Respiratory function in the very old and its impact on disability and mortality

PhD ThesisThe aim of this PhD is to better understand the epidemiology of respiratory function in very old people and specifically examine the relationship between respiratory function and both cognitive function and disability in this age group. Data from the Newcastle 85+ study, a longitudinal cohort study of 85 year olds (born in 1921) were used in this thesis. Very few studies have investigated lung function and especially its impact on disability and mortality in the very old, and the unique point of this study was the multiple measurements of three lung function parameters: FEV1, FVC and PEF, between the ages of 85 and 88 years. Four sub-studies constituted the substantive results chapters of this thesis. The first sub-study described the prevalence of respiratory disease in the very old and the applicability of indicators of poor lung function and their cutpoints in this age group. The second sub-study explored the predictive ability of lung function for subsequent survival. The third sub-study quantified how lung function changes with further ageing in 85 year olds. The fourth sub-study examined the relationship between lung function and disability, particularly the direction of causality, and the potential mediating role of cognitive function. In the very old significant differences were observed between physician-diagnosed COPD and the obstructive classification of spirometry using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and Global lung initiative (GLI) prediction models. Lung function was predictive of mortality in women only. When investigating lung function trajectories of change, smoking and cognitive impairment were associated with lower FEV1. Bidirectional causality between lung function and disability revealed that higher FEV1 at ages 85, 86.5 and 88 was associated with lower disability at subsequent follow-ups (ages 86.5, 88 and 90) whilst higher disability scores at age 85 were associated with lower FEV1 at age 86.5

Glasgow Coma Scale and Its Components on Admission: Are They Valuable Prognostic Tools in Acute Mixed Drug Poisoning?

Introduction. The verbal, eye, and motor components of Glasgow coma scale (GCS) may be influenced by poisoned patients' behavior in an attempted suicide. So, the values of admission GCS and its components for outcomes prediction in mixed drugs poisoning were investigated. Materials and Methods. A followup study data was performed on patients with mixed drugs poisoning. Outcomes were recorded as without complications and with complications. Discrimination was evaluated by calculating the area under the receiver operating characteristic curves (AUC). Results. There was a significant difference between the mean value of each component of GCS as well as the total GCS between patients with and without complication. Discrimination was best for GCS (AUC: 0.933 ± 0.020) and verbal (0.932 ± 0.021), followed by motor (0.911 ± 0.025), then eye (0.89 ± 0.028). Conclusions. Admission GCS and its components seem to be valuable in outcome prediction of patients with mixed drug poisoning

The use and the cost of outpatient diagnostic procedures for cardiovascular diseases in Isfahan province: A utilization study

Cardiovascular diseases (CVDs) are among the most important causes of premature death, disability, disease burden, and increasing the cost of healthcare worldwide. Having an overview of service utilization can help policymakers to plan more effective use of those services and to cut costs. Thus, this study aims to determine the amount of use as well as the cost of various outpatient diagnostic procedures for CVDs in Isfahan province of Iran from 2011 to 2017. This descriptive study used insurance claim data (time period: 2011-2017) from Health Insurance Organization in Isfahan province to determine the amount of use and the cost of various outpatient diagnostic procedures for CVDs. Afterward, based on these data, the use and the cost of various outpatient diagnostic procedures for CVDs were estimated for the total population of Isfahan province. The list of outpatient diagnostic procedures for CVDs was carefully chosen according to experts' opinions. The use and the cost of outpatient diagnostic procedures for CVDs have drastically increased in the study period (2011-2017). Since 2011, the number of procedures and their related costs have increased 6.6 and 30.76 times (11.74 times, adjusted with PPP conversion factor), respectively. Per capita use (per thousand people) was 18.75 in 2011, reaching 116.51 in 2017. Per capita cost (per thousand people) was 1,887,660 IRR (355 PPP$) in 2011, reaching 54,660,365 IRR (3920 PPP$) in 2017. The highest cost and use were related to echocardiography and electrocardiography, respectively. A notable increase has been observed in the share of radionuclide myocardial perfusion scan and analysis of pacemakers and ICDs of the total cost. The use of outpatient diagnostic procedures for CVDs has drastically increased during the studied period. Consequently, the cost borne by the health system and the patients have notably increased. This may be because of the increase in the incidence and prevalence of CVDs during the study period. Greater access to related health services can be mentioned as another reason for this increase. Further research is needed to explain all potential reasons and their importance, which can provoke a suitable health policy reaction. [Abstract copyright: Copyright: © 2022 Journal of Education and Health Promotion.

Predictors of breast cancer screening behavior in women aged 20-69 referred to public health centers: A cross-sectional study in Isfahan Province

Background: Breast cancer is the most common cancer in women. Delay in the diagnosis of breast cancer is a major challenge that can lead to disease progression. Identifying the predictors of breast cancer screening behavior is necessary to promote early detection of breast cancer. This study aims to investigate the predictors of breast cancer screening behavior in women aged 20-69 referred to public health centers. Methods: This cross-sectional study was conducted on 17255 women aged 20-69 years old in Isfahan Province referred to Public Health Centers by the multi-stage random sampling method. data were collected based on the paper forms of women's care aged 20-69 at public health centers, Isfahan, Iran, in 2012. Using STATA 14, logistic regression was employed to explore predictors of breast cancer screening behavior at a 5% significance level. Results: The mean age of women was 36.75 +/- 10.46. About 6006 (34.8%) of women had a history of breast self-examination, and among women aged over 40 years, 17.7% reported ever having a mammogram. The most important factors influencing breast self-examination were age 40-49 (OR = 1.18; 95% CI: 1.06-1.33), history of hormone consumption (OR = 1.23; 95% CI: 1.15-1.33), family history of breast cancer in first-degree relatives (OR = 14.22; 95% CI: 9.83-20.57. The most important factors influencing mammography were hormone consumption (OR = 1.26; 95% CI: 1.05-1.51), and family history of breast cancer in first-degree relatives (OR = 32.55; 95% CI: 20.08-52.70). Conclusions: Our findings indicated that the performance of breast self-examination and mammography was low. The frequency of BC screening behavior was higher among women with BC risk factors The results revealed the need for health authorities to pay attention to education in BC detection methods

A nationwide causal mediation analysis of survival following ST-elevation myocardial infarction

Objective: International studies report a decline in mortality following ST-elevation myocardial infarction (STEMI). The extent to which the observed improvements in STEMI survival are explained by temporal changes in patient characteristics and utilisation of treatments is unknown. Methods: Cohort study using national registry data from the Myocardial Ischaemia National Audit Project between first January 2004 and 30th June 2013. 232 353 survivors of hospitalisation with STEMI as recorded in 247 hospitals in England and Wales. Flexible parametric survival modelling and causal mediation analysis were used to estimate the relative contribution of temporal changes in treatments and patient characteristics on improved STEMI survival. Results: Over the study period, unadjusted survival at 6 months and 1 year improved by 0.9% and 1.0% on average per year (HR: 0.991, 95% CI: 0.988 to 0.994 and HR: 0.990, 95% CI: 0.987 to 0.993, respectively). The uptake of primary percutaneous coronary intervention (PCI) (HR: 1.025, 95% CI: 1.021 to 1.028) and increased prescription of P2Y12 inhibitors (HR: 1.035, 95% CI: 1.031 to 1.039) were significantly associated with improvements in 1-year survival. Primary PCI explained 16.8% (95% CI: 10.8% to 31.6%) and 13.2% (9.2% to 21.9%) of the temporal survival improvements at 6 months and 1 year, respectively, whereas P2Y12 inhibitor prescription explained 5.3% (3.6% to 8.8%) of the temporal improvements at 6 months but not at 1 year. Conclusions: For STEMI in England and Wales, improvements in survival between 2004 and 2013 were significantly explained by the uptake of primary PCI and increased use of P2Y12 inhibitors at 6 months and primary PCI only at 1 year. Trial registration number: NCT0374969

Nurses' perception of clinical decision making in hospitals of Shahrekord University of Medical Sciences in 2019

Background and aim: The most important factor affecting the quality of care is the ability of nurses to make effective clinical decisions. Since identifying nurses 'perceptions of clinical decision making is an important step in improving the quality of care, this study done to determine nurses' perceptions of clinical decision making in hospitals of Shahrekord University of Medical Sciences. Methods: The study was a descriptive research. The study population consisted of clinical nurses working in Ayatollah Kashani and Hajar hospitals in Shahrekord and Seyed al-Shohada in Farsan. 300 nurses were selected through quota random sampling. Data were collected using demographic information questionnaire and Persian version of Clinical Decision Making in Nursing Scale (CDMNS). Data were analyzed using descriptive statistics (mean and standard deviation) and inferential statistics (Mann-Whitney and Kruskal-Wallis) and SPSS (V 21). Results: The mean score of nurses' perception of clinical decision making was 119.11±13.53which was high. The mean decision scores on subscales A, B, C and D were (29.15± 3.38), (33.76 ± 3.50), (25.9 ± 4.1) and (29.30±4.2) which was lower in the subscale of search for information and unbiased assimilation of new information. The results also showed that age, background and unit were significantly correlated with scores of perception of decision making (P<0.05).With increasing in age and background, perception of decision making decreased. And perception of decision making in cardiac unit was more than other units. Conclusion:Since nurses’ perception in “Search for information and unbiased assimilation of new information” subscale in experienced nurses is low, Therefore, planning should be made to increase the ability of experienced nurses to search for new information. Keywords: Clinical decision making, Nurse,Perceptio

Factors Engaged With Women Performance in Doing Regular Breast Self-examination or Referring to Health Centers for Examination and Mammography

Aims: Breast cancer, as the most common cancer in women, will lead to death in case it is not diagnosed timely, and if the early diagnosis is timely, the chance of recovery will increase in the early stages. The aim of this study was to determine the factors engaged with women performance in doing regular breast self-examination or referring to health centers for examination and mammography. Materials and Methods: In this descriptive-analytic cross sectional study, in 2012, 9260 women aged 20 to 65 years old in Isfahan province, Iran were selected from different districts by multistage cluster sampling method. A researcher-made questionnaire was used for data collection. The underlying variables, knowledge of risk factors, signs and symptoms, and beliefs about breast cancer diagnosis were considered as predictors of women performance. The data were analyzed by STATA 13 software, using Pearson correlation coefficient test, univariate, and multivariate logistic regression. Findings: Generally, 55.7% of the patients had a poor knowledge of cancer risk factors. Knowledge about signs and symptoms of breast cancer was relatively good in 83.7% of the patients. Also, women belief in breast cancer diagnosis and treatment was poor. Knowledge of risk factors (OR=1.2), knowledge of signs and symptoms (OR=1.5), and beliefs (OR=1.3) were positive predictors of performance. Conclusion: The underlying variables, knowledge of cancer risk factors, knowledge of signs and symptoms of breast cancer, and belief in the effectiveness of examination increase the women performance (self- examination or referring to health centers for examination) for breast cancer examination

The association of anthropometric indices and cardiac function in healthy adults

BACKGROUND: Obesity is a major risk factor for many diseases including cardiovascular diseases (CVDs). Recently, it has been shown that upper body obesity can predict CVDs per se. In this study, we aimed to determine the association between indicators of upper body obesity and echocardiographic indices. METHODS: In this cross-sectional study conducted in Hajar Hospital in Shahrekord, Iran, from March to August 2014, 80 healthy adults were included. Participants' neck circumference (NC), waist circumference (WC), body mass index (BMI), and blood pressure were measured. Echocardiography was performed for all participants, and echocardiographic indices such as early (E') and late (A') diastolic tissue velocity, early (E) and late (A) transmitral flow velocity, E/E' ratio, pulmonary arterial pressure (PAP), and left atrial volume (LAV) were recorded. The association between these indices were investigated using bivariate Pearson correlation coefficient. RESULTS: For men, NC had a significant correlation with LAV, systolic blood pressure (SBP), diastolic blood pressure (DBP), PAP, and A', and a negative correlation with E'. WC had a significant correlation with LAV, SBP, and PAP, and a negative correlation with E', while BMI had a significant correlation with LAV, PAP, SBP, A, and A'. For women, NC had a significant positive correlation with LAV, A, ejection fraction (EF), SBP, PAP, and A', and a negative correlation with E' and E/E'. WC had a significant positive correlation with LAV, DBP, PAP, A, A', and a negative correlation with E', while BMI had a significant correlation with LAV, EF, SBP, PAP, E', A, and A'. CONCLUSION: The positive correlation of NC with SBP, A, and A', as well as NC, WC, and BMI with LAV and PAP in both sexes, and the negative correlation of NC with E' show the importance of these measures in estimation of metabolic and cardiovascular risk factors

In Vivo Quantification of Bacterial Keratitis with Optical Coherence Tomography

PURPOSE. To quantify the human corneal inflammatory response in treated bacterial keratitis with long-wavelength anterior segment optical coherence tomography (AS-OCT). METHODS. Patients with clinically suspected bacterial keratitis were recruited from the corneal service at Southampton Eye Unit, UK. Patients underwent AS-OCT and slit-lamp examination on presentation (day 0) and days 3, 7, and 14 of treatment. Corneal thickness (CT) in the infiltrated area, infiltrate thickness (IT), and infiltrate width (IW) were measured on highresolution AS-OCT scans. Mean values for each day and rates of change for each interval were calculated and compared (oneway ANOVA, paired t-test). RESULTS. Twenty-six eyes of 26 patients were recruited. Mean CT and IT on presentation were 905 m and 388 m, respectively. On days 3, 7, and 14, CT and IT decreased to 753 m and 320 m (P Ͻ 0.01), 678 m and 296 m (P Ͻ 0.01), and 584 m and 207 m (P Ͻ 0.01), respectively. Mean IW, 1498 m on presentation, did not change during treatment (P Ͼ 0.30). Mean daily rate of CT reduction was faster in the early (days 0 -3) compared to late (days 7-14) phase (4.49% vs. 1.33%, P ϭ 0.006). Mean daily rate of IT reduction was no different in early, middle, and late phases (5.41% vs. 1.19% vs. 3.38%, P Ͼ 0.01). In the late phase, IT decreased faster than CT (3.38% vs. 1.33%, P ϭ 0.003). CONCLUSIONS. CT and IT decreased significantly by day 3 in resolving bacterial keratitis. The rapid early phase reduction in IT and CT was followed by rapid late phase IT reduction. This study demonstrates that serial AS-OCT examination can be used to monitor in vivo the clinical course of inflammatory disease. (Invest Ophthalmol Vis Sci

Use of primary care and other healthcare services between age 85 and 90 years: longitudinal analysis of a single-year birth cohort, the Newcastle 85+ study

Objective: To describe, using data from the Newcastle 85+ cohort study, the use of primary care and other healthcare services by 85-year-olds as they age. Design: Longitudinal population-based cohort study. Setting: Newcastle on Tyne and North Tyneside, UK. Participants: Community dwelling and institutionalised men and women recruited through general practices (n=845, 319 men and 526 women). Results: Contact was established with 97% (n=1409/1459) of eligible 85-year-olds, consent obtained from 74% (n=1042/1409) and 851 agreed to undergo the multidimensional health assessment and a general practice medical records review. A total of 845 participants had complete data at baseline for this study (319 male, 526 female), with 344 (118 male, 226 female) reinterviewed at 60 months. After adjusting for confounders, all consultations significantly increased over the 5 years (incidence rate ratio, IRR=1.03, 95% CI 1.01 to 1.05, P=0.001) as did general practitioner (GP) consultations (IRR=1.03, 95% CI 1.01 to 1.05, P=0.006). Significant increases were also observed in inpatient and day hospital use over time, though these disappeared after adjustment for confounders. Conclusions: Our study of primary, secondary and community care use by the very old reveals that, between the ages of 85 and 90 years, older people are much more likely to consult their GP than any other primary healthcare team members. With a rapidly ageing society, it is essential that both current and future GPs are appropriately skilled, and adequately supported by specialist colleagues, as the main healthcare provider for a population with complex and challenging needs