Adherence to statins and the risk of psoriasis: a population-based cohort study.

BACKGROUND: Statins have been shown to downregulate immune mechanisms activated in psoriasis. However, previous studies on their potential role in preventing psoriasis have yielded conflicting results. OBJECTIVES: To assess the relationship between adherence to statins and the risk of psoriasis. METHODS: This retrospective cohort study included 205,820 health plan enrollees in Israel (mean age 55 years; 54·1% women) who initiated statin treatment from January 1998 through to September 2009. Adherence to statins, measured by the proportion of days covered (PDC), throughout the entire follow-up period (mean 6·2 years) was recorded. Diagnosis codes of psoriasis were assigned by a dermatologist or rheumatologist, or at discharge from hospital. RESULTS: During 1·28 million person-years (PY) of follow-up (median 5·74 years per person; interquartile range 3·78-8·36), 5615 cases of psoriasis (incidence density rate 4·4 per 1000 PY) were recorded. Compared with patients who did not adhere to statins (PDC < 20%), patients covered by statins for 40-59% of the time had a significantly lower risk of psoriasis (P < 0·05), with hazard ratios (HRs) of 0·84 and 0·74 among men and women, respectively. Among patients who adhered better to statins (PDC ≥ 80%), HRs were 0·88 (95% CI 0·79-0·98) and 1·00 (95% CI 0·90-1·11) among men and women, respectively. CONCLUSIONS: The results of the current study suggest that high and long-term adherence to statins is not associated with a meaningful reduction in the risk of developing psoriasis.

A study on the association with hepatitis B and hepatitis C in 1557 patients with lichen planus.

BACKGROUND: Previous reports have demonstrated contradicting results on the association between lichen planus and hepatitis. OBJECTIVES: The aim of this study was to investigate the association between lichen planus and viral hepatitis. METHODS: Patients with lichen planus were compared with controls regarding the prevalence of viral hepatitis in a case-control study using logistic multivariate regression models. The study was performed utilizing the medical database of Clalit Health Services. RESULTS: The study included 1557 lichen planus patients over the age of 20 years and 3115 age- and gender-matched controls. The prevalence of hepatitis C in patients with lichen planus was higher than that in the control group (1.9%, 0.4% respectively, P<0.001). In a multivariate analysis, lichen planus was associated with hepatitis C (OR 4.19, 95% CI 2.21; 7.93). The prevalence of hepatitis B in patients with lichen planus was similar to that in the control group (0.9%, 0.5% respectively, P=0.12). A multivariate analysis revealed that lichen planus was not associated with hepatitis B (OR 1.69, 95% CI 0.82; 3.47). CONCLUSION: Lichen planus is associated with hepatitis C but not with hepatitis B. Physicians who care for patients with lichen planus should consider screening patients with lichen planus for hepatitis C.

Coeliac disease associated with psoriasis.

BACKGROUND: Psoriasis is a chronic inflammatory disorder of the skin reported to be associated with systemic comorbidities. OBJECTIVES: To investigate the association between psoriasis and coeliac disease (CD). METHODS: Patients with psoriasis were compared with age- and sex-matched controls regarding the prevalence of CD in a case-control study. chi(2) and t-tests were used for univariate analysis and a logistic regression model was used for multivariate analysis. The study was performed utilizing the medical database of Clalit Health Services. RESULTS: The study included 12,502 patients with psoriasis aged > 20 years and 24,285 age- and sex-matched controls. The prevalence of CD in patients with psoriasis was increased compared with the prevalence in controls (0.29% and 0.11%, respectively, P < 0.001). In a multivariate analysis psoriasis was associated with CD (odds ratio 2.73, 95% confidence interval 1.65-4.53). CONCLUSIONS: Patients with psoriasis have a greater prevalence of CD than matched controls. Recent studies showed a possibility of undiagnosed CD among patients with psoriasis. Therefore, physicians treating patients with psoriasis should be aware of this possible association.

Psoriasis and chronic obstructive pulmonary disease: a case-control study.

BACKGROUND: Previous reports have demonstrated an association between psoriasis and the metabolic syndrome. Chronic obstructive pulmonary disease (COPD) has also been associated with the metabolic syndrome. OBJECTIVES: To assess the association between psoriasis and COPD in a population-based case-control study. METHODS: A case-control study was performed utilizing the database of Clalit Health Services, a large healthcare provider organization in Israel. Patients over the age of 20 years who were diagnosed with psoriasis ('cases') were compared with a sample of age- and gender-matched enrollees without psoriasis ('controls') regarding the prevalence of COPD. Group matching was performed. Data on health-related lifestyles and other comorbidities were collected. Chi(2) tests, t-tests and logistic regression models were used to compare between study groups. RESULTS: The study included 12,502 psoriasis cases and 24,287 controls. The prevalence of COPD was significantly higher in patients with psoriasis [5.7% vs. 3.6%, P < 0.001, odds ratio (OR) 1.63, 95% confidence interval (CI) 1.47-1.81]. A multivariate logistic regression model demonstrated that psoriasis was significantly associated with COPD, after controlling for confounders, including age, sex, socioeconomic status, smoking and obesity (adjusted OR 1.27, 95% CI 1.13-1.42, P < 0.001). CONCLUSIONS: In this large, population-based case-control study, psoriasis was found to be associated with COPD. Dermatologists caring for patients with psoriasis should be aware of this association, consult an internist or pulmonologist, and advise the patients to stop smoking and reduce additional risk factors for COPD.

Nonattendance in a dermatology clinic--a large sample analysis.

BACKGROUND: Previous studies have described factors determining non-attendance at dermatology appointments in small sample sizes. OBJECTIVE: To perform an analysis of factors associated with non-attendance in a dermatology clinic in a larger sample. METHODS: Factors determining non-attendance were examined in 52 604 consecutive first-time visits to a dermatology clinic over a period of 44 months. RESULTS: Non-attendance proportion was 27.6%. Among children, non-attendance was associated with waiting for an appointment < 7 days [odds ratio (OR), 1.44], Bedouin sector (OR, 1.30), rural Jewish sector (OR, 0.45) and the treating physician. Among adults, non-attendance was associated with female gender (OR, 1.08), age < 55 years (OR, 1.65), waiting time for an appointment < 7 days (OR, 1.44), timing of the appointment between 1 and 4 pm (OR, 1.13), Bedouin sector (OR, 1.63), rural Jewish sector (OR, 0.46) and the treating physician. CONCLUSION: Non-attendance is common among Bedouins, adult female patients and young adults and is more likely as waiting times become longer. Strategies to reduce non-attendance are needed.

Indices of iron deficiency and anaemia in Bedouin and Jewish toddlers in southern Israel.

AIMS: To estimate the prevalence of iron deficiency and iron deficiency anaemia using haematological indices. METHODS: Prospective interventional study. Healthy toddlers from Bedouin and Jewish towns in southern Israel. Capillary blood was sampled to assess iron status and nutritional history recorded. Parents were given specific nutritional instructions. Anaemia was defined as haemoglobin level < or = 11 gr/dL. Iron deficiency without anaemia was defined as mean corpuscular volume (MCV) < 70 fL and/or red blood cell width (RDW) > or = 16, with haemoglobin level > 11 gr/dL. Toddlers with iron deficiency were treated with 5 mg/kg/day of elemental iron. Follow-up iron and nutritional status was performed 1 and 2 months after enrolment. RESULTS: At the time of enrolment 42% of the 107 Jewish and 93% of the 43 Bedouin toddlers were iron deficient (p < 0.001). Significantly higher proportions of Bedouin toddlers were breastfed, drank tea, did not eat meat, did not take supplementary iron in their first year of life and were previously diagnosed with anaemia. Rate of follow-up was 55% among Bedouins and 33% among Jews. The mean haemoglobin rise over two months was 0.91 gr/dL (95% CI: 0.63-1.18 gr/dL; p < 0.001) in Bedouins and 0.58 gr/dL (95% CI: 0.14-1.02 gr/dL; p = 0.014) in Jews. CONCLUSIONS: Higher rates of anaemia and iron deficiency, as well as most of the risk factors, found among the Bedouin toddlers, call for the design and implementation of innovative, culturally appropriate interventions in the Bedouin population.

Termination of pregnancy: attitudes and behavior of women in a traditional society.

OBJECTIVES: The Bedouin Arabs, a Muslim traditional ethnic minority in Israel, are faced with difficult choices when offered prenatal diagnosis as part of the universally provided prenatal care in Israel. This paper is to examine attitudes towards and practice of pregnancy termination, following an unfavorable prenatal diagnosis. METHODS: Semistructured interviews with 83 women were conducted to study attitudes. Data from the Soroka Medical Center, where all births in the area take place, were used to assess the rate of terminations of pregnancies following a diagnosis of a chromosomal anomaly. RESULTS: While divided on the question of termination, many women believed that a second medical opinion is needed, preferably from an Arab physician. The reasons for termination are both child- and mother-related. Opposing termination is based on both the suspicion that the diagnosis might be wrong and on religious reasons. Between 1995 and 1999, 686 Bedouin women had undergone amniocentesis (2.4% of all pregnancies). Six of 11 pregnancies with the diagnosis of a trisomy were terminated (54.5%). All cases in which a trisomy was terminated were trisomy 21. CONCLUSIONS: Culturally acceptable prenatal diagnostic services for Muslim populations should be based on early testing, and should involve Muslim physicians and religious authorities.

Decisions regarding pregnancy termination among Bedouin couples referred to third level ultrasound clinic.

OBJECTIVE: To identify predictors of parental decision whether to terminate a pregnancy after a diagnosis of a major congenital malformation in a traditional society. STUDY DESIGN: The Bedouin Arabs in southern Israel are a traditional society, with a high incidence of congenital disorders. Data were abstracted from medical records of 295 families who sought counseling in the third level ultrasound clinic between 1990 and 1996. Statistical analysis included univariate and multiple logistic regression. RESULTS: The diagnosis of a major malformation was confirmed in 64% of the cases. Pregnancy termination was a realistic option for 125 women (66.5%) as the rest were too advanced in their pregnancy. Such a delay was less common in cases of multiple malformations than in a single malformation (19.2% versus 39.0% respectively, P < 0.01). Forty-nine of the 125 women (39.2%) chose to terminate their pregnancy. The only significant predictors of termination decision were earlier gestational week at diagnosis and previous uncompleted pregnancies. CONCLUSIONS: These findings indicate the importance of promoting early genetic counseling and early prenatal diagnosis, for any population where abortions are not readily acceptable.

Peripheral insulin sensitivity as modified by diet and exercise training.

To determine which component of a high-fat sucrose diet (HFS) caused insulin resistance and whether exercise training or fiber could prevent it, six dietary treatments were tested in rats: low-fat complex carbohydrate (LFCC); high-fat complex carbohydrate (HFCC); low-fat sucrose (LFS); high-fat sucrose (HFS); HFS plus fiber (HFS + F); and HFS plus exercise training (HFS + EX). After 10 wk rats were subjected to an intravenous glucose-tolerance test. The HFS and HFS + F groups developed glucose intolerance, as indicated by significantly greater areas under their glucose curves compared with the LFCC group's areas. The LFS, HFS, HFS + F, and HFS + EX groups developed insulin resistance, as indicated by significantly greater areas under their insulin curves compared with the LFCC and HFCC groups' areas. Either the presence of sucrose or the absence of complex carbohydrates, not high fat, was responsible for the insulin resistance and it was not improved by adding fiber to the diet or by exercise training.

Organization and learning of visual-motor information during different orders of limb movement: step, velocity, acceleration.

Theoretical use of the tracking paradigm as a means of understanding perceptual-motor organization has been influenced by ambiguous assumptions concerning the relation of time orders of force production to the learning and performance of time orders of limb movement. This study provides both a conceptual framework for clarifying these assumptions, and empirical data for testing them. The independent variables were (a) target motion (step, velocity, acceleration); (b) stick loading (elasticity, damping, mass); and (c) practice. The dependent variables were absolute terror for step and time-integrated squared error for velocity and acceleration. The hypothesis was that proficiency of tracking is inversely related to mathematical complexity of reactive forces, within constraints imposed by familiarity with required types of transfer functions. Five subjects were assigned to track one type of target motion in each of the three loading conditions, respectively. Cursor-present "training" trials were alternated with cursor-absent "test" trials. Thereby, a premium was placed on attention to proprioceptive feedback, at least at the start of training. The hypothesis could not be rejected.

Quantification of chorea in Huntington's disease by power spectral analysis.

A spectral analysis technique for quantifying dyskinesia in patients with diagnosis of Hungtington's Disease (chorea) (H.D.) is described. Spectral analysis involves computation of the magnitude of abnormal involuntary movements (AIMS) and of their distribution in frequency. It has the advantage of providing an objective measure of such movements. Three H.D. patients under different drug regimens and three age-matched controls have been evaluated and representative time records and power spectra are presented. Analysis established marked differences in the amplitude and shape of the normal and patient spectra. In addition, spectral analysis proved sensitive to differences in drug treatments among patients suggesting its additional use in evaluating the efficacy of therapeutic agents in the treatment of movement disorders.

Information processing in an urban fire department communication system.

One of the most important functions of any fire department is to provide selective contact with fire fighting units and to dispatch these units based on information gathered from street alarm boxes and telephones. This paper is concerned with the problem of dispatching tactical response information to remote fire fighting units and with the effect of workload on the dispatch function.

The isocitrate dehydrogenases of Acinetobacter lwoffi. Studies on the regulation of a nicotinamide-adenine dinucleotide phosphate-linked isoenzyme.

Of the two NADP-linked isocitrate dehydrogenases in Acinetobacter lwoffi the higher-molecular-weight form, isoenzyme-II, is reversibly stimulated sixfold by low concentrations of glyoxylate or pyruvate. Kinetic results indicate that this stimulation of activity involves both an increase in V(max.) and a decrease in the apparent K(m) values for substrates, most markedly that for NADP(+). Other changes brought about by glyoxylate or pyruvate include a shift in the pH optimum for activity and an increased stability to inactivation by heat or urea. Mixtures of glyoxylate plus oxaloacetate, known to inhibit isocitrate dehydrogenases from other organisms, produce inhibition of both A. lowffi isoenzymes, and do not reflect the stimulatory specificity of glyoxylate for isoenzyme-II. Isoenzyme-II is also stimulated by AMP and ADP, but the activation by glyoxylate or pyruvate is shown to be quite independent of the adenylate activation. Differential desensitization of the enzyme by urea to the two types of activator further supports the view that the enzyme possesses two distinct allosteric regulatory sites. The metabolic significance of the activations is discussed.