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PubMed2003

Functional status and overall quality of life in a multiethnic HIV-positive population.

The objective of this study was to examine the sociodemographic and behavioral variables associated with quality of life (QOL) among multiethnic, economically disadvantaged patients with HIV/AIDS. A cross-sectional survey was conducted in a large inner-city HIV/AIDS clinic serving medically indigent residents of Houston, Texas, and the surrounding area. On arrival at the clinic, patients were systematically approached and asked to complete a questionnaire, offered in both English and Spanish. Demographic characteristics, stage of disease, and behavioral variables were assessed in addition to work-role functioning and overall health-related QOL. Multiple regression analysis was conducted to assess the relationships between the variables of interest. Of 617 patients approached and asked to participate in the study, 385 (62.4%) consented to complete the questionnaire. Demographic composition of the sample was as follows: 78% male, 25% white, 44% black, and 29% Hispanic. Forty-five percent of the participants were infected through men having sex with men (MSM), 35% through heterosexual contact, and 11% through injection drug use. Racial/ethnic minorities reported significantly (p < 0.05) poorer physical functioning and work-role functioning. Participants with higher nadir CD4 cell counts (> 500 per cubic millimeter), MSM HIV exposure, and more education (beyond high school) reported better physical functioning and work-role functioning. Overall QOL and work-related functioning were significantly impaired in this patient population. The impaired functional status findings hold for every social, demographic, and behavioral subgroup examined. Findings suggest that the influence of social inequality persist even among a universally disadvantaged population.

Adult↗
PubMed2001

The use of computed tomography for the diagnosis of acute appendicitis in children does not influence the overall rate of negative appendectomy or perforation.

BACKGROUND: Computed tomography (CT) has been used more frequently to diagnose acute appendicitis in children. The purpose of this study was to determine whether the use of CT has any influence on negative appendectomy or perforation rates. METHODS: Review of a prospective database of children having appendectomy for suspected acute appendicitis. Negative appendectomy and perforation rates were determined by correlation with final pathology reports. RESULTS: Eighty-five consecutive patients underwent appendectomy for the suspicion of acute appendicitis. The overall negative appendectomy rate was 17.6%, being 19.4% in females and 16.6% in males (p = 0.75). The overall accuracy, sensitivity and positive predictive value of CT were 75%, 91%, and 81%, respectively. Patients that had CT did not have a significantly lower rate of negative appendectomy (17.9% vs. 19.3%, p > 0.99) or perforation (26% vs. 17%; p = 0.53). CONCLUSIONS: The use of CT for the diagnosis of appendicitis in children does not change the negative appendectomy rate. Results of studies performed in adults may not be extrapolated to the evaluation of children with suspected acute appendicitis.

Adolescent↗
PubMed2005

Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men.

BACKGROUND: Obesity is a strong risk factor for type 2 diabetes. However, few studies have compared the predictive power of overall obesity with that of central obesity. The cutoffs for waist circumference (WC) and waist-to-hip ratio (WHR) as measures of abdominal adiposity remain controversial. OBJECTIVE: The objective was to compare body mass index (BMI), WC, and WHR in predicting type 2 diabetes. DESIGN: A prospective cohort study (Health Professionals Follow-Up Study) of 27 270 men was conducted. WC, WHR, and BMI were assessed at baseline. Covariates and potential confounders were assessed repeatedly during the follow-up. RESULTS: During 13 y of follow-up, we documented 884 incident type 2 diabetes cases. Age-adjusted relative risks (RRs) across quintiles of WC were 1.0, 2.0, 2.7, 5.0, and 12.0; those of WHR were 1.0, 2.1, 2.7, 3.6, and 6.9; and those of BMI were 1.0, 1.1, 1.8, 2.9, and 7.9 (P for trend < 0.0001 for all). Multivariate adjustment for diabetes risk factors only slightly attenuated these RRs. Adjustment for BMI substantially attenuated RRs for both WC and WHR. The receiver operator characteristic curve analysis indicated that WC and BMI were similar and were better than WHR in predicting type 2 diabetes. The cumulative proportions of type 2 diabetes cases identified according to medians of BMI (>/=24.8), WC (>/=94 cm), and WHR (>/=0.94) were 82.5%, 83.6%, and 74.1%, respectively. The corresponding proportions were 78.9%, 50.5%, and 65.7% according to the recommended cutoffs. CONCLUSIONS: Both overall and abdominal adiposity strongly and independently predict risk of type 2 diabetes. WC is a better predictor than is WHR. The currently recommended cutoff for WC of 102 cm for men may need to be reevaluated; a lower cutoff may be more appropriate.

Abdomen↗
PubMed2005

Chemotherapy-induced amenorrhea: influence on disease-free survival and overall survival in receptor-positive premenopausal early breast cancer patients.

BACKGROUND: The aim of this study was to evaluate the influence of early chemotherapy-induced amenorrhea (CIA) on disease-free survival and overall survival in premenopausal patients with receptor-positive early breast cancer treated with adjuvant chemotherapy without any hormonotherapy. PATIENTS AND METHODS: Retrospectively, we reviewed data from 130 premenopausal patients with localized hormone-sensitive breast cancer. These patients were treated between 1985 and 1995 at the same institution. They all underwent a loco-regional treatment and adjuvant chemotherapy. Early CIA was defined as an amenorrhea arising during the first year following the beginning of chemotherapy. Predictors of early CIA were examined. The survival analyses were done using the Kaplan-Meier method and Cox analysis. RESULTS: Median follow-up was 9 years. Mean age was 42.9 +/- 5 years. Ninety-two per cent of patients had histologically-proven positive axillary nodes. Adjuvant chemotherapy contained no anthracycline in 63%. Early CIA occurred during or after adjuvant chemotherapy in 57% of the patients. It was definitive in 91%. In our study, age was the only CIA predictor in univariate analysis. Women who experienced early CIA tend to have a longer disease-free survival, but the difference was not significant. This trend was lost in multivariate analysis, most probably due to the small sample size. The overall survival was not different. CONCLUSION: Although not statistically significant, our results on a very selected population of patients suggest that a chemotherapy-induced amenorrhea might have its own therapeutic effect besides the cytotoxic action of chemotherapy.

Adult↗
PubMed2005

A tail strength measure for assessing the overall univariate significance in a dataset.

We propose an overall measure of significance for a set of hypothesis tests. The 'tail strength' is a simple function of the p-values computed for each of the tests. This measure is useful, for example, in assessing the overall univariate strength of a large set of features in microarray and other genomic and biomedical studies. It also has a simple relationship to the false discovery rate of the collection of tests. We derive the asymptotic distribution of the tail strength measure, and illustrate its use on a number of real datasets.

Biometry↗
PubMed2005

C-reactive protein in the prediction of cardiovascular and overall mortality in middle-aged men: a population-based cohort study.

AIMS: Cut-offs for C-reactive protein concentrations have been recommended for risk stratification, but little is known about how these cut-offs predict cardiovascular risk in population-based cohorts. We therefore assessed the association of C-reactive protein levels with cardiovascular mortality in a population-based cohort of 2321 middle-aged men stratified by the presence of cardiovascular disease (CVD) at baseline. METHODS AND RESULTS: C-reactive protein concentrations were categorized according to current recommendations (1 and 3 mg/L). During the 15 year follow-up, 77 men without CVD and 121 men with CVD at baseline died of CVD. In men without CVD at baseline (n=1476), age-adjusted cardiovascular mortality was 4.1-fold higher (95% CI 2.1-8.2) for C-reactive protein levels between 3.0 and 9.9 mg/L at baseline than for C-reactive protein levels <1.0 mg/L. In men with CVD at baseline (n=845), the corresponding age-adjusted cardiovascular mortality was 3.3-fold higher (95% CI 2.0-5.3). Adjustment for conventional CVD risk factors attenuated the risk somewhat. Further adjustment for dietary and lifestyle factors and factors related to insulin resistance did not affect the association. Classification of C-reactive protein by tertiles gave qualitatively similar results, but identified twice as many men at high risk. C-reactive protein levels also predicted overall mortality. CONCLUSION: Currently, recommended cut-offs for C-reactive protein levels identify men at risk for cardiovascular and overall death independently of conventional and other risk factors in a population-based sample of middle-aged men with and without CVD at baseline. Lower cut-offs may better identify men at high risk for cardiovascular death, but improvement of current recommendations will require standardization of C-reactive protein assays.

Adult↗
PubMed2006

Effects of cardiac resynchronization therapy on overall mortality and mode of death: a meta-analysis of randomized controlled trials.

AIMS: Cardiac resynchronization therapy (CRT) has been shown to improve symptoms and exercise tolerance in patients with advanced heart failure (HF). However, studies were underpowered to address its effect on overall mortality. To evaluate whether CRT alone (without a combined defibrillator function) reduces overall mortality as compared with optimal pharmacological therapy, and how it affects the mode of death in patients with advanced HF. METHODS AND RESULTS: Public domain databases were systematically searched. Randomized controlled studies that evaluated the effects of CRT alone in patients with advanced HF and a depressed left ventricular systolic performance were selected for this analysis. Trials, which did not independently report data on CRT alone or had a follow-up period of less than 3 months, were excluded. Five studies were identified and analyzed. They included a total of 2371 patients, 1028 controls and 1343 CRT-treated patients. Pooled analysis demonstrated that CRT alone, as compared with optimal medical therapy, significantly reduced all-cause mortality by 29% [16.9 vs. 20.7%; odds ratio (OR), 0.71; 95% confidence interval (CI), 0.57-0.88] and mortality due to progressive HF by 38% (6.7 vs. 9.7%; OR, 0.62; 95% CI, 0.45-0.84). No effect on sudden cardiac death (SCD) was observed with CRT (6.4 vs. 5.9%; OR, 1.04; 95% CI, 0.73-1.22). CONCLUSIONS: CRT alone as compared with optimal medical therapy reduces all-cause mortality in patients with advanced HF. It predominantly reduces worsening HF mortality, not affecting SCD.

Aged↗
PubMed2004

Overall prognosis with current treatment of infertility.

Few reports provide pregnancy or birth rates for large groups of infertile couples having a comprehensive range of treatments. This model utilizes published evidence about diagnosis, treatment, the duration of treatment and the proportion of couples receiving treatment. Assisted reproduction technology treatment (ART) utilization was set arbitrarily at three levels: 3, 10 or 50% of the couples that had no live birth after conventional treatment. For each diagnosis and treatment the model estimated total live births, singleton live births and multiple live births per 10,000 couples. The overall live birth rate with non-ART treatment would be 37%, involving 3,725 live births, of which 3,478 (93%) would be singleton and 247 (7%) would be multiple. With ART utilization at 3, 10 and 50% of couples with persistent infertility in each diagnostic category, live birth rates were 39, 43 and 47% respectively, with 8, 10 and 12% multiple births. The corresponding utilization of ART would be 244, 813 and 1481 ART cycles per 10(6) population per annum. Typical management of infertility would fall short of 50% live births even with extensive utilization of ART. Underlying unknown untreatable factors remain barriers to greater overall success in the treatment of infertility.

Birth Rate↗
PubMed1976

Variola minor in Bragança Paulista County, 1956: overall description of the epidemic and of its study.

An overall description of the epidemic of variola minor (alastrim) affecting Bragança Paulista County (Brazil) in 1956 is given. A total of 484 cases were recorded for 210 households, one hotel and one boarding school. At least 95 per cent of the households with cases of the disease in the capital city were surveyed and 90 per cent of the households in the rural districts. An orphanage, an old folk's home, the County jail and 10 schools operating in the capital city and some other social groups without cases were also surveyed, as well as 125 households without cases but with one or more contacts with the disease. An overall attack rate of 1924 cases, 267 cases and 781 cases per 100,000 inhabitants was obtained, respectively, for the capital city, the rural environment and the whole County. Clinical, epidemiological, serological and environmental surveys were conducted. Evidence on identification of the epidemic disease is presented. Study of the epidemic was made at these levels: the disease itself (frequency and severity); the disease in the individual (association of characteristics of persons with occurrence and clinical severity of variola minor); the disease in social units (occurrence and spread in households and school classes); the disease in small communities (occurrence and spread in housing projects, city blocks and farms); the disease in two large communities with contrasting socio-economic characteristics (the capital city and the rural environment); and the disease in the County as a whole.

Brazil↗
PubMed2005

Does one's own and one's spouse's education affect overall and cause-specific mortality in the elderly?

OBJECTIVES: To examine educational gradients in overall and cause-specific mortality among elderly married men and women and their spouses. METHODS: Using the census-based Israel Longitudinal Mortality Study (1983-92), 13 573 married men and 6563 married women were identified who were aged 70-89 years at baseline. Cox proportional hazard models were used to assess the strength of the association between education and overall and cause-specific mortality. RESULTS: Educational gradients for own and spouse's mortality varied by gender and cause of death. In particular, in relation to cardiovascular disease, men married to uneducated wives experienced elevated mortality risks [hazard ratio (HR) = 1.30; 95% confidence interval (95% CI) 1.11-1.52]. Women were generally unaffected by their husband's education, except for those who died from non-breast cancer, for whom husband's low education had a harmful effect (HR = 1.98; 95% CI 1.26-3.11). CONCLUSIONS: Mortality among elderly married persons is associated with one's own and one's spouse's educational achievement. Research using partner's education as a proxy for one's own attainment may be omitting valuable information regarding these and other health risks.

Aged↗
PubMed2003

Hyperfractionated radiation therapy for hypopharyngeal carcinoma compared with conventional radiation therapy: local control, laryngeal preservation and overall survival.

BACKGROUND: Recent randomized trials have revealed the effectiveness of hyperfractionated radiation therapy for treating head and neck carcinomas, especially in their local control. Because the hypopharynx is located near the larynx, increasing local control of hypopharyngeal carcinomas achieves greater laryngeal preservation, which is very important for patients' quality of life. In consideration of this, our facility adopted hyperfractionated radiation therapy for hypopharyngeal carcinoma in 1996. In this study we compared the results of this therapy with those of conventional radiation therapy. METHODS: Forty-two patients with hypopharyngeal carcinoma whose tumors were inoperable or who refused surgery were treated with curative intended radiation therapy between April 1975 and January 2002 at Tokyo Metropolitan Komagome Hospital. Of these patients, 23 were treated with hyperfractionated radiation therapy (the HF group) and 19 were treated with conventional fractionated radiation therapy (the CF group). In the HF group, the numbers of patients at each clinical stage were as follows: stage I, 2; stage II, 5; stage III, 6; stage IV, 10. The fraction size was 1.2 Gy and the mean total dose was 73.4 Gy (range, 66-79.2 Gy). In the CF group, the corresponding numbers were as follows: stage I, 3; stage II, 1; stage III, 5; stage IV, 10. The fraction size was 1.8-2.0 Gy and the mean total dose was 65.4 Gy (range, 60-70 Gy). RESULTS: The 3-year local control rates for the HF group and the CF group were 61.5 and 18.4%, respectively (P = 0.016). The 3-year pharyngolaryngectomy-free survival rates for the HF group and the CF group were 64.7% and 5.3%, respectively (P = 0.0008). The 3-year overall survival rates for the HF group and the CF group were 69.3 and 31.6%, respectively (P = 0.075). CONCLUSION: This study suggests that hyperfractionated radiation therapy for hypopharyngeal carcinoma is promising with a better local control rate, a greater laryngeal preservation rate and a relatively better overall survival rate.

Adult↗
PubMed2005

Recombinant human erythropoietin and overall survival in cancer patients: results of a comprehensive meta-analysis.

BACKGROUND: Anemia associated with cancer and cancer therapy is an important clinical and economic factor in the treatment of malignant diseases. METHODS: We conducted a systematic literature review to assess the efficacy of erythropoietin to prevent or treat anemia in cancer patients with regard to red blood cell transfusions, hematologic response, adverse events, and overall survival. We searched the Cochrane Library, Medline, EMBASE, and other databases for relevant articles published from January 1985 to December 2001. We included all randomized controlled trials that compared the use of recombinant human erythropoietin (plus transfusion, if needed) with no erythropoietin treatment (plus transfusion, if needed). Relative risks (RRs) and 95% confidence intervals (CIs) were calculated under a fixed-effects model. Clinical and statistical heterogeneity were examined with sensitivity analyses and meta-regression. Statistical tests for effect estimates were two-sided. RESULTS: We identified 27 trials involving 3287 adult patients. Patients treated with erythropoietin had a lower relative risk of having a blood transfusion than untreated patients (RR = 0.67, 95% CI = 0.62 to 0.73). Erythropoietin-treated patients with baseline hemoglobin levels lower than 10 g/dL were more likely to have a hematologic response than untreated patients (RR = 3.60, 95% CI = 3.07 to 4.23). The relative risk for thromboembolic complications after erythropoietin treatment was not statistically significantly increased (RR = 1.58, 95% CI = 0.94 to 2.66) compared with that of untreated patients. There is suggestive but inconclusive evidence that erythropoietin may improve overall survival (adjusted data: hazard ratio [HR] = 0.81, 95% CI = 0.67 to 0.99; unadjusted data: HR = 0.84, 95% CI = 0.69 to 1.02). CONCLUSIONS: Erythropoietin treatment may reduce the risk for blood transfusions and improve hematologic response in cancer patients. However, our favorable survival outcome is in contrast to two large (N = 351 and 939) recently published randomized controlled trials in which erythropoietin-treated patients had statistically significantly worse survival than untreated patients. Possible reasons for the disparity with our results include differences in study population and design, higher target hemoglobin levels and higher risk of thromboembolic complications, and concerns that erythropoietin may stimulate tumor growth.

Anemia↗
PubMed2004

Epidemiology of hip and knee pain and its impact on overall health status in older adults.

OBJECTIVES: To obtain prevalence rates of hip and knee pain in elderly people and compare combinations of symptoms with overall health status. METHODS: We performed a cross-sectional postal survey of a random sample of 5500 Oxfordshire residents aged 65 yr and older. Prevalence estimates were based on the screening question: 'During the past 12 months, have you had pain in or around either of your hip/knee joints on most days for one month or longer?' Overall health status was assessed with the SF-36 questionnaire. RESULTS: The response rate was 66.3% (3341/5039 eligible people), and was highest (approximately reverse similar 72%) for the 65-74 yr age-group. The percentage reporting hip pain was 19.2% [95% confidence interval (CI) 17.9-20.6], and 32.6% (95% CI 31.0-34.3) reported knee pain. The percentage reporting hip and knee pain was 11.3%, and 40.7% reported hip or knee pain. Less than half (48%) of the symptomatic respondents had unilateral problems affecting one hip or knee joint only. SF-36 scores worsened as the number of symptomatic hip and knee joints increased (P<0.001 for physical function, physical role limitation and bodily pain). CONCLUSIONS: Patterns of hip and knee symptoms are complex in older people. Amongst the symptomatic, most have more than one hip/knee affected. This has implications for treatment and health status measurement. In the absence of hip and knee symptoms, general health status scores of elderly people are similar to those of people aged under 65 yr.

Aged↗
PubMed1999

Effect of pelvic endometrial implants on overall reproductive functions of female rats.

The effects of pelvic endometrial implants on the overall reproductive potential of female rats were investigated. After homologous transplantation in the peritoneum, the ectopic endometrium developed into highly vascularized nodes that gradually increased in mass until the 9th week postsurgery and then plateaued. In the presence of these implants, overall reproductive function was adversely affected. The effect was of greatest magnitude during 50-70 days posttransplantation. As compared with values in corresponding controls, ovulation was reduced by 43% (6 of 14) (p < 0.05), mating rate was reduced by 44% (12 of 27) (p < 0.025), and premature termination of pregnancy occurred in 34% (5 of 15) of rats. Wastage of pregnancy, which included complete termination or reduction of fetal number, occurred during the postimplantation course of gestation. Furthermore, 100% of the rats with transplants failed to respond to the copulomimetic stimulation for the induction of pseudopregnancy (p < 0.01, compared with corresponding controls). However, on exposure to vasectomized males, 46% (6 of 13) of these rats exhibited development of pseudopregnancy (p < 0.05, compared with corresponding group receiving copulomimetic stimulation). Increased rate of mating failure and differential pseudopregnancy rates after copulomimetic and natural cervical stimulation suggest that the rats with endometrial explants possibly had an absence or a short appearance of behavioral estrus. Hormonal assessment during the preovulatory phase showed a tendency toward lower mean levels of preovulatory estradiol and significantly lower LH (p < 0.01) and progesterone (p < 0.01) concentrations. The adversely affected reproductive functions may be a secondary consequence of these altered endocrine milieus.

Abortion, Spontaneous↗
PubMed2003

One site on the apoB-100 specifically binds 17-beta-estradiol and regulates the overall structure of LDL.

The major protein component (apoB-100) of low-density lipoprotein (LDL) is known as a multipotential molecule the several functional regions of which can all be affected by key structural modifications driven by specific domains. Based on our previous report on structural and conformational modifications of apoB-100 in the presence of 17-beta-estradiol (E2), we characterized the interaction between E2 and the apoB-100 and further explored the induced alterations in terms of the structural arrangement of the whole LDL particle. We report evidence for the existence on apoB-100 of a single specific and saturable binding site for E2, the occupancy of which modifies the overall structure of the protein, inducing an increase in the alpha-helix fraction. As a consequence, the structure of the LDL particle is deeply perturbed, with a change in the arrangement of both the outer shell and lipid core and an overall volume shrinkage. The evidence of a regulation of apoB-100 structure by a physiological ligand opens new perspectives in the study of the biological addressing of the LDL particle and suggests a novel rationale in the search for mechanisms underlying the beneficial role of E2 in decreasing the risk of early lesions in atherosclerosis.

Apolipoprotein B-100↗
PubMed2001

Improved overall survival among responders to preoperative chemoradiation for locally advanced rectal cancer.

The aim of this study was to determine if the response to preoperative radiation and chemotherapy with continuous infusion 5-fluorouracil (5-FU) was predictive for survival among patients with locally advanced rectal cancer. Preoperative chemoradiation (CTX/XRT) that delivered 45 Gy in 25 fractions over 5 weeks with continuous infusion 5-FU (300 mg/m2/day) was given to 117 patients. The pretreatment stage distribution, as determined by endorectal ultrasound (u), included uT2N0 in 2%, uT3N0 in 47%, uT3N1 in 49%, and uT4N0 in 2% of cases; endorectal ultrasound was not performed in 13% of cases (15 patients). Approximately 6 weeks after completion of CTX/XRT, surgery was performed. Adjuvant chemotherapy, consisting of 400 to 425 mg/m2 of 5-FU plus 20 mg/m2 leucovorin for 5 days, was administered every 28 days for 4 to 6 cycles after surgical resection. Among the 74 patients treated with adjuvant chemotherapy, the preoperative stage of disease was 31 with T3N0 and 43 T3N1. Median follow-up was 46 months (range 2 to 89 months). The pathologic tumor stages were Tis-2N0 in 26%, T2N1 in 5%, T3N0 in 21%, T3N1 in 15%, T4N0 in 5%, and T4N1 in 1%; a complete response (CR) to preoperative CTX/XRT was pathologically confirmed in 32 (27%) of patients. Tumor down-staging occurred in 72 (62%) cases. A sphincter-saving procedure (SP) was possible in 59% of patients. The median DFS and overall survival rates for responders were 46 months and 47 months, respectively; for non-responders these outcome measures were 38 months and 41 months, respectively. Log-rank analysis showed that the distant metastatic-free survival rates improved with any response to CTX/XRT (p < 0.00001), CR to CTX/XRT (p < 0.009) and SP (p < 0.012). Likewise, these parameters also significantly influenced DFS rates (CTX/XRT p < 0.00001; CR p < 0.006; and SP p < 0.008). Control of pelvic disease was influenced by clinical size (p < 0.002) and SP (p < 0.016) on univariate analysis. On multivariate analysis only clinical size (p < 0.002) continued to be a significant factor for local control. Factors on multivariate analysis that resulted in significant improvements in cancer-specific survival included any response to preoperative CTX/XRT (p < 0.017) and administration of adjuvant chemotherapy (p < 0.034). Any response to preoperative CTX/XRT improved distant metastatic-free and disease-free survival rates. Multivariate analysis confirmed that a response to preoperative CTX/XRT predicted for improvements in overall survival among patients with locally advanced rectal cancer. Patients who fail to respond to preoperative 5-FU based chemotherapy given concomitantly with radiation have higher rates of distant metastases with adjuvant 5-FU therapy.

Adult↗
PubMedDate not supplied

Survey response rates and overall patient satisfaction scores: what do they mean?

Within the health care community, more and more emphasis is being placed on patient satisfaction. This study was undertaken in a midwestern, nonprofit, 300-bed acute care hospital to gain a better understanding of how nonresponse rates and patient characteristics affect patient satisfaction scores. With a response rate of 34.2%, it appears that nonresponse bias may have an impact. When looking at variables that may affect the overall score, the multiple regression model used in this analysis was able to explain only 7.5% of the variability in the overall satisfaction score seeming to indicate the unpredictability of the score. This study supports the need to analyze groups of patients rather than patients as a whole to determine what affects their response, both within and between healthcare organizations.

Acute Disease↗
PubMedDate not supplied

Postmenopausal estrogen therapy and Alzheimer disease: overall negative findings.

An inverse association between estrogen therapy (ET) and Alzheimer disease (AD) has been reported in some, but not in all studies. We investigated the association between ET and AD in postmenopausal women using a population-based case-control design. Women who developed AD from 1985 through 1989 in Rochester, MN (cases, n=264) were individually matched by age (+/-1 y) to control women free of dementia from the same population (controls, n=264). ET exposure (>/=6 mo after menopause) was ascertained by abstracting the complete medical records archived in the records-linkage system of the Rochester Epidemiology Project. The frequency of ET use was similar in cases (11.4%) and controls [10.6%; odds ratio=1.10; 95% confidence interval (CI)=0.63-1.93]. However, cases who used ET had a suggestive trend for an earlier age at start of ET compared with controls (median, 49.0 vs. 50.5 y; P=0.06). Although smoking (ever vs. never) was not associated with AD overall, we observed an interaction between smoking and ET. The odds ratio of AD in ET users was 4.55 (95% CI=1.33-15.53) among smokers, but was 0.68 (95% CI=0.35-1.32) among never-smokers (P for interaction=0.01). Our findings do not confirm a significant association between ET and AD overall; however, the possible interaction with smoking deserves further study.

Aged↗