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Biomedical subjects

S Ebrahim

Publications and source records attributed to S Ebrahim.

At least 145 records · Page 8Linked to original sources
PubMed1999

The 'number need to treat': does it help clinical decision making?

The number needed to treat (NNT) is an increasingly popular way of presenting the effects of treatment. However, the NNT varies markedly depending on the baseline risk of patients, the outcome considered, and the clinical setting. Furthermore geographic and secular trends make the NNT unstable between places and over time. Particular caution is needed in deriving the NNT from pooled absolute risk differences in meta-analysis. In general, the NNT should be calculated by applying the relative risk reduction on treatment estimated by trials or meta-analysis to populations of specified absolute high, average or low risk to illustrate a range of possible NNTs.

Antihypertensive Agents↗
PubMed1999

Observing the process of care: a stroke unit, elderly care unit and general medical ward compared.

BACKGROUND AND PURPOSE: Patients on stroke units have better outcomes but it is not known why. We investigated the process of care on a stroke unit, an elderly care unit and a general medical ward. METHODS: Comparison of the three settings was by non-participant observation of 12 patients in each. Data were analysed using multi-level modelling methods. RESULTS: Stroke unit patients spent more time out of bed and out of their bay or room, and had more opportunities for independence than patients on the medical ward. There were more observed attempts on the stroke unit than on the general medical ward to interact with drowsy, cognitively- or speech-impaired patients. Stroke unit patients spent more time with visitors. Most of these aspects of care were also found on the elderly care unit, where patients also spent less time asleep or 'disengaged', more time interacting with nurses, and were given appropriate help more often than those elsewhere. Stroke unit patients received less eye contact, were ignored and treated in a dehumanizing way more frequently and had more negative interactions or activities than those elsewhere. CONCLUSIONS: We have identified some aspects of the process of care which may help explain the improved outcomes on stroke units. These aspects were also observed in the elderly care unit.

Adult↗
PubMed1999

Stroke in the very old : clinical presentation and determinants of 3-month functional outcome: A European perspective. European BIOMED Study of Stroke Care Group.

BACKGROUND AND PURPOSE: The oldest old represent the fastest-growing segment of the elderly population in developed countries. Knowledge of age-specific aspects of stroke is essential to establish diagnostic and therapeutic pathways and to set up prevention and rehabilitation programs. We sought to evaluate stroke features and functional outcome in patients aged >/=80 years compared with the younger age groups. METHODS: In a European Union Concerted Action involving 7 countries, 4499 patients hospitalized for first-in-a-lifetime stroke were evaluated for demographics, risk factors, clinical presentation, resource use, and 3-month disability (Barthel Index) and handicap (Rankin Scale). RESULTS: Overall, 3141 patients (69.8%) were aged <80 years, and 1358 (30.2%) were aged >/=80 years. At baseline, female sex, prestroke institutionalization, and a worse prestroke Rankin score were significantly more frequent in the older patients, as were coma, paralysis, swallowing problems, and urinary incontinence in the acute phase (all P values <0.001). Brain imaging and other diagnostic tools were significantly less used in the older patients. Paralysis, swallowing problems, and incontinence during hospitalization independently predicted 3-month disability or handicap in both groups. For the older patients, prestroke institutionalization proved a further strong and independent determinant of 3-month disability (odds ratio, 2.33; 95% CI, 1.22 to 4.45) and handicap (odds ratio, 7.04; 95% CI, 1.62 to 30. 69). CONCLUSIONS: In the very old, both medical and sociodemographic factors may significantly influence stroke outcome, showing peculiar characteristics. Knowledge of these determinants may reduce the burden on health systems, improving quality of care.

Adolescent↗
PubMed1999

Carotid plaque, intima media thickness, cardiovascular risk factors, and prevalent cardiovascular disease in men and women: the British Regional Heart Study.

BACKGROUND AND PURPOSE: B-mode ultrasound is a noninvasive method of examining the walls of peripheral arteries and provides measures of the intima-media thickness (IMT) at various sites (common carotid artery, bifurcation, internal carotid artery) and of plaques that may indicate early presymptomatic disease. The reported associations between cardiovascular risk factors, clinical disease, IMT, and plaques are inconsistent. We sought to clarify these relationships in a large, representative sample of men and women living in 2 British towns. METHODS: The study was performed during 1996 in 2 towns (Dewsbury and Maidstone) of the British Regional Heart Study that have an approximately 2-fold difference in coronary heart disease risk. The male participants were drawn from the British Regional Heart Study and were recruited in 1978-1980 and form part of a national cohort study of 7735 men. A random sample of women of similar age to the men (55 to 77 years) was also selected from the age-sex register of the general practices used in the original survey. A wide range of data on social, lifestyle, and physiological factors, cardiovascular disease symptoms, and diagnoses was collected. Measures of right and left common carotid IMT (IMTcca) and bifurcation IMT (IMTbif) were made, and the arteries were examined for plaques 1.5 cm above and below the flow divider. RESULTS: Totals of 425 men and 375 women were surveyed (mean age, 66 years; range, 56 to 77 years). The mean (SD) IMTcca observed were 0. 84 (0.21) and 0.75 (0.16) mm for men and women, respectively. The mean (SD) IMTbif were 1.69 (0.61) and 1.50 (0.77) mm for men and women, respectively. The correlation between IMTcca and IMTbif was similar in men (r=0.36) and women (r=0.38). There were no differences in mean IMTcca or IMTbif between the 2 towns. Carotid plaques were very common, affecting 57% (n=239) of men and 58% (n=211) of women. Severe carotid plaques with flow disturbance were rare, affecting 9 men (2%) and 6 women (1.6%). Plaques increased in prevalence with age, affecting 49% men and 39% of women aged <60 years and 65% and 75% of men and women, respectively, aged >70 years. Plaques were most common among men in Dewsbury (79% affected) and least common among men in Maidstone (34% affected). IMTcca showed a different pattern of association with cardiovascular risk factors from IMTbif and was associated with age, SBP, and FEV1 but not with social, lifestyle, or other physiological risk factors. IMTbif and carotid plaques were associated with smoking, manual social class, and plasma fibrinogen. IMTbif and carotid plaques were associated with symptoms and diagnoses of cardiovascular diseases. IMTbif associations with cardiovascular risk factors and prevalent cardiovascular disease appeared to be explained by the presence of plaques in regression models and in analyses stratified by plaque status. CONCLUSIONS: IMTcca, IMTbif, and plaque are correlated with each other but show differing patterns of association with risk factors and prevalent disease. IMTcca is strongly associated with risk factors for stroke and with prevalent stroke, whereas IMTbif and plaque are more directly associated with ischemic heart disease risk factors and prevalent ischemic heart disease. Our analyses suggest that presence of plaque, rather than the thickness of IMTbif, appears to be the major criterion of high risk of disease, but confirmation of these findings in other populations and in prospective studies is required. The association of fibrinogen with plaque appears to be similar to its association with incident cardiovascular disease. Further work elucidating the composition of plaques using ultrasound imaging would be helpful, and more data, analyzed to distinguish plaque from IMTbif and IMTcca, are required to understand the significance of thicker IMT in the absence of plaque.

Age Distribution↗
PubMed1999

The auditory brainstem response--are South African ENT's missing the point?

The use and misuse of the auditory brainstem response (ABR) test by hearing professionals is often related to the extent and nature of the training they have received. This study used a postal survey based questionnaire to investigate the levels of training in, knowledge about, and appropriateness of referral for, ABR testing in Ear, Nose and Throat (ENT) surgeons and registrars in Gauteng, South Africa. Thirty-seven actively practising ENT specialists and registrars were sampled using a convenience sampling technique. Overall, a poor level of training and knowledge in ABR and its related areas of audiology was identified. This was mirrored by a high demand for further education. Considering the prevalence of auditory disorders in South Africa, and the push towards primary care and early intervention, this study's results highlight the need for improved training in ABR for ENT surgeons and registrars.

Adult↗
PubMed1999

Peak expiratory flow rate in elderly Malaysians.

An epidemiological survey was conducted among 1,414 healthy ambulatory elderly persons aged 55 years and above in the Kuala Langat district, Selangor. The relationship between peak expiratory flow rate (PEFR), demographic variables, socioeconomic status, smoking, alcohol use and respiratory symptoms were examined. The peak expiratory flow declined with age and were lower in women of all ages. Smoking had a modest effect on PEFR in men but not on PEFR in women. The combination of respiratory symptoms of cough, phlegm and wheeze were related to lower PEFR values. Prediction equations are presented derived from the population sample which may be of assistance in assessing observed to expected ratios among elderly people in Malaysia.

Aged↗
PubMed1998

Social determinants of psychiatric morbidity and well-being in immigrant elders and whites in east London.

OBJECTIVES: The social conditions under which migrants to the UK live may be more significant than the experience of migration itself in leading to increased risk of mental illness. We aimed to compare the prevalence of mental, physical and social health problems in elderly Somalis, Bengalis and whites living in a deprived inner London area and examine associations between environmental circumstances, social support, physical health status, mood and life satisfaction in these groups. In addition, we wanted to test the hypothesis that differences in mental health between immigrants and whites are explained by social disadvantages rather than ethnicity. DESIGN: Cross-sectional survey with participants drawn from age-sex registers of general practices, augmented by other sources. SETTING: East London--'first-generation' Somali and Bengali immigrants and white British. SUBJECTS: A total of 274 people aged 60+ years: 72 Somalis, 75 Bengalis and 127 whites. MAIN OUTCOME MEASURES: Symptoms of Anxiety and Depression Scale (SAD), Life Satisfaction Index (LSI). High SAD scores indicate more anxiety and depression symptoms; high LSI scores indicate greater life satisfaction. MAIN RESULTS: Highest SAD scores were found among Bengalis; lowest LSI scores were found among Bengalis and Somalis. The prevalences of depression (SAD score 6+) were 25% in Somalis, 77% in Bengalis and 25% in east London whites. Physical health status and SAD scores were associated in Somalis (r = +0.31, p < or = 0.01). Bengalis (r = +0.47, p < or = 0.001) and east London whites (r = +0.27, p < or = 0.01). Physical health problems also related to lower LSI scores in Somalis (r = -0.24, p < or = 0.05) and east London whites (r = -0.24, p < or = 0.01). Social factors (i.e. poor housing conditions, low family support and reported need of community services) were strongly associated with SAD scores among Somalis (r = +0.5, p < or = 0.001) and, to a lesser extent, among Bengalis (r = +0.33, p < or = 0.01). Ethnicity (i.e. being an immigrant as opposed to a non-immigrant) became a statistically non-significant risk factor for high SAD scores after adjusting for the effects of age, weekly income, physical health and social problems (OR = 0.71, 95% CI = 0.5-1.1, p = 0.09). A residual, but much attenuated effect for ethnicity on LSI scores persisted in the estimated model after controlling for the same set of independent risk factors (OR = 0.7, 95% CI = 0.4-1, p = 0.05). CONCLUSION: The marked variation in mental health between ethnic groups in east London might be a reflection of socioeconomic and health differentials acting concomitantly and adversely. Inequalities in housing, social support, income and physical health status accounted for variation in mood observed between immigrants and whites, and may partly explain differences in life satisfaction. These results seem to support a 'multiple jeopardy' theory of ageing in ethnic minorities in east London. Greater efforts are needed to recognize anxiety and depression in immigrant elders. Better social support and housing among 'minority ethnic' elders who live alone might be expected to alleviate social stress and improve mental health and psychological well-being.

Acculturation↗
PubMed1998

Chest pain on questionnaire and prediction of major ischaemic heart disease events in men.

OBJECTIVE: To examine the prediction of major ischaemic heart disease events by questionnaire-assessed chest pain and other symptoms. DESIGN: Population-based prospective study. SUBJECTS: 7735 randomly selected men, aged 40-59 years at entry. METHODS: Symptoms and history of diagnosed ischaemic heart disease were ascertained by administered questionnaire at baseline. Follow-up was for an average of 14.7 years, for first major ischaemic heart disease event. RESULTS: During follow-up, 969 men had a major ischaemic heart disease event. 'Definite' angina (chest pain fulfilling all WHO criteria) and 'possible' angina (exertional chest pain without all other WHO criteria) were associated with similar ischaemic heart disease outcome, and a single combined angina category was used. In the whole cohort, the relative risks (95% CI) of a major ischaemic heart disease event were 2.03 (1.61, 2.57) for angina only, 2.13 (1.72, 2.63) for possible myocardial infarction only and 4.50 (3.57, 5.66) for angina plus possible myocardial infarction, compared to no chest pain. The relative risk for recall of an ischaemic heart disease diagnosis was 3.98 (3.36, 4.71). Only 33% of men with angina or possible myocardial infarction symptoms recalled a previous ischaemic heart disease diagnosis. In men without recall of an ischaemic heart disease diagnosis (in whom 82% of events during follow-up occurred), chest pain symptoms remained predictive of major ischaemic heart disease events with relative risks (95% CI) of 1.69 (1.27, 2.24) for angina only, 1.49 (1.12, 1.97) for possible myocardial infarction only and 2.55 (1.44, 4.53) for angina plus possible myocardial infarction. 'Other chest pain' increased risk of a major ischaemic heart disease event by 1.19 (1.01, 1.40) compared to no chest pain. Symptoms of breathlessness or calf pain on walking increased ischaemic heart disease risk in men with 'other chest pain' and in men without chest pain, but had no further effect on ischaemic heart disease risk in men with symptoms of angina or possible myocardial infarction. CONCLUSIONS: In defining angina by chest pain questionnaire, the exertional component is the crucial criterion. When using questionnaire-assessed symptoms to determine ischaemic heart disease risk, information on previous ischaemic heart disease diagnoses should be taken into account. The majority of men with angina or possible myocardial infarction symptoms do not have a diagnosis of ischaemic heart disease, but they remain at significantly increased risk of a major ischaemic heart disease event. The value of breathlessness and calf pain on walking in stratifying ischaemic heart disease risk is restricted to men with 'other chest pain' or no chest pain.

Adult↗