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Biomedical subjects

Jean Ferrières

Publications and source records attributed to Jean Ferrières.

At least 19 recordsLinked to original sources

Study of the impact of perilipin polymorphisms in a French population.

BACKGROUND: Perilipins are proteins localized at the surface of the lipid droplet in adipocytes, steroid-producing cells and ruptured atherosclerotic plaques playing a role in the regulation of triglyceride deposition and mobilization. We investigated whether perilipin gene polymorphisms were associated with obesity, type 2 diabetes, and their related variables (anthropometric variables, plasma leptin, lipids, glucose and insulin concentrations) in a cross-sectional random sample of 1120 French men and women aged 35 to 65 years old, including 227 obese (BMI >or= 30 kg/m2) and 275 type 2 diabetes subjects. RESULTS: Among 7 perilipin polymorphisms tested, only 2 (rs4578621 and rs894160) of them were frequent enough to be fully investigated and we genotyped the sample using the PCR-RFLP method. No significant associations could be found between any of these polymorphisms and the studied phenotypes. CONCLUSION: The rs4578621 and rs894160 polymorphisms of the perilipin gene are not major genetic determinants of obesity and type 2 diabetes-related phenotypes in a random sample of French men and women.

Adult↗

Association between the metabolic syndrome and parental history of premature cardiovascular disease.

AIMS: The goal of this study is to assess the association between the metabolic syndrome (MS) and parental history of cardiovascular disease (CVD). METHODS AND RESULTS: Participants were recruited in a population survey of 3441 men and women, aged 35-64. MS was defined with NCEP-III guidelines. Familial history of myocardial infarction (MI), angina, and stroke was assessed with a standardized questionnaire. Parental premature CVD was defined if CVD occurred before 55/65 years in the father/mother. A total of 390 men and 281 women had MS. Positive parental CVD was associated with MS in women (43.0 vs. 36.8%, P<0.001) but not in men (36.9 vs. 31.8%, P=0.06). Similarly, parental premature CVD was associated with MS in women (19.2 vs. 11.8%, P<0.0007) but not in men (11.1 vs. 11.1%, ns). In women with MS, the age, centre, and educational level adjusted odds ratios [OR (95% CI)] of having a positive parental premature stroke was 1.84 (1.0-3.38), P=0.049. This OR was 1.76 (1.23-2.76), P=0.007 for combined parental premature MI and stroke and 1.67 (1.17-2.38), P=0.004 for combined premature MI, stroke, and angina. After further adjustment on personal coronary heart disease and CVD risk factors, the ORs of having a positive parental history of combined premature MI and stroke [1.75 (1.11-2.76), P=0.016] or MI, stroke, and angina [1.79 (1.21-2.63), P=0.003], remained statistically significant, in women with MS. CONCLUSION: The MS is associated with parental premature CVD independently of classical CV risk factors, suggesting that MS is a contributor to the familial aggregation of premature CVD.

Adult↗

Prognosis at 6 months for coronary and cerebrovascular patients: impact of antiplatelet agents and statins: results from the Prevenir III study.

PURPOSE: The aim of the Prevenir III study was to assess, in secondary prevention, the risk after 6 months of subsequent coronary and cerebrovascular events in a population of patients in private practice. METHODS: A prospective observational survey, including patients diagnosed with previous myocardial infarction, unstable angina or stroke, was carried out by French general practitioners and cardiologists. RESULTS: 9556 patients were selected by 3746 physicians representative of French physicians. The medical records of 8288 were analyzed. After a 6-month follow-up, 116 patients (1.4%) had been hospitalized for coronary or cerebrovascular event i.e. cumulative incidence 3.6 per 100 person-years (95% CI 2.9-4.2). The rate of coronary events was 0.9% and the cumulative incidence 2.3% person-years (95% CI 1.8-2.8), the event rate of stroke was 0.5% and the cumulative incidence 1.3 person-years (95% CI 0.9-1.7) and all-cause mortality was 1.2% i.e. 3.1 per 100 person-years (95% CI 2.5-3.7). Patients treated with statins and antiplatelet agents, or both, were less likely to undergo subsequent events than patients not receiving statins or antiplatelet agents. All-cause mortality rate decreased dramatically (Hazard Ratio 0.4 95% CI 0.2-0.7 after adjustment for age, sex, diagnosis at inclusion, time elapsed since the index event, cardiovascular and non cardiovascular history, betablockers, angiotensin-converting enzyme inhibitors and cardiovascular risk factors) in patients treated with a combination of statins and antiplatelet agents when compared to patients treated with neither statins nor antiplatelet agents. CONCLUSION: Our survey enabled a better understanding of the prognosis at 6 months in a large sample of coronary and cerebrovascular patients. We observed the beneficial impact of the combination of statins and antiplatelet agents in cardiovascular secondary prevention.

Aged↗

[Medical guidelines and medical practices: The example of lipid lowering therapy].

INTRODUCTION: The SPOT epidemiologic survey assessed the results of long-term cholesterol-lowering therapy in France and the reasons why patients do or do not meet their therapeutic objectives. OBJECTIVE: To assess the guidelines on which doctors base their practices for cholesterol-lowering therapy and make suggestions to improve the match between recommendations and practices. METHODS: LDL cholesterol was measured in 2479 French outpatients in 2003 and classified according to whether it met therapeutic objectives of 3 different scales: the official French (AFSSAPS) recommendations issued in 2000, the physician's opinion of the ideal level for the patient, and the physician's goal level for the patient. Agreement between these 3 criteria was analyzed. RESULTS: French doctors used guidelines stricter than the official recommendations to assess the achievement of lipid-lowering objectives. DISCUSSION: Physicians rely more on American than French guidelines. They also considered the patient's history and clinical condition in setting individual goals.

Attitude of Health Personnel↗

Independent contribution of dairy products and calcium intake to blood pressure variations at a population level.

PURPOSE: Previous studies have shown a potential inverse relationship between blood pressure and daily calcium intake. The aim of the study was to assess the independent contribution of dairy product and calcium intake to blood pressure variations at a population level. METHODS: A sample of 912 men aged 45-64 years was randomly selected from the general population, as part of the French MONICA cross-sectional survey on cardiovascular risk factors (1995-1996). Extensive questionnaires on risk factors were filled out and each participant completed a three-consecutive-day food record. Two blood pressure measurements were performed at rest. In statistical analyses subjects were grouped according to quintiles of dairy product or calcium intakes. RESULTS: Systolic and diastolic blood pressures significantly decreased from the lowest [145.4 (standard error (SE) 1.55) and 89.0 (SE 0.94) mmHg respectively] to the highest quintile [135.6 (SE 1.26) and 85.3 (SE 0.84) mmHg respectively] of dairy product intakes in bivariate analysis. After multivariate linear regression analysis adjusted for confounders [centre, age, daily sodium, magnesium, calcium and alcohol intake, daily energy intake without alcohol, dieting, physical activity, body mass index (BMI), smoking, and use of antihypertensive or lipid-lowering drugs], the difference in systolic blood pressure remained significant. Results were similar when calcium intake was considered. After adjustment for confounders, the association between calcium-dairy product combination and blood pressure was the most significant when intakes of dairy products and calcium were both higher than the median. CONCLUSION: Dairy products and dietary calcium are both significantly and independently associated with low levels of systolic blood pressure.

Animals↗

Is exercise testing useful to improve the prediction of coronary events in asymptomatic subjects?

OBJECTIVE: The value of exercise testing (ET) in asymptomatic subjects remains controversial and is unknown in countries with a low coronary heart disease (CHD) incidence. The aim of this study was to investigate the ability of ET to improve the prediction of a first coronary event in such a population. METHODS: Using a prospective cohort study, 1051 consecutive healthy asymptomatic adults were enrolled in a cardiovascular screening program including ET. The pre-test risk of CHD was evaluated by the 10-year Framingham risk function. Positive ET was defined as a horizontal or downsloping ST-segment depression >/=1.0 mm. The primary outcome was total coronary events (CE) occurrence, including cardiac deaths, acute myocardial infarction and stable or unstable angina. The mean follow-up period was 6 years. RESULTS: Subjects were aged 18-79 years and 36% were women. A total of 89 subjects (8.5%) had a positive ET. Positive exercise testing was associated with CE occurrence in a univariate analysis only in subjects with higher pre-test risk, defined by a 10-year Framingham risk >10.4% [hazards ratio (HR)=2.61; 95% confidence interval (CI) (1.07-6.40)]. In this risk category, ET was able to provide incremental information over the major risk factors in both men and women [risk factor-adjusted HR for positive ET=2.86; 95% CI (1.14-7.20)]. This risk excess in subjects with positive ET persisted even when a coronary revascularization was performed. Subjects with intermediate pre-test probability (10-15%) and positive ET had a post-test probability of CE largely equivalent to the probability in subjects with known CHD. CONCLUSION: Additional information provided by ET in subjects with a pre-test risk at 10-years >10% should lead to a more efficient use of risk-reducing therapies than it would be the case in this risk category with the analysis of traditional risk factors only.

Adolescent↗

Prognosis of patients with atherothrombotic disease: a prospective survey in a non-hospital setting.

BACKGROUND AND PURPOSE: Ischemic stroke, myocardial infarction and peripheral arterial disease are the clinical expression of a single underlying pathology. However, atherothrombotic diseases are often associated and little is known of the prognosis of these diseases taken as a whole. METHODS: The objective of the survey was to estimate the one-year occurrence of subsequent vascular events in patients with atherothrombotic disease. We measured the occurrence of myocardial infarction, ischemic stroke and cardiovascular death. Patients were enrolled by private practice physicians in a non-hospital setting. They had to present with at least one of myocardial infarction, ischemic non-embolic stroke, and peripheral arterial disease. The Kaplan-Meier method was used to determine the event-free survival and a multivariate analysis was used to assess predictors of cardiovascular events. RESULTS: 7783 eligible patients were enrolled by 3039 physicians. As a whole, 296 of 7783 patients (3.8%) experienced at least one ischemic event: 78 non-fatal myocardial infarction (26.4% of first events), 120 non-fatal stroke (40.5%) and 98 cardiovascular deaths (33.1%). For patients with a single location, the rate (crude percentage) of a first recurrent event was 2.9%, 4.8% and 3.2% in myocardial infarction, ischemic stroke and peripheral arterial disease; for patients with several locations the rate was 5.6%, 8.3%, 5.9%, respectively. But for patients with a single location, the one-year cumulative cardiovascular event rate observed separately in men or women, adjusted by age, was not statistically different whatever the location. CONCLUSIONS: Despite recent recommendations drawn from large clinical trials in secondary prevention, the risk of cardiovascular events remains very high in patients followed up in daily practice with a history of one or several atherothrombotic locations.

Aged↗

Antithrombotic management after an ischemic stroke in French primary care practice: results from three pooled cross-sectional studies.

BACKGROUND AND PURPOSE: We aimed at quantifying and explaining the underuse of antithrombotic treatments after an ischemic stroke in patients seen in French primary care. METHODS: We pooled all ischemic stroke patients included in 3 observational primary care-based observational studies. French general practitioners and cardiologists recruited 14,544 patients with atherothrombotic disease including 4,322 with an ischemic stroke. Antithrombotic therapies and risk factors were prospectively recorded. Patients with atrial fibrillation (AF) were considered appropriate for oral anticoagulants (OAC) and those without AF for antiplatelet drugs. RESULTS: Out of the 4,322 stroke patients, 3,732 (86.3%) were taking at least one antithrombotic drug. Among the 765 patients with AF, 333 (43.5%) received OAC and 2,718 (86.9%) out of the 3,129 patients appropriate for antiplatelet drug were taking antiplatelet drug. Multivariate analyses did not single out any risk factors for nonuse of OAC and showed that female sex (OR = 1.48; IC 95%: 1.14-1.92) was associated with nonuse of antiplatelet drugs. Conversely, past myocardial infarction (OR = 0.44; IC 95%: 0.26-0.71) and hypercholesterolemia (OR = 0.64; IC 95%: 0.50-0.81) were associated with appropriate use of antiplatelet drugs. CONCLUSION: More than 50% of stroke patients with AF do not receive OAC and 15% of those without AF do not receive antiplatelet drugs. These findings are not satisfactorily explained by the main patients' characteristics and practitioner's speciality and underline the complexity of the process which allows the transfer of scientific evidence in clinical practice.

Adult↗

C-reactive protein elevation predicts pulse pressure reduction in hypertensive subjects.

Cross-sectional studies have shown a positive association between increased pulse pressure (PP) and an increased likelihood of a C-reactive protein (CRP) level >3 mg/L. In a retrospective subgroup analysis of the hypertensive subjects of the multicenter double-blind study, REASON (PREterax in Regression of Arterial Stiffness in a ContrOlled Double-BliNd), in which fixed first-line antihypertensive combination therapy with an angiotensin converting enzyme (ACE) inhibitor, perindopril (2 mg), and a diuretic, indapamide (0.625 mg), proved significantly more effective than atenolol in normalizing PP, we sought to determine whether perindopril plus indapamide was also more effective than atenolol in lowering CRP levels and, if so, whether this effect correlated with a preferential reduction in PP. At the final visit (12 months) in the 269 patients studied, the decrease in PP was greater, and the proportion of patients with CRP >3 mg/L lower (17.9% versus 28. 9%, P=0.03; adjusted odds ratio, 1.02 to 4.08, P=0.01), in the perindopril plus indapamide group than in the atenolol group. After adjustment for confounders, patients with a baseline CRP >3 mg/L displaying the greatest decrease in PP were more likely (P=0.04) to have a CRP < or =3 mg/L at 12 months. No such relationship was found with systolic or diastolic blood pressure. Perindopril-indapamide combination therapy is more effective than beta-blockade in lowering elevated CRP in hypertensive subjects. This effect is significantly associated with a more effective PP reduction in patients with baseline CRP >3 mg/L.

Adrenergic beta-Antagonists↗

Fasting insulin concentrations and coronary heart disease incidence in France and Northern Ireland: the PRIME Study.

BACKGROUND: Reports about the relationships between insulin concentrations and CHD risk are controversial. The objective of this survey was to study the association between insulin levels and CHD risk in middle-aged male participants of the PRIME Study after 5 years of follow-up. METHODS: Our study adopted a nested case-control design including 294 cases of CHD and 536 controls randomly selected among healthy participants from the PRIME cohort. Data were obtained by questionnaires (medical history, lifestyle), standardised clinical measurements (blood pressure, anthropometric measurements), and a blood sample was obtained for biological measurements. Odds-Ratios for associations of four ordered classes of insulin concentration with CHD risk after adjustment for confounding factors were estimated using conditional logistic regression. RESULTS: In Belfast, a significant trend (p<0.03) was observed between insulin classes and CHD risk in bivariate analyses, but this association lost its significance after multiple adjustments. In the French centres, a high risk of CHD (OR=3.24 [1.80-5.85], p<0.0001) was observed only for the second class of insulin concentration (6.5 to 9.9 mIU/l), compared with the reference class (<6.5 mIU/l). After multiple adjustments, this association remained highly significant (OR=2.92 [1.44-5.92], p<0.005). CONCLUSIONS: In Belfast (high-risk population), a significant trend was observed between insulin concentration classes and CHD risk but hyperinsulinaemia lost its association with CHD risk in multivariate analyses. In the French centres (lower risk population), slightly increased insulin concentrations were associated with a high risk of CHD, independently of cardiovascular risk factors and other features of the metabolic syndrome, but very high insulin concentrations were not.

Case-Control Studies↗

Effect of early initiation of statins on survival in patients with acute myocardial infarction (the USIC 2000 Registry).

We evaluated the association of statin initiation within 48 hours of admission for an acute myocardial infarction with a 1-year prognosis on a nationwide scale. Patients who received a statin within 48 hours of admission but not before hospitalization had an improved prognosis (hazard ratio 0.57, 95% confidence interval 0.38 to 0.86, p <0.007) after adjustment for covariates and propensity score.

Aged↗

Ozone air pollution is associated with acute myocardial infarction.

BACKGROUND: Despite the diversity of the studied health outcomes, types and levels of pollution, and various environmental settings, there is substantial evidence for a positive link between urban air pollution and cardiovascular diseases. The objective of this study was to test the associations between air pollutants and the occurrence of acute myocardial infarction (AMI). METHODS AND RESULTS: Pollutant concentrations (SO2, NO2, and O3) were measured hourly as part of the automated air quality network. Since 1985, an AMI registry (the Toulouse MONICA Project) has been collecting data in the southwest of France. All cases of AMI and sudden and probable cardiac deaths are recorded for subjects 35 to 64 years of age. We studied the short-term exposure effect of pollution on the risk of AMI (from January 1, 1997, to June 30, 1999) using a case-crossover design method. We performed a conditional logistic regression analysis to calculate relative risks (RRs) and their 95% CIs. After adjustment for temperature, relative humidity, and influenza epidemics, the RRs (for an increase of 5 microg/m3 of O3 concentration) for AMI occurrence were significant for the current-day and 1-day-lag measurements (RR, 1.05; 95% CI, 1.01 to 1.08; P=0.009; and RR, 1.05; 95% CI, 1.01 to 1.09; P=0.007, respectively). Subjects 55 to 64 years of age with no personal history of ischemic heart disease were the most susceptible to develop an AMI (RR, 1.14; 95% CI, 1.06 to 1.23). NO2 and SO2 exposures were not significantly associated with the occurrence of AMI. CONCLUSIONS: Observational data confirm that short-term O3 exposure within a period of 1 to 2 days is related to acute coronary events in middle-aged adults without heart disease, whereas NO2 and SO2 are not.

Adult↗

The APOA4 Thr347->Ser347 polymorphism is not a major risk factor of obesity.

OBJECTIVE: The goal of this study was to assess the association between the APOA4 Thr(347)-->Ser(347) polymorphism and BMI and obesity. RESEARCH METHODS AND PROCEDURES: Men and women (n = 3320), randomly recruited in three independent population surveys from the north, east, and south of France, were genotyped for the APOA4 Thr(347)-->Ser(347) polymorphism. RESULTS: There were 1327 overweight (825 men, 502 women) and 611 obese (313 men, 298 women) subjects. The prevalences of subjects carrying at least one Ser(347) allele (*/Ser(347)) were 36.5%, 33.8%, and 34.3% in controls, overweight, and obese subjects, respectively (not significant), and those of the Ser(347)/Ser(347) genotype were 4.5%, 3.0%, and 2.2%, respectively (not significant). In both men and women, mean BMI and body weight were not significantly different among APOA4 genotypes. There was no evidence of heterogeneity among centers, smoking status, alcohol intake, physical activity, and educational level categories. In men, mean waist girth was lower in Ser(347)/Ser(347) (92.2 +/- 9.4 cm) than in Thr(347) carriers (95.9 +/- 10.9 cm; p = 0.01), and plasma triglycerides levels were lower in Ser(347) (1.41 +/- 1.04 mM) than in Thr(347)/Thr(347) carriers (1.55 +/- 1.23 mM; p = 0.01). DISCUSSION: These results suggest that the APOA4 347Ser allele is not a major risk factor for obesity or overweight.

Adult↗

Trends in coronary heart disease in France during the second half of the 1990s.

BACKGROUND: Data on the recent evolution in coronary heart disease (CHD) mortality and incidence rates are lacking in France. This paper aims to investigate whether the declining trends observed from 1985-1993 still persist in the second half of the 1990s. METHODS: Population registers of acute CHD have been implemented in three specific geographical areas, first as part of the MONICA Project (1985-1993) and, since 1997, according to a simplified registration procedure. Weighted Poisson regressions have been used to investigate time trends in CHD events in men and women aged 35-64 after correction for registration differences. RESULTS: Data obtained from 1997-2000 showed that the north-to-south gradient of decreasing frequency of CHD events in France was still present. Besides, they revealed no specific trend in CHD morbidity by centre and gender, except in Lille (in the north of France) where events tended to increase in women. Coronary heart disease mortality rates in recent years were decreasing in men, particularly in the north and east of France, but were stable in women with, even, a rising tendency in the north. CONCLUSION: The decreasing trend in CHD events in France observed from the mid 1980s to the early 1990s seemed to markedly slow down in the second half of the 1990s.

Adult↗

Increased resting heart rate with pollutants in a population based study.

BACKGROUND: Air pollution is associated with cardiovascular mortality. Changes in the autonomic nervous system may contribute to cardiac arrhythmias and cardiovascular mortality. This study investigated the relations between air pollutant concentrations of sulphur dioxide (SO(2)), ozone (O(3)), nitric dioxide (NO(2)), and resting heart rate (RHR) in a population based study. METHODS: A sample of 863 middle aged men and women, living in Toulouse (MONICA centre) area, was randomly recruited. A cross sectional survey on cardiovascular risk factors was carried. RHR was measured twice in a sitting position after a five minute rest. Multivariate analyses with quintiles of RHR were performed using polytomous logistic regression. Models were adjusted for temperature, season, relative humidity, sex, physical activity, blood pressure, C reactive protein, and cardiovascular drugs. RESULTS: For NO(2), the OR (odds ratio) (95% CI) associated with an increase of 5 microg/m(3) in the current day of medical examination was 1.14 (1.03 to 1.25) in quintile Q5 of RHR compared with Q1, p for trend = 0.003. For SO(2), OR was 1.16 (0.94 to 1.44) in Q5 compared with Q1, p for trend = 0.05, and for O(3), OR was 0.96 (0.91 to 1.01) in Q5 compared with Q1, p for trend = 0.11. No significant association was seen when the daily mean concentration of NO(2), SO(2), and O(3) was considered during the previous day as well as when day lag 2 or 3 was considered. The cumulative concentration (three consecutive days) of O(3) is negatively associated with RHR (p for trend = 0.02). CONCLUSION: Changes in pulse rate could reflect cardiac rhythm changes and may be part of the pathophysiological link between pollution and cardiovascular mortality.

Adult↗

Household income is associated with the risk of metabolic syndrome in a sex-specific manner.

OBJECTIVE: To assess the relationship between household income and metabolic syndrome in men and women. RESEARCH DESIGN AND METHODS: A total of 1,695 men and 1,664 women, aged 35-64 years, from three distinct geographical areas of France were investigated. Waist girth, plasma triglycerides, HDL cholesterol, glucose, and systolic blood pressure were used to define metabolic syndrome according to the National Cholesterol Education Program (NCEP)/Adult Treatment Panel III (ATPIII) guidelines. Household income, educational level, occupational category, working status, consumption of psychotropic drugs, accommodation status, household composition, physical activity at work and during leisure time, alcohol consumption, and smoking habits were recorded with a standardized questionnaire. RESULTS: There were 390 (23.0%) men and 381 (16.9%) women who satisfied NCEP/ATPIII criteria for metabolic syndrome. Household income (P < 0.0001) and consumption of psychotropic drugs (P = 0.0005) were associated with metabolic syndrome in women but not in men. In contrast, educational level, occupational category, working status, and accommodation status were associated with metabolic syndrome in both men and women. After adjustment on lifestyle variables, household income (interaction P < 0.004) remained inversely associated with metabolic syndrome in women but not in men. CONCLUSIONS: These data suggest that limited household income, which reflects a complex unfavorable social and economic environment, may increase the risk of metabolic syndrome in a sex-specific manner.

Adult↗

[Prognosis at six months for primary care patients: prognostics factors analysis].

UNLABELLED: AIM OF THE SURVEY: The aim of the PREVENIR III study was to assess, in secondary prevention, the risk of subsequent coronary and cerebrovascular events at six months in a population of patients in private practice. METHODS: This was a prospective observational survey (6-month follow-up), including patients diagnosed with previous myocardial infarction, unstable angina or ischemic stroke, carried out by French general practitioners and cardiologists in private practice. RESULTS: 8288 patients were selected by 3746 physicians (2961 general practitioners and 785 cardiologists) representative of French metropolitan physicians in private practice. In this analysis the medical records of 6859 coronary patients were analyzed. After a 6-month follow-up, 84 patients had been hospitalized for a subsequent coronary or cerebrovascular event (1.2%) i.e. cumulative incidence 3.1 event per 100 person-years (95% CI 2.4-3.8). In the coronary population 77.4% of the subsequent vascular events were coronary events and 22.6% were cerebrovascular events. The event rate of coronary events was 0.9% and the cumulative incidence 2.3 event per 100 person-years (95% CI 1.8-2.8), the risk of secondary ischemic stroke was 0.3% and the cumulative incidence 0.7 event per 100 person-years (95% CI 0.4-1.0), and the all-cause mortality rate was 1.0% and the cumulative incidence 2.5 event per 100 person-years (95% CI 1.9-3.1). 61.0% of total death was cardiovascular deaths. Multivariate analysis showed that older age, recent index event, three vessel disease were more likely to undergo recurrent events. CONCLUSION: Our survey enabled a better understanding of the prognosis at six months for a large sample of coronary patients recruited in private practice medicine. For coronary patients treated in private practice the risk of subsequent events and total mortality is far from insignificant.

Adult↗