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Factors associated with increased risk of exacerbation and hospital admission in a cohort of ambulatory COPD patients: a multiple logistic regression analysis. The EOLO Study Group.

BACKGROUND AND OBJECTIVE: The aim of this study was to develop and validate two models to estimate the probabilities of frequent exacerbations (more than 1 per year) and admissions for chronic obstructive pulmonary disease (COPD) that can be used in a primary care setting. METHODS: Information was obtained in a cross-sectional observational study on ambulatory COPD patients performed in 201 general practices located throughout Spain. The model for admissions included 713 cases, 499 for the developmental sample and 214 in the validation sample; the model for frequent exacerbations included 896 patients, 627 in the developmental sample and 269 in the validation model. Candidate variables to be included in both models were: age, sex, body mass index (BMI), FEV(1) as percent predicted [FEV(1 )(% pred.)], active smoking, chronic mucus hypersecretion (CMH) and significant comorbidity. RESULTS: The admission model contained 2 readily obtainable variables: comorbidity (OR = 1.97; CI 95% = 1. 24-3.14) and FEV(1)(% pred.) (OR = 0.72; 0.58-0.88, for every 10 units), and well calibrated in developmental and validation samples (goodness-of-fit tests: p = 0.989 and p = 0.720, respectively). The model for frequent exacerbations included 3 variables: age (OR = 1. 21; 1.01-1.44; for every 10 years of increasing age), FEV(1 )(% pred. ) (OR = 0.82; 0.70-0.96, for every 10 units) and CMH (OR = 1.54; 1. 11-2.14) and also well calibrated (p = 0.411 and p = 0.340 in the developmental and validation samples, respectively). CONCLUSIONS: Our results suggest that FEV(1) impairment explains part of the risk of frequent exacerbations and hospital admissions. Furthermore, CMH and increasing age are significantly associated with the risk of frequent exacerbations, but severity of exacerbations provoking hospital admissions is associated with the presence of significant comorbidity. These important and easily measurable variables contain valuable information for optimal management of ambulatory patients with COPD.

Age Factors↗

Independent predictors of recurrence of chronic subdural hematoma: results of multivariate analysis performed using a logistic regression model.

OBJECT: The authors attempted to determine independent predictors that contribute to the recurrence of chronic subdural hematoma (CSDH). METHODS: A total of 105 consecutive patients who underwent surgery for CSDH were included in this study. Eleven patients underwent a repeated operation because the CSDH recurred. Univariate and multivariate analyses were performed to assess the relationships among various variables and CSDH recurrence. Finally, four variables were found to be independently associated with the recurrence of CSDH: 1) absence of a multiplicity of hematoma cavities on CT scans; 2) presence of a history of seizure; 3) width of the hematoma; and 4) absence of a history of diabetes mellitus (DM). CONCLUSIONS: As previously reported, the width of the hematoma is related to the incidence of CSDH recurrence. In this study, the lack of a multiplicity of hematoma cavities was the favorite predictor of CSDH recurrence. In addition, histories of seizure and no past DM are closely related to the incidence of CSDH recurrence.

Adult↗

Urinary schistosomiasis in southern Ghana: a logistic regression approach to data from a community-based integrated control program.

The data for this analysis are based on the schistosomiasis control project of the Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana, designed to study the feasibility and effectiveness of an integrated schistosomiasis control program. It embraced chemotherapy and health education for community motivation. The study was carried out from 1993 to 1997. This paper presents observations made 24 months after intervention. Eight communities in southern Ghana were grouped into three areas. Individuals in all the areas received praziquantel after the baseline data collection in 1992-1993. Area 1 had passive while Area 3 received active health education. Area 2 received no education. Prevalence of schistosomiasis was the response variable of interest while age, sex, and area were considered as possible influencing variables. The model for the baseline data indicated no significant difference in prevalence among the three areas. The model 24 months after intervention indicated a significant difference among the three areas, suggesting a possible influence of the health education that motivated community participation in the provision of facilities for the control of schistosomiasis.

Adolescent↗

[Econometric and ethical validation of regression logistics. Reducing of the number of patients in the evaluation of mortality].

In general, a large number of patients is needed to conclude whether the results of a therapeutic strategy are significant or not. One can lower this number with a logit. The method has been proposed in an article published recently (Cost-utility analysis of early thrombolytic therapy, Pharmaco Economics, 1992). The present article is an essay aimed at validating the method, both from the econometric and ethical points of view.

Economics, Medical↗