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Undetected cognitive impairment (CI) and dementia are important clinical and epidemiological problems. This study addresses the effectiveness of using a single self-reported measure of severe memory problems (SMP) as a screen for CI and dementia. For the purposes of the study, 3220 elderly women participated in a mailed Health Survey Questionnaire and telephone interviews. Cognitive scores derived from the Telephone Interview for Cognitive Status-modified (TICSm) were calculated. Based on a multi-stage assessment strategy, all subjects were classified in one of three status categories: dementia, CI, or unimpaired. The SMP question was suggestive of cognitive problems in the majority of responders. t-tests found affirmative responders scored much lower on the cognitive test than negative responders. The SMP question had a sensitivity of .24 and a specificity of .99 for screening CI and dementia. While other assessment measures are needed, the SMP question is highly suggestive of CI and may serve as a first-stage screen in clinical and research settings. [ABSTRACT FROM AUTHOR]

To assess the association between infant sleeping position and risk of sudden infant death syndrome (SIDS) in an ethnically diverse US population, the authors conducted a population-based case-control study in 11 counties in California from May 1997 through April 2000. The authors conducted in-person interviews with the mothers of 185 SIDS cases and 312 randomly selected race/ethnicity- and age-matched controls to collect information on sleeping positions. Infants who had last been put down to sleep in the prone or side position were at greater risk of SIDS than were infants who had last been put down on their backs (adjusted odds ratio (AOR) = 2.6 (95% confidence interval (CI): 1.5, 4.5) and AOR = 2.0 (95% CI: 1.2, 3.4) for the prone and side positions, respectively). The risk of SIDS was especially high for an unstable side position in which an infant was placed on its side and found prone (AOR = 8.7, 95% CI: 3.3, 22.7). Infants who were usually placed on their backs to sleep but had last been put down in the prone or side position (an unaccustomed position) had a significantly high risk of SIDS (AOR = 8.2 (95% CI: 2.6, 26.0) and AOR = 6.9 (95% CI: 2.3, 20.6) for the prone and side positions, respectively). Infants placed in an unaccustomed prone or side sleeping position had a higher risk of SIDS than infants who were always placed prone or on the side. [ABSTRACT FROM AUTHOR]

Background: Studies of hormone replacement therapy (HRT) and dementia and cognitive impairment show mixed results. This study assessed the prevalence of dementia and cognitive impairment in users and nonusers of HRT defined using computer-stored prescription information.Methods: The study involved 3924 women 75 years of age and older who were members of the Southern California Kaiser Permanente Medical Care Program in 1998. HRT use was determined based on prescription data for 1992-1998. Cognitive function and dementia were assessed using the Telephone Interview of Cognitive Status supplemented by the Telephone Dementia Questionnaire and medical record review.Results: Odds ratios (ORs) for cognitive impairment/dementia showed expected associations with age, education, ethnicity, and a history of stroke or Parkinson's disease. After adjustment, the OR for cognitive impairment or dementia in HRT users compared with HRT nonusers was 0.91 (95% confidence interval 0.75-1.10). The adjusted ORs for all dementia and dementia without cause in HRT users compared with nonusers were 0.77 (95% confidence interval 0.59- 1.00) and 0.78 (0.58-1.05), respectively. Twenty percent of women with cognitive impairment or dementia who had been classified as HRT users by prescription (one prescription each year from 1992-1998) denied hormone use compared with 8.8% of women without impairment. Medical record review validated prescription information for the impaired women.Conclusions: The study identified an important methodologic problem in studies of HRT and cognitive impairment and dementia that depend on recalled information about drug exposure. A protective effect of HRT for cognitive impairment and dementia was neither established nor ruled out based on the prescription data. [ABSTRACT FROM AUTHOR]

PURPOSE: This cross-sectional study sought to identify diabetes accurately in a study population of 3681 women age 75 and older and to determine the association of diabetes with cognitive performance. METHODS: A previously validated test, the Telephone Interview of Cognitive Screening-Modified (TICSm) was given to assess cognitive status. A diabetes case identification database, medical record review and self-report were used to determine diabetes cases. 489 (13.3%) of the women in the study were classified with diabetes and 3192 without diabetes. RESULTS: t-tests and linear regression analyses determined that diabetic women had a mean TICSm score 1.4 points lower (i.e. more impaired) than non-diabetic women. Using linear regression to adjust for age, education, and vascular disease, diabetic women showed a 1.1 lower score on the TICSm. Similar adjustments were made for potential confounding variables such as depression, hormone replacement therapy (HRT), high body weight, smoking, alcohol use and exercise and diabetics again showed a 1.0 lower score. CONCLUSION: This study, which utilizes highly rigorous case identification methodology, provides further evidence that diabetes is associated with significantly worse cognitive performance in the elderly. [ABSTRACT FROM AUTHOR]

Objective: To describe the design, development, and baseline characteristics of enrollees of a home-based, interdisciplinary, dyadic, pilot dementia care program., Design: Single-arm, dementia care intervention in partnership with primary care providers delivered by Health Coaches to persons with dementia and caregiver "dyads" and supervised by an interdisciplinary team., Setting: Home- and virtual-based dyad support., Participants: Persons with mild cognitive impairment or dementia diagnosis and/or who were prescribed antidementia medications; had an identified caregiver willing to participate; were under the care of a partner primary care provider; and had health insurance through the affiliated accountable care organization (Banner Health Network)., Intervention: Provision of personalized dementia education and support in the home or virtually by Health Coaches supported by an interdisciplinary team., Measurements: Cognition, function, mood, and behavior of persons with dementia; caregiver stress and program satisfaction; primary care provider satisfaction., Results: Served dyads from three primary care clinics with a total of 87 dyads enrolled between December 2018 and June 2020., Conclusion: A pilot Dementia Care Partners demonstrated feasibility and suggested acceptability, and high satisfaction among primary care providers and caregivers., Competing Interests: Disclosures Dr. Goldfarb received honorarium from the CME Institute. Dr. Reiman is a co-founder and shareholder in ALZPath and receives grant funding from NIA grant P30 AG019610, Banner Alzheimer's Foundation, Banner Health Foundation, and the State of Arizona. Dr. Atri receives grants or contracts from the Alzheimer's Disease Consortia, Coordinating Research Institutes or Government Funding (ACTC, ADCS, ATRI, NIH), Indiana University (observational cohort), Johns Hopkins (clinical trial), Global Alzheimer's Platform, Athira, Alzheon, Biohaven (with ADCS), Eisai (with ATRI/ACTC), Lilly (with ACTC/NIH), Novartis, and NIH. He receives book royalty from Oxford University Press, payment or honoraria from Abbvie, Acadia, Biogen, Harvard Medical School Post-Graduate Continuing Education (HMS PGME). Dr. Atri receives Reimbursement or providing flights, transportation or lodging for advisor Eisai, Grifols, Novo Nordisk, Roche/Genentech, Harvard Medical School Post-Graduate Continuing Education (HMS PGME). He receives support for travel or lodging for advisory meetings or educational programs by AbbVie, Acadia, Alzheimer's Association, Biogen, Eisai, Grifols, Novo Nordisk, Roche/Genentech, HMS PGME, National Institutes of Health. Dr. Atri participates on Data Safety Monitoring Board or Advisory Board for Roche/Genentech (and partner: Chugai). He has a leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid for Alzheimer's Association - Co-chair or member of several workgroups/organizing committees (unpaid) and Alzheimer's Disease International (ADI) - Chair of Medical Scientific Advisory Panel and Member of Board of ADI (unpaid). Dr. Tariot receives consulting fees from Acadia, Avanir, Biogen, and Lilly, honoraria from Biogen, support for attending meetings from Novartis and Avanir, participates on advisory boards for Genentech and Abbvie, and has stock ownership in Adamas Pharmaceuticals. This work was funded by philanthropic support from Edward Fein, the Edson Family, a Cigna grant, the Banner Alzheimer's Foundation, Banner Health Foundation, and the Sun Health Foundation. Dr. Allen, Lori Nisson, Dr. Petitti, Donald Saner, Carrie Langford, and Dr. Burke have no conflicts of interest to report. The authors acknowledge the contributions of the Dementia Care Partners Health Coaches – Serena Lowery, Juliana Crouch, JennaBelle Gessel, and Clare Mueller; Research Assistants – Joshua Sipes and Anja Trncic; Information technology team – Robert Bauer III, Matthew Miller and Ashleigh Hendrickson; Program development consultant – Deborah Boyle, MSN, RN. They also express sincere gratitude to all Dementia Care Partners dyads, primary care providers and associated clinic teams., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

The rapid spread of severe acute respiratory syndrome coronavirus 2 infection across the globe triggered an unprecedented increase in research activities that resulted in an astronomical publication output of observational studies. However, most studies failed to apply fully the necessary methodological techniques that systematically deal with different biases and confounding, which not only limits their scientific merit but may result in harm through misleading information. In this article, we address a few important biases that can seriously threaten the validity of observational studies of coronavirus disease 2019 (COVID-19). We focus on treatment selection bias due to patients' preference on goals of care, medical futility and disability bias, survivor bias, competing risks, and the misuse of propensity score analysis. We attempt to raise awareness and to help readers assess shortcomings of observational studies of interventions in COVID-19., (© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Models can be valuable tools to address uncertainty, trade-offs, and preferences when trying to understand the effects of interventions. Availability of results from two or more independently developed models that examine the same question (comparative modeling) allows systematic exploration of differences between models and the effect of these differences on model findings. Guideline groups sometimes commission comparative modeling to support their recommendation process. In this commissioned collaborative modeling, modelers work with the people who are developing a recommendation or policy not only to define the questions to be addressed but ideally, work side-by-side with each other and with systematic reviewers to standardize selected inputs and incorporate selected common assumptions. This paper describes the use of commissioned collaborative modeling by the U.S. Preventive Services Task Force (USPSTF), highlighting the general challenges and opportunities encountered and specific challenges for some topics. It delineates other approaches to use modeling to support evidence-based recommendations and the many strengths of collaborative modeling compared with other approaches. Unlike systematic reviews prepared for the USPSTF, the commissioned collaborative modeling reports used by the USPSTF in making recommendations about screening have not been required to follow a common format, sometimes making it challenging to understand key model features. This paper presents a checklist developed to critically appraise commissioned collaborative modeling reports about cancer screening topics prepared for the USPSTF., (Copyright © 2017 American Journal of Preventive Medicine. All rights reserved.)

Background: Extreme heat is a public health challenge. The scarcity of directly comparable studies on the association of heat with morbidity and mortality and the inconsistent identification of threshold temperatures for severe impacts hampers the development of comprehensive strategies aimed at reducing adverse heat-health events., Objectives: This quantitative study was designed to link temperature with mortality and morbidity events in Maricopa County, Arizona, USA, with a focus on the summer season., Methods: Using Poisson regression models that controlled for temporal confounders, we assessed daily temperature-health associations for a suite of mortality and morbidity events, diagnoses, and temperature metrics. Minimum risk temperatures, increasing risk temperatures, and excess risk temperatures were statistically identified to represent different "trigger points" at which heat-health intervention measures might be activated., Results: We found significant and consistent associations of high environmental temperature with all-cause mortality, cardiovascular mortality, heat-related mortality, and mortality resulting from conditions that are consequences of heat and dehydration. Hospitalizations and emergency department visits due to heat-related conditions and conditions associated with consequences of heat and dehydration were also strongly associated with high temperatures, and there were several times more of those events than there were deaths. For each temperature metric, we observed large contrasts in trigger points (up to 22 °C) across multiple health events and diagnoses., Conclusion: Consideration of multiple health events and diagnoses together with a comprehensive approach to identifying threshold temperatures revealed large differences in trigger points for possible interventions related to heat. Providing an array of heat trigger points applicable for different end-users may improve the public health response to a problem that is projected to worsen in the coming decades.

Background: Parkinson's disease (PD) is the most prevalent movement disorder of the central nervous system, and affects more than 6.3 million people in the world. The characteristic motor features include tremor, bradykinesia, rigidity, and impaired postural stability. Current therapy based on augmentation or replacement of dopamine is designed to improve patients' motor performance but often leads to levodopa-induced adverse effects, such as dyskinesia and motor fluctuation. Clinicians must regularly monitor patients in order to identify these effects and other declines in motor function as soon as possible. Current clinical assessment for Parkinson's is subjective and mostly conducted by brief observations made during patient visits. Changes in patients' motor function between visits are hard to track and clinicians are not able to make the most informed decisions about the course of therapy without frequent visits. Frequent clinic visits increase the physical and economic burden on patients and their families., Objective: In this project, we sought to design, develop, and evaluate a prototype mobile cloud-based mHealth app, "PD Dr", which collects quantitative and objective information about PD and would enable home-based assessment and monitoring of major PD symptoms., Methods: We designed and developed a mobile app on the Android platform to collect PD-related motion data using the smartphone 3D accelerometer and to send the data to a cloud service for storage, data processing, and PD symptoms severity estimation. To evaluate this system, data from the system were collected from 40 patients with PD and compared with experts' rating on standardized rating scales., Results: The evaluation showed that PD Dr could effectively capture important motion features that differentiate PD severity and identify critical symptoms. For hand resting tremor detection, the sensitivity was .77 and accuracy was .82. For gait difficulty detection, the sensitivity was .89 and accuracy was .81. In PD severity estimation, the captured motion features also demonstrated strong correlation with PD severity stage, hand resting tremor severity, and gait difficulty. The system is simple to use, user friendly, and economically affordable., Conclusions: The key contribution of this study was building a mobile PD assessment and monitoring system to extend current PD assessment based in the clinic setting to the home-based environment. The results of this study proved feasibility and a promising future for utilizing mobile technology in PD management.

In this study we characterized the relationship between temperature and mortality in central Arizona desert cities that have an extremely hot climate. Relationships between daily maximum apparent temperature (ATmax) and mortality for eight condition-specific causes and all-cause deaths were modeled for all residents and separately for males and females ages <65 and ≥ 65 during the months May-October for years 2000-2008. The most robust relationship was between ATmax on day of death and mortality from direct exposure to high environmental heat. For this condition-specific cause of death, the heat thresholds in all gender and age groups (ATmax = 90-97 °F; 32.2-36.1 °C) were below local median seasonal temperatures in the study period (ATmax = 99.5 °F; 37.5 °C). Heat threshold was defined as ATmax at which the mortality ratio begins an exponential upward trend. Thresholds were identified in younger and older females for cardiac disease/stroke mortality (ATmax = 106 and 108 °F; 41.1 and 42.2 °C) with a one-day lag. Thresholds were also identified for mortality from respiratory diseases in older people (ATmax = 109 °F; 42.8 °C) and for all-cause mortality in females (ATmax = 107 °F; 41.7 °C) and males <65 years (ATmax = 102 °F; 38.9 °C). Heat-related mortality in a region that has already made some adaptations to predictable periods of extremely high temperatures suggests that more extensive and targeted heat-adaptation plans for climate change are needed in cities worldwide.

Background: Prior research shows that work in agriculture and construction/extraction occupations increases the risk of environmental heat-associated death., Purpose: To assess the risk of environmental heat-associated death by occupation., Methods: This was a case-control study. Cases were heat-caused and heat-related deaths occurring from May-October during the period 2002-2009 in Maricopa County, Arizona. Controls were selected at random from non-heat-associated deaths during the same period in Maricopa County. Information on occupation, age, sex, and race-ethnicity was obtained from death certificates. Logistic regression analysis was used to estimate odds ratios for heat-associated death., Results: There were 444 cases of heat-associated deaths in adults (18+ years) and 925 adult controls. Of heat-associated deaths, 332 (75%) occurred in men; a construction/extraction or agriculture occupation was described on the death certificate in 115 (35%) of these men. In men, the age-adjusted odds ratios for heat-associated death were 2.32 (95% confidence interval 1.55, 3.48) in association with construction/extraction and 3.50 (95% confidence interval 1.94, 6.32) in association with agriculture occupations. The odds ratio for heat-associated death was 10.17 (95% confidence interval 5.38, 19.23) in men with unknown occupation. In women, the age-adjusted odds ratio for heat-associated death was 6.32 (95% confidence interval 1.48, 27.08) in association with unknown occupation. Men age 65 years and older in agriculture occupations were at especially high risk of heat-associated death., Conclusion: The occurrence of environmental heat-associated death in men in agriculture and construction/extraction occupations in a setting with predictable periods of high summer temperatures presents opportunities for prevention.

Background: Most heat-related deaths occur in cities, and future trends in global climate change and urbanization may amplify this trend. Understanding how neighborhoods affect heat mortality fills an important gap between studies of individual susceptibility to heat and broadly comparative studies of temperature-mortality relationships in cities., Objectives: We estimated neighborhood effects of population characteristics and built and natural environments on deaths due to heat exposure in Maricopa County, Arizona (2000-2008)., Methods: We used 2000 U.S. Census data and remotely sensed vegetation and land surface temperature to construct indicators of neighborhood vulnerability and a geographic information system to map vulnerability and residential addresses of persons who died from heat exposure in 2,081 census block groups. Binary logistic regression and spatial analysis were used to associate deaths with neighborhoods., Results: Neighborhood scores on three factors-socioeconomic vulnerability, elderly/isolation, and unvegetated area-varied widely throughout the study area. The preferred model (based on fit and parsimony) for predicting the odds of one or more deaths from heat exposure within a census block group included the first two factors and surface temperature in residential neighborhoods, holding population size constant. Spatial analysis identified clusters of neighborhoods with the highest heat vulnerability scores. A large proportion of deaths occurred among people, including homeless persons, who lived in the inner cores of the largest cities and along an industrial corridor., Conclusions: Place-based indicators of vulnerability complement analyses of person-level heat risk factors. Surface temperature might be used in Maricopa County to identify the most heat-vulnerable neighborhoods, but more attention to the socioecological complexities of climate adaptation is needed.

Purpose: Cancer screening procedures have brought great benefit to the public's health. However, the science of cancer screening and the evidence arising from research in this field as it is applied to policy is complex and has been difficult to communicate, especially on the national stage. We explore how epidemiologists have contributed to this evidence base and to its translation into policy., Methods: Our essay focuses on breast and lung cancer screening to identify commonalities of experience by epidemiologists across two different cancer sites and describe how epidemiologists interact with evolving scientific and policy environments., Results: We describe the roles and challenges that epidemiologists encounter according to the maturity of the data, stakeholders, and the related political context. We also explore the unique position of cancer screening as influenced by the legislative landscape where, due to recent healthcare reform, cancer screening research plays directly into national policy., Conclusions: In the complex landscape for cancer screening policy, epidemiologists can increase their impact by learning from past experiences, being well prepared and communicating effectively., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Computer simulations have been used to model infectious diseases to examine the outcomes of alternative strategies for managing their spread. Methicillin resistant Staphylococcus aureus (MRSA) skin and soft tissue infections have become prominent in many communities and efforts are underway to reduce the spread of this organism both in hospitals and communities. Currently, there are few tools for policy makers to use to examine the outcome of various choices when making decisions about MRSA. Using the example of MRSA, we describe, in this paper, a rigorous approach for development and validation of a tool that simulates the spread of MRSA infections. We used sensitivity analyses in a novel way and validated the simulation results against local data over time. Our approach for simulation development and validation is generalizeable to simulations of other diseases., (Copyright 2010 Elsevier Inc. All rights reserved.)

Objective: To assess correlates of glycemic control in a diverse population of children and youth with diabetes., Study Design: This was a cross-sectional analysis of data from a 6-center US study of diabetes in youth, including 3947 individuals with type 1 diabetes (T1D) and 552 with type 2 diabetes (T2D), using hemoglobin A(1c) (HbA(1c)) levels to assess glycemic control., Results: HbA(1c) levels reflecting poor glycemic control (HbA(1c) >or= 9.5%) were found in 17% of youth with T1D and in 27% of those with T2D. African-American, American Indian, Hispanic, and Asian/Pacific Islander youth with T1D were significantly more likely to have higher HbA(1c) levels compared with non-Hispanic white youth (with respective rates for poor glycemic control of 36%, 52%, 27%, and 26% vs 12%). Similarly poor control in these 4 racial/ethnic groups was found in youth with T2D. Longer duration of diabetes was significantly associated with poorer glycemic control in youth with T1D and T2D., Conclusions: The high percentage of US youth with HbA(1c) levels above the target value and with poor glycemic control indicates an urgent need for effective treatment strategies to improve metabolic status in youth with diabetes.

Background: Little evidence exists that links teamwork to patient outcomes. We conducted this study to determine if patients of teams with good teamwork had better outcomes than those with poor teamwork., Methods: Observers used a standardized instrument to assess team behaviors. Retrospective chart review was performed to measure 30-day outcomes. Multiple logistic regressions were calculated to assess the independence of the association between teamwork with patient outcome after adjusting for American Society of Anesthesiologists (ASA) score., Results: In univariate analyses, patients had increased odds of complications or death when the following behaviors were exhibited less frequently: information sharing during intraoperative phases, briefing during handoff phases, and information sharing during handoff phases. Composite measures of teamwork across all operative phases were significantly associated with complication or death after adjusting for ASA score (odds ratio 4.82; 95% confidence interval, 1.30-17.87)., Conclusion: When teams exhibited infrequent team behaviors, patients were more likely to experience death or major complication.

The U.S. Preventive Services Task Force (USPSTF) seeks to provide reliable and accurate evidence-based recommendations to primary care clinicians. However, clinicians indicate frustration with the lack of guidance provided by the USPSTF when the evidence is insufficient to make a recommendation. This article describes a new USPSTF plan to commission its Evidence-based Practice Centers to collect information in 4 domains pertinent to clinical decisions about prevention and to report this information routinely. The 4 domains are potential preventable burden, potential harm of the intervention, costs (both monetary and opportunity), and current practice. The process and rationale used to select these domains are presented, along with examples of how clinicians might use the information to guide clinical decision making when evidence is insufficient.

Objectives: To assess the risk of death in relation to apolipoprotein E (APOE) genotype and to evaluate how APOE genotype interacts with dementia and with other major medical conditions to affect survival., Design: A 6-year prospective cohort study of dementia, APOE genotype and survival., Setting: Health maintenance organization in southern California., Participants: One thousand eight hundred forty-two white women aged 75 and older., Measurements: Dementia was determined using a multistage assessment procedure, medical record, and death certificate review., Results: With women with the APOE 3/3 genotype as the referent, age-adjusted hazard ratios (HRs) for death according to genotype were 1.25 (95% confidence interval (CI)=1.00-1.56) for APOE 2/4, 3/4, or 4/4 and 0.83 (95% CI=0.62-1.13) for APOE 2/3 or 2/2. Survival was associated with APOE genotype (log rank test P=.02). Women with the APOE 2/4, 3/4, or 4/4 genotype died at an earlier age, and those with APOE 2/2 or 2/3 died later than those with the APOE 3/3 genotype. After adjustment for age, education, and hormone use, HRs for death were significantly higher in women with the APOE 2/4, 3/4, or 4/4 genotype who developed dementia (HR=3.74; 95% CI=2.81-4.99) and the APOE 2/3 genotype (HR=3.23; 95%=CI=1.97-5.28) than in women without dementia and the APOE 3/3 genotype. The HRs for death were greater with other medical conditions, but no interaction with any APOE genotype was found., Conclusion: In this population of elderly women, although having at least one epsilon4 allele increased the chances of an earlier death, having dementia increased the risk of death regardless of APOE genotype.

Objectives: We examined whether social networks had a protective association with incidence of dementia among elderly women., Methods: We prospectively studied 2249 members of a health maintenance organization who were 78 years or older, were classified as free of dementia in 2001, and had completed at least 1 follow-up interview in 2002 through 2005. We used the Telephone Interview for Cognitive Status-modified, the Telephone Dementia Questionnaire, and medical record review to assess cognitive status. We used the Lubben Social Network Scale-6 to assess social network. We estimated hazard ratios for incident dementia with Cox proportional hazards models, adjusting for age at entry, education, hormone use, cognitive status scores, and health conditions., Results: We identified 268 incident cases of dementia during follow-up. Compared with women with smaller social networks, the adjusted hazard ratio for incident dementia in women with larger social networks was 0.74 (95% confidence interval=0.57, 0.97)., Conclusions: Our findings suggest that larger social networks have a protective influence on cognitive function among elderly women. Future studies should explore which aspects of social networks are associated with dementia risk and maintenance of cognitive health.

Objective: The objective of the study was to assess the prevalence and determinants of elevated apolipoprotein B (apoB) and dense low-density lipoprotein (LDL) in United States youth with type 1 or type 2 diabetes., Methods: We conducted cross-sectional analyses of apoB concentrations, LDL density, and prevalence of elevated apoB levels and dense LDL from the SEARCH for Diabetes in Youth study, a six-center U.S.-based study of youth with diabetes onset younger than 20 years of age (2657 with type 1 and 345 with type 2)., Results: Among youth with type 1 diabetes, 11% had elevated apoB (>or=100 mg/dl, 1.95 mm/liter), 8% had dense LDL (relative flotation rateor=130 mg/dl, 3.36 mm/liter). In contrast, among youth with type 2 diabetes, 36% had elevated apoB, 36% had dense LDL, but only 23% had elevated LDL-cholesterol. Dense LDL and apoB each increased with hemoglobin A1c in both types. Among type 1 diabetics in poor glycemic control (hemoglobin A1c>or=9.5%), 28% had elevated apoB, and 18% had dense LDL, whereas 72% of poorly controlled type 2 diabetics had elevated apoB and 62% had dense LDL., Conclusions: In youth with type 1 diabetes, elevated apoB and dense LDL were not highly prevalent, whereas elevated apoB and dense LDL were common lipoprotein abnormalities in youth with type 2 diabetes. The prevalence of these risk factors substantially increased with poor glycemic control in both groups, stressing the importance of achieving and maintaining an optimal glucose control.

The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) published its main findings in December, 2002. It recommended thiazide diuretics as a first-line treatment of hypertension. The current study describes the prescribing patterns of thiazide diuretics in four regions of Kaiser Permanente, a large national United States Health Maintenance Organization--two regions that had an ALLHAT clinical center and two that did not. We tested the hypothesis that participation in a clinical trial leads to quicker and greater adoption of study recommendations than non-participation in a trial. The relative percentage of filled outpatient prescriptions for the period 2 or 3 years before the ALLHAT main publication through December 31, 2004 was calculated by region for thiazide-type diuretics and for calcium channel blockers (CCBs), beta-blockers, central alpha-blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and other antihypertensive diuretics. In the 2 years after publication of the ALLHAT trial findings, the percentage of all prescriptions for thiazide diuretics increased from 11.2% to 12.4% in the two regions with an ALLHAT clinical site and from 8.9% to 10.1% in the two regions without an ALLHAT clinical site (p > 0.05). The percentage of new prescriptions for thiazide diuretics increased from 13.7% to 16.6% in the two regions with an ALLHAT clinical site and from 10.8% to 13.0% in the two regions without an ALLHAT clinical site (p > 0.05). Participation in a clinical hypertension study does not appear to accelerate adoption of study recommendations.

Objective: Assessment of the prevalence of serum lipid abnormalities in US youth with type 1 or type 2 diabetes., Study Design: The SEARCH for Diabetes in Youth Study was a cross-sectional, population-based study, conducted in six centers. Subjects were 2448 youth with diabetes who had a study examination. Outcome measures were fasting measures of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, and non-HDL-C. Analysis was descriptive., Results: The overall prevalence of high TC concentration (>240 mg/dL) was 5%; the overall prevalence of high LDL-C (>160 mg/dL) was 3%, and the overall prevalence of high triglyceride (>400 mg/dL) was 2%. About half of the participants (48%) had an LDL-C concentration above the optimal level of 100 mg/dL. Among youth ages 10+, the prevalence of abnormal lipids was higher in type 2 (n = 283) than in type 1 diabetes (n = 1963): 33% versus 19% had TC concentration >200 mg/dL; 24% versus 15% had LDL-C concentration >130 mg/dL; 29% versus 10% had triglyceride concentration >150 mg/dL; 44% versus 12% had HDL-C concentration <40 mg/dL. Only 1% of youth were receiving pharmacologic therapy for dyslipidemia., Conclusions: A substantial proportion of young patients with diabetes have abnormal serum lipids.

Background: Mixed results exist as to whether positive surgical margins impact survival. The aim of this study was to determine whether positive surgical margins are indeed associated with decreased survival in patients with primary head and neck cancer., Methods: We conducted a retrospective cohort study of 261 cases diagnosed with cancer of the larynx or tongue between 1995 and 1999. Cases were followed through December 31, 2002. Survival curves by margin status were generated by Kaplan-Meier methods. Categorical data were evaluated with odds ratios (OR)., Results: All-cause mortality was markedly higher in cases with positive margins as compared with those with negative margins (54% versus 29%, P = 0.005). This pattern also appeared after adjusting for age and sex (OR = 2.97, 95% CI: 1.29-6.84)., Conclusion: Our findings suggest that positive surgical margin status is associated with increased mortality. This association also generally persists after adjustment for tumor size, stage, and adjuvant therapy.