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PubMed2005

High plasma levels of intact and cleaved soluble urokinase receptor reflect immune activation and are independent predictors of mortality in HIV-1-infected patients.

BACKGROUND: High blood levels of soluble urokinase receptor (suPAR) measured by enzyme-linked immunoassay (ELISA) (bulk measurement of 3-domain and 2-domain suPAR [suPAR(I-III), suPAR(II-III)], and suPAR(I-III) ligand complexes) strongly predict mortality in HIV-1-infected patients. This study investigated plasma levels of suPAR(I-III), suPAR(II-III), and 1-domain suPAR [suPAR(I)] and their predictive value for survival in HIV patients. METHODS: Plasma suPAR was measured by ELISA and 3 different time-resolved fluorescence immunoassays detecting suPAR(I-III), suPAR(I-III) plus suPAR(II-III), and suPAR(I) in 99 HIV patients and 59 healthy individuals. RESULTS: Plasma suPAR(I-III), suPAR(II-III), and suPAR(I) were increased in HIV patients and increased with HIV disease progression (P < 0.001 for all). In multivariate linear regression analysis, soluble immune activation markers and hemoglobin were independent predictors of plasma suPAR in HIV patients, whereas the neutrophil concentration was the only independent predictor of plasma suPAR in controls. In univariate Cox analysis, higher levels of suPAR(I-III), suPAR(II-III), and suPAR(I) predicted increased mortality risk (P < 0.001 for all). In multivariate Cox analysis adjusting for CD4+ count, HIV RNA, beta2-microglobulin, hemoglobin and clinical stage, higher levels of suPAR(I-III) and suPAR(II-III) were independent predictors of increased mortality risk (P < 0.05 for both), whereas suPAR(I) was not. CONCLUSIONS: Plasma levels of different suPAR forms are increased and associated with immune activation in HIV patients, and suPAR(I-III) and suPAR(II-III) are independent predictors of mortality in these patients.

Adult↗

PubMed2006

Predictors of hepatitis C virus RNA levels in a prospective cohort study of drug users.

High levels of hepatitis C virus (HCV) RNA are associated with a poor response to treatment of chronic hepatitis C, and a substantial reduction in HCV RNA levels predicts a favorable treatment response. We prospectively studied time-dependent and time-independent predictors of HCV RNA levels in 264 drug users with chronic HCV infection. Interviews on medical history and high-risk behaviors, phlebotomy for HIV viral load, serum HCV RNA levels as measured by the COBAS Amplicor HCV Monitor (Roche Diagnostics, Branchburg, NJ), and a lymphocyte subset assay were performed. Factors associated with HCV RNA levels over time were analyzed using a linear mixed model. Nearly 70% of the participants were men, two thirds were Hispanic, and the mean age was 46 years. HCV RNA levels increased over time. Older age (P < 0.001), HIV seropositivity (P = 0.03), and HCV nongenotype 1 (P = 0.05) were predictors of higher HCV RNA levels on multivariate analysis. Among 142 HIV-seropositive participants, a detectable HIV-1 viral load (P < 0.001) and recent alcohol use (P = 0.02) were predictors of higher HCV RNA levels. The predictors of higher HCV RNA levels found in this longitudinal study are consistent with those of prior cross-sectional studies. Further studies are warranted to determine if treatment of alcohol use affects HCV RNA levels.

Adult↗

PubMed2004

Prospective study of the clinical predictors of a positive abdominal computed tomography in blunt trauma patients.

BACKGROUND: CT scans are often used in the evaluation of blunt trauma patients. Many scans are negative. Clinical predictors of positive abdominal CT scans would be beneficial in patient care. METHODS: A prospective study of 213 patients at a Level I trauma center presenting with blunt trauma who underwent abdominal CT scan. Indications for CT scan were analyzed statistically, using univariate and multivariate models. RESULTS: Univariate chi2 tests showed abnormal pelvis x-ray (p = 0.0002) and an intubated patient (p = 0.03) were predictors of a positive CT scan. When subjected to multivariate logistic regression, these two indications were significant predictors of a positive CT scan, abnormal pelvis x-ray (p = 0.0005, OR=6.6, 95% CI), and an intubated patient (p = 0.02, OR=2.6, 95% CI). Univariate chi2 tests also showed that alcohol intoxication was statistically significant predictor of a negative CT scan (p = 0.03). CONCLUSION: Our data suggest that an abnormal pelvis x-ray and intubation are significant risk factors for a positive CT scan. Alcohol intoxication, mechanism of injury, and unreliable examination, without other associated indication for a scan, may warrant further study.

Abdominal Injuries↗

PubMed2005

Pretransplant pregnancy-associated plasma protein-a as a predictor of chronic allograft nephropathy and posttransplant cardiovascular events.

BACKGROUND: Cardiovascular disease and chronic allograft nephropathy (CAN) are two of the main complications observed in patients after renal transplantation. Both appear to be manifestations of the same process, in which inflammation plays a determinate role. Pregnancy-associated plasma protein A (PAPP-A) has been shown to be a marker of acute coronary syndrome and cardiovascular pathology. The objective of this study was to demonstrate whether or not serum concentration of pretransplant PAPP-A is a marker of CAN and a predictor of posttransplant cardiovascular events. METHODS: In all, 178 renal transplants (65% males; 53+/-12 years of age) followed up over the course of 49.3+/-33.6 months were used in this study. During the follow-up period, 19 patients developed CAN (diagnosed by renal biopsy) and 27 patients had a cardiovascular event. Previous to transplantation, the following were determined: ultrasensitive C-reactive protein (CRP) (nephelometry); interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) (immunofluorimetric automatized method), and ultrasensitive PAPP-A (ELISA). RESULTS: A positive correlation was found between PAPP-A and the inflammatory markers (PAPP-A vs. CRP, r=0.218; P=0.004; PAPP-A vs. IL-6, r=0.235; P<0.001; PAPP-A vs. TNF-alpha, r=0.372; P<0.001). The multiple regression analysis showed PAPP-A (relative risk [RR]: 6.4; 95% confidence interval [CI]:1.24-33.11; P=0.027) and CRP (RR: 6.05; 95% CI:1.21-29.74; P=0.028) to be predictors of posttransplant cardiovascular events and PAPP-A (RR: 4.27; 95% CI: 1.03-17.60; P=0.044) and TNF-alpha (RR: 5.6; 95% CI: 1.43-21.83; P=0.013) to be predictors of CAN. CONCLUSIONS: PAPP-A correlated with the inflammatory markers studied (CRP, IL-6 and TNF-alpha). Pretransplant serum concentration of PAPP-A is a predictor of posttransplant cardiovascular events and CAN.

Adult↗

PubMed2006

Predictors of perceived health status in patients after kidney transplantation.

BACKGROUND: Patients after kidney transplantation have decreased mortality, morbidity and better quality of life compared to people on dialysis. Major efforts are being directed towards research into graft and patient survival. Research into quality of life is less intensive. The aim of this study was to explore the predictors of perceived health status (PHS) in kidney transplant recipients. METHODS: Out of 218 patients after kidney transplantation 138 participated in the study. Linear regression analysis was performed to predict PHS, measured with the SF-36 questionnaire, in three age categories (<40, 40-59, >or=60 years). Independent variables included social support (measured with the Social Support List Discrepancies questionnaire), sociodemographic and medical variables, side effects and compliance. RESULTS: Predictors of better PHS in patients<40 years were better social support (P<or=0.001), lower creatinine (P<or=0.001) and lower stress from adverse effects (P<or=0.001). In the group of patients aged 40-59 years higher education (P<or=0.05), increased housekeeping activities (P<or=0.01) and lower stress from adverse effects (P<or=0.001) predicted better PHS. In the last age group predictors of better PHS were lower rate of dialysis (P<or=0.05) and posttransplant hospitalizations (P<or=0.01), absence of diabetes mellitus (P<or=0.01) and lower stress from adverse effects (P<or=0.05). CONCLUSIONS: Major differences exist in PHS among kidney transplant recipients depending on their age. Side effects of therapy are the most important predictor of PHS for all age groups. PHS of young patients mostly depends on their renal function and their social support. Education and working activities are most important for middle-aged people whereas in older patients PHS is mostly affected by comorbidity.

Adolescent↗

PubMed2001

Predictors of adherence to Copaxone therapy in individuals with relapsing-remitting multiple sclerosis.

The purpose of this study was to evaluate psychological, biophysical, and sociodemographic variables as predictors of adherence to glatiramer acetate (Copaxone) therapy in individuals with relapsing-remitting multiple sclerosis (MS). Because Copaxone is a daily subcutaneous injection, individuals with MS are challenged by the daily routine of preparation and administration of this medication. Despite the challenges, some individuals with MS adhere to treatment with injectable medications with little or no difficulty, while others struggle to adhere to, and soon abandon, the daily task. It is important to identify predictors of adherence to Copaxone therapy so those at risk can be identified early and provided with individualized support at the onset of therapy. Potential participants were identified from the Consortium of Multiple Sclerosis Centers North American Research Committee on Multiple Sclerosis Patient Registry database (n = 600) and from the Shared Solutions MS patient support database (n = 600). Individuals who had taken or stopped taking Copaxone were specifically selected. Those taking multiple immunomodulating drugs or not able to complete the data collection instruments were excluded. Booklets containing four instruments (MS Self-Efficacy Control and Function Subscales, Rosenberg Self-Esteem Scale, Herth Hope Index [HHI], and Performance Scale) and sociodemographic data sheets were mailed to 1,200 individuals. Of the 594 who completed and returned booklets, 341 individuals had relapsing-remitting MS and met the inclusion criteria. There were 225 individuals in the adherent group and 116 in the nonadherent group. Logistic regression analysis revealed four significant predictors of adherence: self-efficacy (control), hope, perception that the doctor was the most supportive of the individual taking Copaxone, and no previous use of other immunomodulators. The higher the score on the MS Self-Efficacy Control Subscale and HHI, the more likely the individual will adhere to Copaxone therapy. The MS Self-Efficacy Control Subscale and HHI show promise of being useful predictors of adherence. Further testing is recommended. Physician support should be conveyed to all individuals starting and maintaining Copaxone therapy for MS. Greater support needs to be provided to those who have previously taken immunomodulating drugs.

Adult↗

PubMed1992

Why children start smoking cigarettes: predictors of onset.

We review findings from 27 prospective studies of the onset of cigarette smoking conducted since 1980. Almost 300 measures of predictors of smoking onset were examined, and 74% of them provided multivariate support for predictors of onset derived from theory and previous empirical findings. Expected relationships were strongly supported for (a) socioeconomic status, with students with compromised status being more likely to try smoking; (b) social bonding variables, particularly peer and school bonding, with less support for family bonding; (c) social learning variables, especially peer smoking and approval, prevalence estimates, and offers/availability, with less consistent support for parent smoking and approval; (d) refusal skills self efficacy; (e) knowledge, attitudes and intentions, with the expected stronger predictions from intentions than from attitudes than from knowledge; and (f) broad indicators of self-esteem. The few investigators who analyzed their data separately by age, gender, or ethnicity found many differences by these factors, though there were too few of them to detect any pattern with confidence. Though the 27 studies are far from perfect, we believe that they confirm the importance of many well-accepted predictors and raise some questions about others. In particular, family smoking, bonding and approval each received unexpectedly low support. It is not clear whether this lack of support reflects reality as it has always been, is due to a changing reality, reflects developmental changes, either in the age of subjects or the stage of onset, or is due to poor measurement and too few tests. Future prospective studies need to be theory-driven, use measures of known reliability and validity, report analyses of scale properties, and use statistical methods appropriate to the hypotheses or theories under study. Finally, we encourage more investigations of the potentially different predictors of transitions to experimental or regular cigarette smoking. This will require multi-wave studies and careful measurement of changes in smoking behavior.

Adolescent↗

PubMed2005

Iatrogenic effects of psychosocial interventions for substance use disorders: prevalence, predictors, prevention.

AIMS: To examine the prevalence and personal and intervention-related predictors of potential iatrogenic effects associated with psychosocial interventions for substance use disorders and provide a conceptual framework to guide further research on such effects. METHOD: A review of relevant studies focuses on the prevalence and predictors of potential iatrogenic effects of psychosocial treatment and prevention programs for substance use disorders. RESULTS: Between 7% and 15% of patients who participate in psychosocial treatment for substance use disorders may be worse off subsequent to treatment than before. In addition, several controlled trials of substance use prevention have shown some apparent iatrogenic effects, including more positive expectations about substance use and a rise in alcohol use and alcohol-related problems. Probable person-related predictors of deterioration associated with treatment include younger age and unmarried status, more serious current diagnoses and substance use problems and more psychiatric and interpersonal problems. Probable intervention-related predictors of deterioration include lack of bonding; lack of monitoring; confrontation, criticism and high emotional arousal; deviancy modeling; and stigma, low or inappropriate expectations and lack of challenge. CONCLUSION: A significant minority of individuals with substance use problems appear to deteriorate during or shortly after participation in treatment or prevention programs. Safety standards and monitoring procedures are needed to routinely identify potential adverse consequences of intervention programs; research is needed to clarify whether deterioration is due to iatrogenic effects of interventions and to identify new approaches to counteract any such effects.

Humans↗

PubMed2006

Bayesian selection of predictors of conception probabilities across the menstrual cycle.

There is increasing interest in identifying predictors of human fertility, including environmental exposures, behavioural factors, and biomarkers, such as mucus or reproductive hormones. Epidemiological studies typically measure fecundability, the per menstrual cycle probability of conception, using time to pregnancy data. A critical predictor, which is often ignored in the design or analysis, is the timing of non-contracepting intercourse in the menstrual cycle. In order to limit confounding by behavioural differences between exposure groups, it may be preferable to base inferences on day-specific conception probabilities in relation to intercourse timing. This article proposes Bayesian methods for selection of predictors of day-specific conception probabilities. A particular focus is the case in which data on ovulation timing are not available. We focus on the selection of fertile days in the cycle during which conception probabilities are non-negligible and predictors may play a role. Data from recent European and Italian prospective studies of daily fecundability are presented, and the proposed approach is used to estimate cervical mucus effects within a mid-cycle potentially fertile window using data from the Italian study.

Bayes Theorem↗

PubMed2005

Predictors of death on the waiting list for liver transplantation characterized by a long waiting time.

The number of patients dying while on the liver transplantation (LT) waiting list (WL) has continued to increase in recent years as a result of severe shortage of organs. Therefore, it is important to evaluate the existing models that predict death on the WL and to determine the independent predictors of death. The study cohort comprised 152 adult patients listed for LT in our centre over a period of 2 years (January 2001 to January 2003). The 12-month survival rate has been calculated by Kaplan-Meier method. The survival analysis performed by Cox proportional hazard model has evaluated the three parameters which compose the model for end-stage liver disease (MELD) score. Forty-four patients (28.9%) died while listed for LT. The survival rate was 92% at 3 months, 80% at 6 months and 69% at 12 months. Median survival was not reached. MELD score was found to be an excellent predictor of death at 12 months on our WL--c-statistic (area under curve) 0.84. In our survival analysis, only international normalized (prothrombin) ratio (INR) and serum creatinine were identified as an independent predictors of death (P < 0.0001). A new simplified version of the MELD score, which does not include serum bilirubin, is proposed and its c-statistic as predictor for death on the WL at 12 months is 0.86, as good as the original MELD score, when evaluated on our list. There is a fourfold increase in mortality on our WL for LT between 3 and 12 months after the inclusion. A simplified version of the MELD score, using only serum creatinine and INR might be taken into account when predicting 12 months mortality on WL with longer waiting time, but it has to be confirmed by other prospective studies.

Adult↗

PubMed2005

Predictors of a positive baseline bone scan in breast cancer.

The aim of this retrospective study was to determine the predictors of a positive bone scan in female patients with breast carcinoma. The participants were 126 females with newly diagnosed breast carcinoma and a baseline bone scan. Patients who had started treatment before their bone scan were excluded. Bone scans were assessed as "no metastases" or "definite skeletal metastases" without knowledge of the patient's predictor variables. Those with "possible metastases" were correlated with other available imaging and clinical information, and recategorized as "no metastases" or "definite skeletal metastases". Results were compared with predictor variables. Significant predictors were increasing age, a higher histopathological grading and positive progesterone receptor status following a forward-stepwise logistic regression analysis. Axillary nodal status, tumour size and oestrogen receptor status did not correlate with a positive bone scan. Not every patient needs a staging bone scan. This study is important because it predicts the need for baseline scintigraphy for specific patients in whom skeletal metastases are more likely to be present or to develop. The findings are particularly valuable in times of worldwide resource scarcity and evolving surgical practice.

Adult↗

PubMed2005

Predictors of diabetic end-stage renal disease in Japan.

Diabetes mellitus (DM) has been the leading cause of incident dialysis in Japan since 1998, according to the Japanese Society for Dialysis Therapy (JSDT). In particular, the number of male DM dialysis patients is increasing. DM is becoming a worldwide epidemic in both developed and developing countries. Strategies to detect individuals at high-risk of developing CKD and end-stage renal disease (ESRD) are needed that can be implemented on a population-basis. Among the commonly measured variables, dipstick urinalysis (proteinuria, haematuria), blood pressure, serum creatinine, body mass index (BMI), and serum uric acid are significant predictors of ESRD. Recently, we evaluated the effect of DM as a risk factor of developing ESRD. DM was diagnosed when the fasting plasma glucose (FPG) was 126 mg/dL or more in participants (n = 78529) of the 1993 screening program in Okinawa. The prevalence of DM was 5.2%. The odds ratio (95% CI) of DM for developing ESRD was 3.098 (1.738-5.525, P = 0.0001) after adjusting for possible confounding variables. Early detection and treatment of DM might prevent DM-related ESRD. We examined 7125 non-DM screenees who underwent a 1-day health check between April 1997 and March 1998. They were followed-up until March 2000 to determine whether they developed DM. Over the 2 years, the cumulative incidence of DM was 2.3%, 2.9% in men and 1.3% in women. Proteinuria was the most robust predictor of the development of DM; the adjusted relative risk (95% CI) was 1.90 (1.14-3.17). Obesity, per se, is also recognized as a risk factor for developing proteinuria. The higher the BMI, the higher the risk of developing ESRD; the adjusted odds ratio (95% CI) was 1.273 (1.121-1.446, P = 0.0002) for men. Other than being overweight (BMI = 25.0 kg/m2), a smoking habit was a significant predictor of developing proteinuria. The prevalence of obesity and DM is increasing in Japan. It is possible that the impact of obesity and complications of DM are different among races and ethnicities. Public relations regarding the risk of DM and its complications are especially important in Asian countries. Asians have more fat than non-Asians, even at the same BMI levels. Knowledge of the predictors of DM-ESRD is crucial as a first step toward prevention. Consistent with this notion, initiatives on the management of CKD and ESRD were recently organized in Japan and internationally.

Asian People↗

PubMed2006

Predictors of seminal vesicle invasion before radical prostatectomy.

AIM: To predict whether or not seminal vesicle invasion is present before radical prostatectomy, the relationships between clinical parameters and seminal vesicle invasion were analyzed. METHODS: A review was conducted of 187 patients who had been clinically diagnosed with stages A(2), B(0), B(1), B(2) or C prostate cancer and who had undergone radical prostatectomy without neoadjuvant therapy. The parameters analyzed for potential predictors of seminal vesicle invasion before radical prostatectomy included age, clinical stage, serum prostate-specific antigen (PSA) level at biopsy, tumor differentiation of biopsy specimens and percentage of cancer positive cores by biopsy. For percentage of cancer positive cores by biopsy, 143 of 187 patients who underwent transrectal sextant biopsy or more than six transrectal ultrasound guided core biopsies were evaluated. These parameters were subjected to univariate and multivariate logistic regression analyses to identify predictors for seminal vesicle invasion. RESULTS: The median age was 66.8 years (range 51-77 years). Of 187 patients, 27 (14.4%) had seminal vesicle invasion confirmed pathologically. There were significant differences in all parameters except for age between patients with positive and negative seminal vesicle invasion on univariate analysis. Multivariate analysis revealed that serum PSA level, tumor differentiation of biopsy specimens and percentage of cancer positive cores were significant independent predictors of seminal vesicle invasion. CONCLUSIONS: The results showed serum PSA level, tumor differentiation of biopsy specimens and percentage of cancer positive cores by biopsy before radical prostatectomy may be useful predictors for seminal vesicle invasion.

Aged↗

PubMed2006

Trends and predictors of aggressive therapy for clinical locally advanced prostate carcinoma.

OBJECTIVE: To determine the patterns and predictors of aggressive local therapies for patients with clinically advanced (cT3) prostate carcinoma, as the USA National Cancer Institute considers external beam radiotherapy (EBRT) to be the most appropriate treatment for these patients, and currently there is less evidence supporting the use of radical prostatectomy (RP). PATIENTS AND METHODS: We used the Surveillance, Epidemiology and End Results (SEER) cancer registries to identify patients diagnosed with cT3 disease between 1995 and 2001. Sociodemographic and clinical data included patient age, race/ethnicity, marital status, SEER registry, year of diagnosis, tumour stage and grade, and treatment. Multivariate logistic regression was used to identify significant predictors of receiving (i) RP vs EBRT, (ii) any aggressive local treatment (RP or EBRT) or no treatment. RESULTS: Between 1995 and 2001, the proportion of men receiving aggressive local therapy for cT3 disease increased by 11% (58.4% to 69.4%), with a 20% increase in EBRT (40.3% to 60.2%) but a decline by half in RP (18.1% to 9.3%). Younger age was the strongest predictor of receiving RP rather than EBRT, and younger age with being married being a predictor of receiving aggressive local therapy (adjusted relative risk for marriage 1.33, 95% confidence interval 1.18-1.87). Black men were significantly less likely than non-Hispanic white men to receive aggressive therapy, with a relative risk of 0.56 (0.45-0.69). CONCLUSION: By 2001, 70% of patients with cT3 disease were receiving aggressive local therapy, with EBRT 6.5 times more common than RP. Clinical trials are needed to rigorously assess the effects of different local treatment strategies on clinical outcomes in men with cT3 prostate carcinoma.

Aged↗

PubMed1998

Predictors of GP service use: a community survey of an elderly Australian sample.

As part of a study of an elderly community-dwelling Australian population, predictors of general practitioner (GP) service use were identified. The sample of 897 persons, aged 70 years or older and living in Canberra and Queanbeyan, were interviewed about their health and well-being. Data on the number of GP visits in the following 12-month period were obtained from the Health Insurance Commission. There were important gender differences in the prediction of both contact and volume of service use. Need variables (physical health in men, and disability and anxiety in women) were the most important predictors. Men who were older or who had lower occupational status used more medical services, as did women with less education or higher levels of extraversion. Men with lower social support were less likely to contact a GP, but social support was not related to volume of service use for either men or women. Since at most 21% of the variance in the volume of GP service use could be explained, despite the wide range of predictors considered and the different statistical approaches adopted, better measures of service use and predictors need to be developed.

Activities of Daily Living↗

PubMed2001

Predictors of early rescreening in the National Cervical Screening Program, Australia.

OBJECTIVE: To identify variables that predict early rescreening after a negative Pap smear report. METHODS: Cohort study using the records of a statewide Cervical Cytology Registry in Victoria, Australia. The cohort comprised 31,082 women who had a negative Pap smear report during the first half of 1996 and who were rescreened within the subsequent 36 months. Early rescreening was defined as a further Pap smear within 21 months. RESULTS: The strongest predictor of early rescreening was a recommendation at the time of issuing the negative Pap smear report by the laboratory for retesting before two years (adjusted odds ratio = 3.81, 95% confidence interval (CI) 3.58-4.05). Mention of reactive or inflammatory change as part of the negative Pap smear report was also a powerful predictor (adjusted odds ratio = 1.67, 95% CI 1.50-1.85). Significant predictors associated with the women were young age, high socio-economic status and residence in the capital city. Significant predictors associated with the practitioner were if either the index or subsequent smear was collected by an obstetrician/ gynaecologist or a hospital-based clinic, or if the practitioner collecting the index smear was a female. The population-attributable risk per cent associated with the laboratory recommendation was 27%. CONCLUSIONS: This data suggests that a multifaceted strategy targeting pathology laboratories, practitioners and women may be needed to reduce early rescreening. IMPLICATIONS: Early rescreening is wasteful of health resources. New screening programs should be designed to avoid this problem.

Adult↗

PubMed2005

Depressive symptoms and insecure attachment as predictors of disability in a clinical population of patients with episodic and chronic migraine.

OBJECTIVES: To define predictors of migraine-related disability in patients with episodic and chronic migraine referred to a specialty migraine clinic, focusing on depressive symptoms and insecure attachment style that, because of their association with responses to pain and physical illness, might be predictive of greater migraine-related disability. BACKGROUND: The Migraine Disability Assessment questionnaire (MIDAS) has proved to be a reliable and easy-to-use instrument to assess migraine-related disability. As clinicians are increasingly using MIDAS in their diagnostic and treatment decisions for patient care, an understanding of the factors influencing migraine-related disability is essential for a rationale use of such an instrument. METHODS: Two-hundred patients suffering from episodic migraine without aura (EM), and chronic migraine (CM) with and without medication overuse, and referred to a specialty headache clinic were evaluated using the MIDAS, the Beck Depression Inventory (BDI), and the Attachment Style Questionnaire (ASQ). Diagnosis of episodic and chronic migraine was operationally defined according to the International Headache Society (IHS) and Silberstein-Lipton criteria. RESULTS: Multiple regression analysis showed that, in the total sample, disability was higher in those patients with CM, more severe depressive symptoms, an insecure style of attachment (as reflected by a lower score on the ASQ confidence scale), and experiencing more severe headache pain intensity. In the subgroup of patients with episodic migraine, an insecure style of attachment emerged as the most significant predictor of disability (other significant predictors were female sex and number of headache days per month). In contrast, in the subgroup of patients with CM, the only significant predictor of the total MIDAS score was a greater severity of depressive symptoms. CONCLUSIONS: Our findings demonstrate the relevance of attachment style, an enduring psychological trait not evaluated in previous studies, in influencing the disability level in patients with migraine and confirm the role of comorbid depressive symptoms in modulating the impact of migraine on every day functioning.

Adolescent↗

PubMed2005

Poststroke epilepsy: occurrence and predictors--a long-term prospective controlled study (Akershus Stroke Study).

PURPOSE: The aims of the study were to assess the occurrence of poststroke epilepsy (PSE) in patients with ischemic strokes, to identify predictors, and to investigate whether treatment in a stroke unit (SU) influenced the long-term outcomes of epilepsy. METHODS: Patients with PSE, defined as those having two ore more unprovoked epileptic seizures > or = 1 week after an ischemic stroke, were identified from a cohort of 484 patients with ischemic strokes. The patients were prospectively assessed 7-8 years after stroke or until death. Different variables were studied to look for possible predictors. RESULTS: From 484 patients with ischemic strokes, PSE developed in 12 (2.5%) and 15 (3.1%) patients during the first year and 7-8 years after stroke, respectively. Eight (53%) of these patients were treated in a stroke unit (SU), and seven (47%) were treated in a general medical ward (GMW). The mean age of those who developed PSE and those who did not was 74.3 years and 76.3 years, respectively. In a multivariate analysis, a Scandinavian Stroke Scale (SSS) score < 30 on admission was a significant predictor for developing PSE [odds ratio (OR), 4.9; p = 0.004). CONCLUSIONS: The prevalence of PSE, 7 to 8 years after an ischemic stroke, was 3.1%. SSS scores < 30 on admission were a significant predictor for PSE. Neither treatment in SU versus GMW, cortical location, nor age at onset of stroke seemed to influence the risk of developing PSE.

Age Factors↗