Publications by authors named "Jaroslav Rosenberger"

80 Publications

The role of diabetes mellitus in the effectiveness of intradialytic exercise intervention on patients' muscle function.

Endocrinol Diabetes Nutr 2021 May 1. Epub 2021 May 1.

Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia; Olomouc University Society and Health Institute, Palacky University Olomouc, Olomouc, Czech Republic; Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands. Electronic address:

Introduction: The purpose of this study is to identify the role of diabetes mellitus in the effectiveness of intradialytic exercise intervention among haemodialysis patients.

Methods: In this multicentre study 90 dialysed patients were allocated to the experimental (EXG, n=57) or control group (CNG, n=33). In EXG, we included 20 diabetic and 37 non-diabetic patients. In CNG, we enrolled 8 diabetic and 25 non-diabetic patients. EXG underwent a 12-week supervised, progressive, intradialytic resistance training programme, while CNG stayed inactive during dialysis. Baseline, post-interventional and post-follow-up assessments of maximal force during hip extension (HE), hip flexion (HF) and knee extension (KE) contractions were completed in both groups of patients.

Results: HE increased in diabetic and non-diabetic EXG patients (diabetic EXG, change: +14.5N; 95% CI=-5.5 to +34.5; non-diabetic EXG, +18.6N; 95% CI=+3.4 to +33.8) and diabetic CNG patients (change: +17.9N; 95% CI=-9.2 to +44.9). Only non-diabetic CNG patients experienced a decrease in HE (change: -22.8N; 95% CI=-36.9 to -8.7, P<.05).

Conclusions: Resistance training improved muscle function among dialysis patients regardless of the presence of diabetes mellitus. We found that non-diabetic patients lose their muscle function extensively during inactivity, while diabetic patients retain their muscle function.
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http://dx.doi.org/10.1016/j.endinu.2021.02.002DOI Listing
May 2021

Plasma neurofilament light chain levels are predictors of disease activity in multiple sclerosis as measured by four-domain NEDA status, including brain volume loss.

Mult Scler 2021 Feb 26:1352458521998039. Epub 2021 Feb 26.

Pro Magnet, Košice, Slovak Republic.

Background: The research is focused on sensitive biomarkers in multiple sclerosis (MS).

Objective: The aim of the study was to assess the relationship between plasma neurofilament light chain (pNfL) and disease activity as defined by the concept NEDA (no evident disease activity), including brain volumetry, in a cohort of MS patients treated with disease-modifying treatment (DMT).

Methods: Levels of pNfL (Single Molecule Array (SIMOA) technology) were examined in 95 RRMS (relapsing-remitting multiple sclerosis) patients and analyzed in relationship to NEDA-3 status and NEDA-BVL (brain volume loss; NEDA-3 extended by brain volumetry) during the last 12 months. The statistical model was developed using logistic regression analysis, including the independent variables: demographic, clinical, and magnetic resonance imaging (MRI) data. Dependent variables were NEDA-3 and NEDA-BVL status.

Results: The mean age of the study participants ( = 95, 62% females) was 37.85 years (standard deviation (SD) = 9.62) and the median disability score was 3.5 (2.5-4.1). Receiver operating characteristics (ROC) analysis showed that pNfL predicts NEDA-3 (the sensitivity and specificity of the model were 92% and 78%, respectively,  < 0.001) and NEDA-BVL status (the sensitivity and specificity were 80% and 65%, respectively,  < 0.001).

Conclusion: The results show that pNfL levels are a useful biomarker of disease activity determined by NEDA-BVL status, including brain MRI-volumetry in patients with RRMS.
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http://dx.doi.org/10.1177/1352458521998039DOI Listing
February 2021

Does Depression and Anxiety Mediate the Relation between Limited Health Literacy and Diet Non-Adherence?

Int J Environ Res Public Health 2020 10 28;17(21). Epub 2020 Oct 28.

Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.

Limited health literacy (HL), depression and anxiety are common in dialyzed patients and affect health outcomes and self-management. We explored whether depression and anxiety mediate the association of HL with diet non-adherence (DN-A) in dialyzed patients. We performed a cross-sectional study in 20 dialysis clinics in Slovakia ( = 452; mean age: 63.6 years; males: 60.7%). Hierarchical cluster analysis was performed to create three HL groups. Logistic regression adjusted for age, gender and education was used to explore whether depression and anxiety mediate the association of HL with DN-A. Patients in the moderate HL group were more likely to be non-adherent to diet (OR (Odds Ratio)/95% CI: 2.19/1.21-3.99) than patients in the high HL group. Patients in the low HL and moderate HL group more likely reported depression or anxiety. Patients reporting depression (OR/95% CI: 1.94/1.26-2.98) or anxiety (OR/95% CI: 1.81/1.22-2.69) were more likely to be non-adherent with diet. Adjustment for depression reduced the association between moderate HL and DN-A by 19.5%. Adjustment for anxiety reduced the association between moderate HL and DN-A by 11.8%. Anxiety and depression partly mediated the association of HL with DN-A. More attention should be paid to treating patients' psychological distress to ensure adequate adherence with recommended diet.
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http://dx.doi.org/10.3390/ijerph17217913DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7663113PMC
October 2020

Cognitive Event-Related Potentials-The P300 Wave Is a Prognostic Factor of Long-Term Disability Progression in Patients With Multiple Sclerosis.

J Clin Neurophysiol 2020 Oct 5. Epub 2020 Oct 5.

Departments of Neurology.

Purpose: Multiple sclerosis (MS) is a chronic disorder with a variable course. The aim of our study was to find out whether cognitive event-related potentials are prognostic for patient disability at the 15-year follow-up.

Methods: In the observed cohort of patients with MS, we examined the event-related potentials at baseline (2003). Functional status (Expanded Disability Status Scale score) was then assessed 15 years later, and the prognostic model was developed using binary logistic regression analysis. The independent variables included demographic (age, sex, and education), clinical (disability in 2003), radiologic (MRI lesion load), and event-related potentials parameters. The prognostic accuracy of the proposed model was evaluated by calculating the area under the receiver-operating characteristics curve.

Results: The study sample consisted of 85 patients with MS. The mean age was 35.5 (SD, 11.2) years, and the median disability score was 3.0 (1-7) in 2003 and 5.0 (1.5-9.5) in 2018. The significant prognostic factors of poor Expanded Disability Status Scale are higher baseline Expanded Disability Status Scale, longer MS duration, and prolonged P300 latency. The sensitivity and specificity of the cutoff at 5.0 for the disability score were 94% and 89%, respectively, with the area under the receiver-operating characteristics curve 0.94 (95% confidence interval, 0.889-0.984; P < 0.001).

Conclusions: The results show that out of event-related potentials, the P300 wave latency is a prognostic of long-term disability progression in patients with MS.
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http://dx.doi.org/10.1097/WNP.0000000000000788DOI Listing
October 2020

MicroRNA molecules as predictive biomarkers of adaptive responses to strength training and physical inactivity in haemodialysis patients.

Sci Rep 2020 09 24;10(1):15597. Epub 2020 Sep 24.

Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, 9700 RB, The Netherlands.

The miRNA-206 and miRNA-23a play an important role in muscle tissue hypertrophy, regeneration and atrophy. Both of these miRNAs have been highlighted as promising adaptation predictors; however, the available evidence on associations is inconclusive. Therefore, our aim was to assess the expression levels of these two miRNAs as predictors of change in muscle function during strength training and physical inactivity among dialysed patients. For this purpose, 46 haemodialysis patients were monitored for 12-weeks of either intradialytic strength training (EXG, n = 20) or physical inactivity during dialysis (CON, n = 26). In both groups of patients, we assessed the baseline expression levels of miRNA-23a and miRNA-206 and the isometric force generated during hip flexion (HF) contraction before and after the 12-week period. Among the EXG group, the expression of miRNA-206 predicted the change in HF (R = 0.63, p = 0.0005) much more strongly than the expression of miRNA-23a (R = 0.21, p = 0.027). Interestingly, baseline miRNA-23a (R = 0.30, p = 0.006) predicted the change in HF much more than miRNA-206 (p = ns) among the CON group. Our study indicates that the baseline expression of miRNA-206 could predict the response to strength training, while miRNA-23a could serve as a potential predictive marker of functional changes during physical inactivity in dialysis patients.
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http://dx.doi.org/10.1038/s41598-020-72542-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7519115PMC
September 2020

Improvement of mortality prediction accuracy in critically ill patients through combination of SOFA and APACHE II score with markers of stress haematopoiesis.

Int J Lab Hematol 2020 Dec 16;42(6):796-800. Epub 2020 Aug 16.

1st Department of Anesthesiology and Intensive Medicine, Medical School, Louis Pasteur University Hospital, Šafárik University, Košice, Slovakia.

Introduction: In critically ill patients nucleated red blood cells (NRBC) and immature granulocytes (IG) appear in the peripheral blood as the consequence of stress haematopoesis. The aim of this retrospective study was to evaluate the diagnostic value of NRBC and IG and to propose a model of improved mortality prediction including these parameters in the assessment of critically ill patients.

Methods: The study included 338 critically ill adult patients hospitalized at Department of Anaesthesiology and Intensive Medicine, Louis Pasteur University Hospital in Kosice. As NRBC positive patients were considered patients with peripheral NRBC > 0.01 × 10 /L and IG positivity as >0.03 × 10 /L. Apache II index was calculated 24 hours after admission and Systemic Organ Failure Assessment (SOFA) on the day with the worst clinical condition.

Results: NRBC positivity was found in 27.6% of patients. The mortality of NRBC positive patients was 48.38%, significantly higher than 23.7% of NRBC negative patients. IG positivity was 79.0% and their mortality was also higher as compared with that of IG negative patients (69.3% vs 33.8%). Three regression models predicting mortality including stress haematopoiesis markers, APACHE II, SOFA scores and age had sufficient level of sensitivity and specificity.

Conclusion: The presence of NRBC in the peripheral blood and the IG increase are available early risk predictors of mortality in critically ill patients. Regression models designed by combination of SOFA, APACHE II, and the new haematological parameters increase the accuracy and effectivity of diagnostic process in predicting prognosis and risk of mortality with high sensitivity and specificity.
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http://dx.doi.org/10.1111/ijlh.13308DOI Listing
December 2020

The effects of an intradialytic resistance training on lower extremity muscle functions.

Disabil Rehabil 2020 May 24:1-7. Epub 2020 May 24.

Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.

The loss of muscle functions is a significant health issue among dialysis patients. Poor muscle strength negatively affects a patient's mobility, independence and quality of life. The aim of the study was to assess the effects of an intradialytic resistance training (IRT) on lower extremity muscle functions among dialysed patients. Ninety patients were allocated into an experimental group ( = 57) or control group (CNG) ( = 33) according to the location of the dialysis service center. Fifty-eight patients completed the study follow-up. The intervention regarded 12-week IRT, while the controls remained physically inactive during hemodialysis. In both groups of patients, we assessed lower extremity muscle functions by a diagnostics of maximal isometric force generated during hip flexion (HF), hip extension (HE), and knee extension (KE) contractions at baseline, after the 12-weeks intervention and after a further 12-weeks follow up. We found that improvements in HE between baseline and post-intervention were significantly larger for the experimental than the CNG (difference 32.0, 95% CI = 12.3-51.8,  = 0.002). For the other primary outcomes, we found no differences between the groups, and neither for the two other indices of muscle strength (HF and KE). At 12-weeks follow-up, we found no statistically significant differences between the two groups. Our findings indicate that exercise during dialysis not just suppresses adverse effects in muscle strength and functioning, but effectively and safely increases lower extremities muscle function in a relatively short time.Implications for RehabilitationRegular, progressive, resistance training realized during dialysis is well tolerated and safe for exercise interventions in hemodialysis patients.A 12-weeks intradialytic resistance training is effective in the prevention and clinical management of muscle function loss among hemodialysis patients.The range of improvements in muscle functions, demonstrated by the assessment of maximal isometric force, varied severely during different lower extremity movements of hemodialysis patients.
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http://dx.doi.org/10.1080/09638288.2020.1766581DOI Listing
May 2020

Juvenile Idiopathic Arthritis: Roma Children Seem to Run More Risk than Non-Roma.

Int J Environ Res Public Health 2020 03 31;17(7). Epub 2020 Mar 31.

Department of Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Ant. Deusinglaan 1, 9713 AV Groningen, The Netherlands.

Ethnic information regarding juvenile idiopathic arthritis (JIA) exists for various populations across the world but is fully lacking for Roma. We assessed the occurrence and clinical characteristics of JIA in Roma vs. non-Roma children. : We obtained data on all outpatients ( = 142) from a paediatric rheumatology centre (age 3 to 18 years) in the eastern part of Slovakia (Kosice region). We assessed patients' age, gender, disease type and related extra-articular conditions by ethnicity. We obtained population data from the 2011 census. : The share of Roma children was higher in the clinical JIA sample than in the overall population (24.6%, = 35, Roma in the sample vs. 10.8%, = 142, Roma in the population, < 0.05). Moreover, Roma children had been diagnosed more frequently with extra-articular conditions but did not differ in other symptoms. Treatments also did not differ by ethnicity. : Roma children had been diagnosed more with JIA than their non-Roma peers. This calls for further research on the causes of this increased disease burden in Roma children.
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http://dx.doi.org/10.3390/ijerph17072377DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7177970PMC
March 2020

Does Health Literacy of Hemodialyzed Patients Predict the Type of Their Vascular Access? A Cross-Sectional Study on Slovak Hemodialyzed Population.

Int J Environ Res Public Health 2020 01 20;17(2). Epub 2020 Jan 20.

FMC-dialysis services Slovakia, Trieda SNP 1, 040 11 Kosice, Slovakia.

Effective vascular access (VA) is an essential condition for providing hemodialysis, affecting patients' health outcomes. We aim to explore how health literacy (HL) as a non-clinical factor is associated with the decision-making process regarding VA type selection. Using data from 20 dialysis centers across Slovakia ( = 542, mean age = 63.6, males = 60.7%), the association of HL with type of VA (arteriovenous fistula (AVF) vs. central venous catheter (CVC)) was analyzed using a logistic regression model adjusted for sociodemographic characteristics and comorbidity. Sociodemographic data and data on nine domains of HL were collected by questionnaire. Data on VA and comorbidity were obtained from a medical records. Patients with a greater ability to engage with healthcare providers (odds ratio (OR): 1.34; 95% confidence interval (CI): 1.00-1.78), those with a better ability to navigate the healthcare system (OR: 1.41; 95% CI: 1.08-1.85), those more able to find good health information (OR: 1.52; 95% CI: 1.15-2.03), and those who understand it well enough to know what to do (OR: 1.52; 95% CI: 1.12-2.06) are more likely to have AVF. Patients' HL is associated with the type of VA; therefore, it should be considered in the decision-making process regarding the selection of the type of VA, thereby informing strategies for improving patients' HL and doctor-patient communication.
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http://dx.doi.org/10.3390/ijerph17020675DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7013526PMC
January 2020

Is Health Literacy of Dialyzed Patients Related to Their Adherence to Dietary and Fluid Intake Recommendations?

Int J Environ Res Public Health 2019 11 5;16(21). Epub 2019 Nov 5.

Department of Community & Occupational Health, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.

Non-adherence to dietary and fluid intake recommendations (NADFIR) is an important factor for the effective treatment of dialyzed patients and may be hindered by low health literacy (HL). Therefore, we assessed whether low HL of dialyzed patients is associated with their NADFIR. We performed a multicentric cross-sectional study in 20 dialysis clinics in Slovakia ( = 452; response rate: 70.1%; mean age = 63.6 years; males: 60.7%). We assessed the association between nine domains of HL and non-adherence (high serum potassium, high serum phosphate, relative overhydration, and self-reported NADFIR) using general linear models adjusted for age and gender. Moreover, we assessed the moderation by socioeconomic status (SES). We found higher NADFIR among patients with less sufficient information for health management (high serum phosphate level; odds ratio (OR): 0.77; 95% confidence interval (CI): 0.63-0.94), with a lower ability to actively manage their health (self-reported diet non-adherence; OR: 0.74; 95% CI: 0.62-0.89), and those less able to actively engage with healthcare providers (overhydrated; OR: 0.78; 95% CI: 0.65-0.94). Moreover, SES modified this relation. Low HL affects the adherence of dialyzed patients. This shows a need to support patients with low HL and to train healthcare providers to work with these patients, taking into account their SES.
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http://dx.doi.org/10.3390/ijerph16214295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6862452PMC
November 2019

The effects of intradialytic resistance training on muscle strength, psychological well-being, clinical outcomes and circulatory micro-ribonucleic acid profiles in haemodialysis patients: Protocol for a quasi-experimental study.

Medicine (Baltimore) 2019 May;98(19):e15570

Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein, Groningen, Netherlands.

Background: Intradialytic resistance training (IRT) protects patients' muscle mass and functions against protein-energy wasting, malnutrition and cachexia. However, the evidence of the effects of such an intervention in haemodialysis patients is limited and not conclusive. To improve the applicability of such interventions, we need a better understanding of molecular, functional and psycho-social adaptation in dialysed patients following a physical training. Therefore, the aim of this study is to investigate the effects of IRT on lower extremity muscle functions, quality of life, and anxiety and depression, clinical outcomes and circulatory micro-ribonucleic acid (miRNA) profiles in patients on chronic haemodialysis therapy.

Methods: We will perform a quasi-experimental study in 3 dialysis centres. Patients will be recruited via their nephrologists and will be allocated to an experimental and a control group based on the location of the patients' dialysis centre. Patients allocated to the experimental group will undergo a 12-week IRT, while the control group will remain physically inactive during dialysis. The primary outcome is the change in the maximal force produced during an isometric contraction of lower extremity muscles. Secondary outcomes regard quality of life, anxiety and depression, clinical outcomes and circulatory miRNA profiles. Patients' level of health literacy defined as the ability to get and understand health information will be also measured in the study as a potential modifier of effects.

Discussion: This quasi-experimental study can add in an important way to our understanding of the effects of resistance training on dialysis patients' muscle strength, quality of life and disease-specific outcomes.
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http://dx.doi.org/10.1097/MD.0000000000015570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6531031PMC
May 2019

EU questionnaire to screen for obstructive sleep apnoea validated in Slovakia.

Cent Eur J Public Health 2018 Dec;26 Suppl:S32-S36

Department of Public Health and Hygiene, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovak Republic.

Objective: Obstructive sleep apnoea syndrome (OSAS) associated with daytime sleepiness (DS) contributes to a higher incidence of motor vehicle accidents. Validation of fitness to drive in driving license applicants, with special concern regarding OSAS accompanied by excessive DS, became mandatory under new EU legislation in January 2016. The aim of the study was to translate and validate the recommended questionnaire to screen for OSAS (Q-OSAS) in the Slovak population. No data on any Q-OSAS validation has previously been published.

Methods: The translated Q-OSAS was administered to 311 Slovak patients prior to a planned overnight polysomnography. The diagnostic accuracy of the Q-OSAS in OSAS with an apnoea-hypopnoea index of 15 or more/h of sleep was evaluated by calculating the area under the ROC curve.

Results: The sensitivity and specificity of the cut-off at 10 points for the Q-OSAS was 57% and 67%, respectively, with an increase of sensitivity and a decrease of specificity with a lowering of the cut-off values. Excluding the Epworth Sleepiness Scale (ESS) score from the final statistics yielded the best sensitivity (77%), specificity (50%), and an area under the ROC curve (0.637) for the cut-off value of 8 points (an equivalent of 10 points with the full version of the Q-OSAS).

Conclusion: The Q-OSAS is an appropriate screening tool to facilitate the screening of subjects potentially at risk from moderate and severe OSAS. A modified two-step interpretation of the Q-OSAS in Slovakia yielded the best sensitivity, and in the future could promote evaluation of sleepiness in sleep and wake disorders other than OSAS for fitness to drive.
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http://dx.doi.org/10.21101/cejph.a5278DOI Listing
December 2018

Health Differences between Roma and Non-Roma in the Slovak Dialyzed Population.

Int J Environ Res Public Health 2018 02 18;15(2). Epub 2018 Feb 18.

Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Safarik University, 040 11 Kosice, Slovak Republic.

Background: Roma health has not been studied systematically. Thus far, it has been shown that Roma compared to non-Roma have a significantly higher likelihood of getting end-stage renal disease and that their chances for survival on dialysis are lower. Evidence is lacking regarding morbidity between Roma and non-Roma. The aim was to compare the health status of dialyzed Roma and non-Roma using the Charlson comorbidity index (CCI). All Slovak dialysis centers for adults were asked to fill in a questionaire with demographic and clinical data, including comorbidity. Cross-sectional analysis of 2082 patients with an average age of 63.8 ± 13.8 years was performed. Comorbidity was expressed as the CCI, and ethnic differences were calculated. Linear regression was performed to adjust for differences in gender and age in both ethnic groups. Roma represented 13.0% of the whole dialyzed population (n = 270). Comorbidity expressed as CCI was significantly lower in the Roma population (p < 0.001). After adjusting for gender and age, ethnicity failed to be associated with the CCI in the linear regression analysis (p = 0.965, variance of the model-adjusted R² 38.6%). The health status of dialyzed Slovak Roma does not differ cross-sectionally when adjusted for age and gender from the health status of dialyzed non-Roma.
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http://dx.doi.org/10.3390/ijerph15020360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858429PMC
February 2018

Differences between Slovak and Dutch patients scheduled for coronary artery bypass graft surgery regarding clinical and psychosocial predictors of physical and mental health-related quality of life.

Eur J Cardiovasc Nurs 2018 04 12;17(4):324-335. Epub 2017 Dec 12.

3 University of Groningen, University Medical Center Groningen, Department of Community & Occupational Medicine, The Netherlands.

Background: Differences in health-related quality of life in coronary artery disease patients and associated factors between patients of central and western European descent are rarely investigated. We aim to test differences between Dutch and Slovak health-related quality of life, whether nationality predicted health-related quality of life and if standardised beta weights of health-related quality of life determinants differ across countries.

Design: An observational multicentre study at university cardiac centres in the Netherlands and Slovakia.

Methods: In 226 coronary artery disease patients, health-related quality of life was measured by the Short Form Health Survey 36, anxiety and depression were measured using the Hospital Anxiety and Depression Scale, and type D personality was assessed with the 14-item Type D Scale. Multivariate analysis was used to explore the effect of patient characteristics on the physical and mental component summaries. Estimates of each predictor's beta value of the physical and mental component summaries in the Slovak and Dutch patient sample were separately calculated using the Cummings criterion for comparison of two independent betas.

Results: Stronger predictors of physical health-related quality of life in Slovak patients were educational level, current smoking, poor functional status, history of diabetes and amount of social support. In Dutch patients, only more symptoms of depression was a stronger predictor ( P<0.05). Regarding Slovak mental health-related quality of life, stronger predictors were educational level, current smoking and amount of social support. Female gender, history of myocardial infarction and more symptoms of depression were stronger predictors in Dutch patients ( P<0.05).

Conclusion: Descent and differences between both populations in determinants of health-related quality of life should be considered while planning care, follow-up, health education and rehabilitation.
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http://dx.doi.org/10.1177/1474515117747571DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5888767PMC
April 2018

Posttransplant Anemia as a Prognostic Factor of Mortality in Kidney-Transplant Recipients.

Biomed Res Int 2017 19;2017:6987240. Epub 2017 Mar 19.

Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Safarik University, Kosice, Slovakia; Department of Community & Occupational Health, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.

Findings on the association between posttransplant anemia (PTA) and mortality in posttransplant patients are scarce. This study explored whether PTA shortly after kidney transplantation (KT) predicts mortality at up to 10 years' follow-up, stratified for chronic kidney disease (CKD) stages. PTA was divided into 3 categories according to the hemoglobin (Hb) value: severe (Hb < 10 g/dl), mild (10.0 g/dl ≤ Hb < 11.9 g/dl), or no PTA (Hb ≥ 12 g/dl). CKD stages were estimated using the CKD-EPI formula and divided into 2 groups: CKD1-2 and CKD3-5. Cox regression, stratified according to CKD, was performed to identify whether different categories of PTA predicted mortality in KT recipients. Age, being female, and both mild and severe PTA contributed significantly to the Cox regression model on mortality in CKD1-2. In the Cox regression model for mortality in CKD3-5, age and severe PTA contributed significantly to this model. PTA shortly after KT increased the risk of mortality at up to 10 years' follow-up. Even mild PTA is associated with a 6-fold higher risk of mortality and severe PTA with a 10-fold higher risk of mortality in CKD1-2. Clinical evaluation and treatment of anemia might reduce the higher risk of mortality in patients with PTA in early stages of CKD after KT.
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http://dx.doi.org/10.1155/2017/6987240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5376439PMC
April 2017

Poor sleep quality in patients with multiple sclerosis: gender differences.

Brain Behav 2016 11 20;6(11):e00553. Epub 2016 Sep 20.

Graduate School Kosice Institute for Society and Health Safarik University Kosice Slovakia; Department of Community & Occupational Health University of Groningen University Medical Center Groningen Groningen the Netherlands.

Objectives: Most of the psychological and physical factors associated with poor sleep quality in patients with multiple sclerosis (MS) have a different prevalence in women and men, but whether or not these factors contribute differently to sleep quality in women and men with MS remains unclear. The aim of this study was to identify possible gender differences in factors related to poor sleep quality in MS patients.

Material And Methods: We collected data from 153 patients with MS. Patients filled out the Pittsburgh Sleep Quality Index (PSQI), the Hospital Anxiety and Depression Scale, and one item of the Short Form-36 regarding pain.

Results: The best model of predictors of poor sleep quality consisting of gender, depression, anxiety, pain, and the interaction between gender and pain showed that the only variable interacting with gender, which was significantly associated with poor sleep quality was pain (odds ratio [OR] for interaction of pain with male gender was 15.4, 95% CI: 2.4; 39.5). Separate models for men and women consisting of pain, depression, anxiety, after adjustment for age, disease duration, and disability showed that pain was the only variable associated with poor sleep quality in men (OR = 12.7, 95% CI: 1.9; 29.6), whereas depression (OR = 4.1, 95% CI: 1.3; 13.2) and anxiety (OR = 6.8, 95% CI: 2.4; 19.1) were in women.

Conclusions: Factors contributing to poor sleep quality in MS patients differ by gender. Depression and anxiety are associated with poor sleep quality in women, whereas pain is in men. This highlights the need to apply gender-specific approaches to the treatment of sleep disorders.
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http://dx.doi.org/10.1002/brb3.553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102648PMC
November 2016

Do coping strategies mediate the association between Type D personality and quality of life among people with multiple sclerosis?

J Health Psychol 2018 10 24;23(12):1557-1565. Epub 2016 Jul 24.

1 Pavol Jozef Safarik University in Kosice, Slovakia.

The aim of this study is to explore whether different coping strategies are able to mediate the association between Type D personality and quality of life. We collected information from 156 consecutive patients (response rate: 72.9%; 75.0% women; median age: 40 ± 3 years). Patients completed the Type D Scale-14, the Coping Self-Efficacy Scale and the Short-Form Health Survey for measuring physical and mental quality of life. The mediating effect of coping was analysed using correlations, linear regressions and the Sobel z-test. In the mental quality of life, all three studied coping strategies mediated the association between Type D personality and quality of life.
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http://dx.doi.org/10.1177/1359105316660180DOI Listing
October 2018

Is Poor Sleep Quality Associated With Greater Disability in Patients With Multiple Sclerosis?

Behav Sleep Med 2018 Mar-Apr;16(2):106-116. Epub 2016 May 18.

b Graduate School Kosice Institute for Society and Health, Safarik University , Kosice , Slovakia.

Poor sleep is a serious burden for patients with multiple sclerosis (MS). The aim of this study is to assess whether the association between sleep quality and disability in MS patients is direct or mediated by depression, pain, and fatigue. We collected data from 152 patients with MS who filled out the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale, the Multidimensional Fatigue Inventory and one item of the Short Form-36 regarding pain. The relationship between poor sleep and disability was found to be indirect, mediated by depression (p < 0.05), pain (p < 0.001) and physical fatigue (p < 0.01). Treatment of sleep disturbances may have beneficial effects beyond improving sleep. It may reduce depression, pain, and physical fatigue, which in turn may lessen disability.
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http://dx.doi.org/10.1080/15402002.2016.1173555DOI Listing
December 2017

Sense of coherence as a mediator between hostility and health-related quality of life among coronary heart disease patients.

Heart Lung 2016 Mar-Apr;45(2):126-31. Epub 2016 Jan 8.

Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.

Objectives: To explore the association between hostility and health-related quality of life (HRQoL) among coronary heart disease (CHD) patients, and whether these associations are mediated by sense of coherence (SOC).

Background: Intervention research has shown that a decrease in levels of hostility leads to an increase of HRQoL among individuals with CHD. However, the mechanisms that link hostility and HRQoL in CHD patients are not clear.

Methods: 509 CHD patients (mean age 58.8 ± 7.3, 29.3% female) were examined.

Results: Hostility was associated with poorer mental HRQoL. Adding SOC to the model weakened the strength of the association between hostility and mental HRQoL. The effect of hostility on mental HRQoL was explained for 61.9% by SOC. Neither hostility nor SOC was associated with physical HRQoL.

Conclusions: Our findings indicate that low SOC may partially explain the adverse effect of hostility on low mental HRQoL in CHD patients.
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http://dx.doi.org/10.1016/j.hrtlng.2015.11.004DOI Listing
October 2016

Self-esteem, social participation, and quality of life in patients with multiple sclerosis.

J Health Psychol 2017 07 12;22(8):984-992. Epub 2016 Jan 12.

1 Pavol Jozef Safarik University, Slovakia.

The aim of this study is to explore whether self-esteem and social participation are associated with the physical and mental quality of life (Physical Component Summary, Mental Component Summary) and whether self-esteem can mediate the association between these variables. We collected information from 118 consecutive multiple sclerosis patients. Age, gender, disease duration, disability status, and participation were significant predictors of Physical Component Summary, explaining 55.4 percent of the total variance. Self-esteem fully mediated the association between social participation and Mental Component Summary (estimate/standard error = -4.872; p < 0.001) and along with disability status explained 48.3 percent of the variance in Mental Component Summary. These results can be used in intervention and educational programs.
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http://dx.doi.org/10.1177/1359105315621778DOI Listing
July 2017

Does poorer self-rated health mediate the effect of Roma ethnicity on mortality in patients with coronary artery disease after coronaro-angiography?

Int J Public Health 2016 Apr 12;61(3):375-82. Epub 2015 Dec 12.

Department of Community and Occupational Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.

Objectives: The aim of this prospective cohort study was to assess the effect of Roma ethnicity and self-rated health (SRH) on 9-year all-cause mortality in patients with coronary artery disease (CAD) after coronaro-angiography (CAG), and whether SRH mediates the effect of ethnicity.

Methods: 623 patients (103 Roma) were included. We obtained data from medical records and patients interviews. A Cox regression model adjusted for age, gender and education was used to analyze the effect of Roma ethnicity on mortality, as well as potential mediation by SRH.

Results: Roma ethnicity and poor SRH were predictors of increased mortality in patients with CAD, with hazard rates (95 % confidence intervals) 2.34 (1.24; 4.42) and 1.81 (1.02; 3.21). Adding education decreased the size of ethnic differences in mortality. The mediating effect of SRH on the association of ethnicity with mortality was not statistically significant; neither modified ethnicity the effect of SRH.

Conclusions: Poor SRH does not mediate the higher mortality among Roma patients after CAG even though it indicates an increased risk of mortality. Roma patients with CAD have to be referred for special cardiological care earlier.
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http://dx.doi.org/10.1007/s00038-015-0771-yDOI Listing
April 2016

Longitudinal Changes in Body Composition in Patients After Initiation of Hemodialysis Therapy: Results From an International Cohort.

J Ren Nutr 2016 Mar 28;26(2):72-80. Epub 2015 Nov 28.

Fresenius Medical Care, Bad Homburg, Germany.

Objective: In patients with advanced kidney disease, metabolic and nutritional derangements induced by uremia interact and reinforce each other in a deleterious vicious circle. Literature addressing the effect of dialysis initiation on changes in body composition (BC) is limited and contradictory. The aim of this study was to evaluate changes in BC in a large international cohort of incident hemodialysis patients.

Methods: A total of 8,227 incident adult end-stage renal disease patients with BC evaluation within the initial first 6 months of baseline, defined as 6 months after renal replacement therapy initiation, were considered. BC, including fat tissue index (FTI) and lean tissue index (LTI), were evaluated by Body Composition Monitor (BCM, Fresenius Medical Care, Bad Homburg, Germany). Exclusion criteria at baseline were lack of a BCM measurement before or after baseline, body mass index (BMI) < 18.5 kg/m(2), presence of metastatic solid tumors, treatment with a catheter, and prescription of less or more than 3 treatments per week. Maximum follow-up was 2 years. Descriptive analysis was performed comparing current values with the baseline in each interval (delta analysis). Linear mixed models considering the correlation structure of the repeated measurements were used to evaluate factors associated with different trends in FTI and LTI.

Results: BMI increased about 0.6 kg/m(2) over 24 months from baseline. This was associated with increase in FTI of about 0.95 kg/m(2) and a decrease in LTI of about 0.4 kg/m(2). Female gender, diabetic status, and low baseline FTI were associated with a significant greater increase of FTI. Age > 67 years, diabetes, male gender, high baseline LTI, and low baseline FTI were associated with a significant greater decrease of LTI.

Conclusions: With the transition to hemodialysis, end-stage renal disease patients presented with distinctive changes in BC. These were mainly associated with gender, older age, presence of diabetes, low baseline FTI, and high baseline LTI. BMI increases did not fully represent the changes in BC.
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http://dx.doi.org/10.1053/j.jrn.2015.10.001DOI Listing
March 2016

Social participation in early and established rheumatoid arthritis patients.

Disabil Rehabil 2016 19;38(12):1172-9. Epub 2015 Aug 19.

a Graduate School Kosice Institute for Society and Health, Safarik University Kosice , Kosice , Slovak Republic .

Purpose: The aim of the study was to examine whether rheumatoid arthritis (RA) patients with different levels of restriction in social participation differ in disease related as well as psychosocial variables and whether a similar pattern can be found among early and established RA patients.

Method: Two samples of RA patients with early (n = 97; age = 53 ± 12.3 years; disease duration = 2.8 ± 1.2 years; 76% women) and established (n = 143; age = 58 ± 10.3 years; disease duration = 16.1 ± 3.6 years; 86% women) were collected. The pattern of differences for the patients with different level of participation restriction (no restriction, mild, moderate or high restriction) was explored by the Jonckheere-Terpstra test.

Results: Significant differences were found between patients with different levels of social participation restrictions in both samples in pain, fatigue, functional disability, anxiety, depression and mastery. Generally, it was found that patients with higher restrictions experienced more pain and fatigue, more anxiety and depression and reported lower mastery. Similar pattern of differences concerning disease activity and self-esteem was found mainly in the established group.

Conclusions: The study shows that the level of perceived restrictions in social participation are highly relevant regarding the disease related variables such as pain, fatigue and functional disability as well as psychological status and personal resources in both early and established RA.

Implications For Rehabilitation: Supporting involvement and participation of individuals with rheumatoid arthritis is important for decreasing the impact of RA symptoms on everyday life. Recognition and empowerment of individual resources such a mastery and self-esteem of RA patients could be beneficial for overcoming restrictions in participation.
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http://dx.doi.org/10.3109/09638288.2015.1076071DOI Listing
January 2017

Anemia has a negative impact on self-rated health in kidney transplant recipients with well-functioning grafts: findings from an 8-year follow-up study.

Qual Life Res 2016 Jan 14;25(1):183-92. Epub 2015 Jul 14.

Faculty of Medicine, Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovakia.

Purpose: Anemia is a predictor of mortality and of self-rated health (SRH). However, studies on the relationship between SRH and changes in hemoglobin (Hb) value over time stratified by chronic kidney disease (CKD) stages are lacking. The aim is to explore whether a change in Hb-value over time associates with SRH at up to 8-year follow-up, stratified for CKD stages.

Methods: A prospective study with a baseline measurement between the 3rd and 12th month after KT was performed on 337 consecutive patients. Demographic and clinical data were retrieved from medical records. CKD stages were estimated using the CKD-EPI formula and divided into two groups: CKD1-2 and CKD3-5. Generalized estimating equations (GEE) were performed to identify associations of SRH at follow-up in both CKD groups.

Results: Male gender, new-onset diabetes mellitus after KT (NODAT), a decrease in estimated glomerular filtration rate (eGFR) and Hb-value over time contributed significantly to the GEE model on SRH at follow-up in CKD1-2. For SRH at follow-up in CKD3-5, older age, male gender and chronic renal allograft dysfunction (CRAD) contributed significantly to the GEE model.

Conclusions: At up to 8-year follow-up, male gender, NODAT, a decrease in eGFR and Hb-value over time are associated with poorer SRH in CKD1-2. In such patients, we suggest monitoring slight deteriorations in eGFR and Hb-values. In CKD3-5, higher age, male gender and higher presence of CRAD are associated with poorer SRH at up to 8-year follow-up. In these patients, adequate treatment would slow down CRAD progression.
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http://dx.doi.org/10.1007/s11136-015-1067-7DOI Listing
January 2016

Modifiable factors associated with achievement of high-volume post-dilution hemodiafiltration: results from an international study.

Int J Artif Organs 2015 May 6;38(5):244-50. Epub 2015 Jun 6.

Fresenius Medical Care, Bad Homburg - Germany.

Background: The aim was to investigate factors associated with the successful achievement of ≥21 l/session of substitution fluid volume in patients on post-dilution hemodiafiltration.

Methods: 3315 patients treated in 6 European countries with the Fresenius 5008 CorDiax machine including the AutoSub Plus feature were considered. Variables that showed a relationship with convection volume were entered in a multivariable logistic regression model.

Results: Mean blood flow was 379 ± 68 ml/min. Median substitution volume was 24.7 L (IQR 22.0-27.4 L). Mean filtration fraction was 28.3 ± 4.1%. 81.5% of sessions qualified as high-volume HDF (substitution volumes ≥21 L). Higher age, dialyzer surface area, blood flow and treatment time were positively associated with the achievement of ≥21 L substitution volume; higher body mass index, male gender, higher hematocrit, graft or catheter vs. fistula, and start of week vs. mid-week were negatively associated.

Conclusions: Dialysis center policy in terms of blood flow, treatment time, filter size, and perhaps even hemoglobin targets plays a key role in achieving high-volume HDF. All of these are modifiable factors that can help in prescribing an optimal combination of dialyzer size, achievable blood flows, and treatment times.
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http://dx.doi.org/10.5301/ijao.5000414DOI Listing
May 2015

Importance of an individual's evaluation of functional status for health-related quality of life in patients with multiple sclerosis.

Disabil Health J 2015 Jul 10;8(3):372-9. Epub 2015 Mar 10.

Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovakia; Department of Community & Occupational Health, University of Groningen, University Medical Centre Groningen, the Netherlands.

Background: Quantifying the clinical impact of multiple sclerosis (MS) is one of the most important determinants for optimizing individual patient care. Useful clinical measures for MS can be evaluated from different perspectives.

Objective/hypothesis: This cross-sectional study compared physical disability and functional status as assessed by a neurologist and by a patient and explored how they are associated with the health-related quality of life (HRQoL).

Methods: We collected data from 223 patients. One neurologist scored functional disability using the Kurtzke's Expanded Disability Status Scale (EDSS) and patients evaluated their functional status using the Incapacity Status Scale (ISS). HRQoL was assessed using the Physical and Mental Component Summary (PCS, MCS) of the Short Form-36 Health Survey (SF-36). Multiple linear regressions were applied to analyze the data.

Results: Total EDSS and ISS scores correlated significantly (r = .67; p ≤ .001). Regression analyses showed that EDSS was significantly related to PCS, but not to MCS. After adding ISS into the analysis the association between EDSS and PCS became non-significant. ISS contributed significantly to the explained variance in both models. The final model explained 49% of the total variance for PCS and 15% for MCS.

Conclusions: Functional disability as measured by a neurologist (EDSS) is associated with PCS, but not with MCS, whereas functional disability as measured by patients (ISS) is significantly associated with both HRQoL dimensions. Neurologists should target their attention more on patients' evaluations of their functional status in order to detect the most bothersome problems that are affecting a patient's quality of life.
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http://dx.doi.org/10.1016/j.dhjo.2015.02.006DOI Listing
July 2015

Relationship between the non-motor items of the MDS-UPDRS and Quality of Life in patients with Parkinson's disease.

J Neurol Sci 2015 17;353(1-2):87-91. Epub 2015 Apr 17.

Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovak Republic; Dept. of Community and Occupational Health, University Medical Center Groningen, Groningen, The Netherlands.

The Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) is a newly developed comprehensive tool to assess Parkinson's disease (PD), which covers a wider range of non-motor PD manifestations than the original UPDRS scale. The aim of this study was to assess the relationship between the MDS-UPDRS and Quality of Life (QoL) and to analyze the relationship between individual MDS-UPDRS non-motor items and QoL. A total of 291 PD patients were examined in a multicenter Slovak study. Patients were assessed by the MDS-UPDRS, HY scale and PDQ39. Data were analyzed using the multiple regression analyses. The mean participant age was 68.0 ± 9.0 years, 53.5% were men, mean disease duration was 8.3 ± 5.3 years and mean HY was 2.7 ± 1.0. In a multiple regression analysis model the PDQ39 summary index was related to MDS-UPDRS parts II, I and IV respectively, but not to part III. Individual MDS-UPDRS non-motor items related to the PDQ39 summary index in the summary group and in the non-fluctuating patients subgroup were pain, fatigue and features of dopamine dysregulation syndrome (DDS). In the fluctuating PD patient subgroup, PDQ39 was related to pain and Depressed mood items. Other MDS-UPDRS non-motor items e.g. Anxious mood, Apathy, Cognitive impairment, Hallucinations and psychosis, Sleep problems, Daytime sleepiness and Urinary problems were related to some PDQ39 domains. The overall burden of NMS in PD is more important in terms of QoL than motor symptoms. Individual MDS-UPDRS non-motor items related to worse QoL are especially pain and other sensations, fatigue and features of DDS.
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http://dx.doi.org/10.1016/j.jns.2015.04.013DOI Listing
February 2016

The mediating effect of coping on the association between fatigue and quality of life in patients with multiple sclerosis.

Psychol Health Med 2015 16;20(6):653-61. Epub 2015 Apr 16.

a Faculty of Medicine, Department of Social Medicine, Institute of Public Health , Safarik University , Kosice , Slovakia.

Fatigue, as one of the most frequent symptoms in patients with multiple sclerosis (MS), has various adverse effects on the physical and mental health-related quality of life (PCS, MCS) of patients. The aim of this study was to explore whether coping mediates the relationship between fatigue and PCS and MCS. We collected data from 154 consecutive MS patients (76.0% women; mean age 40.0 ± 9.9). Patients completed the Short-Form Health Survey (SF-36), the multidimensional fatigue inventory (MFI-20) and the coping self-efficacy scale. The mediating effect of coping was analysed using linear regressions and the Sobel z-test. In PCS significant mediation was found in some of the fatigue dimensions (general, physical and reduced Motivation), while in MCS, it was significant in all dimensions. These results can be implemented into educational programmes for patients, their caregivers or physicians, and can also be helpful in the treatment process.
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http://dx.doi.org/10.1080/13548506.2015.1032310DOI Listing
April 2016

Seven years' mortality in Roma and non-Roma patients after coronary angiography.

Eur J Public Health 2015 Oct 30;25(5):765-9. Epub 2015 Mar 30.

5 Department of Community & Occupational Health, University Medical Center Groningen, University of Groningen, The Netherlands.

Background: Ethnicity is associated with differences in clinical course and outcomes of cardiac disease, often in association with a poorer socioeconomic position. The aim of this study was to compare the mortality after coronary angiography (CAG) of Roma and non-Roma patients matched for education and adjusted for gender and age.

Methods: In total, 816 patients were included in the study (167 Roma and 649 non-Roma). Data on socio-demographic background, disease history, use of drugs, coronary findings and type of treatment were obtained from medical records. Mortality was assessed up to seven years after CAG. Kaplan-Meier curves of mortality were plotted, and differences between the Roma and non-Roma patients were assessed using log-rank tests, matched for education and adjusted for gender and age.

Results: Mortality after CAG was significantly higher among Roma than non-Roma (log-rank test χ(2) = 7.59, P < 0.01) and remained so after matching for education and adjustment for gender, age, history of previous myocardial infarction and abnormal CAG (hazard ratio: 2.07, 95% confidence interval: 1.13-3.82).

Conclusion: Mortality after CAG is higher among Roma, and this is not due to differences in age, gender or education. These results warrant further reconsideration of the management of Roma cardiac patients.
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http://dx.doi.org/10.1093/eurpub/ckv057DOI Listing
October 2015

Waist circumference as an independent risk factor for NODAT.

Ann Transplant 2015 Mar 20;20:154-9. Epub 2015 Mar 20.

Clinic of Internal Medicine I, University Hospital Martin and Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia.

Background: New-onset diabetes mellitus after transplantation (NODAT) is a serious and frequent complication of solid organ transplantations. NODAT leads to 2-3 times higher cardiovascular morbidity and mortality. Visceral obesity is a key factor for diabetes mellitus type 2 and metabolic syndrome development, and is an independent risk factor for cardiovascular diseases.

Material And Methods: The series consisted of 167 patients after primary kidney transplantation from a dead donor (64 patients had developed NODAT), average age of the series was 46.1±11.6 years. We retrospectively examined waist circumference, body mass index, and weight gain in the 12th month after transplantation. We examined average level of triglycerides, cholesterol, and immunosuppression throughout the 12 monitored months.

Results: Patients with NODAT were significantly older (P=0.004) and had greater waist circumference (P<0.0001) and higher average sirolimus level (P=0.0262). We identified the following independent risk factors for NODAT by using multivariate analysis: age at the time of transplantation above 50 years (HR=2.5038, [95% CI: 1.7179 to 3.6492], P<0.0001), waist circumference in men greater than 94 cm (HR=1.9492, [95% CI: 1.1697 to 3.2480], P=0.0104) and in women greater than 80 cm (HR=4.5018, [95% CI: 1.8669 to 10.8553], P=0.009). By using correlation coefficient we have proved that greater waist circumference was related to higher incidence of NODAT (r=0.1935, [95% CI: 0.01156 to 0.3630], P=0.0374). Graft survival (death censored) 12 months after kidney transplantation was 97.1% in the control group and 95.3% in the NODAT group (P=0.5381). Patient survival 12 months after kidney transplantation in the control group was 98.1% and in the NODAT group it was 96.9% (P=0.6113).

Conclusions: We identified waist circumference as an independent risk factor for NODAT in our analysis.
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http://dx.doi.org/10.12659/AOT.892067DOI Listing
March 2015