76
|
DeWilde SJ, Carey IM, Shah SM, Harris T, Rudnicka AR, Whincup PH, Cook DG. PS07 Trends in Blood Pressure in England: Good Treatment or Good Luck? Br J Soc Med 2012. [DOI: 10.1136/jech-2012-201753.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
77
|
Carey IM, Shah SM, Harris T, DeWilde S, Cook DG. PL01 A Simple Morbidity Score for UK Primary Care: A New Tool for Research and Healthcare Outcome Monitoring. Br J Soc Med 2012. [DOI: 10.1136/jech-2012-201753.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
78
|
Shah SM, Carey IM, Harris T, DeWilde S, Victor CR, Cook DG. OP85 Do Good Health and Material Circumstances Protect Older People from the Increase in Mortality after Bereavement? Br J Soc Med 2012. [DOI: 10.1136/jech-2012-201753.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
79
|
Gurjar V, Halvadia BM, Bharaney RP, Ajwani V, Shah SM, Rai S, Trivedi M. Study of two techniques for midline laparotomy fascial wound closure. Indian J Surg 2012; 76:91-4. [PMID: 24891770 DOI: 10.1007/s12262-012-0612-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 06/06/2012] [Indexed: 11/29/2022] Open
Abstract
To study the results of two techniques, simple interrupted closure and continuous with intermittent Aberdeen knot technique for midline laparotomy fascial wound closure. A random selection of 200 midline laparotomy cases was done. In one group (group A) of 100 cases, midline fascial wound closure was done with continuous sutures with intermittent Aberdeen knot technique using Prolene No. 1 suture material. In the other group (group B) of 100 cases, closure was done with the technique of simple interrupted sutures with Prolene No.1 suture material. Comparison of both the techniques regarding preoperative status and postoperative complication such as incisional hernia, wound dehiscence, suture sinus formation, stitch granuloma, and chronic wound pain was done according to clinical examination and recorded in the pro forma prepared. In group A, postoperative complications were incisional hernia 3 %, wound dehiscence 4 %, and suture sinus formation 1 %. In group B, postoperative complication were incisional hernia 5 %, wound dehiscence 4 %, and suture sinus formation 1 %. All these complications were statistically insignificant, in both group comparisons. While the complication such as stitch granuloma 3 %, chronic wound pain 3 %, and wound infection 4 % in group A was significantly less than in group B where the complication of stitch granuloma was 12 %, chronic wound pain 13 %, and wound infection 13 % (P value 0.03, P value 0.018, and P value 0.048, respectively). Both the techniques, simple interrupted suture closure and continuous with intermittent Aberdeen knot closure for midline laparotomy fascial wounds, show a similar rate of postoperative complication such as incisional hernia, wound dehiscence, and suture sinus formation. But the continuous suturing with intermittent Aberdeen knot technique is a better option to prevent complications such as stitch granuloma, chronic wound pain, and wound infection, which are higher in the simple interrupted fascial wound closure technique.
Collapse
|
80
|
Carey IM, DeWilde S, Shah SM, Harris T, Whincup PH, Cook DG. Statin use after first myocardial infarction in UK men and women from 1997 to 2006: Who started and who continued treatment? Nutr Metab Cardiovasc Dis 2012; 22:400-408. [PMID: 21194912 DOI: 10.1016/j.numecd.2010.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 09/21/2010] [Accepted: 09/28/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS To examine trends in initiation and continuation of statin treatment after myocardial infarction (MI) and their determinants, during a period of increasing usage. METHODS AND RESULTS 9367 patients aged 30-84 with a first Myocardial Infarction (MI) in 1997-2006 were identified in DIN-LINK, an anonymised, UK primary care database. We assessed statin initiation (prescription within 6 months of MI) and continued therapy (% covered by a prescription on a given day of those prescribed a statin within 6 months). The influences of co-morbidities and socio-economic deprivation (Index of Multiple Deprivation) were examined. Statin initiation increased from 37% for MIs in 1997 to 92% in 2006. Continuation at 1 year remained stable over successive cohorts at approximately 80%, settling to about 76% in patients with 5-10 years follow up. Younger age, affluence, revascularisation in 6 months after MI, and absence of congestive heart failure, predicted higher initiation and continuation; a diagnosis of hypertension or diabetes predicted higher initiation, while smoking was associated with poorer continuation. Men had higher initiation and continued therapy, but these effects were largely explained by their younger age. Type of statin initially prescribed did not influence continued usage. CONCLUSION Statin use after MI increased markedly between 1997 and 2006, whilst continued therapy remained high and stable. Importantly, first choice of statin had no effect on continuation. Whilst the high current levels of initiation may have reached a ceiling, increasing continuation rates among smokers, older patients and those from lower socio-economic groups, should remain a priority.
Collapse
|
81
|
Eldeeb SM, Abdelmoula WM, Shah SM, Fahmy AS. Quantitative assessment of age-related macular degeneration using parametric modeling of the leakage transfer function: preliminary results. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2012:5967-5970. [PMID: 23367288 DOI: 10.1109/embc.2012.6347353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Age-related macular degeneration (AMD) is a major cause of blindness and visual impairment in older adults. The wet form of the disease is characterized by abnormal blood vessels forming a choroidal neovascular membrane (CNV), that result in destruction of normal architecture of the retina. Current evaluation and follow up of wet AMD include subjective evaluation of Fluorescein Angiograms (FA) to determine the activity of the lesion and monitor the progression or regression of the disease. However, this subjective evaluation prevents accurate monitoring of the disease progression or regression in response to a pharmacologic agent. In this work, we present a method that allows objective assessment of the activity of a CNV lesion which can be statistically compared across different patient and time points. The method is based on a hypothesis that the discrepancy in the time-intensity signals among the diseased and normal retinal areas are due to an implicit transfer function whose parameters can be used to characterize the retina. The method begins with parametric modeling of the temporal variation of the lesion and background intensities. Then, the values of the model parameters are used to evaluate the change in the activity of the disease. Preliminary results on five datasets show that the calculated parameters are highly correlated with the Visual Acuity (VA) of the patients.
Collapse
|
82
|
Desai NR, Shah SM, Cohen J, McLaughlin M, Dalal HR. Zosyn (piperacillin/tazobactam) reformulation: Expanded compatibility and coadministration with lactated Ringer's solutions and selected aminoglycosides. Ther Clin Risk Manag 2011; 4:303-14. [PMID: 18728835 PMCID: PMC2504059 DOI: 10.2147/tcrm.s2564] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Zosyn® , also known as Tazocin® for injection, contains piperacillin and tazobactam and was approved by the US Food and Drug Administration in 1993 for the treatment of indicated serious infections. In 1995, United States Pharmacopoeia and European Pharmacopoeias reduced the particulate limit for injectables by 40%, based on general safety concerns. Wyeth attempted to control sporadic batch failures (associated with increased particulate formation) by shortening product expiration dating from 36 to 24 months and optimizing the stopper siliconization process. These modifications did not correct the problem completely. Wyeth reformulated Zosyn by incorporating two stabilizing functional excipients, ethylene diamine tetraacetic acid disodium salt (EDTA disodium) and sodium citrate, which solved the particulate formation problem. These two functional excipients also allowed for the first time Y-site coadministration of reformulated Zosyn product with amikacin and gentamicin at specific doses and concentrations, and with certain diluents, and the use of Ca++ ion-containing Lactated Ringer’s for admixture preparation. Reformulated Zosyn (approved 2005) may provide useful options of drug administration to healthcare professionals to lessen levels of particulates. Supportive data is provided for the expanded compatibility of reformulated Zosyn with different types of Ringer’s solutions used globally and for the Y-site coadministration of amikacin and gentamicin aminoglycosides.
Collapse
|
83
|
Lim HJ, Black TR, Shah SM, Sarker S, Metcalfe J. Evaluating repeated patient handling injuries following the implementation of a multi-factor ergonomic intervention program among health care workers. JOURNAL OF SAFETY RESEARCH 2011; 42:185-191. [PMID: 21855689 DOI: 10.1016/j.jsr.2011.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 04/06/2011] [Accepted: 05/18/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate repeated patient handling injuries following a multi-factor ergonomic intervention program among health care workers. METHODS This was a quasi-experimental study which had an intervention group and a non-randomized control group. Data were collected from six hospitals in Saskatchewan, Canada from September 1, 2001 to December 1, 2006. RESULTS A total of 1,480 individuals who had a previous injury were eligible for the study. Medium and small size hospitals in the intervention group had significantly fewer repeated injuries than in the control group. Multivariate analysis showed that the intervention group had 38.1% lower odds of having repeated injury compared to the control group, after adjusting for hospital size. CONCLUSIONS The work-related repeated injury after a multi-factor intervention program was reduced. The synergistic relationships between components of multi-factor intervention and applicability of injury prevention programs to different settings need to be further explored. IMPACT ON INDUSTRY Implementing a multi-factor program with the right equipment and training can lower the risk of injury among health care workers.
Collapse
|
84
|
Shah SM, Carey IM, Harris T, Dewilde S, Cook DG. Antipsychotic prescribing to older people living in care homes and the community in England and Wales. Int J Geriatr Psychiatry 2011; 26:423-34. [PMID: 20878663 DOI: 10.1002/gps.2557] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2010] [Accepted: 04/29/2010] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Excessive use of antipsychotic medication by older people is an international concern, but there is limited comparative information on their use in different residential settings. This paper describes and compares antipsychotic prescribing to older people in care homes and the community in England and Wales. METHOD Analysis of a primary care database (THIN) with 403 259 community and 10 387 care home residents aged 65-104 years in 2008-9. RESULTS 3677 (0.9%) patients in the community and 2173 (20.9%) in care homes (20.5% in residential homes, 21.7% in nursing homes) received an antipsychotic medication prescription in the last 90 days. Most patients had received prescriptions for more than three months and 60% of prescriptions were for atypical antipsychotics. In patients without severe mental illness, 2367 (0.6%) patients in the community and 1765 (18.2%) in care homes received antipsychotic medication; such prescribing was common for patients with recorded dementia (30.2% in care home, 10.1% in the community). In care homes, younger age and living in the North of England predicted prescribing, but care home type did not. In the community, female gender, increasing age, living in a deprived area and the North predicted prescribing. CONCLUSIONS Despite safety concerns, antipsychotic prescribing is markedly higher in care homes than in the community, and strongly associated with dementia in both settings. In England and Wales, we estimate that 54 000 older care home patients and 50 000 community patients receive antipsychotic medication without a diagnosis of severe mental illness with important implications for health and social services.
Collapse
|
85
|
Black TR, Shah SM, Busch AJ, Metcalfe J, Lim HJ. Effect of transfer, lifting, and repositioning (TLR) injury prevention program on musculoskeletal injury among direct care workers. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2011; 8:226-235. [PMID: 21400388 DOI: 10.1080/15459624.2011.564110] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Musculoskeletal injuries among health care workers is very high, particularly so in direct care workers involved in patient handling. Efforts to reduce injuries have shown mixed results, and strong evidence for intervention effectiveness is lacking. The purpose of our study was to evaluate the effectiveness of a Transfer, Lifting and Repositioning (TLR) program to reduce musculoskeletal injuries (MSI) among direct health care workers. This study was a pre- and post-intervention design, utilizing a nonrandomized control group. Data were collected from the intervention group (3 hospitals; 411 injury cases) and the control group (3 hospitals; 355 injury cases) for periods 1 year pre- and post-intervention. Poisson regression analyses were performed. Of a total 766 TLR injury cases, the majority of injured workers were nurses, mainly with back, neck, and shoulder body parts injured. Analysis of all injuries and time-loss rates (number of injuries/100 full-time employees), rate ratios, and rate differences showed significant differences between the intervention and control groups. All-injuries rates for the intervention group dropped from 14.7 pre-intervention to 8.1 post-intervention. The control group dropped from 9.3 to 8.4. Time-loss injury rates decreased from 5.3 to 2.5 in the intervention group and increased in the control group (5.9 to 6.5). Controlling for group and hospital size, the relative rate of all-injuries and time-loss injuries for the pre- to post-period decreased by 30% (RR = 0.693; 95% CI = 0.60-0.80) and 18.6% (RR = 0.814; 95% CI = 0.677-0.955), respectively. The study provides evidence for the effectiveness of a multifactor TLR program for direct care health workers, especially in small hospitals.
Collapse
|
86
|
Campochiaro PA, Hafiz G, Channa R, Shah SM, Nguyen QD, Ying H, Do DV, Zimmer-Galler I, Solomon SD, Sung JU, Syed B. Antagonism of Vascular Endothelial Growth Factor for Macular Edema Caused by Retinal Vein Occlusions: Two-Year Outcomes. Ophthalmology 2010; 117:2387-2394.e1-5. [DOI: 10.1016/j.ophtha.2010.03.060] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 03/23/2010] [Accepted: 03/26/2010] [Indexed: 10/19/2022] Open
|
87
|
Lee KK, Shah SM, Moser MA. Risk factors predictive of severe diverticular hemorrhage. Int J Surg 2010; 9:83-5. [PMID: 20937418 DOI: 10.1016/j.ijsu.2010.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 09/18/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND Diverticular disease is a common cause for lower gastrointestinal bleeding. Although the hemorrhage often resolves spontaneously, some patients will require massive transfusions and emergency surgery. In this study we report risk factors predictive of severe diverticular bleeds. METHODS We completed a retrospective analysis of 99 patients, admitted with lower gastrointestinal bleeding and colonoscopic evidence of diverticulosis and no other cause of the hemorrhage between January 1995 and December 2005. A database was generated and univariate and multivariate analyses were carried out. RESULTS Of the 99 patients, 23 patients were classified as having a severe bleed defined as having a systolic blood pressure below 90 mm Hg, requirement for more than 6 units of transfusion, or emergent surgery. Multiple logistic regression showed that the initial hemoglobin (p = 0.001), INR ≥ 1.5 (p = 0.003), initial diastolic blood pressure (p = 0.024), initial heart rate (p = 0.047), and blood pressure medications (p = 0.049) predicted severe diverticular hemorrhage. CONCLUSIONS The identified predictor variables are all quantifiable at the time of initial presentation, and these may help identify severe cases of diverticular bleeding requiring urgent management.
Collapse
|
88
|
Agarwal MM, Dhatt GS, Shah SM. Gestational diabetes mellitus: simplifying the international association of diabetes and pregnancy diagnostic algorithm using fasting plasma glucose. Diabetes Care 2010; 33:2018-20. [PMID: 20519664 PMCID: PMC2928355 DOI: 10.2337/dc10-0572] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the impact of the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria on 1) gestational diabetes mellitus (GDM) diagnosis compared with the American Diabetes Association (ADA) criteria and 2) the fasting plasma glucose (FPG) to predict GDM. RESEARCH DESIGN AND METHODS In 10,283 pregnant women undergoing a 75-g oral glucose tolerance test (OGTT) for universal screening of GDM, two FPG thresholds (of the OGTT) were used to rule in and to rule out GDM. RESULTS The IADPSG and ADA criteria identified GDM in 3,875 (37.7%) women and 1,328 (12.9%) women, respectively (P < 0.0005). FPG thresholds of >or=5.1 mmol/l ruled in GDM in 2,975 (28.9%) women with 100% specificity, while <4.4 mmol/l ruled out GDM in 2,228 (21.7%) women with 95.4% sensitivity. FPG independently could have avoided the OGTT in 5,203 (50.6%) women. CONCLUSIONS The IADPSG criteria increased GDM prevalence nearly threefold. By circumventing a significant number of OGTTs, an initial FPG can greatly simplify the IADPSG diagnostic algorithm.
Collapse
|
89
|
Nikfarjam M, Kimchi ET, Gusani NJ, Shah SM, Sehmbey M, Shereef S, Staveley-O'Carroll KF. A reduction in delayed gastric emptying by classic pancreaticoduodenectomy with an antecolic gastrojejunal anastomosis and a retrogastric omental patch. J Gastrointest Surg 2009; 13:1674-82. [PMID: 19548039 DOI: 10.1007/s11605-009-0944-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Accepted: 06/03/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND Delayed gastric emptying (DGE) continues to be a major cause of morbidity following pancreaticoduodenectomy (PD). A change in the method of reconstruction following PD was instituted in an attempt to reduce the incidence DGE. METHODS Patients undergoing PD from January 2002 to December 2008 were reviewed and outcomes determined. Pylorus-preserving pancreaticoduodenectomy (PPPD) with a retrocolic duodenojejunal anastomosis (n = 79) or a classic PD with a retrocolic gastrojejunostomy (n = 36) was performed prior to January 2008. Thereafter, a classic PD with an antecolic gastrojejunal anastomosis and placement of a retrogastric vascular omental patch was undertaken (n = 36). RESULTS A statistically significant decrease in DGE was noted in the antecolic group compared to the entire retrocolic group (14% vs 40%; p = 0.004) and compared to patients treated by classic PD with a retrocolic anastomosis alone (14% vs 39%; p = 0.016). On multivariate analysis, the only modifiable factor associated with reduced DGE was the antecolic technique with an omental patch, odds ratio (OR) 0.3 (confidence interval (CI) 0.1-0.8) p = 0.022. Male gender was associated with an increased risk of DGE with OR 2.3 (CI 1.1-4.8) p = 0.026. CONCLUSION A classic PD combined with an antecolic anastomosis and retrogastric vascular omental patch results in a significant reduction in DGE.
Collapse
|
90
|
Labarthe DR, Dai S, Day RS, Fulton JE, Grunbaum JA, Shah SM, Wen E. Project HeartBeat! Concept, development, and design. Am J Prev Med 2009; 37:S9-16. [PMID: 19524162 PMCID: PMC4465373 DOI: 10.1016/j.amepre.2009.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 10/30/2008] [Accepted: 04/16/2009] [Indexed: 11/28/2022]
Abstract
Major cardiovascular disease (CVD) risk factors begin development in childhood and adolescence. Project HeartBeat! studied early development of these risk factors as growth processes. Growth, body composition, sexual maturation, major CVD risk factors, and cardiac structure and function were monitored every 4 months for up to 4 years among 678 children and adolescents (49.1% girls; 20.1% blacks) aged 8, 11, or 14 years at study entry. All resided in The Woodlands or Conroe TX. Interviews were conducted at entry and annually on diet, physical activity, and health history of participants and their families. Data were collected from 1991 to 1995, and study investigators continue data analysis and reporting. Overlap in ages at examination among three cohorts (aged 8-12, 11-15, and 14-18 years at baseline) and use of multilevel modeling methods permit analysis of some 5500 observations on each principal variable for the synthetic cohort from ages 8 to 18 years. The mixed-longitudinal design provides trajectories of change with age, for total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides; systolic, and fourth-phase and fifth-phase diastolic blood pressure, and left ventricular mass. These trajectories are then related to concurrent measures of multiple indices of body composition and sexual maturation and adjusted for energy intake and physical activity. The data provide valuable insights into risk factor development and suggest a fresh approach to understanding influences on blood lipids, blood pressure, and left ventricular mass during the period of childhood and adolescence, a period of dynamic change in these risk factors.
Collapse
|
91
|
Labarthe DR, Dai S, Fulton JE, Harrist RB, Shah SM, Eissa MA. Systolic and fourth- and fifth-phase diastolic blood pressure from ages 8 to 18 years: Project HeartBeat! Am J Prev Med 2009; 37:S86-96. [PMID: 19524161 DOI: 10.1016/j.amepre.2009.04.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 10/30/2008] [Accepted: 04/16/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Systolic and fourth-phase and fifth-phase diastolic blood pressure (SBP, DBP4, DBP5) have appeared to differ in their patterns of age-related change, and SBP and DBP5 differ in their respective associations with anthropometric variables. Project HeartBeat! investigated trajectories of change in SBP, DBP4, and SBP5 with age and their relationships with indices of adiposity, controlling for energy intake, physical activity, and sexual maturation. METHODS Project HeartBeat! was a mixed longitudinal study in 678 black and white girls and boys aged 8, 11, or 14 years at first examination, followed at 4-month intervals for up to 4 years (1991-1995). A statistical model was estimated for the trajectory of change in each blood pressure measure from ages 8 to 18 years. RESULTS For SBP, DBP4, and DBP5, the trajectories were sigmoid, parabolic, and linear in form, respectively. SBP and DBP4 differed significantly by gender; DBP4 and DBP5 were significantly related to race. Adjusted for age, gender, and race, all relationships of adiposity-related variables (percent body fat, abdominal circumference, skinfold thickness, and BMI and its fat and fat-free components) with SBP were positive and significant. Corresponding relationships for DBP4 were notably weaker but significant, and for DBP5, weak or not significant. After adjusting for diet, physical inactivity, and maturation, no DBP5 relationship with adiposity indices remained significant. CONCLUSIONS SBP, DBP4, and DBP5 are distinct in patterns of change with age, relationships to gender and race, and patterns of association with multiple anthropometric indices related to adiposity.
Collapse
|
92
|
Fulton JE, Dai S, Steffen LM, Grunbaum JA, Shah SM, Labarthe DR. Physical activity, energy intake, sedentary behavior, and adiposity in youth. Am J Prev Med 2009; 37:S40-9. [PMID: 19524155 PMCID: PMC5821119 DOI: 10.1016/j.amepre.2009.04.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Revised: 10/30/2008] [Accepted: 04/15/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND It is unclear to what extent factors affecting energy balance contribute to the development of body fatness in youth. The objective of the current study was to describe the relationship of physical activity, energy intake, and sedentary behavior to BMI, fat free-mass index (FFMI), and fat mass index (FMI) in children aged 10-18 years. METHODS In the subsample studied, participants were 245 girls and 227 boys (aged > or =10 years at entry or during follow-up assessments, or aged 11-14 years at entry) followed for 4 years from entry at ages 8, 11, or 14 years. At baseline and anniversary examinations, trained interviewers used a questionnaire to assess time spent daily in moderate-to-vigorous physical activity (MVPA), sedentary behavior, and energy intake (kcal/day). Sexual maturation was assessed by direct observation of pubic-hair development (Tanner Stages 1-5). Triplicate recordings of height and weight were used to estimate BMI by the standard formula (kg/m(2)); bioelectric impedance was used to estimate percent body fat for calculating FFMI and FMI (kg/m(2)). Multilevel models were used to examine the association of MVPA, energy intake, and sedentary behavior with BMI, FFMI, and FMI. Data were analyzed in 2007-2008. RESULTS Energy intake was unrelated to FMI or FFMI in models adjusted for age or sexual maturation or in any model to BMI. Sedentary behavior was unrelated to FMI in any model or to FFMI or BMI in models adjusted for age or sexual maturation. MVPA was inversely related to FMI. CONCLUSIONS In children aged 10-18 years, MVPA was inversely associated with fat mass and with BMI. Investigations in youth of dietary intake and physical activity, including interventions to prevent or reverse overweight as represented by BMI, should address its fat and lean components and not BMI alone.
Collapse
|
93
|
Do DV, Nguyen QD, Shah SM, Browning DJ, Haller JA, Chu K, Yang K, Cedarbaum JM, Vitti RL, Ingerman A, Campochiaro PA. An exploratory study of the safety, tolerability and bioactivity of a single intravitreal injection of vascular endothelial growth factor Trap-Eye in patients with diabetic macular oedema. Br J Ophthalmol 2009; 93:144-9. [DOI: 10.1136/bjo.2008.138271] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
94
|
Nowshad G, Shah SM, Bano R, Alam S, Alvi A, Jehan N. Correlates Of Access To Antenatal Care In Villages Of Pakistan. Ann Epidemiol 2008. [DOI: 10.1016/j.annepidem.2008.08.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
95
|
Ferguson LW, Rajput ML, Muhajarine N, Shah SM, Rajput A. Clinical features at first visit and rapid disease progression in Parkinson's disease. Parkinsonism Relat Disord 2008; 14:431-5. [DOI: 10.1016/j.parkreldis.2007.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Revised: 09/24/2007] [Accepted: 10/14/2007] [Indexed: 10/22/2022]
|
96
|
Clatney L, Macdonald H, Shah SM. Mental health care in the primary care setting: family physicians' perspectives. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2008; 54:884-889. [PMID: 18556498 PMCID: PMC2426969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To assess family physicians' interactions with mental health professionals (MHPs), their satisfaction with the delivery of mental health care in primary health care settings, and their perceptions of areas for improvement. DESIGN Mailed survey. SETTING Province of Saskatchewan. PARTICIPANTS All FPs in Saskatchewan (N = 816) were invited to participate in the study; 31 were later determined to be ineligible because they were specialist physicians, were no longer practising regularly, or could not be located. MAIN OUTCOME MEASURES Family physicians' self-reported satisfaction with and interest in mental health care; perceived strengths and areas for improvement in the quality of mental health care delivery in primary health care settings. RESULTS The response rate was 48%, with 375 FPs completing the survey. More than half of the responding FPs (56%) reported seeing 11 or more patients with mental health problems per week. Although 83% of responding FPs were interested or very interested in identifying or treating mental health problems, fewer than half (46%) reported being satisfied with the mental health care they were able to deliver. Family physician satisfaction was significantly higher among those with on-site MHPs (P < .05) and those who saw fewer patients with mental health problems per week (P < .01). The most common mode of interaction that FPs reported having with MHPs was through written correspondence; somewhat less common were telephone and face-to-face interactions. The most common strength FPs identified in their provision of mental health care was having access to psychiatrists, community mental health nurses, and other MHPs. The most common area for improvement in primary mental health care also fell under the category of access. Specifically, FPs felt access to psychiatrists needed to be improved. CONCLUSION Mental health problems are very common in primary care. Most FPs are very interested in the detection and treatment of mental health problems. Despite this high level of interest, however, FPs are generally dissatisfied with the quality of mental health care they are able to provide. Access to MHPs was cited as a critical element in improving the delivery of mental health services in primary care.
Collapse
|
97
|
Shah SM, Cook DG. Socio-economic determinants of casualty and NHS Direct use. J Public Health (Oxf) 2008; 30:75-81. [PMID: 18216300 DOI: 10.1093/pubmed/fdn001] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is limited evidence on the social determinants of A&E use and concerns over the equity of NHS Direct utilization. METHODS We analysed data from the 2004-05 British General Household Survey, which included 20,421 participants. Logistic regression was used to examine individual casualty use in the last 3 months and household NHS Direct use in the last year. RESULTS Casualty use was higher for individuals living in rented accommodation or without car access, lower income groups, unskilled manual workers, current smokers and for individuals with limiting illness. In contrast, NHS Direct use was lower in households with older residents, low income, no car access and where the head of household was from a manual occupational group, a minority ethnic group or born outside the UK. The odds ratio for use of NHS Direct for households in the lowest equivalized income quintile was 0.67 (0.55-0.81). Adjustment for limiting illness increased the effect of socio-economic factors on NHS Direct use. CONCLUSIONS Reduced access to A&E services will disproportionately affect poorer individuals, whereas increased investment in telephone services will benefit affluent populations. Current national policy may widen inequities in access to emergency care.
Collapse
|
98
|
Ghazi NG, Ciralsky JB, Shah SM, Campochiaro PA, Haller JA. Optical coherence tomography findings in persistent diabetic macular edema: the vitreomacular interface. Am J Ophthalmol 2007; 144:747-754. [PMID: 17869207 DOI: 10.1016/j.ajo.2007.07.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Revised: 07/11/2007] [Accepted: 07/11/2007] [Indexed: 11/23/2022]
Abstract
PURPOSE To assess the optical coherence tomography (OCT) characteristics of eyes with persistent clinically significant diabetic macular edema (PDME) after focal laser treatment, with emphasis on the vitreomacular interface (VMI) characteristics. DESIGN Prospective, observational case series. METHODS Fifty eyes with PDME after at least one focal laser treatment were enrolled prospectively. Slit-lamp biomicroscopy, stereoscopic fundus photography, fluorescein angiography (FA), and OCT were performed for each eye. The main outcome measures included the detection rate of VMI abnormalities (VMIA) by OCT in comparison with biomicroscopy, fundus photography, and FA (traditional techniques); the relationship between VMIA and the number of focal laser sessions per eye and FA leakage pattern. RESULTS Two of 50 eyes were excluded because of incomplete data. For the remaining 48 eyes, 25 eyes (52.1%) demonstrated definite VMIA, including anomalous vitreal adhesions, epiretinal membrane (ERM), or both, and six eyes (12.5%) had questionable VMIA. OCT in general was 1.94 times more sensitive than traditional techniques combined in detecting VMIA (P = .00003). The number of focal laser sessions and diffuse FA leakage were not associated with an increased prevalence of VMIA (P = .13 and P = .47, respectively). CONCLUSIONS This study demonstrates a high prevalence of VMIA in eyes with PDME after focal laser treatment and underscores the superiority of OCT in detecting these abnormalities. OCT evaluation of eyes with PDME may be helpful in identifying VMIA, which may impact treatment selection and patient subgroup stratification.
Collapse
|
99
|
Desai NR, Shah SM, Koczone J, Vencl-Joncic M, Sisto C, Ludwig SA. Zinc content of commercial diluents widely used in drug admixtures prepared for intravenous infusion. INTERNATIONAL JOURNAL OF PHARMACEUTICAL COMPOUNDING 2007; 11:426-432. [PMID: 23969523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
During ongoing quality improvement efforts with two Wyeth parenteral products, Protonix and Zosyn, we noted that dosing solutions prepared from the products yielded inconsistent results on the United States Pharmacopeia Chapter 788 test for subvisible particulates. This manuscript discusses variables that have a direct impact on intravenous products meeting compendial monograph specifications under conditions that are encountered in the clinical setting. The rubber stoppers of vials used for parenteral products, different parts of commercial admixture bags, and the tubing of the administration sets and devices contain residual amounts of metal ions, plasticizers, and other additives incorparated for specific functions. The transition metal ions, including zinc and copper, may leach into drug products during manufacture and during storage of dosing admixture bags prepared for infusion in hospital pharmacies or clinics. The metal ions may compromise the quality of the infusion admixture through catalytic drug degradation and/or generation of undesirable metal ion complexes, which may convert soluble drug molecules into insoluble particulates. To preserve the quality of the drug product, it is essential that metal ion leachables be controlled proactively during manufacture of the drug product; knowledge of metal ion contents in the commercial diluents use for reconstitution, admixture preparation, and flushing of the administration lines is also critical.
Collapse
|
100
|
Abstract
Katayama syndrome is an early clinical manifestation of schistosomiasis that occurs several weeks post-infection with Schistosoma spp (trematode) worms. Because of this temporal delay and its non-specific presentation, it is the form of schistosomiasis most likely to be misdiagnosed by travel medicine physicians and infectious disease specialists in non-endemic countries. Katayama syndrome appears between 14-84 days after non-immune individuals are exposed to first schistosome infection or heavy reinfection. Disease onset appears to be related to migrating schistosomula and egg deposition with individuals typically presenting with nocturnal fever, cough, myalgia, headache, and abdominal tenderness. Serum antibodies and schistosome egg excretion often substantiate infection if detected. Diffuse pulmonary infiltrates are found radiologically, and almost all cases have eosinophilia and a history of water contact 14-84 days before presentation of clinical symptoms; patients respond well to regimens of praziquantel with and without steroids. Artemisinin treatment given early after exposure may decrease the risk of the syndrome.
Collapse
|