The recent Flare-OA questionnaire measuring flare in knee and hip osteoarthritis (OA) (19 items in 5 domains, numerical rating scale) showed good psychometric properties along with classical test ...theory. This study aimed to determine its scaling properties by Rasch analysis and to present evidence for a refined scalable version.
The participants were 398 subjects (mean age 64 years standard deviation = 8.1, 70.4% women) recruited from Australia, France, and the United States, with clinically and radiologically symptomatic knee or hip OA, who completed an online survey. The sample was split into derivation and validation subsamples, stratified by country and joint. Rasch analysis examined differential item functioning (DIF) for sex, age, country, and joint. A confirmatory factor analysis and an analysis of convergent validity were performed to document the psychometric properties of the short version.
To fit the Rasch model, we reordered thresholds of answering modalities when necessary. Two items were removed. A local dependency between 2 items was solved by combining items modalities into a super-item. A uniform DIF (expected and nonremoved) was identified for one item that was split by joint, and a nonuniform DIF for one item for age and country (removed). The person-item threshold distribution showed a well-focused scale; the confirmatory factor analysis and the analysis of convergent validity showed good fit indicators for the short version.
The Rasch analysis was helpful in guiding the decision to refine the measurement instrument. After analysis, the 16-item Flare-OA self-report questionnaire is available for use in clinical research.
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•The person-item threshold distribution showed a well-focused scale.•The Rasch analysis was helpful to shorten the questionnaire.•An item about swelling showed DIF according to the joint, as expected.•One item was removed because of a nonuniform DIF for age and country.•The Flare-OA-16 questionnaire is available for use in clinical research.
This study aims to compare methods of constructing a composite score for the Flare-OA-16 self-reported questionnaire.
Participants with knee and hip osteoarthritis (OA) completed a validated 16-item ...questionnaire assessing five domains of flare. Three estimation methods were compared: (i) second-order confirmatory factor analysis (CFA); (ii) logistic regression, according to the participant's self-report of flare (yes/no); and (iii) Rasch method, with weighted scores in each dimension. The distribution (floor effect FF and ceiling effect CF) were described and the known-group validity (by self-reported flare) tested by Wilcoxon rank-sum test. Similarity between the scores was analyzed by intraclass correlation coefficient (ICC) and their performance against self-report compared by areas under ROC curves (AUC). Intrascore test-retest reliability at 14 days was assessed by ICC.
In a sample of 381 participants, 247 reported having a flare. CFA showed fit indices (comparative fit index CFI = 0.95; root mean square error of approximation RMSEA = 0.08) and estimated composite mean score = 4.33(SD = 2.85) (FF = 14.9%, CF = 0%). For the logistic regression estimation, the mean composite score was 6.48 (SD = 3.13) (FF = 0%; CF = 0%). With Rasch model, the mean composite score was 4.35 (SD = 2.60) (FF = 14.9%; CF = 0%). Similarity analysis indicated a greater concordance between CFA and Rasch scores (ICC = 0.98) than between logistic regression score and the two others (ICC = 0.88 with Rasch score and 0.90 with CFA score). The AUC indicated similar performance of all methods: logistic model (AUC = 0.89 0.85–0.92), CFA, and Rasch model (AUC = 0.86 0.82–0.90). The difference between groups was significant (P < .05) for scores estimated by CFA (3.98), Rasch model (4.95), and logistic regression (4.30). The reproducibility was ICC = 0.84 (0.75–0.90) for Rasch and CFA scores and ICC = 0.78(0.66–86) for logistic model.
Three alternatives explored to build a composite score showed similar construct validity. Some metric superiority (better score distribution and reproducibility) of the Rasch model is promising for the detection of occurrence and assessment of severity of a flare in OA.
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•A score to assess the occurrence and severity of flares of knee or hip osteoarthritis (OA) would help guide interventions.•Three estimation methods to obtain a composite score for the Flare-OA-16 self-reported questionnaire were compared: second-order confirmatory factor analysis, logistic regression, and Rasch model.•The three methods showed similar performance in predicting self-reported flare but a better scale distribution was in favor of the Rasch model.
The QT interval measures cardiac repolarization, and prolongation is associated with adverse cardiovascular outcomes and death. The exponential Bazett correction formula overestimates the QT interval ...during tachycardia.
We evaluated 4 formulas of QT interval correction in individuals with sinus tachycardia for the identification of coronary artery disease, heart failure, and mortality.
The Penn Atrial Fibrillation Free study is a large cohort study of patients without atrial fibrillation. The present study examined 6723 Penn Atrial Fibrillation Free study patients without a history of heart failure and with baseline sinus rate ≥100 beats/min. Medical records were queried for index clinical parameters, incident cardiovascular events, and all-cause mortality. The QT interval was corrected by using Bazett (QT/RR(0.5)), Fridericia (QT/RR(0.33)), Framingham QT + 0.154 * (1000 - RR), and Hodges (QT + 105 * (1/RR - 1)) formulas.
In 6723 patients with a median follow-up of 4.5 years (interquartile range 1.9-6.4 years), the annualized cardiovascular event rate was 2.3% and the annualized mortality rate was 2.2%. QT prolongation was diagnosed in 39% of the cohort using the Bazett formula, 6.2% using the Fridericia formula, 3.7% using the Framingham formula, and 8.7% using the Hodges formula. Only the Hodges formula was an independent risk marker for death across the range of QT values (highest tertile: hazard ratio 1.26; 95% confidence interval 1.03-1.55).
Although all correction formulas demonstrated an association between QTc values and cardiovascular events, only the Hodges formula identified one-third of individuals with tachycardia that are at higher risk of all-cause mortality. Furthermore, the Bazett correction formula overestimates the number of patients with a prolonged QT interval and was not associated with mortality. Future work may validate these findings and result in changes to automated algorithms for QT interval assessment.
•Understanding the role of e-cigarettes in quitting smoking is important for public health.•This longitudinal study examined potential moderators of the effects of e-cigarette use.•The study cohort ...experienced the introduction and growth of e-cigarettes during their 30 s.•E-cigarette use was associated with less smoking cessation in all study analyses.
Evidence for use of electronic cigarettes (e-cigs) as a potential aid in quitting or reducing combustible cigarette (c-cig) use is mixed. This study examined the extent to which e-cig initiation among smokers in their 30 s predicted quitting or reducing smoking or nicotine dependence symptoms by age 39, and whether the role of e-cigs in quitting differed by prospectively assessed moderators.
Data were from the Seattle Social Development Project (SSDP), a panel study of 808 diverse participants with high retention. A subsample of 221 smokers at age 33 was selected for analysis. Self-reports of c-cig use and dependence were assessed longitudinally at ages 33 and 39. Sixteen potential moderators were examined, including social demographics, smoking attitudes and desire to quit, other health behaviors and status, and adolescent and early adult assessments of smoking history.
The use of e-cigs was consistently associated with a lower likelihood of quitting c-cigs by age 39, after accounting for frequency of prior c-cig use at age 33. This negative association persisted across all moderators examined, although it was nonsignificant among those with a definite desire to cut down. Among those who did not quit smoking, e-cig use had no association with decreases in either quantity of c-cigs used or dependence symptoms.
Results indicate that e-cigarette use was not helpful for quitting or reducing combustible cigarette use in the 30 s. Rather, across extensive tests of moderation, e-cig initiation consistently predicted less quitting during this important age period for successful cessation.
Abstract Purpose Age at sexual initiation is strongly associated with sexually transmitted infections (STI); yet, prevention programs aiming to delay sexual initiation have shown mixed results in ...reducing STI. This study tested three explanatory mechanisms for the relationship between early sexual debut and STI: number of sexual partners, individual characteristics, and environmental antecedents. Methods A test-and-replicate strategy was employed using two longitudinal studies: the Seattle Social Development Project (SSDP) and Raising Healthy Children (RHC). Childhood measures included pubertal age, behavioral disinhibition, and family, school, and peer influences. Alcohol use and age of sexual debut were measured during adolescence. Lifetime number of sexual partners and having sex under the influence were measured during young adulthood. Sexually transmitted infection diagnosis was self-reported at age 24. Early sex was defined as debut at <15 years. Path models were developed in SSDP evaluating relationships between measures, and were then tested in RHC. Results The relationship between early sex and STI was fully mediated by lifetime sex partners in SSDP, but only partially in RHC, after accounting for co-occurring factors. Behavioral disinhibition predicted early sex, early alcohol use, number of sexual partners, and sex under the influence, but had no direct effect on STI. Family management protected against early sex and early alcohol use, whereas antisocial peers exacerbated the risk. Conclusions Early sexual initiation, a key mediator of STI, is driven by antecedents that influence multiple risk behaviors. Targeting co-occurring individual and environmental factors may be more effective than discouraging early sexual debut and may concomitantly improve other risk behaviors.
IntroductionHospital-acquired thrombosis (HAT) is defined as any venous thromboembolism (VTE)-related event during a hospital admission or occurring up to 90 days post discharge, and is associated ...with significant morbidity, mortality and healthcare-associated costs. Although surgery is an established risk factor for VTE, operations with a short hospital stay (<48 hours) and that permit early ambulation are associated with a low risk of VTE. Many patients undergoing short-stay surgical procedures and who are at low risk of VTE are treated with graduated compression stockings (GCS). However, evidence for the use of GCS in VTE prevention for this cohort is poor.Methods and analysisA multicentre, cluster randomised controlled trial which aims to determine whether GCS are superior in comparison to no GCS in the prevention of VTE for surgical patients undergoing short-stay procedures assessed to be at low risk of VTE. A total of 50 sites (21 472 participants) will be randomised to either intervention (GCS) or control (no GCS). Adult participants (18–59 years) who undergo short-stay surgical procedures and are assessed as low risk of VTE will be included in the study. Participants will provide consent to be contacted for follow-up at 7-days and 90-days postsurgical procedure. The primary outcome is the rate of symptomatic VTE, that is, deep vein thrombosis or pulmonary embolism during admission or within 90 days. Secondary outcomes include healthcare costs and changes in quality of life. The main analysis will be according to the intention-to-treat principle and will compare the rates of VTE at 90 days, measured at an individual level, using hierarchical (multilevel) logistic regression.Ethics and disseminationEthical approval was granted by the Camden and Kings Cross Research Ethics Committee (22/LO/0390). Findings will be published in a peer-reviewed journal and presented at national and international conferences.Trial registration numberISRCTN13908683.
Fragile X–associated tremor/ataxia syndrome (FXTAS) is a debilitating late-onset neurodegenerative disease in premutation carriers of the expanded CGG repeat in FMR1 that presents with a spectrum of ...neurological manifestations, such as gait ataxia, intention tremor, and parkinsonism P. J. Hagerman, R. J. Hagerman, Ann. N. Y. Acad. Sci. 1338, 58–70 (2015); S. Jacquemont et al., JAMA 291, 460–469 (2004). Here, we performed whole-genome sequencing (WGS) on male premutation carriers (CGG55–200) and prioritized candidate variants to screen for candidate genetic modifiers using a Drosophila model of FXTAS. We found 18 genes that genetically modulate CGG-associated neurotoxicity in Drosophila, such as Prosbeta5 (PSMB5), pAbp (PABPC1L), e(y)1 (TAF9), and CG14231 (OSGEPL1). Among them, knockdown of Prosbeta5 (PSMB5) suppressed CGG-associated neurodegeneration in the fly as well as in N2A cells. Interestingly, an expression quantitative trait locus variant in PSMB5, PSMB5rs11543947-A, was found to be associated with decreased expression of PSMB5 and delayed onset of FXTAS in human FMR1 premutation carriers. Finally, we demonstrate evidence that PSMB5 knockdown results in suppression of CGG neurotoxicity via both the RAN translation and RNA-mediated toxicity mechanisms, thereby presenting a therapeutic strategy for FXTAS.
•Abstaining from marijuana predicts fewer symptoms of alcohol use disorder.•Abstaining from marijuana predicts fewer symptoms of nicotine dependence.•Abstaining from marijuana predicts fewer symptoms ...of generalized anxiety disorder.•Chronic adult marijuana use predicts more symptoms of substance use disorders.
The present study is a prospective examination of the relationship between regular marijuana use from adolescence through young adulthood and mental health outcomes at age 33.
Data came from a gender-balanced, ethnically diverse longitudinal panel of 808 participants from Seattle, Washington. Outcomes included symptom counts for six mental health disorders. Regular marijuana use was tracked during adolescence and young adulthood. Regression analyses controlled for demographics and early environment, behaviors, and individual risk factors.
Nonusers of marijuana reported fewer symptoms of alcohol use disorder, nicotine dependence, and generalized anxiety disorder than any category of marijuana users. More persistent regular marijuana use in young adulthood was positively related to more symptoms of cannabis use disorder, alcohol use disorder, and nicotine dependence at age 33.
Findings highlight the importance of avoiding regular marijuana use, especially chronic use in young adulthood. Comprehensive prevention and intervention efforts focusing on marijuana and other substance use might be particularly important in the context of recent legalization of recreational marijuana use in Washington and other U.S. states.
Trials of preventive interventions for children that were implemented in the 1980s have reported sustained positive outcomes on behavioral and health outcomes into adulthood, years after the end of ...the intervention. This present study examines whether intervention in childhood may show sustained benefits across generations.
To examine possible intervention outcomes on the offspring of individuals (now parents) who participated in the Raising Healthy Children preventive intervention as children in the elementary grades.
This nonrandomized controlled trial was conducted in public elementary schools serving high-crime areas in Seattle, Washington. The panel originated in Seattle but was followed up locally and in out-of-state locations over time. Data analyzed in this study were collected from September 1980 to June 2011, with follow-up of the firstborn offspring (aged 1 through 22 years) of 182 parents who had been in the full intervention vs control conditions in childhood. Their children were assessed across 7 waves in 2 blocks (2002-2006 and 2009-2011). Data were analyzed for this article from September 2018 through January 2019.
In grades 1 through 6, the Raising Healthy Children intervention provided elementary school teachers with methods of classroom management and instruction, first-generation (G1) parents with skills to promote opportunities for children's active involvement in the classroom and family, and second-generation (G2) child with social and emotional skills training.
Outcomes examined in the third-generation (G3) offspring were self-regulation (emotion, attention, and behavioral regulation), cognitive capabilities, and social capabilities. Risk behaviors, including substance use and delinquency, were examined from age 6 years to study completion. Early onset of sexual activity was examined from age 13 years to study completion. Intent-to-treat analyses controlled for potential confounding factors.
A total of 182 G3 children were included in this analysis (72 in the full intervention and 110 in the control condition; mean age at first wave of data collection, 7 range, 1-13 years). Significant differences in the offspring of intervention parents were observed across 4 domains: improved early child developmental functioning (ages 1-5 years; significant standardized β range, 0.45-0.56), lower teacher-rated behavioral problems (ages 6-18 years; significant standardized β range, -0.39 to -0.46), higher teacher-rated academic skills and performance (ages 6-18 years; significant standardized β range, 0.34-0.49), and lower child-reported risk behavior (ages 6-18 years; odds ratio for any drug use alcohol, cigarettes, or marijuana, 0.27 95% CI, 0.10-0.73).
To our knowledge, this is the first study to report significant intervention differences in the offspring of participants in a universal childhood preventive intervention. Cost-benefit analyses have examined the benefits of childhood intervention in the target generation. The present study suggests that additional benefits can be realized in the next generation as well.
ClinicalTrials.gov Identifier: NCT04075019.
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