2
|
Maloney EM, Corcoran P, Costello DJ, O'Reilly ÉJ. Association between social deprivation and incidence of first seizures and epilepsy: a prospective population based cohort. Epilepsia 2022; 63:2108-2119. [PMID: 35611982 PMCID: PMC9544186 DOI: 10.1111/epi.17313] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 05/05/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Epidemiologic studies have investigated whether social deprivation is associated with a higher incidence of epilepsy and results are conflicting, especially in children. The mechanisms underlying a potential association are unclear. This study examines whether there is an association between social deprivation and the incidence of first seizures (unprovoked and provoked) and new diagnosis of epilepsy by comparing incidence across an area-level measure of deprivation in a population-based cohort. METHODS Multiple methods of case identification followed by individual case validation and classification were carried out in a defined geographical area (population 542,868) to identify all incident cases of first provoked and first unprovoked seizures and new diagnosis of epilepsy presenting during the calendar year 2017. An area-level relative deprivation index, based on ten indicators from census data, was assigned to each patient according to registered address and categorised into quintiles from most to least deprived. RESULTS The annual incidence of first unprovoked seizures (n=372), first provoked seizures (n=189) and new diagnosis of epilepsy (n=336) was highest in the most deprived areas compared to the least deprived areas (incidence ratios of 1·79 (95%CI 1·26, 2·52), 1·55 (95%CI 1·04, 2·32) and 1·83 (95%CI 1·28, 2·62), respectively). This finding was evident in both adults and children and in those with structural and unknown aetiologies of epilepsy. SIGNIFICANCE The incidence of first seizures and new diagnosis of epilepsy is associated with more social deprivation. The reason for this higher incidence is likely multifactorial.
Collapse
Affiliation(s)
- Eimer M Maloney
- Epilepsy Service, Department of Neurology, Cork University Hospital, Ireland.,School of Medicine, University College Cork, Ireland.,School of Public Health, University College Cork, Ireland
| | - Paul Corcoran
- School of Public Health, University College Cork, Ireland
| | - Daniel J Costello
- Epilepsy Service, Department of Neurology, Cork University Hospital, Ireland.,School of Medicine, University College Cork, Ireland.,FutureNeuro SFI Research Centre for Chronic and Rare Neurological Diseases hosted in RCSI, Dublin 2, Ireland
| | - Éilis J O'Reilly
- School of Public Health, University College Cork, Ireland.,Department of Nutrition, Harvard TH Chan School of Public Health, USA.,Environmental Research Institute, University College Cork, Ireland
| |
Collapse
|
3
|
Wibring K, Lingman M, Herlitz J, Bång A. The potential of new prediction models for emergency medical dispatch prioritisation of patients with chest pain: a cohort study. Scand J Trauma Resusc Emerg Med 2022; 30:34. [PMID: 35527302 PMCID: PMC9080130 DOI: 10.1186/s13049-022-01021-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/25/2022] [Indexed: 08/30/2023] Open
Abstract
Abstract
Objectives
To develop emergency medical dispatch (EMD) centre prediction models with high sensitivity and satisfying specificity to identify high-priority patients and patients suitable for non-emergency care respectively, when assessing patients with chest pain.
Methods
Observational cohort study of 2917 unselected patients with chest pain who contacted an EMD centre in Sweden due to chest pain during 2018. Multivariate logistic regression was applied to develop models predicting low-risk or high-risk condition, that is, occurrence of time-sensitive diagnosis on hospital discharge.
Results
Prediction models were developed for the identification of patients suitable for high- and low-priority dispatch, using 11 and 10 variables respectively. The area under the receiver-operating characteristic curve (AUROC) for the high-risk prediction model was 0.79 and for the low-risk model it was 0.74. When applying the high-risk prediction model, 56% of the EMS missions were given highest priority, compared with 65% with the current standard. When applying the low-risk model, 7% were given the lowest priority compared to 1% for the current standard. The new prediction models outperformed today’s dispatch priority accuracy in terms of sensitivity as well as positive and negative predictive value in both high- and low-risk prediction. The low-risk model predicted almost six times as many patients as having low-risk conditions compared with today’s standard. This was done without increasing the number of high-risk patients wrongly assessed as low-risk.
Conclusions
By introducing prediction models, based on logistic regression analyses, using variables obtained by standard EMD-questions on age, sex, medical history and symptomology, EMD prioritisation can be improved compared with using current criteria index-based ones. This will allow a more efficient emergency medical services resource allocation.
Collapse
|
5
|
Watson A, Clubbs Coldron B, Wingfield B, Ruddell N, Clarke C, Masterson S, McConnell D, Coates V. Exploring variation in ambulance calls and conveyance rates for adults with diabetes mellitus who contact the Northern Ireland Ambulance Service: a retrospective database analysis. Br Paramed J 2021; 6:15-23. [PMID: 34966247 PMCID: PMC8669640 DOI: 10.29045/14784726.2021.12.6.3.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: People with diabetes frequently contact the ambulance service about acute problems. Overall, treating diabetes and its associated complications costs the NHS 10% of the annual budget. Reducing unnecessary hospital admissions and ambulance attendances is a high priority policy for the NHS across the UK. This study aimed to determine the characteristics of emergency calls for people with diabetes who contact the ambulance service and are subsequently conveyed to hospital by the Northern Ireland Ambulance Service (NIAS). Methods: A retrospective dataset from the NIAS was obtained from the NIAS Trust’s Command and Control system relating to calls where the final complaint group was ‘Diabetes’ for the period 1 January 2017 to 23 November 2019. Results: Of a total 11,396 calls related to diabetes, 63.2% of callers to the NIAS were conveyed to hospital. Over half of the calls related to males, with 35.5% of callers aged 60–79. The more deprived areas had a higher frequency of calls and conveyance to hospital, with this decreasing as deprivation decreased. Calls were evenly distributed across the week, with the majority of calls originating outside of GP working hours, although callers were more likely to be conveyed to hospital during working hours. Calls from healthcare professionals were significantly more likely to be conveyed to hospital, despite accounting for the minority of calls. Conclusion: This research found that older males were more likely to contact the ambulance service but older females were more likely to be conveyed to hospital. The likelihood of conveyance increased if the call originated from an HCP or occurred during GP working hours. The availability of alternative care pathways has the potential to reduce conveyance to hospital, which has been particularly important during the COVID-19 pandemic. Integration of data is vitally important to produce high quality research and improve policy and practice in this area.
Collapse
|
6
|
Hermann B, Conant LL, Cook CJ, Hwang G, Garcia-Ramos C, Dabbs K, Nair VA, Mathis J, Bonet CNR, Allen L, Almane DN, Arkush K, Birn R, DeYoe EA, Felton E, Maganti R, Nencka A, Raghavan M, Shah U, Sosa VN, Struck AF, Ustine C, Reyes A, Kaestner E, McDonald C, Prabhakaran V, Binder JR, Meyerand ME. Network, clinical and sociodemographic features of cognitive phenotypes in temporal lobe epilepsy. Neuroimage Clin 2020; 27:102341. [PMID: 32707534 PMCID: PMC7381697 DOI: 10.1016/j.nicl.2020.102341] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/10/2020] [Accepted: 07/03/2020] [Indexed: 01/14/2023]
Abstract
This study explored the taxonomy of cognitive impairment within temporal lobe epilepsy and characterized the sociodemographic, clinical and neurobiological correlates of identified cognitive phenotypes. 111 temporal lobe epilepsy patients and 83 controls (mean ages 33 and 39, 57% and 61% female, respectively) from the Epilepsy Connectome Project underwent neuropsychological assessment, clinical interview, and high resolution 3T structural and resting-state functional MRI. A comprehensive neuropsychological test battery was reduced to core cognitive domains (language, memory, executive, visuospatial, motor speed) which were then subjected to cluster analysis. The resulting cognitive subgroups were compared in regard to sociodemographic and clinical epilepsy characteristics as well as variations in brain structure and functional connectivity. Three cognitive subgroups were identified (intact, language/memory/executive function impairment, generalized impairment) which differed significantly, in a systematic fashion, across multiple features. The generalized impairment group was characterized by an earlier age at medication initiation (P < 0.05), fewer patient (P < 0.001) and parental years of education (P < 0.05), greater racial diversity (P < 0.05), and greater number of lifetime generalized seizures (P < 0.001). The three groups also differed in an orderly manner across total intracranial (P < 0.001) and bilateral cerebellar cortex volumes (P < 0.01), and rate of bilateral hippocampal atrophy (P < 0.014), but minimally in regional measures of cortical volume or thickness. In contrast, large-scale patterns of cortical-subcortical covariance networks revealed significant differences across groups in global and local measures of community structure and distribution of hubs. Resting-state fMRI revealed stepwise anomalies as a function of cluster membership, with the most abnormal patterns of connectivity evident in the generalized impairment group and no significant differences from controls in the cognitively intact group. Overall, the distinct underlying cognitive phenotypes of temporal lobe epilepsy harbor systematic relationships with clinical, sociodemographic and neuroimaging correlates. Cognitive phenotype variations in patient and familial education and ethnicity, with linked variations in total intracranial volume, raise the question of an early and persisting socioeconomic-status related neurodevelopmental impact, with additional contributions of clinical epilepsy factors (e.g., lifetime generalized seizures). The neuroimaging features of cognitive phenotype membership are most notable for disrupted large scale cortical-subcortical networks and patterns of functional connectivity with bilateral hippocampal and cerebellar atrophy. The cognitive taxonomy of temporal lobe epilepsy appears influenced by features that reflect the combined influence of socioeconomic, neurodevelopmental and neurobiological risk factors.
Collapse
Affiliation(s)
- Bruce Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Lisa L Conant
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Cole J Cook
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Gyujoon Hwang
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Camille Garcia-Ramos
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kevin Dabbs
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Veena A Nair
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jedidiah Mathis
- Department of Radiology Froedtert & Medical College of Wisconsin, Milwaukee, WI, USA
| | - Charlene N Rivera Bonet
- Neuroscience Training Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Linda Allen
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Dace N Almane
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Karina Arkush
- Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | - Rasmus Birn
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Neuroscience Training Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Edgar A DeYoe
- Department of Radiology Froedtert & Medical College of Wisconsin, Milwaukee, WI, USA; Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Elizabeth Felton
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Rama Maganti
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Andrew Nencka
- Department of Radiology Froedtert & Medical College of Wisconsin, Milwaukee, WI, USA
| | - Manoj Raghavan
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Umang Shah
- Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | - Veronica N Sosa
- Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | - Aaron F Struck
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Candida Ustine
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anny Reyes
- Department of Psychiatry, University of California-San Diego, La Jolla, CA, USA
| | - Erik Kaestner
- Department of Psychiatry, University of California-San Diego, La Jolla, CA, USA
| | - Carrie McDonald
- Department of Psychiatry, University of California-San Diego, La Jolla, CA, USA
| | - Vivek Prabhakaran
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Neuroscience Training Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jeffrey R Binder
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mary E Meyerand
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Neuroscience Training Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| |
Collapse
|
7
|
Wändell P, Fredrikson S, Carlsson AC, Li X, Gasevic D, Sundquist J, Sundquist K. Epilepsy in immigrants and Swedish-born: A cohort study of all adults 18 years of age and older in Sweden. Seizure 2020; 76:116-122. [PMID: 32062322 DOI: 10.1016/j.seizure.2020.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE We aimed to study the association between country of birth and incident epilepsy in several immigrant groups using Swedish-born individuals as referents. METHOD The study population included all adults aged 18 years and older in Sweden, living and deceased, 6,690,598 in the first-generation and 6,683,125 in the second-generation sub-study. Epilepsy was defined as having at least one registered diagnosis of epilepsy in the National Patient Register. The incidence of epilepsy in different immigrant groups, using Swedish-born as referents, was assessed by Cox regression, expressed as hazard ratios (HRs) and 95 % confidence intervals (CI). The models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, and neighbourhood socioeconomic status. RESULTS In the first-generation sub-study, totally 76,541 individuals had at least one registered diagnosis of epilepsy (1.14 % in total; men 1.22 % and women 1.07 %), and in the second-generation study 72,545 (1.09 %; men 1.18 % and women 0.99 %). After adjusting for confounders, in first-generation immigrants compared to their Swedish-born counterparts the incidence was somewhat lower among both men (HR 0.92, 0.90-0.96) and women (HR 0.93, 0.90-0.96), and in the second-generation immigrants among women (HR 0.95, 0.92-0.99) but not men (HR 0.99; 0.96-1.02). Among immigrant groups, a higher incidence of epilepsy was observed among first-generation women from Africa and Iraq, and second-generation men and women from Bosnia, and women from Finland. CONCLUSIONS Risk of epilepsy was lower in immigrants in general compared to the Swedish-born population; but with higher incidence in some specific groups.
Collapse
Affiliation(s)
- Per Wändell
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
| | - Sten Fredrikson
- Department of Clinical Neuroscience, Division of Neurology, Karolinska Institutet Huddinge, Stockholm, Sweden
| | - Axel C Carlsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Academic Primary Health Care Centre, Stockholm Region, Stockholm, Sweden
| | - Xinjun Li
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Danijela Gasevic
- Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden; Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Matsue, Shimane University, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden; Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Matsue, Shimane University, Japan
| |
Collapse
|