Predictive Effect Of Age Research Articles

The leading role of personality in concerns about autonomous vehicles.

Development of autonomous vehicles (AVs) is growing in a rapid rate, however, the most dominant barriers in their adoption seem to be rather psychological than technical. The present online survey study aimed to investigate which demographical and personality dimensions predict attitudes towards AVs on a Hungarian sample (N = 328). Data was collected by convenience and snowball sampling. Three-level hierarchical regression models were applied: in the first level, demographical variables, then general personality traits and third, attitude-like personality factors were entered. We demonstrated that the predictive effect of age, gender and education disappeared when personality dimensions were included into the models. Importantly, more positive general attitudes towards technology and higher optimism regarding innovations predicted eagerness to adopt AVs. On the other hand, individuals with more negative attitudes and higher dependence on technology as well as those with lower level of Sensory Sensation Seeking and higher level of Conscientiousness were more concerned about AVs. Our results suggest that AV acceptance cannot be regarded as a one-dimensional construct and that certain personality traits might be stronger predictors of AV acceptance than demographical factors.

ESTIMATION OF THE PREDICTIVE EFFECT OF BODY MASS INDEX-PERCENTILE ON SKELETAL MATURATION IN A NIGERIAN POPULATION.

Objectives: To determine the predicting the effect of BMI-index percentile on the skeletal maturation of Nigerian children. 
 Design: A prospective cross-sectional study.
 Setting: This study was conducted in a tertiary health care facility in North-Central Nigeria.
 Participants: Children between the ages of 5-17 years consisting of 44 males and 30 females that presented in the Child Dental clinic over a period of eight months were recruited for the study.
 Main outcome measured: Skeletal maturation was assessed using the middle phalanx of the third finger (MP3) while the standard WHO growth chart specific for age (2-20 years) and gender was used for grading BMI-percentile. The unpaired t-test was used to compare mean chronological age of the stages of MP3 according to gender. Multinomial logistic regression used to determine the predictive effect of age, gender and BMI percentile on pubertal growth spurt.
 Results: The BMI-percentile had weak correlation with the pubertal growth spurt (r=0.089, p=0.448). Gender (p=0.004) and chronological age had significant (p<0.001) predictive effect on the skeletal maturation. A one-percentile increase in the BMI-percentile decreases the likelihood of healthy children to be in the peak-pubertal by 1.504 when compared to obese children (p=0.305). 
 Conclusions: This study showed that BMI-percentile is a weak predictor of skeletal maturation. However, obese children had a tendency towards advanced skeletal maturation than healthy participants. It is therefore suggested that orthodontists should consider early implementation of jaw modification treatments among obese children.

The role of resilience and student-teacher relationship in affecting the parent-child separation-PTSS among left-behind children in China

Despite the large body of research on Post-traumatic Stress Disorder symptoms (PTSS) caused by “part forever”, such as catastrophic events (e.g., earthquake), relatively few studies focus exclusively on PTSS caused by “living with separation” among the rural left-behind children in China. To investigate the relationship between resilience, student–teacher relationship, and parent–child separation-PTSS (PCS-PTSS), 271 rural left-behind children in Anhui province of China were recruited to participate in the current study. A longitudinal tracking study collected data on resilience, student–teacher relationship, and PCS-PTSS at two-time points. Multilevel linear regression analysis showed that age and resilience significantly negatively predict the PCS-PTSS marginally after controlling for gender, and the regression slope of age on PCS-PTSS was moderated considerably by the student–teacher relationship, which indicates the student–teacher relationship can weaken the predictive effect of age on PCS-PTSS. Additionally, the student–teacher relationship did not moderate the regression slope of resilience on parent–child separation PTSS. The present study mainly sheds light on the role of resilience and the student–teacher relationship to PCS-PTSS. The theoretical and practical implications, as well as the limitations of the current study, are discussed.

Exploring Hepatocellular Carcinoma Mortality Using Weighted Regression Estimation for the Cohort Effect in Taiwan from 1976 to 2015.

To estimate the cohort effects that remove the efficacy of age and the period in the age-period statistics of a contingency table, the multiphase method is put forward. Hepatocellular carcinoma (HCC) is one of the most common malignancies of the liver. Understanding the predictive effects of age, period, and cohort on HCC mortality trends may help to estimate the future HCC burden, identify etiological factors, and advise public health prevention programs. Estimates of future HCC mortality and the associated health burden were forecast using an age–period–cohort (APC) model of analysis. By running a regression of residuals that were isolated from the median polish stage of cohort classification, the study controlled for HCC mortality confounding variables and interpreted time trends in HCC rates. The literature shows that the weighted mean estimation derived from the confidence interval (CI) is relatively restricted (compared to the equal-weighted evaluation). This study aimed to illustrate the effects of age, period, and cohort on the incidence and mortality rates, along with the weight equivalent to the segment of death number caused by HCC in each cohort. The objective of that work was to evaluate the proposed method for appraising cohort effects within the age-period data of contingency tables. The weighted mean estimate from the regression model was found to be robust and thus warrants consideration in forecasting future HCC mortality trends. The final phase was factored in to calculate the magnitude of cohort effects. In conclusion, owing to the relatively constricted CI and small degree of uncertainty, the weighted mean estimates can be used for projections based on simple linear extrapolation.

Efficacy of anti-epidermal growth factor receptor agents in patients with RAS wild-type metastatic colorectal cancer ≥ 70 years

PurposeColorectal cancer (CRC) affects many older adults. We investigated the efficacy and safety of adding anti-epidermal growth factor receptor (EGFR) agents to doublet chemotherapy (DC) in older patients. MethodsPatients with RAS wild-type (WT) metastatic CRC (mCRC) receiving first-line DC + anti-EGFR (n = 1191) or DC alone (n = 729) from seven trials in the Aide de Recherche en Cancerologie Digestive database were included. The prognostic and predictive effects of age were investigated. Progression-free and overall survival (OS) were evaluated between age groups (≥70 vs <70) for DC + anti-EGFR. In addition, outcomes were compared between DC+/-anti-EGFR within age groups in three trials with a DC alone arm. Subsequently, the same analysis was conducted for left-sided tumours. Adverse events grade ≥3 (G3+) were compared between age groups. ResultsOlder (vs younger) patients receiving DC + anti-EGFR had similar progression-free survival (PFS) (8.7 vs 10.3 months; hazard ratio (HR) = 1.20 [0.96–1.49];p = 0.107) but inferior OS (21.3 vs 26.3; HR = 1.36 [1.08–1.72];p = 0.011). DC + anti-EGFR (vs DC alone) improved OS (23.9 vs 20.3; HR = 0.82 [0.70–0.95];p = 0.008) and PFS (11.2 vs 8.9; HR = 0.70 [0.60–0.82];p < 0.001) in younger but not older patients: OS (24.7 vs 17.6; HR [95% confidence interval {CI}] = 0.77 [0.58–1.04];p = 0.092) and PFS (9.1 vs 8.7; HR [95% CI] = 0.85[0.63–1.15];p = 0.287). In left-sided ‘only’ tumours, the following outcomes for older (vs younger) patients were observed. For DC + anti-EGFR, PFS 9 versus 11.2 months; HR1.10 (95% CI 0.83–1.46); p = 0.52, OS 25.6 vs 30.3 HR 1.32 (95% CI 0.97–1.79), p = 0.086. For DC + anti-EGFR (vs DC alone), PFS and OS for younger patients were 11.9 vs 9.2 months HR 0.60 (95% CI 0.47–0.78) p < 0.001 and 24.1 versus 23.3 months HR 0.84 (95% CI 0.67–1.04), respectively. For older patients, PFS and OS were 13.1 versus 8.5 months, HR 0.51 (95% CI, 0.28–0.93), P = 0.027 and 26.3 versus 16.5 months HR 0.49 (95% CI, 0.28–0.85), respectively. There was no significant difference in toxicity among different age groups. ConclusionsOlder (vs younger) patients with mCRC RAS WT patients had comparable toxicity and efficacy with the addition of anti-EGFR agents to chemotherapy.

Pre-operative predictive factors of grade II and III meningiomas

Purpose:Meningiomas are the most common primary intracranial tumors. They are graded into three pathologic grades. Surgical gross total resection is the definitive treatment of meningiomas, but follow-up or stereotactic radiosurgery is sometimes advised for asymptomatic, incidentally diagnosed meningiomas. For a decision making, pre-operative prediction of Grade II and III meningiomas which are more aggressive clinically, is important. We have reviewed our intracranial meningioma series, based on their clinical, radiological, and location, to analyze the predictive factors of Grade II and III meningiomas. Patients and Methods:The clinical, radiological, operative and pathological reports of patients who were operated for intracranial meningiomas between September 1986 and July 2019 have been reviewed retrospectively from our patient database. Their age, sex, tumor location, absence or presence of peritumoral edema, and the pathological grade of meningiomas have been noted. The predictive effect of age, sex, peritumoral edema and location of tumor is analyzed statistically for pathological grade. Results:There were 1401 patients with intracranial meningiomas, 1015 of them were female, 386 were male (female/male=2.6). Their mean age was 52.2 years. There were 1219 Grade I, 164 Grade II, and 18 Grade III meningiomas. Male sex, and non-skull base location were predictive for Grade II and III meningiomas. Conclusion:While advising conservative treatment (follow-up, or stereotactic radiosurgery) for asymptomatic, incidental meningiomas, it should be kept in mind that male sex, and/or non-skull base location are risk factors for the more aggressive Grade II and III meningiomas.

The predictive effect of internet addiction and psychiatric disorders on traditional peer bullying

Objective: Traditional peer bullying (TPB) is a worldwide problem and 20-56% of adolescents are thought to be affected. Some studies suggest that internet addiction may be related to negative behaviors such as bullying. This study aimed to determine the prevalence of TPB in the clinical psychiatric sample of adolescents and to investigate the predictive effect of age, gender, psychiatric diseases and (internet addiction) IA on roles in TPB. Methods: This cross-sectional study conducted with 214 adolescents in the age range of 12-16 years. Schedule for Affective Disor-ders and Schizophrenia for School-Age Children-Present and Lifetime Version were used for psychiatric evaluations of the participants. Olweus Bully/Victim Questionnaire (OBVQ) and Young Internet Addiction Scale were carried out to all participants. The predictive effect of age, gender, IA and psychiatric disorders on roles in TPB was evaluated by multinomial logistic regression analysis. Results: The mean age of the participants was 14.5 years. According to the results of the OBVQ, 49% of the participants were involved in TPB (victims: 35%, bullies: 14%). Regression analysis revealed that age and gender had no effect on roles in TPB, but IA had a predictive effect on both victi-mization (p

Negative predictors of shunt surgery outcome in normal pressure hydrocephalus.

The prevalence of idiopathic normal pressure hydrocephalus (iNPH) and vascular comorbidity increases with age. It has not been clarified if high age and vascular disease are negative predictors of shunt surgery outcome in patients with iNPH. The aim of this study was to investigate the impact of high age and vascular comorbidity on outcome after shunt surgery in patients with iNPH. All 332 patients with iNPH who were treated with shunts between 2011 and 2015 at a single centre were consecutively included. Hellström iNPH scale, without the neuropsychological tests, was calculated preoperatively and at follow-up 12months after shunt surgery. Outcome was defined as the difference between the post-operative and preoperative iNPH scale scores. A multivariable model was used to investigate the predictive effects of age and vascular comorbidity on shunt surgery outcome. In a multivariable analysis of covariance (ANCOVA) with post-operative outcome as the dependent variable, increasing age (years, B=-0.63, P<.001) and history of ischaemic stroke (B=-10.06, P=.0038) were negative predictors of shunt surgery outcome after controlling for waiting time for surgery, symptom severity at preoperative control, presence of diabetes mellitus, hypertension, hyperlipidaemia, history of myocardial infarction, duration of symptoms and shunt complications. High age and established cerebrovascular disease are associated with less favourable outcome after shunt surgery in patients with iNPH.

Views on aging: older adults' self-perceptions of age and of health.

Perceptions of age and perceptions of health have each been found to predict future health and well-being, yet surprisingly, studies typically focused on one or the other. Studies on perceived age suggested that its effects on longevity may be mediated by perceived health. Within each of these lines of research, the constructs have not been consistently operationalized, making it difficult to generalize across studies. We aimed to investigate the associations of different measures of perceptions of age and of health with one another and with longevity. Data collected at baseline from the 851 participants of the Rutgers Aging and Health longitudinal study (mean age 73) included perceptions of age and health, each assessed with four different single-item measures, sociodemographic, and health measures. Mortality was followed-up for 10years. All four health perceptions and two of the age perceptions (Age-group identity and nearness-to-death) were associated with survival time. Age and health perceptions had similar independent effects in models that included measures of both types, controlling for demographics and chronic conditions, though not after controlling for age. In contrast with our hypothesis, health perceptions did not mediate the association between age perceptions and mortality. Findings regarding health perceptions were generally consistent across measures, whereas age perception measures differed in their associations with various outcomes, indicating that they assess different subjective age constructs. The findings correspond with proposed explanations for the predictive effect of age and health perceptions and support the significant though weaker independent effects of age perceptions compared with health perceptions.

Bottom-up or top-down? Examining global and domain-specific evaluations of how one's life is unfolding over time.

We employed bottom-up and top-down perspectives to evaluate the link between how individuals view their lives as unfolding over time overall and in multiple life domains. Participants from an American adult lifespan sample (n=1,003, mean age=54.39years, 49% female, 94% Caucasian) evaluated their recollected past, current, and anticipated future satisfaction in seven life domains (health, work, finances, contribution to others, relationships with one's children, close relationships, sex life) and for their lives overall (life satisfaction) at two time points separated by 9 years. Mean-level trends varied by life domain and age. In cross-sectional and longitudinal analyses, domain-specific beliefs about changes in one's life explained substantial amounts of variance in perceived changes in overall life satisfaction, and multiple domains had unique predictive effects. Domain-specific beliefs also substantially mediated the predictive effect of age on perceived change in life satisfaction. Findings provide consistent support for the bottom-up perspective and limited support for the top-down model. Accordingly, individuals seem to derive beliefs concerning how their lives overall are unfolding over time based on perceived changes across multiple life domains.

Do age and gender differences exist in selfie-related behaviours?

Recently scholars have started examining selfie-related behaviour, with an emphasis on young women. However, little is known about age and gender differences in selfie-taking and posting patterns. To address this gap, an online survey of a sample of 3763 Norwegian social media users was carried out. This study provides the first empirical evidence on how adolescents (aged 12 to 19), young adults (20–30) and adults (31–50) differ in terms of selfie behaviour. Females were more likely to take personal and group selfies, post personal selfies, crop photos and use photographic filters compared to males. Adolescents were found to be more likely than young adults to take own and group selfies, post own selfies, and use photographic filters. Similarly, young adults were more likely to take own and group selfies, post and edit photos than older adults. The predictive effect of age was stronger among women than among men regarding selfie taking, posting and editing behaviour. The interpretations and implications of the study findings are discussed in the light of previous literature.

Distinct age and self-rated health crossover mortality effects for African Americans: Evidence from a national cohort study

The predictive effects of age and self-rated health (SRH) on all-cause mortality are known to differ across race and ethnic groups. African American adults have higher mortality rates than Whites at younger ages, but this mortality disparity diminishes with advancing age and may “crossover” at about 75–80 years of age, when African Americans may show lower mortality rates. This pattern of findings reflects a lower overall association between age and mortality for African Americans than for Whites, and health-related mechanisms are typically cited as the reason for this age-based crossover mortality effect. However, a lower association between poor SRH and mortality has also been found for African Americans than for Whites, and it is not known if the reduced age and SRH associations with mortality for African Americans reflect independent or overlapping mechanisms. This study examined these two mortality predictors simultaneously in a large epidemiological study of 12,181 African Americans and 17,436 Whites. Participants were 45 or more years of age when they enrolled in the national REasons for Geographic and Racial Differences in Stroke (REGARDS) study between 2003 and 2007. Consistent with previous studies, African Americans had poorer SRH than Whites even after adjusting for demographic and health history covariates. Survival analysis models indicated statistically significant and independent race*age, race*SRH, and age*SRH interaction effects on all-cause mortality over an average 9-year follow-up period. Advanced age and poorer SRH were both weaker mortality risk factors for African Americans than for Whites. These two effects were distinct and presumably tapped different causal mechanisms. This calls into question the health-related explanation for the age-based mortality crossover effect and suggests that other mechanisms, including behavioral, social, and cultural factors, should be considered in efforts to better understand the age-based mortality crossover effect and other longevity disparities.

Baseline anti-dsDNA concentrations and previous treatments predict response to Adalimumab and Etanercept: A retrospective investigation of 146 psoriasis patients

BackgroundAdalimumab and Etanercept are TNF-α antagonists commonly used for treatment of moderate-to-severe psoriasis and psoriatic-arthritis. Reliable instruments to assist the selection of patients for a specific treatment in a real-world scenario are unavailable. ObjectiveTo identify patient characteristics and baseline laboratory parameters predicting response to Adalimumab- and Etanercept-treatment. MethodsWe report a retrospective observational study including 116 and 64 psoriasis-patients treated with Adalimumab and Etanercept, respectively, at a dermatological outpatient clinic of a university hospital. Thirty four patients contributed data to both biologics. First occurrence of either loss-of-response or serious-side-effects (LOR/SSE) was chosen as clinical endpoint and predictors were identified using Cox-regression. ResultsBaseline anti-double-stranded DNA (anti-dsDNA) concentrations, number of previous treatments with TNF-α antagonists in general and previous treatment with Etanercept in particular significantly predicted LOR/SSE to Adalimumab. The predictive effect of baseline anti-dsDNA was conserved in TNF-α antagonist naïve patients. Number of previous systemic treatments other than TNF-α antagonists significantly predicted LOR/SSE to Etanercept. Age and baseline psoriasis area and severity index (PASI) did not predict response to either biologic in a clinically significant manner. ConclusionOur data suggests that treatment with Adalimumab may promise best results in psoriasis-patients with (A) low baseline anti-dsDNA concentrations, and (B) no previous TNF-α antagonist treatment. A clinically significant predictive effect of age and baseline PASI on response to Adalimumab and Etanercept is unlikely.

2340 – The role of age and gender in predicting serum levels of IL-6 and TNF-α in patients with schizophrenia and major depression

Introduction Growing evidence in the field of psychoneuroimmunology indicates an interconnection between psychiatric disorders, in particular schizophrenia and mood disorders, and cytokine alternations. Gender and aging are commonly reported to affect cytokine levels, but contrasting conclusions still represent a topic for debate. Objectives and aims Our aim was to investigate the role of age and gender in the serum levels of Interleukin-6 (IL-6) and Tumor Necrosis Factor-alpha (TNF-α), in patients with schizophrenia (SCH) and major depression (MDD). Method We measured serum levels of IL-6 and TNF-α in acute exacerbation of illness, in 37 patients with MDD, and compared them to 43 patients with SCH. The serum levels were measured by the enzyme-linked immunosorbent assay (ELISA). All patients fulfilled the ICD-10 criteria. Results The significant interaction between gender and psychiatric disorders on serum cytokine levels, and the association between IL-6 and TNF-α and age, in both groups of patients, were not detected. However, when applied the linear regression model with the serum cytokine levels as dependant variable, and age, gender, and psychiatric disorder as independent variables, the significant predictive effect of age on levels of both investigated cytokines was detected. The patients over 35 years of age had higher levels of IL-6 and even significantly lower levels of TNF-α, regardless of the diagnosis. Conclusion The results suggest that the aging process could be a relevant factor influencing the immune status of patients with SCH and MDD. Further prospective studies are essential to further investigate biological mechanisms that underlie these multidimensional interconnections.

Exploring older and younger adults' preferences for health information and participation in decision making using the Health Information Wants Questionnaire (HIWQ)

Existing measurements of patient preferences cover only a limited range of health information and participation in decision making. A broader approach is necessary to understand the breadth and variations in patient preferences. To explore the breadth and variances in patient preferences for health information and participation in decision making and to understand the relationship between age and each type of preference. The Health Information Wants Questionnaire (HIWQ) was administered during May-December 2010 to gather data about the information and corresponding decision-making autonomy participants would want in seven areas: diagnosis, treatment, laboratory tests, self-care, complementary and alternative medicine (CAM), psychosocial factors and health-care providers. A large state university, public libraries and senior centres in Maryland, USA. A convenience sample of 438 individuals, including 226 undergraduates (mean age = 20; SD = 2.15) and 212 community-dwelling older adults (mean age = 72; SD = 9.00). Ratings on the information and decision-making items of the HIWQ. Participants expressed higher levels of preference for information than for participation in decision making on six of seven subscales. On the psychosocial subscale, they expressed stronger desire for participation in decision making than for information. Age had no predictive effect on the overall preferences or specific preferences for information and participation in decision making about standard treatments and CAM. The predictive effect of age on the other types of preferences varied significantly. Physicians should take into account the breadth and variations in patient preferences. The predictive effect of age on patient preferences varied depending on the specific area of preferences.

Fulvestrant (F) and letrozole (L) combination in second-line or more for estrogen receptor (ER)-positive (+) metastatic breast cancer (MBC): Efficacy and predictive factors of response.

e11137 Background: Preclinical data show that complete estrogen blockade, by down regulating ER and inhibiting estrogen synthesis, has greater effect on tumor growth than either treatment alone. Combination of an aromatase inhibitor (AI) and F may be an optimal second-line therapy by preventing activation of growth factor pathways and possible cross talk with ER. One clinical study has shown no benefit of adding anastrozole (A) to F at first relapse. No clinical data on combination L and F in the second line or more MBC is available. Methods: ER+, progesterone receptor(PgR) + or negative (-) MBC patients (pts) with prior chemo and/or non-AI endocrine(E) therapy were treated with L and F. Pts with complete/partial response, or stable disease were considered to have clinical benefit (CR+PR+SD). The predictive effect of age, number of prior regimens, ER/PgR status, and lobular histology were examined using Chi-square test. Results: 32 pts received L (2.5 mg/d po) plus F (250 mg/month, im). Mean age was 70 (Range: 35-92), median number of prior treatments was 2 (range1-6). 25 pts had ER+/PgR+, 7 pts had ER+/PgR- tumors. 25 pts had prior non-AI E therapy. 8 pts had lobular histology. Overall clinical benefit rate was 71% (3 CR, 7 PR, 13 SD). Mean duration of the clinical benefit was 15 months (range 2-38). 8 pts progressed under therapy. Age > 65 vs younger (89% vs 46%, p=0.007), prior treatments< 4 vs more (87% vs 25%, p=0.0007) and ER+/PgR+ vs ER+/PgR- (84% vs 42%, p<0.05) were predictive of clinical benefit; lobular histology and prior E therapy did not have any effect on clinical benefit (p>0.05). Conclusions: In pretreated MBC, combination of L and F can be effective with mean clinical benefit duration of 15 months. Older age, < 4 prior lines of therapy, and expression of both ER/PgR are predictive of clinical benefit while lobular histology and prior E therapy are not. L and F combination can be a reasonable option in selected group of MBC pts and should be further evaluated in larger studies using high dose F schedule.

Factores predictores de uso problemático de alcohol en personas atendidas en una sala de emergencia

Objectives. To assess the predictive effect of key individual-level characteristics to identify cases of alcohol use problems among patients visiting an emergency room. Materials and methods. The study sample was composed of 371 people attending an emergency room in a public hospital in Lima, Peru, during a period of seven complete days in January, 2005. For data gathering, we used a questionnaire for demographic information, the SIDUC/CICAD for recent use (i.e., in the last 6 hours) of psychoactive substances before arriving to the emergency room, and the AUDIT, to identify alcohol use problems in the last year. Univariate and multivariate logistic regression models were used to estimate the predictive effect of age, sex, area of attention in the emergency room, presence of physical injuries and recent use of alcohol. Results. The odds of being a case of alcohol use problem for males is 26 times the odds of having that problem for females (p-value&lt;0,001). Stratified analysis by sex and adjusted by age and area of attention in the emergency room, showed that males who had recent use of alcohol were more likely of having alcohol use problems as compared to those who did not have recent alcohol use (OR=5.2; 95% CI: 2.4 - 11.5; p&lt;0,001), while for females such an association did not exist. Conclusions. These results support screening initiatives for those males who have recent alcohol use before arriving to an emergency room in order to identify cases of alcohol-related problems and refer them for an appropriate counseling or medical treatment.

A clinical prediction rule for the diagnosis of coronary artery disease: validation, updating, and extension

The aim was to validate, update, and extend the Diamond-Forrester model for estimating the probability of obstructive coronary artery disease (CAD) in a contemporary cohort. Prospectively collected data from 14 hospitals on patients with chest pain without a history of CAD and referred for conventional coronary angiography (CCA) were used. Primary outcome was obstructive CAD, defined as ≥ 50% stenosis in one or more vessels on CCA. The validity of the Diamond-Forrester model was assessed using calibration plots, calibration-in-the-large, and recalibration in logistic regression. The model was subsequently updated and extended by revising the predictive value of age, sex, and type of chest pain. Diagnostic performance was assessed by calculating the area under the receiver operating characteristic curve (c-statistic) and reclassification was determined. We included 2260 patients, of whom 1319 had obstructive CAD on CCA. Validation demonstrated an overestimation of the CAD probability, especially in women. The updated and extended models demonstrated a c-statistic of 0.79 (95% CI 0.77-0.81) and 0.82 (95% CI 0.80-0.84), respectively. Sixteen per cent of men and 64% of women were correctly reclassified. The predicted probability of obstructive CAD ranged from 10% for 50-year-old females with non-specific chest pain to 91% for 80-year-old males with typical chest pain. Predictions varied across hospitals due to differences in disease prevalence. Our results suggest that the Diamond-Forrester model overestimates the probability of CAD especially in women. We updated the predictive effects of age, sex, type of chest pain, and hospital setting which improved model performance and we extended it to include patients of 70 years and older.

Factores predictores de uso problemático de alcohol en personas atendidas en una sala de emergencia

To assess the predictive effect of key individual-level characteristics to identify cases of alcohol use problems among patients visiting an emergency room. The study sample was composed of 371 people attending an emergency room in a public hospital in Lima, Peru, during a period of seven complete days in January, 2005. For data gathering, we used a questionnaire for demographic information, the SIDUC/CICAD for recent use (i.e., in the last 6 hours) of psychoactive substances before arriving to the emergency room, and the AUDIT, to identify alcohol use problems in the last year. Univariate and multivariate logistic regression models were used to estimate the predictive effect of age, sex, area of attention in the emergency room, presence of physical injuries and recent use of alcohol. The odds of being a case of alcohol use problem for males is 26 times the odds of having that problem for females (p-value<0,001). Stratified analysis by sex and adjusted by age and area of attention in the emergency room, showed that males who had recent use of alcohol were more likely of having alcohol use problems as compared to those who did not have recent alcohol use (OR=5.2; 95% CI: 2.4 - 11.5; p<0,001), while for females such an association did not exist. These results support screening initiatives for those males who have recent alcohol use before arriving to an emergency room in order to identify cases of alcohol-related problems and refer them for an appropriate counseling or medical treatment.

Letrozole and Fulvestrant Combination in Second Line or More for Estrogen Receptor Positive Metastatic Breast Cancer; Efficacy and Predictive Factors of Response

Background: Preclinical data show that complete estrogen blockade by both down regulating estrogen receptor and inhibiting estrogen synthesis, has greater effect on tumor growth than either treatment alone. Combination of an aromatase inhibitor and fulvestrant may be an optimal second line therapy by preventing activation of growth factor pathways and possible cross talk with ER. One clinical study has shown no benefit of adding anastrozole to fulvestrant at first relapse. No clinical data on combination letrozole and fulvestrant in the second line or more metastatic beast cancer setting is available. Methods: Estrogen receptor (ER) positive, progesterone receptor (PgR) positive or negative metastatic breast cancer patients with prior chemo and/or non-aromatase inhibitor (non-AI) endocrine therapy were treated with letrozole and fulvestrant. Patients with complete response(CR) partial response(PR), or stable disease(SD) were considered to have clinical benefit (CR+PR+SD). The predictive effects of age, number of prior regimens, ER/PgR status, histology, sites of metastatic disease were examined using Chi-square test. Results: Thirty-two patients received oral letrozole 2.5 mg daily plus fulvestrant 250 mg intramuscular injection monthly. Mean age was 70 (range: 35-92), median number of prior treatments was 2 (range2-6). 25 pts had ER+/ PgR+, 7 pts had ER+/PgR- tumors. Twenty-five patients had prior non-AI endocrine therapy. Eight patients had lobular histology. Overall clinical benefit rate was 71% (3 CR, 7 PR, and 13 SD). Mean duration of the clinical benefit was 15 months (range 2-38). Nine patients progressed under therapy. Age more than 65 versus younger (89% vs 46%, P=0.007), prior treatments less than 4 versus more (87% vs 25%, P=0.0007) and ER+/PgR+ versus ER+/PgR- (84% versus 42%, P 0.05) . Conclusions: In previously treated metastatic breast cancer patients, combination of letrozole and fulvestrant can be effective with a mean clinical benefit duration of 15 months. Older age, less than four prior lines of therapy, and expression of both ER/PgR are predictive of clinical benefit while lobular histology, site of metastatic disease and prior non-AI endocrine therapy are not. Letrozole and fulvestrant combination can be a reasonable option in selected group of previously treated metastatic breast cancer patients and should be further evaluated in larger studies utilizing recently approved high dose (500 mg) fulvestrant schedule.