Risk of subsequent ischemic and hemorrhagic stroke in patients hospitalized for immune-mediated diseases: a nationwide follow-up study from Sweden

Background: Certain immune-mediated diseases (IMDs) have been associated with increased risk for cardiovascular disorders. The aim of the present study was to examine whether there is an association between 32 different IMDs and first hospitalization for ischemic or hemorrhagic stroke. Methods: All individuals in Sweden hospitalized with a main diagnosis of IMD (without previous or coexisting stroke), between January 1, 1987 and December 31, 2008 (n = 216,291), were followed for first hospitalization for ischemic or hemorrhagic stroke. The reference population was the total population of Sweden. Adjusted standardized incidence ratios (SIRs) for ischemic and hemorrhagic stroke were calculated. Results: Totally 20 and 15 of the 32 IMDs studied, respectively, were associated with an increased risk of ischemic and hemorrhagic stroke during the follow-up. The overall risks of ischemic and hemorrhagic stroke during the first year after hospitalization for IMD were 2.02 (95 % CI 1.90-2.14) and 2.65 (95 % CI 2.27-3.08), respectively. The overall risk of ischemic or hemorrhagic stroke decreased over time, to 1.50 (95 % CI 1.46-1.55) and 1.83 (95 % CI 1.69-1.98), respectively, after 1-5 years, and 1.29 (95 % CI 1.23-1.35) and 1.47 (95 % CI 1.31-1.65), respectively, after 10+ years. The risk of hemorrhagic stroke was >= 2 during the first year after hospitalization for seven IMDs: ankylosing spondylitis (SIR = 8.11), immune thrombocytopenic purpura (SIR = 8.60), polymyalgia rheumatica (SIR = 2.06), psoriasis (SIR = 2.88), rheumatoid arthritis (SIR = 3.27), systemic lupus erythematosus (SIR = 8.65), and Wegener ' s granulomatosis (SIR = 5.83). The risk of ischemic stroke was >= 2 during the first year after hospitalization for twelve IMDs: Addison's disease (SIR = 2.71), Crohn's disease (SIR = 2.15), Grave's disease (SIR = 2.15), Hashimoto's thyroiditis (SIR = 2.99), immune thrombocytopenic purpura (SIR = 2.35), multiple sclerosis (SIR = 3.05), polymyositis/dermatomyositis (SIR = 3.46), rheumatic fever (SIR = 3.91), rheumatoid arthritis (SIR = 2.08), Sjgren's syndrome (SIR = 2.57), systemic lupus erythematosus (SIR = 2.21), and ulcerative colitis (SIR = 2.15). Conclusions: Hospitalization for many IMDs is associated with increased risk of ischemic or hemorrhagic stroke. The findings suggest that several IMDs are linked to cerebrovascular disease

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Abstract. The objective of this study was to examine the reliability and validity of the Malay version of the 18-item Audit of Diabetes Dependent Quality of Life (the Malay ADDQOL). Patients with type 2 diabetes mellitus who fulfilled the inclusion criteria were systematically selected. The Malay ADDQOL linguistically validated from the 18-item English version ADDQOL was selfadministered twice at a 1-week interval. Two hundred eighty-eight respondents were included in the study. Analysis involved checking the feasibility, floor and ceiling effects, internal consistency, test-retest reliability and factor analysis. Item means and standard deviations fulfilled the Likert scale assumptions. The Cronbach's alpha was 0.943 (lower bound of the 95% CI of 0.935) and the intraclass correlation coefficient was 0.81 (95% CI from 0.72 to 0.87). Exploratory one factor analysis showed factor loadings above 0.5 for all the 18 items. The Malay ADDQOL has acceptable linguistic validity. It is feasible, has excellent reliability, content, construct validity, and is recommended to be used among Malay-speaking diabetic patients

Screening for Chronic Obstructive Pulmonary Disease: Validity and Reliability of a Portable Device in Non-Specialized Healthcare Settings.

INTRODUCTION AND OBJECTIVES:The underdiagnosis of chronic obstructive pulmonary disease (COPD) could be improved through screening using portable devices simpler than conventional spirometers in specific healthcare settings to reach a higher percentage of the at-risk population. This study was designed to assess the validity and reliability of the COPD-6 portable device to screen for COPD in non-specialized healthcare settings. METHODS:Prospective cohort study to validate a diagnostic test. Three cohorts were recruited: primary care (PC), emergency services (ES) and community pharmacies (CPh). STUDY POPULATION:individuals with risk factors for COPD (>40 years, smoking >10 pack-years, with respiratory symptoms). The values measured using the COPD-6 were FEV1, FEV6 and the FEV1/FEV6 ratio. Subsequently, participants underwent conventional spirometry at hospital, using a post-bronchodilator FEV1/FVC value <0.7 as the gold standard criterion for the COPD diagnosis. RESULTS:437 participants were included, 362 were valid for the analysis. COPD was diagnosed in 114 patients (31.5%). The area under the ROC curve for the COPD-6 for COPD screening was 0.8.The best cut-off point for the FEV1/FEV6 ratio was 0.8 (sensitivity, 92.1%) using spirometry with the bronchodilator test as the gold standard. There were practically no differences in the COPD-6 performance in the different settings and also regarding age, gender and smoking status. CONCLUSIONS:The COPD-6 device is a valid tool for COPD screening in non-specialized healthcare settings. In this context, the best cut-off point for the FEV1/FEV6 ratio is 0.8

Validity Generalization for Cognitive, Psychomotor, and Perceptual Tests for Craft Jobs in the Utility Industry

This study looked at the generalizability of several test types for a sample of craft jobs in the utility industry. Results indicated that, in line with previous research, cognitive tests seemed to generalize well across all the job types studied. On the other hand, perceptual and psychomotor tests also seemed to generalize for assembly and less skilled jobs. Combining these test types into batteries for future studies is indicated

Certain briefe treatises, written by diverse learned men, concerning the ancient and moderne government of the Church : wherein both the primitive institution of episcopacie is maintained, and the lawfulnesse of the ordination of the Protestant ministers beyond the seas likewise defended : the particulars whereof are set downe in the leafe following.

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