Publications by authors named "Haroutune K Armenian"

21 Publications

  • Page 1 of 1

Prospective study of predictors of poor self-rated health in a 23-year cohort of earthquake survivors in Armenia.

J Epidemiol Glob Health 2015 Sep 14;5(3):265-74. Epub 2015 Feb 14.

School of Public Health, American University of Armenia, 40 Marshal Baghramian Ave., Yerevan 0019, Armenia.

Long-term prospective studies exploring general health outcomes among disaster survivors are rare. Self-rated health (SRH) - a proven correlate of morbidity and mortality prognosis - was used to investigate predictors of perceived health status among a 23-year cohort of survivors of 1988 Spitak earthquake in Armenia. A geographically-stratified subsample of 725 adults from a larger initial cohort was followed during the period of 1990-2012. A logistic regression model identified predictors of SRH. Adjusted relative risks for the long-term predictors of SRH were calculated. The rate of poor SRH among the survivors was 18.8%, fair 56.5%, and good/excellent 24.7%. In the fitted model, long-term risk factors of poor SRH included baseline body mass index, baseline multi-morbidity, number of experienced stressful life events, and perceived poor living standards during the post-earthquake decade, while participation in sports in the early 1990s was a protective factor. Short-term protective factors included socio-economic status score, social support, employment and dignity, while current household size was a risk factor for poor SRH. No association was found between earthquake exposure severity and SRH after 23 years. However, the identified predictors included a number of modifiable lifestyle, material and psychological factors. Thus, interventions targeting these factors could have a long-lasting impact on disaster victims' health status.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jegh.2014.12.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320530PMC
September 2015

Loss and psychosocial factors as determinants of quality of life in a cohort of earthquake survivors.

Health Qual Life Outcomes 2015 Feb 6;13:13. Epub 2015 Feb 6.

Department of Psychiatry and Biobehavioral Sciences, UCLA/Duke University National Center for Child Traumatic Stress, UCLA, Los Angeles, CA, USA.

Background: Despite the existing evidence of a long lasting effect of disaster related experiences on physical and psychological health, few studies have evaluated long-term quality of life (QOL) outcomes of disaster survivors and the factors associated with such outcomes.

Methods: 23 years after the 1988 Spitak earthquake in Armenia, the associations of demographic characteristics, trauma exposure and psychosocial variables on QOL were explored among a cohort of 725 exposed individuals. The EQ-5D-5 L instrument was applied to measure QOL of participants. Multivariate linear and ordinal logistic regressions were applied to evaluate the determinants of QOL and its underlying five domains (mobility, self-care, usual activity, pain/discomfort, and anxiety/depression).

Results: Older age, current depression, post-traumatic stress disorder and anxiety symptoms were negatively associated with QOL. Additionally, those with severe losses (who did not receive any financial/material aid) had significantly poorer QOL outcomes, with higher odds of mobility difficulties (OR = 1.86, p < 0.05), self-care difficulties (OR = 2.85, p < 0.05), and mood problems (OR = 2.69, p < 0.05). However, those with severe earthquake related losses who received financial/material aid reported less self-care difficulties (OR = 0.21, p < 0.05) usual activity difficulties (OR = 0.40, p < 0.05), and mood problems (OR = 0.44, p < 0.05). Finally, each unit increase in current social support score was found to be significantly associated with a better QOL outcome and better self-reported outcomes across all underlying domains of QOL.

Conclusions: These findings suggest that earthquake related loss and concurrent psychopathology symptoms can have adverse impact on the QOL of survivors. They also indicate that well-targeted post-disaster financial/material aid and social support should be considered as means for improving the long-term QOL outcomes of disaster survivors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12955-015-0209-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336679PMC
February 2015

Rate and predictors of postpartum depression in a 22-year follow-up of a cohort of earthquake survivors in Armenia.

Arch Womens Ment Health 2014 Jun 17;17(3):229-37. Epub 2014 Jan 17.

School of Public Health, American University of Armenia, 40 Marshal Baghramian Avenue, Yerevan, 0019, Armenia,

Disasters have serious long-term impact on mental health for those exposed. The aim of this study was to identify predictors of postpartum depression among survivors of the 1988 devastating earthquake in Armenia. A nested case-control design was applied to investigate postpartum depression in a large-scale cohort of survivors followed between 1990 and 2012. From an original group of 725 adults who were assessed for psychopathology in 1990, 146 women reported having a delivery after the earthquake and were included in this study. Women with postpartum depression were identified using Edinburgh Postnatal Depression Scale. A logistic regression model was fitted to identify the predictors of postpartum depression. Of the 146 women, 19 (13.0%) had postpartum depression. Five independent predictors of postpartum depression were identified: number of woman's stressful life events (odds ratio (OR)=2.06), her prior history of postpartum depression (OR=16.98), delivering sick/dead neonate (OR=13.65), poor living standards during the post-earthquake decade (OR=5.77), and perceiving oneself reliable in 1990 (OR=0.24). Anxiety in 1990 was marginally significantly related to the outcome (OR=3.75). The rate of postpartum depression in this 22-year cohort was similar to that among the Armenian general population. Earthquake exposure was not related to postpartum depression, indicating that the impact of disaster-related trauma diminishes over time. The identified predictors provided evidence to develop interventions targeting groups of women most prone to postpartum depression under such circumstances.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00737-013-0404-5DOI Listing
June 2014

Short and long term determinants of incident multimorbidity in a cohort of 1988 earthquake survivors in Armenia.

Int J Equity Health 2013 Aug 20;12:68. Epub 2013 Aug 20.

School of Public Health, American University of Armenia, 40 Marshal Baghramian Avenue, Yerevan 0019, Armenia.

Background: Multimorbidity, presence of two or more health conditions, is a widespread phenomenon affecting populations' health all over the world. It becomes a serious public health concern due to its negative consequences on quality of life, mortality, and cost of healthcare services utilization. Studies exploring determinants of multimorbidity are limited, particularly those looking at vulnerable populations prospectively over time. This study aimed at identifying short and long term socioeconomic, psychosocial, and health behavioral determinants of incident multimorbidity among a cohort of the 1988 Armenian earthquake survivors.

Methods: The study included a representative subsample of 725 from a larger initial cohort of the earthquake survivors. Data on this subsample were collected via four phases of this cohort study during the period 1990-2012. The final logistic regression analysis eliminated all those cases with baseline multimorbidity to investigate short and long term determinants of incident multimorbidity; this subsample included 600 participants.

Results: More than 75% of the studied sample had multimorbidity. Perceived low affordability of healthcare services, poor living standards during the post-earthquake decade, and lower education were independent predictors of incident multimorbidity developed during the period 1990-2012. Stressful life events and poor social support were among psychosocial determinants of incident multimorbidity. Participants' baseline BMI reported in 1990 was independently associated with incident multimorbidity.

Conclusions: Most of the identified determinants of incident multimorbidity in our study population were markers of social inequities, indicating that inequities pose a serious threat to both individual and public health-related outcomes. Strategies targeting to decrease such inequities along with promotion of healthy lifestyle and strengthening of social networks may considerably reduce multimorbidity among population groups with similar socioeconomic and cultural profiles.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1475-9276-12-68DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751856PMC
August 2013

Triggers for attacks in familial Mediterranean fever: application of the case-crossover design.

Am J Epidemiol 2012 May 10;175(10):1054-61. Epub 2012 Jan 10.

Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E-3153, Baltimore, MD 21205-2179, USA.

The etiology of recurrent attacks of serositis in familial Mediterranean fever (FMF) is not completely understood. Uncontrolled clinical case series have reported that factors associated with emotional, physiological, or physical stress precede and might trigger the attacks. This case-crossover study, conducted between July 2007 and May 2008, aimed to estimate the role of precipitating factors in attacks in a sample of Armenian FMF patients in Yerevan, Armenia, where 104 patients contributed 55 case and 189 control time periods. The authors used conditional logistic regression to compare frequency of exposure to stressful events, strenuous physical activity, menstrual periods, and high-fat food consumption prior to FMF attacks and on attack-free random days. Multiple stressful life events predicted FMF attacks 2 days following the event. After adjustment for treatment, an additional stressful event was associated with an estimated 70% increase in the odds of having an FMF attack on the second day (95% confidence interval: 1.04, 2.79). High levels of perceived stress were also associated with FMF attacks. Physical exertion and high-fat diet did not increase the likelihood of FMF attacks. The possibility of prevention of attacks in FMF needs to be tested through stress-reduction interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/aje/kwr460DOI Listing
May 2012

Interaction of maternal age and mode of delivery in the development of postpartum depression in Yerevan, Armenia.

J Affect Disord 2011 Dec 10;135(1-3):77-81. Epub 2011 Aug 10.

Center for Health Services Research and Development, American University of Armenia, Yerevan, Armenia.

Background: To investigate determinants of development of postpartum depression among women in Yerevan, Armenia.

Method: A case-control study of all reproductive age (18-45) women having 1-3 months old children registered in 7 Primary Health Care (PHC) facilities, in Yerevan. We used Edinburgh Postnatal Depression Scale (EPDS) and a structured questionnaire to assess possible postpartum depression status of mothers and exposure status through telephone interviews.

Results: The study had a 96.7% response rate for 63 cases and 272 controls. The prevalence of possible postpartum depression was 14.4%. The risk of possible postpartum depression associated with age less than 25 years at childbirth was increased only among women who delivered their child through C-section (OR=7.8; 95% CI: 1.5-40.7). Meanwhile, this risk was much lower among women who delivered through vaginal delivery (OR=0.9; 95% CI: 0.4-1.8).

Limitations: EPDS had not been translated and validated in Armenia. Study population included only women having 1-3 months old children.

Conclusion: The study suggested that the effect of younger age at last childbirth on the risk of possible postpartum depression development was higher for women who gave birth through C-section compared to those with vaginal delivery. Despite the stressful and crisis conditions existing in Armenia over the past 2 decades the prevalence of possible postpartum depression does not differ much from that in other societies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jad.2011.06.061DOI Listing
December 2011

Prevention of amyloidosis in familial Mediterranean fever with colchicine: a case-control study in Armenia.

Med Princ Pract 2009 30;18(6):441-6. Epub 2009 Sep 30.

American University of Armenia, Yerevan, Republic of Armenia.

Objective: To determine whether or not the use of colchicine decreases the risk of amyloidosis among Armenian patients with familial Mediterranean fever (FMF).

Subjects And Methods: The study included 99 Armenian patients from the Center of Medical Genetics database with genetically ascertained FMF; 33 had renal amyloidosis and 66 were randomly selected control patients without renal amyloidosis. Self- reported colchicine use was assessed by interviewer-based questionnaire.

Results: The patients with incident amyloidosis were more likely to be older men, but younger at the time of disease onset, and more likely to have had a family history of amyloidosis and M694F mutation in the MEFV gene compared to patients without amyloidosis. The risk of amyloidosis decreased with adequate colchicine use rather than nonadequate use (adjusted odds ratio, OR, 0.48, 95% confidence interval, CI, 0.16-1.43), continuous colchicine use rather than interrupted use (adjusted OR 0.15, 95% CI 0.04-0.53), earlier rather than later initiation age of colchicine treatment (adjusted OR 0.95, 95% CI 0.90-1.01), current colchicine rather than ever/never colchicine use (adjusted OR 0.20, 95% CI 0.05-0.89).

Conclusion: The study demonstrated that colchicine treatment is effective in preventing amyloidosis among Armenian patients with FMF and that earlier initiation and continuous therapy at an adequate dose of 1.2-1.8 mg/day may be associated with a decreased amyloidosis risk among Armenian patients with FMF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000235892DOI Listing
February 2010

Epidemiology: a problem-solving journey.

Am J Epidemiol 2009 Jan 12;169(2):127-31. Epub 2008 Nov 12.

Department of Epidemiology, the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

As a scientific discipline, epidemiology has helped liberate the practice of public health and medicine from dogmatic thinking over the past century. This commentary highlights some integrating principles to explain why epidemiology is a problem-solving discipline. The first of these is that epidemiology is an information science. Epidemiology generates information for decision-making at all levels of the health-care system, including information for both individuals and the general public. Although all scientific disciplines produce data that may be used for decision-making, there is more immediacy for the decisions in epidemiology. The second principle is that epidemiology operates within an environment of complex systems. Etiologic factors operate in complex systems, and the use of a systems analysis approach in investigating health problems must be considered. The third principle is that epidemiology is not just a scientific discipline but a professional practice area as well. Epidemiology has a solid disciplinary scientific base, and its practice requires well-grounded academic preparation. Its objectives are very much within the public-social domain, and a well-defined, outcome-oriented, prevention-based philosophy steers its practice. In a number of universities, epidemiology is taught today as a research discipline rather than as an operational, problem-solving one. In conclusion, this commentary emphasizes the need to accept the fact that epidemiology has as much of a social role as a scientific one. Public health action, problem solving, and a sense of mission are what brings many students to epidemiology. A problem-solving, action-oriented epidemiology is consistent with that sense of mission.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/aje/kwn311DOI Listing
January 2009

Low bone mineral density, coronary heart disease, and stroke mortality in men and women: the Third National Health and Nutrition Examination Survey.

Ann Epidemiol 2007 Nov 28;17(11):841-6. Epub 2007 Aug 28.

Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD 20782, USA.

Purpose: The aim of this study is to determine the long-term association of bone mineral density and cardiovascular disease mortality.

Methods: The data used are from the Third National Health and Nutrition Examination Survey (NHANES III), a nationally representative sample of noninstitutionalized civilians. A cohort of white, black, and Mexican-American persons ages 50 years and older at baseline (1988-1994) was followed through 2000 for coronary heart disease (CHD; n = 4690) and stroke mortality (n = 5272) using the NHANES III Linked Mortality File.

Results: Death certificates were used to identify 369 CHD and 166 stroke deaths. Results were evaluated to determine the relative risk of CHD or stroke per one standard deviation lower bone mineral density after adjusting for multiple risk factors. In Cox proportional hazards models, risk of CHD death and risk of stroke death were not associated with low bone mineral density among men. For women, no significant associations were found for stroke (relative risk, 1.34; 95% confidence interval, 0.86-2.07, p = 0.20) or CHD (relative risk, 1.26; 95% confidence interval, 0.88, 1.80; p = 0.21).

Conclusions: Low bone mineral density was not associated with risk of cardiovascular disease in men. Among women with low bone mineral density, risk of CHD and stroke were elevated, but no significant associations were found.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annepidem.2007.06.005DOI Listing
November 2007

Latency and exposure-health associations in Gulf War veterans with early fatigue onsets: a case-control study.

Ann Epidemiol 2007 Oct 26;17(10):799-806. Epub 2007 Jul 26.

Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, MD, USA.

Purpose: To see if self-reported exposures were associated with health in early-onset Gulf War illnesses (GWIs) cases and healthy Gulf War veteran controls.

Methods: Forty-nine cases and 44 controls completed questionnaires about wartime exposures and symptoms experienced. Odds ratios were calculated using 2 x 2 tables and logistic regression. The incubation curve of fatigue onsets in cases was drawn to highlight exposure/health associations using Sartwell's method and tested with the Shapiro-Wilk test. The incubation period was defined as the time from arrival in the Persian Gulf to fatigue onset.

Results: The incubation curve was right skewed and lognormally distributed (p = 0.48; p > 0.05 indicates lognormality), suggesting an association between a wartime exposure and fatigue. Exposure to oil fire smoke, pesticides, contaminated food or water, dead animals, scud missile attacks, dead bodies, prisoners of war, artillery or small arms fire, and chemical suits was significantly associated with GWIs. Pyridostigmine bromide (PB) was the only continuous exposure significantly associated with GWIs. The odds of having GWIs increased by 1.3% for every PB pill taken (95% confidence interval 1.001-1.02). There were significant trends toward worse health with greater intake of PB.

Conclusions: These analyses suggest that wartime exposures, including exposure to PB, are associated with fatigue.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annepidem.2007.05.001DOI Listing
October 2007

Feeding practices of babies and the development of atopic dermatitis in children after 12 months of age in Armenia: is there a signal?

Eur J Epidemiol 2006 18;21(9):723-5. Epub 2006 Oct 18.

We investigated the influence of feeding practices on development of atopic dermatitis (AD) in Armenian children (n = 240). In multivariate models early introduction to solids, family history of atopy, and breastfeeding by a mother with atopic condition were associated with the development of AD after 12 months post-term. A prospective study in Armenia is recommended to confirm our findings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10654-006-9061-6DOI Listing
January 2007

Familial aggregation of fainting in a case-control study of neurally mediated hypotension patients who present with unexplained chronic fatigue.

Europace 2006 Oct 18;8(10):846-51. Epub 2006 Aug 18.

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6148, Baltimore, MD 21205, USA.

Aims: We hypothesized that family history of fainting is a risk factor for adult-onset neurally mediated hypotension (NMH) in patients who present with chronic fatigue rather than fainting.

Methods And Results: A nested case-control study of Gulf War veterans gathered fainting histories directly from 197 first-degree relatives of 16 fatigued NMH cases, 26 fatigued controls, and 17 healthy controls. NMH status was determined by tilt testing. Female relatives of fatigued controls reported more fainting than female relatives of cases (P<0.01); there were no significant differences in the frequency of fainting in male relatives by case or control status, or in either gender by age at first faint or by familial relationship to the proband. The odds of NMH patients giving any family history of fainting were 0.56 (95% CI 0.15, 2.07). Recurrence risks calculated using lifetime prevalences of fainting in male military personnel of similar age to our participants were low (1.5-1.7) and did not differ by case or control status.

Conclusion: Family history of fainting is not a risk factor for adult-onset NMH in fatigued veterans. Our findings may differ from other studies of familial aggregation in NMH because of study methods or because NMH-fatiguers may differ from NMH-fainters.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/europace/eul092DOI Listing
October 2006

Health-related quality of life and depression among older people in Yerevan, Armenia: a comparative survey of retirement home and household residents aged 65 years old and over.

Age Ageing 2006 Mar 18;35(2):190-3. Epub 2006 Jan 18.

College of Health Sciences, Center for Health Services Research and Development, American University of Armenia, 40 Marshal Baghramyan, Yerevan 375019, Armenia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ageing/afj039DOI Listing
March 2006

Characterizing Gulf War Illnesses: neurally mediated hypotension and postural tachycardia syndrome.

Am J Med 2005 Dec;118(12):1421-7

Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjmed.2005.06.034DOI Listing
December 2005

A positive or a negative confounding variable? A simple teaching aid for clinicians and students.

Ann Epidemiol 2005 Jul 21;15(6):421-3. Epub 2005 Jan 21.

Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.

Anticipating the direction of a confounding variable can be problematic especially to introductory students. Using elementary rules of mathematics, we describe below a simple instructional tool for deriving the direction of confounding bias. The tool is illustrated with examples and a heuristic mathematical justification is also described.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annepidem.2004.10.004DOI Listing
July 2005

Application of case-crossover and case-time-control study designs in analyses of time-varying predictors of T-cell homeostasis failure.

Ann Epidemiol 2005 Feb;15(2):137-44

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.

Purpose: To evaluate the association of sexual behavior and recreational drug exposures with T-cell homeostasis failure (TCHF), which corresponds to the onset of a rapid decline in an individual's T lymphocyte count, which occurs on average approximately 1.75 years prior to an initial diagnosis of acquired immunodeficiency syndrome (AIDS).

Methods: A case-crossover design and a case-time-control design, both nested within the Multicenter AIDS Cohort Study of 4954 homosexual and bisexual men initiated in 1983.

Results: In the case-crossover analysis, use of both recreational drugs and hashish were found to be protective against TCHF (odds ratios < or = 0.41), based on comparisons with four earlier control periods. However, a significant decreasing trend in the prevalence of these exposures was observed over time, thus motivating the implementation of the case-time-control design. Using the latter approach, the associations of drug use (odds ratio=0.53; 95% confidence interval (CI): 0.22, 1.28) and hashish use (odds ratio=0.46; 95% CI: 0.20, 1.05) with TCHF were no longer statistically significant.

Conclusions: The difference in inferences between these approaches demonstrates the importance of evaluating temporal trends in exposures when using a case-crossover design.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annepidem.2004.05.002DOI Listing
February 2005

Incident hypertension associated with depression in the Baltimore Epidemiologic Catchment area follow-up study.

J Affect Disord 2004 Dec;83(2-3):127-33

Department of Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD 21204, USA.

Background: This study evaluates the role of depression as a specific risk factor for hypertension.

Methods: This study analyzed the prospective data in the Baltimore Epidemiologic Catchment Area (ECA) Follow-up Study (n=1920), a longitudinal population-based study of mental illness in East Baltimore. Incident cases of hypertension as assessed by self-report (n=148) in 1993 were compared to the remaining cohort without hypertension (n=901) across three waves of ECA interviews (1981, 1982, 1993). Depression and related symptoms were measured at baseline (1981) by the Diagnostic Interview Schedule (DIS) and categorized as dysphoria, dysthymia, or major depressive episode (MDE) according to Diagnostic and Statistical Manual (DSM) III criteria.

Results: Individuals with a major depressive episode compared to those who reported never having dysphoria had a marginally significant increased risk for hypertension (Odds Ratio (OR)=2.16; 95% Confidence Interval (CI) (0.94,4.98)) after adjustment for age, gender, race, body mass index, Nam-Powers socioeconomic score, alcohol usage, smoking, exercise, diabetes status, and number of general medical visits. MDE reported to have begun more than a year before the baseline measurement was associated with an increased risk for incident hypertension (Adjusted OR=3.67, 95% CI (1.25,10.79).

Limitations: Potential misclassification of self-reported hypertension outcome.

Conclusions: Even though the data are based on self-report of hypertension, these findings suggest that depression may be an independent risk factor for hypertension particularly for those with recurrent episodes or a long term history of the disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jad.2004.06.004DOI Listing
December 2004

Predictors of cause-specific hospital readmission in patients with heart failure.

Clin Cardiol 2003 Sep;26(9):411-8

Department of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.

Background: Repeated hospital readmissions are frequent and increasing over time in patients with heart failure (HF). The predictors for readmission in patients with HF are not completely understood.

Hypothesis: The study was undertaken to investigate the time course of readmission by specific cause in patients with HF, and to examine the independent effects of HF etiology and left ventricular (LV) function on cause-specific readmissions.

Methods: A retrospective cohort of 493 consecutive patients with HF was followed for readmission for 16.5 +/- 12.3 months. Ischemic etiology of HF was defined as history of myocardial infarction (MI), coronary artery bypass graft (CABG), percutaneous transluminal coronary angioplasty (PTCA), or > or = 70% coronary stenosis. Left ventricular function was assessed echocardiographically. Cause-specific readmissions were classified as HF, cardiovascular disease (CVD) other than HF, and other non-CVD.

Results: The annual readmission rate was 56.6%. Median time to readmission was 91 days, with 18.3% patients readmitted within 1 month after discharge. Ischemic etiology independently predicted all-cause readmission: Cox hazard ratio (95% confidence interval): 1.40 (1.11-1.79). This relationship was significant in women (1.83 [1.31-2.55]), but not in men (1.15 [0.82-1.62]), while readmissions were equally frequent in both genders. Similarly, ischemic etiology significantly predicted readmission for CVD in women (4.18 [2.14-8.19]), but not in men (1.49 [0.83-2.67]). However, LV dysfunction independently predicted readmission for recurrent HF (2.44 [1.46-4.08]), while ischemic etiology was not predictive in either gender.

Conclusions: Readmissions for recurrent HF comprise only one-third of total hospital readmissions in patients with HF. Ischemic etiology is a significant predictor of readmission, and most of this effect is mediated through a four-fold increased risk of readmission for CVD other than HF in women. Readmission for recurrent HF is predicted by LV dysfunction but not by ischemic etiology. Patients with HF can be accurately risk stratified for cause-specific readmission with available clinical data.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/clc.4960260906DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6654034PMC
September 2003

Factors associated with human herpesvirus type 8 infection in an injecting drug user cohort.

Sex Transm Dis 2003 Mar;30(3):199-204

Department of Epidemiology, The Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland 21205, USA.

Background: Human herpesvirus type 8 (HHV-8) has been infrequently studied in injecting drug user (IDU) populations.

Goal: To estimate the seroprevalence of HHV-8 and risk factors for infection in a cohort of 2,946 IDUs.

Study Design: In this nested cross-sectional study of 390 IDUs, lytic HHV-8 indirect immunofluorescence assay (IFA) was utilized to estimate the HHV-8 seroprevalence. Multivariate logistic regression was used to assess risk factors for infection.

Results: The HHV-8 seroprevalence among the IDUs examined in 1988 was 11.5% (95% confidence interval, 8.5-15.13). HHV-8 seroprevalence in this population was associated with being female (OR = 2.2; = 0.080), having a larger body mass index (OR = 3.0; = 0.053), and history of genital warts (OR = 4.0; = 0.023). Injection of any drug more than daily exhibited an inverse effect on HHV-8 seropositivity (OR = 0.5; = 0.085).

Conclusion: The seroprevalence of HHV-8 in this population is similar to that seen in the general population, with risk factors being more consistent with sexual behaviors than injection drug use.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/00007435-200303000-00004DOI Listing
March 2003

Risk factors for depression in the survivors of the 1988 earthquake in Armenia.

J Urban Health 2002 Sep;79(3):373-82

Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA.

Most studies of psychopathology following disasters are concerned with posttraumatic stress disorder (PTSD). The present analyses sought to assess the rate and determinants of depression in adult survivors of the 1988 earthquake in Armenia. Unlike previous studies of earthquakes, the present analyses derive from a well-defined cohort of survivors who underwent diagnostic interviewing to characterize psychiatric morbidity. As part of a cohort study of 32,743 survivors of the 1988 earthquake in Armenia, a stratified population sample of 1,785 persons was interviewed about 2 years following the disaster using a special questionnaire based on the National Institute of Mental Health (NIMH) Disaster Interview Schedule/Disaster Supplement. 52% met the criteria for major depression. Of these, a total of 177 cases of depression with no other psychiatric diagnosis or comorbidity were compared with 583 controls from the same interviewed group who did not fulfill the criteria for any psychiatric disorder. Cases and controls were compared as to data obtained independently at the aftermath of the disaster on a number of exposures and characteristics related to the earthquake. More of the cases involved females (odds ratio [OR] for males 0.7 [95% confidence interval [CI] 0.5-0.9]) and from the city of Gumri, which had some of the worst destruction (OR for residents of Gumri 5.9 [95% CI 4.0-8.8]). Being with someone in the same building at the moment of the earthquake was protective for depression (OR for presence of other people 0.5 [95% CI 0.3-0.6]), and the risk of depression increased with the amount of loss that the family sustained as a result of the earthquake (OR for highest level of loss 2.5 [95% CI 1.3-4.8]). The use of alcohol was protective for depression (OR for those who drink 0.5 [95% CI 0.3-0.8]). In various models of multivariate adjustment and analysis, the increased risk of depression with loss, geographic location, and female gender was maintained. Also, being with someone during the disaster, receiving assistance and support after the earthquake, and alcohol use were protective for depression in these multivariate analyses. Depression is a common sequel to an earthquake. As with our previous study of PTSD, we were able to relate intensity of the disaster and loss to the risk of depression in a general population sample. The role of social support during and after the disaster as a protective mechanism against adverse psychological outcome was highlighted again. Whereas alcohol use in our previous study was not related to PTSD outcome, it is noteworthy that in the present analyses it emerged as a protective factor for depression.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jurban/79.3.373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3456783PMC
September 2002

Urinary incontinence and psychological distress in community-dwelling older adults.

J Am Geriatr Soc 2002 Mar;50(3):489-95

Department of Family Practice and Community Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.

Objectives: To examine the relationship between urinary incontinence (UI) and psychological distress in older adults. We hypothesized that persons with UI associated with condition-specific functional loss would be most likely to report psychological distress.

Design: A population-based longitudinal survey.

Setting: Continuing participants in a study of community-dwelling adults who were initially living in East Baltimore in 1981.

Participants: Persons aged 50 and older (n=781) at follow-up interviews conducted between 1993 and 1996 for whom complete data were available.

Measurements: Participants were classified as incontinent if they reported any uncontrolled urine loss within the 12 months preceding the 13-year follow-up interview. Condition-specific functional loss secondary to UI was further assessed based on a series of questions relating directly to participants' inability to engage in certain activities due to their UI. Psychological distress was assessed using the General Health Questionnaire (GHQ) at interviews in 1981 and at the 13-year follow-up.

Results: Persons with UI were more likely to experience psychological distress as measured by the GHQ than were persons without UI (unadjusted odds ratio (OR)=1.74, 95% confidence interval (CI)=1.13-2.68). Persons with condition-specific functional loss secondary to UI were substantially more likely to have psychological distress as measured by the GHQ than were persons without UI (unadjusted OR=4.02, 95% CI=1.86-8.70). In multivariate models that controlled for potentially influential characteristics such as age, gender, ethnicity, and chronic medical conditions the association between condition-specific functional loss secondary to UI and psychological distress remained statistically significant. Among people with UI, persons with persistently elevated GHQ scores were much more likely to report condition-specific functional impairment from UI (adjusted OR=6.55, 95% CI=1.94-22.12).

Conclusion: Individuals with UI, especially when incontinence was associated with condition-specific functional loss, were more likely to have psychological distress than were other older adults. Our findings support a general conceptual model that condition-specific functional impairment mediates the relationship between a chronic medical condition and psychological distress.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827934PMC
http://dx.doi.org/10.1046/j.1532-5415.2002.50115.xDOI Listing
March 2002
-->