Top PDF Sleep-disordered breathing and mortality: a prospective cohort study.

Sleep-disordered breathing and mortality: a prospective cohort study.

Sleep-disordered breathing and mortality: a prospective cohort study.

Funding: Supported by the National Heart, Lung, and Blood Institute through the following cooperative agreements: U01-HL53940 (University of Washington), U01-HL53941 (Boston University), U01-HL63463 (Case Western Reserve University), U01-HL53937 (Johns Hopkins University), U01-HL53938 (University of Arizona), U01-HL53916 (University of California, Davis), U01-HL53934 (University of Minnesota), U01-HL63429 (Missouri Breaks Research), and U01-HL53931 (New York University). The funding institutions had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: NMP received honoraria and travel support for continuing medical education lectures or symposia sponsored by Respironics and Resmed Inc. DMR is currently the holder (through New York University) of multiple patents licensed to Covidian and Fisher & Paykel Healthcare on the use of nasal CPAP, the primary treatment of obstructive sleep apnea, and to Advance Brain Monitoring, Protech on diagnostic tools for use in ambulatory monitoring of sleep apnea, and recieves royalties from these. DMR has also held industry-sponsored grants relating to sleep and sleep-disordered breathing treatments with Restore Medical, St. Jude Medical, Guidant (Boston Scientific), Protech, Advanced Brain Monitoring, and Korosensor. At no time were any of the activities of DMR in the Sleep Heart Health Study data collection or analysis directly related to any of his listed activities in ways that compromised the study, as reviewed annually by the Steering Committee. SR has National Institutes of Health grants that fund research into the association of sleep disorders and health outcomes. SR is a member of the Sleep Research Society Board of Directors. SR is the Principal Investigator for a contract between University Hospitals of Cleveland and Dymedix, Inc. to validate sleep signals of sleep apnea diagnosis. MLU has a Baxter Healthcare Grant (Reanalysis of the HEMO Study using novel analytic approaches). MLU is personally unaware of a Baxter sleep product and this support did not influence his contribution to this work.
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Prevalence and Impact of Sleep Disordered Breathing in Patients with Severe Aortic Stenosis.

Prevalence and Impact of Sleep Disordered Breathing in Patients with Severe Aortic Stenosis.

A total of 140 patients with high-grade aortic stenosis who were evaluated for TAVI at our cen- tre between 2010 and 2013 were screened prospectively for our study using polygraphy. The study was approved by the local medical ethics committee (Ethikkommission an der Medizi- nischen Fakultät der Rheinischen Friedrich-Wilhelms-Universität Bonn, project approval no. 255/08). Informed written consent was obtained from all patients. All patients underwent our standard preoperative diagnostic tests, which included comprehensive 2D- and 3D-transtho- racic and transesophageal echocardiography (Philips iE 33 ultrasound system, Amsterdam, The Netherlands) as well as coronary angiography with invasive determination of left ventricu- lar end-diastolic pressure (LVEDP) [12, 13]. Left ventricular end-diastolic volume, left ventric- ular end-systolic volume, left ventricular ejection fraction (LVEF) and left atrial volume were determined by 2D echocardiography. Right ventricular systolic pressure was estimated on the basis of the modified Bernoulli equation and was considered equal to the systolic pulmonary artery pressure (sPAP). Body surface area was calculated using the DuBois formula. The 30-day mortality risk was estimated by means of the logistic EuroSCORE (www.euroscore.org) and the Society of Thoracic Surgeons (STS) score ((http://riskcalc.sts.org/) algorithms that are based on the presence of coexisting illnesses.[14] Patients were followed on an outpatient basis 180 and 365 days after the procedure and every year thereafter. Patients who did not come to their follow-up appointments were interviewed by telephone.
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Decrease of perforin positive CD3+γδ-T cells in patients with obstructive sleep disordered breathing

Decrease of perforin positive CD3+γδ-T cells in patients with obstructive sleep disordered breathing

the general population, and therefore constitute a public health problem. OSA is linked to increased mortality mainly due to higher prevalence of cardiovascular events [2]. The underly- ing mechanism is still under investigation but it is likely mul- tifactorial. In addition to promoting a pro-atherogenic pattern in the peripheral blood [3], OSA increases nuclear factor kap- pa B (NFκB)-dependent endothelial inflammation [4]. Recent research has linked cytotoxic lymphocytes (CTL) to ateriosclerotic plaque instability and thus the risk of acute cardio-vascular events [5]. The main mechanism of cellular cytotoxicity is based on the secretion of the proteins perforin and granzymes into immunological synapse between a cyto- toxic lymphocyte and a target cell [6]. Ultimately, the combi- nation of perforin and GrB induces cell death by activating the caspase cascade leading to nuclear fragmentation and apopto- sis [7]. While enhanced activity of cytotoxic lymphocytes constitutes an attractive idea to explain the increased cardio- vascular risk in OSA, currently, there is little evidence to sup- port a causal link between OSA in humans and an increased number or activity of perforin positive CD8 + lymphocytes [8]. Chronic inflammation is known to raise the risk of carcino- genesis [9]. Interestingly, OSA has also been linked to carci- nogenesis, opening new possibilities to account for the in- creased mortality in OSA patients [10]. Intermittent hypoxia, sleep fragmentation, and increase in adipose tissue are three typical features of OSA patients. Any of them is known to influence inflammatory cascades and the immune system [11]. In this study, we tested the impact of each component of OSA in the immune response by analyzing perforin and GrB positive lymphocytes in non-obese patients with either intermittent hypoxia (OSA) or non-hypoxic sleep fragmentation.
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Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study

Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study

Sedation is an important component of care for patients under mechanical ventilation (MV) in the ICU. Significant distress is related to MV itself or to routine procedural in- terventions [1] and minimizing pain, anxiety and distress is a major recommendation in recent guidelines [2]. Pain and anxiety control is usually obtained with analgesics and sedatives that ensure comfort, improve synchrony with the ventilator and decrease work of breathing [3]. Some studies, however, have shown that oversedation is associ- ated with poor outcomes, including delirium, prolonged MV, ventilator-associated pneumonia, long ICU and hos- pital length of stay [3-6], posttraumatic stress disorder [7] and cognitive impairment [8,9] as well as increased costs [10-12]. Nevertheless, the issue of early sedation has seldom been evaluated, especially in randomized controlled studies. Despite the current recommendations [2], there is still a significant gap between evidence from recent trials and implementation in clinical practice [2,6,13,14]. Moreover, to date no large randomized controlled trials of sedation strategies used mortality as the primary outcome. In addition, clinical trials of sedation have until now enrolled patients mostly after 24 to 48 hours following initiation of MV, resulting in inadequate assessment of early sedation practice and its association with clinically relevant out- comes [15-17].
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Predictive factors for the appearance of  after myringotomy with ventilation tube placement

Predictive factors for the appearance of after myringotomy with ventilation tube placement

Tympanosclerosis is a pathology that may appear when tissue repair occurs, in which high quantities of collagenic fibrosis tissue are deposited in the lamina propria which covers the ossicles, the walls of the tympanic cavity and the medial layer of the tympanic membrane [1, 2]. The thickness due to collagen gives way to the formation of a homogenous and hyaline substance, that is later subject to the deposition of crystals of calcium and phosphate [3–6]. When the deposition of crystals occurs only on the tympanic membrane, which is the most frequent location, it is named myringosclerosis [1, 7–9]. This process may assume clinical importance if it is able to interfere with the transmission of the sound vibrations through the structures of the middle ear [1, 10].
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Arq. Bras. Cardiol.  vol.72 número2

Arq. Bras. Cardiol. vol.72 número2

dies and, therefore, involve important questions of ethics; b) prospective architecture: they have the architecture of a cohort study, meaning that they are prospective, with the particularity that the investigator uses a technique of ran- dom allocation (randomization) to form groups with similar characteristics, so that the individuals of a group receive a certain type of treatment while those of the other group re- main as controls; c) control: it is necessary to compare the experience of a group of patients undergoing the new treat- ment with a group of similar patients who receive the con- ventional treatment. If there is no conventional treatment of real value, it can be appropriated to use a control group of non-treated patients. The most adequate technique for distributing the individuals in treated and control groups is randomization, which allows the allocation by chance; d) randomization: is a decision process that allows the study and control groups to be allocated by chance, being the best technique to avoid selection bias. In addition, it reduces the possibility of confusion bias. The beauty of randomization lies in the fact that it allows the distribution of known and unknown outcome determinants in a similar manner between the study and control groups, if the sample size is large enough 6 .
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PROGRAM OF INTESTINAL REHABILITATION AND EARLY POSTOPERATIVE ENTERAL NUTRITION: A PROSPECTIVE COHORT STUDY

PROGRAM OF INTESTINAL REHABILITATION AND EARLY POSTOPERATIVE ENTERAL NUTRITION: A PROSPECTIVE COHORT STUDY

Routine postoperative nasogastric tube is associated with patients´ discomfort, anxiety, depression and delirium; increased swallow reflex, which lead to pharyngeal lesions, aerophagia and hydro-electrolytic loss; rhinitis, pharyngitis and sinusitis causing pain, fiver and secondary pneumonia; infective and non-infective pulmonary complications with the need of oxygen and ventilatory support; prolonged postoperative ileus producing discomfort, delayed enteral nutrition and risk of aspiration. On the other hand, the beneficial effects of nasogastric tube concerning gastric distension and PNV are limited 20 .
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Incidence and treatment of developmental hip dysplasia in Mongolia: a prospective cohort study.

Incidence and treatment of developmental hip dysplasia in Mongolia: a prospective cohort study.

Whether, how and when to screen for DDH in newborns is still a matter of debate. Some authors argue that the benefit is unclear because neonatal DDH can spontaneously resolve and the effects of long term outcomes in adulthood have not been established. Others claim that only a selected sub-cohort of all newborns should be evaluated with ultrasound [10,12-15]. Clarke et al. could confirm that selective ultrasound is a successful surveillance strategy and has economic advantages compared to comprehensive screening [15]. However, the results and recommendations generated in European and North American studies cannot be transferred to Mongolia. Europe is mainly using the Graf technique, however, America the Harcke technique, which makes results difficult to compare. In Mongolia the currently provided standard care to diagnose and treat DDH is unreliable and potentially harmful, both in terms of exposure to radiation and treatment complications. Diagnosis of DDH is based on a clinical examination for asymmetric gluteal folds and the Ortolani test. However, neither are reliable tests of hip abnormalities [16,17]. Patients with positive test results receive plain film radiography at follow-up visits. Unfortunately, the x-ray equipment is often outdated and projection errors are not always accounted for. In Mongolia most children are at least 6 months old when they are diagnosed with DDH. Standard care consists of overhead extensions for repositioning, and Pavlik harnesses with a forced abduction of up to 90 degrees, which can cause avascular necrosis of the femoral head. Moreover, if a child needs hip surgery, standards are usually not sufficient to allow complex interventions in infants and toddlers in Mongolia.
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en 0103 507X rbti 29 02 0128

en 0103 507X rbti 29 02 0128

Another caveat is that the ambitions are too high: “We are going to be the best ICU in the country with the lowest standardized mortality ratio (SMR)!” Although this ambition is desirable the target is not very “actionable” and corrective actions are, therefore, elusive. Many of the currently available quality indicators lack the actionability and are, therefore, not useful. However, despite the fact that actionable indicators come with build-in solutions summarized in a “toolbox”, implementing them in real life is cumbersome and especially enforcing them in multidisciplinary medical teams remains a challenge. (5)
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Baseline Prolonged PR Interval and Outcome of Cardiac Resynchronization Therapy: A Systematic Review and Meta-analysis

Baseline Prolonged PR Interval and Outcome of Cardiac Resynchronization Therapy: A Systematic Review and Meta-analysis

Our search strategy yielded 580 potentially relevant articles (82 articles from EMBASE and 498 articles from MEDLINE). After exclusion of 204 duplicated articles, 376 underwent title and abstract review. Three hundred and seventy articles were excluded at this stage since they were not cohort studies, did not report the outcome of interest (incidence of death/ HF hospitalization) or were not conducted in patients with CRT, leaving six for full-length article reviews. Therefore, six retrospective cohort studies with 17,432 normal PR and 4,278 prolonged PR patients were included in this meta-analysis. Figure 1 outlines the search and literature review process. The clinical characteristics and summary of the included studies are described in Table 1.
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Fluid overload and changes in serum creatinine after cardiac surgery: predictors of mortality and longer intensive care stay. A prospective cohort study

Fluid overload and changes in serum creatinine after cardiac surgery: predictors of mortality and longer intensive care stay. A prospective cohort study

We conducted a cohort study. This study was approved by the Ethics Committees of the Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardi- ologia (IC/FUC), Porto Alegre, RS, Brazil and Universi- dade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil, and registered under the numbers 4560/10 and 1781/107, respectively. Data were collected anonymously following the clinical routine, with a waiver for informed consent. We conducted a one year cohort prospective study of all patients from the Postoperative ICU who underwent surgery involving cardiopulmonary bypass (CPB) in a tertiary cardiac referral hospital, Instituto de Cardiologia do Rio Grande do Sul/Fundação Universi- tária de Cardiologia (IC/FUC), beginning September 2010. Inclusion criteria were as follows: adult patients (>18 years old) submitted to the following elective surgi- cal procedures: myocardial revascularization surgery, valve replacement surgery, valve replacement surgery plus myocardial revascularization, atrial septoplasty and ventricular septoplasty. The exclusion criteria were as follows: length of stay in the Postoperative ICU less
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Influenza morbidity and mortality in elderly patients receiving statins: a cohort study.

Influenza morbidity and mortality in elderly patients receiving statins: a cohort study.

Methodology/Principal Findings: We conducted a population-based cohort study over 10 influenza seasons (1996 to 2006) using linked administrative databases in Ontario, Canada. We identified all adults older than 65 years who had received an influenza vaccination prior to the start of influenza season and distinguished those also prescribed statins (23%) from those not also prescribed statins (77%). Propensity-based matching, which accounted for each individual’s likelihood of receiving a statin, yielded a final cohort of 2,240,638 patients, exactly half of whom received statins. Statins were associated with small protective effects against pneumonia hospitalization (odds ratio [OR] 0.92; 95% CI 0.89–0.95), 30-day pneumonia mortality (0.84; 95% CI 0.77–0.91), and all-cause mortality (0.87; 95% CI 0.84–0.89). These protective effects attenuated substantially after multivariate adjustment and when we excluded multiple observations for each individual, declined over time, differed across propensity score quintiles and risk groups, and were unchanged during post-influenza season periods. The main limitations of this study were the observational study design, the non-specific outcomes, and the lack of information on medications while hospitalized.
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Polymorphisms in NFKB1 and TLR4 and interaction with dietary and life style factors in relation to colorectal cancer in a Danish prospective case-cohort study.

Polymorphisms in NFKB1 and TLR4 and interaction with dietary and life style factors in relation to colorectal cancer in a Danish prospective case-cohort study.

We have previously shown that carriage of the variant del-allele of the functional ins/del NFKB1/rs28362491 polymorphism is associated with increased risk of CRC and interacted with meat intake in a subset of the current study group [30] in agreement with results from two other studies also reporting increased risk of CRC among variant carriers of the polymorphism among a Malaysian [31] and a Swedish population [32], but not a Chinese study group [32]. A functional SNP in TLR4 (rs4986790) has been extensively studied and has been associated with neoplastic progression in vitro [33], aggressive human colon cancer [33], IBD [34–37] and CRC [38–40]. However others were not able to find an association between CRC and the SNP [41– 43]. In a Canadian study [44], intake of dietary saturated fatty acids was inversely related to blood level of high density lipoprotein cholesterol in individuals homozygous for the TLR4/ rs5030728 G-allele. TLR4/rs5030728 may therefore interact with dietary components in the gut.
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Does video gaming affect orthopaedic skills acquisition? A prospective cohort-study.

Does video gaming affect orthopaedic skills acquisition? A prospective cohort-study.

In this study, we did not demonstrate a difference in skill acquisition between gamers and non-gamers. Although a coinci- dental significant training effect was observed in both cohorts (except for fluoroscopy), the video gaming cohort was not superior in any metric compared to the non-gaming group. The correlation coefficients in Figure 3 & 4 also demonstrate how precisely the polynomial regression trend lines followed the scores per metric. The commonalities between metrics included scoring a better baseline by second week and peak scores being achieved by the last attempt for both cohorts.
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Pneumococcal serotypes and mortality following invasive pneumococcal disease: a population-based cohort study.

Pneumococcal serotypes and mortality following invasive pneumococcal disease: a population-based cohort study.

multivariate logistic regression analysis (a statistical approach) to look for associations between S. pneumoniae serotypes and death within 30 days of admission to hospital for pneumococcal bacteremia or meningitis. Overall, 18% of the nearly 19,000 people included in this analysis died within 30 days of hospital admission; among the children younger than 5 years included in the study, the death rate was 3%. Among patients 5 years old or older, nine S. pneumoniae serotypes were associated with a more than 3-fold higher death rate (mostly from bacteremia) than serotype 1, the most common serotype isolated during the study. Interestingly, in young children, a different set of serotypes seemed to be associated with death. However, because so few children died from IPD, this result is statistically uncertain. The researchers’ results also show that age, gender, having meningitis, having other illnesses, and alcoholism all affected a patient’s chances of dying from IPD. What Do These Findings Mean? These findings show that specific pneumococcal serotypes strongly affect the likelihood that a person aged 5 years or over will die within 30 days of admission to hospital with IPD. Importantly, unlike previous studies, this study was large and comprehensive—the Danish surveillance center covers more than 90% of the Danish population—and the researchers carefully took other factors into account that might have affected a patient’s chances of dying from IPD. Thus, these new insights into which pneumococcal serotypes are most deadly could help in the design of new pneumococcal vaccines, at least for people aged 5 years or older. For younger children, however, the results are not as informative and a similar study now needs to be done in developing countries, where more young people die from IPD.
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General population knowledge about extreme heat: a cross sectional survey in Lisbon and Madrid

General population knowledge about extreme heat: a cross sectional survey in Lisbon and Madrid

We carried out a cross-sectional observational study, using a questionnaire previously utilized in Brussels and Amsterdam (see Appendix A) [18]. We conducted the survey in Lisbon on 20–22 June 2016 and in Madrid on 29 June–1 July 2016. This summer period was chosen to be able to ask about heat awareness during a warm time. A team of two surveyors and a field coordinator carried out the survey in each city. We used a convenience sample of passers-by located in six survey locations in each city presenting different socio-economic backgrounds [19]. At least 20 interviews were carried out per each of the 12 survey locations. Passers-by were asked to participate and provided verbal consent. Interviews were conducted in Portuguese, Spanish or English. Individuals older than 12 years, living in Lisbon or Madrid and speaking one of the survey languages were eligible for inclusion. We excluded respondents who were not living in Lisbon or Madrid and without information on age, education or nationality.
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Microcephaly: normality parameters and its determinants in northeastern Brazil : a multicentre prospective cohort study

Microcephaly: normality parameters and its determinants in northeastern Brazil : a multicentre prospective cohort study

The use of steroids during pregnancy, especially in early stages of pregnancy, appears to have effects on the foetus and on dose dependence (22). Animal models indicate that the use of corticosteroids during pregnancy are associated with cognitive and behavioural changes (23). In addition, an Australian cohort study identified that the use of antenatal corticosteroids may reduce the cephalic perimeter by up to 4% (24). A meta-analysis in 2015 suggested that use may lead to damage in the development of the new-born (25). This study adds to this body of knowledge, favouring the association suggested, which may serve as a basis for future work. It is noteworthy that while the first three factors, intrauterine growth restriction, congenital anomalies and oligohydramnios, are pathological conditions of pregnancy intrinsically correlated to the development of the braincase and its content, resulting in a predictably high level of risk, the fourth factor, the use of steroids during pregnancy, presents itself as an external condition, which suggests serious side effects of therapy with pharmacological mechanisms that merits investigation.
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Rev. Col. Bras. Cir.  vol.42 número6

Rev. Col. Bras. Cir. vol.42 número6

Objective: To assess the application of aponeurotic sling by a modified technique with direct visualization of needles in patients with stress urinary incontinence. Methods Methods Methods Methods Methods: we applied the Kings Health Questionnaire (KHQ) for quality of life, gynecological examination, urinalysis I and urine culture approximately seven days prior to the urodynamic study (UDS) and the one-hour PAD test in patients undergoing making aponeurotic sling with its passing through the retropubic route with direct visualization of the needle, PAD test and King’s Helth Questionnaire before and after surgery. Results Results Results Results Results: The mean age was 50.6 years, BMI of 28 and Leak Pressure (LP) 58,5cm H 2 O; 89% were Caucasian. Forty-six of them were monitored for three and six months, 43 for 12 months. The objective cure rate at 12 months postoperatively was approximately 93.5%. In evaluating quality of life, we observed a significant improvement in 12 months postoperatively compared with the preoperative period. There was no no urethral/bladder injury. As adverse results, we had one persistent urinary retention (2.3%), who was submitted to urethrolysis, currently without incontinence. Conclusion Conclusion Conclusion Conclusion Conclusion: The proposed procedure is safe as for the risk of bladder or urethral injuries, promoting significant improvement in quality of life and objective cure.
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Arq. NeuroPsiquiatr.  vol.62 número2A

Arq. NeuroPsiquiatr. vol.62 número2A

The questions about learning and cognitive skills depend on factors beyond those associated with SD, with an impor- tant influence of low income, children’s work, lack of disease treatment, family disharmony, psychological problems and ot- hers, in addition to school difficulties. The complaints directly related to the mothers, such as the inability to impose limits to the children, anger roused by the children’s demands and uncertainty about their mothering ability, produce anguish and anxiety in the child, which may manifest as sleep disorders 20 .

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MORTALITY AND FUNCTIONAL IMPAIRMENT AFTER HIP FRACTURE – A PROSPECTIVE STUDY IN A PORTUGUESE POPULATION

MORTALITY AND FUNCTIONAL IMPAIRMENT AFTER HIP FRACTURE – A PROSPECTIVE STUDY IN A PORTUGUESE POPULATION

as admitted for any reason or if he/she was decea- sed. Only after all these unsuccessful attempts pa- tients were considered lost to follow up. The tele- phone interview included questions regarding cur- rent health status of the patient, discharge details, treatment after discharge and also health-related quality of life, briefly assessed using the first two questions of the Medical Outcomes Study Short Form-36, and independence in activities of daily li- ving, using the Katz’s Index of Independence in Ac- tivities of Daily Living. With regard to activities of daily living, we have classified the response options for each question in 4 categories: able to do without difficulty (Cat1), able to do with some difficulty (Cat2), able to do with much difficulty (Cat3), and unable to do without assistance (Cat4). In the case of deceased patients, answers were gi- ven by relatives and caregivers and correspond to the last known condition prior to death. The pro- portion of response to the questions of daily living was 86.2% in males and 99.2% in female patients. The follow-up period was calculated for each individual from the date of admission with the in- dex fracture to the date of telephone interview or the date of death, in deceased patients. Survival throughout the first year after hip fracture was an- alyzed using the Kaplan-Meier method and the sig- nificance of gender differences was evaluated using the log-rank test. The magnitude of sex-spe- cific, age-adjusted associations between potential prognostic factors and mortality were estimated using hazard ratios (HR) and respective 95% con- fidence intervals (95%CI), calculated using Cox’s proportional hazards model.
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