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The Southern dietary pattern, derived within the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort, is characterised by high consumption of added fats, fried food, organ meats, processed meats and sugar-sweetened beverages and is associated with increased risk of several chronic diseases. The aim of the present study was to identify characteristics of individuals with high adherence to this dietary pattern. We analysed data from REGARDS, a national cohort of 30 239 black and white adults ≥45 years of age living in the USA. Dietary data were collected using the Block 98 FFQ. Multivariable linear regression was used to calculate standardised beta coefficients across all covariates for the entire sample and stratified by race and region. We included 16 781 participants with complete dietary data. Among these, 34·6 % were black, 45·6 % male, 55·2 % resided in stroke belt region and the average age was 65 years. Black race was the factor with the largest magnitude of association with the Southern dietary pattern (Δ = 0·76 sd, P < 0·0001). Large differences in Southern dietary pattern adherence were observed between black participants and white participants in the stroke belt and non-belt (stroke belt Δ = 0·75 sd, non-belt Δ = 0·77 sd). There was a high consumption of the Southern dietary pattern in the US black population, regardless of other factors, underlying our previous findings showing the substantial contribution of this dietary pattern to racial disparities in incident hypertension and stroke.
For expert evidence to be tested, a thorough understanding of the evidence is critical. Experts are privileged in that they are able to give evidence, on more than what they have directly observed, and they have the power to influence a judicial decision. For an expert opinion to be successfully challenged, its weaknesses or flawed logic need to be identified, and a thorough understanding of the medical topic is required. Achieving this is not straightforward, as what is being said appears to be based on impenetrable material.
Self-harm is common in prisoners. There is an association between self-harm in prisoners and subsequent suicide, both within prison and on release. The aim of this study is to develop and evaluate a prediction model to identify male prisoners at high risk of self-harm.
We developed an 11-item screening model, based on risk factors identified from the literature. This screen was administered to 542 prisoners within 7 days of arrival in two male prisons in England. Participants were followed up for 6 months to identify those who subsequently self-harmed in prison. Analysis was conducted using Cox proportional hazard regression. Discrimination and calibration were determined for the model. The model was subsequently optimized using multivariable analysis, weighting variables, and dropping poorly performing items.
Seventeen (3.1%) of the participants self-harmed during follow up (median 53 days). The strongest risk factors were previous self-harm in prison (adjusted hazard ratio [aHR] = 9.3 [95% CI: 3.3–16.6]) and current suicidal ideation (aHR = 7.6 [2.1–27.4]). As a continuous score, a one-point increase in the suicide screen was significantly associated with self-harm (HR = 1.4, 1.1–1.7). At the prespecified cut off score of 5, the screening model was associated with an area under the curve (AUC) of 0.66 (0.53–0.79), with poor calibration. The optimized model saw two items dropped from the original screening tool, weighting of risk factors based on a multivariable model, and an AUC of 0.84 (0.76–0.92).
Further work is necessary to clarify the association between risk factors and self-harm in prison. Despite good face validity, current screening tools for self-harm need validation in new prison samples.
Use of antipsychotics to treat behavioural symptoms of dementia has been associated with increased risks of mortality and stroke. Little is known about individual patient characteristics that might be associated with bad or good outcomes.
We examined the risperidone clinical trial data to look for individual patient characteristics associated with these adverse outcomes.
Data from all double-blind randomised controlled trials of risperidone in dementia patients (risperidone n = 1009, placebo n = 712) were included. Associations between characteristics and outcome were analysed based on crude incidences and exposure-adjusted incidence rates, and by time-to-event analyses using Cox proportional hazards regression. Interactions between treatment (risperidone or placebo) and characteristic were analysed with a Cox proportional hazards regression model with main effects for treatment and characteristic in addition to the interaction term.
Baseline complications of depression (treatment by risk factor interaction on cerebrovascular adverse event (CVAE) hazard ratio (HR): P = 0.025) and delusions (P = 0.043) were associated with a lower relative risk of CVAE in risperidone-treated patients (HR = 1.47 and 0.54, respectively) compared to not having the complication (HR = 5.88 and 4.16). For mortality, the only significant baseline predictor in patients treated with risperidone was depression, which was associated with a lower relative risk (P<0.001). The relative risk of mortality was increased in risperidone patients treated with anti-inflammatory medications (P = 0.021).
Only anti-inflammatory medications increased mortality risk with risperidone. The reduced risks of CVAE in patients with comorbid depression and delusions, and of mortality with depression, may have clinical implications when weighing the benefits and risks of treatment with risperidone in patients with dementia.
The objective of the present study was to examine the relationship of dietary fried fish consumption and risk of cardiovascular events and all-cause mortality.
Prospective cohort study among participants of the REasons for Geographic And Racial Differences in Stroke (REGARDS) study who resided in the USA.
The primary outcome measures included the hazard ratios (HR) of incident CVD including first incident fatal or non-fatal ischaemic stroke or myocardial infarction and all-cause mortality, based on cumulative average fish consumption ascertained at baseline.
Participants (n 16 479) were enrolled between 2003 and 2007, completed the self-administered Block98 FFQ and were free of CVD at baseline.
There were 700 cardiovascular events over a mean follow-up of 5·1 years. After adjustment for sociodemographic variables, health behaviours and other CVD risk factors, participants eating ≥2 servings fried fish/week (v. <1 serving/month) were at a significantly increased risk of cardiovascular events (HR=1·63; 95 % CI 1·11, 2·40). Intake of non-fried fish was not associated with risk of incident CVD. There was no association found with dietary fried or non-fried fish intake and cardiovascular or all-cause mortality.
Fried fish intake of two or more servings per week is associated with an increased risk of cardiovascular events. Given the increased intake of fried fish in the stroke belt and among African Americans, these data suggest that dietary fried fish intake may contribute to geographic and racial disparities in CVD.
• Polarization in Congress is the highest since Reconstruction.
• Polarization is not an artifact of roll call voting. It also occurs in campaign contributions.
• Polarization in Congress is largely due to the Republican Party becoming more conservative.
• Polarization and income inequality appear to be mutually causal.
This essay updates our findings on political polarization in Congress and elite political actors who work through Congress to affect public policy. We also link various threads of our research with the other essays in this volume. We begin with a discussion of the methodologies that enabled us to identify the emergence of political polarization in Congress, and then turn to substantive results.
A BRIEF HISTORY OF D-NOMINATE AND DW-NOMINATE
In 1984, we (Poole and Rosenthal) published a paper in the Journal of Politics titled “The Polarization of American Politics.” We found that beginning in the mid-1970s, American politics became much more divisive at the congressional level. More Democratic legislators staked out consistently liberal positions, and more Republicans supported wholly conservative ones. The primary evidence in that study, which focused exclusively on the Senate, were ratings issued by interest groups such as the Americans for Democratic Action and the United States Chamber of Commerce.
These early findings motivated us to develop better measures of legislative ideology. Because interest group ratings are in fact aggregations of legislator roll call voting decisions, we believed that much better information would be available by scaling the individual roll call votes directly. Consequently, we adapted the standard dichotomous logit (or probit) model to develop the NOMINATE (Nominal Three-step Estimation) procedure.
NOMINATE is based on a simple spatial model of voting behavior. Each legislator is represented by a single point, and each roll call is represented by two points – one for the “yea” position and one for “nay.” These points form a spatial map that summarizes the roll calls. This spatial map is much like a road map. Tables in road atlases that tabulate the distances between every pair of sizable cities in the United States contain much the same information as the corresponding map of the United States, but a table gives you no idea what the U.S. looks like. Indeed, atlases contain maps as well as a table. Much like a road map, a spatial map formed from roll calls gives us a way of visualizing the political world of a legislature.