Examining the robustness of the obesity paradox in maintenance hemodialysis patients: a marginal structural model analysis.

BACKGROUND: The inverse association between body mass index (BMI) and mortality observed in patients treated with maintenance hemodialysis (MHD), also known as the obesity paradox, may be a result of residual confounding. Marginal structural model (MSM) analysis, a technique that accounts for time-varying confounders, may be more appropriate to investigate this association. We hypothesize that after applying MSM, the inverse association between BMI and mortality in MHD patients is attenuated. METHODS: We examined the associations between BMI and all-cause mortality among 123 624 adult MHD patients treated during 2001-6. We examined baseline and time-varying BMI using Cox proportional hazards models and MSM while considering baseline and time-varying covariates, including demographics, comorbidities and markers of malnutrition and inflammation. RESULTS: The patients included 45% women and 32% African Americans with a mean age of 61(SD 15) years. In all models, BMI showed a linear incremental inverse association with mortality. Compared with the reference (BMI 25 to <27.5 kg/m(2)), a BMI of <18 kg/m(2) was associated with a 3.2-fold higher death risk [hazard ratio (HR) 3.17 (95% CI 3.05-3.29)], and mortality risks declined with increasing BMI with the greatest survival advantage of 31% lower risk [HR 0.69 (95% CI 0.64-0.75)] observed with a BMI of 40 to <45 kg/m(2). CONCLUSIONS: The linear inverse relationship between BMI and mortality is robust across models including MSM analyses that more completely account for time-varying confounders and biases.

A Review of Programs, Components and Outcomes in Biomedical Research Faculty Development.

BACKGROUND/OBJECTIVE: To review, compare and synthesize current faculty development programs and components. Findings are expected to facilitate research that will increase the competency and competitiveness of less-established biomedical research faculty. METHODS: We reviewed the current literature on research faculty development programs, and report on their type, components, outcomes and limitations. RESULTS: Nineteen articles met inclusion criteria. There were no prospective studies; most were observational and all lacked a control group. Mentoring was the most successful program type, and guided and participatory learning the most successful enabling mechanism, in achieving stated program goals. CONCLUSIONS: Our findings are limited by the small number of current studies, wide variation in implementation, study design, and populations, and the lack of uniform metrics. However, results suggest that future prospective, randomized studies should employ quantitative criteria, and examine individual, human factors that predict "success."

Study of the fingertip pattern as a tool for the identification of the dermatoglyphic trait in bronchial asthma.

INTRODUCTION: Bronchial Asthma is one of the most extensively studied respiratory diseases and its genetic basis is well established. Dermatoglyphic traits are formed under genetic control early in development but may be affected by environmental factors during first trimester of pregnancy. These patterns may represent the genetic makeup of an individual and therefore his/her predisposition to certain diseases. Patterns of dermatoglyphics have been studied in various congenital disorders like Down's syndrome, Klinefelter's syndrome and also in chronic diseases like Hypertension, Diabetes Mellitus etc. Epidermal ridge patterns of finger tips in bronchial asthma patients were studied to find out fingertip pattern as Dermatoglyphic features in patients of Bronchial Asthma; it's comparison and association if exists between normal and bronchial asthma patients and also to find use of fingertip pattern in early childhood as non-invasive anatomical marker for bronchial asthma in adulthood. METHODS: The study was conducted on clinically diagnosed all bronchial asthma patients attending OPD of Dr Ulhas Patil Medical College, Jalgaon. Matched controls were selected without any respiratory problem or any symptoms related to asthma from medical students, staff members and paramedical staff of hospital after taking the informed consent and permission from the institutional ethical committee. Data collection and fingertip prints were taken by ink and rolling finger method. Prints taken were analysed and tabulated; data was analysed by using statistical tests. RESULTS: Study shows that decrease in number of arches, increase in AFRC in patients as compared with controls. Also there were increased ulnar loops in male patients and increased Whorls and radial loops in female patients. CONCLUSION: The fingerprints can represent a non-invasive anatomical marker of bronchial asthma risk and facilitate early detection and effective management which is vital for selecting appropriate agents for treating infections.