Modelling unobserved heterogeneity Theoretical and practical aspects

SIGLEAvailable from British Library Document Supply Centre- DSC:DX186528 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

The effect of definitions of activities of daily living on estimates of changing ability among older people

Physical functioning status is often assessed using scales of activities of daily living and instrumental activities of daily living. Different ways of defining change in adequacy of performance of both activities of daily living and instrumental activities of daily living tasks may be used, including increasing difficulty in performance, the need for assistance and inability to do tasks. In this prospective study, we investigated the effect of different definitions of decline on estimates of physical function, and explored the relationships between decline in each activity of daily living individually and potential predictors. The study was based on a sample of 999 individuals aged 65 years or more who participated in a national survey of quality of life, of whom 531 (68% of those eligible for follow up) responded 12-18 months later. Different definitions of decline were used and the prevalence of decline was, depending on the individual activities of daily living item, used as an outcome in logistic regression models. The results showed that the strength of association with chronic diseases, demographic, psychological and environmental factors varied by altering the activities of daily living item used. Decline in ability to walk 400 yards was strongly associated with respiratory problems (odds ratio 3.5 [95% confidence interval 1.3-9.0]) while decline in ability to get on a bus was associated with musculoskeletal problems (odds ratio 2.8 [95% confidence interval 1.4-5.6]). In conclusion, the prevalence of decline varies by definition, and summary measures which are customarily used to describe disability, may be inadequate for the assessment and identification of predictors of decline in functional ability

Thioridazine and sudden unexplained death in psychiatric patients

Background Sudden death has been linked to antipsychotic therapy, but the relative risk associated with specific drugs is unknown. Aims To assess the risk of sudden unexplained death associated with antipsychotic drug therapy and its relation to drug dose and individual agents. Method A case—control study of psychiatric in-patients dying suddenly in five hospitals in the north-east of England and surviving controls matched for age, gender and mental disorder. Logistic regression analysis was used to identify significant risk factors, and odds ratios were calculated. Results Sixty-nine case—control clusters were identified. Probable sudden unexplained death was significantly associated with hypertension, ischaemic heart disease and current treatment with thioridazine (adjusted odds ratio=5.3, 95% CI 1.7-16.2, P=0.004). There was no significant association with other individual antipsychotic drugs. Conclusions Thioridazine alone was associated with sudden unexplained death, the likely mechanism being drug induced arrythmia

Variations in acute stroke care and the impact of organised care on survival from a European perspective: the European Registers of Stroke (EROS) investigators

<p>Background: The need for stroke care is escalating with an ageing population, yet methods to estimate the delivery of effective care across countries are not standardised or robust. Associations between quality and intensity of care and stroke outcomes are often assumed but have not been clearly demonstrated.</p> <p>Objective: To examine variations in acute care processes across six European populations and investigate associations between the delivery of care and survival.</p> <p>Methods: Data were obtained from population-based stroke registers of six centres in France, Lithuania, UK, Spain, Poland and Italy between 2004 and 2006 with follow-up for 1 year. Variations in the delivery of care (stroke unit, multidisciplinary team and acute drug treatments) were analysed adjusting for case mix and sociodemographic factors using logistic regression methods. Unadjusted and adjusted survival probabilities were estimated and stratified by levels of Organised Care Index.</p> <p>Results: Of 1918 patients with a first-ever stroke registered, 30.7% spent more than 50% of their hospital stay in a stroke unit (13.9–65.4%) among centres with a stroke unit available. The percentage of patients assessed by a stroke physician varied between 7.1% and 96.6%. There were significant variations after adjustment for confounders, in the organisation of care across populations. Significantly higher probabilities of survival (p<0.01) were associated with increased organisational care.</p> <p>Conclusions: This European study demonstrated associations between delivery of care and stroke outcomes. The implementation of evidence-based interventions is suboptimal and understanding better ways to implement these interventions in different healthcare settings should be a priority for health systems.</p&gt