Genetic Sharing with Cardiovascular Disease Risk Factors and Diabetes Reveals Novel Bone Mineral Density Loci.

Bone Mineral Density (BMD) is a highly heritable trait, but genome-wide association studies have identified few genetic risk factors. Epidemiological studies suggest associations between BMD and several traits and diseases, but the nature of the suggestive comorbidity is still unknown. We used a novel genetic pleiotropy-informed conditional False Discovery Rate (FDR) method to identify single nucleotide polymorphisms (SNPs) associated with BMD by leveraging cardiovascular disease (CVD) associated disorders and metabolic traits. By conditioning on SNPs associated with the CVD-related phenotypes, type 1 diabetes, type 2 diabetes, systolic blood pressure, diastolic blood pressure, high density lipoprotein, low density lipoprotein, triglycerides and waist hip ratio, we identified 65 novel independent BMD loci (26 with femoral neck BMD and 47 with lumbar spine BMD) at conditional FDR < 0.01. Many of the loci were confirmed in genetic expression studies. Genes validated at the mRNA levels were characteristic for the osteoblast/osteocyte lineage, Wnt signaling pathway and bone metabolism. The results provide new insight into genetic mechanisms of variability in BMD, and a better understanding of the genetic underpinnings of clinical comorbidity

Do Not-For-Profits Make a Difference in Social Services? A Survey Study

firm organisation,, legal status,, non-profit organisations,, public enterprise, L22, L3,

SPECIALIZATION OF NURSING HOME CARE AND OUTCOMES -super-1

Implications of nursing home specialization for health outcomes were examined. The formal hypothesis tested in this study was that facilities specializing in the treatment of certain kinds of residents, as reflected in a critical mass of such residents, are more likely to experience better health outcomes over time compared to facilities that do not specialize in the treatment of such residents. Activities of Daily Living (ADLs), survival, and several diagnosis-specific outcomes were analyzed for residents. Multivariate state-dependence and logistic regression models were estimated for residents of six diagnostic sub-groups. Specialization was empirically defined in terms of concentration of residents with certain diagnoses within nursing facilities. Empirical results indicate that specialization has some positive effects on some outcomes. For instance, facilities specializing in the care of Alzheimer's disease patients appear to produce comparatively better outcomes with respect to restraint use and accidents. Residents with diagnoses of hypertension or ischemic heart disease in specialized facilities also fare better in terms of survival. Residents with a diagnosis of cerebrovascular disease in specialized facilities were found to experience worse outcomes with respect to most of the outcomes modeled in this study, however. Overall, specialization only appears to make a difference in the outcomes of residents with certain medical conditions for some health outcomes. Regression results also indicate that basic measures of frailty such as functional deficiencies, incontinence, and behavioral problems largely contribute to detrimental effects irrespective of the diagnostic group or the outcome considered. Copyright 2000 by The Policy Studies Organization.