SEARCH · PubMed Health

Results for “Predictors”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 775 records · Page 43Linked to original sources

PubMed2005

Survivin as a marker of cervical intraepithelial neoplasia and high-risk human papillomavirus and a predictor of virus clearance and prognosis in cervical cancer.

We analyzed survivin as a marker of cervical intraepithelial neoplasia (CIN) and high-risk human papillomavirus (HR-HPV) and a predictor of HPV clearance and disease outcome in cervical cancer in 302 samples (squamous cell carcinomas [SCCs], 150; CIN lesions, 152) by immunohistochemical staining with survivin antibody and HPV testing using polymerase chain reaction. HR-HPV types were associated closely with CIN and SCC. There was a significant linear relationship between grade and intensity of survivin expression (P = .0001). Survivin overexpression also was associated strongly with HR-HPV type (P = .0001). Multivariate regression analysis revealed survivin and p16(INK4a) as equally strong independent predictors of HR-HPV. Deregulated survivin expression did not predict clearance or persistence of HR-HPV after treatment of CIN or survival in cervical cancer in univariate (P = .417) or multivariate analysis. After adjustment for HR-HPV, stage, age, and tumor grade in the Cox regression model, only stage (P = .0001) and age (P = .0001) remained independent prognostic predictors. Survivin seems to be an early marker of cervical carcinogenesis. Up-regulated survivin expression was an independent predictor of HR-HPV in cervical lesions, most plausibly explained by its normal transcriptional repression by wild-type p53 being eliminated by HR-HPV E6 oncoprotein.

Biomarkers, Tumor↗

PubMed2002

Predictors of emotional distress, general health, and caregiving outcomes in family caregivers of stroke survivors.

Predictors of emotional distress, general health, and stroke-related caregiving outcomes were determined in 104 family caregivers of stroke survivors based on a conceptual model derived from Lazarus' theory of stress and coping. Predictors of emotional distress (R(2) =.48, p <.001) were low caregiver self-esteem, high task difficulty, and high threat appraisal. Predictors of poorer health (R(2) =.25, p <.001) were not living with the patient, low household income, and high threat appraisal. Predictors of poor stroke-related care-giving outcomes (R(2) =.45, p <.001) were emotional distress, low benefit appraisal, high task difficulty, and high threat appraisal. Findings suggest potential areas for multidimensional caregiver interventions.

Journal Article↗

PubMed2005

Group-based guilt as a predictor of commitment to apology.

Whether the Australian government should officially apologize to Indigenous Australians for past wrongs is hotly debated in Australia. The predictors of support amongst non-Indigenous Australians for such an apology were examined in two studies. The first study (N=164) showed that group-based guilt was a good predictor of support for a government apology, as was the perception that non-Indigenous Australians were relatively advantaged. In the second study (N=116) it was found that group-based guilt was an excellent predictor of support for apology and was itself predicted by perceived non-Indigenous responsibility for harsh treatment of Indigenous people, and an absence of doubts about the legitimacy of group-based guilt. National identification was not a predictor of group-based guilt. The results of the two studies suggest that, just as individual emotions predict individual action tendencies, so group-based guilt predicts support for actions or decisions to be taken at the collective level.

Adult↗

PubMed2005

Gonorrhea and chlamydia infection among women visiting family planning clinics: racial variation in prevalence and predictors.

CONTEXT: Black women are disproportionately infected with gonorrhea and chlamydia. Because of the potential impact of these infections on women's reproductive health, it is important to determine whether different factors are predictive of infection in women of different races. METHODS: Data from 31,762 women aged 15-24 who were tested for gonorrhea and chlamydia at Missouri family planning clinics in 2001 were used to calculate the prevalence of each infection by selected variables. Logistic regression analysis was used to assess factors associated with the risk of infection. RESULTS: Overall, 0.7% of women had gonorrhea, and 4% had chlamydia. The gonorrhea rate was 4% for blacks and 0.4% for whites; the chlamydia rate, 9% and 4%, respectively. Independent predictors of gonorrhea in both races were symptoms, recent sexual contact with a partner who had STD symptoms, and chlamydia infection. Predictors specific to whites were visiting the clinic for STD care and having a new partner or multiple partners in the past year. Being aged 15-21 was associated with an elevated risk of gonorrhea for blacks only. In both racial groups, chlamydia infection was associated with younger age, contact with a symptomatic partner, cervicitis, cervical friability and gonorrhea positivity. Additional predictors among whites were having a new partner, having multiple partners and having pelvic inflammatory disease; no other factors were significant for blacks. CONCLUSIONS: The prevalence and predictors of gonorrhea and chlamydia infection differ significantly between blacks and whites. Until these disparities are better understood, it will be difficult to establish screening criteria for gonorrhea.

Adolescent↗

PubMed2003

Fractional esterification rate of cholesterol and ratio of triglycerides to HDL-cholesterol are powerful predictors of positive findings on coronary angiography.

BACKGROUND: We examined the predictive value of various clinical and biochemical markers for angiographically defined coronary artery disease (aCAD). Specifically, we assessed the value of the ratio of plasma triglyceride (TGs) to HDL-cholesterol (HDL-C) and the fractional esterification rate of cholesterol in plasma depleted of apolipoprotein B (apoB)-containing lipoproteins (FER(HDL)), a functional marker of HDL and LDL particle size. METHODS: Patients (788 men and 320 women) undergoing coronary angiography were classified into groups with positive [aCAD(+)] and negative [aCAD(-)] findings. Patient age, body mass index, waist circumference, blood pressure (BP), medications, drinking, smoking, exercise habits, and plasma total cholesterol (TC), LDL-cholesterol (LDL-C), HDL-unesterified cholesterol, HDL-C, TGs, FER(HDL), apoB, log(TG/HDL-C), and TC/HDL-C were assessed. Lipids and apoproteins were measured by standard laboratory procedures; FER(HDL) was determined by a radioassay. RESULTS: Members of the aCAD(+) group were older and had a higher incidence of smoking and diabetes than those in the aCAD(-) group. The aCAD(+) group also had higher TG, apoB, FER(HDL), and log(TG/HDL-C) and lower HDL-C values. aCAD(+) women had greater waist circumference and higher plasma TC and TC/HDL-C. aCAD(+) men, but not women, had higher plasma LDL-C. In the multivariate logistic model, the significant predictors of the presence of aCAD(+) were FER(HDL), age, smoking, and diabetes. If only laboratory tests were included in the multivariate logistic model, FER(HDL) appeared as the sole predictor of aCAD(+). Log(TG/HDL-C) was an independent predictor when FER(HDL) was omitted from multivariate analysis. CONCLUSIONS: FER(HDL) was the best laboratory predictor of the presence of coronary atherosclerotic lesions.

Adolescent↗

PubMed1994

Noninvasive predictors of systemic embolism in mitral stenosis. An echocardiographic and clinical study of 500 patients.

Few predictors of systemic embolism in patients with mitral stenosis have been identified by noninvasive methods. This study used the most powerful noninvasive diagnostic tool, transthoracic echocardiography, as well as other noninvasive clinical information to look for predictors. Five hundred consecutive patients with a mitral valve area of 2 cm2 or less were studied. They were divided into two groups: group 1 consisted of 143 patients with a history of systemic embolism and group 2 consisted of 357 patients with no history of systemic embolism. Using a stepwise logistic regression on a random subsample of 400 patients, 4 independent predictors were found: the presence of atrial fibrillation (p = 0.003, relative risk [RR] = 2.3, 95% CI = 1.3, 4.2), the absence of significant tricuspid regurgitation (p = 0.008, RR = 2.5, 95% CI = 1.3, 4.9), the absence of aortic regurgitation (p = 0.022, RR = 2.2, 95% CI = 1.1, 4.2), and the presence of left atrial smoky echoes (p = 0.039, RR = 1.7, 95% CI = 1.1, 3.0). When the above model, together with significant interaction terms, was applied to the remaining 100 patients, both the Hosmer-Lemeshow and Brown goodness-of-fit statistics were not significant (p = 0.888 and p = 0.248, respectively), indicating that the fit was adequate and the model was validated. Thus, important noninvasive predictors of systemic embolism in patients with mitral stenosis can easily be obtained. Subgroups of patients with high risk of systemic embolism can be identified. This may refine our therapeutic strategies to prevent the catastrophe of systemic embolism.

Adolescent↗

PubMed1997

Preoperative predictors of operative morbidity and mortality in COPD patients undergoing bilateral lung volume reduction surgery.

Bilateral volume reduction surgery (VRS) improves lung function for selected patients with emphysema. However, predictors of outcome are not well defined. We reviewed the preoperative characteristics of the first 47 consecutive patients who underwent bilateral VRS at the Massachusetts General Hospital in order to define potential predictors of unacceptable outcome. Preoperative data included spirometry, plethysmography, diffusion of carbon monoxide (Dco), maximum inspiratory pressure (MIP), maximum expiratory pressure, resting arterial blood gases (ABG), cardiopulmonary exercise testing with ABG and lactate sampling, and radionuclide ventriculography. Prepulmonary and postpulmonary rehabilitation 6-min walk tets (6MWT), and preoperative chest CT scans were also obtained. Twenty-two subjects were male and 17 of the subjects were on the lung transplant list. Patient characteristics included age of 60.5 +/- 7.5 years, FEV1 of 0.67 +/- 0.20 L, total lung capacity of 7.56 +/- 1.7 L, Dco of 7.40 +/- 4.1 mL/min/mm Hg, and PaCO2 of 41.6 +/- 6.4 mm Hg (mean +/- SD). The FEV1, vital capacity, MIP, resting room air PaCO2, prepulmonary and postpulmonary rehabilitation 6MWT, and PaCO2 at maximum oxygen consumption correlated with length of hospitalization (p < 0.05). Based on analysis of 41 of 47 patients for whom there were complete data, the inability to walk more than 200 m on the 6MWT before or after preoperative pulmonary rehabilitation, and resting PaCO2 > or = 45 mm Hg were the best predictors of an unacceptable outcome. If either of these characteristics was present, six of 16 vs zero of 25 died (Fisher's Exact Test, p = 0.0025, one-tailed) and 11 of 16 vs four of 25 had hospital courses > 21 days (p < 0.002). Both the 6MWT < 200 m and resting PaCO2 > or = 45 mm Hg alone correlated with death (p = 0.004 and p = 0.012, respectively) and the resting PaCO2 > or = 45 mm Hg correlated with hospital days > 21 (p = 0.0002). In conclusion, the data suggest that the inability to walk at least 200 m in 6 min before or after pulmonary rehabilitation and a resting room air PaCO2 > or = 45 mm Hg are excellent preoperative predictors of unacceptable postoperative outcomes.

Exercise Test↗

PubMed1998

Validation of the modified multisystem organ failure score as a predictor of mortality in patients with AIDS-related Pneumocystis carinii pneumonia and respiratory failure.

STUDY OBJECTIVES: To validate a previously developed multisystem organ failure (MSOF) score with and without the addition of the lactate dehydrogenase (LDH) level as a predictor of survival to hospital discharge in patients with AIDS-related Pneumocystis carinii pneumonia (PCP) and acute respiratory failure (ARF). DESIGN: Retrospective chart review between April 1, 1991, and September 30, 1996. SETTING: University-affiliated tertiary care center in downtown Vancouver, British Columbia, Canada. PATIENTS: All patients with PCP-related ARF admitted to the ICU of St. Paul's Hospital during the study period. INTERVENTIONS: As putative prognostic instruments, data were extracted regarding the APACHE II (acute physiology and chronic health evaluation II), acute lung injury (ALI), AIDS, and modified MSOF scores, as well as LDH levels, at entry to the ICU. Patients were stratified based on an LDH level of < or > or = 2,000 U/L and this threshold was assessed in its predictability of outcome when added to each of the above scores. For APACHE II, the score was categorized in six groups and evaluated with and without inclusion of the LDH. Receiver operating characteristic curves were constructed for LDH and for each score with and without the LDH level to assess accuracy of prediction. The area under each curve was calculated and compared to estimate the statistical significance of observed differences. MEASUREMENTS AND RESULTS: There were 40 admissions to the ICU of 38 patients with 52.5% mortality. The ALI and AIDS scores were not predictive of outcome. The modified MSOF and APACHE II scores were significant predictors of survival and the performance of both was enhanced by the addition of LDH. CONCLUSIONS: Both the APACHE II and the modified MSOF scores were significant predictors of outcome in the patient population studied. These results validate the modified MSOF score as an effective predictor of survival to hospital discharge among patients with AIDS-related PCP who develop ARF and the performance of the score is enhanced by the addition of the LDH level.

AIDS-Related Opportunistic Infections↗

PubMed1998

Perioperative predictors of acute cholecystitis after cardiovascular surgery.

OBJECTIVE: To determine the incidence, diagnostic features, and perioperative predictors of acute cholecystitis after cardiovascular surgery. DESIGN: Inception cohort study. SETTING: A tertiary care 54-bed cardiothoracic ICU. PATIENTS: All patients admitted to an ICU after cardiovascular surgery during a 42-month period. INTERVENTION: Collection of relevant preoperative, operative, and ICU data from a database and medical charts. PRIMARY OUTCOME: Postoperative acute cholecystitis (AC). RESULTS: Out of 11,330 admissions, 876 patients stayed in the ICU more than 7 days and 30 of them (3%) developed postoperative AC. AC was diagnosed a median of 26 days after cardiovascular surgery (interquartile range, 11 to 41 days). All patients with AC developed at least two criteria of the systemic inflammatory response syndrome (SIRS), and 16 of them (53%) were vasopressor-dependent on the day of diagnosis. Trends in biochemical testing of liver function were not diagnostic for AC. Death occurred in seven of 17 patients (41%) who underwent cholecystectomy, three of nine patients (33%) treated with percutaneous cholecystostomy, and one of four patients (25%) treated conservatively (p=not significant). Specific earlier predictors of AC were arterial vascular disease, preoperative oxygen delivery less than 430 mL/min x m2, longer times on cardiopulmonary bypass, surgical re-exploration, ICU course complicated by cardiac arrhythmia, mechanical ventilation > or = 3 days, bacteremia, and nosocomial infections. CONCLUSION: The incidence of AC is low after cardiovascular surgery. Although SIRS and hemodynamic instability were common at the time of diagnosis, the delayed occurrence and lack of specificity of these features for AC limited their utility for early diagnosis. Specific predictors of AC should be sought in the ICU setting to identify patients who are at risk for AC after cardiovascular surgery. When identified, such predictors can prompt earlier diagnosis and treatment. Further evaluation of the selection criteria for different treatment options is needed in order to decrease the morbidity and mortality associated with AC.

Acute Disease↗

PubMed2001

Bupropion for smoking cessation : predictors of successful outcome.

OBJECTIVES: To identify predictors of smoking abstinence at the end of medication use that could assist in the optimal use of a sustained-release (SR) form of bupropion for treating cigarette smokers. DESIGN: A double-blind, placebo-controlled, dose-response trial. SETTING: Multicenter (three sites) study conducted in the United States. PARTICIPANTS: Six hundred fifteen healthy men and women (> or = 18 years of age) who were smoking > or = 15 cigarettes per day and who were motivated to stop smoking. INTERVENTION: Random assignment of patients to placebo or SR bupropion treatment, 100, 150, or 300 mg/d, for 7 weeks (total duration of study was 52 weeks: 7 weeks of treatment and 45 weeks of follow-up). MEASUREMENTS AND RESULTS: Logistic regression was used to identify predictors of abstinence at the end of the medication phase. Univariate predictors included the following: bupropion dose (p < 0.001); older age (p = 0.024); lower number of cigarettes smoked per day (cpd) (p < 0.001); lower Fagerström Tolerance Questionnaire score (p = 0.011); longest time previously abstinent that was < 24 h or > 4 weeks (p < 0.001); absence of other smokers in the household (p = 0.021); greater number of previous stop attempts (p = 0.019); and study site (p = 0.004). Multivariate predictors of abstinence at the end of the medication phase were the following: higher bupropion dose (p < 0.001); lower number of cpd (p < 0.001); longest time previously abstinent from smoking (p = 0.002); male gender (p = 0.014); and study site (p = 0.021). CONCLUSION: Bupropion SR therapy was effective in treating cigarette smokers independently of all other characteristics studied. Lower smoking rate, brief periods (ie, < 24 h) or long periods (ie, > 4 weeks) of abstinence with previous attempts to stop smoking, and male gender were predictive of better outcomes, independent of the dose of bupropion that was used.

Adult↗

PubMed2003

Resting lung function and hemodynamic parameters as predictors of exercise capacity in patients with chronic heart failure.

STUDY OBJECTIVES: The aim of this study was to examine the role of resting pulmonary function and hemodynamic parameters as predictors of exercise capacity in patients with chronic heart failure. MEASUREMENTS AND RESULTS: Fifty-one patients with chronic heart failure underwent resting pulmonary function testing, including inspiratory capacity (IC) and symptom-limited, treadmill cardiopulmonary exercise testing (CPET). Right-heart catheterization and radionuclide ventriculography were performed within 2 days of CPET. Mean (+/- SD) left ventricular ejection fraction was 31 +/- 12% and cardiac index was 2.34 +/- 0.77 L/min/m(2). Percentage of predicted FEV(1) was 92 +/- 14%, percentage of predicted FVC was 94 +/- 15%, FEV(1)/FVC was 81 +/- 4%, and percentage of predicted IC was 84 +/- 18%. Mean peak oxygen uptake (peak O(2)) was 17.9 +/- 5.4 mL/kg/min. Analysis of variance among the three functional Weber classes showed statistically significant differences for pulmonary capillary wedge pressure (PCWP) and IC. Specifically, the more severe the exercise intolerance, the lower was IC and the higher was PCWP. In a multivariate stepwise regression analysis, using peak O(2) (liters per minute) as the dependent variable and the pulmonary function test measurements as independent variables, the only significant predictor selected was IC (r = 0.71, p < 0.0001). In a final stepwise regression analysis including all the independent variables of the resting pulmonary function tests and hemodynamic measurements, the two predictors selected were IC and PCWP (r(2) = 0.58). CONCLUSIONS: In patients with chronic heart failure, IC is inversely related to PCWP and is a strong independent predictor of functional capacity.

Cardiac Output↗

PubMed2005

Shock on admission day is the best predictor of prolonged mechanical ventilation in the ICU.

STUDY OBJECTIVES: To determine the incidence of prolonged mechanical ventilation (PMV), which is associated with increased health-care costs and risks of adverse events, and to identify its early predictors. DESIGN: Retrospective cohort. SETTING: A medical-surgical ICU in a university-affiliated hospital. PATIENTS OR PARTICIPANTS: All patients admitted to the ICU over 3 years who received mechanical ventilation (MV) for > 12 h. INTERVENTIONS: None. MEASUREMENTS: PMV was defined as MV lasting > 21 days. We recorded epidemiologic data, severity scores, worst Pao(2)/fraction of inspired oxygen (Fio(2)), presence of shock on ICU admission day, cause for MV, length of MV, ICU length of stay (LOS), and hospital LOS. PMV patients were compared to patients weaned before 21 days (non-PMV group) to determine predictors of PMV. RESULTS: Of 551 hospital admissions, 319 patients (58%) required MV > 12 h. One hundred thirty patients died early and were excluded. Seventy-nine patients (14%) required PMV. The non-PMV group consisted of 110 patients. Simplified acute physiology score (SAPS) II, APACHE (acute physiology and chronic health evaluation) II, therapeutic intervention scoring system, Pao(2)/Fio(2), shock, ICU LOS, and hospital LOS differed significantly between groups. However, logistic regression identified shock on ICU admission day as the only independent predictor of PMV (odds ratio, 3.10; p = 0.001). SAPS II and Pao(2)/Fio(2) had the nearest coefficients and were used to build the predictive model. Sensitivity analysis was performed including the 130 patients who died early, and shock remained the most powerful predictor. CONCLUSIONS: PMV was a frequent event in this cohort. The presence of shock on ICU admission day was the only prognostic factor, even adjusting for severity of illness and hypoxemia.

APACHE↗

PubMed2002

Outcome predictors in morbidly obese recipients of an adjustable gastric band.

BACKGROUND: The authors investigated the outcome predictors in obese patients who underwent laparoscopic adjustable banding with the Lap-Band. METHODS: The 3-year excess weight loss (EWL) and rate of band-related complications (pouch dilatation and port leakage) were analyzed in 260 morbidly obese patients, according to several possible predictive characteristics. Success rate (EWL > 50%), failure rate (EWL < 20%) and weight regain rate (regain of > 10% EWL between 1 and 3 yrs) were considered. RESULTS: The Lap-Band produced a 43.0 +/- 22.3% EWL, corresponding to a BMI reduction from 46.6 +/- 7.0 to 36.8 +/- 6.6 kg/m2. Success rate was 35.7%, failure rate was 14.1% and weight regain rate was 20.7%. Pouch dilatation occurred in 32 patients (12.3%), band erosion in 2 (0.8%), port leakage in 74 (28.5%), and port twisting in 2 (0.8%). Major band-related surgery was requested in 11 patients (4.2%) and minor port-related surgery in 62 patients (23.9%). Significant success predictors were found to be age < 40 years and BMI < 50 kg/m2. Significant failure predictors were found to be male sex and non-sweet eating behavior. Significant weight regain predictors were found to be BMI < 50 kg/m2 and the occurrence of a port leakage. Port leakage was significantly more frequent in women and in patients with BMI < 50 kg/m2. The prevalence of pouch dilatation was threefold higher in women than in men. CONCLUSIONS: Lap-Band was associated with a good outcome and with a low rate of severe complications. The outcome was more influenced by physiological and technical reasons than by psychological or behavioural factors.

Adult↗

PubMed1998

Predictors of participation in aftercare sessions and self-help groups following completion of intensive outpatient treatment for substance abuse.

OBJECTIVE: The goals of this study were to identify predictors of greater participation in aftercare treatment sessions and self-help groups during the first 3 months following completion of a 4-week intensive outpatient rehabilitation (IOP) program. METHOD: The subjects were 138 male veterans who met DSM-III-R criteria for lifetime diagnoses of both alcohol and cocaine dependence (n = 67), alcohol dependence only (n = 48) or cocaine dependence only (n = 23); completed an IOP program; and expressed a desire to enter a formal aftercare program. Analyses examined relationships between predictor variables from five different domains and number of aftercare sessions and self-help groups attended in the last week of each month of the follow-up period. RESULTS: Of the many potential predictor variables that were examined, only remission from cocaine and alcohol dependence during IOP and higher AIDS risk behavior scores in the prior 6 months contributed independently to the prediction of greater participation in aftercare. Further analyses identified several variables that were differential predictors of participation in individualized relapse prevention aftercare versus standard 12-step focused group aftercare. More years of cocaine use, greater current legal problems and a lack of current alcohol dependence predicted greater self-help participation at the level of a trend. CONCLUSIONS: The achievement of remission from substance use dependence during IOP may be an important criterion for moving to the next level of care. However, the results of the present study also point to the need for an increased focus on factors present during the course of aftercare in future studies of retention in aftercare following outpatient rehabilitation.

Acquired Immunodeficiency Syndrome↗

PubMed2001

Childhood and adolescent predictors of alcohol abuse and dependence in young adulthood.

OBJECTIVE: To provide a comprehensive examination of childhood and adolescent predictors of alcohol abuse and dependence at age 21, theoretically guided by the social development model. METHOD: Data were taken from an ethnically diverse urban sample of 808 students (51% male), surveyed at age 10 and followed prospectively to age 21 in 1996. Potential predictors of alcohol abuse and dependence at age 21 were measured at ages 10, 14 and 16. Relationships between these predictors and alcohol abuse and dependence were examined at each age, to assess changes in their patterns of prediction over time. RESULTS: Strong bonding to school, close parental monitoring of children and clearly defined family rules for behavior, appropriate parental rewards for good behaviors, high level of refusal skills and strong belief in the moral order predicted a lower risk for alcohol abuse and dependence at age 21. Of these, strong bonding to school consistently predicted lower alcohol abuse and dependence from all three ages (10, 14 and 16). By contrast, youths who had a higher risk of alcohol abuse and dependence at age 21 engaged in more problem behaviors, had more opportunities to be involved with antisocial individuals and spent more time with and were more bonded to those individuals, viewed fewer negative consequences from antisocial behaviors and held more favorable views on alcohol use. Of these, prior problem behaviors and antisocial opportunities and involvements at ages 10, 14 and 16 consistently predicted alcohol abuse and dependence at age 21. CONCLUSIONS: These important malleable predictors, identifiable as early as age 10, provide potential intervention targets for the prevention of alcohol abuse and dependence in early adulthood.

Adolescent↗

PubMed2005

Individual and partner predictors of recovery from alcohol-use disorder over a nine-year interval: findings from a community sample of alcoholic married men.

OBJECTIVE: Numerous studies have focused on the predictors of recovery in persons with alcohol use disorder (AUD). Most have been retrospective and have measured only predictors of short-term recovery after the completion of treatment. This prospective study evaluates the role of psychological and social factors in a community sample of both alcoholics and their partners in predicting recovery over a 9-year interval. METHOD: Alcoholic diagnostic status and life functioning of 134 community-recruited, initially coupled men meeting criteria for a 3-year Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, AUD diagnosis at baseline were assessed over the 9-year period. Their partners also were assessed. Prediction involved comparing those who still had an AUD diagnosis at 9-year follow-up against those who no longer met AUD criteria. RESULTS: Predictors of recovery included number of experiences with treatment, education, number of years of intervening recovery over the follow-up period, partner baseline AUD status and partner's social support network. Alcoholics' initial severity of drinking did not predict long-term outcome. Furthermore, recovered men's partners decreased their AUD in the interim, whereas nonremitters' partners increased their AUD. The findings highlight the transitions in and out of AUD, with 62% of the men having stable drinking patterns of either remission or unremitting AUD diagnosis over the entire follow-up period. CONCLUSIONS: This study demonstrated the importance of interpersonal factors in maintaining AUD or promoting recovery. Consideration of partner characteristics and the marital context as factors in the recovery process is essential. Future research should examine the predictors of recovery in women, in adolescents and in racial groups other than white.

Adult↗

PubMed2000

Predictors of short-term outcome in Chinese patients with ambulatory heart failure for heart transplantation with ejection fraction <25%.

Heart transplantation (HT) provides longer survival than that of the natural history in patients with dilated cardiomyopathy (DCM). However, the optimal timing for cardiac transplantation and predictors of mortality in patients with end-stage cardiomyopathy (ESCM) has been poorly defined. The primary purpose of this study focused on the natural history of ambulatory patients with ESCM for HT assessment. Secondly, we tried to determine prognostic factors of individuals with the poorest short-term outcome and the optimal timing for HT in patients with ESCM. Finally, clinical treatment with angiotensin converting-enzyme inhibitors (ACEIs), carvedilol and amiodarone in the prevention of mortality caused by ESCM, were retrospectively evaluated. The short-term outcomes of 119 referral patients with ESCM for four years were observed. The patients had New York Heart Association class III to IV dyspnea at initial assessment for HT. Left ventricular ejection fraction (LVEF) was 17 +/- 6% and cardiac index (CI) was 2.0 +/- 0.6l/min/m2. After optimization of medical treatment, the patients were divided into two major groups according to CI equal to or less than 2.0l/min/m2 and more than 2.0l/min/m2. HTs were accepted in 88 patients and the patients were divided into two groups: medical treatment (group 1, 56 patients) or HT (group 3, 32 patients); HT was not accepted in the other 31 patients (group 2). We studied the probability of the survival curve and prognostic variables of the groups with medical treatment in the follow-up of 12 +/- 9 months. During follow-up, 49 patients were alive without HT. The remaining 38 patients died; 27 patients were in group 1 and 11 patients were in group 2. Eight deaths in group 2 were sudden. The actuarial survival rate among the non-HT population was 73%, 68%, 63 %, and 56 % at 3, 6, 9 and 12 months, respectively. The actuarial survival rate among group 1 was 70 %, 59 %, 55 %, and 52 % at 3, 6, 9 and 12 months, respectively. The actuarial survival rate among group 2 was 87 %, 85 %, 77 %, and 65 % at 3, 6, 9 and 12 months, respectively. A comparison, excluding patients with HT, was performed with those who had survived < 1 year and > or 1 year after assessment, and those who had died. Two parameters were independent predictors of prognosis on univariate and multivariate analysis: total pulmonary vascular resistance (TPR) > or = 14 Wood units (W) and CI < 1.65 l/min/m2 at 6 and 12 months after assessment. Treatment with amiodarone for ventricular tachycardia (VT) showed no convincing role in the prevention of sudden death in our patients. Also, treatment with ACEIs or carvedilol for heart failure was unconvincing to improve the short-term outcome in this study. Our results suggest in properly selected patients that HT should be considered within six months among patients with severe heart failure. Hemodynamic parameters associated with right cardiac function are important determinants of mortality caused by progressive heart failure. Predictors such as CI and TPR may be considered as important markers of mortality in prediction of short-term outcome in patients with ESCM, as other predictors reported in the literature.

Adolescent↗

PubMed2000

Neonatal assisted ventilation: predictors, frequency, and duration in a mature managed care organization.

OBJECTIVES: Reference data are lacking on the frequency and duration of assisted ventilation in neonates. This information is essential for determining resource needs and planning clinical trials. As mortality becomes uncommon, ventilator utilization is increasingly used as a measure for assessing therapeutic effect and quality of care in intensive care medicine. Valid comparisons require adjustments for differences in a patient's baseline risk for assisted ventilation and prolonged ventilator support. The aims of this study were to determine the frequency and length of ventilation (LOV) in preterm and term infants and to develop models for predicting the need for assisted ventilation and length of ventilator support. METHODS: We performed a retrospective, population-based cohort study of 77 576 inborn live births at 6 Northern California hospitals with level 3 intensive care nurseries in a group-model managed care organization. The gestational age-specific frequency and duration of assisted ventilation among surviving infants was determined. Multivariable regression was performed to determine predictors for assisted ventilation and LOV. RESULTS: Of 77 576 inborn live births in the study, 11 199 required admission to the neonatal intensive care unit and of these, 1928 survivors required ventilator support. The proportion of infants requiring assisted ventilation and the median LOV decreased markedly with increasing gestational age. In addition to gestational age, admission illness severity, 5-minute Apgar scores, presence of anomalies, male sex, and white race were important predictors for the need for assisted ventilation. The ability of the models to predict need for ventilation was high, and significantly better than birth weight alone with an area under the receiver operating characteristic curve of.90 versus.70 for preterm infants, and.88 versus.50 for term infants. For preterm infants, gestational age, admission illness severity, oxygenation index, anomalies, and small-for-gestational age status were significant predictors for LOV, accounting for 60% of the variance in the length of assisted ventilation. For term infants, oxygenation index and anomalies were significant predictors but only accounted for 29% of the variance. CONCLUSIONS: Considerable variation exists in the utilization of ventilator support among infants of closely related gestational age. In addition, a number of medical risk factors influence the need for, and length of, assisted ventilation. These models explain much of the variance in LOV among preterm infants but explain substantially less among term infants.neonatal intensive care, assisted ventilation, Score for Neonatal Acute Physiology, resource consumption, prematurity.

California↗