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Brkovic V, Nikolic G, Baralic M, Kravljaca M, Milinkovic M, Pavlovic J, Lausevic M, Radovic M. A Study on Mortality Predictors in Hemodialysis Patients Infected with COVID-19: Impact of Vaccination Status. Vaccines (Basel) 2023; 12:2. [PMID: 38276661 PMCID: PMC10819519 DOI: 10.3390/vaccines12010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 01/27/2024] Open
Abstract
The global outbreak of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has prompted significant public health concerns. This study focuses on 442 chronic hemodialysis patients diagnosed with COVID-19, emphasizing the impact of vaccination status on clinical outcomes. The study investigates the correlation between vaccination status and laboratory findings, aiming to identify predictive factors for mortality. Results indicate that vaccination status plays a crucial role in outcomes. Full vaccination, evidenced by two or three doses, is associated with better outcomes, including reduced incidence of bilateral pneumonia and lower risks of complications such as hemorrhage and thrombosis. Laboratory analyses reveal significant differences between vaccinated and unvaccinated patients in parameters like C-reactive protein, ferritin, and white blood cell counts. Univariate and multivariate Cox proportional hazards regression analyses identify several factors influencing mortality, including comorbidities, pneumonia development, and various inflammatory markers. In conclusion among hemodialysis patients affected by COVID-19 infection, vaccination with at least three doses emerges as a protective factor against fatal outcomes. Independent predictors of mortality are CRP levels upon admission, maximum CRP values during the illness and cardiovascular comorbidities. Noteworthy lymphocytopenia during infection exhibits a notable level of specificity and sensitivity in predicting mortality.
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Affiliation(s)
- Voin Brkovic
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Gorana Nikolic
- Institute of Pathology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marko Baralic
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milica Kravljaca
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marija Milinkovic
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jelena Pavlovic
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Mirjana Lausevic
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milan Radovic
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Kalala SS, Schumacher LM, Thomas JG, Lipton RB, Pavlovic J, Bond DS. Association of Migraine and Blood Pressure-Does Obesity Severity Have a Moderating Role? Int J Behav Med 2023:10.1007/s12529-023-10241-7. [PMID: 37973767 DOI: 10.1007/s12529-023-10241-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The relationship between migraine and blood pressure (BP) is equivocal, warranting exploration of potential moderators. Obesity associates with both migraine and BP in a dose-dependent fashion, although its role as a moderator has not been evaluated. We examined the relation between migraine and BP in women with comorbid migraine and obesity, and whether this relation was influenced by obesity severity. METHODS Women with migraine and obesity (n = 134) completed a 28-day headache diary before randomization to lifestyle intervention or migraine education. BP (systolic (SBP)/diastolic (DBP)), body mass index (BMI), and waist circumference (WC) were measured before diary completion. Hierarchical linear regression assessed associations between BP and migraine characteristics (headache frequency, duration, and pain intensity), and obesity severity (both total (BMI) and abdominal (WC)) as moderators of these associations. RESULTS Participants (BMI = 35.4 ± 6.5 kg/m2; WC = 105.4 ± 15.6 cm, SBP = 113.1 ± 12.1/DPB = 68.1 ± 8.0 mmHg) reported 8.4 ± 4.5 migraine days that lasted 20.2 ± 15.9 h with mean pain intensity of 5.9 ± 1.6 on a 10-point scale. DBP inversely related to migraine days in both total (β = - 0.226, p = .010) and abdominal (β = 0.214, p = .015) obesity severity models. SBP and obesity severity did not relate to migraine characteristics. Obesity severity did not moderate relations between migraine characteristics and BP (p's > .05). CONCLUSION Among women with comorbid migraine and obesity, DBP inversely related to migraine frequency; however, obesity severity did not affect the strength of this or other examined associations. Future studies including healthy weight controls and men and women with continuous BP measures are needed to confirm these findings and identify mechanisms and moderators.
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Affiliation(s)
| | - Leah M Schumacher
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1801 N. Broad St, Philadelphia, PA, 19129, USA.
| | - J Graham Thomas
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital, Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Richard B Lipton
- Department of Neurology and the Montefiore Headache Center, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Jelena Pavlovic
- Department of Neurology and the Montefiore Headache Center, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Dale S Bond
- Departments of Surgery and Research, Hartford Hospital/Hartford HealthCare, Hartford, CT, USA
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Hadzivukovic N, Pavlovic J, Zivanovic S, Ivkovic N, Racic M. How Useful are Mid-Arm and Calf Circumferences to Indicate Reduced Muscle Mass in Order to Recognize GLIM-Defined Malnutrition in Elderly Individuals? Niger J Clin Pract 2023; 26:1652-1658. [PMID: 38044770 DOI: 10.4103/njcp.njcp_287_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/18/2023] [Indexed: 12/05/2023]
Abstract
AIMS The aim of this study was to estimate cutoff values of mid-upper arm circumference (MUAC) and calf circumference (CC) for reduced muscle mass and analyze their accuracy in identifying malnutrition among individuals of 65 years of age or older in Bosnia and Herzegovina. MATERIALS AND METHODS The study is a secondary analysis dataset assessing nutritional risk and malnutrition among 446 community-dwellers and nursing home residents in Bosnia and Herzegovina. Malnutrition assessment included phenotypic criterions (weight loss, low body mass index, and reduced muscle mass) and etiologic criterions (inadequate food intake, disease-related inflammation, or albumin levels) according to recommendations of the Global Leadership Initiative on Malnutrition (GLIM). Receiver operating curves were used to calculate MUAC and CC's cutoff values as compared to the Mini Nutritional Assessment (MNA). RESULTS The optimal cutoff value for MUAC in men was 24 cm (AUC = 0.910, sensitivity 100%, specificity 77%), and in women 23 cm (AUC = 0.792, sensitivity 64%, specificity 83%). Optimal cutoff value of CC in men was 31 cm (AUC = 0.818, sensitivity 100%, specificity 67%) and in women 29 cm (AUC = 0.882, sensitivity 86%, specificity 74%). Two hundred fifty nine elderly individuals were categorized as malnourished/at risk for malnutrition per MNA. The prevalence of malnutrition based on GLIM criteria ranged from 19% to 30%. CONCLUSIONS The study suggested that MUAC and CC may be used as the alternative indicators of muscle mass when other assessment methods are unavailable. Future validation and reliability studies for GLIM using anthropometric parameters as a proxy of reduced muscle mass are needed.
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Affiliation(s)
- N Hadzivukovic
- Department of Nursing, Faculty of Medicine, University of East Sarajevo, Foca, Bosnia and Herzegovina
| | - J Pavlovic
- Department of Nursing, Faculty of Medicine, University of East Sarajevo, Foca, Bosnia and Herzegovina
| | - S Zivanovic
- Department of Nursing, Faculty of Medicine, University of East Sarajevo, Foca, Bosnia and Herzegovina
| | - N Ivkovic
- Department of Oral Rehabilitation, Faculty of Medicine, University of East Sarajevo, Foca, Bosnia and Herzegovina
| | - M Racic
- Department of Primary Health Care and Public Health, Faculty of Medicine, University of East Sarajevo, Foca, Bosnia and Herzegovina
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Kostic I, Nikolic N, Milanovic S, Milenkovic I, Pavlovic J, Paravinja A, Nikolic M. Silicon modifies leaf nutriome and improves growth of oak seedlings exposed to phosphorus deficiency and Phytophthora plurivora infection. Front Plant Sci 2023; 14:1265782. [PMID: 37705706 PMCID: PMC10495579 DOI: 10.3389/fpls.2023.1265782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/10/2023] [Indexed: 09/15/2023]
Abstract
Beneficial effects of silicon (Si) on plants have primarily been studied in crop species under single stress. Moreover, nutrient acquisition-based responses to combination of biotic and abiotic stresses (a common situation in natural habitats) have rarely been reported, in particular in conjunction with soil amendments with Si. Pedunculate oak (Quercus robur L.), one of the ecologically and economically most important tree species in Europe, is facing a severe decline due to combined stresses, but also problems in assisted regeneration in nurseries. Here, we studied the effect of Si supply on the leaf nutriome, root traits and overall growth of 12-weeks-old oak seedlings exposed to abiotic stress [low phosphorus (P) supply], biotic stress (Phytophthora plurivora root infection), and their combination. The application of Si had the strongest ameliorative effect on growth, root health and root phenome under the most severe stress conditions (i.e., combination of P deficiency and P. plurivora root infection), where it differentially affected the uptake and leaf accumulation in 11 out of 13 analysed nutrients. Silicon supply tended to reverse the pattern of change of some, but not all, leaf nutrients affected by stresses: P, boron (B) and magnesium (Mg) under P deficiency, and P, B and sulphur (S) under pathogen attack, but also nickel (Ni) and molybdenum (Mo) under all three stresses. Surprisingly, Si affected some nutrients that were not changed by a particular stress itself and decreased leaf Mg levels under all the stresses. On the other hand, pathogen attack increased leaf accumulation of Si. This exploratory work presents the complexity of nutrient crosstalk under three stresses, and opens more questions about genetic networks that control plant physiological responses. Practically, we show a potential of Si application to improve P status and root health in oak seedlings, particularly in nurseries.
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Affiliation(s)
- Igor Kostic
- Laboratory of Plant Nutrition, Institute for Multidisciplinary Research, University of Belgrade, Belgrade, Serbia
| | - Nina Nikolic
- Laboratory of Plant Nutrition, Institute for Multidisciplinary Research, University of Belgrade, Belgrade, Serbia
| | - Slobodan Milanovic
- Faculty of Forestry, University of Belgrade, Belgrade, Serbia
- Faculty of Forestry and Wood Technology, Mendel University in Brno, Brno, Czechia
| | - Ivan Milenkovic
- Faculty of Forestry, University of Belgrade, Belgrade, Serbia
- Faculty of Forestry and Wood Technology, Mendel University in Brno, Brno, Czechia
| | - Jelena Pavlovic
- Laboratory of Plant Nutrition, Institute for Multidisciplinary Research, University of Belgrade, Belgrade, Serbia
| | - Ana Paravinja
- Laboratory of Plant Nutrition, Institute for Multidisciplinary Research, University of Belgrade, Belgrade, Serbia
| | - Miroslav Nikolic
- Laboratory of Plant Nutrition, Institute for Multidisciplinary Research, University of Belgrade, Belgrade, Serbia
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Hajiboland R, Moradi A, Kahneh E, Poschenrieder C, Nazari F, Pavlovic J, Tolra R, Salehi-Lisar SY, Nikolic M. Weed Species from Tea Gardens as a Source of Novel Aluminum Hyperaccumulators. Plants (Basel) 2023; 12:plants12112129. [PMID: 37299108 DOI: 10.3390/plants12112129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
Increased availability of toxic Al3+ is the main constraint limiting plant growth on acid soils. Plants adapted to acid soils, however, tolerate toxic Al3+, and some can accumulate Al in their aerial parts to a significant degree. Studies on Al-tolerant and Al-accumulating species have mainly focused on the vegetation of acid soils distributed as two global belts in the northern and southern hemispheres, while acid soils formed outside these regions have been largely neglected. The acid soils (pH 3.4-4.2) of the tea plantations in the south Caspian region of Northern Iran were surveyed over three seasons at two main locations. Aluminum and other mineral elements (including nutrients) were measured in 499 plant specimens representing 86 species from 43 families. Al accumulation exceeding the criterion for accumulator species (>1000 µg g-1 DW) was found in 36 species belonging to 23 families of herbaceous annual or perennial angiosperms, in addition to three bryophyte species. Besides Al, Fe accumulation (1026-5155 µg g-1 DW) was also observed in the accumulator species that exceeded the critical toxicity concentration, whereas no such accumulation was observed for Mn. The majority of analyzed accumulator plants (64%) were cosmopolitan or pluriregional species, with a considerable rate of Euro-Siberian elements (37%). Our findings, which may contribute to phylogenetic studies of Al accumulators, also suggest suitable accumulator and excluder species for the rehabilitation of acid-eroded soils and introduce new model species for investigating Al accumulation and exclusion mechanisms.
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Affiliation(s)
- Roghieh Hajiboland
- Department of Plant, Cell and Molecular Biology, University of Tabriz, Tabriz 51666-16471, Iran
| | - Aiuob Moradi
- Watershed Management and Forests and Rangelands Research Department, Guilan Agricultural and Natural Resources Research and Education Center, Agricultural Research, Education and Extension Organization (AREEO), Rasht 41635-3394, Iran
| | - Ehsan Kahneh
- Tea Research Center, Iran Horticultural Science Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Lahijan 44159-77788, Iran
| | - Charlotte Poschenrieder
- Plant Physiology Laboratory, Bioscience Faculty, Universidad Autónoma de Barcelona, 08193 Bellaterra, Spain
| | - Fatemeh Nazari
- Department of Plant, Cell and Molecular Biology, University of Tabriz, Tabriz 51666-16471, Iran
| | - Jelena Pavlovic
- Institute for Multidisciplinary Research, University of Belgrade, Kneza Viseslava 1, 11030 Belgrade, Serbia
| | - Roser Tolra
- Plant Physiology Laboratory, Bioscience Faculty, Universidad Autónoma de Barcelona, 08193 Bellaterra, Spain
| | | | - Miroslav Nikolic
- Institute for Multidisciplinary Research, University of Belgrade, Kneza Viseslava 1, 11030 Belgrade, Serbia
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Savic J, Pavlovic J, Stanojevic M, Bosnic P, Kostic Kravljanac L, Nikolic N, Nikolic M. Silicon Differently Affects Apoplastic Binding of Excess Boron in Wheat and Sunflower Leaves. Plants (Basel) 2023; 12:1660. [PMID: 37111882 PMCID: PMC10144595 DOI: 10.3390/plants12081660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/04/2023] [Accepted: 04/13/2023] [Indexed: 06/19/2023]
Abstract
Monocots and dicots differ in their boron (B) requirement, but also in their capacity to accumulate silicon (Si). Although an ameliorative effect of Si on B toxicity has been reported in various crops, differences among monocots and dicots are not clear, in particular in light of their ability to retain B in the leaf apoplast. In hydroponic experiments under controlled conditions, we studied the role of Si in the compartmentation of B within the leaves of wheat (Triticum vulgare L.) as a model of a high-Si monocot and sunflower (Helianthus annuus L.) as a model of a low-Si dicot, with the focus on the leaf apoplast. The stable isotopes 10B and 11B were used to investigate the dynamics of cell wall B binding capacity. In both crops, the application of Si did not affect B concentration in the root, but significantly decreased the B concentration in the leaves. However, the application of Si differently influenced the binding capacity of the leaf apoplast for excess B in wheat and sunflower. In wheat, whose capacity to retain B in the leaf cell walls is lower than in sunflower, the continuous supply of Si is crucial for an enhancement of high B tolerance in the shoot. On the other hand, the supply of Si did not contribute significantly in the extension of the B binding sites in sunflower leaves.
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Affiliation(s)
- Jasna Savic
- Faculty of Agriculture, University of Belgrade, Nemanjina 6, 11080 Belgrade, Serbia
| | - Jelena Pavlovic
- Institute for Multidisciplinary Research, University of Belgrade, Kneza Viseslava 1, 11030 Belgrade, Serbia
| | - Milos Stanojevic
- Institute for Multidisciplinary Research, University of Belgrade, Kneza Viseslava 1, 11030 Belgrade, Serbia
- Faculty of Sciences and Mathematics, University of Pristina in Kosovska Mitrovica, Lole Ribara 29, 38220 Kosovska Mitrovica, Serbia
| | - Predrag Bosnic
- Institute for Multidisciplinary Research, University of Belgrade, Kneza Viseslava 1, 11030 Belgrade, Serbia
| | - Ljiljana Kostic Kravljanac
- Institute for Multidisciplinary Research, University of Belgrade, Kneza Viseslava 1, 11030 Belgrade, Serbia
| | - Nina Nikolic
- Institute for Multidisciplinary Research, University of Belgrade, Kneza Viseslava 1, 11030 Belgrade, Serbia
| | - Miroslav Nikolic
- Institute for Multidisciplinary Research, University of Belgrade, Kneza Viseslava 1, 11030 Belgrade, Serbia
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Schumacher LM, Farris SG, Thomas JG, Lipton RB, Pavlovic J, Vgontzas A, Bond DS. Interrelationships of Sleep Quality, Obesity Severity, and Clinical Headache Features among Women with Comorbid Migraine and Obesity. J Clin Med 2023; 12:1742. [PMID: 36902529 PMCID: PMC10003353 DOI: 10.3390/jcm12051742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/01/2023] [Accepted: 02/09/2023] [Indexed: 02/24/2023] Open
Abstract
Obesity and migraine are often comorbid. Poor sleep quality is also common among individuals with migraine and may be influenced by comorbidities such as obesity. However, understanding of migraine's relationship with sleep and the potential exacerbating effect of obesity remains limited. This study evaluated the associations of migraine characteristics and clinical features with sleep quality among women with comorbid migraine and overweight/obesity and assessed the interplay between obesity severity and migraine characteristics/clinical features in relation to sleep quality. Women seeking treatment for migraine and obesity (n = 127; NCT01197196) completed a validated questionnaire assessing sleep quality (Pittsburgh Sleep Quality Index-PSQI). Migraine headache characteristics and clinical features were assessed using smartphone-based daily diaries. Weight was measured in-clinic, and several potential confounders were assessed using rigorous methods. Nearly 70% of participants endorsed poor sleep quality. Greater monthly migraine days and the presence of phonophobia related to poorer sleep quality, and specifically poorer sleep efficiency, controlling for confounders. Obesity severity was neither independently associated nor interacted with migraine characteristics/features to predict sleep quality. Poor sleep quality is common among women with comorbid migraine and overweight/obesity, although obesity severity does not appear to uniquely relate to or exacerbate the association between migraine and sleep in this population. Results can guide research on mechanisms of the migraine-sleep link and inform clinical care.
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Affiliation(s)
- Leah M. Schumacher
- Department of Kinesiology, College of Public Health, Temple University, 1800 N. Broad St., Philadelphia, PA 19121, USA
| | - Samantha G. Farris
- Department of Psychology, Rutgers, The State University of New Jersey, 53 Avenue East, 211 Tillett Hall, Piscataway, NJ 08854, USA
| | - J. Graham Thomas
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI 02903, USA
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond Street, Providence, RI 02903, USA
| | - Richard B. Lipton
- Department of Neurology and the Montefiore Headache Center, Albert Einstein College of Medicine, 1250 Waters Pl #8, The Bronx, NY 10461, USA
- Department of Neurology and the Montefiore Headache Center, Montefiore Medical Center, 1250 Waters Pl #8, The Bronx, NY 10461, USA
| | - Jelena Pavlovic
- Department of Neurology and the Montefiore Headache Center, Albert Einstein College of Medicine, 1250 Waters Pl #8, The Bronx, NY 10461, USA
- Department of Neurology and the Montefiore Headache Center, Montefiore Medical Center, 1250 Waters Pl #8, The Bronx, NY 10461, USA
| | - Angeliki Vgontzas
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, 60 Fenwood Rd 1st Floor, Boston, MA 02115, USA
| | - Dale S. Bond
- Departments of Surgery and Research, Hartford Hospital, 80 Seymour St., Hartford, CT 06102, USA
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MacGregor EA, Komori M, Krege JH, Baygani S, Vincent M, Pavlovic J, Igarashi H. Efficacy of lasmiditan for the acute treatment of perimenstrual migraine. Cephalalgia 2022; 42:1467-1475. [PMID: 35979677 DOI: 10.1177/03331024221118929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Perimenstrual migraine attacks in women with menstrual migraine is difficult to treat. This post-hoc analysis evaluated the efficacy of lasmiditan, a high affinity and selective 5-HT1F receptor agonist, for perimenstrual attacks. METHODS Patients from two randomized, double-blind, placebo-controlled clinical trials (MONONOFU and CENTURION) were instructed to treat an attack with a single dose of study medication within four hours of pain onset. After dosing, the proportion of patients who achieved freedom from migraine-related head pain, most bothersome symptom, and disability was reported at baseline up to 48 hours after dose and pooled data were evaluated. RESULTS A total of 303 patients (MONONOFU N = 78; CENTURION N = 225) treated perimenstrual migraine attacks with lasmiditan 50 mg (N = 24), 100 mg (N = 90), 200 mg (N = 110), and placebo (N = 79). More patients achieved migraine-related head pain freedom with lasmiditan 200 mg versus placebo at all time points assessed. At 2 hours, 33.6% of patients in the 200-mg group (p < 0.001), and 16.7% of patients in the 100-mg (p = 0.11) and 50-mg (p = 0.19) groups were pain free, compared with 7.6% in the placebo group. CONCLUSIONS Lasmiditan treatment of perimenstrual migraine attacks was associated with freedom from migraine-related head pain at two hours, early onset of efficacy, and sustained efficacy.Clinical Trial registration: NCT03962738 and NCT03670810.
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Affiliation(s)
- E Anne MacGregor
- Centre for Reproductive Medicine, St Bartholomew's Hospital, London, UK
| | | | | | | | | | | | - Hisaka Igarashi
- Department of Internal Medicine, Headache Care Unit, Fujitsu Clinic, Kawasaki, Japan
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Chatzipanagi A, Pavlovic J, Ktistakis M, Komnos D, Fontaras G. Evolution of European light-duty vehicle CO 2 emissions based on recent certification datasets. Transp Res D Transp Environ 2022; 107:103287. [PMID: 35784496 PMCID: PMC9231554 DOI: 10.1016/j.trd.2022.103287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A new vehicle testing procedure (WLTP - Worldwide Light duty vehicle Test Procedure) was introduced in the European Union (EU) in 2017. In order to examine its actual impact on CO2 emissions for different vehicle technologies and categories, this study analysed data from vehicles certified and registered in the EU in 2019 and 2020. It was found that in average, for all vehicles sold in 2020, the increase in CO2 emissions due to the intoduction of the WLTP was 21% for passenger cars and 27% for vans. Also that diesel vehicles are impacted more than gasoline ones and that the impact on conventional hybrid vehicles is 27% and plug-in hybrid vehicles between 0% (in 2020) and 11% (in 2019). Models employed revealed that the increase in CO2 is mainly due to the higher test masses and more realistic road load coefficients of WLTP that result in higher cycle energy demands. Moreover, results confirmed that the impact of the WLTP's introduction is in line, both in terms of absolute increase and variability, with model-based predictions performed before fleet-wide data were made available.
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Hyun J, Qin J, Wang C, Katz M, Pavlovic J, Derby C, Lipton R. Reliabilities of mean and variability of ambulatory pain among community dwelling older adults. Innov Aging 2021. [PMCID: PMC8969072 DOI: 10.1093/geroni/igab046.3221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Individual’s pain experiences vary substantially over time periods, and the variability in pain may be an important metric to predict health consequences. However, research on its reliability is lacking among older adults. We aimed to examine the reliabilities of both intra-individual mean (IIM) and intra-individual variability (IIV) of subjective pain reports assessed using ecological momentary assessments (EMA) among racially diverse, community dwelling older adults. Participants were from the Einstein Aging Study (N=311, age=70-91) and completed a 14-day EMA protocol which included self-reports of pain intensity 6 times a day. Pain IIV was quantified using intraindividual standard deviation (iSD). We followed Wang and Grimm(2012)’s approach to calculate the reliability of IIM and IIV. Over a 2-week period, we found excellent reliabilities for both pain IIM (.99) and pain IIV (.91), showing that these measures are reliable and can be used to link with various health outcomes among community dwelling older adults. We also estimated the average number of assessments that produce acceptable levels of reliability. The average of 2 assessments for pain IIM and 23 assessments for pain IIV produced values that exceeded reliability score of .80, suggesting that a briefer study design may be used to reduce participants’ burden with reliable pain metrics. Future studies need to examine whether pain IIV is associated with cognitive, emotional, and physical health among older adults and whether intervention studies that target to reduce pain IIV improve health consequences.
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Affiliation(s)
- Jinshil Hyun
- Albert Einstein College of Medicine, Bronx, New York, United States
| | - Jiyue Qin
- Albert Einstein College of Medicine, Bronx, New York, United States
| | - Cuiling Wang
- Albert Einstein College of Medicine, Bronx, New York, United States
| | - Mindy Katz
- Albert Einstein College of Medicine, Bronx, New York, United States
| | - Jelena Pavlovic
- Albert Einstein College of Medicine, Bronx, New York, United States
| | - Carol Derby
- Albert Einstein College of Medicine, Bronx, New York, United States
| | - Richard Lipton
- Albert Einstein College of Medicine, Bronx, New York, United States
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Knight E, Harrington E, Sliwinski M, Graham-Engeland J, Pavlovic J, Engeland C. Inflammatory Biomarkers and Sex Hormones Interact to Predict Ecologically-Assessed Cognitive Performance. Innov Aging 2021. [PMCID: PMC8682454 DOI: 10.1093/geroni/igab046.3616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Inflammatory biomarkers and sex hormones have been investigated as independent risk and resilience factors for cognitive decline in older adults. Many sex hormones are anti-inflammatory and there is emerging evidence that sex hormones may buffer the risk for cognitive decline associated with higher inflammation. However, few studies have included concurrent examination of inflammation and sex hormones in studies of cognitive performance and cognitive aging. A diverse sample of older adults (N = 245; 65% female, 42% Black, 13% Hispanic; mean age = 76.8 years) had blood drawn before and after a two-week measurement burst that included three cognitive tests (6x per day) assessing working spatial memory, perceptual speed, and feature binding. Testosterone, estradiol, estrone, and six basal cytokine concentrations were quantified. Composite scores of basal inflammation were calculated. Multilevel modeling indicated that heightened inflammation related to poorer spatial working memory performance (B = 0.213, 95%CI[0.11, 0.414], p = .040). In addition, sex hormones moderated the association of cytokine concentration with perceptual speed (e.g., basal cytokines x testosterone: B = 0.13, [-0.24, -0.03], p = 0.013; similar effects evident for estrogens). Decomposition these interactions revealed that heightened inflammation predicted poorer performance, but only among individuals with lower sex-hormone concentrations. This study provides evidence of immune and hormonal-by-immune associations with performance in two cognitive domains in older adults. Examining the functional crosstalk between immune and sex hormone functioning will improve understanding of risk and resilience factors related to cognitive performance and help predict cognitive decline in older adults.
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Affiliation(s)
- Erik Knight
- University of Colorado Boulder, Boulder, Colorado, United States
| | - Erin Harrington
- Pennsylvania State University, University Park, Pennsylvania, United States
| | - Martin Sliwinski
- The Pennsylvania State University, University Park, Pennsylvania, United States
| | | | - Jelena Pavlovic
- Albert Einstein College of Medicine, Bronx, New York, United States
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12
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Kiarashi J, Jion Y, Giglio B, Pavlovic J, Armand CE, Grosberg BM, Lipton RB, Vollbracht S, Robbins MS. Elective Hospitalizations for Intractable Headache: Outcomes and Response Predictors. Neurol Clin Pract 2021; 11:188-193. [PMID: 34484886 DOI: 10.1212/cpj.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/19/2020] [Indexed: 11/15/2022]
Abstract
Objective To review our inpatient experience treating a variety of headache disorders with heterogeneous therapies and to determine outcomes and predictors of response. Methods We conducted an institutional review board-approved retrospective chart review of elective inpatient headache admissions from the Montefiore Headache Center from 2014 to 2018. We examined factors associated with response and outcomes at discharge and posthospitalization follow-up in an intractable population. Patients received different classes of IV medications including antiemetics, neuroleptics, dihydroergotamine, lidocaine, steroids, valproic acid, and nerve blocks, and home preventive medications were either continued or changed before discharge. Improvements were defined at discharge by headache intensity compared with before hospitalization. Results Among the 83 admissions, pain improvement at discharge occurred in 90.4% (n = 75) of the overall sample, 89.5% (n = 60) of those with chronic migraine, 75.0% (n = 9) of patients with new daily persistent headache, and 89.5% (n = 34) of all those with acute medication overuse. Fifty-six patients (67.5%) reported improvement of a 3-or-more-point reduction in headache intensity at discharge, with a mean reduction of 4.84 ± SD 2.51 (range 1-10). Of the 66 patients who received IV dihydroergotamine, 59 (89.4%) of them improved at discharge. Of the 11 (13.2%) patients who received IV lidocaine, 7 (63.6%) improved. Of the 14 (16.9%) patients who received nerve blocks, all 14 (100%) improved at discharge. Of the 75 patients who had improved at discharge, 63 (84%) followed up and 50 (79.4%) of those patients remained improved. At the second follow-up, 68 (81.9%) patients returned for follow-up on average of 71 days (range 10-283) after discharge. Conclusions Our inpatient headache experience featured numerous treatments with high rates of improvement in the short and intermediate term for all headache disorders. These results may suggest that stratified hospitalized care including polytherapy may be useful for many patients.
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Affiliation(s)
- Jessica Kiarashi
- UT Southwestern Medical Center (JK), Dallas; National Neuroscience Institute (YJ), Singapore; NYU Langone Medical Center (BG); Montefiore Medical Center (JP, CEA, RBL), Bronx, NY; Hartford Healthcare Headache Center (BMG), West Hartford, CT; Columbia University Medical Center (SV), Westchester; and Weill Cornell Medicine (MSR), New York, NY
| | - Yasmin Jion
- UT Southwestern Medical Center (JK), Dallas; National Neuroscience Institute (YJ), Singapore; NYU Langone Medical Center (BG); Montefiore Medical Center (JP, CEA, RBL), Bronx, NY; Hartford Healthcare Headache Center (BMG), West Hartford, CT; Columbia University Medical Center (SV), Westchester; and Weill Cornell Medicine (MSR), New York, NY
| | - Brandon Giglio
- UT Southwestern Medical Center (JK), Dallas; National Neuroscience Institute (YJ), Singapore; NYU Langone Medical Center (BG); Montefiore Medical Center (JP, CEA, RBL), Bronx, NY; Hartford Healthcare Headache Center (BMG), West Hartford, CT; Columbia University Medical Center (SV), Westchester; and Weill Cornell Medicine (MSR), New York, NY
| | - Jelena Pavlovic
- UT Southwestern Medical Center (JK), Dallas; National Neuroscience Institute (YJ), Singapore; NYU Langone Medical Center (BG); Montefiore Medical Center (JP, CEA, RBL), Bronx, NY; Hartford Healthcare Headache Center (BMG), West Hartford, CT; Columbia University Medical Center (SV), Westchester; and Weill Cornell Medicine (MSR), New York, NY
| | - Cynthia E Armand
- UT Southwestern Medical Center (JK), Dallas; National Neuroscience Institute (YJ), Singapore; NYU Langone Medical Center (BG); Montefiore Medical Center (JP, CEA, RBL), Bronx, NY; Hartford Healthcare Headache Center (BMG), West Hartford, CT; Columbia University Medical Center (SV), Westchester; and Weill Cornell Medicine (MSR), New York, NY
| | - Brian M Grosberg
- UT Southwestern Medical Center (JK), Dallas; National Neuroscience Institute (YJ), Singapore; NYU Langone Medical Center (BG); Montefiore Medical Center (JP, CEA, RBL), Bronx, NY; Hartford Healthcare Headache Center (BMG), West Hartford, CT; Columbia University Medical Center (SV), Westchester; and Weill Cornell Medicine (MSR), New York, NY
| | - Richard B Lipton
- UT Southwestern Medical Center (JK), Dallas; National Neuroscience Institute (YJ), Singapore; NYU Langone Medical Center (BG); Montefiore Medical Center (JP, CEA, RBL), Bronx, NY; Hartford Healthcare Headache Center (BMG), West Hartford, CT; Columbia University Medical Center (SV), Westchester; and Weill Cornell Medicine (MSR), New York, NY
| | - Sarah Vollbracht
- UT Southwestern Medical Center (JK), Dallas; National Neuroscience Institute (YJ), Singapore; NYU Langone Medical Center (BG); Montefiore Medical Center (JP, CEA, RBL), Bronx, NY; Hartford Healthcare Headache Center (BMG), West Hartford, CT; Columbia University Medical Center (SV), Westchester; and Weill Cornell Medicine (MSR), New York, NY
| | - Matthew S Robbins
- UT Southwestern Medical Center (JK), Dallas; National Neuroscience Institute (YJ), Singapore; NYU Langone Medical Center (BG); Montefiore Medical Center (JP, CEA, RBL), Bronx, NY; Hartford Healthcare Headache Center (BMG), West Hartford, CT; Columbia University Medical Center (SV), Westchester; and Weill Cornell Medicine (MSR), New York, NY
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Pavlovic J, Kostic L, Bosnic P, Kirkby EA, Nikolic M. Interactions of Silicon With Essential and Beneficial Elements in Plants. Front Plant Sci 2021; 12:697592. [PMID: 34249069 PMCID: PMC8261142 DOI: 10.3389/fpls.2021.697592] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/27/2021] [Indexed: 05/18/2023]
Abstract
Silicon (Si) is not classified as an essential element for plants, but numerous studies have demonstrated its beneficial effects in a variety of species and environmental conditions, including low nutrient availability. Application of Si shows the potential to increase nutrient availability in the rhizosphere and root uptake through complex mechanisms, which still remain unclear. Silicon-mediated transcriptional regulation of element transporters for both root acquisition and tissue homeostasis has recently been suggested as an important strategy, varying in detail depending on plant species and nutritional status. Here, we summarize evidence of Si-mediated acquisition, uptake and translocation of nutrients: nitrogen (N), phosphorus (P), potassium (K), calcium (Ca), magnesium (Mg), sulfur (S), iron (Fe), zinc (Zn), manganese (Mn), copper (Cu), boron (B), chlorine (Cl), and nickel (Ni) under both deficiency and excess conditions. In addition, we discuss interactions of Si-with beneficial elements: aluminum (Al), sodium (Na), and selenium (Se). This review also highlights further research needed to improve understanding of Si-mediated acquisition and utilization of nutrients and vice versa nutrient status-mediated Si acquisition and transport, both processes which are of high importance for agronomic practice (e.g., reduced use of fertilizers and pesticides).
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Affiliation(s)
- Jelena Pavlovic
- Institute for Multidisciplinary Research, University of Belgrade, Belgrade, Serbia
| | - Ljiljana Kostic
- Institute for Multidisciplinary Research, University of Belgrade, Belgrade, Serbia
| | - Predrag Bosnic
- Institute for Multidisciplinary Research, University of Belgrade, Belgrade, Serbia
| | - Ernest A. Kirkby
- Faculty of Biological Sciences, Leeds University, Leeds, United Kingdom
| | - Miroslav Nikolic
- Institute for Multidisciplinary Research, University of Belgrade, Belgrade, Serbia
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Cady R, Gottschalk C, Pavlovic J. Redefining Expectations for Migraine Prevention. Neurology 2021. [DOI: 10.17925/usn.2021.17.suppl.1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
With the advent of new preventive migraine treatments, such as calcitonin gene-related peptide inhibitor monoclonal antibodies, there is a need to ensure realistic treatment expectations, and to carefully consider therapeutic options. Current treatment guidelines suggest that reductions in mean monthly headache days of ≥50% from baseline should be considered evidence of treatment efficacy, although in some patients, benefits can be seen at lower thresholds. However, patients may expect greater reductions in migraine attacks, so setting realistic expectations is important for treatment success. As treatment side effects and a lack of efficacy are the main reasons for treatment discontinuation, possible side effects should be discussed, and the individual goals of patients considered. Current American Headache Society guidelines suggest candidacy for preventive migraine treatment is primarily based on the frequency of attacks in the USA, with treatment recommended for patients who have ≥4 migraine days per month. However, even fewer than 4 monthly headache days per month can have a severe impact on overall health-related quality of life in addition to impairment during individual episodes. Finally, the use of acute therapy should be carefully monitored and considered when treatment decisions are being made, to ensure optimization of use, and to avoid overuse and progression to chronic migraine. These considerations indicate that patient needs are multifaceted and that management decisions need to be crafted on a case-by-case basis.
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15
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Schumacher L, Wing R, Thomas JG, Pavlovic J, Digre K, Farris S, Steffen K, Sarwer D, Bond D. Does sexual functioning improve with migraine improvements and/or weight loss?-A post hoc analysis in the Women's Health and Migraine (WHAM) trial. Obes Sci Pract 2020; 6:596-604. [PMID: 33354338 PMCID: PMC7746968 DOI: 10.1002/osp4.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Despite plausibility of migraine headaches contributing to impaired sexual function among women, data are inconsistent and point to obesity as a potential confounder. Prospective studies that assess the relative importance of migraine improvements and weight loss in relation to sexual function could help elucidate associations among migraine, obesity and female sexual dysfunction (FSD). OBJECTIVE To evaluate sexual function changes and predictors of improvement after behavioural weight loss (BWL) intervention for migraine or migraine education (ME). METHODS Women with migraine and overweight/obesity were randomized to 16 weeks of BWL (n = 54) or ME (n = 56). Participants completed a 4-week smartphone headache diary and the Female Sexual Function Index (FSFI) at pre- and post-treatment. A validated FSFI total cut-off score defined FSD. We compared changes in FSFI scores and FSD rates between conditions and evaluated migraine improvements and weight loss as predictors of sexual functioning in the full sample. RESULTS Among treatment completers (n = 85), 56 (65.9%) participants who reported sexual activity at pre- and post-treatment were analysed. Migraine improvements were similar between conditions, whereas BWL had greater weight losses compared with ME. FSD rates did not change overall (48.2% to 44.6%, p = .66) or by condition (BWL: 56.0% to 40.0% vs. ME: 41.9% to 48.4%, p = .17). Similar patterns were observed for changes in FSFI total and subscale scores. Across conditions, larger weight losses predicted greater improvements in FSFI total and arousal subscale scores, whereas larger migraine headache frequency reductions predicted greater improvements in FSFI satisfaction subscale scores. CONCLUSION Sexual functioning did not improve with either BWL or ME despite migraine headache improvements in both conditions and weight loss after BWL. However, weight loss related to improvements in physiological components of the sexual response (i.e., arousal) and overall sexual functioning, whereas reduced headache frequency related to improved sexual satisfaction. Additional research with larger samples is needed.
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Affiliation(s)
- Leah Schumacher
- Department of Psychiatry and Human BehaviorAlpert Medical School of Brown University/The Miriam Hospital, Weight Control and Diabetes Research CenterProvidenceRhode IslandUSA
| | - Rena Wing
- Department of Psychiatry and Human BehaviorAlpert Medical School of Brown University/The Miriam Hospital, Weight Control and Diabetes Research CenterProvidenceRhode IslandUSA
| | - J. Graham Thomas
- Department of Psychiatry and Human BehaviorAlpert Medical School of Brown University/The Miriam Hospital, Weight Control and Diabetes Research CenterProvidenceRhode IslandUSA
| | - Jelena Pavlovic
- Department of Neurology and the Montefiore Headache CenterAlbert Einstein College of Medicine/Montefiore Medical CenterBronxNew YorkUSA
| | - Kathleen Digre
- Department of NeurologyUniversity of Utah Health Sciences CenterSalt Lake CityUtahUSA
| | - Samantha Farris
- Department of Psychology, RutgersThe State University of New JerseyPiscatawayNew JerseyUSA
| | - Kristine Steffen
- Department of Pharmaceutical SciencesNorth Dakota State UniversityFargoNorth DakotaUSA
- Neuropsychiatric Research InstituteNorth Dakota State UniversityFargoNorth DakotaUSA
| | - David Sarwer
- Center for Obesity Research and Education, College of Public HealthTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Dale Bond
- Department of Psychiatry and Human BehaviorAlpert Medical School of Brown University/The Miriam Hospital, Weight Control and Diabetes Research CenterProvidenceRhode IslandUSA
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16
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Lipton RB, Wang C, Hyun J, Katz MJ, Derby CA, Pavlovic J. Variability in every day pain is associated with mild cognitive impairment (MCI): Results from the Einstein Aging Study (EAS). Alzheimers Dement 2020. [DOI: 10.1002/alz.045355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Cuiling Wang
- Albert Einstein College of Medicine New York NY USA
| | - Jinshil Hyun
- Albert Einstein College of Medicine New York NY USA
| | - Mindy J Katz
- Albert Einstein College of Medicine New York NY USA
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Pavlovic J, Franco O, Kavousi M, Ikram M, Deckers J, Ikram M, Leening J. Recommendations and associated levels of evidence for statin use in primary prevention of cardiovascular disease: a comparison at population level of the ESC, ACC/AHA, USPSTF, and CCS Guidelines. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
It is unclear to what extent the 2019 European Society of Cardiology (ESC), 2018 American College of Cardiology/ American Heart Association (ACC/AHA), 2016 US Preventive Services Task Force (USPSTF), and 2016 Canadian Cardiovascular Society (CCS) guidelines differ in assigning levels of evidence and classes of recommendations (LOE/class) to lipid-lowering treatment recommendations in primary prevention of cardiovascular disease (CVD).
Purpose
To compare LOE/class from four commonly used guidelines at population level.
Methods
A total of 7262 participants, aged 45–75 years of age and without history of CVD, from the prospective population-based Rotterdam Study were included. Per guideline, proportions of the population recommended statin therapy by LOE/class, sensitivity and specificity, and numbers needed to treat at 10 years (NNT10y) were calculated.
Results
Mean age was 61.1 (SD 6.9) years, and 58.2% were women. ESC, ACC/AHA, USPSTF and CCS strongly recommended statin use for a respective 33.8%, 48.1%, and 40.2% and 73.0% of the eligible population based on high-quality evidence, while in an additional 55.3%, 7.1%, 8.4% and 9.2% of participants statins use could or should be considered based on varying LOE/class. The sensitivity for treatment recommendations supported with strong, high quality evidence was 61.6% for ESC (“IA”), 74.6% for ACC/AHA (“IA or IB”), 69.4% for USPSTF (“USPSTF-B”) and 92.5% for CCS (“strong”). Specificity was highest for the ACC/AHA at 46.8% and lowest for ESC at 11.4%. Estimated NNT10y for those with the strongest LOE/class were comparable across all guidelines, ranging from 18 to 26 for moderate-intensity statin use, and 11 to 16 for high-intensity statin use. NNT10y reflective of recommendations supported with moderate strength of LOE/class varied substantially among guidelines for both moderate-intensity and high-intensity statin use, ranging from 33 for ESC and USPSTF to 91 for CCS.
Conclusions
Assigned LOE/class varied greatly among four clinical practice guidelines for primary prevention of CVD. Efforts for harmonized and comparable evidence grading system for clinical practice guidelines in primary prevention of CVD may reduce ambiguity, and reinforce updated evidence-based recommendations for appropriate treatment of populations for whom clear evidence for benefit of statin use is available.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Pavlovic
- Erasmus Medical Center, Epidemiology, Rotterdam, Netherlands (The)
| | - O.H Franco
- University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland
| | - M Kavousi
- Erasmus Medical Center, Epidemiology, Rotterdam, Netherlands (The)
| | - M.K Ikram
- Erasmus Medical Center, Epidemiology, Rotterdam, Netherlands (The)
| | - J.W Deckers
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands (The)
| | - M.A Ikram
- Erasmus Medical Center, Epidemiology, Rotterdam, Netherlands (The)
| | - J.G Leening
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands (The)
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Pavlovic J, Kavousi M, Ikram M, Leening J. Updated treatment thresholds in the 2019 ESC/EAS dyslipidaemia guidelines substantially expand indications for statin use for primary prevention at population level: results from the Rotterdam Study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In the recent update of the ESC/EAS practice guidelines for the management of dyslipidaemias, indications for statin treatment in primary prevention have been expanded to those at lower cardiovascular disease (CVD) risk and with lower LDL levels, as well as to those 65 to 75 years of age according to their level of predicted CVD risk.
Purpose
To compare the implications of the 2016 and 2019 ESC/EAS guidelines and determine the extent to which these updates affect treatment recommendations at population level.
Methods
We calculated 10-year CVD risk following the 2016 and 2019 ESC/EAS guideline recommendations and proportions of individuals qualifying for statin treatment categories per guideline. The study population included 7262 participants free of CVD, aged 45 to 75 years, from the Dutch prospective population-based Rotterdam Study.
Results
Mean (SD) age was 61.1 (6.9) years and 58.2% were women. Diabetes was present in 8.4% of the participants, 24.7% were smokers, mean LDL was 3.7 (0.9) mmol/L, and mean blood pressure was 137/80 (20/11) mmHg. Next to lifestyle changes, the 2016 and 2019 ESC/EAS guidelines recommend statin treatment in 13.2% (N=961) and 37.7% (N=2738) of the total population and consider statin treatment in 37.0% (N=2689) and 51.4% (N=3733), respectively. When stratified by 5-year age groups, the 2016 and 2019 ESC/EAS guidelines overall suggest a respective 29.7% (N=411) and 60.7% (N=839) of adults aged 45–55 years to be considered for statin treatment. While adults with an estimated 10-year SCORE risk of fatal CVD <1% and LDL <4.9 mmol/L were deemed to be at sufficiently low risk in the 2016 ESC/EAS guidelines and hence were suggested only lifestyle advice to modify their cardiovascular risk, in the 2019 update, 517 individuals (i.e. 37.4% of 1383 adults aged 45–55 years) were considered for statin treatment. The 2016 ESC/EAS guidelines did not provide treatment recommendations for individuals aged >65 years, while the 2019 ESC/EAS guidelines recommend statin treatment in 69.2% (N=1430) and considers treatment in another 27.7% (N=571) among the study population aged 65–75 years (N=2065).
Conclusions
Updated treatment recommendations in the 2019 ESC/EAS dyslipidaemia guideline substantially expand statin treatment to asymptomatic individuals aged 45–55 at low risk, and individuals aged 65–75 years. Whether the broadening of statin indications in asymptomatic low-risk individuals and those aged 65–75 years will lead to greater uptake of primary prevention efforts and thereby long-term lowering of the burden of CVD in Europe, remains to be investigated.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Pavlovic
- Erasmus Medical Center, Epidemiology, Rotterdam, Netherlands (The)
| | - M Kavousi
- Erasmus Medical Center, Epidemiology, Rotterdam, Netherlands (The)
| | - M.A Ikram
- Erasmus Medical Center, Epidemiology, Rotterdam, Netherlands (The)
| | - J.G Leening
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands (The)
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Lillis J, Thomas JG, Lipton RB, Rathier L, Roth J, Pavlovic J, O'Leary KC, Bond DS. The Association of Changes in Pain Acceptance and Headache-Related Disability. Ann Behav Med 2020; 53:686-690. [PMID: 30289426 DOI: 10.1093/abm/kay076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Migraine accounts for substantial suffering and disability. Previous studies show cross-sectional associations between higher pain acceptance and lower headache-related disability in individuals with migraine, but none has evaluated this association longitudinally during migraine treatment. PURPOSE This study evaluated whether changes in pain acceptance were associated with changes in headache-related disability and migraine characteristics in a randomized controlled trial (Women's Health and Migraine) that compared effects of behavioral weight loss (BWL) treatment and migraine education (ME) on headache frequency in women with migraine and overweight/obesity. METHODS This was a post hoc analysis of 110 adult women with comorbid migraine and overweight/obesity who received 16 weeks of either BWL or ME. Linear and nonlinear mixed effects modeling methods were used to test for between-group differences in change in pain acceptance, and also to examine the association between change in pain acceptance and change in headache disability. RESULTS BWL and ME did not differ on improvement in pain acceptance from baseline across post-treatment and follow-up. Improvement in pain acceptance was associated with reduced headache disability, even when controlling for intervention-related improvements in migraine frequency, headache duration, and pain intensity. CONCLUSIONS This study is the first to show that improvements in pain acceptance following two different treatments are associated with greater reductions in headache-related disability, suggesting a potential new target for intervention development. CLINICAL TRIALS INFORMATION NCT01197196.
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Affiliation(s)
- Jason Lillis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Psychiatry and Human Behavior, The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - J Graham Thomas
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Psychiatry and Human Behavior, The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Richard B Lipton
- Department of Neurology and the Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurology and the Montefiore Headache Center, Montefiore Medical Center, Bronx, NY, USA
| | - Lucille Rathier
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Psychiatry and Human Behavior, The Miriam Hospital, Providence, RI, USA
| | - Julie Roth
- Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Neurology, Rhode Island Hospital, Providence, RI, USA
| | - Jelena Pavlovic
- Department of Neurology and the Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurology and the Montefiore Headache Center, Montefiore Medical Center, Bronx, NY, USA
| | - Kevin C O'Leary
- Department of Psychiatry and Human Behavior, The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Dale S Bond
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Psychiatry and Human Behavior, The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
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Baralic M, Bontic A, Pavlovic J, Lausevic M, Gajic S, Kravljaca M, Brkovic V, Milinkovic M, Karadzic V, Kezic A, Radovic' M. P1199THE IMPORTANCE OF DETERMINING ALPHA-2-MACROGLOBULIN CONCENTRATITON IN PATIENTS ON PERITONEAL DIALYSIS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
To determine the concentration of Alpha-2-macroglobulin (α2M) and its activity in patients treated with peritoneal dialysis (PD) and healthy subjects (H).
Method
a cross-sectional study included 50 PD and 30 H, in which the concentration of active α2M molecules was determined. The measurement is based on covalent binding of α2M and trypsin and zymography with gelatin incorporated into the electrophoretic gel.
Results
The intensity of proteolytic bands seen with native α2M was analyzed in relation to the concentration of α2M in patients with PD with less and / or more than three peritonitis. Linear dependence was only visible in the case of the upper range, which originates from the intact α2M-trypsin complex. The highest coefficient of variation is calculated for the smallest α2M concentration (4.2%). The signal intensities originating from α2M (H) were higher compared to PD, with the PD group being lower in patients with higher peritonitis, and the difference was more pronounced as concentration increased, resulting in a lower slope of dependence. The proposed method can reliably measure the amount of α2M originating in a group H, while the quantification of α2M in PD groups that may have structurally altered α2M can be seen more for condition estimation than for accurate measurements. The zymographic test in this experiment allows us to investigate the relationship of the concentration, structure and function of α2M in different pathological conditions, as well as in the presence of modifying agents that can accompany them.
Conclusion
A simple method for the determination of α2M concentration and function by zymography has been developed, which can be used to examine residual α2M activity after partial denaturation or structural modification due to disease.
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Affiliation(s)
- Marko Baralic
- Belgrade, Clinical centre of Serbia, Nephrology, Belgrade, Serbia
| | - Ana Bontic
- Belgrade, Belgrade, Clinical centre of Serbia Nephrology, Belgrade, Serbia
| | - Jelena Pavlovic
- Belgrade, Belgrade, Clinical centre of Serbia Nephrology, Belgrade, Serbia
| | - Mirjana Lausevic
- Belgrade, Belgrade, Clinical centre of Serbia Nephrology, Belgrade, Serbia
| | - Selena Gajic
- Belgrade, Belgrade, Clinical centre of Serbia Nephrology, Belgrade, Serbia
| | - Milica Kravljaca
- Belgrade, Belgrade, Clinical centre of Serbia Nephrology, Belgrade, Serbia
| | - Voin Brkovic
- Belgrade, Belgrade, Clinical centre of Serbia Nephrology, Belgrade, Serbia
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Evans WE, Raynor HA, Howie W, Lipton RB, Thomas GJ, Wing RR, Pavlovic J, Farris SG, Bond DS. Associations between lifestyle intervention-related changes in dietary targets and migraine headaches among women in the Women's Health and Migraine (WHAM) randomized controlled trial. Obes Sci Pract 2020; 6:119-125. [PMID: 32313669 PMCID: PMC7156864 DOI: 10.1002/osp4.376] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/20/2019] [Accepted: 09/28/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Migraine and obesity are comorbid particularly in women of reproductive age. Obesity treatment involves reducing energy intake and improving dietary quality but the effect of these changes on migraine is largely unknown. OBJECTIVE To determine if adherence to dietary intervention targets (ie, total energy, dietary fat intake, and dietary quality) were associated with improvements in migraine and weight. METHODS Eighty-four women with overweight/obesity and migraine were randomized to and completed either a 16-week behavioral weight loss (BWL) or a migraine education (ME) intervention. For 28 days at baseline and posttreatment, women recorded monthly migraine days, duration, and maximum pain intensity via smartphone-based diary. At each assessment, weight was measured and dietary intake (total energy intake, percent (%) energy from fat, and diet quality, as measured by the Healthy Eating Index, 2010 [HEI-2010]) was assessed using three nonconsecutive 24-hour diet recalls. RESULTS There were no significant group differences in change mean migraine days per month (BWL: -2.6+4.0, ME: -4.0+4.4; p = 0.1). Participants in BWL significantly reduced their percent fat intake 3.8% (p = 0.004) and improved total diet quality (HEI-2010) by 6.7 points (p = 0.003) relative to baseline and those in ME (%fat: +0.3%; p = 0.821; HEI-2010: +0.7; p = 0.725). After controlling for race/ethnicity and weight change, changes in dietary intake were not related to changes in migraine characteristics or weight loss among BWL participants (p's > 0.05). CONCLUSIONS Changes in dietary intake among participants were small and may have been insufficient to improve migraine in women with overweight/obesity and migraine.
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Affiliation(s)
- Whitney E. Evans
- Weight Control and Diabetes Research CenterBrown University Alpert Medical School/The Miriam Hospital ProvidenceRhode IslandUSA
| | - Hollie A. Raynor
- Department of NutritionUniversity of TennesseeKnoxvilleTennessee
| | - Whitney Howie
- Weight Control and Diabetes Research CenterBrown University Alpert Medical School/The Miriam Hospital ProvidenceRhode IslandUSA
| | - Richard B. Lipton
- Department of NeurologyAlbert Einstein College of Medicine/Montefiore Medical CenterNew YorkUSA
| | - Graham J. Thomas
- Weight Control and Diabetes Research CenterBrown University Alpert Medical School/The Miriam Hospital ProvidenceRhode IslandUSA
| | - Rena R. Wing
- Weight Control and Diabetes Research CenterBrown University Alpert Medical School/The Miriam Hospital ProvidenceRhode IslandUSA
| | - Jelena Pavlovic
- Department of NeurologyAlbert Einstein College of Medicine/Montefiore Medical CenterNew YorkUSA
| | - Samantha G. Farris
- Department of Psychology, Rutgersthe State University of New JerseyPiscatawayNew Jersey
| | - Dale S. Bond
- Weight Control and Diabetes Research CenterBrown University Alpert Medical School/The Miriam Hospital ProvidenceRhode IslandUSA
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Bauer J, Pavlovic J, Kutejová E, Bauerova V. How disease-associated mutations may alter the dynamic motion of the N-terminal domain of the human cardiac ryanodine receptor. Acta Crystallogr A Found Adv 2019. [DOI: 10.1107/s2053273319093689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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23
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Pavlovic J, Szalayová A, Kostan J, Djinovic-Carugo K, Bauerova V, Bauer J. High-resolution dimeric crystal structures of wild-type and mutant Aspergillus niger glucose oxidase. Acta Crystallogr A Found Adv 2019. [DOI: 10.1107/s2053273319094233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Pavlovic J, Racic M, Ivkovic N, Jatic Z. Comparison of Nutritional Status Between Nursing Home Residents and Community Dwelling Older Adults: a Cross-Sectional Study from Bosnia and Herzegovina. Mater Sociomed 2019; 31:19-24. [PMID: 31213950 PMCID: PMC6511369 DOI: 10.5455/msm.2019.31.19-24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim: The aim of the study was to determine the differences in nutritional status and risk for malnutrition between nursing home and community-dwelling residents. Methods: Cross-sectional study included 146 nursing home residents and 300 community-dwelling elderly adults from four municipalities in Bosnia and Herzegovina. Anthropometric measurements, biochemical analyses, nutritive, functional and cognitive assessments were carried out. Nutritional status and risk for malnutrition were assessed by Mini Nutritional Assessment (MNA), Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II (Screen II) and the food intake analysis for the past 24 hours. Functional status was assessed by the Lawton scale, the Katz Independence Index, Timed Up and Go test, the Functional Reach Test. Mini Cog test and Six-item cognitive impairment test were used for the evaluation of cognitive functioning. Results: The incidence of high nutritive risk by SCREEN II (100%) and being “at risk for malnutrition” by MNA (81.60%) was higher among nursing home residents compared to community-dwellers. Community-dwelling elderly people had higher BMI (27.94 ± 4.73), weight (78.40 ± 13.99), height (167.69 ± 9.74), waist circumference (97.77 ± 12.88), hip circumference (104.61 ± 11.47), mid-arm arm (27.54 ± 3.58), hip (27.54 ± 3.58) and calf circumference (34.02 ± 5.16 ). Statistical differences in regards to place of living were found in functional status (p<0.001), cognitive functioning (p<0.001) and hand grip strength (p<0.001). Conclusion: The frequency of malnutrition and high nutritional risk was higher in respondents who were living in the nursing homes compared to community-dwellers. The results of this study showed that health professionals involved in the care for institutionalized elderly people should implement routine screening of malnutrition within the comprehensive geriatric assessment in their daily practice.
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Affiliation(s)
- Jelena Pavlovic
- Department of Nursing, Faculty of Medicine in Foca, University of East Sarajevo, Bosnia and Herzegovina
| | - Maja Racic
- Thomas J. Stephens & Associates, Phoenix, USA
| | - Nedeljka Ivkovic
- Department of Oral Rehabilitation, Faculty of Medicine in Foca, University of East Sarajevo, Bosnia and Herzegovina
| | - Zaim Jatic
- Departmenf of Family Medicine, Faculty of Medicine, University of Sarajevo, Bosnia and Herzegovina
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Racic M, Pavlovic J, Hadzivukovic N, Ivkovic N. Perceptions, attitudes, and expectation of baccalaureate nurses toward position of nursing in Bosnia and Herzegovina. Int J Health Plann Manage 2019; 34:e1223-e1235. [PMID: 30945354 DOI: 10.1002/hpm.2767] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/03/2019] [Accepted: 02/05/2019] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Numerous challenges and barriers have emerged since changing the minimum requirement for those interested in pursuing employment as a nurse in Europe to a baccalaureate degree. To analyze the perceptions of baccalaureate nurses regarding the current status of their profession and the issues involved in implementing the prerequisite of earning a baccalaureate degree in order to practice as nurses in Bosnia and Herzegovina. METHODS A series of six focus groups were undertaken with 49 baccalaureate nurses employed in primary health care centers and regional hospitals. The focus groups were recorded and transcribed verbatim. Data collected were analyzed using conventional content analysis approach. RESULTS Baccalaureate nurses report dissatisfaction with their level of autonomy and anxiety over their limited career opportunities. They expressed concern over difficult working conditions, inadequate financial compensation, and ongoing resistance by physicians as the primary barriers to implementing advanced nursing education and professional reform. The global image of the nursing profession is negative. CONCLUSION The perception is that revising the legal framework regarding nursing qualifications, duties, and standards will result in reform necessary to positively affect the during profession. Progress toward implementing reform of the nursing profession is negligible. Addressing barriers such as work environment, lack of job classification, fair payment, autonomy, and interdisciplinary collaboration toward the competences of baccalaureate nurse is essential if successful reform is to occur.
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Affiliation(s)
- Maja Racic
- Department of Primary Health Care and Public Health, Faculty of Medicine in Foca, University of East Sarajevo, Bosnia and Herzegovina
| | - Jelena Pavlovic
- Department of Nursing, Faculty of Medicine in Foca, University of East Sarajevo, Bosnia and Herzegovina
| | - Natalija Hadzivukovic
- Department of Nursing, Faculty of Medicine in Foca, University of East Sarajevo, Bosnia and Herzegovina
| | - Nedeljka Ivkovic
- Department of Oral Rehabilitation, Faculty of Medicine in Foca, University of East Sarajevo, Bosnia and Herzegovina
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Racic M, Ivkovic N, Pavlovic J, Zuza A, Hadzivukovic N, Bozovic D, Pekez-Pavlisko T. Factors influencing health profession students' willingness to practice in rural regions of Bosnia and Herzegovina: a cross-sectional study. Rural Remote Health 2019; 19:4717. [PMID: 30807698 DOI: 10.22605/rrh4717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The literature indicates different factors influencing recruitment of health professional students to work in rural areas. The purpose of this study is to explore the willingness of health profession students in the Faculty of Medicine Foca, University of East Sarajevo, Bosnia and Herzegovina to work in a rural area following graduation and the factors influencing incentives to pursue a rural career. METHODS The cross-sectional study included first-year through sixth-year students aged 18 years or older and enrolled in one of three study programs at the Faculty of Medicine: medicine, dentistry and nursing. The questionnaire was distributed at the beginning of the winter semester during the first required lecture for each year and study program class. Data was analyzed using student t-test, analysis of variance when appropriate, Kruskal-Wallis test and multivariate logistic regression analysis. RESULTS A total of 519 students participated, an 88.3% response rate. Three hundred and ninety-nine (77%) participants responded positively to the question 'When you complete your studies, would you be inclined to accept a job in a rural region?' Factors associated with willingness to practise in rural areas included being female (p=0.027) and having a rural upbringing (p=0.037). Significant differences between medicine, nursing and dentistry students were found in their opinion that willingness to work in rural practice depends greatly on the possibility to get residency more easily (p=0.001). Compared to their peers, nursing students had better opportunities to attend national courses cost-free (p=0.027) and to be involved in the education of new generations of health profession students (p=0.001). Getting a post in an urban area after a work period in a rural area was most valued as an incentive by dentistry students (p=0.037). The multivariate logistic regression model was used to analyze predictors of willingness to practise in rural areas. Students who had been raised in a rural community (p=0.042) as well as female students (p=0.016) were more likely to accept rural practice. Statistical significance at an alpha level of 0.05 was not reached for study program and year of study. CONCLUSIONS The results of the study showed a high willingness of medicine, dentistry and nursing students to work in rural areas following graduation. Female students and students who were raised in a rural community were more likely to choose a rural career. Stakeholders should be committed to strengthening the rural deployment of health professionals by creating a more attractive, rural environment.
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Affiliation(s)
- Maja Racic
- Department of Primary Health Care and Public Health, Faculty of Medicine in Foca, University of East Sarajevo, Bosnia and Herzegovina
| | - Nedeljka Ivkovic
- Department of Oral Rehabilitation, Faculty of Medicine in Foca, University of East Sarajevo, Bosnia and Herzegovina
| | - Jelena Pavlovic
- Department of Nursing, Faculty of Medicine, University of East Sarajevo, Bosnia and Herzegovina
| | - Aleksandra Zuza
- Department of Dental Pathology, Faculty of Medicine, University of East Sarajevo, Bosnia and Herzegovina
| | - Natalija Hadzivukovic
- Department of Nursing, Faculty of Medicine, University of East Sarajevo, Bosnia and Herzegovina
| | - Djordje Bozovic
- Department of Oral Rehabilitation, Faculty of Medicine in Foca, University of East Sarajevo, Bosnia and Herzegovina
| | - Tanja Pekez-Pavlisko
- Family Medicine Center "Tanja Pekez-Pavlisko", A.G. Matosa 42, 44320 Kutina, Croatia
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Pennells L, Kaptoge S, Wood A, Sweeting M, Zhao X, White I, Burgess S, Willeit P, Bolton T, Moons KGM, van der Schouw YT, Selmer R, Khaw KT, Gudnason V, Assmann G, Amouyel P, Salomaa V, Kivimaki M, Nordestgaard BG, Blaha MJ, Kuller LH, Brenner H, Gillum RF, Meisinger C, Ford I, Knuiman MW, Rosengren A, Lawlor DA, Völzke H, Cooper C, Marín Ibañez A, Casiglia E, Kauhanen J, Cooper JA, Rodriguez B, Sundström J, Barrett-Connor E, Dankner R, Nietert PJ, Davidson KW, Wallace RB, Blazer DG, Björkelund C, Donfrancesco C, Krumholz HM, Nissinen A, Davis BR, Coady S, Whincup PH, Jørgensen T, Ducimetiere P, Trevisan M, Engström G, Crespo CJ, Meade TW, Visser M, Kromhout D, Kiechl S, Daimon M, Price JF, Gómez de la Cámara A, Wouter Jukema J, Lamarche B, Onat A, Simons LA, Kavousi M, Ben-Shlomo Y, Gallacher J, Dekker JM, Arima H, Shara N, Tipping RW, Roussel R, Brunner EJ, Koenig W, Sakurai M, Pavlovic J, Gansevoort RT, Nagel D, Goldbourt U, Barr ELM, Palmieri L, Njølstad I, Sato S, Monique Verschuren WM, Varghese CV, Graham I, Onuma O, Greenland P, Woodward M, Ezzati M, Psaty BM, Sattar N, Jackson R, Ridker PM, Cook NR, D'Agostino RB, Thompson SG, Danesh J, Di Angelantonio E. Equalization of four cardiovascular risk algorithms after systematic recalibration: individual-participant meta-analysis of 86 prospective studies. Eur Heart J 2019; 40:621-631. [PMID: 30476079 PMCID: PMC6374687 DOI: 10.1093/eurheartj/ehy653] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/03/2018] [Accepted: 10/04/2018] [Indexed: 12/19/2022] Open
Abstract
AIMS There is debate about the optimum algorithm for cardiovascular disease (CVD) risk estimation. We conducted head-to-head comparisons of four algorithms recommended by primary prevention guidelines, before and after 'recalibration', a method that adapts risk algorithms to take account of differences in the risk characteristics of the populations being studied. METHODS AND RESULTS Using individual-participant data on 360 737 participants without CVD at baseline in 86 prospective studies from 22 countries, we compared the Framingham risk score (FRS), Systematic COronary Risk Evaluation (SCORE), pooled cohort equations (PCE), and Reynolds risk score (RRS). We calculated measures of risk discrimination and calibration, and modelled clinical implications of initiating statin therapy in people judged to be at 'high' 10 year CVD risk. Original risk algorithms were recalibrated using the risk factor profile and CVD incidence of target populations. The four algorithms had similar risk discrimination. Before recalibration, FRS, SCORE, and PCE over-predicted CVD risk on average by 10%, 52%, and 41%, respectively, whereas RRS under-predicted by 10%. Original versions of algorithms classified 29-39% of individuals aged ≥40 years as high risk. By contrast, recalibration reduced this proportion to 22-24% for every algorithm. We estimated that to prevent one CVD event, it would be necessary to initiate statin therapy in 44-51 such individuals using original algorithms, in contrast to 37-39 individuals with recalibrated algorithms. CONCLUSION Before recalibration, the clinical performance of four widely used CVD risk algorithms varied substantially. By contrast, simple recalibration nearly equalized their performance and improved modelled targeting of preventive action to clinical need.
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Affiliation(s)
- Lisa Pennells
- Department of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK
| | - Stephen Kaptoge
- Department of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK
| | - Angela Wood
- Department of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK
| | - Mike Sweeting
- Department of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK
| | - Xiaohui Zhao
- Department of Physiology, Development and Neuroscience, University of Cambridge, Downing Street, Cambridge, UK
| | - Ian White
- MRC Clinical Trials Unit, University College London, 90 High Holborn, London, UK
| | - Stephen Burgess
- Department of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK
- MRC Biostatistics Unit, Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, UK
| | - Peter Willeit
- Department of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK
- Department of Neurology and Neurosurgery, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Thomas Bolton
- Department of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK
| | - Karel G M Moons
- Epidemiology: Methodology, Julius Center Research Program Methodology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, the Netherlands
| | - Yvonne T van der Schouw
- Department of Epidemiology, Julius Center Research Program Cardiovascular Epidemiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, the Netherlands
| | - Randi Selmer
- Division of Epidemiology, Norwegian Institute of Public Health, Postboks 222 Skøyen, Oslo, Norway
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK
| | - Vilmundur Gudnason
- Icelandic Heart Association, Hjartavernd Holtasmá¡ri 1, Kópavogur, Iceland
- Faculty of Medicine, University of Iceland, Vatnsmýrarvegur 16, Reykjavik, Iceland
| | - Gerd Assmann
- Assmann-Foundation for Prevention, Gronowskistraße 33, Münster, Germany
| | - Philippe Amouyel
- Institut Pasteur de Lille, 1 rue du Professeur Calmette, Lille, France
| | - Veikko Salomaa
- National Institute for Health and Welfare, Mannerheimintie 166, Helsinki, Finland
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, UK
| | - Børge G Nordestgaard
- Department of Clinical Medicine, Copenhagen University Hospital, Blegdamsvej 3, Copenhagen, Denmark
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, USA
| | - Lewis H Kuller
- Department of Epidemiology, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, USA
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Neuenheimer Feld 581, Heidelberg, Germany
- University of Heidelberg, Grabengasse 1, Heidelberg, Germany
| | - Richard F Gillum
- Department of Medicine, Howard University College of Medicine, 2041 Georgia Avenue, Washington, DC, USA
| | - Christa Meisinger
- German Research Center for Environmental Health, Ingolstädter Landstraße 1, Neuherberg, Germany
| | - Ian Ford
- Institute of Health & Wellbeing, University of Glasgow, Boyd Orr Building, University Avenue, Glasgow, UK
| | - Matthew W Knuiman
- Faculty of Health and Medical Sciences, School of Population and Global Health, University of Western Australia, 35 Stirling Highway, Perth, Western Australia, Australia
| | - Annika Rosengren
- Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 3, Gothenburg, Sweden
- Wallenberg Laboratory, Sahlgrenska University Hospital, Blå stråket 5, Gothenburg, Sweden
| | - Debbie A Lawlor
- Department of Social Medicine, University of Bristol, Bristol, UK
| | - Henry Völzke
- Institute of Community Medicine, University of Greifswald, Ellernholzstraße 1/2, Greifswald, Germany
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Tremona Rd, Southampton, UK
| | | | - Edoardo Casiglia
- Department of Medicine, University of Padova, 2 Via Giustiniani, Padova, Italy
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 1 Yliopistonranta, Kuopio, Finland
| | - Jackie A Cooper
- Centre for Cardiovascular Genetics, University College London, 5 University Street, London, UK
| | - Beatriz Rodriguez
- Department of Geriatric Medicine, University of Hawaii, 1960 East-West Road, Honolulu, HI, USA
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Ing 40, 5 tr, Uppsala, Sweden
| | | | - Rachel Dankner
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Charleston, SC, USA
| | - Karina W Davidson
- Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, USA
| | - Robert B Wallace
- College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA, USA
| | - Dan G Blazer
- Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, USA
| | - Cecilia Björkelund
- Department of Public Health and Community Medicine, University of Gothenburg, Medicinaregatan 16, Gothenburg, Sweden
| | - Chiara Donfrancesco
- Department of Cardiovascular, Dysmetabolic and Aging-Associated Diseases, Istituto Superiore di Sanità (ISS), 299 Viale Regina Elena, Rome, Italy
| | | | - Aulikki Nissinen
- National Institute for Health and Welfare, Mannerheimintie 166, Helsinki, Finland
| | - Barry R Davis
- Department of Biostatistics, The University of Texas School of Public Health, 1200 Pressler Street, Houston, TX, USA
| | - Sean Coady
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, 31 Center Drive, Bethesda, MD, USA
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, UK
| | - Torben Jørgensen
- Research Centre for Prevention and Health, 5 Øster Farimagsgade, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, 5 Øster Farimagsgade, Copenhagen, Denmark
- Aalborg University, Fredrik Bajers Vej 5, Aalborg, Denmark
| | - Pierre Ducimetiere
- Faculté de Médecine, Université Paris Descartes, 12 Rue de l'Ecole de Médecine, Paris, France
| | - Maurizio Trevisan
- CUNY School of Medicine, City College of New York, 160 Convent Ave, New York, NY, USA
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, Malmö, Sweden
| | - Carlos J Crespo
- School of Community Health, Portland State University, 506 SW Mill St, Portland, OR, USA
| | - Tom W Meade
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Marjolein Visser
- Department of Health Sciences, Vrije Universiteit Amsterdam, VU University Medical Center, De Boelelaan 1085, Amsterdam, the Netherlands
| | - Daan Kromhout
- Department of Epidemiology, University Medical Centre Groningen, University of Grogingen, Hanzeplein 1, Groningen, the Netherlands
| | - Stefan Kiechl
- Department of Neurology and Neurosurgery, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Makoto Daimon
- Faculty of Medicine, Yamagata University, 1-4-12 Kojirakawa-machi, Yamagata, Japan
| | - Jackie F Price
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, UK
| | | | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden, the Netherlands
| | - Benoît Lamarche
- Pavillon Ferdinand-Vandry, Université Laval, 2440 Hochelaga, Quebec, Canada
| | - Altan Onat
- Department of Cardiology, Cerrahpaşa Faculty of Medicine, Istanbul University, Beyazıt, Fatih, Istanbul, Turkey
| | | | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, the Netherlands
| | - Yoav Ben-Shlomo
- Bristol Neuroscience, Bristol University, Queens Road, Bristol, UK
| | - John Gallacher
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, UK
| | - Jacqueline M Dekker
- The Institute for Health and Care Research, VU University Medical Center, De Boelelaan 1085, Amsterdam, the Netherlands
| | | | - Nawar Shara
- Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, 6525 Belcrest Road, Hyattsville, MD, USA
| | - Robert W Tipping
- Clinical Biostatistics, Merck, 2000 Galloping Hill Road, Kenilworth, NJ, USA
| | - Ronan Roussel
- Centre de Recherche des Cordeliers, INSERM, 15 rue de l'Ecole de Médecine, Paris, France
| | - Eric J Brunner
- Institute of Epidemiology & Health, University College London, 1-19 Torrington Place, London, UK
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, 21 Arcisstraße, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Biedersteiner Str. 29, Munich, Germany
| | - Masaru Sakurai
- Department of Social and Environmental Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, Japan
| | - Jelena Pavlovic
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, the Netherlands
| | - Ron T Gansevoort
- Department of Internal Medicine, University Medical Centre Groningen, University of Grogingen, Hanzeplein 1, Groningen, the Netherlands
| | - Dorothea Nagel
- Klinikum der Universität München, Ludwig-Maximilians-Universität, 15 Marchioninistraße, Munich, Germany
| | - Uri Goldbourt
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Elizabeth L M Barr
- Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Australia
| | - Luigi Palmieri
- Department of Cardiovascular, Dysmetabolic and Aging-Associated Diseases, Istituto Superiore di Sanità (ISS), 299 Viale Regina Elena, Rome, Italy
| | - Inger Njølstad
- Department of Public Health, University of Tromsø, Hansine Hansens veg 18, Tromsø, Norway
| | - Shinichi Sato
- Chiba Prefectural Institute of Public Health, 666-2 Nito-no-machi Chuo-ku, Chiba, Japan
| | - W M Monique Verschuren
- Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, Bilthoven, The Netherlands
| | - Cherian V Varghese
- Noncommunicable Diseases, Disability, Violence and Injury Prevention Department, World Health Organization, 20 Avenue Appia, Geneva 27, Switzerland
| | - Ian Graham
- School of Medicine, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland
| | - Oyere Onuma
- Noncommunicable Diseases, Disability, Violence and Injury Prevention Department, World Health Organization, 20 Avenue Appia, Geneva 27, Switzerland
| | - Philip Greenland
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 420 East Superior Street, Chicago, IL, USA
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, 75 George Street, Oxford, UK
- The George Institute for Global Health, University of New South Wales, 1 King Street Newtown, Sydney, Australia
| | - Majid Ezzati
- Faculty of Medicine, School of Public Health, Norfolk Place, St Mary's Campus, Imperial College London, London, UK
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, University of Washington, 1730 Minor Avenue, Seattle, WA, USA
| | - Naveed Sattar
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, 126 University Place, Glasgow, UK
| | - Rod Jackson
- Faculty of Medical and Health Sciences, University of Auckland, 261 Morrin Road, Auckland, New Zealand
| | - Paul M Ridker
- Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA, USA
| | - Nancy R Cook
- Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA, USA
| | - Ralph B D'Agostino
- Mathematics and Statistics Department, Boston University, 111 Cummington Mall, Boston, MA, USA
| | - Simon G Thompson
- Department of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK
| | - John Danesh
- Department of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK
| | - Emanuele Di Angelantonio
- Department of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK
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Abstract
Key cycle changes occur as women transition from reproductive life to menopause, and they can be roughly linked to menopausal staging. It is important to understand the types of studies that inform the current knowledge. Patterns of symptoms within menstrual cycles (sleep, headache) generally favor worsening in association with the perimenstrual phase of the cycle, and patterns of chronic symptoms, such as hot flashes and adverse mood, appear to be worse when hormones are more variable.
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Affiliation(s)
- Amanda Allshouse
- Department of Biostatistics, Colorado School of Public Health, 13001 E 17th Place, Aurora, CO 80045, USA
| | - Jelena Pavlovic
- Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, 12631 East 17th Avenue, Mail Stop B-198, Aurora, CO 80045, USA.
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Pavlovic J, Greenland P, Deckers JW, Brugts JJ, Kavousi M, Dhana K, Ikram MA, Hofman A, Stricker BH, Franco OH, Leening MJG. Comparison of ACC/AHA and ESC Guideline Recommendations Following Trial Evidence for Statin Use in Primary Prevention of Cardiovascular Disease: Results From the Population-Based Rotterdam Study. JAMA Cardiol 2018; 1:708-13. [PMID: 27439175 DOI: 10.1001/jamacardio.2016.1577] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC) guidelines both recommend lipid-lowering treatment for primary prevention based on global risk for cardiovascular disease (CVD). However, randomized clinical trials (RCTs) for statin use have included participants with specific risk-factor profiles. OBJECTIVE To evaluate the overlap between the ACC/AHA and ESC guideline recommendations and available evidence from RCTs for statin use in primary prevention of CVD. DESIGN, SETTING, AND PARTICIPANTS We calculated the 10-year risk for hard atherosclerotic CVD (ASCVD) following the ACC/AHA guideline, 10-year risk of CVD mortality following the ESC guideline, and we determined eligibility for each of 10 major RCTs for primary prevention of CVD. Conducted from July 2014 to August 2015, this study included 7279 individuals free of CVD, aged 45 to 75 years, examined between 1997 and 2008 for the Rotterdam Study, a prospective population-based cohort. MAIN OUTCOMES AND MEASURES Proportions of individuals qualifying for lipid-lowering treatment per guidelines, proportions of individuals eligible for any of the 10 RCTs, overlap between these groups, and corresponding ASCVD incidence rates. RESULTS Of the 7279 individuals included in the study, 58.2% were women (n = 4238) and had a mean (SD) age of 61.1 (6.9) years. The ACC/AHA guidelines would recommend statin initiation in 4284 participants (58.9%), while the ESC guidelines would in 2399 participants (33.0%) (overlapping by 95.8% with ACC/AHA). A total of 3857 participants (53.0%) met eligibility criteria for at least 1 RCT. Recommendations from both guidelines and trial evidence overlapped for 1546 participants (21.2%), who were at high risk for ASCVD (21.5 per 1000 person-years). A further 1703 participants (23.4%) would be recommended for statins by the guidelines in the absence of direct trial evidence, while 1176 (16.2%) would have been eligible for at least 1 trial without being recommended statin treatment by any guideline. Finally, 1719 participants (23.6%) would not be recommended a statin, nor would qualify for any of the trials. These individuals had low incidence of ASCVD (3.3 per 1000 person-years). CONCLUSIONS AND RELEVANCE Based on this European population study, ACC/AHA and ESC prevention guidelines often did not align at the individual level. However, for one-fifth of the general population, guidelines on both sides of the Atlantic recommend statin initiation, with trial data supporting the efficacy. There should be no controversy about providing optimal preventive medication to these individuals.
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Affiliation(s)
- Jelena Pavlovic
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Jaap W Deckers
- Department of Cardiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Klodian Dhana
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands4Department of Neurology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands5Department of Radiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands6Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands7Department of Internal Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands8Inspectorate for Health Care, Utrecht, the Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands3Department of Cardiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands6Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Schroeder RA, Brandes J, Buse DC, Calhoun A, Eikermann-Haerter K, Golden K, Halker R, Kempner J, Maleki N, Moriarty M, Pavlovic J, Shapiro RE, Starling A, Young WB, Nebel RA. Sex and Gender Differences in Migraine—Evaluating Knowledge Gaps. J Womens Health (Larchmt) 2018; 27:965-973. [DOI: 10.1089/jwh.2018.7274] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
| | - Jan Brandes
- Nashville Neuroscience Group, Nashville, Tennessee
- Department of Neurology, Vanderbilt University, Nashville, Tennessee
| | - Dawn C. Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Anne Calhoun
- Carolina Headache Institute, Durham, North Carolina
| | | | | | - Rashmi Halker
- Department of Neurology, Mayo Clinic, Phoenix, Arizona
| | - Joanna Kempner
- Department of Sociology, Rutgers University, New Brunswick, New Jersey
| | - Nasim Maleki
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Maureen Moriarty
- Department of Nursing, Marymount University, Arlington, Virginia
| | - Jelena Pavlovic
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Robert E. Shapiro
- Department of Neurological Sciences, University of Vermont, Burlington, Vermont
| | | | - William B. Young
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rebecca A. Nebel
- Society for Women's Health Research, Washington, District of Columbia
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Farris SG, Thomas JG, Abrantes AM, Godley FA, Roth JL, Lipton RB, Pavlovic J, Bond DS. Intentional avoidance of physical activity in women with migraine. Cephalalgia Reports 2018. [DOI: 10.1177/2515816318788284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Given the benefits of habitual physical activity for migraine management and overall health, it is important to understand the reasons for low physical activity levels in those with migraine. Beliefs that physical activity can trigger and/or worsen migraine pain may contribute to low physical activity levels via intentional avoidance of physical activity, particularly of higher intensities. This study evaluated intentional avoidance of physical activity at varying intensity levels and its association with (a) leisure-time physical activity levels, (b) beliefs that physical activity will trigger and/or worsen migraine, and (c) migraine characteristics. Participants were women ( n = 100) who screened positive for migraine on the IDMigraine and completed an online survey on physical activity and migraine. The majority of the sample (78%) reported avoiding physical activity to manage migraine attacks at least once in the past month, and most reported avoidance of both moderate- and vigorous-intensity activity. Among those who reported avoidance, moderate- and vigorous-intensity physical activity was avoided on an average of 4.0 ± 2.0 and 4.1 ± 2.2 days/week, respectively. More frequent avoidance of vigorous-intensity physical activity (but not moderate-intensity) was significantly correlated with lower vigorous-intensity physical activity indicated by fewer days/week ( r = −0.28, p = 0.016) and fewer minutes/day ( r = −0.29, p = 0.011). The frequency of physical activity avoidance was significantly correlated with stronger expected likelihood that physical activity, at both intensity levels, will both trigger ( r = 0.39–0.43, p < 0.01) and worsen ( r = 0.24–0.25, p < 0.05) migraine attacks. Individuals who avoided physical activity reported a significantly higher number of migraine attacks in the past month and were more likely to have chronic migraine, compared to those who did not report avoidance. Intentional avoidance of moderate- and vigorous-intensity physical activity is a common migraine management strategy that is associated with lower levels of vigorous-intensity physical activity, stronger beliefs that physical activity will trigger or worsen migraine, and more frequent migraine attacks. Individuals with migraine who avoid physical activity may benefit from targeted intervention to address beliefs about physical activity and migraine, which has the strong potential to improve both migraine and health outcomes.
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Affiliation(s)
- Samantha G Farris
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Centers for Preventative and Behavioral Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Psychology, Rutgers, the State University of New Jersey, Piscataway, NJ, USA
| | - J Graham Thomas
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Ana M Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, RI, USA
| | | | - Julie L Roth
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Neurology, Rhode Island Hospital, Providence, RI, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, New York, USA
- Montefiore Medical Center/Montefiore Headache Center, New York, USA
| | - Jelena Pavlovic
- Department of Neurology, Albert Einstein College of Medicine, New York, USA
- Montefiore Medical Center/Montefiore Headache Center, New York, USA
| | - Dale S Bond
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
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Sood S, Haifer C, Yu L, Pavlovic J, Gow PJ, Jones RM, Visvanathan K, Angus PW, Testro AG. Early viral-specific T-cell testing predicts late cytomegalovirus reactivation following liver transplantation. Transpl Infect Dis 2018; 20:e12934. [PMID: 29809312 DOI: 10.1111/tid.12934] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/29/2018] [Accepted: 05/17/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Although antiviral prophylaxis is effective in preventing early cytomegalovirus (CMV) reactivation following liver transplantation (OLT), it predisposes patients to late CMV after prophylaxis has ceased. QuantiFERON-CMV (QFN-CMV, Qiagen, The Netherlands) measures an individual's viral-specific immune response. METHODS Fifty-nine OLT recipients were prospectively monitored post-OLT in an observational cohort study. QFN-CMV was performed at regular time-points. An absolute QFN-CMV <0.1 IU/mL was considered non-reactive. RESULTS 50/59 (84.7%) had a reactive QFN-CMV by M6. 38/59 (64.4%) had antiviral prophylaxis or treatment before M6, with 31/38 (81.6%) developing a reactive QFN-CMV by 6 months. Over 90% already had a reactive result as early as 3 months post transplant, 3 patients (5.08%) developed late CMV between 6-12 months (median 251 days)-all had a non-reactive M6 QFN-CMV. And 2/3 experienced CMV disease. Non-reactive M6 QFN-CMV was significantly associated with late CMV (OR = 54.4, PPV = 0.33, NPV = 1.00, P = .003). CONCLUSION Although only 5% of recipients developed late CMV, 2/3 suffered CMV disease. M6 QFN-CMV has an excellent NPV for late CMV, suggesting patients who exhibit a robust ex vivo immune response at M6 can safely cease CMV monitoring. Furthermore, >90% already express viral-specific immunity as early as 3 months. Conceivably, antiviral prophylaxis could be discontinued early in these patients.
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Affiliation(s)
- S Sood
- Liver Transplant Unit Victoria, Austin Health, University of Melbourne, Melbourne, Vic., Australia.,Department of Gastroenterology & Hepatology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic., Australia.,Innate Immune Laboratory, St Vincent's Hospital, University of Melbourne, Melbourne, Vic., Australia
| | - C Haifer
- Liver Transplant Unit Victoria, Austin Health, University of Melbourne, Melbourne, Vic., Australia
| | - L Yu
- Innate Immune Laboratory, St Vincent's Hospital, University of Melbourne, Melbourne, Vic., Australia
| | - J Pavlovic
- Liver Transplant Unit Victoria, Austin Health, University of Melbourne, Melbourne, Vic., Australia
| | - P J Gow
- Liver Transplant Unit Victoria, Austin Health, University of Melbourne, Melbourne, Vic., Australia
| | - R M Jones
- Liver Transplant Unit Victoria, Austin Health, University of Melbourne, Melbourne, Vic., Australia
| | - K Visvanathan
- Innate Immune Laboratory, St Vincent's Hospital, University of Melbourne, Melbourne, Vic., Australia
| | - P W Angus
- Liver Transplant Unit Victoria, Austin Health, University of Melbourne, Melbourne, Vic., Australia
| | - A G Testro
- Liver Transplant Unit Victoria, Austin Health, University of Melbourne, Melbourne, Vic., Australia
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Bayrampour H, Hapsari P, Pavlovic J. Barriers to Addressing Perinatal Mental Health Issues in Midwifery Settings. Journal of Obstetrics and Gynaecology Canada 2018. [DOI: 10.1016/j.jogc.2018.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bayrampour H, Hapsari AP, Pavlovic J. Barriers to addressing perinatal mental health issues in midwifery settings. Midwifery 2018; 59:47-58. [DOI: 10.1016/j.midw.2017.12.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/08/2017] [Accepted: 12/21/2017] [Indexed: 12/18/2022]
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Farris SG, Thomas JG, Abrantes AM, Lipton RB, Pavlovic J, Smitherman TA, Irby MB, Penzien DB, Roth J, O'Leary KC, Bond DS. Pain worsening with physical activity during migraine attacks in women with overweight/obesity: A prospective evaluation of frequency, consistency, and correlates. Cephalalgia 2017; 38:1707-1715. [PMID: 29237284 DOI: 10.1177/0333102417747231] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Migraine is a neurological disease involving recurrent attacks of moderate-to-severe and disabling head pain. Worsening of pain with routine physical activity during attacks is a principal migraine symptom; however, the frequency, individual consistency, and correlates of this symptom are unknown. Given the potential of this symptom to undermine participation in daily physical activity, an effective migraine prevention strategy, further research is warranted. This study is the first to prospectively evaluate (a) frequency and individual consistency of physical activity-related pain worsening during migraine attacks, and (b) potential correlates, including other migraine symptoms, anthropometric characteristics, psychological symptoms, and daily physical activity. Methods Participants were women (n = 132) aged 18-50 years with neurologist-confirmed migraine and overweight/obesity seeking weight loss treatment in the Women's Health and Migraine trial. At baseline, participants used a smartphone diary to record migraine attack occurrence, severity, and symptoms for 28 days. Participants also completed questionnaires and 7 days of objective physical activity monitoring before and after diary completion, respectively. Patterning of the effect of physical activity on pain was summarized within-subject by calculating the proportion (%) of attacks in which physical activity worsened, improved, or had no effect on pain. Results Participants reported 5.5 ± 2.8 (mean ± standard deviation) migraine attacks over 28 days. The intraclass correlation (coefficient = 0.71) indicated high consistency in participants' reports of activity-related pain worsening or not. On average, activity worsened pain in 34.8 ± 35.6% of attacks, had no effect on pain in 61.8 ± 34.6% of attacks and improved pain in 3.4 ± 12.7% of attacks. Few participants (9.8%) reported activity-related pain worsening in all attacks. A higher percentage of attacks where physical activity worsened pain demonstrated small-sized correlations with more severe nausea, photophobia, phonophobia, and allodynia (r = 0.18 - 0.22, p < 0.05). Pain worsening due to physical activity was not related to psychological symptoms or total daily physical activity. Conclusions There is large variability in the effect of physical activity on pain during migraine attacks that can be accounted for by individual differences. For a minority of participants, physical activity consistently contributed to pain worsening. More frequent physical activity-related pain worsening was related to greater severity of other migraine symptoms and pain sensitivity, which supports the validity of this diagnostic feature. Study protocol ClinicalTrials.govIdentifier: NCT01197196.
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Affiliation(s)
- Samantha G Farris
- 1 Alpert Medical School of Brown University, Providence, RI, USA.,2 The Miriam Hospital, Centers for Preventative and Behavioral Medicine, Providence, RI, USA.,3 Butler Hospital, Behavioral Medicine and Addictions Research Unit, Providence, RI, USA
| | - J Graham Thomas
- 1 Alpert Medical School of Brown University, Providence, RI, USA.,4 The Miriam Hospital, Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Ana M Abrantes
- 1 Alpert Medical School of Brown University, Providence, RI, USA.,3 Butler Hospital, Behavioral Medicine and Addictions Research Unit, Providence, RI, USA
| | - Richard B Lipton
- 5 Albert Einstein College of Medicine, Department of Neurology, New York, NY, USA.,6 Montefiore Medical Center/Montefiore Headache Center, New York, NY, USA
| | - Jelena Pavlovic
- 5 Albert Einstein College of Medicine, Department of Neurology, New York, NY, USA.,6 Montefiore Medical Center/Montefiore Headache Center, New York, NY, USA
| | - Todd A Smitherman
- 7 University of Mississippi, Department of Psychology, Oxford, MS, USA
| | - Megan B Irby
- 8 Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Julie Roth
- 1 Alpert Medical School of Brown University, Providence, RI, USA.,9 Rhode Island Hospital, Department of Neurology, Providence, RI, USA
| | - Kevin C O'Leary
- 1 Alpert Medical School of Brown University, Providence, RI, USA.,4 The Miriam Hospital, Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Dale S Bond
- 1 Alpert Medical School of Brown University, Providence, RI, USA.,4 The Miriam Hospital, Weight Control and Diabetes Research Center, Providence, RI, USA
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Sheikh HU, Pavlovic J, Loder E, Burch R. Risk of Stroke Associated With Use of Estrogen Containing Contraceptives in Women With Migraine: A Systematic Review. Headache 2017; 58:5-21. [PMID: 29139115 DOI: 10.1111/head.13229] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/04/2017] [Accepted: 10/04/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Migraine with aura has been associated with increased risk of ischemic and hemorrhagic stroke. Prior studies have shown a further increase in risk in women using combined hormonal contraceptives (CHCs). This has led to guidelines recommending against use of CHCs in this population. We sought to assess whether the risk of stroke is associated with the dose of estrogen and whether there is evidence of synergism between migraine and CHCs. We also sought to assess whether an interaction effect exists between migraine and CHCs. METHODS We searched PubMed, the Cochrane Library, and EMBASE from inception through January 2016 for relevant English-language studies of adults, of any design. We included studies that examined exposure to CHCs and reported outcomes of ischemic or hemorrhagic stroke. Data extraction and assessment of study quality were conducted independently by reviewer pairs and quality was assessed with the GRADE and Newcastle Ottawa scales. RESULTS Of 2480 records, 15 studies met inclusion criteria and six provided odds ratios for the relevant population. The point estimates for the odds ratios for ischemic stroke in women with migraine who used CHCs with any dose of estrogen ranged from 2.08 to 16.9. Studies were generally small and confidence intervals were wide. No studies reported odds ratios for stroke risk as a function of estrogen dose in women with migraine, largely due to insufficient sample sizes. No interaction effect between migraine and CHCs was seen in the seven studies that assessed this. One study differentiated risk by presence or absence of migraine aura and found an increased risk in the migraine with aura population (OR 6.1; CI 3.1 to 12.1 in migraine with aura vs 1.8; CI 1.1 to 2.9 in the migraine without aura group). Studies generally had high Newcastle Ottawa scores and low GRADE levels of evidence. No studies met all three supplementary quality criteria (assessed migraine subtype, used International Classification of Headache Disorders criteria for diagnosis of migraine, and stratified risk by estrogen dose). CONCLUSIONS This systematic review shows a lack of good quality studies assessing risk of stroke associated with low dose estrogen use in women with migraine. Further study in this area is needed. The available evidence is consistent with an additive increase in stroke risk with CHC use in women with migraine with aura. Since the absolute risk of stroke is low even in the presence of these risk factors, use of CHCs in women who have migraine with aura should be based on an individualized assessment of harms and benefits.
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Affiliation(s)
- Huma U Sheikh
- Mt. Sinai, Icahn School of Medicine, New York, NY, USA (H.U. Sheikh)
| | - Jelena Pavlovic
- Montefiore Medical Center, AECOM, Bronx, New York (J. Pavlovic)
| | - Elizabeth Loder
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (E. Loder and R. Burch)
| | - Rebecca Burch
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (E. Loder and R. Burch)
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Leening M, Pavlovic J, Kavousi M, Ikram M, Deckers J, Franco O. P6213Differences in recommendations and associated level of evidence for statins in primary prevention of CVD according to the ACC/AHA 2013, CCS 2016, ESC 2016, and USPSTF 2016 clinical practice guidelines. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Leening M, Pavlovic J, Deckers J, Kavousi M, Hofman A, Ikram M, Greenland P, Franco O. 3098Assessing gaps in cholesterol treatment guidelines for primary prevention of cardiovascular disease using clinical trial evidence: results from the prospective population-based Rotterdam Study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.3098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Santoro N, Crawford SL, El Khoudary SR, Allshouse AA, Burnett-Bowie SA, Finkelstein J, Derby C, Matthews K, Kravitz HM, Harlow SD, Greendale GA, Gold EB, Kazlauskaite R, McConnell D, Neal-Perry G, Pavlovic J, Randolph J, Weiss G, Chen HY, Lasley B. Menstrual Cycle Hormone Changes in Women Traversing Menopause: Study of Women's Health Across the Nation. J Clin Endocrinol Metab 2017; 102:2218-2229. [PMID: 28368525 PMCID: PMC5505186 DOI: 10.1210/jc.2016-4017] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/17/2017] [Indexed: 12/14/2022]
Abstract
CONTEXT Menstrual cycle hormone patterns in women approaching menopause are inadequately studied. OBJECTIVE To describe day-to-day menstrual cycle hormones in women as they approach menopause from the Study of Women's Health Across the Nation Daily Hormone Study (DHS). DESIGN DHS enrollees collected daily urine for one entire menstrual cycle or up to 50 days, whichever came first, annually, up to the final menstrual period (FMP) or for up to 10 years. SETTING Seven sites across the United States. PARTICIPANTS A total of 511 premenopausal or early perimenopausal women at enrollment, within 10 years before menopause. INTERVENTION Time-to-FMP measurement. MAIN OUTCOME MEASURES Evidence of luteal activity (ELA), determined using objective algorithms. Menstrual cycle/segment length; whole cycle, and segment integrated urinary luteinizing hormone, follicle-stimulating hormone, estrone conjugates, and pregnanediol glucuronide (Pdg) for each year, organized around the FMP. RESULTS Mean menstrual cycle length was remarkably preserved at 26 to 27 days in ELA cycles; non-ELA cycles had greater variability. The percentage of cycles that were ELA remained high until 5 years before the FMP (87.9%); only 22.8% of cycles within 1 year of the FMP were ELA. Whole cycle hormones remained relatively stable up to 3 years before the FMP, when gonadotropins began to increase. Pdg excretion declined slowly with progress to the FMP, but Pdg patterns of ELA cycles remained distinguishable from non-ELA. CONCLUSIONS Menstrual cycle hormone patterns in perimenopausal women resemble those of midreproductive-aged women until 5 years before menopause, and presumably ovulatory cycles retain a potentially fertile pattern up to the end of reproductive life.
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Affiliation(s)
- Nanette Santoro
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, Colorado 80045
| | - Sybil L. Crawford
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | - Samar R. El Khoudary
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
| | - Amanda A. Allshouse
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, Colorado 80045
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado 80045
| | | | - Joel Finkelstein
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114
| | - Carol Derby
- Departments of Neurology and Epidemiology & Population Health, Albert Einstein College of Medicine, New York, New York 10461
| | - Karen Matthews
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
| | - Howard M. Kravitz
- Departments of Psychiatry and Preventive Medicine, Rush University Medical Center, Chicago, Illinois 60612
| | - Sioban D. Harlow
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan 48109-5624
| | - Gail A. Greendale
- Department of Medicine, University of California, Los Angeles Medical Center, Los Angeles, California 90095
| | - Ellen B. Gold
- Department of Public Health Sciences, University of California Davis Health, Davis, California 95817
| | - Rasa Kazlauskaite
- Departments of Psychiatry and Preventive Medicine, Rush University Medical Center, Chicago, Illinois 60612
| | - Dan McConnell
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan 48109-5624
| | | | - Jelena Pavlovic
- Departments of Neurology and Epidemiology & Population Health, Albert Einstein College of Medicine, New York, New York 10461
| | - John Randolph
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan 48109-5624
| | - Gerson Weiss
- Department of Obstetrics and Gynecology, Rutgers-New Jersey Medical School, Newark, New Jersey 07103
| | - Hsiang-Yu Chen
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
| | - Bill Lasley
- Department of Public Health Sciences, University of California Davis Health, Davis, California 95817
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Moran EE, Wang C, Katz M, Ozelius L, Schwartz A, Pavlovic J, Ortega RA, Lipton RB, Zimmerman ME, Saunders-Pullman R. Cognitive and motor functioning in elderly glucocerebrosidase mutation carriers. Neurobiol Aging 2017; 58:239.e1-239.e7. [PMID: 28728889 DOI: 10.1016/j.neurobiolaging.2017.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/13/2017] [Accepted: 06/18/2017] [Indexed: 01/27/2023]
Abstract
Mutations in the glucocerebrosidase (GBA) gene are a strong genetic risk factor for the development of Parkinson's disease and dementia with Lewy Bodies. However the penetrance of GBA mutations is low for these diseases in heterozygous carriers. The aim of this study was to examine the relationship between mutation status and cognitive and motor functioning in a sample of community-dwelling older adults. Using linear mixed effects models, we examined the effect of heterozygous mutation status on 736 community-dwelling older adults (≥70 years) without dementia or Parkinson's disease assessed over an average of 6 years, 28 of whom had a single GBA mutation (primarily N370S). Verbal memory was measured using the picture version of the Free and Cued Selective Reminding Test, and carriers showed significantly (p < 0.05) greater decline in verbal memory over time. There was no difference in motor function or any other cognitive domain. Taken together, these results suggest an effect, but an overall limited burden, of harboring a single GBA mutation in aging mutation carriers.
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Affiliation(s)
- Eileen E Moran
- Department of Psychology, Fordham University, Bronx, NY, USA.
| | - Cuiling Wang
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mindy Katz
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Laurie Ozelius
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alison Schwartz
- Department of Neurology, Mount Sinai Beth Israel, New York, NY, USA
| | - Jelena Pavlovic
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Roberto A Ortega
- Department of Neurology, Mount Sinai Beth Israel, New York, NY, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Molly E Zimmerman
- Department of Psychology, Fordham University, Bronx, NY, USA; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rachel Saunders-Pullman
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurology, Mount Sinai Beth Israel, New York, NY, USA
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Pavlovic J. Embracing Innovation: New Voices in Constructivist Psychology. Journal of Constructivist Psychology 2017. [DOI: 10.1080/10720537.2016.1271378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pavlovic J, Samardzic J, Kostic L, Laursen KH, Natic M, Timotijevic G, Schjoerring JK, Nikolic M. Silicon enhances leaf remobilization of iron in cucumber under limited iron conditions. Ann Bot 2016; 118:271-80. [PMID: 27371693 PMCID: PMC4970368 DOI: 10.1093/aob/mcw105] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/25/2016] [Indexed: 05/05/2023]
Abstract
BACKGROUND AND AIMS Retranslocation of iron (Fe) from source tissues enhances plant tolerance to Fe deficiency. Previous work has shown that silicon (Si) can alleviate Fe deficiency by enhancing acquisition and root to shoot translocation of Fe. Here the role of Si in Fe mobilization in older leaves and the subsequent retranslocation of Fe to young leaves of cucumber (Cucumis sativus) plants growing under Fe-limiting conditions was investigated. METHODS Iron ((57)Fe or naturally occurring isotopes) was measured in leaves at different positions on plants hydroponically growing with or without Si supply. In parallel, the concentration of the Fe chelator nicotianamine (NA) along with the expression of nicotianamine synthase (NAS) involved in its biosynthesis and the expression of yellow stripe-like (YSL) transcripts mediating Fe-NA transport were also determined. KEY RESULTS In plants not receiving Si, approximately half of the total Fe content remained in the oldest leaf. In contrast, Si-treated plants showed an almost even Fe distribution among leaves with four different developmental stages, thus providing evidence of enhanced Fe remobilization from source leaves. This Si-stimulated Fe export was paralleled by an increased NA accumulation and expression of the YSL1 transporter for phloem loading/unloading of the Fe-NA complex. CONCLUSIONS The results suggest that Si enhances remobilization of Fe from older to younger leaves by a more efficient NA-mediated Fe transport via the phloem. In addition, from this and previous work, a model is proposed of how Si acts to improve Fe homeostasis under Fe deficiency in cucumber.
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Affiliation(s)
- Jelena Pavlovic
- Plant Nutrition Research Group, Institute for Multidisciplinary Research, University of Belgrade, Kneza Viseslava 1, 11030 Belgrade, Serbia
| | - Jelena Samardzic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Vojvode Stepe 444-A, 11010 Belgrade, Serbia
| | - Ljiljana Kostic
- Plant Nutrition Research Group, Institute for Multidisciplinary Research, University of Belgrade, Kneza Viseslava 1, 11030 Belgrade, Serbia
| | - Kristian H Laursen
- Plant and Soil Science Section, Department of Plant and Environmental Sciences, Faculty of Science, University of Copenhagen, Thorvaldsensvej 40, DK-1871 Frederiksberg C, Copenhagen, Denmark
| | - Maja Natic
- Faculty of Chemistry, University of Belgrade, Studentski trg 12-16, 11000 Belgrade, Serbia
| | - Gordana Timotijevic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Vojvode Stepe 444-A, 11010 Belgrade, Serbia
| | - Jan K Schjoerring
- Plant and Soil Science Section, Department of Plant and Environmental Sciences, Faculty of Science, University of Copenhagen, Thorvaldsensvej 40, DK-1871 Frederiksberg C, Copenhagen, Denmark
| | - Miroslav Nikolic
- Plant Nutrition Research Group, Institute for Multidisciplinary Research, University of Belgrade, Kneza Viseslava 1, 11030 Belgrade, Serbia
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Thomas JG, Pavlovic J, Lipton RB, Roth J, Rathier L, O’Leary KC, Buse DC, Evans EW, Bond DS. Ecological momentary assessment of the relationship between headache pain intensity and pain interference in women with migraine and obesity. Cephalalgia 2016; 36:1228-1237. [DOI: 10.1177/0333102415625613] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background While pain intensity during migraine headache attacks is known to be a determinant of interference with daily activities, no study has evaluated: (a) the pain intensity-interference association in real-time on a per-headache basis, (b) multiple interference domains, and (c) factors that modify the association. Methods Participants were 116 women with overweight/obesity and migraine seeking behavioral treatment to lose weight and decrease headaches in the Women’s Health and Migraine trial. Ecological momentary assessment, via smartphone-based 28-day headache diary, and linear mixed-effects models were used to study associations between pain intensity and total- and domain-specific interference scores using the Brief Pain Inventory. Multiple factors (e.g. pain catastrophizing (PC) and headache management self-efficacy (HMSE)) were evaluated either as independent predictors or moderators of the pain intensity-interference relationship. Results Pain intensity predicted degree of pain interference across all domains either as a main effect (coeff = 0.61–0.78, p < 0.001) or interaction with PC, allodynia, and HMSE ( p < 0.05). Older age and greater allodynia consistently predicted higher interference, regardless of pain intensity (coeff = 0.04–0.19, p < 0.05). Conclusions Pain intensity is a consistent predictor of pain interference on migraine headache days. Allodynia, PC, and HMSE moderated the pain intensity-interference relationship, and may be promising targets for interventions to reduce pain interference.
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Affiliation(s)
- J Graham Thomas
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, USA
| | - Jelena Pavlovic
- Department of Neurology and the Montefiore Headache Center, Albert Einstein College of Medicine/Montefiore Medical Center, USA
| | - Richard B Lipton
- Department of Neurology and the Montefiore Headache Center, Albert Einstein College of Medicine/Montefiore Medical Center, USA
| | - Julie Roth
- Department of Neurology, Alpert Medical School of Brown University/Rhode Island Hospital, USA
| | - Lucille Rathier
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, USA
| | - Kevin C O’Leary
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, USA
| | - Dawn C Buse
- Department of Neurology and the Montefiore Headache Center, Albert Einstein College of Medicine/Montefiore Medical Center, USA
| | - E Whitney Evans
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, USA
| | - Dale S Bond
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, USA
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Nikolic M, Nikolic N, Kostic L, Pavlovic J, Bosnic P, Stevic N, Savic J, Hristov N. The assessment of soil availability and wheat grain status of zinc and iron in Serbia: Implications for human nutrition. Sci Total Environ 2016; 553:141-148. [PMID: 26925726 DOI: 10.1016/j.scitotenv.2016.02.102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/15/2016] [Accepted: 02/15/2016] [Indexed: 06/05/2023]
Abstract
The deficiency of zinc (Zn) and iron (Fe) is a global issue causing not only considerable yield losses of food crops but also serious health problems. We have analysed Zn and Fe concentrations in the grains of two bread wheat cultivars along native gradient of micronutrient availability throughout Serbia. Although only 13% of the soil samples were Zn deficient and none was Fe deficient, the levels of these micronutrients in grain were rather low (median values of 21 mg kg(-1) for Zn and 36 mg kg(-1) for Fe), and even less adequate in white flour. Moreover, excessive P fertilization of calcareous soils in the major wheat growing areas strongly correlated with lower grain concentration of Zn. Our results imply that a latent Zn deficiency in wheat grain poses a high risk for grain quality relevant to human health in Serbia, where wheat bread is a staple food.
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Affiliation(s)
- Miroslav Nikolic
- Plant Nutrition Research Group, Institute for Multidisciplinary Research, University of Belgrade, PO Box 33, 11030 Belgrade, Serbia.
| | - Nina Nikolic
- Plant Nutrition Research Group, Institute for Multidisciplinary Research, University of Belgrade, PO Box 33, 11030 Belgrade, Serbia
| | - Ljiljana Kostic
- Plant Nutrition Research Group, Institute for Multidisciplinary Research, University of Belgrade, PO Box 33, 11030 Belgrade, Serbia
| | - Jelena Pavlovic
- Plant Nutrition Research Group, Institute for Multidisciplinary Research, University of Belgrade, PO Box 33, 11030 Belgrade, Serbia
| | - Predrag Bosnic
- Plant Nutrition Research Group, Institute for Multidisciplinary Research, University of Belgrade, PO Box 33, 11030 Belgrade, Serbia
| | - Nenad Stevic
- Plant Nutrition Research Group, Institute for Multidisciplinary Research, University of Belgrade, PO Box 33, 11030 Belgrade, Serbia
| | - Jasna Savic
- Plant Nutrition Research Group, Institute for Multidisciplinary Research, University of Belgrade, PO Box 33, 11030 Belgrade, Serbia; Faculty of Agriculture, University of Belgrade, Nemanjina 6, 11080 Belgrade, Serbia
| | - Nikola Hristov
- Institute of Field and Vegetable Crops, Maksima Gorkog 30, 21000 Novi Sad, Serbia
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Martin VT, Pavlovic J, Fanning KM, Buse DC, Reed ML, Lipton RB. Perimenopause and Menopause Are Associated With High Frequency Headache in Women With Migraine: Results of the American Migraine Prevalence and Prevention Study. Headache 2016; 56:292-305. [PMID: 26797693 DOI: 10.1111/head.12763] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To examine the relationship of headache frequency to the stages of the menopausal transition in mid-life women with migraine. BACKGROUND Past studies suggest that the perimenopause is associated with an increased prevalence of migraine, particularly in those with a history of premenstrual syndrome. The effect of the menopausal transition on the frequency of headache attacks in women with migraine has not been explored. METHODS This was a cross-sectional observational study. Using data from the 2006 American Migraine, Prevalence and Prevention study survey, women meeting modified ICHD-3 beta criteria for migraine between the ages of 35-65 years were included in analyses. Women who had never menstruated or were pregnant, breastfeeding, or using exogenous sex hormones were excluded. The 2006 survey was selected because it included detailed questions on the menstrual cycle. The stages of the menopausal transition were defined based upon the self-reported cycle length and/or duration of amenorrhea. The primary outcome, high vs low headache frequency, was defined using a cut score of ≥10 headache days per month. Binary logistic regression models were used to assess the influence of menopausal stage on headache frequency category using premenopause as the reference group. Adjustments for stage of menopausal transition and sociodemographics (eg, age and income) were included in the first model, while the second model included sociodemographics, depression, body mass index, preventative medications, and medication overuse. RESULTS The study sample included 3664 women at a mean age of 46 years. Among women who were premenopausal, 8.0% (99/1242) were in the high frequency headache group in comparison with 12.2% (154/1266) of perimenopausal and 12.0% (131/1095) of postmenopausal women. Compared with premenopausal women, the adjusted odds of being in the high frequency headache group was 1.62 (95% CI = 1.23, 2.12) for perimenopausal and 1.76 (95% CI = 1.23, 2.52) for postmenopausal women (Model 1). In model 2, high frequency headache was only increased in perimenopausal women with an OR of 1.42 (95% CI = 1.03, 1.94). CONCLUSIONS The risk of high frequency headache is increased in women during the perimenopause compared to premenopause in the fully adjusted model. The fact that the increased risk of high frequency headache was not statistically significant for menopause in the fully adjusted models suggests that different mechanisms might account for the increased risk for this stage of the menopausal transition. Recognition of the increased risk of high frequency headache during the menopausal transition suggests a need for optimized preventive treatment of migraine during this time of women's life.
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Affiliation(s)
- Vincent T Martin
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA (V.T. Martin)
| | - Jelena Pavlovic
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Headache Center, Bronx, NY, USA (J. Pavlovic, D.C. Buse, and R.B. Lipton)
| | | | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Headache Center, Bronx, NY, USA (J. Pavlovic, D.C. Buse, and R.B. Lipton)
| | - Michael L Reed
- Vedanta Research, Chapel Hill, NC, USA (K.M. Fanning and M.L. Reed)
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Headache Center, Bronx, NY, USA (J. Pavlovic, D.C. Buse, and R.B. Lipton).,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton)
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Micic RJ, Simonovic RM, Mitic SS, Kostic DA, Mitic MN, Simonovic SR, Pavlovic J. Development and use of the kinetic method for determination of trace amounts of vanadium (V) in water samples from objects of the environment. J WATER CHEM TECHNO+ 2015. [DOI: 10.3103/s1063455x15040037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Evans EW, Lipton RB, Peterlin BL, Raynor HA, Thomas JG, O'Leary KC, Pavlovic J, Wing RR, Bond DS. Dietary intake patterns and diet quality in a nationally representative sample of women with and without severe headache or migraine. Headache 2015; 55:550-61. [PMID: 25758250 DOI: 10.1111/head.12527] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE/BACKGROUND The role of diet in migraine is not well understood. We sought to characterize usual dietary intake patterns and diet quality in a nationally representative sample of women with and without severe headache or migraine. We also examined whether the relationship between migraine and diet differs by weight status. METHODS In this analysis, women with migraine or severe headache status was determined by questionnaire for 3069 women, ages 20-50 years, who participated in the National Health and Nutrition Examination Study, 1999-2004. Women who experienced severe headaches or migraines were classified as migraine for the purposes of this analysis. Dietary intake patterns (micro- and macronutrient intake and eating frequency) and diet quality, measured by the Healthy Eating Index, 2005, were determined using one 24-hour dietary recall. RESULTS Dietary intake patterns did not significantly differ between women with and without migraine. Normal weight women with migraine had significantly lower diet quality (Healthy Eating Index, 2005 total scores) than women without migraine (52.5 ± 0.9 vs. 45.9 ± 1.0; P < .0001). CONCLUSIONS Whereas findings suggest no differences in dietary intake patterns among women with and without migraine, dietary quality differs by migraine status in normal weight women. Prospective analyses are needed to establish how diet relates to migraine onset, characteristics, and clinical features in individuals of varying weight status.
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Affiliation(s)
- E Whitney Evans
- Weight Control and Diabetes Research Center, The Miriam Hospital, Brown University Alpert Medical School, Providence, RI, USA
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Sood S, Haifer C, Yu J, Pavlovic J, Visvanathan K, Gow P, Jones R, Angus P, Testro A. A Novel Immune Function Biomarker Predicts Early Clinical Outcomes Following Liver Transplantation. Transplantation 2014. [DOI: 10.1097/00007890-201407151-00491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bityutskii N, Pavlovic J, Yakkonen K, Maksimović V, Nikolic M. Contrasting effect of silicon on iron, zinc and manganese status and accumulation of metal-mobilizing compounds in micronutrient-deficient cucumber. Plant Physiol Biochem 2014; 74:205-11. [PMID: 24316009 DOI: 10.1016/j.plaphy.2013.11.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 11/13/2013] [Indexed: 05/06/2023]
Abstract
Although the beneficial role of silicon (Si) in alleviation of abiotic stress is well established, little is known of the relevance of Si nutrition under microelement deficiency. The aim of our work was to investigate the physiological role of Si in relation to micronutrient (Fe, Zn and Mn) deficiencies in cucumber (Cucumis sativus L.). Cucumber (cv. Semkross) plants were grown hydroponically in a complete nutrient solution (control) and in nutrient solutions free from Fe, Zn or Mn, with or without Si supply. Plant tissue concentrations of microelements, organic acids and phenolics were measured. Si supply effectively mitigated the symptoms of Fe deficiency, but only in part, the symptoms of Zn- or Mn deficiency. Leaf Fe concentration significantly increased in plants deprived of Fe but treated with Si, whereas the concentrations of other microelements were not affected by Si supply. The effects of Si supply in increasing accumulation of both organic acids and phenolic compounds in cucumber tissues were exclusively related to Fe nutrition. Enhancement of Fe distribution towards apical shoot parts, along with the tissue accumulation of Fe-mobilizing compounds such as citrate (in leaves and roots) or cathechin (in roots) appears to be the major alleviating effect of Si. Si nutrition, however, was without effect on the mobility and tissue distribution of either Zn or Mn.
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Affiliation(s)
- Nikolai Bityutskii
- Department of Agricultural Chemistry, Saint Petersburg State University, 16th linia 29, V.O. Saint Petersburg 199178, Russia
| | - Jelena Pavlovic
- Institute for Multidisciplinary Research (IMSI), University of Belgrade, Kneza Višeslava 1, 11030 Belgrade, Serbia
| | - Kirill Yakkonen
- Department of Agricultural Chemistry, Saint Petersburg State University, 16th linia 29, V.O. Saint Petersburg 199178, Russia
| | - Vuk Maksimović
- Institute for Multidisciplinary Research (IMSI), University of Belgrade, Kneza Višeslava 1, 11030 Belgrade, Serbia
| | - Miroslav Nikolic
- Institute for Multidisciplinary Research (IMSI), University of Belgrade, Kneza Višeslava 1, 11030 Belgrade, Serbia.
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Simic S, Pavlovic J, Vukicevic V, Vujacic A. The craniofacial morphology of school children in Kosovska Mitrovica. Praxis Med 2014. [DOI: 10.5937/pramed1403061s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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