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Biomedical subjects

James S Goodwin

Publications and source records attributed to James S Goodwin.

63 records · Page 4Linked to original sources
PubMed2002

Survival of women after breast conserving surgery for early stage breast cancer.

BACKGROUND: Increasing numbers of older women with breast cancer are receiving breast-conserving surgery (BCS). However, substantial numbers of them are not receiving either axillary dissection or adjuvant irradiation. OBJECTIVE: To determine whether failure to perform axillary dissection or irradiation is associated with decreased survival in women with early-stage breast cancer. METHOD: We studied 26,290 women aged > or = 25 in 1988-1993 from the surveillance, epidemiology, and end results (SEER) data and 5,328 women aged > or = 65 in 1991-1993 from SEER-Medicare linked data, who had early-stage breast cancer and received BCS. RESULTS: Twenty seven percent of women aged > or = 25 receiving BCS did not receive axillary dissection, most of whom (74%) were age > or = 65. Women receiving BCS with axillary dissection had lower 7-year breast cancer-specific mortality than did those without dissection (hazard ratio = 0.53, 95% confidence interval: 0.44-0.63). We found an interaction between receipt of axillary dissection and radiotherapy on survival of older women after BCS. Women who received either axillary dissection or radiotherapy experienced similar survivals to those who received both axillary dissection and radiation, while women who received neither treatment experienced poorer survival (hazard ratio = 1.76, 1.23-2.52), after controlling for demographics, tumor size and comorbidity. CONCLUSIONS: Women who receive neither axillary dissection nor radiation therapy after BCS experience an increased risk of death from breast cancer. The lack of improvement in the past two decades in survival of older women with breast cancer may be explained in part by the increasing use of treatments that do not address potential tumor in axillary nodes.

Adult↗
PubMed2002

Differential effects of premorbid physical and emotional health on recovery from acute events.

OBJECTIVES: Emotional health may have an important effect on disease onset, but there has been little work evaluating premorbid emotional health on recovery from disability that results from acute medical events. The aim of this study is to determine whether premorbid emotional health is predictive of recovery in functional ability 1 year after reporting a stroke, heart attack, or hip fracture (event). DESIGN: A prospective cohort study of an older population-based sample from 1986 to 1992. SETTING: Data are from baseline and six annual follow-ups of the North Carolina Established Population for Epidemiological Study of the Elderly. PARTICIPANTS: Two hundred forty whites and blacks aged 65 and older who reported a stroke, heart attack, or hip fracture during one of the first five follow-up interviews and had an increased level of disability at that follow-up. MEASUREMENT: Improvement in disability in activities of daily living (ADLs) 1 year postevent. RESULTS: High depressive symptoms at baseline showed a significant association with poorer recovery in functional ability 1-year postevent after adjustments were made for sociodemographic characteristics, smoking status, ADLs at time of event, cognitive status, and prior history of disease. Compared with nondepressed subjects, depressed subjects had an odds ratio (OR) of 0.38 (95% confidence interval (CI) = 0.16-0.94) for recovery 1 year after reporting a stroke, heart attack, or hip fracture. Additionally, among subjects who reported low depressive symptoms, high positive affect was significantly associated with increased odds of recovery (OR = 2.70, 95% CI = 1.10-6.68), adjusting for the same variables. CONCLUSIONS: Emotional health, independent of other baseline measures, is associated with recovery in functional ability 1 year after a major health event. Our findings suggest that reducing premorbid levels of depressive symptoms or increasing positive affect may help the recovery process.

Activities of Daily Living↗
PubMed2002

Developing a geriatric business plan for an academic medical center.

Leaders of geriatric programs at academic health centers (AHCs) face several challenges in seeking support for clinical program development. These challenges relate to how revenues from Medicare activities flow within AHCs. Typically, clinical departments such as the Department of Medicine see a very small proportion of total AHC Medicare revenue and frequently experience losses on their Medicare activities. In contrast, hospitals in AHCs see the bulk of the revenues and typically experience substantial profits. This article examines this situation in some detail, with specific examples from AHCs with which the author has consulted.The unique effect of Medicare revenue on AHCs requires the geriatric leader to identify who gains and who loses from Medicare activity within his or her AHC and to seek support for geriatric programs based on that analysis.

Academic Medical Centers↗
PubMed2002

Handgrip strength and mortality in older Mexican Americans.

OBJECTIVES: To examine the association between handgrip strength and mortality in older Mexican American men and women. DESIGN: A 5-year prospective cohort study. SETTING: Five southwestern states: Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS: A population-based sample of 2,488 noninstitutionalized Mexican-American men and women aged 65 and older. MEASUREMENTS: Maximal handgrip strength, timed walk, and body mass index were assessed at baseline during 1993/94. Self-reports of functional disability, various medical conditions, and status at follow-up were obtained. RESULTS: Of the baseline sample with complete data, 507 persons were confirmed deceased 5 years later. Average handgrip strength +/- standard deviation was significantly higher in men (28.4 kg +/- 9.5) than in women (18.2g +/- 6.5). Of men who had a handgrip strength less than 22.01 kg and women who had a handgrip strength less than 14 kg, 38.2% and 41.5%, respectively, were dead 5 years later. In men in the lowest handgrip strength quartile, the hazard ratio of death was 2.10 (95% confidence interval (CI) = 1.31-3.38) compared with those in the highest handgrip strength quartile, after controlling for sociodemographic variables, functional disability, timed walk, medical conditions, body mass index, and smoking status at baseline. In women in the lowest handgrip strength quartile, the hazard ratio of death was 1.76 (95%I = 1.05-2.93) compared with those in the highest handgrip strength quartile. Poorer performance in the timed walk and the presence of diabetes mellitus, hypertension, and cancer were also significant predictors of mortality 5 years later. CONCLUSION: Handgrip strength is a strong predictor of mortality in older Mexican Americans, after controlling for relevant risk factors.

Aged↗
PubMed2002

Diabetes mellitus as a risk factor for hip fracture in mexican american older adults.

BACKGROUND: Hip fracture in older adults is a significant medical, social, and economic concern to society. Little is known regarding diabetes as a risk factor for hip fracture in the Mexican American population. The objective of this study was to examine diabetes and other potential risk factors for hip fracture in a sample of community-dwelling, older, Mexican American adults. METHODS: The study was a prospective cohort design involving the Hispanic Established Population for the Epidemiologic Study of the Elderly, a longitudinal study involving a weighted probability sample of Mexican American adults (>65 years) living in the southwestern United States. Included in the study were 3050 older Mexican American subjects who were originally interviewed and tested at baseline and then followed with reassessment at 2, 5, and 7 years. Incidence of hip fracture was examined for subjects over 7-year follow-up. RESULTS: At baseline, 690 subjects were identified with diabetes. One hundred and thirty-four subjects experienced a first-time hip fracture during follow-up. Cox proportional hazard regression revealed an increased hazard ratio for hip fracture in subjects with diabetes compared to those without diabetes (hazard ratio = 1.57, 95% confidence interval [CI(95)] = 1.03, 2.39, p <.04) when adjusted for age, body mass index, smoking, and previous stroke. The hazard ratio for Mexican Americans taking insulin was 2.84 (CI(95) = 1.49, 5.43, p <.002) when adjusted for covariates. CONCLUSIONS: We found diabetes was associated with increased risk for a hip fracture in older Mexican Americans, particularly subjects taking insulin. Diabetes has not previously been considered a risk factor for hip fracture in older adults. The high incidence of type 2 diabetes in the Mexican American population highlights the need for increased research on risk factors in this ethnic group.

Age Factors↗
PubMed2002

The interaction of cognitive and emotional status on subsequent physical functioning in older mexican americans: findings from the Hispanic established population for the epidemiologic study of the elderly.

BACKGROUND: Optimal mental health (cognitive and emotional functioning) is an important factor for maintaining physical function. This study investigated the effects of cognitive and emotional status on subsequent lower body function in a population-based sample of older Mexican Americans. METHODS: A 2-year prospective cohort study included Mexican Americans aged 65 and older who scored 18 or higher on the Mini-Mental State Examination (MMSE) at baseline interview and for whom complete data on a summary performance measure of lower body function were available at the 2-year follow-up interview (n = 2068). In-home interviews in 1993-1994 and 1995-1996 assessed sociodemographic variables, physical health conditions, cognitive function, emotional health, and lower body function. RESULTS: In a multivariate analysis, continuous MMSE (b = 0.06; SE 0.02, p =.004) and Center for Epidemiological Studies-Depression (CES-D) (b = -0.53; SE 0.17, p =.002) scores at baseline were significantly associated with a summary performance measure of lower body function 2 years later, controlling for age, gender, marital status, education, selected medical conditions, and baseline summary performance score. A significant MMSE-by-CES-D interaction (p =.002) on summary performance score was also found after adjustments were made for age, gender, marital status, education, chronic health conditions, and baseline summary performance score. After adjusting for age, gender, marital status, education, selected medical conditions, and baseline summary performance score, subjects with low cognition (MMSE score 18-21) and high depressive symptoms (CES-D score > or = 16) were the most likely to have poor summary performance scores 2 years later (b = -0.95, SE 0.36, p =.008), followed by subjects with high cognition (MMSE score > 21) and high depressive symptoms (CES-D score > or = 16) (b = -0.57, SE 0.19, p =.003), and those with low cognition (MMSE score 18-21) and low depressive symptoms (CES-D score < 16) (b = -0.47, SE 0.22, p =.03), with high cognition (MMSE score > 21) and low depressive symptoms (CES-D score < 16) used as the reference. CONCLUSIONS: Our results confirm prior investigations showing both cognitive function and emotional health predict subsequent lower body function, and extend these findings to older Mexican Americans. In addition, our results indicate that good emotional health moderates the impact of low cognition on subsequent physical function.

Age Factors↗
PubMed2002

Geographic variations in breast cancer survival among older women: implications for quality of breast cancer care.

BACKGROUND: Breast cancer care, such as utilization of screening procedures and types of treatment received, varies substantially by geographic region of the United States. However, little is known about variations in survival with breast cancer. METHODS: We examined breast cancer incidence, survival, and mortality in the 66 health service areas covered by the Surveillance, Epidemiology, and End Results (SEER) program for women aged 65 and older at diagnosis. Incidence and survival data were derived from SEER, while breast cancer mortality data were from Vital Statistics data. RESULTS: There was considerable variation in breast cancer survival among the 66 health service areas (chi2 = 202.7, p <.0001). There was also significant variation in incidence and mortality from breast cancer. In a partial correlation weighted for the size of the health service area, both incidence (r =.812) and percent 5-year survival (r = -.587) correlate with mortality. In a Poisson regression analysis, the combination of variation in incidence and variation in survival explains 90.9% of the variation in mortality. CONCLUSIONS: There is considerable geographic variation in survival from breast cancer among older women, and this contributes to variation in breast cancer mortality. Geographic variations in breast cancer mortality should diminish as the quality of breast cancer care becomes more standardized.

Aged↗
PubMed2002

Using Medicare data to estimate the prevalence of breast cancer screening in older women: comparison of different methods to identify screening mammograms.

OBJECTIVES: To compare different methods for defining screening mammograms with Medicare claims and their impact on estimates of breast cancer screening rates. METHODS: Medicare outpatient facility and physician claims for 61,962 women in 1993 and 59,652 women in 1998 were reviewed for evidence of receipt of screening mammography. We compared the estimates of screening mammography use derived from CPT (Current Procedure Terminology) codes to categorize mammograms as screening or diagnostic versus using an algorithm that uses CPT codes plus breast-related diagnoses in the prior two years. We also compared estimates obtained from review of physician claims alone, facility claims alone, or the combination of the two sources of claims. RESULTS: Use of physician claims alone produced estimates of screening rates similar to rates calculated from use of both physician and outpatient (facility) claims. In 1993, the CPT code for screening mammography underestimated the rate of screening compared to estimates generated by using the algorithm (8.3 percent versus 18.0 percent prevalence, p<0.001). By 1998, the screening prevalence rate generated from using the CPT code for screening mammography more closely approximated the rate generated by the algorithm (23.0 percent versus 25.1 percent). By all methods of estimating screening mammography with Medicare claims, its prevalence increased substantially between 1993 and 1998. CONCLUSION: Providers increased their use of the screening mammography code in their charges to Medicare during the 1990s. This has improved the claims' ability to distinguish screening from diagnostic mammograms, but screening rates computed with claims continue to fall below those generated from self-reports of mammography use among general populations of older women.

Aged↗