bluuebunny/crossref_metadata_2025_split huggingface dataset:
The metabolic syndrome and coronary heart disease in older women: findings from the British Women's Heart and Health Study
Authors: Lawlor D. A. , Ebrahim S. , Davey Smith G. 
Published: July 2004

AbstractAims  To compare two proposed definitions of the metabolic syndrome and to determine the clinical importance of the syndrome with respect to its association with coronary heart disease (CHD).Methods  Cross‐sectional study of 3770 women aged 60–79 years randomly selected from 23 British towns.Results  The prevalence of the metabolic syndrome was high in this population and similar with both definitions: 28.2% (95% confidence interval 26.8, 29.7%) of the women had metabolic syndrome according to a modified version of the WHO definition, and 29.2% (27.7, 30.7%) had the ATP III‐defined syndrome. There was reasonable agreement between the two definitions, with 79% of the participants being similarly classified by both definitions. The syndrome was associated with prevalent CHD, with the magnitude of the association with CHD being similar for both definitions. The odds ratio (95% confidence interval) for the age, smoking, physical activity, adult and childhood social class adjusted association of the WHO defined syndrome with prevalent CHD was 1.45 (1.19, 1.75) and for the ATP III‐defined syndrome was 1.53 (1.27, 1.85). Insulin resistance alone, hypertension alone and dyslipidaemia alone were all associated with CHD, with the magnitudes of these associations being similar to those for the WHO and ATP III‐defined syndrome with CHD.Conclusions  The prevalence of the metabolic syndrome is high in older British women and is associated with CHD. There is reasonable agreement between a modified version of the WHO definition and the ATP III definition of the syndrome, and both are similarly associated with CHD. Single components of the syndrome are associated with CHD to a similar magnitude as the syndrome.
Sex‐differences in prevalence of electrocardiographic left ventricular hypertrophy in Type 2 diabetes: The Casale Monferrato Study
Authors: Bruno G. , Giunti S. , Bargero G. , Ferrero S. , Pagano G. , Perin P. Cavallo 
Published: July 2004

AbstractAims  Although left ventricular hypertrophy (LVH) defined by either standard 12‐lead ECG or echocardiography strongly predicts cardiovascular mortality, its prevalence in Type 2 diabetes is largely unknown. We have assessed prevalence of ECG‐LVH and its relationship with clinical and metabolic variables in an Italian population‐based cohort of subjects with Type 2 diabetes.Methods  The study‐base was 965 (61.3%) subjects with Type 2 diabetes of the population‐based cohort living in Casale Monferrato (Italy). LVH was defined by ECG Cornell voltage‐duration product. All measurements were centralized.Results  ECG‐LVH was diagnosed in 165/965 subjects, giving a prevalence of 17.1% (95% CI 14.7–19.5). Large sex differences were found, with higher prevalence in women (23.5%, 19.9–27.0) than in men (8.4%, 5.6–11.0), even after adjustment for age, BMI and hypertension (OR 3.83, 95% CI 2.5–5.9). At the examination, subjects with ECG‐LVH were older than those without it. Similar age‐ and sex‐adjusted values of HbA1c, plasma lipids, fibrinogen, uric acid and creatinine were found in the two subgroups. No differences in prevalence of hypertension, CHD, increased QT duration or dispersion, micro‐ and macro‐albuminuria were found between subjects with ECG‐LVH and those without it. In logistic regression analysis, variables independently associated with ECG‐LVH, after age‐adjustment, were sex and diastolic blood pressure.Conclusions  This population‐based study shows: (i) a high prevalence of ECG‐LVH in Type 2 diabetic subjects; (ii) 3‐fold higher risk in women than in men, independently of age, BMI, and blood pressure; (iii) an independent association between ECG‐LVH and diastolic blood‐pressure. Screening for ECG‐LVH in diabetic subjects is therefore recommended, particularly in diabetic women.
Evaluating risk factors associated with severe hypoglycaemia in epidemiology studies—what method should we use?
Authors: Bulsara M. K. , Holman C. D. J. , Davis E. A. , Jones T. W. 
Published: July 2004

AbstractAims  To determine the most appropriate regression models to use when assessing risk factors for severe hypoglycaemia and to investigate the impact of model misspecification and its clinical implications.Methods  A total of 1229 children with Type 1 diabetes (mean age 11.7 years sd 4.1), of which 605 (49.2%) were males, were studied. Prospective assessment of severe hypoglycaemia (an event leading to loss of consciousness or seizure) was made over the 9‐year period, 1992–2001. Patients were seen every 3 months and episodes of hypoglycaemia along with clinical data were recorded. Over 70% of children never experienced a severe hypoglycaemic event. Data were analysed using the Poisson regression, negative binomial, zero‐inflated Poisson (ZIP) and zero‐inflated negative binomial (ZINB) models. The over‐dispersion and likelihood ratio statistics were calculated and the analytical methods compared.Results  The Poisson regression model did not fit the data well. The negative binomial and the zero inflated Poisson and negative binomial models fitted the data better than Poisson.Conclusions  The commonly used Poisson regression models to analyse hypoglycaemia epidemiology may lead to biased parameter estimates and incorrect determination of risk factors for hypoglycaemia. We recommend the use of the negative binomial or zero inflated models to examine any risk factors associated with severe hypoglycaemia. Careful consideration must be given to the interpretation of hypoglycaemia surveys and their analysis.
A 14‐year prospective study of autonomic nerve function in Type 1 diabetic patients: association with nephropathy
Authors: Forsén A. , Kangro M. , Sterner G. , Norrgren K. , Thorsson O. , Wollmer P. , Sundkvist G. 
Published: July 2004

AbstractAims  Prospective studies of autonomic nerve function are rare. We have followed the progression of autonomic dysfunction in relation to nephropathy over 14 years in Type 1 diabetic patients.Methods  Autonomic nerve function was assessed by heart‐rate responses to deep breathing (E/I ratio) and tilting (acceleration and brake indices) and by the postural blood pressure reaction in 58 patients, 43 of whom were reassessed after 14 years. Nephropathy was evaluated by the degree of albuminuria (albuminuria > 20 µg/min or > 0.03 g/24 h) and glomerular filtration rate (51Cr‐EDTA plasma clearance). The acceleration index had deteriorated after 7 years (P = 0.0155), whereas the E/I ratio (P = 0.0070) and the diastolic postural blood pressure reaction (P = 0.0054) had deteriorated 14 years after the baseline examination (age‐corrected values). All those with albuminuria at the third examination showed signs of autonomic neuropathy at baseline (10 of 10) compared with only nine of 22 without (P = 0.0016). Multiple regression analysis showed that the association between autonomic dysfunction and future albuminuria was due to the E/I ratio. In addition, individuals with an abnormal postural diastolic blood pressure fall (n = 7) at baseline showed a greater fall in glomerular filtration rate more than others 7–14 years later [29 (16.5) ml/min/1.72 m2 vs. 11 (9) ml/min/1.72 m2; P = 0.0074].Conclusion  Autonomic nerve function had deteriorated after 14 years. Autonomic neuropathy and abnormal postural diastolic blood pressure falls at baseline were associated with future renal complications.
Association of aldose reductase gene Z+2 polymorphism with reduced susceptibility to diabetic nephropathy in Caucasian Type 1 diabetic patients
Authors: Lajer M. , Tarnow L. , Fleckner J. , Hansen B. V. , Edwards D. G. , Parving H‐H. , Boel E. 
Published: July 2004

AbstractAims  The Z−2 allele of the (AC)n polymorphism in the aldose reductase gene (ALR2) confers increased risk of microvascular diabetic complications, whereas the Z+2 allele has been proposed to be a marker of protection. However data are conflicting. Therefore, we investigated whether this polymorphism is associated with diabetic nephropathy and retinopathy in Type 1 diabetes mellitus in a large case–control study and a family‐based analysis.Methods  A total of 431 Type 1 diabetic patients with diabetic nephropathy and 468 patients with longstanding Type 1 diabetes and persistent normoalbuminuria were genotyped for the case–control study. In addition, 102 case trios and 98 control trios were genotyped for a family‐based study.Results  Thirteen different alleles were identified. In the case–control study, the Z+2 allele frequency was significantly higher in the normoalbuminuric diabetic than in patients with diabetic nephropathy (0.17 vs. 0.11, P = 0.008), suggesting a protective function of the Z+2 allele. No significant increase in the frequency of the putative risk allele Z−2 was found in patients with diabetic nephropathy vs. controls (0.39 vs. 0.36). No association with diabetic retinopathy was found. Although the results of the transmission of the Z−2 and Z+2 alleles in the independent family‐based study were consistent with the association study, the number of informative families was limited and thus differences were not statistically significant.Conclusions  The Z+2 allele of the ALR2 promoter polymorphism is associated with a reduced susceptibility to diabetic nephropathy in Danish Type 1 diabetic patients, suggesting a minor role for the polyol pathway in the pathogenesis of diabetic kidney disease. No association of the ALR2 polymorphism with diabetic retinopathy was found.
Thiazolidinediones and congestive heart failure—exacerbation or new onset of left ventricular dysfunction?
Authors: Srivastava P. M. , Calafiore P. , MacIsaac R. J. , Hare D. L. , Jerums G. , Burrell L. M. 
Published: July 2004

AbstractBackground  Patients with diabetes mellitus have a high incidence of coronary heart disease and congestive heart failure (CHF). Thiazolidinediones (TZD) are a new class of pharmacological agents for the treatment of Type 2 diabetes mellitus, which have many beneficial cardiovascular effects. Peripheral oedema and weight gain have been reported in 4.8% of subjects on TZDs alone, with a higher incidence noted in those receiving combination insulin therapy (up to 15%), but there is limited data on the occurrence of CHF.Methods and results  In this paper, we report on six cases of TZD‐induced fluid retention with symptoms and signs of peripheral oedema and/or CHF that occurred in subjects attending our diabetic clinic. The predominant finding in all cases was of diastolic dysfunction. All subjects were obese and hypertensive, with 5/6 having the additional risk factor of LVH, 5/6 subjects had microvascular complications, whilst 3/6 were also on insulin therapy.Conclusion  We suggest that obese, hypertensive diabetics may benefit from echocardiographic screening prior to commencement of TZDs, as these agents may exacerbate underlying undiagnosed left ventricular diastolic dysfunction.
Peer Victimization: The Role of Emotions in Adaptive and Maladaptive Coping
Authors: Kochenderfer‐Ladd Becky 
Published: July 2004

AbstractMediator models were examined in which children's emotional reactions to peer aggression were hypothesized to mediate their selection of coping strategies and subsequent peer victimization and internalizing problems. Self‐report data were collected from 145 ethnically diverse kindergarten through fifth grade children (66 females and 79 males) who attended a predominantly low‐ to middle‐class school. Hypothetical scenarios were used to assess children's anticipated responses to peer aggression. Victims reported more intense negative emotions (e.g., fear and anger) than did nonvictims. Fear emerged as a predictor of advice seeking which, in turn, predicted conflict resolution and fewer internalizing problems. Conflict resolution was associated with reductions in victimization. Anger and embarrassment predicted revenge seeking which, in turn, was associated with increases in victimization. Additional pathways predicting changes in peer victimization across a single academic year as a function of children's emotional and coping responses to peer abuse are discussed.
The Social Cognitions of Socially Withdrawn Children
Authors: Wichmann Cherami , Coplan Robert J. , Daniels Tina 
Published: July 2004

AbstractThe purpose of this study was to examine the social cognitions of peer‐identified socially withdrawn children. Participants included 457 children from grades four, five and six (54% females, 46% males). Children completed a selection of self‐ and peer‐report measures including: (1) peer‐rated behavioral nominations; (2) hostile intent biases and social responses to ambiguous situations; (3) social goals and self‐efficacy; and (4) a newly developed measure of causal attributions. An extreme groups procedure was used to identify three groups of children: (1) socially withdrawn (n=50); (2) aggressive (n=53); and (3) a comparison group (n=206). As compared with their peers, withdrawn children displayed a pattern of self‐defeating attributions for social situations, reported lower efficacy for assertive goals, and indicated a preference for non‐assertive, withdrawn strategies to deal with hypothetical conflict situations. Findings are discussed with respect to implications for interventions, and directions for further research are presented.
Methods for the analysis of bleeding outcomes in randomized trials of PLT transfusion triggers
Authors: Cook R.J. , Heddle N.M. , Rebulla P. , Sigouin C.S. , Webert K.E. ,   the Biomedical Excellence for Safer Transfusion (BEST) Working Party of the International Society for Blood Transfusion
Published: July 2004

BACKGROUND:  A number of methodologic challenges arise in the analysis of bleeding data from clinical trials of PLT transfusion triggers. It is important to understand the assumptions and role of the various methods of analysis to interpret published trials and to design future studies appropriately.STUDY DESIGN AND METHODS:  The methods of analysis used for testing the effectiveness and safety of transfusion strategies are reviewed from several recent PLT transfusion trigger trials. The underlying assumptions of these methods are discussed, as well as the clinical interpretations of the resulting summary statistics. Four methods of analysis were applied to data from a large PLT transfusion trigger study to illustrate the differences in the interpretations that can arise from various approaches.RESULTS:  PLT transfusion trigger trials of patients with leukemia have based their primary analyses on 1) simple dichotomous classifications of whether or not at least 1 day of clinically important bleeding was experienced; 2) the time to the first day of clinically important bleeding; and 3) the proportion of days at risk with clinically important bleeding. Recurrent event methods provide a robust alternative approach to the analysis of this kind of data and should be considered if interest is in capturing the overall burden of bleeding over time. These four methods differ in the extent to which they utilize information on the number of days with bleeding and the temporal variation in bleeding patterns. Inferences drawn regarding the relative safety and efficacy of different transfusion triggers can vary depending on the method of analysis.CONCLUSION:  To rigorously design and analyze future PLT transfusion studies based on bleeding outcomes, it is important to have a clear understanding of the interpretation of the different ways of analyzing bleeding outcomes. The analysis strategy should be selected based on the clinical question being addressed.
Platelet transfusions during coronary artery bypass graft surgery are associated with serious adverse outcomes
Authors: Spiess Bruce D. , Royston David , Levy Jerrold H. , Fitch Jane , Dietrich Wulf , Body Simon , Murkin John , Nadel Andrea 
Published: July 2004

BACKGROUND:  Platelet (PLT) transfusions are administered in cardiac surgery to prevent or treat bleeding, despite appreciation of the risks of blood component transfusion. The current analysis investigates the hypothesis that PLT transfusion is associated with adverse outcomes associated with coronary artery bypass graft surgery (CABG).STUDY DESIGN AND METHODS:  Data originally collected during double‐blind placebo‐controlled phase III trials for licensure of Trasylol (aprotinin injection) were retrospectively analyzed. Adverse outcome data of patients (n = 1720) that received, and did not receive, perioperative PLT transfusion were compared. Logistic regression analysis was used to assess the association of perioperative adverse events with PLT transfusion. Propensity scoring analysis was used to verify results of the logistic regression.RESULTS:  Patients receiving PLTs were more likely to have prolonged hospital stays, longer surgeries, more bleeding, re‐operation for bleeding, and more RBC transfusions, and less likely to have full‐dose aprotinin administration. Adverse events were statistically more frequent in patients that received one or more PLT transfusion. Logistic regression analysis showed that PLT transfusion was associated with infection, vasopressor use, respiratory medication use, stroke, and death. Propensity scoring analysis confirmed the risk of PLT transfusion.CONCLUSIONS:  PLT transfusion in the perioperative period of CABG was associated with increased risk for serious adverse events. PLT transfusion may be a surrogate marker for sicker patients and have no causal role in the outcomes observed. However, a direct contribution to outcomes remains possible.
Validation and assessment of a blood‐donor arm disinfectant containing chlorhexidine and alcohol
Authors: Wong P.‐Y. , Colville V.L. , White V. , Walker H.M. , Morris R.A. ,   The Microbial Contamination and Infection Control Subcommittee, Australian Red Cross Blood Service
Published: July 2004

BACKGROUND:  To minimize the bacterial contamination rate in blood collected from donors, a study was designed to evaluate the suitability of a single‐use chlorhexidine‐alcohol antiseptic for donor arm preparation at all blood collection venues in Australia.STUDY DESIGN AND METHODS:  A prospective study of bacterial load on the skin was performed on 616 blood donors’ arms before and after disinfection using a direct swabbing and plating technique. Disinfection was achieved with a swab containing 1 percent chlorhexidine gluconate with 75 percent alcohol, which was applied to the skin in a prescribed method. Feedback from blood donors and staff was obtained using questionnaires.RESULTS:  After disinfection, 99 percent of donor arms had bacterial counts of 5 cfu per plate or less, and 99.5 percent had counts of 10 cfu per plate or less, respectively. The mean colony count for all donors after disinfection was 0.39, and the percentage reduction was 99 compared to predisinfection. Sixteen donors (3%) noted transient skin irritation. The majority of staff (64%) preferred not to use the new disinfectant due to the difficulty opening the packaging and an excessive amount of antiseptic solution per pack.CONCLUSION:  The bacteriologic study showed that the disinfectant satisfied the requirements of the Australian Red Cross Blood Service for use to prepare blood‐donor arms before venesection. An improvement to the packaging was required before it could be acceptable to all staff.
Storage of platelets in additive solution for up to 12 days with maintenance of good in‐vitro quality
Authors: Van Der Meer Pieter F. , Pietersz Ruby N.I. , Reesink Henk W. 
Published: July 2004

BACKGROUND:  Storage of PLT concentrates (PCs) may be extended beyond 5 days, provided in‐vitro and in‐vivo variables allow longer storage and bacterial screening is performed. The aim of this study was to examine in‐vitro storage characteristics of PCs in various storage solutions: plasma only, or mixtures of plasma with PAS‐II, PAS‐III, PAS‐IIIM, and Composol.STUDY DESIGN AND METHODS:  PCs from five pooled buffy‐coats and WBCs reduced by filtration were stored in 1.3‐L butyryl‐tri‐hexyl‐citrate‐plasticised PVC containers. First, a paired comparison was made between PAS‐II and Composol, with 35‐percent final plasma concentration (n = 10). Then, plasma, PAS‐III with 30‐percent plasma, PAS‐IIIM with 20‐ and 30‐percent plasma, and Composol with 20 and 30‐percent final plasma concentration were compared (n = 5 pairs). Finally, 50 PCs in Composol with 35‐percent final plasma concentration were studied.RESULTS:  PCs in PAS‐II or Composol had a mean ± SD pH of 6.95 ± 0.09 and 6.96 ± 0.08 at Day 12, respectively. For PCs in PAS‐IIIM and Composol with 30‐percent final plasma concentration, pH on Day 7 was 7.00 ± 0.02 and 6.83 ± 0.05. With 20‐percent final plasma concentration, pH was 6.98 ± 0.02 and 6.81 ± 0.03 for PAS‐IIIM and Composol, respectively. PCs in PAS‐III with 30‐percent plasma had a pH on Day 7 of 6.87 ± 0.03, whereas PCs in 100‐percent plasma had a pH of 7.05 ± 0.03. PCs in Composol with 35‐percent plasma maintained pH greater than 6.8 in 48 of 50 of the units (96%), averaging 7.00 ± 0.10 on Day 8.CONCLUSION:  In‐vitro quality of PCs in AS with at least 35‐percent plasma can be maintained for 7 to 12 days after collection.
Detection of bacterial contamination of platelet components: six years’ experience with the BacT/ALERT system
Authors: Munksgaard Lars , Albjerg Lene , Lillevang Søren T. , Gahrn‐Hansen Bente , Georgsen Jørgen 
Published: July 2004

BACKGROUND:  Hemovigilance has shown that bacteria cause more fatalities than other infections together. Surveillance for detection of bacteria in platelets (PLTs) was initiated. Concomitantly, the storage period for PLTs was extended from 5 to 7 days to reduce cost.STUDY DESIGN AND METHODS:  Analysis was performed of all cases of a positive signal in a screening procedure for contaminated PLTs taking into account results of confirmative cultures and results of culture from blood components including bacteria strains. Records were assessed from patients transfused with blood components issued before the screening culture became positive.RESULTS:  Samples were collected from 22,057 PLT units. An initial reaction was seen in 84 (0.38%). Growth was confirmed in 70 of these. Of the associated PLT units, 26 had been issued or outdated at the time when the culture was found to be reactive, in 27 bacteria were found, and in 17 cultures were negative. The bacteria found were mainly from normal skin flora. Sixty‐six patients received 75 blood components issued before the screening system alarmed. None of these patients had a transfusion reaction reported. The outdating fell to less than 5 percent.CONCLUSION:  A screening system for detection of bacterial contamination was implemented without increase in cost owing to extension of storage time to 7 days. Transfusion of several contaminated blood components was prevented.