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Secondary Analysis (secondary + analysis)
Selected AbstractsAnticholinergics and Ketamine Sedation in Children: A Secondary Analysis of Atropine Versus GlycopyrrolateACADEMIC EMERGENCY MEDICINE, Issue 2 2010Steven M. Green MD Abstract Objectives:, Adjunctive anticholinergics are commonly administered during emergency department (ED) ketamine sedation in children under the presumption that drying oral secretions should decrease the likelihood of airway and respiratory adverse events. Pharmacologic considerations suggest that glycopyrrolate might exhibit a superior adverse effect profile to atropine. The authors contrasted the adverse events noted with use of each of these anticholinergics in a large multicenter observational database of ketamine sedations. Methods:, This was a secondary analysis of an observational database of 8,282 ED ketamine sedations assembled from 32 prior series. The authors compared the relative incidence of six adverse events (airway and respiratory adverse events, laryngospasm, apnea, emesis, recovery agitation, and clinically important recovery agitation) between children who received coadministered atropine, glycopyrrolate, or no anticholinergic. Multivariable analysis using the specific anticholinergic as a covariate was performed, while controlling for other known predictors. Results:, Atropine was associated with less vomiting (5.3%) than either glycopyrrolate (10.7%) or no anticholinergic (11.4%) in both unadjusted and multivariable analyses. Glycopyrrolate was associated with significantly more airway and respiratory adverse events (6.4%) than either atropine (3.3%) or no anticholinergic (3.0%) and similarly more clinically important recovery agitation (2.1% vs. 1.2 and 1.3%). There were, however, no differences noted in odds of laryngospasm and apnea. Conclusions:, This secondary analysis unexpectedly found that the coadministered anticholinergic atropine exhibited a superior adverse event profile to glycopyrrolate during ketamine sedation. Any such advantage requires confirmation in a separate trial; however, our data cast doubt on the traditional premise that glycopyrrolate might be superior. Further, neither anticholinergic showed efficacy in decreasing airway and respiratory adverse events. ACADEMIC EMERGENCY MEDICINE 2010; 17:157,162 © 2010 by the Society for Academic Emergency Medicine [source] Microdebriders Used in Functional Endoscopic Sinus Surgery: Secondary Analysis and Validation of a New Tissue Model,THE LARYNGOSCOPE, Issue 9 2005Sandeep P. Dave MD Abstract Objectives/Hypothesis: To validate a previously reported in vitro tissue model for microdebrider comparison and determine which microdebrider, tissue type, blade type, and suction strength is most efficient. Specifically, the goal of the secondary analysis is to expand on the results of the preliminary analy-sis by increasing the sample size, and introduce an aspiration efficiency score (AES) to facilitate microdebrider comparison. Study Design: Prospective randomized comparison. Methods: A prospective randomized comparison of the Diego Powered Dissector and XPS 3000 Powered ENT System was conducted using a soft tissue and a firm tissue model. In addition to evaluating tissue aspiration with straight and angled blades, clogging rates and clearance times were measured. Both standard wall suction and liposuction were used. Basic statistical analysis, a one-way analysis of variance, and a post hoc Student's t test were performed to compare outcomes. Results: With standard wall suction, the microdebriders were equivalent for the overall microdebrider comparison. For the "head to head" comparison with standard wall suction, the devices were also equivalent when using the straight blades, but the XPS 3000 aspirated more tissue when using the angled blades. With liposuction, the XPS 3000 and liposuction independently aspirated more tissue but clogged more often compared with the Diego PD and regular suction. The aspiration efficiency of soft tissue (oysters) and straight blades was superior compared with firm tissue (scallops) and angled blades. For the "head to head" comparison with liposuction, the XPS 3000 aspirated more tissue regardless of tissue type, but the Diego PD clogged less with firm tissue (scallops). Overall, the AES favored the XPS 3000, soft tissue (oysters), straight blades, and liposuction. Conclusion: Our tissue model represents a reliable and reproducible means of microdebrider comparison. Statistically significant differences between the Diego PD and XPS 3000, as well as between tissue types, blade types, and suction strengths, are reported. Using these results, microdebrider manufacturers can adopt similar tissue models, expand on the current AES, and include other commercially available microdebrider devices to test and report product performance to the consumer. Perhaps an optimal open to closed ratio or liposuction pressure can be determined that yields the greatest tissue aspiration with the fewest number of clogs. [source] The stability of correlates of labour force activityACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2009G. Waghorn Objective:, To investigate the stability of correlates of labour force activity among people with affective and anxiety disorders, compared with healthy adults, between 1998 and 2003. Method:, Secondary analyses of multi-stage probability samples of community residents (n1998 = 37 580 and n2003 = 36 088) obtained from repeat administrations of an Australian population survey. Results:, Proportionally, fewer people with affective or anxiety disorders were employed compared with well controls. Extent of employment restrictions, sex, age left school, country of birth, age and educational attainment were strong correlates of labour force participation and current employment. These effects were stable despite improved labour market conditions in 2003. Conclusion:, These results can inform decisions about access to substantial forms of employment assistance. Subgroups of people with anxiety and depression, with severe employment restrictions, low education, low language proficiency, aged 15,24 years, or aged 55 years or more, may require greater access to substantial employment assistance. [source] Lipid-lowering therapy in patients with type 2 diabetes: the case for early interventionDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 4 2008Armin Steinmetz Abstract Chronic complications of type 2 diabetes, in particular, macrovascular complications, confer substantial morbidity and mortality and adversely affect a patient's quality of life. Early intensive intervention to control cardiovascular risk factors is essential in clinical management. Atherogenic dyslipidaemia characterized by elevated triglycerides, a low level of high-density lipoprotein cholesterol (HDL-C), and an increase in the preponderance of small, dense low-density lipoprotein (LDL) particles, is a key modifiable risk factor for macrovascular diabetic complications. Lowering low-density lipoprotein cholesterol (LDL-C) with a statin (or the combination of statin and ezetimibe) is the main focus for reducing cardiovascular risk in patients with diabetes. However, statins fail to address the residual cardiovascular risk associated with low HDL-C. Fibrates are effective against all components of the atherogenic dyslipidaemia associated with type 2 diabetes. Secondary analyses of the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study suggest a role for early treatment with fenofibrate in improving cardiovascular risk reduction in type 2 diabetes and provide safety data supporting the use of fenofibrate in combination with a statin. Data from the FIELD study suggest that fenofibrate may also have potential to impact on microvascular diabetic complications associated with type 2 diabetes. Data are awaited from the ongoing Action to Control Cardiovascular Risk in Diabetes (ACCORD) study to evaluate the outcome benefits of combining fenofibrate with a statin in patients with type 2 diabetes. Finally, in view of divergent study results and outstanding data, assessment of the risk of the individual with type 2 diabetes is mandatory to assist clinical decision-making when initiating lipid therapy. Copyright © 2008 John Wiley & Sons, Ltd. [source] Treatment of symptomatic diabetic polyneuropathy with the antioxidant ,-lipoic acid: a meta-analysisDIABETIC MEDICINE, Issue 2 2004D. Ziegler Abstract Aims To determine the efficacy and safety of 600 mg of ,-lipoic acid given intravenously over 3 weeks in diabetic patients with symptomatic polyneuropathy. Methods We searched the database of VIATRIS GmbH, Frankfurt, Germany, for clinical trials of ,-lipoic acid according to the following prerequisites: randomized, double-masked, placebo-controlled, parallel-group trial using ,-lipoic acid infusions of 600 mg i.v. per day for 3 weeks, except for weekends, in diabetic patients with positive sensory symptoms of polyneuropathy which were scored by the Total Symptom Score (TSS) in the feet on a daily basis. Four trials (ALADIN I, ALADIN III, SYDNEY, NATHAN II) comprised n = 1258 patients (,-lipoic acid n = 716; placebo n = 542) met these eligibility criteria and were included in a meta-analysis based on the intention-to-treat principle. Primary analysis involved a comparison of the differences in TSS from baseline to the end of i.v. Treatment between the groups treated with ,-lipoic acid or placebo. Secondary analyses included daily changes in TSS, responder rates (, 50% improvement in TSS), individual TSS components, Neuropathy Impairment Score (NIS), NIS of the lower limbs (NIS-LL), individual NIS-LL components, and the rates of adverse events. Results After 3 weeks the relative difference in favour of ,-lipoic acid vs. placebo was 24.1% (13.5, 33.4) (geometric mean with 95% confidence interval) for TSS and 16.0% (5.7, 25.2) for NIS-LL. The responder rates were 52.7% in patients treated with ,-lipoic acid and 36.9% in those on placebo (P < 0.05). On a daily basis there was a continuous increase in the magnitude of TSS improvement in favour of ,-lipoic acid vs. placebo which was noted first after 8 days of treatment. Among the individual components of the TSS, pain, burning, and numbness decreased in favour of ,-lipoic acid compared with placebo, while among the NIS-LL components pin-prick and touch-pressure sensation as well as ankle reflexes were improved in favour of ,-lipoic acid after 3 weeks. The rates of adverse events did not differ between the groups. Conclusions The results of this meta-analysis provide evidence that treatment with ,-lipoic acid (600 mg/day i.v.) over 3 weeks is safe and significantly improves both positive neuropathic symptoms and neuropathic deficits to a clinically meaningful degree in diabetic patients with symptomatic polyneuropathy. Diabet. Med. 21, 114,121 (2004) [source] Modeling missing binary outcome data in a successful web-based smokeless tobacco cessation programADDICTION, Issue 6 2010Keith Smolkowski ABSTRACT Aim To examine various methods to impute missing binary outcome from a web-based tobacco cessation intervention. Design The ChewFree randomized controlled trial used a two-arm design to compare tobacco abstinence at both the 3- and 6-month follow-up for participants randomized to either an enhanced web-based intervention condition or a basic information-only control condition. Setting Internet in the United States and Canada. Participants Secondary analyses focused upon 2523 participants in the ChewFree trial. Measurements Point-prevalence tobacco abstinence measured at 3- and 6-month follow-up. Findings The results of this study confirmed the findings for the original ChewFree trial and highlighted the use of different missing-data approaches to achieve intent-to-treat analyses when confronted with substantial attrition. The use of different imputation methods yielded results that differed in both the size of the estimated treatment effect and the standard errors. Conclusions The choice of imputation model used to analyze missing binary outcome data can affect substantially the size and statistical significance of the treatment effect. Without additional information about the missing cases, they can overestimate the effect of treatment. Multiple imputation methods are recommended, especially those that permit a sensitivity analysis of their impact. [source] Caffeine, cognitive failures and health in a non-working community sampleHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 1 2009Andrew P Smith Abstract Rationale Most studies of the effects of caffeine on performance have been conducted in the laboratory and further information is required on the real-life effects of caffeine consumption on cognition. In addition, possible effects of caffeine consumption on a range of health outcomes should also be assessed in these studies to enable cost-benefit analyses to be conducted. Objectives Secondary analyses of a large epidemiological database (N,=,3223 non-working participants, 57% female, with a mean age of 49.6 years, range 17,92 years) were conducted to examine associations between caffeine consumption (mean caffeine consumption was 140,mg/day, range 0,1800,mg) and cognitive failures (errors of memory, attention and action) in a non-working sample. Associations between caffeine consumption and physical and mental health problems were also examined. Methods The study involved secondary analyses of a database formed by combining the Bristol Stress and Health at Work and Cardiff Health and Safety at Work studies. Associations between caffeine consumption and frequency of cognitive failures and health outcomes were examined in a sample of non-workers. Results After controlling for possible confounding factors significant associations between caffeine consumption and fewer cognitive failures were observed. Initial analyses suggested that many health variables were associated with regular level of caffeine consumption. However, most of the significant effects of caffeine disappeared when demographic and lifestyle factors were controlled for. Consumption of caffeine was, however, associated with a reduced risk of depression. These effects were also observed in separate analyses examining the source of the caffeine (coffee and tea). Conclusions Overall, the results show that caffeine consumption may benefit cognitive functioning in a non-working population. This confirms earlier findings from working samples. This beneficial effect of caffeine was not associated with negative health consequences. Indeed, consumption of caffeine was found to be associated with a reduced risk of depression. Copyright © 2008 John Wiley & Sons, Ltd. [source] Elderly suicide and the 2003 SARS epidemic in Hong KongINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 2 2006Sau Man Sandra Chan Abstract Background Hong Kong was struck by the community outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003. In the same year, the elderly suicide rate in Hong Kong showed a sharp upturn from a previous downward trend. Methods Secondary analyses using Poisson Regression Models on the suicide statistics from the Census and Statistics Department of the Hong Kong Government were performed. Results In a Poisson Regression Model on the annual suicide rates in elders aged 65 and over in years 1986,2003, 2002 served as the reference year. Suicide rates in 1986,1997 were significantly higher than the reference year, with an Incident Rate Ratio (IRR) of 1.34 to 1.61. However, rates in 1998,2001 did not differ from the reference year significantly, representing stabilization of suicide rates for 4 years after 1997. The elderly suicide rate increased to 37.46/100,000 in 2003, with an IRR of 1.32 (p,=,0.0019) relative to 2002. Such trend is preserved when female elderly suicide rates in 1993,2003 were analyzed, while suicide rates in elderly men and younger age groups did not follow this pattern. Discussions Mechanistic factors such as breakdown of social network and limited access to health care might account for the findings. These factors could have potentiated biopsychosocial risk factors for suicide at individual levels, particularly in elderly. Female elders, by way of their previous readiness to utilize social and health services instituted in the past decade, are thus more susceptible to the effects of temporary suspension of these services during the SARS epidemic. Conclusions The SARS epidemic was associated with increased risk of completed suicide in female elders, but not in male elders or the population under 65 years of age. Copyright © 2006 John Wiley & Sons, Ltd. [source] Evaluation of the Personal Dental Services (Wave 1) for Lambeth, Southwark and Lewisham Primary Care Trusts , Part 1: Retrospective analyses of registration data and access issuesJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2005Helen Best BDS MDS PhD Abstract Aim/objective, The purpose of the study was to undertake analyses of registration data for the personal dental services (PDS) of Lambeth, Southwark and Lewisham primary care trusts and relate the analyses to the PDS goal ,of ,increasing ,uptake ,of ,dental services. Method, Secondary analyses of registration statistics provided by the Dental Practice Board were undertaken for both 1 years pre-PDS (October 1997 to September 1998) and post-PDS (October 1998 to March 2003) periods. Three sets of analyses were undertaken to consider different aspects of changing registrations: (1) Absolute numbers of patients registered at each time interval; (2) Rates of change in numbers of patients registered for the entire period after the introduction of PDS; and (3) Rates of change in numbers of patients registered ,for ,the ,most recent 3 years of available data. Results, There was a significant increase in the numbers of children registered under capitation, post-PDS as compared to the pre-PDS level (all ages and both genders combined). Post-PDS, the rate of increase for the children was approximately one additional child per practice per month (0.96, 95% CI 0.41,1.52). Similarly there was a significant trend for increasing adults registrations over time of about two and a half adults per practice per month (2.42, 95% CI 0.90,3.95). There was no evidence of a change in registrations for children or adults in total over the most recent period of 3 years. Conclusions, The analysis of the absolute numbers of registered patients each month indicated that the PDS practices had more children registered than before the implementation of the PDS scheme, but not adults. Overall post-implementation there was a trend for increasing registrations in both children and adults, but the most recent data indicated a plateau effect. Further consideration of facilitators to achieve PDS goals of improved uptake of services is required, particularly as they relate to local contexts. [source] Real world contexts in PISA science: Implications for context-based science educationJOURNAL OF RESEARCH IN SCIENCE TEACHING, Issue 8 2009Peter J. Fensham Abstract The PISA assessment instruments for students' scientific literacy in 2000, 2003, and 2006 have each consisted of units made up of a real world context involving Science and Technology, about which students are asked a number of cognitive and affective questions. This article discusses a number of issues from this use of S&T contexts in PISA and the implications they have for the current renewed interest in context-based science education. Suitably chosen contexts can engage both boys and girls. Secondary analyses of the students' responses using the contextual sets of items as the unit of analysis provides new information about the levels of performance in PISA 2006 Science. Embedding affective items in the achievement test did not lead to gender/context interactions of significance, and context interactions were less than competency ones. A number of implications for context-based science teaching and learning are outlined and the PISA 2006 Science test is suggested as a model for its assessment. © 2009 Wiley Periodicals, Inc. J Res Sci Teach 46: 884,896, 2009 [source] Gene-Environment Interaction in Patterns of Adolescent Drinking: Regional Residency Moderates Longitudinal Influences on Alcohol UseALCOHOLISM, Issue 5 2001Richard J. Rose Background: Drinking frequency escalates rapidly during adolescence. Abstinence declines markedly, and drinking monthly or more often becomes normative. Individual differences in adolescent drinking patterns are large, and some patterns are predictive of subsequent drinking problems; little, however, is known of the gene,environment interactions that create them. Methods: Five consecutive and complete birth cohorts of Finnish twins, born 1975,1979, were enrolled sequentially into a longitudinal study and assessed, with postal questionnaires, at ages 16, 17, and 18.5 years. The sample included 1786 same-sex twin pairs, of whom 1240 pairs were concordantly drinking at age 16. Maximum likelihood models were fit in longitudinal analyses of the three waves of drinking data to assess changes in genetic and environmental influences on alcohol use across adolescence. Secondary analyses contrasted twin pairs residing in rural versus those in urban environments to investigate gene,environment interactions. Results: Longitudinal analyses revealed that genetic factors influencing drinking patterns increased in importance across the 30-month period, and effects arising from common environmental influences declined. Distributions of drinking frequencies in twins residing in urban and rural environments were highly similar, but influences on drinking varied between the two environments. Genetic factors assumed a larger role among adolescents residing in urban areas, while common environmental influences were more important in rural settings. Formal modeling of the data established a significant gene,environment interaction. Conclusions: The results document the changing impact of genetic and environmental influences on alcohol use across adolescence. Importantly, the results also reveal a significant gene,environment interaction in patterns of adolescent drinking and invite more detailed analyses of the pathways and mechanisms by which environments modulate genetic effects. [source] Using Student Risk Factors in School Violence Surveillance Reports: Illustrative Examples for Enhanced Policy Formation, Implementation, and EvaluationLAW & POLICY, Issue 3 2001Michael J. Furlong This article presents information about the range and type of violent and associated behaviors that occur on American school campuses. We argue that the prevailing practice of reporting single-item population estimate trends from school violence surveillance surveys provides an incomplete basis upon which to form and evaluate public policy related to school violence. The presentation draws upon information derived from the 1993, 1995, 1997, and 1999 Centers for Disease Control's Youth Risk Behavior Surveillance (YRBS) surveys (CDC 1995, 1996, 1998, 2000) and the 1997,1998 California Student Survey (CSS) (Austin et al. 2001). Secondary analyses using the YRBS and the CSS are used to illustrate the importance of considering risk and school adjustment patterns when examining school violence trends to formulate public policy agendas. [source] How many Australian deaths from heart disease and stroke could be avoided by a small reduction in population cholesterol levels?NUTRITION & DIETETICS, Issue 3 2009Rachel HUXLEY Abstract Aim:, To quantify the number of premature deaths from coronary heart disease and ischaemic stroke that potentially could be avoided annually among the Australian population if a sustained 10% reduction in the mean population level of low-density lipoprotein cholesterol were to be achieved. Methods:, Data were obtained on the number of deaths from coronary heart disease and stroke in the Australian population, subdivided into age and sex strata, and on the mean population level of low-density lipoprotein cholesterol. Published relative risks (95% CI) from a meta-analysis of lipid-lowering therapy were used to calculate the reduction in the relative risk for coronary heart disease and stroke associated with a 5%, 10% and 15% reduction in low-density lipoprotein cholesterol. The expected number of deaths from coronary heart disease and ischaemic stroke avoidable with a 10% reduction in low-density lipoprotein cholesterol was modelled. Secondary analyses were performed assuming reductions in low-density lipoprotein cholesterol of 5% and 15%. Results:, A 10% reduction in low-density lipoprotein cholesterol would prevent 2279 deaths from coronary heart disease (95% CI: 2025,2531 deaths) and 641 deaths from ischaemic stroke (95% CI: 440,881 deaths). The projected benefits are greatest among the elderly, although some benefit would be expected in all age and sex groups and among individuals with a broad range of baseline levels of low-density lipoprotein cholesterol. Conclusions:, A small leftward shift in the low-density lipoprotein cholesterol distribution of the adult Australian population has the potential to save about 3000 lives from coronary heart disease and stroke annually. Achieving this goal will require the active participation of key public health, food industry and government stakeholders. [source] Systematic review and meta-analysis of clinically relevant adverse events from HMG CoA reductase inhibitor trials worldwide from 1982 to present,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 2 2007David L. McClure PhD Abstract Purpose Our objective was to determine the association of clinically relevant adverse events from a systematic review and meta-analysis of statin randomized controlled trials (RCT). Methods We performed the meta-analysis in the manner of a Cochrane Collaboration systematic review. Outcomes were discontinuances of therapy or muscle-related symptoms due to adverse events. We searched for articles from 1982 through June 2006 in MEDLINE and other databases. The main inclusion criteria were double blind, placebo controlled RCTs with a monotherapy intervention of any marketed statin and active surveillance of adverse events. We excluded studies of drug interactions, organ transplants, or exercise, or those not meeting all of the study quality criteria. The primary analysis was a statin formulation stratified fixed-effect model using Peto odds-ratios (POR). Secondary analyses explored the stability of the primary results. Results Over 86,000 study participants from 119 studies were included. Available statins were associated with a lower POR of discontinuance (overall: 0.88 [0.84, 0.93], largest effect with pravastatin: 0.79 [0.74, 0.84]), an elevated POR of rhabdomyolysis (1.59 [0.54, 4.70]) and myositis (2.56 [1.12, 5.85]), and null odds of myalgia (1.09 [0.97, 1.23]). Cerivastatin by comparison demonstrated larger PORs for discontinuances and muscle-related adverse events. Secondary analyses demonstrated the stability of the results. Conclusions Overall, discontinuation of statin therapy due to adverse events was no worse than placebo. The risks of muscle-related adverse events were in general agreement with the known risks of statins. Copyright © 2006 John Wiley & Sons, Ltd. [source] Zoledronic acid delays the onset of skeletal-related events and progression of skeletal disease in patients with advanced renal cell carcinomaCANCER, Issue 5 2003Allan Lipton M.D. Abstract BACKGROUND The objective of this study was to assess the efficacy and safety of zoledronic acid in patients with bone metastases secondary to renal cell carcinoma (RCC). METHODS A retrospective subset analysis of patients with RCC enrolled in a multicenter, randomized, placebo-controlled study of zoledronic acid was performed. Patients were randomized to receive zoledronic acid (4 or 8 mg as a 15-minute infusion) or placebo with concomitant antineoplastic therapy every 3 weeks for 9 months. The primary efficacy analysis was the proportion of patients with one or more skeletal-related events (SREs), which were defined as pathologic fracture, spinal cord compression, radiation therapy, or surgery to bone. Secondary analyses included time to first SRE, skeletal morbidity rate (events per year), disease progression, and multiple event analysis. RESULTS In this subset of 74 patients with RCC, zoledronic acid (4 mg) was found to significantly reduce the proportion of patients with an SRE (37% vs. 74% for placebo; P = 0.015). Similarly, zoledronic acid significantly reduced the mean skeletal morbidity rate (2.68 vs. 3.38 for placebo; P = 0.014) and extended the time to the first event (median not reached vs. 72 days for placebo; P = 0.006). A multiple event analysis demonstrated that the risk of developing an SRE was reduced by 61% compared with placebo (hazard ratio of 0.394; P = 0.008). The median time to progression of bone lesions was significantly longer for patients who were treated with zoledronic acid (P = 0.014 vs. placebo). Zoledronic acid appeared to be well tolerated; the most common adverse events in all treatment groups included bone pain, nausea, anemia, and emesis. CONCLUSIONS Zoledronic acid (4 mg as a 15-minute infusion) demonstrated significant clinical benefit in patients with bone metastases from RCC, suggesting that further investigation of zoledronic acid in this patient population is warranted. Cancer 2003;98:962,9. © 2003 American Cancer Society. DOI 10.1002/cncr.11571 [source] The effect of fluoride gel on incipient carious lesions in a low-caries child populationCOMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY, Issue 4 2007Gert-Jan Truin Abstract,,, Objectives:, Secondary analyses were performed to study the cariostatic efficacy of semi-annual professional fluoride gel application on incipient carious lesions in low-caries children initially aged 9.5,11.5 years. Methods:, Double-blind randomized controlled clinical trial. Results:, The mean treatment effect of fluoride gel for enamel and dentinal caries lesions after 4 years' follow-up was 0.92 D2,3FS and 0.20 D3FS, respectively. When enamel lesions were included in the DFS count (i.e. D2,3FS), the preventive fraction (PF) showed borderline significance (23%; P = 0.05). No significant treatment effect of professionally applied fluoride gel was found for D2,3FS and D3FS scores of the second molars. The PF for D2,3FS of occlusal, approximal, buccal and lingual surfaces and for buccal and palatal pits and fissures differed not significantly. Conclusion:, Professionally applied fluoride gel showed no statistically significant caries-inhibiting effect on both enamel and dentine lesions in the permanent dentition of low-caries children. [source] Factors Associated with Physician Interventions to Address Adolescent SmokingHEALTH SERVICES RESEARCH, Issue 3 2004Tammy H. Sims Objective. To determine the percent of adolescent Medicaid patients with medical record documentation about tobacco use status and cessation assistance; and factors associated with providers documenting and intervening with adolescent smokers. Data Source. Secondary analysis of data collected in 1999 from medical records of Wisconsin Medicaid health maintenance organization (HMO) recipients 11 to 21 years old. Study Design. Random reviews and data collection were related to visits from January 1997 to January 1999. Data collected included patient demographics, provider type, number of visits, and whether smoking status and cessation interventions were documented. Data Extraction Methods. Medical charts were reviewed and a database was created using a data abstraction tool developed and approved by a committee to address tobacco use in Medicaid managed care participants. Principal Findings. Among adolescents seen by a physician from 1997 to 1999, tobacco use status was documented in 55 percent of patient charts. Most often tobacco use status was documented on history and physical or prenatal forms. Of identified adolescent smokers, 50 percent were advised to quit, 42 percent assisted, and 16 percent followed for smoking cessation. Pregnant patients were more likely to have tobacco use documented than nonpregnant patients (OR=10.8, 95 percent CI=4.9 to 24). The odds of documentation increased 21 percent for every one-year increase in patient age. Conclusions. Providers miss opportunities to intervene with adolescents who may be using tobacco. Medical record prompts, similar to the tobacco use question on prenatal forms and the tobacco use vital sign stamp, are essential for reminding providers to consistently document and address tobacco use among adolescents. [source] Risk of perineal damage is not a reason to discourage a sitting birthing position: a secondary analysisINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2010A. De Jonge Summary Aim:, To examine the association between semi-sitting and sitting position at the time of birth and perineal damage amongst low-risk women in primary care. Background:, Evidence on the association between birthing positions and perineal trauma is not conclusive. Most studies did not distinguish between positions during the second stage of labour and position at the time of birth. Therefore, although birthing positions do not seem to affect the overall perineal trauma rate, an increase in trauma with upright position for birthing cannot be ruled out. Methods:, Secondary analysis was performed on data from a large trial. This trial was conducted amongst primary care midwifery practices in the Netherlands. A total of 1646 women were included who had a spontaneous, vaginal delivery. Perineal outcomes were compared between women in recumbent, semi-sitting and sitting position. Logistic regression analysis was used to examine the effects of these positions after controlling for other factors. Findings:, No significant differences were found in intact perineum rates between the position groups. Women in sitting position were less likely to have an episiotomy and more likely to have a perineal tear than women in recumbent position. After controlling for other factors, the odds ratios (OR) were 0.29 [95% confidence interval (CI): 0.16,0.54] and 1.83 (95% CI: 1.22,2.73) respectively. Women in semi-sitting position were more likely to have a labial tear than women in recumbent position (OR: 1.43, 95% CI: 1.00,2.04). Conclusion:, A semi-sitting or sitting birthing position does not need to be discouraged to prevent perineal damage. Women should be encouraged to use positions that are most comfortable to them. [source] The effects of antidepressant medication adherence as well as psychosocial and clinical factors on depression outcome among older adultsINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 2 2008Hayden B. Bosworth Abstract Objective To examine the contribution of medication adherence to 12-month depression scores in the context of other psychosocial and clinical predictors of depression in a sample of older adults treated for depression. Methods Secondary analysis of a prospective cohort study involving 241 older patients undergoing depression treatment using a standardized algorithm. Depression was measured at baseline and 12-months post-baseline. Baseline predictor variables included antidepressant adherence, barriers to antidepressant adherence, four domains of social support, basic and instrumental activities of daily living (BADLs and IADLs), and clinical factors including past history of depression and medical comorbidities. Results Nearly 28% of patients reported being nonadherent with their antidepressant medication. In bivariate analyses, greater antidepressant medication nonadherence, more medication barriers, poorer subjective social support, less non-family interaction, greater BADL and IADL limitations, poor self-rated health, higher baseline depression scores, and not having diabetes were related to higher 12-month depression scores. In multivariable analyses, greater medication nonadherence, not having diabetes, poorer subjective social support, greater BADL limitations, and higher baseline depression scores were related to higher 12-month depression scores. Conclusion Interventions should be directed toward improving antidepressant adherence and modifiable psychosocial variables. Copyright © 2007 John Wiley & Sons, Ltd. [source] Are cognitively intact seniors with subjective memory loss more likely to develop dementia?INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 9 2002Philip St John Abstract Background Subjective memory loss (SML) is common in elderly persons. It is not clear if SML predicts the development of dementia. Objectives (1) to determine if SML in those with normal cognition predicts dementia or cognitive impairment without dementia (CIND); (2) to determine if an association is independent of the effect of age, gender and depressive symptoms. Methods Secondary analysis of the Manitoba Study of Health and Aging (MSHA), a population-based prospective study. Data were collected in 1991, and follow-up was done 5 years later. Community-dwelling seniors sampled randomly from a population-based registry in the Canadian province of Manitoba, stratified on age and region. Only those scoring in the normal range of the Modified mini-mental state examination (3MS) were included. Predictor variables were self-reported memory loss, 3MS, Center for epidemiological studies,depression scale (CES-D), age, gender, and education. Outcomes were mortality and cognitive impairment five years later. Results In bivariate analyses, SML was associated with both death and dementia. In multivariate models, SML did not predict mortality. After adjusting for age, gender, and depressive symptoms, SML predicted dementia. However, after adjusting for baseline 3MS score, SML did not predict dementia. Conclusions Memory complaints predict the development of dementia over five years, and clinicians should monitor these persons closely. However, the proportion of persons developing dementia was small, and SML alone is unlikely to be a useful clinical predictor of dementia. Copyright © 2002 John Wiley & Sons, Ltd. [source] Intimate partner violence and cardiovascular risk: is there a link?JOURNAL OF ADVANCED NURSING, Issue 10 2009Kelly Scott-Storey Abstract Title.,Intimate partner violence and cardiovascular risk: is there a link? Aim., This paper is a report of a study of the relationship between stress associated with intimate partner violence and smoking and cardiovascular risk. Background., Stress related to intimate partner violence persists after a woman leaves an abusive relationship. Persistent stress is associated with cardiovascular disease, the leading single cause of death among women. Smoking, an established risk factor for cardiovascular disease, is a coping mechanism commonly used to decrease the anxiety and stress of intimate partner violence. However, cardiovascular health is poorly understood in abused women. Method., Secondary analysis of data collected between 2004 and 2005 with a community sample of 309 women who had separated from an abusive partner 3 months to 3 years previously was conducted to create a descriptive profile of cardiovascular risk. Bivariate tests of association and logistic regression analysis were used to test relationships among variables. Results., Of the women, 44·1% were smokers; 53·2% had body mass indices classified as overweight or obese; 54·7% had blood pressures above normal range; and 50·8% reported cardiovascular symptoms. Neither severity of intimate partner violence nor smoking behaviours were statistically significant in explaining the presence of cardiovascular symptoms. Conclusion., The prevalence of hypertension, obesity and smoking suggests that survivors of intimate partner violence may be at heightened risk for cardiovascular disease and warrant clinical attention. Because cardiac symptoms develop as women get older, the mean age of 39 years in this sample may explain why intimate partner violence severity and smoking did not sufficiently explain the presence of cardiac symptoms. [source] The Overlap Syndrome of Depression and Delirium in Older Hospitalized PatientsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2009Jane L. Givens MD OBJECTIVES: To measure the prevalence, predictors, and posthospitalization outcomes associated with the overlap syndrome of coexisting depression and incident delirium in older hospitalized patients. DESIGN: Secondary analysis of prospective cohort data from the control group of the Delirium Prevention Trial. SETTING: General medical service of an academic medical center. Follow-up interviews at 1 month and 1 year post-hospital discharge. PARTICIPANTS: Four hundred fifty-nine patients aged 70 and older who were not delirious at hospital admission. MEASUREMENTS: Depressive symptoms assessed at hospital admission using the 15-item Geriatric Depression Scale (cutoff score of 6 used to define depression), daily assessments of incident delirium from admission to discharge using the Confusion Assessment Method, activities of daily living at admission and 1 month postdischarge, and new nursing home placement and mortality determined at 1 year. RESULTS: Of 459 participants, 23 (5.0%) had the overlap syndrome, 39 (8.5%) delirium alone, 121 (26.3%) depression alone, and 276 (60.1%) neither condition. In adjusted analysis, patients with the overlap syndrome had higher odds of new nursing home placement or death at 1 year (adjusted odds ratio (AOR)=5.38, 95% confidence interval (CI)=1.57,18.38) and 1-month functional decline (AOR=3.30, 95% CI=1.14,9.56) than patients with neither condition. CONCLUSION: The overlap syndrome of depression and delirium is associated with significant risk of functional decline, institutionalization, and death. Efforts to identify, prevent, and treat this condition may reduce the risk of adverse outcomes in older hospitalized patients. [source] Single-Point Assessment of Warfarin Use and Risk of Osteoporosis in Elderly MenJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2008Claudine Woo PhD OBJECTIVES: To determine whether warfarin use, assessed at a single point in time, is associated with bone mineral density (BMD), rates of bone loss, and fracture risk in older men. DESIGN: Secondary analysis of data from a prospective cohort study. SETTING: Six U.S. clinical centers. PARTICIPANTS: Five thousand five hundred thirty-three community-dwelling, ambulatory men aged 65 and older with baseline warfarin use data. MEASUREMENTS: Warfarin use was assessed as current use of warfarin at baseline using an electronic medication coding dictionary. BMD was measured at the hip and spine at baseline, and hip BMD was repeated at a follow-up visit 3.4 years later. Self-reported nonspine fractures were centrally adjudicated. RESULTS: At baseline, the average age of the participants was 73.6 ± 5.9, and 321 (5.8%) were taking warfarin. Warfarin users had similar baseline BMD as nonusers (n=5,212) at the hip and spine (total hip 0.966 ± 0.008 vs 0.959 ± 0.002 g/cm2, P=.37; total spine 1.079 ± 0.010 vs 1.074 ± 0.003 g/cm2, P=.64). Of subjects with BMD at both visits, warfarin users (n=150) also had similar annualized bone loss at the total hip as nonusers (n=2,683) (,0.509 ± 0.082 vs ,0.421 ± 0.019%/year, P=.29). During a mean follow-up of 5.1 years, the risk of nonspine fracture was similar in warfarin users and nonusers (adjusted hazard ratio=1.06, 95% confidence interval=0.68,1.65). CONCLUSION: In this cohort of elderly men, current warfarin use was not associated with lower BMD, accelerated bone loss, or higher nonspine fracture risk. [source] Psychometric Properties of the Activities-Specific Balance Confidence Scale and the Survey of Activities and Fear of Falling in Older WomenJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2008Kristine M.C. Talley MS OBJECTIVES: To compare the psychometric properties of the Activities-specific Balance Confidence Scale (ABC) and the Survey of Activities and Fear of Falling in the Elderly (SAFE). DESIGN: Secondary analysis using baseline and 12-week data from a randomized, controlled trial on fall prevention. SETTING: Upper Midwest metropolitan area with assessments conducted in participants' homes. PARTICIPANTS: Population-based sample of 272 noninstitutionalized female Medicare beneficiaries aged 70 and older at risk of falling. MEASUREMENTS: Participants self-administered the ABC, SAFE, Geriatric Depression Scale, and Medical Outcomes Study 36-item Short Form Survey. During a home visit, a nurse practitioner administered the Berg Balance Test and Timed Up and Go, measured gait speed, and asked about falls and chronic illnesses. RESULTS: Baseline internal consistency measured using Cronbach alpha was 0.95 for the ABC and 0.82 for the SAFE. Baseline concurrent validity between the ABC and SAFE measured using a correlation coefficient was ,0.65 (P<.001). ABC and SAFE scores were significantly correlated at baseline with physical performance tests and self-reported health status. The ABC had stronger baseline correlations than the SAFE with most measures. Neither instrument demonstrated responsiveness to change at 12 weeks. CONCLUSION: The ABC and SAFE demonstrated strong internal-consistency reliability and validity when self-administered. The ABC had stronger associations with physical functioning and may be more appropriate for studies focused on improving physical function. Both instruments demonstrated ceiling effects, which may explain the lack of responsiveness to change in relatively nonfrail older women. Instruments sensitive to measuring lower levels of fear of falling are needed to capture the full range of this phenomenon in this population. [source] Energy-Containing Nutritional Supplements Can Affect Usual Energy Intake Postsupplementation in Institutionalized Seniors with Probable Alzheimer's DiseaseJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2006Matthew D. Parrott BSc OBJECTIVES: To determine whether increases in caloric intake associated with consumption of a mid-morning nutritional supplement for 3 weeks were maintained in the week after stopping the supplement and to investigate the effects of body mass index (BMI) and cognitive and behavioral measures on this response. DESIGN: Secondary analysis of a previously published randomized, crossover, nonblinded clinical trial. SETTING: A fully accredited geriatric care facility affiliated with the University of Toronto. PARTICIPANTS: Thirty institutionalized seniors with probable Alzheimer's disease (AD) who ate independently. MEASUREMENTS: Investigator-weighed food intake, body weight, cognitive (Severe Impairment Battery; Global Deterioration Scale) and behavioral (Neuropsychiatric Inventory,Nursing Home version; London Psychogeriatric Rating Scale) assessments. RESULTS: Individuals who responded successfully to supplementation as indicated by increases in daily energy intake were likely to maintain 58.8% of that increase postsupplementation, although stopping the supplement was associated with decreased habitual energy intake in low-BMI individuals who reduced their daily intakes during supplementation in response to the extra calories. Cognitive/behavioral tests were not reliable predictors of postsupplement intake. CONCLUSION: Institutionalized seniors with probable AD are likely to alter their usual energy intakes to maintain changes resulting from 3 weeks of supplementation. This effect may allow for rotating supplementation schedules in nursing homes that could reduce staff burden, but only for those individuals who are most likely to respond favorably. These data indicate that nutritional supplements and diet plans should be carefully prescribed in low-BMI individuals to limit variability in total energy provided and thus prevent lower-than-normal intake. [source] Meaningful Change and Responsiveness in Common Physical Performance Measures in Older AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2006Subashan Perera PhD OBJECTIVES: To estimate the magnitude of small meaningful and substantial individual change in physical performance measures and evaluate their responsiveness. DESIGN: Secondary data analyses using distribution- and anchor-based methods to determine meaningful change. SETTING: Secondary analysis of data from an observational study and clinical trials of community-dwelling older people and subacute stroke survivors. PARTICIPANTS: Older adults with mobility disabilities in a strength training trial (n=100), subacute stroke survivors in an intervention trial (n=100), and a prospective cohort of community-dwelling older people (n=492). MEASUREMENTS: Gait speed, Short Physical Performance Battery (SPPB), 6-minute-walk distance (6MWD), and self-reported mobility. RESULTS: Most small meaningful change estimates ranged from 0.04 to 0.06 m/s for gait speed, 0.27 to 0.55 points for SPPB, and 19 to 22 m for 6MWD. Most substantial change estimates ranged from 0.08 to 0.14 m/s for gait speed, 0.99 to 1.34 points for SPPB, and 47 to 49 m for 6MWD. Based on responsiveness indices, per-group sample sizes for clinical trials ranged from 13 to 42 for substantial change and 71 to 161 for small meaningful change. CONCLUSION: Best initial estimates of small meaningful change are near 0.05 m/s for gait speed, 0.5 points for SPPB, and 20 m for 6MWD and of substantial change are near 0.10 m/s for gait speed, 1.0 point for SPPB, and 50 m for 6MWD. For clinical use, substantial change in these measures and small change in gait speed and 6MWD, but not SPPB, are detectable. For research use, these measures yield feasible sample sizes for detecting meaningful change. [source] The Effectiveness of a Community-Based Program for Reducing the Incidence of Falls in the Elderly: A Randomized TrialJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2004Lindy Clemson BAppSc(OT), MAppSc(OT) Objectives: To test whether Stepping On, a multifaceted community-based program using a small-group learning environment, is effective in reducing falls in at-risk people living at home. Design: A randomized trial with subjects followed for 14 months. Setting: The interventions were conducted in community venues, with a follow-up home visit. Participants: Three hundred ten community residents aged 70 and older who had had a fall in the previous 12 months or were concerned about falling. Intervention: The Stepping On program aims to improve fall self-efficacy, encourage behavioral change, and reduce falls. Key aspects of the program are improving lower-limb balance and strength, improving home and community environmental and behavioral safety, encouraging regular visual screening, making adaptations to low vision, and encouraging medication review. Two-hour sessions were conducted weekly for 7 weeks, with a follow-up occupational therapy home visit. Measurements: The primary outcome measure was falls, ascertained using a monthly calendar mailed by each participant. Results: The intervention group experienced a 31% reduction in falls (relative risk (RR)=0.69, 95% confidence interval (CI)=0.50,0.96; P=.025). This was a clinically meaningful result demonstrating that the Stepping On program was effective for community-residing elderly people. Secondary analysis of subgroups showed that it was particularly effective for men (n=80; RR=0.32, 95% CI=0.17,0.59). Conclusion: The results of this study renew attention to the idea that cognitive-behavioral learning in a small-group environment can reduce falls. Stepping On offers a successful fall-prevention option. [source] Hospice Usage by Minorities in the Last Year of Life: Results from the National Mortality Followback SurveyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2003K. Allen Greiner MD OBJECTIVES: To examine racial/ethnic variations in rates of hospice use in a national cohort and to identify individual characteristics associated with hospice use. DESIGN: Secondary analysis of the 1993 National Mortality Followback Survey (NMFS), a nationally obtained sample using death certificates and interviews with relatives (proxy respondents) to provide mortality, social, and economic data and information about healthcare utilization in the last year of life for 23,000 deceased individuals. SETTING: Hospice care. PARTICIPANTS: Individuals aged 15 and older who died in 1993. Subjects were included in this analysis if they died of nontraumatic causes (N = 11,291). MEASUREMENTS: Hospice use was dichotomized by proxy responses indicating use or nonuse of home or inpatient hospice services. The percentage of individuals using hospice services in the last year of life was calculated. RESULTS: Unadjusted bivariate results found that African Americans were less likely to use hospice than whites (odds ratio (OR) = 0.59; P < .001) and that those without a living will (LW) (OR = 0.23; P < .001) and without a cancer diagnosis (OR = 0.28; P < .001) were less likely to use hospice. The negative relationship between African Americans and hospice use was unaffected when controlled for sex, education, marital status, existence of a LW, income, and access to health care. Logistic models revealed that presence of a LW diminished the negative relationship between African Americans and hospice use, but the latter remained significant (OR = 0.83; P = .033). A subanalysis of subjects aged 55 and older showed a significant interaction between access to care and race/ethnicity with respect to hospice use (P = .044). Inclusion of income in this multivariable logistic model attenuated the relationship between African-American race/ethnicity and hospice use (OR = 0.77), and the difference between whites and African Americans became only marginally statistically significant (P = .060). CONCLUSION: In the 1993 NMFS, hospice use was negatively associated with African-American race/ethnicity independent of income and access to healthcare. The relationship is not independent of age, insurance type, or history of stroke. For subjects aged 55 and older, access to healthcare may be an important confounder of the negative relationship between African-American race/ethnicity and hospice use. Consistent with previous studies, this analysis found that African Americans were less likely to use LWs than whites. The reduced importance of African-American race/ethnicity on hospice use with the inclusion of presence of a LW in logistic models suggests that similar cultural processes may shape differences between African Americans and whites in advance care planning and hospice use. [source] Nursing care quality and adverse events in US hospitalsJOURNAL OF CLINICAL NURSING, Issue 15-16 2010Robert J Lucero Aim., To examine the association between nurses' reports of unmet nursing care needs and their reports of patients' receipt of the wrong medication or dose, nosocomial infections and patient falls with injury in hospitals. Background., Because nursing activities are often difficult to measure, and data are typically not collected by health care organisations, there are few studies that have addressed the association between nursing activities and patient outcomes. Design., Secondary analysis of cross-sectional data collected in 1999 from 10,184 staff nurses and 168 acute care hospitals in the US. Methods., Multivariate linear regression models estimated the effect of unmet nursing care needs on adverse events given the influence of patient factors and the care environment. Results., The proportion of necessary nursing care left undone ranged from 26% for preparing patients and families for discharge to as high as 74% for developing or updating nursing care plans. A majority of nurses reported that patients received the wrong medication or dose, acquired nosocomial infections, or had a fall with injury infrequently. However, nurses who reported that these adverse events occurred frequently varied considerably [i.e. medication errors (15%), patient falls with injury (20%), nosocomial infection (31%)]. After adjusting for patient factors and the care environment, there remained a significant association between unmet nursing care needs and each adverse event. Conclusion., The findings suggest that attention to optimising patient care delivery could result in a reduction in the occurrence of adverse events in hospitals. Relevance to clinical practice., The occurrence of adverse events may be mitigated when nurses complete care activities that require them to spend time with their patients. Hospitals should engage staff nurses in the creation of policies that influence human resources management to enhance their awareness of the care environment and patient care delivery. [source] Patient perceptions of helpful communication in the context of advanced cancerJOURNAL OF CLINICAL NURSING, Issue 13-14 2010Kelli I Stajduhar Aims and objectives., Based on a secondary analysis of data from a large qualitative study on cancer care communication, we address the question: what do patients with advanced cancer identify as helpful in their communication encounters with health care providers? Background., Communication is of critical importance to the care of patients with advanced cancer. A better understanding of what such patients identify as helpful in their communication encounters with nurses and other health care providers seems critical to creating evidence-informed recommendations for best practices. Design., Secondary analysis of qualitative interview data. Methods., Data from 18 participants interviewed individually and 16 focus group participants, with advanced cancer in the palliative phase of care. Interpretive description methodology informed data collection and analysis. Results., Findings suggest four key elements are critically important to consider in communications with patients in an advanced or palliative phase , respecting the importance of time, demonstrating caring, acknowledging fear and balancing hope and honesty in the provision of information. Conclusions., Communication is an important element in the provision of advanced cancer care. Relevance to clinical practice., Findings emphasise the complex meanings inherent in cancer care communication and identify central themes that are fundamental to effective cancer care communication. [source] | ||||||||||||||||||||||||||||||||||||||||