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Different Risk Profiles (different + risk_profile)
Selected AbstractsAcute ischemic stroke and transient ischemic attack in the very old , risk factor profile and stroke subtype between patients older than 80 years and patients aged less than 80 yearsEUROPEAN JOURNAL OF NEUROLOGY, Issue 8 2007J. I. Rojas Old age groups have different risk profile and stroke features compared to younger groups. Our aim was to examine the risk factor profile and stroke subtype in patients older than 80 years with ischemic stroke. Data of 535 patients with ischemic stroke or transient ischemic attack (TIA) were prospectively recorded. Cardiovascular risk factors and stroke subtype in individuals aged 80 years or older were compared with patients under 80. Of 535 patients a total of 179 were over 80 years (33.5%). The mean age was 84.4 ± 4.4 years (61.8%; 111 women). The most common risk factors included hypertension (82.7%) and hyperlipidemia (40.2%). Lacunar stroke was the most frequent subtype of stroke (41.7%). When the groups were compared, we observed the following risk factors more frequently in the group older than 80: female patients (P = <0.001), hypertension (OR = 1.62), atrial fibrillation (OR = 2.64); whereas diabetes (OR = 0.54), hyperlipidemia (OR = 0.57), smoking (OR = 0.17) and obesity (OR = 0.58) were more frequent in the group younger than 80. In the old group we found a high incidence of ischemic stroke in women. We also found a higher frequency of hypertension and atrial fibrillation. The available and future epidemiological data will provide a better knowledge about the effect of typical risk factors in old people. [source] Magnetic Resonance Imaging of Implantable Cardiac Rhythm Devices at 3.0 TeslaPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2008J. ROD GIMBEL M.D. Background: A relaxation of the prohibition of scanning cardiac rhythm device patients is underway, largely because of the growing experience of safe scanning events at 1.5T. Magnetic resonance imaging (MRI) at 3T is becoming more common and may pose a different risk profile and outcome of MRI of cardiac device patients. Methods: No restrictions were placed on pacemaker dependency, region scanned, device type, or manufacturer. Sixteen scans at 3T were performed with an electrophysiologist present on 14 patients with a variety of devices from various manufacturers. An "MRI-S" strategy was used. Multimodal monitoring was required. Device interrogation was performed prior to, immediately after, and 1,3 months after the MRI. For nonpacemaker-dependent device patients, attempts were made to turn all device features off (with OOO programming the goal) conceptually rendering the device "invisible." In pacemaker-dependent patients, the device was programmed to asynchronous mode at highest output for the duration of the scan with the goal of rendering the device conceptually "invulnerable" to MRI effects. The specific absorption rate (SAR) was limited to 2W/kg. Results: All patients were successfully scanned. No arrhythmias were noted. No significant change in the programmed parameters, pacing thresholds, sensing, impedance, or battery parameters was noted. The insertable loop recorder (ILR) recorded prolonged artifactual asystole during MRI. One patient noted chest burning during the scan. Conclusions: Device patients may undergo carefully tailored 3T MRI scans when pre-MRI reprogramming of the device occurs in conjunction with extensive monitoring, supervision, and follow-up. [source] Policy options for alcohol price regulation: the importance of modelling population heterogeneityADDICTION, Issue 3 2010Petra Sylvia Meier ABSTRACT Context and aims Internationally, the repertoire of alcohol pricing policies has expanded to include targeted taxation, inflation-linked taxation, taxation based on alcohol-by-volume (ABV), minimum pricing policies (general or targeted), bans of below-cost selling and restricting price-based promotions. Policy makers clearly need to consider how options compare in reducing harms at the population level, but are also required to demonstrate proportionality of their actions, which necessitates a detailed understanding of policy effects on different population subgroups. This paper presents selected findings from a policy appraisal for the UK government and discusses the importance of accounting for population heterogeneity in such analyses. Method We have built a causal, deterministic, epidemiological model which takes account of differential preferences by population subgroups defined by age, gender and level of drinking (moderate, hazardous, harmful). We consider purchasing preferences in terms of the types and volumes of alcoholic beverages, prices paid and the balance between bars, clubs and restaurants as opposed to supermarkets and off-licenses. Results Age, sex and level of drinking fundamentally affect beverage preferences, drinking location, prices paid, price sensitivity and tendency to substitute for other beverage types. Pricing policies vary in their impact on different product types, price points and venues, thus having distinctly different effects on subgroups. Because population subgroups also have substantially different risk profiles for harms, policies are differentially effective in reducing health, crime, work-place absence and unemployment harms. Conclusion Policy appraisals must account for population heterogeneity and complexity if resulting interventions are to be well considered, proportionate, effective and cost-effective. [source] Application of a propensity score to adjust for channelling bias with NSAIDs,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 6 2004S. V. Morant Abstract Purpose To compare the relative risks of upper GI haemorrhage (UGIH) in users of Newer versus Older, non-specific NSAIDs when adjusted for channelling bias by regression on individual covariates, a propensity score and both. Methods Cohort study of patients prescribed NSAIDs between June 1987 and January 2000. Exposure to Newer and Older non-specific NSAIDs was identified, and risk factors evaluated for each patient. Results of multiple covariate analyses and the propensity scoring technique to assess potential channelling bias in comparisons between Newer and Older non-specific NSAIDs were compared. Results This study included 7.1 thousand patient years (tpy) exposure to meloxicam, 1.6,tpy exposure to coxibs, and 628,tpy exposure to Older non-specific NSAIDs. Patients receiving Newer NSAIDs were older, more likely to have a history of GI symptoms, and at higher risk for GI complications. Adjusting for these risk factors reduced the relative risks of UGIH on meloxicam and coxibs versus Older non-specific NSAIDs to 0.84 (95%CI 0.60, 1.17) and 0.36 (0.14, 0.97) respectively. Conclusions Channelling towards high GI risk patients occurred in the prescribing of Newer NSAIDs. Propensity scores highlighted the markedly different risk profiles of users of Newer and Older non-specific NSAID. Correcting for channelling bias, coxib exposure, but not meloxicam exposure, was associated with less UGIH than Older non-specific NSAID exposure. In the present study, corrections made by regression on a propensity score and on individual covariates were similar. Copyright © 2004 John Wiley & Sons, Ltd. [source] Selection bias in Teratology Information Service pregnancy outcome studiesBIRTH DEFECTS RESEARCH, Issue 2 2001K. A. Johnson Background Pregnancy outcome studies conducted through Teratology Information Services (TIS) rely on volunteer subjects. If these subjects tend to have different risk profiles than the population from which they are drawn, the results of TIS studies may have limited generalizability. Methods We selected all subjects who enrolled in the California Teratogen Information Service (CTIS) pregnancy outcome study for prenatal exposure to carbamazepine or valproic acid between 1990 and 1997 and who received prenatal care through Kaiser Permanente of Southern California (n = 13). We compared these subjects to Kaiser patients identified through the Maternal Serum Alpha Fetoprotein Program with exposure to carbamazepine or valproic acid but who had not enrolled in the CTIS project. The controls were matched by Kaiser location and pregnancy year using a 2:1 ratio (n = 26). Medical records were reviewed and the prevalence of 14 pregnancy risk factors was compared between the two groups. Results There were no significant differences between the groups on any one risk factor; however, a notably higher proportion of women who did not enroll in the CTIS study used tobacco or had a positive family history of congenital anomalies. Conclusions Although the sample was small, and results may not apply to other exposures in different health care environments, these data provide some evidence that women who enroll in TIS pregnancy outcome studies do not have a substantially different pregnancy risk profile than women who do not. Efforts to address possible selection bias should be incorporated in future TIS study design. Teratology 64:79,82, 2001. © 2001 Wiley-Liss, Inc. [source] | ||||||||||