Use of Socioeconomic Status in Health Research—Reply Braveman, Paula A.; Cubbin, Catherine; Egerter, Susan ...
JAMA : the journal of the American Medical Association,
04/2006, Volume:
295, Issue:
15
Journal Article
Peer reviewed
In their Special Communication on socioeconomic status (SES) in health research, Dr Braveman and colleagues1 concluded that the correlation between achieved education and income is moderately strong ...(Spearman correlation coefficient 0.41 to 0.67) and that these indices of socioeconomic class are related but not interchangeable. In a representative population-based sample of 310 men and women from Prague, Czech Republic, the Spearman correlation coefficient between education (based on highest education degree achieved, 5 levels) and material well-being (a composite measure of income and wealth) was 0.23.2 This is much lower than in any of the surveys examined by Braveman et al. Because time, place, economic and social conditions, and other circumstances might alter what a given SES measure reflects, researchers (and readers of research) should always consider whether particular SES measures-and assumptions about their meaning-are applicable for a given health outcome and study population in a particular setting.
Lietuvos paveldosaugos pradmenys įžvelgiami jau XIX amžiuje. Būtent tada inteligentijos sluoksniuose pastebimas aktyvesnis susidomėjimas kultūros paveldu, jo supratimu bei apsauga. Taigi, ...paveldosaugos sistema yra palyginus jauna sritis, su kiekviena diena vis labiau prasiskverbianti į visuomeninį gyvenimą ir tampanti neatsiejama jo dalimi. Vis dažniau informacijos sklaidos tarnyba nagrinėja kultūros paveldo apsaugos aktualijas. Deja, nedaug dėmesio skiriama kultūrinio palikimo išsaugojimo ištakoms bei pioneriams-romantikams, dirbusiems šitoje srityje susižavėjimo Vilniaus krašto kultūros palikimu vardan, įžvelgusiems jo istorinę, tautinę ir ideologinę svarbą. Lietuvos paveldosaugos srityje ypač nusipelnė Lietuvos mokslo draugija (toliau – LMD) ir Vilniaus mokslo bičiulių draugija (toliau – VMBD). Jos susikūrė 1907 m., lygiagrečiai veikė visą tarpukarį. Draugijų veiklos sritys ir tikslai panašus. Abiejų organizacijų nariai aktyviai ir entuziastingai stengėsi išsaugoti Lietuvos Didžiosios Kunigaikštystės (toliau – LDK) kultūrinį palikimą. Tik XX a. pradžioje politinė situacija, padalijusi Lietuvos žemes į dvi stovyklas, sukėlė, kaip rašoma draugijų susirašinėjimo dokumentuose, dirbtinę konfrontaciją. Lietuvos istoriografijoje LMD darbai susilaukė daugiai dėmesio, negu VMBD. Apie Draugiją daug žinių suteikia Lietuvos valstybės istorijos archyve saugomi dokumentai, veiklos ataskaitos. Vertinga yra VMBD surinkta ikonografija, naudojama šių dienų specialistų. Apie VMBD veiklą... toliau žr. visą tekstą
First steps of the heritage preservation in Lithuania are penetrated in 19th century. Greater interest in cultural heritage, its comprehension and preservation among eggheads it is noticed namely then. So, the system of heritage preservation is comparably a young sphere, which momentarily day-after-day infiltrates into a social life and becomes integrant. Cultural heritage preservation topicalities are more frequently examined presently by the mass media. Unfortunately, not enough attention is paid to fountainhead of the cultural heritage, as well as to pathfinders-romanticists who worked in this field fascinated by Vilnius region cultural heritage and envisaged its historical, ethnic and ideological significance. Science Society of Lithuania (further – SSL) and Vilnius science mates’ union (VSMU) in the field of heritage preservation have commanded notably. Societies were established in 1907 and functioned in parallel during the whole inter-war period. Goals and activity fields of both societies were alike. Members of both societies actively and enthusiastically attempted to retain the cultural heritage of the Grand Duchy of Lithuania (GDL). And only at the beginning of 20th century when Lithuania under influence of political situation was divided into two camps, an artificial contrariety aroused between them, as is known from the correspondence of the societies. Works of SSL attained more attention of the Lithuania’s historiography than works of VSMU. Documents, activity... to full text
This thesis explores the epidemiology and risk factors of eating disorders. It focuses on the impact of the political and cultural changes that occured in the Czech Republic in the early 1990s. The ...term eating disorders includes mental illnesses characterized by disturbances in eating behaviour: anorexia nervosa, bulimia nervosa and various eating disorders not otherwise specifieed. It appears that the incidence of anorexia nervosa was increasing until 1970s and remains stable since. The incidence of bulimia nervosa was rising until the end of 1990s. However, the data come from the western countries only. The epiemiological data from the Central and Eastern Europe region remain sparse. Eating disorders have multifactorial aetiology; which includes the recently emerging factors related to migration and acculatuation. Therefore, we hypothesised that the prevalence and incidence of eating disorders in the Czech Repulic rose in the 1990s and that factors associated with migration experiences may play a role in the development and maintenance of eating disorders. This thesis contains three different papers exploring different aspects of this hypothesis. The first paper shows that the number of hospital admissions for eating disorders in females aged 10-39 quadrupled between 1981 and 2001, and remained high till...
Congenital factor VII (FVII) deficiency is a rare genetic bleeding disorder characterized by deficient or reduced activity of coagulation FVII. It is caused by genetic variants in the
gene. We aimed ...to evaluate the rate of detection of pathogenic variants in the
gene in a large group of patients with FVII deficiency and investigate the correlations between the
genotype and FVII activity (FVII:C). Moreover, the influence of the common genetic variant rs6046: c.1238G>A; p.(Arg413Gln), designated as the M2 allele, on FVII:C was investigated. Genetic analysis of the
gene was performed on 704 index patients (IPs) using either direct Sanger- or next-generation sequencing. Genetic variants were detected in 390 IPs, yielding a variant detection rate (VDR) of 55%. Notably, the VDR exhibited a linear decline with increasing FVII:C levels. We identified 124 genetic variants, of which 48 were not previously reported. Overall, the frequency of the M2 allele was considerably higher in patients with mild deficiency (FVII:C > 20 IU/dl). Furthermore, IPs lacking an identified pathogenic variant exhibited a significantly higher prevalence of the M2 allele (69%) compared to IPs with a disease-causing variant (47%). These results strongly support the association of the M2 allele with decreased FVII:C levels. This study shows the utility of FVII:C as a predictive marker for identifying pathogenic variants in patients with FVII deficiency. The M2 allele contributes to the reduction of FVII:C levels, particularly in cases of mild deficiency.
Patients with chronic lymphocytic leukemia (CLL) bearing TP53 mutations experience chemorefractory disease and are therefore candidates for targeted therapy. However, the significance of low-burden ...TP53 mutations with <10% variant allele frequency (VAF) remains a matter for debate. Herein, we describe clonal evolution scenarios of low-burden TP53 mutations, the clinical impact of which we analyzed in a “real-world” CLL cohort. TP53 status was assessed by targeted next-generation sequencing (NGS) in 511 patients entering first-line treatment with chemo- and/or immunotherapy and 159 patients in relapse before treatment with targeted agents. Within the pretherapy cohort, 16% of patients carried low-burden TP53 mutations (0.1% to 10% VAF). Although their presence did not significantly shorten event-free survival after first-line therapy, it affected overall survival (OS). In a subgroup with TP53 mutations of 1% to 10% VAF, the impact on OS was observed only in patients with unmutated IGHV who had not received targeted therapy, as patients benefited from switching to targeted agents, regardless of initial TP53 mutational status. Analysis of the clonal evolution of low-burden TP53 mutations showed that the highest expansion rates were associated with fludarabine, cyclophosphamide, and rituximab regimen in both first- and second-line treatments (median VAF increase, 14.8× and 11.8×, respectively) in contrast to treatment with less intense treatment regimens (1.6×) and no treatment (0.8×). In the relapse cohort, 33% of patients carried low-burden TP53 mutations, which did not expand significantly upon targeted treatment (median VAF change, 1×). Sporadic cases of TP53 mutations' clonal shifts were connected with the development of resistance-associated mutations. Altogether, our data support the incorporation of low-burden TP53 variants in clinical decision making.
•Low-burden TP53 mutations in CLL do not significantly affect the response duration to chemo- and/or immunotherapy, but shorten OS.•Clonal expansion of low-burden TP53 mutations in CLL is associated with intense chemoimmunotherapy, but not with targeted therapy.
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To evaluate whether the distribution of seizures throughout the day is the same in ambulatory outpatient conditions as observed in inpatient conditions.
We analyzed records from consecutive patients ...who had ambulatory EEG monitoring for 24 to 72 hours using Digitrace™ EEG recording system. The participants maintained a log of symptoms and signaled the time when symptoms occurred by pushing an event button. Additionally, automatic seizure and spike detection was performed on each record using Persyst detection software.
Of 831 reports analyzed, 44 unique patients had definite ictal events. There were a total of 129 electrographic seizures (34 subclinical) with timing as follows: frontal (31), temporal (71), and generalized, posterior, or central (27). Frontal lobe seizures occurred more frequently between 12 am and 12 pm as compared to temporal lobe seizures, which occurred more frequently between 12 pm and 12 am (p = 0.017). Analysis of frontal lobe seizures revealed a cluster of 10 seizures centered at 6:33 am (range 5:15-7:30 am) with p = 0.0064. Temporal lobe seizures had a cluster of 24 seizures centered at 8:49 pm (range 6:45-11:56 pm) with p = 0.0437.
In ambulatory outpatient conditions, electrographic seizures follow day/night patterns similar to those observed in hospital conditions. Frontal seizures occur preferentially in the early morning hours and temporal lobe seizures occur in the early evening hours.
Summary
Patients with epilepsy have 20‐fold risk of sudden death when compared to the general population. Uncontrolled seizures is the most consistent risk factor, and death often occurs at night or ...in relation to sleep. We examined seizure‐related respiratory disturbances in sleep versus wakefulness, focusing on periictal oxygen saturation. Respiratory measures were examined in 48 recorded seizures (sleep, n = 23, wake, n = 25) from 20 adult patients with epilepsy. Seizures from sleep were associated with lower saturation, as compared to seizures from wakefulness, both during ictal (sleep median = 90.8, wake median = 95.5; p < 0.01) and postictal periods (sleep median = 94.3, wake median = 96.9; p = 0.05). Compared to wake‐related seizures, seizures from sleep were also associated with a larger desaturation drop (sleep median = −4.2, wake median = −1.2; p = 0.01). Postictal generalized electroencephalography (EEG) suppression (PGES) occurred more frequently after seizures from sleep (39%), as compared to wake‐related seizures (8%, p = 0.01). Our findings suggest that nocturnal seizures may entail a higher sudden unexpected death in epilepsy (SUDEP) severity burden, as they are associated with more severe and longer hypoxemia events, and more frequently followed by PGES, both factors implicated in sudden death.
Variants in recombination-activating genes (
) are common genetic causes of autosomal recessive forms of combined immunodeficiencies (CID) ranging from severe combined immunodeficiency (SCID), Omenn ...syndrome (OS), leaky SCID, and CID with granulomas and/or autoimmunity (CID-G/AI), and even milder presentation with antibody deficiency.
We aim to estimate the incidence, clinical presentation, genetic variability, and treatment outcome with geographic distribution of patients with the
defects in populations inhabiting South, West, and East Slavic countries.
Demographic, clinical, and laboratory data were collected from
-deficient patients of Slavic origin via chart review, retrospectively. Recombinase activity was determined
by flow cytometry-based assay.
Based on the clinical and immunologic phenotype, our cohort of 82 patients from 68 families represented a wide spectrum of
deficiencies, including SCID (
= 20), OS (
= 37), and LS/CID (
= 25) phenotypes. Sixty-seven (81.7%) patients carried
and 15 patients (18.3%) carried
biallelic variants. We estimate that the minimal annual incidence of
deficiency in Slavic countries varies between 1 in 180,000 and 1 in 300,000 live births, and it may vary secondary to health care disparities in these regions. In our cohort, 70% (
= 47) of patients with
variants carried p.K86Vfs
33 (c.256_257delAA) allele, either in homozygous (
= 18, 27%) or in compound heterozygous (
= 29, 43%) form. The majority (77%) of patients with homozygous
p.K86Vfs
33 variant originated from Vistula watershed area in Central and Eastern Poland, and compound heterozygote cases were distributed among all Slavic countries except Bulgaria. Clinical and immunological presentation of homozygous
p.K86Vfs
33 cases was highly diverse (SCID, OS, and AS/CID) suggestive of strong influence of additional genetic and/or epigenetic factors in shaping the final phenotype.
We propose that
p.K86Vfs
33 is a founder variant originating from the Vistula watershed region in Poland, which may explain a high proportion of homozygous cases from Central and Eastern Poland and the presence of the variant in all Slavs. Our studies in this cohort of
founder variants confirm that clinical and immunological phenotypes only partially depend on the underlying genetic defect. As access to HSCT is improving among RAG-deficient patients in Eastern Europe, we anticipate improvements in survival.
Poor sleep is a frequent complaint in patients with psychogenic nonepileptic seizures (PNES). However, few studies have examined sleep problems in this population. We aimed to compare sleep ...complaints in patients with PNES with those with epilepsy. Subjects diagnosed as having PNES by experts using video-electroencephalography (vEEG) were recruited through the Brigham and Women's Hospital epilepsy monitoring unit (EMU) between 3/25/2013 and 3/29/2018. Controls were patients with epilepsy recruited through the EMU and subspecialty clinics. All subjects were given the Beck Depression Inventory, 2nd Edition (BDI-II) and the Quality of Life in Epilepsy Inventory-10 (QOLIE-10). Subjective sleep problems were identified from item 16 (changes in sleep patterns) of the BDI-II. Independent sample t-test, chi-square test, and Spearman correlation were used. A total of 149 patients with PNES and 82 patients with epilepsy completed the BDI-II and QOLIE-10. Compared with control subjects with epilepsy, patients with PNES more frequently reported moderate–severe changes in sleep patterns, notably sleeping less than usual, waking up 1–2 h too early, and having trouble returning to sleep. These changes in sleep patterns were associated with worse quality of life. Our findings suggest that sleep is more commonly reported as a problem in PNES compared with epilepsy. Because sleep plays a major role in good health, understanding the specific sleep problem in PNES may provide insight for improving quality of life for this challenging disorder.
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