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PubMed1995

Behavioral and psychosocial predictors of physical performance: MacArthur studies of successful aging.

BACKGROUND: Performance-based measures of physical performance are examined for an older cohort of relatively high-functioning men and women. The influences of baseline behavioral, social, and psychological characteristics on patterns of change in performance over 2.5 years are examined. METHODS: A cohort of relatively high-functioning men and women, aged 70-79, identified in 1988 by subsampling from three community-based studies on the basis of physical and cognitive function. Baseline assessments included physical performance, sociodemographic characteristics, health status, and behavioral, social, and psychological characteristics. A summary measure of physical performance was developed from tests of balance, gait, lower body strength and coordination, and manual dexterity. In-home assessments were repeated at follow-up in 1991. RESULTS: Linear regression models were used to identify significant behavioral, social, and psychological predictors of better performance at follow-up, controlling for known sociodemographic and health status predictors. Significant, independent associations with better performance were found for participation in moderate and/or strenuous exercise activity and greater frequency of emotional support from social networks, particularly among those reporting low frequency of instrumental support. These effects remained significant independent of incident health conditions during follow-up. None of the psychological characteristics was a significant predictor. CONCLUSIONS: Maintenance of better physical performance within a high-functioning cohort is influenced by prior exercise behavior and social network emotional support. Observed patterns of both decline and improvement in performance suggest that older age is not uniformly associated with declines. Predictors of better performance identified here may offer potential for effective interventions to promote more successful aging.

Aged↗

PubMed1983

Predictors of happiness.

The current investigation reports findings on the temporal stability of happiness as assessed by the Memorial University of Newfoundland Scale of Happiness (MUNSH), and the stability of the predictor/happiness relationships in three subgroups of persons over 64 years of age. Respondents were interviewed twice, 18 months apart, on the MUNSH and on nine established correlates. Separate multiple regression analyses were used to assess the predictor/happiness relationship for each phase. The stability of happiness was evaluated by the inclusion of phase 1 MUNSH scores in the phase 2 predictor array. For urban and institutional persons the main independent predictors of happiness in both phases were housing satisfaction, health, activities, and changes in life events. For rural individuals only health and marital status remained consistent predictors for both phases. Happiness, greater in rural than in institutionalized persons, remained stable for all groups, with an average of 86% of the accounted MUNSH 2 variance due to MUNSH 1 scores. These results show that, although predictor effectiveness may differ across subgroups, happiness remains stable in later years.

Aged↗

PubMed2006

Male heterosexual crack smokers with multiple sex partners: between- and within-person predictors of condom use intention.

Little research has examined predictors of condom intention within concurrent partnerships. This study examined predictors of intention among 259 male African-American crack smokers with multiple partners. Each participant reported personal condom intention at next sex, condom use self-efficacy, responsibility and outcome expectances for himself and his perceptions for his last two sex partners. Stepwise logistic regressions showed that for both partners one and two, condom use at last sex and personal responsibility for condom use were predictors of intention to use condoms at next sex. Perceived partner responsibility was an additional positive predictor with Partner 2. Hierarchical generalized linear model analyses showed that positive intention was associated negatively with perceived partner responsibility and intimacy, while positively related to situational self-efficacy. Personal responsibility interacted with intimacy such that only men who indicated the highest levels of intimacy were more likely to intend to use condoms. Overall, the findings in this study support the need for examining additional social cognitive constructs that capture the interpersonal aspects of sexual relationships such as personal and perceived responsibility, intimacy and how beliefs may change between multiple partners and across time. Finally, the differences in the valence of perceived partner responsibility across analyses and the interaction of personal responsibility with intimacy suggest the need for studies that include measure of power within the relationship.

Adult↗

PubMed1995

Family and illness predictors of outcome in pediatric brain tumors.

Investigated the prediction of cognitive and behavioral outcomes in 63 children with heterogenous brain tumors. Hierarchical multiple regression analyses were used to determine how family-related variables added to the prediction of children's outcome over and above illness measures. The best predictors of children's behavior problems and adaptive behavior were family and demographic variables, whereas the best predictors of achievement were illness and demographic variables. A combination of family and illness variables, however, was the best predictor of intellectual functioning. In addition to identifying specific predictors of cognitive and behavioral outcome in children with brain tumors, these results lend initial support for the inclusion of contextual factors such as family stress, maternal coping, number of parents in the home, and family SES measures in studies of how disease factors affect outcomes in pediatric brain tumor patients.

Adaptation, Psychological↗

PubMed2004

Predictors of initiation into prostitution among female street youths.

Prostitution among female street youths represents an important risk factor for several health problems. Little is known about the incidence and determinants of prostitution in this vulnerable population, and no data have been previously reported based on a longitudinal follow-up study. The objective of this study was to determine predictors of initiation into prostitution among female street youths. Female youths aged 14 to 25 years were enrolled in the Montreal Street Youth Cohort. They completed a baseline and at least one follow-up questionnaire between January 1995 and March 2000. Girls who reported never having engaged in prostitution at baseline were followed prospectively to estimate the incidence and predictors of prostitution. Of the 330 female street youths enrolled as of September 2000 in the cohort, 148 reported no history of involvement in prostitution at baseline and completed at least one follow-up questionnaire. Of these 148 girls, 33 became involved in prostitution over the course of the study (mean follow-up 2.4 years), resulting in an incidence rate of 11.1/100 person-years. Multivariate Cox regression analysis revealed having a female sex partner (adjusted hazard ratio [AHR] 3.8; 95% confidence interval [CI] 1.6-9.1) was an independent predictor of initiation into prostitution after controlling for having been on the street at age 15 years or younger (AHR 1.8, 95% CI 0.9-3.8), using acid or phencyclidine (PCP; AHR 2.0, 95% CI 0.9-4.6), using heroin (AHR 1.9, 95% CI 0.7-5.5), the use of drugs greater than twice per week (AHR 1.9, 95% CI 0.9-4.2), and injection drug use (AHR 0.8, 95% CI 0.3-2.4). The incidence of prostitution in female street youths was elevated. Having a female sex partner was a strong predictor of initiating involvement in prostitution.

Adolescent↗

PubMed1997

Apolipoprotein A, fibrinogen, age, and history of stroke are predictors of death in dialysed diabetic patients: a prospective study in 412 subjects.

BACKGROUND: Diabetic patients with end-stage renal failure (ESRD) have a high cardiovascular morbidity and mortality. The underlying mechanisms are not completely elucidated. The aim of our study was to define predictors of death in diabetic patients with end-stage renal disease. PATIENTS AND METHODS: We performed a prospective study in 35 dialysis centres in Germany between 1985 and 1994. To evaluate predictors and risk factors in this population we examined 412 diabetic patients at the time of admission to dialysis treatment (peritoneal dialysis (PD) or haemodialysis (HD)). Classification of the type of diabetes was done according the criteria of the National Diabetes Data Group [1,2]. Items assessed at the time of admission were coronary artery disease (CAD), peripheral occlusive disease (POD), and stroke. CAD was defined as a history of myocardial infarction with the corresponding changes in the ECG or luminal narrowing by more than 50% in at least one coronary artery upon coronarangiography; POD was defined as claudication and/or brachial-tibial ratio (BTR) less than 0.9 or a history of amputation. Assessment of the nutritional state comprised body mass index, skinfold thickness of the upper arm and lateral thorax area, and urea concentration. Cholesterol, HDL, LDL, apolipoprotein A (ApoA-I) and B (ApoB), triglycerides, lipoprotein(a) (Lp(a)), and fibrinogen were measured. As an index of disturbed cardiac innervation beat-to-beat variation was measured. Outcome measurements were causes of death (i.e. cardiac and non-cardiac) and time of survival. RESULTS: One hundred and eighty of 412 (44%) patients died during the observation period. Patients who died were older (61 +/- 12 versus 53 +/- 15 years P < 0.0001), had lower skin fold thickness (13.1 +/- 6.0 versus 15.1 +/- 7.3 mm P < 0.04), lower ApoA-I (100 +/- 35 versus 111 +/- 32 mg/dl P < 0.005) and higher fibrinogen (515 +/- 146 versus 451 +/- 155 mg/dl P < 0.02). Type II diabetic patients had a lower mean survival time than type I (34 versus 66 months P < 0.0006). The mode of renal replacement therapy (PD or HD) had no adverse effect on survival time. Survivors less frequently had a history of CAD, POD and stroke than non-survivors. In multivariate analysis ApoA-I, fibrinogen, age and stroke were independent predictors of cardiac and non-cardiac death in diabetic patients with end-stage renal failure. Lipid values and nutritional state did not independently predict the overall and cardiovascular mortality. CONCLUSION: This study in dialysed diabetic patients identifies several predictors of death, some of which are susceptible to intervention.

Adult↗

PubMed2003

Personal and occupational predictors of sciatica in the GAZEL cohort.

BACKGROUND: The objectives of this prospective study were to investigate personal and occupational predictors of sciatica and to compare the risk factors for sciatica and those for low back pain without sciatica. METHODS: The study analysed data from 841 men, initially free from low back pain, who were followed for 2 years. Subjects were participants in the French GAZEL cohort of employees of the national electricity and gas company. The predictive factors for sciatica and low back pain without sciatica were compared with a polytomous model. RESULTS: Height and driving were predictors only for sciatica, and bending forward and backward at work was a predictor only for low back pain without sciatica. The odds ratio (OR) for sciatica associated with 'height >180 cm' was 3, with a 95% confidence interval (CI) of 1.4-6.5; for driving >2 h daily it was 2 (CI = 0.94-4.10) and for driving >2 h several days a week 2.7 (CI = 1.20-6.10). CONCLUSION: This study confirmed that height and driving are risk factors for sciatica and that sciatica has specific predictors different from those for other types of low back pain. Future studies should consider sciatica separately from these.

Adult↗

PubMed1993

Predictors of decline in social relationships in the rural elderly.

Prospective evidence for predictors of decline in social relationships over a 3-year follow-up period in an elderly cohort are presented. The cohort consisted of men (n = 903) and women (n = 1,673) over age 65 years in two rural Iowa counties who were interviewed in 1982 and again in 1985. Three separate measures of social relationships were dichotomized into lower and higher levels and included the number of close friends and relatives (less than three vs. three or more), church attendance (less than once per month or not at all vs. once per month or more), and membership in a group (nonmember vs. member). Those with higher social relationship levels at both interviews were compared with those who had higher levels at baseline but lower levels at follow-up (i.e., a decline in social relationship level) using logistic regression. In multivariate analysis, important baseline predictors of decline in social relationship levels included greater age, lower educational level, lower memory test score, the presence of physical disabilities, and a higher level of depressive symptoms. Marital status and lower self-perceived health status were less consistent predictors, and having any living children, history of major illness, and continence status were generally not important predictors of decline in social relationship levels. These findings underscore the multifactorial and complex influences on changes in social relationships, but they also identify factors for possible prevention and intervention strategies.

Aged↗

PubMed1995

Predictors of adopting leisure-time physical activity among a biracial community cohort.

Literature on the correlates and predictors of leisure-time physical activity among African-American population is sparse. This cohort study assessed correlates of leisure-time physical activity (specific large muscle activities during the past month at least three times a week) in a biracial population in 1987 and predictors for the adoption of this behavior 4 years later among those initially inactive. Random digit dialing methods were used to identify residents of two South Carolina communities in 1987. In 1991, 3,223 of these residents were resurveyed (62% response rate). In general, the correlates of leisure-time physical activity (education, > or = 12 years; nonsmoking; weight loss behaviors; and physician advice) were similar for each sex and race group. In 1987, the definition of leisure-time physical activity was not met by 831 (54% of 1,542) white women, 374 (76% of 489) African-American women, 586 (59% of 991) white men, and 126 (63% of 201) African-American men. Among those who were inactive in 1987, 22-24% of white adults and African-American men and 14% of African-American women adopted physical activity 4 years later. Twelve years or more of education was a predictor among white women (risk ratio = 1.7, 95% confidence interval 1.2-2.6) and African-American women (risk ratio = 3.1, 95% confidence interval 1.4-6.9), but not among men. Having a physician discuss physical activity was a predictor among white women (risk ratio = 1.9, 95% confidence interval 1.3-2.7), African-American women (risk ratio = 1.7, 95% confidence interval 0.9-3.2), white men (risk ratio = 2.0, 95% confidence interval 1.3-3.1), and African-American men (risk ratio = 2.7, 95% confidence interval 1.0-7.6). These results highlight the strong effect of educational attainment on adoption of healthy behaviors and support the involvement of physicians to promote physical activity among all race and sex groups.

Adult↗

PubMed1997

Multiplane transoesophageal echocardiographic absence of thoracic aortic plaque is a powerful predictor for absence of significant coronary artery disease in valvular patients, even in the elderly. A large prospective study.

AIMS: This study was conducted to examine whether detection of atherosclerotic aortic plaque by multiplane transoesophageal echocardiography could predict the absence or presence of significant coronary artery disease in young and elderly valvular patients. METHODS AND RESULTS: Clinical and angiographic features and transoesophageal echocardiography findings were prospectively analysed in 278 consecutive valvular patients. In 93 patients with significant coronary artery disease, 85 had thoracic aortic plaque on transoesophageal echocardiography studies. In contrast, aortic plaque existed in only 33 of the remaining 185 patients with normal or mildly abnormal coronary arteries. Therefore, the presence of aortic plaque on transoesophageal echocardiography studies had a sensitivity of 91%, a specificity of 82%, and positive and negative predictive values of 72% and 95%, respectively, for significant coronary artery disease. In the 109 patients aged > or = 70 years, these sensitivity, specificity, and positive and negative predictive values were 96%, 78%, 79%, and 96%, respectively. The above high negative predictive value was the major finding of this study and indicated that the absence of thoracic plaque is a strong predictor for absence of significant coronary artery disease. There was a significant relationship between the degree of aortic intimal changes and the severity of coronary artery disease (P < 0.0001). Multivariate logistic regression analysis revealed that aortic plaque, angina, hypercholesterolaemia and age were significant predictors of coronary artery disease: aortic plaque was the most significant independent predictor, even in patients > or = to 70 years. CONCLUSION: This large prospective study indicates that examination of thoracic atherosclerotic plaque, by multiplane transoesophageal echocardiography, is a marker for coronary artery disease, and is a particularly powerful predictor for absence of significant coronary artery disease in valvular patients, even in the elderly.

Adult↗

PubMed2003

Waist circumference, waist-to-hip ratio and body mass index as predictors of adipose tissue compartments in men.

BACKGROUND: The accumulation of fat in visceral and posterior subcutaneous adipose tissue compartments is highly correlated with the metabolic abnormalities that contribute to increased risk of diabetes mellitus and cardiovascular disease. AIM: To determine which of waist circumference (WC), waist-to-hip ratio (WHR) and body mass index (BMI) was the best predictor of intraperitoneal and posterior subcutaneous abdominal adipose tissue mass in men. METHODS: We studied 59 free-living men with a wide range of BMI. WC, WHR and BMI were determined using standard methods. Intraperitoneal, retroperitoneal, anterior subcutaneous and posterior subcutaneous abdominal adipose tissue masses (IPATM, RPATM, ASAATM and PSAATM, respectively) were quantified using magnetic resonance imaging. RESULTS: In univariate regression analysis, WC, WHR and BMI were all significantly and positively correlated (all p < 0.05) with IPATM, RPATM, ASAATM and PSAATM. To assess the relative strength of these associations, we used non-nested regression models. There was no significant difference between WC and WHR in predicting IPATM and RPATM; WC was a stronger predictor of ASAATM (p < 0.001) and PSAATM (p < 0.001) than WHR; WC was also a stronger predictor of IPATM (p = 0.042) and RPATM (p = 0.045) than BMI, but the relative strengths of WC and BMI in predicting ASSATM and PSAATM did not different significantly (p > 0.05); there was no significant difference between BMI and WHR in predicting IPATM and RPATM (p>0.05), but BMI was a stronger predictor of ASAATM (p = 0.036) and PSAATM (p < 0.001) than WHR. DISCUSSION: In men WC is the anthropometric index that most uniformly predicts the distribution of adipose tissue among several fat compartments in the abdominal region, there apparently being little value in measuring WHR or BMI.

Abdomen↗

PubMed2005

Outcome following onset of juvenile idiopathic inflammatory arthritis: II. predictors of outcome in juvenile arthritis.

OBJECTIVE: To assess the relative contributions of demographic, clinical and laboratory variables in predicting outcome in juvenile idiopathic inflammatory arthritis (JIA), based on a review of the existing literature. METHODS: Electronic reference database searches for the previous 10 yr were conducted and studies examining the role of major potential predictors of main outcomes were identified. Where possible, subjects were grouped by JIA disease subtype. In addition to demographic variables, the following disease-related predictors were assessed: nature of joint involvement, acute-phase response, and presence of autoantibodies. These were then analysed for three main outcomes of interest: remission as assessed by disease activity; functional impairment; and structural damage as assessed by radiological joint erosions. RESULTS: In general, female gender, polyarticular and symmetrical joint involvement, elevated inflammatory markers and rheumatoid factor positivity were the most consistent predictors of a poor outcome, although the studies were frequently inconsistent in both the direction and the magnitude of the effects. CONCLUSIONS: These data are too variable to accurately identify those predictors associated with poor outcome following the onset of JIA. Although some of this variation may be the result of true differences between study populations, the vast majority of inconsistencies are explainable by the absence of standardized classification systems, outcome definitions, therapeutic approach and research tools. More comprehensive prospective evaluation is required before robust prediction models can be generated.

Acute-Phase Reaction↗

PubMed2006

Direct healthcare costs and predictors of costs in patients with primary Sjogren's syndrome.

OBJECTIVES: To analyse the healthcare usage, direct healthcare costs and predictors of cost in primary Sjögren's syndrome (PSS) in the UK and to compare the findings with the data from healthy control groups and rheumatoid arthritis (RA) patients. METHODS: A total of 129 patients with PSS (American-European criteria), 91 with RA and 92 controls, were included in the study. All groups were age-matched females and all completed questionnaires on health status (SF-36) and healthcare utilization (economic component of the Stanford Health Assessment Questionnaire). Annual direct healthcare costs were calculated (and expressed in 2004 UK pound sterling) and predictors of costs for each patient group were determined by regression analyses. Age, health status, disease duration and anti-Ro/La antibody positivity were used as potential predictor variables. RESULTS: Mean age was similar in the PSS (59.2 yrs, S.D. 11.6), RA (60.3 yrs, S.D. 10.5) and control groups (57.7 yrs, S.D. 12.5). The mean disease duration was 5.4 yrs (S.D. 4.8) in the PSS group and 13.4 yrs (S.D. 11.4) in the RA group. The mean annual total direct cost per patient [95% confidence interval (CI)] was 2188 pounds sterling (1831 and 2546 pounds sterling) in the PSS group, 2693 pounds sterling(2069 and 3428 pounds sterling) in the RA group and 949 pounds sterling (741 and 1156 pounds sterling) in the control group. The costs in the PSS group were greater than for the RA and control groups for visits to all healthcare professionals (total) as well as visits to the dentist, dental hospital and ophthalmologist. The costs in the PSS and RA groups were higher than in controls for diagnostic tests and visits to hospital and the accident and emergency (A&E) department. The PSS group also incurred higher costs than controls, but lower costs than the RA group, for visits to a rheumatologist, urine and blood tests, assistive devices and drug therapy. Regression analysis identified the SF-36 physical function subscale as the best predictor of costs in PSS patients as well as controls and the mental health subscale in RA patients. CONCLUSION: This is the first study to evaluate direct healthcare costs in patients with PSS. PSS has a significant impact on the healthcare system, similar to that of RA, by more than doubling costs compared with control patients.

Adult↗

PubMed2006

Incidence and predictors of difficult and impossible mask ventilation.

BACKGROUND: Mask ventilation is an essential element of airway management that has rarely been studied as the primary outcome. The authors sought to determine the incidence and predictors of difficult and impossible mask ventilation. METHODS: A four-point scale to grade difficulty in performing mask ventilation (MV) is used at the authors' institution. They used a prospective, observational study to identify cases of grade 3 MV (inadequate, unstable, or requiring two providers), grade 4 MV (impossible to ventilate), and difficult intubation. Univariate and multivariate analyses of a variety of patient history and physical examination characteristics were used to establish risk factors for grade 3 and 4 MV. RESULTS: During a 24-month period, 22,660 attempts at MV were recorded. 313 cases (1.4%) of grade 3 MV, 37 cases (0.16%) of grade 4 MV, and 84 cases (0.37%) of grade 3 or 4 MV and difficult intubation were observed. Body mass index of 30 kg/m or greater, a beard, Mallampati classification III or IV, age of 57 yr or older, severely limited jaw protrusion, and snoring were identified as independent predictors for grade 3 MV. Snoring and thyromental distance of less than 6 cm were independent predictors for grade 4 MV. Limited or severely limited mandibular protrusion, abnormal neck anatomy, sleep apnea, snoring, and body mass index of 30 kg/m or greater were independent predictors of grade 3 or 4 MV and difficult intubation. CONCLUSIONS: The authors observed the incidence of grade 3 MV to be 1.4%, similar to studies with the same definition of difficult MV. Presence of a beard is the only easily modifiable independent risk factor for difficult MV. The mandibular protrusion test may be an essential element of the airway examination.

Adult↗

PubMed1999

Predictors of patient satisfaction in an outpatient plastic surgery clinic.

Although outcome measurement in medical care has traditionally included various aspects of clinical and functional status, patient satisfaction is another important metric in the assessment of health care quality. Determining which factors contribute most to patient satisfaction can assist health care providers in improving care. In an era of diminishing resources, satisfaction ratings can further aid third-party payers in determining who provides those services. The authors used the ordinal logistic regression method to develop a predictive model for patient satisfaction in an outpatient plastic surgery clinic. Consecutive patients who attended a university outpatient plastic surgery clinic were asked to complete the Visit Specific Patient Satisfaction Questionnaire (VSQ) after their clinic visit. Type of clinic (e.g., hand clinic, aesthetic clinic, breast clinic) and demographic variables like age, gender, race, and education were added to the questionnaire to control for possible confounding effects. The authors constructed an ordinal logistic regression model using the overall visit response as the dependent variable and the eight other response categories as independent variables. A total of 345 patients completed the VSQ, which takes each patient less than 2 minutes to complete. The patient response rate was more than 95%. Statistically significant predictors included (1) personal manner of physician (odds ratio [OR], 18.0; p = 0.0002), (2) time spent with physician (OR, 4.7; p = 0.0099), (3) length of time to get an appointment (OR, 4.6; p = 0.0055), and (4) explanation of what was done (OR, 3.9; p = 0.0263). There was no statistically significant association between overall satisfaction scores and the following factors: (1) length of wait in the clinic (OR, 2.7; p = 0.0747), (2) getting through to the clinic by phone (OR, 0.71; p = 0.5439), (3) convenience of the clinic's location (OR, 2.3; p = 0.1368), and (4) technical skills of the physician (OR, 1.0; p = 0.9974). The predictive model was adjusted for possible confounding due to the type of clinic and demographic variables. In this study the most important predictors of patient satisfaction were those related to efficient clinic operation (scheduling of appointments and clinic waiting time) and the quality of the patient-physician interaction. Clinic facilities (like clinic location and ease of phone contact) were not significant predictors. Because patients often have difficulty assessing the technical skills of physicians, this variable was not a significant predictor. To improve patient satisfaction in plastic surgery outpatient clinics, efforts and resources should be directed toward expedient and empathic delivery of care.

Adolescent↗

PubMed1994

Useful predictors of bile duct stones in patients undergoing laparoscopic cholecystectomy. McGill Gallstone Treatment Group.

OBJECTIVE: The authors determined the most useful predictors of common bile duct (CBD) stones as diagnosed by endoscopic retrograde cholangiopancreatography (ERCP) in patients who underwent laparoscopic cholecystectomy (LC). METHODS: Prospective and retrospective collection of historical, biochemical and ultrasonographic data was used. Receiver operating characteristics curve analysis was used to determine optimal biochemical cut-off values. Multivariate analysis using logistic regression with generation of the best model identifying independent predictors of CBD stones also was employed. Prospective validation of the model was performed on an independent group of patients. RESULTS: Endoscopic retrograde cholangiopancreatographies were performed before LC in 106 patients, and after LC in 33. Only four of ten clinical variables evaluated independently predicted the presence of CBD stones. The optimal model predicted a 94% probability of CBD stones in a patient older than 55 years of age who presented with an elevated bilirubin (over 30 mumol/L) and positive ultrasound findings (a dilated CBD, and a CBD stone seen on ultrasound). This model was validated prospectively in a subsequent series of 49 patients in which the probability of CBD stone was only 8% when all four predictors were absent. CONCLUSIONS: The identified independent clinical predictors of a CBD stone helps select a population of symptomatic gallstone bearers who benefit most from cholangiographic assessment.

Adolescent↗

PubMed2002

Predictors of caregiver and family functioning following traumatic brain injury: social support moderates caregiver distress.

OBJECTIVE: This study examined predictors of family dysfunction and caregiver distress among 60 pairs of persons who sustained a traumatic brain injury and their caregivers. DESIGN: A cross-sectional design that used hierarchical multiple regression analyses evaluated the relative influences of time since injury, awareness of deficit, and neurobehavioral and neuropsychological functioning of the person with injury, and caregiver perceived social support. RESULTS: The predictor model accounted for 52% of the variance in family dysfunction and 39% in caregiver psychological distress. Neurobehavioral disturbance in the person with injury was the strongest predictor of caregiver distress. Social support showed a direct and linear relationship to family functioning, and it was the strongest predictor of family functioning. Social support was a powerful moderator of caregiver psychological distress. In the absence of adequate social support, caregiver distress increased with longer time after injury, cognitive dysfunction, and unawareness of deficit in care recipients, whereas these characteristics were not associated with distress among caregivers with adequate social support. CONCLUSIONS: Rehabilitation professionals should stress the importance of caregivers and families of persons with TBI seeking and obtaining adequate social support.

Adaptation, Psychological↗

PubMed1999

von Willebrand factor and soluble thrombomodulin as predictors of adverse events among subjects with peripheral or coronary atherosclerosis.

Increased levels of the endothelial markers von Willebrand factor and soluble thrombomodulin have been identified as predictors of the development of adverse cardiovascular events. The purpose of this study was to determine which of these markers is the best predictor of such events. Both markers were measured using enzyme-linked immunosorbent assays in 111 subjects at high risk of cardiovascular disease (50 with peripheral atherosclerosis and 66 who had suffered myocardial infarction). After a mean of 46 months, a follow-up investigation was performed and cardiovascular end-points (myocardial infarction, stroke, measured progression of peripheral atherosclerosis, arterial surgery, etc.) were noted. Multivariate analysis revealed that both markers were independent predictors among the 54 subjects who suffered any one of the cardiovascular end-points (P < 0.01). However, only an increased level of von Willebrand factor predicted the outcome among the 39 subjects who suffered a myocardial infarction, stroke or arterial surgery (P < 0.05). We conclude that von Willebrand factor is a marginally better predictor of cardiovascular events than soluble thrombomodulin.

Aged↗