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Decreased Odds (decreased + odds)
Selected AbstractsHepatitis C virus risk behaviors within the partnerships of young injecting drug usersADDICTION, Issue 7 2010Judith A. Hahn ABSTRACT Aims Young injection drug users (IDU) are at high risk for hepatitis C virus (HCV). We sought to determine whether perceiving one's injecting partner to be HCV positive was associated with decreased odds of engaging in receptive needle/syringe sharing (RNS) or ancillary equipment sharing (AES) with that partner. Design Cross sectional study. Setting 2003 to 2007 in San Francisco. Participants 212 young (under age 30) IDU who were HCV antibody negative reported on 492 injecting partnerships. Measurements Self-reported RNS and AES within injecting partnerships. Findings RNS and AES (in the absence of RNS) occurred in 23% and 64% of injecting partnerships in the prior month. The odds of engaging in RNS were significantly lower for relationships in which the participant reported that his/her partner was HCV positive (odds ratio [OR] 0.49; 95% confidence interval [CI] 0.25,0.95). This association was attenuated when adjusted for reusing one's own needle/syringe (adjusted OR 0.57; 95% CI 0.28,1.15). The odds of engaging in AES were lower for participants who did not know the HCV status of their partner, only among non-sexual partnerships (OR 0.47; 95% CI 0.29,0.76). Conclusions Because perceiving one's partner to be HCV positive was associated with decreased RNS, increased HCV testing and partner disclosure may be warranted. AES was common and was decreased only among non-sexual partnerships in which the HCV status of the partner was not known. This suggests that interventions to reduce AES in young IDU must be widespread. [source] The Use of Scripting at Triage and Its Impact on ElopementsACADEMIC EMERGENCY MEDICINE, Issue 5 2010Daniel A. Handel MD Abstract Objectives:, The objective of this study was to measure the effect of scripting language at triage on the likelihood of elopements, controlling for patient volume and other potential confounding variables. Methods:, This was a pre- and postintervention cohort study using the same 5-month period (November 2007,March 2008 and November 2008,March 2009, respectively) that included in the analysis all patients 21 years of age and older, who presented to the triage window in the emergency department (ED) waiting room (not by ambulance). As part of the scripting, triage nurses informed patients of the longest waiting time (at that point in time) for any patients still waiting to be brought back from the waiting room into the ED. Rates of elopement were compared between patients who did and did not receive the scripting, controlling for individual and daily ED variables. Results:, A total of 24,390 ED visits were included in this analysis. The elopement rate was 4.4% among ED patients in the prescripting period, compared to 2.3% in the postscripting period. In a multivariate logistic regression model, the use of scripting was significantly associated with decreased odds of elopement, compared to the nonscripting group (odds ratio [OR] = 0.61, 95% confidence interval [CI] = 0.46 to 0.80). Conclusions:, The use of triage scripting was found to significantly reduce elopement rates in patients placed in the ED waiting room, even after controlling for other confounding variables. Scripting is a simple and underutilized technique that can have a positive effect for patients and the ED. ACADEMIC EMERGENCY MEDICINE 2010; 17:495,500 © 2010 by the Society for Academic Emergency Medicine [source] Limited Response to Cardiac Resynchronization Therapy in Patients with Concomitant Right Ventricular DysfunctionJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2010M.P.H., PAUL B. TABEREAUX M.D. Limited Response to CRT in Patients with RVD.,Introduction: Patients with left ventricular dysfunction (LVD) and LV dyssynchrony may respond to cardiac resynchronization therapy (CRT). However, right ventricular dysfunction (RVD) is a predictor of decreased survival in patients with LVD, and its influence on clinical response to CRT is unknown. The purpose of this study was to examine the effect of RVD on the clinical response to CRT. Methods and Results: A retrospective cohort of consecutive patients who underwent implantation of a CRT implantable cardioverter-defibrillator (ICD) were included and deemed to have RVD based on a RV ejection fraction <0.40. A lack of response to CRT was defined as: death, heart transplantation, implantation of an LV assist device, absent improvement in NYHA functional class at 6 months or hospice care. Among 130 patients included (mean age 58 ± 11 years, 68.5% male, 87.7% Caucasian, 51.5% nonischemic cardiomyopathy), 77 (59.2%) had no response to CRT as defined above. Of the nonresponders, 43 (56%) had RVD and 34 (44%) did not have RVD (P = 0.02). After adjustment for age, race, gender, cardiomyopathy type, atrial fibrillation, serum sodium, and severe mitral regurgitation, RVD (adjusted OR = 0.34, 95%CI 0.14,0.82), female gender (adjusted OR = 0.36, 95%CI 0.14,0.95), and serum creatinine (adjusted OR = 0.25, 95%CI 0.09,0.71) were independently associated with decreased odds of response to CRT. There was a significant difference in survival of patients with and without RVD after CRT (log rank P = 0.01). Conclusion: RVD represents a strong predictor of lack of clinical response to CRT in patients with CHF due to LVD and should be considered when prescribing CRT. (J Cardiovasc Electrophysiol, Vol. 21, pp. 431,435, April 2010) [source] Epidemiology of slow and fast colonic transit using a scale of stool form in a communityALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2007R. S. CHOUNG Summary Background, Measurement of gastrointestinal transit is commonly performed in the clinic, but data on transit in the community are lacking. Aim, To estimate the prevalence of slow and fast colonic transit using stool form, and potential risk factors. Methods, A validated self-reported gastrointestinal symptom questionnaire was mailed to 4196 randomly selected members of the community (response rate 54%). One question asked the subject to self-report their stool form using the Bristol Stool Scale. Results, Overall, 18%, 9% and 73% met stool form criteria for slow, fast or normal colonic transit, respectively. Increased odds for slow transit were observed with a higher Somatic Symptom Checklist score (OR = 1.6; 1.3,2.0), while a decreased odds for slow transit was observed in males relative to females (OR = 0.6; 0.5,0.8). An increased odds for fast transit was observed with higher Somatic Symptom Checklist score (OR = 2.3; 1.7,2.9) and a history of cholecystectomy (OR = 1.8; 1.2,2.8). Increasing body mass index (per 5 units) was associated with decreased odds for slow (OR = 0.85; 0.78,0.93), and an increased odds for fast (OR = 1.1; 1.04,1.24) colonic transit. Conclusion, Based on stool form assessment, nearly one in five community members may have slow colonic transit and one in 12 have accelerated colonic transit. [source] Prevalence of and risk factors for prostatitis in African American men: The Flint Men's Health StudyTHE PROSTATE, Issue 1 2009Lauren P. Wallner Abstract INTRODUCTION Prostatitis is a common, yet ill-defined condition without clear diagnostic criteria and treatment strategies. Previous studies examining the prevalence and correlates of prostatitis are limited in their inclusion of primarily white populations. The objective of the current study was to identify prevalence of and risk factors for prostatitis in a population-based sample of African-American men. METHODS In 1996, a probability sample of 703 African-American men, aged 40,79, residing in Genesee County, Michigan without a prior history of prostate cancer/surgery provided responses to a structured interview-administered questionnaire which elicited information regarding sociodemographics, current stress and health ratings, and past medical history, including history of physician diagnosed prostatitis, BPH and sexually transmitted diseases. Logistic regression was used to identify predictors of prostatitis after adjustment for age. RESULTS Forty-seven (6.7%) of the 703 men reported a history of prostatitis. Increased frequency of sexual activity and physical activity were significantly associated with decreased odds of disease. Moderate to severe lower urinary tract symptoms (LUTS) and a history of BPH were significantly associated with prostatitis after adjustment for age. CONCLUSION After adjustment for age, LUTS severity and history of BPH were associated with increased odds of prostatitis. BMI, physical activity and sexual frequency were associated with decreased odds of prostatitis. Finally, poor emotional and physical health, high perceived stress and low social support were associated with an increased risk of prostatitis history. Importantly, these findings suggest that the primary risk factors for this condition are largely modifiable and highlight potential targets for future prevention. Prostate 69: 24,32, 2009. © 2008 Wiley,Liss, Inc. [source] Failure of Intimate Partner Violence Screening Among Patients With Substance Use DisordersACADEMIC EMERGENCY MEDICINE, Issue 8 2010Esther K. Choo MD ACADEMIC EMERGENCY MEDICINE 2010; 17:886,889 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, This study examined the relationship between substance use disorder (SUD) and intimate partner violence (IPV) screening and management practices in the emergency department (ED). Methods:, This was a retrospective cohort study of adult ED patients presenting to an urban, tertiary care teaching hospital over a 4-month period. An automated electronic data abstraction process identified consecutive patients and retrieved visit characteristics, including results of three violence screening questions, demographic data, triage acuity, time of visit, and International Classifications of Disease, 9th revision (ICD-9), diagnosis codes. Data on management were collected using a standardized abstraction tool by two reviewers masked to the study question. Multivariate logistic regression was used to determine predictors of screening and management. Results:, In 10,071 visits, 6,563 violence screens were completed. IPV screening was documented in 33.5% of patients with alcohol-related diagnoses (95% confidence interval [CI] = 27.7% to 39.3%, ,2 = 116.78, p < 0.001) and 53.3% of patients with drug-related diagnoses (95% CI = 44.3% to 62.3%, ,2 = 7.69, p = 0.006), compared to 66.1% of patients without these diagnoses (95% CI = 65.2% to 67.1%). In the multivariate analysis, alcohol (odds ratio [OR] = 0.30, 95% CI = 0.22 to 0.40) and drug use (OR = 0.56, 95% CI = 0.38 to 0.83) were associated with decreased odds of screening. Of completed screens, 429 (6.5%) were positive, but violence was addressed further in only 55.7% of patients. Substance abuse did not appear to affect the odds of having positive screens addressed further by providers (OR = 1.96, 95% CI = 0.39 to 10.14). Conclusions:, This study found an association between SUD and decreased odds of IPV screening. Failure to screen for IPV in the setting of substance use may represent a missed opportunity to address a critical health issue and be a barrier to successful intervention. [source] | ||||||||||