645 research outputs found
Addressing Exercise Education in Clinton County, NY
In Clinton County, NY residents state that obesity, chronic disease, physical inactivity and low wages are top concerns. Many of these identified problems are tightly integrated and exacerbated by a lack of exercise education in this population. To address this, an exercise education pamphlet was created to be distributed to individuals in the community. The pamphlet focuses on discussing barriers such as time and cost of exercise, as well as enabling individuals with stretching information and local resources.https://scholarworks.uvm.edu/fmclerk/1409/thumbnail.jp
Needs Assessment of Suicide Prevention in Vermont Middle and High Schools
Introduction. Adolescent suicide is epidemic. 17% of high school students con- sidered suicide and 8% attempting to take their lives in 2015 nationwide. Vermont has seen a 2% increase within the last two years according to the VT Youth Risk Behavior Survey. School is one of several settings where effective suicide interventions could take place. Previous studies have identified means prevention as an effective way to combat adolescent suicide. This study aims to identify training levels and comfort of school staff in dealing with suicidality.
Methods. A survey was emailed to all schools in Vermont covering grades 6-12. The survey addressed employee demographics, training, perception of suicide in their school, and concern regarding lethal means. Questions were multiple choice, scaled and free responses. Data was analyzed using SPSS and free responses were organized using thematic content analysis.
Results. 126 responses represented 46% of Vermont middle and high schools. 77% agreed or strongly agreed that they felt confident in recognizing a student with suicidality. Respondents were not comfortable implementing lethal means prevention. Respondents identified early intervention and trusting communicative relationships as key to prevention, and identified lack of time, protocols, and resources as obstacles.
Discussion. Respondents identified suicidality in 2.2% of their students, com- pared to the YRBS that recognized 12% of adolescents. Survey technique may con- tribute to this discrepancy, but it is also likely that schools are failing to identify students at risk. A lack of comfort recognizing suicidality and implementing prevention techniques warrants standardized training, screening and response protocols.https://scholarworks.uvm.edu/comphp_gallery/1265/thumbnail.jp
Inflammatory Markers and Genes: Epidemiologic Studies on their Roles in Cardiovascular Disease
Established cardiovascular risk factors such as hypertension, hyperlipidemia, diabetes mellitus and
smoking do not fully explain the occurrence of cardiovascular disease; although the majority of patients
have at least one of these risk factors, a substantial proportion of cases occurs in individuals that
have none.1 As such, further insight is required into the pathophysiology of cardiovascular disease
and in factors that may identify individuals at high risk.
One of the most relevant insights in atherosclerosis of the past years is the recognition of the
role of inflammation.2 Research on inflammatory markers, both experimental and epidemiological,
has taken flight, and several of these markers have been implicated in cardiovascular disease.3 This
development was accompanied by an expansion of research on genetic variation that may influence
inflammatory processes. The field of genetics has rapidly evolved over the last years because of improved
technology and methodology in combination with the emergence of large, publicly available
genetic databases.4
The purpose of this thesis was to expand the knowledge on inflammatory markers and inflammatory
genes that may play a part in the pathophysiology of cardiovascular disease. We focused on
factors that have drawn increased attention in the recent years, such as C-reactive protein (CRP) and
lipoprotein-associated phospholipase A2 (Lp-PLA2), and examined their roles in both atherothrombotic
disease and in heart failure. Most studies were conducted within the Rotterdam Study, a population-
based cohort study among 7983 men and women aged 55 years and over living in a well-defined
suburb of Rotterdam, the Netherlands.5 During a visit of the participants to the research center, blood
was drawn in order to assess inflammatory markers and genetic variation. Several measures of atherosclerosis
were assessed at the research center, and furthermore, participants were followed-up
for the occurrence of coronary events and heart failure. Specifically, the main research questions we
examined were as follows.
With regard to inflammation, atherosclerosis and coronary events:
- Is CRP serum level associated with atherosclerosis and coronary events?
- Is variation in the CRP gene and variation in the complement factor H gene associated with coronary
events, and do these genes interact to predict disease?
- Is Lp-PLA2 activity associated with atherosclerosis?
With regard to inflammation and heart failure:
- What is the distribution of echocardiographic parameters in an asymptomatic population, and do
these parameters predict mortality?
- Are the inflammatory markers CRP and Lp-PLA2 associated with the occurrence of heart failure
Joint Models with Multiple Longitudinal Outcomes and a Time-to-Event Outcome: a Corrected Two-Stage Approach
Joint models for longitudinal and survival data have gained a lot of
attention in recent years, with the development of myriad extensions to the
basic model, including those which allow for multivariate longitudinal data,
competing risks and recurrent events. Several software packages are now also
available for their implementation. Although mathematically straightforward,
the inclusion of multiple longitudinal outcomes in the joint model remains
computationally difficult due to the large number of random effects required,
which hampers the practical application of this extension. We present a novel
approach that enables the fitting of such models with more realistic
computational times. The idea behind the approach is to split the estimation of
the joint model in two steps; estimating a multivariate mixed model for the
longitudinal outcomes, and then using the output from this model to fit the
survival submodel. So called two-stage approaches have previously been
proposed, and shown to be biased. Our approach differs from the standard
version, in that we additionally propose the application of a correction
factor, adjusting the estimates obtained such that they more closely resemble
those we would expect to find with the multivariate joint model. This
correction is based on importance sampling ideas. Simulation studies show that
this corrected-two-stage approach works satisfactorily, eliminating the bias
while maintaining substantial improvement in computational time, even in more
difficult settings.Comment: 33 pages, 7 figures and 7 tables including appendices. Accepted in
Statistics and Computin
Short-term Mortality and Postoperative Complications of Abdominal Aortic Aneurysm Repair in Obese versus Non-obese Patients
BACKGROUND: Obesity is a risk factor not only for abdominal aortic aneurysm (AAA) but also for complications after vascular surgery. This study was to determine the effect of obesity on short-term mortality and post-intervention complications after AAA repair. METHODS: A systematic review and meta-analysis were performed. A systematic search was performed in PubMed; the articles describing the differences in post-intervention complications after open or endovascular repair of an AAA between obese and non-obese patients were selected. The primary outcome was short-term mortality defined as in-hospital mortality or mortality within 30 days after AAA repair. The secondary outcomes were cardiac complications, pulmonary failure, renal failure, and wound infections. The meta-analysis was performed using OpenMeta. RESULTS: Four articles were included in the meta-analysis; these articles included 35,989 patients of which 10,917 (30.3%) were obese. The meta-analysis showed no significant differences for short-term mortality (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.69ā1.04). Also, no significant difference was found in pulmonary failure (OR, 1.09; 95% CI, 0.85ā1.42). However, obese patients were less likely to suffer from cardiac complications (OR, 0.73; 95% CI, 0.55ā0.96). Nevertheless, there was a significantly higher risk of renal failure (OR, 1.16; 95% CI, 1.05ā1.30) and wound infections (OR, 1.92; 95% CI, 1.55ā2.38) in obese patients. CONCLUSION: Obesity is not a risk factor for short-term mortality after AAA repair compared to non-obesity. Moreover, obese patients suffer less from cardiac complications than non-obese patients
Spatial QRS-T angle predicts cardiac death in a general population
AIMS: The aim of this study was to assess the prognostic importance of the
spatial QRS-T angle for fatal and non-fatal cardiac events. METHODS AND
RESULTS: Electrocardiograms (ECGs) were recorded in 6134 men and women
aged 55 years and over from the prospective population-based Rotterdam
Study. Spatial QRS-T angles were categorized as normal, borderline or
abnormal. Using Cox's proportional hazards model, abnormal angles showed
increased hazard ratios of cardiac death (age-and sex-adjusted hazard
ratio 5.2 (95% CI 4.0-6.8)), non-fatal cardiac events (2.2 (1.5-3.1)),
sudden death (5.6 (3.7-8.5)) and total mortality (2.3 (2.0-2.7)). None of
the classical cardiovascular and ECG predictors provided larger hazard
ratios. After adjustment for these predictors, the association of abnormal
spatial QRS-T angles with all fata
Distribution of echocardiographic parameters and their associations with cardiovascular risk factors in the Rotterdam Study
Insight into echocardiographic parameters in the general population may facilitate early recognition of ventricular dysfunction, reducing the population morbidity and mortality of heart failure. We examined the distribution of structural, systolic and diastolic echocardiographic parameters and their associations with cardiovascular risk factors in the Rotterdam Study, a population-based cohort study in men and women aged ā„55Ā years. Participants with prevalent heart failure, myocardial infarction and atrial fibrillation and flutter were excluded. Echocardiographic parameters were assessed using two-dimensional, M-mode and Doppler echocardiography. Echocardiograms were available in 4,425 participants. Structural parameters were generally larger in men, and most consistently associated with age, body mass index and blood pressure in both sexes. Prevalence of moderate or poor left ventricular systolic function was 3.9% in men and 2.1% in women. Age, body mass index and blood pressure were most consistently associated with systolic function. E/A ratio was lower in women than in men. Age and diastolic blood pressure were most consistently associated with E/A ratio in both sexes. In conclusion, ventricular systolic and diastolic dysfunction is present in asymptomatic individuals. Selected established cardiovascular risk factors are associated with structural, systolic and diastolic parameters
Joint models with multiple longitudinal outcomes and a time-to-event outcome: a corrected two-stage approach
Joint models for longitudinal and survival data have gained a lot of attention in recent years, with the development of myriad extensions to the basic model, including those which allow for multivariate longitudinal data, competing risks and recurrent events. Several software packages are now also available for their implementation. Although mathematically straightforward, the inclusion of multiple longitudinal outcomes in the joint model remains computationally difficult due to the large number of random effects required, which hampers the practical application of this extension. We present a novel approach that enables the fitting of such models with more realistic computational times. The idea behind the approach is to split the estimation of the joint model in two steps: estimating a multivariate mixed model for the longitudinal outcomes and then using the output from this model to fit the survival submodel. So-called two-stage approaches have previously been proposed and shown to be biased. Our approach differs from the standard version, in that we additionally propose the application of a correction factor, adjusting the estimates obtained such that they more closely resemble those we would expect to find with the multivariate joint model. This correction is based on importance sampling ideas. Simulation studies show that this corrected two-stage approach works satisfactorily, eliminating the bias while maintaining substantial improvement in computational time, even in more difficult settings
Anti-oxidized LDL antibodies and coronary artery disease: a systematic review
Antibodies to oxidized LDL (oxLDL) may be associated with improved outcomes in cardiovascular disease. However, analysis is restricted by heterogenous study design and endpoints. Our objective was to conduct a comprehensive systematic review assessing anti-oxLDL antibodies in relation to coronary artery disease (CAD). Through a systematic literature search, we identified all studies assessing the relationship of either, IgG or IgM ox-LDL/ copper-oxLDL/ malondialdehyde-LDL, with coronary atherosclerosis or cardiovascular events in populations with, and without, established CAD. Systematic review best practices were adhered to and study quality was assessed. An initial electronic database search identified 2059 records, which was subsequently followed by abstract and full-text review. Finally, we included 18 studies with over 1811 patients with CAD. The studies varied according to populations studied, conventional cardiovascular risk factors and interventional modalities used to assess CAD. IgM anti-oxLDL antibodies were found to indicate protection from more severe CAD and possibly cardiovascular events, whilst the relationship with IgG is more complex and difficult to elucidate, with studies reporting divergent results. In this systematic review, there is evidence that suggests a relationship between anti-oxLDL antibodies and CAD, especially for the IgM subclass. However, further studies, with well-characterized prospective cohorts, will be important to clarify these associations
The use of intravascular ultrasound imaging to improve use of inferior vena cava filters in a high-risk bariatric population
ObjectivePulmonary embolism is the leading cause of death after gastric bypass procedures for obesity, approximating 0.5% to 4%. All bariatric patients, but especially the super-obese, which have a body mass index (BMI) >50 kg/m2, are at significant risk for postoperative venous thromboembolism (VTE). Visualization and weight limitations of fluoroscopy tables exclude most bariatric and all super-obese patients from inferior vena cava (IVC) filter placement using fluoroscopy. Intravascular ultrasound (IVUS)-guided IVC filter placement is the only modality that allows these high-risk patients to have an IVC filter placed.MethodsHospital and outpatient records of the 494 patients who underwent gastric bypass procedures from January 1, 2004, to May 31, 2006, were reviewed. All patients who had concurrent IVC filter placement with the use of IVUS guidance were selected. Comorbidities, outcomes, and complications were recorded.ResultsWe identified 27 patients with mean BMI of 70 Ā± 3 kg/m2; of these, 25 were super-obese (BMI >50 kg/m2). Procedures included five laparoscopic and 22 open gastric bypass operations. All patients underwent concurrent IVC filter placement using IVUS guidance. In addition to super-obesity, indications for IVC filter placement included history of VTE (n = 4), known hypercoagulable state (n = 2), and profound immobility (n = 21). Mean follow up was 293 Ā± 40 days. Technical success rate was 96.3%. There were no catheter site complications. In one surviving patient, a nonfatal pulmonary embolism was detected by computed tomography 2 months postoperatively. Two patients died, and autopsy excluded VTE as the cause of death in both.ConclusionThis study suggests efficacy of IVUS-guided IVC filter placement in preventing mortality from pulmonary embolism in high-risk bariatric patients, including the super-obese. IVUS-guided IVC filter placement can be safely performed with an excellent success rate in all bariatric patients, including the super-obese, who otherwise would not be candidates for IVC filter placement due to the limitations imposed by their large body habitus
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