Background: A better management of chronic skin disorders (CSDs) requires a knowledge of their impact from the patient’ s point of view. Objectives: To determine which aspects of the patient’ s life are mainly impai...Background: A better management of chronic skin disorders (CSDs) requires a knowledge of their impact from the patient’ s point of view. Objectives: To determine which aspects of the patient’ s life are mainly impaired in the different CSDs,andprovide comparative references to estimate better the real impact of the different CSDs. Patients and methods: A prospective cross-sectional and matched study of 1356 adult outpatients to compare the health-related quality of life (HRQL) profile in chronic urticaria (466 CU), psoriasis (464 PSO) and atopic dermatitis (426 AD), using the VQ-Dermato, a multidimensional instrument in French validated for CSDs. Results: After adjustment for confounders, HRQL dimensions were differently affected in the three CSDs. The ’ physical discomfort’ dimension was more degraded in AD and CU than in PSO (P < 0.001), and ’ leisure activities’ more in PSO than in CU (P < 0.001). ‘ Self-perception’ and ‘ reatment-induced restrictions’ dimensions were much less affected in CU than in PSO and AD (P < 0.001). In PSO, the ‘ daily living activities’ dimension was much less impaired than in CU and AD (P < 0.001). No aspect of HRQL was really spared in AD. Conclusions. The comparison shows that CU, PSO and AD are characterized by completely different qualitative profiles of impact on HRQL, which are influenced by their clinical characteristics and usual treatment options. It underlines the severe impairment of CU which is often underestimated.展开更多
OBJECTIVE: Two common health care delivery systems in the United States are fe e-for-service and managed care systems, including health maintenance organizat ions (HMOs). Differences may exist in patient outcomes depe...OBJECTIVE: Two common health care delivery systems in the United States are fe e-for-service and managed care systems, including health maintenance organizat ions (HMOs). Differences may exist in patient outcomes depending upon the health care delivery system in which they are enrolled. We evaluated possible differen ces in the stage at diagnosis for breast and cervical cancer between 2 Medicare health care delivery systems (ie, fee for service and HMO) over the period 1985 -2001. METHODS: We used a linkage of 2 national databases: the Medicare databas e from the Centers for Medicare and Medicaid Services and the National Cancer In stitute’s Surveillance, Epidemiology, and End Results program database to evalu ate differences in stage at diagnosis between HMO and fee for service for breast and cervical cancer. RESULTS: We studied 130,336 Medicare-aged women with brea st cancer (83%Medicare fee for service) and 6,758 women with cervical cancer (8 7%Medicare fee for service). We found an earlier stage of diagnosis for HMO pat ients, which remained significant after adjusting for potential confounding vari ables. Women enrolled in HMOs with breast cancer were 17%more likely and those with cervical cancer 35%more likely to be diagnosed at an in situ stage of diag nosis than fee-for-service patients. It is of note that when women had other c ancer diagnoses, no statistically significant differences were seen in stage at diagnosis for either cancer between fee-for-service and HMO patients. CONCLUSI ON: Differences exist in stage at diagnosis between Medicare patients enrolled i n HMOs compared with fee for service. This is likely due in part to use of or ac cess to care.展开更多
The type of acute coronary syndromemay account for different prognoses between men andwomen aftermyocardial infarction. This study assessed gender differences in 28-daymortality rates for first or recurrent Q-wave and...The type of acute coronary syndromemay account for different prognoses between men andwomen aftermyocardial infarction. This study assessed gender differences in 28-daymortality rates for first or recurrent Q-wave and non-Q-wave myocardial infarctions and unstable angina by using data from 5 registries that included 20,836 patients (24.8%women). Mortality rates were higher in women with first Q-wave myocardial infarction but not in the other patients after adjusting for confounding variables.展开更多
The goal of this study was to determine if restenosis is increased in mild and moderate chronic kidney disease (CKD) patients after percutaneous coronary intervention (PCI). Mortality is increased in CKD after PCI. Re...The goal of this study was to determine if restenosis is increased in mild and moderate chronic kidney disease (CKD) patients after percutaneous coronary intervention (PCI). Mortality is increased in CKD after PCI. Restenosis may contribute to increased late mortality. We analyzed 11,187 patients with a creatinine >1.8 mg/dl from the Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) trial, grouped by estimated creatinine clearance(CrCl)(< 60, 60 to 89, >89ml/min). The Cox proportional hazards models investigated the association between CrCl group and death, myocardial infarction, and target vessel revascularization(TVR). Generalized estimating equation regression models determined the association between CrCl group and lesion-specific restenosis. At 30 days, therewas no difference in myocardial infarction, death, or TVR between the CrCl groups. At nine months, mortality was higher in the lowest CrCl group(2.2%, 1.2%, 0.8%; p >0.001), which was no longer significant after adjusting for confounding variables. Myocardial infarction and TVR were not different between the groups. In patients undergoing protocol follow-up angiography, restenosis(< 50%) was not increased with CKD(32%, 32%, 37%; p=0.02). Mortality nine months after PCI is mildly increased in mild or moderate CKD patients. However, restenosis is not and does not account for the increased mortality.展开更多
文摘Background: A better management of chronic skin disorders (CSDs) requires a knowledge of their impact from the patient’ s point of view. Objectives: To determine which aspects of the patient’ s life are mainly impaired in the different CSDs,andprovide comparative references to estimate better the real impact of the different CSDs. Patients and methods: A prospective cross-sectional and matched study of 1356 adult outpatients to compare the health-related quality of life (HRQL) profile in chronic urticaria (466 CU), psoriasis (464 PSO) and atopic dermatitis (426 AD), using the VQ-Dermato, a multidimensional instrument in French validated for CSDs. Results: After adjustment for confounders, HRQL dimensions were differently affected in the three CSDs. The ’ physical discomfort’ dimension was more degraded in AD and CU than in PSO (P < 0.001), and ’ leisure activities’ more in PSO than in CU (P < 0.001). ‘ Self-perception’ and ‘ reatment-induced restrictions’ dimensions were much less affected in CU than in PSO and AD (P < 0.001). In PSO, the ‘ daily living activities’ dimension was much less impaired than in CU and AD (P < 0.001). No aspect of HRQL was really spared in AD. Conclusions. The comparison shows that CU, PSO and AD are characterized by completely different qualitative profiles of impact on HRQL, which are influenced by their clinical characteristics and usual treatment options. It underlines the severe impairment of CU which is often underestimated.
文摘OBJECTIVE: Two common health care delivery systems in the United States are fe e-for-service and managed care systems, including health maintenance organizat ions (HMOs). Differences may exist in patient outcomes depending upon the health care delivery system in which they are enrolled. We evaluated possible differen ces in the stage at diagnosis for breast and cervical cancer between 2 Medicare health care delivery systems (ie, fee for service and HMO) over the period 1985 -2001. METHODS: We used a linkage of 2 national databases: the Medicare databas e from the Centers for Medicare and Medicaid Services and the National Cancer In stitute’s Surveillance, Epidemiology, and End Results program database to evalu ate differences in stage at diagnosis between HMO and fee for service for breast and cervical cancer. RESULTS: We studied 130,336 Medicare-aged women with brea st cancer (83%Medicare fee for service) and 6,758 women with cervical cancer (8 7%Medicare fee for service). We found an earlier stage of diagnosis for HMO pat ients, which remained significant after adjusting for potential confounding vari ables. Women enrolled in HMOs with breast cancer were 17%more likely and those with cervical cancer 35%more likely to be diagnosed at an in situ stage of diag nosis than fee-for-service patients. It is of note that when women had other c ancer diagnoses, no statistically significant differences were seen in stage at diagnosis for either cancer between fee-for-service and HMO patients. CONCLUSI ON: Differences exist in stage at diagnosis between Medicare patients enrolled i n HMOs compared with fee for service. This is likely due in part to use of or ac cess to care.
文摘The type of acute coronary syndromemay account for different prognoses between men andwomen aftermyocardial infarction. This study assessed gender differences in 28-daymortality rates for first or recurrent Q-wave and non-Q-wave myocardial infarctions and unstable angina by using data from 5 registries that included 20,836 patients (24.8%women). Mortality rates were higher in women with first Q-wave myocardial infarction but not in the other patients after adjusting for confounding variables.
文摘The goal of this study was to determine if restenosis is increased in mild and moderate chronic kidney disease (CKD) patients after percutaneous coronary intervention (PCI). Mortality is increased in CKD after PCI. Restenosis may contribute to increased late mortality. We analyzed 11,187 patients with a creatinine >1.8 mg/dl from the Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) trial, grouped by estimated creatinine clearance(CrCl)(< 60, 60 to 89, >89ml/min). The Cox proportional hazards models investigated the association between CrCl group and death, myocardial infarction, and target vessel revascularization(TVR). Generalized estimating equation regression models determined the association between CrCl group and lesion-specific restenosis. At 30 days, therewas no difference in myocardial infarction, death, or TVR between the CrCl groups. At nine months, mortality was higher in the lowest CrCl group(2.2%, 1.2%, 0.8%; p >0.001), which was no longer significant after adjusting for confounding variables. Myocardial infarction and TVR were not different between the groups. In patients undergoing protocol follow-up angiography, restenosis(< 50%) was not increased with CKD(32%, 32%, 37%; p=0.02). Mortality nine months after PCI is mildly increased in mild or moderate CKD patients. However, restenosis is not and does not account for the increased mortality.
