128 research outputs found
Impact of Dental Diseases on Quality-Adjusted Life Expectancy in US Adults
Comparing the burden of dental conditions to other health outcomes provides useful insight for public policy. We aimed to estimate quality-adjusted life expectancy (QALE) loss due to dental conditions in the US adult population. Social inequalities in QALE loss by dental conditions were also examined. Data from 3 cross-sectional waves of the National Health and Nutrition Examination Survey (NHANES waves 2001 to 2002, 2003 to 2004, and 2011 to 2012) were pooled and analyzed. The average age of study participants (n = 9,445) was 48.4 y. Disutility scores were derived from self-rated health and the numbers of physically unhealthy days, mentally unhealthy days, and days with activity limitation, employing a previously published algorithm. The associations between the disutility scores and the numbers of decayed teeth, missing teeth, and periodontitis were examined by multiple linear regression stratified by age groups (20–39, 40–59, and ≥60 y), adjusted for other covariates (age, sex, wave fixed effect, educational attainment, smoking, and diabetes). The QALE loss due to dental conditions at the age of 20 was estimated using life tables. Decayed and missing teeth, but not periodontitis, were associated with a larger disutility score. The coefficient for decayed teeth was larger among the older population, whereas that of missing teeth was smaller among them. The estimated QALE loss was 0.43 y (95% confidence interval [CI], 0.28–0.59), which reached 5.3% of QALE loss (8.15 y; 95% CI, 8.03–8.27) due to overall morbidity. There were clear social gradients in QALE loss by dental conditions across the life course, and people with high school or less education had 0.32 y larger QALE loss in total compared with people with college or more education. This study suggests that improvements in people’s dental health may yield substantial gains in population health and well-being. The necessity of more comprehensive public health strategies is highlighted
Study protocol; Thyroid hormone Replacement for Untreated older adults with Subclinical hypothyroidism - a randomised placebo controlled Trial (TRUST).
Subclinical hypothyroidism (SCH) is a common condition in elderly people, defined as elevated serum thyroid-stimulating hormone (TSH) with normal circulating free thyroxine (fT4). Evidence is lacking about the effect of thyroid hormone treatment. We describe the protocol of a large randomised controlled trial (RCT) of Levothyroxine treatment for SCH.
Participants are community-dwelling subjects aged ≥65 years with SCH, diagnosed by elevated TSH levels (≥4.6 and ≤19.9 mU/L) on a minimum of two measures ≥ three months apart, with fT4 levels within laboratory reference range. The study is a randomised double-blind placebo-controlled parallel group trial, starting with levothyroxine 50 micrograms daily (25 micrograms in subjects <50Kg body weight or known coronary heart disease) with titration of dose in the active treatment group according to TSH level, and a mock titration in the placebo group. The primary outcomes are changes in two domains (hypothyroid symptoms and fatigue / vitality) on the thyroid-related quality of life questionnaire (ThyPRO) at one year. The study has 80% power (at p = 0.025, 2-tailed) to detect a change with levothyroxine treatment of 3.0% on the hypothyroid scale and 4.1% on the fatigue / vitality scale with a total target sample size of 750 patients. Secondary outcomes include general health-related quality of life (EuroQol), fatal and non-fatal cardiovascular events, handgrip strength, executive cognitive function (Letter Digit Coding Test), basic and instrumental activities of daily living, haemoglobin, blood pressure, weight, body mass index and waist circumference. Patients are monitored for specific adverse events of interest including incident atrial fibrillation, heart failure and bone fracture.
This large multicentre RCT of levothyroxine treatment of subclinical hypothyroidism is powered to detect clinically relevant change in symptoms / quality of life and is likely to be highly influential in guiding treatment of this common condition.
Clinicaltrials.gov NCT01660126 ; registered 8th June 2012
Recommended from our members
Power-crowbar impacts on plasma characteristics in ZT-40
Detailed analysis of the impact of I/sub phi/ and I/sub theta/ power crowbars on the ZT-40 plasma is presented for the operational period between shots 1620-3600. It is demonstrated that in both aided- and self-reversed modes the main effect of the I/sub phi/ power crowbar is to lengthen the time to l/e of peak current, whereas the main effect of the I/sub theta/ power crowbar is to extend the reversal of B/sub phi/ at the wall, primarily in self-reversed operation. It is shown that this extension has the effect of also decreasing the current decay rate to the point where no distinction is seen between the two modes. A saturation is seen in the decay time (tau/sub l/e/ less than or equal to 0.4 ms) once the field reversal in either mode exceeds approximately 0.3 ms. Possible physical explanations of these effects are discussed
Recommended from our members
Radially resolved emission spectroscopy on ZT-40M
Measurements of line integrated emission profiles of D/sub ..beta../, OIII, OV, OVI, and CV line radiation have been performed in the ZT-40M device at Los Alamos National Laboratory. The behavior of these emission profiles will be presented for several operating currents, fill pressures, and current risetimes. The basic oxygen radial structures are seen to resemble an onion skin at any particular time, with OIII farthest out in radius and OVI nearest the axis, as one would expect in the absence of any anomalous heating mechanisms (such as thermal instabilities). The rate at which the various lines occur during several different current level discharges appears to be consistent with increased losses for increased I/sub phi/ during the early phases of heating (up to OVI), while the later stages are consistent with a much lower energy loss and a heating rate proportional to I/sup 2/. Evidence of enhanced wall interaction in the latter stages of the discharge is presented
Recommended from our members
Spatially resolved spectrometer system for the ZT-40 device
A spatially resolved emission spectroscopy system designed for use on the ZT-40 device at the Los Alamos National Laboratory is described. The three-chord system consists of independent dispersive elements and detectors for each chord, on a common wavelength drive. The system has been installed and is currently in use on ZT-40. Preliminary results of CV (227.1 nm) line radiation measurements are presented
Recommended from our members
An overview of the long pulse experiment
Simple one dimensional models of laser generated impulse for pulse lengths up to about 1 ms have shown a trend to higher coupling efficiency for fixed fluence at longer pulse lengths. This would lead to more efficient use of the available laser energy in a real defensive system. An experiment was conducted at KMS Fusion, Inc. during the period 2-26 September 1986 using the 1.054 micrometer wavelength Chroma laser. This experiment was designed to enable a detailed comparison between the calculational tools and measurable quantities such as the pulse length dependence of impulse generation efficiency. In particular, targets were designed to distinguish between impulse generated directly by the laser-solid interaction, and that component due to secondary coupling processes such as lateral reradiation from the hot plasma layer in front of the target, and pressure from plasma expansion along the target surface. (DWL
Recommended from our members
Plasma-current fluctuations and decay-rate behavior in the ZT-40 device
A detailed examination of the behavior of the fluctuations of dI/sub plasma//dt in the ZT-40 device over 2500 shots is presented. Historical variations in these fluctuations are discussed along with several possible explanations of these variations. The dependence of these fluctuations on fill pressure, B/sub phi/ at the wall, and the relation of these I/sub phi/ fluctuations to the decay of the plasma current are examined. A physical picture consistent with the observed data is presented to explain the relation between the current decay and fluctuations, and the dependence of the fluctuations on B/sub phi/ wall
Effects of blockage of urine and/or bile flow on diflunisal conjugation and disposition in rats
1. The effects of surgical blockage of either or both of the urinary and biliary excretion routes on the elimination of diflunisal (DF) and its conjugates were investigated in pentobarbitone-anaesthetized rats given DF at 10mg/kg i.v. 2. In control animals the acyl glucuronide and phenolic glucuronide conjugates were excreted predominantly in bile, whereas the sulphate conjugate was eliminated almost exclusively in urine. 3. Bilateral ureter ligation had little effect on DF elimination, except for accumulation of the sulphate conjugate in plasma. Compensatory biliary excretion did not occur. 4. Total plasma clearance of DF decreased from 1.01 to 0.68 ml/min per kg following bile duct ligation. Plasma concentrations and urinary excretion of the glucuronides were elevated. 5. In rats with blockage of both urinary and biliary excretion routes, total plasma clearance of DF decreased to 0.59 ml/min per kg. Both the sulphate and phenolic glucuronide conjugates accumulated in plasma, whereas the acyl glucuronide peaked at 30 min and then declined in parallel with DF. The latter result indicates systemic instability of DF acyl glucuronide with hydrolytic regeneration of DF as the likely major consequence
- …