the SS cohort compared with the comparison cohort. The adjusted HR of RF was 3.04 for the SS cohort compared with the comparison cohort, after we adjusted for sex, age, and comorbidities. The HRs of RF for patients with primary SS and secondary SS compared with the comparison cohort were 2.99 and 3.93, respectively (P for trend <.001. The HRs of RF increased as the severity of SS increased, from 2.34 for those with no inpatient care experience to 5.15 for those with inpatient care experience (P for trend <.001. CONCLUSION: This study indicates that clinical physicians should not only consider secondary SS but also primary SS as a critical factor that increases the risk of RF.

  18. The WISTAH hand study: A prospective cohort study of distal upper extremity musculoskeletal disorders

    OpenAIRE

    Garg Arun; Hegmann Kurt T; Wertsch Jacqueline J; Kapellusch Jay; Thiese Matthew S; Bloswick Donald; Merryweather Andrew; Sesek Richard; Deckow-Schaefer Gwen; Foster James; Wood Eric; Kendall Richard; Sheng Xiaoming; Holubkov Richard

    2012-01-01

    Abstract Background Few prospective cohort studies of distal upper extremity musculoskeletal disorders have been performed. Past studies have provided somewhat conflicting evidence for occupational risk factors and have largely reported data without adjustments for many personal and psychosocial factors. Methods/design A multi-center prospective cohort study was incepted to quantify risk factors for distal upper extremity musculoskeletal disorders and potentially develop improved methods for ...

  19. The High Prevalence of Diabetes in a Large Cohort of Patients Drawn From Safety Net Clinics

    Science.gov (United States)

    McBurnie, MaryAnn; Paul, Ludmilla; Potter, Jennifer E.; McCann, Sheila; Mayer, Kenneth; Melgar, Gerardo; D’Amato, Sele; DeVoe, Jennifer E.

    2016-01-01

    Introduction Underserved populations have been overlooked or underrepresented in research based on data from diabetes registries. We estimated diabetes prevalence using a cohort developed from the electronic health records of 3 networks of safety net clinics that provide care to underserved populations. Methods ADVANCE (Accelerating Data Value Across a National Community Health Center Network) is a partnership of the OCHIN Community Health Information Network (OCHIN), the Health Choice Network (HCN), and the Fenway Health Institute (FHI), representing 97 federally qualified health centers (FQHCs) and 744 clinic sites in 22 US states. Among 952,316 adults with a body mass index (BMI) measurement and at least 2 outpatient visits in 2012 to 2014, we calculated diabetes prevalence using outpatient diagnoses, diagnostic laboratory results, or dispenses of anti-hyperglycemic agents no more than 730 days apart. We calculated prevalence by age, sex, race, Hispanic ethnicity, and BMI class. Results The crude prevalence of diabetes was 14.4%. Men had a higher prevalence than women (16.5% vs 13.2%); diabetes prevalence increased across age categories. White patients had the lowest prevalence (11.4%) and Hawaiian/Pacific Islanders, the highest prevalence (21.9%), with prevalence ranging from 15.2% to 16.5% for other race/ethnicities. The association between BMI class and diabetes prevalence was similar across all racial/ethnic groups. Conclusion The ADVANCE diabetes cohort offers an opportunity to conduct epidemiologic and comparative effectiveness research on underserved and underrepresented individuals, who have a higher prevalence of diabetes than the general US population. PMID:27309415

  20. Amyloid PET in European and North American cohorts; and exploring age as a limit to clinical use of amyloid imaging

    Energy Technology Data Exchange (ETDEWEB)

    Chiotis, Konstantinos [Karolinska Institutet, Department of NVS, Center for Alzheimer Research, Translational Alzheimer Neurobiology, Stockholm (Sweden); Carter, Stephen F. [Karolinska Institutet, Department of NVS, Center for Alzheimer Research, Translational Alzheimer Neurobiology, Stockholm (Sweden); University of Manchester, Wolfson Molecular Imaging Centre, Institute of Brain, Behaviour and Mental Health, Manchester (United Kingdom); Farid, Karim [Karolinska Institutet, Department of NVS, Center for Alzheimer Research, Translational Alzheimer Neurobiology, Stockholm (Sweden); APHP, Hotel-Dieu Hospital, Department of Nuclear Medicine, Paris (France); Savitcheva, Irina [Karolinska University Hospital Huddinge, Department of Radiology, Stockholm (Sweden); Nordberg, Agneta [Karolinska Institutet, Department of NVS, Center for Alzheimer Research, Translational Alzheimer Neurobiology, Stockholm (Sweden); Karolinska University Hospital Huddinge, Department of Geriatric Medicine, Stockholm (Sweden); Collaboration: for the Diagnostic Molecular Imaging (DiMI) network and the Alzheimer' s Disease Neuroimaging Initiative

    2015-09-15

    Several radiotracers that bind to fibrillar amyloid-beta in the brain have been developed and used in various patient cohorts. This study aimed to investigate the comparability of two amyloid positron emission tomography (PET) tracers as well as examine how age affects the discriminative properties of amyloid PET imaging. Fifty-one healthy controls (HCs), 72 patients with mild cognitive impairment (MCI) and 90 patients with Alzheimer's disease (AD) from a European cohort were scanned with [11C]Pittsburgh compound-B (PIB) and compared with an age-, sex- and disease severity-matched population of 51 HC, 72 MCI and 84 AD patients from a North American cohort who were scanned with [18F]Florbetapir. An additional North American population of 246 HC, 342 MCI and 138 AD patients with a Florbetapir scan was split by age (55-75 vs 76-93 y) into groups matched for gender and disease severity. PET template-based analyses were used to quantify regional tracer uptake. The mean regional uptake patterns were similar and strong correlations were found between the two tracers across the regions of interest in HC (ρ = 0.671, p = 0.02), amyloid-positive MCI (ρ = 0.902, p < 0.001) and AD patients (ρ = 0.853, p < 0.001). The application of the Florbetapir cut-off point resulted in a higher proportion of amyloid-positive HC and a lower proportion of amyloid-positive AD patients in the older group (28 and 30 %, respectively) than in the younger group (19 and 20 %, respectively). These results illustrate the comparability of Florbetapir and PIB in unrelated but matched patient populations. The role of amyloid PET imaging becomes increasingly important with increasing age in the diagnostic assessment of clinically impaired patients. (orig.)

  1. Amyloid PET in European and North American cohorts; and exploring age as a limit to clinical use of amyloid imaging

    International Nuclear Information System (INIS)

    Several radiotracers that bind to fibrillar amyloid-beta in the brain have been developed and used in various patient cohorts. This study aimed to investigate the comparability of two amyloid positron emission tomography (PET) tracers as well as examine how age affects the discriminative properties of amyloid PET imaging. Fifty-one healthy controls (HCs), 72 patients with mild cognitive impairment (MCI) and 90 patients with Alzheimer's disease (AD) from a European cohort were scanned with [11C]Pittsburgh compound-B (PIB) and compared with an age-, sex- and disease severity-matched population of 51 HC, 72 MCI and 84 AD patients from a North American cohort who were scanned with [18F]Florbetapir. An additional North American population of 246 HC, 342 MCI and 138 AD patients with a Florbetapir scan was split by age (55-75 vs 76-93 y) into groups matched for gender and disease severity. PET template-based analyses were used to quantify regional tracer uptake. The mean regional uptake patterns were similar and strong correlations were found between the two tracers across the regions of interest in HC (ρ = 0.671, p = 0.02), amyloid-positive MCI (ρ = 0.902, p < 0.001) and AD patients (ρ = 0.853, p < 0.001). The application of the Florbetapir cut-off point resulted in a higher proportion of amyloid-positive HC and a lower proportion of amyloid-positive AD patients in the older group (28 and 30 %, respectively) than in the younger group (19 and 20 %, respectively). These results illustrate the comparability of Florbetapir and PIB in unrelated but matched patient populations. The role of amyloid PET imaging becomes increasingly important with increasing age in the diagnostic assessment of clinically impaired patients. (orig.)

  2. Clinical experience with insulin detemir, biphasic insulin aspart and insulin aspart in people with type 2 diabetes: Results from the West India cohort of the A 1 chieve study

    Directory of Open Access Journals (Sweden)

    Sunil M Jain

    2013-01-01

    Full Text Available Background: The A 1 chieve, a multicentric (28 countries, 24-week, non-interventional study evaluated the safety and effectiveness of insulin detemir, biphasic insulin aspart and insulin aspart in people with T2DM (n = 66,726 in routine clinical care across four continents. Materials and Methods: Data was collected at baseline, at 12 weeks and at 24 weeks. This short communication presents the results for patients enrolled from West India. Results: A total of 4192 patients were enrolled in the study. Four different insulin analogue regimens were used in the study. Patients had started on or were switched to biphasic insulin aspart (n = 2846, insulin detemir (n = 596, insulin aspart (n = 517, basal insulin plus insulin aspart (n = 140 and other insulin combinations (n = 83. At baseline glycaemic control was poor for both insulin naïve (mean HbA 1 c: 8.8% and insulin user (mean HbA 1 c: 9.1% groups. After 24 weeks of treatment, both the groups showed improvement in HbA 1 c (insulin naïve: −1.6%, insulin users: −1.7%. SADRs including major hypoglycaemic events or episodes did not occur in any of the study patients. Conclusion: Starting or switching to insulin analogues was associated with improvement in glycaemic control with a low rate of hypoglycaemia.

  3. Clinical experience with insulin detemir, biphasic insulin aspart and insulin aspart in people with type 2 diabetes: Results from the West India cohort of the A1chieve study

    Science.gov (United States)

    Jain, Sunil M.; Jindal, Sushil; Malve, Harshad; Shetty, Raman; Bhoraskar, Anil

    2013-01-01

    Background: The A1chieve, a multicentric (28 countries), 24-week, non-interventional study evaluated the safety and effectiveness of insulin detemir, biphasic insulin aspart and insulin aspart in people with T2DM (n = 66,726) in routine clinical care across four continents. Materials and Methods: Data was collected at baseline, at 12 weeks and at 24 weeks. This short communication presents the results for patients enrolled from West India. Results: A total of 4192 patients were enrolled in the study. Four different insulin analogue regimens were used in the study. Patients had started on or were switched to biphasic insulin aspart (n = 2846), insulin detemir (n = 596), insulin aspart (n = 517), basal insulin plus insulin aspart (n = 140) and other insulin combinations (n = 83). At baseline glycaemic control was poor for both insulin naïve (mean HbA1c: 8.8%) and insulin user (mean HbA1c: 9.1%) groups. After 24 weeks of treatment, both the groups showed improvement in HbA1c (insulin naïve: −1.6%, insulin users: −1.7%). SADRs including major hypoglycaemic events or episodes did not occur in any of the study patients. Conclusion: Starting or switching to insulin analogues was associated with improvement in glycaemic control with a low rate of hypoglycaemia. PMID:24404488

  4. Birth order and mortality: a population-based cohort study.

    Science.gov (United States)

    Barclay, Kieron; Kolk, Martin

    2015-04-01

    This study uses Swedish population register data to investigate the relationship between birth order and mortality at ages 30 to 69 for Swedish cohorts born between 1938 and 1960, using a within-family comparison. The main analyses are conducted with discrete-time survival analysis using a within-family comparison, and the estimates are adjusted for age, mother's age at the time of birth, and cohort. Focusing on sibships ranging in size from two to six, we find that mortality risk in adulthood increases with later birth order. The results show that the relative effect of birth order is greater among women than among men. This pattern is consistent for all the major causes of death but is particularly pronounced for mortality attributable to cancers of the respiratory system and to external causes. Further analyses in which we adjust for adult socioeconomic status and adult educational attainment suggest that social pathways only mediate the relationship between birth order and mortality risk in adulthood to a limited degree. PMID:25777302

  5. Impact of therapeutic drug monitoring of antiretroviral drugs in routine clinical management of patients infected with human immunodeficiency virus and related health care costs: a real-life study in a large cohort of patients

    OpenAIRE

    Perrone V; Cattaneo D; Radice S; Sangiorgi D.; Federici AB; Gismondo, MR; Medaglia M; Micheli V; Vimercati S; Pallone E; Degli Esposti L; Clementi E

    2014-01-01

    Valentina Perrone,1 Dario Cattaneo,1 Sonia Radice,1 Diego Sangiorgi,2 Augusto B Federici,3 Maria Rita Gismondo,4 Massimo Medaglia,5 Valeria Micheli,4 Stefania Vimercati,5 Enza Pallone,6 Luca Degli Esposti,2 Emilio Clementi1,71Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, L Sacco University Hospital, University of Milan, Milan, 2CliCon Srl, Health, Economics and Outcomes Research, Ravenna, 3Hematology and Transfusion Medicine, Department of Clinical Sciences an...

  6. Metabolic syndrome in a cohort of affectively ill patients, a naturalistic study

    DEFF Research Database (Denmark)

    Vinberg, Maj; Madsen, Maiken; Breum, Leif;

    2012-01-01

    at a Mood Disorder Clinic. Methods: Patients were evaluated for the presence of metabolic syndrome (MeS) according to modified NCEP ATP III criteria. Results: Of the 143 patients eligible for participation, 100 patients participated in the study (32% male, mean age 43.6 ± 14.2); the prevalence of MeS was 26......Background: Patients with affective disorder have higher mortality not only because of their affective illness but also because of a higher risk of death from physical illness especially cardiovascular diseases. Aim: To investigate the prevalence in a naturalistic cohort of patient treated...

  7. Rosacea and gastrointestinal disorders - a population-based cohort study

    DEFF Research Database (Denmark)

    Egeberg, A; Weinstock, L B; Thyssen, E P;

    2016-01-01

    BACKGROUND: Rosacea is a common inflammatory facial skin condition. Recent genetic and epidemiologic studies have suggested pathogenic links between rosacea and gastrointestinal disorders, but data are limited. OBJECTIVES: The objective was to investigate the association between rosacea and celiac...... disease (CeD), Crohn's disease (CD), ulcerative colitis (UC), Helicobactor pylori (HP) infection, small intestinal bacterial overgrowth (SIBO), and irritable bowel syndrome (IBS), respectively. METHODS: We performed a nationwide cohort study. A total of 49,475 patients with rosacea, and 4,312,213 general...... population controls were identified using nationwide administrative registers. We established the prevalence of the aforementioned disorders, and used Cox regression to obtain hazard ratios (HRs) of the risk of new-onset CeD, CD, UC, HP infection, SIBO, and IBS, respectively, in patients with rosacea...

  8. Spectrum of neurodevelopmental disabilities: a cohort study in hungary.

    Science.gov (United States)

    Gergev, Gyurgyinka; Máté, Adrienn; Zimmermann, Alíz; Rárosi, Ferenc; Sztriha, László

    2015-03-01

    The spectrum of neurodevelopmental disabilities was studied in a cohort of patients in Hungary. A search for etiologies and assessment of the degree of intellectual disability were carried out. The study included 241 (131 boys) patients. Disability occurred without any prenatal, perinatal, and/or neonatal adverse events in 167 patients. They were classified into the following subgroups: genetic syndromes with recognized etiology, global developmental delay/intellectual disability in association with dysmorphic features but unknown etiology, global developmental delay/intellectual disability without dysmorphic features and recognized etiology, brain malformations, inborn errors of metabolism, leukoencephalopathies, epileptic syndromes, developmental language impairment, and neuromuscular disorders. Adverse events occurred in 74 children classified into subgroups such as cerebral palsy after delivery preterm or at term, and disabilities without cerebral palsy. The etiology was identified in 66.4%, and genetic diagnosis was found in 19.5%. Classification of neurodevelopmental disorders contribute to etiological diagnosis, proper rehabilitation, and genetic counseling. PMID:24868008

  9. Effectiveness of DNA-recombinant anti-hepatitis B vaccines in blood donors: a cohort study

    Directory of Open Access Journals (Sweden)

    Petry Andrea

    2007-11-01

    Full Text Available Abstract Background Although various studies have demonstrated efficacy of DNA-recombinant anti-hepatitis B vaccines, their effectiveness in health care settings has not been researched adequately. This gap is particularly visible for blood donors, a group of significant importance in the reduction of transfusion-transmitted hepatitis B. Methods This is a double cohort study of 1411 repeat blood donors during the period 1998–2002, involving a vaccinated and an unvaccinated cohort, with matching of the two in terms of sex, age and residence. Average follow-up was 3.17 person-years. The outcome measure was infection with hepatitis B virus (HBV, defined by testing positive on serologic markers HBsAg or anti-HBC. All blood donors were from the blood bank in Joaçaba, federal state of Santa Catarina, Brazil. Results The cohorts did not differ significantly regarding sex, age and marital status but the vaccinated cohort had higher mean number of blood donations and higher proportion of those residing in the county capital Joaçaba. Hepatitis B incidences per 1000 person-years were zero among vaccinated and 2,33 among non-vaccinated, resulting in 100% vaccine effectiveness with 95% confidence interval from 30,1% to 100%. The number of vaccinated persons necessary to avoid one HBV infection in blood donors was estimated at 429 with 95% confidence interval from 217 to 21422. Conclusion The results showed very high effectiveness of DNA-recombinant anti-HBV vaccines in blood donors. Its considerable variation in this study is likely due to the limited follow-up and the influence of confounding factors normally balanced out in efficacy clinical trials.

  10. Reproducibility in echocardiographic assessment of diastolic function in a population based study (the STANISLAS Cohort study.

    Directory of Open Access Journals (Sweden)

    Zied Frikha

    Full Text Available There is limited evidence regarding intra-observer and inter-observer variations in echocardiographic measurements of diastolic function. This study aimed to assess this reproducibly within a population-based cohort study.Sixty subjects in sinus rhythm were randomly selected among 4th visit participants of the STANISLAS Cohort (Lorraine region, France. This 4th examination systematically included M-mode, 2-dimensional, DTI and pulsed-wave Doppler echocardiograms. Reproducibility of variables was studied by intra-class correlation coefficients (ICC and Bland Altman plots.Our population was on average middle-aged (50 ± 14 y, overweight (BMI = 26 ± 6 kg/m2 and non-smoking (87% with a quarter of the participants having self-declared hypertension or treated with anti-hypertensive medication(s. Intra-observer ICC were > 0.90 for all analyzed parameters except for left ventricular ejection fraction (LVEF which was 0.89 (0.81-0.93. The mean relative intra-observer differences were small and limits of agreement of relative differences were narrow for all considered parameters ( 0.90 for all analyzed parameters except for LVEF (ICC = 0.87 and both mitral and pulmonary A wave duration (0.83 and 0.73 respectively. The mean relative inter-observer differences were <5% for all parameters except for pulmonary A wave duration (mean difference = 6.5%. Limits of agreement of relative differences were narrow (<15%, except for mitral A wave duration and velocity (both <20% as well as left ventricular mass and pulmonary A wave duration (both <30%. Intra-observer agreements with regard to the presence and severity of diastolic dysfunction were excellent (Kappa = 0.93 (0.83-1.00 and 0.88 (0.75-0.99, respectively.In this validation study within the STANISLAS cohort, diastolic function echocardiographic parameters were found to be highly reproducible. Diastolic dysfunction consequently appears as a highly effective clinical and research tool.

  11. Can Psychopathology at Age 7 Be Predicted from Clinical Observation at One Year? Evidence from the ALSPAC Cohort

    Science.gov (United States)

    Allely, C. S.; Doolin, O.; Gillberg, C.; Gillberg, I. C.; Puckering, C.; Smillie, M.; McConnachie, A.; Heron, J.; Golding, J.; Wilson, P.

    2012-01-01

    One of the challenges of developmental psychopathology is to determine whether identifiable pathways to developmental disorders exist in the first months or years of life. Early identification of such disorders poses a similar challenge for clinical services. Using data from a large contemporary birth cohort, we examined whether psychopathology at…

  12. Children and Clinical Studies: Why Clinical Studies Are Important

    Medline Plus

    Full Text Available ... E-Newsletters About NHLBI Organization NHLBI Director Budget, Planning, & Legislative Advisory ... Learn more about Children and Clinical Studies Importance of Children in Clinical Studies Children have often ...

  13. Influence of advancing age on clinical presentation, treatment efficacy and safety, and long-term outcome of pre-excitation syndromes: a retrospective cohort study of 961 patients included over a 25-year period

    Science.gov (United States)

    Brembilla-Perrot, Béatrice; Olivier, Arnaud; Sellal, Jean-Marc; Manenti, Vladimir; Brembilla, Alice; Villemin, Thibaut; Admant, Philippe; Beurrier, Daniel; Bozec, Erwan; Girerd, Nicolas

    2016-01-01

    Objectives There are very little data on pre-excitation syndrome (PS) in the elderly. We investigated the influence of advancing age on clinical presentation, treatment and long-term outcome of PS. Setting Single-centre retrospective study of patient files. Participants In all, 961 patients (72 patients ≥60 years (mean 68.5±6), 889 patients <60 years (mean 30.5±14)) referred for overt pre-excitation and indication for electrophysiological study (EPS) were followed for 5.3±5 years. Usual care included 24 h Holter monitoring, echocardiography and EPS. Patients underwent accessory pathway (AP) ablation if necessary. Primary and secondary outcome measures Occurrence of atrial fibrillation (AF) or procedure-induced adverse event. Results Electrophysiological data and recourse to AP ablation (43% vs 48.5%, p=0.375) did not significantly differ between the groups. Older patients more often had symptomatic forms (81% vs 63%, p=0.003), history of spontaneous AF (8% vs 3%, p=0.01) or adverse presentation (poorly tolerated arrhythmias: 18% vs 7%, p=0.0009). In multivariable analysis, patients ≥60 years had a significantly higher risk of history of AF (OR=4.2, 2.1 to 8.3, p=0.001) and poorly tolerated arrhythmias (OR=3.8, 1.8 to 8.1, p=0.001). Age ≥60 years was associated with an increased major AP ablation complication risk (10% vs 1.9%, p=0.006). During follow-up, occurrence of AF (13.9% vs 3.6%, p<0.001) and incidence of poorly tolerated tachycardia (4.2% vs 0.6%, p=0.001) were more frequent in patients ≥60 years, although frequency of ablation failure or recurrence was similar (20% vs 15.5%, p=0.52). In multivariable analysis, patients ≥60 years had a significantly higher risk of AF (OR=2.9, 1.2 to 6.8, p≤0.01). Conclusions In this retrospective monocentre study, patients ≥60 years referred for PS work up appeared at higher risk of AF and adverse presentation, both prior and after the work up. These results suggest that, in elderly

  14. Academic Achievement in Primary School in Offspring Born to Mothers With Type 1 Diabetes (the EPICOM Study): A Register-Based Prospective Cohort Study

    DEFF Research Database (Denmark)

    Knorr, Sine; Clausen, Tine D; Vlachová, Zuzana;

    2015-01-01

    OBJECTIVE: This study examined the effect of maternal pregestational type 1 diabetes on offspring primary school performance. RESEARCH DESIGN AND METHODS: We performed a prospective combined clinical and register-based cohort study comparing primary school performance in offspring (n = 707) of wo...

  15. Health and function of participants in the Long Life Family Study: A comparison with other cohorts

    DEFF Research Database (Denmark)

    Newman, Anne B; Glynn, Nancy W; Taylor, Christopher A;

    2011-01-01

    Individuals from families recruited for the Long Life Family Study (LLFS) (n= 4559) were examined and compared to individuals from other cohorts to determine whether the recruitment targeting longevity resulted in a cohort of individuals with better health and function. Other cohorts with similar...... data included the Cardiovascular Health Study, the Framingham Heart Study, and the New England Centenarian Study. Diabetes, chronic pulmonary disease and peripheral artery disease tended to be less common in LLFS probands and offspring compared to similar aged persons in the other cohorts. Pulse...

  16. SLE disease patterns in a Danish population-based lupus cohort: an 8-year prospective study

    DEFF Research Database (Denmark)

    Laustrup, H; Voss, A; Green, A;

    2009-01-01

    In 1995 all systemic lupus erythematosus (SLE) patients in the county of Funen were retrieved from four separate and independent sources as part of an 8-year prospective study to determine the pattern of disease activity and damage accumulation in a community based lupus cohort of predominantly...... Scandinavian ancestry. Incident cases were subsequently identified by surveillance of these sources. Established and new cases underwent annual, structured interviews, clinical examination and blood sampling. The Systemic Lupus Erythematosus Diseases Activity Index SLEDAI and Systemic Lupus International...... Collaborating Clinics SLICC scores were calculated. Flares were defined as modified - SLEDAI >/= 4.The annual flare rate in definite SLE (D-SLE) was 0.21 (95%CI 0.18-0.24) versus 0.03 (95%CI 0.01-0.07) in incomplete SLE (I-SLE). Forty-three per cent of the entire study population had no disease exacerbations...

  17. Intensification of insulin therapy in patients with type 2 diabetes: a retrospective, non- interventional cohort study of patients treated with insulin glargine or biphasic human insulin in daily clinical practice

    Science.gov (United States)

    2013-01-01

    Background The aim of this study is to compare the efficacy of intensification of insulin treatment with insulin glargine and biphasic human insulin in patients with type 2 diabetes on concomitant therapy with oral antidiabetic drugs (OAD) in daily clinical practice. Methods A retrospective multicentre parallel two-arm study included 301 patients with type 2 diabetes already on treatment with biphasic human insulin twice daily (bd) in combination with OAD. Data were collected retrospectively from 142 patients who had been switched from biphasic human insulin to insulin glargine in a period of 6–12 months prior to their inclusion (active group) and compared to data collected retrospectively from 159 patients who continued treatment with biphasic human insulin bd for the same time period (control group). Our primary objective was to examine the efficacy of the two treatments, assessed as change in HbA1c. Secondary objectives were to examine for changes in fasting blood glucose (FBG), body weight, treatment with OAD or fast-acting insulin and safety, by assessing the frequency and severity of hypoglycaemic episodes. Results At the end of the study there was a significant reduction in HbA1c in both arms. The least squares (LS) mean [(95% confidence intervals (CI)] reduction in HbA1c was -1.13 (-0.96 to -1.30)% in the active and -0.59 (-0.41to -0.77)% in the control group [LS mean treatment difference 0.53 (0.31-0.76)%, p < 0.001]. Similarly, fasting blood glucose declined significantly in both arms. The LS mean decline in FBG was -47.02 (-37.89 to -56.14) mg/dl in the active and -19.73 (-11.57 to -27.89) mg/dl in the control group [LS mean treatment difference 27.85 (15.74-39.95) mg/dl, p < 0.001]. No significant difference in hypoglycaemic episodes and in body weight was found. In the active group, more patients received rapid-acting pre-meal insulin and used insulin secretagogues drugs. Conclusions Glargine alone or in combination with fast acting insulin

  18. Risk factors for self-reported arm lymphedema among female breast cancer survivors: a prospective cohort study

    OpenAIRE

    Togawa, Kayo; Ma, Huiyan; Sullivan-Halley, Jane; Neuhouser, Marian L.; Imayama, Ikuyo; Baumgartner, Kathy B.; Smith, Ashley Wilder; Alfano, Catherine M.; McTiernan, Anne; Ballard-Barbash, Rachel; Bernstein, Leslie

    2014-01-01

    Introduction Lymphedema is a potentially debilitating condition that occurs among breast cancer survivors. This study examines the incidence of self-reported lymphedema, timing of lymphedema onset, and associations between sociodemographic, clinical and lifestyle factors and lymphedema risk across racial-ethnic groups using data from a multicenter, multiethnic prospective cohort study of breast cancer survivors, the Health, Eating, Activity and Lifestyle Study. Methods A total of 666 women di...

  19. Liver elasticity measurement before and after biliary drainage in patients with obstructive jaundice: a prospective cohort studya prospective cohort study

    OpenAIRE

    Kubo, Kimitoshi; Kawakami, Hiroshi; Kuwatani, Masaki; Nishida, Mutsumi; Kawakubo, Kazumichi; Kawahata, Shuhei; Taya, Yoko; Kubota, Yoshimasa; Amano, Toraji; Shirato, Hiroki; Sakamoto, Naoya

    2016-01-01

    Background Obstructive jaundice has been reported to influence liver elasticity, independent of liver fibrosis. The aim of our prospective study was to evaluate the changes in liver elasticity, before and after biliary drainage, in patients with obstructive jaundice, and to evaluate the correlation between elasticity measures and serum markers of liver fibrosis. Methods This is a prospective cohort study of 20 patients with obstructive jaundice. Liver elasticity was assessed by Transient Elas...

  20. Internet-Based Birth-Cohort Studies: Is This the Future for Epidemiology?

    OpenAIRE

    Firestone, Ridvan; Cheng, Soo; Pearce, Neil; Douwes, Jeroen; Merletti, Franco; Pizzi, Costanza; Pivetta, Emanuele; Rusconi, Franca; Richiardi, Lorenzo

    2015-01-01

    Background International collaborative cohorts the NINFEA and the ELF studies are mother-child cohorts that use the internet for recruitment and follow-up of their members. The cohorts investigated the association of early life exposures and a wide range of non-communicable diseases. Objective The objective is to report the research methodology, with emphasis on the advantages and limitations offered by an Internet-based design. These studies were conducted in Turin, Italy and Wellington, New...

  1. Cohort profile: the English longitudinal study of ageing.

    Science.gov (United States)

    Steptoe, Andrew; Breeze, Elizabeth; Banks, James; Nazroo, James

    2013-12-01

    The English Longitudinal Study of Ageing (ELSA) is a panel study of a representative cohort of men and women living in England aged ≥50 years. It was designed as a sister study to the Health and Retirement Study in the USA and is multidisciplinary in orientation, involving the collection of economic, social, psychological, cognitive, health, biological and genetic data. The study commenced in 2002, and the sample has been followed up every 2 years. Data are collected using computer-assisted personal interviews and self-completion questionnaires, with additional nurse visits for the assessment of biomarkers every 4 years. The original sample consisted of 11 391 members ranging in age from 50 to 100 years. ELSA is harmonized with ageing studies in other countries to facilitate international comparisons, and is linked to financial and health registry data. The data set is openly available to researchers and analysts soon after collection (http://www.esds.ac.uk/longitudinal/access/elsa/l5050.asp). PMID:23143611

  2. Effects on heart function of neoadjuvant chemotherapy and chemoradiotherapy in patients with cancer in the esophagus or gastroesophageal junction – a prospective cohort pilot study within a randomized clinical trial

    International Nuclear Information System (INIS)

    Neoadjuvant therapy for cancer of the esophagus or gastroesophageal (GE)-junction is well established. The pros and cons of chemoradiotherapy and chemotherapy are debated. Chemoradiotherapy might impair cardiac function eliciting postoperative morbidity. The aim of this pilot study was to describe acute changes in left ventricular function following chemoradiotherapy or chemotherapy. Patients with esophageal and (GE)-junction cancer enrolled at our center into a multicenter trial comparing neoadjuvant chemoradiotherapy and chemotherapy were eligible. Patients were randomized to receive cisplatin and 5-fluorouracil with or without the addition of 40 Gy radiotherapy prior to surgery. Left ventricular function was evaluated using echocardiography and plasma N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) before and after neoadjuvant treatment. The primary outcome measure was left ventricular global strain (GS). Clinical effects were assessed using repeated exercise tests. Linear mixed models were used to analyze the effects of treatment group, and the interaction between groups. 40 patients participated (chemoradiotherapy, n = 17; chemotherapy, n = 23). In the chemoradiotherapy group there was no change in left ventricular global strain but mitral annular plane systolic excursion (MAPSE) of the ventricular septum, early diastolic filling velocity (E-velocity), and the ratio of early to late ventricular filling velocities (E/A ratio) decreased significantly (p = 0.02, p = 0.01, and p = 0.03, respectively). No changes were observed in the chemotherapy group. There was a trend towards an interaction effect for MAPSE sept and E (p = 0.09 and p = 0.09). NT-proBNP increased following chemoradiotherapy (p = 0.05) but not after chemotherapy (p > 0.99), and there was a trend towards an interaction effect (p = 0.07). Working capacity decreased following neoadjuvant treatment (chemoradiotherapy p = 0.001, chemotherapy p = 0.03) and was more pronounced after

  3. Clinical study on IgG4-related autoimmune pancreatitis

    Institute of Scientific and Technical Information of China (English)

    吴庆军

    2013-01-01

    Objective To investigate the clinical features of IgG4-related autoimmune pancreatitis(IgG4-related AIP). Methods A prospective cohort study on IgG4 related disease(IgG4-RD) was carried out in Peking Union Medical College Hospital during December 2010 to June

  4. Ten years of progress in the Hokkaido birth cohort study on environment and children’s health: cohort profile—updated 2013

    OpenAIRE

    Kishi, Reiko; KOBAYASHI, Sachiko; Ikeno, Tamiko; Araki, Atsuko; Miyashita, Chihiro; Itoh, Sachiko; Sasaki, Seiko; Okada, Emiko; Kobayashi, Sumitaka; Kashino, Ikuko; Itoh, Kumiko; Nakajima, Sonomi

    2013-01-01

    The Hokkaido Study on Environment and Children’s Health is an ongoing cohort study that began in 2002. The study consists of two prospective birth cohorts, the Sapporo cohort (n = 514) and the Hokkaido large-scale cohort (n = 20,940). The primary goals of this study are to first examine the potential negative effects of perinatal environmental chemical exposures on birth outcomes, including congenital malformations and growth retardation; second, to evaluate the development of allergies, infe...

  5. Increasing incidence of early onset type 1 (insulin-dependent) diabetes mellitus: a study of Danish male birth cohorts

    DEFF Research Database (Denmark)

    Green, A; Andersen, P K; Svendsen, Anders Jørgen;

    1992-01-01

    To provide information of the incidence trends of Type 1 (insulin-dependent) diabetes mellitus we performed a cohort study of a series of Danish male birth cohorts. All male livebirths in Denmark between 1 January 1949 and 31 December 1964, were investigated regarding the development of Type 1...... 1705 diabetic subjects were identified of whom 23 were not representative of idiopathic Type 1 diabetes. The cumulative rate of Type 1 diabetes development during the first 20 years of life increased from 2.37 to 2.90 per 1000 for the first eight and last eight birth cohorts, respectively. A log...... diabetes during the first 20 years of life using the files of the Danish Conscript Board, supplemented by a search in the Danish National Registry of Deaths. Diagnosis was verified and clinical information obtained from medical records. The material is estimated to be more than 95% complete. A total of...

  6. GENDER-RELATED DIFFERENCES IN CLINICAL COURSE OF CROHN?S DISEASE IN AN ASIAN POPULATION: a retrospective cohort review

    Directory of Open Access Journals (Sweden)

    Siu-tong LAW

    2014-04-01

    Full Text Available Context Data from Asian populations about gender-related differences in Crohn’s disease are few. Objectives This study was to analyze the clinical characteristics between women and men affected by Crohn’s disease. Methods This was a retrospective cohort study to analyze consecutive Crohn’s disease patients from Jan 2000 to Dec 2012. Clinical and phenotypic characteristics and treatment outcomes were evaluated. Results 79 patients (55 male and two of them with positive family history were diagnosed with Crohn’s disease. Ileocolonic disease and inflammatory lesion was the most dominant site of involvement and disease behavior respectively in both men and women. Apart from higher frequency of nausea (45.83 vs 23.64%, P 0.024 and lower body mass index (19.44 vs 22.03 kg/m2, P 0.003 reported in women, no significant gender-related differences in clinical characteristics were observed. Women were more associated with delay use of immunosuppressive therapy (12 vs 36 months, P = 0.028, particularly for those aged less than 40 years old (85 vs 62.6%, P = 0.023. Cox proportional hazard regression analysis revealed that active smoking (HR, 4.679; 95% CI, 1.03-21.18 and delayed use of immunosuppressive therapy (HR, 4.13; 95% CI, 1.01-16.88 were only independent risk factors associated with increased risk of complications. Conclusions There were no significant gender-specific differences in clinical and phenotypic characteristics between male and female Crohn’s disease patients. Smoking history and delay use of immunosuppressive therapy were associated with higher risk of complications.

  7. Dietary Antioxidants and Melanoma: Evidence from Cohort and Intervention Studies.

    Science.gov (United States)

    Miura, Kyoko; Green, Adèle C

    2015-01-01

    Melanoma is the most serious form of skin cancer affecting mostly people of Caucasian origin and is associated with high exposure to solar ultraviolet (UV) radiation. Antioxidants in the diet are thought to prevent UV-induced DNA damage and oxidative stress and laboratory-based studies have shown that high antioxidant intakes inhibit melanoma development. Corresponding epidemiological evidence is inconsistent, however. We therefore reviewed results from prospective observational studies and randomized controlled trials (RCTs) to clarify whether consumption of antioxidant vitamin C, E (tocopherol), and A (retinol), carotenoids and selenium, as food, supplements, or both, or high fruit and vegetable intake, reduce the incidence of cutaneous melanoma. A total of 9 studies (2 cohort, 1 nested case-control, 6 RCTs) were included. Neither antioxidant nutrients, individually or combined, nor fruit and vegetable intake showed any strong and significant associations with melanoma, though the number of relevant studies was limited and several had methodological shortcomings. In particular, melanoma was not a primary disease outcome in any of the RCTs and therefore, none adequately accounted for potential confounding by sun exposure. In conclusion, available evidence is currently inadequate to assess possible beneficial effects of antioxidant intake on melanoma risk. PMID:26147450

  8. STATUS REPORT, BEGIN TO DEVELOP COMPLETE OPERATIONS MANUALS FOR THE COHORT: PREPARE TO IMPLEMENT A COHORT STUDY OF CHILDREN'S ENVIRONMENTAL HEALTH

    Science.gov (United States)

    As a precursor to the National Children's Study (NCS), the North Carolina Cohort Study (NC Cohort Study) will provide the opportunity to field test procedures to better inform the implementation of the NCS. In order to test some of the study hypotheses, it will be important to ob...

  9. Alcohol and ovarian cancer risk: Results from the Netherlands Cohort Study

    NARCIS (Netherlands)

    Schouten, L.J.; Zeegers, M.P.A.; Goldbohm, R.A.; Brandt, P.A. van den

    2004-01-01

    Objective: To study alcohol consumption in relation to ovarian cancer risk in a prospective cohort study. Methods: The Netherlands Cohort Study on diet and cancer was initiated in 1986. A self-administered questionnaire on dietary habits and other risk factors for cancer was completed by 62,573 post

  10. A study of the clinical and radiological features in a cohort of 93 patients with a COL2A1 mutation causing spondyloepiphyseal dysplasia congenita or a related phenotype

    DEFF Research Database (Denmark)

    Terhal, Paulien A; Nievelstein, Rutger Jan A J; Verver, Eva J J;

    2015-01-01

    -like dysplasia (n = 2). The remaining 13 patients had normal stature with mild SED, Stickler-like syndrome or multiple epiphyseal dysplasia. Over 50% of the patients had undergone orthopedic surgery, usually for scoliosis, femoral osteotomy or hip replacement. Odontoid hypoplasia was present in 56% (95% CI 38......Type 2 collagen disorders encompass a diverse group of skeletal dysplasias that are commonly associated with orthopedic, ocular, and hearing problems. However, the frequency of many clinical features has never been determined. We retrospectively investigated the clinical, radiological, and...... genotypic data in a group of 93 patients with molecularly confirmed SEDC or a related disorder. The majority of the patients (80/93) had short stature, with radiological features of SEDC (n = 64), others having SEMD (n = 5), Kniest dysplasia (n = 7), spondyloperipheral dysplasia (n = 2), or Torrance...

  11. Diabetes mellitus and risk of bladder cancer: a meta-analysis of cohort studies.

    Directory of Open Access Journals (Sweden)

    Xin Xu

    Full Text Available OBJECTIVE: Diabetes is associated with increased risk of cancer at several sites, but its association with risk of bladder cancer is still controversial. We examined this association by conducting a systematic review and meta-analysis of cohort studies. METHODS: Studies were identified by searching PubMed, EMBASE, Scopus, Web of Science, Cochrane register, and Chinese National Knowledge Infrastructure (CNKI databases through April 29, 2012. Summary relative risks (SRRs with their corresponding 95% confidence intervals (CIs were calculated using a random-effects model. RESULTS: A total of fifteen cohort studies were included in this meta-analysis. Analysis of all studies showed that diabetes was associated with a borderline statistically significant increased risk of bladder cancer (RR 1.11, 95% CI 1.00-1.23; p<0.001 for heterogeneity; I(2 = 84%. When restricting the analysis to studies that had adjusted for cigarette smoking (n = 6 or more than three confounders (n = 7, the RRs were 1.32 (95% CI 1.18-1.49 and 1.20 (95% CI 1.02-1.42, respectively. There was no significant publication bias (p = 0.62 for Egger's regression asymmetry test. CONCLUSIONS: Our findings support that diabetes was associated with an increased risk of bladder cancer. More future studies are warranted to get a better understanding of the association and to provide convincing evidence for clinical practice in bladder cancer prevention.

  12. Transitioning to HIV Pre-Exposure Prophylaxis (PrEP) from Non-Occupational Post-Exposure Prophylaxis (nPEP) in a Comprehensive HIV Prevention Clinic: A Prospective Cohort Study.

    Science.gov (United States)

    Siemieniuk, Reed A C; Sivachandran, Nirojini; Murphy, Pauline; Sharp, Andrea; Walach, Christine; Placido, Tania; Bogoch, Isaac I

    2015-08-01

    The uptake of pre-exposure prophylaxis (PrEP) for HIV prevention remains low. We hypothesized that a high proportion of patients presenting for HIV non-occupational post-exposure prophylaxis (nPEP) would be candidates for PrEP based on current CDC guidelines. Outcomes from a comprehensive HIV Prevention Clinic are described. We evaluated all patients who attended the HIV Prevention Clinic for nPEP between January 1, 2013 and September 30, 2014. Each patient was evaluated for PrEP candidacy based on current CDC-guidelines and subjectively based on physician opinion. Patients were then evaluated for initiation of PrEP if they met guideline suggestions. Demographic, social, and behavioral factors were then analyzed with logistic regression for associations with PrEP candidacy and initiation. 99 individuals who attended the nPEP clinic were evaluated for PrEP. The average age was 32 years (range, 18-62), 83 (84%) were male, of whom 46 (55%) men who had have sex with men (MSM). 31 (31%) met CDC guidelines for PrEP initiation, which had very good agreement with physician recommendation (kappa=0.88, 0.78-0.98). Factors associated with PrEP candidacy included sexual exposure to HIV, prior nPEP use, and lack of drug insurance (p<0.05 for all comparisons). Combining nPEP and PrEP services in a dedicated clinic can lead to identification of PrEP candidates and may facilitate PrEP uptake. Strategies to ensure equitable access of PrEP should be explored such that those without drug coverage may also benefit from this effective HIV prevention modality. PMID:26154174

  13. Molecular and Clinical Characterization of Albinism in a Large Cohort of Italian Patients

    OpenAIRE

    Gargiulo, Annagiusi; Testa, Francesco; Rossi, Settimio; Di Iorio, Valentina; Fecarotta, Simona; de Berardinis, Teresa; Iovine, Antonello; Magli, Adriano; Signorini, Sabrina; Fazzi, Elisa; Galantuomo, Maria Silvana; Fossarello, Maurizio; Montefusco, Sandro; Ciccodicola, Alfredo; Neri, Alberto

    2011-01-01

    This study is the first comprehensive mutational analysis of all genes associated with nonsyndromic albinism, performed in combination with a detailed clinical ophthalmic evaluation of a large series of Italian patients with albinism.

  14. Methadone and perinatal outcomes: a retrospective cohort study.

    LENUS (Irish Health Repository)

    Cleary, Brian J

    2012-02-01

    OBJECTIVE: The purpose of this study was to examine the relationship among methadone maintenance treatment, perinatal outcomes, and neonatal abstinence syndrome. STUDY DESIGN: This was a retrospective cohort study of 61,030 singleton births at a large maternity hospital from 2000-2007. RESULTS: There were 618 (1%) women on methadone at delivery. Methadone-exposed women were more likely to be younger, to book late for antenatal care, and to be smokers. Methadone exposure was associated with an increased risk of very preterm birth <32 weeks of gestation (adjusted odds ratio [aOR], 2.47; 95% confidence interval [CI], 1.40-4.34), being small for gestational age <10th percentile (aOR, 3.27; 95% CI, 2.49-4.28), admission to the neonatal unit (aOR, 9.14; 95% CI, 7.21-11.57), and diagnosis of a major congenital anomaly (aOR, 1.94; 95% CI, 1.10-3.43). There was a dose-response relationship between methadone and neonatal abstinence syndrome. CONCLUSION: Methadone exposure is associated with an increased risk of adverse perinatal outcomes, even when known adverse sociodemographic factors have been accounted for. Methadone dose at delivery is 1 of the determinants of neonatal abstinence syndrome.

  15. Cohort Profile: The Nicotine Dependence in Teens (NDIT) Study.

    Science.gov (United States)

    O'Loughlin, Jennifer; Dugas, Erika N; Brunet, Jennifer; DiFranza, Joseph; Engert, James C; Gervais, Andre; Gray-Donald, Katherine; Karp, Igor; Low, Nancy C; Sabiston, Catherine; Sylvestre, Marie-Pierre; Tyndale, Rachel F; Auger, Nathalie; Auger, Nathalie; Mathieu, Belanger; Tracie, Barnett; Chaiton, Michael; Chenoweth, Meghan J; Constantin, Evelyn; Contreras, Gisèle; Kakinami, Lisa; Labbe, Aurelie; Maximova, Katerina; McMillan, Elizabeth; O'Loughlin, Erin K; Pabayo, Roman; Roy-Gagnon, Marie-Hélène; Tremblay, Michèle; Wellman, Robert J; Hulst, Andraeavan; Paradis, Gilles

    2015-10-01

    The Nicotine Dependence in Teens (NDIT) study is a prospective cohort investigation of 1294 students recruited in 1999-2000 from all grade 7 classes in a convenience sample of 10 high schools in Montreal, Canada. Its primary objectives were to study the natural course and determinants of cigarette smoking and nicotine dependence in novice smokers. The main source of data was self-report questionnaires administered in class at school every 3 months from grade 7 to grade 11 (1999-2005), for a total of 20 survey cycles during high school education. Questionnaires were also completed after graduation from high school in 2007-08 and 2011-12 (survey cycles 21 and 22, respectively) when participants were aged 20 and 24 years on average, respectively. In addition to its primary objectives, NDIT has embedded studies on obesity, blood pressure, physical activity, team sports, sedentary behaviour, diet, genetics, alcohol use, use of illicit drugs, second-hand smoke, gambling, sleep and mental health. Results to date are described in 58 publications, 20 manuscripts in preparation, 13 MSc and PhD theses and 111 conference presentations. Access to NDIT data is open to university-appointed or affiliated investigators and to masters, doctoral and postdoctoral students, through their primary supervisor (www.nditstudy.ca). PMID:25022274

  16. Complex regional pain syndrome 1 – the Swiss cohort study

    Directory of Open Access Journals (Sweden)

    Perez Roberto SGM

    2008-06-01

    Full Text Available Abstract Background Little is known about the course of Complex Regional Pain Syndrome 1 and potential factors influencing the course of this disorder over time. The goal of this study is a to set up a database with patients suffering from suspected CRPS 1 in an initial stadium, b to perform investigations on epidemiology, diagnosis, prognosis, and socioeconomics within the database and c to develop a prognostic risk assessment tool for patients with CRPS 1 taking into account symptomatology and specific therapies. Methods/design Prospective cohort study. Patients suffering from a painful swelling of the hand or foot which appeared within 8 weeks after a trauma or a surgery and which cannot be explained by conditions that would otherwise account for the degree of pain and dysfunction will be included. In accordance with the recommendations of International Classification of Functioning, Disability and Health (ICF model, standardised and validated questionnaires will be used. Patients will be monitored over a period of 2 years at 6 scheduled visits (0 and 6 weeks, 3, 6, 12, and 24 months. Each visit involves a physical examination, registration of therapeutic interventions, and completion of the various study questionnaires. Outcomes involve changes in health status, quality of life and costs/utility. Discussion This paper describes the rationale and design of patients with CRPS 1. Ideally, potential risk factors may be identified at an early stage in order to initiate an early and adequate treatment in patients with increased risk for delayed recovery. Trial registration Not applicable

  17. Exposure to traffic and lung function in adults: a general population cohort study

    OpenAIRE

    Carlsen, Hanne Krage; Modig, Lars; Levinsson, Anna; Kim, Jeong-Lim; Toren, Kjell; Nyberg, Fredrik; Olin, Anna-Carin

    2015-01-01

    Objectives: To investigate the association between living near dense traffic and lung function in a cohort of adults from a single urban region. Design: Cross-sectional results from a cohort study. Setting: The adult-onset asthma and exhaled nitric oxide (ADONIX) cohort, sampled during 2001-2008 in Gothenburg, Sweden. Exposure was expressed as the distance from participants' residential address to the nearest road with dense traffic (>10 000 vehicles per day) or very dense traffic (>30 ...

  18. HIV-infected adolescents in southern Africa can achieve good treatment outcomes: results from a retrospective cohort study

    OpenAIRE

    Shroufi, Amir; Gunguwo, Hilary; Dixon, Mark; Nyathi, Mary; Ndebele, Wedu; Saint-Sauveur, Jean-François; Taziwa, Fabian; Ferreyra, Cecilia; Viñoles, Mari-Carmen; Ferrand, Rashida A.

    2013-01-01

    Objectives: In this study we examine whether adolescents treated for HIV/AIDS in southern Africa can achieve similar treatment outcomes to adults. Design: We have used a retrospective cohort study design to compare outcomes for adolescents and adults commencing antiretroviral therapy (ART) between 2004 and 2010 in a public sector hospital clinic in Bulawayo, Zimbabwe. Methods: Cox proportional hazards modelling was used to investigate risk factors for death and loss to follow-up (LTFU) (defin...

  19. Pregnancy Outcomes of In Vitro Fertilization with or without Ovarian Hyperstimulation Syndrome: A Retrospective Cohort Study in Chinese Patients

    OpenAIRE

    Xuan Jiang; Cheng-Yan Deng; Zheng-Yi Sun; Wei-Lin Chen; Han-Bi Wang; Yuan-Zheng Zhou; Li Jin

    2015-01-01

    Background: The effect of ovarian hyperstimulation syndrome (OHSS) on pregnancy outcomes of in vitro fertilization (IVF) patients is still ambiguous. This study aimed to analyze pregnancy outcomes of IVF with or without OHSS in Chinese patients. Methods: A retrospective cohort study was undertaken to compare pregnancy outcomes between 190 women with OHSS and 197 women without OHSS. We examined the rates of clinical pregnancy, multiple pregnancies, miscarriage, live birth, preterm delivery,...

  20. Cytomegalovirus Infection and the Risk of Mortality and Frailty in Older Women: A Prospective Observational Cohort Study

    OpenAIRE

    Wang, George C.; Kao, Wen Hong L.; Murakami, Peter; Xue, Qian-Li; Chiou, Roger B.; Detrick, Barbara; McDyer, John F.; Richard D Semba; Casolaro, Vincenzo; Walston, Jeremy D.; Fried, Linda P.

    2010-01-01

    Cytomegalovirus (CMV), a prevalent pathogen, causes severe disease in immunocompromised humans. However, present understanding is limited regarding the long-term clinical effect of persistent CMV infection in immunocompetent adults. The authors conducted a prospective observational cohort study (1992–2002) of 635 community-dwelling women in Baltimore, Maryland, aged 70–79 years in the Women's Health and Aging Studies to examine the effect of CMV infection on the risk of frailty, a common geri...

  1. Social stress and depression during pregnancy and in the postnatal period in British Pakistani mothers: A cohort study

    OpenAIRE

    Husain, Nusrat; Cruickshank, Kennedy; Husain, Meher; Khan, Sarah; Tomenson, Barbara; Rahman, Atif

    2012-01-01

    Background Depressive disorders are common and disabling among perinatal women. The rates are high in ethnic minority groups. The causes are not known in British Pakistani women. The aim of this study was to estimate the rates, correlates and maintaining factors of perinatal depression in a Pakistani sample in UK. The design used was a cross-sectional two phase population based survey with a prospective cohort study. Methods All women in 3rd trimester attending antenatal clinic were screened ...

  2. Feasibility of Using a Large Clinical Data Warehouse to Automate the Selection of Diagnostic Cohorts

    OpenAIRE

    Stephen, Reejis; Boxwala, Aziz; Gertman, Paul

    2003-01-01

    Data from Clinical Data Warehouses (CDWs) can be used for retrospective studies and for benchmarking. However, automated identification of cases from large datasets containing data items in free text fields is challenging. We developed an algorithm for categorizing pediatric patients presenting with respiratory distress into Bronchiolitis, Bacterial pneumonia and Asthma using clinical variables from a CDW. A feasibility study of this approach indicates that case selection may be automated.

  3. CLINICAL PRESENTATION AND ASSOCIATION AMONG TUBERCULOSIS PATIENTS; COHORT COMPARISON BETWEEN SMOKERS VERSUS NEVER-SMOKE IN PENANG, MALAYSIA

    Directory of Open Access Journals (Sweden)

    Wasif Gillani. S

    2011-01-01

    Full Text Available We aimed to compare the demographic and clinical characteristics with risk determination of TB patients who were smokers vs. non-smokers. The retrospective, observational & cross-sectional cohort survey was done to compare disease characteristic and clinical presentation during treatment of TB. Cluster random sampling employed in Chest Clinic of Penang General Hospital from January/2006 to June/2008. Statistical test were used with p-value ≤ 0.05 were considered statistically significant at 95% level of confidence interval. A total of 524 TB patients were recruited in study. Of this, 250 (47.7% were never smokers and rest 274 (52.3% were under ever-smoker. Majority of patients who had EPTB (79% were never smoke and majority of patients (62.8% who had pulmonary with EPTB were ever smokers. Ever smokers TB patients were commonly associated with older age and male gender, they also had higher proportion of risk factors compared to never smokers; high alcohol consumption (61% versus 3%, IVDU (48% versus 2%. There were significant relationships between smoking status of TB patient with race and initial Mantoux test. Ever smokers were significantly more likely to have moderate or far advanced lung’s lesion but less likely to present with minimal lesion on chest X-ray. Ever smokers TB patients were six times more likely to have opacity on chest X-ray compared to never smokers respectively. Smoking association had a significant effect on the severity of clinical, microbiological and radiological presentations resulting in more aggressive course of the disease compared with never smoking patients.

  4. Clinical Studies with Epothilones

    Science.gov (United States)

    Altmann, Karl-Heinz

    As indicated in previous chapters, epothilone research so far has delivered seven new chemical entities that have been advanced to clinical trials in humans (Fig. 1). However, the amount of clinical data publicly available at this time strongly varies between individual compounds, depending on their development stage, but also on the general publication policy of the developing company. The compound that has been most comprehensively characterized in the clinical literature is ixabepilone (BMS-247550), for which trial results have been described in a number of articles in peer-reviewed journals and which has been granted FDA approval for two clinical indications on Oct. 16, 2007. For all other compounds, most of the information on clinical trials is available only in abstract form. In all these cases it remains uncertain, whether the content of these abstracts fully reflects the content of the subsequent (poster or oral) presentations at the corresponding meeting; in fact, it seems likely that additional data will have been included in the actual meeting presentations that may not have been available at the time of abstract submission. As this is unknown to the author, such additional information cannot be considered in this chapter, which is solely based on information documented in accessible abstracts or journal publications. It should also be kept in mind that the interpretation of data from ongoing clinical trials or forward looking statements based on data from completed trials are always preliminary in character.

  5. Golestan cohort study of oesophageal cancer: feasibility and first results.

    Science.gov (United States)

    Pourshams, A; Saadatian-Elahi, M; Nouraie, M; Malekshah, A F; Rakhshani, N; Salahi, R; Yoonessi, A; Semnani, S; Islami, F; Sotoudeh, M; Fahimi, S; Sadjadi, A R; Nasrollahzadeh, D; Aghcheli, K; Kamangar, F; Abnet, C C; Saidi, F; Sewram, V; Strickland, P T; Dawsey, S M; Brennan, P; Boffetta, P; Malekzadeh, R

    2005-01-17

    To investigate the incidence of oesophageal cancer (EC) in the Golestan province of North-East Iran, we invited 1349 rural and urban inhabitants of Golestan province aged 35-80 to undergo extensive lifestyle interviews and to provide biological samples. The interview was repeated on a subset of 130 participants to assess reliability of questionnaire and medical information. Temperature at which tea was consumed was measured on two occasions by 110 subjects. Samples of rice, wheat and sorghum were tested for fumonisin contamination. An active follow-up was carried out after 6 and 12 months. A total of 1057 subjects (610 women and 447 men) participated in this feasibility study (78.4% participation rate). Cigarette smoking, opium and alcohol use were reported by 163 (13.8%), 93 (8.8%) and 39 (3.7%) subjects, respectively. Tobacco smoking was correlated with urinary cotinine (kappa = 0.74). Most questionnaire data had kappa > 0.7 in repeat measurements; tea temperature measurement was reliable (kappa = 0.71). No fumonisins were detected in the samples analysed. During the follow-up six subjects were lost (0.6%), two subjects developed EC (one dead, one alive); in all, 13 subjects died (with cause of death known for 11, 84.6%). Conducting a cohort study in Golestan is feasible with reliable information obtained for suspected risk factors; participants can be followed up for EC incidence and mortality. PMID:15597107

  6. Medical Graduates, Tertiary Hospitals, and Burnout: A Longitudinal Cohort Study

    Science.gov (United States)

    Parr, Justin M.; Pinto, Nigel; Hanson, Martin; Meehan, Ashlea; Moore, Peter T.

    2016-01-01

    Background: Burnout among junior doctors can affect patient care. We conducted a longitudinal cohort study designed to explore the incidence of burnout in medical interns and to examine the changes in burnout during the course of the intern year. Methods: Interns were recruited at two tertiary hospitals in Brisbane, Australia (n=180). Participants completed surveys at four time points during their internship year. All interns (100%) completed the baseline survey during their orientation. Response rates were 85%, 88%, and 79%, respectively, at 5-week, 6-month, and 12-month follow-up. Results: Interns reported high levels of personal and work-related burnout throughout the year that peaked at 6 months with mean scores of 42.53 and 41.81, respectively. Increases of 5.1 points (confidence interval [CI] 2.5,7.7; P=0.0001) and 3.5 points (CI 1.3,5.6; P=0.0015) were seen at 6 months for personal and work-related burnout, respectively. The mean score for patient-related burnout at 12 months was 25.57, and this number had increased significantly by 5.8 points (CI 3.2,8.5; Pburnout was 55.9%. Conclusion: Our study showed that burnout is a common problem among interns. The high incidence of burnout demonstrates the need for appropriate strategies to prevent adverse effects on doctors' quality of life and on the quality of care patients receive. PMID:27046399

  7. Sensor, a population-based cohort study on gastroenteritis in the Netherlands: incidence and etiology.

    NARCIS (Netherlands)

    Wit, M.A.S. de; Koopmans, M.P.G.; Kortbeek, L.M.; Wannet, W.J.B.; Vinje, J; Leusden, F. van; Bartelds, A.I.M.; Duynhoven, Y.T.H.P. van

    2001-01-01

    A prospective population-based cohort study with a nested case- control study was conducted to estimate the incidence of gastroenteritis and the associated pathogens in the general Dutch population. Follow-up of two consecutive cohorts was performed by weekly reporting cards from december 1998 to de

  8. Ten years of progress in the Hokkaido birth cohort study on environment and children's health: cohort profile--updated 2013.

    Science.gov (United States)

    Kishi, Reiko; Kobayashi, Sachiko; Ikeno, Tamiko; Araki, Atsuko; Miyashita, Chihiro; Itoh, Sachiko; Sasaki, Seiko; Okada, Emiko; Kobayashi, Sumitaka; Kashino, Ikuko; Itoh, Kumiko; Nakajima, Sonomi

    2013-11-01

    The Hokkaido Study on Environment and Children's Health is an ongoing cohort study that began in 2002. The study consists of two prospective birth cohorts, the Sapporo cohort (n = 514) and the Hokkaido large-scale cohort (n = 20,940). The primary goals of this study are to first examine the potential negative effects of perinatal environmental chemical exposures on birth outcomes, including congenital malformations and growth retardation; second, to evaluate the development of allergies, infectious diseases and neurodevelopmental disorders and perform longitudinal observations of the children's physical development to clarify the causal relationship between these outcomes and environmental chemicals; third, to identify individuals genetically susceptible to environmental chemicals; finally, to identify the additive effects of various environmental factors in our daily life, such as secondhand smoke exposure or low folate intake during early pregnancy. In this paper, we introduce our recent progress in the Hokkaido study with a cohort profile updated in 2013. For the last ten years, we followed pregnant women and their offspring, measuring various environmental chemicals, i.e., PCB, OH-PCB and dioxins, PFCs (Perfluorinated Compounds), Organochlorine pesticides, Phthalates, bisphenol A and mercury. We discovered that the concentration of toxic equivalents (TEQ) of dioxin and other specific congeners of PCDF or PCDD have effects on birth weight, infants' neurodevelopment and immune function. There were significant gender differences in these effects; our results suggest that male infants have more susceptibility to those chemical exposures than female infants. Interestingly, we found maternal genetic polymorphisms in AHR, CYP1A1 or GSTs that significantly modified the dioxin concentrations in maternal blood, suggesting different dioxin accumulations in the bodies of individuals with these genotypes, which would lead to different dioxin exposure levels. These genetic

  9. 75 FR 9902 - Proposed Collection; Comment Request; The Agricultural Health Study: A Prospective Cohort Study...

    Science.gov (United States)

    2010-03-04

    ... history information for respondents enrolled in the Agriculture Health Study. This represents a request to... Health Study: A Prospective Cohort Study of Cancer and Other Disease Among Men and Women in Agriculture... Disease Among Men and Women in Agriculture (NCI) (OMB : 0925-0406). Type of Information Collection...

  10. Impact of tamsulosin exposure on late complications following cataract surgery: retrospective cohort study.

    Science.gov (United States)

    González-Martín-Moro, Julio; González-López, Julio José; Gómez-Sanz, Fernando; Zarallo-Gallardo, Jesús; Cobo-Soriano, Rosario

    2014-08-01

    The purpose of this study is to measure the impact of tamsulosin intake on five postoperative cataract surgery complications (toxic anterior segment syndrome, rebound uveitis, retinal detachment, macular edema, and postoperative endophthalmitis). This retrospective cohort study was conducted at University Hospital of Henares. The study included 660-eyes of 660 patients submitted to cataract surgery at the ophthalmology unit of Hospital del Henares (Madrid) between 2 March 2009 and 28 February 2010. Extracapsular cataract extraction, combined glaucoma and cataract surgery phacovitrectomy, posterior capsule rupture and zonular damage were considered exclusion criteria. Clinical charts were reviewed during July 2012. Patients were divided in two groups (exposed and non-exposed to tamsulosin). Cumulative incidence of toxic anterior segment syndrome, rebound uveitis, retinal detachment, macular edema and postoperative endophthalmitis were compared in both groups. Rebound uveitis (relative risk [RR] 3.39; confidence interval [CI] 1.63-7.08) and macular edema (RR 4.15; CI 1.06-16.22) were more common in the tamsulosin-exposed group. Retinal detachment had a similar incidence in both groups. We observed no cases of endophthalmitis or toxic anterior segment syndrome in either of the two groups. Tamsulosin exposure in this cohort was associated with a higher risk of rebound uveitis and macular edema but the other three studied postoperative complications had a similar incidence in both groups. PMID:24158613

  11. Dioxins and endometriosis: cohort study of women in West Virginia

    Energy Technology Data Exchange (ETDEWEB)

    Diliberto, J.; Birnbaum, L. [U.S. Environmental Protection Agency, NHEERL, ETD, Research Triangle Park, NC (United States); Staats, D.A. [West Virginia Dept. of Environmental Protection, Charleston, WV (United States); Staats, D.A.; Becker, J.; Jude, D.; Chouinard, S.C.; Smith, T. [Marshall Univ. Medical Center, Huntington, WV (United States); Sirinek, L. [West Virginia Dept. of Environmental Protection, Wheeling, WV (United States); Clark, G. [Xenobiotic Detection Systems Inc., Durham, NC (United States); Landy, R. [U.S. Environmental Protection Agency, Region 3, ESC, Ft. Meade, MD (United States)

    2004-09-15

    The women in this endometriosis/dioxin health study reside in the Kanawha/Ohio River Valley area of West Virginia and comprise a potential cluster (cohort) of individuals who have been exposed to dioxins (dioxin and dioxin-like chemicals) at background levels higher than those seen in other areas of the United States. The emissions from an unique constellation of chemical industries appear to have led to high levels of environmental dioxin contaminants. In addition, this area has a high incidence of endometriosis. Previous animal studies, both in nonhuman primates and rodents, have demonstrated a correlation between dioxin exposure and endometriosis. Human epidemiology studies have suggested an association but have not demonstrated a statistically significant correlation, possibly due to limitations in study design such as insufficient numbers, measurement of only TCDD rather than total equivalents to TCDD (TEQs), and/or lack of surgical ascertainment of endometriosis. The present study is addressing these issues. Thus, we have the unusual congruence of identified emission sources and high background levels of dioxins and a potentially related elevation of endometriosis. Endometriosis is a condition suffered by women in which the endometrial tissue, that usually lines the uterus, migrates to other areas. Most commonly it is found in the abdomen, bladder, ovaries or bowel. Patients with endometriosis experience pelvic pain, irregular bleeding, infertility and other problems. Immune suppression has been associated with severe endometriosis. This debilitating condition is a poorly understood disease. In the United States, this condition affects millions of women in their reproductive years and is showing up more frequently in very young women. Endometriosis will seriously impact future fertility and health care utilization. Data suggest that the rate of endometriosis in the Kanawha and Ohio River valleys is higher than is seen in other regions of the United States.

  12. Prospective cohort study of comprehensive prevention to gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Hai-Qiang Guo; Peng Guan; Hai-Long Shi; Xuan Zhang; Bao-Sen Zhou; Yuan Yuan

    2003-01-01

    AIM: To evaluate the preliminary effects of comprehensive prevention of gastric cancer in Zhuanghe County epidemiologically.METHODS: Stratified sampling and cluster sampling were applied to define the intervention group and the control group. The prospective cohort study was used for evaluating the effect of preventing gastric cancer. The relative risk (RR)and attributable risk percent (AR %) of intervention on gastric cancer death were calculated. Potential years of life lost (PLYY) of the disease was analyzed, and the RR and AR %of PYLL were calculated. Survival analysis was applied among the screened patients.RESULTS: In the first 4 years after intervening, the relative risk (RR) of intervention on death was 0.5059 (95 % CI:0.3462~0.7392,P<0.05) with significance statistically. AR %of the intervention on death was 49.41%. The RR of intervention on cumulative PYLL was 0.6778 (95 % CI:0.5604~0.8198,P<0.05) with statistic significance. AR %of the intervention on cumulative PYLL was 30.32 %. The four-year survival rate of the screened patients was 0.6751(95 % CI: 0.5298~0.9047).CONCLUSION: The initiative intervention results showed that the intervention approach used in the trial was effective, it reduced mortality and increased survival rate, and alleviated the adverse effect of gastric cancer on the health and life of screened population.

  13. The use of new technologies in Cohort studies

    Directory of Open Access Journals (Sweden)

    Carlos Antonio Bruno da Silva

    2010-03-01

    élites de posicionamento (GPS para a localização de residências, o uso de coletas de DNA para comparações futuras, as bases de dados institucionais e governamentais são fontes de informações que abreviam, minimizam gastos e dão maior confiabilidade aos estudos de muito longa duração.Tem-se visto antigos trabalhos realizados há décadas sendo submetidos a novas avaliações estatísticas com o desenvolvimento de novas teorias e descobertas. Neste número da revista brasileira em promoção da saúde, acompanhamos o nascimento de uma nova coorte(14, que acompanhará a evolução dos determinantes de saúde de população de uma grande comunidade do Nordeste do Brasil.REFERÊNCIAS1. Morabia A, Guthold R. Wilhelm Weinberg’s 1913Large Retrospective Cohort Study: a rediscovery. Am JEpidemiol. 2007;165(7:727-33.2. Doll R. Cohort studies: history of the method. II.Retrospective cohort studies. Soz Praventivmed.2001;46(3:152-60. Erratum in: Soz Praventivmed2002;47(2:90.3. Dawber TR, Meadors GF, Moore Jr. FE. Epidemiologicalapproaches to heart disease: the Framingham Study.Am J Public Health Nations Health. 1951;41(3:279-81.4. Fonseca MGU, Peres F, Firmo JOA, Uchoa E.,Percepção de risco: maneiras de pensar e agirno manejo de agrotóxicos. Ciênc saúde coletiva[periódico na Internet]. 2007 Mar [acesso em 2010Maio 26]; 12(1:39-50. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232007000100009&lng=en&nrm=iso. doi: 10.1590/S1413-81232007000100009.5. Victora CG, Barros FC. Cohort profile: the 1982Pelotas (Brazil birth cohort study. Int J Epidemiol.2006;35(2:237-42.6. Armenian HK (editor. Applications of the case-controlmethod. Epidemiol Rev. 1994;16:1-164.7. Samet JM, Muñoz A. Evolution of the cohort study.Epidemiol Rev. 1998;20(1:1-14.8. Doll R. Cohort studies: history of the method. II.Retrospective cohort studies. Soz Praventivmed.2001;46(3:152-60. Erratum in: Soz Praventivmed2002;47(2:909. Lima-Costa MF, Barreto SM. Tipos de

  14. Adherence to antiretroviral prophylaxis for HIV prevention: a substudy cohort within a clinical trial of serodiscordant couples in East Africa.

    Directory of Open Access Journals (Sweden)

    Jessica E Haberer

    Full Text Available Randomized clinical trials of oral antiretroviral pre-exposure prophylaxis (PrEP for HIV prevention have widely divergent efficacy estimates, ranging from 0% to 75%. These discrepancies are likely due to differences in adherence. To our knowledge, no studies to date have examined the impact of improving adherence through monitoring and/or intervention, which may increase PrEP efficacy, or reported on objective behavioral measures of adherence, which can inform PrEP effectiveness and implementation.Within the Partners PrEP Study (a randomized placebo-controlled trial of oral tenofovir and emtricitabine/tenofovir among HIV-uninfected members of serodiscordant couples in Kenya and Uganda, we collected objective measures of PrEP adherence using unannounced home-based pill counts and electronic pill bottle monitoring. Participants received individual and couples-based adherence counseling at PrEP initiation and throughout the study; counseling was intensified if unannounced pill count adherence fell to 80% adherence. Study limitations include potential shortcomings of the adherence measures and use of a convenience sample within the substudy cohort.The high PrEP adherence achieved in the setting of active adherence monitoring and counseling support was associated with a high degree of protection from HIV acquisition by the HIV-uninfected partner in heterosexual serodiscordant couples. Low PrEP adherence was associated with sexual behavior, alcohol use, younger age, and length of PrEP use. Please see later in the article for the Editors' Summary.

  15. Feasibility of a cohort study on health risks caused by occupational exposure to radiofrequency electromagnetic fields

    Directory of Open Access Journals (Sweden)

    Wahrendorf Jürgen

    2009-05-01

    Full Text Available Abstract Background The aim of this study was to examine the feasibility of performing a cohort study on health risks from occupational exposure to radiofrequency electromagnetic fields (RF-EMF in Germany. Methods A set of criteria was developed to evaluate the feasibility of such a cohort study. The criteria aimed at conditions of exposure and exposure assessment (level, duration, preferably on an individual basis, the possibility to assemble a cohort and the feasibility of ascertaining various disease endpoints. Results Twenty occupational settings with workers potentially exposed to RF-EMF and, in addition, a cohort of amateur radio operators were considered. Based on expert ratings, literature reviews and our set of predefined criteria, three of the cohorts were identified as promising for further evaluation: the personnel (technicians of medium/short wave broadcasting stations, amateur radio operators, and workers on dielectric heat sealers. After further analyses, the cohort of workers on dielectric heat sealers seems not to be feasible due to the small number of exposed workers available and to the difficulty of assessing exposure (exposure depends heavily on the respective working process and mixture of exposures, e.g. plastic vapours, although exposure was highest in this occupational setting. The advantage of the cohort of amateur radio operators was the large number of persons it includes, while the advantage of the cohort of personnel working at broadcasting stations was the quality of retrospective exposure assessment. However, in the cohort of amateur radio operators the exposure assessment was limited, and the cohort of technicians was hampered by the small number of persons working in this profession. Conclusion The majority of occupational groups exposed to RF-EMF are not practicable for setting up an occupational cohort study due to the small numbers of exposed subjects or due to exposure levels being only marginally higher

  16. Coffee consumption during pregnancy and the risk of hyperkinetic disorder and ADHD: a prospective cohort study

    DEFF Research Database (Denmark)

    Linnet, Karen Markussen; Wisborg, Kirsten; Secher, Niels Jørgen;

    2008-01-01

    Aim: Based on hypotheses from experimental studies, we studied the association between intrauterine exposure to coffee and the risk of clinically verified hyperkinetic disorder and attention-deficit hyperactivity disorder (ADHD). Methods: A cohort study with prospectively collected data from...... 88 children with hyperkinetic disorder and ADHD. Information about coffee consumption during pregnancy was obtained at 16 weeks of gestation from self-administrated questionnaires. Potential confounding factors were evaluated using Cox regression analyses. Results: We found that intrauterine exposure...... to 10 or more cups of coffee per day was associated with a threefold increased risk of hyperkinetic disorder and ADHD. After adjustments for a number of confounding factors, the risk decreased and became statistically insignificant (RR 2.3, 95% CI 0.9-5.9). Conclusion: Prenatal exposure to high levels...

  17. The Impact of Surgery on the Developmental Status of Late Preterm Infants – A Cohort Study

    Directory of Open Access Journals (Sweden)

    Amit Trivedi

    2015-01-01

    Full Text Available Aims: Despite increasing evidence in the literature regarding the impact of late prematurity on subsequent developmental impairment, the developmental outcome of late preterm infants who undergo major surgery remains unclear. The aim of this study therefore was to determine the developmental outcome for a cohort of late preterm surgical population.Methods: Late preterm infants with a gestational age from 34-36 weeks inclusive who were enrolled in the state-wide prospective Development After Infant Surgery (DAISy study and who had undergone non-cardiac major surgery within the first ninety days of life were eligible for inclusion. Infants were assessed at one and three years of ages.Results: Forty-six infants were enrolled in the study, of which 38 infants had a complete developmental assessment at one year of age. Of these infants, late preterm infants scored significantly lower than the standardized norms of the assessment on the expressive language and gross motor subscales. At three years of age 26 infants were reassessed: late preterm infants who underwent major surgery only scored significantly lower than the standardized norms on the cognitive subscale (p<0.001.Conclusions: These data provide the evidence that late preterm infants who undergo major non-cardiac surgery are at risk of developmental impairment and consideration should be given to enrolling this cohort in multi-disciplinary developmental follow-up clinics.

  18. Comparison of A level and UKCAT performance in students applying to UK medical and dental schools in 2006: cohort study

    OpenAIRE

    James, David; Yates, Janet; Nicholson, Sandra

    2010-01-01

    Objectives To determine whether the UK Clinical Aptitude Test (UKCAT) adds value to the selection process for school leaver applicants to medical and dental school, and in particular whether UKCAT can reduce the socioeconomic bias known to affect A levels. Design Cohort study Setting Applicants to 23 UK medical and dental schools in 2006. Participants 9884 applicants who took the UKCAT in the UK and who achieved at least three passes at A level in their school leaving examinations (53% of all...

  19. When are breast cancer patients at highest risk of venous thromboembolism: a cohort study using English healthcare data

    OpenAIRE

    Walker, Alex J.; West, Joe; Card, Timothy R; Crooks, Colin J; Kirwan, Cliona C; Grainge, Matthew J

    2015-01-01

    Breast cancer patients are at increased risk of VTE, particularly in the peri-diagnosis period. However, no previous epidemiological studies have investigated the relative impact of breast cancer treatments in a time-dependent manner. We aimed to determine the impact of breast cancer stage, biology and treatment on the absolute and relative risks of VTE, using several recently linked data sources from England. Our cohort comprised 13,202 breast cancer patients from the Clinical Practice Resea...

  20. Putative invasive pulmonary aspergillosis in critically ill patients with chronic obstructive pulmonary disease: a matched cohort study

    OpenAIRE

    Delsuc, Claire; Cottereau, Aurélie; Frealle, Emilie; Bienvenu, Anne-Lise; Dessein, Rodrigue; Jarraud, Sophie; Dumitrescu, Oana; Le Maréchal, Marion; Wallet, Florent; Friggeri, Arnaud; Argaud, Laurent; Rimmelé, Thomas; Nseir, Saad; Ader, Florence

    2015-01-01

    Introduction Patients with advanced chronic obstructive pulmonary disease (COPD) are at risk for developing invasive pulmonary aspergillosis. A clinical algorithm has been validated to discriminate colonization from putative invasive pulmonary aspergillosis (PIPA) in Aspergillus-positive respiratory tract cultures of critically ill patients. We focused on critically ill patients with COPD who met the criteria for PIPA. Methods This matched cohort study included critically ill patients with CO...

  1. Low health literacy predicts decline in physical function among older adults: findings from the LitCog cohort study

    OpenAIRE

    Smith, Samuel G.; O'Conor, Rachel; Curtis, Laura M.; Waite, Katie; Deary, Ian J; Paasche-Orlow, Michael; Wolf, Michael S.

    2015-01-01

    BACKGROUND: Limited health literacy is associated with worse physical function in cross-sectional studies. We aimed to determine if health literacy is a risk factor for decline in physical function among older adults.METHODS: A longitudinal cohort of 529 community-dwelling American adults aged 55-74 years were recruited from an academic general internal medicine clinic and federally qualified health centres in 2008-2011. Health literacy (Newest Vital Sign), age, gender, race, education, chron...

  2. The Anyang Esophageal Cancer Cohort Study: Study Design, Implementation of Fieldwork, and Use of Computer-Aided Survey System

    OpenAIRE

    Liu, Fangfang; Guo, Fangcen; Zhou, Yue; He, Zhonghu; Tian, Xiuyun; Guo, Chuanhai; Ning, Tao; Pan, Yaqi; Cai, Hong; Ke, Yang

    2012-01-01

    Background Human papillomavirus (HPV) has been observed repeatedly in esophageal squamous cell carcinoma (ESCC) tissues. However, the causal relationship between HPV infection and the onset of ESCC remains unknown. A large cohort study focusing on this topic is being carried out in rural Anyang, China. Methodology/Principal Findings The Anyang Esophageal Cancer Cohort Study (AECCS) is a population-based prospective endoscopic cohort study designed to investigate the association of HPV infecti...

  3. The HIV-Brazil cohort study: design, methods and participant characteristics.

    Directory of Open Access Journals (Sweden)

    Alexandre Grangeiro

    Full Text Available BACKGROUND: The HIV-Brazil Cohort Study was established to analyze the effectiveness of combination antiretroviral therapy (cART and the impact of this treatment on morbidity, quality of life (QOL and mortality. The study design, patients' profiles and characteristics of cART initiation between 2003 and 2010 were described. METHODOLOGY/PRINCIPAL FINDINGS: Since 2003, the HIV-Brazil Cohort has been following HIV-infected adults receiving cART at 26 public health care facilities, using routine clinical care data and self-reported QOL questionnaires. When not otherwise available, data are obtained from national information systems. The main outcomes of interest are diseases related or unrelated to HIV; suppression of viral replication; adverse events; virological, clinical and immunological failures; changes in the cART; and mortality. For the 5,061 patients who started cART between 2003 and 2010, the median follow-up time was 4.1 years (IQR 2.2-5.9 years with an 83.4% retention rate. Patient profiles were characterized by a predominance of men (male/female ratio 1.7∶1, with a mean age of 36.9 years (SD 9.9 years; 55.2% had been infected with HIV via heterosexual contact. The majority of patients (53.4% initiated cART with a CD4+ T-cell count ≤200 cells/mm3. The medications most often used in the various treatment regimens were efavirenz (59.7% and lopinavir/ritonavir (18.2%. The proportion of individuals achieving viral suppression within the first 12 months of cART use was 77.4% (95% CI 76.1-78.6. Nearly half (45.4% of the patients presented HIV-related clinical manifestations after starting cART, and the AIDS mortality rate was 13.9 per 1,000 person-years. CONCLUSIONS/SIGNIFICANCE: Results from cART use in the daily practice of health services remain relatively unknown in low- and middle-income countries, and studies with the characteristics of the HIV-Brazil Cohort contribute to minimizing these shortcomings, given its scope and patient

  4. Demographics, clinical disease characteristics, and quality of life in a large cohort of psoriasis patients with and without psoriatic arthritis

    Directory of Open Access Journals (Sweden)

    Truong B

    2015-11-01

    Full Text Available B Truong,1,* N Rich-Garg,2,* BD Ehst,1 AA Deodhar,2 JH Ku,2 K Vakil-Gilani,2 A Danve,2 A Blauvelt,1,3 1Department of Dermatology, Oregon Health and Science University, 2Division of Arthritis and Rheumatic Diseases, Oregon Health and Science University, 3Oregon Medical Research Center, Portland, OR, USA *These authors contributed equally to this work Innovation: What is already known about the topic: psoriasis (PsO is a common skin disease with major impact on quality of life (QoL. Patient-reported data on QoL from large number of PsO patients with and without psoriatic arthritis (PsA are limited. What this study adds: In a large cohort referred to a university psoriasis center, patients with PsO and concomitant PsA (~30% in this group had greater degrees of skin and nail involvement and experienced greater negative impacts on QoL. Despite large numbers of patients with moderate-to-severe disease, use of systemic therapy by community practitioners was uncommon. Background: PsO and PsA are common diseases that have marked adverse impacts on QoL. The disease features and patient-reported QoL data comparing PsO and PsA patients are limited. Objective: To identify and compare demographics, clinical disease characteristics, and QoL scores in a large cohort of PsO patients with and without PsA. Methods: All PsO patients seen in a psoriasis specialty clinic, named the Center of Excellence for Psoriasis and Psoriatic Arthritis, were enrolled in an observational cohort. Demographic, QoL, and clinical data were collected from patient-reported questionnaires and from physical examinations performed by Center of Excellence for Psoriasis and Psoriatic Arthritis dermatologists and a rheumatologists. Cross sectional descriptive data were collected and comparisons between patients with PsO alone and those with concomitant PsA are presented. Results: A total of 568 patients were enrolled in the database. Mean age of PsO onset was 28 years and mean disease

  5. Aragon workers’ health study – design and cohort description

    OpenAIRE

    Casasnovas José A; Alcaide Victor; Civeira Fernando; Guallar Eliseo; Ibañez Borja; Borreguero Jesús; Laclaustra Martin; León Montserrat; Peñalvo José; Ordovás José M; Pocovi Miguel; Sanz Ginés; Fuster Valentín

    2012-01-01

    Abstract Background Spain, a Mediterranean country with relatively low rates of coronary heart disease, has a high prevalence of traditional cardiovascular risk factors and is experiencing a severe epidemic of overweight/obesity. We designed the Aragon Workers’ Health Study (AWHS) to characterize the factors associated with metabolic abnormalities and subclinical atherosclerosis in a middle aged population in Spain free of clinical cardiovascular disease. The objective of this paper is to des...

  6. Sociodemographic factors and vestibular schwannoma: a Danish nationwide cohort study

    DEFF Research Database (Denmark)

    Schüz, Joachim; Steding-Jessen, Marianne; Hansen, Søren;

    2010-01-01

    Vestibular schwannoma (VS) (or acoustic neuroma) accounts for about 5%-6% of all intracranial tumors; little is known about the etiology. We investigated the association between various sociodemographic indicators and VS in a cohort of 3.26 million Danish residents, with 1087 cases identified in 35...

  7. Small bowel angiodysplasia and novel disease associations: a cohort study.

    LENUS (Irish Health Repository)

    Holleran, Grainne

    2013-04-01

    Gastrointestinal angiodysplasias recurrently bleed, accounting for 3-5% of obscure gastrointestinal bleeding. The advent of small bowel capsule endoscopy (SBCE) has led to an increased recognition of small bowel angiodysplasias (SBAs) but little is known about their etiology. Previous small cohorts and case reports suggest an equal gender incidence and associations with cardiovascular disease, renal impairment, and coagulopathies.

  8. Psychosocial work environment and antidepressant medication: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Westergaard-Nielsen Niels

    2009-07-01

    Full Text Available Abstract Background Adverse psychosocial work environments may lead to impaired mental health, but it is still a matter of conjecture if demonstrated associations are causal or biased. We aimed at verifying whether poor psychosocial working climate is related to increase of redeemed subscription of antidepressant medication. Methods Information on all antidepressant drugs (AD purchased at pharmacies from 1995 through 2006 was obtained for a cohort of 21,129 Danish public service workers that participated in work climate surveys carried out during the period 2002–2005. Individual self-reports of psychosocial factors at work including satisfaction with the work climate and dimensions of the job strain model were obtained by self-administered questionnaires (response rate 77,2%. Each employee was assigned the average score value for all employees at his/her managerial work unit [1094 units with an average of 18 employees (range 3–120]. The risk of first-time AD prescription during follow-up was examined according to level of satisfaction and psychosocial strain by Cox regression with adjustment for gender, age, marital status, occupational status and calendar year of the survey. Results The proportion of employees that received at least one prescription of ADs from 1995 through 2006 was 11.9% and prescriptions rose steadily from 1.50% in 1996 to the highest level 6.47% in 2006. ADs were prescribed more frequent among women, middle aged, employees with low occupational status and those living alone. None of the measured psychosocial work environment factors were consistently related to prescription of antidepressant drugs during the follow-up period. Conclusion The study does not indicate that a poor psychosocial work environment among public service employees is related to prescription of antidepressant pharmaceuticals. These findings need cautious interpretation because of lacking individual exposure assessments.

  9. Evaluation of chemotherapy response with serum squamous cell carcinoma antigen level in cervical cancer patients: a prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Mingzhu Yin

    Full Text Available MRI does not always reflect tumor response after chemotherapy. Therefore, it is necessary to explore additional parameters to more accurately evaluate tumor response for the subsequent clinical determination about radiotherapy or radical surgery. A training cohort and an external validation cohort were used to examine the predictive performance of SCC-ag to evaluate tumor response from teaching hospital of Harbin Medical University. The study included 397 women with SCC (age: 28-73 years. Patients consecutively enrolled between August 2008 and January 2010 (n = 205 were used as training cohort. Patients consecutively enrolled between February 2010 and May 2011 (n = 192 were used as validation cohort. A multivariate regression analysis of the data from the training cohort indicated that serum SCC-ag level is an independent factor for neo-adjuvant chemotherapy (NACT response. Analysis of the data from the validation cohort suggested that chemotherapy response could be more accurately predicted by SCC-ag than by magnetic resonance imaging (MRI (sensitivity (Se: 0.944 vs. 0.794; specificity (Sp: 0.727 vs. 0.636; positive predictive value (PPV: 0.869 vs. 0.806; negative predictive value (NPV: 0.873 vs. 0.618; the area under ROC curve (AUC: 0.898 vs. 0.734. Combining SCC-ag with MRI was more powerful than MRI alone (Se: 0.952 vs. 0.794; Sp: 0.833 vs. 0.636; PPV: 0.916 vs. 0.806; NPV: 0.902 vs. 0.618; AUC: 0.950 vs. 0.734. Our study indicates that serum SCC-ag level is a sensitive and reliable measure to evaluate cervical cancer response to chemotherapy. Using SCC-ag in combination with MRI findings further improves the predictive power.

  10. Impact of the Jamaican birth cohort study on maternal, child and adolescent health policy and practice.

    Science.gov (United States)

    McCaw-Binns, A; Ashley, D; Samms-Vaughan, M

    2010-01-01

    The Jamaica Perinatal Morbidity and Mortality Survey (JPMMS) was a national study designed to identify modifiable risk factors associated with poor maternal and perinatal outcome. Needing to better understand factors that promote or retard child development, behaviour and academic achievement, we conducted follow-up studies of the birth cohort. The paper describes the policy developments from the JPMMS and two follow-up rounds. The initial study (1986-87) documented 94% of all births and their outcomes on the island over 2 months (n = 10 508), and perinatal (n = 2175) and maternal deaths (n = 62) for a further 10 months. A subset of the birth cohort, identified by their date of birth through school records, was seen at ages 11-12 (n = 1715) and 15-16 years (n = 1563). Findings from the initial survey led to, inter alia, clinic-based screening for syphilis, referral high-risk clinics run by visiting obstetricians, and the redesign and construction of new labour wards at referral hospitals. The follow-up studies documented inadequate academic achievement among boys and children attending public schools, and associations between under- and over-nutrition, excessive television viewing (>20 h/week), inadequate parental supervision and behavioural problems. These contributed to the development of a television programming code for children, a National Parenting Policy, policies aimed at improving inter-sectoral services to children from birth to 5 years (Early Childhood Commission) and behavioural interventions of the Violence Prevention Alliance (an inter-sectoral NGO) and the Healthy Lifestyles project (Ministry of Health). Indigenous maternal and child health research provided a local evidence base that informed public policy. Collaboration, good communication, being vigilant to opportunities to influence policy, and patience has contributed to our success. PMID:20078824

  11. Clinical course of a cohort of children with non-neurogenic daytime urinary incontinence symptoms followed at a tertiary center

    Directory of Open Access Journals (Sweden)

    Adrienne Lebl

    2016-04-01

    Full Text Available Abstract Objective: To characterize a cohort of children with non-neurogenic daytime urinary incontinence followed-up in a tertiary center. Methods: Retrospective analysis of 50 medical records of children who had attained bladder control or minimum age of 5 years, using a structured protocol that included lower urinary tract dysfunction symptoms, comorbidities, associated manifestations, physical examination, voiding diary, complementary tests, therapeutic options, and clinical outcome, in accordance with the 2006 and 2014 International Children's Continence Society standardizations. Results: Female patients represented 86.0% of this sample. Mean age was 7.9 years and mean follow-up was 4.7 years. Urgency (56.0%, urgency incontinence (56.0%, urinary retention (8.0%, nocturnal enuresis (70.0%, urinary tract infections (62.0%, constipation (62.0%, and fecal incontinence (16.0% were the most prevalent symptoms and comorbidities. Ultrasound examinations showed alterations in 53.0% of the cases; the urodynamic study showed alterations in 94.7%. At the last follow-up, 32.0% of patients persisted with urinary incontinence. When assessing the diagnostic methods, 85% concordance was observed between the predictive diagnosis of overactive bladder attained through medical history plus non-invasive exams and the diagnosis of detrusor overactivity achieved through the invasive urodynamic study. Conclusions: This subgroup of patients with clinical characteristics of an overactive bladder, with no history of urinary tract infection, and normal urinary tract ultrasound and uroflowmetry, could start treatment without invasive studies even at a tertiary center. Approximately one-third of the patients treated at the tertiary level remained refractory to treatment.

  12. Handling ethical, legal and social issues in birth cohort studies involving genetic research: responses from studies in six countries

    Directory of Open Access Journals (Sweden)

    LeGrandeur Jane

    2010-03-01

    handling of sensitive information and return of results. In all studies, signs of child abuse require reports to authorities, but this disclosure duty is not always stated in consent materials. Studies vary in whether they will return to participants results of routine tests/measures, but none inform participants about findings with unknown clinical significance. Conclusions Analysis of how cohort studies in various jurisdictions handle key ELS issues provides informative data for comparison and contrast. Consideration of these and other examples and further scholarly exploration of ELS issues provides insight on how best to address these aspects in ways that respect the well-being of participants, especially children who become research subjects at the start of their lives.

  13. Clinical variables serve as prognostic factors in a model for survival from glioblastoma multiforme: an observational study of a cohort of consecutive non-selected patients from a single institution

    International Nuclear Information System (INIS)

    Although implementation of temozolomide (TMZ) as a part of primary therapy for glioblastoma multiforme (GBM) has resulted in improved patient survival, the disease is still incurable. Previous studies have correlated various parameters to survival, although no single parameter has yet been identified. More studies and new approaches to identify the best and worst performing patients are therefore in great demand. This study examined 225 consecutive, non-selected GBM patients with performance status (PS) 0–2 receiving postoperative radiotherapy with concomitant and adjuvant TMZ as primary therapy. At relapse, patients with PS 0–2 were mostly treated by reoperation and/or combination with bevacizumab/irinotecan (BEV/IRI), while a few received TMZ therapy if the recurrence-free period was >6 months. Median overall survival and time to progression were 14.3 and 8.0 months, respectively. Second-line therapy indicated that reoperation and/or BEV/IRI increased patient survival compared with untreated patients and that BEV/IRI was more effective than reoperation alone. Patient age, ECOG PS, and use of corticosteroid therapy were significantly correlated with patient survival and disease progression on univariate analysis, whereas p53, epidermal growth factor receptor, and O6-methylguanine-DNA methyltransferase expression (all detected by immunohistochemistry), tumor size or multifocality, and extent of primary operation were not. A model based on age, ECOG PS, and corticosteroids use was able to predict survival probability for an individual patient. The survival of RT/TMZ-treated GBM patients can be predicted based on patient age, ECOG PS, and corticosteroid therapy status

  14. Quality of life in Parkinson's disease improved by apomorphine pump: the OPTIPUMP cohort study.

    Science.gov (United States)

    Drapier, Sophie; Eusebio, Alexandre; Degos, Bertrand; Vérin, Marc; Durif, Franck; Azulay, Jean Philippe; Viallet, François; Rouaud, Tiphaine; Moreau, Caroline; Defebvre, Luc; Fraix, Valerie; Tranchant, Christine; Andre, Karine; Courbon, Christine Brefel; Roze, Emmanuel; Devos, David

    2016-06-01

    To report on OPTIPUMP, a cohort study, investigating the impact in real-life clinical settings of continuous subcutaneous apomorphine infusion (CSAI) on the quality of life (HRQoL) of patients with Parkinson's disease. OPTIPUMP was a prospective, open-label, observational cohort study involving 30 investigational sites in France. CSAI was proposed as part of routine clinical care to patients aged ≥18 years, in absence of dementia, with a PD diagnosis and based on the presence of motor fluctuations not controlled by oral treatments. The impact of APO-pump on quality of life was evaluated as the difference in PDQ-39 scores between the initiation treatment and the follow-up visit after 6 months' treatment. All adverse events were recorded. Hyper- and hypodopaminergic behavioral tolerance was assessed on the Ardouin Scale of Behavior in Parkinson's Disease. Between September 2011 and January 2013, we enrolled 142 patients: 42 patients were withdrawn due to pump removal (33), death (4), lost of follow-up (4), no available data (1). 100 completed the study. At 6 months, their HRQoL had significantly improved (p = 0.011), as had their total UPDRS score (p < 0.001). Regarding the safety profile, Ardouin scale scores indicated that their hyperdopaminergic behaviors had not increased. CSAI had a favorable impact on HRQoL, with benefits outweighing risks. The analysis of the withdrawn patients highlights the heterogeneity of the use of the pump having an impact on its efficacy and tolerability. PMID:27060084

  15. Maternal thyroid function and the outcome of external cephalic version: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    van der Donk Riet W

    2011-01-01

    Full Text Available Abstract Background To investigate the relation between maternal thyroid function and the outcome of external cephalic version (ECV in breech presentation. Methods Prospective cohort study in 141 women (≥ 35 weeks gestation with a singleton fetus in breech. Blood samples for assessing thyroid function were taken prior to ECV. Main outcome measure was the relation between maternal thyroid function and ECV outcome indicated by post ECV ultrasound. Results ECV success rate was 77/141 (55%, 41/48 (85% in multipara and 36/93 (39% in primipara. Women with a failed ECV attempt had significantly higher TSH concentrations than women with a successful ECV (p Conclusions Higher TSH levels increase the risk of ECV failure. Trial registration number ClinicalTrials.gov: NCT00516555

  16. Recall Bias in Childhood Atopic Diseases Among Adults in The Odense Adolescence Cohort Study

    DEFF Research Database (Denmark)

    Mortz, Charlotte G; Andersen, Klaus E; Bindslev-Jensen, Carsten

    2015-01-01

    Atopic dermatitis (AD) is a common disease in childhood and an important risk factor for the later development of other atopic diseases. Many publications on childhood AD use questionnaires based on information obtained in adulthood, which introduce the possibility of recall bias. In a prospective...... cohort study, recall bias was evaluated in 1,501 unselected schoolchildren (mean age 14 years) evaluated for the first time in 1995 with a standardized questionnaire combined with a clinical examination and repeated in 2010. The lifetime prevalence of AD was 34.1% including data obtained both during...... school age and 15 years later, compared with 23.6% including data only from adulthood. The most important factors for remembering having had AD in childhood were: (i) long duration of dermatitis in childhood; (ii) adult hand eczema; and (iii) concomitant atopic disease. Recall bias for childhood AD...

  17. Dietary fiber intake and mortality among survivors of myocardial infarction: prospective cohort study

    OpenAIRE

    Li, Shanshan; Flint, Alan; Pai, Jennifer K.; Forman, John P.; Hu, Frank B.; Willett, Walter C.; Rexrode, Kathryn M.; Mukamal, Kenneth J; Rimm, Eric B

    2014-01-01

    Objective To evaluate the associations of dietary fiber after myocardial infarction (MI) and changes in dietary fiber intake from before to after MI with all cause and cardiovascular mortality. Design Prospective cohort study. Setting Two large prospective cohort studies of US women and men with repeated dietary measurements: the Nurses’ Health Study and the Health Professionals Follow-Up Study. Participants 2258 women and 1840 men who were free of cardiovascular disease, stroke, or cancer at...

  18. Dietary fiber intake and mortality among survivors of myocardial infarction: prospective cohort study

    OpenAIRE

    Li, Shanshan; Flint, Alan; Pai, Jennifer K.; Forman, John P.; Hu, Frank B.; Willett, Walter C.; Rexrode, Kathryn M.; Mukamal, Kenneth J; Rimm, Eric B

    2014-01-01

    Objective: To evaluate the associations of dietary fiber after myocardial infarction (MI) and changes in dietary fiber intake from before to after MI with all cause and cardiovascular mortality. Design: Prospective cohort study. Setting: Two large prospective cohort studies of US women and men with repeated dietary measurements: the Nurses’ Health Study and the Health Professionals Follow-Up Study. Participants: 2258 women and 1840 men who were free of cardiovascular disease, stroke, or cance...

  19. Sleep-disordered breathing and mortality: a prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Naresh M Punjabi

    2009-08-01

    Full Text Available BACKGROUND: Sleep-disordered breathing is a common condition associated with adverse health outcomes including hypertension and cardiovascular disease. The overall objective of this study was to determine whether sleep-disordered breathing and its sequelae of intermittent hypoxemia and recurrent arousals are associated with mortality in a community sample of adults aged 40 years or older. METHODS AND FINDINGS: We prospectively examined whether sleep-disordered breathing was associated with an increased risk of death from any cause in 6,441 men and women participating in the Sleep Heart Health Study. Sleep-disordered breathing was assessed with the apnea-hypopnea index (AHI based on an in-home polysomnogram. Survival analysis and proportional hazards regression models were used to calculate hazard ratios for mortality after adjusting for age, sex, race, smoking status, body mass index, and prevalent medical conditions. The average follow-up period for the cohort was 8.2 y during which 1,047 participants (587 men and 460 women died. Compared to those without sleep-disordered breathing (AHI: or=30.0 events/h sleep-disordered breathing were 0.93 (95% CI: 0.80-1.08, 1.17 (95% CI: 0.97-1.42, and 1.46 (95% CI: 1.14-1.86, respectively. Stratified analyses by sex and age showed that the increased risk of death associated with severe sleep-disordered breathing was statistically significant in men aged 40-70 y (hazard ratio: 2.09; 95% CI: 1.31-3.33. Measures of sleep-related intermittent hypoxemia, but not sleep fragmentation, were independently associated with all-cause mortality. Coronary artery disease-related mortality associated with sleep-disordered breathing showed a pattern of association similar to all-cause mortality. CONCLUSIONS: Sleep-disordered breathing is associated with all-cause mortality and specifically that due to coronary artery disease, particularly in men aged 40-70 y with severe sleep-disordered breathing. Please see later in the

  20. The spectrum of intermediate syndrome following acute organophosphate poisoning: a prospective cohort study from Sri Lanka.

    Directory of Open Access Journals (Sweden)

    Pradeepa Jayawardane

    2008-07-01

    Full Text Available BACKGROUND: Intermediate syndrome (IMS is a major cause of death from respiratory failure following acute organophosphate poisoning. The objective of this study was to determine repetitive nerve stimulation (RNS predictors of IMS that would assist in patient management and clinical research. METHODS AND FINDINGS: Seventy-eight consenting symptomatic patients with organophosphate poisoning were assessed prospectively with daily physical examination and RNS. RNS was done on the right and left median and ulnar nerves at 1, 3, 10, 15, 20, and 30 Hz. The study was conducted as a prospective observational cohort study in the Central Province, Sri Lanka. IMS was diagnosed in ten out of 78 patients using a priori clinical diagnostic criteria, and five of them developed respiratory failure. All ten patients showed progressive RNS changes correlating with the severity of IMS. A decrement-increment was observed at intermediate and high frequencies preceding the onset of clinical signs of IMS. As the patient developed clinical signs of IMS, decrement-increment was progressively noted at low and intermediate frequencies and a combination of decrement-increment and repetitive fade or severe decrement was noted at high frequencies. Severe decrement preceded respiratory failure in four patients. Thirty patients developed forme fruste IMS with less severe weakness not progressing to respiratory failure whose RNS was characterized by decrement-increment or a combination of decrement-increment and repetitive fade but never severe decrements. CONCLUSIONS: Characteristic changes in RNS, preceding the development of IMS, help to identify a subgroup of patients at high risk of developing respiratory failure. The forme fruste IMS with the characteristic early changes on RNS indicates that IMS is a spectrum disorder. RNS changes are objective and precede the diagnosis and complications of IMS. Thus they may be useful in clinical management and research.

  1. Respiratory cancer in Danish bakers: a 10 year cohort study.

    OpenAIRE

    Tüchsen, F; Nordholm, L.

    1986-01-01

    A national cohort based on the census at 9 November 1970 and the death registration files from 1970 to 1980 was analysed to see if skilled Danish bakers had an excess of respiratory cancer. The group of skilled bakers was divided into occupational subgroups to try to narrow down the possible causes of cancer. Significant excess mortality was found among skilled bakers in retail bakeries, skilled bakers in hotels and restaurants, and independent bakers. To adjust for confounding factors, the S...

  2. Cost-efficiency of specialist inpatient rehabilitation for working-aged adults with complex neurological disabilities: A multicentre cohort analysis of a national clinical dataset

    OpenAIRE

    Turner-Stokes, Lynne Frances; Williams, Heather; Bill, Alan; Bassett, Paul; Sephton, Keith

    2015-01-01

    Objectives To evaluate functional outcomes, care needs and cost-efficiency of specialist rehabilitation for a multicentre cohort of inpatients with complex neurological disability, comparing different diagnostic groups across 3 levels of dependency. Design A multicentre cohort analysis of prospectively collected clinical data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database, 2010–2015. Setting All 62 specialist (levels 1 and 2) rehabilitation services in En...

  3. 2004 update of dosimetry for the Utah Thyroid Cohort Study.

    Science.gov (United States)

    Simon, Steven L; Anspaugh, Lynn R; Hoffman, F Owen; Scholl, Alan E; Stone, Mary B; Thomas, Brian A; Lyon, Joseph L

    2006-02-01

    In the 1980s, individual thyroid doses and uncertainties were estimated for members of a cohort of children identified in 1965 in Utah and Nevada who had potentially been exposed to fallout from the Nevada Test Site. That reconstruction represented the first comprehensive assessment of doses received by the cohort and was the first large effort to assess the uncertainty of dose on an individual person basis. The data on dose and thyroid disease prevalence during different periods were subsequently used in an analysis to determine risks of radiogenic thyroid disease. This cohort has received periodic medical follow-up to observe changes in disease frequency and to reassess the previously reported radiation-related risks, most recently after a Congressional mandate in 1998. In a recent effort to restore the databases and computer codes used to estimate doses in the 1980s, various deficiencies were found in the estimated doses due to improperly operating computer codes, corruption of secondary data files, and lack of quality control procedures. From 2001 through 2004, the dosimetry system was restored and corrected and all doses were recalculated. In addition, two parameter values were updated. While the mean of all doses has not changed significantly, many individual doses have changed by more than an order of magnitude. PMID:16435919

  4. Perceived age as clinically useful biomarker of ageing: cohort study

    DEFF Research Database (Denmark)

    Christensen, Kaare; Thinggaard, Mikael; McGue, Matt;

    2009-01-01

    young men, and 11 older women (assessors); 1826 twins aged >or=70. MAIN OUTCOME MEASURES: Assessors: perceived age of twins from photographs. Twins: physical and cognitive tests and molecular biomarker of ageing (leucocyte telomere length). RESULTS: For all three groups of assessors, perceived age was...

  5. Clinical and laboratorial impact of antiretroviral therapy in a cohort of Portuguese patients chronically infected with HIV-2

    Directory of Open Access Journals (Sweden)

    Ana Miranda

    2014-11-01

    Full Text Available Introduction: HIV-2 infection is endemic in West Africa and some European countries, namely Portugal. HIV-2 antiretroviral (ARV treatment presents some restrains related to intrinsic resistance to non-nucleoside reverse transcriptase inhibitors (NNRTI and fusion inhibitors, and poorer response to protease inhibitors (PI. Material and Methods: Retrospective observational study of a cohort of 135 infected HIV-2 patients, diagnosed between 1989 and 2008. Objectives: Evaluation of epidemiologic, clinical, immunologic and virologic progression, comparing to groups of patients (naïve vs ARV experienced; characterization of therapeutic, immunologic and virologic response. SPSS version 20.0 was used for statistical analysis. Results: The study included 135 patients: 41% (n=55 naïve and 59% (n=80 with ARV experience. The comparison between groups (naïve vs ARV revealed: male prevalence 76% vs 50%; mean age 54.5 years vs 54.8 (p=0.90; main geographic origin Guiné Bissau (47% vs 44% and Portugal (22% vs 33%; and transmission mainly acquired by heterosexual contact (87% vs 80%. Mean time since diagnosis was 14 vs 13 years (p=0.31; 2% vs 50% presented AIDS criteria at diagnosis (p350 cell/mm3 at diagnosis (p2 regimes. Considering the first ARV therapy: 56% initiated PI, 30% NTRI and 5% integrase inhibitor (II-based regimens. Currently, 54 patients maintain regular follow-up and ARV therapy: 60% NTRI+PI; 37% NRTI+PI+II and 3% NRTI+II. TDF/FTC is the backbone in 56%. Most frequent PIs are LPV/r (54%, DRV/r (19% and ATV/r (12%. Mean time of exposure to NRTI=3 years, PI=7 years and II=2 years. Immunologic recovery was sustained for each of the ARV class considered (NRTI Δ=+144 cell/mm3; PI=Δ+92 cell/mm3; II=Δ=+116 cell/mm3. Conclusions: This is a cohort accompanied for a long period and the majority of patients present extensive ARV experience. The ARV-experienced patients registered a favourable response to treatment, with sustained immune recovery (

  6. Electronic Cigarettes Efficacy and Safety at 12 Months: Cohort Study

    Science.gov (United States)

    Fiore, Maria; La Vecchia, Carlo; Marzuillo, Carolina; Gualano, Maria Rosaria; Liguori, Giorgio; Cicolini, Giancarlo; Capasso, Lorenzo; D'Amario, Claudio; Boccia, Stefania; Siliquini, Roberta; Ricciardi, Walter; Villari, Paolo

    2015-01-01

    Objective To evaluate the safety and efficacy as a tool of smoking cessation of electronic cigarettes (e-cigarettes), directly comparing users of e-cigarettes only, smokers of tobacco cigarettes only, and smokers of both. Design Prospective cohort study. Final results are expected in 2019, but given the urgency of data to support policies on electronic smoking, we report the results of the 12-month follow-up. Data Sources Direct contact and structured questionnaires by phone or via internet. Methods Adults (30–75 years) were included if they were smokers of ≥1 tobacco cigarette/day (tobacco smokers), users of any type of e-cigarettes, inhaling ≥50 puffs weekly (e-smokers), or smokers of both tobacco and e-cigarettes (dual smokers). Carbon monoxide levels were tested in a sample of those declaring tobacco smoking abstinence. Main Outcome Measures Sustained smoking abstinence from tobacco smoking at 12 months, reduction in the number of tobacco cigarettes smoked daily. Data Synthesis We used linear and logistic regression, with region as cluster unit. Results Follow-up data were available for 236 e-smokers, 491 tobacco smokers, and 232 dual smokers (overall response rate 70.8%). All e-smokers were tobacco ex-smokers. At 12 months, 61.9% of the e-smokers were still abstinent from tobacco smoking; 20.6% of the tobacco smokers and 22.0% of the dual smokers achieved tobacco abstinence. Adjusting for potential confounders, tobacco smoking abstinence or cessation remained significantly more likely among e-smokers (adjusted OR 5.19; 95% CI: 3.35–8.02), whereas adding e-cigarettes to tobacco smoking did not enhance the likelihood of quitting tobacco and did not reduce tobacco cigarette consumption. E-smokers showed a minimal but significantly higher increase in self-rated health than other smokers. Non significant differences were found in self-reported serious adverse events (eleven overall). Conclusions Adding e-cigarettes to tobacco smoking did not facilitate

  7. Prognosis of acute low back pain: design of a prospective inception cohort study

    Directory of Open Access Journals (Sweden)

    York John

    2006-06-01

    Full Text Available Abstract Background Clinical guidelines generally portray acute low back pain as a benign and self-limiting condition. However, evidence about the clinical course of acute low back pain is contradictory and the risk of subsequently developing chronic low back pain remains uncertain. There are few high quality prognosis studies and none that have measured pain, disability and return to work over a 12 month period. This study aims to provide the first estimates of the one year prognosis of acute low back pain (pain of less than 2 weeks duration in patients consulting primary care practitioners. A secondary aim is to identify factors that are associated with the prognosis of low back pain. Methods/Design The study is a prospective inception cohort study. Consecutive patients consulting general medical practitioners, physiotherapists and chiropractors in the Sydney metropolitan region will complete a baseline questionnaire regarding their back pain. Subsequently these patients will be followed up by telephone 6 weeks, 3 months and 12 months after the initial consultation. Patients will be considered to have recovered from the episode of back pain if they have no pain and no limitation of activity, and have returned to pre-injury work status. Life tables will be generated to determine the one year prognosis of acute low back pain. Prognostic factors will be assessed using Cox regression. Discussion This study will provide the first estimates of the one year prognosis of acute low back pain in a representative sample of primary care patients.

  8. HIV incidence among men who have sex with men in Beijing: a prospective cohort study

    OpenAIRE

    Li, Dongliang; Li, Shuming; Liu, Yingjie; Gao, Yanjie; Yu, Mingrun; Yang, Xueying; Li, Qingchun; Jiang, Shulin; Zhou, Zhenhai; Zhang, Zheng; Yan, Li; Jiang, Guiyan; Xiao, Dong; Pan, Stephen W.; Luo, Fengji

    2012-01-01

    Objectives (1) To assess the HIV incidence rate among men who have sex with men (MSM) in a large cohort study in Beijing, China and (2) to identify sociodemographic and behavioural risk factors of HIV seroconversion among MSM in Beijing, China. Design A prospective cohort study. Setting Baseline and follow-up visits were conducted among MSM in Beijing, China. Participants A cohort of 797 HIV-seronegative MSM was recruited from August to December 2009, with follow-up occurring after 6 and 12 m...

  9. Vegetarianism, low meat consumption and the risk of colorectal cancer in a population based cohort study

    OpenAIRE

    Anne M. J. Gilsing; Schouten, Leo J.; R. Alexandra Goldbohm; Dagnelie, Pieter C.; van den Brandt, Piet A.; Weijenberg, Matty P.

    2015-01-01

    To study how a vegetarian or low meat diet influences the risk of colorectal cancer compared to a high meat diet, and to assess the explanatory role of factors associated with these diets. In the Netherlands Cohort Study – Meat Investigation Cohort (NLCS-MIC) (cohort of 10,210 individuals including 1040 self-defined vegetarians), subjects completed a baseline questionnaire in 1986, based on which they were classified into vegetarians (n = 635), pescetarians (n = 360), 1 day/week- (n = 1259), ...

  10. IQ in childhood and vegetarianism in adulthood: 1970 British cohort study

    OpenAIRE

    Gale, Catharine R; Deary, Ian J.; Batty, G David; Schoon, Ingrid

    2007-01-01

    Objective To examine the relation between IQ in childhood and vegetarianism in adulthood.Design Prospective cohort study in which IQ was assessed by tests of mental ability at age 10 years and vegetarianism by self-report at age 30 years.Setting Great Britain.Participants 8170 men and women aged 30 years participating in the 1970 British cohort study, a national birth cohort.Main outcome measures Self-reported vegetarianism and type of diet followed.Results 366 (4.5%) participants said they w...

  11. Cohort Profile: The Malaysian Cohort (TMC) project: a prospective study of non-communicable diseases in a multi-ethnic population

    OpenAIRE

    Jamal, Rahman; Syed Zakaria, Syed Zulkifli; Kamaruddin, Mohd Arman; Abd Jalal, Nazihah; Ismail, Norliza; Mohd Kamil, Norkhamiwati; Abdullah, Noraidatulakma; Baharudin, Norhafizah; Hussin, Noor Hamidah; Othman, Hanita; Mahadi, Nor Muhammad; ,

    2014-01-01

    The Malaysian Cohort study was initiated in 2005 by the Malaysian government. The top-down approach to this population-based cohort study ensured the allocation of sufficient funding for the project which aimed to recruit 100 000 individuals aged 35–70 years. Participants were recruited from rural and urban areas as well as from various socioeconomic groups. The main objectives of the study were to identify risk factors, to study gene-environment interaction and to discover biomarkers for the...

  12. The Impact of the Thai Motorcycle Transition on Road Traffic Injury: Thai Cohort Study Results

    OpenAIRE

    Berecki-Gisolf, Janneke; Yiengprugsawan, Vasoontara; Kelly, Matthew; McClure, Roderick; Seubsman, Sam-ang; Sleigh, Adrian; ,

    2015-01-01

    Objectives The aim of this study was to investigate the impact of motorcycle to car transitioning and urbanisation on traffic injury rates in Thailand. Design Analysis of two consecutive surveys of a large national cohort study. Setting Thailand. Participants The data derived from 57,154 Thai Cohort Study (TCS) participants who provided relevant data on both the 2005 and 2009 surveys. Primary and secondary outcome measures Motorcycle and car traffic crash injury self-reported in 2009, with tw...

  13. The Nail as a Biomonitor of Trace Element Status in Golestan Cohort Study

    OpenAIRE

    Hashemian, Maryam; Poustchi, Hossein; Pourshams, Akram; Khoshnia, Masoud; Brockman, John Douglas; Hekmatdoost, Azita; Abnet, Christian C.; Malekzadeh, Reza

    2016-01-01

    BACKGROUND In the Golestan Cohort Study that was launched to investigate the causes of esophageal cancer, a complete biospecimen bank was established for storage of collected blood, urine, hair, and nail samples. The objective of this study was to evaluate the feasibility of nail samples as a biomarker of selected trace elements status. METHODS Thirty toenail samples were selected randomly from the participants of Golestan Cohort Study (GCS). The samples were cleaned and analyzed for selenium...

  14. Sensor, a population-based cohort study on gastroenteritis in the Netherlands: incidence and etiology.

    OpenAIRE

    Wit, M.A.S. de; Koopmans, M. P. G.; Kortbeek, L. M.; Wannet, W. J. B.; Vinje, J.; Leusden, F. van; Bartelds, A.I.M.; Duynhoven, Y.T.H.P. van

    2001-01-01

    A prospective population-based cohort study with a nested case- control study was conducted to estimate the incidence of gastroenteritis and the associated pathogens in the general Dutch population. Follow-up of two consecutive cohorts was performed by weekly reporting cards from december 1998 to december 1999. Cases and controls in the case-control study supplied a questionnaire and stool samples. The standardized gastroenteritis incidence was 283 per 1,000 person-years. The incidence rose w...

  15. Exposure to Radiofrequency Electromagnetic Fields and Sleep Quality: A Prospective Cohort Study

    OpenAIRE

    Mohler, Evelyn; Frei, Patrizia; Fröhlich, Jürg; Braun-Fahrländer, Charlotte; Röösli, Martin; ,

    2012-01-01

    Background There is persistent public concern about sleep disturbances due to radiofrequency electromagnetic field (RF-EMF) exposure. The aim of this prospective cohort study was to investigate whether sleep quality is affected by mobile phone use or by other RF-EMF sources in the everyday environment. Methods We conducted a prospective cohort study with 955 study participants aged between 30 and 60 years. Sleep quality and daytime sleepiness was assessed by means of standardized questionnair...

  16. Contribution of problem drug users’ deaths to excess mortality in Scotland: secondary analysis of cohort study

    OpenAIRE

    Bloor, Michael; Gannon, Maria; Hay, Gordon; Jackson, Graham; Alastair H Leyland; McKeganey, Neil

    2008-01-01

    Objectives To examine the “Scottish effect”—namely, the growing divergence between mortality in Scotland and England that is not explained by national differences in levels of deprivation—and, more specifically, to examine the extent to which the Scottish effect is explained by cross national differences in the prevalence of problem drug use. Design Secondary analysis of cohort study (the DORIS study). Participants 1033 Scottish drug users recruited to the cohort study in 33 drug treatment fa...

  17. Breast cancer in the Thai Cohort Study: An exploratory case-control analysis

    OpenAIRE

    Jordan, Susan; Lim, Lynette; Vilainerun, Duangkae; Banks, Emily; Sripaiboonkij, Nintita; Seubsman, Sam-ang; Sleigh, Adrian; Bain, Christopher

    2009-01-01

    Breast cancer incidence may be increasing in Thailand but very little research has assessed core breast cancer risk factors in this country. We used baseline questionnaire data from a national cohort study of Thai Open University students in an exploratory case-control study of breast cancer. The study included 43 female cases and 860 age-matched controls selected from the remaining 47,271 female cohort participants. Odds ratios and 95% confidence intervals were calculated using conditional l...

  18. Children and Clinical Studies: Why Clinical Studies Are Important

    Medline Plus

    Full Text Available ... Clinical Studies Children have often had to accept medicines and treatments based on what is known to ... children's health with the goal to develop treatments, drugs, and devices specific to children. Resources for a ...

  19. A Retrospective Cohort Study on the Influence of Comorbidity on Soft Tissue Reactions, Revision Surgery, and Implant Loss in Bone-anchored Hearing Implants

    NARCIS (Netherlands)

    Besten, C.A. den; Nelissen, R.C.; Peer, P.G.M.; Faber, H.T.; Dun, C.A.; Wolf, M.J.; Kunst, H.P.M.; Cremers, C.W.R.J.; Mylanus, E.A.M.; Hol, M.K.

    2015-01-01

    OBJECTIVE: To identify risk factors for complications after bone-anchored hearing implant (BAHI) surgery. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary referral center. PATIENTS: All adult patients who received titanium bone-anchored hearing implants at our clinic between September 1,

  20. Virologic Response to Lopinavir-Ritonavir-Based Antiretroviral Regimens in a Multicenter International Clinical Cohort: Comparison of Genotypic Interpretation Scores▿

    OpenAIRE

    Grant, Philip; Eric C Wong; Rode, Richard; Shafer, Robert; De Luca, Andrea; Nadler, Jeffrey; Hawkins, Trevor; Cohen, Calvin; Harrington, Robert; Kempf, Dale; Zolopa, Andrew

    2008-01-01

    Several genotypic interpretation scores have been proposed for the evaluation of susceptibility to lopinavir/ritonavir (LPV/r) but have not been compared using an independent data set. This study was a retrospective multicenter cohort of patients initiating LPV/r-based therapy. The virologic response (VR) was defined as a viral load of

  1. Clinical and Microbiological Profile of a Retrospective Cohort of Enteric Fever in 2 Spanish Tertiary Hospitals

    OpenAIRE

    Sánchez-Montalvá, Adrián; Martínez-Pérez, Ángela; Pérez-Molina, José Antonio; González-López, Juan José; Lopez-Vélez, Rogelio; Salvador, Fernando; Sánchez, Irene; Planes, Anna M.; Molina, Israel

    2015-01-01

    Abstract Enteric fever in high-income countries is diagnosed mainly in patients returning from endemic countries. We assess the clinical, microbiological, and prognosis aspects of enteric fever in 2 Spanish tertiary hospitals. A retrospective observational study was conducted at Vall d’Hebron University Hospital and Ramón y Cajal University Hospital in Spain. We reviewed medical records of all patients who were diagnosed with enteric fever from January 2000 to January 2014 at these hospitals....

  2. Pneumoconiosis increases the risk of congestive heart failure: A nationwide population-based cohort study.

    Science.gov (United States)

    Yen, Chia-Ming; Lin, Cheng-Li; Lin, Ming-Chia; Chen, Huei-Yong; Lu, Nan-Han; Kao, Chia-Hung

    2016-06-01

    The purpose of the study was to determine the relationship between pneumoconiosis and congestive heart failure (CHF).We collected data from the National Health Insurance Research Database in Taiwan. The study sample comprised 8923 patients with pneumoconiosis and 35,692 nonpneumoconiosis controls enrolled from 2000 to 2011. Patients were followed up until the end of 2011 to evaluate the incidence of CHF. The risk of CHF was analyzed using Cox proportional hazard regression models, and the analysis accounted for factors such as sex, age, comorbidities, and air pollutants (μg/m).The overall incidence of CHF was higher in the pneumoconiosis cohort (15.7 per 1000 person-y) than in the nonpneumoconiosis cohort (11.2 per 1000 person-y), with a crude hazard ratio (HR) of 1.40 (P pneumoconiosis cohort than in the nonpneumoconiosis cohort (P pneumoconiosis cohort compared with the nonpneumoconiosis cohort was significant for men (adjusted HR = 1.40, 95% confidence interval = 1.21-1.62, P pneumoconiosis patients had a higher relative risk of CHF for all age group.Patients with pneumoconiosis were at higher risk for developing CHF than patients in the nonpneumoconiosis cohort, particularly in cases with coexisting coronary artery disease, hypertension, and chronic obstructive pulmonary disease. PMID:27336897

  3. The Groningen assisted reproductive technologies cohort study : developmental status and behavior at 2 years

    NARCIS (Netherlands)

    Jongbloed-Pereboom, Marjolein; Middelburg, Karin J.; Heineman, Maas Jan; Bos, Arend F.; Hadders-Algra, Mijna

    2011-01-01

    Objective: To evaluate whether children's cognitive and psychomotor development and behavior at 2 years are affected by ovarian hyperstimulation and the IVF laboratory procedures or subfertility. Design: Prospective longitudinal cohort study. Setting: University Medical Center Groningen, the Netherl

  4. DRD4 Rare Variants in Attention-Deficit/Hyperactivity Disorder (ADHD): Further Evidence from a Birth Cohort Study

    OpenAIRE

    Tovo-Rodrigues, Luciana; Rohde, Luis A.; Ana M. B. Menezes; Polanczyk, Guilherme V; Kieling, Christian; Julia P Genro; Anselmi, Luciana; Mara H. Hutz

    2013-01-01

    The dopamine receptor D4 (DRD4) is one of the most studied candidate genes for Attention-Deficit/Hyperactivity Disorder (ADHD). An excess of rare variants and non-synonymous mutations in the VNTR region of 7R allele in ADHD subjects was observed in previous studies with clinical samples. We hypothesize that genetic heterogeneity in the VNTR is an important factor in the pathophysiology of ADHD. The subjects included in the present study are members of the 1993 Pelotas Birth Cohort Study (N=5,...

  5. Cardiovascular events prior to or early after diagnosis of systemic lupus erythematosus in the systemic lupus international collaborating clinics cohort

    Science.gov (United States)

    Urowitz, M B; Gladman, D D; Anderson, N M; Su, J; Romero-Diaz, J; Bae, S C; Fortin, P R; Sanchez-Guerrero, J; Clarke, A; Bernatsky, S; Gordon, C; Hanly, J G; Wallace, D J; Isenberg, D; Rahman, A; Merrill, J; Ginzler, E; Alarcón, G S; Fessler, B F; Petri, M; Bruce, I N; Khamashta, M; Aranow, C; Dooley, M; Manzi, S; Ramsey-Goldman, R; Sturfelt, G; Nived, O; Steinsson, K; Zoma, A; Ruiz-Irastorza, G; Lim, S; Kalunian, K C; Ỉnanç, M; van Vollenhoven, R; Ramos-Casals, M; Kamen, D L; Jacobsen, S; Peschken, C; Askanase, A; Stoll, T

    2016-01-01

    Objective To describe the frequency of myocardial infarction (MI) prior to the diagnosis of systemic lupus erythematosus (SLE) and within the first 2 years of follow-up. Methods The systemic lupus international collaborating clinics (SLICC) atherosclerosis inception cohort enters patients within 15 months of SLE diagnosis. MIs were reported and attributed on a specialised vascular event form. MIs were confirmed by one or more of the following: abnormal ECG, typical or atypical symptoms with ECG abnormalities and elevated enzymes (≥2 times upper limit of normal), or abnormal stress test, echocardiogram, nuclear scan or angiogram. Descriptive statistics were used. Results 31 of 1848 patients who entered the cohort had an MI. Of those, 23 patients had an MI prior to SLE diagnosis or within the first 2 years of disease. Of the 23 patients studied, 60.9% were female, 78.3% were Caucasian, 8.7% black, 8.7% Hispanic and 4.3% other. The mean age at SLE diagnosis was 52.5±15.0 years. Of the 23 MIs that occurred, 16 MIs occurred at a mean of 6.1±7.0 years prior to diagnosis and 7 occurred within the first 2 years of follow-up. Risk factors associated with early MI in univariate analysis are male sex, Caucasian, older age at diagnosis, hypertension, hypercholesterolaemia, family history of MI and smoking. In multivariate analysis only age (OR=1.06 95% CI 1.03 to 1.09), hypertension (OR=5.01, 95% CI 1.38 to 18.23), hypercholesterolaemia (OR=4.43, 95% CI 1.51 to 12.99) and smoking (OR=7.50, 95% CI 2.38 to 23.57) remained significant risk factors. Conclusions In some patients with lupus, MI may develop even before the diagnosis of SLE or shortly thereafter, suggesting that there may be a link between autoimmune inflammation and atherosclerosis. PMID:27099765

  6. Breast bud detection: a validation study in the Chilean Growth Obesity Cohort Study

    OpenAIRE

    Pereira, Ana; Garmendia, María Luisa; González, Daniela; Kain, Juliana; Mericq, Verónica; Uauy, Ricardo; Corvalán, Camila

    2014-01-01

    Background Early puberty onset has been related to future chronic disease; however breast bud assessment in large scale population studies is difficult because it requires trained personnel. Thus our aim is to assess the validity of self and maternal breast bud detection, considering girl’s body mass index (BMI) and maternal education. Methods In 2010, 481 girls (mean age = 7.8) from the Growth and Obesity Chilean Cohort Study were evaluated by a nutritionist trained in breast bud detection. ...

  7. Birth cohort differences in physical functioning levels among elderly Brazilians: findings from the Bambui Cohort Study of Aging (1997-2008)

    OpenAIRE

    Oliveira, C. M.; M.F. Lima-Costa

    2011-01-01

    The aim of this study was to investigate the cohort differences in physical functioning levels among the older (cohort members born in 1916-1926 and in 1927-1937) participants of the Bambui Cohort Study of Aging. The data came from participants aged 71-81 who took part at baseline in 1997 (n = 491) and in the 11th wave in 2008 (n = 620). The physical functioning variables included the following self-reported measures: activities of daily living, the instrumental activities of daily living and...

  8. Adequacy of Mental Health Services for HIV-Positive Patients with Depression: Ontario HIV Treatment Network Cohort Study

    DEFF Research Database (Denmark)

    Choi, Stephanie; Boyle, Eleanor; Cairney, John;

    2016-01-01

    BACKGROUND: Major depression can profoundly impact clinical and quality-of-life outcomes of people living with HIV, and this disease is underdiagnosed and undertreated in many HIV-positive individuals. Here, we describe the prevalence of publicly funded primary and secondary mental health service...... use and antidepressant use, as well as mental health care for depression in accordance with existing Canadian guidelines for HIV-positive patients with depression in Ontario, Canada. METHODS: We conducted a prospective cohort study linking data from the Ontario HIV Treatment Network Cohort Study with...... gaps in delivering publicly funded mental health services to depressed HIV-positive patients and identified unequal access to these services, particularly among vulnerable groups. More effective mental health policies and better access to mental health services are required to address HIV-positive...

  9. Prenatal testing among women pregnant after assisted reproductive techniques in Denmark 1995-2000: a national cohort study

    DEFF Research Database (Denmark)

    Gjerris, A.C.; Loft, A.; Pinborg, A.;

    2008-01-01

    BACKGROUND: Women pregnant after assisted reproductive techniques (ART) are generally older than women with spontaneously conceived pregnancies, and are consequently more likely to carry a child affected by a chromosomal disorder. Furthermore, a significantly increased rate of chromosomal...... abnormalities after intracytoplasmatic sperm injection (ICSI) has been reported. The aim of this study was to describe the use and results of prenatal invasive diagnostic testing in a national Danish cohort of in vitro fertilization (IVF)/ICSI pregnancies. Additionally, we examined to what extent second...... trimester serum screening was used. METHODS: We used a register-based cohort study including all ongoing clinical pregnancies achieved by IVF/ICSI in 1995-2000 in Denmark. Data on fertility treatment, pregnancy and pregnancy outcome together with data on cytogenic testing and the use of triple test were...

  10. Use and Safety of Anthroposophic Medications for Acute Respiratory and Ear Infections: A Prospective Cohort Study

    OpenAIRE

    Hamre, Harald J.; Anja Glockmann; Michael Fischer; Riley, David S.; Erik Baars; Helmut Kiene

    2007-01-01

    Objective: Anthroposophic medications (AMED) are widely used, but safety data on AMED from large prospective studies are sparse. The objective of this analysis was to determine the frequency of adverse drug reactions (ADR) to AMED in outpatients using AMED for acute respiratory and ear infections.Methods: A prospective four-week observational cohort study was conducted in 21 primary care practices in Europe and the U.S.A. The cohort comprised 715 consecutive outpatients aged 1 month, treated ...

  11. Effectiveness of DNA-recombinant anti-hepatitis B vaccines in blood donors: a cohort study

    OpenAIRE

    Petry Andrea; de Souza Denise ER; Kupek Emil

    2007-01-01

    Abstract Background Although various studies have demonstrated efficacy of DNA-recombinant anti-hepatitis B vaccines, their effectiveness in health care settings has not been researched adequately. This gap is particularly visible for blood donors, a group of significant importance in the reduction of transfusion-transmitted hepatitis B. Methods This is a double cohort study of 1411 repeat blood donors during the period 1998–2002, involving a vaccinated and an unvaccinated cohort, with matchi...

  12. Individual asbestos exposure: smoking and mortality--a cohort study in the asbestos cement industry.

    OpenAIRE

    Neuberger, M.; Kundi, M

    1990-01-01

    A historical prospective cohort study comprised all persons employed from 1950 to 1981 for at least three years in the oldest asbestos cement factory in the world. From 2816 persons eligible for the study, record based estimates and measurements of dust and fibres and histories of smoking based on interviews were used to calculate individual exposures over time. After observation of 51,218 person-years and registration of 540 deaths, underlying causes of death for this cohort were compared wi...

  13. Comanagement of Geriatric Patients With Hip Fractures: A Retrospective, Controlled, Cohort Study

    OpenAIRE

    Rocca, Gregory J. Della; Moylan, Kyle C.; Crist, Brett D.; Volgas, David A.; Stannard, James P.; Mehr, David R.

    2013-01-01

    The objective of this 3-year retrospective, controlled, cohort study is to characterize an interdisciplinary method of managing geriatric patients with hip fracture. All patients aged 65 years or older admitted to a single academic level I trauma center during a 3-year period with an isolated hip fracture were included as participants for this study. Thirty-one geriatric patients with hip fracture were treated with historical methods of care (cohort 1). The comparison group of 115 similar pat...

  14. Tuberculosis in pediatric patients treated with anti-TNFα drugs: a cohort study

    OpenAIRE

    Calzada-Hernández, Joan; Anton-López, Jordi; Bou-Torrent, Rosa; Iglesias-Jiménez, Estíbaliz; Ricart-Campos, Sílvia; Martín de Carpi, Javier; ,; Torrente-Segarra, Vicenç; Sánchez-Manubens, Judith; Giménez-Roca, Clara; Rozas-Quesada, Librada; Juncosa-Morros, Maria Teresa; Fortuny, Clàudia; Noguera-Julian, Antoni

    2015-01-01

    Background Adult patients receiving anti-TNFα drugs are at increased risk of tuberculosis (TB), but studies in pediatric populations are limited, and the best strategy for latent tuberculosis infection (LTBI) screening in this population remains controversial. We describe the prevalence of LTBI prior to anti-TNFα therapy and the long-term follow-up after biological treatment initiation in a cohort of children and adolescents. Methods Cohort observational study in children and adolescents rece...

  15. Obstetric Outcomes in Chinese Women with Endometriosis: A Retrospective Cohort Study

    OpenAIRE

    Hong Lin; Jin-Hua Leng; Jun-Tao Liu; Jing-He Lang

    2015-01-01

    Background: The effect of endometriosis on obstetric outcomes is still ambiguous. The aim of our study was to determine the association between endometriosis and adverse obstetric outcomes in a cohort of Chinese women. Methods: A retrospective cohort study was undertaken to compare obstetric outcomes between 249 women with endometriosis and 249 women without endometriosis. All women were nulliparous and achieved singleton pregnancies naturally. Women with endometriosis were diagnosed duri...

  16. Alcohol intake and ovarian cancer risk : A pooled analysis of 10 cohort studies

    OpenAIRE

    Genkinger, J.M.; Hunter, D. J.; Spiegelman, D; Anderson, K. E.; Buring, J. E.; Freudenheim, J. L.; Goldbohm, R. A.; Harnack, L.; Hankinson, S E; Larsson, S C; Leitzmann, M; McCullough, M.L.; Marshall, J.; Miller, A.B.; Rodriguez, C.

    2006-01-01

    Alcohol has been hypothesized to promote ovarian carcinogenesis by its potential to increase circulating levels of estrogen and other hormones; through its oxidation byproduct, acetaldehyde, which may act as a cocarcinogen; and by depletion of folate and other nutrients. Case-control and cohort studies have reported conflicting results relating alcohol intake to ovarian cancer risk. We conducted a pooled analysis of the primary data from ten prospective cohort studies. The analysis included 5...

  17. Association between dietary and beverage consumption patterns in the SUN (Seguimiento Universidad de Navarra) cohort study

    OpenAIRE

    Sanchez-Villegas, A.; E. Toledo; Bes-Rastrollo, M.; Martin-Moreno, J.M. (J.M.); Tortosa, A.; Martinez-Gonzalez, M.A. (Miguel Angel)

    2008-01-01

    Objective: The objective of the present study was to determine the dietary patterns of a Mediterranean cohort and relate them to the observed patterns of beverage consumption. Design: Prospective cohort study. Dietary habits were assessed with a semiquantitative FFQ validated in Spain. A principal components factor analysis was used to identify dietary patterns and to classify subjects according to their adherence to these patterns. The association between adherence to each dietar...

  18. Early determinants of physical activity in adolescence: prospective birth cohort study.

    OpenAIRE

    Hallal, P. C.; Wells, J. C.; Reichert, F. F.; Anselmi, L; Victora, C G

    2006-01-01

    OBJECTIVE: To examine the effects of early social, anthropometric, and behavioural variables on physical activity in adolescence. DESIGN: Prospective birth cohort study. SETTING: Pelotas, southern Brazil. PARTICIPANTS: 4453 adolescents aged 10-12 years participating in the Pelotas 1993 birth cohort study (follow-up rate 87.5%). MAIN OUTCOME MEASURES: Sedentary lifestyle (< 300 minutes of physical activity per week) and median physical activity score (minutes per week). RESULTS: The prevalence...

  19. A general semiparametric Z-estimation approach for case-cohort studies

    CERN Document Server

    Nan, Bin

    2012-01-01

    Case-cohort design, an outcome-dependent sampling design for censored survival data, is increasingly used in biomedical research. The development of asymptotic theory for a case-cohort design in the current literature primarily relies on counting process stochastic integrals. Such an approach, however, is rather limited and lacks theoretical justification for outcome-dependent weighted methods due to non-predictability. Instead of stochastic integrals, we derive asymptotic properties for case-cohort studies based on a general Z-estimation theory for semiparametric models with bundled parameters using modern empirical processes. Both the Cox model and the additive hazards model with time-dependent covariates are considered.

  20. A picture is worth a thousand words: maps of HIV indicators to inform research, programs, and policy from NA-ACCORD and CCASAnet clinical cohorts

    Directory of Open Access Journals (Sweden)

    Keri N Althoff

    2016-04-01

    Full Text Available Introduction: Maps are powerful tools for visualization of differences in health indicators by geographical region, but multi-country maps of HIV indicators do not exist, perhaps due to lack of consistent data across countries. Our objective was to create maps of four HIV indicators in North, Central, and South American countries. Methods: Using data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD and the Caribbean, Central, and South America network for HIV epidemiology (CCASAnet, we mapped median CD4 at presentation for HIV clinical care, proportion retained in HIV primary care, proportion prescribed antiretroviral therapy (ART, and the proportion with suppressed plasma HIV viral load (VL from 2010 to 2012 for North, Central, and South America. The 15 Canadian and US clinical cohorts and 7 clinical cohorts in Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru represented approximately 2–7% of persons known to be living with HIV in these countries. Results: Study populations were selected for each indicator: median CD4 at presentation for care was estimated among 14,811 adults; retention was estimated among 87,979 adults; ART use was estimated among 84,757 adults; and suppressed VL was estimated among 51,118 adults. Only three US states and the District of Columbia had a median CD4 at presentation >350 cells/mm3. Haiti, Mexico, and several states had >85% retention in care; lower (50–74% retention in care was observed in the US West, South, and Mid-Atlantic, and in Argentina, Brazil, and Peru. ART use was highest (90% in Mexico. The percentages of patients with suppressed VL in the US South and Northeast were lower than in most of Central and South America. Conclusions: These maps provide visualization of gaps in the quality of HIV care and allow for comparison between and within countries as well as monitoring policy and programme goals within geographical boundaries.

  1. A picture is worth a thousand words: maps of HIV indicators to inform research, programs, and policy from NA-ACCORD and CCASAnet clinical cohorts

    Science.gov (United States)

    Althoff, Keri N; Rebeiro, Peter F; Hanna, David B; Padgett, Denis; Horberg, Michael A; Grinsztejn, Beatriz; Abraham, Alison G; Hogg, Robert; Gill, M John; Wolff, Marcelo J; Mayor, Angel; Rachlis, Anita; Williams, Carolyn; Sterling, Timothy R; Kitahata, Mari M; Buchacz, Kate; Thorne, Jennifer E; Cesar, Carina; Cordero, Fernando M; Rourke, Sean B; Sierra-Madero, Juan; Pape, Jean W; Cahn, Pedro; McGowan, Catherine

    2016-01-01

    Introduction Maps are powerful tools for visualization of differences in health indicators by geographical region, but multi-country maps of HIV indicators do not exist, perhaps due to lack of consistent data across countries. Our objective was to create maps of four HIV indicators in North, Central, and South American countries. Methods Using data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) and the Caribbean, Central, and South America network for HIV epidemiology (CCASAnet), we mapped median CD4 at presentation for HIV clinical care, proportion retained in HIV primary care, proportion prescribed antiretroviral therapy (ART), and the proportion with suppressed plasma HIV viral load (VL) from 2010 to 2012 for North, Central, and South America. The 15 Canadian and US clinical cohorts and 7 clinical cohorts in Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru represented approximately 2–7% of persons known to be living with HIV in these countries. Results Study populations were selected for each indicator: median CD4 at presentation for care was estimated among 14,811 adults; retention was estimated among 87,979 adults; ART use was estimated among 84,757 adults; and suppressed VL was estimated among 51,118 adults. Only three US states and the District of Columbia had a median CD4 at presentation >350 cells/mm3. Haiti, Mexico, and several states had >85% retention in care; lower (50–74%) retention in care was observed in the US West, South, and Mid-Atlantic, and in Argentina, Brazil, and Peru. ART use was highest (90%) in Mexico. The percentages of patients with suppressed VL in the US South and Northeast were lower than in most of Central and South America. Conclusions These maps provide visualization of gaps in the quality of HIV care and allow for comparison between and within countries as well as monitoring policy and programme goals within geographical boundaries. PMID:27049052

  2. Risk for unemployment of cancer survivors: A Danish cohort study

    DEFF Research Database (Denmark)

    Carlsen, Kathrine; Dalton, Susanne Oksbjerg; Diderichsen, Finn;

    2008-01-01

    AIM: To investigate whether cancer survivors are at an increased risk for unemployment after cancer. MATERIALS AND METHODS: A cohort of 65,510 patients who were part of the workforce in the year before diagnosis and a random sample of 316,925 age and gender-matched controls were followed for up to...... that the risk for unemployment was highest amongst persons aged 50-60 years at time of diagnosis. Risk factors for unemployment were found to be manual work, medium income and vocational education. CONCLUSION: Generally, cancer patients were at a small increased risk for unemployment and low...

  3. Obstetric risk indicators for labour dystocia in nulliparous women: A multi-centre cohort study

    Directory of Open Access Journals (Sweden)

    Ottesen Bent

    2008-10-01

    Full Text Available Abstract Background In nulliparous women dystocia is the most common obstetric problem and its etiology is largely unknown. The frequency of augmentation and cesarean delivery related to dystocia is high although it is not clear if a slow progress justifies the interventions. Studies of risk factors for dystocia often do not provide diagnostic criteria for the diagnosis. The aim of the present study was to identify obstetric and clinical risk indicators of dystocia defined by strict and explicit criteria. Methods A multi-centre population based cohort study with prospectively collected data from 2810 nulliparous women in term spontaneous labour with a singleton infant in cephalic presentation. Data were collected by self-administered questionnaires and clinical data-records. Logistic regression analyses were used to estimate adjusted Odds Ratios (OR and 95% confidence intervals (CI are given. Results The following characteristics, present at admission to hospital, were associated with dystocia during labour (OR, 95% CI: dilatation of cervix Conclusion Vaginal examinations at admission provide useful information on risk indicators for dystocia. The strongest risk indicator was use of epidural analgesia and if part of that is causal, it is of concern.

  4. Clinical laboratory studies in Barth Syndrome.

    Science.gov (United States)

    Vernon, Hilary J; Sandlers, Yana; McClellan, Rebecca; Kelley, Richard I

    2014-06-01

    Barth Syndrome is a rare X-linked disorder characterized principally by dilated cardiomyopathy, skeletal myopathy and neutropenia and caused by defects in tafazzin, an enzyme responsible for modifying the acyl chain moieties of cardiolipin. While several comprehensive clinical studies of Barth Syndrome have been published detailing cardiac and hematologic features, descriptions of its biochemical characteristics are limited. To gain a better understanding of the clinical biochemistry of this rare disease, we measured hematologic and biochemical values in a cohort of Barth Syndrome patients. We characterized multiple biochemical parameters, including plasma amino acids, plasma 3-methylglutaconic acid, cholesterol, cholesterol synthetic intermediates, and red blood cell membrane fatty acid profiles in 28 individuals with Barth Syndrome from ages 10 months to 30 years. We describe a unique biochemical profile for these patients, including decreased plasma arginine levels. We further studied the plasma amino acid profiles, cholesterol, cholesterol synthetic intermediates, and plasma 3-methylglutaconic acid levels in 8 female carriers and showed that they do not share any of the distinct, Barth Syndrome-specific biochemical laboratory abnormalities. Our studies augment and expand the biochemical profiles of individuals with Barth Syndrome, describe a unique biochemical profile for these patients, and provide insight into the possible underlying biochemical pathology in this disorder. PMID:24751896

  5. OBSTRUCTIVE JAUNDICE: A CLINICAL STUDY

    OpenAIRE

    Antony,; Rasool Syed

    2016-01-01

    BACKGROUND Jaundice is a frequent manifestation of biliary tract disorders and evaluation of obstructive jaundice is a common problem faced by general surgeons. Obstructive jaundice of varied aetiology is one of the main cause of hospital admissions. Hence, comprehensive study of aetiology, clinical presentation, management of obstructive jaundice is important in management of these patients. AIMS AND OBJECTIVES  Study the clinical history and presentation of obstructiv...

  6. Cohort Profile: The Avon Longitudinal Study of Parents and Children: ALSPAC mothers cohort

    OpenAIRE

    Fraser, A; Macdonald-Wallis, C.; Tilling, K; Boyd, A.; J. Golding; Davey Smith, G.; Henderson, J.; Macleod, J; Molloy, L.; Ness, A; Ring, S.; Nelson, S M; D.A. Lawlor

    2012-01-01

    Summary The Avon Longitudinal Study of Children and Parents (ALSPAC) was established to understand how genetic and environmental characteristics influence health and development in parents and children. All pregnant women resident in a defined area in the South West of England, with an expected date of delivery between 1st April 1991 and 31st December 1992, were eligible and 13 761 women (contributing 13 867 pregnancies) were recruited. These women have been followed over the last 19–22 years...

  7. Eating disorders, pregnancy, and the postpartum period:Findings from the Norwegian Mother and Child Cohort Study (MoBa)

    OpenAIRE

    Watson, Hunna J.; Leila Torgersen; Stephanie Zerwas; Ted Reichborn-Kjennerud; Cecilie Knoph; Camilla Stoltenberg; Anna Maria Siega-Riz; Ann Von Holle; Hamer, Robert M.; Helle Margrete Meltzer; Ferguson, Elizabeth H.; Margaretha Haugen; Per Magnus; Rebecca Kuhns; Bulik, Cynthia M

    2014-01-01

    This review summarizes studies on eating disorders in pregnancy and the postpartum period that have been conducted as part of the broader Norwegian Mother and Child Cohort Study (MoBa). Prior to the 2000s, empirical literature on eating disorders in pregnancy was sparse and consisted mostly of studies in small clinical samples. MoBa has contributed to a new era of research by making population-based and largesample research possible. To date, MoBa has led to 19 eating disorder stu...

  8. A population-based cohort study of oral health in South Brazil: The Porto Alegre Study.

    Science.gov (United States)

    Haas, Alex Nogueira; Gaio, Eduardo José; Wagner, Marcius Comparsi; Rios, Fernando Silva; Costa, Ricardo dos Santos Araujo; Rösing, Cassiano Kuchenbecker; Oppermann, Rui Vicente; Albandar, Jasim; Susin, Cristiano

    2015-01-01

    Few population-based cohort studies have been established in Dentistry and this is especially true for Latin America. We conducted a population-based prospective study focusing on oral health in Porto Alegre, south Brazil, and herein we describe its methodology and discuss directions for further research. The cohort was established in 2001 using a multistage probability sample of 1,465 toothed and 121 edentulous subjects. A 5-year follow-up was performed in 2006 that included 755 individuals. The main aim of this study was to determine the pattern and risk factors for periodontal disease progression and tooth loss incidence. A full-mouth protocol was used including periodontal assessments at six sites per tooth. Primary outcomes were periodontal attachment loss and tooth loss. Oral mucosal lesions, dental plaque, gingivitis, supragingival calculus, probing depths, gingival recession, and dental caries were also assessed. This is the first population-based cohort study to focus on periodontal disease in Latin America. Findings will contribute to our understanding of the epidemiology of periodontal disease and provide valuable data for the planning and implementation of preventive and therapeutic strategies. PMID:26083520

  9. A population-based cohort study of oral health in South Brazil: The Porto Alegre Study

    Directory of Open Access Journals (Sweden)

    Alex Nogueira Haas

    2015-06-01

    Full Text Available Few population-based cohort studies have been established in Dentistry and this is especially true for Latin America. We conducted a population-based prospective study focusing on oral health in Porto Alegre, south Brazil, and herein we describe its methodology and discuss directions for further research. The cohort was established in 2001 using a multistage probability sample of 1,465 toothed and 121 edentulous subjects. A 5-year follow-up was performed in 2006 that included 755 individuals. The main aim of this study was to determine the pattern and risk factors for periodontal disease progression and tooth loss incidence. A full-mouth protocol was used including periodontal assessments at six sites per tooth. Primary outcomes were periodontal attachment loss and tooth loss. Oral mucosal lesions, dental plaque, gingivitis, supragingival calculus, probing depths, gingival recession, and dental caries were also assessed. This is the first population-based cohort study to focus on periodontal disease in Latin America. Findings will contribute to our understanding of the epidemiology of periodontal disease and provide valuable data for the planning and implementation of preventive and therapeutic strategies.

  10. Enteroaggregative Escherichia coli in Daycare—A 1-Year Dynamic Cohort Study

    Science.gov (United States)

    Hebbelstrup Jensen, Betina; Stensvold, Christen R.; Struve, Carsten; Olsen, Katharina E. P.; Scheutz, Flemming; Boisen, Nadia; Röser, Dennis; Andreassen, Bente U.; Nielsen, Henrik V.; Schønning, Kristian; Petersen, Andreas M.; Krogfelt, Karen A.

    2016-01-01

    Enteroaggregative Escherichia coli (EAEC) has been associated with persistent diarrhea, reduced growth acceleration, and failure to thrive in children living in developing countries and with childhood diarrhea in general in industrialized countries. The clinical implications of an EAEC carrier-status in children in industrialized countries warrants clarification. To investigate the pathological significance of an EAEC carrier-state in the industrialized countries, we designed a 1-year dynamic cohort study and performed follow-up every second month, where the study participants submitted a stool sample and answered a questionnaire regarding gastrointestinal symptoms and exposures. Exposures included foreign travel, consumption of antibiotics, and contact with a diseased animal. In the capital area of Denmark, a total of 179 children aged 0–6 years were followed in a cohort study, in the period between 2009 and 2013. This is the first investigation of the incidence and pathological significance of EAEC in Danish children attending daycare facilities. Conventional microbiological detection of enteric pathogens was performed at Statens Serum Institute, Copenhagen, Denmark, and at Hvidovre Hospital, Copenhagen, Denmark. Parents completed questionnaires regarding gastrointestinal symptoms. The EAEC strains were further characterized by serotyping, phylogenetic analysis, and susceptibility testing. EAEC was detected in 25 (14%) of the children during the observational period of 1 year. One or more gastrointestinal symptoms were reported from 56% of the EAEC-positive children. Diarrhea was reported in six (24%) of the EAEC positive children, but no cases of weight loss, and general failure to thrive were observed. The EAEC strains detected comprised a large number of different serotypes, confirming the genetic heterogeneity of this pathotype. EAEC was highly prevalent (n = 25, 14%) in Danish children in daycare centers and was accompanied by gastrointestinal symptoms in

  11. Association between Number of Teeth and Chronic Systemic Diseases: A Cohort Study Followed for 13 Years.

    Directory of Open Access Journals (Sweden)

    Kolade Oluwagbemigun

    Full Text Available There is growing evidence of an association between oral health, specifically dental status, and chronic systemic diseases. However, varying measures of dental status across different populations and low study sample has made comparison of studies and conclusion of findings unclear. Our aim is to examine whether the number of teeth as a measure of dental status is associated with incident chronic diseases in a cohort setting.We conducted a cohort study among 24,313 middle-aged Germans followed up for 13 years. Data on number of teeth as a measure of dental status were obtained through self-reports. Outcomes were clinically-verified incident non-fatal myocardial infarction, stroke, type 2 diabetes mellitus, and cancer. Hazard ratio (HR and 95% confidence intervals (CI were obtained from Cox regression models.Increasing number of teeth is inversely related to risk of myocardial infarction (HR: 0.97; 95% CI: 0.96, 0.99. The full multivariate model of teeth groups showed a strong linear trend for myocardial infarction, a less strong trend for stroke, and no relation with type 2 diabetes mellitus and cancer in a competing risk model. Participants with 18-23 teeth and those without teeth were at 76% (95%CI: 1.04, 3 and 2.93 times (95%CI: 1.61, 5.18 higher risk of myocardial infarction compared to those with nearly all teeth (28-32 teeth.Number of teeth is specifically associated with myocardial infarction and not with other chronic disease indicating that dental status further strengthens the link between oral health and cardiovascular diseases.

  12. Assessment of Allergy to Milk, Egg, Cod, and Wheat in Swedish Schoolchildren: A Population Based Cohort Study.

    Directory of Open Access Journals (Sweden)

    Anna Winberg

    Full Text Available Knowledge about the prevalence of allergies to foods in childhood and adolescence is incomplete. The purpose of this study was to investigate the prevalence of allergies to milk, egg, cod, and wheat using reported data, clinical examinations, and double-blind placebo-controlled food challenges, and to describe the phenotypes of reported food hypersensitivity in a cohort of Swedish schoolchildren.In a population-based cohort of 12-year-old children, the parents of 2612 (96% of invited completed a questionnaire. Specific IgE antibodies to foods were analyzed in a random sample (n=695. Children reporting complete avoidance of milk, egg, cod, or wheat due to perceived hypersensitivity and without physician-diagnosed celiac disease were invited to undergo clinical examination that included specific IgE testing, a celiac screening test, and categorization into phenotypes of food hypersensitivity according to preset criteria. Children with possible food allergy were further evaluated with double-blind challenges.In this cohort, the prevalence of reported food allergy to milk, egg, cod, or wheat was 4.8%. Food allergy was diagnosed in 1.4% of the children after clinical evaluation and in 0.6% following double-blind placebo-controlled food challenge. After clinical examination, children who completely avoided one or more essential foods due to perceived food hypersensitivity were categorized with the following phenotypes: allergy (29%, outgrown allergy (19%, lactose intolerance (40%, and unclear (12%.There was a high discrepancy in the prevalence of allergy to milk, egg, cod and wheat as assessed by reported data, clinical evaluation, and double-blind food challenges. Food hypersensitivity phenotyping according to preset criteria was helpful for identifying children with food allergy.

  13. Record linkage to correct under-ascertainment of cancers in HIV cohorts: The Sinikithemba HIV clinic linkage project.

    Science.gov (United States)

    Sengayi, Mazvita; Spoerri, Adrian; Egger, Matthias; Kielkowski, Danuta; Crankshaw, Tamaryn; Cloete, Christie; Giddy, Janet; Bohlius, Julia

    2016-09-15

    The surveillance of HIV-related cancers in South Africa is hampered by the lack of systematic collection of cancer diagnoses in HIV cohorts and the absence of HIV status in cancer registries. To improve cancer ascertainment and estimate cancer incidence, we linked records of adults (aged ≥ 16 years) on antiretroviral treatment (ART) enrolled at Sinikithemba HIV clinic, McCord Hospital in KwaZulu-Natal (KZN) with the cancer records of public laboratories in KZN province using probabilistic record linkage (PRL) methods. We calculated incidence rates for all cancers, Kaposi sarcoma (KS), cervix, non-Hodgkin's lymphoma and non-AIDS defining cancers (NADCs) before and after inclusion of linkage-identified cancers with 95% confidence intervals (CIs). A total of 8,721 records of HIV-positive patients were linked with 35,536 cancer records. Between 2004 and 2010, we identified 448 cancers, 82% (n = 367) were recorded in the cancer registry only, 10% (n = 43) in the HIV cohort only and 8% (n = 38) both in the HIV cohort and the cancer registry. The overall cancer incidence rate in patients starting ART increased from 134 (95% CI 91-212) to 877 (95% CI 744-1,041) per 100,000 person-years after inclusion of linkage-identified cancers. Incidence rates were highest for KS (432, 95% CI 341-555), followed by cervix (259, 95% CI 179-390) and NADCs (294, 95% CI 223-395) per 100,000 person-years. Ascertainment of cancer in HIV cohorts is incomplete, PRL is both feasible and essential for cancer ascertainment. PMID:27098265

  14. Childhood IQ and risk of bipolar disorder in adulthood: prospective birth cohort study

    OpenAIRE

    Smith, Daniel J; Anderson, Jana; Zammit, Stanley; Meyer, Thomas D; Pell, Jill P; MacKay, Daniel

    2015-01-01

    Background: Intellectual ability may be an endophenotypic marker for bipolar disorder. Aims: Within a large birth cohort, we aimed to assess whether childhood IQ (including both verbal IQ (VIQ) and performance IQ (PIQ) subscales) was predictive of lifetime features of bipolar disorder assessed in young adulthood. Method: We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a large UK birth cohort, to test for an association between measures of childhood IQ a...

  15. Academic achievement of twins and singletons in early adulthood: Taiwanese cohort study

    OpenAIRE

    Tsou, Meng-Ting; Tsou, Meng-Wen; Wu, Ming-Ping; Liu, Jin-Tan

    2008-01-01

    Objectives To examine the long term effects of low birth weight on academic achievements in twins and singletons and to determine whether the academic achievement of twins in early adulthood is inferior to that of singletons. Design Cohort study. Setting Taiwanese nationwide register of academic outcome. Participants A cohort of 218 972 singletons and 1687 twins born in Taiwan, 1983-5. Main outcome measure College attendance and test scores in the college joint entrance examinations. Results ...

  16. Predicting reading and spelling disorders: a 4-year prospective cohort study.

    OpenAIRE

    Bigozzi, Lucia; Tarchi, Christian; Caudek, Corrado; Pinto, Giuliana

    2016-01-01

    In this 4-year prospective cohort study, children with a reading and spelling disorder, children with a spelling impairment, and children without a reading and/or spelling disorder (control group) in a transparent orthography were identified in third grade, and their emergent literacy performances in kindergarten compared retrospectively. Six hundred and forty-two Italian children participated. This cohort was followed from the last year of kindergarten to third grade. In kindergarten, the ch...

  17. The impact of universal newborn hearing screening on longterm literacy outcomes: A prospective cohort study

    OpenAIRE

    Pimperton, H; Blythe, H.; Kreppner, J.; Mahon, H. M.; Stevenson, J.; Terletski, E.; Worsfold, S.; Yuen, H M; Kennedy, C

    2016-01-01

    Objective: To determine whether the benefits of universal newborn hearing screening (UNHS) seen at age 8 years persist through the second decade. Design: Prospective cohort study of a population sample of children with permanent childhood hearing impairment (PCHI) followed up for 17 years since birth in periods with (or without) UNHS. Setting: Birth cohort of 100 000 in southern England. Participants: 114 teenagers aged 13–19 years, 76 with PCHI and 38 with normal hearing. All had previously ...

  18. Alcohol and Difficulty Conceiving in the SUN Cohort: A Nested Case-Control Study

    OpenAIRE

    Cristina Lopez-del Burgo; Alfredo Gea; Jokin de Irala; Martínez-González, Miguel A.; Chavarro, Jorge E.; Estefania Toledo

    2015-01-01

    The role of alcohol on fertility remains unclear. We aimed to investigate the association between alcohol and specific alcoholic beverages consumption and the risk of difficulty getting pregnant. We used a case-control study nested within the Seguimiento Universidad de Navarra (SUN) cohort, a prospective, dynamic and multipurpose cohort of 21,705 Spanish university graduates, followed biennially with mailed questionnaires. We identified 686 case-control pairs, matched for age and time in the ...

  19. Prepregnancy diabetes and offspring risk of congenital heart disease - A nationwide cohort study

    OpenAIRE

    Øyen, Nina; Diaz, Lars J.; Leirgul, Elisabeth; Boyd, Heather A.; Priest, James; Mathiesen, Elisabeth R.; Quertermous, Thomas; Wohlfahrt, Jan; Melbye, Mads

    2016-01-01

    Background—Maternal diabetes mellitus is associated with an increased risk of offspring congenital heart defects (CHD); however, the causal mechanism is poorly understood. We further investigated this association in a Danish nationwide cohort. Methods and Results—In a national cohort study, we identified 2 025 727 persons born from 1978 to 2011; among them were 7296 (0.36%) persons exposed to maternal pregestational diabetes mellitus. Pregestational diabetes melli...

  20. Existing data sources for clinical epidemiology: Danish Cancer in Primary Care cohort

    OpenAIRE

    Jensen H.; Tørring ML; Larsen MB; Vedsted P

    2014-01-01

    Henry Jensen,1,2 Marie Louise Tørring,1 Mette Bach Larsen,3 Peter Vedsted11Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care, 2Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus C, 3Department of Public Health Programs, Randers Regional Hospital, Randers NOE, Denmark Background: In this paper, we describe the settings, content, and possibilities of the Danish Cancer in Primary Care (CaP) cohort as wel...

  1. The Netherlands study of depression in older persons (NESDO; a prospective cohort study

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    Comijs Hannie C

    2011-12-01

    Full Text Available Abstract Background To study late-life depression and its unfavourable course and co morbidities in The Netherlands. Methods We designed the Netherlands Study of Depression in Older Persons (NESDO, a multi-site naturalistic prospective cohort study which makes it possible to examine the determinants, the course and the consequences of depressive disorders in older persons over a period of six years, and to compare these with those of depression earlier in adulthood. Results From 2007 until 2010, the NESDO consortium has recruited 510 depressed and non depressed older persons (≥ 60 years at 5 locations throughout the Netherlands. Depressed persons were recruited from both mental health care institutes and general practices in order to include persons with late-life depression in various developmental and severity stages. Non-depressed persons were recruited from general practices. The baseline assessment included written questionnaires, interviews, a medical examination, cognitive tests and collection of blood and saliva samples. Information was gathered about mental health outcomes and demographic, psychosocial, biological, cognitive and genetic determinants. The baseline NESDO sample consists of 378 depressed (according to DSM-IV criteria and 132 non-depressed persons aged 60 through 93 years. 95% had a major depression and 26.5% had dysthymia. Mean age of onset of the depressive disorder was around 49 year. For 33.1% of the depressed persons it was their first episode. 41.0% of the depressed persons had a co morbid anxiety disorder. Follow up assessments are currently going on with 6 monthly written questionnaires and face-to-face interviews after 2 and 6 years. Conclusions The NESDO sample offers the opportunity to study the neurobiological, psychosocial and physical determinants of depression and its long-term course in older persons. Since largely similar measures were used as in the Netherlands Study of Depression and Anxiety (NESDA; age

  2. Adherence to chemoprophylaxis and Plasmodium falciparum anti-circumsporozoite seroconversion in a prospective cohort study of Dutch short-term travelers

    NARCIS (Netherlands)

    Belderok, S.M.; Hoek, A.; Roeffen, W.F.; Sauerwein, R.; Sonder, G.J.

    2013-01-01

    BACKGROUND: We conducted a prospective study in a cohort of short-term travelers assessing the incidence rate of anti-circumsporozoite seroconversion, adherence to chemoprophylaxis, symptoms of malaria during travel, and malaria treatment abroad. METHODS: Adults were recruited from the travel clinic

  3. Mixed Membership Trajectory Models of Cognitive Impairment in the Multicenter AIDS Cohort Study

    Science.gov (United States)

    Molsberry, Samantha A.; Lecci, Fabrizio; Kingsley, Lawrence; Junker, Brian; Reynolds, Sandra; Goodkin, Karl; Levine, Andrew J.; Martin, Eileen; Miller, Eric N.; Munro, Cynthia A.; Ragin, Ann; Sacktor, Ned; Becker, James T.

    2016-01-01

    Objective The longitudinal trajectories that individuals may take from a state of normal cognition to HIV-associated dementia are unknown. We applied a novel statistical methodology to identify trajectories to cognitive impairment, and factors that affected the “closeness” of an individual to one of the canonical trajectories. Design The Multicenter AIDS Cohort Study (MACS) is a four-site longitudinal study of the natural and treated history of HIV Disease among gay and bisexual men. Methods Using data from 3,892 men (both HIV-infected and uninfected) enrolled in the neuropsychology substudy of the MACS, a Mixed Membership Trajectory Model (MMTM) was applied to capture the pathways from normal cognitive function to mild impairment to severe impairment. MMTMs allow the data to identify canonical pathways and to model the effects of risk factors on an individual’s “closeness” to these trajectories. Results We identified three distinct trajectories to cognitive impairment – one “normal aging” (low probability of mild impairment until age 60), one “premature aging” (mild impairment starting at age 45–50), and one “unhealthy” (mild impairment in 20s and 30s) profile. Second, clinically defined AIDS and not simply HIV Disease, was associated with closeness to the premature aging trajectory. And, third, Hepatitis-C infection, Depression, Race, Recruitment Cohort and Confounding Conditions all affected individual’s closeness to these trajectories. Conclusions These results provide new insight into the natural history of cognitive dysfunction in HIV disease and provide evidence for a potential difference in the pathophysiology of the development of cognitive impairment based on trajectories to impairment. PMID:25565498

  4. Clinical characteristics and outcome of a cohort of 101 patients with hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Christian Rabe; Tillmann Pilz; Christoph Klostermann; Marc Berna; Hans H. Schild; Tilman Sauerbruch; Wolfgang H. Caselmann

    2001-01-01

    AIM To conduct a cohort study of 101 patients with hepatocellular carcinoma (HCC) presenting to a tertiary care medical referral center in Germany between 1997 and 1999.METHODS AND RESULTS Data were retrospectively analyzed by chart review. In 95cases (72 males and 23 females) sufficient data were available for analysis. Twenty-five (29%)of 8.5 patients were HBsAg or anti-HBc positive,21/85 (25%) were anti-HCV positive, and 6/85(7%) were positive for both HBV and HCV-markers. Age was significantly lower in HBV-positive patients than in the other two groups.Thirty-one (34%) of 90 patients had histories of alcohol abuse, In 79/ 94 (84%) patients,cirrhosis was diagnosed. Of these cirrhotic patients, 29/79 (37%) belonged to Child-Pugh's group (CHILD) A, 32/79 (40%) to CHILD B, and 18/79 (23%) to CHILD C. AFP was elevated in 61/91 (67%) patients. A single tumor nodule was found in 38/94 (40%), more than one nodule in 31/94 (34%), and 25/94 (26%) had a diffusely infiltrating tumor, i.e. the tumor margins could not be seen on imaging procedures. Portal vein thrombosis was present in 19/ 94 (20%).Imaging data consistent with lymph node metastases were found in 10/92 (11%), while distant metastases were found in 8/93 (9%).According to Okuda 28/94 (30%) were grouped to stage Ⅰ, 53/94 (56%) were grouped to stage Ⅱ, and 13/94 (14%) were grouped to stage Ⅲ.Survival data were available for 83 patients. The Kaplan-Meier estimate for median survival was 8.4 months. Factors influencing survival were the Okuda score, the presence of portal vein thrombosis, and the presence of ascites. The presence of non-complicated liver cirrhosis by itself, distant metastases, or infection with hepatitis viruses did not influence survival. AFP positivity by itself did not influence survival,though patients with an AFP value greater than 100μg/L did experience shortened survival.Treatment besides tamoxifen or supportive care was associated with prolonged survival. The influence of therapy on

  5. The Pelotas Birth Cohort Study, Rio Grande do Sul, Brazil, 1982-2001

    Science.gov (United States)

    2010-01-01

    Given the growing recognition of the importance of the life course approach for the determination of chronic diseases, birth cohort studies are becoming increasingly important. This paper describes the methods used in the 1982 Pelotas (Brazil) birth cohort study, one of the largest and longest studies of this type in developing countries. All 5,914 hospital births occurring in Pelotas in 1982 (over 99% of all deliveries) were studied prospectively. The main stages of the study took place in 1983, 1984, 1986, 1995, 1997, 2000, and 2001. More than two thousand variables are available for each subject who participated in all stages of the study. Recent phases of the study included the examination of 2,250 males when presenting for the army recruitment exam in 2000, the study of a 27% sample of men and women in 2001 through household visits, and the study of over 400 children born to the cohort women. Follow-up rates in the recent stages of the cohort were 78.9% for the army examination and 69.0% for the household visits. Ethnographic and oral health studies were conducted in sub-samples. Some recent results on blood pressure, adolescent pregnancy, and asthma are presented as examples of utilization of the data. Suggestions on lessons learned for other cohort studies are proposed. PMID:14666206

  6. The Epidemiology, Virology and Clinical Findings of Dengue Virus Infections in a Cohort of Indonesian Adults in Western Java.

    Directory of Open Access Journals (Sweden)

    Herman Kosasih

    2016-02-01

    Full Text Available Dengue has emerged as one of the most important infectious diseases in the last five decades. Evidence indicates the expansion of dengue virus endemic areas and consequently the exponential increase of dengue virus infections across the subtropics. The clinical manifestations of dengue virus infection include sudden fever, rash, headache, myalgia and in more serious cases, spontaneous bleeding. These manifestations occur in children as well as in adults. Defining the epidemiology of dengue in a given area is critical to understanding the disease and devising effective public health strategies.Here, we report the results from a prospective cohort study of 4380 adults in West Java, Indonesia, from 2000-2004 and 2006-2009. A total of 2167 febrile episodes were documented and dengue virus infections were confirmed by RT-PCR or serology in 268 cases (12.4%. The proportion ranged from 7.6 to 41.8% each year. The overall incidence rate of symptomatic dengue virus infections was 17.3 cases/1,000 person years and between September 2006 and April 2008 asymptomatic infections were 2.6 times more frequent than symptomatic infections. According to the 1997 WHO classification guidelines, there were 210 dengue fever cases, 53 dengue hemorrhagic fever cases (including one dengue shock syndrome case and five unclassified cases. Evidence for sequential dengue virus infections was seen in six subjects. All four dengue virus serotypes circulated most years. Inapparent dengue virus infections were predominantly associated with DENV-4 infections.Dengue virus was responsible for a significant percentage of febrile illnesses in an adult population in West Java, Indonesia, and this percentage varied from year to year. The observed incidence rate during the study period was 43 times higher than the reported national or provincial rates during the same time period. A wide range of clinical severity was observed with most infections resulting in asymptomatic disease. The

  7. Clinical characteristics and disease predictors of a large Chinese cohort of patients with autosomal dominant polycystic kidney disease

    OpenAIRE

    Dongping Chen; Yiyi Ma; Xueqi Wang; Shengqiang Yu; Lin Li; Bing Dai; Zhiguo Mao; Lijun Sun; Chenggang Xu; Shu Rong; Mengjun Tang; Hongbo Zhao; Hongchao Liu; Serra, Andreas L.; Nicole Graf

    2014-01-01

    OBJECTIVE: Autosomal dominant polycystic kidney disease (ADPKD) is a relentlessly progressing form of chronic kidney disease for which there is no cure. The aim of this study was to characterize Chinese patients with ADPKD and to identify the factors which predict cyst growth and renal functional deterioration. METHODS: To analyze disease predicting factors we performed a prospective longitudinal observational study in a cohort of 541 Chinese patients with ADPKD and an eGFR ≥ 30 ml/min/1.73 m...

  8. Clinical characteristics and disease predictors of a large Chinese cohort of patients with autosomal dominant polycystic kidney disease

    OpenAIRE

    Chen, Dongping; Ma, Yiyi; Wang, Xueqi; Yu, Shengqiang; Li, Lin; Dai, Bing; Mao, Zhiguo; Sun, Lijun; Xu, Chenggang; Rong, Shu; Tang, Mengjun; Zhao, Hongbo; Liu, Hongchao; Andreas L Serra; Graf, Nicole

    2014-01-01

    OBJECTIVE: Autosomal dominant polycystic kidney disease (ADPKD) is a relentlessly progressing form of chronic kidney disease for which there is no cure. The aim of this study was to characterize Chinese patients with ADPKD and to identify the factors which predict cyst growth and renal functional deterioration. METHODS: To analyze disease predicting factors we performed a prospective longitudinal observational study in a cohort of 541 Chinese patients with ADPKD and an eGFR ≥ 30 ml/min/1.7...

  9. Clinical significance of autoantibodies in a large cohort of patients with chronic graft-versus-host disease defined by NIH criteria.

    Science.gov (United States)

    Kuzmina, Zoya; Gounden, Verena; Curtis, Lauren; Avila, Daniele; Rnp, Tiffani Taylor; Baruffaldi, Judy; Cowen, Edward W; Naik, Haley B; Hasni, Sarfaraz A; Mays, Jacqueline W; Mitchell, Sandra; Baird, Kristin; Steinberg, Seth M; Pavletic, Steven Z

    2015-02-01

    There is an unmet need for identifying new clinical biomarkers in chronic Graft-versus-Host-disease (cGVHD) suitable for diagnosis and disease monitoring. Circulating autoantibodies represent an ongoing immune response and suggest a pathogenic role for B cells in cGVHD. Autoantibodies could be useful markers of cGVHD disease activity, severity, or organ specificity; however, their clinical utility is not established. The focus of this study was to determine the incidence and associations of a broad array of clinical autoantibodies with cGVHD manifestations in a large patient cohort characterized by NIH criteria. A panel of 21 circulating antibodies commonly used in clinical medicine was tested in 280 cGVHD patients (70% severe) enrolled in a cross-sectional prospective natural history study. Median cGVHD duration was two years. Patients with circulating autoantibodies (62%) had significantly higher levels of IgM (P antibodies were detected in 35% of patients. Prior rituximab therapy (n = 66) was associated with reduced presence of autoantibodies (48 vs. 66% P = 0.01). Only oral cGVHD was significantly associated with presence of autoantibodies in this study (P = 0.028). No significant associations were found between cGVHD activity and severity, and presence of autoantibodies. Circulating autoantibodies are common in patients with advanced cGVHD. Their presence is associated with better quantitative immunologic reconstitution but does not have utility as a clinical biomarker of cGVHD. PMID:25363867

  10. "Burnout in Medical Oncology Fellows: a Prospective Multicenter Cohort Study in Brazilian Institutions".

    Science.gov (United States)

    Cubero, Daniel I G; Fumis, Renata Rego Lins; de Sá, Thiago Hérick; Dettino, Aldo; Costa, Felipe Osório; Van Eyll, Brigitte M R H Adam; Beato, Carlos; Peria, Fernanda Maris; Mota, Augusto; Altino, José; Azevedo, Sérgio Jobim; da Rocha Filho, Duílio Reis; Moura, Melba; Lessa, Álvaro Edson Ramos; Del Giglio, Auro

    2016-09-01

    Burnout syndrome is a common occurrence among oncologists. Doctors enrolled in residency programs in clinical oncology are exposed to similar risk factors; however, few data are available in this population. This study assessed the occurrence of burnout and associated factors among first-year residents at Brazilian institutions. The present prospective, multicenter, cohort study was conducted with doctors enrolled in residency programs in clinical oncology at Brazilian institutions affiliated with the public health system. The participants answered a sociodemographic questionnaire, the Maslach Burnout Inventory (MBI), Lipp's Stress Inventory, and the Beck Depression Inventory (BDI), upon admission to the program and 6 and 12 months later. Of 37 eligible residency programs in 2009, 11 (30.6 %) agreed to participate in the study. Fifty-four residents, representing 100 % of new admissions to the participating institutions, were included. Most of the participants met the criteria for severe burnout upon admission to the residency programs (emotional exhaustion in 49.0 % and depersonalization in 64.7 %). The scores on MBI domains emotional exhaustion and depersonalization increased significantly (p < 0.01) during the first year of residency, and the prevalence of burnout increased to 88 % at the end of that first year. The present study found a high prevalence of burnout among doctors enrolled in residency programs in clinical oncology at Brazilian institutions. A large fraction of the participants met the criteria for burnout syndrome upon admission to the program, which suggests that the problem began during the course of the previous residency program in internal medicine. PMID:25952940

  11. Study designs in dermatology: A review for the clinical dermatologist.

    Science.gov (United States)

    Silverberg, Jonathan I

    2015-11-01

    A working knowledge of common research study designs and their advantages and disadvantages is necessary for critical reading of the literature by clinicians. However, understanding study designs and related statistical methodologies may be perceived as being complex and difficult to execute. This review aims to provide a practical foundation for basic study designs and to help physicians identify pitfalls that commonly occur in clinical studies and their level of evidence. Topics covered include the pros and cons of observational versus prospectively controlled studies, case-control, cohort, randomized controlled studies, adaptive controlled trials and metaanalyses, and the role of matching in studies. PMID:26475532

  12. Serum 25-Hydroxyvitamin D Concentrations ≥40 ng/ml Are Associated with >65% Lower Cancer Risk: Pooled Analysis of Randomized Trial and Prospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Sharon L McDonnell

    Full Text Available Higher serum 25-hydroxyvitamin D [25(OHD] concentrations have been associated with a lower risk of multiple cancer types across a range of 25(OHD concentrations.To investigate whether the previously reported inverse association between 25(OHD and cancer risk could be replicated, and if a 25(OHD response region could be identified among women aged 55 years and older across a broad range of 25(OHD concentrations.Data from two cohorts representing different median 25(OHD concentrations were pooled to afford a broader range of 25(OHD concentrations than either cohort alone: the Lappe cohort (N = 1,169, a randomized clinical trial cohort (median 25(OHD = 30 ng/ml and the GrassrootsHealth cohort (N = 1,135, a prospective cohort (median 25(OHD = 48 ng/ml. Cancer incidence over a multi-year period (median: 3.9 years was compared according to 25(OHD concentration. Kaplan-Meier plots were developed and the association between 25(OHD and cancer risk was examined with multivariate Cox regression using multiple 25(OHD measurements and spline functions. The study included all invasive cancers excluding skin cancer.Age-adjusted cancer incidence across the combined cohort (N = 2,304 was 840 cases per 100,000 person-years (1,020 per 100,000 person-years in the Lappe cohort and 722 per 100,000 person-years in the GrassrootsHealth cohort. Incidence was lower at higher concentrations of 25(OHD. Women with 25(OHD concentrations ≥40 ng/ml had a 67% lower risk of cancer than women with concentrations <20 ng/ml (HR = 0.33, 95% CI = 0.12-0.90.25(OHD concentrations ≥40 ng/ml were associated with substantial reduction in risk of all invasive cancers combined.

  13. Cohort study of institutionalized elderly people: fall risk factors from the nursing diagnosis

    Directory of Open Access Journals (Sweden)

    Karine Marques Costa dos Reis

    2015-12-01

    Full Text Available Objective: to determine the incidence of falls in elderly residents of long-stay institutions of the Federal District, to identify the aspects involved in the falls, in terms of risk factors, from the application of scales and the Taxonomy II of NANDA-I, and to define the level of accuracy with its sensitivity and specificity for application in the clinical nursing practice. Method: this was a cohort study with the evaluation of 271 elderly people. Cognition, functionality, mobility and other intrinsic factors were evaluated. After six months, the elderly people who fell were identified, with significance analysis then performed to define the risk factors. Results: the results showed an incidence of 41%. Of the 271 patients included, 69 suffered 111 episodes of falls during the monitoring period. Risk factors were the presence of stroke with its sequelae (OR: 1.82, 95% CI 1.01 - 3.28, p=.045, presenting more than five chronic diseases (OR: 2.82, 95% CI 1.43 - 5.56, p=.0028, foot problem (OR: 2.45, 95% CI 1.35 - 4.44, p=.0033 and motion (OR: 2.04, 95% CI 1.15 - 3.61, p=.0145. Conclusion: the taxonomy has high validity regarding the detection of elderly people at risk of falling and should be applied consistently in the clinical nursing practice.

  14. Survival after Locoregional Treatments for Hepatocellular Carcinoma: A Cohort Study in Real-World Patients

    Science.gov (United States)

    Signoriello, Simona; Annunziata, Annalisa; Lama, Nicola; Signoriello, Giuseppe; Chiodini, Paolo; De Sio, Ilario; Daniele, Bruno; Di Costanzo, Giovanni G.; Calise, Fulvio; Olivieri, Graziano; Castaldo, Vincenzo; Lanzetta, Rosario; Piai, Guido; Marone, Giampiero; Visconti, Mario; Fusco, Mario; Di Maio, Massimo; Perrone, Francesco; Gallo, Ciro; Gaeta, Giovanni B.

    2012-01-01

    Evidence of relative effectiveness of local treatments for hepatocellular carcinoma (HCC) is scanty. We investigated, in a retrospective cohort study, whether surgical resection, radiofrequency ablation (RFA), percutaneous ethanol injection (PEI), and transarterial embolization with (TACE) or without (TAE) chemotherapy resulted in different survival in clinical practice. All patients first diagnosed with HCC and treated with any locoregional therapy from 1998 to 2002 in twelve Italian hospitals were eligible. Overall survival (OS) was the unique endpoint. Three main comparisons were planned: RFA versus PEI, surgical resection versus RFA/PEI (combined), TACE/TAE versus RFA/PEI (combined). Propensity score method was used to minimize bias related to non random treatment assignment. Overall 425 subjects were analyzed, with 385 (91%) deaths after a median followup of 7.7 years. OS did not significantly differ between RFA and PEI (HR 1.11, 95% CI 0.79–1.57), between surgery and RFA/PEI (HR 0.95, 95% CI 0.64–1.41) and between TACE/TAE and RFA/PEI (HR 0.88, 95% CI 0.66–1.17). 5-year OS probabilities were 0.14 for RFA, 0.18 for PEI, 0.27 for surgery, and 0.15 for TACE/TAE. No locoregional treatment for HCC was found to be more effective than the comparator. Adequately powered randomized clinical trials are still needed to definitely assess relative effectiveness of locoregional HCC treatment. PMID:22654628

  15. A prospective cohort study of the use of domiciliary intravenous antibiotics in bronchiectasis

    Science.gov (United States)

    Bedi, Pallavi; Sidhu, Manjit K; Donaldson, Lucienne S; Chalmers, James D; Smith, Maeve P; Turnbull, Kim; Pentland, Joanna L; Scott, Jenny; Hill, Adam T

    2014-01-01

    Background: We introduced domiciliary intravenous (IV) antibiotic therapy in patients with bronchiectasis to promote patient-centred domiciliary treatment instead of hospital inpatient treatment. Aim: To assess the efficacy and safety of domiciliary IV antibiotic therapy in patients with non-cystic fibrosis bronchiectasis. Methods: In this prospective study conducted over 5 years, we assessed patients’ eligibility for receiving domiciliary treatment. All patients received 14 days of IV antibiotic therapy and were monitored at baseline/day 7/day 14. We assessed the treatment outcome, morbidity, mortality and 30-day readmission rates. Results: A total of 116 patients received 196 courses of IV antibiotics. Eighty courses were delivered as inpatient treatment, 32 as early supported discharge (ESD) and 84 as domiciliary therapy. There was significant clinical and quality of life improvement in all groups, with resolution of infection in 76% in the inpatient group, 80% in the ESD group and 80% in the domiciliary group. Morbidity was recorded in 13.8% in the inpatient group, 9.4% in the ESD group and 14.2% in the domiciliary IV group. No mortality was recorded in either group. Thirty-day readmission rates were 13.8% in the inpatient group, 12.5% in the ESD group and 14.2% in the domiciliary group. Total bed days saved was 1443. Conclusion: Domiciliary IV antibiotic therapy in bronchiectasis is clinically effective and was safe in our cohort of patients. PMID:25340361

  16. Factors Associated with Unplanned Dialysis Starts in Patients followed by Nephrologists: A Retropective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Pierre Antoine Brown

    Full Text Available The number of patients starting dialysis is increasing world wide. Unplanned dialysis starts (patients urgently starting dialysis in hospital is associated with increased costs and high morbidity and mortality. Risk factors for starting dialysis urgently in hospital have not been well studied. The primary objective of this study was to identify risk factors for unplanned dialysis starts in patients followed in a multidisciplinary chronic kidney disease (CKD clinic. We performed a retrospective cohort study of 649 advanced CKD patients followed in a multidisciplinary CKD clinic at a tertiary care hospital from January 01, 2010 to April 30, 2013. Patients were classified as unplanned start (in hospital or elective start. Multivariable logistic regression was used to identify variables associated with unplanned dialysis initiation. 184 patients (28.4% initiated dialysis, of which 76 patients (41.3% initiated dialysis in an unplanned fashion and 108 (58.7% starting electively. Unplanned start patients were more likely to have diabetes (68.4% versus 51.9%; p = 0.04, CAD (42.1% versus 24.1%; p = 0.02, congestive heart failure (36.8% versus 17.6%; p = 0.01, and were less likely to receive modality education (64.5% vs 89.8%; p < 0.01 or be assessed by a surgeon for access creation (40.8% vesrus 78.7% p < 0.01. On multivariable analysis, higher body mass index (OR 1.07, 95% CI 1.02, 1.13, and a history of congestive heart failure (OR 2.41, 95% CI 1.09, 5.41 were independently associated with an unplanned start. Unplanned dialysis initiation is common among advanced CKD patients, even if they are followed in a multidisciplinary chronic kidney disease clinic. Timely education and access creation in patients at risk may lead to lower costs and less morbidity and mortality.

  17. Mortality risk amongst nursing home residents evacuated after the Fukushima nuclear accident: a retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Shuhei Nomura

    Full Text Available BACKGROUND: Safety of evacuation is of paramount importance in disaster planning for elderly people; however, little effort has been made to investigate evacuation-related mortality risks. After the Fukushima Daiichi Nuclear Plant accident we conducted a retrospective cohort survival survey of elderly evacuees. METHODS: A total of 715 residents admitted to five nursing homes in Minamisoma city, Fukushima Prefecture in the five years before 11th March 2011 joined this retrospective cohort study. Demographic and clinical characteristics were drawn from facility medical records. Evacuation histories were tracked until the end of 2011. The evacuation's impact on mortality was assessed using mortality incidence density and hazard ratios in Cox proportional hazards regression. RESULTS: Overall relative mortality risk before and after the earthquake was 2.68 (95% CI: 2.04-3.49. There was a substantial variation in mortality risks across the facilities ranging from 0.77 (95% CI: 0.34-1.76 to 2.88 (95% CI: 1.74-4.76. No meaningful influence of evacuation distance on mortality was observed although the first evacuation from the original facility caused significantly higher mortality than subsequent evacuations, with a hazard ratio of 1.94 (95% CI: 1.07-3.49. CONCLUSION: High mortality, due to initial evacuation, suggests that evacuation of the elderly was not the best life-saving strategy for the Fukushima nuclear disaster. Careful consideration of the relative risks of radiation exposure and the risks and benefits of evacuation is essential. Facility-specific disaster response strategies, including in-site relief and care, may have a strong influence on survival. Where evacuation is necessary, careful planning and coordination with other nursing homes, evacuation sites and government disaster agencies is essential to reduce the risk of mortality.

  18. Hypertensive disorders of pregnancy and subsequent risk of solid cancer-A nationwide cohort study.

    Science.gov (United States)

    Behrens, Ida; Basit, Saima; Jensen, Allan; Lykke, Jacob Alexander; Nielsen, Lars Peter; Wohlfahrt, Jan; Kjaer, Susanne K; Melbye, Mads; Boyd, Heather Allison

    2016-07-01

    Women with hypertensive disorders of pregnancy (HDP) have higher levels of antiangiogenic growth factors during pregnancy than women with normotensive pregnancies. Since angiogenesis is necessary for solid cancer growth and spread, we hypothesized that women with a history of HDP might have a reduced risk of solid cancers (cancers other than lymphomas, hematologic cancers and nonmelanoma skin cancers) later in life. In a register-based cohort study of 1.08 million women giving birth at least once between 1978 and 2011, we used Cox regression to estimate hazard ratios (HRs) comparing solid cancer rates for women with and without a history of HDP. In this cohort, 68,236 women (6.3%) had ≥1 pregnancy complicated by HDP and 42,236 women (3.9%) developed solid tumors during follow-up. A history of HDP was not associated with a clinically meaningful reduction in the overall rate of solid cancer (HR 0.96, 95% confidence interval 0.92-1.00), regardless of HDP severity or time since HDP, nor was there a general tendency toward reduced solid cancer rates across organ sites. A history of HDP was only significantly associated with decreased rates of breast and lung cancers and with increased rates of endometrial and urinary tract cancers. Overall, our results do not support the hypothesis that women with a history of HDP have a reduced overall risk of solid cancer due to a persistent post-HDP antiangiogenic state or an innate tendency toward antiangiogenesis. Observed associations with specific cancers may instead be due to other pregnancy-related mechanisms or to residual/unmeasured confounding. PMID:26919086

  19. Radiosurgical treatment of sporadic vestibular schwannomas: A prospective cohort study

    International Nuclear Information System (INIS)

    Objective: To analyze the preliminary experience of radiosurgery for Vestibular Schwannomas at the Pontificia Universidad Catolica de Chile. Material and methods: The first 17 patients with sporadic Vestibular Schwannomas treated by radiosurgery at our institution are reported. The marginal dose used was 12 to 12.5 Gy. prescribed at the 70 or 80 isodose fine. Patients were controlled at 6, 12 and 24 months with magnetic resonance, audiometric study and clinical examination. Results: In all of the 17 patients treated a decrease tumor enhancement on MR was demonstrated. In 16 patients (94%) a pattern of central tumor necrosis was observed during the firs year Actuarial useful hearing was maintained in 62.5% at 2 year after treatment. Facial nerve function was maintained in all of the 15 patients with normal function at treatment (100%). Trigeminal function was maintained in ah of the 14 patients (100%) with previous normal trigeminal function. The mean time to return to work or normal activities was 11.5 days after treatment. Conclusions: These preliminary results are comparable with results published in the literature and reinforce the demonstrate role of radiosurgery in the management of vestibular schwannomas

  20. [Clinical and biological effectiveness of antiretroviral therapy in the ANRS 1215 cohort].

    Science.gov (United States)

    De Beaudrap, P; Diouf, A; Bousso Niang, K

    2014-10-01

    In 1998, the cohort ANRS 1215 was launched in Senegal with one of the first African antiretroviral treatment programs. Four hundred forty four HIV-infected adults started on ART were included between 1998 and 2004, and followed up to 2010. Mortality before 6 months was 15.6/100 person-year (PY) and associated to the initial disease severity. It decreased to 3.36/100 PY thereafter. The cumulative risks of virologic failure at 60 months and of drug resistance at 48 months were 25% and 16%, respectively. PMID:24619515

  1. Impact of hyperkalaemia definition on incidence assessment: implications for epidemiological research based on a large cohort study in newly diagnosed heart failure patients in primary care

    OpenAIRE

    Martín-Pérez, Mar; Ruigómez, Ana; Michel, Alexander; García Rodríguez, Luis A.

    2016-01-01

    Background Various definitions of hyperkalaemia have been used in clinical research, and data from routine clinical practice on its incidence are sparse. We aimed to establish the incidence of hyperkalaemia in patients with newly diagnosed heart failure in the UK general population using different definitions for the condition. Methods We conducted a large retrospective cohort study using data from The Health Improvement Network primary care database. Patients with newly diagnosed heart failu...

  2. Four years of natural history of HIV-1 infection in African women : a prospective cohort study in Kigali (Rwanda), 1988-1993

    OpenAIRE

    Leroy, V.; Msellati, Philippe; Lepage, P; Batungwanayo, J.; Hitimana, D.G.; Taelman, H.; Bogaerts, J.; Boineau, F.; Van De Perre, P.; Simonon, A; Salamon, R.; Dabis, F

    1995-01-01

    Clinical features and mortality due to human immunodeficiency virus type-1 (HIV-1) infection in women are described as part of a prospective 4-year cohort study on perinatal transmission of HIV in Kigali, Rwanda. Two hundred fifteen HIV-positive (HIV+) and 216 HIV-negative (HIV-) pregnant women were enrolled at delivery between November 1988 and June 1989. Clinical information collected during systematic quarterly examinations was compared. HIV antibody tests were performed at delivery and CD...

  3. Methods used for successful follow-up in a large scale national cohort study in Thailand

    Directory of Open Access Journals (Sweden)

    Chokkanapitak Jaruwan

    2011-05-01

    Full Text Available Abstract Background Ensuring successful follow-up is essential when conducting a prospective cohort study. Most existing literature reviewing methods to ensure a high response rate is based on experience in developed nations. Findings We report our 4-year follow-up success for a national cohort study examining the health transition underway in Thailand. We began the cohort study in 2005 with a baseline postal questionnaire sent to all 200,000 Thais enrolled as distance learning students at Sukhothai Thammathirat Open University and residing all over Thailand; 87,134 or 44% of the students responded. Subsequently we used University and national media to inform cohort members of study progress. Also, we prepared a health book with study results and health advice which was distributed to all cohort members. After 4 years we repeated the survey and achieved a 71% response rate. In this paper we report the methods used to achieve this response The initial follow-up mail-out generated a response rate of about 48% reflecting the extensive preparatory work between baseline and follow-up. After 4 rounds of telephone contact (more than 100,000 phone calls and 4 related mail-out rounds progressively over 16 months an overall response rate was achieved of just over 71% (n = 60,774. The total cost was US$4.06/respondent - 19% for printing, 21% for postage, 14% for tape measures (included in mail-out, 18% for data processing 22% for prizes and 6% for telephone. Conclusions Many of the methods reported as effective for mail questionnaire and cohort response rates held true for Thailand. These included being associated with a university, incentivating cooperation, follow-up contact, providing a second copy of questionnaire where necessary, and assurance of confidentiality. Telephone contact with the cohort and the small prizes given to responders were particularly important in the Thai context as was Thai leadership of the research team.

  4. Study protocol: the JEU cohort study – transversal multiaxial evaluation and 5-year follow-up of a cohort of French gamblers

    OpenAIRE

    Challet-Bouju, Gaëlle; Hardouin, Jean-Benoit; Vénisse, Jean-Luc; Romo, Lucia; Valleur, Marc; Magalon, David; Fatséas, Mélina; Chéreau-Boudet, Isabelle; Gorsane, Mohamed-Ali; . .; Grall-Bronnec, Marie

    2014-01-01

    Background There is abundant literature on how to distinguish problem gambling (PG) from social gambling, but there are very few studies of the long-term evolution of gambling practice. As a consequence, the correlates of key state changes in the gambling trajectory are still unknown. The objective of the JEU cohort study is to identify the determinants of key state changes in the gambling practice, such as the emergence of a gambling problem, natural recovery from a gambling problem, resolut...

  5. Assessment of participation bias in cohort studies: systematic review and meta-regression analysis

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    Sérgio Henrique Almeida da Silva Junior

    2015-11-01

    Full Text Available Abstract The proportion of non-participation in cohort studies, if associated with both the exposure and the probability of occurrence of the event, can introduce bias in the estimates of interest. The aim of this study is to evaluate the impact of participation and its characteristics in longitudinal studies. A systematic review (MEDLINE, Scopus and Web of Science for articles describing the proportion of participation in the baseline of cohort studies was performed. Among the 2,964 initially identified, 50 were selected. The average proportion of participation was 64.7%. Using a meta-regression model with mixed effects, only age, year of baseline contact and study region (borderline were associated with participation. Considering the decrease in participation in recent years, and the cost of cohort studies, it is essential to gather information to assess the potential for non-participation, before committing resources. Finally, journals should require the presentation of this information in the papers.

  6. Coffee prevents proximal colorectal adenomas in Japanese men: a prospective cohort study.

    Science.gov (United States)

    Nakamura, Tomiyo; Ishikawa, Hideki; Mutoh, Michihiro; Wakabayashi, Keiji; Kawano, Atsuko; Sakai, Toshiyuki; Matsuura, Nariaki

    2016-09-01

    This prospective cohort study aimed to show that coffee prevents the recurrence of colorectal tumors (adenomas, precursors of colorectal cancer, and early-stage colorectal cancers) as well as colorectal cancer. The present study included 307 patients who participated in a clinical study that required endoscopy to remove a colorectal tumor. The amount of coffee consumed by the patients at study inclusion and the frequency of colorectal tumors, as detected by colonoscopy over the subsequent 4 years, were assessed. Coffee consumption was determined using a diet survey that included 3-consecutive-day food records. The risk of colorectal tumor recurrence was significantly lower (odds ratio=0.21; 95% confidence interval, 0.06-0.74) in patients who consumed more than three cups of coffee per day compared with those who consumed no coffee. No correlation was observed between the examined factors, including green tea and black tea intake and the amount of caffeine consumed. In subanalysis divided by the tumor location within the colorectum, the odds ratio of colorectal tumor recurrence in the proximal colon showed a tendency toward reduction as coffee consumption increased; however, increased coffee consumption significantly increased colorectal tumor recurrence in the distal colon. We showed that high coffee consumption reduced the overall occurrence of colorectal tumors, affected by the reduction in the proximal colon. PMID:26291025

  7. Clinical outcomes of locked plating of distal femoral fractures in a retrospective cohort

    Science.gov (United States)

    2013-01-01

    Purpose Locked plating (LP) of distal femoral fractures has become very popular. Despite technique suggestions from anecdotal and some early reports, knowledge about risk factors for failure, nonunion (NU), and revision is limited. The purpose of this study was to analyze the complications and clinical outcomes of LP treatment for distal femoral fractures. Materials and methods From two trauma centers, 243 consecutive surgically treated distal femoral fractures (AO/OTA 33) were retrospectively identified. Of these, 111 fractures in 106 patients (53.8% female) underwent locked plate fixation. They had an average age of 54 years (range 18 to 95 years): 34.2% were obese, 18.9% were smokers, and 18.9% were diabetic. Open fractures were present in 40.5% with 79.5% Gustilo type III. Fixation constructs for plate length, working length, and screw concentration were delineated. Nonunion and/or infection, and implant failure were used as outcome complication variables. Outcome was based on surgical method and addressed according to Pritchett for reduction, range of motion, and pain. Results Eighty-three (74.8%) of the fractures healed after the index procedure. Twenty (18.0%) of the patients developed a NU. Four of 20 (20%) resulted in a recalcitrant NU. Length of comminution did not correlate to NU (p = 0.180). Closed injuries had a higher tendency to heal after the index procedure than open injuries (p = 0.057). Closed and minimally open (Gustilo/Anderson types I and II) fractures healed at a significantly higher rate after the index procedure compared to type III open fractures (80.0% versus 61.3%, p = 0.041). Eleven fractures (9.9%) developed hardware failure. Fewer nonunions were found in the submuscular group (10.7%) compared to open reduction (32.0%) (p = 0.023). Fractures above total knee arthroplasties had a significantly greater rate of failed hardware (p = 0.040) and worse clinical outcome according to Pritchett (p = 0.040). Loss of

  8. Tuberculosis and homelessness in Montreal: a retrospective cohort study

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    Tan de Bibiana Jason

    2011-10-01

    Full Text Available Abstract Background Montreal is Canada's second-largest city, where mean annual tuberculosis (TB incidence from 1996 to 2007 was 8.9/100,000. The objectives of this study were to describe the epidemiology of TB among homeless persons in Montreal and assess patterns of transmission and sharing of key locations. Methods We reviewed demographic, clinical, and microbiologic data for all active TB cases reported in Montreal from 1996 to 2007 and identified persons who were homeless in the year prior to TB diagnosis. We genotyped all available Mycobacterium tuberculosis isolates by IS6110 restriction fragment length polymorphism (IS6110-RFLP and spoligotyping, and used a geographic information system to identify potential locations for transmission between persons with matching isolates. Results There were 20 cases of TB in homeless persons, out of 1823 total reported from 1996-2007. 17/20 were Canadian-born, including 5 Aboriginals. Homeless persons were more likely than non-homeless persons to have pulmonary TB (20/20, smear-positive disease (17/20, odds ratio (OR = 5.7, 95% confidence interval (CI: 1.7-20, HIV co-infection (12/20, OR = 14, 95%CI: 4.8-40, and a history of substance use. The median duration from symptom onset to diagnosis was 61 days for homeless persons vs. 28 days for non-homeless persons (P = 0.022. Eleven homeless persons with TB belonged to genotype-defined clusters (OR = 5.4, 95%CI: 2.2-13, and ten potential locations for transmission were identified, including health care facilities, homeless shelters/drop-in centres, and an Aboriginal community centre. Conclusions TB cases among homeless persons in Montreal raise concerns about delayed diagnosis and ongoing local transmission.

  9. Anthroposophic therapy for chronic depression: a four-year prospective cohort study

    Directory of Open Access Journals (Sweden)

    Willich Stefan N

    2006-12-01

    Full Text Available Abstract Background Depressive disorders are common, cause considerable disability, and do not always respond to standard therapy (psychotherapy, antidepressants. Anthroposophic treatment for depression differs from ordinary treatment in the use of artistic and physical therapies and special medication. We studied clinical outcomes of anthroposophic therapy for depression. Methods 97 outpatients from 42 medical practices in Germany participated in a prospective cohort study. Patients were aged 20–69 years and were referred to anthroposophic therapies (art, eurythmy movement exercises, or rhythmical massage or started physician-provided anthroposophic therapy (counselling, medication for depression: depressed mood, at least two of six further depressive symptoms, minimum duration six months, Center for Epidemiological Studies Depression Scale, German version (CES-D, range 0–60 points of at least 24 points. Outcomes were CES-D (primary outcome and SF-36 after 3, 6, 12, 18, 24, and 48 months. Data were collected from July 1998 to March 2005. Results Median number of art/eurythmy/massage sessions was 14 (interquartile range 12–22, median therapy duration was 137 (91–212 days. All outcomes improved significantly between baseline and all subsequent follow-ups. Improvements from baseline to 12 months were: CES-D from mean (standard deviation 34.77 (8.21 to 19.55 (13.12 (p Conclusion In outpatients with chronic depression, anthroposophic therapies were followed by long-term clinical improvement. Although the pre-post design of the present study does not allow for conclusions about comparative effectiveness, study findings suggest that the anthroposophic approach, with its recourse to non-verbal and artistic exercising therapies can be useful for patients motivated for such therapies.

  10. The association between fracture site and obesity in men: a population-based cohort study.

    Science.gov (United States)

    Premaor, Melissa O; Compston, Juliet E; Fina Avilés, Francesc; Pagès-Castellà, Aina; Nogués, Xavier; Díez-Pérez, Adolfo; Prieto-Alhambra, Daniel

    2013-08-01

    A site-dependent association between obesity and fracture has been reported in postmenopausal women. In this study we investigated the relationship between body mass index (BMI) and fracture at different skeletal sites in older men (≥65 years). We carried out a population-based cohort study using data from the Sistema d'Informació per al Desenvolupament de l'Investigació en Atenció Primària (SIDIAP(Q) ) database. SIDIAP(Q) contains the primary care and hospital admission computerized medical records of >1300 general practitioners (GPs) in Catalonia (Northeast Spain), with information on a representative 30% of the population (>2 million people). In 2007, 186,171 men ≥65 years were eligible, of whom 139,419 (74.9%) had an available BMI measurement. For this analysis men were categorized as underweight/normal (BMI < 25 kg/m(2) , n = 26,298), overweight (25 ≤ BMI < 30 kg/m(2) , n = 70,851), and obese (BMI ≥ 30 kg/m(2) , n = 42,270). Incident fractures in the period 2007 to 2009 were ascertained using International Classification of Diseases, 10th edition (ICD-10) codes. A statistically significant reduction in clinical spine and hip fractures was observed in obese (relative risk [RR], 0.65; 95% confidence interval [CI], 0.53-0.80 and RR, 0.63; 95% CI, 0.54-0.74, respectively), and overweight men (RR, 0.77; 95% CI, 0.64-0.92 and RR, 0.63; 95% CI 0.55-0.72, respectively) when compared with underweight/normal men. Additionally, obese men had significantly fewer wrist/forearm (RR, 0.77; 95% CI, 0.61-0.97) and pelvic (RR, 0.44; 95% CI, 0.28-0.70) fractures than underweight/normal men. Conversely, multiple rib fractures were more frequent in overweight (RR, 3.42; 95% CI, 1.03-11.37) and obese (RR, 3.96; 95% CI, 1.16-13.52) men. In this population-based cohort of older men, obesity was associated with a reduced risk of clinical spine, hip, pelvis, and wrist/forearm fracture and increased risk of multiple rib fractures when compared

  11. An inventory of Canadian pregnancy and birth cohort studies: research in progress

    Directory of Open Access Journals (Sweden)

    Joly Marie-Pier

    2012-10-01

    Full Text Available Abstract Background A web-based inventory was developed as a voluntary registry of Canadian pregnancy and birth cohort studies, with the objective to foster collaboration and sharing of research tools among cohort study groups as a means to enrich research in maternal and child health across Canada. Description Information on existing birth cohort studies conducted in Canada exclusively or as part of broader international initiatives was accessed by searching the literature in PubMed and PsychInfo databases. Additional studies were identified by enquiring about the research activities of researchers at Canadian universities or working in affiliated hospitals or research centres or institutes. Of the fifty-eight birth cohort studies initially identified, forty-six were incorporated into the inventory if they were of a retrospective and/or prospective longitudinal design and with a minimum of two phases of data collection, with the first period having occurred before, during, or shortly after pregnancy and had an initial study sample size of a minimum of 200 participants. Information collected from each study was organized into four main categories: basic information, data source and period of collection, exposures, and outcome measures and was coded and entered into an Excel spreadsheet. The information incorporated into the Excel spreadsheet was double checked, completed when necessary, and verified for completeness and accuracy by contacting the principal investigator or research coordinator. All data collected were then uploaded onto the website of the Institute of Human Development Child and Youth Health of the Canadian Institutes of Health Research. Subsequently, the database was updated and developed as an online searchable inventory on the website of the Maternal, Infant, Child and Youth Research Network. Conclusions This inventory is unique, as it represents detailed information assembled for the first time on a large number of Canadian

  12. CLINICAL STUDY OF ANORECTAL MALFORMATIONS

    OpenAIRE

    Umesh; Sowmya,

    2015-01-01

    BACKGROUND: A norectal malformations are relatively encountered anomalies. Presentations may vary from mild to severe and bowel control is t he main concern. AIM: To study the modes of presentation , types of anomalies , associated anomalies , reliability of clinical signs and radiological investigations in the diagnosis and the prognosis and continence in the post - operative in relation to type of anomaly and associated anomaly (s)...

  13. Locoregional first recurrence after mastectomy: prospective cohort studies with and without immediate chemotherapy

    International Nuclear Information System (INIS)

    Purpose: To evaluate prospectively the impact of combination chemotherapy in the combined modality treatment of isolated first locoregional recurrence (LRR) following mastectomy for breast cancer. Methods and Materials: Between 1979 and 1989, 120 chemotherapy-naive women with isolated LRR as first failure after mastectomy were prospectively identified, uniformly staged, and systematically followed. Treatment consisted of excision if feasible, radical locoregional radiotherapy, and a hormonal maneuver (unless estrogen receptor negative). The initial chemotherapy cohort also received 8 cycles of doxorubicin and cyclophosphamide. This was compared to a subsequent control cohort. Results: For all patients, the 10-year actuarial relapse-free survival ± 95% confidence interval was 42.1 ± 9.2%, and overall survival was 56.8 ± 9.1%. No difference was seen in locoregional control between cohorts. At 5 years, distant recurrence-free survival for chemotherapy and control cohort respectively was 75.4 ± 10.8% and 60.7 ±12.5% (p = 0.33) and overall survival was 81.9% ± 9.6 and 74.3% ± 11.2 (p = 0.24). Univariate analysis showed no prognostic importance for any imbalance between cohorts. Cox modeling confirmed that complete resection was strongly associated with fewer LRR (hazard ratio [HR] 0.32, p = 0.001) and also with better overall survival (HR 1.82, p = 0.019). Chemotherapy produced a substantial reduction in risk of death (HR 0.72 CI 0.421-1.235, p = 0.23). Conclusions: In this prospective but nonrandomized study of treatment for first LRR, the risk of death in the later control cohort was 1.39 times the risk in the chemotherapy cohort but failed to reach statistical significance. The results justify further study

  14. A cohort study on Actinobacillus pleuropneumoniae colonisation in suckling piglets

    NARCIS (Netherlands)

    Tobias, T.J.; Klinkenberg, D.; Bouma, A.; Broek, van den J.; Daemen, A.J.J.M.; Wagenaar, J.A.; Stegeman, J.A.

    2014-01-01

    Actinobacillus pleuropneumoniae causes respiratory disease in pigs and despite the use of preventive measures such as vaccination and antimicrobials clinical outbreaks still occur. At weaning often many piglets are not colonised. If differences in prevalence between litters are large and if factors

  15. Cigarette Smoking and Risk of Lung Cancer in Korean Men: The Seoul Male Cancer Cohort Study

    OpenAIRE

    Bae, Jong-Myon; Lee, Moo-Song; Shin, Myung-Hee; Kim, Dong-Hyun; Li, Zhong-Min; Ahn, Yoon-Ok

    2007-01-01

    Lung cancer is the leading cause of cancer deaths in Korea. The aim of this study was to estimate lung cancer risk of cigarette smoking in Korean men by a 10-yr follow-up prospective cohort study using the primary databases. The number of subjects was 14,272 men, who had full information of smoking habits among participants in the Seoul Male Cancer Cohort Study (SMCC). Total 125,053 person-years were calculated by determining the number of days from the start of follow-up, January 1, 1993, un...

  16. Salt intake, cured meat consumption, refrigerator use and stomach cancer incidence: A prospective cohort study (Netherlands)

    NARCIS (Netherlands)

    Brandt, P.A. van den; Botterweck, A.A.M.; Goldbohm, R.A.

    2003-01-01

    Objective: Many case-control studies have reported that salt and cured meat intake are positively, and refrigerator use is inversely, associated with stomach cancer risk. In the current prospective study these associations were evaluated. Methods: The Netherlands Cohort Study consisted of 120,852 me

  17. Socioeconomic status and stomach cancer incidence in men: Results from the Netherlands Cohort Study

    NARCIS (Netherlands)

    Loon, A.J.M. van; Goldbohm, R.A.; Brandt, P.A. van den

    1998-01-01

    Study objective - To study the association between socioeconomic status (SES) and stomach cancer incidence (cardia and non-cardia) and the role of lifestyle factors in explaining this association. Design - Prospective cohort study on diet and cancer that started in 1986. Data were collected by means

  18. Child Maltreatment in the "Children of the Nineties": A Cohort Study of Risk Factors

    Science.gov (United States)

    Sidebotham, Peter; Heron, Jon

    2006-01-01

    Aim: To analyze the multiple factors affecting the risk of maltreatment in young children within a comprehensive theoretical framework. Methods: The research is based on a large UK cohort study, the Avon Longitudinal Study of Parents and Children. Out of 14,256 children participating in the study, 293 were investigated by social services for…

  19. A Newfoundland cohort of familial and sporadic idiopathic pulmonary fibrosis patients: clinical and genetic features

    Directory of Open Access Journals (Sweden)

    Fernandez Bridget A

    2012-08-01

    Full Text Available Abstract Background Idiopathic pulmonary fibrosis (IPF is an adult-onset Idiopathic Interstitial Pneumonia (IIP usually diagnosed between age 50 to 70 years. Individuals with Familial Pulmonary Fibrosis (FPF have at least one affected first or second-degree relative and account for 0.5-20% of cases. Methods We ascertained and collected DNA samples from a large population-based cohort of IPF patients from Newfoundland, Canada. For each proband, a family history was documented and medical records were reviewed. Each proband was classified as familial (28 patients or sporadic (50 patients and all 78 probands were screened for variants in four highly penetrant, adult-onset PF genes (SFTPC, SFTPA2, TERT,TERC. Results Seventy-eight IPF probands were enrolled of whom 28 (35.9% had a positive family history. These 28 familial patients led to the recruitment of an additional 49 affected relatives (total of 77 FPF patients. By age 60 years, 42% of the familial cohort had been diagnosed with PF compared with only 16% of the sporadic patient collection (χ2 = 8.77, p = 0.003. Mean age of diagnosis in the familial group was significantly younger than the sporadic group (61.4 years vs. 66.6 yrs, p = 0.012 with a wider age range of diagnosis (19–92 years compared with 47–82 years. Thirty-three of 77 (42.8% FPF patients had a tissue diagnosis and all but five had usual interstitial pneumonia histology. Compared with other published case series, the familial IIP histologies were more homogeneous. Three of 28 familial probands (10.7% and none of the 50 sporadic probands had pathogenic variants in the four genes tested. All three familial probands had mutations in TERT. Other phenotypes associated with telomerase deficiency were present in these families including cirrhosis, bone marrow hypoplasia and premature graying. Telomere length assays were performed on mutation carriers from two families and confirmed telomere-related deficiency

  20. Clinical prediction in early pregnancy of infants small for gestational age by customised birthweight centiles: findings from a healthy nulliparous cohort.

    Directory of Open Access Journals (Sweden)

    Lesley M E McCowan

    Full Text Available OBJECTIVE: Small for gestational age (SGA infants comprise up to 50% of all stillbirths and a minority are detected before birth. We aimed to develop and validate early pregnancy predictive models for SGA infants. METHODS: 5628 participants from SCOPE, a prospective study of nulliparous pregnant women, were interviewed at 15 ± 1 weeks' gestation. Fetal anthropometry, uterine and umbilical Doppler studies were performed at 20 ± 1 weeks'. The cohort was divided into training (n = 3735 and validation datasets (n = 1871. All-SGA (birthweight 12 months to conceive, university student, cigarette smoking, proteinuria, daily vigorous exercise and diastolic blood pressure ≥ 80. Recreational walking ≥ 4 times weekly, rhesus negative blood group and increasing random glucose were protective. AUC for clinical risk factors was 0.63. Fetal abdominal or head circumference z scores <10(th centile and increasing uterine artery Doppler resistance at 20 ± 1 weeks' were associated with increased risk. Addition of these parameters increased the AUC to 0.69. Clinical predictors of Normotensive and Hypertensive-SGA were sub-groups of All-SGA predictors and were quite different. The combined clinical and ultrasound AUC for Normotensive and Hypertensive-SGA were 0.69 and 0.82 respectively. CONCLUSION: Predictors for SGA of relevance to clinical practice were identified. The identity and predictive potential differed in normotensive women and those who developed hypertension.

  1. Hemoglobin and Hematocrit Levels in the Prediction of Complicated Crohn's Disease Behavior – A Cohort Study

    Science.gov (United States)

    Rieder, Florian; Paul, Gisela; Schnoy, Elisabeth; Schleder, Stephan; Wolf, Alexandra; Kamm, Florian; Dirmeier, Andrea; Strauch, Ulrike; Obermeier, Florian; Lopez, Rocio; Achkar, Jean-Paul; Rogler, Gerhard; Klebl, Frank

    2014-01-01

    Background Markers that predict the occurrence of a complicated disease behavior in patients with Crohn's disease (CD) can permit a more aggressive therapeutic regimen for patients at risk. The aim of this cohort study was to test the blood levels of hemoglobin (Hgb) and hematocrit (Hct) for the prediction of complicated CD behavior and CD related surgery in an adult patient population. Methods Blood samples of 62 CD patients of the German Inflammatory Bowel Disease-network “Kompetenznetz CED” were tested for the levels of Hgb and Hct prior to the occurrence of complicated disease behavior or CD related surgery. The relation of these markers and clinical events was studied using Kaplan-Meier survival analysis and adjusted COX-proportional hazard regression models. Results The median follow-up time was 55.8 months. Of the 62 CD patients without any previous complication or surgery 34% developed a complication and/or underwent CD related surgery. Low Hgb or Hct levels were independent predictors of a shorter time to occurrence of the first complication or CD related surgery. This was true for early as well as late occurring complications. Stable low Hgb or Hct during serial follow-up measurements had a higher frequency of complications compared to patients with a stable normal Hgb or Hct, respectively. Conclusions Determination of Hgb or Hct in complication and surgery naïve CD patients might serve as an additional tool for the prediction of complicated disease behavior. PMID:25116048

  2. Low Back Pain in Student Nurses: Literature Review and Prospective Cohort Study.

    Science.gov (United States)

    Menzel, Nancy; Feng, Du; Doolen, Jessica

    2016-01-01

    There is consensus that registered nurses worldwide have a high prevalence of work-related musculoskeletal disorders, particularly of the back. Patient handling activities such as lifting present the highest risk of injury, activities that begin in nursing school. A literature review identified 21 studies of back pain in nursing students, indicating a wide range of prevalence rates. A prospective cohort study of nursing students in a United States baccalaureate program followed 119 students who completed the Nordic Musculoskeletal Questionnaire upon beginning the 16 month upper division major and then a year later. There was no statistically significant change in low back pain prevalence over time. While nursing students have intermittent and brief exposure to patient handling activities, nursing schools must nevertheless protect them before they enter the high risk profession of nursing by teaching evidence-based safe patient handling techniques, empowering students to refuse unsafe manual lifts, and ensuring that the clinical settings with which they affiliate have adequate mechanical equipment available. PMID:27176750

  3. Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study.

    Science.gov (United States)

    Riva-Cambrin, Jay; Kestle, John R W; Holubkov, Richard; Butler, Jerry; Kulkarni, Abhaya V; Drake, James; Whitehead, William E; Wellons, John C; Shannon, Chevis N; Tamber, Mandeep S; Limbrick, David D; Rozzelle, Curtis; Browd, Samuel R; Simon, Tamara D

    2016-04-01

    OBJECT The rate of CSF shunt failure remains unacceptably high. The Hydrocephalus Clinical Research Network (HCRN) conducted a comprehensive prospective observational study of hydrocephalus management, the aim of which was to isolate specific risk factors for shunt failure. METHODS The study followed all first-time shunt insertions in children younger than 19 years at 6 HCRN centers. The HCRN Investigator Committee selected, a priori, 21 variables to be examined, including clinical, radiographic, and shunt design variables. Shunt failure was defined as shunt revision, subsequent endoscopic third ventriculostomy, or shunt infection. Important a priori-defined risk factors as well as those significant in univariate analyses were then tested for independence using multivariate Cox proportional hazard modeling. RESULTS A total of 1036 children underwent initial CSF shunt placement between April 2008 and December 2011. Of these, 344 patients experienced shunt failure, including 265 malfunctions and 79 infections. The mean and median length of follow-up for the entire cohort was 400 days and 264 days, respectively. The Cox model found that age younger than 6 months at first shunt placement (HR 1.6 [95% CI 1.1-2.1]), a cardiac comorbidity (HR 1.4 [95% CI 1.0-2.1]), and endoscopic placement (HR 1.9 [95% CI 1.2-2.9]) were independently associated with reduced shunt survival. The following had no independent associations with shunt survival: etiology, payer, center, valve design, valve programmability, the use of ultrasound or stereotactic guidance, and surgeon experience and volume. CONCLUSIONS This is the largest prospective study reported on children with CSF shunts for hydrocephalus. It confirms that a young age and the use of the endoscope are risk factors for first shunt failure and that valve type has no impact. A new risk factor-an existing cardiac comorbidity-was also associated with shunt failure. PMID:26636251

  4. Nurse competence between three generational nurse cohorts: A cross-sectional study.

    Science.gov (United States)

    Meretoja, Riitta; Numminen, Olivia; Isoaho, Hannu; Leino-Kilpi, Helena

    2015-08-01

    Research indicates significant differences between nurse cohorts in many work-related factors. This study compared nurse competence between three generational cohorts comprising the current nursing workforce. The Nurse Competence Scale was used to collect data for this cross-sectional study from 2052 nurses in a university hospital in Finland. Data were analysed statistically. Significant differences were found between nurse cohorts in their competence. The length of work experience had a significant impact on the development of competence. The oldest cohort, with the longest work experience, had the highest competence scores (70.1 on a visual analogue scale), and the youngest had the lowest (59.0). All cohorts were most competent in patient-related nursing tasks, in maintenance of professional competence and in ethical care. Nurses were weakest in the development of nursing practice and the use of evidence-based knowledge. Targeted interventions in teaching-coaching for different nurse generations are needed to ensure the maintenance of nurse competence and high-quality patient care. PMID:24689751

  5. Exercise in a Healthy Heart Program: A Cohort Study

    OpenAIRE

    Meikle, J.; al-Sarraf, A; Li, M; Grierson, K.; Frohlich, J

    2013-01-01

    Objective To assess the effects of exercise on resting heart rate (RHR), weight, lipid profile, and blood pressure. We hypothesized that the participants who increased their physical activity would show improvement in their cardiovascular risk factors compared to those who did not. Design Retrospective chart review over the mean duration of 4.9 years of follow-up. Setting Healthy Heart Program Prevention Clinic at St. Paul’s Hospital, Vancouver, British Columbia, Canada. Participants We revie...

  6. Birth cohort differences in the use of medications in a Brazilian population of older elderly: the Bambuí cohort study of aging (1997 and 2008)

    OpenAIRE

    Antônio Ignácio de Loyola Filho; Josélia O A Firmo; Elizabeth Uchôa; Maria Fernanda Lima-Costa

    2011-01-01

    This study examined differences in the use of medications in two birth cohorts (born from 1916 to 1926 and from 1927 to 1937) among older elderly in the population-based cohort study in Bambuí, Minas Gerais State, Brazil. The study used data on participants who were 71-81 years of age in the baseline survey in 1997 (n = 492) and in the 11th wave, in 2008 (n = 620). The number of medications currently consumed (mean = 4.6 and 3.4, respectively) and prevalence of polypharmacy (46.6% and 29.1%, ...

  7. Workplace bullying, sleep problems and leisure-time physical activity: a prospective cohort study

    DEFF Research Database (Denmark)

    Hansen, Åse Marie; Gullander, Maria; Hogh, Annie;

    2015-01-01

    OBJECTIVES: Workplace bullying is a potent stressor that may increase sleep problems. Since physical fitness improves resilience to stress, it seems plausible that recreational physical activities may moderate the association between bullying and sleep. The study aimed to examine prospectively...... whether (i) bullying increases the risk of sleep problems, and (ii) the association between bullying and sleep problems is moderated by leisure-time physical activity (LTPA). METHODS: The study sample comprised a cohort of public and private sector employees, who were enrolled into the Work Bullying and...... Harassment (WBH) cohort (N=3278) or the Psychosocial Risk Factors for Stress and Mental Disease (PRISME) cohort (N=4455). We measured workplace bullying using one question that was preceded by a definition of bullying. We used the Karolinska sleep questionnaire to assess sleep problems. The number of hours...

  8. CLINICAL PROFILE OF PATIENTS WITH EARLY AXIAL SPONDYLOARTHRITIS (RUSSIAN COHORT OF PATIENTS

    Directory of Open Access Journals (Sweden)

    E. E. Gubar'

    2014-01-01

    Full Text Available Objective: to study clinical manifestations of axial spondyloarthritis (axSpA fulfilling ASAS criteria and to evaluate Russian version of modified New York criteria for the diagnosis of AS in Russian patients.Subjects and methods. Authors examined 73 patients aged 18–45 years suffering from inflammatory back pain for a period from 3 months to 5 years. BASDAI and ASDAS-CRP were used to assess activity, whereas BASFI – to evaluate functional status. Examination included: assessment of HLA-B27 rate, X-ray of pelvis and lumbar spine, ultrasonography of hip joints and calcaneal regions, magnetic-resonance imaging (MRI of sacroiliac joints, lumbar spine and hip joints (if clinical signs of injury are present, densitometry of lumbar spine (LII–IV and femoral neck.Results. Mean age of patients was 28.3±6.4 years, mean duration of disease – 19.9±14.4 months. HLA-B27 was found in 94.5% of patients. Mean BASDAI value was 4.1±1.9; ASDAS – 2.7±1.3; BASFI – 2.6±2.1. Peripheral arthritis was observed in 65.8% of cases, coxitis – in 31.5%, calcaneal enthesitis – in 61.6%, dactylitis – in 19.2%, low bone mineral density – in 17.8%. MRI showed inflammatory changes of axial skeleton in 84.9% of patients, active sacroiliitis (SI – in 72.6%. X-ray revealed definite SI in 49.3% of patients («classic» AS. According to MRI data, 30.1% of patients with active SI and without structural changes of sacroiliac joints had pre-radiological stage of AS (by Russian version of modified New York criteria. 74.0% of patients fulfilled both sets of ASAS criteria for axSpA, 5.5% – met only I criteria set, whereas 20.5% – only II criteria set. Three groups of patients were defined. The first included patients with radiologically proven SI, the second – with MRI-proven SI and the third – patients without SI. Significant difference between the groups was detected either by gender (number of males in groups I and II exceeded that in group

  9. EPIDEMIOLOGICAL STUDY OF MORTALITY AND SYMPTOMATIC MORBIDITIES AMONG MIC LEAK EXPOSED COHORT IN 1984: 24 YEARS OF EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Nalok

    2014-01-01

    Full Text Available BACK GROUND : An industrial disaster in form of Methyl Isocyanate and other toxic products leak occurred in Bhopal on night of 2 nd /3 rd December 1984 and led to death of about 2000 persons and 1000 cattle within 72 hours. Besides death , it led to multisystem/organ involvement , clinically evidenced by symptomatic morbidities (lungs/ eyes main target organs besides other systems involvemen t. METHODOLOGY : To study mortalities and morbidities besides other objectives , a Prospective epidemiological study was planned through six community health clinics to follow the cohort of affected people living in gas affected area and a matched control liv ing in distant are a through six monthly house to house survey. Interview of head of family or an adult respondent was taken on the visit. RESULTS : Over the 24 years of the data collection exercise reveals that after acute stage was over the mortalities cam e down to levels or lower than the national averages for matching age groups. However respiratory causes were the main reason for the mortalities , among both affected as well as control cohort. Respiratory , ophthalmic , gastrointestinal and skin morbidities attained a plateau since 1999 , where all morbidities are occurring within 20%. However , morbidities in affected area are found to be higher than seen in control area. Experience suggests further in depth cli nical studies among symptomatic

  10. Children and Clinical Studies: Why Clinical Studies Are Important

    Medline Plus

    Full Text Available ... Systematic Evidence Reviews & Clinical Practice Guidelines Resources Continuing Education Researchers Funding Training & Career Development Division of Intramural Research Research Resources Research Meeting Summaries Technology Transfer Clinical Trials What Are Clinical Trials? Children & ...

  11. The prevalence of allergic diseases in an unselected group of 6-year-old children. The DARC birth cohort study

    DEFF Research Database (Denmark)

    Kjaer, Henrik Fomsgaard; Eller, Esben; Høst, Arne; Andersen, Klaus Ejner; Bindslev-Jensen, Carsten

    2008-01-01

    This study determines the prevalence of atopic dermatitis, asthma, rhinoconjunctivitis, food hypersensitivity and urticaria and the frequency of sensitization in children with and without clinical allergic disease. In an ongoing prospective non-interventional birth cohort study of 562 unselected...... children, 404 children were subjected to interview, clinical examination, lung function measurements and allergy testing at 6 yr of age. Sensitization measured by skin prick test (SPT) and specific immunoglobulin E (S-IgE) was determined for 24 different allergens. The 1-yr period prevalence of atopic......% and 55% (defined as SPT >/=3 mm and/or S-IgE >/=0.35 kU/l for at least one allergen). Symptoms were linked to sensitization for 44% in the asthma group and 42% in the rhinoconjunctivitis group, whereas sensitization could not be linked to worsening of the eczema in any cases of atopic dermatitis...

  12. Effect of therapeutic hypothermia on gas exchange and respiratory mechanics: a retrospective cohort study.

    Science.gov (United States)

    Karnatovskaia, Lioudmila V; Festic, Emir; Freeman, William D; Lee, Augustine S

    2014-06-01

    Targeted temperature management (TTM) may improve respiratory mechanics and lung inflammation in acute respiratory distress syndrome (ARDS) based on animal and limited human studies. We aimed to assess the pulmonary effects of TTM in patients with respiratory failure following cardiac arrest. Retrospective review of consecutive cardiac arrest cases occurring out of hospital or within 24 hours of hospital admission (2002-2012). Those receiving TTM (n=44) were compared with those who did not (n=42), but required mechanical ventilation (MV) for at least 4 days following the arrest. There were no between-group differences in age, gender, body mass index, APACHE II, or fluid balance during the study period. The TTM group had lower ejection fraction, Glasgow Coma Score, and more frequent use of paralytics. Matched data analyses (change at day 4 compared with baseline of the individual subject) showed favorable, but not statistically significant trends in respiratory mechanics endpoints (airway pressure, compliance, tidal volume, and PaO2/FiO2) in the TTM group. The PaCO2 decreased significantly more in the TTM group, as compared with controls (-12 vs. -5 mmHg, p=0.02). For clinical outcomes, the TTM group consistently, although not significantly, did better in survival (59% vs. 43%) and hospital length of stay (12 vs. 15 days). The MV duration and Cerebral Performance Category score on discharge were significantly lower in the TTM group (7.3 vs. 10.7 days, p=0.04 and 3.2 vs. 4, p=0.01). This small retrospective cohort suggests that the effect of TTM ranges from equivalent to favorable, compared with controls, for the specific respiratory and clinical outcomes in patients with respiratory failure following cardiac arrest. PMID:24840620

  13. Long-term mortality in patients diagnosed with pneumococcal meningitis: a Danish nationwide cohort study

    DEFF Research Database (Denmark)

    Roed, Casper; Engsig, Frederik Neess; Omland, Lars; Skinhøj, Peter; Obel, Niels

    2010-01-01

    The objective of the study was to determine the long-term mortality and the causes of death in patients diagnosed with pneumococcal meningitis. The authors performed a nationwide, population-based cohort study including all Danish patients diagnosed with pneumococcal meningitis from 1977 through ...

  14. No certain predictors for mutation status in a Danish cohort with familial hypercholesterolemia: a descriptive study

    DEFF Research Database (Denmark)

    Nybo, Mads; Brusgaard, Klaus; Hansen, Annebirthe Bo

    2007-01-01

    OBJECTIVE: In order to enable clinicians to refer the right persons suspected of familial hypercholesterolemia (FH) for mutation screening, a retrospective study was conducted in a Danish FH cohort. DESIGN AND METHODS: The study comprised 643 probands and 395 relatives, of which 421 individuals h...

  15. Differences in kinetic variables between injured and noninjured novice runners : A prospective cohort study

    NARCIS (Netherlands)

    Bredeweg, Steef W.; Kluitenberg, Bas; Bessem, Bram; Buist, Ida

    2013-01-01

    Objectives: This prospective study examined differences in kinetic variables between injured and noninjured novice female and male runners and their potential contribution to RRIs. Design: A prospective cohort study. Methods: At baseline vertical ground reaction forces were assessed with an instrume

  16. K-ras oncogene mutations in sporadic colorectal cancer in The Netherlands Cohort Study

    NARCIS (Netherlands)

    Brink, M.; Goeij, A.F.P.M. de; Weijenberg, M.P.; Roemen, G.M.J.M.; Lentjes, M.H.F.M.; Pachen, M.M.M.; Smits, K.M.; Bruïne, A.P. de; Goldbohm, R.A.; Brandt, P.A. van den

    2003-01-01

    Activation of K-ras oncogene has been implicated in colorectal carcinogenesis, being mutated in 30-60% of the adenocarcinomas. In this study, 737 incident colorectal cancer (CRC) patients, originating from 120 852 men and women (55-69 years at baseline) participating in the Netherlands Cohort Study

  17. A Birth Cohort Study: Conceptual and Design Considerations and Rationale. Working Paper Series.

    Science.gov (United States)

    Moore, Kristin; Manlove, Jennifer; Richter, Kerry; Halle, Tamara; Le Menestrel, Suzanne; Zaslow, Martha; Greene, Angela Dungee; Mariner, Carrie; Romano, Angela; Bridges, Lisa

    The Early Childhood Longitudinal Study, Birth Cohort 2000 (ECLS-B) is a study that will assess children's health status and their growth and development in domains that are critical for later school readiness and academic achievement. This paper is one of several that have been prepared in support of ECLS-B design efforts. It is anticipated that…

  18. The Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study : rationale and methods

    NARCIS (Netherlands)

    Kaplan, Bonnie J.; Giesbrecht, Gerald F.; Leung, Brenda M. Y.; Field, Catherine J.; Dewey, Deborah; Bell, Rhonda C.; Manca, Donna P.; O'Beirne, Maeve; Johnston, David W.; Pop, Victor J.; Singhal, Nalini; Gagnon, Lisa; Bernier, Francois P.; Eliasziw, Misha; McCargar, Linda J.; Kooistra, Libbe; Farmer, Anna; Cantell, Marja; Goonewardene, Laki; Casey, Linda M.; Letourneau, Nicole; Martin, Jonathan W.

    2014-01-01

    The Alberta Pregnancy Outcomes and Nutrition (APrON) study is an ongoing prospective cohort study that recruits pregnant women early in pregnancy and, as of 2012, is following up their infants to 3 years of age. It has currently enrolled approximately 5000 Canadians (2000 pregnant women, their offsp

  19. Role of students’ context in predicting academic performance at a medical school: a retrospective cohort study

    OpenAIRE

    Thiele, Tamara; Pope, Daniel; Singleton, A; Stanistreet, D.

    2016-01-01

    Objectives This study examines associations between medical students’ background characteristics (postcode-based measures of disadvantage, high school attended, sociodemographic characteristics), and academic achievement at a Russell Group University. Design Retrospective cohort analysis. Setting Applicants accepted at the University of Liverpool medical school between 2004 and 2006, finalising their studies between 2010 and 2011. Participants 571 students (with an English home postcode) regi...

  20. THE MAIN DIRECTIONS OF PROSPECTIVE COHORT STUDY OF POPULATION LIVING AROUND THE SEMIPALATINSK NUCLEAR TEST SITE

    OpenAIRE

    ZHUNUSSOVA T.; Grosche, B; Apsalikov, K.; BELIKHINA T.; Pivina, L.; Muldagaliev, T.

    2014-01-01

    In the paper we have presented the possibilities of prospective cohort study of health status in the radiation exposed population living around the Semipalatinsk nuclear test site. It was substantiated the necessity of international cooperation of scientists from Kazakhstan, Europe, Japan and the United States for long-term study of radiation effects for the people and the environment.

  1. Pre-diagnostic alcohol consumption and postmenopausal breast cancer survival: a prospective patient cohort study

    NARCIS (Netherlands)

    Vrieling, A.; Buck, K.; Heinz, J.; Obi, N.; Benner, A.; Flesch-Janys, D.; Chang-Claude, J.

    2012-01-01

    Study results on the association of alcohol consumption with breast cancer survival are inconsistent, partly due to the use of different survival outcomes. We assessed the association of pre-diagnostic alcohol consumption with survival and recurrence in a prospective cohort study in Germany includin

  2. Asthma and Attention-Deficit/Hyperactivity Disorder: A Nationwide Population-Based Prospective Cohort Study

    Science.gov (United States)

    Chen, Mu-Hong; Su, Tung-Ping; Chen, Ying-Sheue; Hsu, Ju-Wei; Huang, Kai-Lin; Chang, Wen-Han; Chen, Tzeng-Ji; Bai, Ya-Mei

    2013-01-01

    Background: Previous cross-sectional studies have suggested an association between asthma and attention-deficit/hyperactivity disorder (ADHD), but the temporal relationship was not determined. Using a nationwide population-based prospective case-control cohort study (1:4, age-/gender-matched), we hypothesized that asthma in infanthood or early…

  3. Predictive factors of postpartum fatigue: a prospective cohort study among working women

    NARCIS (Netherlands)

    Bakker, M.; Beek, A.J. van der; Hendriksen, I.J.M.; Bruinvels, D.J.; Poppel, M.N. van

    2014-01-01

    Objectives The aim of this study was to investigate which prepartum determinants contribute to the development of postpartum (PP) fatigue among working women in the Netherlands. Methods A prospective cohort study in 15 Dutch companies was conducted to measure different potential predictors using sel

  4. Depressive symptoms, insulin sensitivity and insulin secretion in the RISC cohort study

    NARCIS (Netherlands)

    Bot, M.; Pouwer, F.; De Jonge, P.; Nolan, J. J.; Mari, A.; Hojlund, K.; Golay, A.; Balkau, B.; Dekker, J. M.

    2013-01-01

    Aim. This study explored the association of depressive symptoms with indices of insulin sensitivity and insulin secretion in a cohort of non-diabetic men and women aged 30 to 64 years. Methods. The study population was derived from the 3-year follow-up of the Relationship between Insulin Sensitivity

  5. Cohort Comparisons in Resources and Functioning among Centenarians: Findings from the Georgia Centenarian Study

    Science.gov (United States)

    Cho, Jinmyoung; Martin, Peter; Margrett, Jennifer; MacDonald, Maurice; Poon, Leonard W.; Johnson, Mary Ann

    2012-01-01

    The purpose of this study was to examine cohort comparisons in levels of resources (e.g., mental health, physical functioning, economic and social resources, and cognitive functioning) for 211 community-dwelling centenarians (whose Mini-Mental Status Examination score was 23 or higher) of phases I and III of the Georgia Centenarian Study. The…

  6. Clinical Validation of the 2005 ISUP Gleason Grading System in a Cohort of Intermediate and High Risk Men Undergoing Radical Prostatectomy.

    Directory of Open Access Journals (Sweden)

    Sheila F Faraj

    Full Text Available In 2005, the International Society of Urological Pathology (ISUP introduced several modifications to the original Gleason system that were intended to enhance the prognostic power of Gleason score (GS. The objective of this study was to clinically validate the 2005 ISUP Gleason grading system for its ability to detect metastasis. We queried our institutional RP database for men with NCCN clinically localized intermediate to high-risk disease undergoing radical prostatectomy (RP between 1992 and 2010 with no additional treatment until the time of metastatic progression. A case-cohort design was utilized. A total of 333 available RP samples were re-reviewed and GS was reassigned per the 2005 ISUP Gleason system. Cumulative incidence of metastasis was 0%, 8.4%, 24.5% and 44.4% among specimens that were downgraded, unchanged, had one point GS increase and two point GS increase, respectively. The hazard ratio for metastasis raised in GS 8 and 9 compared to GS 7 from 2.77 and 5.91 to 3.49 and 9.31, respectively. The survival c-index of GS increased from 0.70 to 0.80 when samples were re-graded at 5 years post RP. The c-index of the reassigned GS was higher than the original GS (0.77 vs 0.64 for predicting PCSM at 10 years post RP. The regraded GS improved the prediction of metastasis and PCSM. This validates the updated Gleason grading system using an unambiguous clinical endpoint and highlights the need for reassignment of Gleason grading according to 2005 ISUP system when considering comparisons of novel biomarkers to clinicopathological variables in archival cohorts.

  7. Clinical Characteristics and Disease Predictors of a Large Chinese Cohort of Patients with Autosomal Dominant Polycystic Kidney Disease

    OpenAIRE

    Chen, Dongping; Ma, Yiyi; Wang, Xueqi; Yu, Shengqiang; Li, Lin; Dai, Bing; Mao, Zhiguo; Sun, Lijun; Xu, Chenggang; Rong, Shu; Tang, Mengjun; Zhao, Hongbo; Liu, Hongchao; Andreas L Serra; Graf, Nicole

    2014-01-01

    Objective Autosomal dominant polycystic kidney disease (ADPKD) is a relentlessly progressing form of chronic kidney disease for which there is no cure. The aim of this study was to characterize Chinese patients with ADPKD and to identify the factors which predict cyst growth and renal functional deterioration. Methods To analyze disease predicting factors we performed a prospective longitudinal observational study in a cohort of 541 Chinese patients with ADPKD and an eGFR ≥30 ml/min/1.73 m2. ...

  8. Early versus late Gamma Knife radiosurgery following transsphenoidal resection for nonfunctioning pituitary macroadenomas: a matched cohort study.

    Science.gov (United States)

    Pomeraniec, I Jonathan; Dallapiazza, Robert F; Xu, Zhiyuan; Jane, John A; Sheehan, Jason P

    2016-07-01

    OBJECT Gamma Knife radiosurgery (GKRS) is frequently employed to treat residual or recurrent nonfunctioning pituitary macroadenomas. There is no consensus as to whether GKRS should be used early after surgery or if radiosurgery should be withheld until there is evidence of radiographic progression of tumor. METHODS This is a retrospective review of patients with nonfunctioning pituitary macroadenomas who underwent transsphenoidal surgery followed by GKRS between 1996 and 2013 at the University of Virginia Health System. Patients were stratified based on the interval between resection and radiosurgery. Operative results and imaging and clinical outcomes were compared across groups following early (≤ 6 months) or late (> 6 months) radiosurgery. RESULTS Sixty-four patients met the study criteria and were grouped based on early (n = 32) or late (n = 32) GKRS following transsphenoidal resection. There was a greater risk of tumor progression after GKRS in the late radiosurgical group (p = 0.027) over a median radiographic follow-up period of 68.5 months. Furthermore, there was a significantly higher occurrence of post-GKRS endocrinopathy in the late radiosurgical cohort (p = 0.041). Seventeen percent of patients without endocrinopathy in the early cohort developed new endocrinopathies during the follow-up period versus 64% in the late cohort (p = 0.036). This difference was primarily due to a significantly higher rate of tumor growth during the observation period of the late treatment cohort (p = 0.014). Of these patients with completely new endocrinopathies, radiation-associated pituitary insufficiency developed in 1 of 2 patients in the early group and in 3 of 7 (42.9%) patients in the late group. CONCLUSIONS Early treatment with GKRS appears to decrease the rate of radiographic and symptomatic progression of subtotally resected nonfunctioning pituitary macroadenomas compared with late GKRS treatment after a period of expectant management. Delaying radiosurgery may

  9. Testing the sexually abused-sexual abuser hypothesis: A prospective longitudinal birth cohort study.

    Science.gov (United States)

    Leach, Chelsea; Stewart, Anna; Smallbone, Stephen

    2016-01-01

    The sexually abused-sexual abuser hypothesis posits that persons, especially males, who are sexually abused as children are at particular risk of sexually abusing others later in life. We tested this hypothesis by prospectively examining associations between maltreatment and offending in a birth cohort of 38,282 males with a maltreatment history and/or at least one finalized offense. We examined these associations within the context of the wider birth population. Proportionally few boys were the subject of official notifications for sexual abuse (14.8% of maltreated boys, and 1.4% of the birth population); proportionally very few of these sexually abused boys (3%) went on to become sexual offenders; and, contrary to findings typically reported in retrospective clinical studies, proportionally few sexual offenders (4%) had a confirmed history of sexual abuse. Poly-victimization (exposure to multiple types of maltreatment) was significantly associated with sexual offending, violent offending, and general (nonsexual, nonviolent) offending. We found no specific association between sexual abuse and sexual offending, and nor did we find any association between sexual abuse and sexual offending specifically within the poly-victimized group. The total number of sexual abuse notifications did make a small unique contribution to the variance in sexual offending compared to other offending. Implications concerning maltreated boys and male sexual offenders are discussed. PMID:26615777

  10. The relationships between neonatal encephalopathy and cerebral palsy: a cohort study.

    Science.gov (United States)

    Evans, K; Rigby, A S; Hamilton, P; Titchiner, N; Hall, D M

    2001-03-01

    There is a high risk of cerebral palsy (CP) following neonatal encephalopathy (NE) with fits, often attributed to intrapartum asphyxia. The evidence for the association is inconclusive and antepartum factors offer an alternative explanation. A cohort study was carried out to assess the evidence for and against hypoxic ischaemic injury as the cause of NE-associated CP in term infants. A total of 57 159 consecutive births were enrolled. There were 150 cases with NE, of whom 92 had at least one fit and 58 had no fits. The incidence of all NE was 2.62 per 1000 births and of NE with fits was 1.61 per 1000 births. Infants with NE were followed-up to identify those with cerebral palsy. There were 13 cases of four-limb cerebral palsy and three with hemiplegia among the survivors. In 12 of the 13 cases of four-limb CP, a combination of low Apgar scores, an early onset acute evolving encephalopathy, acidosis, renal dysfunction and the absence of antepartum factors suggested an acute intrapartum event as the immediate cause of the NE. An obstetric event likely to cause acute hypoxic injury was identified in four of the 12 cases. The clinical picture was similar in the four with and the eight without a specific obstetric event. The pathway leading to NE-associated CP remains unexplained, but intrapartum events appear to play a major role in most cases. PMID:12521875

  11. Opportunistic illnesses in Brazilian children with AIDS: results from two national cohort studies, 1983-2007

    Directory of Open Access Journals (Sweden)

    Heukelbach Jorg

    2011-07-01

    Full Text Available Abstract Background HAART has significantly reduced AIDS-related morbidity in children. However, limited evidence is available from developing countries regarding patterns of opportunistic illnesses. We describe these events and their associated factors in children with AIDS in Brazil. Methods This study is based on two representative retrospective multi-center cohorts including a total 1,859 children with AIDS, infected via mother-to-child transmission (MTCT, between 1983-2002. Opportunistic illnesses were described and analyzed over time. The association of demographic, clinical and operational data with the occurrence of opportunistic diseases was assessed. Results In total, 1,218 (65.5% had at least one event of an opportunistic disease. Variables significantly associated with occurrence of these events included: region of residence (OR 2.68-11.33, as compared to the Northern region, age Pneumocystis jirovecii pneumonia (21.9 vs. 13.2%; p Conclusions Despite the significant reduction in recent years, opportunistic illnesses are still common in Brazilian children with AIDS in the HAART era, especially bacterial diseases. The data reinforce the need for scaling up prevention of MTCT, early diagnosis of infection, and improvement of comprehensive pediatric care.

  12. The Systemic Inflammatory Response Syndrome (SIRS in acutely hospitalised medical patients: a cohort study

    Directory of Open Access Journals (Sweden)

    Storgaard Merete

    2009-12-01

    Full Text Available Abstract Background Sepsis is an infection which has evoked a systemic inflammatory response. Clinically, the Systemic Inflammatory Response Syndrome (SIRS is identified by two or more symptoms including fever or hypothermia, tachycardia, tachypnoea and change in blood leucocyte count. The relationship between SIRS symptoms and morbidity and mortality in medical emergency ward patients is unknown. Methods We conducted a prospective cohort study of the frequency of SIRS and its relationship to sepsis and death among acutely hospitalised medical patients. In 437 consecutive patients, SIRS status, blood pressure, infection and comorbidity on admission was registered together with 28-day mortality. Results A hundred and fifty-four patients (35% had SIRS on admission, 211 patients (48% had no SIRS, and 72 patients (16% had insufficient data to evaluate their SIRS status. SIRS patients were 2.2 times more frequently infected, with 66/154 SIRS patients versus 41/211 non-SIRS patients: p Conclusion We found SIRS status on admission to be moderately associated with infection and strongly related to 28-day mortality.

  13. The Autism Birth Cohort (ABC:a study of autism spectrum disorders in MoBa

    Directory of Open Access Journals (Sweden)

    Pål Surén

    2014-12-01

    Full Text Available Background: Autism spectrum disorders (ASDs are characterized by persistent deficits in social communication and interaction and restricted, repetitive patterns of behavior, interests or activities. In most cases, the cause of ASD is likely to be a combination of genetic predisposition and environmental exposures occurring in fetal life or early infancy. Consequently, a prospective pregnancy cohort like MoBa represents an ideal platform for studies of ASDs in children.Methods: The Autism Birth Cohort (ABC Study has identified potential ASD cases in MoBa through questionnaire- based screening, parental and professional referrals, and linkages to the Norwegian Patient Register. ASD diagnoses have been ascertained through in-person clinical assessments and medical record reviews.Current results: By the end of 2012, the ABC Study had identified 518 ASD cases in MoBa. The ASD prevalence in school-age children is 0.7-0.8%, which is in line with nationwide estimates for Norway. The most important source of ASD case identification was registry linkages, while only a minority was detected through early screening. Published findings show that screening at 18 months misses the majority of ASD cases. Analyses of risk factors for ASDs have shown that maternal use of folic acid supplements in early pregnancy may lower the child’s risk of developing ASDs and that paternal obesity appears to increase the child’s risk of ASDs.Future plans: ASD case identification will continue through annual registry linkages and subsequent reviews of medical records. Analyses of plasma samples and RNA samples will be conducted to investigate prenatal and perinatal microbial exposures, innate immune and inflammatory responses, biomarkers of autism risk, and exposures to xenobiotics. Analyses of deciduous teeth will also investigate the effect of medications and environmental toxins. Exome sequencing of DNA from ASD cases and their parents is ongoing, and will elucidate the

  14. Consequences of gestational diabetes in an urban hospital in Viet Nam: a prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Jane E Hirst

    Full Text Available BACKGROUND: Gestational diabetes mellitus (GDM is increasing and is a risk for type 2 diabetes. Evidence supporting screening comes mostly from high-income countries. We aimed to determine prevalence and outcomes in urban Viet Nam. We compared the proposed International Association of the Diabetes and Pregnancy Study Groups (IADPSG criterion, requiring one positive value on the 75-g glucose tolerance test, to the 2010 American Diabetes Association (ADA criterion, requiring two positive values. METHODS AND FINDINGS: We conducted a prospective cohort study in Ho Chi Minh City, Viet Nam. Study participants were 2,772 women undergoing routine prenatal care who underwent a 75-g glucose tolerance test and interview around 28 (range 24-32 wk. GDM diagnosed by the ADA criterion was treated by local protocol. Women with GDM by the IADPSG criterion but not the ADA criterion were termed "borderline" and received standard care. 2,702 women (97.5% of cohort were followed until discharge after delivery. GDM was diagnosed in 164 participants (6.1% by the ADA criterion, 550 (20.3% by the IADPSG criterion. Mean body mass index was 20.45 kg/m(2 in women with out GDM, 21.10 in women with borderline GDM, and 21.81 in women with GDM, p<0.001. Women with GDM and borderline GDM were more likely to deliver preterm, with adjusted odds ratios (aORs of 1.49 (95% CI 1.16-1.91 and 1.52 (1.03-2.24, respectively. They were more likely to have clinical neonatal hypoglycaemia, aORs of 4.94 (3.41-7.14 and 3.34 (1.41-7.89, respectively. For large for gestational age, the aORs were 1.16 (0.93-1.45 and 1.31 (0.96-1.79, respectively. There was no significant difference in large for gestational age, death, severe birth trauma, or maternal morbidity between the groups. Women with GDM underwent more labour inductions, aOR 1.51 (1.08-2.11. CONCLUSIONS: Choice of criterion greatly affects GDM prevalence in Viet Nam. Women with GDM by the IADPSG criterion were at risk of preterm delivery

  15. Longitudinal associations between physical load and chronic low back pain in the general population: the Doetichem Cohort Study

    NARCIS (Netherlands)

    Oostrom, S.H.; Verschuren, M.; Vet, de H.C.; Boshuizen, H.C.; Picavet, H.S.

    2012-01-01

    Study Design. Prospective cohort study. Objective. We explored long-term associations between physical load exposure and chronic low back pain (LBP) using data from an ongoing population-based cohort study. Summary of Background Data. Physical load in work or daily life is often studied in relation

  16. Retrospective Cohort Study of 207 Cases of Osteochondritis Dissecans of the Knee

    Science.gov (United States)

    Green, Daniel W.; Arbucci, John; Silberman, Jason; Luderowski, Eva; Uppstrom, Tyler J.; Nguyen, Joseph; Tuca, Maria

    2016-01-01

    Objectives: Describe the clinical characteristics, image findings, and outcomes of patients with juvenile osteochondritis dissecans (JOCD) of the knee. To our knowledge, this is the largest single-surgeon cohort of JOCD patients. Methods: Retrospective cohort study of knee JOCD patients assessed by a single pediatric orthopaedic surgeon at a tertiary care center between 2005-2015. All diagnoses were confirmed by magnetic resonance imaging (MRI). Patients with patellar dislocations or osteochondral fractures were excluded. Demographic data, sports played, comorbidities, surgical procedures, and clinical data were extracted from charts. Images were analyzed to identify the location and size of lesions. Chi-square or Fisher’s exact tests were used to compare discrete variables, and Mann-Whitney U and Kruskal Wallis tests to compare continuous variables between groups. P-values of basketball (29.4%). JOCD was present bilaterally in 27 patients (15%), 14 knees had bifocal OCD (6.8%), and only 1 patient had bifocal lesions in both knees. Most common location was medial femoral condyle (56.3%) followed by lateral femoral condyle (23.1%), trochlea (11.4%), patella (9%), and tibia (0.5%). In the sagittal view, most common location was the middle third of the condyles (48.7%). Surgery was performed in 72 knees (34.8%), with an average age at surgery of 14.1 years (9.3-18.1). Bilateral JOCD was present in 13 surgical patients (18.8%), but only 3 patients had bilateral surgery. Two operative patients had bifocal JOCD (2.7%) and surgery on both lesions. Location distribution did not differ between surgical and non-surgical lesions. The average normalized area of non-surgical JOCD lesions was 6.8 (0.1-18), whereas surgical lesions averaged a significantly higher area of 7.7 (0.5-17) (p=0.023). Average BMI was 21.6 versus 20.2 for surgical and non-surgical patients, respectively, significantly higher for those who underwent surgery (p=0.002). Most common procedure was fixation

  17. Clinical and inflammatory characteristics of the European U-BIOPRED adult severe asthma cohort.

    Science.gov (United States)

    Shaw, Dominick E; Sousa, Ana R; Fowler, Stephen J; Fleming, Louise J; Roberts, Graham; Corfield, Julie; Pandis, Ioannis; Bansal, Aruna T; Bel, Elisabeth H; Auffray, Charles; Compton, Chris H; Bisgaard, Hans; Bucchioni, Enrica; Caruso, Massimo; Chanez, Pascal; Dahlén, Barbro; Dahlen, Sven-Erik; Dyson, Kerry; Frey, Urs; Geiser, Thomas; Gerhardsson de Verdier, Maria; Gibeon, David; Guo, Yi-Ke; Hashimoto, Simone; Hedlin, Gunilla; Jeyasingham, Elizabeth; Hekking, Pieter-Paul W; Higenbottam, Tim; Horváth, Ildikó; Knox, Alan J; Krug, Norbert; Erpenbeck, Veit J; Larsson, Lars X; Lazarinis, Nikos; Matthews, John G; Middelveld, Roelinde; Montuschi, Paolo; Musial, Jacek; Myles, David; Pahus, Laurie; Sandström, Thomas; Seibold, Wolfgang; Singer, Florian; Strandberg, Karin; Vestbo, Jorgen; Vissing, Nadja; von Garnier, Christophe; Adcock, Ian M; Wagers, Scott; Rowe, Anthony; Howarth, Peter; Wagener, Ariane H; Djukanovic, Ratko; Sterk, Peter J; Chung, Kian Fan

    2015-11-01

    U-BIOPRED is a European Union consortium of 20 academic institutions, 11 pharmaceutical companies and six patient organisations with the objective of improving the understanding of asthma disease mechanisms using a systems biology approach.This cross-sectional assessment of adults with severe asthma, mild/moderate asthma and healthy controls from 11 European countries consisted of analyses of patient-reported outcomes, lung function, blood and airway inflammatory measurements.Patients with severe asthma (nonsmokers, n=311; smokers/ex-smokers, n=110) had more symptoms and exacerbations compared to patients with mild/moderate disease (n=88) (2.5 exacerbations versus 0.4 in the preceding 12 months; pgastro-oesophageal reflux with lower lung function. Sputum eosinophil count was higher in severe asthma compared to mild/moderate asthma (median count 2.99% versus 1.05%; p=0.004) despite treatment with higher doses of inhaled and/or oral corticosteroids.Consistent with other severe asthma cohorts, U-BIOPRED is characterised by poor symptom control, increased comorbidity and airway inflammation, despite high levels of treatment. It is well suited to identify asthma phenotypes using the array of "omic" datasets that are at the core of this systems medicine approach. PMID:26357963

  18. Suicide and mental illness in parents and risk of suicide in offspring: a birth cohort study

    DEFF Research Database (Denmark)

    Sørensen, Holger J; Mortensen, Erik L; Wang, August G;

    2009-01-01

    BACKGROUND: A family history of completed suicide and psychiatric illness has been identified as risk factors for suicide. AIMS: To examine the risk of offspring suicide in relation to parental history of suicide and other parental risk factors. METHOD: The study population consisted of 7,177 adult...... offspring born 1959-1961 and their parents from the Copenhagen Perinatal Cohort. Cohort members and their parents who had committed suicide were identified in the Danish Causes of Death Registry (follow-up until December 31, 2005), while information on psychiatric hospitalisation history was obtained from...... the Danish Psychiatric Central Research Register. RESULTS: Forty-eight cohort members, 77 mothers and 133 fathers had committed suicide during the follow-up. Independent of parental psychiatric illness and social status, parental suicide significantly increased suicide risk in offspring (hazard ratio...

  19. Sex effects on short-term complications after hip fracture: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Ekström W

    2015-08-01

    Full Text Available Wilhelmina Ekström,1 Bodil Samuelsson,2 Sari Ponzer,3 Tommy Cederholm,4,5 Karl-Göran Thorngren,6 Margareta Hedström7 1Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, 2Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, 3Department of Clinical Science and Education, Section of Orthopaedics, Karolinska Institutet, Södersjukhuset, Stockholm, 4Department of Public Health and Caring Sciences, 5Department of Geriatrics, Uppsala University, Uppsala University Hospital, Uppsala, 6Department of Clinical Sciences, Lund, Orthopaedics, Lund University, Lund, 7Department of Orthopaedics, Institute of Clinical Science, Intervention and Technology (CLINTEC, Karolinska University Hospital, Huddinge, Stockholm, Sweden Objectives: To evaluate potential sex differences and other factors associated with complications within 4 months after a hip fracture.Methods: A total of 1,915 patients ≥65 years (480 men with hip fracture were consecutively included in a prospective multicenter cohort study. A review of medical records and patient interviews according to a study protocol based on the Standardized Audit of Hip Fractures in Europe (SAHFE, RIKSHÖFT was performed. Sex differences in comorbidity according to the American Society of Anesthesiologists score and complications 4 months after a hip fracture were registered. Multivariate logistic regression analysis was performed to identify factors related to complications.Results: Male sex was associated with worse general health according to the American Society of Anesthesiologists classification (P=0.005 and with more comorbidities (P<0.001. Male sex emerged as a risk factor for developing pneumonia (P<0.001, and additionally, 18% of the men suffered from cardiac complications compared with 13% of the females (P=0.018. Female sex was predisposed for urinary tract infections, 30% vs 23

  20. The Netherlands Cohort Study – Meat Investigation Cohort; a population-based cohort over-represented with vegetarians, pescetarians and low meat consumers

    OpenAIRE

    Gilsing, Anne MJ; Weijenberg, Matty P.; Goldbohm, R. Alexandra; Dagnelie, Pieter C.; van den Brandt, Piet A.; Schouten, Leo J.

    2013-01-01

    Background Vegetarian diets have been associated with lower risk of chronic disease, but little is known about the health effects of low meat diets and the reliability of self-reported vegetarian status. We aimed to establish an analytical cohort over-represented with vegetarians, pescetarians and 1 day/week meat consumers, and to describe their lifestyle and dietary characteristics. In addition, we were able to compare self-reported vegetarians with vegetarians whose status has been confirme...

  1. The longitudinal urban cohort ageing study (LUCAS: study protocol and participation in the first decade

    Directory of Open Access Journals (Sweden)

    Dapp Ulrike

    2012-07-01

    Full Text Available Abstract Background We present concept, study protocol and selected baseline data of the Longitudinal Urban Cohort Ageing Study (LUCAS in Germany. LUCAS is a long-running cohort study of community-dwelling seniors complemented by specific studies of geriatric patients or diseases. Aims were to (1 Describe individual ageing trajectories in a metropolitan setting, documenting changes in functional status, the onset of frailty, disability and need of care; (2 Find determinants of healthy ageing; (3 Assess long-term effects of specific health promotion interventions; (4 Produce results for health care planning for fit, pre-frail, frail and disabled elderly persons; (5 Set up a framework for embedded studies to investigate various hypotheses in specific subgroups of elderly. Methods/Design In 2000, twenty-one general practitioners (GPs were recruited in the Hamburg metropolitan area; they generated lists of all their patients 60 years and older. Persons not terminally ill, without daily need of assistance or professional care were eligible. Of these, n = 3,326 (48 % agreed to participate and completed a small (baseline and an extensive health questionnaire (wave 1. In 2007/2008, a re-recruitment took place including 2,012 participants: 743 men, 1,269 women (647 deaths, 197 losses, 470 declined further participation. In 2009/2010 n = 1,627 returned the questionnaire (90 deaths, 47 losses, 248 declined further participation resulting in a good participation rate over ten years with limited and quantified dropouts. Presently, follow-up data from 2007/2008 (wave 2 and 2009/2010 (wave 3 are available. Data wave 4 is due in 2011/2012, and the project will be continued until 2013. Information on survival and need of nursing care was collected continuously and cross-checked against official records. We used Fisher’s exact test and t-tests. The study served repeatedly to evaluate health promotion interventions and concepts. Discussion LUCAS

  2. Meat consumption and risk of breast cancer in the UK Women's Cohort Study

    OpenAIRE

    Taylor, E F; Burley, V J; Greenwood, D C; Cade, J E

    2007-01-01

    We performed a survival analysis to assess the effect of meat consumption and meat type on the risk of breast cancer in the UK Women's Cohort Study. Between 1995 and 1998 a cohort of 35 372 women was recruited, aged between 35 and 69 years with a wide range of dietary intakes, assessed by a 217-item food frequency questionnaire. Hazard ratios (HRs) were estimated using Cox regression adjusted for known confounders. High consumption of total meat compared with none was associated with premenop...

  3. Animal products, calcium and protein and prostate cancer risk in the Netherlands Cohort Study

    OpenAIRE

    Schuurman, A.G.; Brandt, P.A. van den; Dorant, E.; R. A. Goldbohm

    1999-01-01

    Prostate cancer risk in relation to consumption of animal products, and intake of calcium and protein was investigated in the Netherlands Cohort Study. At baseline in 1986, 58 279 men aged 55–69 years completed a self-administered 150-item food frequency questionnaire and a questionnaire on other risk factors for cancer. After 6.3 years of follow-up, 642 prostate cancer cases were available for analysis. In multivariate case-cohort analyses adjusted for age, family history of prostate cancer ...

  4. Risk of developing diabetes is inversely related to lung function: a population-based cohort study.

    OpenAIRE

    Engström, Gunnar; Janzon, Lars

    2002-01-01

    AimTo investigate whether reduced lung function is a risk factor for developing diabetes. MethodsNon-diabetic men (n = 382) from the population-based cohort 'Men Born in 1914' were examined with spirometry at age 55 years. The cohort was re-examined at 68 years. Diabetes and fasting plasma glucose at follow-up were studied in relation to vital capacity (VC) and forced expiratory volume (FEV1.0) at baseline. ResultsFifteen men developed diabetes during the follow-up. The ...

  5. Incidence of asthma and mortality in a cohort of young adults: a 7-year prospective study

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    Bugianio Massimilian; Cazzoletti Lucia; Locatelli Francesca; Marco Roberto; Carosso Aurelia; Marinoni Alessandra

    2005-01-01

    Abstract Background Few longitudinal data exist on the incidence of asthma in young adults and on the overall mortality risk due to asthma. A 7-year follow-up prospective study was performed to assess the incidence of asthma and mortality from all causes in a cohort of young adults. Methods The life status of a cohort of 6031 subjects, aged 20–44 years, who replied to a respiratory screening questionnaire between 1991 and 1992, was ascertained in 1999. A new questionnaire investigating the hi...

  6. Intake of nitrate and nitrite and the risk of gastric cancer: a prospective cohort study.

    OpenAIRE

    Loon, A.J.M. van; Botterweck, A.A.M.; Goldbohm, R. A.; Brants, H.A.M.; van Klaveren, J.D.; van den Brandt, P.A.

    1998-01-01

    The association between the intake of nitrate or nitrite and gastric cancer risk was investigated in a prospective cohort study started in 1986 in the Netherlands, of 120,852 men and women aged 55-69 years. At baseline, data on dietary intake, smoking habits and other covariates were collected by means of a self-administered questionnaire. For data analysis, a case-cohort approach was used, in which the person-years at risk were estimated from a randomly selected subcohort (1688 men and 1812 ...

  7. Early diagnosis of neuropathy in leprosy--comparing diagnostic tests in a large prospective study (the INFIR cohort study.

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    Wim H van Brakel

    Full Text Available BACKGROUND: Leprosy is the most frequent treatable neuromuscular disease. Yet, every year, thousands of patients develop permanent peripheral nerve damage as a result of leprosy. Since early detection and treatment of neuropathy in leprosy has strong preventive potential, we conducted a cohort study to determine which test detects this neuropathy earliest. METHODS AND FINDINGS: One hundred and eighty-eight multibacillary (MB leprosy patients were selected from a cohort of 303 and followed for 2 years after diagnosis. Nerve function was evaluated at each visit using nerve conduction (NC, quantitative thermal sensory testing and vibrometry, dynamometry, monofilament testing (MFT, and voluntary muscle testing (VMT. Study outcomes were sensory and motor impairment detected by MFT or VMT. Seventy-four of 188 patients (39% had a reaction, neuritis, or new nerve function impairment (NFI event during a 2-year follow-up. Sub-clinical neuropathy was extensive (20%-50%, even in patients who did not develop an outcome event. Sensory nerve action potential (SNAP amplitudes, compound motor action potential (CMAP velocities, and warm detection thresholds (WDT were most frequently affected, with SNAP impairment frequencies ranging from 30% (median to 69% (sural. Velocity was impaired in up to 43% of motor nerves. WDTs were more frequently affected than cold detection thresholds (29% versus 13%, ulnar nerve. Impairment of SNC and warm perception often preceded deterioration in MF or VMT scores by 12 weeks or more. CONCLUSIONS: A large proportion of leprosy patients have subclinical neuropathy that was not evident when only MFT and VMT were used. SNC was the most frequently and earliest affected test, closely followed by WDT. They are promising tests for improving early detection of neuropathy, as they often became abnormal 12 weeks or more before an abnormal monofilament test. Changes in MFT and VMT score mirrored changes in neurophysiology, confirming their

  8. Demographical, Viro-Immunological, Clinical and Therapeutical Characteristics of HIV-Infected Patients in an “Epidemiologically Unexplored” Region of Italy (Calabria Region): the CalabrHIV Cohort

    Science.gov (United States)

    Postorino, Maria Concetta; Luciani, Filippo; Mangano, Carmelo; Carpentieri, Maria Stella; Scerbo, Paolo; Priamo, Armando; Berardelli, Giuseppina; Marino, Roberto; Vallone, Alfredo; Serrao, Nicola; Pisani, Vincenzo; Costa, Chiara; Terremoto, Albano; Foti, Giuseppe; Cosco, Lucio; Calderazzo, Massimo; Corigliano, Domenico; Scordo, Preziosa; Strazzulla, Alessio; Torti, Carlo

    2015-01-01

    Background and Objectives HIV epidemics may differ among epidemiological contexts. We aimed at constructing an HIV clinical cohort whose main epidemiological, clinical and therapeutical characteristics are described (the CalabrHIV cohort, Calabria Region, Southern Italy). Methods The CalabrHIV Cohort includes all HIV patients on active follow-up in all infectious disease centers in the Calabria Region as at October 2014. All information was recorded in a common electronic database. Not-infectious co-morbidities (such as cardiovascular diseases, bone fractures, diabetes, renal failure and hypertension) were also studied. Results 548 patients (68% males; 59% aged 50 years old patients than in <50 years old ones (30% vs. 6%; p<0.0001). Co-morbidity was more frequent in HCV and/or HBV co-infected than in HIV mono-infected patients (46.6% vs. 31.7%: p=0.0006). Conclusion This cohort presentation study sheds light, for the first time, on HIV patients’ characteristics in the Calabria Region. We showed that HIV-infected patients with chronic hepatitis were affected by concomitant not-infectious co-morbidities more than the HIV mono-infected individuals. New HCV treatments are therefore to be implemented in the co-infected population. PMID:26543523

  9. Mortality Prediction after the First Year of Kidney Transplantation: An Observational Study on Two European Cohorts

    Science.gov (United States)

    Lorent, Marine; Giral, Magali; Pascual, Manuel; Koller, Michael T.; Steiger, Jürg; Trébern-Launay, Katy; Legendre, Christophe; Kreis, Henri; Mourad, Georges; Garrigue, Valérie; Rostaing, Lionel; Kamar, Nassim; Kessler, Michèle; Ladrière, Marc; Morelon, Emmanuel; Buron, Fanny; Golshayan, Dela; Foucher, Yohann

    2016-01-01

    After the first year post transplantation, prognostic mortality scores in kidney transplant recipients can be useful for personalizing medical management. We developed a new prognostic score based on 5 parameters and computable at 1-year post transplantation. The outcome was the time between the first anniversary of the transplantation and the patient’s death with a functioning graft. Afterwards, we appraised the prognostic capacities of this score by estimating time-dependent Receiver Operating Characteristic (ROC) curves from two prospective and multicentric European cohorts: the DIVAT (Données Informatisées et VAlidées en Transplantation) cohort composed of patients transplanted between 2000 and 2012 in 6 French centers; and the STCS (Swiss Transplant Cohort Study) cohort composed of patients transplanted between 2008 and 2012 in 6 Swiss centers. We also compared the results with those of two existing scoring systems: one from Spain (Hernandez et al.) and one from the United States (the Recipient Risk Score, RRS, Baskin-Bey et al.). From the DIVAT validation cohort and for a prognostic time at 10 years, the new prognostic score (AUC = 0.78, 95%CI = [0.69, 0.85]) seemed to present significantly higher prognostic capacities than the scoring system proposed by Hernandez et al. (p = 0.04) and tended to perform better than the initial RRS (p = 0.10). By using the Swiss cohort, the RRS and the the new prognostic score had comparable prognostic capacities at 4 years (AUC = 0.77 and 0.76 respectively, p = 0.31). In addition to the current available scores related to the risk to return in dialysis, we recommend to further study the use of the score we propose or the RRS for a more efficient personalized follow-up of kidney transplant recipients. PMID:27152510

  10. Malignant transformation of oral leukoplakia: a retrospective cohort study of 218 Chinese patients

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    Zhou Zeng-Tong

    2010-12-01

    Full Text Available Abstract Background Oral leukoplakia (OL is the best-known potentially malignant disorder. A new binary system to grade dysplasia was proposed by WHO, but the biological significance in predicting malignant transformation risk is unknown. The objective of this study is to estimate the rate of malignant transformation in a long-term follow-up cohort, explore the usefulness of the new binary system of grading dysplasia and identify significant risk factors of OL malignant transformation in China. Methods A total of 218 patients with clinical and histopathologic diagnosis of OL were retrospectively reviewed. They were selected among all archived files at the Department of Oral Mucosal Diseases, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. The mean follow-up period was 5.3 years. Results Among 218 cases, 39 (17.9% OL patients developed oral cancer, with a mean duration of 5.2 years. Cox regression analysis revealed that dysplasia was an independent risk factor for OL malignant transformation, but age, gender, lesion site, diet habit, smoking and ethanol intake were not risk factors. High-risk dysplastic OL was associated with a 4.57-fold (95% confidence interval, 2.36-8.84; P Conclusions The new binary system's function in predicting OL malignant transformation risk was investigated in this survey. The utilization of high-risk dysplasia as a significant indicator for evaluating malignant transformation risk in patients with OL was suggested, which may be helpful to guide treatment selection in clinical practice.

  11. Fluid status in peritoneal dialysis patients: the European Body Composition Monitoring (EuroBCM study cohort.

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    Wim Van Biesen

    Full Text Available BACKGROUND: Euvolemia is an important adequacy parameter in peritoneal dialysis (PD patients. However, accurate tools to evaluate volume status in clinical practice and data on volume status in PD patients as compared to healthy population, and the associated factors, have not been available so far. METHODS: We used a bio-impedance spectroscopy device, the Body Composition Monitor (BCM to assess volume status in a cross-sectional cohort of prevalent PD patients in different European countries. The results were compared to an age and gender matched healthy population. RESULTS: Only 40% out of 639 patients from 28 centres in 6 countries were normovolemic. Severe fluid overload was present in 25.2%. There was a wide scatter in the relation between blood pressure and volume status. In a multivariate analysis in the subgroup of patients from countries with unrestricted availability of all PD modalities and fluid types, older age, male gender, lower serum albumin, lower BMI, diabetes, higher systolic blood pressure, and use of at least one exchange per day with the highest hypertonic glucose were associated with higher relative tissue hydration. Neither urinary output nor ultrafiltration, PD fluid type or PD modality were retained in the model (total R² of the model = 0.57. CONCLUSIONS: The EuroBCM study demonstrates some interesting issues regarding volume status in PD. As in HD patients, hypervolemia is a frequent condition in PD patients and blood pressure can be a misleading clinical tool to evaluate volume status. To monitor fluid balance, not only fluid output but also dietary input should be considered. Close monitoring of volume status, a correct dialysis prescription adapted to the needs of the patient and dietary measures seem to be warranted to avoid hypervolemia.

  12. Malignant transformation of oral leukoplakia: a retrospective cohort study of 218 Chinese patients

    International Nuclear Information System (INIS)

    Oral leukoplakia (OL) is the best-known potentially malignant disorder. A new binary system to grade dysplasia was proposed by WHO, but the biological significance in predicting malignant transformation risk is unknown. The objective of this study is to estimate the rate of malignant transformation in a long-term follow-up cohort, explore the usefulness of the new binary system of grading dysplasia and identify significant risk factors of OL malignant transformation in China. A total of 218 patients with clinical and histopathologic diagnosis of OL were retrospectively reviewed. They were selected among all archived files at the Department of Oral Mucosal Diseases, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. The mean follow-up period was 5.3 years. Among 218 cases, 39 (17.9%) OL patients developed oral cancer, with a mean duration of 5.2 years. Cox regression analysis revealed that dysplasia was an independent risk factor for OL malignant transformation, but age, gender, lesion site, diet habit, smoking and ethanol intake were not risk factors. High-risk dysplastic OL was associated with a 4.57-fold (95% confidence interval, 2.36-8.84; P < 0.001) increased risk of malignant transformation, compared with low-risk dysplasia. Consistent with this result, high-risk dysplastic OL had signicantly higher malignant incidence than low-risk dysplasia, particularly during the first 2-3 years of follow-up, by Kaplan-Meier analysis (Log-rank test, P < 0.001). The new binary system's function in predicting OL malignant transformation risk was investigated in this survey. The utilization of high-risk dysplasia as a significant indicator for evaluating malignant transformation risk in patients with OL was suggested, which may be helpful to guide treatment selection in clinical practice

  13. Cohort Profile: The Framingham Heart Study (FHS): overview of milestones in cardiovascular epidemiology.

    Science.gov (United States)

    Tsao, Connie W; Vasan, Ramachandran S

    2015-12-01

    The Framingham Heart Study (FHS) has conducted seminal research defining cardiovascular disease (CVD) risk factors and fundamentally shaping public health guidelines for CVD prevention over the past five decades. The success of the Original Cohort, initiated in 1948, paved the way for further epidemiological research in preventive cardiology. Due to the keen observations suggesting the role of shared familial factors in the development of CVD, in 1971 the FHS began enroling the second generation cohort, comprising the children of the Original Cohort and the spouses of the children. In 2002, the third generation cohort, comprising the grandchildren of the Original Cohort, was initiated to additionally explore genetic contributions to CVD in greater depth. Additionally, because of the predominance of White individuals of European descent in the three generations of FHS participants noted above, the Heart Study enrolled the OMNI1 and OMNI2 cohorts in 1994 and 2003, respectively, aimed to reflect the current greater racial and ethnic diversity of the town of Framingham. All FHS cohorts have been examined approximately every 2-4 years since the initiation of the study. At these periodic Heart Study examinations, we obtain a medical history and perform a cardiovascular-focused physical examination, 12-lead electrocardiography, blood and urine samples testing and other cardiovascular imaging studies reflecting subclinical disease burden.The FHS has continually evolved along the cutting edge of cardiovascular science and epidemiological research since its inception. Participant studies now additionally include study of cardiovascular imaging, serum and urine biomarkers, genetics/genomics, proteomics, metabolomics and social networks. Numerous ancillary studies have been established, expanding the phenotypes to encompass multiple organ systems including the lungs, brain, bone and fat depots, among others. Whereas the FHS was originally conceived and designed to study the

  14. Frequency of and Risk Factors for Depression among Participants in the Swiss HIV Cohort Study (SHCS.

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    Alexia Anagnostopoulos

    Full Text Available We studied the incidence and prevalence of, and co-factors for depression in the Swiss HIV Cohort Study.Depression-specific items were introduced in 2010 and prospectively collected at semiannual cohort visits. Clinical, laboratory and behavioral co-factors of incident depression among participants free of depression at the first two visits in 2010 or thereafter were analyzed with Poisson regression. Cumulative prevalence of depression at the last visit was analyzed with logistic regression.Among 4,422 participants without a history of psychiatric disorders or depression at baseline, 360 developed depression during 9,348 person-years (PY of follow-up, resulting in an incidence rate of 3.9 per 100 PY (95% confidence interval (CI 3.5-4.3. Cumulative prevalence of depression during follow-up was recorded for 1,937/6,756 (28.7% participants. Incidence and cumulative prevalence were higher in injection drug users (IDU and women. Older age, preserved work ability and higher physical activity were associated with less depression episodes. Mortality (0.96 per 100 PY, 95% CI 0.83-1.11 based upon 193 deaths over 20,102 PY was higher among male IDU (2.34, 1.78-3.09, female IDU (2.33, 1.59-3.39 and white heterosexual men (1.32, 0.94-1.84 compared to white heterosexual women and homosexual men (0.53, 0.29-0.95; and 0.71, 0.55-0.92. Compared to participants free of depression, mortality was slightly elevated among participants with a history of depression (1.17, 0.94-1.45 vs. 0.86, 0.71-1.03, P = 0.033. Suicides (n = 18 did not differ between HIV transmission groups (P = 0.50, but were more frequent among participants with a prior diagnosis of depression (0.18 per 100 PY, 95%CI 0.10-0.31; vs. 0.04, 0.02-0.10; P = 0.003.Depression is a frequent co-morbidity among HIV-infected persons, and thus an important focus of care.

  15. Mortality after parental death in childhood: a nationwide cohort study from three Nordic countries.

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    Jiong Li

    2014-07-01

    Full Text Available BACKGROUND: Bereavement by spousal death and child death in adulthood has been shown to lead to an increased risk of mortality. Maternal death in infancy or parental death in early childhood may have an impact on mortality but evidence has been limited to short-term or selected causes of death. Little is known about long-term or cause-specific mortality after parental death in childhood. METHODS AND FINDINGS: This cohort study included all persons born in Denmark from 1968 to 2008 (n = 2,789,807 and in Sweden from 1973 to 2006 (n = 3,380,301, and a random sample of 89.3% of all born in Finland from 1987 to 2007 (n = 1,131,905. A total of 189,094 persons were included in the exposed cohort when they lost a parent before 18 years old. Log-linear Poisson regression was used to estimate mortality rate ratio (MRR. Parental death was associated with a 50% increased all-cause mortality (MRR = 1.50, 95% CI 1.43-1.58. The risks were increased for most specific cause groups and the highest MRRs were observed when the cause of child death and the cause of parental death were in the same category. Parental unnatural death was associated with a higher mortality risk (MRR = 1.84, 95% CI 1.71-2.00 than parental natural death (MRR = 1.33, 95% CI 1.24-1.41. The magnitude of the associations varied according to type of death and age at bereavement over different follow-up periods. The main limitation of the study is the lack of data on post-bereavement information on the quality of the parent-child relationship, lifestyles, and common physical environment. CONCLUSIONS: Parental death in childhood or adolescence is associated with increased all-cause mortality into early adulthood. Since an increased mortality reflects both genetic susceptibility and long-term impacts of parental death on health and social well-being, our findings have implications in clinical responses and public health strategies. Please see later in the article for the

  16. Adherence to Disease Modifying Drugs among Patients with Multiple Sclerosis in Germany: A Retrospective Cohort Study.

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    Kerstin Hansen

    Full Text Available Long-term therapies such as disease modifying therapy for Multiple Sclerosis (MS demand high levels of medication adherence in order to reach acceptable outcomes. The objective of this study was to describe adherence to four disease modifying drugs (DMDs among statutorily insured patients within two years following treatment initiation. These drugs were interferon beta-1a i.m. (Avonex, interferon beta-1a s.c. (Rebif, interferon beta-1b s.c. (Betaferon and glatiramer acetate s.c. (Copaxone.This retrospective cohort study used pharmacy claims data from the data warehouse of the German Institute for Drug Use Evaluation (DAPI from 2001 through 2009. New or renewed DMD prescriptions in the years 2002 to 2006 were identified and adherence was estimated during 730 days of follow-up by analyzing the medication possession ratio (MPR as proxy for compliance and persistence defined as number of days from initiation of DMD therapy until discontinuation or interruption.A total of 52,516 medication profiles or therapy cycles (11,891 Avonex, 14,060 Betaferon, 12,353 Copaxone and 14,212 Rebif from 50,057 patients were included into the analysis. Among the 4 cohorts, no clinically relevant differences were found in available covariates. The Medication Possession Ratio (MPR measured overall compliance, which was 39.9% with a threshold MPR≥0.8. There were small differences in the proportion of therapy cycles during which a patient was compliant for the following medications: Avonex (42.8%, Betaferon (40.6%, Rebif (39.2%, and Copaxone (37%. Overall persistence was 32.3% at the end of the 24 months observation period, i.e. during only one third of all included therapy cycles patients did not discontinue or interrupt DMD therapy. There were also small differences in the proportion of therapy cycles during which a patient was persistent as follows: Avonex (34.2%, Betaferon (33.4%, Rebif (31.7% and Copaxone (29.8%.Two years after initiating MS-modifying therapy, only

  17. The risk of cryptorchidism among sons of women working in horticulture in Denmark: a cohort study

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    Gabel Pernille

    2011-11-01

    Full Text Available Abstract Background Androgens are crucial for normal testicular descent. Studies show that some pesticides have estrogenic or antiandrogenic effects, and that female workers exposed to pesticides have increased risk of having a boy with cryptorchidism. The main objective of the present study was to investigate whether pregnant women exposed to pesticides due to their work in horticulture experience excess risk of having sons with cryptorchidism. Methods We conducted a cohort study of pregnant women working in horticulture using four cohorts including one cohort established with data from the departments of occupational medicine in Jutland and Funen and three existing mother-child cohorts (n = 1,468. A reference group was established from the entire Danish population of boys born in the period of 1986-2007 (n = 783,817. Nationwide Danish health registers provided information on birth outcome, cryptorchidism diagnosis and orchiopexy. The level of occupational exposure to pesticides was assessed by expert judgment blinded towards outcome status. Risk of cryptorchidism among exposed horticulture workers compared to the background population and to unexposed horticulture workers was assessed by Cox regression models. Results Pesticide exposed women employed in horticulture had a hazard ratio (HR of having cryptorchid sons of 1.39 (95% CI 0.84; 2.31 and a HR of orchiopexy of 1.34 (0.72; 2.49 compared to the background population. Analysis divided into separate cohorts revealed a significantly increased risk of cryptorchidism in cohort 2: HR 2.58 (1.07;6.20 and increased risk of orchiopexy in cohort 4: HR 2.76 (1.03;7.35, but no significant associations in the other cohorts. Compared to unexposed women working in horticulture, pesticide exposed women had a risk of having sons with cryptorchidism of 1.34 (0.30; 5.96 and of orchiopexy of 1.93 (0.24;15.4. Conclusions The data are compatible with a slightly increased risk of cryptorchidism in sons of women

  18. Return to work in a cohort of low back pain patients: development and validation of a clinical prediction rule

    OpenAIRE

    Heymans, M.W.; Anema, J.R.; Buuren, van, S.; Knol, D. L.; Mechelen, Van; Vet, van der, Paul E.

    2009-01-01

    BACKGROUND: From the viewpoint of cost prevention, it is necessary to identify patients that are of high risk for long-term work disability, production loss and sick-leave. METHODS: Secondary data analysis in a cohort of 628 workers on sick-leave between 3 and 6 weeks due to low back pain (LBP). The association of a broad set of demographic, work, LBP and psychosocial related factors on lasting return to work was studied using Cox regression analysis with backward selection. The most relevant...

  19. Mild cognitive impairment: Profile of a cohort from a private sector memory clinic

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    Srikanth Srinivasan

    2014-01-01

    Full Text Available Background: Private hospital memory clinics might see a different clientele than university or academic institutes due to referral biases. Objective: To characterize the profile of patients with mild cognitive impairment (MCI from a private sector memory clinic. Materials and Methods: MCI was diagnosed according to revised clinical criteria of Petersen et al. For a subset of patients with MCI medial temporal atrophy and cerebral small vessel disease (white matter lesions and lacunes were rated on magnetic resonance imaging (MRI scans and analyzed for their contribution towards cognitive impairment. Results: Subjects with MCI formed one-third (113/371 of this memory clinic sample from a private hospital. MCI could be effectively diagnosed and subtyped using a brief cognitive scale (Concise Cognitive Test (CONCOG. The amnestic MCI (single and multiple domains subtype comprised the majority of cases with MCI. In a subsample of 33 patients, lacunar infarcts were more common than white matter lesions and hippocampal atrophy and were inversely associated with verbal fluency. Conclusions: MCI may be more commonly encountered in private hospital settings probably due to early referrals. It is possible to diagnose and subtype MCI using a brief cognitive instrument such as the CONCOG. In this sample, lacunar infarcts were more commonly encountered than medial temporal atrophy in such patients.

  20. Treatment and outcomes of an Australian cohort of outpatients with bipolar I or schizoaffective disorder over twenty-four months: implications for clinical practice

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    Kulkarni Jayashri

    2012-12-01

    Full Text Available Abstract Background The Bipolar Comprehensive Outcomes Study (BCOS is a 2-year, prospective, non-interventional, observational study designed to explore the clinical and functional outcomes associated with ‘real-world’ treatment of participants with bipolar I or schizoaffective disorder. All participants received treatment as usual. There was no study medication. Methods Participants prescribed either conventional mood stabilizers (CMS; n = 155 alone, or olanzapine with, or without, CMS (olanzapine ± CMS; n = 84 were assessed every 3 months using several measures, including the Young Mania Rating Scale, 21-item Hamilton Depression Rating Scale, Clinical Global Impressions Scale – Bipolar Version, and the EuroQol Instrument. This paper reports 24-month longitudinal clinical, pharmacological, functional, and socioeconomic data. Results On average, participants were 42 (range 18 to 79 years of age, 58%; were female, and 73%; had a diagnosis of bipolar I. Polypharmacy was the usual approach to pharmacological treatment; participants took a median of 5 different psychotropic medications over the course of the study, and spent a median proportion of time of 100%; of the study on mood stabilizers, 90%; on antipsychotics, 9%; on antidepressants, and 5%; on benzodiazepines/hypnotics. By 24 months, the majority of participants had achieved both symptomatic and syndromal remission of both mania and depression. Symptomatic relapse rates were similar for both the CMS alone (65%; and the olanzapine ± CMS (61%; cohorts. Conclusions Participants with bipolar I or schizoaffective disorder in this study were receiving complex medication treatments that were often discordant with recommendations made in contemporary major treatment guidelines. The majority of study participants demonstrated some clinical and functional improvements, but not all achieved remission of symptoms or syndrome.