Association between sedating medications and delirium in older inpatients.

Objectives: To examine the association between Beers criteria sedative medications and delirium in a large cohort of hospitalized elderly adults with common medical conditions.

Design: Retrospective cohort and nested case-control studies.

Setting: 374 U.

Access to subspecialty care for patients with mobility impairment: a survey.

Background: Adults who use wheelchairs have difficulty accessing physicians and receive less preventive care than their able-bodied counterparts.

Objective: To learn about the accessibility of medical and surgical subspecialist practices for patients with mobility impairment.

Design: A telephone survey was used to try to make an appointment for a fictional patient who was obese and hemiparetic, used a wheelchair, and could not self-transfer from chair to examination table.

Income inequality and 30 day outcomes after acute myocardial infarction, heart failure, and pneumonia: retrospective cohort study.

Objectives: To examine the association between income inequality and the risk of mortality and readmission within 30 days of hospitalization.

Design: Retrospective cohort study of Medicare beneficiaries in the United States. Hierarchical, logistic regression models were developed to estimate the association between income inequality (measured at the US state level) and a patient's risk of mortality and readmission, while sequentially controlling for patient, hospital, other state, and patient socioeconomic characteristics.

Patterns of obstetric infection rates in a large sample of US hospitals.

Objective: Maternal infection is a common complication of childbirth, yet little is known about the extent to which infection rates vary among hospitals. We estimated hospital-level risk-adjusted maternal infection rates (RAIR) in a large sample of US hospitals and explored associations between RAIR and select hospital features.

Study Design: This retrospective cohort study included hospitals in the Perspective database with >100 deliveries over 2 years.

Using tailored telephone counseling to accelerate the adoption of colorectal cancer screening.

Background: Few interventions to increase colorectal cancer screening have used a stage of change model to promote screening adoption. None have used computer-assisted tailored telephone counseling calls. This study's purpose was to implement and evaluate stage-based computer-assisted tailored telephone counseling to promote colorectal cancer screening in a primary care population.

Fracture risk and antiresorptive medication use in older women in the USA.

Unlabelled: Risk of fragility fractures in older women appears to be under-recognized and under treated. Analysis of a national sample of older US women reveals that over 5 million are at high risk of fracture; only one third of these report being told they have osteoporosis and one quarter are receiving appropriate treatment.

Introduction: Substantial numbers of older women in the United States suffer fragility fractures each year.

Trends in hospital care for hip fractures.

Unlabelled: To assess the impact of the aging population on the occurrence of fragility fractures, we examined hospital discharges for hip fracture among U.S. women and men aged 45 years and older from 1993 through to 2003.

Does race/ethnicity moderate the association between job strain and leisure time physical activity?

Background: Racial/ethnic minorities report myriad barriers to regular leisure time physical activity (LTPA), including the stress and fatigue resulting from their occupational activities.

Purpose: We sought to investigate whether an association exists between job strain and LTPA, and whether it is modified by race or ethnicity.

Methods: Data were collected from 1,740 adults employed in 26 small manufacturing businesses in eastern Massachusetts.

Applying a stage model of behavior change to colon cancer screening.

Background: There has been limited use of stages of change models in characterizing colorectal cancer (CRC) screening. We assess the applicability of the Precaution Adoption Model (PAPM) by determining the distribution of stages of adoption and by elucidating differences among stages.

Methods: The study is based on 1394 responses (69%) to a survey mailed in 2002 to patients in a primary care population.

Employed adolescents and beliefs about self-efficacy to avoid smoking.

This paper examines self-efficacy to avoid cigarette smoking and its association with smoking and quitting behavior, peer and worksite influences, nicotine dependence, and socio-demographic variables among employed adolescents. A cross-sectional survey was used to collect data from employed adolescents ages 15-18 who worked in 10 participating grocery stores in Massachusetts. Eighty-three percent of workers (n=379) completed the survey.

Do social influences contribute to occupational differences in quitting smoking and attitudes toward quitting?

Purpose: To examine occupational differences in social influences supporting quitting smoking and their relationships to intentions and self-efficacy to quit smoking and to quitting.

Design: Data were collected as part of a large worksite cancer prevention intervention trial.

Setting: Forty-four worksites.

The effects of a health promotion-health protection intervention on behavior change: the WellWorks Study.

Objectives: This study assessed the effects of a 2-year integrated health promotion-health protection work-site intervention on changes in dietary habits and cigarette smoking.

Methods: A randomized, controlled intervention study used the work site as the unit of intervention and analysis; it included 24 predominantly manufacturing work sites in Massachusetts (250-2500 workers per site). Behaviors were assessed in self-administered surveys (n = 2386; completion rates = 61% at baseline, 62% at final).

Underusers of mammogram screening: stage of adoption in five U.S. subpopulations. The NCI Breast Cancer Screening Consortium.

Background: The purpose of this report is to describe the characteristics of women ages 50 to 80 who do not follow commonly accepted mammography screening guidelines. It provides unique understanding of the robustness of characteristics of underusers across five different U.S.

Double jeopardy: workplace hazards and behavioral risks for craftspersons and laborers.

Purpose: To address three specific questions in a sample of craftspersons and laborers: (1) Do craftspersons and laborers exposed to workplace hazards have higher behavioral risks, such as smoking and high-fat diets, than those with few job risks? (2) Compared to workers with few job risks, do workers exposed to risks on the job have higher intentions to reduce their behavioral risks? (3) Does concern about the level of exposure to risks on the job increase workers' intentions to reduce behavioral risks?

Design: A cross-sectional self-administered survey was conducted in participating worksites.

Setting: Twenty-two predominantly manufacturing worksites in Massachusetts.

Subjects: Craftspersons and laborers responding to the survey and employed in these 22 worksites (completion rate = 61%, N = 1841).

Factors affecting the performance of the models in the Mortality Probability Model II system and strategies of customization: a simulation study.

Objectives: To examine the impact of hospital mortality and intensive care unit (ICU) size on the performance of the Mortality Probability Model II system for use in quality assessment, and to examine the ability of model customization to produce accurate estimates of hospital mortality to characterize patients by severity of illness for clinical trials.

Design: Prospective evaluation of model performance, using retrospective data.

Setting: Data for the simulation were assembled from six adult medical and surgical ICUs in Massachusetts and New York.

Mortality probability models for patients in the intensive care unit for 48 or 72 hours: a prospective, multicenter study.

Objective: To develop models in the Mortality Probability Model (MPM II) system to estimate the probability of hospital mortality at 48 and 72 hrs in the intensive care unit (ICU), and to test whether the 24-hr Mortality Probability Model (MPM24), developed for use at 24 hrs in the ICU, can be used on a daily basis beyond 24 hrs.

Design: A prospective, multicenter study to develop and validate models, using a cohort of consecutive admissions.

Setting: Six adult medical and surgical ICUs in Massachusetts and New York adjusted to reflect 137 ICUs in 12 countries.

Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients.

Objective: To revise and update models in the Mortality Probability Model (MPM II) system to estimate the probability of hospital mortality among 19,124 intensive care unit (ICU) patients that can be used for quality assessment within and among ICUs.

Design And Setting: Models developed and validated on consecutive admissions to adult medical and surgical ICUs in 12 countries.

Patients: A total of 12,610 patients for model development, 6514 patients for model validation.

Explaining variability of cost using a severity-of-illness measure for ICU patients.

Factors related to hospital resource use by intensive care unit (ICU) patients, including severity of illness at admission and intensity of therapy during the first 24 ICU hours were explored in this study. Analysis was based on 2,749 patients admitted to the general medical-surgical ICU at Baystate Medical Center, Springfield, Massachusetts, between February 1, 1983 and January 10, 1985. Resource use was indexed by hospital length of stay (LOS) adjusted for differences between ICU and other hospital days.

Intensive care unit patient follow-up. Mortality, functional status, and return to work at six months.

Six months after hospital discharge, we followed up 1545 patients who had received care in the general medical-surgical intensive care unit (ICU) of a tertiary care hospital. Vital status could not be ascertained for 200 of these patients. Of the 1345 former ICU patients for whom a determination of vital status could be made, 1261 (94%) were alive and 84 (6%) had died.

Refining intensive care unit outcome prediction by using changing probabilities of mortality.

Estimating prognosis is potentially useful as a measure of ICU performance and as a guide for the clinical care of individual patients. In this study, mortality prediction models (MPMs) for patients in an adult general medical-surgical ICU were derived from data gathered at ICU admission and after 24 and 48 h of ICU care. A predictive model was developed which incorporated a sequence of probabilities collected over time in the ICU.

A comparison of methods to predict mortality of intensive care unit patients.

This paper presents results of the first study explicitly designed to compare three methods for predicting hospital mortality of ICU patients: the Acute Physiology Score (APS), the Simplified Acute Physiology Score (SAPS), and the Mortality Prediction Model (MPM). With respect to sensitivity, specificity, and total correct classification rates, these methods performed comparably on a cohort of 1,997 consecutive ICU admissions. In these patients from a single hospital, the APS overestimated and the SAPS underestimated the probability of hospital mortality.

Validation of the mortality prediction model for ICU patients.

We tested recently developed admission and 24-h models of hospital mortality on 1,997 consecutive admissions to a general medical/surgical ICU. This study population was independent of the group used to develop the models. The admission prediction model estimated each patient's probability of hospital mortality based on seven routinely collected admission variables.

Applications of microcomputer spreadsheet packages as adjuncts to multiple logistic regression analysis.

This paper illustrates how a microcomputer spreadsheet package can be used by epidemiologists to facilitate the computation of multiple logistic regression (MLR) probabilities, as well as odds ratios and associated confidence intervals, given the coefficients of the MLR model. By formatting a spreadsheet, data entry is greatly simplified, and computations are accomplished without any arithmetic manipulations on the part of the user. This approach makes it feasible for clerical support staff to assist in the computation of seemingly complex expressions.

A method for predicting survival and mortality of ICU patients using objectively derived weights.

Data at ICU admission and after 24 h in the ICU were collected on 755 patients, to derive multiple logistic regression models for predicting hospital mortality. The derived models contained relatively few and easily obtained variables. The weight associated with each variable was determined objectively.

Two-year outcome of adult intensive care patients.

Five hundred fifty-eight patients admitted to a general/medical surgical intensive care unit were studied 2 years after hospital discharge to determine whether they were still alive, were able to perform daily activities, and had returned to work. The overall 2-year survivorship (hospital and long-term) was 63.5%.