OBJECTIVE -To systematically evaluate the evidence for an association between physical activity of moderate intensity and risk of type 2 diabetes. RESEARCH DESIGN AND METHODS -We searched EMBASE and Medline throughMarch 2006 and examined reference lists of retrieved articles. We excluded studies that did not assess physical activity of moderate intensity independent of activities of vigorous intensity (more than six times the resting metabolic rate). Information on study design, participant characteristics, assessment of physical activity, and outcomes and estimates of associations were extracted independently by two investigators. We calculated summary relative risks (RRs) using a random-effects model for the highest versus the lowest reported duration of activities.RESULTS -We identified 10 prospective cohort studies of physical activity of moderate intensity and type 2 diabetes, including a total of 301,221 participants and 9,367 incident cases. Five of these studies specifically investigated the role of walking. The summary RR of type 2 diabetes was 0.69 (95% CI 0.58 -0.83) for regular participation in physical activity of moderate intensity as compared with being sedentary. Similarly, the RR was 0.70 (0.58 -0.84) for regular walking (typically Ն2.5 h/week brisk walking) as compared with almost no walking. The associations remained significant after adjustment for BMI. Similar associations were observed in men and women and in the U.S. and Europe.CONCLUSIONS -These findings indicate that adherence to recommendations to participate in physical activities of moderate intensity such as brisk walking can substantially reduce the risk of type 2 diabetes. Diabetes Care 30:744 -752, 2007T he prevalence of type 2 diabetes is high and expected to increase dramatically in the U.S. and worldwide (1). Type 2 diabetes is a chronic disease associated with premature mortality and various debilitating complications (2). Intensive treatment regimens can prevent some but not all complications (3). Therefore, primary prevention efforts are clearly needed.Moderately intense physical activities, such as walking and gardening, are the most common forms of activity among adults in the U.S. (4) and may be an easily adoptable, relatively safe means to reduce the risk of type 2 diabetes. Randomized trials have shown that physical activity alone or in conjunction with dietary changes can reduce the incidence of type 2 diabetes (5-8). However, the intensity of activity required remains unclear because the independent role of moderately intense activities has not been directly examined in these trials.Observational studies have consistently reported an inverse association between physical activity and type 2 diabetes, but most of these studies focused on vigorous activities or physical activity of various intensities combined (e.g., 9,10). In this article, we systematically review the epidemiological evidence on the association between physical activity of moderate intensity and risk of type 2 diabetes. RESEARCH DESIGN AND METHODS -We s...

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BACKGROUND: Gestational age (GA) is frequently unknown or inaccurate in pregnancies in low-income countries. Early identification of preterm infants may help link them to potentially life-saving interventions. METHODS: We conducted a validation study in a community-based birth cohort in rural Bangladesh. GA was determined by pregnancy ultrasound (<20 weeks). Community health workers conducted home visits (<72 hours) to assess physical/neuromuscular signs and measure anthropometrics. The distribution, agreement, and diagnostic accuracy of different clinical methods of GA assessment were determined compared with early ultrasound dating. RESULTS: In the live-born cohort (n = 1066), the mean ultrasound GA was 39.1 weeks (SD 2.0) and prevalence of preterm birth (<37 weeks) was 11.4%. Among assessed newborns (n = 710), the mean ultrasound GA was 39.3 weeks (SD 1.6) (8.3% preterm) and by Ballard scoring the mean GA was 38.9 weeks (SD 1.7) (12.9% preterm). The average bias of the Ballard was –0.4 weeks; however, 95% limits of agreement were wide (–4.7 to 4.0 weeks) and the accuracy for identifying preterm infants was low (sensitivity 16%, specificity 87%). Simplified methods for GA assessment had poor diagnostic accuracy for identifying preterm births (community health worker prematurity scorecard [sensitivity/specificity: 70%/27%]; Capurro [5%/96%]; Eregie [75%/58%]; Bhagwat [18%/87%], foot length <75 mm [64%/35%]; birth weight <2500 g [54%/82%]). Neonatal anthropometrics had poor to fair performance for classifying preterm infants (areas under the receiver operating curve 0.52–0.80). CONCLUSIONS: Newborn clinical assessment of GA is challenging at the community level in low-resource settings. Anthropometrics are also inaccurate surrogate markers for GA in settings with high rates of fetal growth restriction.

ALBI and PALBI grades are accurate survival metrics in high-risk patients undergoing conventional transarterial chemoembolization for HCC. Use of these scores allows for more refined survival stratification within CPC and BCLC stage.

Background: Epidemiologic studies linking ambient air pollution to the onset of acute cardiovascular events often rely on date of hospital admission for exposure assessment. Methods: We investigated the extent of exposure misclassification resulting from assigning exposure to PM2.5 based on 1) date of hospital admission, or 2) time of hospital presentation compared to PM2.5 exposure based on time of stroke symptom onset. We performed computer simulations to evaluate the impact of this source of exposure misclassification on estimates of air pollution health effects in the context of a time-stratified case-crossover study. Results: Among 1101 patients admitted for a confirmed acute ischemic stroke to a Boston area hospital, symptom onset occurred a median of 1 calendar day before hospital admission (range = 0 – 30 days). The difference between ambient PM2.5 exposure based on the calendar day of admission versus time of symptom onset ranged from −47 to 36 μg/m3 (−0.1 ± 7.1 μg/m3; mean ± standard deviation). The simulation study indicated that for nonnull associations, exposure assessment based on hospitalization date led to estimates that were biased toward the null by 60%–66%, whereas assessment based on time of hospital presentation yielded estimates that were biased toward the null by 37%–42%. Conclusions: Epidemiologic studies of air pollution-related risk of acute cardiovascular events that assess exposure based on date of hospitalization likely underestimate the strength of associations. Using data on time of hospital presentation would marginally attenuate, but not eliminate, this important source of bias.

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Benign inflammatory nodules occur rarely after percutaneous ablation of renal tumors and may mimic tumor seeding of the applicator track.