Abstract:
OBJECTIVE:To assess the effects of social deprivation on survival after cardiac surgery and to examine the influence of potentially modifiable risk factors. DESIGN:Analysis of prospectively collected data. Prognostic models used to examine the additional effect of social deprivation on the end points. SETTING:Birmingham and north west England. PARTICIPANTS:44 902 adults undergoing cardiac surgery, 1997-2007. MAIN OUTCOME MEASURES:Social deprivation with census based 2001 Carstairs scores. All cause mortality in hospital and at mid-term follow-up. RESULTS:In hospital mortality for all cardiac procedures was 3.25% and mid-term follow-up (median 1887 days; range 1180-2725 days) mortality was 12.4%. Multivariable analysis identified social deprivation as an independent predictor of mid-term mortality (hazard ratio 1.024, 95% confidence interval 1.015 to 1.033; P<0.001). Smoking (P<0.001), body mass index (BMI, P<0.001), and diabetes (P<0.001) were associated with social deprivation. Smoking at time of surgery (1.294, 1.191 to 1.407, P<0.001) and diabetes (1.305, 1.217 to 1.399, P<0.001) were independent predictors of mid-term mortality. The relation between BMI and mid-term mortality was non-linear and risks were higher in the extremes of BMI (P<0.001). Adjustment for smoking, BMI, and diabetes reduced but did not eliminate the effects of social deprivation on mid-term mortality (1.017, 1.007 to 1.026, P<0.001). CONCLUSIONS:Smoking, extremes of BMI, and diabetes, which are potentially modifiable risk factors associated with social deprivation, are responsible for a significant reduction in survival after surgery, but even after adjustment for these variables social deprivation remains a significant independent predictor of increased risk of mortality.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Pagano D,Freemantle N,Bridgewater B,Howell N,Ray D,Jackson M,Fabri BM,Au J,Keenan D,Kirkup B,Keogh BE,Quality and Outcomes Research Unit (QuORU) UHB Birmingham.,North West Quality Improvement Programme in Cardiac Interventions (Udoi
10.1136/bmj.b902subject
Has Abstractpub_date
2009-04-02 00:00:00pages
b902eissn
0959-8138issn
1756-1833journal_volume
338pub_type
杂志文章,多中心研究abstract::The studyHewlett S, Almeida C, Ambler N, et al. Reducing arthritis fatigue impact: two-year randomised controlled trial of cognitive behavioural approaches by rheumatology teams (RAFT). Ann Rheum Dis 2019;78:465-72.Hewlett S, Almeida C, Ambler N, et al. Group cognitive behavioural programme to reduce the impact of rhe...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
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abstract:OBJECTIVE:To compare blood pressure control, satisfaction, and adherence to drug treatment in patients with treated hypertension followed up by their family physicians either every three months or every six months for three years. DESIGN:Randomised equivalence clinical trial. Settings 50 family practices in south east...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.37967.374063.EE
更新日期:2004-01-24 00:00:00
abstract:OBJECTIVES:To compare "hospital at home" and hospital care as an inpatient in acute exacerbations of chronic obstructive pulmonary disease. DESIGN:Prospective randomised controlled trial with three months' follow up. SETTING:University teaching hospital offering secondary care service to 350 000 patients. PATIENTS:S...
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更新日期:2000-11-18 00:00:00
abstract:OBJECTIVE:To determine whether the link suggested between growth in utero and during infancy and death from cardiovascular disease in men is also present in women. DESIGN:Follow up study of women and men whose birth weight and weight at 1 year of age had been recorded. SETTING:Hertfordshire, England. SUBJECTS:5585 w...
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更新日期:1993-12-11 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2005-04-02 00:00:00
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更新日期:1990-11-10 00:00:00
abstract:OBJECTIVE:To estimate the effectiveness of delivering an anthelmintic through a community child health programme on the weight gain of preschool children in Uganda. DESIGN:Cluster randomised controlled trial. SETTING:Eastern Uganda. PARTICIPANTS:48 parishes participating in a new programme for child health: 24 offer...
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pub_type: 杂志文章,随机对照试验
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更新日期:2006-07-15 00:00:00
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更新日期:1993-01-23 00:00:00
abstract::The UN has reported that five multinational pharmaceutical companies would cut down HIV drug prices in the developing world. One of these drug companies is GlaxoWellcome, which has promised to reduce the price of zidovudine and lamivudine to US$2 in the poorest nations, a fifth of its price in the US. Although Peter ...
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更新日期:2000-05-20 00:00:00
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更新日期:1993-03-20 00:00:00
abstract:OBJECTIVE:To describe the clinical circumstances in which psychiatric patients commit suicide. DESIGN:National clinical survey. SETTING:England and Wales. SUBJECTS:A two year sample of people who had committed suicide, in particular those who had been in contact with mental health services in the 12 months before de...
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pub_type: 杂志文章
doi:10.1136/bmj.318.7193.1235
更新日期:1999-05-08 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.314.7077.329
更新日期:1997-02-01 00:00:00
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pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.c5065
更新日期:2010-10-06 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2011-07-07 00:00:00
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更新日期:2001-07-28 00:00:00
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pub_type: 杂志文章,随机对照试验
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更新日期:2009-08-14 00:00:00
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pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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更新日期:2002-10-19 00:00:00
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更新日期:2012-12-13 00:00:00
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更新日期:2016-07-21 00:00:00
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更新日期:1993-11-13 00:00:00
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更新日期:2012-03-15 00:00:00
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更新日期:2013-10-01 00:00:00
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更新日期:2008-11-18 00:00:00
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pub_type: 杂志文章
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更新日期:1988-12-17 00:00:00
abstract:OBJECTIVES: To provide contemporary estimates of the prevalence of microcephaly in Europe, determine if the diagnosis of microcephaly is consistent across Europe, and evaluate whether changes in prevalence would be detected using the current European surveillance performed by EUROCAT (the European Surveillance of Conge...
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pub_type: 杂志文章,多中心研究
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更新日期:2016-09-13 00:00:00
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pub_type: 杂志文章
doi:10.1136/bmj.j3984
更新日期:2017-09-22 00:00:00
abstract:OBJECTIVE:To compare the effectiveness of corticosteroid injections with physiotherapy for the treatment of painful stiff shoulder. DESIGN:Randomised trial. SETTING:40 general practices. SUBJECTS:109 patients consulting general practitioners for shoulder pain were enrolled in the trial. INTERVENTIONS:Patients were ...
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pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.317.7168.1292
更新日期:1998-11-07 00:00:00
abstract::Cancer control encompasses the whole spectrum from prevention and early diagnosis to treatment and palliation. The key to the future of cancer control will be to establish multidisciplinary approaches to each type of cancer across this spectrum. For primary prevention this requires some understanding of the causes of ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.309.6952.449
更新日期:1994-08-13 00:00:00