Study Inclusion Criteria (study + inclusion_criterion)

Distribution by Scientific Domains

Selected Abstracts

Estimation of stage-specific fibrosis progression rates in chronic hepatitis C virus infection: A meta-analysis and meta-regression,

HEPATOLOGY, Issue 2 2008
Hla-Hla Thein
Published estimates of liver fibrosis progression in individuals with chronic hepatitis C virus (HCV) infection are heterogeneous. We aimed to estimate stage-specific fibrosis progression rates and their determinants in these individuals. A systematic review of published prognostic studies was undertaken. Study inclusion criteria were as follows: (1) presence of HCV infection determined by serological assays; (2) available information about age at assessment of liver disease or HCV acquisition; (3) duration of HCV infection; and (4) histological and/or clinical diagnosis of cirrhosis. Annual stage-specific transition probabilities (F0,F1, , , F3,F4) were derived using the Markov maximum likelihood estimation method and a meta-analysis was performed. The impact of potential covariates was evaluated using meta-regression. A total of 111 studies of individuals with chronic HCV infection (n = 33,121) were included. Based on the random effects model, the estimated annual mean (95% confidence interval) stage-specific transition probabilities were: F0,F1 0.117 (0.104,0.130); F1,F2 0.085 (0.075,0.096); F2,F3 0.120 (0.109,0.133); and F3,F4 0.116 (0.104,0.129). The estimated prevalence of cirrhosis at 20 years after the infection was 16% (14%,19%) for all studies, 18% (15%,21%) for cross-sectional/retrospective studies, 7% (4%,14%) for retrospective-prospective studies, 18% (16%,21%) for studies conducted in clinical settings, and 7% (4%,12%) for studies conducted in nonclinical settings. Duration of infection was the most consistent factor significantly associated with progression of fibrosis. Conclusion: Our large systematic review provides increased precision in estimating fibrosis progression in chronic HCV infection and supports nonlinear disease progression. Estimates of progression to cirrhosis from studies conducted in clinical settings were lower than previous estimates. (HEPATOLOGY 2008.) [source]

Integrated specialty mental health care among older minorities improves access but not outcomes: results of the PRISMe study

Patricia A. Areán
Abstract Objective In this secondary data analysis of Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRIMSe) study, we hypothesized that older minorities who receive mental health services integrated in primary care settings would have greater service use and better mental health outcomes than older minorities referred to community services. Method We identified 2,022 (48% minorities) primary care patients 65 years and older, who met study inclusion criteria and had either alcohol misuse, depression, and/or anxiety. They were randomized to receive treatment for these disorders in the primary care clinic or to a brokerage case management model that linked patients to community-based services. Service use and clinical outcomes were collected at baseline, three months and six months post randomization on all participants. Results Access to and participation in mental health /substance abuse services was greater in the integrated model than in referral; there were no treatment by ethnicity effects. There were no treatment effects for any of the clinical outcomes; Whites and older minorities in both integrated and referral groups failed to show clinically significant improvement in symptoms and physical functioning at 6 months. Conclusions While providing services in primary care results in better access to and use of these services, accessing these services is not enough for assuring adequate clinical outcomes. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Influences of study design and location on the relationship between particulate matter air pollution and birthweight

Jennifer D. Parker
Summary A large number of studies have identified a relationship between particulate matter air pollution and birthweight. Although reported associations are small and varied, they have been identified in studies from places around the world. Exposure assignment, covariates and study inclusion criteria vary among studies. To examine the effect of these and other study characteristics on associations between particulate matter and birthweight, US birth records for singletons delivered at 40 weeks gestation in 2001,03 during the months of March, June, September and December were linked to quarterly estimates of pollution exposure, both particulate matter exposure and exposure to multiple pollutants, by county of residence and month of birth. Annual, 9-month and trimester-specific exposures were assigned. Among births linked to particulate matter exposure there was a small association between coarse particle exposure and birthweight (beta ,13 g per 10 µg/m3 increase [95% CI ,18.3 g, ,7.6 g]) after controlling for maternal factors; this association was attenuated slightly and remained statistically significant after further adjustment for contextual factors, year of birth, region, or urban,rural status. The associations were slightly weaker among births linked to multiple pollutant exposure than among births linked to just particulate matter exposure. The association varied markedly by region, ranging from a decrement of 43 g per 10 µg/m3[95% CI ,58.6 g, ,27.6 g] in the north-west to a null association in the south-west. Trimester findings were smaller, yet remained significant and varied regionally. The association between fine particle exposure and birthweight varied considerably, with an overall small positive association that became null after control for region. This study found that wide regional differences in association may contribute to the varied published findings. The association between coarse particle exposure and birthweight appeared robust, if small; fine particles had no overall association with birthweight. [source]

New predictive equations for spirometric reference values and comparison with Morris equation in a Korean population

RESPIROLOGY, Issue 3 2008
Chang-Hoon LEE
Background and objective: The clinical importance of the differences between actual and predicted spirometric indices in non-Western populations is poorly defined. This study evaluated the differences between the spirometric values derived from Morris equation, traditionally used in South Korea, and the actual values, in the classification and detection of patients with respiratory diseases, and developed new predictive equations for the calculation of reference spirometric values for healthy Koreans. Methods: Data derived from a subset of the population who completed the initial baseline survey of the Korean Health and Genome Study were used to develop new predictive equations for spirometric reference values, using multiple linear regression. The effects of the new equations relative to those of Morris on the detection and classification of patients with respiratory diseases were then evaluated. Results: In total, 9999 people completed the baseline survey; a subgroup of 1314 met the study inclusion criteria and were used to develop the new predictive equations. Morris equation are 53.8% less accurate in detecting people with restrictive disorders and 15.8% less accurate in estimating the severity of COPD than the newly derived equations, although the differences between values derived from the traditional equations and values from the new equations were as small as 3.3,7.6%. Conclusions: The use of spirometric reference values that underestimate the actual parameters, despite the small differences, may have a significant influence on the detection of patients with restrictive disorders and the staging of COPD. [source]

Scope of practice of occupational therapists working in Victorian community health settings

Lynne Quick
Background/aim:,Current health policy places emphasis on community-based health care and it is expected that there will be an increase in the number of people receiving care in community settings. This study aimed to examine the profile and scope of practice of occupational therapists working in Victorian community health settings and the amount and type of health promotion activity incorporated into their role. Method:,An anonymous postal questionnaire was sent to 205 community-based Victorian occupational therapists. One hundred and one (49.3% response rate) questionnaires were returned, with 72 respondents (35.1%) meeting study inclusion criteria. A descriptive research design was used to address study aims. Results:,Results indicate that the majority of community health occupational therapists are experienced practitioners, have a varied scope of practice and report a high level of job satisfaction. Compared with previous studies, there is an increase in new graduate occupational therapists starting their career in community health settings, a greater number of part-time workers and a diversification of clinical and non-clinical roles. Barriers to practice that exist include high demand for service, limited funding and time spent on administrative tasks. Although health promotion was regarded as an important role of community health workers, a large number of therapists were not involved in this activity because of limited knowledge and clinical work taking priority. Conclusion:,Study findings have implications for occupational therapy training, and there is a clear need for input at policy level to address the significant resource allocation issues raised. [source]

Quantified superiority of cognitive behaviour therapy to antidepressant drugs: a challenge to an earlier meta-analysis

G. B. Parker
Objective:, The study aimed to review the conclusion of a previously published meta-analysis which quantified distinct superiority of cognitive therapy to antidepressant drug-therapy (P < 0.0001). Method:, We sought to include all studies used in the original meta-analysis. Adopting both that study's inclusion criteria and additional criteria resulted in a reduced set of studies. We analysed both ,completer' and ,intention to treat' data, using effect size and odds ratio quantification. Results:, There was an overall trend for cognitive therapy to be superior to antidepressant drug-therapy, but this was significant for only one of the four meta-analyses (an intention to treat analysis). We demonstrated considerable heterogeneity between studies, and a significantly higher drop-out rate in the antidepressant groups. Conclusion:, The previous interpretation , cognitive therapy being distinctly superior to antidepressant medication , cannot be sustained from the currently analysed data set. [source]