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Significant Predictors (significant + predictor)
Kinds of Significant Predictors Selected AbstractsChanges and predictors of change in the physical health status of heroin users over 24 monthsADDICTION, Issue 3 2009Anna Williamson ABSTRACT Aims (i) To describe the course of physical health among the ATOS cohort over 24 months; and (ii) to examine the effects of treatment, drug use patterns and social and psychological factors on health status over 24 months. Design Longitudinal cohort. Setting Sydney, Australia. Participants A total of 615 heroin users recruited for the Australian Treatment Outcome Study (ATOS). Findings The general health of the cohort improved significantly over 24 months. Significant predictors of poor health over 24 months were: being older, being female, past month heroin, other opiate and tobacco use, past month unemployment and current major depression. Spending a greater proportion of time in residential rehabilitation (RR) was associated with better health over 24 months. No other treatment factors demonstrated a significant, independent relationship with health. Conclusions The physical health of dependent heroin users is affected by drug use and psychosocial problems. RR treatment appears to be particularly beneficial to the health of heroin users, suggesting the importance of a comprehensive approach to improving health among this group. [source] Elevated prevalence of hepatitis C infection in users of United States veterans medical centers,HEPATOLOGY, Issue 1 2005Jason A. Dominitz Several studies suggest veterans have a higher prevalence of hepatitis C virus infection than nonveterans, possibly because of military exposures. The purpose of this study was to estimate the prevalence of anti,hepatitis C antibody and evaluate factors associated with infection among users of Department of Veterans Affairs medical centers. Using a two-staged cluster sample, 1,288 of 3,863 randomly selected veterans completed a survey and underwent home-based phlebotomy for serological testing. Administrative and clinical data were used to correct the prevalence estimate for nonparticipation. The prevalence of anti,hepatitis C antibody among serology participants was 4.0% (95% CI, 2.6%-5.5%). The estimated prevalence in the population of Veterans Affairs medical center users was 5.4% (95% CI, 3.3%-7.5%) after correction for sociodemographic and clinical differences between participants and nonparticipants. Significant predictors of seropositivity included demographic factors, period of military service (e.g., Vietnam era), prior diagnoses, health care use, and lifestyle factors. At least one traditional risk factor (transfusion or intravenous drug use) was reported by 30.2% of all subjects. Among those testing positive for hepatitis C antibody, 78% either had a transfusion or had used injection drugs. Adjusting for injection drug use and nonparticipation, seropositivity was associated with tattoos and incarceration. Military-related exposures were not found to be associated with infection in the adjusted analysis. In conclusion, the prevalence of hepatitis C in these subjects exceeds the estimate from the general US population by more than 2-fold, likely reflecting more exposure to traditional risk factors among these veterans. (HEPATOLOGY 2005;41:88,96.) [source] Incidence of anaemia among HIV-infected patients treated with highly active antiretroviral therapy,HIV MEDICINE, Issue 8 2007SM Curkendall Objective The aim of the study was to compare the incidence of anaemia in patients treated with zidovudine (ZDV) with that in patients treated with highly active antiretroviral therapy (HAART) not including ZDV. Methods Using HIV Insight, a database of abstracted US HIV care centre medical charts, ZDV-naïve patients starting ZDV-containing HAART were compared with those starting non-ZDV, nucleoside reverse transcriptase inhibitor-containing HAART. Cohorts were divided as follows: group 1: without baseline anaemia [haemoglobin (Hb) ,11 g/dL]; group 2: with baseline anaemia (Hb <11 g/dL). The incidence of anaemia (anaemia diagnosis, Hb <11 g/dL, erythropoietic therapy or blood transfusion) was computed for group 1. The anaemia hazard ratio (HR) was adjusted using Cox regression. The rate of worsening anaemia (Hb decrease ,1.0 g/dL) was computed for group 2. Results In group 1, the incidence of anaemia was 24.3 and 8.1 per 100 person-years in the ZDV and non-ZDV cohorts, respectively, after 6 months of follow-up, and 12.5 and 5.3 per 100 person-years after 24 months. Significant predictors of anaemia were ZDV, low initial Hb, injecting drug use, CD4 count <200 cells/,L and AIDS. The adjusted HR for ZDV was 1.6 (P=0.005). In group 2, the ZDV/non-ZDV risk ratio for worsening anaemia was 2.2 (95% confidence interval 1.1,4.3). Conclusions Patients initiating ZDV-containing HAART are at greater risk of developing new anaemia or worsening anaemia than patients initiating non-ZDV-containing HAART. [source] Comparison of the prevalence and risk factors for depressive symptoms among elderly nursing home residents in Taiwan and Hong KongINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2005Yun-Fang Tsai Abstract Background Depression in the elderly has become a serious health care issue worldwide. However, no studies have compared the prevalence and risk factors for depressive symptoms among institutionalized Chinese elders living in different regions. Objectives To explore and compare the prevalence and risk factors for depressive symptoms among elderly residents of nursing homes in Taiwan and Hong Kong. Methods Random sampling was used to recruit participants from eight nursing homes in each region. A total of 150 elders from Taiwan and 214 elders from Hong Kong participated. Results The prevalence of depressive symptoms was significantly higher in participants from Hong Kong (65.4%) than in Taiwan (43.3%). Logistic regression analysis indicated that gender, satisfaction with living situation, perceived health condition, and perceived income adequacy significantly predicted depressive symptoms in elderly nursing home residents in Taiwan. Significant predictors of depressive symptoms in the Hong Kong sample were satisfaction with living situation, cognitive status, and functional status. Conclusions It is important to consider risk factors specific to a target population when developing depression intervention programs. Copyright © 2005 John Wiley & Sons, Ltd. [source] Psychopathology and autobiographical memory in stroke and non-stroke hospitalized patientsINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 1 2003Mark John Sampson Abstract Background Psychopathology and autobiographical memory were investigated in a cohort of stroke and non-stroke hospitalized patients. Both these cohorts have been identified as having high levels of psychopathology (Katon and Sullivan 1990; Burvill et al., 1995). Difficulties recalling specific autobiographical memories (overgeneral memory) have been identified as important psychological variables in depression and predictors of outcome (Williams and Scott 1988; Brittlebank et al., 1993). Intrusive autobiographical memories have also been found to be associated with depression and overgeneral memory in depressed women (Kuyken and Brewin, 1995) and depressed cancer patients (Brewin et al., 1998a). This study looked at levels of psychopathology and autobiographical memories in stroke and non-stroke hospital patients. Method 417 patients were screened, of the 176 eligible 103 agreed to participate (54 stroke and 49 non-stroke). Participants were assessed for overgenerality using the Autobiographical Memory Test and intrusiveness of memories using the Impact of Events Scale. Also assessed were PTSD-like symptoms (PCL-S), mood (HADS, GHQ-28) and cognitive ability (MMSE, verbal fluency, digit span and estimated pre-morbid IQ). Results No significant differences were found between stroke and non-stroke patients on severity of depression, anxiety, severity of PTSD-like symptoms or autobiographical memories. Backward multivariate regression analyses for combined data (stroke and non-stroke) indicated that overgeneral memory recall, intrusive memories of past events and intrusive memories of illness were significant independent predictors of depression (HADS). Avoidance of intrusive memories and reported childhood distress were not predictors of overgeneral memory recall. Significant predictors of overgeneral memory recall were; Gender, antidepressant medication, and estimated IQ. Conclusion Significant levels of psychopathology were identified in this cohort. However, there were no significant differences in the levels of depression, anxiety, PTSD symptoms and autobiographical memory between stroke and non-stroke hospitalized patients. Of particular interest was the finding that PTSD-like symptoms did not appear to be influenced by the nature of the person's illness. In combined data (stroke and non-stroke) autobiographical memories (intrusive images of their illness, intrusive memories of other events and overgeneral memory recall variables) were significant predictors of depression in this cohort. This suggests that psychological intervention of memory processes may be a worthwhile target in psychological intervention for depression in these cohorts. Gender, cognitive impairment, antidepressant medication, and estimated IQ were significant predictors of overgeneral memory recall and further investigation into the validity of these findings are warranted. Suggestions for further research and limitations of the study are also discussed. Copyright © 2002 John Wiley & Sons, Ltd. [source] Practitioner assessments of ,good enough' parenting: factorial surveyJOURNAL OF CLINICAL NURSING, Issue 8 2009Julie Taylor Aim., The aim of this study was to measure health visitors' professional judgements on ,good enough' parenting and identify what factors and combinations of these are important when making such judgements. Background., The relationship between parenting and child health is unclear. Whilst agreement exists that ,good enough' parenting requires boundary setting, consistency and putting the child's needs first, attempting to define ,good enough' parenting in precise terms is complex. When faced with a complex situation, practitioners rely on relatively few factors to form judgements. Design., Factorial survey methods were employed using vignette techniques. Methods., Vignettes were constructed using previous research on those variables, which may influence nurses' judgements, for example, accommodation and child dentition. The level of factors was randomly varied. Two thousand vignettes were administered to a sample of 200 health visitors in two Health Boards who then made a judgement about this scenario. Analysis., Data were analysed through multiple regression with dummy variables and one-way analysis of variance. Regression equations for both good enough mothering and good enough parenting are reported. Results., The models used are significant predictors of parenting and mothering. Significant predictors on health visitor judgements' were boundary setting in sleep behaviours, type of housing inhabited and health behaviours. Although parenting and mothering are often conflated, health visitors appear to separate these aspects when making judgements based on type of housing. Conclusions., Most professionals can articulate what makes a ,good' parent, equally they may have strong views regarding what constitutes ,poor' parenting. The difficulty is in determining when parenting is ,good enough' to provide a child with a nurturing environment. Relevance to clinical practice., This study suggests that practitioners move their thresholds of what is ,good enough' depending on a narrow range of factors. Awareness of the factors, which influence individuals' judgements is important in safeguarding children. [source] Victim-reported risk factors for continued abusive behavior: Assessing the dangerousness of arrested batterersJOURNAL OF COMMUNITY PSYCHOLOGY, Issue 4 2003Lauren Bennett Cattaneo Policy changes have dramatically increased the number of domestic violence cases entering criminal courts, creating a critical need for competent risk assessment. This study adds to the knowledge base about risk factors important to consider in such assessments, using a prospective design and follow-up through victim interview. Participants were 169 primarily African American women who appeared at a court intake center following the arrest of an abusive partner. We reached over half of these participants for follow-up 3 months later. Questionnaires administered at intake elicited information about demographics, substance abuse, the history of physical and psychological abuse in the relationship, the batterer's general violence, and the victim's own assessment of her level of endangerment. All variables were measured through victim report, combined with official records when relevant. Significant predictors of continued abusive behavior were the batterer's history of alcohol abuse, the severity of abuse in the relationship, the batterer's general violence, the level of psychological abuse in the relationship, and, notably, the victim's own assessment of the dangerousness of her case. Most variables were stronger in their sensitivity, or ability to correctly identify reabusers, than their specificity, or ability to correctly identify nonreabusers. Implications for practice and research are discussed. © 2003 Wiley Periodicals, Inc. J Comm Psychol 31: 349,369, 2003. [source] Salient Environmental and Perceptual Correlates of Current and Established Smoking for 2 Representative Cohorts of Indiana AdolescentsJOURNAL OF SCHOOL HEALTH, Issue 3 2009Dong-Chul Seo PhD ABSTRACT PURPOSE:, A secondary analysis of 2000 and 2004 Indiana Youth Tobacco Survey (IYTS) data was conducted to investigate salient environmental and perceptual correlates of adolescents' current and established smoking while controlling for demographic variables such as gender, grade, and race/ethnicity and to compare the pattern of significant correlates between the years. METHODS:, The IYTS was an anonymous school-based survey regarding tobacco use; familiarity with pro- and anti-tobacco media messages; exposure to environmental tobacco smoke (ETS); minors' access to tobacco products; and general knowledge, attitudes, and beliefs about tobacco. In 2000, a representative sample of 1416 public high school students in grades 9-12 and 1516 public middle school students in grades 6-8 (71.44% and 72.53% response rates, respectively) were surveyed. In 2004, 3433 public high school students and 1990 public middle school students (63.04% and 65.44 % response rates, respectively) were surveyed. RESULTS:, Significant predictors of adolescents' current and established smoking habits included exposure to ETS either in homes or in cars, exposure to pro-tobacco messages, perceived benefit of smoking, and perceived peer acceptance of smoking. The influence of exposure to pro-tobacco messages greatly outweighed exposure to any anti-tobacco messages. CONCLUSIONS:, The findings of this study warrant that more efforts and resources be placed on preventing youth from being exposed to ETS, and to control pro-tobacco marketing and improve the tobacco counter-marketing messages. The perceived benefits of smoking found here indicate that smoking for relaxation and weight control may be major influencing factors on adolescent smoking. [source] Alcohol Consumption among Low-Income Pregnant LatinasALCOHOLISM, Issue 11 2005Christina D. Chambers Abstract: Background: Due to changing cultural norms, Latinas of childbearing age residing in the U.S. may be at increasing risk of drinking harmful levels of alcohol during pregnancy, and may also be unaware of the risks for Fetal Alcohol Spectrum Disorders associated with this behavior. We assessed the prevalence of alcohol consumption in a sample of low-income pregnant Latinas and examined risk factors for alcohol use in the periconceptional period. Methods: As part of a larger intervention trial, a cross-sectional in-home interview study was conducted among a sample of 100 pregnant low-income Latinas receiving services from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in San Diego County, California. Results: Fifty-seven percent of respondents indicated they were either life-time abstainers or had not consumed any alcohol in the periconceptional period. Forty-three percent reported some alcohol use in the three months prior to recognition of the current pregnancy, and 20% reported at least one binge episode of four or more standard drinks during that time frame. Five percent reported drinking seven or more drinks per week, and 8% continued drinking alcohol after recognition of pregnancy. Significant predictors of any alcohol use in the periconceptional period included English language/higher level of acculturation, younger maternal age, lower parity, higher level of education, younger age at first drink, and having ever smoked. Women who were aware of alcohol warning messages and /or had more knowledge of the Fetal Alcohol Syndrome (FAS) were significantly more likely to have consumed alcohol in the periconceptional period. Frequency of periconceptional use of alcohol did not differ between women who planned or did not plan the pregnancy. Conclusion: The prevalence and pattern of early pregnancy alcohol consumption in this sample of Latinas is similar to patterns noted in other race/ethnic groups in the U.S. Level of knowledge about FAS and awareness of warning messages was not protective for early pregnancy alcohol consumption, suggesting that specific knowledge was insufficient to prevent exposure or that other factors reinforce maintenance of alcohol consumption in early pregnancy. Selective interventions in low-income Latinas are warranted, and should be focused on women of reproductive age who are binge or frequent drinkers and who are at risk of becoming pregnant. [source] Predictors of inappropriate utilization of intravenous proton pump inhibitorsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2007W. AFIF Summary Background, Inappropriate use of intravenous proton pump inhibitors is prevalent. Aim, To assess appropriateness of intravenous proton pump inhibitor prescribing. Methods, Retrospective review of in-patient prescribing of intravenous pantoprazole over a 2-month period in 2004, in an academic centre. Prescribing was deemed appropriate before and after endoscopic haemostasis, and in fasting individuals requiring a proton pump inhibitor. Results, Amongst 107 patients, 49 (46%) had upper gastrointestinal bleeding. Overall, 33 (31%, 95% CI: 22,41%) received appropriate therapy (indication, dose and duration), 61 (57%, 95% CI: 47,67%) had an inappropriate indication, and 13 (12%, 95% CI: 7,20%) had an incorrect treatment dose or duration. Therapy was appropriate in 20 (41%, 95% CI: 27,55%) with upper gastrointestinal bleeding, and 13 (22%, 95% CI: 12,33%) in the non-upper gastrointestinal bleeding group. Appropriate prescribing rates decreased (from 41% to 16%, 95% on difference CI: 14,38%) when considering intravenous proton pump inhibitor use while awaiting endoscopy as inappropriate. Significant predictors of inappropriate use were increasing age and decreasing mean daily dose, with a trend for prescriptions written during evening shifts. Conclusion, Inappropriate intravenous proton pump inhibitor utilization was most frequent in the non-upper gastrointestinal bleeding group, mostly for unrecognized indications. Educational interventions to optimize utilization should target prescribing in older patients, those receiving lower mean daily doses, and, perhaps, prescribing outside regular hours. [source] Low risk of overt nephropathy after 24 yr of childhood-onset type 1 diabetes mellitus (T1DM) in NorwayPEDIATRIC DIABETES, Issue 5 2006Torild Skrivarhaug Aim:, To estimate the risk of diabetic nephropathy and associated risk factors in a nationwide cohort of childhood-onset type 1 diabetes mellitus (T1DM) and 19,30 yr of diabetes duration. Methods:, Patients diagnosed with childhood-onset T1DM (<15 yr) from 1973 through 1982, who previously (1989,1990) participated in a clinical examination to assess diabetic complications, were invited for a new examination in 2002,2003. Of 355 eligible patients, 299 participated (84.2%), and complete urine samples for evaluation of albuminuria were obtained from 295 patients, with a mean age of 33 yr (range 20.9,44.0) and mean diabetes duration of 24 yr (range 19.3,29.9). Persistent microalbuminuria and overt nephropathy [albumin excretion rate (AER) 15,200 ,g/min and AER > 200 ,g/min, respectively] in at least two out of three consecutive overnight urine samples were defined as diabetic nephropathy. Results:, Overt nephropathy was found in 7.8% [95% confidence interval (CI) 4.7,10.9] and persistent microalbuminuria in 14.9% (95% CI 10.8,19.0) of the subjects. Hemoglobin A1c (HbA1c) (p = 0.001), systolic blood pressure (BP) (p = 0.002), total cholesterol (p = 0.019), and C-reactive protein (CRP) (p = 0.019) were associated with diabetic nephropathy. Significant predictors in 1989,1990 for the development of diabetic nephropathy in 2002,2003 were HbA1c (p < 0.001), AER (p = 0.007), and cholesterol (p = 0.022). Conclusions:, In a subgroup of patients diagnosed with childhood-onset T1DM in 1973,1982, 7.8% had overt nephropathy after 19,30 yr of diabetes duration, which is low compared with studies from other countries. HbA1c, systolic BP, total cholesterol, and CRP were each independently associated with diabetic nephropathy. [source] Persistence with cholinesterase inhibitor therapy in a population-based cohort of patients with Alzheimer's diseasePHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 7 2010Joseph E. Amuah PhD Abstract Purpose To estimate the risk (and determinants) of discontinuing cholinesterase inhibitors (ChEIs) in a population-based sample of Alzheimer's disease (AD) patients. Methods This is a retrospective cohort study based on linked de-identified administrative health data from the province of Saskatchewan, Canada. The cohort included all AD patients receiving a ChEI prescription during the first year of provincial coverage (2000,2001). Persistence was defined as no gap of 60+ days between depletion and subsequent refill of a ChEI prescription. Kaplan-Meier analysis was used to estimate the risk of discontinuation over 40 months. Cox regression with time-varying covariates was used to assess risk factors for ChEI discontinuation. Results The sample included 1080 patients (64% female, average age 80,±,7 years). Baseline mean (SD) Mini-Mental State Examination (MMSE) and Functional Activities Questionnaire (FAQ) scores were 20.8 (4.4) and 17.5 (7.7), respectively. Over 40 months, 84% discontinued therapy. The 1-year risk of discontinuation was 66.4% (95%CI 63.5,69.3%). Discontinuation was significantly more likely for females (adjusted HR 1.34, 95%CI 1.16,1.55) and among those with lower MMSE scores (2.52, 2.01,3.17 if <15), not receiving social assistance (1.25, 1.07,1.45), and paying at least 65% of total prescription costs (1.51, 1.30,1.74). It was significantly less likely for patients with frequent physician visits (0.78, 0.66,0.93, for 7,19 vs. <7 visits), higher Chronic Disease Scores (0.74, 0.61,0.89, for 7+ vs. <4), and FAQ scores of 9+ (0.82, 0.69,0.99). Conclusion The likelihood of discontinuing ChEI therapy was high in this real-world sample of AD patients. Significant predictors included clinical, socioeconomic, and practice factors. Copyright © 2010 John Wiley & Sons, Ltd. [source] Supportive-expressive group therapy for women with metastatic breast cancer: survival and psychosocial outcome from a randomized controlled trialPSYCHO-ONCOLOGY, Issue 4 2007David W. Kissane Abstract Background: Mixed reports exist about the impact of supportive-expressive group therapy (SEGT) on survival. Methods: From 485 women with advanced breast cancer recruited between 1996,2002, 227 (47%) consented and were randomized within an average 10 months of cancer recurrence in a 2:1 ratio to intervention with 1 year or more of weekly SEGT plus three classes of relaxation therapy (147 women) or to control receiving three classes of relaxation therapy (80 women). The primary outcome was survival; psychosocial well-being was appraised secondarily. Analysis was by intention-to-treat. Results: SEGT did not prolong survival (median survival 24.0 months in SEGT and 18.3 in controls; univariate hazard ratio for death 0.92 [95% CI, 0.69,1.26]; multivariate hazard ratio, 1.06 [95% CI, 0.74,1.51]). Significant predictors of survival were treatment with chemotherapy and hormone therapy (p<0.001), visceral metastases (p<0.001) and advanced disease at first diagnosis (p<0.05). SEGT ameliorated and prevented new DSM-IV depressive disorders (p = 0.002), reduced hopeless,helplessness (p = 0.004), trauma symptoms (p = 0.04) and improved social functioning (p = 0.03). Conclusions: SEGT did not prolong survival. It improved quality of life, including treatment of and protection against depression. Copyright © 2007 John Wiley & Sons, Ltd. [source] The role of traumatic event history in non-medical use of prescription drugs among a nationally representative sample of US adolescentsTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 1 2010Jenna L. McCauley Background:, Building on previous research with adolescents that examined demographic variables and other forms of substance abuse in relation to non-medical use of prescription drugs (NMUPD), the current study examined potentially traumatic events, depression, posttraumatic stress disorder (PTSD), other substance use, and delinquent behavior as potential correlates of past-year non-medical use of prescription drugs. Method:, A nationally representative sample of 3,614 non-institutionalized, civilian, English-speaking adolescents (aged 12,17 years) residing in households with a telephone was selected. Demographic characteristics, traumatic event history, mental health, and substance abuse variables were assessed. NMUPD was assessed by asking if, in the past year, participants had used a prescription drug in a non-medical manner. Multivariable logistic regressions were conducted for each theoretically derived predictor set. Significant predictors from each set were then entered into a final multivariable logistic regression to determine significant predictors of past-year NMUPD. Results:, NMUPD was endorsed by 6.7% of the sample (n = 242). The final multivariable model showed that lifetime history of delinquent behavior, other forms of substance use/abuse, history of witnessed violence, and lifetime history of PTSD were significantly associated with increased likelihood of NMUPD. Conclusions: Risk reduction efforts targeting NMUPD among adolescents who have witnessed significant violence, endorsed abuse of other substances and delinquent behavior, and/or endorsed PTSD are warranted. Interventions for adolescents with history of violence exposure or PTSD, or those adjudicated for delinquent behavior, should include treatment or prevention modules that specifically address NMUPD. [source] Incidence of changes and predictive factors for sexual function after coronary stentingANDROLOGIA, Issue 1 2007H. Shi Summary The study was aimed at determining the incidence of changes in sexual function and identifying the possible associated variables of erectile dysfunction (ED) in coronary artery disease (CAD) patients undergoing coronary stenting. Four hundred and sixty-seven patients were retrospectively contacted with a questionnaire regarding sexual function from 6 months pre-stenting to 6 months post-stenting by telephone follow up. Univariate analyses were used to determine prognostic variables. ED changed following stenting in CAD (P < 0.05), in acute coronary syndrome (ACS) (P > 0.05) and in chronic coronary syndrome (CCS) (P < 0.05). Sexual activity was not resumed in 8.1%, was unchanged in 33.8%, increased in 0% and decreased in 58.0%. The average frequency of sexual activity decreased every month in CAD (P < 0.05), in ACS (P < 0.05) and in CCS (P < 0.01) after undergoing coronary stenting respectively. The mean time interval between the onset of ED and CAD was 33 months. Resuming sexual activity after stenting varied from 2 weeks to 30 months. Significant predictors of ED after coronary stenting were mean age, diabetes mellitus, 2,3-vessel disease or current smoking status. It was concluded that coronary stenting had a significant incidence of ED. Mean age, diabetes mellitus, 2,3-vessel disease or current smoking status showed to be the main variables associated with ED. Attempts to improve individual secondary prevention outcomes (controlling serum glucose and smoking cessation) should be designed. [source] Predictors of early rescreening in the National Cervical Screening Program, AustraliaAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2001Heather Mitchell Objective: To identify variables that predict early rescreening after a negative Pap smear report. Methods: Cohort study using the records of a statewide Cervical Cytology Registry in Victoria, Australia. The cohort comprised 31,082 women who had a negative Pap smear report during the first half of 1996 and who were rescreened within the subsequent 36 months. Early rescreening was defined as a further Pap smear within 21 months. Results: The strongest predictor of early rescreening was a recommendation at the time of issuing the negative Pap smear report by the laboratory for retesting before two years (adjusted odds ratio = 3.81, 95% confidence interval (Cl) 3.58,4.05). Mention of reactive or inflammatory change as part of the negative Pap smear report was also a powerful predictor (adjusted odds ratio = 1.67, 95% Cl 1.50,1.85). Significant predictors associated with the women were young age, high socio-economic status and residence in the capital city. Significant predictors associated with the practitioner were if either the index or subsequent smear was collected by an obstetrician/gynaecologist or a hospital-based clinic, or if the practitioner collecting the index smear was a female. The population-attributable risk per cent associated with the laboratory recommendation was 27%. Conclusions: This data suggests that a multi-faceted strategy targeting pathology laboratories, practitioners and women may be needed to reduce early rescreening. Implications: Early rescreening is wasteful of health resources. New screening programs should be designed to avoid this problem [source] Short-term Functional Decline and Service Use in Older Emergency Department Patients With Blunt InjuriesACADEMIC EMERGENCY MEDICINE, Issue 7 2010Scott T. Wilber MD ACADEMIC EMERGENCY MEDICINE 2010; 17:679,686 © 2010 by the Society for Academic Emergency Medicine Abstract Background:, Injuries are a common reason for emergency department (ED) visits by older patients. Although injuries in older patients can be serious, 75% of these patients are discharged home after their ED visit. These patients may be at risk for short-term functional decline related to their injuries or treatment. Objectives:, The objectives were to determine the incidence of functional decline in older ED patients with blunt injuries not requiring hospital admission for treatment, to describe their care needs, and to determine the predictors of short-term functional decline in these patients. Methods:, This institutional review board,approved, prospective, longitudinal study was conducted in two community teaching hospital EDs with a combined census of 97,000 adult visits. Eligible patients were , 65 years old, with blunt injuries <48 hours old, who could answer questions or had a proxy. We excluded those too ill to participate; skilled nursing home patients; those admitted for surgery, major trauma, or acute medical conditions; patients with poor baseline function; and previously enrolled patients. Interviewers collected baseline data and the used the Older Americans Resources and Services (OARS) questionnaire to assess function and service use. Potential predictors of functional decline were derived from prior studies of functional decline after an ED visit and clinical experience. Follow-up occurred at 1 and 4 weeks, when the OARS questions were repeated. A three-point drop in activities of the daily living (ADL) score defined functional decline. Data are presented as means and proportions with 95% confidence intervals (CIs). Logistic regression was used to model potential predictors with functional decline at 1 week as the dependent variable. Results:, A total of 1,186 patients were evaluated for eligibility, 814 were excluded, 129 refused, and 13 were missed, leaving 230 enrolled patients. The mean (±SD) age was 77 (±7.5) years, and 70% were female. In the first week, 92 of 230 patients (40%, 95% CI = 34% to 47%) had functional decline, 114 of 230 (49%, 95% CI = 43% to 56%) had new services initiated, and 76 of 230 had an unscheduled medical contact (33%, 95% CI = 27% to 39%). At 4 weeks, 77 of 219 had functional decline (35%, 95% CI = 29% to 42%), 141 of 219 had new services (65%, 95% CI = 58% to 71%), and 123 of 219 had an unscheduled medical contact (56%, 95% CI = 49% to 63%), including 15% with a repeated ED visit and 11% with a hospital admission. Family members provided the majority of new services at both time periods. Significant predictors of functional decline at 1 week were female sex (odds ratio [OR] = 2.2, 95% CI = 1.1 to 4.5), instrumental ADL dependence (IADL; OR = 2.5, 95% CI = 1.3 to 4.8), upper extremity fracture or dislocation (OR = 5.5, 95% CI = 2.5 to 11.8), lower extremity fracture or dislocation (OR = 4.6, 95% CI = 1.4 to 15.4), trunk injury (OR = 2.4, 95% CI = 1.1 to 5.3), and head injury (OR = 0.48, 95% CI = 0.23 to 1.0). Conclusions:, Older patients have a significant risk of short-term functional decline and other adverse outcomes after ED visits for injuries not requiring hospitalization for treatment. The most significant predictors of functional decline are upper and lower extremity fractures. [source] Substance use disorders among adolescents with bipolar spectrum disordersBIPOLAR DISORDERS, Issue 4 2008Benjamin I Goldstein Objective:, We set out to examine the prevalence and correlates of substance use disorders (SUD) in a large sample of adolescents with bipolar disorder (BP). Methods:, Subjects were 249 adolescents ages 12 to 17 years old who fulfilled DSM-IV criteria for bipolar I disorder [(BPI), n = 154], or bipolar II disorder [(BPII), n = 25], or operationalized criteria for BP not otherwise specified [(BP NOS), n = 70], via the Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS). As part of the multi-site Course and Outcome of Bipolar Youth study, demographic, clinical, and family history variables were measured via intake clinical interview with the subject and a parent/guardian. Results:, The lifetime prevalence of SUD among adolescents with BP was 16% (40/249). Results from univariate analyses indicated that subjects with, as compared to without, SUD were significantly less likely to be living with both biological parents, and that there was significantly greater lifetime prevalence of physical abuse, sexual abuse, suicide attempts, conduct disorder, and posttraumatic stress disorder among subjects with SUD. Subjects with SUD reported significantly greater 12-month prevalence of trouble with police, and females with SUD reported significantly greater 12-month prevalence of pregnancy and abortion. Significant predictors of SUD in a logistic regression model included living with both biological parents (lower prevalence), conduct disorder and suicide attempts (increased prevalence). In logistic regression analyses controlling for demographic differences and conduct disorder, SUD remained significantly associated with trouble with police, whereas the association of SUD with pregnancy and abortion was reduced to a statistical trend. The prevalence of SUD was not significantly different among child- versus adolescent-onset BP subjects. Conclusions:, SUD among adolescents with BP is associated with profound hazards including suicide attempts, trouble with police, and teenage pregnancy and abortion. [source] Foetal size to final heightACTA PAEDIATRICA, Issue 6 2000J Karlberg It is well known that some adult diseases, such as cardiovascular diseases, may be programmed during foetal life. It is not clear, however, whether final height may be predicted from foetal growth. A longitudinal cohort of full-term healthy Swedish babies (n = 3650) was followed up from birth to maturity in a population-based growth study. Length or height and its changes were analysed from birth to 18 y of age; 2807 children, with data available on birth length, final height and parental height, were included in this analysis. The result clearly shows that length at birth relates to final height. In terms of standard deviation scores (SDS), the mean difference in length at birth from the mean was greatly decreased in final height, but retained the same order as was seen at birth. In terms of centimeter difference from the reference mean values, the difference in length at birth remained roughly stable into final height. For instance, babies 5 cm above or below the mean birth length will end up approximately 5 cm above or below the mean in final height. Parental height,a surrogate value of the genetic final height potential of an individual,is shown to influence postnatal growth in height strongly. However, the difference from the mean in length at birth remained into adulthood within the same midparental height group. Conclusion: This study reveals that trends in foetal linear growth continue into maturity. Foetal growth is a significant predictor of postnatal growth. Final height is dependent on both the magnitude of foetal growth and the genetic potential in stature, and appears to some extent to be programmed from foetal growth. [source] Does self-control account for the relationship between binge drinking and alcohol-related behaviours?CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 2 2002Alex R. Piquero Introduction Gottfredson and Hirschi's theory that there is an underlying factor accounting for all sorts of antisocial behaviour has attracted widespread theoretical and empirical attention. One of their most controversial statements is a ,generality' hypothesis, a notion that criminal, deviant and reckless acts are highly correlated because they are caused by individual differences in self-control. In this paper, we examine the extent to which self-control accounts for the relationship between two behaviours: binge drinking and involvement in alcohol-related behaviours, including criminal behaviour. Method Questionnaires were given to students at a southern US university. A final sample of 241 students (35% males, 91% whites, aged 17,40). One question concerned binge-drinking, 11 others related to other alcohol-related behaviour; a 24-item scale measured self-control and sex was recorded. A probit model was used to test the effect of low self-control on binge drinking and on other alcohol-related behaviours. It was found that self-control exhibits a positive effect on both. But binge drinking and other alcohol-related behaviours are correlated, so a further analysis using a bivariate probit model was undertaken using a naïve model (no covariates), an unconstrained model (allowing self-control to exert a unique effect on both outcomes), and a constrained model forcing self-control to be the same for both outcomes. Results Our results suggest that while low self-control is a significant predictor of both binge drinking and alcohol-related problems, it does not fully account for the relationship between the two outcomes. In addition, separate estimation for each sex reveal a substantively different pattern of results. Discussion Further research is needed to disentangle the differences between the sexes. Situational factors, especially in males, may account for adverse alcohol-related behaviours. Other measures of self-control are also needed. Copyright © 2002 Whurr Publishers Ltd. [source] The Determinants of Students' Perceived Learning Outcomes and Satisfaction in University Online Education: An Empirical Investigation,DECISION SCIENCES JOURNAL OF INNOVATIVE EDUCATION, Issue 2 2006Sean B. Eom ABSTRACT In this study, structural equation modeling is applied to examine the determinants of students' satisfaction and their perceived learning outcomes in the context of university online courses. Independent variables included in the study are course structure, instructor feedback, self-motivation, learning style, interaction, and instructor facilitation as potential determinants of online learning. A total of 397 valid unduplicated responses from students who have completed at least one online course at a university in the Midwest were used to examine the structural model. The results indicated that all of the antecedent variables significantly affect students' satisfaction. Of the six antecedent variables hypothesized to affect the perceived learning outcomes, only instructor feedback and learning style are significant. The structural model results also reveal that user satisfaction is a significant predictor of learning outcomes. The findings suggest online education can be a superior mode of instruction if it is targeted to learners with specific learning styles (visual and read/write learning styles) and with timely, meaningful instructor feedback of various types. [source] Prevalence and risk of traumatic gingival recession following elective lip piercingDENTAL TRAUMATOLOGY, Issue 1 2006Jonathan W. Leichter Abstract,,, The aims of this study were to evaluate the prevalence, risk and odds ratios of gingival recession defects associated with elective lip piercing and wearing of stud jewelry, and to attempt to identify risk factors that might permit the incidence of recession and its severity to be predicted, using Miller's classification. Ninety-one subjects with lip piercing and labrets were evaluated with regard to gender, age, smoking history, orthodontic history, and labret characteristics. An age-matched group of 54 individuals without peri-oral piercing provided the control. Gingival recession was recorded on teeth opposing a labret in 68.13% of pierced subjects. By contrast, only 22.2% of unpierced individuals demonstrated recession. The odds ratio between pierced and control groups indicates a likelihood of recession 7.5 times greater in a pierced individual wearing a labret than in an unpierced individual. Logistical regression analysis showed that age, gender, smoking and labret configuration did not significantly influence the development of recession. Furthermore, an illustrative example indicates that piercing and provision of a labret might typically increase the risk of recession occurring from 34.4% (pre-piercing) to 80.8 %. Recession severity was greater in the pierced group, with Miller's class 2 and 3 defects observed in 18.7% of the pierced but not at all in the unpierced group. Ordinal regression identified previous orthodontic treatment as the only significant predictor of Miller's grade. We concluded that a clear link exists between lip piercing, labret use and gingival recession. Belief that labret placement and configuration can be modified to provide protection is unfounded. [source] Oral piercing and oral trauma in a New Zealand sampleDENTAL TRAUMATOLOGY, Issue 5 2005J. A. Kieser Abstract,,, This study investigated the periodontal and dental trauma resultant from tongue and lip piercings in a convenience sample of 43 adult dental patients. Patients underwent an intra-oral examination followed by the administration of a questionnaire. Each patient was examined for lingual or buccal recession of the upper and lower incisors as well as the extent of abnormal toothwear or trauma on these teeth. Following bivariate analyses, regression analyses were conducted to test the study hypotheses and derive adjusted estimates for the dependent variables. Of the 43 individuals who participated (93.0% females; mean age 21 years; age range 14,34 years) 76.7% had a tongue piercing, 34.9% had a lip piercing, and 11.6% had both. Only four had had their piercing procedure provided by a doctor or dentist. Postpiercing complications were reported by 34.9%. Most of those with a labial piercing (80.0%) had 1+ labial site with gingival recession (GR), and almost one-third of those with a tongue piercing had at least one lingual site with GR. Age was a significant predictor of the prevalence of lingual recession, with the odds of having lingual recession increasing by 1.17 (95% CI 1.01, 1.35) for every year older than 14. Age was the only significant predictor of the number of lingual sites with recession, but was not a predictor of the prevalence of labial recession or the number of affected sites. There were no significant associations between piercings and abnormal toothwear or trauma. These findings suggest that oral piercings are associated with localized gingival recession, and that the providers of such procedures should ensure that, as part of the informed consent process, prospective patients are informed of the likelihood that their periodontal health may be compromised. [source] The evolution of depression and suicidality in first episode psychosisACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2010R. Upthegrove Upthegrove R, Birchwood M, Ross K, Brunett K, McCollum R, Jones L. The evolution of depression and suicidality in first episode psychosis. Objective:, To have a clearer understanding of the ebb and flow of depression and suicidal thinking in the early phase of psychosis, whether these events are predictable and how they relate to the early course of psychotic symptoms. Method:, Ninety-two patients with first episode psychosis (FEP) completed measures of depression, including prodromal depression, self-harm and duration of untreated psychosis. Follow-up took place over 12 months. Results:, Depression occurred in 80% of patients at one or more phases of FEP; a combination of depression and suicidal thinking was present in 63%. Depression in the prodromal phase was the most significant predictor of future depression and acts of self-harm. Conclusion:, Depression early in the emergence of a psychosis is fundamental to the development of future depression and suicidal thinking. Efforts to predict and reduce depression and deliberate self-harm in psychosis may need to target this early phase to reduce later risk. [source] How many well vs. unwell days can you expect over 10 years, once you become depressed?ACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2009T. A. Furukawa Objective:, Prognostic studies of major depression have mainly focused on episode remission and relapse, and only a limited number of studies have examined long-term course of depressive symptomatology at threshold and subthreshold levels. Method:, The Group for Longitudinal Affective Disorders Study has conducted prospective serial assessments of a cohort of heretofore untreated major depressive episodes for 10 years under naturalistic conditions. Results:, Of the 94 patients in the cohort, the follow-up rate was 70% of the 11 280 person-months. Around 77% of the follow-up months were spent in euthymia, 16% in subthreshold depression and 7% in major depression. Duration of the index episode before reaching recovery was the only significant predictor of the ensuing well time. Conclusion:, On average, patients with major depression starting treatment today may expect to spend three quarters of the next decade in euthymia but the remaining one quarter in subthrehold or threshold depression. [source] Corrected head circumference centiles as a possible predictor of developmental performance in high-risk neonatal intensive care unit survivorsDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 11 2005François V Bolduc MD FRCPC The aim of this study was to evaluate the predictive value of corrected head circumference (HC) centiles at 2 years of age with respect to developmental performance in a series of high-risk neonatal intensive care unit (NICU) survivors with microcephaly. The study used a retrospective review of the clinical files of children seen in a clinic devoted to the follow-up of all high-risk survivors of a hospital's level III NICU. All children with microcephaly (occipital-frontal circumference below the 2nd centile for sex) at 2 years of age were identified. The HC obtained at 2 years was corrected to the ages for which the absolute HC corresponded to either the 50th or 2nd centile for the child's sex. Of 312 high-risk patients followed, 38 (12.2%) were microcephalic. Fifteen performed below the 50th age-corrected HC centile (severe developmental delay), 12 performed between the 50th and 2nd age-corrected HC centile (moderate developmental delay), and 11 performed above the 2nd age-corrected HC centile (mild developmental delay). The absolute value of HC measurement was not a predictor of developmental performance. Of all clinical factors evaluated, only coexisting epilepsy was found to be a significant predictor of less than the 50th age-corrected HC centile developmental performance (Chi2=6.134, p=0.01). We conclude that in a high-risk population, the presence of microcephaly implies developmental impairment, though neither the absolute HC measurement nor the corrected HC centile is predictive. Coexisting epilepsy in this context appears to worsen developmental outcome. [source] Elevated fasting plasma C-peptide occurs in non-diabetic individuals with fatty liver, irrespective of insulin resistanceDIABETIC MEDICINE, Issue 9 2009G. Perseghin Abstract Aims Studies have pointed to insulin resistance as a pathogenic factor in fatty liver. Although pancreatic B-cell function is believed to be involved, its role is unclear. This study was undertaken to test whether fasting C-peptide, an index of fasting B-cell function, was related to intra-hepatic fat (IHF) content in non-diabetic humans. Methods We assessed, retrospectively, fasting plasma C-peptide concentration in 31 patients with fatty liver and 62 individuals without fatty liver. The IHF content was measured by proton magnetic resonance spectroscopy (1H-MRS), while insulin sensitivity was estimated based on fasting plasma glucose and insulin with the homestasis model assessment (HOMA) 2 method. Results Age, sex and body mass index (BMI) were not different between groups. Patients with fatty liver had higher fasting insulin (P < 0.01), C-peptide (P < 0.005) and lower insulin sensitivity (HOMA2-%S). Fasting insulin alone explained 14% of the IHF content variability (P < 0.001); inclusion of fasting C-peptide in multivariate regression explained up to 32% (P < 0.001). A subgroup analysis was performed by matching 1 : 1 for HOMA2-%S. These data were analysed by conditional logistic regression which showed that, when HOMA2-%S was matched between groups, fasting C-peptide remained the only significant predictor of fatty liver. Conclusions Non-diabetic individuals with fatty liver are characterized by increased fasting plasma C-peptide concentration, irrespective of their insulin resistant state. [source] A longitudinal observational study of insulin therapy and glycaemic control in Scottish children with Type 1 diabetes: DIABAUD 3DIABETIC MEDICINE, Issue 11 2006Scottish Study Group for the Care of the Young with Diabetes Abstract Objective/background, Our objective was to investigate glycaemic control in children with Type 1 diabetes in Scotland and to analyse the effect of changing ,conventional' insulin regimen strategies on outcome. DIABAUD 2 (1997,1998) (D2) demonstrated that average glycaemic control in young people with Type 1 diabetes in Scotland was poor, with mean HbA1c of 9.0%. Over 90% were then treated with a twice-daily insulin regimen. The aim of DIABAUD 3 (2002,2004) (D3) was to determine if control had improved, and to examine changes in insulin regimen and effects on glycaemic control. Methods, In DIABAUD 3, data were collected prospectively on children aged < 15 years. in nine out of 15 centres throughout Scotland. HbA1c on 986 subjects was measured in a single Diabetes Control and Complications Trial-aligned laboratory. The results were compared with those from DIABAUD 2, for the same nine centres. Multiple regression comparison was performed to adjust for imbalance in relevant confounders (e.g. age, duration, height and weight, insulin dose and centre). Results, For D3, the age range was 1.1,14.9 years (62% aged 10,14 years), mean (± sd) HbA1c 9.2% ± 1.5 (compared with D2, 9.0% ± 1.5). Only 9.7% achieved the target of HbA1c < 7.5%. The number of subjects in D3 on twice-daily injections was 51% (compared with 94% in D2), 43% on three-times-daily injections (2% in D2) and 2.3% on four or more (1.9% in D2): HbA1c did not differ in these groups. In both the D2 and D3 cohorts, HbA1c rose with age. After adjustment for other variables in the combined datasets, insulin regimen was not a significant predictor of HbA1c (F = 0.19, d.f. = 3, 1774; P = 0.90). Conclusion, The glycaemic control in young people in Scotland remains poor and above the national target. Over 4 years, moderate intensification of insulin therapy (i.e. from two to three injections each day, usually reflecting splitting of the evening dose) across the population failed to improve the average HbA1c and reduce the increase seen with age. A national programme away from ,conventional' to an ,intensive' regimen of insulin therapy is required. [source] Hyperglycaemia and mortality of diabetic patients with candidaemiaDIABETIC MEDICINE, Issue 9 2005M. S. Bader Abstract Aims To determine whether the degree of hyperglycaemia has an impact on in-hospital mortality in diabetic patients with candidaemia. Methods A retrospective cohort study of 87 diabetic patients with candidaemia admitted between June 1995 and June 2003 was carried out at two medical centres. Patients were stratified into two groups: those with moderate hyperglycaemia (7 days post-candidaemia mean blood glucose < 13.9 mmol/l) and those with severe hyperglycaemia (7 days post-candidaemia mean blood glucose , 13.9 mmol/l). A stepwise logistic regression analysis was performed to determine whether the degree of hyperglycaemia was a significant predictor of mortality. Results During the follow-up period from admission till discharge, 34 (39.1%) patients had died. Nine (69.2%) of 13 patients with severe hyperglycaemia have died while 25 (33.8%) of 74 patients with moderate hyperglycaemia have died. Multivariate analysis identified three independent determinants of death; Apache II score , 23 [OR 8.1, 95% CI (2.6, 25.3), P = 0.0003], mean blood glucose levels 7 days post-candidaemia , 13.9 mmol/l [OR 6.8, 95% CI (1.2, 38.2), P = 0.03], and mechanical ventilation [OR 6.5, 95% CI (2.21), P = 0.03]. Conclusion Severe hyperglycaemia is an important marker of increased mortality among hospitalized diabetic patients with candidaemia. [source] Left ventricular diastolic dysfunction in patients with chronic renal failure: impact of diabetes mellitusDIABETIC MEDICINE, Issue 6 2005J. Miyazato Abstract Aims Left ventricular (LV) hypertrophy and LV diastolic dysfunction are cardiac changes commonly observed in patients with chronic renal failure (CRF) as well as hypertension. Although the impairment of LV diastolic function in patients with diabetes mellitus has been shown, little is known about the specific effect of diabetes on LV diastolic function in patients with CRF. The present study was designed to investigate the impact of diabetic nephropathy on LV diastolic dysfunction, independent of LV hypertrophy, in CRF patients. Methods In 67 patients with non-dialysis CRF as a result of chronic glomerulonephritis (n = 33) or diabetic nephropathy (n = 34), and 134 hypertensive patients with normal renal function, two-dimensional and Doppler echocardiographic examinations were performed, and LV dimension, mass, systolic function, and diastolic function were evaluated. Results LV mass was increased and LV diastolic dysfunction was advanced in subjects with CRF compared with hypertensive controls. In the comparison of echocardiographic parameters between the two groups of CRF patients, i.e. chronic glomerulonephritis and diabetic nephropathy groups, all indices of LV diastolic function were more deteriorated in the diabetic nephropathy group than in the chronic glomerulonephritis group, although LV structure including hypertrophy and systolic function did not differ between the groups. In a multiple regression analysis, the presence of diabetes (i.e. diabetic nephropathy group) was a significant predictor of LV diastolic dysfunction in CRF subjects, independent of other influencing factors such as age, blood pressure, renal function, anaemia and LV hypertrophy. Conclusion The present findings suggest that LV diastolic dysfunction, independent of LV hypertrophy, is specifically and markedly progressed in patients with CRF as a result of diabetic nephropathy. [source] | |||||||||||||||||||||||||||||||||||||||||||||||||