Medical History Variables Research Articles

The Fibroid Registry for Outcomes Data (FIBROID) for Uterine Embolization: Short-Term Outcomes

The Fibroid Registry for Outcomes Data (FIBROID) was founded in 1999 to serve as a prospective multicenter database of women undergoing uterine embolization for leiomyomata. This paper presents an analysis of the short-term outcomes of patients enrolled at 72 participating sites. Of a total 3005 patients, 2729 had a 30-day follow-up interview, which provided information on any further medical care, adverse events, time to return to work, and time to return to normal activities. The Registry defined an adverse event as an unexpected problem that required an unanticipated clinic visit or unanticipated therapy. Seventy-four percent of all patients received preprocedure antibiotics and one fourth was also given antibiotics postprocedure. Uterine embolizations were generally carried out under intravenous conscious sedation and supplemented with narcotics, two thirds of which were patient-controlled. In one participating center, regional analgesia was used in 12% of cases. Overall, 5% of patients had postprocedure deep vein thrombosis (DVT) prophylaxis with automated intermittent compression boots. Seventy-four percent of procedures were technically successful. Technical failures occurred when only one uterine artery could be identified for embolization or when bilateral uterine artery catheterization was unsuccessful. The average hospital stay was 1.68 days. During hospitalization, 90 patients experienced 94 adverse events, of which 20 were major. Eleven of these prolonged the hospital stay. Pain and nausea were the most common conditions, but one patient had a femoral nerve injury, which resulted in permanent leg pain. Other problems included drug reaction, urinary retention, and contrast reaction. Of 74 minor complications, groin hematomas were the most common (n = 22). Other minor complications included less severe nausea, pain, vessel injury, drug reaction, urinary retention, and contrast reaction, as well as device-related problems and nontarget embolization. Patients generally resumed normal activities after 2 weeks. Major and minor adverse events were combined for univariate analysis. Possible predictors for perioperative complications, including patient demographic variables, medical history variables, presenting signs and symptoms, medications used, procedure-related variables, and site-related variables, were included. Only length of procedure, site status (ie, core registry sites vs participating sites), and size of leiomyomata were found to have predictive value for operative complications (odds ratio [OR], 1.012; 95% confidence interval [CI], 1.005-1.019; OR, 0.334; 95% CI, 0.15-0.76; OR, 1.0173; 95% Cl, 1.0131-0138; respectively). After multivariate analysis, site status was no longer predictive of perioperative adverse advents. By the 1-month postprocedure evaluation, 710 patients had reported adverse events. Major complications (n = 111; 4%) were persistent bleeding in 7 patients, infection or possible infection in 17, new hot flashes in 2, thromboembolism in 4, recurrent pain in 65, sloughing or passing leiomyomata in 19, and spinal headache in one patient. Twenty additional patients had unspecified adverse events. Six hundred ten women had minor postprocedure complications, which included less severe experiences of these symptoms. Pain, new hot flushes, and sloughing were the most common (n = 264, 156, and 123, respectively). One patient had a repeat uterine embolization after an initial failure. Another 31 patients required surgical intervention, including 3 hysterectomies, for resolution of postprocedure complications. Dilatation and curettage and hysteroscopy were the most common procedures for sloughing leiomyomata or passing leiomyomata tissue. History of therapy for leiomyomata, race listed as black, history of current or recent smoking, and comorbidity were predictive of complications in the 30 days postprocedure on univariate analysis.

Trial of Remote Telemedicine Support for Patients with Chronic Respiratory Failure at Home through a Multistation Communication System

To create and test a multistation telemedicine support system, three remote locations were connected: the homes of two patients with chronic respiratory failure, the hospital of the attending physician, and the hospital of the pulmonary specialist. Real-time connections were set up between the three locations. Medical history and biologic variables were noninvasively recorded, including blood pressure, arterial oxygen saturation, three-lead electrocardiogram, and end-tidal carbon dioxide. Both physicians shared in these data real-time. If necessary, the respiratory specialist could provide medical advice to the attending physician based on the patient's condition. The trial program resulted in the same information being exchanged remotely using the multi-station telemedicine system that would be exchanged in a direct, face-to-face encounter. This result, together with the improvement in quality of life and the establishment of appropriate treatment and cooperation between the respiratory specialist and attending physician, suggests our system can be considered useful and promising for further use.

Parkinson disease

To determine the proportion of individuals in a clinic-based setting that present with asymmetric Parkinson disease (PD) and identify predictive factors associated with asymmetric symptoms. The authors examined right vs left difference scores on the Unified Parkinson Disease Rating Scale motor subscale in a consecutive clinical series of 1,277 individuals diagnosed with PD. Predictors of asymmetry included sex, symptomatic disease duration, age at onset, initial motor symptom laterality, handedness, and medical history variables (e.g., family history of PD). Nearly half the sample (46%) met criteria for asymmetric disease based on a right vs left difference score of > or =5 points, and 12% of the sample had a difference score of > or =10 (difference score: mean = 4, SD = 3.4). All three cardinal features of PD showed characteristics of asymmetric disease presentation. Multiple regression analyses showed that an increased discrepancy between right- and left-sided symptoms was significantly associated with a shorter disease duration, younger age at symptomatic onset, asymmetric initial symptom onset, hand dominance, and a positive self-reported family history of "other" neurodegenerative disorder. Hand dominance was related to the side of asymmetric disease such that left-handed individuals tended to have more severe disease on the left side of the body. Asymmetric presentation of Parkinson disease features was a common occurrence in the clinical cohort. Asymmetry was reliably predicted by several clinical characteristics, although the moderate level of explained variance (i.e., between 16 and 23%) highlighted the need for additional research examining predictive models of asymmetric disease. Recommendations for the classification and measurement of asymmetric disease are discussed.

A Prediction Rule to Identify Low-risk Patients with Heart Failure

To derive a prediction rule using data available in the emergency department (ED) to identify a group of patients hospitalized for the treatment of heart failure who are at low risk of death and serious complications. The authors analyzed data for all 33,533 patients with a primary hospital discharge diagnosis of heart failure in 1999 who were admitted from EDs in Pennsylvania. Candidate predictors were demographic and medical history variables and the most abnormal examination or diagnostic test values measured in the ED (vital signs only) or on the first day of hospitalization. The authors constructed classification trees to identify a subgroup of patients with an observed rate of death or serious medical complications before discharge < 2%; the tree that identified the subgroup with the lowest rate of this outcome and an inpatient mortality rate < 1% was chosen. Within the entire cohort, 4.5% of patients died and 6.8% survived to hospital discharge after experiencing a serious medical complication. The prediction rule used 21 prognostic factors to classify 17.2% of patients as low risk; 19 (0.3%) died and 59 (1.0%) survived to hospital discharge after experiencing a serious medical complication. This clinical prediction rule identified a group of patients hospitalized from the ED for the treatment of heart failure who were at low risk of adverse inpatient outcomes. Model performance needs to be examined in a cohort of patients with an ED diagnosis of heart failure and treated as outpatients or hospitalized.

Epidemiology of cardiovascular risk in Chinese chronic kidney disease patients

To identify the risk factors associated with cardiovascular disease (CVD) in Chinese chronic kidney disease (CKD) patients. As part of a multicenter Chinese cohort study, the clinical data associated with CVD of 1239 patients with CKD (stage 2 - 5) hospitalized in 7 grade 3A hospitals distributed in 5 regions of China 2002 - 2003 were collected. Logistic regression model was used to analyze the association between CVD and the demographic variables, lifestyle, medical history, medication, physical examination, and laboratory variables. (1) Increase of serum C-reactive protein (CRP, cut off > 10 mg/L) was an independent risk factor for development of coronary artery disease (CAD) (OR 2.13; 95% confidence interval [CI], 1.32 - 3.43). 21.5% of the patients in this group showed a value of CRP > 10 mg/L. (2) Being female, anemia, and systolic hypertension were the major determinants of the development of left ventricular hypertrophy (OR 2.99, CI 2.09 - 4.26; OR 2.66, CI 1.19 - 3.57; and OR 1.02, CI 1.00 to -1.02). 54.2% of the patients in this group had their systolic pressure controlled under 140mmHg, and only 15% of the patients in this group had their hemoglobin remain at the level >or= 110 g/L. (3) There was a significant interaction between the calcium-phosphate product and congestive heart failure (CHF) (OR 1.023, CI 1.01 - 1.03). 25.9% of the patients in this cohort had their calcium-phosphate product >or= 55. (4) Hypoalbuminemia (OR 6.01, CI 1.25 - 28.96) and diastolic hypertension (OR 1.05, CI 1.00 - 1.09) played major role in determining cerebrovascular accidents (CVA). In these cohort the prevalence of hypoalbuminemia was 37.3%. (5) Diabetes was associated with CAD (OR 2.34), CHF (OR 1.97), and CVA (OR 4.40), although its prevalence was lower in Chinese CKD patients (20%). Age was the risk factors of CAD (OR 1.04) and CVA (OR 1.22). Hypertension was associated with LVH (OR 1.016), CHF (OR 1.02), and CVA (OR 1.04). CKD is associated with nontraditional risk factors for the development of CVD, including chronic inflammation, malnutrition and calcium-phosphate disorders. Particular care must be taken to give optimal treatment for the most important CVD risk factors active in Chinese CKD patients, e.g. anemia and hypertension.

Kinematics of the Lumbar Spine During Classic Ballet Postures

Postural characteristics and three-dimensional (3D) kinematics of the lumbar spine were examined during classic ballet gestures in 25 expert dancers (17 females, 8 males; mean age, 21 ± 4 yrs). The 3D displacements of the thorax to the pelvis were sampled with a 3D-electrogoniometer during right and left arabesque, developpe a la seconde, and pied-en-main, and a photographic technique was used to calculate lower-limb elevation, shoulder inclination, and tragus or C7 displacement. The incidence of low-back (43%) and hip pain (40%) was large. Arabesque was characterized by lumbar extension (20-25°), ipsilateral bending (˜20°), and contralateral rotation (˜10°), and a 90° angle between the thighs. During pied-enmain and developpe a la seconde, lumbar flexion (˜30°), ipsilateral bending (10–15°), and contralateral rotation (˜20°) occurred. The angle between the thighs was 150° and 120°, respectively. There was poor correlation between medical history, anthropometrical characteristics, and postural and kinematics variables, except for shoulder inclination, which differed significantly between dancers with hip or low-back problems and those without complaints. We conclude that no relationship exists between hip flexibility and the lumbar spine contribution to various ballet tasks, suggesting that lower-limb elevation during arabesque and developpe a la seconde depends more on hip flexibility than on a lumbar contribution.

Predictors of preventive health knowledge among female emergency department patients

Study objectives: A broad sample of 18- to 55-year-old women seeking treatment at a high-volume, urban emergency department (ED) were invited to participate in a study with the goals of (1) defining the extent of their knowledge on the purpose and suggested intervals of preventive health screening modalities and contraceptive and sexually transmitted disease preventive techniques relevant to women; and (2) determining whether demographic characteristics and medical history predict their knowledge on these topics. Methods: Using published surveys on women's health topics as a template, the authors created an anonymous, written, multiple-choice, self-administered, English-language survey about Papanicolaou tests, breast self-examinations, mammograms, condoms, emergency contraception, and birth control. After the instrument was pilot tested, surveys were administered to 18- to 55-year-old English-speaking women seeking treatment in our ED during 66 8-hour shifts in July and August 2002, 32 4-hour shifts in October and November 2002, and 32 4-hour shifts in April and May 2003. To reflect the patient volume patterns for the ED, each day of the week was sampled equally, and shifts were sampled so that 25% of the 7 am to 11 am shifts, 50% of the 11 am to 11 pm shifts, and 25% of the 11 pm to 7 am shifts were represented. In addition to demographic questions, the women were asked about their medical history, including use of screening modalities, contraceptive and sexually transmitted disease preventive techniques, and knowledge-based questions on the who, why, when, and how often of the screening and preventive techniques recommended use. Surveys were entered into an Epi Info 2002 database and analyzed in STATA 7. Analyses included summary statistics and constructing multivariable logistic regression models to predict correct responses to the knowledge-based questions by using demographic characteristics and medical history variables as potential predictors. Results: Of 1,203 women approached to participate in the survey, 1,101 spoke English, and 780 (70.8%) of these agreed to complete all or part of the questionnaire. The majority of respondents were white, single, Catholic, and without health insurance. Most (62%) of the women in the sample were younger than 35 years ( P P Conclusion: Although women in this age group demonstrated strong knowledge on some preventive health topics, there were clear areas of knowledge deficit, particularly about mammograms and emergency contraception. Younger, nonwhite women without private insurance appear less likely to understand the purpose of and recommended intervals for preventive health screening modalities and contraceptive and sexually transmitted disease preventive techniques. During interaction with these subgroups, emergency physicians should be mindful of potential misunderstandings on these topics and address them accordingly.

Gender disparities in common sense models of illness among myocardial infarction victims.

Symptom attributions were contrasted between male and female myocardial infarction victims (N = 157) who were comparable on age, cardiac risk status, medical history, symptom presentation, and other variables. Women were less likely than men to attribute their prehospital symptoms to cardiac causes. In the context of hearing symptom attributions or advice from support persons, women were less likely than men to report receiving a cardiac attribution or advice to seek medical attention. Results have implications for how victim gender influences the lay interpretation of cardiac symptoms.

Prevalence of estrogen or estrogen–progestin hormone therapy use

Objective To use nationally representative data to produce prevalence estimates of combination estrogen–progestin therapy and estrogen-only therapy by covariates, and to evaluate differences between current use of short duration (less than 5 years) and current long-term use. Methods We analyzed data from female respondents 40 years of age and older ( n = 9400) who were interviewed in the 1999 National Health Interview Survey. Hormone therapy use was categorized into four types: current estrogen–progestin therapy use, current estrogen-only therapy use, former hormone therapy use, and never use. We calculated the prevalence of hormone therapy by different levels of previously identified covariates of hormone therapy, as well as overall prevalence of hormone therapy use by length of use. Results Approximately 24% of women aged 40 years or older were current hormone users. Of these, 30% were taking estrogen–progestin therapy, and 70% were taking estrogen-only therapy. The prevalence of hormone use differed dramatically by hysterectomy status and age, and less so by many demographic, health-risk behavior, medical access, and medical history variables. Among women with no hysterectomy, the associations with many of the covariates were stronger for estrogen–progestin therapy use than for estrogen-only therapy use. Only 3% of women were estimated to be current estrogen–progestin therapy users for 5 or more years, whereas 10% were current estrogen-only therapy users for 5 or more years. Conclusion Although many women at midlife and older were current hormone users, very few were long-term users of estrogen–progestin therapy.

Using a Rasch scale to characterize the clinical features of patients with a clinical diagnosis of uncertain, probable, or possible Alzheimer disease at intake.

This study examined the clinical features of patients with clinical diagnoses of probable Alzheimer disease (AD), possible AD, and uncertain. Case study comparing three groups of AD patients diagnosed at their initial visit to an Alzheimer outpatient clinic. Southern Illinois University School of Medicine's Center for Alzheimer Disease and Related Disorders (CADRD) assessment sites (20) in rural Illinois. 300 patients assessed at CADRD between January 1, 1994 and July 1, 2000. Patients were given an extensive clinical battery consisting of physical and neurologic examination, mental status testing including the Mini-Mental State Exam (MMSE), Short Blessed Dementia (SBD) and Blessed Dementia Scale (ADL), medical history evaluation, and laboratory tests. Other data included age at visit, gender, and medical history variables. Mean MMSE, SBD, and ADL scores differed significantly between groups (p's < 0.01). In all three cognitive tests, the uncertain group was the least impaired while the probable AD group was the most impaired. A Rasch model indicated that only the cognitive measures were useful in discriminating between the three diagnostic groups. In general, probable AD patients were distinguished from possible AD patients by the severity of their dementia as measured by the MMSE, ADL and SBD as well as Hachinski-Ischemic Score (HIS) scores. A Rasch model did well at predicting group membership based upon dementia measures only. The uncertain group differed from the AD groups in age and dementia severity as measured by the MMSE, ADL and SBD. Noting differences between this and previous studies, we speculate disparity may be related to differences in population ethnicity.

Classification of shoulder complaints in general practice by means of nonmetric multidimensional scaling

Groenier KH, Winters JC, Meyboom de Jong B. Classification of shoulder complaints in general practice by means of nonmetric multidimensional scaling. Objectives: To determine if a classification of shoulder complaints in general practice can be made from variables of medical history and physical examination with nonmetric multidimensional scaling and to investigate the reproducibility of results from an earlier hierarchical cluster analysis. Design: A classification study performed using nonmetric multidimensional scaling. Setting: Four general practices in the Netherlands. Participants: Ninety-eight consecutive patients presenting with shoulder complaints in general practice were examined at study entry and after 2 weeks of treatment. Intervention: All patients were treated with a nonsteroidal anti-inflammatory drug during the first 2 weeks of treatment. Main Outcome Measures: Eleven variables of the medical history and 19 variables of the physical examination were used in a nonmetric multidimensional scaling analysis. Results: The analysis of the data at inclusion as well after 2 weeks shows that a 1-dimensional configuration can be used to represent the shoulder complaints. The results of the cluster analysis are consistent with the results of the nonmetric multidimensional scaling. The degree of limitation in range of motion and the degree of pain felt by the patients together determine the position of the patients on the dimension. Conclusions: The analysis shows that detailed classifications for the diagnosis of patients with shoulder complaints in general practice cannot be confirmed by empirical data available to the general practitioner. The results confirmed the recommendations of the new Dutch Guidelines for Shoulder Complaints, issued in 1999.

Prognostic factors for the vascular components of erectile dysfunction in patients on renal replacement therapy.

A total of 76 male patients on renal replacement therapy (RRT) were investigated. Erectile dysfunction (ED) was defined as insufficient erection during visual erotic stimulation (VES) or during sleep as measured with Rigiscan and Erectiometer. Data on medical history, physical examination, and laboratory variables were collected. Furthermore, penile pharmacological duplex ultrasonography (PPDU) was performed. Univariate and multivariate logistic regressions were used to determine prognostic values and to develop prognostic models. Independent prognostic factors for ED were the number of cardiovascular events, waist-hip ratio, body mass index, and acceleration time (AT) as measured with PPDU. Independent prognostic factors for an abnormal AT (>100 ms) were number of cardiovascular events, age category, and the presence of carotid bruits. Independent prognostic factors for insufficient veno-occlusion during PPDU were number of cardiovascular events and supine diastolic blood pressure. The vascular contribution to ED in patients on RRT is substantial. Data from medical history, limited physical examination, and PPDU contribute to the prediction of the vascular contribution to ED.

A review of diagnostic techniques in the differential diagnosis of epileptic and nonepileptic seizures.

The diagnosis of psychogenic nonepileptic seizures (PNES) is complex. Long-term electroencephalogram monitoring with video recording (video EEG) is the most common method of differential diagnosis of epilepsy and PNES. However, video EEG is complex, costly, and unavailable in some areas. Thus, alternative diagnostic techniques have been studied in the search for a diagnostic method that is as accurate as video EEG, but more cost effective, convenient, and readily available. This paper reviews the literature regarding possible diagnostic alternatives and organizes findings into 7 areas of study: demographic and medical history variables, seizure semiology, provocative testing, prolactin levels, single photon emission computed tomography, psychological testing, and neuropsychological testing. For each area, the literature is summarized, and conclusions about the accuracy of the technique as a diagnostic tool are drawn. Overall, it appears unlikely that any of the reviewed alternative techniques will replace video EEG monitoring; rather they may be more successful as complementary diagnostic tools. An important focus for further investigations involves combinations of diagnostic techniques for the differential diagnosis of epilepsy and PNES.

Recreational drug use: A neglected risk factor for end-stage renal disease

Case series have suggested that heroin and cocaine users are at increased risk for renal failure, but the contribution of heroin and other addictive drugs to the incidence of end-stage renal disease (ESRD) in the general population remains unknown. To clarify this issue, we conducted a case-control study in the general population to examine associations between drug use and treated ESRD. Cases were 716 patients who started therapy for ESRD in 1991, identified through a regional registry. Controls were 361 persons of similar age (20 to 65 years) selected by random digit dialing. Main risk factors examined were the lifetime use of heroin, cocaine, and other addictive drugs, assessed by telephone interview. After adjustment for age, sex, race, socioeconomic status, and history of hypertension and diabetes, persons who had ever used heroin or other opiates (any amount) were at increased risk for ESRD (adjusted odds ratio, 19.1; 95% confidence interval, 1.7 to 208.7). After adjustment for the same sociodemographic and medical history variables, the use of cocaine or crack and psychedelic drugs was also associated with ESRD, but these associations could not be separated from the effects of heroin use. © 2001 by the National Kidney Foundation, Inc.

Sleep and behavior problems in school-aged children.

The primary purposes of the present study were to survey the prevalence of sleep problems in school-aged children and to examine these associations with parental perception of sleep problems, medical history, and childhood psychopathology. Sleep and medical history questionnaires and the Child Behavior Checklist were administered to the parents of 472 children between ages 4 and 12 years receiving routine pediatric care from urban, rural, and suburban pediatric practices. Although sleep problems were reported for 10.8% of the sample during the past 6 months, less than one half of the parents who identified sleep problems reported that they had discussed sleep with their child's pediatrician. The best predictor of current sleep problems was a history of sleep problems before age 2 years. Sleep problems such as snoring, tiredness during the day, and taking excessive time to fall asleep were very common, occurring at least 1 night per week in over 20% of the total sample. Factor analysis of the sleep problems questionnaire resulted in 5 sleep problem factors that accounted for 58.7% of the variance. Specific sleep problem factors include: parasomnias, enuresis/gags, tiredness, noisy sleep, and insomnia. Sleep problem factor scores were differentially associated with medical history variables and measures of childhood psychopathology. Children rated highly on parasomnias were more likely to have frequent falls and to display pica. Parasomnias and noisy sleep were inversely associated with socioeconomic status (SES). Children from lower SES families were rated higher on these factors than children from higher SES families. Enuresis/gags was the only sleep problem factor associated with age. Younger children scored higher on this factor. Duration of naps was highly correlated with age and with bed times during the week and weekends. As expected, younger children were more likely to nap for longer periods and to have earlier bed times. In addition, higher tiredness factor scores were associated with napping and with later bed times during the week and weekend. Boys were much more likely than were girls to have higher scores on enuresis/gags, and higher enuresis/gags scores were associated with an increased prevalence of trauma and falls. Bed times were not associated with any other sleep problem factor score. Children rated highly on tiredness were more likely to have a history of hospitalizations. Tiredness factor scores were strongly associated with the sleep practice of sharing a bed but not with sharing a room. Sharing a room was not associated with any sleep problem factor score. High scores on noisy sleep were associated with allergies, falls frequently, and with sharing a bed. Children with high scores on the insomnias were also more likely to display an increased prevalence of allergies. Parental perception of global sleep problems was surprisingly common in school-aged children receiving routine pediatric care. Parental reports of their children's sleep problems may be a red flag for specific sleep problems and psychiatric, social, or medical problems. Sleep problems should be queried about during pediatric visits for school-aged children.

Cognitive Changes 5 Years After Coronary Artery Bypass Grafting

To determine the long-term (preoperative to 5 years postoperative) and late (1-5 years postoperative) changes in cognitive test performance in patients after coronary artery bypass grafting. The departments of surgery and neurology at The Johns Hopkins University School of Medicine, Baltimore, Md. A group of 102 patients who completed preoperative and follow-up cognitive testing up to 5 years after coronary artery bypass grafting. A battery of neuropsychological tests, assessing 8 cognitive domains (attention, language, verbal and visual memory, visuoconstruction, executive function, and psychomotor and motor speed), was administered preoperatively and at 1 month, 1 year, and 5 years postoperatively. Significant changes in neuropsychological test scores from baseline to 5 years were observed in only 3 of the 8 domains: there were declines in visuoconstruction and psychomotor speed and an improvement in executive function. When the period from baseline to 5 years was divided into 2 intervals, we found that cognitive test scores generally improved from baseline to 1 year. By contrast, between 1 and 5 years, there was significant decline in all cognitive domains except for attention and executive function. Some potential explanatory covariates (demographic, medical history, and surgery variables) were associated with changes from baseline to 5 years in some cognitive domains, but few covariates were statistically significant in more than 1 cognitive domain. The change in cognitive test performance between baseline and 5 years is likely related to several factors, including low baseline performance and practice effects. The significant decline in performance between 1 and 5 years, however, raises the possibility that a late cognitive decline may be occurring in this population. Additional studies, with the use of a nonsurgical control group, are needed to determine if the observed cognitive decline is related to bypass surgery itself, normal aging in a population with cardiovascular risk factors, or some combination of these and other factors.

Odorant confusion matrix: the influence of patient history on patterns of odorant identification and misidentification in hyposmia

The odorant confusion matrix (OCM) is an odorant identification test in which the number of correct odorant identifications quantifies the level of olfactory function. As with other confusion matrices, the OCM reflects distortions of sensory perception as errors in identification. Previous work with the OCM suggests that, within an individual, hyposmia is associated with a stable shift in odorant perception. The current study examined whether consistent shifts in odorant perception are also characteristic of the various pathologies that lead to an olfactory loss. In a retrospective study, OCM response patterns for 135 hyposmic patients were fit into a five-dimensional space in which the distances between subjects reflected the dissimilarities between their OCM response patterns. Multivariate regression was performed relating position in the five-dimensional space to each of 11 factors representing 33 demographic and medical history variables. One factor, named congestion (gathering the variables of past polyposis, current polyposis, and current nasal obstruction due to swelling), was significantly indicative of patterns of responses on the OCM, independent of the level of hyposmia. These data suggest that conductive olfactory loss may be associated with alterations in odorant perception, which are reflected in consistent odorant confusions. Such alterations in perception may eventually serve as a basis for a clinical test to provide differential diagnoses as to the sources of olfactory losses.

Predictors of Post-Hospital Employment Status for Psychiatric Patients in Hong Kong: From Perceptions of Rehabilitation Professionals To Empirical Evidence

Fifty participants with mental illness and a concrete discharge plan were selected from two mental hospitals in Hong Kong and assessed on their Psychosocial support by the Chinese Version of the Significant Others Scale, social vocational competence using the Workshop Behavior Checklist and the Vocational Social Skills Scale, medical history, work history, and demographic variables. At three months after discharge, the employed participants (n = 12) were shown to have better psychosocial support and social vocational competence than the unemployed participants (n = 24) by univariate comparison. The employed and unemployed participants did not differ in their medical and work history, and demographic variables. Implications of the results for rehabilitation programming are discussed.

Estrogen replacement therapy among elderly women: results from the 1995 medicare current beneficiary survey

Research Objectives: To develop population-based estimates of estrogen replacement therapy use rates in 1995 among women over age 65 living in the community; to estimate the impact of socioeconomic and health characteristics on estrogen use. Method: Estimates are based on a large, nationally representative sample of Medicare beneficiaries; detailed self-report data were merged with Medicare claims. Results: Overall, 13.1% of women reported use of estrogen replacement therapy in 1995. Estrogen users were more likely to be white, age 65–74, with private insurance, high income, history of osteoporosis and heart problems, no history of breast cancer, and a patient of gynecologists. Conclusions: Estrogen use was substantially lower among the socioeconomically disadvantaged, controlling for medical history variables, suggesting considerable inequity in access to estrogen replacement therapy treatment.

Vertebral Fractures and Mortality in Older Women

Osteoporotic fractures, including clinically detected vertebral fractures, are associated with increased mortality. However, only one third of vertebral fractures are diagnosed. It is unknown whether vertebral fractures, whether clinically apparent or not, are associated with greater mortality. To test the hypothesis that women with prevalent vertebral fractures have greater mortality than those without fractures and to describe causes of death associated with vertebral fractures. Prospective cohort study with mean follow-up of 8.3 years. Four clinical centers in the United States. A total of 9575 women aged 65 years or older and enrolled in the Study of Osteoporotic Fractures. Vertebral fractures by radiographic morphometry; calcaneal bone mineral density; demographic, medical history, and lifestyle variables; blood pressure; and anthropometric measures. In a subset of 606 participants, thoracic curvature was measured during a second clinic visit. Hazard ratios for mortality and cause-specific mortality. At baseline, 1915 women (20.0%) were diagnosed as having vertebral fractures. Compared with women who did not have a vertebral fracture, women with 1 or more fractures had a 1.23-fold greater age-adjusted mortality rate (95% confidence interval, 1.10-1.37). Mortality rose with greater numbers of vertebral fractures, from 19 per 1000 woman-years in women with no fractures to 44 per 1000 woman-years in those with 5 or more fractures (P for trend, <.001). In particular, vertebral fractures were related to the risk of subsequent cancer (hazard ratio, 1.4;95% confidence interval, 1.1-1.7) and pulmonary death (hazard ratio, 2.1;95% confidence interval, 1.4-3.0). In the subset of women who underwent thoracic curvature measurements, severe kyphosis was also related to pulmonary deaths (hazard ratio, 2.6;95% confidence interval, 1.3-5.1). Women with radiographic evidence of vertebral fractures have an increased mortality rate, particularly from pulmonary disease and cancer.