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To study the risk factors for Plasmodium vivax gametocyte carriage, the presence or absence of gametocytes was determined in 2,125 patients with P. vivax malaria participating in clinical trials at the Hospital for Tropical Diseases in Bangkok, Thailand. Stepwise logistic regression models were used to determine which variables were significantly related to gametocyte carriage. On admission, 615 patients (29%) had detectable gametocytes (before treatment). After treatment had started, an additional 245 patients (11%) developed patent gametocytemia. The variables retained by multivariate analysis were highest observed temperature (adjusted odds ratio [AOR] per degrees C increase = 0.82, 95% confidence interval [CI] = 0.71-0.94, P = 0.006), asexual parasitemia > 9,200/muL (AOR = 2.8, 95% CI = 1.9-4.2, P < 0.0001), erythrocyte counts (AOR = 0.8/million/muL increase, 95% CI = 0.67-0.95, P = 0.01), monocyte percentage (AOR = 0.93 per % increase, 95% CI = 0.89-0.96, P < 0.0001), lymphocyte percentage (AOR = 0.98 per % increase, 95% CI = 0.97-0.99, P = 0.006), albumin (AOR = 0.67 per 10 g/mL increase, 95% CI = 0.5-0.9, P = 0.007), and anion gap (AOR = 1.1 per unit increase, 95% CI = 1.02-1.14, P = 0.009). The possible significance of these observations is discussed.
Am J Trop Med Hyg 2004 Dec
PMID:Risk factors for Plasmodium vivax gametocyte carriage in Thailand. 1564 56

We identified methadone maintenance therapy (MMT) use during follow-up interviews and examined associations between MMT use and socio-demographic and drug-related variables using generalized estimating equations (GEE). Of the 1587 participants recruited into this cohort, 170 (11%) were enrolled in MMT at baseline and additional 498 (31%) initiated MMT during follow-up. Of those ever enrolled in MMT, 406 (61%) ceased MMT and re-initiated MMT on more than one occasion. The median treatment duration was 14.4 months. Factors that were negatively and significantly associated with MMT use in multivariate analyses included: Aboriginal ethnicity (adjusted odds ratio [AOR] = 0.40); recent incarceration (AOR = 0.79); sex trade involvement (AOR = 0.87); syringe lending (AOR = 0.72); heroin injection (AOR = 0.64), whereas female gender (AOR = 2.47), HIV positivity (AOR = 1.57), and crack cocaine smoking (AOR = 1.23) were positively and significantly associated with being on MMT. Unstable housing, syringe borrowing, non-fatal overdose, cocaine injection, and residence in Vancouver's Downtown Eastside were not associated with MMT use in multivariate analyses. Our study demonstrates high rates of initiation of and retention in MMT among local IDUs. While the use of MMT was associated with reductions in heroin use and HIV risk behavior, barriers to Aboriginal IDUs were evident, and the association with increased crack cocaine use deserves further study.
Drug Alcohol Depend 2005 Dec 12
PMID:Factors associated with methadone maintenance therapy use among a cohort of polysubstance using injection drug users in Vancouver. 1596 14

Near-hanging is an increasing presentation to hospitals in Australasia. We reviewed the clinical management and outcome of these patients as they presented to public hospitals in Queensland. A retrospective clinical record audit was made at five public hospitals between 1991 and 2000. Of 161 patients enrolled, 82% were male, 8% were indigenous and 10% had made a previous hanging attempt. Chronic medical illnesses were documented in 11% and previous psychiatric disorders in 42%. Of the 38 patients with a Glasgow Coma Scale score (GCS) of 3 on arrival at hospital, 32% returned to independent living and 63% died. Fifty-two patients received CPR, of whom 46% had an independent functional outcome. Independent predictors of mortality were a GCS on hospital arrival of 3 (AOR 150, CI 95% 12.4-1818, P<0.001), taking plain X-rays of the cervical spine (AOR 0.06, CI 95% 0.004-0.97, P=0.047) and contact with the ground (AOR 0.03, CI 95% 0.002-0.62, P=0.02). Only 66% had imaging of the cervical spine performed with other imaging performed infrequently. There were three laryngeal, two hyoid bone and three cervical spine injuries and one carotid dissection. The number of cervical spine X-rays required to find a significant cervical spine fracture was 54. Near-hanging presenting to hospital with a poor conscious state or even cardiac arrest can have a favourable clinical outcome. Radiological investigations are infrequently performed despite a low GCS precluding early accurate assessment. Given the general favourable outcome, an aggressive approach to searching for correctable injuries is recommended.
Anaesth Intensive Care 2006 Dec
PMID:Near-hanging as presenting to hospitals in Queensland: recommendations for practice. 1718 91

Carbapenem resistance among Gram-negative bacilli has become an increasingly serious problem worldwide, and the emergence and spread of carbapenem-resistant Escherichia coli (CREC) is also becoming a serious problem. To date, however, risk factors for CREC acquisition have not been determined, so we decided to evaluate this in hospitalized patients through matched case-control study. Nosocomially acquired CREC was isolated from 46 patients between January 1997 and December 2007. For each patient, 3 matched-control subjects were selected. Previous use of carbapenem (adjusted odds ratio [AOR], 6.50) and metronidazole (AOR, 4.25), the presence of biliary drainage catheter (AOR, 4.59), and prior hospital stay (AOR 1.02) were found as independent risk factors for CREC. Our results suggest that the nosocomial acquisition of CREC may be favored by the selection pressure of carbapenems and metronidazole and also related to prior hospital stay and the presence of biliary drainage catheter.
Diagn Microbiol Infect Dis 2008 Dec
PMID:Risk factors for the acquisition of carbapenem-resistant Escherichia coli among hospitalized patients. 1899 12

Spirometry is necessary to diagnose and assess severity of COPD, but is used infrequently. Therapy with inhaled medications can improve COPD outcomes, but are not without risks. The use of spirometry may help mitigate the therapy risks if treatment is appropriate based on spirometry results. Before determining benefits of spirometry use, it is important to examine use of medications and the use of spirometry. Our objective was to characterize the association between the use of spirometry and respiratory medications in newly diagnosed COPD. This is a retrospective, longitudinal study using data from the Department of Veterans Affairs. We identified patients with a new diagnosis of COPD (index date). Spirometry use was measured two years before to six months after the index date. Respiratory medications were measured within one year following the index date. The association between spirometry and medication use was evaluated using logistic regressions and stratified by quintiles of the propensity scores for the probability of having had spirometry performed. A total of 81,162 patients were included and 30.8% had a spirometry performed. Patients with spirometry were more likely to have been dispensed an inhaled corticosteroid (AOR = 1.22 (95% CI, 1.11-1.36) to 1.61 (1.45-1.79)), long-acting beta-agonists (AOR = 1.41(1.25-1.58) to 1.63(1.45-1.83)), and ipratropium bromide (AOR = 1.25(1.16-1.35) to 1.64 (1.49-1.81)) across quintiles. Patients with spirometry were more likely to have medications added. The use of spirometry around a new diagnosis of COPD was associated with higher likelihood of using and adding respiratory medications after diagnosis.
COPD 2008 Dec
PMID:Medication use patterns associated with spirometry in diagnosing COPD. 1935 50

Telephone surveys with national probability samples of English-speaking adults have suggested that popular support for punitive policies toward people living with HIV/AIDS (PLWHA) declined in the 1990s, but AIDS-related stigma persists in the United States. Our aim was to assess the prevalence and impact of AIDS-related stigma in non-Hispanic Black and Hispanic communities. A cross-sectional computer-assisted telephone-interview survey was conducted in summer 2003 with African-American, Afro-Caribbean, Haitian, and Hispanic 18-39 year-old residents of 12 high AIDS-incidence areas in Broward County, Florida. Stigma items were adopted from national surveys, but interviews were conducted in Spanish and Haitian Creole as well as in English. Stigma scores were higher than those reported for national samples, especially among Haitians interviewed in Creole. AIDS-related stigma was associated with never receiving an HIV-antibody test (adjusted odds ratio [AOR] = 0.78, 95% confidence interval [CI]: 0.62-0.99, P = .046), an elevated perception of HIV risk (AOR = 1.32, 95% CI: 1.01-1.73, P = .045) and a failure to participate in HIV-prevention efforts (AOR = 0.53, 95% CI: 0.34-0.85, P = .008). Interventions are needed to mitigate the pernicious effects of AIDS-related stigma.
AIDS Behav 2009 Dec
PMID:AIDS-related stigma among Black and Hispanic young adults. 1968 Aug

Depressive illness is common among the aged population. A case control study was conducted, focusing on risk factors influencing depression among the elderly. This study involved 130 elderly patients diagnosed to have depressive illness from the psychiatric clinics of Kuala Lumpur Hospital (HKL) and Universiti Kebangsaan Malaysia Hospital (HUKM). Another group of 130 elderly patients with no history of depressive illness were recruited from the medical specialist clinics. The majority of cases were female (75.4%), aged 60-74 years (92.3%) and from Chinese ethnic group (59.2%). Non-Malay elderly has three times risk (AOR 2.537, 95% CI 1.439-4.471) of suffering the depressive illness compared to the Malay elderly, the elderly with chronic health problems are more likely to be depressed compared to those who do not suffer from any chronic illness (p trend <0.001). Other risk factors identified were family history of depression with four times risk (AOR 4.225, 95% CI 2.017-8.848) and lower social support with eight times risk (AOR 7.949, 95% CI 2.588-24.417). Social support is not only important in encouraging the elderly to practice healthy life style but proven to influence the risk of getting depression among them. Hence, it is very crucial that the elderly is given total attention, respect and love from all parties to ensure prosperity and meaningfulness in life.
Med J Malaysia 2008 Dec
PMID:A case control study on factors that influence depression among the elderly in Kuala Lumpur Hospital and Universiti Kebangsaan Malaysia Hospital. 1980 99

To better understand access to HIV testing and prevention services experienced by Latinos, we evaluated data compiled through Baltimore City Health Department HIV outreach efforts in 2008. Of 6,443 clients served, Latinos were more likely male, young, and less-educated than non-Latinos. A greater proportion of Latinos had never been tested for HIV compared to non-Latinos (63% vs. 20%, P < 0.001). Male gender (AOR 1.58, 95% CI 1.04, 2.44), >8th grade education (AOR 2.4, 95% CI 1.60, 3.60) were associated with accessing HIV testing in the past. Increasing age, identifying as gay or bisexual, history of sexually-transmitted disease, and injection drug use were also associated with reporting prior HIV testing. HIV prevention services for Latinos should expand to reach those who are younger, heterosexual, of lower educational level, and female.
J Immigr Minor Health 2010 Dec
PMID:Predictors of HIV testing among Latinos in Baltimore City. 1983 May 63

There has been a significant increase in the use of steroid avoidance regimens as initial treatment for kidney transplant recipients. Early results of the effectiveness of this strategy has been mixed with certain prospective trials indicating increased acute rejection but population-based studies indicating similar or better graft survival as compared to steroid maintenance. We conducted a retrospective study of national registry data to evaluate risk factors for discontinuation of steroid avoidance protocols based on patient characteristics and concomitant immunosuppression. We evaluated 84 647 solitary kidney transplant recipients in the US with at least 6 months graft survival including 24 218 initially discharged without maintenance steroids. We utilized logistic models to assess risk factors for new initiation of steroids after initial steroid-avoidance and survival models to describe graft survival for patients after return to steroids. The most prominent risk factors for new initiation of steroids after deceased donor kidney transplantation included African-American race (AOR = 1.32, p < 0.01), retransplants (AOR = 1.81, p < 0.01), highly sensitized recipients (AOR = 1.29, p < 0.01), recipients with Medicaid (AOR = 1.85, p < 0.01), elevated HLA-MM (AOR = 1.26, p < 0.01) and older donor age (AOR = 1.19, p < 0.01). Concomitant medications were also significantly associated with the propensity to newly initiate steroids. Cumulatively the study suggests that both patient characteristics and concomitant medications are strongly associated with the success of steroid avoidance immunosuppressive regimens.
Am J Transplant 2009 Dec
PMID:The success of continued steroid avoidance after kidney transplantation in the US. 1984 94

To quantify the extent that South Carolina HIV/AIDS cases could have been diagnosed during a prior arrest we designed a retrospective population-based cohort study linking case reports from HIV/AIDS Reporting System (HARS) and the South Carolina Law Enforcement Division database. Data from individuals newly diagnosed between January 2001 and December 2005 were linked with statewide arrest records from April 1991 through November 2005. Criminal history data for this report were derived from 28 state prisons and more than 250 law enforcement agencies (jails, lockups, detention centers). Odds ratios and 95% confidence intervals were used to determine how demographic variables and arrest reasons affects receipt of HIV testing. There were 1961/4036 (48.6%) incident cases of HIV diagnosis that had at least one arrest prior to their first positive HIV test. When restricted to 1286/1961 (65.6%) individuals most likely to have been HIV-infected at the time of arrest, 592 (46%) were early testers (no AIDS within 1 year) and 694 (54%) developed AIDS more than 1 year of testing (late testers). After controlling for gender, age, race, behavioral risk and source of HIV report, the odds of being a late tester increased with age (p < 0.001). Overall, 3750 separate arrests were recorded for these 1286 individuals and 491 (13%) arrests were for drug and alcohol or sex crimes. Individuals with 4 or more arrests were more likely to be late testers when compared to those with fewer than 4 arrests (adjusted odds ratio [AOR] 3.30; 95% confidence [CI] 2.28, 4.72). Correctional facilities present considerable opportunities to identify individuals with undiagnosed HIV infection. Providing correctional facilities with the infrastructure for implementation of routine HIV testing would consequently have a significant impact on the health status of the entire community.
AIDS Patient Care STDS 2009 Dec
PMID:Missed opportunities for early HIV diagnosis in correctional facilities. 1990 69


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