Childhood socioeconomic position and objectively measured physical capability levels in adulthood: a systematic review and meta-analysis

<p><b>Background:</b> Grip strength, walking speed, chair rising and standing balance time are objective measures of physical capability that characterise current health and predict survival in older populations. Socioeconomic position (SEP) in childhood may influence the peak level of physical capability achieved in early adulthood, thereby affecting levels in later adulthood. We have undertaken a systematic review with meta-analyses to test the hypothesis that adverse childhood SEP is associated with lower levels of objectively measured physical capability in adulthood.</p> <p><b>Methods and Findings:</b> Relevant studies published by May 2010 were identified through literature searches using EMBASE and MEDLINE. Unpublished results were obtained from study investigators. Results were provided by all study investigators in a standard format and pooled using random-effects meta-analyses. 19 studies were included in the review. Total sample sizes in meta-analyses ranged from N = 17,215 for chair rise time to N = 1,061,855 for grip strength. Although heterogeneity was detected, there was consistent evidence in age adjusted models that lower childhood SEP was associated with modest reductions in physical capability levels in adulthood: comparing the lowest with the highest childhood SEP there was a reduction in grip strength of 0.13 standard deviations (95% CI: 0.06, 0.21), a reduction in mean walking speed of 0.07 m/s (0.05, 0.10), an increase in mean chair rise time of 6% (4%, 8%) and an odds ratio of an inability to balance for 5s of 1.26 (1.02, 1.55). Adjustment for the potential mediating factors, adult SEP and body size attenuated associations greatly. However, despite this attenuation, for walking speed and chair rise time, there was still evidence of moderate associations.</p> <p><b>Conclusions:</b> Policies targeting socioeconomic inequalities in childhood may have additional benefits in promoting the maintenance of independence in later life.</p&gt

Individual accumulation of heterogeneous risks explains perinatal inequalities within deprived neighbourhoods

Dutch' figures on perinatal mortality and morbidity are poor compared to EU-standards. Considerable within-country differences have been reported too, with decreased perinatal health in deprived urban areas. We investigated associations between perinatal risk factors and adverse perinatal outcomes in 7,359 pregnant women participating in population-based prospective cohort study, to establish the independent role, if any, for living within a deprived urban neighbourhood. Main outcome measures included perinatal death, intrauterine growth restriction (IUGR), prematurity, congenital malformations, Apgar at 5 min < 7, and pre-eclampsia. Information regarding individual risk factors was obtained from questionnaires, physical examinations, ultrasounds, biological samples, and medical records. The dichotomous Dutch deprivation indicator was additionally used to test for unexplained deprived urban area effects. Pregnancies from a deprived neighbourhood had an increased risk for perinatal death (RR 1.8, 95% CI [1.1; 3.1]). IUGR, prematurity, Apgar at 5 min < 7, and pre-eclampsia also showed higher prevalences (P < 0.05). Residing within a deprived neighbourhood was associated with increased prevalence of all measured risk factors. Regression analysis showed that the observed neighbourhood related differences in perinatal outcomes could be attributed to the increased risk factor prevalence only, without a separated role for living within a deprived neighbourhood. Women from a deprived neighbourhood had significantly more 'possibly avoidable' risk factors. To conclude, women from a socioeconomically deprived neighbourhood are at an increased risk for adverse pregnancy outcomes. Differences regarding possibly avoidable risk factors imply that preventive strategies may prove effective

Obstetrical outcome valuations by patients, professionals, and laypersons: Differences within and between groups using three valuation methods

Background: Decision-making can be based on treatment preferences of the patient, the doctor, or by guidelines based on lay people's preferences. We compared valuations assigned by three groups: patients, obstetrical care professionals, and laypersons, for health states involving both mother and (unborn) child. Our aim was to compare the valuations of different groups using different valuation methods and complex obstetric health outcome vignettes that involve both maternal and neonatal ou

Analysis of early mesothelial cell responses to Staphylococcus epidermidis isolated from patients with peritoneal dialysis-associated peritonitis

The major complication of peritoneal dialysis (PD) is the development of peritonitis, an infection within the abdominal cavity, primarily caused by bacteria. PD peritonitis is associated with significant morbidity, mortality and health care costs. Staphylococcus epidermidis is the most frequently isolated cause of PD-associated peritonitis. Mesothelial cells are integral to the host response to peritonitis, and subsequent clinical outcomes, yet the effects of infection on mesothelial cells are not well characterised. We systematically investigated the early mesothelial cell response to clinical and reference isolates of S. epidermidis using primary mesothelial cells and the mesothelial cell line Met-5A. Using an unbiased whole genome microarray, followed by a targeted panel of genes known to be involved in the human antibacterial response, we identified 38 differentially regulated genes (adj. p-value &lt; 0.05) representing 35 canonical pathways after 1 hour exposure to S. epidermidis. The top 3 canonical pathways were TNFR2 signaling, IL-17A signaling, and TNFR1 signaling (adj. pvalues of 0.0012, 0.0012 and 0.0019, respectively). Subsequent qPCR validation confirmed significant differences in gene expression in a number of genes not previously described in mesothelial cell responses to infection, with heterogeneity observed between clinical isolates of S. epidermidis, and between Met-5A and primary mesothelial cells. Heterogeneity between different S. epidermidis isolates suggests that specific virulence factors may play critical roles in influencing outcomes from peritonitis. This study provides new insights into early mesothelial cell responses to infection with S. epidermidis, and confirms the importance of validating findings in primary mesothelial cells

Risk of pocket hematoma in patients on chronic anticoagulation with warfarin undergoing electrophysiological device implantation: a comparison of different peri-operative management strategies

OBJECTIVE: Periprocedural management of warfarin remains challenging in patients requiring electrophysiological device surgery. For patients at high risk of thromboembolic events, guidelines recommend bridging therapy with heparin; however, this strategy is associated with a high risk of pocket hematoma. This paper systematically reviews studies appraising the risk of pocket hematoma with different perioperative anticoagulation strategies. METHODS: All relevant studies identified in MEDLINE/PubMed, The Cochrane Collaboration CENTRAL, clinicaltrials.org and in bibliographies of key articles. Estimates were combined using a fixed effects model. Heterogeneity was assessed by p values of chi(2) statistics and I-2. Publication bias was assessed by visual examination of funnel plots and by Egger test. Fifteen studies enrolling 5911 patients met all inclusion criteria and were included in this review. RESULTS: Heparin bridging compared with no heparin was associated with increased risk of pocket hematoma (OR = 4.47, 95% CI 3.21-6.23, p &lt; 0.00001), and prolonged hospital stay (9.13 +/- 1.9 days vs. 5.11 +/- 1.39 days, p &lt; 0.00001). Warfarin continuation was not associated with increased pocket hematoma compared to warfarin discontinuation (p = 0.38), but was associated with reduced risk of pocket hematoma compared with heparin bridging (OR = 0.37, 95% CI 0.2-0.69, p = 0.002). Thromboembolic complications were reduced with heparin bridging vs. no heparin (0.50% vs.1.07%, p = 0.02), and no significant differences were reported between heparin bridging vs. warfarin continuation (p = 0.83). CONCLUSIONS: Heparin bridging is associated with a higher risk of pocket hematoma and a prolonged hospital stay. Perioperative continuation of warfarin reduces the occurence of pocket hematoma compared with heparin bridging without any significant differences in thromboembolic complications

Pattern, style and timing of British–Irish Ice Sheet retreat: Shetland and northern North Sea sector

The offshore sector around Shetland remains one of the least well‐studied parts of the former British–Irish Ice Sheet with several long‐standing scientific issues unresolved. These key issues include (i) the dominance of a locally sourced ‘Shetland ice cap’ vs an invasive Fennoscandian Ice Sheet; (ii) the flow configuration and style of glaciation at the Last Glacial Maximum (i.e. terrestrial vs marine glaciation); (iii) the nature of confluence between the British–Irish and Fennoscandian Ice Sheets; (iv) the cause, style and rate of ice sheet separation; and (v) the wider implications of ice sheet uncoupling on the tempo of subsequent deglaciation. As part of the Britice‐Chrono project, we present new geological (seabed cores), geomorphological, marine geophysical and geochronological data from the northernmost sector of the last British–Irish Ice Sheet (north of 59.5°N) to address these questions. The study area covers ca. 95 000 km2, an area approximately the size of Ireland, and includes the islands of Shetland and the surrounding continental shelf, some of the continental slope, and the western margin of the Norwegian Channel. We collect and analyse data from onshore in Shetland and along key transects offshore, to establish the most coherent picture, so far, of former ice‐sheet deglaciation in this important sector. Alongside new seabed mapping and Quaternary sediment analysis, we use a multi‐proxy suite of new isotopic age assessments, including 32 cosmogenic‐nuclide exposure ages from glacially transported boulders and 35 radiocarbon dates from deglacial marine sediments, to develop a synoptic sector‐wide reconstruction combining strong onshore and offshore geological evidence with Bayesian chronosequence modelling. The results show widespread and significant spatial fluctuations in size, shape and flow configuration of an ice sheet/ice cap centred on, or to the east of, the Orkney–Shetland Platform, between ~30 and ~15 ka BP. At its maximum extent ca. 26–25 ka BP, this ice sheet was coalescent with the Fennoscandian Ice Sheet to the east. Between ~25 and 23 ka BP the ice sheet in this sector underwent a significant size reduction from ca. 85 000 to <50 000 km2, accompanied by several ice‐margin oscillations. Soon after, connection was lost with the Fennoscandian Ice Sheet and a marine corridor opened to the east of Shetland. This triggered initial (and unstable) re‐growth of a glaciologically independent Shetland Ice Cap ca. 21–20 ka BP with a strong east–west asymmetry with respect to topography. Ice mass growth was followed by rapid collapse, from an area of ca. 45 000 km2 to ca. 15 000 km2 between 19 and 18 ka BP, stabilizing at ca. 2000 km2 by ~17 ka BP. Final deglaciation of Shetland occurred ca. 17–15 ka BP, and may have involved one or more subsidiary ice centres on now‐submerged parts of the continental shelf. We suggest that the unusually dynamic behaviour of the northernmost sector of the British–Irish Ice Sheet between 21 and 18 ka BP – characterized by numerous extensive ice sheet/ice mass readvances, rapid loss and flow redistributions – was driven by significant changes in ice mass geometry, ice divide location and calving flux as the glaciologically independent ice cap adjusted to new boundary conditions. We propose that this dynamism was forced to a large degree by internal (glaciological) factors specific to the strongly marine‐influenced Shetland Ice Cap