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Factors associated with length of stay in three London teaching hospitals during 1972 and 1975 were examined in patients treated for myocardial infarction, cerebrovascular disease, inguinal hernia without obstruction, and gall stones. Statistical analyses were carried out with multiple regressions on log lengths of stay.Increased length of stay was associated with infection in all four groups and with the seriousness of operative procedures in all but patients with cerebrovascular disease. Although age was a significant variable in patients with hernias and gall stones, it had relatively little practical effect on length of stay. Other significant variables in at least one disease were obesity, number of abnormalities in blood chemistry, administration of parenteral fluids or oxygen, or use of monitoring devices, and whether chest radiography was carried out, blood electrolytes and urea were measured, or anticoagulants were used. Patients with cerebrovascular disease who were not discharged to their own homes stayed on average more than two and a half times longer than other patients.Between a third and a half of the variance was explained by these variables and the variation among firms. The method described is reproducible in other hospital settings, and the study shows that much new information could be available routinely without mounting expensive field trials.
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PMID:Firm, patient, and process variables associated with length of stay in four diseases. 63 Feb 21

The American Society of Anesthesiologists' (ASA) Physical Status Classification was tested for consistency of use by a questionnaire sent to 304 anesthesiologists. They were requested to classify ten hypothetical patients. Two hundred fifty-five (77.3 percent) responded to two mailings. The mean number of patients rated consistently was 5.9. Four patients elicited wide ranges of responses. Age, obesity, previous myocardial infarction, and anemia provoked controversy. There was no significant difference in responses from different regions of the country. Academic anesthesiologists rated a greater number identical than did those in private practice (P less than 0.01). There was no difference in ratings between those who used the classification for billing purposes and those who did not. The ASA Physical Status Classification is useful but suffers from a lack of scientific precision.
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PMID:ASA physical status classifications: a study of consistency of ratings. 69 77

Risk factors were compared in 300 patients with brain stroke and 120 patients with neurosis or sciatic pains. It was found that arterial hypertension (p = 0.001) and diabetes (p = 0.01) were significantly more frequent in cases of brain stroke. Disturbances of lipid metabolism, tobacco smoking and obesity showed no significant difference. Extracerebral atherosclerosis (p = 0.001) increased the risk of stroke. Coronary arterial disease was most frequent (48.8%), myocardial infarction (8.3%) and calcifications in the aorta (32%) were second and third in frequency. Presence of at least two risk factors may be an indication to prophylactic treatment.
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PMID:[Risk factors in stroke]. 72 25

We studied the prevalence and the risk factor among the patients of gout in Mexico. Research was conducted in the National Institute of Cardiology and in our private practice. Prevalence of hiperuricemia and gout in the Institute of Cardiology was of 1% (970 out of nearly 100,000 patients). We divided those cases of two subgroups: Reumatology patients (333) and Cardiovascular patients (529). In the first group primary gout was (96.3), and (50.32% in the second. Risk factor was quite different too: nephropathy 9.9%, lithiasis 9.3%, pyelonephritis 2.7%, cardioangiosclerosis 12.9%, aortosclerosis 6.6%, coronary insufficiency 6.3%, myocardial infarction 0.9%, arterial hypertension 24.6% obesity 56.1% and diabetes 9.9% in the Reumatology group; in the Cardiovascular one, nephropathy 14.3%, lithiasis 12.2%, pyelonephritis 7.1%, cardioangiosclerosis 62.7%, aortosclerosis 31.7%, coronary insufficiency 24.9%, myocardial infarction 29%, arterial hypertension 51%, obesity 54.8% and diabetes 20.4%. Among the private practice patients prevalence was of 10.1% (961). In an early age (39 years) in men and a later one for women (53 years). Other characteristics of epidemiology and risk factor are: primary gout 89%, atherosclerosis 5%, coronary disease 4.6%, lithiasis 4.7%, nephropathy 2%, pyelonephritis 1%, obesity 43%, and diabetes 4.6%. In an small group of patients of our private practice we made an exhaustive study of risk factor and the metabolic disorder of lipids. We found the following frequency: 9.3 of nephropathy, 31.2% of lithiasis, 18.7% of pyelonephritis, 68.9% of cardioangiosclerosis, 46.8% de coronary insufficiency, 9.3% of myocardial infarction, 68.7% of arterial hypertension, 68.7% of obesity and 18.7% of diabetes. In the lipid profile we found an increase in triglicerids and prebeta lipoprotein. We have amply discussed the relation between hiperuricemia and pathology considered as a risk factor from the genetic point of view as well as the metabolic and circumstancial aspect. From all that we concluded that risk is multifactorial.
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PMID:[Various epidemiological aspects of hyperuricemia and gout in Mexico: incidence and the cardiovascular risk factor]. 72 44

Clinical, angiological, and biochemical examinations were performed in 981 men and 30 women with organic afflictions of peripheral arteries, and in 411 men and 50 women without any signs of peripheral arterial lesions. Their family histories were thoroughly recorded with particular reference to the occurrence of myocardial infarction, cerebral accidents before and after the age of 60 years, and death of these causes; further, of hypertension, diabetes mellitus, obliterations and gangraenes, in each patient's siblings, parents, and all four grandparents. Furthermore, the significance of positive family history in combination with other risk factors was investigated. Family history can be considered positive with respect to obliterative atherosclerosis when in anyone of the patient's grandparents, parents, or siblings an obliteration of peripheral arteries is present or when anyone of them died of myocardial infarction or apoplexy, especially when aged under 60 years. Presence of several factors in the specified next of kin accelerates the obliterative process in the patient. A positive family history, however, plays no decisive role either alone or in combination with any other single risk factor, but only in combination with two or more other factors, one of which is always tobacco smoking; it is not significant in any combination with obesity.
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PMID:Positive family history as a risk factor of obliterative atherosclerosis. 72 85

Blood pressure was measured under standardized conditions in 151 first-grade schoolchildren. The values of this small sample were normally distributed and statistical analysis was therefore performed. The systolic blood pressure of boys and girls was 102.0 +/- 9 mm Hg and the diastolic blood pressure 69.5 +/- 7.3 mm Hg. Boys and girls were also analyzed separately. The data fit in very well those from the literature, and it is concluded that the values from the literature, especially those of the "Task force of blood pressure control", can be used with high probability for Berne and Switzerland as well. Additional findings: The skin thickness of all children and of girls correlates with blood pressure in the normal range. The family history with regard to risk factors is probably only of importance if precise questions are asked, since general inquiries about obesity, myocardial infarction, and hypertension did not yield useful results.
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PMID:[Blood pressure determination in children: normal values for a given age group]. 73 28

Four hundred sixty patients with ischemic heart disease (IHD) were examined: 226 of them--with myocardial infarction; 38--stenocardia, 196--myocardiosclerosis. With age advancing all forms of IHD increase. The incidence of the followed up risk factors progessively increases. Hypertension has the greatest share--56.30 per cent out of all the subjects examined. Second place as regards incidence is occupied by the emotional stress--46.52 per cent. Further they are as follows: heredity--38.91 per cent; tobacco smoking--34.57 per cent, sedentary life--32,83 per cent, obesity--31.52 per cent, overfeeding--30 per cent, hypercholesterinemia--30 per cent, diabetes--17.61 per cent. The significance of the indicated risk factors alarmingly grows, consideration given to their combined effect. An average of 3.18 risk factors fall on patient. In patients with myocardial infarction they are more frequent and appear at an earlier age. Such an accumulation of the noxae upon the contemporary man requires the complex effors of the whole society.
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PMID:[Risk factors in ischemic heart disease patients]. 73 28

A study of the distribution of the various risk factors for coronary artery disease as a function of the age and sex of a homogenous population of 316 patients has brought to light the following findings: -- These was found to be a greater incidence (statistically significant) of hypertension disorders of glucose metabolism obesity and hypercholesterolaemia in the females, and of tobacco consumption (cigarettes) and, to a lesser extent, of hypertriglyceridaemia and of gout in the males; -- The females who 'tot up' risk factors have their myocardial infarction at a greater age than the males -- The risk factor which separates the two sexes in the consumption of cigarette tobacco. These findings agree with those already in the literature.
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PMID:[Myocardial infarction: comparative study of principal risk factors in the two sexes]. 82 69

In a 22-year followup of 3686 San Francisco longshoremen, a cohort analysis assessed job activity and six personal characteristics in relation to 395 fatal heart attacks. Four cohorts aged 35-44, 45-54, 55-64, and 65-74 in 1951 were studied annually for job shifts affecting energy output and for sudden or delayed death from heart attack by age 75. All subjects underwent multiphasic screening for heavy cigarette smoking, higher blood pressure, history of prior heart disease, obesity, abnormal glucose metabolism, and higher blood cholesterol. The first three of these characteristics added risk of fatal heart attack. The amount of risk varied in the four cohorts. Higher energy output on the job reduced risk of fatal heart attack, especially sudden death, in the two younger cohorts, where less active workers were at threefold increased risk. Lack of this effect in the two older cohorts could imply real differences in their work habits, such as being less energetic in heavy jobs or more energetic in light jobs than the younger cohorts. Or, before the study began, early deaths may have winnowed susceptibles from the two older cohorts. Combined low-energy output, heavy smoking, and higher blood pressure increased risk by as much as 20-fold. By elimination of these adverse influences, this population might have had an 88% reduction in its rate of fatal heart attack during the 22 years.
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PMID:Work-energy level, personal characteristics, and fatal heart attack: a birth-cohort effect. 84 74

Lipid and carbohydrate metabolism abnormalities are reviewed with particular emphasis on the role of insulin and interrelationships between carbohydrate and lipid metabolism. The pathogenesis of atherosclerosis is discussed in terms of the association of abnormal circulating insulin levels. Some of the conditions associated with abnormal insulin levels and atherosclerosis are diabetes mellitis, hypertriglyceridemia, obesity, uremia, and oral contraceptive use. There is evidence that a proportion of subjects who have atherosclerosis or at risk have elevated circulating insulin levels. There is also increasing evidence that the arterial wall is an insulin-sensitive tissue. More women with myocardial infarction take oral contraceptives than controls do. Those who take the pill have 9 times the risk of others to develop cerebral ischemia or thrombosis. Many oral contraceptives cause abnormalities in glucose tolerance associated with elevated plasma insulin levels, and a degree of insulin resistance is induced. A number of the metabolic consequences of the pill may be caused by the elevated insulin levels.
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PMID:The relationship of abnormal circulating insulin levels to atherosclerosis. 85 12


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