Factors associated with the development of persistently depressed cardiac output during the first year after cardiac transplantation.

The purpose of this study was to determine factors associated with the development of a persistently depressed cardiac output during the first year after cardiac transplantation. With this aim in mind, the records of 133 consecutive patients undergoing orthotopic cardiac transplantation and surviving for > or = 1 year after transplantation were reviewed. For each patient, the mean cardiac index for each of the 3-month periods, 0-3, 4-6, 7-9, and 10-12 months after transplantation was calculated. Of the 133 patients, 19 (14%) had a mean cardiac index < 2.4 l/min/m2 during > or = 3 of these 3-month periods. The pre- and post-transplantation clinical, immunologic, and hemodynamic data of these 19 patients (study group) were compared with the remaining 114 patients (control group). Compared with the control group, the patients in the study group were older (56 +/- 5 vs. 46 +/- 15 years; p = 0.0001), more frequently had ischemic heart disease as the original diagnosis (58 vs. 37%; p < 0.05), had a lower preoperative cardiac index (1.91 +/- 0.53 vs. 2.71 +/- 1.0 l/min/m2; p = 0.0001), more frequently did not receive perioperative anti-T cell therapy (47 vs. 25%; p = 0.046), and had a greater median number of infections during the first year after transplantation (5 vs. 3; p = 0.027). However, only one factor--a low preoperative cardiac index--emerged as an independent predictor of the development of a persistently depressed cardiac index during the first year after transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)

Cognitive impairment among elderly adults in Shanghai, China.

This study reports the methods and initial findings of the first longitudinal study of Alzheimer's disease and dementia in China. A probability sample of 5,055 noninstitutionalized elderly persons in Shanghai was tested directly during the first phase of the study using a Chinese version of the Mini-Mental State Examination (MMSE). Details of sampling design and data collection procedures are described. Overall, some 4.1 percent of adults 55 years or older may be classified as having severe cognitive impairment, and 14.4 percent are mild cases. The rates for females are higher than for males by a ratio of 3.75 in the severe category, and 2.6 in the mild group. Within each age group, cognitive impairment rates vary by education. Multiple logistic regression was used to examine, within each age group, the nature of the association between the presence of a cognitive impairment and educational level controlling for sex. The results showed that educational attainment has a highly significant inverse relationship with prevalence of cognitive impairments (severe vs others). On the other hand, when educational attainment was controlled for in the logistic regression model, sex was significantly associated with prevalence of cognitive disorders for the age groups 65-74 and 75 years or older, but not for the group 55-64 years. These findings suggest the impact that basic educational deficits have on human cognitive functioning as measured through tests like the MMSE. Cross-tabulations of impairment rates according to marital status, economic status, and health-related problems are also presented.