Biomedical subjects

M Zureik

Publications and source records attributed to M Zureik.

At least 37 records · Page 2Linked to original sources

PubMed2000

Long-term outcome in asymptomatic men with exercise-induced premature ventricular depolarizations.

BACKGROUND: Exercise testing is widely used in the diagnosis of coronary artery disease, but the long-term outcome for asymptomatic persons with exercise-induced premature ventricular depolarizations remains unclear. We used data from the Paris Prospective Study I to assess the long-term outcome for such persons. METHODS: A total of 6101 asymptomatic French men (42 to 53 years of age) who were free of clinically detectable cardiovascular disease underwent a standardized graded exercise test between 1967 and 1972. Subjects were prospectively classified as having or not having frequent premature ventricular depolarizations (a run of two or more consecutive premature ventricular depolarizations or premature ventricular depolarizations constituting more than 10 percent of all ventricular depolarizations during any of the 30-second electrocardiographic recordings). RESULTS: During exercise, 138 subjects had frequent premature ventricular depolarizations. After 23 years of follow-up, these subjects had a higher risk of death from cardiovascular causes than the men without frequent premature ventricular depolarizations during exercise (relative risk, 2.67; 95 percent confidence interval, 1.76 to 4.07). In a multivariate model, with adjustment for age, body-mass index, heart rate at rest, systolic blood pressure, tobacco use, level of physical activity, presence or absence of diabetes, total cholesterol level, and the presence or absence of premature ventricular depolarizations before exercise and during recovery from exercise, both an exercise test that was positive for ischemia and the occurrence of frequent premature ventricular depolarizations during exercise remained independently associated with an increased risk of death from cardiovascular causes, with similar relative risks (2.63 [95 percent confidence interval, 1.93 to 3.59] and 2.53 [95 percent confidence interval, 1.65 to 3.88], respectively). CONCLUSIONS: The occurrence of frequent premature ventricular depolarizations during exercise in asymptomatic middle-aged men is associated with a long-term increase in the risk of death from cardiovascular causes.

Adult↗

PubMed2000

A decrease in diastolic blood pressure combined with an increase in systolic blood pressure is associated with a higher cardiovascular mortality in men.

OBJECTIVES: The study evaluated the risk of cardiovascular mortality according to combined spontaneous (non-treatment-related) changes in both systolic and diastolic blood pressure (BP). BACKGROUND: Long-term longitudinal changes in blood pressure may be a more accurate determinant of cardiovascular risk since changes in systolic or diastolic blood pressure over a period of time reflect the evolution of arterial and arteriolar alterations. METHODS: Two independent French male cohorts were studied: the IPC cohort (Investigations Préventives et Cliniques) composed of 15,561 men aged 20 to 82 years who had had two visits spaced four to 10 years apart, and the Paris Prospective Study composed of 6,246 men aged 42 to 53 years, examined annually for a period of four years. None of the subjects were taking antihypertensive medication. Annual changes in BP were estimated, and subjects were divided into groups according to the increase, lack of change, or decrease of systolic or diastolic BP. Nine groups were formed by combining the changes of systolic and diastolic BP. Cardiovascular mortality was assessed for a mean period of 13.5 years for the IPC Study and 17 years for the Paris Prospective Study. RESULTS: In both cohorts, after adjustment for age and major risk factors, the group with an increase in systolic and a decrease in diastolic BP presented the highest relative risk of cardiovascular mortality compared to the group with no changes in either systolic or diastolic BP (relative risk: 2.07 [1.05 to 4.06] in the IPC Study and 2.16 [1.16 to 4.01] in the Paris Prospective Study). CONCLUSIONS: Assessment of spontaneous changes of BP over a long period of time can contribute to the evaluation of cardiovascular risk. Subjects whose systolic BP increased while their diastolic BP decreased had the highest cardiovascular risk independently of absolute values of BP or other risk factors.

Adult↗

PubMed2000

Using Global Initiative for Asthma guidelines to assess asthma severity in populations.

The classification of asthmatics into severity categories is a crucial issue for assessing the asthma burden within a community, in which a proportion of patients is currently treated. There is no epidemiological method currently available. The Global Initiative for Asthma (GINA) was used to classify 4,362 patients aged 16-45 yrs (49% males, 42% taking inhaled corticosteroids), enrolled by 545 chest specialists in France with short standardized questionnaires including forced expiratory volume in one second (FEV1) measurements. Two independent GINA classifications were combined, one based only on symptoms and FEVI, and the other based only on current medication, to construct a final "symptom-FEV1 medication" classification. Almost 40% of the patients classed as step 1, 30% of those classed as step 2 and 13% of those classed as step 3 in the initial symptom-FEV1-classification, were allocated to categories of higher severity in the final classification. The approach was validated by showing that the proportions of: 1) patients considered by the physicians as having severe or moderately severe asthma; 2) patients with a history of hospital admission for asthma; and 3) patients with a history of emergency department visits for asthma, increased with severity steps in the final classification, for each step of the two initial independent classifications. The treatment manage plan in the Global Initiative for Asthma was not developed for assessing severity of asthma but rather to describe the recommended therapy for asthma with different severity. This is the first attempt to assess the severity of asthma in a large population of asthmatics mostly taking treatment, based on the Global Initiative for Asthma guidelines. The authors propose this simple and pragmatic procedure for a potential classification which should be put to the test in other studies.

Adolescent↗

PubMed2000

Common carotid intima-media thickness predicts occurrence of carotid atherosclerotic plaques: longitudinal results from the Aging Vascular Study (EVA) study.

The role of the increase in the common carotid artery (CCA) intima-media wall thickness (IMT) in the atherosclerotic process is questionable. This longitudinal study examined the predictive value of CCA-IMT measured at baseline examination (at sites free of plaques) on the occurrence of atherosclerotic plaques in the extracranial carotid arteries during 4 years of follow-up study in a sample of 1010 subjects aged 59 to 71 years. Ultrasound examinations were performed at baseline and 2 years and 4 years later. The occurrence of carotid plaques during follow-up was defined as the appearance of >/=1 plaque in previously normal carotid segments and/or the appearance of new plaques in the carotid segments that previously had plaques. Carotid plaque occurrence was observed in 185 subjects (18.3%). Age- and sex- adjusted odds ratios of carotid plaque occurrence were 2.66 (95% CI 1.58 to 4.46, P<0.001) in subjects having intermediate baseline CCA-IMT values (quartiles 2 and 3) and 3.67 (CI 2.09 to 6.44, P<0.001) in those having the highest baseline CCA-IMT values (quartile 4) compared with those having the lowest baseline CCA-IMT values (quartile 1). Multivariate adjustment for major cardiovascular risk factors did not alter the results. These findings were observed for men and women as well as for subjects with and without carotid plaques at baseline. This 4-year longitudinal study shows that CCA-IMT predicts carotid plaque occurrence in a large sample of relatively old subjects. It extends the findings obtained from cross-sectional studies and suggests that increased intima-media thickness might occur in an earlier phase of the atherosclerotic process.

Aged↗

PubMed1999

Use of personal passive samplers for measurement of NO(2), NO, and O(3) levels in panel studies.

We measured personal exposure to nitrogen dioxide (NO(2)), nitrogen monoxide (NO), and ozone (O(3)), using personal passive samplers during three 4-day periods, in a panel study of asthmatics continuing the normal activities of everyday life. Fifty-five adults, mean age 42 years, 53% men, and 39 children, mean age 11 years, 67% boys, wore two Ogawa passive samplers simultaneously: one for O(3), the other for NO(2) and NO. Mean outdoor pollution was measured at a regional monitoring network. Personal exposure levels were scattered; they were (on average) higher than stationary-site levels for NO and lower for NO(2) and O(3). In adults, 41% of the variance of personal exposure to NO(2) was explained by mean stationary-site measurement levels (P<0.0001). Twenty-one percent additional variance was explained by living near a main road, not having an extractor fan over the cooker, older age, and male sex. NO and O(3) personal exposures correlated poorly with stationary-site measurements. In panel studies of the health effects of air pollution, personal exposure to NO(2) and NO can be measured satisfactorily by passive samplers: such measurements are necessary for NO but not for NO(2). For O(3), accurate personal exposure measurement remains a challenge and further technical development is required.

Activities of Daily Living↗

PubMed1999

[Evaluation of the ability of asthmatic children to use a breath-actuated pressurized inhaler].

BACKGROUND: Poor inhaler technique in asthmatics is well documented. The objective of this study was to evaluate the influence of reading the instruction leaflet and the consultant's explanations on the use of the new breath-actuated inhaler (Autohaler 3M). METHODS: In this study were participating 379 asthmatic children and adolescents, aged from four to 17 years (mean age: 10; 64% boys), recruited by 80 pediatricians. The use of the Autohaler device was considered to be correct if the shaking, lip position, deep inhalation and apnea were all properly performed. RESULTS: The Autohaler was used correctly by 42% of the subjects simply after reading the instruction leaflet (phase I), and by 75% of the subjects who, having failed phase I, received the consultant's explanations (phase II). At the end of phases I and II, the device was correctly used by 84% of the subjects. In multivariate analysis, those under the age of nine years and those with no prior use of inhaler systems accounted for a significant amount of the incorrect use of the Autohaler during phase I. In phase II, only the fact of being less than nine years old was significantly related to incorrect use. CONCLUSION: More than four-fifths of the asthmatic children and adolescents properly used the Autohaler after merely reading the instructions and after receiving additional explanation from the consultant. The marked improvement obtained after medical explanations underlines the essential educative role of the physician when prescribing. Young children require specific training and particularly careful attention.

Adolescent↗

PubMed1999

Differential association of common carotid intima-media thickness and carotid atherosclerotic plaques with parental history of premature death from coronary heart disease : the EVA study.

Familial aggregation of coronary heart disease (CHD) has been reported in several studies. The specific underlying mechanisms and the relative contribution of atherosclerosis to the subsequent CHD events in subjects with family history are not well established. This study examined the association of parental history of premature death from CHD with ultrasound carotid measurements of atherosclerosis in a population of 1040 subjects aged 59 to 71 years. Ultrasound examination included measurements of intima-media thickness at the common carotid arteries (at sites free of plaques) and assessment of atherosclerotic plaques in the extracranial carotid arteries. Subjects who reported that 1 or both parents had sudden death or died of myocardial infarction before the age of 65 years were considered positive for parental history of premature death from CHD (n=53, 5.1%). The prevalence of atheromatous plaques was higher in subjects with history of premature death from CHD compared with those without history (41.5% versus 20.5%, P<0.001). Age- and sex-adjusted odds ratio of atheromatous plaques associated with parental history of premature death from CHD was 2.85 (95% confidence interval, 1.60 to 5.08; P<0.001). Multivariate adjustment for major known cardiovascular risk factors did not markedly alter the results (odds ratio, 2.70; P<0.002). In contrast, common carotid intima-media thickness was not associated with parental history of premature death from CHD (0.66+/-0.11 versus 0.66+/-0.12 mm, P=0.76). These findings were observed in both men and women. In conclusion, parental history of premature death from CHD is strongly associated with carotid plaques. Familial transmission of CHD risk does not seem to be specifically mediated by arterial wall thickening measured at sites free of plaques.

Aged↗

PubMed1999

Cross-sectional and 4-year longitudinal associations between brachial pulse pressure and common carotid intima-media thickness in a general population. The EVA study.

BACKGROUND AND PURPOSE: The cross-sectional and 4-year longitudinal associations between brachial pulse pressure (PP) and ultrasound measurements of common carotid intima-media thickness (CCA-IMT) were assessed. METHODS: A population of 957 volunteers aged 59 to 71 years was recruited from the electoral rolls of the city of Nantes (western France) and reexamined 4 years later. Longitudinal changes in PP and CCA-IMT were computed as the difference between 4-year follow-up and baseline values. RESULTS: Baseline CCA-IMT and PP were positively associated in both age- and sex-adjusted analysis (partial correlation coefficient=0.20, P<0.001) and in multivariate analysis adjusted for traditional cardiovascular risk factors and mean blood pressure (partial correlation coefficient=0.18, P<0.001). In longitudinal analysis, baseline PP was associated with the change in 4-year CCA-IMT (partial correlation coefficient=0.11, P<0.001), and baseline CCA-IMT was a predictor of the 4-year change in PP (partial correlation coefficient=0.10, 0.001<P<0.01). No association between mean blood pressure and CCA-IMT was observed once PP was taken into account, in either cross-sectional or longitudinal analyses (partial correlation coefficients ranged from 0.00 to 0.03). Similar patterns of results were observed in hypertensive, nonhypertensive, and antihypertensive-treated and -nontreated subjects. CONCLUSIONS: This longitudinal study of a large population of relatively aged subjects suggests that elevated levels of PP are associated with the progression of CCA-IMT, and increased CCA-IMT is associated with PP widening. The nature of these relationships and whether atherosclerosis progression over time is involved or not in these associations merit further investigations.

Aged↗

PubMed1999

[Patient knowledge of asthma: results of a national survey in pneumology].

Knowledge of asthma and its treatment were evaluated in a survey of 1,000 asthmatics using a self-questionnaire with closed questions. As far as the disease was concerned, 87.4% of patients knew that the bronchi were the pathological organ and 70.6% that the disease persisted between attacks. Overall knowledge of the disease (pathological organ, persistence of the disease between attacks, chronic inflammation associated with acute bronchoconstriction) was adequate in only 25.6% of patients. It was associated with the educational level [higher > primary; p = 0.001], the grade of asthma [severe > mild; p = 0.007] and the number of medicines inhaled [(n > 3) > (N < 2); p = 0.001)]. As far as medicines were concerned, knowledge of their mechanisms of action varied according to therapeutic groups: antiallergics [78.6%], antibiotics [77.7%], antihistamines [74.5%], LA beta2-mimetics [45.9%], theophylline [31.9%], corticosteroids [31.7%], beta2-mimetics [24.8%]. No factor was statistically correlated with greater familiarity. However, only 7.2% of patients treated with metered-dose aerosols expressed handling problems and 78.8% of asthmatics questioned felt that they were sufficiently informed about their disease and its treatment. Information and education thus remain a priority in the management of asthma.

Adolescent↗

PubMed1997

Decline in serum total cholesterol and the risk of death from cancer.

We investigated whether decline over time in serum cholesterol was associated with the risk of death from cancer in French men. We studied 6,230 working men, age 43-52 years in 1967-1972, who had at least three annual measurements of serum cholesterol. We estimated individual change over time in serum total cholesterol using within-person linear regression. During an average of 17 years of follow-up after the last examination, 747 subjects died from cancer. The multivariate-adjusted relative risks for subjects in the fourth (highest increase in serum total cholesterol), third, and second quartiles, compared with men in the first quartile (who had a decrease in serum total cholesterol), were 0.70 [95% confidence interval (CI) = 0.56-0.87], 0.71 (95% CI = 0.57-0.88), and 0.74 (95% CI = 0.61-0.91), respectively. The group with the highest decline in cholesterol displayed an excess risk for most cancer sites. These associations were more pronounced in subjects whose weight remained stable or decreased over time than in those who gained weight.

Adult↗

PubMed1997

Predicting the outcome in elderly patients of hospital admission for acute care in Paris, France: construction and initial validation of a simplex index.

OBJECTIVE: To develop a simple index able to identify at an early stage those elderly patients at high risk of requiring discharge to a residential or nursing home after admission to hospital for acute care. For these patients, early discharge planning might lead to a more effective management and reduce the length of hospitalisation. DESIGN, SETTING, AND PATIENTS: This was a prospective study conducted in two teaching hospitals in Paris, France. A total of 510 consecutive patients was included. They were aged 75 years or more and had been admitted to acute medical care units through the emergency department. MEASUREMENTS: Demographic data, social support, physical disability, mental disability, and pathologic status were assessed shortly after admission (within 24-48 hours). MAIN OUTCOME MEASURES: Outcome of hospitalisation was defined as discharge to home or residential/nursing home. RESULTS: The index, developed by multiple logistic regression, included six variables: the wish of patients' principal career about their returning home after acute hospitalisation, presence of a chronic condition, ability to perform toileting, ability to know the name of the hospital or the city, their age, and their living arrangements. The sensitivity of the index in identifying patients at high risk of requiring discharge to a residential/nursing home was 74.4%, the specificity 63.8% the positive predictive value was 57.8%, and the negative predictive value was 80.6%. CONCLUSIONS: The simple index, using data available very early in the course of hospitalisation, provides an accurate prediction of the hospitalisation outcome. The performance of the index should be tested in other populations and the practical benefits of risk screening should be assessed in a controlled trial to evaluate whether the intervention is useful and without any adverse effects.

Activities of Daily Living↗

PubMed1997

[Evaluation of the everyday use of a metered dose aerosol triggered by inhalation (the "Autohaler" system)].

Although corticosteroids or beta2-agonists administered by inhalation are recommended as a first line treatment of asthma, standard pressurized metered dose inhalers are used correctly in only 3-% of cases. This study on the new breath-actuated inhaler Autohaler fulfils two objectives: first, to evaluate the respective influence of the reading of the instruction notice and the prescriber's explanations on the correct use of the Autohaler and second, to determine the profile of subjects most refractory to its correct use. The study was conducted by general practitioners in 2,467 asthmatic subjects with poor inhaler technique. The Autohaler was used correctly right from the start in 42.8% of subjects simply after reading the instruction notice (phase I) and in 68% of subjects after receiving the prescriber's explanations (phase II). At the end of phases I and II, correct use was performed by 82% of subjects. After stratification and adjustment, the probability of incorrect use, derived from the odds ratio: i) increased by 80% between 35 and 64 years of age and by 280% beyond 65 years; ii) was 30% higher in cases of severe asthma; iii) was 50% higher in cases of regular use of a pMDI and 80% higher in the absence of previous treatment with inhalers; iv) was 2.5 times lower in subjects who had a secondary education and 5 times higher in those with a university education; v) was not correlated with either sex or habitation. We conclude that the breath-actuated inhaler Autohaler allow correct treatment in 82% of poor inhaler technique patients after reading the instruction notice and brief prescriber's explanation, but some patients, elderly or low level of education, must be given clear, detailed and continuing information.

Administration, Inhalation↗

PubMed1996

Serum cholesterol concentration and death from suicide in men: Paris prospective study I.

OBJECTIVE: To investigate whether low serum cholesterol concentration or changing serum cholesterol concentration is associated with risk of suicide in men. DESIGN: Cohort study with annual repeat measurements of serum cholesterol concentration (for up to four years). SETTING: Paris, France. SUBJECTS: 6393 working men, aged 43-52 in 1967-72, who had at least three measurements of serum cholesterol concentration. MAIN OUTCOME MEASURES: Individual change over time in serum cholesterol concentration (estimated using within person linear regression method); death from suicide during average of 17 years' follow up after last examination. RESULTS: 32 men committed suicide during follow up. After adjustment for age and other factors, relative risk of suicide for men with low average serum cholesterol concentration (< 4.78 mmol/l) compared with those with average serum cholesterol concentration of 4.78-6.21 mmol/l was 3.16 (95% confidence interval 1.38 to 7.22, P = 0.007). Men whose serum cholesterol concentration decreased by more than 0.13 mmol/l a year had multivariate adjusted relative risk of 2.17 (0.97 to 4.84, P = 0.056) compared with those whose cholesterol remained stable (change of < or = 0.13 mmol/l a year). CONCLUSION: Both low serum cholesterol concentration and declining cholesterol concentration were associated with increased risk of death from suicide in men. Although there is some evidence in favour of a concomitant rather than a causal effect for interpreting these associations, long term surveillance of subjects included in trials of lipid lowering treatments seems warranted.

Adult↗

PubMed1996

High alcohol-related premature mortality in France: concordant estimates from a prospective cohort study and national mortality statistics.

This study examines the magnitude of alcohol-related premature death in the French population, which still has the highest average alcohol intake in the world and a relatively low coronary heart disease mortality rate. Two data sources were used: the national mortality data in 1990 and a prospective mortality experience in a cohort of 2,687 middle-aged working men examined in 1980-1985 and followed-up during an average of 9.3 years. In the general population study, alcohol-related premature mortality (35-64 years) was calculated using alcohol-attributable fractions (AAFs) derived from studies of alcohol involvement in deaths from various causes. In the cohort, it was estimated from AAFs and attributable risk using both alcohol exposure prevalence and relative risks of death according to alcohol intake categories. In 1990, estimates of 19.1% and 13.0% of all premature deaths in French men and women were attributed to alcohol. Digestive diseases followed by malignant neoplasms in men and by unintentional injuries in women were major contributors to the total number of alcohol-related premature deaths. In the cohort study, 90 deaths occurred during the follow-up period. The estimation of alcohol-related premature mortality using AAFs was 24.4%. The relative risk of total mortality (adjusted for age, smoking habits, and body mass index) for men who consumed > 60 ml/day of alcohol, compared with those who consumed 0-25 ml/day was 1.9 (95% confidence interval: 1.1-3.5). The consumption of 26-60 ml/day was not associated with reduced risk of mortality, and the adjusted relative risk for this group was 1.3 (95% confidence interval: 0.7-2.5). The estimated attributable risk of premature mortality caused by consumption of > 25 ml/day of alcohol was 29.9%. This study reports the persisting high alcohol-related premature mortality in the French general population, as well as in middle-aged working men. The results suggest that efforts should be paid to reduce further the consumption of alcohol in France.

Adult↗

PubMed1996

Alcohol consumption, gamma-glutamyl transpeptidase (GGT), and pulmonary function: a cross-sectional and longitudinal study in working men.

Epidemiological studies of the relationships between pulmonary function and reported alcohol intake showed inconsistent results. The use of biological markers of alcohol is needed. The objective of this study was to assess the relationships of alcohol consumption, assessed by a standardized questionnaire, and gamma-glutamyl transpeptidase (GGT), to forced expiratory volume in 1 sec (FEV1) level and decline over 10 years, in working men. Three hundred twenty-eight policemen aged 22-55 years were examined in 1980 (first survey) and again in 1990 (second survey). The two cross-sectional analyses used the 1980 data and the 1990 data separately. Longitudinal analysis used 1980 alcohol consumption and GGT values, and 10-year FEV1 decline. In both cross-sectional surveys, elevated alcohol consumption was significantly associated with impaired age-adjusted and height-adjusted FEV1. Further adjustment for smoking habit, education level, and asthmatic status did not alter these results. An increase of 25 g/day of alcohol was associated with 50.0 ml (95% confidence interval: 1.5 to 98.5) and 55.3 ml (95% confidence interval: 7.8 to 102.8) decrease of corresponding multivariate-adjusted FEV1 in 1980 and in 1990, respectively. GGT was also negatively associated with FEV1 in both cross-sectional surveys. Similar patterns of associations were also observed between vital capacity measurements and alcohol variables. In the longitudinal analysis, there was no relationship between either alcohol consumption or GGT and FEV1 decline. Findings suggest that alcohol consumption was associated with impaired lung function, but there was no evidence of accelerated FEV1 decline over 10 years related to alcohol consumption in this "healthy" population of middle-aged men.

Age Factors↗

PubMed1996

Weights at birth and in early infancy, systolic pressure, and left ventricular structure in subjects aged 8 to 24 years.

The objective of this study was to determine whether systolic pressure and left ventricular mass in children, adolescents, and young adults are related to fetal and infant growth. Blood pressure measurements and M-mode echocardiography were performed in 210 subjects aged 8 to 24 years whose information on weights at birth and in early infancy, written by physicians, was obtained from the children's health record booklets. Systolic pressure, adjusted for sex and current height or for sex, current age, weight, and height, was the highest in subjects with low birth weight. No association was observed between systolic pressure and weight at either 9 months or 2 years. Left ventricular mass, adjusted for sex and current height or for sex, current age, weight, and height, increased with decreasing weight at 9 months or 2 years, independent of systolic pressure. Increased ventricular mass associated with reduced infant growth was concentric, resulting from a proportionate thickening of the posterior wall and interventricular septum. Left ventricular mass was not related to birth weight. These findings were observed in both sexes and in all age subgroups and were independent of gestational age, birth order, and parental risk factors. This study supports the hypothesis that systolic pressure and left ventricular mass might be partly determined during fetal life and early infancy. The mechanisms that underlie the associations of blood pressure and left ventricular structure with weights at birth and in early infancy should be studied thoroughly.

Adolescent↗

PubMed1995

Fatty acid proportions in cholesterol esters and risk of premature death from cancer in middle aged French men.

OBJECTIVE: To assess the association of proportions of fatty acids in cholesterol esters with the risk of premature death from cancer in middle aged men. DESIGN: Prospective cohort study. SETTING: Paris, France. SUBJECTS: 3277 working men aged 36-52 in 1981-5. MAIN OUTCOME MEASURES: Cancer mortality during an average of 9.3 years of follow up. RESULTS: 59 men died of cancer during follow up. The age adjusted relative risks for men in the highest thirds of the distribution of the proportions of linoleic, palmitoleic, and oleic acid in cholesterol esters as compared with those in the corresponding lowest thirds were 0.16 (95% confidence interval 0.05 to 0.51), 3.39 (1.63 to 7.05), and 4.22 (1.95 to 9.12), respectively. Adjustment for and stratification by smoking, alcohol consumption, serum cholesterol concentration, and body mass index did not alter the results. At the time of examination subjects with cancer had a lower intake of polyunsaturated fats, assessed by 24 hour recall, than those without cancer (13.2 v 17.4 g/day, P < 0.01). CONCLUSIONS: Monounsaturated and polyunsaturated fatty acids of cholesterol esters are strong biological markers that predict premature death from cancer in French men. Consistently, intake of polyunsaturated fats did not seem to increase the risk of death from cancer. The association of biological markers of dietary fat intake with incidence of and mortality from cancer should be investigated prospectively in other populations.

Adult↗

PubMed1995

Returning home after acute hospitalization in two French teaching hospitals: predictive value of patients' and relatives' wishes.

Identifying elderly patients who are unable to return home immediately after acute hospitalization is difficult. For these patients, early planning of discharge might reduce the length of hospitalization. We conducted a cohort study to investigate the roles of patients' characteristics and patients' and principal carers' wishes about patients returning home in predicting the outcome of hospitalization for 510 patients aged 75 years or more admitted to acute medical care units via the emergency departments of two teaching hospitals in Paris (France). Patients' characteristics and patients' and principal carers' wishes were investigated within 24-48 hours of admission. The outcome of hospitalization was defined as discharge to home or residential/nursing home. The opposition of the principal carer to a patient returning home was the most powerful predictor of discharge to a residential/nursing home. Advanced age, living alone, disability in Activities of Daily Living, altered mental state and presence of a chronic condition fatal within 4 years were also independently associated with discharge to a residential/nursing home. The patient's wishes were predictive in univariate but not in multivariate analysis. These results suggest that the principal carer's wishes about a patient returning home might be taken into consideration early in a hospital stay for more effective discharge planning.

Activities of Daily Living↗