We performed a cross-sectional study to evaluate the association of anemia with diastolic dysfunction and left ventricular hypertrophy(LVH) in outpatients who had coronary artery disease. Logistic regression was used ...We performed a cross-sectional study to evaluate the association of anemia with diastolic dysfunction and left ventricular hypertrophy(LVH) in outpatients who had coronary artery disease. Logistic regression was used to examine the association of blood hemoglobin(Hb) concentrations with diastolic dysfunction and LVH in 822 participants in the Heart and Soul Study who had normal sinus rhythm and preserved systolic function(left ventricular ejection fraction< 50%). Using transthoracic echocardiography, diastolic dysfunction was defined as diastolically dominant pulmonary vein flow, and LVH was defined as left ventricular mass index >90 g/m2. Anemia(Hb< 13 g/dl) was present in 24%of participants(197 of 822). The prevalence of diastolic dysfunction ranged from 8%in participants who did not have anemia(Hb< 13 g/dl) to 13%in those who had moderate anemia(Hb 11 to 13 g/dl) to 24%in those who had severe anemia(Hb< 11 g/dl, p=0.004 for trend). After multivariable adjustment, moderate anemia(odds ratio [OR] 2.0, 95%confidence interval [CI] 1.1 to 3.6) and severe anemia(OR 6.6, 95%CI 1.9 to 24.9) remained strongly associated with diastolic dysfunction. In contrast, moderate anemia(OR 1.4, 95%CI 1.0 to 2.1) and severe anemia(OR 1.6, 95%CI 0.6 to 4.6) were not significantly associated with LVH.We found anemia to be strongly associated with diastolic dysfunction but not with LVH in this community-based sample of outpatients who had established coronary disease.展开更多
Larger keratinocyte carcinoma (KC) lesions are associated with higher morbidity. This study examined the association of potentially modifiable characteristics, including treatment delay, with KC defect size after Mohs...Larger keratinocyte carcinoma (KC) lesions are associated with higher morbidity. This study examined the association of potentially modifiable characteristics, including treatment delay, with KC defect size after Mohs micrographic surgery (MMS). A stratified random sample of patients treated for KC with MMS were selected for telephone interview. Two hundred and nineteen interviews were completed (refusal rate 24% ). Regression models were used to examine the predictors to defect size and delay. Anatomic site, age, histology, and gender predicted defect size(R2 =0.39) and were used as control variables. Selfreported delay between initial physician examination and MMS predicted defect size (P=0.0004), with greater than 1 y delay being associated with a doubling of defect size (adjusted odds ratio (OR) 2.0; 95% confidence interval (CI) 1.3- 3.1). Delays of this duration were associated with initial examination by a primary provider (unadjusted OR 3.9; 95% CI 1.7- 8.8), misdiagnosis (unadjusted OR 6.8; 95% CI 2.5- 18.7), being treated without biopsy (unadjusted OR 23.3; 95% CI 6.5- 83.7), and multiple surgical removals (unadjusted OR 6.2; 95% CI 2.5- 15.5). All but provider specialty were independent predictors of delay. Attention to processes of care delivery for KC may have a greater impact on morbidity than efforts are earlier detection by the public.展开更多
文摘We performed a cross-sectional study to evaluate the association of anemia with diastolic dysfunction and left ventricular hypertrophy(LVH) in outpatients who had coronary artery disease. Logistic regression was used to examine the association of blood hemoglobin(Hb) concentrations with diastolic dysfunction and LVH in 822 participants in the Heart and Soul Study who had normal sinus rhythm and preserved systolic function(left ventricular ejection fraction< 50%). Using transthoracic echocardiography, diastolic dysfunction was defined as diastolically dominant pulmonary vein flow, and LVH was defined as left ventricular mass index >90 g/m2. Anemia(Hb< 13 g/dl) was present in 24%of participants(197 of 822). The prevalence of diastolic dysfunction ranged from 8%in participants who did not have anemia(Hb< 13 g/dl) to 13%in those who had moderate anemia(Hb 11 to 13 g/dl) to 24%in those who had severe anemia(Hb< 11 g/dl, p=0.004 for trend). After multivariable adjustment, moderate anemia(odds ratio [OR] 2.0, 95%confidence interval [CI] 1.1 to 3.6) and severe anemia(OR 6.6, 95%CI 1.9 to 24.9) remained strongly associated with diastolic dysfunction. In contrast, moderate anemia(OR 1.4, 95%CI 1.0 to 2.1) and severe anemia(OR 1.6, 95%CI 0.6 to 4.6) were not significantly associated with LVH.We found anemia to be strongly associated with diastolic dysfunction but not with LVH in this community-based sample of outpatients who had established coronary disease.
文摘Larger keratinocyte carcinoma (KC) lesions are associated with higher morbidity. This study examined the association of potentially modifiable characteristics, including treatment delay, with KC defect size after Mohs micrographic surgery (MMS). A stratified random sample of patients treated for KC with MMS were selected for telephone interview. Two hundred and nineteen interviews were completed (refusal rate 24% ). Regression models were used to examine the predictors to defect size and delay. Anatomic site, age, histology, and gender predicted defect size(R2 =0.39) and were used as control variables. Selfreported delay between initial physician examination and MMS predicted defect size (P=0.0004), with greater than 1 y delay being associated with a doubling of defect size (adjusted odds ratio (OR) 2.0; 95% confidence interval (CI) 1.3- 3.1). Delays of this duration were associated with initial examination by a primary provider (unadjusted OR 3.9; 95% CI 1.7- 8.8), misdiagnosis (unadjusted OR 6.8; 95% CI 2.5- 18.7), being treated without biopsy (unadjusted OR 23.3; 95% CI 6.5- 83.7), and multiple surgical removals (unadjusted OR 6.2; 95% CI 2.5- 15.5). All but provider specialty were independent predictors of delay. Attention to processes of care delivery for KC may have a greater impact on morbidity than efforts are earlier detection by the public.