GLORIA

GEOMAR Library Ocean Research Information Access

Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
Filter
  • Ovid Technologies (Wolters Kluwer Health)  (28)
  • English  (28)
  • 1
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 145, No. Suppl_1 ( 2022-03)
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 145, No. Suppl_1 ( 2022-03)
    Abstract: Introduction: Acute myocardial infarction (AMI) is a leading cause of morbidity, mortality, and healthcare costs in the United States (US). Aspirin is an effective, low-cost pharmaceutical that can significantly reduce mortality after AMI. The extent of self-administration of aspirin by individuals at the onset of an AMI is undocumented and must be assumed to be the rare exception. Even among adults admitted to an emergency room, only half receive aspirin within a few hours. Objective: The objective of this study was to evaluate the benefits and potential harms of adults self-administering a single dose of aspirin at the onset of chest pain in the US, including deaths delayed from AMI, deaths due to excessive bleeding, and costs per year of life saved (YOLS). Methods: Estimates of AMI incidence rate from the Global Burden of Disease study and population data from the US Census Bureau were used to derive a study cohort of adults over the age of 40 in the US in 2019. We conducted a systematic review to quantify the positive predictive value of a non-specific chest pain for AMI. A 25% relative risk reduction of mortality, based on the Second International Study of Infarct Survival (ISIS) Trial, was applied to case fatality rates of MI derived from a prior global review study. The main outcome was net deaths delayed from aspirin, calculated from deaths delayed post AMI accounting for deaths from excessive bleeding. Secondary outcomes included YOLS and cost of aspirin/YOLS, calculated summing the YOLS and dividing by total cost of aspirin for all adults experiencing chest pain. All analyses were stratified in 5-year age-sex groups. Results: Assuming all adults over the age of 40 years in the US took aspirin within 2 hours of chest pain onset, the total net deaths delayed in 2019 was estimated to be 81,810. There was a total of 83,226 deaths delayed post AMI, which was offset by 1,417 aspirin-related deaths from excess bleeding, leading to an estimated 869,727 YOLS. The cost of the pills was $423,066, translating to $0.49 per YOLS. Benefits were greatest among males and older adults between ages 65 to 75 years. Conclusions: For less than fifty cents per year of life saved, aspirin has the potential to save over 80,000 lives in the US. Benefits of reducing deaths post AMI outweighed the risk of bleeding from aspirin. As aspirin is cost-effective and easily-accessed, efforts should be made to promote ready access and timely use of aspirin within the first 2 hours of chest pain to reduce mortality associated with AMI in the US and abroad.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1466401-X
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
  • 2
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. 5 ( 2020-05), p. 1381-1387
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. 5 ( 2020-05), p. 1381-1387
    Abstract: Long-term effect of lifestyle changes on stroke incidence has not been estimated in randomized trials. We used observational data to estimate the incidence of stroke under hypothetical lifestyle strategies in the NHS (Nurses’ Health Study). Methods— We considered 3 nondietary strategies (smoking cessation, exercising ≥30 min/d, gradual body mass index reduction if overweight/obese) and several dietary strategies (eating ≥3 servings/wk of fish, ≤3 servings/wk of unprocessed red meat, no processed red meat, ≥1 servings/d of nuts, etc). We used the parametric g-formula to estimate the 26-year risk of stroke under these strategies. Results— In 59 727 women, mean age 52 years at baseline in 1986, the estimated 26-year risks under no lifestyle interventions were 4.7% for total stroke, 2.4% for ischemic stroke, and 0.7% for hemorrhagic stroke. Under the combined nondietary interventions, the estimated 26-year risk of total stroke was 3.5% (95% CI, 2.6%–4.3%) and ischemic stroke was 1.6% (95% CI, 1.1%–2.1%). Smaller reductions in total stroke risk were estimated under isolated dietary strategies of increased intake of fish and nuts and reduced intake of unprocessed red meat. Ischemic stroke risk was lower under reduced intake of unprocessed and processed red meat, and hemorrhagic stroke risk was lower under a strategy of increased fish consumption. Conclusions— In this population of middle-aged women, sustained, lifestyle modifications were estimated to reduce the 26-year risk of total stroke by 25% and ischemic stroke by 36%. Sustained dietary modifications were estimated to reduce the 26-year risk of total stroke by 23%.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    RVK:
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
  • 3
    In: Medical Care, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. 3 ( 2017-03), p. 261-266
    Abstract: With the increasing focus on reducing hospital readmissions in the United States, numerous readmissions risk prediction models have been proposed, mostly developed through analyses of structured data fields in electronic medical records and administrative databases. Three areas that may have an impact on readmission but are poorly captured using structured data sources are patients’ physical function, cognitive status, and psychosocial environment and support. Objective of the Study: The objective of the study was to build a discriminative model using information germane to these 3 areas to identify hospitalized patients’ risk for 30-day all cause readmissions. Research Design: We conducted clinician focus groups to identify language used in the clinical record regarding these 3 areas. We then created a dataset including 30,000 inpatients, 10,000 from each of 3 hospitals, and searched those records for the focus group-derived language using natural language processing. A 30-day readmission prediction model was developed on 75% of the dataset and validated on the other 25% and also on hospital specific subsets. Results: Focus group language was aggregated into 35 variables. The final model had 16 variables, a validated C-statistic of 0.74, and was well calibrated. Subset validation of the model by hospital yielded C-statistics of 0.70–0.75. Conclusions: Deriving a 30-day readmission risk prediction model through identification of physical, cognitive, and psychosocial issues using natural language processing yielded a model that performs similarly to the better performing models previously published with the added advantage of being based on clinically relevant factors and also automated and scalable. Because of the clinical relevance of the variables in the model, future research may be able to test if targeting interventions to identified risks results in reductions in readmissions.
    Type of Medium: Online Resource
    ISSN: 0025-7079
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2045939-7
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
  • 4
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation Vol. 129, No. suppl_1 ( 2014-03-25)
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 129, No. suppl_1 ( 2014-03-25)
    Abstract: Introduction: Health disparities remain pervasive in US and eliminating such disparities is one of the overarching goals of the Healthy People 2020 agenda. Previous studies have assessed the disparities in risk of coronary heart disease (CHD) mortality by race/ethnicity, but most of them only focused on the average CHD risk without taking into account the full risk distribution which would enable analysis of specific high-risk sub-groups. In this study, we estimated the 10-year risk distribution of CHD mortality based on 5 leading modifiable risk factors in US (i.e. smoking, adiposity, high blood pressure, serum cholesterol and blood glucose). We quantified the racial disparities in absolute CHD risk while accounting for full risk distribution. Methods: We included 3866 individuals aged 45 to 74 years, who were black or white, non-pregnant, free of CHD and had measurements of all 5 risk factors from 6 consecutive 2-year cycles of the National Health and Nutrition Examination Survey 1999-2010. We used mortality data from National Center for Health Statistics to estimate the cause-age-sex-race specific mortality in 2010. We also obtained hazard ratios of the selected 5 risk factors on CHD mortality from large meta-analyses of epidemiological studies. We predicted the 10-year risk of CHD death for each individual by simulating their survival process from 2010 to 2020 incorporating competing risks by death from other correlated causes. To assess health disparities, we compared the 5 th , 25 th , 50 th , 75 th and 95 th percentile of the predicted risks between black and white by age and sex. Results: More than half of the black and white population aged 45 to 74 years had a low 10-year risk of CHD death ( 〈 2%). The age-sex-race specific distributions of 10-year CHD risk were right-skewed with a large proportion of population on the low risk tail. Comparing to white, black had similar shape of CHD risk distributions, but higher risk levels at all percentiles across age and sex groups. In 55-64 ages where CHD was the major cause of death, the median of CHD risk for black males was 2.9% (interquartile range (IQR) 1.7% - 4.4%), which was 0.7% larger than that for white males (2.2%, IQR 1.4% - 3.3%). This risk difference was similar in females: the median CHD risk for black females was 1.6% (IQR 0.9% - 2.4%) and 0.9% for white females (IQR 0.5% - 1.5%). The disparities became larger on the high risk tail (95 th percentile of predicted risk), where black had 2.7% higher risk for male and 2.3% for female in 55-64 ages. In older age groups (65-74 ages), such difference increased to 3.5% for both male and female. Conclusions: This analysis showed a skewed 10-year CHD risk distribution in US. The racial disparities are larger in the high risk sub-groups compared to those in the center of the risk distribution, indicating that the high risk subgroups should be the target population of intervention that aims to reduce health disparities in US.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1466401-X
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
  • 5
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. suppl_1 ( 2017-02)
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. suppl_1 ( 2017-02)
    Abstract: Randomized trials have examined the short-term effects of lifestyle interventions on the risk of stroke. Using observational data to estimate the long-term effect of such strategies requires valid adjustment for time-varying confounders- such as hypertension- that are affected by prior lifestyle risk factors. We estimated the long-term effect of hypothetical lifestyle strategies on risk of stroke using data from the Nurses’ Health Study, a prospective cohort. We followed 60,390 women, aged 52 years on average at baseline, from 1986 to 2010. We used a Monte Carlo simulation to estimate the 24-year risk of stroke had all participants followed three non-dietary lifestyle strategies: smoking cessation, exercising (≥30 minutes/day), reducing body mass index (BMI) by 5% every two years if overweight/obese; as well as several dietary strategies including: eating ≥ 3 servings/week of fish, eating ≤ 3 servings/week of unprocessed red meat, eating no processed red meat, eating ≥ 5 servings/day of fruits and vegetables, among others. We used the parametric g-formula to adjust for baseline and time-varying confounders, comparing the estimated risk of stroke under our specified strategies of interest to the same had all participants followed a “do-nothing” strategy. The observed 24-year risks of total, ischemic and hemorrhagic stroke in this cohort were 2.9%, 2.2% and 0.6%. The estimated risk of total stroke was 25% lower (95% CI: 5% to 46%) under a combination of all three non-dietary strategies, the most effective being exercise (19% lower risk) and smoking cessation (5% lower risk). Of the dietary strategies, eating ≤ 3 servings of unprocessed red meat reduced the estimated risk of total stroke by 4% (1% to 7%). The risk of ischemic stroke under all three non-dietary strategies was 36% lower (15% to 59%), but risk of hemorrhagic stroke did not materially change. Exercise reduced the estimated risk of ischemic stroke by 29% (7% to 56%) and lowering BMI by 4% (0% to 8%). Additionally, ischemic stroke risk was lowered by 9% (0% to 19%) by decreasing intake of processed red meat and 6% (2% to 10%) by decreasing intake of unprocessed red meat. In summary, lifestyle modifications were estimated to reduce the 24-year risk of total stroke by up to 25% in this population of middle-aged women.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    RVK:
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
  • 6
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  JAIDS Journal of Acquired Immune Deficiency Syndromes Vol. 67, No. Supplement 4 ( 2014-12-1), p. S173-S178
    In: JAIDS Journal of Acquired Immune Deficiency Syndromes, Ovid Technologies (Wolters Kluwer Health), Vol. 67, No. Supplement 4 ( 2014-12-1), p. S173-S178
    Type of Medium: Online Resource
    ISSN: 1525-4135
    RVK:
    RVK:
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 2038673-4
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
  • 7
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 131, No. suppl_1 ( 2015-03-10)
    Abstract: Background: Yerba mate tea, made from tree leaves of Ilex paraguariensis, is a widely consumed beverage in South America. Animal studies have reported improvement in serum lipids parameters and reduction in cholesterol content and size of aortic lesions with consumption of ilex paraguariensis extracts, that contain potentially bioactive saponin, phenolic compounds and methilxanthines. Few studies have been conducted in humans, mostly pilot studies. Evidence on the association between mate tea consumption and lipid profile, Apolipoprotein (Apo) AI, Apo B and C-reactive protein (CRP) in humans are sparse. We assessed these associations among adults from Argentina, Chile and Uruguay. Methods: CESCAS I (Center of Excellence in Cardiovascular Health of South America Study I) study is an observational population-based prospective cohort study of 7,600 participants from general population of four cities in the three countries. We conducted a cross-sectional analysis in a randomly selected subsample of 988 subjects aged 35 to 74 years. Participants with previous cardiovascular events or receiving lipid-lowering agents were excluded. Mate consumption and other dietary habits were assessed using a previously validated 126-item food frequency questionnaire. Multivariable linear regression models were used to examine the associations between Apo AI, B, CRP, and other lipids by tertiles (T) of mate tea consumption. The models adjusted for age, smoking status, body mass index, physical activity, alcohol intake, ‘prudent’ or ‘Western’ diet-pattern scores (identified by principal component analysis), added sugar to the mate, and presence of diabetes. Results: The sample included 418 men and 570 women. The proportion of mate drinkers (at least once a month during last year) were 40% in Temuco (Chile), 84% in Canelones (Uruguay), 89% in Marcos Paz and 91% in Bariloche (Argentina). Median mate intake across tertiles was 0, 590 and 1875ml/day in men and 0, 625 and 1875ml/day in women, respectively. Higher mate consumption (T3 vs. T1) was independently associated with higher levels of Apo AI in both men (5.1mg/L, 95% CI, 0.1 to 10.1) and women (6.7mg/L, 95% CI, 1.5 to 11.9). In men higher mate consumption was also associated with lower levels of triglycerides (-49mg/dL, 95% CI, -11 to -86) and in women with slightly lower Apo B/AI ratio (-0.05, 95% CI, -0.001 to -0.06). Differences in total cholesterol, HDL cholesterol, LDL cholesterol, Apo B, and CRP were not statistically significant. Conclusions: Among generally healthy adults, higher consumption of mate during the past 12 months was associated with higher levels of APO-A1 in both men and women, and with lower triglycerides levels in men.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1466401-X
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
  • 8
    In: Epidemiology, Ovid Technologies (Wolters Kluwer Health), Vol. 27, No. 3 ( 2016-05), p. 414-422
    Type of Medium: Online Resource
    ISSN: 1044-3983
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 2042095-X
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
  • 9
    In: Epidemiology, Ovid Technologies (Wolters Kluwer Health), Vol. 23, No. 4 ( 2012-07), p. 631-640
    Type of Medium: Online Resource
    ISSN: 1044-3983
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 2042095-X
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
  • 10
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Epidemiology Vol. 26, No. 2 ( 2015-03), p. 153-162
    In: Epidemiology, Ovid Technologies (Wolters Kluwer Health), Vol. 26, No. 2 ( 2015-03), p. 153-162
    Type of Medium: Online Resource
    ISSN: 1044-3983
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 2042095-X
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
Close ⊗
This website uses cookies and the analysis tool Matomo. More information can be found here...