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PubMed2004

Predictors of death during 10 years after coronary artery bypass grafting with particular emphasis on age.

OBJECTIVES: To describe predictors of death during 10 years of follow-up after coronary artery bypass grafting (CABG); to evaluate whether age interacts with the influence of various predictors on outcome; and to compare the mortality during 10 years after CABG with the mortality in an age- and sex-matched control population. DESIGN: Prospective, observational study. SETTING: Department of Thoracic and Cardiovascular Surgery at Sahlgrenska University Hospital and Scandinavian Heart Centre in Göteborg, Sweden. PARTICIPANTS: All patients from western Sweden who underwent CABG between 1 June 1988 and 1 June 1991 without simultaneous valve surgery and with no previous CABG. MAIN OUTCOME MEASUREMENTS: All-cause mortality during 10 years but more than 30 days after CABG. RESULTS: In all, 2000 patients participated in the survey. The following factors appeared as independent predictors of death: preoperative factors-age, history of congestive heart failure, cerebrovascular disease, history of intermittent claudication, current smoking, degree of left ventricular impairment, valvular disease and duration of angina pectoris; peroperative factors-ventilator time and neurological complications; postoperative factors-arrhythmia, requirement of digitalis and requirement of antidiabetics. There was an interaction between age and history of cerebrovascular disease with a stronger impact on outcome in younger patients. The late (>30 days after CABG) 10-year mortality in the study cohort was 29.6% compared with 25.9% in the control population (P=0.02). CONCLUSION: Among patients who underwent CABG, 13 independent predictors for mortality were found, mainly among preoperative factors but also among peroperative factors, postoperative complications and medication requirement after CABG.

Adult↗

PubMed2002

Clinical and radiographic predictors of the etiology of computed tomography-diagnosed intrathoracic lymphadenopathy in HIV-infected patients.

In HIV-infected patients with intrathoracic lymphadenopathy, it is not known whether clinical and radiographic findings are useful in predicting a specific diagnosis. We determined the etiology and predictors of the etiology of computed tomography (CT)-diagnosed intrathoracic lymphadenopathy in HIV-infected patients evaluated from June 1993 through April 1999. Multivariate analyses were performed to determine clinical and radiographic predictors of the three most common diagnoses. Of 318 patients, 110 (35%) had lymphadenopathy on chest CT. Among these 110 patients, tuberculosis/nontuberculous mycobacterial disease ( = 31), bacterial pneumonia ( = 26), and lymphoma ( = 21) were the most common diagnoses. Multivariate analysis identified cough and necrosis of lymph nodes on chest CT as independent predictors of tuberculosis/nontuberculous mycobacterial disease. African-American race, symptoms for 1 to 7 days, dyspnea, and presence of airways disease on chest CT were independent predictors of bacterial pneumonia; symptoms for >7 days, absence of cough, and absence of pulmonary nodules on CT independently predicted lymphoma. Intrathoracic lymphadenopathy is a frequent chest CT finding in HIV-infected patients. Opportunistic infections and lymphoma are the most common causes, and specific clinical and radiographic features can suggest these particular diagnoses.

AIDS-Related Opportunistic Infections↗

PubMed2000

Comparison of predictors of extubation from mechanical ventilation in children.

OBJECTIVE: Unsuccessful extubation from mechanical ventilation increases mortality and morbidity. Therefore, the identification of an accurate predictor of successful extubation is desirable. This study was designed to determine whether the results of easily performed respiratory measurements, particularly if reported as "combined extubation" indices, were better predictors of extubation failure in a pediatric population than were readily available clinical data. DESIGN: Prospective observational study. SETTING: Tertiary pediatric intensive care unit. PATIENTS: All children who required mechanical ventilation for >/=24 hrs during a 12-month period and whose parents gave informed written consent. INTERVENTIONS: Respiratory function measurements were made (on average) 7 hrs (range, 0.2-25.0 hrs) before extubation. Arterial blood gas results were obtained immediately before extubation. The values of each predictor associated with maximum sensitivity and specificity were determined, and the areas under receiver operator characteristic curves were compared to determine the most accurate predictor of successful extubation. MEASUREMENTS AND MAIN RESULTS: A total of 47 children (mean age, 3.90 yrs; range, 0.10-17.3 yrs) were studied; extubation failed in 7. A low tidal volume (<7.5 mL/kg) and a low minute volume (<250 mL/kg) had the highest sensitivities (86% and 71%, respectively) and specificities (61% and 71%, respectively) in predicting extubation failure. The a/A ratio performed least well in predicting extubation failure (area under the receiver operating characteristic curve, 0.51). CONCLUSIONS: Volume measurements during pediatric mechanical ventilation may facilitate successful extubation.

Journal Article↗

PubMed2003

Back to work: predictors of return to work among patients with back disorders certified as sick: a two-year follow-up study.

STUDY DESIGN: A 2-year follow-up study of patients with back disorders certified as sick. OBJECTIVES: To identify predictors of return to work. SUMMARY OF BACKGROUND DATA: Back disorders are common health problems and the most important disorders associated with absence from work in the welfare states. Predictors of future absence may be of help in allocating rehabilitation efforts to such patients. Possible predictors include demographic and medical factors, the patients' functional status, and former absence. METHODS: For this study, 190 patients certified as sick who attended a back disorder outpatient clinic from September 1997 to December 1998 answered a questionnaire. Demographic data, medical factors, self-assessed function, and absence data were recorded. Return to work, defined as returning to work for at least 60 consecutive calendar days, was used in Cox regression analyses. RESULTS: According to multiple Cox regression analyses, age of 40 to 49 years (HR, 0.52; 95% confidence interval [95%CI], 0.29-0.94), high pain intensity (HR, 0.30; 95%CI, 0.17-0.55), low self-assessed work ability (HR, 0.43; 95%CI, 0.25-0.73), and a self-predicted absence status of not returning to work (HR, 0.31; 95%CI, 0.17-0.54) predicted longer time until return to work. Back disorders with radiation predicted shorter time until return to work (HR, 2.08; 95%CI, 1.37-3.16). The COOP/WONCA chart's physical fitness, daily activities, overall health, and change in health were associated with time until return to work in univariate analyses only, as was the duration of the sickness certification episodes from start to inclusion and the degree of sickness certification at inclusion. CONCLUSIONS: Information about the age of the patients, diagnoses, pain intensity, self-assessed work ability, and self-predicted absence status may be used as predictors of time until return to work in patients with back disorders certified as sick who attend a back disorder outpatient clinic.

Adult↗

PubMed2004

Predictors of back pain in a general population cohort.

STUDY DESIGN: The study used longitudinal data from the first and second cycles (1994-1995 and 1996-1997) of the Canadian National Population Health Survey. OBJECTIVE: Our objective was to derive prediction models for back pain in the general male and female household populations. SUMMARY OF BACKGROUND DATA: Little is known about the predictors of back pain in the general population. Most previous studies focused on specific occupational groups and used a cross-sectional or case-control design. METHODS: The study cohort consisted of all respondents aged 18+ years who reported no back problems in the 1994-1995 National Population Health Survey cycle (N = 11,063). Potential predictors of chronic back pain were classified into nine groups and entered into stepwise logistic regression models. Bootstrap methods were used to derive the final models and assess their predictive power. RESULTS: The overall incidence of back pain was 44.7 per 1,000 person-years and was higher in women (47.0 per 1,000 person-years) compared with men (42.2 per 1,000 person-years). In men, significant predictors of back pain were age (peak effect in 45-64 years), height, self-rated health, usual pattern of activity (especially heavy work), yard work or gardening (negative association), and general chronic stress. In women, significant factors were self-reported restrictions in activity, being diagnosed with arthritis, personal stress, and history of psychological trauma in childhood or adolescence. CONCLUSIONS: Overall health and psychosocial factors are important predictors of back pain in both men and women. Other risk factors differ between the two sexes.

Adolescent↗

PubMed2005

Monitoring global volume-related hemodynamic or regional variables after initial resuscitation: What is a better predictor of outcome in critically ill septic patients?

OBJECTIVE: Regional variables of organ dysfunction are thought to be better monitoring variables than global pressure-related hemodynamic variables. Whether a difference exists between regional and global volume-related variables in critically ill patients after resuscitation is unknown. DESIGN: Prospective diagnostic test evaluation. SETTING: University-affiliated mixed intensive care unit. PATIENTS: Twenty-eight critically ill patients. INTERVENTIONS: Using standardized resuscitation, hemodynamic optimization was targeted at mean arterial pressure, heart rate, occlusion pressure, cardiac output, systemic vascular resistance, and urine output. Primary outcome variable was in-hospital mortality. MEASUREMENTS AND MAIN RESULTS: During resuscitation, global volume-related hemodynamic variables were measured simultaneously and compared with regional variables. At admission no variable was superior as a predictor of outcome. During resuscitation, significant changes were seen in mean arterial pressure, central venous pressure, oxygen delivery, systemic vascular resistance, total blood volume, right heart and ventricle end-diastolic volume, right ventricle ejection fraction, right and left stroke work index, intramucosal carbon dioxide pressure, gastric mucosal pH, mucosal-end tidal Pco2 gap, indocyanine green blood clearance, indocyanine green plasma clearance, and plasma disappearance rate. Multivariate analysis identified lactate, gastric mucosal pH, mucosal-end tidal Pco2 gap, mucosal-arterial Pco2 gap, indocyanine green plasma clearance, and plasma disappearance rate of dye as nondependent predictors of outcome. Patients who subsequently died had a significantly lower gastric mucosal pH, higher intramucosal carbon dioxide pressure and mucosal-end tidal Pco2 gap, and lower indocyanine green blood clearance, indocyanine green plasma clearance, plasma disappearance rate, and right ventricular end-diastolic volume index, of which gastric mucosal pH, mucosal-end tidal Pco2 gap, and indocyanine green blood clearance were the most important predictors of outcome. CONCLUSIONS: Initial resuscitation of critically ill patients with shock does not require monitoring of regional variables. After stabilization, however, regional variables are the best predictors of outcome.

Aged↗

PubMed2006

The hospital as predictor of children's and adolescents' length of stay.

OBJECTIVE: To predict psychiatric hospital length of stay (LOS) for a sample of Illinois Department of Children and Family Services wards across 4 fiscal years. METHOD: A prospective design was implemented using the Children's Severity of Psychiatric Illness scale, a reliable and valid measure of psychiatric severity, risk factors, youth strengths, and contextual/environmental factors. Data were collected for 1,930 hospital episodes across 44 hospitals from fiscal year 1998 through fiscal year 2001. Youths were screened for admission appropriateness by the Illinois Screening, Assessment, and Supportive Services (SASS) program. The Children's Severity of Psychiatric Illness was completed by SASS workers upon conclusion of their crisis interviews. In addition to completing the Children's Severity of Psychiatric Illness, SASS workers reported on demographic information and LOS. RESULTS: The sample of 1,930 youths was randomly split to form development (n = 983) and validation (n = 947) samples. LOS was predicted using ordinary least squares regression. Thirty percent of the variance (F(19,666) = 16.6, p < .0001) in LOS was predicted for the development sample and 22% (F(14,657) = 14.6, p < .0001) was predicted for the confirmation sample. Hospital was the largest and most consistent predictor of LOS for both samples after controlling for clinical variables. Two hospitals accounted for approximately 10% of the variance in both samples (development beta = .273, p < .01 and beta = -.169, p < .01). Two SASS agencies also consistently predicted LOS (development beta = -.134, p < .05 and beta = .102, p < .05). No consistent changes in predictors of LOS occurred over time (FY98-FY01). CONCLUSIONS: These findings suggest that nonclinical variables are the primary predictors of LOS in the Illinois system of care. In addition, these variables are consistent predictors over time. Quality assurance efforts might seek to further understand potential practice pattern variations across hospitals and SASS agencies.

Adolescent↗

PubMed2004

Predictors of early mortality in a cohort of human immunodeficiency virus type 1-infected african children.

BACKGROUND: Pediatric human immunodeficiency virus type 1 (HIV-1) infection follows a bimodal clinical course with rapid progression in 10-45% of children before the age of 2 years and slower progression in the remainder. A prospective observational study was undertaken to determine predictors of mortality in HIV-1-infected African infants during the first 2 years of life. METHODS: Infants in a perinatal cohort identified to be HIV-1-infected by DNA PCR were followed monthly to 1 year, then quarterly to 2 years or death. RESULTS: Among 62 HIV-1-infected infants, infection occurred by the age of 1 month in 56 (90%) infants, and 32 (52%) died at median age of 6.2 months. All infant deaths were caused by infectious diseases, most frequently pneumonia (75%) and diarrhea (41%). Univariate predictors of infant mortality included maternal CD4 count <200 cells/microl [hazard ratio (HR), 3.4; P = 0.008], maternal anemia (HR = 3.7; P = 0.005), delivery complications (HR = 2.7; P = 0.01), low birth weight (HR = 4.1; P = 0.001), weight, length and head circumference </=5th percentile at age 1 month (HR = 3.7, P = 0.003; HR = 5.8, P < 0.001; and HR = 10.4, P < 0.001, respectively), formula-feeding (HR = 4.0; P = 0.01), infant CD4% </=15% (HR = 5.5; P = 0.01), infant CD4 count <750 (HR = 9.7; P = 0.006) and maternal death (HR = 2.9, P = 0.05). In multivariate analysis, maternal CD4 count <200 (HR = 2.7; P = 0.03) and delivery complications (HR = 3.4; P = 0.005) were independently associated with infant mortality. CONCLUSIONS: Advanced maternal HIV disease, maternal anemia, delivery complications, early growth faltering, formula-feeding and low infant CD4 were predictors of early mortality in African HIV-1-infected infants. In resource-poor settings, these predictors may be useful for early identification and treatment of high risk infants.

Africa↗

PubMed2006

Nontricyclic antidepressants: predictors of nonadherence.

According to professionals, medication nonadherence is often attributed to adverse effects or early remission. There is, however, little evidence to support these attributions. Our aim was to study the predictors of nonadherence in primary care patients with a new antidepressant (AD) prescription. We used a prospective cohort study with 6-month follow-up among 147 primary care patients who were newly prescribed with a nontricyclic AD for depression. They were recruited in 19 community pharmacies in the Netherlands that were linked to 85 general practitioners. An electronic pill container (medication event monitoring system; Aardex Ltd, Untermüli, Switzerland) registered the adherence for 6 months. The predictive values of patient, prescriber, pharmacist, and drug-related characteristics were expressed in univariate and multivariate odds ratios with 95% confidence intervals. Outcome measures showed nonadherence, as expressed in these factors (all dichotomous): (1) incorrect intakes (<80% period coverage); (2) extra pill intakes (>1 per day); (3) drug holidays (>or=1). We found that not only a positive drug attitude, the most important predictor, but also adverse effects, early treatment response, longer onset of depression, and a higher educational level predicted the correct intake of ADs. Extra intakes were predicted by ADs with a shorter half-life and by experience of adverse effects. Drug holidays were predicted by patients with less social support and a negative drug attitude. In conclusion, the predictors of adherence were multifactorial and varied across the 3 adherence types. A positive drug attitude emerged as the most important predictor for correct intakes and drug holidays.

Adult↗

PubMed2004

Percent of cores positive for cancer is a better preoperative predictor of cancer recurrence after radical prostatectomy than prostate specific antigen.

PURPOSE: We examined the prognostic significance of clinical and pathological variables on outcome following radical retropubic prostatectomy (RRP) in a cohort of patients in the post-prostate specific antigen (PSA) era. MATERIALS AND METHODS: We reviewed the clinical and pathological data on a cohort of 476 patients who underwent RRP for localized prostate cancer between January 1990 and July 2001 by 1 urologist (WCD). Median age, preoperative PSA and followup were 61 years, 5.8 ng/ml and 49 months, respectively. We used Cox proportional hazard modeling to evaluate the prognostic significance of clinical and pathological variables for cancer recurrence, defined as 2 successive PSA determinations 0.3 ng/ml or greater. RESULTS: Of the 476 patients 53 (11%) had recurrence. Estimated cancer nonprogression probability was 86% (95% CI 83 to 90) and 76% (95% CI 68 to 86) at 5 and 10 years, respectively. Two multivariate analyses were performed. The first analysis, using only preoperative indicators, found that the percent of biopsy cores positive for cancer and biopsy Gleason score were the best predictive indicators of recurrence. The second multivariate analysis, using preoperative and postoperative indicators, found that the percent of biopsy cores positive for cancer, RRP Gleason score and the combined pathological stage/margin status variable were the best predictive indicators of recurrence. PSA was not found to be an important predictor of recurrence on either multivariate analysis. Patients with a percent of biopsy cores in the upper half of the distribution (greater than 28% positive) were at significantly increased risk for recurrence compared with those in the lower half of the distribution (28% or less positive) (HR 3.86, p <0.001). CONCLUSIONS: The percent of cores positive for cancer was a better predictor of cancer recurrence than PSA in this post-PSA era RRP series. In addition, surgical Gleason score and pathological stage/surgical margins were also independent predictors of cancer recurrence after RRP. These 3 predictors are displayed in a nomogram-type format to summarize estimated 5 and 10-year recurrence-free probabilities.

Adult↗

PubMed2005

Predictors of prostate cancer evaluated by receiver operating characteristics partial area index: a prospective institutional study.

PURPOSE: To our knowledge we introduce the ROC partial area under the curve (AUC) index as a method of evaluating the discriminative power of different prostate cancer predictors. Peripheral zone volume and peripheral zone prostate specific antigen (PSA) density are introduced as potential predictors and compared with other known predictors of prostate cancer. MATERIALS AND METHODS: During 1999, 220 consecutive patients with suspected early prostate cancer were examined using total PSA, free PSA, total prostate volume, transition zone volume and transrectal ultrasonography guided sextant biopsy of the prostate. The free-to-total PSA ratio, PSA density, transition zone PSA density, peripheral zone volume and peripheral zone PSA density were calculated. Usually total AUC is used to evaluate the discriminative power of different parameters. In this study parameters were evaluated by the ROC partial area index, which includes only the AUC in highly sensitivity parts of the ROC curve. Explorative analysis using logistic regression analysis was performed to investigate the ability of combinations of parameters to predict cancer. RESULTS: Of the 220 patients 75 were diagnosed with cancer. In the subgroup of 160 patients with PSA less than 10 microg/l 44 had cancer. Transition zone PSA density and PSA density had significant discriminative power in the total group, while none of the parameters were discriminative in the subgroup of patients. CONCLUSIONS: When high sensitivity is demanded, the ROC partial area index seems to be meaningful for evaluating the discriminative power of potential predictors. In our study none of the evaluated parameters had discriminative power in patients with PSA less than 10 microg/l, while transition zone PSA density and PSA density showed discriminative power in the total group of patients.

Adult↗

PubMed2005

Preoperative prostate specific antigen doubling time and velocity are strong and independent predictors of outcomes following radical prostatectomy.

PURPOSE: Prostate specific antigen (PSA) is a useful marker for predicting outcomes following treatment for prostate cancer but, given the evolving nature of prostate cancer, there is an ongoing need to refine its use. We assessed preoperative PSA doubling time (PSADT) and PSA velocity (PSAV) as predictors of outcome following radical retropubic prostatectomy (RRP). MATERIALS AND METHODS: We identified 2,290 men who were treated with RRP for prostate cancer between 1990 and 1999 with multiple preoperative PSA measurements available. PSADT was calculated by log linear regression and PSAV was calculated by linear regression. These parameters were used in preoperative and postoperative multivariate models for the end points of biochemical and clinical progression, and cancer death. RESULTS: At a median followup of 7.1 years (range 0.1 to 14.5) biochemical progression, clinical progression and death from prostate cancer were observed in 583, 156 and 42 patients, respectively. The HR for death from prostate cancer was 6.22 (95% CI 3.33 to 11.61) in men with PSADT less than 18 months vs 18 or greater and 6.54 (95% CI 3.51 to 12.19) in men with PSAV greater than 3.4 ng/ml yearly vs 3.4 or less. On multivariate analysis adjusting for preoperative or postoperative variables PSADT and PSAV remained significant predictors of each outcome. When assessed jointly, PSAV was significant as a predictor of biochemical progression, while PSADT was a significant predictor of clinical progression and cancer death. CONCLUSIONS: This study confirms the usefulness of preoperative PSA kinetics for predicting post-RRP outcomes, which may be useful for stratifying patients, so that rational management decisions can be made with respect to observation, intervention and adjuvant treatment. While PSADT maybe biologically more accurate and stronger on multivariate analysis, PSAV is clinically easier to use and a good approximation in the short term.

Adult↗

PubMed2004

Improved predictors of outcome in postcholecystectomy pain.

BACKGROUND: Endoscopic interventions have limited efficacy in sphincter of Oddi dysfunction (SOD) Type 3. Improved predictors of response to treatment are needed. METHODS: Patients with postcholecystectomy pain underwent a standardized history and physical examination and were then managed individually. Long-term outcome was determined by record review and telephone interview. Initial predictors of response to treatment were assessed. RESULTS: Mean follow-up for the 74 subjects was 36 months. Fifty were improved, and 24 had persistent pain. Patients were likely to respond to sphincterotomy if their pain was not continuous, if it was accompanied by nausea or vomiting, and if there had been a pain free interval after cholecystectomy of at least 1 year. When 2 or 3 of these predictors were present, 85% of SOD Type 2 patients and 56% of Type 3 patients had a good response. Initial history and examination features also predicted response to treatment of neuropathic pain. CONCLUSION: Among patients with postcholecystectomy pain, specific features of the initial history and examination predict response to treatment with higher accuracy than the SOD grade. These predictors identify a subset of Type 3 patients likely to respond to sphincterotomy.

Adult↗

PubMed2005

Amount of systemic steroid medication is a strong predictor for the use of complementary and alternative medicine in patients with inflammatory bowel disease: results from a German national survey.

OBJECTIVES: Previous studies have suggested that inflammatory bowel disease (IBD) patients rank high among users of complementary and alternative medicine (CAM). To further elucidate this phenomenon, we sent questionnaires to a large sample of IBD patients in Germany to determine the patterns and predictors of their CAM use. METHODS: Pretested 73-item questionnaires were mailed to a randomly selected representative sample of 1000 IBD patients from the approximately 16,000 members and associates of the German Crohn's and Colitis Association. Predictors of CAM use were evaluated by logistic regression models. RESULTS: Completed questionnaires were returned by 684 patients (female patients, 61.4%; Crohn's disease patients, 58.3%; ulcerative colitis patients, 38.2%). Of the 671 adult respondents, 344 (51.3%) had experience with CAM, and significantly more of the ulcerative colitis patients (59.8%) than the Crohn's disease patients (48.3%) had experience with CAM. There was no difference by gender. Homeopathy (52.9%) and herbal medicine (43.6%) were the most commonly used types of CAM. The most frequent personal reasons for CAM use were the search for an "optimum treatment" (78.9%) and the wish to stop taking steroids (63.8%). Using logistic regression, we found that total cortisone intake (P = 0.0077), but not duration of disease, was a strong predictor of CAM use. Other predictors were experience with psychosomatic and psychotherapeutic support (P = 0.0029), relaxation techniques (P = 0.0284), an academic education (P = 0.0173), a diet utilizing whole grains (P = 0.0123), and a normal body weight (P = 0.0215). Although 80% of patients indicated that they were interested in using CAM in the future, only 24.7% felt sufficiently informed about it. CONCLUSIONS: More than 50% of a large group of German IBD patients had used CAM. Prolonged or intensive steroid treatment, an academic education, active ways of coping, and a health-conscious life-style are associated with CAM use. Given the potential side effects and interactions, the treating physician should focus on thorough information about the benefits and limitations of conventional and complementary treatment options, especially for IBD patients who have received prolonged or intensive steroid treatment.

Adaptation, Psychological↗

PubMed2004

Predictors of children's healthcare use: the value of child versus parental perspectives on healthcare needs.

OBJECTIVE: The objective of this study was to examine the relationship between healthcare use and children's healthcare needs as assessed from the perspectives of children themselves, parents, and healthcare practitioners. RESEARCH DESIGN: We conducted a prospective cohort study in which service use was monitored for the 12 months before and after administration of a health survey. SUBJECTS: We studied 384 parents and children aged 6 to 11 years enrolled for 2 years in a northern California health maintenance organization or a Medicaid managed care program in Rhode Island. MEASURES: Child and parent perspectives on needs were determined using the Child Health and Illness Profile, Child Edition (CHIP-CE). Plan administrative data were used to develop a treated morbidity index, which was based on diagnosis codes recorded by practitioners during the year before the survey and to obtain prospective measures of service use. RESULTS: For both child- and parent-respondents, low satisfaction and comfort scale scores from the CHIP-CE were significant predictors of number of visits. CHIP-CE domain scales unrelated to future use were risk avoidance, resilience, and achievement. Multivariable regression using CHIP-CE information collected from children explained more variation in total physician visits than models that used parent-respondent data. The treated morbidity index was a weaker predictor of physician visits than the CHIP-CE scale scores. None of the domain scales were significant predictors of any emergency department use or any specialist use; however, the treated morbidity index was associated with any specialist use. CONCLUSIONS: A child's sense of well-being and burden of symptoms predict future use. Perceived healthcare needs, as assessed by the CHIP-CE, is a better predictor of children's service use than evaluated needs as assessed by physician-diagnosed disorders. Our results support the validity of using the responses of children aged 6 to 11 years as a measure of need for future health care.

Adaptation, Psychological↗

PubMed2004

Diabetic ketoacidosis: predictors of outcome in a pediatric intensive care unit of a developing country.

OBJECTIVES: To study the outcome and predictors of mortality in children with diabetic ketoacidosis. DESIGN: Retrospective case series. SETTING: Pediatric intensive care unit of an urban multiple-specialty teaching and referral hospital in north India. PATIENTS: Sixty-eight patients with diabetic ketoacidosis treated between 1993 and 2000. INTERVENTIONS: Data were retrieved from case records with respect to patients' age; clinical features; osmolality at admission; blood glucose, serum potassium, and arterial pH at admission, 6 hrs, and 24 hrs; complications during the course of hospital stay; treatment; and outcome in terms of survival or death. Survivors and nonsurvivors were compared to determine the predictors of mortality. MEASUREMENTS AND MAIN RESULTS: The mean (sd) age of the study population was 6.9 (3.5) yrs (range, 0.5-12 yrs). Impaired consciousness (n = 45; 66%), rapid breathing (n = 41; 60%), and vomiting (n = 35; 51.4%) were common presenting symptoms. Thirty-two (50%) patients had clinically evident dehydration. Precipitating events identified were new-onset diabetes with sepsis (37%), new-onset diabetes alone (31%), insulin omission (15%), and infection with insulin omission (7%). The mean (sd) blood glucose, osmolality, and pH at admission were 473 (sd 184) mg/dL, 305 (sd 24) mOsm/L, and 7.08 (sd 0.1), respectively. Complications noted during treatment were hypokalemia (n = 28; 41%), hypoglycemia (n = 10; 15%), cerebral edema (n = 9; 13.2%), and pulmonary edema (n = 2; 3%). Nine (13.2%) patient died, with the causes of death being septic shock (n = 4), cerebral edema (n = 2), cerebral edema with pulmonary edema (n = 2), and hypokalemia with ventricular tachycardia (n = 1). Those who died were older, had higher osmolality and severe acidosis at admission, and had persistent hyperglycemia and acidosis at 6-12 hrs. On multiple logistic regression analysis, osmolality at admission was the most significant predictor of death. CONCLUSIONS: Two thirds of children with diabetic ketoacidosis in our series had new-onset diabetes, and 13.2% died. Serum osmolality at admission was the most important predictor of death.

Age Distribution↗

PubMedDate not supplied

Chronic fatigue and sociodemographic characteristics as predictors of psychiatric disorders in a community-based sample.

OBJECTIVES: To explore the roles of chronic fatigue and sociodemographic characteristics (eg, parental status, work status, socioeconomic status, sex, age, marital status, and ethnicity) as predictors of psychiatric disorders. METHODS: A stratified random sample of 18,675 adults residing in diverse neighborhoods in Chicago completed a telephone-screening questionnaire. A control group without chronic fatigue (N = 74) and a group of individuals with chronic fatigue (N = 227) were identified and administered a semi-structured psychiatric interview. Stepwise logistic regression analyses predicting occurrence of current and lifetime psychiatric disorders according to chronic fatigue status and sociodemographics were conducted on this overall sample of 301 participants. RESULTS: Chronic fatigue, low socioeconomic status, and unemployment were among significant predictors of overall Axis I psychiatric disorders. Chronic fatigue functioned as a predictor for mood and anxiety disorders (including posttraumatic stress disorder), but did not function as a predictor for somatoform disorders, substance abuse/dependence, and eating disorders. Low socioeconomic status and unemployment were significantly associated with current psychiatric disorder, and low socioeconomic status was also significantly associated with mood and anxiety disorders. Women were significantly more likely to experience mood disorder, and minorities (eg, African Americans, Latinos, and individuals of other ethnicity) were significantly more likely to report posttraumatic stress disorder. CONCLUSIONS: Results support prior findings for increased rates of psychiatric disorder among individuals with chronic fatigue and highlight the roles of low socioeconomic status, unemployment, being a woman, and being classified as a minority in their association with certain psychiatric disorders.

Adult↗

PubMedDate not supplied

Alexithymia as predictor of treatment outcome in patients with functional gastrointestinal disorders.

OBJECTIVE: A previous study found a strong association between alexithymia and functional gastrointestinal disorders (FGID). The objective of this study was to investigate whether alexithymia might be a predictor of treatment outcome in patients with FGID. METHODS: A group of FGID outpatients classified by the 'Rome I' criteria was divided into improved (N= 68) and unimproved (N= 44) groups on the basis of pre-established criteria after 6 months of treatment. Patients were administered the 20-item Toronto Alexithymia Scale, the Hospital Anxiety and Depression Scale, and the Gastrointestinal Symptom Rating Scale both before and after 6 months of treatment. RESULTS: At the base-line assessment, compared with the improved patients, the unimproved patients had significantly higher levels of anxiety, depression, alexithymia, and gastrointestinal symptoms. Stability of alexithymia was demonstrated by significant correlations between base-line and follow-up TAS-20 scores in the entire sample. Moreover, hierarchical regression analyses showed that the stability of TAS-20 scores over the 6-month treatment period could not be accounted for by their associations with anxiety and depression scores. In logistic regression analyses, base-line alexithymia and depression emerged as significant predictors of treatment outcome. Relative to depression, however, alexithymia was the stronger predictor. CONCLUSIONS: Alexithymia is a reliable and stable predictor of treatment outcome in FGID patients. Although further studies are needed, clinicians might improve treatment outcome by identifying patients with high alexithymia, and attempting to improve these patients' skills for coping with emotionally stressful situations.

Adult↗