Dr Lamnisos received his PhD in Statistics from the University of Warwick. In 2013, he joined the European University of Cyprus as a Lecturer in Medical Statistics. He has research interest in developing novel computational algorithms for implementing robust variable selection in high dimensional regression. Furthermore, he use spatial statistics to develop area-based deprivation indices using census data. He also provides his statistical expertise in Public Health research projects
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Research Items (53)
Hemorrhoids is a common disorder and a leading cause of rectal bleeding, with unpleasant discomfort and pain for the patient. Medication and surgery are the standard treatments of hemorrhoids. In this study, we are investigating an alternative herbal treatment of hemorrhoids using the Arum maculatum L. (Araceae). A randomized controlled trial was conducted with a test treatment period of 2 weeks using a sample of 53 diagnosed patients from Greece to assess the efficacy of Arum maculatum in treating symptomatic hemorrhoids. The patients randomly assigned to consume a liquid mixture of Arum maculatum or a standard antihemorrhoid cream. The primary outcome was the health-related quality of life measured by the SF-36 health survey at the baseline and 2 weeks after the end of treatment. The mixed ANOVA statistical method was used to compare the groups. Participants in the treatment group had significantly greater improvement in all measures of the SF-36. Particularly the treatment effect for the physical health summary was 5.0 [95% confidence interval (CI): 0.9-9.1] while for the mental health summary was 4.7 (95% CI: 1.3-8.0). This trial shows that treatment with Arum maculatum improves the quality of life of patients with hemorrhoids, but further studies are needed to confirm these results.
Background: The Shoulder Pain and Disability Index is one of the most common questionnaire to evaluate the impact of shoulder disorders on function. There is no valid and reliable Greek version of the Shoulder Pain and Disability Index available at present for all shoulder disorders. Therefore, the aim of the current study was to test the reliability and validity of the Shoulder Pain and Disability Index in patients with shoulder pain for at least four weeks. Methods: The validation study was conducted in clinical settings by questionnaires comprising the Greek Shoulder Pain and Disability Index and Disability of the Arm, Shoulder, and Hand questionnaire. 130 (68 women and 62 men) Greek reading patients over 18 years old with shoulder pain for at least four weeks were recruited from physical therapy clinics. Internal consistency of the translated instrument was measured using Cronbach’s α. to establish test-retest reliability, the patients without any change in their condition after 2–3 days from their initial visit were asked to complete the Shoulder Pain and Disability Index for a second time. An intraclass correlation coefficient was used to assess the test-retest reliability of the Shoulder Pain and Disability Index. The Greek version of the Shoulder Pain and Disability Index and Disability of the Arm, Shoulder, and Hand questionnaire was also administered in both visits. Concurrent validity was measured by correlating the Shoulder Pain and Disability Index with the Greek Shoulder Pain and Disability Index and Disability of the Arm, Shoulder and Hand scale using Pearson’s correlation coefficient. Results: The results showed that the Greek Shoulder Pain and Disability Index has good internal consistency (Cronbach α = 0.947), test-retest reliability (ICC =0.926) and concurrent validity (r > 0.7). The standard error of measurement (SEM) and the smallest detectable change (SDC) of the Greek SPADI total score were 4.77 and 13.18. Conclusions: The Greek version of the Shoulder Pain and Disability Index is a reliable and valid measure when administered to patients aged over 18 years old with shoulder pain for at least four weeks. • Implications for Rehabilitation • The Greek version of the Shoulder Pain and Disability Index has been found to be reliable and valid when used in patients with shoulder pain for at least four weeks. • The results of the psychometric characteristics were compatible with those of the original English version. • The Shoulder Pain and Disability Index could be applied to a Greek-speaking population to assess functional limitations and symptoms in patients over 18 years old with shoulder pain for at least four weeks.
Study design: Diagnostic test study. Background: There is a growing body of evidence of different physiotherapy tools used to diagnose De Quervain Tenosynovitis. However, the tool that is most useful still needs to be elucidated. Purpose: The purpose of this clinical study was to evaluate the validity and reliability of the Finkelstein test. Methods: This study included 45 healthy individuals. The Finkelstein test, Wrist Hyperflexion and Abduction of the Thumb test (WHAT) and the Eichhoff test were performed by two clinical physiotherapists. Any pain reported was measured using a VAS scale (0 10). Inter-rater reliability and Test-retest reliability was studied with a second measurement one week later. Results: The Finkelstein´s and Eichhoff´s tests revealed False Positives, of 46,7% and 53,3% respectively. The percentage of agreement for the WHAT test was fair (0.21 0.40) and for the Eichhoff test, moderate (0.41 0.60). Reliability of Finkelstein’s test with regard to the presence or absence of pain revealed a moderate agreement (Kappa=0.41 0.60). Inter rater reliability had a moderate percentage of agreement (Kappa=0.41 0.60) assessing the presence of pain or no pain; and a fair percentage of agreement (Kappa result=0.21 0.40) when pain was measured with VAS with results being statistically significant (p<0,05). Conclusions: Finkelstein´s test alone, does not appear to validly and reliably assist in the assessment and diagnosis of De Quervain’s tenosynovitis.
Background: During the past decades Streptococcus pneumoniae has developed significant resistance to many classes of antimicrobial drugs. Potential risk factors for colonization of the nasopharynx by Streptococcus pneumoniae in children and for carriage of drug resistant strains were examined. Methods: Between 2007 and 2008 nasopharyngeal swabs were collected from 402 children 6 months to 5 years old visiting the public sector immunization centers and outpatient departments as well as offices of paediatricians from private practice in Nicosia district in Cyprus. Information on demographic characteristics and potential risk factors of participating children were collected using a standardized questionnaire distributed to parents. Results: In multivariable analyses we found that attendance at day care center, having siblings in the family and having both parents originating from Cyprus, statistically increased the risk of pneumococcal colonization. Full immunization with PCV7 appears to be a protective factor against colonization by pneumococcus. Previous administration of antimicrobials during the last month prior to specimen collection appeared to be the most consistent risk factor for carrying a non susceptible strain of Streptococcus pneumoniae to either penicillin or erythromycin. Factors such as age, nationality, previous or current breastfeeding, passive exposure to cigarette smoke and attendance in a day care center do not appear as independent risk factors for colonization by non susceptible strains. Conclusions: Prudent use of antibiotics especially for upper respiratory tract infections in children as well as increased vaccination coverage by the pneumococcal conjugate vaccines could prove effective in reducing levels of colonization by drug resistant pneumococcal strains.
- Apr 2018
INTRODUCTION: The wide use of social media in the last years changed decisively the way that a variety of health organizations tried to form effective health promotion campaigns. OBJECTIVE: To conduct a systematic literature review on the use of social media for sexual health promotion. MATERIAL AND METHOD: A systematic literature review was conducted in PubMed and Cochrane, using the following keywords: social media, social networking sites, use, sexual health promotion campaigns, sexual health promotion interventions. Among 186 results, 14 studies met the inclusion criteria, since we included only the randomized controlled trials because they have the lowest systematic bias. RESULTS: Four studies used Facebook, one study used MySpace, two studies used text messaging and emails and seven studies used web-based applications to empower users at sexual health issues. Four studies found statistically significant increase in knowledge for sexual health issues such as HIV prevention and sexually transmitted infections. Two studies found statistically significant increase in condom use and two studies found statistically significant delay of sexual activity initiation. There were also two studies indicated that communication improvement between parents and children may be an effective way of sexual health promotion. Finally one study found that social networking sites have the potential to empower active users to remove sexual references from their public social media profile and one study found statistically significant increase in comfort that active users discuss any issue of sexual health through social media channels. CONCLUSIONS: Social media are effective in sexual health promotion but more studies with decreased bias are needed to be conducted in order to make safer conclusions.
S. pneumoniae may cause serious invasive infections mainly in children and elderly adults leading to significant morbidity and mortality. This report describes the circulating serotypes and antimicrobial resistance of S. pneumoniae colonizing the nasopharynx of Cypriot children in 2007-2008 when the immunization coverage of children was still relatively low. The study focused on children between 6 months to 5 years of age in the Nicosia district. A nasopharyngeal specimen was obtained from 402 children who visited public immunization centers, public outpatient departments and the offices of private sector practicing pediatricians. The percentage of carriage was 35.3%. Intermediate and full resistance to penicillin was estimated at 39.4% and 1.4%, respectively. Intermediate and full resistance to erythromycin was estimated at 1.4% and 39.6%, respectively. Resistance to clindamycin was found to be 30.8%. MLSb was the dominant phenotype of resistance (77.2%). Multi-resistance was found amongst 24.1% of strains. Most frequent colonizing serotypes were 15B, 6B, 23A, 23B, 19F. The two vaccine serotypes 6B and 19F were highly resistant to both penicillin and erythromycin and were also multi-resistant at 27% and 50%, respectively. The percentages of fully immunized, partially immunized and non immunized children with the PCV7 were 24.6%, 14.3%, and 61.1%, respectively. Fully immunized children carried fewer vaccine serotypes in comparison with the non immunized children (p = .05). Some vaccine serotypes were among those more frequently colonizing children and exhibit significant resistance. An increase in vaccination coverage and prudent use of antimicrobials could have a significant impact on resistance.
The study is a clinical trial to evaluate the validity and the reliability of the Finkelstein’s test, a pathognomonic sign of the de Quervain´s disease.
Breast cancer is the most frequently occurring disease in which the diagnosis may lead to extensive emotional, physical and social discomfort and audible feelings internal conflict emotions. Fear of activity makes patients insensitive causing the body to weaken. As a result of surgery created imbalances in body structures and orthostatic changes that alter the biomechanics of the body and which are maximized by weak as a result of inactivity. modern studies have shown how the exercise and the exercise is generally to reverse many compared with the absence of motor activity. The purpose and primary objective of this randomized clinical study is to investigate the utility and effectiveness of alternative exercise program with the method Graham, in women with mastectomy with respect to the functional capacity and quality of life. the study included 37 women with breast cancer (n = 37), which had been lymphoid cleaning and removal volume which been allocated randomly separation by the process of the lottery the usual care (group a, n = 20) and the usual care group and additional tweaks Graham (group B, n = 17). For the statistical analysis of the data used central tendency and dispersion measures and comparisons averages (pair sample t test) to investigate changes in the evaluated parameters of quality of life, functionality, physical activity and balance stability between different times evaluations (Start, week 4, week 8). There were also comparisons averages for independent samples (independent sample t test) to investigate the differences between the groups in each evaluated parameter at any time. The significance level was set at p≤ 0,05. results: the study completed in eight weeks from January 2015 up to march 2015, with intermediate measurements in February. The findings of the study showed greater improvement in quality of life (questionnaire Fact B) to group routine care and additional tweaks Graham in connection with the group routine care in 4th (105.89 ± 22.02 vs 96.55 ± 15.86) and 8th week (113.28 ± 19.23 vs 95.38 ± 14.94) of the program for 4 and 8 weeks compared to baseline (95.51 ± 29.15 vs 95.10 ± 19.06) of the procedure (p
O1 HIV-1 diversity in Bulgaria (current molecular epidemiological picture) Ivailo Alexiev, Reneta Dimitrova, Anna Gancheva, Asya Kostadinova, Mariyana Stoycheva, Daniela Nikolova, Ivaylo Elenkov O2 Knowledge, attitudes and practices of the general population on HIV/AIDS, hepatitis B and C in Romania Cătălin Tilișcan, Mioara Predescu, Bogdan Păunescu, Anca Streinu-Cercel, Oana Săndulescu, Claudiu Mihai Șchiopu, Mădălina Hristache, Lăcrămioara Aurelia Brîndușe, Adrian Streinu-Cercel O3 The prevalence of human leukocyte antigen-B*57:01 allele carriers and CXCR4 tropism among newly diagnosed HIV infected patients in Serbia Marija Todorovic, Marina Siljic, Dubravka Salemovic, Valentina Nikolic, Ivana Pesic-Pavlovic, Jovan Ranin, Djordje Jevtovic, Maja Stanojevic O4 HIV transmission among stable serodiscordant couples from the former Pediatric Cohort follow up in the National Institute of Infectious Diseases Ana Maria Tudor, Delia Vlad, Mariana Mărdărescu, Sorin Petrea, Cristina Petre, Ruxandra Neagu-Drăghicenoiu, Rodica Ungurianu, Alina Cibea, Odette Chirilă, Cristian Anghelina, Ileana Coserea O5 Unemployment is associated with syringe sharing among people who inject drugs in Greece Pantelia-Amalia Krikelli, Eirini Pavlitina, Mina Psichogiou, Demetris Lamnisos, Leslie Williams, Anya Korobchuk, Britt Skaathun, Pavlo Smyrnov, John Schneider, Vana Sypsa, Dimitrios Paraskevis, Angelos Hatzakis, Samuel R. Friedman, Georgios K. Nikolopoulos O6 Correlation of adipocytokine levels in different types of lipodystrophy in HIV/AIDS patients Gordana Dragović, Danica Srdić, Al Musalhi Khawla, Ivan Soldatović, Jelena Nikolić, Djordje Jevtović, Devaki Nair O7 IP10 – a possible biomarker for the progression of HIV infection Aura Temereanca, Adelina Rosca, Luminita Ene, Benchawa Soontornniyomkij, Carmen Diaconu, Claudia Dita, Cristian Achim, Simona Ruta O8 A permanent challenge: persistent low viremia in HIV positive patients on ART Șerban Benea, Ruxandra Moroti, Raluca Jipa, Eliza Manea, Andrada Stan, Elisabeta Benea, Dan Oțelea, Adriana Hristea O9 Infections in IDUs according to their HIV status Adriana Hristea, Irina Lăpădat, Raluca Jipa, Ruxandra Moroti, Șerban Benea, Doina Antonică, Irina Panait, Roxana Petre O10 Trends in combined antiretroviral therapy used in methadone program integrated with HIV care - 20 years of experience Justyna D. Kowalska, Ewa Pietraszkiewicz, Ewa Grycner, Ewa Firlag-Burkacka, Andrzej Horban O11 Extracellular cyclophilin A – inflammatory mediator in HIV infected patients Ovidiu Vlaicu, Leontina Bănică, Simona Paraschiv, Ana-Maria Tudor, Ruxandra Moroti, Dan Oțelea O12 High cardiovascular disease risk in Serbian population, an issue of concern Bojana Dimitrijević, Ivan Soldatović, Đorđe Jevtović, Jovana Kusić, Dubravka Salemović, Jovan Ranin, Gordana Dragović O13 Genotypic rifampicin resistance in HIV/ tuberculosis coinfected patients from a tertiary level infectious diseases hospital Dragoș Florea, Ioana Bădicuț, Alexandru Rafila, Cornel Camburu, Adriana Histrea, Mihaela Frățilă, Dan Oțelea O14 Occurrence of residual HCV RNA in liver and peripheral blood mononuclear cells among patients with chronic hepatitis C infection and/or HCV/HIV coinfection after IFN-based therapy Ivana Gmizic, Dubravka Salemovic, Ivana Pesic-Pavlovic, Marina Siljic, Valentina Nikolic, Miljana Djonin-Nenezic, Ivana Milosevic, Branko Brmbolic, Maja Stanojevic O15 Romanian nationwide screening for infection with HIV and hepatitis B and C viruses Anca Streinu-Cercel, Oana Săndulescu, Alina Cristina Neguț, Mioara Predescu, Alexandra Mărdărescu, Mihai Săndulescu, Adrian Streinu-Cercel O16 Treatment emergent variants to combined direct antiviral agents therapy against hepatitis C virus Ana Belen Pérez, Natalia Chueca, Marta Álvarez, Juan Carlos Alados, Antonio Rivero, Francisco Vera, Marcial Delgado, Javier Salmeron, Miguel Jiménez, Maria José Blanco, Moises Diago, Miguel Garcia-deltoro, Marta Alvarez, Francisco Téllez, Federico García O17 Clinical and epidemiological aspects in tuberculosis/HIV coinfected patients Diana Tănase, Eliza Manea, Rodica Bacruban, Dragoș Florea, Dan Oțelea, Alexandru Rafila, Mariana Mărdărescu, Adriana Hristea O18 Resistance to NS3 protease inhibitors in persons with chronic hepatitis C infected with hepatitis C virus subtype 1a from Croatia Ivana Grgic, Ana Planinic, Maja Santak, Lana Gorenec, Snjezana Zidovec Lepej, Adriana Vince O19 Analysis of a simplified diagnostic score for tuberculous meningitis in HIV-infected adults with meningitis Eliza Manea, Adriana Hristea, Șerban Benea, Ruxandra Moroti, Diana Tănase, Cristian M. Niculae, Simona Merisor, Raluca Jipa O20 Molecular tracing of the origin of HIV-1 infection among persons who inject drugs in Athens: a phyloethnic study Dimitrios Paraskevis, Evangelia Kostaki, Georgios K. Nikolopoulos, Vana Sypsa, Mina Psichogiou, Dimitra Paraskeva, Athanassios Skoutelis, Meni Malliori, Samuel R. Friedman, Angelos Hatzakis O21 The dynamics of virological response to HIV-1 infection and antiretroviral therapy initiation in patients with and without HLA-B*5701 Allele Malgorzata Hackiewicz, Piotr Zabek, Ewa Firlag-Burkacka, Andrzej Horban, Justyna Dominika Kowalska O22 Increase in the numbers of non-B subtypes and potential recombinant forms circulating among Slovenian MSM in the recent years Maja M. Lunar, Jana Mlakar, Mario Poljak O23 Genotyping intrahost polymorphisms in hepatitis C virus E2 protein associated with resistance to antibody neutralization Leontina Bănică, Eliza Martin, Valeriu Gheorghiță, Andrei Petrescu, Dan Oțelea, Costin-Ioan Popescu, Simona Paraschiv O24 Genotyping of HCV NS3 protease inhibitors resistance and phenotyping of rare double resistance mutations in HCV cell culture system Emil Neaga, Vlaicu Ovidiu, Andrei Juncu, Leontina Bănică, Simona Paraschiv, Dan Oțelea, Costin-Ioan Popescu O25 Employment status controls the relationship between neurocognitive impairment and depression in a cohort of young HIV-infected adults since childhood Adrian Luca, Florin Lazăr, Anca Elena Luca, Luminița Ene, Cristian Achim O26 Predictors of survival in parenterally-infected HIV positive children and youth diagnosed with progressive multifocal leukoencephalopathy Cosmina Gingăraş, Ștefan Adrian Anton, Roxana Rădoi, Simona Tetradov, Grațiela Țârdei, Maria Nica, Razvan Alexandru Capşa, Cristian L. Achim, Cristiana Oprea, Luminița Ene O27 Neurocognitive and brain functioning in HIV-infected young MSM treated with cART Bogna Szymańska, Natalia Gawron, Agnieszka Pluta, Emilia Łojek, Ewa Firląg – Burkacka, Andrzej Horban, Robert Bornstein, et HARMONIA3 Study Group O28 Clinical value of RT-PCR detection of Toxoplasma gondii DNA in cerebrospinal fluid Olivia Burcoș, Simona Manuela Erscoiu, Filofteia Bănicioiu Cojanu, Andreea Toderan, Maria Nica, Ionuț Cristian Popa, Emanoil Ceaușu, Petre Iacob Calistru O29 Characteristics of sleep disorders in Romanian adults infected with human immunodeficiency virus Manuela Arbune, Mirela Alexandrache, Anca-Adriana Arbune, Doina-Carina Voinescu O30 Diagnosing neuroHIV: the rift between clinicians and pathologists Ioan-Alexandru Diaconu, Laurențiu Stratan, Victoria Aramă, Luciana Nichita, Alexandra Diaconu, Anca Negru, Alina Orfanu, Anca Leuștean, Daniela Adriana Ion O31 A challenging neurological complication in a HIV-infected young woman with multiple opportunistic infections Irina Ianache, Cristiana Oprea O32 Brain abscess with uncertain etiology in a late-presenter HIV infected patient Anca Leuștean, Cristina Popescu, Alina Orfanu, Anca Negru, Remulus Catana, Cristina Murariu, Ioan-Alexandru Diaconu, Mihaela Rădulescu, Cătălin Tilișcan, Victoria Aramă O33 Cerebral toxoplasmosis and left crural monoparesis with fatal evolution in a noncompliant patient with AIDS C3 Iosif Marincu, Patricia Poptelecan, Valeria Bică, Florin Lazăr, Livius Tirnea O34 Opportunistic infections still a problem in HIV-infected patients in cART era: a Romanian single center experience Irina Ianache, Roxana Rădoi, Manuela Nica, Grațiela Țârdei, Luminița Ene, Emanoil Ceaușu, Petre Calistru, Cristiana Oprea P1: Epidemiological aspects of co-infection of HIV/TB in Moldova Iurie Osoianu, Ala Halacu P2 Perinatal exposure at HIV infection in Oltenia region Andreea Cristina Stoian, Florentina Dumitrescu, Iulian Diaconescu, Augustin Cupșa, Lucian Giubelan, Loredana Ionescu, Irina Niculescu P3 Women living with HIV in Mureș county Carmen Chiriac, Nina Șincu, Iringo Zaharia Kezdi, Anca Georgescu, Brândușa Țilea, Cristina Girbovan, Andrea Incze, Andrea Fodor P4 Late diagnosis of HIV infection in children - a challenge for Romania Alina Cibea, Mariana Mărdărescu, Cristina Petre, Ruxandra Drăghicenoiu, Rodica Ungurianu, Ana Maria Tudor, Delia Vlad, Carina Matei P5 Cirrhosis Assessment in Patients Co-infected HIV-Hepatitis B Virus Elena Dumea, Lucian Cristian Petcu, Simona Claudia Cambrea P6 HIV late presenters in Craiova Regional Center, Romania Florentina Dumitrescu, Augustin Cupsa, Andreea Cristina Stoian, Lucian Giubelan, Irina Niculescu, Iulian Diaconescu, Dan Hurezeanu, Livia Dragonu, Mioara Cotulbea P7 Some aspects of malignancies in patients HIV / AIDS Simona Manuela Erscoiu, Ionuț Cristian Popa, Denisa Stroie, Petronela Ionescu, Nedeea Duță, Camelia Dobrea, Irina Voican, Emanoil Ceaușu, Petre Iacob Calistru P8 Factors associated with resilience among people living with HIV in Romania Florin Lazăr P9 Fever in HIV-infected patients: a thorny problem to be solved by the clinicians Lucian Giubelan, Augustin Cupșa, Iulian Diaconescu, Florentina Dumitrescu, Dan Hurezeanu, Livia Dragonu, Irina Niculescu, Andreea Cristina Stoian, Oana Obretin, Mariana Stănescu, Mihai Jianu P10 Th1, Th2, Th9, Th17 and Th22 cytokines in acute and chronic HIV-1 infection Lana Gorenec, Snjezana Zidovec Lepej, Ivana Grgic, Ana Planinic, Janja Iscic Bes, Adriana Vince, Josip Begovac P11 Dyslipidemia in HIV-infected patients treated with protease inhibitors – case report Luminița Elena Horga P12 Why use less treatment for the metabolic abnormalities in HIV patients-too many drugs? Corina Itu, Luminița Elena Horga, Laura Augusta David-Aldea, Anca Ciorogar, Cristian Jianu, Mihaela Lupșe P13 Sacral Herpes Zoster, with hyperalgesic form, in a patient with C3 stage HIV infection Iuliana Caramangiu, Ovidiu Roșca, Monica Cialma, Andreea Ardeleanu, Iosif Marincu P14 Factors associated with in-hospital mortality in tuberculous and cryptococcal meningitis Raluca Jipa, Eliza Manea, Șerban Benea, Irina Lăpădat, Nicoleta Irimescu, Irina Panait, Cristian Niculae, Adriana Hristea P15 Lipodystrophy: still present adverse event in resource-limited settings Jovana Kusic, Djordje Jevtovic, Dubravka Salemovic, Jovan Ranin, Bozana Dimitrijevic, Gordana Dragovic P16 TB and HIV coinfected patient, an emergent challenge - case report Laura-Augusta Aldea-David P17 Efficacy of prophylactic antiretroviral treatment in new-born infants from HIV-positive mothers in 2012-2014, for the North-Eastern part of Romania Carmen Manciuc, Cristina Nicolau, Liviu Prisăcariu, Alexandra Largu P18 Surveillance of mother to child transmission of HIV in Romania – 31 December 2015 Mariana Mărdărescu, Adrian Streinu-Cercel, Cristina Petre, Marieta Iancu, Sanda Vintilă, Daniela Vitelaru, Iosif Ionel, Claudiu Mihai Șchiopu, Alexandra-Henriette Mărdărescu P19 The antiretroviral therapy failure and the need to select the effective treatment in the Republic of Moldova Pavel Micsanschi, Tiberiu Holban, Ina Bîstrițchi, Lucia Pârțână, Angela Nagîț, Svetlana Popovici, Maria Talmaci, Irina Cucerova P20 Disseminated cryptococcosis in a patient with C3 HIV stage and multiresistant to antiretroviral therapy with lethal evolution Sorina Georgiana Mitrescu, Dana Mihalcea, Iulia Caramangiu, Ovidiu Roșca, Iosif Maricu P21 Aspects of tuberculosis infection in HIV-positive patients from Romania – our experience Anca Negru, Daniela Munteanu, Victoria Aramă, Raluca Mihăilescu, Ioan Diaconu, Remulus Catana, Cristina Popescu, Alina Orfanu, Anca Leuștean, Mihaela Rădulescu, Cătălin Tilișcan, Raluca Năstase, Violeta Molagic, Irina Duport, Cristina Dragomirescu, Ștefan Sorin Aramă P22 Dyslipidemia in HIV-infected patients Nicoleta M Negruț P23 Challenges in the management of an HIV seropositive patient with psoriasis undergoing immunomodulator therapy Violeta Elena Niță, Daniela Ioana Munteanu, Raluca Mihăilescu, Ioan Diaconu, Anca Negru, Cristina Popescu, Victoria Aramă P24 Acute peritonitis as a sign of IRIS in an HIV-infected patient with MAC latent infection Alina Orfanu, Cristina Popescu, Anca Leuștean, Anca Negru, Remulus Catana, Ioan Diaconu, Cătălin Tilișcan, Victoria Aramă, Sorin Ștefan Aramă P25 The virologic outcome of the treatment of chronic hepatitis B among HIV co-infected patients on HAART Ivana Pesic Pavlovia, Dubravka Salemovic, Jovan Ranin, Djordje Jevtovic P26 A case of HIV encephalopathy with aphasia, agnosia, apraxia and right homonymous hemianopsia Ovidiu Roșca, Andreea Ardeleanu, Iulia Caramangiu, Daniela Desaga, Valerica Bică, Sorina Mitrescu, Iosif Marincu P27 Molecular footprints on human immunodeficiency virus -1 genome and association with phylogenetic clustering among subtype B infected patients in Serbia Marina Siljic, Dubravka Salemovic, Valentina Nikolic, Djordje Jevtovic, Ivana Pesic-Pavlovic, Jovan Ranin, Marija Todorovic , Maja Stanojevic P28 Neurosyphilis and human immunodeficiency virus infection: double challenge Nina-Ioana Șincu, Anca Georgescu, Brândușa Țilea, Iringo Zaharia Kezdi, Andrea Incze, Cristina Gârbovan, Carmen Lucia Chiriac P29 Differences between HIV-infected adults since childhood and non HIV-infected persons on managing everyday life Anca Elena Luca, Florin Lazăr, Adrian Luca, Luminița Ene, Roxana Rădoi, Adina Talnariu, Silvia Suciu, Cristian Achim P30 Molecular detection of Bartonella quintana in a HIV immunodepressed patient with fever and isolated lymphadenopathy - Case report Diana Gabriela Iacob, Dragoș Florea, Simona Iacob P31 Present epidemiological characteristics of HIV/AIDS newly diagnosed cases in South-Eastern Romania Manuela Arbune, Miruna Drăgănescu, Alina Iancu P32 The gender’s preferences among opportunists? Ruxandra Moroti, Cristian M Niculae, Simona Merisor, Eliza Manea, Serban Benea, Andrada Stan, Raluca Hrisca, Raluca Jipa, Diana Tanase, Adriana Hristea P33 Polymorphism of interleukin-28B gene in persons with chronic hepatitis C from Croatia Ivana Grgic, Ana Planinic, Lana Gorenec, Snjezana Zidovec Lepej, Adriana Vince
Purpose The purpose of this study was to investigate the efficacy of Bioptron light therapy for the treatment of acute ankle sprains. Method A parallel group, single-blind, controlled study was carried out in patients with grade II acute ankle sprains. Patients were randomly allocated into two treatment groups (n = 25 for each). Both groups received cryotherapy, and the test group also received Bioptron light therapy. All treatments were performed daily for 5 d. Evaluations included self-reported pain via a visual analogue scale, degree of ankle edema, and ankle range of motion via goniometry carried out before the treatment and at the end of the treatment. Results The test group showed the largest magnitude of improvement for all evaluations at treatment five, and the between-group differences observed were statistically significant (p < 0.0005 for each). Conclusions These data provide preliminary evidence of the efficacy of Bioptron light therapy supplemented with cryotherapy for the treatment of acute ankle sprains; however, larger studies are required to confirm these results. Implications for Rehabilitation Ankle sprains are common acute injuries among professional and recreational sports players but also among people in general. Cryotherapy is the first-standard treatment of acute ankle sprains. Phototherapy such as Bioptron light has been recommended supplement to cryotherapy to reduce the symptoms of ankle sprains. The results of the present trial showed that using BIOPTRON LIGHT and cryotherapy the rehabilitation period of acute ankle sprains can be reduced.
This study aimed to compare the effectiveness of the combined low-level laser therapy (LLLT) and passive stretching with combined placebo LLLT laser and the same passive stretching exercises in patients suffering from Αnkylosing spondylitis. Forty-eight patients suffering from Αnkylosing spondylitis participated in the study and were randomized into two groups. Group A (n = 24) was treated with a λ = 820 Ga-Al-As laser CW, with power intensity = 60 mW/cm2, energy per point in each session = 4.5 J, total energy per session = 27.0 J, in contact with specific points technique, plus passive stretching exercises. Group B (n = 24), received placebo laser plus the same passive stretching exercises. Both groups received 12 sessions of laser or placebo within 8 weeks; two sessions per week (weeks 1–4) and one session per week (weeks 5–8). Pain and function scales were completed before the treatment, at the end of the fourth and eighth week of treatment, and 8 weeks after the end of treatment (follow-up). Group A revealed a significant improvement after 8 weeks of treatment in all pain and function scales. At 8-week follow-up, the improvement remained only for the pain, while for all other function outcomes the differences were not statistically significant. The results suggested that after an 8-week treatment and after a follow-up, the combination of LLLT and passive stretching exercises decreased pain more effectively than placebo LLLT along with the same passive stretching exercises in patients with Αnkylosing spondylitis. Future studies are needed to establish the relative and absolute effectiveness of the above protocol.
INTRODUCTION: In Cyprus, there are no accepted measures of deprivation. This study investigates the association between all-cause premature mortality (<65 years) and a series of socio-economic indicators providing the foundations for developing a country-specific composite index of socio-economic deprivation. METHODS: Standardised mortality ratios (SMRs) of overall and gender-specific premature mortality were calculated for the period 2004-11 to ensure sufficient numbers. Bayesian hierarchical Poisson models with spatially unstructured and/or structured random effects were used to identify the magnitude of the “social gradient” in terms of each of twenty-six area-level 2001 census indicators. RESULTS: SMRs (range 0 to 5) were unreliable at this small level of aggregation (N=370, median population 233, IQR: 75-784, 10% of areas >3000). Up to two-fold differences remained in smoothed maps (range: 0.76-1.35), with 39% of the variation explained locally. A striking southeast to northwest spatial pattern was revealed with higher rates in less dense and remote areas. Strong negative associations were observed with proportion of households with persons aged less than 14 (0.89, 95%CI= 0.85-0.94 per SD increase) and proportion of houses constructed after 1990 (0.90, 95%CI= 0.86-0.94). Surprisingly, traditional indicators of deprivation, such as unemployment, did not exhibit associations with premature mortality. The top five indicators associated were increased proportion of retired people, disabled or chronically ill, illiterate, single-person households and households with no PC, all with an increase of about 10% per SD increase. CONCLUSIONS: There appeared to be a clear urban-rural divide in premature mortality, with rural and remote areas at a disadvantage. While the indicators which demonstrated significant associations with mortality are commonly used as proxy measures of deprivation, they are also characteristic of rural life. Since deprivation may take different meaning depending on context, this should be incorporated into the development of an index of deprivation.
- Aug 2014
- 20th IEA World Congress of Epidemiology
INTRODUCTION: At 77 per 100,000, female breast cancer incidence rates in Cyprus are consistent with other countries in Southern Europe. However, with complete absence of GIS from the Public Health arena, the extent of geographic inequalities in mortality and incidence across communities on the island, if any, remain unknown. We investigated the geographical patterning of breast cancer across small-areas in Cyprus and its association with rurality indicators. METHODS: Standardised Mortality and Incidence Ratios (SMRs/SIRs) across 370 communities were calculated based on latest available registry data for period 2004-2011 and 2003-2008 respectively to ensure sufficient numbers. Bayesian hierarchical Poisson models with spatially unstructured and/or structured random effects were used to smooth maps and investigate the association with population density (rurality), population potential (remoteness from major population centers) and percentage of retired population. RESULTS: SMRs (range 0-6) and SIRs (range 0-4) were unreliable at such a small level of aggregation (median population 129, IQR: 47-416, 10% of areas >1500). Nevertheless, up to two-fold differences remained across smoothed maps, with as much as 80% of the variation explained locally. Mortality and incidence demonstrated a similar geographic pattern with higher rates in and around metropolitan areas and lower rates in rural and mountainous areas. Population density (1.13 95%CI=1.04-1.23, per SD increase) and population potential (1.09 95%CI=1.01-1.19) were both significantly associated with increased mortality rates. Similar associations were observed with incidence rates which were also inversely associated with the percentage of retired population (0.92, 95%CI=0.84-0.99). Interestingly, more than three-fold differences were observed in Mortality-to-Incidence ratios, suggesting differences in survival and/or registration quality. CONCLUSIONS: Even on a small island like Cyprus there is substantial small-area variation in breast cancer mortality and incidence rates, more likely to suggest urban-rural differences in reproduction-related factors, even though the influence of other lifestyle and environmental factors cannot be ruled out.
INTRODUCTION: In contrast to the large body of literature on traffic pollution, there is only a handful of studies on the respiratory health of children in the vicinity of power plants, even though the energy industry is the main contributor to outdoor air pollution. METHODS: Based on responses to the ISAAC questionnaire of 5,817 15-17 year-old participants in a nationwide survey, we investigated: active asthma (i.e. report of asthma and wheeze and/or night time cough unrelated to colds in the past 12 months), inactive asthma and respiratory symptoms without a diagnosis in the vicinity of power plants in relation to the rest of the island. Associations in terms of GIS-calculated distance of the participants’ community to any of the three power plants were investigated in logistic models before and after adjusting for potential confounders. RESULTS: At 7.4% (95% CI: 4.5,11.3), the prevalence of active asthma at 5km from power plants appeared elevated compared to national levels, but any effect appeared restricted to the 5km-zone. Compared to >30 km away, those in the vicinity of power plants were nearly twice as likely to report active asthma with an adjusted OR of 1.83 95%CI (1.03, 3.24). No clear pattern was observed for inactive asthma while the OR of respiratory symptoms in the absence of diagnosis was 0.76 (95% CI: 0.58, 1.01), suggesting, if not diagnostic or reporting bias, an increased likelihood for symptomatic children to receive a diagnosis after more frequent or severe attacks. CONCLUSIONS: Higher prevalence of active asthma was observed in the vicinity of power plants, with no evidence of a distance-response relationship. Due to the small size of these communities, this corresponds to a small fraction of active asthma attributable to plant emissions but raises questions about environmental justice since the most affected communities are also socio-economically disadvantaged.
- Mar 2014
Numerous studies have reported adverse effects of traffic pollution on respiratory health. Exposure to power plants emissions has not been as comprehensively studied. The prevalence of asthma and respiratory symptoms was investigated among 15-17 year-olds in communities in the vicinity of power plants in Cyprus in relation to the rest of the island. Cross-sectional study METHODS: Based on responses of 5817 participants to the ISAAC questionnaire, study outcomes were: active asthma (i.e. report of asthma and current symptoms), inactive asthma and respiratory symptoms without a diagnosis. Associations in terms of the distance of the participants' community to any of the three power plants were investigated in logistic models before and after adjusting for known confounders. At 7.4% (95% CI: 4.5, 11.3), the prevalence of active asthma in communities at 5 km of power plants appeared elevated but reduced to national levels of 5% at longer distances. Adjusted odds ratio for active asthma was 1.83 (95% CI: 1.04, 3.24) in the 5 km zone compared to 30 km away. No clear pattern was observed for inactive asthma while the odds ratio of respiratory symptoms in the absence of diagnosis was 0.76 (95% CI: 0.58, 1.01) in the affected communities. Higher prevalence of active asthma was observed in the vicinity of power plants, with no evidence of a distance-response relationship. With less than 5% of this age-group residing in close proximity to power plants, this corresponds to a small fraction of active asthma attributable to power plant emissions.
- Jan 2014
To assess vitamin D status among Cypriot adolescents and investigate potential determinants including BMI and body fat percentage (BF%). Participants had cross-sectional assessments of serum vitamin D, physical activity, dietary vitamin D intake and sun exposure. Linear and logistic regression models were used to explore the associations of vitamin D with potential predictors. Hospitals, Cyprus, November 2007-May 2008. Adolescents (n 671) aged 16-18 years. Mean serum vitamin D was 22·90 (sd 6·41) ng/ml. Only one in ten children had sufficient levels of vitamin D (≥30 ng/ml), while the prevalence of vitamin D deficiency (12-20 ng/ml) and severe deficiency (<12 ng/ml) was 31·7 % and 4·0 %, respectively. Lower vitamin D was associated with winter and spring season, female gender, reduced sun exposure in winter and darker skin. Participants with highest BMI and BF% when compared with a middle reference group had increased adjusted odds of vitamin D insufficiency (OR = 3·00; 95 % CI 1·21, 7·45 and OR = 5·02; 95 % CI 1·80, 13·97, respectively). A similar pattern, although not as strong, was shown for vitamin D deficiency with BF% (OR = 1·81; 95 % CI 1·04, 3·16) and BMI (OR = 1·51; 95 % CI 0·85, 2·67). Participants in the lowest BMI and BF% groups also displayed compromised vitamin D status, suggesting a U-shaped association. Vitamin D deficiency in adolescence is very prevalent in sunny Cyprus, particularly among females, those with darker skin and those with reduced sun exposure in winter. Furthermore, vitamin D status appears to have a U-shaped association with adiposity measures.
Background: The association between area-level deprivation and health is well established. However, in some European countries, including Cyprus, there are no accepted measures of deprivation while the extent of geographical inequalities in mortality, if any, remains unknown. Objectives: To investigate the magnitude of small-area inequalities in premature mortality (before 65) across 405 communities in Cyprus and its association with deprivation and rurality indices. Methods: Standardised mortality ratios (SMRs) of overall and gender-specific premature mortality were calculated for the period 2004-11 to ensure sufficient numbers. Bayesian hierarchical Poisson models with spatially unstructured and/or structured random effects were used to “smooth” maps. Urban-rural differences by population density and population potential as well as associations with a 2001 census-based composite “Townsend-like” indicator of deprivation and its components i.e. unemployment, overcrowding and not owner occupied (NOO) households were investigated. Results: SMRs (range 0 to 5) were unreliable at this small level of aggregation (median population 233, IQR: 75-784, 10% of areas >3000). Nevertheless, up to two-fold differences remained in smoothed maps (range: 0.76-1.35). A striking southeast to northwest spatial pattern was revealed with higher rates in less dense and isolated areas of the island. With the exception of NOO, neither the composite score nor its components seem to explain the observed pattern. Rate ratios of premature mortality were 1.14 (95%CI=1.03,1.28), 1.18 (95%CI=1.01,1.37) and 1.25 (95%CI=1.04,1.50) higher in areas with increasing proportion of NOO households. Furthermore, 16% (95%CI=0%,38%) higher premature mortality but 12% lower (95%CI=-14%,0.1%) was observed in areas with low (i.e. remote) and high (i.e. major metropolitan areas) population potential respectively. Conclusions: On a small island there are two-fold differences in premature mortality, with remote areas at a disadvantage perhaps reflecting the effect of selective migration or access to services. Traditional indicators of deprivation do not explain the observed pattern, highlighting the need for public health and epidemiological research to develop country-specific deprivation indices. Main Message: There are urban-rural differences in premature mortality in Cyprus, not explained by traditional deprivation indicators, perhaps more accurately capturing urban aspects of deprivation.
Background: Social capital can be viewed as an individual or a collective attribute, with structural and cognitive components, and it can be distinguished as bonding, bridging and linking. However, there is no uniformity across studies in terms of its measurement and while extensively studied at the community level, studies in occupational settings are sparse. Objectives: To explore the construct validity of a short measure of social capital at work (SCW) and investigate its association with self-rated health and psychological distress. Methods: A random sample of 10% of all nurses in Cyprus, recruited during a nationwide educational programme, responded to the Greek version of an 8-item scale, originally used in the Finish Public Sector Study. The goodness of fit of the unidimensional, two- and three-factor solutions were compared in confirmatory factor analyses. Multivariable linear and logistic regression models were used to investigate the association of SCW with self-rated health (Visual Analogue Scale) and psychological distress (GHQ-12 ≥ 4). Results: As many as 29.8% of the 362 participants rated their health < 69 on VAS 0-100 and one in four scored ≥ 4 on the GHQ-12. The three-factor solution of bonding (a=0.76), bridging (a=0.78) and linking (a=0.89) was the only acceptable fit as indicated by all goodness of fit indices (GFI=0.956, CFI=0.967, RMSE=0.091). Higher odds of psychological distress were observed among those in the lowest tertile of social capital (adjOR=1.93 95%CI=0.88, 4.75), particularly with regards to bonding social capital (adjOR=2.71 95%CI=1.08, 6.79), adjusted for age, gender, income, marital status, length of employment, housing tenure and residential instability. On average, low bonding and linking social capital were also significantly associated with poorer self-rated health. Conclusions: Associations with self-rated health and psychological distress were stronger with bonding (“getting along”), and linking (“vertical power differentials”) social capital, however this may reflect a weakness of the measure to fully capture bridging (“getting ahead”) social capital (2 items). While this aspect might need strengthening, the scale generally appears largely consistent with a multidimensional scale of bonding, bridging and linking social capital. Main Message: A short measure of Social Capital at Work showed good psychometric properties in a different setting and language It may be a promising tool for assessing the heath effects of workplace social capital in future epidemiological studies.
The identification of increased cardiometabolic risk among asymptomatic individuals remains a huge challenge. The aim of this meta-analysis was to compare the association of body mass index (BMI), which is an index of general obesity, and waist-to-height ratio (WHtR), an index of abdominal obesity, with cardiometabolic risk in cross-sectional and prospective studies. PubMed and Embase databases were searched for cross-sectional or prospective studies that evaluated the association of both BMI and WHtR with several cardiometabolic outcomes. The strength of relative risk (RR) with 95% confidence interval (CI) was calculated using the optimal cutoffs of BMI and WHtR in cross-sectional studies, while any available cutoff was used in prospective studies. The pooled estimate of the ratio of RRs (rRR [=RRBMI/RRWHtR]) with 95% CIs was used to compare the association of WHtR and BMI with cardiometabolic risk. Meta-regression was used to identify possible sources of heterogeneity between the studies. Twenty-four cross-sectional studies and ten prospective studies with a total number of 512,809 participants were identified as suitable for the purpose of this meta-analysis. WHtR was found to have a stronger association than BMI with diabetes mellitus (rRR: 0.71, 95% CI: 0.59-0.84) and metabolic syndrome (rRR: 0.92, 95% CI: 0.89-0.96) in cross-sectional studies. Also in prospective studies, WHtR appears to be superior to BMI in detecting several outcomes, including incident cardiovascular disease, cardiovascular disease mortality, and all-cause mortality. The usefulness of WHtR appears to be better in Asian than in non-Asian populations. BMI was not superior to WHtR in any of the outcomes that were evaluated. However, the results of the utilized approach should be interpreted cautiously because of a substantial heterogeneity between the results of the studies. Meta-regression analysis was performed to explain this heterogeneity, but none of the evaluated factors, ie, sex, origin (Asians, non-Asians), and optimal BMI or WHtR cutoffs were significantly related with rRR. The results of this meta-analysis support the use of WHtR in identifying adults at increased cardiometabolic risk. However, further evidence is warranted because of a substantial heterogeneity between the studies.
Background As wastewater reuse is becoming imperative in water scarce regions, in addition to evaluation of the extent of potential health risks involved, an assessment of public acceptance is necessary for a sustainable water reuse scheme to be successful. Objectives: To investigate public awareness, attitudes and health risk perceptions of water reuse among the general public in Cyprus. Methods A questionnaire survey was performed with a national sample of 800 participants stratified by district using …
The MC$^3$ (Madigan and York, 1995) and Gibbs (George and McCulloch, 1997) samplers are the most widely implemented algorithms for Bayesian Model Averaging (BMA) in linear regression models. These samplers draw a variable at random in each iteration using uniform selection probabilities and then propose to update that variable. This may be computationally inefficient if the number of variables is large and many variables are redundant. In this work, we introduce adaptive versions of these samplers that retain their simplicity in implementation and reduce the selection probabilities of the many redundant variables. The improvements in efficiency for the adaptive samplers are illustrated in real and simulated datasets.
Background The Greek-Cypriot (G/C) and Turkish-Cypriot (T/C) communities have lived apart since 1974, with the former presumably adopting a more westernized way of life. We estimated the prevalence of asthma and allergies among children in the two communities and investigated differences in socio-demographic and lifestyle risk factors. Methods The ISAAC questionnaire was completed by 10156 children aged 7–8 and 13–14 years. Relative differences in asthma and allergic symptoms between the two communities were expressed as odds ratios (OR), estimated in multivariable logistic regression models before and after adjusting for participants’ risk characteristics. Results In contrast to our original speculation, consistently lower prevalence rates were observed for respiratory outcomes (but not eczema) among G/C compared to T/C children in both age-groups. For instance, the prevalence of current wheeze among 7–8 year-olds was 8.7% vs 11.4% (OR = 0.74, 95%, CI: 0.61, 0.90) and of current rhinoconjuctivitis 2.6% vs 4.9% (OR = 0.52, 95% CI: 0.37, 0.71). Surprisingly, the proportion reporting family history of allergy was almost double in the G/C community. With the exception of early life nursery attendance, several protective factors were more prevalent amongst T/C, such as bedroom sharing, less urbanized environment and exposure to farm animals. In contrast, exposure to tobacco smoke was more frequent in the T/C community. Controlling for risk factors did not account for the observed lower prevalence of current wheeze (in the younger age-group) and rhinoconjuctivitis (in both age-groups) among G/C children while differences in the prevalence of eczema between the two communities were no longer statistically significant. Conclusions A mixed picture of potential risk factors was observed in the two communities of Cyprus, not consistently favoring one over the other community since, for example, bedroom sharing and rural living but also exposure to tobacco smoke were more common among T/C children. Investigated risk factors do not fully account for the lower prevalence of asthma and allergies among G/C children, especially against a background of higher family history of allergy in this community.
This article describes methods for efficient posterior simulation for Bayesian variable selection in Generalized Linear Models with many regressors but few observations. The algorithms use a proposal on model space which contains a tuneable parameter. An adaptive approach to choosing this tuning parameter is described which allows automatic, efficient computation in these models. The method is applied to examples from normal linear and probit regression. Relevant code and datasets are posted as an online supplement.
- Jun 2013
Purpose: One of the major challenges for health care professionals in heart failure (HF) management is to maintain and/or improve HF patient health-related quality of life. The Minnesota Living With Heart Failure Questionnaire (MLHFQ) is one of the most comprehensive and widely used tools for measuring health-related quality of life among patients with HF. The aim of the study was to assess the psychometric properties of the Greek version of the tool. Methods: The MLHFQ was administered among 128 Greek-Cypriot HF patients to assess the internal consistency, content validity, and contrast validity of its Greek version. Exploratory factor analysis was undertaken to establish its construct validity. Results: The factor analysis in this study provided support for a 3-factor solution explaining 64.15% of the variance (physical, emotional, and social subscales). The internal consistency for the Greek version of the MLHFQ total scale (0.95) and subscales (0.80-0.94) were found to be high. The contrast validity of the Greek version of the MLHFQ was explored through cumulative MLHFQ scores and comparisons that were able to distinguish among all different levels of HF severity, as defined by the New York Heart Association functional class grouping. Conclusion: This study provides support for the reliability and validity of the Greek version of the MLHFQ.
- May 2013
Objective: High body mass index (BMI) has been shown to be associated with asthma, but the pattern of this association is still unclear and may differ by gender or stage of puberty. BMI is only a proxy of adiposity, whereas estimation of body fat percent (BF%) by the bioimpedance technique is considered an accurate measure of adiposity. We investigated whether BMI and BF% behave differently in their association with asthma between genders, before and during adolescence. Design and methods: In this cross-sectional study of 10,981 schoolchildren, we used logistic regression models to examine the pattern of association of BMI and BF% with asthma. Results: In the case of BF%, both the highest (odds ratio [OR]: 1.68, 95% confidence interval [95% CI]: 1.21-2.30) and lowest (OR: 1.59, 95% CI: 1.13-2.23) z-score categories conferred an increased adjusted risk for active asthma. The likelihood ratio test (LRT) of nonlinearity yielded significant results (P < 0.01) for BF%. In contrast, the LRT for BMI yielded a nonsignificant result (P = 0.45) indicating a linear association of asthma with BMI. A unit increase in BMI z-score conferred an increase in the adjusted odds of active asthma (OR: 1.14, 95% CI: 1.02-1.27). In the case of BF%, the adjusted ORs for active asthma at the highest and lowest z-score categories in both genders, before and during adolescence, were similarly elevated, exhibiting a U-shape pattern. Conclusions: In contrast to the linear association observed with BMI, BF% displayed a U-shaped association with asthma and may be the preferred measure of adiposity in epidemiological studies of asthma in children.
Background Studies on the association of birth by caesarean section (C/S) and allergies have produced conflicting findings. Furthermore, evidence on whether this association may differ in those at risk of atopy is limited. This study aims to investigate the association of mode of delivery with asthma and atopic sensitization and the extent to which any effect is modified by family history of allergies. Methods Asthma outcomes were assessed cross-sectionally in 2216 children at age 8 on the basis of parents’ responses to the ISAAC questionnaire whilst skin prick tests to eleven aeroallergens were also performed in a subgroup of 746 children. Adjusted odds ratios of asthma and atopy by mode of delivery were estimated in multivariable logistic models while evidence of effect modification was examined by introducing interaction terms in the models. Results After adjusting for potential confounders, children born by C/S appeared significantly more likely than those born vaginally to report ever wheezing (OR 1.36, 95% CI 1.07-1.71), asthma diagnosis (OR 1.41, 95% CI 1.09-1.83) and be atopic (OR 1.67, 95% CI 1.08-2.60). There was modest evidence that family history of allergies may modify the effect of C/S delivery on atopy (p for effect modification=0.06) but this was not the case for the asthma outcomes. Specifically, while more than a two-fold increase in the odds of being a topic was observed in children with a family history of allergies if born by C/S (OR 2.62, 95% CI 1.38-5.00), no association was observed in children without a family history of allergies (OR 1.16, 95% CI 0.64-2.11). Conclusions Birth by C/S is associated with asthma and atopic sensitization in childhood. The association of C/S and atopy appears more pronounced in children with family history of allergies.
Background: Area-based composite measures of deprivation are frequently used to describe social inequalities in health. “Traditional” measures include the UK’s Townsend Index while newly developed multi-dimensional indices in several European countries use factor analytic techniques. It is not uncommon for such indices (e.g. France, Hungary) to include some, if not all, of the four components of the Townsend Index. Objectives: First-time exploration of the geographical variability of a Townsend-like Index across Cypriot communities and the extent to which the components share a common latent factor. Methods: Three of the components were available at community level (n=370) from the 2001 census i.e. % unemployed economically active population, % not owner occupied households and % households with >1 person/room. The fourth component was replaced with % households with no computer (PC) since not owning a car is not recorded in the census. After normalisation/standardisation, Bayesian hierarchical models with spatially unstructured and structured random effects were used to describe the pattern in each indicator while a spatial factor model was developed to explore the relationship between the components. Results: Pairwise correlations were generally low (e.g. r=0.37 between unemployment and overcrowding being the highest) while internal consistency between the variables was insufficient (Cronbach’s alpha=0.55). PC ownership was the only variable that displayed a striking spatial (i.e. urban-rural) structure and was not considered further since its correlations with the rest were in the opposite direction. Furthermore, there was evidence that the remaining indicators exhibit a different geography in Cyprus since the shared component accounted only for 25% (95% Cr.I= 18%, 33%) of the total variability of unemployment and 9% (95% Cr.I= 5%, 14%) of not owner-occupied households while for overcrowding it was negligible. Conclusions: A Townsend-like Index does not appear to be an adequate measure of social inequalities in Cyprus. With the release of the 2011 census, efforts should concentrate on developing a home-grown index from a wider set of possible indicators as well as by exploring its association with health outcomes.
Whilst emerging evidence from animal and cell experiments has shown high-density lipoprotein cholesterol to have anti-inflammatory effects consistent with a protective role in asthma, human studies investigating the relationship of high-density lipoprotein cholesterol with asthma have produced conflicting results. To examine the association between serum lipids among Cypriot children aged 11-12 years and prevalence of asthma at age 15-17 years. In 3982 children, we assessed serum lipids, body mass index and maximal oxygen consumption at baseline (2001-2003) and explored associations with respiratory health at follow-up (2007) using multiple logistic regression models. Lower levels of high-density lipoprotein cholesterol at age 11-12 years were found in subjects who reported ever asthma (58.2 vs. 60.0 mg/dL, P = 0.005) and active asthma (57.5 vs. 59.9 mg/dL, P = 0.010) in adolescence, in comparison with their respective reference groups. Total cholesterol, low-density lipoprotein and triglycerides had no association with any of the asthma outcomes. In contrast, with estimated odds ratios of 1.89 (95% CI 1.19-3.00) and 1.89 (95% CI 1.02-3.53), ever asthma and active asthma respectively appeared particularly pronounced among those who at baseline had high-density lipoprotein cholesterol <40 mg/dL, even after adjusting for potential confounders including body mass index and maximal oxygen consumption. CONCLUSIONS & CLINICAL RELEVANCE: Low-serum high-density lipoprotein cholesterol in childhood is associated with an increased risk for asthma in adolescence, suggesting a potential role of this lipoprotein in the pathogenesis of paediatric asthma.
This paper examines prior choice in probit regression through a predictive cross-validation criterion. In particular, we focus on situations where the number of potential covariates is far larger than the number of observations, such as in gene expression data. Cross-validation avoids the tendency of such models to fit perfectly. We choose the scale parameter c in the standard variable selection prior as the minimizer of the log predictive score. Naive evaluation of the log predictive score requires substantial computational effort, and we investigate computationally cheaper methods using importance sampling. We find that K-fold importance densities perform best, in combination with either mixing over different values of c or with integrating over c through an auxiliary distribution. KeywordsBayesian variable selection–Cross-validation–Gene expression data–Importance sampling–Log predictive score–Ridge prior
- Dec 2011
Heart failure (HF) is a clinical condition with major socioeconomic burden. Scientists are trying to find effective solutions to eliminate the effects of the disease and the current innovations in research address the introduction of HF management programmes (HF-MPs). A meta-analysis was undertaken to estimate the effect of HF-MP with a nurse-driven pre-discharge phase on the outcomes of HF and all-cause re-admission. A systematic search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Library (reviews and clinical trials) was performed to locate randomised controlled trials (RCTs), published in English language, which implemented any HF-MP with discharge planning carried out by a nurse. Identified articles were further screened for additional studies. Two reviewers independently screened relevant abstracts or titles using a standardised predefined check list. Pilot studies, studies additionally assessing other conditions and studies that evolved technology utilities or included medication management beyond optimisation of therapy, were excluded. Selected articles were thoroughly screened and data of interest (characteristics and outcomes) were obtained. Quality assessment was done by two reviewers separately. Nineteen RCTs were selected for the meta-analysis. The overall pooled effect (relative risk, RR) of the intervention group compared with the control group was estimated by using a random effects analysis (95% confidence interval (CI)) for the outcomes of HF-related re-admission and all-cause re-admission. The overall RR of HF re-admissions was 0.68, 95% CI (0.53, 0.86), p<0.05 and of all-cause re-admission was 0.85, 95% CI (0.76, 0.94), p<0.05 favouring the intervention. Metaregression analysis was performed while trying to explain the observed heterogeneity but none of the factors (environment, duration of follow-up, origin and complexity) were significantly related with the RR. No significant publication bias was observed regarding both HF and all-cause re-admission. The results of the current meta-analysis highlight the potential of HF-MPs with nurse-driven pre-discharge interventions to reduce hospital re-admissions. Essential characteristics or components of a successful HF-MP are still to be determined; thus more studies are required to solve this issue.
Model search in probit regression is often conducted by simultaneously exploring the model and parameter space, using a reversible jump MCMC sampler. Standard sam-plers often have low model acceptance probabilities when there are many more regres-sors than observations. Implementing recent suggestions in the literature leads to much higher acceptance rates. However, high acceptance rates are often associated with poor mixing of chains. Thus, we design a more general model proposal that allows us to pro-pose models "further" from our current model. This proposal can be tuned to achieve a suitable acceptance rate for good mixing. The effectiveness of this proposal is linked to the form of the marginalization scheme when updating the model and we propose a new efficient implementation of the automatic generic transdimensional algorithm of Green (2003). We also implement other previously proposed samplers and compare the efficiency of all methods on some gene expression datasets. Finally, the results of these applications lead us to propose guidelines for choosing between samplers. Relevant code and datasets are posted as an online supplement.
This article describes a method for e-cient posterior simulation for Bayesian vari- able selection in probit regression models with many regressors but few observations. A proposal on model space is described which contains a tuneable parameter. An adaptive approach to choosing this tuning parameter is described which allows auto- matic, e-cient computation in these models. The methods is applied to the analysis of gene expression data.