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Moradhvaj, Samir KC. Differential impact of maternal education on under-five mortality in rural and urban India. Health Place 2023; 80:102987. [PMID: 36801652 DOI: 10.1016/j.healthplace.2023.102987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/15/2023] [Accepted: 02/02/2023] [Indexed: 02/20/2023]
Abstract
Under-five mortality rate (U5MR) differs by rural-urban place of residence and mother's education; however, the rural-urban gap in U5MR by mother's educational attainment is unclear in the existing literature. Using five rounds of the national family health surveys (NFHS I-V) conducted between 1992-93 and 2019-21 in India, this study estimated the main and interaction effects of rural-urban and maternal education on U5MR. The mixed effect Cox proportional hazard (MECPH) model was used to predict the risk of under-five mortality (U5M). The finding shows that unadjusted U5MR remained 50 per cent higher in rural areas than in urban areas across the surveys. Whereas, after controlling for demographic, socioeconomic, and maternal health care predictors of U5M, the MECPH regression results indicated that urban children had a higher risk of death than their rural counterparts in NFHS I-III. However, there are no significant rural-urban differences in the last two surveys (NFHS IV -V). In addition, increasing maternal education levels were associated with lower U5M in all surveys. Though, in recent years, primary education has had no significant effect. The U5M risk was additionally lower for urban children than rural children whose mothers had secondary and higher education by NFHS-III; however, this additional urban advantage was no longer significant in recent surveys. The higher impact of secondary education on U5MR in urban areas in the past may be attributed to poor socio-economic, healthcare conditions in rural areas. Overall, maternal education, particularly secondary education, remained a protective factor for U5M in both rural and urban areas, even after controlling for predictors. Therefore, there is a need to increase the focus on secondary education for girls for a further decline in U5M.
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Affiliation(s)
- Moradhvaj
- International Institute for Applied Systems Analysis (IIASA), Laxenburg, Austria; Vienna Institute of Demography of the Austrian Academy of Sciences, Vienna, Austria; Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/OAW, WU), Vienna, Austria.
| | - K C Samir
- International Institute for Applied Systems Analysis (IIASA), Laxenburg, Austria; Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/OAW, WU), Vienna, Austria; Asian Demographic Research Institute (ADRI) at Shanghai University, Shanghai, China.
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Chang FC, Huang YT, Wu VCC, Tu HT, Lin CP, Yeh JK, Cheng YT, Chang SH, Chu PH, Chou AH, Chen SW. Surgical volume and outcomes of surgical ablation for atrial fibrillation: a nationwide population-based cohort study. BMC Cardiovasc Disord 2023; 23:84. [PMID: 36774460 PMCID: PMC9922454 DOI: 10.1186/s12872-023-03101-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Atrial fibrillation is the most common cardiac arrythmia and causes many complications. Sinus rhythm restoration could reduce late mortality of atrial fibrillation patients. The Maze procedure is the gold standard for surgical ablation of atrial fibrillation. Higher surgical volume has been documented with favorable outcomes of various cardiac procedures such as mitral valve surgery and aortic valve replacement. We aimed to determine the volume-outcome relationship (i.e., association between surgical volume and outcomes) for the concomitant Maze procedure during major cardiac surgeries. METHODS This nationwide population-based cohort study retrieved data from the Taiwan National Health Insurance Research Database. Adult patients undergoing concomitant Maze procedures during 2010-2017 were identified; consequently, 2666 patients were classified into four subgroups based on hospital cumulative surgery volumes. In-hospital outcomes and late outcomes during follow-up were analyzed. Logistic regression and Cox proportional hazards model were used to analyze the volume-outcome relationship. RESULTS Patients undergoing Maze procedures at lower-volume hospitals tended to be frailer and had higher comorbidity scores. Patients in the highest-volume hospitals had a lower risk of in-hospital mortality than those in the lowest-volume hospitals [adjusted odds ratio, 0.30; 95% confidence interval (CI), 0.15-0.61; P < 0.001]. Patients in the highest-volume hospitals had lower rates of late mortality than those in the lowest-volume hospitals, including all-cause mortality [adjusted hazard ratio (aHR) 0.53; 95% CI 0.40-0.68; P < 0.001] and all-cause mortality after discharge (aHR 0.60; 95% CI 0.44-0.80; P < 0.001). CONCLUSIONS A positive hospital volume-outcome relationship for concomitant Maze procedures was demonstrated for in-hospital and late follow-up mortality. The consequence may be attributed to physician skill/experience, experienced multidisciplinary teams, and comprehensive care processes. We suggest referring patients with frailty or those requiring complicated cardiac surgeries to high-volume hospitals to improve clinical outcomes. TRIAL REGISTRATION the institutional review board of Chang Gung Memorial Hospital approved all data usage and the study protocol (registration number: 202100151B0C502).
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Affiliation(s)
- Feng-Cheng Chang
- grid.145695.a0000 0004 1798 0922Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Tung Huang
- grid.145695.a0000 0004 1798 0922Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Victor Chien-Chia Wu
- grid.145695.a0000 0004 1798 0922Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Hui-Tzu Tu
- grid.145695.a0000 0004 1798 0922Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Chia-Pin Lin
- grid.145695.a0000 0004 1798 0922Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Jih-Kai Yeh
- grid.145695.a0000 0004 1798 0922Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Ting Cheng
- grid.145695.a0000 0004 1798 0922Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 33305 Taiwan
| | - Shang-Hung Chang
- grid.145695.a0000 0004 1798 0922Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan ,grid.145695.a0000 0004 1798 0922Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Pao-Hsien Chu
- grid.145695.a0000 0004 1798 0922Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - An-Hsun Chou
- grid.145695.a0000 0004 1798 0922Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Shao-Wei Chen
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan. .,Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan. .,Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 33305, Taiwan.
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Jadid KD, Cao Y, Petersson J, Sjövall A, Angenete E, Matthiessen P. Long-term oncological outcomes for minimally invasive surgery versus open surgery for colon cancer-a population-based nationwide study with a non-inferiority design. Colorectal Dis 2023; 25:954-963. [PMID: 36762443 DOI: 10.1111/codi.16512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/20/2023] [Accepted: 01/29/2023] [Indexed: 02/11/2023]
Abstract
AIM The study aimed to compare 5-year overall survival in a national cohort of patients undergoing curative abdominal resection for colon cancer by minimally invasive surgery (MIS) or by the open (OPEN) technique. METHODS All patients diagnosed between 2010 and 2016 in Sweden with pathological Union International Contre le Cancer Stages I-III colon cancer localized in the caecum, ascending colon, hepatic flexure or sigmoid colon and those who underwent curative right sided hemicolectomy, sigmoid resection or high anterior resection by MIS or OPEN were included. Patients were identified in the Swedish Colorectal Cancer Registry from which all data were retrieved. The analyses were performed as intention-to-treat and the relationship between surgical technique (MIS or OPEN) and overall mortality within 5 years was analysed. For the primary research question a non-inferiority hypothesis was assumed with a statistical power of 90%, a one-side type I error of 2.5% and a non-inferiority margin of 2%. For the secondary analyses, multilevel survival regression models with the patients matched by propensity scores were employed, adjusted for patient- and tumour-related variables. RESULTS A total of 11 605 pathological Union International Contre le Cancer Stages I-III patients were included with 3297 MIS (28.4%) and 8308 OPEN (71.6%) and were followed until 31 December 2020. The primary analysis demonstrated superiority for MIS compared to OPEN. The multilevel survival regression analyses confirmed that 5-year overall survival was higher in MIS with a hazard ratio of 0.874 (95% confidence interval 0.791-0.965), and if excluding pT4 the outcome was similar, with a hazard ratio of 0.847 (95% confidence interval 0.756-0.948). CONCLUSION This observational study demonstrated that MIS was favourable to OPEN with regard to 5-year overall survival. These results support the use of laparoscopic colon cancer surgery in routine practice.
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Affiliation(s)
- Kaveh Dehlaghi Jadid
- Department of Surgery, Örebro University Hospital, Örebro, Sweden.,Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Josefin Petersson
- SSORG-Scandinavian Surgical Outcomes Research Group, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annika Sjövall
- Gastrointestinal Oncology and Colorectal Surgery Unit, Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Angenete
- SSORG-Scandinavian Surgical Outcomes Research Group, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Matthiessen
- Department of Surgery, Örebro University Hospital, Örebro, Sweden.,Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Grischott T, Rachamin Y, Senn O, Hug P, Rosemann T, Neuner-Jehle S. Medication Review and Enhanced Information Transfer at Discharge of Older Patients with Polypharmacy: a Cluster-Randomized Controlled Trial in Swiss Hospitals. J Gen Intern Med 2023; 38:610-618. [PMID: 36045192 PMCID: PMC9432794 DOI: 10.1007/s11606-022-07728-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Medication safety in patients with polypharmacy at transitions of care is a focus of the current Third WHO Global Patient Safety Challenge. Medication review and communication between health care professionals are key targets to reduce medication-related harm. OBJECTIVE To study whether a hospital discharge intervention combining medication review with enhanced information transfer between hospital and primary care physicians can delay hospital readmission and impact health care utilization or other health-related outcomes of older inpatients with polypharmacy. DESIGN Cluster-randomized controlled trial in 21 Swiss hospitals between January 2019 and September 2020, with 6 months follow-up. PARTICIPANTS Sixty-eight senior physicians and their blinded junior physicians included 609 patients ≥ 60 years taking ≥ 5 drugs. INTERVENTIONS Participating hospitals were randomized to either integrate a checklist-guided medication review and communication stimulus into their discharge processes, or follow usual discharge routines. MAIN MEASURES Primary outcome was time-to-first-readmission to any hospital within 6 months, analyzed using a shared frailty model. Secondary outcomes covered readmission rates, emergency department visits, other medical consultations, mortality, drug numbers, proportions of patients with potentially inappropriate medication, and the patients' quality of life. KEY RESULTS At admission, 609 patients (mean age 77.5 (SD 8.6) years, 49.4% female) took a mean of 9.6 (4.2) drugs per patient. Time-to-first-readmission did not differ significantly between study arms (adjusted hazard ratio 1.14 (intervention vs. control arm), 95% CI [0.75-1.71], p = 0.54), nor did the 30-day hospital readmission rates (6.7% [3.3-10.1%] vs. 7.0% [3.6-10.3%]). Overall, there were no clinically relevant differences between study arms at 1, 3, and 6 months after discharge. CONCLUSIONS The combination of a structured medication review with enhanced information transfer neither delayed hospital readmission nor improved other health-related outcomes of older inpatients with polypharmacy. Our results may help researchers in balancing practicality versus stringency of similar hospital discharge interventions. STUDY REGISTRATION ISRCTN18427377, https://doi.org/10.1186/ISRCTN18427377.
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Affiliation(s)
- Thomas Grischott
- Institute of Primary Care, University of Zurich & University Hospital Zurich, Zurich, Switzerland.
| | - Yael Rachamin
- Institute of Primary Care, University of Zurich & University Hospital Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich & University Hospital Zurich, Zurich, Switzerland
| | - Petra Hug
- Institute of Primary Care, University of Zurich & University Hospital Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich & University Hospital Zurich, Zurich, Switzerland
| | - Stefan Neuner-Jehle
- Institute of Primary Care, University of Zurich & University Hospital Zurich, Zurich, Switzerland
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Zazzara MB, Villani ER, Palmer K, Fialova D, Corsonello A, Soraci L, Fusco D, Cipriani MC, Denkinger M, Onder G, Liperoti R. Frailty modifies the effect of polypharmacy and multimorbidity on the risk of death among nursing home residents: Results from the SHELTER study. Front Med (Lausanne) 2023; 10:1091246. [PMID: 36817789 PMCID: PMC9929152 DOI: 10.3389/fmed.2023.1091246] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/06/2023] [Indexed: 02/04/2023] Open
Abstract
Background Frailty, disability, and polypharmacy are prevalent in nursing home (NH) residents, often co-occurring with multimorbidity. There may be a complex interplay among them in terms of outcomes such as mortality. Aims of the study were to (i) assess whether nursing home residents with polypharmacy (5-9 medications) or hyperpolypharmacy (≥10 drugs), have an increased risk of death and (ii) whether any association is modified by the co-presence of frailty or disability. Methods Cohort study with longitudinal mortality data including 4,023 residents from 50 European and 7 Israeli NH facilities (mean age = 83.6 years, 73.2% female) in The Services and Health for Elderly in Long Term care (SHELTER) cohort study. Participants were evaluated with the interRAI-LongTerm Care assessment tool. Frailty was evaluated with the FRAIL-NH scale. Hazard ratio (HR) of death over 12 months was assessed with stratified Cox proportional hazards models adjusted for demographics, facilities, and cognitive status. Results 1,042 (25.9%) participants were not on polypharmacy, 49.8% (n = 2,002) were on polypharmacy, and 24.3% (n = 979) on hyperpolypharmacy. Frailty and disability mostly increased risk of death in the study population (frailty: HR = 1.85, 95%CI 1.49-2.28; disability: HR = 2.10, 95%CI 1.86-2.47). Among non-frail participants, multimorbidity (HR = 1.34, 95%CI = 1.01-1.82) and hyperpolypharmacy (HR = 1.61, 95%CI = 1.09-2.40) were associated with higher risk of death. Among frail participants, no other factors were associated with mortality. Polypharmacy and multimorbidity were not associated with mortality after stratification for disability. Conclusions Frailty and disability are the strongest predictors of death in NH residents. Multimorbidity and hyperpolypharmacy increase mortality only in people without frailty. These findings may be relevant to identify patients who could benefit from tailored deprescription.
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Affiliation(s)
- Maria Beatrice Zazzara
- Fondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy,*Correspondence: Maria Beatrice Zazzara ✉
| | - Emanuele Rocco Villani
- Università Cattolica del Sacro Cuore, Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy,Emanuele Rocco Villani ✉
| | - Katie Palmer
- Università Cattolica del Sacro Cuore, Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy
| | - Daniela Fialova
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Andrea Corsonello
- Unit of Geriatric Medicine, IRCCS INRCA (Istituto Nazionale Ricovero e Cura Anziani), Dipartimento di Medicina Interna e Terapia Medica, Cosenza, Italy
| | - Luca Soraci
- Unit of Geriatric Medicine, IRCCS INRCA (Istituto Nazionale Ricovero e Cura Anziani), Dipartimento di Medicina Interna e Terapia Medica, Cosenza, Italy
| | - Domenico Fusco
- Fondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy
| | - Maria Camilla Cipriani
- Fondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy
| | - Michael Denkinger
- AGAPLESION Bethesda Ulm, Geriatric Research Ulm University and Geriatric Center Ulm/Alb Donau, Ulm, Germany
| | - Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy,Università Cattolica del Sacro Cuore, Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy,Università Cattolica del Sacro Cuore, Polo Interdipartimentale Scienze Dell'Invecchiamento, Neuroscienze, Testa-collo ed Ortopedia, Rome, Italy
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Zhang HS, Choi DW, Kim HS, Kang HJ, Jhang H, Jeong W, Nam CM, Park S. Increasing disparities in the proportions of active treatment and 5-year overall survival over time by age groups among older patients with gastric cancer in Korea. Front Public Health 2023; 10:1030565. [PMID: 36699910 PMCID: PMC9869046 DOI: 10.3389/fpubh.2022.1030565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
Purpose As older patients with gastric cancer increase in Korea, no consensus indicative of anti-cancer treatment exists for the oldest old (age 85+). We investigated potential disparities in the proportion of surgery-including active treatment and the degree of survival improvement over time by age groups, and whether heterogeneity exists in the protective effect of time period on overall survival (OS) by age at diagnosis clusters. Materials and methods A nationwide cohort (N = 63,975) of older patients with gastric cancer (age at diagnosis 70+) in 2005-2012 were followed until the end of 2018. Patients were categorized into four time period groups by their year of diagnosis. Cancer treatment patterns and 5-year OS were analyzed accordingly, and a random coefficients Cox model with random intercepts and random slopes of time period by age at diagnosis clusters was employed. Results The mean age of patients was 76.4, and 60.4% were males. Most patients had 0-1 comorbidities (73.3%) and low-risk frailty scores (74.2%). Roughly two-thirds of patients received some form of anti-cancer treatment (62.4%), and while the number of comorbidities and the proportion of high-risk frailty scores trended toward an increase, the proportion of patients receiving anti-cancer treatment increased from 58% in 2005-2006 to 69.6% in 2011-2012. The proportion of surgery-including active treatment increased to over 70% in the 70-74 years old group, while stagnating at 10% in the 90+ years old group. Differences in the slope of 5-year OS improvement resulted in a widening survival gap between the old (age 70-84) and the oldest old. The protective effect of time period on OS hazard in the oldest old was not monotonically reduced with increasing "chronological" age but varied quite randomly, especially among female patients. Conclusion Our study showed no upper age limit in terms of benefiting from the advances in the detection and treatment of gastric cancer over time. Thus, "functional" age rather than "chronological" age should be the criterion for anti-cancer screening and treatment, and actual implementation of proven treatments in the oldest old patients to reduce their non-compliance with treatment in clinical practice is needed to improve gastric cancer survival for all.
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Affiliation(s)
- Hyun-Soo Zhang
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea,Department of Biomedical Informatics, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Dong-Woo Choi
- Data Link and Operations Team, Cancer Big-Data Center, National Cancer Center, National Cancer Control Institute, Goyang, Republic of Korea
| | - Han Sang Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Hye Jung Kang
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Hoyol Jhang
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Wonjeong Jeong
- Cancer Knowledge and Information Center, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Chung Mo Nam
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea,Department of Biomedical Informatics, College of Medicine, Yonsei University, Seoul, Republic of Korea,Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Sohee Park
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea,*Correspondence: Sohee Park ✉
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Lin SM, Liu PPS, Tu YK, Lai ECC, Yeh JI, Hsu JY, Munir KM, Peng CCH, Huang HK, Loh CH. Risk of heart failure in elderly patients with atrial fibrillation and diabetes taking different oral anticoagulants: a nationwide cohort study. Cardiovasc Diabetol 2023; 22:1. [PMID: 36609317 PMCID: PMC9824984 DOI: 10.1186/s12933-022-01688-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/05/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Heart failure (HF) is a critical complication in elderly patients with atrial fibrillation (AF) and diabetes mellitus (DM). Recent preclinical studies suggested that non-vitamin K antagonist oral anticoagulants (NOACs) can potentially suppress the progression of cardiac fibrosis and ischemic cardiomyopathy. Whether different oral anticoagulants influence the risk of HF in older adults with AF and DM is unknown. This study aimed to evaluate the risk of HF in elderly patients with AF and DM who were administered NOACs or warfarin. METHODS A nationwide retrospective cohort study was conducted based on claims data from the entire Taiwanese population. Target trial emulation design was applied to strengthen causal inference using observational data. Patients aged ≥ 65 years with AF and DM on NOAC or warfarin treatment between 2012 and 2019 were included and followed up until 2020. The primary outcome was newly diagnosed HF. Propensity score-based fine stratification weightings were used to balance patient characteristics between NOAC and warfarin groups. Hazard ratios (HRs) were estimated using Cox proportional hazard models. RESULTS The study included a total of 24,835 individuals (19,710 NOAC and 5,125 warfarin users). Patients taking NOACs had a significantly lower risk of HF than those taking warfarin (HR = 0.80, 95% CI 0.74-0.86, p < 0.001). Subgroup analyses for individual NOACs suggested that dabigatran (HR = 0.86, 95% CI 0.80-0.93, p < 0.001), rivaroxaban (HR = 0.80, 95% CI 0.74-0.86, p < 0.001), apixaban (HR = 0.78, 95% CI 0.68-0.90, p < 0.001), and edoxaban (HR = 0.72, 95% CI 0.60-0.86, p < 0.001) were associated with lower risks of HF than warfarin. The findings were consistent regardless of age and sex subgroups and were more prominent in those with high medication possession ratios. Several sensitivity analyses further supported the robustness of our findings. CONCLUSIONS This nationwide cohort study demonstrated that elderly patients with AF and DM taking NOACs had a lower risk of incident HF than those taking warfarin. Our findings suggested that NOACs may be the preferred oral anticoagulant treatment when considering the prevention of heart failure in this vulnerable population. Future research is warranted to elucidate causation and investigate the underlying mechanisms.
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Affiliation(s)
- Shu-Man Lin
- Department of Physical Medicine and Rehabilitation, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan ,grid.411824.a0000 0004 0622 7222School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Peter Pin-Sung Liu
- Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung Yang Rd., Hualien, 97002 Taiwan ,grid.411824.a0000 0004 0622 7222Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Yu-Kang Tu
- grid.19188.390000 0004 0546 0241Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan ,grid.19188.390000 0004 0546 0241Department of Dentistry, National Taiwan University Hospital and School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Edward Chia-Cheng Lai
- grid.64523.360000 0004 0532 3255School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jih-I Yeh
- grid.411824.a0000 0004 0622 7222School of Medicine, Tzu Chi University, Hualien, Taiwan ,Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung Yang Rd., Hualien, 97002 Taiwan
| | - Jin-Yi Hsu
- grid.411824.a0000 0004 0622 7222School of Medicine, Tzu Chi University, Hualien, Taiwan ,Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung Yang Rd., Hualien, 97002 Taiwan
| | - Kashif M. Munir
- grid.411024.20000 0001 2175 4264Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD USA
| | - Carol Chiung-Hui Peng
- grid.189504.10000 0004 1936 7558Section of Endocrinology, Diabetes, Nutrition & Weight Management, Boston University School of Medicine, Boston, MA USA
| | - Huei-Kai Huang
- School of Medicine, Tzu Chi University, Hualien, Taiwan. .,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. .,Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung Yang Rd., Hualien, 97002, Taiwan.
| | - Ching-Hui Loh
- School of Medicine, Tzu Chi University, Hualien, Taiwan. .,Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung Yang Rd., Hualien, 97002, Taiwan.
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Risk factors for arm lymphedema following breast cancer surgery: a Japanese nationwide database study of 84,022 patients. Breast Cancer 2023; 30:36-45. [PMID: 35997891 DOI: 10.1007/s12282-022-01395-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/14/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although arm lymphedema is a well-known complication following breast cancer surgery, previous studies involving a small population showed inconsistent results regarding the risk. Therefore, we examined the risk factors using a Japanese nationwide database. METHODS Female patients who underwent breast cancer surgery from April, 2016, to March, 2020, were identified from a Japanese nationwide database. Multivariable survival analyses for 19 baseline factors (12 patient characteristics, four tumor characteristics, and three surgical procedures) were conducted to investigate risk factors associated with treatments for postoperative lymphedema (such as lymphatic bypass, compositive drainage therapy, hospitalization, and Kampo use) with a multilevel model to adjust for within-hospital clustering. We also conducted multivariable analysis for five postoperative factors (two local complications and three postoperative therapies) with adjustment for 19 baseline factors. RESULTS The study included 84,022 patients; 1547 (1.8%) received treatments for lymphedema during a median follow-up of 119 weeks (interquartile range, 59-187 weeks). Young age, obesity, smoking, collagen diseases, advanced cancer stage, total mastectomy, axillary dissection, postoperative bleeding, chemotherapy, and radiotherapy were identified as risk factors. Postoperative chemotherapy (hazard ratio, 3.78 [95% confidence interval, 3.35-4.26]) and axillary dissection (2.46 [1.95-3.11]) showed the highest odds ratio among the risk factors. The cumulative probabilities in high-risk patients reached approximately 3% at 1 year and 6% at 4 years after surgery. CONCLUSIONS This study identified several risk factors for postoperative lymphedema in breast cancer surgery. The treatment initiation increased markedly within the first year and gradually after 1 year post-surgery.
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Natale G, Zhang Y, Hanes DW, Clouston SAP. Obesity in Late-Life as a Protective Factor Against Dementia and Dementia-Related Mortality. Am J Alzheimers Dis Other Demen 2023; 38:15333175221111658. [PMID: 37391890 PMCID: PMC10580725 DOI: 10.1177/15333175221111658] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
OBJECTIVE We estimated the conversion from cognitively normal to mild cognitive impairment (MCI) to probable dementia and death for underweight, normal, overweight, and obese older adults, where the timing of examinations is associated with the severity of dementia. METHODS We analyzed six waves of the National Health and Aging Trends Study (NHATS). Body mass (BMI) was computed from height and weight. Multi-state survival models (MSMs) examined misclassification probability, time-to-event ratios, and cognitive decline. RESULTS Participants (n = 6078) were 77 years old, 62% had overweight and/or obese BMI. After adjusting for the effects of cardiometabolic factors, age, sex, and race, obesity was protective against developing dementia (aHR=.44; 95%CI [.29-.67]) and dementia-related mortality (aHR=.63; 95%CI [.42-.95]). DISCUSSION We found a negative relationship between obesity and dementia and dementia-related mortality, a finding that has been underreported in the literature. The continuing obesity epidemic might complicate the diagnosis and treatment of dementia.
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Affiliation(s)
- Ginny Natale
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Yun Zhang
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Douglas William Hanes
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Sean AP Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
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Merritt RE, Abdel-Rasoul M, D'Souza DM, Kneuertz PJ. Lymph Node Upstaging for Robotic, Thoracoscopic, and Open Lobectomy for Stage T2-3N0 Lung Cancer. Ann Thorac Surg 2023; 115:175-182. [PMID: 35714729 DOI: 10.1016/j.athoracsur.2022.05.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/06/2022] [Accepted: 05/25/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND There may be equivalent efficacy of the lymph node evaluation for minimally invasive lobectomy compared with open lobectomy for stage I non-small cell lung cancer. We sought to compare the lymph node evaluation for lobectomy by approach for patients with larger tumors who are clinically node negative. METHODS This retrospective study analyzed 24 257 patients with clinical stage T2-3N0M0 non-small cell lung cancer from the National Cancer Database. Inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics. The rates of pathologic lymph node upstaging were compared. A Cox multivariable regression model was performed to test the association with overall survival. RESULTS After IPTW adjustment 20 834 patients were included in the analysis. Of these, 1996 patients underwent robotic lobectomy, 5122 patients underwent thoracoscopic lobectomy, and 13 725 patients underwent open lobectomy from 2010 to 2017. The IPTW-adjusted N1 upstaging rate was similar for robotic (11.79%), thoracoscopic (11.49%), and open (11.85%) lobectomy (P = .274). The adjusted N2 upstaging rates were 5.03%, 5.66%, and 6.15% for robotic, thoracoscopic, and open lobectomy, respectively (P = .274). On IPTW-adjusted multivariable analysis, robotic and thoracoscopic lobectomy were associated with improved survival compared with open lobectomy (P < .001). CONCLUSIONS There was no significant difference in N1 and N2 lymph node upstaging rates between surgical approaches for patients with clinical stage T2-3N0 non-small cell lung cancer, indicating similarly effective lymph node evaluation. Overall survival after robotic and thoracoscopic lobectomy was significantly better compared with open lobectomy in this patient population with a high propensity for occult nodal disease.
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Affiliation(s)
- Robert E Merritt
- Department of Surgery, Thoracic Surgery Division, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | | | - Desmond M D'Souza
- Department of Surgery, Thoracic Surgery Division, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Peter J Kneuertz
- Department of Surgery, Thoracic Surgery Division, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Doan LMT, Angione C, Occhipinti A. Machine Learning Methods for Survival Analysis with Clinical and Transcriptomics Data of Breast Cancer. Methods Mol Biol 2023; 2553:325-393. [PMID: 36227551 DOI: 10.1007/978-1-0716-2617-7_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Breast cancer is one of the most common cancers in women worldwide, which causes an enormous number of deaths annually. However, early diagnosis of breast cancer can improve survival outcomes enabling simpler and more cost-effective treatments. The recent increase in data availability provides unprecedented opportunities to apply data-driven and machine learning methods to identify early-detection prognostic factors capable of predicting the expected survival and potential sensitivity to treatment of patients, with the final aim of enhancing clinical outcomes. This tutorial presents a protocol for applying machine learning models in survival analysis for both clinical and transcriptomic data. We show that integrating clinical and mRNA expression data is essential to explain the multiple biological processes driving cancer progression. Our results reveal that machine-learning-based models such as random survival forests, gradient boosted survival model, and survival support vector machine can outperform the traditional statistical methods, i.e., Cox proportional hazard model. The highest C-index among the machine learning models was recorded when using survival support vector machine, with a value 0.688, whereas the C-index recorded using the Cox model was 0.677. Shapley Additive Explanation (SHAP) values were also applied to identify the feature importance of the models and their impact on the prediction outcomes.
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Affiliation(s)
- Le Minh Thao Doan
- School of Computing, Engineering and Digital Technologies, Teesside University, Middlesbrough, UK
| | - Claudio Angione
- School of Computing, Engineering and Digital Technologies, Teesside University, Middlesbrough, UK
- Centre for Digital Innovation, Teesside University, Middlesbrough, UK
- Healthcare Innovation Centre, Teesside University, Middlesbrough, UK
- National Horizons Centre, Teesside University, Darlington, UK
| | - Annalisa Occhipinti
- School of Computing, Engineering and Digital Technologies, Teesside University, Middlesbrough, UK.
- Centre for Digital Innovation, Teesside University, Middlesbrough, UK.
- National Horizons Centre, Teesside University, Darlington, UK.
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Leclerc C, Vink M, Schmeets H. Does Residential Context Matter? Neighborhood Migrant Concentration and Citizenship Acquisition in the Netherlands. INTERNATIONAL MIGRATION REVIEW 2022. [DOI: 10.1177/01979183221115165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Existing studies analyzing the relation between immigrants’ residential environment and their propensity to naturalize produce contradictory findings. These results are difficult to interpret, as studies typically do not measure residential characteristics at a sufficiently fine-grained scale to test hypotheses about social networks and naturalization, do not model the data's multi-level structure appropriately, and do not account for selection into the residential environment. To address these shortcomings, this article draws on longitudinal micro-data from administrative registers at the neighborhood level in the Netherlands (approximately 1300 residents per neighborhood). We employ a stratified Cox proportional hazard model with shared frailty and inverse probability of treatment weighting to reduce bias due to self-selection into neighborhoods and draw on proxies of social networks in such areas. Our analyses provide support for the ‘migrant enclosure hypothesis,’ as we find that greater migrant concentration in the neighborhood is associated with lower naturalization rates and largely driven by the density of migrant social networks in those residential areas. In the Dutch context, this negative effect of migrant enclosure is especially prevalent among the large, long-settled migrant communities from Morocco and Turkey. We also find support for the ‘naturalization diffusion hypothesis’ and observe that the negative naturalization effect of residing in neighborhoods with higher levels of migrant concentration is offset by the presence of immigrants who have completed the naturalization procedure. Together, these findings reveal a nuanced picture that contrasts with de-contextualized cost-benefit theories of immigrant naturalization and highlights the relevance of the local context of immigrant settlement.
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Affiliation(s)
- Christophe Leclerc
- Maastricht University Faculty of Arts and Social Sciences, Maastricht, Netherlands
| | | | - Hans Schmeets
- Maastricht University Faculty of Arts and Social Sciences, Maastricht, Netherlands
- Statistics Netherlands Heerlen, Heerlen, Netherlands
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Pavlisko EN, Neely ML, Kopetskie H, Hwang DM, Farver CF, Wallace WD, Arrossi A, Illei P, Sever ML, Kirchner J, Frankel CW, Snyder LD, Martinu T, Shino MY, Zaffiri L, Williams N, Robien MA, Singer LG, Budev M, Tsuang W, Shah PD, Reynolds JM, Weigt SS, Belperio JA, Palmer SM, Todd JL. Prognostic implications of and clinical risk factors for acute lung injury and organizing pneumonia after lung transplantation: Data from a multicenter prospective cohort study. Am J Transplant 2022; 22:3002-3011. [PMID: 36031951 PMCID: PMC9925227 DOI: 10.1111/ajt.17183] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/05/2022] [Accepted: 08/21/2022] [Indexed: 01/28/2023]
Abstract
We determined prognostic implications of acute lung injury (ALI) and organizing pneumonia (OP), including timing relative to transplantation, in a multicenter lung recipient cohort. We sought to understand clinical risks that contribute to development of ALI/OP. We analyzed prospective, histologic diagnoses of ALI and OP in 4786 lung biopsies from 803 adult lung recipients. Univariable Cox regression was used to evaluate the impact of early (≤90 days) or late (>90 days) posttransplant ALI or OP on risk for chronic lung allograft dysfunction (CLAD) or death/retransplantation. These analyses demonstrated late ALI/OP conferred a two- to threefold increase in the hazards of CLAD or death/retransplantation; there was no association between early ALI/OP and these outcomes. To determine risk factors for late ALI/OP, we used univariable Cox models considering donor/recipient characteristics and posttransplant events as candidate risks. Grade 3 primary graft dysfunction, higher degree of donor/recipient human leukocyte antigen mismatch, bacterial or viral respiratory infection, and an early ALI/OP event were significantly associated with increased late ALI/OP risk. These data from a contemporary, multicenter cohort underscore the prognostic implications of ALI/OP on lung recipient outcomes, clarify the importance of the timing of these events, and identify clinical risks to target for ALI/OP prevention.
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Affiliation(s)
| | - Megan L. Neely
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | | | - David M. Hwang
- Sunnybrook Health Sciences Centre, Ontario, Canada
- University Health Network, University of Toronto, Ontario, Canada
| | | | - W. Dean Wallace
- University of Southern California, Los Angeles, CA
- University of California Los Angeles, Los Angeles, CA
| | | | | | - Michelle L. Sever
- Rho, Durham, NC
- PPD Government and Public Health Services, Morrisville, NC
| | - Jerry Kirchner
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Courtney W. Frankel
- Duke University Medical Center, Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Durham, NC
| | - Laurie D. Snyder
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
- Duke University Medical Center, Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Durham, NC
| | - Tereza Martinu
- University Health Network, University of Toronto, Ontario, Canada
| | | | - Lorenzo Zaffiri
- Duke University Medical Center, Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Durham, NC
| | - Nikki Williams
- National Institute of Allergy and Infectious Diseases, Washington, DC
| | - Mark A. Robien
- National Institute of Allergy and Infectious Diseases, Washington, DC
| | - Lianne G. Singer
- University Health Network, University of Toronto, Ontario, Canada
| | | | | | | | - John M. Reynolds
- Duke University Medical Center, Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Durham, NC
| | - S. Sam Weigt
- University of California Los Angeles, Los Angeles, CA
| | | | - Scott M. Palmer
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
- Duke University Medical Center, Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Durham, NC
| | - Jamie L. Todd
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
- Duke University Medical Center, Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Durham, NC
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Zhong Z, Wu Q, Lai Y, Dai L, Gao Y, Liao W, Feng X, Yang P. Risk for uveitis relapse after COVID-19 vaccination. J Autoimmun 2022; 133:102925. [PMID: 36209692 PMCID: PMC9531657 DOI: 10.1016/j.jaut.2022.102925] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/16/2022] [Accepted: 09/27/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Several studies suggested that coronavirus disease 2019 (COVID-19) vaccination may lead to uveitis, a vision-threatening condition often associated with a variety of autoimmune or autoinflammatory diseases. This study aims to explore factors that influence the risk of uveitis relapse after COVID-19 vaccination to guide the prevention of disease. METHODS Uveitis relapse was evidenced by worsening activity of intraocular inflammation (e.g. anterior chamber cells, vitreous haze) as defined by the Standardization of Uveitis Nomenclature Working Group. Time to uveitis relapse since the administration of each dose of COVID-19 vaccine was compared across participants with modifiable variables. RESULTS The primary analysis included 438 non-COVID-19 participants with 857 doses of COVID-19 vaccine administered in total. The median age was 41 years (interquartile range, 30 to 51), and 57.3% were female. A total of 39 episodes of uveitis relapse events occurred in 34 patients after the receipt of a dose of COVID-19 vaccine within 30 days. The median time to relapse after vaccination was 5 days (interquartile range, 1 to 14). Concomitant use of systemic glucocorticoids at the time of vaccination was independently associated with a decrease in risk of relapse after vaccination (HR, 0.23 [95% CI, 0.07-0.74]; P value = 0.014). There was a trend in attenuating the risk of relapse with increasing prednisone dose from none to less than 20 mg per day and then to 20 mg per day or greater (P value for trend = 0.029). CONCLUSIONS Concomitant treatment with systemic glucocorticoids for uveitis at the time of COVID-19 vaccination was associated with a dose-dependent lower risk of uveitis relapse after vaccination.
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Affiliation(s)
| | | | | | | | | | | | | | - Peizeng Yang
- Corresponding author. The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Chongqing, 400016, China
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Benny C, Smith BT, Hyshka E, Senthilselvan A, Veugelers PJ, Pabayo R. Investigating the association between income inequality in youth and deaths of despair in Canada: a population-based cohort study from 2006 to 2019. J Epidemiol Community Health 2022; 77:jech-2022-219630. [PMID: 36323502 DOI: 10.1136/jech-2022-219630] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/15/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Deaths due to suicide, drug overdose and alcohol-related liver disease, collectively known as 'deaths of despair', have been markedly increasing since the early 2000s and are especially prominent in young Canadians. Income inequality has been linked to this rise in deaths of despair; however, this association has not yet been examined in a Canadian context, nor at the individual level or in youth. The study objective was to examine the association between income inequality in youth and deaths of despair among youth over time. METHODS We conducted a population-based longitudinal study of Canadians aged 20 years or younger using data from the Canadian Census Health and Environment Cohorts. Baseline data from the 2006 Canadian Census were linked to the Canadian Vital Statistics Database up to 2019. We employed multilevel survival analysis models to quantify the association between income inequality in youth and time-to deaths of despair. RESULTS The study sample included 1.5 million Canadians, representing 7.7 million Canadians between the ages of 0 and 19 at baseline. Results from the weighted, adjusted multilevel survival models demonstrated that income inequality was associated with an increased hazard of deaths of despair (adjusted HR (AHR) 1.35; 95% CI 1.04 to 1.75), drug overdose (AHR 2.38; 95% CI 1.63 to 3.48) and all-cause deaths (AHR 1.10; 95% CI 1.04 to 1.18). Income inequality was not significantly associated with suicide deaths (AHR 1.23, 95% CI 0.93 to 1.63). CONCLUSION The results show that higher levels of income inequality in youth are associated with an increased hazard of all-cause death, deaths of despair and drug overdose in young Canadians. This study is the first to reveal the association between income inequality and deaths of despair in youth and does so using a population-based longitudinal cohort involving multilevel data. The results of this study can inform policies related to income inequality and deaths of despair in Canada.
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Affiliation(s)
- Claire Benny
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Brendan T Smith
- Public Health Ontario, Toronto, Ontario, Canada
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | | | - Paul J Veugelers
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Roman Pabayo
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Centre for Healthy Communities, University of Alberta School of Public Health, Edmonton, Alberta, Canada
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O’ Dowd A, Hirst RJ, Setti A, Kenny RA, Newell FN. Self-Reported Sensory Decline in Older Adults Is Longitudinally Associated With Both Modality-General and Modality-Specific Factors. Innov Aging 2022; 6:igac069. [PMID: 36600808 PMCID: PMC9799047 DOI: 10.1093/geroni/igac069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Indexed: 12/31/2022] Open
Abstract
Background and Objectives Self-reported sensory data provide important insight into an individual's perception of sensory ability. It remains unclear what factors predict longitudinal change in self-reported sensory ability across multiple modalities during healthy aging. This study examined these associations in a cohort of older adults for vision, hearing, taste, and smell. Research Design and Methods Data on self-report sensory ability were drawn from 5,065 participants of The Irish Longitudinal Study on Ageing (mean age at baseline = 61.6, SD = 9.5, range 32-93 years; 59% female; resident in the Republic of Ireland) across 6 waves of data collection (2009-2021). Covariates included demographics, lifestyle factors, and measures of sensory, physical, mental, and cognitive health. Independent discrete survival analyses were performed for each sensory modality. Results A transition to self-reported fair/poor hearing was most prevalent (21% of the sample), followed by fair/poor vision (19%), smell (11%), and taste (6%). Participants who self-reported fair/poor function in one sensory modality were likely to report fair/poor ability in another sensory modality, although not for all pairings. Only self-rated fair/poor health was associated with increased odds of self-reported fair/poor ability across all sensory modalities. Age was associated with increased odds of self-reported fair/poor hearing, smell, and taste, as was current smoker status (vision, smell, and taste). Several other sensory (e.g., eye disease, hearing aid use) and nonsensory covariates (e.g., education, depression) were associated with the odds of self-reported fair/poor ability in one or two sensory modalities only. Discussion and Implications Over time, older adults perceive associations in fair/poor ability for multiple sensory modalities, albeit somewhat inconsistently. Both modality-general and modality-specific factors are associated with a transition from normal to fair/poor sensory ability. These results suggest the need for more routine testing of multiple senses with increasing age.
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Affiliation(s)
- Alan O’ Dowd
- Address correspondence to: Alan O’ Dowd, PhD, Institute of Neuroscience, Trinity College Dublin, College Green, Dublin 2, D02 PN40, Ireland. E-mail:
| | - Rebecca J Hirst
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland,The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Annalisa Setti
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland,School of Applied Psychology, University College Cork, Cork, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland,Mercer Institute for Successful Ageing, St. James Hospital, Dublin, Ireland
| | - Fiona N Newell
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
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Hallet J, Tillman B, Zuckerman J, Guttman MP, Chesney T, Mahar AL, Chan WC, Coburn N, Haas B. Association Between Frailty and Time Alive and At Home After Cancer Surgery Among Older Adults: A Population-Based Analysis. J Natl Compr Canc Netw 2022; 20:1223-1232.e9. [PMID: 36351336 DOI: 10.6004/jnccn.2022.7052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/06/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Although frailty is known to impact short-term postoperative outcomes, its long-term impact is unknown. This study examined the association between frailty and remaining alive and at home after cancer surgery among older adults. METHODS Adults aged ≥70 years undergoing cancer resection were included in this population-based retrospective cohort study using linked administrative datasets in Ontario, Canada. The probability of remaining alive and at home in the 5 years after cancer resection was evaluated using Kaplan-Meier methods. Extended Cox regression with time-varying effects examined the association between frailty and remaining alive and at home. RESULTS Of 82,037 patients, 6,443 (7.9%) had preoperative frailty. With median follow-up of 47 months (interquartile range, 23-81 months), patients with frailty had a significantly lower probability of remaining alive and at home 5 years after cancer surgery compared with those without frailty (39.1% [95% CI, 37.8%-40.4%] vs 62.5% [95% CI, 62.1%-63.9%]). After adjusting for age, sex, rural living, material deprivation, immigration status, cancer type, surgical procedure intensity, year of surgery, and receipt of perioperative therapy, frailty remained associated with increased hazards of not remaining alive and at home. This increase was highest 31 to 90 days after surgery (hazard ratio [HR], 2.00 [95% CI, 1.78-2.24]) and remained significantly elevated beyond 1 year after surgery (HR, 1.56 [95% CI, 1.48-1.64]). This pattern was observed across cancer sites, including those requiring low-intensity surgery (breast and melanoma). CONCLUSIONS Preoperative frailty was independently associated with a decreased probability of remaining alive and at home after cancer surgery among older adults. This relationship persisted over time for all cancer types beyond short-term mortality and the initial postoperative period. Frailty assessment may be useful for all candidates for cancer surgery, and these data can be used when counseling, selecting, and preparing patients for surgery.
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Affiliation(s)
- Julie Hallet
- 1Department of Surgery, University of Toronto, Toronto, Ontario
- 2Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario
- 3ICES, Toronto, Ontario
- 4Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario
| | - Bourke Tillman
- 3ICES, Toronto, Ontario
- 5Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario; and
| | - Jesse Zuckerman
- 1Department of Surgery, University of Toronto, Toronto, Ontario
- 3ICES, Toronto, Ontario
| | - Matthew P Guttman
- 1Department of Surgery, University of Toronto, Toronto, Ontario
- 3ICES, Toronto, Ontario
| | - Tyler Chesney
- 1Department of Surgery, University of Toronto, Toronto, Ontario
| | - Alyson L Mahar
- 3ICES, Toronto, Ontario
- 6Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Natalie Coburn
- 1Department of Surgery, University of Toronto, Toronto, Ontario
- 2Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario
- 3ICES, Toronto, Ontario
- 4Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario
| | - Barbara Haas
- 1Department of Surgery, University of Toronto, Toronto, Ontario
- 3ICES, Toronto, Ontario
- 4Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario
- 6Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Gender inequality in source country modifies sex differences in stroke incidence in Canadian immigrants. Sci Rep 2022; 12:17965. [PMID: 36289316 PMCID: PMC9605977 DOI: 10.1038/s41598-022-22771-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 10/19/2022] [Indexed: 01/24/2023] Open
Abstract
Research suggests that gender inequality, measured using the gender inequality index (GII), influences stroke mortality in women compared to men. We examine how source country GII modifies the rate of ischemic stroke in women compared to men after immigration to Canada, a country with low gender inequality. We used linked health data and immigration records of 452,089, stroke-free immigrants aged 40-69 year who migrated from 123 countries. Over 15 years of follow-up, 5991 (1.3%) had an incident ischemic stroke. We demonstrate (a) a lower adjusted rate of stroke in women compared to men (hazard ratio 0.64; 95% CI 0.61-0.67); (b) that sex differences in stroke incidence were modified by source country GII, as the hazard of stroke in women vs. men attenuated by a factor of 1.06 for every 0.1 increase in the GII of the source country (Psex*GII = 0.002); and (c) migration to a country with low GII attenuates the adverse effect of source country GII on sex differences in stroke incidence. Evaluating pathways through which source country gender inequality differentially influences stroke risk in immigrant women compared to men could help develop strategies to mitigate the effects of early-life gender inequality on stroke risk.
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Ramos-Rodríguez E, Pérez-Martínez C, Conde-Porcuna JM. A Non-Stressful Temperature Rise and Greater Food Availability Could Increase Tolerance to Calcium Limitation of Daphnia cf. pulex (Sensu Hebert, 1995) Populations in Cold Soft-Water Lakes. BIOLOGY 2022; 11:biology11101539. [PMID: 36290443 PMCID: PMC9598739 DOI: 10.3390/biology11101539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022]
Abstract
Calcium (Ca) is an important driver of community structure in freshwaters. We examined the combined effects of increased temperatures and variations in food quantity on the tolerance to low Ca of Daphnia pulex. The aim was to predict the impact of climate warming on this keystone zooplanktonic species in cold-climate lakes. We conducted a factorial life-history experiment in a clone of North American Daphnia cf. pulex to analyse the interaction effects of a temperature increase (17.5 °C−21 °C) within their physiological preferred range and expected by climate warming over the next few decades and a narrow Ca gradient (0.25−1.74 mg Ca L−1) under stressful vs. abundant food conditions. We found a striking positive synergistic effect of Ca and temperature on D. pulex reproduction at high food conditions. Although the increase in temperature to 21 °C greatly reduced survival, high energy allocation to reproduction at high food levels allowed the population to succeed in poor Ca (<0.25 mg Ca L−1). Results suggest that climate warming and higher food availability will make the populations of many cold and Ca-limited lakes more tolerant to low Ca levels with higher growth population rates, thereby altering zooplanktonic community structures and inducing potential cascading effects on the food web.
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Affiliation(s)
- Eloísa Ramos-Rodríguez
- Departamento de Ecología, Facultad de Ciencias, Universidad de Granada, 18071 Granada, Spain
- Instituto del Agua, Universidad de Granada, 18003 Granada, Spain
- Correspondence: ; Tel.: +34-958-24-10-00 (ext. 20094)
| | - Carmen Pérez-Martínez
- Departamento de Ecología, Facultad de Ciencias, Universidad de Granada, 18071 Granada, Spain
- Instituto del Agua, Universidad de Granada, 18003 Granada, Spain
| | - José María Conde-Porcuna
- Departamento de Ecología, Facultad de Ciencias, Universidad de Granada, 18071 Granada, Spain
- Instituto del Agua, Universidad de Granada, 18003 Granada, Spain
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Stavem K, Schirmer H, Gulsvik A. Respiratory symptoms and cardiovascular causes of deaths: A population-based study with 45 years of follow-up. PLoS One 2022; 17:e0276560. [PMID: 36264870 PMCID: PMC9584444 DOI: 10.1371/journal.pone.0276560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022] Open
Abstract
This study determined the association between respiratory symptoms and death from cardiovascular (CV) diseases during 45 years in a pooled sample of four cohorts of random samples of the Norwegian population with 95,704 participants. Respiratory symptoms were assessed using a modification of the MRC questionnaire on chronic bronchitis. We analyzed the association between respiratory symptoms and specific cardiovascular deaths by using Cox regression analysis with age as the time variable, accounting for cluster-specific random effects using shared frailty for study cohort. Hazard ratios (HR) for death were adjusted for sex, highest attained education, smoking habits, occupational air pollution, and birth cohort. Overall, 12,491 (13%) of participants died from CV diseases: 4,123 (33%) acute myocardial infarction, 2,326 (18%) other ischemic heart disease, 2,246 (18%) other heart diseases, 2,553 (20%) cerebrovascular diseases, and 1,120 (9%) other vascular diseases. The adjusted HR (95% confidence interval) for CV deaths was 1.9 (1.7–2.1) in men and 1.5 (1.2–1.9) in women for “yes” to the question “Are you breathless when you walk on level ground at an ordinary pace?”. The same item response showed an adjusted HR for death from acute myocardial infarction of 1.8 (1.5–2.1), other ischemic heart disease 2.2 (1.8–2.7), other heart diseases 1.5 (1.1–1.9), cerebrovascular disease 1.8 (1.5–2.3), and other circulatory diseases 1.7 (1.2–2.4). The adjusted HR for CV death was 1.3 (1.2–1.4) when answering positive to the question” Are you more breathless than people of your own age when walking uphill?”. However, positive answers to questions on cough, phlegm, wheezing and attacks of breathlessness were after adjustments not associated with early CV deaths. The associations between CV deaths and breathlessness were also present in never smokers. Self-reported breathlessness was associated with CV deaths and could be an early marker of CV deaths.
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Affiliation(s)
- Knut Stavem
- Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- * E-mail:
| | - Henrik Schirmer
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
| | - Amund Gulsvik
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
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Abota TL, Gashe FE, Deyessa N. Perinatal intimate partner violence and postpartum contraception timing among currently married women in Southern Ethiopia: A multilevel Weibull regression modeling. Front Public Health 2022; 10:913546. [PMID: 36339168 PMCID: PMC9627296 DOI: 10.3389/fpubh.2022.913546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/30/2022] [Indexed: 01/22/2023] Open
Abstract
Background Adopting contraception on time is a critical intervention for postpartum women, but violence exposure around pregnancy may interfere with postpartum contraceptive use behaviors. Hence, this study aimed to investigate the time duration of the first modern contraceptive adoption and its individual-and community-level predictors among postpartum women in the Wolaita zone, South Ethiopia. Methods A community-based prospective follow-up study was conducted among 1,292 postpartum women nested in 38 "Kebles" (clusters) using multistage-clustered sampling techniques. A multilevel Weibull regression model was employed to investigate predictors of time-to-method initiation after childbirth using STATA Version 14. Kaplan-Meier curve and Wilcoxon log-rank test were used to estimate time-to-modern contraceptive use across different variables. All variables with p-values <0.05 were considered for multivariate analysis. Adjusted time ratios (ATR) with 95 % CI were computed using Weibull accelerated failure time models. Results Of the respondents, 62% (95% CI: 59.1-64.5) had started the first modern contraception within a year after childbirth. The restricted mean survival time-to-postpartum modern contraceptive use was 6.28 months. Being a rural dweller (aTR: 1.44; 95% CI: 1.06-1.99) and living in the middle household wealth quintiles (aTR: 1.10; 95% CI: 1.02-1.19) predicted longer time duration to adopt first modern contraception by 44 and 10%, respectively. The women from the community with a high early marriage (aTR: 1.14; 95% CI: 1.01-1.28) took longer time to initiate modern postpartum methods. Furthermore, women who had no history of perinatal abuse took less time than those who had a history of abuse to start postpartum contraception (aTR: 0.71; 95% CI: 0.66-0.78). Conclusion Rural residence, poor household wealth status, history of perinatal abuse, and a high rate of early marriage in the community are predicted to lengthen the time duration to start modern postpartum contraception. Thus, community-level women's empowerment, particularly among rural women and integration of intimate partner violence screening into family planning counseling throughout the continuum of care will likely to improve postpartum contraception timing.
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Affiliation(s)
- Tafesse Lamaro Abota
- College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
- Department of Epidemiology and Biostatistics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fikre Enqueselassie Gashe
- Department of Epidemiology and Biostatistics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Negussie Deyessa
- Department of Epidemiology and Biostatistics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Yu L, Li T, Yang Z, Zhang X, Xu L, Wu Y, Yu Z, Shen P, Lin H, Shui L, Tang M, Jin M, Chen K, Wang J. Long-term exposure to residential surrounding greenness and incidence of diabetes: A prospective cohort study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 310:119821. [PMID: 35870530 DOI: 10.1016/j.envpol.2022.119821] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/27/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
Exposure to residential greenness might affect population health through increasing physical activity and social engagement, improving mental health, and reducing harmful environmental exposure. However, evidence on the association of greenness with risk of diabetes is still controversial. In this study, we recruited a total of 22,535 participants aged ≥18 years from Yinzhou District, Ningbo, Zhejiang Province, China to investigate the associations between residential greenness and risk of diabetes incidence. Residential greenness was estimated using Normalized Difference Vegetation Index (NDVI), Enhanced Vegetation Index (EVI), and Vegetation Continuous Field (VCF). We also calculated cumulative average NDVI, EVI and VCF values, and changes in NDVI, EVI and VCF during the follow-up period. We used Cox proportional hazards models controlling for demographic characteristics, lifestyles, individual socioeconomic status, history of diseases and particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5) to examine hazard ratios (HRs) and 95% confidence intervals (95% CIs) and assessed physical activity, body mass index (BMI) or PM2.5 as potential mediators. During 84,992.64 person-years of follow-up, a total of 1,154 incident cases of diabetes occurred. In multivariable models, living in the highest quartile of cumulative average NDVI, EVI and VCF within 250-m buffer was associated with 57% (HR = 0.43, 95% CI: 0.36, 0.52), 62% (HR = 0.38, 95% CI: 0.32, 0.45), and 55% (HR = 0.45, 95% CI: 0.38, 0.54) reduction in diabetes risk compared with the lowest quartile, respectively. Results remained similar for NDVI, EVI, and VCF within 500-m and 1000-m buffers. Stratified analyses showed stronger association for residential greenness and diabetes among older people. The association between greenness and diabetes did not appear to be mediated by physical activity, PM2.5 or BMI. Our findings suggested that higher residential greenness was significantly associated with lower risk of diabetes.
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Affiliation(s)
- Luhua Yu
- Department of Epidemiology and Biostatistics at School of Public Health and National Clinical Research Center for Child Health of the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Tiezheng Li
- Department of Epidemiology and Biostatistics at School of Public Health and National Clinical Research Center for Child Health of the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Zongming Yang
- Department of Epidemiology and Biostatistics at School of Public Health and National Clinical Research Center for Child Health of the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Xinhan Zhang
- Department of Epidemiology and Biostatistics at School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Lisha Xu
- Department of Epidemiology and Biostatistics at School of Public Health and National Clinical Research Center for Child Health of the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Yonghao Wu
- Department of Epidemiology and Biostatistics at School of Public Health and National Clinical Research Center for Child Health of the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Zhebin Yu
- Department of Epidemiology and Biostatistics at School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Peng Shen
- Department of Chronic Disease and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, 315040, China
| | - Hongbo Lin
- Department of Chronic Disease and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, 315040, China
| | - Liming Shui
- Yinzhou District Health Bureau of Ningbo, Ningbo, 315040, China
| | - Mengling Tang
- Department of Epidemiology and Biostatistics at School Public Health and the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Mingjuan Jin
- Department of Epidemiology and Biostatistics at School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Kun Chen
- Department of Epidemiology and Biostatistics at School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Jianbing Wang
- Department of Epidemiology and Biostatistics at School of Public Health and National Clinical Research Center for Child Health of the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China.
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Dujmovic M, Roederer T, Frison S, Melki C, Lauvin T, Grellety E. COVID-19 in French nursing homes during the second pandemic wave: a mixed-methods cross-sectional study. BMJ Open 2022; 12:e060276. [PMID: 36127110 PMCID: PMC9490301 DOI: 10.1136/bmjopen-2021-060276] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/01/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION French nursing homes were deeply affected by the first wave of the COVID-19 pandemic, with 38% of all residents infected and 5% dying. Yet, little was done to prepare these facilities for the second pandemic wave, and subsequent outbreak response strategies largely duplicated what had been done in the spring of 2020, regardless of the unique needs of the care home environment. METHODS A cross-sectional, mixed-methods study using a retrospective, quantitative data from residents of 14 nursing homes between November 2020 and mid-January 2021. Four facilities were purposively selected as qualitative study sites for additional in-person, in-depth interviews in January and February 2021. RESULTS The average attack rate in the 14 participating nursing facilities was 39% among staff and 61% among residents. One-fifth (20) of infected residents ultimately died from COVID-19 and its complications. Failure to thrive syndrome (FTTS) was diagnosed in 23% of COVID-19-positive residents. Those at highest risk of death were men (HR=1.78; 95% CI: 1.18 to 2.70; p=0.006), with FTTS (HR=4.04; 95% CI: 1.93 to 8.48; p<0.001) or in facilities with delayed implementation of universal FFP2 masking policies (HR=1.05; 95% CI: 1.02 to 1.07; p<0.001). The lowest mortality was found in residents of facilities with a partial (HR=0.30; 95% CI: 0.18 to 0.51; p<0.001) or full-time physician on staff (HR=0.20; 95% CI: 0.08 to 0.53; p=0.001). Significant themes emerging from qualitative analysis centred on (1) the structural, chronic neglect of nursing homes, (2) the negative effects of the top-down, bureaucratic nature of COVID-19 crisis response, and (3) the counterproductive effects of lockdowns on both residents and staff. CONCLUSION Despite high resident mortality during the first pandemic wave, French nursing homes were ill-prepared for the second, with risk factors (especially staffing, lack of medical support, isolation/quarantine policy, etc) that affected case fatality and residents' and caregivers' overall well-being and mental health.
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Affiliation(s)
- Morgane Dujmovic
- Department of Epidemiology and Training, Epicentre, Paris, France
| | - Thomas Roederer
- Department of Epidemiology and Training, Epicentre, Paris, France
| | - Severine Frison
- Department of Epidemiology and Training, Epicentre, Paris, France
| | - Carla Melki
- Emergency Cell, Médecins Sans Frontières, Paris, France
| | - Thomas Lauvin
- Emergency Cell, Médecins Sans Frontières, Paris, France
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Ishii M, Kuramitsu S, Yamanaga K, Matsuo H, Horie K, Takashima H, Terai H, Kikuta Y, Ishihara T, Saigusa T, Sakamoto T, Suematsu N, Shiono Y, Asano T, Masamura K, Doijiri T, Toyota F, Ogita M, Kurita T, Matsuo A, Harada K, Yaginuma K, Kanemura N, Sonoda S, Yokoi H, Tanaka N, Tsujita K. Association of guideline-directed medical therapy adherence with outcomes after fractional flow reserve-based deferral of revascularization. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 8:600-608. [PMID: 35108383 DOI: 10.1093/ehjcvp/pvac008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/21/2021] [Accepted: 01/29/2022] [Indexed: 11/14/2022]
Abstract
AIMS Guideline-directed medical therapy (GDMT) is essential to prevent future cardiovascular events in chronic coronary syndrome (CCS) patients. However, whether achieving optimal GDMT could improve clinical outcomes in CCS patients with deferred lesions based on fraction flow reserve (FFR) remains thoroughly investigated. We sought to evaluate the association of GDMT adherence with long-term outcomes after FFR-based deferral of revascularization in a real-world registry. METHODS AND RESULTS This is a post-hoc analysis of the J-CONFIRM registry (long-term outcomes of Japanese patients with deferral of coronary intervention based on fractional flow reserve in multicentre registry). Optimal GDMT was defined as combining four types of medications: antiplatelet drug, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker, beta-blocker, and statin. After stratifying patients by the number of individual GDMT agents at 2 years, landmark analysis was conducted to assess the relationship between GDMT adherence at 2 years and 5-year major adverse cardiac events (MACEs), defined as a composite of all-cause death, target vessel-related myocardial infarction, clinically driven target vessel revascularization. Compared with the suboptimal GDMT group (continuing ≤3 types of medications, n = 974), the optimal GDMT group (n = 139) showed a lower 5-year incidence of MACE (5.2% vs. 12.4%, P = 0.02). The optimal GDMT was associated with a lower risk of MACE (hazard ratio: 0.41; 95% confidence interval: 0.18 to 0.92; P = 0.03). CONCLUSION Patients with optimal GDMT were associated with better outcomes, suggesting the importance of achieving optimal GDMT on long-term prognosis in CCS patients after FFR-guided deferral of revascularization.
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Affiliation(s)
- Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1 Chome 1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Shoichi Kuramitsu
- Department of Cardiology, Kokura Memorial Hospital, 3 Chome-2-1 Asano, Kokurakita Ward, Kitakyushu 802-8555, Japan
| | - Kenshi Yamanaga
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1 Chome 1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, 4 Chome-14-4, Yabuta-minami, Gifu City, Gifu 500-8384, Japan
| | - Kazunori Horie
- Department of Cardiovascular Medicine, Sendai Kousei Hospital, 4-15 Hirosemachi, Aoba Ward, Sendai 980-0873, Japan
| | - Hiroaki Takashima
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute 480-1195, Japan
| | - Hidenobu Terai
- Department of Cardiology, Kanazawa Cardiovascular Hospital, Ha-16 Tanakamachi, Kanazawa 920-0007, Japan
| | - Yuetsu Kikuta
- Department of Cardiology, Fukuyama Cardiovascular Hospital, 2-39 Midorimachi, Fukuyama 720-0804, Japan
| | - Takayuki Ishihara
- Kansai Rosai Hospital Cardiovascular Center, 3-chōme-1-69 Inabasō, Amagasaki 660-8511, Japan
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3 Chome-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Tomohiro Sakamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5 Chome-3 No. 1 Chikami, Minami Ward, Kumamoto 861-4193, Japan
| | - Nobuhiro Suematsu
- Department of Cardiology, Saiseikai Fukuoka General Hospital, 1 Chome-3-46 Tenjin, Fukuoka 810-0001, Japan
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Taku Asano
- Department of Cardiology, St Luke's International Hospital, 9-1 Akashicho, Chuo City Tokyo 104-8560, Japan
| | - Katsuhiko Masamura
- Department of Cardiology, Nakamura Hospital, 4-28 Tennocho, Echizen 915-0068, Japan
| | - Tatsuki Doijiri
- Department of Cardiology, Yamato Seiwa Hospital, 9 Chome-8-2 Minamirinkan, Yamato 242-0006, Japan
| | - Fumitoshi Toyota
- Department of Cardiology, Chidoribashi Hospital, 5-18-1 Chiyo, Fukuoka 812-8633, Japan
| | - Manabu Ogita
- Department of Cardiology, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Shizuoka 410-2295, Japan
| | - Tairo Kurita
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2 Chome-174, Mie 514-8507, Japan
| | - Akiko Matsuo
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, Higashiuratsujicho, Kamigyo Ward, Kyoto 602-8031, Japan
| | - Ken Harada
- Department of Cardiology, Chubu Rosai Hospital, 1-10-6 Komei, Minato Ward, Nagoya 455-8530, Japan
| | - Kenji Yaginuma
- Department of Cardiology, Juntendo University Urayasu Hospital, 2 Chome-1-1 Tomioka, Chiba 279-0021, Japan
| | - Noriyoshi Kanemura
- Department of Cardiology, Kainan hospital, Minamihonden-396 Maegasucho, Aichi 498-8502, Japan
| | - Shinjo Sonoda
- Department of Cardiovascular Failure Therapy, Saga University, 5-1-1, Nabeshima 849-8501, Japan
| | - Hiroyoshi Yokoi
- Department of Cardiology, Fukuoka Sanno Hospital, 3-6-45 Momochihama, Sawara-ku, Fukuoka 814-0001, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0998, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1 Chome 1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
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Abstract
BACKGROUND This article identifies the most influential methods reports for group-randomized trials and related designs published through 2020. Many interventions are delivered to participants in real or virtual groups or in groups defined by a shared interventionist so that there is an expectation for positive correlation among observations taken on participants in the same group. These interventions are typically evaluated using a group- or cluster-randomized trial, an individually randomized group treatment trial, or a stepped wedge group- or cluster-randomized trial. These trials face methodological issues beyond those encountered in the more familiar individually randomized controlled trial. METHODS PubMed was searched to identify candidate methods reports; that search was supplemented by reports known to the author. Candidate reports were reviewed by the author to include only those focused on the designs of interest. Citation counts and the relative citation ratio, a new bibliometric tool developed at the National Institutes of Health, were used to identify influential reports. The relative citation ratio measures influence at the article level by comparing the citation rate of the reference article to the citation rates of the articles cited by other articles that also cite the reference article. RESULTS In total, 1043 reports were identified that were published through 2020. However, 55 were deemed to be the most influential based on their relative citation ratio or their citation count using criteria specific to each of the three designs, with 32 group-randomized trial reports, 7 individually randomized group treatment trial reports, and 16 stepped wedge group-randomized trial reports. Many of the influential reports were early publications that drew attention to the issues that distinguish these designs from the more familiar individually randomized controlled trial. Others were textbooks that covered a wide range of issues for these designs. Others were "first reports" on analytic methods appropriate for a specific type of data (e.g. binary data, ordinal data), for features commonly encountered in these studies (e.g. unequal cluster size, attrition), or for important variations in study design (e.g. repeated measures, cohort versus cross-section). Many presented methods for sample size calculations. Others described how these designs could be applied to a new area (e.g. dissemination and implementation research). Among the reports with the highest relative citation ratios were the CONSORT statements for each design. CONCLUSIONS Collectively, the influential reports address topics of great interest to investigators who might consider using one of these designs and need guidance on selecting the most appropriate design for their research question and on the best methods for design, analysis, and sample size.
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Affiliation(s)
- David M Murray
- Office of Disease Prevention, National Institutes of Health, North Bethesda, MD, USA
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Price AN, Pathak R, Guthrie GM, Kumar M, Moftakhari H, Moradkhani H, Nadolnyak D, Magliocca NR. Multi-Level Influences on Center-Pivot Irrigation Adoption in Alabama. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2022. [DOI: 10.3389/fsufs.2022.879161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Rates of poverty and economic inequality in rural Alabama are among the nation's highest and increasing agricultural productivity can provide a needed boost to these communities. The transition from rain-fed to irrigation-fed (RFtoIF) agriculture has significantly increased farm productivity and profitability elsewhere in the United States. Despite this potential to enhance stability and resilience in rural economies, irrigated cropland accounts for only 5% of Alabama's total cropland as numerous barriers remain to irrigation adoption. To encourage RFtoIF transition, it is imperative to identify the challenges faced by individual farmers at farm, community, and state levels. This study presents a multi-level mixed effects survival analysis to identify the physiographic, socioecological, and economic factors that influence the location and timing of irrigation adoption. We integrate spatiotemporal cropland and climatological data with field-verified locations of center-pivot irrigation systems, local physiographic characteristics, and parcel-level surface water access and average well depth. Access to surface water, costs to access groundwater, and soil characteristics were generally important influences in all regions, but regions were differentiated by the extent to which new irrigation was more responsive to social influences vs. precipitation and price trends. Our findings also highlighted the diversity of farming conditions across the state, which suggested that diverse policy tools are needed that acknowledge the varying motivations and constraints faced by Alabama's farmers.
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Canton C, Boussari O, Boulin M, Le Malicot K, Taieb J, Dahan L, Lopez A, Lepage C, Bachet JB. Impact of G-CSF Prophylaxis on Chemotherapy Dose-Intensity, Link Between Dose-Intensity and Survival in Patients with Metastatic Pancreatic Adenocarcinoma. Oncologist 2022; 27:e571-e579. [PMID: 35289915 PMCID: PMC9255980 DOI: 10.1093/oncolo/oyac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In metastatic pancreatic adenocarcinoma, few data are available on the use of granulocyte-colony stimulating factor (G-CSF) prophylaxis and its impact on dose-intensity (DI), or the link between DI and progression-free survival (PFS). This study assessed the impact of G-CSF prophylaxis on the DI received by patients and the relationship between full DI and PFS according to chemotherapy regimens. PATIENTS AND METHODS Patients from three first-line randomized phase II clinical trials were included in this retrospective cohort. G-CSF prophylaxis groups were identified and balanced according to baseline characteristics using a propensity score. Patients were classified into 2 treatment groups (FOLFIRINOX vs FOLFIRI/nab-paclitaxel (NAB)). DI was a binary variable (full/reduced). Adverse events were defined using NCI-CTCAE v4.0. RESULTS Of the 498 patients, 154 (31%) were in "prophylaxis" group; 179 (36%) were treated by FOLFIRINOX and 319 (64%) by FOLFIRI/NAB. In FOLFIRINOX group, G-CSF prophylaxis was significantly associated with a higher rate of full DI (OR, 5.07; 95% CI, 1.52-16.90; P < .01) while in FOLFIRI/NAB group, it was significantly associated with a lower rate of full DI (OR, 0.23; 95% CI, 0.06-0.83; P = .03). Full DI was associated with a non-significant increase in PFS (FOLFIRINOX group: HR 0.83; 95% CI, 0.59-1.16; P = .27; FOLFIRI/NAB group: HR 0.84; 95% CI, 0.63-1.11; P = .22). CONCLUSION Granulocyte-colony stimulating factor prophylaxis was associated with a higher rate of full DI with FOLFIRINOX. Full DI was associated with a non-significant increase in PFS. These results need to be confirmed prospectively.
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Affiliation(s)
- Clémence Canton
- Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital of Dijon, Dijon, France
- EPICAD INSERM LNC-UMR 1231 University of Burgundy and Franche-Comté, Dijon, France
| | - Olayidé Boussari
- EPICAD INSERM LNC-UMR 1231 University of Burgundy and Franche-Comté, Dijon, France
- Fédération Francophone de Cancérologie Digestive, Dijon, France
| | - Mathieu Boulin
- EPICAD INSERM LNC-UMR 1231 University of Burgundy and Franche-Comté, Dijon, France
- Department of Pharmacy, University Hospital of Dijon, Dijon, France
| | - Karine Le Malicot
- EPICAD INSERM LNC-UMR 1231 University of Burgundy and Franche-Comté, Dijon, France
- Fédération Francophone de Cancérologie Digestive, Dijon, France
| | - Julien Taieb
- Department of Hepato-Gastroenterology, Georges Pompidou European Hospital, Carpem, Sorbonne Paris City, Paris Descartes University, Paris, France
| | - Laetitia Dahan
- Department of Hepato-Gastroenterology and Digestive Oncology, La Timone, AMU, Marseille, France
| | - Anthony Lopez
- Department of Hepato-Gastroenterology, University Hospital Nancy-Brabois, Nancy, France
| | - Come Lepage
- Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital of Dijon, Dijon, France
- EPICAD INSERM LNC-UMR 1231 University of Burgundy and Franche-Comté, Dijon, France
| | - Jean-Baptiste Bachet
- Department of Hepato-Gastroenterology, Pitié-Salpêtrière Hospital, Paris, France
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Process Mining the Performance of a Real-Time Healthcare 4.0 Systems Using Conditional Survival Models. ALGORITHMS 2022. [DOI: 10.3390/a15060196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As the world moves into the exciting age of Healthcare 4.0, it is essential that patients and clinicians have confidence and reassurance that the real-time clinical decision support systems being used throughout their care guarantee robustness and optimal quality of care. However, current systems involving autonomic behaviour and those with no prior clinical feedback, have generally to date had little focus on demonstrating robustness in the use of data and final output, thus generating a lack of confidence. This paper wishes to address this challenge by introducing a new process mining approach based on a statistically robust methodology that relies on the utilisation of conditional survival models for the purpose of evaluating the performance of Healthcare 4.0 systems and the quality of the care provided. Its effectiveness is demonstrated by analysing the performance of a clinical decision support system operating in an intensive care setting with the goal to monitor ventilated patients in real-time and to notify clinicians if the patient is predicted at risk of receiving injurious mechanical ventilation. Additionally, we will also demonstrate how the same metrics can be used for evaluating the patient quality of care. The proposed methodology can be used to analyse the performance of any Healthcare 4.0 system and the quality of care provided to the patient.
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Rubio FJ, Drikvandi R. MEGH: A parametric class of general hazard models for clustered survival data. Stat Methods Med Res 2022; 31:1603-1616. [PMID: 35668699 PMCID: PMC9315191 DOI: 10.1177/09622802221102620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In many applications of survival data analysis, the individuals are treated in different medical centres or belong to different clusters defined by geographical or administrative regions. The analysis of such data requires accounting for between-cluster variability. Ignoring such variability would impose unrealistic assumptions in the analysis and could affect the inference on the statistical models. We develop a novel parametric mixed-effects general hazard (MEGH) model that is particularly suitable for the analysis of clustered survival data. The proposed structure generalises the mixed-effects proportional hazards and mixed-effects accelerated failure time structures, among other structures, which are obtained as special cases of the MEGH structure. We develop a likelihood-based algorithm for parameter estimation in general subclasses of the MEGH model, which is implemented in our R package MEGH. We propose diagnostic tools for assessing the random effects and their distributional assumption in the proposed MEGH model. We investigate the performance of the MEGH model using theoretical and simulation studies, as well as a real data application on leukaemia.
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Affiliation(s)
| | - Reza Drikvandi
- Department of Mathematical Sciences, 3057Durham University, Durham, UK
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80
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Panis S, Schmidt T. When does “inhibition of return” occur in spatial cueing tasks? Temporally disentangling multiple cue-triggered effects using response history and conditional accuracy analyses. OPEN PSYCHOLOGY 2022. [DOI: 10.1515/psych-2022-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Abstract
Research on spatial cueing has shown that uninformative cues often facilitate mean response time (RT) performance in valid- compared to invalid-cueing conditions at short cue-target stimulus-onset-asynchronies (SOAs), and robustly generate a reversed or inhibitory cueing effect at longer SOAs that is widely known as inhibition-of-return (IOR). To study the within-trial time course of the IOR and facilitation effects we employ discrete-time hazard and conditional accuracy analyses to analyze the shapes of the RT and accuracy distributions measured in two experimental tasks. Our distributional analyses show that (a) IOR is present only from ~160 ms to ~280 ms after target onset for cue-target SOAs above ~200 ms, (b) facilitation does not precede IOR, but co-occurs with it, (c) the cue-triggered motor response activation is selectively and actively inhibited before target onset, (d) the presence of a central cue causes a temporary negative cueing effect in the conditional accuracy functions, (e) the IOR effect consists of a facilitatory and an inhibitory component when compared to central cueing, and (f) the within-trial time course of IOR is not affected much by the task employed (detection or localization). We conclude that the traditional mean performance measures conceal crucial information on behavioral dynamics in spatial cueing paradigms.
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Affiliation(s)
- Sven Panis
- Experimental Psychology Unit, Faculty of Social Sciences , Technische Universität Kaiserslautern , Erwin-Schrödinger-Straße, Building 57 , Kaiserslautern , Germany
| | - Thomas Schmidt
- Experimental Psychology Unit, Faculty of Social Sciences , Technische Universität Kaiserslautern , Erwin-Schrödinger-Stra-ße, Building 57 , Kaiserslautern , Germany
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81
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K. C. M, Oral E, Rung AL, Trapido EJ, Rozek LS, Fontham ETH, Bensen JT, Farnan L, Steck SE, Song L, Mohler JL, Peters ES. Neighborhood deprivation and risk of mortality among men with prostate cancer: Findings from a long-term follow-up study. Prostate 2022; 82:783-792. [PMID: 35201637 PMCID: PMC9306458 DOI: 10.1002/pros.24320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 01/10/2022] [Accepted: 02/04/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND The overall survival rate of prostate cancer (PCa) has improved over the past decades. However, huge socioeconomic and racial disparities in overall and prostate cancer-specific mortality exist. The neighborhood-level factors including socioeconomic disadvantage and lack of access to care may contribute to disparities in cancer mortality. This study examines the impact of neighborhood deprivation on mortality among PCa survivors. METHODS North Carolina-Louisiana Prostate Cancer Project (PCaP) data were used. A total of 2113 men, 1046 AA and 1067 EA, with PCa were included in the analysis. Neighborhood deprivation was measured by the Area Deprivation Index (ADI) at the census block group level using data from the US Census Bureau. Quintiles of ADI were created. Cox proportional hazards and competing risk models with mixed effects were performed to estimate the effect of neighborhood deprivation on all-cause and PCa-specific mortality adjusted for age, race, study site, insurance status, and comorbidities. RESULTS Participants living in the most deprived neighborhoods had an increased risk for all-cause mortality (quintiles 4 + 5: adjusted hazard ratio [aHR] = 1.51, 95% confidence interval [CI] = 1.16-1.96) compared to those in the least deprived (quintile 1) neighborhoods. The risk of prostate cancer-specific mortality was also higher among those living in the deprived neighborhoods (quintiles 4 + 5: aHR = 1.90, 95% CI = 1.10-3.50) than those in the least deprived neighborhood. CONCLUSIONS The findings suggest neighborhood-level resources or health interventions are essential to improve survival among men with PCa. Additional research should focus on the mechanisms of how the neighborhood environment affects mortality.
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Affiliation(s)
- Madhav K. C.
- Department of Internal Medicine, Yale School of MedicineCancer Outcomes, Public Policy, and Effectiveness Research (COPPER) CenterNew HavenConnecticutUSA
- Department of Epidemiology, School of public HealthEpidemiology Program, Louisiana State University Health Sciences Center‐New OrleansNew OrleansLouisianaUSA
| | - Evrim Oral
- Department of Biostatistics, School of Public HealthBiostatistics Program, Louisiana State University Health Sciences Center‐New OrleansNew OrleansLouisianaUSA
| | - Ariane L. Rung
- Department of Epidemiology, School of public HealthEpidemiology Program, Louisiana State University Health Sciences Center‐New OrleansNew OrleansLouisianaUSA
| | - Edward J. Trapido
- Department of Epidemiology, School of public HealthEpidemiology Program, Louisiana State University Health Sciences Center‐New OrleansNew OrleansLouisianaUSA
| | - Laura S. Rozek
- Department of Environmental Health SciencesUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | - Elizabeth T. H. Fontham
- Department of Epidemiology, School of public HealthEpidemiology Program, Louisiana State University Health Sciences Center‐New OrleansNew OrleansLouisianaUSA
| | - Jeannette T. Bensen
- Department of EpidemiologyGillings School of Global Public Health, University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Lineberger Comprehensive Cancer Center, School of MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Laura Farnan
- Lineberger Comprehensive Cancer Center, School of MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Susan E. Steck
- Department of Epidemiology and BiostatisticsArnold School of Public Health, University of South CarolinaColumbiaSouth CarolinaUSA
| | - Lixin Song
- School of NursingUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - James L. Mohler
- Department of UrologyRoswell Park Comprehensive Cancer CenterNew YorkNew YorkUSA
| | - Edward S. Peters
- Department of Epidemiology, School of public HealthEpidemiology Program, Louisiana State University Health Sciences Center‐New OrleansNew OrleansLouisianaUSA
- Department of EpidemiologyCollege of Public HealthUniversity of Nebraska Medical CenterOmahaNebraskaUSA
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82
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Koulidiati JL, Kaboré R, I Nebié E, Sidibé A, Lohmann J, Brenner S, Badolo H, Hamadou S, Ouédraogo N, De Allegri M. Timely completion of childhood vaccination and its predictors in Burkina Faso. Vaccine 2022; 40:3356-3365. [PMID: 35487810 DOI: 10.1016/j.vaccine.2022.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/10/2022] [Accepted: 04/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Despite important progress in global vaccination coverage, many countries are still facing preventable disease outbreaks. Timely vaccination is important in getting adequate protection against disease. In light of the paucity of relevant literature, this study investigated the timely completion of childhood routine immunization and identified factors associated with timely vaccination in Burkina Faso. METHODS We extracted data on child vaccination and other child characteristics from a household survey conducted across 24 districts in 2017. We extracted data on health system characteristics from a parallel facility survey. We applied a Kaplan-Meier time-to-event analysis to estimate timely vaccination coverage defined as the proportion of children that received a given vaccine in the period between three days before and 28 days after the recommended age. We used a Cox proportional hazard model with mixed effects to identify factors associated with timely vaccination. RESULTS In total, 3,138 children aged between 16 and 36 months who could present an immunization booklet were included in the study.The main finding is the existence of an important gap showing that timely vaccination coverage was lower than vaccination coverage. More specifically,this gap ranged from 16% for BCG to 43% for Penta 3. In addition, region and distance between the household and the nearest health facility were the main factors associated with timely full vaccination coverage and specifically for Penta3, MCV1 and MCV2. CONCLUSIONS This study highlights that timely vaccination coverage remains substantially lower than vaccination coverage. Timeliness of vaccination should therefore be considered as a metric to assess the status of immunization in a country. Geographical accessibility continues to represent a major barrier to timely vaccination, calling for specific interventions on both supply-side (e.g. outreach activities) and demand-side (e.g. vouchers or community-based interventions for vaccination) to counteract its negative effect.
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Affiliation(s)
- Jean-Louis Koulidiati
- Heidelberg Institute of Global Health, University Hospital Heidelberg and Faculty of Medicine, Heidelberg, Germany
| | - Rémi Kaboré
- Institut de Santé Publique d'Epidémiologie et du Développement (ISPED), Université de Bordeaux, France
| | - Eric I Nebié
- Centre de recherche en santé de Nouna (CRSN), Nouna Burkina Faso, Burkina Faso; Swiss Tropical and Public Health Institute, University of Basel, Switzerland
| | - Annick Sidibé
- Ministère de la santé, Direction de la prévention par la vaccination, Ouagadougou, Burkina Faso
| | - Julia Lohmann
- Heidelberg Institute of Global Health, University Hospital Heidelberg and Faculty of Medicine, Heidelberg, Germany; Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephan Brenner
- Heidelberg Institute of Global Health, University Hospital Heidelberg and Faculty of Medicine, Heidelberg, Germany
| | | | | | | | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital Heidelberg and Faculty of Medicine, Heidelberg, Germany
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Nishi T, Ishii M, Tsujita K, Okamoto H, Koto S, Nakai M, Sumita Y, Iwanaga Y, Matoba S, Kobayashi Y, Hirata KI, Hikichi Y, Yokoi H, Ikari Y, Uemura S. Outcomes of Venoarterial Extracorporeal Membrane Oxygenation Plus Intra-Aortic Balloon Pumping for Treatment of Acute Myocardial Infarction Complicated by Cardiogenic Shock. J Am Heart Assoc 2022; 11:e023713. [PMID: 35377180 PMCID: PMC9075437 DOI: 10.1161/jaha.121.023713] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Clinical outcomes of acute myocardial infarction complicated by cardiogenic shock remain poor with high in‐hospital mortality. Veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) has been widely used for patients with acute myocardial infarction complicated by cardiogenic shock refractory to conservative therapy, which is likely fatal without mechanical circulatory support. However, whether additional intra‐aortic balloon pumping (IABP) use during VA‐ECMO support improves clinical outcomes remains controversial. This study sought to investigate prognostic impact of the combined VA‐ECMO plus IABP treatment compared with VA‐ECMO alone. Methods and Results From the nationwide Japanese administrative case‐mix Diagnostic Procedure Combination (DPC), the JROAD (Japanese Registry of All Cardiac and Vascular Diseases)–DPC, we identified 3815 patients with acute myocardial infarction complicated by cardiogenic shock who underwent primary percutaneous coronary intervention and managed with VA‐ECMO. Of these, 2964 patients (77.7%) were managed with IABP (VA‐ECMO plus IABP), whereas 851 (22.3%) were managed without IABP (VA‐ECMO alone). We compared in‐hospital, 7‐day, and 30‐day mortality between the VA‐ECMO plus IABP versus the VA‐ECMO alone support. Patients managed with VA‐ECMO plus IABP demonstrated significantly lower in‐hospital, 7‐day, and 30‐day mortality than those managed with VA‐ECMO alone (adjusted odds ratios [95% CI] of 0.47 [95% CI, 0.38–0.59], 0.41 [95% CI, 0.33–0.51], and 0.30 [95% CI, 0.25–0.37], respectively). The findings were consistent in the propensity matching and inverse probability of treatment‐weighting models. Conclusions This large‐scale, nationwide study demonstrated that the combination of VA‐ECMO plus IABP support was associated with significantly lower mortality compared with VA‐ECMO support alone in patients presenting with acute myocardial infarction complicated by cardiogenic shock who underwent primary percutaneous coronary intervention.
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Affiliation(s)
- Takeshi Nishi
- Department of Cardiology Kawasaki Medical School Kurashiki Okayama Japan
| | - Masanobu Ishii
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto City Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto City Japan
| | - Hiroshi Okamoto
- Department of Cardiology Kawasaki Medical School Kurashiki Okayama Japan
| | - Satoshi Koto
- Department of Cardiology Kawasaki Medical School Kurashiki Okayama Japan
| | | | - Yoko Sumita
- National Cerebral and Cardiovascular Center Suita Japan
| | | | - Satoaki Matoba
- Department of Cardiovascular Medicine Graduate School of Medical Science Kyoto Prefectural University of Medicine Kyoto Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine Chiba University Graduate School of Medicine Chiba Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan
| | - Yutaka Hikichi
- Department of Cardiology Saga-Ken Medical Centre Koseikan Saga Japan
| | | | - Yuji Ikari
- Department of Cardiovascular Medicine Tokai University School of Medicine Isehara Japan
| | - Shiro Uemura
- Department of Cardiology Kawasaki Medical School Kurashiki Okayama Japan
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84
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Thorpe LE, Adhikari S, Lopez P, Kanchi R, McClure LA, Hirsch AG, Howell CR, Zhu A, Alemi F, Rummo P, Ogburn EL, Algur Y, Nordberg CM, Poulsen MN, Long L, Carson AP, DeSilva SA, Meeker M, Schwartz BS, Lee DC, Siegel KR, Imperatore G, Elbel B. Neighborhood Socioeconomic Environment and Risk of Type 2 Diabetes: Associations and Mediation Through Food Environment Pathways in Three Independent Study Samples. Diabetes Care 2022; 45:798-810. [PMID: 35104336 PMCID: PMC9016733 DOI: 10.2337/dc21-1693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/05/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We examined whether relative availability of fast-food restaurants and supermarkets mediates the association between worse neighborhood socioeconomic conditions and risk of developing type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS As part of the Diabetes Location, Environmental Attributes, and Disparities Network, three academic institutions used harmonized environmental data sources and analytic methods in three distinct study samples: 1) the Veterans Administration Diabetes Risk (VADR) cohort, a national administrative cohort of 4.1 million diabetes-free veterans developed using electronic health records (EHRs); 2) Reasons for Geographic and Racial Differences in Stroke (REGARDS), a longitudinal, epidemiologic cohort with Stroke Belt region oversampling (N = 11,208); and 3) Geisinger/Johns Hopkins University (G/JHU), an EHR-based, nested case-control study of 15,888 patients with new-onset T2D and of matched control participants in Pennsylvania. A census tract-level measure of neighborhood socioeconomic environment (NSEE) was developed as a community type-specific z-score sum. Baseline food-environment mediators included percentages of 1) fast-food restaurants and 2) food retail establishments that are supermarkets. Natural direct and indirect mediating effects were modeled; results were stratified across four community types: higher-density urban, lower-density urban, suburban/small town, and rural. RESULTS Across studies, worse NSEE was associated with higher T2D risk. In VADR, relative availability of fast-food restaurants and supermarkets was positively and negatively associated with T2D, respectively, whereas associations in REGARDS and G/JHU geographies were mixed. Mediation results suggested that little to none of the NSEE-diabetes associations were mediated through food-environment pathways. CONCLUSIONS Worse neighborhood socioeconomic conditions were associated with higher T2D risk, yet associations are likely not mediated through food-environment pathways.
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Affiliation(s)
- Lorna E Thorpe
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Samrachana Adhikari
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Priscilla Lopez
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Rania Kanchi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA
| | | | - Carrie R Howell
- Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Aowen Zhu
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL
| | - Farrokh Alemi
- Department of Health Administration and Policy, George Mason University, Fairfax, VA
| | - Pasquale Rummo
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Elizabeth L Ogburn
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Yasemin Algur
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA
| | - Cara M Nordberg
- Department of Population Health Sciences, Geisinger, Danville, PA
| | | | - Leann Long
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL
| | - April P Carson
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL
| | - Shanika A DeSilva
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA
| | - Melissa Meeker
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA
| | - Brian S Schwartz
- Department of Population Health Sciences, Geisinger, Danville, PA
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - David C Lee
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY
| | - Karen R Siegel
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Brian Elbel
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
- New York University Wagner Graduate School of Public Service, New York, NY
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85
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Huang HK, Liu PPS, Lin SM, Hsu JY, Yeh JI, Lai ECC, Peng CCH, Munir KM, Loh CH, Tu YK. Diabetes-Related Complications and Mortality in Patients With Atrial Fibrillation Receiving Different Oral Anticoagulants : A Nationwide Analysis. Ann Intern Med 2022; 175:490-498. [PMID: 35157495 DOI: 10.7326/m21-3498] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Evidence about the association between types of oral anticoagulants and hazards of diabetes complications is limited in patients with atrial fibrillation (AF) and diabetes mellitus (DM). OBJECTIVE To compare the hazards of diabetes complications and mortality between patients with AF and DM receiving non-vitamin K antagonist oral anticoagulants (NOACs) and those receiving warfarin. DESIGN A retrospective cohort study. SETTING Nationwide data obtained from Taiwan's National Health Insurance Research Database. PATIENTS Patients with AF and DM receiving NOACs or warfarin between 2012 and 2017 in Taiwan were enrolled. Treatment groups were determined by patients' first initiation of oral anticoagulants. MEASUREMENTS Hazards of diabetes complications (macrovascular complications, microvascular complications, and glycemic emergency) and mortality in the NOAC and warfarin users were investigated with a target trial design. Cause-specific Cox proportional hazards models were used to estimate hazard ratios (HRs). Propensity score methods with stabilized inverse probability of treatment weighting were applied to balance potential confounders between treatment groups. RESULTS In total, 19 909 NOAC users and 10 300 warfarin users were included. Patients receiving NOACs had significantly lower hazards of developing macrovascular complications (HR, 0.84 [95% CI, 0.78 to 0.91]; P < 0.001), microvascular complications (HR, 0.79 [CI, 0.73 to 0.85]; P < 0.001), glycemic emergency (HR, 0.91 [CI, 0.83 to 0.99]; P = 0.043), and mortality (HR, 0.78 [CI, 0.75 to 0.82]; P < 0.001) than those receiving warfarin. Analyses with propensity score matching showed similar results. Several sensitivity analyses further supported the robustness of our findings. LIMITATION The claims-based data did not allow for detailed data on patients' lifestyles and laboratory examinations to be obtained. CONCLUSION Non-vitamin K antagonist oral anticoagulants were associated with lower hazards of diabetes complications and mortality than warfarin in patients with AF and DM. PRIMARY FUNDING SOURCE Hualien Tzu Chi Hospital.
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Affiliation(s)
- Huei-Kai Huang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, and Department of Family Medicine and Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan (H.K.H.)
| | - Peter Pin-Sung Liu
- Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan (P.P.S.L.)
| | - Shu-Man Lin
- Department of Physical Medicine and Rehabilitation, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and School of Medicine, Tzu Chi University, Hualien, Taiwan (S.M.L.)
| | - Jin-Yi Hsu
- Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and School of Medicine, Tzu Chi University, Hualien, Taiwan (J.Y.H., C.H.L.)
| | - Jih-I Yeh
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and School of Medicine, Tzu Chi University, Hualien, Taiwan (J.I.Y.)
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan (E.C.C.L.)
| | - Carol Chiung-Hui Peng
- Section of Endocrinology, Diabetes, Nutrition & Weight Management, Boston University School of Medicine, Boston, Massachusetts (C.C.H.P.)
| | - Kashif M Munir
- Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland (K.M.M.)
| | - Ching-Hui Loh
- Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and School of Medicine, Tzu Chi University, Hualien, Taiwan (J.Y.H., C.H.L.)
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, and Department of Dentistry, National Taiwan University Hospital and School of Dentistry, National Taiwan University, Taipei, Taiwan (Y.K.T.)
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86
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Leung ACM, Santhanam R, Kwok RCW, Yue WT. Could Gamification Designs Enhance Online Learning Through Personalization? Lessons from a Field Experiment. INFORMATION SYSTEMS RESEARCH 2022. [DOI: 10.1287/isre.2022.1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Online learning is of growing importance to institutions and learners, and the COVID-19 pandemic has underscored its importance even more. Because learner autonomy is relatively high in these online environments, they must engage in self-regulated learning processes to achieve successful learning outcomes, but studies show that most learners are not able to do so. Hence, in this longitudinal field experiment, using a massively open online course (MOOCs), a type of online learning environment, we investigate whether gamified interventions through the learning platform can foster learners to engage in self-regulated learning processes and improve their learning outcomes. We find that gamification interventions are indeed useful, but for these gamification interventions to succeed, they must be designed to provide personalized feedback to learners that match with their learning goal-orientation. Overall, our findings point to the fact that gamification designs in online learning platforms can enhance learners’ engagement and learning outcomes, but they must be personalized. A one-size-fits-all approach to gamification design in online learning just does not work and may even backfire to reduce the engagement of some learners.
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Affiliation(s)
- Alvin Chung Man Leung
- Department of Information Systems, College of Business, City University of Hong Kong, Hong Kong
| | - Radhika Santhanam
- Division of MIS, Price College of Business, University of Oklahoma, Norman, Oklahoma 73019
| | - Ron Chi-Wai Kwok
- Department of Information Systems, College of Business, City University of Hong Kong, Hong Kong
| | - Wei Thoo Yue
- Department of Information Systems, College of Business, City University of Hong Kong, Hong Kong
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87
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Mabizela SE, Bruce J. Investigating the risk factors for academic difficulties in the medical programme at a South African university. BMC MEDICAL EDUCATION 2022; 22:208. [PMID: 35346178 PMCID: PMC8962061 DOI: 10.1186/s12909-022-03274-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The National Benchmark Test (NBT) that determines academic readiness is widely used by Faculties as an additional measure to select students for the study of medicine. Despite this, many students continue to experience academic challenges that culminate in delayed graduation and sometimes academic exclusion or discontinuation of studies. AIM This study aimed to understand academic and non-academic variables linked with academic difficulties in the first three years of medical education. METHODS The study sample consisted of six cohorts of medical students for the period 2011 to 2016 (n = 1392). Only the first three of the six-year medical programme were selected for analysis. Survival analysis and Cox Proportional Hazard (CPH) was used to identify academic and non-academic variables associated with academic difficulties. RESULTS A total of 475 students (34%) experienced academic difficulty; 221 (16%) in the first year of study, 192 (14%) in the second year and 62 (5%) in the third year of study. The results show that Intermediate Upper, Lower and Basic levels for all NBT domains, living in university residence, rurality and male gender were risk factors for academic difficulty. CONCLUSION In mitigating these factors, the NBT must inform the type of support programmes to augment the students' skills and promote academic success. Additionally, existing support programmes should be evaluated to ascertain if they reach students at risk and whether participating in these programmes yield positive academic outcomes.
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Affiliation(s)
- Sfiso Emmanuel Mabizela
- Centre for Health Science Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Judith Bruce
- School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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88
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Seaman K, Ludlow K, Wabe N, Dodds L, Siette J, Nguyen A, Jorgensen M, Lord SR, Close JCT, O'Toole L, Lin C, Eymael A, Westbrook J. The use of predictive fall models for older adults receiving aged care, using routinely collected electronic health record data: a systematic review. BMC Geriatr 2022; 22:210. [PMID: 35291948 PMCID: PMC8923829 DOI: 10.1186/s12877-022-02901-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/04/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Falls in older adults remain a pressing health concern. With advancements in data analytics and increasing uptake of electronic health records, developing comprehensive predictive models for fall risk is now possible. We aimed to systematically identify studies involving the development and implementation of predictive falls models which used routinely collected electronic health record data in home-based, community and residential aged care settings. METHODS A systematic search of entries in Cochrane Library, CINAHL, MEDLINE, Scopus, and Web of Science was conducted in July 2020 using search terms relevant to aged care, prediction, and falls. Selection criteria included English-language studies, published in peer-reviewed journals, had an outcome of falls, and involved fall risk modelling using routinely collected electronic health record data. Screening, data extraction and quality appraisal using the Critical Appraisal Skills Program for Clinical Prediction Rule Studies were conducted. Study content was synthesised and reported narratively. RESULTS From 7,329 unique entries, four relevant studies were identified. All predictive models were built using different statistical techniques. Predictors across seven categories were used: demographics, assessments of care, fall history, medication use, health conditions, physical abilities, and environmental factors. Only one of the four studies had been validated externally. Three studies reported on the performance of the models. CONCLUSIONS Adopting predictive modelling in aged care services for adverse events, such as falls, is in its infancy. The increased availability of electronic health record data and the potential of predictive modelling to document fall risk and inform appropriate interventions is making use of such models achievable. Having a dynamic prediction model that reflects the changing status of an aged care client is key to this moving forward for fall prevention interventions.
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Affiliation(s)
- Karla Seaman
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
| | - Kristiana Ludlow
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Nasir Wabe
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Laura Dodds
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Joyce Siette
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.,The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, Australia
| | - Amy Nguyen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.,St Vincent's Clinical School, Medicine, University of New South Wales, Sydney, Australia
| | - Mikaela Jorgensen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, Sydney, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | | | - Libby O'Toole
- Aged Care Quality and Safety Commission, Sydney, Australia
| | - Caroline Lin
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Annaliese Eymael
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
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89
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van Mackelenbergh MT, Seither F, Möbus V, O'Shaughnessy J, Martin M, Joensuu H, Untch M, Nitz U, Steger GG, Miralles JJ, Barrios CH, Toi M, Bear HD, Muss H, Reimer T, Nekljudova V, Loibl S. Effects of capecitabine as part of neo-/adjuvant chemotherapy - A meta-analysis of individual breast cancer patient data from 13 randomised trials including 15,993 patients. Eur J Cancer 2022; 166:185-201. [PMID: 35305453 DOI: 10.1016/j.ejca.2022.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/28/2022] [Accepted: 02/04/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Despite the large number of patients with early breast cancer (EBC) who have been treated with capecitabine in randomised trials, no individual patient data meta-analysis has been conducted. The primary objective was to examine the effect of capecitabine on disease-free survival (DFS), and the secondary objectives were to analyse distant DFS (DDFS), overall survival (OS), pathological complete response (for neoadjuvant studies) and the interaction between capecitabine-related toxicity and treatment effect. METHODS www. CLINICALTRIALS gov and www.pubmed.ncbi.nlm.nih.gov were searched using the following criteria: use of capecitabine for EBC as adjuvant or neoadjuvant therapy; multicentre randomised trial with >100 patients; recruitment completed, and outcomes available. Required data were available for 13 trials. RESULTS Individual data from 15,993 patients were collected. Cox regression analyses of all included patients revealed that the addition of capecitabine did not alter DFS significantly compared with treatment without capecitabine (hazard ratio [HR] 0.952; 95% CI 0.895-1.012; P value = 0.115). There was also no effect on DFS in the subset of studies where capecitabine was given instead of another drug (HR 1.035; 95% CI 0.945-1.134; P = 0.455). However, capecitabine administered in addition to the standard systemic treatment improved DFS (HR 0.888; 95% CI 0.817-0.965; P = 0.005). An OS improvement was observed in the entire cohort (HR 0.892; 95% CI 0.824-0.965, P = 0.005) and in the subset of capecitabine addition (HR 0.837; 95% CI 0.751, 0.933, P = 0.001). Subgroup analyses revealed that triple-negative breast cancer (TNBC) patients benefitted from treatment with capecitabine overall and in addition to other systemic treatments in terms of DFS and OS. CONCLUSION Capecitabine was able to improve DFS and OS in patients with TNBC and in all patients with EBC when administered in addition to systemic treatment.
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Affiliation(s)
- Marion T van Mackelenbergh
- German Breast Group, Neu-Isenburg, Germany; Department of Gynecology and Obstetrics, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.
| | | | - Volker Möbus
- University Hospital Frankfurt, Frankfurt, Germany
| | - Joyce O'Shaughnessy
- US Oncology Research, Inc., The Woodlands, TX, USA; Texas Oncology/Baylor University Medical Center, Dallas, TX, USA
| | - Miguel Martin
- Instituto de Investigacion Sanitaria Gregorio Marañon, CIBERONC, Universidad Complutense, Madrid, Spain; Spanish Breast Cancer Group, GEICAM, Madrid, Spain
| | - Heikki Joensuu
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Ulrike Nitz
- Breast Center Niederrhein, Evangelical Hospital Johanniter Bethesda, Mönchengladbach, Germany
| | - Guenther G Steger
- Department of Internal Medicine I and Gaston H. Glock Research Centre, Medical University of Vienna, Vienna, Austria
| | | | - Carlos H Barrios
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Grupo Oncoclinicas, Porto Alegre, Brazil
| | - Masakazu Toi
- Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Harry D Bear
- NRG Oncology and Division of Surgical Oncology, Massey Cancer Center, Virginia Commonwealth University, VCU Health, Richmond, VA, USA
| | - Hyman Muss
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Toralf Reimer
- Breast Center, University of Rostock, Rostock, Germany
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90
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Kitaguchi-Iwakiri Y, Kamoi K, Takase H, Okubo Y, Ohno-Matsui K. Long-term incidence of posterior capsular opacification in patients with non-infectious uveitis. Sci Rep 2022; 12:4296. [PMID: 35277585 PMCID: PMC8917155 DOI: 10.1038/s41598-022-08325-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/07/2022] [Indexed: 11/24/2022] Open
Abstract
Little is known about the long-term incidence of posterior capsule opacification (PCO) after cataract surgery in patients with uveitis. This retrospective study included 211 eyes of 146 patients with non-infectious uveitis who underwent cataract surgery and implantation of an Acrysof SN60WF (Surface: plasma-treated, Optic and Haptic: hydrophobic acrylic), iSert XY-1 (Surface: UV-ozone-treated, Optic and Haptic: hydrophobic acrylic), or iSert 251/255 (Surface: UV-ozone-treated, Optics: hydrophobic acrylic, Haptic: polymethyl methacrylate). The cumulative incidences of PCO and subsequent yttrium–aluminum-garnet (Nd:YAG) capsulotomy over the 5-year follow-up were analyzed, and patients who were implanted with different intraocular lenses (IOLs) were compared. Mixed-effects Cox proportional hazard models showed that, compared with the Acrysof group, the iSert XY-1 group had higher risks of PCO (adjusted HR, 7.26; 95% CI, 1.82–28.8) and Nd:YAG capsulotomy (adjusted HR, 6.50; 95% CI, 1.55–27.2). Similar results were obtained when the Acrysof group was compared with the iSert 251/255 group for PCO (adjusted HR, 8.22; 95% CI, 2.35–28.7) and Nd:YAG capsulotomy (adjusted HR, 8.26; 1.90–36.0). These data suggest that a plasma-treated surface, hydrophobic acrylic optic and hydrophobic acrylic haptic, of the IOL could enhance biocompatibility even under inflammatory conditions, thus suppressing PCO development.
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Affiliation(s)
- Yuki Kitaguchi-Iwakiri
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Koju Kamoi
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Hiroshi Takase
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yusuke Okubo
- Division of Lifecourse Epidemiology, Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.,Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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91
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Cai G, Li X, Zhang Y, Wang Y, Ma Y, Xu S, Shuai Z, Peng X, Pan F. Knee symptom but not radiographic knee osteoarthritis increases the risk of falls and fractures: results from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2022; 30:436-442. [PMID: 34863991 DOI: 10.1016/j.joca.2021.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the effect of knee symptoms and radiographic osteoarthritis (ROA) on the risk of falls, recurrent falls, and fractures. DESIGN Participants from the Osteoarthritis Initiative were classified as having 'no', 'unilateral' or 'bilateral' knee symptoms (≥19 on a 0-96 Western Ontario and McMaster Universities Osteoarthritis Index) and ROA (Kellgren-Lawrence grade ≥2) for each visit. Self-reported falls and fractures in the past 12 months were extracted at baseline and follow-up visits until month 96. Recurrent falls were defined as having ≥2 falls in the past 12 months. Hazard ratios (HR) with 95% confidence intervals (CI) were estimated using mixed-effects complementary log-log regression. RESULTS Of 4465 participants, 3145 (70%), 1681 (38%), and 806 (18%) experienced at least one fall, recurrent fall, and fracture, respectively, over 96 months. Compared to participants without symptomatic knee, unilateral and bilateral knee symptoms were associated with a 17% increased risk of falls and a 36-46% increased risk of recurrent falls, and bilateral knee symptoms increased the risk of fractures (HR 1.45, 95%CI 1.17 to 1.81). Compared to participants with no ROA in either knee, bilateral ROA was associated with a reduced risk of falls (HR 0.87, 95%CI 0.77 to 0.99) and fractures (HR 0.78, 95%CI 0.64 to 0.96). No statistically significant interactions between knee symptoms and ROA were observed. CONCLUSIONS This large population-based study showed that knee symptoms but not ROA increased the risk of falls, recurrent falls, and fractures, and that adults with bilateral ROA may have a lower risk of falls and fractures.
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Affiliation(s)
- G Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, Anhui, China.
| | - X Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, Anhui, China.
| | - Y Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, Anhui, China.
| | - Y Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, Anhui, China.
| | - Y Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, Anhui, China.
| | - S Xu
- Department of Rheumatism and Immunity, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China.
| | - Z Shuai
- Department of Rheumatism and Immunity, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China.
| | - X Peng
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Anhui Medical University, Hefei 230088, Anhui, China.
| | - F Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, Anhui, China.
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92
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Ríos V, Denova-Gutiérrez E, Barquera S. Association between living in municipalities with high crowding conditions and poverty and mortality from COVID-19 in Mexico. PLoS One 2022; 17:e0264137. [PMID: 35192660 PMCID: PMC8863291 DOI: 10.1371/journal.pone.0264137] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/03/2022] [Indexed: 12/15/2022] Open
Abstract
Background The World Health Organization stated a pandemic by severe acute respiratory syndrome coronavirus SARS-Cov2 (COVID-19) on March, 2020 with devastating implications for populations, healthcare systems, and economies globally. Objective The present study explores the association between patients living in municipalities with crowding conditions and poverty and mortality from COVID-19 in Mexico; specifically evaluating the socioeconomic characteristics of the municipality in which the patients reside and some individual characteristics. Methods In the present study, we examined public information collected from the National Epidemiological Surveillance System informing all persons tested for SARS-CoV-2 and published by the Ministry of Health. The present analysis was restricted to those with the date of registration to October 12, 2021. The association between the main exposures (overcrowded conditions and poverty) and the outcomes of interest (death by COVID-19) was explored using Cox proportional hazard regression models, including frailty penalties to accommodate multilevel data and random effects for the municipality of case occurrence. Results A total of 9619917 subjects were included in the Epidemiological Surveillance System for viral respiratory disease platform. Of those for which results were available, 6141403 were negative for COVID-19 and 3478514 were positive for COVID-19; with a total of 273216 deaths in those who tested positive. Among those positive to COVID-19 mean age was 46.9. Patients living in municipalities with high rates of crowding conditions increased the risk of dying from COVID-19 by 8% (95% CI: 1.03, 1.14). Individuals living in municipalities with indigenous background was associated with an increased risk of dying from COVID-19 (HR = 1.10; 95% CI: 1.04, 1.17). Individuals living in municipalities with illiteracy (HR = 1.09; 95% CI: 1.03, 1.11), poverty (HR = 1.17; 95% CI: 1.14, 1.19), food insecurity (HR = 1.094; 95% CI 1.02, 1.06), limited access to social security (HR = 1.10; 95% CI: 1.08, 1.13) and health services (HR = 1.06; 95% CI: 1.04, 1.08) had a higher risk of mortality from COVID-19. Conclusion Our data suggest that patients living in municipalities with higher rates of crowding conditions and higher rates of poverty had elevated risk of mortality from COVID-19. In Mexico, the COVID-19 pandemic is a systemic crisis linked to human development since we have seen that it affects less developed and more vulnerable municipalities. Policies to reduce vulnerabilities and develop strategies to deal with health crises like the current one needs to be considered.
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Affiliation(s)
| | - Edgar Denova-Gutiérrez
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Simón Barquera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- * E-mail:
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93
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Paixao ES, Cardim LL, Costa MCN, Brickley EB, de Carvalho-Sauer RCO, Carmo EH, Andrade RFS, Rodrigues MS, Veiga RV, Costa LC, Moore CA, França GVA, Smeeth L, Rodrigues LC, Barreto ML, Teixeira MG. Mortality from Congenital Zika Syndrome - Nationwide Cohort Study in Brazil. N Engl J Med 2022; 386:757-767. [PMID: 35196428 PMCID: PMC7612437 DOI: 10.1056/nejmoa2101195] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Prenatal exposure to Zika virus has potential teratogenic effects, with a wide spectrum of clinical presentation referred to as congenital Zika syndrome. Data on survival among children with congenital Zika syndrome are limited. METHODS In this population-based cohort study, we used linked, routinely collected data in Brazil, from January 2015 through December 2018, to estimate mortality among live-born children with congenital Zika syndrome as compared with those without the syndrome. Kaplan-Meier curves and survival models were assessed with adjustment for confounding and with stratification according to gestational age, birth weight, and status of being small for gestational age. RESULTS A total of 11,481,215 live-born children were followed to 36 months of age. The mortality rate was 52.6 deaths (95% confidence interval [CI], 47.6 to 58.0) per 1000 person-years among live-born children with congenital Zika syndrome, as compared with 5.6 deaths (95% CI, 5.6 to 5.7) per 1000 person-years among those without the syndrome. The mortality rate ratio among live-born children with congenital Zika syndrome, as compared with those without the syndrome, was 11.3 (95% CI, 10.2 to 12.4). Among infants born before 32 weeks of gestation or with a birth weight of less than 1500 g, the risks of death were similar regardless of congenital Zika syndrome status. Among infants born at term, those with congenital Zika syndrome were 14.3 times (95% CI, 12.4 to 16.4) as likely to die as those without the syndrome (mortality rate, 38.4 vs. 2.7 deaths per 1000 person-years). Among infants with a birth weight of 2500 g or greater, those with congenital Zika syndrome were 12.9 times (95% CI, 10.9 to 15.3) as likely to die as those without the syndrome (mortality rate, 32.6 vs. 2.5 deaths per 1000 person-years). The burden of congenital anomalies, diseases of the nervous system, and infectious diseases as recorded causes of deaths was higher among live-born children with congenital Zika syndrome than among those without the syndrome. CONCLUSIONS The risk of death was higher among live-born children with congenital Zika syndrome than among those without the syndrome and persisted throughout the first 3 years of life. (Funded by the Ministry of Health of Brazil and others.).
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Affiliation(s)
- Enny S Paixao
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Luciana L Cardim
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Maria C N Costa
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Elizabeth B Brickley
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Rita C O de Carvalho-Sauer
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Eduardo H Carmo
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Roberto F S Andrade
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Moreno S Rodrigues
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Rafael V Veiga
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Larissa C Costa
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Cynthia A Moore
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Giovanny V A França
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Liam Smeeth
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Laura C Rodrigues
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Mauricio L Barreto
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Maria G Teixeira
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
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94
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Chen GY, Wu ZF, Lin YT, Cheng KI, Huang YT, Huang ST, Hargono A, Li CY. Association between General Anesthesia and Root Canal Treatment Outcomes in Patients with Mental Disability: A Retrospective Cohort Study. J Pers Med 2022; 12:jpm12020213. [PMID: 35207701 PMCID: PMC8876241 DOI: 10.3390/jpm12020213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 02/04/2023] Open
Abstract
In the population of individuals with a disability, mental illness patients can be uncooperative during dental treatment; thus, general anesthesia has been widely applied during dental procedures. This study aims to investigate the association between general anesthesia and the outcomes of root canal treatment in patients with disability. Teeth treatment records of patients with disability from Kaohsiung Medical University Hospital Research Database and electronic database from January 2005 to December 2018 were used in this retrospective cohort study. The authors conducted analysis comparing root canal treatment outcomes under general anesthesia and non-general anesthesia, indicated by endodontic re-treatment or post-treatment teeth extraction. Over the 9-year follow-up period, root canal treatment outcomes representing a cumulative survival rate of 87.68% and 74.51% in the general anesthesia group and non-general anesthesia group, respectively, were found. After adjustment for potential confounders, the teeth with general anesthesia showed a substantially and significantly reduced HR of root canal treatment failure at 0.24 (95% confidence interval, 0.12 to 0.49). Our study supported the notion that root canal treatment with general anesthesia may entail substantial reduction of treatment failure in patients with disability.
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Affiliation(s)
- Guan-Yu Chen
- Department and Graduate, Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Z.-F.W.); (K.-I.C.)
| | - Zhi-Fu Wu
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Z.-F.W.); (K.-I.C.)
- Department of Anesthesiology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yi-Ting Lin
- Department of Dentistry, Division of Special Care Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (Y.-T.L.); (S.-T.H.)
- School of Dentistry, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Kuang-I Cheng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Z.-F.W.); (K.-I.C.)
- Department of Anesthesiology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yu-Ting Huang
- Department of Medical Research, Division of Medical Statistics and Bioinformatics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Shun-Te Huang
- Department of Dentistry, Division of Special Care Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (Y.-T.L.); (S.-T.H.)
- School of Dentistry, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Arief Hargono
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia;
| | - Chung-Yi Li
- Department and Graduate, Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia;
- Department of Public Health, College of Public Health, China Medical University, Taichung 40402, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
- Correspondence:
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95
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Chesover AD, Eskander A, Griffiths R, Pasternak JD, Pole JD, Wolter NE, Wasserman JD. The Impact of Hospital Surgical Volume on Healthcare Utilization Outcomes After Pediatric Thyroidectomy. World J Surg 2022; 46:1082-1092. [PMID: 35113199 DOI: 10.1007/s00268-022-06456-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND A positive relationship between an individual surgeon's operative volume and clinical outcomes after pediatric and adult thyroidectomy is well-established. The impact of a hospital's pediatric operative volume on surgical outcomes and healthcare utilization, however, are infrequently reported. We investigated associations between hospital volume and healthcare utilization outcomes following pediatric thyroidectomy in Canada's largest province, Ontario. METHODS Retrospective analysis of administrative and health-related population-level data from 1993 to 2017. A cohort of 1908 pediatric (<18 years) index thyroidectomies was established. Hospital volume was defined per-case as thyroidectomies performed in the preceding year. Healthcare utilization outcomes: length of stay (LOS), same day surgery (SDS), readmission, and emergency department (ED) visits were measured. Multivariate analysis adjusted for patient-level, disease and hospital-level co-variates. RESULTS Hospitals with the lowest volume of pediatric thyroidectomies, accounted for 30% of thyroidectomies province-wide and performed 0-1 thyroidectomies/year. The highest-volume hospitals performed 19-60 cases/year. LOS was 0.64 days longer in the highest, versus the lowest quartile. SDS was 83% less likely at the highest, versus the lowest quartile. Hospital volume was not associated with rate of readmission or ED visits. Increased ED visits were, however, associated with male sex, increased material deprivation, and rurality. CONCLUSIONS Increased hospital pediatric surgical volume was associated with increased LOS and lower likelihood of SDS. This may reflect patient complexity at such centers. In this cohort, low-volume hospitals were not associated with poorer healthcare utilization outcomes. Further study of groups disproportionately accessing the ED post-operatively may help direct resources to these populations.
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Affiliation(s)
- Alexander D Chesover
- Division of Endocrinology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada.,Department of Endocrinology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, M1-102, Toronto, ON, M4N 3M5, Canada.,ICES Queen's, Abramsky Hall, Room 208, 21 Arch Street, Kingston, ON, K7L 3N6, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), Toronto, ON, Canada.,Michael Garron Hospital, University of Toronto, Toronto, ON, Canada
| | - Rebecca Griffiths
- ICES Queen's, Abramsky Hall, Room 208, 21 Arch Street, Kingston, ON, K7L 3N6, Canada
| | - Jesse D Pasternak
- Division of General Surgery, University Health Network, 200 Elizabeth St, Toronto, ON, M5G 2C1, Canada
| | - Jason D Pole
- ICES Queen's, Abramsky Hall, Room 208, 21 Arch Street, Kingston, ON, K7L 3N6, Canada.,Centre for Health Services Research, The University of Queensland, Building 33, Princess Alexandra Hospital campus, Brisbane, QLD, 4102, Australia
| | - Nikolaus E Wolter
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Jonathan D Wasserman
- Division of Endocrinology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. .,Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
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96
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Young J, Re VL, Kim HN, Sterling TR, Althoff KN, Gebo KA, Gill MJ, Horberg MA, Mayor AM, Moore RD, Silverberg MJ, Klein MB. Do contemporary antiretrovirals increase the risk of end-stage liver disease? Signals from patients starting therapy in the North American AIDS Cohort Collaboration on Research and Design. Pharmacoepidemiol Drug Saf 2022; 31:214-224. [PMID: 34729853 PMCID: PMC9089458 DOI: 10.1002/pds.5379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/14/2021] [Accepted: 10/31/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Despite effective antiretroviral therapy, rates of end-stage liver disease (ESLD) remain high. It is not clear whether contemporary antiretrovirals contribute to the risk of ESLD. METHODS We included patients from cohorts with validated ESLD data in the North American AIDS Cohort Collaboration on Research and Design. Patients had to initiate antiretroviral therapy after 1 January 2004 with a nucleos(t)ide backbone of either abacavir/lamivudine or tenofovir/emtricitabine and a contemporary third (anchor) drug. Patients were followed until a first ESLD event, death, end of a cohort's ESLD validation period, loss to follow-up or 31 December 2015. We estimated associations between cumulative exposure to each drug and ESLD using a hierarchical Bayesian survival model with weakly informative prior distributions. RESULTS Among 10 564 patients included from 12 cohorts, 62 had an ESLD event. Of the nine anchor drugs, boosted protease inhibitors atazanavir and darunavir had the strongest signals for ESLD, with increasing hazard ratios (HR) and narrowing credible intervals (CrI), from a prior HR of 1.5 (95% CrI 0.32-7.1) per 5 year's exposure to posterior HRs respectively of 1.8 (95% CrI 0.82-3.9) and 2.0 (95% CrI 0.86-4.7). Both backbones and efavirenz showed no signal. Hepatitis C coinfection was the most important covariate risk factor (HR 4.4, 95% CrI 2.6-7.0). CONCLUSIONS While contemporary antiretrovirals pose less risk for ESLD than hepatitis coinfection, atazanavir and darunavir had a toxicity signal. We show how hierarchical Bayesian modelling can be used to detect toxicity signals in cohort event monitoring data even with complex treatments and few events.
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Affiliation(s)
- Jim Young
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, Glen Site, McGill University Health Centre, Montreal QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal QC, Canada.,Corresponding Author: Jim Young, Research Institute of the McGill University Health Centre, 5252 boul de Maisonneuve W, #3C.23, Montréal, QC H4A 3S5 Canada. Tel. +1-514-934-1934 ext.32198,
| | - Vincent Lo Re
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - H. Nina Kim
- Department of Medicine, University of Washington, Seattle WA, USA
| | - Timothy R. Sterling
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville TN, USA
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore MD, USA
| | - Kelly A. Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - M. John Gill
- Department of Medicine, University of Calgary, Calgary AB, Canada
| | - Michael A. Horberg
- Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute, Rockville MD, USA
| | - Angel M. Mayor
- Retrovirus Research Center, Internal Medicine Department, School of Medicine, Universidad Central del Caribe, Bayamón PR, USA
| | - Richard D. Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore MD, USA
| | | | - Marina B. Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, Glen Site, McGill University Health Centre, Montreal QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal QC, Canada.,CIHR Canadian HIV Trials Network, Vancouver BC, Canada
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97
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Piróth Z, Fülöp G, Boxma-de Klerk BM, Abdelghani M, Omerovic E, Andréka P, Fontos G, Neumann FJ, Richardt G, Smits PC. Correlation and Relative Prognostic Value of Fractional Flow Reserve and Pd/Pa of Nonculprit Lesions in ST-Segment-Elevation Myocardial Infarction. Circ Cardiovasc Interv 2022; 15:e010796. [PMID: 35045732 DOI: 10.1161/circinterventions.121.010796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The applicability of resting indices to guide noninfarct-related artery revascularization in ST-elevation myocardial infarction is unknown. METHODS We analyzed the correlation and prognostic value of fractional flow reserve (FFR) and resting distal coronary to aortic pressure ratio (Pd/Pa) in all patients of the Compare-Acute trial in whom, after successful primary percutaneous coronary intervention, the noninfarct-related artery was interrogated by both and treated medically. The treating cardiologist was blinded to these values. The primary end point was the composite of target vessel (interrogated noninfarct-related artery) related nonfatal target vessel myocardial infarction and target vessel repeat revascularization at 36 months. RESULTS Five hundred seventeen patients (665 vessels) were included. On receiver-operating characteristic analysis, the optimal Pd/Pa cut off for FFR≤0.80 was 0.905 (C statistic: 0.894). The diagnostic accuracy of Pd/Pa was 80.15% (95% CI, 76.91%-83.12%) with respect to FFR. During the 36-month follow-up, 130 target vessel revascularization and 14 target vessel myocardial infarction occurred. FFR and Pd/Pa had a diagnostic accuracy to predict these events of 62.86% (95% CI, 59.06%-66.54%) and 56.84% (95% CI, 52.98%-60.64%), respectively (P=0.20). When they were discrepant, FFR was significantly better than Pd/Pa in identifying which vessels could be safely deferred (P=0.048). CONCLUSIONS Immediately after successful primary percutaneous coronary intervention, resting Pd/Pa has a diagnostic accuracy of 80% with respect to FFR measured in the noninfarct-related artery. FFR is not significantly superior in predicting target vessel myocardial infarction and target vessel revascularization during 36 months of follow-up but, in case FFR and Pd/Pa are discrepant, FFR is superior in identifying which nonculprit vessels can be safely deferred. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01399736.
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Affiliation(s)
- Zsolt Piróth
- Hungarian Institute of Cardiology, Budapest, Hungary (Z.P., G.F., P.A., G.F.)
| | - Gábor Fülöp
- Hungarian Institute of Cardiology, Budapest, Hungary (Z.P., G.F., P.A., G.F.)
| | - Bianca M Boxma-de Klerk
- Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (B.M.B.-d.K., P.C.S.).,Department of Statistics and Education, Franciscus Academy, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands (B.M.B.-d.K.)
| | - Mohammad Abdelghani
- Amsterdam UMC, University of Amsterdam, the Netherlands (M.A.).,Department of Cardiology, Al-Azhar University, Cairo, Egypt (M.A.)
| | - Elmir Omerovic
- Department of Cardiology, Gothenburg University Hospital, Sweden (E.O.)
| | - Péter Andréka
- Hungarian Institute of Cardiology, Budapest, Hungary (Z.P., G.F., P.A., G.F.)
| | - Géza Fontos
- Hungarian Institute of Cardiology, Budapest, Hungary (Z.P., G.F., P.A., G.F.)
| | - Franz-Josef Neumann
- Department of Cardiology, University Heart Center Freiburg - Bad Krozingen, Germany (F.-J.N.)
| | - Gert Richardt
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (G.R.)
| | - Pieter C Smits
- Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (B.M.B.-d.K., P.C.S.)
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98
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Gunasekara ADM, Anothaisintawee T, Youngkong S, Ha NT, McKay GJ, Attia J, Thakkinstian A. Neoadjuvant Treatment with HER2-Targeted Therapies in HER2-Positive Breast Cancer: A Systematic Review and Network Meta-Analysis. Cancers (Basel) 2022; 14:cancers14030523. [PMID: 35158791 PMCID: PMC8833584 DOI: 10.3390/cancers14030523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/14/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Human epidermal growth factor receptor 2 (HER2)-positive breast cancer causes more aggressive progression of disease and poorer outcomes for patients. HER2-targeted medicines used as neoadjuvant systemic therapy could improve clinical outcomes in early-stage or locally advanced breast cancer patients. The purpose of this systematic review and network meta-analysis was to identify the neoadjuvant anti-HER2 therapy with the best balance between efficacy and safety. We found that trastuzumab emtansine + pertuzumab + chemotherapy had a high pathologic complete response with a low risk of adverse events compared to other neoadjuvant anti-HER2 regimens, while the pertuzumab + trastuzumab + chemotherapy regimen showed the highest disease-free survival. However, further trial data on neoadjuvant regimens with trastuzumab emtansine are needed to confirm these findings. Abstract This systematic review aimed to identify neoadjuvant anti-human epidermal growth factor receptor 2 (HER2) therapies with the best balance between efficacy and safety. Methods: A network meta-analysis was applied to estimate the risk ratios along with 95% confidence intervals (CIs) for pathological complete response (pCR) and serious adverse events (SAE). A mixed-effect parametric survival analysis was conducted to assess the disease-free survival (DFS) between treatments. Results: Twenty-one RCTs with eleven regimens of neoadjuvant anti-HER2 therapy (i.e., trastuzumab + chemotherapy (TC), lapatinib + chemotherapy (LC), pertuzumab + chemotherapy (PC), pertuzumab + trastuzumab (PT), trastuzumab emtansine + pertuzumab (T-DM1P), pertuzumab + trastuzumab + chemotherapy (PTC), lapatinib + trastuzumab + chemotherapy (LTC), trastuzumab emtansine + lapatinib + chemotherapy (T-DM1LC), trastuzumab emtansine + pertuzumab + chemotherapy(T-DM1PC), PTC followed by T-DM1P (PTC_T-DM1P), and trastuzumab emtansine (T-DM1)) and chemotherapy alone were included. When compared to TC, only PTC had a significantly higher DFS with a hazard ratio (95% CI) of 0.54 (0.32–0.91). The surface under the cumulative ranking curve (SUCRA) suggested that T-DM1LC (91.9%) was ranked first in achieving pCR, followed by the PTC_T-DM1P (90.5%), PTC (74.8%), and T-DM1PC (73.5%) regimens. For SAEs, LTC, LC, and T-DM1LC presented with the highest risks (SUCRA = 10.7%, 16.8%, and 20.8%), while PT (99.2%), T-DM1P (88%), and T-DM1 (83.9%) were the safest regimens. The T-DM1PC (73.5% vs. 71.6%), T-DM1 (70.5% vs. 83.9%), and PTC_T-DM1P (90.5% vs. 47.3%) regimens offered the optimal balance between pCR and SAE. Conclusions: The T-DM1PC, T-DM1, and PTC_T-DM1P regimens had the optimal balance between efficacy and safety, while DFS was highest for the PTC regimen. However, these results were based on a small number of studies, and additional RCTs assessing the efficacy of regimens with T-DM1 are still needed to confirm these findings.
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Affiliation(s)
- Agampodi Danushi M. Gunasekara
- Mahidol University Health Technology Assessment Graduate Program (MUHTA), Mahidol University, Bangkok 10400, Thailand; (A.D.M.G.); (N.T.H.); (A.T.)
- Department of Paraclinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana, Colombo 10390, Sri Lanka
| | - Thunyarat Anothaisintawee
- Mahidol University Health Technology Assessment Graduate Program (MUHTA), Mahidol University, Bangkok 10400, Thailand; (A.D.M.G.); (N.T.H.); (A.T.)
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
- Correspondence: (T.A.); (S.Y.); Tel.: +66-2-201-1406 (T.A.)
| | - Sitaporn Youngkong
- Mahidol University Health Technology Assessment Graduate Program (MUHTA), Mahidol University, Bangkok 10400, Thailand; (A.D.M.G.); (N.T.H.); (A.T.)
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand
- Correspondence: (T.A.); (S.Y.); Tel.: +66-2-201-1406 (T.A.)
| | - Nguyen T. Ha
- Mahidol University Health Technology Assessment Graduate Program (MUHTA), Mahidol University, Bangkok 10400, Thailand; (A.D.M.G.); (N.T.H.); (A.T.)
- School of Medicine, Vietnam National University, Ho Chi Minh City 700000, Vietnam
| | - Gareth J. McKay
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Belfast BT12 6BA, UK;
| | - John Attia
- School of Medicine and Public Health, College of Health and Wellbeing, University of Newcastle, Newcastle, NSW 2308, Australia;
| | - Ammarin Thakkinstian
- Mahidol University Health Technology Assessment Graduate Program (MUHTA), Mahidol University, Bangkok 10400, Thailand; (A.D.M.G.); (N.T.H.); (A.T.)
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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99
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Simpson CR, Kirk DS. Is Police Misconduct Contagious? Non-trivial Null Findings from Dallas, Texas. JOURNAL OF QUANTITATIVE CRIMINOLOGY 2022; 39:425-463. [PMID: 35039710 PMCID: PMC8754082 DOI: 10.1007/s10940-021-09532-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 05/24/2023]
Abstract
Objectives Understanding if police malfeasance might be "contagious" is vital to identifying efficacious paths to police reform. Accordingly, we investigate whether an officer's propensity to engage in misconduct is associated with her direct, routine interaction with colleagues who have themselves engaged in misbehavior in the past. Methods Recognizing the importance of analyzing the actual social networks spanning a police force, we use data on collaborative responses to 1,165,136 "911" calls for service by 3475 Dallas Police Department (DPD) officers across 2013 and 2014 to construct daily networks of front-line interaction. And we relate these cooperative networks to reported and formally sanctioned misconduct on the part of the DPD officers during the same time period using repeated-events survival models. Results Estimates indicate that the risk of a DPD officer engaging in misconduct is not associated with the disciplined misbehavior of her ad hoc, on-the-scene partners. Rather, a greater risk of misconduct is associated with past misbehavior, officer-specific proneness, the neighborhood context of patrol, and, in some cases, officer race, while departmental tenure is a mitigating factor. Conclusions Our observational findings-based on data from one large police department in the United States-ultimately suggest that actor-based and ecological explanations of police deviance should not be summarily dismissed in favor of accounts emphasizing negative socialization, where our study design also raises the possibility that results are partly driven by unobserved trait-based variation in the situations that officers find themselves in. All in all, interventions focused on individual officers, including the termination of deviant police, may be fruitful for curtailing police misconduct-where early interventions focused on new offenders may be key to avoiding the escalation of deviance.
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Affiliation(s)
- Cohen R. Simpson
- Department of Methodology, London School of Economics and Political Science, London, UK
- Nuffield College, University of Oxford, Oxford, UK
| | - David S. Kirk
- Nuffield College, University of Oxford, Oxford, UK
- Department of Sociology, University of Oxford, Oxford, UK
- Leverhulme Centre for Demographic Science, University of Oxford, Oxford, UK
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100
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Alexandre F, Molinier V, Hayot M, Chevance G, Moullec G, Varray A, Héraud N. Association between long-term oxygen therapy provided outside the guidelines and mortality in patients with COPD. BMJ Open 2022; 12:e049115. [PMID: 35017234 PMCID: PMC8753397 DOI: 10.1136/bmjopen-2021-049115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Hypoxaemia is a frequent complication of chronic obstructive pulmonary disease (COPD). To prevent its consequences, supplemental oxygen therapy is recommended by international respiratory societies. However, despite clear recommendations, some patients receive long-term oxygen therapy (LTOT), while they do not meet prescription criteria. While evidence suggests that acute oxygen supply at high oxygenation targets increases COPD mortality, its chronic effects on COPD mortality remain unclear. Thus, the study will aim to evaluate through a systematic review and individual patient data meta-analysis (IPD-MA), the association of LTOT prescription outside the guidelines on survival over time in COPD. METHODS Systematic review and IPD-MA will be conducted according to Preferred Reporting Items for a Systematic Review and Meta-Analyses IPD guidelines. Electronic databases (PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, OpenGrey and BioRxiv/MedRxix) will be scanned to identify relevant studies (cohort of stable COPD with arterial oxygen tension data available, with indication of LTOT filled out at the moment of the study and with a survival follow-up). The anticipated search dates are January-February 2022. The main outcome will be the association between LTOT and time to all-cause mortality according to hypoxaemia severity, after controlling for potential covariates and all available clinical characteristics. Quantitative data at the level of the individual patient will be used in a one-step approach to develop and validate a prognostic model with a Cox regression analysis. The one-step IPD-MA will be conducted to study the association and the moderators of association between supplemental oxygen therapy and mortality. Multilevel survival analyses using Cox-mixed effects models will be performed. ETHICS AND DISSEMINATION As a protocol for a systematic review, a formal ethics committee review is not required. Only studies with institutional approval from an ethics committee and anonymised IPD will be included. Results will be disseminated through peer-reviewed publications and presentations in conferences. PROSPERO REGISTRATION NUMBER CRD42020209823.
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Affiliation(s)
- Francois Alexandre
- Direction de la recherche clinique et de l'innovation en santé, Korian SA, Lodève, France
| | - Virginie Molinier
- Direction de la recherche clinique et de l'innovation en santé, Korian SA, Lodève, France
| | - Maurice Hayot
- PhyMedExp, Université de Montpellier, INSERM, CNRS, CHRU de Montpellier, Montpellier, France
| | | | - Gregory Moullec
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Alain Varray
- EuroMov Digital Health in Motion, IMT Mines Ales, University of Montpellier, Montpellier, France
| | - Nelly Héraud
- Direction de la recherche clinique et de l'innovation en santé, Korian SA, Lodève, France
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