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At least 775 records · Page 43Linked to original sources
PubMed1986

Stress and heart disease: evidence of associations between unemployment and heart disease from the OPCS Longitudinal Study.

The OPCS Longitudinal Study has been used to study both overall and cause-specific mortality patterns in 1971-1981 among men and women directly or indirectly affected by unemployment in April 1971. Groups studied included men seeking work in 1971, the wives of men seeking work in 1971 and other women in the same households as a man seeking work in 1971. The findings of this project are summarized here and attention is focused on mortality from circulatory diseases, in particular ischaemic heart disease. The study provides evidence which could be seen as supporting hypotheses about relationships between stress and overall mortality, with a marked excess for suicides. The evidence with respect to ischaemic heart disease is positive but less convincing with excess mortality from this cause principally occurring among younger unemployed men and among the wives of men who were seeking work in 1971. Given the sharp contrasts in the pattern and levels of unemployment between 1971 and 1981 it is difficult to extrapolate from these findings to the present day.

Adolescent↗
PubMed2005

Excess injury mortality among smokers: a neglected tobacco hazard.

OBJECTIVE: To assess the mortality risks from injuries for smokers and ex-smokers and to quantify the mortality burden of smoking from injury in Taiwan. METHODS: Smokers' (and ex-smokers') mortality risks from injuries were compared with that of non-smokers in a merged cohort from Taiwan. A total of 64,319 male subjects were followed up for 12-18 years. Relative risks (RR) (adjusted for age and alcohol use) and 95% confidence intervals (CI) for cause specific injury deaths were calculated using the Cox proportional hazard model. Relative risks of injury mortality were also calculated to assess the presence of dose-response relations with daily smoking quantity. RESULTS: Alcohol use adjusted relative mortality risks for all injuries (RR 1.69, 95% CI 1.39 to 2.05) including those from motor vehicle accidents (RR 1.88, 95% CI 1.44 to 2.45) and non-motor vehicle accidents (RR 1.48, 95% CI 1.11 to 1.99) were significantly higher for smokers than non-smokers. Mortality was also increased for most subtypes of non-motor vehicle injuries including falls, fires, and job related injuries. Furthermore, these increases were dose dependent, with the heaviest smokers having the highest risk and the lightest smokers the lowest risk, and ex-smokers, no increase. In 2001, over one fifth (23%) of all male injury deaths in Taiwan was associated with smoking. CONCLUSION: This study demonstrated the significant association between fatal injuries and smoking. This relation adds further weight to smoking cessation campaigns.

Accidental Falls↗
PubMed2006

Endothelial dysfunction and low-grade inflammation explain much of the excess cardiovascular mortality in individuals with type 2 diabetes: the Hoorn Study.

OBJECTIVE: The mechanisms responsible for the increased cardiovascular disease risk that accompanies type 2 diabetes (T2D) remain poorly understood. It is commonly held that endothelial dysfunction and low-grade inflammation can explain, at least in part, why deteriorating glucose tolerance is associated with cardiovascular disease. However, there is no direct evidence for this contention. METHODS AND RESULTS: In this population-based study (n=631), T2D was cross-sectionally associated with both endothelial dysfunction and low-grade inflammation, whereas impaired glucose metabolism (IGM) was associated only with low-grade inflammation. These findings were independent of other risk factors that accompany T2D or IGM. During a follow-up of 11.7 years (median; range 0.5 to 13.2 years), low-grade inflammation was associated with a greater risk of cardiovascular mortality (hazard ratio, 1.43 [95% CI, 1.17 to 1.77] per 1 SD difference). For endothelial dysfunction, the association with cardiovascular mortality was stronger in diabetic (hazard ratio, 1.87 [95% CI, 1.43 to 2.45]) than in nondiabetic individuals (hazard ratio, 1.23 [95% CI, 0.86 to 1.75]; P interaction=0.06). Finally, T2D-associated endothelial dysfunction and low-grade inflammation explained approximately 43% of the increase in cardiovascular mortality risk conferred by T2D. CONCLUSIONS: These data emphasize the necessity of randomized controlled trials of strategies that aim to decrease cardiovascular disease risk by improving endothelial function and decreasing low-grade inflammation, especially for T2D patients.

Aged↗
PubMed2006

Optimal medical therapy is superior to transplantation for the treatment of class I, II, and III heart failure: a decision analytic approach.

BACKGROUND: The survival benefit of heart transplantation (HT) compared with optimal medical therapy (OMT) has never been tested. METHODS AND RESULTS: We created a decision analytic model that simulates a randomized clinical trial of OMT versus HT for each New York Heart Association (NYHA) class. The simulation calculates average life expectancy. The following assumptions were made for OMT annual mortality: class I no excess mortality from HF; class II and III based on MERIT-HF are 5.3% and 8.1%. Class IV is 12.8%, based on COPERNICUS. HT mortality rates were based on survival curves for HT 1982 to 2001. For classes I, II, and III, OMT demonstrated a life expectancy gain of 113 months (232+/-2.2 versus 119+/-2.1), 38 months (152+/-2.1 versus 114+/-2.1), and 6 months (117+/-1.8 versus 111+/-2.2), respectively, over HT. Class IV favored HT with a life expectancy gain of 26 months (107+/-2.1 versus 81+/-1.4) over OMT. Sensitivity analysis revealed if improvement in OMT decreased mortality by 38% for class IV patients, OMT and HT would have equivalent life expectancies. If improvement in HT resulted in a 7% increase in post-HT survival, OMT and HT would be equivalent for class III patients. If improvement in HT resulted in a 30% increase in post-HT survival, OMT and HT would be equivalent for class II patients. CONCLUSIONS: Our model predicts that currently, OMT is superior to HT for classes I, II, and III, but HT is superior for class IV. However, future advances in OMT or HT may change the relative benefits of these treatment modalities.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Risk of pulmonary aspiration among patients receiving enteral nutrition support.

We investigated the prevalence, incidence, and risk factors for pulmonary aspiration in all tube-fed adult patients over 6 months. Twelve aspiration events occurred among 276 patients (prevalence, 4.4%; 95% confidence interval, 2.2% to 7.6%). The incidence of aspiration was 2.4 per 1000 tube-feeding days (95% confidence interval, 1.2 to 3.9 per 1000). Despite 17% overall mortality, there was no excess mortality and little morbidity associated with aspiration. The major risk factors for aspiration were patient age (p less than .015) and location in the hospital (p less than .008): the probability of aspiration in the intensive care units (n = 113) was 0.9% compared with 4.9% on medical or surgical wards (n = 142), 16.7% among patients transferred from the intensive care unit to the ward (n = 18), and 33% among patients transferred from the ward to the intensive care unit (n = 3). Pulmonary aspiration is an uncommon and generally benign event among enterally supported patients. More frequent aspiration among ward than intensive care unit patients suggests that aspiration is not an inevitable consequence of severe illness, but can be prevented with adequate nursing care and pulmonary precautions. The fear of aspiration is not a sufficient cause to withhold enteral nutrition support in acutely ill patients.

Adult↗
PubMed1997

Randomized trial of carvedilol in treatment of congestive heart failure.

BACKGROUND: Members of the U.S. Cardevivol Study Group at Lovelace Scientific Resources, Albuquerque, NM, designed and carried out a large multicenter randomized clinical trial of Cardevilol vs placebo in patients with clinical heart failure and ejection fraction < 0.35. RESULTS: Derived exposure and death data at 50-day intervals to 400 days were used to construct tables of comparative mortality, all ages, both sexes and all durations to 400 days combined, in the Carvedilol and the placebo groups Derivation of expected mortality is explained in detail. CONCLUSIONS: Excess mortality, measured as mortality ratio or excess death rate, was much higher in the placebo than in the Cardevilol-treated group.

Adrenergic beta-Antagonists↗
PubMed1991

Differences in patient mix: a partial explantation for the excessive Medicare mortality observed in some Puerto Rican hospitals.

Data from a census in a Puerto Rican community were used to retrospectively compare patients admitted to government hospitals in terms of demographic variables, mental status and functional status in the community prior to admission. A total of 268 patients admitted to a hospital at least once during the study period were identified. Patients admitted to government hospitals were poorer, less educated, less functional and had a higher level of mental impairment. However, in comparison to private hospitals, stratified analysis showed consistently higher in-hospital mortality rates among patients admitted to government hospitals when other variables were taken into account.

Age Factors↗