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Biomedical subjects

T G Ganiats

Publications and source records attributed to T G Ganiats.

At least 19 recordsLinked to original sources
PubMed1991

Factors associated with paradoxical survival at higher blood pressures in the very old.

Paradoxically greater survival for persons aged 85 years and older with higher blood pressures has been reported in a Finnish population study (Br Med J 1988;296:887-9). In a previous report, the authors demonstrated improved 10-year survival with increasing diastolic blood pressure in men (but not in women) aged 75 years and older in the Rancho Bernardo Chronic Disease Study (Br Med J 1989;298:1356-7). However, few of the covariates which could potentially explain this effect were obtained at the visit used in that analysis. In an effort to confirm these reports of paradoxical survival and to explore possible reasons for them, the authors analyzed all-cause and cardiovascular mortality in 795 men and women aged 75-96 years (mean, 80.6), evaluated in 1984-1987 and followed prospectively for an average of 3 years after that comprehensive examination. Of 63 deaths, 48 (76%) were in men; 43 (68%) of all deaths were cardiovascular. Kaplan-Meier survival analyses showed a significant trend for improved survival with increasing diastolic pressure in men aged 80 years and older versus all-cause mortality (chi 2 p less than or equal to 0.01), and cardiovascular mortality (chi 2 p less than or equal to 0.00). These trends were not evident in men aged less than 80 years or in women in either age group. Results were not explained by differences in the use of antihypertensive medication, pulse pressure, history of hypertension, history of coronary heart disease, isolated systolic hypertension, interval change in diastolic pressure (over an average of 12 years), or by cholesterol, triglycerides, fasting plasma glucose, smoking, or body mass index. Thus, the paradoxical relation of improved all-cause and cardiovascular survival in men aged 80 years or older with higher diastolic pressure is not explained by a wide range of biologic and historical factors.

Age Factors↗
PubMed1991

Evaluation of cost-effectiveness research: a survey of recent publications.

Because of interest in cost containment, a series of basic guidelines for performing cost-effectiveness research has evolved in the past decade. These guidelines advise that the perspective of the cost study be clarified, that all applicable costs, benefits, and health outcomes be included, and that discounting and sensitivity analyses be performed where appropriate. A survey of 47 recent cost-effectiveness publications selected via MEDLINE and manual searches confirms our hypothesis that many studies do not adhere to these guidelines. Since such short-comings can lead to misleading or ill-founded conclusions, attention must be paid to the principles of cost-effectiveness research to avoid making major, inappropriate health policy decisions.

Bibliometrics↗
PubMed1990

Effect of normal MSAFP screening on maternal age for genetic amniocentesis.

Routine maternal serum alpha-fetoprotein (MSAFP) screening for neural tube defects is considered by many to be standard obstetrical care, and recently many have encouraged this test to screen for Trisomy-21 (Down's syndrome). We questioned whether, after a normal MSAFP screen, the risk of Trisomy-21 decreases enough to warrant modifying the recommended age for genetic amniocentesis for Down's syndrome. A logistic regression was developed which, using reported values for sensitivity and specificity for MSAFP detection of Trisomy-21 and assuming a constant threshold risk in opting for amniocentesis, indicates that genetic amniocentesis for Trisomy-21 may be deferred in some women who have a normal MSAFP screening. Sensitivity analysis of varying thresholds for a normal MSAFP demonstrates that a 37 year old woman with a median MSAFP level has the same risk for Trisomy-21 as an unscreened women who is 4.5 years younger. An abnormal MSAFP is useful in screening for neural tube defects and possibly for Trisomy-21. A normal MSAFP may allow for delaying the potentially risky amniocentesis in otherwise low-risk pregnancies.

Adult↗
PubMed1990

Clustering of atherogenic behaviors in coffee drinkers.

We studied the clustering of coffee consumption and selected atherogenic behaviors in older adults living in a southern California community. Men were somewhat more likely to drink caffeinated coffee while women were more likely to drink decaffeinated coffee. In men, but not women, caffeinated coffee drinking decreased with age and decaffeinated coffee drinking increased. Caffeinated coffee drinkers drank more alcohol, consumed more dietary saturated fats and cholesterol, were more likely to be current smokers and less likely to be current exercisers than were non-coffee drinkers. Smoking and exercise also showed a dose-response relationship to the amount of caffeinated coffee consumed. Risk factor levels among drinkers of decaffeinated coffee were more like those of caffeinated coffee than non-drinkers. These data illustrate the clustering of atherogenic behaviors with coffee drinking and highlight their potential importance in interpreting the growing body of literature about coffee and health.

Age Factors↗
PubMed1989

Circumcision.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Principles of cost-effectiveness research.

Recent advances in the theoretical concepts behind cost-effectiveness evaluation have led to a marked improvement of the techniques used in cost-effectiveness research. Any effective program will have not only dollar costs and dollar benefits but also nondollar costs and benefits. Cost studies evaluate the relative weights of these costs and benefits to determine whether the program's value is worth the expense. Key elements to consider include direct costs of the program, costs of future workup of treatment, costs of evaluating and treating complications resulting from the program, future medical costs averted, discounting of future costs and health effects, and a sensitivity analysis. Despite the recent theoretical advances, cost-effectiveness research raises multiple controversies, including some key ethical issues.

Cost-Benefit Analysis↗