Politeness principles of Leech

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Abstracts / Journal of Clinical Epidemiology 55 (2002) 627–632

Abstracts HYPERTENSION CONTROL: HOW WELL ARE WE DOING? Borzecki AM, Wong AT, Berlowitz DR Center for Health Quality, Outcomes and Economic Research, Bedford VAMC, Bedford, MA and Boston University School of Public Health, Boston, MA Purpose of study: Studies have consistently shown that most patients with established hypertension have poorly controlled blood pressure. Most of these are based on patient data predating the JNC VI guidelines and do not consider the importance of tighter control in certain subgroups. We sought to determine the adequacy of BP control in Veterans Affairs (VA) patients with hypertension and to determine level of control in subgroups with diabetes and renal disease in the post JNC VI era. Methods: At each of 10 VA sites, we randomly selected approximately 100 patients with a diagnosis of hypertension. We undertook a retrospective chart review for the period January 1 to December 31, 1999, abstracting data on visit type, blood pressure (BP), comorbidities, and medications. We supplemented this with information from VA administrative databases. We examined level of BP control based on the last BP available for the year, in all patients and in subgroups with diabetes and renal disease attending primary care and medical subspecialty clinics. We compared these groups and looked at differences between sites. Results: Of our total sample of 981, 23% of patients had a BP 160/90; 57% had a BP 140/90. For those 140/90, the range among sites was 50–66% but there was no significant (NS) difference between sites (p0.3). Of our subsample of 338 patients with diabetes, 25% had a BP  160/90, 60% had a BP 140/90 and 78% had a BP 130/85. /, There was NS difference in level of control between non-diabetics and diabetics. Of diabetics with renal disease (N34), 71% had a BP 130/85 and 79% had a BP 125/75; (NS difference compared to diabetics without renal disease, or non-diabetics with renal disease). Of non-diabetics with renal disease (N33), the respective percentages were 64 and 79; (NS difference versus hypertensives without renal disease). Conclusions: Despite a growing awareness of the importance of blood pressure control both within the VA and without, a large proportion of VA hypertensive patients remain suboptimally controlled. Further, despite recent guidelines recommending tighter control for important subgroups they are likewise poorly controlled. DETERMINANTS OF POST-OPERATIVE DEPRESSION AFTER CORONARY ANGIOPLASTY Ogedegbe G, Charlson ME, Allegrante J Weill Medical College of Cornell University, New York, NY Purpose: Depression is a predictor of poor outcomes in coronary artery disease patients. Identifying patients at risk for depression is important for early intervention. The aim was to identify patient characteristics that are associated with depression 1 year after coronary angioplasty. Methods: Participants were patients who had recently undergone coronary angioplasty and were enrolled in a randomized trial of behavioral modification. Demographics, severity of illness, cardiac risk factors, and social support were assessed at baseline. Depression was measured with the Center for Epidemiologic Studies

Depression Scale at baseline and 1 year. Emotional support was assessed by asking patients whether or not they had someone to talk to about personal problems. Patients who responded no to this item were designated as having poor social support. Logistic regression was used to assess the relationship between self-efficacy, social support & depression at one year. Results: 660 patients participated in this study, mean age 63 years, 73% male, & 60% had college education or more. Of the 660, exercise was chosen by 85%, weight loss was chosen by 54%. Smoking cessation was chosen by 25%. 33% of patients were depressed at baseline. 15% had no social support. At 12 months, 12% had persistent depression. Baseline depression (P0.004) and poor social support (P0.04) predicted depression 1 year after angioplasty. Conclusion: Baseline poor social support and depression were predictive of depression at one year in angioplasty patients. Future studies will test the impact of improving social support on postoperative depression in angioplasty patients. FACTORS ASSOCIATED WITH CAREGIVER BURDEN AMONG CAREGIVERS OF PATIENTS WITH CANCER IN A HOSPICE SETTING Goldstein N, Concato J, Fried T, Cherlin E, Kasl S, Bradley E Yale University, New Haven, CT, and VA Medical Center, West Haven, CT Purpose: Previous research has examined caregiver burden in the context of chronic illness, but little is known about this problem in hospice settings. The objective of this project was to identify factors associated with caregiver perceptions of burden among those caring for the terminally ill, with a long-term goal of better understanding the links between the level of burden and the risk of adverse medical and psychological outcomes. Our expectation was that certain groups (e.g., older women) would experience greater burden. Methods: We conducted a cross-sectional survey of primary caregivers in a hospice setting. Among 388 caregivers of patients with cancer admitted between October 1999 and September 2000, 200 (52%) agreed to participate. In-person interviews were conducted to ascertain data on the caregivers’ socio-demographic characteristics, self-reported health status, support systems, religiosity, and amount of assistance they provided to their patients. Using this information, we also calculated a composite social network index, incorporating marital status, religious activities, contact with friends, and participation in community groups. Caregiver burden was measured using a 9-item subset of the Zarit burden inventory, and the summary scores were dichotomized at the upper quartile. Using logistic regression, unadjusted and adjusted analyses identified factors significantly associated with increased burden scores. Results: We found that increased caregiver burden was related to younger age (OR 1.49, CI 1.12–1.99), a worse score on the social network index (OR 1.43, CI 1.05–1.95), and the number of activities in which the caregivers themselves were restricted due to their caregiving responsibilities (OR 1.32, CI 1.11–1.58). Conclusions: Although several factors were associated with caregiver feelings of burden, the specific results we found were not anticipated. Future research should examine these factors, as well as others that might be more easily modifiable, when evaluating increased risk among caregivers.