Cross-sectional and prospective associations between sleep regularity and metabolic health in the Hispanic Community Health Study/Study of Latinos.

STUDY OBJECTIVES: Sleep is an emergent, multi-dimensional risk factor for diabetes. Sleep duration, timing, quality, and insomnia have been associated with diabetes risk and glycemic biomarkers, but the role of sleep regularity in the development of metabolic disorders is less clear. METHODS: We analyzed data from 2107 adults, aged 19-64 years, from the Sueño ancillary study of the Hispanic Community Health Study/Study of Latinos, followed over a mean of 5.7 years. Multivariable-adjusted complex survey regression methods were used to model cross-sectional and prospective associations between the sleep regularity index (SRI) in quartiles (Q1-least regular, Q4-most regular) and diabetes (either laboratory-confirmed or self-reported antidiabetic medication use), baseline levels of insulin resistance (HOMA-IR), beta-cell function (HOMA-ß), hemoglobin A1c (HbA1c), and their changes over time. RESULTS: Cross-sectionally, lower SRI was associated with higher odds of diabetes (odds ratio [OR]Q1 vs. Q4 = 1.64, 95% CI: 0.98-2.74, ORQ2 vs. Q4 = 1.12, 95% CI: 0.70-1.81, ORQ3 vs. Q4 = 1.00, 95% CI: 0.62-1.62, ptrend = 0.023). The SRI effect was more pronounced in older (aged ≥ 45 years) adults (ORQ1 vs. Q4 = 1.88, 95% CI: 1.14-3.12, pinteraction = 0.060) compared to younger ones. No statistically significant associations were found between SRI and diabetes incidence, as well as baseline HOMA-IR, HOMA-ß, and HbA1c values, or their changes over time among adults not taking antidiabetic medication. CONCLUSIONS: Our results suggest that sleep regularity represents another sleep dimension relevant for diabetes risk. Further research is needed to elucidate the relative contribution of sleep regularity to metabolic dysregulation and pathophysiology.

Using tablet technology in operational radiation safety applications.

Tablet computers have become a mainstream product in today's personal, educational, and business worlds. These tablets offer computing power, storage, and a wide range of available products to meet nearly every user need. To take advantage of this new computing technology, a system was developed for the Apple iPad (Apple Inc. 1 Infinite Loop Cupertino, CA 95014) to perform health and safety inspections in the field using editable PDFs and saving them to a database while keeping the process easy and paperless.

Predicting the risk of cardiovascular disease in HIV-infected patients: the data collection on adverse effects of anti-HIV drugs study.

AIMS: HIV-infected patients receiving combination antiretroviral therapy may experience metabolic complications, potentially increasing their risk of cardiovascular diseases (CVDs). Furthermore, exposures to some antiretroviral drugs seem to be independently associated with increased CVD risk. We aimed to develop cardiovascular risk-assessment models tailored to HIV-infected patients. METHODS AND RESULTS: Prospective multinational cohort study. The data set included 22,625 HIV-infected patients from 20 countries in Europe and Australia who were free of CVD at entry into the Data collection on Adverse Effects of Anti-HIV Drugs Study. Using cross-validation methods, separate models were developed to predict the risk of myocardial infarction, coronary heart disease, and a composite CVD endpoint. Model performance was compared with the Framingham score. The models included age, sex, systolic blood pressure, smoking status, family history of CVD, diabetes, total cholesterol, HDL cholesterol and indinavir, lopinavir/r and abacavir exposure. The models performed well with area under the receiver operator curve statistics of 0.783 (range 0.642-0.820) for myocardial infarction, 0.776 (0.670-0.818) for coronary heart disease and 0.769 (0.695-0.824) for CVD. The models estimated more accurately the outcomes in the subgroups than the Framingham score. CONCLUSION: Risk equations developed from a population of HIV-infected patients, incorporating routinely collected cardiovascular risk parameters and exposure to individual antiretroviral therapy drugs, might be more useful in estimating CVD risks in HIV-infected persons than conventional risk prediction models.

Risk of discontinuation of nevirapine due to toxicities in antiretroviral-naive and -experienced HIV-infected patients with high and low CD4+ T-cell counts.

INTRODUCTION: It is unknown whether the increased risk of toxicities in antiretroviral-naive HIV-infected patients initiating nevirapine-based (NVPc) combination antiretroviral therapy (cART) with high CD4+ T-cell counts is also observed when NVPc is initiated in cARTexperienced patients. PATIENTS AND METHODS: 1,571 EuroSIDA patients started NVPc after 1/1/1999, with CD4+ T-cell counts and viral load measured in the 6 months before starting treatment, and were stratified into four groups based on CD4+ T-cell counts at initiation of NVPc (high [H], > 400/mm3 or > 250/mm3 for male or female, respectively, or low [L], < or = 400/mm3 or 5250/mm3 for male or female) and prior antiretroviral experience (antiretroviral-naive [N] or -experienced [E]). Cox proportional hazards models compared the risks of discontinuation of nevirapine due to toxicities or patient/physician choice (TOXPC). RESULTS: After adjustment, there was a significantly lower risk of discontinuation of nevirapine due to TOXPC in the HE group (n = 588; proportion discontinued by 3/12 months: 10/17%, respectively) than in HN (n = 62; 21/32% respectively; overall relative hazard [RH]: 0.56; 95% confidence interval [CI]: 0.34-0.94; P = 0.027). This difference was most pronounced during the first 3 months of NVPc (RH: 0.44; 95% CI: 0.23-0.87; P = 0.017). There were no deaths in the 6 months after starting NVPc resulting from exposure to < 3 months of NVPc exposure within the HE group (incidence: 0; per 1,000 person-years follow up; 95% CI: 0-6.9). After adjustment, there were no differences between the HE and HN groups in discontinuation due to TOXPC in patients starting efavirenz-based cART (RH: 0.91; 95% CI: 0.60-1.38; P = 0.66) or protease-inhibitor-based cART (RH: 1.13; 95% CI: 0.77-1.66; P = 0.52). CONCLUSIONS: Results from this non-randomized study suggest that NVPc might be safer to initiate in antiretroviral-experienced than in antiretroviral-naive patients with high CD4+ T-cell counts.