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Sample records for all-cause ed visits

  1. Beyond Core Indicators of Retention in HIV Care: Missed Clinic Visits Are Independently Associated With All-Cause Mortality

    PubMed Central

    Mugavero, Michael J.; Westfall, Andrew O.; Cole, Stephen R.; Geng, Elvin H.; Crane, Heidi M.; Kitahata, Mari M.; Mathews, W. Christopher; Napravnik, Sonia; Eron, Joseph J.; Moore, Richard D.; Keruly, Jeanne C.; Mayer, Kenneth H.; Giordano, Thomas P.; Raper, James L.

    2014-01-01

    Background. The continuum of care is at the forefront of the domestic human immunodeficiency virus (HIV) agenda, with the Institute of Medicine (IOM) and Department of Health and Human Services (DHHS) recently releasing clinical core indicators. Core indicators for retention in care are calculated based on attended HIV care clinic visits. Beyond these retention core indicators, we evaluated the additional prognostic value of missed clinic visits for all-cause mortality. Methods. We conducted a multisite cohort study of 3672 antiretroviral-naive patients initiating antiretroviral therapy (ART) during 2000–2010. Retention in care was measured by the IOM and DHHS core indicators (2 attended visits at defined intervals per 12-month period), and also as a count of missed primary HIV care visits (no show) during a 24-month measurement period following ART initiation. All-cause mortality was ascertained by query of the Social Security Death Index and/or National Death Index, with adjusted survival analyses starting at 24 months after ART initiation. Results. Among participants, 64% and 59% met the IOM and DHHS retention core indicators, respectively, at 24 months. Subsequently, 332 patients died during 16 102 person-years of follow-up. Failure to achieve the IOM and DHHS indicators through 24 months following ART initiation increased mortality (hazard ratio [HR] = 2.23; 95% confidence interval [CI], 1.79–2.80 and HR = 2.36; 95% CI, 1.89–2.96, respectively). Among patients classified as retained by the IOM or DHHS clinical core indicators, >2 missed visits further increased mortality risk (HR = 3.61; 95% CI, 2.35–5.55 and HR = 3.62; 95% CI, 2.30–5.68, respectively). Conclusions. Beyond HIV retention core indicators, missed clinic visits were independently associated with all-cause mortality. Caution is warranted in relying solely upon retention in care core indicators for policy, clinical, and programmatic purposes. PMID:25091306

  2. ED Patients with Prolonged Complaints and Repeat ED Visits Have an Increased Risk of Depression

    PubMed Central

    Brickman, Kristopher R.; Bahl, Rajiv; Marcinkowski, Nathan F.; Ammons, Katelyn R.; Akpunonu, Peter

    2016-01-01

    Introduction The objective of this study was to explore associations between presenting chief complaints of prolonged symptomatology, patient usage of the emergency department (ED), and underlying depression so that emergency physicians may better target patients for depression screening. Methods A convenience sample of ED patients were administered the Beck Depression Inventory-II (BDI-II) to assess for depression. We correlated completed BDI-II surveys to patient information including demographics, pertinent history of present illness information, and past medical history. Results Out of 425 participants screened, we identified complaints of two weeks or longer in 92 patients (22%). Of these patients, mild to severe depression was recognized in over half of the population (47), yet only nine patients reported a prior depression diagnosis. These 92 patients also visited the ED three times as frequently as those patients with more acute complaints (p<0.001). Finally, our study showed that patients with mild to severe depression had three times as many ED visits compared to patients with minimal or no depression (p<0.001). Conclusion Patients with complaints of symptomatology two weeks or longer are more likely to have underlying depression when presenting to the ED. Patients with three or more ED visits within the past year also have a greater incidence of underlying depression. We found a strong correlation between complaints with symptomatology of two weeks or longer and multiple ED visits, in which underlying depression may have contributed to these patients’ ED visits. PMID:27625727

  3. Air pollution and ED visits for chest pain.

    PubMed

    Szyszkowicz, Mieczyslaw

    2009-02-01

    This was a study of 157,028 emergency department (ED)-diagnosed visits for chest pain (International Classification of Diseases, Ninth Revision [ICD-9]: 786) in 6 cities in Canada. The generalized linear mixed methods technique was applied to analyze the relations between daily counts of ED visits for chest pain on the levels of ambient air pollutants after adjusting for meteorological variables. The daily counts of visits were analyzed separately for the whole period (January-December), warm (April-September), and cold (October-March). The results are presented in the form of the excess risks associated with an increase in the mean values of the pollutant concentrations. The highest increase was obtained for nitrogen dioxide (NO2) exposure in the warm period as follows: 5.9% (95% confidence interval, 3.3-5.8) for mean value equals to 20.1 ppb. The associations of ED visits for chest pain with air pollution are very similar to the associations of ED visits related to cardiac problems. PMID:19371523

  4. Change in incidence of clinic visits for all-cause and rotavirus gastroenteritis in young children following the introduction of universal rotavirus vaccination in Israel.

    PubMed

    Muhsen, Khitam; Chodick, Gabriel; Goren, Sophy; Anis, Emilia; Ziv-Baran, Tomer; Shalev, Varda; Cohen, Dani

    2015-01-01

    Both rotavirus vaccines RotaTeq and Rotarix were efficacious against severe rotavirus gastroenteritis in clinical trials; yet real-world data on the effect of rotavirus vaccines on mild to moderate disease are limited. We used a large computerised database of Maccabi Health Services Health Maintenance Organisation (HMO), the second largest HMO in Israel covering 25% of the Israeli population, to compare the incidence of acute gastroenteritis (AGE) clinic visits in community settings (n=302,445) before (2005-10) and after (2011-13) the introduction of universal rotavirus immunisation in Israel. We retrieved laboratory results of rotavirus antigen tests (n=18,133) and using a weighted analysis, we estimated the impact of rotavirus immunisation on the disease burden of rotavirus AGE clinic visits. Following the introduction of universal rotavirus immunisation, the typical winter peaks of rotavirus AGE were substantially lower and significant reductions of 14.8% (95% confidence interval (CI): 13.5-16.1) in all-cause AGE clinic visits and of 59.7% (95% CI: 59.8-62.6) in rotavirus AGE clinic visits were observed. The decrease was observed in all age groups, but it was greater in children aged 0 to 23 months than those aged 24 to 59 months. Continued rotavirus laboratory surveillance is warranted to monitor the sustainability of these changes.

  5. Change in incidence of clinic visits for all-cause and rotavirus gastroenteritis in young children following the introduction of universal rotavirus vaccination in Israel.

    PubMed

    Muhsen, Khitam; Chodick, Gabriel; Goren, Sophy; Anis, Emilia; Ziv-Baran, Tomer; Shalev, Varda; Cohen, Dani

    2015-01-01

    Both rotavirus vaccines RotaTeq and Rotarix were efficacious against severe rotavirus gastroenteritis in clinical trials; yet real-world data on the effect of rotavirus vaccines on mild to moderate disease are limited. We used a large computerised database of Maccabi Health Services Health Maintenance Organisation (HMO), the second largest HMO in Israel covering 25% of the Israeli population, to compare the incidence of acute gastroenteritis (AGE) clinic visits in community settings (n=302,445) before (2005-10) and after (2011-13) the introduction of universal rotavirus immunisation in Israel. We retrieved laboratory results of rotavirus antigen tests (n=18,133) and using a weighted analysis, we estimated the impact of rotavirus immunisation on the disease burden of rotavirus AGE clinic visits. Following the introduction of universal rotavirus immunisation, the typical winter peaks of rotavirus AGE were substantially lower and significant reductions of 14.8% (95% confidence interval (CI): 13.5-16.1) in all-cause AGE clinic visits and of 59.7% (95% CI: 59.8-62.6) in rotavirus AGE clinic visits were observed. The decrease was observed in all age groups, but it was greater in children aged 0 to 23 months than those aged 24 to 59 months. Continued rotavirus laboratory surveillance is warranted to monitor the sustainability of these changes. PMID:26538450

  6. Population-Based Burden of COPD-Related Visits in the ED

    PubMed Central

    Lippmann, Steven J.; Waller, Anna E.; Hassmiller Lich, Kristen; Travers, Debbie; Weinberger, Morris; Donohue, James F.

    2013-01-01

    Background: Little is known about the population-based burden of ED care for COPD. Methods: We analyzed statewide ED surveillance system data to quantify the frequency of COPD-related ED visits, hospital admissions, and comorbidities. Results: In 2008 to 2009 in North Carolina, 97,511 COPD-related ED visits were made by adults ≥ 45 years of age, at an annual rate of 13.8 ED visits/1,000 person-years. Among patients with COPD (n = 33,799), 7% and 28% had a COPD-related return ED visit within a 30- and 365-day period of their index visit, respectively. Compared with patients on private insurance, Medicare, Medicaid, and noninsured patients were more likely to have a COPD-related return visit within 30 and 365 days and have three or more COPD-related visits within 365 days. There were no differences in return visits by sex. Fifty-one percent of patients with COPD were admitted to the hospital from the index ED visit. Subsequent hospital admission risk in the cohort increased with age, peaking at 65 to 69 years (risk ratio [RR], 1.41; 95% CI, 1.26-1.57); there was no difference by sex. Patients with congestive heart failure (RR, 1.29; 95% CI, 1.22-1.37), substance-related disorders (RR, 1.35; 95% CI, 1.13-1.60), or respiratory failure/supplemental oxygen (RR, 1.25; 95% CI, 1.19-1.31) were more likely to have a subsequent hospital admission compared with patients without these comorbidities. Conclusions: The population-based burden of COPD-related care in the ED is significant. Further research is needed to understand variations in COPD-related ED visits and hospital admissions. PMID:23579283

  7. Trends in Hospital Admission and Surgical Procedures Following ED visits for Diverticulitis

    PubMed Central

    Greenwood-Ericksen, Margaret B.; Havens, Joaquim M.; Ma, Jiemin; Weissman, Joel S.; Schuur, Jeremiah D.

    2016-01-01

    Introduction Diverticulitis is a common diagnosis in the emergency department (ED). Outpatient management of diverticulitis is safe in selected patients, yet the rates of admission and surgical procedures following ED visits for diverticulitis are unknown, as are the predictive patient characteristics. Our goal is to describe trends in admission and surgical procedures following ED visits for diverticulitis, and to determine which patient characteristics predict admission. Methods : We performed a cross-sectional descriptive analysis using data on ED visits from 2006–2011 to determine change in admission and surgical patterns over time. The Nationwide Emergency Department Sample database, a nationally representative administrative claims dataset, was used to analyze ED visits for diverticulitis. We included patients with a principal diagnosis of diverticulitis (ICD-9 codes 562.11, 562.13). We analyzed the rate of admission and surgery in all admitted patients and in low-risk patients, defined as age <50 with no comorbidities (Elixhauser). We used hierarchical multivariate logistic regression to identify patient characteristics associated with admission for diverticulitis. Results Fryom 2006 to 2011 ED visits for diverticulitis increased by 21.3% from 238,248 to 302,612, while the admission rate decreased from 55.7% to 48.5% (−7.2%, 95% CI [−7.78 to −6.62]; p<0.001 for trend). The admission rate among low-risk patients decreased from 35.2% in 2006 to 26.8% in 2011 (−8.4%, 95% CI [−9.6 to −7.2]; p<0.001 for trend). Admission for diverticulitis was independently associated with male gender, comorbid illnesses, higher income and commercial health insurance. The surgical rate decreased from 6.5% in 2006 to 4.7% in 2011 (−1.8%, 95% CI [−2.1 to −1.5]; p<0.001 for trend), and among low-risk patients decreased from 4.0% to 2.2% (−1.8%, 95% CI [−4.5 to −1.7]; p<0.001 for trend). Conclusion From 2006 to 2011 ED visits for diverticulitis increased

  8. Exposure to Community Violence is Associated with Asthma Hospitalizations and ED Visits

    PubMed Central

    Apter, Andrea J.; Garcia, Laura A.; Boyd, Rhonda C.; Wang, Xingmei; Bogen, Daniel K.; Have, Thomas Ten

    2010-01-01

    Background Exposure to community violence (ECV) has been associated with asthma morbidity of children living in inner-city neighborhoods. Objective To examine with prospective longitudinal data whether ECV is independently associated with asthma-related health outcomes in adults. Methods Adults with moderate-severe asthma, recruited from clinics serving inner-city neighborhoods, completed questionnaires covering socio-demographics, asthma severity, and ECV and were followed for 26 weeks. Longitudinal models were employed to assess unadjusted and adjusted associations of subsequent asthma outcomes (emergency department (ED) visits, hospitalizations, FEV1, quality of life). Results 397 adults, 47±14 years, 73% female, 70% African American, 7% Latino, mean FEV1 66%±19%, 133 with hospitalizations and 222 with ED visits for asthma in the year before entry were evaluated. 91 reported ECV. Controlling for age, gender, race/ethnicity, and household income, those exposed to violence had 2.27 (95% CI: 1.32-3.90) times more asthma-related ED visits per month and 2.49 (95% CI: 1.11-5.60) times more asthma-related hospitalizations per month over the 26-week study period compared to those unexposed. Violence-exposed participants also had 1.71 (95% CI: 1.14-2.56) times more overall ED visits per month and 1.72 (95% CI: 0.95-3.11) times more overall hospitalizations per month from any cause. Asthma-related quality of life was lower in the violence-exposed participants (-0.40 (95%CI: -0.77-0.025), p=0.04). Effect modification by depressive symptoms was only statistically significant for the ECV association with overall ED visits and quality of life outcomes (p<.01). Conclusion In adults, ECV is associated with increased hospitalizations and emergency care for asthma or any condition and with asthma-related quality of life. PMID:20816190

  9. Visits to US Emergency Departments by 20 to 29 Year-olds with Chief Complaint of Toothache during 2001–2010

    PubMed Central

    McKinney, Christy M.; Lee, Helen H.; Melbye, Molly L.; Rue, Tessa C.

    2015-01-01

    Background Visits to emergency departments (EDs) for dental complaints are on the rise, yet reliance on EDs for dental care is far from ideal. ED toothache visits represent opportunities to improve access to professional dental care. Methods This research focuses on 20–29 year-olds, who account for more ED toothache visits than other age groups. We analyzed publicly available ED visits data from the National Hospital Ambulatory Medical Care Survey (NHAMCS). We assessed trends in ED toothache visit rates compared with back pain and all-cause ED visits during the past decade. We used 2009–2010 NHAMCS to characterize the more recent magnitude, relative frequency, and independent risk factors for ED toothache visits. Statistical analyses accounted for the complex sampling design. Results The average annual increase in ED visit rates among 20–29 year-olds during 2001–2010 was 6.1% for toothache; 0.3% for back pain; and 0.8% for all-causes ED visits. In 2009–2010, 20–29 year-olds made an estimated 1.27 million ED visits for toothaches and accounted for 42% of all ED toothache visits. Toothache was the fifth most common reason for any ED visit and third most common for uninsured ED visits in 20–29 year-olds. Independent risk factors for ED toothache visits were being uninsured or Medicaid-insured. Conclusions Younger adults increasingly rely on EDs for toothaches—likely because of barriers to accessing professional dental care. Expanding dental coverage and access to affordable dental care could increase options for timely dental care and decrease ED use for dental complaints. PMID:25925521

  10. Inpatient Readmissions and Emergency Department Visits within 30 Days of a Hospital Admission

    PubMed Central

    Brennan, Jesse J.; Chan, Theodore C.; Killeen, James P.; Castillo, Edward M.

    2015-01-01

    Introduction Inpatient hospital readmissions have become a focus for healthcare reform and cost-containment efforts. Initiatives targeting unanticipated readmissions have included care coordination for specific high readmission diseases and patients and health coaching during the post-discharge transition period. However, little research has focused on emergency department (ED) visits following an inpatient admission. The objective of this study was to assess 30-day ED utilization and all-cause readmissions following a hospital admission. Methods This was a retrospective study using inpatient and ED utilization data from two hospitals with a shared patient population in 2011. We assessed the 30-day ED visit rate and 30-day readmission rate and compared patient characteristics among individuals with 30-day inpatient readmissions, 30-day ED discharges, and no 30-day visits. Results There were 13,449 patients who met the criteria of an index visit. Overall, 2,453 (18.2%) patients had an ED visit within 30 days of an inpatient stay. However, only 55.6% (n=1,363) of these patients were admitted at one of these 30-day visits, resulting in a 30-day all-cause readmission rate of 10.1%. Conclusion Approximately one in five patients presented to the ED within 30 days of an inpatient hospitalization and over half of these patients were readmitted. Readmission measures that incorporate ED visits following an inpatient stay might better inform interventions to reduce avoidable readmissions. PMID:26759647

  11. Emergency department visit volume variability

    PubMed Central

    Kang, Seung Woo; Park, Hyun Soo

    2015-01-01

    Objective One of the most important and basic variables in emergency department (ED) operations is patient visit volumes. This variable is usually predicted on the basis of the average ED patient visit volume over a certain period. However, ED patient visit variability is poorly understood. Therefore, we evaluated ED patient visit variability in order to determine if the average can be used to operate EDs. Methods Nationwide ED patient visit data were from the standard emergency patient data of the National Emergency Department Information System. The data are transferred automatically by 141 EDs nationwide. The hourly ED visit volumes over 365 days were determined, and the variability was analyzed to evaluate the representativeness of the average. Results A total of 4,672,275 patient visits were collected in 2013. The numbers of daily ED patient visits were widely dispersed and positively skewed rather than symmetric and narrow with a normal distribution. Conclusion The daily variability of ED visit is too large and it did not show normal distribution. The average visit volume does not adequately represent ED operation. PMID:27752589

  12. An Observational Study to Evaluate the Prevalence of Erectile Dysfunction (ED) and Prescribing Pattern of Drugs in Patients with ED Visiting an Andrology Specialty Clinic, Mumbai: 2012-14

    PubMed Central

    Kulkarni, Vijay R.; Bhagat, Sagar B.; Beldar, Amit S.; Patel, Sadiq B.

    2015-01-01

    Introduction: Erectile dysfunction (ED) is a common occurrence and its incidence is expected to increase significantly along with the increase in various lifestyle diseases. The drug utilization for ED is very low. Also, studies describing the prescription pattern in ED are lacking. Materials and Methods: We conducted a retrospective cross-sectional observational study, including a drug utilization analysis, of 606 prescriptions as per the standard guidelines (WHO and STROBE). Results: Out of 606, 249 (41%) were from the age group of 30-39 years. Addictions were present in 388 (64%). Out of 606, 186 had urological, 154 had cardiovascular and 102 had psychological co-morbid disorders. Out of 348, 201 were prescribed Tadalafil (low dose) on a once daily basis. Out of 172, 121 were prescribed Sildenafil (high dose) on an ‘as and when required’ basis. Nutritional/ herbal supplements were prescribed in 126/606. The ratio of ‘Prescribed Daily Dose’ to ‘Defined Daily Dose’ of Tadalafil, Sildenafil, and Dapoxetine were 1.1, 1.3 and 1.5 respectively. Conclusion: Measures for de-addiction play an important role in the overall management of ED. The most common co-morbid disorders were urological, like BPH, LUTS, etc, followed by cardiovascular, psychological and diabetes. Overall, rational pharmacotherapy was observed. Tadalafil was the most commonly prescribed drug for ED. The main factor in the selection of a particular PDE5 inhibitor was its pharmacokinetics and cost. Udenafil, being the costliest, was the least prescribed. Dapoxetine was used in a significant number of individuals primarily for PE with ED. The combination of Papaverine, Chlorpromazine ± Alprostadil was used as intracavernosal injection in patients not responding to oral drugs. PMID:26393163

  13. Relationships between cold-temperature indices and all causes and cardiopulmonary morbidity and mortality in a subtropical island.

    PubMed

    Lin, Yu-Kai; Wang, Yu-Chun; Lin, Pay-Liam; Li, Ming-Hsu; Ho, Tsung-Jung

    2013-09-01

    This study aimed to identify optimal cold-temperature indices that are associated with the elevated risks of mortality from, and outpatient visits for all causes and cardiopulmonary diseases during the cold seasons (November to April) from 2000 to 2008 in Northern, Central and Southern Taiwan. Eight cold-temperature indices, average, maximum, and minimum temperatures, and the temperature humidity index, wind chill index, apparent temperature, effective temperature (ET), and net effective temperature and their standardized Z scores were applied to distributed lag non-linear models. Index-specific cumulative 26-day (lag 0-25) mortality risk, cumulative 8-day (lag 0-7) outpatient visit risk, and their 95% confidence intervals were estimated at 1 and 2 standardized deviations below the median temperature, comparing with the Z score of the lowest risks for mortality and outpatient visits. The average temperature was adequate to evaluate the mortality risk from all causes and circulatory diseases. Excess all-cause mortality increased for 17-24% when average temperature was at Z=-1, and for 27-41% at Z=-2 among study areas. The cold-temperature indices were inconsistent in estimating risk of outpatient visits. Average temperature and THI were appropriate indices for measuring risk for all-cause outpatient visits. Relative risk of all-cause outpatient visits increased slightly by 2-7% when average temperature was at Z=-1, but no significant risk at Z=-2. Minimum temperature estimated the strongest risk associated with outpatient visits of respiratory diseases. In conclusion, the relationships between cold temperatures and health varied among study areas, types of health event, and the cold-temperature indices applied. Mortality from all causes and circulatory diseases and outpatient visits of respiratory diseases has a strong association with cold temperatures in the subtropical island, Taiwan. PMID:23764675

  14. Relationships between cold-temperature indices and all causes and cardiopulmonary morbidity and mortality in a subtropical island.

    PubMed

    Lin, Yu-Kai; Wang, Yu-Chun; Lin, Pay-Liam; Li, Ming-Hsu; Ho, Tsung-Jung

    2013-09-01

    This study aimed to identify optimal cold-temperature indices that are associated with the elevated risks of mortality from, and outpatient visits for all causes and cardiopulmonary diseases during the cold seasons (November to April) from 2000 to 2008 in Northern, Central and Southern Taiwan. Eight cold-temperature indices, average, maximum, and minimum temperatures, and the temperature humidity index, wind chill index, apparent temperature, effective temperature (ET), and net effective temperature and their standardized Z scores were applied to distributed lag non-linear models. Index-specific cumulative 26-day (lag 0-25) mortality risk, cumulative 8-day (lag 0-7) outpatient visit risk, and their 95% confidence intervals were estimated at 1 and 2 standardized deviations below the median temperature, comparing with the Z score of the lowest risks for mortality and outpatient visits. The average temperature was adequate to evaluate the mortality risk from all causes and circulatory diseases. Excess all-cause mortality increased for 17-24% when average temperature was at Z=-1, and for 27-41% at Z=-2 among study areas. The cold-temperature indices were inconsistent in estimating risk of outpatient visits. Average temperature and THI were appropriate indices for measuring risk for all-cause outpatient visits. Relative risk of all-cause outpatient visits increased slightly by 2-7% when average temperature was at Z=-1, but no significant risk at Z=-2. Minimum temperature estimated the strongest risk associated with outpatient visits of respiratory diseases. In conclusion, the relationships between cold temperatures and health varied among study areas, types of health event, and the cold-temperature indices applied. Mortality from all causes and circulatory diseases and outpatient visits of respiratory diseases has a strong association with cold temperatures in the subtropical island, Taiwan.

  15. Suicidal Ideation is Associated With All-Cause Mortality.

    PubMed

    Shiner, Brian; Riblet, Natalie; Westgate, Christine Leonard; Young-Xu, Yinong; Watts, Bradley V

    2016-09-01

    Suicidal ideation may be associated with all-cause mortality. Available research shows that treatment of depression reduces the risk of all-cause mortality in patients with suicidal ideation. However, this finding has not been replicated in a clinical population, where patients have various mental health conditions. We examined the association between suicidal ideation and all-cause mortality in a clinical cohort. We stratified patients presenting to a mental health clinic from January 2005 through December 2007 based upon their degree of suicidal ideation and obtained vital status information through June 2015. We compared groups using survival analysis, adjusting for patient characteristics and treatment receipt. Among 1,869 patients who completed the initial assessment, there were 363 deaths. Patients with the highest levels of suicidal ideation died at increased rates. Cause-of-death data in the year following the initial assessment indicates that the difference in mortality is not likely attributable to suicide. Accounting for patient characteristics and treatment, which included medical care and mental health care, did not meaningfully diminish the relationship between suicidal ideation and all-cause mortality. Additional research is needed to determine specific treatment elements that may moderate the relationship between suicidal ideation and all-cause mortality. PMID:27612350

  16. Statin Use Reduces Prostate Cancer All-Cause Mortality

    PubMed Central

    Sun, Li-Min; Lin, Ming-Chia; Lin, Cheng-Li; Chang, Shih-Ni; Liang, Ji-An; Lin, I-Ching; Kao, Chia-Hung

    2015-01-01

    Abstract Studies have suggested that statin use is related to cancer risk and prostate cancer mortality. We conducted a population-based cohort study to determine whether using statins in prostate cancer patients is associated with reduced all-cause mortality rates. Data were obtained from the Taiwan National Health Insurance Research Database. The study cohort comprised 5179 patients diagnosed with prostate cancer who used statins for at least 6 months between January 1, 1998 and December 31, 2010. To form a comparison group, each patient was randomly frequency-matched (according to age and index date) with a prostate cancer patient who did not use any type of statin-based drugs during the study period. The study endpoint was mortality. The hazard ratio (HR) and 95% confidence interval (CI) were estimated using Cox regression models. Among prostate cancer patients, statin use was associated with significantly decreased all-cause mortality (adjusted HR = 0.65; 95% CI = 0.60–0.71). This phenomenon was observed among various types of statin, age groups, and treatment methods. Analyzing the defined daily dose of statins indicated that both low- and high-dose groups exhibited significantly decreased death rates compared with nonusers, suggesting a dose–response relationship. The results of this population-based cohort study suggest that using statins reduces all-cause mortality among prostate cancer patients, and a dose–response relationship may exist. PMID:26426656

  17. Association Between Interstitial Lung Abnormalities and All-Cause Mortality

    PubMed Central

    Putman, Rachel K.; Hatabu, Hiroto; Araki, Tetsuro; Gudmundsson, Gunnar; Gao, Wei; Nishino, Mizuki; Okajima, Yuka; Dupuis, Josée; Latourelle, Jeanne C.; Cho, Michael H.; El-Chemaly, Souheil; Coxson, Harvey O.; Celli, Bartolome R.; Fernandez, Isis E.; Zazueta, Oscar E.; Ross, James C.; Harmouche, Rola; Estépar, Raúl San José; Diaz, Alejandro A.; Sigurdsson, Sigurdur; Gudmundsson, Elías F.; Eiríksdottír, Gudny; Aspelund, Thor; Budoff, Matthew J.; Kinney, Gregory L.; Hokanson, John E.; Williams, Michelle C; Murchison, John T.; MacNee, William; Hoffmann, Udo; O’Donnell, Christopher J.; Launer, Lenore J.; Harrris, Tamara B.; Gudnason, Vilmundur; Silverman, Edwin K.; O’Connor, George T.; Washko, George R.; Rosas, Ivan O.; Hunninghake, Gary M.

    2016-01-01

    IMPORTANCE Interstitial lung abnormalities have been associated with decreased six-minute walk distance, diffusion capacity for carbon monoxide and total lung capacity; however to our knowledge, an association with mortality has not been previously investigated. OBJECTIVE To investigate whether interstitial lung abnormalities are associated with increased mortality. DESIGN, SETTING, POPULATION Prospective cohort studies of 2633 participants from the Framingham Heart Study (FHS) (CT scans obtained 9/08–3/11), 5320 from the Age Gene/Environment Susceptibility (AGES)-Reykjavik (recruited 1/02–2/06), 2068 from COPDGene (recruited 11/07–4/10), and 1670 from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE) (between 12/05–12/06). EXPOSURES Interstitial lung abnormality status as determined by chest CT evaluation. MAIN OUTCOMES AND MEASURES All cause mortality over approximately 3 to 9 year median follow up time. Cause-of-death information was also examined in the AGES-Reykjavik cohort. RESULTS Interstitial lung abnormalities were present in 177 (7%) of the participants from FHS, 378 (7%) from AGES-Reykjavik, 156 (8%) from COPDGene, and in 157 (9%) from ECLIPSE. Over median follow-up times of ~3–9 years there were more deaths (and a greater absolute rate of mortality) among those with interstitial lung abnormalities compared to those without interstitial lung abnormalities in each cohort; 7% compared to 1% in FHS (6% difference, 95% confidence interval [CI] 2%, 10%), 56% compared to 33% in AGES-Reykjavik (23% difference, 95% CI 18%, 28%), 16% compared to 11% in COPDGene (5% difference, 95% CI −1%, 11%) and 11% compared to 5% in ECLIPSE (6% difference, 95% CI 1%, 11%). After adjustment for covariates, interstitial lung abnormalities were associated with an increase in the risk of death in the FHS (HR=2.7, 95% CI, 1.1–65, P=0.030), AGES-Reykjavik (HR 1.3, 95% CI 1.2–1.4, P<0.001), COPDGene (HR=1.8, 95% CI, 1.1, 2

  18. Randomized trial of pragmatic education for low-risk COPD patients: impact on hospitalizations and emergency department visits

    PubMed Central

    Siddique, Haamid H; Olson, Raymond H; Parenti, Connie M; Rector, Thomas S; Caldwell, Michael; Dewan, Naresh A; Rice, Kathryn L

    2012-01-01

    Background: Most interventions aimed at reducing hospitalizations and emergency department (ED) visits in patients with chronic obstructive pulmonary disease (COPD) have employed resource-intense programs in high-risk individuals. Although COPD is a progressive disease, little is known about the effectiveness of proactive interventions aimed at preventing hospitalizations and ED visits in the much larger population of low-risk (no known COPD-related hospitalizations or ED visits in the prior year) patients, some of whom will eventually become high-risk. Methods: We tested the effect of a simple educational and self-efficacy intervention (n = 2243) versus usual care (n = 2182) on COPD/breathing-related ED visits and hospitalizations in a randomized study of low-risk patients at three Veterans Affairs (VA) medical centers in the upper Midwest. Administrative data was used to track VA admissions and ED visits. A patient survey was used to determine health-related events outside the VA. Results: Rates of COPD-related VA hospitalizations in the education and usual care group were not significantly different (3.4 versus 3.6 admissions per 100 person-years, respectively; 95% CI of difference −1.3 to 1.0, P = 0.77). The much higher patient-reported rates of non-VA hospitalizations for breathing-related problems were lower in the education group (14.0 versus 19.0 per 100 person-years; 95% CI −8.6 to −1.4, P = 0.006). Rates of COPD-related VA ED visits were not significantly different (6.8 versus 5.3; 95% CI −0.1 to 3.0, P = 0.07), nor were non-VA ED visits (32.4 versus 36.5; 95% CI −9.3 to 1.1, P = 0.12). All-cause VA admission and ED rates did not differ. Mortality rates (6.9 versus 8.3 per 100 person-years, respectively; 95% CI −3.0 to 0.4, P = 0.13) did not differ. Conclusion: An educational intervention that is practical for large numbers of low-risk patients with COPD may reduce the rate of breathing-related hospitalizations. Further research that more

  19. Emergency department visits and proximity to patients' residences, 2009-2010.

    PubMed

    Brown, Amy M; Decker, Sandra L; Selck, Frederic W

    2015-03-01

    The number of emergency department (ED) visits rose 44% from 1991 through 2010, even as the number of hospital EDs declined 10% over the same period. As a result, EDs have increasingly experienced overcrowding and longer waiting times. However, little is known about which ED patients visit, how often patients go to the ED closest to their home, and how differences in geography, patient demographics, and hospital characteristics are associated with ED selection patterns. PMID:25932892

  20. Treatment of Nausea and Vomiting in Pregnancy: Factors Associated with ED Revisits

    PubMed Central

    Sharp, Brian R.; Sharp, Kristen M.; Patterson, Brian; Dooley-Hash, Suzanne

    2016-01-01

    Introduction Nausea and vomiting in pregnancy (NVP) is a condition that commonly affects women in the first trimester of pregnancy. Despite frequently leading to emergency department (ED) visits, little evidence exists to characterize the nature of ED visits or to guide its treatment in the ED. Our objectives were to evaluate the treatment of NVP in the ED and to identify factors that predict return visits to the ED for NVP. Methods We conducted a retrospective database analysis using the electronic medical record from a single, large academic hospital. Demographic and treatment variables were collected using a chart review of 113 ED patient visits with a billing diagnosis of “nausea and vomiting in pregnancy” or “hyperemesis gravidarum.” Logistic regression analysis was used with a primary outcome of return visit to the ED for the same diagnoses. Results There was wide treatment variability of nausea and vomiting in pregnancy patients in the ED. Of the 113 patient visits, 38 (33.6%) had a return ED visit for NVP. High gravidity (OR 1.31, 95% CI [1.06–1.61]), high parity (OR 1.50 95% CI [1.12–2.00]), and early gestational age (OR 0.74 95% CI [0.60–0.90]) were associated with an increase in return ED visits in univariate logistic regression models, while only early gestational age (OR 0.74 95% CI [0.59–0.91]) was associated with increased return ED visits in a multiple regression model. Admission to the hospital was found to decrease the likelihood of return ED visits (p=0.002). Conclusion NVP can be difficult to manage and has a high ED return visit rate. Optimizing care with aggressive, standardized treatment in the ED and upon discharge, particularly if factors predictive of return ED visits are present, may improve quality of care and reduce ED utilization for this condition. PMID:27625723

  1. Treatment of Nausea and Vomiting in Pregnancy: Factors Associated with ED Revisits

    PubMed Central

    Sharp, Brian R.; Sharp, Kristen M.; Patterson, Brian; Dooley-Hash, Suzanne

    2016-01-01

    Introduction Nausea and vomiting in pregnancy (NVP) is a condition that commonly affects women in the first trimester of pregnancy. Despite frequently leading to emergency department (ED) visits, little evidence exists to characterize the nature of ED visits or to guide its treatment in the ED. Our objectives were to evaluate the treatment of NVP in the ED and to identify factors that predict return visits to the ED for NVP. Methods We conducted a retrospective database analysis using the electronic medical record from a single, large academic hospital. Demographic and treatment variables were collected using a chart review of 113 ED patient visits with a billing diagnosis of “nausea and vomiting in pregnancy” or “hyperemesis gravidarum.” Logistic regression analysis was used with a primary outcome of return visit to the ED for the same diagnoses. Results There was wide treatment variability of nausea and vomiting in pregnancy patients in the ED. Of the 113 patient visits, 38 (33.6%) had a return ED visit for NVP. High gravidity (OR 1.31, 95% CI [1.06–1.61]), high parity (OR 1.50 95% CI [1.12–2.00]), and early gestational age (OR 0.74 95% CI [0.60–0.90]) were associated with an increase in return ED visits in univariate logistic regression models, while only early gestational age (OR 0.74 95% CI [0.59–0.91]) was associated with increased return ED visits in a multiple regression model. Admission to the hospital was found to decrease the likelihood of return ED visits (p=0.002). Conclusion NVP can be difficult to manage and has a high ED return visit rate. Optimizing care with aggressive, standardized treatment in the ED and upon discharge, particularly if factors predictive of return ED visits are present, may improve quality of care and reduce ED utilization for this condition.

  2. Fine particulate matter components and emergency department visits among a privately insured population in Greater Houston.

    PubMed

    Liu, Suyang; Ganduglia, Cecilia M; Li, Xiao; Delclos, George L; Franzini, Luisa; Zhang, Kai

    2016-10-01

    Although adverse health effects of PM2.5 (particulate matter with aerodynamic diameter less than 2.5μm) mass have been extensively studied, it remains unclear regarding which PM2.5 components are most harmful. No studies have reported the associations between PM2.5 components and adverse health effects among a privately insured population. In our study, we estimated the short-term associations between exposure to PM2.5 components and emergency department (ED) visits for all-cause and cause-specific diseases in Greater Houston, Texas, during 2008-2013 using ED visit data extracted from a private insurance company (Blue Cross Blue Shield Texas [BCBSTX]). A total of 526,453 ED visits were included in our assessment, with an average of 236 (±63) visits per day. We selected 20 PM2.5 components from the U.S. Environmental Protection Agency's Chemical Speciation Network site located in Houston, and then applied Poisson regression models to assess the previously mentioned associations. Interquartile range increases in bromine (0.003μg/m(3)), potassium (0.048μg/m(3)), sodium ion (0.306μg/m(3)), and sulfate (1.648μg/m(3)) were statistically significantly associated with the increased risks in total ED of 0.71% (95% confidence interval (CI): 0.06, 1.37%), 0.71% (95% CI: 0.21, 1.22%), 1.28% (95% CI: 0.34, 2.24%), and 1.22% (95% CI: 0.23, 2.23%), respectively. Seasonal analysis suggested strongest associations occurred during the warm season. Our findings suggest that a privately insured population, presumably healthier than the general population, may be still at risk of adverse health effects due to exposure to ambient PM2.5 components. PMID:27235902

  3. Emergency Department Visits for Drug-Related Suicide Attempts Involving Antidepressants by Adolescents and Young Adults: 2004 to 2008. The DAWN Report

    ERIC Educational Resources Information Center

    Substance Abuse and Mental Health Services Administration, 2011

    2011-01-01

    In 2008, adolescents made 23,124 visits to the emergency department (ED) for drug-related suicide attempts, and young adults made 38,036 such visits; of these visits, 23.0 percent (5,312 visits) among adolescents and 17.6 percent (6,700 visits) among young adults involved antidepressants. Among ED visits for suicide attempts involving…

  4. Body Mass Index (BMI) and All-Cause Mortality Pooling Project

    Cancer.gov

    The BMI and All-Cause Mortality Pooling Project quantified the risk associated with being overweight and the extent to which the relationship between BMI and all-cause mortality varies by certain factors.

  5. Aftercare, Emergency Department Visits, and Readmission in Adolescents

    ERIC Educational Resources Information Center

    Carlisle, Corine E.; Mamdani, Muhammad; Schachar, Russell; To, Teresa

    2012-01-01

    Objective: U.S. and Canadian data demonstrate decreasing inpatient days, increasing nonurgent emergency department (ED) visits, and short supply of child psychiatrists. Our study aims to determine whether aftercare reduces ED visits and/or readmission in adolescents with first psychiatric hospitalization. Method: We conducted a population-based…

  6. Visiting Professorships

    NASA Astrophysics Data System (ADS)

    Applications are now being accepted for the National Science Foundation (NSF) Visiting Professorships for Women Program. Under this program, women scientists and engineers from industry, government, and academia can be visiting professors at academic institutions in the United States.The program's objectives are to provide opportunities for women to advance their careers in the disciplines of science and engineering that are supported by NSF to provide greater visibility and wider opportunities for women scientists and engineers employed in industry, government, and academic institutions, and to provide encouragement for other women to pursue careers in science and engineering through the awardees' research, lecturing, counseling, and mentoring activities.

  7. Duration of patients’ visits to the hospital emergency department

    PubMed Central

    2012-01-01

    Background Length of stay is an important indicator of quality of care in Emergency Departments (ED). This study explores the duration of patients’ visits to the ED for which they are treated and released (T&R). Methods Retrospective data analysis and multivariate regression analysis were conducted to investigate the duration of T&R ED visits. Duration for each visit was computed by taking the difference between admission and discharge times. The Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) for 2008 were used in the analysis. Results The mean duration of T&R ED visit was 195.7 minutes. The average duration of ED visits increased from 8 a.m. until noon, then decreased until midnight at which we observed an approximately 70-minute spike in average duration. We found a substantial difference in mean duration of ED visits (over 90 minutes) between Mondays and other weekdays during the transition time from the evening of the day before to the early morning hours. Black / African American patients had a 21.4-minute longer mean duration of visits compared to white patients. The mean duration of visits at teaching hospitals was substantially longer than at non-teaching hospitals (243.8 versus 175.6 minutes). Hospitals with large bed size were associated with longer duration of visits (222.2 minutes) when compared to hospitals with small bed size (172.4 minutes) or those with medium bed size (166.5 minutes). The risk-adjusted results show that mean duration of visits on Mondays are longer by about 4 and 9 percents when compared to mean duration of visits on non-Monday workdays and weekends, respectively. Conclusions The duration of T&R ED visits varied significantly by admission hour, day of the week, patient volume, patient characteristics, hospital characteristics and area characteristics. PMID:23126473

  8. The contribution of health anxiety to retrospectively-recalled emergency department visits within a sample of patients in residential substance abuse treatment.

    PubMed

    Fergus, Thomas A; Bardeen, Joseph R; Gratz, Kim L; Fulton, Jessica J; Tull, Matthew T

    2015-01-01

    With the burden of emergency department (ED) use increasing, research examining the factors associated with ED visits among individuals who use the ED most frequently is needed. Given that substance use is strongly linked to ED visits, this study sought to examine the factors associated with greater ED visits among patients with substance use disorders (SUD). More precisely, we examined whether health anxiety incrementally contributes to the prediction of ED visits for medical care among adult patients (N = 118) in a residential substance abuse disorder treatment facility. As predicted, health anxiety was significantly positively correlated with ED visits during the past year. Furthermore, health anxiety remained a significant predictor of ED visits after accounting for sociodemographic variables, frequency of substance use, and physical health status. These results suggest that health anxiety may contribute to increased ED visits for medical care among individuals with SUD.

  9. Visiting 'Voltaire'

    NASA Technical Reports Server (NTRS)

    2005-01-01

    [figure removed for brevity, see original site] Annotated image of PIA04192 Sitting on 'Voltaire'

    Spirit's panoramic camera took this mosaic on martian day, or sol, 549 (July 20, 2005), as it approached a suite of layered rocks named 'Voltaire.' Seven to eight discrete layers can be seen in the bottom portion of the image, running from upper left to lower right. These rock layers are about 20 to 40 centimeters (8 to 16 inches) wide, and extend several meters in length. Spirit visited 'Haussmann' and several other rocks within the layered suite to perform close-up imaging, and to obtain measurements from its Moessbauer and alpha particle X-ray spectrometers.

  10. The association between office-based provider visits and emergency department utilization among Medicaid beneficiaries.

    PubMed

    Widmer, Andrew J; Basu, Rashmita; Hochhalter, Angela K

    2015-06-01

    The purpose of our study was to describe the relationship between office-based provider visits and emergency department (ED) utilization by adult Medicaid beneficiaries. Data were extracted from the publicly-available Medical Expenditure Panel Survey, a nationally representative sample of the civilian non-institutionalized population in the United States. The sample included 1,497 respondents who had full year Medicaid coverage in 2009. Study variables included insurance coverage type, usual source of care, chronic illnesses, and beneficiary demographics. Multivariate analyses were conducted to describe associations between individual characteristics and (a) likelihood of any ED utilization, and (b) number of ED visits by those who utilized the ED at least once in the study year. The analysis was adjusted for demographic characteristics and chronic health conditions. A greater number of office-based provider visits was associated with a higher likelihood of ED utilization. Among those with at least one ED visit, a greater number of office-based visits was associated with a higher number of ED visits. A respondent's age, history of hypertension or myocardial infarction, and Hispanic/Latino ethnicity were associated with having one or more ED visits; age and Hispanic/Latino ethnicity were associated with total number of ED visits among those with at least one. In this representative sample of adult Medicaid beneficiaries, there was no evidence that office-based provider visits reduced ED utilization. Office visits were associated with higher ED utilization, as were certain chronic conditions, older age, and Hispanic/Latino ethnicity. Findings do not support efforts to reduce ED utilization by increasing office-based visits alone.

  11. Preventing infections when visiting

    MedlinePlus

    ... Elsevier Saunders; 2013:chap 36. Infection control. In: Mills JE, ed. Nursing Procedures . 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:chap 2. Pollock M. Universal precautions. ...

  12. Red meat and processed meat consumption and all-cause mortality: a meta-analysis.

    PubMed

    Larsson, Susanna C; Orsini, Nicola

    2014-02-01

    High consumption of red meat and processed meat has been associated with increased risk of several chronic diseases. We conducted a meta-analysis to summarize the evidence from prospective studies on red meat and processed meat consumption in relationship to all-cause mortality. Pertinent studies were identified by searching PubMed through May 2013 and by reviewing the reference lists of retrieved articles. Prospective studies that reported relative risks with 95% confidence intervals for the association of red meat or processed meat consumption with all-cause mortality were eligible. Study-specific results were combined by using a random-effects model. Nine prospective studies were included in the meta-analysis. The summary relative risks of all-cause mortality for the highest versus the lowest category of consumption were 1.10 (95% confidence interval (CI): 0.98, 1.22; n = 6 studies) for unprocessed red meat, 1.23 (95% CI: 1.17, 1.28; n = 6 studies) for processed meat, and 1.29 (95% CI: 1.24, 1.35; n = 5 studies) for total red meat. In a dose-response meta-analysis, consumption of processed meat and total red meat, but not unprocessed red meat, was statistically significantly positively associated with all-cause mortality in a nonlinear fashion. These results indicate that high consumption of red meat, especially processed meat, may increase all-cause mortality.

  13. High-Efficiency Postdilution Online Hemodiafiltration Reduces All-Cause Mortality in Hemodialysis Patients

    PubMed Central

    Moreso, Francesc; Pons, Mercedes; Ramos, Rosa; Mora-Macià, Josep; Carreras, Jordi; Soler, Jordi; Torres, Ferran; Campistol, Josep M.; Martinez-Castelao, Alberto

    2013-01-01

    Retrospective studies suggest that online hemodiafiltration (OL-HDF) may reduce the risk of mortality compared with standard hemodialysis in patients with ESRD. We conducted a multicenter, open-label, randomized controlled trial in which we assigned 906 chronic hemodialysis patients either to continue hemodialysis (n=450) or to switch to high-efficiency postdilution OL-HDF (n=456). The primary outcome was all-cause mortality, and secondary outcomes included cardiovascular mortality, all-cause hospitalization, treatment tolerability, and laboratory data. Compared with patients who continued on hemodialysis, those assigned to OL-HDF had a 30% lower risk of all-cause mortality (hazard ratio [HR], 0.70; 95% confidence interval [95% CI], 0.53–0.92; P=0.01), a 33% lower risk of cardiovascular mortality (HR, 0.67; 95% CI, 0.44–1.02; P=0.06), and a 55% lower risk of infection-related mortality (HR, 0.45; 95% CI, 0.21–0.96; P=0.03). The estimated number needed to treat suggested that switching eight patients from hemodialysis to OL-HDF may prevent one annual death. The incidence rates of dialysis sessions complicated by hypotension and of all-cause hospitalization were lower in patients assigned to OL-HDF. In conclusion, high-efficiency postdilution OL-HDF reduces all-cause mortality compared with conventional hemodialysis. PMID:23411788

  14. High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients.

    PubMed

    Maduell, Francisco; Moreso, Francesc; Pons, Mercedes; Ramos, Rosa; Mora-Macià, Josep; Carreras, Jordi; Soler, Jordi; Torres, Ferran; Campistol, Josep M; Martinez-Castelao, Alberto

    2013-02-01

    Retrospective studies suggest that online hemodiafiltration (OL-HDF) may reduce the risk of mortality compared with standard hemodialysis in patients with ESRD. We conducted a multicenter, open-label, randomized controlled trial in which we assigned 906 chronic hemodialysis patients either to continue hemodialysis (n=450) or to switch to high-efficiency postdilution OL-HDF (n=456). The primary outcome was all-cause mortality, and secondary outcomes included cardiovascular mortality, all-cause hospitalization, treatment tolerability, and laboratory data. Compared with patients who continued on hemodialysis, those assigned to OL-HDF had a 30% lower risk of all-cause mortality (hazard ratio [HR], 0.70; 95% confidence interval [95% CI], 0.53-0.92; P=0.01), a 33% lower risk of cardiovascular mortality (HR, 0.67; 95% CI, 0.44-1.02; P=0.06), and a 55% lower risk of infection-related mortality (HR, 0.45; 95% CI, 0.21-0.96; P=0.03). The estimated number needed to treat suggested that switching eight patients from hemodialysis to OL-HDF may prevent one annual death. The incidence rates of dialysis sessions complicated by hypotension and of all-cause hospitalization were lower in patients assigned to OL-HDF. In conclusion, high-efficiency postdilution OL-HDF reduces all-cause mortality compared with conventional hemodialysis.

  15. Effects of Running on Chronic Diseases and Cardiovascular and All-Cause Mortality.

    PubMed

    Lavie, Carl J; Lee, Duck-chul; Sui, Xuemei; Arena, Ross; O'Keefe, James H; Church, Timothy S; Milani, Richard V; Blair, Steven N

    2015-11-01

    Considerable evidence has established the link between high levels of physical activity (PA) and all-cause and cardiovascular disease (CVD)-specific mortality. Running is a popular form of vigorous PA that has been associated with better overall survival, but there is debate about the dose-response relationship between running and CVD and all-cause survival. In this review, we specifically reviewed studies published in PubMed since 2000 that included at least 500 runners and 5-year follow-up so as to analyze the relationship between vigorous aerobic PA, specifically running, and major health consequences, especially CVD and all-cause mortality. We also made recommendations on the optimal dose of running associated with protection against CVD and premature mortality, as well as briefly discuss the potential cardiotoxicity of a high dose of aerobic exercise, including running (eg, marathons). PMID:26362561

  16. The impact of prescription opioids on all-cause mortality in Canada.

    PubMed

    Imtiaz, Sameer; Rehm, Jürgen

    2016-01-01

    An influential study from the United States generated considerable discussion and debate. This study documented rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century, with clear linkages of all-cause mortality to increasing rates of poisonings, suicides and chronic liver disease deaths. All of these causes of deaths are strongly related to the use of legal and illegal substances, but the study stressed the importance of prescription opioids. Given the similarities between the United States and Canada in prescription opioid use, the assessment of similar all-cause mortality trends is relevant for Canada. As this commentary highlights, the all-cause mortality shifts seen in the United States cannot be seen in Canada for either sex or age groups. The exact reasons for the differences between the two countries are not clear, but it is important for public health to further explore this question. PMID:27476513

  17. Validation of an algorithm to determine the primary care treatability of emergency department visits

    PubMed Central

    Jeffery, Molly Moore; Bellolio, M Fernanda; Wolfson, Julian; Abraham, Jean M; Dowd, Bryan E; Kane, Robert L

    2016-01-01

    Objectives We propose a new claims-computable measure of the primary care treatability of emergency department (ED) visits and validate it using a nationally representative sample of Medicare data. Study design and setting This is a validation study using 2011–2012 Medicare claims data for a nationally representative 5% sample of fee-for-service beneficiaries to compare the new measure's performance to the Ballard variant of the Billings algorithm in predicting hospitalisation and death following an ED visit. Outcomes Hospitalisation within 1 day or 1 week of an ED visit; death within 1 week or 1 month of an ED visit. Results The Minnesota algorithm is a strong predictor of hospitalisations and deaths, with performance similar to or better than the most commonly used existing algorithm to assess the severity of ED visits. The Billings/Ballard algorithm is a better predictor of death within 1 week of an ED visit; this finding is entirely driven by a small number of ED visits where patients appear to have been dead on arrival. Conclusions The procedure-based approach of the Minnesota algorithm allows researchers to use the clinical judgement of the ED physician, who saw the patient to determine the likely severity of each visit. The Minnesota algorithm may thus provide a useful tool for investigating ED use in Medicare beneficiaries. PMID:27566637

  18. Do Patient-Centered Medical Homes Reduce Emergency Department Visits?

    PubMed Central

    David, Guy; Gunnarsson, Candace; Saynisch, Philip A; Chawla, Ravi; Nigam, Somesh

    2015-01-01

    Objective To assess whether adoption of the patient-centered medical home (PCMH) reduces emergency department (ED) utilization among patients with and without chronic illness. Data Sources Data from approximately 460,000 Independence Blue Cross patients enrolled in 280 primary care practices, all converting to PCMH status between 2008 and 2012. Research Design We estimate the effect of a practice becoming PCMH-certified on ED visits and costs using a difference-in-differences approach which exploits variation in the timing of PCMH certification, employing either practice or patient fixed effects. We analyzed patients with and without chronic illness across six chronic illness categories. Principal Findings Among chronically ill patients, transition to PCMH status was associated with 5–8 percent reductions in ED utilization. This finding was robust to a number of specifications, including analyzing avoidable and weekend ED visits alone. The largest reductions in ED visits are concentrated among chronic patients with diabetes and hypertension. Conclusions Adoption of the PCMH model was associated with lower ED utilization for chronically ill patients, but not for those without chronic illness. The effectiveness of the PCMH model varies by chronic condition. Analysis of weekend and avoidable ED visits suggests that reductions in ED utilization stem from better management of chronic illness rather than expanding access to primary care clinics. PMID:25112834

  19. Improving ED efficiency to capture additional revenue.

    PubMed

    Mandavia, Sujal; Samaniego, Loretta

    2016-06-01

    An increase in the number of patients visiting emergency departments (EDs) presents an opportunity for additional revenue if hospitals take four steps to optimize resources: Streamline the patient pathway and reduce the amount of time each patient occupies a bed in the ED. Schedule staff according to the busy and light times for patient arrivals. Perform registration and triage bedside, reducing initial wait times. Create an area for patients to wait for test results so beds can be freed up for new arrivals. PMID:27451568

  20. Weight change and all-cause mortality in older adults: A meta-analysis

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This meta-analysis of observational cohort studies examined the association between weight change (weight loss, weight gain, and weight fluctuation) and all-cause mortality among older adults. We used PubMed (MEDLINE), Web of Science, and Cochrane Library to identify prospective studies published in...

  1. Prospective study of coffee consumption and all-cause, cancer, and cardiovascular mortality in Swedish women.

    PubMed

    Löf, Marie; Sandin, Sven; Yin, Li; Adami, Hans-Olov; Weiderpass, Elisabete

    2015-09-01

    We investigated whether coffee consumption was associated with all-cause, cancer, or cardiovascular mortality in a prospective cohort of 49,259 Swedish women. Of the 1576 deaths that occurred in the cohort, 956 were due to cancer and 158 were due to cardiovascular disease. We used Cox proportional hazard models with adjustment for potential confounders to estimate multivariable relative risks (RR) and 95 % confidence intervals (CI). Compared to a coffee consumption of 0-1 cups/day, the RR for all cause-mortality was 0.81 (95 % CI 0.69-0.94) for 2-5 cups/day and 0.88 (95 % CI 0.74-1.05) for >5 cups/day. Coffee consumption was not associated with cancer mortality or cardiovascular mortality when analyzed in the entire cohort. However, in supplementary analyses of women over 50 years of age, the RR for all cause-mortality was 0.74 (95 % CI 0.62-0.89) for 2-5 cups/day and 0.86 (95 % CI 0.70-1.06) for >5 cups/day when compared to 0-1 cups/day. In this same subgroup, the RRs for cancer mortality were 1.06 (95 % CI 0.81-1.38) for 2-5 cups/day and 1.40 (95 % CI 1.05-1.89) for >5 cups/day when compared to 0-1 cups/day. No associations between coffee consumption and all-cause mortality, cancer mortality, or cardiovascular mortality were observed among women below 50 years of age. In conclusion, higher coffee consumption was associated with lower all-cause mortality when compared to a consumption of 0-1 cups/day. Furthermore, coffee may have differential effects on mortality before and after 50 years of age.

  2. Symmetric Dimethylarginine as Predictor of Graft loss and All-Cause Mortality in Renal Transplant Recipients

    PubMed Central

    Pihlstrøm, Hege; Mjøen, Geir; Dahle, Dag Olav; Pilz, Stefan; Midtvedt, Karsten; März, Winfried; Abedini, Sadollah; Holme, Ingar; Fellström, Bengt; Jardine, Alan; Holdaas, Hallvard

    2014-01-01

    Background Elevated symmetric dimethylarginine (SDMA) has been shown to predict cardiovascular events and all cause mortality in diverse populations. The potential role of SDMA as a risk marker in renal transplant recipients (RTR) has not been investigated. Methods We analyzed SDMA in the placebo arm of the Assessment of Lescol in Renal Transplantation study, a randomized controlled trial of fluvastatin in RTR. Mean follow-up was 5.1 years. Patients were grouped into quartiles based on SDMA levels at study inclusion. Relationships between SDMA and traditional risk factors for graft function and all-cause mortality were analyzed in 925 RTR using univariate and multivariate survival analyses. Results In univariate analysis, SDMA was significantly associated with renal graft loss, all-cause death, and major cardiovascular events. After adjustment for established risk factors including estimated glomerular filtration rate, an elevated SDMA-level (4th quartile, >1.38 μmol/L) was associated with renal graft loss; hazard ratio (HR), 5.51; 95% confidence interval (CI), 1.95–15.57; P=0.001, compared to the 1st quartile. Similarly, SDMA in the 4th quartile was independently associated with all-cause mortality (HR, 4.56; 95% CI, 2.15–9.71; P<0.001), and there was a strong borderline significant trend for an association with cardiovascular mortality (HR, 2.86; 95% CI, 0.99–8.21; P=0.051). Conclusion In stable RTR, an elevated SDMA level is independently associated with increased risk of all-cause mortality and renal graft loss. PMID:24999963

  3. Non–Emergency Department (ED) Interventions to Reduce ED Utilization: A Systematic Review

    PubMed Central

    Morgan, Sofie Rahman; Chang, Anna Marie; Alqatari, Mahfood; Pines, Jesse M.

    2014-01-01

    Objectives Recent health policy changes have focused efforts on reducing emergency department (ED) visits as a way to reduce costs and improve quality of care. This was a systematic review of interventions based outside the ED aimed at reducing ED use. Methods This study was designed as a systematic review. We reviewed the literature on interventions in five categories: patient education, creation of additional non-ED capacity, managed care, prehospital diversion, and patient financial incentives. Studies written in English, with interventions administered outside of the ED, and a comparison group where ED use was an outcome, were included. Two independent reviewers screened search results using MEDLINE, Cochrane, OAIster, or Scopus. The following data were abstracted from included studies: type of intervention, study design, population, details of intervention, effect on ED use, effect on non-ED health care use, and other health and financial outcomes. Quality of individual articles was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines. Results Of 39 included studies, 34 were observational and five were randomized controlled trials. Two of five studies on patient education found reductions in ED use ranging from 21% to 80%. Out of 10 studies of additional non-ED capacity, four showed decreases of 9% to 54%, and one a 21% increase. Both studies on prehospital diversion found reductions of 3% to 7%. Of 12 studies on managed care, 10 had decreases ranging from 1% to 46%. Nine out of 10 studies on patient financial incentives found decreases of 3% to 50%, and one a 34% increase. Nineteen studies reported effect on non-ED use with mixed results. Seventeen studies included data on health outcomes, but 13 of these only included data on hospitalizations rather than morbidity and mortality. Seven studies included data on cost outcomes. According to the GRADE guidelines, all studies had at least some risk of bias, with four

  4. Housework Reduces All-Cause and Cancer Mortality in Chinese Men

    PubMed Central

    Yu, Ruby; Leung, Jason; Woo, Jean

    2013-01-01

    Background Leisure time physical activity has been extensively studied. However, the health benefits of non-leisure time physical activity, particular those undertaken at home on all-cause and cancer mortality are limited, particularly among the elderly. Methods We studied physical activity in relation to all-cause and cancer mortality in a cohort of 4,000 community-dwelling elderly aged 65 and older. Leisure time physical activity (sport/recreational activity and lawn work/yard care/gardening) and non-leisure time physical activity (housework, home repairs and caring for another person) were self-reported on the Physical Activity Scale for the Elderly. Subjects with heart diseases, stroke, cancer or diabetes at baseline were excluded (n = 1,133). Results Among the 2,867 subjects with a mean age of 72 years at baseline, 452 died from all-cause and 185 died from cancer during the follow-up period (2001–2012). With the adjustment for age, education level and lifestyle factors, we found an inverse association between risk of all-cause mortality and heavy housework among men, with the adjusted hazard ratio (HR) of 0.72 (95%CI = 0.57–0.92). Further adjustment for BMI, frailty index, living arrangement, and leisure time activity did not change the result (HR = 0.71, 95%CI = 0.56–0.91). Among women, however, heavy housework was not associated with all-cause mortality. The risk of cancer mortality was significantly lower among men who participated in heavy housework (HR = 0.52, 95%CI = 0.35–0.78), whereas among women the risk was not significant. Men participated in light housework also were at lower risk of cancer mortality than were their counterparts, however, the association was not significant. Leisure time physical activity was not related to all-cause or cancer mortality in either men or women. Conclusion Heavy housework is associated with reduced mortality and cancer deaths over a 9-year period. The underlying mechanism needs further

  5. Presence of a Community Health Center and Uninsured Emergency Department Visit Rates in Rural Counties

    ERIC Educational Resources Information Center

    Rust, George; Baltrus, Peter; Ye, Jiali; Daniels, Elvan; Quarshie, Alexander; Boumbulian, Paul; Strothers, Harry

    2009-01-01

    Context: Community health centers (CHCs) provide essential access to a primary care medical home for the uninsured, especially in rural communities with no other primary care safety net. CHCs could potentially reduce uninsured emergency department (ED) visits in rural communities. Purpose: We compared uninsured ED visit rates between rural…

  6. Reduction of drinking in problem drinkers and all-cause mortality.

    PubMed

    Rehm, J; Roerecke, M

    2013-01-01

    Alcohol consumption has been linked with considerable mortality, and reduction of drinking, especially of heavy drinking, has been suggested as one of the main measures to reduce alcohol-attributable mortality. Aggregate-level studies including but not limited to natural experiments support this suggestion; however, causality cannot be established in ecological analysis. The results of individual-level cohort studies are ambiguous. On the other hand, randomized clinical trials with problem drinkers show that brief interventions leading to a reduction of average drinking also led to a reduction of all-cause mortality within 1 year. The results of these studies were pooled and a model for reduction of drinking in heavy drinkers and its consequences for all-cause mortality risk was estimated. Ceteris paribus, the higher the level of drinking, the stronger the effects of a given reduction. Implications for interventions and public health are discussed. PMID:23531718

  7. Fatty liver disease: Disparate predictive ability for cardiometabolic risk and all-cause mortality

    PubMed Central

    Onat, Altan; Can, Günay; Kaya, Ayşem; Akbaş, Tuğba; Özpamuk-Karadeniz, Fatma; Şimşek, Barış; Çakır, Hakan; Yüksel, Hüsniye

    2015-01-01

    AIM: To assess the association of a surrogate of fatty liver disease (FLD) with incident type-2 diabetes, coronary heart disease, and all-cause mortality. METHODS: In a prospective population-based study on 1822 middle-aged adults, stratified to gender, we used an algorithm of fatty liver index (FLI) to identify associations with outcomes. An index ≥ 60 indicated the presence of FLD. In Cox regression models, adjusted for age, smoking status, high-density lipoprotein cholesterol, and systolic blood pressure, we assessed the predictive value of FLI for incident diabetes, coronary heart disease (CHD), and all-cause mortality. RESULTS: At a mean 8 year follow-up, 218 and 285 incident cases of diabetes and CHD, respectively, and 193 deaths were recorded. FLD was significantly associated in each gender with blood pressure, total cholesterol, apolipoprotein B, uric acid, and C-reactive protein; weakly with fasting glucose; and inversely with high-density lipoprotein-cholesterol and sex hormone-binding globulin. In adjusted Cox models, FLD was (with a 5-fold HR) the major determinant of diabetes development. Analyses further disclosed significant independent prediction of CHD by FLD in combined gender [hazard ratio (HR) = 1.72, 95% confidence interval (CI): 1.17-2.53] and men (HR = 2.35, 95%CI: 1.25-4.43). Similarly-adjusted models for all-cause mortality proved, however, not to confer risk, except for a tendency in prediabetics and diabetic women. CONCLUSION: A surrogate of FLD conferred significant high risk of diabetes and coronary heart disease, independent of some metabolic syndrome traits. All-cause mortality was not associated with FLD, except likely in the prediabetic state. Such a FLI may reliably be used in epidemiologic studies. PMID:26730168

  8. Preliminary study on the relationship between visitation in the emergency department and posttraumatic mental health

    PubMed Central

    Lubomirsky, Bryan; Wang, Xin; Xie, Hong; Smirnoff, Jennifer B.; Biehn, Tracey L.; Contractor, Ateka A.; Elhai, Jon D.; Sutu, Christine; Brickman, Kristopher R.; Liberzon, Israel; McLean, Samuel A.; Tamburrino, Marijo B.

    2016-01-01

    This study documented family/friend support to patients in the Emergency Department (ED), including bedside visits and transportation of patients from the ED after discharge, and measured depression, anxiety, and stress symptoms within 2 weeks, 1 month and 3 months after motor vehicle accidents. Stress and depression symptoms significantly decreased during the initial three months. Family/friend visitation in the ED was negatively associated with anxiety and depression symptoms within 2 weeks and with stress symptoms months after trauma. This pilot study suggests family/friend visitation in the ED is associated with fewer mental health issues in the months following an accident. PMID:27536210

  9. Risks of all-cause and suicide mortality in mental disorders: a meta-review

    PubMed Central

    Chesney, Edward; Goodwin, Guy M; Fazel, Seena

    2014-01-01

    A meta-review, or review of systematic reviews, was conducted to explore the risks of all-cause and suicide mortality in major mental disorders. A systematic search generated 407 relevant reviews, of which 20 reported mortality risks in 20 different mental disorders and included over 1.7 million patients and over a quarter of a million deaths. All disorders had an increased risk of all-cause mortality compared with the general population, and many had mortality risks larger than or comparable to heavy smoking. Those with the highest all-cause mortality ratios were substance use disorders and anorexia nervosa. These higher mortality risks translate into substantial (10-20 years) reductions in life expectancy. Borderline personality disorder, anorexia nervosa, depression and bipolar disorder had the highest suicide risks. Notable gaps were identified in the review literature, and the quality of the included reviews was typically low. The excess risks of mortality and suicide in all mental disorders justify a higher priority for the research, prevention, and treatment of the determinants of premature death in psychiatric patients. PMID:24890068

  10. All-Cause and External Mortality in Released Prisoners: Systematic Review and Meta-Analysis

    PubMed Central

    Zlodre, Jakov

    2012-01-01

    Objectives. We systematically reviewed studies of mortality following release from prison and examined possible demographic and methodological factors associated with variation in mortality rates. Methods. We searched 5 computer-based literature indexes to conduct a systematic review of studies that reported all-cause, drug-related, suicide, and homicide deaths of released prisoners. We extracted and meta-analyzed crude death rates and standardized mortality ratios by age, gender, and race/ethnicity, where reported. Results. Eighteen cohorts met review criteria reporting 26 163 deaths with substantial heterogeneity in rates. The all-cause crude death rates ranged from 720 to 2054 per 100 000 person-years. Male all-cause standardized mortality ratios ranged from 1.0 to 9.4 and female standardized mortality ratios from 2.6 to 41.3. There were higher standardized mortality ratios in White, female, and younger prisoners. Conclusions. Released prisoners are at increased risk for death following release from prison, particularly in the early period. Aftercare planning for released prisoners could potentially have a large public health impact, and further work is needed to determine whether certain groups should be targeted as part of strategies to reduce mortality. PMID:23078476

  11. All-cause mortality risk in elderly individuals with disabilities: a retrospective observational study

    PubMed Central

    Wu, Li-Wei; Chen, Wei-Liang; Peng, Tao-Chun; Chiang, Sheng-Ta; Yang, Hui-Fang; Sun, Yu-Shan; Chan, James Yi-Hsin; Kao, Tung-Wei

    2016-01-01

    Objectives Disability is considered an important issue that affects the elderly population. This study aimed to explore the relationship between disability and all-cause mortality in US elderly individuals. Design Retrospective and longitudinal designs. Setting Data from the National Health and Nutrition Examination Survey (NHANES 1999–2002) conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention. Participants A total of 1834 participants in the age range 60–84 years from NHANES 1999–2002. Main outcome measures We acquired five major domains of disability (activities of daily living (ADL), general physical activities (GPA), instrumental ADL (IADL), lower extremity mobility (LEM) and leisure and social activities (LSA)) through self-reporting. We applied an extended-model approach with Cox (proportional hazards) regression analysis to investigate the relationship between different features of disability and all-cause mortality risk in the study population. Results During a mean follow-up of 5.7 years, 77 deaths occurred. An increased risk of all-cause mortality was identified in elderly individuals with disability after adjustment for potential confounders (HR 2.23; 95% CI 1.29 to 3.85; p=0.004). Participants with more than one domain of disability were associated with a higher risk of mortality (ptrend=0.047). Adjusted HRs and 95% CIs for each domain of disability were 2.53 (1.49 to 4.31), 1.99 (0.93 to 4.29), 1.74 (0.72 to 4.16), 1.57 (0.76 to 3.27) and 1.52 (0.93 to 2.48) for LEM, LSA, ADL, IADL and GPA, respectively. Conclusions The results of this study support an increased association between disability and all-cause mortality in the elderly in the USA. Disability in LEM may be a good predictor of high risk of all-cause mortality in elderly subjects. PMID:27625055

  12. Changes in Traffic Exposure and the Risk of Incident Myocardial Infarction and All-Cause Mortality

    PubMed Central

    Hart, Jaime E.; Rimm, Eric B.; Rexrode, Kathryn M.; Laden, Francine

    2014-01-01

    Background Traffic related exposures, such as air pollution and noise, have been associated with increased cardiovascular morbidity and mortality. Few studies, however, have been able to examine the effects of changes in exposure on changes in risk. Our objective was to explore the associations of changes in traffic exposure with changes in risk 1990–2008 in the Nurses’ Health Study. Methods Incident myocardial infarction (MI) and all-cause mortality were prospectively identified. As a proxy for traffic exposure, we calculated residential distance to roads at all residential addresses 1986–2006, and considered addresses to be “close” or “far” based on distance and road type. To examine the effect of changes in exposure, each consecutive pair of addresses was categorized as: (1) consistently close, (2) consistently far, (3) change from close to far, and (4) change from far to close. We also examined the change in NO2 levels between address pairs. Results In time-varying Cox proportional hazards models adjusted for a variety of risk factors, women living at residences consistently close to traffic were at a higher risk of an incident MI (HR= 1.11; 95% confidence interval = 1.01 – 1.22) and a higher risk of all-cause mortality (1.05; 1.00 – 1.10), compared with those consistently far. The highest risks were seen among women who moved from being far from traffic to close (incident MI: HR=1.50 (95%CI: (1.11–2.03); all-cause mortality: HR=1.17 (95%CI: 1.00–1.37)). Each 1ppb increase in NO2 compared with the previous address was associated with a HR=1.22 for incident MI (95%CI: 0.99–1.50). 1.03 for all-cause mortality (95%CI: 0.92–1.15). Conclusions Our results suggest that changes in traffic exposure (measured as roadway proximity or change in NO2 levels) are associated with changes in risk of MI and all-cause mortality. PMID:23877047

  13. Trends in Emergency Department Resource Utilization for Poisoning-Related Visits, 2003-2011.

    PubMed

    Mazer-Amirshahi, Maryann; Sun, Christie; Mullins, Peter; Perrone, Jeanmarie; Nelson, Lewis; Pines, Jesse M

    2016-09-01

    In recent years, there has been an increase in poisoning-related emergency department (ED) visits. This study examines trends in ED resource utilization for poisoning-related visits over time. A retrospective review of data from the National Hospital Ambulatory Medical Care Survey, 2003-2011, was conducted. All ED visits with a reason for visit or ICD-9 code related to poisoning were included. We examined the number of ED visits and resources used including diagnostic studies and procedures performed, medications provided, admission rates, and length of stay. The proportion of visits involving resource use was tabulated and trends analyzed using survey-weighted logistic regression, grouping into 2-year periods to ensure adequate sample size. Of an estimated 843 million ED visits between 2003 and 2011, 8 million (0.9 %) were related to poisoning. Visits increased from 1.8 million (0.8 %) visits in 2003-2004 to 2.9 million (1.1 %) visits in 2010-2011, p = 0.001. Use of laboratory studies, EKGs, plain radiographs, and procedures remained stable across the study period. CT use was more than doubled, increasing from 5.2 to 13.7 % of visits, p = 0.001. ED length of stay increased by 35.5 % from 254 to 344 min, p = 0.001. Admission rates increased by 45.3 %, from 15.0 to 21.8 %, p = 0.046. Over the entire study period, 52.0 % of poisoned patients arrived via ambulance, and 3.0 % of patients had been discharged from the hospital within the previous 7 days. Poisoning-related ED visits increased over the 8-year study period; poisonings are resource-intensive visits and require increasingly longer lengths of ED stay or hospital admission. PMID:27342464

  14. Emergency Department Visits Related to Schizophrenia Among Adults Aged 18-64: United States, 2009-2011.

    PubMed

    Albert, Michael; McCaig, Linda F

    2015-09-01

    ED care is important for the treatment of acute presentations of schizophrenia and may serve as a safety net for schizophrenic patients not otherwise receiving care (4,5). This analysis of National Hospital Ambulatory Medical Care Survey (NHAMCS) data indicates that during 2009-2011, an average of 382,000 ED visits related to schizophrenia occurred each year among adults aged 18-64, corresponding to an overall visit rate of 20.1 per 10,000 adults. A visit having a first-, second-, or third-listed diagnosis of schizophrenia (i.e., whether the visit was directly or indirectly related to schizophrenia) was included in the analysis to provide a broader description of ED use by these patients. The distribution of the primary diagnosis of visits related to schizophrenia was: schizophrenia (58.8%), another mental disorder (15.4%), and a nonmental health disorder (25.7%) (data not shown). Among adults aged 18-64, the rate for ED visits related to schizophrenia was about twice as high for men as for women. Public insurance (Medicaid, Medicare, or dual Medicare and Medicaid) was more frequently the primary expected source of payment for ED visits related to schizophrenia compared with ED visits not related to schizophrenia. ED visits related to schizophrenia were more frequently made by patients who were homeless compared with ED visits not related to schizophrenia. About one-third of ED visits related to schizophrenia resulted in a hospital admission, and another 16.7% resulted in a transfer to a psychiatric hospital--both higher than the percentages for ED visits not related to schizophrenia. One of the goals of Healthy People 2020 is to improve mental health through prevention and by ensuring access to appropriate, quality mental health services (6). National data on the rates and characteristics of ED visits related to schizophrenia will help policymakers and practitioners address disparities and meet this goal.

  15. Contribution of ED admissions to inpatient hospital revenue.

    PubMed

    Sacchetti, Alfred; Harris, Russell H; Warden, Todd; Roth, Sandra

    2002-01-01

    Emergency department (ED) practices are traditionally profiled in terms of their patient encounters. Such evaluations reflect a preponderance of outpatient visits while crediting income from admitted patients to traditional hospital-based services. This study evaluates the contribution of ED admissions to inpatient hospital revenue. The study was set at an urban tertiary care community hospital with university affiliation. Information referable to ED patients was collected from the hospital's Universal Billing Code (UB-92)-based patient information warehouse. Data fields referable to hospital charges, insurance type, and disposition were used for analysis of a 1-year period from September 1, 1998 to August 31, 1999. Statistical analysis was through chi square and ANOVA. During the study period 33,174 patients were treated in the ED with 6,671 (20%) admitted to inpatient services. Total hospital charges for all ED patients during this time were $107 million dollars with $9.1 million (8.5%) generated from discharged patients and $98.0 million (91.5%) from admitted ED patients (P <.001). Mean charges for individual discharged patients were $344.10 whereas for individual admitted patients mean charges were $14,692.28. (P <.001) Medicaid and self pay represented 55.4% of the insurance coverage for discharged ED patients whereas these same insurance classes accounted for only 16.3% of admitted patients. (P <.001) Medicare visits accounted for 12.7% of discharged ED patients but 60.7% of admitted patients (P <.001). Total hospital gross revenue for inpatient services for the study period was $288 million of which 34% was contributed from admitted ED patients. ED services represent a major source of inpatient hospital revenue. The recognition of the ED's potential in this area may be lost if income from patients admitted through the ED is credited to traditional hospital-based services.

  16. Contribution of ED admissions to inpatient hospital revenue.

    PubMed

    Sacchetti, Alfred; Harris, Russell H; Warden, Todd; Roth, Sandra

    2002-01-01

    Emergency department (ED) practices are traditionally profiled in terms of their patient encounters. Such evaluations reflect a preponderance of outpatient visits while crediting income from admitted patients to traditional hospital-based services. This study evaluates the contribution of ED admissions to inpatient hospital revenue. The study was set at an urban tertiary care community hospital with university affiliation. Information referable to ED patients was collected from the hospital's Universal Billing Code (UB-92)-based patient information warehouse. Data fields referable to hospital charges, insurance type, and disposition were used for analysis of a 1-year period from September 1, 1998 to August 31, 1999. Statistical analysis was through chi square and ANOVA. During the study period 33,174 patients were treated in the ED with 6,671 (20%) admitted to inpatient services. Total hospital charges for all ED patients during this time were $107 million dollars with $9.1 million (8.5%) generated from discharged patients and $98.0 million (91.5%) from admitted ED patients (P <.001). Mean charges for individual discharged patients were $344.10 whereas for individual admitted patients mean charges were $14,692.28. (P <.001) Medicaid and self pay represented 55.4% of the insurance coverage for discharged ED patients whereas these same insurance classes accounted for only 16.3% of admitted patients. (P <.001) Medicare visits accounted for 12.7% of discharged ED patients but 60.7% of admitted patients (P <.001). Total hospital gross revenue for inpatient services for the study period was $288 million of which 34% was contributed from admitted ED patients. ED services represent a major source of inpatient hospital revenue. The recognition of the ED's potential in this area may be lost if income from patients admitted through the ED is credited to traditional hospital-based services. PMID:11781909

  17. WarpVisit

    SciTech Connect

    Loring, Burlen; Reubel, Oliver

    2015-06-10

    WarpVisit is an insitu simulation application that integrates the Warp laser plasma accelerator simulation framework with Visit a parallel visualization application. WarpVisit is written in python and supports interactive or live mode where user can connect to Warp with the Visit GUI and batch mode for batch for non-interactive use on high-performance computing resources.

  18. Heat Stress Illness Emergency Department Visits in National Environmental Public Health Tracking States, 2005-2010.

    PubMed

    Fechter-Leggett, Ethan D; Vaidyanathan, Ambarish; Choudhary, Ekta

    2016-02-01

    Variability of heat stress illness (HSI) by urbanicity and climate region has rarely been considered in previous HSI studies. We investigated temporal and geographic trends in HSI emergency department (ED) visits in CDC Environmental Public Health Tracking Network (Tracking) states for 2005-2010. We obtained county-level HSI ED visit data for 14 Tracking states. We used the National Center for Health Statistics Urban-Rural Classification Scheme to categorize counties by urbanicity as (1) large central metropolitan (LCM), (2) large fringe metropolitan, (3) small-medium metropolitan, or (4) nonmetropolitan (NM). We also assigned counties to one of six US climate regions. Negative binomial regression was used to examine trends in HSI ED visits over time across all counties and by urbanicity for each climate region, adjusting for pertinent variables. During 2005-2010, there were 98,462 HSI ED visits in the 14 states. ED visits for HSI decreased 3.0% (p < 0.01) per year. Age-adjusted incidence rates of HSI ED visits increased from most urban to most rural. Overall, ED visits were significantly higher for NM areas (IRR = 1.41, p < 0.01) than for LCM areas. The same pattern was observed in all six climate regions; compared with LCM, NM areas had from 14 to 90% more ED visits for HSI. These findings of significantly increased HSI ED visit rates in more rural settings suggest a need to consider HSI ED visit variability by county urbanicity and climate region when designing and implementing local HSI preventive measures and interventions.

  19. All-cause and cause-specific mortality of different migrant populations in Europe.

    PubMed

    Ikram, Umar Z; Mackenbach, Johan P; Harding, Seeromanie; Rey, Grégoire; Bhopal, Raj S; Regidor, Enrique; Rosato, Michael; Juel, Knud; Stronks, Karien; Kunst, Anton E

    2016-07-01

    This study aimed to examine differences in all-cause mortality and main causes of death across different migrant and local-born populations living in six European countries. We used data from population and mortality registers from Denmark, England & Wales, France, Netherlands, Scotland, and Spain. We calculated age-standardized mortality rates for men and women aged 0-69 years. Country-specific data were pooled to assess weighted mortality rate ratios (MRRs) using Poisson regression. Analyses were stratified by age group, country of destination, and main cause of death. In six countries combined, all-cause mortality was lower for men and women from East Asia (MRRs 0.66; 95 % confidence interval 0.62-0.71 and 0.76; 0.69-0.82, respectively), and Other Latin America (0.44; 0.42-0.46 and 0.56; 0.54-0.59, respectively) than local-born populations. Mortality rates were similar for those from Turkey. All-cause mortality was higher in men and women from North Africa (1.09; 1.08-1.11 and 1.19; 1.17-1.22, respectively) and Eastern Europe (1.30; 1.27-1.33 and 1.05; 1.01-1.08, respectively), and women from Sub-Saharan Africa (1.34; 1.30-1.38). The pattern differed by age group and country of destination. Most migrants had higher mortality due to infectious diseases and homicide while cancer mortality and suicide were lower. CVD mortality differed by migrant population. To conclude, mortality patterns varied across migrant populations in European countries. Future research should focus both on migrant populations with favourable and less favourable mortality pattern, in order to understand this heterogeneity and to drive policy at the European level. PMID:26362812

  20. All-cause and cause-specific mortality of different migrant populations in Europe.

    PubMed

    Ikram, Umar Z; Mackenbach, Johan P; Harding, Seeromanie; Rey, Grégoire; Bhopal, Raj S; Regidor, Enrique; Rosato, Michael; Juel, Knud; Stronks, Karien; Kunst, Anton E

    2016-07-01

    This study aimed to examine differences in all-cause mortality and main causes of death across different migrant and local-born populations living in six European countries. We used data from population and mortality registers from Denmark, England & Wales, France, Netherlands, Scotland, and Spain. We calculated age-standardized mortality rates for men and women aged 0-69 years. Country-specific data were pooled to assess weighted mortality rate ratios (MRRs) using Poisson regression. Analyses were stratified by age group, country of destination, and main cause of death. In six countries combined, all-cause mortality was lower for men and women from East Asia (MRRs 0.66; 95 % confidence interval 0.62-0.71 and 0.76; 0.69-0.82, respectively), and Other Latin America (0.44; 0.42-0.46 and 0.56; 0.54-0.59, respectively) than local-born populations. Mortality rates were similar for those from Turkey. All-cause mortality was higher in men and women from North Africa (1.09; 1.08-1.11 and 1.19; 1.17-1.22, respectively) and Eastern Europe (1.30; 1.27-1.33 and 1.05; 1.01-1.08, respectively), and women from Sub-Saharan Africa (1.34; 1.30-1.38). The pattern differed by age group and country of destination. Most migrants had higher mortality due to infectious diseases and homicide while cancer mortality and suicide were lower. CVD mortality differed by migrant population. To conclude, mortality patterns varied across migrant populations in European countries. Future research should focus both on migrant populations with favourable and less favourable mortality pattern, in order to understand this heterogeneity and to drive policy at the European level.

  1. Traffic air pollution and mortality from cardiovascular disease and all causes: a Danish cohort study

    PubMed Central

    2012-01-01

    Background Traffic air pollution has been linked to cardiovascular mortality, which might be due to co-exposure to road traffic noise. Further, personal and lifestyle characteristics might modify any association. Methods We followed up 52 061 participants in a Danish cohort for mortality in the nationwide Register of Causes of Death, from enrollment in 1993–1997 through 2009, and traced their residential addresses from 1971 onwards in the Central Population Registry. We used dispersion-modelled concentration of nitrogen dioxide (NO2) since 1971 as indicator of traffic air pollution and used Cox regression models to estimate mortality rate ratios (MRRs) with adjustment for potential confounders. Results Mean levels of NO2 at the residence since 1971 were significantly associated with mortality from cardiovascular disease (MRR, 1.26; 95% confidence interval [CI], 1.06–1.51, per doubling of NO2 concentration) and all causes (MRR, 1.13; 95% CI, 1.04–1.23, per doubling of NO2 concentration) after adjustment for potential confounders. For participants who ate < 200 g of fruit and vegetables per day, the MRR was 1.45 (95% CI, 1.13–1.87) for mortality from cardiovascular disease and 1.25 (95% CI, 1.11–1.42) for mortality from all causes. Conclusions Traffic air pollution is associated with mortality from cardiovascular diseases and all causes, after adjustment for traffic noise. The association was strongest for people with a low fruit and vegetable intake. PMID:22950554

  2. Neighborhood racial composition, social capital and black all-cause mortality in Philadelphia.

    PubMed

    Hutchinson, Rebbeca N; Putt, Mary A; Dean, Lorraine T; Long, Judith A; Montagnet, Chantal A; Armstrong, Katrina

    2009-05-01

    Neighborhood characteristics such as racial composition and social capital have been widely linked to health outcomes, but the direction of the relationship between these characteristics and health of minority populations is controversial. Given this uncertainty, we examined the relationship between neighborhood racial composition, social capital, and black all-cause mortality between 1997 and 2000 in 68 Philadelphia neighborhoods. Data from the U.S. Census, the Philadelphia Health Management Corporation's 2004 Southeast Pennsylvania Community Health Survey, and city vital statistics were linked by census tract and then aggregated into neighborhoods, which served as the unit of analysis. Neighborhood social capital was measured by a summative score of respondent assessments of: the livability of their community, the likelihood of neighbors helping one another, their sense of belonging, and the trustworthiness of their neighbors. After adjustment for the sociodemographic characteristics of neighborhood residents, black age-adjusted all-cause mortality was significantly higher in neighborhoods that had lower proportion of black residents. Neighborhood social capital was also associated with lower black mortality, with the strongest relationship seen for neighborhoods in the top half of social capital scores. There was a significant interaction between racial composition and social capital, so that the effect of social capital on mortality was greatest in neighborhoods with a higher proportion of black residents and the effect of racial composition was greatest in neighborhoods with high social capital. These results demonstrate that age-adjusted all-cause black mortality is lowest in mostly black neighborhoods with high levels of social capital in Philadelphia. PMID:19324485

  3. Vitamin D status and incident cardiovascular disease and all-cause mortality: a general population study.

    PubMed

    Skaaby, Tea; Husemoen, Lise Lotte Nystrup; Pisinger, Charlotta; Jørgensen, Torben; Thuesen, Betina Heinsbæk; Fenger, Mogens; Linneberg, Allan

    2013-06-01

    Low vitamin D status has been associated with cardiovascular disease (CVD) and mortality primarily in selected groups, smaller studies, or with self-reported vitamin D intake. We investigated the association of serum vitamin D status with the incidence of a registry-based diagnosis of ischemic heart disease (IHD), stroke, and all-cause mortality in a large sample of the general population. A total of 9,146 individuals from the two population-based studies, Monica10 and Inter99, were included. Measurements of serum 25-hydroxyvitamin D at baseline were carried out using the IDS ISYS immunoassay system in Monica10 and High-performance liquid chromatography in Inter99. Information on CVDs and causes of death was obtained from Danish registries until 31 December 2008. There were 478 cases of IHD, 316 cases of stroke, and 633 deaths during follow-up (mean follow-up 10 years). Cox regression analyses with age as underlying time axis showed a significant association between vitamin D status and all-cause mortality with a HR = 0.95 (P = 0.005) per 10 nmol/l higher vitamin D level. We found no association between vitamin D status and incidence of IHD or stroke (HR = 1.01, P = 0.442 and HR = 1.00, P = 0.920, respectively). In this large general population study, the observed inverse association between serum vitamin D status and all-cause mortality was not explained by a similar inverse association with IHD or stroke. PMID:23015273

  4. Sleep Apnea as an Independent Risk Factor for All-Cause Mortality: The Busselton Health Study

    PubMed Central

    Marshall, Nathaniel S.; Wong, Keith K. H.; Liu, Peter Y.; Cullen, Stewart R. J.; Knuiman, Matthew W.; Grunstein, Ronald R.

    2008-01-01

    Background: Previously published cohort studies in clinical populations have suggested that obstructive sleep apnea (OSA) is a risk factor for mortality associated with cardiovascular disease. However, it is unknown whether sleep apnea is an independent risk factor for all-cause mortality in a community-based sample free from clinical referral bias. Methods: Residents of the Western Australian town of Busselton underwent investigation with a home sleep apnea monitoring device (MESAM IV). OSA was quantified via the respiratory disturbance index (RDI). Mortality status was determined in 397/400 participants (99.3%) after up to 14 years (mean follow-up 13.4 years) by data matching with the Australian National Death Index and the Western Australian Death Register. Univariate analyses and multivariate Cox proportional hazards modelling were used to ascertain the association between sleep apnea and mortality after adjustment for age, gender, body mass index, mean arterial pressure, total cholesterol, high-density lipoprotein cholesterol, diabetes, and medically diagnosed angina in those free from heart attack or stroke at baseline (n = 380). Results: Among the 380 participants, 18 had moderate-severe OSA (RDI ≥15/hr, 6 deaths) and 77 had mild OSA (RDI 5 to <15/hr, 5 deaths). Moderate-to-severe OSA was independently associated with greater risk of all-cause mortality (fully adjusted hazard ratio [HR] = 6.24, 95% CL 2.01, 19.39) than non-OSA (n = 285, 22 deaths). Mild OSA (RDI 5 to <15/hr) was not an independent risk factor for higher mortality (HR = 0.47, 95% CL 0.17, 1.29). Conclusions: Moderate-to-severe sleep apnea is independently associated with a large increased risk of all-cause mortality in this community-based sample. Citation: Marshall NS; Wong KKH; Liu PY; Cullen SRJ; Knuiman MW; Grunstein RR. Sleep apnea as an independent risk factor for all-cause mortality: The Busselton Health Study. SLEEP 2008;31(8):1079-1085. PMID:18714779

  5. The Effect of Neurobehavioral Test Performance on the All-Cause Mortality among US Population.

    PubMed

    Peng, Tao-Chun; Chen, Wei-Liang; Wu, Li-Wei; Chen, Ying-Jen; Liaw, Fang-Yih; Wang, Gia-Chi; Wang, Chung-Ching; Yang, Ya-Hui

    2016-01-01

    Evidence of the association between global cognitive function and mortality is much, but whether specific cognitive function is related to mortality is unclear. To address the paucity of knowledge on younger populations in the US, we analyzed the association between specific cognitive function and mortality in young and middle-aged adults. We analyzed data from 5,144 men and women between 20 and 59 years of age in the Third National Health and Nutrition Examination Survey (1988-94) with mortality follow-up evaluation through 2006. Cognitive function tests, including assessments of executive function/processing speed (symbol digit substitution) and learning recall/short-term memory (serial digit learning), were performed. All-cause mortality was the outcome of interest. After adjusting for multiple variables, total mortality was significantly higher in males with poorer executive function/processing speed (hazard ratio (HR) 2.02; 95% confidence interval 1.36 to 2.99) and poorer recall/short-term memory (HR 1.47; 95% confidence interval 1.02 to 2.12). After adjusting for multiple variables, the mortality risk did not significantly increase among the females in these two cognitive tests groups. In this sample of the US population, poorer executive function/processing speed and poorer learning recall/short-term memory were significantly associated with increased mortality rates, especially in males. This study highlights the notion that poorer specific cognitive function predicts all-cause mortality in young and middle-aged males. PMID:27595105

  6. The Effect of Neurobehavioral Test Performance on the All-Cause Mortality among US Population

    PubMed Central

    Wu, Li-Wei; Liaw, Fang-Yih; Wang, Gia-Chi; Wang, Chung-Ching

    2016-01-01

    Evidence of the association between global cognitive function and mortality is much, but whether specific cognitive function is related to mortality is unclear. To address the paucity of knowledge on younger populations in the US, we analyzed the association between specific cognitive function and mortality in young and middle-aged adults. We analyzed data from 5,144 men and women between 20 and 59 years of age in the Third National Health and Nutrition Examination Survey (1988–94) with mortality follow-up evaluation through 2006. Cognitive function tests, including assessments of executive function/processing speed (symbol digit substitution) and learning recall/short-term memory (serial digit learning), were performed. All-cause mortality was the outcome of interest. After adjusting for multiple variables, total mortality was significantly higher in males with poorer executive function/processing speed (hazard ratio (HR) 2.02; 95% confidence interval 1.36 to 2.99) and poorer recall/short-term memory (HR 1.47; 95% confidence interval 1.02 to 2.12). After adjusting for multiple variables, the mortality risk did not significantly increase among the females in these two cognitive tests groups. In this sample of the US population, poorer executive function/processing speed and poorer learning recall/short-term memory were significantly associated with increased mortality rates, especially in males. This study highlights the notion that poorer specific cognitive function predicts all-cause mortality in young and middle-aged males.

  7. Development and Validation of a Clinical Risk-Assessment Tool Predictive of All-Cause Mortality

    PubMed Central

    Bello, Ghalib A; Dumancas, Gerard G; Gennings, Chris

    2015-01-01

    In clinical settings, the diagnosis of medical conditions is often aided by measurement of various serum biomarkers through the use of laboratory tests. These biomarkers provide information about different aspects of a patient’s health and overall function of multiple organ systems. We have developed a statistical procedure that condenses the information from a variety of health biomarkers into a composite index, which could be used as a risk score for predicting all-cause mortality. It could also be viewed as a holistic measure of overall physiological health status. This health status metric is computed as a function of standardized values of each biomarker measurement, weighted according to their empirically determined relative strength of association with mortality. The underlying risk model was developed using the biomonitoring and mortality data of a large sample of US residents obtained from the National Health and Nutrition Examination Survey (NHANES) and the National Death Index (NDI). Biomarker concentration levels were standardized using spline-based Cox regression models, and optimization algorithms were used to estimate the weights. The predictive accuracy of the tool was optimized by bootstrap aggregation. We also demonstrate how stacked generalization, a machine learning technique, can be used for further enhancement of the prediction power. The index was shown to be highly predictive of all-cause mortality and long-term outcomes for specific health conditions. It also exhibited a robust association with concurrent chronic conditions, recent hospital utilization, and current health status as assessed by self-rated health. PMID:26380550

  8. Work and family demands: predictors of all-cause sickness absence in the GAZEL cohort

    PubMed Central

    Sabbath, Erika L.; Melchior, Maria; Goldberg, Marcel; Zins, Marie

    2012-01-01

    Background: The aim of this study is to assess the impact of combined work and family demands on all-cause sickness absence and to examine variation in this relationship by occupational grade and gender. Methods: The study sample consists of 13 179 employees of Electricité de France-Gaz de France (EDF-GDF) who were members of the GAZEL occupational cohort in 1995. Combined work and family demands are assessed based on measures of job strain and number of dependants assessed at baseline (1995). Covariates include occupational grade and demographic, behavioural and social variables assessed at baseline. Ratios of sickness absence days to total person-days contributed by each employee were established from administrative data between baseline and the end of follow-up in 2003. Rate ratios across levels of work–family demands were then calculated. Effect modification by gender and grade of employment was tested. Results: In fully adjusted models, individuals with the highest work–family demands had a rate ratio of sickness absence of 1.78 (95% CI 1.47–2.14) compared with low-demand workers. This association was independent of occupational grade and did not vary with gender. Results were not attributable solely to psychiatric sickness absences. Conclusion: High work–family demands at baseline predict long-term all-cause sickness absence across a socio-economically diverse occupational cohort. PMID:21558153

  9. The Effect of Neurobehavioral Test Performance on the All-Cause Mortality among US Population

    PubMed Central

    Wu, Li-Wei; Liaw, Fang-Yih; Wang, Gia-Chi; Wang, Chung-Ching

    2016-01-01

    Evidence of the association between global cognitive function and mortality is much, but whether specific cognitive function is related to mortality is unclear. To address the paucity of knowledge on younger populations in the US, we analyzed the association between specific cognitive function and mortality in young and middle-aged adults. We analyzed data from 5,144 men and women between 20 and 59 years of age in the Third National Health and Nutrition Examination Survey (1988–94) with mortality follow-up evaluation through 2006. Cognitive function tests, including assessments of executive function/processing speed (symbol digit substitution) and learning recall/short-term memory (serial digit learning), were performed. All-cause mortality was the outcome of interest. After adjusting for multiple variables, total mortality was significantly higher in males with poorer executive function/processing speed (hazard ratio (HR) 2.02; 95% confidence interval 1.36 to 2.99) and poorer recall/short-term memory (HR 1.47; 95% confidence interval 1.02 to 2.12). After adjusting for multiple variables, the mortality risk did not significantly increase among the females in these two cognitive tests groups. In this sample of the US population, poorer executive function/processing speed and poorer learning recall/short-term memory were significantly associated with increased mortality rates, especially in males. This study highlights the notion that poorer specific cognitive function predicts all-cause mortality in young and middle-aged males. PMID:27595105

  10. Fitness vs. fatness on all-cause mortality: a meta-analysis.

    PubMed

    Barry, Vaughn W; Baruth, Meghan; Beets, Michael W; Durstine, J Larry; Liu, Jihong; Blair, Steven N

    2014-01-01

    The purpose of this study was to quantify the joint association of cardiorespiratory fitness (CRF) and weight status on mortality from all causes using meta-analytical methodology. Studies were included if they were (1) prospective, (2) objectively measured CRF and body mass index (BMI), and (3) jointly assessed CRF and BMI with all-cause mortality. Ten articles were included in the final analysis. Pooled hazard ratios were assessed for each comparison group (i.e. normal weight-unfit, overweight-unfit and -fit, and obese-unfit and -fit) using a random-effects model. Compared to normal weight-fit individuals, unfit individuals had twice the risk of mortality regardless of BMI. Overweight and obese-fit individuals had similar mortality risks as normal weight-fit individuals. Furthermore, the obesity paradox may not influence fit individuals. Researchers, clinicians, and public health officials should focus on physical activity and fitness-based interventions rather than weight-loss driven approaches to reduce mortality risk.

  11. Non-Traumatic Dental Condition-Related Emergency Department Visits and Associated Costs for Children and Adults with Autism Spectrum Disorders

    PubMed Central

    Nakao, Sy; Scott, JoAnna M.; Masterson, Erin E.; Chi, Donald L.

    2014-01-01

    We analyzed 2010 U.S. National Emergency Department Sample data and ran regression models to test the hypotheses that individuals with ASD are more likely to have non-traumatic dental condition (NTDC)-related emergency department (ED) visits and to incur greater costs for these visits than those without ASD. There were nearly 2.3 million NTDC-related ED visits in 2010. Less than 1.0% (children) and 2.1% (adults) of all ED visits were for NTDC. There was no significant difference in NTDC-related ED visits or costs for children by ASD status. Adults with ASD had significantly lower odds of NTDC-related ED visits (OR=0.39; 95% CI: 0.29, 0.52; P<0.001) but incurred significantly greater mean costs for NTDC-related ED visits (P<0.006) than did adults without ASD. PMID:25374135

  12. The Cohort Study on Prediction of Incidence of All-Cause Mortality by Metabolic Syndrome

    PubMed Central

    Li, Zhixia; Yang, Xinghua; Yang, Jun; Yang, Zhirong; Wang, Shengfeng

    2016-01-01

    Aim The aim was to evaluate the impact of metabolic syndrome (MS), MS individual components and 32 kinds of MS specific component combinations on all-cause mortality risk in a fixed cohort of MJ check-up population. Methods We observed the events of death in a fixed cohort, where the population was composed of 45,542 individuals aged 35–74 who were examined at MJ Health check-up Center in 1997 as baseline examination, and were followed up to 2005. Median duration of follow-up was 7.44 years. MS was defined according to the National Cholesterol Educational Program (the revised NCEP-ATPIII for Asian in 2004), the prevalence of MS was standardized according to China’s fifth census data. We constructed common Cox regression model, simultaneously adjusting the classic risk factors (such as age, sex, smoking, alcohol drinking, physical activity, family history, etc.) to examine the relationship between MS, MS individual components and 32 kinds of MS specific component combinations on the occurrence of death with the fixed cohort. Results The standardized prevalence of MS was 29.75% (male: 30.36%, female: 29.51%). There were 1,749 persons who died during the median 7.44-years follow-up, the mortality rate was 46 per 10,000 person years. The mortality rates were 71 and 35 per 10,000 person years for those with and without MS, respectively. After adjustment for age, sex and classical risk factors, compared with subjects without MS, the hazard ratio of all-cause mortality was 1.26 (95% CI: 1.14–1.40). The all-cause mortality were more highly significant than other combinations (P <0.05) when the following combinations exist: “elevated blood pressure”, “elevated fasting plasma glucose + low high-density lipoprotein cholesterol”, “elevated blood pressure + elevated triglyceride + elevated fasting plasma glucose”, “elevated fasting plasma glucose + low high-density lipoprotein cholesterol + elevated blood pressure + elevated triglyceride”. After adjusting

  13. Apolipoprotein E-related all-cause mortality in hospitalized elderly patients.

    PubMed

    Matera, Maria G; Sancarlo, Daniele; Panza, Francesco; Gravina, Carolina; D'Onofrio, Grazia; Frisardi, Vincenza; Longo, Grazia; D'Ambrosio, Luigi P; Addante, Filomena; Copetti, Massimiliano; Solfrizzi, Vincenzo; Seripa, Davide; Pilotto, Alberto

    2010-09-01

    The most common apolipoprotein E (APOE) allelic variation is implicated in many age-related diseases and human longevity with controversial findings. We investigated the effect of APOE gene polymorphism on all-cause mortality in elderly patients taking into consideration the functional disability, cognitive impairment, malnutrition, and the occurrence of common age-related diseases. APOE genotypes were determined in 2,124 geriatric hospitalized patients (46.5% men and 53.5% women; mean age, 78.2 +/- 7.1 years; range, 65-100 years). At hospital admission, all patients underwent a comprehensive geriatric assessment to evaluate functional disability, cognitive status, nutritional status, and comorbidity. The main and secondary diagnoses at hospital discharge were also recorded. Mortality status was evaluated in all patients after a maximum follow-up of 5 years (range, from 1.26 to 5.23 years; median, 2.86 years). During the study period, 671 patients died (32.0%). At hospital admission, these patients showed a significant higher prevalence of cardiovascular diseases (56.3% vs 53.4%; p = 0.007), neoplasias (32.3% vs 13.7%; p < 0.001), and lower prevalence of neurodegenerative diseases (17.7% vs 20.7%; p < 0.001) than survived patients. Moreover, they also showed an higher prevalence of disability (52.0% vs 25.6%; p < 0.001), cognitive impairment (31.0% vs 18.8%; p < 0.001), and malnutrition (74.0% vs 46.1%; p < 0.001) than survived patients. In the overall study population, the APOE epsilon2 allele was significantly associated to neurodegenerative diseases (odds ratio = 0.59; 95% confidence interval (CI), 0.37-0.94). No significant association between the APOE polymorphism and disability, malnutrition, co-morbidity status, and with all-cause mortality was observed. In patients with cardiovascular diseases, however, a decreased risk of all-cause mortality was found in the epsilon2 allele carriers (hazard ratio = 0.56; 95% CI, 0.36-0.88). In this population, APOE allele

  14. All-Cause and Cause-Specific Risk of Emergency Transport Attributable to Temperature

    PubMed Central

    Onozuka, Daisuke; Hagihara, Akihito

    2015-01-01

    Abstract Although several studies have estimated the associations between mortality or morbidity and extreme temperatures in terms of relative risk, few studies have investigated the risk of emergency transport attributable to the whole temperature range nationwide. We acquired data on daily emergency ambulance dispatches in all 47 prefectures of Japan from 2007 to 2010. We examined the relationship between emergency transport and temperature for each prefecture using a Poisson regression model in a distributed lag nonlinear model with adjustment for time trends. A random-effect multivariate meta-analysis was then applied to pool the estimates at the national level. Attributable morbidity was calculated for high and low temperatures, which were defined as those above or below the optimum temperature (ie, the minimum morbidity temperature) and for moderate and also extreme temperatures, which were defined using cutoffs at the 2.5th and 97.5th temperature percentiles. A total of 15,868,086 cases of emergency transport met the inclusion criteria. The emergency transport was attributable to nonoptimal temperature. The median minimum morbidity percentile was in the 79th percentile for all causes, the 96th percentile for cardiovascular disease, and the 92th percentile for respiratory disease. The fraction attributable to low temperature was 6.94% (95% eCI: 5.93–7.70) for all causes, 17.93% (95% eCI: 16.10–19.25) for cardiovascular disease, and 12.19% (95% eCI: 9.90–13.66) for respiratory disease, whereas the fraction attributable to high temperature was small (all causes = 1.01%, 95% eCI: 0.90–1.11; cardiovascular disease = 0.10%, 95% eCI: 0.04–0.14; respiratory disease = 0.29%, 95% eCI: 0.07–0.50). The all-cause morbidity risk that was attributable to temperature was related to moderate cold, with an overall estimate of 6.41% (95% eCI: 5.47–7.20). Extreme temperatures were responsible for a small fraction, which corresponded to 0.57% (95% e

  15. Alcohol, drinking pattern and all-cause, cardiovascular and alcohol-related mortality in Eastern Europe.

    PubMed

    Bobak, Martin; Malyutina, Sofia; Horvat, Pia; Pajak, Andrzej; Tamosiunas, Abdonas; Kubinova, Ruzena; Simonova, Galina; Topor-Madry, Roman; Peasey, Anne; Pikhart, Hynek; Marmot, Michael G

    2016-01-01

    Alcohol has been implicated in the high mortality in Central and Eastern Europe but the magnitude of its effect, and whether it is due to regular high intake or episodic binge drinking remain unclear. The aim of this paper was to estimate the contribution of alcohol to mortality in four Central and Eastern European countries. We used data from the Health, Alcohol and Psychosocial factors in Eastern Europe is a prospective multi-centre cohort study in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and six Czech towns. Random population samples of 34,304 men and women aged 45-69 years in 2002-2005 were followed up for a median 7 years. Drinking volume, frequency and pattern were estimated from the graduated frequency questionnaire. Deaths were ascertained using mortality registers. In 230,246 person-years of follow-up, 2895 participants died from all causes, 1222 from cardiovascular diseases (CVD), 672 from coronary heart disease (CHD) and 489 from pre-defined alcohol-related causes (ARD). In fully-adjusted models, abstainers had 30-50% increased mortality risk compared to light-to-moderate drinkers. Adjusted hazard ratios (HR) in men drinking on average ≥60 g of ethanol/day (3% of men) were 1.23 (95% CI 0.95-1.59) for all-cause, 1.38 (0.95-2.02) for CVD, 1.64 (1.02-2.64) for CHD and 2.03 (1.28-3.23) for ARD mortality. Corresponding HRs in women drinking on average ≥20 g/day (2% of women) were 1.92 (1.25-2.93), 1.74 (0.76-3.99), 1.39 (0.34-5.76) and 3.00 (1.26-7.10). Binge drinking increased ARD mortality in men only. Mortality was associated with high average alcohol intake but not binge drinking, except for ARD in men.

  16. Alcohol, drinking pattern and all-cause, cardiovascular and alcohol-related mortality in Eastern Europe.

    PubMed

    Bobak, Martin; Malyutina, Sofia; Horvat, Pia; Pajak, Andrzej; Tamosiunas, Abdonas; Kubinova, Ruzena; Simonova, Galina; Topor-Madry, Roman; Peasey, Anne; Pikhart, Hynek; Marmot, Michael G

    2016-01-01

    Alcohol has been implicated in the high mortality in Central and Eastern Europe but the magnitude of its effect, and whether it is due to regular high intake or episodic binge drinking remain unclear. The aim of this paper was to estimate the contribution of alcohol to mortality in four Central and Eastern European countries. We used data from the Health, Alcohol and Psychosocial factors in Eastern Europe is a prospective multi-centre cohort study in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and six Czech towns. Random population samples of 34,304 men and women aged 45-69 years in 2002-2005 were followed up for a median 7 years. Drinking volume, frequency and pattern were estimated from the graduated frequency questionnaire. Deaths were ascertained using mortality registers. In 230,246 person-years of follow-up, 2895 participants died from all causes, 1222 from cardiovascular diseases (CVD), 672 from coronary heart disease (CHD) and 489 from pre-defined alcohol-related causes (ARD). In fully-adjusted models, abstainers had 30-50% increased mortality risk compared to light-to-moderate drinkers. Adjusted hazard ratios (HR) in men drinking on average ≥60 g of ethanol/day (3% of men) were 1.23 (95% CI 0.95-1.59) for all-cause, 1.38 (0.95-2.02) for CVD, 1.64 (1.02-2.64) for CHD and 2.03 (1.28-3.23) for ARD mortality. Corresponding HRs in women drinking on average ≥20 g/day (2% of women) were 1.92 (1.25-2.93), 1.74 (0.76-3.99), 1.39 (0.34-5.76) and 3.00 (1.26-7.10). Binge drinking increased ARD mortality in men only. Mortality was associated with high average alcohol intake but not binge drinking, except for ARD in men. PMID:26467937

  17. Risks of all-cause and site-specific fractures among hospitalized patients with COPD

    PubMed Central

    Liao, Kuang-Ming; Liang, Fu-Wen; Li, Chung-Yi

    2016-01-01

    Abstract Patients with chronic obstructive pulmonary disease (COPD) have a high prevalence of osteoporosis. The clinical sequel of osteoporosis is fracture. Patients with COPD who experience a fracture also have increased morbidity and mortality. Currently, the types of all-cause and site-specific fracture among patients with COPD are unknown. Thus, we elucidated the all-cause and site-specific fractures among patients with COPD. A retrospective, population-based, cohort study was conducted utilizing the Taiwan Longitudinal Health Insurance Database. Patients with COPD were defined as those who were hospitalized with an International Classification of Diseases, Ninth Revision, Clinical Modification code of 490 to 492 or 496 between 2001 and 2011. The index date was set as the date of discharge. The study patients were followed from the index date to the date when they sought care for any type of fracture, date of death, date of health insurance policy termination, or the last day of 2013. The types of fracture analyzed in this study included vertebral, rib, humeral, radial and ulnar/wrist, pelvic, femoral, and tibial and fibular fractures. The cohort consisted of 11,312 patients with COPD. Among these patients, 1944 experienced fractures. The most common site-specific fractures were vertebral, femoral, rib, and forearm fractures (radius, ulna, and wrist) at 32.4%, 31%, 12%, and 11.8%, respectively. The adjusted hazard ratios of fracture were 1.71 [95% confidence interval (95% CI) = 1.56–1.87] for female patient with COPD and 1.50 (95% CI = 1.39–1.52) for patients with osteoporosis after covariate adjustment. Vertebral and hip fractures are common among patients with COPD, especially among males with COPD. Many comorbidities contribute to the high risk of fracture among patients with COPD. PMID:27749576

  18. Association between physical performance and all-cause mortality in CKD.

    PubMed

    Roshanravan, Baback; Robinson-Cohen, Cassianne; Patel, Kushang V; Ayers, Ernest; Littman, Alyson J; de Boer, Ian H; Ikizler, T Alp; Himmelfarb, Jonathan; Katzel, Leslie I; Kestenbaum, Bryan; Seliger, Stephen

    2013-04-01

    In older adults, measurements of physical performance assess physical function and associate with mortality and disability. Muscle wasting and diminished physical performance often accompany CKD, resembling physiologic aging, but whether physical performance associates with clinical outcome in CKD is unknown. We evaluated 385 ambulatory, stroke-free participants with stage 2-4 CKD enrolled in clinic-based cohorts at the University of Washington and University of Maryland and Veterans Affairs Maryland Healthcare systems. We compared handgrip strength, usual gait speed, timed up and go (TUAG), and 6-minute walking distance with normative values and constructed Cox proportional hazards models and receiver operating characteristic curves to test associations with all-cause mortality. Mean age was 61 years and the mean estimated GFR was 41 ml/min per 1.73 m(2). Measures of lower extremity performance were at least 30% lower than predicted, but handgrip strength was relatively preserved. Fifty deaths occurred during the median 3-year follow-up period. After adjustment, each 0.1-m/s decrement in gait speed associated with a 26% higher risk for death, and each 1-second longer TUAG associated with an 8% higher risk for death. On the basis of the receiver operating characteristic analysis, gait speed and TUAG more strongly predicted 3-year mortality than kidney function or commonly measured serum biomarkers. Adding gait speed to a model that included estimated GFR significantly improved the prediction of 3-year mortality. In summary, impaired physical performance of the lower extremities is common in CKD and strongly associates with all-cause mortality. PMID:23599380

  19. Psycho-socioeconomic bio-behavioral associations on all-cause mortality: cohort study

    PubMed Central

    Loprinzi, Paul D.; Davis, Robert E.

    2016-01-01

    Background: The purpose of this study was to examine the cumulative effects of psychological,socioeconomic, biological and behavioral parameters on mortality. Methods: A prospective design was employed. Data from the 2005-2006 National Health and Nutrition Examination Survey (NHANES) were used (analyzed in 2015); follow-up mortality status evaluated in 2011. Psychological function was assessed from the Patient Health Questionnaire-9 (PHQ-9) as a measure of depression. Socioeconomic risk was assessed from poverty level, education, minority status, and social living status. Biological parameters included cholesterol, weight status, diabetes, hypertension and systemic inflammation. Behavioral parameters assessed included physical activity (accelerometry), dietary behavior, smoking status (cotinine) and sleep. These 14 psycho-socioeconomic bio-behavioral (PSBB) parameters allowed for the calculation of an overall PSBB Index, ranging from 0-14. Results: Among the evaluated 2530 participants, 161 died over the unweighted median follow-up period of 70.0 months. After adjustment, for every 1 increase in the overall PSBB index score,participants had a 15% reduced risk of all-cause mortality (HR = 0.85; 95% CI: 0.76-0.96). After adjustment, the Behavioral Index (HR = 0.73; 95% CI: 0.60-0.88) and the Socioeconomic Index(HR = 0.82; 95% CI: 0.68-0.99) were significant, but the Psychological Index (HR = 0.67; 95%CI: 0.29-1.51) and the Biological Index (HR = 1.03; 95% CI: 0.89-1.18) were not. Conclusion: Those with a worse PSBB score had an increased risk of all-cause mortality.Promotion of concurrent health behaviors may help to promote overall well-being and prolong survival. PMID:27386420

  20. Association of resting heart rate and hypertension stages on all-cause and cardiovascular mortality among elderly Koreans: the Kangwha Cohort Study

    PubMed Central

    Ryu, Mikyung; Bayasgalan, Gombojav; Kimm, Heejin; Nam, Chung Mo; Ohrr, Heechoul

    2016-01-01

    Background Elevated resting heart rate and hypertension independently increase the risk of mortality. However, their combined effect on mortality in stages of hypertension according to updated clinical guidelines among elderly population is unclear. Methods We followed a cohort of 6100 residents (2600 males and 3500 females) of Kangwha County, Korea, ranging from 55 to 99 year-olds as of March 1985, for all-cause and cardiovascular mortality for 20.8 years until December 31, 2005. Mortality data were collected through telephone calls and visits (to 1991), and were confirmed by death record matching with the National Statistical Office (1992−2005). Hazard ratios were calculated for all-cause and cardiovascular mortality by resting heart rate and hypertension defined by Eighth Joint National Committee criteria using the Cox proportional hazard model after controlling for confounding factors. Results The hazard ratios associated with resting heart rate > 80 beats/min were higher in hypertensive men compared with normotensives with heart rate of 61–79 beats/min, with hazard ratios values of 1.43 (95% CI: 1.00−1.92) on all-cause mortality for prehypertension, 3.01 (95% CI: 1.07–8.28) on cardiovascular mortality for prehypertension, and 8.34 (95% CI: 2.52−28.19) for stage 2 hypertension. Increased risk (HR: 3.54, 95% CI: 1.16–9.21) was observed among those with both a resting heart rate ≥ 80 beats/min and prehypertension on cardiovascular mortality in women. Conclusions Individuals with coexisting elevated resting heart rate and hypertension, even in prehypertension, have a greater risk for all-cause and cardiovascular mortality compared to those with elevated resting heart rate or hypertension alone. These findings suggest that elevated resting heart rate should not be regarded as a less serious risk factor in elderly hypertensive patients. PMID:27605937

  1. Making Visits Work.

    ERIC Educational Resources Information Center

    Loar, Lynn

    1998-01-01

    Discusses factors in providing safe, supervised setting for visits between parents and children who have been removed from them by child protective services. Presents common overestimations of parental capacity that doom visits, principles for effective visiting, and practical and inexpensive suggestions that are easy to implement and enjoyable…

  2. Emergency Department Visits for Nontraumatic Dental Problems: A Mixed-Methods Study

    PubMed Central

    Chi, Donald L.; Schwarz, Eli; Milgrom, Peter; Yagapen, Annick; Malveau, Susan; Chen, Zunqui; Chan, Ben; Danner, Sankirtana; Owen, Erin; Morton, Vickie; Lowe, Robert A.

    2015-01-01

    Objectives. We documented emergency department (ED) visits for nontraumatic dental problems and identified strategies to reduce ED dental visits. Methods. We used mixed methods to analyze claims in 2010 from a purposive sample of 25 Oregon hospitals and Oregon’s All Payer All Claims data set and interviewed 51 ED dental visitors and stakeholders from 6 communities. Results. Dental visits accounted for 2.5% of ED visits and represented the second-most-common discharge diagnosis in adults aged 20 to 39 years, were associated with being uninsured (odds ratio [OR] = 5.2 [reference: commercial insurance]; 95% confidence interval [CI] = 4.8, 5.5) or having Medicaid insurance (OR = 4.0; 95% CI = 3.7, 4.2), resulted in opioid (56%) and antibiotic (56%) prescriptions, and generated $402 (95% CI = $396, $408) in hospital costs per visit. Interviews revealed health system, community, provider, and patient contributors to ED dental visits. Potential solutions provided by interviewees included Medicaid benefit expansion, care coordination, water fluoridation, and patient education. Conclusions. Emergency department dental visits are a significant and costly public health problem for vulnerable individuals. Future efforts should focus on implementing multilevel interventions to reduce ED dental visits. PMID:25790415

  3. Geographic Inequalities in All-Cause Mortality in Japan: Compositional or Contextual?

    PubMed Central

    Suzuki, Etsuji; Kashima, Saori; Kawachi, Ichiro; Subramanian, S. V.

    2012-01-01

    Background A recent study from Japan suggested that geographic inequalities in all-cause premature adult mortality have increased since 1995 in both sexes even after adjusting for individual age and occupation in 47 prefectures. Such variations can arise from compositional effects as well as contextual effects. In this study, we sought to further examine the emerging geographic inequalities in all-cause mortality, by exploring the relative contribution of composition and context in each prefecture. Methods We used the 2005 vital statistics and census data among those aged 25 or older. The total number of decedents was 524,785 men and 455,863 women. We estimated gender-specific two-level logistic regression to model mortality risk as a function of age, occupation, and residence in 47 prefectures. Prefecture-level variance was used as an estimate of geographic inequalities in mortality, and prefectures were ranked by odds ratios (ORs), with the reference being the grand mean of all prefectures (value  = 1). Results Overall, the degree of geographic inequalities was more pronounced when we did not account for the composition (i.e., age and occupation) in each prefecture. Even after adjusting for the composition, however, substantial differences remained in mortality risk across prefectures with ORs ranging from 0.870 (Okinawa) to 1.190 (Aomori) for men and from 0.864 (Shimane) to 1.132 (Aichi) for women. In some prefectures (e.g., Aomori), adjustment for composition showed little change in ORs, while we observed substantial attenuation in ORs in other prefectures (e.g., Akita). We also observed qualitative changes in some prefectures (e.g., Tokyo). No clear associations were observed between prefecture-level socioeconomic status variables and the risk of mortality in either sex. Conclusions Geographic disparities in mortality across prefectures are quite substantial and cannot be fully explained by differences in population composition. The relative contribution

  4. A gender based analysis of predictors of all cause death after transcatheter aortic valve implantation.

    PubMed

    Conrotto, Federico; D'Ascenzo, Fabrizio; Salizzoni, Stefano; Presbitero, Patrizia; Agostoni, Pierfrancesco; Tamburino, Corrado; Tarantini, Giuseppe; Bedogni, Francesco; Nijhoff, Freek; Gasparetto, Valeria; Napodano, Massimo; Ferrante, Giuseppe; Rossi, Marco Luciano; Stella, Pieter; Brambilla, Nedy; Barbanti, Marco; Giordana, Francesca; Grasso, Costanza; Biondi Zoccai, Giuseppe; Moretti, Claudio; D'Amico, Maurizio; Rinaldi, Mauro; Gaita, Fiorenzo; Marra, Sebastiano

    2014-10-15

    The impact of gender-related pathophysiologic features of severe aortic stenosis on transcatheter aortic valve implantation (TAVI) outcomes remains to be determined, as does the consistency of predictors of mortality between the genders. All consecutive patients who underwent TAVI at 6 institutions were enrolled in this study and stratified according to gender. Midterm all-cause mortality was the primary end point, with events at 30 days and at midterm as secondary end points. All events were adjudicated according to Valve Academic Research Consortium definitions. Eight hundred thirty-six patients were enrolled, 464 (55.5%) of whom were female. At midterm follow-up (median 365 days, interquartile range 100 to 516) women had similar rates of all-cause mortality compared with men (18.1% vs 22.6%, p = 0.11) and similar incidence of myocardial infarction and cerebrovascular accident. Gender did not affect mortality also on multivariate analysis. Among clinical and procedural features, glomerular filtration rate <30 ml/min/1.73 m(2) (hazard ratio [HR] 2.55, 95% confidence interval [CI] 1.36 to 4.79) and systolic pulmonary arterial pressure >50 mm Hg (HR 2.26, 95% CI 1.26 to 4.02) independently predicted mortality in women, while insulin-treated diabetes (HR 3.45, 95% CI 1.47 to 8.09), previous stroke (HR 3.42, 95% CI 1.43 to 8.18), and an ejection fraction <30% (HR 3.82, 95% CI 1.41 to 10.37) were related to mortality in men. Postprocedural aortic regurgitation was independently related to midterm mortality in the 2 groups (HR 11.19, 95% CI 3.3 to 37.9). In conclusion, women and men had the same life expectancy after TAVI, but different predictors of adverse events stratified by gender were demonstrated. These findings underline the importance of a gender-tailored clinical risk assessment in TAVI patients. PMID:25159239

  5. All-Cause and Cause-Specific Mortality Associated with Bariatric Surgery: A Review.

    PubMed

    Adams, Ted D; Mehta, Tapan S; Davidson, Lance E; Hunt, Steven C

    2015-12-01

    The question of whether or not nonsurgical intentional or voluntary weight loss results in reduced mortality has been equivocal, with long-term mortality following weight loss being reported as increased, decreased, and not changed. In part, inconsistent results have been attributed to the uncertainty of whether the intentionality of weight loss is accurately reported in large population studies and also that achieving significant and sustained voluntary weight loss in large intervention trials is extremely difficult. Bariatric surgery has generally been free of these conflicts. Patients voluntarily undergo surgery and the resulting weight is typically significant and sustained. These elements, combined with possible non-weight loss-related mechanisms, have resulted in improved comorbidities, which likely contribute to a reduction in long-term mortality. This paper reviews the association between bariatric surgery and long-term mortality. From these studies, the general consensus is that bariatric surgical patients have: 1) significantly reduced long-term all-cause mortality when compared to severely obese non-bariatric surgical control groups; 2) greater mortality when compared to the general population, with the exception of one study; 3) reduced cardiovascular-, stroke-, and cancer-caused mortality when compared to severely obese non-operated controls; and 4) increased risk for externally caused death such as suicide.

  6. Does cytomegalovirus infection contribute to socioeconomic disparities in all-cause mortality?

    PubMed

    Feinstein, Lydia; Douglas, Christian E; Stebbins, Rebecca C; Pawelec, Graham; Simanek, Amanda M; Aiello, Allison E

    2016-09-01

    The social patterning of cytomegalovirus (CMV) and its implication in aging suggest that the virus may partially contribute to socioeconomic disparities in mortality. We used Cox regression and inverse odds ratio weighting to quantify the proportion of the association between socioeconomic status (SES) and all-cause mortality that was attributable to mediation by CMV seropositivity. Data were from the National Health and Nutrition Examination Survey (NHANES) III (1988-1994), with mortality follow-up through December 2011. SES was assessed as household income (income-to-poverty ratio ≤1.30;>1.30 to≤1.85;>1.85 to≤3.50;>3.50) and education (high school). We found strong associations between low SES and increased mortality: hazard ratio (HR) 1.80; 95% confidence interval (CI): 1.57, 2.06 comparing the lowest versus highest income groups and HR 1.29; 95% CI: 1.13, 1.48 comparing high school education. 65% of individuals were CMV seropositive, accounting for 6-15% of the SES-mortality associations. Age modified the associations between SES, CMV, and mortality, with CMV more strongly associated with mortality in older individuals. Our findings suggest that cytomegalovirus may partially contribute to persistent socioeconomic disparities in mortality, particularly among older individuals. PMID:27268074

  7. Can all cause readmission policy improve quality or lower expenditures? A historical perspective on current initiatives.

    PubMed

    Burgess, James F; Hockenberry, Jason M

    2014-04-01

    All-cause readmission to inpatient care is of wide policy interest in the United States and a number of other countries (Centers for Medicare and Medicaid Services, in the United Kingdom by the National Centre for Health Outcomes Development, and in Australia by the Australian Institute of Health and Welfare). Contemporary policy efforts, including high powered incentives embedded in the current US Hospital Readmission Reduction Program, and the organizationally complex interventions derived in anticipation of this policy, have been touted based on potential cost savings. Strong incentives and resulting interventions may not enjoy the support of a strong theoretical model or the empirical research base that are typical of strong incentive schemes. We examine the historical broad literature on the issue, lay out a 'full' conceptual organizational model of patient transitions as they relate to the hospital, and discuss the strengths and weaknesses of previous and proposed policies. We use this to set out a research and policy agenda on this critical issue rather than attempt to conduct a comprehensive structured literature review. We assert that researchers and policy makers should consider more fundamental societal issues related to health, social support and health literacy if progress is going to be made in reducing readmissions. PMID:23987089

  8. Can all cause readmission policy improve quality or lower expenditures? A historical perspective on current initiatives.

    PubMed

    Burgess, James F; Hockenberry, Jason M

    2014-04-01

    All-cause readmission to inpatient care is of wide policy interest in the United States and a number of other countries (Centers for Medicare and Medicaid Services, in the United Kingdom by the National Centre for Health Outcomes Development, and in Australia by the Australian Institute of Health and Welfare). Contemporary policy efforts, including high powered incentives embedded in the current US Hospital Readmission Reduction Program, and the organizationally complex interventions derived in anticipation of this policy, have been touted based on potential cost savings. Strong incentives and resulting interventions may not enjoy the support of a strong theoretical model or the empirical research base that are typical of strong incentive schemes. We examine the historical broad literature on the issue, lay out a 'full' conceptual organizational model of patient transitions as they relate to the hospital, and discuss the strengths and weaknesses of previous and proposed policies. We use this to set out a research and policy agenda on this critical issue rather than attempt to conduct a comprehensive structured literature review. We assert that researchers and policy makers should consider more fundamental societal issues related to health, social support and health literacy if progress is going to be made in reducing readmissions.

  9. PREFACE: EDS2010 Preface

    NASA Astrophysics Data System (ADS)

    Heggie, Malcolm I.

    2011-03-01

    The biennial international conference on Extended Defects in Semiconductors started in 1978 with a meeting in Hünfeld, Germany. Subsequent meetings rotated between Poland, France, Great Britain, Germany, Russia and Italy, culminating in EDS2004 in Chernogolovka, EDS2006 in Halle and EDS2008 in Poitiers. EDS2010 was held at the University of Sussex at Brighton, UK from September 19th to 24th. An extension of the tabulation of this history, which first appeared on the EDS2006 website, is given in the attached PDF. It is with sadness that we note one of the founders of the series, Prof. Dr Helmut Alexander, passed away on 3 December 2009 and we were proud to dedicate EDS2010 to his memory. It has become a tradition to make an award in his name, and this year it was made to Ivan Isacov for his poster "Electrical levels of dislocation networks in p- and n-type silicon". A short and warm celebration of Prof. Dr Alexander's life by his friends and colleagues, Prof. Drs Helmut Gottschalk, Eicke Weber and Wolfgang Schröter, is included in this volume. The conference was a forum for the state-of-the-art of investigation and modelling of extended defects in semiconductors. Scientists from universities, research institutes and industry made contributions to a deeper understanding of extended defects, their interaction with point defects and their role in the development of semiconductor technology. The remit of the conference included extended defects, nanostructures, nanoparticles, quantum dots and interfaces within semiconducting materials ranging from narrow to wide band gaps, including graphene-derived materials and diamond. Scientific interests range from defect geometry, electronic structure, dynamics, spectroscopy, microscopy, reactions and chemistry to introduction mechanisms, such as implantation and strained layers and the operation of devices such as integrated circuits, heterostructures, and solar cells. The organisers were confronted with a long period between

  10. Racial Disparities in All-Cause Mortality Among Veterans with Type 2 Diabetes

    PubMed Central

    Lynch, Cheryl P.; Gebregziabher, Mulugeta; Echols, Carrae; Gilbert, Gregory E.; Zhao, Yumin

    2010-01-01

    BACKGROUND Racial differences in mortality among veterans with diabetes are less well characterized than those in the general population. OBJECTIVE To examine racial differences in all-cause mortality in a large sample of veterans with diabetes. DESIGN A retrospective cohort. PARTICIPANTS Participants comprised 8,812 veterans with type 2 diabetes. MEASUREMENTS The main outcome measure was time to death. The main predictor was race/ethnicity. Other risk factors (or covariates) included age, gender, marital status, employment, glycosylated hemoglobin (HgbA1c), and several ICD-9 coded physical and mental health comorbidities. RESULTS Average follow-up was 4.5 years; 64% of veterans were non-Hispanic whites (NHW), 97% male, and 84% at least 50 years old. The overall mortality rate was 15% and was significantly lower for non-Hispanic blacks (NHB). Baseline HgbA1c values also differed for NHW (mean = 7.05) and NHB (mean = 7.65) (p < 0.001). In sequentially-built models NHB race was associated with a lower risk of mortality with HR ranging 0.80-0.92. After adjusting for all significant covariates, the risk of mortality remained lower for NHB (HR = 0.84, 95% CI: 0.75, 0.94). Increased mortality risk was associated with age, not being employed or retired, poor glycemic control, cancer, Coronary Heart Disease (CHD), and anxiety disorder; while a lower risk was associated with being female and ever being married. CONCLUSIONS The risk of death among NHB veterans with diabetes remained significantly lower than that of NHW after controlling for important confounding variables. Future studies in the VA need to examine detailed contributions of patient, provider and system-level factors on racial differences in mortality in adults with diabetes, especially if the findings of this study are replicated at other sites or using national VA data. PMID:20532659

  11. All cause mortality and incidence of cancer in workers in bauxite mines and alumina refineries.

    PubMed

    Fritschi, Lin; Hoving, Jan Lucas; Sim, Malcolm R; Del Monaco, Anthony; MacFarlane, Ewan; McKenzie, Dean; Benke, Geza; de Klerk, Nicholas

    2008-08-15

    Bauxite is a reddish clay that is refined to produce alumina, which is then reduced to aluminium. There have been studies examining the health of workers in aluminium smelters, but not workers in bauxite mining and alumina refining. A cohort of employees of 1 large aluminium company since 1983 was assembled (n = 6,485, 5,828 men). Deaths and incident cancers to 2002 were ascertained by linkage to national and state cancer and death registries. SIRs and SMRs were calculated compared to national rates standardizing for calendar year, sex and 5-year age group. The mortality from all causes (SMR 0.68, 95% CI: 0.60-0.77), and from circulatory and respiratory diseases, all cancers combined and injury in the male cohort were lower than in the Australian male population and were similar across work groups and with duration of employment. The only significant increased mortality risk was from pleural mesothelioma. The incidence of all cancers combined was similar to the Australian rate. The cohort had a lower risk of incident lymphohaematopoietic cancer (SIR 0.50, 95% CI: 0.31-0.88) and a higher risk of melanoma (SIR 1.30, 95% CI: 1.00-1.69) although no dose-responses were seen. There was also an increased risk of mesothelioma (SIR 3.49, 95% CI: 1.82-6.71), which was associated with exposures outside the aluminium industry. This study is the first to examine cancer and mortality amongst workers in bauxite mines and alumina refineries and found little evidence for increased cancer incidence or mortality in these workers.

  12. Structural stigma and all-cause mortality in sexual minority populations.

    PubMed

    Hatzenbuehler, Mark L; Bellatorre, Anna; Lee, Yeonjin; Finch, Brian K; Muennig, Peter; Fiscella, Kevin

    2014-02-01

    Stigma operates at multiple levels, including intrapersonal appraisals (e.g., self-stigma), interpersonal events (e.g., hate crimes), and structural conditions (e.g., community norms, institutional policies). Although prior research has indicated that intrapersonal and interpersonal forms of stigma negatively affect the health of the stigmatized, few studies have addressed the health consequences of exposure to structural forms of stigma. To address this gap, we investigated whether structural stigma-operationalized as living in communities with high levels of anti-gay prejudice-increases risk of premature mortality for sexual minorities. We constructed a measure capturing the average level of anti-gay prejudice at the community level, using data from the General Social Survey, which was then prospectively linked to all-cause mortality data via the National Death Index. Sexual minorities living in communities with high levels of anti-gay prejudice experienced a higher hazard of mortality than those living in low-prejudice communities (Hazard Ratio [HR] = 3.03, 95% Confidence Interval [CI] = 1.50, 6.13), controlling for individual and community-level covariates. This result translates into a shorter life expectancy of approximately 12 years (95% C.I.: 4-20 years) for sexual minorities living in high-prejudice communities. Analysis of specific causes of death revealed that suicide, homicide/violence, and cardiovascular diseases were substantially elevated among sexual minorities in high-prejudice communities. Strikingly, there was an 18-year difference in average age of completed suicide between sexual minorities in the high-prejudice (age 37.5) and low-prejudice (age 55.7) communities. These results highlight the importance of examining structural forms of stigma and prejudice as social determinants of health and longevity among minority populations.

  13. Cohort study of all-cause mortality among tobacco users in Mumbai, India.

    PubMed Central

    Gupta, P. C.; Mehta, H. C.

    2000-01-01

    INTRODUCTION: Overall mortality rates are higher among cigarette smokers than non-smokers. However, very little is known about the health effects of other forms of tobacco use widely prevalent in India, such as bidi smoking and various forms of smokeless tobacco (e.g. chewing betel-quid). We therefore carried out a cohort study in the city of Mumbai, India, to estimate the relative risks for all-cause mortality among various kinds of tobacco users. METHODS: A baseline survey of all individuals aged > or = 35 years using voters' lists as a selection frame was conducted using a house-to-house approach and face-to-face interviews. RESULTS: Active follow-up of 52,568 individuals in the cohort was undertaken 5-6 years after the baseline study, and 97.6% were traced. A total of 4358 deaths were recorded among these individuals. The annual age-adjusted mortality rates were 18.4 per 1000 for men and 12.4 per 1000 for women. For men the mortality rates for smokers were higher than those of non-users of tobacco across all age groups, with the difference being greater for lower age groups (35-54 years). The relative risk was 1.39 for cigarette smokers and 1.78 for bidi smokers, with an apparent dose-response relationship for frequency of smoking. Women were basically smokeless tobacco users, with the relative risk among such users being 1.35 and a suggestion of a dose-response relationship. DISCUSSION: These findings establish bidi smoking as no less hazardous than cigarette smoking and indicate that smokeless tobacco use may also cause higher mortality. Further studies should be carried out to obtain cause-specific mortality rates and relative risks. PMID:10994260

  14. Wound healing and all-cause mortality in 958 wound patients treated in home care.

    PubMed

    Zarchi, Kian; Martinussen, Torben; Jemec, Gregor B E

    2015-09-01

    Skin wounds are associated with significant morbidity and mortality. Data are, however, not readily available for benchmarking, to allow prognostic evaluation, and to suggest when involvement of wound-healing experts is indicated. We, therefore, conducted an observational cohort study to investigate wound healing and all-cause mortality associated with different types of skin wounds. Consecutive skin wound patients who received wound care by home-care nurses from January 2010 to December 2011 in a district in Eastern Denmark were included in this study. Patients were followed until wound healing, death, or the end of follow-up on December 2012. In total, 958 consecutive patients received wound care by home-care nurses, corresponding to a 1-year prevalence of 1.2% of the total population in the district. During the study, wound healing was achieved in 511 (53.3%), whereas 90 (9.4%) died. During the first 3 weeks of therapy, healing was most likely to occur in surgical wounds (surgical vs. other wounds: adjusted hazard ratio [AHR] 2.21, 95% confidence interval 1.50-3.23), while from 3 weeks to 3 months of therapy, cancer wounds, and pressure ulcers were least likely to heal (cancer vs. other wounds: AHR 0.12, 0.03-0.50; pressure vs. other wounds: AHR 0.44, 0.27-0.74). Cancer wounds and pressure ulcers were further associated with a three times increased probability of mortality compared with other wounds (cancer vs. other wounds: AHR 3.19, 1.35-7.50; pressure vs. other wounds: AHR 2.91, 1.56-5.42). In summary, the wound type was found to be a significant predictor of healing and mortality with cancer wounds and pressure ulcers being associated with poor prognosis.

  15. Patterns and correlates of drug-related emergency department visits: Results from a national survey

    PubMed Central

    Perron, Brian E.; Bohnert, Amy S. B.; Monsell, Sarah E.; Vaughn, Michael G.; Epperson, Matthew; Howard, Matthew O.

    2010-01-01

    Purpose Drug treatment can be effective in community-based settings, but drug users tend to under-utilize these treatment options and instead seek services in emergency departments (ED) and other acute care settings. The goals of this study were to describe prevalence and correlates of drug-related ED visits. Basic procedures This study used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), which is a nationally representative survey of 43,093 U.S. residents. Main findings The overall prevalence of drug-related ED visits among lifetime drug users was 1.8%; for those with a lifetime drug use disorder, 3.7%. Persons with heroin dependence and inhalant dependence had the highest rates of ED visits, and marijuana dependence was associated with the lowest rates. Multivariate analyses revealed that being socially connected (i.e., marital status) were protective factors against ED visits, whereas psychopathology (i.e., personality or mood disorders) were risk factors. Conclusions Significant variability exists for risk of ED use for different types of drugs. These findings can help inform where links between EDs with local treatment programs can be formed to provide preventative care and injury-prevention interventions to reduce the risk of subsequent ED visits. PMID:20627209

  16. Oxidative Stress Predicts All-Cause Mortality in HIV-Infected Patients

    PubMed Central

    Masiá, Mar; Padilla, Sergio; Fernández, Marta; Rodríguez, Carmen; Moreno, Ana; Oteo, Jose A.; Antela, Antonio; Moreno, Santiago; del Amo, Julia; Gutiérrez, Félix

    2016-01-01

    Objective We aimed to assess whether oxidative stress is a predictor of mortality in HIV-infected patients. Methods We conducted a nested case-control study in CoRIS, a contemporary, multicentre cohort of HIV-infected patients, antiretroviral-naïve at entry, launched in 2004. Cases were patients who died with available stored plasma samples collected. Two age and sex-matched controls for each case were selected. We measured F2-isoprostanes (F2-IsoPs) and malondialdehyde (MDA) plasma levels in the first blood sample obtained after cohort engagement. Results 54 cases and 93 controls were included. Median F2-IsoPs and MDA levels were significantly higher in cases than in controls. When adjustment was performed for age, HIV-transmission category, CD4 cell count and HIV viral load at cohort entry, and subclinical inflammation measured with highly-sensitive C-reactive protein (hsCRP), the association of F2-IsoPs with mortality remained significant (adjusted OR per 1 log10 increase, 2.34 [1.23–4.47], P = 0.009). The association of MDA with mortality was attenuated after adjustment: adjusted OR (95% CI) per 1 log10 increase, 2.05 [0.91–4.59], P = 0.080. Median hsCRP was also higher in cases, and it also proved to be an independent predictor of mortality in the adjusted analysis: OR (95% CI) per 1 log10 increase, 1.39 (1.01–1.91), P = 0.043; and OR (95% CI) per 1 log10 increase, 1.46 (1.07–1.99), P = 0.014, respectively, when adjustment included F2-IsoPs and MDA. Conclusion Oxidative stress is a predictor of all-cause mortality in HIV-infected patients. For plasma F2-IsoPs, this association is independent of HIV-related factors and subclinical inflammation. PMID:27111769

  17. Trends in Emergency Department Visits for Unsupervised Pediatric Medication Exposures, 2004–2013

    PubMed Central

    Lovegrove, Maribeth C.; Weidle, Nina J.; Budnitz, Daniel S.

    2015-01-01

    Background Following reports of increasing emergency department (ED) visits for unsupervised pediatric medication exposures in the 2000s, renewed efforts to improve safety packaging and education were initiated. National data on current trends and implicated medications can help further target interventions. Methods We used nationally-representative data from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project (2004–2013) to assess trends in ED visits for unsupervised medication exposures in children aged <6 years. For 2010–2013, we identified the dosage form and prescription status of implicated medications. Results Based on 13,268 cases, there were an estimated 640,161 ED visits (95% confidence interval: 512,885–767,436) for unsupervised medication exposures from 2004–2013. From 2004–2010, the number of ED visits for unsupervised exposures increased by an average of 5.7% annually, peaking at 75,842. After 2010, this trend reversed and ED visits decreased by an average of 6.7% annually to 59,092 estimated visits in 2013. From 2010–2013, 91.0% of ED visits for unsupervised exposures involved 1 medication, most commonly an oral prescription solid (45.9%), oral over-the-counter (OTC) solid (22.3%), or oral OTC liquid (12.4%); 9.0% of visits involved >1 medication. Over 260 different prescription solids were implicated; opioids (13.8%) and benzodiazepines (12.7%) were the most commonly implicated classes. Four medications were implicated in 91.2% of OTC liquid exposure visits: acetaminophen (32.9%), cough and cold remedies (27.5%), ibuprofen (15.7%), and diphenhydramine (15.6%). Conclusions Targeting prevention efforts based on harm frequency and intervention feasibility can lead to continued reductions in ED visits for pediatric medication exposures. PMID:26347435

  18. National Trends in Resource Utilization Associated with Emergency Department Visits for Syncope

    PubMed Central

    Probst, Marc A.; Kanzaria, Hemal K.; Gbedemah, Misato; Richardson, Lynne D.; Sun, Benjamin C.

    2015-01-01

    Background Over the last 20 years, numerous research articles and clinical guidelines aimed at optimizing resource utilization for emergency department (ED) patients presenting with syncope have been published. Hypothesis We hypothesized there would be temporal trends in syncope-related ED visits and associated trends in imaging, hospital admissions, and diagnostic frequencies. Methods The ED component of National Hospital Ambulatory Medical Care Survey was analyzed from 2001 through 2010, comprising over 358,000 visits (representing an estimated 1.18 billion visits nationally). We selected ED visits with a reason for visit of syncope or fainting and calculated nationally representative weighted estimates for prevalence of such visits, and associated rates of advanced imaging utilization and admission. For admitted patients from 2005 to 2010, the most frequent hospital discharge diagnoses were tabulated. Results During the study period, there were over 3,500 actual ED visits (representing 11.9 million visits nationally) related to syncope, representing roughly 1% of all ED visits. Admission rates for syncope patients ranged from 27% to 35% and showed no significant downward trend (p=0.1). Advanced imaging rates increased from about 21% to 45% and showed a significant upward trend (p < 0.001). For admitted patients, the most common hospital discharge diagnosis was the symptomatic diagnosis of “syncope and collapse” (36.4%). Conclusions Despite substantial efforts by medical researchers and professional societies, resource utilization associated with ED visits for syncope appears to have actually increased. There have been no apparent improvements in diagnostic yield for admissions. Novel strategies may be needed to change practice patterns for such patients. PMID:25943042

  19. Air Pollution and Emergency Department Visits for Depression: A Multicity Case-Crossover Study

    PubMed Central

    Szyszkowicz, Mieczysław; Kousha, Termeh; Kingsbury, Mila; Colman, Ian

    2016-01-01

    BACKGROUND The aim of this study was to investigate the associations between ambient air pollution and emergency department (ED) visits for depression. METHODS Health data were retrieved from the National Ambulatory Care Reporting System. ED visits for depression were retrieved from the National Ambulatory Care Reporting System using the International Classification of Diseases (ICD-10), Tenth revision codes; ICD-10: F32 (mild depressive episode) and ICD-10: F33 (recurrent depressive disorder). A case-crossover design was employed for this study. Conditional logistic regression models were used to estimate odds ratios. RESULTS For females, exposure to ozone was associated with increased risk of an ED visit for depression between 1 and 7 days after exposure, for males, between 1 and 5, and 8 days after exposure, with odds ratios ranging between 1.02 and 1.03. CONCLUSIONS These findings suggest that, as hypothesized, there is a positive association between exposure to air pollution and ED visits for depression.

  20. Visiting Scholar Exchange Reports.

    ERIC Educational Resources Information Center

    Rubin, Kyna, Ed.

    1986-01-01

    Provides reports of four United States scholars who visited China as part of the Visiting Scholar Exchange Program. The titles of the reports are (1) "China Journey: A Political Scientist's Look at Yan'an," (2) "The Social Consequences of Land Reclamation in Chinese Coastal Ecosystems," (3) "Anthropology Lectures in South China," and (4) "The Use…

  1. Secondary Emergency Visits

    PubMed Central

    Mohr, Bruce; Wiley, Preston

    1991-01-01

    This study surveyed patients seeking emergency care at three Calgary hospitals during a 7-day period in February 1989. Twenty-one percent had seen another physician for the same medical problem within 72 hours. The study suggests that secondary visits at emergency departments affect health care costs. Further study is needed to investigate the extent and appropriateness of such visits. PMID:21229002

  2. Hosting the Presidential Visit.

    ERIC Educational Resources Information Center

    Sherouse, Mark A.

    This paper describes the visit of President Bush to the campus of Southern Methodist University (SMU) for the May, 1992 commencement and lessons learned from the experience. The paper describes how SMU made use of lead time and suggests how to estimate cost of such a visit. Discussion of strategies for organizing describes the formation and work…

  3. Presidential visit to MSFC

    NASA Technical Reports Server (NTRS)

    1990-01-01

    President George Bush and Alabama Governor Guy Hunt are greeted by Marshall's sixth Center Director Thomas J. Lee (1989-1994) upon their arrival at Redstone Arsenal (RSA) airfield. This was the first sitting president to visit Marshall Space Flight Center (MSFC) since President Kennedy's visit almost 30 years ago.

  4. Osteoarthritis and all-cause mortality in worldwide populations: grading the evidence from a meta-analysis

    PubMed Central

    Xing, Dan; Xu, Yuankun; Liu, Qiang; Ke, Yan; Wang, Bin; Li, Zhichang; Lin, Jianhao

    2016-01-01

    The objective of this study is to investigate the association between osteoarthritis (OA) and all-cause mortality in worldwide populations and to develop recommendations according to GRADE evidence levels. Literature search through Nov 2015 was performed using the electronic databases (including MEDLINE, EMBASE, EBSCO and Cochrane library). The prospective cohort trials that investigated the association between the symptomatic OA (SxOA) or radiological OA (ROA) and all-cause mortality were identified. Hazard ratios (HR) of all-cause mortality in patients with RxOA or ROA were pooled respectively. The evidence quality was evaluated using the GRADE system, while the recommendations were taken according to the quality. Nine of the published literature met the eligible criteria. Meta-analysis revealed that there was no significant difference in the association between SxOA and all-cause mortality (HR = 0.91, 95% CI: 0.68–1.23) and between ROA and all-cause mortality (HR = 1.13, 95% CI: 0.95–1.35). The overall GARDE evidence quality was very low, which will lower our confidence in taking recommendations. To summarize, there was no reliable and confident evidence existed currently in respect of the association between OA and all-cause mortality. Due to the very low level of evidence quality currently, high-quality studies are still required. PMID:27087682

  5. Aspirin Is Associated With Reduced Cardiovascular and All-Cause Mortality in Type 2 Diabetes in a Primary Prevention Setting

    PubMed Central

    Ong, Greg; Davis, Timothy M.E.; Davis, Wendy A.

    2010-01-01

    OBJECTIVE To determine whether regular aspirin use (≥75 mg/day) is independently associated with cardiovascular disease (CVD) and all-cause mortality in community-based patients with type 2 diabetes and no history of CVD. RESEARCH DESIGN AND METHODS Of the type 2 diabetic patients recruited to the longitudinal observational Fremantle Diabetes Study, 651 (50.3%) with no prior CVD history at entry between 1993 and 1996 were followed until death or the end of June 2007, representing a total of 7,537 patient-years (mean ± SD 11.6 ± 2.9 years). Cox proportional hazards modeling was used to determine independent baseline predictors of CVD and all-cause mortality including regular aspirin use. RESULTS There were 160 deaths (24.6%) during follow-up, with 70 (43.8%) due to CVD. In Kaplan-Meier survival analysis, there was no difference in either CVD or all-cause mortality in aspirin users versus nonusers (P = 0.52 and 0.94, respectively, by log-rank test). After adjustment for significant variables in the most parsimonious Cox models, regular aspirin use at baseline independently predicted reduced CVD and all-cause mortality (hazard ratio [HR] 0.30 [95% CI 0.09–0.95] and 0.53 [0.28–0.98[, respectively; P ≤ 0.044). In subgroup analyses, aspirin use was independently associated with reduced all-cause mortality in those aged ≥65 years and men. CONCLUSIONS Regular low-dose aspirin may reduce all-cause and CVD mortality in a primary prevention setting in type 2 diabetes. All-cause mortality reductions are greatest in men and in those aged ≥65 years. The present observational data support recommendations that aspirin should be used in primary CVD prevention in all but the lowest risk patients. PMID:19918016

  6. Emergency department visits for motor vehicle traffic injuries: United States, 2010-2011.

    PubMed

    Albert, Michael; McCaig, Linda F

    2015-01-01

    Data from the National Hospital Ambulatory Medical Care Survey, 2010-2011. In 2010-2011, the emergency department (ED) visit rate for motor vehicle traffic injuries was highest among persons aged 16-24 years. The rates declined with age after 16-24, with rates for those aged 0-15 similar to those 65 and over. The overall ED visit rate for motor vehicle traffic injuries was higher among non-Hispanic black persons compared with non-Hispanic white and Hispanic persons. Imaging services were ordered or provided at 70.2% of ED visits for motor vehicle traffic injuries, which was higher than for other injury-related ED visits (55.9%). About one-half of ED visits for motor vehicle traffic injuries had a primary diagnosis of sprains and strains of the neck and back, contusion with intact skin surface, or spinal disorders. In spite of improvements in motor vehicle safety in recent years, motor vehicle crashes remain a major source of morbidity and mortality in the United States (1-3). Motor vehicle-related deaths and injuries also result in substantial economic and societal costs related to medical care and lost productivity (4). This report describes the rates and characteristics of emergency department (ED) visits for motor vehicle traffic injuries during 2010-2011 based on nationally representative data from the National Hospital Ambulatory Medical Care Survey (NHAMCS).

  7. AGU sponsors Argentinean's visit

    NASA Astrophysics Data System (ADS)

    Maria C. Azpiazu, an Argentinean space scientist, has been selected to receive travel support to attend the 1991 AGU Spring Meeting in Baltimore under AGU's Latin American Visiting Geophysicist Program. In addition to presenting a paper at the meeting on [Analysis of Electron Density and Temperature Profiles in the E-Region on Geomagnetically Quiet Days,] Azpiazu plans to visit several universities and research institutions.Azpiazu is an assistant professor at the University of Buenos Aires and an assistant researcher at the Argentinean National Research Council. While in the United States she plans to visit Boston and Harvard Universities, MIT, Hanscom Air Force Base, and the University of Colorado.

  8. Predicting asthma-related emergency department visits using big data.

    PubMed

    Ram, Sudha; Zhang, Wenli; Williams, Max; Pengetnze, Yolande

    2015-07-01

    Asthma is one of the most prevalent and costly chronic conditions in the United States, which cannot be cured. However, accurate and timely surveillance data could allow for timely and targeted interventions at the community or individual level. Current national asthma disease surveillance systems can have data availability lags of up to two weeks. Rapid progress has been made in gathering nontraditional, digital information to perform disease surveillance. We introduce a novel method of using multiple data sources for predicting the number of asthma-related emergency department (ED) visits in a specific area. Twitter data, Google search interests, and environmental sensor data were collected for this purpose. Our preliminary findings show that our model can predict the number of asthma ED visits based on near-real-time environmental and social media data with approximately 70% precision. The results can be helpful for public health surveillance, ED preparedness, and targeted patient interventions. PMID:25706935

  9. Resting heart rate and all-cause and cardiovascular mortality in the general population: a meta-analysis

    PubMed Central

    Zhang, Dongfeng; Shen, Xiaoli; Qi, Xin

    2016-01-01

    Background: Data on resting heart rate and risk of all-cause and cardiovascular mortality are inconsistent; the magnitude of associations between resting heart rate and risk of all-cause and cardiovascular mortality varies across studies. We performed a meta-analysis of prospective cohort studies to quantitatively evaluate the associations in the general population. Methods: We searched PubMed, Embase and MEDLINE from inception to Jan. 1, 2015. We used a random-effects model to combine study-specific relative risks and 95% confidence intervals (CIs). We used restricted cubic spline functions to assess the dose–response relation. Results: A total of 46 studies were included in the meta-analysis, involving 1 246 203 patients and 78 349 deaths for all-cause mortality, and 848 320 patients and 25 800 deaths for cardiovascular mortality. The relative risk with 10 beats/min increment of resting heart rate was 1.09 (95% CI 1.07–1.12) for all-cause mortality and 1.08 (95% CI 1.06–1.10) for cardiovascular mortality. Compared with the lowest category, patients with a resting heart rate of 60–80 beats/min had a relative risk of 1.12 (95% CI 1.07–1.17) for all-cause mortality and 1.08 (95% CI 0.99–1.17) for cardiovascular mortality, and those with a resting heart rate of greater than 80 beats/min had a relative risk of 1.45 (95% CI 1.34–1.57) for all-cause mortality and 1.33 (95% CI 1.19–1.47) for cardiovascular mortality. Overall, the results did not differ after adjustment for traditional risk factors for cardiovascular disease. Compared with 45 beats/min, the risk of all-cause mortality increased significantly with increasing resting heart rate in a linear relation, but a significantly increased risk of cardiovascular mortality was observed at 90 beats/min. Substantial heterogeneity and publication bias were detected. Interpretation: Higher resting heart rate was independently associated with increased risks of all-cause and cardiovascular mortality. This

  10. A Retrospective Study of the Clinical Burden of Hospitalized All-Cause and Pneumococcal Pneumonia in Canada

    PubMed Central

    McNeil, Shelly A.; Qizilbash, Nawab; Ye, Jian; Gray, Sharon; Zanotti, Giovanni; Munson, Samantha; Dartois, Nathalie; Laferriere, Craig

    2016-01-01

    Background. Routine vaccination against Streptococcus pneumoniae is recommended in Canada for infants, the elderly, and individuals with chronic comorbidity. National incidence and burden of all-cause and pneumococcal pneumonia in Canada (excluding Quebec) were assessed. Methods. Incidence, length of stay, and case-fatality rates of hospitalized all-cause and pneumococcal pneumonia were determined for 2004–2010 using ICD-10 discharge data from the Canadian Institutes for Health Information Discharge Abstract Database. Population-at-risk data were obtained from the Statistics Canada census. Temporal changes in pneumococcal and all-cause pneumonia rates in adults ≥65 years were analyzed by logistic regression. Results. Hospitalization for all-cause pneumonia was highest in children <5 years and in adults >70 years and declined significantly from 1766/100,000 to 1537/100,000 per year in individuals aged ≥65 years (P < 0.001). Overall hospitalization for pneumococcal pneumonia also declined from 6.40/100,000 to 5.08/100,000 per year. Case-fatality rates were stable (11.6% to 12.3%). Elderly individuals had longer length of stay and higher case-fatality rates than younger groups. Conclusions. All-cause and pneumococcal pneumonia hospitalization rates declined between 2004 and 2010 in Canada (excluding Quebec). Direct and indirect effects from pediatric pneumococcal immunization may partly explain some of this decline. Nevertheless, the burden of disease from pneumonia remains high. PMID:27445530

  11. Coffee consumption and mortality from all causes, cardiovascular disease, and cancer: a dose-response meta-analysis.

    PubMed

    Crippa, Alessio; Discacciati, Andrea; Larsson, Susanna C; Wolk, Alicja; Orsini, Nicola

    2014-10-15

    Several studies have analyzed the relationship between coffee consumption and mortality, but the shape of the association remains unclear. We conducted a dose-response meta-analysis of prospective studies to examine the dose-response associations between coffee consumption and mortality from all causes, cardiovascular disease (CVD), and all cancers. Pertinent studies, published between 1966 and 2013, were identified by searching PubMed and by reviewing the reference lists of the selected articles. Prospective studies in which investigators reported relative risks of mortality from all causes, CVD, and all cancers for 3 or more categories of coffee consumption were eligible. Results from individual studies were pooled using a random-effects model. Twenty-one prospective studies, with 121,915 deaths and 997,464 participants, met the inclusion criteria. There was strong evidence of nonlinear associations between coffee consumption and mortality for all causes and CVD (P for nonlinearity < 0.001). The largest risk reductions were observed for 4 cups/day for all-cause mortality (16%, 95% confidence interval: 13, 18) and 3 cups/day for CVD mortality (21%, 95% confidence interval: 16, 26). Coffee consumption was not associated with cancer mortality. Findings from this meta-analysis indicate that coffee consumption is inversely associated with all-cause and CVD mortality.

  12. Usual walking speed and all-cause mortality risk in older people: A systematic review and meta-analysis.

    PubMed

    Liu, Bing; Hu, Xinhua; Zhang, Qiang; Fan, Yichuan; Li, Jun; Zou, Rui; Zhang, Ming; Wang, Xiuqi; Wang, Junpeng

    2016-02-01

    The purpose of this study was to investigate the relationship between slow usual walking speed and all-cause mortality risk in older people by conducting a meta-analysis. We searched through the Pubmed, Embase and Cochrane Library database up to March 2015. Only prospective observational studies that investigating the usual walking speed and all-cause mortality risk in older adulthood approaching age 65 years or more were included. Walking speed should be specifically assessed as a single-item tool over a short distance. Pooled adjusted risk ratio (RR) and 95% confidence interval (CI) were computed for the lowest versus the highest usual walking speed category. A total of 9 studies involving 12,901 participants were included. Meta-analysis with random effect model showed that the pooled adjusted RR of all-cause mortality was 1.89 (95% CI 1.46-2.46) comparing the lowest to the highest usual walk speed. Subgroup analyses indicated that risk of all-cause mortality for slow usual walking speed appeared to be not significant among women (RR 1.45; 95% CI 0.95-2.20). Slow usual walking speed is an independent predictor of all-cause mortality in men but not in women among older adulthood approaching age 65 years or more. PMID:27004653

  13. The relation of ambulatory heart rate with all-cause mortality among middle-aged men: a prospective cohort study.

    PubMed

    Korshøj, Mette; Lidegaard, Mark; Kittel, France; Van Herck, Koen; De Backer, Guy; De Bacquer, Dirk; Holtermann, Andreas; Clays, Els

    2015-01-01

    The aim of this study was to investigate the association between average 24-hour ambulatory heart rate and all-cause mortality, while adjusting for resting clinical heart rate, cardiorespiratory fitness, occupational and leisure time physical activity as well as classical risk factors. A group of 439 middle-aged male workers free of baseline coronary heart disease from the Belgian Physical Fitness Study was included in the analysis. Data were collected by questionnaires and clinical examinations from 1976 to 1978. All-cause mortality was collected from the national mortality registration with a mean follow-up period of 16.5 years, with a total of 48 events. After adjustment for all before mentioned confounders in a Cox proportional hazards regression analysis, a significant increased risk for all-cause mortality was found among the tertile of workers with highest average ambulatory heart rate compared to the tertile with lowest ambulatory heart rate (Hazard ratio = 3.21, 95% confidence interval: 1.22-8.44). No significant independent association was found between resting clinic heart rate and all-cause mortality. The study indicates that average 24-hour ambulatory heart rate is a strong predictor of all-cause mortality independent from resting clinic heart rate, cardiorespiratory fitness, occupational and leisure time physical activity and other classical risk factors among healthy middle-aged workers.

  14. Prescription monitoring programs and emergency department visits involving opioids, 2004–2011

    PubMed Central

    Maughan, Brandon C.; Bachhuber, Marcus A.; Mitra, Nandita; Starrels, Joanna L.

    2016-01-01

    Objective To determine the association between prescription drug monitoring program (PDMP) implementation and emergency department (ED) visits involving opioid analgesics. Methods Rates of ED visits involving opioid analgesics per 100,000 residents were estimated from the Drug Abuse Warning Network dataset for 11 geographically diverse metropolitan areas in the United States on a quarterly basis from 2004 to 2011. Generalized estimating equations assessed whether implementation of a prescriber-accessible PDMP was associated with a difference in ED visits involving opioid analgesics. Models were adjusted for calendar quarter, metropolitan area, metropolitan area-specific linear time trends, and unemployment rate. Results Rates of ED visits involving opioid analgesics increased in all metropolitan areas. PDMP implementation was not associated with a difference in ED visits involving opioid analgesics (mean difference of 0.8 visits [95% CI: −3.7 to 5.2] per 100,000 residents per quarter). Conclusions During 2004–2011, PDMP implementation was not associated with a change in opioid-related morbidity, as measured by emergency department visits involving opioid analgesics. Urgent investigation is needed to determine the optimal PDMP structure and capabilities to improve opioid analgesic safety. PMID:26454836

  15. Edward (Ed) T. Schneider

    NASA Technical Reports Server (NTRS)

    1989-01-01

    Research Pilot Edward T. Schneider is shown sitting in the cockpit of a McDonnell Douglas F/A-18 Hornet that was used in the High Angle-of-Attack Research Vehicle (HARV) program at the National Aeronautics and Space Administration's Ames - Dryden Flight Research Facility. When the aircraft arrived at the Dryden Facility in 1987, from the US Naval Air Test Center, Patuxent River, Maryland, it consisted of parts in crates. The aircraft crew made an airplane from those parts, and in doing so they took a 'sow's ear' and created a 'silk purse', thus the name on the side of the aircraft. Ed's helmet is from his time in the Navy. The design was taken from the Flag that is flown on the bow of a Navy ship, referred to as the Jack, and is navy blue with the 50 States being represented by the white stars. Ed arrived at the NASA Ames-Dryden Flight Research Facility (later renamed the Dryden Flight Research Center) on July 5, 1982, as a Navy Liaison Officer, becoming a NASA research pilot one year later. Ed was the project pilot for the F-18 High Angle-of-Attack program and later served as a project pilot for the F-15 aeronautical research aircraft, the NASA B-52 launch aircraft, and the SR-71 'Blackbird' aircraft. He served on active duty with the U.S. Navy from 1968 to 1983. Following squadron service he graduated from the U.S. Naval Test Pilot School, Patuxent River, Maryland, in 1973, and then served as an engineering test pilot, and test pilot school instructor at the Naval Air Test Center. Ed has been an active member of the Society of Experimental Test Pilots since 1974. He was made a Fellow of the Society in 1993 and served as its President in 1993/94. In 1996 he was awarded the NASA Exceptional Service Medal and the American Institute of Aeronautics and Astronautics' Chanute Flight Award. He retired as a NASA research pilot in September 2000.

  16. Students Request Supervisory Visits

    ERIC Educational Resources Information Center

    Mooney, Jewell

    1974-01-01

    The author stresses the importance of summer and regular school year visits to vocational agriculture student by the agriculture instructor as opportunities for both project advisement and personal counseling. (EA)

  17. Class Visit Short Cuts.

    ERIC Educational Resources Information Center

    Hofmann, Alice; Somerville, Mary

    1982-01-01

    Describes methods used by the Louisville Free Public Library's children's department to introduce the library's programs and services to elementary school children. Specific suggestions for one-person visitations are provided including pertinent book titles. (EJS)

  18. [The preoperative anaesthetic visit].

    PubMed

    Harms, Christoph; Kindler, Christoph H

    2009-07-01

    Anaesthetists often visit their patients in exceptional situations characterised by preoperative anxiety or distress. Therefore, even brief contact with the patient can be considered intense and meaningful. The initial preoperative anaesthetic visit is the beginning of the relationship between patient and anaesthetist, and should help to explain the planned anaesthetic technique. Preoperative anaesthetic visits are intense and last for 20 minutes on average. They should assert a professional approach to the patient's emotions, particularly to preoperative anxiety, and a structured and clear collection of information including the past history of the patient. These visits should also provide information about the anaesthesia itself and instructions for the patient with respect to the perioperative period. Communication about the side effects and risks of anaesthetic techniques, and the discussion of potential alternatives are mandatory. Worldwide, courts of law increasingly require a documented discussion between the anaesthetist and patient based on risk-benefit evidence. Today, there is in general a shift away from decisions made solely by physicians, reflecting an increased respect for the autonomy of the patient towards a model of shared decision-making and informed choice. Ideally, the preoperative visit follows the four key habits of highly effective clinicians, i.e., to rapidly establish a rapport with the patient and provide an agenda for the visit, to explore the patient's perspectives and expectations, to demonstrate empathy, and to focus on the end of the visit with providing information and including the patient in the decision-making process. Visits are then concluded upon obtaining informed consent from the patient. PMID:19565444

  19. [Differences of mortality risk for all causes and for cardiovascular diseases among occupational classes in men living the Northern Italy].

    PubMed

    Ferrario, M; Porati, S; Chiodini, P; Taborelli, S; Toso, C; Borchini, R; Maretti, A; Cesana, G

    2003-01-01

    To assess socio-occupational (SO) class differences in 8-year risk of all-cause and cardiovascular (CVD) death in an North Italian prospective epidemiological study, five cohorts (four population-based and one factory-based) were investigated at baseline from 1986 to 1995. Follow-up procedures allow to sensor 4339 35-74 years old men up to the end of 1998 for all-cause and cardiovascular deaths. Coronary risk factors were measures according to the standardised methods of MONICA Project. Five SO classes were identified according to the method proposed by Erikson, Golthorpe e Portocarero. Results shows an inverse associations between SO classes and death risk for all-cause and cancer. The higher SO classes showed higher risk of cardiovascular death risk. Possible explanations include high level of job stress among employed managers and professionals.

  20. Tea consumption and mortality of all cancers, CVD and all causes: a meta-analysis of eighteen prospective cohort studies.

    PubMed

    Tang, Jun; Zheng, Ju-Sheng; Fang, Ling; Jin, Yongxin; Cai, Wenwen; Li, Duo

    2015-09-14

    Epidemiological studies have demonstrated inconsistent associations between tea consumption and mortality of all cancers, CVD and all causes. To obtain quantitative overall estimates, we conducted a dose-response meta-analysis of prospective cohort studies. A literature search in PubMed and Embase up to April 2015 was conducted for all relevant papers published. Random-effects models were used to calculate pooled relative risks (RR) with 95 % CI. In eighteen prospective studies, there were 12 221, 11 306 and 55 528 deaths from all cancers, CVD and all causes, respectively. For all cancer mortality, the summary RR for the highest v. lowest category of green tea and black tea consumption were 1·06 (95 % CI 0·98, 1·15) and 0·79 (95 % CI 0·65, 0·97), respectively. For CVD mortality, the summary RR for the highest v. lowest category of green tea and black tea consumption were 0·67 (95 % CI 0·46, 0·96) and 0·88 (95 % CI 0·77, 1·01), respectively. For all-cause mortality, the summary RR for the highest v. lowest category of green tea and black tea consumption were 0·80 (95 % CI 0·68, 0·93) and 0·90 (95 % CI 0·83, 0·98), respectively. The dose-response analysis indicated that one cup per d increment of green tea consumption was associated with 5 % lower risk of CVD mortality and with 4 % lower risk of all-cause mortality. Green tea consumption was significantly inversely associated with CVD and all-cause mortality, whereas black tea consumption was significantly inversely associated with all cancer and all-cause mortality.

  1. Skipping Breakfast and Risk of Mortality from Cancer, Circulatory Diseases and All Causes: Findings from the Japan Collaborative Cohort Study

    PubMed Central

    Yokoyama, Yae; Onishi, Kazunari; Hosoda, Takenobu; Amano, Hiroki; Otani, Shinji; Kurozawa, Youichi; Tamakoshi, Akiko

    2016-01-01

    Background Breakfast eating habits are a dietary pattern marker and appear to be a useful predictor of a healthy lifestyle. Many studies have reported the unhealthy effects of skipping breakfast. However, there are few studies on the association between skipping breakfast and mortality. In the present study, we examined the association between skipping breakfast and mortality from cancer, circulatory diseases and all causes using data from a large-scale cohort study, the Japan Collaborative Cohort Study (JACC) Study. Methods A cohort study of 34,128 men and 49,282 women aged 40–79 years was conducted, to explore the association between lifestyle and cancer in Japan. Participants completed a baseline survey during 1988 to 1990 and were followed until the end of 2009. We classified participants into two groups according to dietary habits with respect to eating or skipping breakfast and carried out intergroup comparisons of lifestyle. Multivariate analysis was performed using the Cox proportional hazard regression model. Results There were 5,768 deaths from cancer and 5,133 cases of death owing to circulatory diseases and 17,112 cases for all causes of mortality during the median 19.4 years follow-up. Skipping breakfast was related to unhealthy lifestyle habits. After adjusting for confounding factors, skipping breakfast significantly increased the risk of mortality from circulatory diseases [hazard ratio (HR) = 1.42] and all causes (HR = 1.43) in men and all causes mortality (HR = 1.34) in women. Conclusion Our findings showed that skipping breakfast is associated with increasing risk of mortality from circulatory diseases and all causes among men and all causes mortality among women in Japan. PMID:27046951

  2. Aortic arch calcification and risk of cardiovascular or all-cause and mortality in dialysis patients: A meta-analysis

    PubMed Central

    Zhang, Ao; Wang, Shiji; Li, Hongxiang; Yang, Juan; Wu, Hui

    2016-01-01

    Studies on aortic arch calcification (AAC) and mortality risk in maintenance dialysis patients have yielded conflicting findings. We conducted this meta-analysis to investigate the association between the presence of AAC and cardiovascular or all-cause and mortality risk in maintenance dialysis patients. Observational studies evaluating baseline AAC and cardiovascular or all-cause mortality risk in maintenance dialysis patients were searched through the PubMed and Embase, CNKI, VIP and Wanfang databases until January 2016. A total of 8 studies with 3,256 dialysis patients were identified. Compared with patients without AAC, the presence of AAC was associated with greater risk of cardiovascular mortality (hazard risk [HR] 2.30; 95% confidence intervals [CI] 1.78–2.97) and all-cause mortality (HR 1.44; 95% CI 1.19–1.75). Subgroup analyses indicated that the pooled HR for cardiovascular and all-cause mortality was 2.31 (95% CI 1.57–3.40) and 1.45 (95% CI 1.08–1.96) for the grade 2/3 AAC. Peritoneal dialysis patients with AAC had greater cardiovascular (HR 3.93 vs. HR 2.10) and all-cause mortality (HR 2.36 vs. HR 1.33) than hemodialysis patients. The AAC appears to be independently associated with excessive cardiovascular and all-cause mortality in maintenance dialysis patients. Regular follow-up AAC might be helpful to stratify mortality risk in dialysis patients. PMID:27748417

  3. Emergency Department Length-Of-Stay For Psychiatric Visits Was Significantly Longer Than For Nonpsychiatric Visits, 2002-11.

    PubMed

    Zhu, Jane M; Singhal, Astha; Hsia, Renee Y

    2016-09-01

    Despite increases in the use of emergency department (EDs) for mental health care, there are limited data on whether psychiatric patients disproportionately contribute to ED crowding. We conducted a retrospective analysis using a national database of ED visits in the period 2002-11 to describe trends in median and ninetieth-percentile length-of-stay for patients with psychiatric versus nonpsychiatric primary diagnoses. Psychiatric patients who visited the ED were transferred to another facility at six times the rate of nonpsychiatric patients. Median lengths-of-stay were similar for psychiatric and nonpsychiatric patients among those who were admitted to the hospital (264 versus 269 minutes) but significantly different for those who were admitted for observation (355 versus 279 minutes), transferred (312 versus 195 minutes), or discharged (189 versus 144 minutes). Overall, differences in ED length-of-stay between psychiatric and nonpsychiatric patients did not narrow over time. These findings suggest deficiencies in ED capacity for psychiatric care, which may necessitate improvements in both throughput and alternative models of care. PMID:27605653

  4. Emergency Department Visits by Older Adults for Motor Vehicle Collisions

    PubMed Central

    Vogel, Jody A.; Ginde, Adit A.; Lowenstein, Steven R.; Betz, Marian E.

    2013-01-01

    Introduction: To describe the epidemiology and characteristics of emergency department (ED) visits by older adults for motor vehicle collisions (MVC) in the United States (U.S.). Methods: We analyzed ED visits for MVCs using data from the 2003–2007 National Hospital Ambulatory Medical Care Survey (NHAMCS). Using U.S. Census data, we calculated annual incidence rates of driver or passenger MVC-related ED visits and examined visit characteristics, including triage acuity, tests performed and hospital admission or discharge. We compared older (65+ years) and younger (18–64 years) MVC patients and calculated odds ratios (OR) and 95% confidence intervals (CIs) to measure the strength of associations between age group and various visit characteristics. Multivariable logistic regression was used to identify independent predictors of admissions for MVC-related injuries among older adults. Results: From 2003–2007, there were an average of 237,000 annual ED visits by older adults for MVCs. The annual ED visit rate for MVCs was 6.4 (95% CI 4.6–8.3) visits per 1,000 for older adults and 16.4 (95% CI 14.0–18.8) visits per 1,000 for younger adults. Compared to younger MVC patients, after adjustment for gender, race and ethnicity, older MVC patients were more likely to have at least one imaging study performed (OR 3.69, 95% CI 1.46–9.36). Older MVC patients were not significantly more likely to arrive by ambulance (OR 1.47; 95% CI 0.76–2.86), have a high triage acuity (OR 1.56; 95% CI 0.77–3.14), or to have a diagnosis of a head, spinal cord or torso injury (OR 0.97; 95% CI 0.42–2.23) as compared to younger MVC patients after adjustment for gender, race and ethnicity. Overall, 14.5% (95% CI 9.8–19.2) of older MVC patients and 6.1% (95% CI 4.8–7.5) of younger MVC patients were admitted to the hospital. There was also a non-statistically significant trend toward hospital admission for older versus younger MVC patients (OR 1.78; 95% CI 0.71–4.43), and

  5. Effects of Cuts in Medicaid on Dental-Related Visits and Costs at a Safety-Net Hospital

    PubMed Central

    Neely, Martha; Rich, Sharron; Gutierrez, Lillelenny Santana; Mehra, Pushkar

    2014-01-01

    We used data from Boston Medical Center, Massachusetts, to determine whether dental-related emergency department (ED) visits and costs increased when Medicaid coverage for adult dental care was reduced in July 2010. In this retrospective study of existing data, we examined the safety-net hospital’s dental-related ED visits and costs for 3 years before and 2 years after Massachusetts Health Care Reform. Dental-related ED visits increased 2% the first and 14% the second year after Medicaid cuts. Percentage increases were highest among older adults, minorities, and persons receiving charity care, Medicaid, and Medicare. PMID:24825223

  6. Dietary, circulating beta-carotene and risk of all-cause mortality: a meta-analysis from prospective studies.

    PubMed

    Zhao, Long-Gang; Zhang, Qing-Li; Zheng, Jia-Li; Li, Hong-Lan; Zhang, Wei; Tang, Wei-Guo; Xiang, Yong-Bing

    2016-01-01

    Observational studies evaluating the relation between dietary or circulating level of beta-carotene and risk of total mortality yielded inconsistent results. We conducted a comprehensive search on publications of PubMed and EMBASE up to 31 March 2016. Random effect models were used to combine the results. Potential publication bias was assessed using Egger's and Begg's test. Seven studies that evaluated dietary beta-carotene intake in relation to overall mortality, indicated that a higher intake of beta-carotene was related to a significant lower risk of all-cause mortality (RR for highest vs. lowest group = 0.83, 95%CI: 0.78-0.88) with no evidence of heterogeneity between studies (I(2) = 1.0%, P = 0.416). A random-effect analysis comprising seven studies showed high beta-carotene level in serum or plasma was associated with a significant lower risk of all-cause mortality (RR for highest vs. lowest group = 0.69, 95%CI: 0.59-0.80) with low heterogeneity (I(2) = 37.1%, P = 0.145). No evidence of publication bias was detected by Begg's and Egger's regression tests. In conclusion, dietary or circulating beta-carotene was inversely associated with risk of all-cause mortality. More studies should be conducted to clarify the dose-response relationship between beta-carotene and all-cause mortality. PMID:27243945

  7. Population-level associations between antiretroviral therapy scale-up and all-cause mortality in South Africa.

    PubMed

    Larson, Elysia; Bendavid, Eran; Tuoane-Nkhasi, Maletela; Mbengashe, Thobile; Goldman, Thurma; Wilson, Melinda; Klausner, Jeffrey D

    2014-08-01

    Our aim was to describe the association between increasing access to antiretroviral therapy and all-cause mortality in South Africa from 2005 to 2009. We undertook a longitudinal, population-level study, using antiretroviral monitoring data reported by PEPFAR implementing partners and province-level and national all-cause mortality records from Statistics South Africa (provider of official South African government statistics) to analyse the association between antiretroviral therapy and mortality. Using mixed effects models with a random intercept for province, we estimated the contemporaneous and lagging association between antiretroviral therapy and all-cause mortality in South Africa. We also conducted subgroup analyses and estimated the number of deaths averted. For each 100 HIV-infected individuals on antiretroviral therapy reported by PEPFAR implementing partners in South African treatment programmes, there was an associated 2.9 fewer deaths that year (95% CI: 1.5, 4.2) and 6.3 fewer deaths the following year (95% CI: 4.6, 8.0). The associated decrease in mortality the year after treatment reporting was seen in both adults and children, and men and women. Treatment provided from 2005 to 2008 was associated with 28,305 deaths averted from 2006 to 2009. The scale-up of antiretroviral therapy in South Africa was associated with a significant reduction in national all-cause mortality.

  8. Modeling the sssociation between 25[OH]D and all-cause mortality in a representative US population sample

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Vitamin D has been identified as a potential key risk factor for several chronic diseases and mortality. The association between all-cause mortality and circulating levels of 25-ydroxyvitamin D (25[OH]D) has been described as non-monotonic with excess mortality at both low and high levels (1). Howev...

  9. Predictors, Including Blood, Urine, Anthropometry, and Nutritional Indices, of All-Cause Mortality among Institutionalized Individuals with Intellectual Disability

    ERIC Educational Resources Information Center

    Ohwada, Hiroko; Nakayama, Takeo; Tomono, Yuji; Yamanaka, Keiko

    2013-01-01

    As the life expectancy of people with intellectual disability (ID) increases, it is becoming necessary to understand factors affecting survival. However, predictors that are typically assessed among healthy people have not been examined. Predictors of all-cause mortality, including blood, urine, anthropometry, and nutritional indices, were…

  10. Milk Consumption and Mortality from All Causes, Cardiovascular Disease, and Cancer: A Systematic Review and Meta-Analysis

    PubMed Central

    Larsson, Susanna C.; Crippa, Alessio; Orsini, Nicola; Wolk, Alicja; Michaëlsson, Karl

    2015-01-01

    Results from epidemiological studies of milk consumption and mortality are inconsistent. We conducted a systematic review and meta-analysis of prospective studies assessing the association of non-fermented and fermented milk consumption with mortality from all causes, cardiovascular disease, and cancer. PubMed was searched until August 2015. A two-stage, random-effects, dose-response meta-analysis was used to combine study-specific results. Heterogeneity among studies was assessed with the I2 statistic. During follow-up periods ranging from 4.1 to 25 years, 70,743 deaths occurred among 367,505 participants. The range of non-fermented and fermented milk consumption and the shape of the associations between milk consumption and mortality differed considerably between studies. There was substantial heterogeneity among studies of non-fermented milk consumption in relation to mortality from all causes (12 studies; I2 = 94%), cardiovascular disease (five studies; I2 = 93%), and cancer (four studies; I2 = 75%) as well as among studies of fermented milk consumption and all-cause mortality (seven studies; I2 = 88%). Thus, estimating pooled hazard ratios was not appropriate. Heterogeneity among studies was observed in most subgroups defined by sex, country, and study quality. In conclusion, we observed no consistent association between milk consumption and all-cause or cause-specific mortality. PMID:26378576

  11. Abdominal obesity modifies the risk of hypertriglyceridemia for all-cause and cardiovascular mortality in hemodialysis patients.

    PubMed

    Postorino, Maurizio; Marino, Carmen; Tripepi, Giovanni; Zoccali, Carmine

    2011-04-01

    Hypertriglyceridemia is the most prevalent lipid alteration in end-stage renal disease, and we studied the relationship between serum triglycerides and all-cause and cardiovascular death in these patients. Since abdominal fat modifies the effect of lipids on atherosclerosis, we analyzed the interaction between serum lipids and waist circumference (WC) as a metric of abdominal obesity. In a cohort of 537 hemodialysis patients, 182 died, 113 from cardiovascular causes, over an average follow-up of 29 months. In Cox models that included traditional and nontraditional risk factors, there were significant strong interactions between triglycerides and WC to both all-cause and cardiovascular death. A fixed (50 mg/dl) excess in triglycerides was associated with a progressive lower risk of all-cause and cardiovascular mortality in patients with threshold WC <95 cm but with a progressive increased risk in those above this threshold. A significant interaction between cholesterol and WC with all-cause and cardiovascular death emerged only in models excluding the triglycerides-WC interaction. Neither high-density lipoprotein (HDL) nor non-HDL cholesterol or their interaction terms with WC were associated with study outcomes. Thus, the predictive value of triglycerides and cholesterol for survival and atherosclerotic complications in hemodialysis patients is critically dependent on WC. Hence, intervention studies in end-stage renal disease should specifically target patients with abdominal obesity and hyperlipidemia.

  12. Association Between Television Viewing Time and All-Cause Mortality: A Meta-Analysis of Cohort Studies.

    PubMed

    Sun, Jiang-Wei; Zhao, Long-Gang; Yang, Yang; Ma, Xiao; Wang, Ying-Ying; Xiang, Yong-Bing

    2015-12-01

    Findings on the association between television (TV) viewing and all-cause mortality in epidemiologic studies have been inconsistent. Therefore, we conducted a meta-analysis of data from prospective cohort studies to quantify this association. Relevant articles were identified by searching MEDLINE (PubMed; National Library of Medicine, Bethesda, Maryland) and EMBASE (Elsevier B.V., Amsterdam, the Netherlands) from inception to March 1, 2015, and reviewing the reference lists of retrieved articles. Study-specific results were pooled using a random-effects model. Of 2,578 citations identified by the search strategy, 10 cohort studies (61,494 deaths among 647,475 individuals) met the inclusion criteria. The summary relative risk of all-cause mortality for the highest category of TV viewing time versus the lowest was 1.33 (95% confidence interval: 1.20, 1.47), with heterogeneity among studies (I(2) = 66.7%, P(heterogeneity) = 0.001). In dose-response meta-analysis, TV viewing time was statistically significantly associated with all-cause mortality risk in a J-shaped fashion (P(nonlinearity) = 0.001). These results indicate that prolonged TV viewing time might increase the risk of all-cause mortality. Given the high prevalence of excessive TV viewing, public health recommendations or interventions aimed at decreasing the amount of TV viewing time in modern societies are warranted.

  13. Investigation of Gender Heterogeneity in the Associations of Serum Phosphorus with Incident Coronary Artery Disease and All-Cause Mortality

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Serum phosphorus levels are associated with increased morbidity and mortality in patients with chronic kidney disease. We examined whether serum phosphorus is associated with all-cause mortality and incident myocardial infarction in the general population using 13,998 middle age subjects from the At...

  14. Prognostic value of physicians' assessment of compliance regarding all-cause mortality in patients with type 2 diabetes: primary care follow-up study

    PubMed Central

    Rothenbacher, Dietrich; Rüter, Gernot; Brenner, Hermann

    2006-01-01

    Background Whether the primary care physician's assessment of patient compliance is a valuable prognostic marker to identify patients who are at increased risk of death, or merely reflects measurement of various treatment parameters such as HbA1C or other laboratory markers is unclear. The objective of this prospective cohort study was to investigate the prognostic value of the physicians' assessment of patient compliance and other factors with respect to all-cause mortality during a one year follow-up period. Methods A prospective cohort study was conducted among 1014 patients with type 2 diabetes aged 40 and over (mean age 69 years, SD 10.4, 45% male) who were under medical treatment in 11 participating practices of family physicians and internists working in primary care in a defined region in South Germany between April and June 2000. Baseline data were gathered from patients and physicians by standardized questionnaire. The physician's assessment of patient compliance was assessed by means of a 4-point Likert scale (very good, rather good, rather bad, very bad). In addition, we carried out a survey among physicians by means of a questionnaire to find out which aspects for the assessment of patient compliance were of importance to make this assessment. Active follow-up of patients was conducted after one year to determine mortality. Results During the one year follow-up 48 (4.7%) of the 1014 patients died. Among other factors such as patient type (patients presenting at office, nursing home or visited patients), gender, age and a history of macrovascular disease, the physician's assessment of patient compliance was an important predictor of all-cause mortality. Patients whose compliance was assessed by the physician as "very bad" (6%) were significantly more likely to die during follow-up (OR = 2.67, 95% CI 1.02–6.97) after multivariable adjustment compared to patients whose compliance was assessed as "rather good" (45%) or "very good" (18%). The HbA1C

  15. Predictive Value of Carotid Distensibility Coefficient for Cardiovascular Diseases and All-Cause Mortality: A Meta-Analysis

    PubMed Central

    Yuan, Chuang; Wang, Jing; Ying, Michael

    2016-01-01

    Aims The aim of the present study is to determine the pooled predictive value of carotid distensibility coefficient (DC) for cardiovascular (CV) diseases and all-cause mortality. Background Arterial stiffness is associated with future CV events. Aortic pulse wave velocity is a commonly used predictor for CV diseases and all-cause mortality; however, its assessment requires specific devices and is not always applicable in all patients. In addition to the aortic artery, the carotid artery is also susceptible to atherosclerosis, and is highly accessible because of the surficial property. Thus, carotid DC, which indicates the intrinsic local stiffness of the carotid artery and may be determined using ultrasound and magnetic resonance imaging, is of interest for the prediction. However, the role of carotid DC in the prediction of CV diseases and all-cause mortality has not been thoroughly characterized, and the pooled predictive value of carotid DC remains unclear. Methods A meta-analysis, which included 11 longitudinal studies with 20361 subjects, was performed. Results Carotid DC significantly predicted future total CV events, CV mortality and all-cause mortality. The pooled risk ratios (RRs) of CV events, CV mortality and all-cause mortality were 1.19 (1.06–1.35, 95%CI, 9 studies with 18993 subjects), 1.09 (1.01–1.18, 95%CI, 2 studies with 2550 subjects) and 1.65 (1.15–2.37, 95%CI, 6 studies with 3619 subjects), respectively, for the subjects who had the lowest quartile of DC compared with their counterparts who had higher quartiles. For CV events, CV mortality and all-cause mortality, a decrease in DC of 1 SD increased the risk by 13%, 6% and 41% respectively, whereas a decrease in DC of 1 unit increased the risk by 3%, 1% and 6% respectively. Conclusions Carotid DC is a significant predictor of future CV diseases and all-cause mortality, which may facilitate the identification of high-risk patients for the early diagnosis and prompt treatment of CV diseases

  16. Diabetes treatments and risk of heart failure, cardiovascular disease, and all cause mortality: cohort study in primary care

    PubMed Central

    Coupland, Carol

    2016-01-01

    Objective To assess associations between risks of cardiovascular disease, heart failure, and all cause mortality and different diabetes drugs in people with type 2 diabetes, particularly newer agents, including gliptins and thiazolidinediones (glitazones). Design Open cohort study. Setting 1243 general practices contributing data to the QResearch database in England. Participants 469 688 people with type 2 diabetes aged 25-84 years between 1 April 2007 and 31 January 2015. Exposures Diabetes drugs (glitazones, gliptins, metformin, sulphonylureas, insulin, other) alone and in combination. Main outcome measure First recorded diagnoses of cardiovascular disease, heart failure, and all cause mortality recorded on the patients’ primary care, mortality, or hospital record. Cox proportional hazards models were used to estimate hazard ratios for diabetes treatments, adjusting for potential confounders. Results During follow-up, 21 308 patients (4.5%) received prescriptions for glitazones and 32 533 (6.9%) received prescriptions for gliptins. Compared with non-use, gliptins were significantly associated with an 18% decreased risk of all cause mortality, a 14% decreased risk of heart failure, and no significant change in risk of cardiovascular disease; corresponding values for glitazones were significantly decreased risks of 23% for all cause mortality, 26% for heart failure, and 25% for cardiovascular disease. Compared with no current treatment, there were no significant associations between monotherapy with gliptins and risk of any complications. Dual treatment with gliptins and metformin was associated with a decreased risk of all three outcomes (reductions of 38% for heart failure, 33% for cardiovascular disease, and 48% for all cause mortality). Triple treatment with metformin, sulphonylureas, and gliptins was associated with a decreased risk of all three outcomes (reductions of 40% for heart failure, 30% for cardiovascular disease, and 51% for all cause

  17. Delayed Effects of Obese and Overweight Population Conditions on All-Cause Adult Mortality Rate in the USA

    PubMed Central

    Okunade, Albert A.; Rubin, Rose M.; Okunade, Adeyinka K.

    2016-01-01

    Currently, there are few studies separating the linkage of pathological obese and overweight body mass indices (BMIs) to the all-cause mortality rate in adults. Consequently, this paper, using annual Behavioral Risk Factor Surveillance System data of the 50 US states and the District of Columbia, estimates empirical regression models linking the US adult overweight (25 ≤ BMI < 30) and obesity (BMI ≥ 30) rates to the all-cause deaths rate. The biochemistry of multi-period cumulative adiposity (saturated fatty acid) from unexpended caloric intakes (net energy storage) provides the natural theoretical foundation for tracing unhealthy BMI to all-cause mortality. Cross-sectional and panel data regression models are separately estimated for the delayed effects of obese and overweight BMIs on the all-cause mortality rate. Controlling for the independent effects of economic, socio-demographic, and other factors on the all-cause mortality rate, our findings confirm that the estimated panel data models are more appropriate. The panel data regression results reveal that the obesity-mortality link strengthens significantly after multiple years in the condition. The faster mortality response to obesity detected here is conjectured to arise from the significantly more obese. Compared with past studies postulating a static (rather than delayed) effects, the statistically significant lagged effects of adult population BMI pathology in this study are novel and insightful. And, as expected, these lagged effects are more severe in the obese than overweight population segment. Public health policy implications of this social science study findings agree with those of the clinical sciences literature advocating timely lifestyle modification interventions (e.g., smoking cessation) to slow premature mortality linked with unhealthy BMIs. PMID:27734013

  18. Use and toxicity of complementary and alternative medicines among patients visiting emergency department: Systematic review

    PubMed Central

    Jatau, Abubakar Ibrahim; Aung, Myat Moe Thwe; Kamauzaman, Tuan Hairulnizam Tuan; Chedi, Basheer A. Z.; Sha’aban, Abubakar; Rahman, Ab Fatah Ab

    2016-01-01

    Many studies have been conducted in health-care settings with regards to complementary and alternative medicine (CAM) use among patients. However, information regarding CAM use among patients in the emergency department (ED) is scarce. The aim of this article was to conduct a systematic review of published studies with regards to CAM use among the ED patients. A literature search of published studies from inception to September 2015 was conducted using PubMed, Scopus, and manual search of the reference list. 18 studies that met the inclusion criteria were reviewed. The prevalence rate of CAM use among ED patients across the studies ranged of 1.4-68.1%. Herbal therapy was the sub-modality of CAM most commonly used and frequently implicated in CAM-related ED visits. Higher education, age, female gender, religious affiliation, and chronic diseases were the most frequent factors associated with CAM use among the ED patients. Over 80% of the ED physicians did not ask the patients about the CAM therapy. Similarly, 80% of the ED patients were ready to disclose CAM therapy to the ED physician. The prevalence rate of CAM use among patients at ED is high and is growing with the current increasing popularity, and it has been a reason for some of the ED visits. There is a need for the health-care professionals to receive training and always ask patients about CAM therapy to enable them provide appropriate medical care and prevent CAM-related adverse events. PMID:27104042

  19. Predicting Emergency Department Visits

    PubMed Central

    Poole, Sarah; Grannis, Shaun; Shah, Nigam H.

    2016-01-01

    High utilizers of emergency departments account for a disproportionate number of visits, often for nonemergency conditions. This study aims to identify these high users prospectively. Routinely recorded registration data from the Indiana Public Health Emergency Surveillance System was used to predict whether patients would revisit the Emergency Department within one month, three months, and six months of an index visit. Separate models were trained for each outcome period, and several predictive models were tested. Random Forest models had good performance and calibration for all outcome periods, with area under the receiver operating characteristic curve of at least 0.96. This high performance was found to be due to non-linear interactions among variables in the data. The ability to predict repeat emergency visits may provide an opportunity to establish, prioritize, and target interventions to ensure that patients have access to the care they require outside an emergency department setting. PMID:27570684

  20. Kidney Function, Albuminuria, and All-Cause Mortality in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study

    PubMed Central

    Warnock, David G.; Muntner, Paul; McCullough, Peter A.; Zhang, Xiao; McClure, Leslie A.; Zakai, Neil; Cushman, Mary; Newsome, Britt B.; Kewalramani, Reshma; Steffes, Michael W.; Howard, George; McClellan, William M.

    2010-01-01

    Background Chronic kidney disease (CKD) and albuminuria are associated with increased risk of all-cause mortality. Study Design Prospective observational cohort study Setting and Participants 17,393 participants (mean age, 64.3 ± 9.6 years) in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. Predictor Estimated glomerular filtration rate (eGFR), urinary albumin-creatinine ratio (ACR). Outcome All-cause mortality (710 deaths); median duration of follow-up: 3.6 years. Measurements and Analysis Categories of eGFR (90– <120, 60–<90, 45–<60, 30–<45, and 15–<30 mL/min/1.73 m2) and urinary ACR (<10 mg/g or normal, 10–<30 mg/g or high normal, 30–300 mg/g or high, and >300 mg/g or very high). Cox’s proportional hazards models were adjusted for demographic factors, cardiovascular covariates, and hemoglobin. Results The background all-cause mortality rate for participants with normal ACR, eGFR of 90–<120 mL/min/1.73 m2 and no CHD was 4.3 deaths/1,000 person-years. Higher ACR was associated with an increased multivariable adjusted hazard ratio for all-cause mortality within each eGFR category. Reduced eGFR was associated with higher adjusted hazard ratio for all-cause mortality for participants with high normal (P value = 0.01) and high (P value <0.001) ACR values, but not for those with normal or very high ACR values. Limitations Only one laboratory assessment for serum creatinine and ACR was available Conclusions Increased albuminuria was an independent risk factor for all-cause mortality. Reduced eGFR was associated with increased mortality risk among those with high normal and high ACR. The mortality rate was low in the normal ACR group and increased in the very high ACR group but did not vary with eGFR in these groups. PMID:20692752

  1. All-cause mortality increased by environmental cadmium exposure in the Japanese general population in cadmium non-polluted areas.

    PubMed

    Suwazono, Yasushi; Nogawa, Kazuhiro; Morikawa, Yuko; Nishijo, Muneko; Kobayashi, Etsuko; Kido, Teruhiko; Nakagawa, Hideaki; Nogawa, Koji

    2015-07-01

    The aim of the present study was to evaluate the effect of environmental cadmium (Cd) exposure indicated by urinary Cd on all-cause mortality in the Japanese general population. A 19-year cohort study was conducted in 1067 men and 1590 women aged 50 years or older who lived in three cadmium non-polluted areas in Japan. The subjects were divided into four quartiles based on creatinine adjusted U-Cd (µg g(-1) cre). The hazard ratio (HR) and 95% confidence interval (CI) for continuous U-Cd or the quartiles of U-Cd were estimated for all-cause mortality using a proportional hazards regression.The all-cause mortality rates per 1000 person years were 31.2 and 15.1 in men and women, respectively. Continuous U-Cd (+1 µg g(-1) cre) was significantly related to the all-cause mortality in men (HR 1.05, 95% CI: 1.02-1.09) and women (HR 1.04, 95% CI: 1.01-1.07). Furthermore in men, the third (1.96-3.22 µg g(-1) cre) and fourth quartile (≥3.23 µg g(-1) cre) of U-Cd showed a significant, positive HR (third: HR 1.35, 95% CI: 1.03-1.77, fourth: HR 1.64, 95% CI: 1.26-2.14) for all-cause mortality compared with the first quartile (<1.14 µg g(-1) cre). In women, the fourth quartile of U-Cd (≥4.66 µg g(-1) cre) also showed a significant HR (1.49, 95% CI 1.11-2.00) for all-cause mortality compared with the first quartile (<1.46 µg g(-1) cre).In the present study, U-Cd was significantly associated with increased mortality in the Japanese general population, indicating that environmental Cd exposure adversely affects the life prognosis in Cd non-polluted areas in Japan.

  2. Television Viewing and Risk of Type 2 Diabetes, Cardiovascular Disease, and All-Cause Mortality A Meta-analysis

    PubMed Central

    Grøntved, Anders; Hu, Frank B.

    2015-01-01

    Context Prolonged television (TV) viewing is the most prevalent and pervasive sedentary behavior in industrialized countries and has been associated with morbidity and mortality. However, a systematic and quantitative assessment of published studies is not available. Objective To perform a meta-analysis of all prospective cohort studies to determine the association between TV viewing and risk of type 2 diabetes, fatal or nonfatal cardiovascular disease, and all-cause mortality. Data Sources and Study Selection Relevant studies were identified by searches of the MEDLINE database from 1970 to March 2011 and the EMBASE database from 1974 to March 2011 without restrictions and by reviewing reference lists from retrieved articles. Cohort studies that reported relative risk estimates with 95% confidence intervals (CIs) for the associations of interest were included. Data Extraction Data were extracted independently by each author and summary estimates of association were obtained using a random-effects model. Data Synthesis Of the 8 studies included, 4 reported results on type 2 diabetes (175 938 individuals; 6428 incident cases during 1.1 million person-years of follow-up), 4 reported on fatal or nonfatal cardiovascular disease (34 253 individuals; 1052 incident cases), and 3 reported on all-cause mortality (26 509 individuals; 1879 deaths during 202 353 person-years of follow-up). The pooled relative risks per 2 hours of TV viewing per day were 1.20 (95% CI, 1.14-1.27) for type 2 diabetes, 1.15 (95% CI, 1.06-1.23) for fatal or nonfatal cardiovascular disease, and 1.13 (95% CI, 1.07-1.18) for all-cause mortality. While the associations between time spent viewing TV and risk of type 2 diabetes and cardiovascular disease were linear, the risk of all-cause mortality appeared to increase with TV viewing duration of greater than 3 hours per day. The estimated absolute risk differences per every 2 hours of TV viewing per day were 176 cases of type 2 diabetes per 100 000

  3. Shadow of diabetes over cardiovascular disease: comparative quantification of population-attributable all-cause and cardiovascular mortality

    PubMed Central

    2012-01-01

    Background We contrasted impacts on all-cause and cardiovascular disease (CVD) mortality of diabetes vs. CVD. Methods Among participants the Tehran lipid and glucose study aged ≥ 30 years (n = 9752), we selected those who participated in the follow-up study until 20 March 2009 (n = 8795). Complete data on covariate were available for 8, 469 participants, contributing to a 67935 person-year follow up. In the analysis of outcomes (all-cause and CVD mortality), diabetes and CVD were assessed using Cox proportional hazard regression model adjusting for established CVD risk factors. We used population attributable hazard fraction (PAHF) and rate advancement period (RAP) that expresses how much sooner a given mortality rate is reached among exposed than among unexposed individuals. Results Ten percent of the participants self-reported to have pervious CVD, and diabetes was ascertained in 17% of participants at baseline examination. During a median follow-up of 9 years 386 participants died of which 184 were due to CVD. All-cause and CVD mortality rate (95% CIs) were 5.5 (5.0-6.1) and 2.6 (2.3-3.0) per 1000 person-year, respectively. The PAHF of all-cause mortality for diabetes 9.2 (7.3-11.1) was greater than the one for CVD 3.5 (1.1-5.5). RAP estimates for all-cause mortality associated with diabetes ranged from 7.4 to 8.6 years whereas the RAP estimates for all-cause mortality associated with CVD ranged from 3.1 to 4.3 years. The PAHF of CVD mortality for diabetes 9.4 (6.8-12.0) was greater than the one for CVD 4.5 (1.8-7.0). RAP estimates for CVD mortality associated with diabetes ranged from 8.2 to 9.8 years whereas the RAP estimates for CVD mortality associated with CVD ranged from 4.7 to 6.7 years. Conclusions We demonstrated that diabetes, which was shown to be keeping pace with prevalent CVD in terms of conferring excess risk of incident CVD, is currently causing more deaths in the population than does CVD. PMID:22704235

  4. Association between ozone and asthma emergency department visits in Saint John, New Brunswick, Canada.

    PubMed Central

    Stieb, D M; Burnett, R T; Beveridge, R C; Brook, J R

    1996-01-01

    This study examines the relationship of asthma emergency department (ED) visits to daily concentrations of ozone and other air pollutants in Saint John, New Brunswick, Canada. Data on ED visits with a presenting complaint of asthma (n = 1987) were abstracted for the period 1984-1992 (May-September). Air pollution variables included ozone, sulfur dioxide, nitrogen dioxide, sulfate, and total suspended particulate (TSP); weather variables included temperature, humidex, dewpoint, and relative humidity. Daily ED visit frequencies were filtered to remove day of the week and long wave trends, and filtered values were regressed on air pollution and weather variables for the same day and the 3 previous days. The mean daily 1-hr maximum ozone concentration during the study period was 41.6 ppb. A positive, statistically significant (p < 0.05) association was observed between ozone and asthma ED visits 2 days later, and the strength of the association was greater in nonlinear models. The frequency of asthma ED visits was 33% higher (95% CI, 10-56%) when the daily 1-hr maximum ozone concentration exceeded 75 ppb (the 95th percentile). The ozone effect was not significantly influenced by the addition of weather or other pollutant variables into the model or by the exclusion of repeat ED visits. However, given the limited number of sampling days for sulfate and TSP, a particulate effect could not be ruled out. We detected a significant association between ozone and asthma ED visits, despite the vast majority of sampling days being below current U.S. and Canadian standards. Images Figure 1. A Figure 1. B Figure 2. Figure 3. PMID:9118879

  5. Continuity in a VA Patient-Centered Medical Home Reduces Emergency Department Visits

    PubMed Central

    Chaiyachati, Krisda H.; Gordon, Kirsha; Long, Theodore; Levin, Woody; Khan, Ali; Meyer, Emily; Justice, Amy; Brienza, Rebecca

    2014-01-01

    Background One major goal of the Patient-Centered Medical Home (PCMH) is to improve continuity of care between patients and providers and reduce the utilization of non-primary care services like the emergency department (ED). Objective To characterize continuity under the Veterans Health Administration’s PCMH model – the Patient Aligned Care Team (PACT), at one large Veterans Affair’s (VA’s) primary care clinic, determine the characteristics associated with high levels of continuity, and assess the association between continuity and ED visits. Design Retrospective, observational cohort study of patients at the West Haven VA (WHVA) Primary Care Clinic from March 2011 to February 2012. Patients The 13,495 patients with established care at the Clinic, having at least one visit, one year before March 2011. Main Measures Our exposure variable was continuity of care –a patient seeing their assigned primary care provider (PCP) at each clinic visit. The outcome of interest was having an ED visit. Results The patients encompassed 42,969 total clinic visits, and 3185 (24%) of them had 15,458 ED visits. In a multivariable logistic regression analysis, patients with continuity of care – at least one visit with their assigned PCP – had lower ED utilization compared to individuals without continuity (adjusted odds ratio [AOR] 0.54; 95% CI: 0.41, 0.71), controlling for frequency of primary care visits, comorbidities, insurance, distance from the ED, and having a trainee PCP assigned. Likewise, the adjusted rate of ED visits was 544/1000 person-year (PY) for patients with continuity vs. 784/1000 PY for patients without continuity (p = 0.001). Compared to patients with low continuity (<33% of visits), individuals with medium (33–50%) and high (>50%) continuity were less likely to utilize the ED. Conclusions Strong continuity of care is associated with decreased ED utilization in a PCMH model and improving continuity may help reduce the utilization of non

  6. Home Weatherization Visit

    SciTech Connect

    Chu, Steven

    2009-01-01

    Secretary Steven Chu visits a home that is in the process of being weatherized in Columbus, OH, along with Ohio Governor Ted Strickland and Columbus Mayor Michael Coleman. They discuss the benefits of weatherization and how funding from the recovery act is having a direct impact in communities across America.

  7. Congressman Clyburn Visit

    ScienceCinema

    Cody, Tom

    2016-07-12

    Congressman James Clyburn visits the new employees of the Savannah River Site. These new jobs the graduates have received are a result of the Recovery Act at work. Lisa Jackson of the Environmental Protection Agency speaks about how the ARRA is in line with President Obama's vision of a better economy and cleaner environment.

  8. Malaysian Students Visit Thailand.

    ERIC Educational Resources Information Center

    International Understanding at School, 1983

    1983-01-01

    Five students and one coordinator from the Unesco Associated Schools Project undertook a study visit to Bangkok to exchange views and experiences. Future joint projects/activities were discussed, and the students gained some insight into the life of their counterparts in Thailand. (RM)

  9. Home Weatherization Visit

    ScienceCinema

    Chu, Steven

    2016-07-12

    Secretary Steven Chu visits a home that is in the process of being weatherized in Columbus, OH, along with Ohio Governor Ted Strickland and Columbus Mayor Michael Coleman. They discuss the benefits of weatherization and how funding from the recovery act is having a direct impact in communities across America.

  10. Revisiting High School Visits

    ERIC Educational Resources Information Center

    Flagel, Andrew

    2012-01-01

    NACAC's anniversary is a great time to follow up on an article on high school visits, a topic of ongoing discussion in every admission and guidance office. The article highlights a variety of potential good outcomes that can be derived from collaborative interactions. Sadly, however, admission representatives are apt to be described by the…

  11. Pangeghtellghet (Visits to Siberia).

    ERIC Educational Resources Information Center

    Kaneshiro, Vera, Ed.

    This reader contains eight stories in St. Lawrence Island Yupik about visits by St. Lawrence Island people to their relatives and friends in Siberia over a quarter of a century ago. The book, which is intended for use in advanced levels of reading instruction, is part of a series of Siberian Yupik reading materials. (AMH)

  12. Congressman Clyburn Visit

    SciTech Connect

    Cody, Tom

    2010-01-01

    Congressman James Clyburn visits the new employees of the Savannah River Site. These new jobs the graduates have received are a result of the Recovery Act at work. Lisa Jackson of the Environmental Protection Agency speaks about how the ARRA is in line with President Obama's vision of a better economy and cleaner environment.

  13. [Visiting the Amana Colonies.

    ERIC Educational Resources Information Center

    Ohrn, Deborah Gore, Ed.

    1992-01-01

    This issue of "The Goldfinch: Iowa History for Young People" focuses upon the Amana Colonies, which were home to many German immigrants in the 19th century, and which retain much of their ethnic heritage today. The articles and activities included in this issue are "Amana Today"; "No Black Buggies in Amana"; "Visiting Tante Marie and Onkel…

  14. Prospective associations between household-, work-, and leisure-based physical activity and all-cause mortality among older Taiwanese adults.

    PubMed

    Chen, Li-Jung; Fox, Kenneth R; Ku, Po-Wen; Sun, Wen-Jung; Chou, Pesus

    2012-09-01

    Most studies on the health effects of leisure time physical activity have focused on mortality. There has been limited research regarding physical activity undertaken at work or around the home and mortality. This study assessed the associations between leisure, work, and household physical activity and subsequent all-cause mortality among older adults aged 65 years and older (n = 2133) in Taiwan, over 8 years. Physical activity was evaluated with the Physical Activity Scale for the Elderly. Cox proportional hazard models were used to estimate the association of physical activity with the risk of mortality. This study demonstrated that a low level of total physical activity is predictive of increased all-cause mortality in both men and women in an East Asian population. It also indicates that leisure- and household-related but not work-related activity are significant contributors to this relationship.

  15. Rebooting the EdD

    ERIC Educational Resources Information Center

    Wergin, Jon F.

    2011-01-01

    In this essay, Jon Wergin reminds readers of the philosophical and historical foundations of the doctor of education (EdD) degree. He argues that the EdD should be based, in large part, on John Dewey's progressive ideals of democratization and Paulo Freire's concepts of emancipatory education. Drawing on theories of reflective practice,…

  16. Dietary, circulating beta-carotene and risk of all-cause mortality: a meta-analysis from prospective studies

    PubMed Central

    Zhao, Long-Gang; Zhang, Qing-Li; Zheng, Jia-Li; Li, Hong-Lan; Zhang, Wei; Tang, Wei-Guo; Xiang, Yong-Bing

    2016-01-01

    Observational studies evaluating the relation between dietary or circulating level of beta-carotene and risk of total mortality yielded inconsistent results. We conducted a comprehensive search on publications of PubMed and EMBASE up to 31 March 2016. Random effect models were used to combine the results. Potential publication bias was assessed using Egger’s and Begg’s test. Seven studies that evaluated dietary beta-carotene intake in relation to overall mortality, indicated that a higher intake of beta-carotene was related to a significant lower risk of all-cause mortality (RR for highest vs. lowest group = 0.83, 95%CI: 0.78–0.88) with no evidence of heterogeneity between studies (I2 = 1.0%, P = 0.416). A random-effect analysis comprising seven studies showed high beta-carotene level in serum or plasma was associated with a significant lower risk of all-cause mortality (RR for highest vs. lowest group = 0.69, 95%CI: 0.59–0.80) with low heterogeneity (I2 = 37.1%, P = 0.145). No evidence of publication bias was detected by Begg’s and Egger’s regression tests. In conclusion, dietary or circulating beta-carotene was inversely associated with risk of all-cause mortality. More studies should be conducted to clarify the dose-response relationship between beta-carotene and all-cause mortality. PMID:27243945

  17. Smoking increases the risk of all-cause and cardiovascular mortality in patients with chronic kidney disease.

    PubMed

    Nakamura, Koshi; Nakagawa, Hideaki; Murakami, Yoshitaka; Kitamura, Akihiko; Kiyama, Masahiko; Sakata, Kiyomi; Tsuji, Ichiro; Miura, Katsuyuki; Ueshima, Hirotsugu; Okamura, Tomonori

    2015-11-01

    Little is known about the magnitude and nature of the combined effect of chronic kidney disease (CKD) and smoking on cardiovascular diseases. We studied this in a Japanese population using a pooled analysis of 15,468 men and 19,154 women aged 40-89 years enrolled in 8 cohort studies. The risk of mortality from all-causes and cardiovascular disease was compared in 6 gender-specific categories of baseline CKD status (non-CKD or CKD) and smoking habits (lifelong never smoked, former smokers, or currently smoking). CKD was defined as a decreased level of estimated glomerular filtration rate (under 60 ml/min per 1.73 m(2)) and/or dipstick proteinuria. Hazard ratios were estimated for each category, relative to never smokers without CKD. During the follow-up period (mean 14.8 years), there were 6771 deaths, 1975 of which were due to cardiovascular diseases. In both men and women, current or former smokers with CKD had the first or second highest crude mortality rates from all-cause and cardiovascular diseases among the 6 categories. After adjustment for age and other major cardiovascular risk factors, the hazard ratios in male and female current smokers with CKD were 2.26 (95% confidence interval, 1.95-2.63) and 1.78 (1.36-2.32) for all-causes, and 2.66 (2.04-3.47) and 1.71 (1.10-2.67) for cardiovascular diseases, respectively. Thus, coexistence of CKD and smoking may markedly increase the risk of all-cause and cardiovascular mortality.

  18. Symptoms of depression and all-cause mortality in farmers, a cohort study: the HUNT study, Norway

    PubMed Central

    Letnes, Jon Magne; Hilt, Bjørn; Bjørngaard, Johan Håkon; Krokstad, Steinar

    2016-01-01

    Objectives To explore all-cause mortality and the association between symptoms of depression and all-cause mortality in farmers compared with other occupational groups, using a prospective cohort design. Methods We included adult participants with a known occupation from the second wave of the Nord-Trøndelag Health Study (Helseundersøkelsen i Nord-Trøndelag 2 (HUNT2) 1995–1997), Norway. Complete information on emigration and death from all causes was obtained from the National Registries. We used the depression subscale of the Hospital Anxiety and Depression Scale (HADS) to measure symptoms of depression. We compared farmers to 4 other occupational groups. Our baseline study population comprised 32 618 participants. Statistical analyses were performed using the Cox proportional hazards models. Results The estimated mortality risk in farmers was lower than in all other occupations combined, with a sex and age-adjusted HR (0.91, 95% CI 0.82 to 1.00). However, farmers had an 11% increased age-adjusted and sex-adjusted mortality risk compared with the highest ranked socioeconomic group (HR 1.11, 95% CI 0.98 to 1.25). In farmers, symptoms of depression were associated with a 13% increase in sex-adjusted and age-adjusted mortality risk (HR 1.13, 95% CI 0.88 to 1.45). Compared with other occupations this was the lowest HR, also after adjusting for education, marital status, long-lasting limiting somatic illness and lifestyle factors (HR 1.08, 95% CI 0.84 to 1.39). Conclusions Farmers had lower all-cause mortality compared with the other occupational groups combined. Symptoms of depression were associated with an increased mortality risk in farmers, but the risk increase was smaller compared with the other occupational groups. PMID:27188811

  19. Apple intake is inversely associated with all-cause and disease-specific mortality in elderly women.

    PubMed

    Hodgson, Jonathan M; Prince, Richard L; Woodman, Richard J; Bondonno, Catherine P; Ivey, Kerry L; Bondonno, Nicola; Rimm, Eric B; Ward, Natalie C; Croft, Kevin D; Lewis, Joshua R

    2016-03-14

    Higher fruit intake is associated with lower risk of all-cause and disease-specific mortality. However, data on individual fruits are limited, and the generalisability of these findings to the elderly remains uncertain. The objective of this study was to examine the association of apple intake with all-cause and disease-specific mortality over 15 years in a cohort of women aged over 70 years. Secondary analyses explored relationships of other fruits with mortality outcomes. Usual fruit intake was assessed in 1456 women using a FFQ. Incidence of all-cause and disease-specific mortality over 15 years was determined through the Western Australian Hospital Morbidity Data system. Cox regression was used to determine the hazard ratios (HR) for mortality. During 15 years of follow-up, 607 (41·7%) women died from any cause. In the multivariable-adjusted analysis, the HR for all-cause mortality was 0·89 (95% CI 0·81, 0·97) per sd (53 g/d) increase in apple intake, HR 0·80 (95% CI 0·65, 0·98) for consumption of 5-100 g/d and HR 0·65 (95% CI 0·48, 0·89) for consumption of >100 g/d (an apple a day), compared with apple intake of <5 g/d (P for trend=0·03). Our analysis also found that higher apple intake was associated with lower risk for cancer mortality, and that higher total fruit and banana intakes were associated lower risk of CVD mortality (P<0·05). Our results support the view that regular apple consumption may contribute to lower risk of mortality. PMID:26787402

  20. Syndecan-4 Is an Independent Predictor of All-Cause as Well as Cardiovascular Mortality in Hemodialysis Patients

    PubMed Central

    Jaroszyński, Andrzej J.; Jaroszyńska, Anna; Przywara, Stanisław; Zaborowski, Tomasz; Książek, Andrzej; Dąbrowski, Wojciech

    2016-01-01

    Background Left ventricular hypertrophy is associated withincreased mortality in hemodialysis (HD) patients.Syndecan-4 plays a role in many processes that are involved in the heart fibrosis and hypertrophy.We designed this study to prospectively determine whether syndecan-4 was predictive of mortality in a group of HD patients. Methods In total, 191 HD patients were included. Clinical, biochemical and echocardiographic parameters were recorded. HD patients were followed-up for 23.18 ± 4.02 months. Results Syndecan-4 levels correlated strongly with geometrical echocardiographic parameters and ejection fraction. Relations with pressure-related parameters were weak and only marginally significant. Using the receiver operating characteristics the optimal cut-off points in predicting all-cause as well as cardiovascular (CV) mortality were evaluated and patients were divided into low and high syndecan-4 groups. A Kaplan–Meier analysis showed that the cumulative incidences of all-cause as well as CV mortality were higher in high serum syndecan-4 group compared with those with low serum syndecan-4 (p<0.001 in both cases).A multivariate Cox proportional hazards regression analysis revealed syndecan-4 concentration to be an independent and significant predictor of all-cause (hazard ratio, 2.99; confidence interval, 2.34 to 3.113; p<0.001)as well as CV mortality (hazard ratio, 2.81;confidence interval, 2.28to3.02; p<0.001). Conclusions Serum syndecan-4 concentration reflects predominantly geometrical echocardiographic parameters. In HD patients serum syndecan-4 concentration is independently associated with all-cause as well as CV mortality. PMID:27685148

  1. Association of sarcopenic obesity with the risk of all-cause mortality: A meta-analysis of prospective cohort studies.

    PubMed

    Tian, Simiao; Xu, Yang

    2016-02-01

    Many prospective studies have investigated the relationship between sarcopenic obesity (SO) and risk of mortality. However, the results have been controversial. The aim of the present study was to evaluate the association between SO and all-cause mortality in adults by a meta-analysis of prospective cohort studies. A systematic literature search was carried out through electronic databases up to September 2014. A total of nine articles with 12 prospective cohort studies, including 35 287 participants and 14 306 deaths, were included in the meta-analysis. Overall, compared with healthy subjects, subjects with SO had a significant increased risk of all-cause mortality (pooled HR 1.24, 95% CI 1.12-1.37, P < 0.001), with significant heterogeneity among studies (I(2)  = 53.18%, P = 0.0188), but no indication for publication bias (P = 0.7373). Heterogeneity became low and no longer significant in the subgroup analyses by three SO definitions. More importantly, SO, defined by mid-arm muscle circumference and muscle strength criteria, significantly increased the risk of mortality (HR 1.46, 95% CI 1.23-1.73 and 1.23, 1.09-1.38, respectively). The risk of all-cause mortality did not appreciably change considering the geography (USA cohorts and non-USA cohorts) or the duration of follow up (≥10 years and <10 years). However, the risk estimate was only significant in men (HR 1.23, 95% CI 1.08-1.41, P = 0.0017), not in women (HR 1.16, P = 0.1332). The results of the present study show that subjects with SO are associated with a 24% increase risk of all-cause mortality, compared with those without SO, in particular in men; the significant association was found independent of geographical location and duration of follow up. PMID:26271226

  2. Apple intake is inversely associated with all-cause and disease-specific mortality in elderly women.

    PubMed

    Hodgson, Jonathan M; Prince, Richard L; Woodman, Richard J; Bondonno, Catherine P; Ivey, Kerry L; Bondonno, Nicola; Rimm, Eric B; Ward, Natalie C; Croft, Kevin D; Lewis, Joshua R

    2016-03-14

    Higher fruit intake is associated with lower risk of all-cause and disease-specific mortality. However, data on individual fruits are limited, and the generalisability of these findings to the elderly remains uncertain. The objective of this study was to examine the association of apple intake with all-cause and disease-specific mortality over 15 years in a cohort of women aged over 70 years. Secondary analyses explored relationships of other fruits with mortality outcomes. Usual fruit intake was assessed in 1456 women using a FFQ. Incidence of all-cause and disease-specific mortality over 15 years was determined through the Western Australian Hospital Morbidity Data system. Cox regression was used to determine the hazard ratios (HR) for mortality. During 15 years of follow-up, 607 (41·7%) women died from any cause. In the multivariable-adjusted analysis, the HR for all-cause mortality was 0·89 (95% CI 0·81, 0·97) per sd (53 g/d) increase in apple intake, HR 0·80 (95% CI 0·65, 0·98) for consumption of 5-100 g/d and HR 0·65 (95% CI 0·48, 0·89) for consumption of >100 g/d (an apple a day), compared with apple intake of <5 g/d (P for trend=0·03). Our analysis also found that higher apple intake was associated with lower risk for cancer mortality, and that higher total fruit and banana intakes were associated lower risk of CVD mortality (P<0·05). Our results support the view that regular apple consumption may contribute to lower risk of mortality.

  3. Association between various sedentary behaviours and all-cause, cardiovascular disease and cancer mortality: the Multiethnic Cohort Study

    PubMed Central

    Kim, Yeonju; Wilkens, Lynne R; Park, Song-Yi; Goodman, Marc T; Monroe, Kristine R; Kolonel, Laurence N

    2013-01-01

    Background It has been proposed that time spent sitting increases all-cause mortality, but evidence to support this hypothesis, especially the relative effects of various sitting activities alone or in combination, is very limited. Methods The association between various sedentary behaviours (time spent: sitting watching television (TV); in other leisure activities; in a car/bus; at work; and at meals) and mortality (all-cause and cause-specific) was examined in the Multiethnic Cohort Study, which included 61 395 men and 73 201 women aged 45–75 years among five racial/ethnic groups (African American, Latino, Japanese American, Native Hawaiian and White) from Hawaii and Los Angeles, USA. Results Median follow-up was 13.7 years and 19 143 deaths were recorded. Total daily sitting was not associated with mortality in men, whereas in women the longest sitting duration (≥10 h/day vs <5 h/day) was associated with increased all-cause (11%) and cardiovascular (19%) mortality. Multivariate hazard ratios (HR) for ≥5 h/day vs <1 h/day of sitting watching TV were 1.19 in men (95% confidence interval (CI) 1.10–1.29) and 1.32 in women (95% CI 1.21–1.44) for all-cause mortality. This association was consistent across four racial/ethnic groups, but was not seen in Japanese Americans. Sitting watching TV was associated with an increased risk for cardiovascular mortality, but not for cancer mortality. Time spent sitting in a car/bus and at work was not related to mortality. Conclusions Leisure time spent sitting, particularly watching television, may increase overall and cardiovascular mortality. Sitting at work or during transportation was not related to mortality. PMID:24062293

  4. Risk of All-Cause Mortality in Alcohol-Dependent Individuals: A Systematic Literature Review and Meta-Analysis☆

    PubMed Central

    Laramée, Philippe; Leonard, Saoirse; Buchanan-Hughes, Amy; Warnakula, Samantha; Daeppen, Jean-Bernard; Rehm, Jürgen

    2015-01-01

    Background Alcohol dependence (AD) carries a high mortality burden, which may be mitigated by reduced alcohol consumption. We conducted a systematic literature review and meta-analysis investigating the risk of all-cause mortality in alcohol-dependent subjects. Methods MEDLINE, MEDLINE In-Process, Embase and PsycINFO were searched from database conception through 26th June 2014. Eligible studies reported all-cause mortality in both alcohol-dependent subjects and a comparator population of interest. Two individuals independently reviewed studies. Of 4540 records identified, 39 observational studies were included in meta-analyses. Findings We identified a significant increase in mortality for alcohol-dependent subjects compared with the general population (27 studies; relative risk [RR] = 3.45; 95% CI [2.96, 4.02]; p < 0.0001). The mortality increase was also significant compared to subjects qualifying for a diagnosis of alcohol abuse or subjects without alcohol use disorders (AUDs). Alcohol-dependent subjects continuing to drink heavily had significantly greater mortality than alcohol-dependent subjects who reduced alcohol intake, even if abstainers were excluded (p < 0.05). Interpretation AD was found to significantly increase an individual's risk of all-cause mortality. While abstinence in alcohol-dependent subjects led to greater mortality reduction than non-abstinence, this study suggests that alcohol-dependent subjects can significantly reduce their mortality risk by reducing alcohol consumption. PMID:26629534

  5. Waist circumference and waist/hip ratio in relation to all-cause mortality, cancer and sleep apnea.

    PubMed

    Seidell, J C

    2010-01-01

    Abdominal obesity assessed by waist or waist/hip ratio are both related to increased risk of all-cause mortality throughout the range of body mass index (BMI). The relative risks (RRs) seem to be relatively stronger in younger than in older adults and in those with relatively low BMI compared with those with high BMI. Absolute risks and risk differences are preferable measures of risk in a public health context but these are rarely presented. There is a great lack of studies in ethnic groups (groups of African and Asian descent particularly). Current cut-points as recommended by the World Health Organization seem appropriate, although it may be that BMI-specific and ethnic-specific waist cut-points may be warranted. Waist alone could replace both waist-hip ratio and BMI as a single risk factor for all-cause mortality. There is much less evidence for waist to replace BMI for cancer risk mainly because of the relative lack of prospective cohort studies on waist and cancer risk. Obesity is also a risk factor for sleep apnoea where neck circumference seems to give the strongest association, and waist-hip ratio is a risk factor especially in severe obstructive sleep apnoea syndrome. The waist circumference and waist-hip ratio seem to be better indicators of all-cause mortality than BMI.

  6. All-cause and cause-specific mortality among Black and White North Carolina state prisoners, 1995-2005

    PubMed Central

    Wohl, David A.; Schoenbach, Victor J.

    2011-01-01

    Purpose We compared mortality rates among state prisoners and other state residents to identify prisoners’ healthcare needs Methods We linked North Carolina prison records with state death records for 1995-2005 to estimate all-cause and cause-specific death rates among Black and White male prisoners aged 20-79 years, and used standardized mortality ratios (SMRs) to compare these observed deaths with the expected number based on death rates among state residents Results The all-cause SMR of Black prisoners was 0.52 (95%CI: 0.48 0.57), with fewer deaths than expected from accidents, homicides, cardiovascular disease and cancer. The all-cause SMR of White prisoners was 1.12 (95%CI: 1.01, 1.25) with fewer deaths than expected for accidents, but more deaths than expected from viral hepatitis, liver disease, cancer, chronic lower respiratory disease, and HIV. Conclusions Mortality of Black prisoners was lower than that of Black state residents for both traumatic and chronic causes of death. Mortality of White prisoners was lower than that of White state residents for accidents, but higher for several chronic causes of death. Future studies should investigate the effect of prisoners’ pre-incarceration and in-prison morbidity, the prison environment, and prison healthcare on prisoners’ patterns of mortality. PMID:21737304

  7. Impact of Extreme Heat Events on Emergency Department Visits in North Carolina (2007-2011).

    PubMed

    Fuhrmann, Christopher M; Sugg, Margaret M; Konrad, Charles E; Waller, Anna

    2016-02-01

    Extreme heat is the leading cause of weather-related mortality in the U.S. Extreme heat also affects human health through heat stress and can exacerbate underlying medical conditions that lead to increased morbidity and mortality. In this study, data on emergency department (ED) visits for heat-related illness (HRI) and other selected diseases were analyzed during three heat events across North Carolina from 2007 to 2011. These heat events were identified based on the issuance and verification of heat products from local National Weather Service forecast offices (i.e. Heat Advisory, Heat Watch, and Excessive Heat Warning). The observed number of ED visits during these events were compared to the expected number of ED visits during several control periods to determine excess morbidity resulting from extreme heat. All recorded diagnoses were analyzed for each ED visit, thereby providing insight into the specific pathophysiological mechanisms and underlying health conditions associated with exposure to extreme heat. The most common form of HRI was heat exhaustion, while the percentage of visits with heat stroke was relatively low (<10%). The elderly (>65 years of age) were at greatest risk for HRI during the early summer heat event (8.9 visits per 100,000), while young and middle age adults (18-44 years of age) were at greatest risk during the mid-summer event (6.3 visits per 100,000). Many of these visits were likely due to work-related exposure. The most vulnerable demographic during the late summer heat event was adolescents (15-17 years of age), which may relate to the timing of organized sports. This demographic also exhibited the highest visit rate for HRI among all three heat events (10.5 visits per 100,000). Significant increases (p < 0.05) in visits with cardiovascular and cerebrovascular diseases were noted during the three heat events (3-8%). The greatest increases were found in visits with hypotension during the late summer event (23%) and sequelae during

  8. Association Between Tooth Loss, Body Mass Index, and All-Cause Mortality Among Elderly Patients in Taiwan

    PubMed Central

    Hu, Hsiao-Yun; Lee, Ya-Ling; Lin, Shu-Yi; Chou, Yi-Chang; Chung, Debbie; Huang, Nicole; Chou, Yiing-Jenq; Wu, Chen-Yi

    2015-01-01

    Abstract To date, the effect of tooth loss on all-cause mortality among elderly patients with a different weight group has not been assessed. This retrospective cohort study evaluated the data obtained from a government-sponsored, annual physical examination program for elderly citizens residing in Taipei City during 2005 to 2007, and follow-up to December 31, 2010. We recruited 55,651 eligible citizens of Taipei City aged ≥65 years, including 29,572 men and 26,079 women, in our study. Their mortality data were ascertained based on the national death files. The number of missing teeth was used as a representative of oral health status. We used multivariate Cox proportional hazards regression analysis to determine the association between tooth loss and all-cause mortality. After adjustment for all confounders, the hazard ratios (HRs) of all-cause mortality in participants with no teeth, 1 to 9 teeth, and 10 to 19 teeth were 1.36 [95% confidence interval (CI): 1.15–1.61], 1.24 (95% CI: 1.08–1.42), and 1.19 (95% CI: 1.09–1.31), respectively, compared with participants with 20 or more teeth. A significant positive correlation of body mass index (BMI) with all-cause mortality was found in underweight and overweight elderly patients and was represented as a U-shaped curve. Subgroup analysis revealed a significant positive correlation in underweight (no teeth: HR = 1.49, 95% CI: 1.21–1.83; 1–9 teeth: HR = 1.23, 95% CI: 1.03–1.47; 10–19 teeth: HR = 1.20, 95% CI: 1.06–1.36) and overweight participants (no teeth: HR = 1.37, 95% CI: 1.05–1.79; 1–9 teeth: HR = 1.27, 95% CI: 1.07–1.52). The number of teeth lost is associated with an increased risk of all-cause mortality, particularly for participants with underweight and overweight. PMID:26426618

  9. Emergency Department Visits Involving Nonmedical Use of Central Nervous System Stimulants among Adults Aged 18 to 34 ...

    MedlinePlus

    ... Emergency Department (ED) Visits Involving Nonmedical Use of Pharmaceuticals* among Adults Aged 18 to 34, by Alcohol ... 2007 2008 2009 2010 2011 * Nonmedical use of pharmaceuticals includes taking more than the prescribed dose of ...

  10. Goddard Visiting Scientist Program

    NASA Technical Reports Server (NTRS)

    2000-01-01

    Under this Indefinite Delivery Indefinite Quantity (IDIQ) contract, USRA was expected to provide short term (from I day up to I year) personnel as required to provide a Visiting Scientists Program to support the Earth Sciences Directorate (Code 900) at the Goddard Space Flight Center. The Contractor was to have a pool, or have access to a pool, of scientific talent, both domestic and international, at all levels (graduate student to senior scientist), that would support the technical requirements of the following laboratories and divisions within Code 900: 1) Global Change Data Center (902); 2) Laboratory for Atmospheres (Code 910); 3) Laboratory for Terrestrial Physics (Code 920); 4) Space Data and Computing Division (Code 930); 5) Laboratory for Hydrospheric Processes (Code 970). The research activities described below for each organization within Code 900 were intended to comprise the general scope of effort covered under the Visiting Scientist Program.

  11. Frequent Emergency Department Visits and Hospitalizations Among Homeless People With Medicaid: Implications for Medicaid Expansion

    PubMed Central

    Bharel, Monica; Zhang, Jianying; O’Connell, Elizabeth; Clark, Robin E.

    2015-01-01

    Objectives. We examined factors associated with frequent hospitalizations and emergency department (ED) visits among Medicaid members who were homeless. Methods. We included 6494 Massachusetts Medicaid members who received services from a health care for the homeless program in 2010. We used negative binomial regression to examine variables associated with frequent utilization. Results. Approximately one third of the study population had at least 1 hospitalization and two thirds had 1 or more ED visits. More than 70% of hospitalizations and ED visits were incurred by only 12% and 21% of these members, respectively. Homeless individuals with co-occurring mental illness and substance use disorders were at greatest risk for frequent hospitalizations and ED visits (e.g., incidence rate ratios [IRRs] = 2.9–13.8 for hospitalizations). Individuals living on the streets also had significantly higher utilization (IRR = 1.5). Conclusions. Despite having insurance coverage, homeless Medicaid members experienced frequent hospitalizations and ED visits. States could consider provisions under the Patient Protection and Affordable Care Act (e.g., Medicaid expansion and Health Homes) jointly with housing programs to meet the needs of homeless individuals, which may improve the quality and cost effectiveness of care. PMID:26447915

  12. Variation in computed tomography imaging for pediatric injury-related emergency visits

    PubMed Central

    Marin, Jennifer R.; Wang, Li; Winger, Daniel G.; Mannix, Rebekah C.

    2016-01-01

    Objectives To assess variation in the use of computed tomography (CT) for pediatric injury-related emergency department (ED) visits. Study design Retrospective cohort study of visits to 14 network-affiliated EDs from November 2010 through February 2013. Visits were identified by International Classification of Diseases, 9th revision, Clinical Modification diagnosis codes. Primary outcome was CT use. We used descriptive statistics and performed multivariable logistic regression to evaluate the association of patient and ED covariates on any and body region-specific CT use. Results Of the 80,868 injury-related visits, 11.4% included CT, and 28.4% of those had more than one study. Across EDs, CT use ranged from 7.6%- 25.5% of visits and did not correlate with institutional injury severity score (P=0.33) or admission/transfer rates (P=0.07). In multivariable analysis of non-pediatric EDs, trauma centers and non-academic EDs were associated with CT use. Higher pediatric volume was associated with any CT use, however, there was an inverse relationship between volume and non-head CT use. When the pediatric ED was included in multivariable modeling, the effect of level 1-3 trauma center designation remained, and the pediatric level 1 trauma center was less likely to use most body region-specific CTs. Conclusions There is wide variation in CT imaging for pediatric injury-related visits not solely attributable to case mix. Future work to optimize CT utilization should focus on additional factors contributing to imaging practices and interventions. PMID:26233603

  13. Diet Quality Scores and Prediction of All-Cause, Cardiovascular and Cancer Mortality in a Pan-European Cohort Study

    PubMed Central

    Lassale, Camille; Gunter, Marc J.; Romaguera, Dora; Peelen, Linda M.; Van der Schouw, Yvonne T.; Beulens, Joline W. J.; Freisling, Heinz; Muller, David C.; Ferrari, Pietro; Huybrechts, Inge; Fagherazzi, Guy; Boutron-Ruault, Marie-Christine; Affret, Aurélie; Overvad, Kim; Dahm, Christina C.; Olsen, Anja; Roswall, Nina; Tsilidis, Konstantinos K.; Katzke, Verena A.; Kühn, Tilman; Buijsse, Brian; Quirós, José-Ramón; Sánchez-Cantalejo, Emilio; Etxezarreta, Nerea; Huerta, José María; Barricarte, Aurelio; Bonet, Catalina; Khaw, Kay-Tee; Key, Timothy J.; Trichopoulou, Antonia; Bamia, Christina; Lagiou, Pagona; Palli, Domenico; Agnoli, Claudia; Tumino, Rosario; Fasanelli, Francesca; Panico, Salvatore; Bueno-de-Mesquita, H. Bas; Boer, Jolanda M. A.; Sonestedt, Emily; Nilsson, Lena Maria; Renström, Frida; Weiderpass, Elisabete; Skeie, Guri; Lund, Eiliv; Moons, Karel G. M.; Riboli, Elio; Tzoulaki, Ioanna

    2016-01-01

    Scores of overall diet quality have received increasing attention in relation to disease aetiology; however, their value in risk prediction has been little examined. The objective was to assess and compare the association and predictive performance of 10 diet quality scores on 10-year risk of all-cause, CVD and cancer mortality in 451,256 healthy participants to the European Prospective Investigation into Cancer and Nutrition, followed-up for a median of 12.8y. All dietary scores studied showed significant inverse associations with all outcomes. The range of HRs (95% CI) in the top vs. lowest quartile of dietary scores in a composite model including non-invasive factors (age, sex, smoking, body mass index, education, physical activity and study centre) was 0.75 (0.72–0.79) to 0.88 (0.84–0.92) for all-cause, 0.76 (0.69–0.83) to 0.84 (0.76–0.92) for CVD and 0.78 (0.73–0.83) to 0.91 (0.85–0.97) for cancer mortality. Models with dietary scores alone showed low discrimination, but composite models also including age, sex and other non-invasive factors showed good discrimination and calibration, which varied little between different diet scores examined. Mean C-statistic of full models was 0.73, 0.80 and 0.71 for all-cause, CVD and cancer mortality. Dietary scores have poor predictive performance for 10-year mortality risk when used in isolation but display good predictive ability in combination with other non-invasive common risk factors. PMID:27409582

  14. Level of incongruence during cardiac rehabilitation and prediction of future CVD-related hospitalizations plus all-cause mortality.

    PubMed

    Meyer, Fiorenza A; Stauber, Stefanie; Wilhelm, Matthias; Znoj, Hansjörg; von Känel, Roland

    2015-01-01

    Independent of traditional risk factors, psychosocial risk factors increase the risk of cardiovascular disease (CVD). Studies in the field of psychotherapy have shown that the construct of incongruence (meaning a discrepancy between desired and achieved goals) affects the outcome of therapy. We prospectively measured the impact of incongruence in patients after undergoing a cardiac rehabilitation program. We examined 198 CVD patients enrolled in a 8-12 week comprehensive cardiac rehabilitation program. Patients completed the German short version of the Incongruence Questionnaire and the SF-36 Health Questionnaire to measure quality of life (QoL) at discharge of rehabilitation. Endpoints at follow-up were CVD-related hospitalizations plus all-cause mortality. During a mean follow-up period of 54.3 months, 29 patients experienced a CVD-related hospitalization and 3 patients died. Incongruence at discharge of rehabilitation was independent of traditional risk factors a significant predictor for CVD-related hospitalizations plus all-cause mortality (HR 2.03, 95% CI 1.29-3.20, p = .002). We also found a significant interaction of incongruence with mental QoL (HR .96, 95% CI .92-.99, p = .027), i.e. incongruence predicted poor prognosis if QoL was low (p = .017), but not if QoL was high (p = .74). Incongruence at discharge predicted future CVD-related hospitalizations plus all-cause mortality and mental QoL moderated this relationship. Therefore, incongruence should be considered for effective treatment planning and outcome measurement.

  15. Diet Quality Scores and Prediction of All-Cause, Cardiovascular and Cancer Mortality in a Pan-European Cohort Study.

    PubMed

    Lassale, Camille; Gunter, Marc J; Romaguera, Dora; Peelen, Linda M; Van der Schouw, Yvonne T; Beulens, Joline W J; Freisling, Heinz; Muller, David C; Ferrari, Pietro; Huybrechts, Inge; Fagherazzi, Guy; Boutron-Ruault, Marie-Christine; Affret, Aurélie; Overvad, Kim; Dahm, Christina C; Olsen, Anja; Roswall, Nina; Tsilidis, Konstantinos K; Katzke, Verena A; Kühn, Tilman; Buijsse, Brian; Quirós, José-Ramón; Sánchez-Cantalejo, Emilio; Etxezarreta, Nerea; Huerta, José María; Barricarte, Aurelio; Bonet, Catalina; Khaw, Kay-Tee; Key, Timothy J; Trichopoulou, Antonia; Bamia, Christina; Lagiou, Pagona; Palli, Domenico; Agnoli, Claudia; Tumino, Rosario; Fasanelli, Francesca; Panico, Salvatore; Bueno-de-Mesquita, H Bas; Boer, Jolanda M A; Sonestedt, Emily; Nilsson, Lena Maria; Renström, Frida; Weiderpass, Elisabete; Skeie, Guri; Lund, Eiliv; Moons, Karel G M; Riboli, Elio; Tzoulaki, Ioanna

    2016-01-01

    Scores of overall diet quality have received increasing attention in relation to disease aetiology; however, their value in risk prediction has been little examined. The objective was to assess and compare the association and predictive performance of 10 diet quality scores on 10-year risk of all-cause, CVD and cancer mortality in 451,256 healthy participants to the European Prospective Investigation into Cancer and Nutrition, followed-up for a median of 12.8y. All dietary scores studied showed significant inverse associations with all outcomes. The range of HRs (95% CI) in the top vs. lowest quartile of dietary scores in a composite model including non-invasive factors (age, sex, smoking, body mass index, education, physical activity and study centre) was 0.75 (0.72-0.79) to 0.88 (0.84-0.92) for all-cause, 0.76 (0.69-0.83) to 0.84 (0.76-0.92) for CVD and 0.78 (0.73-0.83) to 0.91 (0.85-0.97) for cancer mortality. Models with dietary scores alone showed low discrimination, but composite models also including age, sex and other non-invasive factors showed good discrimination and calibration, which varied little between different diet scores examined. Mean C-statistic of full models was 0.73, 0.80 and 0.71 for all-cause, CVD and cancer mortality. Dietary scores have poor predictive performance for 10-year mortality risk when used in isolation but display good predictive ability in combination with other non-invasive common risk factors.

  16. Sodium and potassium intake and risk of cardiovascular events and all-cause mortality: the Rotterdam Study

    PubMed Central

    Witteman, Jacqueline C. M.; Stijnen, Theo; Kloos, Margot W.; Hofman, Albert; Grobbee, Diederick E.

    2007-01-01

    Background Dietary electrolytes influence blood pressure, but their effect on clinical outcomes remains to be established. We examined sodium and potassium intake in relation to cardiovascular disease (CVD) and mortality in an unselected older population. Methods A case–cohort analysis was performed in the Rotterdam Study among subjects aged 55 years and over, who were followed for 5 years. Baseline urinary samples were analyzed for sodium and potassium in 795 subjects who died, 206 with an incident myocardial infarction and 181 subjects with an incident stroke, and in 1,448 randomly selected subjects. For potassium, dietary data were additionally obtained by food-frequency questionnaire for 78% of the cohort. Results There was no consistent association of urinary sodium, potassium, or sodium/potassium ratio with CVD and all-cause mortality over the range of intakes observed in this population. Dietary potassium estimated by food frequency questionnaire, however, was associated with a lower risk of all-cause mortality in subjects initially free of CVD and hypertension (RR = 0.71 per standard deviation increase; 95% confidence interval: 0.51–1.00). We observed a significant positive association between urinary sodium/potassium ratio and all-cause mortality, but only in overweight subjects who were initially free of CVD and hypertension (RR = 1.19 (1.02–1.39) per unit). Conclusion The effect of sodium and potassium intake on CVD morbidity and mortality in Western societies remains to be established. PMID:17902026

  17. Sleep Duration and All-Cause Mortality: A Systematic Review and Meta-Analysis of Prospective Studies

    PubMed Central

    Cappuccio, Francesco P.; D'Elia, Lanfranco; Strazzullo, Pasquale; Miller, Michelle A.

    2010-01-01

    Background: Increasing evidence suggests an association between both short and long duration of habitual sleep with adverse health outcomes. Objectives: To assess whether the population longitudinal evidence supports the presence of a relationship between duration of sleep and all-cause mortality, to investigate both short and long sleep duration and to obtain an estimate of the risk. Methods: We performed a systematic search of publications using MEDLINE (1966-2009), EMBASE (from 1980), the Cochrane Library, and manual searches without language restrictions. We included studies if they were prospective, had follow-up >3 years, had duration of sleep at baseline, and all-cause mortality prospectively. We extracted relative risks (RR) and 95% confidence intervals (CI) and pooled them using a random effect model. We carried out sensitivity analyses and assessed heterogeneity and publication bias. Results: Overall, the 16 studies analyzed provided 27 independent cohort samples. They included 1,382,999 male and female participants (follow-up range 4 to 25 years), and 112,566 deaths. Sleep duration was assessed by questionnaire and outcome through death certification. In the pooled analysis, short duration of sleep was associated with a greater risk of death (RR: 1.12; 95% CI 1.06 to 1.18; P < 0. 01) with no evidence of publication bias (P = 0.74) but heterogeneity between studies (P = 0.02). Long duration of sleep was also associated with a greater risk of death (1.30; [1.22 to 1.38]; P < 0.0001) with no evidence of publication bias (P = 0.18) but significant heterogeneity between studies (P < 0.0001). Conclusion: Both short and long duration of sleep are significant predictors of death in prospective population studies. Citation: Cappuccio FP; D'Elia L; Strazzullo P; Miller MA. Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. SLEEP 2010;33(5):585-592. PMID:20469800

  18. Hearing impairment and incident disability and all-cause mortality in older British community-dwelling men

    PubMed Central

    Liljas, Ann E. M.; Wannamethee, S. Goya; Whincup, Peter H.; Papacosta, Olia; Walters, Kate; Iliffe, Steve; Lennon, Lucy T.; Carvalho, Livia A.; Ramsay, Sheena E.

    2016-01-01

    Background and objective: hearing impairment is common in older adults and has been implicated in the risk of disability and mortality. We examined the association between hearing impairment and risk of incident disability and all-cause mortality. Design and setting: prospective cohort of community-dwelling older men aged 63–85 followed up for disability over 2 years and for all-cause mortality for 10 years in the British Regional Heart Study. Methods: data were collected on self-reported hearing impairment including hearing aid use, and disability assessed as mobility limitations (problems walking/taking stairs), difficulties with activities of daily living (ADL) and instrumental ADL (IADL). Mortality data were obtained from the National Health Service register. Results: among 3,981 men, 1,074 (27%) reported hearing impairment. Compared with men with no hearing impairment, men who could hear and used a hearing aid, and men who could not hear despite a hearing aid had increased risks of IADL difficulties (age-adjusted OR 1.86, 95% CI 1.29–2.70; OR 2.74, 95% CI 1.53–4.93, respectively). The associations remained after further adjustment for covariates including social class, lifestyle factors, co-morbidities and social engagement. Associations of hearing impairment with incident mobility limitations, incident ADL difficulties and all-cause mortality were attenuated on adjustment for covariates. Conclusion: this study suggests that hearing problems in later life could increase the risk of having difficulties performing IADLs, which include more complex everyday tasks such as shopping and light housework. However, further studies are needed to determine the associations observed including the underlying pathways. PMID:27146303

  19. Road traffic noise is associated with increased cardiovascular morbidity and mortality and all-cause mortality in London

    PubMed Central

    Halonen, Jaana I.; Hansell, Anna L.; Gulliver, John; Morley, David; Blangiardo, Marta; Fecht, Daniela; Toledano, Mireille B.; Beevers, Sean D.; Anderson, Hugh Ross; Kelly, Frank J.; Tonne, Cathryn

    2015-01-01

    Aims Road traffic noise has been associated with hypertension but evidence for the long-term effects on hospital admissions and mortality is limited. We examined the effects of long-term exposure to road traffic noise on hospital admissions and mortality in the general population. Methods and results The study population consisted of 8.6 million inhabitants of London, one of Europe's largest cities. We assessed small-area-level associations of day- (7:00–22:59) and nighttime (23:00–06:59) road traffic noise with cardiovascular hospital admissions and all-cause and cardiovascular mortality in all adults (≥25 years) and elderly (≥75 years) through Poisson regression models. We adjusted models for age, sex, area-level socioeconomic deprivation, ethnicity, smoking, air pollution, and neighbourhood spatial structure. Median daytime exposure to road traffic noise was 55.6 dB. Daytime road traffic noise increased the risk of hospital admission for stroke with relative risk (RR) 1.05 [95% confidence interval (CI): 1.02–1.09] in adults, and 1.09 (95% CI: 1.04–1.14) in the elderly in areas >60 vs. <55 dB. Nighttime noise was associated with stroke admissions only among the elderly. Daytime noise was significantly associated with all-cause mortality in adults [RR 1.04 (95% CI: 1.00–1.07) in areas >60 vs. <55 dB]. Positive but non-significant associations were seen with mortality for cardiovascular and ischaemic heart disease, and stroke. Results were similar for the elderly. Conclusions Long-term exposure to road traffic noise was associated with small increased risks of all-cause mortality and cardiovascular mortality and morbidity in the general population, particularly for stroke in the elderly. PMID:26104392

  20. Associations of high HDL cholesterol level with all-cause mortality in patients with heart failure complicating coronary heart disease

    PubMed Central

    Cai, Anping; Li, Xida; Zhong, Qi; Li, Minming; Wang, Rui; Liang, Yingcong; Chen, Wenzhong; Huang, Tehui; Li, Xiaohong; Zhou, Yingling; Li, Liwen

    2016-01-01

    Abstract The aim of the present study was to evaluate the association between HDL cholesterol level and all-cause mortality in patients with ejection fraction reduced heart failure (EFrHF) complicating coronary heart disease (CHD). A total of 323 patients were retrospectively recruited. Patients were divided into low and high HDL cholesterol groups. Between-group differences and associations between HDL cholesterol level and all-cause mortality were assessed. Patients in the high HDL cholesterol group had higher HDL cholesterol level and other lipid components (P <0.05 for all comparison). Lower levels of alanine aminotransferase (ALT), high-sensitivity C-reactive protein (Hs-CRP), and higher albumin (ALB) level were observed in the high HDL cholesterol group (P <0.05 for all comparison). Although left ventricular ejection fraction (LVEF) were comparable (28.8 ± 4.5% vs 28.4 ± 4.6%, P = 0.358), mean mortality rate in the high HDL cholesterol group was significantly lower (43.5% vs 59.1%, P = 0.007). HDL cholesterol level was positively correlated with ALB level, while inversely correlated with ALT, Hs-CRP, and NYHA classification. Logistic regression analysis revealed that after extensively adjusted for confounding variates, HDL cholesterol level remained significantly associated with all-cause mortality although the magnitude of association was gradually attenuated with odds ratio of 0.007 (95% confidence interval 0.001–0.327, P = 0.012). Higher HDL cholesterol level is associated with better survival in patients with EFrHF complicating CHD, and future studies are necessary to demonstrate whether increasing HDL cholesterol level will confer survival benefit in these populations of patients. PMID:27428188

  1. Substance Abuse and Mental Health Visits Among Adolescents Presenting to US Emergency Departments

    PubMed Central

    Fahimi, Jahan; Aurrecoechea, Adrian; Anderson, Erik; Herring, Andrew; Alter, Harrison

    2015-01-01

    Objectives To identify factors associated with adolescent emergency department (ED) visits for substance abuse, including those complicated by mental health (dual diagnosis), and to analyze their effect on ED length of stay (LOS) and disposition. Methods We performed a secondary analysis of ED visits by adolescents (aged 11-24) using the National Hospital Ambulatory Medical Care Survey (1997-2010), identifying visits for mental health, substance use, and dual diagnosis. Univariate and multivariate statistics were used to analyze demographic and visit-level factors, factors associated with substance use and dual diagnosis visits, and the effects of substance use and mental health conditions on emergency department LOS and disposition. Results Substance use and mental health accounted for 2.1% and 4.3% of all adolescent visits, respectively, with 20.9% (95% confidence interval [CI] 18.3-23.5%) of substance abuse visits complicated by mental health. Factors significantly associated with substance use include: male gender, urban location, West region, ambulance arrival, night and weekend shift, anxiety disorders, mood disorders, and psychotic disorders. Additional LOS was 89.77 minutes for mental health, 71.33 minutes for substance use, and 139.97 minutes for dual diagnosis visits, as compared to visits where these conditions were not present. Both mental health and substance use were associated with admission/transfer as compared to other dispositions: mental health, odds ratio (OR) 5.93 (95% CI 5.14-6.84), illicit drug use, OR 3.56 (95% CI 2.72-4.64), and dual diagnosis, OR 6.86 (95% 4.67-10.09). Conclusions Substance abuse and dual diagnosis are common among adolescent ED visits and are strongly associated with increased use of prehospital resources, emergency department length of stay, and need for hospitalization. PMID:25875990

  2. Sexual Orientation and All-Cause Mortality Among US Adults Aged 18 to 59 Years, 2001–2011

    PubMed Central

    Björkenstam, Charlotte; Mays, Vickie M.

    2016-01-01

    To determine whether sexual minorities have an earlier mortality than do heterosexuals, we investigated associations between sexual orientation assessed in the 2001 to 2010 National Health and Nutrition Examination Surveys (NHANES) and mortality in the 2011 NHANES-linked mortality file. Mortality follow-up time averaged 69.6 months after NHANES. By 2011, 338 individuals had died. Sexual minorities evidenced greater all-cause mortality than did heterosexuals after adjusting for demographic confounding. These effects generally disappeared with further adjustment for NHANES-detected health and behavioral differences. PMID:26985610

  3. ED Utilization Trends in Sports-Related Traumatic Brain Injury

    PubMed Central

    Pomerantz, Wendy J.; Gittelman, Mike

    2013-01-01

    BACKGROUND: Emergency department (ED) visits for sports-related traumatic brain injuries (TBIs) have risen. This study evaluated how the number and severity of admissions have changed as ED visits for sports-related TBIs have increased. METHODS: A retrospective study of children aged 0 to 19 years at a level 1 trauma center was performed. Patients from 2002 to 2011 with a primary or secondary diagnosis of TBI were identified from the hospital’s inpatient and outpatient trauma registries. Frequencies were used to characterize the population, χ2 analysis was performed to determine differences between groups, and regression analysis looked at relationship between year and injury severity score or length of stay. RESULTS: Sport was responsible for injury in 3878 (15.4%) cases during the study period; 3506 (90.4%) were discharged from the hospital, and 372 (9.6%) were admitted. Seventy-three percent were male patients and 78% Caucasian; mean age was 13 ± 3.5 years. ED visits for sports-related TBIs increased 92% over the study period, yet there was no significant change (χ2 = 9.8, df = 9, P = .37) in the percentage of children admitted. Mean injury severity score for those admitted decreased from 7.8 to 4.8 (β = –0.46; P = .006); length of stay trended downward (β = –0.05; P = .05). CONCLUSIONS: The percentage of children being admitted from the ED with sports-related TBI has not changed over the past 10 years. The severity of admitted sports-related TBI is decreasing. Additional research is needed to correlate these trends with other TBI mechanisms. PMID:24081999

  4. The impact of smoking-related illness in the ED: an attributable risk model.

    PubMed

    Bernstein, Steven L

    2002-05-01

    The objective of this study was to estimate the clinical and economic impact of smoking among adult emergency department (ED) patients. An attributable risk analysis of patients seen in 2 urban EDs in 1998 was performed. Data were obtained from hospital databases, national sources describing the prevalence of smoking in the state, and risk ratios for smoking-related illnesses. Of 78,617 patient visits, 12,573 (16.0%) had any smoking-related International Classification of Diseases, 9th Revision code. The smoking-attributable risk fraction (SARF) for all patients was 4.9% (95% confidence interval [CI] 4.7%-5.0%). Of 13,245 admissions, 6.8% (95% CI 6.4%-7.2%) were smoking attributable. Of $296,962,685 in hospital charges, 10.0% (95% CI 9.9%-10.1%) were smoking attributable. The SARFs for ED visits, admissions, and charges for men were higher than for women (all P <.0001). Smoking-attributable illness accounts for 4.9% of ED adult visits, 6.8% of ED adult admissions, and 10.0% of hospital charges. The use of ED-based smoking intervention remains to be determined.

  5. Serum Calcification Propensity Is a Strong and Independent Determinant of Cardiac and All-Cause Mortality in Kidney Transplant Recipients.

    PubMed

    Dahle, D O; Åsberg, A; Hartmann, A; Holdaas, H; Bachtler, M; Jenssen, T G; Dionisi, M; Pasch, A

    2016-01-01

    Calcification of the vasculature is associated with cardiovascular disease and death in kidney transplant recipients. A novel functional blood test measures calcification propensity by quantifying the transformation time (T50 ) from primary to secondary calciprotein particles. Accelerated T50 indicates a diminished ability of serum to resist calcification. We measured T50 in 1435 patients 10 weeks after kidney transplantation during 2000-2003 (first era) and 2009-2012 (second era). Aortic pulse wave velocity (APWV) was measured at week 10 and after 1 year in 589 patients from the second era. Accelerated T50 was associated with diabetes, deceased donor, first transplant, rejection, stronger immunosuppression, first era, higher serum phosphate and lower albumin. T50 was not associated with progression of APWV. During a median follow-up of 5.1 years, 283 patients died, 70 from myocardial infarction, cardiac failure or sudden death. In Cox regression models, accelerated T50 was strongly and independently associated with both all-cause and cardiac mortality, low versus high T50 quartile: hazard ratio 1.60 (95% confidence interval [CI] 1.00-2.57), ptrend   = 0.03, and 3.60 (95% CI 1.10-11.83), ptrend   = 0.02, respectively. In conclusion, calcification propensity (T50 ) was strongly associated with all-cause and cardiac mortality of kidney transplant recipients, potentially via a cardiac nonAPWV-related pathway. Whether therapeutic improvement of T50 improves outcome awaits clarification in a randomized trial. PMID:26375609

  6. Birth characteristics and all-cause mortality: a sibling analysis using the Uppsala birth cohort multigenerational study.

    PubMed

    Juárez, S; Goodman, A; De Stavola, B; Koupil, I

    2016-08-01

    This paper investigates the association between perinatal health and all-cause mortality for specific age intervals, assessing the contribution of maternal socioeconomic characteristics and the presence of maternal-level confounding. Our study is based on a cohort of 12,564 singletons born between 1915 and 1929 at the Uppsala University Hospital. We fitted Cox regression models to estimate age-varying hazard ratios of all-cause mortality for absolute and relative birth weight and for gestational age. We found that associations with mortality vary by age and according to the measure under scrutiny, with effects being concentrated in infancy, childhood or early adult life. For example, the effect of low birth weight was greatest in the first year of life and then continued up to 44 years of age (HR between 2.82 and 1.51). These associations were confirmed in within-family analyses, which provided no evidence of residual confounding by maternal characteristics. Our findings support the interpretation that policies oriented towards improving population health should invest in birth outcomes and hence in maternal health. PMID:27138055

  7. Meta-analysis on the risk of all-cause mortality and cardiovascular death in the early stage of hypertension.

    PubMed

    Yue, Menglin; Zhang, Huimin; Li, Rong

    2016-07-01

    To evaluate the relationship among the early stage of hypertension, cardiovascular death, the mortality of coronary heart disease and stroke. Two researchers searched online data of PubMed, Embase and Cochrane library databases and other related papers and manual retrieval conference papers. A prospective cohort study of relative risks and 95% CIs about the comparison with ideal blood pressure, the pre-hypertension and the all-cause mortality or the death of cardiovascular that corrected a variety of risk factors. Compared with ideal blood pressure, the corrected risk factors, the pre-hypertension couldn't increase the RR of the all caused mortality; but it could increase remarkably the mortality of cardiovascular, coronary heart disease and stroke, and there was a significant difference between the two later (P<0.001). Compared with the ideal blood pressure, the pre-hypertension still increased the risk of death of cardiovascular disease and the death rate of the stroke was higher than coronary heart disease. PMID:27592484

  8. Annual Cost of U.S. Hospital Visits for Pediatric Abusive Head Trauma

    PubMed Central

    Peterson, Cora; Xu, Likang; Florence, Curtis; Parks, Sharyn E.

    2015-01-01

    We estimated the frequency and direct medical cost from the provider perspective of U.S. hospital visits for pediatric abusive head trauma (AHT). We identified treat-and-release hospital emergency department (ED) visits and admissions for AHT among patients aged 0–4 years in the Nationwide Emergency Department Sample and Nationwide Inpatient Sample (NIS), 2006–2011. We applied cost-to-charge ratios and estimated professional fee ratios from Truven Health MarketScan® to estimate per-visit and total population costs of AHT ED visits and admissions. Regression models assessed cost differences associated with selected patient and hospital characteristics. AHT was diagnosed during 6,827 (95% confidence interval [CI] [6,072, 7,582]) ED visits and 12,533 (95% CI [10,395, 14,671]) admissions (28% originating in the same hospital’s ED) nationwide over the study period. The average medical cost per ED visit and admission were US$2,612 (error bound: 1,644–3,581) and US$31,901 (error bound: 29,266–34,536), respectively (2012 USD). The average total annual nationwide medical cost of AHT hospital visits was US$69.6 million (error bound: 56.9–82.3 million) over the study period. Factors associated with higher per-visit costs included patient age <1 year, males, coexisting chronic conditions, discharge to another facility, death, higher household income, public insurance payer, hospital trauma level, and teaching hospitals in urban locations. Study findings emphasize the importance of focused interventions to reduce this type of high-cost child abuse. PMID:25911437

  9. Annual Cost of U.S. Hospital Visits for Pediatric Abusive Head Trauma.

    PubMed

    Peterson, Cora; Xu, Likang; Florence, Curtis; Parks, Sharyn E

    2015-08-01

    We estimated the frequency and direct medical cost from the provider perspective of U.S. hospital visits for pediatric abusive head trauma (AHT). We identified treat-and-release hospital emergency department (ED) visits and admissions for AHT among patients aged 0-4 years in the Nationwide Emergency Department Sample and Nationwide Inpatient Sample (NIS), 2006-2011. We applied cost-to-charge ratios and estimated professional fee ratios from Truven Health MarketScan(®) to estimate per-visit and total population costs of AHT ED visits and admissions. Regression models assessed cost differences associated with selected patient and hospital characteristics. AHT was diagnosed during 6,827 (95% confidence interval [CI] [6,072, 7,582]) ED visits and 12,533 (95% CI [10,395, 14,671]) admissions (28% originating in the same hospital's ED) nationwide over the study period. The average medical cost per ED visit and admission were US$2,612 (error bound: 1,644-3,581) and US$31,901 (error bound: 29,266-34,536), respectively (2012 USD). The average total annual nationwide medical cost of AHT hospital visits was US$69.6 million (error bound: 56.9-82.3 million) over the study period. Factors associated with higher per-visit costs included patient age <1 year, males, coexisting chronic conditions, discharge to another facility, death, higher household income, public insurance payer, hospital trauma level, and teaching hospitals in urban locations. Study findings emphasize the importance of focused interventions to reduce this type of high-cost child abuse.

  10. Google Flu Trends Spatial Variability Validated Against Emergency Department Influenza-Related Visits

    PubMed Central

    Jalalpour, Mehdi; Levin, Scott; Washington, Raynard E; Pines, Jesse M; Rothman, Richard E; Dugas, Andrea Freyer

    2016-01-01

    Background Influenza is a deadly and costly public health problem. Variations in its seasonal patterns cause dangerous surges in emergency department (ED) patient volume. Google Flu Trends (GFT) can provide faster influenza surveillance information than traditional CDC methods, potentially leading to improved public health preparedness. GFT has been found to correlate well with reported influenza and to improve influenza prediction models. However, previous validation studies have focused on isolated clinical locations. Objective The purpose of the study was to measure GFT surveillance effectiveness by correlating GFT with influenza-related ED visits in 19 US cities across seven influenza seasons, and to explore which city characteristics lead to better or worse GFT effectiveness. Methods Using Healthcare Cost and Utilization Project data, we collected weekly counts of ED visits for all patients with diagnosis (International Statistical Classification of Diseases 9) codes for influenza-related visits from 2005-2011 in 19 different US cities. We measured the correlation between weekly volume of GFT searches and influenza-related ED visits (ie, GFT ED surveillance effectiveness) per city. We evaluated the relationship between 15 publically available city indicators (11 sociodemographic, two health care utilization, and two climate) and GFT surveillance effectiveness using univariate linear regression. Results Correlation between city-level GFT and influenza-related ED visits had a median of .84, ranging from .67 to .93 across 19 cities. Temporal variability was observed, with median correlation ranging from .78 in 2009 to .94 in 2005. City indicators significantly associated (P<.10) with improved GFT surveillance include higher proportion of female population, higher proportion with Medicare coverage, higher ED visits per capita, and lower socioeconomic status. Conclusions GFT is strongly correlated with ED influenza-related visits at the city level, but unexplained

  11. High diet quality is associated with a lower risk of cardiovascular disease and all-cause mortality in older men.

    PubMed

    Atkins, Janice L; Whincup, Peter H; Morris, Richard W; Lennon, Lucy T; Papacosta, Olia; Wannamethee, S Goya

    2014-05-01

    Although diet quality is implicated in cardiovascular disease (CVD) risk, few studies have investigated the relation between diet quality and the risks of CVD and mortality in older adults. This study examined the prospective associations between dietary scores and risk of CVD and all-cause mortality in older British men. A total of 3328 men (aged 60-79 y) from the British Regional Heart Study, free from CVD at baseline, were followed up for 11.3 y for CVD and mortality. Baseline food-frequency questionnaire data were used to generate 2 dietary scores: the Healthy Diet Indicator (HDI), based on WHO dietary guidelines, and the Elderly Dietary Index (EDI), based on a Mediterranean-style dietary intake, with higher scores indicating greater compliance with dietary recommendations. Cox proportional hazards regression analyses assessed associations between quartiles of HDI and EDI and risk of all-cause mortality, CVD mortality, CVD events, and coronary heart disease (CHD) events. During follow-up, 933 deaths, 327 CVD deaths, 582 CVD events, and 307 CHD events occurred. Men in the highest compared with the lowest EDI quartile had significantly lower risks of all-cause mortality (HR: 0.75; 95% CI: 0.60, 0.94; P-trend = 0.03), CVD mortality (HR: 0.63; 95% CI: 0.42, 0.94; P-trend = 0.03), and CHD events (HR: 0.66; 95% CI: 0.45, 0.97; P-trend = 0.05) but not CVD events (HR: 0.79; 95% CI: 0.60, 1.05; P-trend = 0.16) after adjustment for sociodemographic, behavioral, and cardiovascular risk factors. The HDI was not significantly associated with any of the outcomes. The EDI appears to be more useful than the HDI for assessing diet quality in relation to CVD and morality risk in older men. Encouraging older adults to adhere to the guidelines inherent in the EDI criteria may have public health benefits.

  12. Higher diet quality is associated with decreased risk of all-cause, cardiovascular disease, and cancer mortality among older adults.

    PubMed

    Reedy, Jill; Krebs-Smith, Susan M; Miller, Paige E; Liese, Angela D; Kahle, Lisa L; Park, Yikyung; Subar, Amy F

    2014-06-01

    Increased attention in dietary research and guidance has been focused on dietary patterns, rather than on single nutrients or food groups, because dietary components are consumed in combination and correlated with one another. However, the collective body of research on the topic has been hampered by the lack of consistency in methods used. We examined the relationships between 4 indices--the Healthy Eating Index-2010 (HEI-2010), the Alternative Healthy Eating Index-2010 (AHEI-2010), the alternate Mediterranean Diet (aMED), and Dietary Approaches to Stop Hypertension (DASH)--and all-cause, cardiovascular disease (CVD), and cancer mortality in the NIH-AARP Diet and Health Study (n = 492,823). Data from a 124-item food-frequency questionnaire were used to calculate scores; adjusted HRs and 95% CIs were estimated. We documented 86,419 deaths, including 23,502 CVD- and 29,415 cancer-specific deaths, during 15 y of follow-up. Higher index scores were associated with a 12-28% decreased risk of all-cause, CVD, and cancer mortality. Specifically, comparing the highest with the lowest quintile scores, adjusted HRs for all-cause mortality for men were as follows: HEI-2010 HR: 0.78 (95% CI: 0.76, 0.80), AHEI-2010 HR: 0.76 (95% CI: 0.74, 0.78), aMED HR: 0.77 (95% CI: 0.75, 0.79), and DASH HR: 0.83 (95% CI: 0.80, 0.85); for women, these were HEI-2010 HR: 0.77 (95% CI: 0.74, 0.80), AHEI-2010 HR: 0.76 (95% CI: 0.74, 0.79), aMED HR: 0.76 (95% CI: 0.73, 0.79), and DASH HR: 0.78 (95% CI: 0.75, 0.81). Similarly, high adherence on each index was protective for CVD and cancer mortality examined separately. These findings indicate that multiple scores reflect core tenets of a healthy diet that may lower the risk of mortality outcomes, including federal guidance as operationalized in the HEI-2010, Harvard's Healthy Eating Plate as captured in the AHEI-2010, a Mediterranean diet as adapted in an Americanized aMED, and the DASH Eating Plan as included in the DASH score.

  13. All-Cause and Cause-Specific Risk of Emergency Transport Attributable to Temperature: A Nationwide Study.

    PubMed

    Onozuka, Daisuke; Hagihara, Akihito

    2015-12-01

    Although several studies have estimated the associations between mortality or morbidity and extreme temperatures in terms of relative risk, few studies have investigated the risk of emergency transport attributable to the whole temperature range nationwide.We acquired data on daily emergency ambulance dispatches in all 47 prefectures of Japan from 2007 to 2010. We examined the relationship between emergency transport and temperature for each prefecture using a Poisson regression model in a distributed lag nonlinear model with adjustment for time trends. A random-effect multivariate meta-analysis was then applied to pool the estimates at the national level. Attributable morbidity was calculated for high and low temperatures, which were defined as those above or below the optimum temperature (ie, the minimum morbidity temperature) and for moderate and also extreme temperatures, which were defined using cutoffs at the 2.5th and 97.5th temperature percentiles.A total of 15,868,086 cases of emergency transport met the inclusion criteria. The emergency transport was attributable to nonoptimal temperature. The median minimum morbidity percentile was in the 79th percentile for all causes, the 96th percentile for cardiovascular disease, and the 92th percentile for respiratory disease. The fraction attributable to low temperature was 6.94% (95% eCI: 5.93-7.70) for all causes, 17.93% (95% eCI: 16.10-19.25) for cardiovascular disease, and 12.19% (95% eCI: 9.90-13.66) for respiratory disease, whereas the fraction attributable to high temperature was small (all causes = 1.01%, 95% eCI: 0.90-1.11; cardiovascular disease = 0.10%, 95% eCI: 0.04-0.14; respiratory disease = 0.29%, 95% eCI: 0.07-0.50). The all-cause morbidity risk that was attributable to temperature was related to moderate cold, with an overall estimate of 6.41% (95% eCI: 5.47-7.20). Extreme temperatures were responsible for a small fraction, which corresponded to 0.57% (95% eCI: 0.50-0.62) for extreme

  14. A systematic review and meta-analysis of nut consumption and incident risk of CVD and all-cause mortality.

    PubMed

    Mayhew, Alexandra J; de Souza, Russell J; Meyre, David; Anand, Sonia S; Mente, Andrew

    2016-01-28

    Dietary patterns containing nuts are associated with a lower risk of CVD mortality, and increased nut consumption has been shown to have beneficial effects on CVD risk factors including serum lipid levels. Recent studies have reported on the relationship between nut intake and CVD outcomes and mortality. Our objective was to systematically review the literature and quantify associations between nut consumption and CVD outcomes and all-cause mortality. Five electronic databases (through July 2015), previous reviews and bibliographies of qualifying articles were searched. In the twenty included prospective cohort studies (n 467 389), nut consumption was significantly associated with a lower risk of all-cause mortality (ten studies; risk ratio (RR) 0·81; 95 % CI 0·77, 0·85 for highest v. lowest quantile of intake, P het=0·04, I 2=43 %), CVD mortality (five studies; RR 0·73; 95 % CI 0·68, 0·78; P het=0·31, I 2=16 %), all CHD (three studies; RR 0·66; 95 % CI 0·48, 0·91; P het=0·0002, I 2=88 %) and CHD mortality (seven studies; RR 0·70; 95 % CI 0·64, 0·76; P het=0·65, I 2=0 %), as well as a statistically non-significant reduction in the risk of non-fatal CHD (three studies; RR 0·71; 95 % CI 0·49, 1·03; P het=0·03, I 2=72 %) and stroke mortality (three studies; RR 0·83; 95 % CI 0·69, 1·00; P het=0·54, I 2=0 %). No evidence of association was found for total stroke (two studies; RR 1·05; 95 % CI 0·69, 1·61; P het=0·04, I 2=77 %). Data on total CVD and sudden cardiac death were available from one cohort study, and they were significantly inversely associated with nut consumption. In conclusion, we found that higher nut consumption is associated with a lower risk of all-cause mortality, total CVD, CVD mortality, total CHD, CHD mortality and sudden cardiac death.

  15. Association between Rainfall and Pediatric Emergency Department Visits for Acute Gastrointestinal Illness

    PubMed Central

    Drayna, Patrick; McLellan, Sandra L.; Simpson, Pippa; Li, Shun-Hwa; Gorelick, Marc H.

    2010-01-01

    Background Microbial water contamination after periods of heavy rainfall is well described, but its link to acute gastrointestinal illness (AGI) in children is not well known. Objectives We hypothesize an association between rainfall and pediatric emergency department (ED) visits for AGI that may represent an unrecognized, endemic burden of pediatric disease in a major U.S. metropolitan area served by municipal drinking water systems. Methods We conducted a retrospective time series analysis of visits to the Children’s Hospital of Wisconsin ED in Wauwatosa, Wisconsin. Daily visit totals of discharge International Classification of Diseases, 9th Revision codes of gastroenteritis or diarrhea were collected along with daily rainfall totals during the study period from 2002 to 2007. We used an autoregressive moving average model, adjusting for confounding variables such as sewage release events and season, to look for an association between daily visits and rainfall after a lag of 1–7 days. Results A total of 17,357 AGI visits were identified (mean daily total, 7.9; range, 0–56). Any rainfall 4 days prior was significantly associated with an 11% increase in AGI visits. Expected seasonal effects were also seen, with increased AGI visits in winter months. Conclusions We observed a significant association between rainfall and pediatric ED visits for AGI, suggesting a waterborne component of disease transmission in this population. The observed increase in ED visits for AGI occurred in the absence of any disease outbreaks reported to public health officials in our region, suggesting that rainfall-associated illness may be underestimated. Further study is warranted to better address this association. PMID:20515725

  16. Epidemiology of Injury-Related Emergency Department Visits in the US among Youth with Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Kalb, Luther G.; Vasa, Roma A; Ballard, Elizabeth D.; Woods, Steven; Goldstein, Mitchell; Wilcox, Holly C.

    2016-01-01

    Several reports suggest children with autism spectrum disorder (ASD) are more likely to be seen for injury-related ED visits; however, no nationally representative study has examined this question. Using data from the 2008 Nationwide Emergency Department Sample, over a quarter of all visits among those with ASD were related to injury. In the…

  17. The impact of a series of hurricanes on the visits to two central Florida Emergency Departments.

    PubMed

    Platz, Elke; Cooper, Herbert P; Silvestri, Salvatore; Siebert, Carl F

    2007-07-01

    We analyzed the impact of three consecutive hurricanes in 2004 on two central Florida Emergency Department (ED) patient volumes and types of presentations. Data were extracted from the hospital database and compared to the previous year. At both EDs visits dropped significantly on the day of all three hurricanes compared to 2003. The decrease in patient volume was even greater during the second and third hurricane compared to the first one. Once weather conditions improved, a dramatic rise in patient census was noted. During the aftermath of the first hurricane a significantly higher number of patients with injuries and carbon monoxide (CO) intoxications was seen, as well as ED visits due to lack of oxygen, electricity or hemodialysis. During the aftermath of a hurricane, EDs should be staffed and equipped to treat greater numbers of patients with acute injuries.

  18. Socio-economic inequalities in all-cause mortality in Europe: an exploration of the role of heightened social mobility.

    PubMed

    Simons, Audrey M W; Groffen, Daniëlle A I; Bosma, Hans

    2013-12-01

    The larger than expected socio-economic inequalities in health in more egalitarian countries might be explained by a heightened social mobility in these countries. Therefore, the aim of this explorative study was to examine the associations between country-level social mobility, income inequality and socio-economic differences in all-cause mortality, using country-level secondary data from 12 European countries. Both income equality and social mobility were found to be associated with larger socio-economic differences in mortality, particularly in women. These findings suggest that social mobility and income equality, beside their shiny side of improving population health, might have a shady side of increasing socio-economic health inequalities.

  19. The effect of atmospheric thermal conditions and urban thermal pollution on all-cause and cardiovascular mortality in Bangladesh.

    PubMed

    Burkart, Katrin; Schneider, Alexandra; Breitner, Susanne; Khan, Mobarak Hossain; Krämer, Alexander; Endlicher, Wilfried

    2011-01-01

    This study assessed the effect of temperature and thermal atmospheric conditions on all-cause and cardiovascular mortality in Bangladesh. In particular, differences in the response to elevated temperatures between urban and rural areas were investigated. Generalized additive models (GAMs) for daily death counts, adjusted for trend, season, day of the month and age were separately fitted for urban and rural areas. Breakpoint models were applied for determining the increase in mortality above and below a threshold (equivalent) temperature. Generally, a 'V'-shaped (equivalent) temperature-mortality curve with increasing mortality at low and high temperatures was observed. Particularly, urban areas suffered from heat-related mortality with a steep increase above a specific threshold. This adverse heat effect may well increase with ongoing urbanization and the intensification of the urban heat island due to the densification of building structures. Moreover, rising temperatures due to climate change could aggravate thermal stress.

  20. High Blood Pressure and All-Cause and Cardiovascular Disease Mortalities in Community-Dwelling Older Adults.

    PubMed

    Wu, Chen-Yi; Hu, Hsiao-Yun; Chou, Yiing-Jenq; Huang, Nicole; Chou, Yi-Chang; Li, Chung-Pin

    2015-11-01

    Although hypertension is common among older adults, the optimal blood pressure (BP) for survival in older adults remains unclear. We attempt to use a large cohort to assess the relationship between BP and mortality and to gain insight into what level of BP is required for optimal survival in older adults.A total of 77,389 community-dwelling adults, aged ≥65 years, were followed between 2006 and 2010. Mortality was determined using matching cohort identifications with national death files. Cox proportional hazards regression models were used to evaluate the relationship of BP with all-cause, cardiovascular disease (CVD), and expanded-CVD mortalities.The mortality risks of the stage 2-3 hypertension group were substantial (all-cause mortality: hazard ratio [HR]: 1.23; 95% confidence interval [CI]: 1.10-1.37; CVDs mortality: HR: 1.31; 95% CI: 1.05-1.64; expanded-CVDs mortality: HR: 1.40; 95% CI: 1.15-1.71). The cardiovascular and expanded-cardiovascular mortality risks were lowest when systolic blood pressures were 120 to 129 mm Hg, and increased significantly when systolic blood pressures (SBPs) were ≥160 mm Hg or diastolic BPs were ≥90 mm Hg. A J-curve phenomenon for SBP on CVD and expanded-CVD mortality was observed. The impacts of stage 2-3 hypertension on mortality risks were significantly increased among women. The mortality risks of hypertension were not attenuated with older age.This study provides insight for identifying the optimal BP for survival in older adults, and extends the knowledge of the impacts of hypertension on mortality risks among women and the older adults.

  1. [Indirect, population effect of mass pneumococcal vaccinations (PCV7) on all-cause pneumonia incidence in Kielce, Poland].

    PubMed

    Patrzałek, Marian; Albrecht, Piotr; Sobczyński, Maciej

    2011-01-01

    In these article they made analysis of indirect, population effects of mass, free of charge, pneumococcal vaccinations (PCV7) on all-cause pneumonia incidence in Kielce, Poland. The strongest and significant fall (p=0.00079) in all-cause pneumonia incidence in the analyzed period 2005-2009 compared with remaining groups were observed in the group of children under 2 of years of life. He amounted to the 74% (around 25/1000 in 2005; 6/1000 in 2009). In the entire ancient group 0-29, embracing children under 2 yrs of life the fall of pneumonia incidence rate amounted to the 48% (from 2.8/1000 in 2005; 1.5/1000 in 2009). In the age 65+ group the fall in the incidence amounted to the 45% (19/1000 in 2005; <11/1000 in 2009 r.). At the moment they didn't observe, of such a fall in age groups 30-49 yrs and 50-64 yrs. Presented results are pointing population effectiveness of applied in Kielce mass vaccination in a 2+1 scheme. Analyzing only pneumonia requiring the hospitalization they tried at work to estimate, in the definitely simplified way, financial effects of mass pneumococcal vaccination in Kielce. Analysis showed at children up to 2 yrs frugalities of the row of the 174,420 zloty annually. In the group above 1 year of life analogous analysis showed frugalities of row 789,480 zloty. Results presented by us should, in our opinion, to induce decision-makers for free of charge mass pneumococcal vaccinations to entire Poland.

  2. Body mass index before and after breast cancer diagnosis: Associations with all-cause, breast cancer, and cardiovascular disease mortality

    PubMed Central

    Nichols, Hazel B.; Trentham-Dietz, Amy; Egan, Kathleen M.; Titus-Ernstoff, Linda; Holmes, Michelle D.; Bersch, Andrew J.; Holick, Crystal N.; Hampton, John M.; Stampfer, Meir J.; Willett, Walter C.; Newcomb, Polly A.

    2009-01-01

    Background Factors related to improving outcomes in breast cancer survivors are of increasing public health significance. We examined post-diagnosis weight change in relation to mortality risk in a cohort of breast cancer survivors. Methods We analyzed data from a cohort of 3,993 women aged 20−79 living in New Hampshire, Massachusetts or Wisconsin with invasive, nonmetastatic breast cancers diagnosed in 1988−1999 identified through state registries. Participants completed a structured telephone interview 1−2 years after diagnosis and returned a mailed follow-up questionnaire in 1998−2001 that addressed post-diagnosis weight and other factors. Vital status information was obtained from the National Death Index through December 2005. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated from Cox proportional hazards models and adjusted for pre-diagnosis weight, age, stage, smoking, physical activity and other important covariates. Results During an average 6.3 years of follow-up from the post-diagnosis questionnaire, we identified 421 total deaths, including 121 deaths from breast cancer and 95 deaths from cardiovascular disease. Increasing post-diagnosis weight gain and weight loss were each associated with greater all-cause mortality. Among women who gained weight after breast cancer diagnosis, each 5 kg gain was associated with a 12% increase in all-cause mortality (p=0.004), a 13% increase in breast cancer-specific mortality (p=0.01), and a 19% increase in cardiovascular disease mortality (p=0.04). Associations with breast cancer mortality were not modified by pre-diagnosis menopausal status, cigarette smoking, or body mass index. Conclusion These findings suggest that efforts to minimize weight gain after a breast cancer diagnosis may improve survival. PMID:19366908

  3. Fruit and vegetable consumption and all-cause, cancer and CVD mortality: analysis of Health Survey for England data

    PubMed Central

    Oyebode, Oyinlola; Gordon-Dseagu, Vanessa; Walker, Alice; Mindell, Jennifer S

    2014-01-01

    Background Governments worldwide recommend daily consumption of fruit and vegetables. We examine whether this benefits health in the general population of England. Methods Cox regression was used to estimate HRs and 95% CI for an association between fruit and vegetable consumption and all-cause, cancer and cardiovascular mortality, adjusting for age, sex, social class, education, BMI, alcohol consumption and physical activity, in 65 226 participants aged 35+ years in the 2001–2008 Health Surveys for England, annual surveys of nationally representative random samples of the non-institutionalised population of England linked to mortality data (median follow-up: 7.7 years). Results Fruit and vegetable consumption was associated with decreased all-cause mortality (adjusted HR for 7+ portions 0.67 (95% CI 0.58 to 0.78), reference category <1 portion). This association was more pronounced when excluding deaths within a year of baseline (0.58 (0.46 to 0.71)). Fruit and vegetable consumption was associated with reduced cancer (0.75 (0.59–0.96)) and cardiovascular mortality (0.69 (0.53 to 0.88)). Vegetables may have a stronger association with mortality than fruit (HR for 2 to 3 portions 0.81 (0.73 to 0.89) and 0.90 (0.82 to 0.98), respectively). Consumption of vegetables (0.85 (0.81 to 0.89) per portion) or salad (0.87 (0.82 to 0.92) per portion) were most protective, while frozen/canned fruit consumption was apparently associated with increased mortality (1.17 (1.07 to 1.28) per portion). Conclusions A robust inverse association exists between fruit and vegetable consumption and mortality, with benefits seen in up to 7+ portions daily. Further investigations into the effects of different types of fruit and vegetables are warranted. PMID:24687909

  4. All-Cause and Cause-Specific Mortality among Users of Basal Insulins NPH, Detemir, and Glargine

    PubMed Central

    Strandberg, Timo E.; Christopher, Solomon; Haukka, Jari; Korhonen, Pasi

    2016-01-01

    Background Insulin therapy in type 2 diabetes may increase mortality and cancer incidence, but the impact of different types of basal insulins on these endpoints is unclear. Compared to the traditional NPH insulin, the newer, longer-acting insulin analogues detemir and glargine have shown benefits in randomized controlled trials. Whether these advantages translate into lower mortality among users in real life is unknown. Objective To estimate the differences in all-cause and cause-specific mortality rates between new users of basal insulins in a population-based study in Finland. Methods 23 751 individuals aged ≥40 with type 2 diabetes, who initiated basal insulin therapy in 2006–2009 were identified from national registers, with comprehensive data for mortality, causes of death, and background variables. Propensity score matching was performed on characteristics. Follow-up time was up to 4 years (median 1.7 years). Results 2078 deaths incurred. With NPH as reference, the adjusted HRs for all-cause mortality were 0.39 (95% CI, 0.30–0.50) for detemir, and 0.55 (95% CI, 0.44–0.69) for glargine. As compared to glargine, the HR was 0.71 (95% CI, 0.54–0.93) among detemir users. Compared to NPH, the mortality risk for both cardiovascular causes as well as cancer were also significantly lower for glargine, and especially for detemir in adjusted analysis. Furthermore, the results were robust in various sensitivity analyses. Conclusion In real clinical practice, mortality was substantially higher among users of NPH insulin as compared to insulins detemir or glargine. Considering the large number of patients who require insulin therapy, this difference in risk may have major clinical and public health implications. Due to limitations of the observational study design, further investigation using an interventional study design is warranted. PMID:27031113

  5. High Blood Pressure and All-Cause and Cardiovascular Disease Mortalities in Community-Dwelling Older Adults

    PubMed Central

    Wu, Chen-Yi; Hu, Hsiao-Yun; Chou, Yiing-Jenq; Huang, Nicole; Chou, Yi-Chang; Li, Chung-Pin

    2015-01-01

    Abstract Although hypertension is common among older adults, the optimal blood pressure (BP) for survival in older adults remains unclear. We attempt to use a large cohort to assess the relationship between BP and mortality and to gain insight into what level of BP is required for optimal survival in older adults. A total of 77,389 community-dwelling adults, aged ≥65 years, were followed between 2006 and 2010. Mortality was determined using matching cohort identifications with national death files. Cox proportional hazards regression models were used to evaluate the relationship of BP with all-cause, cardiovascular disease (CVD), and expanded-CVD mortalities. The mortality risks of the stage 2–3 hypertension group were substantial (all-cause mortality: hazard ratio [HR]: 1.23; 95% confidence interval [CI]: 1.10–1.37; CVDs mortality: HR: 1.31; 95% CI: 1.05–1.64; expanded-CVDs mortality: HR: 1.40; 95% CI: 1.15–1.71). The cardiovascular and expanded-cardiovascular mortality risks were lowest when systolic blood pressures were 120 to 129 mm Hg, and increased significantly when systolic blood pressures (SBPs) were ≥160 mm Hg or diastolic BPs were ≥90 mm Hg. A J-curve phenomenon for SBP on CVD and expanded-CVD mortality was observed. The impacts of stage 2–3 hypertension on mortality risks were significantly increased among women. The mortality risks of hypertension were not attenuated with older age. This study provides insight for identifying the optimal BP for survival in older adults, and extends the knowledge of the impacts of hypertension on mortality risks among women and the older adults. PMID:26632749

  6. Alcohol Use as Risk Factors for Older Adults’ Emergency Department Visits: A Latent Class Analysis

    PubMed Central

    Choi, Namkee G.; Marti, C. Nate Nathan; DiNitto, Diana M.; Choi, Bryan Y.

    2015-01-01

    Introduction Late middle-aged and older adults’ share of emergency department (ED) visits is increasing more than other age groups. ED visits by individuals with substance-related problems are also increasing. This paper was intended to identify subgroups of individuals aged 50+ by their risk for ED visits by examining their health/mental health status and alcohol use patterns. Methods Data came from the 2013 National Health Interview Survey’s Sample Adult file (n=15,713). Following descriptive analysis of sample characteristics by alcohol use patterns, latent class analysis (LCA) modeling was fit using alcohol use pattern (lifetime abstainers, ex-drinkers, current infrequent/light/moderate drinkers, and current heavy drinkers), chronic health and mental health status, and past-year ED visits as indicators. Results LCA identified a four-class model. All members of Class 1 (35% of the sample; lowest-risk group) were infrequent/light/moderate drinkers and exhibited the lowest probabilities of chronic health/mental health problems; Class 2 (21%; low-risk group) consisted entirely of lifetime abstainers and, despite being the oldest group, exhibited low probabilities of health/mental health problems; Class 3 (37%; moderate-risk group) was evenly divided between ex-drinkers and heavy drinkers; and Class 4 (7%; high-risk group) included all four groups of drinkers but more ex-drinkers. In addition, Class 4 had the highest probabilities of chronic health/mental problems, unhealthy behaviors, and repeat ED visits, with the highest proportion of Blacks and the lowest proportions of college graduates and employed persons, indicating significant roles of these risk factors. Conclusion Alcohol nonuse/use (and quantity of use) and chronic health conditions are significant contributors to varying levels of ED visit risk. Clinicians need to help heavy-drinking older adults reduce unhealthy alcohol consumption and help both heavy drinkers and ex-drinkers improve chronic

  7. The air quality health index and emergency department visits for urticaria in Windsor, Canada.

    PubMed

    Kousha, Termeh; Valacchi, Giuseppe

    2015-01-01

    Ambient air pollution exposure has been associated with several health conditions, limited not only to respiratory and cardiovascular systems but also to cutaneous tissues. However, few epidemiological studies examined pollution exposure on skin problems. Basically, the common mechanism by which pollution may affect skin physiology is by induction of oxidative stress and inflammation. Urticaria is among the skin pathologies that have been associated with pollution. Based on the combined effects of three ambient air pollutants, ozone (O₃), nitrogen dioxide (NO₂), and fine particulate matter (PM) with a median aerodynamic diameter of less than 2.5 μm (PM(2.5)), on mortality, the Air Quality Health Index (AQHI) in Canada was developed. The aim of this study was to examine the associations of short-term changes in AQHI with emergency department (ED) visits for urticaria in Windsor-area hospitals in Canada. Diagnosed ED visits were retrieved from the National Ambulatory Care Reporting System (NACRS). A time-stratified case-crossover design was applied to 2905 ED visits (males = 1215; females = 1690) for urticaria from April 2004 through December 2010. Odds ratios (OR) and their corresponding 95% confidence intervals (95%CI) for ED visits associated with increase by one unit of risk index were calculated employing conditional logistic regression. Positive and significant results were observed between AQHI levels and OR for ED visits for urticaria in Windsor for lags 2 and 3 days. A distributed lag nonlinear model technique was applied to daily counts of ED visits for lags 0 to 10 and significant results were obtained from lag 2 to lag 5 and for lag 9. These findings demonstrated associations between ambient air pollution and urticarial confirming that air pollution affects skin conditions.

  8. The air quality health index and emergency department visits for urticaria in Windsor, Canada.

    PubMed

    Kousha, Termeh; Valacchi, Giuseppe

    2015-01-01

    Ambient air pollution exposure has been associated with several health conditions, limited not only to respiratory and cardiovascular systems but also to cutaneous tissues. However, few epidemiological studies examined pollution exposure on skin problems. Basically, the common mechanism by which pollution may affect skin physiology is by induction of oxidative stress and inflammation. Urticaria is among the skin pathologies that have been associated with pollution. Based on the combined effects of three ambient air pollutants, ozone (O₃), nitrogen dioxide (NO₂), and fine particulate matter (PM) with a median aerodynamic diameter of less than 2.5 μm (PM(2.5)), on mortality, the Air Quality Health Index (AQHI) in Canada was developed. The aim of this study was to examine the associations of short-term changes in AQHI with emergency department (ED) visits for urticaria in Windsor-area hospitals in Canada. Diagnosed ED visits were retrieved from the National Ambulatory Care Reporting System (NACRS). A time-stratified case-crossover design was applied to 2905 ED visits (males = 1215; females = 1690) for urticaria from April 2004 through December 2010. Odds ratios (OR) and their corresponding 95% confidence intervals (95%CI) for ED visits associated with increase by one unit of risk index were calculated employing conditional logistic regression. Positive and significant results were observed between AQHI levels and OR for ED visits for urticaria in Windsor for lags 2 and 3 days. A distributed lag nonlinear model technique was applied to daily counts of ED visits for lags 0 to 10 and significant results were obtained from lag 2 to lag 5 and for lag 9. These findings demonstrated associations between ambient air pollution and urticarial confirming that air pollution affects skin conditions. PMID:25849769

  9. Emergency department visits for drug poisoning: United States, 2008-2011.

    PubMed

    Albert, Michael; McCaig, Linda F; Uddin, Sayeedha

    2015-04-01

    Poisoning is the leading cause of injury-related mortality in the United States, with more than 40,000 deaths annually. Drugs account for 90% of poisoning deaths, and the number of deaths from drug poisoning has increased substantially in recent years. The emergency department (ED) plays an important role in the treatment of poisoning. This report describes nationally representative data on ED visits for drug poisoning during 2008-2011.

  10. The association of clinical indication for exercise stress testing with all-cause mortality: the FIT Project

    PubMed Central

    Kim, Joonseok; Al-Mallah, Mouaz; Juraschek, Stephen P.; Brawner, Clinton; Keteyian, Steve J.; Nasir, Khurram; Dardari, Zeina A.; Blumenthal, Roger S.

    2016-01-01

    Introduction We hypothesized that the indication for stress testing provided by the referring physician would be an independent predictor of all-cause mortality. Material and methods We studied 48,914 patients from The Henry Ford Exercise Testing Project (The FIT Project) without known congestive heart failure who were referred for a clinical treadmill stress test and followed for 11 ±4.7 years. The reason for stress test referral was abstracted from the clinical test order, and should be considered the primary concerning symptom or indication as stated by the ordering clinician. Hierarchical multivariable Cox proportional hazards regression was performed, after controlling for potential confounders including demographics, risk factors, and medication use as well as additional adjustment for exercise capacity in the final model. Results A total of 67% of the patients were referred for chest pain, 12% for shortness of breath (SOB), 4% for palpitations, 3% for pre-operative evaluation, 6% for abnormal prior testing, and 7% for risk factors only. There were 6,211 total deaths during follow-up. Compared to chest pain, those referred for palpitations (HR = 0.72, 95% CI: 0.60–0.86) and risk factors only (HR = 0.72, 95% CI: 0.63–0.82) had a lower risk of all-cause mortality, whereas those referred for SOB (HR = 1.15, 95% CI: 1.07–1.23) and pre-operative evaluation (HR = 2.11, 95% CI: 1.94–2.30) had an increased risk. In subgroup analysis, referral for palpitations was protective only in those without coronary artery disease (CAD) (HR = 0.75, 95% CI: 0.62–0.90), while SOB increased mortality risk only in those with established CAD (HR = 1.25, 95% CI: 1.10–1.44). Conclusions The indication for stress testing is an independent predictor of mortality, showing an interaction with CAD status. Importantly, SOB may be associated with higher mortality risk than chest pain, particularly in patients with CAD. PMID:27186173

  11. Objectively Measured Daily Steps and Subsequent Long Term All-Cause Mortality: The Tasped Prospective Cohort Study

    PubMed Central

    Dwyer, Terence; Pezic, Angela; Sun, Cong; Cochrane, Jenny; Venn, Alison; Srikanth, Velandai; Jones, Graeme; Shook, Robin; Sui, Xuemei; Ortaglia, Andrew; Blair, Steven; Ponsonby, Anne-Louise

    2015-01-01

    Background Self–reported physical activity has been inversely associated with mortality but the effect of objectively measured step activity on mortality has never been evaluated. The objective is to determine the prospective association of daily step activity on mortality among free-living adults. Methods and Findings Cohort study of free-living adults residing in Tasmania, Australia between 2000 and 2005 who participated in one of three cohort studies (n = 2 576 total participants). Daily step activity by pedometer at baseline at a mean of 58.8 years of age, and for a subset, repeated monitoring was available 3.7 (SD 1.3) years later (n = 1 679). All-cause mortality (n = 219 deaths) was ascertained by record-linkage to the Australian National Death Index; 90% of participants were followed-up over ten years, until June 2011. Higher daily step count at baseline was linearly associated with lower all-cause mortality (adjusted hazard ratio AHR, 0.94; 95% CI, 0.90 to 0.98 per 1 000 steps; P = 0.004). Risk was altered little by removing deaths occurring in the first two years. Increasing baseline daily steps from sedentary to 10 000 steps a day was associated with a 46% (95% CI, 18% to 65%; P = 0.004) lower risk of mortality in the decade of follow-up. In addition, those who increased their daily steps over the monitoring period had a substantial reduction in mortality risk, after adjusting for baseline daily step count (AHR, 0.39; 95% CI, 0.22 to 0.72; P = 0.002), or other factors (AHR, 0.38; 95% CI, 0.21–0.70; P = 0.002). Conclusions Higher daily step count was linearly associated with subsequent long term mortality among free living adults. These data are the first to quantify mortality reductions using an objective measure of physical activity in a free living population. They strongly underscore the importance of physical inactivity as a major public health problem. PMID:26536618

  12. Change of Nutritional Status Assessed Using Subjective Global Assessment Is Associated With All-Cause Mortality in Incident Dialysis Patients

    PubMed Central

    Kwon, Young Eun; Kee, Youn Kyung; Yoon, Chang-Yun; Han, In Mee; Han, Seung Gyu; Park, Kyoung Sook; Lee, Mi Jung; Park, Jung Tak; Han, Seung H.; Yoo, Tae-Hyun; Kim, Yong-Lim; Kim, Yon Su; Yang, Chul Woo; Kim, Nam-Ho; Kang, Shin-Wook

    2016-01-01

    Abstract Subjective global assessment (SGA) is associated with mortality in end-stage renal disease (ESRD) patients. However, little is known whether improvement or deterioration of nutritional status after dialysis initiation influences the clinical outcome. We aimed to elucidate the association between changes in nutritional status determined by SGA during the first year of dialysis and all-cause mortality in incident ESRD patients. This was a multicenter, prospective cohort study. Incident dialysis patients with available SGA data at both baseline and 12 months after dialysis commencement (n = 914) were analyzed. Nutritional status was defined as well nourished (WN, SGA A) or malnourished (MN, SGA B or C). The patients were divided into 4 groups according to the change in nutritional status between baseline and 12 months after dialysis commencement: group 1, WN to WN; group 2, MN to WN; group 3, WN to MN; and group 4, MN to MN. Cox proportional hazard analysis was performed to clarify the association between changes in nutritional status and mortality. Being in the MN group at 12 months after dialysis initiation, but not at baseline, was a significant risk factor for mortality. There was a significant difference in the 3-year survival rates among the groups (group 1, 92.2%; group 2, 86.0%; group 3, 78.2%; and group 4, 63.5%; log-rank test, P < 0.001). Multivariate Cox regression analysis revealed that the mortality risk was significantly higher in group 3 than in group 1 (hazard ratio [HR] 2.77, 95% confidence interval [CI] 1.27–6.03, P = 0.01) whereas the mortality risk was significantly lower in group 2 compared with group 4 (HR 0.35, 95% CI 0.17–0.71, P < 0.01) even after adjustment for confounding factors. Moreover, mortality risk of group 3 was significantly higher than in group 2 (HR 2.89, 95% CI 1.22–6.81, P = 0.02); there was no significant difference between groups 1 and 2. The changes in nutritional status assessed by SGA

  13. Change of Nutritional Status Assessed Using Subjective Global Assessment Is Associated With All-Cause Mortality in Incident Dialysis Patients.

    PubMed

    Kwon, Young Eun; Kee, Youn Kyung; Yoon, Chang-Yun; Han, In Mee; Han, Seung Gyu; Park, Kyoung Sook; Lee, Mi Jung; Park, Jung Tak; Han, Seung H; Yoo, Tae-Hyun; Kim, Yong-Lim; Kim, Yon Su; Yang, Chul Woo; Kim, Nam-Ho; Kang, Shin-Wook

    2016-02-01

    Subjective global assessment (SGA) is associated with mortality in end-stage renal disease (ESRD) patients. However, little is known whether improvement or deterioration of nutritional status after dialysis initiation influences the clinical outcome. We aimed to elucidate the association between changes in nutritional status determined by SGA during the first year of dialysis and all-cause mortality in incident ESRD patients. This was a multicenter, prospective cohort study. Incident dialysis patients with available SGA data at both baseline and 12 months after dialysis commencement (n = 914) were analyzed. Nutritional status was defined as well nourished (WN, SGA A) or malnourished (MN, SGA B or C). The patients were divided into 4 groups according to the change in nutritional status between baseline and 12 months after dialysis commencement: group 1, WN to WN; group 2, MN to WN; group 3, WN to MN; and group 4, MN to MN. Cox proportional hazard analysis was performed to clarify the association between changes in nutritional status and mortality. Being in the MN group at 12 months after dialysis initiation, but not at baseline, was a significant risk factor for mortality. There was a significant difference in the 3-year survival rates among the groups (group 1, 92.2%; group 2, 86.0%; group 3, 78.2%; and group 4, 63.5%; log-rank test, P < 0.001). Multivariate Cox regression analysis revealed that the mortality risk was significantly higher in group 3 than in group 1 (hazard ratio [HR] 2.77, 95% confidence interval [CI] 1.27-6.03, P = 0.01) whereas the mortality risk was significantly lower in group 2 compared with group 4 (HR 0.35, 95% CI 0.17-0.71, P < 0.01) even after adjustment for confounding factors. Moreover, mortality risk of group 3 was significantly higher than in group 2 (HR 2.89, 95% CI 1.22-6.81, P = 0.02); there was no significant difference between groups 1 and 2. The changes in nutritional status assessed by SGA during the first

  14. Independent and joint effects of sedentary time and cardiorespiratory fitness on all-cause mortality: the Cooper Center Longitudinal Study

    PubMed Central

    Shuval, Kerem; Finley, Carrie E; Barlow, Carolyn E; Nguyen, Binh T; Njike, Valentine Y; Pettee Gabriel, Kelley

    2015-01-01

    Objectives To examine the independent and joint effects of sedentary time and cardiorespiratory fitness (fitness) on all-cause mortality. Design, setting, participants A prospective study of 3141 Cooper Center Longitudinal Study participants. Participants provided information on television (TV) viewing and car time in 1982 and completed a maximal exercise test during a 1-year time frame; they were then followed until mortality or through 2010. TV viewing, car time, total sedentary time and fitness were the primary exposures and all-cause mortality was the outcome. The relationship between the exposures and outcome was examined utilising Cox proportional hazard models. Results A total of 581 deaths occurred over a median follow-up period of 28.7 years (SD=4.4). At baseline, participants’ mean age was 45.0 years (SD=9.6), 86.5% were men and their mean body mass index was 24.6 (SD=3.0). Multivariable analyses revealed a significant linear relationship between increased fitness and lower mortality risk, even while adjusting for total sedentary time and covariates (p=0.02). The effects of total sedentary time on increased mortality risk did not quite reach statistical significance once fitness and covariates were adjusted for (p=0.05). When examining this relationship categorically, in comparison to the reference category (≤10 h/week), being sedentary for ≥23 h weekly increased mortality risk by 29% without controlling for fitness (HR=1.29, 95% CI 1.03 to 1.63); however, once fitness and covariates were taken into account this relationship did not reach statistical significance (HR=1.20, 95% CI 0.95 to 1.51). Moreover, spending >10 h in the car weekly significantly increased mortality risk by 27% in the fully adjusted model. The association between TV viewing and mortality was not significant. Conclusions The relationship between total sedentary time and higher mortality risk is less pronounced when fitness is taken into account. Increased car time, but

  15. Losing Life and Livelihood: A Systematic Review and Meta-Analysis of Unemployment and All-Cause Mortality

    PubMed Central

    Roelfs, David J.; Shor, Eran; Davidson, Karina W.; Schwartz, Joseph E.

    2011-01-01

    Unemployment rates in the United States remain near a 25-year high and global unemployment is rising. Previous studies have shown that unemployed persons have an increased risk of death, but the magnitude of the risk and moderating factors have not been explored. The study is a random-effects meta-analysis and meta-regression designed to assess the association between unemployment and all-cause mortality among working-age persons. We extracted 235 mortality risk estimates from 42 studies, providing data on more than 20 million persons. The mean hazard ratio (HR) for mortality was 1.63 among HRs adjusted for age and additional covariates. The mean effect was higher for men than for women. Unemployment was associated with an increased mortality risk for those in their early and middle careers, but less for those in their late-career. The risk of death was highest during the first 10 years of follow up, but decreased subsequently. The mean HR was 24% lower among the subset of studies controlling for health-related behaviors. Public health initiatives could target unemployed persons for more aggressive cardiovascular screening and interventions aimed at reducing risk-taking behaviors. PMID:21330027

  16. Losing life and livelihood: a systematic review and meta-analysis of unemployment and all-cause mortality.

    PubMed

    Roelfs, David J; Shor, Eran; Davidson, Karina W; Schwartz, Joseph E

    2011-03-01

    Unemployment rates in the United States remain near a 25-year high and global unemployment is rising. Previous studies have shown that unemployed persons have an increased risk of death, but the magnitude of the risk and moderating factors have not been explored. The study is a random effects meta-analysis and meta-regression designed to assess the association between unemployment and all-cause mortality among working-age persons. We extracted 235 mortality risk estimates from 42 studies, providing data on more than 20 million persons. The mean hazard ratio (HR) for mortality was 1.63 among HRs adjusted for age and additional covariates. The mean effect was higher for men than for women. Unemployment was associated with an increased mortality risk for those in their early and middle careers, but less for those in their late career. The risk of death was highest during the first 10 years of follow-up, but decreased subsequently. The mean HR was 24% lower among the subset of studies controlling for health-related behaviors. Public health initiatives could target unemployed persons for more aggressive cardiovascular screening and interventions aimed at reducing risk-taking behaviors.

  17. European Regional Differences in All-Cause Mortality and Length of Stay for Patients with Hip Fracture.

    PubMed

    Medin, Emma; Goude, Fanny; Melberg, Hans Olav; Tediosi, Fabrizio; Belicza, Eva; Peltola, Mikko

    2015-12-01

    The objective of this study was to compare healthcare performance for the surgical treatment of hip fractures across and within Finland, Hungary, Italy, the Netherlands, Norway, Scotland, and Sweden. Differences in age-adjusted and sex-adjusted 30-day and one-year all-cause mortality rates following hip fracture, as well as the length of stay of the first hospital episode in acute care and during a follow up of 365 days, were investigated, and associations between selected country-level and regional-level factors with mortality and length of stay were assessed. Hungary showed the highest one-year mortality rate (mean 39.7%) and the lowest length of stay in one year (12.7 days), whereas Italy had the lowest one-year mortality rate (mean 19.1 %) and the highest length of stay (23.3 days). The observed variations were largely explained by country-specific effects rather than by regional-level factors. The results show that there should still be room for efficiency gains in the acute treatment of hip fracture, and clinicians, healthcare managers, and politicians should learn from best practices. This study demonstrates that an international comparison of acute hospital care is possible using pooled individual-level administrative data. PMID:26633868

  18. Differences between immigrants at various durations of residence and host population in all-cause mortality, Canada 1991-2006.

    PubMed

    Omariba, D Walter Rasugu; Ng, Edward; Vissandjée, Bilkis

    2014-01-01

    We used data from the 1991-2006 Canadian Census Mortality and Cancer Follow-up Study to compare all-cause mortality for immigrants with that of the Canadian-born population. The study addressed two related questions. First, do immigrants have a mortality advantage over the Canadian-born? Second, if immigrants have a mortality advantage, does it persist as their duration of residence increases? The analysis fitted sex-stratified hazard regression models for the overall sample and for selected countries of birth (UK, China, India, Philippines, and the Caribbean). Predictors were assessed at baseline. Mortality was lower among immigrants than the Canadian-born even after adjusting for a selected group of socio-demographic and socio-economic factors. The mortality differences persisted even after long residence in Canada, but appeared to be dependent on the age of the individual and the country of origin. Interpreted in light of known explanations of immigrant mortality advantage, the results mostly reflect selection effects.

  19. All-Cause and Cause-Specific Mortality Among Men Released From State Prison, 1980–2005

    PubMed Central

    Rosen, David L.; Wohl, David A.

    2008-01-01

    Objectives. We compared mortality of ex-prisoners and other state residents to identify unmet health care needs among former prisoners. Methods. We linked North Carolina prison records with state death records for 1980 to 2005 to estimate the number of overall and cause-specific deaths among male ex-prisoners aged 20 to 69 years and used standardized mortality ratios (SMRs) to compare these observed deaths with the number of expected deaths had they experienced the same age-, race-, and cause-specific death rates as other state residents. Results. All-cause mortality among White (SMR = 2.08; 95% confidence interval [CI] = 2.04, 2.13) and Black (SMR = 1.03; 95% CI = 1.01, 1.05) ex-prisoners was greater than for other male NC residents. Ex-prisoners' deaths from homicide, accidents, substance use, HIV, liver disease, and liver cancer were greater than the expected number of deaths estimated using death rates among other NC residents. Deaths from cardiovascular disease, lung cancer, respiratory diseases, and diabetes were at least 30% greater than expected for White ex-prisoners, but less than expected for Black ex-prisoners. Conclusions. Ex-prisoners experienced more deaths than would have been expected among other NC residents. Excess deaths from injuries and medical conditions common to prison populations highlight ex-prisoners' medical vulnerability and the need to improve correctional and community preventive health services. PMID:18923131

  20. Estimating the Time-Varying Joint Effects of Obesity and Smoking on All-Cause Mortality Using Marginal Structural Models.

    PubMed

    Banack, Hailey R; Kaufman, Jay S

    2016-01-15

    Obesity and smoking are independently associated with a higher mortality risk, but previous studies have reported conflicting results about the relationship between these 2 time-varying exposures. Using prospective longitudinal data (1987-2007) from the Atherosclerosis Risk in Communities Study, our objective in the present study was to estimate the joint effects of obesity and smoking on all-cause mortality and investigate whether there were additive or multiplicative interactions. We fit a joint marginal structural Poisson model to account for time-varying confounding affected by prior exposure to obesity and smoking. The incidence rate ratios from the joint model were 2.00 (95% confidence interval (CI): 1.79, 2.24) for the effect of smoking on mortality among nonobese persons, 1.31 (95% CI: 1.13, 1.51) for the effect of obesity on mortality among nonsmokers, and 1.97 (95% CI: 1.73, 2.22) for the joint effect of smoking and obesity on mortality. The negative product term from the exponential model revealed a submultiplicative interaction between obesity and smoking (β = -0.28, 95% CI: -0.45, -0.11; P < 0.001). The relative excess risk of interaction was -0.34 (95% CI: -0.60, -0.07), indicating the presence of subadditive interaction. These results provide important information for epidemiologists, clinicians, and public health practitioners about the harmful impact of smoking and obesity.

  1. What Is Ag-Ed?

    ERIC Educational Resources Information Center

    Linley, Judy; Mylne, Lee

    1998-01-01

    Ag-Ed, an agricultural education project for upper elementary students, was held in conjunction with the Toowoomba Show in Queensland, Australia. Agriculture industry representatives provided 20 interactive agricultural presentations for class groups, which were supplemented with a teacher resource-package containing a directory and 13 sections of…

  2. Study: To minimize errors, rely on interpreters when caring for LEP patients in the ED.

    PubMed

    2012-08-01

    A new study strongly suggests that it is important for EDs to rely on professional interpreters, rather than ad hoc interpreters or no interpreters at all, when caring for patients with limited English proficiency (LEP). The researchers examined health care encounters involving LEP patients at two pediatric EDs, and found that the encounters associated with professional interpreters were associated with far fewer errors of potential clinical consequence than the encounters associated with ad hoc interpreters or no interpreters. Experts say the most important first step in minimizing language-based errors is to identify patients with LEP when they present for care. Professional interpreters are defined as having at least 100 hours of training. Researchers say that when evaluating interpreters, professional training is more valuable in terms of minimizing errors than experience on the job. Make sure that interpreters are available to LEP patients throughout the course of their ED visit as well as during any follow-up visits or telephone calls.

  3. Washington state initiative trims Medicaid budget, ED utilization without denying access.

    PubMed

    2014-06-01

    In its first year of operation, Washington state's "ER is for Emergencies" initiative has helped to save the state's Medicaid budget $33.6 million. The initiative, which is based on the implementation of seven best practices, has succeeded in part by improving care coordination and by linking EDs across the state so information can be shared electronically. Leaders of the effort concede that while state pressure was essential in pushing providers to address excess use of the ED for nonemergency needs, they stress that the approach worked because all sides were willing to sit down and hammer out a solution. Further, they note that the infrastructure is now in place to address other problems in a similar fashion. An analysis of claims data shows that in the first year of the initiative, ED visits by Medicaid recipients declined by 9.9%, and the rate of visits by frequent ED utilizers declined by 10.7%. The analysis also shows that ED visits resulting in a scheduled drug prescription fell by 24%, and the rate of visits for a low-acuity diagnosis declined by 14.2%. While many EDs had to adjust their staffing and other resources to accommodate reduced volumes, others experienced few changes or even saw an uptick in volume, possibly from implementation of the Affordable Care Act. Leaders of the effort say the biggest challenge involved with implementing the initiative was securing administrative buy-in for investments that would likely result in improved efficiency and care, but also reduced revenue--at least initially.

  4. Identification of inappropriate medication use in elderly patients with frequent emergency department visits

    PubMed Central

    Wong, Jeffrey; Marr, Patricia; Kwan, Debbie; Meiyappan, Soumia; Adcock, Lesley

    2014-01-01

    Objective: To determine the demographic and health care characteristics of elderly family health team patients who are frequent emergency department (ED) users, focusing on potentially inappropriate medications (PIMs) and access to primary care services. Design: Cross-sectional retrospective chart review. Setting: Academic family medicine clinic in Toronto, Ontario. Participants: A total of 46 elderly patients (age >65 years) with 4 or more visits to a University Health Network–affiliated ED between April 1, 2010, and March 31, 2011. Main outcome measures: Using the validated STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions) criteria, PIMs were identified. The primary objective was to determine whether PIMs were associated with more frequent ED use. The secondary objective was to determine whether patients who had previously undergone a clinic pharmacist-led medication review had fewer PIMs. We also determined the health characteristics of these patients at the time of their last ED visit of the study period. Utilization of primary care resources, both prior to and after ED visits, was determined. Results: Sixty-five percent of patients were taking at least 1 PIM. The total number of PIMs in the study population was 71. Having more PIMs was significantly correlated with a higher number of ED visits (r = 0.32, p < 0.05). Patients with a previous medication review had a similar number of PIMs compared with those without a review. The mean number of concurrent medications was 12.1 and the mean Charlson Comorbidity Index score was 3.7. Significant delay between hospital discharge and primary care follow-up (median 13 days) was observed. Conclusion: Elderly patients who are more frequent ED users have a greater number of PIMs. Primary care resources appear to be underused in this population. PMID:25360151

  5. Late-Life Risk Factors for All-Cause Dementia and Differential Dementia Diagnoses in Women: A Prospective Cohort Study.

    PubMed

    Neergaard, Jesper Skov; Dragsbæk, Katrine; Hansen, Henrik Bo; Henriksen, Kim; Christiansen, Claus; Karsdal, Morten Asser

    2016-03-01

    Since the first evidence of a decline in dementia incidence was reported in 2011, the focus on modifiable risk factors has increased. The possibility of risk factor intervention as a prevention strategy has been widely discussed; however, further evidence in relation to risk factors is still needed. The Prospective Epidemiologic Risk Factor (PERF I) study was an observational prospective study of postmenopausal Danish women who were initially examined between 1999 and 2001 (n = 5855). Follow-up data on diagnosis and survival as of December 31, 2014 was retrieved from the National Danish Patient Registry and the National Danish Causes of Death Registry. Cox proportional hazards regression model was applied to calculate adjusted hazard ratios (HR) for selected risk factors for dementia. Of 5512 eligible subjects, 592 developed dementia within the follow-up period of maximum 15 years. The independent factors associated with increased risk of all-cause dementia were depression (HR = 1.75 [95% CI 1.32-2.34]) and impaired fasting glucose levels. A dose-response relationship was observed between fasting glucose level and risk of dementia with HRs of 1.25 [1.05-1.49] and 1.45 [1.03-2.06] for impaired (5.6-6.9 mmol/L) and hyperglycemic (≥7.0 mmol/L) glucose levels, respectively. The factors associated with a decreased risk of dementia were overweight in late-life (HR = 0.75 [0. 62-0.89]) and physical activity at least once weekly (HR = 0.77 [0.61-0.96]). The identified risk factors for dementia in women in late-life are all considered modifiable. This supports the notion that prevention strategies may improve the poor future prospects for dementias in the ageing population.

  6. A Prospective Longitudinal Cohort to Investigate the Effects of Early Life Giardiasis on Growth and All Cause Diarrhea

    PubMed Central

    Donowitz, Jeffrey R.; Alam, Masud; Kabir, Mamun; Ma, Jennie Z.; Nazib, Forida; Platts-Mills, James A.; Bartelt, Luther A.; Haque, Rashidul; Petri, William A.

    2016-01-01

    Background. Growth stunting in children under 2 years of age in low-income countries is common. Giardia is a ubiquitous pathogen in this age group but studies investigating Giardia's effect on both growth and diarrhea have produced conflicting results. Methods. We conducted a prospective longitudinal birth cohort study in Dhaka, Bangladesh, with monthly Giardia and continuous diarrheal surveillance. Results. 629 children were enrolled within the first 72 hours of life, and 445 completed 2 years of the study. 12% of children were stunted at birth with 57% stunted by 2 years. 7% of children had a Giardia positive surveillance stool in the first 6 months of life, whereas 74% had a positive stool by 2 years. The median time to first Giardia positive surveillance stool was 17 months. Presence of Giardia in a monthly surveillance stool within the first 6 months of life decreased length-for-age Z score at 2 years by 0.4 (95% confidence interval, −.80 to −.001; P value .05) whereas total number of Giardia positive months over the 2-year period of observation did not. Neither variable was associated with weight-for-age Z score at 2 years. In our model to examine predictors of diarrhea only exclusive breastfeeding was significantly associated with decreased diarrhea (P value <.001). Concomitant giardiasis was neither a risk factor nor protective. Conclusions. Early life Giardia was a risk factor for stunting at age 2 but not poor weight gain. Presence of Giardia neither increased nor decreased odds of acute all cause diarrhea. PMID:27313261

  7. Low all-cause mortality despite high cardiovascular risk in elderly Greek-born Australians: attenuating potential of diet?

    PubMed

    Kouris-Blazos, Antigone; Itsiopoulos, Catherine

    2014-01-01

    Elderly Greek-born Australians (GA) consistently show lower rates of all-cause and CVD mortality compared with Australian-born. Paradoxically, however, this is in spite of a higher prevalence of CVD risk factors. This paper reviews the findings from the Food Habits in Later Life (FHILL) study, other studies on Greek migrants to Australia and clinical studies investigating dietary mechanisms which may explain the "morbidity mortality paradox". The FHILL study collected data between 1988 and 1991 on diet, health and psycho-social variables on 818 people aged 70 and over from Sweden, Greece, Australia (Greeks and Anglo-Celts), Japan and were followed up for 5-7 years to determine survival status. The FHILL study was the first to develop a score which captured the key features of a traditional plant-based Mediterranean diet pattern (MDPS). A higher score improved overall survival in both Greek and non-Greek elderly reducing the risk of death by 50% after 5-7 years. Of the 5 cohorts studied, elderly GA had the lowest risk of death, even though they had the highest rates of obesity and other CVD risk factors (developed in the early years of migration with the introduction of energy dense foods). GA appeared to be "getting away" with these CVD risk factors because of their continued adherence in old age to a Mediterranean diet, especially legumes. We propose that the Mediterranean diet may, in part, be operating to reduce the risk of death and attenuate established CVD risk factors in GA by beneficially altering the gut microbiome and its metabolites. PMID:25516310

  8. Racial disparities in all-cause mortality among younger commercially insured women with incident metastatic breast cancer.

    PubMed

    Leopold, Christine; Wagner, Anita K; Zhang, Fang; Lu, Christine Y; Earle, Craig; Nekhlyudov, Larissa; Degnan, Dennis-Ross; Frank Wharam, J

    2016-07-01

    Racial disparities in breast cancer mortality persist and are likely related to multiple factors. Over the past decade, progress has been made in treating metastatic breast cancer, particularly in younger women. Whether disparities exist in this population is unknown. Using administrative claims data between 2000 and 2011 (OptumInsight, Eden Prairie, MN) of members insured through a large national US health insurer, we identified women aged 25-64 years diagnosed with incident metastatic breast cancer diagnosed between November 1, 2000, and December 31, 2008. We examined time from diagnosis to death, with up to 3 years of follow-up. We stratified analyses by geocoded race and socio-economic status, age-at-diagnosis, morbidity score, US region of residence, urban/non-urban, and years of diagnosis. We constructed Kaplan-Meier survival plots and analyzed all-cause mortality using multivariate Cox proportional hazard models. Among 6694 women with incident metastatic breast cancer (78 % Caucasian, 4 % African American, and 18 % other), we found higher mortality rates among women residing in predominantly African American versus Caucasian neighborhoods (hazard ratio (HR) 1.84; 95 % confidence interval, CI 1.39-2.45), women with high versus lower morbidity (HR 1.30 [1.12-1.51]), and women whose incident metastatic diagnosis was during 2000-2004 versus 2005-2008 (HR 1.60 [1.39-1.83]). Caucasian (HR 0.61 [0.52-0.71]) but not African American women (HR not significant) experienced improved mortality in 2005-2008 versus 2000-2004. Despite insured status, African American women and women with multi-morbidity had poorer survival. Only Caucasian women had improved mortality over time. Modifiable risk factors for increased mortality need to be addressed in order to reduce disparities. PMID:27342456

  9. Risk of All-Cause and Prostate Cancer-Specific Mortality After Brachytherapy in Men With Small Prostate Size

    SciTech Connect

    Nguyen, Paul L.; Chen, Ming H.; Choueiri, Toni K.; Hoffman, Karen E.; Hu, Jim C.; Martin, Neil E.; Beard, Clair J.; Dosoretz, Daniel E.; Moran, Brian J.; Katin, Michael J.; Braccioforte, Michelle H.; Ross, Rudi; Salenius, Sharon A.; Kantoff, Philip W.; D'Amico, Anthony V.

    2011-04-01

    Background: Brachytherapy for prostate cancer can be technically challenging in men with small prostates ({<=}20 cc), but it is unknown whether their outcomes are different than those of men with larger prostates. Methods and Materials: We studied 6,416 men treated with brachytherapy in one of 21 community-based practices. Cox regression and Fine and Gray's regression were used to determine whether volume {<=}20 cc was associated with a higher risk of all-cause mortality (ACM) or prostate cancer-specific mortality (PCSM), respectively, after adjustment for other known prognostic factors. Results: 443 patients (6.9%) had a prostate volume {<=}20 cc. After a median follow-up of 2.91 years (interquartile range, 1.06-4.79), volume {<=}20 cc was associated with a significantly higher risk of ACM (adjusted hazard ratio = 1.33 [95% CI 1.08-1.65], p = 0.0085) with 3-year estimates of ACM for {<=}20 cc vs. >20 cc of 13.0% vs. 6.9% (p = 0.028). Only 23 men (0.36%) have died of prostate cancer, and no difference was seen in PCSM by volume (p = 0.4). Conclusion: Men with small prostates at the time of implant had a 33% higher risk of ACM, and the underlying cause of this remains uncertain. No increase in PCSM was observed in men with volume {<=}20cc, suggesting that a small prostate should not in itself be a contraindication for brachytherapy, but inasmuch as absolute rates of PCSM were small, further follow-up will be needed to confirm this finding.

  10. Gender Differences in Emergency Department Visits and Detox Referrals for Illicit and Nonmedical Use of Opioids

    PubMed Central

    Ryoo, Hyeon-Ju; Choo, Esther K.

    2016-01-01

    Introduction Visits to the emergency department (ED) for use of illicit drugs and opioids have increased in the past decade. In the ED, little is known about how gender may play a role in drug-related visits and referrals to treatment. This study performs gender-based comparison analyses of drug-related ED visits nationwide. Methods We performed a cross-sectional analysis with data collected from 2004 to 2011 by the Drug Abuse Warning Network (DAWN). All data were coded to capture major drug categories and opioids. We used logistic regression models to find associations between gender and odds of referral to treatment programs. A second set of models were controlled for patient “seeking detox,” or patient explicitly requesting for detox referral. Results Of the 27.9 million ED visits related to drug use in the DAWN database, visits by men were 2.69 times more likely to involve illicit drugs than visits by women (95% CI [2.56, 2.80]). Men were more likely than women to be referred to detox programs for any illicit drugs (OR 1.12, 95% CI [1.02–1.22]), for each of the major illicit drugs (e.g., cocaine: OR 1.27, 95% CI [1.15–1.40]), and for prescription opioids (OR 1.30, 95% CI [1.17–1.43]). This significant association prevailed after controlling for “seeking detox.” Conclusion Women are less likely to receive referrals to detox programs than men when presenting to the ED regardless of whether they are “seeking detox.” Future research may help determine the cause for this gender-based difference and its significance for healthcare costs and health outcomes. PMID:27330662

  11. Visit a Farm? Surely Not!

    ERIC Educational Resources Information Center

    Graham, Bill

    2012-01-01

    Popular myth has it that visiting a farm can be dangerous, but there are only a few occasions when children have become ill during a school visit to a farm. Simple, sensible precautions, including wearing appropriate clothing, such as trousers and wellington boots (if wet) or sensible shoes, and careful hand-washing, are all that is required. The…

  12. The Virginia Home Visiting Consortium

    ERIC Educational Resources Information Center

    Bodkin, Catherine

    2010-01-01

    The Virginia Home Visiting Consortium (HVC) is a collaboration of public and private organizations which work to improve the effectiveness and efficiency of home visiting services throughout the state. The HVC identified service needs and gaps and has focused on increasing the interagency state and local partnerships so that resources are…

  13. Overview of Deployed EDS Technologies

    SciTech Connect

    Martz, H E; Crawford, C

    2009-09-24

    The term explosive detection system (EDS) is used by the TSA to describe equipment that is certified to detect explosives in checked bags. The EDS, as certified, by the TSL must consist of device for interrogating a bag and an automated detection algorithm (ATD) for evaluating the results of the interrogation. We only consider CT as the interrogation device in this report. A schematic drawing of a CT-based EDS is shown in Figure 2. The output of the ATD is the binary decision of alarm or non-alarm. Alarms may true- or false-positives. Non-alarms may be true- or false-negatives. False positives are also denoted false alarms. The true detection means that the ATD reports an alarm when a threat is present in the scanned bag. The probability of detecting a threat given that a threat is present is denoted the probability of detection (PD). The probability of false alarm (PFA) is the case when an alarm is reported when a threat is not present in a bag. Certification in this context means passing tests for PD and PFA at the TSL. The results of the EDS include CT cross-sectional images of the bag and specifics about the alarmed objects generated by ATD. These results are presented on a display so that a person may override the decision of ATD and declare the alarm to be a non-alarm. This process is denoted clearing. Bags that are not cleared by the person are sent to a secondary inspection process. Here the bags may be opened or assessed with explosive trace detection (ETD) in order to clear the bags. Bags that are not cleared at this point are evaluated by an ordinance disposal team. The CT scanner along with ATD is denoted Level 1 screening. The process of clearing on a display is denoted Level 2 screening. Secondary inspection is denoted Level 3 screening. Vendors of the deployed EDSs supply the TSA with equipment for all three levels. Therefore, the term EDS may include the equipment provided for Levels 1, 2 and 3. A schematic diagram of an EDS and the levels of

  14. Impact of performance grading on annual numbers of acute myocardial infarction-associated emergency department visits in Taiwan

    PubMed Central

    Tzeng, I-Shiang; Liu, Su-Hsun; Chen, Kuan-Fu; Wu, Chin-Chieh; Chen, Jih-Chang

    2016-01-01

    Abstract To reduce patient boarding time at the emergency department (ED) and to improve the overall quality of the emergent care system in Taiwan, the Minister of Health and Welfare of Taiwan (MOHW) piloted the Grading Responsible Hospitals for Acute Care (GRHAC) audit program in 2007–2009. The aim of the study was to evaluate the impact of the GRHAC audit program on the identification and management of acute myocardial infarction (AMI)-associated ED visits by describing and comparing the incidence of AMI-associated ED visits before (2003–2007), during (2007–2009), and after (2009–2012) the initial audit program implementation. Using aggregated data from the MOHW of Taiwan, we estimated the annual incidence of AMI-associated ED visits by Poisson regression models. We used segmented regression techniques to evaluate differences in the annual rates and in the year-to-year changes in AMI-associated ED visits between 2003 and 2012. Medical comorbidities such as diabetes mellitus, hyperlipidemia, and hypertensive disease were considered as potential confounders. Overall, the number of AMI-associated patient visits increased from 8130 visits in 2003 to 12,695 visits in 2012 (P-value for trend < 0.001), corresponding to an average annual growth rate of 5.3% (95%confidence interval [CI]: 0.5–10%). Although age was a major risk factor for AMI-associated ED visits, the statistical association was observed in middle-to-old (aged 40–64; P-value < 0.001) and older aged individuals (aged ≥65; P-value <0.001). As compared to 2003–2007, AMI-associated ED visits increased slightly during the intervention roll-in period (2007–2009, slope = 394.5, P-value = 0.117) followed by a dramatic uptake in the early post-intervention period (2010–2012, slope = 1037, P-value = 0.083). There was evidence suggesting for a significant intervention effect of the GRHAC program on identifying critically ill patients with AMI-associated diagnosis at the ED

  15. Reduction in emergency department visits for children's asthma, ear infections, and respiratory infections after the introduction of state smoke-free legislation.

    PubMed

    Hawkins, Summer Sherburne; Hristakeva, Sylvia; Gottlieb, Mark; Baum, Christopher F

    2016-08-01

    Despite the benefits of smoke-free legislation on adult health, little is known about its impact on children's health. We examined the effects of tobacco control policies on the rate of emergency department (ED) visits for childhood asthma (N=128,807), ear infections (N=288,697), and respiratory infections (N=410,686) using outpatient ED visit data in Massachusetts (2001-2010), New Hampshire (2001-2009), and Vermont (2002-2010). We used negative binomial regression models to analyze the effect of state and local smoke-free legislation on ED visits for each health condition, controlling for cigarette taxes and health care reform legislation. We found no changes in the overall rate of ED visits for asthma, ear infections, and upper respiratory infections after the implementation of state or local smoke-free legislation or cigarette tax increases. However, an interaction with children's age revealed that among 10-17-year-olds state smoke-free legislation was associated with a 12% reduction in ED visits for asthma (adjusted incidence rate ratios (aIRR) 0.88; 95% CI 0.83, 0.95), an 8% reduction for ear infections (0.92; 0.88, 0.97), and a 9% reduction for upper respiratory infections (0.91; 0.87, 0.95). We found an overall 8% reduction in ED visits for lower respiratory infections after the implementation of state smoke-free legislation (0.92; 0.87, 0.96). The implementation of health care reform in Massachusetts was also associated with a 6-9% reduction in all children's ED visits for ear and upper respiratory infections. Our results suggest that state smoke-free legislation and health care reform may be effective interventions to improve children's health by reducing ED visits for asthma, ear infections, and respiratory infections. PMID:27283094

  16. Reduction in emergency department visits for children's asthma, ear infections, and respiratory infections after the introduction of state smoke-free legislation.

    PubMed

    Hawkins, Summer Sherburne; Hristakeva, Sylvia; Gottlieb, Mark; Baum, Christopher F

    2016-08-01

    Despite the benefits of smoke-free legislation on adult health, little is known about its impact on children's health. We examined the effects of tobacco control policies on the rate of emergency department (ED) visits for childhood asthma (N=128,807), ear infections (N=288,697), and respiratory infections (N=410,686) using outpatient ED visit data in Massachusetts (2001-2010), New Hampshire (2001-2009), and Vermont (2002-2010). We used negative binomial regression models to analyze the effect of state and local smoke-free legislation on ED visits for each health condition, controlling for cigarette taxes and health care reform legislation. We found no changes in the overall rate of ED visits for asthma, ear infections, and upper respiratory infections after the implementation of state or local smoke-free legislation or cigarette tax increases. However, an interaction with children's age revealed that among 10-17-year-olds state smoke-free legislation was associated with a 12% reduction in ED visits for asthma (adjusted incidence rate ratios (aIRR) 0.88; 95% CI 0.83, 0.95), an 8% reduction for ear infections (0.92; 0.88, 0.97), and a 9% reduction for upper respiratory infections (0.91; 0.87, 0.95). We found an overall 8% reduction in ED visits for lower respiratory infections after the implementation of state smoke-free legislation (0.92; 0.87, 0.96). The implementation of health care reform in Massachusetts was also associated with a 6-9% reduction in all children's ED visits for ear and upper respiratory infections. Our results suggest that state smoke-free legislation and health care reform may be effective interventions to improve children's health by reducing ED visits for asthma, ear infections, and respiratory infections.

  17. The novel marker LTBP2 predicts all-cause and pulmonary death in patients with acute dyspnoea.

    PubMed

    Breidthardt, Tobias; Vanpoucke, Griet; Potocki, Mihael; Mosimann, Tamina; Ziller, Ronny; Thomas, Gregoire; Laroy, Wouter; Moerman, Piet; Socrates, Thenral; Drexler, Beatrice; Mebazaa, Alexandre; Kas, Koen; Mueller, Christian

    2012-11-01

    The risk stratification in patients presenting with acute dyspnoea remains a challenge. We therefore conducted a prospective, observational cohort study enrolling 292 patients presenting to the emergency department with acute dyspnoea. A proteomic approach for antibody-free targeted protein quantification based on high-end MS was used to measure LTBP2 [latent TGF (transforming growth factor)-binding protein 2] levels. Final diagnosis and death during follow-up were adjudicated blinded to LTBP2 levels. AHF (acute heart failure) was the final diagnosis in 54% of patients. In both AHF (P<0.001) and non-AHF (P=0.015) patients, LTBP2 levels at presentation were significantly higher in non-survivors compared with survivors with differences on median levels being 2.2- and 1.5-fold respectively. When assessing the cause of death, LTBP2 levels were significantly higher in patients dying from pulmonary causes (P=0.0005). Overall, LTBP2 powerfully predicted early pulmonary death {AUC (area under the curve), 0.95 [95% CI (confidence interval), 0.91-0.98]}. In ROC (receiver operating characteristic) curve analyses for the prediction of 1-year mortality LTBP2 achieved an AUC of 0.77 (95% CI, 0.71-0.84); comparable with the predictive potential of NT-proBNP [N-terminal pro-B-type natriuruetic peptide; 0.77 (95% CI, 0.72-0.82)]. Importantly, the predictive potential of LTBP2 persisted in patients with AHF as the cause of dypnea (AUC 0.78) and was independent of renal dysfunction (AUC 0.77). In a multivariate Cox regression analysis, LTBP2 was the strongest independent predictor of death [HR (hazard ratio), 3.76 (95% CI, 2.13-6.64); P<0.0001]. In conclusion, plasma levels of LTBP2 present a novel and powerful predictor of all-cause mortality, and particularly pulmonary death. Cause-specific prediction of death would enable targeted prevention, e.g. with pre-emptive antibiotic therapy.

  18. A review and meta-analysis of the effect of weight loss on all-cause mortality risk.

    PubMed

    Harrington, Mary; Gibson, Sigrid; Cottrell, Richard C

    2009-06-01

    Overweight and obesity are associated with increased morbidity and mortality, although the range of body weights that is optimal for health is controversial. It is less clear whether weight loss benefits longevity and hence whether weight reduction is justified as a prime goal for all individuals who are overweight (normally defined as BMI>25 kg/m2). The purpose of the present review was to examine the evidence base for recommending weight loss by diet and lifestyle change as a means of prolonging life. An electronic search identified twenty-six eligible prospective studies that monitored subsequent mortality risk following weight loss by lifestyle change, published up to 2008. Data were extracted and further analysed by meta-analysis, giving particular attention to the influence of confounders. Moderator variables such as reason for weight loss (intentional, unintentional), baseline health status (healthy, unhealthy), baseline BMI (normal, overweight, obese), method used to estimate weight loss (measured weight loss, reported weight loss) and whether models adjusted for physical activity (adjusted data, unadjusted data) were used to classify subgroups for separate analysis. Intentional weight loss per se had a neutral effect on all-cause mortality (relative risk (RR) 1.01; P = 0.89), while weight loss which was unintentional or ill-defined was associated with excess risk of 22 to 39 %. Intentional weight loss had a small benefit for individuals classified as unhealthy (with obesity-related risk factors) (RR 0.87 (95 % CI 0.77, 0.99); P = 0.028), especially unhealthy obese (RR 0.84 (95 % CI 0.73, 0.97); P = 0.018), but appeared to be associated with slightly increased mortality for healthy individuals (RR 1.11 (95 % CI 1.00, 1.22); P = 0.05), and for those who were overweight but not obese (RR 1.09 (95 % CI 1.02, 1.17); P = 0.008). There was no evidence for weight loss conferring either benefit or risk among healthy obese. In conclusion, the available evidence does

  19. Factors Associated With Emergency Department Visits: A Multistate Analysis of Adult Fee-for-Service Medicaid Beneficiaries

    PubMed Central

    Agarwal, Parul; Bias, Thomas K.; Madhavan, Suresh; Sambamoorthi, Nethra; Frisbee, Stephanie; Sambamoorthi, Usha

    2016-01-01

    Objective The objective of this study was to examine the association of patient- and county-level factors with the emergency department (ED) visits among adult fee-for-service (FFS) Medicaid beneficiaries residing in Maryland, Ohio, and West Virginia. Methods A cross-sectional design using retrospective observational data was implemented. Patient-level data were obtained from 2010 Medicaid Analytic eXtract files. Information on county-level health-care resources was obtained from the Area Health Resource file and County Health Rankings file. Results In adjusted analyses, the following patient-level factors were associated with higher number of ED visits: African Americans (incidence rate ratios [IRR] = 1.47), Hispanics (IRR = 1.63), polypharmacy (IRR = 1.89), and tobacco use (IRR = 2.23). Patients with complex chronic illness had a higher number of ED visits (IRR = 3.33). The county-level factors associated with ED visits were unemployment rate (IRR = 0.94) and number of urgent care clinics (IRR = 0.96). Conclusion Patients with complex healthcare needs had a higher number of ED visits as compared to those without complex healthcare needs. The study results provide important baseline context for future policy analysis studies around Medicaid expansion options.

  20. Factors Associated With Emergency Department Visits: A Multistate Analysis of Adult Fee-for-Service Medicaid Beneficiaries

    PubMed Central

    Agarwal, Parul; Bias, Thomas K.; Madhavan, Suresh; Sambamoorthi, Nethra; Frisbee, Stephanie; Sambamoorthi, Usha

    2016-01-01

    Objective The objective of this study was to examine the association of patient- and county-level factors with the emergency department (ED) visits among adult fee-for-service (FFS) Medicaid beneficiaries residing in Maryland, Ohio, and West Virginia. Methods A cross-sectional design using retrospective observational data was implemented. Patient-level data were obtained from 2010 Medicaid Analytic eXtract files. Information on county-level health-care resources was obtained from the Area Health Resource file and County Health Rankings file. Results In adjusted analyses, the following patient-level factors were associated with higher number of ED visits: African Americans (incidence rate ratios [IRR] = 1.47), Hispanics (IRR = 1.63), polypharmacy (IRR = 1.89), and tobacco use (IRR = 2.23). Patients with complex chronic illness had a higher number of ED visits (IRR = 3.33). The county-level factors associated with ED visits were unemployment rate (IRR = 0.94) and number of urgent care clinics (IRR = 0.96). Conclusion Patients with complex healthcare needs had a higher number of ED visits as compared to those without complex healthcare needs. The study results provide important baseline context for future policy analysis studies around Medicaid expansion options. PMID:27512721

  1. Eliminating Medicaid adult dental coverage in California led to increased dental emergency visits and associated costs.

    PubMed

    Singhal, Astha; Caplan, Daniel J; Jones, Michael P; Momany, Elizabeth T; Kuthy, Raymond A; Buresh, Christopher T; Isman, Robert; Damiano, Peter C

    2015-05-01

    Dental coverage for adults is an elective benefit under Medicaid. As a result of budget constraints, California Medicaid eliminated its comprehensive adult dental coverage in July 2009. We examined the impact of this policy change on emergency department (ED) visits by Medicaid-enrolled adults for dental problems in the period 2006-11. We found that the policy change led to a significant and immediate increase in dental ED use, amounting to more than 1,800 additional dental ED visits per year. Young adults, members of racial/ethnic minority groups, and urban residents were disproportionately affected by the policy change. Average yearly costs associated with dental ED visits increased by 68 percent. The California experience provides evidence that eliminating Medicaid adult dental benefits shifts dental care to costly EDs that do not provide definitive dental care. The population affected by the Medicaid adult dental coverage policy is increasing as many states expand their Medicaid programs under the ACA. Hence, such evidence is critical to inform decisions regarding adult dental coverage for existing Medicaid enrollees and expansion populations. PMID:25941275

  2. Air Pollution and Emergency Department Visits for Depression: A Multicity Case-Crossover Study

    PubMed Central

    Szyszkowicz, Mieczysław; Kousha, Termeh; Kingsbury, Mila; Colman, Ian

    2016-01-01

    BACKGROUND The aim of this study was to investigate the associations between ambient air pollution and emergency department (ED) visits for depression. METHODS Health data were retrieved from the National Ambulatory Care Reporting System. ED visits for depression were retrieved from the National Ambulatory Care Reporting System using the International Classification of Diseases (ICD-10), Tenth revision codes; ICD-10: F32 (mild depressive episode) and ICD-10: F33 (recurrent depressive disorder). A case-crossover design was employed for this study. Conditional logistic regression models were used to estimate odds ratios. RESULTS For females, exposure to ozone was associated with increased risk of an ED visit for depression between 1 and 7 days after exposure, for males, between 1 and 5, and 8 days after exposure, with odds ratios ranging between 1.02 and 1.03. CONCLUSIONS These findings suggest that, as hypothesized, there is a positive association between exposure to air pollution and ED visits for depression. PMID:27597809

  3. Alcohol-Related Emergency Department Visits Associated with Collegiate Football Games

    ERIC Educational Resources Information Center

    Shook, Janice; Hiestand, Brian C.

    2011-01-01

    Objective: In 2003, after several post-college football game riots, multiple strategies including strict enforcement of open container laws were instituted by the authors' city and university. The authors compared alcohol-related visits to the on-campus emergency department (ED) associated with home football games in 2002 and 2006, hypothesizing…

  4. Relationship between summertime ambient ozone levels and emergency department visits for asthma in central New Jersey

    SciTech Connect

    Weisel, C.P.; Cody, R.P.; Lioy, P.J.

    1995-03-01

    The 5-year retrospective study of the association between temperature and emergency department (ED) visits for asthma with mean ambient ozone levels between 10:00 and 15:00 was conducted in central New Jersey during the summer months. An association was identified in each of the years (1986-1990). Between 8 and 34% of the total variance in ED visits for asthma was explained by the two environmental variables in the step-wise multiple regression analysis. ED visits occurred 28% more frequently when the mean ozone levels were >0.06 ppm than when they were < 0.06 ppm. This result was statistically significant in a covariance analysis. An evaluation of the effects of ozone on asthmatics reported in the literature was completed to determine if, as proposed by Bates, the results from different types of studies were coherent among the health metrics. A consistency in the magnitude of reported effects and the time lag between exposure and response for four different health indices (symptom reports, decrements in expiratory flow, ED visits, and hospital admissions) was identified and indicates a coherence between ozone and respiratory response to ozone exposure. This supports a proposition that ozone adversely affects asthmatics at levels below the current U.S. standard. 34 refs., 1 fig., 4 tabs.

  5. Susceptibility to Heat-Related Fluid and Electrolyte Imbalance Emergency Department Visits in Atlanta, Georgia, USA

    PubMed Central

    Heidari, Leila; Winquist, Andrea; Klein, Mitchel; O’Lenick, Cassandra; Grundstein, Andrew; Ebelt Sarnat, Stefanie

    2016-01-01

    Identification of populations susceptible to heat effects is critical for targeted prevention and more accurate risk assessment. Fluid and electrolyte imbalance (FEI) may provide an objective indicator of heat morbidity. Data on daily ambient temperature and FEI emergency department (ED) visits were collected in Atlanta, Georgia, USA during 1993–2012. Associations of warm-season same-day temperatures and FEI ED visits were estimated using Poisson generalized linear models. Analyses explored associations between FEI ED visits and various temperature metrics (maximum, minimum, average, and diurnal change in ambient temperature, apparent temperature, and heat index) modeled using linear, quadratic, and cubic terms to allow for non-linear associations. Effect modification by potential determinants of heat susceptibility (sex; race; comorbid congestive heart failure, kidney disease, and diabetes; and neighborhood poverty and education levels) was assessed via stratification. Higher warm-season ambient temperature was significantly associated with FEI ED visits, regardless of temperature metric used. Stratified analyses suggested heat-related risks for all populations, but particularly for males. This work highlights the utility of FEI as an indicator of heat morbidity, the health threat posed by warm-season temperatures, and the importance of considering susceptible populations in heat-health research. PMID:27706089

  6. All-Cause Mortality of Low Birthweight Infants in Infancy, Childhood, and Adolescence: Population Study of England and Wales

    PubMed Central

    Watkins, W. John; Kotecha, Sarah J.; Kotecha, Sailesh

    2016-01-01

    Background Low birthweight (LBW) is associated with increased mortality in infancy, but its association with mortality in later childhood and adolescence is less clear. We investigated the association between birthweight and all-cause mortality and identified major causes of mortality for different birthweight groups. Methods and Findings We conducted a population study of all live births occurring in England and Wales between 1 January 1993 and 31 December 2011. Following exclusions, the 12,355,251 live births were classified by birthweight: 500–1,499 g (very LBW [VLBW], n = 139,608), 1,500–2,499 g (LBW, n = 759,283), 2,500–3,499 g (n = 6,511,411), and ≥3,500 g (n = 4,944,949). The association of birthweight group with mortality in infancy (<1 y of age) and childhood/adolescence (1–18 y of age) was quantified, with and without covariates, through hazard ratios using Cox regression. International Classification of Diseases codes identified causes of death. In all, 74,890 (0.61%) individuals died between birth and 18 y of age, with 23% of deaths occurring after infancy. Adjusted hazard ratios for infant deaths were 145 (95% CI 141, 149) and 9.8 (95% CI 9.5, 10.1) for the VLBW and LBW groups, respectively, compared to the ≥3,500 g group. The respective hazard ratios for death occurring at age 1–18 y were 6.6 (95% CI 6.1, 7.1) and 2.9 (95% CI 2.8, 3.1). Male gender, the youngest and oldest maternal age bands, multiple births, and deprivation (Index of Multiple Deprivation score) also contributed to increased deaths in the VLBW and LBW groups in both age ranges. In infancy, perinatal factors, particularly respiratory issues and infections, explained 84% and 31% of deaths in the VLBW and LBW groups, respectively; congenital malformations explained 36% and 23% in the LBW group and ≥2,500 g groups (2,500–3,499 g and ≥3,500 g groups combined), respectively. Central nervous system conditions explained 20% of deaths in childhood/adolescence in the VLBW

  7. Incidence of Emergency Department Visits for ST-Elevation Myocardial Infarction in a Recent 6-Year Period in the United States

    PubMed Central

    Ward, Michael J.; Kripalani, Sunil; Zhu, Yuwei; Storrow, Alan B.; Dittus, Robert S.; Harrell, Frank E.; Self, Wesley H.

    2014-01-01

    The incidence and longitudinal trends of patients with ST-elevation myocardial infarction (STEMI) presenting to U.S. emergency departments (EDs) are currently unknown. Efforts to use effective treatments for cardiovascular disease may decrease ED STEMI presentation. We conducted a descriptive epidemiological analysis of STEMI visits to EDs between 2006 and 2011 using the Nationwide ED Sample (NEDS), the largest source of U.S. ED data, to determine the incidence of patients with STEMIs presenting to U.S. EDs. We included adult ED visits with an ICD-9CM diagnosis of STEMI and calculated incidence rates for STEMI ED visits using U.S. census population data. Incidence calculations were stratified by age group, geographic region, and year. From 2006–2011, there was a mean of 258,106 STEMIs presenting to EDs per year, declining from 300,466 in 2006 to 227,343 in 2011. Incidence of ED STEMI visits per 10,000 adults declined from 10.1 (95% CI 9.8, 10.8) in 2006 to 7.3 (95% CI 6.8, 7.8) in 2011. The Midwest had the highest rate of ED STEMIs at 10.0 (95% CI 9.2, 10.8) and the West had the lowest with 6.6 (95% CI 6.1, 7.0). The incidence of STEMI decreased for all age groups during the study period. In conclusion, we report the first national estimates of STEMI presentation to U.S. EDs, which demonstrate decreasing incidence across all age groups and all geographic regions between 2006 and 2011. A declining STEMI incidence may affect the quality and timeliness of STEMI care. Continued national STEMI surveillance is needed to guide healthcare resource allocation. PMID:25465931

  8. States leverage telepsychiatry solutions to ease ED crowding, accelerate care.

    PubMed

    2015-02-01

    Many states are having success turning to telepsychiatry-based solutions to connect mental health patients with needed care while also decompressing crowded EDs. Just one year into a statewide telepsychiatry initiative in North Carolina (NC-STeP), administrators say the approach has saved as much as $7 million, and hospital demand for the service is higher than anticipated. In Texas, mental health emergency centers (MHEC) that use telepsychiatry to connect patients in rural areas with needed psychiatric care are freeing up EDs to focus on medical care. In just 11 months, 91 North Carolina hospitals have at least started the process to engage in NC-STeP. Much of the savings from NC-STeP come from involuntary commitment orders being overturned as a result of the telepsychiatry consults, reducing the need for expensive inpatient care. Implementing NC-STeP has involved multiple hurdles including credentialing difficulties and technical/firewall challenges. The Texas model provides 24/7 availability of psychiatrists via telemedicine through a network of MHECs. In-person staff at the MHECs perform basic screening tests and blood draws so that medical clearance can be achieved without the need for an ED visit in most cases. Funding for the MHECs comes from the state, hospitals in the region, and local governmental authorities that reap savings or benefits from the initiative. PMID:25688413

  9. States leverage telepsychiatry solutions to ease ED crowding, accelerate care.

    PubMed

    2015-02-01

    Many states are having success turning to telepsychiatry-based solutions to connect mental health patients with needed care while also decompressing crowded EDs. Just one year into a statewide telepsychiatry initiative in North Carolina (NC-STeP), administrators say the approach has saved as much as $7 million, and hospital demand for the service is higher than anticipated. In Texas, mental health emergency centers (MHEC) that use telepsychiatry to connect patients in rural areas with needed psychiatric care are freeing up EDs to focus on medical care. In just 11 months, 91 North Carolina hospitals have at least started the process to engage in NC-STeP. Much of the savings from NC-STeP come from involuntary commitment orders being overturned as a result of the telepsychiatry consults, reducing the need for expensive inpatient care. Implementing NC-STeP has involved multiple hurdles including credentialing difficulties and technical/firewall challenges. The Texas model provides 24/7 availability of psychiatrists via telemedicine through a network of MHECs. In-person staff at the MHECs perform basic screening tests and blood draws so that medical clearance can be achieved without the need for an ED visit in most cases. Funding for the MHECs comes from the state, hospitals in the region, and local governmental authorities that reap savings or benefits from the initiative.

  10. Increases in heart failure visits after Christmas and New Year's Day.

    PubMed

    Reedman, Lisa Armstrong; Allegra, John R; Cochrane, Dennis G

    2008-01-01

    The authors hypothesized increased emergency department (ED) visits for heart failure (HF) during a 2-week Christmas holiday period similar to a recent study showing increased cardiac death rates. A retrospective analysis was performed from a database of 18 EDs in New Jersey and New York from January 1, 1996, to November 30, 2004, analyzing HF visits from December 1 to January 31. The authors compared the mean daily visits for the 2-week holiday period of December 25 to January 7, as well as December 26 to December 30 and January 2 to January 5, using the Student t test. A total of 4.7 million patients were studied, 65,646 with an ED diagnosis of HF and 11,525 during January and December. There was a 23% (95% confidence interval [CI], 14%-31%; P<.001) increase in daily visits for December 25 to January 7 and a 33% (95% CI, 16%-51%; P=.007) and 30% (95% CI, 22%-38%; P<.01) increase in the 4 days following Christmas and New Year's, respectively. The authors found a significant increase in daily HF visits in the 2-week holiday period and the 4 days following the holidays, even greater than that reported for sudden cardiac death.

  11. 28 CFR 540.46 - Attorney visits.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Attorney visits. 540.46 Section 540.46... PERSONS IN THE COMMUNITY Visiting Regulations § 540.46 Attorney visits. Requirements for attorney visits... chapter). Provisions pertinent to attorney visits for pretrial inmates are contained in § 551.117 of...

  12. Skylab mission report, third visit

    NASA Technical Reports Server (NTRS)

    1974-01-01

    An evaluation is presented of the operational and engineering aspects of the third Skylab visit, including information on the performance of the command and service module and the experiment hardware, the crew's evaluation of the visit, and other visit-related areas of interest such as biomedical observations. The specific areas discussed are contained in the following: (1) solar physics and astrophysics investigations; (2) Comet Kohoutek experiments; (3) medical experiments; (4) earth observations, including data for the multispectral photographic facility, the earth terrain camera, and the microwave radiometer/scattermometer and altimeter; (5) engineering and technology experiments; (6) food and medical operational equipment; (7) hardware and experiment anomalies; and (8) mission support, mission objectives, flight planning, and launch phase summary. Conclusions discussed as a result of the third visit to Skylab involve the advancement of the sciences, practical applications, the durability of man and systems in space, and spaceflight effectiveness and economy.

  13. Astronaut Steve Swanson Visits Goddard

    NASA Video Gallery

    On Tuesday, 3 March 2015, a special guest visited NASA Goddard Space Flight Center during his time back on Earth. Steven Swanson, NASA astronaut, intrigued the audience by highlighting his adventur...

  14. Tests and visits before surgery

    MedlinePlus

    Before surgery - tests; Before surgery - doctor visits ... Pre-op is the time before your surgery. It means "before operation." During this time, you will meet with one of your doctors. This may be your surgeon or primary care ...

  15. Preparing for an Office Visit

    MedlinePlus

    ... a Neurologist Preparing for an Office Visit Your Rights as a Patient Family & Friends Communities Research Matters Donate Clinical Trials Animal Research Resources Neurology Now Magazine Patient Education Brochures ...

  16. The CACREP Site Visit Process

    ERIC Educational Resources Information Center

    Lee, Courtland C.

    2013-01-01

    An important step in the CACREP review process is the campus site visit. The visit involves a team, usually from comparable institutions, coming to a campus for a review of the counselor training program(s). The role of the team is to be the CACREP Board's representative on campus to verify the self-study. In this article, the author reviews…

  17. Visiting Vehicle Ground Trajectory Tool

    NASA Technical Reports Server (NTRS)

    Hamm, Dustin

    2013-01-01

    The International Space Station (ISS) Visiting Vehicle Group needed a targeting tool for vehicles that rendezvous with the ISS. The Visiting Vehicle Ground Trajectory targeting tool provides the ability to perform both realtime and planning operations for the Visiting Vehicle Group. This tool provides a highly reconfigurable base, which allows the Visiting Vehicle Group to perform their work. The application is composed of a telemetry processing function, a relative motion function, a targeting function, a vector view, and 2D/3D world map type graphics. The software tool provides the ability to plan a rendezvous trajectory for vehicles that visit the ISS. It models these relative trajectories using planned and realtime data from the vehicle. The tool monitors ongoing rendezvous trajectory relative motion, and ensures visiting vehicles stay within agreed corridors. The software provides the ability to update or re-plan a rendezvous to support contingency operations. Adding new parameters and incorporating them into the system was previously not available on-the-fly. If an unanticipated capability wasn't discovered until the vehicle was flying, there was no way to update things.

  18. Emergency Department Visits Involving Misuse and Abuse of the Antipsychotic Quetiapine: Results from the Drug Abuse Warning Network (DAWN).

    PubMed

    Mattson, Margaret E; Albright, Victoria A; Yoon, Joanna; Council, Carol L

    2015-01-01

    Case reports in medical literature suggest that the atypical antipsychotic quetiapine, a medication not previously considered to have abuse potential, is now being subject to misuse and abuse (MUA; ie, taken when not prescribed for them or used in a way other than instructed by their health professional). Here we present systematic, nationally representative data from the 2005 to 2011 Drug Abuse Warning Network (DAWN) for prevalence of emergency department (ED) visits among the U.S. general population involving quetiapine and related to MUA, suicide attempts, and adverse reactions. Nationally, quetiapine-related ED visits increased 90% between 2005 and 2011, from 35,581 ED visits to 67,497. DAWN data indicate that when used without medical supervision for recreational/self-medication purposes, quetiapine poses health risks for its users, especially among polydrug users and women. These findings suggest that the medical and public health communities should increase vigilance concerning this drug and its potential for MUA. PMID:26056465

  19. Emergency Department Visits Involving Misuse and Abuse of the Antipsychotic Quetiapine: Results from the Drug Abuse Warning Network (DAWN)

    PubMed Central

    Mattson, Margaret E; Albright, Victoria A; Yoon, Joanna; Council, Carol L

    2015-01-01

    Case reports in medical literature suggest that the atypical antipsychotic quetiapine, a medication not previously considered to have abuse potential, is now being subject to misuse and abuse (MUA; ie, taken when not prescribed for them or used in a way other than instructed by their health professional). Here we present systematic, nationally representative data from the 2005 to 2011 Drug Abuse Warning Network (DAWN) for prevalence of emergency department (ED) visits among the U.S. general population involving quetiapine and related to MUA, suicide attempts, and adverse reactions. Nationally, quetiapine-related ED visits increased 90% between 2005 and 2011, from 35,581 ED visits to 67,497. DAWN data indicate that when used without medical supervision for recreational/self-medication purposes, quetiapine poses health risks for its users, especially among polydrug users and women. These findings suggest that the medical and public health communities should increase vigilance concerning this drug and its potential for MUA. PMID:26056465

  20. Patient-Reported Geriatric Symptoms as Risk Factors for Hospitalization and Emergency Department Visits

    PubMed Central

    Chandra, Anupam; Crane, Sarah J; Tung, Ericka E; Hanson, Gregory J; North, Frederick; Cha, Stephen S; Takahashi, Paul Y

    2015-01-01

    There is an urgent need to identify predictors of adverse outcomes and increased health care utilization in the elderly. The Mayo Ambulatory Geriatric Evaluation (MAGE) is a symptom questionnaire that was completed by patients aged 65 years and older during office visits to Primary Care Internal Medicine at Mayo Clinic in Rochester, MN. It was introduced to improve screening for geriatric conditions. We conducted this study to explore the relationship between self-reported geriatric symptoms and hospitalization and emergency department (ED) visits within 1 year of completing the survey. This was a retrospective cohort study of patients who completed the MAGE from April 2008 to December 2010. The primary outcome was an ED visit or hospitalization within 1 year. Predictors included responses to individual questions in the MAGE. Data were obtained from the electronic medical record and administrative records. Logistic regression analyses were performed from significant univariate factors to determine predictors in a multivariable setting. A weighted scoring system was created based upon the odds ratios derived from a bootstrap process. The sensitivity, specificity, and AUC were calculated using this scoring system. The MAGE survey was completed by 7738 patients. The average age was 76.2 ± 7.68 years and 57% were women. Advanced age, a self-report of worse health, history of 2 or more falls, weight loss, and depressed mood were significantly associated with hospitalization or ED visits within 1 year. A score equal to or greater than 2 had a sensitivity of 0.74 and specificity of 0.45. The calculated AUC was 0.60. The MAGE questionnaire, which was completed by patients at an outpatient visit to screen for common geriatric issues, could also be used to assess risk for ED visits and hospitalization within 1 year. PMID:26029477

  1. Non-Traumatic Dental Condition-Related Emergency Department Visits and Associated Costs for Children and Adults with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Nakao, Sy; Scott, JoAnna M.; Masterson, Erin E.; Chi, Donald L.

    2015-01-01

    We analyzed 2010 US National Emergency Department Sample data and ran regression models to test the hypotheses that individuals with ASD are more likely to have non-traumatic dental condition (NTDC)-related emergency department (ED) visits and to incur greater costs for these visits than those without ASD. There were nearly 2.3 million…

  2. Real time analysis under EDS

    NASA Astrophysics Data System (ADS)

    Schneberk, D.

    1985-07-01

    The analysis component of the Enrichment Diagnostic System (EDS) developed for the Atomic Vapor Laser Isotope Separation Program (AVLIS) at Lawrence Livermore National Laboratory (LLNL) is described. Four different types of analysis are performed on data acquired through EDS: (1) absorption spectroscopy on laser-generated spectral lines, (2) mass spectrometer analysis, (3) general purpose waveform analysis, and (4) separation performance calculations. The information produced from this data includes: measures of particle density and velocity, partial pressures of residual gases, and overall measures of isotope enrichment. The analysis component supports a variety of real-time modeling tasks, a means for broadcasting data to other nodes, and a great degree of flexibility for tailoring computations to the exact needs of the process. A particular data base structure and program flow is common to all types of analysis. Key elements of the analysis component are: (1) a fast access data base which can configure all types of analysis, (2) a selected set of analysis routines, (3) a general purpose data manipulation and graphics package for the results of real time analysis.

  3. Air Pollution and Emergency Department Visits for Otitis Media: A Case-Crossover Study in Edmonton, Canada

    PubMed Central

    Zemek, Roger; Szyszkowicz, Mieczysław; Rowe, Brian H.

    2010-01-01

    Background Otitis media (OM) is one of the most common early childhood infections, resulting in an enormous economic burden to the health care system through unscheduled doctor visits and antibiotic prescriptions. Objectives The objective of this study was to investigate the potential association between ambient air pollution exposure and emergency department (ED) visits for OM. Materials and Methods Ten years of ED data were obtained from Edmonton, Alberta, Canada, and linked to levels of air pollution: carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), sulfur dioxide, and particulate matter (PM) of median aerometric diameter ≤ 10 and 2.5 μm (PM10 and PM2.5 respectively). A time-stratified case-crossover technique was applied to analyze the associations between ambient air pollution and health outcomes. Conditional logistic regression analysis with the subject’s identification number as a stratum variable was used to obtain odds ratios (ORs) and their corresponding 95% confidence intervals after adjustment for meteorological factors. Results We based the analysis on 14,527 ED visits for OM over 10 years in children 1–3 years of age. We observed statistically significant positive associations between ED visits for OM and interquartile increases in CO and NO2 levels after adjusting for ambient temperature and relative humidity. We observed the strongest associations (expressed by ORs) in the warmer months (April–September) in girls and all patients for exposure to CO and NO2, and in boys for exposure to CO, for 2 days before an OM ED visit. Conclusions These results support the hypothesis that ED visits for OM are associated with ambient air pollution. PMID:20663739

  4. Associations Between the Serum Metabolome and All-Cause Mortality Among African Americans in the Atherosclerosis Risk in Communities (ARIC) Study.

    PubMed

    Yu, Bing; Heiss, Gerardo; Alexander, Danny; Grams, Morgan E; Boerwinkle, Eric

    2016-04-01

    Early and accurate identification of people at high risk of premature death may assist in the targeting of preventive therapies in order to improve overall health. To identify novel biomarkers for all-cause mortality, we performed untargeted metabolomics in the Atherosclerosis Risk in Communities (ARIC) Study. We included 1,887 eligible ARIC African Americans, and 671 deaths occurred during a median follow-up period of 22.5 years (1987-2011). Chromatography and mass spectroscopy identified and quantitated 204 serum metabolites, and Cox proportional hazards models were used to analyze the longitudinal associations with all-cause and cardiovascular mortality. Nine metabolites, including cotinine, mannose, glycocholate, pregnendiol disulfate, α-hydroxyisovalerate, N-acetylalanine, andro-steroid monosulfate 2, uridine, and γ-glutamyl-leucine, showed independent associations with all-cause mortality, with an average risk change of 18% per standard-deviation increase in metabolite level (P < 1.23 × 10(-4)). A metabolite risk score, created on the basis of the weighted levels of the identified metabolites, improved the predictive ability of all-cause mortality over traditional risk factors (bias-corrected Harrell's C statistic 0.752 vs. 0.730). Mannose and glycocholate were associated with cardiovascular mortality (P < 1.23 × 10(-4)), but predictive ability was not improved beyond the traditional risk factors. This metabolomic analysis revealed potential novel biomarkers for all-cause mortality beyond the traditional risk factors.

  5. Patient and Community-Level Socio-Demographic Characteristics Associated with Emergency Department Visits for Childhood Injury; A Retrospective Analysis of Data from the Pediatric Emergency Care Applied Research Network (PECARN) Core Data Project 2004–2008

    PubMed Central

    Macy, Michelle L.; Zonfrillo, Mark R.; Cook, Lawrence J.; Funai, Tomohiko; Goldstick, Jason; Stanley, Rachel M.; Chamberlain, James M.; Cunningham, Rebecca M.; Lipton, Robert; Alpern, Elizabeth R.

    2015-01-01

    Objective To examine pediatric emergency department (ED) visits over 5 years, trends in injury severity, and associations between injury-related ED visit outcome and patient and community-level socio-demographic characteristics. Study design Retrospective analysis of administrative data provided to the Pediatric Emergency Care Applied Research Network Core Data Project, 2004–2008. Home addresses were geocoded to determine census block group and associated socio-demographic characteristics. Maximum Abbreviated Injury Scale severity and Severity Classification System scores were calculated. Generalized estimating equations were used to test for associations between socio-demographic characteristics and admission or transfer among injury-related ED visits. Results Overall ED visits and injury-related visits increased from 2004 to 2008 at study sites. Of 2,833,676 successfully geocoded visits, 700,821 (24.7%) were injury-related. The proportion of higher severity injury-related visits remained consistent. Nearly 10% of injury-related visits resulted in admission or transfer each year. After adjusting for age, sex, payer, and injury severity, odds of admission or transfer were lower among minority children and children from areas with moderate and high prevalence of poverty. Conclusions Pediatric injury-related ED visits to included sites increased over the study period while injury severity, anticipated resource utilization, and visit outcomes remained stable, with low rates of admission or transfer. Socio-demographic differences in injury-related visits and ED disposition were apparent. ED-based injury surveillance is essential to understand disparities, inform targets for prevention programs, and reduce the overall burden of childhood injuries. PMID:26141551

  6. The many faces of access: reasons for medically nonurgent emergency department visits.

    PubMed

    Guttman, Nurit; Zimmerman, Deena R; Nelson, Myra Schaub

    2003-12-01

    Investigating why people use the hospital emergency department (ED) for visits considered medically nonurgent can enhance our understanding of people's expectations of health care services, of their conceptions of prudent lay judgment, and of difficulties in negotiating the logistics of primary care services. This study identified reasons for such ED use from users' perspectives in both pediatric and adult visits. Respondents were asked to explain what brought them to the ED and to define an emergency. The study was conducted in two northeastern U.S. hospital EDs. The analysis drew on a convenience sample of 408 (331 pediatric, 77 adult users) face-to-face interviews that employed both open- and closed-ended questions. Findings indicate most patients had medical insurance and a regular place of care and most arrived by car or taxi. Twelve main themes emerged under three main categories: conceptions of needs, appropriateness, and preference for the ED. The findings indicate that various reasons for ED use may be construed as access issues. These include beliefs regarding limited availability of after-hour consultation services and of timely appointments at one's primary care site. Drawing on the findings, a typology that distinguishes between groups of users according to their preference for the ED, a level of congruence between their own reason and their definition of an emergency was developed. The typology suggests that people's concerns that influence their decision to come to the ED cannot be solved simply by expanding primary care services or by educational interventions. Its application yields recommendations for services and interventions. PMID:14756500

  7. Cardiovascular Health Metrics and All-cause and Cardiovascular Disease Mortality Among Middle-aged Men in Korea: The Seoul Male Cohort Study

    PubMed Central

    Kim, Ji Young; Ko, Young-Jin; Rhee, Chul Woo; Park, Byung-Joo; Kim, Dong-Hyun; Bae, Jong-Myon; Shin, Myung-Hee; Lee, Moo-Song; Li, Zhong Min

    2013-01-01

    Objectives This study estimated the association of cardiovascular health behaviors with the risk of all-cause and cardiovascular disease (CVD) mortality in middle-aged men in Korea. Methods In total, 12 538 men aged 40 to 59 years were enrolled in 1993 and followed up through 2011. Cardiovascular health metrics defined the following lifestyle behaviors proposed by the American Heart Association: smoking, physical activity, body mass index, diet habit score, total cholesterol, blood pressure, and fasting blood glucose. The cardiovascular health metrics score was calculated as a single categorical variable, by assigning 1 point to each ideal healthy behavior. A Cox proportional hazards regression model was used to estimate the hazard ratio of cardiovascular health behavior. Population attributable risks (PARs) were calculated from the significant cardiovascular health metrics. Results There were 1054 total and 171 CVD deaths over 230 690 person-years of follow-up. The prevalence of meeting all 7 cardiovascular health metrics was 0.67%. Current smoking, elevated blood pressure, and high fasting blood glucose were significantly associated with all-cause and CVD mortality. The adjusted PARs for the 3 significant metrics combined were 35.2% (95% confidence interval [CI], 21.7 to 47.4) and 52.8% (95% CI, 22.0 to 74.0) for all-cause and CVD mortality, respectively. The adjusted hazard ratios of the groups with a 6-7 vs. 0-2 cardiovascular health metrics score were 0.42 (95% CI, 0.31 to 0.59) for all-cause mortality and 0.10 (95% CI, 0.03 to 0.29) for CVD mortality. Conclusions Among cardiovascular health behaviors, not smoking, normal blood pressure, and recommended fasting blood glucose levels were associated with reduced risks of all-cause and CVD mortality. Meeting a greater number of cardiovascular health metrics was associated with a lower risk of all-cause and CVD mortality. PMID:24349653

  8. Daytime Napping and the Risk of Cardiovascular Disease and All-Cause Mortality: A Prospective Study and Dose-Response Meta-Analysis

    PubMed Central

    Yamada, Tomohide; Hara, Kazuo; Shojima, Nobuhiro; Yamauchi, Toshimasa; Kadowaki, Takashi

    2015-01-01

    Study Objectives: To summarize evidence about the association between daytime napping and the risk of cardiovascular disease and all-cause mortality, and to quantify the potential dose-response relation. Design: Meta-analysis of prospective cohort studies. Methods and Results: Electronic databases were searched for articles published up to December 2014 using the terms nap, cardiovascular disease, and all-cause mortality. We selected well-adjusted prospective cohort studies reporting risk estimates for cardiovascular disease and all-cause mortality related to napping. Eleven prospective cohort studies were identified with 151,588 participants (1,625,012 person-years) and a mean follow-up period of 11 years (60% women, 5,276 cardiovascular events, and 18,966 all-cause deaths). Pooled analysis showed that a long daytime nap (≥ 60 min/day) was associated with a higher risk of cardiovascular disease (rate ratio [RR]: 1.82 [1.22–2.71], P = 0.003, I2 = 37%) compared with not napping. All-cause mortality was associated with napping for ≥ 60 min/day (RR: 1.27 [1.11–1.45], P < 0.001, I2 = 0%) compared with not napping. In contrast, napping for < 60 min/day was not associated with cardiovascular disease (P = 0.98) or all-cause mortality (P = 0.08). Meta-analysis demonstrated a significant J-curve dose-response relation between nap time and cardiovascular disease (P for nonlinearity = 0.01). The RR initially decreased from 0 to 30 min/day. Then it increased slightly until about 45 min/day, followed by a sharp increase at longer nap times. There was also a positive linear relation between nap time and all-cause mortality (P for non-linearity = 0.97). Conclusions: Nap time and cardiovascular disease may be associated via a J-curve relation. Further studies are needed to confirm the efficacy of a short nap. Citation: Yamada T, Hara K, Shojima N, Yamauchi T, Kadowaki T. Daytime napping and the risk of cardiovascular disease and all-cause mortality: a prospective study and

  9. Instability of EDS maglev systems

    SciTech Connect

    Cai, Y.; Chen, S.S.

    1993-09-01

    Instabilities of an EDS maglev suspension system with 3 D.O.F. and 5 D.O.F. vehicles traveling on a double L-shaped set of guideway conductors have been investigated with various experimentally measured magnetical force data incorporated into the theoretical models. Divergence and flutter are obtained from both analytical and numerical solutions for coupled vibration of the 3 D.O.F. maglev vehicle model. Instabilities of five direction motions (heave, slip, rill, pitch and yaw) are observed for the 4 D.O.F. vehicle model. It demonstrates that system parameters, such as, system damping, vehicle geometry and coupling effects among five different motions play very important roles in the occurrence of dynamic instabilities of maglev vehicles.

  10. Visitation arrangements for impaired parents.

    PubMed

    Montgomery, Stephen A; Street, David F

    2011-07-01

    Forensic mental health professionals are frequently asked to evaluate the parenting skills of divorcing parents because the court seeks help in determining the custody, visitation, and parenting time arrangements for the children. When one of the parents is impaired, the court wants to know the way to help the children have a good relationship with that parent and keep the children safe. There is little empirical research to answer such questions. In this article, the authors describe their methodology for providing useful clinical information to the court to help guide their decisions regarding visitation with impaired parents.

  11. Stennis visits Lake Cormorant school

    NASA Technical Reports Server (NTRS)

    2010-01-01

    Alexis Harry, assistant director of Astro Camp at NASA's John C. Stennis Space Center, talks with students at Lake Cormorant (Miss.) Elementary School during a 'Living and Working in Space' presentation March 30. Stennis hosted the school presentation during a visit to the Oxford area. Harry, who also is a high school biology teacher in Slidell, La., spent time discussing space travel with students and answering questions they had about the experience, including queries about how astronauts eat, sleep and drink in space. The presentation was sponsored by the NASA Office of External Affairs and Education at Stennis. For more information about NASA education initiatives, visit: http://education.ssc.nasa.gov/.

  12. Ketogenic Diet Decreases Emergency Room Visits and Hospitalizations Related to Epilepsy

    PubMed Central

    Luniova, Anastasia; Abdelmoity, Ahmed

    2016-01-01

    Background. Approximately, one-third of patients with epilepsy are refractory to pharmacological treatment which mandates extensive medical care and imposes significant economic burden on patients and their societies. This study intends to assess the impact of the treatment with ketogenic diet (KD) on reducing seizure-related emergency room visits and hospitalizations in children with refractory epilepsy. Methods. This is a retrospective review of children treated with the KD in one tertiary center. We compared a 12 months' period prior to KD with 12 months after the diet was started in regard to the number of emergency department (ED) visits, hospitalizations, and hospital days as well as their associated charges. Results. 37 patients (57% males) were included. Their ages at time of KD initiation were (4.0 ± 2.78) years. Twelve months after the KD initiation, the total number of ED visits was reduced by 36% with a significant decrease of associated charges (p = 0.038). The number of hospital admissions was reduced by 40% and the number of hospital days was reduced by 39%. The cumulative charges showed net cost savings after 9 months when compared to the prediet baseline. Conclusion. In children with refractory epilepsy, treatment with the ketogenic diet reduces the number of ED visits and hospitalizations and their corresponding costs. PMID:27752367

  13. Short-term Effects of Ambient Air Pollution on Emergency Department Visits for Asthma: An Assessment of Effect Modification by Prior Allergic Disease History

    PubMed Central

    Sohn, Jungwoo; Cho, Jaelim; Cho, Seong-Kyung; Choi, Yoon Jung; Shin, Dong Chun

    2016-01-01

    Objectives The goal of this study was to investigate the short-term effect of ambient air pollution on emergency department (ED) visits in Seoul for asthma according to patients’ prior history of allergic diseases. Methods Data on ED visits from 2005 to 2009 were obtained from the Health Insurance Review and Assessment Service. To evaluate the risk of ED visits for asthma related to ambient air pollutants (carbon monoxide [CO], nitrogen dioxide [NO2], ozone [O3], sulfur dioxide [SO2], and particulate matter with an aerodynamic diameter <10 μm [PM10]), a generalized additive model with a Poisson distribution was used; a single-lag model and a cumulative-effect model (average concentration over the previous 1-7 days) were also explored. The percent increase and 95% confidence interval (CI) were calculated for each interquartile range (IQR) increment in the concentration of each air pollutant. Subgroup analyses were done by age, gender, the presence of allergic disease, and season. Results A total of 33 751 asthma attack cases were observed during the study period. The strongest association was a 9.6% increase (95% CI, 6.9% to 12.3%) in the risk of ED visits for asthma per IQR increase in O3 concentration. IQR changes in NO2 and PM10 concentrations were also significantly associated with ED visits in the cumulative lag 7 model. Among patients with a prior history of allergic rhinitis or atopic dermatitis, the risk of ED visits for asthma per IQR increase in PM10 concentration was higher (3.9%; 95% CI, 1.2% to 6.7%) than in patients with no such history. Conclusions Ambient air pollutants were positively associated with ED visits for asthma, especially among subjects with a prior history of allergic rhinitis or atopic dermatitis. PMID:27744674

  14. Emergency Department Visits for Asthma Exacerbation due to Weather Conditions and Air Pollution in Chuncheon, Korea: A Case-Crossover Analysis

    PubMed Central

    Kwon, Jae-Woo; Han, Young-Ji; Oh, Moo Kyung; Lee, Chang Youl; Kim, Ja Yeun; Kim, E Jin; Kim, Ho

    2016-01-01

    Purpose This retrospective study was conducted to estimate the effects of climate factors and air pollution on asthma exacerbations using a case-crossover analysis. Methods Patients who visited the emergency department (ED) of 2 university hospitals in Chuncheon for asthma exacerbations from January 1, 2006, to December 31, 2011, were enrolled. Daily average data for meteorological factors (temperature, daily temperature range, relative humidity, wind speed, atmospheric pressure, presence of rain, solar irradiation, and presence of fog) and the daily average levels of gaseous air pollutants (SO2, NO2, O3, CO, and PM10) were obtained. A case-crossover analysis was performed using variables about the weather and air pollution at 1-week intervals between cases and controls before and after ED visits. Results There were 660 ED visits by 583 patients with asthma exacerbations. Low relative humidity (lag 1 and 2) and high wind speed (lag 1, 2, and 3) were associated with ED visits for asthma. Fog (lag 2) showed protective effects against asthma exacerbations in Chuncheon (risk increase: -29.4% [95% CI=-46.3% to -7.2%], P=0.013). These relationships were stronger in patients ≤19 years old than in those >60 years old. High levels of ambient CO (lag 1, 2, and 3) and NO2 (lag 2 and 3) were associated with decreased ED visits for asthma. However, there were no significant relationships among levels of ambient CO or NO2 and asthma exacerbations after adjusting for wind speed and relative humidity. Conclusions High wind speed and low humidity were associated with an increased risk of asthma ED visits. Fog was associated with a decreased risk of asthma ED visits after controlling for seasonal variations in weather and air pollution. PMID:27582402

  15. 28 CFR 540.47 - Media visits.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Media visits. 540.47 Section 540.47... PERSONS IN THE COMMUNITY Visiting Regulations § 540.47 Media visits. Requirements for media visits are governed by the provisions on contact with news media (see subpart E of this part). A media...

  16. 28 CFR 540.47 - Media visits.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Media visits. 540.47 Section 540.47... PERSONS IN THE COMMUNITY Visiting Regulations § 540.47 Media visits. Requirements for media visits are governed by the provisions on contact with news media (see subpart E of this part). A media...

  17. 28 CFR 540.47 - Media visits.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Media visits. 540.47 Section 540.47... PERSONS IN THE COMMUNITY Visiting Regulations § 540.47 Media visits. Requirements for media visits are governed by the provisions on contact with news media (see subpart E of this part). A media...

  18. 28 CFR 540.47 - Media visits.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Media visits. 540.47 Section 540.47... PERSONS IN THE COMMUNITY Visiting Regulations § 540.47 Media visits. Requirements for media visits are governed by the provisions on contact with news media (see subpart E of this part). A media...

  19. 28 CFR 540.47 - Media visits.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Media visits. 540.47 Section 540.47... PERSONS IN THE COMMUNITY Visiting Regulations § 540.47 Media visits. Requirements for media visits are governed by the provisions on contact with news media (see subpart E of this part). A media...

  20. Paediatric trauma in the USA: patterns of emergency department visits and associated hospital resource use.

    PubMed

    Odetola, Folafoluwa O; Gebremariam, Achamyeleh

    2015-01-01

    Trauma is the leading cause of mortality and morbidity among children in the USA. To examine the variation in the epidemiology and patterns of visits to emergency departments (EDs), and test the hypothesis that children evaluated at trauma centre EDs will have higher injury severity and a higher likelihood of hospitalisation versus those evaluated at non-trauma centre EDs, we analysed a national database of all injured children aged 0-20 years evaluated at US EDs in 2009. Childhood injuries are a frequent cause of visits to US EDs, with a national point prevalence of 620 cases per 10,000 children aged 0-20 years. Epidemiology of childhood injuries in the USA is significant for male gender preponderance, significant seasonal and geographical variation, and disproportionately more frequent injury to the extremities than other sites of the body. National hospital resource use was significant, with greater burden borne by trauma centres which disproportionately provided care to the most severely injured children.

  1. Beautiful Science: Worth a Visit

    ERIC Educational Resources Information Center

    Bingham, Frederick M.

    2013-01-01

    For those in the profession of teaching physics who reside in or plan to visit the Los Angeles area, I would highly recommend a trip to the Huntington Library in San Marino, specifically to a permanent exhibit entitled "Beautiful Science: Ideas that Changed the World" in the Dibner Hall of the History of Science. The exhibit contains original…

  2. Visiting School Campuses: Reporter Guide

    ERIC Educational Resources Information Center

    Carr, Sarah

    2013-01-01

    Spending time in schools and classrooms can be one of the best ways for novice reporters to dive into the education beat, and for veteran journalists to find fresh inspiration. While it is certainly not necessary for every story, education journalists should try their best to make time to visit schools. Classroom observations and campus tours help…

  3. A Modern Visit to Galileo

    ERIC Educational Resources Information Center

    Freilich, Florence G.

    1970-01-01

    Describes the author's visit to the Italian cities where Galileo lived. Discusses the legendary swinging Cathedral lamp and the Leaning Tower of Pisa. Describes the science apparatus used by Galileo and other men of science which appear in the Museum of the History of Science in Florence. Presents six pictures of items viewed within the museum.…

  4. The effects of control of systolic and diastolic hypertension on cardiovascular and all-cause mortality in a community-based population cohort.

    PubMed

    Barengo, N C; Antikainen, R; Kastarinen, M; Laatikainen, T; Tuomilehto, J

    2013-11-01

    The objective of this study (follow-up of 26,113 people) was to investigate differences in the risk of cardiovascular disease (CVD) and all-cause mortality among hypertensive people according to the control of systolic blood pressure (SBP) and diastolic blood pressure (DBP). People with a history of coronary heart disease, heart failure, cancer or incomplete data at baseline (n=1113) were excluded from the study. The participants were classified into six groups according to their blood pressure status. Treated hypertensive individuals with controlled SBP and DBP did not experience an increase in all-cause mortality compared with normotensive people. The increase in all-cause mortality was 1.48-fold (95% confidence interval (CI) 1.09-2.01) among those who were treated with antihypertensive drugs and had only their DBP controlled and 1.45-fold (95% CI 1.04-2.02) among those who were treated and had only their SBP controlled. Treated patients with both SBP and DBP controlled did not have an increased risk of CVD mortality when compared with normotensive people. The risk of CVD mortality was statistically significantly higher in treated hypertensive people with SBP alone, DBP alone or both SBP and DBP uncontrolled. Our study indicates that uncontrolled SBP alone and DBP alone are risk factors of all-cause and CVD mortality.

  5. The reverse J shaped association between serum total 25- hydroxyvitamin D and all-cause mortality: The impact of assay standardization

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The impact of standardizing the originally measured serum total 25-hydroxyvitamin D [25(OH)D] values from Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) on the association between 25(OH)D and rate of all-cause mortality was evaluated. Values were standardized to gold ...

  6. Habitual Sleep Duration and Insomnia and the Risk of Cardiovascular Events and All-cause Death: Report from a Community-Based Cohort

    PubMed Central

    Chien, Kuo-Liong; Chen, Pei-Chung; Hsu, Hsiu-Ching; Su, Ta-Chen; Sung, Fung-Chang; Chen, Ming-Fong; Lee, Yuan-Teh

    2010-01-01

    Study Objectives: To investigate the relationship between sleep duration and insomnia severity and the risk of all-cause death and cardiovascular disease (CVD) events Design: Prospective cohort study Setting: Community-based Participants: A total of 3,430 adults aged 35 years or older Intervention: None Measurements and Results: During a median 15.9 year (interquartile range, 13.1 to 16.9) follow-up period, 420 cases developed cardiovascular disease and 901 cases died. A U-shape association between sleep duration and all-cause death was found: the age and gender-adjusted relative risks (95% confidence interval [CI]) of all-cause death (with 7 h of daily sleep being considered for the reference group) for individuals reporting ≤ 5 h, 6 h, 8 h, and ≥ 9 h were 1.15 (0.91–1.45), 1.02 (0.85–1.25), 1.05 (0.88–1.27), and 1.43 (1.16–1.75); P for trend, 0.019. However, the relationship between sleep duration and risk of CVD were linear. The multivariate-adjusted relative risk (95% CI) for all-cause death (using individuals without insomnia) were 1.02 (0.86–1.20) for occasional insomnia, 1.15 (0.92–1.42) for frequent insomnia, and 1.70 (1.16–2.49) for nearly everyday insomnia (P for trend, 0.028). The multivariate adjusted relative risk (95% CI) was 2.53 (1.71–3.76) for all-cause death and 2.07 (1.11–3.85) for CVD rate in participants sleeping ≥9 h and for those with frequent insomnia. Conclusions: Sleep duration and insomnia severity were associated with all-cause death and CVD events among ethnic Chinese in Taiwan. Our data indicate that an optimal sleep duration (7–8 h) predicted fewer deaths. Citation: Chien K; Chen P; Hsu H; Su T; Sung F; Chen M; Lee Y. Habitual sleep duration and insomnia and the risk of cardiovascular events and all-cause death: report from a community-based cohort. SLEEP 2010;33(2):177–184. PMID:20175401

  7. Bedside point of care toxicology screens in the ED: Utility and pitfalls

    PubMed Central

    Bhalla, Ashish

    2014-01-01

    Exposure to drugs and toxins is a major cause for patients’ visits to the emergency department (ED). For most drugs-of-abuse intoxication, ED physicians are skeptical to rely on results of urine drug testing for emergent management decisions. This is partially because immunoassays, although rapid, have limitations in sensitivity and specificity and chromatographic assays, which are more definitive, are more labor intensive. Testing for toxic alcohols is needed, but rapid commercial assays are not available. ED physicians need stat assays for acetaminophen, salicylates, co-oximetry, cholinesterase, iron, and some therapeutic drugs that could be used as agents of self-harm. In this review, we look at the potential limitations of these screening tests and suggest improvements and innovations needed for better clinical utilization. New drugs of abuse should be sought and assays should be developed to meet changing abuse patterns. PMID:25337490

  8. Bedside point of care toxicology screens in the ED: Utility and pitfalls.

    PubMed

    Bhalla, Ashish

    2014-07-01

    Exposure to drugs and toxins is a major cause for patients' visits to the emergency department (ED). For most drugs-of-abuse intoxication, ED physicians are skeptical to rely on results of urine drug testing for emergent management decisions. This is partially because immunoassays, although rapid, have limitations in sensitivity and specificity and chromatographic assays, which are more definitive, are more labor intensive. Testing for toxic alcohols is needed, but rapid commercial assays are not available. ED physicians need stat assays for acetaminophen, salicylates, co-oximetry, cholinesterase, iron, and some therapeutic drugs that could be used as agents of self-harm. In this review, we look at the potential limitations of these screening tests and suggest improvements and innovations needed for better clinical utilization. New drugs of abuse should be sought and assays should be developed to meet changing abuse patterns. PMID:25337490

  9. Occupational class inequalities in all-cause and cause-specific mortality among middle-aged men in 14 European populations during the early 2000s.

    PubMed

    Toch-Marquardt, Marlen; Menvielle, Gwenn; Eikemo, Terje A; Kulhánová, Ivana; Kulik, Margarete C; Bopp, Matthias; Esnaola, Santiago; Jasilionis, Domantas; Mäki, Netta; Martikainen, Pekka; Regidor, Enrique; Lundberg, Olle; Mackenbach, Johan P

    2014-01-01

    This study analyses occupational class inequalities in all-cause mortality and four specific causes of death among men, in Europe in the early 2000s, and is the most extensive comparative analysis of occupational class inequalities in mortality in Europe so far. Longitudinal data, obtained from population censuses and mortality registries in 14 European populations, from around the period 2000-2005, were used. Analyses concerned men aged 30-59 years and included all-cause mortality and mortality from all cancers, all cardiovascular diseases (CVD), all external, and all other causes. Occupational class was analysed according to five categories: upper and lower non-manual workers, skilled and unskilled manual workers, and farmers and self-employed combined. Inequalities were quantified with mortality rate ratios, rate differences, and population attributable fractions (PAF). Relative and absolute inequalities in all-cause mortality were more pronounced in Finland, Denmark, France, and Lithuania than in other populations, and the same countries (except France) also had the highest PAF values for all-cause mortality. The main contributing causes to these larger inequalities differed strongly between countries (e.g., cancer in France, all other causes in Denmark). Relative and absolute inequalities in CVD mortality were markedly lower in Southern European populations. We conclude that relative and absolute occupational class differences in all-cause and cause specific mortality have persisted into the early 2000's, although the magnitude differs strongly between populations. Comparisons with previous studies suggest that the relative gap in mortality between occupational classes has further widened in some Northern and Western European populations.

  10. Cardiac troponin and C-reactive protein for predicting all-cause and cardiovascular mortality in patients with chronic kidney disease: A meta-analysis

    PubMed Central

    Li, Wei-Jie; Chen, Xu-Miao; Nie, Xiao-Ying; Zhang, Jing; Cheng, Yun-Jiu; Lin, Xiao-Xiong; Wu, Su-Hua

    2015-01-01

    Elevated serum levels of cardiac troponin and C-reactive protein are associated with all-cause and cardiovascular mortality in patients with end-stage renal disease. However, the relationship between these two biomarker levels and mortality in patients with chronic kidney disease remains unclear. We conducted a meta-analysis to quantify the association of cardiac troponin and C-reactive protein levels with all-cause and cardiovascular mortality in patients with chronic kidney disease. Relevant studies were identified by searching the MEDLINE database through November 2013. Studies were included in the meta-analysis if they reported the long-term all-cause or cardiovascular mortality of chronic kidney disease patients with abnormally elevated serum levels of cardiac troponin or C-reactive protein. Summary estimates of association were obtained using a random-effects model. Thirty-two studies met our inclusion criteria. From the pooled analysis, cardiac troponin and C-reactive protein were significantly associated with all-cause (HR 2.93, 95% CI 1.97-4.33 and HR 1.21, 95% CI 1.14-1.29, respectively) and cardiovascular (HR 3.27, 95% CI 1.67-6.41 and HR 1.19, 95% CI 1.10-1.28, respectively) mortality. In the subgroup analysis of cardiac troponin and C-reactive protein, significant heterogeneities were found among the subgroups of population for renal replacement therapy and for the proportion of smokers and the C-reactive protein analysis method. Elevated serum levels of cardiac troponin and C-reactive protein are significant associated with higher risks of all-cause and cardiovascular mortality in patients with chronic kidney disease. Further studies are warranted to explore the risk stratification in chronic kidney disease patients. PMID:26017799

  11. N-3 long-chain polyunsaturated fatty acids and risk of all-cause mortality among general populations: a meta-analysis

    PubMed Central

    Chen, Guo-Chong; Yang, Jing; Eggersdorfer, Manfred; Zhang, Weiguo; Qin, Li-Qiang

    2016-01-01

    Prospective observational studies have shown inconsistent associations of dietary or circulating n-3 long-chain polyunsaturated fatty acids (LCPUFA) with risk of all-cause mortality. A meta-analysis was performed to evaluate the associations. Potentially eligible studies were identified by searching PubMed and EMBASE databases. The summary relative risks (RRs) with 95% confidence intervals (CIs) were calculated using the random-effects model. Eleven prospective studies involving 371 965 participants from general populations and 31 185 death events were included. The summary RR of all-cause mortality for high-versus-low n-3 LCPUFA intake was 0.91 (95% CI: 0.84–0.98). The summary RR for eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intake was 0.83 (95% CI: 0.75–0.92) and 0.81 (95% CI: 0.74–0.95), respectively. In the dose-response analysis, each 0.3 g/d increment in n-3 LCPUFA intake was associated with 6% lower risk of all-cause mortality (RR = 0.94, 95% CI: 0.89–0.99); and each 1% increment in the proportions of circulating EPA and DHA in total fatty acids in blood was associated with 20% (RR = 0.80, 95% CI: 0.65–0.98) and 21% (RR = 0.79, 95% CI: 0.63–0.99) decreased risk of all-cause mortality, respectively. Moderate to high heterogeneity was observed across our anlayses. Our findings suggest that both dietary and circulating LCPUFA are inversely associated with all-cause mortality. PMID:27306836

  12. Occupational Class Inequalities in All-Cause and Cause-Specific Mortality among Middle-Aged Men in 14 European Populations during the Early 2000s

    PubMed Central

    Toch-Marquardt, Marlen; Menvielle, Gwenn; Eikemo, Terje A.; Kulhánová, Ivana; Kulik, Margarete C.; Bopp, Matthias; Esnaola, Santiago; Jasilionis, Domantas; Mäki, Netta; Martikainen, Pekka; Regidor, Enrique; Lundberg, Olle; Mackenbach, Johan P.

    2014-01-01

    This study analyses occupational class inequalities in all-cause mortality and four specific causes of death among men, in Europe in the early 2000s, and is the most extensive comparative analysis of occupational class inequalities in mortality in Europe so far. Longitudinal data, obtained from population censuses and mortality registries in 14 European populations, from around the period 2000–2005, were used. Analyses concerned men aged 30–59 years and included all-cause mortality and mortality from all cancers, all cardiovascular diseases (CVD), all external, and all other causes. Occupational class was analysed according to five categories: upper and lower non-manual workers, skilled and unskilled manual workers, and farmers and self-employed combined. Inequalities were quantified with mortality rate ratios, rate differences, and population attributable fractions (PAF). Relative and absolute inequalities in all-cause mortality were more pronounced in Finland, Denmark, France, and Lithuania than in other populations, and the same countries (except France) also had the highest PAF values for all-cause mortality. The main contributing causes to these larger inequalities differed strongly between countries (e.g., cancer in France, all other causes in Denmark). Relative and absolute inequalities in CVD mortality were markedly lower in Southern European populations. We conclude that relative and absolute occupational class differences in all-cause and cause specific mortality have persisted into the early 2000's, although the magnitude differs strongly between populations. Comparisons with previous studies suggest that the relative gap in mortality between occupational classes has further widened in some Northern and Western European populations. PMID:25268702

  13. For success with frequent ED utilizers, take steps to understand patient needs, connect them with appropriate resources.

    PubMed

    2013-05-01

    Through its newly created Consistent Care Program, St. Luke's Hospital in Cedar Rapids, IA, has been able to significantly reduce ED utilization among patients who have been identified as having used the ED at least 12 times in the past year. Patients who meet program criteria are automatically identified once per month. A committee of social workers, nurses, and providers then creates care plans for these individuals, so that when they present to the ED, emergency providers will have a consistent road map to follow. In one year, the program has reduced the number ED visits among frequent utilizers by one-third, saving the hospital close to $1 million. Of the original 103 patients who were first identified for the program in January of 2012, only 10 patients still meet the criteria of visiting the ED 12 times in 12 months. Administrators say that key elements of the program are case manager who can interact with the patients and their providers, a mechanism for flagging these patients when they present to the ED, and engaged providers. PMID:23667953

  14. Emergency Department Visits for Homelessness or Inadequate Housing in New York City before and after Hurricane Sandy.

    PubMed

    Doran, Kelly M; McCormack, Ryan P; Johns, Eileen L; Carr, Brendan G; Smith, Silas W; Goldfrank, Lewis R; Lee, David C

    2016-04-01

    Hurricane Sandy struck New York City on October 29, 2012, causing not only a large amount of physical damage, but also straining people's health and disrupting health care services throughout the city. In prior research, we determined that emergency department (ED) visits from the most vulnerable hurricane evacuation flood zones in New York City increased after Hurricane Sandy for several medical diagnoses, but also for the diagnosis of homelessness. In the current study, we aimed to further explore this increase in ED visits for homelessness after Hurricane Sandy's landfall. We performed an observational before-and-after study using an all-payer claims database of ED visits in New York City to compare the demographic characteristics, insurance status, geographic distribution, and health conditions of ED patients with a primary or secondary ICD-9 diagnosis of homelessness or inadequate housing in the first week after Hurricane Sandy's landfall versus the baseline weekly average in 2012 prior to Hurricane Sandy. We found statistically significant increases in ED visits for diagnosis codes of homelessness or inadequate housing in the week after Hurricane Sandy's landfall. Those accessing the ED for homelessness or inadequate housing were more often elderly and insured by Medicare after versus before the hurricane. Secondary diagnoses among those with a primary ED diagnosis of homelessness or inadequate housing also differed after versus before Hurricane Sandy. These observed differences in the demographic, insurance, and co-existing diagnosis profiles of those with an ED diagnosis of homelessness or inadequate housing before and after Hurricane Sandy suggest that a new population cohort-potentially including those who had lost their homes as a result of storm damage-was accessing the ED for homelessness or other housing issues after the hurricane. Emergency departments may serve important public health and disaster response roles after a hurricane, particularly for

  15. Visit-to-visit variability of blood pressure and coronary heart disease, stroke, heart failure and mortality: A cohort study

    PubMed Central

    Muntner, Paul; Whittle, Jeff; Lynch, Amy I.; Colantonio, Lisandro D.; Simpson, Lara M.; Einhorn, Paula T.; Levitan, Emily B.; Whelton, Paul K; Cushman, William C.; Louis, Gail T.; Davis, Barry R.; Oparil, Suzanne

    2016-01-01

    Background Variability of blood pressure (BP) across outpatient visits is frequently dismissed as random fluctuation around a patient’s underlying BP. Objective: Examine the association between visit-to-visit variability (VVV) of systolic and diastolic BP (SBP and DBP) on cardiovascular disease and mortality outcomes. Design Prospective cohort study Setting Post-hoc analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Participants 25,814 ALLHAT participants. Measurements VVV of SBP was defined as the standard deviation (SD) across BP measurements obtained at 7 visits conducted from 6 to 28 months following ALLHAT enrollment. Participants free of cardiovascular disease events during the first 28 months of follow-up were followed from the month 28 study visit through the end of active ALLHAT follow-up. Outcomes included fatal coronary heart disease or non-fatal myocardial infarction, all-cause mortality, stroke and heart failure. Results There were 1194 cases of fatal CHD or non-fatal MI, 1948 deaths, 606 cases of stroke and 921 cases of heart failure during follow-up. After multivariable adjustment including mean SBP, the hazard ratio comparing participants in the highest versus lowest quintile of SD of SBP (≥14.4 mmHg versus <6.5 mmHg) was 1.30 (1.06–1.59) for fatal coronary heart disease or non-fatal myocardial infarction, 1.58 (1.32–1.90) for all-cause mortality, 1.46 (1.06–2.01) for stroke, and 1.25 (0.97–1.61) for heart failure. Higher VVV of DBP was also associated with cardiovascular disease events and mortality. Limitations Long-term outcomes were not available. Conclusions Higher VVV of SBP is associated with increased cardiovascular disease and mortality risk. Future studies should examine whether reducing VVV of BP lowers this risk. Primary funding source National Institutes of Health PMID:26215765

  16. Usefulness of Beta2-Microglobulin as a Predictor of All-Cause and Nonculprit Lesion-Related Cardiovascular Events in Acute Coronary Syndromes (from the PROSPECT Study).

    PubMed

    Möckel, Martin; Muller, Reinhold; Searle, Julia; Slagman, Anna; De Bruyne, Bernard; Serruys, Patrick; Weisz, Giora; Xu, Ke; Holert, Fabian; Müller, Christian; Maehara, Akiko; Stone, Gregg W

    2015-10-01

    In the Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT) study, plaque burden, plaque composition, and minimal luminal area were associated with an increased risk of adverse cardiovascular events arising from untreated atherosclerotic lesions (vulnerable plaques) in patients with acute coronary syndromes (ACS). We sought to evaluate the utility of biomarker profiling and clinical risk factors to predict 3-year all-cause and nonculprit lesion-related major adverse cardiac events (MACEs). Of 697 patients who underwent successful percutaneous coronary intervention (PCI) for ACS, an array of 28 baseline biomarkers was analyzed. Median follow-up was 3.4 years. Beta2-microglobulin displayed the strongest predictive power of all variables assessed for all-cause and nonculprit lesion-related MACE. In a classification and regression tree analysis, patients with beta2-microglobulin >1.92 mg/L had an estimated 28.7% 3-year incidence of all-cause MACE; C-peptide <1.32 ng/ml was associated with a further increase in MACE to 51.2%. In a classification and regression tree analysis for untreated nonculprit lesion-related MACE, beta2-microglobulin >1.92 mg/L identified a cohort with a 3-year rate of 18.5%, and C-peptide <2.22 ng/ml was associated with a further increase to 25.5%. By multivariable analysis, beta2-microglobulin was the strongest predictor of all-cause and nonculprit MACE during follow-up. High-density lipoprotein (HDL), transferrin, and history of angina pectoris were also independent predictors of all-cause MACE, and HDL was an independent predictor of nonculprit MACE. In conclusion, in the PROSPECT study, beta2-microglobulin strongly predicted all-cause and nonculprit lesion-related MACE within 3 years after PCI in ACS. C-peptide and HDL provided further risk stratification to identify angiographically mild nonculprit lesions prone to future MACE.

  17. Usefulness of Beta2-Microglobulin as a Predictor of All-Cause and Nonculprit Lesion-Related Cardiovascular Events in Acute Coronary Syndromes (from the PROSPECT Study).

    PubMed

    Möckel, Martin; Muller, Reinhold; Searle, Julia; Slagman, Anna; De Bruyne, Bernard; Serruys, Patrick; Weisz, Giora; Xu, Ke; Holert, Fabian; Müller, Christian; Maehara, Akiko; Stone, Gregg W

    2015-10-01

    In the Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT) study, plaque burden, plaque composition, and minimal luminal area were associated with an increased risk of adverse cardiovascular events arising from untreated atherosclerotic lesions (vulnerable plaques) in patients with acute coronary syndromes (ACS). We sought to evaluate the utility of biomarker profiling and clinical risk factors to predict 3-year all-cause and nonculprit lesion-related major adverse cardiac events (MACEs). Of 697 patients who underwent successful percutaneous coronary intervention (PCI) for ACS, an array of 28 baseline biomarkers was analyzed. Median follow-up was 3.4 years. Beta2-microglobulin displayed the strongest predictive power of all variables assessed for all-cause and nonculprit lesion-related MACE. In a classification and regression tree analysis, patients with beta2-microglobulin >1.92 mg/L had an estimated 28.7% 3-year incidence of all-cause MACE; C-peptide <1.32 ng/ml was associated with a further increase in MACE to 51.2%. In a classification and regression tree analysis for untreated nonculprit lesion-related MACE, beta2-microglobulin >1.92 mg/L identified a cohort with a 3-year rate of 18.5%, and C-peptide <2.22 ng/ml was associated with a further increase to 25.5%. By multivariable analysis, beta2-microglobulin was the strongest predictor of all-cause and nonculprit MACE during follow-up. High-density lipoprotein (HDL), transferrin, and history of angina pectoris were also independent predictors of all-cause MACE, and HDL was an independent predictor of nonculprit MACE. In conclusion, in the PROSPECT study, beta2-microglobulin strongly predicted all-cause and nonculprit lesion-related MACE within 3 years after PCI in ACS. C-peptide and HDL provided further risk stratification to identify angiographically mild nonculprit lesions prone to future MACE. PMID:26254706

  18. Population density, socioeconomic environment and all-cause mortality: a multilevel survival analysis of 2.7 million individuals in Denmark.

    PubMed

    Meijer, Mathias; Kejs, Anne Mette; Stock, Christiane; Bloomfield, Kim; Ejstrud, Bo; Schlattmann, Peter

    2012-03-01

    This study examines the relative effects of population density and area-level SES on all-cause mortality in Denmark. A shared frailty model was fitted with 2.7 million persons aged 30-81 years in 2,121 parishes. Residence in areas with high population density increased all-cause mortality for all age groups. For older age groups, residence in areas with higher proportions of unemployed persons had an additional effect. Area-level factors explained considerably more variation in mortality among the elderly than among younger generations. Overall this study suggests that structural prevention efforts in neighborhoods could help reduce mortality when mediating processes between area-level socioeconomic status, population density and mortality are found.

  19. Effect of Urate-Lowering Therapy on All-Cause and Cardiovascular Mortality in Hyperuricemic Patients without Gout: A Case-Matched Cohort Study

    PubMed Central

    Chen, Jiunn-Horng; Lan, Joung-Liang; Cheng, Chi-Fung; Liang, Wen-Miin; Lin, Hsiao-Yi; Tsay, Gregory J; Yeh, Wen-Ting; Pan, Wen-Harn

    2015-01-01

    Objectives An increased risk of mortality in patients with hyperuricemia has been reported. We examined (1) the risk of all-cause and cardiovascular disease (CVD) mortality in untreated hyperuricemic patients who did not receive urate-lowering therapy (ULT), and (2) the impact of ULT on mortality risk in patients with hyperuricemia. Methods In this retrospective case-matched cohort study during a mean follow-up of 6.4 years, 40,118 Taiwanese individuals aged ≥17 years who had never used ULT and who had never had gout were examined. The mortality rate was compared between 3,088 hyperuricemic patients who did not receive ULT and reference subjects (no hyperuricemia, no gout, no ULT) matched for age and sex (1:3 hyperuricemic patients/reference subjects), and between 1,024 hyperuricemic patients who received ULT and 1,024 hyperuricemic patients who did not receive ULT (matched 1:1 based on their propensity score and the index date of ULT prescription). Cox proportional hazard modeling was used to estimate the respective risk of all-cause and CVD (ICD-9 code 390–459) mortality. Results After adjustment, hyperuricemic patients who did not receive ULT had increased risks of all-cause (hazard ratio, 1.24; 95% confidence interval, 0.97–1.59) and CVD (2.13; 1.34–3.39) mortality relative to the matched reference subjects. Hyperuricemic patients treated with ULT had a lower risk of all-cause death (0.60; 0.41–0.88) relative to hyperuricemic patients who did not receive ULT. Conclusion Under-treatment of hyperuricemia has serious negative consequences. Hyperuricemic patients who received ULT had potentially better survival than patients who did not. PMID:26683302

  20. Vascular Disease and Risk Stratification for Ischemic Stroke and All-Cause Death in Heart Failure Patients without Diagnosed Atrial Fibrillation: A Nationwide Cohort Study

    PubMed Central

    Melgaard, Line; Gorst-Rasmussen, Anders; Rasmussen, Lars Hvilsted; Lip, Gregory Y. H.; Larsen, Torben Bjerregaard

    2016-01-01

    Background Stroke and mortality risk among heart failure patients previously diagnosed with different manifestations of vascular disease is poorly described. We conducted an observational study to evaluate the stroke and mortality risk among heart failure patients without diagnosed atrial fibrillation and with peripheral artery disease (PAD) or prior myocardial infarction (MI). Methods Population-based cohort study of patients diagnosed with incident heart failure during 2000–2012 and without atrial fibrillation, identified by record linkage between nationwide registries in Denmark. Hazard rate ratios of ischemic stroke and all-cause death after 1 year of follow-up were used to compare patients with either: a PAD diagnosis; a prior MI diagnosis; or no vascular disease. Results 39,357 heart failure patients were included. When compared to heart failure patients with no vascular disease, PAD was associated with a higher 1-year rate of ischemic stroke (adjusted hazard rate ratio [HR]: 1.34, 95% confidence interval [CI]: 1.08–1.65) and all-cause death (adjusted HR: 1.47, 95% CI: 1.35–1.59), whereas prior MI was not (adjusted HR: 1.00, 95% CI: 0.86–1.15 and 0.94, 95% CI: 0.89–1.00, for ischemic stroke and all-cause death, respectively). When comparing patients with PAD to patients with prior MI, PAD was associated with a higher rate of both outcomes. Conclusions Among incident heart failure patients without diagnosed atrial fibrillation, a previous diagnosis of PAD was associated with a significantly higher rate of the ischemic stroke and all-cause death compared to patients with no vascular disease or prior MI. Prevention strategies may be particularly relevant among HF patients with PAD. PMID:27015524

  1. Association of blood pressure with all-cause mortality and stroke in Japanese hemodialysis patients: the Japan Dialysis Outcomes and Practice Pattern Study.

    PubMed

    Inaba, Masaaki; Karaboyas, Angelo; Akiba, Takashi; Akizawa, Tadao; Saito, Akira; Fukuhara, Shunichi; Combe, Christian; Robinson, Bruce M

    2014-07-01

    The association of low blood pressure (BP) with high mortality is a characteristic for hemodialysis patients. This analysis clarifies the association of BP with mortality and stroke in Japanese hemodialysis (HD) patients and examines the association separately for patients with and without antihypertensive medication (BP meds). We analyzed 9134 patients from Japan in phases 1-4 (1999-2011) of the Dialysis Outcomes and Practice Patterns Study (DOPPS), a prospective cohort study of in-center HD patients. The association of patient systolic (SBP) and diastolic (DBP) blood pressure with all-cause and cause-specific mortality was assessed using adjusted Cox regression. A U-shaped association between BP and all-cause mortality was observed, with lowest mortality for baseline SBP 140-159 mmHg and DBP 65-74 mmHg. Both SBP and DBP were positively and monotonically associated with stroke-related death: hazard ratio (95% confidence interval) was 1.24 (1.01-1.53) per 20 mmHg higher SBP and 1.23 (1.05-1.44) per 10 mmHg higher DBP. No evidence of interaction was found between SBP and use of BP meds regarding all-cause mortality (P for interaction = 0.97); the association between SBP and stroke-related death was slightly stronger among patients not on BP meds than patients on BP meds (P for interaction = 0.09). In Japanese HD patients, both low and high BP are associated with all-cause mortality. This analysis also documents a positive and monotonic association of BP with stroke-related deaths. Although our analysis indicates that the prescription of BP meds to hypertensive patients might protect against stroke-related death, additional study is warranted. PMID:24629041

  2. Cereal fibre intake and risk of mortality from all causes, CVD, cancer and inflammatory diseases: a systematic review and meta-analysis of prospective cohort studies.

    PubMed

    Hajishafiee, Maryam; Saneei, Parvane; Benisi-Kohansal, Sanaz; Esmaillzadeh, Ahmad

    2016-07-01

    Dietary fibre intake has been associated with a lower risk of mortality; however, findings on the association of different sources of dietary fibre with mortality are conflicting. We performed a systematic review and meta-analysis of the prospective cohort studies to assess the relation between cereal fibre intake and cause-specific mortality. Medline/PubMed, SCOPUS, EMBASE, ISI web of Science and Google scholar were searched up to April 2015. Eligible prospective cohort studies were included if they provided hazard ratios (HR) or relative risks (RR) and corresponding 95 % CI for the association of cereal fibre intake and mortality from all causes, CVD, cancer and inflammatory diseases. The study-specific HR were pooled by using the random-effects model. In total, fourteen prospective studies that examined the association of cereal fibre intake with mortality from all causes (n 48 052 death), CVD (n 16 882 death), cancer (n 19 489 death) and inflammatory diseases (n 1092 death) were included. The pooled adjusted HR of all-cause mortality for the highest v. the lowest category of cereal fibre intake was 0·81 (95 % CI 0·79, 0·83). Consumption of cereal fibre intake was associated with an 18 % lower risk of CVD mortality (RR 0·82; 95 % CI 0·78, 0·86). Moreover, an inverse significant association was observed between cereal fibre intake and risk of death from cancer (RR 0·85; 95 % CI 0·81, 0·89). However, no significant association was seen between cereal fibre intake and inflammation-related mortality. This meta-analysis provides further evidence that cereal fibre intake was protectively associated with mortality from all causes, CVD and cancer. PMID:27193606

  3. Past recreational physical activity, body size, and all-cause mortality following breast cancer diagnosis: results from the Breast Cancer Family Registry

    PubMed Central

    Keegan, Theresa H. M.; Milne, Roger L.; Andrulis, Irene L.; Chang, Ellen T.; Sangaramoorthy, Meera; Phillips, Kelly-Anne; Giles, Graham G.; Goodwin, Pamela J.; Apicella, Carmel; Hopper, John L.; Whittemore, Alice S.; John, Esther M.

    2010-01-01

    Few studies have considered the joint association of body mass index (BMI) and physical activity, two modifiable factors, with all-cause mortality after breast cancer diagnosis. Women diagnosed with invasive breast cancer (n=4,153) between 1991 and 2000 were enrolled in the Breast Cancer Family Registry through population-based sampling in Northern California, USA; Ontario, Canada; and Melbourne and Sydney, Australia. During a median follow-up of 7.8 years, 725 deaths occurred. Baseline questionnaires assessed moderate and vigorous recreational physical activity and BMI prior to diagnosis. Associations with all-cause mortality were assessed using Cox proportional hazards regression, adjusting for established prognostic factors. Compared with no physical activity, any recreational activity during the three years prior to diagnosis was associated with a 34% lower risk of death (hazard ratio (HR) = 0.66, 95% confidence interval (CI): 0.51-0.85) for women with estrogen receptor (ER)-positive tumors, but not those with ER-negative tumors; this association did not appear to differ by race/ethnicity or BMI. Lifetime physical activity was not associated with all-cause mortality. BMI was positively associated with all-cause mortality for women diagnosed at age ≥50 years with ER-positive tumors (compared with normal-weight women, HR for overweight = 1.39, 95% CI: 0.90-2.15; HR for obese = 1.77, 95% CI: 1.11-2.82). BMI associations did not appear to differ by race/ethnicity. Our findings suggest that physical activity and BMI exert independent effects on overall mortality after breast cancer. PMID:20140702

  4. Meta-analysis: low-dose intake of vitamin E combined with other vitamins or minerals may decrease all-cause mortality.

    PubMed

    Jiang, Shan; Pan, Zhenyu; Li, Hui; Li, Fenglan; Song, Yanyan; Qiu, Yu

    2014-01-01

    It has been suggested that vitamin E alone or combined with other vitamins or minerals can prevent oxidative stress and slow oxidative injury-related diseases, such as cardiovascular disease and cancer. A comprehensive search of PubMed/MEDLINE, EMBASE and the Cochrane Library was performed. Relative risk was used as an effect measure to compare the intervention and control groups. A total of 33 trials were included in the meta-analysis. Neither vitamin E intake alone (RR=1.01; 95% CI, 0.97 to 1.04; p=0.77) nor vitamin E intake combined with other agents (RR=0.97; 95% CI, 0.89 to 1.06; p=0.55) was correlated with all-cause mortality. Subgroup analyses revealed that low-dose vitamin E supplementation combined with other agents is associated with a statistically significant reduction in all-cause mortality (RR=0.92; 95% CI, 0.86 to 0.98; p=0.01), and vitamin E intake combined with other agents is associated with a statistically significant reduction in mortality rates among individuals without probable or confirmed diseases (RR=0.92; 95% CI, 0.86 to 0.99; p=0.02). Neither vitamin E intake alone nor combined with other agents is associated with a reduction in all-cause mortality. But a low dose (<400 IU/d) of vitamin E combined with other agents is correlated with a reduction in all-cause mortality, and vitamin E intake combined with other agents is correlated with a reduction in the mortality rate among individuals without probable or confirmed diseases.

  5. Examining the association between serum lactic dehydrogenase and all-cause mortality in patients with metabolic syndrome: a retrospective observational study

    PubMed Central

    Wu, Li-Wei; Kao, Tung-Wei; Lin, Chien-Ming; Yang, Hui-Fang; Sun, Yu-Shan; Liaw, Fang-Yih; Wang, Chung-Ching; Peng, Tao-Chun; Chen, Wei-Liang

    2016-01-01

    Objectives Emerging evidence indicates that elevated serum lactic dehydrogenase (LDH) levels are associated with increased cardiovascular mortality, but the mechanisms for this relationship remain uncertain. Since metabolic syndrome (MetS) is correlated with a higher risk of cardiovascular complications, we investigated the joint association between serum LDH levels and all-cause mortality in the US general population with MetS. Design Retrospective study. Setting The USA. Participants A retrospective observational study of 3872 adults with MetS and 7516 adults without MetS in the National Health and Nutrition Examination Survey III was performed. Main outcome measures Participants with and without MetS were both divided into 3 groups according to their serum LDH level. Multivariable Cox regression analyses and Kaplan-Meier survival probabilities were used to jointly relate all-cause, cardiovascular and cancer mortality risk to different serum LDH levels. Results For all-cause mortality in participants with MetS, multivariable adjusted HRs were 1.006 (95% CI 0.837 to 1.210; p=0.947) for serum LDH of 149–176 U/L compared with 65–149 U/L, and 1.273 (95% CI 1.049 to 1.547; p=0.015) for serum LDH of 176–668 U/L compared with 65–149 U/L. Conclusions Results support a positive association between higher level of serum LDH and mortality from all causes in individuals with MetS. PMID:27217285

  6. Determining the effectiveness of the pentavalent rotavirus vaccine against rotavirus hospitalizations and emergency department visits using two study designs

    PubMed Central

    Donauer, Stephanie; Payne, Daniel C.; Edwards, Kathryn M.; Szilagyi, Peter G.; Hornung, Richard W.; Weinberg, Geoffrey A.; Chappell, James; Hall, Caroline B.; Parashar, Umesh D.; Staat, Mary Allen

    2015-01-01

    The objective of this study is to determine the vaccine effectiveness (VE) of the pentavalent rotavirus vaccine (RV5) for preventing rotavirus-related hospitalizations and emergency department (ED) visits during the 2006–07 and 2007–08 rotavirus seasons using two study designs. Active, prospective population-based surveillance was conducted to identify cases of laboratory-confirmed rotavirus-related hospitalizations and ED visits to be used in case-cohort and case-control designs. VE was calculated using one comparison group for the case-cohort method and two comparison groups for the case-control method. The VE estimates produced by the three analyses were similar. Three doses of RV5 were effective for preventing rotavirus-related hospitalizations and ED visits in each analysis, with VE estimated as 92% in all three analyses. Two doses of RV5 were also effective, with VE ranging from 79% to 83%. A single dose was effective in the case-cohort analysis, but was not significant in either of the case-control analyses. The case-cohort and the case-control study designs produced the same VE point estimates for completion of the three dose series. Two and three doses of RV5 were effective in preventing rotavirus-related hospitalizations and ED visits. PMID:23583814

  7. Short-term effect of dust storms on the risk of mortality due to respiratory, cardiovascular and all-causes in Kuwait.

    PubMed

    Al-Taiar, Abdullah; Thalib, Lukman

    2014-01-01

    This study aimed to investigate the impact of dust storms on short-term mortality in Kuwait. We analyzed respiratory and cardiovascular mortality as well as all-cause mortality in relation to dust storm events over a 5-year study period, using data obtained through a population-based retrospective ecological time series study. Dust storm days were identified when the national daily average of PM10 exceeded 200 μg/m(3). Generalized additive models with Poisson link were used to estimate the relative risk (RR) of age-stratified daily mortality associated with dust events, after adjusting for potential confounders including weather variables and long-term trends. There was no significant association between dust storm events and same-day respiratory mortality (RR = 0.96; 95%CI 0.88-1.04), cardiovascular mortality (RR = 0.98; 95%CI 0.96-1.012) or all-cause mortality (RR = 0.99; 95%CI 0.97-1.00). Overall our findings suggest that local dust, that most likely originates from crustal materials, has little impact on short-term respiratory, cardiovascular or all-cause mortality. PMID:23329278

  8. Depression or anxiety and all-cause mortality in adults with atrial fibrillation – A cohort study in Swedish primary care

    PubMed Central

    Wändell, Per; Carlsson, Axel C.; Gasevic, Danijela; Wahlsträm, Lars; Sundquist, Jan; Sundquist, Kristina

    2016-01-01

    Objective Our aim was to study depression and anxiety in atrial fibrillation (AF) patients as risk factors for all-cause mortality in a primary care setting. Methods The study population included adults (n = 12 283) of 45 years and older diagnosed with AF in 75 primary care centres in Sweden. The association between depression or anxiety and all-cause mortality was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (95% CIs). Analyses were conducted in men and women, adjusted for age, educational level, marital status, neighborhood socio-economic status (SES), change of neighborhood status and anxiety or depression, respectively, and cardiovascular co-morbidities. As a secondary analysis, background factors and their association with depression or anxiety were explored. Results The risk of all-cause mortality was higher among men with depression compared to their counterparts without depression even after full adjustment (HR = 1.28, 95% CI 1.08–1.53). For anxiety among men and anxiety or depression among women with AF, no associations were found. Cerebrovascular disease was more common among depressed AF patients. Conclusions Increased awareness of the higher mortality among men with AF and subsequent depression is called for. We suggest a tight follow-up and treatment of both ailments in clinical practice. PMID:26758363

  9. ED security: a national telephone survey.

    PubMed

    Ellis, G L; Dehart, D A; Black, C; Gula, M J; Owens, A

    1994-03-01

    To determine current practices regarding security measures in the emergency department (ED), a random sample of 250 hospitals with EDs was surveyed by telephone. Security issues addressed included personnel (in-house security, contract guards, or police), hours of staffing in the ED, how security is armed, whether ED doors are locked at off-hours, and whether alarm buttons, direct phone lines, a paging code, closed circuit surveillance, metal detectors, and seclusion rooms are used. This information was stratified according to hospital size, ED census, rural/suburban/urban setting, teaching/nonteaching status, and region. Generally, on-site security presence increases with increasing hospital size and ED census, suburban and urban locations, and teaching status. Small, rural hospitals are more likely to lock the ED doors at off-hours, whereas the use of security codes does not clearly follow demographic trends. Larger hospitals in suburban and urban settings and having a teaching status are more likely to have secure/detention rooms and closed circuit surveillance. The use of alarm buttons and/or direct telephone lines varies widely, but is generally more common in larger, teaching hospitals, located in urban and suburban settings.

  10. Smoking and Risk of All-cause Deaths in Younger and Older Adults: A Population-based Prospective Cohort Study Among Beijing Adults in China.

    PubMed

    Li, Kuibao; Yao, Chonghua; Di, Xuan; Yang, Xinchun; Dong, Lei; Xu, Li; Zheng, Meili

    2016-01-01

    Cigarette smoking is the leading preventable cause of death worldwide. Few studies, however, have examined the modified effects of age on the association between smoking and all-cause mortality.In the current study, the authors estimated the association between smoking and age-specific mortality in adults from Beijing, China. This is a large community-based prospective cohort study comprising of 6209 Beijing adults (aged ≥40 years) studied for approximately 8 years (1991-1999). Hazard ratios (HRs) and attributable fractions associated with smoking were estimated by Cox proportional hazard models, adjusting for age, sex, alcohol intake, body mass index, systolic blood pressure, hypertension, and heart rate.The results showed, compared with nonsmokers, the multivariable-adjusted HRs for all-cause mortality were 2.7(95% confidence interval (CI):1.56-4.69) in young adult smokers (40-50 years) and 1.31 (95% CI: 1.13-1.52) in old smokers (>50 years); and the interaction term between smoking and age was significant (P = 0.026). Attributable fractions for all-cause mortality in young and old adults were 63% (95% CI: 41%-85%) and 24% (95% CI: 12%-36%), respectively. The authors estimated multivariate adjusted absolute risk (mortality) by Poisson regression and calculated risk differences and 95% CI by bootstrap estimation. Mortality differences (/10,000 person-years) were 15.99 (95% CI: 15.34-16.64) in the young and 74.61(68.57-80.65) in the old. Compared with current smokers, the HRs of all-cause deaths for former smokers in younger and older adults were 0.57 (95% CI: 0.23-1.42) and 0.96 (95% CI: 0.73-1.26), respectively.The results indicate smoking significantly increases the risks of all-cause mortality in both young and old Beijing adults from the relative and absolute risk perspectives. Smoking cessation could also reduce the excess risk of mortality caused by continuing smoking in younger adults compared with older individuals.

  11. Impact of diabetes mellitus on risk of cardiovascular disease and all-cause mortality: Evidence on health outcomes and antidiabetic treatment in United States adults

    PubMed Central

    Liu, Longjian; Simon, Barbara; Shi, Jinggaofu; Mallhi, Arshpreet Kaur; Eisen, Howard J

    2016-01-01

    AIM To examine the epidemic of diabetes mellitus (DM) and its impact on mortality from all-cause and cardiovascular disease (CVD), and to test the effect of antidiabetic therapy on the mortality in United States adults. METHODS The analysis included a randomized population sample of 272149 subjects ages ≥ 18 years who participated in the National Health Interview Surveys (NHIS) in 2000-2009. Chronic conditions (hypertension, DM and CVD) were classified by participants’ self-reports of physician diagnosis. NHIS-Mortality Linked Files, and NHIS-Medical Expenditure Panel Survey Linkage Files on prescribed medicines for patients with DM were used to test the research questions. χ2, Poisson and Cox’s regression models were applied in data analysis. RESULTS Of all participants, 22305 (8.2%) had DM. The prevalence of DM significantly increased from 2000 to 2009 in all age groups (P < 0.001). Within an average 7.39 (SD = 3) years of follow-up, male DM patients had 1.56 times higher risk of death from all-cause (HR = 1.56, 95%CI: 1.49-1.64), 1.72 times higher from heart disease [1.72 (1.53-1.93)], 1.48 times higher from cerebrovascular disease [1.48 (1.18-1.85)], and 1.67 times higher from CVD [1.67 (1.51-1.86)] than subjects without DM, respectively. Similar results were observed in females. In males, 10% of DM patients did not use any antidiabetic medications, 38.1% used antidiabetic monotherapy, and 51.9% used ≥ 2 antidiabetic medications. These corresponding values were 10.3%, 40.4% and 49.4% in females. A significant protective effect of metformin monotherapy or combination therapy (except for insulin) on all-cause mortality and a protective but non-significant effect on CVD mortality were observed. CONCLUSION This is the first study using data from multiple linkage files to confirm a significant increased prevalence of DM in the last decade in the United States. Patients with DM have significantly higher risk of death from all-cause and CVD than those without

  12. Inter-Ethnic Differences in Quantified Coronary Artery Disease Severity and All-Cause Mortality among Dutch and Singaporean Percutaneous Coronary Intervention Patients

    PubMed Central

    Gijsberts, Crystel M.; Seneviratna, Aruni; Hoefer, Imo E.; Agostoni, Pierfrancesco; Rittersma, Saskia Z. H.; Pasterkamp, Gerard; Hartman, Mikael; Pinto de Carvalho, Leonardo; Richards, A. Mark; Asselbergs, Folkert W.; de Kleijn, Dominique P. V.; Chan, Mark Y.

    2015-01-01

    Background Coronary artery disease (CAD) is a global problem with increasing incidence in Asia. Prior studies reported inter-ethnic differences in the prevalence of CAD rather than the severity of CAD. The angiographic “synergy between percutaneous coronary intervention (PCI) with taxus and cardiac surgery” (SYNTAX) score quantifies CAD severity and predicts outcomes. We studied CAD severity and all-cause mortality in four globally populous ethnic groups: Caucasians, Chinese, Indians and Malays. Methods We quantified SYNTAX scores of 1,000 multi-ethnic patients undergoing PCI in two tertiary hospitals in the Netherlands (Caucasians) and Singapore (Chinese, Indians and Malays). Within each ethnicity we studied 150 patients with stable CAD and 100 with ST-elevated myocardial infarction (STEMI). We made inter-ethnic comparisons of SYNTAX scores and all-cause mortality. Results Despite having a younger age (mean age Indians: 56.8 and Malays: 57.7 vs. Caucasians: 63.7 years), multivariable adjusted SYNTAX scores were significantly higher in Indians and Malays than Caucasians with stable CAD: 13.4 [11.9-14.9] and 13.4 [12.0-14.8] vs. 9.4 [8.1-10.8], p<0.001. Among STEMI patients, SYNTAX scores were highest in Chinese and Malays: 17.7 [15.9-19.5] and 18.8 [17.1-20.6] vs. 15.5 [13.5-17.4] and 12.7 [10.9-14.6] in Indians and Caucasians, p<0.001. Over a median follow-up of 709 days, 67 deaths (stable CAD: 37, STEMI: 30) occurred. Among STEMI patients, the SYNTAX score independently predicted all-cause mortality: HR 2.5 [1.7-3.8], p<0.001 for every 10-point increase. All-cause mortality was higher in Indian and Malay STEMI patients than Caucasians, independent of SYNTAX score (adjusted HR 7.2 [1.5-34.7], p=0.01 and 5.8 [1.2-27.2], p=0.02). Conclusion Among stable CAD and STEMI patients requiring PCI, CAD is more severe in Indians and Malays than in Caucasians, despite having a younger age. Moreover, Indian and Malay STEMI patients had a greater adjusted risk of all-cause

  13. Smoking and Risk of All-cause Deaths in Younger and Older Adults: A Population-based Prospective Cohort Study Among Beijing Adults in China.

    PubMed

    Li, Kuibao; Yao, Chonghua; Di, Xuan; Yang, Xinchun; Dong, Lei; Xu, Li; Zheng, Meili

    2016-01-01

    Cigarette smoking is the leading preventable cause of death worldwide. Few studies, however, have examined the modified effects of age on the association between smoking and all-cause mortality.In the current study, the authors estimated the association between smoking and age-specific mortality in adults from Beijing, China. This is a large community-based prospective cohort study comprising of 6209 Beijing adults (aged ≥40 years) studied for approximately 8 years (1991-1999). Hazard ratios (HRs) and attributable fractions associated with smoking were estimated by Cox proportional hazard models, adjusting for age, sex, alcohol intake, body mass index, systolic blood pressure, hypertension, and heart rate.The results showed, compared with nonsmokers, the multivariable-adjusted HRs for all-cause mortality were 2.7(95% confidence interval (CI):1.56-4.69) in young adult smokers (40-50 years) and 1.31 (95% CI: 1.13-1.52) in old smokers (>50 years); and the interaction term between smoking and age was significant (P = 0.026). Attributable fractions for all-cause mortality in young and old adults were 63% (95% CI: 41%-85%) and 24% (95% CI: 12%-36%), respectively. The authors estimated multivariate adjusted absolute risk (mortality) by Poisson regression and calculated risk differences and 95% CI by bootstrap estimation. Mortality differences (/10,000 person-years) were 15.99 (95% CI: 15.34-16.64) in the young and 74.61(68.57-80.65) in the old. Compared with current smokers, the HRs of all-cause deaths for former smokers in younger and older adults were 0.57 (95% CI: 0.23-1.42) and 0.96 (95% CI: 0.73-1.26), respectively.The results indicate smoking significantly increases the risks of all-cause mortality in both young and old Beijing adults from the relative and absolute risk perspectives. Smoking cessation could also reduce the excess risk of mortality caused by continuing smoking in younger adults compared with older individuals. PMID:26817876

  14. Night-shift work increases morbidity of breast cancer and all-cause mortality: a meta-analysis of 16 prospective cohort studies.

    PubMed

    Lin, Xiaoti; Chen, Weiyu; Wei, Fengqin; Ying, Mingang; Wei, Weidong; Xie, Xiaoming

    2015-11-01

    Night-shift work (NSW) has previously been related to incidents of breast cancer and all-cause mortality, but many published studies have reported inconclusive results. The aim of the present study was to quantify a potential dose-effect relationship between NSW and morbidity of breast cancer, and to evaluate the association between NSW and risk of all-cause mortality. The outcomes included NSW, morbidity of breast cancer, cardiovascular mortality, cancer-related mortality, and all-cause mortality. Sixteen investigations were included, involving 2,020,641 participants, 10,004 incident breast cancer cases, 7185 cancer-related deaths, 4820 cardiovascular end points, and 2480 all-cause mortalities. The summary risk ratio (RR) of incident breast cancer for an increase of NSW was 1.057 [95% confidence interval (CI) 1.014-1.102; test for heterogeneity p = 0.358, I(2) = 9.2%]. The combined RR (95% CI) of breast cancer risk for NSW vs daytime work was: 1.029 (0.969-1.093) in the <5-year subgroup, 1.019 (1.001-1.038) for 5-year incremental risk, 1.025 (1.006-1.044) for 5- to 10-year exposure times, 1.074 (1.010-1.142) in the 10- to 20-year subgroup, and 1.088 (1.012-1.169) for >20-year exposure lengths. The overall RR was 1.089 (95% CI 1.016-1.166) in a fixed-effects model (test for heterogeneity p = 0.838, I(2) = 0%) comparing rotating NSW and day work. Night-shift work was associated with an increased risk of cardiovascular death (RR 1.027, 95% CI 1.001-1.053), and all-cause death 1.253 (95% CI 0.786-1.997). In summary, NSW increased the risk of breast cancer morbidity by: 1.9% for 5 years, 2.5% for 5-10 years, 7.4% for 10-20 years, and 8.8% for >20-years of NSW. Additionally, rotating NSW enhanced the morbidity of breast cancer by 8.9%. Moreover, NSW was associated with a 2.7% increase in cardiovascular death.

  15. Dietary sodium-to-potassium ratio as a risk factor for stroke, cardiovascular disease and all-cause mortality in Japan: the NIPPON DATA80 cohort study

    PubMed Central

    Okayama, Akira; Okuda, Nagako; Miura, Katsuyuki; Okamura, Tomonori; Hayakawa, Takehito; Akasaka, Hiroshi; Ohnishi, Hirofumi; Saitoh, Shigeyuki; Arai, Yusuke; Kiyohara, Yutaka; Takashima, Naoyuki; Yoshita, Katsushi; Fujiyoshi, Akira; Zaid, Maryam; Ohkubo, Takayoshi; Ueshima, Hirotsugu

    2016-01-01

    Objectives To evaluate the impact of dietary sodium and potassium (Na–K) ratio on mortality from total and subtypes of stroke, cardiovascular disease (CVD) and all causes, using 24-year follow-up data of a representative sample of the Japanese population. Setting Prospective cohort study. Participants In the 1980 National Cardiovascular Survey, participants were followed for 24 years (NIPPON DATA80, National Integrated Project for Prospective Observation of Non-communicable Disease And its Trends in the Aged). Men and women aged 30–79 years without hypertensive treatment, history of stroke or acute myocardial infarction (n=8283) were divided into quintiles according to dietary Na–K ratio assessed by a 3-day weighing dietary record at baseline. Age-adjusted and multivariable-adjusted HRs were calculated using the Mantel-Haenszel method and Cox proportional hazards model. Primary outcome measures Mortality from total and subtypes of stroke, CVD and all causes. Results A total of 1938 deaths from all causes were observed over 176 926 person-years. Na–K ratio was significantly and non-linearly related to mortality from all stroke (p=0.002), CVD (p=0.005) and total mortality (p=0.001). For stroke subtypes, mortality from haemorrhagic stroke was positively related to Na–K ratio (p=0.024). Similar relationships were observed for men and women. The observed relationships remained significant after adjustment for other risk factors. Quadratic non-linear multivariable-adjusted HRs (95% CI) in the highest quintile versus the lowest quintile of Na–K ratio were 1.42 (1.07 to 1.90) for ischaemic stroke, 1.57 (1.05 to 2.34) for haemorrhagic stroke, 1.43 (1.17 to 1.76) for all stroke, 1.39 (1.20 to 1.61) for CVD and 1.16 (1.06 to 1.27) for all-cause mortality. Conclusions Dietary Na–K ratio assessed by a 3-day weighing dietary record was a significant risk factor for mortality from haemorrhagic stroke, all stroke, CVD and all causes among a Japanese population

  16. Epidemiology of Injury-Related Emergency Department Visits in the US Among Youth with Autism Spectrum Disorder.

    PubMed

    Kalb, Luther G; Vasa, Roma A; Ballard, Elizabeth D; Woods, Steven; Goldstein, Mitchell; Wilcox, Holly C

    2016-08-01

    Several reports suggest children with autism spectrum disorder (ASD) are more likely to be seen for injury-related ED visits; however, no nationally representative study has examined this question. Using data from the 2008 Nationwide Emergency Department Sample, over a quarter of all visits among those with ASD were related to injury. In the multivariate analyses, the odds of an injury-related visit was 54 % greater among those with ASD compared to youth with intellectual disability (ID), but 48 % less compared to youth without ID or ASD. Compared to all other pediatric injury-visits in the US, visits among children with ASD were more likely to be due to self-inflicted injury and poisoning and were more likely to result in hospitalization (all p < 0.001).

  17. Data-driven process and operational improvement in the emergency department: the ED Dashboard and Reporting Application.

    PubMed

    Stone-Griffith, Suzanne; Englebright, Jane D; Cheung, Dickson; Korwek, Kimberly M; Perlin, Jonathan B

    2012-01-01

    Emergency departments (EDs) in the United States are expected to provide consistent, high-quality care to patients. Unfortunately, EDs are encumbered by problems associated with the demand for services and the limitations of current resources, such as overcrowding, long wait times, and operational inefficiencies. While increasing the effectiveness and efficiency of emergency care would improve both access and quality of patient care, coordinated improvement efforts have been hindered by a lack of timely access to data. The ED Dashboard and Reporting Application was developed to support data-driven process improvement projects. It incorporated standard definitions of metrics, a data repository, and near real-time analysis capabilities. This helped acute care hospitals in a large healthcare system evaluate and target individual improvement projects in accordance with corporate goals. Subsequently, there was a decrease in "arrival to greet" time--the time from patient arrival to physician contact--from an average of 51 minutes in 2007 to the goal level of less than 35 minutes by 2010. The ED Dashboard and Reporting Application has also contributed to data-driven improvements in length of stay and other measures of ED efficiency and care quality. Between January 2007 and December 2010, overall length of stay decreased 10.5 percent while annual visit volume increased 13.6 percent. Thus, investing in the development and implementation of a system for ED data capture, storage, and analysis has supported operational management decisions, gains in ED efficiency, and ultimately improvements in patient care. PMID:22724375

  18. Collaborative effort in Washington state slashes non-essential use of the ED by Medicaid patients, delivering millions in projected savings.

    PubMed

    2013-04-01

    Early data suggest a coordinated, state-wide effort has reduced non-essential use of the ED by 10% among Medicaid recipients in Washington state, and is projected to save the state an estimated $31 million in the first year of the approach. The effort includes the adoption of seven best practices by hospitals across the state.These include the creation of an Emergency Department Information Exchange, so that EDs can immediately access a patient's utilization history, strict narcotic prescribing guidelines, and regular feedback reports to hospitals regarding ED utilization patterns. The effort was prompted by threats by the state legislature to limit Medicaid payments for ED visits deemed not medically necessary in the emergency setting. The legislature backed down when emergency physicians in the state countered with their own proposal to reduce nonessential use of the ED. They worked with other health care groups in the state to develop the plan. Data on the first six months of the effort are included in a report to the state legislature by the Washington State Health Care Authority. Among the findings are a 23% reduction in ED visits among Medicaid recipients with five or more visits, a 250% increase in providers who have registered with the state's Prescription Monitoring Program, aimed at identifying patients with narcotic-seeking behavior, and a doubling in the number of shared care plans, intended to improve care coordination. Emergency providers say big challenges remain, including a need for more resources for patients with mental health and dental care needs.

  19. Co-op Site Visitation and beyond.

    ERIC Educational Resources Information Center

    Page, Norman R.

    1997-01-01

    A survey of 26 faculty cooperative education coordinators, 18 students, and 13 site supervisors found that 80% thought faculty site visits were important; barriers to visits were time and distance; and alternatives included visiting only new sites or those with problems, using telephone or video, and hosting site supervisors on campus. (SK)

  20. 28 CFR 540.42 - Visiting times.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Visiting times. 540.42 Section 540.42 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT CONTACT WITH PERSONS IN THE COMMUNITY Visiting Regulations § 540.42 Visiting times. (a) Each Warden shall establish...

  1. 28 CFR 540.42 - Visiting times.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Visiting times. 540.42 Section 540.42 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT CONTACT WITH PERSONS IN THE COMMUNITY Visiting Regulations § 540.42 Visiting times. (a) Each Warden shall establish...

  2. 28 CFR 540.42 - Visiting times.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Visiting times. 540.42 Section 540.42 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT CONTACT WITH PERSONS IN THE COMMUNITY Visiting Regulations § 540.42 Visiting times. (a) Each Warden shall establish...

  3. 28 CFR 540.42 - Visiting times.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Visiting times. 540.42 Section 540.42 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT CONTACT WITH PERSONS IN THE COMMUNITY Visiting Regulations § 540.42 Visiting times. (a) Each Warden shall establish...

  4. Case Study of Home-School Visits

    ERIC Educational Resources Information Center

    Aguerrebere, Yolanda

    2009-01-01

    This case study evaluated one site of a California teacher home visit program. Home visits have been an important means of connecting families and schooling. In 1999, California inaugurated a statewide home visit program to promote effective partnership between home and school for low-achieving schools. At this site, families in 3 kindergarten…

  5. 28 CFR 540.42 - Visiting times.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Visiting times. 540.42 Section 540.42 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT CONTACT WITH PERSONS IN THE COMMUNITY Visiting Regulations § 540.42 Visiting times. (a) Each Warden shall establish...

  6. Job Candidates' Views of Site Visits.

    ERIC Educational Resources Information Center

    Fink, Laurence S.; And Others

    1994-01-01

    Followed 62 Master of Business Administration students through job search involving 97 site visits to determine whether site visits changed perceptions of visited companies, attitudes toward those firms, and intentions to accept job offers. Findings suggest that organizations can improve recruitment success by paying attention to how site visits…

  7. Home Visits in Geropsychiatry Fellowship Training

    ERIC Educational Resources Information Center

    Roane, David M.; Teusink, J. Paul; Wortham, Jennifer A.

    2002-01-01

    Purpose: The psychiatric home visit is an effective intervention for elderly patients who otherwise would not receive mental health services. Home visits also have potential to be useful for training. Here, the current practice of home visits in geropsychiatry fellowship programs is examined. Design and Methods: The directors of 55 current…

  8. Emergency Department Visits and Neuroimaging for Concussion Patients from 2006–2011

    PubMed Central

    Zonfrillo, Mark R.; Kim, Konny H.; Arbogast, Kristy B.

    2015-01-01

    Objectives Concussion is the most common type of mild traumatic brain injury for which patients present to the emergency department (ED). It is critical to understand the contemporary epidemiology of concussion and rates of head computed tomography (CT) use in head-injured patients in order to inform education of evidence-based clinical practice guidelines to emergency medicine providers. Methods This was a cross-sectional analysis of the Nationwide Emergency Department Sample (NEDS) for years 2006 to 2011, representing a stratified probability sample of all U.S. hospital-based EDs. Patients of all ages with concussion diagnoses were included, and those with intracranial hemorrhages or prolonged loss of consciousness were excluded. Descriptive and bivariate statistics were summarized for patient demographics, injury mechanism, Injury Severity Scores (ISS), and concussion incidence rates, based on U.S. Census Bureau population estimates. Results There were 756,214,762 (weighted) ED visits in the NEDS between 2006 and 2011, of which 0.5% received diagnoses of concussion. The national incidence rate of concussion visits increased 22.6% from 195 visits per 100,000 person-years in 2006, to 239 visits per 100,000 person-years in 2011. The incidence of concussion visits increased by 28.1% from 2006 to 2011 overall (580,573 to 743,994) and within all age group categories. The rate of head CT use in patients diagnosed with concussion increased 35.7% (range 34.5% to 46.8%) for the entire group from 2006 to 2011 (p < 0.0001). The injury severity of patients’ injuries decreased over time (66.4% ISS < 5 in 2006, and 75% in 2011; p < 0.0001), while the proportion of discharged patients increased over time (78.1% in 2006, 86.6% in 2011; p < 0.0001). Conclusions ED visits for concussions have increased over time, with a corresponding increase in head CT utilization despite a decrease in injury severity. Increased visits may be due to more concussion awareness and recognition of

  9. 78 FR 55684 - ConnectED Workshop

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-11

    ... stakeholders from the education, technology, and government sectors to share ideas, discuss policies, and... convene stakeholders from the education, technology, and government sectors to share ideas, discuss... National Telecommunications and Information Administration ConnectED Workshop AGENCY:...

  10. MicroED data collection and processing

    SciTech Connect

    Hattne, Johan; Reyes, Francis E.; Nannenga, Brent L.; Shi, Dan; Cruz, M. Jason de la; Leslie, Andrew G. W.; Gonen, Tamir

    2015-07-01

    The collection and processing of MicroED data are presented. MicroED, a method at the intersection of X-ray crystallography and electron cryo-microscopy, has rapidly progressed by exploiting advances in both fields and has already been successfully employed to determine the atomic structures of several proteins from sub-micron-sized, three-dimensional crystals. A major limiting factor in X-ray crystallography is the requirement for large and well ordered crystals. By permitting electron diffraction patterns to be collected from much smaller crystals, or even single well ordered domains of large crystals composed of several small mosaic blocks, MicroED has the potential to overcome the limiting size requirement and enable structural studies on difficult-to-crystallize samples. This communication details the steps for sample preparation, data collection and reduction necessary to obtain refined, high-resolution, three-dimensional models by MicroED, and presents some of its unique challenges.

  11. Beautiful Science: Worth a Visit

    NASA Astrophysics Data System (ADS)

    Bingham, Frederick M.

    2013-03-01

    For those in the profession of teaching physics who reside in or plan to visit the Los Angeles area, I would highly recommend a trip to the Huntington Library in San Marino, specifically to a permanent exhibit entitled "Beautiful Science: Ideas that Changed the World" in the Dibner Hall of the History of Science. The exhibit contains original books and manuscripts from the library's own collections. The sheer magnitude of human achievement represented here and the amount of effort and money that must have been required to amass these books boggles the mind.

  12. The combined impact of adherence to five lifestyle factors on all-cause, cancer and cardiovascular mortality: a prospective cohort study among Danish men and women.

    PubMed

    Petersen, Kristina E N; Johnsen, Nina F; Olsen, Anja; Albieri, Vanna; Olsen, Lise K H; Dragsted, Lars O; Overvad, Kim; Tjønneland, Anne; Egeberg, Rikke

    2015-03-14

    Individual lifestyle factors have been associated with lifestyle diseases and premature mortality by an accumulating body of evidence. The impact of a combination of lifestyle factors on mortality has been investigated in several studies, but few have applied a simple index taking national guidelines into account. The objective of the present prospective cohort study was to investigate the combined impact of adherence to five lifestyle factors (smoking, alcohol intake, physical activity, waist circumference and diet) on all-cause, cancer and cardiovascular mortality based on international and national health recommendations. A Cox proportional hazards model was used to estimate hazard ratios (HR) with 95 % CI. During a median follow-up of 14 years, 3941 men and 2827 women died. Among men, adherence to one additional health recommendation was associated with an adjusted HR of 0·73 (95 % CI 0·71, 0·75) for all-cause mortality, 0·74 (95 % CI 0·71, 0·78) for cancer mortality and 0·70 (95 % CI 0·65, 0·75) for cardiovascular mortality. Among women, the corresponding HR was 0·72 (95 % CI 0·70, 0·75) for all-cause mortality, 0·76 (95 % CI 0·73, 0·80) for cancer mortality and 0·63 (95 % CI 0·57, 0·70) for cardiovascular mortality. In the present study, adherence to merely one additional health recommendation had a protective effect on mortality risk, indicating a huge potential in enhancing healthy lifestyle behaviours of the population. PMID:25690300

  13. Mediterranean diet and other lifestyle factors in relation to 20-year all-cause mortality: a cohort study in an Italian population.

    PubMed

    Prinelli, Federica; Yannakoulia, Mary; Anastasiou, Costas A; Adorni, Fulvio; Di Santo, Simona G; Musicco, Massimo; Scarmeas, Nikolaos; Correa Leite, Maria L

    2015-03-28

    The aim of the present analysis was to evaluate the association of the Mediterranean diet (MeDi), smoking habits and physical activity with all-cause mortality in an Italian population during a 20-year follow-up study. A total of 1693 subjects aged 40-74 who enrolled in the study in 1991-5 were asked about dietary and other lifestyle information at baseline. Adherence to the MeDi was evaluated by the Mediterranean dietary score (MedDietScore). A healthy lifestyle score was computed by assigning 1 point each for a medium or high adherence to the MedDietScore, non-smoking and physical activity. Cox models were used to assess the associations between lifestyle factors and healthy lifestyle scores and all-cause mortality, adjusting for potential confounders. The final sample included 974 subjects with complete data and without chronic disease at baseline. During a median of 17·4 years of follow-up, 193 people died. Subjects with high adherence to the MedDietScore (hazard ratio (HR) 0·62, 95 % CI 0·43, 0·89)), non-smokers (HR 0·71, 95 % CI 0·51, 0·98) and physically active subjects (HR 0·55, 95 % CI 0·36, 0·82) were at low risk of death. Each point increase in the MedDietScore was associated with a significant 5 % reduction of death risk. Subjects with 1, 2 or 3 healthy lifestyle behaviours had a significantly 39, 56, and 73 % reduced risk of death, respectively. A high adherence to MeDi, non-smoking and physical activity were strongly associated with a reduced risk of all-cause mortality in healthy subjects after long-term follow-up. This reduction was even stronger when the healthy lifestyle behaviours were combined. PMID:25746109

  14. The Association between Sulfonylurea Use and All-Cause and Cardiovascular Mortality: A Meta-Analysis with Trial Sequential Analysis of Randomized Clinical Trials

    PubMed Central

    Varvaki Rados, Dimitris; Catani Pinto, Lana; Reck Remonti, Luciana; Bauermann Leitão, Cristiane; Gross, Jorge Luiz

    2016-01-01

    Background Sulfonylureas are an effective and inexpensive treatment for type 2 diabetes. There is conflicting data about the safety of these drugs regarding mortality and cardiovascular outcomes. The objective of the present study was to evaluate the safety of the sulfonylureas most frequently used and to use trial sequential analysis (TSA) to analyze whether the available sample was powered enough to support the results. Methods and Findings Electronic databases were reviewed from 1946 (Embase) or 1966 (MEDLINE) up to 31 December 2014. Randomized clinical trials (RCTs) of at least 52 wk in duration evaluating second- or third-generation sulfonylureas in the treatment of adults with type 2 diabetes and reporting outcomes of interest were included. Primary outcomes were all-cause and cardiovascular mortality. Additionally, myocardial infarction and stroke events were evaluated. Data were summarized with Peto odds ratios (ORs), and the reliability of the results was evaluated with TSA. Forty-seven RCTs with 37,650 patients and 890 deaths in total were included. Sulfonylureas were not associated with all-cause (OR 1.12 [95% CI 0.96 to 1.30]) or cardiovascular mortality (OR 1.12 [95% CI 0.87 to 1.42]). Sulfonylureas were also not associated with increased risk of myocardial infarction (OR 0.92 [95% CI 0.76 to 1.12]) or stroke (OR 1.16 [95% CI 0.81 to 1.66]). TSA could discard an absolute difference of 0.5% between the treatments, which was considered the minimal clinically significant difference. The major limitation of this review was the inclusion of studies not designed to evaluate safety outcomes. Conclusions Sulfonylureas are not associated with increased risk for all-cause mortality, cardiovascular mortality, myocardial infarction, or stroke. Current evidence supports the safety of sulfonylureas; an absolute risk of 0.5% could be firmly discarded. Review registration PROSPERO CRD42014004330 PMID:27071029

  15. The Effect of Coffee and Quantity of Consumption on Specific Cardiovascular and All-Cause Mortality: Coffee Consumption Does Not Affect Mortality.

    PubMed

    Loomba, Rohit S; Aggarwal, Saurabh; Arora, Rohit R

    2016-01-01

    Previous studies have examined whether or not an association exists between the consumption of caffeinated coffee to all-cause and cardiovascular mortality. This study aimed to delineate this association using population representative data from the National Health and Nutrition Examination Survey III. Patients were included in the study if all the following criteria were met: (1) follow-up mortality data were available, (2) age of at least 45 years, and (3) reported amount of average coffee consumption. A total of 8608 patients were included, with patients stratified into the following groups of average daily coffee consumption: (1) no coffee consumption, (2) less than 1 cup, (3) 1 cup a day, (4) 2-3 cups, (5) 4-5 cups, (6) more than 6 cups a day. Odds ratios, 95% confidence intervals, and P values were calculated for univariate analysis to compare the prevalence of all-cause mortality, ischemia-related mortality, congestive heart failure-related mortality, and stroke-related mortality, using the no coffee consumption group as reference. These were then adjusted for confounding factors for a multivariate analysis. P < 0.05 were considered statistically significant. Univariate analysis demonstrated an association between coffee consumption and mortality, although this became insignificant on multivariate analysis. Coffee consumption, thus, does not seem to impact all-cause mortality or specific cardiovascular mortality. These findings do differ from those of recently published studies. Coffee consumption of any quantity seems to be safe without any increased mortality risk. There may be some protective effects but additional data are needed to further delineate this.

  16. All-cause mortality in the cohorts of the Spanish AIDS Research Network (RIS) compared with the general population: 1997–2010

    PubMed Central

    2013-01-01

    Background Combination antiretroviral therapy (cART) has produced significant changes in mortality of HIV-infected persons. Our objective was to estimate mortality rates, standardized mortality ratios and excess mortality rates of cohorts of the AIDS Research Network (RIS) (CoRIS-MD and CoRIS) compared to the general population. Methods We analysed data of CoRIS-MD and CoRIS cohorts from 1997 to 2010. We calculated: (i) all-cause mortality rates, (ii) standardized mortality ratio (SMR) and (iii) excess mortality rates for both cohort for 100 person-years (py) of follow-up, comparing all-cause mortality with that of the general population of similar age and gender. Results Between 1997 and 2010, 8,214 HIV positive subjects were included, 2,453 (29.9%) in CoRIS-MD and 5,761 (70.1%) in CoRIS and 294 deaths were registered. All-cause mortality rate was 1.02 (95% CI 0.91-1.15) per 100 py, SMR was 6.8 (95% CI 5.9-7.9) and excess mortality rate was 0.8 (95% CI 0.7-0.9) per 100 py. Mortality was higher in patients with AIDS, hepatitis C virus (HCV) co-infection, and those from CoRIS-MD cohort (1997–2003). Conclusion Mortality among HIV-positive persons remains higher than that of the general population of similar age and sex, with significant differences depending on the history of AIDS or HCV coinfection. PMID:23961924

  17. Association between Body Mass Index and All-Cause Mortality in Hypertensive Adults: Results from the China Stroke Primary Prevention Trial (CSPPT)

    PubMed Central

    Yang, Wei; Li, Jian-Ping; Zhang, Yan; Fan, Fang-Fang; Xu, Xi-Ping; Wang, Bin-Yan; Xu, Xin; Qin, Xian-Hui; Xing, Hou-Xun; Tang, Gen-Fu; Zhou, Zi-Yi; Gu, Dong-Feng; Zhao, Dong; Huo, Yong

    2016-01-01

    The association between elevated body mass index (BMI) and risk of death has been reported in many studies. However, the association between BMI and all-cause mortality for hypertensive Chinese adults remains unclear. We conducted a post-hoc analysis using data from the China Stroke Primary Prevention Trial (CSPPT). Cox regression analysis was performed to determine the significance of the association of BMI with all-cause mortality. During a mean follow-up duration of 4.5 years, 622 deaths (3.0%) occurred among the 20,694 participants aged 45–75 years. A reversed J-shaped relationship was observed between BMI and all-cause mortality. The hazard ratios (HRs) for underweight (<18.5 kg/m2), overweight (24.0–27.9 kg/m2), and obesity (≥28.0 kg/m2) were calculated relative to normal weight (18.5–23.9 kg/m2). The summary HRs were 1.56 (95% CI, 1.11–2.18) for underweight, 0.78 (95% CI 0.64–0.95) for overweight and 0.64 (95% CI, 0.48–0.85) for obesity. In sex-age-specific analyses, participants over 60 years of age had optimal BMI in the obesity classification and the results were consistent in both males and females. Relative to normal weight, underweight was associated with significantly higher mortality. Excessive weight was not associated with increased risk of mortality. Chinese hypertensive adults had the lowest mortality in grade 1 obesity. PMID:27338470

  18. All-cause, drug-related, and HIV-related mortality risk by trajectories of jail incarceration and homelessness among adults in New York City.

    PubMed

    Lim, Sungwoo; Harris, Tiffany G; Nash, Denis; Lennon, Mary Clare; Thorpe, Lorna E

    2015-02-15

    We studied a cohort of 15,620 adults who had experienced at least 1 jail incarceration and 1 homeless shelter stay in 2001-2003 in New York City to identify trajectories of these events and tested whether a particular trajectory was associated with all-cause, drug-related, or human immunodeficiency virus (HIV)-related mortality risk in 2004-2005. Using matched data on jail time, homeless shelter stays, and vital statistics, we performed sequence analysis and assessed mortality risk using standardized mortality ratios (SMRs) and marginal structural modeling. We identified 6 trajectories. Sixty percent of the cohort members had a temporary pattern, which was characterized by sporadic experiences of brief incarceration and homelessness, whereas the rest had the other 5 patterns, which reflected experiences of increasing, decreasing, or persistent jail or shelter stays. Mortality risk among individuals with a temporary pattern was significantly higher than those of adults who had not been incarcerated or stayed in a homeless shelter during the study period (all-cause SMR: 1.35, 95% confidence interval (CI): 1.14, 1.59; drug-related SMR: 4.60, 95% CI: 3.17, 6.46; HIV-related SMR: 1.54, 95% CI: 1.03, 2.21); all-cause and HIV-related SMRs in other patterns were not statistically significantly different. When we compared all 6 trajectories, the temporary pattern was more strongly associated with higher mortality risk than was the continuously homelessness pattern. Institutional interventions to reduce recurrent cycles of incarceration and homelessness are needed to augment behavioral interventions to reduce mortality risk.

  19. Mediterranean diet and other lifestyle factors in relation to 20-year all-cause mortality: a cohort study in an Italian population.

    PubMed

    Prinelli, Federica; Yannakoulia, Mary; Anastasiou, Costas A; Adorni, Fulvio; Di Santo, Simona G; Musicco, Massimo; Scarmeas, Nikolaos; Correa Leite, Maria L

    2015-03-28

    The aim of the present analysis was to evaluate the association of the Mediterranean diet (MeDi), smoking habits and physical activity with all-cause mortality in an Italian population during a 20-year follow-up study. A total of 1693 subjects aged 40-74 who enrolled in the study in 1991-5 were asked about dietary and other lifestyle information at baseline. Adherence to the MeDi was evaluated by the Mediterranean dietary score (MedDietScore). A healthy lifestyle score was computed by assigning 1 point each for a medium or high adherence to the MedDietScore, non-smoking and physical activity. Cox models were used to assess the associations between lifestyle factors and healthy lifestyle scores and all-cause mortality, adjusting for potential confounders. The final sample included 974 subjects with complete data and without chronic disease at baseline. During a median of 17·4 years of follow-up, 193 people died. Subjects with high adherence to the MedDietScore (hazard ratio (HR) 0·62, 95 % CI 0·43, 0·89)), non-smokers (HR 0·71, 95 % CI 0·51, 0·98) and physically active subjects (HR 0·55, 95 % CI 0·36, 0·82) were at low risk of death. Each point increase in the MedDietScore was associated with a significant 5 % reduction of death risk. Subjects with 1, 2 or 3 healthy lifestyle behaviours had a significantly 39, 56, and 73 % reduced risk of death, respectively. A high adherence to MeDi, non-smoking and physical activity were strongly associated with a reduced risk of all-cause mortality in healthy subjects after long-term follow-up. This reduction was even stronger when the healthy lifestyle behaviours were combined.

  20. Relation of resting heart rate to risk for all-cause mortality by gender after considering exercise capacity (the Henry Ford exercise testing project).

    PubMed

    Aladin, Amer I; Whelton, Seamus P; Al-Mallah, Mouaz H; Blaha, Michael J; Keteyian, Steven J; Juraschek, Stephen P; Rubin, Jonathan; Brawner, Clinton A; Michos, Erin D

    2014-12-01

    Whether resting heart rate (RHR) predicts mortality independent of fitness is not well established, particularly among women. We analyzed data from 56,634 subjects (49% women) without known coronary artery disease or atrial fibrillation who underwent a clinically indicated exercise stress test. Baseline RHR was divided into 5 groups with <60 beats/min as reference. The Social Security Death Index was used to ascertain vital status. Cox hazard models were performed to determine the association of RHR with all-cause mortality, major adverse cardiovascular events, myocardial infarction, or revascularization after sequential adjustment for demographics, cardiovascular disease risk factors, medications, and fitness (metabolic equivalents). The mean age was 53 ± 12 years and mean RHR was 73 ± 12 beats/min. More than half of the participants were referred for chest pain; 81% completed an adequate stress test and mean metabolic equivalents achieved was 9.2 ± 3. There were 6,255 deaths over 11.0-year mean follow-up. There was an increased risk of all-cause mortality with increasing RHR (p trend <0.001). Compared with the lowest RHR group, participants with an RHR ≥90 beats/min had a significantly increased risk of mortality even after adjustment for fitness (hazard ratio 1.22, 95% confidence interval 1.10 to 1.35). This relationship remained significant for men, but not significant for women after adjustment for fitness (p interaction <0.001). No significant associations were seen for men or women with major adverse cardiovascular events, myocardial infarction, or revascularization after accounting for fitness. In conclusion, after adjustment for fitness, elevated RHR was an independent risk factor for all-cause mortality in men but not women, suggesting gender differences in the utility of RHR for risk stratification. PMID:25439450

  1. Emergency Department Visits and Inpatient Admissions Associated with Priapism among Males with Sickle Cell Disease in the United States, 2006–2010

    PubMed Central

    Dupervil, Brandi; Grosse, Scott; Burnett, Arthur; Parker, Christopher

    2016-01-01

    People with sickle cell disease (SCD) suffer from numerous acute complications that can result in multiple hospitalizations and emergency department (ED) and outpatient care visits. Priapism, a prolonged unwanted erection of the penis not due to sexual stimulation, is a serious complication among males with SCD. Variations in estimates of prevalence make it difficult to accurately assess the burden of this complication of SCD. We analyzed data from the Nationwide Emergency Department Sample (NEDS), a product of the Healthcare Cost and Utilization Project, for the years 2006 through 2010 to measure the numbers of ED visits and to examine patterns of subsequent hospitalizations associated with priapism among male patients with SCD. We find that among ED visits associated with males with SCD, those prompted by priapism are more likely to result in hospitalization than are those associated with pain. PMID:27078839

  2. The Arctic Visiting Speakers Program

    NASA Astrophysics Data System (ADS)

    Wiggins, H. V.; Fahnestock, J.

    2013-12-01

    The Arctic Visiting Speakers Program (AVS) is a program of the Arctic Research Consortium of the U.S. (ARCUS) and funded by the National Science Foundation. AVS provides small grants to researchers and other Arctic experts to travel and share their knowledge in communities where they might not otherwise connect. The program aims to: initiate and encourage arctic science education in communities with little exposure to arctic research; increase collaboration among the arctic research community; nurture communication between arctic researchers and community residents; and foster arctic science education at the local level. Individuals, community organizations, and academic organizations can apply to host a speaker. Speakers cover a wide range of arctic topics and can address a variety of audiences including K-12 students, graduate and undergraduate students, and the general public. Preference is given to tours that reach broad and varied audiences, especially those targeted to underserved populations. Between October 2000 and July 2013, AVS supported 114 tours spanning 9 different countries, including tours in 23 U.S. states. Tours over the past three and a half years have connected Arctic experts with over 6,600 audience members. Post-tour evaluations show that AVS consistently rates high for broadening interest and understanding of arctic issues. AVS provides a case study for how face-to-face interactions between arctic scientists and general audiences can produce high-impact results. Further information can be found at: http://www.arcus.org/arctic-visiting-speakers.

  3. Cooking Coal Use and All-Cause and Cause-Specific Mortality in a Prospective Cohort Study of Women in Shanghai, China

    PubMed Central

    Kim, Christopher; Seow, Wei Jie; Shu, Xiao-Ou; Bassig, Bryan A.; Rothman, Nathaniel; Chen, Bingshu E.; Xiang, Yong-Bing; Hosgood, H. Dean; Ji, Bu-Tian; Hu, Wei; Wen, Cuiju; Chow, Wong-Ho; Cai, Qiuyin; Yang, Gong; Gao, Yu-Tang; Zheng, Wei; Lan, Qing

    2016-01-01

    Background: Nearly 4.3 million deaths worldwide were attributable to exposure to household air pollution in 2012. However, household coal use remains widespread. Objectives: We investigated the association of cooking coal and all-cause and cause-specific mortality in a prospective cohort of primarily never-smoking women in Shanghai, China. Methods: A cohort of 74,941 women were followed from 1996 through 2009 with annual linkage to the Shanghai vital statistics database. Cause-specific mortality was identified through 2009. Use of household coal for cooking was assessed through a residential history questionnaire. Cox proportional hazards models estimated the risk of mortality associated with household coal use. Results: In this cohort, 63% of the women ever used coal (n = 46,287). Compared with never coal use, ever use of coal was associated with mortality from all causes [hazard ratio (HR) = 1.12; 95% confidence interval (CI): 1.05, 1.21], cancer (HR = 1.14; 95% CI: 1.03, 1.27), and ischemic heart disease (overall HR = 1.61; 95% CI: 1.14, 2.27; HR for myocardial infarction specifically = 1.80; 95% CI: 1.16, 2.79). The risk of cardiovascular mortality increased with increasing duration of coal use, compared with the risk in never users. The association between coal use and ischemic heart disease mortality diminished with increasing years since cessation of coal use. Conclusions: Evidence from this study suggests that past use of coal among women in Shanghai is associated with excess all-cause mortality, and from cardiovascular diseases in particular. The decreasing association with cardiovascular mortality as the time since last use of coal increased emphasizes the importance of reducing use of household coal where use is still widespread. Citation: Kim C, Seow WJ, Shu XO, Bassig BA, Rothman N, Chen BE, Xiang YB, Hosgood HD III, Ji BT, Hu W, Wen C, Chow WH, Cai Q, Yang G, Gao YT, Zheng W, Lan Q. 2016. Cooking coal use and all-cause and cause-specific mortality in

  4. Drugs with anticholinergic effects and cognitive impairment, falls and all-cause mortality in older adults: A systematic review and meta-analysis

    PubMed Central

    Ruxton, Kimberley; Woodman, Richard J; Mangoni, Arduino A

    2015-01-01

    Aim The aim was to investigate associations between drugs with anticholinergic effects (DACEs) and cognitive impairment, falls and all-cause mortality in older adults. Methods A literature search using CINAHL, Cochrane Library, Embase and PubMed databases was conducted for randomized controlled trials, prospective and retrospective cohort and case-control studies examining the use of DACEs in subjects ≥65 years with outcomes on falls, cognitive impairment and all-cause mortality. Retrieved articles were published on or before June 2013. Anticholinergic exposure was investigated using drug class, DACE scoring systems (anticholinergic cognitive burden scale, ACB; anticholinergic drug scale, ADS; anticholinergic risk scale, ARS; anticholinergic component of the drug burden index, DBIAC) or assessment of individual DACEs. Meta-analyses were performed to pool the results from individual studies. Results Eighteen studies fulfilled the inclusion criteria (total 124 286 participants). Exposure to DACEs as a class was associated with increased odds of cognitive impairment (OR 1.45, 95% CI 1.16, 1.73). Olanzapine and trazodone were associated with increased odds and risk of falls (OR 2.16, 95% CI 1.05, 4.44; RR 1.79, 95% CI 1.60, 1.97, respectively), but amitriptyline, paroxetine and risperidone were not (RR 1.73, 95% CI 0.81, 2.65; RR 1.80, 95% CI 0.81, 2.79; RR 1.39, 95% CI 0.59, 3.26, respectively). A unit increase in the ACB scale was associated with a doubling in odds of all-cause mortality (OR 2.06, 95% CI 1.82, 2.33) but there were no associations with the DBIAC (OR 0.88, 95% CI 0.55, 1.42) or the ARS (OR 3.56, 95% CI 0.29, 43.27). Conclusions Certain individual DACEs or increased overall DACE exposure may increase the risks of cognitive impairment, falls and all-cause mortality in older adults. PMID:25735839

  5. Examining Non-Linear Associations between Accelerometer-Measured Physical Activity, Sedentary Behavior, and All-Cause Mortality Using Segmented Cox Regression.

    PubMed

    Lee, Paul H

    2016-01-01

    Healthy adults are advised to perform at least 150 min of moderate-intensity physical activity weekly, but this advice is based on studies using self-reports of questionable validity. This study examined the dose-response relationship of accelerometer-measured physical activity and sedentary behaviors on all-cause mortality using segmented Cox regression to empirically determine the break-points of the dose-response relationship. Data from 7006 adult participants aged 18 or above in the National Health and Nutrition Examination Survey waves 2003-2004 and 2005-2006 were included in the analysis and linked with death certificate data using a probabilistic matching approach in the National Death Index through December 31, 2011. Physical activity and sedentary behavior were measured using ActiGraph model 7164 accelerometer over the right hip for 7 consecutive days. Each minute with accelerometer count <100; 1952-5724; and ≥5725 were classified as sedentary, moderate-intensity physical activity, and vigorous-intensity physical activity, respectively. Segmented Cox regression was used to estimate the hazard ratio (HR) of time spent in sedentary behaviors, moderate-intensity physical activity, and vigorous-intensity physical activity and all-cause mortality, adjusted for demographic characteristics, health behaviors, and health conditions. Data were analyzed in 2016. During 47,119 person-year of follow-up, 608 deaths occurred. Each additional hour per day of sedentary behaviors was associated with a HR of 1.15 (95% CI 1.01, 1.31) among participants who spend at least 10.9 h per day on sedentary behaviors, and each additional minute per day spent on moderate-intensity physical activity was associated with a HR of 0.94 (95% CI 0.91, 0.96) among participants with daily moderate-intensity physical activity ≤14.1 min. Associations of moderate physical activity and sedentary behaviors on all-cause mortality were independent of each other. To conclude, evidence from this

  6. Evidence for a black-white crossover in all-cause and coronary heart disease mortality in an older population: the North Carolina EPESE.

    PubMed Central

    Corti, M C; Guralnik, J M; Ferrucci, L; Izmirlian, G; Leveille, S G; Pahor, M; Cohen, H J; Pieper, C; Havlik, R J

    1999-01-01

    OBJECTIVES: This cohort study evaluated racial differences in mortality among Blacks and Whites 65 years and older. METHODS: A total of 4136 men and women (1875 Whites and 2261 Blacks) living in North Carolina were interviewed in 1986 and followed up for mortality until 1994. Hazard ratios (HRs) for all-cause and cause-specific mortality were calculated, with adjustment for sociodemographic and coronary heart disease (CHD) risk factors. RESULTS: Black persons had higher mortality rates than Whites at young-old age (65-80 years) but had significantly lower mortality rates after age 80. Black persons age 80 or older had a significantly lower risk of all-cause mortality (HR of Blacks vs Whites, 0.75; 95% confidence interval [CI] = 0.62, 0.90) and of CHD mortality (HR 0.44: 95% CI = 0.30, 0.66). These differences were not observed for other causes of death. CONCLUSIONS: Racial differences in mortality are modified by age. This mortality crossover could be attributed to selective survival of the healthiest oldest Blacks or to other biomedical factors affecting longevity after age 80. Because the crossover was observed for CHD deaths only, age overreporting by Black older persons seems an unlikely explanation of the mortality differences. PMID:10076478

  7. The Impact of Superoxide Dismutase-1 Genetic Variation on Cardiovascular and All-Cause Mortality in a Prospective Cohort Study: The Yamagata (Takahata) Study

    PubMed Central

    Otaki, Yoichiro; Watanabe, Tetsu; Nishiyama, Satoshi; Takahashi, Hiroki; Arimoto, Takanori; Shishido, Tetsuro; Miyamoto, Takuya; Konta, Tsuneo; Shibata, Yoko; Sato, Hidenori; Kawasaki, Ryo; Daimon, Makoto; Ueno, Yoshiyuki; Kato, Takeo; Kayama, Takamasa; Kubota, Isao

    2016-01-01

    Background Oxidative stress is a major cause of cardiovascular disease. Superoxide dismutase-1 (SOD1) is an antioxidant that protects against oxidative stress. Deoxyribonucleic acid (DNA) variations such as single nucleotide polymorphism (SNP) or haplotypes within the SOD gene are reportedly associated with the development of cardiovascular disease. However, it remains to be determined whether SOD1 variability is associated with cardiovascular or all-cause mortality in the general population. Methods and Results This prospective cohort study included 2799 subjects who participated in a community-based health study with a 10-year follow-up. We genotyped 639 SNPs and found the association of SNP rs1041740 and rs17880487 within a SOD1 gene with cardiovascular mortality. There were 193 deaths during the follow-up period including 57 cardiovascular deaths. Multivariate Cox proportional hazard regression analysis revealed that the homozygous T-allele of rs1041740 was associated with all-cause and cardiovascular deaths after adjusting for confounding factors. The net reclassification index was significantly improved by adding rs1041740 as a cardiovascular risk factor. On the other hand, cardiovascular death was not observed in homozygous T-allele carriers of rs17880487. Haplotype analysis identified the haplotype with T-allele of rs1041740 and that with T-allele of rs17880487 as increasing and decreasing susceptibility for cardiovascular mortality, and it had complementary SNP sequences. Conclusion Variation in the SOD1 gene was associated with cardiovascular deaths in the general population. PMID:27755600

  8. Low-Risk Lifestyle Behaviors and All-Cause Mortality: Findings From the National Health and Nutrition Examination Survey III Mortality Study

    PubMed Central

    Zhao, Guixiang; Tsai, James; Li, Chaoyang

    2011-01-01

    Objectives. We examined the relationship between 4 low-risk behaviors—never smoked, healthy diet, adequate physical activity, and moderate alcohol consumption—and mortality in a representative sample of people in the United States. Methods. We used data from 16958 participants aged 17 years and older in the National Health and Nutrition Examination Survey III Mortality Study from 1988 to 2006. Results. The number of low-risk behaviors was inversely related to the risk for mortality. Compared with participants who had no low-risk behaviors, those who had all 4 experienced reduced all-cause mortality (adjusted hazard ratio [AHR]=0.37; 95% confidence interval [CI]=0.28, 0.49), mortality from malignant neoplasms (AHR=0.34; 95% CI=0.20, 0.56), major cardiovascular disease (AHR=0.35; 95% CI=0.24, 0.50), and other causes (AHR=0.43; 95% CI=0.25, 0.74). The rate advancement periods, representing the equivalent risk from a certain number of years of chronological age, for participants who had all 4 high-risk behaviors compared with those who had none were 11.1 years for all-cause mortality, 14.4 years for malignant neoplasms, 9.9 years for major cardiovascular disease, and 10.6 years for other causes. Conclusions. Low-risk lifestyle factors exert a powerful and beneficial effect on mortality. PMID:21852630

  9. Fitness and fatness as predictors of mortality from all causes and from cardiovascular disease in men and women in the lipid research clinics study.

    PubMed

    Stevens, June; Cai, Jianwen; Evenson, Kelly R; Thomas, Ratna

    2002-11-01

    The relative size of the effects of fitness and fatness on longevity has been studied in only one cohort. The authors examined this issue using data from 2,506 women and 2,860 men in the Lipid Research Clinics Study. The mean age was 46.6 years in women and 45.1 years in men at baseline (1972-1976). Fitness was assessed using a treadmill test, and fatness was assessed as body mass index calculated from measured height and weight. Participants were followed for vital status through 1998. Hazard ratios were calculated using proportional hazard models that included covariates for age, education, smoking, alcohol intake, and the dietary Keys score. Fitness and fatness were both associated with mortality from all causes and from cardiovascular disease. For mortality from all causes, the adjusted hazard ratios were 1.32 among the fit-fat, 1.30 among the unfit-not fat, and 1.57 among the unfit-fat women compared with fit-not fat women. Among men the same hazard ratios were 1.25, 1.44, and 1.49 [corrected]. There were no significant interactions between fitness and fatness in either men or women. The authors conclude that both fitness and fatness are risk factors for mortality, and that being fit does not completely reverse the increased risk associated with excess adiposity.

  10. Incidence of and Predictors for Early Return Visits to the Emergency Department

    PubMed Central

    Ko, Mingchung; Lee, Yaling; Chen, Chuchieh; Chou, Pesus; Chu, Dachen

    2015-01-01

    Abstract The aim of this study is to estimate the proportion of and predictors for early return visits (ERVs) to the emergency department (ED) in Taiwan. This is a population-based study using data of 1 million people randomly selected from all beneficiaries of the Taiwan National Health Insurance. All ED visits in 2012 were analyzed. The ERVs to the ED were defined as those ED revisits within 3 days after the initial ED visit. We employed a generalized estimation equation model to investigate the independent effects of various characteristics associated with the initial ED visit on ERVs. The overall proportion of ERVs within 3 days with a same dichotomous diagnostic category according to injury or noninjury was 4.3% (6740/158,132), and the overall proportion of hospitalizations after ERVs was 24.1% (1627/6740). Male subjects (4.3%) were more likely to have ERVs with an adjusted odds ratio (AOR) of 1.10 (95% confidence interval [CI]: 1.04–1.16). Compared with patients aged 18 to 64 years (4.0%), those aged >64 years had a significantly increased risk of ERVs (6.2%, AOR: 1.49, 95% CI: 1.39–1.59). In comparison to patients with injury diagnoses (2.2%), those with noninjury diagnoses had a higher risk of ERVs (5.2%, AOR: 2.50, 95% CI: 2.33–2.70). Compared with patients initially treated at medical centers (3.7%), those initially treated at regional (4.5%, AOR: 1.28, 95% CI: 1.20–1.37) or district hospitals (4.5%, AOR: 1.38, 95% CI: 1.27–1.49) had significantly higher risks of ERVs. Among the 6740 patients with ERVs, 2622 (38.9%) returned to a different hospital, and these patients tended to be those aged 18 to 64 years and initially treated at district hospitals. The risk of ERVs was associated with demographic characteristics and accreditation level of hospital. We noted a large proportion of patients with ERVs to a different hospital. The reason underlying this phenomenon warrants further investigations. PMID:26512573

  11. Whole-grain products and whole-grain types are associated with lower all-cause and cause-specific mortality in the Scandinavian HELGA cohort.

    PubMed

    Johnsen, Nina F; Frederiksen, Kirsten; Christensen, Jane; Skeie, Guri; Lund, Eiliv; Landberg, Rikard; Johansson, Ingegerd; Nilsson, Lena M; Halkjær, Jytte; Olsen, Anja; Overvad, Kim; Tjønneland, Anne

    2015-08-28

    No study has yet investigated the intake of different types of whole grain (WG) in relation to all-cause and cause-specific mortality in a healthy population. The aim of the present study was to investigate the intake of WG products and WG types in relation to all-cause and cause-specific mortality in a large Scandinavian HELGA cohort that, in 1992-8, included 120 010 cohort members aged 30-64 years from the Norwegian Women and Cancer Study, the Northern Sweden Health and Disease Study, and the Danish Diet Cancer and Health Study. Participants filled in a FFQ from which data on the intake of WG products were extracted. The estimation of daily intake of WG cereal types was based on country-specific products and recipes. Mortality rate ratios (MRR) and 95 % CI were estimated using the Cox proportional hazards model. A total of 3658 women and 4181 men died during the follow-up (end of follow-up was 15 April 2008 in the Danish sub-cohort, 15 December 2009 in the Norwegian sub-cohort and 15 February 2009 in the Swedish sub-cohort). In the analyses of continuous WG variables, we found lower all-cause mortality with higher intake of total WG products (women: MRR 0·89 (95 % CI 0·86, 0·91); men: MRR 0·89 (95 % CI 0·86, 0·91) for a doubling of intake). In particular, intake of breakfast cereals and non-white bread was associated with lower mortality. We also found lower all-cause mortality with total intake of different WG types (women: MRR 0·88 (95 % CI 0·86, 0·92); men: MRR 0·88 (95 % CI 0·86, 0·91) for a doubling of intake). In particular, WG oat, rye and wheat were associated with lower mortality. The associations were found in both women and men and for different causes of deaths. In the analyses of quartiles of WG intake in relation to all-cause mortality, we found lower mortality in the highest quartile compared with the lowest for breakfast cereals, non-white bread, total WG products, oat, rye (only men), wheat and total WG types. The MRR for highest v

  12. Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies

    PubMed Central

    Keum, NaNa; Giovannucci, Edward; Fadnes, Lars T; Boffetta, Paolo; Greenwood, Darren C; Tonstad, Serena; Vatten, Lars J; Riboli, Elio; Norat, Teresa

    2016-01-01

    Objective To quantify the dose-response relation between consumption of whole grain and specific types of grains and the risk of cardiovascular disease, total cancer, and all cause and cause specific mortality. Data sources PubMed and Embase searched up to 3 April 2016. Study selection Prospective studies reporting adjusted relative risk estimates for the association between intake of whole grains or specific types of grains and cardiovascular disease, total cancer, all cause or cause specific mortality. Data synthesis Summary relative risks and 95% confidence intervals calculated with a random effects model. Results 45 studies (64 publications) were included. The summary relative risks per 90 g/day increase in whole grain intake (90 g is equivalent to three servings—for example, two slices of bread and one bowl of cereal or one and a half pieces of pita bread made from whole grains) was 0.81 (95% confidence interval 0.75 to 0.87; I2=9%, n=7 studies) for coronary heart disease, 0.88 (0.75 to 1.03; I2=56%, n=6) for stroke, and 0.78 (0.73 to 0.85; I2=40%, n=10) for cardiovascular disease, with similar results when studies were stratified by whether the outcome was incidence or mortality. The relative risks for morality were 0.85 (0.80 to 0.91; I2=37%, n=6) for total cancer, 0.83 (0.77 to 0.90; I2=83%, n=11) for all causes, 0.78 (0.70 to 0.87; I2=0%, n=4) for respiratory disease, 0.49 (0.23 to 1.05; I2=85%, n=4) for diabetes, 0.74 (0.56 to 0.96; I2=0%, n=3) for infectious diseases, 1.15 (0.66 to 2.02; I2=79%, n=2) for diseases of the nervous system disease, and 0.78 (0.75 to 0.82; I2=0%, n=5) for all non-cardiovascular, non-cancer causes. Reductions in risk were observed up to an intake of 210-225 g/day (seven to seven and a half servings per day) for most of the outcomes. Intakes of specific types of whole grains including whole grain bread, whole grain breakfast cereals, and added bran, as well as total bread and total breakfast cereals were also associated

  13. Whole-grain products and whole-grain types are associated with lower all-cause and cause-specific mortality in the Scandinavian HELGA cohort.

    PubMed

    Johnsen, Nina F; Frederiksen, Kirsten; Christensen, Jane; Skeie, Guri; Lund, Eiliv; Landberg, Rikard; Johansson, Ingegerd; Nilsson, Lena M; Halkjær, Jytte; Olsen, Anja; Overvad, Kim; Tjønneland, Anne

    2015-08-28

    No study has yet investigated the intake of different types of whole grain (WG) in relation to all-cause and cause-specific mortality in a healthy population. The aim of the present study was to investigate the intake of WG products and WG types in relation to all-cause and cause-specific mortality in a large Scandinavian HELGA cohort that, in 1992-8, included 120 010 cohort members aged 30-64 years from the Norwegian Women and Cancer Study, the Northern Sweden Health and Disease Study, and the Danish Diet Cancer and Health Study. Participants filled in a FFQ from which data on the intake of WG products were extracted. The estimation of daily intake of WG cereal types was based on country-specific products and recipes. Mortality rate ratios (MRR) and 95 % CI were estimated using the Cox proportional hazards model. A total of 3658 women and 4181 men died during the follow-up (end of follow-up was 15 April 2008 in the Danish sub-cohort, 15 December 2009 in the Norwegian sub-cohort and 15 February 2009 in the Swedish sub-cohort). In the analyses of continuous WG variables, we found lower all-cause mortality with higher intake of total WG products (women: MRR 0·89 (95 % CI 0·86, 0·91); men: MRR 0·89 (95 % CI 0·86, 0·91) for a doubling of intake). In particular, intake of breakfast cereals and non-white bread was associated with lower mortality. We also found lower all-cause mortality with total intake of different WG types (women: MRR 0·88 (95 % CI 0·86, 0·92); men: MRR 0·88 (95 % CI 0·86, 0·91) for a doubling of intake). In particular, WG oat, rye and wheat were associated with lower mortality. The associations were found in both women and men and for different causes of deaths. In the analyses of quartiles of WG intake in relation to all-cause mortality, we found lower mortality in the highest quartile compared with the lowest for breakfast cereals, non-white bread, total WG products, oat, rye (only men), wheat and total WG types. The MRR for highest v

  14. A Visit With a Curandero

    PubMed Central

    Mull, J. Dennis; Mull, Dorothy S.

    1983-01-01

    One author visited a Mexican-American folk healer in the Los Angeles area, not as a patient but as a fellow health professional. Information was obtained from this healer, a curandero, regarding his background, his clientele, the illnesses he treats, the therapeutic techniques he uses and his relationship with the official health care system. This information was generally consistent with statements about curanderismo that have appeared in the social sciences literature. It also provided additional insight into practices that have been alluded to in that literature but not described in detail. With few exceptions, curanderos would seem to be talented healers whose efforts often benefit their patients and whose continued popularity has important implications for physicians, especially those serving large numbers of people of Mexican descent. PMID:6659503

  15. Understanding decisions leading to nonurgent visits to the paediatric emergency department: caregivers’ perspectives

    PubMed Central

    Kua, Phek Hui Jade; Wu, Li; Ong, E-Lin Tessa; Lim, Zi Ying; Yiew, Jinmian Luther; Thia, Xing Hui Michelle; Sung, Sharon Cohan

    2016-01-01

    INTRODUCTION A significant percentage of paediatric emergency department (ED) attendances worldwide are nonurgent, adversely affecting patient outcomes and healthcare systems. This study aimed to understand the reasons behind nonurgent ED visits, in order to develop targeted and effective preventive interventions. METHODS In-depth interviews were conducted with 49 caregivers to identify the decision-making factors related to taking children to the ED of KK Women’s and Children’s Hospital, Singapore. Interviews were carried out in the emergency room of the hospital after the children had been diagnosed with nonurgent conditions by the attending physician. Interview transcripts were analysed based on grounded theory principles. RESULTS The demographics of our study cohort were representative of the target population. The main reasons given by the caregivers for attending paediatric EDs included perceived severity of the child’s symptoms, availability of after-hours care, perceived advantage of a paediatric specialist hospital and mistrust of primary care physicians’ ability to manage paediatric conditions. Insurance or welfare was a contributing factor for only a small portion of caregivers. CONCLUSION The reasons provided by Singaporean caregivers for attending paediatric EDs were similar to those reported in studies conducted in Western countries. However, the former group had a unique understanding of the local healthcare system. The study’s findings may be used to develop interventions to change the knowledge, attitudes and behaviours of caregivers in Singapore. PMID:26805668

  16. Creating a national home visiting research network.

    PubMed

    Duggan, Anne; Minkovitz, Cynthia S; Chaffin, Mark; Korfmacher, Jon; Brooks-Gunn, Jeanne; Crowne, Sarah; Filene, Jill; Gonsalves, Kay; Landsverk, John; Harwood, Robin

    2013-11-01

    Home visiting can play a key role in the early childhood system of services. For home visiting to achieve its potential, decision-makers must make informed choices regarding adoption, adaptation, coordination, scale-up, and sustainment. We need a coordinated, focused, and theory-based home visiting research infrastructure to inform such decisions. The transdisciplinary Home Visiting Research Network (HVRN) was established in July 2012 with funding from the Health Resources and Services Administration. Its goal is to promote the translation of research findings into policy and practice. Its objectives are to (1) develop a national home visiting research agenda, (2) advance the use of innovative research methods; and (3) provide a research environment that is supportive of the professional development of emerging researchers interested in home visiting. A Management Team designs and directs activities to achieve these objectives through Work Teams. A Steering Committee of national leaders representing stakeholder groups oversees progress. HVRN's Coordinating Center supports the Work Teams and HVRN's Home visiting Applied Research Collaborative, a practice-based research network of home visiting programs. This article describes HVRN's rationale, approach, and anticipated products. We use home visiting-primary care coordination as an illustration, noting potential roles for pediatric practices and pediatric researchers and research educators in HVRN activities. HVRN creates the infrastructure for a rigorous program of research to inform policy and practice on home visiting as part of the system of services to improve family functioning, parenting, and child outcomes.

  17. Creating a national home visiting research network.

    PubMed

    Duggan, Anne; Minkovitz, Cynthia S; Chaffin, Mark; Korfmacher, Jon; Brooks-Gunn, Jeanne; Crowne, Sarah; Filene, Jill; Gonsalves, Kay; Landsverk, John; Harwood, Robin

    2013-11-01

    Home visiting can play a key role in the early childhood system of services. For home visiting to achieve its potential, decision-makers must make informed choices regarding adoption, adaptation, coordination, scale-up, and sustainment. We need a coordinated, focused, and theory-based home visiting research infrastructure to inform such decisions. The transdisciplinary Home Visiting Research Network (HVRN) was established in July 2012 with funding from the Health Resources and Services Administration. Its goal is to promote the translation of research findings into policy and practice. Its objectives are to (1) develop a national home visiting research agenda, (2) advance the use of innovative research methods; and (3) provide a research environment that is supportive of the professional development of emerging researchers interested in home visiting. A Management Team designs and directs activities to achieve these objectives through Work Teams. A Steering Committee of national leaders representing stakeholder groups oversees progress. HVRN's Coordinating Center supports the Work Teams and HVRN's Home visiting Applied Research Collaborative, a practice-based research network of home visiting programs. This article describes HVRN's rationale, approach, and anticipated products. We use home visiting-primary care coordination as an illustration, noting potential roles for pediatric practices and pediatric researchers and research educators in HVRN activities. HVRN creates the infrastructure for a rigorous program of research to inform policy and practice on home visiting as part of the system of services to improve family functioning, parenting, and child outcomes. PMID:24187127

  18. Plant immunity: the EDS1 regulatory node.

    PubMed

    Wiermer, Marcel; Feys, Bart J; Parker, Jane E

    2005-08-01

    ENHANCED DISEASE SUSCEPTIBILITY 1 (EDS1) and its interacting partner, PHYTOALEXIN DEFICIENT 4 (PAD4), constitute a regulatory hub that is essential for basal resistance to invasive biotrophic and hemi-biotrophic pathogens. EDS1 and PAD4 are also recruited by Toll-Interleukin-1 receptor (TIR)-type nucleotide binding-leucine rich repeat (NB-LRR) proteins to signal isolate-specific pathogen recognition. Recent work points to a fundamental role of EDS1 and PAD4 in transducing redox signals in response to certain biotic and abiotic stresses. These intracellular proteins are important activators of salicylic acid (SA) signaling and also mediate antagonism between the jasmonic acid (JA) and ethylene (ET) defense response pathways. EDS1 forms several molecularly and spatially distinct complexes with PAD4 and a newly discovered in vivo signaling partner, SENESCENCE ASSOCIATED GENE 101 (SAG101). Together, EDS1, PAD4 and SAG101 provide a major barrier to infection by both host-adapted and non-host pathogens.

  19. A Quantitative Content Analysis of Mercer University MEd, EdS, and Doctoral Theses

    ERIC Educational Resources Information Center

    Randolph, Justus J.; Gaiek, Lura S.; White, Torian A.; Slappey, Lisa A.; Chastain, Andrea; Harris, Rose Prejean

    2010-01-01

    Quantitative content analysis of a body of research not only helps budding researchers understand the culture, language, and expectations of scholarship, it helps identify deficiencies and inform policy and practice. Because of these benefits, an analysis of a census of 980 Mercer University MEd, EdS, and doctoral theses was conducted. Each thesis…

  20. Higher Diet Quality Is Associated with Decreased Risk of All-Cause, Cardiovascular Disease, and Cancer Mortality among Older Adults12

    PubMed Central

    Reedy, Jill; Krebs-Smith, Susan M.; Miller, Paige E.; Liese, Angela D.; Kahle, Lisa L.; Park, Yikyung; Subar, Amy F.

    2014-01-01

    Increased attention in dietary research and guidance has been focused on dietary patterns, rather than on single nutrients or food groups, because dietary components are consumed in combination and correlated with one another. However, the collective body of research on the topic has been hampered by the lack of consistency in methods used. We examined the relationships between 4 indices—the Healthy Eating Index–2010 (HEI-2010), the Alternative Healthy Eating Index–2010 (AHEI-2010), the alternate Mediterranean Diet (aMED), and Dietary Approaches to Stop Hypertension (DASH)—and all-cause, cardiovascular disease (CVD), and cancer mortality in the NIH-AARP Diet and Health Study (n = 492,823). Data from a 124-item food-frequency questionnaire were used to calculate scores; adjusted HRs and 95% CIs were estimated. We documented 86,419 deaths, including 23,502 CVD- and 29,415 cancer-specific deaths, during 15 y of follow-up. Higher index scores were associated with a 12–28% decreased risk of all-cause, CVD, and cancer mortality. Specifically, comparing the highest with the lowest quintile scores, adjusted HRs for all-cause mortality for men were as follows: HEI-2010 HR: 0.78 (95% CI: 0.76, 0.80), AHEI-2010 HR: 0.76 (95% CI: 0.74, 0.78), aMED HR: 0.77 (95% CI: 0.75, 0.79), and DASH HR: 0.83 (95% CI: 0.80, 0.85); for women, these were HEI-2010 HR: 0.77 (95% CI: 0.74, 0.80), AHEI-2010 HR: 0.76 (95% CI: 0.74, 0.79), aMED HR: 0.76 (95% CI: 0.73, 0.79), and DASH HR: 0.78 (95% CI: 0.75, 0.81). Similarly, high adherence on each index was protective for CVD and cancer mortality examined separately. These findings indicate that multiple scores reflect core tenets of a healthy diet that may lower the risk of mortality outcomes, including federal guidance as operationalized in the HEI-2010, Harvard’s Healthy Eating Plate as captured in the AHEI-2010, a Mediterranean diet as adapted in an Americanized aMED, and the DASH Eating Plan as included in the DASH score. PMID

  1. Association between Insulin Monotherapy versus Insulin plus Metformin and the Risk of All-Cause Mortality and Other Serious Outcomes: A Retrospective Cohort Study

    PubMed Central

    Holden, Sarah E.; Jenkins-Jones, Sara; Currie, Craig J.

    2016-01-01

    Aims To determine if concomitant metformin reduced the risk of death, major adverse cardiac events (MACE), and cancer in people with type 2 diabetes treated with insulin. Methods For this retrospective cohort study, people with type 2 diabetes who progressed to insulin with or without metformin from 2000 onwards were identified from the UK Clinical Practice Research Datalink (≈7% sample of the UK population). The risks of all-cause mortality, MACE and incident cancer were evaluated using multivariable Cox models comparing insulin monotherapy with insulin plus metformin. We accounted for insulin dose. Results 12,020 subjects treated with insulin were identified, including 6,484 treated with monotherapy. There were 1,486 deaths, 579 MACE (excluding those with a history of large vessel disease), and 680 cancer events (excluding those in patients with a history of cancer). Corresponding event rates were 41.5 (95% CI 39.4–43.6) deaths, 20.8 (19.2–22.5) MACE, and 21.6 (20.0–23.3) cancer events per 1,000 person-years. The adjusted hazard ratios (aHRs) for people prescribed insulin plus metformin versus insulin monotherapy were 0.60 (95% CI 0.52–0.68) for all-cause mortality, 0.75 (0.62–0.91) for MACE, and 0.96 (0.80–1.15) for cancer. For patients who were propensity-score matched, the corresponding aHRs for all-cause mortality and cancer were 0.62 (0.52–0.75) and 0.99 (0.78–1.26), respectively. For MACE, the aHR was 1.06 (0.75–1.49) prior to 1,275 days and 1.87 (1.22–2.86) after 1,275 days post-index. Conclusions People with type 2 diabetes treated with insulin plus concomitant metformin had a reduced risk of death and MACE compared with people treated with insulin monotherapy. There was no statistically significant difference in the risk of cancer between people treated with insulin as monotherapy or in combination with metformin. PMID:27152598

  2. 34 CFR 85.942 - ED Deciding Official.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false ED Deciding Official. 85.942 Section 85.942 Education Office of the Secretary, Department of Education GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 85.942 ED Deciding Official. The ED Deciding Official is an ED officer who has...

  3. Modification of the effect of ambient air pollution on pediatric asthma emergency visits: susceptible subpopulations

    PubMed Central

    Strickland, Matthew J; Klein, Mitchel; Flanders, W Dana; Chang, Howard H; Mulholland, James A; Tolbert, Paige E; Darrow, Lyndsey A

    2016-01-01

    Background Children may have differing susceptibility to ambient air pollution concentrations depending on various background characteristics of the children. Methods Using emergency department (ED) data linked with birth records from Atlanta, Georgia, we identified ED visits for asthma or wheeze among children aged 2–16 years from 1 January 2002 through 30 June 2010 (n=109,758). We stratified by preterm delivery, term low birth weight, maternal race, Medicaid status, maternal education, maternal smoking, delivery method, and history of a bronchiolitis ED visit. Population-weighted daily average concentrations were calculated for 1-hour maximum carbon monoxide and nitrogen dioxide; 8-hour maximum ozone; and 24-hour average particulate matter less than 10 microns in diameter, particulate matter less than 2.5 microns in diameter (PM2.5), and the PM2.5 components sulfate, nitrate, ammonium, elemental carbon, and organic carbon, using measurements from stationary monitors. Poisson time-series models were used to estimate rate ratios for associations between three-day moving average pollutant concentrations and daily ED visit counts and to investigate effect-measure modification by the stratification factors. Results Associations between pollutant concentrations and asthma exacerbations were larger among children born preterm and among children born to African American mothers. Stratification by race and preterm status together suggested that both factors affected susceptibility. The largest estimated effect size (for an interquartile-range increase in pollution) was observed for ozone among preterm births to African American mothers: rate ratio=1.138 (95% confidence interval=1.077–1.203). In contrast, the rate ration for the ozone association among full-term births to mothers of other races was 1.025 (0.970–1.083). Conclusions Results support the hypothesis that children vary in their susceptibility to ambient air pollutants. PMID:25192402

  4. MicroED data collection and processing.

    PubMed

    Hattne, Johan; Reyes, Francis E; Nannenga, Brent L; Shi, Dan; de la Cruz, M Jason; Leslie, Andrew G W; Gonen, Tamir

    2015-07-01

    MicroED, a method at the intersection of X-ray crystallography and electron cryo-microscopy, has rapidly progressed by exploiting advances in both fields and has already been successfully employed to determine the atomic structures of several proteins from sub-micron-sized, three-dimensional crystals. A major limiting factor in X-ray crystallography is the requirement for large and well ordered crystals. By permitting electron diffraction patterns to be collected from much smaller crystals, or even single well ordered domains of large crystals composed of several small mosaic blocks, MicroED has the potential to overcome the limiting size requirement and enable structural studies on difficult-to-crystallize samples. This communication details the steps for sample preparation, data collection and reduction necessary to obtain refined, high-resolution, three-dimensional models by MicroED, and presents some of its unique challenges. PMID:26131894

  5. MicroED data collection and processing

    PubMed Central

    Hattne, Johan; Reyes, Francis E.; Nannenga, Brent L.; Shi, Dan; de la Cruz, M. Jason; Leslie, Andrew G. W.; Gonen, Tamir

    2015-01-01

    MicroED, a method at the intersection of X-ray crystallography and electron cryo-microscopy, has rapidly progressed by exploiting advances in both fields and has already been successfully employed to determine the atomic structures of several proteins from sub-micron-sized, three-dimensional crystals. A major limiting factor in X-ray crystallography is the requirement for large and well ordered crystals. By permitting electron diffraction patterns to be collected from much smaller crystals, or even single well ordered domains of large crystals composed of several small mosaic blocks, MicroED has the potential to overcome the limiting size requirement and enable structural studies on difficult-to-crystallize samples. This communication details the steps for sample preparation, data collection and reduction necessary to obtain refined, high-resolution, three-dimensional models by MicroED, and presents some of its unique challenges. PMID:26131894

  6. Nonalcoholic Fatty Liver Disease Is Associated With Higher 1-year All-Cause Rehospitalization Rates in Patients Admitted for Acute Heart Failure

    PubMed Central

    Valbusa, Filippo; Bonapace, Stefano; Grillo, Cristina; Scala, Luca; Chiampan, Andrea; Rossi, Andrea; Zoppini, Giacomo; Lonardo, Amedeo; Arcaro, Guido; Byrne, Christopher D.; Targher, Giovanni

    2016-01-01

    Abstract Repeat hospitalization due to acute heart failure (HF) is a global public health problem that markedly impacts on health resource use. Identifying novel predictors of rehospitalization would help physicians to determine the optimal postdischarge plan for preventing HF rehospitalization. Nonalcoholic fatty liver disease (NAFLD) is an emerging risk factor for many heart diseases, including HF. We assessed whether NAFLD at hospital admission predicts 1-year all-cause rehospitalization in patients with acute HF. We enrolled all patients consecutively admitted for acute HF to our General Medicine Division, from January 2013 to April 2014, after excluding patients with acute myocardial infarction, severe heart valve diseases, malignancy, known liver diseases, and those with volume overload related to extracardiac causes. NAFLD was diagnosed by ultrasonography and exclusion of competing etiologies. The primary outcome of the study was the 1-year all-cause rehospitalization rate. Among the 107 patients enrolled in the study, the cumulative rehospitalization rate was 12.1% at 1 month, 25.2% at 3 months, 29.9% at 6 months, and 38.3% at 1 year. Patients with NAFLD had markedly higher 1-year rehospitalization rates than those without NAFLD (58% vs 21% at 1 y; P < 0.001 by the log-rank test). Cox regression analysis revealed that NAFLD was associated with a 5.5-fold increased risk of rehospitalization (adjusted hazard ratio 5.56, 95% confidence interval 2.46–12.1, P < 0.001) after adjustment for multiple HF risk factors and potential confounders. In conclusion, NAFLD was independently associated with higher 1-year rehospitalization in patients hospitalized for acute HF. PMID:26886619

  7. Elevated AST-to-platelet ratio index is associated with increased all-cause mortality among HIV-infected adults in Zambia

    PubMed Central

    Vinikoor, Michael J.; Sinkala, Edford; Mweemba, Aggrey; Zanolini, Arianna; Mulenga, Lloyd; Sikazwe, Izukanji; Fried, Michael W.; Eron, Joseph J.; Wandeler, Gilles; Chi, Benjamin H.

    2015-01-01

    Background and Aims We investigated the association between significant liver fibrosis, determined by AST-to-platelet ratio index (APRI), and all-cause mortality among HIV-infected patients prescribed antiretroviral therapy (ART) in Zambia Methods Among HIV-infected adults who initiated ART, we categorized baseline APRI scores according to established thresholds for significant hepatic fibrosis (APRI ≥1.5) and cirrhosis (APRI ≥2.0). Using multivariable logistic regression we identified risk factors for elevated APRI including demographic characteristics, body mass index (BMI), HIV clinical and immunologic status, and tuberculosis. In the subset tested for hepatitis B surface antigen (HBsAg), we investigated the association of hepatitis B virus co-infection with APRI score. Using Kaplan-Meier analysis and Cox proportional hazards regression we determined the association of elevated APRI with death during ART. Results Among 20,308 adults in the analysis cohort, 1,027 (5.1%) had significant liver fibrosis at ART initiation including 616 (3.0%) with cirrhosis. Risk factors for significant fibrosis or cirrhosis included male sex, BMI <18, WHO clinical stage 3 or 4, CD4+ count <200 cells/mm3, and tuberculosis. Among the 237 (1.2%) who were tested, HBsAg-positive patients had four times the odds (adjusted odds ratio, 4.15; 95% CI, 1.71–10.04) of significant fibrosis compared HBsAg-negatives. Both significant fibrosis (adjusted hazard ratio 1.41, 95% CI, 1.21–1.64) and cirrhosis (adjusted hazard ratio 1.57, 95% CI, 1.31–1.89) were associated with increased all-cause mortality. Conclusion Liver fibrosis may be a risk factor for mortality during ART among HIV-infected individuals in Africa. APRI is an inexpensive and potentially useful test for liver fibrosis in resource-constrained settings. PMID:25581487

  8. Is the adiposity-associated FTO gene variant related to all-cause mortality independent of adiposity? Meta-analysis of data from 169,551 Caucasian adults

    PubMed Central

    Mirza, S. S.; Zhao, J. H.; Chasman, D. I.; Fischer, K.; Qi, Q.; Smith, A. V.; Thinggaard, M.; Jarczok, M. N.; Nalls, M. A.; Trompet, S.; Timpson, N. J.; Schmidt, B.; Jackson, A. U.; Lyytikäinen, L. P.; Verweij, N.; Mueller-Nurasyid, M.; Vikström, M.; Marques-Vidal, P.; Wong, A.; Meidtner, K.; Middelberg, R. P.; Strawbridge, R. J.; Christiansen, L.; Kyvik, K. O.; Hamsten, A.; Jääskeläinen, T.; Tjønneland, A.; Eriksson, J. G.; Whitfield, J. B.; Boeing, H.; Hardy, R.; Vollenweider, P.; Leander, K.; Peters, A.; van der Harst, P.; Kumari, M.; Lehtimäki, T.; Meirhaeghe, A.; Tuomilehto, J.; Jöckel, K.-H.; Ben-Shlomo, Y.; Sattar, N.; Baumeister, S. E.; Smith, G. Davey; Casas, J. P.; Houston, D. K.; März, W.; Christensen, K.; Gudnason, V.; Hu, F. B.; Metspalu, A.; Ridker, P. M.; Wareham, N. J.; Loos, R. J. F.; Tiemeier, H.; Sonestedt, E.; Sørensen, T. I. A.

    2015-01-01

    Summary Previously, a single nucleotide polymorphism (SNP), rs9939609, in the FTO gene showed a much stronger association with all-cause mortality than expected from its association with body mass index (BMI), body fat mass index (FMI) and waist circumference (WC). This finding implies that the SNP has strong pleiotropic effects on adiposity and adiposity-independent pathological pathways that leads to increased mortality. To investigate this further, we conducted a meta-analysis of similar data from 34 longitudinal studies including 169,551 adult Caucasians among whom 27,100 died during follow-up. Linear regression showed that the minor allele of the FTO SNP was associated with greater BMI (n = 169,551; 0.32 kg m−2; 95% CI 0.28–0.32, P < 1 × 10−32), WC (n = 152,631; 0.76 cm; 0.68–0.84, P < 1 × 10−32) and FMI (n = 48,192; 0.17 kg m−2; 0.13–0.22, P = 1.0 × 10−13). Cox proportional hazard regression analyses for mortality showed that the hazards ratio (HR) for the minor allele of the FTO SNPs was 1.02 (1.00–1.04, P = 0.097), but the apparent excess risk was eliminated after adjustment for BMI and WC (HR: 1.00; 0.98–1.03, P = 0.662) and for FMI (HR: 1.00; 0.96–1.04, P = 0.932). In conclusion, this study does not support that the FTO SNP is associated with all-cause mortality independently of the adiposity phenotypes. PMID:25752329

  9. Final Report - Summer Visit 2010

    SciTech Connect

    Bank, R

    2011-09-12

    During my visit to LLNL during the summer of 2010, I worked on algebraic multilevel solvers for large sparse systems of linear equations arising from discretizations of partial differential equations. The particular solver of interest is based on ILU decomposition. The setup phase for this AMG solve is just the single ILU decomposition, and its corresponding error matrix. Because the ILU uses a minimum degree or similar sparse matrix ordering, most of the fill-in, and hence most of the error, is concentrated in the lower right corner of the factored matrix. All of the major multigrid components - the smoother, the coarse level correction matrices, and the fine-to-coarse and coarse-to-fine rectangular transfer matrices, are defined in terms of various blocks of the ILU factorization. Although such a strategy is not likely to be optimal in terms of convergence properties, it has a relatively low setup cost, and therefore is useful in situations where setup costs for more traditional AMG approaches cannot be amortized over the solution of many linear systems using the same matrix. Such a situation arises in adaptive methods, where often just one linear system is solved at each step of an adaptive feedback loop, or in solving nonlinear equations by approximate Newton methods, where the approximate Jacobian might change substantially from iteration to iteration. In general terms, coarse levels are defined in terms of successively smaller lower right blocks of the matrix, typically decreasing geometrically in order. The most difficult issue was the coarse grid correction matrix. The preconditioner/smoother for a given level is just the corresponding lower right blocks of the ILU factorization. The coarse level matrix itself is just the Schur complement; this matrix is not known exactly using just the ILU decomposition in the setup phase. Thus we approximate this matrix using various combinations of the preconditioning matrix and the error matrix. During my visit, several

  10. Association of Age, Systolic Blood Pressure, and Heart Rate with Adult Morbidity and Mortality after Urgent Care Visits

    PubMed Central

    Hart, James; Woodruff, Michael; Joy, Elizabeth; Dalto, Joseph; Snow, Gregory; Srivastava, Rajendu; Isaacson, Brad; Allen, Todd

    2016-01-01

    Introduction Little data exists to help urgent care (UC) clinicians predict morbidity and mortality risk. Age, systolic blood pressure (SBP), and heart rate (HR) are easily obtainable and have been used in other settings to predict short-term risk of deterioration. We hypothesized that there is a relationship between advancing age, SBP, HR, and short-term health outcomes in the UC setting. Methods We collected retrospective data from 28 UC clinics and 22 hospitals in the Intermountain Healthcare system between years 2008–2013. Adult patients (≥18 years) were included if they had a unique UC visit and HR or SBP data. Three endpoints following UC visit were assessed: emergency department (ED) visit within three days, hospitalization within three days, and death within seven days. We analyzed associations between age, SBP, HR and endpoints using local regression with a binomial likelihood. Five age groups were chosen from previously published national surveys. Vital sign (VS) distributions were determined for each age group, and the central tendency was compared against previously published norms (90–120mmHg for SBP and 60–100bpm for HR.) Results A total of 1,720,207 encounters (714,339 unique patients) met the inclusion criteria; 51,446 encounters (2.99%) had ED visit within three days; 12,397 (0.72%) experienced hospitalization within three days; 302 (0.02%) died within seven days of UC visit. Heart rate and SBP combined with advanced age predicted the probability of ED visit (p<0.0001) and hospitalization (p<0.0001) following UC visit. Significant associations between advancing age and death (p<0.0001), and VS and death (p<0.0001) were observed. Odds ratios of risk were highest for elderly patients with lower SBP or higher HR. Observed distributions of SBP were higher than published normal ranges for all age groups. Conclusion Among adults seeking care in the UC, associations between HR and SBP and likelihood of ED visits and hospitalization were more

  11. Association of Age, Systolic Blood Pressure, and Heart Rate with Adult Morbidity and Mortality after Urgent Care Visits

    PubMed Central

    Hart, James; Woodruff, Michael; Joy, Elizabeth; Dalto, Joseph; Snow, Gregory; Srivastava, Rajendu; Isaacson, Brad; Allen, Todd

    2016-01-01

    Introduction Little data exists to help urgent care (UC) clinicians predict morbidity and mortality risk. Age, systolic blood pressure (SBP), and heart rate (HR) are easily obtainable and have been used in other settings to predict short-term risk of deterioration. We hypothesized that there is a relationship between advancing age, SBP, HR, and short-term health outcomes in the UC setting. Methods We collected retrospective data from 28 UC clinics and 22 hospitals in the Intermountain Healthcare system between years 2008–2013. Adult patients (≥18 years) were included if they had a unique UC visit and HR or SBP data. Three endpoints following UC visit were assessed: emergency department (ED) visit within three days, hospitalization within three days, and death within seven days. We analyzed associations between age, SBP, HR and endpoints using local regression with a binomial likelihood. Five age groups were chosen from previously published national surveys. Vital sign (VS) distributions were determined for each age group, and the central tendency was compared against previously published norms (90–120mmHg for SBP and 60–100bpm for HR.) Results A total of 1,720,207 encounters (714,339 unique patients) met the inclusion criteria; 51,446 encounters (2.99%) had ED visit within three days; 12,397 (0.72%) experienced hospitalization within three days; 302 (0.02%) died within seven days of UC visit. Heart rate and SBP combined with advanced age predicted the probability of ED visit (p<0.0001) and hospitalization (p<0.0001) following UC visit. Significant associations between advancing age and death (p<0.0001), and VS and death (p<0.0001) were observed. Odds ratios of risk were highest for elderly patients with lower SBP or higher HR. Observed distributions of SBP were higher than published normal ranges for all age groups. Conclusion Among adults seeking care in the UC, associations between HR and SBP and likelihood of ED visits and hospitalization were more

  12. [Time analysis of pharmacists' home visit duties].

    PubMed

    Horii, Kota; Hirasawa, Shinichiro; Toshima, Chiaki; Morimoto, Masao; Shiraishi, Takeya; Maeda, Keigo; Hirohara, Masayoshi; Kushida, Kazuki

    2014-12-01

    Pharmacists' home visit duties include accepting prescriptions, making inquiries with the attending physician, preparing medication, giving guidance on medication, going on home visits(round trips), and handling insurance claims. In the present study, we measured the time required for each duty and determined work duration per visit. The study took place during September 2013; the sample included 116 subjects and 211 home visits were conducted. Pharmacists' mean work duration per visit was 73 min and 15 s; they spent an average of 36 min and 13 s of this period on round trips involving home visits and providing guidance on medication. Pharmacists are responsible for preparing medication for outpatients; therefore, it can be assumed that they can visit patients at their homes only during the estimated 2-h period after lunch and before the commencement of outpatient service in the evening. Therefore, it is difficult for one pharmacist to visit more than five patients a day. The number of patients that each pharmacist can visit in one week(6 working days)is estimated at 25-30.

  13. Validation of ICD-9-CM codes for identification of acetaminophen-related emergency department visits in a large pediatric hospital

    PubMed Central

    2013-01-01

    Background Acetaminophen overdose is a major concern among the pediatric population. Our objective was to assess the validity of International Classification of Disease (ICD-9-CM) codes for identification of pediatric emergency department (ED) visits resulting from acetaminophen exposure or overdose. Methods We conducted a retrospective medical record review of ED visits at Texas Children’s Hospital in Houston, Texas, between January 1, 2005, and December 31, 2010. Visits coded with 1 or more ICD-9 codes for poisoning (965, 977, and their subcodes and supplemental E-codes E850, E858, E935, E947, and E950 and their subcodes) were identified from an administrative database, and further review of the medical records was conducted to identify true cases of acetaminophen exposure or overdose. We then examined the sensitivity, positive predictive value, and percentage of false positives identified by various codes and code combinations to establish which codes most accurately identified acetaminophen exposure or overdose. Results Of 1,215 ED visits documented with 1 or more of the selected codes, 316 (26.0%) were a result of acetaminophen exposure or overdose. Sensitivity was highest (87.0%) for the combination of codes 965.4 (poisoning by aromatic analgesics, not elsewhere classified) and E950.0 (suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics), with a positive predictive value of 86.2%. Code 965.4 alone yielded a sensitivity of 85.1%, with a positive predictive value of 92.8%. Code performance varied among age groups and depending on the type of exposure (intentional or unintentional). Conclusion ICD-9 codes are useful for ascertaining which ED visits are a result of acetaminophen exposure or overdose within the pediatric population. However, because ICD-9 coding differs by age group and depending on the type of exposure, hypothesis-driven strategies must be utilized for each pediatric age group to avoid misclassification. PMID

  14. Adolescent Female Text Messaging Preferences to Prevent Pregnancy After an Emergency Department Visit: A Qualitative Analysis

    PubMed Central

    Schnall, Rebecca; Stockwell, Melissa S; Castaño, Paula M; Higgins, Tracy; Westhoff, Carolyn; Santelli, John; Dayan, Peter S

    2016-01-01

    Background Over 15 million adolescents use the emergency department (ED) each year in the United States. Adolescent females who use the ED for medical care have been found to be at high risk for unintended pregnancy. Given that adolescents represent the largest users of text messaging and are receptive to receiving text messages related to their sexual health, the ED visit represents an opportunity for intervention. Objective The aim of this qualitative study was to explore interest in and preferences for the content, frequency, and timing of an ED-based text message intervention to prevent pregnancy for adolescent females. Methods We conducted semistructured, open-ended interviews in one urban ED in the United States with adolescent females aged 14-19 years. Eligible subjects were adolescents who were sexually active in the past 3 months, presented to the ED for a reproductive health complaint, owned a mobile phone, and did not use effective contraception. Using an interview guide, enrollment continued until saturation of key themes. The investigators designed sample text messages using the Health Beliefs Model and participants viewed these on a mobile phone. The team recorded, transcribed, and coded interviews based on thematic analysis using the qualitative analysis software NVivo and Excel. Results Participants (n=14) were predominantly Hispanic (13/14; 93%), insured (13/14; 93%), ED users in the past year (12/14; 86%), and frequent text users (10/14; 71% had sent or received >30 texts per day). All were interested in receiving text messages from the ED about pregnancy prevention, favoring messages that were “brief,” “professional,” and “nonaccusatory.” Respondents favored texts with links to websites, repeated information regarding places to receive “confidential” care, and focused information on contraception options and misconceptions. Preferences for text message frequency varied from daily to monthly, with random hours of delivery to

  15. Canadian EdGEO National Workshop Program

    NASA Astrophysics Data System (ADS)

    Clinton, L. A.; Haidl, F. M.; Hymers, L. A.; van der Flier-Keller, E.

    2009-05-01

    Established in the early 1970s, EdGEO supports locally driven geosciences workshops for Canadian teachers. Workshops are organized by geoscientists and teachers, and typically have field, laboratory and classroom components. Grants of up to $3000 per workshop are available from the National EdGEO Program. By providing educational opportunities for today's teachers and, through them, their students, EdGEO seeks to cultivate a heightened awareness of our planet. EdGEO workshops provide teachers with potential fieldtrip sites for their students and the knowledge, enthusiasm and materials to inspire their students to engage in geoscience. Networking opportunities with local experts promote the importance of the geoscience profession. The expected result is an improved capacity on the part of Canadians to understand the Earth and to make informed decisions, especially with regard to the use of mineral and energy resources, the maintenance and remediation of the environment, and response to geological hazards. There exists a critical need to provide teachers with training and resources to tackle their Earth science curricula. In 2008, EdGEO supported fourteen workshops, with an unprecedented 521 teachers attending. These teachers then used our resources to reach an estimated 14,000 students during that single academic year. EdGEO workshops are locally driven and are therefore very diverse. Workshops are strongly tied to the provincial curriculum, focus on a specific geoscience topic, or may be largely field-based to demonstrate and practice how field activities could be incorporated into Earth science teaching. Many strive to include all of these important components. Geoscientists and teachers work collaboratively to develop and deliver EdGEO workshops to ensure that the activities can be effectively used in the classroom. The length of these professional development opportunities range from two-hour sessions to several days, and can generally accommodate up to twenty

  16. Air pollution and emergency department visits for cardiac and respiratory conditions: a multi-city time-series analysis

    PubMed Central

    2009-01-01

    Background Relatively few studies have been conducted of the association between air pollution and emergency department (ED) visits, and most of these have been based on a small number of visits, for a limited number of health conditions and pollutants, and only daily measures of exposure and response. Methods A time-series analysis was conducted on nearly 400,000 ED visits to 14 hospitals in seven Canadian cities during the 1990s and early 2000s. Associations were examined between carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), sulfur dioxide (SO2), and particulate matter (PM10 and PM2.5), and visits for angina/myocardial infarction, heart failure, dysrhythmia/conduction disturbance, asthma, chronic obstructive pulmonary disease (COPD), and respiratory infections. Daily and 3-hourly visit counts were modeled as quasi-Poisson and analyses controlled for effects of temporal cycles, weather, day of week and holidays. Results 24-hour average concentrations of CO and NO2 lag 0 days exhibited the most consistent associations with cardiac conditions (2.1% (95% CI, 0.0–4.2%) and 2.6% (95% CI, 0.2–5.0%) increase in visits for myocardial infarction/angina per 0.7 ppm CO and 18.4 ppb NO2 respectively; 3.8% (95% CI, 0.7–6.9%) and 4.7% (95% CI, 1.2–8.4%) increase in visits for heart failure). Ozone (lag 2 days) was most consistently associated with respiratory visits (3.2% (95% CI, 0.3–6.2%), and 3.7% (95% CI, -0.5–7.9%) increases in asthma and COPD visits respectively per 18.4 ppb). Associations tended to be of greater magnitude during the warm season (April – September). In particular, the associations of PM10 and PM2.5with asthma visits were respectively nearly three- and over fourfold larger vs. all year analyses (14.4% increase in visits, 95% CI, 0.2–30.7, per 20.6 μg/m3 PM10 and 7.6% increase in visits, 95% CI, 5.1–10.1, per 8.2 μg/m3 PM2.5). No consistent associations were observed between three hour average pollutant concentrations and

  17. A systematic review of nonsurgical single-visit versus multiple-visit endodontic treatment

    PubMed Central

    Wong, Amy WY; Zhang, Chengfei; Chu, Chun-hung

    2014-01-01

    Conventional endodontic treatment used to require multiple visits, but some clinicians have suggested that single-visit treatment is superior. Single-visit endodontic treatment and multiple-visit endodontic treatment both have their advantages and disadvantages. This paper is a literature review of the research on nonsurgical single-visit versus multiple-visit endodontic treatment. The PubMed database was searched using the keywords (endodontic treatment OR endodontic therapy OR root canal treatment OR root canal therapy) AND (single-visit OR one-visit OR 1-visit). Review papers, case reports, data studies, and irrelevant reports were excluded, and 47 papers on clinical trials were reviewed. The studies generally had small sample sizes, and the endodontic procedures varied among the studies. Meta-analysis on the selected studies was performed, and the results showed that the postoperative complications of the single-visit and multiple-visit endodontic treatment were similar. Furthermore, neither single-visit endodontic treatment nor multiple-visit treatment had superior results over the other in terms of healing or success rate. Results of limited studies on disinfection of the root canals using low-energy laser photodynamic therapy is inconclusive, and further studies are necessary to show whether laser should be used in endodontic treatment. This review also found that that neither single-visit endodontic treatment nor multiple-visit treatment could guarantee the absence of postoperative pain. Since the study design of many studies displayed significant limitation and the materials and equipment used in endodontic treatment have dramatically changed in recent years, prospective randomized clinical trials are needed to further verify the postoperative pain and success rates of single-visit versus multiple-visit endodontic treatment. PMID:24855389

  18. A systematic review of nonsurgical single-visit versus multiple-visit endodontic treatment.

    PubMed

    Wong, Amy Wy; Zhang, Chengfei; Chu, Chun-Hung

    2014-01-01

    Conventional endodontic treatment used to require multiple visits, but some clinicians have suggested that single-visit treatment is superior. Single-visit endodontic treatment and multiple-visit endodontic treatment both have their advantages and disadvantages. This paper is a literature review of the research on nonsurgical single-visit versus multiple-visit endodontic treatment. The PubMed database was searched using the keywords (endodontic treatment OR endodontic therapy OR root canal treatment OR root canal therapy) AND (single-visit OR one-visit OR 1-visit). Review papers, case reports, data studies, and irrelevant reports were excluded, and 47 papers on clinical trials were reviewed. The studies generally had small sample sizes, and the endodontic procedures varied among the studies. Meta-analysis on the selected studies was performed, and the results showed that the postoperative complications of the single-visit and multiple-visit endodontic treatment were similar. Furthermore, neither single-visit endodontic treatment nor multiple-visit treatment had superior results over the other in terms of healing or success rate. Results of limited studies on disinfection of the root canals using low-energy laser photodynamic therapy is inconclusive, and further studies are necessary to show whether laser should be used in endodontic treatment. This review also found that that neither single-visit endodontic treatment nor multiple-visit treatment could guarantee the absence of postoperative pain. Since the study design of many studies displayed significant limitation and the materials and equipment used in endodontic treatment have dramatically changed in recent years, prospective randomized clinical trials are needed to further verify the postoperative pain and success rates of single-visit versus multiple-visit endodontic treatment.

  19. Impact of Mental Health and Substance Use Disorders on Emergency Department Visit Outcomes for HIV Patients

    PubMed Central

    Choi, Brian Y.; DiNitto, Diana M.; Marti, C. Nathan; Choi, Namkee G.

    2016-01-01

    Introduction A disproportionate number of individuals with human immunodeficiency virus (HIV) have mental health and substance-use disorders (MHSUDs), and MHSUDs are significantly associated with their emergency department (ED) visits. With an increasing share of older adults among HIV patients, this study investigated the associations of MHSUDs with ED outcomes of HIV patients in four age groups: 21–34, 35–49, 50–64, and 65+ years. Methods We used the 2012 Nationwide Emergency Department Sample (NEDS) dataset (unweighted n=23,244,819 ED events by patients aged 21+, including 115,656 visits by patients with HIV). Multinomial and binary logistic regression analyses, with “treat-and-release” as the base outcome, were used to examine associations between ED outcomes and MHSUDs among visits that included a HIV diagnosis in each age group. Results Mood and “other” mental disorders had small effects on ED-to-hospital admissions, as opposed to treat-and-release, in age groups younger than 65+ years, while suicide attempts had medium effects (RRR=3.56, CI [2.69–4.70]; RRR=4.44, CI [3.72–5.30]; and RRR=5.64, CI [4.38–7.26] in the 21–34, 35–49, and 50–64 age groups, respectively). Cognitive disorders had medium-to-large effects on hospital admissions in all age groups and large effects on death in the 35–49 (RRR=7.29, CI [3.90–13.62]) and 50–64 (RRR=5.38, CI [3.39–8.55]) age groups. Alcohol use disorders (AUDs) had small effects on hospital admission in all age groups (RRR=2.35, 95% CI [1.92–2.87]; RRR=2.15, 95% CI [1.95–2.37]; RRR=1.92, 95% CI [1.73–2.12]; and OR=1.93, 95% CI [1.20–3.10] in the 21–34, 35–49, 50–64, and 65+ age groups, respectively). Drug use disorders (DUDs) had small-to-medium effects on hospital admission (RRR=4.40, 95% CI [3.87–5.0]; RRR=4.07, 95% CI [3.77–4.40]; RRR=4.17, 95% CI [3.83–4.55]; and OR=2.53, 95% CI [2.70–3.78] in the 21–34, 35–49, 50–64, and 65+ age groups, respectively). AUDs

  20. The Trouble with the Ed.D

    ERIC Educational Resources Information Center

    Flessa, Joseph

    2007-01-01

    This article review examines Arthur Levine's 2005 "Educating School Leaders," a report that recommended the elimination of the Ed.D. and the establishment of a new degree, the Master's in Educational Administration. The article review draws attention to the central irony of Levine's report: after chronicling the many ways that schools of education…

  1. Precipitator rehabilitation ComEd Waukegan station

    SciTech Connect

    Sanda, L.; Hermanas, G.

    1996-12-31

    ComEd`s Waukegan Station successfully completed a total rehabilitation of its Unit 8 electrostatic precipitator (ESP) and recovered 66 MW that has been lost due to burning Western Coal. This practice began in the 1970`s for emission`s compliance. The unit now operates at it maximum continuous rating (MCR) with increased fuel flexibility.

  2. The Consequences of edTPA

    ERIC Educational Resources Information Center

    Greenblatt, Deborah

    2016-01-01

    States and teacher preparation programs across the country are increasingly using a teacher candidate assessment called edTPA. The purpose? To make sure that teacher candidates are ready and able to teach before they begin their careers. The teacher performance assessment requires candidates to compile a portfolio that consists of lesson plans,…

  3. Factors associated with healthcare visits by young children for nontoxic poisoning exposures.

    PubMed

    Polivka, Barbara J; Casavant, Marcel; Baker, S David

    2010-12-01

    Poison control centers have been shown to be a cost-effective alternative to healthcare visits for poisoning exposures, yet emergency departments (ED) and urgent care centers (UCC) continue to be frequently accessed for poisoning exposures in young children. We sought to identify predictors of young children who obtain healthcare for a nontoxic poisoning exposure. Poisoning exposure cases for children ≤5 years old who sought ED, UCC, or clinic care between 2001 and 2005 from an urban regional pediatric hospital system were identified from poisoning ICD-9 codes in the hospital administrative data and from a poisoning designation in the National Electronic Injury Surveillance System (NEISS) data. Cases (n = 2,494) were reviewed and categorized as either toxic or nontoxic. Toxic exposures were those with more than minimal potential for clinical effects. Most cases were between 1 and 2 years old, male, White, enrolled in Medicaid, sought ED care, had no referring physician, and brought to the facility by a parent/guardian. Logistic regression analysis revealed that the odds of seeking healthcare for a nontoxic poisoning exposure were significantly greater if the child was African American, enrolled in Medicaid, had a non-medication related poisoning, and was brought to the healthcare site by a parent/guardian. Healthcare costs and unnecessary use of healthcare resources for nontoxic poisoning exposures could be reduced by educating parents and providers of children at high risk for inappropriate healthcare visits for nontoxic poisonings to initially contact the poison control center (1-800-222-1222).

  4. Arsenic exposure from drinking water, and all-cause and chronic-disease mortalities in Bangladesh (HEALS): a prospective cohort study

    PubMed Central

    Argos, Maria; Kalra, Tara; Rathouz, Paul J; Chen, Yu; Pierce, Brandon; Parvez, Faruque; Islam, Tariqul; Ahmed, Alauddin; Rakibuz-Zaman, Muhammad; Hasan, Rabiul; Sarwar, Golam; Slavkovich, Vesna; van Geen, Alexander; Graziano, Joseph; Ahsan, Habibul

    2014-01-01

    Summary Background Millions of people worldwide are chronically exposed to arsenic through drinking water, including 35–77 million people in Bangladesh. The association between arsenic exposure and mortality rate has not been prospectively investigated by use of individual-level data. We therefore prospectively assessed whether chronic and recent changes in arsenic exposure are associated with all-cause and chronic-disease mortalities in a Bangladeshi population. Methods In the prospective cohort Health Effects of Arsenic Longitudinal Study (HEALS), trained physicians unaware of arsenic exposure interviewed in person and clinically assessed 11 746 population-based participants (aged 18–75 years) from Araihazar, Bangladesh. Participants were recruited from October, 2000, to May, 2002, and followed-up biennially. Data for mortality rates were available throughout February, 2009. We used Cox proportional hazards model to estimate hazard ratios (HRs) of mortality, with adjustment for potential confounders, at different doses of arsenic exposure. Findings 407 deaths were ascertained between October, 2000, and February, 2009. Multivariate adjusted HRs for all-cause mortality in a comparison of arsenic at concentrations of 10·1–50·0 μg/L, 50·1–150·0 μg/L, and 150·1–864·0 μg/L with at least 10·0 μg/L in well water were 1·34 (95% CI 0·99–1·82), 1·09 (0·81–1·47), and 1·68 (1·26–2·23), respectively. Results were similar with daily arsenic dose and total arsenic concentration in urine. Recent change in exposure, measurement of total arsenic concentrations in urine repeated biennially, did not have much effect on the mortality rate. Interpretation Chronic arsenic exposure through drinking water was associated with an increase in the mortality rate. Follow-up data from this cohort will be used to assess the long-term effects of arsenic exposure and how they might be affected by changes in exposure. However, solutions and resources are urgently

  5. Serum 25(OH)D Is a 2-Year Predictor of All-Cause Mortality, Cardiac Death and Sudden Cardiac Death in Chest Pain Patients from Northern Argentina

    PubMed Central

    Naesgaard, Patrycja A.; León De La Fuente, Ricardo A.; Nilsen, Stein Tore; Woie, Leik; Aarsland, Torbjoern; Brede, Cato; Staines, Harry; Nilsen, Dennis W. T.

    2012-01-01

    Background Several studies have shown an association between vitamin D deficiency and cardiovascular risk. Vitamin D status is assessed by determination of 25-hydroxyvitamin D [25(OH)D] in serum. Methods We assessed the prognostic utility of 25(OH)D in 982 chest-pain patients with suspected acute coronary syndrome (ACS) from Salta, Northern Argentina. 2-year follow-up data including all-cause mortality, cardiac death and sudden cardiac death were analyzed in quartiles of 25(OH)D, applying univariate and multivariate analysis. Results There were statistically significant changes in seasonal 25(OH)D levels. At follow-up, 119 patients had died. The mean 25(OH)D levels were significantly lower among patients dying than in long-term survivors, both in the total population and in patients with a troponin T (TnT) release (n = 388). When comparing 25(OH)D in the highest quartile to the lowest quartile in a multivariable Cox regression model for all-cause mortality, the hazard ratio (HR) for cardiac death and sudden cardiac death in the total population was 0.37 (95% CI, 0.19–0.73), p = 0.004, 0.23 (95% CI, 0.08–0.67), p = 0.007, and 0.32 (95% CI, 0.11–0.94), p = 0.038, respectively. In patients with TnT release, the respective HR was 0.24 (95% CI, 0.10–0.54), p = 0.001, 0.18 (95% CI, 0.05–0.60), p = 0.006 and 0.25 (95% CI, 0.07–0.89), p = 0.033. 25(OH)D had no prognostic value in patients with no TnT release. Conclusion Vitamin D was shown to be a useful biomarker for prediction of mortality when obtained at admission in chest pain patients with suspected ACS. Trial registration ClinicalTrials.gov NCT01377402 PMID:22970121

  6. Low Systolic Blood Pressure and Mortality From All Causes and Vascular Diseases Among Older Middle-aged Men: Korean Veterans Health Study

    PubMed Central

    Yi, Sang-Wook; Ohrr, Heechoul

    2015-01-01

    Objectives: Recently, low systolic blood pressure (SBP) was found to be associated with an increased risk of death from vascular diseases in a rural elderly population in Korea. However, evidence on the association between low SBP and vascular diseases is scarce. The aim of this study was to prospectively examine the association between low SBP and mortality from all causes and vascular diseases in older middle-aged Korean men. Methods: From 2004 to 2010, 94 085 Korean Vietnam War veterans were followed-up for deaths. The adjusted hazard ratios (aHR) were calculated using the Cox proportional hazard model. A stratified analysis was conducted by age at enrollment. SBP was self-reported by a postal survey in 2004. Results: Among the participants aged 60 and older, the lowest SBP (<90 mmHg) category had an elevated aHR for mortality from all causes (aHR, 1.9; 95% confidence interval [CI], 1.2 to 3.1) and vascular diseases (International Classification of Disease, 10th revision, I00-I99; aHR, 3.2; 95% CI, 1.2 to 8.4) compared to those with an SBP of 100 to 119 mmHg. Those with an SBP below 80 mmHg (aHR, 4.5; 95% CI, 1.1 to 18.8) and those with an SBP of 80 to 89 mmHg (aHR, 3.1; 95% CI, 0.9 to 10.2) also had an increased risk of vascular mortality, compared to those with an SBP of 90 to 119 mmHg. This association was sustained when excluding the first two years of follow-up or preexisting vascular diseases. In men younger than 60 years, the association of low SBP was weaker than that in those aged 60 years or older. Conclusions: Our findings suggest that low SBP (<90 mmHg) may increase vascular mortality in Korean men aged 60 years or older. PMID:25857648

  7. Influence of Androgen Deprivation Therapy on All-Cause Mortality in Men With High-Risk Prostate Cancer and a History of Congestive Heart Failure or Myocardial Infarction

    SciTech Connect

    Nguyen, Paul L.; Chen, Ming-Hui; Beckman, Joshua A.; Beard, Clair J.; Martin, Neil E.; Choueiri, Toni K.; Hu, Jim C.; Dosoretz, Daniel E.; Moran, Brian J.; Salenius, Sharon A.; Braccioforte, Michelle H.; Kantoff, Philip W.; D'Amico, Anthony V.; Ennis, Ronald D.

    2012-03-15

    Purpose: It is unknown whether the excess risk of all-cause mortality (ACM) observed when androgen deprivation therapy (ADT) is added to radiation for men with prostate cancer and a history of congestive heart failure (CHF) or myocardial infarction (MI) also applies to those with high-risk disease. Methods and Materials: Of 14,594 men with cT1c-T3aN0M0 prostate cancer treated with brachytherapy-based radiation from 1991 through 2006, 1,378 (9.4%) with a history of CHF or MI comprised the study cohort. Of these, 22.6% received supplemental external beam radiation, and 42.9% received a median of 4 months of neoadjuvant ADT. Median age was 71.8 years. Median follow-up was 4.3 years. Cox multivariable analysis tested for an association between ADT use and ACM within risk groups, after adjusting for treatment factors, prognostic factors, and propensity score for ADT. Results: ADT was associated with significantly increased ACM (adjusted hazard ratio [AHR] = 1.76; 95% confidence interval [CI], 1.32-2.34; p = 0.0001), with 5-year estimates of 22.71% with ADT and 11.62% without ADT. The impact of ADT on ACM by risk group was as follows: high-risk AHR = 2.57; 95% CI, 1.17-5.67; p = 0.019; intermediate-risk AHR = 1.75; 95% CI, 1.13-2.73; p = 0.012; low-risk AHR = 1.52; 95% CI, 0.96-2.43; p = 0.075). Conclusions: Among patients with a history of CHF or MI treated with brachytherapy-based radiation, ADT was associated with increased all-cause mortality, even for patients with high-risk disease. Although ADT has been shown in Phase III studies to improve overall survival in high-risk disease, the small subgroup of high-risk patients with a history of CHF or MI, who represented about 9% of the patients, may be harmed by ADT.

  8. Association of body mass index with all-cause mortality in patients with diabetes: a systemic review and meta-analysis

    PubMed Central

    Chang, Hsiao-Wen; Li, Yi-Hwei; Hsieh, Chang-Hsun; Liu, Pang-Yen

    2016-01-01

    Background The obesity paradox phenomenon has been found in different populations, such as heart failure and coronary heart disease, which suggest that patients with established cardiovascular disease (CVD) and with normal weight had higher risk of mortality than those with overweight or obesity. However, the obesity paradox is controversial among patients with diabetes which has been considered as the coronary heart disease equivalent. The aim of our study was to summarize current findings on the relationship between body mass index (BMI) and all-cause mortality in patients with diabetes and make a meta-analysis. Methods We searched previous studies from MEDLINE, EMBASE, and the Cochrane databases using the keywords: BMI, mortality, diabetes, and obesity paradox or reverse epidemiology. Finally, sixteen studies were identified and 385,925 patients were included. Patients were divided into five groups based on BMI (kg/m2) levels: underweight (<18.5), normal weight (18.5–24.9), overweight (25–29.9), mild obesity (30–34.9), and morbid obesity (>35). A random effect meta-analysis was performed by the inverse variance method. Results As compared with the normal weight, the underweight had higher risk of mortality [hazard ratio (HR): 1.59, 95% confidence interval (CI): 1.32–1.91]. In contrast, the overweight and the mild obesity had lower risk of mortality than the normal weight (HR: 0.86, 95% CI: 0.78–0.96, and 0.88, 95% CI: 0.78–1.00, respectively), but the morbid obesity did not (HR: 0.99, 95% CI: 0.84–1.16). In addition, the subgroup analysis by sex showed that the overweight had the lowest mortality as compared with the normal weight (HR: 0.82, 95% CI: 0.74–0.90) and the obesity in males, but the risk of mortality did not differ among groups in females. Notably, the heterogeneity was significant in most of group comparisons. Conclusions Our meta-analysis showed a U-shaped relationship between BMI and all-cause mortality in patients with diabetes

  9. Neighbourhood Characteristics and Long-Term Air Pollution Levels Modify the Association between the Short-Term Nitrogen Dioxide Concentrations and All-Cause Mortality in Paris

    PubMed Central

    Deguen, Séverine; Petit, Claire; Delbarre, Angélique; Kihal, Wahida; Padilla, Cindy; Benmarhnia, Tarik; Lapostolle, Annabelle; Chauvin, Pierre; Zmirou-Navier, Denis

    2015-01-01

    Background While a great number of papers have been published on the short-term effects of air pollution on mortality, few have tried to assess whether this association varies according to the neighbourhood socioeconomic level and long-term ambient air concentrations measured at the place of residence. We explored the effect modification of 1) socioeconomic status, 2) long-term NO2 ambient air concentrations, and 3) both combined, on the association between short-term exposure to NO2 and all-cause mortality in Paris (France). Methods A time-stratified case-crossover analysis was performed to evaluate the effect of short-term NO2 variations on mortality, based on 79,107 deaths having occurred among subjects aged over 35 years, from 2004 to 2009, in the city of Paris. Simple and double interactions were statistically tested in order to analyse effect modification by neighbourhood characteristics on the association between mortality and short-term NO2 exposure. The data was estimated at the census block scale (n=866). Results The mean of the NO2 concentrations during the five days prior to deaths were associated with an increased risk of all-cause mortality: overall Excess Risk (ER) was 0.94% (95%CI=[0.08;1.80]. A higher risk was revealed for subjects living in the most deprived census blocks in comparison with higher socioeconomic level areas (ER=3.14% (95%CI=[1.41-4.90], p<0.001). Among these deprived census blocks, excess risk was even higher where long-term average NO2 concentrations were above 55.8 μg/m3 (the top tercile of distribution): ER=4.84% (95%CI=[1.56;8.24], p for interaction=0.02). Conclusion Our results show that people living in census blocks characterized by low socioeconomic status are more vulnerable to air pollution episodes. There is also an indication that people living in these disadvantaged census blocks might experience even higher risk following short-term air pollution episodes, when they are also chronically exposed to higher NO2 levels

  10. Nighttime sleep duration, 24-hour sleep duration and risk of all-cause mortality among adults: a meta-analysis of prospective cohort studies

    PubMed Central

    Shen, Xiaoli; Wu, Yili; Zhang, Dongfeng

    2016-01-01

    A dose-response meta-analysis was conducted to summarize evidence from prospective cohort studies about the association of nighttime sleep duration and 24-hour sleep duration with risk of all-cause mortality among adults. Pertinent studies were identified by a search of Embase and PubMed databases to March 2015. A two-stage random-effects dose–response meta-analysis was used to combine study-specific relative risks and 95% confidence intervals [RRs (95% CIs)]. Thirty-five articles were included. Compared with 7 hours/day, the RRs (95% CIs) of all-cause mortality were 1.07 (1.03–1.13), 1.04 (1.01–1.07), 1.01 (1.00–1.02), 1.07 (1.06–1.09), 1.21 (1.18–1.24), 1.37 (1.32–1.42) and 1.55 (1.47–1.63) for 4, 5, 6, 8, 9, 10 and 11 hours/day of nighttime sleep, respectively (146,830 death cases among 1,526,609 participants), and the risks were 1.09 (1.04–1.14), 1.05 (1.02–1.09), 1.02 (1.00–1.03), 1.08 (1.05–1.10), 1.27 (1.20–1.36), 1.53 (1.38–1.70) and 1.84 (1.59–2.13) for 4, 5, 6, 8, 9, 10 and 11 hours/day of 24-hour sleep, respectively (101,641 death cases among 903,727 participants). The above relationships were also found in subjects without cardiovascular diseases and cancer at baseline, and other covariates did not influence the relationships substantially. The results suggested that 7 hours/day of sleep duration should be recommended to prevent premature death among adults. PMID:26900147

  11. How to Host a School Visit

    ERIC Educational Resources Information Center

    Eboch, Chris

    2006-01-01

    Bringing a "real live" author into the school can be a great fun for both kids and staff. However, it can also be a disaster. In this article, the author offers ideas on how to host a school visit. Library media specialists can help ensure a successful visit by preparing in advance: define the goals, communicate the expectations, provide…

  12. Should Supervisors Intervene during Classroom Visits?

    ERIC Educational Resources Information Center

    Marshall, Kim

    2015-01-01

    Real-time coaching has become the go-to supervisory model in some schools (especially charters), with supervisors routinely jumping in during teacher observations and sometimes taking over the class to model a more effective approach. The author sets out goals and guidelines for impromptu classroom visits that include visiting each classroom at…

  13. Home Visitation--A Chance for Counseling

    ERIC Educational Resources Information Center

    Crosen, Roger L.

    1976-01-01

    Some ideas for improving the effectiveness of home visitation of students by vocational agriculture instructors include: planning for the visit, getting to know the student, assessing the home situation for influencing factors, using home responsibilities for plant and animal care as learning experiences, and considering life goals. (MS)

  14. 42 CFR 409.48 - Visits.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... covered each time an HHA employee or someone providing home health services under arrangements enters the... INSURANCE BENEFITS Home Health Services Under Hospital Insurance § 409.48 Visits. (a) Number of allowable... home health visits. All Medicare home health services are covered under hospital insurance unless...

  15. 28 CFR 551.120 - Visiting.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Visiting. 551.120 Section 551.120 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT MISCELLANEOUS... special visits to protect the inmate's business interests or to help prepare for trial....

  16. Home visits in family medicine residency

    PubMed Central

    Jakubovicz, Difat; Srivastava, Anita

    2015-01-01

    Abstract Problem addressed There has been a decline in family physicians providing home visits to housebound patients. Objective of program To increase family medicine residents’ exposure to home visits; their comfort and skills in providing home visits; and their willingness to provide home visits after graduation. Program description Between 2000 and 2010, each family practice resident at St Joseph’s Health Centre Family Medicine Teaching Unit in Toronto, Ont, was assigned at least 1 housebound patient to care for longitudinally over 2 years; the rationale for this was to increase the sense of “ownership” and responsibility among residents for their assigned homebound patients. Starting in 2003, until the program’s conclusion in 2010, residents were asked to fill out surveys before and after the program to assess their comfort with and confidence in providing home visits, as well as their satisfaction with the program. Survey responses were analyzed for changes over the course of residency training. A total of 85 residents completed the home visit teaching program between 2003 and 2010 inclusive. Conclusion While residents’ willingness to provide home visits did not increase over the course of residency, their confidence in making housecalls did increase. There was also a trend toward increased confidence among residents in working with community agencies. Thus, having home visit patients be a part of resident practices might play an important role in increasing the likelihood that future family physicians will continue to care for their patients when those patients are no longer ambulatory. PMID:26052599

  17. 28 CFR 548.19 - Pastoral visits.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Pastoral visits. 548.19 Section 548.19 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT RELIGIOUS... clergyperson's or faith group representative's credentials. (b) Pastoral visits may not be counted as...

  18. 28 CFR 548.19 - Pastoral visits.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Pastoral visits. 548.19 Section 548.19 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT RELIGIOUS... clergyperson's or faith group representative's credentials. (b) Pastoral visits may not be counted as...

  19. 28 CFR 548.19 - Pastoral visits.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Pastoral visits. 548.19 Section 548.19 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT RELIGIOUS... clergyperson's or faith group representative's credentials. (b) Pastoral visits may not be counted as...

  20. 28 CFR 548.19 - Pastoral visits.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Pastoral visits. 548.19 Section 548.19 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT RELIGIOUS... clergyperson's or faith group representative's credentials. (b) Pastoral visits may not be counted as...

  1. 28 CFR 548.19 - Pastoral visits.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Pastoral visits. 548.19 Section 548.19 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT RELIGIOUS... clergyperson's or faith group representative's credentials. (b) Pastoral visits may not be counted as...

  2. 28 CFR 540.62 - Institutional visits.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Institutional visits. 540.62 Section 540.62 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT CONTACT WITH PERSONS IN THE COMMUNITY Contact With News Media § 540.62 Institutional visits. (a) A...

  3. Home Visiting: Looking Back and Moving Forward

    ERIC Educational Resources Information Center

    Boller, Kimberly; Strong, Debra A.; Daro, Deborah

    2010-01-01

    Recent large federal investments in services for pregnant women and young children will fuel the expansion of home visiting services across the U.S. The authors summarize the history of home visiting and describe trends toward evidence-based and national program models. Moving to an integrated system requires supports for implementation with…

  4. Assessing Quality in Home Visiting Programs

    ERIC Educational Resources Information Center

    Korfmacher, Jon; Laszewski, Audrey; Sparr, Mariel; Hammel, Jennifer

    2013-01-01

    Defining quality and designing a quality assessment measure for home visitation programs is a complex and multifaceted undertaking. This article summarizes the process used to create the Home Visitation Program Quality Rating Tool (HVPQRT) and identifies next steps for its development. The HVPQRT measures both structural and dynamic features of…

  5. Implementing and Preparing for Home Visits

    ERIC Educational Resources Information Center

    McWilliam, R. A.

    2012-01-01

    The most common setting for early intervention services for infants and toddlers with disabilities and their families is the home. This article discusses home- and community-based early intervention and how the routines-based interview (RBI) can set the stage for successful home visits. It also addresses what has been learned about home visiting,…

  6. 28 CFR 540.62 - Institutional visits.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Institutional visits. 540.62 Section 540.62 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT CONTACT WITH PERSONS IN THE COMMUNITY Contact With News Media § 540.62 Institutional visits. (a) A...

  7. Association between all-cause mortality and insurance status transition among the elderly population in a rural area in Korea: Kangwha Cohort Study.

    PubMed

    Jang, Sung-In; Yi, Sang-Wook; Sull, Jae-Woong; Park, Eun-Cheol; Kim, Jae-Hyun; Ohrr, Heechoul

    2015-05-01

    The study purpose was to examine the association between health insurance transition and all-cause mortality. 3206 residents in Korea who participated in two surveys in 1985 and 1994, were followed-up during 1994-2008. Adjusted hazard ratios (aHR) were calculated using Cox hazard model. Participants were divided into four groups by insurance transition (the "National Health Insurance (NHI)-NHI", "NHI-Medicaid", "Medicaid-NHI", and "Medicaid-Medicaid" groups), where NHI-Medicaid means participants covered by NHI in 1985 but by Medicaid in 1994. For men covered by NHI in 1985, the mortality risk in the NHI-Medicaid was higher (aHR=1.47) than in the NHI-NHI. For men and women, covered by Medicaid in 1985, aHR was non-significantly lower in the Medicaid-NHI than in the Medicaid-Medicaid. When four groups were analyzed together, men in the Medicaid-Medicaid (aHR=1.67) and NHI-Medicaid (aHR=1.46) groups had higher mortality risk than males in the NHI-NHI, whereas no significant difference was observed for females. In conclusion, transition from NHI to Medicaid increases mortality risk, and transition from Medicaid to NHI may mitigate risk, while remaining on Medicaid pose the greatest risk, especially for men. Therefore, policy makers should strengthen coverage for Medicaid. The weak effects of transition from NHI to Medicaid on mortality for women require validation.

  8. Straight Metalworking Fluids and All-Cause and Cardiovascular Mortality Analyzed by Using G-Estimation of an Accelerated Failure Time Model With Quantitative Exposure: Methods and Interpretations.

    PubMed

    Picciotto, Sally; Ljungman, Petter L; Eisen, Ellen A

    2016-04-01

    Straight metalworking fluids have been linked to cardiovascular mortality in analyses using binary exposure metrics, accounting for healthy worker survivor bias by using g-estimation of accelerated failure time models. A cohort of 38,666 Michigan autoworkers was followed (1941-1994) for mortality from all causes and ischemic heart disease. The structural model chosen here, using continuous exposure, assumes that increasing exposure from 0 to 1 mg/m(3) in any single year would decrease survival time by a fixed amount. Under that assumption, banning the fluids would have saved an estimated total of 8,468 (slope-based 95% confidence interval: 2,262, 28,563) person-years of life in this cohort. On average, 3.04 (slope-based 95% confidence interval: 0.02, 25.98) years of life could have been saved for each exposed worker who died from ischemic heart disease. Estimates were sensitive to both model specification for predicting exposure (multinomial or logistic regression) and characterization of exposure as binary or continuous in the structural model. Our results provide evidence supporting the hypothesis of a detrimental relationship between straight metalworking fluids and mortality, particularly from ischemic heart disease, as well as an instructive example of the challenges in obtaining and interpreting results from accelerated failure time models using a continuous exposure in the presence of competing risks. PMID:26968943

  9. Thymic function failure and C-reactive protein levels are independent predictors of all-cause mortality in healthy elderly humans.

    PubMed

    Ferrando-Martínez, Sara; Romero-Sánchez, María Concepción; Solana, Rafael; Delgado, Juan; de la Rosa, Rafael; Muñoz-Fernández, Ma Angeles; Ruiz-Mateos, Ezequiel; Leal, Manuel

    2013-02-01

    Relationship between thymic function and elderly survival has been suspected, despite the fact that formal proof is elusive due to technical limitations of thymic function-related markers. The newly described sj/β-TREC ratio allows now, by overcoming these limitations, an accurate measurement of thymic output in elderly humans. Thus, the aim of this study was to determine the impact of thymic function and inflammatory markers on healthy elderly human survival. Healthy volunteers (n = 151), aged over 65, were asked to participate (CARRERITAS cohort). Subjects were excluded if diagnosed of dementia or, during the last 6 months, had clinical data of infection, hospital admission, antitumor therapy, or any treatment that could influence the immune status. Thymic function (sj/β-TREC ratio), CD4:CD8 T cell ratio, C-reactive protein, interleukin-6, and neutrophilia were determined from basal samples. All basal variables and age were associated with 2-year all-cause mortality. Multivariate analysis showed that only thymic function and C-reactive protein were independently associated with time to death. In conclusion, we show, for the first time, the direct role of thymic function in human survival. C-reactive protein raise is also a marker of mortality in the healthy elderly, in a thymic-independent way.

  10. The combined relationship of occupational and leisure-time physical activity with all-cause mortality among men, accounting for physical fitness.

    PubMed

    Clays, Els; Lidegaard, Mark; De Bacquer, Dirk; Van Herck, Koen; De Backer, Guy; Kittel, France; de Smet, Patrick; Holtermann, Andreas

    2014-03-01

    The aim of this study was to assess the combined relationship of occupational physical activity and leisure-time physical activity with all-cause mortality among men, while accounting for physical fitness. The prospective Belgian Physical Fitness Study included 1,456 male workers aged 40-55 years who were free of coronary heart disease at baseline. Baseline data were collected through questionnaires and clinical examinations from 1976 to 1978. To estimate physical fitness, a submaximal graded exercise test was performed on a bicycle ergometer. Total mortality was registered during a mean follow-up period of 16.9 years. Main results were obtained through Cox proportional hazards regression analysis. A total of 145 deaths were registered during follow-up. After adjustment for confounders, a significantly increased mortality rate was observed in workers who had low levels of both physical activity types (hazard ratio = 2.07, 95% confidence interval: 1.03, 4.19) but also in workers combining high occupational physical activity and low leisure-time physical activity (hazard ratio = 2.04, 95% confidence interval: 1.07, 3.91); the latter finding was particularly pronounced among workers with a low physical fitness level. The present results confirm the existence of a complex interplay among different physical activity settings and fitness levels in predicting mortality.

  11. Time Allocation in Primary Care Office Visits

    PubMed Central

    Tai-Seale, Ming; McGuire, Thomas G; Zhang, Weimin

    2007-01-01

    Objectives To use an innovative videotape analysis method to examine how clinic time was spent during elderly patients' visits to primary care physicians. Secondary objectives were to identify the factors that influence time allocations. Data Sources A convenience sample of 392 videotapes of routine office visits conducted between 1998 and 2000 from multiple primary care practices in the United States, supplemented by patient and physician surveys. Research Design Videotaped visits were examined for visit length and time devoted to specific topics—a novel approach to study time allocation. A survival analysis model analyzed the effects of patient, physician, and physician practice setting on how clinic time was spent. Principal Findings Very limited amount of time was dedicated to specific topics in office visits. The median visit length was 15.7 minutes covering a median of six topics. About 5 minutes were spent on the longest topic whereas the remaining topics each received 1.1 minutes. While time spent by patient and physician on a topic responded to many factors, length of the visit overall varied little even when contents of visits varied widely. Macro factors associated with each site had more influence on visit and topic length than the nature of the problem patients presented. Conclusions Many topics compete for visit time, resulting in small amount of time being spent on each topic. A highly regimented schedule might interfere with having sufficient time for patients with complex or multiple problems. Efforts to improve the quality of care need to recognize the time pressure on both patients and physicians, the effects of financial incentives, and the time costs of improving patient–physician interactions. PMID:17850524

  12. Characteristics of Cannabis-Only and Other Drug Users Who Visit the Emergency Department

    PubMed Central

    Woodruff, Susan I.; McCabe, Cameron T.; Hohman, Melinda; Clapp, John D.; Shillington, Audrey M.; Eisenberg, Kimberly; Sise, C. Beth; Castillo, Edward M.; Chan, Theodore C.; Sise, Michael J.

    2016-01-01

    Abstract Emergency department (ED) settings have gained interest as venues for illegal drug misuse prevention and intervention, with researchers and practitioners attempting to capitalize on the intersection of need and opportunity within these settings. This study of 686 adult patients visiting two EDs for various reasons who admitted drug use compared daily cannabis-only users, nondaily cannabis-only users, and other drug users on sociodemographic and drug-related severity outcomes. The three drug use groups did not differ on most sociodemographic factors or medical problem severity scores. Forty-five percent of the sample was identified as having a drug use problem. ED patients who used drugs other than cannabis were at particular risk for high drug use severity indicators and concomitant problems such as psychiatric problems and alcohol use severity. However, 19–29% of cannabis-only users were identified as having problematic drug use. Furthermore, daily cannabis-only users fared less well than nondaily cannabis users with regard to drug use severity indicators and self-efficacy for avoiding drug use. Results may assist emergency medicine providers and medical social workers in matching patients to appropriate intervention. For example, users of drugs other than cannabis (and perhaps heavy, daily cannabis-only users) may need referral to specialty services for further assessment. Enhancement of motivation and self-efficacy beliefs could be an important target of prevention and treatment for cannabis-only users screened in the ED. PMID:27689138

  13. Characteristics of Cannabis-Only and Other Drug Users Who Visit the Emergency Department

    PubMed Central

    Woodruff, Susan I.; McCabe, Cameron T.; Hohman, Melinda; Clapp, John D.; Shillington, Audrey M.; Eisenberg, Kimberly; Sise, C. Beth; Castillo, Edward M.; Chan, Theodore C.; Sise, Michael J.

    2016-01-01

    Abstract Emergency department (ED) settings have gained interest as venues for illegal drug misuse prevention and intervention, with researchers and practitioners attempting to capitalize on the intersection of need and opportunity within these settings. This study of 686 adult patients visiting two EDs for various reasons who admitted drug use compared daily cannabis-only users, nondaily cannabis-only users, and other drug users on sociodemographic and drug-related severity outcomes. The three drug use groups did not differ on most sociodemographic factors or medical problem severity scores. Forty-five percent of the sample was identified as having a drug use problem. ED patients who used drugs other than cannabis were at particular risk for high drug use severity indicators and concomitant problems such as psychiatric problems and alcohol use severity. However, 19–29% of cannabis-only users were identified as having problematic drug use. Furthermore, daily cannabis-only users fared less well than nondaily cannabis users with regard to drug use severity indicators and self-efficacy for avoiding drug use. Results may assist emergency medicine providers and medical social workers in matching patients to appropriate intervention. For example, users of drugs other than cannabis (and perhaps heavy, daily cannabis-only users) may need referral to specialty services for further assessment. Enhancement of motivation and self-efficacy beliefs could be an important target of prevention and treatment for cannabis-only users screened in the ED.

  14. Trajectory of body shape in early and middle life and all cause and cause specific mortality: results from two prospective US cohort studies

    PubMed Central

    Hu, Frank B; Wu, Kana; Must, Aviva; Chan, Andrew T; Willett, Walter C; Giovannucci, Edward L

    2016-01-01

    Objective To assess body shape trajectories in early and middle life in relation to risk of mortality. Design Prospective cohort study. Setting Nurses’ Health Study and Health Professionals Follow-up Study. Population 80 266 women and 36 622 men who recalled their body shape at ages 5, 10, 20, 30, and 40 years and provided body mass index at age 50, followed from age 60 over a median of 15-16 years for death. Main outcome measures All cause and cause specific mortality. Results Using a group based modeling approach, five distinct trajectories of body shape from age 5 to 50 were identified: lean-stable, lean-moderate increase, lean-marked increase, medium-stable/increase, and heavy-stable/increase. The lean-stable group was used as the reference. Among never smokers, the multivariable adjusted hazard ratio for death from any cause was 1.08 (95% confidence interval 1.02 to 1.14) for women and 0.95 (0.88 to 1.03) for men in the lean-moderate increase group, 1.43 (1.33 to 1.54) for women and 1.11 (1.02 to 1.20) for men in the lean-marked increase group, 1.04 (0.97 to 1.12) for women and 1.01 (0.94 to 1.09) for men in the medium-stable/increase group, and 1.64 (1.49 to 1.81) for women and 1.19 (1.08 to 1.32) for men in the heavy-stable/increase group. For cause specific mortality, participants in the heavy-stable/increase group had the highest risk, with a hazard ratio among never smokers of 2.30 (1.88 to 2.81) in women and 1.45 (1.23 to 1.72) in men for cardiovascular disease, 1.37 (1.14 to 1.65) in women and 1.07 (0.89 to 1.30) in men for cancer, and 1.59 (1.38 to 1.82) in women and 1.10 (0.95 to 1.29) in men for other causes. The trajectory-mortality association was generally weaker among ever smokers than among never smokers (for all cause mortality: P for interaction <0.001 in women and 0.06 in men). When participants were classified jointly according to trajectories and history of type 2 diabetes, the increased risk of death associated with heavier

  15. Cytoplasmic Streaming - Skylab Student Experiment ED-63

    NASA Technical Reports Server (NTRS)

    1973-01-01

    This chart describes the Skylab student experiment (ED-63), Cytoplasmic Streaming, proposed by Cheryl A. Peitz of Arapahoe High School, Littleton, Colorado. Experiment ED-63 was to observe the effect of zero-gravity on cytoplasmic streaming in the aquatic plant named Elodea, commonly called water weed or water thyme. The phenomenon of cytoplasmic streaming is not well understood, but it is recognized as the circulation mechanism of the internal materials or cytoplasm of a cell. Cytoplasm is a gelatinous substance that has the ability to change its viscosity and flow, carrying various cell materials with it. The activity can be stimulated by sunlight or heat. In March 1972, NASA and the National Science Teachers Association selected 25 experiment proposals for flight on Skylab. Science advisors from the Marshall Space Flight Center aided and assisted the students in developing the proposals for flight on Skylab.

  16. Relation of blood pressure and all-cause mortality in 180,000 Japanese participants: pooled analysis of 13 cohort studies.

    PubMed

    Murakami, Yoshitaka; Hozawa, Atsushi; Okamura, Tomonori; Ueshima, Hirotsugu

    2008-06-01

    Hypertension is a leading cause of death because of cardiovascular disease and predominantly affects total mortality. To reduce avoidable deaths from hypertension, we need to collect blood pressure data and assess their impact on total mortality. To examine this issue, a meta-analysis of 13 cohort studies was conducted in Japan. Poisson regression was used for estimating all-cause mortality rates and ratios. In the model, blood pressure data were treated as continuous (10-mm Hg increase) and categorical (every 10 mm Hg) according to recommendations of the Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of Hypertension. Potential confounders included body mass index, smoking, drinking, and cohort. The impact of hypertension was measured by the population-attributable fraction. After excluding participants with cardiovascular disease history, 176 389 participants were examined in the analysis. Adjusted mortality rates became larger as the blood pressure increased, and these were more distinct in younger men and women. Hazard ratios also showed the same trends, and these trends were more apparent in younger men (hazard ratio [unit: 10-mm Hg increase] aged 40 to 49 years: systolic blood pressure 1.37 (range: 1.15 to 1.62); diastolic blood pressure 1.46 [range: 1.05 to 2.03]) than older ones (hazard ratio: aged 80 to 89 years: systolic blood pressure 1.09 [range: 1.05 to 1.13]and diastolic blood pressure 1.12 [range: 1.03 to 1.22]). Population-attributable fraction of hypertension was approximately 20% when the normal category was used as a reference level and was 10% when we included the prehypertension group in the reference level. In conclusion, high blood pressure raised the risk of total mortality, and this trend was higher in the younger Japanese population.

  17. Early Fungicidal Activity as a Candidate Surrogate Endpoint for All-Cause Mortality in Cryptococcal Meningitis: A Systematic Review of the Evidence

    PubMed Central

    Montezuma-Rusca, Jairo M.; Powers, John H.; Follmann, Dean; Wang, Jing; Sullivan, Brigit; Williamson, Peter R.

    2016-01-01

    Background Cryptococcal meningitis (CM) is a leading cause of HIV-associated mortality. In clinical trials evaluating treatments for CM, biomarkers of early fungicidal activity (EFA) in cerebrospinal fluid (CSF) have been proposed as candidate surrogate endpoints for all- cause mortality (ACM). However, there has been no systematic evaluation of the group-level or trial-level evidence for EFA as a candidate surrogate endpoint for ACM. Methods We conducted a systematic review of randomized trials in treatment of CM to evaluate available evidence for EFA measured as culture negativity at 2 weeks/10 weeks and slope of EFA as candidate surrogate endpoints for ACM. We performed sensitivity analysis on superiority trials and high quality trials as determined by Cochrane measures of trial bias. Results Twenty-seven trials including 2854 patients met inclusion criteria. Mean ACM was 15.8% at 2 weeks and 27.0% at 10 weeks with no overall significant difference between test and control groups. There was a statistically significant group-level correlation between average EFA and ACM at 10 weeks but not at 2 weeks. There was also no statistically significant group-level correlation between CFU culture negativity at 2weeks/10weeks or average EFA slope at 10 weeks. A statistically significant trial-level correlation was identified between EFA slope and ACM at 2 weeks, but is likely misleading, as there was no treatment effect on ACM. Conclusions Mortality remains high in short time periods in CM clinical trials. Using published data and Institute of Medicine criteria, evidence for use of EFA as a surrogate endpoint for ACM is insufficient and could provide misleading results from clinical trials. ACM should be used as a primary endpoint evaluating treatments for cryptococcal meningitis. PMID:27490100

  18. Adherence to a healthy diet according to the World Health Organization guidelines and all-cause mortality in elderly adults from Europe and the United States.

    PubMed

    Jankovic, Nicole; Geelen, Anouk; Streppel, Martinette T; de Groot, Lisette C P G M; Orfanos, Philippos; van den Hooven, Edith H; Pikhart, Hynek; Boffetta, Paolo; Trichopoulou, Antonia; Bobak, Martin; Bueno-de-Mesquita, H B; Kee, Frank; Franco, Oscar H; Park, Yikyung; Hallmans, Göran; Tjønneland, Anne; May, Anne M; Pajak, Andrzej; Malyutina, Sofia; Kubinova, Růžena; Amiano, Pilar; Kampman, Ellen; Feskens, Edith J

    2014-11-15

    The World Health Organization (WHO) has formulated guidelines for a healthy diet to prevent chronic diseases and postpone death worldwide. Our objective was to investigate the association between the WHO guidelines, measured using the Healthy Diet Indicator (HDI), and all-cause mortality in elderly men and women from Europe and the United States. We analyzed data from 396,391 participants (42% women) in 11 prospective cohort studies who were 60 years of age or older at enrollment (in 1988-2005). HDI scores were based on 6 nutrients and 1 food group and ranged from 0 (least healthy diet) to 70 (healthiest diet). Adjusted cohort-specific hazard ratios were derived by using Cox proportional hazards regression and subsequently pooled using random-effects meta-analysis. During 4,497,957 person-years of follow-up, 84,978 deaths occurred. Median HDI scores ranged from 40 to 54 points across cohorts. For a 10-point increase in HDI score (representing adherence to an additional WHO guideline), the pooled adjusted hazard ratios were 0.90 (95% confidence interval (CI): 0.87, 0.93) for men and women combined, 0.89 (95% CI: 0.85, 0.92) for men, and 0.90 (95% CI: 0.85, 0.95) for women. These estimates translate to an increased life expectancy of 2 years at the age of 60 years. Greater adherence to the WHO guidelines is associated with greater longevity in elderly men and women in Europe and the United States.

  19. Interferon-Based Treatment of Hepatitis C Virus Infection Reduces All-Cause Mortality in Patients With End-Stage Renal Disease

    PubMed Central

    Hsu, Yueh-Han; Hung, Peir-Haur; Muo, Chih-Hsin; Tsai, Wen-Chen; Hsu, Chih-Cheng; Kao, Chia-Hung

    2015-01-01

    Abstract The long-term survival of end-stage renal disease (ESRD) patients with hepatitis C virus (HCV) infection who received interferon treatment has not been extensively evaluated. The HCV cohort was the ESRD patients with de novo HCV infection from 2004 to 2011; they were classified into treated and untreated groups according to interferon therapy records. Patients aged <20 years and those with a history of hepatitis B, kidney transplantation, or cancer were excluded. The control cohort included ESRD patients without HCV infection matched 4:1 to the HCV cohort by age, sex, and year of ESRD registration. We followed up all study participants until kidney transplantation, death, or the end of 2011, whichever came first. We assessed risk of all-cause mortality by using the multivariate Cox proportional hazard model with time-dependent covariate. In the HCV cohort, 134 patients (6.01%) received interferon treatment. Compared with the uninfected control cohort, the treated group had a lower risk of death (hazard ratio 0.47, 95% confidence interval [CI] 0.22–0.99). The untreated group had a 2.62-fold higher risk (95% CI 1.24–5.55) of death compared with the treated group. For the HCV cohort without cirrhosis or hepatoma, the risk of death in the treated group was further markedly reduced (hazard ratio 0.17, 95% CI 0.04–0.68) compared with that in the control cohort. For ESRD patients with HCV infection, receiving interferon treatment is associated with a survival advantage. Such an advantage is more prominent in HCV patients without cirrhosis or hepatoma. PMID:26632730

  20. Socioeconomic inequalities in all-cause mortality in the Czech Republic, Russia, Poland and Lithuania in the 2000s: findings from the HAPIEE Study

    PubMed Central

    Vandenheede, Hadewijch; Vikhireva, Olga; Pikhart, Hynek; Kubinova, Ruzena; Malyutina, Sofia; Pajak, Andrzej; Tamosiunas, Abdonas; Peasey, Anne; Simonova, Galina; Topor-Madry, Roman; Marmot, Michael; Bobak, Martin

    2014-01-01

    Background Relatively large socioeconomic inequalities in health and mortality have been observed in Central and Eastern Europe (CEE) and the former Soviet Union (FSU). Yet comparative data are sparse and virtually all studies include only education. The aim of this study is to quantify and compare socioeconomic inequalities in all-cause mortality during the 2000s in urban population samples from four CEE/FSU countries, by three different measures of socioeconomic position (SEP) (education, difficulty buying food and household amenities), reflecting different aspects of SEP. Methods Data from the prospective population-based HAPIEE (Health, Alcohol, and Psychosocial factors in Eastern Europe) study were used. The baseline survey (2002–2005) included 16 812 men and 19 180 women aged 45–69 years in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and seven Czech towns. Deaths in the cohorts were identified through mortality registers. Data were analysed by direct standardisation and Cox regression, quantifying absolute and relative SEP differences. Results Mortality inequalities by the three SEP indicators were observed in all samples. The magnitude of inequalities varied according to gender, country and SEP measure. As expected, given the high mortality rates in Russian men, largest absolute inequalities were found among Russian men (educational slope index of inequality was 19.4 per 1000 person-years). Largest relative inequalities were observed in Czech men and Lithuanian subjects. Disadvantage by all three SEP measures remained strongly associated with increased mortality after adjusting for the other SEP indicators. Conclusions The results emphasise the importance of all SEP measures for understanding mortality inequalities in CEE/FSU. PMID:24227051

  1. Terrorism drill shows ED response plan flaws.

    PubMed

    2005-07-01

    Valuable lessons can be learned by paying attention to your processes and communication equipment during a disaster drill. Did your radios and pagers work adequately? If not, it may be time for a new vendor. Going through the drill helps remind the entire ED staff to funnel all communications and key decisions through the disaster response leader. Make sure to update your disaster response handbook to reflect important lessons learned during the drill.

  2. Material Interface Reconstruction in VisIt

    SciTech Connect

    Meredith, J S

    2005-01-27

    In this paper, we first survey a variety of approaches to material interface reconstruction and their applicability to visualization, and we investigate the details of the current reconstruction algorithm in the VisIt scientific analysis and visualization tool. We then provide a novel implementation of the original VisIt algorithm that makes use of a wide range of the finite element zoo during reconstruction. This approach results in dramatic improvements in quality and performance without sacrificing the strengths of the VisIt algorithm as it relates to visualization.

  3. Regional Energy Deployment System (ReEDS)

    SciTech Connect

    Short, W.; Sullivan, P.; Mai, T.; Mowers, M.; Uriarte, C.; Blair, N.; Heimiller, D.; Martinez, A.

    2011-12-01

    The Regional Energy Deployment System (ReEDS) is a deterministic optimization model of the deployment of electric power generation technologies and transmission infrastructure throughout the contiguous United States into the future. The model, developed by the National Renewable Energy Laboratory's Strategic Energy Analysis Center, is designed to analyze the critical energy issues in the electric sector, especially with respect to potential energy policies, such as clean energy and renewable energy standards or carbon restrictions. ReEDS provides a detailed treatment of electricity-generating and electrical storage technologies and specifically addresses a variety of issues related to renewable energy technologies, including accessibility and cost of transmission, regional quality of renewable resources, seasonal and diurnal generation profiles, variability of wind and solar power, and the influence of variability on the reliability of the electrical grid. ReEDS addresses these issues through a highly discretized regional structure, explicit statistical treatment of the variability in wind and solar output over time, and consideration of ancillary services' requirements and costs.

  4. Pediatric Emergency Visits and Short-Term Changes in PM2.5 Concentrations in the U.S. State of Georgia

    PubMed Central

    Strickland, Matthew J.; Hao, Hua; Hu, Xuefei; Chang, Howard H.; Darrow, Lyndsey A.; Liu, Yang

    2015-01-01

    Background: Associations between pediatric emergency department (ED) visits and ambient concentrations of particulate matter ≤ 2.5 μm in diameter (PM2.5) have been reported in previous studies, although few were performed in nonmetropolitan areas. Objective: We estimated associations between daily PM2.5 concentrations, using a two-stage model that included land use parameters and satellite aerosol optical depth measurements at 1-km resolution, and ED visits for six pediatric conditions in the U.S. state of Georgia by urbanicity classification. Methods: We obtained pediatric ED visits geocoded to residential ZIP codes for visits with nonmissing PM2.5 estimates and admission dates during 1 January 2002–30 June 2010 for 2- to 18-year-olds for asthma or wheeze (n = 189,816), and for 0- to 18-year-olds for bronchitis (n = 76,243), chronic sinusitis (n = 15,745), otitis media (n = 237,833), pneumonia (n = 52,946), and upper respiratory infections (n = 414,556). Daily ZIP code–level estimates of 24-hr average PM2.5 were calculated by averaging concentrations within ZIP code boundaries. We used time-stratified case-crossover models stratified on ZIP code, year, and month to estimate odds ratios (ORs) between ED visits and same-day and previous-day PM2.5 concentrations at the ZIP code level, and we investigated effect modification by county-level urbanicity. Results: A 10-μg/m3 increase in same-day PM2.5 concentrations was associated with ED visits for asthma or wheeze (OR = 1.013; 95% CI: 1.003, 1.023) and upper respiratory infections (OR = 1.015; 95% CI: 1.008, 1.022); associations with previous-day PM2.5 concentrations were lower. Differences in the association estimates across levels of urbanicity were not statistically significant. Conclusion: Pediatric ED visits for asthma or wheeze and for upper respiratory infections were associated with PM2.5 concentrations in Georgia. Citation: Strickland MJ, Hao H, Hu X, Chang HH, Darrow LA, Liu Y. 2016. Pediatric

  5. Interprofessional Collaboration to Improve Discharge from Skilled Nursing Facility to Home: Preliminary Data on Postdischarge Hospitalizations and Emergency Department Visits.

    PubMed

    Reidt, Shannon L; Holtan, Haley S; Larson, Tom A; Thompson, Bruce; Kerzner, Lawrence J; Salvatore, Toni M; Adam, Terrence J

    2016-09-01

    An interprofessional collaborative practice model was established at Hennepin County Medical Center to improve discharge management from the transitional care unit of the skilled nursing facility (SNF) to home. The practice model involves a geriatrician, nurse practitioner, and pharmacist who care for individuals at a community-based SNF. Before SNF discharge, the pharmacist conducts a chart and in-person medication review and collaborates with the nurse practitioner to determine the discharge medication regimen. The pharmacist's review focuses on assessing the indication, safety, effectiveness, and convenience of medications. The pharmacist provides follow-up in-home or over the telephone 1 week after SNF discharge, focusing on reviewing medications and assessing adherence. Hospitalizations and emergency department (ED) visits 30 days after SNF discharge of individuals who received care from this model was compared with those of individuals who received usual care from a nurse practitioner and geriatrician. From October 2012 through December 2013, the intervention was delivered to 87 individuals, with 189 individuals serving as the control group. After adjusting for age, sex, race, and payor, those receiving the intervention had a lower risk of ED visits (odds ratio (OR) = 0.46, 95% confidence interval (CI) = 0.22-0.97), although there was no significant difference in hospitalizations (OR = 0.47, 95% CI = 0.21-1.08). The study suggests that an interprofessional approach involving a pharmacist may be beneficial in reducing ED visits 30 days after SNF discharge. PMID:27385197

  6. Annual Checkups Are Becoming Wellness Visits

    MedlinePlus

    ... family history and lifestyle, medication reviews, checks of vital signs and scheduling preventive screenings and vaccinations. "When you ... another important element of wellness visits. "Electronic medical records have the potential to be powerful tools to ...

  7. Smokey Visits Station Flight Control Room

    NASA Video Gallery

    Smokey Bear celebrated his 68th birthday with a special visit to the International Space Station Flight Control Room at Johnson Space Center in Houston. On May 14, Smokey went where no bear had gon...

  8. Indiana School for the Blind Visits Goddard

    NASA Video Gallery

    This video shows highlights of the Indiana School for the Blind and Visually Impaired, and the Indian Creek Public High School visit to NASA's Goddard Space Flight Center in June 2011. Both blind a...

  9. 28 CFR 540.41 - Visiting facilities.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... required by the type of institution. The Warden shall ensure that the visiting area is as comfortable and... perimeter, but always under supervision of staff. (b) Institutions of medium and high security levels,...

  10. 28 CFR 540.41 - Visiting facilities.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... required by the type of institution. The Warden shall ensure that the visiting area is as comfortable and... perimeter, but always under supervision of staff. (b) Institutions of medium and high security levels,...

  11. Drug-Related Hospital Emergency Room Visits

    MedlinePlus

    ... supplements. Highlights from the 2009 Drug Abuse Warning Network In 2009, there were nearly 4.6 million ... Report: Highlights of the 2009 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits . ...

  12. President Obama and Family Visit KSC

    NASA Video Gallery

    President Obama, accompanied by First Lady Michelle Obama and their two daughters, visited NASA’s Kennedy Space Center on Friday, Apr. 29. The First Family then boarded the Marine One helicopter ...

  13. Visit-to-Visit Glucose Variability Predicts the Development of End-Stage Renal Disease in Type 2 Diabetes

    PubMed Central

    Yang, Ya-Fei; Li, Tsai-Chung; Li, Chia-Ing; Liu, Chiu-Shong; Lin, Wen-Yuan; Yang, Sing-Yu; Chiang, Jen-Huai; Huang, Chiu-Ching; Sung, Fung-Chang; Lin, Cheng-Chieh

    2015-01-01

    Abstract The purpose of this study was to examine the association of glucose variability using coefficient of variation of fasting plasma glucose (FPG-CV) and coefficient of variation of glycated hemoglobin (HbA1c-CV) to end-stage renal disease (ESRD) in 31,841 Chinese patients with type 2 diabetes. Patients with type 2 diabetes enrolled in National Diabetes Care Management Program, aged ≧30 years, and free of ESRD (n = 31,841) in January 1, 2002 to December 31, 2004 were included. Extended Cox proportional hazards regression models with competing risk of all-cause mortality were used to evaluate risk factors on ESRD incidence. Patients were followed till 2012. After a median follow-up period of 8.23 years, 1642 patients developed ESRD, giving a crude incidence rate of 6.27/1000 person-years (6.36 for men, 6.19 for women). After the multivariate adjustment, both FPG-CV and HbA1c-CV were independent predictors of ESRD with corresponding hazard ratios of 1.20 (95% confidence interval [CI] 1.01, 1.41), 1.24 (95% CI 1.05, 1.46) in HbA1c-CV from fourth to fifth quintile and 1.23 (95% CI 1.03, 1.47) in FPG-CV from fifth quintile. One-year visit-to-visit glucose variability expressed by FPG-CV and HbA1c-CV predicted development of ESRD in patients with type 2 diabetes, suggesting therapeutic strategies toward a goal to minimize glucose fluctuation. PMID:26554779

  14. Mid-term NEAT review: analysing the improvements in hospital ED performance.

    PubMed

    Khanna, Sankalp; Boyle, Justin; Good, Norm; Lind, James

    2014-01-01

    Introduced with a promise to reduce overcrowding in the Emergency Department (ED) and the associated morbidity and mortality linked to bed access difficulties, the National Emergency Access Target (NEAT) is now over halfway through transitionary arrangements towards a target of 90% of patients that visit a hospital ED being admitted or discharged within 4 hours. Facilitation and reward funding has ensured hospitals around the country are remodelling workflows to ensure compliance. Recent reports however show that the majority of hospitals are still far from being able to meet this target. We investigate the NEAT journey of 30 Queensland hospitals over the past two years and compare this performance to a previous study that investigated the 4 hour ED discharge performance of these hospitals at various times of day and under varying occupancy conditions. Our findings reveal that, while most hospitals have made significant improvements to their 4 hour discharge performance in 2013, the underlying flow patterns and periods of poor NEAT compliance remain largely unchanged. The work identifies areas for targeted improvement to inform system redesign and workflow planning.

  15. General practitioners’ home visit tendency and readmission-free survival after COPD hospitalisation: a Danish nationwide cohort study

    PubMed Central

    Lykkegaard, Jesper; Larsen, Pia V; Paulsen, Maja S; Søndergaard, Jens

    2014-01-01

    Background: The tendency of general practitioners (GPs) to conduct home visits is considered an important aspect of practices’ accessibility and quality of care. Aims: To investigate whether GPs’ tendency to conduct home visits affects 30-day readmission or death after hospitalisation with chronic obstructive pulmonary disease. Methods: All Danish patients first-time hospitalised with COPD during the years 2006–2008 were identified. The association between the GP’s tendency to conduct home visits and the time from hospital discharge until death or all-cause readmission was analysed by means of Cox regression adjusted for multiple patient and practice characteristics. Results: The study included 14,425 patients listed with 1,389 general practices. Approximately 31% of the patients received a home visit during the year preceding their first COPD hospitalisation, and within 30 days after discharge 19% had been readmitted and 1.6% had died without readmission. A U-shaped dose–response relationship was found between GP home visit tendency and readmission-free survival. The lowest adjusted risk of readmission or death was recorded among patients who were listed with a general practice in which >20–30% of other listed first-time COPD-hospitalised patients had received a home visit. The risk was higher if either 0% (hazard rate ratio 1.18 (1.01–1.37)) or >60% (hazard rate ratio 1.23 (1.04–1.44)) of the patients had been visited. Conclusion: A moderate GP tendency to conduct home visits is associated with the lowest 30-day risk of COPD readmission or death. A GP’s tendency to conduct home visits should not be used as a unidirectional indicator of the ability to prevent COPD hospital readmissions. PMID:25429436

  16. Health, ED use, and early identification of young children exposed to trauma

    PubMed Central

    Roberts, Yvonne Humenay; Huang, Cindy Y.; Crusto, Cindy A.; Kaufman, Joy S.

    2014-01-01

    Background Childhood trauma is an important public health problem with financial, physical health, and mental health repercussions. Emergency Departments are often the first point of contact for many young children affected by emotionally or psychologically traumatic events (e.g., neglect, separation from primary caregiver, maltreatment, witness to domestic violence within the family, natural disasters). Study Objectives Describe the prevalence of physical health symptoms, ED use and health related problems in young children (birth through 5 years) affected by trauma, and to predict whether or not children experiencing trauma are more likely to be affected by health related problems. Methods Community-based, cross-sectional survey of 208 young children. Traumatic events were assessed by the Traumatic Events Screening Inventory – Parent Report Revised. Child health symptoms and health related problems were measured using the Caregiver Information Questionnaire, developed by ORC Macro. Results Seventy-two percent of children had experienced at least one type of traumatic event. Children exposed to trauma were also experiencing recent health related events, including visits to the ED (32.2%) and the doctor (76.9%) for physical health symptoms, and recurring physical health problems (40.4%). Children previously exposed to high levels of trauma (4 or more types of events) were 2.9 times more likely to report having had recently visited the ED for health purposes. Conclusions Preventing recurrent trauma or recognizing early trauma exposure is difficult but essential if long-term negative consequences are to be mitigated or prevented. Within emergency departments, there are missed opportunities for identification and intervention for trauma-exposed children, as well as great potential for expanding primary and secondary prevention of maltreatment-associated illness, injury and mortality. PMID:24565881

  17. EDS Coal Liquefaction Process Development. Phase V. Laboratory evaluation of the characteristics of EDS Illinois bottoms

    SciTech Connect

    Lao, T C; Levasseur, A A

    1984-02-01

    This interim report documents work carried out by Combustion Engineering, Inc. under a contract to Exxon Research and Engineering Company to develop a conceptual Hybrid Boiler design fueled by the vacuum distillation residue (vacuum bottoms) derived from Illinois No. 6 coal in the EDS Coal Liquefaction Process. This report was prepared by Combustion Engineering, Inc., and is the first of two reports on the predevelopment phase of the Hybrid Boiler program. This report covers the results of a laboratory investigation to assess the fuel and ash properties of EDS vacuum bottoms. The results of the laboratory testing reported here were used in conjunction with Combustion Engineering's design experience to predict fuel performance and to develop appropriate boiler design parameters. These boiler design parameters were used to prepare the engineering design study reported in EDS Interim Report FE-2893-113, the second of the two reports on the predevelopment phase of the Hybrid Boiler Program. 46 figures, 29 tables.

  18. Emergency Department Non-Urgent Visits and Hospital Readmissions Are Associated with Different Socio-Economic Variables in Italy

    PubMed Central

    Barbadoro, Pamela; Di Tondo, Elena; Menditto, Vincenzo Giannicola; Pennacchietti, Lucia; Regnicoli, Februa; Di Stanislao, Francesco; D’Errico, Marcello Mario; Prospero, Emilia

    2015-01-01

    Objective The aim of this paper was to evaluate socio-economic factors associated to poor primary care utilization by studying two specific subjects: the hospital readmission rate, and the use of the Emergency Department (ED) for non-urgent visits. Methods The study was carried out by the analysis of administrative database for hospital readmission and with a specific survey for non-urgent ED use. Results Among the 416,698 sampled admissions, 6.39% (95% CI, 6.32–6.47) of re-admissions have been registered; the distribution shows a high frequency of events in the age 65–84 years group, and in the intermediate care hospitals (51.97%; 95%CI 51.37–52.57). The regression model has shown the significant role played by age, type of structure (geriatric acute care), and deprivation index of the area of residence on the readmission, however, after adjusting for the intensity of primary care, the role of deprivation was no more significant. Non-urgent ED visits accounted for the 12.10%, (95%CI 9.38–15.27) of the total number of respondents to the questionnaire (N = 504). The likelihood of performing a non-urgent ED visit was higher among patients aged <65 years (OR 3.2, 95%CI 1.3–7.8 p = 0.008), while it was lower among those perceiving as urgent their health problem (OR 0.50, 95%CI 0.30–0.90). Conclusions In the Italian context repeated readmissions and ED utilization are linked to different trajectories, besides the increasing age and comorbidity of patients are the factors that are related to repeated admissions, the self-perceived trust in diagnostic technologies is an important risk factor in determining ED visits. Better use of public national health care service is mandatory, since its correct utilization is associated to increasing equity and better health care utilization. PMID:26076346

  19. A dose-response meta-analysis of the impact of body mass index on stroke and all-cause mortality in stroke patients: a paradox within a paradox.

    PubMed

    Bagheri, M; Speakman, J R; Shabbidar, S; Kazemi, F; Djafarian, K

    2015-05-01

    The obesity paradox is often attributed to fat acting as a buffer to protect individuals in fragile metabolic states. If this was the case, one would predict that the reverse epidemiology would be apparent across all causes of mortality including that of the particular disease state. We performed a dose-response meta-analysis to assess the impact of body mass index (BMI) on all-cause and stroke-specific mortality among stroke patients. Data from relevant studies were identified by systematically searching PubMed, OVID and Scopus databases and were analysed using a random-effects dose-response model. Eight cohort studies on all-cause mortality (with 20,807 deaths of 95,651 stroke patients) and nine studies of mortality exclusively because of stroke (with 8,087 deaths of 28,6270 patients) were evaluated in the meta-analysis. Non-linear associations of BMI with all-cause mortality (P < 0.0001) and mortality by stroke (P = 0.05) were observed. Among overweight and obese stroke patients, the risk of all-cause mortality increased, while the risk of mortality by stroke declined, with an increase in BMI. Increasing BMI had opposite effects on all-cause mortality and stroke-specific mortality in stroke patients. Further investigations are needed to examine how mortality by stroke is influenced by a more accurate indicator of obesity than BMI.

  20. Wait watchers. Smart organizations are demonstrating that while they can't erase ED wait times, they can leverage technology to keep patients better informed.

    PubMed

    Gamble, Kate Huvane

    2010-04-01

    Increases in ED visits are significantly affecting patient access, quality, cost and care management--a trend that is expected to continue. A number of organizations are dealing with the increased demand for services by implementing technologies to keep patients better informed of wait times. Publishing ED wait times online offers hospitals a way to communicate information to patients quickly without requiring a significant investment from the IT staff. Hospitals are also utilizing visibility boards to keep both patients and staff updated on patient conditions and room status. PMID:20426236

  1. Illness episodes, physician visits, and depressive symptoms.

    PubMed

    Berkanovic, E; Hurwicz, M L

    1992-08-01

    Although there is a large literature examining the effects of distress on the demand for medical care, the data on which this literature is based are equivocal. Nonetheless, this literature is cited frequently by those who advocate a national mental health policy designed to produce a cost-effective "medical offset effect." In this study, longitudinal data on illness episodes, physician visits, and depressive symptoms were collected from 940 Medicare recipients enrolled in a health maintenance organization (HMO) under a Tax Equity and Fiscal Responsibility Act (TEFRA) contract. Seven waves of interviews were conducted over a period of 1 year. This article presents two sets of analyses. In the first, controlling for chronic conditions and demographics reported at baseline, the relationships between depressive symptoms reported at baseline, and all illness episodes and physician visits that occurred over the subsequent year are examined. In the second, controlling for depressive symptoms and demographics reported at baseline, the relationships between illness episodes and physician visits over the study year, and depressive symptoms recorded at the final interview are examined. The data indicate that, whereas depressive symptoms at baseline are virtually unrelated to subsequent illness episodes and physician visits, illness episodes and physician visits are related to subsequent depressive symptoms. These data indicate, therefore, that policies aimed at diverting the distressed from seeking medical care may result in further inequities in the receipt of needed care. PMID:10120227

  2. Passive damping in EDS maglev systems.

    SciTech Connect

    Rote, D. M.

    2002-05-03

    There continues to be strong interest in the subjects of damping and drag forces associated with electrodynamic suspension (EDS) systems. While electromagnetic drag forces resist the forward motion of a vehicle and therefore consume energy, damping forces control, at least in part, the response of the vehicle to disturbances. Ideally, one would like to reduce the drag forces as much as possible while retaining adequate damping forces to insure dynamic stability and satisfactory ride quality. These two goals turn out to be difficult to achieve in practice. It is well known that maglev systems tend to be intrinsically under damped. Consequently it is often necessary in a practical system design to enhance the damping passively or actively. For reasons of cost and simplicity, it is desirable to rely as much as possible on passive damping mechanisms. In this paper, rough estimates are made of the passive damping and drag forces caused by various mechanisms in EDS systems. No attention will be given to active control systems or secondary suspension systems which are obvious ways to augment passive damping mechanisms if the latter prove to be inadequate.

  3. Text message program improves outcomes, decreases ED utilization among ED patients with poorly controlled diabetes.

    PubMed

    2014-02-01

    Diabetic patients who lack access to primary care tend to frequent the ED, often with complications from their disease that could have been prevented with proper management and education. To get around the problem of access, researchers tested an automated program that continuously delivered educational messaging via text to a group of patients who presented to the ED with poorly controlled diabetes. After six months, researchers noted improvements in Hb A1c levels, self-reported medication adherence, and ED utilization when compared with a control group. And the impact was particularly noteworthy among Latinos, according to the researchers. The text messaging program, dubbed TExT-Med, was developed by four physicians and two diabetes educators. The messages were delivered daily, and contained educational as well motivational content derived from the National Diabetes Education Program.There were also medication reminders, healthy living challenges, and trivia questions about diabetes. At six months, Hb A1c levels decreased by 1.05% in the intervention group, compared to 0.60% in the control group, and self-reported medication adherence improved from 4.5 to 5.4 (as measured on an 8 point scale) in the intervention group versus a decrease of 0.1 in the control group. During the six-month study period, 35.9% of patients in the intervention group presented to the ED for care, as compared to 51.6% of patients in the control group.

  4. Managing ecotourism visitation in protected areas

    USGS Publications Warehouse

    Marion, J.L.; Farrell, T.A.; Lindberg, Kreg; Wood, Megan Epler; Engeldrum, David

    1998-01-01

    Ecotourism management seeks to integrate and balance several potentially conflicting objectives: protection of natural and cultural resources, provision of recreation opportunities and generation of economic benefits. In the absence of effective planning and management, ecotourism can lead to significant negative impacts on vegetation, soil, water, wildlife, historic resources, cultures, and visitor experiences. This chapter reviews visitor-related natural resource and experience impacts associated with ecotourism within protected areas. The influence of factors that control the nature and extent of impacts are also reviewed, including type and amount of use, the variable resistance and resilience of environmental attributes such as vegetation and soil types, and the role of management in shaping visitation, resources and facilities to support visitation while minimizing associated impacts. Implications for managing the effects of protected area visitation are highlighted, including carrying capacity decision frameworks and selecting management strategies and tactics.

  5. "When Are You Coming to Visit?" Home Visits and Seeing Our Students

    ERIC Educational Resources Information Center

    Schlessman, Elizabeth

    2013-01-01

    The process that led the author to home visits was a gradual one. She sensed that on the other side of the bus ride home, students' lives were much richer and more varied than could be taken into account by classroom conversations, curriculum, and conferences. Home visits made her even more aware of the need to provide opportunities for students…

  6. Overview of the federal home visiting program.

    PubMed

    Adirim, Terry; Supplee, Lauren

    2013-11-01

    On March 23, 2010, the President signed into law the Affordable Care Act (Public Law 111-148), which included an amendment of Title V of the Social Security Act authorizing the creation of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. Authorized and funded at $1.5 billion for 5 years, the MIECHV represents a large investment in health and development outcomes for at-risk children through evidence-based home visiting programs. The MIECHV presents unprecedented opportunities to integrate early childhood services systems, not only on the federal level but also within states and local communities. The MIECHV is funded in escalating amounts over 5-year period authorized, as follows: $100 million in fiscal year (FY) 2010, $250 million in FY 2011, $350 million in FY 2012, $400 million in FY 2013, and $400 million in FY 2014. Most of the funding is being provided to states and territories to provide home visiting services in their at-risk communities. In addition, the legislation included a 3% set-aside for tribes, tribal organizations, and urban Indian organizations and a 3% set-aside for research and evaluation. This investment has spurred the creation of more comprehensive and coordinated early childhood service systems across the United States. This article provides an overview of the MIECHV program, including descriptions of the various requirements under the Affordable Care Act. These include partnering with states to provide evidence-based home visiting services to at-risk families, working with tribal communities to implement culturally competent home visiting programs, and developing a mechanism to systematically review the evidence of effectiveness for home visiting program models and to conduct a national evaluation of the MIECHV program. PMID:24187124

  7. The AAS Visiting Professor Programs: Three Anniversaries

    NASA Astrophysics Data System (ADS)

    Philip, A. G. Davis

    2003-05-01

    The AAS Program of Visiting Professors was started in 1958 with three astronomers as lecturers. They were Paul Merrill (Mt. Wilson and Palomar Observatories), Seth Nicholson (Mt. Wilson and Palomar Observatories) and Harlow Shapley (Harvard College Observatory). The program was run by a Committee on Visiting Professors from 1958 through 1963. The program was funded by grants from the National Science Foundation. The Executive Officer of the AAS, Paul Routley headed the program from the 1963 - 64 academic year through the 1968 - 69 academic year. Larry Fredrick headed the program for 1969 - 70 and then Hank Gurin headed it through 1973 -74, the last year of the program. At the end of this summer meeting, the combined Visiting Professors Program and the Shapley Program will be starting their 47th year. The Shapley Visiting Lectureships in Astronomy Program was started in the 1974 - 75 academic year under the leadership of Hank Gurin. The original funding came from the Perkin Fund and a three year grant from the Research Corporation. In 1975 the Shapley Endowment fund was set up to help pay the expenses of the program. In 1976 there was support from the Slipher fund which lasted through the 1978 - 79 academic year. From 1979 to the present the program is financed by the Shapley Endowment Fund and by the contributions made by institutions which host the visits. In the fall of 1998 the fee that Institutions pay to the AAS in support of their Shapley visits was reduced from 300 to 250 to make it easier for them to apply for visits. Members of the AAS have made contributions to the program over the years and we are very appreciative of this support. In 1974 there were 42 lecturers in the program, of whom four are still active giving lectures (George Carruthers, Larry Fredrick, Arlo Landolt and Davis Philip). After the summer meeting, the Shapley Program will be embarking on its 30th year. Now there are 82 astronomers in the program and we get from 40 to 60 requests a year

  8. METAvivor Reps Visit NCI at Frederick | Poster

    Cancer.gov

    Three representatives of METAvivor visited NCI at Frederick on April 13 to meet and tour with Balamurugan Kuppusamy, Ph.D., staff scientist in the laboratory of Esta Sterneck, Ph.D., senior investigator, Laboratory of Cell and Developmental Signaling, Center for Cancer Research.  The purpose of the visit was to learn more about Kuppusamy’s research. Kuppusamy is a recipient of a $50,000, two-year grant awarded by METAvivor to study the role of the CEBPD-FBXW7 signaling pathway in inflammatory breast cancer.

  9. Bringing your child to visit a very ill sibling

    MedlinePlus

    ... patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005. Crit Care Clin . ... In: Fuhrman BP and Zimmerman JJ, eds. Pediatric Critical Care . 3rd ed. Philadelphia, PA: Elsevier Mosby; 2005:chap ...

  10. Capillary Study - Skylab Student Experiment ED-72

    NASA Technical Reports Server (NTRS)

    1973-01-01

    This chart describes the Skylab student experiment ED-72, Capillary Study, proposed by Roger G. Johnson of St. Paul, Mirnesota. Johnson theorized that capillary rise might continue to infinity in Skylab's zero-gravity environment. The behavior of fluids, particularly their flow properties in a low-gravity environment, had been important from the time that Robert H. Goddard launched his liquid-fueled rockets in the 1920's to the more sophisticated space systems of the day. It was necessary to design fluid-flow systems that would not only overcome the lack of gravity but also overcome, or take advantage of, the effect of surface tension. In March 1972, NASA and the National Science Teachers Association selected 25 experiment proposals for flight on Skylab. Science advisors from the Marshall Space Flight Center aided and assisted the students in developing the proposals for flight on Skylab.

  11. 29 CFR 1908.6 - Conduct of a visit.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... CONSULTATION AGREEMENTS § 1908.6 Conduct of a visit. (a) Preparation. (1) An onsite consultative visit shall be made only after appropriate preparation by the consultant. Prior to the visit, the consultant shall... conference. An initial visit may include training and education for employers and employees, if the need...

  12. 29 CFR 1908.6 - Conduct of a visit.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... CONSULTATION AGREEMENTS § 1908.6 Conduct of a visit. (a) Preparation. (1) An onsite consultative visit shall be made only after appropriate preparation by the consultant. Prior to the visit, the consultant shall... conference. An initial visit may include training and education for employers and employees, if the need...

  13. 22 CFR 125.5 - Exemptions for plant visits.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Exemptions for plant visits. 125.5 Section 125... EXPORT OF TECHNICAL DATA AND CLASSIFIED DEFENSE ARTICLES § 125.5 Exemptions for plant visits. (a) A... course of a classified plant visit by a foreign person, provided: The classified visit has itself...

  14. 22 CFR 125.5 - Exemptions for plant visits.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Exemptions for plant visits. 125.5 Section 125... EXPORT OF TECHNICAL DATA AND CLASSIFIED DEFENSE ARTICLES § 125.5 Exemptions for plant visits. (a) A... course of a classified plant visit by a foreign person, provided: The classified visit has itself...

  15. A Visitation/Training Program for Institutionalized Elderly.

    ERIC Educational Resources Information Center

    Fling, Sheila; Tayloe, Bryan

    Research on the use of paraprofessionals and trained volunteers for visitation programs with elders is limited. To determine the effects of a visitation program on nursing home residents and their college student and elder visitors, and to explore the effectiveness of special training for such visitation, nursing home residents (N=25) visited with…

  16. 22 CFR 125.5 - Exemptions for plant visits.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Exemptions for plant visits. 125.5 Section 125... EXPORT OF TECHNICAL DATA AND CLASSIFIED DEFENSE ARTICLES § 125.5 Exemptions for plant visits. (a) A... course of a classified plant visit by a foreign person, provided: The classified visit has itself...

  17. 42 CFR 405.2463 - What constitutes a visit.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... visit. (3) Visit—Mental health. A mental health visit is a face-to-face encounter between a RHC or FQHC... or FQHC practitioner, in accordance with paragraph (b)(1) of this section, for mental health services... diagnosis or treatment on the same day; (ii) Has a medical visit and a mental health visit on the same...

  18. Vitamin C Deficiency of Korean Homeless Patients Visiting to Emergency Department with Acute Alcohol Intoxication.

    PubMed

    Lee, Hui Jai; Shin, Jonghwan; Hong, Kijeong; Jung, Jin Hee

    2015-12-01

    Vitamins are essential micronutrients for maintenance of tissue functions. Vitamin deficiency is one of the most serious and common health problems among both chronic alcoholics and the homeless. However, the vitamin-level statuses of such people have been little studied. We evaluated the actual vitamin statuses of alcoholic homeless patients who visited an emergency department (ED). In this study the blood levels of vitamins B1, B12, B6, and C of 217 alcoholic homeless patients were evaluated retrospectively in a single urban teaching hospital ED. Vitamin C deficiency was observed in 84.3% of the patients. The vitamin B1, B12, and B6 deficiency rates, meanwhile, were 2.3%, 2.3%, and 23.5%, respectively. Comparing the admitted patients with those who were discharged, only the vitamin C level was lower. (P=0.003) In fact, the patients' vitamin C levels were markedly diminished, vitamin C replacement therapy for homeless patients should be considered in EDs.

  19. Vitamin C Deficiency of Korean Homeless Patients Visiting to Emergency Department with Acute Alcohol Intoxication

    PubMed Central

    2015-01-01

    Vitamins are essential micronutrients for maintenance of tissue functions. Vitamin deficiency is one of the most serious and common health problems among both chronic alcoholics and the homeless. However, the vitamin-level statuses of such people have been little studied. We evaluated the actual vitamin statuses of alcoholic homeless patients who visited an emergency department (ED). In this study the blood levels of vitamins B1, B12, B6, and C of 217 alcoholic homeless patients were evaluated retrospectively in a single urban teaching hospital ED. Vitamin C deficiency was observed in 84.3% of the patients. The vitamin B1, B12, and B6 deficiency rates, meanwhile, were 2.3%, 2.3%, and 23.5%, respectively. Comparing the admitted patients with those who were discharged, only the vitamin C level was lower. (P=0.003) In fact, the patients' vitamin C levels were markedly diminished, vitamin C replacement therapy for homeless patients should be considered in EDs. PMID:26713065

  20. PTSD in Depressed Mothers in Home Visitation

    PubMed Central

    Ammerman, Robert T.; Putnam, Frank W.; Chard, Kathleen M.; Stevens, Jack; Van Ginkel, Judith B.

    2013-01-01

    Recent research has suggested that mothers participating in home visitation programs have a high incidence of mental health problems, particularly depression. Posttraumatic stress disorder (PTSD) is a common comorbidity with depression, yet its prevalence among home visiting populations and implications for parenting and maternal functioning have not been examined. This study contrasted depressed mothers with (n = 35) and without PTSD (n = 55) who were enrolled in a home visitation program. Results indicated that depressed mothers with comorbid PTSD were more likely to have experienced childhood sexual abuse, had greater severity of depressive symptoms, increased social isolation, and lower overall functioning than their counterparts without PTSD. Among PTSD mothers, greater severity of PTSD symptoms, in particular avoidance and emotional numbness, were associated with increased maternal psychopathology and parenting deficits even after controlling for depression severity. These findings add to the literature documenting the negative impacts of PTSD on maternal functioning and parenting. Implications for screening and treatment in the context of home visitation are discussed. PMID:24307928

  1. CoSN Delegation Visits Scandinavia

    ERIC Educational Resources Information Center

    Technology & Learning, 2008

    2008-01-01

    In November 2007, a delegation from the Consortium for School Networking visited three Scandinavian countries to examine best practices. The delegates were motivated by their desire to understand the high achievement levels of students in Finland, Sweden, and Denmark. For several years, students in these countries have been outperforming their…

  2. A Visit to Three Parisian School Libraries.

    ERIC Educational Resources Information Center

    PEB Exchange, 1998

    1998-01-01

    Presents brief site-visit reports of three Paris (France) public schools to study the planning and use of each school's library. Observations from an elementary, middle, and high school include the overall library design, book classification and access systems, technology use, budgeting, and librarian role. (GR)

  3. Innovative technology offers virtual visitation for families.

    PubMed

    Thibeau, Shelley; Ricouard, Dawn; Gilcrease, Carolyn

    2012-10-01

    Parents of preterm infants and infants with congenital anomalies requiring treatment must begin their relationship with their infant in the unfamiliar and often stressful neonatal intensive care unit, full of strange sights and sounds. Innovative technology such as webcams offers virtual visitation, which holds potential to improve parent-infant bonding and reduce parents' self-perceived stress.

  4. Toward Population Impact from Home Visiting

    ERIC Educational Resources Information Center

    Dodge, Kenneth A.; Goodman, W. Benjamin; Murphy, Robert; O'Donnell, Karen J.; Sato, Jeannine M.

    2013-01-01

    Although some home visiting programs have proven effective with the families they serve, no program has yet demonstrated broader impact on an entire county or state population. This article describes the Durham Connects program, which aims to achieve broad county-level effects by coalescing community agencies to serve early-intervention goals…

  5. Visiting a science centre: what's on offer?

    NASA Astrophysics Data System (ADS)

    Russell, Ian

    1990-09-01

    Science centres are a valuable resource, used more frequently by family groups and primary school parties than by secondary schools. The importance of affective learning, involving attitude changes, is stressed. Provided the right approach is used, accompanying adults can help children get the most out of a visit.

  6. Parent Involvement in Early Childhood Home Visiting

    ERIC Educational Resources Information Center

    Korfmacher, Jon; Green, Beth; Staerkel, Fredi; Peterson, Carla; Cook, Gina; Roggman, Lori; Faldowski, Richard A.; Schiffman, Rachel

    2008-01-01

    This review provides an overview of an important aspect of early childhood home visiting research: understanding how parents are involved in program services and activities. Involvement is defined as the process of the parent connecting with and using the services of a program to the best of the client's and the program's ability. The term…

  7. Home Visitation Assessing Progress, Managing Expectations

    ERIC Educational Resources Information Center

    Daro, Deborah

    2006-01-01

    Early intervention efforts to promote healthy child development have long been a central feature of social service and public health reforms. Today, prenatal care, well-baby visits, and assessments to detect possible developmental delays are commonplace in most communities. Recently, child abuse prevention advocates have applied a developmental…

  8. Using quality improvement to promote implementation and increase well child visits in home visiting.

    PubMed

    Goyal, Neera K; Ammerman, Robert T; Massie, Julie A; Clark, Margaret; Van Ginkel, Judith B

    2016-03-01

    A key goal of home visiting is to connect children with medical homes through anticipatory guidance regarding recommended well child care (WCC). Substantial barriers to WCC among low socioeconomic families can limit achievement of this outcome. Quality improvement strategies have been widely adopted in healthcare but only recently implemented in home visiting to achieve program outcomes. The objective of this initiative was to increase the percentage of infants enrolled in home visiting who completed at least 3 recommended WCC visits in the first 6 months of life within a large, multi-model program comprised of 11 sites. A series of 33 quality improvement cycles were conducted at 3 sites involving 18 home visitors and 139 families with infants in the target age range. These were deployed sequentially, and changes within and across sites were monitored using trend charts over time. Adopted strategies were then implemented program-wide. Initiatives focused on staff training in WCC recommendations, data collection processes, monthly family tracking reports, and enhanced communication with primary care offices. Data were shared in iterative sessions to identify methods for improving adherence. Wide baseline variability across sites was observed, with the percentage of infants with recommended care ranging from 35% to 83%. Over the project timeline, the percentage of infants receiving at least 3 WCC visits in the first 6 months increased from 58% to 86%. Quality improvement within home visiting can be used to improve WCC adherence and provides an example of maximizing implementation of home visiting interventions. PMID:26699456

  9. Life Satisfaction and Frequency of Doctor Visits

    PubMed Central

    Kim, Eric S.; Park, Nansook; Sun, Jennifer K.; Smith, Jacqui; Peterson, Christopher

    2015-01-01

    Objective Identifying positive psychological factors that reduce health care use may lead to innovative efforts that help build a more sustainable and high quality health care system. Prospective studies indicate that life satisfaction is associated with good health behaviors, enhanced health, and longer life, but little information is available about the association between life satisfaction and health care use. We tested whether higher life satisfaction was prospectively associated with fewer doctor visits. We also examined potential interactions between life satisfaction and health behaviors. Methods Participants were 6,379 adults from the Health and Retirement Study, a prospective and nationally representative panel study of American adults over the age of 50. Participants were tracked for four years. We analyzed the data using a generalized linear model with a gamma distribution and log link. Results Higher life satisfaction was associated with fewer doctor visits. On a six-point life satisfaction scale, each unit increase in life satisfaction was associated with an 11% decrease in doctor visits—after adjusting for sociodemographic factors (RR = 0.89, 95% CI = 0.86 to 0.93). The most satisfied respondents (N=1,121; 17.58%) made 44% fewer doctor visits than the least satisfied (N=182; 2.85%). The association between higher life satisfaction and reduced doctor visits remained even after adjusting for baseline health and a wide range of sociodemographic, psychosocial, and health-related covariates (RR = 0.96, 95% CI = 0.93 to 0.99). Conclusions Higher life satisfaction is associated with fewer doctor visits, which may have important implications for reducing health care costs. PMID:24336427

  10. Feasibility of Non-Mydriatic Ocular Fundus Photography in the Emergency Department: Phase I of the FOTO-ED Study

    PubMed Central

    Bruce, Beau B.; Lamirel, Cédric; Biousse, Valérie; Ward, Antionette; Heilpern, Katherine L.; Newman, Nancy J.; Wright, David W.

    2011-01-01

    Objectives Examination of the ocular fundus is imperative in many acute medical and neurologic conditions, but direct ophthalmoscopy by non-ophthalmologists is underutilized, poorly performed, and difficult without pharmacologic pupillary dilation. The objective was to examine the feasibility of non-mydriatic fundus photography as a clinical alternative to direct ophthalmoscopy by emergency physicians (EPs). Methods Adult patients presenting to the emergency department (ED) with headache, acute focal neurologic deficit, diastolic blood pressure ≥ 120 mmHg, or acute visual change had ocular fundus photographs taken by nurse practitioners using a non-mydriatic fundus camera. Photographs were reviewed by a neuro-ophthalmologist within 24 hours for findings relevant to acute ED patient care. Nurse practitioners and patients rated ease, comfort, and speed of non-mydriatic fundus photography on a 10-point Likert scale (10 best). Timing of visit and photography were recorded by automated electronic systems. Results Three hundred fifty patients were enrolled. There were 1,734 photographs taken during 230 nurse practitioner shifts. Eighty-three percent of the 350 patients had at least one eye with a high quality photograph, while only 3% of patients had no photographs of diagnostic value. Mean ratings were ≥ 8.7 (standard deviation [SD] ≤ 1.9) for all measures. The median photography session lasted 1.9 minutes (interquartile range [IQR] 1.3 to 2.9 minutes), typically accounting for less that 0.5% of the patient’s total ED visit. Conclusions Non-mydriatic fundus photography taken by nurse practitioners is a feasible alternative to direct ophthalmoscopy in the ED. It is performed well by non-physician staff, is well-received by staff and patients, and requires a trivial amount of time to perform. PMID:21906202

  11. Is poor oral health a risk marker for incident cardiovascular disease hospitalisation and all-cause mortality? Findings from 172 630 participants from the prospective 45 and Up Study

    PubMed Central

    Joshy, Grace; Arora, Manish; Korda, Rosemary J; Chalmers, John; Banks, Emily

    2016-01-01

    Objective To investigate the relationship between oral health and incident hospitalisation for ischaemic heart disease (IHD), heart failure (HF), ischaemic stroke and peripheral vascular disease (PVD) and all-cause mortality. Design Prospective population-based study of Australian men and women aged 45 years or older, who were recruited to the 45 and Up Study between January 2006 and April 2009; baseline questionnaire data were linked to hospitalisations and deaths up to December 2011. Study exposures include tooth loss and self-rated health of teeth and gums at baseline. Setting New South Wales, Australia. Participants Individuals aged 45–75 years, excluding those with a history of cancer/cardiovascular disease (CVD) at baseline; n=172 630. Primary outcomes Incident hospitalisation for IHD, HF, ischaemic stroke and PVD and all-cause mortality. Results During a median follow-up of 3.9 years, 3239 incident hospitalisations for IHD, 212 for HF, 283 for ischaemic stroke and 359 for PVD, and 1908 deaths, were observed. Cox proportional hazards models examined the relationship between oral health indicators and incident hospitalisation for CVD and all-cause mortality, adjusting for potential confounding factors. All-cause mortality and incident CVD hospitalisation risk increased significantly with increasing tooth loss for all outcomes except ischaemic stroke (ptrend<0.05). In those reporting no teeth versus ≥20 teeth left, risks were increased for HF (HR, 95% CI 1.97, 1.27 to 3.07), PVD (2.53, 1.81 to 3.52) and all-cause mortality (1.60, 1.37 to 1.87). The risk of IHD, PVD and all-cause mortality (but not HF or ischaemic stroke) increased significantly with worsening self-rated health of teeth and gums (ptrend<0.05). In those reporting poor versus very good health of teeth and gums, risks were increased for IHD (1.19, 1.03 to 1.38), PVD (1.66, 1.13 to 2.43) and all-cause mortality (1.76, 1.50 to 2.08). Conclusions Tooth loss and, to a lesser extent, self

  12. Racial-Ethnic Disparities in Opioid Prescriptions at Emergency Department Visits for Conditions Commonly Associated with Prescription Drug Abuse

    PubMed Central

    Tien, Yu-Yu; Hsia, Renee Y.

    2016-01-01

    Prescription drug abuse is a growing problem nationally. In an effort to curb this problem, emergency physicians might rely on subjective cues such as race-ethnicity, often unknowingly, when prescribing opioids for pain-related complaints, especially for conditions that are often associated with drug-seeking behavior. Previous studies that examined racial-ethnic disparities in opioid dispensing at emergency departments (EDs) did not differentiate between prescriptions at discharge and drug administration in the ED. We examined racial-ethnic disparities in opioid prescription at ED visits for pain-related complaints often associated with drug-seeking behavior and contrasted them with conditions objectively associated with pain. We hypothesized a priori that racial-ethnic disparities will be present among opioid prescriptions for conditions associated with non-medical use, but not for objective pain-related conditions. Using data from the National Hospital Ambulatory Medical Care Survey for 5 years (2007–2011), the odds of opioid prescription during ED visits made by non-elderly adults aged 18–65 for ‘non-definitive’ conditions (toothache, back pain and abdominal pain) or ‘definitive’ conditions (long-bone fracture and kidney stones) were modeled. Opioid prescription at discharge and opioid administration at the ED were the primary outcomes. We found significant racial-ethnic disparities, with non-Hispanic Blacks being less likely (adjusted odds ratio ranging from 0.56–0.67, p-value < 0.05) to receive opioid prescription at discharge during ED visits for back pain and abdominal pain, but not for toothache, fractures and kidney stones, compared to non-Hispanic whites after adjusting for other covariates. Differential prescription of opioids by race-ethnicity could lead to widening of existing disparities in health, and may have implications for disproportionate burden of opioid abuse among whites. The findings have important implications for medical

  13. Racial-Ethnic Disparities in Opioid Prescriptions at Emergency Department Visits for Conditions Commonly Associated with Prescription Drug Abuse.

    PubMed

    Singhal, Astha; Tien, Yu-Yu; Hsia, Renee Y

    2016-01-01

    Prescription drug abuse is a growing problem nationally. In an effort to curb this problem, emergency physicians might rely on subjective cues such as race-ethnicity, often unknowingly, when prescribing opioids for pain-related complaints, especially for conditions that are often associated with drug-seeking behavior. Previous studies that examined racial-ethnic disparities in opioid dispensing at emergency departments (EDs) did not differentiate between prescriptions at discharge and drug administration in the ED. We examined racial-ethnic disparities in opioid prescription at ED visits for pain-related complaints often associated with drug-seeking behavior and contrasted them with conditions objectively associated with pain. We hypothesized a priori that racial-ethnic disparities will be present among opioid prescriptions for conditions associated with non-medical use, but not for objective pain-related conditions. Using data from the National Hospital Ambulatory Medical Care Survey for 5 years (2007-2011), the odds of opioid prescription during ED visits made by non-elderly adults aged 18-65 for 'non-definitive' conditions (toothache, back pain and abdominal pain) or 'definitive' conditions (long-bone fracture and kidney stones) were modeled. Opioid prescription at discharge and opioid administration at the ED were the primary outcomes. We found significant racial-ethnic disparities, with non-Hispanic Blacks being less likely (adjusted odds ratio ranging from 0.56-0.67, p-value < 0.05) to receive opioid prescription at discharge during ED visits for back pain and abdominal pain, but not for toothache, fractures and kidney stones, compared to non-Hispanic whites after adjusting for other covariates. Differential prescription of opioids by race-ethnicity could lead to widening of existing disparities in health, and may have implications for disproportionate burden of opioid abuse among whites. The findings have important implications for medical provider education

  14. An Analysis of US Emergency Department Visits From Falls From Skiing, Snowboarding, Skateboarding, Roller-Skating, and Using Nonmotorized Scooters.

    PubMed

    Nathanson, Brian H; Ribeiro, Kara; Henneman, Philip L

    2016-07-01

    We analyzed the US incidence of emergency department (ED) visits and hospitalizations for falls from skiing, snowboarding, skateboarding, roller-skating, and nonmotorized scooters in 2011. The outcome was hospital admission from the ED. The primary analysis compared pediatric patients aged 1 to 17 years to adults aged 18 to 44 years. The analysis used ICD-9 E-codes E885.0 to E885.4 using discharge data from the Nationwide Emergency Department Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Approximately 214 000 ED visits met study criteria. Skiing injuries had the highest percentage of hospitalizations (3.30% in pediatric patients and 6.65% in adults 18-44 years old). Skateboard and snowboard injuries were more likely to require hospitalization than roller skating injuries in pediatric patients (odds ratio = 2.42; 95% CI = 2.14-2.75 and odds ratio = 1.83; 95% CI =1.55-2.15, respectively). In contrast, skateboard and snowboard injuries were less severe than roller-skating injuries in adults.

  15. ExpandED Options: Learning beyond High School Walls

    ERIC Educational Resources Information Center

    ExpandED Schools, 2014

    2014-01-01

    Through ExpandED Options by TASC, New York City high school students get academic credit for learning career-related skills that lead to paid summer jobs. Too many high school students--including those most likely to drop out--are bored or see classroom learning as irrelevant. ExpandED Options students live the connection between mastering new…

  16. Teaching Elementary School Social Studies Methods under edTPA

    ERIC Educational Resources Information Center

    An, Sohyun

    2016-01-01

    This article reports a self-study that analyzes my experience as a teacher educator navigating a turbulent educational landscape with the advent of edTPA. The data consist of my journal entries, the syllabi, handouts, work submitted by my students, and course evaluations. Data were analyzed by using an inductive process to describe how the edTPA…

  17. Visit to Shikhany, 1987. Technical report

    SciTech Connect

    Not Available

    1988-08-29

    In August 1987, the Soviet Union invited participants in the chemical weapons negotiations at the Conference on Disarmament in Geneva to visit the Soviet military chemical facility at Shikhany. The presentation at Shikhany of chemical weapons and of weapon destruction took place on 3 and 4 October 1987. Six members of the US delegation attended. The presentation provided unclassified information on seven chemical agents or agent composites and nineteen weapons for delivery of chemical agents. This report provides a ready reference to the information obtained from the Shikhany visit. Information is included on principal agent types and weapons types. Shikhany is the site of a Soviet military facility and is located in the Volsk district nine hundred kilometers southeast of Moscow, and lies northwest of and adjacent to the Volga river. This report provides descriptions of the chemical munitions displayed for the visitors, the chemical agents for use in the munitions, and Soviet chemical agent demilitarization.

  18. A practical three visit complete denture system.

    PubMed

    Ling, B C

    2000-10-01

    Standard prosthodontic procedures require five visits to construct a set of complete maxillary and mandibular dentures. Various attempts have been made to reduce these procedures to four or three appointments. However, most of these techniques require the use of visible light polymerized resin as the final denture base materials. Visible light-cured resin materials have inferior physical properties and biocompatibility problems as compared with heat cured polymethylmethacrylate. This paper describes a system of complete denture construction which requires three clinical appointments instead of the usual five visits. This system is made possible by using the VLC base/tray material as the preliminary impression material as well as the application of a new biometric wax occlusion rim. It retains the use of polymethylmethacrylate as the denture base material. This system also utilizes all the procedures used in the conventional five appointment system of complete denture construction. PMID:11709981

  19. National Ice Center Visiting Scientist Program

    NASA Technical Reports Server (NTRS)

    Austin, Meg

    2002-01-01

    The long-term goal of the University Corporation for Atmospheric Research (UCAR) Visiting Scientist Program at the National Ice Center (NIC) is to recruit the highest quality visiting scientists in the ice research community for the broad purpose of strengthening the relationship between the operational and research communities in the atmospheric and oceanic sciences. The University Corporation for Atmospheric Research supports the scientific community by creating, conducting, and coordinating projects that strengthen education and research in the atmospheric, oceanic and earth sciences. UCAR accomplishes this mission by building partnerships that are national or global in scope. The goal of UCAR is to enable researchers and educators to take on issues and activities that require the combined and collaborative capabilities of a broadly engaged scientific community.

  20. United States-Russia exchange visits

    SciTech Connect

    Desmond, W.J.; Czajkowski, A.F.; Zack, N.R.; Martin, H.R.; Gardner, B.; Schlegel, S.; Von Hippel, F.

    1995-09-01

    The Department of Energy, under a government-to-government program, hosted the first visit with the Russian Federation to exchange information and technologies for special nuclear material control, accounting, and physical protection at a plutonium storage facility. The Russian specialists toured a storage facility at the Hanford Site near Richland, Washington, and were shown the physical protection and materials control systems that DOE employs to protect excess nuclear materials. Technical discussions included topics associated with protective forces and their operation, perimeter and interior intrusion detection and assessment equipment/systems, vulnerability assessment demonstrations, and the vault monitoring and materials control systems. In October, the Russian Federation hosted a reciprocal visit to the Mayak Enterprise civil plutonium storage facility, previously known as Chelyabinsk-65. The US specialists participated in technical discussions on the protection and control of plutonium and supported an evaluation of safeguards and security at the Mayak storage facility.

  1. Web Formation - Skylab Student Experiment ED-52

    NASA Technical Reports Server (NTRS)

    1973-01-01

    Judith S. Miles of Lexington High School, Lexington, Massachusetts, proposed skylab student experiment ED-52, Web Formation. This experiment was a study of a spider's behavior in a weightless environment. The geometrical structure of the web of the orb-weaving spider provides a good measure of the condition of its central nervous system. Since the spider senses its own weight to determine the required thickness of web material and uses both the wind and gravity to initiate construction of its web, the lack of gravitational force in Skylab provided a new and different stimulus to the spider's behavioral response. Two common cross spiders, Arabella and Anita, were used for the experiment aboard the Skylab-3 mission. After initial disoriented attempts, both spiders produced almost Earth-like webs once they had adapted to weightlessness. This photograph is of Arabella, a cross spider, in her initial attempt at spirning a web. This picture was taken by the crew of the Skylab 3 mission before Arabella adapted to her new environment.

  2. Neuroscientists’ Classroom Visits Positively Impact Student Attitudes

    PubMed Central

    Fitzakerley, Janet L.; Michlin, Michael L.; Paton, John; Dubinsky, Janet M.

    2013-01-01

    The primary recommendation of the 2010 President’s Council of Advisors on Science and Technology report on K-12 education was to inspire more students so that they are motivated to study science. Scientists’ visits to classrooms are intended to inspire learners and increase their interest in science, but verifications of this impact are largely qualitative. Our primary goal was to evaluate the impact of a longstanding Brain Awareness classroom visit program focused on increasing learners understanding of their own brains. Educational psychologists have established that neuroscience training sessions can improve academic performance and shift attitudes of students from a fixed mindset to a growth mindset. Our secondary goal was to determine whether short interactive Brain Awareness scientist-in-the-classroom sessions could similarly alter learners’ perceptions of their own potential to learn. Teacher and student surveys were administered in 4th-6th grade classrooms throughout Minnesota either before or after one-hour Brain Awareness sessions that engaged students in activities related to brain function. Teachers rated the Brain Awareness program as very valuable and said that the visits stimulated students’ interest in the brain and in science. Student surveys probed general attitudes towards science and their knowledge of neuroscience concepts (particularly the ability of the brain to change). Significant favorable improvements were found on 10 of 18 survey statements. Factor analyses of 4805 responses demonstrated that Brain Awareness presentations increased positive attitudes toward science and improved agreement with statements related to growth mindset. Overall effect sizes were small, consistent with the short length of the presentations. Thus, the impact of Brain Awareness presentations was positive and proportional to the efforts expended, demonstrating that short, scientist-in-the-classroom visits can make a positive contribution to primary school

  3. Building Relationships by Revisiting Home Visits

    ERIC Educational Resources Information Center

    Hillman, Carol B.

    2011-01-01

    The author can't think of any better way to begin a relationship with a young school-bound child than to make a home visit. Home is where the heart is. Home is where the child feels most comfortable, where a child feels safe. When he is at home, a child can more easily welcome a new adult into his world and take the lead in establishing this…

  4. Neuroscientists' classroom visits positively impact student attitudes.

    PubMed

    Fitzakerley, Janet L; Michlin, Michael L; Paton, John; Dubinsky, Janet M

    2013-01-01

    The primary recommendation of the 2010 President's Council of Advisors on Science and Technology report on K-12 education was to inspire more students so that they are motivated to study science. Scientists' visits to classrooms are intended to inspire learners and increase their interest in science, but verifications of this impact are largely qualitative. Our primary goal was to evaluate the impact of a longstanding Brain Awareness classroom visit program focused on increasing learners understanding of their own brains. Educational psychologists have established that neuroscience training sessions can improve academic performance and shift attitudes of students from a fixed mindset to a growth mindset. Our secondary goal was to determine whether short interactive Brain Awareness scientist-in-the-classroom sessions could similarly alter learners' perceptions of their own potential to learn. Teacher and student surveys were administered in 4(th)-6(th) grade classrooms throughout Minnesota either before or after one-hour Brain Awareness sessions that engaged students in activities related to brain function. Teachers rated the Brain Awareness program as very valuable and said that the visits stimulated students' interest in the brain and in science. Student surveys probed general attitudes towards science and their knowledge of neuroscience concepts (particularly the ability of the brain to change). Significant favorable improvements were found on 10 of 18 survey statements. Factor analyses of 4805 responses demonstrated that Brain Awareness presentations increased positive attitudes toward science and improved agreement with statements related to growth mindset. Overall effect sizes were small, consistent with the short length of the presentations. Thus, the impact of Brain Awareness presentations was positive and proportional to the efforts expended, demonstrating that short, scientist-in-the-classroom visits can make a positive contribution to primary school

  5. John Dewey's Visits to Hawai'i

    ERIC Educational Resources Information Center

    McEwan, Hunter

    2015-01-01

    John Dewey visited Hawai'i on three separate occasions. Of all three trips, by far the most important, as far as Dewey's influence on education in Hawai'i is concerned, was in 1899 when he came with his wife, Alice Chipman Dewey, to help launch the University Extension program in Honolulu. The Deweys' second trip was a very brief one--twenty years…

  6. Visit of the Federal President of Germany

    SciTech Connect

    2007-12-05

    Le D.G. H.Schopper a le plaisir de souhaiter la bienvenue au président de la République fédérale allemande, Richard von Weizsäcker (président féderale de 1984-1994). C'est la première visite d'un président allemand dans l'histoire du Cern.

  7. Visit of the Federal President of Germany

    ScienceCinema

    None

    2016-07-12

    Le D.G. H.Schopper a le plaisir de souhaiter la bienvenue au président de la République fédérale allemande, Richard von Weizsäcker (président féderale de 1984-1994). C'est la première visite d'un président allemand dans l'histoire du Cern.

  8. TechEdSat Nano-Satellite Series Fact Sheet

    NASA Technical Reports Server (NTRS)

    Murbach, Marcus; Martinez, Andres; Gua