Biomedical subjects

John Concato

Publications and source records attributed to John Concato.

45 records · Page 3Linked to original sources

PubMed2002

Thrombolysis for acute stroke in routine clinical practice.

BACKGROUND: Studies have demonstrated that thrombolytic therapy for acute stroke can be given safely and effectively in study settings with experienced clinicians, but the patient outcomes associated with thrombolytic therapy in routine clinical practice require investigation. OBJECTIVES: To compare outcomes among patients given intravenous thrombolysis in routine clinical practice with the results of the National Institute of Neurological Disorders and Stroke rt-PA Study (NINDS cohort) and to examine whether protocol deviations are associated with adverse events. METHODS: Retrospective cohort of community-based patients given thrombolysis for acute stroke from May 1, 1996, through December 31, 1998, in 16 Connecticut hospitals (Connecticut cohort). RESULTS: Forty-two (67%) of 63 patients in the Connecticut cohort had at least 1 major protocol deviation, and 61 (97%) had major or minor protocol deviations. Overall, the in-hospital mortality was higher in the Connecticut cohort (16/63 [25%]) compared with the NINDS cohort (40/312 [13%]; P =.01). The serious extracranial hemorrhage rate was also higher for the Connecticut cohort (8/63 [13%] vs 5/312 [2%]; P =.001). Patients in the Connecticut cohort without major protocol deviations had outcomes similar to those in the NINDS cohort; however, patients in the Connecticut cohort with major protocol deviations had higher rates of in-hospital mortality (13/42 [31%] vs 40/312 [13%]; P =.002) and serious extracranial hemorrhage (7/42 [17%] vs 5/312 [2%]; P =.001). CONCLUSIONS: Protocol deviations occur commonly when thrombolytic therapy is given to stroke patients in routine clinical practice. Patients who receive thrombolysis with major protocol deviations have higher rates of in-hospital mortality and serious extracranial hemorrhage than patients in the NINDS cohort.

Adult↗

PubMed2002

Patient preferences for treatment of lupus nephritis.

OBJECTIVE: To examine the amount of improvement in renal survival that lupus patients require before choosing cyclophosphamide over azathioprine for the treatment of lupus nephritis. METHODS: Patients were presented with descriptions of cyclophosphamide and azathioprine and asked to indicate their preferred choice if each conferred an equal probability of renal survival. Strength of preference was assessed by systematically increasing the probability of renal survival of the more toxic treatment until the respondent's choice switched. RESULTS: Ninety-three well-educated women (mean age +/- SD 40 +/- 7 years) participated in the study. Ninety-eight percent (91/93) of the participants chose azathioprine over cyclophosphamide when both drugs conferred an equal probability of renal survival. Although most subjects switched preferences to cyclophosphamide for better renal survival, 31% (28/91) were unwilling to switch from azathioprine to cyclophosphamide for improved short-term renal survival, and 15% (14/91) were unwilling to switch from azathioprine to cyclophosphamide for improved long-term renal survival. CONCLUSION: Although the majority of patients switched preferences to cyclophosphamide for better renal survival, a substantial minority was unwilling to accept the toxicity associated with cyclophosphamide, even if it was much better than azathioprine at preventing renal failure.

Adolescent↗

PubMed2002

Do women prefer female obstetricians?

OBJECTIVE: To investigate gender preferences for obstetricians in a hospital setting and to examine its relationship to patient satisfaction. METHODS: Using methods of qualitative analysis, we interviewed a convenience sample of 67 obstetric patients during their postpartum hospital stay, asking open-ended questions about gender preferences of health care providers and satisfaction with health care. RESULTS: Overall, 58% of patients (n = 39) had no preference for physician gender, 34% (n = 23) preferred female physicians, and 7% (n = 5) preferred male physicians. Physicians' interpersonal style, communication style, and technical expertise were considered important characteristics by patients. Although most patients had no preference for physician gender, the majority of patients preferred a female nurse. Patient satisfaction scores were not associated with physician gender. CONCLUSION: Our study found that a majority of women did not prefer a female obstetrician. Our results suggest that physician gender is less important to patients than other physician characteristics.

Adolescent↗

PubMed2002

Stressful life events among community-living older persons.

OBJECTIVES: To identify the life events that older persons experience as most stressful, to evaluate older persons' perceptions of the consequences of these stressful events for their lives, and to evaluate the relationship of demographic factors and measures of health and functional status to these perceptions. DESIGN: Cross-sectional study. PARTICIPANTS: Seven hundred fifty-four community-living persons aged 70 years or older. MEASURES: During a comprehensive assessment, participants identified the most stressful event that they had experienced in the past 5 years and, subsequently, rated its stressfulness and perceived consequences. RESULTS: Six hundred three participants (80%) identified a stressful life event. Of these, 18% identified a personal illness, 42% the death of a family member or friend, 23% the illness of a family member or friend, and 17% a nonmedical event. Although participants consistently rated their events as highly stressful, they reported widely varied consequences of these events for their lives. While 27% to 59% of participants across the 4 event types reported considerable negative consequences, 17% to 36% reported positive consequences such as starting new activities that have become important to them and changing for the better how they feel about their lives. Dependence in instrumental activities of daily living and depressive symptoms were independently associated with several negative perceived consequences. CONCLUSIONS: Older persons experience a wide array of stressful life events, with only a small minority reporting personal illnesses as the most stressful. Similar stressful events can have either negative or positive consequences for older persons' lives. This variation in response to stressful events among older persons may indicate different degrees of resilience, a potentially important factor underlying successful aging that deserves further investigation.

Adaptation, Psychological↗

PubMed2002

Use of alcohol, illicit drugs, and tobacco among characters on prime-time television.

Previous research of addictive substances suggests that use of alcohol, illicit drugs, and tobacco is overrepresented on prime-time television (TV). These studies, however, have relied on frequency counts of the substance, rather than the prevalence of use among characters. Therefore, the objectives of this study were to compare the prevalence of alcohol, illicit drug, and tobacco users among characters on prime-time TV during 1995 and 1996 with rates of use in the United States. In addition, we determined if the ratio of male to female, young to old, and white to minority addictive substance users on prime-time TV were similar to the equivalent U.S. ratios. Comparing results for prime-time TV characters versus the U.S. population (respectively), 11.0% (99% CI, 9.8-12.1) drank alcohol versus 51.0%; 0.8% (99% CI, 0.5-1.1) used illicit drugs versus 6.1%; and 2.5% (99% CI, 2.0-3.1) smoked tobacco versus 28.9%. In addition, no consistent pattern was evident in our analyses that assessed whether addictive substance users on prime-time TV were more frequently represented as men, young, or minority compared to the similar U.S. ratio. These results indicate that contrary to prevailing beliefs, alcohol, illicit drug, and tobacco users are uncommon on prime-time TV and are less prevalent than in the U.S. population.

Adolescent↗

PubMed2002

The health-related effects of alcohol use in older persons: a systematic review.

Increased alcohol consumption is associated with substantial morbidity and mortality in young and middle-aged adult populations, but its effects on the health of older adults have received less attention. The objective of the study was to review published studies that assessed the effects of alcohol on falls or fall injuries, functional impairment, cognitive impairment, and all-cause mortality among older adults. MEDLINE database and bibliographies of selected citations were searched for English language studies published between 1966 and 1998 that examined the relationship between alcohol and one or more of the above outcomes. Also a study was analyzed if it included participants 60 years of age or older, or a broader age range of participants and reported results for older subgroups, or predominantly older participants as evidenced by a mean age of 65 years of age or above. Information on studies' sample sizes, exposure and outcome measures, and risk estimates were extracted, and articles were evaluated for methodologic quality using predetermined criteria. Eighty-four studies were identified that examined 91 potential exposure-outcome associations including falls or fall injuries (n = 26); functional impairment (n = 13); cognitive impairment (n = 32); and all-cause mortality (n = 20). The percentage of studies demonstrating harm, no association, or benefit by outcome included falls (15% vs. 81% vs. 4%); functional disability (38% vs. 46% vs. 16%); cognitive impairment (31% vs. 66% vs. 3%); and all-cause mortality (15% vs. 65% vs. 20%). Studies (n = 84) inconsistently adhered to methodologic standards. Although 90% provided eligibility criteria; 61% cited participation rates; and 73% described the methods used to measure alcohol exposure; only 44% adjusted for potentially important confounding factors; and 26% distinguished former drinkers from nondrinkers. Of the cohort studies (n = 47), 30% assessed for change in participants' exposure status over time, and 17% determined whether losses to follow-up varied by exposure status. The magnitude of risk posed by alcohol use for falls or fall injuries, functional disability, cognitive impairment, and all-cause mortality among older adults remains uncertain. Prospective studies are needed to better define the health-related effects of alcohol use in older populations.

Aged↗

PubMed2002

Pain-related disability among older male veterans receiving primary care.

BACKGROUND: Pain is common among older persons and is associated with substantial disability, but factors that increase the risk for pain-related disability remain poorly defined. We sought to identify factors associated with disability due to pain in a sample of older veterans receiving primary care. METHODS: Participants (N = 494) in this cross-sectional study included male veterans aged 65 years and older who were enrolled in a Veterans Affairs primary care clinic and who reported pain within the prior 12 months. Candidate factors included demographic, psychological, medical, and pain (e.g., intensity, site, duration) characteristics and were ascertained during face-to-face interviews. We assessed participants' level of pain-related disability by asking them to rate on a 0 to 10 scale the extent to which pain interfered with their ability to do daily activities (0 = no interference at all and 10 = no longer doing daily activities due to pain). Patients with scores of 0, 1-6, and 7-10 (approximate upper quartile) were classified as having no, low/moderate, and high pain-related disability. RESULTS: The distribution of pain-related disability was none = 149 (30%), low/moderate = 210 (43%), and high = 135 (27%). Factors associated with high (vs no) pain-related disability included the presence of depressive symptoms, defined as a score of 16 or greater on the Center for Epidemiologic Studies-Depression scale (adjusted odds ratio [AOR] = 3.12, 95% confidence interval [CI] = 1.42-6.85), and pain intensity, defined as a one-unit increase on a 0-10 numeric rating scale (AOR = 1.84, 95% CI = 1.61-2.12). Other factors associated with high pain-related disability included the presence of pain on most days of every month (AOR = 3.59, 95% CI = 1.82-7.08) and low back pain (AOR = 2.36, 95% CI = 1.13-4.94). Depressive symptoms, pain intensity, and the presence of pain on most days of every month were also significantly and independently associated with low/moderate (vs no) pain-related disability. CONCLUSIONS: Pain-related disability is common among older male veterans receiving primary care. As modifiable factors, depressive symptoms and pain intensity are associated with pain-related disability and represent appropriate targets for intervention efforts among older persons with pain.

Activities of Daily Living↗

PubMed2002

How good is the evidence linking breastfeeding and intelligence?

BACKGROUND: We conducted a critical review of the many studies that have tried to determine whether breastfeeding has a beneficial effect on intellect. DESIGN/METHODS: By searching Medline and the references of selected articles, we identified publications that evaluated the association between breastfeeding and cognitive outcomes. We then appraised and described each study according to 8 principles of clinical epidemiology: 1) study design, 2) target population: whether full-term infants were studied, 3) sample size, 4) collection of feeding data: whether studies met 4 standards of quality- suitable definition and duration of breastfeeding, and appropriate timing and source of feeding data, 5) control of susceptibility bias: whether studies controlled for socioeconomic status and stimulation of the child, 6) blinding: whether observers of the outcome were blind to feeding status, 7) outcome: whether a standardized individual test of general intelligence at an age older than 2 years was used, and 8) format of results: whether studies reported an effect size or some other strategy to interpret the clinical impact of results. RESULTS: We identified 40 pertinent publications from 1929 to February 2001. Twenty-seven (68%) concluded that breastfeeding promotes intelligence. Many studies, however, had methodological flaws. Only 2 papers studied full-term infants and met all 4 standards of high-quality feeding data, controlled for 2 critical confounders, reported blinding, used an appropriate test, and allowed the reader to interpret the clinical significance of the findings with an effect size. Of these 2, 1 study concluded that the effect of breastfeeding on intellect was significant, and the other did not. CONCLUSION: Although the majority of studies concluded that breastfeeding promotes intelligence, the evidence from higher quality studies is less persuasive.

Adolescent↗

PubMedDate not supplied

Measuring alcohol consumption among older adults: a comparison of available methods.

We determined levels of agreement and concordance between five alcohol measures among older veterans from a VA primary care clinic (N=303) and community-dwelling Medicare beneficiaries (N=511). The individuals recruited for the study had not been previously identified for alcohol use. Quantity-frequency questions, a binge drinking question, the Alcohol Use Disorders Identification Test, CAGE, and questions on lifetime consumption were administered to all current drinkers. To assess agreement between the measures, we conducted pairwise comparisons (eg, QF vs. CAGE) by determining the percentage of participants who screened positive on both measures and calculated kappa values to determine concordance. Only modest levels of agreement and concordance were found between the measures. The use of any individual measure may fail to detect many older adults with important alcohol exposures. Until optimal methods for measuring alcohol exposures in elderly adults are defined, we suggest that a combination of measures be used when obtaining alcohol histories in older persons.

Aged↗