Predicting death over 8 years in a prospective cohort of HIV-infected women: the Women's Interagency HIV Study.

ObjectivesPredicting mortality in middle-aged HIV-infected (HIV+) women on antiretroviral therapies (ART) is important for understanding the impact of HIV infection. Several health indices have been used to predict mortality in women with HIV infection. We evaluated: (1) an HIV biological index, Veterans Aging Cohort Study (VACS); (2) a physical index, Fried Frailty Index (FFI); and (3) a mental health index, Center for Epidemiologic Studies-Depression (CES-D). Proportional hazards regression analyses were used to predict death and included relevant covariates.DesignProspective, observational cohort.SettingMulticentre, across six sites in the USA.Participants1385 multirace/ethnic ART-experienced HIV+ women in 2005.Primary and secondary outcomesAll deaths, AIDS deaths and non-AIDS deaths up to ~8 years from baseline.ResultsIncluded together in one model, VACS Index was the dominant, significant independent predictor of all deaths within 3 years (HR=2.20, 95% CI 1.83, 2.65, χ2=69.04, p<0.0001), and later than 3 years (HR=1.55, 95% CI 1.30, 1.84, χ2=23.88, p<0.0001); followed by FFI within 3 years (HR=2.06, 95% CI 1.19, 3.57, χ2=6.73, p=0.01) and later than 3 years (HR=2.43, 95% CI 1.58, 3.75, χ2=16.18, p=0.0001). CES-D score was not independently associated with mortality.Conclusions and relevanceThis is the first simultaneous evaluation of three common health indices in HIV+ adults. Indices reflecting physical and biological ageing were associated with death

Workers’ experience of psychological ownership in the engineering industry : A quantitative study of workers’ views on sick leave.

Problembakgrund: Sedan 2010 har en ökning av sjukfrånvaro konstaterats i Sverige. Ökningen härleds bland annat till förändringar i attityder hos arbetare. Organisationer har väl kännedom om vilka risker, orsaker och problem som följer vid arbetsuppgifter av fysisk karaktär. Trots att organisationer har kunskap kring förebyggande åtgärder behöver det inte leda till en förändring kring sjukfrånvaro då även andra faktorer är betydande. I en större tillverkningsindustri har tendenser på skillnader mellan två avdelningar gällande sjukfrånvaro observerats. Arbetare kan i vissa fall välja sjukfrånvaro, vilket definieras som valet att inte gå till sin arbetsplats oavsett arbetarens upplevda hälsotillstånd. Då även andra faktorer påverkar sjukfrånvaron hos arbetare kommer detta diskuteras i studien och vad det kan tänkas bero på. Syfte: Studiens syfte är att utifrån arbetstillfredsställelse, engagemang och attityder utröna om det finns likheter och olikheter mellan två avdelningars sjukfrånvaro i en större tillverkningsindustri. Därför kommer arbetares upplevelse av arbetstillfredsställelse, engagemang och attityder i sitt arbete att undersökas. Metod: En enkätundersökning med 175 arbetare inom en större tillverkningsindustri utgör studiens datamaterial. Resultat: Studien visar att psykologiskt ägarskap har visat sig kunna förklara arbetares sjukfrånvaro i tillverkningsindustrier. Detta ger en förklaring till arbetares arbetstillfredsställelse, engagemang och attityder. Arbetare med hög grad av psykologiskt ägarskap tenderar visa mer stolthet mot det de producerar, ha en högre lojalitet mot organisationen samt en högre organisationsidentifikation vilket är kopplat till lägre sjukfrånvaro. Studiens bidrag påvisar faktorerna arbetstillfredsställelse, engagemang och attityders påverkan på arbetares sjukfrånvaro vid större företag inom tillverkningsindustrin. Studiens praktiska resultat kan användas av chefer och ledare inom större tillverkningsindustri, eftersom psykologiskt ägarskap har visat sig kunna ge viss förklaring till arbetares sjukfrånvaro då känslan av ägarskap påverkar arbetares arbetstillfredsställelse, engagemang och attityder. Problem: An increase in absenteeism has been observed in Sweden since 2010 and derives partly from changes in the attitudes of workers. Organizations are well aware of the risks, causes and problems which occur within a physical working environment. Although organizations have obtained knowledge regarding the prevention and minimization of these factors, there are still experienced difficulties when trying to change the trend for sickness absence, since other factors are also crucial. In a larger engineering plant, tendencies of differences between two departments regarding absenteeism have been observed. Workers in some cases choose sick leave, which is defined as the choice not to go to their workplace in spite of the workers' perceived health status. Other factors which also affects the absenteeism of workers will be further discussed in the thesis, and well as how to manage these obstacles. Purpose: The study's purpose is based on job satisfaction, commitment and attitudes to determine whether there are similarities and differences between the two departments absence at a major engineering plant. Therefore, workers' perception of job satisfaction, commitment and attitudes of their work will be examined. Method: A survey of has been conducted by asking 175 workers in a major engineering plant, which is the basis for this study's collected data. Results: The study shows that psychological ownership has proven to be able to explain workers sick leave in engineering industries. This provides an explanation for workers’ job satisfaction, commitment and attitudes. Workers with a high degree of psychological ownership tend to show more pride on what they produce, have a higher loyalty to the organization as well as a higher organization identification, which is linked to lower absenteeism. The study’s contribution also demonstrates the factors of job satisfaction, commitment, and of attitudes impact on worker absenteeism at major engineering industries. The results of this study can be used by managers and leaders within larger engineering industries, as psychological ownership has been shown to provide some explanation for worker absenteeism when the feeling of ownership affect workers’ job satisfaction, commitment and attitudes.

Chronically depressed mood and cancer risk in older persons

Background: Depression has been proposed as a predisposing factor for cancer, but prospective studies have been inconclusive. We examined whether a high level of depressive symptoms, present for a long time, is associated with increased risk of cancer in the elderly. Methods: Data were obtained and analyzed from persons who lived in three communities (Massachusetts, Iowa, and Connecticut) of the Established Populations for Epidemiologic Studies of the Elderly, a prospective cohort study with a mean follow-up of 3.8 years that included 4825 persons (1708 men and 3117 women) aged 71 years and older. Chronically depressed mood was defined as present when the number of depressive symptoms exceeded specific cut points on the Center for Epidemiologic Studies-Depression scale at baseline (1988) and 3 and 6 years before baseline. New cases of cancer were identified from Medicare hospitalization records and death certificates. Results: Of the 4825 persons studied, 146 (3.0%) were chronically depressed. The incidence rate of cancer was 30.5 per 1000 person-years for the 146 persons with chronic depression and 21.9 per 1000 person-years for the 4679 nonchronically depressed persons. After adjustment for age, sex, race, disability, hospital admissions, alcohol intake, and smoking, the hazard ratio for cancer associated with chronically depressed mood was 1.88 (95% confidence interval = 1.13-3.14). The excess risk of cancer associated with chronic depression was consistent for most types of cancer and was not specific to cigarette smokers. Conclusion: When present for at least 6 years, depression was associated with a generally increased risk of cancer

Gut metabolome and microbiota signatures predict response to treatment with exclusive enteral nutrition in a prospective study in children with active Crohn’s disease

BackgroundPredicting response to exclusive enteral nutrition (EEN) in active Crohn’s disease (CD) could lead to therapy personalization and pretreatment optimization.ObjectivesThis study aimed to explore the ability of pretreatment parameters to predict fecal calprotectin (FCal) levels at EEN completion in a prospective study in children with CD.MethodsIn children with active CD, clinical parameters, dietary intake, cytokines, inflammation-related blood proteomics, and diet-related metabolites, metabolomics and microbiota in feces, were measured before initiation of 8 wk of EEN. Prediction of FCal levels at EEN completion was performed using machine learning. Data are presented with medians (IQR).ResultsOf 37 patients recruited, 15 responded (FCal < 250 μg/g) to EEN (responders) and 22 did not (nonresponders). Clinical and immunological parameters were not associated with response to EEN. Responders had lesser (μmol/g) butyrate [responders: 13.2 (8.63–18.4) compared with nonresponders: 22.3 (12.0–32.0); P = 0.03], acetate [responders: 49.9 (46.4–68.4) compared with nonresponders: 70.4 (57.0–95.5); P = 0.027], phenylacetate [responders: 0.175 (0.013–0.611) compared with nonresponders: 0.943 (0.438–1.35); P = 0.021], and a higher microbiota richness [315 (269–347) compared with nonresponders: 243 (205–297); P = 0.015] in feces than nonresponders. Responders consumed (portions/1000 kcal/d) more confectionery products [responders: 0.55 (0.38–0.72) compared with nonresponders: 0.19 (0.01–0.38); P = 0.045]. A multicomponent model using fecal parameters, dietary data, and clinical and immunological parameters predicted response to EEN with 78% accuracy (sensitivity: 80%; specificity: 77%; positive predictive value: 71%; negative predictive value: 85%). Higher taxon abundance from Ruminococcaceae, Lachnospiraceae, and Bacteroides and phenylacetate, butyrate, and acetate were the most influential variables in predicting lack of response to EEN.ConclusionsWe identify microbial signals and diet-related metabolites in feces, which could comprise targets for pretreatment optimization and personalized nutritional therapy in pediatric CD

Characteristics of nondisabled older persons who perform poorly in objective tests of lower extremity function

OBJECTIVES: It has been suggested that nondisabled older persons with poor performance of lower extremity function are ideal targets for interventions of disability prevention. However, health-related factors associated with poor performance are largely unknown. Using data from a representative sample of nondisabled older persons, this study identifies the diseases and biological markers that characterize this group of the population. DESIGN AND PARTICIPANTS: A total of 3381 persons aged 71 or older, interviewed and administered a battery of physical performance tests at the sixth annual follow-up of the Established Populations for Epidemiologic Studies of the Elderly (EPESE), who reported no need for help in walking 1/4 mile or climbing stairs. MEASUREMENTS: Lower extremity performance was measured using a short battery of tests including assessment of standing balance, a timed 2.4-m walk, and timed test of rising 5 times from a chair. Chronic conditions were ascertained as self-report of a physician diagnosis. Data on previous hospitalizations were obtained from the Medicare data-base. Nonfasting blood samples were obtained and processed with standard methods. RESULTS: In a multivariate analysis, older age, female gender, higher BMI, history of hip fracture and diabetes, one or more hospital admissions for acute infection in the last 3 years, lower levels of hemoglobin and albumin, and higher leukocytes and γ-glutamyl transferase were all associated independently with poor performance. CONCLUSIONS: Screening for older patients who are not disabled but have poor lower extremity performance selects a subgroup of the population with a high percentage of women, high prevalence of diabetes and hip fracture, and high levels of biological markers of inflammation. This group represents about 10% of the US population 70 to 90 years old. These findings should be considered in planning specifically tailored interventions for disability prevention in this subgroup