716 research outputs found
Bone mineral density and risk of heart failure in older adults: The Cardiovascular Health Study
Background
Despite increasing evidence of a common link between bone and heart health, the relationship between bone mineral density (
BMD
) and heart failure (
HF
) risk remains insufficiently studied.
Methods and Results
We investigated whether
BMD
measured by dualâenergy xâray absorptiometry was associated with incident
HF
in an older cohort. Cox models were stratified by sex and interactions of
BMD
with race assessed.
BMD
was examined at the total hip and femoral neck separately, both continuously and by World Health Organization categories. Of 1250 participants, 442 (55% women) developed
HF
during the median followâup of 10.5Â years. In both black and nonblack women, neither total hip nor femoral neck
BMD
was significantly associated with
HF
; there was no significant interaction by race. In black and nonblack men, total hip, but not femoral neck,
BMD
was significantly associated with
HF
, with evidence of an interaction by race. In nonblack men, lower total hip
BMD
was associated with higher
HF
risk (hazard ratio, 1.13 [95% CI, 1.01â1.26] per 0.1Â g/cm
2
decrement), whereas in black men, lower total hip
BMD
was associated with lower
HF
risk (hazard ratio, 0.74 [95% CI, 0.59â0.94]). There were no black men with total hip osteoporosis. Among nonblack men, total hip osteoporosis was associated with higher
HF
risk (hazard ratio, 2.83 [95% CI, 1.39â5.74]) compared with normal
BMD
.
Conclusions
Among older adults, lower total hip
BMD
was associated with higher
HF
risk in nonblack men but lower risk in black men, with no evidence of an association in women. Further research is needed to replicate these findings and to study potential underlying pathways.
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Survival following parathyroidectomy among United States dialysis patients
Survival following parathyroidectomy among United States dialysis patients.BackgroundSecondary hyperparathyroidism (SHPTH) is highly prevalent among persons with end-stage renal disease (ESRD). SHPTH has been linked to uremic bone disease, vascular calcification, and a higher risk of death. Parathyroidectomy (PTX) can dramatically reduce parathyroid hormone (PTH) and phosphate levels; however, the relationship between PTX and survival is not known.MethodsWe conducted an observational matched cohort study utilizing data from the United States Renal Database System (USRDS) in which 4558 patients undergoing a first PTX while on hemodialysis or peritoneal dialysis were individually matched by age, race, gender, cause of ESRD, dialysis duration, prior transplantation status, and dialysis modality to 4558 control patients who did not undergo PTX. Patients were followed from the date of PTX until they died or were lost to follow-up.ResultsThe 30-day postoperative mortality rate following PTX was 3.1%. Long-term relative risks of death among patients undergoing PTX were estimated to be 10% to 15% lower than those of matched control patients not undergoing surgery. Survival curves between the 2 groups crossed 587 days following PTX. Median survival was 53.4 months (95% CI: 51.2â56.4) in the PTX group, and 46.8 months (95% CI: 44.7â48.9) in the control group.ConclusionPTX was associated with higher short-term, and lower long-term, mortality rates among U.S. patients receiving chronic dialysis. Measures to attenuate SHPTH may play an important role in reducing mortality among patients with end-stage renal disease
Vitamin D and the risk of dementia and Alzheimer disease
OBJECTIVE: To determine whether low vitamin D concentrations are associated with an increased risk of incident all-cause dementia and Alzheimer disease. METHODS: One thousand six hundred fifty-eight elderly ambulatory adults free from dementia, cardiovascular disease, and stroke who participated in the US population-based Cardiovascular Health Study between 1992-1993 and 1999 were included. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were determined by liquid chromatography-tandem mass spectrometry from blood samples collected in 1992-1993. Incident all-cause dementia and Alzheimer disease status were assessed during follow-up using National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association criteria. RESULTS: During a mean follow-up of 5.6 years, 171 participants developed all-cause dementia, including 102 cases of Alzheimer disease. Using Cox proportional hazards models, the multivariate adjusted hazard ratios (95% confidence interval [CI]) for incident all-cause dementia in participants who were severely 25(OH)D deficient (<25 nmol/L) and deficient (â„25 to <50 nmol/L) were 2.25 (95% CI: 1.23-4.13) and 1.53 (95% CI: 1.06-2.21) compared to participants with sufficient concentrations (â„50 nmol/L). The multivariate adjusted hazard ratios for incident Alzheimer disease in participants who were severely 25(OH)D deficient and deficient compared to participants with sufficient concentrations were 2.22 (95% CI: 1.02-4.83) and 1.69 (95% CI: 1.06-2.69). In multivariate adjusted penalized smoothing spline plots, the risk of all-cause dementia and Alzheimer disease markedly increased below a threshold of 50 nmol/L. CONCLUSION: Our results confirm that vitamin D deficiency is associated with a substantially increased risk of all-cause dementia and Alzheimer disease. This adds to the ongoing debate about the role of vitamin D in nonskeletal conditions.National Heart, Lung, and Blood InstituteNational Institute of Neurological Disorders and StrokeNational Institute on AgingAlzheimer's AssociationMary Kinross Charitable TrustJames Tudor FoundationHalpin TrustAge Related Diseases and Health TrustNorman Family Charitable TrustUK National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsul
O2â03â02: Vitamin D and the risk of developing neuroimaging abnormalities
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152624/1/alzjjalz201507143.pd
Dietary Phosphorus, Blood Pressure, and Incidence of Hypertension in the Atherosclerosis Risk in Communities Study and the Multi-Ethnic Study of Atherosclerosis
Greater phosphorus intake has been associated with lower levels of blood pressure in cross-sectional studies. This association, however, has not been assessed prospectively. We studied 13444 participants from the Atherosclerosis Risk in Communities cohort and the Multi-Ethnic Study of Atherosclerosis, with diet assessed at baseline using validated food frequency questionnaires. Blood pressure and use of antihypertensive medication were determined at baseline and during follow-up visits. Compared to individuals in the lowest quintile of phosphorus intake at baseline, those in the highest quintile had lower baseline systolic and diastolic blood pressure after adjustment for dietary and non-dietary confounders (â2.0 mmHg, 95% confidence interval â3.6, â0.5; p for trend=0.01; and â0.6, 95% confidence interval â1.6, +0.3, p for trend=0.20, respectively). During an average 6.2 years of follow-up, 3345 cases of hypertension were identified. Phosphorus intake was associated with the risk of hypertension (hazard ratio 0.80, 95% confidence interval 0.80-1.00, comparing extreme quintiles; p for trend=0.02) after adjustment for non-dietary factors, but not after additional adjustment for dietary variables (hazard ratio 1.01, 95% confidence interval 0.82-1.23, p for trend=0.88). Phosphorus from dairy products but not from other sources was associated with lower baseline blood pressure and reduced risk of incident hypertension. Hazard ratios (95% confidence interval) comparing extreme quintiles were 0.86 (0.76-0.97), p for trend=0.01, for phosphorus from dairy foods and 1.04 (0.93-1.17), p for trend=0.48, for phosphorus from other foods. These findings could indicate an effect of phosphorus in conjunction with other dairy constituents or of dairy itself without involvement of phosphorus
Seeking Clarity within Cloudy Effluents: Differentiating Fungal from Bacterial Peritonitis in Peritoneal Dialysis Patients
Fungal peritonitis is a serious complication of peritoneal dialysis (PD) therapy with the majority of patients ceasing PD permanently. The aims of this study were to identify risk factors and clinical associations that may discriminate between fungal from bacterial peritonitis.We retrospectively identified episodes of fungal peritonitis from 2001-2010 in PD patients at Liverpool and Westmead Hospitals (Australia). Fungal peritonitis cases were matched in a 1:2 ratio with patients with bacterial peritonitis from each institution's dialysis registry, occurring closest in time to the fungal episode. Patient demographic, clinical and outcome data were obtained from the medical records.Thirty-nine episodes of fungal peritonitis (rate of 0.02 episodes per patient-year of dialysis) were matched with 78 episodes of bacterial peritonitis. Candida species were the commonest pathogens (35/39; 90% episodes) with Candida albicans (37%), Candida parapsilosis (32%) and Candida glabrata (13%) the most frequently isolated species. Compared to bacterial peritonitis, fungal peritonitis patients had received PD for significantly longer (1133 vs. 775 catheter-days; pâ=â0.016), were more likely to have had previous episodes of bacterial peritonitis (51% vs. 10%; pâ=â0.01), and to have received prior antibacterial therapy (51% vs. 10%; pâ=â0.01). Patients with fungal peritonitis were less likely to have fever and abdominal pain on presentation, but had higher rates of PD catheter removal (79% vs. 22%; p<0.005), and permanent transfer to haemodialysis (87% vs. 24%; p<0.005). Hospital length of stay was significantly longer in patients with fungal peritonitis (26.1 days vs. 12.6 days; pâ=â0.017), but the all-cause 30-day mortality rate was similar in both groups. Fluconazole was a suitable empiric antifungal agent; with no Candida resistance detected.Prompt recognition of clinical risk factors, initiation of antifungal therapy and removal of PD catheters are key considerations in optimising outcomes
Predicting prescribed magnification
Aim: To determine the best method of estimating the optimum magnification needed by visually impaired patients. Methods: The magnification of low vision aids prescribed to 187 presbyopic visually impaired patients for reading newspapers or books was compared with logMAR distance and near acuity (at 25 cm) and magnification predicted by +4 D step near additions. Results: Distance letter (r = 0.58) and near word visual acuity (r = 0.67) were strongly correlated to the prescribed magnification as were predictive formulae based on these measures. Prediction using the effect of proximal magnification resulted in a similar correlation (r = 0.67) and prediction was poorer in those who did not benefit from proximal magnification. The difference between prescribed and predicted magnification was found to be unrelated to the condition causing visual impairment (F = 2.57, p = 0.08), the central visual field status (F = 0.57, p = 0.57) and patient psychology (F = 0.44, p = 0.51), but was higher in those prescribed stand magnifiers than high near additions (F = 5.99, p < 0.01). Conclusions: The magnification necessary to perform normal visual tasks can be predicted in the majority of cases using visual acuity measures, although measuring the effect of proximal magnification demonstrates the effect of stronger glasses and identifies those in whom prescribed magnification is more difficult to predict
Observation of Hadronic W Decays in t-tbar Events with the Collider Detector at Fermilab
We observe hadronic W decays in t-tbar -> W (-> l nu) + >= 4 jet events using
a 109 pb-1 data sample of p-pbar collisions at sqrt{s} = 1.8 TeV collected with
the Collider Detector at Fermilab (CDF). A peak in the dijet invariant mass
distribution is obtained that is consistent with W decay and inconsistent with
the background prediction by 3.3 standard deviations. From this peak we measure
the W mass to be 77.2 +- 4.6 (stat+syst) GeV/c^2. This result demonstrates the
presence of two W bosons in t-tbar candidates in the W (-> l nu) + >= 4 jet
channel.Comment: 20 pages, 4 figures, submitted to PR
Search for Chargino-Neutralino Associated Production at the Fermilab Tevatron Collider
We have searched in collisions at = 1.8 TeV for events
with three charged leptons and missing transverse energy. In the Minimal
Supersymmetric Standard Model, we expect trilepton events from
chargino-neutralino (\chione \chitwo) pair production, with subsequent decay
into leptons. We observe no candidate , ,
or events in 106 pb integrated
luminosity. We present limits on the sum of the branching ratios times cross
section for the four channels: \sigma_{\chione\chitwo}\cdot
BR(\chione\chitwo\to 3\ell+X) 81.5 \mgev\sp and
M_\chitwo > 82.2 \mgev\sp for , ~\mgev\sp and
M_\squark= M_\gluino.Comment: 9 pages and 3 figure
Search for charged Higgs decays of the top quark using hadronic tau decays
We present the result of a search for charged Higgs decays of the top quark,
produced in collisions at 1.8 TeV. When the charged
Higgs is heavy and decays to a tau lepton, which subsequently decays
hadronically, the resulting events have a unique signature: large missing
transverse energy and the low-charged-multiplicity tau. Data collected in the
period 1992-1993 at the Collider Detector at Fermilab, corresponding to
18.70.7~pb, exclude new regions of combined top quark and charged
Higgs mass, in extensions to the standard model with two Higgs doublets.Comment: uuencoded, gzipped tar file of LaTeX and 6 Postscript figures; 11 pp;
submitted to Phys. Rev.
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