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Mortality, ethnicity, and education in an occupational cohort

Jonas, Saran; Grieco, Giacinto; Norman, Robert; Grumet, Surah; Kedan, Ilan
Purpose: The purpose of this paper is to investigate the relationship between occupational degree requirement and mortality between ethnic groups in a cohort of urban workers. Design/methodology/approach: The study included 118,606 health-insured full-time workers from the New York City Health and Hospitals Corporation (HHC). Mortality rates (MR) and mortality rate ratios (MRR) were calculated for major ethnic categories. Estimates were adjusted for age, sex, and occupational degree requirement. Findings: Prior to adjustment for degree requirement, mortality rates (MRs) by ethnic groups in the Health and Hospitals Corporation were in line with national estimates: highest for blacks, followed by whites, Hispanics, and Asian/Pacific Islander (APIs). After adjustment, the MR for blacks became comparable to whites (mortality rate ratio (MRR) = 1.02). The low-Hispanic MR did not change; the Hispanic advantage persisted (MRR = 0.66), as did the API advantage (MRR = 0.50). Research limitations/implications: Higher education may not substantially change the MR for Hispanics, and it may only account for a portion of the survival advantage among APIs. The findings also suggest that without reducing the disparity in higher education attainment between blacks and whites, equality in other socioeconomic factors may not abolish the disparity in mortality between these groups. Originality/value: This study bypassed common limitations of ethnic mortality studies, with intrinsic parity for certain socio-economic status factors (full-time employment and health care access) across cohort members and consistent ethnic classification across time-points. This includes a cohort of API workers with complete self-identification of ethnicity, which has not been accomplished by previous investigations.
PSYCH:2014-45500-003
ISSN: 2042-8367
CID: 1422422

Vegetative State 2.0 [Commentary]

Grieco, Giacinto
ORIGINAL:0008309
ISSN: 1944-0030
CID: 395442

Reply to the letter by Derendorf: Clinical trials and dipyridamole formulation selection [Letter]

Grieco, G; Jonas, S
ISI:000243592700015
ISSN: 1015-9770
CID: 70340

Dipyridamole plus aspirin: the best regimen for stroke prevention after noncardioembolic focal cerebral ischemia [Editorial]

Jonas, Saran; Grieco, Giacinto
PMID: 16567930
ISSN: 1015-9770
CID: 71248

Editorial comment--an approach to the estimation of the risk of TTP during clopidogrel therapy [Editorial]

Jonas, Saran; Grieco, Giacinto
PMID: 14757895
ISSN: 1524-4628
CID: 71249

Potential value of triple antiplatelet therapy for secondary stroke prevention [Letter]

Jonas, Saran; Grieco, Giacinto
PMID: 14512584
ISSN: 1524-4628
CID: 71250

The Sygen multicenter acute spinal cord injury study

Geisler FH; Coleman WP; Grieco G; Poonian D
STUDY DESIGN: Randomized, double-blind, sequential, multicenter clinical trial of two doses of Sygen versus placebo. OBJECTIVES: To determine efficacy and safety of Sygen in acute spinal cord injury. SUMMARY OF BACKGROUND DATA: An earlier, single-center trial in 28 patients showed an improvement (50.0% vs. 7.1%, P = 0.034) in marked recovery with Sygen. METHODS: Standard clinical trial techniques. RESULTS: The prospectively planned analysis at the prespecified endpoint time for all patients was negative. There was a significant effect in all patients in the primary outcome variable (the percentage of marked recovery) at week 8, the end of the dosing period. There was a significant effect in all patients in the time at which marked recovery is first achieved. Restricted to severity Group B, which has small sample size, the primary efficacy analysis showed a trend but did not reach significance. There is a large, consistent and, at some time points, significant effect in the primary outcome variable in the nonoperated patients through week 26. The American Spinal Injury Association motor, light touch, and pinprick scores showed a consistent trend in favor of Sygen, as also did bowel function, bladder function, sacral sensation, and anal contraction. The less severely injured patients appeared to have a greater beneficial drug effect. Evidence against an effect of Sygen was minimal and scattered. CONCLUSIONS: Although not proven in the primary efficacy analysis of this trial, Sygen appears to be beneficial in patients with severe spinal cord injury
PMID: 11805614
ISSN: 0362-2436
CID: 43159

Recruitment and early treatment in a multicenter study of acute spinal cord injury

Geisler, F H; Coleman, W P; Grieco, G; Poonian, D
STUDY DESIGN: Post hoc secondary analysis of data from 1992 to 1998 in the trial of Sygen in Acute Spinal Cord Injury. OBJECTIVES: Quasi-epidemiologic understanding of injury and treatment patterns and of recruitment in an SCI trial. No drug efficacy results. SUMMARY OF BACKGROUND DATA: The most recent large epidemiologic study was the National SCI Database by Stover and colleagues around 1980. METHODS: Emphasis on descriptive, rather than inferential, statistics: consistent with secondary analysis. RESULTS: The study involved 760 patients at 28 centers in North America. Cervical injuries were more common than thoracic, and complete injuries were more common than incomplete injuries. Recruitment in the complete cervical stratum was 332, but the incomplete thoracic strata had only 31 patients combined. Vital signs at arrival and on randomization show fair stability. Clock times show more injuries on weekends and nights but suggest immediate attention was given. Elapsed times to treatment (especially EMT and Medevac arrival) are short. The rate of direct admission to tertiary centers, traction weight, and time to surgery vary among centers. Inpatient rehabilitation appeared driven by insurance in addition to severity. CONCLUSIONS: The imbalances in favor of cervical and of complete injuries would make it hard for studies to attain results for SCI in general. The vital signs and time patterns suggest local protocol-driven stabilization to prevent secondary physiologic injury early after SCI. Some features of care vary among centers, but the sparseness of prospective data in specific injury and treatment categories suggests that treatment guidelines have limited empirical support and should be made cautiously.
PMID: 11805612
ISSN: 0362-2436
CID: 395392

Measurements and recovery patterns in a multicenter study of acute spinal cord injury

Geisler, F H; Coleman, W P; Grieco, G; Poonian, D
STUDY DESIGN: Post hoc, secondary analysis of data from 1992 to 1998 in the trial of Sygen in acute spinal cord injury. OBJECTIVES: Quasi-epidemiologic understanding of measurement tools and of recovery patterns. No drug efficacy results. SUMMARY OF BACKGROUND DATA: Many authors have studied individual scales for measuring the severity of spinal cord injury. METHODS: Emphasis on descriptive, rather than inferential, statistics: consistent with secondary analysis. RESULTS: Of the 760 patients, 43 died within 365 days. The rate was higher for complete injuries (7.1% vs. 3.2%, P = 0.017). Marked recovery at 26 weeks was more frequent in those with better baseline American Spinal Injury Association (ASIA) Impairment Scale (AIS) scores, but was not different for methylprednisolone within versus after 3 hours. Light touch scores improved at each visit, more so in those with higher scores at baseline. Bladder control similarly improved. Motor and sensory scores exhibited departures from assumptions underlying normal-theory statistical techniques: t test and analysis of variance. Furthermore, they were mixtures of differing distributions from different study strata, so that overall conclusions depend on the mixture of patients seen. CONCLUSIONS: The prognosis of these patients with spinal cord injury seen at 28 centers in North America during the mid-1990s appears better than was often assumed earlier. The general patterns are similar across different measurement scales, although there are intriguing differences. The patterns in different strata are different in specifics, and complete injuries do less well. Pooling data from different strata may result in probability distributions that depart from normal-theory assumptions and give misleading results depending on recruitment patterns.
PMID: 11805613
ISSN: 0362-2436
CID: 395382

"Natural" recovery from acute spinal cord injury among placebo patients in the GM1 ganglioside multi-center study: integrating clinical function and statistical analyses in therapeutic trials [Meeting Abstract]

Grieco, Giacinto; Geisler, F; Dorsey, F; Piva, S; Poonian, D; Fiorentini, R
Objectives: Characterize recovery from acute spinal cord injury (ASCI), integrating functional anatomy with standard rating instruments and their clinical and statistical properties, so as to facilitate design and interpretation of clinical trials. Background: Detailed longitudinal data on evolution of deficits from ASCI have not previously been reported. The 797-patient (346 on placebo) GM1 ASCI trial is the largest controlled treatment human ASCI study, with the most comprehensive database on "natural" recovery in a population given standard care. Design and methods: The NASCIS II MPSS dosing regimen was started =8 hours post-injury. Follow-ups were at 8, 16, 26, & 52 weeks. Assessments included: AIS (Baseline only), Modified Benzel Classification (MBC; not at Baseline), ASIA Motor Score (AMS; 5 muscles/limb), ASIA Sensory Evaluation (ASE), relative and absolute levels of impaired pin and light touch sensation, and bowel and bladder function. The statistical properties of these assessments for placebo patients were analyzed and contrasted with spinal cord anatomy and function. Results: The spinal cord, SCI, and recovery from SCI constitute related but distinct anatomical and functional continua. No one assessment provides a continuous measure of global cord function. Motor, sensory, and autonomic functions are separately assessed on scales with radically different clinical and statistical properties. All motor scales suffer from failure to assess the 12-segment "no man's land" of T2-L1. AMS distributions are therefore mostly unanalyzable. Conclusion: The properties of the ASE and sensory levels of impairment most closely conform to functional anatomy. Motor scales have substantial clinical and statistical limitations
ORIGINAL:0008307
ISSN: 0922-6028
CID: 395422