Zivotofsky v. Kerry: Of Passports, Politics, and Foreign Policy Powers

This commentary profiles the upcoming Supreme Court decision in Zivotofsky v. Kerry, which will decide, for the first time in United States history, the dividing line between legislative and executive authority to recognize foreign nations. Though it emanates from a seemingly-benign passport disagreement about a place-of-birth designation, this case will address an unprecedented and extremely controversial issue about separation of powers that has somehow evaded a Supreme Court decision. The Author profiles the case history and applicable legal precedent and analyzes the arguments for both sides before recommending that the Court should not find the President\u27s power in this area of foreign policy to be either supreme or exclusive

Treatment of International Human Rights Violations in the United States

INTRODUCTION: Health-related quality of life (HRQoL) in patients treated in intensive care has been reported to be lower compared with age- and sex-adjusted control groups. Our aim was to test whether stratifying for coexisting conditions would reduce observed differences in HRQoL between patients treated in the ICU and a control group from the normal population. We also wanted to characterize the ICU patients with the lowest HRQoL within these strata. METHODS: We did a cross-sectional comparison of scores of the short-form health survey (SF-36) questionnaire in a multicenter study of patients treated in the ICU (n = 780) and those from a local public health survey (n = 6,093). Analyses were in both groups adjusted for age and sex, and data stratified for coexisting conditions. Within each stratum, patients with low scores (below -2 SD of the control group) were identified and characterized. RESULTS: After adjustment, there were minor and insignificant differences in mean SF-36 scores between patients and controls. Eight (n = 18) and 22% (n = 51) of the patients had low scores (-2 SD of the control group) in the physical and mental dimensions of SF-36, respectively. Patients with low scores were usually male, single, on sick leave before admission to critical care, and survived a shorter time after being in ICU. CONCLUSIONS: After adjusting for age, sex, and coexisting conditions, mean HRQoL scores were almost equal in patients and controls. Up to 22% (n = 51) of the patients had, however, a poor quality of life as compared with the controls (-2 SD). This group, which more often consisted of single men, individuals who were on sick leave before admission to the ICU, had an increased mortality after ICU. This group should be a target for future support

Emotional support predicts more sickness absence and poorer self assessed work ability: a two-year prospective cohort study

<p>Abstract</p> <p>Background</p> <p>While back pain and stressful work environment are shown to be important causes of sickness absence the effect of psychosocial resources on sickness absence, and on self assessed work ability, is less commonly investigated. The aim of this study was to assess these associations in a two-year follow-up study.</p> <p>Methods</p> <p>341 working people aged 45 to 64, randomly drawn from the population, responded to a questionnaire at baseline and at a two-year follow-up. Poisson regression was used to analyse the association of psychosocial factors (psychosocial instruments on work environment, emotional support and psychological resources) and previous back pain (low back and/or neck) at baseline with sickness absence (spells and days) at follow-up, controlling for effects of age, sex, BMI, smoking, alcohol, occupation, disease and previous sickness absence. Logistic regression was used to study the associations of psychosocial factors and previous back pain at baseline with self assessed prognosis of poor work ability six months from follow-up. Finally, a multivariate analysis tested the independent effects of previous back pain and 3 psychosocial factors derived in a factor analysis: 1. work environment; 2. emotional support; 3. psychological resources, on work ability and absence days and spells.</p> <p>Results</p> <p>80% of the sickness absence spells within the last 12 months before follow-up were short-term (≤ 14 days). In the final model, high emotional support predicted <it>more </it>sickness absence spells (RR 1.36; 1.11-1.67) and days (RR 1.68, 1.22-2.31). Previous back pain (OR 2.56; 1.13-5.81), high emotional support (OR 1.58; 1.02-2.46), and low psychological resources (OR 0.62; 0.44-0.89) were related to <it>poorer </it>self assessed prognosis of work ability at follow up.</p> <p>Conclusions</p> <p>In a general middle aged working population high emotional support was related to more sickness absence and also poorer self assessed prognosis of work ability. Our findings suggest that both sickness absence and self assessed work ability are dependent of life outside work and can be affected by a person's close community.</p

Measuring health-related quality of life in patients with chronic obstructive pulmonary disease in a routine hospital setting: Feasibility and perceived value

BACKGROUND: Assessment of health-related quality of life is so far mainly used in specific research settings and not widely accepted in the routine care of patients. Lack of trust in accuracy and reliability and lack of knowledge concerning the questionnaires used, methods, terminology, are just some of the perceived barriers for a more widespread dissemination of these instruments into routine health care. The present study was undertaken in order to test the feasibility of a computerised system for collecting and analysing health-related quality of life in a routine clinical setting and to examine the thoughts and attitudes among physicians concerning the value of these measurements. METHODS: Seventy-four patients with chronic pulmonary lung disease were asked to assess their health-related quality of life with a computerised version of the SF-36 questionnaire before a regular the visit to a physician. The results were immediately available for the physician during the consultation for comparison of information given by the patients and the physician's evaluation of the patients overall health status. A focus group interview with the physicians was performed before and after the implementation of routine measurements of health-related quality of life. RESULTS: The systematic assessment concept worked satisfactorily. All patients approached agreed to participate and completed the assessment on the touch screen computer. A weak correlation was found between patients' self-rated health and pulmonary function and between physicians' evaluation and pulmonary function. The physicians appreciated the SF-36 assessments and the value of the patients' perspective although only a few could pinpoint new clinical decisions based upon this new information. CONCLUSION: Physicians' clinical evaluation and patients' self-rating of health status offer unique and important information that are complementary

Hopelessness the ‘active ingredient’? : associations of hopelessness and depressive symptoms with Interleukin-6.

Objective: Previous research has revealed a relationship of depressive symptoms and hopelessness with cardiovascular diseases (CVDs) which are associated with elevated levels of interleukin-6 (IL-6). The objective of this study was to explore whether depressive symptoms and hopelessness are independent predictors of IL-6 levels. Method: Hopelessness, depressive symptoms, and IL-6 were measured in 45 Swedish adults (26 women and 19 men; age range: 31-65 years). Two separated linear regressions were conducted with hopelessness and depressive symptoms serving as individual predictors of IL-6. Another regression analysis examined whether the two predictors predict IL-6 when controlling for each other. The regression coefficients of the models with one predictor and with both predictors were compared. Results: As predicted, after adjusting for age, BMI, illness, smoking, and gender, more depressive symptoms and more hopelessness predicted higher IL-6 levels in independent regressions. When controlling for each other, hopelessness, but not depressive symptoms, predicted IL-6 levels. Finally, when controlling for hopelessness, the regression between depressive symptoms and IL-6 level was significantly reduced; however, there was no significant change in the regression between hopelessness and IL-6 level when controlling for depressive symptoms. Conclusions: Thus, these results suggest that depressive symptoms and hopelessness are not independent predictors of IL-6 levels. Future research should explore the interplay of hopelessness and depressive symptoms on other risk factors of CVDs

Pronounced Diurnal Pattern of Salivary C-Reactive Protein (CRP) With Modest Associations to Circulating CRP Levels

C-reactive protein (CRP), a humoral component of the innate immune system with important functions in host-defense, is extensively used as a sensitive biomarker of systemic inflammation. During inflammation, hepatocyte-derived CRP rises dramatically in the blood due to increased interleukin-6 (IL-6) levels. Reliable detection of CRP in saliva, instead of blood, would offer advantages regarding sampling procedure and availability but using saliva as a diagnostic body fluid comes with challenges. The aims of this study were to evaluate associations between salivary CRP, total protein levels in saliva and serum CRP. Furthermore, we examined associations with plasma IL-6, body mass index (BMI), tobacco smoking and age. Salivary CRP was investigated by ELISA in 107 middle-aged participants from the general population. We employed spectrophotometric determination of total protein levels. Correlation analyses were used for associations of salivary CRP with serum CRP (turbidimetry), plasma IL-6 (Luminex®), BMI and smoking habits. Salivary median CRP was 68% higher (p=0.009), and total protein levels were 167% higher (p<0.0001), in morning compared to evening saliva. The correlation coefficients between serum and salivary CRP were low to moderate, but stronger for evening than morning saliva. Plasma IL-6 correlated significantly with serum CRP (rs=0.41, p<0.01), but not with morning or evening salivary CRP. Non-smokers showed 103% higher salivary CRP levels (p=0.015), whereas serum CRP was independent of smoking status. As opposed to CRP in serum, salivary CRP was not associated with BMI. Salivary CRP was 90% higher among the age interval 60–69 years compared to subjects aged 45–59 (p=0.02) while serum CRP levels did not differ between the age groups. In conclusion, CRP in saliva did not straightforwardly reflect serum concentrations. This raises questions regarding adequate reflection of biological events. The pronounced diurnal salivary CRP pattern accentuates the importance of standardizing the time-point of sampling

Adverse health effects of low levels of perceived control in Swedish and Russian community samples

Background: This cross-sectional study of two middle-aged community samples from Sweden and Russia examined the distribution of perceived control scores in the two populations, investigated differences in individual control items between the populations, and assessed the association between perceived control and self-rated health. Methods: The samples consisted of men and women aged 45–69 years, randomly selected from national and local population registers in southeast Sweden (n = 1007) and in Novosibirsk, Russia (n = 9231). Data were collected by structured questionnaires and clinical measures at a visit to a clinic. The questionnaire covered socioeconomic and lifestyle factors, societal circumstances, and psychosocial measures. Self-rated health was assessed by standard single question with five possible answers, with a cut-off point at the top two alternatives. Results: 32.2 % of Swedish men and women reported good health, compared to 10.3 % of Russian men and women. Levels of perceived control were also significantly lower in Russia than in Sweden and varied by socio-demographic parameters in both populations. Sub-item analysis of the control questionnaire revealed substantial differences between the populations both in the perception of control over life and over health. Logistic regression analysis revealed that the odds ratios (OR) of poor self-rated health were significantly increased in men and women with low perceived control in both countries (OR between 2.61 and 4.26). Conclusion: Although the cross-sectional design does not allow causal inference, these results support the view that perceived control influences health, and that it may mediate the link between socioeconomic hardship and health

Rationale for a Swedish cohort consortium

We herein outline the rationale for a Swedish cohort consortium, aiming to facilitate greater use of Swedish cohorts for world-class research. Coordination of all Swedish prospective population-based cohorts in a common infrastructure would enable more precise research findings and facilitate research on rare exposures and outcomes, leading to better utilization of study participants' data, better return of funders' investments, and higher benefit to patients and populations. We motivate the proposed infrastructure partly by lessons learned from a pilot study encompassing data from 21 cohorts. We envisage a standing Swedish cohort consortium that would drive development of epidemiological research methods and strengthen the Swedish as well as international epidemiological competence, community, and competitiveness.Peer reviewe

Circulating Matrix Metalloproteinase-9 Is Associated with Cardiovascular Risk Factors in a Middle-Aged Normal Population

Background: Elevated levels of circulating matrix metalloproteinase-9 (MMP-9) have been demonstrated in patients with established coronary artery disease (CAD). The aim of this study was to analyse levels of MMP-9 in a population free from symptomatic CAD and investigate their associations with cardiovascular (CV) risk factors, including C-reactive protein (CRP).   Methods: A cross-sectional study was performed in a population based random sample aged 45–69 (n = 345, 50% women). MMP-9 levels were measured in EDTA-plasma using an ELISA-method. CV risk factors were measured using questionnaires and standard laboratory methods. Results: Plasma MMP-9 was detectable in all participants, mean 38.9 ng/mL (SD 22.1 ng/mL). Among individuals without reported symptomatic CAD a positive association (p&lt;0.001) was seen, for both men and women, of MMP-9 levels regarding total risk load of eight CV risk factors i.e. blood pressure, dyslipidemia, diabetes, obesity, smoking, alcohol intake, physical activity and fruit and vegetable intake. The association was significant also after adjustment for CRP, and was not driven by a single risk factor alone. In regression models adjusted for age, sex, smoking, alcohol intake and CRP, elevated MMP-9 levels were independently positively associated with systolic blood pressure (p = 0.037), smoking (p&lt;0.001), alcohol intake (p = 0.003) and CRP (p&lt;0.001). The correlation coefficient between MMP-9 and CRP was r = 0.24 (p&lt;0.001).   Conclusions: In a population without reported symptomatic CAD, MMP-9 levels were associated with total CV risk load as well as with single risk factors. This was found also after adjustment for CRP  Original Publication: Peter Garvin, Lennart Nilsson, John Carstensen, Lena Jonasson and Margareta Kristenson, Circulating Matrix Metalloproteinase-9 Is Associated with Cardiovascular Risk Factors in a Middle-Aged Normal Population, 2008, PLoS ONE, (3), 3, e1774. http://dx.doi.org/10.1371/journal.pone.0001774 Licensee: Public Library of Science (PLoS) http://www.plos.org/</p