Association of hormone therapy and incident gout: population-based case-control study

OBJECTIVE This study aims to assess the odds of developing incident gout in association with the use of postmenopausal estrogen-progestogen therapy, according to type, timing, duration, and route of administration of estrogen-progestogen therapy. METHODS We conducted a retrospective population-based case-control analysis using the United Kingdom-based Clinical Practice Research Datalink. We identified women (aged 45 y or older) who had a first-time diagnosis of gout recorded between 1990 and 2010. We matched one female control with each case on age, general practice, calendar time, and years of active history in the database. We used multivariate conditional logistic regression to calculate odds ratios (ORs) with 95% CIs (adjusted for confounders). RESULTS The adjusted OR for gout with current use of oral formulations of opposed estrogens (estrogen-progestogen) was 0.69 (95% CI, 0.56-0.86) compared with never use. Current use was associated with a decreased OR for gout in women without renal failure (adjusted OR, 0.71; 95% CI, 0.57-0.87) and hypertension (adjusted OR, 0.62; 95% CI, 0.44-0.87) compared with never use. Tibolone was associated with a decreased OR for gout (adjusted OR, 0.77; 95% CI, 0.63-0.95) compared with never use. Estrogens alone did not alter the OR for gout. CONCLUSIONS Current use of oral opposed estrogens, but not unopposed estrogens, is associated with a decreased OR for incident gout in women without renal failure and is more pronounced in women with hypertension. Use of tibolone is associated with a decreased OR for incident gout. The decreased OR for gout may be related to the progestogen component rather than the estrogen component.

Diabetes, use of antidiabetic drugs, and the risk of glioma

BACKGROUND Prior epidemiologic studies suggest inverse relations between diabetes and glioma risk, but the underlying mechanisms, including use of antidiabetic drugs, are unknown. METHODS We therefore performed a matched case-control analysis using the Clinical Practice Research Datalink (CPRD). We identified incident glioma cases diagnosed between 1995 and 2012 and matched each case with 10 controls on age, gender, calendar time, general practice, and years of active history in the CPRD. We performed conditional logistic regression to estimate odds ratios (ORs) with 95% CIs, adjusted for body mass index and smoking. RESULTS We identified 2005 cases and 20 050 controls. Diabetes was associated with decreased risk of glioma (OR = 0.74; 95% CI = 0.60-0.93), particularly glioblastoma (OR = 0.69; 95% CI = 0.51-0.94). Glioblastoma risk reduction was markedly pronounced among diabetic men (OR = 0.60; 95% CI = 0.40-0.90), most apparently for those with diabetes of long-term duration (OR for >5 vs 0 y = 0.46; 95% CI = 0.26-0.82) or poor glycemic control (OR for HbA1c ≥8 vs <6.5% = 0.20; 95% CI = 0.06-0.70). In contrast, the effect of diabetes on glioblastoma risk was absent among women (OR = 0.85; 95% CI = 0.53-1.36). No significant associations with glioma were found for use of metformin (OR for ≥30 vs 0 prescriptions = 0.72; 95% CI = 0.38-1.39), sulfonylureas (OR = 0.71; 95% CI = 0.39-1.30), or insulin (OR = 0.79; 95% CI = 0.37-1.69). CONCLUSIONS Antidiabetic treatment appears to be unrelated to glioma, but long-term diabetes duration and increased HbA1c both show decreased glioma risk. Stronger findings in men than women suggest low androgen levels concurrent with diabetes as a biologic mechanism.

Empirical Analysis of Credit Risk Regime Switching and Temporal Conditional Default Correlation in Credit Default Swap Valuation: The Market liquidity effect

In this paper, we extend the debate concerning Credit Default Swap valuation to include time varying correlation and co-variances. Traditional multi-variate techniques treat the correlations between covariates as constant over time; however, this view is not supported by the data. Secondly, since financial data does not follow a normal distribution because of its heavy tails, modeling the data using a Generalized Linear model (GLM) incorporating copulas emerge as a more robust technique over traditional approaches. This paper also includes an empirical analysis of the regime switching dynamics of credit risk in the presence of liquidity by following the general practice of assuming that credit and market risk follow a Markov process. The study was based on Credit Default Swap data obtained from Bloomberg that spanned the period January 1st 2004 to August 08th 2006. The empirical examination of the regime switching tendencies provided quantitative support to the anecdotal view that liquidity decreases as credit quality deteriorates. The analysis also examined the joint probability distribution of the credit risk determinants across credit quality through the use of a copula function which disaggregates the behavior embedded in the marginal gamma distributions, so as to isolate the level of dependence which is captured in the copula function. The results suggest that the time varying joint correlation matrix performed far superior as compared to the constant correlation matrix; the centerpiece of linear regression models.

Physician coding for mental illness reimbursement and the need for mental health parity

Many patients with anxiety and depression initially seek treatment from their primary care physicians. Changes in insurance coverage and current mental parity laws, make reimbursement for services a problem. This has led to a coding dilemma for physicians seeking payment for their services. This study seeks to determine first the frequency at which primary care physicians use alternative coding, and secondly, if physicians would change their coding practices, provided reimbursement was assured through changes in mental parity laws. A mail survey was sent to 260 randomly selected primary care physicians, who are family practice, internal medicine, and general practice physicians, and members of the Harris County Medical Society. The survey evaluated the physicians' demographics, the number of patients with psychiatric disorders seen by primary care physicians, the frequency with which physicians used alternative coding, and if mental parity laws changed, the rate at which physicians would use a psychiatric illness diagnosis as the primary diagnostic code. The overall response rate was 23%. Only 47 of the 59 physicians, who responded, qualified for the study and of those 45% used a psychiatric disorder to diagnose patients with a primary psychiatric disorder, 47% used a somatic/symptom disorder, and 8% used a medical diagnosis. From the physicians who would not use a psychiatric diagnosis as a primary ICD-9 code, 88% were afraid of not being reimbursed and 12% were worried about stigma or jeopardizing insurability. If payment were assured using a psychiatric diagnostic code, 81% physicians would use a psychiatric diagnosis as the primary diagnostic code. However, 19% would use an alternative diagnostic code in fear of stigmatizing and/or jeopardizing patients' insurability. Although the sample size of the study design was adequate, our survey did not have an ideal response rate, and no significant correlation was observed. However, it is evident that reimbursement for mental illness continues to be a problem for primary care physicians. The reformation of mental parity laws is necessary to ensure that patients receive mental health services and that primary care physicians are reimbursed. Despite the possibility of improved mental parity legislation, some physicians are still hesitant to assign patients with a mental illness diagnosis, due to the associated stigma, which still plays a role in today's society. ^

Edén: relato, imagen y proyecto. El concepto de paraíso terrenal como generador de arquitecturas

Esta tesis, Edén: relato, imagen y proyecto. El concepto de Paraíso terrenal como generador de arquitecturas se realiza con el objetivo de estudiar los vínculos entre la idea de Edén, o Paraíso y la arquitectura. Siempre trabajando desde los tres niveles de representación, relato, imagen y proyecto. En la aproximación al objeto de estudio, se procede a estudiar el relato en sí, y se hallan, en la forma misma del relato, unas implicaciones relacionadas con el mundo mitológico y arquetípico. Estos resultados iniciales son la detección de que cada una de las partes que forman el conjunto edénico, han sido previamente objetos de culto en religiones corte pagano o chamánico, desde la prehistoria. El agua, los árboles, los animales, la tierra y los surcos del huerto, todos ellos han sido objetos de veneración desde tiempos inmemoriales. Trazando la genealogía de estos objetos de culto se acude al análisis arquetípico, que relaciona estos objetos venerados con el inconsciente y con la manifestación espontanea de los mismos en la realidad. Estos estudios arrojan resultados con implicaciones espaciales, arquitectónicas y se concluye que más que un ideal o un lugar en concreto, en el mito o en la realidad, lo que definitivamente parece (y demuestra) ser, es una tipología arquitectónica relacionada en su estructura formal y teórica con la del jardín cerrado. La manifestación en imagen de estos resultados y la investigación misma, llevan a acudir a unas de las imágenes más primitivas del Jardín del Edén, y que de hecho son previas a la “invención” del Hortus Conclusus como tal. Estas son las representaciones mozárabes del Paraíso Terrenal como lugar cierto en la tierra, que aparecen en los mappaemundi incluidos en los Códices de los Beatos. En el estudio de los mismos se comprende la estructura formal y teórica de lo que son las arquitecturas paradisíacas. Su calado en la cultura occidental hace que estos documentos sirvan como exoesqueletos del proyecto paradisíaco. Además, por su variedad arrojan gran número de resultados de índole espacial. Los resultados arrojados por el estudio de las representaciones edénicas de los Beatos llevan la investigación a otro momento e imágenes de la historia de la arquitectura donde, por su radicalidad de planteamientos y tabula rasa con las arquitecturas previas son necesarios nuevos lenguajes de aproximación al tema proyectual por el deseo globalizador que implican estas arquitecturas, esto es en el periodo de la arquitectura moderna. Se utiliza como elemento calibrador El poema del ángulo recto de Le Corbusier. Este documento gráfico no sólo nos da la clave que bullía en este periodo con respecto a una nueva aproximación a la superficie terrestre y al medio. Este instrumento también sirve de catalizador entre lo real y lo ideal y es una síntesis de operaciones arquitectónicas, que mediante la comparación y/o oposición con los resultados previos del estudio arquetípico y de los Beatos, genera grandes grupos de características que se hallan entrelazadas en los proyectos paradisíacos. Gracias a estos documentos se puede concluir con una síntesis de características que comparten los proyectos paradisiacos, que en todo caso son esto, proyectos en plural. No existe la unicidad, ya que se infiere de este estudio que son, en conjunto, una forma de hacer ciertas arquitecturas. Tienen características medibles y reproducibles y unas condiciones tipológicas y de generación de campos que permiten producir muchos tipos de proyectos, todos ellos de tipología paradisíaca. ABSTRACT This thesis, Eden: Tale, Image and Project. The Concept of Terrestrial Paradise as a Generator of Architectures, is carried out with the objective of studying the relations between the idea of Eden or Paradise and architecture. In every case working from the three levels of representation, tale, image and project. On the approximation to the object of study, the investigation is centered on the tale itself, and in the same core of it, are found some implications that relate it with the world of mythology and archetype. These initial results consist of detecting that each one of the parts that form the edenic set; have previously been objects of cult in religions of a pagan or shamanic nature, since pre-historic times. Water, animals, earth and the grooves of the orchard, have all been objects of reverence since the dawn of time. Tracing the genealogy of these objects an archetypal type of analysis is taken on, which relates the revered objects with the subconscious and with the spontaneous manifestation of these in reality. These studies also provide results with spatial and architectonic implications, and it is concluded that more than an ideal or a concrete place, in myth or reality, what it definitely seems (and shows to be) is an architectonic typology, related in its formal and theoretical structure with that of the enclosed garden. The manifestation in image of these results, and the investigation itself, lead to reach for one of the most primitive set of images of the Garden of Eden, and that are in fact previous to the “invention” of the Hortus Conclusus as such. A collection of mozárabe representations of the Terrestrial Paradise as a concrete place on Earth. These are the mappaemundi included in the Codexes of the Beatos. By their study, the formal and theoretical structure of paradisal architectures is understood. Their importance in occidental culture makes these documents bring out their side as exoskeletons of the paradisal Project. Also, for their variety, they cast a great number of results of a spatial nature. The results released by the study of the edenic representations of the Beatos take the investigation to another moment and set of images within the history of architecture, where the radicality of the approaches to architecture, and the tabula rasa in relation to previous architectures make it necessary to invent new languages of approximation to the subject of project. This happens because of the globalizing tones that imply these architectures. The lapse of time referred to would be during the general practice of modern architecture. The object of calibration would be The Poem of the Right Angle, by Le Corbusier. The graphic document not only gives us the key of what flowed during that time when a new approximation to the surface of earth and to the environment was retrieved. This instrument also serves as a catalyst between real and ideal, and it is a synthesis of architectural operations that by comparison and/or opposition with the previous results of the archetypal study, and of the Beatos, generates large groups of characteristics that are intertwined in the paradisal project. Due to these documents we can conclude the investigation with a series of characteristics that share the paradisal projects, which in any case are this, projects, in plural. There is no uniqueness. From these findings, it can be inferred that a Paradisal Project is a way to undertake a project, and certain kinds of architecture. They are measurable and are underlaid by a consistent pattern, they also have typological conditions and of field generation, that make it possible to produce many kinds of projects, all of a paradisal typology.