Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study.

Objective: To assess the potential impact of controlling risk factors on the incidence of venous thromboembolism by estimating the population attributable risk (defined as the percentage of all cases of a disease in a population that can be "attributed" to a risk factor) for deep vein thrombosis and pulmonary embolism associated with venous thromboembolism risk factors.

Methods: Using data from a population-based, nested, case-control study of the 625 Olmsted County, Minnesota, residents with a definite first lifetime deep vein thrombosis or pulmonary embolism diagnosed during the 15-year period 1976 to 1990 and 625 unaffected Olmsted County residents matched for age and sex, we developed a conditional logistic regression model appropriate to the matched case-control study design and then estimated attributable risk for the risk factors individually and collectively.

Results: Fifty-nine percent of the cases of venous thromboembolism in the community could be attributed to institutionalization (current or recent hospitalization or nursing home residence).

Patient perspectives on the doctor of the future.

Background And Objectives: Health care reform has been the subject of considerable debate, particularly among those in politics, insurance, and business. Patients, however, have largely been ignored in this discussion. As the role of the health care consumer receives increased attention, it is important to consider patient values and preferences for a future system of care.

An English-language clinic-based literacy program is effective for a multilingual population.

Objective: To assess the effectiveness of a clinic-based pediatric literacy intervention on a multilingual population.

Background: Clinic-based literacy interventions are effective among English- and Spanish-speaking children. No data exist for multilingual populations.

A sociocultural stress and coping model for mental health outcomes among African American caregivers in Southern California.

A sociocultural stress and coping model to explain emotional distress among caregivers of family members who have dementia across ethnic and cultural groups is presented and explored in a sample of 41 African American and 128 non-African American caregivers. In this sample, African American caregivers reported lower levels of burden but equal levels of depression and anxiety. In the structural equation model, previous reports that African Americans' lower appraisal of caregiving as burdensome resulted in lower levels of emotional distress were confirmed.

The prevalence and pattern of complementary and alternative medicine use in individuals with diabetes.

Objective: This study compared the prevalence and pattern of use of complementary and alternative medicine (CAM) in individuals with and without diabetes and identified factors associated with CAM use.

Research Design And Methods: The 1996 Medical Expenditure Panel Survey, a nationally representative sample of the U.S.

Reciprocity in parent-child relations over the adult life course.

Objectives: This research assessed how parents' transfers of sentiment, time, and financial assets to their adolescent/young adult children affect the children's propensity in middle age to provide social support to their aging parents. We tested whether the mechanism of long-term intergenerational exchange is better modeled as a return on investment, an insurance policy triggered by the longevity or physical frailty of parents, or the result of altruistic (or other nonreciprocal) motivations on the part of adult children.

Methods: Models were examined with 6 waves of data from the University of Southern California Longitudinal Study of Generations.

Incidence of venous thromboembolism in hospitalized patients vs community residents.

Objective: To estimate the incidence rates of deep venous thrombosis (DVT) and pulmonary embolism (PE) in hospitalized patients and to compare these with incidence rates in community residents.

Patients And Methods: We performed a retrospective review of the complete medical records from a population-based inception cohort of patients who resided in Olmsted County, Minnesota, and had an incident DVT or PE from 1980 through 1990.

Results: From 1980 through 1990, 911 Olmsted County residents experienced their first lifetime event of definite, probable, or possible venous thromboembolism.

Does engagement with life enhance survival of elderly people in Sweden? The role of social and leisure activities.

Objectives: This research examined whether engagement with life, defined as involvement in social, leisure, and productive activities, produced a survival advantage among oldest old persons in Sweden. Survival was investigated with respect to activities that involved (a) social integration, (b) physical mobility, and (c) neither social nor physical aspects. The authors also investigated the degree to which any observed survival benefits were related to prior health differences that select older adults into active roles.

Palpable breast cancers are inherently different from nonpalpable breast cancers.

Background: We examined the clinicopathologic profile of T1 cancers to determine whether palpable cancers are different from nonpalpable cancers.

Methods: A prospective database was reviewed. Palpable T1 cancers were compared with nonpalpable T1 cancers.

Hospital admissions, length of stay, charges, and in-hospital death among patients with systemic sclerosis.

Objective: To investigate population hospitalization rates to community hospitals for systemic sclerosis (SSc, scleroderma) and examine whether age, sex, race, and insurance status independently predict length of stay (LOS), hospital charges, and in-hospital death.

Methods: The 1995 Healthcare Cost and Utilization Project national inpatient sample was used to identify 3,621 SSc hospitalizations. Weighted age, sex, and race-specific frequencies were divided by population estimates to calculate hospitalizations per million people.

A prospective cohort study of practice guidelines in inflammatory bowel disease.

Objectives: Practice guidelines should improve care, but they are not routinely followed, in part because of lack of proven benefit. We evaluated the effect of introducing guidelines for inflammatory bowel disease (IBD) on practice variation and the IBD Quality of Life (IBDQ) score.

Methods: This was a prospective, controlled, cohort study.

Clinical identification of compensatory structures on projective tests: a self psychological approach.

In this article I discuss compensatory structure, a concept from Kohut's (1971, 1977) psychology of the self that is not as familiar as Kohut's other views about the self. Compensatory structures are attempts to repair selfobject failure, usually by strengthening idealization or twinship in the face of mirroring deficits. Compensatory structures, particularly their early indications, can be detected on projective tests for identifying adaptive resources and treatment potential.

School attendance and school performance: a population-based study of children with asthma.

Objective: To analyze school attendance and school achievement as outcomes of the care of children with asthma.

Methods: A previously identified Rochester, Minnesota, cohort of children with asthma and age- and sex-matched children without asthma were studied. School attendance, standardized achievement test scores, grade point average, grade promotion, and class rank of graduating students for children with asthma and control subjects were obtained from the Rochester Public School system.

The epidemiology of venous thromboembolism in the community.

The incidence of venous thromboembolism exceeds 1 per 1000; over 200,000 new cases occur in the United States annually. Of these, 30% die within 30 days; one-fifth suffer sudden death due to pulmonary embolism. Despite improved prophylaxis, the incidence of venous thromboembolism has been constant since 1980.

Predicting axillary nodal positivity in 2282 patients with breast carcinoma.

Axillary lymph node status continues to be the single most important prognostic variable for breast cancer survival despite significant progress in the molecular and genetic characterization of breast malignancies. All patients with invasive breast cancer who underwent axillary lymph node dissection as part of their treatment were evaluated by 11 clinical and pathologic factors, including the primary lesion's T category (TNM staging system), whether the lesion was clinically palpable, the presence of lymphatic or vascular invasion, nuclear grade, estrogen and progesterone receptors, S-phase, age, HER2/neu overexpression, histology (infiltrating lobular or ductal), and ploidy. A total of 2282 axillary dissections were performed: 391 in patients with ductal carcinoma in situ (DCIS) [3 of which (0.

The management of ductal carcinoma in situ of the breast.

Ductal carcinoma in situ (DCIS) of the breast is a heterogeneous group of lesions with diverse malignant potential. It is the most rapidly growing subgroup within the breast cancer family with more than 42 000 new cases diagnosed in the United States during 2000. Most new cases are nonpalpable and are discovered mammographically.

Trends in the incidence of venous stasis syndrome and venous ulcer: a 25-year population-based study.

Background: The incidence rates of venous stasis syndrome and venous ulcer are uncertain, and trends in incidence are unknown.

Methods: We performed a retrospective review of the complete (inpatient and outpatient) medical records of a community population (Olmsted County, Minnesota) to estimate the incidence of venous stasis syndrome and venous ulcer during the 25-year period, 1966 to 1990, and to describe trends in incidence.

Results: A total of 1131 patients received a first lifetime diagnosis of venous stasis syndrome.

Fluoroscopically guided Norplant removal.

The Norplant contraceptive implant system is a commonly used method of contraception worldwide. Implant placement and removal are usually simple office-based outpatient procedures. Norplant removal can occasionally become difficult, usually secondary to improper insertion.

Breast cancer after augmentation mammoplasty.

Background: It is thought that implants interfere with breast cancer diagnosis and that cancers in women who have had breast augmentation carry a worse prognosis.

Methods: A prospective breast cancer database was reviewed, comparing augmented and nonaugmented patients for details of histology, palpability, tumor size, nodal status, mammographic status, receptor status, nuclear grade, stage, and outcome.

Results: Ninety-nine cancers in augmented women and 2857 cancers in nonaugmented women were identified.

Predicted impact of attaining smoking reduction goals on mortality.

The impact of reducing smoking initiation, increasing smoking cessation, and combination approaches on life expectancy, deaths averted, and life-years gained in a birth cohort of 50,000 persons and in the state population (3.6 million) were analyzed. A 60% reduction in initiation of smoking in adolescents would increase life expectancy by 0.