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Wand B.M.,The University of Notre Dame Australia | Chiffelle L.A.,Progress Physiotherapy Services | O'Connell N.E.,Brunel University | McAuley J.H.,George Institute for International Health | Desouza L.H.,Brunel University
European Spine Journal | Year: 2010

For an individual, the functional consequences of an episode of low back pain is a key measure of their clinical status. Self-reported disability measures are commonly used to capture this component of the back pain experience. In non-acute low back pain there is some uncertainty of the validity of this approach. It appears that self-reported assessment of disability and direct measurements of functional status are only moderately related. In this cross-sectional study, we investigated this relationship in a sample of 94 acute low back pain patients. Both self-reported disability and a performance-based assessment of disability were assessed, along with extensive profiling of patient characteristics. Scale consistency of the performance-based assessment was investigated using Cronbach's alpha, the relationship between self-reported and performance-based assessment of disability was investigated using Pearson's correlation. The relationship between clinical profile and each of the disability measures were examined using Pearson's correlations and multivariate linear regression. Our results demonstrate that the battery of tests used are internally reliable (Cronbach's alpha = 0.86). We found only moderate correlations between the two disability measures (r = 0.471, p < 0.001). Self-reported disability was significantly correlated with symptom distribution, medication use, physical well-being, pain intensity, depression, somatic distress and anxiety. The only significant correlations with the performance-based measure were symptom distribution, physical well-being and pain intensity. In the multivariate analyses no psychological measure made a significant unique contribution to the prediction of the performance-based measure, whereas depression made a unique contribution to the prediction of the self-reported measure. Our results suggest that self-reported and performance-based assessments of disability are influenced by different patient characteristics. In particular, it appears self-reported measures of disability are more influenced by the patient's psychological status than performance-based measures of disability. © 2009 Springer-Verlag.


Martiniuk A.L.C.,George Institute for International Health
International Journal of Health Services | Year: 2012

The weak health system in Honduras contributes to poor health indicators. To improve population health, a number of volunteer medical brigades from developed countries provide health services in Honduras. To date, there is little information on the brigades' activities and impact. The primary objective of this article is to increase understanding of the type of health care provided by voluntary medical brigades by evaluating and presenting data on patients' presenting symptoms, diagnoses, and care outcomes. The article focuses on an ongoing medical brigade organized by Canadian health professionals in conjunction with Honduras' largest national non-governmental organization. This is a descriptive study of data that are routinely collected by volunteer Canadian health care professionals. Data on all patients presenting to temporary primary health care facilities across Honduras between 2006 and 2009 were analyzed. The data were used to analyze patient demographics, presenting symptoms, diagnoses, and treatments. We found that the brigades provide additional human resources to the relatively weak Honduran health care system. However, while brigades may increase solidarity between Hondurans and Canadians, concerns persist regarding cost-effectiveness and continuity of care for conditions treated by short-term brigade volunteers. Greater scrutiny is needed to increase brigades' effectiveness and ensure they are supportive of domestic health systems. © 2012, Baywood Publishing Co., Inc.


Domanski M.J.,Mount Sinai Cardiovascular Institute | Mahaffey K.,Duke University | Hasselblad V.,Duke University | Brener S.J.,New York Methodist Hospital | And 11 more authors.
JAMA - Journal of the American Medical Association | Year: 2011

Context: Several small studies have suggested that cardiac enzyme elevation in the 24 hours following coronary artery bypass graft (CABG) surgery is associated with worse prognosis, but a definitive study is not available. Also, the long-term prognostic impact of small increases of perioperative enzyme has not been reported. Objective: Toquantify the relationship between peak post-CABG elevation of biomarkers of myocardial damage and early, intermediate-, and long-term mortality, including determining whether there is a threshold below which elevations lack prognostic significance. Data Sources: Studies (randomized clinical trials or registries) of patients undergoing CABG surgery in which postprocedural biomarker and mortality data were collected and included. A search of the PubMed database was performed in July 2008 using the search terms coronary artery bypass, troponin, CK-MB, and mortality. Study Selection: Studies evaluating mortality and creatine kinase (CK-MB), troponin, or both were included. One study investigator declined to participate and 3 had insufficient data. Data Extraction: Two independent reviewers determined study eligibility. The principal investigator from each eligible study was contacted to request his/her participation. Once institutional review board approval for the use of these data for this purpose was obtained, we requested patient-level data from each source. Data were examined to ensure that cardiac markers had been measured within 24 hours after CABG surgery, key baseline covariates, and mortality were available. Results: A total of 18 908 patients from 7 studies were included. Follow-up varied from 3 months to 5 years. Mortality was found to be a monotonically increasing function of the CK-MB ratio. The 30-day mortality rates by categories of CK-MB ratio were 0.63% (95% confidence interval [CI], 0.36%-1.02%) for 0 to <1, 0.86% (95% CI, 0.49%-1.40%) for 1 to <2, 0.95% (95% CI, 0.72%-1.22%) for 2 to <5, 2.09% (95% CI, 1.69%-2.57%) for 5 to <10, 2.78% (95% CI, 2.12%-3.58%) for 10 to <20, and 7.06% (95% CI, 5.46%-8.96%) for 20 to ≥40. Of the variables considered, the CK-MB ratio was the strongest independent predictor of death to 30 days and remained significant even after adjusting for a wide range of baseline risk factors (χ2=143, P<.001; hazard ratio [HR] for each 5 point-increment above the upper limits of normal [ULN]=1.12;95%CI, 1.10-1.14). This result was strongest at 30 days, but the adjusted association persisted from 30 days to 1 year (χ2=24; P<.001; HR for each 5-point increment above ULN=1.17; 95% CI, 1.10-1.24) and a trend was present from 1 year to 5 years (χ2=2.8; P=.10; HR for each 5-point increment above ULN=1.05; 95% CI, 0.99-1.11). Similar analyses using troponin as the marker of necrosis led to the same conclusions (χ2=142 for 0-30 days and χ2=40 for 30 days to 6 months, both P<.001; HR for each 50 points above the ULN=1.28; 95% CI, 1.23-1.33 and 1.15; 95% CI, 1.10-1.21, respectively). Conclusions: Among patients who had undergone CABG surgery, elevation of CK-MB or troponin levels within the first 24 hours was independently associated with increased intermediate- and long-term risk of mortality. ©2011 American Medical Association. All rights reserved.


Jee S.H.,Yonsei University | Kivimaki M.,University College London | Kang H.-C.,Yonsei University | Park I.S.,National Health Insurance Corporation | And 5 more authors.
European Heart Journal | Year: 2011

Aims A potential role for cardiovascular disease (CVD) risk factors in the aetiology of suicide has not been comprehensively examined. In addition to being small in scale and poorly characterized, existing studies very rarely sample Asian populations in whom risk factorsuicide relationships may plausibly differ to Caucasian groups. We examined the association between a series of CVD risk factors and future mortality from suicide. Methods and resultsThe Korean Cancer Prevention Study is a prospective cohort study comprising 1 234 927 individuals (445 022 women) aged 3095 years with extensive measurement of established CVD risk factors at baseline and subsequent mortality surveillance. Fourteen years of follow-up gave rise to 472 deaths (389 in men and 83 in women) from suicide. After adjustment for a range of covariates, in men, smoking hazard ratio; 95 CI: (current vs. never: 1.69; 1.27, 2.24), alcohol intake (124 g/day vs. none: 1.29; 1.00, 1.66), blood cholesterol (<240 vs. <200 mg/dL: 0.54; 0.36, 0.80), body mass index (underweight vs. normal weight: 2.08; 1.26, 3.45), stature [quartile 1(lowest) vs. 4: 1.68; 1.23, 2.30], socioeconomic status [quartile 1(lowest) vs. 4: 1.65; 1.21, 2.24], and martial status (unmarried vs. other: 1.60; 0.83, 3.06) were related to suicide mortality risk. These associations were generally apparent in women, although of lower magnitude. Exercise and blood pressure were not associated with completed suicide. ConclusionIn this cohort of Korean men and women, a series of CVD risk factors were associated with an elevated risk of future suicide mortality. © 2011 The Author.


White S.L.,George Institute for International Health | White S.L.,University of Sydney | Polkinghorne K.R.,Monash Medical Center | Atkins R.C.,Monash Medical Center | And 2 more authors.
American Journal of Kidney Diseases | Year: 2010

Background: The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) is more accurate than the Modification of Diet in Renal Disease (MDRD) Study equation. We applied both equations in a cohort representative of the Australian adult population. Study Design: Population-based cohort study. Setting & Participants: 11,247 randomly selected noninstitutionalized Australians aged ≥ 25 years who attended a physical examination during the baseline AusDiab (Australian Diabetes, Obesity and Lifestyle) Study survey. Predictors & Outcomes: Glomerular filtration rate (GFR) was estimated using the MDRD Study and CKD-EPI equations. Kidney damage was defined as urine albumin-creatinine ratio ≥ 2.5 mg/mmol in men and ≥ 3.5 mg/mmol in women or urine protein-creatinine ratio ≥ 0.20 mg/mg. Chronic kidney disease (CKD) was defined as estimated GFR (eGFR) ≥ 60 mL/min/1.73 m2 or kidney damage. Participants were classified into 3 mutually exclusive subgroups: CKD according to both equations; CKD according to the MDRD Study equation, but no CKD according to the CKD-EPI equation; and no CKD according to both equations. All-cause mortality was examined in subgroups with and without CKD. Measurements: Serum creatinine and urinary albumin, protein, and creatinine measured on a random spot morning urine sample. Results: 266 participants identified as having CKD according to the MDRD Study equation were reclassified to no CKD according to the CKD-EPI equation (estimated prevalence, 1.9%; 95% CI, 1.4-2.6). All had an eGFR ≥ 45 mL/min/1.73 m2 using the MDRD Study equation. Reclassified individuals were predominantly women with a favorable cardiovascular risk profile. The proportion of reclassified individuals with a Framingham-predicted 10-year cardiovascular risk ≥ 30% was 7.2% compared with 7.9% of the group with no CKD according to both equations and 45.3% of individuals retained in stage 3a using both equations. There was no evidence of increased all-cause mortality in the reclassified group (age- and sex-adjusted hazard ratio vs no CKD, 1.01; 95% CI, 0.62-1.97). Using the MDRD Study equation, the prevalence of CKD in the Australian population aged ≥ 25 years was 13.4% (95% CI, 11.1-16.1). Using the CKD-EPI equation, the prevalence was 11.5% (95% CI, 9.42-14.1). Limitations: Single measurements of serum creatinine and urinary markers. Conclusions: The lower estimated prevalence of CKD using the CKD-EPI equation is caused by reclassification of low-risk individuals. © 2010 National Kidney Foundation, Inc.

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