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PubMed2004

Age- and sex-specific incidence, risk, and latency period of a perioperative acute thromboembolism syndrome (PATS).

We investigated age- and sex-specific incidence, risk factors, and latency period of a perioperative acute thromboembolism syndrome (PATS) in a large cohort study. We prospectively analyzed data on 21903 consecutive surgery patients to determine the incidence of myocardial infarction, pulmonary embolism, deep venous thrombosis, stroke, and cardiovascular death within 30 postoperative days. Among 255 (1.2 percent) patients with thromboembolism, 105 (0.48 percent) suffered myocardial infarction (mean latency: 5 days), 30 (0.14 percent) suffered pulmonary embolism (6 days), 23 (0.11 percent) suffered deep venous thrombosis (10 days), 97 (0.44 percent) suffered stroke (11 days), and 13 (0.06 percent) died (12 days). The critical period was postoperative week 1 for myocardial infarction and pulmonary embolism, and postoperative week 1 and 2 for deep venous thrombosis, stroke, and death. Risk of all events increased with age (P<0.0001), particularly for over 70 years (odds ratio: 12.5; 95 percent confidence interval, 7.8 to 19.9). Males had an increased risk (P<0.0001) of myocardial infarction (odds ratio; 1.5; 95 percent confidence interval, 1.0 to 2.3). Females had an increased risk (P<0.0001) of pulmonary embolism (odds ratio: 2.7; 95 percent confidence interval, 1.3 to 5.9) and deep venous thrombosis (odds ratio: 9.8; 95 percent confidence interval, 3.3 to 29.3). Risk of thromboembolic event was higher (P<0.0001) in patients with a history of arterial thrombotic events or cancer. Trend analysis indicates that thromboembolic events will increase 3-fold over the next decade. Our findings enable identification of higher risk patients for prophylactic anti-thromboembolic treatment and awareness of the critical postoperative period.

Acute Disease↗
PubMed1997

Cardiovascular events and correlates in the Veterans Affairs Diabetes Feasibility Trial. Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type II Diabetes.

BACKGROUND: The risks and benefits of intensive therapy in non-insulin-dependent diabetes mellitus (NIDDM) need to be defined. In preparation for a long-term trial, a feasibility study of 153 men in 5 medical centers compared standard vs intensive insulin therapy. OBJECTIVE: To assess the rate of development of new cardiovascular events and their correlates. METHODS: Patients with a mean +/- SD age of 60 +/- 6 years and diagnosis of NIDDM for 7.8 +/- 4.0 years were randomly assigned to a standard (1 insulin injection every morning) or to an intensive treatment arm (stepped plan from 1 evening injection of insulin, alone or with glipizide, to multiple daily injections) designed to attain near-normal glycemia levels. A 2.07% separation of glycosylated hemoglobin (HbA1c) was sustained for a mean follow-up of 27 months (P < .001). Predefined cardiovascular events were assessed by a committee unaware of treatment assignment. RESULTS: Mild and moderate hypoglycemic events were more frequent in the intensive than in the standard treatment arm (16.5 vs 1.5 per patient per year, respectively). Mean insulin dose was 23% lower in the standard treatment arm (P < .001). There were 61 new cardiovascular events in 24 patients (32%) in the intensive treatment arm and in 16 patients (20%) in the standard treatment arm (P = .10). There was no difference in total and cardiovascular mortality (n = 5 and n = 3 in the intensive and standard treatment arms, respectively) or in new events in patients with cardiovascular history (n = 10 in each arm). In Cox regression analysis, the only significant correlate for new cardiovascular events was previous cardiovascular disease (P = .04). Entering in the analysis any baseline cardiovascular abnormality, the regression model indicated a lower HbA1c level prior to the event as the only correlate for new cardiovascular events (P = .05). CONCLUSION: A long-term prospective trial is needed to assess the risk-benefit ratio of intensive insulin therapy for NIDDM in patients who require it.

Aged↗
PubMed2002

Prognostic value of 2D echocardiography in patients presenting with acute chest pain and non-diagnostic ECG for ST-elevation myocardial infarction.

The purpose of the present study was to test the hypothesis that early detection of regional wall motion abnormalities (WMA) by 2D echocardiography (ECHO) accurately predicts further cardiac events in patients presenting with acute chest pain. A prospective analysis was performed in subjects admitted with the first presentation of acute chest pain and a non-diagnostic ECG for acute ST-elevation myocardial infarction. Patients with known coronary artery disease were excluded. All subjects were contacted by phone for a 30days follow-up regarding cardiac events defined as PCI/CABG, AMI, and death. In 132 consecutive patients (89 male, 43 female) complete data sets consisting of case history (H; abnormal: typical angina), ECG (abnormal: ST-depression, T-inversion, atypical ST-elevation, LBBB), serum markers (TnI; abnormal: elevation of troponin I=0.5 ng/ml), ECHO (abnormal: WMA) and follow-up were available. In 45 patients, 60 cardiac events occurred (three deaths, 24 AMI, 33 PCI/CABG). Positive (PPV; %) and negative predictive values (NPV; %) of ECHO were superior to all other diagnostic tests (P<0.05 each) for adverse cardiac events, evolving AMI or death, and superior to history and ECG for later need of revascularisation (PCI/ACVB). Multivariate analysis revealed that WMA in ECHO predict cardiac events independently of age, gender, and the common combination of investigations (H/ECG/TnI). A significant independent impact of ECHO was also determined for the prediction of AMI/death or PCI/CABG. The study shows that early 2D echocardiography provides superior prognostic information concerning the risk of subsequent complications in patients with acute chest pain and a non-diagnostic ECG for ST-elevation-AMI.

Acute Disease↗
PubMed2006

The evolutionary history of Drosophila buzzatii. XXXVI. Molecular structural analysis of Osvaldo retrotransposon insertions in colonizing populations unveils drift effects in founder events.

Previous work on transposable element distribution in colonizing populations of Drosophila buzzatii revealed a high frequency of occupancy in several chromosomal sites. Two explanatory hypotheses were advanced: the founder hypothesis, by which founder genetic drift was responsible, and the unstable hypothesis that assigns this unusual distribution to bursts of transposition toward some chromosomal sites. Here, we study the molecular structure of three euchromatic Osvaldo clones isolated from sites occupied at high (A4 and B9) and low frequency (B4) in colonizing populations, to test these hypotheses. Large insertions, duplications, and indels in the Osvaldo coding region and LTR were detected in the A4 clone and a truncated Osvaldo with many substitutions was found in the B9 clone. These altered sequences indicate that the two copies of this retroelement are precolonization insertions. Interestingly, the LTR of the A4 clone and the reverse transcriptase region of B9 show identical sequences in all colonizing populations indicating, most probably, that they are identical by descent. Moreover, Osvaldo is inserted at the same nucleotide site in all colonizing populations. On the other hand an almost identical LTR sequence, except by 1 base deletion, was found in the B4 clone compared to the canonical active Osvaldo element. These results suggest that Osvaldo copies in highly occupied sites are, most probably, identical by descent and strongly favor the founder hypothesis. On the other hand, low-insertion-frequency sites could represent recent transposition events. This work emphasizes the importance of molecular population studies to disentangle the effects of genetic drift and transposition in colonization.

Animals↗
PubMed2003

Prognostic value of dobutamine stress echocardiography in patients with diabetes.

OBJECTIVE: The aim of this study was to assess the incremental value of dobutamine stress echocardiography (DSE) for the risk stratification of diabetic patients who are unable to perform an adequate exercise stress test. Exercise capacity is frequently impaired in patients with diabetes. The role of pharmacologic stress echocardiography in the risk stratification of diabetic patients has not been well defined. RESEARCH DESIGN AND METHODS: We studied 396 diabetic patients (mean age 61 +/- 11 years, 252 men [64%]) with limited exercise capacity who underwent DSE for evaluation of known or suspected coronary artery disease (CAD). End points were hard cardiac events (cardiac death and nonfatal myocardial infarction) and all causes of mortality. RESULTS: During a median follow-up of 3 years, 97 patients (24%) died (55 cardiac deaths), and 27 patients had nonfatal myocardial infarction. In an incremental multivariate analysis model, clinical predictors of hard cardiac events were history of congestive heart failure, previous myocardial infarction, hypercholesterolemia, and ejection fraction at rest. The percentage of ischemic segments was incremental to the clinical model in the prediction of hard cardiac events (chi(2) = 37 vs. 18, P < 0.05). Clinical predictors of all causes of mortality were history of congestive heart failure, age, hypercholesterolemia, and ejection fraction at rest. Wall motion score index at peak stress was incremental to the clinical model in the prediction of mortality (chi(2) = 52 vs. 43, P < 0.05). CONCLUSIONS: DSE provides incremental data for the prediction of mortality and hard cardiac events in patients with diabetes who are unable to perform an adequate exercise stress test.

Adrenergic beta-Agonists↗
PubMed2005

Prevalence and correlates of metabolic syndrome (MS) in older adults.

Metabolic syndrome (MS) is known to increase risks for cardiovascular disease. Risks for cardiovascular disease also increase with aging. The aim of the study was to describe prevalence and correlates of MS in older adults. Patients aged 65 years and over without any acute illness that were referred to our geriatrics unite for comprehensive geriatric assessment were included in this cross-sectional study. MS was defined by using the WHO and the National Cholesterol Education Program (NCEP) definitions. The correlates were age, gender, low-grade inflammation as assessed by C-reactive protein (CRP) levels, high-homocysteine, total and LDL cholesterol, lipoprotein-a (Lip-a), apolipoprotein-A (Apo-A), apolipoprotein-B (Apo-B), nutrition point, coronary artery disease (CAD) and cerebrovascular event history. Total 1255 patients, 789 (62.9%) females, 466 (37.1%) males with a mean age of 71.8+/-6.3 years were included in our study. MS prevalence was 16.2% with WHO definition and 23.8% with NCEP definition. Prevalence of CAD in MS and non-metabolic syndrome (non-MS) patients was 38.4% versus 29.5% (p=0.010) in WHO and 35.3% versus 29.6% (p=0.066) in NCEP group, respectively. Prevalence of cerebrovascular event history was 11.3% versus 6.2% in WHO (p=0.008) and 9.9% versus 6.1% (p=0.026) in NCEP group, respectively. Multiple logistic regression analysis was performed to investigate the independent association of variables with the MS. Female sex, high-homocysteine, low-grade inflammation, CAD and cerebrovascular event history was found to be associated with both modified WHO and NCEP MS groups in the multivariate analysis. This study has shown that MS is common in elderly patients with strongly related to CAD and cerebrovascular events. Low grade inflammation as assessed by CRP and high-homocysteine level is strongly related to MS.

Aged↗
PubMed2000

Acute myocardial infarction in young adults: prognostic role of angiotensin-converting enzyme, angiotensin II type I receptor, apolipoprotein E, endothelial constitutive nitric oxide synthase, and glycoprotein IIIa genetic polymorphisms at medium-term follow-up.

BACKGROUND: A number of reports have investigated the association between various gene polymorphisms and the phenotypic expression of myocardial infarction. No investigations have evaluated the prognostic role of genetic factors in young people with premature coronary disease. The aim of this study was to investigate the influence of genetic factors compared with that of conventional risk factors on follow-up events in a population of Italian young adults with myocardial infarction. METHODS AND RESULTS: The study population consisted of 106 young patients (mean age 40 +/- 4 years, range 23 to 45 years) with diagnosis of acute myocardial infarction. Clinical and genetic data from the group of patients with events during follow-up were compared with those from patients without events. The following genetic polymorphisms were tested: angiotensin I converting enzyme, angiotensin II type I receptor, apolipoprotein E (ApoE), endothelial constitutive nitric oxide synthase, and platelet glycoprotein IIIa. Coronary angiography was performed in 94 patients. Coronary angiography showed coronary artery disease in 93% of patients. During follow-up (46 +/- 12 months, range 25 to 72) the overall combined end points (cardiac death, myocardial infarction, and revascularization procedures) accounted for 21 events. Family history of coronary artery disease, smoking, stenosis of the left anterior descending artery at coronary angiography, and ApoE polymorphism (presence of epsilon4 allele) were significantly more prevalent (univariate analysis) in the group of patients with events. Logistic multivariate analysis showed that ApoE polymorphism (P =. 004, odds ratio [OR] 6.8, 95% confidence interval [CI] 2 to 22), family history (P =.005, OR 8.3, 95% CI 2 to 35), smoking after acute myocardial infarction (P =.008, OR 10.9, 95% CI 2 to 62), and left anterior descending coronary artery disease (P =.02. OR 6.6, 95% CI 1.3 to 33) were independent predictors of adverse events. CONCLUSIONS: Myocardial infarction at a young age is commonly characterized by evidence of multiple cardiovascular risk factors and by a favorable prognosis in short- and medium-term follow-up. Evidence of significant disease at coronary angiography suggests the presence of a premature atherosclerotic process. ApoE polymorphism (presence of epsilon4 allele) appears to be a strong independent predictor of adverse events, suggesting a remarkable influence in the accelerated coronary disease.

Adult↗
PubMed1998

Comment on "Social contagion, adolescent sexual behavior, and pregnancy: a nonlinear dynamic EMOSA model".

The epidemic model of the onset of social activities (EMOSA model) for adolescent sexuality by J. L. Rodgers, D. C. Rowe, and M. Buster (1998) is examined. Strengths of the model include the nonlinear dynamic specification that seems reasonably realistic and the potential when used as a theoretical tool to generate new hypotheses for further testing at the individual level. Limitations include the lack of a well-developed statistical framework, the inability to include a variety of predictors to capture both social contagion and individual differences in the same model, and the focus on aggregate-level data. The EMOSA model for sexuality can be reparameterized to a hazard rate or an event history model that eliminates these shortcomings. Growth curve analysis represents another analytic alternative for the EMOSA model that also does not have these limitations.

Adolescent↗
PubMedDate not supplied

Premorbid conditions and precipitating events in early-onset panic disorder.

This study investigates differences in premorbid conditions and in the role of triggering events in the onset of early-onset versus adult-onset panic disorder (PD). Two hundred forty-one outpatients with a principal diagnosis of PD (DSM-IV) were evaluated using a semistructured interview to generate axis I and axis II diagnoses according to DSM-IV, and to collect family history of psychiatric disorders and life events. For statistical analysis the sample was subdivided in two groups according to age at onset (< or =18 years or >18 years). Early-onset and adult-onset patients with PD do not differ in the severity of the disorder and in the interference with their overall functioning. Early-onset patients have (1) higher familial loading for psychiatric disorders in general and for PD in particular; (2) higher frequency of preceding anxiety disorders, dysmorphophobia, and bulimia nervosa; and (3) higher comorbidity rates for personality disorders and particularly for disorders of the "anxious-fearful" cluster. The data we found on life stress indicate that the environmental factors play a major role in the development and/or in precipitating the onset of adult-onset PD. Our findings suggest that the early-onset form of PD seems to be more characterized by endogenous components compared to the adult-onset form.

Adult↗
PubMed1999

The medical dictionary for regulatory activities (MedDRA).

The International Conference on Harmonisation has agreed upon the structure and content of the Medical Dictionary for Regulatory Activities (MedDRA) version 2.0 which should become available in the early part of 1999. This medical terminology is intended for use in the pre- and postmarketing phases of the medicines regulatory process, covering diagnoses, symptoms and signs, adverse drug reactions and therapeutic indications, the names and qualitative results of investigations, surgical and medical procedures, and medical/social history. It can be used for recording adverse events and medical history in clinical trials, in the analysis and tabulations of data from these trials and in the expedited submission of safety data to government regulatory authorities, as well as in constructing standard product information and documentation for applications for marketing authorisation. After licensing of a medicine, it may be used in pharmacovigilance and is expected to be the preferred terminology for international electronic regulatory communication. MedDRA is a hierarchical terminology with 5 levels and is multiaxial: terms may exist in more than 1 vertical axis, providing specificity of terms for data entry and flexibility in data retrieval. Terms in MedDRA were derived from several sources including the WHO's adverse reaction terminology (WHO-ART), Coding Symbols for a Thesaurus of Adverse Reaction Terms (COSTART), International Classification of Diseases (ICD) 9 and ICD9-CM. It will be maintained, further developed and distributed by a Maintenance Support Services Organisation (MSSO). It is anticipated that using MedDRA will improve the quality of data captured on databases, support effective analysis by providing clinically relevant groupings of terms and facilitate electronic communication of data, although as a new tool, users will need to invest time in gaining expertise in its use.

Adverse Drug Reaction Reporting Systems↗
PubMed1999

Frequency of musculoskeletal injuries and risk factors associated with injuries incurred in Quarter Horses during races.

OBJECTIVE: To determine the frequency and anatomic location of musculoskeletal injuries incurred by Quarter Horses during races and to compare data from injured horses and matched control horses. DESIGN: Matched case-control study. ANIMALS: 97 Quarter Horses that sustained a musculoskeletal injury during races and 291 horses from the same races that were not injured. PROCEDURE: Data examined included racing history, race-entrant characteristics, racing events determined by analysis of videotapes of races, and, when performed, results of prerace physical inspections. Data for injured horses were compared with data for control horses, using conditional logistic regression. RESULTS: Incidence of a catastrophic injury among Quarter Horses during races was approximately 0.8/1,000 race starts, whereas incidence of musculoskeletal injury during racing was approximately 2.2/1,000 race starts. Odds of musculoskeletal injury were approximately 8 times greater among horses assessed to be at increased risk of injury on the basis of results of prerace physical inspection than for horses not considered to be at increased risk of injury. Evidence was lacking that 2-year-old horses were at increased risk of injury or that sex influenced the risk of injury among Quarter Horses during races. CONCLUSIONS AND CLINICAL RELEVANCE: Incidence of racing injury among Quarter Horses appears to be lower than that observed among Thoroughbreds. Regulatory veterinarians can identify horses at increased risk of injury on the basis of prerace physical inspection, indicating that these inspections could be used to reduce the risk of injury during races.

Age Factors↗
PubMed1990

[An analysis of the circadian frequency in the onset of acute myocardial infarct].

The purpose of this study was to evaluate if the occurrence of acute myocardial infarction (AMI) follows a regular pattern during the day and, if so, to assess any difference according to sex and patients' age. To determine 24-hour trend of AMI onset, clinical recordings of patients admitted to the CCU for AMI over a period of 8 years were reviewed: 427 patients (310 men and 117 women, aged 24-95 years), with a first AMI and in whom the time of onset of cardiac pain due to MI could be accurately established by history, were selected. Analysis of hourly distribution of the event was performed using a mathematical model based on Whittaker's method for periodic phenomena. It showed the occurrence is cyclic with 2 waves with periods of 6 and 12 hours in all age groups in men an women. No statistical differences were found between observed figures of periods and values calculated by Fourier analysis. The overall occurrence of MI showed a regular pattern with 4 peaks at 4.00 am, 10.00 am, 4.00 am and 10.00 pm. This periodic behaviour is nearly the same both in men and in women. The occurrence of MI is maximal in the morning (34.2% in men, and 35.9% in women); the minimum was recorded during the evening in male patients over 70 years and during the night in the other age groups; it was recorded during the afternoon and the night in women.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1997

Racing-related factors and results of prerace physical inspection and their association with musculoskeletal injuries incurred in thoroughbreds during races.

OBJECTIVE: To describe and compare data from Thoroughbreds that sustained musculoskeletal injuries while racing with data from matched control horses. DESIGN: Matched case-control study. ANIMALS: 216 Thoroughbreds that sustained a musculoskeletal injury while racing and 532 horses from the same races that were not injured. PROCEDURE: Data regarding racing history, race-entrant characteristics, racing events determined by analysis of videotapes of races, and results of prerace physical inspections were determined for all horses. Injured horses were compared with control horses by using conditional logistic regression. RESULTS: Results of prerace inspection by regulatory veterinarians were significantly associated with injury. Odds of musculoskeletal injury, injury of the suspensory apparatus of the forelimb, and injury of the tendon of the superficial digital flexor muscle of the forelimb were 5.5 to 13.5 times greater among horses assessed to be at increased risk of injury by regulatory veterinarians on the basis of results of prerace inspection than for horses not considered to be at increased risk of injury. Odds of an abnormal finding in the suspensory ligament during prerace inspection were 3.4 times greater among horses that injured the suspensory apparatus than among control horses, and odds of an abnormal finding in the tendon of the superficial digital flexor muscle during prerace inspection were 15 times greater among horses that injured the tendon than among control horses. CLINICAL IMPLICATIONS: Regulatory veterinarians can identify horses during prerace physical inspection that have an increased risk of injury during races. Prerace physical inspections could be used to reduce the risk of injury to Thoroughbreds during races.

Animals↗
PubMed2000

Family relationships in prediction of ageing.

This paper presents a study of the predictive value of family relationships from genealogies, and its impact on the delayed ageing. The study comprised adult population over 18 years of age of two urban family practices (N = 1700). The study sample included all patients (total = 581; 57.3% female, 42.7% male) having sought medical assistance of any kind in the period of three consecutive months. The study was performed in two stages. The selection of patients according to the results of the 25th and 75th percentiles of the memory component analysis was done in stage I. The comparison of life history and events across a genealogy in the groups of the 25th and 75th percentile memory deficit was done in stage II. The method used in stage I was a psychological test--Pictures of Object Test (POT) to test the memory deficit. In stage II, personal life histories and description of the genealogies were obtained by individuals' associations expressed in the form of a free text which was then analyzed statistically (SPAD-T), and the results were correlated to data read on the developed genogram. The statistical text analysis of life-events recall and the correlation across a genealogy showed a difference in the patterns of family relationships across a genealogy in the two study groups, and their predictive value for prevention in family practice.

Adolescent↗
PubMed1993

Lipoprotein(a) and apolipoproteins B and A-1 in children and coronary vascular events in their grandparents.

Because premature coronary vascular disease in a first-degree relative increases risk of the disease and the mechanisms may include genetically determined abnormal levels of circulating apolipoproteins, we explored the relationships between schoolchildren's apolipoprotein levels and coronary events in their parents and grandparents. We measured capillary blood concentrations of lipoprotein(a) (Lp(a) and apolipoproteins (apo B and apo A-1) in dried blood spot samples obtained by finger prick from 2010 schoolchildren aged 8 to 12 years, and questioned parents about coronary vascular events in the children's parents and grandparents. Of the 2010 questionnaires sent, 1030 (51%) were returned fully completed. Twenty-three fathers, one mother, and 645 grandparents had had coronary vascular events. There were significant associations between increased Lp(a) levels in children and the numbers of grandparents with coronary vascular events and with increasing grandparent coronary history scores (p < 0.01). There were also positive associations for apo B (p < 0.01) but none for apo A-1. Discriminate analysis showed that the log-transformed Lp(a) level was the variable most predictive of event numbers and of history scores in grandparents (Wilks lambda value = 0.984; p = 0.026); the apo B level was also predictive (Wilks lambda value = 0.988; p = 0.041), but neither the apo A-1 level nor the apo B/A-1 ratio was. We conclude that high Lp(a) and apo B levels in children aged 8 to 12 years are associated with increased risk of coronary vascular disease in older family members, even with a generation gap. These apolipoproteins may largely account for the independent contribution of family history to disease risk. Measurements of Lp(a) and apo B in schoolchildren may help to identify children and their families at increased risk and may facilitate targeting of prevention.

Adult↗
PubMed2005

Importance of implant technique on risk of major paravalvular leak (PVL) after St. Jude mechanical heart valve replacement: a report from the Artificial Valve Endocarditis Reduction Trial (AVERT).

OBJECTIVE: To examine risk factors for major paravalvular leak (PVL) events after mechanical heart valve replacement. METHODS: We analyzed outcome of 807 patients randomized into the Artificial Valve Endocarditis Reduction Trial (AVERT). The mean follow-up time was 30.6 months and 21 major PVL events were reported. Three additional major PVL events associated with endocarditis were excluded from analysis. All baseline medical history variables, as well as operative parameters (including use of pledgets and suture technique) were examined using Cox regression. RESULTS: Major PVL was reported after 11 aortic, 9 mitral, and 1 double valve replacement. 6/404 (1.5%) patients with conventional valves experienced a major PVL event versus 15/403 (3.7%) in the Silzone group. 10/172 (5.8%) patients with valve suture technique without pledgets experienced a major PVL event versus 11/635 (1.7%) patients with pledgets. Final multivariable model showed that only suture technique without pledgets (p=0.005) was an independent significant risk factor for major PVL events. Silzone cuff showed a strong trend (p=0.055). CONCLUSIONS: Suture technique without pledgets is an independent significant risk factor for major PVL events. In this study, use of pledgets during valve replacement had a protective effect against subsequent paravalvular leak, supporting the use of buttress reinforcement for valve suture. The use of Silzone cuff, although not statistically significant, showed a strong trend as a risk factor.

Aged↗
PubMed2000

[Analysis of factors associated with anticoagulant treatment indication in chronic atrial fibrillation. Prospective study of 170 patients admitted at an internal medicine service].

BACKGROUND: Anticoagulant therapy reduces the risk of stroke among patients with chronic atrial fibrillation. The objective of this study was to evaluate the use of anticoagulant therapy and to analyze the factors associated with the indication of anticoagulants in patients with chronic atrial fibrillation. PATIENTS AND METHODS: Prospective study of all patients with chronic atrial fibrillation admitted to our Department of Internal Medicine from February 1997 to September 1998. From each patient data related to the cause of atrial fibrillation, other associated vascular risk factors, use of anticoagulant and/or antiplatelet agents and contraindication to anticoagulants were recorded. RESULTS: A total of 170 patients with chronic atrial fibrillation were studied. The mean age of patients was 77 years (range: 49-94). One hundred and four patients (61%) were older than 75 years. Atrial fibrillation was the main cause for admission only in 11 patients (6.5%). One hundred and sixty-seven patients (98%) had indication for receiving anticoagulant therapy; however, it was indicated in only 67 patients (39%). In other 68 patients (40%), antiplatelet agents were used. Patients over 75 years received anticoagulants less frequently (p < 0.0001). Factors associated with the prescription of anticoagulants in the bivariate analysis included: diabetes mellitus (p = 0.046), high cholesterol level (p = 0.023), age < or = 75 years old (p < 0.0001), history of previous embolic events (p = 0.001) and valvular atrial fibrillation (p < 0.0001). The multivariate analysis showed that only two factors were indeed associated with the prescription of anticoagulants: age < or = 75 years (OR: 6.15) and valvular atrial fibrillation (OR: 4.24). CONCLUSIONS: Anticoagulant therapy is underused in patients with chronic atrial fibrillation, particularly in elderly patients.

Aged↗
PubMed1981

The junior hospital doctors' pay dispute 1975-1976: an analysis of events, issues and conflicts.

In late 1975, for the first time in the history of the National Health Service, junior hospital doctors in the United Kingdom took industrial action. Their pay and working conditions were basic issues, but the dispute was complex. The first part of this article describes these complexities - the significant events, and the grievances and their resolution. In the second part the dispute is analysed in terms of its causes, effects and implications, particularly for the medical profession. The ambivalence, confusion and ignorance about the new contract and the question of breaking government pay policy, problems of representation, and conflicts of interests within the profession are highlighted. It is suggested that the significant economic gains of the junior doctors were not achieved by industrial action.

Conflict, Psychological↗