Jessica Utts

Risk factors and comorbidities in primary biliary cirrhosis: A controlled interview‐based study of 1032 patients

Primary biliary cirrhosis (PBC) is an autoimmune disease of unknown etiology, often associated with other autoimmune conditions. Controlled studies have so far provided conflicting data on risk factors and comorbidity rates in PBC. We enrolled patients with PBC (n = 1032) from 23 tertiary referral centers for liver diseases in the United States and random‐digit‐dialed controls (n = 1041) matched for sex, age, race, and geographical location. Patients and controls were administered a modified version of the US National Health and Nutrition Examination Study (NHANES III) questionnaire by trained personnel to evaluate associations between PBC and social, demographic, personal and family medical histories, lifestyle, and reproductive factors and the rates of comorbidity in affected individuals. Data indicate that having a first‐degree relative with PBC (adjusted odds ratio [AOR] 10.736; 95% confidence interval 4.227‐27.268), history of urinary tract infections (AOR 1.511, 95% CI 1.192‐1.915), past smoking (AOR 1.569, 95% CI 1.292‐1.905), or use of hormone replacement therapies (AOR 1.548, 95% CI 1.273‐1.882) were significantly associated with increased risk of PBC. The frequent use of nail polish slightly increased the risk of having PBC. Other autoimmune diseases were found in 32% of cases and 13% of controls (P<0.0001). In conclusion, environmental factors, possibly including infectious agents through urinary tract infections or chemicals contained in cigarette smoke, may induce PBC in genetically susceptible individuals. Exogenous estrogens may also contribute to explain the female predominance of the disease. (HEPATOLOGY 2005;42:1194–1202.)

What Educated Citizens Should Know About Statistics and Probability

Much has changed since the widespread introduction of statistics courses into the university curriculum, but the way introductory statistics courses are taught has not kept up with these changes. This article discusses the changes, and the way the introductory syllabus should change to reflect them. In particular, seven ideas are discussed that every student who takes elementary statistics should learn and understand in order to be an educated citizen. Misunderstanding these topics leads to cynicism among the public at best, and misuse of study results by policy-makers, physicians, and others at worst.

A Study Comparing Traditional and Hybrid Internet-Based Instruction in Introductory Statistics Classes

Advances in technology coupled with increasing student enrollment numbers have led some universities to begin offering on-line classes. This paper discusses a study comparing a traditional offering of elementary statistics with a “hybrid” offering. In the hybrid offering the class met once a week, but students were required to learn the material on their own using web-based materials and a textbook. We examined differences in student performance, student satisfaction and investment of both student and instructor time. Performance of students in the hybrid offering equaled that of the traditional students, but students in the hybrid were slightly less positive in their subjective evaluation of the course.

Abruptio placentae and perinatal death: A prospective study

Abruptio placentae caused 3.96 perinatal deaths per 1,000 births in a large prospective study. Intrapartum but not prepartum maternal hypertension was observed in the fatal cases. Decidual necrosis at the placental margin and large placental infarcts were the most characteristic placental abnormalities. The decidual necrosis was correlated with maternal cigarette smoking and low pregnancy weight gains in the abruption placentae cases. The fetuses and neonates who died had a pattern of growth retardation characteristic of antenatal undernutrition, indicating that poor maternal nutrition during pregnancy may have contributed to the genesis of the abruptio placentae.

Predictive physiological anticipation preceding seemingly unpredictable stimuli: a meta-analysis.

This meta-analysis of 26 reports published between 1978 and 2010 tests an unusual hypothesis: for stimuli of two or more types that are presented in an order designed to be unpredictable and that produce different post-stimulus physiological activity, the direction of pre-stimulus physiological activity reflects the direction of post-stimulus physiological activity, resulting in an unexplained anticipatory effect. The reports we examined used one of two paradigms: (1) randomly ordered presentations of arousing vs. neutral stimuli, or (2) guessing tasks with feedback (correct vs. incorrect). Dependent variables included: electrodermal activity, heart rate, blood volume, pupil dilation, electroencephalographic activity, and blood oxygenation level dependent (BOLD) activity. To avoid including data hand-picked from multiple different analyses, no post hoc experiments were considered. The results reveal a significant overall effect with a small effect size [fixed effect: overall ES = 0.21, 95% CI = 0.15–0.27, z = 6.9, p < 2.7 × 10−12; random effects: overall (weighted) ES = 0.21, 95% CI = 0.13–0.29, z = 5.3, p < 5.7 × 10−8]. Higher quality experiments produced a quantitatively larger effect size and a greater level of significance than lower quality studies. The number of contrary unpublished reports that would be necessary to reduce the level of significance to chance (p > 0.05) was conservatively calculated to be 87 reports. We explore alternative explanations and examine the potential linkage between this unexplained anticipatory activity and other results demonstrating meaningful pre-stimulus activity preceding behaviorally relevant events. We conclude that to further examine this currently unexplained anticipatory activity, multiple replications arising from different laboratories using the same methods are necessary. The cause of this anticipatory activity, which undoubtedly lies within the realm of natural physical processes (as opposed to supernatural or paranormal ones), remains to be determined.

Use of complementary and alternative medicine during the menopause transition: longitudinal results from the Study of Women's Health Across the Nation.

Objective: This study examined whether use of complementary and alternative (CAM) therapies during the menopause transition varied by ethnicity. Design: The Study of Womens Health Across the Nation is a prospective cohort study following a group of 3,302 women from five racial/ethnic groups at seven clinical sites nationwide. Using longitudinal data encompassing 6 years of follow-up, we examined trends in use of five categories of CAM (nutritional, physical, psychological, herbal, and folk) by menopause status and ethnicity. To account for potential secular trends in CAM use or availability, we also evaluated the trends in CAM use over calendar time. Results: Approximately 80% of all participants had used some form of CAM at some time during the 6-year study period. White and Japanese women had the highest rates of use (60%), followed by Chinese (46%), African American (40%), and Hispanic (20%) women. Overall use of CAM therapy remained relatively stable over the study period. In general, CAM use did not seem to be strongly associated with change in menopause transition status. Use of CAM among white women did not change with transition status. Among Chinese and African American participants, we observed an increase in CAM use as women transitioned to perimenopause and a decrease in use of CAM with transition to postmenopause. Among Hispanic and Japanese women, we observed a decrease in use of CAM in early perimenopause, followed by an increase as women entered late perimenopause and a decrease as they progressed to postmenopause. Patterns of use for the five individual types of CAM varied. White women had relatively stable use of all CAM therapies through the transition. Japanese women decreased use of nutritional and psychological remedies and increased use of physical remedies as they transitioned into late perimenopause. Among African American women, use of psychological remedies increased as they progressed through menopause. Conclusions: Although CAM use did vary in some ethnic groups in relation to advancing menopause status, there was no evidence of influence of calendar time on CAM use. Patterns of CAM use during menopause are likely to be driven by personal experience, menopausal health, and access to therapies. Womens personal preferences should be taken into consideration by healthcare providers for medical decision making during menopause and throughout the aging process.

Cross-sectional analysis of specific complementary and alternative medicine (CAM) use by racial/ethnic group and menopausal status: the Study of Women's Health Across the Nation (SWAN).

Objective:To examine the relationships of race/ethnicity, menopausal status, health characteristics, and symptoms with use of 21 types of complementary and alternative medicine (CAM) in midlife women. Design:Cross-sectional, multiple logistic regression analyses of 2,118 women completing the sixth annual visit in the Study of Womens Health Across the Nation, a multisite, multiethnic, longitudinal study. Results:More than half of women used some type of CAM. Use of most types of CAM differed significantly by race/ethnicity, except the use of ginkgo biloba and glucosamine. Significantly more African Americans at most sites and Chinese women used ginseng. Use of most types of CAM did not differ significantly by menopausal status or vasomotor symptoms, except the use of soy supplements, which was significantly greater among women who reported vasomotor symptoms. Women reporting somatic symptoms were significantly more likely to use glucosamine. Women reporting psychological symptoms were significantly more likely to use ginkgo biloba and soy supplements. The number of comorbidities, moderate or high socioeconomic status, number of healthy behaviors, symptom sensitivity, age, and dietary genistein intake were significantly positively associated with use of several types of CAM. Conclusions:The use of most types of CAM is not related to menopausal status or symptom reporting but to sociodemographic factors, comorbidities, and health behaviors. Given the large proportion of midlife women who use CAM and the potential for interactions with prescribed medications, healthcare practitioners should inquire about CAM use and be aware of which factors influence the use of different types of CAM.

The Association between Gravidity and Primary Biliary Cirrhosis

PURPOSE Primary biliary cirrhosis is an autoimmune disease with female predominance that leads to liver failure. The goal of this study was to identify reproductive risk factors associated with this disease. METHODS We compared 182 cases of PBC with 225 age- and sex-matched friend controls to examine the role of reproductive factors. The survey instrument was developed using standardized questions obtained from the National Health and Nutrition Examination Survey (NHANES) III. RESULTS A total of 126/182 cases (69%) and 141/225 (62.6%) friend controls responded to the survey. More cases than controls reported ever having genitourinary infection [adjusted odds ratio (OR) = 2.12, 95% confidence interval (CI) 1.01, 4.42] among those without a personal or family history of autoimmune disease. The most notable finding was that cases reported significantly more pregnancies than controls (p = 0.008). The adjusted OR for each additional pregnancy among those without a personal or family history of autoimmune disease was 1.40 (95% CI 1.14, 1.7). More controls (24.4%) than cases (16.0%) were nulliparous. Cases reported having five or more children (16.0%) with double the frequency of controls (8.2%). CONCLUSIONS The association reported herein, between primary biliary cirrhosis and gravidity, is particularly significant because of the overwhelming female predominance.

Petroleum ingestion reduces reproduction in Cassin's Auklets☆

Sublethal doses of petroleum reduced reproduction in a free-living seabird, Cassins Auklet (Ptychoramphus aleuticus), nesting on Southeast Farallon Island, California. The proportion of birds laying eggs was reduced 9–13 days after ingestion by gelatin capsule of 300, 600 or 1000 mg bunker C fuel oil, or 1000 mg Prudhoe Bay crude oil. In addition, among those auklets that eventually laid eggs, hatching was reduced by doses of 1000 mg of bunker C but was unaffected by other treatments. Chick development after hatching was unaffected by any treatment. The total time of egg formation from onset of rapid yolk formation to laying was 13 days, and it is early in this period that auklets are vulnerable to petroleum.

Bayesian Resolution of the “Exchange Paradox”

Abstract In this article we present a paradox that can be used to illustrate Bayesian principles in the classroom. The paradox is also resolved using a frequentist argument and illustrates how the misapplication of a symmetry argument causes problems.