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PubMedDate not supplied

Acute myocardial infarction in the elderly with diabetes.

OBJECTIVE: Diabetes mellitus (DM) has been associated with an elevated, short-term risk of death after myocardial infarction (MI). Among the studies of DM, however, few studies have included elderly subjects. The purpose of the present investigation was to determine if non-insulin-treated DM (NIRxDM) and insulin-treated DM (IRxDM) were associated with specific comorbid conditions, clinical findings on arrival, and MI characteristics, as well as a higher 30-day mortality rate in elderly patients with acute MI. DESIGN: The study design was a retrospective medical record review and secondary data analysis of previously collected data from the Cooperative Cardiovascular Project. SETTING: Study setting was Connecticut from June 1, 1992, through February 28, 1993. PATIENTS: Subjects included the entire Medicare population (n = 2050), aged 65 years or older who were hospitalized for acute MI. OUTCOME MEASURES: Mortality rate at 30 days after MI was measured. RESULTS: A history of DM was observed in 29% of the study population. DM status was associated with previous comorbid conditions, poorer functional status, higher body mass index, heart failure on arrival, non-Q-wave MI, and development of atrial fibrillation and oliguria during hospitalization. Patients with DM were less likely to have chest pain on arrival to the hospital. Diabetic status was not a significant predictor of short-term mortality; at 30 days after MI, 17% (n = 242) of the subjects without DM, 19% (n = 71) of those with NIRxDM, and 18% (n = 39) of the subjects with IRxDM died (P = .460). After adjustment for other prognostic factors, it was noted that MI characteristics present on hospital arrival predicted mortality at 30 days in both patients with NIRxDM and patients with IRxDM. CONCLUSIONS: The slightly, but not significantly, increased mortality risk in patients with DM should not minimize the importance of monitoring DM in the acute MI setting. Hospitalization for MI provides an opportunity to provide aggressive lipid and blood pressure management, optimize blood glucose, control heart failure, and institute other secondary preventive interventions in the elderly population with DM.

Aged↗

PubMed2002

Updating the Belgian Nursing Minimum Data Set: framework and methodology.

The Belgium Nursing Minimum Data Set (BNMDS) started nationally in 1988. It has to be updated to reflect the current evolution of health care. This document describes the framework and methodology for this updating project. The main preoccupation of the research project is to update the existing instrument while avoiding an overload of additional items. A wide range and in-depth analysis of the existing data sets (BNMDS and related data sets) is prerequisite with a view to the development of relevant and effective nursing care indicators. New items and their registration are only acceptable when existing data are insufficient for the required indicators. Indicators relate to clinical nursing care as well as the management of nursing care, e.g. nursing care, nurse staffing, variability of nursing care in view of hospitalization types. While the current indicators make the nursing care process visible only, the updated BNMDS and its indicators should pilot the appropriateness of hospital admissions and their modus, e.g. in-patient versus one-day, and length of stay, the quality of nursing care and the adequacy of nurse staffing. The project focuses on six care programs or clinical pathways: care of the elderly, intensive care, chronic care, pediatrics, cardiology and oncology. A first work package includes the development of new indicators and updating of existing ones, based on secondary data analysis of the existing BNMDS and related data sets. The second work package involves the establishment of workgroups for each care program. The workgroups will review, evaluate and fine-tune the proposals of the researchers. Finally, in work package three, the updated BNMDS will be tested in the hospital setting.

Belgium↗

PubMed2005

Use of clinical prediction rules in detecting osteoporosis in a population-based sample of postmenopausal women.

BACKGROUND: Osteoporosis clinical prediction rules attempt to identify the postmenopausal women in whom, on the basis of individual risk factors, bone densitometry will detect low bone mass. We assessed and compared the diagnostic properties of the following 3 osteoporosis clinical prediction rules: the Simple Calculated Osteoporosis Risk Estimation, Osteoporosis Risk Assessment Instrument, and National Osteoporosis Foundation practice guidelines. METHODS: Secondary data analysis of an existing population-based sample of postmenopausal women 45 years or older (N = 202) in Rochester, Minn. RESULTS: Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and positive (LR+) and negative (LR-) likelihood ratios were calculated using the World Health Organization diagnosis of osteoporosis as the reference standard. The Simple Calculated Osteoporosis Risk Estimation had a sensitivity of 100%, specificity of 29%, PPV of 27%, NPV of 100%, LR+ of 1.4, and LR- of 0. The Osteoporosis Risk Assessment Instrument had a sensitivity of 98%, specificity of 40%, PPV of 29%, NPV of 77%, LR+ of 1.4, and LR- of 0.4. The National Osteoporosis Foundation practice guidelines had a sensitivity of 100%, specificity of 10%, PPV of 27%, NPV of 100%, LR+ of 1.1, and LR- of 0. The Simple Calculated Osteoporosis Risk Estimation and Osteoporosis Risk Assessment Instrument were much more specific in postmenopausal women younger than 65 years compared with those 65 years or older. CONCLUSIONS: Our results suggest that these clinical prediction rules do not perform well as a general screening method to identify postmenopausal women who are more likely to have osteoporosis; however, the Osteoporosis Risk Assessment Instrument and Simple Calculated Osteoporosis Risk Estimation may be useful in identifying some women who need not undergo testing, especially younger postmenopausal women.

Absorptiometry, Photon↗

PubMed2002

Effect of abuse on health: results of a national survey.

HYPOTHESIS: The magnitude of risk would be highest for those reporting both types of abuse compared with those reporting 1 type or none. OBJECTIVE: To examine the independent associations between physical or sexual abuse or both and self-reported health status, mental health, and health-risk behaviors among a national school-based sample of adolescent girls. DESIGN: A secondary data analysis of a cross-sectional survey. SETTING: A nationally representative sample of 3015 girls in grades 5 through 12 from 265 public, private, and parochial schools (with an oversampling of urban schools) completed an anonymous survey conducted by the Commonwealth Fund Adolescent Health Survey. PATIENTS OR OTHER PARTICIPANTS: Girls were eligible for this study if they responded to 2 questions assessing past physical and sexual abuse. RESULTS: Among the respondents, 246 (8%) reported a history of physical abuse; 140 (5%), sexual abuse; and 160 (5%), both. Logistic regression controlling for grade, ethnicity, family structure, and socioeconomic status found that those who reported both types of abuse compared with those who did not report any were significantly more likely to experience moderate to severe depressive symptoms (adjusted odds ratio [AOR], 5.10), moderate to high levels of life stress (AOR, 3.28), regular smoking (AOR, 5.90), regular alcohol consumption (AOR, 3.76), use of other illicit drugs in the past 30 days (AOR, 3.44), and fair to poor health status (AOR, 1.74). Finally, girls who reported both types of abuse were 2.07 times more likely to report moderate to high depressive symptoms compared with those reporting only sexual abuse (95% confidence interval, 1.14-3.74). CONCLUSIONS: The magnitude of risk for adolescents reporting both types of abuse compared with no abuse is much greater than that for either abuse type alone. However, compared with both types, no significant increase in risk was detected in those reporting physical abuse only, and only depressive symptoms increased in those reporting sexual abuse only.

Adolescent↗

PubMed2004

Parent weight change as a predictor of child weight change in family-based behavioral obesity treatment.

BACKGROUND: Family-based behavioral weight control treatment involves the parent in the modification of child and parent eating and activity change. OBJECTIVE: To assess if parent standardized body mass index (z-BMI) change predicts child z-BMI change. DESIGN: Secondary data analysis based on parent and child z-BMI changes from 3 family-based, randomized, controlled weight control studies. Hierarchical regression models tested whether parent z-BMI change increased prediction of child z-BMI change through treatment and 24-month follow-up beyond other factors that influence child weight change, such as child age, sex, socioeconomic status, and baseline child and parent z-BMI. Differences in child z-BMI change as a function of quartiles of parental z-BMI change were tested using an analysis of covariance. SETTING: Pediatric obesity research clinic. PARTICIPANTS: Obese 8- to 12-year-old children and their parents from 142 families who participated in family-based weight control programs. MAIN OUTCOME MEASURES: Child and parent z-BMI changes over time. RESULTS: Parent z-BMI change significantly predicted child z-BMI change for the 0- to 6-month (P<.001) and 0- to 24-month (P <.009) time points. In hierarchical regression models, parent z-BMI change was a significant incremental predictor of child z-BMI change at 6 and 24 months, with the additional r(2) ranging from 11.6% at 6 months (P <.001) to 3.8% at 24 months (P =.02). Parents in the highest quartile of z-BMI change had children with significantly greater z-BMI change than that of children with parents in the other quartiles (P =.01). CONCLUSION: Parent z-BMI change is an independent predictor of obese child z-BMI change in family-based behavioral treatment, and youth benefit the most from parents who lose the most weight in family-based behavioral treatments.

Adult↗

PubMed2003

Laparoscopic vs open colectomy: outcomes comparison based on large nationwide databases.

HYPOTHESIS: Laparoscopic colectomy has significant advantages over open colectomy in the treatment of diverticular disease with respect to the length of hospital stay, routine hospital discharge, and postoperative morbidity and mortality. DESIGN: Retrospective secondary data analysis. PATIENTS AND SETTING: Patients with primary International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes for laparoscopic (709 patients [3.8%]) and open sigmoid resection (17 735 patients [96.2%]) were selected from the 1998, 1999, and 2000 Nationwide Inpatient Samples. These databases represent 20% stratified probability samples of all US community hospital discharges. Sampling weights were used to allow generalization of the study findings to the overall US population. Multiple linear and logistic regression analyses were performed to assess the risk-adjusted association between the surgery type and patient outcomes. MAIN OUTCOME MEASURES: Length of hospital stay, in-hospital complications, in-hospital mortality, and the rate of routine discharge. RESULTS: The patients had a mean age of 59.8 years; they were preponderantly white (89.1%) and female (54.0%). After adjusting for other covariates, laparoscopic sigmoidectomy was associated with a shorter mean hospital stay (laparoscopic sigmoidectomy vs open sigmoidectomy, 7.47 vs 9.37 days; P<.001), fewer gastrointestinal tract complications (odds ratio, 0.57; 95% confidence interval, 0.35-0.93; P =.03), a lower overall complication rate (odds ratio, 0.64; 95% confidence interval, 0.47-0.88; P =.007), and a higher routine hospital discharge rate (odds ratio, 2.21; 95% confidence interval, 1.51-3.21; P<.001). CONCLUSION: Laparoscopic sigmoid resection in patients with diverticular disease has statistically and clinically significant advantages over open sigmoid resection with respect to the length of hospital stay, rate of routine hospital discharge, and postoperative in-hospital morbidity.

Age Distribution↗

PubMed2007

Surgeon characteristics and variations in treatment for early-stage breast cancer.

HYPOTHESIS: Adherence to National Institutes of Health consensus statement recommendations for early-stage breast cancer will vary by surgeon characteristics. DESIGN: Secondary data analysis using the Surveillance, Epidemiology, and End Results national tumor registry linked with Medicare claims data. Logistic regression was used to analyze data on a cohort of 1045 surgeons who operated on 9449 Medicare patients with early-stage breast cancer. MAIN OUTCOME MEASURE: Care adherent to the 1990 National Institutes of Health consensus statement recommendations. RESULTS: Surgeon age and specialty were not associated with adherent care overall, nor among breast-conserving surgery or mastectomy subgroups. Patients of higher-volume surgeons were significantly more likely to undergo adherent care overall because of greater use of lymph node dissection among women who received either breast-conserving surgery or mastectomy. Patients of female surgeons and surgeons with a medical school affiliation were less likely to undergo adherent care overall, which was related to greater use of breast-conserving surgery and lesser use of lymph node dissection among patients who underwent breast-conserving surgery. CONCLUSIONS: Several surgeon characteristics are significantly associated with variations in breast cancer treatment received. These results warrant further investigation into the association between these surgeon characteristics and cancer care outcomes.

Aged↗

PubMed2001

Factors associated with the health care utilization of homeless persons.

CONTEXT: Homeless persons face numerous barriers to receiving health care and have high rates of illness and disability. Factors associated with health care utilization by homeless persons have not been explored from a national perspective. OBJECTIVE: To describe factors associated with use of and perceived barriers to receipt of health care among homeless persons. DESIGN AND SETTING: Secondary data analysis of the National Survey of Homeless Assistance Providers and Clients. SUBJECTS: A total of 2974 currently homeless persons interviewed through homeless assistance programs throughout the United States in October and November 1996. MAIN OUTCOME MEASURES: Self-reported use of ambulatory care services, emergency departments, and inpatient hospital services; inability to receive necessary care; and inability to comply with prescription medication in the prior year. RESULTS: Overall, 62.8% of subjects had 1 or more ambulatory care visits during the preceding year, 32.2% visited an emergency department, and 23.3% had been hospitalized. However, 24.6% reported having been unable to receive necessary medical care. Of the 1201 respondents who reported having been prescribed medication, 32.1% reported being unable to comply. After adjustment for age, sex, race/ethnicity, medical illness, mental health problems, substance abuse, and other covariates, having health insurance was associated with greater use of ambulatory care (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.19-5.42), inpatient hospitalization (OR, 2.60; 95% CI, 1.16-5.81), and lower reporting of barriers to needed care (OR, 0.37; 95% CI, 0.15-0.90) and prescription medication compliance (OR, 0.35; 95% CI, 0.14-0.85). Insurance was not associated with emergency department visits (OR, 0.90; 95% CI, 0.47-1.75). CONCLUSIONS: In this nationally representative survey, homeless persons reported high levels of barriers to needed care and used acute hospital-based care at high rates. Insurance was associated with a greater use of ambulatory care and fewer reported barriers. Provision of insurance may improve the substantial morbidity experienced by homeless persons and decrease their reliance on acute hospital-based care.

Adult↗

PubMed2006

Evaluating the comparability of gene expression in blood and brain.

The availability of an accessible tissue whose gene expression profile is similar to more inaccessible CNS tissues has the potential to advance research in neuropsychiatric disorders. We conducted secondary data analysis of transcriptional profiling of 79 human tissues for 33,698 genes using the Affymetrix U133A microarray augmented with a custom microarray (Affymetrix GNF1H), which were produced by the Genomics Institute of the Novartis Research Foundation (http://symatlas.gnf.org). Our analyses suggested that: (a) on a transcriptome level, whole blood shares significant gene expression similarities with multiple CNS tissues; (b) the median non-parametric correlation between transcripts present in both whole blood and CNS was around 0.5; (c) this correlation of 0.5 was intermediate relative to all tissues in the Novartis data set--less than for the maximum achievable value of 0.85, less than a set of immune tissues (0.64), comparable to a heterogeneous set of somatic tissues (0.57) but greater than muscle (0.48) and peripheral nervous system tissues (0.36); (d) about half of a set of candidate genes relevant to schizophrenia were expressed in both whole blood and prefrontal cortex; and (e) the expression levels of many classes of biologically relevant processes were not significantly different between whole blood and prefrontal cortex. These analyses suggest that gene expression in whole blood is neither perfectly correlated and useful nor perfectly uncorrelated and useless with gene expression in multiple brain tissues. This suggests that the cautious and thoughtful use of peripheral gene expression may be a useful surrogate for gene expression in the CNS when it has been determined that the relevant gene is expressed in both.

Brain↗

PubMed1998

Predictors of functional disability in patients with rheumatoid arthritis.

OBJECTIVE: Using the World Health Organization's classification system of the consequences of disease, this study sought to examine the impact of physical and psychological impairment variables, beyond that contributed by social, demographic, and disease variables, on the functional disability of a rheumatoid arthritis (RA) sample. Data collected during an acute episode were used to predict concurrent and future disability status. METHOD: A secondary data analysis of 85 adults hospitalized for exacerbations in arthritis was undertaken. Disability was assessed with the Health Assessment Questionnaire. Physical impairment was measured with the Keitel Function Test and Pain Analog Scales, and psychological impairment was measured with the Center for Epidemiologic Studies Depression Scale and the Perceived Self-Efficacy Scale for People with Arthritis. RESULTS: Our findings indicated that physical impairment, demographic, and disease variables accounted for 64% of the explained variance in disability during the concurrent episode. Psychological impairment as well as demographic and disease variables accounted for 49% of the explained variance in future disability status. CONCLUSION: The combined influence of demographic characteristics and the consequences of the pathology of RA experienced as physical and psychological impairments contributed differentially to disability during concurrent and future time periods.

Activities of Daily Living↗

PubMed2006

Evaluation of the Texas Birth Defects Registry: an active surveillance system.

BACKGROUND: Evaluations of surveillance systems are necessary to determine if the goals of the system are being met, how efficiently the surveillance is being implemented, and if resources are being used appropriately. An evaluation of the Texas Birth Defects Registry was conducted to assess the overall quality of data collection and to examine variations across regions of the state. METHODS: The registry was evaluated by using published guidelines for evaluating public health surveillance systems; the evaluation included staff interviews, process observation, and secondary data analysis. RESULTS: The registry monitors >370,000 births/year through active surveillance, with considerable disparities in workload across regions of the state. Because of the geographic size and substantial population of Texas, data collection is complex. However, the estimated sensitivity of the system appears sufficient, and rates for selected defects are highly comparable with other U.S. active birth-defect surveillance systems. Registry staff continually monitor the quality of data collection and provide additional training. Amid unstable funding, the registry staff have demonstrated optimal foresight and flexibility to adapt and continue quality data collection. Timeliness needs to be improved and more consistent quality assurance is needed across regions of the state. Retaining staff and increasing visibility are essential to providing more stability. CONCLUSIONS: Active surveillance for birth defects is labor-intensive but provides invaluable data for its stakeholders. The Texas Birth Defects Registry has proven to be a quality surveillance system and a beneficial resource for Texas.

Congenital Abnormalities↗

PubMed2001

Self-report quality of life as a predictor of hospitalization for patients with LV dysfunction: a life course approach.

For this secondary data analysis of a large clinical drug study, researchers investigated the independent prognostic utility of self-report quality-of-life measures versus clinical measures for assessing patient risk for heart-failure-related hospitalization. The experience of heart failure varies over the life course; hence, four age groups were investigated. Quality-of-life measures, specifically health-related quality-of-life and psychosocial quality-of-life measures, were found to be independent and significant predictors of heart-failure-related hospitalizations, as compared to traditional clinical indicators. In addition, the psychosocial quality-of-life measure varied by age group in its importance as a predictor of hospitalization, suggesting differential relevance over the life course. Specifically, psychosocial quality of life was most strongly predictive of hospitalization for those ages 21-44, was less predictive for those ages 45-54, and was nonsignificant for those 55-64 years of age and those 65 and over. Including self-report quality-of-life measures provides a more complete picture of the factors associated with risk of hospitalization at different points in the life course for individuals with heart failure. These findings suggest that researchers and practitioners could use self-report quality-of-life measures as additional prognostic indicators of a patient's condition and risk for heart-failure-related hospitalization, especially for younger patients.

Activities of Daily Living↗

PubMed2005

Relationship of age, injury severity, injury type, comorbid conditions, level of care, and survival among older motor vehicle trauma patients.

The purpose of this secondary data analysis was to compare age, injury severity, injury types, selected comorbidities, level of care (at trauma center [TC] and non-trauma center [NTC] hospitals), and survival among older motor vehicle trauma patients (N = 1,478). Patients admitted to both levels of care had similar comorbid conditions. TC patients had a higher injury severity, whereas NTC patients had a greater proportion of soft tissue injuries. Results of logistic regression analyses subsequent to group comparisons revealed that higher injury severity was associated with TC admission. The likelihood of TC admission of severely injured patients decreased in the presence of spinal, internal, and head injuries. Internal injuries, liver, renal, and cardiovascular diseases were associated with non-survival while hypertension was associated with survival. Special attention is needed when triaging older trauma patients because their injuries may be covert, thus putting them at risk for admission to a level of care that may be inappropriate given the extent of their injuries.

Accidents, Traffic↗

PubMed2006

Organizational correlates of the risk-adjusted pressure ulcer prevalence and subsequent survey deficiency citation in California nursing homes.

Organizational correlates of the risk-adjusted pressure ulcer prevalence and subsequent deficiency citation in nursing homes are not known. The purpose of this study was to examine the relationships between these two outcomes and selected organizational variables, including total nurse staffing levels, specialization, centralization, nursing wages, and facility ownership. Secondary data analysis was conducted on a sample of 897 California nursing homes included in the 1996 On-line Survey Certification and Reporting system and the Office of Statewide Health Planning and Development financial disclosure reports of individual California nursing homes. Organizational variables explained a small amount of the variation (adjusted R2 = .04, p < .01). A higher PU prevalence was associated with lower licensed nurse centralization and facilities participating exclusively in the Medicaid program. Receipt of a deficiency was less likely in facilities having a higher total nurse staffing level (OR = .49, p < .001). It was more likely in facilities having a higher risk-adjusted PU prevalence (OR = 1.05, p < .001), more licensed nurses (OR = 2.74, p < .05), a size of 160 beds or more (OR = 1.93, p < .01), and survey teams from specific counties (OR ranging from 2.3 to 6.8, p < .05).

California↗

PubMed2006

Fatigue representations in women with heart failure.

Self-care management of symptoms for persons with heart failure (HF) may only be successful when their representations regarding their symptoms are accurate and linked to appropriate behavioral strategies. The purpose of this secondary data analysis (N = 169 women with HF) was to describe representations of one HF-related symptom, fatigue, and examine whether representations were related to physical health status, health care utilization, and psychological well-being and whether they differed by age. Overall, women agreed that fatigue was chronic, caused by HF, and had serious consequences. Midlife women reported more emotional distress and severe consequences from fatigue than older women. Higher levels of emotional distress due to fatigue from HF were associated with higher levels of health care utilization.

Adult↗

PubMed1984

Empirical test of the interaction model of client health behavior.

The general concepts, variables, and relationships described by the Interaction Model of Client Health Behavior (IMCHB) were used to guide a secondary data analysis of 203 women's decisions to request an amniocentesis. Step-wise multiple regression explained 58% of the variance in these decisions by jointly examining the factors which define the client as unique in her responses to an at-risk pregnancy, as well as factors describing the client-provider interaction. The women could be correctly classified as users or nonusers of prenatal diagnosis with 87% accuracy in a discriminant analysis based on the variables derived from the conceptual model. Finally, structural equation modeling was used to estimate the causal paths described by the general model. While the relationships proposed in the model need further empirical evaluation, this first application serves to demonstrate the testability of the IMCHB and its potential to direct nursing inquiries.

Adult↗

PubMed1991

Risk factors for urinary incontinence one year after nursing home admission.

Secondary data analysis was conducted from a longitudinal nursing home study to identify nonurologic risk factors for continence outcomes at 1 year after admission. Of 434 nursing home admissions, 196 subjects (45%) remained. At 1 year prevalence of incontinence was 43.8%. Age was not associated with prevalence or incidence. Risk factors identified were of male gender, urinary incontinence and poor behavioral adjustment at 2 weeks, presence of dementia and impaired mobility at 2 months. Once established, incontinence tended to persist. The data suggest types of residents who might be targeted for early preventive intervention.

Activities of Daily Living↗

PubMed1985

Community integration of the mentally ill in residential facilities.

Much of the empirical research on the social adjustment of the mentally ill has focused on client variables. More recently, recognition of environmental factors as influences on behavior has led to attempts to determine environmental factors that may play a role in former mental patients' community integration. The secondary data analysis of 87 former state hospital patients in residential facilities suggests that while client characteristics are important in explaining community integration, facility, and community characteristics, particularly the level of skills training offered in the facility, size of city, and level of depersonalization of residents, have a significant impact. Results indicating the major importance of informal interactions between staff and clients are discussed, with implications for facility staff noted.

Activities of Daily Living↗