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Terms modified by Adjusted Odds Selected AbstractsEarly Vasoactive Drugs Improve Heart Failure OutcomesCONGESTIVE HEART FAILURE, Issue 6 2009William Frank Peacock MD Vasoactive therapy is often used to treat acute decompensated heart failure (ADHF). The authors sought to determine whether clinical outcomes are temporally associated with time to vasoactive therapy (vasoactive time) in ADHF. Using the Acute Decompensated Heart Failure (ADHERE) Registry, the authors examined the relationship between vasoactive time and inpatient mortality within 48 hours of hospitalization. Vasoactive agents were used early (defined as <6 hours) in 22,788 (63.8%) patients and late in 12,912 (36.2%). Median vasoactive time was 1.7 and 14.7 hours in the early and late groups, respectively. In-hospital mortality was significantly lower in the early group (odds ratio, 0.87; 95% confidence interval, 0.79,0.96; P=.006), and the adjusted odds of death increased 6.8% for every 6 hours of treatment delay (95% confidence interval, 4.2,9.6; P<.0001). Early vasoactive initiation is associated with improved outcomes in patients hospitalized for ADHF. [source] Association Between Cognitive Function and Social Support with Glycemic Control in Adults with Diabetes MellitusJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2009Toru Okura MD OBJECTIVES: To examine whether cognitive impairment in adults with diabetes mellitus is associated with worse glycemic control and to assess whether level of social support for diabetes mellitus care modifies this relationship. DESIGN: Cross-sectional analysis. SETTING: The 2003 Health and Retirement Study (HRS) Mail Survey on Diabetes and the 2004 wave of the HRS. PARTICIPANTS: Adults aged 50 and older with diabetes mellitus in the United States (N=1,097, mean age 69.2). MEASUREMENTS: Glycosylated hemoglobin (HbA1c) level; cognitive function, measured with the 35-point HRS cognitive scale (HRS-cog); sociodemographic variables; duration of diabetes mellitus; depressed mood; social support for diabetes mellitus care; self-reported knowledge of diabetes mellitus; treatments for diabetes mellitus; components of the Total Illness Burden Index related to diabetes mellitus; and functional limitations. RESULTS: In an ordered logistic regression model for the three ordinal levels of HbA1c (<7.0, 7.0,7.9, ,8.0 mg/dL), respondents with HRS-cog scores in the lowest quartile had significantly higher HbA1c levels than those in the highest cognitive quartile (adjusted odds ratio=1.80, 95% confidence interval=1.11,2.92). A high level of social support for diabetes mellitus care modified this association; for respondents in the lowest cognitive quartile, those with high levels of support had significantly lower odds of having higher HbA1c than those with low levels of support (1.11 vs 2.87, P=.02). CONCLUSION: Although cognitive impairment was associated with worse glycemic control, higher levels of social support for diabetes mellitus care ameliorated this negative relationship. Identifying the level of social support available to cognitively impaired adults with diabetes mellitus may help to target interventions for better glycemic control. [source] Allostatic Load and Frailty in Older AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2009Tara L. Gruenewald PhD OBJECTIVES: To examine the association between allostatic load (AL), an index of multisystem physiological dysregulation, and frailty development over a 3-year follow-up in a sample of older adults. DESIGN: Longitudinal cohort study. SETTING: Community. PARTICIPANTS: High-functioning men and women aged 70 to 79 at study entry. MEASUREMENTS: Multisystem physiological dysregulation, or AL, was assessed according to 13 biomarkers of cardiovascular, endocrine, immune, and metabolic function. An AL score was computed as the total number of biomarkers for which participant values fell into high-risk biomarker quartiles. Frailty status (not frail, intermediate frail, frail) was determined according to the total number of five indicators of frailty: weight loss, exhaustion, weak grip, slow gait, and low physical activity. The association between level of AL at baseline and frailty status 3 years later was examined using ordinal logistic regression in 803 participants not frail at baseline. RESULTS: In a multivariable model adjusting for sociodemographic, health, and behavioral characteristics, each 1-unit increase in AL at baseline was associated with a 10% greater likelihood of frailty at the 3-year follow-up (cumulative adjusted odds ratio=1.10, 95% confidence interval=1.03,1.19). CONCLUSION: These findings support the hypothesis that dysregulation across multiple physiological systems is associated with greater risk of frailty. Greater levels of multisystem physiological dysregulation may serve as a warning sign of frailty development in later life. [source] Hyperglycemia as a Predictor of In-Hospital Mortality in Elderly Patients without Diabetes Mellitus Admitted to a Sub-Intensive Care UnitJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2008Intissar Sleiman MD OBJECTIVES: To investigate the association between hyperglycemia and in-hospital and 45-day mortality in acutely ill elderly patients. DESIGN: Retrospective cohort. SETTING: Hospital medical patients admitted to a sub-intensive care unit (sub-ICU) for elderly patients, which is a level of care between ordinary wards and intensive care. PARTICIPANTS: One thousand two hundred twenty-nine patients (mean age 79.6±8.4) admitted to the sub-ICU from January 2003 to January 2006. Forty patients with acute myocardial infarction and 34 patients with extreme fasting glucose values (<60 or >500 mg/dL) were excluded. Eight hundred twenty-two patients without a history of diabetes mellitus (DM) and 333 patients with a diagnosis of DM were selected and subdivided into three categories according to serum fasting blood glucose: 60 to 126 mg/dL (Group A), 127 to 180 mg/dL (Group B), and 181 to 500 mg/dL (Group C). MEASUREMENTS: Age, sex, mental and functional status, Acute Physiology Score, comorbid conditions, serum albumin, serum cholesterol, fasting serum glucose, and length of stay. In-hospital mortality was the primary outcome, and 45-day mortality was the secondary outcome. RESULTS: Total in-hospital mortality was 14.5%. In patients with and without DM, mortality was 8.8% and 11.3%, respectively, in Group A; 13.6% and 17.3% in Group B, and 12.6% and 34.3% in Group C. After controlling for confounders, newly recognized hyperglycemia (>181 mg/dL) was independently associated with in-hospital mortality (adjusted odds ratio=2.7, 95% confidence interval=1.6,4.8). Forty-five-day mortality in newly recognized hyperglycemic patients was 17.5%, 25.7%, and 42% in Groups A, B, and C, respectively, whereas it was 21.2% in patients with DM. CONCLUSION: In elderly patients, newly recognized hyperglycemia was associated with a higher mortality rate than in those with a prior history of DM. These data suggest that further randomized clinical trials are needed to assess the efficacy and the risk of a target glucose of greater than 180 mg/dL. [source] Footwear Style and Risk of Falls in Older AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2004Thomas D. Koepsell MD Objectives: To determine how the risk of a fall in an older adult varies in relation to style of footwear worn. Design: Nested case-control study. Setting: Group Health Cooperative, a large health maintenance organization in Washington state. Participants: A total of 1,371 adults aged 65 and older were monitored for falls over a 2-year period; 327 qualifying fall cases were compared with 327 controls matched on age and sex. Measurements: Standardized in-person examinations before fall occurrence, interviews about fall risk factors after the fall occurred, and direct examination of footwear were conducted. Questions for controls referred to the last time they engaged in an activity broadly similar to what the case was doing at the time of the fall. Results: Athletic and canvas shoes (sneakers) were the styles of footwear associated with lowest risk of a fall. Going barefoot or in stocking feet was associated with sharply increased risk, even after controlling for measures of health status (adjusted odds ratio=11.2, 95% confidence interval (CI)=2.4,51.8). Relative to athletic/canvas shoes, other footwear was associated with a 1.3-fold increase in the risk of a fall (95% CI=0.9,1.9), varying somewhat by style. Conclusion: Contrary to findings from gait-laboratory studies, athletic shoes were associated with relatively low risk of a fall in older adults during everyday activities. Fall risk was markedly increased when participants were not wearing shoes. [source] A population-based study on the association between type 2 diabetes and periodontal disease in 12,123 middle-aged Taiwanese (KCIS No. 21)JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 5 2009Ting-Ting Wang Abstract Aim: We investigated the association between type 2 diabetes mellitus (T2DM) and periodontal disease (PD) in the context of the current periodontal aetiology model. Material and Methods: In total, 14,747 community residents aged 35,44 years were invited to a community-based PD survey between 2003 and 2006 using the community periodontal index. Significant factors modifying the association between T2DM and PD were ascertained. We further assessed the association between T2DM and the risk for PD, within strata of significant effect modifiers, after controlling for other putative factors. Results: The prevalence rate was 10% higher in subjects with T2DM than in those without. After controlling for significant factors, T2DM was positively associated with the risk for PD (adjusted odds ratio=1.34,95% confidence interval: 1.07,1.74). The results of interaction assessment showed that only the waist was identified as a statistically significant effect modifier for such a positive association. Conclusions: The association between T2DM and the risk for PD among young adult was demonstrated. This finding, together with other aetiological factors, fit with the current hypothesized model of the aetiology of periodontitis. However, the effect of T2DM modified by waist measurement should be verified in future studies. [source] Surgical workload and outcome after resection for carcinoma of the oesophagus and cardia,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2002E. W. Gillison Background: Performing cancer surgery in high-volume centres may lead to improved outcomes. This study explored the relationship between annual workload and outcome following resection for carcinoma of the oesophagus and cardia. Methods: The study was a retrospective case-note review of 1125 patients who had surgery for cardio-oesophageal cancer in the West Midlands region of England. Outcome measures were 30-day mortality and long-term survival. Results: The overall 30-day mortality rate was 10·0 per cent with a median survival of 14 months and a 5-year survival rate of 17·2 per cent. Increasing age, advanced stage of disease and emergency resection independently affected outcome adversely. Forty-one infrequent operators (fewer than four resections per year) performed 146 resections (13·0 per cent), 18 intermediate operators (between four and 11 resections per year) performed 488 resections (43·4 per cent) and five frequent operators (12 or more resections per year) performed 491 resections (43·6 per cent). The 30-day mortality rate was greatest in the infrequent group (15·1 per cent) compared with both the intermediate group (6·6 per cent; adjusted odds 0·40, P = 0·004) and the frequent group (11·8 per cent; odds 0·73, P = 0·28). There were no differences in survival rates between the groups, and no difference in outcome between high- and low-volume hospitals. Conclusion: In this unselected population-based series there was little evidence of a trend of improving 30-day mortality rate with increasing workload, or between workload and long-term survival. © 2002 British Journal of Surgery Society Ltd [source] Cancer incidence after localized therapy for prostate cancerCANCER, Issue 5 2006Kihyuck Moon MD Abstract BACKGROUND. Second cancers may occur in patients who have undergone radiation therapy. The risk for these adverse events after therapy is uncertain. In this study, the authors examined the size and significance of the observed association between occurrences of secondary cancers 5 years after radiotherapy in a large population of men with incident prostate cancer. METHODS. Men with incident prostate cancer were identified from the Surveillance, Epidemiology, and End Results (SEER) registry and were distinguished by the type of treatment received, tumor stage, tumor grade, and age at diagnosis. SEER data also were used to identify occurrences of secondary cancer beginning 5 years after the date patients were diagnosed with prostate cancer. Multivariate logistic regression analysis was used to estimate the adjusted odds of the subsequent occurrence of other cancers associated with types of radiation therapy received and was adjusted for the type of surgery, tumor grade, stage, and patient age. RESULTS. Compared with men who received no prostate cancer-directed radiation, men who received external beam radiation therapy (EBRT) as their only form of radiation therapy had statistically significant increased odds of developing secondary cancers at several sites potentially related to radiation therapy, including the bladder (odds ratio [OR], 1.63; 95% confidence interval [95% CI], 1.44,1.84) and rectum (OR, 1.60; 95% CI, 1.29,1.99). Men who received EBRT also had statistically significant higher odds of developing secondary cancers at sites in the upper body and other areas not potentially related to radiation therapy, including the cecum (OR, 1.63; 95% CI, 1.10,1.70), transverse colon (OR, 1.85; 95% CI, 1.30,2.63), brain (OR, 1.83; 95% CI, 1.22,2.75), stomach (OR, 1.38; 95% CI, 1.09,1.75), melanoma (OR, 1.29; 95% CI, 1.09,1.53), and lung and bronchus (OR, 1.25; 95% CI, 1.13,1.37) compared with the odds among men who received no radiation therapy. Men who received radiation therapy in the form of radioactive implants or isotopes, either in isolation or combined with beam radiation, did not have significantly different odds of secondary cancer occurring at any of the 20 most common sites. CONCLUSIONS. Patients who received with EBRT had significantly higher odds of developing second cancers both overall and in the areas that were exposed to radiation. It is noteworthy that, to the authors' knowledge, this report shows for the first time that, despite the higher doses of radiation delivered, patients who received radioactive implants had the lowest odds of developing second cancers. Cancer 2006. © 2006 American Cancer Society. [source] |